Neurohormonal regulation and the overlapping pathology between heart failure and acute coronary syndromes.
An understanding of the dynamic relationship between the coronary artery and left ventricular (LV) function is important in diagnosing and treating acute coronary disease. Measurement of B-type natriuretic peptide (BNP) provides rapid and accurate identification of patients with impaired LV function, which has proven valuable in differentiating between congestive heart failure (CHF) and symptoms attributable to pulmonary etiologies. Coronary artery and ventricular pathophysiology both are characterized by injury, functional aberrations, and subsequent remodeling. Ischemia occurs in both and accounts for virtually all significant adverse outcomes. The difference in BNP elevations seen in acute ischemia compared with those observed in chronic CHF is striking: Although even small BNP elevations in acute coronary syndromes have powerful prognostic value, it is not likely that they can be effectively used as a diagnostic marker for ischemia.


Evaluation of skills and knowledge on orthostatic blood pressure measurements in elderly patients.
orthostatic hypotension is a common and potentially dangerous condition in elderly patients, often accompanied by dizziness and falls. To diagnose orthostatic hypotension, many physicians rely on blood pressure measurements performed by nurses. observational and descriptive study. departments of Internal Medicine, Geriatric Medicine, and Surgery in eight hospitals throughout the Netherlands. 170 nurses working with elderly people in a general hospital. We selected a sample of 10 nurses on 17 participating wards. to evaluate nurses' skills and knowledge on blood pressure measurements to diagnose orthostatic hypotension, we performed standardized observations, based on published guidelines, of supine and standing blood pressure determination in patients over 65 years. the most important deviations in technique of orthostatic blood pressure measurement from the published guidelines were: time between measuring supine and standing blood pressure varied from 0-30 minutes; in 28% the arm position was not at heart level during standing blood pressure measurements; in 46% the cuff was placed incorrectly. the skills and knowledge of nurses to measure supine and standing blood pressure are inaccurate for diagnosing orthostatic hypotension in elderly patients. Large differences in measurement technique and timing of standing blood pressure could influence the individual detection and treatment of orthostatic hypotension and the reported prevalence of orthostatic hypotension. The blood pressure measurement procedure to diagnose orthostatic hypotension needs more standardization and implementation of guidelines in daily practice.


Anatomical Description of Zygomatic Foramina in African American Skulls.
The zygomaticofacial/temporal/orbital nerve is a terminal branch of the zygomatic nerve and exits the orbit through zygomatic foramina. The nomenclature in the literature varies with some studies identifying all 3 foramina on the malar surface of the zygoma, while others describe each along different aspects of the zygoma. In this study, foramen on the malar surface of the zygoma is termed zygomatic foramen, and the authors describe anatomical variations in the position and number of these foramina in an African American population. Sixty-two African American skulls from the Hamann-Todd collection of the Cleveland Museum of Natural History were studied. The primary outcome was the number of zygomatic foramina on the malar surface of the zygomatic bone. Secondary outcomes included the location of foramina relative to the orbital rim and the frontozygomatic suture. Mean and standard deviation were used to describe measurements. Chi-squared and Wilcoxon signed rank tests were used to analyze measurements between left and right hemicrania. The average number of foramina was 1.98 ± 0.93. More foramina were found on the right (2.13 ± 0.98) when compared with the left (1.68 ± 0.79; p = 0.001). The average distance between the lateral-most and medial-most foramina was 9.7 ± 5.0 mm. The distance from the orbital rim to the lateral foramen was 8.4 ± 4.2 mm, and distance from the orbital rim to the medial foramen was 7.7 ± 2.1 mm. The frontozygomatic suture was 22.9 ± 3.9 mm from the lateral foramen and 27.9 ± 3.6 mm from the medial foramen. The locations of the foramina in relation to the frontozygomatic suture and orbital rim were consistent with other populations. However, in this African American population, more zygomatic foramina were noted compared with previously published results in Korean, Indian, Brazilian, and West Anatolian populations. Surgeons should be cognizant of zygomatic foramina in this population to reduce potential neurovascular complications.


Mass Drug Administration of Artemisinin-piperaquine on High Malaria Epidemic Area.
Malaria is the one of major diseases which threatens people's life in Africa. Out of humanitarianism, Chinese scientists has contributed to research of Artemisinin and ACTS more than 30 years, China provides long-term antimalaria assistance to Africa and gain great achievements. In Moheli, the island of Comoros, the antimalaria group used a new strategy which universal medication and proactive intervention. They established not only an effective antimalaria system and reporting system but also a local antimalaria team. Furthermore, they enhanced publicity and put mass protection and treatment into effect. Finally, they achieved significant result. In order to apply those successful experience to other countries in Africa, this paper summed up those experience and inspirations.


Effect of temperature and social environment on worker size in the ant Temnothorax nylanderi.
Warm temperatures decrease insect developmental time and body size. Social life could buffer external environmental variations, especially in large social groups, either through behavioral regulation and compensation or through specific nest architecture. Mean worker size and distribution of worker sizes within colonies are important parameters affecting colony productivity as worker size is linked to division of labor in insect societies. In this paper, we investigate the effect of stressful warm temperatures and the role of social environment (colony size and size of nestmate workers) on the mean size and size variation of laboratory-born workers in the small European ant Temnothorax nylanderi. To do so, we reared field-collected colonies under medium or warm temperature treatments after having marked the field-born workers and removed the brood except for 30 first instar larvae. Warm temperature resulted in the production of fewer workers and a higher adult mortality, confirming that this regime was stressful for the ants. T. nylanderi ants followed the temperature size rule observed in insects, with a decreased developmental time and mean size under warm condition. Social environment appeared to play an important role as we observed that (i) larger colonies buffered the effect of temperature better than smaller ones (ii) colonies with larger workers produced larger workers whatever the rearing temperature and (iii) the coefficient of variation of worker size was similar in the field and under medium laboratory temperature. This suggests that worker size variation is not primarily due to seasonal environmental fluctuations in the field. Finally, we observed a higher coefficient of variation of worker size under warm temperature. We propose that this results from a disruption of social regulation, i.e. the control of nestmate workers over developing larvae and adult worker size, under stressful conditions.


Fatty acid nitroalkenes ameliorate glucose intolerance and pulmonary hypertension in high-fat diet-induced obesity.
Obesity is a risk factor for diabetes and cardiovascular diseases, with the incidence of these disorders becoming epidemic. Pathogenic responses to obesity have been ascribed to adipose tissue (AT) dysfunction that promotes bioactive mediator secretion from visceral AT and the initiation of pro-inflammatory events that induce oxidative stress and tissue dysfunction. Current understanding supports that suppressing pro-inflammatory and oxidative events promotes improved metabolic and cardiovascular function. In this regard, electrophilic nitro-fatty acids display pleiotropic anti-inflammatory signalling actions. It was hypothesized that high-fat diet (HFD)-induced inflammatory and metabolic responses, manifested by loss of glucose tolerance and vascular dysfunction, would be attenuated by systemic administration of nitrooctadecenoic acid (OA-NO2). Male C57BL/6j mice subjected to a HFD for 20 weeks displayed increased adiposity, fasting glucose, and insulin levels, which led to glucose intolerance and pulmonary hypertension, characterized by increased right ventricular (RV) end-systolic pressure (RVESP) and pulmonary vascular resistance (PVR). This was associated with increased lung xanthine oxidoreductase (XO) activity, macrophage infiltration, and enhanced expression of pro-inflammatory cytokines. Left ventricular (LV) end-diastolic pressure remained unaltered, indicating that the HFD produces pulmonary vascular remodelling, rather than LV dysfunction and pulmonary venous hypertension. Administration of OA-NO2 for the final 6.5 weeks of HFD improved glucose tolerance and significantly attenuated HFD-induced RVESP, PVR, RV hypertrophy, lung XO activity, oxidative stress, and pro-inflammatory pulmonary cytokine levels. These observations support that the pleiotropic signalling actions of electrophilic fatty acids represent a therapeutic strategy for limiting the complex pathogenic responses instigated by obesity.


Evaluation of Er:YAG laser energy transmitted through novel dental zirconia ceramics.
Erbium:yttrium-aluminum-garnet (Er:YAG) laser debonding is a promising removal method in prosthodontics. This study aimed to assess Er:YAG laser energy transmission through novel zirconia ceramics. Five types of ceramic samples: lithium disilicate ceramic (LDC), self-glazed zirconia (SGZ), 3 mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP), 4Y-TZP and 5Y-TZP with 5 thicknesses (0.5, 1.0, 1.5, 2.0, 2.5 mm) and 2 shades (A1, A3), 50 specimens total, were made. Fourier transformation infrared absorption spectra were obtained for each ceramic type, and Er:YAG laser energy transmission tests were conducted for each specimen. The novel zirconia ceramic (SGZ, 4Y-TZP, 5Y-TZP) transmission ranged from 40%-60%. The transmitted laser energy decreased with increasing ceramic thickness, and the differences between different shades were significant (p<0.05). The novel zirconias had a higher translucency than 3Y-TZP at any given thickness and shade, and when the thickness was >1.5 mm, the novel zirconias had a higher translucency than LDC.


Survey of Sarcocystis infection in cattle in east Hokkaido, Japan.
The prevalence of Sarcocystis infection was examined in older cows and imported cattle slaughtered in East Hokkaido. Samples of myocardial tissues were examined for Sarcocystis microscopically. Sarcocystis cysts were detected in 15.7% of 83 older cows, 48.4% of 91 imported cattle which were kept in East Hokkaido prior to slaughter and 51.1% of 94 imported cattle slaughtered immediately after quarantine check. Based on the morphology of the cyst wall and the establishment of infection in experimentally inoculated dog, the Sarcocystis species was identified as Sarcocystis cruzi.


Quantitative approach to analyze hyoid bone movement during swallowing by ultrasound: an integrative review.
To synthesize the scientific knowledge on which measurements of hyoid bone movement during swallowing are obtained by ultrasonography and how to extract these measures. The PECO question and combinations of descriptors and keywords were formulated in the electronic databases Medline/PubMed, EMBASE, Web of Science, Scopus and Lilacs. Articles that used ultrasonography to analyze measurements of hyoid bone movement during swallowing were included, regardless of language, year of publication, or presence of deglutition disorders. The included articles were analyzed for: year, study site, study design, population, sample size, equipment used, transducer positioning, measurements obtained, method of extraction, and reliability of measurements. Twenty-six articles met the eligibility criteria. The most frequent measurement was hyoid movement maximum amplitude, followed by time and velocity. There was great variability in the study population, equipment used, positioning of the transducer and method of extraction of the measurements. Thus, it was not possible to find a standard model to extract the measures. The level of reliability was investigated in only eight articles. Amplitude, time and velocity are the measures of hyoid bone movement during swallowing that can be obtained by ultrasonography. There is no standardization on how to extract these measurements.


Lingual Foramina and Canals of the Mandible: Anatomic Variations in a Lebanese Population.
The aim of this study was to evaluate the mandibular lingual foramina (LF) and canals and their anatomic variations using cone-beam computed tomography (CBCT) technology in a Lebanese population. In this study, we analyzed CBCT images of 90 adult Lebanese patients (41 males and 49 females). We assessed the number and location of the LF. In additional, we measured: (a) The distance from both the alveolar crest and the inferior border of the mandible to the LF and (b) the length of the lingual canals (LCs). The data obtained was analyzed statistically using Shapiro-Wilk normality test, t-test, Chi-square, and Fisher's exact tests. Statistical significance was set at 0.05. In our sample, the LF and canals were present in 93.33% of the CBCT analyzed, and the majority (76.64%) was located above the genial tubercles. The distance from the foramen of the superior and the inferior LCs to the alveolar crest was 16.24 ± 2.82 mm and 25.49 ± 2.43 mm, respectively. The distance from the foramen of the superior canal to the inferior border of the mandible was 14 ± 2.32 mm. The mean length of the superior canal was 5.81 ± 1.6 mm and 4.25 ± 1.2 mm for the inferior one. There were no gender-related differences in the anatomic characteristics of the LF and canals except for the distance measured from the superior canal foramina to the alveolar crest where the measurement was significantly greater in males compared to females. Neither the number of canals nor the positions of the foramina were different between males and females. Within the limits of this study, we concluded that in our sample of Lebanese adults, there was substantial variability in the LF and canals anatomy and location.


Auditory neural pathway evaluation on sensorineural hearing loss using diffusion tensor imaging.
Diffusion tensor imaging is a new in vivo tool not only for the assessment of white matter structural integrity but also for diagnosis and assessment of disease conditions which disturb tissue structural coherence. In this study, we investigated the integrity of auditory pathway in patients of sensorineural hearing loss by means of fractional anisotropy of water diffusion to see any subtle changes of auditory pathways resulting from sensorineural hearing loss. In addition, this study suggests that the diffusion anisotropy measured by diffusion tensor imaging is highly sensitive to otherwise subtle disease processes not normally seen with conventional magnetic resonance imaging or computed tomography contrast.


Hypoxia induces severe right ventricular dilatation and infarction in heme oxygenase-1 null mice.
Heme oxygenase (HO) catalyzes the oxidation of heme to generate carbon monoxide (CO) and bilirubin. CO increases cellular levels of cGMP, which regulates vascular tone and smooth muscle development. Bilirubin is a potent antioxidant. Hypoxia increases expression of the inducible HO isoform (HO-1) but not the constitutive isoform (HO-2). To determine whether HO-1 affects cellular adaptation to chronic hypoxia in vivo, we generated HO-1 null (HO-1(-/-)) mice and subjected them to hypoxia (10% oxygen) for five to seven weeks. Hypoxia caused similar increases in right ventricular systolic pressure in wild-type and HO-1(-/-) mice. Although ventricular weight increased in wild-type mice, the increase was greater in HO-1(-/-) mice. Similarly, the right ventricles were more dilated in HO-1(-/-) mice. After seven weeks of hypoxia, only HO-1(-/-) mice developed right ventricular infarcts with organized mural thrombi. No left ventricular infarcts were observed. Lipid peroxidation and oxidative damage occurred in right ventricular cardiomyocytes in HO-1(-/-), but not wild-type, mice. We also detected apoptotic cardiomyocytes surrounding areas of infarcted myocardium by terminal deoxynucleotide transferase-mediated dUTP nick end-labeling (TUNEL) assays. Our data suggest that in the absence of HO-1, cardiomyocytes have a maladaptive response to hypoxia and subsequent pulmonary hypertension. J.Clin. Invest. 103:R23-R29 (1999).


Fabrication of a centimeter-long cavity on a nanofiber for cavity quantum electrodynamics.
We report the fabrication of a 1.2 cm long cavity directly on a nanofiber using femtosecond laser ablation. The cavity modes with finesse values in the range of 200-400 can enable the "strong-coupling" regime of cavity QED, with high cooperativity of 10-20, for a single atom trapped 200 nm away from the fiber surface [Phys. Rev. A80, 053826 (2009)PLRAAN1050-294710.1103/PhysRevA.80.053826]. Such cavity modes can still maintain the transmission between 40%-60%, suggesting a one-pass intracavity transmission of 99.53%. Other cavity modes, which can enable cooperativity in the range of 3-10, show transmission over 60%-85% and are suitable for fiber-based single-photon sources and quantum nonlinear optics in the "Purcell" regime.


TDAG51 is an ERK signaling target that opposes ERK-mediated HME16C mammary epithelial cell transformation.
Signaling downstream of Ras is mediated by three major pathways, Raf/ERK, phosphatidylinositol 3 kinase (PI3K), and Ral guanine nucleotide exchange factor (RalGEF). Ras signal transduction pathways play an important role in breast cancer progression, as evidenced by the frequent over-expression of the Ras-activating epidermal growth factor receptors EGFR and ErbB2. Here we investigated which signal transduction pathways downstream of Ras contribute to EGFR-dependent transformation of telomerase-immortalized mammary epithelial cells HME16C. Furthermore, we examined whether a highly transcriptionally regulated ERK pathway target, PHLDA1 (TDAG51), suggested to be a tumor suppressor in breast cancer and melanoma, might modulate the transformation process. Cellular transformation of human mammary epithelial cells by downstream Ras signal transduction pathways was examined using anchorage-independent growth assays in the presence and absence of EGFR inhibition. TDAG51 protein expression was down-regulated by interfering small hairpin RNA (shRNA), and the effects on cell proliferation and death were examined in Ras pathway-transformed breast epithelial cells. Activation of both the ERK and PI3K signaling pathways was sufficient to induce cellular transformation, which was accompanied by up-regulation of EGFR ligands, suggesting autocrine EGFR stimulation during the transformation process. Only activation of the ERK pathway was sufficient to transform cells in the presence of EGFR inhibition and was sufficient for tumorigenesis in xenografts. Up-regulation of the PHLDA1 gene product, TDAG51, was found to correlate with persistent ERK activation and anchorage-independent growth in the absence or presence of EGFR inhibition. Knockdown of this putative breast cancer tumor-suppressor gene resulted in increased ERK pathway activation and enhanced matrix-detached cellular proliferation of Ras/Raf transformed cells. Our results suggest that multiple Ras signal transduction pathways contribute to mammary epithelial cell transformation, but that the ERK signaling pathway may be a crucial component downstream of EGFR activation during tumorigenesis. Furthermore, persistent activation of ERK signaling up-regulates TDAG51. This event serves as a negative regulator of both Erk activation as well as matrix-detached cellular proliferation and suggests that TDAG51 opposes ERK-mediated transformation in breast epithelial cells.


Cloning, heterologous expression and antigenicity of a schistosome cercarial protease.
A gene coding for the 30 kDa Schistosoma mansoni cercarial protease was amplified using the polymerase chain reaction (PCR) from genomic DNA templates. Cloning and sequencing of several independent PCR clones revealed the presence of an intron additional to the one described in the original cloning of the gene. The 3 exons were cloned into expression vectors so that they could be expressed as separate glutathione-S-transferase (GST) translational fusions. Recombinant bacteria carrying these expression plasmids expressed the fusion proteins at high levels. Western blotting of bacterial lysates with sera raised against the native S. mansoni cercarial protease showed that all 3 exons were recognized. Thus we have produced recombinant bacteria capable of providing large amounts of an S. mansoni antigen for immunological studies and evaluation as a candidate vaccine.


[Study of Yiqi Chutan Formula in Suppressing A549 Lung Cancer by Regulating Unfolded Protein Response].
To study the inhibition and mechanism on lung cancer A549 cells xenografts in BALB / c nude mice. 40 BALB / c mice were selected to establish lung cancer xenografts models with human lung adenocarcinoma A549 cells,which were randomized into model group,cisplatin group( 0. 002 g / kg), Yiqi Chutan Formula low-dose group( 3. 0 g / kg),Yiqi Chutan Formula high-dose group( 6. 0 g / kg) and combination group[Yiqi Chutan Formula 6. 0( g / kg) / cisplatin 0. 002( g / kg) ], with eight mice in each group. Yiqi Chutan Formula was given once a day with 0. 2 m L from 8th day after modeling,and successive medication for14 days. After given cisplatin with 0. 2 m L by intraperitoneal injection once a day in 17 th day,and modeling for 5 days. The tumor weight and tumor volume were detected. And the tumor inhibitory rate were calculated. The expression of CNX and XBP1 was detected by immunohistochemistry,Western blotting and and real-time quantitative PCR. Compared with the model group, the tumor weight and the tumor volume were lower in cisplatin group, Yiqi Chutan Formula high-dose group and combination group( P < 0. 01);and the combination group was better than the cisplatin group( P < 0. 01). The results of immunohistochemistry, Western blotting and real-time quantitative PCR showed that, compared with the model group, the expression of CNX and XBP1 were lower in cisplatin group, Yiqi Chutan Formula high-dose group and combination group( P < 0. 01),and the combination group was better than the cisplatin group( P < 0. 05 or P < 0. 01). Yiqi Chutan Formula can inhibit A549 lung cancer cells in BALB/c nude mice. Combined with chemotherapy drugs, the killing effect on lung cancer can be enhanceed. Its mechanism may be related to down-regulating CNX and XBP1 to inhibit the unfolded protein response to lead to apoptosis.


Retinal vascular remodelling in radiation retinopathy.
A 34-year-old female developed bilateral radiation retinopathy three months after external beam radiotherapy for pituitary adenoma. The clinical symptoms, fundus abnormalities, and microvascular pathology noted on fluorescein angiography resolved spontaneously over a few months. The most dramatic aspect was the progressive improvement and partial reperfusion of the retinal capillary bed.


Molecular genetic sex determination of Medieval human remains from north Russia: comparison with archaeological and anthropological criteria.
Sex determination presents a difficult problem in archaeology and anthropology in cases of fragmentary or juvenile remains, and where grave goods are absent. Here, a molecular genetic analysis of the sex of human remain from the Early Medieval cemetery at Nefedievo, North Russia, was carried out and the results were compared with archaeological and anthropological data. Teeth without cavities (15 samples) and bones (9 samples) were used as the ancient DNA source. The repetitive sequences in DYZ1, DYZ3, DXZ3 loci, and a unique sequence in the first intron of the X-Y homologous gene amelogenin, were amplified. Sex was determined in 87.5% of the samples by archaeological criteria, in 95.8% of the samples by anthropological methods, and in 79.2% of the samples by DNA analysis. PCR allowed the sex of infant's remains to be identified in individual where the sex could not be determined by anthropological methods and in three remains where sex could not be inferred from archaeological data. Uneven preservation of nuclear DNA loci was evident.


Can baseline serum creatinine and e-GFR predict renal function outcome after augmentation cystoplasty in children?
To assess cut-off value of creatinine and glomerular filtration rate for augmentation cystoplasty (AC) in paediatric age-group. Data of all paediatric-patients (<18 years) with small capacity bladder, in whom AC was advised between 2005-2015 were reviewed. All patients were divided in two-groups, AC-group and control-group (without AC). Creatinine and e-GFR were assessed at the time of surgery, at 6 months and at last follow-up. Renal function deterioration was defined as increase in creatinine by ≥25% from baseline value or new-onset stage-3 CKD or worsening of CKD stage with pre-operative-CKD stage-3. ROCs were plotted using creatinine and e-GFR for AC. A total of 94 patients with mean-age 8.9 years were included. The mean creatinine and e-GFR were 1.33mg/dL and 57.68mL/min respectively. Out of 94 patients, AC was performed in 45 patients and in the remaining 49 patients AC was not done (control-group), as they were not willing for the same. Baseline patient's characteristics were comparable in both Groups. 22 underwent gastro-cystoplasty (GC) and 25 underwent ileo-cystoplasty (IC). Decline in renal function was observed in 15 (33.3%) patients of AC-group and in 31 (63.3%) patients of control-group. Patients having creatinine ≥1.54mg/dL (P=0.004, sensitivity (S) 63.6% and specificity (s) 90.5%) at baseline and e-GFR ≤46mL/min (P=0.000, S=100% and s=85.7%) at the time of surgery had significantly increased probability of renal function deterioration on follow-up after AC. e-GFR ≤46mL/min and creatinine ≥1.54mg/dL at time of surgery could serve as a predictor of renal function deterioration in AC in paediatric patients.


[A case of pseudotumor cerebri with improvement of vision after lumboperitoneal shunt].
Patients with pseudotumor cerebri, also called benign intracranial hypertension, generally have a favorable prognosis. However, this disorder can cause permanent, severe visual loss. To our knowledge, no reports have described in detail retinal damage resulting from pseudotumor cerebri. We report the case of a 26-year-old woman who presented with serious bilateral visual impairment, severe papilledema, and retinal edema in a wide area. She was diagnosed with pseudotumor cerebri. Because of her progressive visual loss and failed medical control, she underwent a lumboperitoneal shunt. After the operation, her visual acuity and visual field improved in her left eye and the retinal edema resolved, but residual pigment epithelial damage was observed. In the first-order component of multifocal electroretinogram, the amplitudes were reduced, and peak implicit times were prolonged in the nasal retina. Retinal damage caused by severe and long-standing retinal edema may contribute to the pathological mechanisms for visual loss as well as optic nerve damage. The course of visual function in our case was important for diagnosis and therapeutic decisions. Because a poor visual outcome may result from pseudotumor cerebri, an ophthalmologist should closely monitor visual loss and visual function.


The Urban Medicine Program: Developing Physician-Leaders to Serve Underserved Urban Communities.
Medical school graduates are poorly prepared to address health care inequities found in urban, underserved communities. The University of Illinois College of Medicine developed the Urban Medicine Program (UMed) to prepare students for the roles of advocate, researcher, policy maker, and culturally competent practitioner through a four-year curriculum integrating principles of public health with direct interventions in local, underserved communities. This study assessed the program's effectiveness and evaluated early outcomes. The authors analyzed data for UMed students (graduating classes 2009-2013) from pre- and postseminar assessments and longitudinal community project progress reports. They also compared UMed and non-UMed outcomes from the same classes, using graduation data and data from two surveys: Medical Students' Attitudes Toward the Underserved (MSATU) and the Intercultural/Professional Assessment. UMed students were more likely than non-UMed students to endorse MSATU constructs ("Universal medical care is a right" [P = .01], "Access to basic medical care is a right" [P = .03], "Access is influenced by social determinants" [P = .03]); to be selected for the Gold Humanism Honor Society (P < .0001); to complete joint degrees (P < .0001); and to enter primary care residencies (P = .002). Early outcomes reveal that a longitudinal, experiential curriculum can provide students with competencies that may prepare them for leadership roles in advocacy, research, and policy making. Contact with diverse communities inculcates-in medical students with predispositions toward helping underserved populations-the self-efficacy and skills to positively influence underserved, urban communities.


Binding proteins from alternative scaffolds.
The use of so-called protein scaffolds for the generation of novel binding proteins via combinatorial engineering has recently emerged as a powerful alternative to natural or recombinant antibodies. This concept requires an extraordinary stable protein architecture tolerating multiple substitutions or insertions at the primary structural level. With respect to broader applicability it should involve a type of polypeptide fold which is observed in differing natural contexts and with distinct biochemical functions, so that it is likely to be adaptable to novel molecular recognition purposes. The quickly growing number of approaches can be classified into three groups: carrier proteins for the display of single variegated loops, scaffolds providing rigid elements of secondary structure, and protein frameworks supporting a group of conformationally variable loops in a fixed spatial arrangement. Generally, such artificial receptor proteins should be based on monomeric and small polypeptides that are robust, easily engineered, and efficiently produced in inexpensive prokaryotic expression systems. Today, progress in protein library technology allows for the parallel development of immunoglobulin (Ig) as well as scaffold-based affinity reagents. Both biomolecular tools have the potential to complement each other, thus expanding the possibility to find an affinity reagent suitable for a given application. The repertoire of protein scaffolds hitherto recruited for combinatorial protein engineering purposes will probably be further expanded in the future, including both additional natural proteins and de novo designed proteins, contributing to the collection of libraries available at present. In this review both the structural features and the practical use of scaffold proteins will be discussed and exemplified.


DNA on a tube: electrostatic contribution to stiffness.
Two simple models are used to estimate the electrostatic contributions to the stiffness of short DNA fragments. The first model views DNA as two strands that are appropriately parametrized and are wrapped helically around a straight cylinder radius equal to the radius of the DNA molecule. The potential energy of the DNA due to phosphate-phosphate electrostatic interactions is evaluated assuming that the charges interact through Debye-Hückel potentials. This potential energy is compared with the potential energy as computed using our second model in which DNA is viewed as two helical strands wrapping around a curved tube whose cross-section is a disk of radius equal to the radius of the DNA. We find that the electrostatic persistence length for B-DNA molecules in the range of 105-130 bp is 125.64 angstroms (37 bp) and 76.05 angstroms (23 bp) at 5 and 10 mM monovalent salt concentration, respectively. If the condensed fraction theta is taken to be 0.715 at 10 mM, then the electrostatic persistence length is 108.28 angstroms (32 bp), while that based on taking into account end effects is 72.87 angstroms (21 bp). At 5 mM monovalent salt, the total persistence length for DNA fragments in this length range is approximately 575.64 angstroms (171 bp), using the best estimate for nonelectrostatic contribution to persistence length. Electrostatic effects thus contribute 21.8% to DNA stiffness at 5 mM for fragments between 105- to 130-bp. In contrast, electrostatics are calculated to make a negligible contribution to the DNA persistence length at physiological monovalent cation concentration. The results are compared with counterion condensation models and experimental data.


Correction: Unorthodox crystalline drug salts via the reaction of amine-containing drugs with CO2.
Correction for 'Unorthodox crystalline drug salts via the reaction of amine-containing drugs with CO2' by Mohammad Soltani et al., Chem. Commun., 2019, 55, 13546-13549, https://doi.org/10.1039/C9CC06429J.


Anti-CD2 producing pig xenografts effect localized depletion of human T cells in a huSCID model.
We investigated whether graft produced anti-human CD2, mediated by adenovirus (Adv) transduction of pig neonatal islet cell clusters (pNICC), would protect xenografts in a humanized mouse model from immune attack and whether such immunosuppression would remain local. A mouse anti-human CD2 Ab (CD2hb11) previously generated by us was genetically engineered to produce chimeric and humanized versions. The three forms of CD2hb11 were named dilimomab (mouse), diliximab (chimeric) and dilizumab (humanized). All 3 forms of CD2hb11 Ab were tested for their ability to bind CD3(+) human T cells and to inhibit a human anti-pig xenogeneic mixed lymphocyte reaction (MLR). They were administered systemically in a humanized mouse model in order to test their ability to deplete human CD3(+) T cells and whether they induced a cytokine storm. An adenoviral vector expressing diliximab was generated for transduction of pNICC. Humanized mice were transplanted with either control-transduced pNICC or diliximab-transduced pNICC and human T cells within grafts and spleens were enumerated by flow cytometry. Dilimomab and diliximab inhibited a human anti-pig xenogeneic response but dilizumab did not. All 3 forms of CD2hb11 Ab bound human T cells in vitro though dilimomab and diliximab exhibited 300-fold higher avidity than dilizumab. All 3 anti-CD2 Abs could deplete human CD3(+) T cells in vivo in a humanized mouse model without inducing upregulation of activation markers or significant release of cytokines. Humanized mice transplanted with diliximab-transduced pNICC afforded depletion of CD3(+) T cells at the graft site leaving the peripheral immune system intact. Local production of a single Ab against T cells can reduce graft infiltration at the xenograft site and may reduce the need for conventional, systemic immunosuppression.


Clinicopathological and prognostic significance of aberrant Arpin expression in gastric cancer.
To detect the expression of Arpin, and determine its correlation with clinicopathological characteristics and the prognosis of gastric cancer (GC) patients. A total of 176 GC patients were enrolled as study subjects and classified into groups according to different clinicopathological variables. GC mucosal tissues were obtained via surgery. Another 43 paraffin-embedded tissue blocks of normal gastric epithelium (> 5 cm away from the edge of the tumor) were included in the control group. Immunohistochemistry (IHC) for the Arpin and Arp3 proteins was performed on the formalin-fixed, paraffin-embedded GC tissues. Additionally, expression of the Arpin protein in 43 normal gastric tissues was also determined using IHC. Expression of the Arpin protein in GC was lower than that in normal gastric mucosa (30.68% vs 60.47%, P < 0.001). A χ2 test of the 176 GC samples used for IHC showed that decreased Arpin expression was associated with advanced TNM stage (P < 0.01) and the presence or absence of lymph node metastasis (80.92% vs 35.56%, P < 0.001). Additionally, a significant correlation was observed between the expression of Arpin and the presence of the Arp2/3 complex in GC tissues (χ2 = 30.535, P < 0.001). Moreover, a multivariate Cox regression analysis revealed that Arpin expression [hazard ratio (HR) = 0.551, P = 0.029] and TNM stage (HR = 5.344, P = 0.001) were independent prognostic markers for overall survival of GC patients. Regarding the 3-year disease-free survival (DFS), the recurrence rate of GC patients with low Arpin expression levels (median DFS 19 mo) was higher than that in the high-Arpin-expression group (median DFS 34 mo, P = 0.022). Low Arpin levels are associated with clinicopathological variables and a poor prognosis in GC patients. Arpin may be regarded as a potential prognostic indicator in GC.


Diagnosing multiple system atrophy: current clinical guidance and emerging molecular biomarkers.
Multiple system atrophy (MSA) is a rare and progressive neurodegenerative disorder characterized by motor and autonomic dysfunction. Accurate and early diagnosis of MSA is challenging due to its clinical similarity with other neurodegenerative disorders, such as Parkinson's disease and atypical parkinsonian disorders. Currently, MSA diagnosis is based on clinical criteria drawing from the patient's symptoms, lack of response to levodopa therapy, neuroimaging studies, and exclusion of other diseases. However, these methods have limitations in sensitivity and specificity. Recent advances in molecular biomarker research, such as α-synuclein protein amplification assays (RT-QuIC) and other biomarkers in cerebrospinal fluid and blood, have shown promise in improving the diagnosis of MSA. Additionally, these biomarkers could also serve as targets for developing disease-modifying therapies and monitoring treatment response. In this review, we provide an overview of the clinical syndrome of MSA and discuss the current diagnostic criteria, limitations of current diagnostic methods, and emerging molecular biomarkers that offer hope for improving the accuracy and early detection of MSA.


Paternal alcohol exposure affects offspring behavior but not body or organ weights in mice.
Male mice consumed liquid alcohol diets containing 20, 10, or 0% ethanol-derived calories (EDC) for 56-61 days. Animals fed the 10 and 0% EDC diets were pair-fed to 20% EDC animals. A nontreated ad libitum group was included to assess the effects of pair-feeding. After treatment, males were bred to nontreated females. Litter size, birthweight, bodyweight at 21 or 55 days of age, and organ weights except for thymus were not affected by paternal alcohol ingestion. There was a dose-related decrease in activity at 20 and 24 days of age in an activity chamber and a dose-related decrease in serum testosterone levels at 55 days of age in male offspring sired by alcohol-consuming males. Offspring sired by males consuming the 20% EDC diet also required fewer trials to learn a passive avoidance task and had longer latencies to reach the choice point in a T maze.


Acute neck edema after (131)I ablation of the thyroid.
A 36-year-old woman with Graves' disease underwent thyroid ablation with oral I (20 mCi) following poor control of hyperthyroidism with carbimazole. Three days later, she presented to the emergency department with a choking sensation, shortness of breath, dysphagia, neck discomfort, and swelling. The prevertebral soft tissue was grossly thickened on the lateral neck radiograph. An urgent contrast-enhanced CT neck revealed severe neck edema and thyroiditis. TSH and free T4 levels were normal, and the neck swelling gradually resolved with corticosteroids. Acute neck edema is an infrequent complication of I ablation, and cross-sectional imaging is useful to exclude airway compromise or infection.


Prostate volume predicts high grade prostate cancer both in digital rectal examination negative (ct1c) and positive (≥ct2) patients.
We aimed to assess the relationship between prostate volume (PV) and high grade prostate carcinoma (HGPCa) in patients with benign and suspicious digital rectal examination (DRE) in our prostate biopsy cohort. Between 2009-2012, 759 consecutive initial transrectal systematic 12 cores prostate biopsies were included. PVs were calculated with transrectal ultrasound. Only prostate adenocarcinomas (PCa) were included into the study. For standardization, patients with missing data, and who have been exposed to any form of hormonal or radiation therapy were excluded. Patients were categorized with DRE (negative or positive) and Gleason sum [<7: low grade PCa(LGPCa), ≥7: HGPCa]. Median PV was significantly lower in patients with HGPCa. There was a significantly increased risk of HGPCa with PV according to all groups in univariate logistic regression (LR). The significant relationship continued in multivariate LR with PSA and age. From the ROC curve analyses, again a significantly statistical concordance was found between the detection of HGPCa and PV (AUC:0.63, p<0.001), as well as between HGPCa and tPSA (AUC:0.73, p<0.001). tPSA and PV were also significantly concordant with HGPCa both in DRE negative and positive patients. There is a significant relationship between HGPCa and decreasing PV. The continued significant relationship both in DRE negative and positive patients reinforces this relation.


Re-irradiation With Carbon Ion Radiotherapy for Pelvic Rectal Cancer Recurrences in Patients Previously Irradiated to the Pelvis.
Re-irradiation of locally recurrent rectal cancer poses challenges due to the proximity of critical organs, such as the bowel. This study aimed at evaluating the safety and efficacy of re-irradiation with Carbon Ion Radiotherapy (CIRT) in rectal cancer patients with local recurrence. Between 2014 and 2018, 14 patients were treated at the National Center of Oncological Hadrontherapy (CNAO Foundation) with CIRT for locally recurrent rectal cancer. All patients concluded the treatment. No G≥3 acute/late reaction nor pelvic infections were observed. The 1-year and 2-year local control rates were, 78% and 52%, respectively, and relapse occurred close to the bowel in 6 patients. The 1-year and 2-year overall survival rates were 100% and 76.2% each; while the 1-year and 2-year metastasis free survival rates were 64.3% and 43%. CIRT as re-irradiation for locally recurrent rectal cancer emerges as a safe and valid treatment with an acceptable rate of morbidity of surrounding healthy tissue.


Isolation and characterization of phenol-catabolizing bacteria from a coking plant.
New phenol degrading bacteria with high biodegradation activity and high tolerance were isolated as Burkholderia cepacia PW3 and Pseudomonas aeruginosa AT2. Both isolates could grow aerobically on phenol as a sole carbon source even at 3 g/l. The whole-cell kinetic properties for phenol degradation by strains PW3 and AT2 showed a Vmax of 0.321 and 0.253 mg/l/min/(mg protein), respectively. The metabolic pathways for phenol biodegradation in both strains were assigned to the meta-cleavage activity of catechol 2,3-dioxygenase.


[How to carry out the indications of cardiac resynchronization therapy in practice?].
Recent studies have demonstrated that cardiac resynchronization therapy diminish morbidity and mortality of patients with heart failure, who remain symptomatic despite an optimal medical treatment and who have a wide QRS. However, 30% of patients are non-responders. Hence, echocardiography constitutes an interesting tool for the diagnosis of asynchrony. Different echocardiographic indices predict response to cardiac resynchronization therapy. In this article, a practical approach is proposed for these patients.


A comparison of stapled vs handsewn anastomosis in anterior resection for carcinoma rectum.
The merits of stapled versus hand sewn anastomosis were evaluated in a prospective randomized study of 60 patients undergoing resection for rectal cancer. The analysed factors included the time required for construction of anastomosis, post operative complications, local recurrence, disease free state and survival. Hand sewn anastomosis was performed in two layers with 3/0 silk in 30 cases and the stapled anastomosis with EEA staplers in 30 cases. The anastomosis time averaged 24 minutes in the suture group and 16 minutes in the stapling group. Five post-operative complications occurred in each group. Six patients of the hand sewn group developed local recurrence as a first sign of treatment failure compared to four patients in the stapled group. The average time of study was 41 months. No significant difference was found in the overall survival pattern of the two groups.


Plants as 'chemical factories' for the production of polyunsaturated fatty acids.
Polyunsaturated fatty acids (PUFAs) are valuable products because of their involvement in several aspects of human health. Market demand for most PUFAs is growing continually and current sources are considered insufficient for satisfying this demand; alternative sources are actively sought after. Oilseed plants can be a potential source of PUFAs if they are appropriately gene engineered. Most of the basic tools for genetic engineering of oilseed plants for giving them the ability to produce PUFAs are already developed. Here we review the prospects of genetic engineering of oilseed plants for producing some valuable long-chain polyunsaturated fatty acids. Genetic transformation for GLA production seems to be a near-term possibility, but gene engineering seems considerably more difficult for the other long-chain PUFAs. Nevertheless, with the current rapid pace of biotechnological advancement, the remaining difficulties may be surmounted in the near future.


[Chemiluminescent enzyme immunoassay of cholecystokinin in rat plasma using an immuno-affinity column as a pretreatment].
The cholecystokinin (CCK) plasma concentration of a basal level in a normal rat was at a hardly detectable level (a few pg/ml) even using the highly sensitive chemiluminescent enzyme immunoassay. In this paper, we prepared an anti-CCK F(ab')2 fragment which was made by pepsin digestion from the anti-CCK antiserum. The anti-CCK F (ab')2 fragment was immobilized to the Sepharose 4B gel activated BrCN and packed to column. We have extracted and concentrated CCK in the rat plasma using this column and the CCK assayed by the chemiluminescent enzyme immunoassay (CL-EIA) of CCK. The immuno-affinity column extraction system was more accurate and precise than a reversed phase gel extraction system. The mean recovery of CCK from the rat pooled plasma using the immuno-affinity column was 62.2% (n = 12) by the proposed CL-EIA. The mean +/- S. E. (n = 3) of the CCK concentration in the fasted rat plasma is 3.54 +/- 0.10 pg/ml. The plasma CCK concentrations of normal rats and those of camostat administrated rats, could be measured by the proposed CL-EIA using the immuno-affinity column as a pretreatment.


Percutaneous versus open tracheostomy in the pediatric trauma population.
The purpose of this study was to determine the safety and efficacy of percutaneous versus open tracheostomy in the pediatric trauma population. A retrospective chart review was conducted of all tracheostomies performed on trauma patients younger than 18 years for an 8-year period. There was no difference in the incidence of brain, chest, or facial injury between the open and percutaneous tracheostomy groups. However, the open group had a significantly lower age (14.2 vs. 15.5 years; P < 0.01) and higher injury severity score (26 vs. 21; P = 0.015). Mean time from injury to tracheostomy was 9.1 days (range, 0 to 16 days) and was not different between the two methods. The majority of open tracheostomies were performed in the operating room and, of percutaneous tracheostomies, at the bedside. Concomitant feeding tube placement did not affect complication rates. There was not a significant difference between complication rates between the two methods of tracheostomy (percutaneous one of 29; open three of 20). Percutaneous tracheostomy can be safely performed in the injured older child.


[Studies of poly(vinyl alcohol)/hydroxylapatite hydrogels compounds for cartilage implantation].
The structures and properties of polyvinyl alcohol (PVA)/hydroxylapatite(HA) composites were investigated. The components and processing conditions were studied for preparation of optimum compound hydrogels with good lubricating feature and high bioactivity. The properties, such as stretch strength, compress strength, friction, compress stress relaxation of various compound hydrogels were compared. The micro-morphology of PVA hydrogels and PVA/HA hydrogels were investigated by use of SEM. It was found that the addition of HA could improve the lubricating feature and mechanical strength of hydrogels, and its compress stress relaxation properties were closer to those of natural cartilages.


Increased carrier mobility in end-functionalized oligosilanes.
We show that a class of oligosilane-arene σ, π-hybrid materials exhibits distinct and enhanced solid-state electronic properties relative to its parent components. In the single crystal structure, the σ-conjugation axis of one molecule points towards the π-face of a neighboring molecule due to an unusual gauche conformation. This organization is hypothesized to be beneficial for charge transport. We show that solution-deposited crystalline films of the hybrid materials show up to a 100-fold increase in space-charge limited current (SCLC) mobility relative to literature reports of photoinduced hole transport in oligosilane films. The discovery that σ, π-hybrids are more than the sum of their parts offers a design opportunity for new materials.


Mutation screening in autosomal dominant congenital cataract families from North India.
Congenital cataract an opacity of the eye lens is present at birth and results in visual impairment during early childhood. If left untreated, it can lead to permanent blindness. Its prevalence is ten times higher in developing countries like India. Thus, we aimed to investigate the underlying genetic defects in three autosomal dominant congenital cataract (ADCC) families from North India. Detailed family histories were collected, pedigrees drawn followed by slit-lamp examination and lens photography. Mutation screening was performed in the candidate genes for crystallins, connexins, and membrane proteins by Sanger sequencing. Pathogenicity of novel variant was assessed bioinformatically. In an ADCC (CC-3006) family with bilateral membranous cataract and microcornea, a novel change (c.1114C>T;p.P372S) in GJA3 has been detected. In other two ADCC families affected with subcapsular (CC-286) and shrunken membranous hypermature cataract (CC-3014), a nonsense mutation (c.463C>T;p.Q155X) in CRYβB2 and a frameshift deletion (c.590_591delAG;p.E197VfsX22) in CRYβA1/A3 respectively, are observed. These variants segregated completely with the phenotypes in respective families and were absent in their unaffected family members and unrelated controls (tested for novel variant in GJA3). Earlier p.Q155X (CRYβB2) and p.E197VfsX22 (CRYβA1/A3) are reported with entirely different phenotypes. Thus, findings in present study expand the mutation spectrum and phenotypic heterogeneity linked with GJA3, CRYβB2, and CRYβA1/A3 for congenital cataracts. Identifying underlying genetic defects is essential for disease management and appropriate genetic counseling.


Chemical radiosensitizers: the Journal history.
Purpose: To review the Journal's coverage of chemical radiosensitizers. Methods: I have reviewed all the possibly-relevant papers that appeared in the Journal prior to 1970 and since 2010, plus the most highly-cited papers from the intervening years. I excluded papers that dealt only with oxygen as a sensitizer, that referred to sensitization of phototoxicity or hyperthermia, or that described interactions with antineoplastic agents unless they clearly distinguish between additive toxicity and radiosensitization. My definition of 'chemical' was very broad, so the coverage includes everything from classical hypoxic cell sensitizers to gold nanoparticles. Results: A literature search identifies ∼600 Journal articles as involving 'radiation sensitizing agents'; these articles are not common in Journals' first years but take off after 1970 with a peak in the late 1980s. Half of the highly-cited radiosensitizer papers were published between 1969 and 1974; the two most-cited radiosensitizer papers were 1969 and 1979 papers on hypoxic cell sensitizers. The third most-cited radiosensitizer paper would not come for two more decades, and it would use a physical rather than a chemical approach to radiosensitization. Conclusion: The development of an agent that would differentially sensitize tumors to irradiation remains a 'holy grail' of clinically-oriented radiobiology. Approaches to this goal have been a major feature of the Journal since its first decade, but we have yet to find such an agent. Perhaps we should be discouraged, but personally, I remain optimistic that we (or our students) will succeed.


Clinical Value of Body Mass Index and Waist-Hip Ratio in Clinicopathological Characteristics and Prognosis of Uterine Leiomyomata.
To explore the relationship between body mass index (BMI) and waist-to-hip ratio (WHR) and clinicopathological characteristics and prognosis of uterine leiomyomata (UL). A retrospective analysis of the clinical data of 133 patients with UL admitted to our hospital from September 2018 to August 2019. According to the BMI standard, the patients were divided into the normal group (n = 32), the super-recombination group (n = 45), and the obesity group (n = 56). According to WHR, the patients were divided into the normal body group (n = 32) and the obesity body group (n = 101). The prognosis of all patients with UL at 3 months postoperatively was evaluated. The relationship between BMI patients and clinical characteristics in different groups was compared, and univariate analysis and multivariate logistic regression model were used to analyze the factors affecting the prognosis of UL patients. The proportion of UL patients in the overweight/obese group was higher than that of the normal group, the proportion of the obese body group was higher than that of the normal body group, and the proportion of the good prognosis group was higher than that of the poor prognosis group (P < 0.05). The difference between the overweight/obese group and the normal group and the obese body group and the normal body group was irregular vaginal bleeding, the number of tumors, and the diameter of the lesion (P < 0.05), and the differences between the degenerations in the obese body group and the normal body group were statistically significant (P < 0.05). Multivariate analysis showed that BMI, WHR, surgical method, and tumor location were all independent risk factors that affected the prognosis of the surgery (P < 0.05). Elevated BMI and WHR can be accompanied by an increased risk of UL. Obesity is a risk factor for UL. Overweight/obese women are more clinically pathological than normal patients, and overweight/obese patients have worse surgical prognosis than normal patients. In order to reduce the prevalence of UL and improve the clinicopathological characteristics and prognosis of patients, clinically obese women should be instructed to use reasonable diet and exercise to control weight.


The Metabolic Syndrome Is Associated with Self-Reported Physical Complaints in Patients with Bipolar Disorder.
The prevalence of metabolic syndrome (MetS) in patients with bipolar disorder is 35 to 40%. It is, however, not established yet whether MetS influences participation in physical activity, walking capacity and global functioning. Sixty-five patients (36 ♀) received a full-fasting laboratory screening, performed a walk test including self-report of pre- and post-test pain, and completed the International Physical Activity Questionnaire and the Quick Inventory of Depressive Symptomatology Self Report (QIDS-SR16). Patients with (n=24) and without (n=41) MetS did not significantly differ in age, gender, psychotropic medication doses, physical activity, smoking behaviour and global functioning. In contrast, patients with MetS had a significantly (a) longer illness duration, (b) higher BMI, and (c) lower walking capacity. Moreover, patients with MetS scored significantly higher on the QIDS. Patients with MetS reported more pain before and after the walking test and more dyspnea following 6 minutes of walking, indicating the physical health challenges facing people with bipolar disorder and MetS seeking to engage in physical activity. The current data give further credence to the importance of interventions promoting the walking capacity in people with bipolar disorder, in particular in these patients at a high risk for cardiovascular diseases.


Cu(2+) and Pt(2+) complexes of pyrazole and triazole based dinucleating ligands.
A series of pyrazole and triazole based dinucleating ligands have been synthesized and their complexation potential for metal ions, which exhibit square planar coordination geometry has been studied. In the case of Cu(2+) the complexation equilibria in solution have been determined using pH titrations. Species with 1 : 1 stoichiometry [CuLH(n)], 2 : 1 stoichiometry [Cu(2)LH(m)], and of dimeric nature [Cu(2)L(2)H(p)], have been detected and their overall stability constants have been measured. The reactivity of the dinuclear species [Cu(2)LH(-1)] towards phosphate ester hydrolysis have shown that the OH-functionality incorporated in some of the ligands does not enhance the hydrolysis rate. Several ligands were reacted with Pt(2+) to give insoluble dinuclear species [Pt(2)LI(3)]. One of them was studied by X-ray diffraction and shows that the two Pt(2+) are bridged by the pyrazolide group and by one I(-). The remaining two positions are occupied by the amino group in alpha position of the heterocyclic ring and a terminal I(-). The nearly planar [Pt(2)LI(3)] units form sheets in the crystals, which are about 4 A apart and thus indicate pi stacking interactions.


Factors associated with the conditional release of persons acquitted by reason of insanity: a decision tree approach.
Most NGRI (not guilty by reason of insanity) acquitties are hospitalized for some period of time following acquittal, which raises the question of when an individual can be safely released into the community. The conditional release (CR) of persons acquitted by reason of insanity, therefore, provokes the question of public safety. This study examines the CR systems in four states--Connecticut, Maryland, New York, and Ohio. A study sample of 529 persons acquitted as NGRI from 1985 to 1987 was followed up for at least five years to determine who is conditionally released. Following a description of the CR systems, findings suggestive of the role of dangerousness and diagnosis as predictors of CR are presented. Personal characteristics are also significant factors in predicting who will be released. The length of hospitalization for this population and other descriptive factors such as history of hospitalization, arrests, substance abuse, family violence, and living arrangements are also addressed.


Impaired gastric acid secretion in mast cell-deficient mice.
Gastric acid secretion in normal (+/+) C57B1/6J mice and congeneic, mast cell-deficient (mi/mi) C57B1/6J mice was examined. The mast cell-deficient animals had approximately 50% of the normal quantity of gastric histamine and a blunted basal acid level and secretory response. These observations were noted despite the presence of parietal cells, which were normal in number and morphology. The H2-antagonist ranitidine inhibited basal acid secretion in both groups of animals. Exogenous histamine induced a significant secretory response in normal and mast cell-deficient groups, but only the secretory response in normal animals could be blocked by the H2-antagonist. Treatment of mast cell-deficient animals with histamine for seven consecutive days before stimulation did not restore the histamine response to the normal (+/+) levels. The normal animals demonstrated an acid secretory response to pentagastrin. Mast cell-deficient mice also responded to pentagastrin, but the response was less than that observed in the normal animals, and a significant difference was not evident in all experiments. Furthermore, simultaneous injection of mast cell-deficient animals with histamine and pentagastrin did not restore pentagastrin responsiveness to normal levels, although the histamine concentration used was sufficient to raise acid secretion to basal levels of normal mice. These results support the conclusion that non-mast cell histamine only partially contributes to basal gastric acid secretion and is insufficient to facilitate full parietal cell responsiveness. Furthermore, pentagastrin requires the presence of mast cells to elicit a maximal secretory response but can use non-mast cell histamine to activate the parietal cells for acid secretion.


A Privacy-Preserved Variational-Autoencoder for DGA Identification in the Education Industry and Distance Learning.
One of the most insidious methods of bypassing security mechanisms in a modern information system is the domain generation algorithms (DGAs), which are used to disguise the identity of malware by periodically switching the domain name assigned to a command and control (C&C) server. Combating advanced techniques, such as DGAs, is an ongoing challenge that security organizations often need to work with and possibly share private data to train better and more up-to-date machine learning models. This logic raises serious concerns about data integrity, trade-related issues, and strict privacy protocols that must be adhered to. To address the concerns regarding the privacy and security of private data, we propose in this work a privacy-preserved variational-autoencoder to DGA combined with case studies from the education industry and distance learning, specifically because the recent pandemic has brought an explosive increase to remote learning. This is a system that, using the secured multi-party computation (SMPC) methodology, can successfully apply machine learning techniques, specifically the Siamese variational-autoencoder algorithm, on encrypted data and metadata. The method proposed for the first time in the literature facilitates learning specialized extraction functions of useful intermediate representations in complex deep learning architectures, producing improved training stability, high generalization performance, and remarkable categorization accuracy.


Demonstration of heterogeneity among the antigenic proteins of Mobiluncus species.
The protein and antigenic profiles of the American Type Culture Collection type strains of Mobiluncus species and those of 114 clinical isolates were determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis and immunoblotting with homologous polyvalent antisera. The majority of isolates (82%) possessed characteristic protein profiles and could be identified to the species level by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis. The major protein bands were also antigenic, and some antigenic cross-reactivity was noted between the two Mobiluncus species. All of the isolates were examined for reactivity with a panel of 12 monoclonal antibodies previously prepared against the type strains. While 56 of 60 clinical isolates of Mobiluncus curtisii (93%) reacted with one or more of the monoclonal antibodies, only 23 of 54 clinical isolates which were identified as Mobiluncus mulieris by biochemical methods (48%) reacted with one or more of the monoclonal antibodies. One of the 4 M. curtisii isolates (25%) and 11 of the 31 M. mulieris isolates (35%) which did not react with the monoclonal antibodies also had atypical protein profiles. These results demonstrate a high degree of heterogeneity in the protein and antigenic profiles of Mobiluncus isolates and suggest that further taxonomic division may be appropriate.


Lack of defective cardiac oxidative metabolism in intact dogs subjected to a prolonged low-dose infusion of Escherichia coli endotoxin.
The aim of the present study was to determine possible direct adverse effects of a 2-hour Escherichia coli endotoxin infusion (50 ng kg-1 min-1) on myocardial oxidative carbohydrate metabolism. The experiments were performed in intact dogs to assay glucose and lactate cardiac uptake and relate them to oxygen consumption (MVO2), CO2 production, and myocardial hemodynamics. Coronary sinus blood flow (CSBF) was measured by thermodilution, and the arteriovenous differences in glucose, lactate, pyruvate, O2, and CO2 were determined by blood samples obtained simultaneously from the carotid artery and sinus coronary. The adequacy of CSBF in meeting cardiac oxygen needs was evaluated by calculating the percentage of anaerobic metabolic rate (% AMR). During endotoxin infusion, CSBF was significantly lowered by 33% while mean aortic blood pressure was decreased by 43%. Cardiac index exhibited a minimal reduction of 14%. Mean arterial blood glucose decreased 30% and arterial lactate increased 100%. Despite the progressively developing hypoglycemia, cardiac glucose uptake increased 140%. Although MVO2 was reduced to 70% of control value, lactate uptake increased 50%. Throughout the experimental period, the % AMR remained negative. Under endotoxin infusion, up to 78% of the cardiac CO2 production was derived from carbohydrate utilization, as compared to 40% prior to endotoxin infusion. Our findings suggest the absence of any toxic action by an endotoxin-sustained infusion on cardiac oxidative metabolism.


Risk Factors for Peritoneal Recurrence in Stage II to III Colon Cancer.
Most previous reports to analyze risk factors for peritoneal recurrence in patients with colon cancer have been observational studies of a population-based cohort. This study aimed to determine the risk factors for peritoneal recurrence in patients with stage II to III colon cancer who underwent curative resection. This was a pooled analysis using a combined database obtained from 3 large phase III randomized trials (N = 3714). Individual patient data were collected from the Japanese Foundation for Multidisciplinary Treatment of Cancer clinical trials 7, 15, and 33, which evaluated the benefits of postoperative 5-fluorouracil-based adjuvant therapies in patients with locally advanced colorectal cancer. We included patients who had stage II to III colon cancer and underwent curative resection with over D2 lymph node dissection. Main outcomes measured were risk factors for peritoneal recurrence without other organ metastasis after curative surgery. Peritoneal recurrence occurred in 2.3% (86/3714) of all patients undergoing curative resection. Mean duration from operation to peritoneal recurrence was 17.0 ± 10.3 months. Of these patients with peritoneal recurrence, 29 patients (34%) had recurrence in ≥1 other organ. Multivariate analysis showed that age (≥60 y: HR = 0.531; p = 0.0182), pathological T4 (HR = 3.802; p < 0.0001), lymph node involvement (HR = 3.491; p = 0.0002), and lymphadenectomy (D2: HR = 1.801; p = 0.0356) were independent predictors of peritoneal recurrence. The overall survival was lower in patients who developed peritoneal recurrence than in those with other recurrence (HR = 1.594; p = 0.002). The regimens of adjuvant chemotherapy were limited to oral 5-fluorouracil. Our findings clarified the risk factors for peritoneal recurrence in patients who underwent curative resection for colon cancer. See Video Abstract at http://links.lww.com/DCR/A609.


Uptake and quantification of intracellular concentration of lipophilic pro-oligonucleotides in HeLa cells.
Several lipophilic prodrugs of oligonucleotides (T12 and T20) bearing enzymolabile protecting groups and labeled with fluorescein were synthesized. Their cellular uptake was studied by three different approaches using fluorescence: fluorescence microscopy, flow cytometry and spectrofluorometry. The corresponding prooligonucleotides (pro-oligos) were rapidly and efficiently taken up by HeLa cells and were found homogeneously in the cytoplasm and in the nucleus. The uptake was proportional to their relative lipophilicity and likely proceeded through a passive diffusion mechanism. Uptake followed a dose-response curve. This prooligo approach led to a 2-log increase of uptake in comparison with a T20 phosphorothioate oligonucleotide. Finally, an intracellular concentration of pro-oligo was estimated between 4 and 6 microM for an external concentration of 1 microM and up to 27 microM for an incubation at 10 microM.


[Globin-coding sequences in the nuclear 28S pre-mRNA and in the cytoplasmic RNA of pigeon erythroid cells].
The steady-state content of globin-coding sequences in nuclear and cytoplasmic RNA of pigeon erythroid cells was estimated by hybridization in the excess of nuclear 28S RNA and cytoplasmic poly(A) + RNA with [3H]DNA, synthesized on globin mRNA. Sequences of 9S globin mRNA are found in 0.06% of molecules of non-ribosomal 28S nuclear RNA (pre-mRNA) of erythroblasts and in 0.5% of molecules of non-ribosomal 28S nuclear RNA of reticulocytes. The content of globin mRNA in erythroblast cytoplasm is, respectively lower than in that of reticulocytes.


Angioimmunoblastic lymphadenopathy and squamous cell carcinoma of lung.
The development of angioimmunoblastic lymphadenopathy in a patient with a slowly growing squamous cell carcinoma of the lung is reported. The possible relation between the two concomitant conditions in this rare case is proposed.


Review of fruit cork spot disorder of Asian pear (Pyrus spp.).
Cork spot disorder has affected the fruit of Asian pear since the 1990s and has become serious in recent years with increasingly affected cultivars and areas. The commodity value of affected fruit is greatly decreased, resulting in severe economic losses. Cork spot disorder of pear fruit is a physiological disorder, and the factors responsible are relatively complex. Research on the cause of cork spot disorder is still at an early stage and, thus, further investigations are needed to elucidate the underlying mechanism of the disorder. In this review, current knowledge of the factors associated with the incidence of cork spot disorder in Asian pear fruit is summarized, including fruit growth and development, fruit nutrient status, and environmental factors. Potential preventive measures and priorities for future research are outlined.


A Morgagni diaphragmatic hernia found after removal of mediastinal tumor.
Morgagni hernia is a disease in which the abdominal contents herniate into the thoracic cavity through a congenital parasternal defect of the diaphragm resulting from an increased intra-abdominal pressure. Obesity, pregnancy, and a history of trauma are considered predisposing factors of Morgagni hernia. However, there is slight evidence that trauma has been the factor. Moreover, Morgagni hernia related to an operation has been rarely reported. We report a case of a female patient, whose mediastinal tumor had been removed 6 months prior to her being diagnosed with postoperative Morgagni hernia. There was a satisfactory result after the repair by an upper abdominal incision.


Human larynx carcinoma cells resistant to cis-diamminedichloroplatinum(II): mechanisms involved in the resistance.
The aim of this study was to characterize two cis-diamminedichloroplatinum(II) (CDDP) resistant cell lines established from human larynx carcinoma HEp2 cells through repeated treatments with increased CDDP concentrations. CK2 cells obtained by continuous treatments were more resistant to CDDP than CA3 cells obtained by acute treatments. The examination of growth characteristics showed that both CDDP resistant cells had doubling times identical to that of the parental cells, but had lower plating efficiency. The possible involvement of glutathione (GSH), glutathione transferases (GST), metallothioneins, P-glycoprotein and drug accumulation in CDDP resistance was examined. Glutathione contents were elevated in both CDDP resistant lines. However, neither GSH nor GST were involved in CDDP resistance. This was demonstrated by simultaneous incubation of parental and CDDP resistant cells with CDDP and specific inhibitors of GSH and GST alpha and pi (buthionine sulfoximine and ethacrinic acid). Similarly, verapamil, an inhibitor of P-glycoprotein, did not influence the sensitivity of parental and resistant cells to CDDP. As compared to the parental cells, CK2 cells became resistant and CA3 cells became sensitive to cadmium, indicating increased level of metallothioneins in CK2 cells, and reduced level in CA3 cells. Measurements of platinum contents in parental and CDDP resistant cells after 1, 3 and 6 hours exposure to 70 mumol CDDP showed reduction in platinum accumulation after each exposure time in CK2 cells, and after 6 hours exposure in CA3 cells. This study identified decreased platinum accumulation as an important mechanism of CDDP resistance in human larynx carcinoma cells.


Tumoral calcinosis in postmenopausal women in urban India: an etiopathologic evaluation of 64 cases.
Tumoral calcinosis (TC) is a distinct pathologic entity of obscure etiology, characterized by soft tissue calcium deposition. We analyzed 64 cases retrieved from surgical records over the last 15 years, to assess the disease pattern and recognize the various stages of the evolution of this lesion. In our study, most patients were women (53/64 cases), 47 of whom were postmenopausal, aged 51-70 years, belonging to lower socioeconomic strata, and involved with household chores. The hip was the most frequently affected site. Repeated trauma probably triggered calcium chelation and deposition at this site. Histologically, 10 cases belonged to stage II and 54 cases to stage III. Fully developed lesions showed chips of calcium surrounded by thick fibrosis, mimicking calcified parasite like the Guinea worm. Precursor lesions seen at the periphery of the main lesion suggests a possible etiological role for trauma. Postmenopausal hormonal imbalance, along with poor nutrition and repeated trauma led to TC in our women population. Awareness of its evolution can lead to a better understanding of the disease with possible therapeutic implications.


Fabrication of multi-layer polymeric micro-sieve having narrow slot pores with conventional ultraviolet-lithography and micro-fabrication techniques.
Fast detection of waterborne pathogens is important for securing the hygiene of drinking water. Detection of pathogens in water at low concentrations and minute quantities demands rapid and efficient enrichment methods in order to improve the signal-to-noise ratio of bio-sensors. We propose and demonstrate a low cost and rapid method to fabricate a multi-layer polymeric micro-sieve using conventional lithography techniques. The micro-fabricated micro-sieves are made of several layers of SU-8 photoresist using multiple coating and exposure steps and a single developing process. The obtained micro-sieves have good mechanical properties, smooth surfaces, high porosity (≈40%), and narrow pore size distribution (coefficient of variation < 3.33%). Sample loading and back-flushing using the multi-layer micro-sieve resulted in more than 90% recovery of pathogens, which showed improved performance than current commercial filters.


Villoglandular papillary adenocarcinoma: case report.
Villoglandular papillary adenocarcinoma (VPA) is a very rare subtype of adenocarcinoma of the uterine cervix, but a well-recognized variant of cervical adenocarcinoma with a favorable prognosis and generally occurring in women of child-bearing age. Herein, we report a case of VPA diagnosed and managed successfully with conservative measure. This management is particularly desirable in young women to preserve reproductive capability.


Developing and testing a case manager impact profile.
The purpose of this study was to develop and test an instrument to measure the activities and perceived outcomes of rural nurse case managers in hospital settings. The Nurse Case Manager Impact Profile (NCMIP) is a 69-item, Likert-type questionnaire organized into two scales, the Activity Scale and the Outcome Scale. Content validity of the NCMIP was endorsed by four experts in nursing case management and rural nursing. Its validity and reliability were assessed in a survey of nurse case managers (N = 302) in nonfederal, rural, U.S. hospitals. Internal consistency was high for the five Activity subscales and for the Activity and Outcome scale: Individual Advocacy (alpha = .85), Clinical Practice (alpha = .85), Teaching (alpha = .89), Research (alpha = .86), System Advocacy (alpha = .85), Activity (alpha = .93), and Outcome (alpha = .92). Factor analysis with orthogonal varimax rotation resulted in clear confirmation of a five-dimensional Activity scale and of two of the five subscales. Factor solutions, however, suggested a reconceptualization of three subscales into three new factors with unifying themes. Although factor solutions confirmed two of the four dimensions of the Outcome Scale, items for the remaining two dimensions reconfigured to suggest overlapping domains. Psychometric testing suggests that the NCMIP warrants further development and testing and, like any new instrument, should be used with discretion and caution.


Computer assisted total parenteral nutrition for pre-term and sick term neonates.
Over the past few years, the use of total parenteral nutrition (TPN) has been established for pre-term and sick term neonates. At 'IASO' Hospital, a series of protocols implemented through the use of a computer programme has been developed to assist in the time consuming task of prescribing and preparing TPN in neonates. The algorithms used for neonates of a different gestational age are based on the protocols created through screening of literature and personal experience. This is important because it heralds a uniformity of the prescription of TPN at IASO and other hospitals where these protocols have been implemented. The objective is to determine the extent of error occurrence of the manual method as opposed to the new computerized procedure of TPN formulation, and to assess the immediate benefits stemming from the computer programme's use, in terms of personnel time reduction. Furthermore, the usefulness of the automated compounder in the computer driven process of TPN solution formulation was also assessed. Gynaecology Hospital 'IASO'. For a period of 6 months, sick and prematurely born babies were included in the study. Calculations regarding the composition of TPN solutions were conducted both by computer and manually. The time needed to complete the procedure and the results' accuracy were measured and compared. Implementation of the protocols into practice via this computer programme has been found to reduce the time spent by the physician and the pharmacist on TPN solution preparation, but the most important contribution is the virtual elimination (no errors in computerized calculation) of errors in the complex task of prescribing and formulating TPN solutions. For example, the average time taken to prepare the individual TPN solutions was 5.2 min while the computerized procedure took 15.4 min. Use of this system can optimize pharmacists' and physicians' work and help prevent prescription and preparation errors.


Detection of microscopic cracks in dental ceramic materials by fluorescent penetrant method.
Ceramic materials are used as implants and prostheses because of their excellent biocompatibility and in the dental field beyond that, because of esthetic advantages and the little plaque accumulation. A disadvantage is their sensitivity to microscopic cracks because of their brittleness. Strength-deteriorating microscopic cracks can be introduced into the ceramic surface by the manufacturing process. The objective of this study was to evaluate three methods on their efficiency to detect microscopic surface cracks of clinical relevance in dental ceramic materials. These methods were light-optical microscopy, fluorescent microscopy after penetration with a fluorescent liquid, and scanning electron microscopy (SEM). It was found that microscopic cracks of critical sizes can be detected using the fluorescent penetrant method, which was not to be proven by light-optical microscopy and even not by SEM. We conclude from our study that the fluorescent penetrant method could help to decrease clinical failures of dental ceramic components that are caused by surface microscopic cracks from the manufacturing process, if this method was routinely performed before the clinical use of the ceramic components.


Measurement of depth-resolved thermal deformation distribution using phase-contrast spectral optical coherence tomography.
An updated B-scan method is proposed for measuring the evolution of thermal deformation fields in polymers. In order to measure the distributions of out-of-plane deformation and normal strain field, phase-contrast spectral optical coherence tomography (PC-SOCT) was performed with the depth range and resolution of 4.3 mm and 10.7 μm, respectively, as thermal loads were applied to three different multilayer samples. The relation between temperature and material refractive index was predetermined before the measurement. After accounting for the refractive index, the thermal deformation fields in the polymer were obtained. The measured thermal expansion coefficient of silicone sealant was approximately equal to its reference value. This method allows correctly assessing the mechanical properties in semitransparent polymers.


Limb salvage in extremity soft-tissue sarcoma: combined modality therapy.
Thirty-two consecutive patients with high-grade soft-tissue sarcoma of an extremity were treated preoperatively with concomitant intra-arterial infusion of Adriamycin (doxorubicin) (10 mg/m2 daily for 10 days) and radiotherapy (2500 rad [25 Gy] in 10 fractions in 2 weeks). En bloc resection was then performed. Postoperatively, depending on the surgical specimen findings, radiotherapy was given to a dose ranging from 5000 rad (50 Gy) in 5 weeks to 6000 rad (60 Gy) in 6 weeks equivalent continuous schedules. No residual tumor was found in 28% of the surgical specimens and only minimal tumor in 41%. A functionally intact limb was preserved in 30 patients (94%). Local recurrence developed in one patient (3%). The actuarial overall survival at three years was 70% and disease-free survival 57%.


Imaging of haemophilic arthropathy in growing joints: pitfalls in ultrasound and MRI.
The purpose of this review was to summarize the current knowledge on the utilization of magnetic resonance imaging (MRI) and ultrasound (US) for assessing arthropathy in children and adolescents with haemophilia and to recognize the limitations of each imaging modality and pitfalls in the diagnosis of soft tissue and osteochondral abnormalities. Awareness of MRI and US limitations and pitfalls in the assessment of joints in persons with haemophilia is essential for accurate diagnosis and optimal management of haemophilic arthropathy.


Toxicity assay for deoxynivalenol using Caenorhabditis elegans.
The progeny production and development rates of the nematode Caenorhabditis elegans when treated with deoxynivalenol (DON) were examined. Both purified DON and a crude extract from Fusarium graminearum cultured on rice were tested on C. elegans wild-type (Bristol N2) and a mutant strain (AU1). Significant effects (Tukey-HSD, p<0.05) on brood size and the rate of larval development from egg to adulthood were observed. Both N2 and AU1 strains showed lower rates of development and smaller brood sizes when exposed to purified DON at concentrations of 500 and 1000 µg ml(-1) When they were exposed to crude extract containing 250 µg ml(-1) DON, the inhibition of egg hatching and a greatly reduced development rate were observed. The results suggest that selection of a more sensitive C. elegans mutant strain could be used as a suitable animal model for conducting DON toxicity assays.


The PTFE Y-graft: one year experience in 21 patients. A preliminary report.
21 patients had aortoiliac reconstructions for aortic aneurysms or occlusive disease with the new PTFE Y-graft during the past 12 months. 2 patients in the aneurysm group with additional renal artery reconstruction suffered postoperative myocardial infarction and subsequently died. 2 patients older than 80 years died after aneurysm repair in cause of graft infection, respectively respiratory insufficiency. All grafts (n=17) are functioning well or did so until death of the patient (n=4). The obvious advantage of the PTFE Y-graft is the fact, that there is no need of preclotting. Suture line--even using 4-0 material at the proximal anastomosis--and graft body is absolutely tight and no blood loss has to be expected from this site. However positioning of the left limb of the y-graft can be difficult in patients with right sided extraperitoneal approach and proximal side end anastomosis. Performing an end-end anastomosis can overcome this problem. For occlusion of the prosthesis limbs two vascular clamps on each side are needed to control blood flow within the rather stiff graft. Immediate and short term function is excellent. There was no material specific complication noted until now. Further longterm experience is necessary to evaluate the definitive quality of this new prosthetic material after some years.


Correlation between computed tomography and bone single photon emission-computed tomography scintigraphy in patients with chronic rhinosinusitis.
Computed tomography (CT) has been the imaging study of choicefor evaluating chronic rhinosinusitis (CRS). 99mTc-MDP bone single photon emission-computed tomography (SPECT) has proven useful at identifying inflammation of bone and its use in CRS has been discussed recently. No studies, however, have documented the correlation between these two imaging modalities in CRS. A retrospective analysis was performed of 30 patients with CRS who underwent CT and SPECT scan of the paranasal sinuses. Increased radiotracer uptake during SPECT scan was compared with CT findings graded on the Lund-Mackay score (LMS). The findings of the two imaging modalities were compared and evaluated for standard correlative statistics for diagnostic tests. SPECT imaging was abnormal in 25/30 patients, and CT was abnormal in 27/30 patients. Correlation between the two was highest for the ethmoid sinuses at 73.3%. SPECT had a high positive predictive value for mucosal inflammation on CT of 84.1%. Approximately 25% of individual sinuses with a positive SPECT in patients without prior surgery were not positive in corresponding sinuses onl CT. There was a positive correlation between the LMS and the number of SPECT positive sinuses within the same patient (r = 0.486; p = 0.006). 99mTc-MDP SPECT scan in patients with CRS is shown to be a useful indicator of bone involvement. The relatively high rate of bone involvement in the absence of mucosal inflammation as seen in this study warrants additional research and the potential need for different therapies than are currently available.


Basal forebrain atrophy is a distinctive pattern in dementia with Lewy bodies.
We determined brain atrophy patterns in dementia with Lewy bodies and Alzheimer's disease using voxel-based morphometry, an indirect volumetry. Ten patients with dementia with Lewy bodies, 10 patients with Alzheimer's disease and 10 controls were included. All groups were matched for age; sex and global differences in voxel intensities were included as confounding covariates. We observed basal forebrain atrophy discriminating dementia with Lewy bodies from Alzheimer's disease. Compared to controls, atrophy of lateral prefrontal cortex and left premotor cortex was seen in dementia with Lewy bodies whereas atrophy of the medial temporal cortex, posterior parietal cortex, thalamus and temporo-occipital areas was observed in Alzheimer's disease. Atrophy of insular cortex was found in both patient groups.


The treatment of multidirectional instability of the shoulder with a rehabilitation programme: Part 2.
The most commonly recommended initial treatment for multidirectional instability is a rehabilitation program. Although there is evidence to support the effect of conservative management on this condition, the published literature provides little information on the exercise parameters of such programs. This paper is the second part of a two-part series that outlines a six-stage rehabilitation program for multidirectional instability with a focus on scapula control and exercise drills into functional positions. This paper outlines stages 3 to 6 of this rehabilitation program. This clinical protocol is currently being tested for efficacy as part of a randomized controlled trial (Australian New Zealand Clinical Trials Registry #ACTRN12613001240730). The information in this paper and additional online supplementary files will provide therapists with adequate detail to replicate the rehabilitation program in the clinical setting.


The effect of antibiotics on the cell morphology of Legionella pneumophila.
Legionella pneumophila, in Buffered Yeast Extract broth, was treated for 5 h at 37 degrees C with rosaramicin, erythromycin, cefotaxime, dibekacin, penicillin, methicillin, cefoxitin, cephalothin, ticarcillin, carbenicillin or polymyxin B at near-MIC levels and above. Electronmicroscopy demonstrated morphological changes to the bacteria in some, but not all, of the antibiotic-treated suspensions. Penicillin, at 1000 micrograms/ml (40 X MIC) but not less, produced smooth bubble-like structures on cell surfaces; methicillin produced rough bubble-like structures at 100 micrograms/ml (MIC) but not at 1000 micrograms/ml. In each case, these structures resembled spheroplasts. Polymyxin B induced small-bleb formation on the bacterial cell surfaces at all concentrations tested (MIC-10 X MIC). The other eight antibiotics did not induce any morphological changes at any concentration tested.


Interleukin-5 mRNA stability in human T cells is regulated differently than interleukin-2, interleukin-3, interleukin-4, granulocyte/macrophage colony-stimulating factor, and interferon-gamma.
Interleukin-5 (IL-5) transcriptional activation and mRNA stability were investigated in a human TH0 T-cell clone (SP-B21) and in nonclonal CD4 TH2 cells, differentiated in vitro from peripheral blood T cells. Cells were stimulated with alpha-CD3 monoclonal antibody (mAb) with and without alpha-CD28 mAb. Comparison to other cytokine genes revealed aspects of mRNA regulation unique to IL-5. The half-life (t1/2) of IL-5 mRNA, determined by addition of actinomycin D (ActinoD) or cyclosporin A (CSA) was longer (by >= 2 h) than that of IL-2, IL-3, IL-4, interferon-gamma, or granulocyte/macrophage colony-stimulating factor. With the exception of IL-5, t1/2 values were significantly shorter with CSA as the transcriptional inhibitor than with ActinoD. The t1/2 value of IL-5 mRNA, but not the other cytokine transcripts, determined with either ActinoD or CSA, was longer than predicted from the kinetics of steady-state mRNA decline. Co-stimulation of both cell types with alpha-CD28 mAb increased the stability of cytokine transcripts weakly, and IL-5 remained the most stable transcript. Thus, the degradation pathway that targets IL-5 is distinct from the other cytokine transcripts measured and involves proteins whose transcription is blocked by ActinoD and CSA. From examination of the levels of transcription initiation (nuclear run-on assay) and steady-state mRNA attained in cultures stimulated in the presence of the protein synthesis inhibitor, cycloheximide, only IL-5 transcription initiation had an absolute dependency on new protein synthesis.


Co-administration of cyclosporine and ketoconazole in idiopathic childhood nephrosis.
The concomitant use of cyclosporine (CsA) and ketoconazole (keto) in children with nephrotic syndrome (NS) has never been reported in the literature. This retrospective cohort study was conducted to investigate cost saving, safety, and efficacy of co-administration of keto and CsA in children with NS. The study included 186 nephrotic children receiving CsA therapy. Most were steroid dependent or resistant, and the most common pathology was focal segmental glomerulosclerosis (62%). Among our patients, 137 received daily keto therapy (keto group) 50 mg/day in addition to CsA, while 49 received CsA alone (non-keto group). The characteristics of both groups were comparable and the mean (+/-SD) duration of treatment was 22.9 +/- 8.1 months. Co-administration of keto significantly reduced the mean dose of CsA with an overall net cost saving of 37%. It also resulted in a significant improvement of CsA response, more successful steroid withdrawal, and decreased the frequency of renal impairment. Keto was generally well tolerated and safe. We conclude that co-administration of low-dose keto with CsA in children with idiopathic NS is safe, significantly reduces the cost of CsA therapy, and may improve the patient outcome.


Intrauterine intestinal obstruction due to fetal midgut volvulus: a report of two cases.
Fetal midgut volvulus is quite rare, and few surviving infants--particularly cases with meconium peritonitis--have been reported in the literature. We report two cases of intrauterine intestinal obstruction due to fetal midgut volvulus associated with intestinal malrotation. In both cases, the infant survived after cesarean section delivery and appropriate surgical intervention, and they both continue to be in good overall condition. We discuss the prenatal signs and outcome of in utero intestinal volvulus. Close prenatal follow-up and appropriate timing of delivery in cases where ultrasound examination shows signs of fetal intestinal obstruction, as well as optimal postnatal treatment, are essential to reduce the morbidity and mortality associated with fetal midgut volvulus.


Comparison of lateral opening wedge calcaneal osteotomy and medial calcaneal sliding-opening wedge cuboid-closing wedge cuneiform osteotomy for correction of planovalgus foot deformity in children.
The purpose of the present study was to compare the clinical and radiographic results between 2 procedures, lateral opening wedge calcaneal osteotomy (LCL) and medial calcaneal sliding-opening wedge cuboid-closing wedge cuneiform osteotomy (3C) in patients with planovalgus foot deformity. A total of 38 patients who underwent either LCL (18 patients, 28 feet) or 3C (20 patients, 32 feet) were included in the present study. The etiology of the planovalgus foot deformity was idiopathic in 16 feet and cerebral palsy in 44 feet. The 2 procedures used in the present study were indicated in symptomatic (pain or callus) children in whom conservative treatment, such as shoe modifications or orthotics, had been applied for more than 1 year but had failed. The patients were evaluated preoperatively, postoperatively, and at the last follow-up visit, both clinically and radiologically, and the interval to union and postoperative courses were compared between the 2 groups. In the LCL group, 19 of the 28 feet (68%) showed a satisfactory outcome and 9 (32%) an unsatisfactory outcome. In the 3C group, 28 of the 32 feet (88%) showed a satisfactory outcome and 4 (12%) an unsatisfactory outcome. The clinical results were not significantly different between the 2 groups, with mild to moderate pes planovalgus deformity. However, the clinical results were better in the 3C group with severe pes planovalgus deformity than in the LCL group with severe pes planovalgus deformity. All 4 radiographic parameters were improved at the last follow-up visit in both groups. In particular, the talar-first metatarsal angle and the calcaneal pitch angle on the weightbearing lateral radiographs were significantly improved in the 3C group with mild to moderate planovalgus foot deformity. All 4 parameters were significantly improved in the 3C group with severe planovalgus foot deformity. No significant differences were observed between the 2 groups in terms of the interval to union and postoperative care. No case of postoperative deep infection or nonunion was encountered in either group. 3C is a more effective procedure than LCL for the correction of pes planovalgus deformity in children, especially severe pes planovalgus deformities.