Strut apposition after coronary stent implantation visualised with optical coherence tomography.
To describe different patterns of stent strut apposition, as visualised with optical coherence tomography. Strut thicknesses were reconstructed according to the manufacturers' specifications. The stent area (SA) was measured by connecting the reconstructed abluminal surfaces of struts with a trace line, and the vessel wall area (VWA) was estimated from the abluminal strut surfaces, as well as from the lumen border, in cases of struts that were separated from the vessel wall by flush. Strut apposition was evaluated by comparing the SA- and VWA traces. We observed four patterns of strut apposition. Based on these, stent struts could be classified as: (I) apposed struts, (II) struts overlying the ostium of a side branch, (III) malapposed struts that were clearly separated from the vessel wall by flush, and (IV) pseudoapposed struts that were not separated from the vessel wall by visual estimate, but were malapposed in the sense that SA<VWA. Pseudoapposed struts were found in frames with "flower-shaped" lumen contours, and were often surrounded by structures of a lower signal intensity than the rest of the vessel wall. For a detailed analysis of strut apposition with OCT, we reconstructed strut thicknesses and estimated stent- and vessel wall areas. With this method, we found four types of strut apposition, where pseudoapposed struts constitute a type of struts not previously described. The clinical importance of pseudoapposed struts remains to be settled.


Inland water microcrustacean assemblages in an altitudinal gradient in Aysen region (46° S, Patagonia Chile).
The Chilean Patagonia has numerous kinds of inland water ecosystems such as lakes, ponds, wetlands and rivers that have been poorly studied due to access difficulties. This study was carried out in Aysen region, in southern Chile, and it included different kinds of water bodies such as rivers, streams, ponds, lagoons and lakes distributed along an altitudinal gradient at 46° S. It was found a low species number, essentially cladocerans, copepods and amphipods. A null model was applied in order to determine the existence of regulator factors of species associations, and the results revealed that they are not random. The patterns would be influenced by geographical and limnological characteristics of the studied sites. Our results would agree with regional studies on habitat heterogeneity such as in Torres del Paine National Park and other zones in Tierra del Fuego island.


Urban wild boars prefer fragmented areas with food resources near natural corridors.
Wild boar populations are expanding throughout the world and intruding into periurban and urban areas. In the last years, wild boar has colonized several European cities, including our study area, the city of Barcelona. It is required to identify the main factors driving wild boar into urban areas prior to establish management measures. We built Boosted Regression Trees (BRT) using 3148 wild boar presences registered in the urban area of Barcelona from 2010 to 2014 to identify the variables correlated with these presences. The variables analysed included proxies for distance to source population, urban food resources, climate and urban habitat structure. Wild boars enter the urban area from close natural habitat using corridors such as streams, preferably in fragmented urban environment, looking for food such as urban green areas or dry pet food from cat colonies. Wild boar presence is higher in spring possibly due to the births of piglets and the dispersion of yearlings during that season, and also when natural resources in the Mediterranean habitat fail to satisfy the nutritional requirements of the wild boar population during the summer season. Management measures derived from this study are currently being applied in the city of Barcelona, including vegetation clearings in the wild boar entrance areas and an awareness campaign aimed at reducing the anthropogenic food availability for wild boars. The methodology used can be applied to other cities with wild boar or even other wildlife species issues. The comparison between the factors attracting wild boars into different urban areas would be helpful to understand the global phenomenon.


An independent brain-computer interface based on covert shifts of non-spatial visual attention.
Modulation of steady-state visual evoked potential (SSVEP) by directing gaze to targets flickering at different frequencies has been utilized in many brain-computer interface (BCI) studies. However, this paradigm may not work with patients suffering from complete locked-in syndrome or other severe motor disabilities that do not allow conscious control of gaze direction. In this paper, we present a novel, independent BCI paradigm based on covert shift of non-spatial visual selective attention. Subjects viewed a display consisting of two spatially overlapping sets of randomly positioned dots. The two dot sets differed in color, motion and flickering frequency. Two types of motion, rotation and linear motion, were investigated. Both, the SSVEP amplitude and phase response were modulated by selectively attending to one of the two dot sets. Offline analysis revealed a predicted online classification accuracy of 69.3+/-10.2% for the rotating dots, and 80.7+/-10.4% for the linearly moving dots.


Shedding of membrane-associated LDL receptor-related protein-1 from microglia amplifies and sustains neuroinflammation.
In the CNS, microglia are activated in response to injury or infection and in neurodegenerative diseases. The endocytic and cell signaling receptor, LDL receptor-related protein-1 (LRP1), is reported to suppress innate immunity in macrophages and oppose microglial activation. The goal of this study was to identify novel mechanisms by which LRP1 may regulate microglial activation. Using primary cultures of microglia isolated from mouse brains, we demonstrated that LRP1 gene silencing increases expression of proinflammatory mediators; however, the observed response was modest. By contrast, the LRP1 ligand, receptor-associated protein (RAP), robustly activated microglia, and its activity was attenuated in LRP1-deficient cells. An important element of the mechanism by which RAP activated microglia was its ability to cause LRP1 shedding from the plasma membrane. This process eliminated cellular LRP1, which is anti-inflammatory, and generated a soluble product, shed LRP1 (sLRP1), which is potently proinflammatory. Purified sLRP1 induced expression of multiple proinflammatory cytokines and the mRNA encoding inducible nitric-oxide synthase in both LRP1-expressing and -deficient microglia. LPS also stimulated LRP1 shedding, as did the heat-shock protein and LRP1 ligand, calreticulin. Other LRP1 ligands, including α2-macroglobulin and tissue-type plasminogen activator, failed to cause LRP1 shedding. Treatment of microglia with a metalloproteinase inhibitor inhibited LRP1 shedding and significantly attenuated RAP-induced cytokine expression. RAP and sLRP1 both caused neuroinflammation in vivo when administered by stereotaxic injection into mouse spinal cords. Collectively, these results suggest that LRP1 shedding from microglia may amplify and sustain neuroinflammation in response to proinflammatory stimuli.


Can a ratio between medial and lateral meniscal volumes be calculated to determine critical meniscal volume in view of post-meniscectomy symptoms?
Partial meniscectomy is a frequently performed treatment strategy for non-suturable meniscal tears. However, the meniscal volume which can be resected without compromising the load-bearing, shock-absorbing function of the meniscus remains a topic of ongoing research. The aim of this study was to calculate the medio-lateral meniscal volume ratio to estimate this volume. In 90 patients (98 pairs of menisci) without meniscal injury, medial and lateral menisci were segmented on MRI imaging and 3D surface models were created to calculate volume. The mean medial meniscal volume was 1928,9mm3 and the mean lateral meniscal volume was 1681,7mm3. A fixed ratio of the medial over the lateral meniscal volume was calculated to be 1,16. The standard deviation of the prediction errors based on this ratio equals 217mm3. This ratio seems a useful parameter in follow-up research to determine whether there is a critical volume which can be resected without post-operative pain and osteoarthritis.


Numerical and experimental studies on dynamic gas emission characteristics of boreholes.
The gas emission rate of boreholes is one of the most important indices for coal and gas outburst prediction. In this work, instantaneous gas emission velocity and environmental effects on borehole gas emission were studied. Through theoretical analysis, the mechanism of crack propagation in the coal borehole was clarified, and the effect of soft and hard coal on gas desorption and gas emission. The results of numerical simulations also indicated that the initial gas emission has a function relationship to the drilling distance and the physical characteristics of the coal seam. A novel dynamic testing technology was proposed to obtain gas emission velocity. Laboratory experiments under adsorption and desorption of CO2 and N2 were performed using coal samples from Xuehu, Fenghui, Weishe, and Wuzhong coal mines. The data of initial gas emission under different coal samples were recorded, and the fitting curves were obtained. The results show a positive correlation between initial gas emission and drilling depth. However, abnormal would occur when the drill pipe enters the soft stratification, and the maximum value of the initial gas emission of the abnormal part is 3.8 times the normal value, which indicates a high degree of sensibility to soft stratification. The results were revealed the dynamic gas emission law of boreholes.


Patterns and presentations of colorectal cancer at Komfo-Anokye teaching hospital Kumasi, Ghana.
Colorectal cancer is a major cause of morbidity and mortality globally and its incidence is increasing in developing countries. This study determined the incidence, clinical features and the histopathological patterns of colorectal cancer at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. A retrospective review of all colorectal cancer cases over a six year period from (2009-2015) presented to the Surgical and Oncological Department of KATH. Patients' records were retrieved and information on their demographics, clinical and pathological presentations recorded. In all, 221 cases of colorectal cancer were identified over the study period. The mean age was 54 ± 16.8 and ranged from 16 to 90 years. Sixteen (7.24%) had family history of cancer and the prevalence of comorbidities was (24.89%). The commonest clinical symptoms presented were weight loss (44.80%), bleeding per rectum (39.82%) and abdominal pain (38.91%) Majority of the patients presented with rectal cancers (48.87%). Microscopically, adenocarcinoma (68.33%) was the most common histopathological type. According to Tumour Node Metastasis (TNM) staging of cancer, majority of the patients 89(40.27%) were identified as being in late stage (TNM Stage III). The overall crude annual incidence was 4.62 per 100000 populations. The age specific standardized incidence rate was 7.93 per 100,000 population. This study has clearly showed a high incidence in colorectal cancer at KATH, with similar trends in clinico-pathological patterns comparable to that of most African countries. These include predominance of rectal cancers, high incidence among younger people and delayed presentation of the disease at advanced stage.


The C. elegans gene pag-3 is homologous to the zinc finger proto-oncogene gfi-1.
Mutations in the Caenorhabditis elegans gene pag-3 result in misexpression of touch receptor-specific genes in the BDU interneurons and in motility defects. We cloned pag-3 and found that the gene encodes a C2H2-type zinc finger protein related to the mammalian GFI-1 protein. Sequencing of the three pag-3 alleles showed that two apparent null alleles encode a nonsense mutation before the zinc fingers and a missense mutation in the fourth zinc finger that changes a coordinating histidine to a tyrosine. The third allele contains a nonsense mutation in the N-terminal region but is not a null allele. Northern analysis showed that a single pag-3 transcript of about 1.6 kb is present in embryos and L1, L2 and L3 larvae. pag-3 message levels were about twofold higher in pag-3 mutants than in wild-type animals, which suggested that pag-3 may negatively regulate its own expression. pag-3lacZ fusion genes were expressed in the BDU interneurons, the touch neurons, 11 VA and 11 VB ventral cord motor neurons, two AVF interneurons and in unidentified neurons of the retrovesicular ganglion. The BDU neurons and the ALM touch neurons are lineal sister cells in the AB.a lineage and the VA and VB motor neurons are lineal sister cells in the AB.p lineage. The VA motor neurons are required for backward movement and the VB motor neurons are required for forward movement. Mosaic analysis showed that the wild-type pag-3 gene is required in the AB.p lineage for coordinated movement and in the AB.a lineage to suppress touch neuron gene expression in the BDU neurons. Because pag-3 is expressed in both the BDU neurons and in the touch neurons, another protein(s) not expressed in the touch neurons may interact with pag-3 to repress touch neuron gene expression in the BDU neurons. Alternatively, another protein in the touch receptor cells may inactivate PAG-3 and allow expression of the touch receptor program. These results show that pag-3 is a temporally regulated gene that is expressed early in development and functions in multiple types of neurons. They also strongly suggest that the PAG3 protein is a DNA-binding protein with properties similar to the mammalian proto-oncogene product GFI-1.


Molecular biology of bone remodeling: implications for new therapeutic targets for osteoporosis.
Osteoporosis is a major public health problem for adults over age 55 years costing billions of euros/dollars. Over the last 20 years anti-resorptive drugs were the treatment of choice for osteoporosis and most were derived from the bisphosphonate molecule. In the last 7 years remarkable advances in molecular biology and genetics have led to a detailed understanding of the bone remodeling cycle and as a result new therapeutic targets for treatment emerged. These new compounds have different modes of action depending on their role in the bone remodeling cycle. A major discovery was the important role of RANKL (receptor activator of nuclear factor kappa B ligand) secreted by osteoblasts and responsible for stimulating osteoclastic bone resorption. This led to development of a potent monoclonal antibody that blocks its action. This drug should be available soon as a new treatment for osteoporosis. Other molecular targets in resorption have been identified and several specific antagonists are potential treatments. However, a significant limiting factor for a new anti-resorptive drug is the cost of bringing it to the market because of the huge costs of a fracture trial. Although anti-resorptive agents have been the backbone of osteoporosis treatment they do not rebuild bone architecture and development of anabolic agents is needed. These are likely to evolve from an understanding of the LRP/Wnt signaling pathway. Already an antibody against sclerostin has shown promise in animal studies, and not to forget parathyroid hormone which was the first clinically useful anabolic treatment for osteoporosis.


Developmental patterns of rhythmic suck and swallow in preterm infants.
Twenty healthy preterm infants (gestational age 26 to 33 weeks, postmenstrual age [PMA] 32.1 to 39.6 weeks, postnatal age [PNA] 2.0 to 11.6 weeks) were studied weekly from initiation of bottle feeding until discharge, with simultaneous digital recordings of pharyngeal and nipple (teat) pressure and nasal thermistor and thoracic strain gauge readings. The percentage of sucks aggregated into 'runs' (defined as > or = 3 sucks with < or = 2 seconds between suck peaks) increased over time and correlated significantly with PMA (r=0.601, p<0.001). The length of the sucking-runs also correlated significantly with PMA (r=0.613, p<0.001). The stability of sucking rhythm, defined as a function of the mean/SD of the suck interval, was also directly correlated with increasing PMA (r=0.503, p=0.002), as was increasing suck rate (r=0.379, p<0.03). None of these measures was correlated with PNA. Similarly, increasing PMA, but not PNA, correlated with a higher percentage of swallows in runs (r=0.364, p<0.03). Stability of swallow rhythm did not change significantly from 32 to 40 weeks' PMA. In low-risk preterm infants, increasing PMA is correlated with a faster and more stable sucking rhythm and with increasing organization into longer suck and swallow runs. Stable swallow rhythm appears to be established earlier than suck rhythm. The fact that PMA is a better predictor than PNA of these patterns lends support to the concept that these patterns are innate rather than learned behaviors. Quantitative assessment of the stability of suck and swallow rhythms in preterm infants may allow prediction of subsequent feeding dysfunction as well as more general underlying neurological impairment. Knowledge of the normal ontogeny of the rhythms of suck and swallow may also enable us to differentiate immature (but normal) feeding patterns in preterm infants from dysmature (abnormal) patterns, allowing more appropriate intervention measures.


Female breast masses during childhood: a 25-year review.
Thirty females were treated at our unit with the diagnosis of breast mass between 1970 and 1995. Twenty-seven girls had surgical intervention; for fibroadenoma (n = 14), cystosarcoma phylloides (n = 5), fibrocystic disease (n = 4), intraductal papilloma (n = 2), metastatic carcinoma (n = 1) and fat necrosis (n = 1), while three patients with fibroadenoma were managed nonoperatively. Surgical complications included a nipple slough and hematoma requiring surgical drainage in two patients after the excision of giant fibroadenomas. Our experience revealed that most of the breast masses can be handled operatively through a circumareolar incision without any major complications. Protection of the developing breast bud, nipple and areola is as important as the appropriate excision of the lesion. A detailed physical examination accompanied with ultrasound scan is sufficient for the correct diagnosis in most cases. Female adolescents presenting with fibroadenoma, fibrocystic disease and cystosarcoma phylloides should undergo surgery after a reasonable observation period of 3-4 menstrual cycles. Excision of discrete, undiagnosed breast masses is warranted. This is indicated first to define the pathology and rule out the rare malignancy, second to obviate enlargement and asymmetry, and third to allay the apprehension of the child and family.


Tonic force maintenance with reduced shortening velocity in arterial smooth muscle.
The isotonic shortening velocity of swine carotid media tissues contracting in response to high K+, histamine, norepinephrine, or AC electrical stimulation rapidly increased to a maximum value and then declined to a steady-state level while force was still increasing or steady. The maximum shortening velocity calculated for no external load on the tissue (Vo) also decreased during the course of contractions when active stress remained constant. The fall in velocity with time was not Ca2+ dependent, because reductions in the [Ca2+] in high K+ solutions that significantly reduced the maximum stress (Fo) had no effect on Vo in the steady state. On washout of high K+ solutions, the ability of the tissue to shorten on isotonic quick release fell rapidly to low levels before isometric stress exhibited significant declines. The data indicate that cross-bridge cycling rates are modulated in this tissue. We suggest that this reflects the formation of attached, noncycling cross bridges (termed latch bridges), which constitute an internal load on the contractile system during tonic contractions.


The assessment and management of suicide risk: state of workshop education.
A systematic search of popular and scholarly databases identified workshops that addressed general clinical competence in the assessment or management of suicide risk, targeted mental health professionals, and had at least one peer-reviewed publication. We surveyed workshop developers and examined empirical articles associated with each workshop. The state of workshop education is characterized by presenting the learning objectives, educational formats, instructor factors, and evaluation studies. Workshops are efficacious for transferring knowledge and shifting attitudes; however, their role in improving clinical care and outcomes of suicidal patients has yet to be determined.


Relationship between neurogenic bowel dysfunction and health-related quality of life in persons with spinal cord injury.
To assess the relationship between the severity of neurogenic bowel and health-related quality of life in persons with various degrees of spinal cord injury. Cross-sectional. A total of 128 people with spinal cord injury. Two questionnaires were sent out by post. One included demographic characteristics and a neurogenic bowel dysfunction score to evaluate the severity of neurogenic bowel dysfunction. The other was a Short-Form 36-Item Health Survey that evaluated the quality of life in persons with spinal cord injury. Approximately half of the persons with spinal cord injury (46.9%) had moderate to severe degrees of neurogenic bowel dysfunction, the severity of which was associated with the physical functioning and physical component summary score in health-related quality of life. The results also showed that more severe neurological classifications led to lower physical component summary scores for impaired physical function and bodily pain. There was no correlation between the length of time elapsed since injury and health-related quality of life. Persons with more severe neurogenic bowel conditions were also found to be more likely to receive rehabilitative therapy. Neurogenic bowel dysfunction is associated with health-related quality of life expression in persons with spinal cord injury, especially in physical functioning and physical component summary.


Brain computer tomography in critically ill patients--a prospective cohort study.
Brain computer tomography (brain CT) is an important imaging tool in patients with intracranial disorders. In ICU patients, a brain CT implies an intrahospital transport which has inherent risks. The proceeds and consequences of a brain CT in a critically ill patient should outweigh these risks. The aim of this study was to critically evaluate the diagnostic and therapeutic yield of brain CT in ICU patients. In a prospective observational study data were collected during one year on the reasons to request a brain CT, expected abnormalities, abnormalities found by the radiologist and consequences for treatment. An "expected abnormality" was any finding that had been predicted by the physician requesting the brain CT. A brain CT was "diagnostically positive", if the abnormality found was new or if an already known abnormality was increased. It was "diagnostically negative" if an already known abnormality was unchanged or if an expected abnormality was not found. The treatment consequences of the brain CT, were registered as "treatment as planned", "treatment changed, not as planned", "treatment unchanged". Data of 225 brain CT in 175 patients were analyzed. In 115 (51%) brain CT the abnormalities found were new or increased known abnormalities. 115 (51%) brain CT were found to be diagnostically positive. In the medical group 29 (39%) of brain CT were positive, in the surgical group 86 (57%), p 0.01. After a positive brain CT, in which the expected abnormalities were found, treatment was changed as planned in 33%, and in 19% treatment was changed otherwise than planned. The results of this study show that the diagnostic and therapeutic yield of brain CT in critically ill patients is moderate. The development of guidelines regarding the decision rules for performing a brain CT in ICU patients is needed.


Characterizing the complexity of enzymes on the basis of their mechanisms and structures with a bio-computational analysis.
Enzymes are basically composed of 20 naturally occurring amino acids, yet they catalyse a dizzying array of chemical reactions, with regiospecificity and stereospecificity and under physiological conditions. In this review, we attempt to gain some understanding of these complex proteins, from the chemical versatility of the catalytic toolkit, including the use of cofactors (both metal ions and organic molecules), to the complex mapping of reactions to proteins (which is rarely one-to-one), and finally the structural complexity of enzymes and their active sites, often involving multidomain or multisubunit assemblies. This work highlights how the enzymes that we see today reflect millions of years of evolution, involving de novo design followed by exquisite regulation and modulation to create optimal fitness for life.


Effects of perennial ryegrass cultivars on milk yield and nitrogen utilization in grazing dairy cows.
The effects of 4 diploid perennial ryegrass cultivars that differed in water-soluble carbohydrate (WSC) concentrations on milk yield and nitrogen (N) utilization in dairy cows were evaluated in a 2-yr grazing experiment. Twelve lactating dairy cows were assigned to 1 cultivar for a 2-wk period in a 4 x 4 Latin square design with 3 replicates. Each year, the experiment lasted 8 wk. Swards were in a vegetative stage throughout the experiment. Herbage constituents were determined, and DM intake was estimated with the n-alkane technique. Nitrogen utilization was calculated as N excreted in milk divided by N intake, assuming a zero N retention. Two cultivars had consistently higher WSC concentrations and slightly lower neutral detergent fiber concentrations than the other 2 cultivars. The ranking of the cultivars in chemical composition traits in both years was rather consistent. Cows grazing the cultivar with the lowest concentration of WSC had the lowest herbage DM intake, N intake, milk yield, and milk N yield in 2002, but with a similar difference in WSC concentration, no differences among cultivars were found in 2003. In both years, milk urea N concentration was slightly higher for cows grazing the cultivar with the lowest WSC concentration, although it was significant only in 2003. Nitrogen utilization (N milk:N intake, g/g) varied between 0.241 and 0.246 in 2002 and between 0.190 and 0.209 in 2003, and in both years there was no effect of cultivar. At relatively high N concentrations in grass and only small differences among cultivars in neutral detergent fiber concentrations, cultivars with an elevated WSC concentration did not increase N utilization in grazing dairy cows.


Derivation and validation of Transform equations to convert historical Enhanced liver fibrosis (ELF) scores to modern equivalents.
The Siemens Healthineers ELF™ Test was designed in 2004 with 2 algorithms to allow choice in histological alignment. Consequently, historical and modern algorithms are not fully harmonized, complicating comparisons involving early datasets. We derived transform equations to equate all ELF score versions, allowing historical data to be used in systematic reviews and meta-analyses. Historical ELF equations were graphed pairwise versus their modern equivalent to assess correlation and derive four transforms. Transforms were validated using multiple datasets and evaluated for median absolute bias, number of samples reflecting clinically significant bias, number of discordant samples, bias at established cutoffs, and regression slope and y-intercept. Three transforms were validated equating Scheuer-aligned and/or age-included historical ELF equations (Immuno 1) to later equations aligned to Ishak and omitting age. A fourth transform corrected ADVIA Centaur® / Atellica® IM ELF scores miscalculated using the Scheuer Immuno 1 equation. Transformed data were well within allowable ELF bias limits. All transforms enabled accurate comparison of ELF scores generated by all historical algorithms to the current ADVIA Centaur / Atellica IM Analyzer ELF score. The transforms presented in this report should be used in systematic reviews and meta-analyses to facilitate comparisons to historical data.


Women cross the 'Catalina Channel' faster than men.
Open-water ultra-distance swimming has a long history where the 'English Channel' (~33 km) was crossed in 1875 for the first time. Nowadays, the three most challenging open-water swims worldwide are the 21-miles (34 km) 'English Channel Swim', the 20.1-miles (32.2 km) 'Catalina Channel Swim' and the 28.5-miles (45.9 km) 'Manhattan Island Marathon Swim', also called the 'Triple Crown of Open Water Swimming'. Recent studies showed that women were able to achieve men's performance in the 'English Channel Swim' or to even outperform men in the 'Manhattan Island Marathon Swim'. However, the analysis of the 'Catalina Channel Swim' as part of the 'Triple Crown of Open Water Swimming' is missing. We investigated performance and sex difference in performance for successful women and men crossing the 'Catalina Channel' between 1927 and 2014. The fastest woman ever was ~22 min faster than the fastest man ever. Although the three fastest women ever were ~20 min faster than the three fastest men ever, the difference reached not statistical significance (p > 0.05). Similarly for the ten fastest ever, the ~1 min difference for women was not significant (p > 0.05). However, when the swimming times of the annual fastest women (n = 39) and the annual fastest men (n = 50) competing between 1927 and 2014 were compared, women (651 ± 173 min) were 52.9 min (16 ± 12%) faster than men (704 ± 279 min) (p < 0.0001). Across years, swimming times decreased non-linearly in the annual fastest men (polynomial 2nd degree) and women (polynomial 3rd degree) whereas the sex difference decreased linearly from 52.4% (1927) to 7.1% (2014). In summary, the annual fastest women crossed the 'Catalina Channel' faster than the annual fastest men. The non-linear decrease in swimming times suggests that female and male swimmers have reached a limit in this event. However, the linear decrease in the sex difference may indicate that women continuously narrow the gap to men.


Combined organic matter and nitrogen removal from a chemical industry wastewater in a two-stage MBBR system.
Pesticide-producing factories generate highly polluting wastewaters containing toxic and hazardous compounds which should be reduced to acceptable levels before discharge. In this study, a chemical industry wastewater was treated in a pre-denitrification moving-bed biofilm reactor system subjected to an increasing internal mixed liquor recycle ratio from 2 to 4. Although the influent wastewater characteristics substantially varied over time, the removal of chemical oxygen demand (COD) and dissolved organic carbon was quite stable and mostly higher than 90%. The highest fraction of the incoming organic matter was removed anoxically, favouring a low COD/N environment in the subsequent aerobic nitrifying tank and thus ensuring stable ammonium removal (90-95%). However, during pH and salt shock periods, nitrifiers were severely inhibited but gradually restored their full nitrifying capability as non-stressing conditions were reestablished. Besides promoting an increase in the maximum nitrification potential of the aerobic attached biomass from 0.34 to 0.63 mg [Formula: see text], the increase in the internal recycle ratio was accompanied by an increase in nitrogen removal (60-78%) and maximum specific denitrification rate (2.7-3.3 mg NOx(-)--N). Total polysaccharides (PS) and protein (PT) concentrations of attached biomass were observed to be directly influenced by the influent organic loading rate, while the PS/PT ratio mainly ranged from 0.3 to 0.5. Results of Microtox tests showed that no toxicity was found in the effluent of both the anoxic and aerobic reactors, indicating that the biological process was effective in removing residual substances which might adversely affect the receiving waters' ecosystem.


Modified Wrap-Around Retainer: A Quick Tip To Enhance the Retention of the Appliance.
As the teeth are in an inherently unstable position after the completion of the orthodontic treatment, a little pressure even from the soft tissues may create a relapse tendency. So there is always a need for a retention period until the gingival and periodontal reorganization is completed around the new position of the tooth. Removable appliances can be used effectively for the retention purpose of which Begg's wrap around retainers are most commonly used. This article presents a new modification in the design of the appliance which will help us to use the retainer more efficiently.


Association of Vitamin D with severity and outcome of COVID-19: Clinical and Experimental Evidence.
The role of vitamin in COVID-19 remains controversial. We investigated the association between endogenous vitamin D and the severity of COVID-19 as well as the mechanisms of action of vitamin D supplementation. 25(OH)D3 in serum was associated with disease severity and outcome in 190 COVID-19 patients. In a COVID-19 animal model using intravenous injection of plasma from patients with COVID-19 ARDS into C57/BL6 mice, mice were treated with 0.25μg human 1,25(OH)D3 or vehicle. Mice were sacrificed on day 4. Cytokines and myeloperoxidase (MPO) in tissues were measured. Changes in gene expression after vitamin D supplementation were measured. Vitamin D deficiency and insufficiency were associated with increased severity and unfavourable outcome after 28 days. Vitamin D levels were negatively associated with biomarkers of COVID-19 severity. Vitamin D supplementation after challenge of mice with COVID-19 plasma led to reduced levels of TNFα, IL-6, IFNγand MPO in the lung, as well as down-regulation of pro-inflammatory pathways. Normal levels of endogenous Vitamin D are associated with reduced severity and risk of unfavourable outcome in COVID-19, possibly through attenuation of tissue-specific hyperinflammation.


Neurotoxicity of Cancer Immunotherapies Including CAR T Cell Therapy.
To outline the spectrum of neurotoxicity seen with approved immunotherapies and in pivotal clinical trials including immune checkpoint inhibitors, chimeric antigen receptor T-cell therapy, vaccine therapy, and oncolytic viruses. There has been an exponential growth in new immunotherapies, which has transformed the landscape of oncology treatment. With more widespread use of cancer immunotherapies, there have also been advances in characterization of its associated neurotoxicity, research into potential underlying mechanisms, and development of management guidelines. Increasingly, there is also mounting interest in long-term neurologic sequelae. Neurologic complications of immunotherapy can impact every aspect of the central and peripheral nervous system. Early recognition and treatment are critical. Expanding indications for immunotherapy to solid and CNS tumors has led to new challenges, such as how to reliably distinguish neurotoxicity from disease progression. Our evolving understanding of immunotherapy neurotoxicity highlights important areas for future research and the need for novel immunomodulatory therapeutics.


Taming Parasites by Tailoring Them.
The next-generation gene editing based on CRISPR (clustered regularly interspaced short palindromic repeats) has been successfully implemented in a wide range of organisms including some protozoan parasites. However, application of such a versatile game-changing technology in molecular parasitology remains fairly underexplored. Here, we briefly introduce state-of-the-art in human and mouse research and usher new directions to drive the parasitology research in the years to come. In precise, we outline contemporary ways to embolden existing apicomplexan and kinetoplastid parasite models by commissioning front-line gene-tailoring methods, and illustrate how we can break the enduring gridlock of gene manipulation in non-model parasitic protists to tackle intriguing questions that remain long unresolved otherwise. We show how a judicious solicitation of the CRISPR technology can eventually balance out the two facets of pathogen-host interplay.


Giant Paratubal Cyst Mimicking Mesenteric Cyst.
Paratubal cysts are adnexal masses located in the broad ligament; whenever the size of the cyst is >20 cm, it is considered a giant cyst and can present with complications including ovarian torsion and perforation. Diagnosis can be made clinically with the help of radiological investigations, although the gold standard diagnostic tool is diagnostic laparoscopy. Managing this condition relies mainly on surgical intervention (open or laparoscopic). Giant paratubal cysts carry challenges in their surgical excision as they carry a higher risk of spillage. We present a case of giant paratubal cyst in a 26-year-old Bahraini female who presented with abdominal distension and pain for 3 years.


Bioresorbable Vascular Scaffolds Versus Drug-Eluting Stents for Diffuse Long Coronary Narrowings.
Clinical benefits of bioresorbable vascular scaffold (BVS) implantation for long coronary lesions were not sufficiently evaluated. The efficacy and safety of BVS and metallic everolimus-eluting stent (EES) were compared for the treatment of long coronary narrowings. A total of 341 patients with diffuse long lesions (requiring device length ≥28 mm) were randomized to receive either BVS (n = 171) or EES (n = 170) implantation. The primary endpoint was major adverse cardiovascular events which included death from cardiac cause, myocardial infarction, device thrombosis, or ischemia-driven target-lesion revascularization at 12 months. The trial was terminated early because the manufacturer stopped supplying BVS. The mean lesion length was 32.2 ± 13.1 mm in the BVS group and 35.3 ± 13.0 mm in the EES group. The 12-month follow-up was completed in 332 patients (97.4%). At 12 months, the primary endpoint events occurred in 2 patients (1.2%) in the BVS group and in 4 patients (2.4%) in the EES group (hazard ratio = 0.49, 95% confidence interval = 0.09 to 2.67, p = 0.398). Definite or probable device thrombosis occurred in 1 patient (0.6%) in the BVS group and 1 patient (0.6%) in the EES group (hazard ratio = 1.00, 95% confidence interval = 0.06 to 15.94, p = 0.998). In conclusion, in patients with long native coronary artery disease, significant differences between BVS and EES were not observed regarding the primary composite endpoint of death from cardiac cause, myocardial infarction, device thrombosis, or target-lesion revascularization at 12 months. However, due to the early termination of this trial and a low number of events, the results cannot be considered clinically relevant (clinicalTrials.gov Identifier: NCT02796157).


Dichlorobis(2-methylquinoline N-oxide-kappaO)zinc(II) from powder data.
The crystal structure of the title compound, [ZnCl(2)(C(10)H(9)NO)(2)], has been determined from laboratory powder diffraction data. Although the powder pattern was initially indexed with tetragonal unit-cell dimensions, the correct solution was found in an orthorhombic space group using a combination of grid-search and simulated-annealing techniques. The subsequent bond-restrained Rietveld refinement gave bond lengths and angles within expected ranges. The molecule has crystallographically imposed twofold symmetry.


Potential of big data analytics in the French in vitro diagnostics market.
The new paradigm of the big data raises many expectations, particularly in the field of health. Curiously, even though medical biology laboratories generate a great amount of data, the opportunities offered by this new field are poorly documented. For better understanding the clinical context of chronical disease follow-up, for leveraging preventive and/or personalized medicine, the contribution of big data analytics seems very promising. It is within this framework that we have explored to use data of a Breton group of laboratories of medical biology to analyze the possible contributions of their exploitation in the improvement of the clinical practices and to anticipate the evolution of pathologies for the benefit of patients. We report here three practical applications derived from routine laboratory data from a period of 5 years (February 2010-August 2015): follow-up of patients treated with AVK according to the recommendations of the High authority of health (HAS), use of the new troponin markers HS and NT-proBNP in cardiology. While the risks and difficulties of using algorithms in the health domain should not be underestimated - quality, accessibility, and protection of personal data in particular - these first results show that use of tools and technologies of the big data repository could provide decisive support for the concept of "evidence based medicine".


Percutaneous transluminal rotational atherectomy for coronary artery disease.
Percutaneous transluminal coronary rotational atherectomy (PTCRA) debulks atherosclerotic plaque from coronary arteries using an abrasive burr. On rotation, the burr selectively removes hard tissue. To assess the effects of PTCRA for coronary artery disease in patients with non-complex and complex lesions (e.g., ostial, long, or diffuse lesions or those arising from in-stent restenosis) of the coronary arteries. We searched the Heart Group specialised register, the Cochrane Library to Issue 2, 2001, and MEDLINE, CINAHL, EMBASE and Current Contents to December 2002 and reviewed reference lists for relevant articles. We included randomised and quasi-randomised controlled trials of PTCRA compared with placebo, no treatment or another intervention and excluded cross-over trials. Data were extracted independently by two authors. We asked authors of trials to provide information when missing data was encountered. Statistical summaries used risk ratios (RR) and weighted mean differences. We included 9 trials enrolling 3,066 patients. There was no evidence of the effectiveness of PTCRA in non-complex lesions. In complex lesions, there were no statistically significant differences in restenosis rates at 6 months (relative risk 1.00; 95% confidence interval 0.83 to 1.20) and 1 year (relative risk 1.21; 95% confidence interval =0.95 to 1.55) in those receiving PTCRA with adjunctive PTCA (PTCRA/PTCA) compared to those receiving PTCA alone. Morphological characteristics distinguishing complex lesions have not been examined in parallel-arm randomised controlled trials. There is equivocal evidence of the effectiveness of PTCRA in in-stent restenosis. Compared to angioplasty alone, PTCRA/PTCA did not result in a statistically significant increase in the risk of major adverse cardiac events (myocardial infarction, emergency cardiac surgery or death) during the in-hospital period (relative risk 1.19; 95% confidence interval =0.78 to 1.83). Compared to angioplasty, PTCRA was associated with 9 times the risk of an angiographically-detectable vascular spasm (relative risk 9.23; 95% confidence interval 4.61 to 18.47), 4 times the risk of perforation (relative risk 3.87; 95% confidence interval 0.82 to 18.21) and about 2 times the risk of transient vessel occlusions (relative risk 2.28; 95% confidence interval 1.00, 5.19) while angiographic dissections (relative risk 0.49; 95% confidence interval 0.33 to 0.75) and stents used as a bailout procedure (relative risk 0.38; 95% confidence interval 0.22 to 0.65) were less common. When conventional PTCA is feasible, PTCRA appears to confer no additional benefits. There is limited published evidence and no long-term data to support the routine use of PTCRA in in-stent restenosis. In certain circumstances (e.g., patients ineligible for cardiac surgery, those with architecturally complex lesions, or those with lesions that fail PTCA), PTCRA may achieve satisfactory revascularisation in subsequent procedures.


Poly(dimethylsiloxane)-stabilized polymer particles from radical dispersion polymerization in nonpolar solvent:influence of stabilizer properties and monomer type [corrected].
Particles used in electrophoretic display applications (EPD) must possess a number of specific properties ranging from stability in a nonaqueous solvent, high reflectivity, low polydispersity, and high charge density to name but a few. The manufacture of such particles is best carried out in the solvent of choice for the EPD. This opens up new interests in the study of nonaqueous dispersion polymerization methods, which deliver polymer particles suspended in low dielectric constant solvents. We explore in this article the use of a poly(dimethylsiloxane) macromonomer for the stabilization of poly(methyl methacrylate) polymer particles in dodecane, a typical solvent of choice for EPDs. The use of this stabilizer is significant for this method as it is directly soluble in the reaction medium as opposed to traditionally used poly(12-hydroxystearic acid)-based stabilizers. Additionally, the present study serves as a baseline for subsequent work, where nonaqueous dispersion polymerization will be used to create polymer particles encapsulating liquid droplets and solid pigment particles. In this article, the influence of the macromonomer molecular weight and concentration on the properties of the synthesized particles is studied. In addition, we investigate the possibility of synthesizing polymer particles from other monomers both as a comonomer for methyl methacrylate and as the only monomer in the process. The influence of macromonomer concentration is also studied throughout all experiments.


Preparation, characterization and application of star-shaped PCL/PEG micelles for the delivery of doxorubicin in the treatment of colon cancer.
Star-shaped polymer micelles have good stability against dilution with water, showing promising application in drug delivery. In this work, biodegradable micelles made from star-shaped poly(ε-caprolactone)/poly(ethylene glycol) (PCL/PEG) copolymer were prepared and used to deliver doxorubicin (Dox) in vitro and in vivo. First, an acrylated monomethoxy poly (ethylene glycol)-poly(ε-caprolactone) (MPEG-PCL) diblock copolymer was synthesized, which then self-assembled into micelles, with a core-shell structure, in water. Then, the double bonds at the end of the PCL blocks were conjugated together by radical polymerization, forming star-shaped MPEG-PCL (SSMPEG-PCL) micelles. These SSMPEG-PCL micelles were monodispersed (polydispersity index = 0.11), with mean diameter of ≈25 nm, in water. Blank SSMPEG-PCL micelles had little cytotoxicity and did not induce obvious hemolysis in vitro. The critical micelle concentration of the SSMPEG-PCL micelles was five times lower than that of the MPEG-PCL micelles. Dox was directly loaded into SSMPEG-PCL micelles by a pH-induced self-assembly method. Dox loading did not significantly affect the particle size of SSMPEG-PCL micelles. Dox-loaded SSMPEG-PCL (Dox/SSMPEG-PCL) micelles slowly released Dox in vitro, and the Dox release at pH 5.5 was faster than that at pH 7.0. Also, encapsulation of Dox in SSMPEG-PCL micelles enhanced the anticancer activity of Dox in vitro. Furthermore, the therapeutic efficiency of Dox/SSMPEG-PCL on colon cancer mouse model was evaluated. Dox/SSMPEG-PCL caused a more significant inhibitory effect on tumor growth than did free Dox or controls (P < 0.05), which indicated that Dox/SSMPEG-PCL had enhanced anticolon cancer activity in vivo. Analysis with terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) showed that Dox/SSMPEG-PCL induced more tumor cell apoptosis than free Dox or controls. These results suggested that SSMPEG-PCL micelles have promising application in doxorubicin delivery for the enhancement of anticancer effect.


Hyperemesis gravidarum: a case report suggesting new concepts and research needs.
Hyperemesis gravidarum has been considered an emotional disorder. Recent studies suggest that reflux esophagitis in combination with gastric dysrhythmias causes hyperemesis. A 10-week-pregnant 28-year-old woman treated successfully with antiemetics was shown to have fluctuations in gastric pH consistent with gastric dysrhythmia and reflux. Although drugs with antiemetic activity give symptomatic improvement, further research is needed to discover safe medications to treat the underlying gastric dysrhythmia.


Respiratory depression after neuraxial opioids in the obstetric setting.
Neuraxial opioids have contributed significantly to improved labor and postcesarean delivery analgesia. In the obstetric population, epidural and intrathecal opioids are associated with a very low risk of clinically significant respiratory depression. Although rare, respiratory depression is a serious risk; patients may die or suffer permanent brain damage as a consequence. This review discusses the mechanism and incidence, as well as the prevention, detection, and management of respiratory depression with morphine, extended-release epidural morphine, and lipophilic opioids in the labor and cesarean delivery setting.


Observations on the geographic variation and skeletal development of Aotus.
The geographic pattern of coat color and craniometric variation were examined in Aotus. The coat color and pattern permitted recognition of the geographic origin of night monkeys from many parts of Latin America. The geographic pattern of craniometric variation differed from the pattern of phenotypic variation and led the authors to doubt the validity and usefulness of the currently recognized subspecific classification. Tooth eruption and bone ossification were studied in a sample of Aotus skeletons. Tentative criteria were presented for judging the ages of night monkeys by visual examination of their teeth or by x-ray of their teeth or bones.


Safety and efficacy of eye drops from umbilical cord blood platelet lysate to treat resistant corneal ulcer.
Umbilical cord blood (UCB) is a novel treatment of resistant corneal ulcers owing to the unique anti-inflammatory molecules and growth factors it contains. Platelet lysates are a potential future alternative. The aim of the present study was to assess the role of human UCB platelet lysate in treating resistant corneal ulcers. This was prospective, non-comparative, interventional case series involving 40 eyes of patients aged 6 - 65 years with persistent corneal ulcers from the Mansoura Ophthalmic Center and Mansoura Research Center for Cord Stem Cells. Patients were classified according to the cause of persistent corneal ulcer into four groups: group I, including 14 eyes with dry eye disease; group II, including six eyes post-keratoplasty; group III, including four eyes with corneal chemical burn; and group IV, including 16 eyes with persistent corneal ulcer from other causes. All participants underwent detailed ophthalmic examinations, and baseline and final best-corrected distance visual acuity (BCDVA) were recorded. Eye drops were prepared from UCB platelet lysate and administered to all patients along with detailed meticulous instructions for the method of use. Clinical progression of wound healing was continuously observed. The treatment response was identified as complete healing, improvement, or treatment failure. BCDVA improved significantly in all studied groups (all P < 0.05). In group I, complete healing, improvement, and treatment failure occurred in 71%, 29%, and 0% of cases. In group II, complete healing, improvement, and treatment failure occurred in 67%, 33%, and 0% of cases. In group III, complete healing, improvement, and treatment failure occurred in 50%, 50%, and 0% of cases. In group IV, complete healing, improvement, and treatment failure occurred in 63%, 12%, and 25% of cases. No adverse events associated with the treatment were observed or subjectively self-reports in the study period. Eye drops from UCB platelet lysate were a novel therapeutic blood component with unique growth factors and anti-inflammatory compounds that could be an effective and safe treatment option in managing persistent corneal ulcers of different causes. A future randomized clinical trial with a large sample size and a longer follow-up is required to confirm these preliminary outcomes.


A novel route of transplantation of human cord blood stem cells in preimmune fetal sheep: the intracelomic cavity.
The intracelomic route for in utero hematopoietic stem cell transplantation was evaluated in preimmune fetal sheep and the engraftment characteristics were defined. Twelve twin ovine fetuses (gestational age: 40-45 days) received intracelomic transplants of human CD3-depleted (50 x 10(6) per lamb) or CD34-selected (1-2 x 10(5) per lamb) cord blood hematopoietic stem cells. Engraftment was evaluated from cell suspensions of the liver, spleen, bone marrow, and thymus by flow cytometry, cloning assays, and polymerase chain reaction (PCR) analyses of human beta2-microglobulin. Four fetuses (33%) aborted shortly after intracelomic transplantation and were not evaluable for engraftment. Engraftment was detected in four fetuses obtained from cesarean delivery on day 70 after transplantation of CD3-depleted cord blood cells. The degrees of engraftment in these four fetuses ranged from 6%-22% in the different organs (as revealed by antigenic analysis of human CD45 with flow cytometry). Three fetuses obtained after cesarean section at 102 (no. 435184) and 105 (no. 915293, no. 037568) days and one fetus delivered at term that received CD34-selected cord blood cells had human engraftment with 10%, 32%, 20%, and 10% CD45(+) cells in bone marrow, respectively. In six of eight fetuses evaluable for human engraftment, chimerism was confirmed by PCR analysis for human beta2-microglobulin, which also identified human cells in brain, spinal cord, heart, lung, and skeletal muscle. This preliminary study indicates that intracelomic transplantation of human hematopoietic stem cells in fetal lambs is feasible and effective in terms of hematopoietic engraftment.


Competitive suppression of Quercus douglasii (Fagaceae) seedling emergence and growth.
Reduced recruitment of blue oak (Quercus douglasii) seedlings in California grasslands and woodlands may result from shifts in seasonal soil water availability coincident with replacement of the native perennial herbaceous community by Mediterranean annuals. We used a combination of container and field experiments to examine the interrelationships between soil water potential, herbaceous neighborhood composition, and blue oak seedling shoot emergence and growth. Neighborhoods of exotic annuals depleted soil moisture more rapidly than neighborhoods of a perennial grass or "no-neighbor" controls. Although effects of neighborhood composition on oak seedling root elongation were not statistically significant, seedling shoot emergence was significantly inhibited in the annual neighborhoods where soil water was rapidly depleted. Seedling water status directly reflected soil water potential, which also determined the extent and duration of oak seedling growth during the first year. End-of-season seedling height significantly influenced survival and growth in subsequent years. While growth and survival of blue oak seedlings may be initially constrained by competition with herbaceous species, subsequent competition with adult blue oak trees may further contribute to reduced sapling recruitment.


[Sleep apnea syndrome and obesity].
Obesity is a main risk factor for sleep apnea syndrome (SAS). The prevalence of SAS is especially high in massive obesity and in visceral obesity. The mechanisms of obstructive apneas in obesity are poorly known, but an increase in upper airway collapsibility probably plays an important role. Several cardiorespiratory complications of SAS, especially systemic arterial hypertension, diurnal alveolar hypoventilation and pulmonary arterial hypertension, are more frequent and more severe in obese patients. An important weight loss resulting from surgical treatment of obesity is often associated with a dramatic decrease in apnea-hypopnea index in patients with massive obesity. In patients with moderate obesity, dietary weight loss is associated with varying degrees of improvement in SAS. Pharyngoplasty and anterior mandibular positioning devices have a low success rate in patients with massive obesity. Nasal continuous positive airway pressure is often the only effective treatment in obese SAS patients.


Three-dimensional measurement and imaging based on multicameras randomly distributed on the circumference.
We present a three-dimensional (3D) measurement and imaging based on a multicamera system. In the presented system, projected images of 3D objects are taken by cameras located at random positions on a circumference, and then the 3D objects can be reconstructed numerically. We introduce an angle correction function to improve the quality of the reconstructed object. The angle correction function can correct the angle error caused by the position errors in the projected images due to the finite pixel size of the image sensor. The numerical results show that the point source was reconstructed successfully by introducing the angle correction function. We also demonstrate experiments: the two objects are located on a rotary stage controlled by a computer, the projected images are taken by a single camera, and by using 33 projected images, the two objects are reconstructed successfully.


Contributions of terminal peptides to the associative behavior of alphas1-casein.
The N- and C-terminal segments of bovine alphas1-casein-B (f1-23 and f136-196) were characterized under conditions that promoted or inhibited self-association to determine the relative contributions of each fragment to the interaction of alphas1-casein with itself or with other caseins. In earlier studies of f1-23, nuclear magnetic resonance (NMR) data and circular dichroism (CD) spectra showed that its conformation was thermostable between 10 degrees and 25 degrees C. In contrast, NMR studies of f136-196 indicated temperature sensitivity between 10 and 60 degrees C, as did near-UV and far-UV CD data, suggesting a molten globule-like structure at higher temperatures. To compare the effects of temperature on conformational attributes of alphas1-casein and its terminal peptides, additional CD studies were conducted over a broader temperature range (10 to 70 degrees C). The far-UV CD spectra indicated little temperature sensitivity for alphas1-casein, and the N-terminal peptide remained thermostable. During molecular dynamics simulations, the N-terminal peptide conformation did not change significantly, but the conformation of the C-terminal peptide (f136-196) was dramatically altered. These changes are correlated with the thermal instability observed by both CD and NMR in f136-196. Analytical ultracentrifugation studies of the self-association reactions of genetic variants A, B, and C of alphas1-casein showed that at 37 degrees C the associative state is primarily dimeric; the amounts of higher order polymers significantly decreased when temperature was increased from 20 to 37 degrees C. In all 3 genetic variants, the C-terminal portion of the whole molecule showed thermal instability with respect to aggregation to higher polymers, confirming the predictions of CD data and molecular dynamics simulations. The temperature dependency of these conformational changes suggests a possible function for alphas1-casein in facilitating casein-casein interactions in casein micelle formation.


Association between advanced cancer patient-caregiver agreement regarding prognosis and hospice enrollment.
Patients with advanced, incurable cancer who understand their illness is incurable are more likely to prefer hospice care at the end of life compared with patients who believe their illness is curable. To the authors' knowledge, it is unclear whether patient-caregiver agreement regarding perceived prognosis is associated with hospice enrollment. The current study examined the prospective relationship between patient-caregiver agreement concerning perceived prognosis and hospice enrollment in the last 30 days of life. Data were collected during a cluster randomized controlled trial examining a communication intervention for oncologists and patients with advanced cancer and their caregivers. At the time of study entry, patients and caregivers (141 dyads) were categorized as endorsing a "good" prognosis if they: 1) reported a >50% chance of surviving ≥2 years; or if they 2) predicted that the patient's quality of life 3 months into the future would be ≥7 on an 11-point scale. Approximately one-fifth of dyads agreed on a poor prognosis whereas approximately one-half disagreed regarding prognosis. In approximately one-third of dyads, patients and caregivers both believed the patient's future quality of life would be good (34%) and that the patient would live for ≥2 years (30%). Patients in these dyads were less likely to enroll in hospice compared with patients in dyads who disagreed and those who agreed on a shorter life expectancy and poor future quality of life. Dyadic understanding of patients' projected life expectancy and future quality of life appears to be predictive of care received at the end of life. Improving rates of hospice enrollment may be best achieved with dyadic interventions.


Early detection of protein depletion in alcoholic cirrhosis: role of body composition analysis.
Malnutrition is common in alcoholic cirrhosis. Bedside nutritional assessment techniques may be unreliable in patients with chronic liver disease. The aim of this study was to quantify changes in body composition and compare methods for measuring body composition in alcoholic cirrhosis. Thirty-eight men with alcoholic cirrhosis were compared with 16 age-matched healthy men. Body composition was assessed using anthropometry and bioelectrical impedance to determine fat-free mass and body fat, deuterium oxide dilution to measure total body water, in vivo neutron activation analysis to measure total body protein, and dual energy x-ray absorptiometry to measure bone mineral content and total body fat mass. With increasing severity of cirrhosis, total body water increased, whereas total body protein decreased with a significant decrease in serum albumin levels. Total body protein levels, expressed as an index, were a more sensitive indicator of protein depletion than serum albumin levels. When patients were assessed by anthropometry and bioelectrical impedance for fat-free mass, there was no reduction compared with controls. Anthropometry and bioelectrical impedance do not accurately reflect changes in body composition associated with chronic liver disease. Quantification of body composition changes in alcoholic cirrhosis requires the use of direct methods such as in vivo neutron activation analysis, dual energy x-ray absorptiometry, or deuterium oxide dilution.


Top-down and bottom-up fabrication techniques for hydrogel based sensing and hormone delivery microdevices.
We review a set of studies dealing with molecular (glucose) sensing and hormone delivery, in which the swelling and shrinking of a hydrogel as a function of glucose concentration play a central role. Confining hydrogels in microfabricated structures permits transduction of their chemomechanical behaviors. Prototype microdevices for wireless glucose sensing and closed loop insulin delivery control have been designed using hydrogels containing phenylboronic acid sidechains. While these devices exhibit desired responses, improved response time is needed, warranting further miniaturization. In a separate application, geometric confinement of glucose oxidase by a pH-sensitive hydrogel membrane sets up a nonlinear feedback loop which enables rhythmic swell/shrink cycles when the system is exposed to a constant glucose concentration. The latter system may be applied to delivery of gonadotropin release hormone, for which rhythmicity of secretion is essential for therapeutic function.


A broad range fluorescent pH sensor based on hollow mesoporous silica nanoparticles, utilising the surface curvature effect.
In this study, a broad range pH sensor was synthesized by loading the pH sensitive dye, fluorescein isothiocyanate (FITC), and a reference dye, rhodamine B isothiocyanate (RITC), into the mesostructure of hollow mesoporous silica nanoparticles (HMSNs) synthesized using a co-condensation method. Compared to a pH sensor based on the same pair of dyes on conventional mesoporous silica nanoparticles (MSNs), this dual-labeled pH sensor based on HMSNs shows a larger pH sensitive range, between 4.5 and 8.5, because of its broad surface curvature distribution which has a strong effect on the apparent pKa values of the FITC dye. The hollow mesoporous silica-dye nanoparticles were used to monitor intracellular pH via a ratiometric fluorescence method. The confocal images demonstrated the capacity of this broad range sensor which can differentiate simultaneously the local pH between various environments, for example, in the medium (pH = 7.2), cytosol (pH ∼ 7) and the endosome-lysosome pathway (pH = 4-5.5).


DCC protein expression in hematopoietic cell populations and its relation to leukemogenesis.
Using flow cytometry and immunoprecipitation (IP), we have investigated the deleted in colon cancer (DCC) protein expression on the bone marrow (BM) and peripheral blood (PB) cells of 16 normal subjects, 17 myelodysplastic syndrome (MDS) patients, and 10 acute myelogenous leukemia (AML) patients. With regard to the BM mononuclear cells (BM-MNCs) of normal subjects, the DCC protein expression ranged from 6.6 to 57.0%. Two-color flow cytometry revealed that among the IBM-MNCs the DCC protein was clearly expressed on the CD14+, CD13+, and factor 8+ cells, whereas it was low on the CD19+ and CD7+ cells and did not express on the CD34+, CD8+, and the glycophorin A+ cells. Further, the DCC protein expression was not seen on the PB CD11b+ and CD13+ cells. The IP results revealed that the 180-kD DCC protein was detected on the MNCs of both the BM and PB cells by the antibodies AF5, specific for the DCC extracellular domain, and G97-449, specific for the cytoplasmic domain. In contrast, flow cytometry did not detect the DCC protein on any BM-MNC MDS lineages (0.1-1.5%) or on AML leukemic cells (0.1-0.9%). The IP results indicated that the AF5 antibody did not detect the DCC protein on BM-MNCs of three of five MDS patients and four of five AML patients; however, the G97-449 antibody detected the 180-kD DCC protein in two MDS patients in whom AF5 had detected greatly reduced DCC band. These findings suggest that the DCC protein presence appears to be associated with normal hematopoiesis, and that its absence on the surfaces of the BM-MNCs and AML cells may contribute to the MDS and AML pathogenesis.


'What is (mental) disease?': an open letter to Christopher Boorse.
This "open letter" to Christopher Boorse is a response to his influential naturalist (value-excluding) analysis of disease from the perspective of linguistic-analytic value theory. The key linguistic-analytic point against Boorse (and other naturalists) is that, although defining disease value free, he (and they) continue to use the term with clear evaluative connotations. A descriptivist (value-entailing) analysis of disease would allow value-free definition consistently with value-laden use: but descriptivism fails when applied to mental disorder because it depends on shared values whereas the values relevant to mental disorders are highly diverse. A part-function analysis, similarly, although initially persuasive for physical disorders, fails with the psychotic mental disorders because these, characteristically, involve disturbances of the rationality of the person as a whole. The difficulties encountered in applying naturalism to mental disorders point, linguistic-analytically, to the possibility that there is, after all, an evaluative element of meaning, deeply hidden but still logically operative, in the concept of disease.


Development of 4-oxime-1,8-naphthalimide as a bioorthogonal turn-on probe for fluorogenic protein labeling.
4-Oxime-1,8-naphthalimide was reported as a novel bioorthogonal turn-on probe based on 1,3-dipolar cycloaddition reactions between in situ generated nitrile oxide and alkenes/alkynes. The resulting isoxazole products displayed dramatically strong fluorescence enhancement upon photoirradiation through isoxazole-oxazole photoisomerization. This new methodology was successfully applied for in situ fluorogenic protein labeling.


Primary culture of lobster (Homarus americanus) olfactory sensory neurons.
Lobster olfactory sensory neurons have contributed to a number of advances in our understanding of olfactory physiology. To facilitate further study of their function, we have developed conditions allowing primary culture of the olfactory sensory neurons in a defined medium. The most common cells in the culture were round cell bodies with diameters of 10-15 micro m that often extended fine processes, features resembling olfactory sensory neurons. We discovered that acetylcholinesterase acted as a growth factor for these cells, improving their survival in culture. We also confirmed previous evidence from spiny lobsters that poly-D-lysine was a superior substrate for olfactory cells of this size and morphology. We then identified olfactory sensory neurons in the culture in two ways. Almost half the cells tested responded to application of a complex odorant with an inward current. An even more rigorous test was made possible by the development of an antiserum to OET-07, an ionotropic glutamate receptor homolog specifically expressed by Homarus americanus olfactory sensory neurons. It labeled a majority of the round cells in the culture, unequivocally identifying them as olfactory sensory neurons.


Access Path to the Ligand Binding Pocket May Play a Role in Xenobiotics Selection by AhR.
Understanding of multidrug binding at the atomic level would facilitate drug design and strategies to modulate drug metabolism, including drug transport, oxidation, and conjugation. Therefore we explored the mechanism of promiscuous binding of small molecules by studying the ligand binding domain, the PAS-B domain of the aryl hydrocarbon receptor (AhR). Because of the low sequence identities of PAS domains to be used for homology modeling, structural features of the widely employed HIF-2α and a more recent suitable template, CLOCK were compared. These structures were used to build AhR PAS-B homology models. We performed molecular dynamics simulations to characterize dynamic properties of the PAS-B domain and the generated conformational ensembles were employed in in silico docking. In order to understand structural and ligand binding features we compared the stability and dynamics of the promiscuous AhR PAS-B to other PAS domains exhibiting specific interactions or no ligand binding function. Our exhaustive in silico binding studies, in which we dock a wide spectrum of ligand molecules to the conformational ensembles, suggest that ligand specificity and selection may be determined not only by the PAS-B domain itself, but also by other parts of AhR and its protein interacting partners. We propose that ligand binding pocket and access channels leading to the pocket play equally important roles in discrimination of endogenous molecules and xenobiotics.


[The role of health education in preventive medicine strategy of the Mexican Institute of Social Security].
This article presents the Mexican Institute for Social Security (IMSS) created in 1943 and describes its main features, its programmes and the role played by health education inside the programmes. It ends by explaining the present situation concerning health education and the changes which are presently envisaged. During its first twenty years, the IMSS promoted preventive medicine and trained health personnel. Since 1979 it has concerned itself mainly with some 10 million peasants and marginal groups. In the frame of a national development programme, a vaccination and detection campaign were implemented and the distribution system of potable water was extended. Mexico with a population of 73 million has the dual characteristics of a developed and a developing country (70 per cent of its population is urban, 30 per cent rural). The overcrowded cities contrast with the isolated rural areas where sanitary conditions are poor and life difficult. The main causes of mortality, in 1978, were: -in the towns: car accidents, cardiovascular diseases and suicide; -in rural areas, acute respiratory infections and intestinal infections. The 1978 Alma Ata international conference on primary health care and the meeting of Ministers of health convened in 1980 by the Pan American Health Organization endorsed the IMSS programmes which emphasize prevention, promote health education and community participation. The cost of preventive measures being cheaper than treatment, 203 million pesos were saved and allocated to the expansion of programmes. Systematic immunization has resulted in a sharp decline of diphteria, polio, rabies, typhoid, pertussis and measles. Early detection of tumours of cervix uteri has saved many lives.


Chronic pain in South Australia - population levels that interfere extremely with activities of daily living.
The prevalence of chronic pain in Australia has only been previously estimated for the state of New South Wales. The aim of this study was to focus estimates on pain severe enough to interfere markedly with daily function irrespective of contact with health services in another region, South Australia. A whole of population random face-to-face survey method (n=2,973) was used, directly standardised against the whole population for age, gender, country of birth and rurality. Respondents were asked about chronic pain and the degree to which it interfered with daily activities. The prevalence of chronic pain was 17.9%, and pain that interfered extremely with activity 5.0%. Chronic pain was associated with older age, living alone, lower income, not being in full-time work and lower educational levels in bivariate analyses, however in multifactor analyses the only significant associations were not currently working (p<0.001) and lower levels of educational achievement (p=0.042). Pain that interfered extremely with activity in multifactor analysis was associated with work status where the odds ratio for work-related injury compared to those in full time work was 19.3 (95% CI 7.30-51.3; p<0.001). This study highlights the high levels of pain with extreme effects on day-to-day life (one in 20 people), the complex inter-relationships of the factors (educational achievement, work status) associated with chronic pain and the impacts that these factors have on the people experiencing such disabling pain in the long-term.


Antibiotic susceptibility tests directly on urine samples using Uro-Quick, a rapid automated system.
During the period June 2003-March 2004, 12,579 urine samples were examined employing the Uro-Quick system. Positive samples (1,948) were subsequently Gram-stained and processed by standard procedures for microorganism identification and antibiotic susceptibility determination by the disk diffusion method. Results of this latter test were compared with those obtained employing the new rapid Uro-Quick method. Antibiotics were introduced in vials containing 2 ml of Mueller-Hinton broth, then 0.5 ml of urine or a bacterial suspension in broth were added; a vial without drug was used as control. After 3 and 5 hours of incubation (for Gram-negative and Gram-positive strains respectively) the instrument showed the results. No growth and a growth curve like the control indicated susceptible and resistant strains respectively. Overall 1,590 Gram-negative strains were tested against ciprofloxacin, nitrofurantoin, amoxicillin-clavulanate, ceftazidime, fosfomycin, imipenem, amikacin, trimethoprim-sulfamethoxazole, and piperacillin-tazobactam, while 358 Gram-positive bacteria were assessed against ciprofloxacin, nitrofurantoin, amoxicillin-clavulanate, ampicillin, fosfomycin, gentamicin, oxacillin and trimethoprim-sulfamethoxazole. Against the major urinary tract pathogens (Escherichia. coli, enterococci, Klebsiella spp. and Proteus spp.) agreement between the Uro-Quick system and the disk diffusion test generally was >90% for all antibiotics tested. On the basis of these results the system appears useful not only for bacteriuria screening, but also to rapidly test the antibiotic susceptibility of common uropathogens.


Molecular Mechanisms of Stem/Progenitor Cell Maintenance in the Adrenal Cortex.
The adrenal cortex is characterized by three histologically and functionally distinct zones: the outermost zona glomerulosa (zG), the intermediate zona fasciculata, and the innermost zona reticularis. Important aspects of the physiology and maintenance of the adrenocortical stem/progenitor cells have emerged in the last few years. Studies have shown that the adrenocortical cells descend from a pool of progenitors that are localized in the subcapsular region of the zG. These cells continually undergo a process of centripetal displacement and differentiation, which is orchestrated by several paracrine and endocrine cues, including the pituitary-derived adrenocorticotrophic hormone, and angiotensin II. However, while several roles of the endocrine axes on adrenocortical function are well established, the mechanisms coordinating the maintenance of an undifferentiated progenitor cell pool with self-renewal capacity are poorly understood. Local factors, such as the composition of the extracellular matrix (ECM) with embedded signaling molecules, and the activity of major paracrine effectors, including ligands of the sonic hedgehog and Wnt signaling pathways, are thought to play a major role. Particularly, the composition of the ECM, which exhibits substantial differences within each of the three histologically distinct concentric zones, has been shown to influence the differentiation status of adrenocortical cells. New data from other organ systems and different experimental paradigms strongly support the conclusion that the interactions of ECM components with cell-surface receptors and secreted factors are key determinants of cell fate. In this review, we summarize established and emerging data on the paracrine and autocrine regulatory loops that regulate the biology of the progenitor cell niche and propose a role for bioengineered ECM models in further elucidating this biology in the adrenal.


Anterior pericardial access to facilitate electrophysiology study and catheter ablation of ventricular arrhythmias: A single tertiary center experience.
Epicardial ablation is becoming an important part of management in patients with ventricular tachycardia (VT). Posterior epicardial access via the Sosa or needle-in-needle (NIN) approach for epicardial VT ablation is considered to be the method of choice for most electrophysiologists. Anterior epicardial access as an alternative technique has recently been proposed, but there are limited data about its safety, efficacy, and the rate of immediate complications. In this study, we report our experience with anterior epicardial access between 2009 and 2016. Between 2009 and June 2016, 100 consecutive patients underwent epicardial VT ablation using an anterior approach. The success rate, epicardial bleeding, and other complications related to the epicardial access in these patients were compared to the previously reported rate of complications in patients whom epicardial access was performed using the NIN or Sosa techniques. Anterior epicardial access was obtained successfully in 100% of patients in the first attempt. The success rate of the anterior approach was comparable with the reported success rate of the NIN technique (100% vs. 100%, P value not significant) but better than the Sosa technique (100% vs. 94%, P = 0.012). None of the patients in the anterior approach series suffered from significant pericardial bleeding (defined as greater than 80 mL of blood loss), RV puncture/damage, or need for an emergent cardiac surgery. An anterior epicardial approach is feasible and appears to have an acceptable safety profile in comparison with other epicardial approaches.


Fusion genes as biomarkers in pediatric cancers: A review of the current state and applicability in diagnostics and personalized therapy.
The incidence of pediatric cancers is rising steadily across the world, along with the challenges in understanding the molecular mechanisms and devising effective therapeutic strategies. Pediatric cancers are presented with diverse molecular characteristics and more distinct subtypes when compared to adult cancers. Recent studies on the genomic landscape of pediatric cancers using next-generation sequencing (NGS) approaches have redefined this field by providing better subtype characterization and novel actionable targets. Since early identification and personalized treatment strategies influence therapeutic outcomes, survival, and quality of life in pediatric cancer patients, the quest for actionable biomarkers is of great value in this field. Fusion genes that are prevalent and recurrent in several pediatric cancers are ideally suited in this context due to their disease-specific occurrence. In this review, we explore the current status of fusion genes in pediatric cancer subtypes and their use as biomarkers for diagnosis and personalized therapy. We discuss the technological advancements made in recent years in NGS sequencing and their impact on fusion detection algorithms that have revolutionized this field. Finally, we also discuss the advantages of pairing liquid biopsy protocols for fusion detection and their eventual use in diagnosis and treatment monitoring.


The Use of Fluoride Varnish in Primary Care in Ontario: A Qualitative Study.
Fluoride varnish (FV) has been shown to prevent dental caries. Physicians and nurses may be ideally situated to apply FV during well-child visits. Currently, public health units across Ontario have been successfully piloting this intervention. Yet, challenges remain at both the political and practice levels. The objectives of this research were to understand the perspectives of key stakeholders on making FV application a routine primary care practice in Ontario and to consider the potential enabling factors and barriers to implementation. In this qualitative study, 16 key stakeholders representing medicine, nursing, dentistry, dental hygiene, public health and government were interviewed. Interview data were transcribed and coded, and a conceptual framework for implementing change to daily health care practice was used as a guide for thematic analysis. Our findings suggest that there is an opportunity for interdisciplinary care when considering children's oral health. There is also motivation and acceptance of this specific intervention across all fields. However, we found that concerns related to funding, knowledge and interprofessional relationships could impede implementation and limit any potential short- or mid-term window for meaningful policy and practice change. With respect to introducing FV into medical practice for children under 5 years of age, the many factors required to implement immediate change are arguably not in alignment. However, policymakers and practitioners are motivated and have identified opportunities for change that may form the foundation for this program in the future.


[Aneurysmal malformation of the vein of Galen in adults].
We present an adult male harbouring a vascular malformation, manifested by haemorrhage, which localization, arterial feeders and venous drainage, match the pattern of choroidal type vein of Galen aneurysmal malformations seen in babies, excepting the absence of anterior choroidal arteries participation. A few cases of vein of Galen aneurysmal malformations were already reported in adults, but haemorrhage was never well documented. This haemorrhage may have a pathogenesis similar to those of pial arteriovenous malformations.


Insulin receptor binding kinetics: modeling and simulation studies.
Biological actions of insulin regulate glucose metabolism and other essential physiological functions. Binding of insulin to its cell surface receptor initiates signal transduction pathways that mediate cellular responses. Thus, it is of great interest to understand the mechanisms underlying insulin receptor binding kinetics. Interestingly, negative cooperative interactions are observed at high insulin concentrations while positive cooperativity may be present at low insulin concentrations. Clearly, insulin receptor binding kinetics cannot be simply explained by a classical bimolecular reaction. Mature insulin receptors have a dimeric structure capable of binding two molecules of insulin. The binding affinity of the receptor for the second insulin molecule is significantly lower than for the first bound insulin molecule. In addition, insulin receptor aggregation occurs in response to ligand binding and aggregation may also influence binding kinetics. In this study, we develop a mathematical model for insulin receptor binding kinetics that explicitly represents the divalent nature of the insulin receptor and incorporates receptor aggregation into the kinetic model. Model parameters are based upon published data where available. Computer simulations with our model are capable of reproducing both negative and positive cooperativity at the appropriate insulin concentrations. This model may be a useful tool for helping to understand the mechanisms underlying insulin receptor binding and the coupling of receptor binding to downstream signaling events.


Prevalent vertebral fracture on bone density lateral spine (VFA) images in routine clinical practice predict incident fractures.
The predictive validity of vertebral fracture assessment (VFA) on bone density lateral spine images to identify prevalent vertebral fractures in routine clinical practice has not been established. Our objective was to estimate the associations of prevalent vertebral fracture identified on VFA images in routine practice with incident hip, all non-vertebral, major osteoporotic, and clinical vertebral fractures, using the Manitoba Bone Density database. From 2010 onward, 9972 men and women (mean age [SD] 76 [6.9] years) had VFA images obtained at the time of bone densitometry that were interpreted for vertebral fracture by the clinicians reading the bone density tests. Definite and possible prevalent vertebral fractures, respectively, were identified in 1575 (15.8%) and 293 (2.9%) using a modified Algorithm Based Qualitative method. We ascertained incident fractures using Manitoba provincial health databases over a mean 2.8 (SD 1.7) years and used Cox proportional hazards models to estimate the associations of prevalent vertebral fractures with incident fractures. Compared to no prevalent vertebral fracture, those with definite prevalent vertebral fracture had higher hazard ratios for incident hip (HR 1.95, 95% C.I. 1.45 to 2.62), non-vertebral (HR 1.99, 95% C.I. 1.68 to 2.35), and clinical vertebral fracture (HR 2.68, 95% C.I. 1.69 to 4.23) adjusted for age, bone mineral density, body mass index, prior fracture, parental hip fracture, glucocorticoid use, alcohol use, smoking, and rheumatoid arthritis. These associations did not vary by FRAX fracture risk estimates or bone mineral density category. Prevalent vertebral fractures identified on densitometric VFA images in routine clinical practice are strongly associated with incident fractures, and this study is the first to show this using any lateral spine imaging modality outside of research settings. These findings are strong evidence supporting the targeted use of densitometric VFA imaging among post-menopausal women and older men referred for bone densitometry.


Contributing Causes of Injury or Death in Grain Entrapment, Engulfment, and Extrication.
Grain entrapments and engulfments are one of most common hazards associated with grain storage facilities, with over 1,140 such entrapments/engulfments documented since the 1970s. The objective of the study was to determine the factors that contribute to injury or death in grain entrapment, engulfment, and extrication cases. A literature review, including data contained in the Purdue Agricultural Confined Spaces Incident Database (PACSID), was conducted to determine the conditions that the body experiences during an entrapment or engulfment in grains and during extrication efforts. Based on the review, the conditions a human body faces during an entrapment, engulfment, or extraction can be split into two broad categories-environmental and physiological/psychological. The environmental factors depend on the grain's properties, depth of entrapment or engulfment, position of the victim's body, and characteristics of the storage unit, which include the grain's lateral pressure, vertical pressure, and weight, as well as friction, oxygen availability and diffusion rate, and grain temperature. The physiological and psychological factors are related to the individual's age and physical and psychological conditions, and manifest themselves in terms of oxygen consumption, asphyxiation (including aspiration, lack of oxygen, compression or splinting of the thorax), blood flow, and heart rate. Of all the above factors, a review of fatality data contained in the PACSID indicate that aspiration, asphyxiation, grain weight, and lateral pressure are most likely the primary cause of death for most entrapment victims. Research gaps found by this study include an understanding of the impact of lateral pressure on lung expansion and oxygen availability and consumption rate, and the need for more case studies to accurately determine cause of death.


[Right internal mammary artery reimplantation into the left internal mammary artery. Y anastomosis. 25 cases].
Distal latero-circumflex arteries (DLCA) and posterior descending artery (PDA) are anatomically too far and cannot be revascularized with internal mammary artery (IMA) by a conventional procedure. The reimplantation of the right IMA into the left IMA in situ increases (2 times) the length of right IMA graft available. Fifty-five patients underwent this technique. Their preoperative status was: 22 males, 3 females; mean age: 57 years, 38% myocardial infarction (MI). Coronary angiography showed: stenosis of the left main coronary artery: 3; stenosis of 3 vessels: 15; 2 vessels: 10; 2.3 anastomoses by patient were performed with Y right and left IMA procedure: 24 LDA, 8 diagonals, 25 DLCA and 1 PDA anastomosis. No deaths were observed in this short series. Morbidity was: 1 MI, 2 sternal sepsis, 1 bilateral phrenic paralysis (all were cured without sequelae). To date (March 90) 15 patients have been followed for 3 to 12 months, 12 are angina-free, 3 are significantly improved, 11 have a negative exercise test. Thallium test is normal in the revascularized area in 14 patients. Seven angiographies have been performed (6 months to 1 year) and all Y right IMA are patent.


When accuracy hurts, and when it helps: a test of the empathic accuracy model in marital interactions.
This study tested predictions from W. Ickes and J. A. Simpson's (1997, 2001) empathic accuracy model. Married couples were videotaped as they tried to resolve a problem in their marriage. Both spouses then viewed a videotape of the interaction, recorded the thoughts and feelings they had at specific time points, and tried to infer their partner's thoughts and feelings. Consistent with the model, when the partner's thoughts and feelings were relationship-threatening (as rated by both the partners and by trained observers), greater empathic accuracy on the part of the perceiver was associated with pre-to-posttest declines in the perceiver's feelings of subjective closeness. The reverse was true when the partner's thoughts and feelings were nonthreatening. Exploratory analyses revealed that these effects were partially mediated through observer ratings of the degree to which partners tried to avoid the discussion issue.


Metastatic Gastric Signet Ring Cell Adenocarcinoma Masquerading as Low Back Pain.
This case report describes a 53-year-old Hispanic male who initially presented with acute hip pain. During workup, sclerotic bone lesions of the lumbar spine were identified on computed tomography (CT) in addition to extensive adenopathy involving the chest and abdomen. Upper endoscopy revealed chronic active gastritis, however, biopsies were negative for malignancy. Eventual bone marrow biopsy showed extensive infiltration by sheets of malignant epithelial cells with signet ring cell formation. Not only is this case significant for maintaining a broad differential in patients presenting with bone pain, but it also demonstrates a diagnosis of metastatic signet ring cell adenocarcinoma confirmed on bone marrow biopsy, which was not detected via earlier endoscopy.


Time-resolved ARPES with tunable 12-21.6 eV XUV at 400 kHz repetition rate.
Time-resolved and angle-resolved photoemission spectroscopy (trARPES) is a powerful method to detect the non-equilibrium electronic structure in solid systems. In this study, we report a trARPES apparatus with tunable photon energy selectively among 12, 16.8, and 21.6 eV at a repetition rate of 400 kHz. The energy and temporal resolutions of the three harmonics are determined as 104/111/157 meV and 276/190/154 fs, respectively. The photon flux on the sample is estimated to be 1010-1011 photons/s by using a photodiode. Finally, the performance of this setup is verified by both equilibrium and non-equilibrium ARPES measurements on topological materials Zr2Te2P and Bi2Se3. Meanwhile, the importance of the tunability of the extreme ultraviolet (XUV) source is highlighted by comparing experimental results measured with the three different photon energies.


Spatial transferability of habitat suitability models of Nephrops norvegicus among fished areas in the Northeast Atlantic: sufficiently stable for marine resource conservation?
Knowledge of the spatial distribution and habitat associations of species in relation to the environment is essential for their management and conservation. Habitat suitability models are useful in quantifying species-environment relationships and predicting species distribution patterns. Little is known, however, about the stability and performance of habitat suitability models when projected into new areas (spatial transferability) and how this can inform resource management. The aims of this study were to model habitat suitability of Norway lobster (Nephrops norvegicus) in five fished areas of the Northeast Atlantic (Aran ground, Irish Sea, Celtic Sea, Scotland Inshore and Fladen ground), and to test for spatial transferability of habitat models among multiple regions. Nephrops burrow density was modelled using generalised additive models (GAMs) with predictors selected from four environmental variables (depth, slope, sediment and rugosity). Models were evaluated and tested for spatial transferability among areas. The optimum models (lowest AICc) for different areas always included depth and sediment as predictors. Burrow densities were generally greater at depth and in finer sediments, but relationships for individual areas were sometimes more complex. Aside from an inclusion of depth and sediment, the optimum models differed between fished areas. When it came to tests of spatial transferability, however, most of the models were able to predict Nephrops density in other areas. Furthermore, transferability was not dependent on use of the optimum models since competing models were also able to achieve a similar level of transferability to new areas. A degree of decoupling between model 'fitting' performance and spatial transferability supports the use of simpler models when extrapolating habitat suitability maps to different areas. Differences in the form and performance of models from different areas may supply further information on the processes shaping species' distributions. Spatial transferability of habitat models can be used to support fishery management when the information is scarce but caution needs to be applied when making inference and a multi-area transferability analysis is preferable to bilateral comparisons between areas.


Impact of Nutritional Supplementation and a Psychomotor Program on Patients With Alzheimer's Disease.
This study aims to evaluate the impact of oral nutritional supplementation (ONS) and a psychomotor rehabilitation program on nutritional and functional status of community-dwelling patients with Alzheimer's disease (AD). A 21-day prospective randomized controlled trial was conducted and third intervention group performed a psychomotor rehabilitation program. Patients were followed up for 180 days. Mean (standard deviation) score of Mini Nutritional Assessment (MNA) increased both in the nutritional supplementation group (NSG; n = 25), 0.4 (0.8), and in the nutritional supplementation psychomotor rehabilitation program group (NSPRG; n = 11), 1.5 (1.0), versus -0.1 (1.1) in the control group (CG; n = 43), P < .05. Further improvements at 90-day follow-up for MNA in NSG: 1.3 (1.2) and NSPRG: 1.6 (1.0) versus 0.3 (1.7) in CG ( P < .05) were observed. General linear model analysis showed that the NSG and NSPRG ▵MNA score improved after intervention, at 21 days and 90 days, was independent of the MNA and Mini-Mental State Examination scores at baseline ( Ps > .05). The ONS and a psychomotor rehabilitation program have a positive impact on long-term nutritional and functional status of patients with AD.