Identifying predictors of antispasmodic use following robotic assisted simple prostatectomy.
Anticholinergic or ß-3 agonist use following robotic simple prostatectomy (RASP) is not well described. We describe rates of antispasmodic use following RASP and identify potential predictors of medication use. A retrospective review of all RASP patients from 2/2016 - 1/2020 was conducted. Patients with no preoperative International Prostate Symptom Score (IPSS) were excluded. Demographics, clinical data, and postoperative medication use were collected by electronic medical record review. Multivariable logistic regression analysis using a priori variables was performed to identify independent factors associated with antispasmodic use. A total of 255 patients underwent RASP at a mean age of 70.0 years ± 7.3 and mean body mass index (BMI) of 28.6 kg/m2 ± 5.0. Median preoperative prostate volume was 132.3 cc ± 45.0. Rates of preoperative diabetes, obstructive sleep apnea (OSA), smoking and alcohol use were 19.6%, 6.3%, 3.1%, and 11.8% respectively; 8.6% of patients (n = 22) initiated antispasmodics at a median of 2.5 months (IQR 1.3-4.2) postoperatively. Median duration of antispasmodic use was 6.5 months (IQR 1.7-14.7). Mirabegron was most commonly prescribed (31.8%). On multivariable logistic regression analysis, OSA was independently associated with postoperative antispasmodic use (OR 8.13, 95% CI 2.02-32.67, p = 0.003); 68.8% of OSA patients were treated with continuous positive airway pressure (CPAP). Treatment was not significantly associated with postoperative antispasmodic use (p = 0.61). Patients with OSA are over 8 times more likely to require antispasmodic medications following RASP in the short term. These patients may benefit from more tailored preoperative counseling.


Pharma industry in India.
Globally ranked fourth by volume and 13th in value, the Indian pharma industry is a leading producer of high-quality, low-cost generic drugs. Its 14% share of the USD 57 billion world generic market is expected to increase to 50% by 2010. With the advantages of cost competitiveness, ability and experience in reverse engineering, availability of skilled scientific and engineering personnel and the capability to produce raw materials for a wide range of drugs from the basic stage, the industry delivers the entire range of therapeutic products. McKinsey & Co. predict that India's pharmaceutical market could reach a size of USD 20 billion by 2015, becoming one of the top 10 drug markets in the world. Generic versions of the cardiovascular drug carvedilol, ANDA-approved allopurinol, verapamil SR and the anticancer drug paclitaxel are some of the recent products introduced by Indian companies, with Caraco, Ranbaxy, Dabur, Dr. Reddy's, Nicholas Piramal India, leading the list. Setting up of integrated drug development companies and aggressive entries into the Japanese drug market have provided further impetus to the country's pharma manufacturing arena.


Seasonal incidence and geographical variation of Nebraska mosquitoes, 1994-95.
A mosquito survey was conducted in Nebraska during 1994-95. Mosquitoes were collected by CO2-baited CDC light traps at 11 localities throughout Nebraska. Total mosquitoes collected was 685,581 per trap (mean = 790) and 1,163,741 per trap (mean = 1,372) during 1994 and 1995, respectively. Twenty-seven mosquito species representing 8 genera were collected. The most abundant mosquitoes collected statewide were Aedes vexans at 74% of the 2-year total, Culex tarsalis at 11%; Aedes trivittatus, 5%; Aedes melanimon, 1.5%; and Aedes triseriatus, 1%. The floodwater mosquitoes were more prevalent in eastern Nebraska while standing-water mosquitoes, especially Culex tarsalis, were more prevalent in the west.


[Immunoprophylaxis of recurrence of T1 G2 bladder tumors with interferon alpha-2b].
Assessment of results with -2b Interferon used as prophylaxis in 20 patients who underwent surgery for T1,G2 urothelial vesical tumours. Dosage was weekly intravesical instillation of 50 x 10(6) IU for three months and then monthly up to one year treatment. Mean follow-up was 17.20 months (4-41 months). Relapse rate over this time was 50%, all before 15 months, a relapsing ratio of 2.82% patients/month and a disease-free interval of 27.5 months. Chances of being disease-free at 30 months is 48.21%. Progression of disease, whether in grade or stage, was observed in 25% cases. No patient showed relevant changes or side effects during treatment, except for 5 patients who reported mictional symptoms mainly during the first 3 months, none of which required discontinuation of treatment. From the data obtained, it can be deduced that for the time being no reason justifies the use of -2b Interferon versus other conventional chemotherapeutical or immunotherapeutical (BCG) agents in the prophylaxis of this type of tumours.


How to Establish Clinical Prediction Models.
A clinical prediction model can be applied to several challenging clinical scenarios: screening high-risk individuals for asymptomatic disease, predicting future events such as disease or death, and assisting medical decision-making and health education. Despite the impact of clinical prediction models on practice, prediction modeling is a complex process requiring careful statistical analyses and sound clinical judgement. Although there is no definite consensus on the best methodology for model development and validation, a few recommendations and checklists have been proposed. In this review, we summarize five steps for developing and validating a clinical prediction model: preparation for establishing clinical prediction models; dataset selection; handling variables; model generation; and model evaluation and validation. We also review several studies that detail methods for developing clinical prediction models with comparable examples from real practice. After model development and vigorous validation in relevant settings, possibly with evaluation of utility/usability and fine-tuning, good models can be ready for the use in practice. We anticipate that this framework will revitalize the use of predictive or prognostic research in endocrinology, leading to active applications in real clinical practice.


Sex differences in emotional perception: Evidence from population of Tuvans (Southern Siberia).
Prior studies have reported that women outperform men in nonverbal communication, including the recognition of emotions through static facial expressions. In this experimental study, we investigated sex differences in the estimation of states of happiness, anger, fear, and disgust through static photographs using a two-culture approach. This study was conducted among the Tuvans and Mongolian people from Southern Siberia. The respondents were presented with a set of photographs of men and women of European and Tuvan origin and were asked to interpret each of them. They were asked: "What does the person in the photo feel?" We found that the Tuvans easily identified happiness and anger; however, the level of accuracy of fear and disgust recognition was low. No sex differences in the recognition of happiness, disgust, and fear were observed. However, anger recognition was significantly moderated by the perceiver's sex and the origin of the model. Compared to Tuvan men, Tuvan women were significantly less accurate in identifying anger in male Tuvans. Furthermore, the age effect was found in recognition of fear: older Tuvans were more accurate while recognizing the fearful faces of Tuvan, but not the European models.


A case-control study showing low creatinine clearance and high magnesium intake as risk factors for hypermagnesemia in older individuals.
According to epidemiological studies, constipation has a negative effect on life expectancy, necessitating appropriate treatment. According to the Pharmaceuticals and Medical Devices Agency (PMDA), patients who have been taking magnesium oxide (MgO) for constipation over a prolonged period, especially those with impaired renal function and older individuals, are at high risk of hypermagnesemia. Therefore, serum Mg levels, which are often not checked in clinical practice, should be monitored in these patients. Thus, to predict elevated serum Mg levels and prevent the development of hypermagnesemia, we aimed to identify the risk factors of hypermagnesemia, especially in the older population. Our study included patients who were prescribed MgO at our hospital between January 1, 2014, and March 31, 2016. Patients who did not meet the inclusion criteria were excluded and matched to adjust for background factors; finally, 35 patients in the hypermagnesemia arm and 140 patients in the non-hypermagnesemia arm were included in the analysis. Multivariate analysis identified estimated creatinine clearance (eCcr) ≤ 28.2 mL/min as a statistically significant risk factor. In addition, MgO dose ≥ 900 mg/day was identified as a risk factor for clinical consideration, although not statistically significant. Furthermore, the incidence of hypermagnesemia was shown to increase to 11.6% for those with MgO dose ≥ 900 mg/day, 27.0% for those with eCcr ≤ 28.2 mL/min, and 53.1% for those with both. Hypermagnesemia may occur in older patients with eCcr ≤ 28.2 mL/min who take more than 900 mg/day of MgO.


Workload even affects hand hygiene in a highly trained and well-staffed setting: a prospective 365/7/24 observational study.
Compliance with hand hygiene (HH) has often not proved satisfactory; high workload is a commonly self-reported reason. Previous studies comparing workload and compliance have not measured workload precisely and have focused on certain times of day. This study aimed to investigate the association between HH compliance and workload, both electronically defined 365/7/24 (primary endpoint). In addition, the quality of commonly used compliance defining methods (hand disinfectant usage, direct observation) was investigated (secondary endpoint). Correlation of electronically measured HH compliance (hand-rub activities (HRA)/HH opportunities) with electronically determined workload (nursing time output/nursing time input) was undertaken over one year at a stem cell transplant unit at University Hospital Basel, Switzerland. HRA and procedures requiring HRA according to the five World Health Organization indications were recorded continuously (365/7/24) using electronic dispensers and electronic documentation, and compliance was calculated accordingly. Hand disinfectant usage was calculated using spending records for one year; direct observation was performed for approximately 1800 HH opportunities. During the investigation, 208,184 HRA, translating into 57 [standard deviation (SD) 10] HRA/patient-day (PD), were performed. Electronically determined compliance ranged from 24% to 66% [mean 42.39% (SD 8%)]. The higher the workload, the lower the compliance (R=-0.411; P<0.001). HRA/PD (r=-0.037), hand disinfectant usage (mean 160mL/PD) and observed compliance (95%; 1734 HRA/1813 HH opportunities) were not found to be associated with workload. Calculated compliance was inversely associated with nurses' workload. HRA/PD, observer-determined compliance and amount of disinfectant dispensed were used as surrogates for compliance, but did not correlate with actual compliance and thus should be used with caution.


Lymphoma with hypercalcemia.
A prospective survey was carried out to determine the incidence of hypercalcemia in hospitalized patients with lymphoma. Serum calcium determinations were carried out during 440 admissions on 152 patients, most of whom had widespread lymphoma. Forty-one of the 152 patients died, all having had calcium levels recorded on that admission. Two of the 152 patients (1.3%) were found to have hypercalcemia. By comparison hypercalcemia occurred in 6 of 34 patients (17.6%) with multiple myeloma.Hypercalcemia is uncommonly associated with lymphoma but may be seen particularly in centres where many patients with this disease are treated. Hypercalcemia readily responds to therapy and is a reversible cause of morbidity, but when associated with lymphoma it usually indicates widespread disease. The mechanism of hypercalcemia is unknown but there is strong evidence for humoral factors that may or may not be related to parathyroid hormone.


Leucine incorporation into the membranellar bands of regenerating and nonregenerating stentor.
Autoradiographs of membranellar bands isolated from regenerating and nonregenerating stentors labeled with tritiated leucine indicate that the synthesis of proteins of the oral apparatus is continuous in Stentor and is not initiated at the time of regeneration.


Item Response Theory and Differential Item Functioning Analyses With the Suicidal Behaviors Questionnaire-Revised in US and Chinese Samples.
Background: Despite the widespread use of the Suicidal Behaviors Questionnaire-Revised (SBQ-R) and advances in item response theory (IRT) modeling, item-level analysis with the SBQ-R has been minimal. Aims: This study extended IRT modeling strategies to examine the response parameters and potential differential item functioning (DIF) of the individual SBQ-R items in samples of US (N = 320) and Chinese (N = 298) undergraduate students. Method: Responses to the items were calibrated using the unidimensional graded response IRT model. Goodness-of-fit, item parameters, and DIF were evaluated. Results: The unidimensional graded response IRT model provided a good fit to the sample data. Results showed that the SBQ-R items had various item discrimination parameters and item severity parameters. Also, each SBQ-R item functioned similarly between the US and Chinese respondents. In particular, Item 1 (history of attempts) demonstrated high discrimination and severity of suicide-related thoughts and behaviors (STBs). Limitations: The use of cross-sectional data from convenience samples of undergraduate students could be considered a major limitation. Conclusion: The findings from the IRT analysis provided empirical support that each SBQ-R item taps into STBs and that scores for Item 1 can be used for screening purposes.


Atrophy mainly affects the limbic system and the deep grey matter at the first stage of multiple sclerosis.
The existence of grey matter (GM) atrophy right after the first clinical event suggestive of multiple sclerosis (MS) remains controversial. The aim of this study was therefore to establish whether regional GM atrophy is already present in the earliest stage of MS assessing regional GM atrophy in a large group of patients. Sixty-two patients with a clinically isolated syndrome (CIS) were examined on a 1.5 T MR imager within 6 months after their first clinical events. A group of 37 matched healthy control subjects were also included in the study. An optimised voxel-based morphometry (VBM) method customised for MS was applied on volumetric T(1)-weighted images. The functional status of patients was assessed using the Expanded Disability Status Scale (EDSS) and the Brief Repeatable Battery. VBM analysis (p<0.005, familywise error corrected) on patients versus control subjects showed the presence of significant focal GM atrophy in patients involving the bilateral insula, the bilateral orbitofrontal cortices, the bilateral internal and inferior temporal regions, the posterior cingulate cortex, the bilateral thalami, the bilateral caudate nuclei, the bilateral lenticular nuclei and the bilateral cerebellum. EDSS was slightly correlated (rho=-0.37 p=0.0027) with the atrophy of the right cerebellum. No correlations have been evidenced between the cognitive status of patients and the regional GM atrophy. The present study performed on a large group of CIS patients demonstrated that regional GM atrophy is present right after the first clinical event of multiple sclerosis and mainly affects the deep GM and the limbic system.


DNA-damaging activity in vivo and bacterial mutagenicity of sixteen hydrazine derivatives as related quantitatively to their carcinogenicity.
Sixteen hydrazine derivatives (hydrazine, 1,1-dimethylhydrazine, 1,2-dimethylhydrazine, phenylhydrazine, procarbazine, isoniazid, isocarboxazid, nialamide, 2,4-dinitrophenylhydrazine, phenelzine, hydralazine, dihydralazine, carbamylhydrazine, mebanazine, iproniazid, and 1-carbamyl-2-phenylhydrazine) were tested for DNA-damaging activity by the alkaline elution technique and for mutagenic activity in the Salmonella-microsome (Ames) test. The first nine compounds listed (56%) were found to induce a significant DNA fragmentation in the liver and/or in the lung of i.p.-treated male Swiss mice. The DNA-damaging potency varied over an approximately 30-fold range. Thirteen of the first 14 compounds listed (81% of the total), isocarboxazid being inactive, were positive in the Ames test, with a broad range of activity towards the five bacterial strains of Salmonella typhimurium used (TA1535, TA100, TA1537. TA1538, and TA98) and of metabolic behavior in the presence of S-9 mix containing rat liver, mouse liver, or mouse lung postmitochondrial preparations from Aroclor-treated animals. The mutagenic potency varied over an almost 7000-fold range. For 11 of the 16 hydrazine derivatives tested, homogeneous carcinogenicity data (induction of pulmonary tumors in mice chronically treated p.o.) were available from literature. Elaboration of these data showed that carcinogenic potency varied over an approximately 1900-fold range. The five most potent carcinogens were all positive in the DNA damage test. Their carcinogenic potency varied over a 130-fold rage and their DNA-damaging potency varied over a 22-fold range. DNA-damaging potency seemed to vary on a more compressed scale, but regression analysis indicated the existence of a strong positive correlation between in vivo DNA-damaging and carcinogenic potencies, while a lack of correlation was found between mutagenic and carcinogenic potencies. There was no correlation between DNA-damaging and mutagenic potencies.


Synthetic Lethality - Its Current Application and Potential in Oncological Treatment.
Synthetic lethality is a gene interaction where a defect in one of the interacting genes is compatible with cell viability, whereas the disruption of both genes leads to cell death. The discovery of the lethal effect of poly(ADP-ribose) polymerase (PARP) inhibitors in BRCA1/2 mutant cells has opened an important direction in the development of targeted therapy in oncology. The PARP inhibitor olaparib has become the first registered drug for recurrent high-grade serous ovarian cancer treatment based on synthetic lethality that has reached the clinic. Current research focuses on the combination of PARP inhibitors and inhibitors of kinases, which control the cell cycle, to prevent or overcome resistance to PARP inhibitors. There are also ongoing clinical trials which examine PARP inhibitor treatment in other types of cancers including tumours presenting the so-called BRCAness phenotype. Screenings for new synthetic lethalities which could serve as potential targets for new drug development have improved with the CRISPR/Cas9 technology, but another key problem persists in the screening efforts, namely the incomplete penetrance of synthetic lethality throughout a tumour cell population. This paper summarises the current application of synthetic lethality principles in oncology and discusses the challenges in research focused on potential new drugs based on synthetic lethality.


Interobserver agreement and the impact of mentorship on the diagnosis of inflammatory bowel disease-associated dysplasia among subspecialist gastrointestinal pathologists.
The diagnosis of inflammatory bowel disease (IBD)-associated dysplasia is challenging, and past studies have demonstrated considerable interobserver variability in such diagnoses. This study aimed to assess interobserver agreement in IBD dysplasia diagnoses among subspecialty GI pathologists and to explore the impact of mentorship on diagnostic variability. Twelve GI pathologist mentees and 7 GI pathologist mentors reviewed 163 digitized slides. Participants rendered a diagnosis of negative for dysplasia, indefinite for dysplasia, low-grade dysplasia, or high-grade dysplasia and provided a confidence level for each case. Interobserver agreement and reliability were assessed using Cohen's and Fleiss' kappa (κ) statistics and intraclass correlation coefficient (ICC) analysis. The overall κ coefficient was 0.42 (95% CI: 0.38-0.46). The overall ICC was 0.67 (95% CI: 0.62-0.72). Κ coefficients ranged from 0.31 to 0.49 for mentor/mentee pairs and from 0.34 to 0.55 for pairs of mentees of the same mentor. The combined κ coefficient was 0.44 (95% CI: 0.39-0.48) for all mentees and 0.39 (95% CI: 0.34-0.43) for all mentors. Common features in low agreement cases included mucosal atrophy, areas of stark contrast, serrations, decreased goblet cells, absent surface epithelium, and poor orientation. Participants were confident in most diagnoses, and increased confidence levels generally correlated with higher interobserver agreement. Interobserver agreement among subspecialist GI pathologists in this curated cohort of IBD dysplasia cases was fair to moderate. Mentorship during GI pathology fellowship does not appear to be a significant factor contributing to interobserver variability, but increased experience also does not seem to improve interobserver agreement.


Development of a web service for analysis in a distributed network.
We describe functional specifications and practicalities in the software development process for a web service that allows the construction of the multivariate logistic regression model, Grid Logistic Regression (GLORE), by aggregating partial estimates from distributed sites, with no exchange of patient-level data. We recently developed and published a web service for model construction and data analysis in a distributed environment. This recent paper provided an overview of the system that is useful for users, but included very few details that are relevant for biomedical informatics developers or network security personnel who may be interested in implementing this or similar systems. We focus here on how the system was conceived and implemented. We followed a two-stage development approach by first implementing the backbone system and incrementally improving the user experience through interactions with potential users during the development. Our system went through various stages such as concept proof, algorithm validation, user interface development, and system testing. We used the Zoho Project management system to track tasks and milestones. We leveraged Google Code and Apache Subversion to share code among team members, and developed an applet-servlet architecture to support the cross platform deployment. During the development process, we encountered challenges such as Information Technology (IT) infrastructure gaps and limited team experience in user-interface design. We figured out solutions as well as enabling factors to support the translation of an innovative privacy-preserving, distributed modeling technology into a working prototype. Using GLORE (a distributed model that we developed earlier) as a pilot example, we demonstrated the feasibility of building and integrating distributed modeling technology into a usable framework that can support privacy-preserving, distributed data analysis among researchers at geographically dispersed institutes.


Introducing an evidence-based medicine curriculum into a family practice residency--is it effective?
To investigate whether teaching an evidence-based medicine (EBM) curriculum increased the knowledge and use of EBM principles in residents' continuity clinics. In 1999, the authors performed a needs assessment with residents and faculty of Cascades East Family Practice Residency in Oregon and constructed a ten-session EBM workshop series that was introduced into the curriculum in 2000. Resident-preceptor interactions during outpatient continuity clinic were tape-recorded prior to and six months following introduction of the curriculum. A 50-item, multiple-choice examination was administered before and after the workshop series. Residents at another FP residency at the same university served as a control group. The same assessments were applied to the experimental and control groups. The tape recordings were analyzed for interactions that contained key EBM phrases or words. Pre-intervention multiple-choice test results were similar (control mean 56%, experimental 53%, p >.22 NS). Post-intervention test scores for the experimental group were significantly improved (mean 72%, p <.001). There was no significant improvement in test results among members of the control group (p >.05 NS). In the recorded resident-preceptor interactions, a marked increase in the use of EBM terms indicated awareness and/or use of EBM in the experimental group. In 1,165 minutes recorded prior to the workshops, EBM terms were used in a total of ten events. In 735 minutes recorded after the workshops, EBM terms were recorded in 67 events. A reduced number of EBM terms were recorded in the control group. Administering a structured EBM curriculum increased residents' knowledge and use of EBM constructs during patient care.


System-in Package of Integrated Humidity Sensor Using CMOS-MEMS Technology.
Temperature/humidity microchips with micropump were fabricated using a CMOS-MEMS process and combined with ZigBee modules to implement a sensor system in package (SIP) for a ubiquitous sensor network (USN) and/or a wireless communication system. The current of a diode temperature sensor to temperature and a normalized current of FET humidity sensor to relative humidity showed linear characteristics, respectively, and the use of the micropump has enabled a faster response. A wireless reception module using the same protocol as that in transmission systems processed the received data within 10 m and showed temperature and humidity values in the display.


Compounds enhanced in a mass spectrometric profile of smokers' exhaled breath versus non-smokers as determined in a pilot study using PTR-MS.
A pilot study has been carried out to define typical characteristics of the trace gas compounds in exhaled breath of non-smokers and smokers to assist interpretation of breath analysis data from patients who smoke with respiratory diseases and lung cancer. Exhaled breath was analyzed using proton transfer reaction-mass spectrometry (PTR-MS) for 370 volunteers (81 smokers, 210 non-smokers, 79 ex-smokers). Volatile organic compounds corresponding to product ions at seven mass-to-charge ratios (m/z 28, 42, 69, 79, 93, 97, 123) in the PTR-MS spectra differentiated between smokers and non-smokers. The Youden index (= maximum of sensitivity + specificity - 1, YI) as a measure for differentiation between smokers and non-smokers was YI = 0.43 for ions at the m/z values 28 (tentatively identified as HCN), YI = 0.75 for m/z = 42 (tentatively identified as acetonitrile) and YI = 0.53 for m/z = 79 (tentatively identified as benzene). No statistically significant difference between smokers and non-smokers was observed for the product ions at m/z = 31 and 33 (compounds tentatively identified as formaldehyde and methanol). When interpreting the exhaled breath of lung cancer or COPD patients, who often smoke, compounds appearing at the above-mentioned seven mass-to-charge ratios should be considered with appropriate care to avoid misdiagnosis. Validation studies in larger numbers of patients with more precise delineation of their smoking behavior and using additional analytical techniques such as GC/MS and SIFT-MS should be carried out.


Consistency and inconsistency of consensus methods for inferring species trees from gene trees in the presence of ancestral population structure.
In the last few years, several statistically consistent consensus methods for species tree inference have been devised that are robust to the gene tree discordance caused by incomplete lineage sorting in unstructured ancestral populations. One source of gene tree discordance that has only recently been identified as a potential obstacle for phylogenetic inference is ancestral population structure. In this article, we describe a general model of ancestral population structure, and by relying on a single carefully constructed example scenario, we show that the consensus methods Democratic Vote, STEAC, STAR, R(∗) Consensus, Rooted Triple Consensus, Minimize Deep Coalescences, and Majority-Rule Consensus are statistically inconsistent under the model. We find that among the consensus methods evaluated, the only method that is statistically consistent in the presence of ancestral population structure is GLASS/Maximum Tree. We use simulations to evaluate the behavior of the various consensus methods in a model with ancestral population structure, showing that as the number of gene trees increases, estimates on the basis of GLASS/Maximum Tree approach the true species tree topology irrespective of the level of population structure, whereas estimates based on the remaining methods only approach the true species tree topology if the level of structure is low. However, through simulations using species trees both with and without ancestral population structure, we show that GLASS/Maximum Tree performs unusually poorly on gene trees inferred from alignments with little information. This practical limitation of GLASS/Maximum Tree together with the inconsistency of other methods prompts the need for both further testing of additional existing methods and development of novel methods under conditions that incorporate ancestral population structure.


A multivariate multilevel Gaussian model with a mixed effects structure in the mean and covariance part.
A traditional Gaussian hierarchical model assumes a nested multilevel structure for the mean and a constant variance at each level. We propose a Bayesian multivariate multilevel factor model that assumes a multilevel structure for both the mean and the covariance matrix. That is, in addition to a multilevel structure for the mean we also assume that the covariance matrix depends on covariates and random effects. This allows to explore whether the covariance structure depends on the values of the higher levels and as such models heterogeneity in the variances and correlation structure of the multivariate outcome across the higher level values. The approach is applied to the three-dimensional vector of burnout measurements collected on nurses in a large European study to answer the research question whether the covariance matrix of the outcomes depends on recorded system-level features in the organization of nursing care, but also on not-recorded factors that vary with countries, hospitals, and nursing units. Simulations illustrate the performance of our modeling approach.


Plutonium movements across the haemochorial placenta of the guinea pig.
In order to measure transplacental movements of plutonium without the complications of fetal accumulation, the fetal circulation of the guinea pig placenta (at 59 to 61 days of gestation) was perfused in situ. Dams were administered trace quantities of tritiated water (to indicate changes in maternal blood flow to the placenta) and 30 mu Ci/kg (i.e., approximately 500 micrograms/kg) of citrated 239Pu by intravenous injection. Plutonium-239 doses were large, approaching the LD50/30 (20 to 80 mu Ci/kg) for other species. Perfusion pressure, maternal cardiac rate, electrocardiogram, blood pressure, and respiratory rate were monitored continuously during each perfusion. Our measurements show that the clearance of plutonium from mother to fetus is small--2.5 +/- 0.5 microliter/min--an amount that is less than 20 per cent of the clearance of inorganic mercury. The indirect measurements of maternal blood flow to the placenta indicate that placental blood flow is greatly diminished in dams dosed with plutonium, which may partially account for the low clearance of plutonium.


Role of damping in spin Seebeck effect in yttrium iron garnet thin films.
The role of damping in the spin Seebeck effect (SSE) was studied experimentally for the first time. The experiments used Y3Fe5O12 (YIG)/Pt bilayered structures where the YIG films exhibit very similar structural and static magnetic properties but very different damping. The data show that a decrease in the damping gives rise to an increase in the SSE coefficient, which is qualitatively consistent with some of the theoretical models. This response also shows quasi-linear behavior, which was not predicted explicitly by previous studies. The data also indicate that the SSE coefficient shows no notable correlations with the enhanced damping due to spin pumping, which can be understood in the frame of two existing models.


[The vestibular function in patients with various forms of chronic purulent otitis media].
A complex vestibulologic examination of 131 patients with otitis media purulenta chronica (OMPC) was made. The patients were divided into groups and subgroups basing on the course of OMPC and presence or absence of subjective vestibular disorders. Vestibular function was assessed in various OMPC forms. Vestibular abnormalities were found in all the examinees. Therefore, all OMPC patients should be examined vestibulologically for early detection of initial, subclinical changes of the inner ear vestibular apparatus and decision on treatment policy.


[Social vulnerability and environmental risk: a methodological approach for evaluating environmental injustice].
The aim of this article was to evaluate socio-environmental vulnerability by selecting and analyzing socioeconomic, demographic, and infrastructural indicators around the Fazenda Botafogo Industrial Park in the city of Rio de Janeiro, Brazil, taking this work as a case study. The study aimed to determine whether there is a correlation between socially vulnerable groups and environmental risk, thus shaping a situation of environmental injustice. The study features a quantitative and spatial analysis based on the use of a geographic information system (GIS). The analyses show a strong correlation between social vulnerability and environmental risk, based on residents' proximity to factories in the target area. The indicators show that the populations with the worst socioeconomic conditions tend to live closest to the industrial sources of environmental risks. Inversely, the population groups with the best socioeconomic conditions tend to live the farthest from such sources.


Risk of stroke in hospitalized SARS-CoV-2 infected patients: A multinational study.
There is an increased attention to stroke following SARS-CoV-2. The goal of this study was to better depict the short-term risk of stroke and its associated factors among SARS-CoV-2 hospitalized patients. This multicentre, multinational observational study includes hospitalized SARS-CoV-2 patients from North and South America (United States, Canada, and Brazil), Europe (Greece, Italy, Finland, and Turkey), Asia (Lebanon, Iran, and India), and Oceania (New Zealand). The outcome was the risk of subsequent stroke. Centres were included by non-probability sampling. The counts and clinical characteristics including laboratory findings and imaging of the patients with and without a subsequent stroke were recorded according to a predefined protocol. Quality, risk of bias, and heterogeneity assessments were conducted according to ROBINS-E and Cochrane Q-test. The risk of subsequent stroke was estimated through meta-analyses with random effect models. Bivariate logistic regression was used to determine the parameters with predictive outcome value. The study was reported according to the STROBE, MOOSE, and EQUATOR guidelines. We received data from 26,175 hospitalized SARS-CoV-2 patients from 99 tertiary centres in 65 regions of 11 countries until May 1st, 2020. A total of 17,799 patients were included in meta-analyses. Among them, 156(0.9%) patients had a stroke-123(79%) ischaemic stroke, 27(17%) intracerebral/subarachnoid hemorrhage, and 6(4%) cerebral sinus thrombosis. Subsequent stroke risks calculated with meta-analyses, under low to moderate heterogeneity, were 0.5% among all centres in all countries, and 0.7% among countries with higher health expenditures. The need for mechanical ventilation (OR: 1.9, 95% CI:1.1-3.5, p = 0.03) and the presence of ischaemic heart disease (OR: 2.5, 95% CI:1.4-4.7, p = 0.006) were predictive of stroke. The results of this multi-national study on hospitalized patients with SARS-CoV-2 infection indicated an overall stroke risk of 0.5%(pooled risk: 0.9%). The need for mechanical ventilation and the history of ischaemic heart disease are the independent predictors of stroke among SARS-CoV-2 patients. None.


Neurotrophic keratopathy and refractive surgery.
Corneal nerve function is an important consideration for the refractive surgeon. In patients without a history of neuropathy, refractive surgery can lead to destruction of corneal nerves and may predispose to keratopathy. The purpose of this review is to provide an update on the effect of refractive surgery on corneal nerve function and the potential for an increased risk of neurotrophic keratopathy development. Recent studies have reinforced that refractive surgery can cause anatomical and functional changes in corneal nerve function. Among the most commonly performed refractive surgery procedures are Laser Assisted In-situ Keratomileusis, Photorefractive Keratectomy, and Small Incision Lenticule Extraction. Due to differences in technique, these procedures can have varying effects on corneal nerve structure. Using in vivo confocal microscopy, postrefractive patients were found to have decreased total nerve density when compared with controls in the immediate postoperative period. In some studies, patients have been shown to undergo re-innervation and regain significant amounts of nerve function. The majority of studies have found that despite decreased nerve cell density, long-term outcomes of refractive surgery patients are generally favorable. However, loss of corneal nerve function can lead to a variety of serious effects ranging from dry eye disease, corneal hypoesthesia/anesthesia, neuropathic pain, to neurotrophic keratopathy and ulceration in the rare cases. Neurotrophic keratopathy is a rare occurrence after keratorefractive surgery and is largely due to damage to corneal nerves. Proper patient selection and counseling are essential to decrease the risk of development of this devastating complication.


Delirium and dementia: diagnostic criteria and fatality rates.
Medically ill patients diagnosed at index admission as delirious, i.e., suffering cognitive decline and an altered state of consciousness, had higher fatality rates than demented, cognitively intact or depressed patients. At a one-year follow-up the death rate of those who had been delirious was still higher than that of demented patients. Delirious patients were more likely to have a diffusely slow EEG, tachycardia and hyperthermia and lower mean systolic and diastolic blood pressure. These result validate the distinction between delirium and dementia and the importance of alteration of consciousness as a defining characteristics of delirium.


Benign triton tumor: a rare entity in head and neck region.
Benign triton tumors (BTT) are very rare lesions composed of mature skeletal muscle and neural tissue. We report a case of a 14-year-old boy who presented with asymptomatic swelling of the chin over an 18-month duration which increased gradually to involve the left side of the lower lip. Clinically, a diagnosis of neurofibroma was made. Excisional biopsy confirmed the diagnosis of a BTT. Having an affinity for large nerve trunks like the brachial and sciatic, these tumors rarely occur in the head and neck region. When they do, they may involve the large central cranial nerve trunk and present as intracranial masses or involve the smaller peripheral nerve twigs and present as asymptomatic skin nodules, of which only four cases involving peripheral nerves are reported in the English literature. Here, we report the fifth documented case of a BTT involving the mental branch of the trigeminal nerve. A brief review of the literature is also provided.


Functional characterization of a cloned pig intestinal peptide transporter (pPepT1).
Absorption of dietary protein can be mediated through the uptake of AA as free AA or small peptides. A H(+)-coupled, peptide transport protein, PepT1, is responsible for the absorption of small peptides arising from digestion of dietary proteins in the small intestine. The magnitude of peptide absorption and the nutritional significance of PepT1 are unknown for many food-producing animals; thus, the objective of this study was to clone and determine the functional characteristics of the pig PepT1 (pPepT1). Two cDNA-encoding pPepT1 were isolated, which contain alternative polyadenylation sites. The predicted pPepT1 is a 708-AA protein, which shows 82.8, 85.7, and 64.7% AA identity to human, sheep, and chicken PepT1, respectively. On northern blots, two pPepT1 mRNA of approximately 2.9 and 3.5 kb were detected in the duodenum, jejunum, and ileum of the small intestine and are presumed to result from alternative polyadenylation. Uptake of [(3)H]-Gly-Sar was measured in Chinese hamster ovary cells transiently transfected with a pPepT1 expression vector to study the functional expression of pPepT1. Peptide transport was H(+)-dependent, with an optimal pH of 6.0 to 6.5. The ability of pPepT1 to transport various peptides was assayed by calculating the concentration of unlabeled peptide that inhibited 50% of [(3)H]-Gly-Sar uptake (IC(50)) in transfected cells. Eleven dipeptides and two tripeptides had IC(50) values that ranged from 0.004 to 0.53 mM. Three peptides, Lys-Lys, Arg-Lys, and Lys-Trp-Lys, had IC(50) values greater than 1. 38 mM and seem to be poor substrates for pPepT1. For all three tetrapeptides examined, uptake of Gly-Sar was too small to measure, even at a concentration of 10 mM tetrapeptide; therefore, IC(50) values could not be calculated. These results demonstrate that pPepT1 can transport a variety of dipeptides and tripeptides but not tetrapeptides.


Renal complications in 6p duplication syndrome: microarray-based investigation of the candidate gene(s) for the development of congenital anomalies of the kidney and urinary tract (CAKUT) and focal segmental glomerular sclerosis (FSGS).
6p duplication syndrome is a rare chromosomal disorder that frequently manifests renal complications, including proteinuria, hypoplastic kidney, and hydronephrosis. We report a girl with the syndrome, manifesting left hydronephrosis, proteinuria/hematuria, and focal segmental glomerular sclerosis (FSGS) resulting in chronic end-stage renal failure, successfully treated with renal transplantation. Microarray comparative genomic hybridization showed the derivative chromosome 6 to have a 6.4-Mb duplication at 6p25.3-p25.1 with 32 protein-coding genes and a 220-Kb deletion at 6p25.3 with two genes of no possible relation to the renal pathology. Review of the literature shows that variation of renal complications in the syndrome is compatible with congenital anomalies of the kidney and urinary tract (CAKUT). FSGS, observed in another patient with 6p duplication syndrome, could be a non-coincidental complication. FOXC1, located within the 6.4-Mb duplicated region at 6p25.3-p25.2, could be a candidate gene for CAKUT, but its single gene duplication effect would not be sufficient. FSGS would be a primary defect associated with duplicated gene(s) albeit no candidate could be proposed, or might occur in association with CAKUT.


Ascorbic acid synthesis by the mammalian fetus.
Fetal rat liver can synthesize ascorbic acid after 16 days of gestation. Fetal kidney was inactive and neither fetal guinea pig liver nor kidney possessed ascorbic acid synthetic ability.


Scootering for Children and Youth Is More Than Fun: Exploration of a Feasible Approach to Improve Function and Fitness.
Describe scootering as a physical therapy intervention for children/adolescents with mobility limitations within the "F-Words for Child Development" (fitness, function, family, friends, fun, and future) and through motion analysis. Perspectives of scootering were explored using the holistic "F-words for Child Development" recommendations for pediatric rehabilitation and through 3-dimensional instrumented motion analysis of children/adolescents with cerebral palsy and children/adolescents with typical development. Scootering was consistent with the F-words tenets for rehabilitative best practice. Many of the motion characteristics of scootering reflected desirable exercise and gait attributes relevant to children/adolescents with cerebral palsy. Scootering is a feasible, functional, and fun activity that has the potential to address many aspects of fitness, function, and gait; meet the needs of families; and provide opportunities for interaction with friends. It is a physical therapy intervention that has the potential to contribute to future health and well-being of children with disabilities. For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A331.


In vitro study of enamel erosion caused by soft drinks and lemon juice in deciduous teeth analysed by stereomicroscopy and scanning electron microscopy.
The erosion caused in vitro by cola-type and guaraná-type beverages (the latter is a soft drink sold in Brazil), and a canned lemon juice on the enamel of human deciduous teeth was analyzed. Morphological analysis of affected enamel was done using stereomicroscopy and scanning electron microscopy (SEM). The harmful effect of all test products on deciduous enamel was clearly demonstrated. Stereomicroscopy showed loss of gloss and an alteration in normal color of enamel, with irregular loss of dental tissue in variable degrees. Such a loss became more serious as the time of incubation increased. Different degrees of solubilization of enamel prisms were demonstrated by SEM, affecting initially the sheaths and the heads of prisms and later their tails. Areas of erosion increased in proportion to the time of incubation. All the products showed a great erosive potential on human deciduous dental enamel.


Effects of local adaptation and interspecific competition on species' responses to climate change.
Local adaptation and species interactions have been shown to affect geographic ranges; therefore, we need models of climate impact that include both factors. To identify possible dynamics of species when including these factors, we ran simulations of two competing species using an individual-based, coupled map-lattice model using a linear climatic gradient that varies across latitude and is warmed over time. Reproductive success is governed by an individual's adaptation to local climate as well as its location relative to global constraints. In exploratory experiments varying the strength of adaptation and competition, competition reduces genetic diversity and slows range change, although the two species can coexist in the absence of climate change and shift in the absence of competitors. We also found that one species can drive the other to extinction, sometimes long after climate change ends. Weak selection on local adaptation and poor dispersal ability also caused surfing of cooler-adapted phenotypes from the expanding margin backwards, causing loss of warmer-adapted phenotypes. Finally, geographic ranges can become disjointed, losing centrally-adapted genotypes. These initial results suggest that the interplay between local adaptation and interspecific competition can significantly influence species' responses to climate change, in a way that demands future research.


Complementary Antibacterial Effects of Bacteriocins and Organic Acids as Revealed by Comparative Analysis of Carnobacterium spp. from Meat.
Carnobacterium maltaromaticum and Carnobacterium divergens are often predominant in the microbiota of vacuum-packaged (VP) meats after prolonged storage at chiller temperatures, and more so in recent studies. We investigated the antibacterial activities of C. maltaromaticum and C. divergens (n = 31) from VP meats by phenotypic characterization and genomic analysis. Five strains showed antibacterial activities against Gram-positive bacteria in a spot-lawn assay, with C. maltaromaticum strains having an intergeneric and C. divergens strains an intrageneric inhibition spectrum. This inhibitory activity is correlated with the production of predicted bacteriocins, including carnobacteriocin B2 and carnolysin for C. maltaromaticum and divergicin A for C. divergens The supernatants of both species cultured in meat juice medium under anaerobic conditions retarded the growth of most Gram-positive and Gram-negative bacteria in broth assay in a strain-dependent manner. C. maltaromaticum and C. divergens produced formate and acetate but not lactate under VP meat-relevant conditions. The relative inhibitory activity by Carnobacterium strains was significantly correlated (P < 0.05) to the production of both acids. Genomic analysis revealed the presence of genes required for respiration in both species. In addition, two clusters of C. divergens have an average nucleotide identity below the cutoff value for species delineation and thus should be considered to be two subspecies. In conclusion, both bacteriocins and organic acids are factors contributing significantly to the antibacterial activity of C. maltaromaticum and C. divergens under VP meat-relevant conditions. A few Carnobacterium strains can be explored as protective cultures to extend the shelf life and improve the safety of VP meats.IMPORTANCE The results of this study demonstrated that both bacteriocins and organic acids are important factors contributing to the antibacterial activities of Carnobacterium from vacuum-packaged (VP) meats. This study demonstrated that formate and acetate are the key organic acids produced by Carnobacterium and demonstrated their association with the inhibitory activity of carnobacteria under VP meat-relevant storage conditions. The role of lactate, on the other hand, may not be as important as previously believed in the antimicrobial activities of Carnobacterium spp. on chilled VP meats. These findings advance our understanding of the physiology of Carnobacterium spp. to better explore their biopreservative properties for chilled VP meats.


Serum concentrations of tumour necrosis factor alpha in childhood chronic inflammatory bowel disease.
Serum tumour necrosis factor alpha (TNF alpha) concentrations were measured by enzyme linked immunoadsorbent assay in 31 normal children and during 65 episodes of clinical remission and 54 episodes of relapse in 92 children with chronic inflammatory bowel disease. An appreciable rise in TNF alpha was found only in children in relapse of ulcerative colitis and colonic Crohn's disease. The group of children with small bowel Crohn's disease in relapse did not show increases of TNF alpha above control concentrations, despite an equivalent rise in disease indices. Height velocity was depressed in children with relapse of large bowel Crohn's disease and ulcerative colitis compared with the equivalent condition in remission. The impairment of growth velocity was significantly greater in relapse of large bowel Crohn's disease and ulcerative colitis than in small bowel Crohn's disease alone, although for the subgroups in stage 1 puberty (prepubertal) the differences were not significant. Inadequate growth in chronic inflammatory bowel disease is currently ascribed to inadequate nutrition and TNF alpha may contribute to this through its cachexia inducing effects. It may, in addition, diminish pituitary growth hormone release. These results suggest that production of TNF alpha may be associated with growth failure in relapse of colonic inflammatory bowel disease.


The percutaneous toxicokinetics of VX in a damaged skin porcine model and the evaluation of WoundStat™ as a topical decontaminant.
This study used a damaged skin, porcine model to evaluate the in vivo efficacy of WoundStat™ for the decontamination of superficial, nerve agent-contaminated wounds. Anaesthetized animals were randomly assigned to either control (n = 7), no decontamination (n = 12) or WoundStat™ (n = 12) treatment groups. Pigs were exposed to a 5× LD50 dose of neat, radiolabelled S-[2-(diisopropylamino)ethyl]-O-ethyl methyl-phosphonothioate (VX; or equivalent volume of sterile saline for the control group) via an area of superficially damaged skin on the ear. WoundStat™ was applied at 30 seconds post-exposure to assigned animals. The VX contaminant (or saline) and decontaminant remained in place for the duration of the study (up to 6 hours). Physiological parameters and signs of intoxication were recorded during the exposure period. Skin and organ samples were taken post mortem for 14 C-VX distribution analyses. Blood samples were taken periodically for toxicokinetic and whole-blood acetylcholinesterase (AChE) activity analyses. VX exposure was accompanied by a rapid decrease in AChE activity in all animals, regardless of decontamination. However, decontamination significantly improved survival rate and time and reduced the severity of signs of intoxication. In addition, the distribution of 14 C-VX in key internal organs and post mortem blood samples was significantly lower in the WoundStat™ treatment group. This study demonstrates that WoundStat™ may be a suitable medical countermeasure for increasing both survival rate and time following VX exposure. The results also suggest that AChE activity is not a useful prognostic indicator.


Mere visual perception of other people's disease symptoms facilitates a more aggressive immune response.
An experiment (N = 28) tested the hypothesis that the mere visual perception of disease-connoting cues promotes a more aggressive immune response. Participants were exposed either to photographs depicting symptoms of infectious disease or to photographs depicting guns. After incubation with a model bacterial stimulus, participants' white blood cells produced higher levels of the proinflammatory cytokine interleukin-6 (IL-6) in the infectious-disease condition, compared with the control (guns) condition. These results provide the first empirical evidence that visual perception of other people's symptoms may cause the immune system to respond more aggressively to infection. Adaptive origins and functional implications are discussed.


Epithelial Dysplasia and Cancer in IBD Strictures.
Colonic strictures and epithelial dysplasia are both known risk factors for the occurrence of colorectal cancer in inflammatory bowel disease (IBD) patients. The aim of the present work was to study colonic stricture as a risk factor for the occurrence of epithelial dysplasia and colonic adenocarcinoma. In a case-control study among 53568 IBD patients undergoing colonoscopy, we compared the prevalence of strictures among cases with dysplasia or adenocarcinoma and controls without such complications by calculating odds ratios (ORs) and their 95% confidence intervals (CIs). Multivariate logistic regressions were used to assess the joint influence of multiple predictor variables (age, sex, IBD type and stricture) on the occurrence of colonic dysplasia or adenocarcinoma. The prevalence of strictures was 1.06% in ulcerative colitis (UC) and 8.71% in Crohn's disease (CD, OR 11.09, 95% CI 9.72-12.70). The prevalence of dysplasia was 3.22% in UC and 2.08% in CD (OR 0.75, 95% CI 0.65-0.86). The prevalence of dysplasia was similar in IBD patients with and without stricture: 2.82 and 2.41%, respectively. The prevalence of cancer was higher in IBD patients with than without stricture: 0.78 and 0.11%, respectively (OR 6.87, 95% CI 3.30-12.89). In the multivariate analysis, old age, male sex and UC, but not stricture, were all significantly and independently associated with dysplasia. Old age, dysplasia and stricture were significantly and independently associated with cancer. The prevalence of epithelial dysplasia is not generally increased in IBD patients with strictures.


Morphological descriptions of second and third instar larvae of Hypopygiopsis violacea Macquart (Diptera:Calliphoridae), a forensically important fly in Malaysia.
Hypopygiopsis violacea, a species of fly of forensic importance, was recovered from a corpse and described for the first time. The morphological structures of the second and third instar larvae of four specimens were examined using light microscope. Observations were focused on three main morphological characters: cephalopharyngeal skeleton, anterior and posterior spiracles. Cephalopharyngeal skeleton of second instar larva is darkly pigmented and without accessory sclerite below the mouth hook. The anterior spiracles of second and third instar larvae have 8-9 papillae each, arranged in a single row. The posterior spiracle of second instar larva has two spiracular slits with no thickening of peritreme. This differentiates it from the third instar, whereby the latter has three slits for each posterior spiracle. Cephalopharyngeal skeleton of third instar larva is heavily pigmented. An accessory sclerite is found below the hook part of third instar larva but is absent in second instar. Peritreme of the posterior spiracle of third instar larva is thick almost complete encircling a button. The intersegmental spines of the cuticular surface are dome-shaped and unicuspid. Third instar larva of this species is large with size approximately 15 mm long. These findings provide important identification features of immature stages of Hy. violacea which could be useful in forensic entomology.


Key role players in health care quality: who are they and what do they think? An experience from Saudi Arabia.
The aim of this study in Medina city in 2009 was to identify key role players who influence the healthcare system and to assess their views regarding the improvement of the quality of health care in Saudi Arabia. In a qualitative, cross-sectional study data were collected from focus group discussions and analysed using a content analysis approach. Key role players were chosen based on their previous experience in providing feedback in health care-related areas: representatives from organizations, interest groups, departments, the media, other governmental organizations and members of the public who actively worked with the Department of Health. The topics discussed were: health and community; health and media; planning for health; female staff views; role of the private health sector; and the role of other governmental agencies. The discussions highlighted the importance of improvement of health facility infrastructure, the implementation of staff training and education, the initiation of quality assurance and safety standards and the extension of the scope of primary care and community health educational programmes.


Physical activity research in Hong Kong from 1987 to 2012: evidence on children and adolescents.
A comprehensive understanding of research on the physical activity (PA) of Hong Kong youth is necessary to develop specific and effective intervention strategies. This review summarizes existing evidence in studies on PA among the Hong Kong youth. An electronic literature search was conducted using MEDLINE, SPORTDiscus, ERIC, and HighWire database. Forty-five studies published from 1987 to 2012 were included in this review. The findings are presented in five categories, namely, health benefits of PA, participation in PA, assessment of PA, correlates of PA, and interventions to promote PA. The results indicate that PA among the youth in Hong Kong has attracted concern in the past decade. Specifically, extensive studies focused on the areas of health benefits of PA, participation in PA, and correlates of PA. Research into context-specific correlates of PA and tailored PA promotion programs for the Hong Kong youth is warranted in the future.


Immunocytochemical localization of GD3 ganglioside to astrocytes in murine cerebellar mutants.
Biochemical analysis of the murine mutants, Purkinje cell degeneration (pcd/pcd), staggerer (sg/sg) and lurcher (Lc/+), which are characterized by neuronal degeneration in the cerebellar cortex, have revealed substantially elevated levels of GD3 ganglioside (ceramide-Glu-Gal-NANA-NANA). Ultrastructural studies on pcd/pcd and sg/sg have shown astrocytes elaborating slender sheet-like processes which wrap around neuronal processes. Seyfried et al. hypothesized that the elevation in GD3 seen in these mutants is attributed to its expression by altered astrocytes. Using a monoclonal antibody to GD3 and a polyclonal antibody to GFAP we have explored the cellular localization of GD3. Positive immunofluorescence was observed in sg/sg, pcd/pcd and Lc/+ cerebella, but not in age-matched normal littermates or in weaver (wv/wv) a fourth cerebellar murine mutation which destroys granule cells prior to their migration across the molecular layer. In wv/wv cerebella, astrocytes do not elaborate sheets of processes and no significant elevations of GD3 are observed biochemically. The positive GD3 staining in pcd/pcd and Lc/+ was confined to the granule cell layer and appeared as many punctate or short, fine profiles, suggestive of binding to thin cytoplasmic processes. No GD3 positive staining was seen in the Bergmann glia or astrocytes of the white matter. GD3-positive staining was seen throughout the cortex in sg/sg which displayed severe disruption of its histoarchitecture with no clear delineation between the molecular and granule cell layers. Ultrastructural localization of GD3 was performed using pre-embedding immunocytochemistry with a PAP technique in sg/sg mice. The cytoplasmic processes and cell bodies of astrocytes displayed positive membrane staining. Our results suggest that astrocytes undergo important changes in membrane composition during pathological reaction caused by neuronal degeneration.


Dural malformations with ophthalmic manifestations: results of particulate embolization in seven patients.
Seven patients with proptosis, chemosis, diplopia, and elevated intraocular pressure were found to have dural arteriovenous malformations with drainage into the cavernous sinus and superior ophthalmic vein. These patients had sufficient symptoms to justify therapeutic embolization with polyvinyl alcohol. Five of seven patients had complete resolution of their ophthalmic symptoms after embolization; the other two had transient improvement. Follow-up was 9-29 months. When 50% or more of the vessels supplying a malformation were embolized, complete relief of symptoms was obtained. Particulate embolization is an effective therapeutic approach in patients with significant ophthalmologic symptoms from dural malformations.


[Action of nonsteroidal anti-inflammatory agents on fibrinolysis and platelet aggregation].
The influence of non-steroidal antiphlogistics (NSA, fluor derivatives of phenylanthranilic acid) on fibrinolysis, platelet function, prostaglandin metabolism and pharmacokinetics of indirect anticoagulants was studied in rats and rabbits in vitro and in vivo. NSA were found to shorten the euglobulin lysis time and to enlarge the lysis zones on fibrin plates. They potentiated the fibrinolytic activity of streptokinase and trypsin. Furthermore, they inhibited platelet aggregation induced by arachidonic acid in rabbits. NSA in combination with inhibitors of thromboxane synthetase potentiated inhibition of aggregation. After oral administration, NSA inhibited formation of thromboxane A2 and prostacyclin in rabbits in a dose-dependent manner. At comparatively low doses, thromboxane A2 synthesis was more effectively inhibited than prostacyclin formation. Due to pharmacokinetic interactions NSA enhanced the anticoagulant effect of indirect anticoagulants and accelerated their distribution and elimination.


[Significance of the corneal thickness in non-contact tonometry].
In this study the Reichert non-contact tonometer (NCT II) was compared with the Goldmann applanation tonometer (GAT) in 25 subjects (50 eyes; pressure range 9-17 mmHg). The relationship NCT/GAT fulfilled the conditions required for legal verification. Marked differences between the readings of both instruments can be caused by anomalous central corneal thickness, because non-contact tonometry is influenced more than conventional applanation tonometry by the corneal thickness. Starting from a central thickness of 0.51 mm, the NCT is assumed to underestimate the actual intraocular pressure in eyes with thinner and to overestimate it in eyes with thicker cornea by 1 mmHg per 0.01 mm difference of corneal thickness. This value changes with individual corneal tissue qualities and is not valid especially in presence of corneal edema.


Efficacy of a topical formulation containing esafoxolaner, eprinomectin and praziquantel (NexGard Combo®) against natural infestations with the cat louse, Felicola subrostratus under field conditions.
Felicola subrostratus is the only species of louse affecting domestic cats. Although it is considered a rare ectoparasite of pet cats, it occurs mainly in stray or shelter animals and is sometimes associated with intense pruritus and secondary bacterial infections. The aim of the present study was to evaluate the efficacy of a single dose of the topical formulation of esafoxolaner, eprinomectin and praziquantel (NexGard Combo®, Boehringer Ingelheim) in cats for the treatment of naturally acquired chewing lice infestation in a multi-site, positive-control, blinded clinical field study. Thirty-one domestic cats presenting natural F. subrostratus infestation were included in the study. The animals had not been treated with any ectoparasiticide within the previous 60 days. After inclusion, each cat was randomly assigned to one of the two groups: group 1, 14 cats treated with NexGard Combo® or group 2, 17 cats treated with Frontline Combo®. A clinical evaluation was performed at days 0 (inclusion), 14 and 30 and consisted in scoring the skin lesions and symptoms and scoring the presence of lice. On day 30, all cats from both groups scored 0 for the presence of live lice and no dead lice were found, demonstrating 100% efficacy. The clinical scores significantly improved from day 0 to day 30 in both groups. During the 30 days of surveillance, no reinfestations due to the hatching of eggs were observed and none of the cats had any adverse reactions. Esafoxolaner demonstrated high efficacy for the treatment of F. subrostratus infestation.


Physeal-sparing reconstruction of anterior cruciate ligament tears in children: results of 57 cases using patellar tendon.
This study evaluated the results of a physeal-sparing technique of intra-articular anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, with particular reference to growth disturbance. Between 1992 and 2007, 57 children with a mean age of 12.2 years (6.8 to 14.5) underwent ACL reconstruction using the same technique. At a mean of 5.5 years (2 to 14) after surgery, 56 patients underwent clinical and radiological evaluation. At that time, 49 patients (87.5%) had reached bony maturity and 53 (95%) achieved A or B according to the IKDC 2000 classification. Four patients had stopped participation in sports because of knee symptoms, and three patients (5.4%) had a subsequent recurrent ACL injury. There was no clinical or radiological evidence of growth disturbance after a mean growth in stature of 20.0 cm (3 to 38). This study demonstrates that ACL reconstruction sparing the physes in children is a safe technique protecting against meniscal tears and giving better results than reconstruction in adults, without causing significant growth disturbance.


Multi-omics analysis profile oral tumor module clusters to reveal the potential pathogenic mechanism.
Oral tumors are malignant cancers caused by abnormal proliferation or pathological changes of soft or hard tissues in the oral cavity. Serious cases may pose a threat to life. However, its precancerous lesions remain unclear. This study is based on a comprehensive strategy to explore a multi-factor-driven oral cancer barrier module, which is an attempt to describe the pathogenesis of the disease and potential regulatory drugs from a global perspective. Functional disease modules were identified by constructing a protein-specific interaction network in patients' oral tissues. Then, comprehensive pathogenesis was explored through combination with analysis of functional and signaling pathway enrichment, prediction of key regulatory factors. It was found that these specifically expressed proteins and their interactions often play a pivotal part in oral tumors. This is reflected in the results of functional and pathway enrichment of modulating genes, which show that they are mainly involved in various immune responses, inflammatory reactions, oral plaque, and oral ulcer-related regulatory processes. This may represent the potential pathogenesis of oral tumors. On the predictive analysis of regulators, a series of ncRNAs (including miR-590, CRNDE and miR-340) and transcription factors (including E2F1, MYC and TP53) were identified that have potential important regulatory effects on oral tumors. These key regulators may manipulate a crucial part of the module sub-network and then work together to mediate the occurrence of oral tumors. On the comprehensive Multi-omics module analysis, the specific proteins and their interactions in patients' oral tissues were identified, while the prominent pivotal regulators were involved in the different pathogenic functions of oral tumors.


Patient-specific commissural alignment for ACURATE neo2 implantation in degenerated surgical bioprostheses.
Valve-in-valve TAVI to treat failing surgical aortic valves (SAVs) is increasingly performed, and commissural alignment is a key technical aspect in such procedures. Surgeons optimize valve alignment, accounting for potential coronary eccentricity and achieving a patient-specific optimized commissural orientation, representing the ideal target for TAVI alignment. Therefore, here we present a dedicated stepwise valve-in-valve implantation technique using the ACURATE neo2. In a specific SAV postoverlap view, isolating one surgical post to the right of the screen representing the target for alignment, rotational orientation of the TAVI commissures, matching the SAV orientation, is achieved and verified before implantation. This technique has been tested in a patient-specific three-dimensionally-printed aortic root anatomy, attached to a pulsatile flow simulator, allowing for native-like simulation of coronary cannulations under fluoroscopy, and enabling detailed assessment with fluoroscopic as well as direct videographic visualization. Furthermore, the technique is exemplified by providing an educational clinical case example.


Grief, Mindfulness and Neural Predictors of Improvement in Family Dementia Caregivers.
Background: Family dementia caregivers often suffer from an immense toll of grief while caring for their loved ones. We sought to identify the clinical relationship between grief, depression and mindfulness and identify neural predictors of symptomatology and improvement. Methods: Twenty three family dementia caregivers were assessed at baseline for grief, mindfulness and depression, of which 17 underwent functional magnetic resonance imaging (fMRI). During fMRI, caregivers were shown faces of either their dementia-stricken relative or that of a stranger, paired with grief-related or neutral words. In nine subjects, post fMRI scans were also obtained after 4 weeks of either guided imagery or relaxation. Robust regression was used to predict changes in symptoms with longitudinal brain activation (BA) changes as the dependent variable. Results: Grief and depression symptoms were correlated (r = 0.50, p = 0.01), and both were negatively correlated with mindfulness (r = -0.70, p = 0.0002; r = -0.52, p = 0.01). Relative to viewing strangers, caregivers showed pictures of their loved ones (picture factor) exhibited increased activation in the dorsal anterior cingulate gyrus and precuneus. Improvement in grief but not mindfulness or depression was predicted by increased relative BA in the precuneus and anterior cingulate (different subregions from baseline). Viewing grief-related vs. neutral words elicited activity in the medial prefrontal cortex and precuneus. Conclusions: Caregiver grief, depression and mindfulness are interrelated but have at least partially nonoverlapping neural mechanisms. Picture and word stimuli related to caregiver grief evoked brain activity in regions previously identified with bereavement grief. These activation foci might be useful as biomarkers of treatment response.


Depression after minor closed head injury: role of dexamethasone suppression test and antidepressants.
The results of dexamethasone suppression test (DST) and the effectiveness of amitriptyline and phenelzine in treating depression with melancholia after minor closed head injury in 10 patients were compared to those in 12 control patients with primary depression and melancholia. Prevalence of abnormal DST results was higher in the control group (91%) than in the closed head injury group (10%). Results of the DST corresponded with clinical improvement. Amitriptyline produced significant and consistent improvement in all control patients at the end of 4 weeks of treatment. No patient in the closed head injury group showed significant improvement with amitriptyline. The closed head injury patients were treated with phenelzine after a 3- to 7-day washout period. No statistical improvement after 4 weeks of treatment with phenelzine was seen in any of these patients. The DST may be useful as an adjunct to the diagnostic and monitoring process in primary depression with melancholia. Depression after minor closed head injury did not correlate with the DST. Amitriptyline and phenelzine have limited use (if any) in depression with melancholia after minor closed head injury.


Morphology of the subgenual prefrontal cortex in pediatric bipolar disorder.
The subgenual prefrontal cortex (SGPFC) is an important brain region involved in emotional regulation and reward mechanisms. Volumetric abnormalities in this region have been identified in adults with bipolar disorder but thus far not in pediatric cases. We examined the volume of this brain region in subjects with pediatric bipolar disorder (PBD) and compared them to healthy controls. Fifty one children and adolescents (mean age ± SD; 13.2 ± 2.9 y) with DSM-IV PBD and 41 (mean age ± SD; 13.7 ± 2.7 y) healthy comparison subjects (HC) underwent 1.5 T structural magnetic resonance imaging (MRI) brain scans. We traced the SGPFC manually and compared SGPFC gray matter volumes using analysis of covariance with age, gender, and intracranial volume as covariates. We also examined the relationship of family history of affective disorders and medication status to SGPFC volumes. SGPFC volumes were not significantly different in PBD and HC subjects. However, exploratory analysis showed PBD subjects who had one or more first degree relatives with mood disorders (n = 33) had significantly smaller left hemisphere SGPFC compared to HC (p = 0.03 Sidak corrected). Current usage of a mood stabilizer was significantly associated with larger right SGPFC volume in PBD (F = 4.82, df = 1/41, p = 0.03). Subjects with PBD and a close family history of mood disorders may have smaller left SGPFC volumes than HC. Mood stabilizing medication may also impact SGPFC size and could have masked more subtle abnormalities overall.


Designer steroids - over-the-counter supplements and their androgenic component: review of an increasing problem.
Colloquially referred to by various misleading monikers ('pro-hormones', 'natural steroids', 'testosterone boosters', etc.) designer anabolic steroids have been popular now for over a decade as a way to achieve classic anabolic steroid-like results from products sold in the legal marketplace. Recent evidence suggests that anabolic steroid use may be the most common cause of hypogonadism in men of reproductive age. Despite recent regulatory efforts that have banned specific compounds, many anabolic-androgenic steroids (AAS) remain available in over-the-counter dietary supplements that are legally sold in the United States. Severe side effects including hepatotoxicity, cholestasis, renal failure, hypogonadism, gynecomastia, and infertility have been reported secondary to the use of these products. While some of these side effects may be reversible, more aggressive use may result in more permanent end-organ damage as has been previously described for the case of aggressive AAS users (Rahnema et al., Fertil Steril, 2014). Designer AAS remain easily available for purchase in over-the-counter bodybuilding supplements and these products appear to be increasingly popular, despite the known health risks associated with their use. We conducted a systematic search to identify the designer steroids that are most commonly sold in dietary supplements as of April 2014 and review what is known regarding their potency and toxicity. We propose that the impact of AAS use on the reproductive and hormonal health of men is underestimated in the literature owing to previous studies' failure to account for designer steroid use. Lastly, we make clinical recommendations to help physicians steer patients away from potentially harmful supplements, and summarize key regulatory obstacles that have allowed potent androgens to remain unregulated in the legal marketplace.


Auditory and visual hallucination prevalence in Parkinson's disease and dementia with Lewy bodies: a systematic review and meta-analysis.
Non-motor features of Parkinson's disease (PD) and dementia with Lewy bodies (DLB), such as auditory hallucinations (AH), contribute to disease burden but are not well understood. Systematic review and random-effects meta-analyses of studies reporting AH associated with PD or DLB. Prevalence of visual hallucinations (VH) in identified studies meeting eligibility criteria were included in meta-analyses, facilitating comparison with AH. Synthesis of qualitative descriptions of AH was performed. PubMed, Web of Science and Scopus databases were searched for primary journal articles, written in English, published from 1970 to 2017. Studies reporting AH prevalence in PD or DLB were screened using PRISMA methods. Searches identified 4542 unique studies for consideration, of which, 26 met inclusion criteria. AH pooled prevalence in PD was estimated to be 8.9% [95% confidence interval (CI) 5.3-14.5], while in DLB was estimated to be 30.8% (±23.4 to 39.3). Verbal hallucinations, perceived as originating outside the head, were the most common form of AH. Non-verbal AH were also common while musical AH were rare. VH were more prevalent, with an estimated pooled prevalence in PD of 28.2% (±19.1 to 39.5), while in DLB they were estimated to be 61.8% (±49.1 to 73.0). Meta-regression determined that the use of validated methodologies to identify hallucinations produced higher prevalence estimates. AH and VH present in a substantial proportion of PD and DLB cases, with VH reported more frequently in both conditions. Both AH and VH are more prevalent in DLB than PD. There is a need for standardised use of validated methods to detect and monitor hallucinations.


Pyogenic liver abscess -- 20 years' experience. Comparison of results of treatment in two periods.
Our aim is to give an audit of our experience over the past two decades in the form of a retrospective study. In two equal periods between 01.01.1982 and 31.03.2001, 56 patients (37 males and 19 females) with pyogenic liver abscess were treated. Image-guided percutaneous drainage was performed in 22.2%/20.6% of the patients; the remainder were treated with open drainage with or without biliary tract reconstruction and liver resection. For antibiotic perfusion of the liver an umbilical vein cannula was inserted in 40.7%/24.1%. Microbiological findings, types of therapy, complications and mortality, etiology, patient characteristics, symptoms, and laboratory data were investigated. The results in the two groups were compared and analyzed statistically. The most common cause of abscess, biliary disease, was seen more often in the second period. Solitary liver abscesses were more frequent. The only characteristic biochemical finding was an elevated alkaline phosphatase level. There were more positive cultures in the second period (70.4%/79.3%), and the number of Escherichia coli or Enterobacter aerogenes infections also increased. In the first period the mortality was 18.5%, whereas in the second no patients were lost. We suggest the importance of individualized therapy based on an early and exact diagnosis. The first treatment step should be image-guided drainage, but under well-defined circumstances open drainage can also be performed with good results.


An audit of baseline HIV-1 genotypic resistance testing in a UK provincial city.
Baseline HIV-1 resistance testing is recommended in the 2005 BHIVA treatment guidelines. We compared the practice in our clinic with these guidelines. The aim of this study was to assess the prevalence of transmitted resistance in all antiretroviral therapy-naïve patients identified from our virology resistance test database. In 2006, 93% of all newly diagnosed patients had a baseline HIV-1 genotypic resistance test performed. The estimated prevalence of transmitted resistance was 8% in newly diagnosed patients and 7% overall with the majority in subtype B. These findings are in keeping with nationally reported data. It was of concern that we also identified a number of patients who had tested negative in the previous year.


Meta-analysis of the central line bundle for preventing catheter-related infections: a case study in appraising the evidence in quality improvement.
The central line bundle to reduce central line-associated bloodstream infections (CLABSI) is widely regarded as one of the most evidence-based quality improvement (QI) interventions. Yet, two high-quality trials reached different conclusions about its effectiveness. To assess the overall evidence on the effectiveness of the central line bundle and also to illustrate issues related to appraising the effectiveness of QI interventions. We searched the English-language literature (MEDLINE to Sept 2014) for prospective evaluations of the central line bundle (hand hygiene, chlorhexidine skin antisepsis, maximum sterile barrier precautions, optimal catheter site selection, daily review of line necessity) on CLABSI. Mantel-Haenszel risk ratios were calculated using a random effects model. Risk of bias was assessed on five domains: comparability of subjects, definition of intervention, assessment of outcome, statistical analysis and co-interventions/heterogeneity. Strength of the evidence was assessed following the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach, a widely recommended framework for assessing the robustness of treatment effect and the likelihood of change as a result of future studies. Across 59 studies, the central line bundle effectively reduced CLABSI by 56% (relative risk 0.44 (95% CI 0.39 to 0.50)). Studies that assessed bundle compliance at the individual patient level reported slightly higher reductions than other studies. Considerable heterogeneity was present in most subgroups. Most studies had unclear or high risk of bias, with only six (10%) studies exhibiting low risk of bias on at least four domains without any high risk. In this subset of higher-quality studies, the reduction was 52% (95% CI 32% to 66%) without heterogeneity. Applying the GRADE framework, the overall strength of the evidence was low, but moderate in quality for the six high-quality studies. This rating is typically interpreted as meaning that further research is likely to have an important impact on our confidence in the effect estimate and may change the estimate. That the central line bundle could receive only a moderate evidence rating may suggest that the GRADE framework, developed mostly for traditional clinical therapies, requires modification for QI interventions. GRADE does not distinguish prospective trials (eg, controlled before-after studies and interrupted time series) from lower-level observational studies. On the other hand, that the two highest quality studies reached different conclusions makes it difficult to conclude that future research would not change the effect estimate, especially given evidence of secular trends and the variability of co-interventions to ensure bundle compliance, which created heterogeneity across studies.


[Uterine sarcoma. Analytic study of 37 cases].
The lack of uniformity in the nomenclature of the uterine sarcomas, it have contributed to a variety and variability of classifications. Fortunately the sarcomas of uterus are rare. The incidence of this tumor is of 3-5% of all the uterine cancers or of 1.7/100,000 women of 20 years or more. The clinical presentation of these tumors is diverse could come bleed uterine abnormal, abdominal pain, pelvic mass, discharge or cervix prominent mass. Clinical discoveries associated with exist the sarcomas how they are the obesity and high blood pressure in a 30% of the patients it are also observed antecedents of pelvic radiation in a 5-10% of the cases. The genomic alterations that is reported the chromosomes in the literature is associated with 1, 7 11 playing an important paper in the initiation or progression of the sarcomas. We was carried out a retrospective analysis of 37 cases of uterine sarcoma managed in the National Institute of Cancerology at one time of 5 years. Being that the leiomiosarcomas comes in the 51.3% of the cases, followed by the stromal sarcoma, bleed uterine abnormal it was the clinical fact of high importance, detecting these patients in Ia and IIa stadiums predominantly. We observed an increment in the incidence of the uterine sarcoma in patients of 40 years or more. 17 patients were managed exclusively with surgery, 17 patients with surgery and radiotherapy and 5 patients with surgery and chemotherapy (2 patients were managed with surgery + radiotherapy + chemotherapy). The index of failure was from the 45.1% to two years in general form, coming metastasic illness in lung, liver and breast mainly. In conclusion, the adjuvant radiotherapy and chemotherapy to the hysterectomy doesn't increase the index of survivor in the several subtype of uterine sarcomas.


Training Induced Improvement on Human Perception of the Force Feedback Provided by A Soft Robotic Glove.
Creating haptic interface by glove-based wearable robotic system has become an increasingly interested topic in the area of human robotic interaction. Many force feedback gloves are constructed based on soft actuators. However, the recent development of haptic and force feedback technology mainly focused on the advancement of the actuating components and mechanism, and innovation of the force feedback rendering algorithms. It seems that another important part of this human-robot-interaction loop, i.e. the human factors, were understudied. Here, this study focused on the learning effect in haptic perception. We designed a pneumatic muscle-based force feedback robotic glove which can provide customized force feedback to the dorsal surface of each finger. An experiment was carried out with a specifically training procedure and evaluation on the force feedback perceptions. The results show that practice-induced improvement can be achieved by this training, allowing people have a better perception of the force feedback provided by this glove.


Novel Bioactive and Therapeutic Dental Polymeric Materials to Inhibit Periodontal Pathogens and Biofilms.
Periodontitis is a common infectious disease characterized by loss of tooth-supporting structures, which eventually leads to tooth loss. The heavy burden of periodontal disease and its negative consequence on the patient's quality of life indicate a strong need for developing effective therapies. According to the World Health Organization, 10⁻15% of the global population suffers from severe periodontitis. Advances in understanding the etiology, epidemiology and microbiology of periodontal pocket flora have called for antibacterial therapeutic strategies for periodontitis treatment. Currently, antimicrobial strategies combining with polymer science have attracted tremendous interest in the last decade. This review focuses on the state of the art of antibacterial polymer application against periodontal pathogens and biofilms. The first part focuses on the different polymeric materials serving as antibacterial agents, drug carriers and periodontal barrier membranes to inhibit periodontal pathogens. The second part reviews cutting-edge research on the synthesis and evaluation of a new generation of bioactive dental polymers for Class-V restorations with therapeutic effects. They possess antibacterial, acid-reduction, protein-repellent, and remineralization capabilities. In addition, the antibacterial photodynamic therapy with polymeric materials against periodontal pathogens and biofilms is also briefly described in the third part. These novel bioactive and therapeutic polymeric materials and treatment methods have great potential to inhibit periodontitis and protect tooth structures.


Overestimated gains in water-use efficiency by global forests.
Increases in terrestrial water-use efficiency (WUE) have been reported in many studies, pointing to potential changes in physiological forcing of global carbon and hydrological cycles. However, gains in WUE are of uncertain magnitude over longer (i.e. >10 years) periods of time largely owing to difficulties in accounting for structural and physiological acclimation. 13 C signatures (i.e. δ13 C) of plant organic matter have long been used to estimate WUE at temporal scales ranging from days to centuries. Mesophyll conductance is a key uncertainty in estimated WUE owing to its influence on diffusion of CO2 to sites of carboxylation. Here we apply new knowledge of mesophyll conductance to 464 δ13 C chronologies in tree-rings of 143 species spanning global biomes. Adjusted for mesophyll conductance, gains in WUE during the 20th century (0.15 ppm year-1 ) were considerably smaller than those estimated from conventional modelling (0.26 ppm year-1 ). Across the globe, mean sensitivity of WUE to atmospheric CO2 was 0.15 ppm ppm-1 . Ratios of internal-to-atmospheric CO2 (on a mole fraction basis; ci /ca ) in leaves were mostly constant over time but differed among biomes and plant taxa-highlighting the significance of both plant structure and physiology. Together with synchronized responses in stomatal and mesophyll conductance, our results suggest that ratios of chloroplastic-to-atmospheric CO2 (cc /ca ) are constrained over time. We conclude that forest WUE may have not increased as much as previously suggested and that projections of future climate forcing via CO2 fertilization may need to be adjusted accordingly.


[Diminution of myopia following operation of macular hole-induced retinal detachment].
This paper presents an assessment of the diminution of myopia in 25 eyes after surgery according to the technique of G. P. Theodossiadis for retinal detachment due to a macular hole. The procedure consists in the stretching and fixation of a silicone sponge at the posterior pole and dispenses entirely with either cryocoagulation or light coagulation. The sponge is stretched and fixed to the sclera at both ends (12 and 6 o'clock), far from the posterior pole. The scleral protrusion thus obtained in the macular area leads to a considerable diminution of the high myopia usually present in such cases. The reduction of myopia is proportionate to the degree of protrusion of the scleral buckle, which in turn depends on the stretching of the sponge and on the amount of subretinal fluid released.


Interneurons of the cat sensorimotor cortex.
In this paper a review is given on the interneurons of the cerebral cortex, their subdivisions and neurophysiology. Special concern is given to short axon (local) interneurons and long-axon (association and callosal) stellate cells. Data obtained from simultaneous recordings of more than one neuron are also presented. However, further research is needed to demonstrate the essential role of the interneurons in information processing.


Temperature-Dependent Superplasticity and Strengthening in CoNiCrFeMn High Entropy Alloy Nanowires Using Atomistic Simulations.
High strength and ductility, often mutually exclusive properties of a structural material, are also responsible for damage tolerance. At low temperatures, due to high surface energy, single element metallic nanowires such as Ag usually transform into a more preferred phase via nucleation and propagation of partial dislocation through the nanowire, enabling superplasticity. In high entropy alloy (HEA) CoNiCrFeMn nanowires, the motion of the partial dislocation is hindered by the friction due to difference in the lattice parameter of the constituent atoms which is responsible for the hardening and lowering the ductility. In this study, we have examined the temperature-dependent superplasticity of single component Ag and multicomponent CoNiCrFeMn HEA nanowires using molecular dynamics simulations. The results demonstrate that Ag nanowires exhibit apparent temperature-dependent superplasticity at cryogenic temperature due to (110) to (100) cross-section reorientation behavior. Interestingly, HEA nanowires can perform exceptional strength-ductility trade-offs at cryogenic temperatures. Even at high temperatures, HEA nanowires can still maintain good flow stress and ductility prior to failure. Mechanical properties of HEA nanowires are better than Ag nanowires due to synergistic interactions of deformation twinning, FCC-HCP phase transformation, and the special reorientation of the cross-section. Further examination reveals that simultaneous activation of twining induced plasticity and transformation induced plasticity are responsible for the plasticity at different stages and temperatures. These findings could be very useful for designing nanowires at different temperatures with high stability and superior mechanical properties in the semiconductor industry.


Characterizing Online Narratives About Colonoscopy Experiences: Comparing Colon Cancer "Screeners" Versus "Survivors".
Effective screening can reduce colorectal cancer mortality; however, screening uptake is suboptimal. Patients' stories about various health topics are widely available online and in behavioral interventions and are valued by patients. Although these narratives may be promising strategies for promoting cancer screening behavior, scant research has compared the influence of different role models. This study involving content analysis of online stories aimed to (a) describe the content of online experiential narratives about colonoscopy; (b) compare narratives from individuals who had a colonoscopy and either had colon cancer (survivors) or did not have colon cancer (screeners); and (c) generate hypotheses for future studies. The authors identified 90 narratives eligible for analysis from 15 websites. More stories were about White patients, men, and routine (vs. diagnostic) colonoscopy. A higher-than-expected number of narratives reported a family history of colorectal cancer or polyps (20%) and a colorectal cancer diagnosis (47%). Colorectal cancer survivor (vs. screener) stories were longer, mentioned symptoms and diagnostic reasons for getting a colonoscopy more often, and described the colonoscopy procedure or referred to it as easy or painless less often. Future studies should examine the effects of the role model's personal characteristics and the colonoscopy test result on reader's perceptions and intentions to have a colorectal cancer screening.


Hernia Size and Mesh Placement in Primary Umbilical Hernia Repair.
Umbilical hernia repair (UHR) using mesh has been demonstrated to significantly reduce recurrence. However, many surgical centers still perform tissue repair for UH. In the present study, we assessed a cohort of veteran patients undergoing a standard open tissue repair for primary UH to determine at which size recurrence may preclude tissue repair. A systematic review of the literature on hernia size recommendations to guide mesh placement was performed. A single-institution single-surgeon retrospective review of all patients undergoing open tissue repair of primary UH (n = 344) was undertaken at the VA North Texas Health Care System between 2005 and 2019. Guidelines for the preferred reporting items for systematic reviews and meta-analysis were undertaken for systematic review. A literature review yielded inconsistent guidance for a specific hernia size to proceed with tissue vs. mesh repair. Our institutional review yielded 17 (4.9%) recurrences. Univariable analysis demonstrated recurrence to be associated with hernia size (2.8 vs. 2.3 cm; P = .04). However, on multivariable analysis, hernia size was demonstrated as not an independent predictor of recurrence [OR 1.47 (95% CI; .97-2.21; P = .07)]. A review of the literature suggests mesh placement most commonly when the hernia size is > 2.0 cm; however, sources of evidence are heterogeneous in study design, patient population, and hernia types studied. Our institutional review demonstrated that primary UHs < 2.3 cm can successfully be treated via tissue repair. Larger, recurrent, incisional, and primary epigastric hernias may benefit from mesh placement.


The death of humanitarianism?: an anatomy of the attack.
Over recent years, the humanitarian community has been under increasing scrutiny and attracted harsh criticism. This mounting critique of humanitarianism has shifted from being concerned primarily with the poor functioning of the humanitarian system to one targeted on basic humanitarian values. This paper is concerned to understand the factors driving the attack on humanitarian values. It identifies four apparently disparate groups who are interested in attacking these values: the anti-imperialists, the realpolitikers, the developmentalists and the neo-peaceniks. It concludes that unless humanitarian actors are aware of these diverse threats to their values and operations, they risk being co-opted or marginalised.