Body image, maternal-fetal attachment, and choice of infant feeding method: a study in taiwan.
Many factors contribute to a pregnant woman's choice of infant feeding method, yet few studies have investigated which factors might be specific to pregnant women in Taiwan. The purpose of this study was to explore the relationships among factors of body image, maternal-fetal attachment, and the choices made by pregnant Taiwanese women about infant feeding method. One hundred and ninety-five pregnant women were recruited during their third trimester at five hospitals in Kaohsiung, Taiwan. Participants completed three questionnaires, including a demographic data form, an attitude to body image scale, and a modified maternal-fetal attachment scale. The results of stepwise logistic regression indicated that the best subset for predicting the criterion variable of breastfeeding intention included higher level of education, primiparity, and a higher level of maternal-fetal attachment. Maternal-fetal attachment, education, and parity are predictive of intended infant feeding method by pregnant women who choose breastfeeding, thereby adding to existing knowledge of the factors involved in feeding method choices of Taiwanese women. Further research should incorporate maternal-fetal attachment into a supportive model of breastfeeding.


Placental thickness in 2D prenatal ultrasonographic examination.
The placental thickness (PTh) is an ultrasonographic measurement commonly used to assess the placenta. The study aimed to determine selected factors influencing PTh in 2D prenatal ultrasonographic examination. It might have a special value in difficult cases for interpretation when PTh is above or below the reference values. In this retrospective study, we analysed the results of foetal ECHO examination of 2833 foetuses performed between June 2016 and December 2019 in our single unit. 596 healthy foetuses older than 12 weeks of gestation from singleton pregnancies were enrolled in the study. The following parameters were used in the further analysis: placental implantation site, gestational age according to the last menstrual period (LMP) and foetal biometry (FB); maternal weight, height, and body mass index (BMI) at the time of examination; and PTh. PTh was affected by its location: posterior 33 mm vs. anterior 30 mm (p < 0.001). Moreover, its thickness significantly correlated with gestational age according to FB (r = 0.386, p < 0.001), LMP (r = 0.369, p < 0.001), maternal weight (r = 0.192, p < 0.001), height (r = 0.125, p = 0.002), and BMI (r = 0.147, p < 0.001), but not with maternal age (r = 0.050, p = 0.219). A linear regression model based on these data explained the 16.38% variability of the tested subjects (p < 0.001). Our observations suggest that maternal weight correlated more strongly with PTh than maternal BMI. For PTh evaluation, it is important to pay attention to the placental implantation site - the posterior placenta was thicker than the anterior placenta. Moreover, PTh variability remains largely unknown; therefore, further research in this field is needed.


Environmental suitability of bare-nosed wombat burrows for Sarcoptes scabiei.
Some of the most important pathogens affecting wildlife are transmitted indirectly via the environment. Yet the environmental stages of pathogens are often poorly understood, relative to infection in the host, making this an important research frontier. Sarcoptic mange is a globally widespread disease caused by the parasitic mite Sarcoptes scabiei. The bare-nosed wombat (Vombatus ursinus) is particularly susceptible, and their solitary nature and overlapping use of burrows strongly indicate the importance of environmental transmission. However, due to the challenge of accessing and monitoring within wombat burrows, there has been limited research into their suitability for off-host mite survival and environmental transmission (i.e., to serve as a fomite). We created a model using published laboratory data to predict mite survival times based on temperature and humidity. We then implemented innovative technologies (ground-penetrating radar and a tele-operated robotic vehicle) to map and access wombat burrows to record temperature and relative humidity. We found that the stable conditions within burrows were conducive for off-host survival of S. scabiei, particularly in winter (estimated mite survival of 16.41 ± 0.34 days) and less so in warmer and drier months (summer estimated survival of 5.96 ± 0.37 days). We also compared two areas with higher and lower average mange prevalence in wombats (13.35% and 4.65%, respectively), finding estimated mite survival was slightly higher in the low prevalence area (10.10 and 12.12 days, respectively), contrary to our expectations, suggesting other factors are also important for population prevalence. Our study is the first to demonstrate the suitability of the bare-nosed wombat burrow for off-host mite survival and environmental transmission. Our findings have implications for understanding observed patterns of mange, disease dynamics and disease management for not only bare-nosed wombats, but also other burrow or den-obligate species exposed to S. scabiei via environmental transmission.


Law-breaking, fairness, and generalized trust: The mediating role of trust in institutions.
Institution-centered accounts of generalized trust rely on the idea that law-breaking and state's unfairness lower individuals' propensity to trust fellow citizens because of a weaker confidence in the state. Despite the theoretical relevance attributed to this mediation mechanism, no empirical analysis in the literature has focused on examining its correlational validity. Using data from the European Social Survey (2010), the Quality of Government EU Regional data, and EUROSTAT, this paper assesses the intervening role of institutional trust on the relationship between crime rates, state's fairness, and generalized trust. Results from a Multilevel SEM (MSEM) mediation analysis indicate that trust in institutions strongly mediates the relationship between violent crimes (i.e. homicide) and generalized trust but not the one between property crimes (i.e. vehicle thefts and robberies) and generalized trust. On the other hand, indicators of fairness (i.e. impartiality and corruption) are all mediated by institutional trust, though impartiality maintains a significant direct effect. Overall, findings support the institutional approach, confirming that the negative relationship between ineffective and unfair institutions and generalized trust passes mostly through people's lost faith in the state.


Conservative water use under high evaporative demand associated with smaller root metaxylem and limited trans-membrane water transport in wheat.
Efficient breeding of drought-tolerant wheat (Triticum spp.) genotypes requires identifying mechanisms underlying exceptional performances. Evidence indicates that the drought-tolerant breeding line RAC875 is water-use conservative, limiting its transpiration rate (TR) sensitivity to increasing vapour pressure deficit (VPD), thereby saving soil water moisture for later use. However, the physiological basis of the response remains unknown. The involvement of leaf and root developmental, anatomical and hydraulic features in regulating high-VPD, whole-plant TR was investigated on RAC875 and a drought-sensitive cultivar (Kukri) in 12 independent hydroponic and pot experiments. Leaf areas and stomatal densities were found to be identical between lines and de-rooted plants didn't exhibit differential TR responses to VPD or TR sensitivity to four aquaporin (AQP) inhibitors that included mercury chloride (HgCl2). However, intact plants exhibited a differential sensitivity to HgCl2 that was partially reversed by β-mercaptoethanol. Further, root hydraulic conductivity of RAC875 was found to be lower than Kukri's and root cross-sections of RAC875 had significantly smaller stele and central metaxylem diameters. These findings indicate that the water-conservation of RAC875 results from a root-based hydraulic restriction that requires potentially heritable functional and anatomical features. The study revealed links between anatomical and AQP-based processes in regulating TR under increasing evaporative demand.


Consensus on Wound Antisepsis: Update 2018.
Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.


The effect of learning styles and study behavior on success of preclinical students in pharmacology.
To evaluate the effect of learning styles and study behaviors on preclinical medical students' pharmacology exam scores in a non-Western setting. Grasha-Reichmann Student Learning Study Scale and a modified Study Behavior Inventory were used to assess learning styles and study behaviors of preclinical medical students (n = 87). Logistic regression models were used to evaluate the independent effect of gender, age, learning style, and study behavior on pharmacology success. Collaborative (40%) and competitive (27%) dominant learning styles were frequent in the cohort. The most common study behavior subcategories were study reading (40%) and general study habits (38%). Adequate listening and note-taking skills were associated with pharmacology success, whereas students with adequate writing skills had lower exam scores. These effects were independent of gender. Preclinical medical students' study behaviors are independent predictive factors for short-term pharmacology success.


A dose-dependent increase in mortality with vesnarinone among patients with severe heart failure. Vesnarinone Trial Investigators.
Vesnarinone, an inotropic drug, was shown in a short-term placebo-controlled trial to improve survival markedly in patients with severe heart failure when given at a dose of 60 mg per day, but there was a trend toward an adverse effect on survival when the dose was 120 mg per day. In a longer-term study, we evaluated the effects of daily doses of 60 mg or 30 mg of vesnarinone, as compared with placebo, on mortality and morbidity. We enrolled 3833 patients who had symptoms of New York Heart Association class III or IV heart failure and a left ventricular ejection fraction of 30 percent or less despite optimal treatment. The mean follow-up was 286 days. There were significantly fewer deaths in the placebo group (242 deaths, or 18.9 percent) than in the 60-mg vesnarinone group (292 deaths, or 22.9 percent) and longer survival (P=0.02). The increase in mortality with vesnarinone was attributed to an increase in sudden death, presumed to be due to arrhythmia. The quality of life had improved significantly more in the 60-mg vesnarinone group than in the placebo group at 8 weeks (P<0.001) and 16 weeks (P=0.003) after randomization. Trends in mortality and in measures of the quality of life in the 30-mg vesnarinone group were similar to those in the 60-mg group but not significantly different from those in the placebo group. Agranulocytosis occurred in 1.2 percent of the patients given 60 mg of vesnarinone per day and 0.2 percent of those given 30 mg of vesnarinone. Vesnarinone is associated with a dose-dependent increase in mortality among patients with severe heart failure, an increase that is probably related to an increase in deaths due to arrhythmia. A short-term benefit in terms of the quality of life raises issues about the appropriate therapeutic goal in treating heart failure.


Lung magnetic resonance imaging for pneumonia in children.
Technical factors have historically limited the role of MRI in the evaluation of pneumonia in children in routine clinical practice. As imaging technology has advanced, recent studies utilizing practical MR imaging protocols have shown MRI to be an accurate potential alternative to CT for the evaluation of pneumonia and its complications. This article provides up-to-date MR imaging techniques that can be implemented in most radiology departments to evaluate pneumonia in children. Imaging findings in pneumonia on MRI are also reviewed. In addition, the current literature describing the diagnostic performance of MRI for pneumonia is discussed. Furthermore, potential risks and limitations of MRI for the evaluation of pneumonia in children are described.


Compression of the S1 Nerve Root by an Extradural Vascular Malformation: A Case Report and Discussion of Atypical Causes of Lumbar Radiculopathy.
We present a case of lumbar radiculopathy due to a vascular malformation in the lumbar spine and discuss various causes of atypical lumbar radiculopathy. Lumbar radiculopathy is a condition of neurologic deficits and painful symptoms of the lower extremities due to nerve root compression, most commonly at the L5 and S1 levels. Several factors contribute to lumbar radiculopathy, including intervertebral disc herniation, foraminal stenosis, and spinal instability. There are also a number of atypical causes, including medication side effects or metabolic disorders, which produce symptoms of radiculopathy but do not involve compression of the nerve root. Anatomic variations in the nerve roots or vascular supply surrounding the nerve root may also increase the risk of developing radiculopathy and serve as an obstacle to interpreting imaging during a preoperative workup. A 38-year-old woman presented with sudden onset radicular symptoms in her right lower extremity. Lumbar magnetic resonance imaging demonstrated a right-sided L5-S1 extruded nucleus pulposus. Her symptoms failed to improve after conservative management so she underwent surgical decompression of L4-S1. Intraoperatively, we discovered an extensive, extradural vascular malformation present at the L5-S1 level and believed this to be the true cause of her radiculopathy. This case represents an atypical cause of lumbar radiculopathy and demonstrates the importance of considering atypical causes during diagnostic workup and preoperative planning.


DDAVP and urine osmolality in refractory enuresis.
A double blind crossover trial of 20 micrograms intranasal 1-deamino-8-d-arginine vasopressin (DDAVP) versus placebo was carried out in 17 children with intractable enuresis aged between 6 and 13 years who had failed to respond to drugs and an enuresis alarm. Fluid intake was not restricted. There was a significant reduction in the number of wet nights. Seven children (41%) were cured or showed considerable improvement, with strong evidence against any placebo effect. The best response was seen in children aged 10 years or over and if urine osmolality after DDAVP reached beyond 1000 mmol/kg or was already at this concentration. The degree of overnight rise in urine osmolality after treatment with DDAVP was not predictable but correlated well with the clinical improvement in nocturnal diuresis present in eight of the children. A further 12 children with equally refractory enuresis were given 20 micrograms of the active drug to take during their school journeys or holidays. Six of them had previously normal overnight urine osmolalities with only two successes, but of the six who had nocturnal diuresis before treatment, five became dry, suggesting that DDAVP acts largely by anti-diuresis and might be most useful in children with nocturnal polyuria.


Epitope characterization of an aromatase monoclonal antibody suitable for the assessment of intratumoral aromatase activity.
Immunohistochemistry is one of the most suitable methods for the detection of intratumoral aromatase in order to identify patients who may respond to aromatase inhibitor therapy in hormone-dependent breast cancer. Previous studies showed statistically significant correlation between results of immnuohistochemistry and biochemical analysis in carcinoma components stained by aromatase monoclonal antibody 677. In this study, determination of the antigenic peptides recognized by aromatase antibodies through epitope mapping, combined with the new knowledge on aromatase-reductase interaction, provide insights for understanding various immunostaining patterns using different aromatase antibodies. Our studies on aromatase-reductase interaction also provided critical information on how aromatase and reductase interact with each other on the endoplasmic reticulum membrane, and identified key residues, including K108 of aromatase, that are involved in the interaction with reductase. Through epitope mapping and taking into consideration the interference with aromatase immunohistochemical staining by NADPH-cytochrome P450 reductase, we demonstrated that monoclonal antibody 677 is a suitable antibody for an assessment of intratumoral aromatase activity in breast cancer patients for making clinical management decisions. These results also provide valuable information to identify new aromatase antibodies for immunohistochemical diagnosis of hormone-dependent breast cancer in future.


Transtibial amputee gait efficiency: Energy storage and return versus solid ankle cushioned heel prosthetic feet.
Energy storage and return (ESR) feet have long been assumed to promote metabolically efficient amputee gait. However, despite being prescribed for approximately 30 yr, there is limited evidence that they achieve this desired function. Here, we report a meta-analysis of data from 10 studies that met our selection criteria to determine whether amputee walking with ESR feet is more efficient than with conventional solid ankle cushioned heel (SACH) feet. Additionally, the data were tested for a relationship with walking speed since it has been suggested ESR feet might perform better at higher speeds. The raw data are highly variable because of differences in study protocols; therefore, we normalized the data and found a statistically significant difference (p < 0.001) between ESR and SACH feet. However, the magnitude of this difference is small, with the cost of transport (COT) with ESR feet being 97.3% of the cost with SACH feet. No relationship between ESR COT and speed was found (p = 0.19). We hypothesize that the small but statistically significant difference between ESR and SACH feet may not constitute a functionally significant improvement in COT, possibly related to the limited push-off power provided by ESR feed compared with nondisabled ankles.


Elevated membrane cholesterol concentrations inhibit glucagon-stimulated adenylate cyclase.
A method was devised which increases the cholesterol concentration of rat liver plasma membranes by exchange from cholesterol-rich liposomes at low temperature (4 degrees C). When the cholesterol concentration of liver plasma membranes is increased, there is an increase in lipid order as detected by a decrease in mobility of an incorporated fatty acid spin probe. This is accompanied by an inhibition of adenylate cyclase activity. The various ligand-stimulated adenylate cyclase activities exhibit different sensitivities to inhibition by cholesterol, with inhibition of glucagon-stimulated greater than fluoride-stimulated greater than basal activity. The bilayer-fluidizing agent benzyl alcohol is able to reverse the inhibitory effect of cholesterol on adenylate cyclase activity in full. The thermostability of fluoride-stimulated cyclase is increased in the cholesterol-rich membranes. Elevated cholesterol concentrations abolish the lipid-phase separation occurring at 28 degrees C in native membranes as detected by an incorporated fatty acid spin probe. This causes Arrhenius plots of glucagon-stimulated adenylate cyclase activity to become linear, rather than exhibiting a break at 28 degrees C. It is suggested that the cholesterol contents of both halves of the bilayer are increased by the method used and that inhibition of adenylate cyclase ensues, owing to the increase in lipid order and promotion of protein-protein and specific cholesterol-phospholipid interactions.


Cutaneous plasmacytosis: report of 6 cases with or without systemic involvement.
Cutaneous plasmacytosis and systemic plasmacytosis are rare entities arising primarily in patients of Japanese descent. The origin and exact pathogenesis are poorly understood. We sought to determine clinicopathologic features of cutaneous and systemic plasmacytosis. We describe the clinicopathologic features of 6 patients with cutaneous plasmacytosis with or without systemic involvement (male:female = 3:1; mean age: 49.7 years; median age: 50.5 years; age range: 29-64 years). Patients presented clinically with multiple, red-brown infiltrated plaques and flat tumors, mainly located on the trunk. Histology revealed in all cases the presence of clusters of mature plasma cells within the dermis. Lymphoid follicles with reactive germinal centers were seen in 3 cases. Five cases showed the expected polyclonal expression of immunoglobulin light chain by the plasma cells, but monoclonality was observed in 1 case, thus showing overlapping features with cutaneous marginal zone lymphoma. One patient revealed overlapping features with multicentric Castleman disease. This was a retrospective study on a relatively small number of patients. Despite typical clinical presentation, some of our patients presented with histopathologic and immunohistochemical features that deviated from the conventional appearance. Our observation confirms and expands previous observations of this elusive entity, suggesting that the spectrum of clinicopathologic presentations may be wider than previously recognized.


Wavelength shift analysis: a simple method to determine the contribution of hemoglobin and myoglobin to in vivo optical spectra.
The ability to quantify the contributions of hemoglobin (Hb) and myoglobin (Mb) to in vivo optical spectra has many applications for clinical and research use such as noninvasive measurement of local tissue O(2) uptake rates and regional blood content. Recent work has demonstrated an approach to independently measure oxygen saturations of Hb and Mb in optical spectra collected in vivo. However, the utility of this approach is limited without information on tissue concentrations of these species. Here we describe a strategy to quantify the contributions of Hb and Mb to in vivo optical spectra. We have found that the peak position of the deoxy-heme peak around 760 nm in the optical spectra of the deoxygenated tissue is a linear function of the relative contributions of Hb and Mb to the optical spectra. Therefore, analysis of this peak position, hereafter referred to as wavelength shift analysis, reveals the relative concentration of Hb to Mb in solutions and intact tissue. Biochemical analysis of muscle homogenates confirmed that the wavelength shift of the combined Hb/Mb peak in in vivo spectra reflects the ratio of concentrations (Hb/Mb) in muscle. The importance of quantifying the Hb contribution is illustrated by our data demonstrating that Hb accounts for approximately 80% of the optical signal in mouse skeletal muscle but only approximately 20% in human skeletal muscle. This advance will facilitate comparison of the metabolic properties between individual muscles and provides a fully noninvasive approach to measuring local respiration that can be adapted for clinical use.


Personal Protective Equipment-Related Problems Experienced by Healthcare Workers, Solutions, and Recommendations: A Qualitative Study.
To understand the problems experienced by healthcare workers (HCWs) who used personal protective equipment (PPE) on their face during the COVID-19 pandemic, their interventions to prevent these problems, and their recommendations for improving the quality of PPE. This descriptive and qualitative study included HCWs (N = 29) from health institutions at different levels in Turkey. Researchers collected data using a semistructured data collection form (13 items) and in-depth individual interviews. Data were analyzed with descriptive statistics and qualitative inductive content analysis. Of the 29 participants, 15 (51.7%) were women, and 18 (62.1%) were nurses. Participants' answers regarding problems related to PPE use were grouped into four main categories, answers regarding the prevention of these problems were grouped into three main categories, and answers regarding improving the quality of PPE were grouped into three main categories. Skin concerns were the most commonly reported problems related to PPE, and interventions to prevent these problems primarily related to skin protection and care. Recommendations to improve the quality of PPE focused on using materials for masks and face shields that reduce pressure and friction; participants also suggested that face shields be produced in sterile and disposable packages. This research indicates that HCWs need support and they are able to create individual solutions for the problems with PPE that they experience. Skin-friendly PPE that ensures the safety and comfort of HCWs should be produced, and hospitals should develop policies for institutional use to prevent PPE injury.


Comparison of IMRT techniques in the radiotherapeutic management of head and neck cancer: is tomotherapy "better" than step-and-shoot IMRT?
Currently, the most common method of delivering intensity-modulated radiotherapy (IMRT) is through step-and-shoot, segmental multi-leaf collimator (SMLC)-based techniques. Although rotational delivery methods such as helical tomotherapy (HT) have been proposed as offering advantages in the treatment of head and neck cancer, a lack of clinical data exists on its potential utility. This study compared dosimetric, clinical, and quality-of-life endpoints among 149 patients treated by HT and SMLC-IMRT for head and neck cancer. Dosimetric analysis revealed that the use of HT resulted in significant improvements with respect to mean dose (23.5 versus 27.9 Gy, p = 0.03) and V30 (30.1 versus 43.9 Gy, p = 0.01) to the contralateral (spared) parotid gland. However, the incidence of grade 3+ xerostomia in the late setting was 10% and 8% among patients treated by HT and SMLC-IMRT, respectively (p = 0.46). There were no significant differences in any of the quality of life endpoints among patients treated by HT and SMLC-IMRT (p > 0.05, for all). Acknowledging the biases inherent in this retrospective analysis, we found that the dosimetric advantages observed with HT compared to SMLC-IMRT failed to translate into significant improvements in clinical outcome. Prospective studies are needed to further evaluate how HT may affect the therapeutic ratio.


The components of kin competition.
It is well known that competition among kin alters the rate and often the direction of evolution in subdivided populations. Yet much remains unclear about the ecological and demographic causes of kin competition, or what role life cycle plays in promoting or ameliorating its effects. Using the multilevel Price equation, I derive a general equation for evolution in structured populations under an arbitrary intensity of kin competition. This equation partitions the effects of selection and demography, and recovers numerous previous models as special cases. I quantify the degree of kin competition, α, which explicitly depends on life cycle. I show how life cycle and demographic assumptions can be incorporated into kin selection models via α, revealing life cycles that are more or less permissive of altruism. As an example, I give closed-form results for Hamilton's rule in a three-stage life cycle. Although results are sensitive to life cycle in general, I identify three demographic conditions that give life cycle invariant results. Under the infinite island model, α is a function of the scale of density regulation and dispersal rate, effectively disentangling these two phenomena. Population viscosity per se does not impede kin selection.


Accurate continuous drug delivery at low infusion rate with a novel microvolumetric infusion pump (MVIP): pump design, evaluation and comparison to the current standard.
Infusion devices for continuous and precise drug administration are indispensable tools in anaesthesia and critical care medicine. Problems such as start-up delays, non-continuous flow and susceptibility to hydrostatic pressure changes at low infusion rates resulting in accidental bolus release or prolonged flow interruption are inherent to current infusion technology. In order to improve precise drug delivery, an innovative technical concept has been realised in a novel microvolumetric infusion pump (MVIP) device. The MVIP principle includes repeated filling and emptying of a non-compliant microsyringe without the use of valves. The performance of the MVIP prototype has been evaluated and compared with standard syringe infusion pump assemblies. The novel MVIP concept has thereby proven to eliminate most problems during infusion start-up, steady state flow and vertical pump displacement, and has the potential of revolutionising infusion technology and setting a new dimension in patient safety.


Light scattering through the graphene oxide liquid crystal in a micro-channel.
In this paper, we examine the light scattering by the flow of levitated flakes in a micro-channel to characterize the tunable functionality of the graphene oxide liquid crystal in the nematic phase. Light interaction with the mentioned material is decomposed to the scattered and transmitted parts and they can determine the orientation of the flakes. Our results demonstrate that, pumping the graphene oxide sample through the micro-channel leads to increase the amplitude of scattered light. The time averaged of scattered light intensity grows by increasing volume fraction. We also find that, the higher volume fraction, the sooner reaching to saturated normalized scattered intensity is. To get deep insight about our experimental results, we rely on the general theoretical properties of the light scattering cross-section incorporating the fluctuation of director vector and dielectric tensor. Our proposal is a promising approach to carry out the mechanical-hydrodynamical approach for controlling the orientation of a typical liquid crystal.


An examination of the needs of families with a brain-injured child.
Data from a questionnaire designed to assess the long-term needs of caregivers of children with brain injury were analyzed. The goals of this study were (1) to identify those needs most important to caregivers, (2) to identify those important needs that were least likely to be met, and (3) to identify characteristics of caregivers that predicted success in having needs met. Caregivers tended to endorse needs focused on acquiring information regarding their child's condition more often than needs to obtain resource or emotional support. On the average, 22 of the 39 needs sampled were considered important to caregivers, while only an average of 9 needs were rated as being met. While there were no strong demographic predictors of success in having important needs met, a regression analysis indicated that respondent gender and age, the number of behavioral problem, exhibited by the brain-injured child, and the Family Crisis Oriented Personal Evaluation Scales (FCOPES) reframing subscale were related to having important needs met. This study indicates that there are significant gaps between what caregivers perceive as important needs and the extent to which caregivers perceive their needs being met.


The effects of estrogen on pulmonary artery vasoreactivity and hypoxic pulmonary vasoconstriction: potential new clinical implications for an old hormone.
Recent research recognizes gender as a major factor determining the outcomes in trauma, ischemia/reperfusion, shock, and sepsis. In particular, estrogen has been demonstrated to exert protective effects in these settings. The effects of estrogens on the pulmonary vasculature are potent and complex yet not fully understood. A better mechanistic understanding may allow for future therapeutic interventions in pulmonary hypertensive crises after cardiac surgery and during acute lung injury as well as in patients with pulmonary arterial hypertension. We searched PubMed for articles in the English language by using the search words pulmonary hypertension, hypoxic pulmonary vasoconstriction, estrogen, estradiol, inflammation, acute injury, ischemia reperfusion, sepsis, trauma, and burns. These were used in various combinations. We read the abstracts of the relevant titles to confirm their relevance, and the full articles were then extracted. References from extracted articles were checked for any additional relevant articles. Estrogen plays a critical role in the improved outcomes in the settings of trauma, shock, sepsis, myocardial ischemia/reperfusion, and acute lung injury. Several new mechanisms of action have been identified. In the pulmonary vasculature, estrogen causes vasodilation and attenuates the vasoconstrictor response to various stimuli, including hypoxia. This is mediated by increased levels of prostacyclin and nitric oxide as well as decreased levels of endothelin-1. In addition, effects on intracellular signaling pathways and several kinases as well as anti-inflammatory mechanisms may contribute as well. Recent studies suggest the importance of acute, nongenomic effects. Estrogen exerts a variety of nongenomic actions, which may allow for future therapeutic interventions in pulmonary vascular disease.


Molecular mechanisms of pathogenicity: how do pathogenic microorganisms develop cross-kingdom host jumps?
It is common knowledge that pathogenic viruses can change hosts, with avian influenza, the HIV, and the causal agent of variant Creutzfeldt-Jacob encephalitis as well-known examples. Less well known, however, is that host jumps also occur with more complex pathogenic microorganisms such as bacteria and fungi. In extreme cases, these host jumps even cross kingdom of life barriers. A number of requirements need to be met to enable a microorganism to cross such kingdom barriers. Potential cross-kingdom pathogenic microorganisms must be able to come into close and frequent contact with potential hosts, and must be able to overcome or evade host defences. Reproduction on, in, or near the new host will ensure the transmission or release of successful genotypes. An unexpectedly high number of cross-kingdom host shifts of bacterial and fungal pathogens are described in the literature. Interestingly, the molecular mechanisms underlying these shifts show commonalities. The evolution of pathogenicity towards novel hosts may be based on traits that were originally developed to ensure survival in the microorganism's original habitat, including former hosts.


Private Equity in Ophthalmology and Optometry: Analysis of Acquisitions from 2012 through 2019 in the United States.
To identify temporal and geographic trends in private equity (PE)-backed acquisitions of ophthalmology and optometry practices in the United States. A cross-sectional study using private equity acquisition and investment data from January 1, 2012, through October 20, 2019. A total of 228 PE acquisitions of ophthalmology and optometry practices in the United States between 2012 and 2019. Acquisition and financial investment data were compiled from 6 financial databases, 4 industry news outlets, and publicly available press releases from PE firms or platform companies. Yearly trends in ophthalmology and optometry acquisitions, including number of total acquisitions, clinical locations, and providers of acquired practices as well as subsequent sales, median holding period, geographic footprint, and financing status of each platform company. A total of 228 practices associated with 1466 clinical locations and 2146 ophthalmologists or optometrists were acquired by 29 PE-backed platform companies. Of these acquisitions, 127, 9, and 92 were comprehensive or multispecialty, retina, and optometry practices, respectively. Acquisitions increased rapidly between 2012 and 2019: 42 practices were acquired between 2012 and 2016 compared to 186 from 2017 through 2019. Financing rounds of platform companies paralleled temporal acquisition trends. Three platform companies, comprising 60% of platforms formed before 2016, were subsequently sold or recapitalized to new PE investors by the end of this study period with a median holding period of 3.5 years. In terms of geographic distribution, acquisitions occurred in 40 states with most PE firms developing multistate platform companies. New York and California were the 2 states with the greatest number of PE acquisitions with 22 and 19, respectively. Private equity-backed acquisitions of ophthalmology and optometry practices have increased rapidly since 2012, with some platform companies having already been sold or recapitalized to new investors. Additionally, private equity-backed platform companies have developed both regionally focused and multistate models of add-on acquisitions. Future research should assess the impact of PE investment on patient, provider, and practice metrics, including health outcomes, expenditures, procedural volume, and staff employment.


Plasticity in leaf-level water relations of tropical rainforest trees in response to experimental drought.
The tropics are predicted to become warmer and drier, and understanding the sensitivity of tree species to drought is important for characterizing the risk to forests of climate change. This study makes use of a long-term drought experiment in the Amazon rainforest to evaluate the role of leaf-level water relations, leaf anatomy and their plasticity in response to drought in six tree genera. The variables (osmotic potential at full turgor, turgor loss point, capacitance, elastic modulus, relative water content and saturated water content) were compared between seasons and between plots (control and through-fall exclusion) enabling a comparison between short- and long-term plasticity in traits. Leaf anatomical traits were correlated with water relation parameters to determine whether water relations differed among tissues. The key findings were: osmotic adjustment occurred in response to the long-term drought treatment; species resistant to drought stress showed less osmotic adjustment than drought-sensitive species; and water relation traits were correlated with tissue properties, especially the thickness of the abaxial epidermis and the spongy mesophyll. These findings demonstrate that cell-level water relation traits can acclimate to long-term water stress, and highlight the limitations of extrapolating the results of short-term studies to temporal scales associated with climate change.


Streptococci isolated from the bloodstream and gingival crevice of man.
One hundred and twenty six strains of streptococci isolated from the bloodstreams of 123 hospital in-patients--55 with endocarditis--and 255 strains isolated from the gingival crevices of 66 volunteers were characterised. Species isolated were Streptococcus mitior, S. sanguis, undifferentiated viridans streptococci, S. salivarius, S. milleri, S. mutans, S. bovis and S. faecalis. There was no significant difference between the distribution of species in blood and in the gingival crevice. S. mitior and S. sanguis were found less frequently in blood than their presence in the gingival crevice would have suggested, whereas S. milleri was found more frequently. This may indicate that S. milleri is more invasive or that it enters the bloodstream from sources other than the gingival crevice.


Antioxidant effect of onion oil (Allium cepa. Linn) on the damages induced by nicotine in rats as compared to alpha-tocopherol.
The beneficial effects of onion oil as an antioxidant has been assessed in nicotine administered rats by studying whether the peroxidative damage caused by nicotine can be effectively combated with the onion oil and the effects compared to vitamin E, a highly efficient antioxidant. Lipid peroxidation products and antioxidant defence system have been studied in liver, lungs, and heart. The rats were injected with nicotine (0.6 mg/kg body wt.) and simultaneously given onion oil (100 mg/kg body wt.) or vitamin E (100 mg/kg body wt.) for 21 days. Concentration of free fatty acids, TBA reactive substances (TBARS), conjugated dienes and hydroperoxides were significantly increased in the tissues of nicotine treated rats as compared to normal rats. Onion oil supplemented to nicotine treated rats showed increased resistance to lipid peroxidation and the effect was near to that of vitamin E fed rats. The activity of catalase and superoxide dismutase decreased in nicotine treated rats. Antioxidants-glutathione content, vitamin C and retinol showed no significant difference but liver vitamin E content significantly decreased in nicotine treated rats. On onion oil or vitamin E supplementation, the concentration of antioxidants were significantly raised in all the tissues studied, however, a significantly increased concentration of glutathione, vitamin E and retinol was noticed in vitamin E+nicotine treated rats. Thus, these results indicate that onion oil is an effective antioxidant against the oxidative damage caused by nicotine as compared to vitamin E.


Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillar group-C Legg-Calvé-Perthes disease.
Results from 26 hips of 24 Legg-Calvé-Perthes disease patients were evaluated retrospectively. There were 22 male and two female patients in the study group. The mean age of the patients was 8.3 years and the mean follow-up was 13.03 years. All the patients were older than 6 years of age and all of them had lateral pillar group C hips. The patients were treated with intertrochanteric uniplanar varus osteotomy. All the patients were mature at the time of the last evaluation. Radiological end results were evaluated according to Stulberg's classification. Six hips healed with spherical congruency (Stulberg class 1 or 2), 19 with aspherical congruency (Stulberg class 3 or 4) and one with aspherical incongruency (Stulberg class 5). Six of 14 hips treated before 9 years of age healed with spherical congruency but all hips treated after 9 years of age healed with Stulberg class 3, 4 or 5 results. Trochanteric overgrowth was evident in 20 hips. The results of this radiological outcome study showed that Herring class C hips treated with proximal femoral varus osteotomy had a poor outcome, especially after 9 years of age in this group of patients.


Antiretroviral treatment interruption and loss to follow-up in two HIV cohorts in Australia and Asia: implications for 'test and treat' prevention strategy.
Both antiretroviral treatment interruption (TI) and cessation have been strongly discouraged since 2006. We describe the incidence, duration, and risk factors for TI and loss-to-follow-up (LTFU) rates across 13 countries. All 4689 adults (76% men) in two large HIV cohorts in Australia and Asia commencing combination antiretroviral therapy (ART) to March 2010 were included. TI was defined by ART cessation >30 days, then recommencement, and loss to follow-up (LTFU) by no visit since 31 March 2009 and no record of death. Survival analysis and Poisson regression methods were used. With median follow-up of 4.4 years [interquartile range (IQR):2.1-6.5], TI incidence was 6.7 per 100 person years (PY) (95% CI:6.1-7.3) pre-2006, falling to 2.0 (95% CI:1.7-2.2) from 2006 (p<0.01). LTFU incidence was 3.5 per 100 PY (95% CI:3.1-3.9) pre-2006, and 4.1 (95% CI:3.5-4.9) from 2006 (p=0.22). TIs accounted for 6.4% of potential time on ART pre-2006 and 1.2% from 2006 (p<0.01), and LTFU 4.7% of potential time on ART pre-2006 and 6.6% from 2006 (p<0.01). Median TI duration was 163 (IQR: 75-391) days pre-2006 and 118 (IQR: 67-270) days from 2006 (p<0.01). Independent risk factors for the first TI were: Australia HIV Observational Database participation; ART initiation pre-2006; ART regimens including stavudine and didanosine; three nucleoside analogue reverse transcriptase inhibitors; ≥7 pills per day; and ART with food restrictions (fasting or with food). In conclusion, since 2006, 7.8% of patients had significant time off treatment, which has the potential to compromise any 'test and treat' policy as during the interruption viral load will rebound and increase the risk of transmission.


Peroneus longus tendinitis: a possible biomechanical etiology.
Tendinitis of the foot and ankle is becoming increasingly common, or at least more commonly recognized, with the recent widespread interest in running. In runners seen in our clinics we have encountered several cases of peroneus longus tendinitis. The authors present a case report and possible biomechanical etiology for peroneus longus tendinitis.


Abnormal chemokine-induced responses of immature and mature hematopoietic cells from motheaten mice implicate the protein tyrosine phosphatase SHP-1 in chemokine responses.
Chemokines regulate a number of biological processes, including trafficking of diverse leukocytes and proliferation of myeloid progenitor cells. SHP-1 (Src homology 2 domain tyrosine phosphatase 1), a phosphotyrosine phosphatase, is considered an important regulator of signaling for a number of cytokine receptors. Since specific tyrosine phosphorylation of proteins is important for biological activities induced by chemokines, we examined the role of SHP-1 in functions of chemokines using viable motheaten (me(v)/me(v)) mice that were deficient in SHP-1. Chemotactic responses to stromal call-derived factor 1 (SDF-1), a CXC chemokine, were enhanced with bone marrow myeloid progenitor cells as well as macrophages, T cells, and B cells from me(v)/me(v) versus wild-type (+/+) mice. SDF-1-dependent actin polymerization and activation of mitogen-activated protein kinases were also greater in me(v)/me(v) versus +/+ cells. In contrast, immature subsets of me(v)/me(v) bone marrow myeloid progenitors were resistant to effects of a number of chemokines that suppressed proliferation of +/+ progenitors. These altered chemokine responses did not appear to be due to enhanced expression of CXCR4 or lack of chemokine receptor expression. However, expression of some chemokine receptors (CCR1, CCR2, CCR3, and CXCR2) was significantly enhanced in me(v)/me(v) T cells. Our results implicate SHP-1 involvement in a number of different chemokine-induced biological activities.


Genome-wide sexually antagonistic variants reveal long-standing constraints on sexual dimorphism in fruit flies.
The evolution of sexual dimorphism is constrained by a shared genome, leading to 'sexual antagonism', in which different alleles at given loci are favoured by selection in males and females. Despite its wide taxonomic incidence, we know little about the identity, genomic location, and evolutionary dynamics of antagonistic genetic variants. To address these deficits, we use sex-specific fitness data from 202 fully sequenced hemiclonal Drosophila melanogaster fly lines to perform a genome-wide association study (GWAS) of sexual antagonism. We identify approximately 230 chromosomal clusters of candidate antagonistic single nucleotide polymorphisms (SNPs). In contradiction to classic theory, we find no clear evidence that the X chromosome is a hot spot for sexually antagonistic variation. Characterising antagonistic SNPs functionally, we find a large excess of missense variants but little enrichment in terms of gene function. We also assess the evolutionary persistence of antagonistic variants by examining extant polymorphism in wild D. melanogaster populations and closely related species. Remarkably, antagonistic variants are associated with multiple signatures of balancing selection across the D. melanogaster distribution range and in their sister species D. simulans, indicating widespread and evolutionarily persistent (about 1 million years) genomic constraints on the evolution of sexual dimorphism. Based on our results, we propose that antagonistic variation accumulates because of constraints on the resolution of sexual conflict over protein coding sequences, thus contributing to the long-term maintenance of heritable fitness variation.


An alternative mechanism for skeletal muscle dysfunction in long-term post-viral lung disease.
Chronic lung disease is often accompanied by disabling extrapulmonary symptoms, notably skeletal muscle dysfunction and atrophy. Moreover, the severity of respiratory symptoms correlates with decreased muscle mass and in turn lowered physical activity and survival rates. Previous models of muscle atrophy in chronic lung disease often modeled COPD and relied on cigarette smoke exposure and LPS-stimulation, but these conditions independently affect skeletal muscle even without accompanying lung disease. Moreover, there is an emerging and pressing need to understand the extrapulmonary manifestations of long-term post-viral lung disease (PVLD) as found in Covid-19. Here, we examine the development of skeletal muscle dysfunction in the setting of chronic pulmonary disease using a mouse model of PVLD caused by infection due to the natural pathogen Sendai virus. We identify a significant decrease in myofiber size when PVLD is maximal at 49 d after infection. We find no change in the relative types of myofibers, but the greatest decrease in fiber size is localized to fast-twitch type IIB myofibers based on myosin heavy chain immunostaining. Remarkably, all biomarkers of myocyte protein synthesis and degradation (total RNA, ribosomal abundance, and ubiquitin-proteasome expression) were stable throughout the acute infectious illness and chronic post-viral disease process. Together, the results demonstrate a distinct pattern of skeletal muscle dysfunction in a mouse model of long-term PVLD. The findings thereby provide new insight into prolonged limitations in exercise capacity in patients with chronic lung disease after viral infections and perhaps other types of lung injury.


The effects of chronic high dose androgen or estrogen treatment on the human prostate [corrected].
Prostate development and disease are androgen dependent. However, the nature of hormonal effects on the prostate of healthy young men is not clear. We, therefore, measured prostate size in males chronically exposed to high doses of androgens (AS; habitual anabolic steroid abusers; n = 15) or estrogens (E; male to female transsexuals; n = 11) and compared the results with those in age-matched healthy eugonadal men without known prostate disorders. Prostate size was measured by planimetric ultrasound as cross-sectional areas and maximal dimensions in three orthogonal dimensions with a 7.5-megahertz B-mode sector scanner biplane in a transrectal transducer at 2.5 mm steps from the base to the apex of prostate. Total prostate volume (TPV) was reconstructed from planimetric sections, central prostate volume (CPV) was calculated by the ellipsoidal formula from the appropriate three maximum dimensions, and peripheral prostate volume was determined by the difference between TPV and CPV. Compared with age-matched controls, TPV was normal (-2%) in AS (P = 0.752) and reduced by 31% in E (P = 0.002), whereas CPV was increased by 20% in AS (P = 0.002) and reduced by 46% in E (P = 0.002), and the ratio of CPV/peripheral prostate volume was increased by 77% in AS (P < 0.001) and decreased by 33% in E (P = 0.047). Blood sex hormone-binding globulin was elevated by nearly 500% in E (P < 0.001), but was reduced by 47% in AS (P = 0.003). Prostate-specific antigen was normal (-6%) in AS (P = 0.799) and decreased by 86% in E (P = 0.002). Prostatic acid phosphatase was increased by 26% in AS (P = 0.007), but was unchanged (-28%) in E (P = 0.106). Total and free testosterone levels were reduced to castrate levels in E, whereas LH, FSH, and total testosterone levels were significantly reduced in AS. We conclude that in the human prostate of young men, CPV is more hormonally sensitive than TPV, and during high dose treatment, CPV is preferentially increased by chronic androgen treatment and decreased by chronic estrogen treatment. The reduction of TPV by estrogens was less than expected if solely attributable to inhibition of endogenous gonadotropin and testosterone secretion, suggesting that estrogens also have a positive effect on the normal human prostate. The reversibility and long term significance of androgen-induced stimulation of CPV and, in particular, its relationship to the onset and severity of benign prostatic hyperplasia remain to be clarified.


Transcriptome Profiling of 'Candidatus Liberibacter asiaticus' in Citrus and Psyllids.
'Candidatus Liberibacter asiaticus' (Las) is an emergent bacterial pathogen that is associated with the devastating citrus huanglongbing (HLB). Vectored by the Asian citrus psyllid, Las colonizes the phloem tissue of citrus, causing severe damage to infected trees. So far, cultivating pure Las culture in axenic media has not been successful, and dual-transcriptome analyses aiming to profile gene expression in both Las and its hosts have a low coverage of the Las genome because of the low abundance of bacterial RNA in total RNA extracts from infected tissues. Therefore, a lack of understanding of the Las transcriptome remains a significant knowledge gap. Here, we used a bacterial cell enrichment procedure and confidently determined the expression profiles of approximately 84% of the Las genes. Genes that exhibited high expression in citrus include transporters, ferritin, outer membrane porins, specific pilins, and genes involved in phage-related functions, cell wall modification, and stress responses. We also found 106 genes to be differentially expressed in citrus versus Asian citrus psyllids. Genes related to transcription or translation and resilience to host defense response were upregulated in citrus, whereas genes involved in energy generation and the flagella system were expressed to higher levels in psyllids. Finally, we determined the relative expression levels of potential Sec-dependent effectors, which are considered as key virulence factors of Las. This work advances our understanding of HLB biology and offers novel insight into the interactions of Las with its plant host and insect vector.


Accelerated functional losses in ageing congenital Minamata disease patients.
Severe methylmercury poisoning occurred in Minamata and neighboring communities in Japan during the 1950s and 1960s. A considerable number of children were born with conditions resembling cerebral palsy, later known as congenital Minamata disease. Although surviving patients are now in their 50s or 60s, few assessments of functional capacities in daily living have been performed. We assessed the changes in Activities of Daily Living (ADL) status of 11 patients over a 10-year period. For assessment of ADL, we applied the Barthel Index (BI) and the Functional Independence Measure (FIM). We obtained the patients' current and previous status information by interview of their caregivers or from medical records and then compared them using the Wilcoxon signed-rank test. Both ADL measures, including the status related with cognition, had significantly declined during the 10 years. The same was true for the overall BI score (p = 0.01). Similarly, all functions of the FIM scores declined (i.e., self-care, sphincter control, mobility, locomotion, communication, and social cognition), and for FIM physical and cognition subscores as well as FIM total score, the declines were statistically significant. The present study indicates that the ADL status of congenital Minamata disease patients, now in their 50s or 60s, has substantially declined during the last 10 years; a decline that was much steeper in comparison with expectation in subjects of similar ages, but in agreement with accelerated ageing also reported in subjects with cerebral palsy, past polio infection, or epilepsy. While already incapacitated due to the prenatal methylmercury poisoning, their accelerated ageing may suggest that patients with developmental neurotoxicity have less reserve capacity to compensate for normal ageing. These patients will need continuous and increasing medical and welfare support in the community.


Preparation of a decadeoxyribonucleotide helix for studies by nuclear magnetic resonance.
A self-complementary decadeoxyribonucleotide d-CpCpApApGpCpTpTpGpG was chemically synthesized by a procedure based on the phosphotriester approach. This procedure was carefully monitored and appropriately modified to ensure the purity of oligomer components at each step of the synthetic scheme. Extensive use was made of both analytical and preparative high-pressure liquid chromatography to purify and characterize the decamer and its constituent oligonucleotides. The final product (1318 A257 units or 16.5 mumol) was obtained in high purity and sufficient quantity for extensive physical studies by UV, CD, and NMR spectroscopy. Our preliminary results show that at a strand concentration of 1.3 X 10(-5) M and in 0.10 M sodium chloride and 0.01 M sodium phosphate buffer, pH 7.0, the decamer duplex has a Tm at 47 degrees C. The CD spectrum of this decamer duplex is similar to that of B-form DNA. All the resonances of the nonexchangeable base protons of the decamer are well resolved in the 1H NMR spectrum, when the single-stranded form was examined by using a 360-MHz spectrometer and when the duplex form was examined by using a 600-MHz spectrometer. These base proton resonances have been tentatively assigned by using the incremental assignment technique. Although the decamer duplex serves as a substrate for AluI restriction endonuclease, it is not cleaved by HindIII endonuclease.


Inferring Pathogen Type Interactions Using Cross-sectional Prevalence Data: Opportunities and Pitfalls for Predicting Type Replacement.
Many multivalent vaccines target only a subset of all pathogenic types. If vaccine and nonvaccine types compete, vaccination may lead to type replacement. The plausibility of type replacement has been assessed using the odds ratio (OR) of co-infections in cross-sectional prevalence data, with OR > 1 being interpreted as low risk of type replacement. The usefulness of the OR as a predictor for type replacement is debated, as it lacks a theoretical justification, and there is no framework explaining under which assumptions the OR predicts type replacement. We investigate the values that the OR can take based on deterministic S usceptible- I infected- S usceptible and S usceptible- Infected- Recovered- S usceptible multitype transmission models. We consider different mechanisms of type interactions and explore parameter values ranging from synergistic to competitive interactions. We find that OR > 1 might mask competition because of confounding due to unobserved common risk factors and cross-immunity, as indicated by earlier studies. We prove mathematically that unobserved common risk factors lead to an elevation of the OR, and present an intuitive explanation why cross-immunity increases the OR. We find that OR < 1 is predictive for type replacement in the absence of immunity. With immunity, OR < 1 remains predictive under biologically reasonable assumptions of unidirectional interactions during infection, and an absence of immunity-induced synergism. Using the OR in cross-sectional data to predict type replacement is justified, but is only unambiguous under strict assumptions. An accurate prediction of type replacement requires pathogen-specific knowledge on common risk factors and cross-immunity.


Segmentation and surface reconstruction of the detailed ear structures, identified in sectioned images.
The structure of the ear, which intervenes between gross anatomy and histology in size, can be best understood by means of three-dimensional (3D) surface models on a computer. Furthermore, surface models are the source of interactive simulation for clinical trials, such as tympanoplasty. The objective of this research was to elaborate the surface models of detailed ear structures, which contribute to learning anatomy or the practice of otology. We produced sectioned images of a cadaver head (pixel size, 0.1 mm; 48-bit color). In the sectioned images, the external, middle, and internal ear structures and other related components were delineated on Photoshop to acquire segmented images at 0.5-mm intervals. Segmented images of each structure were stacked, and the surface was reconstructed to generate a 3D-surface model on commercial software. Thirty surface models showed fine ear topographic anatomy (e.g., semicircular ducts), as expected. Herein, we present the corresponding sectioned images, segmented images, and surface models of ear structures that will be released together. It is hoped that these image data will stimulate the development of medical simulations. The efficient technique of segmentation and surface reconstruction enables the manufacture of surface models from other serial images (e.g., CTs and MRIs).


Comprehensive geriatric assessment in female elderly patients with Alzheimer disease and other types of dementia.
The most visible manifestation of dementia is the progressive inability to activities of daily living (ADL) and to instrumental activities of daily living (IADL). The comprehensive geriatric assessment (CGA) is the validated and recommended instrument to a correct evaluation and decision making in elderly patients. To judge if the decline in cognitive functions is associated with a worsening in functional, emotional and clinical status measured by CGA, we also compared CGA in the same patients stratified for mild, moderate and severe dementia. From September 2004 to November 2005 we studied 47 institutionalized female patients with Alzheimer's disease (AD) and other types of dementia. Mean age was 83.70+/-0.88 years (range 70-101). Their multidimensional evaluation was performed by the CGA. We evaluated geriatric syndromes (AGS, 2004), polypharmacy, frailty, hemoglobin (Hb), serum creatinine (CR) and white blood cells (WBC). We stratified the population in 3 groups for the mini mental state examination (MMSE): severe (MMSE 0-9; 5 patients), moderate (MMSE 10-29; 23 patients) and mild dementia group (MMSE 20-30; 19 patients), and searched for statistical differences in the parameters of CGA. MMSE was significantly related to dependence in ADL (mean=x=1.85), IADL (x=0.57), cumulative illness rating scale-geriatrics (CIRS-G) (x=9.55), geriatric depression scale (GDS) (x=8.71), geriatric syndromes (x=2.49), Hb, CR, WBC and number of drugs (x=6.51, range 2-15) (p=0.001). MMSE low score was also correlated with a worse mini nutritional assessment (MNA) (x=19.5; p=0.003). Frail patients were 61.7%. We found a statistically significant difference in the prevalence of geriatric syndromes between mild vs. moderate dementia group (p=0.02). Mild vs. moderate group, and moderate vs severe group were significantly different concerning Hb levels (p=0.009 and 0.002, respectively). Patients with severe cognitive impairment are more likely to be dependent at ADL and IADL; to present a larger number of comorbidity and geriatric syndromes; to have lower !evels of Hb and higher levels of CR; to be in a worse nutritional status and to take a larger number of drugs. Polypharmacy maybe related to high comorbidity but the risk of irrational drug use should be evaluated. We suggest single testing with CGA as an effective tool providing a comprehensive assessment of elderly, and able to detect unaddressed corrigible problems.


Modeling and Control of Adjustable Articulated Parallel Compliant Actuation Arrangements in Articulated Robots.
Considerable advances in robotic actuation technology have been made in recent years. Particularly the use of compliance has increased, both as series elastic elements as well as in parallel to the main actuation drives. This work focuses on the model formulation and control of compliant actuation structures including multiple branches and multiarticulation, and significantly contributes by proposing an elegant modular formulation that describes the energy exchange between the compliant elements and articulated multibody robot dynamics using the concept of power flows, and a single matrix that describes the entire actuation topology. Using this formulation, a novel gradient descent based control law is derived for torque control of compliant actuation structures with adjustable pretension, with proven convexity for arbitrary actuation topologies. Extensions toward handling unidirectionality of elastic elements and joint motion compensation are also presented. A simulation study is performed on a 3-DoF leg model, where series-elastic main drives are augmented by parallel elastic tendons with adjustable pretension. Two actuation topologies are considered, one of which includes a biarticulated tendon. The data demonstrate the effectiveness of the proposed modeling and control methods. Furthermore, it is shown the biarticulated topology provides significant benefits over the monoarticulated arrangement.


Some characteristics of the participation of lymphocytes in non-immune inflammation.
Leucopenic rats were injected i.v. with either allogeneic or syngeneic lymphocyte suspensions and their capacity to respond to carrageenin tested at various intervals after the injection of the cells. The carrageenin-induced inflammatory response, which is characteristically attenuated in leucopenic animals, was partially but none the less definitely restored when allogeneic cells were transfused 20 min before the irritant, and less so when they were given 1 or 2 h before. Syngeneic cells were effective in restoring this response up to 2 h after injection. Only a small fraction of the exogenous cells, either allogeneic or syngeneic, remained in the blood, and this for short intervals. One hour after administration of cell suspensions blood leucocyte counts again attained previous values. The same rate of disappearance of the cells from blood was observed in splenectomized rats. Removal of the cells from circulation was thought to reflect "homing" into lymphoid tissues and other tissues, but not selectively in the spleen. Lymphocyte constituents, obtained by cell disintegration and injected i.v. into leucopenic rats, did not cause any change in blood leucocyte counts and yet restored the previously inhibited inflammatory response to carrageenin, as much as the viable cells. It is suggested that inflammation-producing materials, either deposited in tissues or formed or transformed at a site of injury, might gain access to the lymphatics during the early stages of a non-immune, inflammatory response, and "stimulate" lymphoid cells in adjacent lymphoid tissues either to release pro-inflammatory factors or to migrate to the site of injury, where they would exert pro-inflammatory activities. Apparently, only a small number of these cells in involved in the response.


[Psychophysics of sweet taste. I. Goals and methods of investigation].
With a view to the solution of problems concerned with the consumer's acceptance of foods in which saccharose had been substituted, a discussion is opened on psychologic and physiologic aspects of the measurability of sensory stimulus-sensation relations. The classic method for measuring taste is the determination of the taste discrimination threshold which is also termed least discernible difference. In the lat years, the discrimination threshold has been determined and calculated mainly as the mean concentration (stimulus) difference resulting from the distribution of the tasters according to their efficiency (probit analysis). In contrast, the new method, which is described in detail, is based on the dependence of the probability of a perception of difference upon the intensity which is linear and represents the initial course of a stimulus-response curve. Differences in efficiency in the group of tasters, which is assumed to be homogeneous, are included in the variance of difference frequencies found. The control of the course of the test by sequential analysis and the binomial weighting of the probabilities obtained allow to perform calculations of the discrimination threshold which are largely free from systematic errors; this discrimination threshold is defined as the concentration difference that engenders the arbitrarily defined alternative probability of Pa = 0.75. To minimize the risk of overrating the measurement result, it is suggested to calculate in addition, on the basis of the binomial distribution, the confidence limits of the discrimination threshold. Furthermore, the constant stimulus method for determining the perception of two stimulus intensities of different sweetening agents is adapted, as to performance and calculation, to the new aspects in discrimination threshold determination.


Carbon nanotube-based bioceramic grafts for electrotherapy of bone.
Bone complexity demands the engineering of new scaffolding solutions for its reconstructive surgery. Emerging bone grafts should offer not only mechanical support but also functional properties to explore innovative bone therapies. Following this, ceramic bone grafts of Glass/hydroxyapatite (HA) reinforced with conductive carbon nanotubes (CNTs) - CNT/Glass/HA - were prepared for bone electrotherapy purposes. Computer-aided 3D microstructural reconstructions and TEM analysis of CNT/Glass/HA composites provided details on the CNT 3D network and further correlation to their functional properties. CNTs are arranged as sub-micrometric sized ropes bridging homogenously distributed ellipsoid-shaped agglomerates. This arrangement yielded composites with a percolation threshold of pc=1.5vol.%. At 4.4vol.% of CNTs, thermal and electrical conductivities of 1.5W·m(-1)·K(-1) and 55S·m(-1), respectively, were obtained, matching relevant requisites in electrical stimulation protocols. While the former avoids bone damaging from Joule's heat generation, the latter might allow the confinement of external electrical fields through the conductive material if used for in vivo electrical stimulation. Moreover, the electrically conductive bone grafts have better mechanical properties than those of the natural cortical bone. Overall, these highly conductive materials with controlled size CNT agglomerates might accelerate bone bonding and maximize the delivery of electrical stimulation during electrotherapy practices.


Effect of exposure to photographs of thin models on self-consciousness in female college students.
The purpose of this study was to assess the immediate influence of brief exposure to images taken from print media on the general self-consciousness and body self-consciousness of 67 college women. After viewing photographs of either thin female models or control photographs, the women completed the Self-consciousness Scale and the Body Self-consciousness Questionnaire. Although alpha was .45, the college women who looked at images of thin female models gave immediate ratings significantly (p < .001) higher on both general Self-consciousness and Body Self-consciousness than those who looked at control images.


(5R)-5-hydroxytriptolide ameliorates diabetic kidney damage by inhibiting macrophage infiltration and its cross-talk with renal resident cells.
Diabetic nephropathy (DN) is the main cause of end-stage renal disease, and there are no targeted treatment options at present. The efficacy of the new immunosuppressive drug (5R)-5-hydroxytriptolide (LLDT8) in improving kidney inflammation has been demonstrated in multiple studies. The present study was intended to investigate the preventive and therapeutic effects of LLDT8 on DN and to reveal its potential pharmacological mechanisms. The effects of LLDT8 on liver and kidney functions, and urine microprotein of Streptozotocin (STZ) induced DN mice were detected. The protective effect of LLDT8 on the kidney tissue was observed by pathological staining and transmission electron microscopy. Cell culture experiments were performed to detect the effects of LLDT8 on the expression of chemokines and epithelial-mesenchymal transition (EMT) in high glucose-induced TCMK1 cells using real-time polymerase chain reaction (RT-PCR) and western blot (WB) techniques and to detect the influence of LLDT8 on the secretion of pro-inflammatory and pro-fibrotic factors in high glucose-induced RAW264.7 cells. In animal experiments, treatment with high-dose LLDT8 (0.25 mg/kg/2d) reduced 24 h urinary albumin excretion, improved structural kidney damage, and delayed fibrosis progression in DN mice. Immunofluorescence results showed that LLDT8 intervention reduced macrophage infiltration in kidney tissues of DN mice. PCR and WB results of kidney tissues showed reduced expressions of chemokines CCL2 and M-CSF1 in the LLDT8 intervention group compared to the DN group. In cellular assays, LLDT8 treatment reduced chemokine secretion in high glucose-induced TCMK1 cells, but had no effect on EMT of TCMK1 cells. LLDT8 treatment reduced the secretion of pro-inflammatory and pro-fibrotic factors in high glucose-induced RAW264.7 cells. The present study suggests that LLDT8 could effectively inhibit the secretion of pro-inflammatory and pro-fibrotic factors by macrophages, which could alleviate high glucose-induced renal tissue injury and slow down the process of tissue fibrosis and DN.


Effects of Ambient Temperature and Relative Humidity on Subsurface Defect Detection in Concrete Structures by Active Thermal Imaging.
Active thermal imaging is an effective nondestructive technique in the structural health monitoring field, especially for concrete structures not exposed directly to the sun. However, the impact of meteorological factors on the testing results is considerable and should be studied in detail. In this study, the impulse thermography technique with halogen lamps heat sources is used to detect defects in concrete structural components that are not exposed directly to sunlight and not significantly affected by the wind, such as interior bridge box-girders and buildings. To consider the effect of environment, ambient temperature and relative humidity, these factors are investigated in twelve cases of testing on a concrete slab in the laboratory, to minimize the influence of wind. The results showed that the absolute contrast between the defective and sound areas becomes more apparent with an increase of ambient temperature, and it increases at a faster rate with large and shallow delaminations than small and deep delaminations. In addition, the absolute contrast of delamination near the surface might be greater under a highly humid atmosphere. This study indicated that the results obtained from the active thermography technique will be more apparent if the inspection is conducted on a day with high ambient temperature and humidity.


Subcutaneous Vulvar Flap Viability Evaluation With Near-Infrared Probe and Indocyanine Green for Vulvar Cancer Reconstructive Surgery: A Feasible Technique.
Introduction: Vulvar cancer is a rare condition affecting older women and accounts for 3-5% of all gynecological cancers. Primary surgical treatment involves the removal of a large amount of tissue for which reconstructive surgery is often necessary with a high rate of postoperative complications. Despite several techniques for the evaluation of vulvar flap viability have been proposed, many methods cannot be performed during surgery and require expensive devices often missing in a gynecological clinic. This study aims to verify the feasibility and the safety of the vulvar flap viability evaluation through a near-infrared endoscopic probe and Indocyanine green (ICG) tracer in a small group of patients and to evaluate long-term vulvar flap outcomes. Methods: Patients with primary vulvar cancer who required surgical treatment and subsequent vulvar flap reconstructive surgery were prospectively included in the study. A 25 mg ICG vial diluted in 20 ml of saline solution was intravenously infused before closing the skin edges of the flaps. All patients were given 0.2 mg/kg body weight of intravenous ICG. After 10-15 min, a near-infrared endoscopic probe was used to evaluate the vulvar flap viability. Results: Of the 18 patients who underwent radical vulvectomy for vulvar cancer during the study period, 15 were included in the analysis. All packaged surgical flaps showed tracer uptake on the surgical margin. No intro-operative complications were recorded neither surgery-related nor to dye infusion. No surgical infection, dehiscence, or necrosis was recorded. Conclusions: Vulvar flap viability assessment using Indocyanine green and a laparoscopic infrared probe is a feasible method. All cases included in the analysis showed a dye uptake on the surgical edge of the flap. Further, prospective studies are needed to confirm the method in clinical practice and to evaluate its superiority over simple subjective clinical evaluation.


Optically induced interaction of magnetic moments in hybrid metamaterials.
We propose a novel type of hybrid metal-dielectric structures composed of silicon nanoparticles and split-ring resonators for advanced control of optically induced magnetic response. We reveal that a hybrid "metamolecule" may exhibit a strong distance-dependent magnetic interaction that may flip the magnetization orientation and support "antiferromagnetic" ordering in a hybrid metamaterial created by a periodic lattice of such metamolecules. The propagation of magnetization waves in the hybrid structures opens new ways for manipulating artificial "antiferromagnetic" ordering at high frequencies.


Subtalar arthroscopy and flurosocopy in percutaneous fixation of intra-articular calcaneal fractures: the best of both worlds.
Fixation of intra-articular calcaneal fractures has traditionally been guided by intraoperative fluoroscopy. Recent reports indicate that there is a role for subtalar arthroscopy in surgical fixation of these fractures. The earliest reports described the use of subtalar arthroscopy for joint assessment during late hardware removal. It then served as an adjunct for joint inspection in open reduction and internal fixation. In its final permutation, percutaneous arthroscopy was performed with minimally invasive reduction and fixation, minimizing soft tissue complications commonly associated with the open approach. In practiced hands, this technique yields good results with minimal morbidity. We performed a prospective analysis of 22 consecutive patients with Sanders II, AO-OTA 83-C2 intra-articular calcaneal fractures who underwent dual-modality imaging (subtalar arthroscopic- and intraoperative fluoroscopic-) guided percutaneous fracture fixation with a minimum follow-up of 2 years. Maximum accepted postreduction step-off was 1 mm. Fractures were fixed definitively with four to eight percutaneous cancellous screws. There was significant correction of Böhler's tuberosity-joint angle from 4.2 degrees±11.1 degrees preoperatively to 21.3 degrees±8.8 degrees on immediate postoperative radiographs, with minimal subsidence to 20.1 degrees±8.2 degrees at 2 years. Böhler's angle correction and joint surface restoration could not be achieved percutaneously in one patient with an impacted, depressed joint fragment. Compared with preoperative values, there was significant improvement in mean Visual Analog Scale, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score, and Short Form-36 (Physical Function) scores at 3 months, with further improvement up to 2-years. Subtalar arthroscopy augments intraoperative fluoroscopy in anatomic reduction of the posterior calcaneal facet of the subtalar joint and is most useful for Sanders type II, AO-OTA 83-C2 fractures. The percutaneous approach further avoids soft tissue complications associated with open reduction. However, this procedure has a steep learning curve, and conversion to open reduction must be considered when percutaneous reduction fails.


Assessment of the geochemical role of colloids and their impact on contaminant toxicity in freshwaters: an example from the Lambro-Po system (Italy).
The role of colloids in regulating element transport, behavior, and bioavailability in aquatic systems is now well-established. It appears that further progress in this research field is being slowed by (i) a limited integration between the geochemical and the biological aspects of the research on colloids and (ii) a persistent gap between well-controlled laboratory studies and real field situations. This paper presents a simultaneous evaluation of the role of colloids in controlling element environmental fate and bioavailability at the confluence between a major river and a polluted tributary. Fractionation of trace elements among suspended particulate matter, colloids, and true solution suggests that colloids may play a role in the removal of trace elements from the water column to bed sediments during the mixing of the two rivers. Toxicity testing of water samples indicates that, in this specific system, contaminants associated with colloids can contribute to water toxicity for the rotifer Brachionus calyciflorus but not for the green alga Pseudokirchneriella subcapitata. To the best of our knowledge, the results for B. calyciflorus are the first ones pointing to the possible contribution of colloid-bound contaminants to water toxicity in environmental samples. Despite the uncertainties associated with field variability, the results of chemical analysis and toxicitytesting show several points of convergence. Following these observations, a few innovative research approaches are suggested to improve the understanding of trace element biogeochemistry in real field situations.


CDK2 transcriptional repression is an essential effector in p53-dependent cellular senescence-implications for therapeutic intervention.
Cellular senescence, a form of cell-cycle arrest, is a tumor-suppressor mechanism triggered by multiple tumor-promoting insults, including oncogenic stress and DNA damage. The role of cyclin-dependent kinase 2 (CDK2) regulation has been evaluated in models of replicative senescence, but little is known regarding its role in other senescence settings. Using in vitro and in vivo models of DNA damage-and oncogene-induced cellular senescence, it was determined that activation of the tumor-suppressor protein p53 (TP53) resulted in repression of the CDK2 transcript that was dependent on intact RB. Ectopic CDK2 expression was sufficient to bypass p53-dependent senescence, and CDK2-specific inhibition, either pharmacologically (CVT313) or by use of a dominant-negative CDK2, was sufficient to induce early senescence. Pharmacologic inhibition of CDK2 in an in vivo model of pineal tumor decreased proliferation and promoted early senescence, and it also decreased tumor penetrance and prolonged time to tumor formation in animals lacking p53. In conclusion, for both oncogene- and DNA damage-induced cellular senescence, CDK2 transcript and protein are decreased in a p53- and RB-dependent manner, and this repression is necessary for cell-cycle exit during senescence. These data show that CDK2 inhibition may be useful for cancer prevention in premalignant hyperproliferative lesions, as well as established tumors.


Niflumic acid alters gating of HCN2 pacemaker channels by interaction with the outer region of S4 voltage sensing domains.
Niflumic acid, 2-[[3-(trifluoromethyl)phenyl]amino]pyridine-3-carboxylic acid (NFA), is a nonsteroidal anti-inflammatory drug that also blocks or modifies the gating of many ion channels. Here, we investigated the effects of NFA on hyperpolarization-activated cyclic nucleotide-gated cation (HCN) pacemaker channels expressed in X. laevis oocytes using site-directed mutagenesis and the two-electrode voltage-clamp technique. Extracellular NFA acted rapidly and caused a slowing of activation and deactivation and a hyperpolarizing shift in the voltage dependence of HCN2 channel activation (-24.5 +/- 1.2 mV at 1 mM). Slowed channel gating and reduction of current magnitude was marked in oocytes treated with NFA, while clamped at 0 mV but minimal in oocytes clamped at -100 mV, indicating the drug preferentially interacts with channels in the closed state. NFA at 0.1 to 3 mM shifted the half-point for channel activation in a concentration-dependent manner, with an EC(50) of 0.54 +/- 0.068 mM and a predicted maximum shift of -38 mV. NFA at 1 mM also reduced maximum HCN2 conductance by approximately 20%, presumably by direct block of the pore. The rapid onset and state-dependence of NFA-induced changes in channel gating suggests an interaction with the extracellular region of the S4 transmembrane helix, the primary voltage-sensing domain of HCN2. Neutralization (by mutation to Gln) of any three of the outer four basic charged residues in S4, but not single mutations, abrogated the NFA-induced shift in channel activation. We conclude that NFA alters HCN2 gating by interacting with the extracellular end of the S4 voltage sensor domains.


Optical Surgical Navigation: A Promising Low-cost Alternative.
State-of-the-art computer-assisted surgery relies on infrared-based cameras for precise positional measurements. However, the cost of purchasing these systems acts as a barrier for smaller healthcare facilities to adopt them. Recently, low-cost optical tracking with cameras has emerged as a promising alternative, but differences in operating room conditions and patient anatomy can cause inconsistencies between procedures. Therefore, it is essential to identify and evaluate individual factors that may affect a procedure. In this study, we evaluate fiducial ArUco markers as a low-cost alternative to traditional markers. To evaluate their effectiveness, we designed a ground truth testing platform, which enables us to measure the real-time difference between the predicted and actual positions. We investigated the effects of warping, line-of-sight obstruction, and operating room lighting as variables that could influence marker tracking in the operating room. Each variable was isolated and simplified to quantifiable modifications to the physical marker and X-Y platform environment. We find that our navigation system is a promising approach for use in computer-navigated surgery, and future work will focus on implementing image processing techniques to improve the accuracy of optical marker tracking.


[Experience of a double or heautoscopy. Psychopathological review and case report].
According to Jaspers, the experience of the double is on of the darkest, heterogeneous and worst studied psychopathological concepts. This research intends to contribute to its clarification and delimitation. We present a clinical case that presented the experience of the double associated to despersonalization, nontypical somatizations, eating disorders and a serious suicidal behaviour. The concept of experience of the double is revised following the clinical description and the psychopathological contributions of different authors. Nowadays, the most accepted term to refer to the experience of the double is "autoscopyc"--to watch oneself--although it would be more correct, etymologicaly, to talk about "beautoscopic" since what it really happens is a deceptive perception of oneself. We agree with recent authors in restricting the concept of "beautoscopyc" to those cases in which the own image is visualized. Furthermore, it is necessary to make an effort to clarify if it deals with a specific disorder or a non-specific phenomenon associated to different medical or psychiatric disorders.


Risk of Cervical Dizziness in Patients With Cervical Spondylosis.
The dizziness associated with cervical spondylosis is a controversial topic given that many experts believe that cervical spondylosis is a common cause of dizziness, whereas others do not believe it exists. To compare the risk of dizziness between patients with cervical spondylosis and matched controls (ie, patients with lumbar spondylosis after propensity score matching [PSM]). This cohort study used medical claims data from the National Health Insurance Research Database of Taiwan for patients 60 years or older with cervical or lumbar spondylosis newly diagnosed in any outpatient department between January 1, 2010, and December 31, 2015. Patients diagnosed with cervical spondylosis were included as the study cohort, and those diagnosed with lumbar spondylosis who were matched to the study cohort via PSM were selected as the control cohort. Both cohorts were followed up for 1 year unless they were diagnosed with dizziness, censored by death, or withdrew from the health insurance program. Data analysis was performed from August 9 to September 20, 2022. The main outcome was the date of outpatient diagnosis of dizziness. The risks of dizziness were compared between groups. The relative risk and incidence rate difference were calculated. A total of 3638 patients with cervical spondylosis (mean [SD] age, 67.9 [7.1] years; 2024 [55.6%] male) and 3638 patients with lumbar spondylosis (mean [SD] age, 68.0 [7.1] years; 2024 [55.6%] male) after PSM were selected as the study and control cohorts, respectively. The patients with cervical spondylosis had higher risk of dizziness than matched controls, with a 1-year relative risk of 1.20 (95% CI, 1.03-1.39). The 1-year incidence of dizziness was 10.2% (95% CI, 9.2%-11.2%) in patients with cervical spondylosis and 8.6% (95% CI, 7.7%-9.5%) in the matched group of lumbar spondylosis. The incidence rate difference between the groups was 1.6% (95% CI, 0.3%-3.0%). These data support the association between dizziness and cervical spondylosis, but the small difference between groups reveals that dizziness associated with cervical spondylosis is uncommon. Clinicians should be wary of diagnosing a cervical cause for dizziness based on an actual history of cervical spondylosis.


Fitness preferential attachment as a driving mechanism in bitcoin transaction network.
Bitcoin is the earliest cryptocurrency and among the most successful ones to date. Recently, its dynamical evolution has attracted the attention of the research community due to its completeness and richness in historical records. In this paper, we focus on the detailed evolution of bitcoin trading with the aim of elucidating the mechanism that drives the formation of the bitcoin transaction network. Our empirical investigation reveals that although the temporal properties of the transaction network possesses scale-free degree distribution like many other networks, its formation mechanism is different from the commonly assumed models of degree preferential attachment or wealth preferential attachment. By defining the fitness value of each node as the ability of the node to attract new connections, we have instead uncovered that the observed scale-free degree distribution results from the intrinsic fitness of each node following a power-law distribution. Our finding thus suggests that the "good-get-richer" rather than the "rich-get-richer" paradigm operates within the bitcoin ecosystem. Based on these findings, we propose a model that captures the temporal generative process by means of a fitness preferential attachment and data-driven birth/death mechanism. Our proposed model is able to produce structural properties in good agreement with those obtained from the empirical bitcoin network.


The PROCAINA (PROstate CAncer INdication Attitudes) Project (Part I): a survey among Italian radiation oncologists on postoperative radiotherapy in prostate cancer.
Radiotherapy (RT) has an established role in the postoperative treatment of prostate cancer patients with extracapsular extension, positive surgical margins or a detectable post-operative prostate-specific antigen (PSA). Despite the large number of patients treated with postoperative RT, some issues about optimal technique, doses, volumes, timing and association with androgen deprivation are still subject of debate. The aim of this survey was to determine the patterns of choice of Italian radiation oncologists in two different clinical cases of postoperative prostate cancer patients. During the 2010 National Congress of the Italian Association of Radiation Oncology (AIRO), four clinical cases were presented to the attending radiation oncologists. Two of them were cases of postoperative prostate cancer, differing in T stage of the primary tumour according to the TNM classification, preoperative staging procedures, preoperative PSA (iPSA), Gleason score of biopsies and definitive pathological specimen after surgery and postoperative PSA. For each clinical case, the radiation oncologists were asked to: (a) give indication to new pre-treatment procedures for staging; b) give indication to postoperative treatment; (c) to define specifically, where indicated, the total dose, type of fractionation, treatment volumes, type of technique, type of image-guided setup control; (d) indicate whether adjuvant hormonal therapy should be prescribed; (e) define criteria that mostly influenced the prescription. A descriptive statistical analysis was then performed. A total of 300 questionnaires were distributed amongst radiation oncologists attending the congress; 128 were completed and considered for this analysis (41%). Some important differences were shown in prescribing and performing postoperative radiotherapy, and some significant differences with international guidelines and data available from the literature were also reviewed and discussed. Despite the results of clinical trials, significant differences still exist among Italian radiation oncologists in deciding postoperative treatment in prostate cancer patients. These patients probably deserve a more uniform approach based on updated, detailed and evidence-based recommendations.


Synthesis of 2-aryl/heteroaryloxazolines from nitriles under metal- and catalyst-free conditions and evaluation of their antioxidant activities.
The synthesis of structurally diverse 2-aryl/heteroaryloxazolines from nitriles and aminoalcohols has been achieved under metal- and catalyst-free conditions in good to excellent yields. An array of functional groups are well-tolerated, thus, allowing the introduction of many important biologically active motifs such as azoles, ring-fused azoles, saturated heterocyclics, and amines in 2-aryloxazoline scaffolds. An evaluation of the antioxidant properties using the DPPH (diphenyl picryl hydrazyl) assay method shows the pyrrole-functionalized 2-aryloxazoline to be the best antioxidant among all the synthesized 2-aryl/heteroaryloxazolines.


Homotypic and Heterotypic Protection and Risk of Reinfection Following Natural Norovirus Infection in a Highly Endemic Setting.
Norovirus is a leading cause of acute gastroenteritis worldwide, yet there is limited information on homotypic or heterotypic protection following natural infection to guide vaccine development. A total of 6020 stools collected from 299 Peruvian children between 2010 and 2014 were tested by norovirus real-time reverse-transcription polymerase chain reaction followed by sequence-based genotyping. Cox proportional hazards models were used to derive adjusted hazard ratios (HRs) of infection among children with vs without prior exposure. Norovirus was detected in 1288 (21.3%) samples. GII.4 (26%), GII.6 (19%), and GI.3 (9%) viruses accounted for 54% of infections. Homotypic protection for GI.3 (HR, 0.35; P = .015), GI.7 (HR, 0.19; P = .022), GII.4 (HR, 0.39; P < .001), and GII.6 (HR, 0.52; P = .006) infections was observed. Hazard analysis showed that children with prior GII.4 infection exhibited heterotypic protection with a 48% reduction of subsequent GI.3 infection (HR, 0.52; P = .005). Prior exposure to GI.3, GII.2, and GII.17 infections enhanced susceptibility to subsequent infections with several other norovirus genotypes. Children up to 2 years of age infected with GII.4 noroviruses demonstrated both homotypic and heterotypic protection to reinfection with other genotypes. These data support the need for ongoing vaccine development efforts with GII.4 as the main component and caution the inclusion of genotypes that may enhance susceptibility to infections.


Modeling of Calcium-dependent Low Intensity Low Frequency Ultrasound Modulation of a Hodgkin-Huxley Neuron.
Non-invasive low intensity, low frequency ultrasound is a progressive neuromodulation approach that can reach deep brain areas with peak spatial and temporal resolution for highly-targeted diagnostic and therapeutic purposes. Coupling the ultrasound mechanical effects to the neural membrane comprises different mechanisms that are, to-date, still a topic of debate. The availability of calcium ions in the extracellular medium is of high significance when it comes to the effect of ultrasound on the neural tissue. Whereby the generated calcium influx can directly affect the voltage-gated ion channels, amplifying their action. We modeled the flexoelectric-induced effects of ultrasound to a single firing neuron, taking into consideration the effect of calcium channel embedding into the neural membrane on the neuron's firing rate, latency response, peak-to-peak voltage, and general shape of the action potential.Clinical Relevance- Upon Ultrasound sonication, the mechanical waves interact with the neural membrane and alter the kinetics of the calcium channels, thus changing the neural response.