Sleep hygiene program implementation in patients with traumatic brain injury.
Traumatic brain injury (TBI) is a serious public health problem. The impact of TBI on the individual is multifaceted and includes neurocognitive, behavioral, and psychiatric disturbances as well as greater predisposition for dementia. A common but significant problem reported by patients after TBI is sleep disturbance. The purpose of this manuscript is twofold: (1) to describe our experience with implementation of the newly developed sleep hygiene guidelines; and (2) to report our preliminary results of implementation of the sleep hygiene guidelines on TBI patient outcomes. A mixed methods approach was used to assess implementation of sleep hygiene guidelines and to gather preliminary data on outcomes. Although not statistically significant, the average self-reported sleep duration of these TBI patients was slightly higher in 2010 than 2009, with a FIM score that was similar for both time points. In 2009, the mean change in functional independence measure (FIM) score (n = 34) was 1.44. In 2010, the mean change in FIM score (n = 33) was 1.42. In 2009, most patients (n = 13) admitted to the hospital continued to take medications and were discharged with a sleep aid. In 2010, most patients reported a change in their sleep medication prescriptions (on medications at admission and none at discharge) or had continued to take their prescribed sleep medications from admission to discharge (n = 12). Sleep disorders have a major impact on health outcomes in patients with TBI. To optimize rehabilitation and ultimately improve functional outcomes of patients with TBI, implementation of evidence-based clinical guidelines for sleep is imperative. We report our initial experience with implementation of sleep guidelines.


Impaired forward model updating in young adults with Tourette syndrome.
Current theories of motor control emphasize how the brain may use internal models of the body to ensure accurate planning and control of movements. One such internal model-a forward model-is thought to generate an estimate of the next motor state and/or the sensory consequences of an upcoming movement, thereby allowing movement errors to be monitored. In addition, forward models may provide a means by which to determine a sense of agency, i.e. the (conscious) sense of authorship and control over our actions. Tourette syndrome is a developmental neurological condition characterized by the occurrence of motor and phonic tics. The involuntary (or voluntary) nature of tics has been the subject of considerable debate, and it was recently argued that the presence of tics in Tourette syndrome could result in a blurring of any subjective boundary between voluntary and involuntary movements. In particular, it was proposed that the level of sensorimotor noise that accompanies tics may be particularly high in Tourette syndrome, and this may contribute to less efficient forward models used to determine agency. We investigated whether the internal monitoring of movements is impaired in individuals with Tourette syndrome, relative to a matched group of typically developing individuals, using a task that involved executing double-step aiming movements using a hand-held robot manipulandum. Participants were required on each trial to execute two movements in turn, each directed to a remembered target location without visual feedback. Importantly, we assumed that to perform accurately on the second (return) movement it would be necessary to update any forward model to take into account errors made during the first (outward) movement. Here we demonstrate that while the Tourette syndrome group were equally accurate, and no more variable, than the matched control group in executing aiming movements to the first (outward) target location, they were significantly less accurate, and exhibited greater movement variability, than controls when executing the second (return) movement. Furthermore, we show that for the return movement only, movement accuracy and movement variability were significantly predicted by the Tourette syndrome group's clinical severity scores. We interpret these findings as consistent with the view that individuals with Tourette syndrome may experience a reduction in the precision of the forward model estimates thought necessary for the accurate planning and control of movements.


[Reduced insulin effect in subclinical fatty liver].
Steatosis of the liver is known to be associated with impaired insulin action and is considered to be a feature of the metabolic syndrome. In the present study we addressed the question whether liver fat content, as measured by proton MR spectroscopy ( (1)H MRS), in healthy subjects without clinical signs (hepatomegaly, elevation of transaminases) of relevant liver disease correlates with whole-body insulin sensitivity. 21 (18 males and 3 females, age 35 +/- 11 years) non-diabetic subjects underwent the euglycemic-hyperinsulinemic clamp test for determination of whole body insulin action. Liver fat content was measured by means of proton MR spectroscopy ( (1)H MRS). Lipid content was calculated as percentage share of the lipid signal in relation to the entire signal of the spectrum (water and lipid signals). Clinically relevant steatosis of the liver was ruled out by standard magnetic resonance imaging (MRI). Subjects with a history of alcohol intake of more than 40 g/d were excluded from analysis. In a single correlation analysis percentage liver fat strongly correlated with insulin sensitivity index (ISI) (r = 0.7, p = 0.001). After adjusting for the effects of percentage body fat (PFAT) percentage liver fat remained an independent determinant of ISI (p = 0.01). Our results suggest that liver fat content is an important predictor of whole-body insulin sensitivity in healthy subjects. The correlation of liver fat content with insulin sensitivity was found in the absence of clinical steatosis and was independent of body fat content.


Epigenetic therapy with inhibitors of histone methylation suppresses DNA damage signaling and increases glioma cell radiosensitivity.
Radiation therapy is widely used to treat human malignancies, but many tumor types, including gliomas, exhibit significant radioresistance. Radiation therapy creates DNA double-strand breaks (DSBs), and DSB repair is linked to rapid changes in epigenetic modifications, including increased histone methylation. This increased histone methylation recruits DNA repair proteins which can then alter the local chromatin structure and promote repair. Consequently, combining inhibitors of specific histone methyltransferases with radiation therapy may increase tumor radiosensitivity, particularly in tumors with significant therapeutic resistance. Here, we demonstrate that inhibitors of the H4K20 methyltransferase SETD8 (UNC-0379) and the H3K9 methyltransferase G9a (BIX-01294) are effective radiosensitizers of human glioma cells. UNC-0379 blocked H4K20 methylation and reduced recruitment of the 53BP1 protein to DSBs, although this loss of 53BP1 caused only limited changes in radiosensitivity. In contrast, loss of H3K9 methylation through G9a inhibition with BIX-01294 increased radiosensitivity of a panel of glioma cells (SER2Gy range: 1.5 - 2.9). Further, loss of H3K9 methylation reduced DSB signaling dependent on H3K9, including reduced activation of the Tip60 acetyltransferase, loss of ATM signaling and reduced phosphorylation of the KAP-1 repressor. In addition, BIX-0194 inhibited DSB repair through both the homologous recombination and nonhomologous end-joining pathways. Inhibition of G9a and loss of H3K9 methylation is therefore an effective approach for increasing radiosensitivity of glioma cells. These results suggest that combining inhibitors of histone methyltransferases which are critical for DSB repair with radiation therapy may provide a new therapeutic route for sensitizing gliomas and other tumors to radiation therapy.


[Trauma and imputability].
The imputability of a bodily damage to a traumatism and the bond of causality are at the basis of the mission of the medical expert in the procedure that leads to indemnification in reparation of a suffered prejudice. The aim of this paper is to enumerate the bases on which the expert grounds to prove the imputability and the bond of causality. He will also insist on the final role of the jurist who, grounding his opinion on the elements of the expert appraisement, will establish the causality and hence the responsibility and the level of reparation.


Safety and efficacy of increasing dosages of glycyl-glutamine for total parenteral nutrition in polytrauma patients.
Supplementation of parenteral nutrition with glutamine (GLN) has been suggested to improve the efficacy of nutritional support by stimulating protein synthesis and improving immunocompetence. In the present study we investigated the impact of infusing the dipeptide glycyl-glutamine (GLY-GLN) at increasing dosages on plasma amino acid concentrations in patients with polytrauma. Nine polytraumatized patients were randomly assigned according their age and their trauma score to three experimental groups. Group 1 received 280, group II 450, and group III 570 mg GLY-GLN per kg body weight/day for a period of four days (3rd to 7th posttraumatic day), resulting in a maximum daily GLN administration (calculated for a 70 kg patient) of 14 g, 21 g and 28 g, respectively. Seven polytraumatized patients receiving the nutrition solution without GLY-GLN supplementation served as controls. All patients received total parenteral nutrition with an average amino acid administration of 1.1 g/kg/day and a total energy intake of 30 kcal/kg/day. GLY-GLN infusion did not evoke any side effects. In comparison with the control group, arterial plasma GLN concentrations increased significantly on day I after start of infusion in groups II and III, but remained raised throughout the study period only in group III (p < 0.003). Similarly, plasma GLY concentrations were also significantly raised in group III (p < 0.04). The maximum increase of plasma GLY was found on the second infusion day, after which plasma concentrations of GLY fell to concentrations even below those observed in the control group at the end of the study period. Excretion of GLY-GLN, GLN or GLY in the urine during the GLY-GLN infusions was negligible. We conclude from this first available dose finding study on glutamine-containing dipeptides that in polytraumatized patients infusion of 570 mg/kg/day of GLY-GLN (corresponding to 28 g glutamine or 40 g dipeptide/70 kg, respectively) is necessary to induce a sustained effect on plasma glutamine concentrations. No pathological accumulation of free glycine or of the dipeptide was seen with any of the three dosage steps of GLY-GLN. Thus, the administration of even high doses of GLY-GLN is feasible and safe in patients with polytrauma and is not associated with any relevant renal substrate loss.


Statistical issues in translational cancer research.
The explosion of knowledge about the basic biological processes and the genetics of cancer has led to increasing optimism that this knowledge can be put to practical clinical use in the near future. Indeed, important examples of translational approaches can already be found in the areas of drug discovery and development, disease diagnosis and classification, selection of therapeutic regimens for individual patients, and designing clinical trials. These are important developments but, as with any new approach, there is a danger of unwarranted enthusiasm and premature clinical application of laboratory results based on insufficient evidence. To carry out the translation of knowledge into practice with maximal efficiency and effectiveness, it is essential to conduct studies with appropriate designs and analyses based on sound statistical principles. This article provides an overview of some of these principles applied to assay development, validation of predictive models, and the design of clinical trials for targeted therapies.


Unlocking Therapeutic Synergy: Tailoring Drugs for Comorbidities such as Depression and Diabetes through Identical Molecular Targets in Different Cell Types.
Research in the field of pharmacology aims to generate new treatments for pathologies. Nowadays, there are an increased number of chronic disorders that severely and durably handicap many patients. Among the most widespread pathologies, obesity, which is often associated with diabetes, is constantly increasing in incidence, and in parallel, neurodegenerative and mood disorders are increasingly affecting many people. For years, these pathologies have been so frequently observed in the population in a concomitant way that they are considered as comorbidities. In fact, common mechanisms are certainly at work in the etiology of these pathologies. The main purpose of this review is to show the value of anticipating the effect of baseline treatment of a condition on its comorbidity in order to obtain concomitant positive actions. One of the implications would be that by understanding and targeting shared molecular mechanisms underlying these conditions, it may be possible to tailor drugs that address both simultaneously. To this end, we firstly remind readers of the close link existing between depression and diabetes and secondly address the potential benefit of the pleiotropic actions of two major active molecules used to treat central and peripheral disorders, first a serotonin reuptake inhibitor (Prozac ®) and then GLP-1R agonists. In the second part, by discussing the therapeutic potential of new experimental antidepressant molecules, we will support the concept that a better understanding of the intracellular signaling pathways targeted by pharmacological agents could lead to future synergistic treatments targeting solely positive effects for comorbidities.


Macrophage migration inhibitory factor increases leukocyte-endothelial interactions in human endothelial cells via promotion of expression of adhesion molecules.
Macrophage migration inhibitory factor (MIF) has been shown to promote leukocyte-endothelial cell interactions, although whether this occurs via an effect on endothelial cell function remains unclear. Therefore, the aims of this study were to examine the ability of MIF expressed by endothelial cells to promote leukocyte adhesion and to investigate the effect of exogenous MIF on leukocyte-endothelial interactions. Using small interfering RNA to inhibit HUVEC MIF production, we found that MIF deficiency reduced the ability of TNF-stimulated HUVECs to support leukocyte rolling and adhesion under flow conditions. These reductions were associated with decreased expression of E-selectin, ICAM-1, VCAM-1, IL-8, and MCP-1. Inhibition of p38 MAPK had a similar effect on adhesion molecule expression, and p38 MAPK activation was reduced in MIF-deficient HUVECs, suggesting that MIF mediated these effects via promotion of p38 MAPK activation. In experiments examining the effect of exogenous MIF, application of MIF to resting HUVECs failed to induce leukocyte rolling and adhesion, whereas addition of MIF to TNF-treated HUVECs increased these interactions. This increase was independent of alterations in TNF-induced expression of E-selectin, VCAM-1, and ICAM-1. However, combined treatment with MIF and TNF induced de novo expression of P-selectin, which contributed to leukocyte rolling. In summary, these experiments reveal that endothelial cell-expressed MIF and exogenous MIF promote endothelial adhesive function via different pathways. Endogenous MIF promotes leukocyte recruitment via effects on endothelial expression of several adhesion molecules and chemokines, whereas exogenous MIF facilitates leukocyte recruitment induced by TNF by promoting endothelial P-selectin expression.


Serum soluble interleukin 2 receptor levels in erythrodermic cutaneous T-cell lymphoma correlate with response to photopheresis-based treatment.
Cutaneous T-cell lymphoma (CTCL) comprises a spectrum of presentations, including erythroderma, pruritus, lymphadenopathy, and circulating atypical lymphocytes. Photopheresis is an extracorporeal treatment in which white blood cell concentrates are subjected to UV irradiation when the serum methoxypsoralen level is above 50 ng/mL. Of patients with CTCL, those with erythroderma have been most responsive to this therapy. In some conditions, including certain malignant hematologic neoplasms, serum soluble interleukin 2 receptor levels (SIL2R) correlate with disease activity. We sought to determine whether serum SIL2R levels correlated with disease activity in six erythrodermic patients with CTCL treated primarily with photopheresis. We measured SIL2R levels in five patients with stage III or greater erythrodermic CTCL and one with stage IIa CTCL. We compared SIL2R values with clinical course, skin scores, CD4/CD8 ratios, peripheral white blood cell counts, and Sézary cell counts, using Pearson correlation coefficients. The SIL2R levels correlated with clinical course and skin scores, even when controlled for other factors noted above. Data preliminarily suggest that serum SIL2R levels may be useful indicators of disease activity in erythrodermic CTCL patients treated with photopheresis.


Neural correlates of correct and errant attentional selection revealed through N2pc and frontal eye field activity.
The goal of this study was to obtain a better understanding of the physiological basis of errors of visual search. Previous research has shown that search errors occur when visual neurons in the frontal eye field (FEF) treat distractors as if they were targets. We replicated this finding during an inefficient form search and extended it by measuring simultaneously a macaque homologue of an event-related potential indexing the allocation of covert attention known as the m-N2pc. Based on recent work, we expected errors of selection in FEF to propagate to areas of extrastriate cortex responsible for allocating attention and implicated in the generation of the m-N2pc. Consistent with this prediction, we discovered that when FEF neurons selected a distractor instead of the search target, the m-N2pc shifted in the same, incorrect direction prior to the erroneous saccade. This suggests that such errors are due to a systematic misorienting of attention from the initial stages of visual processing. Our analyses also revealed distinct neural correlates of false alarms and guesses. These results demonstrate that errant gaze shifts during visual search arise from errant attentional processing.


Long-Term Blood Pressure Variability and Kidney Function in Participants of the ASPREE Trial.
Whether long-term blood pressure variability (BPV) predicts kidney function decline in generally healthy older adults is unknown. We investigated this association in ASPirin in Reducing Events in the Elderly (ASPREE) trial participants. Between 2010 and 2014, Australian and US individuals aged ≥70 years (≥65 if US minority) were recruited and followed with annual study visits for a median of 4.7 years. Time-to-event analyses and linear mixed effects models were used to examine associations between incident chronic kidney disease (CKD), and trajectories of estimated glomerular filtration rate (eGFR) and log albumin-creatinine ratio (log ACR) with systolic BPV as a continuous measure, and, by tertile of SD of systolic blood pressure (BP). BPV was estimated using systolic BP measures from baseline through the second annual visit, and kidney outcomes were assessed following this period. Incident CKD occurred in 1,829 of 6,759 participants (27.2%), and more commonly in BPV tertiles 2 (27.4%) and 3 (28.3%) than tertile 1 (25.5%); however, the risk was not significantly increased after covariate adjustment (tertile 3 hazard ratio = 1.02; 95% confidence interval: 0.91-1.14). Analysis of eGFR (n = 16,193) and log ACR trajectories (n = 15,213) showed individuals in the highest BPV tertile having the lowest eGFR and highest log ACR, cross-sectionally. However, the trajectories of eGFR and log ACR did not differ across BPV tertiles. CKD and markers of reduced kidney function occur more commonly in individuals with higher BPV; however, BPV does not influence trajectory of decline in kidney function over time in older adults who are in generally good health. Trial Number NCT01038583 and ISRCTN83772183.


Renal artery pseudoaneurysm after blunt renal trauma: report on three cases and review of the literature.
Renal artery pseudoaneurysm is a rare complication after renal injury but should be suspected whenever there is recurrent hematuria after renal trauma. We present three cases of pseudoaneurysm after blunt renal trauma and a review of the literature. All patients underwent renal angiography. Two cases were diagnosed during the initial hospital stay due to hematuria, or in the follow-up period during recovery. One patient was hemodynamically unstable. Two patients successfully underwent coil embolization in a single session. In the other case, selective embolization was attempted, but was unsuccessful because artery catheterization was impossible. Procedural and medical success and complications were retrospectively assessed from the patients' records. The clinical presentation, treatment options and clinical decisions are discussed. Renal artery pseudoaneurysm may develop acutely or even years after the initial injury. Signs and symptoms may have a wide spectrum of presentation. Selective angiographic embolization is an effective treatment that reduces the extent of parenchymal infarction.


International strategies to address obesity.
Obesity rates are increasing in most countries throughout the world. The reasons for the increase are complex and involve biological, behavioural and environmental factors. We have unintentionally created environments that encourage over-eating and discourage physical activity. Despite the recognition of the seriousness of obesity to public health, no interventions have been effective in reducing obesity rates on a population basis. Reversing obesity rates within populations will require addressing both individual behaviour and the obesogenic environment. Obesity rates could be reduced by treating affected individuals or by preventing the gradual increase in body weights of the population. Success in long-term obesity treatment is poor and appears to require that large behaviour changes be made and sustained. An alternative approach is to promote small lifestyle changes to prevent the gradual increase in the body weight of populations. America On the Move is an initiative based on promoting small lifestyle changes to prevent weight gain in the US population. This is one strategy could be used in other countries to reduce obesity rates.


Protective role of autophagy in AGE-induced early injury of human vascular endothelial cells.
Advanced glycation end-products (AGEs) contribute to the pathogenesis of diabetes mellitus and atherosclerosis by promoting vascular endothelial cell proliferation, migration, damage and death. In this study, we examined the role of autophagy in HUVECs exposed to AGE-modified bovine serum albumin (AGE-BSA). HUVECs incubated with AGE-BSA for 6 h showed an increase in the formation of acidic vesicular organelles and autophagosomes. AGE-BSA-induced upregulation of microtubule associated protein 1 light chain 3-II (LC3-II), a marker of autophagy, was abolished by pretreatment with the autophagy inhibitor 3-methyladenine (3-MA), and was increased by rapamycin, an autophagy inducer. The increase of lactate dehydrogenase (LDH) leakage induced by AGE-BSA was increased by 3-MA, but not rapamycin. An oxidative inhibitor, α-tocopherol, decreased not only the AGE-BSA-induced increase of reactive oxygen species, but also the upregulation of LC3-II protein levels. These results suggest that AGE-BSA increases the level of autophagy, which is protective against HUVEC injury, and that ROS play a role in this activation of autophagy.


Positioning-related complications of minimally invasive radical prostatectomies.
Because of recent advances in minimally invasive surgical techniques, robot-assisted radical prostatectomy (RARP) has become the primary treatment option in prostate cancer. RARP, however, necessitates patients to be placed in a steep Trendelenberg position, which presents multiple opportunities for complications relating to the positioning of the patient. Our study aims to study the prevalence and demographic predictors of these positioning complications and assess their impacts on length of stay (LOS) and total cost. We included patients who underwent RP from 2008 to 2009 using data extracted from the Nationwide Inpatient Sample database. Positioning complications (eye, nerve, compartment syndrome/rhabdomyolysis) were identified using patient-level diagnosis and procedural International Classification of Disease, 9th edition, Clinical Modification codes. Logistic regression models assessed relationships between demographic factors and occurrence of complications and the effects of them on prolonged LOS and total inpatient cost. Positioning complications occurred in 0.4% of cases with eye complications contributing the most to this frequency. Laparoscopic RP procedure (odds ratio [OR]=2.88, P<0.01) and comorbidities (OR=2.34, P<0.01) were highly associated with increased odds of positioning complication occurrence, whereas RARP procedures (OR=0.93, P>0.4) were not associated with positioning complications. Having positioning complications increased a patient's odds of having increased inpatient costs and extended LOS by almost 400% and 300%, respectively. The steep Trendelenberg position used in RARP was not shown to be associated with patient positioning-related complications in this sample. The occurrence of positioning-related complications, however, places huge burdens on total inpatient costs and LOS.


Comparison of diploid fibroblast and rabbit kidney tissue cultures and a diploid fibroblast microtiter plate system for the isolation of herpes simplex virus.
We evaluated the relative sensitivities of two cell systems (rabbit kidney [RK] and human diploid fibroblast [DF; human embryonic tonsil]) in standard tube cultures versus DF cells in a 48-well microtiter plate system for the detection of both symptomatic and asymptomatic herpes simplex virus (HSV) infection. At least one system isolated HSV in 111 of 809 specimens (13.7%). HSV was isolated in RK tube cultures from 110 specimens (99%), in DF tube cultures from 91 specimens (82%), and in DF microtiter plates from 95 specimens (86%). The frequency of HSV isolation varied with the anatomic site and the presence or absence of a herpetic lesion. The sensitivities of the three culture systems remained similar whether the specimens were obtained from lesions or whether the specimens were taken to determine if asymptomatic excretion of HSV was present. While RK tube cultures were more sensitive than DF tube cultures, the DF microtiter plate system was as sensitive as DF tube cultures and its use is supported as a cheaper and less labor-intensive method for the detection of HSV.


[Health policy of the Republic of Turkey in accordance with the Minutes of the Turkish Parliament (part I)].
Because of the invasion of the Ottoman territory after the World War I, the Turkish War of Liberty was initiated by Mustafa Kemal Pasha and his friends. While they aimed at a successful outcome of the battle, they at the same time tried to achieve a nation-wide organization. In order to look after the nation's medical and social service, on May 2nd 1920, a new ministry called the Ministry for Medical and Social Service was founded. The new ministry's task was not only to concern itself with the medical and social service, but also with immigration and of the immigrants. At the beginning the hitherto existing social system and certain laws were not abolished until they were replaced by new ones in order to prevent an interruption in the social service. In these years the aim of the social system was to struggle against infectious diseases, to prevent infections, to decrease infant mortality and to increase the population, to take measures against diseases from abroad, to pass the laws needed and to form a central authority. Besides these laws which were directly related with the medical and social service during the War of Liberty, the governing of the districts and the regulations concerning the miners in Zonguldak were passed in order to protect peoples' health. Our political existence was confirmed through the signing of the agreement reached by the Lausanne Conference after the War of Liberty and consequently the Medical Care Supreme Council of Istanbul, which had continued its validity as a capitulation, was abolished. The social state policy of the period which had started with the foundation of the Turkish Republic aimed to extend the state's medical staff, continue the employment of the health personnel specialized in medicine, struggle against infectious diseases in an organised way, provide a wide-spread medical service, give priority to preventive health care and establish medical institutions, effect a cooperation of these institutes, pass the necessary laws and establish state supervision in all fields. In the first ten years of the Republic, new schools and courses were started in order to increase the number of the medical staff to be sent to areas deprived of social service. In accordance with the Obligatory Service Law of 1923, doctors who were sent to eastern Turkey were provided with encouraging advantages. The organizational work and the laws concerning infectious diseases like malaria, syphilis and trachoma, which were wide-spread, was effective and successful from the year 1925 onwards when Dr. Refik Saydam was the Minister for Health. The meetings of the Turkish National Congresses on Medicine helped solve the nation's health problems and influenced the state's policy and the Health Ministry's activities. The aim was not merely the protection of peoples' health through education. In this period, many laws were passed with the aim to protect the nation's health and to ensure state control in every field. Some of these are still in force today. Besides the medical treatment of the poor and the old, laws of validity for a long period, which were effective in the protection of the health of children, the adolescent and the pregnant women in the social life and employment, were passed. In the first ten years of the Republic a protective, comprehensive and human health policy was observed in accordance with the policy of the state.


The validity of claims made in orthopaedic print advertisements.
Orthopaedic surgeons are frequently presented with advertisements for orthopaedic and medical products in which companies make claims of clinical and scientific fact. This study was designed to evaluate the statements made in orthopaedic print advertisements and determine whether they are supported by scientific data. Fifty statements from fifty advertisements were chosen at random from six peer-reviewed orthopaedic journals. The companies that placed the advertisements were contacted to provide supporting data for the statement of clinical or scientific fact. Three senior orthopaedic surgeons evaluated the data for quality and support. A high-quality study was defined as a study that could be published in the peer-reviewed literature. A well-supported statement was defined as a statement with enough supporting evidence to be used in clinical practice. The evaluating surgeons were blinded to product and company identification. The supporting data were from a published source for eighteen claims (36%), from a presentation at a public forum or a scientific meeting for twelve claims (24%), or were "data on file" only at the company for twelve claims (24%). Interobserver agreement among the surgeons evaluating the advertisements for quality and support was good (the average intraclass correlation coefficient was 0.72). Of the fifty claims, twenty-two were considered unsupported by scientific data, seventeen were classified as possibly supported, seven were well supported, and four were from companies that did not respond despite three requests. Claims that were supported by published data were significantly more likely to be rated as well supported (p < 0.001). All twelve claims that were supported purely by "data on file" at the company were considered to be poorly supported. Orthopaedic surgeons should interpret claims made in orthopaedic print advertisements with caution. Approximately half of the claims are not supported by enough data to be used in a clinical decision-making process.


Genetic variants regulating insulin receptor signalling are associated with the severity of liver damage in patients with non-alcoholic fatty liver disease.
The aim of this study was to assess the effect of functional ENPP1(ectoenzyme nucleotide pyrophosphate phosphodiesterase 1)/PC-1 (plasma cell antigen-1) and IRS-1 (insulin receptor substrate-1) polymorphisms influencing insulin receptor activity on liver damage in non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of the metabolic syndrome, whose progression is associated with the severity of insulin resistance. 702 patients with biopsy-proven NAFLD from Italy and the UK, and 310 healthy controls. The Lys121Gln ENPP1/PC-1 and the Gly972Arg IRS-1 polymorphisms were evaluated by restriction analysis. Fibrosis was evaluated according to Kleiner. Insulin signalling activity was evaluated by measuring phosphoAKT levels by western blotting in a subset of obese non-diabetic patients. The ENPP1 121Gln and IRS-1 972Arg polymorphisms were detected in 28.7% and 18.1% of patients and associated with increased body weight/dyslipidaemia and diabetes risk, respectively. The ENPP1 121Gln allele was significantly associated with increased prevalence of fibrosis stage >1 and >2, which was higher in subjects also positive for the 972Arg IRS-1 polymorphism. At multivariate analysis, the presence of the ENPP1 121Gln and IRS-1 972Arg polymorphisms was independently associated with fibrosis >1 (OR 1.55, 95% CI 1.24 to 1.97; and OR 1.57, 95% CI 1.12 to 2.23, respectively). Both polymorphisms were associated with a marked reduction of approximately 70% of AKT activation status, reflecting insulin resistance and disease severity, in obese patients with NAFLD. The ENPP1 121Gln and IRS-1 972Arg polymorphisms affecting insulin receptor activity predispose to liver damage and decrease hepatic insulin signalling in patients with NAFLD. Defective insulin signalling may play a causal role in the progression of liver damage in NAFLD.


Air Pollution and Lung Function in Minority Youth with Asthma in the GALA II (Genes-Environments and Admixture in Latino Americans) and SAGE II (Study of African Americans, Asthma, Genes, and Environments) Studies.
Adverse effects of exposures to ambient air pollution on lung function are well documented, but evidence in racial/ethnic minority children is lacking. To assess the relationship between air pollution and lung function in minority children with asthma and possible modification by global genetic ancestry. The study population consisted of 1,449 Latino and 519 African American children with asthma from five different geographical regions in the mainland United States and Puerto Rico. We examined five pollutants (particulate matter ≤10 μm and ≤2.5 μm in diameter, ozone, nitrogen dioxide, and sulfur dioxide), derived from participant residential history and ambient air monitoring data, and assessed over several time windows. We fit generalized additive models for associations between pollutant exposures and lung function parameters and tested for interaction terms between exposures and genetic ancestry. A 5 μg/m(3) increase in average lifetime particulate matter less than or equal to 2.5 μm in diameter exposure was associated with a 7.7% decrease in FEV1 (95% confidence interval = -11.8 to -3.5%) in the overall study population. Global genetic ancestry did not appear to significantly modify these associations, but percent African ancestry was a significant predictor of lung function. Early-life particulate exposures were associated with reduced lung function in Latino and African American children with asthma. This is the first study to report an association between exposure to particulates and reduced lung function in minority children in which racial/ethnic status was measured by ancestry-informative markers.


Development of a Multicomponent Adsorption Isotherm Equation and Its Validation by Modeling.
Researchers have made significant efforts over the past few decades to understand adsorption by developing various simple adsorption isotherm models. However, though many contaminants usually occur as multicomponent mixtures in nature, multicomponent adsorption isotherms have received limited attention and remain an area of inadequate research. We have presented here in a new multicomponent adsorption isotherm model, named the Jeppu Amrutha Manipal Multicomponent (JAMM) isotherm, that can alleviate this problem. We first developed the JAMM multicomponent isotherm using our experimental data sets of arsenic and fluoride competitive adsorption on activated carbon. We then tested the JAMM multicomponent isotherm for a case study of cadmium and zinc competitive adsorption. Next, we further assessed the JAMM isotherm using another competitive adsorption case study of copper and chromium. Through extensive validation studies and error analysis, the JAMM isotherm was able to demonstrate its efficacy in predicting the adsorption behavior in several multicomponent adsorption systems accurately. The main advantage of JAMM isotherm over other multicomponent isotherms is that it utilizes and leverages the single-component adsorption parameters to simulate multicomponent isotherms. The proposed JAMM analytical isotherm model furthermore incorporates the interaction between the components, a mole fraction parameter, and a heterogeneity index, providing a more comprehensive modeling framework for multicomponent adsorption. The mole fraction term was introduced for the distribution of adsorption sites based on the relative number of molecules of each component. An additional term for interaction coefficient was introduced for the representation of interactions. During the validation of JAMM with three experimental case studies with negligible, small, and high competition systems of adsorbates, impressive predictions were exhibited, with the average normalized absolute percentage error as 6.05% and average R2 as 0.86, highlighting the model's robustness, versatility, and reliability. We propose that the new JAMM isotherm modeling framework might profoundly help in chemical engineering, environmental engineering, and materials science applications by providing a potent tool for analyzing and predicting multicomponent adsorption systems.


Distinct roles for RB loss on cell cycle control, cisplatin response, and immortalization in Schwann cells.
Schwann cells play a critical role in peripheral nerve function. Regulated proliferation of Schwann cells is an important facet of the response to nerve injury; however, aberrant proliferation can give rise to Schwann cell tumors such as malignant peripheral nerve sheath tumors (MPNST). These tumors exhibit a range of genetic lesions that include loss of the retinoblastoma tumor suppressor (RB) pathway. RB plays a critical role in the regulation of cellular proliferation and its loss is a common event in human cancers. Here, the specific action of RB loss on Schwann cell proliferation and response to therapeutic intervention was explored. In primary mouse Schwann cells, conditional RB loss led to increased levels of critical cell cycle regulatory gene products, yet provided only a modest influence on proliferation. However, RB-deficient Schwann cells efficiently bypassed the cell cycle inhibitory response to the chemotherapeutic agent cisplatin, which is used in the treatment of MPNST and other glial tumors. Surprisingly, RB loss did not facilitate Schwann cell immortalization; and RB-deficient cells actually were less prone to immortalization than cells containing RB. Furthermore, RB-deficient cells that ultimately re-entered the cell cycle had lost both Schwann cell morphology and markers. Since, RB loss is likely a late event in Schwann cell tumor progression, the action of acute RB loss in immortalized Schwann cells was investigated. In this context, loss of RB had a profound effect on expression of target genes and the response to cisplatin. Thus, the loss of RB in both primary and immortal Schwann cells disrupted the response to anti-mitogenic signals and has implications for therapeutic intervention.


Evaluation of amlodipine in mild to moderate hypertension--a clinical report.
Twenty two patients having mild to moderate hypertension were treated with a single daily dose of amlodipine for 4 weeks. Satisfactory response defined as final diastolic blood pressure < 90 mm of Hg and a reduction from baseline values > 10 mm of Hg could be achieved in 81.8% of patients in supine position and 70% of patients in standing position. Thirteen patients responded to 5 mg dose and 9 patients required 10 mg. Postural hypotension and reflex tachycardia were absent. Three patients has mild leg cramps and constipation. No deleterious effects were observed on liver, kidney and hemopoetic function, or on E.C.G. Changes. Amlodipine given once daily is effective and safe, and is a useful addition to the existing armamentarium of antihypertensive drugs.


Characteristics of Cervical Spine Injury in Pediatric Patients With Facial Fractures.
Cervical spine injury may present with pediatric patients having sustained fractures of the craniofacial skeleton. Management considerations of the cervical spine often take priority to the fractures of the facial skeleton. The goal of this study was to examine this subset of patients with a focus on initial presentation and need for intervention. A retrospective review from 2000 to 2012 of all facial fractures in patients ≤ 18 years at a level 1 trauma center was performed. Patient demographics, location of fractures, and the presence of a cervical spine injury were collected. During this time period, 285 patients met inclusion criteria. Ten patients were found to have a cervical spine injury. Fractures of the zygoma and orbit were significantly associated with a cervical spine injury. Patients with a cervical spine injury had a Glasgow Coma Scale of 11.2 compared with 13.8 in those without (P < 0.05). C1 was injured in 4 patients, C2 in 2 patients, and C3 to C7 in 4 patients. A surgical airway was required in 1 patient, and 6 were intubated in the trauma bay. Fractures of the mandible were significantly associated with injury to C2. Le Fort fractures and palate fractures approached significance with injury to C1. Only 1 patient had neurologic impairment at presentation, manifested as upper extremity parasthesias, and underwent decompression and fusion in the operating room. Those patients admitted (90%) were all admitted for reasons other than management of the cervical spine injury. The majority of patients (70%) were treated with collar immobilization. One patient expired. No patients had a neurologic deficit at the time of discharge. In this study only 1 cervical spine injury necessitated intervention, with an eventual full recovery. Cervical spine injuries presenting with fractures of the facial skeleton appear to be relatively benign in this series; however, care must be taken to identify all such injuries to avoid exacerbation during maneuvers commonly used for facial fracture treatment. Special caution should be used when examining patients with a depressed Glasgow Coma Scale or in those with upper midface fractures.


Complexation-Triggered Fluctuation of π-Conjugation on an Antiaromatic Dicyanoanthracene Dianion.
The formation of Lewis pairs is an important chemical concept. Recently, the complexation of Lewis acidic tris(pentafluorophenyl)borane with Lewis basic moieties and subsequent reduction has emerged as a fascinating strategy for designing novel reactions and structures. The impact of the complexation and subsequent reduction of antiaromatic systems bearing Lewis base moieties has been investigated. We found how Lewis adduct formation stabilizes an antiaromatic system consisting of 9,10-dicyanoanthracene and tris(pentafluorophenyl)borane by using synthesis, X-ray crystallography, spectroscopic analysis, and quantum chemical calculations.


Novel molecular imprinted polymers over magnetic mesoporous silica microspheres for selective and efficient determination of protocatechuic acid in Syzygium aromaticum.
Improving sites accessibility can increase the binding efficiency of molecular imprinted polymers (MIPs). In this work, we firstly synthesized MIPs over magnetic mesoporous silica microspheres (Fe3O4@mSiO2@MIPs) for the selective recognition of protocatechuic acid (PCA). The resulting Fe3O4@mSiO2@MIPs were characterized by transmission electron microscopy (TEM), Fourier transform infrared spectrometer (FT-IR), thermo-gravimetric analysis (TGA), Brunauer-Emmett-Teller (BET), and vibration sample magnetometer (VSM), and evaluated by adsorption isotherms/kinetics and competitive adsorption. The maximum adsorption capacity of PCA on Fe3O4@mSiO2@MIPs was 17.2mg/g (2.3 times that on Fe3O4@SiO2@MIPs). In addition, Fe3O4@mSiO2@MIPs showed a short equilibrium time (140min), rapid magnetic separation (5s) and high stability (retained 94.4% after six cycles). Subsequently, Fe3O4@mSiO2@MIPs were successfully applied for the selective and efficient determination of PCA (29.3μg/g) from Syzygium aromaticum. Conclusively, we combined three advantages into Fe3O4@mSiO2@MIPs, namely, Fe3O4 core for quick separation, mSiO2 layer for enough accessible sites, and surface imprinting MIPs for fast binding and excellent selectivity, to extract PCA from complex systems.


Association of Reported Concern About Increasing Societal Discrimination With Adverse Behavioral Health Outcomes in Late Adolescence.
Public expressions of discrimination may generate stress and behavioral health problems, particularly in racial/ethnic minority or socioeconomically disadvantaged youths. To determine whether concern about increasing discrimination in society reported among adolescents during 2016 and the magnitude of increase in concern from 2016 to 2017 were associated with behavioral health outcomes by 2017 and to examine racial/ethnic or socioeconomic differences in associations. This prospective cohort survey collected data at baseline from January 2 through September 28, 2016 (11th grade), and at follow-up from January 1 through August 10, 2017 (12th grade), at 10 high schools in Los Angeles, California, recruited through convenience sampling. A total of 2572 students completed both surveys. Reported concern, worry, or stress regarding "increasing hostility and discrimination of people because of their race, ethnicity, sexual orientation/identity, immigrant status, religion, or disability status in society" were scored as "not at all" (0) to "extremely" (4). Mean ratings were calculated in a 3-item composite (range, 0-4). Self-reported days of cigarette, alcohol, or marijuana use in the past month (range, 0-30 days), number of substances used in the past 6 months (range, 0-27), mild to moderate depression (yes or no), and attention-deficit/hyperactivity disorder (ADHD) (yes or no) at follow-up. The sample of 2572 students (54.4% female; mean [SD] baseline age, 17.1 [0.4] years; 1969 [87.7%] had at least 1 parent with high school diploma) included 2530 with race/ethnicity data (1198 [47.4%] Hispanic; 482 [19.0%] Asian; 104 [4.1%] African American; 155 [6.1%] multiracial; 419 [16.6%] white; 172 [6.8%] other). Appreciable numbers of students reported feeling very or extremely concerned (baseline, 1047 [41.5%]; follow-up, 1028 [44.6%]), worried (baseline, 743 [29.7%]; follow-up, 795 [34.7%]), or stressed (baseline, 345 [13.9%]; follow-up, 353 [15.5%]) about increasing societal discrimination. Each 1-SD increase on the societal discrimination concern composite in 2016 was associated with more days of past-month cigarette (incidence rate ratio [IRR], 1.77; 95% CI, 1.42-2.20; P < .001), marijuana (IRR, 1.13; 95% CI, 1.01-1.26; P = .03), and alcohol (IRR, 1.11; 95% CI, 1.02-1.21; P = .01) use, more substances used (IRR, 1.07; 95% CI, 1.01-1.17; P = .04), and greater odds of depression (odds ratio [OR], 1.11; 95% CI, 1.01-1.23; P = .04) and ADHD (OR, 1.12; 95% CI, 1.01-1.26; P = .04) symptoms in 2017. The magnitude of increase in societal discrimination concern from 2016 to 2017 was also associated with several behavioral health problems in 2017; some associations were amplified among teenagers who were African American (IRR for cigarette smoking, 2.97; 95% CI, 1.45-6.09) or Hispanic (IRR for cigarette smoking, 1.30; 95% CI, 1.09-1.54) or had parents with less educational attainment (IRR for alcohol use, 1.41 [95% CI, 1.14-1.74]; OR for ADHD, 1.81 [95% CI, 1.13-2.89]). Concern over societal discrimination was common among youths in Los Angeles in 2016 and was associated with behavioral health problems 1 year later. Adolescents' behavioral responses to recent societal expressions of discrimination may warrant public health attention.


Electrode displacement strain imaging of thermally-ablated liver tissue in an in vivo animal model.
Percutaneous thermal ablation is increasingly being used to destroy hepatic tumors in situ. The success of ablative techniques is highly dependent on adequate ablation zone monitoring, and ultrasound-based strain imaging could become a convenient and cost-effective means to delineate ablation zone boundaries. This study investigates in vivo electrode displacement-based strain imaging for monitoring hepatic ablation procedures that are difficult to perform with conventional elastography. a In our method, minute displacements (less than a millimeter) are applied to the unconstrained end of the ablation electrode, resulting in localized tissue deformation within the ablation zone that provides the mechanical stimuli required for strain imaging. This article presents electrode displacement strain images of radiofrequency ablation zones created in porcine liver in vivo (n = 13). Cross-sectional area measurements from strain images of these ablation zones were obtained using manual and automated segmentation. Area measurements from strain images were highly correlated with areas measured on histopathology images, quantitated using linear regression (R = 0.894, P < 0.001 and R = 0.828, P < 0.001, respectively). This study further demonstrates that electrode displacement elastography is capable of providing high-contrast images using widely available commercial ultrasound systems which may potentially be used to assess the extent of thermal ablation zones.


In vitro tetraploid induction and generation of tetraploids from mixoploids in Dioscorea zingiberensis.
This article describes an efficient colchicine-mediated technique for the in vitro induction of tetraploids in Dioscorea zingiberensis and its confirmation by flow cytometry. Buds immersed in 0.2% colchicine solution for 36 hours prior to culture induced as high as 35.6% tetraploid plants. Colchicine-induced tetraploids remained stable after six months in soil. Leaf characteristics of diploids and tetraploids in D. zingiberensis were compared. It was determined that the leaf sizes of glasshouse-grown plants and stomatal sizes of both in vitro and glasshouse-grown plants were suitable parameters for identifying putative tetraploids in D. zingiberensis. Besides generating tetraploids, this technique generated mixoploids in D. zingiberensis. Calli derived from mixoploid leaves were induced to form buds and shoots. Individual shoots were classed as diploid, mixoploid, and tetraploid by flow cytometry. This callus-based technique could be employed when a genome-doubling agent generated mixoploids, but no tetraploids.


Relationship between activities of daily living and cognitive ability in a sample of older adults with heterogeneous educational level.
A number of studies have shown the impact of cognitive abilities on instrumental activities of daily living, in particular executive functions. Nevertheless, it is not clear to what extent these results can be generalized, given that most samples studied have not included people with a low educational level. The current study aims to investigate the association between cognitive abilities and activities of daily living in older adults - with and without dementia - from a middle-income country. The sample consisted of 48 healthy older adults and 29 people with dementia, who were evaluated in an Outpatient Care Unit in a University Reference Center in Rio de Janeiro. Regression analyses indicated that the best predictors for activities of daily living were performance in immediate verbal memory in the case of controls and in a categorical fluency task in the patient group. The educational level itself was not a significant predictor of functional ability in either sample, but showed moderate correlation with the predictors. These results suggest that educational level may be a mediating factor in the association of cognitive variables and activities of daily living, and indicate a potential dissociation in terms of predictors according to the diagnostic status, pointing to relevant treatment directions.


Impacts of phosphorus and zinc levels on phosphorus and zinc nutrition and phytic acid concentration in wheat (Triticum aestivum L.).
Zinc (Zn) and phytic acid content in grain crops are directly related to their nutritional quality and therefore human health. To investigate the nutritional influences of phosphorus (P) and Zn levels on wheat (Triticum aestivum L.), plants were grown hydroponically to maturity in chelator-buffered solutions. Appropriate amounts of P, coupled with sufficient Zn, increased P and Zn concentrations in wheat grain. The Zn supply decreased both phytic acid and the molar ratios of phytic acid to Zn in wheat grain with respect to the Zn(0) treatment. Furthermore, proportions of Zn and P content in the grain relative to that of the whole plant were improved. With increasing P, the proportion of Zn and P content in the grain relative to the whole plant decreased. P and Zn acted antagonistically in roots. Excess P inhibited Zn uptake in roots, while Zn decreased the transfer of P from roots to shoots. For P that had been transported to the shoots, supplemental Zn facilitated its transfer to the grain. Excess P decreased the distribution of Zn in grain, while Zn enhanced the uptake of Zn and P in grain, The combined application of Zn fertilizer with the extensive use of P fertilizer can effectively increase the P and Zn concentration and Zn bioavailability of wheat grain, and hence Zn nutritional quality.


Size dependence of functional alterations in mesenteric arteries from the aldosterone-salt hypertensive rat.
We tested the hypothesis that an elevated potassium-42 ((42)K(+)) efflux (highly dependent on Ca(2+)) and an increase in the sensitivity of contraction and (42)K(+) efflux to norepinephrine (NE) in conduit arteries of aldosterone-salt hypertensive rats (AHR) extended to smaller, distributing arteries. Functional endpoints were compared in two sizes of arteries from the mesenteric bed: second-order branches of the superior mesenteric artery (SMA branches) and the SMA. Contraction and free cytosolic Ca(2+) concentration ([Ca(2+)](c); fura-2 microfluorometry) were measured simultaneously and (42)K(+) efflux was measured separately in SMA branches. Contraction and (42)K(+) efflux were measured separately in SMA. Basal tone, [Ca(2+)](c), and (42)K(+) efflux were similar in SMA branches from AHR and control-salt rats (CSR). However, basal (42)K(+) efflux was elevated in SMA from AHR compared to CSR. The sensitivity of the contractile, [Ca(2+)](c), and (42)K(+) efflux responses to NE was similar in SMA branches. In contrast, the sensitivity of the contractile and (42)K(+) efflux responses to NE was enhanced in SMA from AHR compared to CSR. Inhibiton of endothelium-derived vasoactive substances by pretreatment with N(omega)-nitro-L-arginine methyl ester and indomethacin significantly shifted the NE concentration-response relationships to the left for contraction, [Ca(2+)](c), and (42)K(+) efflux in both SMA branches and SMA from CSR. A similar shift to the left was observed in AHR for contraction but not consistently for [Ca(2+)](c) and (42)K(+) efflux. We conclude that SMA branches from AHR demonstrate neither the elevated basal (42)K(+) efflux, nor the NE supersensitivity exhibited by SMA. Endothelial function was not impaired both in SMA and SMA branches.


Cellulose aerogels from aqueous alkali hydroxide-urea solution.
Highly porous and strong cellulose aerogels were prepared by gelation of cellulose from aqueous alkali hydroxide/urea solution, followed by drying with supercritical CO2. Their morphology, pore structure, and physical properties were characterized by scanning and transmission electron microscopy, X-ray diffraction, nitrogen adsorption measurements, UV/Vis spectrometry, and tensile tests. The cellulose hydrogel was composed of interconnected about 20 nm wide. By using supercritical CO2 drying, the network structure in the hydrogel was well preserved in the aerogel. The results are preliminary but demonstrate the ability of this method to give cellulose aerogels of large surface areas (400-500 m2 g(-1)) which may be useful as adsorbents, heat/sound insulators, filters, catalyst supports, or carbon aerogel precursors.


Hong Kong Chinese community leaders' perspectives on family health, happiness and harmony: a qualitative study.
This paper examines the views of Hong Kong community leaders on the underlying issues that affect family health, happiness and harmony (3Hs) in Hong Kong. Using a community reconnaissance method, a series of individual in-depth interviews with 26 leaders that represent neighbourhoods of diverse socio-economic status (SES) from June to August 2008 were conducted. Participants considered that changing family structure, economic situation and strong work ethic are the most salient factors that affect family 3Hs. The deprived comprehensive social security assistance recipients, single-parent families and migrant women were considered to be the most vulnerable groups to breakdown in family 3Hs and particularly, they lack family resources. Families from different SES have to overcome different challenges in order to achieve and sustain family 3Hs. Leaders from low SES neighbourhood were concerned more about providing tangible help such as child care facilities to improve family resources, whereas leaders from high SES neighbourhood focused more on preventive interventions such as education on relationship skills to achieve better family well-being. The findings offer insights in designing effective social marketing education campaigns and family-friendly workplace policy to promote social harmony through the maintenance of 3Hs families.


Extending the limits of molecular replacement through combined simulated annealing and maximum-likelihood refinement.
Phases determined by the molecular-replacement method often suffer from model bias. In extreme cases, the refinement of the atomic model can stall at high free R values when the resulting electron-density maps provide little indication of how to correct the model, sometimes rendering even a correct solution unusable. Here, it is shown that several recent advances in refinement methodology allow productive refinement, even in cases where the molecular-replacement-phased electron-density maps do not allow manual rebuilding. In test calculations performed with a series of homologous models of penicillopepsin using either backbone atoms, or backbone atoms plus conserved core residues, model bias is reduced and refinement can proceed efficiently, even if the initial model is far from the correct one. These new methods combine cross-validation, torsion-angle dynamics simulated annealing and maximum-likelihood target functions. It is also shown that the free R value is an excellent indicator of model quality after refinement, potentially discriminating between correct and incorrect molecular-replacement solutions. The use of phase information, even in the form of bimodal single-isomorphous-replacement phase distributions, greatly improves the radius of convergence of refinement and hence the quality of the electron-density maps, further extending the limits of molecular replacement.


An outbreak of a mixed infection of Dermatophilus congolensis and Microsporum gypseum in camels (Camelus dromedarius) in Saudi Arabia.
Although both Dermatophilus congolensis and Microsporum gypseum infections have been reported separately in camels, mixed infection involving both agents has not been reported to date. The authors describe a mixed infection of D. congolensis and M. gypseum in camels reared on a dairy farm in Saudi Arabia. A total of 131 out of 559 camels (23.4%) were affected. Forty-eight camels less than one year of age had discrete, circumscribed, crusty, hairless lesions, found in particular on the neck and forelegs. Eighty-three camels of varying ages had extensive hair matting with crusty, hairless lesions, especially on the flanks. Camel calves and young camels demonstrated a relatively greater amount of skin lesions. D. congolensis and M. gypseum were diagnosed by direct microscopy, isolation and histopathology.


Student teachers' beliefs about mentoring and learning to teach during teaching practice.
Various interpretations of mentor roles, by teacher educators and mentors, have been described in the literature on mentoring, while those of student teachers have received less attention. Therefore, this study focuses on student teachers' expectations of mentors and their own contributions to their learning process while they are supervised by a mentor. The main aims of this study were: (1) bridging the research on mentoring and the research on higher education students' learning conceptions by investigating student teachers' beliefs about mentoring and learning to teach, and (2) comparing these beliefs to mentors' ones and recent views on mentoring and learning in order to make suggestions for improving learning to teach. Thirty student teachers, graduates in various academic disciplines, participated. They were attending a one-year teacher education programme at Leiden University in the Netherlands. Structured interviews with the student teachers were audio-taped. Firstly, categories of mentor roles and learning activities were derived from the data. These were linked, secondly, by their focus of attention and, thirdly, empirically by a homogeneity analysis (HOMALS). Six mentor roles, ten learning activities, and one regulation activity were combined in six foci: (1) affective aspects of learning to teach, (2) mentors' teaching styles, (3) assessment of student teachers' performance, (4) reflecting on students' lessons, (5) school context, and (6) self-regulation of learning. The HOMALS analysis yielded a process-product dimension. In this study, the student teachers' beliefs about mentoring were similar to those of mentors. Furthermore, a third of the student teachers expected themselves as thinking critically about their lessons, but nobody expected their mentors to explicate their practical knowledge underlying their teaching. Therefore, the articulation of this knowledge is indicated as an additional mentor role and will be elaborated.


Influence of perceived functional and employment status on cardiopulmonary resuscitation directives.
Perceptions about functional and employment status before admission to the intensive care unit (ICU) may influence how patients and clinicians make decisions about cardiopulmonary resuscitation. To examine the relationship between cardiopulmonary resuscitation directives established within 24 hours of admission to the ICU and clinical perceptions of premorbid functional and employment status. Prospective observational study in 15 university-affiliated centers in Canada, the United States, Australia, and Sweden. A total of 1,008 ICU patients aged 18 years or older expected to stay in the ICU at least 72 hours. By using multinomial logistic regression, we examined the relationship between functional status and employment status perceived by the ICU team 1 month before ICU admission (the independent variables) and resuscitation status (the dependent variable). Each patient had either an explicit resuscitation directive (to resuscitate or not to resuscitate), or an implicit resuscitation directive to resuscitate. On average, patients were 61.7 years (+/-17.4 y) old with an Acute Physiology and Chronic Health Evaluation (APACHE) II score of 21.5 (+/-8.7); 846 (83.9%) were ventilated mechanically within 48 hours and 345 (34.2%) died in the ICU. Most patients (793, 78.7%) had no explicit resuscitation directive; 98 (9.7%) had an explicit plan to resuscitate, whereas 117 (11.6%) had an explicit plan of do-not-resuscitate. Of 1,008 patients, 98 (9.7%) were severely functionally limited, 217 (21.5%) were somewhat limited, 628 (62.3%) were totally independent, and 65 (6.4%) had unknown functional status 1 month before ICU admission. Severe functional status impairment was associated moderately with an explicit plan to resuscitate (odds ratio, 2.2 relative to no explicit directive) and associated strongly with an explicit do-not-resuscitate plan (odds ratio, 6.2 relative to no explicit directive, P value on the difference =.011). This relationship was not influenced by age, sex, APACHE II score, medical or surgical status, admission diagnosis, employment status, or city. However, severe functional status was associated strongly and significantly with an explicit do-not-resuscitate directive among those who could not participate in decision making (odds ratio, 8.2; 95% confidence interval, 4.5-15.0), and more weakly associated in those who could participate (odds ratio, 1.7; 95% confidence interval, 0.3-8.6). Being unemployed was associated with an increased odds of an explicit resuscitation directive versus no explicit directive (odds ratio, 5.5; 95% confidence interval, 2.2-13.4). Functional status impairment perceived by the ICU team is associated clearly with do-not-resuscitate directives in patients unable to participate in decision making. However, the association appears much weaker in patients able to participate in decision making. PATIENTS' perceived employment status also may influence resuscitation decisions. Our results emphasize the challenges of ensuring that crucial resuscitation decisions are not affected adversely by patients' inability to participate in decisions, and by their functional and employment status.


Increased resistance in postobstructive pulmonary vasculopathy: structure-function relationships.
Postobstructive pulmonary vasculopathy (POPV) was produced by chronic ligation (120 days) of the left main pulmonary artery of seven dogs. To explain the abnormal physiological changes found using arterial and venous occlusion (AVO) in POPV (J. Appl. Physiol. 69: 1022-1032, 1990), the light-microscopic morphology, morphometry (n = 5), and ultrastructure (n = 6) of ligated left lower lobes were compared with contralateral control right lower lobes. First, there was a proliferation of bronchial vessels around pulmonary vessels and airways to explain bronchial blood flow rates of 330 ml/min in left lower lobes. The walls of the bronchial vessels contained smooth muscle with minimal elastic tissue and prominent myoendothelial junctions. Second, focal bronchopulmonary anastomoses were seen in pulmonary arteries approximately equal to 100 microns diam, which is consistent with our conclusion that the major site of communication is at the precapillary level and suggests that the limit between arterial and middle segments defined by AVO may lie in arteries of approximately equal to 100 microns. Third, to explain the increased arterial resistance in POPV, the pulmonary arteries had an increased percent medial muscle thickness, peripheral muscularization, and focal intimal thickening but had no plexiform lesions. The ultrastructure of the arteries revealed new intimal cells and numerous myoendothelial junctions rarely found in controls. Capillaries and veins were only subtly altered. Fourth, the hyperreactivity of arteries to serotonin and of veins to histamine found using AVO was partially explained by the increased medial thickness and decreased diameter but may also be due to increased receptor concentration or related to the myoendothelial junctions. We conclude that most of the hemodynamic alterations in POPV are related to morphological abnormalities and that this model has clinical and experimental relevance in the study of bronchopulmonary vascular interactions.


Camptothecin activates SIRT1 to promote lipid catabolism through AMPK/FoxO1/ATGL pathway in C2C12 myogenic cells.
Caloric restriction activates sirtuin 1 (SIRT1) and induces a variety of metabolic effects that are beneficial for preventing age-related disease. The present study screened a commercially available used drug library to develop small molecule activators of SIRT1 as therapeutics for treatment of metabolic disorders. Using an in vitro fluorescence assay, the cancer therapeutic camptothecin increased SIRT1 enzymatic activity by 5.5-fold, indicating it to be a potent SIRT1 activator. Camptothecin also elevated the nicotinamide adenine dinucleotide (NAD)+/NADH ratio and increased SIRT1 protein levels in differentiated C2C12 myogenic cells. Treatment of C2C12 myotubes with camptothecin increased phosphorylation of AMP-dependent kinase (AMPK) and acetyl-coenzyme A carboxylase, caused nuclear translocation and deacetylation of forkhead box O1 (FoxO1), increased transcription and protein expression of adipose triglyceride lipase (ATGL), decreased the amount of intracellular oil droplets, and significantly increased β-oxidation of fatty acids. These in vitro data were confirmed in vivo as camptothecin treatment of C57BL/6J mice reduced fat and plasma triglyceride levels. All of the above camptothecin-induced alterations were attenuated by the SIRT1-specific inhibitor nicotinamide and/or 6-[4-(2-piperidin-1-ylethoxy) phenyl]-3-pyridin-4-ylpyrazolo [1,5-a]pyrimidin (compound C). Thus, camptothecin activation of SIRT1 promotes lipid catabolism through AMPK/FoxO1/ATGL signaling.


The role of religious attendance on mental health among Mexican populations: A contribution toward the discussion of the immigrant health paradox.
In this study, we conducted a path analysis on data from the National Latino and Asian American Study to investigate the role of religious attendance on mental health among Mexican populations. Using data from 868 Latinos of Mexican origin, we further investigated the extent to which religious attendance mediated the direct path between generation status and lifetime prevalence rates of any substance use disorder, depressive disorder, and anxiety disorder. Results indicate that Mexican immigrants endorsed lower lifetime prevalence rates of depressive disorder, anxiety disorder, and substance use disorder and endorsed higher levels of religious attendance. Second, results indicate a significant negative relationship between religious attendance and prevalence rates for depressive disorder, anxiety disorder, and substance use disorder. Third, results indicate that religious attendance was a mediator for the relationship between generation status and the lifetime prevalence rates of substance use disorder only. These results provide a contribution toward the discussion of the immigrant health paradox and further highlight the role that religious attendance plays in the relationship between generational status and the lifetime prevalence rates of substance use disorder. (PsycINFO Database Record


BRCA1-associated epigenetic regulation of p73 mediates an effector pathway for chemosensitivity in ovarian carcinoma.
The majority of tumors arising in BRCA1 mutation carriers exhibit inactivation of p53, a key effector of cell death after DNA damage. Despite the loss of p53, BRCA1-deficient tumor cells exhibit increased sensitivity to cisplatin, and patients with BRCA1-associated ovarian carcinomas experience improved outcomes with platinum-based chemotherapy compared with sporadic cases. Although it is known that chemosensitivity in BRCA1-associated cancers is associated with unrepaired DNA damage, the specific effector pathway mediating the cellular response to platinum-induced damage in these tumors is poorly understood. Here, we show that the p53-related gene p73, encoding a proapoptotic protein that is linked to chemosensitivity in many settings, is upregulated through a novel epigenetic mechanism in both human and murine models of BRCA1-associated ovarian carcinoma. BRCA1-deficient ovarian carcinoma cells exhibit hypermethylation within a p73 regulatory region, which includes the binding site for the p73 transcriptional repressor ZEB1, leading to the abrogation of ZEB1 binding and increased expression of transactivating p73 isoforms (TAp73). Cisplatin chemotherapy induces TAp73 target genes specifically in BRCA1-deficient cells, and knockdown of TAp73 in these cells causes chemoresistance while having little or no effect on BRCA1-expressing tumor cells. In primary ovarian carcinomas, ZEB1 binding site methylation and TAp73 expression correlate with BRCA1 status and with clinical response. Together, these findings uncover a novel regulatory mechanism that supports the contribution of TAp73 as an important mediator of the response to platinum chemotherapy in a subset of ovarian carcinomas. TAp73 might represent a response predictor and potential therapeutic target for enhancing chemosensitivity in this disease.


Predicting outcome after thrombolysis in acute myocardial infarction according to ST-segment resolution at 90 minutes: a substudy of the GUSTO-III trial. Global Use of Strategies To Open occluded coronary arteries.
Resolution of ST-segment elevation after thrombolysis for acute myocardial infarction has been shown to have prognostic significance 3 hours (180 minutes) after the initiation of therapy. Whether prognostically useful information can be achieved as early as 90 minutes after thrombolysis is unknown. An electrocardiographic substudy of 2352 patients from the Global Use of Strategies To Open occluded coronary arteries (GUSTO-III) trial was undertaken to compare outcomes according to ST-segment resolution at 90 minutes versus 180 minutes after administration of thrombolytic therapy. Of 2352 patients in the substudy, 2241 had a baseline and 90-minute electrocardiogram, and 2218 had a baseline and 180-minute ECG. Complete ST-segment resolution occurred in 44.2% of patients at 90 minutes and 56.5% of patients at 180 minutes. ST-segment resolution at both 90 and 180 minutes was associated with lower 30-day and 1-year mortality. Multivariate analysis revealed ST-segment resolution at 90 minutes to be an equally strong predictor of 30-day mortality as resolution at 180 minutes. Patients who were at particularly high risk for mortality were those aged >70 years, those who presented with Killip class >1, and those with anterior infarctions. The presence of ST-segment resolution on standard 12-lead electrocardiographic monitoring 90 minutes after thrombolysis is a useful independent predictor of mortality at 30 days and 1 year. The potential for obtaining prognostic results as early as 90 minutes after thrombolysis sets a new precedent for optimum electrocardiographic monitoring times in these patients.


The development of synkinesis after facial nerve paralysis.
In this study, the development of clinical synkinesis after facial nerve paralysis (FP) and its relationship to electrophysiological findings were investigated. Thirty-four patients who were examined within the first 5 days after onset of FP and who could also be followed up for at least 4 months were included in the study. Electrophysiological investigations consisted of: (1) recording of the direct responses by facial nerve stimulation at the stylomastoid fossa; (2) recording of the 'synkinetic spread' of the supraorbital nerve reflex to the lower facial muscles; (3) recording of the 'lateral spread responses' by stimulating the mandible and zygomatic branches of the facial nerve. Clinical synkinesis developed in 14 of 18 patients (78%) with a direct response ratio (DRr) of less than 40%. Among the 16 patients with a DRr of 40% or more, synkinesis was observed in 3 cases (18.7%) only. The DRr provided reliable information concerning the development of synkinesis. Forty percent seemed to be a reasonable limit to distinguish the high-risk group for the development of clinical synkinesis.


Large-scale mammalian genome rearrangements coincide with chromatin interactions.
Genome rearrangements drastically change gene order along great stretches of a chromosome. There has been initial evidence that these apparently non-local events in the 1D sense may have breakpoints that are close in the 3D sense. We harness the power of the Double Cut and Join model of genome rearrangement, along with Hi-C chromosome conformation capture data to test this hypothesis between human and mouse. We devise novel statistical tests that show that indeed, rearrangement scenarios that transform the human into the mouse gene order are enriched for pairs of breakpoints that have frequent chromosome interactions. This is observed for both intra-chromosomal breakpoint pairs, as well as for inter-chromosomal pairs. For intra-chromosomal rearrangements, the enrichment exists from close (<20 Mb) to very distant (100 Mb) pairs. Further, the pattern exists across multiple cell lines in Hi-C data produced by different laboratories and at different stages of the cell cycle. We show that similarities in the contact frequencies between these many experiments contribute to the enrichment. We conclude that either (i) rearrangements usually involve breakpoints that are spatially close or (ii) there is selection against rearrangements that act on spatially distant breakpoints. Our pipeline is freely available at https://bitbucket.org/thekswenson/locality. Supplementary data are available at Bioinformatics online.


A quest for the artificial leaf.
It has been estimated that the energy captured in one hour of sunlight that reaches our planet is equivalent to annual energy production by human population globally. To efficiently capture the practically inexhaustible solar energy and convert it into high energy density solar fuels provides an attractive 'green' alternative to running our present day economies on rapidly depleting fossil fuels, especially in the context of ever growing global energy demand. Natural photosynthesis represents one of the most fundamental processes that sustain life on Earth. It provides nearly all the oxygen we breathe, the food we consume and fossil fuels that we so much depend on. Imitating the reactions that occur at the early stages of photosynthesis represents the main challenge in the quest for construction of an efficient, robust, self-renewing and cost-effective 'artificial leaf'. In this review we summarize the main molecular features of the natural solar energy converters, photosystem I and photosystem II, that allow them to operate at high quantum efficiencies, and thus inspire the smart matrix design of the artificial solar-to-fuel devices. We also discuss the main challenges that face the field and overview selected recent technological advances that have tremendously accelerated the race for a fully operational artificial leaf that could serve as a viable alternative to fossil fuels for energy production.


Misshapen-like kinase 1 (MINK1) is a novel component of striatin-interacting phosphatase and kinase (STRIPAK) and is required for the completion of cytokinesis.
Cytokinesis is initiated by constriction of the cleavage furrow and terminated by abscission of the intercellular bridge that connects two separating daughter cells. The complicated processes of cytokinesis are coordinated by phosphorylation and dephosphorylation mediated by protein kinases and phosphatases. Mammalian Misshapen-like kinase 1 (MINK1) is a member of the germinal center kinases and is known to regulate cytoskeletal organization and oncogene-induced cell senescence. To search for novel regulators of cytokinesis, we performed a screen using a library of siRNAs and found that MINK1 was essential for cytokinesis. Time-lapse analysis revealed that MINK1-depleted cells were able to initiate furrowing but that abscission was disrupted. STRN4 (Zinedin) is a regulatory subunit of protein phosphatase 2A (PP2A) and was recently shown to be a component of a novel protein complex called striatin-interacting phosphatase and kinase (STRIPAK). Mass spectrometry analysis showed that MINK1 was a component of STRIPAK and that MINK1 directly interacted with STRN4. Similar to MINK1 depletion, STRN4-knockdown induced multinucleated cells and inhibited the completion of abscission. In addition, STRN4 reduced MINK1 activity in the presence of catalytic and structural subunits of PP2A. Our study identifies a novel regulatory network of protein kinases and phosphatases that regulate the completion of abscission.


Present developments in reaching an international consensus for a model-based approach to particle beam therapy.
Particle beam therapy (PBT), including proton and carbon ion therapy, is an emerging innovative treatment for cancer patients. Due to the high cost of and limited access to treatment, meticulous selection of patients who would benefit most from PBT, when compared with standard X-ray therapy (XRT), is necessary. Due to the cost and labor involved in randomized controlled trials, the model-based approach (MBA) is used as an alternative means of establishing scientific evidence in medicine, and it can be improved continuously. Good databases and reasonable models are crucial for the reliability of this approach. The tumor control probability and normal tissue complication probability models are good illustrations of the advantages of PBT, but pre-existing NTCP models have been derived from historical patient treatments from the XRT era. This highlights the necessity of prospectively analyzing specific treatment-related toxicities in order to develop PBT-compatible models. An international consensus has been reached at the Global Institution for Collaborative Research and Education (GI-CoRE) joint symposium, concluding that a systematically developed model is required for model accuracy and performance. Six important steps that need to be observed in these considerations include patient selection, treatment planning, beam delivery, dose verification, response assessment, and data analysis. Advanced technologies in radiotherapy and computer science can be integrated to improve the efficacy of a treatment. Model validation and appropriately defined thresholds in a cost-effectiveness centered manner, together with quality assurance in the treatment planning, have to be achieved prior to clinical implementation.


A primer for the conceptualization of the mechanism of action of electroconvulsive therapy, 1: defining the question.
With regard to the question of how electroconvulsive therapy (ECT) acts, a common answer is that the mechanism of action of the treatment is not well understood. However, this is not true. There is a great deal of information available about what ECT does in the brain, how it does it, and how these effects translate into clinical actions. The very complexity of the available data makes it necessary for the question about mechanisms to be properly defined with regard to physiologic effects, adverse effects, and efficacy in different conditions. This article presents a primer for the conceptualization of the mechanism of action of ECT with special attention to understanding why the question and answer are complex.


Disaster mythology and fact: Hurricane Katrina and social attachment.
Misconceptions about disasters and their social and health consequences remain prevalent despite considerable research evidence to the contrary. Eight such myths and their factual counterparts were reviewed in a classic report on the public health impact of disasters by Claude de Ville de Goyet entitled, The Role of WHO in Disaster Management: Relief, Rehabilitation, and Reconstruction (Geneva, World Health Organization, 1991), and two additional myths and facts were added by Pan American Health Organization. In this article, we reconsider these myths and facts in relation to Hurricane Katrina, with particular emphasis on psychosocial needs and behaviors, based on data gleaned from scientific sources as well as printed and electronic media reports. The review suggests that preparedness plans for disasters involving forced mass evacuation and resettlement should place a high priority on keeping families together--and even entire neighborhoods, where possible--so as to preserve the familiar and thereby minimize the adverse effects of separation and major dislocation on mental and physical health.


Regulation of secretory granule size by the precise generation and fusion of unit granules.
Morphometric evidence derived from studies of mast cells, pancreatic acinar cells and other cell types supports a model in which the post-Golgi processes that generate mature secretory granules can be resolved into three steps: (1) fusion of small, Golgi-derived progranules to produce immature secretory granules which have a highly constrained volume; (2) transformation of such immature granules into mature secretory granules, a process often associated with a reduction in the maturing granule's volume, as well as changes in the appearance of its content and (3) fusion of secretory granules of the smallest size, termed 'unit granules', forming granules whose volumes are multiples of the unit granule's volume. Mutations which perturb this process can cause significant pathology. For example, Chediak-Higashi syndrome / lysosomal trafficking regulator (CHS)/(Lyst) mutations result in giant secretory granules in a number of cell types in human beings with the Chediak-Higashi syndrome and in 'beige' (Lyst(bg)/Lyst(bg)) mice. Analysis of the secretory granules of mast cells and pancreatic acinar cells in Lyst-deficient beige mice suggests that beige mouse secretory granules retain the ability to fuse randomly with other secretory granules no matter what the size of the fusion partners. By contrast, in normal mice, the pattern of granule-granule fusion occurs exclusively by the addition of unit granules, either to each other or to larger granules. The normal pattern of fusion is termed unit addition and the fusion evident in cells with CHS/Lyst mutations is called random addition. The proposed model of secretory granule formation has several implications. For example, in neurosecretory cells, the secretion of small amounts of cargo in granules constrained to a very narrow size increases the precision of the information conveyed by secretion. By contrast, in pancreatic acinar cells and mast cells, large granules composed of multiple unit granules permit the cells to store large amounts of material without requiring the amount of membrane necessary to package the same amount of cargo into small granules. In addition, the formation of mature secretory granules that are multimers of unit granules provides a mechanism for mixing in large granules the contents of unit granules which differ in their content of cargo.


Are environmental pollution and biodiversity levels associated to the spread and mortality of COVID-19? A four-month global analysis.
On March 12th, 2020, the WHO declared COVID-19 as a pandemic. The collective impact of environmental and ecosystem factors, as well as biodiversity, on the spread of COVID-19 and its mortality evolution remain empirically unknown, particularly in regions with a wide ecosystem range. The aim of our study is to assess how those factors impact on the COVID-19 spread and mortality by country. This study compiled a global database merging WHO daily case reports with other publicly available measures from January 21st to May 18th, 2020. We applied spatio-temporal models to identify the influence of biodiversity, temperature, and precipitation and fitted generalized linear mixed models to identify the effects of environmental variables. Additionally, we used count time series to characterize the association between COVID-19 spread and air quality factors. All analyses were adjusted by social demographic, country-income level, and government policy intervention confounders, among 160 countries, globally. Our results reveal a statistically meaningful association between COVID-19 infection and several factors of interest at country and city levels such as the national biodiversity index, air quality, and pollutants elements (PM10, PM2.5, and O3). Particularly, there is a significant relationship of loss of biodiversity, high level of air pollutants, and diminished air quality with COVID-19 infection spread and mortality. Our findings provide an empirical foundation for future studies on the relationship between air quality variables, a country's biodiversity, and COVID-19 transmission and mortality. The relationships measured in this study can be valuable when governments plan environmental and health policies, as alternative strategy to respond to new COVID-19 outbreaks and prevent future crises.


Effect of guar gum-chitosan composites edible coating functionalized with essential oils on the postharvest shelf life of Khasi mandarin at ambient condition.
In the present study, the effects of guar gum (0.7 %):chitosan (0.3 %) based composite edible coating functionalized with coconut oil and essential oils like clove bud oil and cinnamon bark oil were investigated on the postharvest shelf life of Khasi mandarins at ambient conditions (25 ± 5 °C, RH 75 ± 5 %) up to 20 days of storage period. The postharvest characteristics such as weight loss, firmness, acidity, total soluble solids (TSS) and reducing sugar of control and treated fruits were evaluated at 5 days intervals throughout the storage period. The obtained results indicated that the application of guar gum/chitosan-based composite edible coating with coconut oil, clove bud and cinnamon bark essential oil was effective in prolonging the postharvest shelf life of Khasi mandarins as compared to control fruits by minimizing the decay and loss of postharvest quality attributes. The treatment of composite such as guar gum/chitosan/coconut oil/clove oil/cinnamon oil (GGCsC-Cl-Cn) was most effective in maintaining postharvest characteristics of fruits compared to other treatments and control. The significant (p < 0.05) lowest weight loss (38 %) with retention of higher firmness (5.9 N), titratable acidity (0.29 %), and total soluble solid (10.8 %) was noticed in the Khasi mandarins treated with GGCsC-Cl-Cn composite coating on 20 days of storage. Furthermore, the present study confirmed the significance of the developed composite formulation in improving the shelf life of Khasi mandarin.


Cell phone use and behavioural problems in young children.
Potential health effects of cell phone use in children have not been adequately examined. As children are using cell phones at earlier ages, research among this group has been identified as the highest priority by both national and international organisations. The authors previously reported results from the Danish National Birth Cohort (DNBC), which looked at prenatal and postnatal exposure to cell phone use and behavioural problems at age 7 years. Exposure to cell phones prenatally, and to a lesser degree postnatally, was associated with more behavioural difficulties. The original analysis included nearly 13 000 children who reached age 7 years by November 2006. To see if a larger, separate group of DNBC children would produce similar results after considering additional confounders, children of mothers who might better represent current users of cell phones were analysed. This 'new' dataset consisted of 28 745 children with completed Age-7 Questionnaires to December 2008. The highest OR for behavioural problems were for children who had both prenatal and postnatal exposure to cell phones compared with children not exposed during either time period. The adjusted effect estimate was 1.5 (95% CI 1.4 to 1.7). The findings of the previous publication were replicated in this separate group of participants demonstrating that cell phone use was associated with behavioural problems at age 7 years in children, and this association was not limited to early users of the technology. Although weaker in the new dataset, even with further control for an extended set of potential confounders, the associations remained.


Prevalence of Overweight and Obesity, and Its Associated Factors Among Health-care Workers, Teachers, and Bankers in Arusha City, Tanzania.
Tanzania is one of the developing countries experiencing an increasing trend of overweight and obesity among adults. Working adults have been identified as a high-risk group more exposed to the predictors of overweight and obesity than the general population. However, limited studies have been done in this group. This study aimed to identify the prevalence of overweight and obesity and its associated risk factors among health-care workers, teachers, and bankers in Arusha city council. A descriptive cross-sectional study was conducted among health-care workers, teachers, and bankers. A total of 305 working adults aged 18-60 years participated in the study. A modified World Health Organization (WHO) STEPwise approach for chronic disease risk factor surveillance was used to collect data about socio-demographic characteristics, lifestyle behaviors, dietary practices and anthropometric measurement. The Global Physical Activity Questionnaire (GPAQ) was used to collect information about level of physical activities. The anthropometric measurement and level of physical activities were calculated and ranked according to WHO guidelines. Overall, 68.9% (31.1% overweight and 37.8% obese) of working adults were overweight or obese. Age (adjusted odds ratio [AOR=7.73; 95% CI: 1.93-30.87]), gender (AOR=2.60; 95% CI: 1.30-5.21), marital status (AOR=2.47; 95% CI: 1.11-5.50), years spent with the current institution (AOR=4.59; 95% CI: 1.38-17.80), using private car or public transport to and from work (AOR=2.43; 95% CI: 1.10-5.39) and sedentary work (AOR=2.43; 95% CI: 1.04-5.71), were significant factors associated with overweight or obesity. The study identified a higher prevalence of overweight and obesity in Tanzania compared with previous studies. The results from this study are useful for the education sector, financial institutions and health sector on designing workplace wellness programs to reduce the burden of overweight and obesity among this working category.


Clustering of hemodynamic and metabolic abnormalities and of anthropometric characteristics in men and women, aged 21-60 years.
The associations between fat pattern and metabolic profile were evaluated, using cluster analysis, in 214 males and 244 females (aged 21-60 years). The subjects were randomly selected from the patients of one general practice in Castel D'Azzano (Italy). The metabolic status was indexed by blood pressure, blood glucose, uric acid, serum triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (both total and percentage). Fat pattern was evaluated using six skinfolds and three circumferences. The analyses were performed separately on anthropometric and metabolic variables for each sex. The analyses were repeated five times to evaluate the stability of the cluster solution. Anthropometric rather than metabolic variables provided a more stable solution for cluster analysis. Anthropometric clusters showed significantly different metabolic patterns. Most of the differences disappeared when a body mass index (BMI) effect was taken into account but not when an adjustment for waist to hip ratio (WHR) was made. On the other hand, neither BMI nor WHR was able to fully account for the differences in metabolic profiles of metabolic clusters. Cross-classification results of anthropometric and metabolic cluster membership showed a significant, although moderate, degree of association between the two classification sets. These results indicate that in both sexes anthropometric characteristics contribute to a limited degree to the metabolic profile and that the associations probably reflect a complex mechanism.


Clinical presentation of meningococcal disease in childhood.
Although relatively rare, meningococcal disease represents a global health problem being still the leading infectious cause of death in childhood with an overall mortality around 8%. Meningococcal meningitis is the most commonly recognized presentation, accounting for 80% to 85% of all reported cases of meningococcal disease (in half of these cases sepsis is also present concomitantly). The remaining 15-20% of cases are most commonly bloodstream infections only. Meningococcal serogroups A, B, and C account for most cases of meningococcal disease throughout the world. Recently, serogroups W-135 and X (predominantly in Africa) and group Y (in the United States and European countries) have emerged as important disease-causing isolates. Despite recent advances in medical management, the mortality rate of fulminant meningococcemia ranges from 15% to 30%. However, among survivors, 10-30% could have long term sequelae (i.e. sensoneural hearing loss, seizure, motor problems, hydrocephalus, mental retardation, and cognitive and behavioral problems). Considering the clinical severity of meningococcal disease, prevention represents the first approach for avoiding serious complications and possible deaths. The availability of new vaccines able to cover the emerging serotypes including A and Y as well as the availability on the market of new products that could prevent meningococcal B infection represent a great opportunity for the decrease of the burden of this complicated disease.