Luminal fructose modulates fructose transport and GLUT-5 expression in small intestine of weaning rats.
In neonatal rats, precocious introduction of dietary fructose significantly enhances brush-border fructose transport rates and GLUT-5 mRNA levels during early weaning. In this study, these rates and levels were more than two times higher in the anastomosed intestine compared with those in the bypassed loop of weaning pups that underwent Thiry-Vella surgery and consumed high-fructose (HF) diets. In Thiry-Vella pups fed fructose-free (NF) diets, uptake rates and mRNA levels in the anastomosed intestine were very low and similar to those in the bypassed loop. In sham-operated littermates, transport rates and mRNA levels were similar between intestinal regions that corresponded to anastomosed and bypassed loops in Thiry-Vella pups and were two to three times greater in pups fed HF than in those fed NF diet. In contrast, rates of brush-border glucose transport and levels of SGLT-1 and of GLUT-2 mRNA were independent of diet and were similar between bypassed and anastomosed regions. Changes in GLUT-5 expression did not follow a distinct diurnal rhythm. When pups were fed HF diet after 12 h of starvation to empty the intestinal lumen, fructose transport rates increased with feeding duration and reached a plateau 12-24 h after feeding; in contrast, GLUT-5 mRNA levels were highest within 4 h after arrival of chyme in the jejunum and then decreased gradually and returned to baseline levels 24 h later. In littermates fed NF diet, mRNA levels and uptake rates were each independent of feeding duration. Luminal, and not endocrine, signals regulate GLUT-5 expression in weaning pups.


Peptide mimotopes of Mycobacterium tuberculosis carbohydrate immunodeterminants.
Cell-surface saccharides of Mycobacterium tuberculosis appear to be crucial factors in tuberculosis pathogenicity and could be useful antigens in tuberculosis immunodiagnosis. In the present study, we report the successful antigenic and immunogenic mimicry of mannose-containing cell-wall compounds of M. tuberculosis by dodecamer peptides identified by phage-display technology. Using a rabbit antiserum raised against M. tuberculosis cell-surface saccharides as a target for biopanning, peptides with three different consensus sequences were identified. Phage-displayed and chemically synthesized peptides bound to the anticarbohydrate antiserum. Rabbit antibodies elicited against the peptide QEPLMGTVPIRAGGGS recognize the mannosylated M. tuberculosis cell-wall antigens arabinomannan and lipoarabinomannan, and the glycosylated recombinant protein alanine/proline-rich antigen. Furthermore, antibodies were also able to react with mannan from Saccharomyces cerevisiae, but not with phosphatidylinositol dimannosides or arabinogalactan from mycobacteria. These results suggest that the immunogenic peptide mimics oligomannosidic epitopes. Interestingly, this report provides evidence that, in contrast with previously known carbohydrate mimotopes, no aromatic residues are necessary in a peptide sequence for mimicking unusual glycoconjugates synthesized by mycobacteria. The possible usefulness of the identified peptide mimotopes as surrogate reagents for immunodiagnosis and for the study of functional roles of the native non-peptide epitopes is discussed.


Microsurgical tunica albuginea transplantation in an animal model.
Several andrological diseases require surgical repair or reconstruction of tunica albuginea, which envelops the corpora cavernosa penis. Despite intense research efforts involving a variety of biological materials, such as skin, muscle aponeurosis, human dura mater, tunica vaginalis, and pericardium, engineered tunica albuginea suitable for graft use is yet to be obtained. The study investigates microsurgical tunica albuginea allotransplantation in an animal model with the purpose of creation of an organ-specific tissue bank to store penile tissue, from cadaveric donors and male-to-female trans-sexual surgery, for allogeneic transplantation. Materials were tunica albuginea tissue explanted from 15 donor rats, cryopreserved at -80°C, gamma-irradiated, and implanted in 15 recipient rats, of which three rats were used as controls. Penile grafts were explanted at different time intervals; after macroscopic evaluation of the organ, the grafts were processed to morphological, histochemical, and immunohistochemical examinations by light microscopy. Detection of pro-inflammatory cytokines was also performed. Examination of the tunica albuginea allografts collected 1, 3, or 6 months after surgery and of control tunica albuginea fragments showed that tunica albuginea implants achieved biointegration with adjacent tissue at all-time points. The integration of cryopreserved rat tunica albuginea allografts, documented by our study, encourages the exploration of tunica albuginea allotransplantation in humans. In conclusion, the effectiveness and reliability of the tunica albuginea conditioning protocol described here suggest the feasibility of setting up a tunica albuginea bank as a further tissue bank.


Purification and characterization of the 2-ketoaldonate reductase from Brevibacterium ketosoreductum ATCC21914.
2-Ketoaldonate reductase, which is involved in ketogluconate catabolism, was purified to homogeneity from Brevibacterium ketosoreductum ATCC21914. The enzyme was found to catalyze the reduction of 2,5-diketo-D-gluconate to 5-keto-D-gluconate, and to a lesser extent, 2-keto-D-gluconate to D-gluconate, and 2-keto-L-gluconate to L-idonate. The molecular mass of the reductase was 35 kDa by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and 72 kDa by gel filtration, indicating that the native enzyme may exist as a dimer. The reductase was optimally active at pH 6.0 with NADPH as a preferred electron donor. The pI of 4.7 was measured for the enzyme. The apparent Km for 2,5-diketo-D-gluconate and NADPH were 5 microM and 10 microM, respectively. The amino-terminal amino acid sequence was NH2-Ala-Ser-Ile-Ser-Val-Ser-Val-Pro-Ser-Ala- Arg-Leu-Ala-Glu-Asp-Leu-Ser-Asp-Ile-Glu.


Vulnerability related to oral health in early childhood: a concept analysis.
This article is a report of the analysis of the concept of vulnerability and its relationship to oral health in early childhood. Poor oral health is a continued problem for children worldwide. Vulnerability increases the probability of poor oral health outcomes. The lack of clarity of the concept of vulnerability creates difficulty in understanding this multi-factoral condition. Data source included 34 articles covering the period 2000-2009 from a variety of disciplines, including nursing, dentistry, medicine and public health. The concept analysis was conducted using Rodgers' evolutionary method. The literature was analysed and a social ecology model was used to frame the discussion, recognizing family and community influences on children's oral health. The context of oral health in early childhood contributes to the changes in the concept vulnerability. The attributes are closely related to family and community factors and identified as limited parental income, parental education, community-based services and fluoride; and exposure to poor parental habits, parental neglect and harmful toxins. The primary antecedent is identified as a form of limited protection from exposure to various circumstances. Children with limited protection have increased vulnerability and greater probability of poor health outcomes. Nurses who understand the concept of vulnerability related to oral health and can identify factors that create protection and are capable of decreasing vulnerability through parent education, community awareness and policy changes that support children and families.


[Nursing diagnosis of patients in the intraoperative period of cardiac surgery].
The purpose of this study was to identify nursing diagnoses of patients in the intra-operative period of cardiac surgery. One instrument was elaborated and validated for data collection. Such instrument was organized according to The Theory of Basic Human Needs. Seventeen adult patients in the intra-operative period of cardiac surgery were evaluated, of whom 09 were males and 08 were females with the average of 58 years old. Following data collection, the nursing diagnoses were identified based on NANDA's Taxonomy I. The nursing diagnoses identified with a higher frequency than 50% were: Risk for infection (100%), Risk for fluid volume imbalance (100%), Impaired gas exchange (100%), Risk for aspiration (100%), Altered protection (100%), Impaired skin integrity (100%), Risk for peripheral neurovascular dysfunction (100%), Risk for perioperative positioning injury (100%) and Risk for altered body temperature (94.1%). It was identified a predominance of the diagnoses related to psychobiological needs.


Automated Risk Stratification of Hip Osteoarthritis Development in Patients With Femoroacetabular Impingement Using an Unsupervised Clustering Algorithm: A Study From the Rochester Epidemiology Project.
Studies evaluating the natural history of femoroacetabular impingement (FAI) are limited. To stratify the risk of progression to osteoarthritis (OA) in patients with FAI using an unsupervised machine-learning algorithm, compare the characteristics of each subgroup, and validate the reproducibility of staging. Cohort study (prognosis); Level of evidence, 2. A geographic database from the Rochester Epidemiology Project was used to identify patients with hip pain between 2000 and 2016. Medical charts were reviewed to obtain characteristic information, physical examination findings, and imaging details. The patient data were randomly split into 2 mutually exclusive sets: train set (70%) for model development and test set (30%) for validation. The data were transformed via Uniform Manifold Approximation and Projection and were clustered using Hierarchical Density-based Spatial Clustering of Applications with Noise. The study included 1071 patients with a mean follow-up period of 24.7 ± 12.5 years. The patients were clustered into 5 subgroups based on train set results: patients in cluster 1 were in their early 20s (20.9 ± 9.6 years), female dominant (84%), with low body mass index (<19 ); patients in cluster 2 were in their early 20s (22.9 ± 6.7 years), female dominant (95%), and pincer-type FAI (100%) dominant; patients in cluster 3 were in their mid 20s (26.4 ± 9.7) and were mixed-type FAI dominant (92%); patients in cluster 4 were in their early 30s (32.7 ± 7.8), with high body mass index (≥29 ), and diabetes (17%); and patients in cluster 5 were in their early 30s (30.0 ± 9.1), with a higher percentage of males (43%) compared with the other clusters and with limited internal rotation (14%). Mean survival for clusters 1 to 5 was 17.9 ± 0.6, 18.7 ± 0.3, 17.1 ± 0.4, 15.0 ± 0.5, and 15.6 ± 0.5 years, respectively, in the train set. The survival difference was significant between clusters 1 and 4 (P = .02), 2 and 4 (P < .005), 2 and 5 (P = .01), and 3 and 4 (P < .005) in the train set and between clusters 2 and 5 (P = .03) and 3 and 4 (P = .01) in the test set. Cluster characteristics and prognosis was well reproduced in the test set. Using the clustering algorithm, it was possible to determine the prognosis for OA progression in patients with FAI in the presence of conflicting risk factors acting in combination.


Influence of abnormally high leptin levels during pregnancy on metabolic phenotypes in progeny mice.
Maternal obesity increases the risk of obesity in offspring, and obesity is accompanied by an increase in blood leptin levels. The "yellow" mutation at the mouse agouti locus (A(y)) increases blood leptin levels in C57BL preobese pregnant mice without affecting other metabolic characteristics. We investigated the influence of the A(y) mutation or leptin injection at the end of pregnancy in C57BL mice on metabolic phenotypes and the susceptibility to diet-induced obesity (DIO) in offspring. In both C57BL-A(y) and leptin-treated mice, the maternal effect was more pronounced in male offspring. Compared with males born to control mothers, males born to A(y) mothers displayed equal food intake (FI) but decreased body weight (BW) gain after weaning, equal glucose tolerance, and enhanced FI-to-BW ratios on the standard diet but the same FI and BW on the high-fat diet. Males born to A(y) mothers were less responsive to the anorectic effect of exogenous leptin and less resistant to fasting (were not hyperphagic and gained less weight during refeeding after food deprivation) compared with males born to control mothers. However, all progeny displayed equal hypothalamic expression of Agouti gene-related protein (AgRP), neuropeptide Y (NPY), and proopiomelanocortin (POMC) and equal plasma leptin and glucose levels after food deprivation. Leptin injections in C57BL mice on day 17 of pregnancy decreased BW in both male and female offspring but inhibited FI and DIO only in male offspring. Our results show that hyperleptinemia during pregnancy has sex-specific long-term effects on energy balance regulation in progeny and does not predispose offspring to developing obesity.


Bending the Curve: Sensitivity to Bending of Curved Paths and Application in Room-Scale VR.
Redirected walking (RDW) promises to allow near-natural walking in an infinitely large virtual environment (VE) by subtle manipulations of the virtual camera. Previous experiments analyzed the human sensitivity to RDW manipulations by focusing on the worst-case scenario, in which users walk perfectly straight ahead in the VE, whereas they are redirected on a circular path in the real world. The results showed that a physical radius of at least 22 meters is required for undetectable RDW. However, users do not always walk exactly straight in a VE. So far, it has not been investigated how much a physical path can be bent in situations in which users walk a virtual curved path instead of a straight one. Such curved walking paths can be often observed, for example, when users walk on virtual trails, through bent corridors, or when circling around obstacles. In such situations the question is not, whether or not the physical path can be bent, but how much the bending of the physical path may vary from the bending of the virtual path. In this article, we analyze this question and present redirection by means of bending gains that describe the discrepancy between the bending of curved paths in the real and virtual environment. Furthermore, we report the psychophysical experiments in which we analyzed the human sensitivity to these gains. The results reveal encouragingly wider detection thresholds than for straightforward walking. Based on our findings, we discuss the potential of curved walking and present a first approach to leverage bent paths in a way that can provide undetectable RDW manipulations even in room-scale VR.


Reaching Nutritional Adequacy Does Not Necessarily Increase Exposure to Food Contaminants: Evidence from a Whole-Diet Modeling Approach.
Dietary guidelines are designed to help meet nutritional requirements, but they do not explicitly or quantitatively account for food contaminant exposures. In this study, we aimed to test whether dietary changes needed to achieve nutritional adequacy were compatible with acceptable exposure to food contaminants. Data from the French national dietary survey were linked with food contaminant data from the French Total Diet Study to estimate the mean intake of 204 representative food items and mean exposure to 27 contaminants, including pesticides, heavy metals, mycotoxins, nondioxin-like polychlorinated biphenyls (NDL-PCBs) and dioxin-like compounds. For each sex, 2 modeled diets that departed the least from the observed diet were designed: 1) a diet respecting only nutritional recommendations (NUT model), and 2) a diet that met nutritional recommendations without exceeding Toxicological Reference Values (TRVs) and observed contaminant exposures (NUTOX model). Food, nutrient, and contaminant contents in observed diets and NUT and NUTOX diets were compared with the use of paired t tests. Mean observed diets did not meet all nutritional recommendations, but no contaminant was over 48% of its TRV. Achieving all the nutrient recommendations through the NUT model mainly required increases in fruit, vegetable, and fish intake and decreases in meat, cheese, and animal fat intake. These changes were associated with significantly increased dietary exposure to some contaminants, but without exceeding 57% of TRVs. The highest increases were found for NDL-PCBs (from 26% to 57% of TRV for women). Reaching nutritional adequacy without exceeding observed contaminant exposure (NUTOX model) was possible but required further departure from observed food quantities. Based on a broad range of nutrients and contaminants, this first assessment of compatibility between nutritional adequacy and toxicological exposure showed that reaching nutritional adequacy might increase exposure to food contaminants, but within tolerable levels. However, there are some food combinations that can meet nutritional recommendations without exceeding observed exposures.


Retinal function in diabetic macular edema after focal laser photocoagulation.
To assess the effects of focal photocoagulation on retinal function in the macular and perimacular areas in patients with diabetes who have clinically significant macular edema. Eleven patients were assessed after focal laser treatment. Multifocal electroretinogram (ERG) and full-field ERG techniques were used to evaluate the effects of treatment on macular, paramacular, and peripheral retinal function. A modified visual field technique was used to obtain local threshold fields. The posttreatment results were compared with pretreatment results. Changes in local ERG response amplitudes and implicit times were calculated for each patient and presented as difference fields. The changes in local ERG responses were compared with the changes in local field sensitivity. After treatment, the results of the psychophysical tests suggested little or no change in visual function, but changes in retinal function were observed with the multifocal ERG technique. Local ERG responses showed increases in implicit time and decreases in amplitude, compared with pretreatment values. Timing was affected more than amplitude. The results suggest that focal treatment produces changes in retinal function, and these changes are not restricted to the treated macular area.


Fibrotic myofibroblasts manifest genome-wide derangements of translational control.
As a group, fibroproliferative disorders of the lung, liver, kidney, heart, vasculature and integument are common, progressive and refractory to therapy. They can emerge following toxic insults, but are frequently idiopathic. Their enigmatic propensity to resist therapy and progress to organ failure has focused attention on the myofibroblast-the primary effector of the fibroproliferative response. We have recently shown that aberrant beta 1 integrin signaling in fibrotic fibroblasts results in defective PTEN function, unrestrained Akt signaling and subsequent activation of the translation initiation machinery. How this pathological integrin signaling alters the gene expression pathway has not been elucidated. Using a systems approach to study this question in a prototype fibrotic disease, Idiopathic Pulmonary Fibrosis (IPF); here we show organized changes in the gene expression pathway of primary lung myofibroblasts that persist for up to 9 sub-cultivations in vitro. When comparing IPF and control myofibroblasts in a 3-dimensional type I collagen matrix, more genes differed at the level of ribosome recruitment than at the level of transcript abundance, indicating pathological translational control as a major characteristic of IPF myofibroblasts. To determine the effect of matrix state on translational control, myofibroblasts were permitted to contract the matrix. Ribosome recruitment in control myofibroblasts was relatively stable. In contrast, IPF cells manifested large alterations in the ribosome recruitment pattern. Pathological studies suggest an epithelial origin for IPF myofibroblasts through the epithelial to mesenchymal transition (EMT). In accord with this, we found systems-level indications for TGF-beta -driven EMT as one source of IPF myofibroblasts. These findings establish the power of systems level genome-wide analysis to provide mechanistic insights into fibrotic disorders such as IPF. Our data point to derangements of translational control downstream of aberrant beta 1 integrin signaling as a fundamental component of IPF pathobiology and indicates that TGF-beta -driven EMT is one source for IPF myofibroblasts.


PheLiGe: an interactive database of billions of human genotype-phenotype associations.
Genome-wide association studies have provided a vast array of publicly available SNP × phenotype association results. However, they are often in disparate repositories and formats, making downstream analyses difficult and time consuming. PheLiGe (https://phelige.com) is a database that provides easy access to such results via a web interface. The underlying database currently stores >75 billion genotype-phenotype associations from 7347 genome-wide and 1.2 million region-wide (e.g. cis-eQTL) association scans. The web interface allows for investigation of regional genotype-phenotype associations across many phenotypes, giving insights into the biological function affected by the variant in question. Furthermore, PheLiGe can compare regional patterns of association between different traits. This analysis can ascertain whether a co-association is due to pleiotropy or linkage. Moreover, comparison of association patterns for a complex trait of interest and gene expression and protein levels can implicate causal genes.


Use of Epidural Analgesia as an Adjunct in Elective Abdominal Wall Reconstruction: A Review of 4983 Cases.
Use of epidural analgesia in patients undergoing elective abdominal wall reconstruction is common. To assess the impact of epidural analgesia in patients undergoing abdominal wall reconstruction. All patients who underwent elective ventral hernia repair from 2005 to 2014 were retrospectively identified. Patients were divided into two groups by the postoperative use of epidural analgesics as an adjunct analgesic method. Preoperative comorbidities, American Society of Anesthesiologists status, operative findings, postoperative pain management, and venothromboembolic prophylaxis were extracted from the database. Logistic regressions were performed to assess the impact of epidural use. Severity of pain on postoperative days 1 and 2. During the study period, 4983 patients were identified. Of those, 237 patients (4.8%) had an epidural analgesic placed. After adjustment for differences between groups, use of epidural analgesia was associated with significantly lower rates of 30-day presentation to the Emergency Department (adjusted odds ratio [AOR] = 0.53, 95% confidence interval [CI] = 0.32-0.87, adjusted p = 0.01). Use of epidural analgesia resulted in higher odds of abscess development (AOR = 5.89, CI = 2.00-17.34, adjusted p < 0.01) and transfusion requirement (AOR = 2.92, CI = 1.34-6.40, adjusted p < 0.01). Use of epidural analgesia resulted in a significantly lower pain score on postoperative day 1 (3 vs 4, adjusted p < 0.01). Use of epidural analgesia in patients undergoing abdominal wall reconstruction may result in longer hospital stay and higher incidence of complications while having no measurable positive clinical impact on pain control.


Root Anatomy of Mandibular Second Premolars in French Subpopulation: A Retrospective Observational Case Series.
The purpose of this in vivo study is to illustrate endodontic anatomical variants in French subpopulations of human mandibular second premolars to show if the literature matches our findings. This was an observational retrospective study. This study was performed from September 2016 to September 2017. It was conducted on 56 successive cases of root canal therapies on the mandibular second premolars. All procedures were done in conformity with current state-of-the-art practices in endodontics. These included rigorous clinical and radiographic preaccess analysis, appropriate tooth restoration to insure watertight rubber dam installation, surgical microscopic manipulations for precision, systematic use of ultrasonic endodontic tips to manage cavity access preparation, and step-down technique to shape the root canal systems. Fifty-six mandibular second premolars were treated: 76.8% had one canal, and 23.2% had two or more canals. The incidence of two or more canals on mandibular second premolars could be underestimated as our results show. To prevent any missing canals, clinicians must have a perfect knowledge of anatomic variants of the root canal system. Moreover, the systematic use of a surgical microscope, ultrasonic endodontic tips, and a modern step-down technique should facilitate and standardize access cavity preparation, canal localization, and instrumentation.


Asymptomatic congenital lung malformations.
Congenital lung malformations are often discovered incidentally on routine prenatal sonography or postnatal imaging. Lesions such as congenital cystic adenomatoid malformations (CCAM), sequestrations, bronchogenic cysts and congenital lobar emphysema may be asymptomatic at birth or at the time of discovery later in life. Some authors advocate simple observation because of the lack of data on the incidence of long-term complications. However, there are very few described cases where CCAM and intralobar sequestration have remained asymptomatic throughout life; complications eventually develop in virtually all patients. The most common complication is pneumonia, which may respond poorly to medical treatment. Other complications include the development of malignancies (carcinomas and pleuropulmonary blastomas), pneumothorax and hemoptysis or hemothorax. Since lung resection will be required sooner or later for CCAM, intralobar sequestration and intrapulmonary bronchogenic cysts it is best not to wait for complications to occur. For patients diagnosed prenatally, we recommend surgery at 3 to 6 months of life at the latest, so that compensatory lung growth can occur. At this age the postoperative course is usually smooth and long-term follow-up has shown normal respiratory function. Mediastinal bronchogenic cysts also tend to become symptomatic and elective resection is recommended. On the other hand, asymptomatic congenital lobar emphysema may regress spontaneously and observation is warranted. The management of small noncommunicating extralobar sequestrations is more controversial; it is known that these lesions can remain asymptomatic throughout life but complications may develop and they are sometimes difficult to differentiate from neuroblastoma.


Computerized comparison of two autoradiographs.
Our laboratory previously reported (Anal Chem 55: 2345-2348, 1983) the development of a digitizer and FORTRAN program for display and quantification of digitized autoradiographic images. We have since added several capabilities to the program. Coarse "rubber sheeting" (i.e., transforming coordinates to superimpose images) of the image by a quadratic transformation of pixel coordinates is developed from interactive identification of a few matching spots. The program determines thresholds to display a given proportion of the total protein in the image, or a given number of proteins, and it creates a protein list containing the spatial coordinates of each protein with a peak value above this threshold, together with the amount of the protein as measured by the ratio of its integrated intensity above its half-maximum to the total integrated intensity of the image. The lists can be stored on a disk and are used as the primary data for fine adjustments to superimpose images, quantitative comparison of images, and abstract display of proteins. Methods are discussed for presenting comparisons between gels in cases where spots for many proteins change in intensity.


Assessment of indoor air quality in health clubs: insights into (ultra)fine and coarse particles and gaseous pollutants.
Exercising on regular basis provides countless health benefits. To ensure the health, well-being and performance of athletes, optimal indoor air quality, regular maintenance and ventilation in sport facilities are essential. This study assessed the levels of particulate, down to the ultrafine range (PM10, PM2.5, and particle number concentration in size range of 20-1,000 nm, i.e., - PNC20-1000 nm), gaseous pollutants (total volatile organic compounds - TVOCs, CO2, and O3) and comfort parameters (temperature - T, relative humidity - RH) in different functional spaces of health clubs (n = 8), under specific occupancy and ventilation restrictions. In all HCs human occupancy resulted in elevated particles (up to 2-3 times than those previously reported), considering mass concentrations (PM10: 1.9-988.5 μg/m3 PM2.5: 1.6-479.3 μg/m3) and number (PNC 1.23 × 103 - 9.14 × 104 #/cm3). Coarse and fine PM indicated a common origin (rs = 0.888-0.909), while PNC showed low-moderate associations with particle mass (rs = 0.264-0.629). In addition, up to twice-higher PM and PNC were detected in cardiofitness & bodybuilding (C&B) areas as these spaces were the most frequented, reinforcing the impacts of occupational activities. In all HCs, TVOCs (0.01-39.67 mg/m3) highly exceeded the existent protection thresholds (1.6-8.9 times) due to the frequent use of cleaning products and disinfectants (2-28 times higher than in previous works). On contrary to PM and PNC, TVOCs were higher (1.1-4.2 times) in studios than in C&B areas, due to the limited ventilations combined with the smaller room areas/volumes. The occupancy restrictions also led to reduced CO2 (122-6,914 mg/m3) than previously observed, with the lowest values in HCs with natural airing. Finally, the specific recommendations for RH and T in sport facilities were largely unmet thus emphasizing the need of proper ventilation procedures in these spaces.


Enhancing Prediction Models for One-Year Mortality in Patients with Acute Myocardial Infarction and Post Myocardial Infarction Syndrome.
Predicting the risk of mortality for patients with acute myocardial infarction (AMI) using electronic health records (EHRs) data can help identify risky patients who might need more tailored care. In our previous work, we built computational models to predict one-year mortality of patients admitted to an intensive care unit (ICU) with AMI or post myocardial infarction syndrome. Our prior work only used the structured clinical data from MIMIC-III, a publicly available ICU clinical database. In this study, we enhanced our work by adding the word embedding features from free-text discharge summaries. Using a richer set of features resulted in significant improvement in the performance of our deep learning models. The average accuracy of our deep learning models was 92.89% and the average F-measure was 0.928. We further reported the impact of different combinations of features extracted from structured and/or unstructured data on the performance of the deep learning models.


The lived experience of having a neobladder.
The purpose of this phenomenological qualitative study was to describe the lived experience of people who had a neobladder constructed. Men and women with direct and personal knowledge of the experience were interviewed. Analyses of transcribed verbatim narratives were conducted. Major and minor themes with clustered subthemes were identified. Selected themes included diagnosing cancer, detesting the idea of the bag, coping with stressful events, managing tubes and drains, responding to incontinence, keeping the neobladder healthy, and seeing cancer as a lifelong threat.


Antiretroviral drug concentrations in the male and female genital tract: implications for the sexual transmission of HIV.
To summarize the recent literature (2008-2010) on antiretroviral (ARV) drug disposition into the male and female genital tract. Recent studies have confirmed that penetration of antiretroviral agents into the male and female genital tracts are both drug and sex specific. Concentrations achieved vary considerably depending on the class of drug studied, the sampling techniques used and the times samples are obtained. There appear to be several patterns of drug penetration into the male and female genital tract. In addition there appear to be different patterns of genital shedding under the influence of antiretroviral therapy. What effect these factors will have on the sexual transmission of HIV or the evolution and transmission of resistant HIV remains to be seen.


Metastatic Lung Cancer and Distress: Use of the Distress Thermometer for Patient Assessment.
Patients with metastatic lung cancer experience high levels of distress related to their disease trajectory and treatment. Oncology nurses are experts in patient care and symptom management, giving them an opportunity to screen and treat patients' distress. . The objectives of this study were to screen patients for distress and manage their symptoms to positively affect their quality of life, treatment adherence, and clinical outcomes, and to reduce healthcare costs. . This quality improvement project was conducted to pilot the Distress Thermometer (DT) into the care of patients with thoracic cancer and to evaluate the effect of a multifaceted intervention, consisting of a patient education pamphlet and a nurse coaching call, on distress levels. . Severe distress was reported in more than half the patients. A paired-sample t test revealed a significant decrease in distress scores following the intervention.


Microfracture Technique for Chronic Unstable Osteochondral Defect of Knee: Case Report.
Osteochondral fractures of the medial femoral condyle of the knee can be diagnostically and therapeutically challenging. Various techniques of osteochondral defect treatment include fixation, abrasion chondroplasty, drilling, microfracture, autografts, allografts and chondrocyte transplantation A 37-year-old man presented with persistent left knee pain of about six months duration. Concomitant symptoms included swelling, several episodes of locking and clicking, and a sense of instability especially in walking downstairs. MRI scan revealed an unstable osteochondral lesion about 2 cm in diameter involving the medial femoral condyle. The patient underwent arthroscopic removal of the fragment and microfracturing of the defect on the medial femoral condyle. Postoperatively, he was treated with non-weight bearing for six weeks along with quadriceps strengthening and range of motion (ROM) exercises. The final outcome was good as the patient has returned to his previous activities. Microfracture technique is quite effective with regard to the improvement of daily activities with a favorable impact on pain relief and overall satisfactory functional results.


Repression of quiescence-specific polypeptides in chicken heart mesenchymal cells transformed by Rous sarcoma virus.
Chicken heart mesenchymal cells do not proliferate in medium of physiological composition containing plasma (S. Balk, Proc. Natl. Acad. Sci. USA 77:6606-6610, 1980). To understand the molecular events involved in cell quiescence and in the initiation of cell division under physiological conditions, we examined the differences in the patterns of protein synthesis of quiescent, hormone-stimulated, and Rous sarcoma virus-transformed chicken heart mesenchymal cells. We describe the expression of a 20,000-kilodalton (kDa) polypeptide actively synthesized by quiescent cells but not by their transformed counterparts. Normal chicken heart mesenchymal cells stimulated with epidermal growth factor and insulin also repressed the synthesis of the 20,000-kDa polypeptide while actively growing but synthesized increasing amounts of the protein at high cell density (confluence). The synthesis of the 20,000-kDa protein is not restricted to chicken heart mesenchymal cells, since confluent, density-arrested chicken embryo fibroblasts also expressed high levels of the protein. Transformed chicken heart mesenchymal cells and embryo fibroblasts did not synthesize the protein even at high cell density. The 20,000-kDa polypeptide accumulated in the culture medium.


Effects of lysosomal deposition on the friction coefficient of hydrogel contact lenses.
When a contact lens is in contact with the eyelid and the cornea, tear proteins start to be accumulated on the lens and may subsequently undergo conformational changes. Protein adsorption or conformational changes on the lens may lead to discomfort, red eye, or even inflammatory reactions. Although measuring the friction coefficient of contact lens has been linked to comfort degree in vivo, there is not much research about the effects of tear protein deposition on the friction coefficient of the contact lens. Therefore, we investigated the friction coefficient of three distinct materials of contact lenses in two different lysosomal concentrations. We also studied lysozyme deposition on the lens without the influence of friction. The results demonstrated that although the amount of lysozyme deposition was high on all the materials we tested, it was not corresponded to higher friction coefficient. In addition, we investigated the effect of the contact lens care solution we developed on friction coefficient and lysozyme deposition of three different materials of contact lenses. The results showed that the care solution could reduce the increased friction coefficient caused by high lysosomal concentration. Therefore, we proposed a potential mechanism of why lysosomal deposition may result in high friction coefficient for certain types of hydrogel contact lenses.


Influence of atmospheric phase compensation on optical heterodyne power measurements.
The simulation of beam propagation is used to examine the uncertainty inherent to the process of optical power measurement with a practical heterodyne receiver because of the presence of refractive turbulence. Phase-compensated heterodyne receivers offer the potential for overcoming the limitations imposed by the atmosphere by the partial correction of turbulence-induced wave-front phase aberrations. However, wave-front amplitude fluctuations can limit the compensation process and diminish the achievable heterodyne performance.


Quality of life of individuals with schizophrenia living in the community: relationship to socio-demographic, clinical and psychosocial characteristics.
To examine the level of quality of life in individuals with schizophrenia and to test its association with socio-demographic, clinical and psychosocial characteristics. Quality of life has been a focus of concern in mental health care, yet the level of quality of life and its determinants for individuals with schizophrenia are not well known. Cross-sectional, descriptive design. A total of 148 individuals with schizophrenia participated in the study. A demographic information sheet, the 18-item Brief Psychiatric Rating Scale, the Chinese Health Questionnaires, the Mutuality Scale and the World Health Organization Quality of Life Scale, brief version, were used to collect data. Data were analysed with descriptive statistics, Pearson product-moment correlation and stepwise multiple linear regression. Most of participants were single, unemployed, had a low education level and were supported financially by family. Quality of life was positively correlated with age of mental illness onset, mutuality, employment status and monthly household income, whereas it was negatively associated with the length of mental illness, symptom severity and health status. Health status, mutuality, symptom severity, monthly household income and employment status were found to be key significant predictors with mutuality having the greatest effect on quality of life. The findings increase our understanding of socio-demographic, clinical and psychosocial characteristics influencing the degree of quality of life in individuals with schizophrenia. Incorporation of families and communities into the treatment programmes would enhance patients' capabilities of social integration and satisfaction with their lives. Health care providers should make use of community-oriented intervention programmes that aim to strengthen psychosocial functioning. Particularly, programmes that enhance health status and mutuality should be identified and developed for both individuals with schizophrenia and their families.


MiR-26a-5p exerts its influence by targeting EP300, a molecule known for its role in activating the PI3K/AKT/mTOR signaling pathway in CD8+tumor-infiltrating lymphocytes of colorectal cancer.
Surgical resection remains the primary approach for treating colorectal cancer, which is among the prevalent types of cancers affecting the digestive system. Tumor-infiltrating lymphocyte (TIL) therapy has emerged as a prominent area of study in the field of tumor immunotherapy in recent times, with the potential to serve as a supplementary treatment for colorectal cancer. For this investigation, we employed single-cell sequencing data to assess the manifestation extent of miR-26a-5p exists in healthy colon tissue, tissue affected by colorectal cancer, and tissue adjacent to the tumor. According to our findings, tumor-infiltrating T lymphocytes express comparatively less miR-26a-5p in comparison to normal T lymphocytes, the role of it in modulating the function of tumor-infiltrating T lymphocytes is suggested. Studies on miR-26a-5p's involvement in tumor-infiltrating T lymphocytes is limited, despite previous evidence indicating its ability to facilitate the development and advancement of cancerous cells. As a result of our experiments, we concluded that miR-26a-5p hindered the PI3K/AKT/mTOR(PAM) signaling pathway, reducing the ability of CD8+ tumor-infiltrating cells eradicate tumors. Using bioinformatics tools, we utilized prediction methods to identify EP300 as the specific gene targeted by miR-26a-5p. Subsequent research understood that downregulation of EP300 counteracted the suppressive impact exerted by miR-26a-5p on the stimulation of PAM signaling pathway, while it also diminishes the viability and cytotoxicity of CD8+ tumor-infiltrating lymphocytes. Therefore, miR-26a-5p emerges as a compelling option for the effective control of TIL therapy.


Downregulation of KSR1 in pancreatic cancer xenografts by antisense oligonucleotide correlates with tumor drug uptake.
While antisense oligonucleotide (AS-ODN) technology holds promise for the treatment of cancer, to date there have been no clinical successes. Unfortunately, current assays are not sufficiently sensitive to measure tissue ODN levels. Hence it has not been possible to ascertain whether treatment failures result from failure of drug delivery. To investigate the relationship between drug uptake and therapeutic effect, we developed an ultrasensitive noncompetitive hybridization-ligation enzyme-linked immunosorbent assay (NCHL-ELISA) to quantify Kinase Suppressor of Ras1 (KSR1) AS-ODN drug uptake in plasma and tumor tissues. In mice harboring PANC-1 pancreatic cancer xenografts and continuously infused with AS-ODN, our ELISA detects plasma and tumor KSR1 AS-ODN levels over an extended range, from 0.05 nM to 20 nM. Using this sensitive assay, we demonstrate that KSR1 repression in pancreatic cancer xenografts correlates highly with AS-ODN uptake into tumor tissues. In contrast, plasma drug levels do not correlate with tumor drug content or target downregulation. These studies indicate the efficacy of our ELISA, and suggest that tumor biopsy material will need to be procured to estimate the potential of this antisense technology.


Morphology of irradiated microvasculature: a combined in vivo and electron-microscopic study.
The purpose of this study was to establish a standardized experimental system to investigate the local effects of ionizing irradiation in the absence of systemic responses due to radiation. Twenty fully healed rabbit ear chambers in 13 rabbits were irradiated with single exposures of 7500 rads of beta-rays from a strontium-90 source. The irradiation resulted in an acute response, with cellular infiltration of the ear chambers, loss of vasomotion in arterioles, and vasodilatation. Over the weeks following irradiation, a gradual reduction in the number of blood and lymphatic vessels was noticed. A gradual reduction in the number of cells in the interstitium was also observed. Finally, only a few thin-walled blood vessels remained. Their endothelium contained no recognizable organelles and in places had disappeared completely, to expose the vascular basement membrane to the blood. These vessels were observed to be still flowing. No evidence either of capillary blockage due to swelling of endothelial cells or of platelet aggregation leading to thrombosis was obtained.


Exposure and nontarget effects of transgenic Bt corn debris in streams.
Corn (Zea mays L.) transformed with a gene from the bacterium Bacillus thuringiensis (Bt) comprises 49% of all corn in the United States. The input of senesced corn tissue expressing the Bt gene may impact stream-inhabiting invertebrates that process plant debris, especially trichopteran species related to the target group of lepidopteran pests. Our goal was to assess risk associated with transgenic corn debris entering streams. First, we show the input of corn tissue after harvest was extended over months in a stream. Second, using laboratory bioassays based on European corn borer [Ostrinia nubilalis (Hübner)], we found no bioactivity of Cry1Ab protein in senesced corn tissue after 2 wk of exposure to terrestrial or aquatic environments. Third, we show that Bt near-isolines modify growth and survivorship of some species of invertebrates. Of the four nontarget invertebrate species fed Bt near-isolines, growth of two closely related trichopterans was not negatively affected, whereas a tipulid crane fly exhibited reduced growth rates, and an isopod exhibited reduced growth and survivorship on the Cry1Ab near-isoline but not on the stacked Cry1Ab + Cry3Bb1 near-isoline. Because of lack of evidence of bioactivity of Bt after 2 wk and because of lack of nontarget effects on the stacked near-isoline, we suggest that tissue-mediated differences, and not the presence of the Cry1Ab protein, caused the different responses among the species. Overall, our results provide evidence that adverse effects to aquatic nontarget shredders involve complex interactions arising from plant genetics and environment that cannot be ascribed to the presence of Cry1Ab proteins.


A spatial, statistical approach to map the risk of milk contamination by β-hexachlorocyclohexane in dairy farms.
In May 2005, beta-hexachlorocyclohexane (β-HCH) was found in a sample of bovine bulk milk from a farm in the Sacco River valley (Latium region, central Italy). The primary source of contamination was suspected to be industrial discharge into the environment with the Sacco River as the main mean of dispersion. Since then, a surveillance programme on bulk milk of the local farms was carried out by the veterinary services. In order to estimate the spatial probability of β- HCH contamination of milk produced in the Sacco River valley and draw probability maps of contamination, probability maps of β-HCH values in milk were estimated by indicator kriging (IK), a geo-statistical estimator, and traditional logistic regression (LR) combined with a geographical information systems approach. The former technique produces a spatial view of probabilities above a specific threshold at non-sampled locations on the basis of observed values in the area, while LR gives the probabilities in specific locations on the basis of certain environmental predictors, namely the distance from the river, the distance from the pollution site, the elevation above the river level and the intrinsic vulnerability of hydro-geological formations. Based on the β-HCH data from 2005 in the Sacco River valley, the two techniques resulted in similar maps of high risk of milk contamination. However, unlike the IK method, the LR model was capable of estimating coefficients that could be used in case of future pollution episodes. The approach presented produces probability maps and define high-risk areas already in the early stages of an emergency before sampling operations have been carried out.


Genetic toxicology of phthalate esters: mutagenic and other genotoxic effects.
The effects of DEHP on sperm morphology and on peripheral blood micronuclei were studied for 12 weeks following five subacute IP injections of DEHP at 1/6, 1/12, and 1/60 of the LD50 per day. Sperm morphology was examined in both adult mice and rats, while peripheral blood micronuclei were scored in mice up to 4 weeks after treatment. In mice, DEHP at 1/6 LD50 significantly depressed body weight gain for up to 12 weeks after treatment, and reduced epididymal sperm number by 4 weeks. Numbers of morphologically abnormal sperm did not differ from controls in the 12 weeks following treatment. In addition, DEHP did not increase the numbers of peripheral blood micronuclei. Studies in the rat indicated that exposure to doses of 1/6 and 1/12 of the LD50 per day of DEHP resulted in a reduced gain in body weight compared to controls. Testis weight, sperm number, and numbers of morphologically abnormal sperm were unaffected by DEHP following treatment. In separate experiments, DEHP did not induce sister chromatid exchange (SCE) or DNA damage in Chinese hamster ovary (CHO) cells. Although DEHP is known to cause testicular atrophy in rats and to a lesser extent in mice, it did not cause an increase in abnormal sperm in either species. Together with the CHO and micronucleus data, these findings suggest that DEHP has a low probability of causing genetic damage capable of being transmitted through the male germ line.


Assessment of quality of care in maternal and newborn health services available in public health care facilities in Bangladesh.
The study was conducted using the exit interview with patients (n=120), in depth interview with health care providers (n=87) and focus group discussion (n=16) with stakeholders to assess the perceived level of quality of care in maternal and newborn health at public facilities in Bangladesh. Both clients and providers expressed dissatisfaction for inadequate quality of care represented by poor cleanliness, long waiting time with less consultation time, poor compassion by providers, inadequate supply of drugs and unnoticed cost for services varied by level of facilities. Inadequacy in human resource and absenteeism and poor laboratory service were reported to worsen the condition especially at lower level of service delivery. Thus this study explored some important factors like poor quality of care, inadequate technical competencies, information exchange and follow-up services. A deficit in supplies and logistics are strong barrier in regards to quality of care at various levels which needs to be addressed immediately.


The activation of urocortin immunoreactive neurons in the Einger-Westphal nucleus following stress in rats.
Urocortin, a member of the corticotropin releasing factor (CRF) peptide family, has a 45%sequence identity to CRF. Urocortin is ten-times more potent than CRF in increasing CAMP in cells expressing the CRF, receptor, therefore it was postulated to be an endogenous ligand for this receptor. Urocortin possesses the biological activity of CRF, and by activating the CRF(2) receptors, it can directly affect autonomic functions and play an important role in modifying the efferent components of endocrine, immune and behavioral responses to stress.Although urocortin's distribution in the rat brain has been described, with the most abundant urocortin-ir perikarya present in the Edinger-Westphal nucleus (E-WN), little is known about the physiological significance of brain urocortin. Since immediate early gene expression is seen in several midbrain regions, such as in the E-WN, following acute stress, we hypothesized that acute pain stress can result in the activation of the urocortinergic neurons in the E-WN.Fos immunoreactivity, the protein product of the immediate early gene c-fos, was used as a marker of cellular activity. Double-label immunohistochemical and double label immunofluorescence techniques were used in an acute pain stress model to reveal the colocalization of Fos-immunopositivity with urocortin-immunoreactivity (ir) within the E-WN.Our results showed that acute pain stress resulted in the activation of urocortin-ir neurons in the E-WN, peaking at 4 h after acute pain stress, based on the colocalization of Fos-ir with urocortin-ir, and the upregulation of urocortin mRNA transcripts in the E-WN. Based on these results, we suggest that the E-WN is a brain area that shows sustained activation by a painful stressor.


How fixed versus variable gonadotropin dose during controlled ovarian stimulation could influence the management of infertility patients undergoing IVF treatment: a national Delphi consensus.
Define how and when fixed starting gonadotropin doses can be used in current clinical ART practices in Italy. A Delphi conference consisting of three rounds was performed in order to define the ideal clinical conditions in which fixed-gonadotropin-dose during COS should be applied. During the conference, 19 statements about the current ART practice were provided to a panel of twenty-nine national experts. Median score was 5 (IQ:4-6) in all Delphi rounds. Eleven statements (57.9%) were classified as shareable with high-degree of convergence, 2 (10.5%) as shareable with low convergence and 6 (31.6%) as un-shareable with high convergence. The panel reached high consensus regarding some statements: (i) fixed FSH-dose in normoresponders and poor-responder, (ii) importance of predicting ovarian response before COS, considering multiple markers to select the right stimulation protocol for each patient, (iii) importance of therapy simplification and standardization to improve efficiency during COS. Moreover, a low-convergence was reached about use of GnRH antagonist as first treatment line and drug storage at room temperature. However from these findings, the debate remains open regarding some other statements: (a) usefulness of Bologna-criteria to define poor-responders; (b) efficacy to change always stimulation protocol after a failure IVF; (c) utility of AMH-dosed with standardized automatic mode to define normo-responder patients; (d) usefulness to modify the dosage of 12.5 IU/die during COS to improve stimulation effectiveness. Controlled ovarian stimulation remains a challenging clinical step in Assisted Reproductive Technique, especially in some specific patient groups for which no clinical consensus is available. This study is the first attempt to describe the shared clinical opinion regarding the fixed versus variable gonadotropin dose in the real IVF practice.


Pituitary atrophy in Korean (epidemic) hemorrhagic fever: CT correlation with pituitary function and visual field.
Eleven patients with Korean (epidemic) hemorrhagic fever were each studied three times with high-resolution CT in order to demonstrate necrosis of the pituitary gland and to correlate the CT findings with the patients' pituitary function and visual fields. Seven of the 11 patients showed varying degrees of progressive decrease in the height of the pituitary gland: one severe, two moderate, and four mild. The visual fields of all the patients were checked at the time of the third (last) follow-up CT. Six of the 11 patients had bitemporal superior quadrantanopsia. In five patients, the decreased height (atrophic change) of the pituitary gland and the visual-field defect were coincidental. The visual-field defects in those patients were not improved on follow-up examination 5 weeks later. Two patients in whom a 1-year follow-up examination was performed showed no interval changes in the defects. Pituitary function tests were performed in nine of the 11 patients (six with atrophic pituitary glands and three without atrophic changes) at the time of the third CT. Five of the six patients with atrophy showed decreased pituitary reserve function for follicle-stimulating hormone, cortisol, or human growth hormone, while only one patient showed decreased reserve function for cortisol among the three patients without atrophic change. The pituitary atrophic changes observed on follow-up sellar CT are thought to be the result of the ischemic necrosis of the gland. The high probability (five of seven) of visual-field defects in those patients with atrophic glands suggests optochiasmatic and pituitary ischemia as the basic pathogenesis.


Bridging a patient with acute liver failure to liver transplantation by the AMC-bioartificial liver.
Recently a phase I clinical trial has been started in Italy to bridge patients with acute liver failure (ALF) to orthotopic liver transplantation (OLT) by the AMC-bioartificial liver (AMC-BAL). The AMC-BAL is charged with 10 x 10(9) viable primary porcine hepatocytes isolated from a specified pathogen-free (SPF) pig. Here we report a patient with ALF due to acute HBV infection. This patient was treated for 35 h by two AMC-BAL treatments and was bridged to OLT. There was improvement of biochemical and clinical parameters during the treatment. No severe adverse events were observed during treatment and follow-up of 15 months after hospital discharge. Possible porcine endogenous retrovirus (PERV) activity could not be detected in the patient's blood or blood cells up to 12 months after treatment.


FOXG1 is responsible for the congenital variant of Rett syndrome.
Rett syndrome is a severe neurodevelopmental disease caused by mutations in the X-linked gene encoding for the methyl-CpG-binding protein MeCP2. Here, we report the identification of FOXG1-truncating mutations in two patients affected by the congenital variant of Rett syndrome. FOXG1 encodes a brain-specific transcriptional repressor that is essential for early development of the telencephalon. Molecular analysis revealed that Foxg1 might also share common molecular mechanisms with MeCP2 during neuronal development, exhibiting partially overlapping expression domain in postnatal cortex and neuronal subnuclear localization.


Genetic variation of germination cold tolerance in Japanese rice germplasm.
Low temperatures at the initial stages of rice development prevent fast germination and seedling establishment and may cause significant productivity losses. In order to develop rice cultivars exhibiting cold tolerance, it is necessary to investigate genetic resources, providing basic knowledge to allow the introduction of genes involved in low temperature germination ability from accessions into elite cultivars. Japanese rice accessions were evaluated at the germination under two conditions: 13°C for 28 days (cold stress) and 28°C for seven days (optimal temperature). The traits studied were coleoptile and radicle length under optimal temperature, coleoptile and radicle length under cold and percentage of the reduction in coleptile and radicle length due to low temperature. Among the accessions studied, genetic variation for traits related to germination under low temperatures was observed and accessions exhibiting adequate performance for all investigated traits were identified. The use of multivariate analysis allowed the identification of the genotypes displaying cold tolerance by smaller reductions in coleoptile and radicle lenght in the presence of cold and high vigour, by higher coleoptile and radicle growth under cold.


A structured approach to evaluating change among sexual offenders.
Presently, there are no established scales that evaluate change in risk among sexual offenders. The Sex Offender Need Assessment Rating (SONAR) was developed to fill this gap. The SONAR includes five relatively stable factors (intimacy deficits, negative social influences, attitudes tolerant of sex offending, sexual self-regulation, general self-regulation) and four acute factors (substance abuse, negative mood, anger, victim access). The psychometric properties of the scale were examined using data previously collected by Hanson and Harris (1998, 2000). Overall, the scale showed adequate internal consistency and moderate ability to differentiate between recidivists and nonrecidivists (r = .43; ROC area of .74). SONAR continued to distinguish between the groups after controlling for well-established risk indicators, such as age, and scores on the Static-99 (Hanson & Thornton, 2000) and the Violence Risk Appraisal Guide (Quinsey, Harris, Rice, & Cormier, 1998).


[Glaucoma visual fields and filtering operations].
Visual field defects already existing in 81 eyes prior to goniotrepanation (Elliot-Fronimopoulos) were followed up for up to 84 months postoperatively. In 11 eyes there were slight peripheral limitations due to cataract formation. In all of the other cases the visual fields were unchanged.


Impact of trace element addition on biogas production from food industrial waste--linking process to microbial communities.
Laboratory-scale reactors treating food industry waste were used to investigate the effects of additions of cobalt (Co), nickel/molybdenum/boron (Ni/Mo/B) and selenium/tungsten (Se/W) on the biogas process and the associated microbial community. The highest methane production (predicted value: 860 mL g(-1) VS) was linked to high Se/W concentrations in combination with a low level of Co. A combination of quantitative real-time PCR of 16S rRNA genes, terminal restriction fragment length polymorphism (T-RFLP) and clone library sequencing was used for the community analysis. The T-RFLP data show a higher diversity for bacteria than for archaea in all the treatments. The most abundant bacterial population (31-55% of the total T-RFLP fragments' intensity) was most closely related to Actinomyces europaeus (94% homology). Two dominant archaeal populations shared 98-99% sequence homology with Methanosarcina siciliae and Methanoculleus bourgensis, respectively. Only limited influence of the trace metal additions was found on the bacterial community composition, with two bacterial populations responding to the addition of a combination of Ni/Mo/B, while the dominant archaeal populations were influenced by the addition of Ni/Mo/B and/or Se/W. The maintenance of methanogenic activity was largely independent of archaeal community composition, suggesting a high degree of functional redundancy in the methanogens of the biogas reactors.


[A form of dermatosparaxis in a Texel lamb].
A case of dermatosparaxis in a Texel lamb is reported in the present paper. The most striking clinical symptom consisted in the formation of multiple seromas. The findings and symptoms in this case showed a marked similarity to those reported in the literature, though they were not identical.


The art of clinical supervision program: its impact on nurses attitudes towards nursing students.
Background: Increasing health professional student numbers in Australia, in response to looming predicted workforce shortages, resulted in a Federal Government call for action to provide clinical supervision education to health professionals. Objectives: This research aimed to develop, implement and evaluate the programme, 'The Art of Clinical Supervision' (ACS), designed to support nurses facilitate a positive learning environment for student nurses. Method: The ACS programme was presented (n = 199) across Western Australia as a doctoral study, with participants from both the public and private healthcare sector working in a variety of specialties. A triangulation approach of surveys, reflective entries and interviews was utilised to determine its impact. Results: The data indicated that participants improved their understanding of supervision and attitude towards students and supervision after attending the ACS. Conclusions: Health service managers are encouraged to evaluate their staffs' knowledge and attitude towards students with findings used to facilitate a positive learning culture.Impact Statement: The Art of Clinical SupervisionThe purpose of the research was to develop, implement and review a new education programme that could support the development of clinical supervision knowledge and attitude to support student nurse learning. This occurred in an environment of increased student numbers as a strategy to correct a predicted looming workforce shortage.The study findings determined that the programme improved both participant knowledge about how to provide effective clinical supervision (teaching) in the clinical environment, and improved staff attitudes towards students and their place as a learner in the clinical areas.The type of impact was therefore within the domain of quality by improving student learning through effective education strategy.As a result of the doctoral research, involving 200 participants, a Federal Government grant of approx. $500,000 was received to facilitate the training of additional educators to provide the programme across the state of Western Australia. This grant was a partnership between the programme author (researcher) and the Western Australian Government Department of Health. This involved four educators presenting the programme to over 3,000 health professionals in a 3-year period. Despite the cessation of funds with the closure of HWA the programme continues to be delivered through The University of Notre Dame Australia School of Nursing and Midwifery, with only a cost recovery charge.


Is race erased? Decoding race from patterns of neural activity when skin color is not diagnostic of group boundaries.
Several theories suggest that people do not represent race when it does not signify group boundaries. However, race is often associated with visually salient differences in skin tone and facial features. In this study, we investigated whether race could be decoded from distributed patterns of neural activity in the fusiform gyri and early visual cortex when visual features that often covary with race were orthogonal to group membership. To this end, we used multivariate pattern analysis to examine an fMRI dataset that was collected while participants assigned to mixed-race groups categorized own-race and other-race faces as belonging to their newly assigned group. Whereas conventional univariate analyses provided no evidence of race-based responses in the fusiform gyri or early visual cortex, multivariate pattern analysis suggested that race was represented within these regions. Moreover, race was represented in the fusiform gyri to a greater extent than early visual cortex, suggesting that the fusiform gyri results do not merely reflect low-level perceptual information (e.g. color, contrast) from early visual cortex. These findings indicate that patterns of activation within specific regions of the visual cortex may represent race even when overall activation in these regions is not driven by racial information.


Are breast cancer navigation programs cost-effective? Evidence from the Chicago Cancer Navigation Project.
One of the aims of the Chicago Cancer Navigation Project (CCNP) is to reduce the interval of time between abnormal breast cancer screening and definitive diagnosis in patients who are navigated as compared to usual care. In this article, we investigate the extent to which total costs of breast cancer navigation can be offset by survival benefits and savings in lifetime breast cancer-attributable costs. Data sources for the cost-effectiveness analysis include data from published literature, secondary data from the NCI's Surveillance Epidemiology and End Results (SEER) program, and primary data from the CCNP. If women enrolled in CCNP receive breast cancer diagnosis earlier by 6 months as compared to usual care, then navigation is borderline cost-effective for $95,625 per life-year saved. Results from sensitivity analyses suggest that the cost-effectiveness of navigation is sensitive to: the interval of time between screening and diagnosis, percent increase in number of women who receive cancer diagnosis and treatment, women's age, and the positive predictive value of a mammogram. In planning cost-effective navigation programs, special considerations should be made regarding the characteristics of the disease, program participants, and the initial screening test that determines program eligibility.


Hearables: Automatic Sleep Scoring from Single-Channel Ear-EEG in Older Adults.
Sleep disorders are a prevalent problem among older adults, yet obtaining an accurate and reliable assessment of sleep quality can be challenging. Traditional polysomnography (PSG) is the gold standard for sleep staging, but is obtrusive, expensive, and requires expert assistance. To this end, we propose a minimally invasive single-channel single ear-EEG automatic sleep staging method for older adults. The method employs features from the frequency, time, and structural complexity domains, which provide a robust classification of sleep stages from a standardised viscoelastic earpiece. Our method is verified on a dataset of older adults and achieves a kappa value of at least 0.61, indicating substantial agreement. This paves the way for a non-invasive, cost-effective, and portable alternative to traditional PSG for sleep staging.


Comparison of the Thickness of Pulley and Flexor Tendon Between in Neutral and in Flexed Positions of Trigger Finger.
This study aims to compare the morphology of the A1 pulley and flexor tendons in idiopathic trigger finger of digits other than the thumb between in neutral position and in the position with the interphalangeal joints full flexed and with the metacarpophalangeal (MP) joint 0° extended (hook grip position). A total of 48 affected digits and 48 contralateral normal digits from 48 patients who initially diagnosed with idiopathic trigger finger were studied sonographically. Sonographic analysis was focused on the A1 pulley and flexor tendons at the level of the MP joint in the transverse plane. We measured the anterior-posterior thickness of A1 pulley and the sum of the flexor digitorum superficialis and profundus tendons, and also measured the maximum radialulnar width of the flexor tendon in neutral and hook grip positions, respectively. Each measurement was compared between in neutral and in hook grip positions, and also between the affected and contralateral normal digits in each position. In all the digits, the anterior-posterior thickness of flexor tendons significantly increased in hook grip position as compared with in neutral position, whereas radial-ulnar width significantly decreased. Both the A1 pulley and flexor tendons were thicker in the affected digits as compared with contralateral normal digits. The thickness of flexor tendons was significantly increased anteroposteriorly in hook grip position as compared with in neutral position. In trigger finger, A1 pulley and flexor tendon were thickened, and mismatch between the volume of the flexor tendon sheath and the tendons, especially in anterior-posterior direction, might be a cause of repetitive triggering.


Determinants of a simulated cross-country skiing sprint competition using V2 skating technique on roller skis.
The present study investigated the performance-predicting factors of a simulated cross-country (XC) skiing sprint competition on roller skis, on a slow surface. Sixteen elite male XC skiers performed a simulated sprint competition (4 x 850 m heat with a 20-minute recovery) using V2 skating technique on an indoor tartan track. Heat velocities, oxygen consumption, and peak lactate were measured during or after the heats. Maximal skiing velocity was measured by performing a 30-m speed test. Explosive and maximal force production in the upper body was determined by bench press (BP). Subjects also performed maximal anaerobic skiing test (MAST) and the 2 x 2-km double poling (DP) test. The maximal velocity of MAST (VMAST) and velocities at 3 (V3), 5 (V5), 7 (V7) mmol.L lactate levels in MAST were determined. In the 2 x 2-km test, DP economy (VO2SUBDP) and maximal 2-km DP velocity (VDP2KM) were determined. The best single performance-predicting factors for the sprint performance were VDP2KM (r = 0.73, p < 0.01), V7 (r = 0.70, p < 0.01), and VO2SUBDP (r = -0.70, p < 0.01). Faster skiers in sprint simulation had a higher absolute VO2 (L.min) (p < 0.05-0.01) during sprint heats, and higher anaerobic skiing power (VMAST, p < 0.05) and better anaerobic skiing economy (V3, V5, V7, p < 0.05-0.001) than slower skiers. Faster skiers were also stronger in BP, with regard to both absolute (p < 0.01) and relative (p < 0.05) values. In addition, anaerobic characteristics seem to be of importance at the beginning of the XC skiing sprint competition, whereas the aerobic characteristics become more important as the XC skiing sprint competition progressed. This study indicates that sprint skiers should emphasize sport-specific upper body training, and training skiing economy at high speeds.


Public perceptions of an appropriate donor card/brochure.
Donor card/brochures have not had a major impact on donation, though considerable resources have been invested in their development and distribution. One reason for this may be that they have not been evaluated by the people expected to sign them: the American public. A focus group format was used to develop a quantitative survey to assess the public's perception of an appropriate donor card/brochure. Several donor card/brochures were studied to compare and evaluate their effectiveness, content, format, and acceptance of the message. A donor card/brochure was designed that was based on the results of the survey: it included a business reply card for further evaluation. The newly developed donor card/brochure continues to be viewed positively by those returning business reply cards. Most have signed the card and discussed donation with family members.


Zaspopathy in a large classic late-onset distal myopathy family.
Distal myopathies have been associated with mutations in titin, dysferlin, GNE, desmin and myosin. Of these, only titin mutations were previously known to cause dominant late-onset distal myopathy. Recent findings, however, have indicated that patients affected with myofibrillar myopathy have a more distal than proximal muscle phenotype and a proportion of these may have mutations in myotilin, ZASP or filamin C, besides previously known desmin and alphaB-crystallin. Here we report that the disorder in one of the well-characterized autosomal dominant distal myopathy families, the Markesbery et al. family, first reported in 1974, is caused by ZASP mutation A165V. Previous linkage to the titin locus 2q31 proved incorrect. ZASP expression by immunoblotting shows normal presence of the main 32 and 78 kDa bands and immunohistochemistry in patients reveals normal Z-disc localization except for moderate accumulations together with myotilin, desmin alphaB-crystallin and alpha-actinin. Muscle imaging reveals involvement in both the posterior and anterior compartments of the lower leg and considerable affection of proximal leg muscles at later stages. Haplotype studies in this family and in five other unrelated families with European ancestry carrying the identical A165V mutation share common markers at the locus suggesting the existence of a founder mutation.


Efficient Descriptor-Based Segmentation of Parotid Glands With Nonlocal Means.
We introduce descriptor-based segmentation that extends existing patch-based methods by combining intensities, features, and location information. Since it is unclear which image features are best suited for patch selection, we perform a broad empirical study on a multitude of different features. We extend nonlocal means segmentation by including image features and location information. We search larger windows with an efficient nearest neighbor search based on kd-trees. We compare a large number of image features. The best results were obtained for entropy image features, which have not yet been used for patch-based segmentation. We further show that searching larger image regions with an approximate nearest neighbor search and location information yields a significant improvement over the bounded nearest neighbor search traditionally employed in patch-based segmentation methods. Features and location information significantly increase the segmentation accuracy. The best features highlight boundaries in the image. Our detailed analysis of several aspects of nonlocal means-based segmentation yields new insights about patch and neighborhood sizes together with the inclusion of location information. The presented approach advances the state-of-the-art in the segmentation of parotid glands for radiation therapy planning.


Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis.
Numerous studies have examined the comorbidity of depression with cancer, and some have indicated that depression may be associated with cancer progression or survival. However, few studies have assessed whether changes in depression symptoms are associated with survival. In a secondary analysis of a randomized trial of supportive-expressive group therapy, 125 women with metastatic breast cancer (MBC) completed a depression symptom measure (Center for Epidemiologic Studies-Depression Scale [CES-D]) at baseline and were randomly assigned to a treatment group or to a control group that received educational materials. At baseline and three follow-up points, 101 of 125 women completed a depression symptom measure. We used these data in a Cox proportional hazards analysis to examine whether decreasing depression symptoms over the first year of the study (the length of the intervention) would be associated with longer survival. Median survival time was 53.6 months for women with decreasing CES-D scores over 1 year and 25.1 months for women with increasing CES-D scores. There was a significant effect of change in CES-D over the first year on survival out to 14 years (P = .007) but no significant interaction between treatment condition and CES-D change on survival. Neither demographic nor medical variables explained this association. Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with MBC in this sample. Further research is necessary to confirm this hypothesis in other samples, and causation cannot be assumed based on this analysis.


A model for conservative care of low back pain: back school, epidural blocks, mobilization.
Conservative care for low back pain can be an enjoyable and successful experience for the physician. It requires a bit more organization and assistance than other routine forms of orthopaedic practice. It begins with a systematic collection of historical and physical information. The most appropriate conservative treatment is selected specifically for the patient's diagnosis. The patient's participation is required in the conservative treatment, and he must be willing to take responsibility for his condition. Education and training are the mainstay of conservative treatment with the addition of injections, braces, mobilization, medication, or rest as temporary adjuncts.


Rapid detection of antimicrobial resistance in methicillin-resistant Staphylococcus aureus using MALDI-TOF mass spectrometry.
Antimicrobial resistance is a growing problem in modern healthcare. Most antimicrobial susceptibility tests (AST) require long culture times which delay diagnosis and effective treatment. Our group has previously reported a proof-of-concept demonstration of a rapid AST in Escherichia coli using deuterium labeling and MALDI mass spectrometry. Culturing bacteria in D2O containing media incorporates deuterium in newly synthesized lipids, resulting in a mass shift that can be easily detected by mass spectrometry. The extent of new growth is measured by the average mass of synthesized lipids that can be correlated with resistance in the presence of antimicrobials. In this work, we adapt this procedure to methicillin-resistant Staphylococcus aureus using the Bruker MALDI-TOF Biotyper, a low-cost instrument commonly available in diagnostic laboratories. The susceptible strain showed a significant decrease in average mass in on-target microdroplet cultures after 3 hours of incubation with 10 µg/mL methicillin, while the resistant strain showed consistent labeling regardless of methicillin concentration. This assay allows us to confidently detect methicillin resistance in S. aureus after only 3 hours of culture time and minimal sample processing, reducing the turn-around-time significantly over conventional assays. The success of this work suggests its potential as a rapid AST widely applicable in many clinical microbiology labs with minimal additional costs.


Results of laparoscopic compared with open cholecystectomy.
Laparoscopic cholecystectomy was introduced in 1985 and diffused within a few years throughout the world. The avalanche-like spread resulted in this procedure not being scientifically supported by results of controlled clinical trials. By 1997 there were just 13 randomised controlled trials and 150 prospective studies that followed a research protocol, while there were more than 1500 retrospective analyses of series of operations in a country, in a specific hospital, or by a specific surgeon. Comparisons with the conventional laparotomy technique and with minilaparotomy techniques are complicated by the fact that the variables compared, such as operation times, complication rates, and costs, varied over time.


The role of isocolloidoosmotic synthetic colloid addition to St. Thomas Hospital cardioplegic solution for cardioprotection in isolated perfused rat hearts.
Cardiac transplantation is a prominent development in the treatment of patients with severe cardiac diseases. If it is not possible to transplant the heart immediately after removing it from the donor, procedures for preparing, protecting, storing and transferring of the heart constitute a major portion of this study. Selecting the best method among those used for cardioprotection is still been debated. This experimental study investigated whether isocolloidoosmotic solution in addition to St. Thomas Hospital cardioplegic solution would give better cardioprotection. Wistar rat hearts were isolated and perfused by the Langendorff method (n = 6 for each group). In the control group after stabilisation, the hearts were arrested while perfused with St. Thomas Hospital cardioplegic solution for 3 min, then they were placed in cardioplegic solution at 4 degrees C for 6 h. Afterwards the hearts were reperfused. In the experimental groups, modified gelatin fluid (30 g/l) or HES 200/0.5 (50 g/l) or dextran 70 (25 g/l) was added to the cardioplegic solution. Maximum contractility, +dF/dtmax, -dF/dtmax, heart rate, contractility rate product, coronary flow and lactate dehydrogenase, creatine phosphokinase enzyme leakage were measured in all groups during pre-ischemic and post-ischemic periods (10 min after reperfusion). At the end of each experiment, the hearts were weighted and tissue levels of lipid peroxide, expressed in terms of thiobarbituric acid reactive substances, malondialdehyde, glutathione (an important intracellular antioxidant) and ATP were measured. Non-ischemic tissue levels of malondialdehyde, glutathione and ATP were also measured in another group (n = 6). There was no statistically significant difference among the simultaneous experimental and control groups in any criteria evaluated (P > 0.05). The addition of synthetic colloids to the standard cardioplegic solution did not provide further protection except for the gelatin group in which recovered contractile force was not significantly different from the group's initial values. This effect may be explained by its degradation to amino acids which may play a substrate role.


ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine.
Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine.


Acute myocardial infarction elevates serine protease activity in saliva of patients with periodontitis.
There are indications that acute myocardial infarction (AMI) may have an effect on the oral environment, which is reflected in the expression of salivary and gingival proteinases. According to our knowledge, no studies have been carried out to investigate the effect of AMI on the activities of two major tissue-destructive serine protease and microbial effectors, elastase and cathepsin G, produced by oral fluid polymorphonuclear granulocytes (PMN). Therefore, we compared the activities of elastase and cathepsin G in saliva from patients with AMI and from systemically healthy subjects (non-AMI) with similar periodontal conditions. A total of 92 patients (47 AMI and 28 non-AMI patients with gingivitis or periodontitis, and 17 systemically and periodontally healthy subjects as a control group) were recruited. Clinical periodontal measurements were recorded, and stimulated whole-saliva samples were collected. The patients with AMI were clinically examined within 3-4 d after admission to the coronary care unit. The activities of saliva neutrophil elastase and cathepsin G were measured after collection, at specific time-points during incubation (from baseline to 23 h) by specific synthetic peptide substrate assays. The saliva of patients with AMI and periodontitis had a significant trend for the highest elastase activities among the study groups. Elastase and cathepsin G activities correlated significantly with each other in the AMI periodontitis group (r = 0.8, p < 0.01). In a logistic regression analysis, the level of salivary elastase activity associated significantly with periodontitis. AMI may be reflected in PMN serine protease elastase activity in saliva, despite its strong association with periodontitis.


Real-World Outcome and Prognostic Factors Among HER2-Positive Metastatic Breast Cancer Patients Receiving Pyrotinib-Based Therapy: A Multicenter Retrospective Analysis.
To explore the efficacy, safety, and potential factors influencing efficacy and outcome of pyrotinib-based therapy in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) in complex clinical practice. Real-world data for HER2-positive MBC patients treated with pyrotinib-based regimens from 6 hospitals in Northern Anhui, China, from September 2018 to February 2022, were retrospectively collected, and clinicopathological features, efficacy, prognosis, and safety were analyzed. Potential influencing factors including baseline serum vascular endothelial growth factor-A (VEGF-A) for evaluating pyrotinib's treatment response and outcome were also explored. A total of 169 patients with HER2-positive MBC were enrolled. The objective response rate (ORR), disease control rate (DCR), and median progression-free survival (mPFS) of the overall cohort were 65.1%, 87.6%, and 12.4 months, respectively. Pyrotinib is highly beneficial as different treatment lines and appears to be a feasible strategy both in combination with chemotherapeutic drugs and alone. The mPFS values were 16.5 months, 12.4 months, and 9.3 months in the first, second, and third-or-higher lines of anti-HER2 therapy, respectively (P=0.027). The most common adverse event (AE) was diarrhea (88.2%), and patients with < grade 3 diarrhea achieved a longer mPFS than patients with ≥ grade 3 diarrhea (13.3 months vs 6.9 months, P=0.007). Among the patients with available baseline VEGF-A data, the ORR was 43.5% in patients with a high level of VEGF-A, compared to 81.5% in patients with a low level of VEGF-A (P=0.005). Moreover, patients in the VEGF-A-high group exhibited a shorter mPFS time than those in the VEGF-A-low group (7.8 months vs 19.1 months, P=0.004). Further analysis demonstrated AE of diarrhea and VEGF-A at baseline to be independent prognostic factors for PFS. Pyrotinib-based regimens showed promising efficacy, with manageable tolerance, and AE occurrence of severe diarrhea and baseline level of serum VEGF-A are helpful in predicting the treatment outcome of pyrotinib in HER2-positive MBC.


Deniz: the electronic database for beta-thalassemia mutations in the Arab world.
Data on the distribution of beta-thalassemia mutations in Arab populations are usually destined to disparate locations and much of these become increasingly difficult for an average researcher to locate. That is why we aimed at establishing an electronic database network, called Deniz, for beta-thalassemia allele frequency distributions in the Arab world at http://biobase.fatih.edu.tr. The scheme of the database combines the benefits of the relational and hierarchical systems. Detailed statistics of the frequencies of beta-thalassemia mutations are retrieved in tabular forms. Multiple permanent connections allow flexible movement within the database. Queries are processed by the systems language and sent to the user's browser as hypertext markup language documents. The database catalogues the frequencies of beta-thalassemia mutations in 14 Arab countries as pooled from the analysis of 3,138 chromosomes by 36 laboratories. Of the 57 B-globin gene mutations reported in Arabs, IVS-I-110 (G-A), IVS-I-5 (G-C), IVS-I-6 (T-C), IVS-II-1 (G-A), and IVS-I-1 (G-A) are the most encountered and they account for approximately two thirds of the Arab chromosomes registered in Deniz. In addition to its importance as a hub of updated information on the distribution of beta-thalassemia mutations in Arabs, information in Deniz may be used to predict diagnostic strategies that may be offered to natives of unstudied countries. Incidence data may also give important clues on the possible origins of beta-thalassemia in the Arab world. The integration of Deniz with other databases is currently in process and researchers are invited to contribute to the growth of the database.


A rapid assessment of post-disclosure experiences of urban HIV-positive and HIV-negative school-aged children in Kenya.
There has been limited involvement of HIV-negative children in HIV disclosure studies; most studies conducted on the effects of disclosure on children have been with HIV-positive children and HIV-positive mother-child dyads. Seven HIV-positive and five HIV-negative children participated in a larger study conducted to understand the lived experiences of HIV-positive parents and their children during the disclosure process in Kenya. In this study, the experiences of these 12 children after receiving disclosure of their own and their parents' illnesses respectively are presented. Each child underwent an in-depth qualitative semi-structured digitally recorded interview. The recorded interviews were transcribed and loaded into NVivo8 for phenomenological data analysis. Five themes emerged from the data, indicating that HIV-positive and negative children appear to have differing post-disclosure experiences revolving around acceptance of illness, stigma and discrimination, medication consumption, sexual awareness, and use of coping mechanisms. Following disclosure, HIV-negative children accepted their parents' illnesses within a few hours to a few weeks; HIV-positive children took weeks to months to accept their own illnesses. HIV-negative children knew of high levels of stigma and discrimination within the community; HIV-positive children reported experiencing indirect incidences of stigma and discrimination. HIV-negative children wanted their parents to take their medications, stay healthy, and pay their school fees so they could have a better life in the future; HIV-positive children viewed medication consumption as an ordeal necessary to keep them healthy. HIV-negative children wanted their parents to speak to them about sexual-related matters; HIV-positive children had lingering questions about relationships, use of condoms, marriage, and childbearing options. All but one preadolescent HIV-positive child had self-identified a person to speak with for social support. When feeling overwhelmed by their circumstances, the children self-withdrew and performed positive activities (e.g., praying, watching TV, listening to the radio, singing, dancing) to help themselves feel better. Many HIV-affected families have a combination of HIV-positive and negative siblings within the household. Pending further studies conducted with larger sample sizes, the results of this study should assist healthcare professionals to better facilitate disclosure between HIV-positive parents and their children of mixed HIV statuses.


Molecular link between vitamin D and cancer prevention.
The metabolite of vitamin D, 1α,25-dihydroxyvitamin D₃ (also known as calcitriol), is a biologically active molecule required to maintain the physiological functions of several target tissues in the human body from conception to adulthood. Its molecular mode of action ranges from immediate nongenomic responses to longer term mechanisms that exert persistent genomic effects. The genomic mechanisms of vitamin D action rely on cross talk between 1α,25-dihydroxyvitamin D₃ signaling pathways and that of other growth factors or hormones that collectively regulate cell proliferation, differentiation and cell survival. In vitro and in vivo studies demonstrate a role for vitamin D (calcitriol) in modulating cellular growth and development. Vitamin D (calcitriol) acts as an antiproliferative agent in many tissues and significantly slows malignant cellular growth. Moreover, epidemiological studies have suggested that ultraviolet-B exposure can help reduce cancer risk and prevalence, indicating a potential role for vitamin D as a feasible agent to prevent cancer incidence and recurrence. With the preventive potential of this biologically active agent, we suggest that countries where cancer is on the rise--yet where sunlight and, hence, vitamin D may be easily acquired--adopt awareness, education and implementation strategies to increase supplementation with vitamin D in all age groups as a preventive measure to reduce cancer risk and prevalence.


Plasmapheresis in severe forms of myasthenia gravis.
In this study we introduce a new combination treatment of plasma exchange (PE) and high daily doses of prednisone for severe forms of myasthenia gravis (MG). The clinical efficacy of the combined therapy has been tested in 18 patients suffering from severe forms of MG. The protocol included 5 sessions of PE, performed in a range of 15 days, 1 session every 3 days, with concurrent administration of oral prednisone (1 mg/kg of body weight), starting at the first session of PE and given daily for at least 3 months. At the end of the entire cycle of PE, almost complete recovery (more than 90% of the initial clinical score) was obtained in 8 of 18 patients while an improvement between 60 and 90% of the initial score was achieved in 9 of 18 patients. An early improvement was noted 24 h after the beginning of plasmapheresis in 11 of 18 patients. No recurrence of symptoms was reported after 36 months of follow-up for 17 patients. The administration of steroid therapy was never followed by an early exacerbation of myasthenic symptoms as reported when it is administered in the absence of concomitant PE. According to our results, we can conclude that high doses of oral prednisone therapy in simultaneous association with PE lead to successful control of severe forms of MG, significantly superior to the therapeutic strategies until now adopted and reported in literature.


Visuoconstructional impairment in DM1: exploring underlying cognitive processes through the Rey complex figure.
Among the cognitive difficulties shown by myotonic dystrophy type 1 (DM1) patients, visuoconstructional impairment - specifically measured with the Rey-Osterrieth Complex Figure Test (RCFT) - is particularly notable. This study aimed to analyze the performance of DM1 patients and healthy controls (HC) in the RCFT, using different correction systems in order to explore the cognitive processes underlying the poor performance and its associations with other signs and symptoms. Data from 66 DM1 patients and 68 HC were included in this study. All participants had a comprehensive neuropsychological assessment, including the RCFT, which was scored using both the traditional Osterrieth and the Boston Qualitative Scoring System (BQSS) procedures. ANCOVA and Spearman's correlation analyses were conducted. DM1 Patients obtained significantly poorer scores than HC on the RCFT using both correction systems. Regarding BQSS, patients performed worse than HC in both main indexes (Copy Presence Accuracy-CPA and Organization-ORG), and specifically on scores of Configural accuracy, Planning, and Perseveration. Both main indexes - but especially CPA - showed significant and strong correlations with several clinical and cognitive variables. Both visuoconstruction and organizational impairments underlie the poor RCFT performance in DM1. Moreover, visuoconstruction ability appears to be sensitive to the clinical hallmarks of DM1 patients. The RCFT is proposed as a gold standard in DM1 assessment and the merits of using alternative scoring systems are discussed.