The Influence of Connection on the Microleakage Development of Implant- Supported Fixed Bridges.
If bacteria penetrate through the implant-abutment connection, they may initiate inflammatory reactions in the peri-implant tissue. It seems that the type of connection plays a key role in the development of peri-implantitis. The aim of the present in vitro study was to compare the microleakage of implant-supported fixed complete arch bridges at the levels of abutment and implant. Ten identical polyurethane model bases containing six implants each were produced using an edentulous model of the upper jaw. These models were prepared with two types of implant-supported complete arch prostheses. Five specimens were fixed at implant level and five at abutment level. The inner parts implants were inoculated with Escherichia coli (E.coli). Each implant was surrounded with closed bacteria-proof vessels to observe bacterial migration from the inner parts of implants to the nutrient solution. Samples of nutrient solution were taken at different time points up to 2 to 10 days and colony forming units were determined. The bacterial accumulation in the implant-supported bridges at the implant level was significantly lower than at the abutment-level (p=0.00953). For implant-supported fixed complete arch prostheses, bacterial accumulation was lower at the implant level than at the abutment-level.


Potential associations between severity of infection and the presence of virulence-associated genes in clinical strains of Staphylococcus aureus.
The clinical spectrum of Staphylococcus aureus infection ranges from asymptomatic nasal carriage to osteomyelitis, infective endocarditis (IE) and death. In this study, we evaluate potential association between the presence of specific genes in a collection of prospectively characterized S. aureus clinical isolates and clinical outcome. Two hundred thirty-nine S. aureus isolates (121 methicillin-resistant S. aureus [MRSA] and 118 methicillin-susceptible S. aureus [MSSA]) were screened by array comparative genomic hybridization (aCGH) to identify genes implicated in complicated infections. After adjustment for multiple tests, 226 genes were significantly associated with severity of infection. Of these 226 genes, 185 were not in the SCCmec element. Within the 185 non-SCCmec genes, 171 were less common and 14 more common in the complicated infection group. Among the 41 genes in the SCCmec element, 37 were more common and 4 were less common in the complicated group. A total of 51 of the 2014 sequences evaluated, 14 non-SCCmec and 37 SCCmec, were identified as genes of interest. Of the 171 genes less common in complicated infections, 152 are of unknown function and may contribute to attenuation of virulence. The 14 non-SCCmec genes more common in complicated infections include bacteriophage-encoded genes such as regulatory factors and autolysins with potential roles in tissue adhesion or biofilm formation.


Review of diseases and health management in zebrafish Danio rerio (Hamilton 1822) in research facilities.
The use of zebrafish (Danio rerio) in biomedical research has expanded at a tremendous rate over the last two decades. Along with increases in laboratories using this model, we are discovering new and important diseases. We review here the important pathogens and diseases based on some 20 years of research and findings from our diagnostic service at the NIH-funded Zebrafish International Resource Center. Descriptions of the present status of biosecurity programmes and diagnostic and treatment approaches are included. The most common and important diseases and pathogens are two parasites, Pseudoloma neurophilia and Pseudocapillaria tomentosa, and mycobacteriosis caused by Mycobacterium chelonae, M. marinum and M. haemophilum. Less common but deadly diseases are caused by Edwardsiella ictaluri and infectious spleen and kidney necrosis virus (ISKNV). Hepatic megalocytosis and egg-associated inflammation and fibroplasia are common, apparently non-infectious, in zebrafish laboratories. Water quality diseases include supersaturation and nephrocalcinosis. Common neoplasms are spindle cell sarcomas, ultimobranchial tumours, spermatocytic seminomas and a small-cell carcinoma that is caused by a transmissible agent. Despite the clear biosecurity risk, researchers continue to use fish from pet stores, and here, we document two novel coccidia associated with significant lesions in zebrafish from one of these stores.


Effects of dissolved nickel and nickel-contaminated suspended sediment on the scleractinian coral, Acropora muricata.
Intensification of lateritic nickel mining in Southeast Asia and Melanesia potentially threatens coastal ecosystems from increased exposure to nickel and suspended sediment. This study investigated the response of Acropora muricata when exposed to either dissolved nickel, clean suspended sediment or nickel-contaminated suspended sediment for 7 days, followed by a 7-d recovery period. Significant bleaching and accumulation of nickel in coral tissue was observed only after exposure to high dissolved nickel concentrations and nickel-spiked suspended sediment. No effect on A. muricata was observed from exposure to a particulate-bound nickel concentration of 60 mg/kg acid-extractable nickel at a suspended sediment concentration of 30 mg/L TSS. This study demonstrates that bioavailability of nickel associated with suspended sediment exposure plays a key role in influencing nickel toxicity to corals. These findings assist in assessments of risk posed by increasing nickel mining activities on tropical marine ecosystems.


Benchmarking the use of a rapid response team by surgical services at a tertiary care hospital.
Rapid response teams (RRT) are used to prevent adverse events in patients with acute clinical deterioration, and to save costs of unnecessary transfer in patients with lower-acuity problems. However, determining the optimal use of RRT services is challenging. One method of benchmarking performance is to determine whether a department's event rate is commensurate with its volume and acuity. Using admissions between 2009 and 2011 to 18 distinct surgical services at a tertiary care center, we developed logistic regression models to predict RRT activation, accounting for days at-risk for RRT and patient acuity, using claims modifiers for risk of mortality (ROM) and severity of illness (SOI). The model was used to compute observed-to-expected (O/E) RRT use by service. Of 45,651 admissions, 728 (1.6%, or 3.2 per 1,000 inpatient days) resulted in 1 or more RRT activations. Use varied widely across services (0.4% to 6.2% of admissions; 1.39 to 8.73 per 1,000 inpatient days, unadjusted). In the multivariable model, the greatest contributors to the likelihood of RRT were days at risk, SOI, and ROM. The O/E RRT use ranged from 0.32 to 2.82 across services, with 8 services having an observed value that was significantly higher or lower than predicted by the model. We developed a tool for identifying outlying use of an important institutional medical resource. The O/E computation provides a starting point for further investigation into the reasons for variability among services, and a benchmark for quality and process improvement efforts in patient safety.


Update on idiopathic hirsutism: diagnosis and treatment.
Idiopathic hirsutism (IH) is defined as hirsutism in conjunction with normal ovulatory function and normal serum androgen levels. The pathogenesis of IH is still not clear. Increased peripheral 5alpha-reductase enzyme activity and abnormalities of androgen receptor gene polymorphisms have been postulated to explain the pathogenesis of this disorder. It is diagnosed in women who have hirsutism, normal ovulatory function, and normal levels of serum total or free testosterone. Combination treatment of IH, including androgen suppression, peripheral androgen blockade and cosmetic methods is most effective.


A comparison of the acute behavioral effects of inhaled amyl, ethyl, and butyl acetate in mice.
The acute neurobehavioral effects of three acetates (amyl, ethyl, and n-butyl acetate) were investigated after 20-min inhalation exposures in mice using locomotor activity and a functional observational battery (FOB). Ethyl and n-butyl acetate produced significant decreases in locomotor activity at the highest concentrations examined, while amyl acetate was without effect. Minimally effective concentrations for activity-decreasing effects were 2000 ppm for ethyl acetate and 8000 ppm for n-butyl acetate. The potency order was similar in the FOB where ethyl acetate was more potent in disrupting the neurobehavioral measures. The FOB profile of effects for all three acetates included changes in posture, decreased arousal, increased tonic/clonic movements, disturbances in gait, delayed righting reflexes, and increased sensorimotor reactivity. Furthermore, handling-induced convulsions were produced in some mice acutely exposed to each of these acetates. Recovery from the acute effects of these acetates was rapid and began within minutes of removal from the exposure chamber. The acetates produced a profile of neurobehavioral effects that were different from those reported for depressant solvents (i.e., toluene, 1,1,1-trichloroethane) that are subject to abuse. Evidence is emerging for qualitative differences in the acute neurobehavioral effects of various volatile chemicals.


Comparison of argon and CO2 laser stapedotomy in primary otosclerosis surgery.
The primary use for the laser in otosclerosis surgery is to create a stapes footplate fenestration that obviates the need for mechanical footplate removal. Experimental studies that evaluate the potential safety of visible (argon and potassium-titanyl-phosphate [KTP]) and invisible (CO2) light laser systems in stapes surgery report conflicting results. The purpose of this study is to compare the clinical safety and efficacy of the CO2 and argon laser systems when used for primary laser stapedotomy. A retrospective case review of 124 primary laser stapedotomies using either the argon (n = 59) or CO2 (n = 65) laser was performed. Data consisted of pre- and postoperative air and bone conduction audiometry, speech discrimination scores (SDS), intraoperative findings, and postoperative complications. Between group differences (argon v CO2) were sought using standard statistical methodology. The argon and CO2 laser groups were comparable with regards to age, sex, preoperative air-bone gap, and laterality. Mean preoperative air and bone conduction pure-tone average (PTA) and SDS were somewhat higher in the CO2 laser group (P < .05). Postoperatively, both groups showed similar results in mean change in air conduction PTA, air-bone gap, and SDS, as well as in the frequency of complications. There were no anacoustic ears in either group. The results suggest that the argon and CO2 laser systems are comparable with regards to safety and efficacy when used by experienced surgeons for stapedotomy.


Cross-talk mechanisms in the development of insulin resistance of skeletal muscle cells palmitate rather than tumour necrosis factor inhibits insulin-dependent protein kinase B (PKB)/Akt stimulation and glucose uptake.
Insulin resistance in skeletal muscle is one of the earliest symptoms associated with non-insulin-dependent diabetes mellitus (NIDDM). Tumour necrosis factor (TNF) and nonesterified fatty acids have been proposed to be crucial factors in the development of the insulin-resistant state. We here show that, although TNF downregulated insulin-induced insulin receptor (IR) and IR substrate (IRS)-1 phosphorylation as well as phosphoinositide 3-kinase (PI3-kinase) activity in pmi28 myotubes, this was, unlike in adipocytes, not sufficient to affect insulin-induced glucose transport. Rather, TNF increased membrane expression of GLUT1 and glucose transport in these muscle cells. In contrast, the nonesterified fatty acid palmitate inhibited insulin-induced signalling cascades not only at the level of IR and IRS-1 phosphorylation, but also at the level protein kinase B (PKB/Akt), which is thought to be directly involved in the insulin-induced translocation of GLUT4, and inhibited insulin-induced glucose uptake. Palmitate also abrogated TNF-dependent enhancement of basal glucose uptake, suggesting that palmitate has the capacity to render muscle cells resistant not only to insulin but also to TNF with respect to glucose transport by GLUT4 and GLUT1, respectively. Our data illustrate the complexity of the mechanisms governing insulin resistance of skeletal muscle, questioning the role of TNF as a direct inhibitor of glucose homoeostasis in this tissue and shedding new light on an as yet unrecognized multifunctional role for the predominant nonesterified fatty acid palmitate in this process.


Outcome of patients with intracranial non-germinomatous germ cell tumors-lessons from the SIOP-CNS-GCT-96 trial.
Following promising results to increase survival and reduce treatment burden in intracranial non-germinomatous germ cell tumors (NGGCTs), we conducted a European study using dose-intense chemotherapy followed by risk-adapted radiotherapy. All patients received 4 courses of cisplatin/etoposide/ifosfamide. Non-metastatic patients then received focal radiotherapy only (54 Gy); metastatic patients received 30 Gy craniospinal radiotherapy with 24 Gy boost to primary tumor and macroscopic metastatic sites. Patients with localized malignant NGGCT (n = 116) demonstrated 5-year progression-free survival (PFS) and overall survival (OS) of 0.72 ± 0.04 and 0.82 ± 0.04, respectively. Primary tumor sites were: 67 pineal, 35 suprasellar, 5 bifocal, 9 others. One patient died postsurgery in clinical remission; 3 patients progressed during treatment and 27 (23%) relapsed afterward. Fourteen were local, 6 combined, and 7 distant relapses (outside radiation field). Seventeen of the 27 relapsed patients died of disease. Patients with metastatic disease (n = 33) demonstrated 5-year PFS and OS of 0.68 ± 0.09 and 0.75 ± 0.08, respectively; 1 patient died following progression on treatment and 9 (27%) relapsed afterward (5 local, 1 combined, 3 distant). Only one metastatic patient with recurrence was salvaged. Multivariate analysis identified diagnostic alpha-fetoprotein level (serum and/or cerebrospinal fluid level >1000 ng/mL, 19/149 patients, of whom 11 relapsed; P < 0.0003) and residual disease following treatment, including after second-look surgery (n = 52/145 evaluable patients, 26 relapsed; P = 0.0002) as significant prognostic indicators in this cohort. In localized malignant NGGCT, craniospinal radiotherapy could be avoided without increased relapses outside the radiotherapy field. Chemotherapy and craniospinal radiotherapy remain the gold standard for metastatic disease.


Dual physically and chemically crosslinked regenerated cellulose - Gelatin composite hydrogels towards art restoration.
Art restoration poses many challenges for scientists and conservators, as any restorative action can lead to lasting modification or damage to the original artefact. Recent interest in gel encapsulation has grown due to the ability to control the cleaning action; yet the restoration of modern paints such as acrylic-based systems still presents issues due to their extremely high sensitivity to most solvents. Herein, the preparation of dual physically and chemically crosslinked hydrogels based on regenerated cellulose and cinnamoyl-modified gelatin is demonstrated. These dual crosslinked hydrogels show increased mechanical strength and enhanced water retention compared to pure physically crosslinked hydrogels. When applied to acrylic-based paint surfaces, the dual crosslinked hydrogels extract a smaller amount of hydrophilic additives (albeit still leading to swelling within the paint film) versus physically crosslinked gels. It is anticipated that this dual crosslinking approach can be broadly applied to prepare gels for conservation of cultural heritage artefacts.


Intracellular bacteria: the origin of dinoflagellate toxicity.
Dinoflagellate blooms of the same species have been registered either as toxic or nontoxic and, in the latter case, toxicity may be of different types. A hypothesis has been formulated according to which the bacteria having in some way taken part in the toxin formation are either inside the dinoflagellate cell or in the nutritive liquid. The presence of intracellular bacteria in those microorganisms has been studied mainly in material from cultures, a few from the sea, and several strains were isolated from different species. Experiments with crossed inoculations have shown that the bacterial strain from Gonyaulax tamarensis caused the cells of some other species to become toxic. From nontoxic clonal cultures of Prorocentrum balticum, Glenodinium foliaceum, and Gyrodinium instriatum, after inoculation of that bacterial strain, cultures were obtained whose cell extracts showed the same kind of toxicity as G. tamarensis. No toxic action could be found in the extracts of the bacterial cells form the assayed strains. The interference of intracellular bacteria in the metabolism of dinoflagellates must be the main cause of their toxicity.


Assessment of vertical excursions and open-sea psychological performance at depths to 250 fsw.
A series of 10 two-man descending vertical excursion dives was carried out in the open sea from an ocean-floor habitat off the coast of Puerto Rico by four aquanauts saturated on a normoxic-nitrogen breathing mixture at a depth of 106 fsw. The purpose of these dives was two-fold: to validate laboratory findings with respect to decompression schedules and to determine whether such excursions would produce evidence of adaptation to nitrogen narcosis. For the latter, tests designed to measure time estimation, short-term memory, and auditory vigilance were used. The validation of experimental excursion tables was carried out without incidence of decompression sickness. Although no signs of nitrogen narcosis were noted during testing, all subjects made significantly longer time estimates in the habitat and during the excursions than on the surface. Variability and incomplete data prevented a statistical analysis of the short-term memory results, and the auditory vigilance proved unusable in the water.


Micro-CT imaging of tumor angiogenesis: quantitative measures describing micromorphology and vascularization.
Angiogenesis is a hallmark of cancer, and its noninvasive visualization and quantification are key factors for facilitating translational anticancer research. Using four tumor models characterized by different degrees of aggressiveness and angiogenesis, we show that the combination of functional in vivo and anatomical ex vivo X-ray micro-computed tomography (μCT) allows highly accurate quantification of relative blood volume (rBV) and highly detailed three-dimensional analysis of the vascular network in tumors. Depending on the tumor model, rBV values determined using in vivo μCT ranged from 2.6% to 6.0%, and corresponds well with the values assessed using IHC. Using ultra-high-resolution ex vivo μCT, blood vessels as small as 3.4 μm and vessel branches up to the seventh order could be visualized, enabling a highly detailed and quantitative analysis of the three-dimensional micromorphology of tumor vessels. Microvascular parameters such as vessel size and vessel branching correlated very well with tumor aggressiveness and angiogenesis. In rapidly growing and highly angiogenic A431 tumors, the majority of vessels were small and branched only once or twice, whereas in slowly growing A549 tumors, the vessels were much larger and branched four to seven times. Thus, we consider that combining highly accurate functional with highly detailed anatomical μCT is a useful tool for facilitating high-throughput, quantitative, and translational (anti-) angiogenesis and antiangiogenesis research.


Widespread Occurrence of Zoonotic Cryptosporidium Species and Subtypes in Dairy Cattle from Northeast China: Public Health Concerns.
Bovine cryptosporidiosis constitutes a threat to the livestock industry and public health worldwide. In the present study we investigated dairy cattle of all ages in northeast China for the prevalence and genetic traits of Cryptosporidium. Nested polymerase chain reaction of the small subunit rRNA gene was used to identify Cryptosporidium species or genotype. The parasite was detected in 130 of 537 (24.2%) animals sampled from the cities of Harbin (35.2%, 69/196) and Qiqihar (32.1%, 61/190). Cryptosporidium parvum (87/130) was identified as the dominant species by sequence analysis followed by Cryptosporidium bovis (28/130), Cryptosporidium ryanae (5/130), Cryptosporidium andersoni (2/130), Cryptosporidium suis-like genotype (2/130), and mixed C. ryanae/ C. bovis (1/130). Subtyping of C. parvum isolates was based on the DNA polymorphisms of the 60-kDa glycoprotein gene. Subtyping of the C. parvum isolates recognized subtypes IIdA15G1 (24/87) in Harbin and IIdA20G1 (48/87) in Qiqihar. A diversity of Cryptosporidium species/genotype and subtypes was identified in cattle from northeast China. Widespread occurrence of human-pathogenic Cryptosporidium species and subtypes is of public health significance. This is the first study reporting C. parvum subtype IIdA20G1 in China. The findings improve the epidemiological knowledge of bovine cryptosporidiosis in China, highlighting the importance of ongoing Cryptosporidium surveillance.


Oblique and rippled heliosphere structures from the Interstellar Boundary Explorer.
Past analysis has shown that the heliosphere structure can be deduced from correlations between long-scale solar wind pressure evolution and energetic neutral atom emissions. However, this required spatial and temporal averaging that smoothed out small or dynamic features of the heliosphere. In late 2014, the solar wind dynamic pressure increased by roughly 50% over a period of 6 months, causing a time and directional-dependent rise in around 2-6 keV energetic neutral atom fluxes from the heliosphere observed by the Interstellar Boundary Explorer. Here, we use the 2014 pressure enhancement to provide a simultaneous derivation of the three-dimensional heliospheric termination shock (HTS) and heliopause (HP) distances at high resolution from Interstellar Boundary Explorer measurements. The analysis reveals rippled HTS and HP surfaces that are oblique with respect to the local interstellar medium upwind direction, with significant asymmetries in the heliosphere structure compared to steady-state heliosphere models. We estimate that the heliosphere boundaries contain roughly ten astronomical unit-sized spatial variations, with slightly larger variations on the HTS surface than the HP and a large-scale, southwards-directed obliquity of the surfaces in the meridional plane. Comparisons of the derived HTS and HP distances with Voyager observations indicate substantial differences in the heliosphere boundaries in the northern versus southern hemispheres and their motion over time.


[The role of cytokines and reactive oxygen species in the pathogenesis of sepsis].
The role of cytokines and reactive oxygen species (ROS) in multiple and not fully explained pathogenesis of sepsis was presented. Close attention was paid to the contribution of inflammatory cytokines (TNF-alpha, IL-1, IL-6, IL-8) to the enhanced phagocyte-derived oxidative metabolism and the activation of respiratory burst. The pleiotropic interaction of these and the other cytokines creating so-called cytokine network was described, among other things in order to express the phagocytic and endothelial receptors. The significant role of polymorphonuclear leucocytes (PMNLs) and macrophages in the pathogenesis of sepsis was outlined, presenting not only their bactericidal activity but immunoregulatory effect connected with cytokine release as well. The significance of T cells cooperating with PMNLs was presented as well. The participation of antiinflammatory cytokines (IL-10, IL-13) and cytokine inhibitors e.g. soluble TNF receptor (sTNFR) and IL-1 receptor antagonist (IL-1 ra) was mentioned; all of them appear in septic patients and are thought to be natural regulators of immunological response in vivo. The key role of ROS generated by the activated phagocytes during sepsis has been outlined; it is proposed that the hypermetabolic response to sepsis results from enhanced ROS generation and so-called oxidant stress is a consequence of the imbalance between their generation and detoxification. The consequences of the action of oxygen free radicals resulting in lipid peroxidation followed by host auto-injury were also described. At the end a possibility of immunotherapy of sepsis connected with the application of pentoxifylline (PTXF) as TNF-alpha inhibitor was recommended to take into consideration.


Development of Participant-Informed Text Messages to Promote Physical Activity Among African American Women Attending College: A Qualitative Mixed-Methods Inquiry.
The purpose of this study was to develop a participant-informed technology-based physical activity (PA) promotion tool for young overweight and obese African American (AA) women. A mixed-method 3-phase study protocol design was used to develop text messages to promote PA in AA women attending the University of Alabama at Birmingham during the Spring of 2013. Nominal focus groups and a 2-week pilot were used to generate and test participant-developed messages. Participants ( n = 14) had a mean age of 19.79 years ( SD = 1.4) and mean body mass index of 35.9 ( SD = 5.926). Focus group data identified key themes associated with the use of text messages to promote PA including message frequency, length, tone, and time of day. Participants preferred text messages that were brief, specific, and time sensitive. Results showed that text messaging was a feasible and acceptable strategy to promote PA in overweight and obese AA women in a university setting.


Effects of pH and agitation on the growth of Listeria monocytogenes Scott A in brain heart infusion broth containing combined potassium lactate and sodium diacetate during storage at 4 or 10 degrees C.
The objective of this study was to compare the effects of pH on the growth kinetics of Listeria monocytogenes Scott A in static and agitated broths stored at 4 and 10 degrees C with and without a combination of 1.85% potassium lactate (PL) and 0.13% sodium diacetate (SDA) (3.3% of a 60% commercial solution, PURASAL P Opti. Form 4). The pH of brain heart infusion broth without (control) or with 1.85% PL + 0.13% SDA was adjusted to 5.5, 6.0, 6.5, and 7.5. L. monocytogenes Scott A was inoculated (at 10(2) CFU/ml) into pH-adjusted broth, which was stored at 4 or 10 degrees C with or without agitation. At pH 5.5, a listeriostatic effect was observed for the broth containing 1.85% PL + 0.13% SDA at 4 and 10 degrees C both with and without agitation. At pH 6.0, 1.85% PL + 0.13% SDA fully controlled the growth of L. monocytogenes Scott A in static broth at 4 degrees C for up to 20 days and significantly slowed the growth of the pathogen in agitated broth. At 10 degrees C, the growth of L. monocytogenes Scott A was significantly reduced by 1.85% PL + 0.13% SDA in agitated and unagitated broths. At pH 6.5, 1.85% PL + 0.13% SDA significantly suppressed the growth of L. monocytogenes Scott A at both 4 degrees C (P < 0.001) and 10 degrees C (P < 0.01). At pH 7.5, 1.85% PL + 0.13% SDA had a limited effect on the growth of L. monocytogenes Scott A in broth stored at 4 and 10 degrees C. At 4 degrees C, agitation decreased the lag time and increased the growth rate of L. monocytogenes Scott A at all tested pHs. A similar but less obvious trend was observed for broths stored at 10 degrees C. These results indicate that lactate-diacetate combinations effectively acted with low pH and temperature to inhibit the growth of L. monocytogenes Scott A.


Surgical treatment of infected shoulder arthroplasty. A systematic review.
To investigate the best surgical management of infected shoulder arthroplasty. A literature review from 1996 to 2016 identified 15 level IV studies that met inclusion criteria. Persistent infection (PI) was considered as treatment failure. Success was regarded as the absence of symptomatic PI without necessity for further treatment. Surgical outcomes were reported according to the mean weighted Constant and Murley score (CMS) for each treatment group. Overall, 287 patients (146 males/141 females) were identified at a mean follow-up of 50.4 (range 32-99.6) months. The PI in the whole population was 11.5%. The pooled mean CMS, available for 218 patients, was 39 ± 13. Twenty-seven patients (9.4%) were treated with debridement (PI 29.6%, CMS 41 ± 12), 52 patients (18.1%) with resection arthroplasty (PI 11.5%, CMS 29 ± 16), 33 patients (11.5%) with permanent spacers (PI 6.1%, CMS 31 ± 14), 98 patients (34.2%) with two-stage revisions (PI 14.3%, CMS 42 ± 12) and 77 patients (26.8%) with one-stage revisions (PI 3.9%, CMS 49 ± 11). Debridement showed the highest PI rate (29.6%) and one-stage revisions reported the lowest PI rate (3.9%). Resection arthroplasty and spacers showed the poorest CMS when compared to the other procedures (p ≤ 0.0001). The debridement PI rate was significantly higher than almost any other procedure. CMS was significantly higher in patients undergoing revision compared to non-revision procedures (45 ± 12 vs. 35 ± 14) (p < 0.0001). One-stage revisions achieved significantly better results in terms of the PI rate compared to two-stage revisions (p = 0.0223), but not in terms of CMS. Debridement showed the highest PI rate (29.6%) and should not be recommended for the management of infected shoulder arthroplasty. Revisions reported better functional outcomes compared to non-revision procedures. The presence of a significantly lower PI rate with comparablely high mean CMS values suggests that one-stage (where technically applicable) could be superior to two-stage revisions. Unfortunately, well-designed randomized controlled trials using validated patient-based outcomes are lacking in this field. Systematic Review of level IV studies, Level IV.


Women's work roles and their impact on health, well-being, and career: comparisons between the United States, Sweden, and The Netherlands.
As women have become more assimilated into the work-force over recent decades, they have realized considerable changes in their work roles which may contribute to health problems and other negative outcomes such as marital strain and diminished job status. The purpose of this review was threefold: (1) to synthesize data on the distribution of women's work efforts in the areas of paid employment, household chores, and childcare; (2) to outline research which addresses the impact of women's workload on their well-being and careers; and (3) to make international and gender comparisons regarding women's work responsibilities. Our findings showed that women from each of the three countries examined--the United States, Sweden, and The Netherlands--contribute more effort to household chores and childcare and less to the workplace than men do. As a result, their total workloads appear to be somewhat greater and more diffusely distributed than those of men. Heavy workloads may adversely affect women's health, especially in the presence of certain role characteristics (e.g., having a clerical, managerial, professional, or executive position, or caring for young children). Heavy work responsibilities may also undermine marital happiness, particularly if there is perceived inequity in the way partners share household work. Finally, women's total work responsibilities often impact their careers due to compensatory reductions in work commitment and job status. These observations point to the need for further research on women's workload and work roles, on the relationship of work to well-being, and on methods of preventing or alleviating adverse effects on overburdened workers.


Physiotherapy in cervical dystonia: six experimental single-case studies.
The aim of the study was to explore the outcome of a physiotherapy program targeted to improve the quality of life of people with cervical dystonia (CD) by reducing pain, improving awareness of postural orientation, increasing muscle strength, and reducing the effort of moving the head and neck. In six single case studies, the primary outcome measure for each case was the Cervical Dystonia Questionnaire (CDQ) to measure the impact of the program on the individuals' quality of life. Secondary outcome measures were identified for the different components of the physiotherapy program: Visual Analogue Scale (pain); Postural Orientation Index (postural orientation awareness); and Movement Energy Index (effort of moving head and neck). Each of the cases had the severity of their problems scored on the Toronto Western Spasmodic Torticollis Scale. The study period was 26 weeks: 2 weeks' baseline period, 4 weeks' treatment period, and 20 weeks' follow-up. All measures except the Movement Energy Index (MEI) and CDQ-24 were taken three times per week for the first 6 weeks of the study and then once at 3 and 6 months. The MEI was taken once a week during the pretreatment and the treatment periods and during the first 2 weeks of follow-up and also after 3 and 6 months of follow-up. The CDQ-24 was taken once in the pretreatment period, once after completion of treatment, once 2 weeks after treatment, and once at 3 and 6 months of follow-up. Five of the six case studies reported an increase in quality of life at 6-month follow-up, as measured on the CDQ-24. Three of the six cases reported a reduction in pain and severity of the dystonia and had improved scores on the postural orientation measure at 6-month follow-up. All six patients had a reduction in the movement energy scores, but this was not significant. The outcomes of the six case studies would suggest that further investigation is required to show the effectiveness of physiotherapy programs in the management of CD.


Role of mitochondrial superoxide dismutase in contraction-induced generation of reactive oxygen species in skeletal muscle extracellular space.
Contractions of skeletal muscles produce increases in concentrations of superoxide anions and activity of hydroxyl radicals in the extracellular space. The sources of these reactive oxygen species are not clear. We tested the hypothesis that, after a demanding isometric contraction protocol, the major source of superoxide and hydroxyl radical activity in the extracellular space of muscles is mitochondrial generation of superoxide anions and that, with a reduction in MnSOD activity, concentration of superoxide anions in the extracellular space is unchanged but concentration of hydroxyl radicals is decreased. For gastrocnemius muscles from adult (6-8 mo old) wild-type (Sod2(+/+)) mice and knockout mice heterozygous for the MnSOD gene (Sod2(+/-)), concentrations of superoxide anions and hydroxyl radical activity were measured in the extracellular space by microdialysis. A 15-min protocol of 180 isometric contractions induced a rapid, equivalent increase in reduction of cytochrome c as an index of superoxide anion concentrations in the extracellular space of Sod2(+/+) and Sod2(+/-) mice, whereas hydroxyl radical activity measured by formation of 2,3-dihydroxybenzoate from salicylate increased only in the extracellular space of muscles of Sod2(+/+) mice. The lack of a difference in increase in superoxide anion concentration in the extracellular space of Sod2(+/+) and Sod2(+/-) mice after the contraction protocol supported the hypothesis that superoxide anions were not directly derived from mitochondria. In contrast, the data obtained suggest that the increase in hydroxyl radical concentration in the extracellular space of muscles from wild-type mice after the contraction protocol most likely results from degradation of hydrogen peroxide generated by MnSOD activity.


[A new approach to clinical and laboratory diagnosis of systemic and local soft tissue infections].
Dynamic measurements of blood TNF-a, IL-IRA, CRP, oligopeptide, and lactoferrin levels in patients with systemic and local soft tissue infections revealed direct correlation between them which allowed to use these indicators for the diagnosis of systemic infections. Results of clinical and laboratory analyses provided a basis for distinguishing short-term systemic inflammatory response syndrome and sepsis and developing relevant diagnostic criteria. Sepsis combined with systemic inflammatory response syndrome persisting for more than 72 hours after the onset of adequate therapy was characterized by CRP levels > 30 mg/l, oligopeptides > 0.34 U, lactoferrin > 1900 ng/ml, TNF-a > 6 pg/ml, ILL-IRA < 1500 pg/ml Patients with systemic inflammatory response syndrome for less than 72 hours had lower TNF-a, CRP, oligopeptide, and lactoferrin levels with IL-IRA > 1500 pg/ml. This new approach to early diagnosis of systemic infections makes it possible to optimize their treatment and thereby enhance its efficiency.


A personal view of biomedical engineering.
The author describes the history of biomedical engineering from the viewpoint of his own career. He discusses the early debate over what biomedical engineering is, funding considerations, and the steady growth of the field during the 1960s. The development of a research base and the establishment of international links are also examined. Future paths for the discipline are predicted.


[Surgery for complications resulting from para-clinical colorectal examinations].
Colo-rectal perforations during barium enema are exceptional, but very serious. They give rise to a retro- or intra-peritoneal septic barioma. Despite its emergency treatment, the peritonitis remains very severe (50% mortality) and peritoneal toilet is difficult. Peri-visceral complications are also possible. Perforations during diagnostic colonoscopy are less serious, as they occur in a prepared colon. When operated immediately, the mortality is less than 20%. The greatest risk consists of overlooking the initial accident and only reviewing the patient at a late stage. In this case, the mortality is similar to that of the radiological perforations. Perforations during polypectomy are generally small or simple fissures and are less often surgical. Severe haemorrhages requiring a surgical operation are exceptional. All of these complications tend to disappear when certain technical rules are respected and with increasing operator experience.


Molecular genetics of the developing neuroendocrine hypothalamus.
Formation of the mammalian endocrine system and neuroendocrine organs involves complex regulatory networks resulting in a highly specialized cell system able to secrete a diverse array of peptide hormones. The hypothalamus is located in the mediobasal region of the brain and acts as a gateway between the endocrine and nervous systems. From an endocrinology perspective, the parvicellular neurons of the hypothalamus are of particular interest as they function as a control centre for several critical physiological processes including growth, metabolism and reproduction by regulating hormonal signaling from target cognate cell types in the anterior pituitary. Delineating the genetic program that controls hypothalamic development is essential for complete understanding of parvicellular neuronal function and the etiology of congenital disorders that result from hypothalamic-pituitary axis dysfunction. In recent years, studies have shed light on the interactions between signaling molecules and activation of transcription factors that regulate hypothalamic cell fate commitment and terminal differentiation. The aim of this review is to summarize the recent molecular and genetic findings that have advanced our understanding of the emergence of the known important hypophysiotropic signaling molecules in the hypothalamus. We have focused on reviewing the literature that provides evidence of the dependence on expression of specific genes for the normal development and function of the cells that secrete these neuroendocrine factors, as well as studies of the elaboration of the spatial or temporal patterns of changes in gene expression that drive this development.


Cyclic AMP, adenylate cyclase and cyclic AMP-phosphodiesterase activities in diabetic rat adipocytes.
The effect of streptozotocin-induced diabetes on cyclic AMP content, adenylate cyclase and cyclic-AMP phosphodiesterase activities in rat adipocytes was investigated. The results show that diabetes induced an increase in intracellular cyclic AMP. Basal adenylate cyclase activity and in response to norepinephrine were higher in fat cell membranes from diabetic rats. Adenylate cyclase activity stimulated by fluoride was the same in both normal and diabetic preparations. Low and high Km phosphodiesterase activities in adipocytes from diabetic rats were higher than the controls. The results suggest that the deficiency of insulin present in the diabetic state induces an increase in adenylate cyclase activity which increases the cyclic AMP production. This increase in cyclic AMP promotes a higher cyclic AMP-phosphodiesterase activity which is not sufficient to hydrolyze all the newly formed cyclic AMP.


"Unertan syndrome" in two Turkish families in relation to devolution and emergence of Homo erectus: neurological examination, MRI, and PET scans.
"Unertan syndrome" consists of two main symptoms: quadrupedal gait and primitive cognitive abilities including language and conscious experience. To assess the central mechanisms involved in this syndrome, the authors performed MRI and PET scans on affected and unaffected individuals from both families. All affected individuals were also subjected to neurological examination. To assess the integrity of the peripheral and central vestibular system, Barany's caloric test was applied to the affected individuals. Brain MRI and PET scans were performed on normal subjects (n = 7) and patients (n = 7). Right- and left-cerebral and cerebellar areas, including the vermial and callosal areas, were measured on the MRI scans using a computer cursor. Quadrupedal gait, mental retardation, dysartric speech, nystagmus, severe truncal ataxia, hyperreflexia, astasia, and abasia were observed in the affected individuals from both families. Cerebellum and vermis were atrophic in the MRI and PET scans of the first family. In contrast, the brain MRI seemed to be normal in the MRI and PET scans of affected individuals from the second family. The caloric test revealed central vestibular damage in patients from the first family and peripheral vestibular damage in patients from the second family. The results suggest that "Unertan syndrome," discovered in two unrelated families, may be caused by peripheral or central vestibular damage resulting from different genetic defects. Cerebellar hypoplasia may not be a prerequisite for the emergence of this syndrome. Primitive mental abilities may be explained by damage within the vestibulo-cerebellar system, whereas the quadrupedal gait may be due to a genetic defect within the higher brain centers that suppress the atavistic brain networks controlling quadrupedal gait and helped in the emergence of the habitual bipedal gait during human evolution. This retarded development of human locomotion - devolution - may illuminate the brain mechanisms responsible for the transition from quadrupedality to bipedality in human evolution.


Chemical constituents of Rhododendron formosanum show pronounced growth inhibitory effect on non-small-cell lung carcinoma cells.
The aim of the present study was to investigate whether Rhododendron formosanum Hemsl. (Ericaceae), an endemic species in Taiwan, exhibits antineoplastic potential against non-small-cell lung carcinoma (NSCLC). R. formosanum was successively extracted with methanol and then separated into dichloromethane (RFL-DCM), ethyl acetate (RFL-EA), n-butanol (RFL-BuOH), and water (RFL-H2O) fractions. Among these extracts, RFL-EA exhibited the most effective antineoplastic effect. This study also demonstrated that fractions 2 and 3 from the RFL-EA extract (RFL-EA-2, RFL-EA-3) possessed the strongest antineoplastic potential against NSCLC cells. The major phytochemical constituents of RFL-EA-2 and RFL-EA-3 were ursolic acid, oleanolic acid, and betulinic acid. This study indicated that ursolic acid demonstrated the most efficient antineoplastic effects on NSCLC cells. Ursolic acid inhibited growth of NSCLC cells in a dose- and time-dependent manner and stimulated apoptosis. Apoptosis was substantiated by activation of caspase-3 and -9, and a decrease in Bcl-2 and an elevation of the Bax were also observed following ursolic acid treatment. Ursolic acid activated AMP-activated protein kinase (AMPK) and then inhibited the mammalian target of rapamycin (mTOR), which controls protein synthesis and cell growth. Moreover, ursolic acid decreased the expression and/or activity of lipogenic enzymes, such as acetyl-CoA carboxylase (ACC) and fatty acid synthase (FASN) via AMPK activation. Collectively, these data provide insight into the chemical constituents and anticancer activity of R. formosanum against NSCLC cells, which are worthy of continued study.


Scheduling IT staff at a bank: a mathematical programming approach.
We address a real-world optimization problem: the scheduling of a Bank Information Technologies (IT) staff. This problem can be defined as the process of constructing optimized work schedules for staff. In a general sense, it requires the allocation of suitably qualified staff to specific shifts to meet the demands for services of an organization while observing workplace regulations and attempting to satisfy individual work preferences. A monthly shift schedule is prepared to determine the shift duties of each staff considering shift coverage requirements, seniority-based workload rules, and staff work preferences. Due to the large number of conflicting constraints, a multiobjective programming model has been proposed to automate the schedule generation process. The suggested mathematical model has been implemented using Lingo software. The results indicate that high quality solutions can be obtained within a few seconds compared to the manually prepared schedules.


Predictability of idiosyncratic drug toxicity risk for carboxylic acid-containing drugs based on the chemical stability of acyl glucuronide.
Acyl glucuronides (AGs) formed from carboxylic acid-containing drugs have been considered to be a cause of idiosyncratic drug toxicity (IDT). Chemical stability of AGs is supposed to relate to their reactivity. In this study, the half-lives of 21 AGs of carboxylic drugs in potassium phosphate buffer (KPB), human serum albumin (HSA) solution, and human fresh plasma were analyzed in relation to the IDT risk derived from these drugs. The carboxylic drugs were classified into three safety categories of "safe," "warning," and "withdrawn" in terms of their IDT risk. As for the results, the half-lives of AGs in KPB correlated with the IDT risk better than those in HSA solution or in human fresh plasma with regard to the separation of the safe drugs from the warning drugs or the withdrawn drugs. In KPB, whereas the half-lives in the safe category were 7.2 h or longer, those in the withdrawn category were 1.7 h or shorter. The classification value of the half-life in KPB, which separated the safe drugs from the withdrawn drugs was calculated to be 3.6 h by regression analysis. In conclusion, this is the first report that clearly shows the relationship between the IDT risk and chemical stability of AGs in several in vitro systems. The KPB system was considered to be the best for evaluating the stability of AGs, and the classification value of the half-life in KPB serves as a useful key predictor for the IDT risk.


Cause and effect analysis of closed claims in obstetrics and gynecology.
Identifying the etiologies of real or perceived adverse clinical events and undesired outcomes is an important step in improving patient safety and reducing malpractice risks. Systematic analysis of obstetrics and gynecology-related risk management files allows a more complete examination of ways that human and systems factors may contribute to adverse events. To learn the medical complaints of patients who experienced apparent adverse events, the general causes of those adverse events, and the significant specific causal factors involved in obstetrics and gynecology-related risk management cases. This was a retrospective analysis of 90 consecutive obstetrics and gynecology-related internal review files opened by a medical center's risk managers between 1995 and 2001. Each file was analyzed to identify factors that may have contributed to or caused unanticipated adverse events. The main outcome was the pattern of contributing factors when they were aggregated into categories. Fifty percent of cases were associated with inpatient obstetrics. Factors that may have contributed to adverse events were identified in 78% of cases, and most had more than one contributing factor. Thirty-one percent of adverse events were associated with apparent communication problems. Clinical performance issues were identified in 31% of cases, diagnostic issues in 18% of cases, and patient behavior contributed to 14% of adverse events. Diagnostic, therapeutic, and communication issues were the most common factors identified. Although the generalizability of these data are unknown, all obstetrics and gynecology departments face multiple challenges in assuring consistent quality care. Analysis of claims files may help identify opportunities for improvement.


The safety and efficacy of melatonin in the treatment of COVID-19: A systematic review and meta-analysis.
As an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the common signs of coronavirus disease 2019 (COVID-19) are respiratory symptoms, fever, cough, shortness of breath, and dyspnea, with multiple organ injuries in severe cases. Therefore, finding drugs to prevent and treat COVID-19 is urgently needed and expected by the public. Several studies suggested beneficial effects of melatonin for the relevant prevention and treatment. To explore the effect and safety of melatonin in the treatment and provide theoretical support and reference for seeking the most suitable drug for COVID-19, the meta-analysis was carried out accordingly. It included randomized clinical trials of patients with COVID-19 treated with melatonin. Total effective rate was the primary outcome, while C-reactive protein (CRP), arterial oxygen saturation (SaO2), white blood cell count (WBC) were the secondary measures. Random-effect and fixed-effect models were used to evaluate the effect size of some indicators in this meta-analysis. Six eligible studies with 338 participants were included. One hundred seventy subjects were treated with melatonin adjuvant therapy and 168 subjects were assigned to the control group, with total excellent effective rate in subjects treated with melatonin [odds ratio = 3.05, 95 % confidence interval (CI) = 1.47, 6.31, P = .003]. Homogeneity was analyzed by fixed effect model (I2 = 0%). There was no significant difference in CRP between the melatonin group and the control group (weighted mean difference [WMD] = -0.36, 95% CI = -3.65, 2.92, P = .83). Significant difference was not existed in SaO2 between the melatonin treatment group and the control group (WMD = 1, 95% CI = -1.21, 3.22, P = .37). In terms of WBC, there was no significant difference between the 2 groups (WMD = -1.07, 95% CI = -2.44, 0.30, P = .13). The meta-analysis showed that melatonin had the beneficial effects for COVID-19 prevention and treatment as an adjunctive agent in combination with basic treatment for the treatment.


ATP binding modulates the nucleic acid affinity of hepatitis C virus helicase.
The helicase of hepatitis C virus (HCV) unwinds nucleic acid using the energy of ATP hydrolysis. The ATPase cycle is believed to induce protein conformational changes to drive helicase translocation along the length of the nucleic acid. We have investigated the energetics of nucleic acid binding by HCV helicase to understand how the nucleotide ligation state of the helicase dictates the conformation of its nucleic acid binding site. Because most of the nucleotide ligation states of the helicase are transient due to rapid ATP hydrolysis, several compounds were analyzed to find an efficient unhydrolyzable ATP analog. We found that the beta-gamma methylene/amine analogs of ATP, ATPgammaS, or [AlF4]ADP were not effective in inhibiting the ATPase activity of HCV helicase. On the other hand, [BeF3]ADP was found to be a potent inhibitor of the ATPase activity, and it binds tightly to HCV helicase with a 1:1 stoichiometry. Equilibrium binding studies showed that HCV helicase binds single-stranded nucleic acid with a high affinity in the absence of ATP or in the presence of ADP. Upon binding to the ATP analog, a 100-fold reduction in affinity for ssDNA was observed. The reduction in affinity was also observed in duplex DNA with 3' single-stranded tail and in RNA but not in duplex DNA. The results of this study indicate that the nucleic acid binding site of HCV helicase is allosterically modulated by the ATPase reaction. The binding energy of ATP is used to bring HCV helicase out of a tightly bound state to facilitate translocation, whereas ATP hydrolysis and product release steps promote tight rebinding of the helicase to the nucleic acid. On the basis of these results we propose a Brownian motor model for unidirectional translocation of HCV helicase along the nucleic acid length.


Optimising the performance of a lab-scale tidal flow reed bed system treating agricultural wastewater.
A gravel-based tidal flow reed bed system was operated with three different strategies in order to investigate its optimal performance for the treatment of a high strength agricultural wastewater. According to the three strategies, individual reed beds were saturated and unsaturated with the wastewater for different periods while reasonably stable hydraulic and organic loadings were maintained. Experimental results demonstrated that the system produced the highest pollutant removal efficiencies with a relatively short saturated period and long unsaturated period, highlighting the importance of oxygen transfer into reed bed matrices during the treatment. Significant removals of some major organic and inorganic pollutants were achieved under all three operational conditions. Nitrification was not the major route of ammoniacal-nitrogen removal when the system was under high organic loading. Due to the filtration of suspended solids and the accumulation of biomass, gradual clogging of the reed bed matrices took place, which caused concerns over the long-term efficiency of the tidal flow system.


Hue-preserving color image enhancement without gamut problem.
The first step in many techniques for processing intensity and saturation in color images keeping hue unaltered is the transformation of the image data from RGB space to other color spaces such as LHS, HSI, YIQ, HSV, etc. Transforming from one space to another and processing in these spaces usually generate a gamut problem, i.e., the values of the variables may not be in their respective intervals. We study enhancement techniques for color images theoretically in a generalized setup. A principle is suggested to make the transformations gamut-problem free. Using the same principle, a class of hue-preserving, contrast-enhancing transformations is proposed; they generalize existing grey scale contrast intensification techniques to color images. These transformations are also seen to bypass the above mentioned color coordinate transformations for image enhancement. The developed principle is used to generalize the histogram equalization scheme for grey scale images to color images.


Channels' Confirmation and Predictions' Confirmation: From the Medical Test to the Raven Paradox.
After long arguments between positivism and falsificationism, the verification of universal hypotheses was replaced with the confirmation of uncertain major premises. Unfortunately, Hemple proposed the Raven Paradox. Then, Carnap used the increment of logical probability as the confirmation measure. So far, many confirmation measures have been proposed. Measure F proposed by Kemeny and Oppenheim among them possesses symmetries and asymmetries proposed by Elles and Fitelson, monotonicity proposed by Greco et al., and normalizing property suggested by many researchers. Based on the semantic information theory, a measure b* similar to F is derived from the medical test. Like the likelihood ratio, measures b* and F can only indicate the quality of channels or the testing means instead of the quality of probability predictions. Furthermore, it is still not easy to use b*, F, or another measure to clarify the Raven Paradox. For this reason, measure c* similar to the correct rate is derived. Measure c* supports the Nicod Criterion and undermines the Equivalence Condition, and hence, can be used to eliminate the Raven Paradox. An example indicates that measures F and b* are helpful for diagnosing the infection of Novel Coronavirus, whereas most popular confirmation measures are not. Another example reveals that all popular confirmation measures cannot be used to explain that a black raven can confirm "Ravens are black" more strongly than a piece of chalk. Measures F, b*, and c* indicate that the existence of fewer counterexamples is more important than more positive examples' existence, and hence, are compatible with Popper's falsification thought.


A Novel Mutation in the type Iα Regulatory Subunit of Protein Kinase A (PRKAR1A) in a Cushing's Syndrome Patient with Primary Pigmented Nodular Adrenocortical Disease.
A 40-year-old man presented with Cushing's syndrome due to bilateral adrenal hyperplasia with multiple nodules. Computed tomography scan results were atypical demonstrating an enlargement of the bilateral adrenal glands harboring multiple small nodules, but the lesion was clinically diagnosed to be primary pigmented nodular adrenocortical disease (PPNAD) based on both endocrinological test results and his family history. We performed bilateral adrenalectomy and confirmed the diagnosis histologically. An analysis of the patient and his mother's genomic DNA identified a novel mutation in the type Iα regulatory subunit of protein kinase A (PRKAR1A) gene; p.E17X (c.49G>T). This confirmed the diagnosis of PPNAD which is associated with Carney Complex.


A systematic managerial perspective on the environmentally sustainable construction practices of UK.
Construction industry, though is the backbone of any economy, still add a significant portion of emissions, utilising energy supplies, and reasoning in bulk of waste production. The sustainable construction practices are the only solution considering the global climatic challenges. Owing its enormous benefits, a lot of sustainable constructions projects are built around the world, both in developed and developing countries. However, considering the innovative material and technological involvement, and lack of knowledge and expertise, such sustainable construction projects are not always successful. This research aims to investigate the barriers and factors impacting sustainability in the construction projects. More specifically, its primary purpose is to have the perspective of managers on the actors and barriers of sustainable construction in the UK. A mixed method was used to collect the data, one in the mean of questionnaire survey, and the second through the case study. To acquire quantitative data, a snowball sampling was applied to collect the questionnaire survey based data from 128 UK construction managerial positions, such as system managers, sustainability managers, project managers and construction managers, etc. The quantitative acquired data was analysed using mean analysis, relevant importance index (RII), correlation and multiple hierarchical regression. The RII analysis discovered that sustainable construction designs is a top drivers of sustainable construction practices, whereas excessive concentration on price is found as the top impediment of sustainable construction practices. It was also shown by the hierarchical regression analysis that stakeholders factors, project management factors and technological factors significantly impact to sustainable construction practice. However, surprisingly the role of barriers was not observed in the sustainable construction practices of the UK. The same findings were also confirmed with the case study analysis of the Kier Group plc, which believes in the sustainable construction practices. Hence, it is needful for the positive sides of these factors be considered and duly exploited. The research findings provide interesting industrial insights towards sustainable construction projects, while providing useful directions to the industrialists, policymakers and construction professionals, not only by reducing the unfavourable effects, but also by proposing the intention of restoring factors of the environment, economic and social sustainability.


Viable bacteria persist on antibiotic spacers following two-stage revision for periprosthetic joint infection.
Treatment in periprosthetic joint infection (PJI) remains challenging. The failure rate of two-stage revision and irrigation and debridement with component retention in PJI suggests that biofilm cells have a high tolerance to antibiotic chemotherapy. Previous work has demonstrated that biofilm cells have high antibiotic tolerance in vitro, but there is little clinical evidence to support these observations. The aim of this study was to determine if retrieved antibiotic spacers from two-stage revision total knee arthroplasty for PJI have evidence of remaining viable bacteria. Antibiotic poly (methyl methacrylate) (PMMA) spacers from two-stage revision total knee arthroplasty for PJI were prospectively collected and analyzed for bacterial 16s rRNA using polymerase chain reaction (PCR), reverse transcription (RT)-PCR, quantitative RT-PCR (qRT-PCR), and single genome analysis (SGA). PCR and RT-PCR identified bacterial species on 53.8% (7/13) of these samples. When initial culture negative cases are excluded, 68% (6/9) samples were identified with bacterial species. A more rigorous qRT-PCR analysis showed a strong positive signal for bacterial contamination in 30.7% (4/13) of cases. These patients did not show any clinical evidence of PJI recurrence after 15 months of follow-up. Because the half-life of bacterial rRNA is approximately a few days, the identification of bacteria rRNA on antibiotic PMMA spacers suggests that viable bacteria were present after conclusion of antibiotic therapy. This study provides evidence for the high tolerance of biofilm cells to antibiotics in vivo and the important role of bacterial persisters in PJI. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:452-458, 2018.


Differential Spreading of Rhamnolipid Congeners from Pseudomonas aeruginosa.
Rhamnolipids are surfactants produced by many Pseudomonad bacteria, including the species Pseudomonas aeruginosa. These rhamnolipids are known to aid and enable numerous phenotypic traits that improve the survival of the bacteria that make them. These surfactants are also important for industrial products ranging from pharmaceuticals to cleaning supplies to cosmetics, to name a few. Rhamnolipids have structural diversity that leads to an array of congeners; however, little is known about the localization and distribution of these congeners in two-dimensional space. Differential distribution of congeners can reduce the uniformity of applications in industrial settings and create heterogeneity within biological communities. We examined the distribution patterns of combinations of rhamnolipids in commercially available mixtures, cell-free spent media, and colony biofilms using mass spectrometry. We found that even in the absence of cells, congeners exhibit different distribution patterns, leading to different rhamnolipid congener distributions on a surface. Congeners with shorter fatty acid chains were more centrally located, while longer chains were more heterogeneous and distally located. We found that congeners with similar structures can distribute differently. Within developing colony biofilms, we found rhamnolipid distribution patterns differed from cell-free environments, lacking simple trends noted in cell-free environments. Most strikingly, we found the distribution patterns of individual congeners in the colony biofilms to be diverse. We note that the congener distribution is far from homogeneous but composed of numerous local microenvironments of varied rhamnolipid congener composition.


Influence of Menopausal Status on the Symptom Experience of Women Before Breast Cancer Surgery.
Breast cancer treatments can change women's hormonal milieu and alter their symptom experience. Little is known about associations between menopausal status and menopausal symptoms in women with breast cancer before surgery. The purpose of this study was to evaluate for differences in occurrence, severity, and distress of symptoms between premenopausal and postmenopausal women before breast cancer surgery. A total of 312 women with breast cancer completed the Menopausal Symptoms Scale, a self-report measure that evaluated the occurrence, severity, and distress of 46 common symptoms associated with menopause. Regression analyses were used to evaluate for between-group differences in these symptoms. Of the 312 patients enrolled, 37.4% (n = 116) were premenopausal, and 62.6% (n = 196) were postmenopausal. In the multivariate analysis that adjusted for 7 covariates, premenopausal patients reported higher occurrence rates for urinary frequency (P = .006) and reported lower occurrence rates for joint pain/stiffness (P = .011), difficulty falling asleep (P = .025), and vaginal dryness (P = .002). A significant interaction was found between age and menopausal status for hot flashes (P = .002), wake during the night (P = .025), and headache (P = .040). Regardless of menopausal status, women reported high occurrence rates for several menopausal symptoms. Associations between some symptom occurrence rates and menopausal status depended on the patients' age. As part of a preoperative symptom assessment, clinicians need to consider a woman's menopausal status and salient demographic and clinical characteristics. The identification of women with a higher symptom burden will assist with more effective management.


Rate and Risk Factors for Delayed Healing Following Surgical Treatment of Lateral Condyle Humerus Fractures in Children.
Lateral condyle humerus fracture nonunion after surgical fixation has been reported to be <1%. The purpose of this study was to evaluate the rate and risk factors for delayed healing of pediatric lateral condyle fractures after surgical fixation. Retrospective study of all operatively treated lateral condyle fractures at a single institution from 2006 to 2013 was performed. Radiographic evaluation included: measured fracture displacement at both presentation and after surgical fixation, fracture classification, and multiple parameters of pin configuration. Patients who had delayed healing were defined as those not healed by the eighth week of follow-up and were compared with those fractures that healed in <8 weeks to identify risk factors associated with delayed healing. Purposeful selection was utilized to identify factors for entry into a multivariate binary logistic regression model. A total of 210 children were evaluated. Mean follow-up was 25 weeks (4 wk to 5 y). Distribution of Weiss classification was as follows: type 1, 8 (4%); type 2, 61 (29%); and type 3, 141 (67%). There were 33 (16%) delayed unions and 7 of these (3% of the entire cohort) required further surgery to achieve healing. Weiss classification, intraoperative fluoroscopy time, and intraoperative displacement after fixation met criteria for entry into the regression. While Weiss classification did not remain significant within the model, its removal resulted in a 30% change in the parameter estimate for intraoperative fluoroscopy time. For each second increase in fluoroscopy time, there is a 3% increase in the risk of delayed healing. Patients with >1 mm displacement of the lateral cortex after fixation had an increased risk of delayed healing (OR=4.78, P=0.007). Delayed union of lateral condyle fractures is a matter of concern, and the rate of secondary surgery to achieve healing appears to be higher than previously reported. Risks for delayed healing include amount of residual displacement after reduction and the difficulty in attaining that reduction, as defined by fluoroscopy time. Level IV-therapeutic study, case series.


Concept Communication and Interpretation of Illness: A Holistic Model of Understanding in Nursing Practice.
To ensure patient communication in nursing, certain conditions must be met that enable successful exchange of beliefs, thoughts, and other mental states. The conditions that have received most attention in the nursing literature are derived from general communication theories, psychology, and ethical frameworks of interpretation. This article focuses on a condition more directly related to an influential coherence model of concept possession from recent philosophy of mind and language. The basic ideas in this model are (i) that the primary source of understanding of illness experiences is communicative acts that express concepts of illness, and (ii) that the key to understanding patients' concepts of illness is to understand how they depend on patients' lifeworlds. The article argues that (i) and (ii) are especially relevant in caring practice since it has been extensively documented that patients' perspectives on disease and illness are shaped by their subjective horizons. According to coherentism, nurses need to focus holistically on patients' horizons in order to understand the meaning of patients' expressions of meaning. Furthermore, the coherence model implies that fundamental aims of understanding can be achieved only if nurses recognize the interdependence of patients' beliefs and experiences of ill health. The article uses case studies to elucidate how the holistic implications of coherentism can be used as conceptual tools in nursing.


Overview of micro/nano-wind energy harvesters and sensors.
Wind energy is a kind of renewable and widely distributed energy and has attracted more and more attention from researchers in both energy harvesting and sensing fields. Here, micro/nano-wind energy harvesters and sensors have been systematically reviewed. Based on the fundamental wind energy harvesting principle, the windmill-based and aeroelastic harvesters are analyzed at first. On this basis, four kinds of energy harvesters for converting wind energy of different regions and scales have been compared and summarized. An electromagnetic energy harvester is exploited to scavenge macro-scale wind energy, while piezoelectric, electrostatic and triboelectric energy harvesters are applied to collect micro-scale wind energy. In addition, several micro/nano-wind sensors have also been surveyed. Passive wind sensors are exploited and improved to realize high precision and multi-functionality, while active wind sensors and self-powered sensing systems are used for wireless and intelligent wind information monitoring. Finally, the existing challenges and future perspectives in both micro/nano-wind energy harvesters and sensors have been discussed.


The development and validation of hand motion analysis to evaluate competency in central line catheterization.
Traditionally, technical skills proficiency has been assessed by direct observation. While direct observation and feedback are essential components in technical skills learning, they demand considerable investment of faculty time, and as an assessment tool, direct observation is inherently subjective and has been criticized as unreliable. The purpose of this study was to determine if quantitative electromagnetic motion tracking is feasible and can discriminate between experts and nonexperts during simulated ultrasound (US)-guided insertion of a central venous catheter (CVC) guidewire. Ten nonexperts (junior emergency medicine residents) and 10 experts (critical care fellows or attending physicians) were recruited. Electromagnetic sensor probes were used to capture hand motion during an US-guided internal jugular cannulation on a standardized manikin. Hand, US, and needle motion were analyzed for the following metrics: total path length, total time, translational movements, and rotational movements. Subjects were also videotaped and evaluated using a modified, validated global rating scale (GRS) by a blinded expert. There was a significant difference in almost all examined motion parameters between experts and nonexperts. Experts took 66% less time (50.2 seconds vs. 148.7 seconds, p < 0.001) and had significantly less right-hand and US motion (total path length and translational and rotational movements). Left-hand total path length was the only parameter that was not significantly different between groups. Concurrent validity of motion parameters was established by strong correlations (r2 > 0.74) to a previously published, modified GRS. Electromagnetic hand and instrument motion analysis is technically feasible for assessing competence in US-guided insertion of a CVC guidewire in a simulation setting. In showing that it discriminates between the performances of nonexperts and experts, this study has provided evidence for construct validity. It also shows excellent correlation with a modified version of a previously validated GRS, providing evidence of concurrent validity.


[Autoprotective mechanisms in patients with schizophrenic psychoses--compensation and coping].
For a long time, the coping and compensatory mechanisms of patients with schizophrenic psychoses have mostly been neglected by the psychiatric research. We extended the six categories of coping mechanisms described in the Bonn Scale for the Assessment of Basic Symptoms (BSABS) by three further categories. With fifty schizophrenic patients in different stages of their disease semistructured interviews concerning these categories were done. The main sociodemographic and historical parameters were registered as well. Then the protocols of the interviews were analyzed, the coping strategies were quantified, and it was tried to disclose relations between the disease progress and sociodemographic parameters. Patients used to a certain degree of autonomy e. g. unmarried patients had--compared to less independent patients--stronger coping strategies. Patients with a strong interest for their disease and a positive opinion about neuroleptic therapy had--compared to patients without interest for their disease and/or negative opinion about neuroleptic therapy--stronger coping and compensatory psychisms. It is concluded that the coping strategies might be reinforced by influencing these parameters.


Ranolazine refractory angina registry: 1-year results.
Patients with refractory angina (RA) have limited therapeutic options and significant limitations in their quality of life. Ranolazine is approved for patients with chronic stable angina but has not been studied in patients with RA. The Ranolazine Refractory Angina Registry was designed to evaluate the safety, tolerability, and effectiveness in RA patients. In a dedicated RA clinic using an extensive prospective database, 100 patients were enrolled. Angina class, medications, major adverse cardiac events including death, myocardial infarction, and revascularization were obtained at 1, 6, and 12 months. Overall 43% of patients had a ≥2 class improvement in angina. At 1 year, 57% patients remained on ranolazine (91.2%; 500 mg BID), including 58% with a ≥2 class improvement in angina. Reasons for discontinuation included: side effects (n = 16), major adverse cardiac events (n = 10), cost (n = 5), ineffective (n = 6), cost and ineffective (n = 3), and unknown (n = 3). In conclusion, ranolazine is an effective antianginal therapy in patients with RA; still at 1 year only 57% of patients remained on ranolazine because of side effects, suboptimal effectiveness, cost, or progression of disease.


Biological classification: toward a synthesis of opposing methodologies.
Currently a controversy is raging as to which of three competing methodologies of biological classification is the best: phenetics, cladistics, or evolutionary classification. The merits and seeming deficiencies of the three approaches are analyzed. Since classifying is a multiple-step procedure, it is suggested that the best components of the three methods be used at each step. By such a synthetic approach, classifications can be constructed that are equally suited as the basis of generalizations and as an index to information storage and retrieval systems.


The jury is in: p73 is a tumor suppressor after all.
While p53 has been extensively characterized as a tumor suppressor, it has been more difficult to determine whether p63 and/or p73 play a similar role. Every system in which these family members have been studied, from cells to animal models to human tissues, seems to create more questions than answers. Tomasini and colleagues (2677-2691) demonstrate that one isoform of p73 is responsible for preventing tumor formation in vivo, providing critical validation of an isoform-based model of p73 function.


Anesthesia for intracranial aneurysms.
At the Medical University of South Carolina during the past five years, 62 patients have had intracranial aneurysm surgery, with an overall mortality of 4.8%. Anesthesia was given by me to 14 of these patients. Preoperatively these patients were placed on bedrest, steroid prophylaxis, and sedative and antihypertensive medication to reduce th possibility of recurrent subarrachnoid hemorrhage. Halothane-nitrous oxide-oxygen endotracheal anesthesia with controlled ventilation was used, with careful monitoring of EKG, direct arterial pressure, arterial blood gases, body temperature, and urinary output. Adjuncts for control of bleeding and intracranial pressure were osmotic diuresis, cerebrospinal fluid drainage, minimal head-up tilt, and controlled hypotension using trimethaphan (Arfonad). There were no operative deaths, although one patient died postoperatively. Three patients had neurologic deficitys. These data indicate that controlled hypotension is a safe technic which, when properly used, can reduce the risk of anesthesia for intracranial aneurysm surgery.


A risk of bias instrument for non-randomized studies of exposures: A users' guide to its application in the context of GRADE.
The objective of this paper is to explain how to apply, interpret, and present the results of a new instrument to assess the risk of bias (RoB) in non-randomized studies (NRS) dealing with effects of environmental exposures on health outcomes. This instrument is modeled on the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) instrument. The RoB instrument for NRS of exposures assesses RoB along a standardized comparison to a randomized target experiment, instead of the study-design directed RoB approach. We provide specific guidance for the integral steps of developing a research question and target experiment, distinguishing issues of indirectness from RoB, making individual-study judgments, and performing and interpreting sensitivity analyses for RoB judgments across a body of evidence. Also, we present an approach for integrating the RoB assessments within the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess the certainty of the evidence in the systematic review. Finally, we guide the reader through an overall assessment to support the rating of all domains that determine the certainty of a body of evidence using the GRADE approach.


Self-citation rate and impact factor in ophthalmology.
To analyze the self-citation rate (SCR) of ophthalmology journals, determine its possible effect on a journal's impact factor (IF) and compare the SCR of subspecialty journals versus general ophthalmology journals. A retrospective consecutive study of ophthalmology journals listed in the Journal Citations Report (JCR) 2013. We retrieved these parameters from each journal's report: IF, total citations, self-citations, SCR and IF without self-citations (corrected IF). A significant correlation was detected between the number of self-citations and publications (R(2) = 86.3, p = 0.000). Subspecialty journals had a significantly higher SCR than general journals (p = 0.017). No significant difference was found in terms of IF and corrected IF between general and subspecialty journals (p = 0.260 and p = 0.108, respectively). No significant correlation between IF and SCR was detected (p = 0.099). The corrected IF was inversely correlated with SCR (R(2) = -32.6, p = 0.013). An inverse correlation was detected between SCR and IF in the 29 ophthalmology journals with the lowest IF (R(2) = -57.3, p = 0.001). Unlike other fields of medicine, the IF of an ophthalmology journal does not correlate with its SCR. Self-citation is found more often in journals with a low corrected IF and is inversely correlated with IF in the bottom half.


Humanin Nanoparticles for Reducing Pathological Factors Characteristic of Age-Related Macular Degeneration.
Humanin is a novel neuronal peptide that has displayed potential in the treatment of Alzheimer's Disease through the suppression of inflammatory IL-6 cytokine receptors. Such receptors are found throughout the body, including the eye, suggesting its other potential applications. Age-related Macular Degeneration (AMD) is the leading cause of blindness in the developing world. There is no cure for this disease, and current treatments have several negative side effects associated with them, making finding other treatment options desirable. In this study, the potential applications in treating AMD for a more potent humanin derivative, AGA-HNG, were studied. AGA-HNG was synthesized and encapsulated in chitosan Nanoparticles (NPs), which were then characterized for their size, Encapsulation Efficiency (EE), and drug release. Their ability to suppress VEGF secretion and protect against oxidative apoptosis was studied in vitro using ARPE-19 cells. The chitosan NPs exhibited similar anti-VEGF properties and oxidative protection as the free protein while exhibiting superior pharmaceutical characteristics including biocompatibility and drug release. Drug-loaded NPs exhibited a radius of 346nm with desirable pharmacokinetic properties including a stable surface charge (19.5 ± 3.7 mV) and steady drug release capacity. AGA-HNG showed great promise in mediating apoptosis in hypoxic cells. They were also able to significantly reduce VEGF expression in vitro with reduced cellular toxicity compared to the free drug. The ability of this drug delivery system to reduce retinal apoptosis with desirable pharmacokinetic and biocompatible properties makes this a promising therapeutic option for AMD.


Staff perceptions of residents across the long-term care landscape.
This paper reports a study to determine how facility-, resident-, family- and staff-level indicators are empirically associated with staff members' perceptions of residents in nursing homes (NHs), assisted living facilities (ASLs) and family care homes (FCHs). While various efforts have described the ramifications of staff-resident interactions in nursing homes (NHs), few studies identify the factors that potentially influence staff members' perceptions of residents in multiple long-term care settings. The participants were 41 care staff located in five NHs, five ASLs, and 16 FCHs randomly selected in Kentucky, United States of America. Face-to-face and telephone interviews were conducted with care staff, residents in their care, family members of residents, and administrators of participating facilities. Telephone interviews measured staff perceptions of residents on two domains: cohesion (perceived feelings of closeness between staff and residents) and knowledge of residents' personal lives and care needs. Regression models found that staff who were married, reported more positive attitudes towards family members, and worked in smaller facilities reported greater staff-resident cohesion. In addition, staff who cared for a higher percentage of residents with learning difficulties indicated greater knowledge of residents. The findings emphasize the need to consider elements of staff-family relationships when considering staff perceptions of residents. They also imply that clinical interventions designed to enhance social relationships in NHs can be extended across the long-term care landscape to influence the staff-resident-family triad positively.


Cabaret dancers: "Settle down in order to stay mobile?" Bridging theoretical orientations within transnational migration studies.
Adopting a transnational perspective has become essential in understanding the contemporary practices taking place across borders, especially with respect to migrants. In this article, I argue that we can distinguish two theoretical orientations within transnational migration studies: one theorizing the complexity of transnational processes and focusing on established migrants settled in host countries; and the second theorizing transnational practices on the basis of different but continuous forms of mobility. Using the example of cabaret dancers in Switzerland, I show how they develop a very specific form of transnationality, which corresponds at first sight to the second theoretical orientation. Some of them are genuinely "world travelers"—they work in erotic clubs in Switzerland, Japan, or Lebanon, go home regularly to visit their families, or continue their studies. As such, their transnational morphology is highly influenced by gender as well as by the (transnational) nature of the sex industry and the opportunities and legal structure in Switzerland. Nevertheless, to remain in circulation, the dancers need to develop a kind of mobility capital, which involves, paradoxically, becoming "sedentarized" to a certain degree in Switzerland. The article thus advocates a theoretical framework that better captures the experiences of settled as well as of circulatory migrants.


Assessment of anorectal function in selection of patients for ileorectal anastomosis in Crohn's colitis.
Anorectal function has been assessed in 53 patients with Crohn's disease by measurement of resting and squeeze anal canal pressures and the maximum volume tolerated during distension of a balloon in the rectum. Radiographs of the rectum from barium enema examination were also reviewed to assess rectal capacity. Thirty-three patients have had a colectomy and ileorectal anastomosis for Crohn's colitis of whom 13 now have a stoma because they either required a protectomy (n=9) or where closure of a loop ileostomy had not been possible (n=4) because of severe anorectal disease. The maximum tolerated volume was less than 150 ml in 12 of 13 patients who now have a stoma compared with none of the 20 patients who have a functioning anastomosis. Although the correlation between a radiological assessment of rectal capacity and the maximum tolerated volume was poor, a severely contracted rectum was associated with the need for a stoma in six of seven patients compared with only two of 13 patients who did not have radiological signs of a narrow rectum.


Cor pulmonale due to tumor cell microemboli. Report of a case with occult gastric carcinoma.
Progressive dyspnea developed in a 36-year-old woman. Physical examination and chest roentgenogram showed the signs of pulmonary hypertension. She died of respiratory failure in spite of treatment. Autopsy disclosed gastric carcinoma in the pylorus with metastases to the regional lymph nodes, left adrenal gland, and ovaries. There were no gross pulmonary emboli, but more than 50% of pulmonary microvasculature was occluded by tumor cell microemboli. No parenchymal metastases were found in the lung. This case was remarkable because cor pulmonale due to tumor cell microemboli to the lung was the initial and terminal manifestation of clinically occult, but pathologically advanced, gastric carcinoma.


Evaluation of methodologies for assessing the overall diet: dietary quality scores and dietary pattern analysis.
This paper aims to describe different approaches for studying the overall diet with advantages and limitations. Studies of the overall diet have emerged because the relationship between dietary intake and health is very complex with all kinds of interactions. These cannot be captured well by studying single dietary components. Three main approaches to study the overall diet can be distinguished. The first method is researcher-defined scores or indices of diet quality. These are usually based on guidelines for a healthy diet or on diets known to be healthy. The second approach, using principal component or cluster analysis, is driven by the underlying dietary data. In principal component analysis, scales are derived based on the underlying relationships between food groups, whereas in cluster analysis, subgroups of the population are created with people that cluster together based on their dietary intake. A third approach includes methods that are driven by a combination of biological pathways and the underlying dietary data. Reduced rank regression defines linear combinations of food intakes that maximally explain nutrient intakes or intermediate markers of disease. Decision tree analysis identifies subgroups of a population whose members share dietary characteristics that influence (intermediate markers of) disease. It is concluded that all approaches have advantages and limitations and essentially answer different questions. The third approach is still more in an exploration phase, but seems to have great potential with complementary value. More insight into the utility of conducting studies on the overall diet can be gained if more attention is given to methodological issues.


[The randomized study of efficiency of preoperative photodynamic].
The authors made a prospective randomized comparison of results of preoperative photodynamic therapy (PhT) with chemotherapy, preoperative chemotherapy in initial unresectable central non-small cell lung cancer in stage III. The efficiency and safety of preoperative therapy were estimated as well as the possibility of subsequent surgical treatment. The research included patients in stage IIIA and IIIB of central non-small cell lung cancer with lesions of primary bronchi and lower section of the trachea, which initially were unresectable, but potentially the patients could be operated on after preoperative treatment. The photodynamic therapy was performed using chlorine E6 and the light of wave length 662 nm. Since January 2008 till December 2011,42 patients were included in the research, 21 patients were randomized in the group for photodynamic therapy and 21--in group without PhT. These groups were compared according to their sex, age, stage of the disease and histological findings. After nonadjuvant treatment the remissions were reached in 19 (90%) patients of the group with PhT and in 16 (76%) patients without PhT and all the patients were operated on. The explorative operations were made on 3 patients out of 16 operated on in the group without PhT (19%). In the group PhT 14 pneumonectomies and 5 lobectomies were perfomed opposite 10 pneumonectomies and 3 lobectomies in group without PhT. The degree of radicalism of resection appears to be reliably higher in the group PhT (RO-89%, R1-11% as against RO-54%, R1-46% in group without PhT), p = 0.038. The preoperative endobronchial PhT conducted with chemotherapy was characterized by efficiency and safety, allowed the surgical treatment and elevated the degree of radicalism of this treatment in selected patients, initially assessed as unresectable.


Relaxation Processes in Aqueous Systems upon X-ray Ionization: Entanglement of Electronic and Nuclear Dynamics.
The knowledge of primary processes following the interaction of high-energy radiation with molecules in liquid phase is rather limited. In the present Perspective, we report on a newly discovered type of relaxation process involving simultaneous autoionization and proton transfer between adjacent molecules, so-called proton transfer mediated charge separation (PTM-CS) process. Within PTM-CS, transients with a half-transferred proton are formed within a few femtoseconds after the core-level ionization event. Subsequent nonradiative decay of the highly nonequilibrium transients leads to a series of reactive species, which have not been considered in any high-energy radiation process in water. Nonlocal electronic decay processes are surprisingly accelerated upon proton dynamics. Such strong coupling of electronic and nuclear dynamics is a general phenomenon for hydrogen-bonded systems, however, its probability correlates strongly with hydration geometry. We suggest that the newly observed processes will impact future high-energy radiation-chemistry-relevant modeling, and we envision application of autoionization spectroscopy for identification of solution structure details.


Etiologic factors in diaper dermatitis: the role of urine.
Diaper dermatitis may result after repeated or prolonged contact of skin with urine and feces. A hairless mouse model was used to elucidate the role of urine in this process. The results of this work suggest that an important function of urine in the etiology of diaper dermatitis is to increase the pH of the diaper environment by breaking down urea in the presence of fecal urease. This rise in pH increases the activities of fecal proteases and lipases, which can damage skin. Urine can also increase the permeability of diapered skin to irritants and can directly irritate skin when exposure is prolonged.


Hemophagocytic syndrome: A misleading complication of visceral leishmaniasis in children--a series of 12 cases.
To describe the difficulties in diagnosing visceral leishmaniasis (VL) when revealed by hemophagocytic syndrome (HS) in young children. Retrospective study of patients identified over a 17-year period in French pediatric units. This series comprises 12 cases of VL that were either revealed (n = 11) or complicated (on starting treatment with antimony salts [n = 1]) by HS. Clinical manifestations were those of severe VL with sustained high fever and hepatosplenomegaly in children in very poor condition. Biological manifestations always included pancytopenia, marked hypofibrinogenemia and hypertriglyceridemia, hepatic cytolysis, and prominent hemophagocytosis on the bone marrow smear. These features led to transfer to a hematology unit. Ten children were very young (<38 months) at onset (and consequently at infection). Signs of autoimmunity (Coombs' test-positive erythrocytes, antinuclear factors, and various autoantibodies) were found in 4 cases and were probably secondary to polyclonal B cell activation. Serologic tests for Leishmania were negative at onset in 6 children, and no amastigotes were found on the first marrow smear in 8 of 12 cases despite extensive search. Seven patients had not visited foreign countries. All these factors explain the initial diagnostic confusion. Three cases were initially misdiagnosed as familial erythrophagocytic lymphohistiocytosis or infection-associated HS, and these patients were treated with etoposide (once for 5 months) to control the HS after failure of steroids. The diagnostic delay in these cases was 50, 74, and 134 days. When VL was finally diagnosed, amphotericin B monotherapy was effective in 4 cases. Eight patients were treated with antimony salts; 4 were cured, 3 required adjunctive treatment, and 1 worsened (HS) and was cured with steroids and liposomal amphotericin. Regardless of the type of therapy, all 12 children are presumed cured with a mean follow-up of 7 years (range: 6 months-16 years). A diagnosis of VL should, therefore, be seriously considered in all young patients with HS exposed to visceralizing Leishmania sp in Southern Europe. Clinicians and cytopathologists must be aware of the association. Early diagnosis of VL will minimize unnecessary hospitalization and potentially harmful investigations and treatments.


NMR spectroscopy in inhomogeneous B0 and B1 fields with non-linear correlation.
Resolved NMR spectra from samples in inhomogeneous B0 and B1 fields can be obtained with the so-called "ex situ" methodology, employing a train of composite or adiabatic z-rotation RF pulses to periodically refocus the inhomogeneous broadening during the detection of the time-domain signal. Earlier schemes relied on a linear correlation between the inhomogeneous B0 and B1 fields. Here the pulse length, bandwidth, and amplitude of the adiabatic pulses of the hyperbolic secant type are adjusted to improve the refocusing for a setup with non-linear correlation. The field correlation is measured using a two-dimensional nutation experiment augmented with a third dimension with varying RF carrier frequency accounting for off-resonance effects. The pulse optimization is performed with a computer algorithm using the experimentally determined field correlation and a standard adiabatic z-rotation pulse as a starting point for the iterative optimization procedure. The shape of the z-rotation RF pulse is manipulated to provide refocusing for the conditions given by the sample-, magnet-, and RF-coil geometry.