Patterns in Complex Aortic Vascular Surgery Training and Early Career Practice.
Recent literature has suggested a decreasing experience with open aortic surgery among recent vascular surgery graduates. While trainees have a wide exposure to endovascular aortic repair, experience with both endovascular and open management of thoracoabdominal aneurysms, as well as the early career surgeon comfort with these procedures, remains unknown. Thus, we sought to evaluate early practice patterns in the surgical treatment of complex aortic surgery among recent US vascular surgery graduates. An anonymous survey was distributed among all vascular surgeons who completed vascular surgery residency or fellowship in 2020. Self-reported data assessed the number and type of cases performed in training, surgeon experience in early practice, and surgeon desire for additional training in these areas. A total of 62 surgeons completed the survey with a response rate of 35%. Seventy-nine percent of respondents completed fellowship training (as compared to integrated residency), and 87% self-described as training in an academic environment. Sixty-six percent performed less than 5 open thoracoabdominal aortic surgeries and 58% performed less than 5 4-vessel branched/fenestrated aortic repairs (F/BEVARs), including 56% who completed less than 5 physician modified endovascular grafts repairs. Only 11% of respondents felt adequately prepared to perform open thoracoabdominal operations following training. For both open and F/BEVAR procedures, more than 80% respondents plan to perform such procedures with a partner in their current practice, and the majority desired additional open (61%) and endovascular (59%) training for the treatment of thoracoabdominal aneurysms. The reported infrequency in open thoracoabdominal and multivessel F/BEVAR training highlights a desire and utility for an advanced aortic training paradigm for surgeons wishing to focus on this area of vascular surgery. Further research is warranted to determine the optimal way to provide such training, whether through advanced fellowships, junior faculty apprenticeship models, or regionalization of this highly complex patient care. The creation of these programs may provide pivotal opportunity, as vascular surgery and the management of complex aortic pathology continues to evolve.


[Viagra--the first oral treatment for impotence that is not lacking in fatal effects].
Impotence, a common problem especially among older men, can now be treated with Viagra, This oral pill, unlike previous approved treatments mostly involving local injections, does not directly cause penile erection, but increases response to sexual stimulation. It acts by enhancing the relaxant effects of nitric acid on smooth muscle, and thus increases blood flow to certain areas of the penis, leading to erection. It has been evaluated in many randomized trials and in all was more successful in inducing erection than placebos. The most common side-effects include headache, flushing and indigestion, but there have also been reports of fatalities. We describe a 75-year-old man who had an acute myocardial infraction in the past and who had maturity-onset diabetes and hypertension. In the week prior to admission he had a cardiac scan following a few weeks of exacerbation of anginal pain for which he had been taking nitrites. He took a Viagra pill without prescription or medical advice and 2 hours later, during intercourse with his wife, developed audible respiratory distress and lost consciousness. His wife started cardiac massage but not mouth-to-mouth breathing. The emergency team found ventricular fibrillation and gave 5 electrical shocks and amines and atropine. He remained unconscious, but his pulse returned and he was hospitalized. He then had several generalized convulsions treated with i.v. valium. 20 minutes after admission there was asystole and all attempts at resuscitation failed. Cardiovascular status must be considered prior to prescribing Viagra, and the associated risk evaluated.


lon incompatibility associated with mutations causing SOS induction: null uvrD alleles induce an SOS response in Escherichia coli.
The uvrD gene in Escherichia coli encodes a 720-amino-acid 3'-5' DNA helicase which, although nonessential for viability, is required for methyl-directed mismatch repair and nucleotide excision repair and furthermore is believed to participate in recombination and DNA replication. We have shown in this study that null mutations in uvrD are incompatible with lon, the incompatibility being a consequence of the chronic induction of SOS in uvrD strains and the resultant accumulation of the cell septation inhibitor SulA (which is a normal target for degradation by Lon protease). uvrD-lon incompatibility was suppressed by sulA, lexA3(Ind(-)), or recA (Def) mutations. Other mutations, such as priA, dam, polA, and dnaQ (mutD) mutations, which lead to persistent SOS induction, were also lon incompatible. SOS induction was not observed in uvrC and mutH (or mutS) mutants defective, respectively, in excision repair and mismatch repair. Nor was uvrD-mediated SOS induction abolished by mutations in genes that affect mismatch repair (mutH), excision repair (uvrC), or recombination (recB and recF). These data suggest that SOS induction in uvrD mutants is not a consequence of defects in these three pathways. We propose that the UvrD helicase participates in DNA replication to unwind secondary structures on the lagging strand immediately behind the progressing replication fork, and that it is the absence of this function which contributes to SOS induction in uvrD strains.


In vivo regulation of amyloid precursor protein secretion in rat neocortex by cholinergic activity.
The proteolytic cleavage of the amyloid precursor protein (APP) has been shown to be modulated through specific muscarinic receptor activation in vitro in both transfected cell lines and native brain slices, whereas a demonstration of receptor-mediated control of APP processing under in vivo conditions is still lacking. To simulate alterations in muscarinic receptor stimulation in vivo, we have (i) specifically reduced the cortical cholinergic innervation in rats using partial immunolesions with 192IgG-saporin, and (ii) restored cholinergic function in lesioned rats by transplantation of nerve growth factor producing fibroblasts. While total APP levels in cortical homogenates were unaffected by cholinergic deafferentation, we observed a significant reduction in the abundance of secreted APP and a concomitant increase in membrane-bound APP. These changes were reversed in immunolesioned rats with nerve growth factor-producing fibroblasts. There was a strong positive correlation between the ratio of secreted APP to membrane-bound APP and the activity of choline acetyltransferase and M1 muscarinic acetylcholine receptor density (measured by [3H]pirenzepine binding) in experimental groups. Additionally, we observed a transient decrease in the ratio of cortical APP transcripts containing the Kunitz protease inhibitor domain (APP 770 and APP 751) versus APP 695 in rats with cholinergic hypoactivity. The data presented suggest that cortical APP processing is under basal forebrain cholinergic control, presumably mediated through M1 muscarinic acetylcholine receptors on cholinoceptive cortical target cells.


Bilateral electrodermal habituation-dishabituation and resting EEG in remitted schizophrenics.
This study examined bilateral electrodermal responding, heart rate, and resting EEG in schizophrenics who were not psychotic at the time of testing. Twenty-four carefully diagnosed, remitted schizophrenics were compared to 22 medical outpatient controls. Subjects were exposed to 17 pure tones; the 16th tone differed in frequency and duration from the others. Prior to the tone series, subjects engaged in 2 minutes of respiratory maneuvers followed by a 5-minute rest period during which EEG was recorded. Consistent with past reports examining chronic, hospitalized patients, the schizophrenics divided evenly into responding and nonresponding groups and skin conductance responding was associated with a higher rate of spontaneous activity, elevated tonic conductance levels, and more responding during the respiratory exercises. When those responding in the control and schizophrenic groups were compared for number and amplitude of tone-elicited responses, no group differences emerged. There were no differences in dishabituation between these two groups. A variety of analyses failed to reveal any evidence of electrodermal or cerebral asymmetry. There were no differences between the two schizophrenic groups in measures of heart rate or resting EEG. However, consistent with other reports using hospitalized patients, the schizophrenics as a group produced less EEG alpha and more delta than the normal subjects. These results are consistent with the hypothesis that the electrodermal and EEG phenomena identified in psychotic, hospitalized patients represent stable traits characteristic of schizophrenia.


Antiandrogen abiraterone and docetaxel treatments affect Notch1, Jagged1 and Hes1 expressions in metastatic prostate cancer cells.
Prostate cancer is the most common cancer in men. A Notch signaling pathway is an important pathway in cell proliferation, differentiation, and fate. However, currently, the effects of abiraterone based-anti-androgene therapy and docetaxel, the most commonly used standard chemotherapy in prostate cancer treatment, on Notch signaling pathway are unknown. This study aimed to investigate the effects of abiraterone acetate and docetaxel on the expression of Notch1, Jagged1 and Hes1 in prostate cancer cell lines. In vitro effects of abiraterone acetate and docetaxel were examined on Notch1, Jagged1, and Hes1 expression in LNCaP and PC3 PCa cell lines by immunofluorescence, Western blot, and qRT-PCR. MTT proliferation assay was used to evaluate cell proliferation and survival. We found that in the treatment of PC3 cells with abiraterone acetate, docetaxel, and their combination, only mRNA expressions of Notch1, Jagged1 and Hes1 were affected compared to control, but these expression differences were not observed in protein expression. In LNCaP cells, abiraterone acetate and the combination groups reduced Notch1 protein expression. All treatment groups did not alter Jagged1 expression compared to control, but significantly increased the Hes1 gene and protein expression. Our findings suggest that abiraterone and docetaxel treatments affects the expression of Notch signal pathway proteins. But these drugs especially cause significant upregulation in Hes1 expression in PCa cells. Therefore, co-application of Notch signaling inhibitors together with docetaxel and abiraterone chemotherapy, it was thought that decreased Hes1 expression could be stopped the deterioration of the prognosis of the patient.


Glucagon-stimulated adenylate cyclase detects a selective perturbation of the inner half of the liver plasma-membrane bilayer achieved by the local anaesthetic prilocaine.
Prilocaine can increase the fluidity of rat liver plasma membranes, as indicated by a fatty acid spin-probe. This led to the activation of the membrane-bound fluoride-stimulated adenylate cyclase activity, but not the Lubrol-solubilized activity, suggesting that increased lipid fluidity can activate the enzyme. With increasing prilocaine concentrations above 10 mM, the membrane-bound fluoride-stimulated activity was progressively inhibited, even though bilayer fluidity continued to increase and the activity of the solubilized enzyme remained unaffected. Glucagon-stimulated adenylate cyclase was progressively inhibited by increasing prilocaine concentrations. Prilocaine (10 mM) had no effect on the lipid phase separation occurring at 28 degrees C and attributed to those lipids in the external half of the bilayer, as indicated by Arrhenius plots of both glucagon-stimulated adenylate cyclase activity and the order parameter of a fatty acid spin-probe. However, 10 mM-prilocaine induced a lipid phase separation at around 11 degrees C that was attributed to the lipids of the internal (cytosol-facing) half of the bilayer. It is suggested that prilocaine (10 mM) can selectively perturb the inner half of the bilayer of rat liver plasma membranes owing to its preferential interaction with the acidic phospholipids residing there.


Active immunization of prepubertal boars against testosterone: testicular and endocrine responses at 14 months of age.
Thirteen crossbred boars were immunized at 1 mo of age against either testosterone-3-oxime-equine serum albumin (treated boars) or equine serum albumin (control boars) to test the hypothesis that active immunization against testosterone stimulates testicular growth and development in the prepubertal boar. All boars were injected with the appropriate antigen at 2, 3, 4, 5 and 6 mo of age and were slaughtered at 14 mo of age. Active immunization against testosterone resulted in an increase (P less than .05) in tritiated-testosterone binding by plasma within 60 d after the primary immunization; the degree of binding decreased by 6 mo but remained elevated (P less than .05) relative to controls through 12 mo of age. There was no effect of treatment on body weights through 12 mo of age. Concentrations of testosterone in plasma were higher (P less than .05) in testosterone-immunized boars than in controls; this increase was likely due to antibody binding rather than increased testosterone secretion because (1) concentrations of androgen in testicular parenchyma at slaughter were not altered by treatment and (2) plasma concentrations of estrogens were generally not affected by treatment. Concentrations of luteinizing hormone (LH) and follicle stimulating hormone (FSH) were markedly suppressed in testosterone-immunized boars during the time when concentrations of these gonadotropins were high in control boars (greater than 3 mo of age). In spite of suppression of average LH and FSH concentrations, testicular weights, daily sperm production rates and seminal characteristics were similar for the two groups of boars at slaughter. (ABSTRACT TRUNCATED AT 250 WORDS)


[Ultrastructural changes in the MP3 neuron of the mollusk Lymnaea stagnalis after cryopreservation of the isolated brain].
Investigation of a possibility of long-term storage of frozen (-196 degrees C) viable neurons and nervous tissue is one of the central present day problems. In this study ultrastructural changes in neurons of frozen-thawed snail brain were examined as a function of time. We studied the influence of cryopreservation, cryoprotectant (Me2SO), cooling to 4-6 degrees C, and a prolonged incubation in physiological solution at 4-6 degrees C on dictyosomes of Golgi apparatus, endoplasmic reticulum (ER) cisternae and mitochondria. It has been found that responses of these intracellular structures of cryopreserved neurons to the above influences are similar: dissociation of Golgi dictyosomes, swelling of endoplasmic reticulum cisternae and mitochondrial cristae. Both freezing-thawing and cryoprotectant were seen to cause an increase in the number of lysosomes, liposomes, myelin-like structures, and to form large vacuoles. The structural changes in molluscan neurons caused by cryopreservation with Me2SO (2 M) were reversible.


Molecular detection of Rickettsia genus in chigger mites (Trombidiformes: Trombiculidae) collected on small mammals in southeastern brazilian.
Chiggers are ectoparasites of vertebrates and may cause trombiculiasis or transmit pathogens to their hosts. Specimens collected from rodents and marsupials were morphologically identified as Herpetacarus hertigi, Eutrombicula tinami, Kymocta sp., Quadraseta brasiliensis, Quadraseta falconensis, Quadraseta flochi, Quadraseta mackenziei, Quadraseta pazca, Quadraseta trapezoides, Quadraseta sp., Serratacarus sp., and Trombewingia bakeri. These mites were submitted individually to molecular analyses for the detection of bacteria of the genus Coxiella, Hepatozoon and Rickettsia. Samples were positive to Rickettsia only. Obtained sequences for the gltA (350 pb) and ompA (488 pb) genes were identical to "Candidatus Rickettsia colombianensi", a species previously detected in ticks. In addition, molecular identification of mites based on 18S rDNA sequences are provided for H. hertigi, Kymocta sp., Q. brasiliensis, Q. pazca, Q. trapezoides, Quadraseta sp., and T. bakeri for the first time. This is the first report of the detection of a Rickettsia sp. in chigger mites collected on rodents in Brazil.


Successful Medical Management of Bilateral Pneumothorax Due to Nasogastric Tube Misplacement in a Cat.
A 7 yr old female spayed domestic shorthair was evaluated for suspected lily ingestion and acute vomiting. The cat had vomited suspected lily plant material before presentation, and a nasogastric tube (NGT) was placed to continue to administer activated charcoal. The NGT was passed with sedation and limited restraint. To confirm placement, a single lateral radiograph was taken, which showed that the tube was in the trachea, bronchus, through the pulmonary parenchyma, and extending into the region of the craniodorsal retroperitoneal space. The tube was subsequently removed, resulting in a tension pneumothorax. Bilateral thoracostomy tubes were placed and attached to continuous suction. The pneumothorax resolved after 2 days, the thoracostomy tubes were removed, and the cat was discharged on day 3 after admission. To the authors' knowledge, this is the first described pneumothorax complication with successful medical management secondary to routine nasogastric tube placement in a cat. This case report underscores the importance of preparedness for thoracostomy tube placement before removal of any NGT that has been confirmed to be placed through the pulmonary parenchyma.


Mechanisms underlying renoprotection during renin-angiotensin system blockade.
Potential determinants of chronic renal disease (CRD) progression were studied in male Munich-Wistar rats subjected to 5/6 nephrectomy and treated with candesartan (Csn; n = 30) or enalapril (Ena; n = 27) from 5 wk postsurgery. Despite control of systolic blood pressure (SBP; 24 wk: Csn = 143 +/- 9; Ena = 148 +/- 8 mmHg), urinary protein excretion rates (U(pr)V) increased over 24 wk (Csn = 92 +/- 10; Ena = 99 +/- 8mg/day). Glomerulosclerosis scores (GS) at 24 wk were similar for Csn (42 +/- 7%) vs. Ena (42 +/- 4%), values close to those of untreated controls at 12 wk (43 +/- 4%). At 24 wk, SBP and UprV correlated strongly with GS, together accounting for 72% of the variance in GS. Renal cortex mRNA levels (determined by competitive RT-PCR) for transforming growth factor (TGF)-beta1 and monocyte chemoattractant protein (MCP)-1 were elevated in Csn and Ena at 12 wk and remained higher at 24 wk vs. sham. Strong correlations were evident among TGF-beta1, MCP-1, and interleukin-1beta and renal injury at 24 wk. Cns and Ena are thus equally effective renoprotective agents in this model. During renin-angiotensin system inhibition, renoprotection is dependent on control of both SBP and UprV. Incomplete suppression of renal cytokine gene expression may also contribute to CRD progression.


Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the emergency department.
Consensus guidelines recommend sepsis screening for adults with systemic inflammatory response syndrome (SIRS), but the epidemiology of SIRS among adult emergency department (ED) patients is poorly understood. Recent emphasis on cost-effective, outcomes-based healthcare prompts the evaluation of the performance of large-scale efforts such as sepsis screening. We studied a nationally representative sample to clarify the epidemiology of SIRS in the ED and subsequent category of illness. This was a retrospective analysis of ED visits by adults from 2007 to 2010 in the National Hospital Ambulatory Medical Care Survey (NHAMCS). We estimated the incidence of SIRS using initial ED vital signs and a Bayesian construct to estimate white blood cell count based on test ordering. We report estimates with Bayesian modified credible intervals (mCIs). We used 103,701 raw patient encounters in NHAMCS to estimate 372,844,465 ED visits over the 4-year period. The moderate estimate of SIRS in the ED was 17.8% (95% mCI: 9.7 to 26%). This yields a national moderate estimate of approximately 16.6 million adult ED visits with SIRS per year. Adults with and without SIRS had similar demographic characteristics, but those with SIRS were more likely to be categorized as emergent in triage (17.7% versus 9.9%, p<0.001), stay longer in the ED (210 minutes versus 153 minutes, p<0.0001), and were more likely to be admitted (31.5% versus 12.5%, p<0.0001). Infection accounted for only 26% of SIRS patients. Traumatic causes of SIRS comprised 10% of presentations; other traditional categories of SIRS were rare. SIRS is very common in the ED. Infectious etiologies make up only a quarter of adult SIRS cases. SIRS may be more useful if modified by clinician judgment when used as a screening test in the rapid identification and assessment of patients with the potential for sepsis. [West J Emerg Med. 2014;15(3):329-336.].


Molecular detection and genetic characterization of Bartonella species from rodents and their associated ectoparasites from northern Tanzania.
Bartonellae are intracellular bacteria, which can cause persistent bacteraemia in humans and a variety of animals. Several rodent-associated Bartonella species are human pathogens but data on their global distribution and epidemiology are limited. The aims of the study were to: 1) determine the prevalence of Bartonella infection in rodents and fleas; 2) identify risk factors for Bartonella infection in rodents; and 3) characterize the Bartonella genotypes present in these rodent and flea populations. Spleen samples collected from 381 rodents representing six different species were tested for the presence of Bartonella DNA, which was detected in 57 individuals (15.0%; 95% CI 11.3-18.5), of three rodent species (Rattus rattus n = 54, Mastomys natalensis n = 2 and Paraxerus flavovottis n = 1) using a qPCR targeting the ssrA gene. Considering R. rattus individuals only, risk factor analysis indicated that Bartonella infection was more likely in reproductively mature as compared to immature individuals (OR = 3.42, p <0.001). Bartonella DNA was also detected in 53 of 193 Xenopsylla cheopis fleas (27.5%: 95% CI 21.3-34.3) collected from R.rattus individuals. Analysis of ssrA and gltA sequences from rodent spleens and ssrA sequences from fleas identified multiple genotypes closely related (≥ 97% similar) to several known or suspected zoonotic Bartonella species, including B. tribocorum, B. rochalimae, B. elizabethae and B. quintana. The ssrA and gltA sequences obtained from rodent spleens and ssrA sequences obtained from fleas reveal the presence of a diverse set of Bartonella genotypes and increase our understanding of the bartonellae present in Tanzanian. Further studies are needed to fully characterise the prevalence, genotypes and diversity of Bartonella in different host populations and their potential impacts on human health.


Superlensing microscope objective lens.
Conventional microscope objective lenses are diffraction limited; they cannot resolve subdiffraction features of a size smaller than 250-300 nm under white lighting condition. New innovations are required to overcome this limitation. In this paper, we propose and demonstrate a new superlensing objective lens that possesses a resolution of 100 nm, which is a two-times resolution improvement over conventional objectives. This is accomplished by integrating a conventional microscope objective lens with a superlensing microsphere lens using a customized lens adaptor. The new objective lens was successfully demonstrated for label-free super-resolution imaging of 100 nm features in engineering and biological samples, including a Blu-ray disk sample and adenoviruses. Our work opens a new door to develop a generic optical superlens, which may transform the field of optical microscopy and imaging.


Development of the concept of anxiety.
An interesting model in the conceptualization of anxiety--the cognitive dissonance theory--is summarized. Cognitive dissonance is a state where two mutually incompatible realities exist simultaneously, and it is associated with clinical anxiety in man. Anxiety is as distinctive a state cognitively, as it is emotionally and bodily. The clinical symptom most characteristic of anxiety is obsessional checking. The septo-hippocampal system, 'an organ of hesitation and doubt', is probably the neural substrate for Freud's repetition compulsion. It has the task of monitoring ongoing activities, comparing achieved with desired goals, registering discrepancies, dissonances and the threats of dissonances, and bringing ongoing activities to a halt when such registrations occur.


[Hemosorption combined with intensive measures in hemoblastoses].
The results of 24 applications of hemosorption procedure in 19 cases of acute leukemia, chronic myeloleukemia, chronic lymphocytic leukemia and multiple myeloma are discussed. Hemosorption in conjunction with infusions of albumin, hemodesum, rheopolyglucinum, saline and glucose solutions may be recommended for severe and extremely severe toxemia. A high efficiency of the procedure application at different stages of leukemia development in cases of toxemia syndrome, toxico-allergic hepatitis and sepsis was observed.


A novel conformal arc technique for postoperative whole pelvic radiotherapy for endometrial cancer.
Conventional whole pelvic radiotherapy (WPRT) with 3-dimensional conformal radiotherapy (3D-CRT) exposes most of the contents of the true pelvis to the prescribed dose. Intensity-modulated radiation therapy (IMRT) provides more conformal dose distribution and better sparing of critical structures for WPRT. However, IMRT is more complicated in planning and delivery, requiring more expensive equipment and time-consuming quality assurance. We explore and evaluate a novel conformal arc radiotherapeutic technique for postoperative WPRT for endometrial cancer in this study. This technique involves 2-axis conformal arc therapy (2A-CAT) with 180-degree rotation around 2 isocenters each in 2 separate dose-shaping structures. Dosimetric comparison with 3D-CRT and IMRT for 10 endometrial cancer patients undergoing postoperative WPRT was performed to evaluate this new 2A-CAT technique. The mean conformity indices were 0.83, 0.61, and 0.88 for 2A-CAT, 3D-CRT, and IMRT, respectively. The mean homogeneity indices were 1.15, 1.08, and 1.10. The mean doses to bowel, rectum, bladder, and pelvic bone marrow were, respectively, 1.19, 3.39, 4.65, and 1.64 Gy lower with 2A-CAT than with 3D-CRT (P < 0.05), whereas a little higher than with IMRT. The mean dose to normal tissue was 1.87 Gy higher with 2A-CAT than with IMRT (P = 0.00). In postoperative WPRT for endometrial cancer, 2A-CAT significantly improves the dose conformity and sparing of bowel, rectum, and bladder compared with 3D-CRT. Despite dose uniformity and conformity being still inferior to those of IMRT, its simplicity and extensive availability combined with further improvement warrant it as a potential shortcut alternative to IMRT.


Impact of race on hyperparathyroidism, mineral disarrays, administered vitamin D mimetic, and survival in hemodialysis patients.
Blacks have high rates of chronic kidney disease, are overrepresented among the US dialysis patients, have higher parathyroid hormone levels, but greater survival compared to nonblacks. We hypothesized that mineral and bone disorders (MBDs) have a bearing on survival advantages of black hemodialysis patients. In 139,328 thrice-weekly treated hemodialysis patients, including 32% blacks, in a large dialysis organization, where most laboratory values were measured monthly for up to 60 months (July 2001 to June 2006), we examined differences across races in measures of MBDs and survival predictabilities of these markers and administered the active vitamin D medication paricalcitol. Across each age increment, blacks had higher serum calcium and parathyroid hormone (PTH) levels and almost the same serum phosphorus and alkaline phosphatase levels and were more likely to receive injectable active vitamin D in the dialysis clinic, mostly paricalcitol, at higher doses than nonblacks. Racial differences existed in mortality predictabilities of different ranges of serum calcium, phosphorus, and PTH but not alkaline phosphatase. Blacks who received the highest dose of paricalcitol (>10 µg/week) had a demonstrable survival advantage over nonblacks (case-mix-adjusted death hazard ratio = 0.87, 95% confidence level 0.83-0.91) compared with those who received lower doses (<10 µg/week) or no active vitamin D. Hence, in black hemodialysis patients, hyperparathyroidism and hypercalcemia are more prevalent than in nonblacks, whereas hyperphosphatemia or hyperphosphatasemia are not. Survival advantages of blacks appear restricted to those receiving higher doses of active vitamin D. Examining the effect of MBD modulation on racial survival disparities of hemodialysis patients is warranted.


Prolactin secretion and the immune system.
Prolactin receptors were identified on the membranes of lymphocytes have been demonstrated to secrete prolactin. The decrease, as well as the increase of the prolactin level in the plasma are responsible for immune disorders. Prolactin dysfunction has been described in some autoimmune diseases, such as systemic lupus erythematosus, immune arthritis, uveitis, experimental allergic encephalomyelitis and thyroid disease. The normal prolactin secretion is trophic for the lymphocytes, while the high and also the low levels of prolactin may play an immunosuppressive role.


Periodontal Intervention in Speedy Orthodontics-A Case Report.
The use of orthodontic treatment in adult patients is becoming more common and these patients have more specific objectives and concerns related to facial and dental aesthetics, specially regarding duration of treatment. Dentists are on the lookout for techniques for increased efficiency in orthodontic treatment. Alveolar Corticotomy-assisted orthodontic treatment is a recent orthodontic technique that is recently gaining wide acceptance and is recorded as effective means of accelerating orthodontic treatment. A 17-year-old female patient was undergoing orthodontic treatment for the past one year but during her space closure, a visual examination confirmed a buccal thickening that was encountered in the buccal plate between premolars and canine. Periodontal intervention involved elective alveolar decortication in the form of dots performed around the teeth that were to be moved. This was carried out to induce a state of increased tissue turnover and a transient osteopenia, which further helps in faster rate of orthodontic tooth movement. Its main advantages are reduction of treatment time and post-orthodontic stability.


Accounting for country- and time-specific values in the economic evaluation of health-related projects relevant to low- and middle-income countries.
Economic evaluation of health-related projects requires principles and methods to address the various trade-offs that need to be made between costs and benefits, across sectors and social objectives, and over time. Existing guidelines for economic evaluation in low- and middle-income countries embed implicit assumptions about expected changes in the marginal cost per unit of health produced by the healthcare sector, the consumption value of health and the appropriate discount rates for health and consumption. Separating these evaluation parameters out requires estimates for each country over time, which have hitherto been unavailable. We present a conceptual economic evaluation framework that aims to clarify the distinct roles of these different evaluation parameters in evaluating a health-related project. Estimates for each are obtained for each country and in each time period, based on available empirical evidence. Where existing estimates are not available, for future values of the marginal cost per unit of health produced by the healthcare sector, new estimates are obtained following a practical method for obtaining projected values. The framework is applied to a simple, hypothetical, illustrative example, and the results from our preferred approach are compared against those obtained from other approaches informed by the assumptions implicit within existing guidelines. This exposes the consequences of applying such assumptions, which are not supported by available evidence, in terms of potentially sub-optimal decisions. In general, we find that applying existing guidelines as done in conventional practice likely underestimates the value of health-related projects on account of not allowing for expected growth in the marginal cost per unit of health produced by the healthcare sector.


Dental utilization for Medicaid-enrolled adults with developmental disabilities in Iowa residential care facilities.
The goal of this study was to evaluate the dental utilization of Medicaid-enrolled adults in Iowa residential care facilities (n=1423). Medicaid enrollment and claims files for 2003 were used, as well as information from the Iowa Department of Inspections and Appeals. Dental utilization was defined as having any dental visit during 2003. Of the residents, 74.1% utilized at least one dental service in 2003. Residents in facilities that were part of smaller organizations, and younger residents, were more likely to have had a dental visit. Of those with a visit, over 80% received a preventive service but this declined with age. Despite additional barriers, dental utilization was generally good for Medicaid-enrolled residents of residential care facilities in Iowa. Residents in smaller facilities of smaller organizations received more personalized care. Older residents were less likely to have a parent involved, were more likely to be edentulous, and sought care less frequently.


Charcot shoulder and elbow: a review of the literature and update on treatment.
Charcot arthropathy of the shoulder and elbow is a rare disease process initially described in the 1700s; however, it was not until the 19th century that physicians understood its association with other disease processes such as cervical spine pathology and diabetes. A primary complaint is painful or painless joint dysfunction, meaning the orthopedic surgeon is regularly the first physician to evaluate the patient. Frequently, the condition of these patients is misdiagnosed. Although the pathogenesis of the disease is controversial, the etiology is commonly due to syringomyelia. The key to successful management is a thorough history and examination along with a workup including specific laboratory testing and imaging to rule out other disease processes. Most neuropathic shoulders and elbows have historically been managed conservatively because of poor outcomes with operative interventions. Newer data have emerged hinting that early neurosurgical intervention can stabilize this degenerative process. If clinical and radiographic stabilization occurs, recent studies have outlined surgical indications that can provide surgeons with a guide as to patients in whom successful operative outcomes can be achieved in the face of failed conservative management.


How clerkship students learn from real patients in practice settings.
To explore how undergraduate medical students learn from real patients in practice settings, the factors that affect their learning, and how clerkship learning might be enhanced. In 2009, 22 medical students in the three clerkship years of an undergraduate medical program in the United Kingdom made 119 near-contemporaneous audio diary entries reflecting how they learned from real patients. Nineteen attended focus groups; 18 were individually interviewed. The authors used a qualitative theory-building methodology with a conceptual orientation toward Communities of Practice theory. A learning theorist guided selective coding of a constant-comparative analysis. Participants learned informally by participating in the communicative practices of workplaces. Two overlapping practices, patient care and education, were identified. Patient care created learning opportunities, which were enriched when practitioners intentionally supported participants' learning. Education, however, was not always coupled with patient care. So, talk positioned the boundaries of two practices in three configurations: education without patient care, education within patient care, and patient care without education. The nature and quality of participants' learning depended on how practitioners entered dialogue with them and linked the dialogue to authentic patient care. Findings strongly suggest that medical students learn from real patients by participating in patient care within an educational practice. Their learning is affected by clinicians' willingness to engage in supportive dialogue. Promoting an informal, inclusive discourse of workplace learning might enhance clerkship education. This approach should take its place alongside-and perhaps ahead of-the currently dominant discourse of "clinical teaching."


SlypNet: Spikelet-based yield prediction of wheat using advanced plant phenotyping and computer vision techniques.
The application of computer vision in agriculture has already contributed immensely to restructuring the existing field practices starting from the sowing to the harvesting. Among the different plant parts, the economic part, the yield, has the highest importance and becomes the ultimate goal for the farming community. It depends on many genetic and environmental factors, so this curiosity about knowing the yield brought several precise pre-harvest prediction methods using different ways. Out of those techniques, non-invasive yield prediction techniques using computer vision have been proved to be the most efficient and trusted platform. This study developed a novel methodology, called SlypNet, using advanced deep learning networks, i.e., Mask R-CNN and U-Net, which can extract various plant morphological features like spike and spikelet from the visual image of the wheat plant and provide a high-throughput yield estimate with great precision. Mask R-CNN outperformed previous networks in spike detection by its precise detection performance with a mean average precision (mAP) of 97.57%, a F1 score of 0.67, and an MCC of 0.91 by overcoming several natural field constraints like overlapping and background interference, variable resolution, and high bushiness of plants. The spikelet detection module's accuracy and consistency were tested with about 99% validation accuracy of the model and the least error, i.e., a mean square error of 1.3 from a set of typical and complex views of wheat spikes. Spikelet yield cumulatively showed the probable production capability of each plant. Our method presents an integrated deep learning platform of spikelet-based yield prediction comprising spike and spikelet detection, leading to higher precision over the existing methods.


Structure- and Interaction-Based Design of Anti-SARS-CoV-2 Aptamers.
Aptamer selection against novel infections is a complicated and time-consuming approach. Synergy can be achieved by using computational methods together with experimental procedures. This study aims to develop a reliable methodology for a rational aptamer in silico et vitro design. The new approach combines multiple steps: (1) Molecular design, based on screening in a DNA aptamer library and directed mutagenesis to fit the protein tertiary structure; (2) 3D molecular modeling of the target; (3) Molecular docking of an aptamer with the protein; (4) Molecular dynamics (MD) simulations of the complexes; (5) Quantum-mechanical (QM) evaluation of the interactions between aptamer and target with further analysis; (6) Experimental verification at each cycle for structure and binding affinity by using small-angle X-ray scattering, cytometry, and fluorescence polarization. By using a new iterative design procedure, structure- and interaction-based drug design (SIBDD), a highly specific aptamer to the receptor-binding domain of the SARS-CoV-2 spike protein, was developed and validated. The SIBDD approach enhances speed of the high-affinity aptamers development from scratch, using a target protein structure. The method could be used to improve existing aptamers for stronger binding. This approach brings to an advanced level the development of novel affinity probes, functional nucleic acids. It offers a blueprint for the straightforward design of targeting molecules for new pathogen agents and emerging variants.


Preexisting primary glaucoma and intraocular lenses.
Intraocular lens implantation into cataractous eyes that also suffer from primary glaucoma is a rewarding procedure. The need for an IOL in these eyes is even stronger than in otherwise healthy cataractous eyes. With prepupillary IOLs there was a strong reason first to control surgically intraocular pressure prior to cataract surgery with IOL implantation. The advent of retropupillary IOLs has dramatically changed this attitude. Extracapsular cataract extraction (ECCE) and the use of an all-in-the-bag retropupillary IOL is the method of choice. Postoperative medical treatment remains possible as does surgical treatment for the glaucoma. The procedure is suitable for open-angle glaucoma as well as for narrow-angle glaucoma.


[Problems of the separation of prescription and dispensing].
By October 2002, the separation of prescribing and dispensing in Japan had already been implemented for 28 years since the system was inaugurated in 1974. Although the separation rate reached 44.5% in 2001, the questions, "Is the separation necessary in Japan?" or "Has the system been working successfully?" are often heard. These questions are raised because people have not noted the advantages of the system yet, and because the separation itself has many problems or shortcomings. These questions are not only from pharmacists, but also from physicians, patients, or medical and educational institutions. If the problem concerns pharmacists, it is assumed to stem from their lack of ability required for the separation. A breakthrough for an early solution of the problem will be found in a change in education, which includes a range of clinical subjects and long-term clinical practices.


Application of the dual-component model of working memory to ADHD:Greater secondary memory deficit despite confounded cognitive differences.
The dual-component model postulates that working memory capacity consists of two dissociable components: maintenance in primary memory (PM) and retrieval from secondary memory (SM). Recent application of this model to attention-deficit/hyperactivity disorder (ADHD) has revealed that the SM component is more deficient than the PM component across both verbal and spatial modalities. The present study attempts to strengthen this conclusion by addressing two weaknesses in the previous study. First, the present study shows that the SM component continues to be more deficient than the PM component across both modalities under conditions in which (1) all participants were instructed to use the same recall strategy (resulting in the exclusion of fewer participants); and, (2) individual differences in this strategy were controlled. Second, the present study also documents a group difference in word reading efficiency that is confounded with diagnostic status and that might have influenced estimates of PM and SM capacities in the verbal modality. However, although the SM component is more deficient than the PM component in the ADHD group, the magnitude of this interaction does not vary as a function task modality. These findings are interpreted to suggest that the pattern of WM deficiencies observed are part of a causal pathway that can lead to the symptoms of ADHD, as well as to impairments in reading (and intelligence) due to overlapping cue-dependent retrieval mechanisms. These findings provide additional support for the notion that the SM component of WM is an important and neglected target for treatment.


Health insurance, health reform, and outpatient mental health treatment: who benefits?
This research examines how extending health insurance coverage to the previously uninsured impacts outpatient mental health treatment use among adults with different needs. Using data from the Epidemiologic Catchment Area Study and the 1987 National Medical Expenditure Survey, I develop simulations based on estimates of treatment demand. I find that insurance substantially increases demand by the mentally ill, but increased coverage alone cannot meet their treatment needs. Those in better mental health account for significant proportions of additional demand when coverage is expanded. Policies intended to increase access to mental health treatment among targeted groups should carefully consider the costs of increased use by other people.


Outcomes of the 2019 GRAPPA Workshop on Continuous Composite Indices for the Assessment of Psoriatic Arthritis and Membership-recommended Next Steps.
Improving the assessment of psoriatic arthritis (PsA) is a key purpose of the Group for Research and Assessment of Psoriasis and PsA (GRAPPA). Herein, we report the proceedings of the GRAPPA composites workshop at the 2019 GRAPPA annual meeting and the membership's recommended next steps. A review of continuous composite measures was conducted in an introductory workshop, followed by 10 breakout group sessions and a final plenary session for feedback and voting. Participants included 154 members: 87 rheumatologists, 18 dermatologists, 2 rheumatologist/dermatologists, 12 patient research partners, 14 academics, 1 methodologist, and 20 industry members. Of voting members, 88.8% agreed a need exists for a continuous composite measure for routine practice, but only 62% were currently using a composite measure. Of these, 27% were using the 28-joint count Disease Activity Score (DAS), which is not a PsA-specific measure; 20% were using a PsA-specific measure such as PsA DAS (PASDAS), Composite Psoriatic Disease Activity Index (CPDAI), or Disease Activity Index for PsA (DAPSA). Members agreed that the existing measures were not feasible in their current forms (CPDAI 83%, PASDAS 82%, and DAPSA 47%) and that modification should be tested. The majority (76%) agreed that disease effect should be measured separately from disease activity. The GRAPPA membership supports the need for a continuous composite measure of disease activity for use in routine clinical care, the separate measurement of disease effect and activity, and the testing of modifications to candidate instruments rather than the development of new measures.


Hardy type inequalities in [Formula: see text] with sharp remainders.
Sharp remainder terms are explicitly given on the standard Hardy inequalities in [Formula: see text] with [Formula: see text]. Those remainder terms provide a direct and exact understanding of Hardy type inequalities in the framework of equalities as well as of the nonexistence of nontrivial extremals.


Frequent collinear long transfer of DNA inclusive of the whole binary vector during Agrobacterium-mediated transformation.
When Agrobacterium was used to transform Nicotiana plumbaginifolia protoplasts and Arabidopsis thaliana roots and seedlings, a large number of plants were found in which not only the T-region defined by the border repeat sequences but the entire binary vector was integrated, as determined by both PCR and Southern analysis techniques. N. plumbaginifolia protoplast co-cultivation experiments yielded 3 out of 5 transformants with collinear sequence past the left border. In Arabidopsis root transformation experiments, 33% (6/18) of the transformants had T-DNA which exceeded the left border repeat. Vacuum infiltration of Arabidopsis seedlings produced even a greater percentage of transformants with sequences outside the left border repeat (62%, 39/63). The long transfer DNA cosegregated with the T-region encoded hygromycin resistance in the T2 progeny eliminating the possibility that long transfer DNA was of extrachromosomal or Agrobacterium origin. The high frequency of long transfer after vacuum infiltration of A. thaliana needs to be considered when analyzing T-DNA tagged mutants.


Do not despair about severity-yet.
In a recent extended essay, philosopher Daniel Hausman goes a long way towards dismissing severity as a morally relevant attribute in the context of priority setting in healthcare. In this response, we argue that although Hausman certainly points to real problems with how severity is often interpreted and operationalised within the priority setting context, the conclusion that severity does not contain plausible ethical content is too hasty. Rather than abandonment, our proposal is to take severity seriously by carefully mapping the possibly multiple underlying accounts to well-established ethical theories, in a way that is both morally defensible and aligned with the term's colloquial uses.


Palliative care symptom assessment for patients with cancer in the emergency department: validation of the Screen for Palliative and End-of-life care needs in the Emergency Department instrument.
We sought to develop and validate a novel palliative medicine needs assessment tool for patients with cancer in the emergency department. An expert panel trained in palliative medicine and emergency medicine reviewed and adapted a general palliative medicine symptom assessment tool, the Needs at the End-of-Life Screening Tool. From this adaptation a new 13-question instrument was derived, collectively referred to as the Screen for Palliative and End-of-life care needs in the Emergency Department (SPEED). A database of 86 validated symptom assessment tools available from the palliative medicine literature, totaling 3011 questions, were then reviewed to identify validated test items most similar to the 13 items of SPEED; a total of 107 related questions from the database were identified. Minor adaptations of questions were made for standardization to a uniform 10-point Likert scale. The 107 items, along with the 13 SPEED items were randomly ordered to create a single survey of 120 items. The 120-item survey was administered by trained staff to all patients with cancer who met inclusion criteria (age over 21 years, English-speaking, capacity to provide informed consent) who presented to a large urban academic emergency department between 8:00 am and 11:00 pm over a 10-week period. Data were analyzed to determine the degree of correlation between SPEED items and the related 107 selected items from previously validated tools. A total of 53 subjects were enrolled, of which 49 (92%) completed the survey in its entirety. Fifty-three percent of subjects were male, age range was 24-88 years, and the most common cancer diagnoses were breast, colon, and lung. Cronbach coefficient α for the SPEED items ranged from 0.716 to 0.991, indicating their high scale reliability. Correlations between the SPEED scales and related assessment tools previously validated in other settings were high and statistically significant. The SPEED instrument demonstrates reliability and validity for screening for palliative care needs of patients with cancer presenting to the emergency department.


Estimating sexual selection and sexual isolation effects from mating frequencies.
Sexual selection (defined as the change in genotypic or phenotypic frequencies of mated versus total population frequencies) and sexual isolation (defined as the deviation from random mating in mated individuals) show different evolutionary consequences and partially confounded causes. Traditionally, the cross-product estimator has been used to quantify sexual selection, whereas a variety of indexes, such as Yule V, Yule Q, YA, joint I, and others have been used to quantify sexual isolation. Because the two types of estimators use different scales, the effects of both processes cannot be monitored simultaneously. We describe three new related statistics that quantify both sexual selection (PSS) and sexual isolation (PSI) effects for every mating pair combination in polymorphic traits, as well as measure their combined effects (PTI = PSI x PSS). The new statistics have the advantage of providing information on every mating pair combination, quantifying the effects of sexual selection and isolation in the same units, and detecting asymmetry in sexual isolation. The ability of the new statistics to ascertain the biological causes of sexual selection and sexual isolation are investigated under different models involving distinct marginal frequencies, mate propensity, and mate choice coefficients. We also studied the use of classical isolation indexes applied on PSI coefficients, instead of on raw data. The use of the classical indexes applied to PSI coefficients considerably reduces the statistical bias of the estimates, revealing the good estimation properties of the new statistics.


Is there a prognostic role of K-ras point mutations in the serum of patients with advanced non-small cell lung cancer?
The purpose of this study was to investigate the prognostic significance of K-ras mutations in circulating DNA in advanced non-small lung cancer (NSCLC) patients. Serum samples were assessed prior to platinum-based chemotherapy start in 67 patients with advanced NSCLC (stage IIIB or IV), treated between April 1999 and June 2002. Patients were not previously treated with chemotherapy. K-ras oncogene mutations at codon 12 were analyzed by genomic amplification and direct sequencing of the patient's DNA present in serum. Pre-treatment serum was available in all 67 patients. Twenty patients (30%) demonstrated K-ras mutations while 47 patients (70%) had wild-type K-ras. Among K-ras mutations, the amino acid glycine was substituted by cystein in 90% and valine in 10%. When patients were grouped according to K-ras genotype, there was no significant difference for any of the baseline patient characteristics. There was a tendency towards a higher response rate for patients with K-ras mutations versus wild-type K-ras in serum, however not statistically significant (p=0.37). Median progression-free survival was 7.3 months versus 5.5 months in patients with mutations and with wild-type K-ras, respectively (p=0.23). For median overall survival time, the mutation group was comparable to the wild-type K-ras group with 12.5 and 11.4 months, respectively (p=0.28). In conclusion, there were no significant differences between the patients with K-ras mutations and those with wild-type genotype with respect to baseline patient characteristics, response rates, progression-free survival, or overall survival.


[Accelerated desensitization to Dermatophagoides pteronyssinus mites in children with asthma. Results of two years of immunotherapy].
16 children with chronic asthma were given a rush immunotherapy with standardized Dermatophagoides Pteronyssinus extracts. For two years, the dose of 10 IR was injected monthly. Before this rush, six children have received a typical immunotherapy ineffective on asthma. Examination of clinical, medication, immuno-allergologic and functional parameters were recorded before and at 6, 12 and 24 months of the follow-up. Rush immunotherapy was well tolerated. Substantial improvement of asthmatic syndrome was seen in 12 children. Skin sensitivity decreased significantly since 6 months (p less than 0.001). Laboratory results were not changed. At 24 months, improvement of CRF Helium was showed (p less than 0.01). This study with two years follow-up shows that specific immunotherapy is efficacy and possible in children with severe asthma. Symptom, medication, functional scores were substantial improvement.


Blood irradiation by He-Ne laser induces a decrease in platelet responses to physiological agonists and an increase in platelet cyclic GMP.
The effect of He-Ne laser irradiation on platelet adhesion, activation and aggregation was investigated. Citrated whole blood was irradiated in vitro by He-Ne laser (632.8 nm, 7 mW) and then subjected to shear stress (1300 s-1) on subendothelial extracellular matrix (ECM)-coated plates. Laser irradiation was followed by a decrease in platelet adhesion and aggregation on ECM under flow conditions in a time exposure-dependent manner (by 30-40%). The inhibiting effect of laser light on platelets was detectable up to 1 h after the termination of irradiation. Laser irradiation of either platelet-rich plasma, gel-filtered platelets, platelet-poor plasma, or packed blood cells followed by whole blood reconstitution revealed a marked decrease in platelet deposition on ECM only in the cases of platelet-rich plasma or gel filtered platelets. In conventional aggregometry, laser-treated platelet-rich plasma demonstrated a diminished platelet response to both thrombin receptor-activating peptide (TRAP), converting a two-wave aggregation curve to reversible, and to the protein kinase C activator PMA (by 45%). In flow cytometry analysis, irradiated platelets presented lower fibrinogen binding and P-selectin expression in response to TRAP. Laser irradiation had no additional inhibitory effect on dibutyryl cGMP- and dibutyryl cAMP-pretreated platelets. A 50% increase in cGMP level was observed in laser-treated gel filtered platelets, both in the presence and in absence of the phosphodiesterase inhibitor, isobuthylmethylxanthine. The results suggest that guanylate cyclase is one of the primary mediators of the laser effect on platelet function.


Antiemetic effect of ginger in gynecologic oncology patients receiving cisplatin.
To determine whether ginger had antiemetic effect in cisplatin-induced emesis, we conducted a randomized, double-blinded crossover study in 48 gynecologic cancer patients receiving cisplatin-based chemotherapy. Subjects were randomly allocated to regimen A or regimen B in their first cycle of the study. All patients received standard antiemetics in the first day of cisplatin administration. In regimen A, capsules of ginger root powder were given orally 1 g /day for 5 days, starting on the first day of chemotherapy. In regimen B, placebo was given on the first day and metoclopramide was given orally thereafter for 4 days. The patients were then crossed over to receive the other antiemetic regimen in their next cycle of chemotherapy. Among 43 evaluable patients who received both cycles of treatment, success in controls of nausea and emesis were not significantly different between the two regimens in both acute and delayed phases. Restlessness, as a side effect, occurred more often in metoclopramide arm compared to ginger arm (P=0.109). In conclusion, addition of ginger to standard antiemetic regimen has no advantage in reducing nausea or vomiting in acute phase of cisplatin-induced emesis. In delayed phase, ginger and metoclopramide have no statistically significant difference in efficacy.


A Novel Public Health Approach to Measuring Tobacco Cessation Needs Among Cancer Survivors in Alaska.
Cancer survivors who continue to smoke have poorer response to treatment, higher risk for future cancers and lower survival rates than those who quit tobacco after diagnosis. Despite the increased risk for negative health outcomes, tobacco use among Alaskan cancer survivors is 19%, among the highest in the nation. To characterize and address tobacco cessation needs among cancer survivors who called a quit line for help in quitting tobacco, Alaska's Comprehensive Cancer Control program initiated a novel partnership with the state's Tobacco Quit Line. Alaska's Tobacco Quit Line, a state-funded resource that provides confidential coaching, support, and nicotine replacement therapies for Alaskan adults who wish to quit using tobacco, was used to collect demographic characteristics, health behaviors, cessation referral methods and other information on users. From September 2013- December 2014, the Alaska Quit Line included questions about previous cancer status and other chronic conditions to assess this information from cancer survivors who continue to use tobacco. Alaska's Tobacco Quit Line interviewed 3,141 smokers, 129 (4%) of whom were previously diagnosed with cancer. Most cancer survivors who called in to the quit line were female (72%), older than 50 years of age (65%), white (67%), and smoked cigarettes (95%). Cancer survivors reported a higher prevalence of asthma, COPD and heart disease than the non-cancer cohort. Approximately 34% of cancer survivors were referred to the quit line by a health care provider. This report illustrates the need for health care provider awareness of persistent tobacco use among cancer survivors in Alaska. It also provides a sound methodologic design for assessing ongoing tobacco cessation needs among cancer survivors who call a quit line. This survey methodology can be adapted by other public health programs to address needs and increase healthy behaviors among individuals with chronic disease.


[Application of the ASSES scale for the assessment of patient state severity and outcome prediction of acute pancreatitis].
There was estimated the severity state in 129 patients, suffering an acute pancreatitis, using the ASSES, SAPS, APACHE II and V. S. Savelyev's scales. Trustworthy differences of their values were established in survivors and the dead patients immediately after admitting to the hospital, before the operation, in 1-2 and 3-4 days after the operation. The best accuracy in predicting of outcome after the patient admittance to the hospital and in early postoperative period was noted while using the ASSES scale. The sum more than 13 points after admittance to the hospital and before the operation, as well as more than 16 points on the first-second and the third-fourth postoperative days, according to the ASSES scale, witnesses unfavorable prognosis of the disease.


Bats use magnetite to detect the earth's magnetic field.
While the role of magnetic cues for compass orientation has been confirmed in numerous animals, the mechanism of detection is still debated. Two hypotheses have been proposed, one based on a light dependent mechanism, apparently used by birds and another based on a "compass organelle" containing the iron oxide particles magnetite (Fe(3)O(4)). Bats have recently been shown to use magnetic cues for compass orientation but the method by which they detect the Earth's magnetic field remains unknown. Here we use the classic "Kalmijn-Blakemore" pulse re-magnetization experiment, whereby the polarity of cellular magnetite is reversed. The results demonstrate that the big brown bat Eptesicus fuscus uses single domain magnetite to detect the Earths magnetic field and the response indicates a polarity based receptor. Polarity detection is a prerequisite for the use of magnetite as a compass and suggests that big brown bats use magnetite to detect the magnetic field as a compass. Our results indicate the possibility that sensory cells in bats contain freely rotating magnetite particles, which appears not to be the case in birds. It is crucial that the ultrastructure of the magnetite containing magnetoreceptors is described for our understanding of magnetoreception in animals.


Acute ischemic stroke: infarct core estimation on CT angiography source images depends on CT angiography protocol.
To test whether the relationship between acute ischemic infarct size on concurrent computed tomographic (CT) angiography source images and diffusion-weighted (DW) magnetic resonance images is dependent on the parameters of CT angiography acquisition protocols. This retrospective study had institutional review board approval, and all records were HIPAA compliant. Data in 100 patients with anterior-circulation acute ischemic stroke and large vessel occlusion who underwent concurrent CT angiography and DW imaging within 9 hours of symptom onset were analyzed. Measured areas of hyperintensity at acute DW imaging were used as the standard of reference for infarct size. Information regarding lesion volumes and CT angiography protocol parameters was collected for each patient. For analysis, patients were divided into two groups on the basis of CT angiography protocol differences (patients in group 1 were imaged with the older, slower protocol). Intermethod agreement for infarct size was evaluated by using the Wilcoxon signed rank test, as well as by using Spearman correlation and Bland-Altman analysis. Multivariate analysis was performed to identify predictors of marked (≥20%) overestimation of infarct size on CT angiography source images. In group 1 (n=35), median hypoattenuation volumes on CT angiography source images were slightly underestimated compared with DW imaging hyperintensity volumes (33.0 vs 41.6 mL, P=.01; ratio=0.83), with high correlation (ρ=0.91). In group 2 (n=65), median volume on CT angiography source images was much larger than that on DW images (94.8 vs 17.8 mL, P<.0001; ratio=3.5), with poor correlation (ρ=0.49). This overestimation on CT angiography source images would have inappropriately excluded from reperfusion therapy 44.4% or 90.3% of patients eligible according to DW imaging criteria on the basis of a 100-mL absolute threshold or a 20% or greater mismatch threshold, respectively. Atrial fibrillation and shorter time from contrast material injection to image acquisition were independent predictors of marked (≥20%) infarct size overestimation on CT angiography source images. CT angiography protocol changes designed to speed imaging and optimize arterial opacification are associated with significant overestimation of infarct size on CT angiography source images.


In vitro inhibitory profile of NDGA against AChE and its in silico structural modifications based on ADME profile.
Acetylcholinesterase (AChE) inhibitors are currently in focus for the pharmacotherapy of Alzheimer's disease (AD). These inhibitors increase the level of acetylcholine in the brain and facilitate cholinergic neurotransmission. AChE inhibitors such as rivastigmine, galantamine, physostigmine and huperzine are obtained from plants, indicating that plants can serve as a potential source for novel AChE inhibitors. We have performed a virtual screening of diverse natural products with distinct chemical structure against AChE. NDGA was one among the top scored compounds and was selected for enzyme kinetic studies. The IC(50) of NDGA on AChE was 46.2 μM. However, NDGA showed very poor central nervous system (CNS) activity and blood-brain barrier (BBB) penetration. In silico structural modification on NDGA was carried out in order to obtain derivatives with better CNS activity as well as BBB penetration. The studies revealed that some of the designed compounds can be used as lead molecules for the development of drugs against AD.


The optimized acupuncture treatment for neck pain caused by cervical spondylosis: a study protocol of a multicentre randomized controlled trial.
Neck pain is one of the chief symptoms of cervical spondylosis (CS). Acupuncture is a well-accepted and widely used complementary therapy for the management of neck pain caused by CS. In this paper, we present a randomized controlled trial protocol evaluating the use of acupuncture for CS neck pain, comparing the effects of the optimized acupuncture therapy in real practice compared with sham and shallow acupuncture. This trial uses a multicentre, parallel-group, randomized, sham acupuncture and shallow acupuncture, controlled single-blind design. Nine hospitals are involved as trial centres. 945 patients who meet inclusion criteria are randomly assigned to receive optimized acupuncture therapy, sham acupuncture or shallow acupuncture by a computerized central randomization system. The interventions past for 4 weeks with eight to ten treatments in total. The group allocations and interventions are concealed to patients and statisticians. The Northwick Park Neck Pain Questionnaire (NPQ) is used as the primary outcome measure, and the McGill Pain Questionnaire (MPQ) and The Short Form (36) Health Survey (SF-36) are applied as secondary outcome measures. The evaluation is performed at baseline, at the end of the intervention, and at the end of the first month and the third month during follow-up. The statistical analyses will include baseline data comparison and repeated measures of analysis of variance (ANOVA) for primary and secondary outcomes of group and time differences. Adverse events (AEs) will be reported if they occur. This trial is a multicentre randomized control trial (RCT) on the efficacy of acupuncture for CS neck pain and has a large sample size and central randomization in China. It will strictly follow the CONSORT statement and STRICTA extension guideline to report high-quality study results. By setting the control groups as sham and shallow acupuncture, this study attempts to reveal the effects of real acupuncture versus placebo or non-classic acupuncture treatment and evaluate whether classic Chinese medical acupuncture is effective on CS neck pain. This study will provide evidence for the effects of acupuncture on CS neck pain. Chinese Clinical Trial Registry: ChiCTR-TRC-00000184.


Comparison of point-of-care hemostatic assays, routine coagulation tests, and outcome scores in critically ill patients.
The purposes of the study are to compare point-of-care (POC) hemostatic devices in critically ill patients with routine laboratory tests and intensive care unit (ICU) outcome scoring assessments and to describe the time course of these variables in relation to mortality rate. Patients admitted to the ICU with a prognosis of more than 3 days of stay were included. The POC devices, Multiplate platelet aggregometry, rotational thromboelastometry, and ReoRox viscoelastic tests, were used. All variables were compared between survivors and nonsurvivors. Point-of-care results were compared to prothrombin time, activated partial thromboplastin time, platelet count, fibrinogen concentration, and Sequential Organ Failure Assessment score and Simplified Acute Physiology Score 3. Blood was sampled on days 0 to 1, 2 to 3, and 4 to 10 from 114 patients with mixed diagnoses during 237 sampling events. Nonsurvivors showed POC and laboratory signs of hypocoagulation and decreased fibrinolysis over time compared to survivors. ReoRox detected differences between survivors and nonsurvivors better than ROTEM and Multiplate. All POC and routine laboratory tests showed a hypocoagulative response in nonsurvivors compared to survivors. ReoRox was better than ROTEM and Multiplate at detecting differences between surviving and nonsurviving ICU patients. However, Simplified Acute Physiology Score 3 showed the best association to mortality outcome.


Unfolded protein response activation reduces secretion and extracellular aggregation of amyloidogenic immunoglobulin light chain.
Light-chain amyloidosis (AL) is a degenerative disease characterized by the extracellular aggregation of a destabilized amyloidogenic Ig light chain (LC) secreted from a clonally expanded plasma cell. Current treatments for AL revolve around ablating the cancer plasma cell population using chemotherapy regimens. Unfortunately, this approach is limited to the ∼ 70% of patients who do not exhibit significant organ proteotoxicity and can tolerate chemotherapy. Thus, identifying new therapeutic strategies to alleviate LC organ proteotoxicity should allow AL patients with significant cardiac and/or renal involvement to subsequently tolerate established chemotherapy treatments. Using a small-molecule screening approach, the unfolded protein response (UPR) was identified as a cellular signaling pathway whose activation selectively attenuates secretion of amyloidogenic LC, while not affecting secretion of a nonamyloidogenic LC. Activation of the UPR-associated transcription factors XBP1s and/or ATF6 in the absence of stress recapitulates the selective decrease in amyloidogenic LC secretion by remodeling the endoplasmic reticulum proteostasis network. Stress-independent activation of XBP1s, or especially ATF6, also attenuates extracellular aggregation of amyloidogenic LC into soluble aggregates. Collectively, our results show that stress-independent activation of these adaptive UPR transcription factors offers a therapeutic strategy to reduce proteotoxicity associated with LC aggregation.


Triage and resuscitation of critically ill patients in the emergency department: current concepts and practice.
Recognition of tissue hypoxia or cumulative oxygen debt is of fundamental importance for the triage and resuscitation of critically ill patients during the 'golden hour' in the emergency department. Vital signs, shock index and invasive monitoring of mean arterial pressure and central venous pressure have limited roles in evaluating cumulative oxygen debt and systemic oxygen balance in an acute critical illness. The measurement of central venous blood oxygen saturation, arterial lactate concentration, cardiac output and systemic oxygen delivery and consumption can enhance the detection of the clinically occult cumulative oxygen debt in critically ill patients. Organ-specific oxygenation indices such as gastric tonometry and renal function can supplement indicators of systemic oxygen balance to detect ischaemia-hypoxia of non-vital organs. Systemic oxygenation and organ-specific indices can guide the choice of therapy to optimize resuscitation of the macro- and microcirculation in critically ill patients in the emergency department.


Association of the ARLTS1 variants with familial ovarian cancer risk in China.
ARLTS1 has been identified in chromosome 13q14 as a tumor suppressor gene of the adenosine diphosphate-ribosylation factor family with pro-apoptotic characteristics. The ARLTS1 mutation Trp149Stop and Cys148Arg have been shown to be associated with familial cancers, but limited information is available regarding the impact of ARLTS1 variants on familial ovarian cancer (OC). The aim of this study was to evaluate the ARLTS1 genetic variants associated with familial OC risk in China. We genotyped 85 OC patients with family ovarian/breast history, 80 sporadic OC patients, and 120 controls from general population by denaturing high-performance liquid chromatography screening analysis followed by direct sequencing of the conspicuous polymerase chain reaction products. ARLTS1 Cys148Arg revealed a significant association with an increased risk of familial OC compared with both sporadic cases and controls in a dose-dependent manner (P = 0.0031 and 0.012, respectively). In the clinical-pathological study, our results support previous data in demonstrating that familial OC was associated with younger age at diagnosis (49.7 years vs 53.3 years; P = 0.014), higher proportion of tumors of advanced stages (81.2% vs 67.5%; P = 0.033), and higher rates of serous adenocarcinomas (76.4% vs 53.8%; P = 0.028) compared with sporadic OC cases. To investigate the association between genetic variants of ARLTS1 and the clinical-pathological characteristics of familial OC, we identified a significantly higher proportion of serous adenocarcinoma (55/67, 82.1%) and higher rates of advanced stage tumors (88.1% vs 55.6%; P = 0.004) in ARLTS1 Cys148Arg carriers. We showed a significantly increased risk of familial OC for ARLTS1 Cys148Arg variant, which indicate that ARLTS1 may play a role in familial OC.


Inhibitory action of somatostatin on pancreatic alpha and beta cell function.
In normal men, the administration of somatostatin almost completely abolished the glucose stimulated insulin-release seen during control studies (without somatostatin), and caused a further reduction in glucagon secretion beyond that induced by hyperglycemia. Following the infusion, there was a rapid and marked rebound for insulin but not glucagon secretion. These events were attended by a marked retardation of the glucose disappearance rate (K) which exhibited two clearly separable components; the initial slow component (mean K equals 0.64) coincided with the period of insulin suppression and was followed by a faster component (mean K equals 1.37) temporally related to the marked rebound increase in insulin release after discontinuation of the somatostatin infusion. Similarly, the addition of somatostatin infusion completely blocked the release of insulin and growth hormone and delayed the release of glucagon stimulated by arginine infusion. Following the somatostatin infusion there was a small rise in GH and a marked rebound for insulin and this was associated with a higher level of plasma glucose than that found following arginine infusion alone. These data establish that the administration of somatostatin can effectively block the release of insulin stimulated by arginine and glucose, can attenuate the release of glucagon induced by arginine and can enhance the glucose-mediated glucagon suppression. The attendance of a relative hyperglycemia during these events is probably the net result of an impediment in peripheral glucose disposition due to acute insulin lack and a decreased hepatic glucose output secondary to glucagon suppression.


The association of BMI and sarcopenia with survival in patients with glioblastoma multiforme.
Background: The association between obesity and sarcopenia (via temporal muscle thickness) with overall survival (OS) has been evaluated in several glioblastoma multiforme studies, however, the data are inconclusive. Methods: The authors conducted meta-analyses via the generic inverse-variance method with a random-effects model. Results: In the pooled analysis of five studies, including 973 patients, patients with lower temporal muscle thickness had significantly decreased OS (HR: 1.62, 95% CI: 1.16-2.28, p = 0.005). The pooled analysis of five studies, including 2131 patients, demonstrated decreased OS in patients with lower BMI compared with patients with obesity (HR: 1.45, 95% CI: 1.12-1.88, p = 0.005). Conclusion: Readily available body composition parameters could be used for prognosis prediction and to aid in treatment decisions in patients with glioblastoma multiforme.


Looking Inside the Black Box of "Attendance at Services": New Measures for Exploring an Old Dimension in Religion and Health Research.
Research in religion and health has spurred new interest in measuring religiousness. Measurement efforts have focused on subjective facets of religiousness such as spirituality and beliefs, and less attention has been paid to congregate aspects, beyond the single item measuring attendance at services. We evaluate some new measures for religious experiences occurring during congregational worship services. Respondents (N=576) were religiously-diverse community-dwelling adults interviewed prior to cardiac surgery. Exploratory factor analysis of the new items with a pool of standard items yielded a readily interpretable solution, involving seven correlated but distinct factors and one index variable, with high levels of internal consistency. We describe religious affiliation and demographic differences in these measures. Attendance at religious services provides multifaceted physical, emotional, social, and spiritual experiences that may promote physical health through multiple pathways.


Low-dimensional recurrent neural network-based Kalman filter for speech enhancement.
This paper proposes a new recurrent neural network-based Kalman filter for speech enhancement, based on a noise-constrained least squares estimate. The parameters of speech signal modeled as autoregressive process are first estimated by using the proposed recurrent neural network and the speech signal is then recovered from Kalman filtering. The proposed recurrent neural network is globally asymptomatically stable to the noise-constrained estimate. Because the noise-constrained estimate has a robust performance against non-Gaussian noise, the proposed recurrent neural network-based speech enhancement algorithm can minimize the estimation error of Kalman filter parameters in non-Gaussian noise. Furthermore, having a low-dimensional model feature, the proposed neural network-based speech enhancement algorithm has a much faster speed than two existing recurrent neural networks-based speech enhancement algorithms. Simulation results show that the proposed recurrent neural network-based speech enhancement algorithm can produce a good performance with fast computation and noise reduction.


Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: the Traumatic Life Events Questionnaire.
This article describes the development and preliminary validation of a brief questionnaire that assesses exposure to a broad range of potentially traumatic events. Items were generated from multiple sources of information. Events were described in behaviorally descriptive terms, consistent with Diagnostic and Statistical Manual of Mental Disorders IV posttraumatic stress disorder stressor criterion A1. When events were endorsed, respondents were asked if they experienced intense fear, helplessness, or horror (stressor criterion A2). In separate studies with college students, Vietnam veterans, battered women, and residents of a substance abuse program, most items possessed adequate to excellent temporal stability. In a study comparing questionnaire and structured-interview inquiries of trauma history, the 2 formats yielded similar rates of disclosure. Preliminary data on positive predictive power are also presented.


A fresh start for IVM: capacitating the oocyte for development using pre-IVM.
While oocyte IVM is practiced sporadically it has not achieved widespread clinical practice globally. However, recently there have been some seminal advances in our understanding of basic aspects of oocyte biology and ovulation from animal studies that have led to novel approaches to IVM. A significant recent advance in IVM technology is the use of biphasic IVM approaches. These involve the collection of immature oocytes from small antral follicles from minimally stimulated patients/animals (without hCG-priming) and an ∼24 h pre-culture of oocytes in an advanced culture system ('pre-IVM') prior to IVM, followed by routine IVF procedures. If safe and efficacious, this novel procedure may stand to make a significant impact on human ART practices. The objectives of this review are to examine the major scientific advances in ovarian biology with a unique focus on the development of pre-IVM methodologies, to provide an insight into biphasic IVM procedures, and to report on outcomes from animal and clinical human data, including safety data. The potential future impact of biphasic IVM on ART practice is discussed. Peer review original and review articles were selected from PubMed and Web of Science searches for this narrative review. Searches were performed using the following keywords: oocyte IVM, pre-IVM, biphasic IVM, CAPA-IVM, hCG-triggered/primed IVM, natural cycle IVF/M, ex-vivo IVM, OTO-IVM, oocyte maturation, meiotic competence, oocyte developmental competence, oocyte capacitation, follicle size, cumulus cell (CC), granulosa cell, COC, gap-junction communication, trans-zonal process, cAMP and IVM, cGMP and IVM, CNP and IVM, EGF-like peptide and IVM, minimal stimulation ART, PCOS. Minimizing gonadotrophin use means IVM oocytes will be collected from small antral (pre-dominant) follicles containing oocytes that are still developing. Standard IVM yields suboptimal clinical outcomes using such oocytes, whereas pre-IVM aims to continue the oocyte's development ex vivo, prior to IVM. Pre-IVM achieves this by eliciting profound cellular changes in the oocyte's CCs, which continue to meet the oocyte's developmental needs during the pre-IVM phase. The literature contains 25 years of animal research on various pre-IVM and biphasic IVM procedures, which serves as a large knowledge base for new approaches to human IVM. A pre-IVM procedure based on c-type natriuretic peptide (named 'capacitation-IVM' (CAPA-IVM)) has undergone pre-clinical human safety and efficacy trials and its adoption into clinical practice resulted in healthy live birth rates not different from conventional IVF. Over many decades, improvements in clinical IVM have been gradual and incremental but there has likely been a turning of the tide in the past few years, with landmark discoveries in animal oocyte biology finally making their way into clinical practice leading to improved outcomes for patients. Demonstration of favorable clinical results with CAPA-IVM, as the first clinically tested biphasic IVM system, has led to renewed interest in IVM as an alternative, low-intervention, low-cost, safe, patient-friendly ART approach, and especially for patients with PCOS. The same new approach is being used as part of fertility preservation in patients with cancer and holds promise for social oocyte freezing.


Widowhood and the risk of psychiatric care, psychotropic medication and all-cause mortality: a cohort study of 658,022 elderly people in Sweden.
To study the effect of widowhood on the risk of psychiatric care, psychotropic medication and mortality, and to study if the effect is modified by educational level. A nationwide, register-based cohort study. All married or widowed individuals aged 75 and older who were alive and registered in Sweden on 31 December 2004 and still registered on 31 December 2005. A total of 658,022 individuals were included in the study and followed in 2006. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated. Loss of spouse increased the risk of outpatient psychiatric visits, psychotropic medication and all-cause mortality. Prescribed psychotropic medication was more common among those newly bereaved, adjusted OR of 1.46 (95% CI 1.41-1.50), compared to those married. For those widowed for a longer period, the corresponding estimate was 1.12 (95% CI 1.11-1.14). The OR for all-cause mortality was 1.18 (95% CI 1.11-1.26). The analyses also indicated different effects on inpatient care depending on educational level. Loss of spouse increases the risk of people getting psychiatric care, both for severe and minor psychiatric conditions. The effect seems to differ depending on educational level. Further studies are needed to disentangle the mechanism behind the effects of each measurement of psychiatric conditions and how these are affected by educational level.


Designing an e-learning tool to support health practitioners caring for patients taking multiple medications.
Background: Population ageing and improvements in healthcare mean the number of people living with two or more chronic conditions, or 'multimorbidity', is rapidly increasing. This presents a challenge to current disease-specific care delivery models. Adherence to prescribed medications appears particularly challenging for individuals living with multimorbidity, given the often-complex drug regimens required to treat multiple conditions. Poor adherence is associated with increased mortality, as well as wasted healthcare resources. Supporting medication adherence is a key priority for general practitioners (GPs) and practice nurses as they are responsible for much of the disease counselling and medication prescribing associated with chronic illnesses. Despite this, practical resources and training for health practitioners on how to promote adherence in practice is currently lacking. Informed by the principles of patient and public involvement (PPI), the aim of this research was to develop a patient informed e-learning resource to help GPs and nurses support medication adherence. Method: Utilising collective intelligence (CI) and scenario-based design (SBD) methodology, input was gathered from 16 stakeholders to gain insights into barriers to supporting people with multimorbidity who are receiving polypharmacy, strategies for overcoming these barriers, and user needs and requirements to inform the design of the e-learning tool. Results: In total, 67 barriers to supporting people who are taking multiple medications were identified across 8 barrier categories. 162 options for overcoming the identified barriers were then generated. This data was used in the design of a short and flexible e-learning tool for continuous professional development, that has been integrated into general practice and clinical education programmes as a supportive tool. Conclusions: Using CI and SBD methodology was an effective way of facilitating collaboration, idea-generation, and the co-creation of design solutions amongst a diverse group of stakeholders. This approach could be usefully applied to address other complex healthcare-related challenges.


[Laboratory assessment of osteoporosis].
Osteoporosis is characterized by a generalized and progredient bone loss, leading to low bone mass and microarchitectural deterioration with subsequent bone fragility. For some percent of the patients at risk, laboratory findings may reveal unsuspected secondary osteoporosis or may influence some aspects of diagnostics and therapy. The aim of the laboratory tests is, therefore, to exclude to a large extent the most important forms of secondary osteoporosis and other potential bone diseases. Among other determinants, increased bone resorption evaluated by specific biochemical markers has been shown to be associated with increased risk of fractures independently of BMD. The combination of bone mass measurement and assessment of bone turnover by biochemical markers are thus helpful in the assessment of osteoporotic fracture risk. Repeated measurements of biochemical markers during treatment appear to improve the management of osteoporotic patients.


Making the BEST decision-the BESTa project development, implementation and evaluation of a digital Decision Aid in Swedish cancer screening programmes- a description of a research project.
Sweden has a long tradition of organized national population-based screening programmes. Participation rates differ between programmes and regions, being relatively high in some groups, but lower in others. To ensure an equity perspective on screening, it is desirable that individuals make an informed decision based on knowledge rather than ignorance, misconceptions, or fear. Decision Aids (DAs) are set to deliver information about different healthcare options and help individuals to visualize the values associated with each available option. DAs are not intended to guide individuals to choose one option over another. The advantage of an individual Decision Aid (iDA) is that individuals gain knowledge about cancer and screening by accessing one webpage with the possibility to communicate with health professionals and thereafter make their decision regarding participation. The objective is therefore to develop, implement and evaluate a digital iDA for individuals invited to cancer screening in Sweden. This study encompasses a process-, implementation-, and outcome evaluation. Multiple methods will be applied including focus group discussions, individual interviews and the usage of the think aloud technique and self-reported questionnaire data. The project is based on The International Patient Decision Aid Standards (IPDAS) framework and the proposed model development process for DAs. Individuals aged 23-74, including women (the cervical-, breast- and CRC screening module) and men (the CRC screening module), will be included in the developmental process. Efforts will be made to recruit participants with self-reported physical and mental limitations, individuals without a permanent residence and ethnic minorities. To the best of our knowledge, the present study is the first attempt aimed at developing an iDA for use in the Swedish context. The iDA is intended to facilitate shared decision making about participation in screening. Furthermore, the iDA is expected to increase knowledge and raise awareness about cancer and cancer screening. Lay people are involved throughout the whole development and implementation process of the digital DA. NCT05512260.


Potential Dietary and Therapeutic Strategies Involving Indole-3-Carbinole in Preclinical Models of Intestinal Inflammation.
Diet-microbiota interactions are emerging as important contributors in the pathogenesis of inflammatory bowel diseases (IBD), characterized by chronic inflammation of the GI tract. The aryl hydrocarbon receptor (AhR) transcription factor regulates xenobiotic metabolism and is activated by exogenous ligands, including indole-3-carbinole (I3C), which is found in cruciferous vegetables. However, studies investigating the impact of dietary I3C and AhR in preclinical models resembling human IBD are lacking. Mice (WT or AhR KO in IECs, 6-8 weeks) or SAMP/YitFC and AKR/J control (4 weeks, m/f) were fed an AhR ligand-depleted or I3C (200 ppm)-supplemented diet. There were increased levels of LPS and exacerbated inflammation, resulting in increased mortality in AhRΔIEC mice fed the AhR ligand-depleted diet in response to chronic DSS. The mechanisms underlying the protective effects of I3C supplementation during colonic colitis involved amelioration of intestinal inflammation and restoration of the altered gut microbiota, particularly the families of clostridicae and lachnospriaceae. Furthermore, the AhR-depleted diet led to the emergence of pathobiont Parvibacter caecicola in WT mice. SAMP/YitFc mice with spontaneous ileitis showed significant recovery in epithelial abnormalities when fed dietary I3C. These data demonstrate the critical role of AhR and the mechanisms of dietary I3C in maintaining epithelial homeostasis and ameliorating inflammation.


Cytogenotoxicity of Cymbopogon citratus (DC) Stapf (lemon grass) aqueous extracts in vegetal test systems.
The lemon grass, Cymbopogon citratus (DC) Stapf, is an important species of Poaceae family commonly used in the folk medicine in many countries. The aim of this study was to investigate the cytotoxic and genotoxic effects of aqueous extracts from C. citratus leaves on Lactuca sativa (lettuce) root tip meristem cells by cytogenetic studies that have never been done before for lemon grass extracts. For this, lettuce seeds were treated for 72h with different concentrations of lemon grass aqueous extracts (5; 10; 20 and 30 mg/mL). The percentage of germination, root development and cellular behavior were analyzed, and the results showed that the highest concentration of aqueous extracts reduced the mitotic index, the seed germination and the root development of lettuce. The extracts have also induced chromosome aberrations and cellular death in the roots cells of L. sativa.


Epidural anesthesia in coronary artery bypass grafting surgery.
Thoracic epidural anesthesia may affect the outcome of patients undergoing coronary artery bypass graft surgery beneficially by producing superlative perioperative analgesia, stress response attenuation, and cardiac sympatholysis. The technique of instrumentation in combination with full intraoperative heparinization, however, may risk potentially serious adverse effects and undesirable drug effects. This article attempts to establish whether a favorable risk/benefit ratio exists and to clarify the role of sympatholysis by thoracic epidural anesthesia in cardiac surgery.


Activity of enzymes of adenyline compounds metabolism during crush and decompression of muscle tissue. Part I. Adenylate deaminase activity at experimental crush syndrome.
The number of works on investigation of crush syndrome (CS) pathogenesis, of organs and enzymatic systems at traumatic toxicosis is rather limited. While the clinical current of trauma and the lethality prognosis depend on a degree of violations in them. Such investigations are necessary for opportune diagnosis and definition of a treatment tactic. To complete this deficiency, adenylate deaminase (AMPD) level was studied in twelve tissues at experimental CS in vivo. The experimental model of CS on white rats was caused by crush and decompression of femoral muscle tissue. The CS influence on AMPD activity was investigated in hemisphere, cerebellum, hypothalamus, pituitary body, heart, lung, liver, spleen, kidney, adrenal, crushed and not crushed muscles. In muscles, kidney, pituitary body and adrenal the activity decreased in 2 hours crush but the compensation of effect is observed after 5 hours crush. In cerebellum, hemisphere, heart, liver and lung it decreased during both of crush times. After 2 and 5 hours crush in hypothalamus and in spleen AMPD activity appeared much higher than in control. After 2 hours crush at the end of 48 hours decompression, the activity in muscles, kidney, adrenal and pituitary body was lower, in cerebellum, hypothalamus, hemisphere and heart--higher than, in lung, spleen and liver--close to control. After 5 hours crush in the majority of studied tissues at the end of decompression, the activity was below of control. The greatest deviance was observed in muscles. As to brain in cerebellum and hemisphere the parameter was close to, in pituitary body and in hypothalamus it was 1,5-fold of control. AMPD level in the most of studied tissues differs from the control at definite time of crush and decompression. These results mean the possibility of nucleotides pool balance distortion and intermediates accumulation.


Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose.
Subsequent malignant neoplasms (SMNs) are a dominant cause of morbidity and mortality in children treated for Hodgkin's disease (HD). We evaluated select demographic and therapeutic factors associated with SMNs, specifically gender and radiation dose. A total of 930 children treated for HD at five institutions between 1960 and 1990 were studied. Mean age at diagnosis was 13.6 years, and mean follow-up was 16.8 years (maximum, 39.4 years). Treatment included radiation alone (43%), chemotherapy alone (9%), or both (48%). We found that SMNs occurred in 102 (11%) patients, with a 25-year actuarial rate of 19%. With 15,154 patient years of follow-up, only 7.18 cancers were expected (standardized incidence ratio [SIR] = 14.2; absolute excess risk [AER] = 63 cases/10,000 years). The SIR for female subjects, 19.93, was significantly greater than for males, 8.41 (p < 0.0001). After excluding breast cancer, the SIR for female patients was 15.4, still significantly greater than for male patients (p = 0.0012). Increasing radiation dose was associated with an increasing SIR (p = 0.0085). On univariate analysis, an increased risk was associated with female gender, increasing radiation dose, and age at treatment (12-16 years). Using logistic regression, mantle radiation dose increased risk, and this was 2.5-fold for female patients treated with more than 35 Gy primarily because of breast cancer. Survivors of childhood HD are at risk for SMNs, and this risk is greater for female individuals even after accounting for breast cancer. Although SMNs occur in the absence of radiation therapy, the risk increases with RT dose.