Physician attitudes towards-and adoption of-mobile health.
Smartphone apps and mobile devices are an emerging method of healthcare data collection. This study sought to understand how physicians currently view mobile health (mHealth) technologies and use them in patient care. A total of 186 physicians affiliated with Washington University School of Medicine in St. Louis, Missouri, USA completed a survey in 2016 regarding their current implementation of mHealth technologies for patient care and support for further development. More than half of respondents were willing to discuss health apps and mobile devices with patients. However, most were not currently recommending them to patients. Apps/devices that encouraged a healthy diet and weight or tracked heart rate received the highest satisfaction ratings. Apps/devices that accessed the EMR (electronic medical record) remotely, provided medication reminders, or enrolled research subjects garnered the most interest despite respondents lacking prior experience. A majority agreed that collected biometrics are useful for promoting a healthy lifestyle (68%), tracking medical treatment (64%), or conducting research (56%); and agreed that proof of accuracy and precision (81%) and the efficient integration of collected data (68%) are necessary improvements. Uploading data automatically and updating physicians in real-time was the most preferred method of data integration into the EMR. Physicians show interest in using mHealth technologies for patient care but have limited experience, usually with those specific to their specialties. Proof of quality and a method to integrate data into the EMR are necessary for a mainstream role in healthcare.


Antituberculosis cycloartane triterpenoids from Radermachera boniana.
Three new triterpenoids, bonianic acids A (1) and B (2) and 3-O-acetyluncaric acid (3), were isolated from the leaves and twigs of Radermachera boniana, together with six known compounds, ursolic acid (4), oleanolic acid (5), 3-epi-oleanolic acid (6), 3α-O-acetyl-α-boswellic acid (7), ergosterol peroxide (8), and β-sitostenone (9). Ergosterol peroxide (8) and bonianic acids A (1) and B (2) exhibited significant activity against Mycobacterium tuberculosis H37Rv strain.


New approaches for the calibration of exchange-energy densities in local hybrid functionals.
The ambiguity of exchange-energy densities is a fundamental challenge for the development of local hybrid functionals, or of other functionals based on a local mixing of exchange-energy densities. In this work, a systematic construction of semi-local calibration functions (CFs) for adjusting the exchange-energy densities in local hybrid functionals is provided, which directly links a given CF to an underlying semi-local exchange functional, as well as to the second-order gradient expansion of the exchange hole. Using successive steps of integration by parts allows the derivation of correction terms of increasing order, resulting in more and more complicated but also more flexible CFs. We derive explicit first- and second-order CFs (pig1 and pig2) based on B88 generalized-gradient approximation (GGA) exchange, and a first-order CF (tpig1) based on τ-dependent B98 meta-GGA exchange. We combine these CFs with different long-range damping functions and evaluate them for calibration of LDA, B88 GGA, and TPSS meta-GGA exchange-energy densities. Based on a minimization of unphysical nondynamical correlation contributions in three noble-gas dimer potential-energy curves, free parameters in the CFs are optimized, and performance of various approaches in the calibration of different exchange-energy densities is compared. Most notably, the second-order pig2 CF provides the largest flexibility with respect to the diffuseness of the damping function. This suggests that higher-order CFs based on the present integration-by-parts scheme may be particularly suitable for the flexible construction of local hybrid functionals.


Effects of the forage-to-concentrate ratio of the diet on feeding behaviour in young Blond d'Aquitaine bulls.
The activities of bulls, their feeding behaviour and their ruminal pH were examined at several stages during the finishing period, according to the forage-to-concentrate ratio of their diet. Twenty-four bulls of the Blond d'Aquitaine breed (initial body weight = 326 ± 21 kg) were assigned to six balanced pens with a space allowance of 9.4 m2 per bull during the finishing period. They were fed three different diets with achieved forage-to-concentrate ratios of (i) 8% straw and 92% concentrate, (ii) 44% hay and 56% concentrate and (iii) 57% maize silage and 43% concentrate. Bulls had ad libitum access to feed dispensed once daily. Offered and refusals were weighed on 5 consecutive days per week. The bulls were slaughtered at the common final live weight of 650 kg and the finishing period lasted 138, 181 and 155 days for straw-concentrate, hay-concentrate and maize silage-concentrate diets, respectively. The time budget was estimated four times by scan sampling with a 10-min interval. Feeding behaviour was appraised using data from electronic feeding gates. Ruminal pH was measured from a ruminal fluid sample collected by rumenocentesis. On average, the bulls spent 78% of the time lying or standing still, and 11% of the time eating. The forage-to-concentrate ratio of the diet influenced only those activities directly linked to feeding, i.e. eating and drinking. Bulls fed a high-concentrate diet spent less time eating than the other bulls (47 min v. >2 h) and took shorter meals (7 min v. 17 min). The bulls fed the straw-concentrate diet spread their meals over the entire day, whereas the others maintained two major peaks of eating activity, the main one in the morning after feed dispensing, the other one at the end of the diurnal period. Intake rate ranged widely between diets, from 58 g/min on average for the diets based on hay or maize silage up to 173 g/min for the high-concentrate diet. The concentrate-diet bulls also had a lower ruminal pH during the first 2 months of the finishing period. The dispersion of meals based on a high-acidosis-risk diet may be a way to limit the decrease in ruminal pH.


Dissociation between exhaled nitric oxide and hyperresponsiveness in children with mild intermittent asthma.
Bronchial hyperresponsiveness and airway inflammation are distinctive features of asthma. Evaluation of nitric oxide (NO) levels in expired air have been proposed as a reliable method for assessing the airway inflammatory events in asthmatic subjects. A study was undertaken to evaluate whether airway hyperresponsiveness is related to levels of exhaled NO. Thirty two steroid-naive atopic children with mild intermittent asthma of mean (SD) age 11.8 (2.3) years and 28 age matched healthy controls were studied to investigate whether baseline lung function or airway hyperresponsiveness is related to levels of exhaled NO. Airway responsiveness was assessed as the dose of methacholine causing a 20% decrease in forced expiratory volume in one second (FEV(1)) from control (PD(20) methacholine) and exhaled NO levels were measured by chemiluminescence analysis of exhaled air. At baseline asthmatic children had significantly higher NO levels than controls (mean difference 25.87 ppb (95% CI 18.91 to 32.83); p<0.0001) but there were no significant differences in lung function parameters (forced vital capacity (FVC), FEV(1) (% pred), and forced expiratory flows at 25-75% of vital capacity (FEF(25-75%))). In the asthmatic group exhaled NO levels were not significantly correlated with baseline lung function values or PD(20) methacholine. These results suggest that levels of exhaled NO are not accurate predictors of the degree of airway responsiveness to inhaled methacholine in children with mild intermittent asthma.


Essential role of TRPC6 channels in G2/M phase transition and development of human glioma.
Patients with glioblastoma multiforme, the most aggressive form of glioma, have a median survival of approximately 12 months. Calcium (Ca(2+)) signaling plays an important role in cell proliferation, and some members of the Ca(2+)-permeable transient receptor potential canonical (TRPC) family of channel proteins have demonstrated a role in the proliferation of many types of cancer cells. In this study, we investigated the role of TRPC6 in cell cycle progression and in the development of human glioma. TRPC6 protein and mRNA expression were assessed in glioma (n = 33) and normal (n = 17) brain tissues from patients and in human glioma cell lines U251, U87, and T98G. Activation of TRPC6 channels was tested by platelet-derived growth factor-induced Ca(2+) imaging. The effect of inhibiting TRPC6 activity or expression using the dominant-negative mutant TRPC6 (DNC6) or RNA interference, respectively, was tested on cell growth, cell cycle progression, radiosensitization of glioma cells, and development of xenografted human gliomas in a mouse model. The green fluorescent protein (GFP) and wild-type TRPC6 (WTC6) were used as controls. Survival of mice bearing xenografted tumors in the GFP, DNC6, and WTC6 groups (n = 13, 15, and 13, respectively) was compared using Kaplan-Meier analysis. All statistical tests were two-sided. Functional TRPC6 was overexpressed in human glioma cells. Inhibition of TRPC6 activity or expression attenuated the increase in intracellular Ca(2+) by platelet-derived growth factor, suppressed cell growth and clonogenic ability, induced cell cycle arrest at the G2/M phase, and enhanced the antiproliferative effect of ionizing radiation. Cyclin-dependent kinase 1 activation and cell division cycle 25 homolog C expression regulated the cell cycle arrest. Inhibition of TRPC6 activity also reduced tumor volume in a subcutaneous mouse model of xenografted human tumors (P = .014 vs GFP; P < .001 vs WTC6) and increased mean survival in mice in an intracranial model (P < .001 vs GFP or WTC6). In this preclinical model, TRPC6 channels were essential for glioma development via regulation of G2/M phase transition. This study suggests that TRPC6 might be a new target for therapeutic intervention of human glioma.


Recognizing partially occluded parts.
The problem of recognizing an object from a partially occluded boundary image is considered, and the concept of saliency of a boundary segment is introduced. Saliency measures the extent to which the boundary segment distinguishes the object to which it belongs from other objects which might be present. An algorithm is presented which optimally determines the saliency of boundary segments of one object with respect to those of a set of other objects. An efficient template matching algorithm using templates weighted by boundary segment saliency is then presented and employed to recognize partially occluded parts. The results of these experiments illustrate the effectiveness of the new technique.


Improvement of dry mouth by replacing paroxetine with fluvoxamine.
To present a case of improvement of paroxetine-induced dry mouth by substitution of fluvoxamine and analyze this case based on receptor occupancy theory. A 66-year-old woman with major depressive disorder had been treated with brotizolam 0.5 mg/day, flunitrazepam 2 mg/day, sulpiride 100 mg/day, bromazepam 2 mg/day, trazodone 25 mg/day, and paroxetine hydrochloride 10 mg/day. Although her psychological symptoms improved gradually, she complained of dry mouth. Paroxetine was replaced with fluvoxamine maleate 50 mg/day, and the dryness disappeared within a month. We calculated the time courses of muscarinic acetylcholine (mACh) receptor occupancy after oral administration of paroxetine and fluvoxamine at the treatment doses by using pharmacokinetic parameters obtained from the literature. The mACh receptor occupancy was estimated to be decreased from 0.22% to 0.020% by replacing paroxetine with fluvoxamine. The improvement of dry mouth observed after the replacement of paroxetine with fluvoxamine in this patient may have been due to a decrease in the mACh receptor occupancy.


The expression of Jagged1 in the developing mammalian heart correlates with cardiovascular disease in Alagille syndrome.
The establishment of the cardiovascular system represents an early, critical event essential for normal embryonic development, and defects in cardiovascular development are a frequent cause of both in utero and neonatal demise. Congenital cardio-vascular malformations, the most frequent birth defect, can occur as isolated events, but are frequently presented clinically within the context of a constellation of defects that involve multiple organs and that define a specific syndrome. In addition, defects can be a primary effect of gene mutations or result from secondary effects of altered cardiac physiology. Alagille syndrome (AGS) is an autosomal dominant disorder characterized by developmental abnormalities of the heart, liver, eye, skeleton and kidney. Congenital heart defects, the majority of which affect the right-sided or pulmonary circulation, contribute significantly to mortality in AGS patients. Recently, mutations in Jagged1 ( JAG1 ), a conserved gene of the Notch intercellular signaling pathway, have been found to cause AGS. In order to begin to delineate the role of JAG1 in normal heart development we have studied the expression pattern of JAG1 in both the murine and human embryonic heart and vascular system. Here, we demonstrate that JAG1 is expressed in the developing heart and multiple associated vascular structures in a pattern that correlates with the congenital cardiovascular defects observed in AGS. These data are consistent with an important role for JAG1 and Notch signaling in early mammalian cardiac development.


Genetic diversity in Tunisia: a study based on the GM polymorphism of human immunoglobulins.
The GM polymorphism of human immunoglobulins is analyzed in three Berber populations of southern Tunisia and compared to other GM data. Genetic diversity among Tunisian populations is higher than that among Europeans but does not exhibit any significant geographic or linguistic structure. This result suggests a complex pattern of genetic differentiation.


Processing of the E1 glycoprotein of hepatitis C virus expressed in mammalian cells.
The structural part of the hepatitis C virus (HCV) genome encodes a capsid protein, C and two envelope glycoproteins, E1 and E2, released from the virus polyprotein precursor by signalase(s) cleavage(s). The processing of E1 was investigated by infecting simian cells with recombinant vaccinia viruses expressing parts of the HCV structural proteins. When the predicted E1 sequence was expressed alone (amino acid residues 174-370 of the polyprotein) or with the capsid protein gene (residues 1-370). it showed an apparent molecular mass of 35 kDa as measured by SDS-PAGE analysis. However, when E1 was expressed as part of a truncated C-E1-truncated E2 polypeptide (residues 132-383), the processed E1 product had the expected apparent molecular mass of 31 kDa, suggesting that flanking sequences are necessary for the generation of the mature 31 kDa El form. The N-terminal sequence of the two E1 forms was found to be the same. Analysis of the glycosylation pattern showed that, in both species, only four of the five potential N-linked glycosylation sites were recognized, indicating that glycosylation was not involved in the molecular mass difference. We showed that expression of E1 with or without the hydrophobic stretch of amino acids residues 371-383, defined as the E2 signal sequence, may be responsible for the difference in electrophoretic mobility of the two E1 species. In vitro translation assays and site-directed mutagenesis experiments suggest that this sequence remains part of the 31 kDa E1 mature protein.


Role of indocyanine green fluorescence videoangiography in evaluation of subretinal disease.
Indocyanine green (ICG) is a sterile, water-soluble, tricarbocyanine dye that can be used in fundus angiography as an adjunct to sodium fluorescein. It has a peak spectral absorption of 805 nm in blood plasma or blood, as compared with fluorescein, which has a peak spectral absorption of 465 nm. Because the absorption and emission of ICG lies around 835 nm, transmission of energy by the retinal pigment epithelium (RPE) and serosanguinated material is more efficient in this region than in the region of visible light energy. ICG has the property of being approximately 98% bound to blood protein, disallowing extravasation of excessive dye in the highly fenestrated choroidal vasculature. The characteristics of ICG are discussed, including administration and dosage, adverse reactions and use of infrared filters for fundus photography. In addition, two cases are presented to illustrate the clinical application of ICG for diagnosis and treatment of choroidal neovascular membranes. ICG videoangiography can be used to reveal subfoveal choroidal neovascular membranes not previously identified with fluorescein; angiograms can also be used to dramatically highlight retinal and choroidal changes. The use of ICG for fundus videoangiography provides a more accurate and complete evaluation in certain cases of subretinal and choroidal disease.


[Efficacy of HRV-biofeedback as additional treatment of depression and PTSD].
Heartrate variability biofeedback (HRVB) is a non-invasive treatment in which patients are assumed to self-regulate a physiological dysregulated vagal nerve. Although the therapeutic approach of HRVB is promising in various stress-related disorders, it has only been offered on a regular basis in a few mental health treatment settings. To analyse the efficacy of HRV biofeedback as an additional psychophysiological treatment for depression and PTSD. Systematic review with search terms HRV, biofeedback, PTSD, depression, panic disorder and anxiety disorder. Our search of the literature yielded 789 studies. After critical appraisal using the GRADE method, we selected 6 randomised controlled trials (RCTs) and 4 relevant studies. The RCTs with control groups 'treatment as usual' and muscle relaxation training revealed significant clinical efficacy and better results than control conditions after 4 to 8 weeks training. Although this systematic review shows the popularity of HRV in literature, it does not indicate that HRVB really has been reviewed systematically. Significant outcomes of this limited number of randomised studies indicate there may be a clinical improvement when HRVB training is integrated into treatment of PTSD and depression, particularly when this integration procedure is combined with psychotherapy. More research needs to be done with larger groups and further efforts are needed to integrate HRVB into treatment of stress-related disorders in psychiatry. Future research also needs to focus on the psychophysiological mechanisms involved.


The impact of early therapeutic intervention on the central pattern generator in premature newborns - a preliminary study and literature review.
The aim: To study the effect of therapeutic intervention on the improvement of the rhythmicity of non-nutritive and nutritive sucking in premature newborns and on the suck central pattern generator. Material and methods: Stimulation of the breast zone was performed in two premature newborns by means of the Vojta method. Intraoral pressure was measured during non-nutritive and nutritive sucking before and after this therapeutic intervention. The maximum negative pressures generated during individual sucks and the intervals between sucks were analysed. Results: The stimulation of the breast zone using the Vojta method seems to have no impact on the duration of individual sucking episodes. However, a significant improvement in the rhythmicity and regularity of sucking was observed in both newborns: the coefficient of quartile deviation for the intervals decreased from 15% and 11% to 13% and 6%, respectively, and for the maximum negative pressures it decreased from 24% and 27% to 9% and 19%, respectively. Additionally, the median value of the maximum negative pressure decreased in both newborns: from -39 and -37 mmHg to -45 and -60 mmHg, respectively. Conclusions: The stimulation of the breast zone using the Vojta method seems to have a direct impact on the central pattern generator, which improves the rhythmicity as well as the regularity of both non-nutritive and nutritive sucking.


Bronchial involvement in advanced stage lymphangioleiomyomatosis: histopathologic and molecular analyses.
Lymphangioleiomyomatosis (LAM), a rare progressive disease that almost exclusively affects women, is characterized by pulmonary cysts and neoplastic proliferation of smooth muscle-like cells (LAM cells). Airflow obstruction is a physiologic consequence that is commonly observed in LAM and has been attributed to narrowing of peripheral airways. However, histopathologic examinations of the entire airway have been precluded by the limited availability of such specimens. Here, we used explanted lung tissues from 30 LAM patients for a thorough histologic analysis with a special emphasis on the bronchi. We found bronchial involvement by LAM cells and lymphatics in all patients examined. Furthermore, a moderate to severe degree of chronic inflammation (73%), goblet cell hyperplasia (97%), squamous cell metaplasia (83%) of the epithelium, and thickening of basal lamina (93%) were identified in the bronchi. Because LAM cells are transformed by the functional loss of the TSC genes leading to a hyperactivated mammalian target of rapamycin complex 1 (mTORC1) signaling pathway, we confirmed the expression of phospho-p70S6K, phospho-S6, phospho-4E-BP1, and vascular endothelial growth factor (VEGF)-D in LAM cells from all of the patients examined. In contrast, no protein expression of hypoxia-inducible factor 1α, a downstream molecule indicative of mTORC1 activation and leading to VEGF production, was detected in any patient. Our study indicates that late-stage LAM patients commonly have bronchi involved by the proliferation of both LAM cells and lymphatics and that chronic inflammation complicated their disease. Furthermore, the up-regulation of hypoxia-inducible factor 1α, a common event in mTORC1-driven tumor cells, does not occur in LAM cells and plays no role in VEGF-D expression in LAM cells.


Which is worse: uterine papillary serous carcinomas or carcinosarcomas?
It is clear that uterine carcinosarcomas and uterine papillary serous carcinomas (UPSC) have an adverse impact on outcome, but whether carcinosarcomas are worse than UPSC is unclear. The purpose of this study is to compare the pathology, survival, and disease recurrence of patients with carcinosarcomas to patients with UPSC. The medical records of patients diagnosed with carcinosarcomas and UPSC between 1996 and 2009 at Samsung Medical Center were retrospectively analyzed. Information from pathology reports, site of relapse, time to recurrence, and death was obtained. The survival analysis was performed using the Kaplan-Meier method. Thirty seven patients with carcinosarcomas and 38 patients with UPSC were identified during the study period. There was no significant difference in clinical characteristics including age, body mass index, proportion with advanced stage disease, rate of optimal debulking, and adjuvant treatment used. In addition, the pathology showed no significant difference in tumor size, myometrial involvement, lymphovascular invasion, peritoneal cytology, cervical invasion, and lymph node involvement. Patients with carcinosarcomas had similar patterns of relapse as the patients with UPSC. There was no difference in the progression-free and overall survival between the carcinosarcomas and UPSC patients (p=0.804 and p=0.651, respectively). Patients with carcinosarcomas had similar clinicopathological features compared to the patients with UPSC.


Dust exposure and mortality in an American chrysotile textile plant.
Three parallel cohort studies of asbestos factory workers were undertaken to investigate the effects of mineral fibre type and industrial process on malignant mesothelioma, respiratory cancer, and asbestosis. This report describes the mortality of a cohort of 2543 men, defined as all those employed for at least a month from 1938 to 1958 in a textile plant in South Carolina in which chrysotile was the only type of asbestos used. Of these, 863 men (34%) had died before 31 December 1977, one from malignant mesothelioma. Twenty one deaths were ascribed to asbestosis and 66 to cancer of the lung. Compared with the number expected from South Carolina, there was an excess of 30 deaths from respiratory cancer (ICD 160-164) in men 20 or more years after first employment (SMR 199.5). In men employed five years or more, no SMRs for this category rose above 300. Individual exposures were estimated (in mpcf X years) from recorded environmental measurements. Life table analyses and "log-rank" (case-control) analyses both showed a steep linear exposure-response that was some 50-fold greater at similar accumulated dust exposures than in Canadian chrysotile mining and milling. These findings agree closely with those from another study in this plant and confirm that mesothelioma is rarely associated with chrysotile exposure. Cigarette smoking habits did not greatly differ between the textile workers and the Canadian miners and millers. The far greater risk of lung cancer in the textile industry, if not attributable to other identified cocarcinogens, may be related to major differences in the size distribution of fibres in the submicroscopic range which are not detected by the usual fibre or particle counting procedures.


Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis.
There is increasing interest in the role of 'self-management' interventions to support the management of long-term conditions in health service settings. Self-management may include patient education, support for decision-making, self-monitoring and psychological and social support. Self-management support has potential to improve the efficiency of health services by reducing other forms of utilisation (such as primary care or hospital use), but a shift to self-management may lead to negative outcomes, such as patients who feel more anxious about their health, are less able to cope, or who receive worse quality of care, all of which may impact on their health and quality of life. We sought to determine which models of self-management support are associated with significant reductions in health services utilisation without compromising outcomes among patients with long-term conditions. We used systematic review with meta-analysis. We included randomised controlled trials in patients with long-term conditions which included self-management support interventions and reported measures of service utilisation or costs, as well as measures of health outcomes (standardized disease specific quality of life, generic quality of life, or depression/anxiety).We searched multiple databases (CENTRAL, CINAHL, Econlit, EMBASE, HEED, MEDLINE, NHS EED and PsycINFO) and the reference lists of published reviews. We calculated effects sizes for both outcomes and costs, and presented the results in permutation plots, as well as conventional meta-analyses. We included 184 studies. Self-management support was associated with small but significant improvements in health outcomes, with the best evidence of effectiveness in patients with diabetic, respiratory, cardiovascular and mental health conditions. Only a minority of self-management support interventions reported reductions in health care utilisation in association with decrements in health. Evidence for reductions in utilisation associated with self-management support was strongest in respiratory and cardiovascular problems. Studies at higher risk of bias were more likely to report benefits. Self-management support interventions can reduce health service utilization without compromising patient health outcomes, although effects were generally small, and the evidence was strongest in respiratory and cardiovascular disorders. Further work is needed to determine which components of self-management support are most effective.


Effects of bed nets and anti-malaria drugs use on childhood mortality in Kenya's malaria endemic and epidemic areas.
The Kenya Demographic and Health Surveys (KDHS) data collected since 1989 indicate that malaria prone areas have consistently recorded the highest childhood mortality rates. Malaria control programme information also indicates that malaria contributes to about 20 per cent of the deaths among under-five year old children. The 2009-2017 National Malaria Strategy is being implemented to reduce malaria morbidity and mortality. Its key interventions include: bed nets use; anti-malaria drugs use during pregnancy for prevention; and, prompt treatment using anti-malaria drugs of children with fever. This study seeks to establish differentials in childhood mortality rates by these interventions in three malaria prone areas defined as highland epidemic, coast endemic and lake endemic. It also seeks to determine the effects of these interventions on childhood mortality. The data used is drawn from the 2008/9 KDHS. The study sample consists of 3,728 children born less than 60 months prior to the survey. The direct demographic method for estimation of childhood mortality rates and multivariate Poisson regression models are used to analyse the data. The findings show that use of bed nets and anti-malaria drugs are not high in Kenya's malaria prone areas. On the average, only about 60% of the children are found to be in higher use category for each of the three intervention measures. The childhood mortality rates show that higher use of prompt treatment with anti-malaria drugs for children with fever has lower infant and under-five mortality rates in all malaria epidemic and endemic areas compared to lower use. Higher bed nets use has lower childhood mortality rates compared to lower use in coast and lake endemic areas. Higher use of anti-malaria drugs during pregnancy for prevention has lower childhood mortality rates in highland epidemic and lake endemic areas compared to lower use. The regression models fitted show that in highland epidemic area, higher use of anti-malaria drugs during pregnancy for prevention has significant reduction effect on childhood mortality compared to lower use in the presence of breastfeeding duration, toilet facility type and age of child variables. The regression models also show that in combined malaria prone areas, higher prompt treatment of children with fever using anti-malaria drugs has significant reduction effect on both infant and child mortality compared to lower prompt treatment in the presence of breastfeeding duration and toilet facility type variables. This study underscore the need for increasing uptake of malaria interventions and complementing them with longer breastfeeding duration and improved toilet facility in efforts towards reducing infant and child mortality rates in Kenya's malaria prone areas. There is also need to improve quality of individual household data for malaria module in future KDHS undertakings.


Successful management of alloimmunized patients by transfusing HLA compatible and crossmatched platelets.
An average of three (range 0-22) perfect matches for 65 patients could be found in 1490 filed HLA-typed donors. It could increase to 8.7 (0-45) if strong cross-reactive antigens were added. Three methods of platelet crossmatching, i.e, lymphocytotoxicity test (LCT), platelet suspension immunofluorescence test (PSIFT) and solid phase red cell adherence test (SPRCA), were used to search for compatible donors. Forty episodes of apheresis platelet transfusion were evaluated in seven patients. Using one-hour posttransfusional corrected count of increment (CCI), greater than 7500 microliters as a guideline to assess the reliability of these three methods, we found that the efficiency of PSIFT, LCT and SPRCA were 67.5%, 97.5% and 97.5% respectively. Retrospectively, we did the HLA-A, B typing of those matched donors. There was no significant difference in CCI among different HLA match grades. The concordance of LCT and SPRCA was 100%, indicating that all the antibodies were of HLA specificity and there was no platelet specific antibody. We concluded that HLA donor-file and platelet crossmatching technique could be used together in selecting suitable donors for alloimmunized patients.


Gunshot wounds of the suprarenal abdominal aorta.
Four cases of gunshot wounds to the suprarenal abdominal aorta are described. All required prosthetic graft replacement including one or more visceral arterial branches. Two patients survived. Factors important in survival were rapid transportation permitting early resuscitation and retroperitoneal tamponade which delayed exsanguination and permitted stabilization with systematic management. The major problem in management of gunshot wounds of the suprarenal abdominal aorta is limitation of visceral ischemia, particularly hepatic and renal. Special adjuncts such as local renal hypothermia, as used in these cases, or bypass techniques are necessary and should be available before exploration of a periaortic hematoma due to gunshot wound in this area.


p63 establishes epithelial enhancers at critical craniofacial development genes.
The transcription factor p63 is a key mediator of epidermal development. Point mutations in p63 in patients lead to developmental defects, including orofacial clefting. To date, knowledge on how pivotal the role of p63 is in human craniofacial development is limited. Using an inducible transdifferentiation model, combined with epigenomic sequencing and multicohort meta-analysis of genome-wide association studies data, we show that p63 establishes enhancers at craniofacial development genes to modulate their transcription. Disease-specific substitution mutation in the DNA binding domain or sterile alpha motif protein interaction domain of p63, respectively, eliminates or reduces establishment of these enhancers. We show that enhancers established by p63 are highly enriched for single-nucleotide polymorphisms associated with nonsyndromic cleft lip ± cleft palate (CL/P). These orthogonal approaches indicate a strong molecular link between p63 enhancer function and CL/P, illuminating molecular mechanisms underlying this developmental defect and revealing vital regulatory elements and new candidate causative genes.


Requirement of longitudinal synchrony of epileptiform discharges in the hippocampus for seizure generation: a pilot study.
The goal in this study was to assess the role of longitudinal hippocampal circuits in the generation of interictal and ictal activity in temporal lobe epilepsy (TLE) and to evaluate the effects of multiple hippocampal transections (MHT). In 6 patients with TLE, the authors evaluated the synchrony of hippocampal interictal and ictal epileptiform discharges by using a cross-correlation analysis, and the effect of MHT on hippocampal interictal spikes was studied. Five of the 6 patients were studied with depth electrodes, and epilepsy surgery was performed in 4 patients (anterior temporal lobectomy in 1 and MHT in 3). Four hundred eighty-two (95.1%) of 507 hippocampal spikes showed an anterior-to-posterior propagation within the hippocampus, with a fixed peak-to-peak interval. During seizures, a significant increase of synchronization between different hippocampal regions and between the hippocampus and the ipsilateral anterior parahippocampal gyrus was observed in all seizures. An ictal increase in synchronization between the hippocampus and ipsilateral amygdala was seen in only 24.1% of the seizures. No changes in synchronization were noticed during seizures between the hippocampi and the amygdala on either side. The structure leading the epileptic seizures varied over time during a given seizure and also from one seizure to another. Spike analysis during MHT demonstrated that there were two spike populations that reacted differently to this procedure--namely, 1) spikes that showed maximum amplitude at the head of the hippocampus (type H); and 2) spikes that showed the highest amplitude at the hippocampal body (type B). A striking decrease in amplitude and frequency of type B spikes was noticed in all 3 patients after transections at the head or anterior portion of the hippocampal body. Type H spikes were seen in 2 cases and did not change in amplitude and frequency throughout MHT. Type B spikes showed constantly high cross-correlation values in different derivations and a relatively fixed peak-to-peak interval before MHT. This fixed interpeak delay disappeared after the first transection, although high cross-correlation values persisted unchanged. All patients who underwent MHT remained seizure free for more than 2 years. These data suggest that synchronized discharges involving the complete anterior-posterior axis of the hippocampal/parahippocampal (H/P) formation underlie the spread of epileptiform discharges outside the H/P structures and, therefore, for the generation of epileptic seizures originating in the H/P structures. This conclusion is supported by the following observations. 1) Hippocampal spikes are consistently synchronized in the whole hippocampal structures, with a fixed delay between the different hippocampal areas. 2) One or two transections between the head and body of the hippocampal formation are sufficient to abolish hippocampal spikes that are synchronized along the anterior-posterior axis of the hippocampus. 3) Treatment with MHT leads to seizure freedom in patients with H/P epilepsy.


Determining the nucleotide sequence and capsid-coding region of himetobi P virus: a member of a novel group of RNA viruses that infect insects.
We determined the complete genome sequence of Himetobi P virus (HiPV), an insect picorna-like virus, which was isolated from the small brown planthopper, Laodelphax striatellus. The genome of HiPV consists of 9,275 nucleotides excluding the poly (A) tail, and contains two large open reading frames (ORFs), which were separated by a 176-nucleotide noncoding region. The deduced amino acid sequence of the first ORF contains core motifs of picornaviral helicase, protease, and RNA-dependent RNA polymerase. The capsid protein-coding region was mapped onto the second ORF by determining the N-terminal amino acid sequences of the capsid proteins. Subgenomic RNA for the capsid protein gene was not detected in the infected tissue. The capsid protein precursor gene of HiPV lacks an AUG initiation codon at the expected position and the upstream sequence of the gene is predicted to form several stem-loop structures, suggesting that the precursor is produced by internal ribosome entry site (IRES) mediated-translation, as occurs in Plutia stali intestine virus (PSIV). These characteristics of the HiPV genome are similar to those of a new group of RNA viruses consisting of Drosophila C virus (DCV), Rhopalosiphum padi virus (RhPV), and PSIV.


Modulating the RNA processing and decay by the exosome: altering Rrp44/Dis3 activity and end-product.
In eukaryotes, the exosome plays a central role in RNA maturation, turnover, and quality control. In Saccharomyces cerevisiae, the core exosome is composed of nine catalytically inactive subunits constituting a ring structure and the active nuclease Rrp44, also known as Dis3. Rrp44 is a member of the ribonuclease II superfamily of exoribonucleases which include RNase R, Dis3L1 and Dis3L2. In this work we have functionally characterized three residues located in the highly conserved RNB catalytic domain of Rrp44: Y595, Q892 and G895. To address their precise role in Rrp44 activity, we have constructed Rrp44 mutants and compared their activity to the wild-type Rrp44. When we mutated residue Q892 and tested its activity in vitro, the enzyme became slightly more active. We also showed that when we mutated Y595, the final degradation product of Rrp44 changed from 4 to 5 nucleotides. This result confirms that this residue is responsible for the stacking of the RNA substrate in the catalytic cavity, as was predicted from the structure of Rrp44. Furthermore, we also show that a strain with a mutation in this residue has a growth defect and affects RNA processing and degradation. These results lead us to hypothesize that this residue has an important biological role. Molecular dynamics modeling of these Rrp44 mutants and the wild-type enzyme showed changes that extended beyond the mutated residues and helped to explain these results.


Monoamine changes in the brain of cats during slow-wave sleep.
We have found that the metabolism of 5-hydroxytryptamine increases in the hippocampus and that the metabolism of dopamine decreases in the striatum and thalamus during slow-wave sleep, and we suggest that these changes are related to this stage of sleep. We have also found that the concentration of dopamine increases in the hippocampus during slow-wave sleep, and suggest that this may be related to the subsequent appearance of paradoxical sleep. These data raise new questions on the hippocampal role in the sleep-wakefulness cycle.


Combination therapy with venlafaxine and carbamazepine in depressive patients not responding to venlafaxine: pharmacokinetic and clinical aspects.
The chiral antidepressant venlafaxine (VEN) is both a serotonin and a norepinephrine uptake inhibitor. CYP2D6 and CYP3A4 contribute to its metabolism, which has been shown to be stereoselective. Ten CYP2D6 genotyped and depressive (F32x and F33x, ICD-10) patients participated in an open study on the pharmacokinetic and pharmacodynamic consequences of a carbamazepine augmentation in VEN non-responders. After an initial 4-week treatment with VEN (195 +/- 52 mg/day), the only poor metabolizer out of 10 depressive patients had the highest plasma concentrations of S-VEN and R-VEN, respectively, whereas those of R-O-demethyl-VEN were lowest. Five non-responders completed the second 4-week study period, during which they were submitted to a combined VEN-carbamazepine treatment. In the only non-responder to this combined treatment, there was a dramatic decrease of both enantiomers of VEN, O-demethylvenlafaxine, N-desmethylvenlafaxine and N, O-didesmethylvenlafaxine in plasma, which suggests non-compliance, although metabolic induction by carbamazepine cannot entirely be excluded. The administration of carbamazepine [mean +/- SD, range: 360 +/- 89 (200-400) mg/day] over 4 weeks did not result in a significant modification of the plasma concentrations of the enantiomers of VEN and its O- and N-demethylated metabolites in the other patients. In conclusion, these preliminary observations suggest that the combination of VEN and carbamazepine represents an interesting augmentation strategy by its efficacy, tolerance and absence of pharmacokinetic modifications. However, these findings should be verified in a more comprehensive study.


Treatment of diffuse subretinal fibrosis uveitis with rituximab.
Diffuse subretinal fibrosis uveitis (DUS) syndrome is a rare form of granulomatous multifocal choroiditis (MFC) characterised by enlarging areas of subretinal fibrosis (SRF) which coalesce with subsequent macular involvement and visual loss. First described by Palestine, DUS carries a poor visual prognosis despite use of high-dose corticosteroids and systemic immunosuppression. We report two cases of bilateral DUS successfully treated with rituximab. We believe given the B-cell predominance in the underlying pathogenesis of the disease, rituximab should be considered first line in the management of this potentially devastating disease.


Effects of cultural sensitivity training on health care provider attitudes and patient outcomes.
To determine the effectiveness of cultural sensitivity training on the knowledge and attitudes of health care providers, and to assess the satisfaction and health outcomes of patients from different minority groups with health care providers who received training. In this randomised controlled trial, 114 health care providers (nurses and homecare workers) and 133 patients (from two community agencies and one hospital) were randomly assigned to experimental (training) and control groups, and were followed for 18 months. Providers completed the Cultural Awareness Questionnaire and the Dogmatism Scale. Patients completed the Off-Axis-Ratio (OAR) Multidimensional Measure of Functional Capacity, the Client Satisfaction Questionnaire, the Physical and Mental Health Assessment Questionnaire, and the Health and Social Services Utilization Questionnaire. A qualitative analysis was conducted to identify and analyse themes from personal journals kept by participating nurses. Cultural sensitivity training resulted in increased open-mindedness and cultural awareness, improved understanding of multiculturalism, and ability to communicate with minority people. After 1 year patients of mostly European and British origin, who received care from trained providers, showed improvement in utilizing social resources and overall functional capacity without an increase in health care expenditures. The results of this study indicate that a cultural sensitivity training program not only improved knowledge and attitudes among health care providers, but it also yielded positive health outcomes for their patients.


To err is human: Quality management practices in surgical oral pathology, a safety net for medico-legal complications.
Reading a slide and rendering a diagnosis is not only a science but also requires us to appreciate the constant artifact that is introduced in a controlled manner by tissue processing and obtaining a stained tissue section. There are a number of steps involved in getting the final stained tissue section and all these procedures if not performed properly have the potential to give rise to erroneous picture on the slide. Simple errors in judgments can lead to wrong diagnosis and unwarranted treatment. Such mistakes can put us at risk for Medico-Legal problems. The subject of Medico-Legal issues and practice of pathology has been neglected and amount of information available to the practicing professional in India is scarce. This paper focuses on standardized procedures for the various histopathology laboratory exercises. The paper highlights the importance of proper record maintenance with reporting protocols. A list of do's and don'ts for an Oral Pathologist is provided to help him/her in reducing the probable Medico-Legal issues. It does not in any way address the issue of individual competence and diagnostic abilities: That is an aspect for each individual to introspect upon and take remedial action.


[Psychosocial rehabilitation and severe mental illness: Factors that influence patients' attendance in a support group].
Psychosocial rehabilitation for people with chronic-severe mental illness mainly aims to social integration by restoring independent functioning in the community, improving quality of life, and addressing risk factors that lead to social disability. Support groups (SG) are usually part of this multilevel mental health process. Given that non-adherence to treatment is a common phenomenon in people with chronic- severe mental illness, the aim of the current study was to identify which factors influence members' attendance in a support group in a vocational training Program of the Psychosocial Rehabilitation Unit of Byron-Kaissariani Community Mental Health Centre. The SG sessions were weekly, with 45-minute duration, opened to any new member of the Program and coordinated by two therapists. Members' demographic and psychiatric data were gathered from the medical records of the Center. Information about SG was obtained from the reports of the sessions. The sample consisted of 18 women, with mean age 38.56 (±6.92) years. Most of them were high school graduates (61.1%), unmarried (83.3%), with low socioeconomic status (55.5%), suffering from a schizophrenic spectrum disorder (61.1%) with a mean duration 15.22 (±8.44) years. Out of 83 sessions in total, twenty-two (26.5%) were in absence of a co-therapist, 11 (13.3%) after a member's entrance or withdrawal and 11 (13.3%) after a session cancellation. Furthermore, an average of four issues was discussed per session, with mental illness (62.7%) and interpersonal relationships (73.5%) being the most popular topics during the sessions. The statistical analysis demonstrated that members' demographic (age, education, marital status, residence, socioeconomic status, working experience) and psychiatric characteristics (diagnosis, illness duration, rehabilitation program experience) were not associated with the attendance rate in the SG. Similarly, the proportion of participants attending the sessions did not seem to be significantly related to the absence of a co-therapist, to a member's entrance or withdrawal and to a session cancellation. In contrast, attendance seemed to be significantly reduced when the topic of a session focused on members' future expectations/goals (having a family, further education, finding a job) (Beta=-0.32, p=0.006). This finding highlights the need for future research in order to incorporate interventions that promote and address future goals and expectations of people with chronic-severe mental illness in psychosocial rehabilitation services.


Granule fraction inhomogeneity of calcium carbonate/sorbitol in roller compacted granules.
The granule fraction inhomogeneity of roller compacted granules was examined on mixtures of three different morphologic forms of calcium carbonate and three particle sizes of sorbitol. The granule fraction inhomogeneity was determined by the distribution of the calcium carbonate in each of the 10 size fractions between 0 and 2000 microm and by calculating the demixing potential. Significant inhomogeneous occurrence of calcium carbonate in the size fractions was demonstrated, depending mostly on the particles sizes of sorbitol but also on the morphological forms of calcium carbonate. The heterogeneous distribution of calcium carbonate was related to the decrease in compactibility of roller compacted granules in comparison to the ungranulated materials. This phenomenon was explained by a mechanism where fracturing of the ribbon during granulation occurred at the weakest interparticulate bonds (the calcium carbonate: calcium carbonate bonds) and consequently exposed the weakest areas of bond formation on the surface of the granules. Accordingly, the non-uniform allocation of the interparticulate attractive forces in a tablet would cause a lowering of the compactibility. Furthermore, the ability of the powder to agglomerate in the roller compactor was demonstrated to be related to the ability of the powder to be compacted into a tablet, thus the most compactable calcium carbonate and the smallest sized sorbitol improved the homogeneity by decreasing the demixing potential.


Dramatic Regression of a Fungating Breast Lesion Treated with Radiation Therapy.
Although advances in screening mammography have dramatically improved the early detection of breast cancer, a subset of breast cancer cases still present as locally advanced disease. Some of these patients develop fungating lesions, which are difficult to manage and can have a severe impact on the quality of life. Palliative treatment options include surgery, intra-arterial chemotherapy, and radiation therapy. Herein, we describe the case of a patient who presented with a fungating breast mass and demonstrated an immediate and durable response to radiation therapy with a significantly improved quality of life.


Sub-femtomole peptide detection in ion mobility-time-of-flight mass spectrometry measurements.
Sensitivity and detection limit enhancements are obtained for peptides by performing high repetition rate (150 Hz) matrix-assisted laser desorption/ionization (MALDI) coupled with ion mobility-time-of-flight mass spectrometry. Absolute limits of detection (3sigma) for model peptides are on the order of 0.1 fmol of peptide deposited and represent a factor of 40-60 improvement over data obtained using typical low repetition (20 Hz) MALDI. This increase in sensitivity is demonstrated for two-dimensional MALDI-IM-TOFMS peptide mass mapping of bovine hemoglobin.


Syntheses of donor-acceptor-functionalized dihydroazulenes.
The dihydroazulene (DHA)/vinylheptafulvene (VHF) photo/thermoswitch has been of interest for use in molecular electronics and advanced materials. The switching between the two isomers has previously been found to depend strongly on the presence of donor and acceptor groups. The fine-tuning of optical and switching properties relies on ready access to new derivatives via efficient synthetic protocols. The central DHA core is conveniently prepared in a four-step synthesis starting from acetophenone and tropylium substrates. Here, the outcome of this reaction as a function of the nature of the substituent group on the phenyl unit of acetophenone is investigated in detail. A wide variety of functional groups (nitro, cyano, halo, alkyl, amido, and thioether) was tolerated, and the route provided access to a large selection of substituted DHA derivatives (position 2 of DHA). These compounds were investigated for their ability to undergo subsequent functionalization in the seven-membered ring by a regioselective bromination-elimination protocol, introducing a bromo substituent at position 7. Halo-substituted DHAs were subjected to palladium-catalyzed cyanation, Sonogashira, Cadiot-Chodkiewicz, and Suzuki couplings and for the latter reaction; optimized conditions were developed by varying the palladium catalyst. In general, our focus was on reducing the formation of fully unsaturated azulene byproducts.


Morin hydrate augments phagocytosis mechanism and inhibits LPS induced autophagic signaling in murine macrophage.
Morin, a natural flavonoid that is the primary bioactive constituent of the family Moraceae, has been found to be associated with many therapeutic properties. In this study, we evaluated the immunomodulatory activities of increasing concentration of morin hydrate in vitro. Three different concentrations of morin hydrate (5, 10, and 15μM) were used to evaluate their effect on splenocyte proliferation, phagocytic activity of macrophages, cytokine secretion and complement inhibition. We also evaluated the role of morin hydrate on lipopolysaccharide (LPS) induced autophagy. Our study demonstrated that morin hydrate elicited a significant increase in splenocyte proliferation, phagocytic capacity and suppressed the production of cytokines and nitric oxide in activated macrophages. Humoral immunity measured by anti-complement activity showed an increase in inhibition of the complement system after the addition of morin hydrate, where morin hydrate at 15μM concentration induced a significant inhibition. Depending on our results, we can also conclude that morin hydrate protects macrophages from LPS induced autophagic cell death. Our findings suggest that morin hydrate represents a structurally diverse class of flavonoid and this structural variability can profoundly affect its cell-type specificity and its biological activities. Supplementation of immune cells with morin hydrate has an upregulating and immunoprotective effect that shows potential as a countermeasure to the immune dysfunction and suggests an interesting use in inflammation related diseases.


Pilot study of the incidence and prognosis of degenerative Parkinsonian disorders in Aberdeen, United Kingdom: methods and preliminary results.
The objective of this study was to test the methods for a large study of the incidence and prognosis of Parkinson's disease and other degenerative parkinsonian disorders and provide provisional incidence figures. This was a community-based prospective study to identify patients with newly diagnosed non-drug-induced Parkinsonism (>or=2 of tremor, rigidity, bradykinesia, postural instability) from a population of 148,600 people in Aberdeen, Scotland, over 18 months. Multiple search strategies were used to identify patients, including some population screening. Incident patients and age/sex-matched controls had assessments of impairment, disability, quality of life, mood, and cognition and are being followed up yearly. Two hundred and two people with possible parkinsonian symptoms were assessed, and 82 incident patients were identified, 50 with probable Parkinson's disease. The crude incidences of probable Parkinsonism and probable Parkinson's disease were 31.4/100,000/year (95% CI: 24.5-39.7) and 22.4/100,000/year (95% CI: 16.6-29.6), respectively. The mean age of diagnosis of Parkinson's disease was 76.1 +/- 10.0 years and the incidence was greater in men. The methods were generally successful. Provisionally, we found a higher incidence of Parkinson's disease than other comparable studies, and our patients were considerably older. This may reflect better case ascertainment in the elderly. A larger study is planned.


Effect of heterogeneity of rabies virus strain and challenge route on efficacy of inactivated rabies vaccines in mice.
To determine effect of route of challenge and strain of rabies virus on efficacy of inactivated rabies vaccines in mice. 3,056 mice. Challenge was performed with fixed and street rabies virus strains by use of footpad and intracerebral routes as well as IM injection into the hip, shoulder, neck, and masseter muscles. Intraperitoneal and IM vaccination was performed with 1 or 2 doses of 1 of 3 vaccine-strain inactivated rabies vaccines. For 2 of the vaccine strains, the vaccines were adjuvanted and nonadjuvanted. Incubation periods were dependent on route, dose, and virus strain used for challenge. Use of an intramasseter challenge route with challenge virus-strain rabies virus, which more accurately models natural exposure to rabies virus, resulted in reproducible mortality rates in mice. Use of this route revealed that differences among vaccines and challenge virus strains affected mortality rate less than that observed in the National Institutes of Health potency test, even when street isolates of widely variant origin were used for challenge. These results, combined with earlier data, support a proposal for a new rabies potency test that more closely models current vaccine administration practices and natural infection routes.


Maternal diet during early childhood, but not pregnancy, predicts diet quality and fruit and vegetable acceptance in offspring.
Studies have identified prenatal flavour exposure as a determinant of taste preferences in infants; however, these studies have focused on relatively small samples and limited flavours. As many parents struggle with getting children to accept a variety of nutritious foods, a study of the factors influencing food acceptance is warranted. The objective of this study was to determine whether exposure to a wider variety of fruit and vegetables and overall higher diet quality in utero results in acceptance of a greater variety of these foods and better diet quality for offspring during childhood. This study is a secondary data analysis of pregnant women (n = 52) and their resulting offspring recruited for the Women and Their Children's Health study in NSW, Australia. Dietary intake of mothers and children was measured using food frequency questionnaires. Diet quality and vegetable and fruit variety were calculated using the Australian Recommended Food Score and the Australian Child and Adolescent Recommended Food Score. Associations between maternal and child diet quality and variety were assessed using Pearson's correlations and the total effect of in utero maternal pregnancy diet on childhood diet was decomposed into direct and indirect effect using mediation analysis. Maternal pregnancy and post-natal diet were both correlated with child diet for overall diet quality and fruit and vegetable variety (P < 0.001). Mediation analyses showed that the indirect effect of maternal pregnancy diet on child diet was mediated through maternal post-natal diet, particularly for fruit (P = 0.045) and vegetables (P = 0.055). Nutrition intervention should therefore be aimed at improving diet quality and variety in mothers with young children, in order to subsequently improve eating habits of offspring.


Clinical findings in dogs with incidental adrenal gland lesions determined by ultrasonography: 151 cases (2007-2010).
To determine the prevalence of and clinical features associated with incidental adrenal gland lesions (IAGLs) discovered during abdominal ultrasonography in dogs. Retrospective case series. 151 dogs with an IAGL and 400 control dogs. Reports of ultrasonographic examinations of the abdomen of dogs performed during a 3.5-year period were reviewed. Adrenal glands were classified as having an IAGL if a nodule or mass was described or the width of either gland was ≥ 10 mm. For dogs with an IAGL, information regarding signalment, concurrent disorders, and outcome was obtained from the medical record. Findings were compared with those in a control population of 400 dogs examined during the same period. An IAGL was detected in 151 of 3,748 (4%) dogs. Dogs with an IAGL were significantly older (median age, 11.25 years) and heavier (median body weight, 21 kg [46.2 lb]) than the control population (median age, 9.5 years; median body weight, 14 kg [30.8 lb]). Malignant tumors were reported in 6 of 20 (30%) dogs that underwent adrenal glandectomy or necropsy and had a maximum IAGL dimension that ranged from 20 to 46 mm; benign lesions all had a maximum dimension < 20 mm. Various coincidental conditions were reported in dogs with an IAGL, including nonadrenal gland malignant neoplasia in 43 (28.5%) dogs. IAGLs were more likely in dogs ≥ 9 years of age. On the basis of this small data set, malignancy should be suspected for IAGLs ≥ 20 mm in maximum dimension.


The Type 3 Deiodinase Is a Critical Determinant of Appropriate Thyroid Hormone Action in the Developing Testis.
Timely and appropriate levels of thyroid hormone (TH) signaling are necessary to ensure normal developmental outcomes in many tissues. Studies using pharmacological models of altered TH status have revealed an influence of these hormones on testis development and size, but little is known about the role of endogenous determinants of TH action in the developing male gonads. Using a genetic approach, we demonstrate that the type 3 deiodinase (D3), which inactivates TH and protects developing tissues from undue TH action, is a key factor. D3 is highly expressed in the developing testis, and D3-deficient (D3KO) mice exhibit thyrotoxicosis and cell proliferation arrest in the neonatal testis, resulting in an approximately 75% reduction in testis size. This is accompanied by larger seminiferous tubules, impaired spermatogenesis, and a hormonal profile indicative of primary hypogonadism. A deficiency in the TH receptor-α fully normalizes testis size and adult testis gene expression in D3KO mice, indicating that the effects of D3 deficiency are mediated through this type of receptor. Similarly, genetic deficiencies in the D2 or in the monocarboxylate transporter 8 partially rescue the abnormalities in testis size and gonadal axis gene expression featured in the D3KO mice. Our study highlights the testis as an important tissue in which determinants of TH action coordinately converge to ensure normal development and identifies D3 as a critical factor in testis development and in testicular protection from thyrotoxicosis.


Role of pH Value in Clinically Relevant Diagnosis.
As a highly influential physiological factor, pH may be leveraged as a tool to diagnose physiological state. It may be especially suitable for diagnosing and assessing skin structure and wound status. Multiple innovative and elegant smart wound dressings combined with either pH sensors or drug control-released carriers have been extensively studied. Increasing our understanding of the role of pH value in clinically relevant diagnostics should assist clinicians and improve personal health management in the home. In this review, we summarized a number of articles and discussed the role of pH on the skin surface as well as the factors that influence skin pH and pH-relevant skin diseases, but also the relationship of skin pH to the wound healing process, including its influence on the activity of proteases, bacterial enterotoxin, and some antibacterial agents. A great number of papers discussing physiological pH value have been published in recent decades, far too many to be included in this review. Here, we have focused on the impact of pH on wounds and skin with an emphasis on clinically relevant diagnosis toward effective treatment. We have also summarized the differences in skin structure and wound care between adults and infants, noting that infants have fragile skin and poor skin barriers, which makes them more vulnerable to skin damage and compels particular care, especially for wounds.


Latent personality profiles and the relations with psychopathology and psychopathic traits in detained adolescents.
The present study constructed empirically derived subtypes of adolescent offenders based on general traits and examined their associations with psychopathology and psychopathic traits. The sample included 342 detained minors (172 boys and 170 girls; mean age 15.85 years, SD = 1.07) recruited in various Youth Detention Centers across the Flemish part of Belgium. All adolescents provided self-reports on the quick big five, the youth self report, and the youth psychopathic traits inventory to assess general traits, psychopathology, and psychopathic traits respectively. Latent class analyses based on general personality traits were performed and suggested three personality types, consisting of an emotionally labile, close-minded and goal-oriented class, an undercontrolled class, and an emotionally labile-careless class. These three personality types within detained minors showed particular constellations of general traits and differed meaningfully in terms of their mean-scores on externalizing psychopathology and psychopathy measures.


Low striatal glutamate levels underlie cognitive decline in the elderly: evidence from in vivo molecular spectroscopy.
Glutamate (Glu), the principal excitatory neurotransmitter of prefrontal cortical efferents, potentially mediates higher order cognitive processes, and its altered availability may underlie mechanisms of age-related decline in frontally based functions. Although animal studies support a role for Glu in age-related cognitive deterioration, human studies, which require magnetic resonance spectroscopy for in vivo measurement of this neurotransmitter, have been impeded because of the similarity of Glu's spectroscopic signature to those of neighboring spectral brain metabolites. Here, we used a spectroscopic protocol, optimized for Glu detection, to examine the effect of age in 3 brain regions targeted by cortical efferents--the striatum, cerebellum, and pons--and to test whether performance on frontally based cognitive tests would be predicted by regional Glu levels. Healthy elderly men and women had lower Glu in the striatum but not pons or cerebellum than young adults. In the combined age groups, levels of striatal Glu (but no other proton metabolite also measured) correlated selectively with performance on cognitive tests showing age-related decline. The selective relations between performance and striatal Glu provide initial and novel, human in vivo support for age-related modification of Glu levels as contributing to cognitive decline in normal aging.


[Reconstruction of long recurrent strictures of the anterior urethra with a free transplant of buccal mucosa].
The study included 18 patients with recurrent strictures of the anterior urethra. In 16 patients the recurrence arose after several endoscopic operations for inflammatory urethral strictures, in 2--after plastic repair of the stricture by loganson and plastic treatment of hypospadia. The strictures varied in length from 3 to 16 cm. Ventral flap of buccal mucosa was used for plastic reconstruction in 16 patients, dorsal flap--in 2 patients. Follow-up lasted from 1 to 15 months. All the patients were cured. The intubation drainage was removed 4-7 weeks after the operation. Qmax elevated, on the average, from 4.79 +/- 0.78 to 29.5 +/- 1.94 ml/s. The recurrence developed only in 1 patient 6 months after the plastic repair. The patient was successfully operated (internal optic urethrotomy). Thus, short-term outcomes of urethroplasty with buccal transplant showed this operation to be highly effective in correction of long recurrent strictures of anterior urethra in males.


Single-channel recordings from cultured human retinal pigment epithelial cells.
We have applied patch-clamp techniques to on-cell and excised-membrane patches from human retinal pigment epithelial cells in tissue culture. Single-channel currents from at least four ion channel types were observed: three or more potassium-selective channels with single-channel slope conductances near 100, 45, and 25 pS as measured in on-cell patches with physiological saline in the pipette, and a relatively nonselective channel with subconductance states, which has a main-state conductance of approximately 300 pS at physiological ion concentrations. The permeability ratios, PK/PNa, measured in excised patches were 21 for the 100-pS channels, 3 for the 25-pS channels, and 0.8 for the 300-pS nonselective channel. The 45-pS channels appeared to be of at least two types, with PK/PNa's of approximately 41 for one type and 3 for the other. The potassium-selective channels were spontaneously active at all potentials examined. The average open time for these channels ranged from a few milliseconds to many tens of milliseconds. No consistent trend relating potassium-selective channel kinetics to membrane potential was apparent, which suggests that channel activity was not regulated by the membrane potential. In contrast to the potassium-selective channels, the activity of the nonselective channel was voltage dependent: the open probability of this channel declined to low values at large positive or negative membrane potentials and was maximal near zero. Single-channel conductances observed at several symmetrical KCl concentrations have been fitted with Michaelis-Menten curves in order to estimate maximum channel conductances and ion-binding constants for the different channel types. The channels we have recorded are probably responsible for the previously observed potassium permeability of the retinal pigment epithelium apical membrane.


Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome.
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating, chronic condition characterized by chronic pelvic pain, urinary urgency, and frequency and is well-known to be associated with a decrease in work productivity, emotional changes, sleep, sexual dysfunction, and mobility. Many metrics of quality of life (QoL) in this patient population have been developed; however, a unified, standardized approach to QoL in these patients has not been determined. The effects of IC/BPS and co-morbid conditions on QoL are described using current validated metrics. Next, data regarding successful treatment of IC/BPS in terms of QoL improvement are reviewed. While QoL is the single most important clinical measure of success in the treatment of patients suffering from IC/BPS, addressing QoL in this patient population remains a significant challenge, as its effects on QoL are highly variable and unable to be differentiated from the effects of comorbid conditions on QoL, including depression, poor sleep, and inability to work. Future studies will need to address treatment efficacy on the basis of IC/BPS specific QoL metrics, and multi-modal assessment and therapy to address comorbid disease will also play an important role in the future to ensure comprehensive management of these patients.


List-mode maximum-likelihood reconstruction applied to positron emission mammography (PEM) with irregular sampling.
We present a preliminary study of list-mode likelihood reconstruction of images for a rectangular positron emission tomograph (PET) specifically designed to image the human breast. The prospective device consists of small arrays of scintillation crystals for which depth of interaction is estimated. Except in very rare instances, the number of annihilation events detected is expected to be far less than the number of distinguishable events. If one were to histogram the acquired data, most histogram bins would remain vacant. Therefore, it seems natural to investigate the efficacy of processing events one at a time rather than processing the data in histogram format. From a reconstruction perspective, the new tomograph presents a challenge in that the rectangular geometry leads to irregular radial and angular sampling, and the field of view extends completely to the detector faces. Simulations are presented that indicate that the proposed tomograph can detect 8-mm-diameter spherical tumors with a tumor-to-background tracer density ratio of 3:1 using realistic image acquisition parameters. Spherical tumors of 4-mm diameter are near the limit of detectability with the image acquisition parameters used. Expressions are presented to estimate the loss of image contrast due to Compton scattering.


Arthritis and adaptive walking and running.
No longer is rest or inactivity a password for arthritis. Arthritics are now being encouraged to walk, then run--it's part of the exercise continuum that imparts health to many components of the body, including the joints and their support tissues. Joint impact loads during running are less of a concern, whereas flexibility as a shock absorber is more important. The debate on immobilization versus mobilization definitely has shifted to the latter. Much has been learned from sports medicine that can turn a rheumatologist into a "coach."


Knockdown of liver-intestine cadherin decreases BGC823 cell invasiveness and metastasis in vivo.
To assess BGC823 gastric cancer (GC) cell metastasis after knockdown of liver-intestine cadherin (CDH17) and the therapeutic value of CDH17-RNAi-lentivirus in vivo. We evaluated primary tumor growth and assessed local infiltration and systemic tumor dissemination using an orthotopic implantation technique. The therapeutic value of CDH17 knockdown was examined by intratumoral administration of CDH17-RNA interference (RNAi)-lentivirus in an established GC tumor xenograft mouse model. Furthermore, a comparative proteomic approach was utilized to identify differentially expressed proteins in BGC823 and lenti-CDH17-miR-neg cells following CDH17 knockdown. Metastases in the liver and lung appeared earlier and more frequently in animals with tumors derived from BGC823 or lenti-CDH17-miR-neg cells than in tumors derived from lenti-CDH17-miR-B cells. Average tumor weight and volume in the CDH17-RNAi-lentivirus-treated group were significantly lower than those in the control group (tumor volume: 0.89 ± 0.04 cm³ vs 1.16 ± 0.06 cm³, P < 0.05; tumor weight: 1.15 ± 0.58 g vs 2.09 ± 0.08 g, P < 0.05). Fifteen differentially expressed proteins were identified after CDH17 silencing in BGC823 cells, including a variety of cytoskeletal and chaperone proteins as well as proteins involved in metabolism, immunity/defense, cell proliferation and differentiation, cell cycle, and signal transduction. Our data establish a foundation for future studies of the comprehensive protein expression patterns and effects of CDH17 in GC.


Relative survival following hemi-and total hip arthroplasty for hip fractures in Sweden.
Hip fractures are a common problem in the ageing population. Hip arthroplasty is the common treatment option for displaced intracapsular neck of femur fractures. Even though hip replacements are successful in restoring mobility, reducing pain and diminishing loss of health-related quality of life, the potential impact of a hip fracture on life expectancy as well as the postoperative mortality need consideration. The purpose of this study was to describe the mid-term relative survival rate for a cohort of Swedish patients whom underwent total- or hemiarthroplasty surgery following hip fracture. We also explored whether the survival rate is prosthesis-type specific and influenced by comorbidities, sex, socioeconomic and surgical factors. Using prospectively collected information of the Swedish Hip Arthroplasty Register-linked database we identified 43,891 patients operated between 2005 and 2012. Patient- and surgery-specific data in combination with socio-economic data were available for this analysis. We studied relative survival rate and used multivariable modelling with Cox Proportional Hazards Model in Transformed Time. Compared to the Swedish general population the baseline excess hazard was very high in the first half year after the operation, thereafter the excess hazard decreased but remained non-negligible through the 8 years' follow-up period. The mortality rate of males was higher compared to women. Higher Elixhauser comorbidity index (ECI) was associated with worsening survival. However, patients who had ECI = 0 had higher mortality than patients with ECI =1 the first 420 days post fracture. Patients with a hemiarthroplasty had a worse survival than patients with a total hip arthroplasty. Of the hospital types considered university hospitals had lower survival rate. Younger patients had a greater loss of expected life span than patients who suffer hip fracture in their more advanced ages. Swedish hip fracture patients who undergo arthroplasty surgery had a high excess hazard of dying in the first half year following surgery, and this excess hazard never subsided to negligible levels at least up to 8 years after surgery. Interestingly having no prior record of illnesses worsened the initial mortality. Men living alone had the highest long-term excess mortality.


Danazol, a new steroidal inducer of delta-aminolevulinic acid synthetase.
Danazol (a derivative of 17 alpha-ethinyl testosterone) has recently been reported to cause clinical exacerbations of acute intermittent porphyria. In the present study, we demonstrate that danazol is an inducer of hepatic delta-aminolevulinic acid synthetase and that it increases hepatocyte porphyrin production using a chick embryo model. The findings provide an explanation for the clinical observations. Although danazol is a porphyrinogenic agent in the chick embryo and humans it has been reported to be ineffective as a porphyrinogen in rats. The present findings, therefore, also confirm the superiority of the chick embryo as a model system for the screening of drugs and chemicals which may have the potential to cause clinical exacerbations of porphyria.


Calculating model of light transmission efficiency of diffusers attached to a lighting cavity.
A lighting cavity is a reflecting box with light sources inside. Its exit side is covered with a diffuser plate to mix and distribute light, which addresses a key issue of luminaires, display backlights, and other illumination systems. We derive a simple but precise formula for the optical efficiency of diffuser plates attached to a light cavity. We overcome the complexity of the scattering theory and the difficulty of the multiple calculations involved, by carrying out the calculation with a single ray of light that statistically represents all the scattered rays. We constructed and tested several optical cavities using light-emitting diodes, bulk-scattering diffusers, white scatter sheets, and silver coatings. All measurements are in good agreement with predictions from our optical model.


The EICA is dead? Long live the EICA!
An important hypothesis for how plants respond to introduction to new ranges is the evolution of increased competitive ability (EICA). EICA predicts that biogeographical release from natural enemies initiates a trade-off in which exotic species in non-native ranges become larger and more competitive, but invest less in consumer defences, relative to populations in native ranges. This trade-off is exceptionally complex because detecting concomitant biogeographical shifts in competitive ability and consumer defence depends upon which traits are targeted, how competition is measured, the defence chemicals quantified, whether defence chemicals do more than defend, whether 'herbivory' is artificial or natural, and where consumers fall on the generalist-specialist spectrum. Previous meta-analyses have successfully identified patterns but have yet to fully disentangle this complexity. We used meta-analysis to reevaluate traditional metrics used to test EICA theory and then expanded on these metrics by partitioning competitive effect and competitive tolerance measures and testing Leaf-Specific Mass in detail as a response trait. Unlike previous syntheses, our meta-analyses detected evidence consistent with the classic trade-off inherent to EICA. Plants from non-native ranges imposed greater competitive effects than plants from native ranges and were less quantitatively defended than plants from native ranges. Our results for defence were not based on complex leaf chemistry, but instead were estimated from tannins, toughness traits and primarily Leaf-Specific Mass. Species specificity occurred but did not influence the general patterns. As for all evidence for EICA-like trade-offs, we do not know if the biogeographical differences we found were caused by trade-offs per se, but they are consistent with predictions derived from the overarching hypothesis. Underestimating physical leaf structure may have contributed to two decades of tepid perspectives on the trade-offs fundamental to EICA.


A Candida albicans mutant conditionally defective in sterol 14 alpha-demethylation.
A conditional sterol 14 alpha-demethylation mutant of Candida albicans was isolated whose defect was dependent both on the growth temperature and on the culture medium used. Under restrictive conditions, this mutant showed a deficiency in hyphal growth and an increased susceptibility to diverse chemicals, in accordance with the phenotypes of the already known non-conditional mutants of 14 alpha-demethylation. In addition, the mutant was shown to have a conditional defect in respiration. The impaired respiration was also seen in the non-conditional mutants.


Mental health aftercare. Where is nursing?
The author reviews nursing's entrance into mental health aftercare and relates it to the problems that have ensued since the 50s. The role of the community mental health nurse is explored and compared with concepts of aftercare and perceptions of prominent psychiatric/mental health nursing authors. The realities of community mental health nursing in the '80s are contrasted with the thoughts and the ideas of others endeavoring to make contributions to the needs of discharged psychiatric patients. The author reminds us that aftercare begins before the patient leaves a psychiatric facility and stresses that nurses are a natural bridge between the hospital and the community.


Endothelial mosaic in Fuchs' dystrophy. A qualitative evaluation with the specular microscope.
The progressive morphological changes of cornea guttata in Fuchs' endothelial dystrophy have been characterized by clinical specular photomicroscopy. Five specific stages in the development of excrescences can be discerned using this in vivo technique. Several stages can be observed in the same cornea at a given time, although in most cases the majority of guttate changes seemed to have progressed to the same stage of development. All five stages of cornea guttata discerned in this study can occur in a cornea clinically free of edema. Two types of cornea guttata can be identified in vivo. One has a smooth, regular posterior surface, whereas the posterior contour of the second is irregular.


Ictal and interictal SPECT findings in childhood absence epilepsy.
The purpose of this study was to investigate the informative value of single photon emission tomography (SPECT) in relation to the pathophysiological functioning of the brain during absence seizures and the origin of ictal discharges in idiopathic generalized epilepsies (IGEs). Six patients with childhood absence epilepsy (CAE) were selected for the study and two consecutive SPECT sessions were performed concomitant with EEG recordings revealing normal results and during hyperventilation (HV) studies where the ictal discharges were induced either alone or accompanied by clinical absence seizures. All six patients had ictal discharges in their EEGs during HV and two of them also had clinical absences. SPECT findings during HV revealed an overall increase in the cerebral blood flow (CBF) with significantly higher values as compared to the baseline data. There was no indication for any focal origin in either the interictal or the ictal SPECT findings. Results of the study were supportive for the concept of subcortical origin for the absence seizures and they were also promising for the diagnostic value of ictal SPECT in epileptic cases with undetermined origin as to whether they were localization-related or generalized.


Identifying the clinical domains of fibromyalgia: contributions from clinician and patient Delphi exercises.
In evaluating the effectiveness of fibromyalgia (FM) therapies, it is important to assess the impact of those therapies on the full array of domains considered important by both clinicians and patients. The objective of this research was to identify and prioritize the key clinically relevant and important domains impacted by FM that should be evaluated by outcome assessment instruments used in FM clinical trials, and to approach consensus among clinicians and patients on the priority of those domains to be assessed in clinical care and research. Group consensus was achieved using the Delphi method, a structured process of consensus building via questionnaires together with systematic and controlled opinion feedback. The Delphi exercises involved 23 clinicians with expertise in FM and 100 patients with FM as defined by American College of Rheumatology criteria. The Delphi exercise revealed that the domains ranked most highly by patients were similar to the domain rankings by clinicians. Pain was consistently ranked highest by both panels. Fatigue, impact on sleep, health-related quality of life, comorbid depression, and cognitive difficulty were also ranked highly. Stiffness was ranked highly by patients but not clinicians. In contrast, side effects was important to clinicians but was not identified as important in the patient Delphi exercise. The clinician and patient Delphi exercises identified and ranked key domains that need to be assessed in FM research. Based on these results, a conceptual framework for measuring patient-reported outcomes is proposed.


Clinical Utility of a Semiquantitative Method Using Lumbar Radiography as a Screening Tool for Osteoporosis in Elderly Subjects.
BACKGROUND Osteoporosis is a major global public health problem in the current aging era. Osteoporosis is often diagnosed only after patients have a fracture that causes a severe decline in ability to perform activities of daily life. Although the current criterion standard for diagnosing osteoporosis is dual-energy X-ray absorptiometry (DXA), this modality remains less prevalent among general practitioners in geriatric medicine. The aim of this study was to determine the diagnostic utility of visual inspection of lumbar radiography in detecting bone mineral density (BMD) decline. MATERIAL AND METHODS We retrospectively reviewed medical data of 78 patients who underwent both lateral lumbar radiography and DXA. Board-certified radiologists determined the clinical grade of each patient's condition according to the semiquantitative (SQ) method of lumbar fracture assessment. We compared the grades and young adult means of BMD in the lumbar spine and hips as measured using DXA. RESULTS BMD of the femoral neck was significantly lower in patients with severe osteoporosis (grades 2 and 3 as classified using the SQ method) than in those with mild osteoporosis (grades 0 and 1; P<0.05). A receiver operating characteristic curve analysis showed that the SQ method can help predict the decrease in BMD (young adult mean score of <70%) in the femoral neck with moderate accuracy (sensitivity, 0.621; specificity, 0.829; area under the curve, 0.742). CONCLUSIONS These results suggest that lateral lumbar radiography can provide useful information about bone mineral status and can serve as a tool for osteoporosis screening by general practitioners.


Luminal Preservation Protects the Small Intestine in a Brain-dead Rat Model.
Intestinal transplantation depends on donation after brain death (DBD). Luminal preservation (LP) has been beneficial against preservation injury in previous studies in animal models, but none include DBD. This study aims to investigate whether these benefits occur also with DBD. Wistar rats (male, N = 9) underwent brain death for 2 h. Thereafter, vascular perfusion was done with University of Wisconsin solution (UW). The small intestine was then explanted and randomized into 3 groups: control (empty segment), LP+PEG (with polyethylene glycol 3350 solution), or LP+UW (with UW), treated and tied shut. Ice-cold UW was used for cold storage. Samples were taken at procurement and after 4 (t = 4) and 8 h (t = 8) of preservation. Histopathological scorings were performed for intestinal preservation injury, subepithelial space, absence of epithelial lining, and hemeoxygenase-1 expression. There was low-level mucosal injury (median intestinal preservation injury score 2) at procurement. At t = 4, bowels treated without LP had more damage than LP-treated samples (control score 4, LP+PEG 2 and LP+UW 2, P < 0.001 control versus LP+UW). At t = 8, no benefit of LP was observed (control 2, LP+PEG 3, LP+UW 2). Subepithelial space increased with time and the presence of LP; epithelial lining was better conserved in LP-treated samples. Hemeoxygenase-1 staining showed increased intensity with increased damage, irrespective of treatment. Luminal perfusion of the small intestine with UW or PEG protects the mucosa in brain-dead rats for up to 4 h. Fewer benefits of LP were found than previously described in non-DBD models. To mimic the clinical situation, DBD should be included in future animal studies on intestinal preservation.


A major difference between serum and fibronectin in the divalent cation requirement for adhesion and spreading of BHK21 cells.
Adhesion and spreading of BHK21 cells on adsorbed bovine and foetal bovine serum require addition to the medium of a divalent cation. Divalent cations are effective in the order Mn2+ greater than Co2+ greater than Mg2+ greater than Ca2+, with Ca2+ ineffective below 10(-4)M. On purified fibronectin, however, no added divalent cation is required, since the requirement is largely met by adventitious Ca2+ (circa 10(-5)M) in nominally divalent cation-free saline. In such background Ca2+, adhesion and spreading on fibronectin are only slightly slower than in optimal Mg2+, and appear identical, morphologically, and in sensitivity to cytochalasin D. Cells also spread on fibronectin in response to Mg2+, when Ca2+ is buffered below 10(-6)M, showing that external Ca2+ is not needed as a source for an increase in internal Ca2+. Cells can be induced to spread on serum in low Ca2+ by substantially increasing the fibronectin concentration; this supports other evidence that at its unsupplemented concentration, fibronectin contributes little to the spreading of these cells on serum. The Ca2+ requirement for spreading on preparations of vitronectin (serum spreading factor), partially purified from bovine serum, is similar to that on whole serum. Thus the difference in divalent cation requirement between serum and fibronectin may arise because, on serum, the dominant protein responsible for induction of spreading is vitronectin rather than fibronectin.(ABSTRACT TRUNCATED AT 250 WORDS)


National Sleep Foundation's sleep quality recommendations: first report.
To provide evidence-based recommendations and guidance to the public regarding indicators of good sleep quality across the life-span. The National Sleep Foundation assembled a panel of experts from the sleep community and representatives appointed by stakeholder organizations (Sleep Quality Consensus Panel). A systematic literature review identified 277 studies meeting inclusion criteria. Abstracts and full-text articles were provided to the panelists for review and discussion. A modified Delphi RAND/UCLA Appropriateness Method with 3 rounds of voting was used to determine agreement. For most of the sleep continuity variables (sleep latency, number of awakenings >5minutes, wake after sleep onset, and sleep efficiency), the panel members agreed that these measures were appropriate indicators of good sleep quality across the life-span. However, overall, there was less or no consensus regarding sleep architecture or nap-related variables as elements of good sleep quality. There is consensus among experts regarding some indicators of sleep quality among otherwise healthy individuals. Education and public health initiatives regarding good sleep quality will require sustained and collaborative efforts from multiple stakeholders. Future research should explore how sleep architecture and naps relate to sleep quality. Implications and limitations of the consensus recommendations are discussed.


Is Something Missing From Antenatal Education? A Survey of Pregnant Women's Knowledge of Pelvic Floor Disorders.
This study aimed to describe the knowledge on pelvic floor disorders among a cross section of pregnant women. This was an institutional review board-approved cross-sectional survey study of pregnant women with a gestational age of more than 18 weeks at a single tertiary care institution. Participants completed the validated 24-item Prolapse and Incontinence Knowledge Questionnaire, and responses were graded to determine a raw accuracy score (0-100%). Proficiency in the topic was defined as a score greater than 80% on the urinary scale and greater than 50% on the prolapse scale. Four hundred two women completed the survey. Mean ± SD raw accuracy in urinary incontinence was 66% ± 12%, and mean ± SD raw accuracy in pelvic organ prolapse was 41% ± 17%. These results were not significantly different among age or ethnic groups. Pregnant women were more likely to know that delivery could lead to incontinence (62%) than to pelvic organ prolapse (42%; P = 0.02), and 83% knew that pelvic floor exercises could prevent urinary incontinence. Proficiency was low among the population on both scales. Pregnant women have limited knowledge about pelvic floor dysfunction despite being at increased risk for these conditions during and after their pregnancies. This is an area where patient education and empowerment during routine prenatal care could improve.


Impact of surgical parathyroidectomy on chronic kidney disease-mineral and bone disorder (CKD-MBD) - A systematic review and meta-analysis.
For more than 6 decades, many patients with advanced chronic kidney disease (CKD) have undergone surgical parathyroidectomy (sPTX) for severe secondary hyperparathyroidism (SHPT) mainly based historical clinical practice patterns, but not on evidence of outcome.We aimed in this meta-analysis to evaluate the benefits and harms of sPTX in patients with SHPT. We searched MEDLINE (inception to October 2016), EMBASE and Cochrane Library (through Issue 10 of 12, October 2016) and website clinicaltrials.gov (October 2016) without language restriction. Eligible studies evaluated patients reduced glomerular filtration rate (GFR), below 60 mL/min/1.73 m2 (CKD 3-5 stages) with hyperparathyroidism who underwent sPTX. Reviewers working independently and in duplicate extracted data and assessed the risk of bias. The final analysis included 15 cohort studies, comprising 24,048 participants. Compared with standard treatment, sPTX significantly decreased all-cause mortality (RR 0.74 [95% CI, 0.66 to 0.83]) in End Stage Kidney Disease (ESKD) patients with biochemical and / or clinical evidence of SHPT. sPTX was also associated with decreased cardiovascular mortality (RR 0.59 [95% CI, 0.46 to 0.76]) in 6 observational studies that included almost 10,000 patients. The available evidence, mostly observational, is at moderate risk of bias, and limited by indirect comparisons and inconsistency in reporting for some outcomes (eg. short term adverse events, including documented voice change or episodes of severe hypocalcaemia needing admission or long-term adverse events, including undetectable PTH levels, risk of fractures etc.). Taken together, the results of this meta-analysis would suggest a clinically significant beneficial effect of sPTX on all-cause and cardiovascular mortality in CKD patients with SHPT. However, given the observational nature of the included studies, the case for a properly conducted, independent randomised controlled trial comparing surgery with medical therapy and featuring many different outcomes from mortality to quality of life (QoL) is now very strong.


The formation and occurrence of amino acid pyrolysates and related mutagens in cooked foods.
The classes of cooked foods that contain detectable levels of mutagenic activity are discussed together with the effects of different cooking procedures on the extent of mutagen formation. Analytical procedures that have so far been devised to quantify the concentrations of specific mutagenic compounds are described and the levels of these species that have been detected in cooked foods are detailed.