Family members' caregiving situations in palliative home care when sitting service is received: The understanding of multiple realities.
To deepen the understanding of the variation of complexity in family members' caregiving situations, when the private home is the place for care, dying, and sitting service. Seven relatives to a deceased family member from four different families were interviewed twice. Data were analyzed by direct interpretation and categorical aggregation. Various patterns of becoming a caregiver were showed, but family members' willingness to become family caregivers was strongly related to fulfilling the dying persons' wishes to be cared for in their own homes. Important factors for coping with the caregiving situation were their needs of support, the possibility to prepare for death related to a need of communication and planning, the length and predictability of the illness trajectory, and experiences of losses and grief. Sitting service was experienced as supportive for family caregivers when they had possibility to hand over care responsibilities, but as non-supportive when expected help not was received. Family members' experiences of caregiving and their degree of vulnerability must be different, depending on whether it is a self-selected position or an imposed task. In general, family members in this study were willing to participate in caregiving for end-of life care, but subject to their own conditions. One way to decrease vulnerability is to assess the resources and competence in relation to the responsibility the person is expected to assume. The support and other efforts to help family caregivers must be related to their specific needs and reality, not only to what the care organization can offer as a standard solution.


A Chinese Face Dataset with Dynamic Expressions and Diverse Ages Synthesized by Deep Learning.
Facial stimuli have gained increasing popularity in research. However, the existing Chinese facial datasets primarily consist of static facial expressions and lack variations in terms of facial aging. Additionally, these datasets are limited to stimuli from a small number of individuals, in that it is difficult and time-consuming to recruit a diverse range of volunteers across different age groups to capture their facial expressions. In this paper, a deep-learning based face editing approach, StyleGAN, is used to synthesize a Chinese face dataset, namely SZU-EmoDage, where faces with different expressions and ages are synthesized. Leverage on the interpolations of latent vectors, continuously dynamic expressions with different intensities, are also available. Participants assessed emotional categories and dimensions (valence, arousal and dominance) of the synthesized faces. The results show that the face database has good reliability and validity, and can be used in relevant psychological experiments. The availability of SZU-EmoDage opens up avenues for further research in psychology and related fields, allowing for a deeper understanding of facial perception.


New trends in polyoxometalate photoredox chemistry: from photosensitisation to water oxidation catalysis.
Molecular metal oxide clusters, so-called polyoxometalates (POM) have been extensively used as homogeneous photocatalysts in various photoredox reactions such as the oxidation of alkanes, alkenes and alcohols as well as the light-induced mineralisation of various organic and inorganic pollutants. The more general application of POMs as photoactive compounds, in particular in solar energy harnessing, has been hampered as the clusters typically absorb light in the UV-region only. Over the past decade, concepts have been put forward on how the reactivity of this class of compounds can be optimised to improve their overall photoactivity, and a particular focus has been on the design of photocatalytic processes which allow the conversion of solar light into useful chemical reactivity. This perspective gives a brief overview of general aspects of POM photochemistry and critically discusses the advantages and challenges of a range of POM-based systems for photooxidations and photoreductions with a focus on the development of sustainable solar light conversion systems.


As-required versus regular nebulized salbutamol for the treatment of acute severe asthma.
Current British guidelines for the administration of beta2-agonists in acute severe asthma recommend regular nebulized therapy in hospitalized patients, followed by as-required (p.r.n.) use via hand-held devices after discharge. Since beta2-agonists do not possess anti-inflammatory activity in vivo, and are thus unlikely to influence the rate of recovery from an asthma exacerbation, it was hypothesized that patients given the short-acting beta2-agonist salbutamol on an as-required basis after admission to hospital would recover as quickly as those on regular treatment, but with potential reductions in the total dose delivered. Forty-six patients with acute severe asthma were randomly assigned to either regular prescriptions of nebulized salbutamol or to usage on a p.r.n. basis, from 24 h after hospital admission. The primary outcome measures were length of hospital stay, time to recovery, and frequency of salbutamol nebulization from 24 h after admission to discharge. Secondary outcome measures were treatment side-effects (tremor, palpitations), and patient satisfaction. Length of hospital stay was reduced in those patients allocated to p.r.n. salbutamol (geometric mean (GM) 3.7 days) versus regular salbutamol (GM 4.7 days). Time taken for peak expiratory flow to reach 75% of recent best was the same in both groups. There was a highly significant reduction in the number of times nebulized therapy was delivered to the p.r.n. group (GM 7.0, range 1-30) compared with the regular treatment group (GM 14.0, range 4-57; p=0.003; 95% confidence interval for ratio of GMs 1.29-3.09). In addition, patients reported less tremor (p=0.062) and fewer palpitations (p=0.049) in the p.r.n. group. Of the patients in the p.r.n. group who had received regular nebulized therapy on previous admissions (n=12), all preferred the p.r.n. regimen. Prescribing beta2-agonists on a p.r.n. basis from 24 h after hospital admission is associated with reduced amount of drug delivered, incidence of side-effects, and possibly length of hospital stay. This has implications for the efficient use of healthcare resources.


[Intracardiac hemodynamics and myocardial contractile function indices in chronic ischemic heart disease].
Echocardiography was used in the examination of 51 patients with chronic ischemic heart disease (IHD) without accompanying hypertension and congestive circulatory insufficiency. With gradual advancement of the disease, a significant increase in left-ventricular volumes during the systole and diastole was recorded as well as a decrease in the ejection fraction (IF) and velocity of circulatory shortening of the myocardial fibres (Vch) in slight variations of the stroke volume. The IF and Vch were the most characteristic indices for appraising the early manifestations of myocardial contractility disorders. The index of left-ventricular structure functioning intensity (SFI) was used to characterize the functional state of the heart muscle. In patients with a severe course of the disease, SFI was found to be reduced because of an increase in the myocardial mass. The developing damage hypertrophy, however, did not provide for full compensation of left-ventricular function and was attended by a reduction of the indices of contractility and pump function of the heart. This provides the grounds for the assumption that the reduction of SFI in patients with severe IHD is associated with exclusion of part of the myocardium involved in the pathological process from effective functioning.


Kinesin II and regulated intraflagellar transport of Chlamydomonas aurora protein kinase.
The assembly and functioning of cilia and flagella depend on a complex system of traffic between the organelles and the cell body. Two types of transport into these organelles have been identified. The best characterized is constitutive: in a process termed intraflagellar transport (IFT), flagellar structural components are continuously carried into cilia and flagella on transport complexes termed IFT particles via the microtubule motor protein kinesin II. Previous studies have shown that the flagella of the unicellular green alga Chlamydomonas exhibit a second type of protein import that is regulated. During fertilization, the Chlamydomonas aurora protein kinase CALK undergoes regulated translocation from the cell body into the flagella. The motor that powers this second, regulated type of movement is unknown. Here, we have examined the cellular properties of the CALK in Chlamydomonas and used a kinesin II mutant to test the idea that the motor protein is essential for regulated translocation of proteins into flagella. We found that the CALK that is transported into flagella of wild-type gametes becomes part of a membrane-associated complex, that kinesin II is essential for the normal localization of this Chlamydomonas aurora protein kinase in unactivated gametes and that the cAMP-induced translocation of the protein kinase into flagella is disrupted in the fla10 mutants. Our results indicate that, in addition to its role in the constitutive transport of IFT particles and their cargo, kinesin II is essential for regulated translocation of proteins into flagella.


[Inadequate dietary micronutrient intake in men and women in southern Brazil: the EpiFloripa Adults Study, 2012].
This study aimed to estimate dietary intake of micronutrients among adults in a city in Southern Brazil according to sex and age, and to measure the prevalence of inadequate dietary micronutrient intake according to sex. This is a cross-sectional, population-based study with 1,222 adults 22 to 63 years of age living in Florianópolis, Santa Catarina State, Brazil. Data on dietary intake were obtained from two 24-hour recalls (one in the total sample and the other in a subsample of 40% of the research subjects). Micronutrient intake and prevalence rates for inadequate intake were estimated according to the guidelines of the National Research Council and Institute of Medicine. High prevalence rates of inadequate intake in the entire sample were seen for vitamins A, C, D, and E (range, 52%-100%). Calcium and iron intake were more inadequate in women (87.3% and 13.7%, respectively), as was zinc in men (25.1%). Adults in Florianópolis, showed high prevalence rates of inadequate intake of essential micronutrients.


Sarcoidosis: a cause for bilateral facial palsy.
The facial nerve is commonly involved in neural sarcoidosis, but there is only one reported case in which bilateral facial paralysis was the sole manifestation of sarcoidosis. We report a case of sarcoidosis presenting with bilateral facial paralysis as the only sign. The pathology, clinical presentation, pathophysiology and diagnosis of sarcoidosis has been discussed.


Role of laminin-1 and TGF-beta 3 in acinar differentiation of a human submandibular gland cell line (HSG).
Previous studies show that culturing an immortalized human submandibular gland cell line (HSG) on Matrigel, a basement membrane extract, induces cytodifferentiation. We have further defined this model system and identified factors involved in HSG cell acinar development and cyto-differentiation. Acinar development is marked by cell migration into multi-cellular spherical structures, cell proliferation and apoptosis of the centrally localized cells. In addition, functional differentiation was determined by indirect immunofluorescence and immunoblot analysis for cystatin, a salivary gland acinar cell-specific protein found to be produced by differentiated HSG cells. Matrigel contains multiple extracellular matrix proteins, however, laminin-1 was identified as the major matrix component that induced HSG cell acinar development and cytodifferentiation. Antibodies against specific components of Matrigel and against cell surface adhesion molecules were added to cells in culture to identify components important for HSG cell acinar differentiation. Immunostaining of HSG cell acini identified TGF-beta 2 and beta 3 as the predominant isoforms within the cells. Neutralizing antibodies directed against TGF-beta 3 significantly decreased (P < or = 0.0002) the size of acini formed. These results indicate that multiple components, including laminin-1 and TGF-beta 3, contribute to HSG cell acinar development. This model system will be useful to study acinar differentiation and salivary gland-specific protein expression in vitro.


Transtibial ACL femoral tunnel preparation increases odds of repeat ipsilateral knee surgery.
Recent efforts to improve the results of anterior cruciate ligament (ACL) reconstruction have focused on placing the femoral tunnel anatomically. Medial portal femoral tunnel techniques facilitate drilling of femoral tunnels that are more anatomic than those made with transtibial techniques. Few studies have compared the clinical outcomes of these two femoral tunnel techniques. We hypothesized that the transtibial technique is associated with decreased Knee injury and Osteoarthritis Outcome Scores (KOOS) and an increased risk of repeat surgery in the ipsilateral knee when compared with the anteromedial portal technique. Four hundred and thirty-six patients who had undergone primary isolated autograft ACL reconstruction with a transtibial (229 patients) or anteromedial portal (207 patients) technique in 2002 or 2003 were identified in a prospective multicenter cohort. A multiple linear regression model was used to determine whether surgical technique (transtibial or anteromedial portal) was a significant predictor of KOOS at six years postoperatively, after controlling for preoperative KOOS, patient age, sex, activity level, body mass index (BMI), smoking status, graft type, and the presence of meniscal and chondral pathology at the time of reconstruction. A multiple logistic regression model was used to determine whether surgical technique was a significant predictor of repeat ipsilateral knee surgery, after controlling for patient age and activity level, graft type, and meniscal pathology at the time of reconstruction. Postoperative KOOS were available for 387 patients (88.8%). Femoral tunnel drilling technique was not a predictor of the KOOS Quality of Life subscore (p = 0.72) or KOOS Function, Sports and Recreational Activities subscore (p = 0.36) at the six-year follow-up evaluation. Data regarding the prevalence of repeat surgery were available for 380 patients. Femoral tunnel technique was a significant predictor of subsequent ipsilateral knee surgery (odds ratio [OR] = 2.49, 95% confidence interval [CI] = 1.30 to 4.78, p = 0.006). Patients who underwent ACL reconstruction with a transtibial technique had significantly higher odds of undergoing repeat ipsilateral knee surgery relative to those who underwent reconstruction with an anteromedial portal technique.


Observational pain assessment versus self-report in paediatric triage.
To examine if observational pain assessment can be used for purposes of triage in children aged >3 years. A prospective, single blind, controlled trial was undertaken in children who presented to the emergency department (ED) with pain. Pain was assessed in the waiting room and again at triage before any treatment was administered using the Alder Hey Triage Pain Score (AHTPS), an observational tool designed for triage, and a self-report tool, either the Wong-Baker Faces Pain Rating Scale (WBS) for 3-7-year-old children or a visual analogue scale (VAS) for 8-15-year-old children. Scores were compared by instrument (observational and self-report) and ED location (waiting room and triage room). 75 children (29 aged 3-7 years and 46 aged 8-15 years) were enrolled in the study. The AHTPS scores were significantly lower than the scores measured by the WBS/VAS (p<0.001). The level of pain measured by both methods (self-report, observational) was lower in the triage room. Compared with the AHTPS, the WBS and VAS scored significantly lower in the triage room than in the waiting room (p<0.042 and p<0.006, respectively). Observational pain assessment underestimates children's perception of pain and should not be recommended in children aged >3 years. Triage has a calming effect on children.


Uncomplicated midvaginal vesico-vaginal fistula repair in ibadan: a comparison of the abdominal and vaginal routes.
Obstetric fistula is a resultant effect of prolonged obstructed labour. The best surgical management of simple uncomplicated fistula determines the outcome of care. To compare outcome of uncomplicated mid-vaginal fistula between vaginal and abdominal route of repair. This was a hospital based retrospective study conducted at the University College Hospital, Ibadan from January, 2000 till December, 2006. Of the 71 midvaginal fistulae managed, 40.8% had abdominal repair while the remainder were through vaginal approach. The overall repair success rate was 79.2% with comparable outcome in both groups-78.3% for the abdominal and 80% for the vaginal group (p=0.999). The duration of hospital stay did not differ significantly between the groups (p=0.972). Post operative complications were found in 41.4% of the abdominal group compared to none in the vaginal group (p<0.001). The complications were failed repair (20.7%) and urinary tract infection (20.7%). The mean estimated blood loss was 465.5ml in the abdominal group compared to 332.9ml for the vaginal group (p=0.303). Despite the comparable surgical repair outcome of the two methods, the vaginal approach is associated with lesser blood loss and lower risk of post-operative complications. It is recommended that the vaginal route should be employed in the repair of uncomplicated midvaginal fistula unless there are other compelling reasons to the contrary.


A modelized distribution of actomyosin interactions in the vertebrate cardiac muscle.
Preliminary assumption of this model is that interactions between actin and myosin presupposes an exact three-dimensional geometrical correspondence between sites, due to the very short time constants present under physiological conditions. Only small and controlled torsions of the actin filaments are accepted. The model uses geometrical information concerning orientations and dimensions of myosin crossbridges and actin monomeres to modelize the distribution of their inter-actions. An orientation map of actin sites in the cross-section perpendicular to the filament axis is proposed, adapted to the specific filament array of vertebrate muscle. Orientation of myosin crossbridges follows Luther's rules. According to the model, any interaction between actin and myosin implies the superimposition of their respective cross-sectional planes. The axial length of actin monomere is 55 A; the distance between two crossbridges along the myosin filament axis is 143 A. The following properties are derived: 1) The shortening step of the sliding actin filament must be a multiple of 11 A (highest common factor). Taking into account the staggered disposition of the two actin strands and the presence of two heads for each cross-bridge, the most probable value for this shortening step is equal to 99 A. A specific scheme is proposed to describe the shortening process. The behavior of the modelized crossbridge does not need any elastic structure--2) Planes situated at 715 A (lowest common multiple) of actin and myosin coinciding planes are also in coincidence. In a hemi-sarcomere the maximal number of these planes, referred to as simultaneously activable planes, is 10 (20 if both myosin heads are considered). The proportion of interactions authorized by the site orientations is 1/12. In the model, the concept of randomly recruited crossbridges is replaced by a discretized recruitment, based on geometrical properties at an ultrastructural level. The proposed distribution is homogeneous: it can be extended radially in the sarcomere and authorizes the actin filament sliding in the whole physiological range under the control of a dual activation function, reproducing Ca++ temporal and spatial distribution.


[The Problem of Beginning of the Personal Being In the Anthropology of V. E. Frankl].
In this paper we review the V. E. Frankl' conception of the 'person', which he understands as the superior part in man. This study consists of three parts: a) In the first we study 10 thesis that the father of logotherapy offers on the person, namely: 1st) the person is an individual; 2nd) whitaut possibility of sum; 3rd) is a new being; 4th) is spiritual; 5th) is existential; 6th) is the 'I' or the 'ego'; 7th) provides unity and wholeness; 8th) is dynamic; 9th) is able to transcend and to face herself; 10th) He is not understood by itself but from the point of view of transcendence. b) In the second part are studied 7 synonyms that the founder of the third Viennese school of psychology offers on the person: 1st) individual; 2nd) I; 3rd) personality; 4th) existence; 5th) spirit; 6th) heart; 7th) becoming. c) The third part we review the franklian hypothesis defending that the human person appears after the birth of human biological life. Although it is the third part that gives the the title of this work, it can only be understood, and also reviewed, after having founded in the preceding two parties what specifically understand V.E. Frankl for person.


Cortical motor output decreases after neuromuscular fatigue induced by electrical stimulation of the plantar flexor muscles.
Neuromuscular electrical stimulation (NMES) causes early onset of neuromuscular fatigue. Peripheral electrophysiological explorations suggest that supra-spinal alterations are involved through sensitive afferent pathways. As sensory input is projected over the primary somatosensory cortex (S1), S1 area involvement in inhibiting the central motor drive can be hypothesized. This study assessed cortical activity under a fatiguing NMES protocol at low frequency. Twenty healthy males performed five NMES sequences of 17 trains over the plantar flexors (30 Hz, 4 s on/6 s off). Before and after each sequence, neuromuscular tests composed of maximal voluntary contractions (MVCs) were carried out. Cortical activity was assessed during MVCs with functional near-infrared spectroscopy over S1 and primary motor (M1) areas, through oxy- [HbO] and deoxy-haemoglobin [HbR] variation. Electrophysiological data (H-reflex during MVC, EMG activity and level of voluntary activation) were also recorded. MVC torque significantly decreased after the first 17 NMES trains (P < 0.001). The electrophysiological data were consistent with supra-spinal alterations. In addition, [HbO] declined significantly during the protocol over the S1 and M1 areas from the first 17 NMES trains (P < 0.01 and P < 0.001 respectively), while [HbR] increased (P < 0.05 and P < 0.01 respectively), indicating early decline in cortical activity over both primary cortical areas. The declining cortical activity over the M1 area is highly consistent with the electrophysiological findings and supports motor cortex involvement in the loss of force after a fatiguing NMES protocol. In addition, the declining cortical activity over the S1 area indicates that the decreased motor output from M1 is not due to increased S1 inhibitory activity.


[Children and adolescents in street situation: contributions to an understanding of vulnerability and disaffiliation].
The concept of vulnerability is being discussed in the public health area as a potential tool toward the transformation of the health practices for allowing an articulation individual-community. Understanding health as a process of subjectivation determined by social, cultural and historical contexts, this article aims to approach the question children and adolescents in street situation on the basis of the concept of civil vulnerability, using the theoretical background presented by Robert Castel. This author understands the social marginalization lived by different individuals and social groups in a dynamic form, determined by the association of work and social insertion. As refers to children and adolescents in street situation, we believe that they are reflecting a process of intensified vulnerability (culminating in disaffiliation) to which thousands of Brazilian families are subject due to the extreme social inequalities in our country. We hope that our theoretical discussion will be able to contribute to the development of a theoretical reference in public health and to the planning and implementation of health actions directed to this population.


Pertussis toxin substrate is a guanosine 5'-[beta-thio]diphosphate-, N-ethylmaleimide-, Mg2+- and temperature-sensitive GTP-binding protein.
We compared the effects of guanine nucleotides and Mg2+ on ADP-ribosylation of rat brain and liver membrane proteins catalysed by Bordetella pertussis toxin (IAP) and cholera toxin (CT). Labelling of proteins in the presence of [alpha-32P]NAD+, ATP and CT required GTP or guanosine 5'-[gamma-thio]triphosphate (GTP [S]). In contrast, labelling of one (liver) or two (brain) polypeptides by IAP was enhanced by guanosine 5'-[beta-thio]diphosphate (GDP[S]) or GTP, but was blocked by GTP[S] or guanosine 5'-[beta, gamma-imido]triphosphate (p[NH]ppG). The order of labelling intensity was GDP[S] greater than GTP greater than no addition greater than GTP[S] = p [NH]ppG. Mg2+ increased labelling by CT, but decreased labelling by IAP. In addition, Mg2+ potentiated the effects of the guanine nucleotides, increasing the inhibitory effects of GTP[S] and the activatory effects of GDP[S] or GTP. Preincubating liver membranes at 30 degrees C in the presence of 10 mm-MgCl2 inhibited labelling by IAP irreversibly. Pretreatment of liver membranes with 4.95 mM-N-ethylmaleimide decreased labelling by CT by approximately 15%, but almost completely blocked labelling by IAP. These results suggest that the undissociated, GDP-bound, conformation of Ni, the inhibitory GTP-binding protein of adenylate cyclase, is the preferred substrate for ADP-ribosylation by IAP. This conformation, which is prevalent in native membranes, is sensitive to temperature, Mg2+ ions and alkylating agents such as N-ethylmaleimide. At 30 degrees C, Mg2+ may cause dissociation and denaturation of Ni in native membranes.


Measurement of gliding resistance of the extensor pollicis longus and extensor digitorum communis II tendons within the extensor retinaculum.
The etiology of spontaneous extensor pollicis longus (EPL) tendon rupture is still largely unknown. It is possible that friction within the sheath may play a role. The purposes of this study were to compare gliding resistance of the EPL tendon with that of the extensor digitorum communis tendon of the index finger (EDC II) and to find the wrist position that gives the EPL tendon the lowest gliding resistance. Fifteen fresh-frozen cadavers were used. Gliding resistance was measured directly in 7 different wrist positions. The mean gliding resistance of the EPL tendon was 0.16 +/- 0.08 N and that of the EDC II tendon was 0.11 +/- 0.06 N. This difference was significant. There was also a significant effect on gliding resistance due to wrist position. For the EPL tendon, the gliding resistance was significantly greater in 60 degrees wrist flexion compared with all other wrist positions tested. Additionally the gliding resistance of the EPL in 30 degrees flexion, 60 degrees extension, and 15 degrees radial deviation was significantly higher than wrist positions of 30 degrees extension, neutral, and 30 degrees ulnar deviation. Positioning the wrist close to neutral flexion/extension and in some ulnar deviation minimizes the friction within the EPL sheath. Such positions may be advantageous for splinting patients at risk for EPL rupture.


[Effect of organic solvents on catalytic and functional activity of transport Ca2+,Mg2+-ATPase from smooth muscle cell membrane].
It was shown that organic solvents (dioxane, acetone, ethanol, dimethylsulfoxide) at concentrations of < 10% suppress the activity of transport Ca2+, Mg(2+)-ATPase solubilized from plasmatic membranes of smooth muscle cells and Mg(2+)-ATP-dependent accumulation of Ca2+ ions in inverted membrane vesicles. It was found that one of the reasons for the inhibition of enzymatic and transport activity of Ca2+, Mg(2+)-ATPase by the action of these solvents is an increase in the attractive force between oppositely charged active center of the enzyme and the product (products) of the ATP-hydrolase reaction, which is induced by a decrease in the dielectric permeability of incubation medium.


Molecular mechanism of terbinafine resistance in Saccharomyces cerevisiae.
Ten mutants of the yeast Saccharomyces cerevisiae resistant to the antimycotic terbinafine were isolated after chemical or UV mutagenesis. Molecular analysis of these mutants revealed single base pair exchanges in the ERG1 gene coding for squalene epoxidase, the target of terbinafine. The mutants did not show cross-resistance to any of the substrates of various pleiotropic drug resistance efflux pumps tested. The ERG1 mRNA levels in the mutants did not differ from those in the wild-type parent strains. Terbinafine resistance was transmitted with the mutated alleles in gene replacement experiments, proving that single amino acid substitutions in the Erg1 protein were sufficient to confer the resistance phenotype. The amino acid changes caused by the point mutations were clustered in two regions of the Erg1 protein. Seven mutants carried the amino acid substitutions F402L (one mutant), F420L (one mutant), and P430S (five mutants) in the C-terminal part of the protein; and three mutants carried an L251F exchange in the central part of the protein. Interestingly, all exchanges identified involved amino acids which are conserved in the squalene epoxidases of yeasts and mammals. Two mutations that were generated by PCR mutagenesis of the ERG1 gene and that conferred terbinafine resistance mapped in the same regions of the Erg1 protein, with one resulting in an L251F exchange and the other resulting in an F433S exchange. The results strongly indicate that these regions are responsible for the interaction of yeast squalene epoxidase with terbinafine.


Duplication-targeted DNA methylation and mutagenesis in the evolution of eukaryotic chromosomes.
Mammalian genomes are threatened with gene inactivation and chromosomal scrambling by recombination between repeated sequences such as mobile genetic elements and pseudogenes. We present and test a model for a defensive strategy based on the methylation and subsequent mutation of CpG dinucleotides in those DNA duplications that create uninterrupted homologous sequences longer than about 0.3 kilobases. The model helps to explain both the diversity of CpG frequencies in different genes and the persistence of gene fragmentation into exons and introns.


Duodenum as a immediate brake to gastric outflow: a videofluoroscopic and manometric assessment.
Duodenal infusion of HCl or lipid delays gastric emptying. The aim of this study was to assess whether this delay was in part caused by mechanical activity of the duodenum. Synchronized videofluoroscopy and manometry was used in 8 volunteers (5 men and 3 women) to examine contractile and flow patterns during duodenal infusion of 0.9% NaCl, HCl, 5% NaCl, bile, and sodium oleate, each mixed with 20% (wt/vol) barium sulfate. Within 15-30 seconds of infusion, HCl and 5% NaCl induced frequent large-amplitude contractions greater tha those induced by 0.9% NaCl. Initially, there was rapid dispersion of HCl followed by prolonged, tonic occlusion of the duodenum. The duodenal diameter decreased compared with that observed during 0.9% NaCl or oleate infusion. In contrast, after infusion of oleate or bile, duodenal diameter increased and there were fewer, smaller-amplitude, nonpropagating contractions with prolonged retention of solutions. Barium (20%; wt/vol) did not influence the motility index of any solution. HCl and 5% NaCl may restrict gastric outflow by inducing tonic occlusion of the duodenum, whereas bile and lipid may delay clearance by decreasing duodenal tone and contractility. Thus, the duodenum may serve as an immediate brake to gastric outflow either by delaying clearance or by offering rapid tonic resistance.


Increased Symmetric Dimethylarginine Level Is Associated with Worse Hospital Outcomes through Altered Left Ventricular Ejection Fraction in Patients with Acute Myocardial Infarction.
We aimed to investigate whether SDMA- symmetric dimethylarginine -the symmetrical stereoisomer of ADMA- might be a marker of left ventricular function in AMI. Asymmetric dimethylarginine (ADMA) has been implicated in the prognosis after acute myocardial infarction (AMI) and heart failure (HF). Cross sectional prospective study from 487 consecutive patients hospitalized <24 hours after AMI. Patients with HF on admission were excluded. Serum levels of ADMA, SDMA and L-arginine were determined using HPLC. Glomerular filtration rate (eGFR) was estimated based on creatinine levels. Outcomes were in-hospital severe HF, as defined by Killip class >2, and death. Patients were analysed based on SDMA tertiles. Sex, diabetes, dyslipidemia, and prior MI were similar for all tertiles. In contrast, age and hypertension increased across the tertiles (p<0.001). From the first to the last tertile, GRACE risk score was elevated while LVEF and eGFR was reduced. The rate of severe HF and death were gradually increased across the SDMA tertiles (from 0.6% to 7.4%, p = 0.006 and from 0.6% to 5.0%, p = 0.034, respectively). Backward logistic multivariate analysis showed that SDMA was an independent estimate of developing severe HF, even when adjusted for confounding (OR(95%CI): 8.2(3.0-22.5), p<0.001). Further, SDMA was associated with mortality, even after adjustment for GRACE risk score (OR(95%CI): 4.56(1.34-15.52), p = 0.015). Our study showed for the first time that SDMA is associated with hospital outcomes, through altered LVEF and may have biological activity beyond renal function.


[Migraine].
Migraine is one of the most common neurological disorders, with a significant social and economic impact. It is characterized by a constellation of symptoms including headache, nausea or vomiting, intolerance to sensory stimuli and, in 20% of patients, transient neurological signs (the aura). In this article we review new advances on its pathogenesis, based on clinical and experimental data. Recent evidence has shown that, contrary to previous beliefs, migraine is primary a neurogenic disorder. Genetic studies have associated some rare forms of migraine to the mutations of genes that code ionic channels, suggesting that trans-membrane ionic imbalance is a possible pathogenic mechanism for the attacks. Genetic factors may modulate the vulnerability to suffer the attacks in response to environmental/internal triggers. Direct stimulation of the arterial wall is not a provocative factor for the attacks, contrary to stimuli that act primary on the nervous system. It has also been shown that individuals with migraine have an enhanced cortical excitability and lack of habituation. Functional neuroimaging studies have provided evidence that during the attacks there is an abnormal metabolic activity in the cortex and the brainstem. As waves of metabolic depression travel slowly across the cerebral cortex (cortical spreading depression), trigeminal nerve terminals surrounding meningeal arteries are stimulated eliciting a trigemino vascular reflex that explains subsequent vascular changes and headache. Drugs that stabilize nerve membranes and decrease neuronal excitability are effective in migraine prophylaxis. This recent evidence can be used in experimental models to test drugs aimed to new targets, developed to inhibit the cascade of events associated to migraine at different points, based on more fine grain knowledge of migraine pathogenesis.


The tree versus the forest: the fungal tree of life and the topological diversity within the yeast phylome.
A recurrent topic in phylogenomics is the combination of various sequence alignments to reconstruct a tree that describes the evolutionary relationships within a group of species. However, such approach has been criticized for not being able to properly represent the topological diversity found among gene trees. To evaluate the representativeness of species trees based on concatenated alignments, we reconstruct several fungal species trees and compare them with the complete collection of phylogenies of genes encoded in the Saccharomyces cerevisiae genome. We found that, despite high levels of among-gene topological variation, the species trees do represent widely supported phylogenetic relationships. Most topological discrepancies between gene and species trees are concentrated in certain conflicting nodes. We propose to map such information on the species tree so that it accounts for the levels of congruence across the genome. We identified the lack of sufficient accuracy of current alignment and phylogenetic methods as an important source for the topological diversity encountered among gene trees. Finally, we discuss the implications of the high levels of topological variation for phylogeny-based orthology prediction strategies.


A decade of experience evolving visiting dental services in partnership with rural remote Aboriginal communities.
Embedding research capabilities and workforce development activities with clinical service entities promotes the development of sustainable, innovative, quality-focused oral health care services. Clinical and strategic governance is an important area of consideration for rural and remote dental services, posing particular challenges for smaller service structures. Sustaining remote area dental services has some significant complexities beyond those involved in urban service models. This study describes the sustaining structure of a remote area dental service with a decade of history. In the current climate, chief among these challenges may be those associated with dental workforce shortages as these impact most heavily in the public sector, and most particularly, in remote areas. As sustained workforce solutions come from developing a future workforce, an essential element of the workforce governance framework for remote dental service provision should be the inclusion of a student participation programme. Collaborative partnership approaches with Aboriginal health services promote the development and maintenance of effective, culturally sensitive dental services within rural and remote Aboriginal communities. Having sustained care for 10 years, this collaborative model of integrated research, education and service has demonstrated its effectiveness as a service model for Aboriginal communities in Western Australia. This descriptive study finds the core values for this success have been communication, clinical leadership, mentorship within effective governance systems all linked to an integrated education and research agenda.


The quality of skin care products and their ingredients.
Several ingredients used in skin products have been criticized as being excessively harsh, allergenic, or otherwise unsuitable for use, especially in the elderly population. Preservatives, in particular, have been condemned, leading to a proliferation of "preservative-free" products. Other descriptive/promotional phrases with negative connotations are "fragrance-free" and "emulsifier-free." Inferences regarding these designations might suggest that preservatives, fragrances, emulsifiers, and a number of other ingredients serve no important function, are superfluous in terms of product quality, and, therefore, should be left out of all skin products. While this is obviously not the case, neither is the obverse. Ingredients used in skin care products should be carefully chosen to support or maintain the overall effectiveness and utility of the product, and the concentration of such ingredients should be given careful consideration. After briefly reviewing skin structure and changes that occur during aging, this article examines the concept of product quality. Major nondrug ingredient categories will be addressed, including the reasons for using such ingredients in skin care products, the products in which they are required, the limitations and choices available within each category, and guidelines for product selection.


The Scs disulfide reductase system cooperates with the metallochaperone CueP in Salmonella copper resistance.
The human pathogen Salmonella enterica serovar Typhimurium (S Typhimurium) contains a complex disulfide bond (Dsb) catalytic machinery. This machinery encompasses multiple Dsb thiol-disulfide oxidoreductases that mediate oxidative protein folding and a less-characterized suppressor of copper sensitivity (scs) gene cluster, associated with increased tolerance to copper. To better understand the function of the Salmonella Scs system, here we characterized two of its key components, the membrane protein ScsB and the periplasmic protein ScsC. Our results revealed that these two proteins form a redox pair in which the electron transfer from the periplasmic domain of ScsB (n-ScsB) to ScsC is thermodynamically driven. We also demonstrate that the Scs reducing pathway remains separate from the Dsb oxidizing pathways and thereby avoids futile redox cycles. Additionally, we provide new insight into the molecular mechanism underlying Scs-mediated copper tolerance in Salmonella We show that both ScsB and ScsC can bind toxic copper(I) with femtomolar affinities and transfer it to the periplasmic copper metallochaperone CueP. Our results indicate that the Salmonella Scs machinery has evolved a dual mode of action, capable of transferring reducing power to the oxidizing periplasm and protecting against copper stress by cooperating with the cue regulon, a major copper resistance mechanism in Salmonella. Overall, these findings expand our understanding of the functional diversity of Dsb-like systems, ranging from those mediating oxidative folding of proteins required for infection to those contributing to defense mechanisms against oxidative stress and copper toxicity, critical traits for niche adaptation and survival.


Distribution of ADHD symptoms, and associated comorbidity, exposure to risk factors and disability: Results from a general population study.
The aim of this study was to examine whether ADHD is a dimensional trait in the adult general population. We studied whether an increased number of ADHD symptoms was associated with higher comorbidity, exposure to risk factors (childhood abuse and parental psychopathology), and disability. We ascertained whether even low numbers of ADHD symptoms were associated with an increased burden of disease. Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2, N = 5303). NEMESIS-2 is a nationally representative face-to-face survey on mental health of the Dutch general population. ADHD symptoms, mental comorbidity, and disability were assessed using the Adult ADHD Self-Report Scale Screener, the Composite International Diagnostic Interview version 3.0, and the Medical Outcomes Study Short Form Health Survey, respectively. Dose-response relationships were found between the number of ADHD symptoms and Axis I and II mental disorders; exposure to risk factors; and mental and physical disability. Our study supports the notion that ADHD is a dimensional trait in the adult general population. Even low numbers of symptoms were associated with an increased burden of disease, and therefore these should be identified and treated.


A new frog species (Myobatrachidae: Uperoleia) from the Northern Deserts region of Australia, with a redescription of U. trachyderma.
The frog genus Uperoleia (Myobatrachidae) is species rich, with the greatest diversity in the northern monsoonal region of Australia. Due in part to their small body size, conservative morphology and distribution in diverse habitats, the genus is likely to harbor cryptic species. A recent study (Catullo et al. 2013) assessed region-wide genetic, acoustic and phenotypic variation within four species in northern Australia. Catullo et al. (2013) presented multiple lines of evidence that the widespread U. trachyderma comprises distinct allopatric western and eastern lineages within the Northern Deserts bioregion of Australia. Here we formally describe the western lineage as U. stridera sp. nov. and redescribe the eastern (type) clade as U. trachyderma. The new species can be distinguished from U. trachyderma by fewer pulses per call, a faster pulse rate, and the lack of scattered orange to red flecks on the dorsum. The description of U. stridera sp. nov. brings the number of Uperoleia species to 28, by far the largest genus in the Myobatrachidae, and further highlights the Australian monsoonal tropics as a region of high endemism.


Epigenetic inheritance of active chromatin after removal of the main transactivator.
The Drosophila Polycomb and trithorax group proteins act through chromosomal elements such as Fab-7 to maintain repressed or active gene expression, respectively. A Fab-7 element is switched from a silenced to a mitotically heritable active state by an embryonic pulse of transcription. Here, histone H4 hyperacetylation was found to be associated with Fab-7 after activation, suggesting that H4 hyperacetylation may be a heritable epigenetic tag of the activated element. Activated Fab-7 enables transcription of a gene even after withdrawal of the primary transcription factor. This feature may allow epigenetic maintenance of active states of developmental genes after decay of their early embryonic regulators.


[Colonic polyps in children. Experience with polypectomy].
Colonic polyp, the most common gastrointestinal tumor in children, is considered a cause of rectal bleeding in the pediatric population. Colonoscopy is the "gold standard" procedure in diagnosis and therapeutic. To know the incidence and symptomatology of colonic polyps in children to remark on the usefulness of the endoscopic examination. PATIENTS-METHODS AND RESULTS: Between 1985 and 1996, over 1,000 colonoscopies were performed on 50 children between 8 months and 14 years old. The patients had colonic polyps and lower gastrointestinal bleeding. In 40 cases polyps were solitary, 82% were located in rectum sigmoid, and 80% of polyps were found to be juvenile (retention). There were no complications associated with diagnostic and therapeutic endoscopy. The endoscopic method was shown to be very useful for diagnosis as well as treatment of the colonic polyps in children.


ANMCO Position Paper: long-term follow-up of patients with pulmonary thromboembolism.
Venous thromboembolism (VTE), including pulmonary embolism and deep venous thrombosis, is the third most common cause of cardiovascular death. The management of the acute phase of VTE has already been described in several guidelines. However, the management of the follow-up (FU) of these patients has been poorly defined. This consensus document, created by the Italian cardiologists, wants to clarify this issue using the currently available evidence in VTE. Clinical and instrumental data acquired during the acute phase of the disease are the cornerstone for planning the FU. Acquired or congenital thrombophilic disorders could be identified in apparently unprovoked VTE during the FU. In other cases, an occult cancer could be discovered after a VTE. The main targets of the post-acute management are to prevent recurrence of VTE and to identify the patients who can develop a chronic thromboembolic pulmonary hypertension. Knowledge of pathophysiology and therapeutic approaches is fundamental to decide the most appropriate long-term treatment. Moreover, prognostic stratification during the FU should be constantly updated on the basis of the new evidence acquired. Currently, the cornerstone of VTE treatment is represented by both the oral and the parenteral anticoagulation. Novel oral anticoagulants should be an interesting alternative in the long-term treatment.


Disease due to cytomegalovirus and its long-term consequences in renal transplant recipients. Correlation of allograft survival with disease due to cytomegalovirus and rubella antibody level.
We prospectively studied 52 consecutive renal allograft recipients who retained their grafts at least three months. The transplant recipients were observed for five years or longer. Disease due to cytomegalovirus (CMV) occurred in nine (17.3%). Manifestations of disease due to CMV that were significantly more common than in chronologically matched controls in comparable periods after transplantation included fever, leukopenia, hepatic function abnormalities, pneumonia, and renal dysfunction. Life-table analyses suggested a trend of decreased allograft survival with disease due to CMV, but the difference between controls was not statistically significant. A significant inverse correlation were noted between the level of hemagglutination inhibition antibody to rubella virus reached after transplantation and allograft survival. This correlation remained statistically significant even when patients with disease due to CMV were excluded from the analysis.


Molecular pathways: context-dependent approaches to Notch targeting as cancer therapy.
Recent high-throughput genomic sequencing studies of solid tumors, including head and neck squamous cell carcinoma (SCC), ovarian cancer, lung adenocarcinoma, glioblastoma, breast cancer, and lung SCC, have highlighted DNA mutation as a mechanism for aberrant Notch signaling. A primary challenge of targeting Notch for treatment of solid malignancies is determining whether Notch signaling is cancer promoting or tumor suppressing for a specific cancer. We compiled reported Notch receptor and ligand missense and nonsense mutations to glean insights into aberrant Notch signaling. Frequencies of coding mutations differed for the 4 NOTCH genes. A total of 4.7% of tumors harbored NOTCH1 missense or nonsense mutations. NOTCH2, and NOTCH3 had similar overall mutation rates of 1.5% and 1.3%, respectively, whereas NOTCH4 mutations were rarer. Notch ligand genes were rarely mutated. The combined mutation frequency and position spectra of the 4 Notch paralogs across the different cancers provide an opportunity to begin to illuminate the different contributions of each Notch paralog to each tumor type and to identify opportunities for therapeutic targeting. Notch signaling pathway activators and inhibitors are currently in early clinical development for treatment of solid malignancies. Defining the status and consequences of altered Notch signaling will be important for selection of appropriate treatment.


Similar biochemical changes associated with multidrug resistance in human breast cancer cells and carcinogen-induced resistance to xenobiotics in rats.
MCF7 human breast cancer cells selected for resistance to doxorubicin (adriamycin; DoxR) have developed the phenotype of multidrug resistance. Multidrug resistance in DoxR MCF7 cells (called AdrR MCF7 cell line in previous publications) is associated with biochemical changes similar to those induced by carcinogens in rat hyperplastic liver nodules (HNs) and associated with resistance to xenobiotics in that system. In HNs and DoxR cells, exposure to a single agent results in the selection of cells that are cross-resistant to a wide variety of structurally dissimilar toxic agents. Resistance in both systems is associated with decreases in intracellular accumulation of toxins and changes in phase I (decreased cytochrome P1-450) and phase II (increased glutathione transferase and glucuronyltransferase) drug-metabolizing activities. In HNs and DoxR cells, resistance is associated with the induction of relatively stable levels of an immunologically related anionic glutathione transferase isozyme (EC 18.104.22.168). The finding of similar biochemical changes associated with the development of resistance to various xenobiotics in HNs and to many naturally occurring antineoplastic agents and at least one carcinogen (benzo[a]pyrene) in DoxR MCF7 cells suggests that the mechanisms of resistance in these two models may be similar.


Rapid Intrafibrillar Mineralization Strategy Enhances Adhesive-Dentin Interface.
Biomimetic mineralization of dentin collagen appears to be a promising strategy to optimize dentin bonding durability. However, traditional postbonding mineralization strategies based on Ca/P ion release still have some drawbacks, such as being time-consuming, having a spatiotemporal mismatch, and having limited intrafibrillar minerals. To tackle these problems, a prebonding rapid intrafibrillar mineralization strategy was developed in the present study. Specifically, polyacrylic acid-stabilized amorphous calcium fluoride (PAA-ACF) was found to induce rapid intrafibrillar mineralization of the single-layer collagen model and dentin collagen at just 1 min and 10 min, as identified by transmission electron microscopy, scanning electron microscopy, and atomic force microscopy. This strategy has also been identified to strengthen the mechanical properties of demineralized dentin within a clinically acceptable timeframe. Significantly, the bonding strength of the PAA-ACF-treated groups outperformed the control group irrespective of aging modes. In addition, the endogenous matrix metalloproteinases as well as exogenous bacterial erosion were inhibited, thus reducing the degradation of dentin collagen. High-quality integration of the hybrid layer and the underlying dentin was also demonstrated. On the basis of the present results, the concept of "prebonding rapid intrafibrillar mineralization" was proposed. This user-friendly scheme introduced PAA-ACF-based intrafibrillar mineralization into dentin bonding for the first time. As multifunctional primers, PAA-ACF precursors have the potential to shed new light on prolonging the service life of adhesive restorations, with promising significance.


[Dementia in diffuse Lewy body disease].
The article presents diagnostic criteria for dementia associated with diffuse Lewy body disease (DLBD) elaborated by the group of investigators from Nottingham (Byrne et al. 1991). These criteria allow to make the diagnosis of "probable" or "possible" dementia associated with DLBD. With certainty this form of dementia can only be diagnosed by neuropathological examination which reveals diffuse cortical Lewy bodies. At present there is no agreement whether DLBD is a variant of Alzheimer's disease or a separate nosological entity--the second commonest cause of dementia. The main clinical feature of DLBD is coexistence of dementia and symptoms of parkinsonian syndrome. The other important feature which differentiates between DLBD and other forms of dementia is a very considerable early fluctuation of cognitive state. Psychotic symptoms in the course of DLBD--visual and auditory hallucinations, delusions and depression--are common. At present treatment of DLBD is unknown. Treatment of psychotic symptoms is difficult because of the presence of parkinsonism.


H. pylori and mitochondrial changes in epithelial cells. The role of oxidative stress.
Infection with H. pylori plays a role in the pathogenesis of gastritis, peptic ulcer, gastric carcinoma, and gastric lymphoma, but mechanisms leading to the various clinical manifestations remain obscure and are the primary focus of research in this field. Proliferation and apoptosis are essential in the maintenance of gastric tissue homeostasis, and changes seen in their balance may condition gastric mucosal changes during infection. Thus, excessive apoptosis or proliferation inhibition will result in cell mass loss, which is observed in gastric ulcers. On the other hand, accelerated epithelial cell turnover is characteristic of carcinogenic mucosas. There is also scientific evidence that demonstrates an association between H. pylori infection and exacerbated synthesis of free radicals, the latter being well known as a primary cause of cell death. A thorough review of the literature and the results of our experimental research lead to conclude that H. pylori-induced oxidative stress activates the intrinsic pathway of apoptosis. Structural and functional changes caused by this process on mitochondrial organelles lie at the origin of gastric mucosal toxicity, and lead to the development of the various manifestations associated with this infection. Based on these data we suggest that therapy with antioxidants should prove beneficial for the clinical management of patients with H. pylori infection.


Diversity in migratory patterns among Neotropical fishes in a highly regulated river basin.
Migratory behaviour of selected fish species is described in the Paraná River, Brazil-Argentina-Paraguay, to search for patterns relevant to tropical regulated river systems. In a 10 year mark-recapture study, spanning a 1425 km section of the river, 32 867 fishes composed of 18 species were released and 1083 fishes were recaptured. The fishes recaptured were at liberty an average 166 days (maximum 1548 days) and travelled an average 35 km (range 0-625 km). Cluster analysis applied to variables descriptive of movement behaviour identified four general movement patterns. Cluster 1 included species that moved long distances (mean 164 km) upstream (54%) and downstream (40%) the mainstem river and showed high incidence (27%) of passage through dams; cluster 2 also exhibited high rate of movement along the mainstem (49% upstream, 13% downstream), but moved small distances (mean 10 km); cluster 3 included the most fishes moving laterally into tributaries (45%) or not moving at all (25%), but little downstream movement (8%); fishes in cluster 4 exhibited little upstream movement (13%) and farthest downstream movements (mean 41 km). Whereas species could be numerically clustered with statistical models, a species ordination showed ample spread, suggesting that species exhibit diverse movement patterns that cannot be easily classified into just a few classes. The cluster and ordination procedures also showed that adults and juveniles of the same species exhibit similar movement patterns. Conventional concepts about Neotropical migratory fishes portray them as travelling long distances upstream. The present results broaden these concepts suggesting that migratory movements are more diverse, could be long, short or at times absent, upriver, downriver or lateral, and the diversity of movements can vary within and among species. The intense lateral migrations exhibited by a diversity of species, especially to and from large tributaries (above reservoirs) and reservoir tributaries, illustrate the importance of these habitats for the fish species life cycle. Considering that the Paraná River is highly impounded, special attention should be given to the few remaining low-impact habitats as they continue to be targets of hydropower development that will probably intensify the effects on migratory fish stocks.


A randomized clinical trial evaluating a combined alcohol intervention for high-risk college students.
The current study is a multisite randomized alcohol prevention trial to evaluate the efficacy of both a parenting handbook intervention and the Brief Alcohol Screening and Intervention for College Students (BASICS) intervention, alone and in combination, in reducing alcohol use and consequences among a high-risk population of matriculating college students (i.e., former high school athletes). Students (n = 1,275) completed a series of Web-administered measures at baseline (in the summer before starting college) and follow-up (after 10 months). Students were randomized to one of four conditions: parent intervention only, BASICS only, combined (parent and BASICS), and assessment-only control. Intervention efficacy was tested on a number of outcome measures, including peak blood alcohol concentration, weekly and weekend drinking, and negative consequences. Hypothesized mediators and moderators of intervention effect were tested. The overall results revealed that the combined-intervention group had significantly lower alcohol consumption, high-risk drinking, and consequences at 10-month follow-up, compared with the control group, with changes in descriptive and injunctive peer norms mediating intervention effects. The findings of the present study suggest that the parent intervention delivered to students before they begin college serves to enhance the efficacy of the BASICS intervention, potentially priming students to respond to the subsequent BASICS session.


Genetic Diversity of Culicoides stellifer (Diptera: Ceratopogonidae) in the Southeastern United States Compared With Sequences From Ontario, Canada.
Much of the bluetongue (BT) and epizootic hemorrhagic disease (EHD) research in North America focuses on white-tail deer and Culicoides sonorensis (Wirth & Jones) (Diptera: Ceratopogonidae), though several other biting midge species have been suggested as vectors. Culicoides stellifer (Coquillett) has been associated with hosts susceptible to hemorrhagic disease (HD), and more recently, specimens from Florida have tested positive for EHD and BT viral RNA. If C. stellifer is acting as a vector, this could have an impact on the distribution of HD in North America. To determine if gene flow is occurring across the range of C. stellifer within the southeast United States, a mitochondrial haplotype analysis was performed using the COI gene. Our haplotype network showed no population structure in C. stellifer from Florida, Texas, and South Carolina, as the overall genetic divergence between these sites was equal to the genetic divergence within each. We also compared these haplotypes to published sequences of C. stellifer collected in Ontario, Canada. Surprisingly, the genetic diversity of the flies from Ontario was two times greater than what was observed between the southeast U.S. collection sites. This considerable divergence could be evidence of a cryptic species. A better understanding of the connectivity between C. stellifer populations across all of North America will give insight into the distribution of HD. Our results show that gene flow is occurring between sites in the southeastern United States and potentially throughout the eastern distribution of the species.


Practice guideline for evaluation of fever and infection in long-term care facilities.
The elderly population (i.e., persons aged > or = 65 years) in the United States is rapidly expanding and will nearly double in number over the next 30 years. It is estimated that >40% of persons aged > or = 65 years will require care in a long-term care facility (LTCF), such as a skilled nursing facility (SNF), at some point during their lifetime. For the most part, residents of LTCFs are very old and have age-related immunologic changes, chronic cognitive and/or physical impairments, and diseases that alter host resistance; therefore, they are highly susceptible to infections and their complications. The diagnosis of infections in residents of LTCFs is often difficult because LTCFs differ from acute-care facilities in their goals of care, staffing ratios, types of primary care providers, availability of laboratory tests, and criteria for infections. Consequently, guidelines and standards of practice used for diagnosis of infections in patients in acute-care facilities may not be applicable nor appropriate for residents in LTCFs. Moreover, the clinical manifestations of diseases and infections are often subtle, atypical, or nonexistent in the very old. Fever may be low or absent in LTCF residents with infection. The initial evaluation of an LTCF resident suspected of an infection may not be done by a physician. Although nurses commonly perform initial assessments for infection in residents of LTCFs, further studies are needed to determine the appropriateness and validity of this practice. Provided there are no directives (advance or current by resident or caregiver) limiting diagnostic or therapeutic interventions, all residents of LTCFs with suspected symptomatic infection should have appropriate diagnostic laboratory studies done promptly, and the findings should be discussed with the primary care clinician (see Recommendations). The most common infections among LTCF residents are urinary tract infections, respiratory infections, skin or soft tissue infections, and gastroenteritis. Decisions concerning possible transfer of an LTCF resident to an acute-care facility are best expressed through an advance directive or, when not available, through transfer policies developed by the LTCF. In general, LTCF residents have been transferred to an acute-care facility when any of the following conditions exist: (1) the resident is clinically unstable and the resident or family goals indicate aggressive interventions should be initiated, (2) critical diagnostic tests are not available in the LTCF, (3) necessary therapy or the mode of administration of therapy (frequency or monitoring) are beyond the capacity of the LTCF, (4) comfort measures cannot be assured in the LTCF, and (5) specific infection-control measures are not available in the LTCF.


Testing for Salmonella in raw meat and poultry products collected at federally inspected establishments in the United States, 1998 through 2000.
The Food Safety and Inspection Service (FSIS) issued Pathogen Reduction; Hazard Analysis and Critical Control Point (HACCP) Systems; Final Rule (the PR/HACCP rule) on 25 July 1996. To verify that industry PR/HACCP systems are effective in controlling the contamination of raw meat and poultry products with human disease-causing bacteria, this rule sets product-specific Salmonella performance standards that must be met by slaughter establishments and establishments producing raw ground products. These performance standards are based on the prevalence of Salmonella as determined from the FSIS's nationwide microbial baseline studies and are expressed in terms of the maximum number of Salmonella-positive samples that are allowed in a given sample set. From 26 January 1998 through 31 December 2000, federal inspectors collected 98,204 samples and 1,502 completed sample sets for Salmonella analysis from large, small, and very small establishments that produced at least one of seven raw meat and poultry products: broilers, market hogs, cows and bulls, steers and heifers, ground beef, ground chicken, and ground turkey. Salmonella prevalence in most of the product categories was lower after the implementation of PR/HACCP than in pre-PR/HACCP baseline studies and surveys conducted by the FSIS. The results of 3 years of testing at establishments of all sizes combined show that >80% of the sample sets met the following Salmonella prevalence performance standards: 20.0% for broilers, 8.7% for market hogs, 2.7% for cows and bulls, 1.0% for steers and heifers, 7.5% for ground beef, 44.6% for ground chicken, and 49.9% for ground turkey. The decreased Salmonella prevalences may partly reflect industry improvements, such as improved process control, incorporation of antimicrobial interventions, and increased microbial-process control monitoring, in conjunction with PR/HACCP implementation.


Functional and cosmetic outcomes of external approach septoplasty.
The external approach for septoplasty is an important surgical technique to manage severe septal deviations, caudal deformities, and mid-dorsal abnormalities when a simple endonasal approach may not suffice. The procedure is longer in duration and draws on more resources than endonasal septoplasty. The outcome reporting of the external approach for septoplasty is important to provide evidence of benefit for both patients and health care providers. This study was designed to describe functional and cosmetic outcomes of the external approach for septoplasty. A prospective assessment of consecutive patients undergoing the external approach for septoplasty at a tertiary center was performed. Pre- and postoperative nasal peak inspiratory flow (NPIF), symptom scores, 22-Item Sinonasal Outcome Test (SNOT-22), Nasal Obstruction Score, and Short Form 36 (SF-36) quality-of-life scores were assessed. A global Likert change scale was also used for both function and cosmesis. Thirty patients (mean age, 40 ± 15.9 years; 40% women) were assessed with a mean follow-up of 12.2 ± 9.5 months. Mean NPIF improved significantly from 93.3 ± 34.7 to 143.0 ± 44.3 (p < 0.001). Nasal obstruction score improved significantly from 3.6 ± 1.3 to 0.69 ± 1.2 (p < 0.001). SNOT-22 improved significantly from 34.1 ± 17.2 to 12.7 ± 14.9 (p < 0.001). Ninety-six percent had subjective improvement in nasal function, and 96% had no change or improvement in cosmesis. Seventy percent improved by the minimal clinically important difference for NPIF. The external approach for septoplasty is an operation that produces significant improvements in subjective and objective nasal health measures. Although requiring greater training and operative time, it is an appropriate approach for the severely deviated nasal septum.


The Influence of Physical Qualities on Activity Profiles of Female Australian Football Match Play.
The transition of female Australian football (AF) players from amateur to semielite competitions has the potential for athletes to be underprepared for match play. To gain an understanding of the match demands of female football, the aims of this study were to highlight the physical qualities that discriminate selected and nonselected female AF players, investigate activity profiles of female AF players, and gain an understanding of the influence of physical qualities on performance in female AF Methods: Twenty-two female AF state academy players (mean [SD]: age = 23.2 [4.5] y) and 27 nonselected players (mean [SD]: age = 23.4 [4.9] y) completed a Yo-Yo intermittent recovery test level 1, countermovement jump, and 30-m sprint tests were completed prior to the competitive season. During 14 matches, players wore global positioning system units to describe the running demands of match play. Selected players were faster over 30 m (ES = 0.57; P = .04) and covered greater distances on the Yo-Yo IR1 (ES = 1.09; P < .001). Selected midfielders spent greater time on the field and covered greater total distances (ES = 0.73-0.85; P < .01). Players faster over 5 m (r = -.612) and 30 m (r = -.807) and who performed better on the Yo-Yo IR1 (r = .489) covered greater high-speed distances during match play. An emphasis should be placed on the development of physical fitness in this playing group to ensure optimal preparation for the national competition.


The professional identity of the practicante: the case of Aragon, 1857-1936.
The objective of this study was to reconstruct the professional identity of the practicante (male assistant in medicine and surgery) by analyzing three professional journals of this collective in Zaragoza (Aragón). The discourse of practicantes on their profession insists that they were the only assistants for physicians with technical qualities. This affirmation constituted a key element in shaping their identity, contributing in turn to establish the moral and social legitimization of practicantes and their professional authority. This was constructed in counterpoint to the profile, qualifications and gender identity of the other professional healthcare assistant, the nurse. Despite achieving a clear discourse on their professional identity and developing certain professional infrastructures through the work of institutions and key figures, practicantes were not able to consolidate a collective project of upward social mobility that would improve their status and enhance social recognition of the profession. This led to the construction of a group identity that was largely characterized by apathy, frustration and disunion, elements that eventually weakened the profession.


Protein tyrosine kinase inhibitors block the stimulatory actions of phosphotyrosine phosphatase inhibitors to increase cell proliferation, alkaline phosphatase activity, and collagen synthesis in normal human bone cells.
The present study sought to test whether inhibition of phosphotyrosine phosphatases (PTPs) would stimulate proliferation and differentiation of normal bone cells, and whether the PTP inhibitor-mediated effects would be blocked by protein tyrosine kinase (PTK) inhibitors. Three inhibitors [phenylarsine oxide (PAO), orthovanadate (VO(4)), and molybdate (MoO(4))] and two normal human bone cells with different basal differentiation status (i.e., mandible- and vertebra-derived bone cells) were used. Cell proliferation was determined with [(3)H]thymidine incorporation, and confirmed by cell counting. Bone cell differentiation was assessed by increases in alkaline phosphatase (ALP) specific activity and collagen synthesis. The three test PTP inhibitors each stimulated [(3)H]thymidine incorporation in both human bone cell types in a biphasic, dose-dependent manner with optimal doses of 20 nM PAO, 1 microM VO(4) and 2 microM MoO(4), respectively. These PTP inhibitors at mitogenic doses each significantly and reproducibly increased ALP specific activity and collagen synthesis. To determine whether the stimulatory effects of PTP inhibitors could be blocked by PTK inhibitors, the effects of tyrphostin A51 and erbstatin, two potent PTK inhibitors, on the actions of PTK inhibitors on [(3)H]thymidine incorporation and ALP specific activity were evaluated. Both tyrphostin A51 and erbstatin, which by themselves alone significantly inhibited human bone cell proliferation and increased ALP specific activity, completely abolished the stimulatory effects of each of the three test PTP inhibitors on bone cell proliferation and ALP specific activity. In conclusion, these findings confirm the premise that inhibition of PTP activities in normal human bone cells could lead to increases in cell proliferation and differentiation, effects that are independent of basal differentiation status of the cells. More importantly, this study demonstrates for the first time that the stimulatory actions of the PTP inhibitor on bone cell proliferation and ALP could be blocked by a PTK inhibitor, suggesting that the osteogenic effects of PTP inhibitors may depend on PTK activities, presumably to increase basal tyrosyl phosphorylation level. Accordingly, one should interpret results of studies using PTK inhibitors with caution in that an inhibition by a PTK inhibitor does not necessarily indicate the requirement of PTK activities, as it could also suggest involvement of an inhibition of PTPs.


Reexpression of RAG-1 and RAG-2 genes in activated mature mouse B cells.
Recombination activating genes (RAG-1 and RAG-2), involved in V(D)J rearrangement of immunoglobulin genes, have been thought to be expressed only in immature stages of B-cell development. However, RAG-1 and RAG-2 transcripts were found to be reexpressed in mature mouse B cells after culture with interleukin-4 in association with several different co-stimuli. Reexpression was also detected in draining lymph nodes from immunized mice. RAG-1 and RAG-2 proteins could be detected by immunofluorescence microscopy in the nuclei of B cells cultured in vitro and in the germinal centers of draining lymph nodes. These findings suggest that RAG gene products play a heretofore unsuspected role in mature B cells.


Cytological analysis of bronchoalveolar lavage in patients with interstitial lung diseases and the relation of cytological analysis to fibrosis in high-resolution computed tomography.
To evaluate the value of differential cytology of bronchoalveolar lavage (BAL) in common interstitial lung diseases (ILDs) and its relation with high-resolution computed tomography (HRCT) fibrosis. A retrospective analysis of BAL from 91 patients. The total and percentage of cells were collected and analyzed according to published guidelines. The main diagnoses were connective tissue diseases (n = 24), hypersensitivity pneumonitis (HP) (n = 15), sarcoidosis (n = 12), idiopathic pulmonary fibrosis (IPF) (n = 14), smoking-related interstitial lung diseases (sr-ILDs) (n = 8), aspiration (n = 8), and others (n = 10). The lymphocyte percentages differed among diagnoses (F = 2.85, p = 0.008). A greater number of lymphocytes were found in sarcoidosis (Md = 20%, IQR = 12-45%), HP (Md = 29%, IQR = 13-55%), and organizing pneumonia (Md = 28, IQR = 9-50%). No patient with IPF presented with > 25% lymphocytes in BAL. In 6/15 (40%) of the HP cases, the percentage of lymphocytes was < 25%. A total of 56 participants (62%) displayed HRCT findings that were indicative of fibrosis. In those cases the percentage of lymphocytes was 10.1 (IQR = 6.1-18.0) as compared with 20.2% (IQR = 9.7-37.5) of those 35 cases without fibrosis (p = 0.007). In patients with fibrosis in HRCT, the percentage of neutrophils was 11.3 (IQR = 4.1-21.4) as compared with 3.8 (IQR = 1.4-3.8) in those without fibrosis (p = 0.009). Several patterns in differential cytology are observed in common ILDs. The presence of fibrosis has an impact on these findings.


Secular changes on the distribution of body mass index among Chinese children and adolescents, 1985-2010.
To analyze the change in Body Mass Index (BMI) distribution among Chinese children and adolescents for the development of more effective intervention for childhood obesity. Data on the national students' constitution and health survey between 1985 and 2010 was used for this study. Subjects were students aged 7-18 randomly selected from 30 provinces in China. BMI for-age curves were developed by LMS method, and the trend of BMI distribution was determined by comparing the upper BMI percentiles and analyzing the skew shift of distribution between 1985 and 2010. An overall positive swift trend of BMI between 1985 and 2010 was observed among the Chinese school-age children and adolescents. The average median of the BMI increased from 16.8 and 17.0 kg/m2 to 18.2 and 17.9 kg/m2 in 25 years, with increments 0.56 and 0.36 kg/m2 per decade for males and females, respectively. The more obvious increments were found at the high BMI. The total increments of BMI in this period were 4.03 and 2.20 kg/m2 at the 85th, 6.14 and 3.57 kg/m2 at the 95th, and 6.99 and 4.27 kg/m2 at the 97th percentiles, for males and females, respectively. Obvious increments were observed at high BMI of the Chinese children and adolescents. More effective interventions should be taken for control and prevention of obesity and its health consequence for these subgroups. It is necessary to establish a risk-complex system consisting of the identification of BMI scope, the screen of the disease risk factors and the assessment of excessive adiposity.


Neural Coding of Appetitive Food Experiences in the Amygdala.
Real-life experiences involve the consumption of various foods, yet it is unclear how the brain distinguishes and categorizes such food experiences. Despite the crucial roles of the basolateral amygdala (BLA) in appetitive behavior and emotion, how BLA pyramidal cells and interneurons encode food experiences has not yet been well characterized. Here we employ large-scale tetrode recording techniques to investigate the coding properties of pyramidal neurons vs. fast-spiking interneurons in the BLA as mice freely consumed a variety of foods, such as biscuits, rice, milk and water. We found that putative pyramidal cells conformed to the power-of-two-based permutation logic, as postulated by the Theory of Connectivity, to generate specific-to-general neural clique-coding patterns. Many pyramidal cells exhibited firing increases specific to a given food type, while some other pyramidal cells increased firings to various combinations of multiple foods. In contrast, fast-spiking interneurons can increase or decrease firings to given food types, and were more broadly tuned to various food experiences. We further show that a subset of pyramidal cells exhibited rapid desensitization to repeated eating of the same food, correlated with rapid behavioral habituation. Finally, we provide the intuitive visualization of BLA ensemble activation patterns using the dimensionality-reduction classification method to decode real-time appetitive stimulus identity on a moment-to-moment, single trial basis. Elucidation of the neural coding patterns in the BLA provides a key insight into how the brain's emotion and memory circuits performs the computational operation of pattern discrimination and categorization of natural food experiences.


Modification of the inhibitory amino acid for epitope peptide binding onto major histocompatibility complex class II molecules enhances immunogenicity of the antigen.
Previously, the arginine at hen egg-white lysozyme 61 (HEL 61) was characterized as inhibiting T-lymphocyte stimulation due to the inefficient binding of the arginine-containing epitope peptide to the corresponding major histocompatibility complex class II molecules in C57BL/6 mice. In this study, we produced recombinant HEL, with arginine or alanine at HEL 61, and compared its ability to induce immune responses in mice to see whether modification of an inhibitory amino acid could enhance the immunogenicity of an inefficient antigen. Immunization of the mice with modified HEL induced strong antibody and T-cell immune responses against the native antigen. The enhanced T-cell immune response was due to a more specific elevation of the T-cell responses to the HEL 46-61 epitope region than to other epitope regions, although recognition of the other epitope peptides of HEL was generally increased. Mass spectrometric analyses of the epitope peptides generated by splenic antigen-presenting cells indicated that production of the epitope peptides encompassing HEL 46-61 was efficient using the modified antigen. These results suggest that modification of the critical amino acid residue(s) involved in hampering induction of an efficient immune response is an effective method to improve the immunogenicity of an inefficient antigen.


Volume determination with two standards allows absolute quantification and improved chemometric analysis of metabolites by NMR from submicroliter samples.
The accurate measurement of metabolite concentrations in miniscule biological sample volumes is often desirable, yet it remains challenging. In many cases, the starting analyte volumes are imprecisely known, or not directly measurable, and hence absolute metabolite concentrations are difficult to calculate. Here, we introduce volume determination using two standards (VDTS) as a general quantitative method for the analysis of polar metabolites in submicrolitre samples using (1)H NMR spectroscopy. This approach permits the back calculation of absolute metabolite concentrations from small biological samples of unknown volume. Where small sample volumes are also variable, VDTS can improve multivariate chemometric analysis. In this context, principal component analysis (PCA) yielded more logically consistent and biologically insightful outputs when we used volume-corrected spectra, calculated using VDTS, rather than probabilistic quotient normalization (PQN) of raw spectra. As proof-of-principle, the VDTS-based method and PCA were used to analyze polar metabolites in the hemolymph (blood) extracted from larvae of the very small but widely used genetic model organism Drosophila. This analysis showed that the hemolymph metabolomes of males and females are markedly different when larvae are well fed. However, gender-specific metabolomes tend to converge when larval dietary nutrients are restricted. We discuss the biological implications of these surprising results and compare and contrast them to previous analyses of Drosophila hemolymph and mammalian blood plasma. Together, these findings reveal an interesting and hitherto unknown sexual dimorphism in systemic Drosophila metabolites, clearly warranting further biological investigation. Importantly, the VDTS approach should be adaptable to many different analytical platforms, including mass spectrometry.


Femtosecond electron solvation at the ionic liquid/metal electrode interface.
Electron solvation is examined at the interface of a room temperature ionic liquid (RTIL) and an Ag(111) electrode. Femtosecond two-photon photoemission spectroscopy is used to inject an electron into an ultrathin film of RTIL 1-butyl-1-methylpyrrolidinium bis(trifluoromethylsulfonyl)imide ([Bmpyr](+)[NTf2](-)). While much of current literature highlights slower nanosecond solvation mechanisms in bulk ionic liquids, we observe only a femtosecond response, supporting morphology dependent and interface specific electron solvation mechanisms. The injected excess electron is found to reside in an electron affinity level residing near the metal surface. Population of this state decays back to the metal with a time constant of 400 ± 150 fs. Electron solvation is measured as a dynamic decrease in the energy with a time constant of 350 ± 150 fs. We observe two distinct temperature regimes, with a critical temperature near 250 K. The low temperature regime is characterized by a higher work function of 4.41 eV, while the high temperature regime is characterized by a lower work function of 4.19 eV. The total reorganizational energy of solvation changes above and below the critical temperature. In the high temperature regime, the electron affinity level solvates by 540 meV at 350 K, and below the critical temperature, solvation decreases to 200 meV at 130 K. This study will provide valuable insight to interface specific solvation of room temperature ionic liquids.


[Treatment policy in patients with bilateral lesion of internal carotid arteries].
The article deals with the problem of managing patients presenting with bilateral atherosclerotic lesions of internal carotid arteries (ICA). The problem is currently important enough since the number of patients with multiple symptomatic lesions of carotid arteries grows annually. The authors analysed the outcomes of treatment in two groups of patients with bilateral ICA lesions: Group A patients (n=30) underwent carotid endarterectomies (CEA) sequentially during one hospital stay with a 5-7-day interval; Group B patients (n=40) were subjected to CEA also sequentially but with an interval of 2-3 months. The groups were matched for age, character of lesion and ICA stenosis degree. The operations were performed under local anaesthesia with no use of temporary intraarterial bypasses. All patients were subjected to eversion carotid endarterectomy. It was shown that the complication rate in the groups was virtually similar. Hence, it was proved that performing CEA from the two sides sequentially is possible during one hospital stay.


Trichrome vitiligo in segmental type.
Trichrome vitiligo consists of an intermediate zone of hypopigmentation located between the depigmentation center and the normal unaffected skin. Previously, trichrome vitiligo was described in non-segmental vitiligo. Here, we report two cases of trichrome vitiligo that showed a poor response to phototherapy or systemic steroid. These findings suggest that trichrome vitiligo in segmental type seems to be an active lesion resistant to medical treatment.


Increase in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials.
Beginning in December 2014, a series of pivotal trials showed that endovascular thrombectomy (EVT) was highly effective, prompting calls to reorganize stroke systems of care. However, there are few data on how these trials influenced the frequency of EVT in clinical practice. We used data from the Get With The Guidelines-Stroke program to determine how the frequency of EVT changed in US practice. We analyzed prospectively collected data from a cohort of 2 437 975 patients with ischemic stroke admitted to 2222 participating hospitals between April 2003 and the third quarter of 2016. Weighted linear regression with 2 linear splines and a knot at January 2015 was used to compare the slope of the change in EVT use before and after the pivotal trials were published. Potentially eligible patients were defined as last known well to arrival time ≤4.5 hours and National Institutes of Health Stroke Scale score ≥6. The frequency of EVT use was slowly increasing before January 2015 but then sharply accelerated thereafter. In the third quarter 2016, EVT was provided to 3.3% of all patients with ischemic stroke at all hospitals, representing 15.1% of all patients who were potentially eligible for EVT based on stroke duration and severity. At EVT-capable hospitals, 7.5% of all patients with ischemic stroke were treated in the third quarter of 2016, including 27.3% of the potentially eligible patients. From 2013 to 2016, case volumes nearly doubled at EVT-capable hospitals. Mean case volume per EVT-capable hospital was 37.6 per year in the last 4 quarters. EVT case volumes increased in nearly all US states from 2014 to the last 4 quarters, but with persistent geographic variation unexplained by differences in potential patient eligibility. EVT use is increasing rapidly; however, there are still opportunities to treat more patients. Reorganizing stroke systems to route patients to adequately resourced EVT-capable hospitals might increase treatment of eligible patients, improve outcomes, and reduce disparities.


Ethnicity and sexual risk in heterosexual people attending sexual health clinics in England: a cross-sectional, self-administered questionnaire study.
In the UK, people of black ethnicity experience a disproportionate burden of HIV and STI. We aimed to assess the association of ethnicity with sexual behaviour and sexual health among women and heterosexual men attending genitourinary medicine (GUM) clinics in England. The Attitudes to and Understanding of Risk of Acquisition of HIV is a cross-sectional, self-administered questionnaire study of HIV negative people recruited from 20 GUM clinics in England, 2013-2014. Modified Poisson regression with robust SEs was used to calculate adjusted prevalence ratios (aPR) for the association between ethnicity and various sexual risk behaviours, adjusted for age, study region, education and relationship status. Questionnaires were completed by 1146 individuals, 676 women and 470 heterosexual men. Ethnicity was recorded for 1131 (98.8%) participants: 550 (48.6%) black/mixed African, 168 (14.9%) black/mixed Caribbean, 308 (27.2%) white ethnic groups, 105 (9.3%) other ethnicity. Compared with women from white ethnic groups, black/mixed African women were less likely to report condomless sex with a non-regular partner (aPR (95% CI) 0.67 (0.51 to 0.88)), black/mixed African and black/mixed Caribbean women were less likely to report two or more new partners (0.42 (0.32 to 0.55) and 0.44 (0.29 to 0.65), respectively), and black/mixed Caribbean women were more likely to report an STI diagnosis (1.56 (1.00 to 2.42)). Compared with men from white ethnic groups, black/mixed Caribbean men were more likely to report an STI diagnosis (1.91 (1.20 to 3.04)), but did not report risk behaviours more frequently. Men and women of black/mixed Caribbean ethnicity remained more likely to report STI history after adjustment for sexual risk behaviours. Risk behaviours were reported less frequently by women of black ethnicity; however, history of STI was more prevalent among black/mixed Caribbean women. In black/mixed Caribbean men, higher STI history was not explained by ethnic variation in reported risk behaviours. The association between STI and black/mixed Caribbean ethnicity remained after adjustment for risk behaviours.


Transdifferentiation of mature cortical cells to functional abscission cells in bean
Abscission explants of bean (Phaseolus vulgaris L.) were treated with ethylene to induce cell separation at the primary abscission zone. After several days of further incubation of the remaining petiole in endogenously produced ethylene, the distal two-thirds of the petiole became senescent, and the remaining (proximal) portion stayed green. Cell-to-cell separation (secondary abscission) takes place precisely at the interface between the senescing yellow and the enlarging green cells. The expression of the abscission-associated isoform of beta-1,4-glucanhydrolase, the activation of the Golgi apparatus, and enhanced vesicle formation occurred only in the enlarging cortical cells on the green side. These changes were indistinguishable from those that occur in normal abscission cells and confirm the conversion of the cortical cells to abscission-type cells. Secondary abscission cells were also induced by applying auxin to the exposed primary abscission surface after the pulvinus was shed, provided ethylene was added. Then, the orientation of development of green and yellow tissue was reversed; the distal tissue remained green and the proximal tissue yellowed. Nevertheless, separation still occurred at the junction between green and yellow cells and, again, it was one to two cell layers of the green side that enlarged and separated from their senescing neighbors. Evaluation of Feulgen-stained tissue establishes that, although nuclear changes occur, the conversion of the cortical cell to an abscission zone cell is a true transdifferentiation event, occurring in the absence of cell division.


Organizational and environmental factors associated with local multihospital systems: Precipitants for coordination?
Local multihospital systems (LMSs) commonly struggle to effectively coordinate across system members. Although a recent taxonomy of LMSs found the majority of systems to display lower levels of differentiation, integration, and coordination, some categories of LMS forms exhibited higher levels of integration and coordination. This study examines organizational and environmental factors associated with LMS forms displaying higher levels of integration and coordination. Applying a multitheoretical framework and drawing from sources including the American Hospital Association Annual Survey, Intellimed databases, and primary data collected from LMS communications, descriptive and multinomial logistic regression analyses were conducted to examine the association between LMS forms and varied organizational and environmental characteristics among LMSs in Florida, Maryland, Nevada, Texas, Virginia, and Washington. The results of analysis of variance, Games-Howell, and Fisher's exact tests identified significant relationships between each of the five LMS categories and varying market, competitive, organizational, and operational factors. A multinomial logistic regression analysis also distinguished the three most common LMS forms according to organizational and environmental factors. Recognizing the varied degrees of integration and coordination across LMSs today, the results point to several factors that may explain such variation, including market size and resources, local competitors and their forms, organizational size and ownership, patient complexity, and regulatory restrictions. With the continued promotion and development of innovative health care reform models and with the progressing expansion of care into outpatient sites and diverse settings, LMSs will continue to face greater pressure to integrate and coordinate services throughout the continuum of care across system components and service locations. Navigating the challenges of effective coordination requires administrators and policymakers to be cognizant of the organizational and environmental factors that may hinder or fuel coordination efforts across system components in local markets.


Single Sitting Surgical Treatment of Generalized Aggressive Periodontitis Using GTR Technique and Immediate Implant Placement with 10-Year Follow-Up.
This case report exhibits a patient with generalized aggressive periodontitis who has been under maintenance for the past 12 years after being surgically treated in a single sitting and restored with dental implants. A 41-year-old systemically healthy male patient presented complaining of lower anterior teeth mobility and pain in the upper right quadrant. After clinical and radiographic examination, the upper right molars and lower anterior incisors were deemed unrestorable. Covered by doxycycline, the patient received a nonsurgical periodontal treatment. Three weeks later, teeth extraction, immediate implant placement, immediate nonloading provisional prosthesis, and a guided tissue regeneration were performed at indicated areas in a single sitting. The clinical decisions were based on patient compliance, the status of the existing periodontal tissues, and the prognosis of the remaining teeth. During the 12-year follow-up period, no residual pockets were observed and there was no exacerbation of the inflammatory condition. Marginal bone stability is present on all implants. For aggressive periodontal disease, a high risk of relapse as well as limited success and survival of dental implants should be considered. This case shows proper containment of the disease based on appropriate treatment planning and a strict maintenance program.