Comparison of CT and PET/CT for biopsy guidance in oncological patients.
To compare FDG PET/CT and CT for the guidance of percutaneous biopsies with histological confirmation of lesions. We prospectively evaluated 323 patients of whom 181 underwent FDG PET/CT-guided biopsy (total 188 biopsies) and 142 underwent CT-guided biopsy (total 146 biopsies). Biopsies were performed using the same PET/CT scanner with a fluoroscopic imaging system. Technical feasibility, clinical success and complication rates in the two groups were evaluated. Of the 188 biopsies with PET/CT guidance, 182 (96.8%) were successful with conclusive tissue samples obtained and of the 146 biopsies with CT guidance, 137 (93.8%) were successful. Therefore, 6 of 188 biopsies (3.1%) with PET/CT guidance and 9 of 146 (6.1%) with CT guidance were inconclusive (p = 0.19). Due to inconclusive histological results, 4 of the 188 lesions (2.1%) were rebiopsied with PET/CT guidance and 3 of 146 lesions (2.0%) were rebiopsied with CT guidance. Histology demonstrated that 142 of 188 lesions (75.5%) were malignant, and 40 (21.2%) were benign in the PET/CT-guided group, while 89 of 146 lesions (60.9%) were malignant and 48 (32.8%) were benign in the CT-guided group (p = 0.004 and 0.01, respectively). Patients with a histological diagnosis of benign lesion had no recurrence of disease with a minimum of 6 months follow-up. Of the 188 PET/CT-guided biopsies, 6 (3.1%) were repeat biopsies due to a previous nondiagnostic CT-guided biopsy performed in a different diagnostic centre. The interval between the two biopsies was less than a month in all cases. Histology revealed five malignant lesions and one benign lesion among these. The complication rate in the PET/CT-guided biopsy group was 12.7% (24 of 188), while in the CT-guided group, was 9.5% (14 of 146, p = 0.26). Therefore, there was no significant difference in complication rates between PET/CT and CT guidance. PET/CT-guided biopsy is already known to be a feasible and accurate method in the diagnostic work-up of suspected malignant lesions. This prospective analysis of a large number of patients demonstrated the feasibility and advantages of using PET/CT as the imaging method of choice for biopsy guidance, especially where FDG-avid foci do not show corresponding lesions on the CT scan. There were no significant differences in the ability to obtain a diagnostic specimen or in the complication rates between PET/CT and CT guidance.


3697G>A in MT-ND1 is a causative mutation in mitochondrial disease.
Mitochondrial diseases are a group of clinically heterogeneous disorders that can be difficult to diagnose. We report a two and a half year old girl with clinical symptoms compatible with Leigh disease but with no definitive diagnosis. Using next generation sequencing we found that mutation 3697G>A was responsible for the patient's clinical symptoms. Corroboration was performed via segregation analysis in mother and sister and by evolutionary analysis that showed that the mutation is located in a highly conserved region across a wide range of species. Functional analyses corroborated the mutation effect and indicated that the pathophysiological alterations were partially restored by Coenzyme Q10. In addition, we proposed that the presence of the mutation at high frequencies causes the phenotype in the patient, while other family members with intermediate levels of heteroplasmy are symptoms-free.


[Self-reported morbidity by workers in the Family Health Teams].
The health of primary care workers is still a poorly addressed area of study in Brazil. The scope of this study was to describe the standard of self-reported morbidity by workers in Family Health Teams (FHT) in the northeastern macro-region of the state of Minas Gerais. A cross-sectional study was conducted with self-applied questionnaires, including socio-demographical data, labor and health conditions, among all workers in FHT. Self-reported morbidity was categorized based on the International Classification of Primary Care, version 2. Information was collected from 1,731 workers in 204 primary health care units. The group was predominantly comprised of female community health workers. The prevalence of at least one health problem was 26.1% for women and 18.3% for men. The main health problems were related to circulatory, musculoskeletal, respiratory, endocrine-metabolic and nervous systems. After multiple analysis, the variables associated with health problems were related to being female, aged 30 years or more and being on the team for 5 years or longer. The morbidity reported by the FHT workers is similar to that observed for the population in general, highlighting the need for strategies to promote the health of these workers as well.


Exposure to holoendemic malaria results in elevated Epstein-Barr virus loads in children.
Perennial and intense malaria transmission (holoendemic malaria) and Epstein-Barr virus (EBV) infection are 2 cofactors in the pathogenesis of endemic Burkitt lymphoma (eBL). In the present study, we compared EBV loads in children living in 2 regions of Kenya with differing malaria transmission intensities: Kisumu District, where malaria transmission is holoendemic, and Nandi District, where malaria transmission is sporadic. For comparison, blood samples were also obtained from US adults, Kenyan adults, and patients with eBL. Extraction of DNA from blood and quantification by polymerase chain reaction give an EBV load estimate that reflects the number of EBV-infected B cells. We observed a significant linear trend in mean EBV load, with the lowest EBV load detected in US adults and increasing EBV loads detected in Kenyan adults, Nandi children, Kisumu children, and patients with eBL, respectively. In addition, EBV loads were significantly higher in Kisumu children 1-4 years of age than in Nandi children of the same age. Our results support the hypothesis that repeated malaria infections in very young children modulate the persistence of EBV and increase the risk for the development of eBL.


Efficacy and Safety of Sharp Recanalization with the Stiff End of a Microguidewire for Treatment of Refractory Central Venous Occlusions in Hemodialysis Patients.
Sharp recanalization is a viable procedure for some refractory central venous occlusions that cannot be recanalized with the conventional technique. The sharp recanalization procedures reported in previous studies are often rely on costly devices and with a certain proportion of complications. This study aimed to present an inexpensive and risk-controllable coaxial centrifugally sharp recanalization technique that was independent of any additional costly devices. This retrospective study enrolled 8 patients who had received sharp recanalization of central venous occlusions, between August 2017 and May 2021. The sharp recanalization technique was performed centrifugally with the stiff end of a microguidewire after the lesions failed to be passed through with the conventional technique. Clinical data of patients on their lesions, technical success rate, procedure-related complications, and patency rates were collected and analyzed to assess the efficacy and safety of the technique. Technical success was achieved in all patients, with no complications were observed. All symptoms were ameliorated within 48h postsurgery. The median follow-up period was 22 months. All patients maintained patency or assisted patency at 12 month follow-up. Sharp recanalization performed centrifugally with the stiff end of the microguidewire could be a cost-effective and safe alternative procedure for the treatment of refractory central venous occlusion that cannot be recanalized with conventional technique.


It's the fear of the unknown: Transition from higher education for young autistic adults.
More young people with a diagnosis of autism are enrolling and successfully completing higher education courses than ever before and this is set to increase; however, while there is a burgeoning body of literature surrounding the transition into this stage of education, there is a paucity of research that investigates the transition as this population exit higher education. This exploratory qualitative study is one of the first to identify the specific experiences of young autistic adults making this transition, drawing on semi-structured interviews with 21 students and recent graduates. Findings indicate that transition out of higher education is challenging on both practical and psychological levels, manifested by feelings of anxiety and loss. However, there is also evidence that the same phenomenon can also be understood as a positive departure with important implications for identity development. Findings are discussed in relation to future research and implications for practice in higher education institutions.


Perceptual and memorial contributions to developmental prosopagnosia.
Developmental prosopagnosia (DP) is commonly associated with the failure to properly perceive individuating facial properties, notably those conveying configural or holistic content. While this may indicate that the primary impairment is perceptual, it is conceivable that some cases of DP are instead caused by a memory impairment, with any perceptual complaint merely allied rather than causal. To investigate this possibility, we administered a battery of face perception tasks to 11 individuals who reported that their face recognition difficulties disrupt daily activity and who also performed poorly on two formal tests of face recognition. Group statistics identified, relative to age- and gender-matched controls, difficulties in apprehending global-local relations and the holistic properties of faces, and in matching across viewpoints, but these were mild in nature and were not consistently evident at the level of individual participants. Six of the 11 individuals failed to show any evidence of perceptual impairment. In the remaining five individuals, no single perceptual deficit, or combination of deficits, was necessary or sufficient for poor recognition performance. These data suggest that some cases of DP are better explained by a memorial rather than perceptual deficit, and highlight the relevance of the apperceptive/associative distinction more commonly applied to the allied syndrome of acquired prosopagnosia.


Cell-free and alkylated hemoproteins improve survival in mouse models of carbon monoxide poisoning.
I.v. administration of a high-affinity carbon monoxide-binding (CO-binding) molecule, recombinant neuroglobin, can improve survival in CO poisoning mouse models. The current study aims to discover how biochemical variables of the scavenger determine the CO removal from the RBCs by evaluating 3 readily available hemoproteins, 2,3-diphosphoglycerate stripped human hemoglobin (StHb); N-ethylmaleimide modified hemoglobin (NEMHb); and equine myoglobin (Mb). These molecules efficiently sequester CO from hemoglobin in erythrocytes in vitro. A kinetic model was developed to predict the CO binding efficacy for hemoproteins, based on their measured in vitro oxygen and CO binding affinities, suggesting that the therapeutic efficacy of hemoproteins for CO poisoning relates to a high M value, which is the binding affinity for CO relative to oxygen (KA,CO/KA,O2). In a lethal CO poisoning mouse model, StHb, NEMHb, and Mb improved survival by 100%, 100%, and 60%, respectively, compared with saline controls and were well tolerated in 48-hour toxicology assessments. In conclusion, both StHb and NEMHb have high CO binding affinities and M values, and they scavenge CO efficiently in vitro and in vivo, highlighting their therapeutic potential for point-of-care antidotal therapy of CO poisoning.


Autonomic, neuroendocrine, and immune responses to psychological stress: the reactivity hypothesis.
We examined the effects of brief psychological stressors on cardiovascular, neuroendocrine, and cellular immune response in 22 older women to investigate the common effects of stress across systems. Results revealed that psychological stressors heightened cardiac sympathetic activation, elevated plasma catecholamine concentrations, and affected the cellular immune response (ps < 0.05). In a replication and extension, 27 women caring for a spouse with a progressive dementia (high chronic stress) and 37 controls category matched for age and family income (low chronic stress) performed the 12-min laboratory stressor. Measures were taken before (low acute stress) and immediately following (high acute stress) exposure to the laboratory stressors as well as 30 min after termination of the stressor (recovery period). Acute stress again heightened cardiac sympathetic activation, elevated plasma catecholamine concentrations, and affected cellular immune responses (ps < 0.05), whereas chronic stress was associated with higher reports of negative affect, enhanced cardiac sympathetic activation, elevated blood pressure and plasma levels of ACTH, and diminished production of interleukin-1 beta (ps < 0.05). Correlational analyses in both studies further suggested that individuals who showed the greatest stress-related changes in HPA activation also exhibited the greatest diminution in cellular immune response.


Initiation and rapid titration of methadone and slow-release oral morphine (SROM) in an acute care, inpatient setting: a case series.
Methadone titration in an outpatient setting typically involves initiation with subtherapeutic doses with slow titration to mitigate the risks of respiratory depression and overdose. In pregnancy, and generally, subtherapeutic doses of methadone and slow titrations are associated with poorer outcomes in terms of treatment retention and ongoing illicit opioid use. We aim to describe rapid titration of OAT in an inpatient setting for pregnant injection opioid users with high opioid tolerance secondary to a fentanyl-based illicit drug supply. Retrospective case series of patients admitted to a tertiary center with a primary indication of opioid withdrawal and treatment for severe opioid use disorder in pregnancy. Twelve women received rapid methadone titrations with or without slow-release oral morphine for opioid use disorder during a total of fifteen hospital admissions. All women included in the study were active fentanyl users (12/12). Methadone dosing was increased rapidly with no adverse events with a median dose at day 7 of 65 mg (IQR 60-70 mg) and median discharge dose of 85 mg (IQR 70-92.5 mg) during their admission for titration. Slow-release oral morphine was used in half of the titration admissions (8/15) with a median dose of 340 mg (IQR 187.5-425 mg) at discharge. The median length of admission was 12 days (IQR 9.5-15). A rapid titration of methadone was completed in an inpatient setting with or without slow-release oral morphine, without adverse events showing feasibility of this protocol for a pregnant population in an inpatient setting. Patients achieved therapeutic doses of methadone (and/or SROM) faster than outpatient counterparts with no known adverse events.


Fate of nitrate and bromide in an unsaturated zone of a sandy soil under citrus production.
Understanding water and nutrient transport through the soil profile is important for efficient irrigation and nutrient management to minimize excess nutrient leaching below the rootzone. We applied four rates of N (28, 56, 84, and 112 kg N ha(-1); equivalent to one-fourth of annual N rates being evaluated in this study for bearing citrus trees), and 80 kg Br- ha(-1) to a sandy Entisol with >25-yr-old citrus trees to (i) determine the temporal changes in NO3-N and Br- distribution down the soil profile (2.4 m), and (ii) evaluate the measured concentrations of NO3-N and Br- at various depths with those predicted by the Leaching Estimation and Chemistry Model (LEACHM). Nitrate N and Br concentrations approached the background levels by 42 and 214 d, respectively. Model-predicted volumetric water content and concentrations of NO3-N and Br- at various depths within the entire soil profile were very close to measured values. The LEACHM data showed that 21 to 36% of applied fertilizer N leached below the root zone, while tree uptake accounted for 40 to 53%. Results of this study enhance our understanding of N dynamics in these sandy soils, and provide better evaluation of N and irrigation management to improve uptake efficiency, reduce N losses, and minimize the risk of ground water nitrate contamination from soils highly vulnerable to nutrient leaching.


Falling Weight Impact Damage Characterisation of Flax and Flax Basalt Vinyl Ester Hybrid Composites.
Understanding the damage mechanisms of composite materials requires detailed mapping of the failure behaviour using reliable techniques. This research focuses on an evaluation of the low-velocity falling weight impact damage behaviour of flax-basalt/vinyl ester (VE) hybrid composites. Incident impact energies under three different energy levels (50, 60, and 70 Joules) were employed to cause complete perforation in order to characterise different impact damage parameters, such as energy absorption characteristics, and damage modes and mechanisms. In addition, the water absorption behaviour of flax and flax basalt hybrid composites and its effects on the impact damage performance were also investigated. All the samples subjected to different incident energies were characterised using non-destructive techniques, such as scanning electron microscopy (SEM) and X-ray computed micro-tomography (πCT), to assess the damage mechanisms of studied flax/VE and flax/basalt/VE hybrid composites. The experimental results showed that the basalt hybrid system had a high impact energy and peak load compared to the flax/VE composite without hybridisation, indicating that a hybrid approach is a promising strategy for enhancing the toughness properties of natural fibre composites. The πCT and SEM images revealed that the failure modes observed for flax and flax basalt hybrid composites were a combination of matrix cracking, delamination, fibre breakage, and fibre pull out.


Transplantation of dorsal root ganglion into the olfactory bulb of neonatal rats: a histochemical study.
We have transplanted encapsulated dorsal root ganglia (DRG) from adult Wistar albino rats unilaterally into partially bulbectomized (n = 20) neonatal (P3-5) rats of the same strain. Three months postoperatively the animals were perfused and their brains processed by direct thiocholine method for cholinesterases (Ch), specific acetylcholinesterase (AChE) and nonspecific butyrylcholinesterase (BuChE) or stained by Cresyl violet. Selected sections were immunohistochemically stained for olfactory marker protein (OMP). In 17 cases we found surviving transplanted DRG. Fifteen transplants were well integrated with the spared portion of the olfactory bulb (OB) as clearly demonstrated by AChE and BuChE histochemistry, while two did not integrate. Regenerated OMP positive olfactory axons originating from neuroepithelium and AChE positive fibres from OB remnant penetrated into the transplants. In one case, fibers connected with BuChE positive Schwann cells grew from the transplanted DRG into the host OB. Individual sensory neurons of the transplants revealed variable intensity of the AChE staining, thus resembling the pattern of AChE activity in normal DRG. BuChE activity was mostly localized on the surface of sensory neurons in the ring of satellite cells. Some BuChE positive blood vessels penetrated into the DRG, and were observed around sensory neurons. The results showed a considerable viability and adaptability of the sensory neurons in the new environment after a long-term transplantation.


Effectiveness of the oral human attenuated pentavalent rotavirus vaccine (RotaTeq™) postlicensure: a meta-analysis-2006-2020.
Rotavirus (RV), which causes RV-associated gastroenteritis (RVGE), has accounted for considerable morbidity. We aimed to assess the effectiveness (VE) of the oral pentavalent RV vaccine (RotaTeq™) in real-world settings in children and infants with gastroenteritis. We performed a systematic search for peer-reviewed studies published between 1 January 2006 and 1 May 2020 and a meta-analysis to calculate the VE of RotaTeq™ vaccine. The primary outcome was the pooled three-dose vaccine VE. Stratified analysis of the vaccine VEs was performed according to dosages, study design, population age, socioeconomic status (SES), introduction condition, control group types, outcomes of RV disease, and RV strains. After screening 2359 unique records, 28 studies were included and meta-analyzed. The overall VE estimate was 84% (95% confidence interval [CI], 80-87%). Stratified analyses revealed a nonnegligible impact of factors such as study design and SES. Other factors did not show great impart to VE with no significant differences between groups. RotaTeq™ is effective against RV infection, especially in high-income countries. Adopting suitable study methods and expansion of RV surveillance in low-income regions is crucial to assess VE in real-life settings and provide feasible vaccine regimens to improve vaccine VE.


Ultra-low-cost 3D gaze estimation: an intuitive high information throughput compliment to direct brain-machine interfaces.
Eye movements are highly correlated with motor intentions and are often retained by patients with serious motor deficiencies. Despite this, eye tracking is not widely used as control interface for movement in impaired patients due to poor signal interpretation and lack of control flexibility. We propose that tracking the gaze position in 3D rather than 2D provides a considerably richer signal for human machine interfaces by allowing direct interaction with the environment rather than via computer displays. We demonstrate here that by using mass-produced video-game hardware, it is possible to produce an ultra-low-cost binocular eye-tracker with comparable performance to commercial systems, yet 800 times cheaper. Our head-mounted system has 30 USD material costs and operates at over 120 Hz sampling rate with a 0.5-1 degree of visual angle resolution. We perform 2D and 3D gaze estimation, controlling a real-time volumetric cursor essential for driving complex user interfaces. Our approach yields an information throughput of 43 bits s(-1), more than ten times that of invasive and semi-invasive brain-machine interfaces (BMIs) that are vastly more expensive. Unlike many BMIs our system yields effective real-time closed loop control of devices (10 ms latency), after just ten minutes of training, which we demonstrate through a novel BMI benchmark--the control of the video arcade game 'Pong'.


Environment.
In contrast to the approaches to resource management and preservation of the past decade, a new perspective on environmental problems is emerging. Six major trends in scientific thinking are (i) increased efforts to examine environments In holistic frameworks, (ii) greater attention to life support systems, (iii) enlarged canvass of the range of choices in resource management, (iv) refinement in methods of risk assessment, (v) streamlined methods for monitoring environmental change, and (vi) more emphasis on the global framework.


Supplementing an immunomodulatory feed ingredient to modulate thermoregulation, physiologic, and production responses in lactating dairy cows under heat stress conditions.
This study compared vaginal temperature, physiologic, and productive parameters in lactating dairy cows supplemented or not with Omnigen-AF (Phibro Animal Health, Teaneck, NJ) during the summer months in a tropical environment. Thirty-two lactating, primiparous (n = 16) and multiparous (n = 16) pregnant Holstein × Gir cows were ranked by parity, days in milk, body weight, and body condition score (BCS), and assigned to receive (SUPP; n = 16) or not (CON; n = 16) Omnigen-AF (Phibro Animal Health, Teaneck, NJ) at 56 g/cow daily (as-fed basis). During the experimental period (d -6 to 56), cows were maintained in a single drylot pen with ad libitum access to water and a total mixed ration, and milked twice daily. Cows received Omnigen-AF mixed with 200 g of corn (as-fed basis) after the daily morning milking through self-locking head gates, whereas CON cows concurrently received 56 g of kaolin mixed with 200 g of corn. For feed intake evaluation, cows from both treatments were randomly divided in 4 groups of 8 cows each, and allocated to 8 individual feeding stations for 3 d. Intake was evaluated 4 times per group from d 1 to 56. From d -6 to 0, d 15 to 28, and d 43 to 56, cow vaginal temperature was recorded hourly. Environmental temperature-humidity index (THI) was also recorded hourly from d 15 to 28 and d 43 to 56. Cows were evaluated for body weight and BCS on d -6 and 56, individual milk production was recorded daily from d -6 to 56, and milk samples were collected on d -6, 0, 7, 14, 21, 28, 35, 42, 49, and 56 for analyses of somatic cell count and milk components. Blood samples were collected on d -6, -3, 0, 9, 15, 18, 21, 24, 27, 36, 45, 48, 51, 54, and 56. Results from samples or observations collected from d -6 to 0 were included as an independent covariate in each respective analysis. Environmental THI was 74.2 ± 0.5 and cows were exposed to THI >68 for 633 h within a total of 672 h of evaluation. Cows assigned to CON had greater vaginal temperature on d 28, 43, 45, and from d 48 to 55 (by 0.38 to 0.52%), as well as greater mean somatic cell count (by 97%) and serum haptoglobin concentrations (by 89%) compared with SUPP cows. Cows assigned to SUPP had greater mean dry matter intake (by 7%), BCS on d 56 (by 11%), and mean serum insulin concentrations (by 35%) compared with CON cows. Hence, SUPP ameliorated hyperthermia, improved nutritional status, and modulated systemic and mammary gland immune parameters in lactating dairy cows exposed to heat stress conditions.


Astrocytes & Astrocyte derived Extracellular Vesicles in Morphine Induced Amyloidopathy: Implications for Cognitive Deficits in Opiate Abusers.
While opiates like morphine play a major role in the pharmacotherapy for the control of pain associated with various diseases, paradoxically, their long-term use is associated with cognitive impairments. Furthermore, morphine administration has been shown to result in neuronal synaptodendritic injury in rodent brains, leading to neurodegeneration. We recently reported the role of astrocytes as contributors of amyloidosis associated with HIV-associated neurological disorders. Herein we hypothesize that morphine could induce astrocytic amyloidosis, which, in turn, could be disseminated to various regions in the brain by astrocyte-derived EVs (ADEVs). In this study we demonstrate brain region-specific up-regulation of astrocytic amyloids in morphine dependendent rhesus macaques. In addition, herein we also demonstrate increased expression of β-site cleaving enzyme (BACE1), APP, and Aβ in human primary astrocytes (HPAs) exposed to morphine. Mechanisms involved in this process included the up-regulation of hypoxia-inducible factor (HIF-1α), its translocation and binding to the promoter of BACE1, leading to increased BACE1 activity and, generation of Aβ 1-42. Gene silencing approaches confirmed the regulatory role of HIF-1α in BACE1 mediated amyloidosis leading to astrocyte activation and neuroinflammation. We next sought to assess whether morphine-stimulated ADEVs could carry amyloid cargoes. Results showed that morphine exposure induced the release of morphine-ADEVs, carrying amyloids. Interestingly, silencing HIF-1α in astrocytes not only reduced the numbers of ADEV released, but also the packaging of amyloid cargos in the ADEVs. These findings were further validated in brain derived EVs (BEVs) isolated from macaques, wherein it was shown that BEVs from morphine-dependent macaques, carried varieties of amyloid cargoes including the cytokine IL-1β. This is the first report implicating the role of HIF-1α-BACE1 axis in morphine-mediated induction of astrocytic amyloidosis, leading, in turn, to neuroinflammation and release of the amyloid cargoes via ADEVs. These findings set the groundwork for the future development of therapeutic strategies for targeting cognitive deficits in chronic opiate users.


Epidemiology and incidence of plague in the world, 1958-79.
During the period 1958 - 79, 46 937 cases of human plague were recorded in the world, but the general downward tendency of plague incidence remained, remembering that 40 484 human cases were recorded in 1950. The current incidence of plague is an indication of the epidemicity of plague in its natural foci. In general, during the period under consideration, plague manifestations followed the universally recognized laws of the epidemicity of the disease. Anthroponotic bubonic plague-the most epidemic form of plague-was noted rarely and in limited areas. A considerable proportion of human plague cases occurred in southern Viet Nam, where the defoliation carried out over vast areas during the military operations is thought to have been one cause of the high incidence.Despite the general downward trend in plague incidence, 30 countries of the world were affected by the disease. Therefore, continuous epidemiological surveillance for plague remains an urgent task confronting the health authorities of the countries having known or potential natural foci.


Is pre-operative heart rate variability a prognostic indicator for overall survival and cancer recurrence in patients with primary colorectal cancer?
Heart Rate Variability (HRV) represents efferent vagus nerve activity which is suggested to be inversely related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various types of cancer. HRV is also believed to predict the occurrence and severity of post-operative complications. We aimed to determine the role of pre-operative HRV as a prognostic factor in overall and cancer free survival in patients with colorectal cancer. Retrospective analysis was performed in a detailed dataset of patients diagnosed with primary colorectal cancer between January 2010 and December 2016, who underwent curative surgical treatment. HRV was measured as time-domain parameters (SDNN (Standard Deviation of NN-intervals) and RMSSD (Root Mean Square of Successive Differences)) based on pre-operative 10 second ECGs. Groups were created by baseline HRV: Low HRV (SDNN <20ms or RMSSD <19ms) and normal HRV (SDNN ≥20ms or RMSSD ≥19ms). Primary endpoints were overall and cancer free survival. A total of 428 patients were included in this study. HRV was not significantly associated with overall survival (SDNN <20ms vs SDNN ≥20ms:24.4% vs 22.8%, adjusted HR = 0.952 (0.607-1.493), p = 0.829; RMSSD <19ms vs RMSSD ≥19ms:27.0% vs 19.5%, adjusted HR = 1.321 (0.802-2.178), p = 0.274) or cancer recurrence (SDNN <20ms vs ≥20ms:20.1% vs 18.7%, adjusted HR = 0.976 (0.599-1.592), p = 0.924; RMSSD <19ms vs ≥19ms, 21.5% vs 16.9%, adjusted HR = 1.192 (0.706-2.011), p = 0.511). There was no significant association between HRV and CEA-level at one year follow-up, or between HRV and occurrence of a post-operative complication or the severity of post-operative complications. Heart rate variability was not associated with overall or cancer free survival in patients with primary colorectal cancer who underwent curative surgical treatment. These results do not align with results found in studies including only patients with advanced cancer, which suggests that there is only an association in the other direction, cancer causing low HRV.


Staged bilateral far-lateral approach for bilateral cervicomedullary junction neurenteric cysts in a 10-year-old girl.
Neurenteric cysts are rare and benign lesions that consist of ectopic alimentary tissue residing in the central nervous system. They tend to occur most frequently in an intraspinal rather than intracranial location. Intracranial neurenteric cysts are a rare occurrence in the pediatric population. These lesions typically present as unilateral cystic structures in the lower cerebellopontine angle and craniocervical junction. To the authors' knowledge, there have been no reported cases of bilateral localization of intracranial neurenteric cysts. In this report, they present an unusual case of a 10-year-old girl who was found to have bilateral intracranial neurenteric cysts at the pontomedullary junction. The patient was successfully treated with staged, bilateral far-lateral transcondylar resection of the cysts. The authors also provide a brief overview of the literature describing intracranial neurenteric cysts in children.


Cigarette smoke components are not very effective in directly inactivating alpha 1-proteinase inhibitor.
Cigarette smoke was found to be rather ineffective in inactivating alpha 1-proteinase inhibitor (alpha 1-PI) in aqueous solution, whereas a slow inactivation of alpha 1-PI by a dimethyl sulfoxide extract of whole cigarette smoke condensate was observed. However, this inactivation could only partially be prevented by antioxidants indicating that it is not, or at least not exclusively, due to oxidation. The bulk of inactive alpha 1-PI found in lung lavage fluids from smokers is thus probably generated through endogenous mechanisms and not through smoke components directly.


Impaired neutrophil extracellular trap formation: a novel defect in the innate immune system of aged individuals.
Neutrophil extracellular traps (NETs) are a recently discovered addition to the defensive armamentarium of neutrophils, assisting in the immune response against rapidly dividing bacteria. Although older adults are more susceptible to such infections, no study has examined whether aging in humans influences NET formation. We report that TNF-α-primed neutrophils generate significantly more NETs than unprimed neutrophils and that lipopolysaccharide (LPS)- and interleukin-8 (IL-8)-induced NET formation exhibits a significant age-related decline. NET formation requires generation of reactive oxygen species (ROS), and this was also reduced in neutrophils from older donors identifying a mechanism for reduced NET formation. Expression of IL-8 receptors (CXCR1 and CXCR2) and the LPS receptor TLR4 was similar on neutrophils from young and old subjects, and neutrophils challenged with phorbol-12-myristate-13-acetate (PMA) showed no age-associated differences in ROS or NET production. Taken together, these data suggest a defect in proximal signalling underlies the age-related decline in NET and ROS generation. TNF-α priming involves signalling through p38 MAP kinase, but activation kinetics were comparable in neutrophils from young and old donors. In a clinical setting, we assessed the capacity of neutrophils from young and older patients with chronic periodontitis to generate NETs in response to PMA and hypochlorous acid (HOCL). Neutrophil extracellular trap generation to HOCL, but not PMA, was lower in older periodontitis patients but not in comparison with age-matched controls. Impaired NET formation is thus a novel defect of innate immunity in older adults but does not appear to contribute to the increased incidence of periodontitis in older adults.


A pilot study of the use of EEG-based synchronized Transcranial Magnetic Stimulation (sTMS) for treatment of Major Depression.
Repetitive Transcranial Magnetic Stimulation (rTMS) is an effective treatment for Major Depressive Disorder (MDD), and is based upon delivery of focal high-energy pulses of electromagnetic stimulation. We postulated that delivery of rTMS at the subject's individual alpha frequency (synchronized TMS, or sTMS) would achieve efficacy with lower energy of stimulation. We developed a device that rotates neodymium cylindrical magnets at three locations along the midline above the subject's scalp to impart low-energy, sinusoidal-waveform magnetic brain stimulation over a broad area, and performed this efficacy study. Fifty-two subjects with MDD were enrolled in a randomized, sham controlled, double-blind treatment study (Trial Registration: NCT01683019). Forty-six subjects were included in the final analysis. Most subjects received concurrent antidepressant medications that remained unchanged during the study. Subjects were randomized to three treatment groups: 1) active sTMS with a fixed frequency at the subject's alpha frequency; 2) active sTMS with a random stimulus frequency that varied between 8 Hz and 13 Hz; and, 3) sham sTMS. 20 half-hour sTMS sessions were administered 5 days per week for 4 weeks. Subjects with either fixed or random frequency active sTMS had statistically significantly greater percentage reduction in depression severity compared to sham (48.5% vs. 19.3%, respectively; p = 0.001). No significant difference was found between fixed and random groups (p = 0.30). No significant side effects were reported. These results suggest that sTMS may be an effective treatment for MDD.


Practice of Peritoneal Dialysis Catheter Flushing in Australia and New Zealand: Multi-Center Cross-Sectional Survey.
Evidence of effective interventions to prevent peritoneal dialysis (PD) catheter malfunction before first use is presently insufficient to guide clinical care. Regular flushing of the PD catheter (e.g. before PD commencement) has been adopted by some practitioners in the belief that it will prevent catheter obstruction and/or malfunction. The aim of this study was to characterize and evaluate PD catheter flushing practices across Australian and New Zealand PD units. An on-line survey was distributed to all 62 PD units in Australia (12 August 2016; n = 51) and New Zealand (2 February 2017; n = 11), with questions relating to PD catheter flushing practices, audit, and outcomes. Forty-nine units of variable size (< 16 to > 100 patients) completed the survey (79% response rate). All centers flushed PD catheters at some stage after insertion as routine unit practice. Forty-one units (84%) routinely flushed during periods of PD rest at varying intervals ranging from alternate daily to monthly. The type and volume of solution used to flush varied between units. Units that practised routine flushing of PD catheters were almost twice as likely to audit their catheter-related outcomes (66% vs 38%, p = 0.23) and more likely to have reported blocked catheters in the preceding 12 months (84% vs 0%, p = 0.01) compared with those units that did not routinely flush PD catheters. Thirty units (61%) regularly audited and monitored catheter-related outcomes. This study identified a wide variation in center practices relating to PD catheter flushing. Drawing conclusions about any relationship between flushing practices and clinical outcomes was impeded by the relatively low uptake of regular auditing and monitoring of catheter-related outcomes across surveyed units. Evaluation of the benefits and harms of standardized PD catheter flushing practices on patient outcomes in a randomized trial is needed to guide practice.


Epileptic negative myoclonus and brief asymmetric tonic seizures. A supplementary sensorimotor area involvement for both negative and positive motor phenomena.
Epileptic negative myoclonus (ENM) is an epileptic motor dysfunction characterised by brief lapses of postural tone provoked by paroxysmal cortical discharges. We report the electrophysiological and video-polygraphic findings in a patient presenting with the unusual association of ENM and brief asymmetric tonic-postural seizures of cryptogenetic origin. Focal EMG silent periods in the left deltoid muscle (mean duration 81.2 +/- 16.4 ms), time-locked with vertex spikes were present. The time lag between spikes and ENM was 33.1 +/- 4.6 ms. We suggest the involvement of mesial frontal areas in the genesis of both negative and positive motor phenomena.


Solute segregation and thermal stability of nanocrystalline solid solution systems.
A model coupling first principles and thermodynamics was developed to describe the thermal stability of a nanograin structure in solid solution alloys. The thermodynamic functions of solute segregation and conditions for thermal stabilization were demonstrated for both strongly and weakly solute-segregating systems. The dependence of segregation behavior on the grain size, solute concentration and temperature was quantified, where the parameters to control destabilization of the nanograin structure at a given temperature were predicted. For the first time it was found that there exists a transformation from the single-extreme to dual-extreme rule of the total Gibbs free energies of the solid solution systems with the decrease of solute concentration or increase of temperature. The model calculations were confirmed quantitatively by the experimental results, and a nanocrystalline W-10 at%Sc solid solution with a highly stable grain structure in a broad range from room temperature to 1600 K was prepared. The universal mechanism disclosed in this study will facilitate the design of nanocrystalline alloys with high thermal stability through matching of the doping element and the initial grain size.


Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans.
Insulin resistance plays an important role in the pathophysiology of diabetes and is associated with obesity and other cardiovascular risk factors. The "gold standard" glucose clamp and minimal model analysis are two established methods for determining insulin sensitivity in vivo, but neither is easily implemented in large studies. Thus, it is of interest to develop a simple, accurate method for assessing insulin sensitivity that is useful for clinical investigations. We performed both hyperinsulinemic isoglycemic glucose clamp and insulin-modified frequently sampled iv glucose tolerance tests on 28 nonobese, 13 obese, and 15 type 2 diabetic subjects. We obtained correlations between indexes of insulin sensitivity from glucose clamp studies (SI(Clamp)) and minimal model analysis (SI(MM)) that were comparable to previous reports (r = 0.57). We performed a sensitivity analysis on our data and discovered that physiological steady state values [i.e. fasting insulin (I(0)) and glucose (G(0))] contain critical information about insulin sensitivity. We defined a quantitative insulin sensitivity check index (QUICKI = 1/[log(I(0)) + log(G(0))]) that has substantially better correlation with SI(Clamp) (r = 0.78) than the correlation we observed between SI(MM) and SI(Clamp). Moreover, we observed a comparable overall correlation between QUICKI and SI(Clamp) in a totally independent group of 21 obese and 14 nonobese subjects from another institution. We conclude that QUICKI is an index of insulin sensitivity obtained from a fasting blood sample that may be useful for clinical research.


[Analysis of correlation between trabecular microstructure and clinical imaging parameters in fracture region of osteoporotic hip].
To analyze the correlation between the trabecular microstructure and the clinical imaging parameters in the fracture region of osteoporotic hip so as to provide a simple method to evaluate the trabecular microstructure by a non-invasive way. Between June 2012 and January 2013, 16 elderly patients with femoral neck fracture underwent hip arthroplasty were selected as the trial group; 5 young patients with pelvic fracture were selected as the control group. The hip CT examination was done, and cancellous bone volume/marrow cavity volume (CV/MV) was analyzed with Mimics 10.01 software in the control group. The CT scan and bone mineral density (BMD) measurement were performed on normal hips of the trial group, and cuboid specimens were gained from the femoral necks at the place of the tensional trabeculae to evaluate the trabecular microstructure parameters by Micro-CT, including bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular spacing (Tb.Sp), trabecular thickness (Tb.Th), connect density (Conn.D), and structure model index (SMI). The correlation between imaging parameters and microstructure parameters was analyzed. In the trial group, the BMD value was 0.491-0.698 g/cm2 (mean, 0.601 g/cm2); according to World Health Organization (WHO) standard, 10 cases were diagnosed as having osteoporosis, and 6 cases as having osteopenia. The CV/MV of the trial group (0.670 1 +/- 0.102 0) was significantly lower than that of the control group (0.885 0 +/- 0.089 1) (t = -4.567, P = 0.000). In the trial group, CV/MV had correlation with BV/TV, Tb.Th, and SMI (P < 0.05); however, CV/MV had no correlation with Tb.N, Tb.Sp, or Conn.D (P > 0.05). BV/TV had correlation with Tb.Th, Tb.N, Tb.Sp, and SMI (P < 0.05), but it had no correlation with Conn.D (P=0.075). There was no correlation between BMD and microstructure parameters (P > 0.05). CV/MV obviously decreases in the osteoporotic hip, and there is a correlation between CV/MV and the microstructure parameters of BV/TV, Tb.Th, and SMI, to some extent, which can reflect the variety of the microstructure of the trabeculae. There is no correlation between BMD of femoral neck and microstructure parameters.


Comparison of inorganic nitrogen concentrations in airborne particles at inshore and offshore sites in the Yellow Sea (2017-2019): Long-range transport and potential impact on marine productivity.
Atmospheric deposition of nitrogen is one of the most important external nutrient sources. We investigated the concentrations of NO3- and NH4+ in airborne particles at both an offshore and an inshore site in the Yellow Sea. At the offshore site, devoid of local sources and located downwind from the highly developed areas of Korea and China, the concentrations of atmospheric particulate NO3- and NH4+ were ∼88 ± 101 nmol m-3 and ∼102 ± 102 nmol m-3, respectively, likely due to the transboundary long-range transport of pollutants. The inshore site showed a concentration ∼2 times higher than the offshore site. Considering not only dry inorganic nitrogen deposition but also wet and organic material deposition, the total atmospheric nitrogen deposition was estimated to contribute roughly 10 % to the new production in the Yellow Sea.


Host intraspatial selection of infectious bronchitis virus populations.
Arkansas (Ark)-type infectious bronchitis virus (IBV) subpopulations with an S gene sequence distinct from the vaccine predominant consensus were previously found in the upper respiratory tract of chickens within 3 days after inoculation. This finding indicated that a distinct virus subpopulation was rapidly positively selected by the chicken upper respiratory tract. We hypothesized that during host invasion, the replicating IBV population further changes as it confronts the distinct environments of different tissues, leading to selection of the most fit population. We inoculated 15-day-old chickens with 10(4) 50% embryo infective doses of an Ark-type IBV commercial vaccine via the ocular and nasal routes and characterized the sequences of the S1 gene of IBV contained in tear fluid, trachea, and reproductive tract of individual chickens at different times postinoculation. The predominant IBV phenotype contained in the vaccine (before inoculation) became a minor or nondetectable population at all times in all tissues after replication in the majority of the chickens, corroborating our previous findings. Five new predominant populations designated component (C) 1 through C5, showing distinct nonsynonymous changes, i.e., nucleotide changes resulting in different amino acids encoded and thus in a phenotypic change of the predominant virus population, were detected in the tissues or fluids of individual vaccinated chickens. Due to the different biochemical properties of some amino acids that changed in the S1 glycoprotein, we anticipate that phenotypic shift occurred during the invasion process. Significant differences were detected in the incidence of some distinct IBV predominant populations in tissues and fluids; e.g., phenotype C1 showed the highest incidence in the reproductive tract of the chickens, achieving a significant difference versus its incidence in the trachea (P < 0.05). These results indicate for the first time that IBV undergoes intraspatial variation during host invasion, i.e., the dominant genotype/phenotype further changes during host invasion as the microenvironment of distinct tissues exerts selective pressure on the replicating virus population.


Synthesis and antimicrobial evaluation of dirithromycin (AS-E 136; LY237216), a new macrolide antibiotic derived from erythromycin.
Dirithromycin is a 9-N-11-O-oxazine derivative which is formed by condensation of 9(S)-erythromycylamine with 2-(2-methoxyethoxy)acetaldehyde. Dirithromycin is hydrolyzed, either under acidic conditions or in vivo, to its major active metabolite, 9(S)-erythromycylamine. The antimicrobial spectrum of dirithromycin is similar to that of erythromycin; both antibiotics are active against gram-positive bacteria, Legionella spp., Helicobacter pylori, and Chlamydia trachomatis. Comparable results were obtained for each antibiotic in MIC and MBC determinations and in the potential development of resistance in vitro. The effects of human serum, bacterial growth media, test methodology, and inoculum size on MICs were similar for each antibiotic. In standard mouse protection studies, dirithromycin was more efficacious than erythromycin against experimental infections after subcutaneous administration of antibiotic. These results were consistent with pharmacokinetic studies in rodents, which showed that dirithromycin gave more persistent concentrations of antibiotic in serum and tissues than were achieved with erythromycin. These studies indicate that dirithromycin possesses antimicrobial activity comparable to that of erythromycin in vitro but is more active than erythromycin in vivo, which may be attributable to the persistence of antimicrobial activity in the tissue(s) of the test animals.


Improving the outcomes of children affected by parental substance abuse: a review of randomized controlled trials.
Substance abuse is a major public health concern that impacts not just the user but also the user's family. The effect that parental substance abuse has on children has been given substantial attention over the years. Findings from the literature suggest that children of substance-abusing parents have a high risk of developing physical and mental health and behavioral problems. A number of intervention programs have been developed for parents who have a substance abuse problem. There have also been a number of interventions that have been developed for children who have at least one parent with a substance abuse problem. However, it remains unclear how we can best mitigate the negative effects that parental substance abuse has on children due to the scarcity of evaluations that utilize rigorous methodologies such as experimental designs. The purpose of this study is to review randomized controlled trials of intervention programs targeting parents with substance abuse problems and/or children with at least one parent with a substance abuse problem in order to identify programs that show some promise in improving the behavioral and mental health outcomes of children affected by parental substance abuse. Four randomized controlled trials that met our eligibility criteria were identified using major literature search engines. The findings from this review suggest that interventions that focus on improving parenting practices and family functioning may be effective in reducing problems in children affected by parental substance abuse. However, further research utilizing rigorous methodologies are needed in order to identify other successful interventions that can improve the outcomes of these children long after the intervention has ended.


Alstrom syndrome gene is a stem-cell-specific regulator of centriole duplication in the Drosophila testis.
Asymmetrically dividing stem cells often show asymmetric behavior of the mother versus daughter centrosomes, whereby the self-renewing stem cell selectively inherits the mother or daughter centrosome. Although the asymmetric centrosome behavior is widely conserved, its biological significance remains largely unclear. Here, we show that Alms1a, a Drosophila homolog of the human ciliopathy gene Alstrom syndrome, is enriched on the mother centrosome in Drosophila male germline stem cells (GSCs). Depletion of alms1a in GSCs, but not in differentiating germ cells, results in rapid loss of centrosomes due to a failure in daughter centriole duplication, suggesting that Alms1a has a stem-cell-specific function in centrosome duplication. Alms1a interacts with Sak/Plk4, a critical regulator of centriole duplication, more strongly at the GSC mother centrosome, further supporting Alms1a's unique role in GSCs. Our results begin to reveal the unique regulation of stem cell centrosomes that may contribute to asymmetric stem cell divisions.


Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage.
The Boston criteria are the basis for a noninvasive diagnosis of cerebral amyloid angiopathy (CAA) in the setting of lobar intracerebral hemorrhage (ICH). We assessed the accuracy of these criteria in individuals with lobar microbleeds (MBs) without ICH. We identified individuals aged >55 years having brain magnetic resonance imaging (MRI) and pathological assessment of CAA in a single academic hospital and a community-based population (Framingham Heart Study [FHS]). We determined the positive predictive value (PPV) of the Boston criteria for CAA in both cohorts, using lobar MBs as the only hemorrhagic lesion to fulfill the criteria. We included 102 individuals: 55 from the hospital-based cohort and 47 from FHS (mean age at MRI 74.7 ± 8.5 and 83.4 ± 10.9 years; CAA prevalence 60% and 46.8%; cases with any lobar MB 49% and 21.3%; and cases with ≥2 strictly lobar MBs 29.1% and 8.5%, respectively). PPV of "probable CAA" (≥2 strictly lobar MBs) was 87.5% (95% confidence interval [CI], 60.4-97.8) and 25% (95% CI, 13.2-78) in hospital and general populations, respectively. Strictly lobar MBs strongly predict CAA in non-ICH individuals when found in a hospital context. However, their diagnostic accuracy in the general population appears limited.


Chemical and biological studies of Tc-99m N,N'-bis(mercaptoacetamido)-ethylenediamine: a potential replacement for I-131 iodohippurate.
The tetradentate chelating agent N,N'-bis(benzoylmercaptoacetamido)ethylenediamine was synthesized for evaluation as a potential technetium-99m renal-function radiopharmaceutical. Complexes were prepared using different reducing agents and analyzed by high-performance liquid chromatography. Biological studies were performed in mice, rats, and rabbits and indicated that the new agent is cleared by the kidneys significantly faster than Tc-99m DTPA (p less than 0.01) and slightly slower than I-131 o-iodohippuric acid (p greater than 0.05). There was no evidence of significant renal retention. Renal excretion in all species studied was 70--75% of the injected dose in 30 min; biliary excretion in rats was 7% in animals with normal renal function and 18% in 90 min in the absence of renal function. We conclude that limited clinical trials are warranted.


(Un)expected roles of c-IAPs in apoptotic and NFkappaB signaling pathways.
A family of anti-apoptotic regulators known as inhibitor of apoptosis (IAP) proteins block cell death in response to diverse stimuli. In spite of the fact that cellular IAP1 and 2 (c-IAP1 and 2) were discovered more than 12 years ago, their physiological roles have remained obscure. Several molecular mechanisms were proposed to explain their anti-apoptotic activity, ranging from direct inhibition and ubiquitination of pro-apoptotic molecules, to the activation of pro-survival signaling. New findings present a surprising and complex twists. On the one hand, cIAP1 and c-IAP2 suppress Tumor Necrosis Factor alpha (TNFalpha) stimulated cell death by preventing formation of the TNF Receptor 1 (TNFR1) pro-apoptotic signaling complex. On the other hand, they regulate pro-survival NFkappaB signaling pathways: in the non-canonical pathway, by ubiquitination of NFkappaB-inducing kinase (NIK), and in the canonical pathway, by a yet-to-be-defined mechanism. In addition, c-IAPs self-regulate their protein levels through RING domain mediated auto-ubiquitination. Here, we discuss the most recent progress in our understanding of the biological roles of c-IAPs, as well as the implications of targeting c-IAPs for therapeutic intervention.


Endogenous opioids released from perforant path modulate norepinephrine actions and inhibitory postsynaptic potentials in guinea pig CA3 pyramidal cells.
The stimulus parameters needed for the release of endogenous opioid peptides were investigated using an in vitro radioligand displacement assay in living guinea pig hippocampal slices. Electrical stimulation of the enkephalin-containing fibers in the perforant path caused the release of endogenous opioid peptides and the subsequent displacement of [3H]-[D-Ala2,N-methyl-Phe4,glyol5]enkephalin binding. High frequency trains of stimuli (10 Hz for 1 sec every 10 sec) were more effective than lower frequency stimulation (1 Hz continuous) at evoking opioid peptide release. Having identified an effective stimulation paradigm able to release endogenous opioids, the electrophysiological effects of endogenous opioids on CA3 pyramidal cells were measured in the guinea pig hippocampal slice preparation. Unlike exogenously applied opioids, stimulated release of endogenous opioid peptides from the perforant path did not significantly reduce inhibitory postsynaptic potential (IPSP) amplitudes recorded in CA3 pyramidal cells. However, perforant path stimulation in the presence of naloxone did cause a dramatic increase in IPSP amplitudes. CA3 pyramidal cells were not directly affected by perforant path stimulation. The naloxone-sensitive increase in IPSPs was delayed 3 min in onset and lasted for several minutes. In addition, the increase in the IPSPs was specifically blocked either by the beta adrenergic antagonist propranolol or by pretreating the animals with reserpine. These findings indicate that endogenous opioids regulate the effects of norepinephrine in the CA3 region of the guinea pig hippocampus. In addition, endogenously released norepinephrine appeared to act on GABAergic interneurons to increase the amplitude of the IPSP recorded in CA3 pyramidal cells.


Night driving (mesopic) visual acuity in sober male alcoholics with and without liver disease.
Night driving (mesopic) visual acuity and recovery after dazzle has been reported to be reduced in patients with liver disease. Mesopic visual acuity and dazzle recovery were evaluated in 32 patients with alcoholic cirrhosis, 29 alcoholics without liver disease, and 27 age-matched normal controls. All subjects were sober for at least 7 days prior to visual testing, a mean sobriety period of 22 and 39 weeks in alcoholics and cirrhotics, respectively. Serum vitamin A levels and/or dark adaptation were normal in all. Mean best decimal acuities were not significantly different among the groups: alcoholic cirrhotics, 0.32 +/- 0.02; alcoholics, 0.32 +/- 0.02; and normals 0.33 +/- 0.03 at 2 min. Although cirrhotics had significantly higher SGOT and lower albumin levels than alcoholics, mesopic acuity did not relate to liver blood tests. Decimal acuity following a dazzle stimulus was not significantly worse in cirrhotics and alcoholics compared to normals. Sober patients with alcoholic cirrhosis or a history of alcoholism have no evidence of a static mesopic visual defect and therefore may not have impaired night driving vision.


Adaptive ageing surgeons.
The surgical workforce is ageing. This will impact on future workforce supply and planning, as well as the professional performance and welfare of surgeons themselves. This paper is a 'call to arms' to surgeons to consider the complex problem of advancing years and surgical performance. We aim to promote discussion about the issue of ageing as it relates to surgeons, while exploring ways in which successful ageing in surgeons may be promoted. The task-specific aspects of surgical practice suggest that it is a physically and cognitively demanding task, reliant on a range of fine motor, sensory, visuospatial, reasoning, memory and processing skills. Many of these skills potentially decline with age, although there is great inter-individual variation, particularly in cognitive performance. Nevertheless, there is some consensus in the literature that age-related cognitive changes exist in a proportion of surgeons, and there is an increase in operative mortality rates for certain surgical procedures performed by older and more experienced surgeons. In the absence of mandatory retirement, guidance is needed in regard to individualizing the timing of retirement and encouraging reflective and adaptive practice based on insight into how one's skills and performance may change with age. This may be best facilitated by some form of informed and guided self-monitoring or 'self-screening'. It should be emphasized that self-screening is not a form of self-treatment but aims to enhance insight, using a tool kit of resources to promote adaptive ageing. Moreover, self-screening should not be restricted to cognition, which is only part of the picture of ageing, but extended to emphasize the maintenance of mental and physical wellness, and the acceptance of independent professional treatment and support when required.


The rational zero point for an illness index with ratio properties.
To be of greatest use for the measurement of significant variations in treatment outcomes, a health status index should have ratio properties. Previous attempts to construct such a scale using the magnitude estimation technique have failed, principally because of an inappropriate choice for the zero point. By rejecting death as the logical zero point for a scale of social preference and choosing instead the absence of that being measured (dysfunction and discomfort), the authors attained reliable values from patients, for an illness index, using magnitude estimation. This type of scale allows comparative judgments between treatment methods to be made with greater validity. It should aid in the wise allocation of health care resources.


[Chest pain in women in the emergency room: management and evolution].
To evaluate the diagnosis of chest pain in women receiving medical care in the emergency room in relation to follow-up, as well as describing its influence on the therapeutic management when compared to men. A current cohort study compared 67 patients of ages ranging from 50 to 65 years (35 women and 32 men) with chest pain, consecutively examined in the emergency room and followed up for 120 days. The outcomes assessed were: acute myocardial infarction, unstable angina, stable angina, cerebral ischemia, myocardial revascularization surgery, angioplasty, death and hospitalization. During diagnostic investigation of chest pain in the emergency room, no significant gender related difference was perceived. However, proportionally, women were given less cardiologic medication and more tranquilizers. Women were less likely to be referred for hospitalization than men (p=0.02). As for the occurrence of acute myocardial infarction, unstable angina, stable angina, cerebral ischemia, myocardial revascularization surgery, angioplasty and death, no differences between genders were noted during follow-up. Comparing the diagnostic accuracy of chest pain in the emergency room between women and men, there was no significant difference in relation to the number of tests. Nevertheless, women were less often referred for hospitalization and their therapeutic cardiologic management was less aggressive. The follow-up presented the same rate of outcome for both genders, therefore attention must be given to the chest pain symptom irrespective of gender.


Prevalence of Neospora caninum antibodies in sheep and goats in Pakistan.
The purpose of the present study was to obtain seroepidemiological information on the Neospora caninum infection status of sheep and goats in different areas of Punjab Province and Azad Kashmir (Pakistan). A cross-sectional study, with the use of a competitive ELISA, showed an overall 27.7% (35 of 128) (95% confidence interval [CI] ± 7.7%) and 8.6% (13 of 142) (95% CI ± 4.6%) seroprevalence of N. caninum antibodies in sheep and goats, respectively. The difference in seroprevalence between sheep and goat populations was statistically significant (P < 0.05). The highest prevalence (37.4% ± 13.2%) was recorded in the tailless breed of sheep.


European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2010 update.
Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the updated recommendations of a European panel of expert neonatologists who had developed consensus guidelines after critical examination of the most up-to-date evidence in 2007. These updated guidelines are based upon published evidence up to the end of 2009. Strong evidence exists for the role of a single course of antenatal steroids in RDS prevention, but the potential benefit and long-term safety of repeated courses are unclear. Many practices involved in preterm neonatal stabilisation at birth are not evidence-based, including oxygen administration and positive pressure lung inflation, and they may at times be harmful. Surfactant replacement therapy is crucial in the management of RDS, but the best preparation, optimal dose and timing of administration at different gestations is not always clear. Respiratory support in the form of mechanical ventilation may also be lifesaving, but can cause lung injury, and protocols should be directed at avoiding mechanical ventilation where possible by using nasal continuous positive airways pressure or nasal ventilation. For babies with RDS to have best outcomes, it is essential that they have optimal supportive care, including maintenance of a normal body temperature, proper fluid management, good nutritional support, management of the ductus arteriosus and support of the circulation to maintain adequate tissue perfusion.


Ultrastructural analysis of the X1X2X3O sex chromosome system during the spermatogenesis of Tegenaria domestica (Arachnida).
An ultrastructural study was performed on the sex chromosomes (male X1X2X3O) during the spermatogenesis of Tegenaria domestica (Arachnida, Agelenidae). This study was carried out using random and serially cut sections. During pachytene and diplotene the three X chromosomes are longitudinally paired. Each of these consists of a central core of condensed chromatin, surrounded by a field of dense chromatin projections through which the chromosomes are in contact with one another. These projections may be responsible for the recognition and pairing of the sex chromosomes and in some way participate in their non-disjunction during anaphase I. A study of the structure and behaviour of the sex chromosomes during spermatogenesis is also presented. The available information on non-synaptonemal complex-mediated chromosome pairing and a systematization of sex chromosome structure in spiders are discussed.


Impact of fluvoxamine on outpatient treatment of COVID-19 in Honduras in a prospective observational real-world study.
Background: The COVID-19 pandemic has impacted millions of lives globally. While COVID-19 did not discriminate against developed or developing nations, it has been a significant challenge for third world countries like Honduras to have widespread availability of advanced therapies. The concept of early treatment was almost unheard of when early outpatient treatments utilizing repurposed drugs in Latin American countries began showing promising results. One such drug is fluvoxamine, which has shown tremendous potential in two major studies. As a direct result, fluvoxamine was added to the standard of care in a major medical center outpatient COVID-19 clinic. Methods: This is a prospective observational study performed at the Hospital Centro Médico Sampedrano (CEMESA) in San Pedro Sula, Cortes, Honduras in the COVID-19 outpatient clinic. All patients were at least 15 years of age who had presented with mild or moderate signs and symptoms of COVID-19, and who also had a documented positive SARS-CoV-2 antigen or Reverse Transcription Polymerase Chain Reaction (RT-PCR) were included in the study. These patients then were all prescribed fluvoxamine. The cohort of patients who decided to take fluvoxamine were compared for primary endpoints of mortality and hospitalization risk to the cohort who did not take fluvoxamine. Patients were then monitored for 30 days with the first follow up at 7 days and the second follow up at 10-14 days of symptom onset. Categorical variables were compared by Pearson Chi-square test. The Relative risk was calculated using regression models. Continuous variables were compared by t-test and Wilcoxon rank-sum tests. Results: Out of total 657 COVID-19 cases, 594 patients took fluvoxamine and 63 did not take fluvoxamine. A total of five patients (0.76 percent) died, with only one death occurring in the fluvoxamine group. Patients who received fluvoxamine had a significantly lower relative risk of mortality (RR 0.06, p 0.011, 95% CI 0.007-0.516). There was a lower relative risk of hospitalization in the patients who in the fluvoxamine group. (-10 vs. 30 hospitalizations, RR 0.49, p = 0.035, 95% CI 0.26-0.95). There was 73 percent reduction in relative risk of requiring oxygen in the fluvoxamine group (RR 0.27, p < 0.001, 95% CI 0.14-0.54 Mean lymphocytes count on the first follow-up visit was significantly higher in the fluvoxamine group (1.72 vs. 1.38, Δ 0.33, p 0.007, CI 0.09-0.58). Conclusion: The results of our study suggest that fluvoxamine lowers the relative risk of death, hospitalization, and oxygen requirement in COVID 19 patients.


[L.A. Khodorkov--famous organizer of military healthcare (on the occasion of 110th anniversary of birth)].
The article is devoted to the life journey and professional activity of Lipa Avrumovich Khodorkov, one of the most famous organizer of native military medicine. Great attention is paid to his work in office as a chief of medical-evacuation headquarter of the Main army medical department of the Red Forces during the Great Patriotic War 1941-1945. Stages of service of L.A. Khodorkov in offices as a deputy chief of the Main army medical department, hief medical officer of Baltic military district, chief of Department of training of physicians (for Missile Forces and Army) of Military-medical Academy n. a. S.M. Kirov and his actiity as a instructor of faculty of organization and tacticts of medical service of the academy.


Impaired carotid viscoelastic properties in women with polycystic ovaries.
The purpose of this study was to assess the elastic properties of the carotid arteries in women with polycystic ovarian syndrome, asymptomatic women with polycystic ovaries, and healthy controls. We recruited the following 60 subjects: 20 symptomatic women with polycystic ovaries attending the reproductive endocrinology clinics, 20 asymptomatic women with polycystic ovaries attending the family planning clinic, and 20 staff volunteers as healthy controls with normal ovaries on transvaginal scan. Compliance and stiffness index were assessed in the common and internal carotid arteries using duplex ultrasound equipped with an echo-locked arterial wall-tracking system. Compliance was significantly lower in the common carotid artery in symptomatic and asymptomatic women with polycystic ovaries than in the controls (10.7, 14.1, and 19.2 %mm Hg(-1)x10(-2), respectively). The arterial stiffness index was correspondingly increased (12.3, 10.2, and 6.7, respectively). Similar results were obtained in the internal carotid artery for compliance (10.1, 11.0, and 16.9 %mm Hg(-1)x10(-2), respectively) and stiffness index (14.8, 16.2, and 8.7, respectively). The results of this study provide additional evidence of vascular dysfunction in women with polycystic ovaries and are compatible with the hypothesis that they are at increased risk from coronary artery disease and stroke.


Management of Primary Care: a challenge for international cooperation in health.
The need to resolve immediate problems in basic healthcare systems and the decisions that must be made in the daily management of healthcare centers must reach beyond awareness of common sense, and be reinforced by the evidence sought in scientific knowledge that will provide a new look at the facts and phenomena that happen on a daily basis. This article examines an experience of triangular cooperation in health between Angola, Brazil and Japan, which took place in Luanda, Angola between 2011 and 2014. The "Project to Strengthen the Healthcare Through the Development of Human Resources at the Josina Hospital and in other Healthcare Services, and to Revitalize Primary Healthcare in Angola (ProForsa)", with the involvement of Fiocruz as the party executing the primary healthcare component. This is an innovative role in technical cooperation as a tool of political action. A training program with multiple possibilities enabled technical-political partnerships in an approach for "structuring cooperation in health". The article analyzes how interventions in international cooperation in health management may create scientific evidence that, together with the local political context, can transform organizational elements such as healthcare centers, their clinical management and physical infrastructure.


Gene flow in a national cross-breeding beef population.
Future progress in genetic improvement and the monitoring of genetic resources in beef cattle requires a detailed understanding of the population under selection. This study examines the gene flow in the UK beef population with an uncommon breeding structure involving interaction between the beef and dairy populations. British Cattle Movement Service records were used as the primary source of information, and these data were triangulated with UK government statistics, other industry information sources and existing literature to build up a profile of the UK beef industry. Estimates were made of the breed composition of suckler cows, breeding bulls and the prime slaughter population. Cross-bred animals made up 85% and 94%, respectively, of the commercial beef breeding cow and prime slaughter populations. Holstein/Friesian (through cross-breeding) made up the largest proportion of genes in both these populations with 33% and 28%, respectively. The next five most popular breeds were specialist beef breeds: Limousin (22% and 18%), Charolais (11% and 6%), Simmental (9% and 11%), Angus (7% and 8%) and Belgian Blue (6% and 6%). Combined, the top seven beef breeds accounted for 94% of beef genetics in the prime slaughter population, and 80% of this came from non-native breeds. The influence of dairy breeds in the commercial beef breeding population was highlighted by the fact that 44% of replacement commercial beef breeding females were sourced from beef-sired crosses in the dairy herd, and in total 74% of all maternal grand dams of prime slaughter animals were Holstein/Friesian. The use of selection index technology was also investigated by analysing breeding bull sale results, with the correlation between the terminal sire index and sale price of young breeding bulls being generally moderate but significant, ranging from 0.21 to 0.38 across the major beef breeds. The most influential source of genetics in the commercial suckler beef herd was natural service breeding bulls. These were mostly sourced from pedigree breeders, and accounted for 47.8% of the genetics in the prime beef population. Artificial insemination sires were responsible for 16.6% of prime beef genetics, with the remaining 35.6% coming from dairy breeds, 95% of which was Holstein/Friesian.


Glomerular and medullary architecture in the kidney of Anna's Hummingbird.
Hummingbirds have rates of water turnover that are among the highest of any bird, consuming up to five times their body mass in nectar each day. To determine if the processing of these extraordinary volumes of water is associated with structural specializations in the kidney, we examined the renal morphology of Anna's hummingbird (Calypte anna) using scanning electron microscopy of vascular and tubular casts. The glomerular tufts are simple, containing a single, unbranched capillary that is spiraled or folded back on itself only one or two times. There is no evidence that nectarivory in this species is associated with a relative increase in the size of the glomeruli. The medullary cones are small, containing only a few loops of Henle and collecting ducts. The vasa recta form a complex network of branching and anastomosing capillaries. In this nectarivore, the structures necessary to produce urine that is hyperosmotic to plasma are poorly developed or absent, which is consistent with urine osmolalities that are uniformly low. J. Morphol. 240:95-100, 1999. © 1999 Wiley-Liss, Inc.


Chronic arthritis associated with the presence of intrasynovial rubella virus.
In this report we present 21 instances in which live rubella virus was isolated from synovial fluid obtained from 6 cases of inflammatory oligoarthritis or polyarthritis over a period of 2 years in the absence of firm clinical evidence of rubella. In 3 cases (cases 1, 2, 6,) a persistent oligoarthritis predominantly affecting the knee joints occurred in 2 adult women and one man, lasting to date 27, 29, and 18 months respectively, and in one of these cases virions were found in cells of the synovial membrane. In case 3 a boy of 9 presented with an illness indistinguishable from the systemic variety of juvenile chronic arthritis (Still's disease). In case 4 a young man with persistent monoarthritis was found to have ankylosing spondylitis, and in case 5 a progressive erosive polyarthritis developed 5 years after an attack of rubella complicated by rubella arthritis. The virus was identified by a variety of virological techniques and infection confirmed by immunofluorescence and (in one case) electron microscopy.


Evaluation of the potential of fungal and plant laccases for active-packaging applications.
Laccases from Trametes versicolor (TvL), Myceliophthora thermophila (MtL), and Rhus vernicifera (RvL) were investigated with regard to their potential utilization as oxygen scavengers in active packages containing food susceptible to oxidation reactions. The substrate selectivity of the laccases was investigated with a set of 17 reducing substrates, mainly phenolic compounds. The temperature dependence of reactions performed at low temperatures (4-31 °C) was studied. Furthermore, the laccases were subjected to immobilization in a latex/clay matrix and drying procedures performed at temperatures up to 105 °C. The results show that it is possible to immobilize the laccases with retained activity after dispersion coating, drying at 75-105 °C, and subsequent storage of the enzyme-containing films at 4 °C. TvL and, to some extent, MtL were promiscuous with regard to their reducing substrate, in the sense that the difference in activity with the 17 substrates tested was relatively small. RvL, on the other hand, showed high selectivity, primarily toward substrates resembling its natural substrate urushiol. When tested at 7 °C, all three laccases retained >20% of the activity they had at 25 °C, which suggests that it would be possible to utilize the laccases also in refrigerated food packages. Coating and drying resulted in a remaining enzymatic activity ranging from 18 to 53%, depending on the drying conditions used. The results indicate that laccases are useful for active-packaging applications and that the selectivity for reducing substrates is an important characteristic of laccases from different sources.


Phospholamban ablation rescues sarcoplasmic reticulum Ca(2+) handling but exacerbates cardiac dysfunction in CaMKIIdelta(C) transgenic mice.
We previously showed that transgenic mice expressing Ca(2+)/calmodulin-dependent protein kinase II delta(C) (CaMKII-TG) develop dilated cardiomyopathy associated with increased ryanodine receptors (RyR2) phosphorylation, enhanced sarcoplasmic reticulum (SR) Ca(2+) leak and lowering of SR Ca(2+) load. We hypothesized that phospholamban (PLN) ablation would restore SR Ca(2+) load and prevent the decreased ventricular contractility, dilation and mortality seen in CaMKII-TG. Our objectives were to generate CaMKII-TG mice lacking PLN, determine whether the maladaptive effects of cardiac CaMKIIdelta(C) expression were corrected, and establish the mechanistic basis for these changes. CaMKII-TG were crossed with PLN knockout (PLN-KO) mice to generate KO/TG mice. Myocytes from wild type (WT), CaMKII-TG, PLN-KO and KO/TG were compared. The decreased SR Ca(2+) load and twitch Ca(2+) transients seen in CaMKII-TG were normalized in KO/TG. Surprisingly the heart failure phenotype was exacerbated, as indicated by increased left ventricular dilation, decreased ventricular function, increased apoptosis and greater mortality. In KO/TG myocytes SR Ca(2+) sparks and leak were significantly increased, presumably because of the combined effects of restored SR Ca(2+) load and RyR2 phosphorylation. Mitochondrial Ca(2+) loading was increased in cardiomyocytes from KO/TG versus WT or CaMKII-TG mice and this was dependent on elevated SR Ca(2+) sparks. Cardiomyocytes from KO/TG showed poor viability, improved by inhibiting SR Ca(2+) release and mitochondrial Ca(2+) loading. Normalizing cardiomyocyte SR Ca(2+) loading in the face of elevated CaMKII and RyR2 phosphorylation leads to enhanced SR Ca(2+) leak and mitochondrial Ca(2+) elevation, associated with exacerbated cell death, heart failure and mortality.


Inadequate physician knowledge of the effects of diet on blood lipids and lipoproteins.
To assess the nutrition knowledge of physicians on the basic effects of diet on blood lipids and lipoproteins. Anonymous mailed dietary knowledge surveys to 6000 randomly selected physicians in the United States licensed in either Internal Medicine or Cardiology. Response rate: 16% (n = 639). Half of the physicians did not know that canola oil and 26% did not know olive oil were good sources of monounsaturated fat. Ninety-three percent (84% of cardiologists vs. 96% of internists; p < 0.001) did not know that a low-fat diet, in general, would increase blood triglycerides. Approximately three-quarters (70% of cardiologists vs. 77% of internists; p < 0.01) did not know a low-fat diet would decrease HDL-c and almost half (45%) thought that a low-fat diet would not change HDL-c. If physicians are to implement dietary and cholesterol management guidelines, they will likely need to become more knowledgeable about nutrition.


Effect of short-chain carbohydrates on human intestinal bifidobacteria and Escherichia coli in vitro.
Plate counts and small subunit (SSU) rRNA abundance were used to study the effects of fructo-oligosaccharides (FOS), fructose, or galacto-oligosaccharides (GOS) on bifidobacterial populations in human faecal microbiotas. The bacteria were grown in pH-controlled anaerobic fermentation vessels. Untreated cultures and fructose-amended fermenters were used as controls. Bifidobacterium longum, B. adolescentis and B. angulatum comprised the dominant bifidobacterial populations throughout the experiment. No major differences were found in the four treatments, in terms of viable counts of the organisms or of total populations of bifidobacteria at any time point. However, large differences were observed with respect to the abundance of bifidobacterial SSU rRNA between the treatments. Greatest bifidobacterial SSU rRNA abundance was seen in FOS cultures, with the lowest in the untreated control fermentation. GOS and fructose also increased bifidobacterial SSU rRNA. Cultures supplemented with FOS and GOS were also associated with lower colony counts and SSU rRNA abundance for Escherichia coli, compared with fructose-supplemented and control fermenters. At the 24-h time point, the untreated control contained 19.8 microg of enterobacterial SSU rRNA/ml of culture fluid, compared with 11.4 microg/ml for the fructose fermentation, and 2.6 and 0.5 microg/ml for the FOS and GOS culture vessels, respectively.


White, brown, beige/brite: different adipose cells for different functions?
Brown adipose tissue (BAT) is a major site of nonshivering thermogenesis in mammals. Rodent studies indicated that BAT thermogenic activity may protect against obesity. Recent findings using novel radiodiagnosis procedures revealed unanticipated high activity of BAT in adult humans. Moreover, complex processes of cell differentiation leading to the appearance of active brown adipocytes have been recently identified. The brown adipocytes clustered in defined anatomical BAT depots of rodents arise from mesenchymal precursor cells common to the myogenic cell lineage. They are being called "classical" or "developmentally programmed" brown adipocytes. However, brown adipocytes may appear after thermogenic stimuli at anatomical sites corresponding to white adipose tissue (WAT). This process is called the "browning" of WAT. The brown adipocytes appearing in WAT derive from precursor cells different from those in classical BAT and are closer to the white adipocyte cell lineage. The brown adipocytes appearing in WAT are often called "inducible, beige, or brite." The appearance of these inducible brown adipocytes in WAT may also involve transdifferentiation processes of white-to-brown adipose cells. There is no evidence that the ultimate thermogenic function of the beige/brite adipocytes differs from that of classical brown adipocytes, although some genetic data in rodents suggest a relevant role of the browning process in protection against obesity. Although the activation of classical BAT and the browning process share common mechanisms of induction (eg, noradrenergic-mediated induction by cold), multiple novel adrenergic-independent endocrine factors that activate BAT and the browning of WAT have been identified recently. In adult humans, BAT is mainly composed of beige/brite adipocytes, although recent data indicate the persistence of classical BAT at some anatomical sites. Understanding the biological processes controlling brown adipocyte activity and differentiation could help the design of BAT-focused strategies to increase energy expenditure and fight against obesity.


Association of anti-inflammatory and antiangiogenic therapies negatively influences prostate cancer progression in TRAMP mice.
Chronic inflammation has been implicated in cancer etiology and angiogenesis is stimulated in this disease. In prostate, the crosstalk between malignant epithelial cells and their microenvironment is an essential step of tumorigenesis during which glandular stroma undergo changes designated as reactive stroma. Thus, the aim herewith was to evaluate the effects of associating anti-inflammatory and antiangiogenic therapies on cancer progression, correlating them with steroid hormone receptor (AR and ERα), reactive stroma (vimentin, αSMA, and TGF-β), and cell proliferation (PCNA) markers expression in the Transgenic Adenocarcinoma of Mouse Prostate (TRAMP) model. TRAMP mice (12-week old) were divided into the groups: Control (TRCON): received the vehicles used for drug dilution; Celecoxib (TRCEL): received oral doses of the anti-inflammatory drug celecoxib (15 mg/kg) twice daily; Nintedanib (TRNTB): received oral doses of the antiangiogenic drug nintedanib (10 mg/kg) daily; Nintedanib+Celecoxib (TRNTCEL): received the combination of drugs. After 6 weeks, mice were euthanized and ventral prostate samples were harvested for morphological, immunohistochemical, and Western blotting analyses. While celecoxib led to fibromuscular hypertrophy attenuation, nintedanib significantly reduced the incidence of well-differentiated adenocarcinoma (WDAC) foci in relation to controls, both when administered per se or in association to celecoxib. Furthermore, drug combination was associated with unique effects, including lower incidence of HGPIN lesions; lower AR stromal distribution; changes in ERα localization from epithelial nuclei to stroma as well as significant decrease of TGF-β levels and associated angiogenesis. In parallel, all treatments applied resulted in reduced inflammatory marker and vimentin (VIM) expression. Celecoxib plus nintedanib is an effective antitumor combination against prostate cancer progression in TRAMP mice, showing remarkable efficacy in relation to isolated therapies. Importantly, this efficacy might be due to drug association effect on driving AR and mainly ERα distribution in the prostatic tissue towards benign patterns. In addition, celecoxib and nintedanib impaired the development of a stromal reaction by reducing the recruitment of reactive stroma cells and maintaining a normal smooth muscle cell-rich prostate stroma in TRAMP mice. Collectively, these findings pointed to the beneficial effects of combining anti-inflammatory and antiangiogenic strategies to prevent or delay prostatic tumorigenesis.


Palliative surgery for gastric carcinoma.
This paper presents practical points concerning palliative surgery for carcinoma of the stomach. The results which may be obtained are evaluated.


Multimodality Strategy for Cardiovascular Risk Assessment: Performance in 2 Population-Based Cohorts.
Current strategies for cardiovascular disease (CVD) risk assessment among adults without known CVD are limited by suboptimal performance and a narrow focus on only atherosclerotic CVD (ASCVD). We hypothesized that a strategy combining promising biomarkers across multiple different testing modalities would improve global and atherosclerotic CVD risk assessment among individuals without known CVD. We included participants from MESA (Multi-Ethnic Study of Atherosclerosis) (n=6621) and the Dallas Heart Study (n=2202) who were free from CVD and underwent measurement of left ventricular hypertrophy by ECG, coronary artery calcium, N-terminal pro B-type natriuretic peptide, high-sensitivity cardiac troponin T, and high-sensitivity C-reactive protein. Associations of test results with the global composite CVD outcome (CVD death, myocardial infarction, stroke, coronary or peripheral revascularization, incident heart failure, or atrial fibrillation) and ASCVD (fatal or nonfatal myocardial infarction or stroke) were assessed over >10 years of follow-up. Multivariable analyses for the primary global CVD end point adjusted for traditional risk factors plus statin use and creatinine (base model). Each test result was independently associated with global composite CVD events in MESA after adjustment for the components of the base model and the other test results (P<0.05 for each). When the 5 tests were added to the base model, the c-statistic improved from 0.74 to 0.79 (P=0.001), significant integrated discrimination improvement (0.07, 95% confidence interval [CI] 0.06-0.08, P<0.001) and category free net reclassification improvement (0.47; 95% CI, 0.38-0.56; P=0.003) were observed, and the model was well calibrated (χ2=12.2, P=0.20). Using a simple integer score counting the number of abnormal tests, compared with those with a score of 0, global CVD risk was increased among participants with a score of 1 (adjusted hazard ratio, 1.9; 95% CI, 1.4-2.6), 2 (hazard ratio, 3.2; 95% CI, 2.3-4.4), 3 (hazard ratio, 4.7; 95% CI, 3.4-6.5), and ≥4 (hazard ratio, 7.5; 95% CI, 5.2-10.6). Findings replicated in the Dallas Health Study were similar for the ASCVD outcome. Among adults without known CVD, a novel multimodality testing strategy using left ventricular hypertrophy by ECG, coronary artery calcium, N-terminal pro B-type natriuretic peptide, high-sensitivity cardiac troponin T, and high-sensitivity C-reactive protein significantly improved global CVD and ASCVD risk assessment.


Characterization of the mouse homolog of the XPBC/ERCC-3 gene implicated in xeroderma pigmentosum and Cockayne's syndrome.
The human XPBC/ERCC-3 DNA repair gene specifically corrects the repair defect of xeroderma pigmentosum (XP) complementation group B and rodent repair mutant cell lines of group 3. The gene encodes a presumed DNA- and chromatin-binding helicase involved in early steps of the excision repair pathway. To study the evolution of this gene, its expression in different tissues and stages of development and to permit the generation of a mouse model of XP by targeted gene replacement in mouse embryonal stem cells, we have isolated the mouse XPBC/ERCC-3 homolog. Sequence comparison of the predicted protein revealed a 96% amino acid identity with the human gene product. Notably, all postulated functional domains were strictly conserved. The mouse XPBC/ERCC-3 promoter is--like its human counterpart--devoid of classical promoter elements such as TATA and CAAT boxes and contains several conserved segments with unknown function. One of these conserved regions, consisting in part of a polypyrimidine track, is also present in the ERCC-1 promoter. The mouse XPBC/ERCC-3 gene is expressed constitutively at low levels in all tissues examined except for testis, where its expression is significantly enhanced.


Health Risks and Outcomes of Homelessness in School-Age Children and Youth: A Scoping Review of the Literature.
Despite reports that over 1.3 million school-age children (ages 5-18) were homeless in 2019, little is known about the effects of homelessness on their overall health and well-being. To better understand where gaps exist, a scoping review of the literature was conducted to identify studies of the physical, mental, and behavioral health risks and outcomes of school-age children experiencing homelessness or housing instability. Following the Joanna Briggs Institute framework and Preferred Reporting Items (PRISMA) guidelines, seven electronic databases were searched using key words: homelessness, children, health, and well-being. Of the 4,372 records, 23 articles met inclusion criteria. Most examined mental health and high-risk activities or behavioral risks related to school achievement. Few studies tracked the long-term health outcomes of homeless school-age children. Findings have implications for school nurses who have contact with children experiencing homelessness and are in position to intervene to prevent negative health sequelae in this vulnerable population.


Opioid innervation of the caudal ventrolateral medulla is not critical for the expression of the aortic depressor nerve response in the rabbit.
We investigated the influence of endogenous opioids in the caudal ventrolateral medulla (CVLM) on the expression of the baroreflex response induced by the electrical stimulation (50 Hz, 0.2 ms, 11 V, 10 s) of the aortic depressor nerve. We used microinjection of selective opioid antagonists into the functionally identified depressor area of the CVLM in chloralose-anesthetized rabbits. Injection of vehicles or the mu-antagonist beta-funaltrexamine (0.3 nmol) into the CVLM had no effects, while naloxone (20 nmol), ICI 174,864 (delta-antagonist, 0.3 nmol) or nor-binaltorphimine (kappa-antagonist, 1 nmol) abolished the depressor response, but themselves all elicited a tonic depressor effect as well. In contrast, intravenous naloxone (5 mg/kg) induced a small but significant increase in arterial pressure and did not alter the depressor response. Hypotensive hemorrhage induced a decrease in arterial pressure similar to that seen with local injection of naloxone into the CVLM, but did not change the reflex, suggesting that the reflex abolition was not due to the decrease in basal arterial pressure per se. CVLM injection of glutamate (10 nmol) or the GABA-antagonist bicuculline (0.1 nmol), non-opioid agents which activate CVLM and induce a tonic depressor effect, also abolished the depressor response suggesting that the reflex abolition was secondary to general activation or disinhibition of the CVLM. Thus, although the CVLM is tonically inhibited by endogenous opioid inputs acting via delta- and kappa-receptors, our data provide no evidence that opioid neurons which provide input to this region constitute a specific and integral component in mediating the aortic depressor response. However, the more general role that opioids play in tonically influencing the resting level of activity in the CVLM, is nevertheless very important in enabling the normal expression of this baroreflex.


Cognitive Assessment of OCD Patients: NeuroVR vs Neuropsychological Test.
This study aimed to evaluate the reliability and validity of the Neuro-Virtual Reality as tool for the neuropsychological assessment in OCD patients. We used the neuropsychological battery and a virtual version of the Multiple Errand Test (V-MET), developed using the NeuroVR software, in order to evaluate the executive functions, the ability to plan ahead on complex problem solving tasks in daily life in 30 obsessive compulsive disorder (OCD) patients and 30 healthy controls. The results showed the presence of difficulties of OCD patients: lower levels of divided attention and higher levels of errors; higher mean rank of inefficiencies, interpretation failures and rule breaks and longer time of execution of the whole task. By contrast, controls have higher level of efficiency and better performance. In addition, a significant correlation was found between the V-MET and the neuropsychological battery which confirms and supports the ecological validity of neurocognitive assessment through NeuroVirtual Reality.


New technologies for organ replacement and augmentation.
The most common causes of disability and death are diseases of the heart, lungs, liver, kidneys, and pancreas, many of which are potentially treated by organ transplantation. The effect of organ dysfunction and failure will likely grow over time, and patients will increasingly expect "safer" transplants, in particular in cases of "preemptive transplantation." New technologies are being developed in part because of the limited availability of organs, and include transplantation with stem cells, tissue engineering, cloning, and xenotransplantation, which some researchers believe promise ready solutions. Although exciting, none of these approaches alone is likely to address the need for organ replacement. We propose that a melding of these new technologies adapted to the distinct challenges and imperatives of the various organs may address this daunting challenge.