A novel technique for the determination of body fat by computed tomography.
We have developed a new method of measuring fat volume of the human body, using computed tomographic scanning (CT scan) - no ideal or direct method has been available for this calculation. In our study a human body is divided into 11 cylindrical shapes, ie a head, a chest, an abdomen, both sides of forearms, upper arms, thighs and calves to be subjected to the measurement. Eleven computed tomographic sections were examined at the middle point of each segment to obtain the areas of fat tissue. Volume of each cylindrical segment was calculated by multiplying a cross-sectional area of fat tissue by the height of each part. Then the volume of fat tissue of the whole body was determined by the sum of fat tissue volume of eleven parts (as above). By this method, nine massive obese subjects with 147-188 percent of ideal body weight were found to possess fat tissue occupying 30-63 percent of total body volume. We also found female obese patients had a significantly higher percentage of fat tissue than male obese patients when they had same degree of obesity. In addition to the study above, we examined 18 control and 19 obese subjects and measured subcutaneous fat, muscle plus bone and visceral fat separately by CT scan at the umbilicus level. In obese subjects, increased abdominal fatty mass was mainly due to the accumulation of subcutaneous fat, although substantial increase of visceral fatty mass was demonstrated in a few cases.


Excited-state structural dynamics of cytosine from resonance Raman spectroscopy.
Cytosine, a nucleobase found in both DNA and RNA, is known to form photoproducts upon UV irradiation, damaging the nucleic acids and leading to cancer and other diseases. To determine the molecular mechanism by which these photoproducts occur, we have measured the resonance Raman spectra of cytosine at wavelengths throughout its 267 nm absorption band. Self-consistent analysis of the resulting resonance Raman excitation profiles and absorption spectrum using a time-dependent wave packet formalism yields both the excited-state structural changes and electronic parameters. From this analysis, we have been able to determine that, at most, 31% of the reorganization energy upon excitation is directed along photochemically relevant modes.


Flow cytometric analysis of cytokine production by normal human peripheral blood dendritic cells and monocytes: comparative analysis of different stimuli, secretion-blocking agents and incubation periods.
In this paper, we comparatively analyze the effects of the following different stimuli on the production and intracellular accumulation of the interleukin (IL)-1 beta, IL-6, IL-12, tumor necrosis factor-alpha (TNF-alpha), and IL-8 inflammatory cytokines in both normal human peripheral blood (PB) dendritic cell (DC) subsets and monocytes: lipopolysaccharide (LPS) versus Staphylococcus aureus cowan I (SAC) in the presence or absence of interferon-(IFN)-gamma-, cytokine secretion-blocking agents (brefeldin A alone versus brefeldin A plus monensin), and incubation periods (6, 12, and 24 h). For this purpose, a four-color multiple-staining direct immunofluorescence technique analyzed by flow cytometry was systematically used in all experiments (n = 19). Our results show that after stimulation, an important proportion of each of the two CD33(+) myeloid DC subsets as well as the monocytes produce significant amounts of all cytokines analyzed under each of the experimental conditions assayed. In contrast, CD33(-/+lo) lymphoplasmocytoid DC failed to produce detectable levels of any of the above-mentioned cytokines under the same stimulatory conditions. Upon comparing the different stimuli used, LPS was associated with higher percentages of cytokine-producing cells compared with SAC, especially within the CD33(hi) DC subset; interestingly, the addition of IFN-gamma enhanced the response of monocytes to both LPS and SAC. As regards the secretion-blocking agents, brefeldin A alone was superior to the combination of brefeldin A and monensin. This is because it was frequently associated with both a higher percentage of cytokine-positive cells and greater amounts of detectable cytokines per cell. Sequential analysis of cytokine production by PB DC and monocytes after 6, 12, and 24 h of cell culture showed that after 6 h, an increased cell death rate existed among DC, which became even undetectable at 24 h, in the absence of a significant increase in cytokine secretion. In summary, our results show that from the experimental conditions assayed in this paper, to induce cytokine production by normal human DC and monocytes, maximum response is obtained once PB samples are stimulated for 6 h with LPS (with or without IFN-gamma) in the presence of brefeldin A alone.


Conceptual representations in goal-directed decision making.
Emerging evidence suggests that the long-established distinction between habit-based and goal-directed decision-making mechanisms can also be sustained in humans. Although the habit-based system has been extensively studied in humans, the goal-directed system is less well characterized. This review brings to that task the distinction between conceptual and nonconceptual representational mechanisms. Conceptual representations are structured out of semantic constituents (concepts)--the use of which requires an ability to perform some language-like syntactic processing. Decision making--as investigated by neuroscience and psychology--is normally studied in isolation from questions about concepts as studied in philosophy and cognitive psychology. We ask what role concepts play in the "goal-directed" decision-making system. We argue that one fruitful way of studying this system in humans is to investigate the extent to which it deploys conceptual representations.


Endoscopically treated Cronkhite-Canada syndrome associated with minute intramucosal gastric cancer: an analysis of molecular pathology.
There have been no reports of Cronkhite-Canada syndrome (CCS) associated gastric cancer resected with endoscopy because it is very difficult to identify small cancers that are candidates for endoscopic resection. We report a case of CCS with gastric cancer treated with endoscopic submucosal dissection, and we evaluate the molecular pathological analysis of malignant transformation in patients with CCS. A 74-year-old man had an advanced rectal cancer and gastrointestinal polyposis after presenting with hypoproteinemia, partial hair loss and atrophic nails as well as hyperpigmentation on the hands. He was diagnosed as having CCS. On upper endoscopy, a 7 mm discolored polyp with an irregular microvascular pattern revealed by magnified narrow-band imaging (NBI) was identified in gastric diffuse CCS polyposis. This lesion was treated with endoscopic submucosal dissection and diagnosed as a flat, elevated-type, mucosal well-differentiated tubular adenocarcinoma without lymphatic or venous infiltration, and with tumor-free margins. Microsatellite instability was detected in both the cancer and the surrounding CCS polyps. Mucin-histochemical analysis of the cancer area showed the complete intestinal type, and thus may have differentiated the CCS polyps from that of the common gastric hyperplastic polyps. This case illustrates that a clue to detecting small cancers may be to look for the discolored lesion among reddish CCS polyposis and thereafter to observe the irregular vascular pattern with NBI endoscopy. From the viewpoint of genetic alterations, patients with CCS polyps are considered to be at high risk for developing gastric cancer, and therefore careful follow-up examinations are necessary for the early detection of malignancies.


New operative strategy in the treatment of metastasizing medullary carcinoma of the thyroid.
Medullary carcinoma of the thyroid (MTC) is exceptional in that the hormone calcitonin produced by the tumor cells represents a specific and sensitive tumor marker. Careful screening by serial calcitonin determinations following pentagastrin stimulation allows for the early detection of metastatic disease. We have adopted a method of meticulous modified radical neck dissection to eradicate persistent or recurrent MCT in 11 patients treated over a 15-month period. This surgical approach resulted in potentially curative treatment in two patients. Effective tumor reduction was achieved in another seven. Two patients have persistent or progressive disease despite maximum efforts to eradicate malignant tissue. Follow-up is presently incomplete in one patient. Postoperative complications included recurrent nerve paralysis (n = 3), hypoparathyroidism (n = 2), muscular weakness (n = 2) and Horner's syndrome (n = 3). The majority of nervous complications improved spontaneously. It is concluded that the adopted method of meticulous modified radical neck dissection offers the chance of cure to some patients and results in the removal of substantial tumor mass in the majority of others. Postoperative problems are mostly temporary and are deemed acceptable.


Sustainability of transgenic insecticidal cultivars: integrating pest genetics and ecology.
This review examines potential impacts of transgenic cultivars on insect population dynamics and evolution. Experience with classically bred, insecticidal cultivars has demonstrated that a solid understanding of both the target insect's ecology and the cultivar's performance under varied field conditions will be essential for predicting area-wide effects of transgenic cultivars on pest and natural enemy dynamics. This experience has also demonstrated the evolutionary capacity of pests for adaptive response to insecticidal traits in crops. Biochemical and genetic studies of insect adaptation to the Bacillus thuringiensis (Bt) toxins expressed by currently marketed transgenic cultivars indicate a high risk for rapid adaptation if these cultivars are misused. Theoretical and practical issues involved in implementing strategies to delay pest adaptation to insecticidal cultivars are reviewed. Emphasis is placed on examining the "high dose"/refuge strategy that has become the goal of industry and regulatory authorities.


What makes people leave LESS food? Testing effects of smaller portions and information in a behavioral model.
To contribute to a better understanding of consumer food leftovers and to facilitate their reduction in out-of-home settings, our study analyzes the effects of two common intervention strategies for reducing leftovers in a holistic behavioral model. Based on a quasi-experimental baseline-intervention design, we analyzed how the display of information posters and the reduction of portion sizes take an effect on personal, social and environmental determinants in a structural equation model. Applying data from online surveys and observations among 880 guests (503 baseline, 377 intervention) during two weeks in a university canteen, the suggested model allows to assign effects from the two interventions on plate leftovers to specific changes in behavioral determinants. Portion size reductions for target dishes are found to relate to lower levels of plate waste based on conscious perception, represented in smaller portion size ratings. Effects from seeing information posters are found to base on changed personal attitudes, subjective norms and perceived behavioral control. However, depending on how an individual reacts to the information (by only making an effort to finish all food or by making an effort and additionally choosing a different dish in the canteen) there are opposite effects on these determinants and consequently also on plate leftovers. Overall, the differentiated results on intervention effects strongly support the benefits of more holistic and in-depth analyses of interventions to reduce plate leftovers and therefore to contribute to more sustainable food consumption in out-of-home settings.


Inhibition of microtubule sliding by Ni2+ and Cd2+: evidence for a differential response of certain microtubule pairs within the bovine sperm axoneme.
Bovine sperm, extracted with 0.1% Triton X-100, frozen at -20 degrees C for 48-120 hours, and thawed, disintegrated by microtubule sliding when 1 mM MgATP was added. Microtubules and outer dense fibers (ODFs) were usually extruded in groups or "bundles". A total of 44.5% of the cells extruded two distinct bundles, one from each side of the connecting piece, exhibiting opposite curvatures. Only one bundle was observed in 46.2% of the cells, and 9.2% showed no signs of sliding. Transmission electron microscopy (T.E.M.) showed one group consisting of the 4,5-6,7 elements, with the 9,1,2 elements on the other side of the axoneme making up the other bundle. T.E.M. revealed that when only one side of the axoneme had extruded elements, they were always from the 4,5-6,7 group. The remainder of the axoneme (8,9,1,2,3 and the central pair) was left relatively intact, suggesting a difference in the sliding response of the nine pairs of axonemal microtubules. These results indicate a predisposition for sliding between elements 7 and 8 over that between doublets 2 and 3, perhaps due to a disparity in activation thresholds. Also, both Ni2+ and Cd2+ appear to selectively block activation of 2-3 interdoublet sliding. Incubation with 0.25 mM Ni2+ prior to adding MgATP modified the percentages of sliding patterns: 8.6% demonstrated two-sided extrusion, 58.2% showed one-sided, and 33.2% had no extruded bundles. Again, when half the axoneme was missing, it was always the 4,5-6,7 group. Ten micromolar Cd2+ altered the sliding pattern similarly to Ni2+, with 28% two-sided extrusion, 55.9% one-sided extrusion and 16.1% with no extruded bundles. Either pretreatment regimen impeded extrusion of the 9,1,2 group in a high percentage of cells, compared to untreated cells. This specific inhibition of the 9,1,2 side by Ni2+ or Cd2+ is especially significant since Ni2+ also inhibits spontaneous wave initiation in bull sperm (Lindemann et al.: Journal of Cell Biology 87:420-426, 1980), and both Ni2+ and Cd2+ reportedly block the flagellar Ca(2+)-response in rat sperm (Lindemann and Goltz: Cell Motility and the Cytoskeleton 10:420-431, 1988; Lindemann et al.: Cell Motility and the Cytoskeleton 20:316-324, 1991).


Nursing sensitive outcomes in patients with rheumatoid arthritis: A systematic literature review.
Although rheumatology nursing has been shown to be effective in managing patients with rheumatoid arthritis, patient outcomes sensitive to nursing interventions (nursing sensitive outcomes) have not been systematically studied. The objective of this study was to identify and delineate relevant patient outcomes measured in studies that reported nursing interventions in patients with rheumatoid arthritis. A systematic search was conducted from 1990 to 2016. Inclusion criteria were (i) patients with rheumatoid arthritis, (ii) adult population age ≥16years, (iii) nurse as part of the care team or intervention delivery, (iv) primary research only, (v) English language, and (vi) quantitative studies with nursing sensitive outcomes. Medline, CINAHL, Ovid nursing, Cochrane library and PsycINFO databases were searched for relevant studies. Using the predetermined inclusion/exclusion criteria, nine reviewers working in pairs assessed the eligibility of the identified studies based on titles and abstracts. Papers meeting the inclusion criteria were retrieved and full texts were further assessed. Critical Appraisal Skills Programme tools were used to assess the quality of the included studies. Data on nursing sensitive outcomes were extracted independently by two reviewers. The Outcome Measures in Rheumatology comprehensive conceptual framework for health was used to contextualise and present findings. Of the 820 articles retrieved, 7 randomised controlled trials and 3 observational studies met the inclusion criteria. Seventeen nursing sensitive outcomes were identified (disease activity, clinical effects, pain, early morning stiffness duration, fatigue, patient safety issues, function, knowledge, patient satisfaction, confidence in care received, mental health status, self-efficacy, patient attitude/perception of ability to control arthritis, quality of life, health utility, health care resources, death). These fitted into 10 health intervention domains in keeping with the pre-specified conceptual framework for health: disease status, effectiveness, safety, function, knowledge, satisfaction, psychological status, quality of life, cost, death. A total of 59 measurement instruments were identified comprising patient reported outcome measures (n=31), and biologic measures and reports (n=28). This review is notable in that it is the first to have identified, and reported, a set of multidimensional outcome measures that are sensitive to nursing interventions in rheumatology specifically. Further research is required to determine a core set of outcomes to be used in all rheumatology nursing intervention studies.


TNFalpha in patients with end-stage heart failure on medical therapy or supported by a left ventricular assist device.
In the heart elevated levels of TNFalpha can cause lethal heart failure, like Dilated Cardiomyopathy (DCM). The level of TNFalpha production is in part determined by promoter gene polymorphisms. We investigated whether the TNFalpha promoter gene polymorphism is in this way involved in the outcome of end-stage heart failure and predicts whether patients require left ventricular assist device (LVAD) support or can be kept on medical therapy (MT)while awaiting heart transplantation (HTx). As most patients in this study received a heart transplant, the role of the TNFalpha polymorphisms in transplant rejection was studied as well. In twenty nine patients with DCM, 35 patients with Ischemic Heart Disease (IHD; both on MT), 26 patients on LVAD support and 61 cardiac transplant donors TNFalpha plasma level was detected by EASIA. In both patients groups high levels of TNFalpha plasma levels was observed however, in patients supported by LVAD this increase was much higher compared to patients on MT. Furthermore, this increase seems to be associated with the TNF 1 allele ('G' at position -308) instead of the TNF2 allele (A at position -308). The promoter polymorphisms at positions -238, -244 and -308 were observed by polymerase chain reaction and sequencing. Polymorphism at positions -238, -244 and -308 did not show any relevant differences between the groups. However, at position -308, a trend of a higher incidence of the TNF2 allele (an "A" at position -308) in DCM patients compared to donors was shown. The distribution of the TNF1 and TNF2 alleles was not different in patients on medical therapy compared to the patients supported by a LVAD. No association was found between patients' TNFalpha promoter gene polymorphism and rejection. However, patients that received a donor heart with the TNF2 allele developed more rejection episodes, compared to patients that received a donor heart with the TNF1 allele. TNFalpha levels are high in patients with end-stage heart failure on MT, but even higher in patients on LVAD support. These high TNFalpha plasma levels however, are not correlated with the TNF2 allele but seems to be associated with the TNF1 allele. Furthermore, in HTx the donor TNFalpha gene seem to play a more important role in severity of acute rejection than that of the patient.


Malnutrition and disease progression in patients with rheumatoid arthritis.
To examine the changes in nutritional status during the progression of rheumatoid arthritis (RA), we studied anthropometric and biochemical variables in 97 Japanese patients with RA. Anthropometric data included body mass index (BMI), triceps skinfold thickness (TSF), and arm muscle area (AMA). Levels of albumin and cholesterol in serum, and lymphocyte count were studied as biochemical variables. The prevalence of malnutrition defined as hypoalbuminemia less than 3.4 g/dl was 24.7%, similar to the reports in other countries. Analysis of the data according to disease stage showed that malnutrition in RA was characterized by a progressive reduction in body protein. Body mass index and TSF were increased in patients with stage 1 disease, whereas serum albumin and AMA were within normal range. Stage 2 patients had normal BMI with decreased body protein, albumin, and AMA. Progression to stages 3 and 4 was associated with a stepwise decrease in AMA; serum albumin and BMI remained in the same range as stage 2. Albumin values and AMA were significantly lower in patients with poor functional class and high C-reactive protein. The characteristic progression of malnutrition in RA is attributed to excessive protein catabolism evoked by inflammatory cytokines and by disuse atrophy due to functional impairment.


Abnormal tapetum development in hermaphrodites of an androdioecious tree, Tapiscia sinensis.
Tapiscia sinensis (Tapisciaceae) has been proven to be a functional androdioecious species with both male and hermaphroditic individuals, and pollen viability of male is far higher than that of hermaphrodites. To better understand the causes of the low pollen viability in hermaphroditic flowers, different stages of anther development were observed. We found that hermaphroditic flowers exhibit abnormal tapetum development, resulting in low pollen viability. To clarify the underlying molecular mechanism of abnormal tapetum development in hermaphrodites, quantitative real-time PCR (qRT-PCR) analyses were performed. The results revealed that the expression levels of an important transcription factor for tapetum development and function, Tapiscia sinensis DYSFUNCTIONAL TAPETUM1 (TsDYT1) and its potential downstream regulatory genes Tapiscia sinensis DEFECTIVE in TAPETAL DEVELOPMENT and FUNCTION1 (TsTDF1), Tapiscia sinensis ABORTED MICROSPORE (TsAMS) and Tapiscia sinensis MALE STERILITY 1 (TsMS1) were all significantly downregulated in hermaphrodites compared with males at some key stages of anther development. Amino acid sequence similarity, expression pattern, gene structure and subcellular localization of these genes were analyzed, and the results indicated functional conservation between T. sinensis and homologues in Arabidopsis thaliana. Next, rapid amplification of cDNA end (RACE) and thermal asymmetric interlaced PCR (TAIL-PCR) were employed to clone the full-length cDNA and promoter sequences of these genes, respectively. In addition, results of yeast two-hybrid (Y2H) analysis showed that TsDYT1 can form heterodimers with TsAMS, and yeast one-hybrid (Y1H) demonstrated that TsDYT1 directly binds to the promoter regions of TsTDF1 and TsMS1. TsTDF1 can directly regulate expression of TsAMS, suggesting that a functionally conserved pathway exists between A. thaliana and T. sinensis to regulate tapetum development. In conclusion, the results suggest that abnormal expression of core transcription factors for tapetum development, including TsDYT1, TsTDF1, TsAMS and TsMS1, plays an important role in the abnormal development of the tapetum in T. sinensis hermaphrodites. Furthermore, a hermaphroditic tapetum with abnormal function causes the low pollen viability of hermaphroditic trees. Our results provide new insight into our understanding of the underlying mechanism of why pollen viability is much higher in males than hermaphrodites of the androdioecious tree T. sinensis.


ST segment elevation myocardial infarction following elective direct current synchronised cardioversion for atrial fibrillation.
Atrial fibrillation is the most common arrhythmia in clinical practice. There is no difference in mortality, incidence of stroke or quality of life regardless of whether the rhythm control or rate control strategy is used. However, in certain circumstances, such as when rate control is inadequate, rhythm control is a viable option. We present a 74-year-old Eurasian man with a history of hypertension who presented with new-onset atrial fibrillation and sustained an ST segment elevation myocardial infarction following elective direct current cardioversion.


Long-term stability of MMPI-A scales.
Adolescents (24 boys, 37 girls) from public school settings were given the MMPI-A on 2 occasions with approximately 1 year between testing sessions. Long-term stability of validity, clinical, content, supplementary, and the new Psychopathology Five scales are examined and correlation coefficients are presented. The reliabilities of the MMPI-A scales are consistent with previously reported data. In addition, improvements made during development of the MMPI-A may have led generally to modest increases in stability of the clinical scales for adolescents. Given the importance of both short-term and long-term test-retest data in the evaluation of the validity of an assessment instrument, this study represents an important step in evaluating the validity of the MMPI-A for assessment of personality.


Fluoroscopy radiation safety for spine interventional pain procedures in university teaching hospitals.
Fluoroscopic guidance is frequently utilized in performing various types of interventional techniques. The major purpose of fluoroscopy is accurate needle placement to ensure target specificity and accurate delivery of the injected drug. However, radiation exposure may be associated with risks to physician, patient, and personnel. Multiple studies have evaluated the risk of radiation exposure and techniques to reduce the risk in private practice settings. However, the literature is scant in evaluating the risk of radiation exposure in teaching hospitals in university settings. To evaluate safety and duration of radiation exposure for fluoroscopy guided interventional pain procedures in university pain clinics. Retrospective, case study. The data was reviewed from the fluoroscopy machines from March 2004 to April 2004 at two university pain clinics. Mean fluoroscopy time (FT), mean radiation dose per procedure, and utilization of pulsed fluoroscopy were analyzed. Data of a total of 165 cases of spine injection procedures were collected. The mean fluoroscopy time for lumbar epidural steroid injection, facet joint block, sympathetic nerve block, sacroiliac joint injection, and discography were 46.6 +/- 4.2; 81.5 +/- 12.8; 64.4 +/- 11; 50.6 +/- 41.9 and 146.8 + 25.1 seconds respectively. There were significant differences in fluoroscopy exposure times and radiation dosage for epidural steroid injection among different teaching physicians. Pulsed fluoroscopy was used in less than 10% of cases. The results of this study show that the fluoroscopy exposure time for various interventional procedures performed in the university settings are significantly higher than the radiation exposure periods in private practice settings. This study also showed significant differences among physicians in the same university setting.


Thyrocardiotoxic embolic syndrome.
Embolic occlusion of lower extremity arteries caused by hyperthyroidism-induced atrial fibrillation occurs rarely. Severe end organ damage may be prevented by aggressive medical and surgical intervention. Subtle signs of hyperthyroidism should be sought when arterial occlusion and atrial dysrhythmia are discovered. About 25% of thyrotoxic patients have atrial fibrillation, and up to 40% of this subgroup have systemic emboli; thus, 3% to 10% of all thyrotoxic patients may have systemic emboli. This estimation supports the recommendation for anticoagulation in all hyperthyroid individuals with atrial fibrillation.


Long-term follow-up with optical coherence tomography and microperimetry in eyes with metamorphopsia after macula-off retinal detachment repair.
to report the long-term sequential morphological and functional results in eyes with metamorphopsia after retinal detachment (RD) repair. in six eyes of six patients aged 58.7 ± 11.0 years with metamorphopsia after successful buckling surgery for macula-off RD, best-corrected visual acuity (BCVA), fundus biomicroscopy, Amsler grid test, time-domain optical coherence tomography (TD-OCT) and central 12° microperimetry (MP-1) were performed at months 1, 3, 6, 12, and 18. At 5 to 6 years after surgery all patients underwent also spectral domain (SD)-OCT. three eyes slowly recovered pre-RD BCVA. In the remaining three eyes-with good final BCVA-the interrupted junction line between photoreceptor cell inner and outer segments (IS/OS) was progressively less evident after RD surgery; and the external limiting membrane was preserved on SD-OCT examination. In all eyes post-operative metamorphopsia faded with time, but fully disappeared in 6 years only in two eyes without photoreceptor abnormalities. One of the two eyes with subretinal fluid up to 6 months and IS/OS disruption had central dense scotoma with relatively unstable fixation on MP-1 and persistent metamorphopsia. Macular sensitivity (MS) increased from 9.7 ± 7.1 at month 1 to 13.5 ± 5.6 dB at the final check, and was weakly (r=0.33) correlated with post-operative BCVA and OCT abnormalities. long-standing metamorphopsia can occur after successful macula-off RD repair even without detectable photoreceptor disruption on OCT. Post-operative BCVA recovery weakly correlates with increasing MS, and late restoration of the photoreceptor layer may be observed.


Responsiveness of a single-item indicator versus a multi-item scale: assessment of emotional well-being in an international adjuvant breast cancer trial.
A single-item linear analogue self-assessment scale for mood was compared with a 28-item adjective checklist for emotional well-being. To confirm its concurrent validity and responsiveness to treatment and recurrence in patients with breast cancer, emotional well-being was assessed every 3 months for 2 years and at 1 and 6 months after recurrence in 1,169 patients who were premenopausal and 960 patients who were postmenopausal. These patients were enrolled in two International Breast Cancer Study Group randomized clinical trials in operable breast cancer conducted from 1986 to 1993. To assess concurrent validity, Pearson's correlation between the linear analogue self-assessment scale and the adjective checklist were calculated for each time-point within each treatment group and for the two assessments after recurrence. Responsiveness to treatment and recurrence were analyzed using paired t tests and the squared ratio of these t tests, an estimate of relative efficiency. Concurrent validity of the mood linear analogue self-assessment was consistently confirmed across four language groups. Both measures were responsive; out of 24 changes over time, 19 were in the expected direction for the linear analogue self-assessment scale (p < or = 0.05 for 9 of 19) and 17 for the adjective checklist (p < or = 0.05 for 10 of 17). The linear analogue self-assessment scale was less but significantly efficient for detection of treatment effects, with relative efficiency estimates ranging from 0.16 to 2.45 and a median of 0.66 among the comparisons with relatively stable estimates (/t/ > or = 1.0) and more efficient for recurrence than the adjective checklist. The mood linear analogue self-assessment scale is a valid indicator of emotional well-being in patients with breast cancer in large multicenter, multicultural trials in which comprehensive scales are less feasible. This investigation supports the clinical relevance of linear analogue self-assessment scales as indicators of components of quality of life in cancer clinical trials.


Predictive factors of severe postoperative pain in the postanesthesia care unit.
I.v. morphine titration (IMT) is widely used in the postanesthesia care unit to achieve pain relief. Numerous factors contribute to variability in postoperative pain or morphine consumption. We analyzed prospectively the pre- and intraoperative predictive factors of severe postoperative pain defined as a dose of IMT >0.15 mg/kg or a failure of IMT. We assessed the role of preoperative information about pain, medical treatments, and intraoperative events and their role on postoperative pain. After IMT, patients were divided into two groups: severe pain (SP) and nonsevere pain. Data are expressed as mean +/- SD. Three hundred forty-two patients were included in the study: 200 (58%) in the nonsevere pain group and 142 (42%) in the SP group. Using a univariate analysis, there was no significant difference between groups related to medical or surgical history except for more frequent preoperative treatments in the SP group (P < 0.05). Duration of the surgical procedure and anesthesia were longer in the SP group (P < 0.001). The dose of sufentanil and visual analog scale scores before and at the end of IMT were higher in the SP group (P < 0.001). Using a multivariate analysis, a high dose of intraoperative opioid (sufentanil dose >0.6 microg/kg) (Odds ratio = 2.68, P < 0.001), a general anesthetic procedure (Odd ratio = 3.96, P = 0.03), and the use of preoperative analgesic drugs (Odds ratio = 1.91, P < 0.01) were independent factors associated with severe postoperative pain. A higher intraoperative dose of sufentanil, general anesthesia, and preoperative treatment with analgesics were significantly associated with severe postoperative pain.


Optimal Analysis to Discriminate Males' Osteoporosis With Simple Physiological Indicators: A Cutoff Point Study.
Males account for one third of global hip fracture patients, and their hip fracture-related mortality rate is higher than that of females. Scholars have primarily investigated self-evaluation indicators for elderly Caucasians and other ethnicities, and have rarely conducted large-scale cutoff point studies on Asian males. In this study, a large-scale database on bone mineral density (BMD) examinations was used to conduct a cutoff point study on males with osteoporosis. This study involved a retrospective research design. Males who accepted BMD examinations from 2009 to 2012 at a large teaching hospital in Taiwan were sampled in this study. This study used the database for analyzing effects with using osteoporosis self-assessment indicator, age, body weight, and body mass index (BMI) to discriminate osteoporosis in males, specifically focusing on accuracy, cutoff point, sensitivity, specificity, and positive and negative predictive values. Overall, receiver operating characteristic curve for the samples reached 70%. These cutoff points included: a body weight is less than 58.8 kg, BMI is 23 kg/m2, and the osteoporosis self-assessment score is -1.86, to identify osteoporosis. Involving body weight and BMI as optimal assessing indicators for assessing osteoporosis among males younger than 65 years, and the osteoporosis self-assessment tool was ideal for measuring males older than 65 years. Professional health staff should apply convenient, low-cost, and accurate evaluation tools that can assist Asian males in planning preventive osteoporosis strategies to avoid osteoporotic fractures and death.


Development of an extensive set of 16S rDNA-targeted primers for quantification of pathogenic and indigenous bacteria in faecal samples by real-time PCR.
The microbiota of the human intestinal tract constitutes a complex ecosystem. We report the design and optimization of an extensive set of 16S rDNA-targeted species- and group-specific primers for more accurate quantification of bacteria from faecal samples with real-time PCR. A linear range of quantification between 0.1-10 pg and 10 ng of specific target genome was obtained, which corresponds to detection of ca 30-4500 to 1.9 x 10(6)-6.0 x 10(6) target bacterial genomes. Functionality of the assays was confirmed by quantification of target bacterial DNA from faecal DNA preparations of healthy volunteers and irritable bowel syndrome (IBS) patients. Additionally, spiking of faecal preparations with Helicobacter pylori, Clostridium difficile or Campylobacter jejuni was used to confirm the accurate and sensitive quantification. Real-time PCR is a very sensitive and precise technique for an extensive quantitative evaluation of gut microbiota and is feasible for detection of human pathogens from faecal samples. To design and optimize an extensive set of real-time PCR assays targeting a large group of predominant and pathogenic GI microbial species for further use in updating the current knowledge of the putative role of gut microbiota in health and disease.


Aggregates of oligo(dG) bind and inhibit topoisomerase II activity and induce formation of large networks.
DNA cleavage by eukaryotic type II DNA topoisomerase (EC 5.99.1.3) was strongly inhibited by an oligonucleotide containing 10 dGua residues. Catalytic activities of topoisomerase II, as measured by relaxation and decatenation reactions, were also inhibited by oligo(dG)10. Inhibition was specific to oligo(dG)10; other oligonucleotides, nucleotides, or single-stranded DNAs tested did not influence the activity of topoisomerase II. Oligo(dG)10 did not inhibit other activities such as restriction enzymes. Although the enzyme neither binds nor cleaves oligo(dG)10, inhibition can be explained by the finding that topoisomerase II binds tightly with aggregated oligo(dG) structures (estimated to contain between 20 and 30 molecules of monomeric oligo(dG)10) that form spontaneously prior to addition of enzyme. These aggregated oligo(dG)-topoisomerase complexes are large networks that can be pelleted by a 20-min centrifugation step in a Microfuge. Western blotting with a monoclonal antibody confirmed that topoisomerase II is trapped in these pellets. The ability of the enzyme to form large DNA-protein networks could be a biochemical mechanism by which topoisomerase II might promote or participate in chromosome condensation in vivo prior to mitosis.


Innate immunity and environmental correlates of Haemoproteus prevalence and intensity in an opportunistic breeder.
While parasite infection can have substantial fitness consequences in organisms, the predictors of parasite prevalence and intensity are often complex and vary depending on the host species. Here, we examined correlates of Haemoproteus (a common malaria parasite) prevalence and intensity in an opportunistically breeding songbird, the red crossbill (Loxia curvirostra). Specifically, we quantified Haemoproteus prevalence and intensity in crossbills caught in the Grand Teton National Park from 2010 to 2013. We found that parasite prevalence varies seasonally and across years, with the highest number of infected individuals occurring in the summer, although there was variation across summers sampled, and that prevalence was positively related to annual mean cone crop sizes (a measure of crossbill food abundance) and daily ambient temperature (a correlate of vector abundance). Parasite intensity was significantly and positively related to one measure of innate immunity, leucocyte counts per blood volume. Finally, neither crossbill age, ecomorph, nor sex had significant effects on parasite infection intensity; however, parasite prevalence did significantly vary among ecomorph and age classes. These results support the interpretation that a combination of physiological (specifically immune activity) and environmental factors affects parasite prevalence and infection intensity in this opportunistically breeding avian species.


Gastrointestinal tuberculosis: 17 cases collected in 4 hospitals in the northeastern suburb of Paris.
Gastrointestinal tuberculosis is a rare form of extrapulmonary tuberculosis and its diagnosis can be difficult. To analyze the diagnostic and therapeutic characteristics of gastrointestinal tuberculosis. Retrospective study from 17 cases collected in 4 hospitals in Seine Saint-Denis between 1987 and 2002. Seventeen cases and 19 localizations were collected: small intestine (N = 7), ileocecum (N = 6), colon (N = 4) and gastroduodenum (N = 2). Two patients had two localizations. Mean age was 43.9 years. Subjects from immigrant populations (76.5%) were preferentially affected. Twenty-three percent of patients (13 tested) were infected by human immunodeficiency virus. Weight-loss and general weakness (88%), abdominal pain (88%), fever (59%), nausea/vomiting (53%) were the predominant symptoms. The delay in diagnosis was 82 days (range: 7-180) and time before specific treatment 31.6 days (range: 7-90). Histological evidence of caseating granuloma was found in six patients. Mycobacterium tuberculosis was detected in six. Digestive imaging was abnormal in 15 patients. Mesenteric lymph nodes were the most common associated site of tuberculosis (N = 8, 47%). Mean duration of treatment was 8.2 months (range: 6-12). Thirteen patients were cured, three died and one was lost to follow up. Gastrointestinal tuberculosis is not an uncommon diagnosis in the north-eastern Parisian area, especially among immigrant populations and immunodeficient patients. The most frequent localizations are the small intestine and ileocecum. Diagnosis can be made by pathology and/or bacteriology on endoscopic and/or surgical biopsy samples.


Bimodal activation of acetyl-CoA carboxylase by glutamate.
Acetyl-CoA carboxylase (ACC) catalyzes the formation of malonyl-CoA, an essential substrate for fatty acid biosynthesis and a potent inhibitor of fatty acid oxidation. Here, we provide evidence that glutamate may be a physiologically relevant activator of ACC. Glutamate induced the activation of both major isoforms of ACC, prepared from rat liver, heart, or white adipose tissue. In agreement with previous studies, a type 2A protein phosphatase contributed to the effects of glutamate on ACC. However, the protein phosphatase inhibitor microcystin LR did not abolish the effects of glutamate on ACC activity. Moreover, glutamate directly activated purified preparations of ACC when protein phosphatase activity was excluded. Phosphatase-independent ACC activation by glutamate was also reflected by polymerization of the enzyme as judged by size-exclusion chromatography. The sensitivity of ACC to direct activation by glutamate was diminished by treatment in vitro with AMP-activated protein kinase or cAMP-dependent protein kinase or by beta-adrenergic stimulation of intact adipose tissue. We conclude that glutamate, an abundant intracellular amino acid, induces ACC activation through complementary actions as a phosphatase activator and as a direct allosteric ligand for dephosphorylated ACC. This study supports the general hypothesis that amino acids fulfill important roles as signal molecules as well as intermediates in carbon and nitrogen metabolism.


Sepsis quality in safety-net hospitals: An analysis of Medicare's SEP-1 performance measure.
Newly enacted policies at the state and federal level in the United States require acute care hospitals to engage in sepsis quality improvement. However, responding to these policies requires considerable resources and may disproportionately burden safety-net hospitals. To better understand this issue, we analyzed the relationship between hospital safety-net status and performance on Medicare's SEP-1 quality measure. We linked multiple publicly-available datasets with information on SEP-1 performance, structural hospital characteristics, hospital financial case mix, and health system affiliation. We analyzed the relationship between hospital safety-net status and SEP-1 performance, as well as whether hospital characteristics moderated that relationship. We analyzed data from 2827 hospitals, defining safety-net hospitals using financial case mix data. The 703 safety-net hospitals performed worse on Medicare's SEP-1 quality measure (adjusted difference 2.3% compliance, 95% CI -4.0%--0.6%). This association was most evident in hospitals not affiliated with health systems, in which the difference between safety-net and non-safety-net hospitals was 6.8% compliance (95% CI -10.4%--3.3%). Existing sepsis policies may harm safety-net hospitals and widen health disparities. Our findings suggest that strategies to promote collaboration among hospitals may be an avenue for sepsis performance improvement in safety-net hospitals.


Porcine granulosa cells in suspension culture. II. Luteinization and hCG responsiveness.
Granulosa cells from small follicles were cultured as suspensions in spinner flasks for 10 days in the absence or presence of follicle-stimulating hormone (FSH). With or without FSH, the cultured cells ultrastructurally resembled luteinized cells to different degrees. FSH increased progesterone accumulation in the culture medium. Ovine prolactin potentiated the effect of FSH in terms of the quantity of progesterone produced and the duration of accumulation. FSH increased acute human chorionic gonadotropin (hCG)-responsive progesterone secretion in short-term incubations of cultured granulosa cells. Responsiveness of FSH-cultured cells was maximal at day 4; that of control cultured cells was maximal at day 6. Adenylate cyclase activity of homogenates of cells cultured for 4, 6, or 8 days was measured. FSH induced in cultured cells an hCG sensitivity of the adenylate cyclase enzyme. These results indicate that FSH induced hCG-responsive progesterone secretion and hCG-responsive adenylate cyclase activity that correlate with ultrastructural signs of luteinization and with the previously reported FSH induction of hCG receptors.


After the storm: experiences and insights from the front.
You can never totally prepare for a disaster. However, from each occurrence we learn new lessons and gain insight to the preparations, collaborative strategies and flexible tactics needed to respond effectively. The scenarios below are a small sampling of what ACHE affiliates dealt with in the wake of Hurricanes Katrina and Rita. The leaders of these healthcare organizations know the importance of having a comprehensive disaster plan, adapting to the situation you face and stepping back to evaluate and make adjustments for the future.


Plasticity of the adult avian song control system.
There is extensive plasticity of the song behavior of birds and the neuroendocrine circuit that regulates this behavior in adulthood. One of the most pronounced examples of plasticity, found in every species of seasonally breeding bird examined, is the occurrence of large seasonal changes in the size of song control nuclei and in their cellular attributes. This seasonal plasticity of the song circuits is primarily regulated by changes in the secretion and metabolism of gonadal testosterone (T). Both androgenic and estrogenic sex steroids contribute to seasonal growth of the song system. These steroids act directly on the forebrain song nucleus HVC, which then stimulates growth of its efferent target nuclei transsynaptically. Seasonal growth and regression of the song circuits occur rapidly and sequentially following changes in circulating T and its metabolites. As the neural song circuits change across seasons, there are changes in different aspects of song behavior, including the structural stereotypy of songs, their duration, and the rate of production. The burden of evidence supports a model in which changes in song behavior are a consequence rather than a cause of the changes in the song circuits of the brain. Seasonal plasticity of the song system may have evolved as an adaptation to reduce the energetic demands imposed by these regions of the brain outside the breeding season, when the use of song for mate attraction and territorial defense is reduced or absent. The synaptic plasticity that accompanies seasonal changes in the song system may have acted as a preadaptation that enabled the evolution of adult song learning in some species of birds.


Noninvasive positive-pressure ventilation in pediatric status asthmaticus.
OBJECTIVE: To describe the use of noninvasive positive-pressure ventilation in children with status asthmaticus. DESIGN: Brief report. SETTING: Pediatric intensive care unit in two tertiary institutions. SUBJECTS: Children with severe acute asthma and hypercarbic respiratory failure. INTERVENTIONS: Noninvasive positive-pressure ventilation using a bilevel positive-pressure (BIPAP) device. MEASUREMENTS AND MAIN RESULTS: Three children, ages 9, 11, and 15 yrs, were treated for hypercarbic respiratory failure caused by status asthmaticus by using BIPAP. The duration of pediatric intensive care unit admission was 48 hrs, and the duration of therapy ranged from 12 to 17 hrs. Inspiratory positive airway pressure ranged from 10 to 14 cm H(2)O (0.98-1.37 kPa), with a mean of 12 cm H(2)O (1.18 kPa). Expiratory positive airway pressure ranged from 4 to 5 cm H(2)O (0.39-0.49 kPa), with a mean of 5 cm H(2)O (0.49 kPa). Pulse oximetry was monitored continuously until resolution of symptoms. The mean values for respiratory rate, pH, and CO(2) tension were compared at initiation, 3-4 hrs, and >12 hrs after beginning BIPAP. BIPAP treatment resulted in improved ventilatory status as shown by an increase in pH from a mean of 7.26 on admission to 7.38 after 3-4 hrs and after 12 hrs, respectively. However, respiratory rate showed a steady decrease from a mean of 31.7 breaths/min on admission to 24 breaths/min at 3-4 hrs and 19 breaths/min at >12 hrs of BIPAP therapy. CO(2) tension (Pco(2)) decreased from a mean value of 54.6 mm Hg (7.28 kPa) on admission to 36.4 mm Hg (4.85 kPa) at 3-4 hrs of treatment; the mean Pco(2) after >12 hrs of treatment was 39.8 mm Hg (5.31 kPa). CONCLUSION: In three children with status asthmaticus, BIPAP seemed to improve ventilation and gas exchange, culminating in resolution of hypercarbic respiratory failure. A prospective, randomized, and controlled study is required to determine its role in pediatric status asthmaticus.


Tracing 8,600 participants 36 years after recruitment at age seven for the Tasmanian Asthma Study.
To trace all participants 36 years after the original Tasmanian Asthma Study (TAS). In 1968, the TAS investigated asthma in 8,583 children who were born in 1961. We attempted to trace these participants in 2002-04 using names, dates of birth and gender. Current addresses were sought by computer linkage to the Commonwealth Electoral Roll, the Medicare database and the Tasmanian marriage records. Computer linkage was conducted with the National Death Index (NDI). Siblings of participants were also linked to the Commonwealth Electoral Roll and those identified were sent a letter requesting the participant's address. The Australian Twin Registry (ATR) and the 1991-93 TAS substudy were used to locate participant addresses. After three rounds of electoral roll linkage, 56% of all cohort members were traced. Name changes were identified for 49% of the 3,477 females not initially matched to the electoral roll using linkage to marriage records. NDI linkage yielded a 0.7% match. Medicare linkage identified addresses for 27% of the 1,982 remaining participants. Writing to siblings located 60% of 1,661 participants. One hundred and eighty-three participants were matched to the 1991-93 TAS and 23 twins matched to the ATR. Overall, 81.5% of the cohort members were identified. With these methods, we have been able to trace a possible address for a large portion of the original participants, with the electoral roll linkage being the most useful. It is possible to trace Australians for follow-up studies using electronic linkage, although without unique identifiers it is labour and resource intensive and requires matching to several databases.


Early Metabolome Profiling and Prognostic Value in Paraquat-Poisoned Patients: Based on Ultraperformance Liquid Chromatography Coupled To Quadrupole Time-of-Flight Mass Spectrometry.
Paraquat (PQ) has caused countless deaths throughout the world. There remains no effective treatment for PQ poisoning. Here we study the blood metabolome of PQ-poisoned patients using ultraperformance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UPLC/Q-TOF MS). Patients were divided into groups according to blood PQ concentration. Healthy subjects served as controls. Metabolic features were statistically analyzed using multivariate pattern-recognition techniques to identify the most important metabolites. Selected metabolites were further compared with a series of clinical indexes to assess the prognostic value. PQ-poisoned patients showed substantial differences compared with healthy subjects. Based on variable of importance in the project (VIP) values and statistical analysis, 17 metabolites were selected and identified. These metabolites well-classified low PQ-poisoned patients, high PQ-poisoned patients, and healthy subjects, which was better than that of a complete blood count (CBC). Among the 17 metabolites, 20:3/18:1-PC (PC), LPA (0:0/16:0) (LPA), 19-oxo-deoxycorticosterone (19-oxo-DOC), and eicosapentaenoic acid (EPA) had prognostic value. In particular, EPA was the most sensitive one. Besides, the levels of EPA was correlated with LPA and 19-oxo-DOC. If EPA was excessively consumed, then prognosis was poor. In conclusion, the serum metabolome is substantially perturbed by PQ poisoning. EPA is the most important biomarker in early PQ poisoning.


Ocular and orbital lesions: surface coil MR imaging.
Nine lesions, four ocular (three melanomas, one hemangioma) and five orbital (two perioptic meningiomas, one hemangioma, one pseudotumor, one mucocele), were evaluated by magnetic resonance surface coil imaging at 1.5 T. Small ocular lesions with 3.9-4.5-mm-elevation were demonstrated. The use of two different pulse sequences resulted in separation of melanoma from adjacent retinal detachment. Contrast obtained between orbital lesions and the adjacent normal structures was better than that demonstrated with high-resolution computed tomography.


Bilateral subtentorial empyema complicated with nosocomial acinectobacter ventriculitis: a case report.
Subtentorial subdural empyema is a rare and life threatening intracranial suppuration. It is usually an intracranial complication of otogenic infections. Early diagnosis and surgical drainage are the most important factors determining prognosis. The high mortality reported in the literature reflects the severity of subtentorial subdural empyema if proper management is delayed. Intracranial infections usually require between 4 to 6 weeks of intravenous antibiotics therapy. However, the prolonged duration of hospitalization as well as requirement for neurosurgically inserted indwelling devices may predispose these patients to new nosocomial infections.


Seroprevalence of Neospora caninum in non-carnivorous wildlife from Spain.
Serum samples from 1034 non-carnivorous wildlife from Spain were tested for antibodies to Neospora caninum by competitive screening enzyme linked immunosorbent assay (ELISA) and confirmed by an indirect fluorescent antibody test (IFAT). High agreement was observed between results in both techniques (kappa value higher than 0.9). Prevalences of N. caninum antibodies positive by both techniques were 11.8% of 237 red deer (Cervus elaphus), 7.7% of 13 barbary sheep (Ammotragus lervia), 6.1% of 33 roe deer (Capreolus capreolus) and 0.3% of 298 wild boar (Sus scrofa). In one of 53 hares (Lepus granatensis), antibodies were found in the ELISA but could not be confirmed by IFAT due to lack of sample. Antibodies to N. caninum were not found in any of 251 wild rabbits (Oryctolagus cuniculus), 79 fallow deer (Dama dama), 27 mouflon (Ovis ammon), 40 chamois (Rupicapra pyrenaica) and three Spanish ibex (Capra pyrenaica). Statistically significant differences were observed between N. caninum seroprevalence in red deer and management of hunting estates (open versus fenced) with higher prevalence in fenced estates, and among sampling sites. Seroprevalence was particularly high in some areas (MO estate in South-Central Spain or some estates of Catalonia, North-East Spain), while no contact with N. caninum was observed in others. Results indicate that in certain areas of Spain, N. caninum is present in wildlife, especially in red deer. These results have important implications in both sylvatic cycles and may influence the prevalence of infection in cattle farms in those areas. To our knowledge, this is the first report of antibodies to N. caninum in wildlife from Spain and the first report of N. caninum antibodies in barbary sheep and wild boar.


Effects of sleep deprivation and recovery sleep upon cell proliferation in adult rat dentate gyrus.
Numerous behavioral and environmental factors modulate the production of new cells in the adult mammalian brain. Although sleep loss has previously been shown to dramatically suppress brain cell proliferation, the effect of recovery sleep after a period of sleep deprivation is not known. Using the disk-over-water paradigm, adult male Sprague-Dawley rats were sleep deprived for 48 h. Separate groups were then allowed either an 8 h period of recovery sleep or an additional 8 h of sleep deprivation. A third group of rats served as a control, and were not sleep deprived. At 54 h, all rats received an injection of 5-bromo-2'-deoxyuridine (200 mg/kg, i.p.) and were killed 2 h later. When compared with control rats, a 36% reduction in cell proliferation was observed in the dentate gyrus of rats subjected to 56 h of sleep deprivation. A similar reduction in proliferation (39%) was observed in rats allowed an 8 h period of recovery sleep. In both deprivation groups, the magnitude of suppression of cell proliferation was approximately twice as large in the posterior hippocampus as it was in the anterior hippocampus. These data confirm previous results that an extended period of sleep deprivation exerts a strong suppressant effect on cell proliferation in the rat dentate gyrus, and demonstrate that this suppression of cell proliferation shows no evidence of recovery for at least 8 h following a 48 h period of sleep deprivation.


Splenic marginal zone B-cell lymphoma associated with primary Sjögren's syndrome.
We describe a 67-year-old woman with primary Sjögren's syndrome who developed a splenic marginal zone B-cell lymphoma, and complained of a dry mouth and Raynaud's phenomenon. She had splenomegaly, swollen lymph nodes and monoclonal IgM-kappa cryoglobulin. After splenectomy, Raynaud's phenomenon had improved with the decrease of cryoglobulin. This is the first case of primary Sjögren's syndrome with splenic marginal zone B-cell lymphoma to be reported.


Cerebral edema, altered mental status, seizures, acute stroke, leptomeningeal metastases, and paraneoplastic syndrome.
Neurologic symptoms commonly occur in oncology patients, and in some cases they may be the presenting symptom of malignancy. Cancer-related neurologic syndromes are rarely pathognomonic and must be differentiated from other benign or serious conditions. This article reviews common neuro-oncologic syndromes that may lead to urgent evaluation in the emergency department, including cerebral edema, altered mental status, seizures, acute stroke, leptomeningeal metastases, and paraneoplastic neurologic syndromes.


An Atmospherically Driven Optical Switch.
The atmospheric regulation of the photophysical properties of 1 gives rise to a new optical switch. This optical information can be translated with the utmost spatial and molecular economy using confocal single molecule spectroscopy. R=OH.


Strengthening mindfetalness.
Pregnant women have varying degrees of awareness of their unborn baby's fitness. A challenge for midwives is to strengthen awareness and use the information from the unborn baby's mother to increase the possibility for a healthy baby to be born. A special kind of mindfulness, here referred to as mindfetalness are suggested to be a concept to use in antenatal care.


Investigation of Direct-Acting Oral Anticoagulants and the Incidence of Venous Thromboembolism in Patients Weighing ≥120 kg Compared to Patients Weighing <120 kg.
Direct oral anticoagulants (DOACs) present a favorable alternative to warfarin based on the decreased burden of monitoring and fewer drug and food interactions. Although studied in the general population, limited clinical data justifying efficacy in patients weighing ≥120 kg present concern for using DOACs in this specific population. The purpose was to identify if a difference exists in incidence of recurrent thromboembolic events in patients receiving a DOAC for the indication of venous thromboembolism (VTE) weighing ≥120 kg compared to patients weighing <120 kg. A retrospective database analysis was conducted with patients on apixaban, dabigatran, or rivaroxaban for treatment of VTE from the Veterans Integrated Service Network 8 between January 2012 and June 2017. The primary outcome was incidence of recurrent VTEs while on anticoagulation. Fisher's exact tests were used to evaluate difference in VTEs between the groups. There were 133 patients weighing ≥120 kg and 1063 patients weighing <120 kg identified within the 5-year time frame that met inclusion criteria. Although no statistically significant difference was found in incidence of recurrent VTEs between study groups (0.8% vs 1.1%; odds ratio: 0.66; 95% confidence interval: 0.09-5.14; P = .69) few events occurred limiting the power to be able to detect a difference. This study found no difference in VTE recurrence in patients weighing ≥120 kg compared to patients <120 kg with few events in either group. Although promising, additional studies are needed to confirm these findings.


Independent effects of colour on object identification and memory.
We examined the effects of colour on object identification and memory using a study-test priming procedure with a coloured-object decision task at test (i.e., deciding whether an object is correctly coloured). Objects were selected to have a single associated colour and were either correctly or incorrectly coloured. In addition, object shape and colour were either spatially integrated (i.e., colour fell on the object surface) or spatially separated (i.e., colour formed the background to the object). Transforming the colour of an object from study to test (e.g., from a yellow banana to a purple banana) reduced priming of response times, as compared to when the object was untransformed. This utilization of colour information in object memory was not contingent upon colour falling on the object surface or whether the resulting configuration was of a correctly or incorrectly coloured object. In addition, we observed independent effects of colour on response times, whereby coloured-object decisions were more efficient for correctly than for incorrectly coloured objects but only when colour fell on the object surface. These findings provide evidence for two distinct mechanisms of shape-colour binding in object processing.


Endotoxin reduces maximal oxygen consumption in hepatocytes independent of any hypoxic insult.
The cause of the metabolic disturbances in sepsis remains uncertain, but there is increasing evidence suggesting that haemodynamic changes are not solely responsible. We addressed the question of whether endotoxin has a significant effect on cellular oxygen metabolism, independent of confounding haemodynamic defects. Prospective, controlled experimental study. University Laboratory. Human hepatocyte cell line. The oxygen consumption rate (OCR) was calculated from the fall in oxygen tension in a sealed cuvette containing Hep G2 cells in suspension. The oxygen tension was measured by porphyrin phosphorescence half-life analysis. Resting OCR was measured in control cells and after 1, 6 and 24 h of endotoxin exposure. In a second series of experiments, resting and maximal OCR was measured after 6 and 24 h of endotoxin exposure and in control cells using the addition of a mitochondrial uncoupler (FCCP); this uncouples the respiratory chain from ATP synthesis, thereby removing negative feedback and allowing the respiratory chain to work at maximal rate. Endotoxin caused a rise in resting OCR at 1 h which was significant by 6 h but had returned to control values by 24 h. Maximal OCR also increased at 6 h, however exposure to endotoxin for 24 h significantly reduced maximal OCR compared to the control cells. Endotoxin has complex effects on cellular energy metabolism causing an initial rise in the oxygen consumption rate and a significant limitation in oxygen consumption capacity at 24 h. These complex effects would be in keeping with the varied responses seen in patients.


[A rare case of auricular piloleiomyoma].
The authors described the case of leiomyoma of soft tissues of external ear auricle. It was arising from the wound due to ear ring sticking.


Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee.
Ultrasound is the most commonly used imaging technique for the evaluation of thyroid nodules. Sonographic findings are often not specific, and definitive diagnosis is usually made through fine-needle aspiration biopsy or even surgery. In reviewing the literature, terms used to describe nodules are often poorly defined and inconsistently applied. Several authors have recently described a standardized risk stratification system called the Thyroid Imaging, Reporting and Data System (TIRADS), modeled on the BI-RADS system for breast imaging. However, most of these TIRADS classifications have come from individual institutions, and none has been widely adopted in the United States. Under the auspices of the ACR, a committee was organized to develop TIRADS. The eventual goal is to provide practitioners with evidence-based recommendations for the management of thyroid nodules on the basis of a set of well-defined sonographic features or terms that can be applied to every lesion. Terms were chosen on the basis of demonstration of consistency with regard to performance in the diagnosis of thyroid cancer or, conversely, classifying a nodule as benign and avoiding follow-up. The initial portion of this project was aimed at standardizing the diagnostic approach to thyroid nodules with regard to terminology through the development of a lexicon. This white paper describes the consensus process and the resultant lexicon.


The influence of pH and aeration rate on the fermentation of D-xylose by Candida shehatae.
The effects of the initial pH and air supply on the production of ethanol from D-xylose using the yeast Candida shehatae in a batch reactor were investigated. The initial pH was altered within the range of 2.5-6.5 and the specific aeration rate from 0.0-0.3 vv-1 min-1. The results showed that the most favorable initial pH for ethanol production was 4.5 and aeration via the stirring vortex of the bioreactor was sufficient. Under these conditions, the maximum specific growth rate (mu(m)) was 0.329 h-1; biomass production rate (b), 0.024 kg m-3 h-1; overall biomass yield (YGx/s), 0.036 kg kg-1; the specific uptake rate of D-xylose (qs), 2.0 kg kg-1 h-1; and the specific ethanol production rate (qE), 0.72 kg kg-1 h-1 (both at 20 h culture time). The average xylitol yield (Yxy/s) was 0.078 kg kg-1 and the overall ethanol yield (YGE/s), 0.41 kg kg-1. Both qs and qE diminished once the exponential growth phase was over.


Biodegradable nanoparticles modified by branched polyethylenimine for plasmid DNA delivery.
The main objective of this work is to build a comparative account of two PLGA nanoparticle (NP)-based gene delivery systems namely, plasmid DNA (pDNA) encapsulated PLGA NPs (PLGA-E) and surface adsorbed pDNA on PLGA-BPEI NPs (PLGA-BPEI), with respect to the extent of internalization and intracellular release of pDNA. Several formulations have also been evaluated systematically for determination of the optimal transfection efficiency. The zeta-potential, particle size measurements and DNase I protection assay established the importance of the BPEI chain length in regulating the effective loading and condensation of pDNA with PLGA-BPEI NPs and pDNA protection ability of PLGA-BPEI NPs. The colloidal stability of these formulations was also investigated as a function of serum concentration. The in vitro release of pDNA from both kind of formulations was studied at pH 7.4 and pH 5.0 by comparing the kinetics of pH-triggered release of pDNA from PLGA-BPEI-25K(5) and PLGA-E. In vitro time-dependent gene transfection efficiencies were studied in presence as well as in absence of serum for NIH3T3 and HEK293 cells. The cell viability and intracellular localization were also investigated using MTT assay and confocal microscopy study, respectively.


Genomics via optical mapping. III: Contiging genomic DNA.
In this paper, we describe our algorithmic approach to constructing an alignment of (contiging) a set of restriction maps created from the images of individual genomic (uncloned) DNA molecules digested by restriction enzymes. Generally, these DNA segments are sized in the range of 1-4 Mb. The goal is to devise contiging algorithms capable of producing high-quality composite maps rapidly and in a scaleable manner. The resulting software is a key component of our physical mapping automation tools and has been used to create complete maps of various microorganisms (E. coli, P. falciparum and D. radiodurans). Experimental results match known sequence data.


[Chondroclastic properties of the cartilaginous tissue macrophages of developing bone].
By the electron microscopic and cytochemical studies, in the vascular canals of cartilaginous epiphyses and in the zones of endochondral process of the rabbit and rat femoral bones, there were revealed monocytes, macrophages, the cells of the intermediate differentiation stages among the perivascularly located forms. In the lysosomes as well as on the surface of cytoplasmic membrane of mature macrophages the activity of acid phosphatase and non-specific esterase was demonstrable. Phagolysosomes showed accumulation of 35S-sulphate label 2 hours after its injection into an organism. Macrophages cause degradation of non-mineralized cartilaginous matrix by secreting hydrolases and other enzymes and then phagocytize the preformed substrate. In the zones of endochondral process, macrophages also penetrate into the "capsules" of hypertrophic chondrocytes and are involved in their destruction. The cells are regarded as tissue--specific macrophages--chondroclasts.


Volume reductions in frontopolar and left perisylvian cortices in methamphetamine induced psychosis.
Consumption of methamphetamine disturbs dopaminergic transmission and sometimes provokes schizophrenia-like-psychosis, named methamphetamine-associated psychosis (MAP). While previous studies have repeatedly reported regional volume reductions in the frontal and temporal areas as neuroanatomical substrates for psychotic symptoms, no study has examined whether such neuroanatomical substrates exist or not in patients with MAP. Magnetic resonance images obtained from twenty patients with MAP and 20 demographically-matched healthy controls (HC) were processed for voxel-based morphometry (VBM) using Diffeomorphic Anatomical Registration using Exponentiated Lie Algebra. An analysis of covariance model was adopted to identify volume differences between subjects with MAP and HC, treating intracranial volume as a confounding covariate. The VBM analyses showed significant gray matter volume reductions in the left perisylvian structures, such as the posterior inferior frontal gyrus and the anterior superior temporal gyrus, and the frontopolar cortices, including its dorsomedial, ventromedial, dorsolateral, and ventrolateral portions, and white matter volume reduction in the orbitofrontal area in the patients with MAP compared with the HC subjects. The smaller regional gray matter volume in the medial portion of the frontopolar cortex was significantly correlated with the severe positive symptoms in the individuals with MAP. The volume reductions in the left perisylvian structure suggest that patients with MAP have a similar pathophysiology to schizophrenia, whereas those in the frontopolar cortices and orbitofrontal area suggest an association with antisocial traits or vulnerability to substance dependence.


Domain communication in Thermotoga maritima Arginine Binding Protein unraveled through protein dissection.
Substrate binding proteins represent a large protein family that plays fundamental roles in selective transportation of metabolites across membrane. The function of these proteins relies on the relative motions of their two domains. Insights into domain communication in this class of proteins have been here collected using Thermotoga maritima Arginine Binding Protein (TmArgBP) as model system. TmArgBP was dissected into two domains (D1 and D2) that were exhaustively characterized using a repertoire of different experimental and computational techniques. Indeed, stability, crystalline structure, ability to recognize the arginine substrate, and dynamics of the two individual domains have been here studied. Present data demonstrate that, although in the parent protein both D1 and D2 cooperate for the arginine anchoring; only D1 is intrinsically able to bind the substrate. The implications of this finding on the mechanism of arginine binding and release by TmArgBP have been discussed. Interestingly, both D1 and D2 retain the remarkable thermal/chemical stability of the parent protein. The analysis of the structural and dynamic properties of TmArgBP and of the individual domains highlights possible routes of domain communication. Finally, this study generated two interesting molecular tools, the two stable isolated domains that could be used in future investigations.


Comparative full genome analysis of four infectious laryngotracheitis virus (Gallid herpesvirus-1) virulent isolates from the United States.
Gallid herpesvirus-1 (GaHV-1), commonly named infectious laryngotracheitis (ILT) virus, causes the respiratory disease in chickens known as ILT. The molecular determinants associated with differences in pathogenicity of GaHV-1 strains are not completely understood, and a comparison of genomic sequences of isolates that belong to different genotypes could help identify genes involved in virulence. Dideoxy sequencing, 454 pyrosequencing and Illumina sequencing-by-synthesis were used to determine the nucleotide sequences of four genotypes of virulent strains from GaHV-1 groups I-VI. Three hundred and twenty-five open reading frames (ORFs) were compared with those of the recently sequenced genome of the Serva vaccine strain. Only four ORFs, ORF C, U(L)37, ICP4 and U(S)2 differed in amino acid (aa) lengths among the newly sequenced genomes. Genome sequence alignments were used to identify two regions (5' terminus and the unique short/repeat short junction) that contained deletions. Seventy-eight synonymous and 118 non-synonymous amino acid substitutions were identified with the examined ORFs. Exclusive to the genome of the Serva vaccine strain, seven non-synonymous mutations were identified in the predicted translation products of the genes encoding glycoproteins gB, gE, gL and gM and three non-structural proteins U(L)28 (DNA packaging protein), U(L)5 (helicase-primase) and the immediate early protein ICP4. Furthermore, our comparative sequence analysis of published and newly sequenced GaHV-1 isolates has provided evidence placing the cleavage/packaging site (a-like sequence) within the inverted repeats instead of its placement at the 3' end of the U(L) region as annotated in the GenBank's entries NC006623 and HQ630064.


Dental CT: imaging technique, anatomy, and pathologic conditions of the jaws.
In addition to conventional imaging methods, dental CT has become an established method for anatomic imaging of the jaws prior to dental implant placement. More recently, this high-resolution imaging technique has gained importance in diagnosing dental-associated diseases of the mandible and maxilla. Since most radiologists have had little experience in these areas, many of the CT findings remain undescribed. The objective of this review article is to present the technique of dental CT, to illustrate the typical appearance of jaw anatomy and dental-related diseases of the jaws with dental CT, and to show where it can serve as an addition to conventional imaging methods in dental radiology.


Remarkably enhanced excimer formation of naphthylacetate in cation-charged gamma-cyclodextrin.
[reaction: see text] 6(A),6(D)-Bispyridinio-appended gamma-cyclodextrin effectively enhanced the excimer fluorescence of 2-naphthylacetate. This increase derived from the increase of formation of the 1:2 complex between the cation-charged gamma-cyclodextrin and 2-naphthylacetate by the electrostatic interaction between the host and the guest.


A re-evaluation of the tissue distribution and physiology of xanthine oxidoreductase.
Xanthine oxidoreductase is an enzyme which has the unusual property that it can exist in a dehydrogenase form which uses NAD+ and an oxidase form which uses oxygen as electron acceptor. Both forms have a high affinity for hypoxanthine and xanthine as substrates. In addition, conversion of one form to the other may occur under different conditions. The exact function of the enzyme is still unknown but it seems to play a role in purine catabolism, detoxification of xenobiotics and antioxidant capacity by producing urate. The oxidase form produces reactive oxygen species and, therefore, the enzyme is thought to be involved in various pathological processes such as tissue injury due to ischaemia followed by reperfusion, but its role is still a matter of debate. The present review summarizes information that has become available about the enzyme. Interpretations of contradictory findings are presented in order to reduce confusion that still exists with respect to the role of this enzyme in physiology and pathology.


The influence of health needs assessment on health care decision-making in London health authorities.
Health needs assessment gained prominence under the model of health care purchasing developed to support the 1991 reforms of the UK National Health Service (NHS). The objectives of this paper are to determine how needs assessment has been used in the NHS, to assess the influence it has had on decision-making, and to relate the observed uses of needs assessment to competing theoretical models of health care policy-making. A survey of needs assessment activity in 14 London health authorities identified 217 needs assessments conducted between 1993 and 1996. Semi-structured interviews were conducted with public health and commissioning staff in each authority. The survey indicated that needs assessment directly supported decision-making and action in two-thirds of the studies identified, but up to 20% of needs assessments had no impact on service provision. Four key functions of health needs assessment were observed: identifying a problem; planning detailed changes to services; providing post hoc justification for earlier decisions; and using participation in needs assessment to build 'ownership' of subsequent decisions. The survey suggests that needs assessment is, in practice, consistent with a 'mixed scanning' model of decision-making. Needs assessment is used to help select issues for detailed investigation and to direct analytical and decision-making resources. However, certain key areas are not amenable to technical analysis and solution, and are resolved through bargaining.


Renal effects of enalapril in hypertensive patients with glomerulonephritis.
Renal effects of enalapril maleate in ten hypertensive patients with glomerulonephritis were evaluated after 1 and 16 weeks of therapy. Systemic blood pressure decreased, glomerular filtration rate was not significantly changed, and sodium fractional excretion and renal plasma flow increased, whereas renal vascular resistances and filtration fraction decreased acutely at the end of the study. Proteinuria diminished, but no variations in qualitative pattern were observed. ACE inhibitors, promoting efferent rather than afferent arteriolar vasodilatation and reduction of glomerular permeability coefficient, may reduce glomerular capillary hypertension and the development of proteinuria.


A simple and reliable predictor for an adequate laryngeal view with rigid endoscopic laryngoscopy.
It is sometimes impossible to obtain an adequate laryngeal view during rigid endoscopic laryngoscopy. This may be due to a high tongue base. Our study seeks to determine a correlation between tongue base level and the adequacy of laryngeal view obtained with a 70-degree rigid endoscope. Over a period of 4 months, patients from a voice clinic were gathered and categorized into class I to III according to Mallampati et al (1985). Rigid laryngo-videostroboscopy was conducted to assess the larynx and the adequacy of the view was recorded. 74 patients were recruited. The number of adequate views were: class I = 18/20 (90%); class II = 20/33 (60.6%); class III = 7/21 (33.3%). chi 2 analysis demonstrated significance trend in all 3 classes. The level of the tongue base correlated well with the adequacy of laryngeal view obtained from a 70-degree rigid endoscope. This can be used to predict the success of obtaining adequate views during rigid laryngoscopy.


Development of a morphologically-based scoring system for postimplantation New Zealand White rabbit embryos.
Rodent whole-embryo culture (WEC) systems are well-established, as are several corresponding morphological scoring systems. Recently, WEC techniques for rabbits have been developed, creating the need for a morphological evaluation system in this species. Consequently, we developed a gestational-age-based quantitative morphology evaluation system for rabbit embryos. Detailed descriptions of 21 embryonic structures, as collected from gestational day (gd) 9-13 rabbit embryos, formed the basis for this evaluation system. These descriptions were then developed into specific criteria for assigning numerical scores to quantify the degree of development of each embryonic structure. The overall morphologic score was calculated as the average of the individual structure scores. To make the system as informative as possible, the numerical scale of the scoring system was gestationally age-based (i.e., range of potential scores was 9.0-13.0). The scoring system was then applied in the evaluation of New Zealand White (NZW) rabbit embryos explanted on gd 9 and cultured for 48 hr. Embryos grown in vitro developed normally, but at a slightly slower rate in vitro than in vivo, as evidenced by the lower morphology score (10.4 in vitro, 11.0 in vivo) and measures of growth (somite number, total protein, and head length). This work firmly establishes the normal archetype of embryonic development in the gd 9-13 NZW rabbit and provides an important tool for the advancement of mechanistic studies of rabbit embryos developing both in vivo and in vitro.


Dynamic photocontrol of the coffee-ring effect with optically tunable particle stickiness.
When a colloidal drop dries on a surface, most of the particles accumulate at the drop periphery, yielding a characteristic ring-shaped pattern. This so-called coffee-ring effect (CRE) is observed in any pinned evaporating drop containing non-volatile solutes. Here, the CRE is dynamically controlled for the first time by using light, and an unprecedented reconfigurability of the deposit profile is demonstrated. This is achieved through a new mechanism where particle stickiness is optically tuned on demand, thus offering reliable modulation of the deposition pattern. The system consists of anionic nanoparticles and photosensitive cationic surfactants dispersed in water. It is shown that light-dependent modulation of surfactant-particle interactions dictates particle attraction and trapping at the liquid-gas interface, which allows us to direct particle deposition into a wide range of patterns from rings to homogeneous disks. Patterning from single drops is photoreversible upon changing the wavelength whereas spatial control in multiple drop arrays is achieved using a photomask.


[Apelin, a neuropeptide that counteracts vasopressin secretion].
Apelin is a peptide that was recently isolated as the endogenous ligand for the human orphan APJ receptor, a G protein-coupled receptor which shares 31 % amino-acid sequence identity with the angiotensin type 1 receptor. Apelin naturally occurs in the brain and plasma as 13 (pE13F) and 17 amino-acid (K17F) fragments of a single pro-peptide precursor. In transfected CHO cells, K17F and pE13F bind with high affinity to the rat APJ receptor, promote receptor internalization, and inhibit forskolin-induced cAMP formation. In the same cells, pE13F activates MAP kinase and PI3 kinase pathways. Apelin and APJ receptors are both widely distributed in the brain but are particularly highly expressed in the supraoptic (SON) and paraventricular (PVN) hypothalamic nuclei. Dual labeling studies demonstrate that within these two nuclei, apelin and its receptor are colocalized with vasopressin (AVP) in a subset of magnocellular neurons. In lactating rats, characterized by increases in both synthesis and release of AVP, central injection of apelin inhibits the phasic electrical activity of AVP neurons, reduces plasma AVP levels, and increases aqueous diuresis. Moreover, water deprivation, while increasing the activity of AVP neurons, reduces plasma apelin concentrations and induces an intra-neuronal pile up of the peptide, thereby decreasing the inhibitory effect of apelin on AVP release and preventing additional water loss at the kidney level. Taken together, these data demonstrate that apelin counteracts the effects of AVP in the maintenance of body fluid homeostasis. In addition, apelin and its receptor are present in the cardiovascular system, i.e. heart, kidney and vessels. Systemically administered apelin reduces arterial blood pressure, increases cardiac contractility and reduces cardiac loading. The development of non peptidic analogs of apelin may therefore offer new therapeutic avenues for the treatment of cardiovascular disorders.


Characterization of the haem oxygenase protein family in Arabidopsis thaliana reveals a diversity of functions.
HOs (haem oxygenases) catalyse the oxidative cleavage of haem to BV (biliverdin), iron and carbon monoxide. In plants, the product of the reaction is BV IXalpha, the precursor of the PHY (phytochrome) chromophore and is thus essential for proper photomorphogenesis. Arabidopsis thaliana contains one major biochemically characterized HO (HY1) and three additional putative HOs (HO2, HO3 and HO4). All four proteins are encoded in the nucleus but contain chloroplast translocation sequences at their N-termini. The transit peptides of all four proteins are sufficient for chloroplast translocalization as shown by GFP (green fluorescent protein) reporter gene fusions. Overall, all four proteins can be divided into two subfamilies: HO1 and HO2. Here we show that all members of the HO1 subfamily (HY1, HO3 and HO4) are active monomeric HOs and can convert haem to BV IXalpha using spinach Fd (ferredoxin) as an electron donor. Addition of a second electron donor, such as ascorbate, led to a 10-fold increase in the haem conversion rate. Furthermore, haem turnover is also promoted by light when spinach thylakoids are present. All HO1 family members displayed similar kinetic parameters indicating they all have a possible involvement in PHY chromophore biosynthesis. HO2 did not yield sufficient amounts of soluble protein and therefore required the construction of a synthetic gene adapted to the codon usage of Escherichia coli. HO2 is unable to bind or degrade haem and therefore it is not a haem oxygenase. However, HO2 shows strong binding of proto IX (protoporphyrin IX), a precursor for both haem and chlorophyll biosynthesis. A possible function of HO2 in the regulation of tetrapyrrole metabolism is discussed.


Serum S100 protein could predict altered consciousness in glyphosate or glufosinate poisoning patients.
Central nervous system (CNS) complications such as seizures and reduced consciousness are important in glufosinate and may occur in severe glyphosate poisoning. The aim of this study was to assess the possible role of serum S100B protein as a biochemical marker of CNS complications associated with glyphosate or glufosinate poisoning. The study enrolled 40 patients (23 glyphosate poisoning and 17 glufosinate poisoning). Altered consciousness and seizure were observed during hospitalization. S100B level was measured with fully automated modular analytic E170 system using electrochemoluminometric immunoassay. Among 40 patients, neurologic features were observed in 12 patients with a median time to onset of 21.5 (IQR 8.25-24.75) h. Serum S100B concentrations measured on admission were higher in the group with neurologic features than in the group without neurologic features [0.148 μg/L (IQR 0.128-0.248) vs. 0.072 μg/L (IQR 0.047-0.084), p < .001]. Univariate analysis of measured patient raw parameters using a ROC curve showed that S100B was a significant predictor of neurologic features in glyphosate and glufosinate poisoning. The area under the ROC curve was 0.894 (95% confidential interval 0.791-0.998). When S100B was set at 0.0965, its sensitivity and specificity for predicting neurologic features in glyphosate and glufosinate poisoning were 92% and 82%, respectively. In our pilot study, S100B was a significant predictor of neurologic complications in patients with glyphosate and glufosinate poisoning. Large prospective cohorts are needed to confirm this finding.


Chronic lymphocytic leukaemia of T cell origin. Clinical variation possibly due to involvement of different T lymphocyte subpopulations.
Based on the literature and 2 patients studied, we suggest that at least 2 different clinical entities are included in the concept of T CLL: (i) a clinical variant characterized by a relatively benign course, splenomegaly without lymphadenopathy, low lymphocyte count and granulocytopenia; the proliferating lymphocyte is morphologically mature, of medium size and a cytoplasm with azurophilic granules staining positively for acid phosphatase and corresponding to parallel tubular arrays as demonstrated by electron microscopy. The cells form E-rosettes, have no surface-membrane-bound Ig, but Fc-receptors for IgG. With monoclonal antibodies, the phenotype is OKT3+, OKT4- and OKT8+, theoretically corresponding to the suppressor/cytotoxic T lymphocyte subset, but functionally the cells demonstrate killer cell (responsible for ADCC), but not natural or suppressor cell activity. (ii) another clinical variant with an aggressive course, massive hepato-splenomegaly, lymph node enlargement and very high lymphocyte counts; the lymphocytes are small without cytoplasmic granules; their immunological and functional characteristics have not been determined, but morphologically the cells correspond to the T helper/inducer lymphocyte subset. Thus, involvement of different T lymphocyte subsets may be the reason for the clinical variation in T CLL.


Physical activity, waist-to-hip ratio, and other risk factors for ovarian cancer: a follow-up study of older women.
We investigated the association of epithelial ovarian cancer with physical activity, waist-to-hip ratio, reproductive factors, and family history of cancer in a prospective cohort study of 31,396 postmenopausal women. Ninety-seven women developed incident epithelial ovarian cancer over 7 years. The number of livebirths was associated with lower risk (multivariate-adjusted relative risks for 1-2, 3-4, and > 4 livebirths compared with nulliparity were 0.64, 0.47, and 0.43, respectively). A family history of ovarian cancer in a first-degree relative was associated with a 2.5 times greater risk (95% confidence interval = 0.90-6.7). Multivariate-adjusted relative risks for the upper three quartiles of waist-to-hip ratio compared with the lowest quartile were 2.0, 1.6, and 2.3, respectively. Women with "moderate" and "high" levels of physical activity compared with those with "low" physical activity had relative risks of 1.4 and 2.1, respectively. Positive associations of physical activity and waist-to-hip ratio with ovarian cancer seem inconsistent with existing theories of ovarian cancer pathogenesis.


Discriminative stimulus properties of pentobarbital and progesterone in male and female rats.
Intact male and ovariectomized female rats were trained to discriminate 12 mg/kg pentobarbital from physiological saline. Generalization tests with different doses of pentobarbital did not reveal significant sex differences in the pentobarbital generalization gradient. Different doses of progesterone produced a generalization gradient to pentobarbital in ovariectomized females, but not in intact males. The results of the present experiment thus suggests that systemic administration of progesterone produces a "pentobarbital-like" stimulus in ovariectomized female rats, but not in intact males.


Superior vena cava syndrome: A radiation oncologist's perspective.
Superior vena cava syndrome is referred to as a constellation of symptoms and signs caused by obstruction of superior vena cava. It can occur due to both benign and malignant causes with the latter being the predominant. There is a paradigm shift in the approach to manage this condition. It is no longer considered a medical emergency and histological diagnosis is necessary before treatment. This article reviews the causes, symptoms, pathophysiology, and overall management policy which have changed over decades.


Probabilistic inferential decision-making under time pressure in rhesus macaques (Macaca mulatta).
Decisions often involve the consideration of multiple cues, each of which may inform selection on the basis of learned probabilities. Our ability to use probabilistic inference for decisions is bounded by uncertainty and constraints such as time pressure. Previous work showed that when humans choose between visual objects in a multiple-cue, probabilistic task, they cope with time pressure by discounting the least informative cues, an example of satisficing or "good enough" decision-making. We tested two rhesus macaques (Macaca mulatta) on a similar task to assess their capacity for probabilistic inference and satisficing in comparison with humans. In each trial, a monkey viewed two compound stimuli consisting of four cue dimensions. Each dimension (e.g., color) had two possible states (e.g., red or blue) with different probabilistic weights. Selecting the stimulus with highest total weight yielded higher odds of receiving reward. Both monkeys learned the assigned weights at high accuracy. Under time pressure, both monkeys were less accurate as a result of decreased use of cue information. One monkey adopted the same satisficing strategy used by humans, ignoring the least informative cue dimension. Both monkeys, however, exhibited a strategy not reported for humans, a "group-the-best" strategy in which the top two cues were used similarly despite their different assigned weights. The results validate macaques as an animal model of probabilistic decision-making, establishing their capacity to discriminate between objects using at least four visual dimensions simultaneously. The time pressure data suggest caution, however, in using macaques as models of human satisficing. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Melanopsin (Opn4) utilizes Gαi and Gβγ as major signal transducers.
Melanopsin (Opn4), a ubiquitously expressed photoreceptor in all classes of vertebrates, is crucial for both visual and non-visual signaling. Opn4 supports visual functions of the eye by sensing radiance levels and discriminating contrast and brightness. Non-image-forming functions of Opn4 not only regulate circadian behavior, but also control growth and development processes of the retina. It is unclear how a single photoreceptor could govern such a diverse range of physiological functions; a role in genetic hardwiring could be one explanation, but molecular and mechanistic evidence is lacking. In addition to its role in canonical Gq pathway activation, here we demonstrate that Opn4 efficiently activates Gi heterotrimers and signals through the G protein βγ. Compared with the low levels of Gi pathway activation observed for several Gq-coupled receptors, the robust Gαi and Gβγ signaling of Opn4 led to both generation of PIP3 and directional migration of RAW264.7 macrophages. We propose that the ability of Opn4 to signal through Gαi and Gβγ subunits is a major contributor to its functional diversity.


[Primary neuroectodermal tumour of the kidney invading the wall of the inferior vena cava. Surgical strategy].
Primary neuroectodermal tumours (PNET) are very aggressive malignant tumours, rapidly progressing to metastasis and death. They rarely involve the kidney, as only 23 cases have been described in the literature. Renal tumours, regardless of their histology, spread to the inferior vena cava (IVC) in 4% to 10% of cases. Invasion of the inferior vena cava wall by tumour thrombus is rare and, when it occurs, is often limited to the ostium of the renal vein. The authors report a case of primary neuroectodermal tumour of the kidney with thrombus in the inferior vena cava ascending to the right atrium (level IV), invading the wall of the IVC and associated with a non-infiltrating papillary urothelial tumour of the ureter. They describe the surgical management of this tumour and present a review of the literature.


[Injuries from external causes in minors (less than 18 years of age) and adults at a hospital in Colombia].
To define and compare the types of injuries from external causes in patients more than and less than 18 years of age treated by the Mario Correa Rengifo Hospital. An analysis was conducted of data retrieved from the Sistema de Vigilancia de Lesiones de Causa Externa (Surveillance System for Injuries from External Causes) maintained by the Mario Correa Rengifo Hospital in Cali, Colombia, to compare minors (less than 18 years of age) with adults during January 2004-December 2007. A total of 4 507 minors were seen, most of whom (69.3%) were boys, with unintentional injuries (75.5%); however, 88% of the intentional injuries were person-to-person and 12% were self-inflicted. Injuries had occurred most frequently in the home (44.1%) and on the street (39.5%); the most frequent activity was recreation (53.3%). The minors had more head injuries (odds ratio [OR] = 1.62; P = 0.0000) and maxillofacial injuries (OR = 1.49; P = 0.0000) than did the adults. Alcohol had been consumed in 5.8% and drugs in 2.6%, both of which increased intentional injuries (alcohol OR = 4.25 and drugs OR = 1.56). The number of patients less than 18 years of age with injuries from external causes being treated at the Mario Correa Rengifo Hospital is constantly rising. The circumstances regarding injuries seen in children and adolescents differ from those of adults in that minors tend to suffer more unintentional injuries in the home or in the street where they play regularly. It is important that special educational and structural strategies be implemented to prevent injuries of this type.