The Effect of a Peanut-Enriched Weight Loss Diet Compared to a Low-Fat Weight Loss Diet on Body Weight, Blood Pressure, and Glycemic Control: A Randomized Controlled Trial.
The objective of this study was to examine the effect of consuming 35 g of peanuts prior to two main meals per day as part of a weight loss diet, compared to a traditional low-fat weight loss diet, on body weight, markers of glycemic control, and blood pressure in adults at risk of type 2 diabetes over 6 months. A two-arm randomized controlled trial was conducted. Adults (age > 18 years) with a BMI of >26 kg/m2 at risk of type 2 diabetes were randomized to the peanut group or the traditional low-fat-diet group (control). The peanut group was advised to consume 35 g of lightly salted dry-roasted peanuts prior to two main meals per day. Participants in the control group were given education to follow a low-fat diet. Both groups had dietetic counseling to restrict energy intake (women: <5500 kJ/1300 kcal/d; men: <7000 kJ/1700 kcal/d). Outcome assessment occurred at baseline, 3 months, and 6 months. In total, 107 participants were randomized (65% female; mean age 58 ± 14 years, BMI 33 ± 5.4 kg/m2, waist circumference 109 ± 13 cm, AUSDRISK score 15 ± 5 points), and 76 participants completed the study. No between-group difference in body weight (primary outcome) was observed at 6 months (mean difference, −0.12 kg; 95% CI, −2.42, 2.18; p = 0.92). The mean weight loss at 6 months was 6.7 ± 5.1 kg in the cohort (visit p < 0.001). HbA1c, fasting glucose, fasting insulin, 2-h glucose, and HOMA-IR were not different between the groups. Systolic blood pressure was reduced to a greater extent in the peanut group vs. the control group at 6 months (−5.33 mmHg; 95% CI, −9.23, −1.43; p = 0.008). Intake of 35 g of peanuts prior to two main meals per day, in the context of an energy-restricted diet, resulted in weight loss comparable to a traditional low-fat weight loss diet without preloads. Greater systolic blood pressure reductions were observed with peanut intake, which may lower cardiovascular disease risk.


Preventive health services and lifestyle practices in cancer survivors: a population health investigation.
Long term health in cancer survivors require both preventive health services and certain health behavior practices in order to prevent the major chronic diseases that can occur for any adult in the general population. Despite this we currently do not know the pattern of clinical preventive services and health behaviors of cancer survivors in the US population. The present study examines the patterns of preventive health activities in two domains: clinical preventive services and healthy lifestyle practices in a heterogeneous population of cancer survivors. Longitudinal analyses of Medical Expenditure Panel Survey (MEPS) data, a nationally representative health survey, for the calendar years 2000 through 2004 were conducted. Cancer survivors were defined as individuals diagnosed with cancer in the baseline year and alive in the subsequent year. To address both provider based and behavioral health activities, two categories of care were included: clinical preventive services consisting of influenza immunization, routine physical examination, and a dental check up within the last year using the follow-up year data and healthy lifestyle practices including engaging in moderate/vigorous exercise three times per week, maintaining a body mass index (BMI) within normal range, and not currently smoking. Chi-square tests and Poisson regressions were performed to identify factors that were associated with these preventive health activities. Unadjusted rates of preventive health activities were as follows: 78% had a routine physical check up, 66% visited the dentist at least annually, and 54% received an influenza immunization. Across healthy lifestyle practices, 80% did not smoke, 52% engaged in regular exercise, and 37% maintained their BMI within normal range. Only 31% received all three clinical preventive services and only 16.5% engaged in all three healthy lifestyle practices. Across both domains of preventive health activities, age, marital status, and education were positively associated with the number of services. Presence of diabetes and poorer mental health were associated with greater number of clinical preventive services and lower number of healthy lifestyle practices. Cancer survivors with fair/poor perception of their mental health had lower number of clinical preventive services and those with fair/poor perception of physical health engaged in lower number of healthy lifestyle practices. Demographic and health status factors impacted the two domains differentially. The rates and predictors of preventive care varied by type of service/domain suggesting that individualization is needed in creating a comprehensive preventive service and lifestyle activity plan that accounts for the survivor's specific total care needs, including all comorbidities. However, it was also found that cancer survivors are less likely to engage in all types of preventive activities; a one-size-fit-all approach is not recommended for preventive health education and planning for this population. Our study findings suggest the need to address the overall long term healthcare of cancer survivors by prioritizing and developing individualized preventive plans to optimize care that emphasize education, self care perceptions, and incorporate other comorbidities.


Rapid Separation and Quantitation of Cocaine and its Metabolites in Human Serum by Differential Mobility Spectrometry-tandem Mass Spectrometry (DMS-MS-MS).
Cocaine continues to be one of the most widespread abused illicit drugs in the USA. Rapid methods are needed for the identification and quantitation of cocaine and its metabolites, benzoylecgonine (BE), ecgonine methyl ester (EME) and cocaethylene (CE), in biological specimens by clinical and forensic toxicology laboratories. Presented is a differential ion mobility spectrometry-tandem mass spectrometry (DMS-MS-MS) method for the analysis of cocaine and its major metabolites in human serum that requires minimal sample preparation and no column chromatography. A Shimadzu Nexera X2 ultra-high performance liquid chromatography system was used to infuse the samples into the DMS cell at a rate of 30 μL/min. Separation of cocaine and its metabolites were performed in a SelexION DMS component from Sciex coupled to a QTRAP 6500 with an IonDrive Turbo V source for TurbolonSpray® using acetonitrile as a chemical modifier. Analysis consisted of ramping the CoV from -35 V to -6 V while monitoring the multiple reaction monitoring (MRM) transitions of each analyte. The assay was evaluated for linearity, bias, precision, carryover, interferences and stability. Calibration curves ranged from 10 to 1,000 ng/mL with linear regression correlation coefficients (r2) of 0.9912 or greater for each analyte. The limit of quantitation was set at 10 ng/mL. Intra-day precision (%CV) ranged from 0% to 15% for cocaine, 1% to 19% for BE, 1% to 17% for EME and 0% to 18% for CE. Inter-day precision ranged from 9% to 14% for cocaine, 2% to 17% for BE, 5% to 11% for EME and 5% to 15% for CE. No carryover or interferences were detected. Bland-Altman analysis of previously analyzed specimens by UPLC-MS-MS showed variability of 30% or less. The method demonstrates the applicability of DMS-MS-MS for high throughout analysis of drugs and their metabolites in clinical and forensic toxicology laboratories.


Discovery of a spontaneous genetic mouse model of preeclampsia.
Preeclampsia remains a leading cause of maternal and fetal morbidity and mortality but has an unknown etiology. Women with elevated baseline blood pressure have an increased risk of this disorder. We hypothesized that BPH/5 mice, an inbred mouse strain with mildly elevated blood pressure, would develop a pregnancy-induced hypertensive syndrome. Nonpregnant female BPH/5 and C57BL/6 mice underwent thoracic aortic implantation of telemeters. After 7 days of recovery and 5 days of baseline mean arterial blood pressure (MAP) recording, strain-matched timed matings were carried out. MAP was recorded continuously during pregnancy and for 1 week after birth. In separate mice in metabolic cages, urinary protein was tracked, followed by renal histological analysis. Before pregnancy, the BPH/5 strain had elevated baseline MAP compared with the C57BL/6 strain, but both strains had similar total urinary protein levels and renal histology. MAP remained stable in both groups during the first 2 weeks of pregnancy. However, at the start of the last trimester, MAP began to rise further in the BPH/5 mice; it rose to peak levels just before delivery and returned to prepregnancy levels by 2 days after delivery. This was accompanied by late-gestational proteinuria and progressive glomerulosclerosis. No changes were observed in the C57BL/6 group except for a small decrease in MAP at mid gestation. The BPH/5 group delivered significantly smaller litters despite normal numbers of fetuses early in gestation, and longitudinal ultrasound studies documented fetal demise before the onset of hypertension and renal disease. This is the first report of an animal model that spontaneously develops a syndrome that bears close resemblance to preeclampsia, and it should have an impact on our understanding of the pathophysiology of this disorder.


Aloe Vera Extract Gel-Biosynthesized Selenium Nanoparticles Enhance Disease Resistance in Lettuce by Modulating the Metabolite Profile and Bacterial Endophytes Composition.
The use of nanotechnology to suppress crop diseases has attracted significant attention in agriculture. The present study investigated the antifungal mechanism by which aloe vera extract gel-biosynthesized (AVGE) selenium nanoparticles (Se NPs) suppressed Fusarium-induced wilt disease in lettuce (Lactuca sativa). AVGE Se NPs were synthesized by utilizing sodium selenite as a Se source and AVGE as a biocompatible capping and reducing agent. Over 21 d, 2.75% of total AVGE Se NPs was dissolved into Se ions, which was more than 8-fold greater than that of bare Se NPs (0.34%). Upon exposure to soil applied AVGE Se NPs at 50 mg/kg, fresh shoot biomass was significantly increased by 61.6 and 27.8% over the infected control and bare Se NPs, respectively. As compared to the infected control, the shoot levels of citrate, isocitrate, succinate, malate, and 2-oxo-glutarate were significantly upregulated by 0.5-3-fold as affected by both Se NPs. In addition, AVGE Se NPs significantly increased the shoot level of khelmarin D, a type of coumarin, by 4.40- and 0.71-fold over infected controls and bare Se NPs, respectively. Additionally, AVGE Se NPs showed greater upregulation of jasmonic acid and downregulation of abscisic acid content relative to bare Se NPs in diseased shoots. Moreover, the diversity of bacterial endophytes was significantly increased by AVGE Se NPs, with the values of Shannon index 40.2 and 9.16% greater over the infected control and bare Se NPs. Collectively, these findings highlight the significant potential of AVGE Se NPs as an effective and biocompatible strategy for nanoenabled sustainable crop protection.


Exercise and Toll-like receptors.
Toll-like receptors (TLRs) are highly conserved trans-membrane proteins that play an important role in the detection and recognition of microbial pathogens. The key product of TLR signalling in antigen presenting cells is the production of inflammatory cytokines and proteins. The TLR pathway plays an important role in mediating whole body inflammation, which has been implicated in the development of chronic disease. An accumulation of chronic, low-grade inflammation is common in individuals that live a sedentary lifestyle; however, the mechanism underlying this connection is not fully understood. There is evidence to show that TLRs may be involved in the link between a sedentary lifestyle, inflammation, and disease. Recent studies have shown that both acute aerobic and chronic resistance exercise resulted in decreased monocyte cell-surface expression of TLRs. Furthermore, a period of chronic exercise training decreases both inflammatory cytokine production and the cell-surface expression of TLR4 on monocytes. These effects may contribute to post-exercise immunodepression and the reported higher susceptibility to infection in athletes. However over the long-term, a decrease in TLR expression may represent a beneficial effect because it decreases the inflammatory capacity of leukocytes, thus altering whole body chronic inflammation. The precise physiological stimulus mediating an exercise-induced decrease in cell-surface TLR expression is not known; however a number of possible signals have been implicated including anti-inflammatory cytokines, stress hormones and heat shock proteins.


The lived body and the perioperative period in replacement surgery: older people's experiences.
This paper is a report of a study to explore older people's experiences of their lived bodies during the perioperative period for a hip or knee replacement. Replacement surgery of a major joint for older people suffering from osteoarthritis is an established treatment in developed countries. Scientific knowledge is available on replacement surgery from several perspectives, but not about older people's experiences of the entire perioperative period of a replacement procedure. A qualitative longitudinal study was conducted between 2002 and 2004. Audiotaped interviews were carried out with 12 older people, on five different occasions during the perioperative period. The data were analysed using latent qualitative content analysis. The perioperative period of a hip or knee replacement can be regarded as a process of transition which includes six critical phases. The transition was supported with the dream of becoming as able-bodied as previously in life, by having surgery. In addition, our findings revealed that the care recipients lacked knowledge about the surgical intervention as a whole. The meaning of having joint replacement surgery was to overcome the confinement of living with a painful and unreliable body. Furthermore, care recipients struggled to regain a body in charge and control of their lives, yet from a new starting point. The care recipients were not prepared for the transitional changes through the perioperative period. Further research is needed to develop an appropriate programme for patient care during the perioperative period, in order to facilitate the process of transition.


How has psycho-behavioural research advanced our understanding of hypoglycaemia in type 1 diabetes?
Almost 100 years since the discovery of insulin, hypoglycaemia remains a barrier for people with type 1 diabetes to achieve and maintain blood glucose at levels which prevent long-term diabetes-related complications. Although hypoglycaemia is primarily attributable to the limitations of current treatment and defective hormonal counter-regulation in type 1 diabetes, the central role of psycho-behavioural factors in preventing, recognizing and treating hypoglycaemia has been acknowledged since the early 1980s. Over the past 25 years, as documented in the present review, there has been a substantial increase in psycho-behavioural research focused on understanding the experience and impact of hypoglycaemia. The significant contributions have been in understanding the impact of hypoglycaemia on a person's emotional well-being and aspects of life (e.g. sleep, driving, work/social life), identifying modifiable psychological and behavioural risk factors, as well as in developing psycho-behavioural interventions to prevent and better manage (severe) hypoglycaemia. The impact of hypoglycaemia on family members has also been confirmed. Structured diabetes education programmes and psycho-behavioural interventions with a focus on hypoglycaemia have both been shown to be effective in addressing problematic hypoglycaemia. However, the findings have also revealed the complexity of the problem and the need for a personalized approach, taking into account the individual's knowledge of, and emotional/behavioural reactions to hypoglycaemia. Evidence is emerging that people with persistent and recurrent severe hypoglycaemia, characterized by deeply entrenched cognitions and lack of concern around hypoglycaemia, can benefit from tailored cognitive behavioural therapy.


[Early detection of psychosis in children and adolescents - have developmental particularities been sufficiently considered?].
The early detection and treatment of persons at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. The two current favored at-risk approaches, i.e., the «ultra high risk» and the «basic symptom» criteria, were developed mainly using adult samples. Initial evidence suggests, however, that they cannot simply be applied to children and adolescents. For «ultra-high risk» criteria, there is indication of some attenuated psychotic symptoms being potentially nonspecific in adolescents, and of brief limited intermittent symptoms being difficult to clinically classify in children when observable behavioral correlates are missing. For basic symptoms, too, only a preliminary indication of their usefulness in children and adolescents exists. Since developmental peculiarities in the assessment of basic symptoms should be considered, a child and youth version of the Schizophrenia Proneness Instrument (SPI-CY) was developed. In conclusion, research on the clinical-prognostic validity of the at-risk criteria and their potential adaption to the special needs of children and adolescents is needed. If a «Prodromal Risk Syndrome for Psychosis» or «Attenuated Psychotic Symptoms Syndrome» are included in the upcoming DSM-5, it should be highlighted that its suitability for children and adolescents is only insufficiently known.


Animal models in neonatal resuscitation research: What can they teach us?
Animal models have made and continue to make important contributions to neonatal medicine. For example, studies in fetal sheep have taught us much about the physiology of the fetal-to-neonatal transition. However, whereas animal models allow multiple factors to be investigated in a logical and systematic manner, no animal model is perfect for humans and so we need to understand the fundamental differences in physiology between the species in question and humans. Although most physiological systems are well conserved between species, some small differences exist and so wherever possible the knowledge generated from preclinical studies in animals should be tested in clinical trials. However, with the rise of evidence-based medicine the distinction between scientific knowledge generation and evidence gathering has been confused and the two have been lumped together. This misunderstands the contribution that scientific knowledge can provide. Science should be used to guide the gathering of evidence by informing the design of clinical trials, thereby increasing their likelihood of success. While scientific knowledge is not evidence, in the absence of evidence it is likely to be the best option for guiding clinical practice.


Self-Reported Adverse Events of COVID-19 Vaccines in Polish Healthcare Workers and Medical Students. Cross-Sectional Study and Pooled Analysis of CoVaST Project Results in Central Europe.
Optimization of COVID-19 vaccination rate among healthcare personnel is of utmost priority to secure provision of uninterrupted care and to protect the most vulnerable patients. This study, as part of the global CoVaST project, aimed to assess the occurrence of short-term adverse events (SRAEs) of two most administered COVID-19 vaccines, mRNA-based (Pfizer-BioNTech and Moderna) and viral vector-based (AstraZeneca) in healthcare sector workers (HWs). A cross-sectional survey-based study was carried out for the first time among 317 Polish healthcare sector personnel and medical students using a validated and pre-tested questionnaire. The online questionnaire included 25 pre-tested, validated questions concerning demographic data, medical parameters, COVID-19-related anamneses, and local or systemic reactions (reactogenicity) associated with COVID-19 vaccination. Descriptive statistics, inferential tests and binary logistic regression were performed. Out of the 247 participating HWs, 79.8% were females, and 77.5% received mRNA-based vaccines, while 24.5% received a viral vector-based vaccine. Cumulatively, 78.9% and 60.7% of the participants reported at least one local and one systemic SRAE respectively, following their COVID-19 first or second dose of vaccine. A wide array of SRAEs was observed, while pain at injection site (76.9%) was the most common local SRAE, and fatigue (46.2%), headache (37.7%), muscle pain (31.6%) were the most common systemic SRAEs. The vast proportion of local (35.2%) and systemic (44.8%) SRAEs subsided up to 1 day after inoculation with both types of vaccines. The mRNA-based vaccine versions seem to cause higher prevalence of local SRAEs, mainly pain within injection site (81.3% vs. 71.7%; p = 0.435), while the viral vector-based vaccine was linked with increased incidents of mild systemic side effects (76.7% vs. 55.3%; p = 0.004) after both doses. Pooled analysis revealed uniform results while comparing the prevalence of SRAEs in HWs as recipients in four central European countries (OR = 2.38; 95% CI = 2.03-2.79). The study confirmed the safety of commonly administered vaccines against COVID-19, which were associated with mild, self-resolving adverse events. No major vaccine-related incidents were reported which would affect every day functioning, significantly. The younger age group (below 29 y.o.) were associated with an increased risk of adverse events generally. The results enhanced current data regarding COVID-19 vaccination active surveillance in selected occupational groups.


Water fluoridation and ethnic inequities in dental caries profiles of New Zealand children aged 5 and 12-13 years: analysis of national cross-sectional registry databases for the decade 2004-2013.
Gross and important inequities have historically existed in the oral health profiles of New Zealand children. Following the New Zealand Government's strategic oral health vision, launched in 2006, nationally collected information from 2004 to 2013 was used to analyze patterns in the prevalence of no obvious decay experience (caries-free) and mean decayed-missing-filled teeth indices over time and by community water fluoridation (CWF) and ethnic classifications in New Zealand children aged 5 years and in school year 8 (generally aged 12-13 years). National aggregated data collected from children's routine child oral health service dental examinations were retrieved, and combined with demographic information from Statistics New Zealand. Children's CWF status was defined by the public water supply status of their school. Crude and standardized population estimates of caries-free prevalence and mean decayed-missing-filled teeth indices over time were derived. Unweighted linear regression models of main effects and two-factor interactions were investigated by age group. Dental examination data were available from 417,318 children aged 5 years and 471,333 year 8 children; of whom 93,715 (22.5 %) and 94,001 (19.9 %), respectively, were Māori. Dental examination coverage of Māori children was significantly less than their non-Māori counterparts (approximately 11 % and 14 % for aged 5 and year 8 children, respectively). Regression analysis revealed that caries-free prevalence and mean decayed-missing-filled teeth indices significantly improved over the study period for both age groups. Significant and sustained differences were observed between Māori and non-Māori children, and between CWF and non-CWF exposed groups. However, a convergence of dental profiles between non-Māori children in CWF and non-CWF regions was observed. Significant and important gains in New Zealand children's oral health profiles appear to have been made over the last decade. Māori children continued to carry a disproportionate oral health burden, even for those in CWF regions. The apparent profile convergence between non-Māori children in CWF and non-CWF regions is noteworthy; although a likely consequence of demographic shifts and unmeasured confounders. CWF itself did not remove disparities in caries levels between Māori and non-Māori children. Multiple, multi-pronged strategies are needed that overcome the array of factors which disadvantage Māori.


Validating EEG, MEG and Combined MEG and EEG Beamforming for an Estimation of the Epileptogenic Zone in Focal Cortical Dysplasia.
MEG and EEG source analysis is frequently used for the presurgical evaluation of pharmacoresistant epilepsy patients. The source localization of the epileptogenic zone depends, among other aspects, on the selected inverse and forward approaches and their respective parameter choices. In this validation study, we compare the standard dipole scanning method with two beamformer approaches for the inverse problem, and we investigate the influence of the covariance estimation method and the strength of regularization on the localization performance for EEG, MEG, and combined EEG and MEG. For forward modelling, we investigate the difference between calibrated six-compartment and standard three-compartment head modelling. In a retrospective study, two patients with focal epilepsy due to focal cortical dysplasia type IIb and seizure freedom following lesionectomy or radiofrequency-guided thermocoagulation (RFTC) used the distance of the localization of interictal epileptic spikes to the resection cavity resp. RFTC lesion as reference for good localization. We found that beamformer localization can be sensitive to the choice of the regularization parameter, which has to be individually optimized. Estimation of the covariance matrix with averaged spike data yielded more robust results across the modalities. MEG was the dominant modality and provided a good localization in one case, while it was EEG for the other. When combining the modalities, the good results of the dominant modality were mostly not spoiled by the weaker modality. For appropriate regularization parameter choices, the beamformer localized better than the standard dipole scan. Compared to the importance of an appropriate regularization, the sensitivity of the localization to the head modelling was smaller, due to similar skull conductivity modelling and the fixed source space without orientation constraint.


Functional properties of proteins from the coelomic fluid of the wounded sea star Asterias rubens (L).
Impact on viability and adhesion of three protein fractions, separated by size, from the coelomic fluid of wounded Asterias rubens', was tested on autologous coelomocytes. In addition antimicrobial property of the protein fractions was tested on the Gram-negative bacterium Vibrio parahaemolyticus. All fractions promoted viability and the larger proteins facilitated adhesion of the coelomocytes. The strongest antimicrobial effect was caused by the fraction with the smallest proteins.


Impact of Truncated Oxidized Phosphatidylcholines on Phospholipase A2 Activity in Mono- and Polyunsaturated Biomimetic Vesicles.
The interplay between inflammatory and redox processes is a ubiquitous and critical phenomenon in cell biology that involves numerous biological factors. Among them, secretory phospholipases A2 (sPLA2) that catalyze the hydrolysis of the sn-2 ester bond of phospholipids are key players. They can interact or be modulated by the presence of truncated oxidized phosphatidylcholines (OxPCs) produced under oxidative stress from phosphatidylcholine (PC) species. The present study examined this important, but rarely considered, sPLA2 modulation induced by the changes in biophysical properties of PC vesicles comprising various OxPC ratios in mono- or poly-unsaturated PCs. Being the most physiologically active OxPCs, 1-palmitoyl-2-(5'-oxo-valeroyl)-sn-glycero-3-phosphocholine (POVPC) and 1-palmitoyl-2-glutaryl-sn-glycero-3-phosphocholine (PGPC) have been selected for our study. Using fluorescence spectroscopy methods, we compared the effect of OxPCs on the lipid order as well as sPLA2 activity in large unilamellar vesicles (LUVs) made of the heteroacid PC, either monounsaturated [1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC)], or polyunsaturated [1-palmitoyl-2-docosahexaenoyl-sn-glycero-3-phosphocholine (PDPC)] at a physiological temperature. The effect of OxPCs on vesicle size was also assessed in both the mono- and polyunsaturated PC matrices. Results: OxPCs decrease the membrane lipid order of POPC and PDPC mixtures with PGPC inducing a much larger decrease in comparison with POVPC, indicative that the difference takes place at the glycerol level. Compared with POPC, PDPC was able to inhibit sPLA2 activity showing a protective effect of PDPC against enzyme hydrolysis. Furthermore, sPLA2 activity on its PC substrates was modulated by the OxPC membrane content. POVPC down-regulated sPLA2 activity, suggesting anti-inflammatory properties of this truncated oxidized lipid. Interestingly, PGPC had a dual and opposite effect, either inhibitory or enhancing on sPLA2 activity, depending on the protocol of lipid mixing. This difference may result from the chemical properties of the shortened sn-2-acyl chain residues (aldehyde group for POVPC, and carboxyl for PGPC), being, respectively, zwitterionic or anionic under hydration at physiological conditions.


A comparison of the sports safety policies and practices of community sports clubs during training and competition in northern Sydney, Australia.
To compare the safety policies and practices reported to be adopted during training and competition by community sports clubs in northern Sydney, Australia. This cross sectional study involved face to face interviews, using an 81 item extensively validated questionnaire, with representatives of 163 community netball, rugby league, rugby union, and soccer clubs (response rate 85%). The study was undertaken during the winter sports season of 2000. Two separate 14 item scales were developed to analyse the level of safety policy adoption and safety practice implementation during training and competition. The statistical analysis comprised descriptive and inferential analysis stratified by sport. The reliability of the scales was good: Cronbach's alpha = 0.70 (competition scale) to 0.81 (training scale). Significant differences were found between the safety scores for training and competition for all clubs (mean difference 11.2; 95% confidence interval (CI) 10.0 to 12.5) and for each of the four sports: netball (mean difference 14.9; 95% CI 12.6 to 17.2); rugby league (mean difference 10.3; 95% CI 7.1 to 13.6); rugby union (mean difference 9.4; 95% CI 7.1 to 11.7); and soccer (mean difference 8.4; 95% CI 6.5 to 10.3). The differences in the mean competition and training safety scores were significant for all sports. This indicates that safety policies were less often adopted and practices less often implemented during training than during competition. As injuries do occur at training, and sports participants often spend considerably more time training than competing, sporting bodies should consider whether the safety policies and practices adopted and implemented at training are adequate.


ACR appropriateness criteria on metastatic bone disease.
Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include (99m)Tc bone scanning, MRI, CT, radiography, and 2-[(18)F]fluoro-2-deoxyglucose-PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations. In some cases, no imaging is indicated. The recommendations contained herein are the result of evidence-based consensus by the ACR Appropriateness Criteria((R)) Expert Panel on Musculoskeletal Radiology.


Hexavalent chromium reduction in a sulfur reducing packed-bed bioreactor.
The most commonly used approach for the detoxification of hazardous industrial effluents and wastewaters containing Cr(VI) is its reduction to the much less toxic and immobile form of Cr(III). This study investigates the cleanup of Cr(VI) containing wastewaters using elemental sulfur as electron acceptor, for the production of hydrogen sulfide that induces Cr(VI) reduction. An elemental sulfur reducing packed-bed bioreactor was operated at 28-30°C for more than 250 days under varying influent Cr(VI) concentrations (5.0-50.0 mg/L) and hydraulic retention times (HRTs, 0.36-1.0 day). Ethanol or acetate (1000 mg/L COD) was used as carbon source and electron donor. The degree of COD oxidation varied between 30% and 85%, depending on the operating conditions and the type of organic carbon source. The oxidation of organic matter was coupled with the production of hydrogen sulfide, which reached a maximum concentration of 750 mg/L. The biologically produced hydrogen sulfide reduced Cr(VI) chemically to Cr(III) that precipitated in the reactor. Reduction of Cr(VI) and removal efficiency of total chromium always exceeded 97% and 85%, respectively, implying that the reduced chromium was retained in the bioreactor. This study showed that sulfur can be used as an electron acceptor to produce hydrogen sulfide that induces efficient reduction and immobilization of Cr(VI), thus enabling decontamination of Cr(VI) polluted wastewaters.


Diagnostic value of serum hCG on the outcome of pregnancy of unknown location: a systematic review and meta-analysis.
BACKGROUND The term 'pregnancy of unknown location' (PUL) refers to cases where a pregnancy test is positive but the pregnancy cannot be visualized by transvaginal sonography (TVS). Various strategies integrating TVS and serum hCG measures are used to follow-up until the location and/or viability of the pregnancy becomes clear; however, the optimal strategy to predict the outcome of pregnancy in women with PUL is unknown. Therefore, we performed a systematic review and meta-analysis to determine the diagnostic accuracy of the various serum hCG strategies in women with PUL. METHODS We searched Medline and EMBASE for articles which were published (in any language) from 1980 to January 2012 on strategies using serum hCG in women with PUL and reporting on the final outcome of pregnancy. RESULTS From 980 selected titles, 23 articles, all cohort studies, were included. There were 10 studies on a single serum hCG cut-off level, 4 on serum hCG ratio (hCG 48 h/hCG 0 h) and 6 on logistic regression modelling. Three other strategies were reported using serum hCG, serum progesterone and/or uterine curettage findings; each of these strategies comprised a single study. Comparative diagnostic studies have not been performed on the diagnostic value of serum hCG in women with PUL. Included studies showed substantial clinical heterogeneity in the definition of the outcome, and only data for the pregnancy outcome ectopic pregnancy (EP) were suitable for meta-analysis. The receiver operating characteristic curves showed that the serum hCG ratios and logistic regression models had a better performance as compared with an absolute single serum hCG level (as the curve was considerably closer to the diagonal, indicating no diagnostic value). CONCLUSIONS Overall the study was limited by the high clinical heterogeneity of the data but in women with PUL diagnostic strategies using serum hCG ratios, either alone or in logistic regression models, have the best diagnostic performance in the case of EP. Well defined prospective comparative studies using standardized diagnostics and clinical application plus agreed definitions of outcome are required to identify the best strategy to diagnose pregnancy outcome in women with PUL.


Does progesterone show neuroprotective effects on traumatic brain injury through increasing phosphorylation of Akt in the hippocampus?
There are currently no federally approved neuroprotective agents to treat traumatic brain injury. Progesterone, a hydrophobic steroid hormone, has been shown in recent studies to exhibit neuroprotective effects in controlled cortical impact rat models. Akt is a protein kinase known to play a role in cell signaling pathways that reduce edema, inflammation, apoptosis, and promote cell growth in the brain. This study aims to determine if progesterone modulates the phosphorylation of Akt via its threonine 308 phosphorylation site. Phosphorylation at the threonine 308 site is one of several sites responsible for activating Akt and enabling the protein kinase to carry out its neuroprotective effects. To assess the effects of progesterone on Akt phosphorylation, C57BL/6 mice were treated with progesterone (8 mg/kg) at 1 (intraperitonally), 6, 24, and 48 hours (subcutaneously) post closed-skull traumatic brain injury. The hippocampus was harvested at 72 hours post injury and prepared for western blot analysis. Traumatic brain injury caused a significant decrease in Akt phosphorylation compared to sham operation. However, mice treated with progesterone following traumatic brain injury had an increase in phosphorylation of Akt compared to traumatic brain injury vehicle. Our findings suggest that progesterone is a viable treatment option for activating neuroprotective pathways after traumatic brain injury.


A novel method to follow meiotic progression in Arabidopsis using confocal microscopy and 5-ethynyl-2'-deoxyuridine labeling.
Meiosis progression in the more recent past has been investigated using 5-bromo-2'-deoxyuridine (BrdU) uptake by S-phase meiocytes undergoing DNA replication. BrdU uptake is detected by reaction with BrdU antibody followed by epifluorescent microscopy examination of chromosome spreads and/or squashes. We here report using confocal microscopic examination of intact meiocytes in conjunction with the new thymidine analog 5-ethynyl-2'-deoxyuridine (EdU). The simplicity of the EdU detection coupled with confocal examination of anthers provides a more exact temporal description of meiotic prophase I progression in Arabidopsis and opens up the possibility of examining the coordination of microsporocyte development with the other tissues of the anther. Using our time course protocol, we have determined the duration of wild type Arabidopsis leptotene to be 5 h, zygotene -6 h, pachytene -10 h and a diplotene duration of approximately 1 h. We estimate G2 duration to be approximately 7 h based on the timing of the initial appearance of EdU signal in early leptotene meiocytes. In addition we have found that DNA replication in meiocytes is not done synchronously with the associated tapetal layer of cells. The EdU labeling suggests that S-phase replication of meiocyte DNA precedes the duplication of tapetal cell DNA. The increased number of meiotic staging criteria that can be assessed in our confocal analysis, as compared to chromosome spreading or squashing, makes the identification of even the early and late portions of the prophase I substages attainable. This enhanced staging coupled with the ability to easily generate large data sets at hourly time points makes it possible to more exactly determine substage duration and to detect modest temporal abnormalities involving meiocyte entrance into and/or exit from leptotene, zygotene and pachytene. Confocal analysis also makes it possible to study the relationships between different cell types within the flower bud as meiosis proceeds.


Immunophenotypic diagnosis of clinical and preclinical chronic lymphatic leukemia by using monoclonal antibodies against the cCLLa, a CLL-associated antigen.
The clinical usefulness of monoclonal antibodies (MoAbs) against the cCLLa, an antigen restricted to B-chronic lymphatic leukemia (CLL) and its variants, was ascertained in 65 patients with overt CLL and 25 individuals with unexplained mild lymphocytosis. Healthy volunteers (n = 25) and patients with malignant and nonmalignant disorders (n = 58) served as controls. The following observations were made in CLL. (a) Anti-cCLLa MoAbs identified neoplastic CLL cells as judged by the high correlation (r = .985) between monoclonal surface immunoglobulins (Slgs) and cCLLa expression in all patients, and dual-label flow cytometry studies showing cCLLa expression by monoclonal Slg-bearing B-CLL cells but not by normal B lymphocytes. (b) The size of the circulating cCLLa-positive clone paralleled the degree of lymphocytosis (r = .987) and was associated with reciprocal (r = .893) relative T lymphopenia. Ten patients with borderline lymphocytosis exhibited a subset of monoclonal Slg/cCLLa-positive cells ranging from 16% to 45% of the total. These patients were indistinguishable from those with CLL in terms of age, clone lineage, and reciprocal relative T lymphopenia. Two patients have progressed to overt CLL within 19 months, but eight have not (observation time, 18 to 82 months). These data suggest that anti-cCLLa MoAbs are sensitive probes useful to identify and monitor cCLLa clones during their clinical and preclinical phases.


Keratocystic odontogenic tumor: treatment modalities: study of 3 cases.
Management of the keratocystic odontogenic tumor has been one of the most controversial entities of the maxillofacial surgery. It can become quite large because of its ability for significant expansion, extension into adjacent tissues and rapid growth and also has high reccurence rate as it shows a thin, friable wall, which is often difficult to enucleate from the bone in toto, and have small satellite cysts within the fibrous wall. There are various treatment modalities suggested from conservative to radical approach, but studies have shown even with conservative approach good results are achieved. In this paper we are presenting various treatment modalities and 3 cases have been discussed.


Education and smoking: confounding or effect modification by phenotypic personality traits?
Little is known about whether educational gradients in smoking patterns can be explained by financial measures of socioeconomic status (SES) and/or personality traits. To assess whether the relationship of education to (1) never smoking and (2) having quit smoking would be confounded by financial measures of SES or by personality; whether lower Neuroticism and higher Conscientiousness would be associated with having abstained from or quit smoking; and whether education effects were modified by personality. Using data from the Midlife Development in the US National Survey, 2,429 individuals were classified as current (n = 695), former (n = 999), or never (n = 735) smokers. Multinomial logistic regressions examined study questions. Greater education was strongly associated with both never and former smoking, with no confounding by financial status and personality. Never smoking was associated with lower Openness and higher Conscientiousness, while have quit was associated with higher Neuroticism. Education interacted additively with Conscientiousness to increase and with Openness to decrease the probability of never smoking. Education and personality should be considered unconfounded smoking risks in epidemiologic and clinical studies. Educational associations with smoking may vary by personality dispositions, and prevention and intervention programs should consider both sets of factors.


Hypocholesterolemic effect of an enteric-coated garlic supplement.
To evaluate the hypocholesterolemic effect of an enteric-coated garlic supplement standardized for allicin-releasing potential in mild to moderate hypercholesterolemic patients. A double-blind randomized, placebo-controlled intervention study was conducted in 46 hypercholesterolemic subjects who had failed or were not compliant with drug therapy. Each subject was given dietary counseling to lower fat intake and enteric-coated Australian garlic powder tablets with 9.6 mg allicin-releasing potential or matching placebo tablets. After 12 weeks, the garlic supplement group (n=22) had a significant reduction in total cholesterol (TC, -0.36 mmol/L. -4.2%) and LDL-cholesterol (LDL-C, -0.44 mmol/L, -6.6%) while the placebo group (n=24) had a non-significant increase in TC (0.13 mmol/L, 2.0%) and LDL-C (0.18 mmol/L, 3.7%). HDL-cholesterol was significantly increased in the placebo group (0.09 mmol/L, 9.1%), compared to the garlic group (-0.02 mmol/L, -0.9%). and no significant difference in triglycerides or in LDL/HDL ratio was observed between groups. The study demonstrates that enteric-coated garlic powder supplements with 9.6 mg allicin-releasing potential may have value in mild to moderate hypercholesterolemic patients when combined with a low fat diet. Taken with other evidence, the efficacy of garlic for lipoprotein metabolism might require allicin bioavailability to be enhanced through the use of, for example, an enteric-coated dose form. If this is the case, the possibility remains that greater hypocholesterolemic efficacy may be evident at a higher allicin dose. Also noteworthy in this study was a small reduction in energy intake with garlic compared with placebo, attributable to reduction in fat, carbohydrate and alcohol intakes. This may also have contributed to the effects on blood lipids. This study suggests that garlic supplementation has a cholesterol-lowering effect, which may be mediated by direct action of a biologically active compound or compounds and in part through the effect on food and nutrient intake.


Laparoscopic cytoreductive nephrectomy is associated with significantly improved survival compared with open cytoreductive nephrectomy or targeted therapy alone.
The aim of the present study was to compare the survival outcomes for patients with metastatic renal cell carcinoma (mRCC) who underwent laparoscopic cytoreductive nephrectomy (CN) vs. open CN vs. targeted therapy (TT) alone at our institution. A retrospective chart review was performed at our institution for patients who underwent CN prior to TT (laparoscopic, n=48; open, n=48) or who were deemed unfit for surgery and received TT alone (n=36), between January 2007 and December 2012. Kaplan-Meier estimated survival and Cox proportional hazards analyses were performed. Laparoscopic CN was associated with significantly longer survival compared with open CN or TT alone (median survival 24 vs. <12 months, respectively; P<0.01). On multivariate analysis, laparoscopic CN was an independent predictor of survival [hazard ratio (HR)=0.48, P<0.01), controlling for preoperative risk factors, while survival was similar between open CN and TT alone (HR=0.85, P=0.54). In our experience, laparoscopic CN appears to be a significant predictor of survival in mRCC. Selection bias of the surgeon for patients with improved survival may account for clinical variables that were otherwise difficult to quantify. For patients who were not candidates for laparoscopic CN, open CN did not confer a survival benefit over TT alone, while it was associated with increased morbidity.


'Candidatus Magnetoglobus multicellularis', a multicellular, magnetotactic prokaryote from a hypersaline environment.
Phylogenetic analysis and phenotypic characterization were used to assign a multicellular magnetotactic prokaryote the name 'Candidatus Magnetoglobus multicellularis'. 'Candidatus Magnetoglobus multicellularis' lives in a large hypersaline coastal lagoon from Brazil and has properties that are unique among prokaryotes. It consists of a compact assembly or aggregate of flagellated bacterial cells, highly organized in a sphere, that swim in either helical or straight trajectories. The life cycle of 'Candidatus Magnetoglobus multicellularis' is completely multicellular, in which one aggregate grows by enlarging the size of its cells and approximately doubling the volume of the whole organism. Cells then divide synchronously, maintaining the spherical arrangement; finally the cells separate into two identical aggregates. Phylogenetic 16S rRNA gene sequence analysis showed that 'Candidatus Magnetoglobus multicellularis' is related to the dissimilatory sulfate-reducing bacteria within the Deltaproteobacteria and to other previously described, but not yet well characterized, multicellular magnetotactic prokaryotes.


Computational design of DNA binding domain-retained fusion proteins and virtual screening against FDA-approved drugs.
Even though the transcription factors (TFs) are not regarded as good drug targets, mutated or dysregulated TFs can be a unique class of drug targets. Specifically, the TF fusion protein, which is the translated structural variants including TFs may affect downstream to promote tumorigenesis. To date, we lack the fusion protein sequence information and 3D structure information in identifying the potential drugs of fusion proteins. In this study, we predicted the 3D structures of 732 transcription factor fusion proteins (TFFPs). For the top five most frequent TFFPs, we performed the virtual screening across the FDA-approved drugs. Our study will provide an initial platform to develop novel therapeutic targets in the transcription factor fusion proteins.


Statin Treatment by Low-Density Lipoprotein Cholesterol Levels in Patients With Non-ST-Segment Elevation Myocardial Infarction/Unstable Angina Pectoris (from the CRUSADE Registry).
Elevated low-density lipoprotein cholesterol (LDL-C) is associated with increased risk of myocardial infarction and is a target for disease prevention. The association between initial LDL-C and statin treatment in patients with non-ST-segment elevation myocardial infarction (NSTEMI)/unstable angina pectoris (UAP) has not been well characterized. We explored detailed LDL-C levels and statin treatment in 22,938 patients with NSTEMI/UAP enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines Registry (2003 to 2006). Patients reporting home statin use or previous cardiovascular disease were excluded. We examined statin receipt at discharge across 4 categories of baseline LDL-C: very low (<70 mg/dl), low (70 to 99 mg/dl), high (100 to 129 mg/dl), and very high (≥130 mg/dl). The largest proportion of patients had LDL-C ≥130 mg/dl (32.6%), followed by LDL-C 100 to 129 mg/dl (32.1%), LDL-C 70 to 99 mg/dl (24.9%), and LDL-C <70 mg/dl (10.4%). Compared with high LDL-C categories, patients in the lowest LDL-C category had their first NSTEMI/UAP event at a significantly older age and had higher rates of other cardiovascular risk factors (including hypertension and diabetes) but were less likely to have a family history of coronary artery disease. Overall, 80.3% of eligible patients with NSTEMI/UAP received statins at discharge, ranging from 63.8% in those with very low LDL-C (<70 mg/dl) to 88.1% in those with very high LDL-C (>130 mg/dl). In conclusion, >1/3 of patients with NSTEMI/UAP had an LDL-C level <100. Those with low LDL-C were older, had more co-morbidities, and were less likely to be prescribed a statin at discharge than those with higher LDL-C.


Fungal biofilm resistance.
Fungal biofilm infections have become increasingly recognised as a significant clinical problem. One of the major reasons behind this is the impact that these have upon treatment, as antifungal therapy often fails and surgical intervention is required. This places a large financial burden on health care providers. This paper aims to illustrate the importance of fungal biofilms, particularly Candida albicans, and discusses some of the key fungal biofilm resistance mechanisms that include, extracellular matrix (ECM), efflux pump activity, persisters, cell density, overexpression of drug targets, stress responses, and the general physiology of the cell. The paper demonstrates the multifaceted nature of fungal biofilm resistance, which encompasses some of the newest data and ideas in the field.


Efficacy of omeprazole and amoxicillin with either clarithromycin or metronidazole on eradication of Helicobacter pylori in Chinese peptic ulcer patients.
One-week triple therapy with proton pump inhibitors, clarithromycin and amoxicillin has recently been proposed as the first-line treatment for Helicobacter pylori (H. pylori) infection; however, data regarding the effects of this regimen in China are scarce. The aim of this prospective and randomized study was to compare the efficacy of clarithromycin and metronidazole when they were combined with omeprazole and amoxicillin on eradication of H. pylori and ulcer healing in Chinese peptic ulcer patients. A total of 103 subjects with H. pylori-positive peptic ulcer were randomly divided into two groups, and accepted triple therapy with omeprazole 20 mg, amoxicillin 1000 mg and either clarithromycin 500 mg (OAC group, n = 58) or metronidazole 400 mg (OAM group, n = 45). All drugs were given twice daily for 7 d. Patients with active peptic ulcer were treated with omeprazole 20 mg daily for 2-4 wk after anti-H. pylori therapy. Six to eight weeks after omeprazole therapy, all patients underwent endoscopies and four biopsies (two from the antrum and two others from the corpus of stomach) were taken for rapid urease test and histological analysis (with modified Giemsa staining) to examine H. pylori. Successful eradication was defined as negative results from both examination methods. One hundred patients completed the entire course of therapy and returned for follow-up. The eradication rate of H. pylori for the per-protocol analysis was 89.3% (50/56) in OAC group and 84.1% (37/44) in OAM group. Based on the intention-to-treat analysis, the eradication rate of H. pylori was 86.2% (50/58) in OAC group and 82.2% (37/45) in OAM group. There were no significant differences in eradication rates between the two groups on either analysis. The active ulcer-healing rate was 96.7% (29/30) in OAC group and 100% (21/21) in OAM group (per-protocol analysis, P>0.05). Six patients in OAC group (10.3%) and five in OAM group (11.1%) reported adverse events (P>0.05). One-week triple therapy with omeprazole and amoxicillin in combination with either clarithromycin or metronidazole is effective for the eradication of H. pylori. The therapeutic regimen comprising metronidazole with low cost, good compliance and mild adverse events may offer a good choice for the treatment of peptic ulcers associated with H. pylori infection in China.


Olive oil biophenols and women's health.
Olea europea, the olive tree, is an ancient tree that originates from the Mediterranean environment of Asia Minor. The edible olive fruit is also used for its oil, gained by the process of pressing, a nutrient with proven beneficial effects. Virgin olive oil is the natural juice of the olive fruit, which plays a major role in the healthy Mediterranean diet. The source of its health effects are the biophenols and squalenes (oleocanthal, tyrosol, hydroxytyrosol, oleuropein) it contains. They provide an exceptional antioxidative activity, removing harmful compounds from the body. Oxidants are essential in the genesis of many diseases and conditions, such as cardiovascular disorders, cancer, osteoporosis, Alzheimer disease, and premenstrual syndrome. Oleic acid, an unsaturated fatty acid, has demonstrated a significant effect in the prevention of malignant diseases such as colon cancer and breast cancer. Biophenols from olive oil successfully suppress the synthesis of LDL, a protein that is crucial in the development of cardiovascular disease, by reducing blood pressure and the development of atherosclerotic plaques. In addition, there is strong evidence of the antimicrobic effect of the biphenols from olive oil that successfully destroy colonies of microorganisms which may cause respiratory tract, intestinal, and genital tract infections.


Therapy insight: management of Graves' disease during pregnancy.
The diagnosis of Graves' disease in pregnancy can be complex because of normal gravid physiologic changes in thyroid hormone metabolism. Mothers with active Graves' disease should be treated with antithyroid drugs, which impact both maternal and fetal thyroid function. Optimally, the lowest possible dose should be used to maintain maternal free thyroxine levels at or just above the upper limit of the normal nonpregnant reference range. Fetal thyroid function depends on the balance between the transplacental passage of thyroid-stimulating maternal antibodies and thyroid-inhibiting antithyroid drugs. Elevated levels of serum maternal anti-TSH-receptor antibodies early in the third trimester are a risk factor for fetal hyperthyroidism and should prompt evaluation of the fetal thyroid by ultrasound, even in women with previously ablated Graves' disease. Maternal antithyroid medication can be modulated to treat fetal hyperthyroidism. Serum TSH and either total or free thyroxine levels should be measured in fetal cord blood at delivery in women with active Graves' disease, and those with a history of (131)I-mediated thyroid ablation or thyroidectomy who have anti-TSH-receptor antibodies. Neonatal thyrotoxicosis can occur in the first few days of life after clearance of maternal antithyroid drug, and can last for several months, until maternal antibodies are also cleared.


[Current treatment of bladder exstrophy].
The treatment of vesical exstrophy has greatly improved over the last twenty years. The most important progresses are: closing the bladder before the 72nd hour of life; iliac osteotomy allowing fusion of the pubis when closing the bladder; lengthening of the penis by liberation of the corpora cavernosa; entero-cystoplasty when the reconstructed bladder is too small. Most surgeons practice the same timing for the different operations. Urinary and genital anomalies can be cured at the same time. In relation to urinary problems, about 80% of cases achieve good continence. An urinary diversion, using "Coffey's" technique, must be performed in the presence of incontinence. Concerning genital problems in boys and girls, reconstructive surgery allows restoration of almost normal genital organs. Intercourse seems to be satisfactory in most cases. There is a high sterility rate in men.


Histopathologic findings of keratoconus corneas underwent penetrating keratoplasty according to topographic measurements and keratoconus severity.
To investigate the histopathologic and morphological changes of the corneas with keratoconus (KC) undergoing penetrating keratoplasty (PKP) according to topographic findings and severity of KC. The corneal tissue of 35 samples with KC was retrospectively evaluated with conventional light microscopy. Topographic and pachymetric parameters of keratoconus corneas by means of Pentacam such as mean keratometry (K) and central corneal thickness (CCT) were recorded. Severity of KC was graded according to Amsler-Krumeich classification. Epithelial thinning and breaks in Bowman's layer are the most common findings in keratoconus corneas (94.3% and 82.9% corneas, respectively). The results revealed statistically significant higher mean K value and lower CCT in the keratoconus corneas that were affected by epithelial thinning, breaks in the Bowman's layer, folds in the Descemet's membrane, epithelial scars, breaks in Descemet's membrane, and stromal scars than those corneas without these findings (P<0.05). Moreover, those corneas with epithelial thinning, breaks in the Bowman's layer, folds in Descemet's membrane, epithelial scars, and stromal scars had significantly more severe disease than those corneas without these findings (P<0.05). The presence of the stromal and epithelial scars were associated with the higher KC severity, in which, respectively, 87.5% and 80.0% of the corneas with stromal and epithelial scars had stage 4 of the KC severity. It seems that there are some specific patterns in histologic changes of the keratoconus corneas. The presence of pathologic findings was correlated with thinner and steeper corneas. Epithelial or stromal scars were associated with the highest disease severity. The description of histopathologic findings of KC may help in elucidating the pathogenesis of the disease and help pathologist in differentiating KC from other corneal diseases.


[Endocarditis caused by Streptococcus pneumoniae in children: case report and review].
Endocarditis caused by Streptococcus pneumoniae in children is an infrequent disease, corresponding to 3-7% of all cases of endocarditis. However, it is highly relevant because of its severity with the possibility of producing valvular ring abscesses and destruction, and high mortality that reaches up to 61% if medical and surgical treatment are not started early in the course of the illness. Over 50% of cases are associated to other sites of infection such as meningitis, pneumonia, sinusitis or mastoiditis. We report a 10-months-old infant who was admitted with meningitis and endocarditis due to S. pneumoniae, who presented with severe heart failure and required aortic valve replacement. A review of the literature of endocarditis caused by S. pneumoniae in pediatrics is presented.


The importance of eggs in an environmentally sustainable diet.
Food and diet globally have a significant environmental impact. Whilst there is broad agreement on the principles underpinning a healthy, sustainable diet, the interpretation of what it might mean in practice is widely debated. Misconceptions are common, including around the environmental impact of eggs and their place in a healthy, sustainable diet. Eggs are often categorised with other animal proteins such as beef, lamb, poultry, meat and dairy when reporting on the potential environmental impact of food and diets. However, the shift towards more planet-friendly diets demands a clear understanding of the evidence base on which such a diet should be based. This review evaluates scientific reports and peer-reviewed articles that have evaluated the environmental impact of hens' eggs in terms of greenhouse gas emissions (GHGEs), and land and water use and compared the impacts of eggs with those of other animal and plant proteins. This overview shows that eggs are responsible for less carbon, land and water use than other animal proteins, particularly beef and only slightly more than most plant proteins. Eggs are a nutritious, convenient and relatively inexpensive food, which traditionally has had an important place in the diet both in the United Kingdom and globally. It is therefore important to understand where they fit in terms of environmental impact and into advice on healthier, more sustainable dietary patterns.


[Study of clinical efficiency of essential phospholipids and silymarin combination in nonalcoholic and alcoholic steatohepatitis].
The issues of steatohepatitis treatment in the pathogenesis of which a major role plays lipid accumulation in hepatocyte and increased processes of free radical oxidation of lipids. Developed a method of treatment of patients with alcoholic and nonalcoholic steatohepatitis with the inclusion of a combination of essential phospholipids (EPL) and silymarin (SM). A comparative assessment of results of treatment with the inclusion of a combination of EPL and SM, Essentiale and Carsil in 60 patients with alcoholic and nonalcoholic steatohepatitis. Revealed the preferential efficiency of combination EPL and SM in these patients in regard of shortening the time clinical manifestations of disease, reducing transaminase activity, normalization of the cholestasis and cholesterol. Given practical recommendations of treatment patients with alcoholic and nonalcoholic steatohepatitis with the inclusion of a combination of EPL and CM.


Electrophilic fluorination of pyroglutamic acid derivatives: application of substrate-dependent reactivity and diastereoselectivity to the synthesis of optically active 4-fluoroglutamic acids.
Electrophilic fluorination of enantiomerically pure 2-pyrrolidinones (4) derived from (L)-glutamic acid has been investigated as a method for the synthesis of single stereoisomers of 4-fluorinated glutamic acids. Reaction of the lactam enolate derived from 9 with NFSi results in a completely diastereoselective monofluorination reaction to yield the monocyclic trans-substituted alpha-fluoro lactam product 21. Unfortunately, a decreased kinetic acidity in 21 and other structurally related monofluorinated products renders them resistant to a second fluorination. In contrast, the bicyclic lactam 12 is readily difluorinated under the standard conditions described to yield the alpha,alpha-difluoro lactam 24. The difference in reactivity between the two types of related lactams is attributed mainly to the presence or lack of a steric interaction between the base used for deprotonation and the protecting group present in the pyrrolidinone substrates. This conclusion was reached based on analysis of the X-ray crystal structure of 21, molecular modeling, and experimental evidence. The key intermediates 21 and 24 are converted to (2S,4R)-4-fluoroglutamic acid and (2S)-4,4-difluoroglutamic acid, respectively.


SREBP-1c and Sp1 interact to regulate transcription of the gene for phosphoenolpyruvate carboxykinase (GTP) in the liver.
The sterol regulatory element-binding protein-1c (SREBP-1c), as well as SREBP-1a and SREBP-2, inhibit transcription of the gene encoding the cytosolic form of phosphoenolpyruvate carboxykinase (GTP) (PEPCK-C). There are two SREBP regulatory elements (SREs) in the PEPCK-C gene promoter (-322 to -313 and -590 to -581). The SRE at -590 overlaps an Sp1 site on the opposite strand of the DNA. These SREs bound SREBP-1a and SREBP-1c with low affinity but the addition of purified upstream stimulatory activity enhanced the binding of SREBP-1 to both of these sites. Mutating these SREs increased both unstimulated (5-fold) and protein kinase A-stimulated transcription (8-27-fold) from the PEPCK-C gene promoter; this was lost when both SREs were mutated. The SRE at -590 differs by a single base pair from the SRE in the low density lipoprotein (LDL) receptor gene (T in the PEPCK-C gene promoter at -582, compared with an A in the SRE of the gene for the LDL receptor promoter). Introduction of the LDL receptor SRE into the PEPCK-C gene promoter increased SREBP-1c binding and caused a 10-fold enhancement of basal transcription from the promoter, rather than an inhibition as observed with the SRE in the PEPCK-C gene promoter. The T/A change does not alter the binding of Sp1 to its site on the opposite strand of the DNA. Sp1 bound to the promoter independently of SREBP-1c but competed with SREBP-1c for binding. Sp1 does not bind to the SRE at -322. Chromatin immunoprecipitation analysis, using rat hepatocytes, demonstrated that SREBP-1 and Sp1 were associated in vivo with putative regulatory regions corresponding to the SREs in the PEPCK-C gene promoter. We propose that insulin represses transcription of the gene for PEPCK-C by inducing SREBP-1c production in the liver, which interferes with the stimulatory effect of Sp1 at -590 of the PEPCK-C gene promoter.


Nocturnal oxygen desaturation and disordered sleep as a potential factor in executive dysfunction in sickle cell anemia.
Previous research has identified cognitive impairment in children with sickle cell anemia (SCA, Hemoglobin SS) compared with controls, partly accounted for by overt neuropathology after clinical stroke, "covert" ("silent") infarction, and severity of anemia. However, cognitive deficits have also been identified in children with SCA with no history of stroke and a normal T2-weighted magnetic resonance imaging (MRI) scan. Our aim was to investigate whether nocturnal hemoglobin oxygen desaturation and sleep fragmentation could be associated with cognitive impairment in children with SCA. We assessed 10 children with SCA (9 with normal MRI) using neuropsychological measures of executive function. Cognitive assessment was immediately followed by overnight polysomnography to record nocturnal hemoglobin oxygen saturation and sleep arousals. Decreases in hemoglobin oxygen saturation and/or increased sleep arousals were associated with reduced performance on cognitive assessment. Nocturnal hemoglobin oxygen desaturation and sleep fragmentation may be a contributing factor to executive dysfunction in SCA.


Cyclooxygenase-2 and caspase 3 expression in trimethyltin-induced apoptosis in the mouse hippocampus.
The neurotoxicant trimethyltin (TMT) induces massive neuronal loss in vivo in the hippocampus of rodents, accompanied by behavioral alterations. The present study investigates the pattern of cell death after in vivo administration of TMT to adult mice. In the granular cell layer of the Dentate Gyrus, TUNEL staining detected DNA fragmentation, and apoptotic bodies were also evident. In addition, a ladder pattern of internucleosomal DNA fragmentation was shown in agarose gel electrophoresis. We show that activated caspase-3, which is known to play a pivotal role in apoptotic processes, is clearly expressed by degenerating neurons. Inducible cyclooxygenase is also expressed at cytoplasmic level by degenerating granular neurons, suggesting that this enzyme may participate in TMT-induced neurodegeneration.


The relationship between history of falling and physical function in subjects with peripheral arterial disease.
The purpose of this study was to determine whether peripheral arterial disease (PAD) subjects with a history of falling had more impaired physical function than their non-falling counterparts. A total of 120 PAD subjects (26%) who had fallen over the past year and 346 PAD subjects (74%) who had not fallen were evaluated. Additionally, subjects were characterized on physical function, consisting of balance, strength, ambulatory function, and monitored physical activity, as well as PAD-specific measures of ankle/brachial pressure index (ABPI) and treadmill claudication distances. Full-tandem stance time was 19% shorter (p < 0.001) in the fallers than in the non-fallers (7.2 +/- 0.3 vs 8.9 +/- 0.1 s; mean +/- SEM), and the self-reported ability to climb stairs was 36% lower (27 +/- 4 vs 42 +/- 2%). Furthermore, the fallers were 126% more likely (p < 0.001) to report ambulatory stumbling and unsteadiness, took 14% longer (p = 0.022) to perform five sequential sit-to-stand transfers using an armless chair, covered 16% shorter distance (p < 0.001) during a 6-min walk test, and were 25% less physically active than the non-fallers. The groups had similar ABPI and treadmill claudication distances (p < 0.05). A history of falling was independently related to the self-reported ability to climb stairs, the full-tandem stance time, self-reported ambulatory stumbling and unsteadiness, and daily physical activity (multiple R = 0.47, p < 0.001). In conclusion, impairments in multiple domains of physical function were associated with a history of falling in PAD subjects with intermittent claudication. Furthermore, the link between poor physical function and falling was independent of PAD severity.


Complex multicellular functions at a unicellular eukaryote level: Learning, memory, and immunity.
According to experimental data, eukaryote unicellulars are able to learn, have immunity and memory. Learning is carried out in a very primitive form, and the memory is not neural but an epigenetic one. However, this epigenetic memory, which is well justified by the presence and manifestation of hormonal imprinting, is strong and permanent in the life of cell and also in its progenies. This memory is epigenetically executed by the alteration and fixation of methylation pattern of genes without changes in base sequences. The immunity of unicellulars is based on self/non-self discrimination, which leads to the destruction of non-self invaders and utilization of them as nourishment (by phagocytosis). The tools of learning, memory, and immunity of unicellulars are uniformly found in plasma membrane receptors, which formed under the effect of dynamic receptor pattern generation, suggested by Koch et al., and this is the basis of hormonal imprinting, by which the encounter between a chemical substance and the cell is specifically memorized. The receptors and imprinting are also used in the later steps of evolution up to mammals (including man) in each mentioned functions. This means that learning, memory, and immunity can be deduced to a unicellular eukaryote level.


Surface Structure of Organic Semiconductor [ n]Phenacene Single Crystals.
Surface structure relaxation of organic semiconductors affects the properties of organic devices, although such relaxation has not been well explored. Only two examples have been experimentally reported; tetracene shows a large surface relaxation, while rubrene exhibits no relaxation. Therefore, a systematic investigation of the surface relaxation is conducted on [ n]phenacenes ( n = 5, 7, and 9). Electron density analyses are performed based on the synchrotron surface X-ray scattering with the aid of first-principles calculations. The results show little surface relaxation in [ n]phenacenes.


Possible association of high urinary magnesium and taurine to creatinine ratios with metabolic syndrome risk reduction in Australian aboriginals.
Background. Because of the epidemic of metabolic syndrome (MS) in Australian Aboriginals known for their higher cardiovascular mortality and shorter life expectancy, we analyzed the possible relationship of their MS risks with the current dietary custom. Methods. The subjects were 84 people aged 16-79 years. The health examination was conducted according to the basic protocol of WHO-CARDIAC (Cardiovascular Diseases and Alimentary Comparison) Study. Results. The highest prevalence among MS risks was abdominal obesity (over 60%). After controlling for age and sex, the odds of obesity decreased significantly with high level of urinary magnesium/creatinine ratio (Mg/cre) (OR, 0.11; 95% CI, 0.02-0.57; P < .05). The significant inverse associations of fat intake with Mg/cre and of fast food intake with urinary taurine/creatinine ratio were revealed. Conclusions. The high prevalence of obesity in the Aboriginal people of this area may partly be due to the reduction of beneficial nutrients intake including Mg and taurine.


Family members' satisfaction with critical care: a pilot study.
the aim of this pilot study was to describe family members' satisfaction with the care provided in a Swedish intensive care unit (ICU) based on the following needs: assurance, information, proximity, support, and comfort, which are all included in the Critical Care Family Satisfaction Survey (CCFSS). knowledge concerning satisfaction with care among family members with a critically ill relative in an ICU is important if the family is to be met professionally. the study design was descriptive and retrospective, with a consecutive selection of family members of critically ill people cared for in an ICU. In total 35 family members participated. quantitative analyses based on 20 questions, and a qualitative analysis, based on two open questions was used. The median, average value and percent were computed for every question. The open questions were analyzed using qualitative content analysis. the family members had a high level of satisfaction regarding all groups of needs. They were especially satisfied with flexible visiting hours and the high quality of treatment that the ill person received. The shortcomings that emerged were that family members wanted the physician to be more available for regular talks, the room for relatives was felt to be uncomfortable; and it was felt there were deficiencies in the preparations before the patient's transferral to a ward. the results highlight the family members' need for regular information and the need to improve the environment in the waiting rooms for family members. The ICU staff's competence and their way of encountering the ill person and their family seem to be important for family members' satisfaction with the care.


Estimating the burden of multiple endemic diseases and health conditions using Bayes' Theorem: A conditional probability model applied to UK dairy cattle.
The Global Burden of Animal Diseases (GBADs) is an international collaboration aiming, in part, to measure and improve societal outcomes from livestock. One GBADs objective is to estimate the economic impact of endemic diseases in livestock. However, if individual disease impact estimates are linearly aggregated without consideration for associations among diseases, there is the potential to double count impacts, overestimating the total burden. Accordingly, the authors propose a method to adjust an array of individual disease impact estimates so that they may be aggregated without overlap. Using Bayes' Theorem, conditional probabilities were derived from inter-disease odds ratios in the literature. These conditional probabilities were used to calculate the excess probability of disease among animals with associated conditions, or the probability of disease overlap given the odds of coinfection, which were then used to adjust disease impact estimates so that they may be aggregated. The aggregate impacts, or the yield, fertility, and mortality gaps due to disease, were then attributed and valued, generating disease-specific losses. The approach was illustrated using an example dairy cattle system with input values and supporting parameters from the UK, with 13 diseases and health conditions endemic to UK dairy cattle: cystic ovary, disease caused by gastrointestinal nematodes, displaced abomasum, dystocia, fasciolosis, lameness, mastitis, metritis, milk fever, neosporosis, paratuberculosis, retained placenta, and subclinical ketosis. The diseases and conditions modelled resulted in total adjusted losses of £ 404/cow/year, equivalent to herd-level losses of £ 60,000/year. Unadjusted aggregation methods suggested losses 14-61% greater. Although lameness was identified as the costliest condition (28% of total losses), variations in the prevalence of fasciolosis, neosporosis, and paratuberculosis (only a combined 22% of total losses) were nearly as impactful individually as variations in the prevalence of lameness. The results suggest that from a disease control policy perspective, the costliness of a disease may not always be the best indicator of the investment its control warrants; the costliness rankings varied across approaches and total losses were found to be surprisingly sensitive to variations in the prevalence of relatively uncostly diseases. This approach allows for disease impact estimates to be aggregated without double counting. It can be applied to any livestock system in any region with any set of endemic diseases, and can be updated as new prevalence, impact, and disease association data become available. This approach also provides researchers and policymakers an alternative tool to rank prevention priorities.


Influence of ejaculation frequency on seminal parameters.
Several factors have been shown to influence semen parameters, one of which is sexual abstinence; a clinical criteria included in the semen evaluation to provide maximum sperm quality. The aim of the present study was to assess the effect of a daily ejaculation frequency on conventional and functional semen parameters. Semen samples were collected daily over a period of two weeks of which every second sample per person was processed and analyzed according to the World Health Organization guidelines. Furthermore, mitochondrial function, intracellular reactive oxygen species production and sperm DNA fragmentation were evaluated by flow cytometry. Total sperm count and seminal volume per ejaculation declined and remained decreased for the duration of the daily ejaculation period. However, conventional parameters such as sperm concentration, motility, progressive motility, morphology, vitality and functional parameters such as sperm plasma membrane integrity, mitochondrial membrane potential and DNA fragmentation was not significantly affected and remained similar to the initial measurement throughout the daily ejaculation period. Despite intra- and inter individual variations, the average values of the basic semen parameters remained above the WHO (2010) reference values throughout the daily ejaculation period. Interestingly, a decreasing trend in intracellular ROS production was observed, although statistically not significant. The study shows that an extended 2 week period of daily ejaculation does not have major clinical effects on conventional and functional seminal parameters.


Injury-induced changes in liver specific transcription factors HNF-1α and HNF-4α.
The hepatic acute phase response(APR) is an organ-specific response to a diverse array of insults and is largely under transcriptional control. Liver-specific transcription factors, hepatic nuclear factors (HNFs)-1α and 4α play important roles in maintenance of liver phenotype and function and their binding activity changes early after injury. However, their roles in modulation of the liver's response over time are not defined. C57/BL6 mice were anesthetized and exposed to 95°C water for 10 s to create a 15% body surface area full-thickness burn. At specific time points, the mice were sacrificed. An ELISA for IL-6 was performed on serum and hepatic mRNA levels for fibrinogen-γ and serum amyloid A(SAA)-3 were obtained through polymerase chain reaction (PCR). Transcriptional factor binding activity was assessed with electrophoretic mobility shift assays. Serum IL-6 levels peaked at 3 h and fibrinogen-γ and SAA mRNA levels increased more than 6-fold at 12 h before returning to control levels at 48 h. The binding activity of HNF-4α and HNF-1α rapidly declined after injury (1.5 h) but recovered to near control level at 24 and 6 h, respectively. Changes in HNF-4α and HNF-1α binding occurred before changes in acute phase protein mRNA levels and were preceded by the peak in IL-6 levels. The rapid suppression and reconstitution of liver-specific transcription factor binding after injury may represent a mechanism that allows the normal liver phenotype to change and an injury-response phenotype to prevail. This mechanism in the liver's adaptive response to injury suggests a central role for both HNF-4α and HNF-1α in transcriptional regulation of the hepatic APR.


Cleaved fiber optic double nanohole optical tweezers for trapping nanoparticles.
We demonstrate the trapping of single 20 and 40 nm polystyrene spheres at the cleaved end of a fiber optic with a double nanohole aperture in gold and without any microscope optics. An optical transmission increase of 15% indicates a trapping event for the 40 nm particle, and the jump is 2% for the 20 nm particle. This modular technique can be used to replace those used with current optical trapping setups that require complicated free space optics and frequent calibration, with one that is modular and requires no free space optics. This simple arrangement with the potential for fiber translation is of interest for future biosensor and optical nano-pipette devices.


Characterizing cassava farmer typologies and their seed sourcing practices to explore opportunities for economically sustainable seed business models in Rwanda.
The overdependency on local cassava varieties and informal seed sources by farmers in Rwanda has contributed to the spread of cassava viral diseases. The use of improved planting materials made available through formal seed sources, that assure seed quality, is one way to prevent future disease outbreaks. In order to increase the availability of, and farmers access to, such materials there is increasing interest to develop seed business models. This study aims to understand seed sourcing practices of different farm typologies to inform the development of tailored seed business models. A total of 390 farmers were interviewed and the collected data was analyzed into clusters, resulting in seven farm typologies. Seed sourcing strategies, seed replacement dynamics and purchasing behavior of these typologies were explored via a seed tracing study. We find that more commercial oriented farmers have better access to formal seed sources. Nevertheless, the majority of farmers in all typologies accessed new varieties and quality cassava seed via informal channels. At both formal and informal sources, cash investments in seed were mainly made by the categories of better-off farmers, and were one-time investments to acquire a new variety. Based on farmers current seed sourcing practices, clarifications on the differences between farmers and their willingness-to-pay, the roles of seed degeneration, cost-benefit analysis, value propositions and profit formulas seem important requirements for the further development of viable cassava seed business models. We conclude that tailoring seed business models can have a high potential as it acknowledges differences among farmers, but that careful coordination is needed to ensure that one approach or intervention does not contrast with and/or undermine the others.


Bacterial colonization of percutaneous sutures.
The direct electron microscopic examination of 15 sutures and 15 staples removed from 10 healed surgical wounds showed, on the intradermal portions, consistent colonization by bacteria growing in adherent biofilms. This clearly demonstrable bacterial colonization of biomaterials within the wound tract had not resulted in infection or perceptible inflammation in any of the wounds. These bacterial cells were of several morphotypes, including gram-positive cocci, and all specimens yielded cultures of the autochthonous (native) skin bacterium, Staphylococcus epidermidis. The bacteria within the wound tracts were enveloped by extracellular material that appeared on scanning electron microscopy to be a condensed amorphous residue and on transmission electron microscopy to be a fibrous extracellular matrix. We suggest that this mode of growth, in which the colonizing bacteria are enveloped in a copious exopolysaccharide glycocalix, protects the bacteria from host defense factors and accounts for their persistence on the suture surfaces until they are removed with the sutures.


Clinical in vestigation of misdiagnosis of invasive pulmonary aspergillosis in 26 immunocompetent patients.
The clinical features of invasive pulmonary aspergillosis (IPA) in immunocompromised patients is well studied in the past decades. While the manifestations of IPA in immunocompetent patients remain unclear.The purpose of this study was to determine the clinical and radiological manifestations of invasive pulmonary aspergillosis (IPA) in patients without immunosuppression, as well as the reasons for the misdiagnosis of IPA. We retrieved and retrospectively reviewed the records of 102 patients from whom surgical lung specimens of chronic inflammatory granulomas were harvested. 26 patients were eventually diagnosed with pulmonary aspergillosis on Grocott methenamine silver staining. We investigated these patients in detail. We found that the rate of misdiagnosis before the lung surgery was as high as 73%. The most common symptom was hemoptysis, and the main feature in radiology was nodule or mass lesion. Air crescent sign or Halo sign were not common in our study. The atypical radiological manifestations and non-specific clinical findings make the diagnosis of IPA difficult and lead to a high misdiagnosis rate.


Boron Intake and decreased risk of mortality in kidney transplant recipients.
In a search for potentially modifiable factors to improve long-term outcome among kidney transplant recipients (KTR), we hypothesized that boron exposure is associated with improved long-term outcome in KTR. We determined 24 h urinary boron excretion using inductively coupled plasma mass spectrometry as a measure of boron exposure in 693 stable KTR (57% male, mean age 53y), enrolled in the TransplantLines Food and Nutrition Biobank and Cohort Study. Dietary intake was assessed using validated food-frequency questionnaires. Linear regression analyses showed that dietary intake of fruit, wine and nuts were key determinants of boron excretion. In addition, boron excretion was negatively correlated with homocysteine and inflammatory parameters. In total, 73 (32%), 47 (20%) and 30 (13%) KTR died among the lowest, middle and highest tertiles of 24 h urinary boron excretion, respectively (Plog-rank < 0.001). Cox regression analyses showed that high boron excretion was strongly associated with lower risk of mortality, independent of age, sex, estimated glomerular filtration rate and history of cardiovascular disease (HR per doubling: 0.51, 95% CI: 0.40 to 0.66, P < 0.001). Boron may be an overlooked target to improve long-term survival among KTR and potentially other patients, likely through pathways other than inflammation or the methionine-homocysteine cycle that were previously suggested. Interventional trials are warranted to confirm the potential of dietary boron supplementation in KTR and other patient populations.


The effect of acute exercise on pistol shooting performance of police officers.
Previous studies indicate that rifle shooting performance while standing is compromised when fatigued. Apprehension of suspects by police officers may involve foot pursuit and firing a weapon from a standing position. The purpose of the current study was to investigate pistol shooting performance in police officers under similar conditions of physical fatigue. Participants (mean age: 30.1 years; 4.4 years of experience as police officer) completed two shooting trials separated by an acute bout of exercise on a cycle ergometer to voluntary exhaustion. Each trial consisted of three rounds of five rapid-fire shots at a target, each round separated by a 15-s rest. Participants' backs were turned to the target between rounds. Despite physical exertion, with an average heart rate of 164 bpm, shooting accuracy (mean distance of the closest 4 shots from the center of the target) and precision (diameter of the tightest 4-shot grouping) remained unchanged on postexercise trials relative to preexercise trials. This suggests that automatic shooting reactions override the adverse consequences of fatiguing exercise on shooting performance.


The variance of length of stay and the optimal DRG outlier payments.
Prospective payment schemes in health care often include supply-side insurance for cost outliers. In hospital reimbursement, prospective payments for patient discharges, based on their classification into diagnosis related group (DRGs), are complemented by outlier payments for long stay patients. The outlier scheme fixes the length of stay (LOS) threshold, constraining the profit risk of the hospitals. In most DRG systems, this threshold increases with the standard deviation of the LOS distribution. The present paper addresses the adequacy of this DRG outlier threshold rule for risk-averse hospitals with preferences depending on the expected value and the variance of profits. It first shows that the optimal threshold solves the hospital's tradeoff between higher profit risk and lower premium loading payments. It then demonstrates for normally distributed truncated LOS that the optimal outlier threshold indeed decreases with an increase in the standard deviation.


Qualitative cross-sectional study of the perceived causes of depression in South Asian origin women in Toronto.
To explore how South Asian origin women in Toronto, Canada, understand and explain the causes of their depression. Cross-sectional in-depth qualitative interviews. Outpatient service in Toronto, Ontario. Ten women with symptoms of depression aged between 22 and 65 years of age. Seven were from India, two from Sri Lanka and one from Pakistan. Four were Muslim, three Hindu and three Catholic. Two participants had university degrees, one a high school diploma and seven had completed less than a high school education. Eight were married, one was unmarried and one a widow. Three main factors emerged from the participant narratives as the causes of depression: family and relationships, culture and migration and socioeconomic. The majority of the participants identified domestic abuse, marital problems and interpersonal problems in the family as the cause of their depression. Culture and migration and socioeconomic factors were considered contributory. None of our study participants reported spiritual, supernatural or religious factors as causes of depression. A personal-social-cultural model emerged as the aetiological paradigm for depression. Given the perceived causation, psycho-social treatment methods may be more acceptable for South Asian origin women.


High-grade SCFE: the role of surgical hip dislocation and reduction.
The patient with an unstable slipped capital femoral epiphysis poses a challenging problem to the treating physician to improve the position of the displaced epiphysis to avoid femoroacetabular impingement without developing avascular necrosis (AVN)-a potentially devastating complication. Although the standard operative procedure of in situ pinning following an incidental reduction while positioning the patient on the table, has been the mainstay of treatment in North America, other viable options are available including a surgical dislocation approach to the hip followed by a modified Dunn osteotomy with control of the retinacular vessels, reduction of the epiphysis, and internal fixation with pins or screws. Although technically demanding, this approach offers an opportunity to reduce the epiphysis to avoid femoroacetabular impingement, and limit the possibility for the development of AVN. The early results for this procedure are promising with all studies demonstrating excellent reduction of the epiphysis and an overall lower incidence of AVN when compared with in situ pinning.


Artemisia annua L. Polyphenol-Induced Cell Death Is ROS-Independently Enhanced by Inhibition of JNK in HCT116 Colorectal Cancer Cells.
c-Jun N-terminal kinase (JNK) is activated by chemotherapeutic reagents including natural plant polyphenols, and cell fate is determined by activated phospho-JNK as survival or death depending on stimuli and cell types. The purpose of this study was to elucidate the role of JNK on the anticancer effects of the Korean plant Artemisia annua L. (pKAL) polyphenols in p53 wild-type HCT116 human colorectal cancer cells. Cell morphology, protein expression levels, apoptosis/necrosis, reactive oxygen species (ROS), acidic vesicles, and granularity/DNA content were analyzed by phase-contrast microscopy; Western blot; and flow cytometry of annexin V/propidium iodide (PI)-, dichlorofluorescein (DCF)-, acridine orange (AO)-, and side scatter pulse height (SSC-H)/DNA content (PI)-stained cells. The results showed that pKAL induced morphological changes and necrosis or late apoptosis, which were associated with loss of plasma membrane/Golgi integrity, increased acidic vesicles and intracellular granularity, and decreased DNA content through downregulation of protein kinase B (Akt)/β-catenin/cyclophilin A/Golgi matrix protein 130 (GM130) and upregulation of phosphorylation of H2AX at Ser-139 (γ-H2AX)/p53/p21/Bak cleavage/phospho-JNK/p62/microtubule-associated protein 1 light chain 3B (LC3B)-I. Moreover, JNK inhibition by SP600125 enhanced ROS-independently pKAL-induced cell death through downregulation of p62 and upregulation of p53/p21/Bak cleavage despite a reduced state of DNA damage marker γ-H2AX. These findings indicate that phospho-JNK activated by pKAL inhibits p53-dependent cell death signaling and enhances DNA damage signaling, but cell fate is determined by phospho-JNK as survival rather than death in p53 wild-type HCT116 cells.


Practices and Barriers in Sexual History Taking: A Cross-Sectional Study in a Public Adult Primary Care Clinic.
Surveys report low frequencies of sexual history (SH) obtained in primary care. Sexually transmitted infections incidence can be reduced with timely screening. It is important to determine whether providers obtain thorough SH and to identify needs for improvement. To evaluate the frequency and depth of SH taking in primary care. In this cross-sectional cohort study, 1,017 primary care visits were reviewed (1,017 adult patients, female 55.26%). 417 patients were seen by male providers and 600 patients were seen by female providers. Multivariate ordered and logit models were deployed. The primary outcome measures included SH taking rates and completeness based on the 5 P model as described by the Centers for Disease Control and Prevention. All components of SH were explored in 1.08% of visits. Partial SH was obtained in 33.92% of visits. No SH was taken in the majority of visits (65%). SH was more likely to be taken from female patients than from male patients (P < .001), and was less likely to be obtained from older patients as compared to younger individuals (P < .001). There was no significant difference in SH taking between male and female providers (P = .753). The provider title and the level of training were found to be independent predictors of SH taking (P < .001). The results of this study highlight an unmet need for more comprehensive and consistent SH taking amongst providers, particularly in high-risk settings, so that SH can be used as a valuable tool in preventive care. To the best of our knowledge, this is the largest study to date examining SH taking in the primary care setting. Limitations include the retrospective study design, lack of generalizability to other hospitals, and inconsistencies in available data. The SH taking rates in primary care clinics are globally low with a variation depending on the provider position or level of training, provider gender, and patient age. Palaiodimos L, Herman HS, Wood E, et al. Practices and Barriers in Sexual History Taking: A Cross-Sectional Study in a Public Adult Primary Care Clinic. J Sex Med 2020;17:1509-1519.