[Lack of knowledge of Guidelines for Prevention of Atherosclerosis in Childhood and Adolescence by pediatricians in the city of São Paulo].
To report the extent of knowledge of pediatricians in São Paulo concerning the Guidelines. At pediatric events or hospitals, pediatricians were given a questionnaire about the time of training, work, dedication in the area of pediatrics, and academic performance for reply to multiple choice questions with information drawn from the Guidelines. The Chi -square and the Chi -square of linear trend tests were chosen for statistical calculations. Among 370 pediatricians surveyed, 65.7% had no previous knowledge of the Guidelines. The cut-off for the hits was > or = 70% (> or = 5 correct replies). Only 136 pediatricians (36.7%) reached the cut-off and no gender differences were found in knowledge (p = 0.25). Among 187 professionals involved in academic activities, 45 (24%) hit the cut-off and about 183 participants from non-academic activities, 23 (12.7%) reached > or = 5 hit points (p <0.001). Pediatricians in the public sector had better knowledge about preventive measures for atherosclerosis risk factors (46.1%, p = 0.01). Awareness of the Guidelines was independent from training time. The majority of pediatricians in the city of São Paulo were not familiar with the Guidelines for Prevention of Atherosclerosis in Childhood and Adolescence and individual strategies were rarely found. Medical education and adequate disclosure of the Guidelines are necessary for active control of populational risk factors.


The meaning of care dependency as shared by care givers and care recipients: a concept analysis.
This paper is a report of a concept analysis to identify a meaning of care dependency that can be shared by both care givers and care recipients. Care dependency can be perceived from the care recipient's and the care giver's perspective. To allow for comparisons, both sides should share the same understanding of the concept. The current research about care dependency has focused on external assessment by nurses and suffers from a tendency to use the concept with different meanings. As a consequence, research on dependency may capture different phenomena. Walker and Avant's method for concept analysis served as the guideline for this study. The Medline, CINAHL and Cochrane databases were searched for the period 1996-2006 using the terms dependence, dependency, care dependence and care dependency. Care dependency can be defined as a subjective, secondary need for support in the domain of care to compensate a self-care deficit. Functional limitations are a necessary antecedent and unmet needs are a possible consequence of care dependency. The conceptual difference between care dependency, functional limitations and unmet needs may be meaningless for study participants. They may better understand these differences if they are asked about all three phenomena in the same investigation. Care givers and care recipients can agree on the suggested attributes of care dependency but may judge them in different ways. Self-assessed care dependency has the potential to challenge preconceptions of care givers about care dependency.


Disaster Preparedness Impact In A Complex Ophthalmology Practice: A Review Of Patients Receiving Intravitreal Injections.
A private tertiary care ophthalmology practice was analyzed to see how Hurricane Irma affected patient care. Eighty-two patients (96 eyes) that missed their scheduled appointments due to Hurricane Irma were reviewed. Patients were being treated with intravitreal injection therapy for diabetic retinopathy, radiation retinopathy, vein occlusions, choroidal neovascularization, or neovascular age-related macular degeneration. The authors assessed patients' visual acuity and macular thickness changes before the hurricane and their initial visit after the storm. Emergency preparedness was also evaluated in this setting. Patients on average were delayed 19.6 days. On average, best-corrected visual acuity was 20/97 (0.7 logMAR) before the hurricane and 20/82 (0.6 logMAR) after the storm. The average central macular thickness change was -1.30 μm. Intraocular pressure was not significantly affected and there were no ocular complications associated with the delay in therapy. A back-up electrical system was in place to maintain appropriate temperature for storage of medications and proper access to medical records. The authors believe that minimizing delay in treatment was the most important contributing factor to preventing worsening of ocular disease. Ophthalmology clinics should strive for appropriate treatment modality regarding injection intervals prior to a natural disaster and emergency planning with excellent patient communication both before and after natural disasters.


Reproducibility and variation of diffusion measures in the squirrel monkey brain, in vivo and ex vivo.
Animal models are needed to better understand the relationship between diffusion MRI (dMRI) and the underlying tissue microstructure. One promising model for validation studies is the common squirrel monkey, Saimiri sciureus. This study aims to determine (1) the reproducibility of in vivo diffusion measures both within and between subjects; (2) the agreement between in vivo and ex vivo data acquired from the same specimen and (3) normal diffusion values and their variation across brain regions. Data were acquired from three healthy squirrel monkeys, each imaged twice in vivo and once ex vivo. Reproducibility of fractional anisotropy (FA), mean diffusivity (MD), and principal eigenvector (PEV) was assessed, and normal values were determined both in vivo and ex vivo. The calculated coefficients of variation (CVs) for both intra-subject and inter-subject MD were below 10% (low variability) while FA had a wider range of CVs, 2-14% intra-subject (moderate variability), and 3-31% inter-subject (high variability). MD in ex vivo tissue was lower than in vivo (30%-50% decrease), while FA values increased in all regions (30-39% increase). The mode of angular differences between in vivo and ex vivo PEVs was 12 degrees. This study characterizes the diffusion properties of the squirrel monkey brain and serves as the groundwork for using the squirrel monkey, both in vivo and ex vivo, as a model for diffusion MRI studies.


Breastfeeding or breast milk for procedural pain in neonates.
Pain in the neonate is associated with acute behavioural and physiological changes. Cumulative pain is associated with morbidities, including adverse neurodevelopmental outcomes. Studies have shown a reduction in changes in physiological parameters and pain score measurements following pre-emptive analgesic administration in neonates experiencing pain or stress. Non-pharmacological measures (such as holding, swaddling and breastfeeding) and pharmacological measures (such as acetaminophen, sucrose and opioids) have been used for analgesia. This is an update of a review first published in 2006 and updated in 2012. The primary objective was to evaluate the effectiveness of breastfeeding or supplemental breast milk in reducing procedural pain in neonates. The secondary objective was to conduct subgroup analyses based on the type of control intervention, gestational age and the amount of supplemental breast milk given. We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registries (ICTRP, ISRCTN and clinicaltrials.gov) in August 2022; searches were limited from 2011 forwards. We checked the reference lists of included studies and relevant systematic reviews. We included randomised controlled trials (RCTs) or quasi-RCTs of breastfeeding or supplemental breast milk versus no treatment/other measures in neonates. We included both term (≥ 37 completed weeks postmenstrual age) and preterm infants (< 37 completed weeks' postmenstrual age) up to a maximum of 44 weeks' postmenstrual age. The study must have reported on either physiological markers of pain or validated pain scores. We assessed the methodological quality of the trials using the information provided in the studies and by personal communication with the authors. We extracted data on relevant outcomes, estimated the effect size and reported this as a mean difference (MD). We used the GRADE approach to assess the certainty of evidence. Of the 66 included studies, 36 evaluated breastfeeding, 29 evaluated supplemental breast milk and one study compared them against each other. The procedures conducted in the studies were: heel lance (39), venipuncture (11), intramuscular vaccination (nine), eye examination for retinopathy of prematurity (four), suctioning (four) and adhesive tape removal as procedure (one). We noted marked heterogeneity in the control interventions and pain assessment measures amongst the studies. Since many studies included multiple arms with breastfeeding/supplemental breast milk as the main comparator, we were not able to synthesise all interventions together. Individual interventions are compared to breastfeeding/supplemental breast milk and reported. The numbers of studies/participants presented with the findings are not taken from pooled analyses (as is usual in Cochrane Reviews), but are the overall totals in each comparison. Overall, the included studies were at low risk of bias except for masking of intervention and outcome assessment, where nearly one-third of studies were at high risk of bias. Breastfeeding versus control Breastfeeding may reduce the increase in heart rate compared to holding by mother, skin-to-skin contact, bottle feeding mother's milk, moderate concentration of sucrose/glucose (20% to 33%) with skin-to-skin contact (low-certainty evidence, 8 studies, 784 participants). Breastfeeding likely reduces the duration of crying compared to no intervention, lying on table, rocking, heel warming, holding by mother, skin-to-skin contact, bottle feeding mother's milk and moderate concentration of glucose (moderate-certainty evidence, 16 studies, 1866 participants). Breastfeeding may reduce percentage time crying compared to holding by mother, skin-to-skin contact, bottle feeding mother's milk, moderate concentration sucrose and moderate concentration of sucrose with skin-to-skin contact (low-certainty evidence, 4 studies, 359 participants). Breastfeeding likely reduces the Neonatal Infant Pain Scale (NIPS) score compared to no intervention, holding by mother, heel warming, music, EMLA cream, moderate glucose concentration, swaddling, swaddling and holding (moderate-certainty evidence, 12 studies, 1432 participants). Breastfeeding may reduce the Neonatal Facial Coding System (NFCS) score compared to no intervention, holding, pacifier and moderate concentration of glucose (low-certainty evidence, 2 studies, 235 participants). Breastfeeding may reduce the Douleur Aigue Nouveau-né (DAN) score compared to positioning, holding or placebo (low-certainty evidence, 4 studies, 709 participants). In the majority of the other comparisons there was little or no difference between the breastfeeding and control group in any of the outcome measures. Supplemental breast milk versus control Supplemental breast milk may reduce the increase in heart rate compared to water or no intervention (low-certainty evidence, 5 studies, 336 participants). Supplemental breast milk likely reduces the duration of crying compared to positioning, massage or placebo (moderate-certainty evidence, 11 studies, 1283 participants). Supplemental breast milk results in little or no difference in percentage time crying compared to placebo or glycine (low-certainty evidence, 1 study, 70 participants). Supplemental breast milk results in little or no difference in NIPS score compared to no intervention, pacifier, moderate concentration of sucrose, eye drops, gentle touch and verbal comfort, and breast milk odour and verbal comfort (low-certainty evidence, 3 studies, 291 participants). Supplemental breast milk may reduce NFCS score compared to glycine (overall low-certainty evidence, 1 study, 40 participants). DAN scores were lower when compared to massage and water; no different when compared to no intervention, EMLA and moderate concentration of sucrose; and higher when compared to rocking or pacifier (low-certainty evidence, 2 studies, 224 participants). Due to the high number of comparator interventions, other measures of pain were assessed in a very small number of studies in both comparisons, rendering the evidence of low certainty. The majority of studies did not report on adverse events, considering the benign nature of the intervention. Those that reported on adverse events identified none in any participants. Subgroup analyses were not conducted due to the small number of studies. Moderate-/low-certainty evidence suggests that breastfeeding or supplemental breast milk may reduce pain in neonates undergoing painful procedures compared to no intervention/positioning/holding or placebo or non-pharmacological interventions. Low-certainty evidence suggests that moderate concentration (20% to 33%) glucose/sucrose may lead to little or no difference in reducing pain compared to breastfeeding. The effectiveness of breast milk for painful procedures should be studied in the preterm population, as there are currently a limited number of studies that have assessed its effectiveness in this population.


[Mobility study of influenza C virus proteins in cellulose acetate electrophoresis].
Four strains of influenza C virus were studied by cellulose acetate electrophoresis. All of them were found to contain super-capsid proteins destroyed by electrophoresis apparently due to contact with sodium dodecylsulphate. According to Laver's classification, influenza C viruses may be placed with Group 3 viruses. Among major virion proteins of influenza C viruses matrix protein was found to be the most stable forming a separate protein band on cellulose acetate, and it may be readily identified and eluted from paper in preparative amounts.


Quantification of speed-up and accuracy of multi-CPU computational flow dynamics simulations of hemodynamics in a posterior communicating artery aneurysm of complex geometry.
Towards the translation of computational fluid dynamics (CFD) techniques into the clinical workflow, performance increases achieved with parallel multi-central processing unit (CPU) pulsatile CFD simulations in a patient-derived model of a bilobed posterior communicating artery aneurysm were evaluated while simultaneously monitoring changes in the accuracy of the solution. Simulations were performed using 2, 4, 6, 8, 10 and 12 processors. In addition, a baseline simulation was obtained with a dual-core dual CPU computer of similar computational power to clinical imaging workstations. Parallel performance indices including computation speed-up, efficiency (speed-up divided by number of processors), computational cost (computation time × number of processors) and accuracy (velocity at four distinct locations: proximal and distal to the aneurysm, in the aneurysm ostium and aneurysm dome) were determined from the simulations and compared. Total computation time decreased from 9 h 10 min (baseline) to 2 h 34 min (10 CPU). Speed-up relative to baseline increased from 1.35 (2 CPU) to 3.57 (maximum at 10 CPU) while efficiency decreased from 0.65 to 0.35 with increasing cost (33.013 to 92.535). Relative velocity component deviations were less than 0.0073% and larger for 12 CPU than for 2 CPU (0.004 ± 0.002%, not statistically significant, p=0.07). Without compromising accuracy, parallel multi-CPU simulation reduces computing time for the simulation of hemodynamics in a model of a cerebral aneurysm by up to a factor of 3.57 (10 CPUs) to 2 h 34 min compared with a workstation with computational power similar to clinical imaging workstations.


A Regulatory Circuit Composed of a Transcription Factor, IscR, and a Regulatory RNA, RyhB, Controls Fe-S Cluster Delivery.
Fe-S clusters are cofactors conserved through all domains of life. Once assembled by dedicated ISC and/or SUF scaffolds, Fe-S clusters are conveyed to their apo-targets via A-type carrier proteins (ATCs). Escherichia coli possesses four such ATCs. ErpA is the only ATC essential under aerobiosis. Recent studies reported a possible regulation of the erpA mRNA by the small RNA (sRNA) RyhB, which controls the expression of many genes under iron starvation. Surprisingly, erpA has not been identified in recent transcriptomic analysis of the iron starvation response, thus bringing into question the actual physiological significance of the putative regulation of erpA by RyhB. Using an sRNA library, we show that among 26 sRNAs, only RyhB represses the expression of an erpA-lacZ translational fusion. We further demonstrate that this repression occurs during iron starvation. Using mutational analysis, we show that RyhB base pairs to the erpA mRNA, inducing its disappearance. In addition, IscR, the master regulator of Fe-S homeostasis, represses expression of erpA at the transcriptional level when iron is abundant, but depleting iron from the medium alleviates this repression. The conjunction of transcriptional derepression by IscR and posttranscriptional repression by RyhB under Fe-limiting conditions is best described as an incoherent regulatory circuit. This double regulation allows full expression of erpA at iron concentrations for which Fe-S biogenesis switches from the ISC to the SUF system. We further provide evidence that this regulatory circuit coordinates ATC usage to iron availability. Regulatory small RNAs (sRNAs) have emerged as major actors in the control of gene expression in the last few decades. Relatively little is known about how these regulators interact with classical transcription factors to coordinate genetic responses. We show here how an sRNA, RyhB, and a transcription factor, IscR, regulate expression of an essential gene, erpA, in the bacterium E. coli ErpA is involved in the biogenesis of Fe-S clusters, an important class of cofactors involved in a plethora of cellular reactions. Interestingly, we show that RyhB and IscR repress expression of erpA under opposite conditions in regard to iron concentration, forming a regulatory circuit called an "incoherent network." This incoherent network serves to maximize expression of erpA at iron concentrations where it is most needed. Altogether, our study paves the way for a better understanding of mixed regulatory networks composed of RNAs and transcription factors.


Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households.
To investigate the frequency of catastrophic expenditures for emergency obstetric care, explore its risk factors, and assess the effect of these expenditures on households in the Kayes region, Mali. Data on 484 obstetric emergencies (242 deaths and 242 near-misses) were collected in 2008-2011. Catastrophic expenditure for emergency obstetric care was assessed at different thresholds and its associated factors were explored through logistic regression. A survey was subsequently administered in a nested sample of 56 households to determine how the catastrophic expenditure had affected them. Despite the fee exemption policy for Caesareans and the maternity referral-system, designed to reduce the financial burden of emergency obstetric care, average expenses were 152 United States dollars (equivalent to 71 535 Communauté Financière Africaine francs) and 20.7 to 53.5% of households incurred catastrophic expenditures. High expenditure for emergency obstetric care forced 44.6% of the households to reduce their food consumption and 23.2% were still indebted 10 months to two and a half years later. Living in remote rural areas was associated with the risk of catastrophic spending, which shows the referral system's inability to eliminate financial obstacles for remote households. Women who underwent Caesareans continued to incur catastrophic expenses, especially when prescribed drugs not included in the government-provided Caesarean kits. The poor accessibility and affordability of emergency obstetric care has consequences beyond maternal deaths. Providing drugs free of charge and moving to a more sustainable, nationally-funded referral system would reduce catastrophic expenses for households during obstetric emergencies.


Feed of Siamese fighting fish, Betta splendens, (Regan, 1910) in open pond: live and formulated diets.
The growth rate and percent survival of Betta splendens when submitted to formulated diet and live food treatments are evaluated. The three different diets were used and designated as: formulated diet (basal diet); live food diet (plankton) and mixed diet (formulated diet with plankton). The live food diet contained plankton belonging to an open pond. High mortality was reported with live food (plankton) treatment whereas higher percent survival occurred with formulated diet. Highest specific growth rate, weight gain and final weight were reported in the mixed diet treatment and were significantly different (p<0.01) from those in formulated diet and live food treatments. The gut contents of B. splendens in mixed diet and live food treatments comprised, Rotifera and Bacillariophyceae species in high percentages or rather, over 78% of total organisms. Lecane sp. was the most ingested zooplankton species by B. splendens in both treatments (mixed diet and live food), with the phytoplankton species Asterionella sp. and Melosira sp. respectively in mixed diet and in live food, respectively. Results indicated that the formulated diet influenced the water parameters dissolved oxygen, total suspended solids, total dissolved solids and pH. The live food in the open pond was not enough to improve the growth rate and percent survival of B. splendens. The growth performance of B. splendens; had the best results with mixed diet which was capable of maintaining species's survival (82%) and development in artificial conditions, benefiting the culture management of ornamental fish.


Hemodynamic responses to continuous versus pulsatile mechanical unloading of the failing left ventricle.
Debate exists regarding the merits and limitations of continuous versus pulsatile flow mechanical circulatory support. To characterize the hemodynamic differences between each mode of support, we investigated the acute effects of continuous versus pulsatile unloading of the failing left ventricle in a bovine model. Heart failure was induced in male calves (n = 14). During an acute study, animals were instrumented through thoracotomy for hemodynamic measurement. A continuous flow (n = 8) and/or pulsatile flow (n = 8) left ventricular assist device (LVAD) was implanted and studied during maximum support ( approximately 5 L/min) and moderate support ( approximately 2-3 L/min) modes. Pulse pressure (PP), surplus hemodynamic energy (SHE), and (energy equivalent pressure [EEP]/mean aortic pressure (MAP) - 1) x 100% were derived to characterize hemodynamic energy profiles during the different support modes. Standard hemodynamic parameters of cardiac performance were also derived. Data were analyzed by repeated measures one-way analysis of variance within groups and unpaired Student's t-tests across groups. During maximum and moderate continuous unloading, PP, SHE, and (EEP/MAP - 1) x 100% were significantly decreased compared with baseline and compared with pulsatile unloading. As a result, continuous unloading significantly altered left ventricular peak systolic pressure, aortic systolic and diastolic pressure, +/-dP/dt, and rate x pressure product, whereas pulsatile unloading preserved a normal profile of physiologic values. As continuous unloading increased, the pressure-volume relationship collapsed, and the aortic valve remained closed. In contrast, as pulsatile unloading increased, a comparable decrease in left ventricular volumes was noted. However, a normal range of left ventricular pressures was preserved. Continuous unloading deranged the physiologic profile of myocardial and vascular hemodynamic energy utilization, whereas pulsatile unloading preserved more normal physiologic values. These findings may have important implications for chronic LVAD therapy.


Behavioral Health Diagnoses Among Children and Adolescents Hospitalized in the United States: Observations and Implications.
The study described rates and characteristics of U.S. children hospitalized with a behavioral (mental or substance use) disorder. This cross-sectional analysis of data from the 2012 Kids' Inpatient Database included 483,281 hospitalizations in general and children's hospitals of persons under age 21 with a primary or secondary behavioral diagnosis. The admission rate with any behavioral diagnosis was 5.5 per 1,000 children in the U.S. population, with 2.9 having a primary behavioral diagnosis. Common primary diagnoses included depression (34%), other mood (31%), psychotic (9%), and substance use (7%) disorders. The most common behavioral diagnoses secondary to a primary diagnosis that is not behavioral were depression (26%), attention-deficit disorder (26%), and substance use disorders (22%). Suicide or self-harm was rarely the primary diagnosis (.1%) but complicated 12% of admissions with a primary behavioral diagnosis. Variations in admissions (per 1,000 children in the U.S. population) with a primary behavioral diagnosis were noted by race-ethnicity (blacks, 3.2; whites, 2.9; and Hispanics, 1.4), insurance (public, 2.9; private, 2.0), and geographic region. Fifty-nine of every 1,000 peripartum admissions in the 12-20 age group had a secondary behavioral diagnosis. Patients with behavioral comorbidities were more likely to be transferred to another facility (8.0% versus 2.2%, p<.001). Behavioral disorders comorbid to nonbehavioral disorders increased length of stay (4.3 versus 3.3 days, p<.001) and costs ($12,742 versus $9,929, p<.001). Nearly 500,000 pediatric admissions in 2012 included behavioral disorders. Comorbidities were associated with longer stays and an estimated $1.36 billion additional annual costs, which were disproportionately borne by public insurance.


Technical and radiographic considerations for magnetic resonance imaging-guided focused ultrasound capsulotomy.
Magnetic resonance imaging-guided focused ultrasound (MRgFUS) is an emerging treatment modality that enables incisionless ablative neurosurgical procedures. Bilateral MRgFUS capsulotomy has recently been demonstrated to be safe and effective in treating obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). Preliminary evidence has suggested that bilateral MRgFUS capsulotomy can present increased difficulties in reaching lesional temperatures as compared to unilateral thalamotomy. The authors of this article aimed to study the parameters associated with successful MRgFUS capsulotomy lesioning and to present longitudinal radiographic findings following MRgFUS capsulotomy. Using data from 22 attempted MRgFUS capsulotomy treatments, the authors investigated the relationship between various sonication parameters and the maximal temperature achieved at the intracranial target. Lesion volume and morphology were analyzed longitudinally using structural and diffusion tensor imaging. A retreatment procedure was attempted in one patient, and their postoperative imaging is presented. Skull density ratio (SDR), skull thickness, and angle of incidence were significantly correlated with the maximal temperature achieved. MRgFUS capsulotomy lesions appeared similar to those following MRgFUS thalamotomy, with three concentric zones observed on MRI. Lesion volumes regressed substantially over time following MRgFUS. Fractional anisotropy analysis revealed a disruption in white matter integrity, followed by a gradual return to near-baseline levels concurrent with lesion regression. In the patient who underwent retreatment, successful bilateral lesioning was achieved, and there were no adverse clinical or radiographic events. With the current iteration of MRgFUS technology, skull-related parameters such as SDR, skull thickness, and angle of incidence should be considered when selecting patients suitable for MRgFUS capsulotomy. Lesions appear to follow morphological patterns similar to what is seen following MRgFUS thalamotomy. Retreatment appears to be safe, although additional cases will be necessary to further evaluate the associated safety profile.


Predator-induced fear causes PTSD-like changes in the brains and behaviour of wild animals.
Predator-induced fear is both, one of the most common stressors employed in animal model studies of post-traumatic stress disorder (PTSD), and a major focus of research in ecology. There has been a growing discourse between these disciplines but no direct empirical linkage. We endeavoured to provide this empirical linkage by conducting experiments drawing upon the strengths of both disciplines. Exposure to a natural cue of predator danger (predator vocalizations), had enduring effects of at least 7 days duration involving both, a heightened sensitivity to predator danger (indicative of an enduring memory of fear), and elevated neuronal activation in both the amygdala and hippocampus - in wild birds (black-capped chickadees, Poecile atricapillus), exposed to natural environmental and social experiences in the 7 days following predator exposure. Our results demonstrate enduring effects on the brain and behaviour, meeting the criteria to be considered an animal model of PTSD - in a wild animal, which are of a nature and degree which can be anticipated could affect fecundity and survival in free-living wildlife. We suggest our findings support both the proposition that PTSD is not unnatural, and that long-lasting effects of predator-induced fear, with likely effects on fecundity and survival, are the norm in nature.


It's Complicated: Navigating Multiple Identities in Small Town America.
During the past few years, research focused on individuals who identify as gay, lesbian, bisexual, and transgender (LGBT) have increased. However, much of this literature focuses on White LGBT individuals, and less on individuals who have intersected identities, such as being both gay/lesbian and a person of color. Consequently, this population becomes obscured in scholarly discourses, thus being made "invisible" with regard to theory, research, and clinical interventions, with the result that clinicians are provided little or no knowledge of theories or best practices when working with individuals who are both sexual minority and people of color. This article discusses an integrated theoretical and treatment process when working with clients who are navigating multiple oppressed identities.


Differences Regarding the Molecular Features and Gut Microbiota Between Right and Left Colon Cancer.
For many years, developmental and physiological differences have been known to exist between anatomic segments of the colorectum. Because of different outcomes, prognoses, and clinical responses to chemotherapy, the distinction between right colon cancer (RCC) and left colon cancer (LCC) has gained attention. Furthermore, variations in the molecular features and gut microbiota between right and LCCs have recently been a hot research topic. CpG island methylator phenotype-high, microsatellite instability-high colorectal cancers are more likely to occur on the right side whereas tumors with chromosomal instability have been detected in approximately 75% of LCC patients and 30% of RCC patients. The mutation rates of oncogenes and tumor suppressor genes also differ between RCC and LCC patients. Biofilm is more abundant in RCC patients than LLC patients, as are Prevotella, Selenomonas, and Peptostreptococcus. Conversely, Fusobacterium, Escherichia/Shigella, and Leptotrichia are more abundant in LCC patients compared to RCC patients. Distinctive characteristics are apparent in terms of molecular features and gut microbiota between right and LCC. However, how or to what extent these differences influence diverging oncologic outcomes remains unclear. Further clinical and translational studies are needed to elucidate the causative relationship between primary tumor location and prognosis.


Multilayered polyelectrolyte-coated gold nanorods as multifunctional optical contrast agents for cancer cell imaging.
We report the application of multilayered polyelectrolyte-coated gold nanorods (GNRs) as multifunctional optical contrast agents for cancer cell imaging. The surface modification of GNRs improves their chemical stability and facilitates them to be taken up by cancer cells through electrostatic interaction. The unique longitudinal surface plasmon resonance property of GNRs makes them suitable as both "scattering contrast agents" and "Raman contrast agents". In our experiments, the staining of GNRs in cells was further confirmed by dark field microscopy and Raman microscopy. Our experiment results indicated that GNRs have great potential as multifunctional "optical contrast agents" for future in vivo animal imaging.


Endometrial biopsy in Holstein-Friesian dairy cows. II. Correlations between histological criteria.
Endometrial biopsies were taken for histological assessment from 97 cows which calved in a commercial dairy herd between April and August 1984. The main objectives of this study were to analyze the interrelationships among histological criteria and to identify a shortlist of histological parameters to be included in subsequent analysis of associations with results of bacteriological culture, clinical findings and reproductive performance. Epithelial height and segmented cell counts were highly correlated within biopsy, between horns and between days. Subjective assessment of inflammation in the epithelium and/or stratum compactum generally identified biopsies which had any inflammation present. Cows which had inflammation in a biopsy from day 26 were likely to show inflammatory changes at day 40. Quantitative and subjective assessments of gland number, dilation and fibrosis were highly correlated. There was a positive association between the number of cross sections and the diameter of glands, and both of these criteria were negatively correlated with fibrosis and inflammatory changes. There may be different functional significance of the same histological finding at a different number of days postpartum.


TLR2 engagement on CD8 T cells enables generation of functional memory cells in response to a suboptimal TCR signal.
TLR are involved in the detection of microbial infection as well as endogenous ligands that signal tissue and cell damage in mammals. This recognition plays an essential role in innate immune response and the initiation of adaptive immune response. We have previously shown that murine CD8 T cells express TLR2, and that costimulation of Ag-activated CD8 T cells with TLR2 ligands enhances their proliferation, survival, and effector functions. We also demonstrated that TLR2 engagement on CD8 T cells significantly reduces their need for costimulatory signals delivered by APC. We show in this study that TLR2 engagement on CD8 T cells lowers the Ag concentration required for optimal activation, and converts a partial activation into a productive process leading to a significant expansion of cells. Using altered peptide ligands, we demonstrate that TLR2 engagement increases CD8 T cell activation and enables the generation of functional memory cells in response to a low TCR signal. This increased activation is associated with an augmented activation of the PI3K. Taken together, our results demonstrate that TLR2 engagement on CD8 T cells lowers their activation threshold for TCR signal strength and enables efficient memory cell generation in response to a weak TCR signal.


Effects of Web-Based Group Mindfulness Training on Stress and Sleep Quality in Singapore During the COVID-19 Pandemic: Retrospective Equivalence Analysis.
The COVID-19 pandemic has negatively impacted psychological health. Mindfulness training, which helps individuals attend to the present moment with a nonjudgmental attitude, improves sleep and reduces stress during regular times. Mindfulness training may also be relevant to the mitigation of harmful health consequences during acute crises. However, certain restrictions may necessitate the web-based delivery of mindfulness training (ie, rather than in-person group training settings). The objective of our study was to examine the effects of mindfulness interventions during the COVID-19 pandemic and to evaluate the effectiveness of web-based interventions. Data from an ongoing study were used for this retrospective equivalence analysis. Recruited participants were enrollees from mindfulness courses at a local charity organization that promoted mental wellness. This study had no exclusion criteria. We created three groups; two groups received their training during the COVID-19 pandemic (in-person training group: n=36; videoconferencing group: n=38), and a second control group included participants who were trained before the pandemic (n=86). Our primary outcomes were self-reported stress and sleep quality. Baseline levels and changes in these variables due to mindfulness training were compared among the groups via an analysis of covariance test and two one-tailed t tests. Baseline perceived stress (P=.50) and sleep quality (P=.22) did not differ significantly among the three groups. Mindfulness training significantly reduced stress in all three groups (P<.001), and this effect was statistically significant when comparing videoconferencing to in-person training (P=.002). Sleep quality improved significantly in the prepandemic training group (P<.001). However, sleep quality did not improve in the groups that received training during the pandemic. Participants reported that they required shorter times to initiate sleep following prepandemic mindfulness training (P<.001), but this was not true for those who received training during the pandemic. Course attendance was high and equivalent across the videoconferencing and comparison groups (P=.02), and participants in the videoconferencing group engaged in marginally more daily practice than the in-person training group. Web-based mindfulness training via videoconferencing may be a useful intervention for reducing stress during times when traditional, in-person training is not feasible. However, it may not be useful for improving sleep quality.


Epstein-Barr virus-associated meningoencephalomyelitis: intrathecal reactivation of the virus in an immunocompetent child.
Neurologic complications, including meningoencephalitis, transverse myelitis, and peripheral neuropathy, have been reported in patients with acute infectious mononucleosis. Chronic active Epstein-Barr virus and human immunodeficiency virus infections occasionally induce central nervous system lymphoma. On the other hand, central nervous system disease alone associated with Epstein-Barr virus rarely occurs in previously healthy individuals. A 15-year-old girl who developed acute disseminated encephalomyelitis-like disease presenting fever, anuresis, diplopia, and muscle weakness is described here. Clinical and neuroimaging studies led to the diagnosis of encephalomyelitis. Despite the absence of infectious mononucleosis-like symptoms, anti-Epstein-Barr virus antibody titers in serum and cerebrospinal fluid showed the virus reactivation. The copy number of Epstein-Barr virus DNA increased in cerebrospinal fluid but not in peripheral blood. Ganciclovir and repeated methyl-prednisolone pulse therapy resulted in complete resolution. Central nervous system disease on the limited intrathecal reactivation of Epstein-Barr virus in immunocompetent children should be differentiated from acute disseminated encephalomyelitis.


Sex-linked genetic diversity originates from persistent sociocultural processes at microgeographic scales.
Population genetics has been successful at identifying the relationships between human groups and their interconnected histories. However, the link between genetic demography inferred at large scales and the individual human behaviours that ultimately generate that demography is not always clear. While anthropological and historical context are routinely presented as adjuncts in population genetic studies to help describe the past, determining how underlying patterns of human sociocultural behaviour impact genetics still remains challenging. Here, we analyse patterns of genetic variation in village-scale samples from two islands in eastern Indonesia, patrilocal Sumba and a matrilocal region of Timor. Adopting a 'process modelling' approach, we iteratively explore combinations of structurally different models as a thinking tool. We find interconnected socio-genetic interactions involving sex-biased migration, lineage-focused founder effects, and on Sumba, heritable social dominance. Strikingly, founder ideology, a cultural model derived from anthropological and archaeological studies at larger regional scales, has both its origins and impact at the scale of villages. Process modelling lets us explore these complex interactions, first by circumventing the complexity of formal inference when studying large datasets with many interacting parts, and then by explicitly testing complex anthropological hypotheses about sociocultural behaviour from a more familiar population genetic standpoint.


Genetic Predisposition to Symptomatic Lumbar Disk Herniation in Pediatric and Young Adult Patients.
Case-control whole-genome sequencing analysis of a highly select, young cohort with symptomatic lumbar disk herniation (LDH) compared with the standard variation in a large reference population. To assess genetic influences predisposing pediatric and young adult patients to symptomatic LDH. LDH has traditionally been attributed to natural weakening or mechanical insult, but recent literature supports a potential genetic influence. Young patients with symptomatic, clinically confirmed LDH who underwent surgical treatment were included. Patients were younger than the average age of presentation, limiting the influence of environmental risks. DNA collected from these patients was compared with a reference genome (1000 Genomes Project). A genome-wide association study using whole-genome sequencing was used to characterize genetic mutations potentially associated with LDH. Among the 61 candidate genes flagged, 20 had missense mutations in 2 or more LDH cases. Missense mutations in collagen-encoding genes were observed in 12 of 15 patients (80%). A potential association with clinical presentation was indicated by odds ratios of key single-nucleotide polymorphism (SNP) variants in genes that encode collagen. Relative to the reference population, the LDH cohort demonstrated two statistically significant SNP variants in the gene encoding for aggrecan, a protein that facilitates load-bearing properties in the cartilaginous end plate. Aggrecan genes SNPs rs3817428 and rs11638262 were significantly associated with decreased odds of symptomatic LDH: odds ratio 0.05 (0.02-0.11) and 0.04 (0-0.26), respectively (P < 1 × 10 for both). These results suggest that collagen-encoding variants may be a genetic risk factor for LDH. They also shed new light on the role of variants that impact aggrecan, which sustains the cartilaginous end plate. Genetic predisposition to LDH may therefore be related to a multimodal combination of mutations that affect the nucleus pulposus, annulus fibrosus, and the cartilaginous end plates. 4.


The written language of deaf adolescents: patterns of performance.
A study was conducted of the written language skills of a representative sample of 69 adolescents with severe and profound hearing losses, using both a standardized language sample (TOWL-2) and a letter. The overall results confirmed the generally low levels of performance typically found in this population and the existence of a developmental plateau. Nevertheless, performance levels were not uniformly low. The sample scored relatively high on measures of orthographic conventions and on semantics, but considerably lower on use of grammar. While females scored higher than males, and students in Auditory/Oral (A/O) programs scored higher than those in Total Communication (TC) programs, the profile of scores did not vary by group. In general, the letter elicited higher levels of performance than the standardized sample, although the latter elicited more grammatically complex writing. Factor analysis indicated that the various measures derived from the two samples were associated more strongly by genre than by levels of language form.


Bio-Inspired Stretchable Absolute Pressure Sensor Network.
A bio-inspired absolute pressure sensor network has been developed. Absolute pressure sensors, distributed on multiple silicon islands, are connected as a network by stretchable polyimide wires. This sensor network, made on a 4'' wafer, has 77 nodes and can be mounted on various curved surfaces to cover an area up to 0.64 m × 0.64 m, which is 100 times larger than its original size. Due to Micro Electro-Mechanical system (MEMS) surface micromachining technology, ultrathin sensing nodes can be realized with thicknesses of less than 100 µm. Additionally, good linearity and high sensitivity (~14 mV/V/bar) have been achieved. Since the MEMS sensor process has also been well integrated with a flexible polymer substrate process, the entire sensor network can be fabricated in a time-efficient and cost-effective manner. Moreover, an accurate pressure contour can be obtained from the sensor network. Therefore, this absolute pressure sensor network holds significant promise for smart vehicle applications, especially for unmanned aerial vehicles.


Structure of pocks on the chorioallantoic membrane of fertile hens' eggs induced by herpes simplex virus types 1 and 2.
The fine structure of the chorioallantoic membrane of the fertile hen's egg infected with herpes simplex virus Types 1 and 2 was examined. Lesions induced by Type 1 virus were small, confined to the chorionic layer of the membrane and proliferative in nature with slight cellular infiltration into the mesoderm after incubation up to 7 days. With the Type 2 virus-induced pocks, reaction occurred throughout the thickness of the chorioallantoic membrane, and haemorrhages, necroses, ulceration and cellular infiltration of the mesoderm were prominent features. Inoculation of the membranes with Type 2 virus resulted in a large number of infected chorion cells compared with Type 1, whilst the cells of the mesoderm and blood vessels became infected with Type 2 virus but not Type 1. Two types of intranuclear granules, lattice structures in both nuclei and cytoplasm and virus particles with variously structured cores were found specifically in Type 2 infected cells.


[Minor components from the carminomycin complex].
Three components differing by their properties from the carminomycins described earlier were isolated from the carminomycin complex. Comparison of the IR and UV spectra, as well as chromatographic and physicochemical properties of 2 of them showed that they were dihydrocarminomycin and its aglycone or dihydrocarminomycinone, which was prepared earlier by synthesis. The third component was a chromophore belonging to 1,4,6-trihydroxyanthraquinone. Investigation of its IR spectrum, physicochemica properties and PMR spectrum showed it to be carboxymethylethylcarminomycinone identical to epsilon-rodomycinone. The data were confirmed by 13C-NMR spectrometry.


Serum nesfatin-1, ghrelin, and lipid levels in adolescents with first episode drug naïve unipolar depression.
Background: Major depressive disorder (MDD) is a mental health and emotional disorder that affects children and adolescents worldwide. This study aimed to evaluate serum nesfatin-1, ghrelin, and lipid levels as biological markers of adolescent MDD and their relationship with the severity of depression-anxiety and suicide risk in MDD. Methods:This study included 37 drug naïve adolescents between the ages of 12 and 18 who were diagnosed with a first episode MDD according to the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) and DSM-V diagnostic criteria. Thirty-three healthy adolescents between the ages of 12 and 18 were included as the control group. The Children's Depression Inventory (CDI), Screen for Child Anxiety Related Disorders (SCARED), and Suicide Probability Scale (SPS) were used to evaluate the subjects in the MDD and control groups. In the first stage, serum nesfatin-1, ghrelin, and lipid levels were compared between the adolescents diagnosed with MDD and the control group. Next, the correlations between these levels and the CDI, SCARED, and SPS scores were evaluated. Results: Nesfatin-1 levels were significantly lower in the MDD group than the control group (p < 0.001) A positive correlation was found between the nesfatin-1 levels and the SPS scores. Conclusions: This is the first study to evaluate nesfatin-1 levels in adolescent depression, suggesting that nesfatin-1, ghrelin, total cholesterol, and low-density lipoprotein cholesterol (LDL) levels can be used as biomarkers in child-adolescent MDD. However, it is evident that further studies with larger samples and post-treatment measurements are needed.


Head Injury- A Maxillofacial Surgeon's Perspective.
Injuries and violence are one of the leading causes of mortality worldwide. A substantial portion of these injuries involve the maxillofacial region. Among the concomitant injuries, injuries to the head and cervical spine are amongst those that demand due consideration on account of their life threatening behaviour. Studies have shown that facial fractures have a strong association with traumatic brain injury. Knowledge of the types and mechanisms of traumatic brain injury is crucial for their treatment. Many a times, facial fractures tend to distract our attention from more severe and often life threatening injuries. Early diagnosis of these intracranial haemorrhage leads to prompt treatment which is essential to improve the outcome of these patients. An oral and maxillofacial surgeon should be able to suspect and diagnose head injury and also provide adequate initial management.


[The treatment of peripapillary diverticula of the duodenum].
An original operation is proposed for localization of the diverticulum in the descending portion of the duodenum which excludes traumas of the pancreas. Clinical observations are described.


Role of FKS Gene in the Susceptibility of Pathogenic Fungi to Echinocandins.
Echinocandins are antifungal agents that specifically inhibit the biosynthesis of 1,3-β-D-glucan, a major structural component of fungal cell walls. Echinocandins are recommended as first-line or alternative/salvage therapy for candidiasis and aspergillosis in antifungal guidelines of various countries. Resistance to echinocandins has been reported in recent years. The mechanism of echinocandin resistance involves amino acid substitutions in hot spot regions of the FKS gene product, the catalytic subunit of 1,3-β-D-glucan synthase. This resistance mechanism contributes to not only acquired resistance in Candida spp., but also inherent resistance in some pathogenic fungi. An understanding of the echinocandin resistance mechanism is important to develop both effective diagnosis and treatment options for echinocandin-resistant fungal diseases.


The influence of personality on neural mechanisms of observational fear and reward learning.
Fear and reward learning can occur through direct experience or observation. Both channels can enhance survival or create maladaptive behavior. We used fMRI to isolate neural mechanisms of observational fear and reward learning and investigate whether neural response varied according to individual differences in neuroticism and extraversion. Participants learned object-emotion associations by observing a woman respond with fearful (or neutral) and happy (or neutral) facial expressions to novel objects. The amygdala-hippocampal complex was active when learning the object-fear association, and the hippocampus was active when learning the object-happy association. After learning, objects were presented alone; amygdala activity was greater for the fear (vs. neutral) and happy (vs. neutral) associated object. Importantly, greater amygdala-hippocampal activity during fear (vs. neutral) learning predicted better recognition of learned objects on a subsequent memory test. Furthermore, personality modulated neural mechanisms of learning. Neuroticism positively correlated with neural activity in the amygdala and hippocampus during fear (vs. neutral) learning. Low extraversion/high introversion was related to faster behavioral predictions of the fearful and neutral expressions during fear learning. In addition, low extraversion/high introversion was related to greater amygdala activity during happy (vs. neutral) learning, happy (vs. neutral) object recognition, and faster reaction times for predicting happy and neutral expressions during reward learning. These findings suggest that neuroticism is associated with an increased sensitivity in the neural mechanism for fear learning which leads to enhanced encoding of fear associations, and that low extraversion/high introversion is related to enhanced conditionability for both fear and reward learning.


Medicine's missing dimension.
In medicine we tend to restrict practice to using a purely intellectual understanding grounded in science to conceptualize patients and their illnesses. This approach is radically different from the experientially rich healing practices found throughout the world that presumably date to the beginning of humanity. Shamanistic healing is often typified as involving magical thinking and communication with beings other than human. These aspects of traditional healing are difficult to merge with science, the backbone of our medical practice. However, we can also describe traditional healing as meeting patients beyond the conventional self and beyond conceptual filters to directly face sickness and death in a larger context. There are a variety of traditions for learning to live our lives in this larger context, including contemplative religious practices and secular mindfulness practice. Although self discipline, effort and courage are likely to be required to take these paths, they can transform the practice of medicine into a richer experience. Using Zen Buddhism as an example of a contemplative spiritual approach, I will explore how it is possible to preserve a respectful relationship to science while engaging in healing as what the African Bushmen called "a life thing, a death thing".


An expanded view of self-management: patients' perceptions of education and support in an intervention for chronic musculoskeletal pain.
Chronic pain is prevalent, costly, and is associated with profound psychological effects. Although pain is prevalent in returning veterans of the recent military conflicts in Afghanistan and Iraq (Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn [OEF/OIF/OND] Veterans), little is known about chronic pain in these patients. This study's objective was to ascertain perceptions of a multicomponent intervention tested in a randomized controlled trial for OEF/OIF/OND veterans with chronic musculoskeletal pain (Evaluation of Stepped Care for Chronic Pain [ESCAPE]). Qualitative interviews were conducted with 26 patients in the intervention arm of ESCAPE (21% of total intervention patients) to determine patients' experiences with and perceptions of the intervention. Patients were purposefully sampled to include treatment responders (defined as ≥30% reduction in pain-related disability or pain severity), nonresponders, and noncompleters (completed <50% of trial). Qualitative analysis was guided by grounded theory. Both responders and nonresponders discussed the importance of the self-management education they received. Of particular significance, patients identified the nurse care manager who administered the intervention as being integral to patients' ability to self-manage their chronic pain. Patients described important ways in which the nurse facilitated their self-management, reported under three themes: 1) helping patients find what works for their pain; 2) holding patients accountable for their pain management; 3) motivating and providing emotional support to patients. Results corroborate previous work and suggest that current conceptualizations of self-management are incomplete. A model is proposed that not only depicts self-management as involving more than activities and strategies, but also acknowledges the central role of relationships and support in pain self-management.


Erlotinib inhibits progression to dysplasia in a colitis-associated colon cancer model.
To investigate the role of epidermal growth factor receptor (EGFR) in colitis-associated dysplasia using the EGFR tyrosine kinase inhibitor erlotinib. Sprague-Dawley rats received trinitrobenzene sulfonic acid (TNBS; 30 mg in 50% ethanol, ic), followed 6 wk later by reactivation with TNBS (5 mg/kg, iv) for 3 d. To induce colitis-associated dysplasia, rats then received TNBS (iv) twice a week for 10 wk. One group received erlotinib (10 mg/kg, ip) for 1 wk before the start of the reactivation of the colitis and 2 wk after (21 d); the rest received the vehicle. After rats were euthanized, the colons were removed and analyzed for damage and expression of the EGFR downstream effectors Erk1/2 and c-Myc. Ninety percent of the vehicle-treated animals had dysplasia in any region of the colon. Erlotinib-treated animals had a significant decrease in the incidence of dysplasia compared to vehicle-treated animals in all regions of the colon (50.00% ± 11.47% vs 90.00% ± 10.00% in proximal, P < 0.05; 15.00% ± 8.19% vs 50.00% ± 16.67% in mid, P < 0.05; and 20.00% ± 9.17% vs 70.00% ± 15.28% in distal, P < 0.01). Erlotinib-treated animals also had reduced cell proliferation, reduced active Erk1/2, and reduced c-Myc in colon epithelium compared with the vehicle-treated animals. In vitro, erlotinib treatment was shown to markedly decrease c-Myc and pErk1/2 levels in rat epithelial cells. Proliferation of rat epithelial cells was stimulated by epidermal growth factor and inhibited by erlotinib (P < 0.05). Erlotinib can decrease the development of colitis-associated dysplasia, suggesting a potential therapeutic use for erlotinib in patients with long-standing colitis.


Two-dimensional Ising transition through a technique from two-state opinion-dynamics models.
The Ising ferromagnetic model on a square lattice is revisited using the Galam unifying frame (GUF), set to investigate two-state opinion-dynamics models. When combined with Metropolis dynamics, an unexpected intermediate "dis/order" regime is found with the coexistence of two attractors associated, respectively, to an ordered and a disordered phases. The basin of attraction of initial conditions for the disordered phase attractor starts from zero size at a first critical temperature T(c1) to embody the total landscape of initial conditions at a second critical temperature T(c2), with T(c1)≈1.59 and T(c2)≈2.11 in J/k(B) units. It appears that T(c2) is close to the Onsager result T(c)≈2.27. The transition, which is first-order-like, exhibits a vertical jump to the disorder phase at T(c2), reminiscent of the rather abrupt vanishing of the corresponding Onsager second-order transition. However, using Glauber dynamics combined with GUF does not yield the intermediate phase and instead the expected classical mean-field transition is recovered at T(c)≈3.09. Accordingly, although the "dis/order" regime produced by the GUF-Metropolis combination is not physical, it is an intriguing result to be understood. In particular the fact that Glauber and Metropolis dynamics yield so different results using GUF needs an explanation. The possibility of extending GUF to larger clusters is discussed.


Social media usage and health promoting lifestyle in profile related socio-demographic factors in Turkey.
Background: Social media represents a revolutionary new trend that offers opportunities for and threats toward modifying health behaviours. Although social media has considerable health promotion and education tools, this article summarizes the relationship between the health promoting lifestyle and Facebook usage, as Facebook is one of the most popular tools in social media. Methods: We carried out a cross-sectional, descriptive study with 423 Facebook users living in Ankara, Turkey. Nonlinear canonical correlation analysis (OVERALS) was used to describe the complex links between health behaviours, social media usage and demographic characteristics. Results: In this study, a two-dimensional solution with an actual fit measure equal to 0.958was found, and this solution can be interpreted as about 48% of the explained variance. This two-dimensional result shows the relationships and differences between healthy lifestyle subdimensions, social media usage and some demographic characteristics. Conclusion: Using OVERALS, we found evidences supporting associations among social media use, health promoting lifestyle and socio-demographic factors. Further, the complex correlations among these variables were interpreted.


Tests of phenotypic and genetic concordance and their application to the conservation of Panamanian golden frogs (Anura, Bufonidae).
Evolutionarily significant units (ESUs) differ in the extent to which they capture, or even consider, adaptive variation, and most such designations are based solely on neutral genetic differences that may not capture variation relevant to species' adaptabilities to changing environmental conditions. While concordant patterns of divergence among data sets (i.e. neutral and potentially non-neutral characters) can strengthen ESU designations, determining whether such criteria are met for highly variable taxa is especially challenging. This study tests whether previously defined ESUs for endangered Panamanian golden frogs (Atelopus varius and Atelopus zeteki) exhibit concordant variation among multiple phenotypic traits and mitochondrial DNA sequences, and the extent to which such divergence corresponds to environmental differences. Multivariate analyses identify phenotypic and genetic differentiation consistent with proposed ESUs and support the status of A. varius and A. zeteki as separate species. Moreover, the significant association detected between ESU co-membership and genetic similarity, which remained strong after removing the effect of geographic distance, also indicates that genetic differences are not simply due to isolation by distance. Two phenotypic characters (body size and the extent of dorsal black patterning) that differ among ESUs also co-vary with environmental differences, suggesting that to the extent that these phenotypic differences are heritable, variation may be associated with adaptive divergence. Lastly, discriminant function analyses show that the frogs can be correctly assigned to ESUs based on simultaneous analysis of multiple characters. The study confirms the merit of conserving the previously proposed golden frog ESUs as well as demonstrates the utility and feasibility of combined analyses of ecological, morphological and genetic variation in evaluating ESUs, especially for highly variable taxa.


Efficacy of an aiming device for the placement of distal interlocking screws in trochanteric fixation nailing.
Locked intramedullary nailing continues to be the surgical treatment of choice for most long bone fractures. Performing distal interlocks can be a technical challenge. Free hand (FH) technique remains to be most popular. Radiation exposure, particularly to the surgeon still remains a concern with this technique. A prospective randomized analysis of 20 patients undergoing operative fixation with long trochanteric fixation nailing for intertrochanteric or subtrochanteric fractures was performed. The groups were randomized into (1) aiming arm group (AA) and (2) FH group by computer generated randomization technique. Two distal interlocking screws were placed in every case. Various parameters were analyzed including total operating time, distal interlocking time, total fluoroscopy time, distal fluoroscopy time and nail dimensions. The variables in two groups were compared to each other using Fischer's exact test. The mean distal interlock time was 7.1 +/- 2.4 and 12.1 +/- 3.2 min for AA and FH techniques respectively. There was a 41.3% decrease in the distal interlock time with the device, which was statistically significant (P < 0.001). The distal interlock fluoroscopy time was 9.2 +/- 4.9 and 28.9 +/- 16.4 s with AA technique and the FH technique respectively. This 68.2% reduction in time taken for distal fluoroscopy was statistically significant (P < 0.001). However, the reduction in the total fluoroscopy time was statistically not significant. The AA is very efficient and user friendly and also reduces the radiation exposure.


Gastroesophageal reflux in children with functional constipation.
Functional constipation and gastroesophageal reflux disease are two major and commonly encountered components of childhood functional gastrointestinal disorders. Epidemiological studies in the adult population support that there is a significant overlap between the different functional disorders of the digestive tract. Therefore, we aimed to investigate the frequency of gastroesophageal reflux disease in children with functional constipation and to compare clinical findings and 24-h esophageal pH monitoring with a group of patients with suspected gastroesophageal reflux disease. Children between 4 and 16 years old with functional constipation (based on Rome III criteria, Group 1; n=38) were prospectively evaluated. A control group was composed of patients with symptoms suggesting gastroesophageal reflux disease (Group 2; n= 40). All patients included in the study were asked about reflux-related symptoms, and then all cases underwent 24-h esophageal pH monitoring analysis. Delayed gastric emptying symptoms such as belching and hiccups were more common in patients in Group 1 (p=0.002, p=0.021, respectively), whereas chronic cough was more common in patients in Group 2 (p=0.012). According to the 24-h esophageal pH monitoring, pathologic acid reflux in the lower and/or laryngopharyngeal portion of the esophagus was determined in 39.5% of the patients in Group 1 and in 42.5% of the patients in Group 2 (p=0.96). No significant difference was found in terms of age, gender and duration of constipation in patients with and without acid reflux in Group 1 patients. Pyrosis (66.6 vs. 0%, p=0.00001)was more common in Group 1 patients with acid reflux, but hiccups (20 vs. 69.5%, p=0.007) and belching (33.3 vs. 60.8%, p=0.184) were more common in patients in Group 1 without acid reflux. Gastroesophageal reflux disease should be considered in the treatment and monitoring of patients with functional constipation. Further studies are needed using 24-h pH multichannel impedance.


Asynchronous interpretation of manual and automated audiometry: Agreement and reliability.
Introduction Remote interpretation of automated audiometry offers the potential to enable asynchronous tele-audiology assessment and diagnosis in areas where synchronous tele-audiometry may not be possible or practical. The aim of this study was to compare remote interpretation of manual and automated audiometry. Methods Five audiologists each interpreted manual and automated audiograms obtained from 42 patients. The main outcome variable was the audiologist's recommendation for patient management (which included treatment recommendations, referral or discharge) between the manual and automated audiometry test. Cohen's Kappa and Krippendorff's Alpha were used to calculate and quantify the intra- and inter-observer agreement, respectively, and McNemar's test was used to assess the audiologist-rated accuracy of audiograms. Audiograms were randomised and audiologists were blinded as to whether they were interpreting a manual or automated audiogram. Results Intra-observer agreement was substantial for management outcomes when comparing interpretations for manual and automated audiograms. Inter-observer agreement was moderate between clinicians for determining management decisions when interpreting both manual and automated audiograms. Audiologists were 2.8 times more likely to question the accuracy of an automated audiogram compared to a manual audiogram. Discussion There is a lack of agreement between audiologists when interpreting audiograms, whether recorded with automated or manual audiometry. The main variability in remote audiogram interpretation is likely to be individual clinician variation, rather than automation.


Inhibition of the primary motor cortex can alter one's "sense of effort": effects of low-frequency rTMS.
Studies using force-matching tasks have suggested that when we feel a "sense of effort," cortical regions may act to increase motor commands, and thus recruit additional motor units, in order to compensate for the exerted force. We hypothesized that suppressing activity in the primary motor cortex (M1), which is the source of the motor commands, would initiate the same process, and induce the same sense of effort. In a force-matching task, grip force was applied to 'right' hand and 10 healthy participants were asked to try to exert the same amount by using 'left' hand, with no visual feedback. On some trials, low-frequency, repetitive transcranial magnetic stimulation (lf-rTMS) was used to suppress the M1 and the primary somatosensory cortex (SI) in the left hemisphere, separately. Results showed that participants tended to overestimate the level of exerted force by up to 24%. In contrast, sham stimulation of the M1 and lf-rTMS over the SI did not significantly affect participants' estimations. Further, the M1 suppression resulted in a 42% reduction in motor-evoked potentials. Thus, the M1 suppression can affect our sense of effort, suggesting that compensatory neural mechanisms that increase the MI activity may play an important role in producing senses of effort.


Comparison of thylakoid structure and organization in sun and shade Haberlea rhodopensis populations under desiccation and rehydration.
The resurrection plant, Haberlea rhodopensis can survive nearly total desiccation only in its usual low irradiation environment. However, populations with similar capacity to recover were discovered recently in several sunny habitats. To reveal what kind of morphological, structural and thylakoid-level alterations play a role in the acclimation of this low-light adapted species to high-light environment and how do they contribute to the desiccation tolerance mechanisms, the structure of the photosynthetic apparatus, the most sensitive component of the chlorophyll-retaining resurrection plants, was analyzed by transmission electron microscopy, steady state low-temperature fluorescence and two-dimensional Blue-Native/SDS PAGE under desiccation and rehydration. In contrast to the great differences in the morphology of plants, the ultrastructure and the organization of thylakoids were surprisingly similar in well-hydrated shade and sun populations. A high ratio of photosystem (PS)I binding light harvesting complex (LHC)II, important in low- and fluctuating light environment, was characteristic to both shade and sun plant, and the ratios of the main chlorophyll-protein complexes were also similar. The intensive protective mechanisms, such as shading by steep leaf angle and accumulation of protective substances, probably reduced the light intensity at the chloroplast level. The significantly increased ratio of monomer to oligomer antennae in well-hydrated sun plants may be connected with the temporary high light exposure of chloroplasts. During desiccation, LHCII was removed from PSI and part of PSII supercomplexes disassembled with some loss of PSII core and LHCII. The different reorganization of antennae, possibly connected with different quenching mechanisms, involved an increased amount of monomers in shade plants but unchanged proportion of oligomers in sun plants. Desiccation-induced responses were more pronounced in sun plants which also had a greater capacity to recover due to their stress-acclimated attitude.


Central venous catheters: a survey of ICU practices.
This paper describes the current infection control practices for CVC care and compares these to evidence-based practice guidelines. Intensive care patients with central venous catheters (CVCs) are at risk of catheter-related infection, which increases morbidity, mortality and health care costs. Infection control practices, including care of intravenous administration sets and catheter sites, are undertaken by nurses in an attempt to avoid infection. Although practice guidelines are available, infection control practices may vary between practitioners and institutions; however, current practice has not been formally surveyed. A prospective, cross-sectional descriptive survey was carried out. Intensive care units (n = 14) in Australia were surveyed about their infection control policies for CVC care. Results were tabulated and compared with evidence-based practice guidelines. A wide variety of responses was received about duration of administration set use for standard, parenteral nutrition and propofol (lipid-based anaesthetic) infusions; ad hoc administration set connection technique; dressing frequency, materials and solutions; and barrier precautions used during procedures. There was inconsistent adherence to the guidelines. There is variation in the infection control approach to CVC care. Greater adherence to existing Centers for Disease Control Guidelines would assist in the standardization of best practice and facilitate evidence-based care.


Functional graph contrastive learning of hyperscanning EEG reveals emotional contagion evoked by stereotype-based stressors.
This study delves into the intricacies of emotional contagion and its impact on performance within dyadic interactions. Specifically, it focuses on the context of stereotype-based stress (SBS) during collaborative problem-solving tasks among female pairs. Through an exploration of emotional contagion, this study seeks to unveil its underlying mechanisms and effects. Leveraging EEG-based hyperscanning technology, we introduced an innovative approach known as the functional graph contrastive learning (fGCL), which extracts subject-invariant representations of neural activity patterns from feedback trials. These representations are further subjected to analysis using the dynamic graph classification (DGC) model, aimed at dissecting the process of emotional contagion along three independent temporal stages. The results underscore the substantial role of emotional contagion in shaping the trajectories of participants' performance during collaborative tasks in the presence of SBS conditions. Overall, our research contributes invaluable insights into the neural underpinnings of emotional contagion, thereby enriching our comprehension of the complexities underlying social interactions and emotional dynamics.


Lifetime and current prevalence of common DSM-IV mental disorders, their demographic correlates, and association with service utilisation and disability in older Australian adults.
To describe lifetime and 12 month prevalence of common DSM-IV mental disorders, their demographic correlates, and association with service utilisation and disability in Australians aged 65-85 years of age. The sample included Australian residents aged 65-85 years who participated in the 2007 Australian National Survey of Mental Health and Well-being (n=1905). The prevalence of DSM-IV mental disorders was estimated using the lay-interviewer administered World Mental Health version of the Composite International Diagnostic Interview. Eight percent had experienced an affective disorder, 10% an anxiety disorder, and 12% a substance use disorder at some point in their life. Sex, age, and marital status were significant correlates of any lifetime mental disorder. Approximately, 2%, 4%, and 1% of old age respondents met criteria for mood, anxiety, and substance use disorders in the past 12 months, respectively. The presence of physical disorder, disability, and greater treatment service use were associated with any mental disorder in the past 12 months. Prevalence of lifetime and 12 month disorders by age band revealed a decrease as age increased. A substantial number of community dwelling old age Australians have experienced a mental disorder in their lifetime. Demographic correlates of mental disorder were relatively consistent between lifetime and 12 month prevalence of disorders, although sex made less of an impact and the presence of physical disorders more of an impact in recent disorders. Twelve month prevalence data suggest that a high proportion of old age Australians still experience mental disorders, predominantly anxiety and major depression.


Liquid-liquid phase separation of N-isopropylpropionamide aqueous solutions above the lower critical solution temperature.
We investigate driving forces of the liquid-liquid phase separation of N-isopropylpropionamide (NiPPA) aqueous solutions above the lower critical solution temperature using molecular dynamics simulations. Spontaneous phase separations of the model aqueous solution with a modified OPLS-AA force field are observed above the experimentally determined cloud point. The destabilization toward the phase separation is confirmed by temperature dependence of the long-wavelength limit of the concentration-concentration structure factor, the dominant component of which is found to be an increasing effective attraction between NiPPA molecules. At varying temperatures, the potentials of mean force (PMFs) between a pair of NiPPA molecules at infinite dilution are obtained and decomposed into the nonpolar and Coulombic contributions. The nonpolar contribution, arising essentially from molecular volume, promotes association of NiPPA molecules with increasing temperature while the Coulombic one antagonizes the association. Thus, our analysis leads to a conclusion that the driving force of thermally induced aggregation of NiPPA molecules is the temperature dependence of the nonpolar contribution in PMF between NiPPA molecules, not the temperature dependence of the number or strength of hydrogen bonds between NiPPA and water molecules.


In-house measurement of the sulfur anomalous signal and its use for phasing.
Five test structures (orthorhombic and trigonal trypsin, cubic and rhombohedral insulin and thaumatin) have been solved by the SAD (single-wavelength anomalous diffraction) method using highly redundant data collected at 100 K with a CCD detector, rotating-anode generator and three-circle goniometer. The very weak anomalous scattering (primarily from sulfur) was sufficient to locate all the anomalous scatterers using the integrated direct and Patterson methods in SHELXD. These positions and occupancies were used without further refinement to estimate phases that were extended to native (in-house) resolution by the sphere of influence algorithm in SHELXE. The final map correlation coefficients relative to the anisotropically refined structures were in the range 0.81-0.97. The use of highly redundant medium-resolution laboratory data for sulfur-SAD phasing combined with high-resolution synchrotron native data for phase expansion and structure refinement clearly has considerable potential.


Extracting factors associated with vaccination from Twitter data and mapping to behavioral models.
Social media platform, particularly Twitter, is a rich data source that allows monitoring of public opinions and attitudes toward vaccines.Established behavioral models like the 5C psychological antecedents model and the Health Belief Model (HBM) provide a well-structured framework for analyzing shifts in vaccine-related behavior. This study examines if the extracted data from Twitter contains valuable insights regarding public attitudes toward vaccines and can be mapped to two behavioral models. This study focuses on the Arab population, and a search was carried out on Twitter using: ' تلقيحي OR تطعيم OR تطعيمات OR لقاح OR لقاحات' for two years from January 2020 to January 2022. Then, BERTopicmodeling was applied, and several topics were extracted. Finally, the topics were manually mapped to the factors of the 5C model and HBM. 1,068,466 unique users posted 3,368,258 vaccine-related tweets in Arabic. Topic modeling generated 25 topics, which were mapped to the 15 factors of the 5C model and HBM. Among the users, 32.87%were male, and 18.06% were female. A significant 55.77% of the users were from the MENA (Middle East and North Africa) region. Twitter users were more inclined to accept vaccines when they trusted vaccine safety and effectiveness, but vaccine hesitancy increased due to conspiracy theories and misinformation. The association of topics with these theoretical frameworks reveals the availability and diversity of Twitter data that can predict behavioral change toward vaccines. It allows the preparation of timely and effective interventions for vaccination programs compared to traditional methods.


[Gastrectomy with end-loop jejunogastroplasty in stomach cancer].
Experience with surgical treatment of 147 patients after gastrectomy with jejunogastroplasty and creation of end-loop esophageal-intestinal anastomosis is analyzed. Original methods of jejunogastroplasty are based on end-loop construction of esophageal-intestinal anastomosis simulating anatomic-functional analog of lost cardia and pylorus and replacing reservoir function of the stomach. One year and later after surgery 83 patients with end-loop esophageal-intestinal anastomosis and 73 patients with anastomosis were examined. It is demonstrated that jejunogastroplasty with end-loop anastomosis is characterized by low frequency (6%) and degree of reflux-esophagitis. Passage of food through duodenum in end - loop jejunogastroplasty decreases frequency and degree of demping-syndrome. Active isolating function of end-loop anastomosis was demonstrated with x-ray and manometric methods. Primary jejunogastroplasty with end-loop anastomosis leads to reduction of frequency and severity of postoperative pathological syndromes and permits to improve quality life of operated patients.


[Inflammatory bowel diseases in the XXI century].
Modern strategy of the treatment of inflammatory bowel disease (IBD), aimed at molecular targets of inflammation, is described in the article. It has reviewed the successe and failure of anticytokine therapy based on the application of Infliximab, Adalimumab and Certolizumab. The Results of Priority researchs of transplantation of mesenchymal stromal cells (MSCs) in the Central Scientific Research Institute of Gastroenterology are shown in the article. Clinical observations of patients with ulcerative colitis (UC) and Crohn's disease (CD) showed that intravenous infusion of allogeneic MSCs significantly increases the duration of remission, reduces the risk of recurrence and is comparable to the effectiveness of Infliximab. The use of MSCs allowed to cancel the corticosteroids and cytotoxic agents, except 5-ASA drugs, in the majority of patients with UC and CD. MSCs have a multidirectional regulatory impact on the inflammatory process: stimulate the functional activity of the suppressed immune system, reduce the intensity of the autoimmune reactions and the activity of immunopathological processes. The program and indications for treatment with MSCs are developed and suggested for clinical practice. Transplantation of MSCs is indicated in patients with hormone resistant, hormone-dependent forms of IBD characterized by high activity of the inflammatory process at the early stages of the disease. Accumulated clinical experience demonstrates the reducing of antibodies to infliximab after systemic MSC transplantation that helps to prevent and to overcome the secondary inneficiencies of anticytokine therapy. It has been possible to achieve significant improvement and even complete elimination of disease activity in patients resistant to all previous treatments.


Association Between Transtibial Meniscus Root Repair and Rate of Meniscal Healing and Extrusion on Postoperative Magnetic Resonance Imaging: A Prospective Multicenter Study.
Prospective studies evaluating second-look imaging of meniscus root repair using a transtibial pull-out technique are limited; therefore, optimal surgical indications and the technique for meniscus root repair remain uncertain. It was hypothesized that there would be a high rate of healing, improvement in meniscal extrusion, and prevention of articular cartilage degeneration and subchondral bone abnormalities after meniscus root repair. Case series; Level of evidence, 4. Consecutive patients undergoing transtibial root repair were prospectively enrolled at 2 orthopaedic centers between March 2017 and January 2019. Pre- and postoperative magnetic resonance imaging (MRI) scans were reviewed by a musculoskeletal radiologist in a blinded fashion for meniscal healing, quantification of extrusion, articular cartilage grade, subchondral bone changes, and coronary/meniscotibial ligament abnormalities. Given persistent extrusion observed on postoperative MRI scans, an additional 10 patients gave consent and were enrolled for immediate (before weightbearing) postoperative MRI scans. A total of 45 patients (16 male, 29 female; mean ± standard deviation age, 42.3 ± 12.9 years; body mass index, 31.6) were prospectively enrolled in the study; there were 47 meniscus root repairs: 29 medial and 18 lateral (2 with both). Postoperative MRI was obtained at an average of 6.3 months (range, 5.1-8 months); 98% of meniscal repairs had evidence of healing. Mean extrusion increased significantly, from 1.9 ± 1.5 mm preoperatively to 2.6 ± 1.4 mm postoperatively (P = .03). There was no significant progression of chondromalacia grade, subchondral edema, insufficiency fracture, subchondral cysts, or subchondral collapse. In the additional 10-patient cohort, the mean preoperative extrusion (1.6 ± 1.2 mm) was not significantly different from that immediately postoperatively (2.0 ± 1.0 mm; P = .23). Prospective MRI analysis of transtibial meniscus root repair confirmed a high rate of meniscal healing and no observable progression of cartilage degeneration or subchondral bone abnormalities at the short-term follow-up. However, meniscal extrusion worsened in the first 6 months after surgery. NCT03037242 (ClinicalTrials.gov identifier).


Response of C and N cycles to N fertilization in Sphagnum and Molinia-dominated peat mesocosms.
Plant communities play an important role in the C-sink function of peatlands. However, global change and local perturbations are expected to modify peatland plant communities, leading to a shift from Sphagnum mosses to vascular plants. Most studies have focused on the direct effects of modification in plant communities or of global change (such as climate warming, N fertilization) in peatlands without considering interactions between these disturbances that may alter peatlands' C function. We set up a mesocosm experiment to investigate how Greenhouse Gas (CO2, CH4, N2O) fluxes, and dissolved organic carbon (DOC) and total dissolved N (TN) contents are affected by a shift from Sphagnum mosses to Molinia caerulea dominated peatlands combined with N fertilization. Increasing N deposition did not alter the C fluxes (CO2 exchanges, CH4 emissions) or DOC content. The lack of N effect on the C cycle seems due to the capacity of Sphagnum to efficiently immobilize N. Nevertheless, N supply increased the N2O emissions, which were also controlled by the plant communities with the presence of Molinia caerulea reducing N2O emissions in the Sphagnum mesocosms. Our study highlights the role of the vegetation composition on the C and N fluxes in peatlands and their responses to the N deposition. Future research should now consider the climate change in interaction to plants community modifications due to their controls of peatland sensitivity to environmental conditions.


Development and Characterization of A Novel Prox1-EGFP Lymphatic and Schlemm's Canal Reporter Rat.
The lymphatic system plays a key role in tissue fluid homeostasis, immune cell trafficking, and fat absorption. We previously reported a bacterial artificial chromosome (BAC)-based lymphatic reporter mouse, where EGFP is expressed under the regulation of the Prox1 promoter. This reporter line has been widely used to conveniently visualize lymphatic vessels and other Prox1-expressing tissues such as Schlemm's canal. However, mice have a number of experimental limitations due to small body size. By comparison, laboratory rats are larger in size and more closely model the metabolic, physiological, and surgical aspects of humans. Here, we report development of a novel lymphatic reporter rat using the mouse Prox1-EGFP BAC. Despite the species mismatch, the mouse Prox1-EGFP BAC enabled a reliable expression of EGFP in Prox1-expressing cells of the transgenic rats and allowed a convenient visualization of all lymphatic vessels, including those in the central nervous system, and Schlemm's canal. To demonstrate the utility of this new reporter rat, we studied the contractile properties and valvular functions of mesenteric lymphatics, developed a surgical model for vascularized lymph node transplantation, and confirmed Prox1 expression in venous valves. Together, Prox1-EGFP rat model will contribute to the advancement of lymphatic research as a valuable experimental resource.


Regulation of Gadd45gamma expression by C/EBP.
The Gadd45gamma (growth arrest and DNA damage-inducible) gene is activated transcriptionally by at least two kinds of agents: DNA damaging agent such as methyl methanesulfonate (MMS) and UV radiation, or cytokines such as interleukin (IL)-6, IL-2 and granulocyte colony-stimulating factor (G-CSF). To investigate the sequences and transcription factors involved in induction of Gadd45gamma after treatment with IL-6, the human gene was cloned and sequenced. We found C/EBP (CCAAT/enhancer-binding protein) family proteins, major transcription factors in the IL-6 signal transduction pathway, could regulate the transcriptional activity of the Gadd45gamma promoter. In addition, a noncanonical C/EBP-binding site within the Gadd45gamma promoter where C/EBPbeta and C/EBPdelta could bind, was identified by electrophoretic mobility shift assay (EMSA) and reporter gene analysis. Furthermore, we found a coordinated expression profile between Gadd45gamma mRNA and C/EBPs (beta and delta) protein during the differentiation of M1 cells: the amount of Gadd45gamma transcripts became maximal when both C/EBPbeta and C/EBPdelta levels were high, on day 1 of differentiation of M1 cells after treatment with IL-6. These findings suggest that mitotic growth arrest coupled to M1 cell differentiation is mediated by C/EBPs stimulation of growth arrest-associated genes such as Gadd45gamma.


Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.
In patients with the acute respiratory distress syndrome, massive alveolar collapse and cyclic lung reopening and overdistention during mechanical ventilation may perpetuate alveolar injury. We determined whether a ventilatory strategy designed to minimize such lung injuries could reduce not only pulmonary complications but also mortality at 28 days in patients with the acute respiratory distress syndrome. We randomly assigned 53 patients with early acute respiratory distress syndrome (including 28 described previously), all of whom were receiving identical hemodynamic and general support, to conventional or protective mechanical ventilation. Conventional ventilation was based on the strategy of maintaining the lowest positive end-expiratory pressure (PEEP) for acceptable oxygenation, with a tidal volume of 12 ml per kilogram of body weight and normal arterial carbon dioxide levels (35 to 38 mm Hg). Protective ventilation involved end-expiratory pressures above the lower inflection point on the static pressure-volume curve, a tidal volume of less than 6 ml per kilogram, driving pressures of less than 20 cm of water above the PEEP value, permissive hypercapnia, and preferential use of pressure-limited ventilatory modes. After 28 days, 11 of 29 patients (38 percent) in the protective-ventilation group had died, as compared with 17 of 24 (71 percent) in the conventional-ventilation group (P<0.001). The rates of weaning from mechanical ventilation were 66 percent in the protective-ventilation group and 29 percent in the conventional-ventilation group (P=0.005): the rates of clinical barotrauma were 7 percent and 42 percent, respectively (P=0.02), despite the use of higher PEEP and mean airway pressures in the protective-ventilation group. The difference in survival to hospital discharge was not significant; 13 of 29 patients (45 percent) in the protective-ventilation group died in the hospital, as compared with 17 of 24 in the conventional-ventilation group (71 percent, P=0.37). As compared with conventional ventilation, the protective strategy was associated with improved survival at 28 days, a higher rate of weaning from mechanical ventilation, and a lower rate of barotrauma in patients with the acute respiratory distress syndrome. Protective ventilation was not associated with a higher rate of survival to hospital discharge.


Alcohol and endogenous sex steroid levels in postmenopausal women: a cross-sectional study.
Breast cancer risk increases with increased levels of alcohol consumption, potentially through an effect on sex hormone levels. In a cross-sectional study among Dutch participants (n = 17,357) of the European Prospective Investigation into Cancer and Nutrition conducted in Utrecht, The Netherlands (Prospect-EPIC), we investigated the relation between alcohol intake and estrogen and androgen levels. Alcohol intake was calculated from a food frequency questionnaire. Women were included if they were postmenopausal, had donated a blood sample, and did not use hormone replacement therapy or oral contraceptives at the time of blood donation (n = 1093). Women who consumed more than 25 g of alcohol per day had higher levels of estrone (P(trend) = 0.001), estradiol (P(trend) = 0.03), dehydroepiandrosterone sulfate (P(trend) = 0.18), and higher estrone/estradiol (P(trend) = 0.14) and estrone/androstenedione (P(trend) = 0.06) ratios, compared with nondrinkers. Levels of androstenedione, testosterone, and SHBG did not differ between women who consumed alcohol and nondrinkers. Furthermore, there were no differences in the free androgen index or estradiol to testosterone ratio. In conclusion, levels of estrogens and dehydroepiandrosterone sulfate are higher in women who consume more alcohol. This finding supports the hypothesis that alcohol use may increase breast cancer risk at least partially through an effect on sex steroid levels.


Genomic analysis reveals the population structure and antimicrobial resistance of avian Pasteurella multocida in China.
To investigate the population structure and antimicrobial resistance (AMR) of avian Pasteurella multocida in China. Utilizing WGS analysis, we explored the phylogeny using a dataset of 546 genomes, comprising avian P. multocida isolates from China (n = 121), the USA (n = 165), Australia(n = 153), Bangladesh (n = 3) and isolates of other hosts from China (n = 104). We examined the integrative and conjugative element (ICE) structures and the distribution of their components carrying resistance genes, and reconstructed the evolutionary history of A:L1:ST129 (n = 110). The population structure of avian P. multocida in China was dominated by the A:L1:ST129 clone with limited genetic diversity. A:L1:ST129 isolates possessed a broader spectrum of resistance genes at comparatively higher frequencies than those from other hosts and countries. The novel putative ICEs harboured complex resistant clusters that were prevalent in A:L1:ST129. Bayesian analysis predicted that the A:L1:ST129 clone emerged around 1923, and evolved slowly. A:L1:ST129 appears to possess a host predilection towards avian species in China, posing a potential health threat to other animals. The complex AMR determinants coupled with high frequencies may strengthen the population dominance of A:L1:ST129. The extensive antimicrobial utilization in poultry farming and the mixed rearing practices could have accelerated AMR accumulation in A:L1:ST129. ICEs, together with their resistant clusters, significantly contribute to resistance gene transfer and facilitate the adaptation of A:L1:ST129 to ecological niches. Despite the genetic stability and slow evolution rate, A:L1:ST129 deserves continued monitoring due to its propensity to retain resistance genes, warranting global attention to preclude substantial economic losses.


Occupational physical activity and renal cell cancer: a nationwide cohort study in Sweden.
The causes of renal cell cancer remain incompletely understood. In one previous retrospective case-control study, high occupational physical activity has been associated with a decreased risk among men, but not among women. Our aim was to investigate the association between occupational physical activity and renal cell cancer in a large cohort in Sweden. A cohort of Swedish men and women was identified in the nationwide censuses in 1960 and 1970, and the reported occupations were classified into 4 levels of physical demands. Follow-up from 1971 through 1989 was accomplished through record linkages to the Swedish Cancer Registry. Multivariate Poisson regression models were used to estimate relative risk (RR) and 95% confidence intervals (CI). We found a monotonic increase in risk of renal cell cancer with decreasing level of occupational physical activity among men (p for trend <0.001). After adjustment for socio-economic status, place of residence, and calendar year of follow-up, men with long-term sedentary jobs had a 25% (RR = 1.25, 95% CI 1.02-1.53) increased risk compared to men with physically demanding occupations. Among women there was no association, the dose-risk trend was not significant (p for trend >0.50). Occupational physical activity was inversely associated with renal cell cancer among men. The absence of association among women might be due to smaller range of exposure, confounding by household work or reproductive factors, or to a difference in biological response to physical activity in men and women.