Do the effects measured by intraoperative and postoperative STN macrostimulation in Parkinson's disease match?
The aim of our study was to compare the results obtained by intraoperative and postoperative subthalamic nucleus (STN) macrostimulation in Parkinson's disease (PD). One hundred three PD patients implanted with bilateral STN stimulation were included. The thresholds for efficacy and side effects (motor contraction; paresthesias; oculomotor signs) observed on the same trajectory and at the same depth during the intraoperative evaluation and the first postoperative setting of STN stimulation parameters were collected. The level of improvement was divided into four categories depending on the degree of rigidity reduction: 0: no effect, A (mediocre efficacy): 20-50%, B (good efficacy): 60-100%, LL: lesion-like effect (disappearance of rigidity after implantation). Efficacy of STN stimulation was analyzed in 83 patients for a total of 664 contacts. For the best effects (B, LL), the results obtained in the operative room were concordant with those of the postoperative evaluation for 81% of the contacts. For the mediocre effects (A) and absence of efficacy, the results were only concordant in 20%. Side effects were analyzed in 103 patients for a total of 824 contacts. In 35% of the tested contacts paresthesias that were absent during surgery were observed postoperatively. This discrepancy was of 17% for the motor and of 10% for oculomotor side effects. Differences between the type of electrodes used, the stimulation parameters employed and the conditions of the assessment could explain these discrepancies.


Amplified ribosomal spacer sequence: structure and evolutionary origin.
A novel class of repeated sequences consisting of tandem arrays of ribosomal spacer sequence has been discovered in a mouse genome. Comparison to normal ribosomal DNA reveals that one repeat unit consists of two separate parts of spacer sequence. This amplified spacer sequence has a pseudogene-like structure but is distinct from the previously reported pseudogenes and orphons in regions lacking coding sequences. So far the amplified spacer sequence has been found only in the BALB/c mouse genome but not in ten other laboratory strains and several wild-type mouse stocks. Surprisingly, a part of the amplified spacer sequence unit had a higher homology to the corresponding part of the ribosomal DNA sequence of Mus musculus molossinus, a Japanese wild-type mouse, than to the corresponding part of the rDNA of the BALB/c mouse. These findings suggest that the amplified spacer sequence of the BALB/c mouse might have partly originated in M. m. molossinus or in a related subspecies.


Isotopic effects on the dynamics of the CH3(+) + H2 → CH5(+) → CH3(+) + H2 reaction.
Diffusion Monte Carlo is used to investigate the anharmonic zero-point energy corrected energies for the CH(3)(+) + H(2)→ CH(5)(+) → CH(3)(+) + H(2) process as a function of the center of mass separation of the two fragments. In addition to the title reaction, all possible deuterated and several tritiated (CH(4)T(+) and CH(3)T(2)(+)) analogues of this reaction are investigated. As anticipated, the replacement of one or more of the hydrogen atoms with deuterium or tritium atoms lowers the zero-point energy of the system. Further, in the partially deuterated or tritiated isotopologues, the lowest energy configuration generally has the heavy atoms in the CH(3)(+) fragment. Analysis of the wave functions allows us to study how zero-point energy influences the approach geometries sampled during low-energy collisions between CH(3)(+) and H(2), and to gain insights into how the dynamics is affected by the substitution of heavier isotopes for one or more of the hydrogen atoms. Differences between quantum and classical descriptions of the title reaction are also discussed.


Evaluation of a Completion Total Mesorectal Excision in Patients After Local Excision of Rectal Cancer: A Word of Caution.
Background: According to Dutch guidelines, locally excised, low-risk, pT1 or ypT0-1 rectal cancer should not necessarily be followed by completion total mesorectal excision (cTME) in contrast to rectal cancers with higher T stages or unfavorable features. This study evaluated cTME after local excision at a national level with possible determinants for decision-making. Methods: All patients in the Dutch Colorectal Audit (DCRA) who underwent local excision of rectal cancer between 2012 and 2015 were included. Guideline adherence for performing cTME was determined with univariate and multivariate analyses to identify factors related to noncompliance. Results: According to the guidelines, of 530 included patients, cTME was indicated in 283 (53%), and among those, was performed in 82 (29%). Guideline adherence for performing cTME improved significantly (P<.001), from 10% in 2012 to 44% in 2015. Lower Charlson comorbidity index in patients with high-risk pT1 rectal cancer and younger patients (aged 61-70 years vs ≥80 years) with pT≥2 rectal cancer were associated with increased performance of cTME (odds ratio [OR], 13.50; 95% CI, 1.39-131.32, and OR, 6.25; 95% CI, 1.83-21.31, respectively). Conclusions: In this population-based study from the Netherlands, only a minority of patients underwent cTME after local excision of rectal cancer with pathologic features indicating the need for further treatment according to the guidelines. Although the percentage of patients undergoing cTME increased over time, the study indicated a tendency toward rectal-preserving treatment with potential oncologic risks.


Easy access to modified cyclodextrins by an intramolecular radical approach.
A simple method to modify the primary face of cyclodextrins (CDs) is described. The 6(I)-O-yl radical of α-, β-, and γ-CDs regioselectively abstracts the H5(II), located in the adjacent D-glucose unit, by an intramolecular 1,8-hydrogen-atom-transfer reaction through a geometrically restricted nine-membered transition state to give a stable 1,3,5-trioxocane ring. The reaction has been extended to the 1,4-diols of α- and β-CD to give the corresponding bis(trioxocane)s. The C2-symmetric bis(trioxocane) corresponding to the α-CD is a stable crystalline solid whose structure was confirmed by X-ray diffraction analysis. The calculated geometric parameters confirm that the primary face is severely distorted toward a narrower elliptical shape for this rim.


The effects of exercise duration on adrenal HSP72/73 induction in rats.
This study investigated the effects of varying durations of exercise training on heat shock proteins 72 and 73 (HSP72/73) induction in the rat adrenal gland. Female Sprague-Dawley rats (120 days old) were assigned to either a sedentary control group (C) or one of the three endurance exercise training groups. Trained animals ran on a treadmill at approximately 75% VO2max for 10 weeks (4-5 days week-1) at one of the three different exercise durations (30 min day-1=T30, 60 min day-1=T60, or 90 min day-1=T90). All durations of exercise training resulted in an increase in the HSP72 levels (P < 0.0001). The magnitude of the training-induced elevation in the HSP72 levels in the adrenal gland increased as a function of the training duration ( approximately 60-fold increase in T90; approximately 40-fold increase in T60; and approximately 15-fold increase in T30). Longer exercise durations (>60 min day-1), also resulted in small but significant increase in HSP73 level ( approximately 1.2-fold increase in both T60 and T90; P < 0.05). These results demonstrate that the physiological stress created by chronic treadmill running can induce both HSP72 and HSP73 in rat adrenal gland. Increased levels of adrenal HSP72/73 expression during rigorous exercise, may be one of the adaptive mechanisms of the adrenals to cope with an increased dose of stress.


Selection and parameterization of cortical neurons for neuroprosthetic control.
When designing neuroprosthetic interfaces for motor function, it is crucial to have a system that can extract reliable information from available neural signals and produce an output suitable for real life applications. Systems designed to date have relied on establishing a relationship between neural discharge patterns in motor cortical areas and limb movement, an approach not suitable for patients who require such implants but who are unable to provide proper motor behavior to initially tune the system. We describe here a method that allows rapid tuning of a population vector-based system for neural control without arm movements. We trained highly motivated primates to observe a 3D center-out task as the computer played it very slowly. Based on only 10-12 s of neuronal activity observed in M1 and PMd, we generated an initial mapping between neural activity and device motion that the animal could successfully use for neuroprosthetic control. Subsequent tunings of the parameters led to improvements in control, but the initial selection of neurons and estimated preferred direction for those cells remained stable throughout the remainder of the day. Using this system, we have observed that the contribution of individual neurons to the overall control of the system is very heterogeneous. We thus derived a novel measure of unit quality and an indexing scheme that allowed us to rate each neuron's contribution to the overall control. In offline tests, we found that fewer than half of the units made positive contributions to the performance. We tested this experimentally by having the animals control the neuroprosthetic system using only the 20 best neurons. We found that performance in this case was better than when the entire set of available neurons was used. Based on these results, we believe that, with careful task design, it is feasible to parameterize control systems without any overt behaviors and that subsequent control system design will be enhanced with cautious unit selection. These improvements can lead to systems demanding lower bandwidth and computational power, and will pave the way for more feasible clinical systems.


[The value of SF-36 questionnaire for the measurement of life quality in chronic obstructive pulmonary disease].
This study was performed in chronic obstructive pulmonary disease (COPD) patients to compare the SF-36 questionnaire with pulmonary function tests and non-functional parameters. Fourty-five COPD patients diagnosed according to GOLD 2004 criteria were included in the study. The stable patients were evaluated by spirometry, static lung volumes, diffusion capacity, 6 MWD, BORG scale, MMRC dyspnea measurement and SF-36 life questionnaire performed on the same day. The mean age of the patients was 66 +/- 10 years and the female/male ratio was 4/41. The mean FEV1/FVC ratio was 0.49 (moderate COPD n = 18, severe COPD n = 27). The RV/TLC ratio was 0.52. Walking distance was less than normal, with a mean of 375 +/- 119 m. All the SF-36 scale except pain index are low compared to normal. General health perceptions, physical functioning, role physical, role emotional, social functioning, energy and mental health index are as follows: 47 +/- 24, 50 +/- 30, 35 +/- 38, 49 +/- 37, 63 +/- 33, 49 +/- 20, 59 +/- 20, respectively. When the general health scale compared with FVC and FEV1 revealed moderate correlation was found (r = 0.56, r = 0.55, respectively). Physical functioning compared with FVC, FEV1, RV/TLC and IC revealed moderate correlation (r = 0.62, r = 0.67, r = -0.54, r = 0.65, respectively). General health and physical functioning scales correlated with the non-functional parameters (MMRC, 6 MWD) (r = -0.51, r = 0.53, r = -0.61, r = 0.64 respectively). The SF-36 general quality of life questionnaire is a useful measurement instrument for the evaluation of therapeutic efficiency and follow up of COPD patients.


Cardiovascular effects of cocaine: enhancement by yohimbine and atropine.
The cardiovascular effects of cocaine, alone and in combination with yohimbine and/or atropine, were studied in dogs anesthetized with pentobarbital sodium. All dogs were instrumented for the measurement of arterial blood pressure, left ventricular contractile force, left circumflex coronary artery blood flow, lead II ECG and heart rate. Dogs were divided into two groups; one group received no pretreatment, the other group was pretreated with atropine sulfate, 2 mg/kg. Both groups received two i.v. doses of cocaine, 1 mg/kg, approximately 3.5 hr apart. Thirty minutes before administration of the second cocaine dose, yohimbine, 0.25 mg/kg, i.v. was administered. In control animals which did not receive atropine or yohimbine, there was no difference in the cardiovascular responses to the two cocaine doses administered on this schedule. Administration of cocaine alone increased mean arterial blood pressure 9.6 +/- 2.2 mm Hg and increased the rate-pressure product, an index of myocardial oxygen consumption, 12.6 +/- 4.7%. Coronary blood flow was increased 13.1 +/- 4%. Yohimbine pretreatment significantly enhanced the cardiovascular actions of cocaine and this enhancement was most pronounced in the presence of atropine. When cocaine was administered after treatment with both atropine and yohimbine, mean arterial blood pressure was increased 44.2 +/- 7.2 mm Hg, heart rate was increased 30 +/- 7.9 beats/min and the rate-pressure product was increased by 72 +/- 10.1%, whereas coronary blood flow was increased only 42.8 +/- 12%. These data suggest that presynaptic alpha adrenergic and cholinergic muscarinic blockade may significantly increase the risk of cocaine-induced cardiovascular toxicity.


[Hyponatremia in liver cirrhosis: pathogenesis and treatment].
Hyponatremia is the most common electrolyte disorder in patients with cirrhosis. This disorder can be a result of substantial loss of extracellular fluid "hypotonic or hypovolemic hyponatremia" or develop in the context of an increase in extracellular fluid volume and in the absence of major sodium losses; this situation occurs in patients with advanced cirrhosis and is known as "dilutional or hypervolemic hyponatremia". In dilutional or hypervolemic hyponatremia, serum sodium concentration is reduced, plasma volume is increased (although the effective plasma volume is decreased due to marked arterial vasodilation in the splanchnic circulation) and extracellular fluid volume is increased, with ascites and edema in the absence of signs of dehydration. This is a result of the marked deterioration in renal excretion of solute-free water, leading to disproportionate water retention in relation to sodium retention. Hypotonic hyponatremia represents 10% of all hyponatremias in patients with cirrhosis. Since hypervolemic hyponatremia is by far the most frequent form of this disorder, the present chapter will concentrate specifically on hypervolemic hyponatremia in cirrhosis.


Microglial contribution to oxidative stress in Alzheimer's disease.
Microglia are the CNS macrophage and are a primary cellular component of plaques in Alzheimer's disease (AD) that may contribute to the oxidative stress associated with chronic neurodegeneration. We now report that superoxide anion production in microglia or macrophages from 3 different species is increased by long term exposure (24 hours) to A beta peptides. Since A beta competes for the uptake of opsonized latex beads and for the production of superoxide anion by opsonized zymosan, a likely site of action are membrane receptors associated with the uptake of opsonized particles or fibers. The neurotoxic fibrillar peptides A beta (1-42) and human amylin increase radical production whereas a non-toxic, non-fibrillar peptide, rat amylin, does not. We also report that the effect of A beta peptides on superoxide anion production is not associated with a concomitant increase in nitric oxide (NO) production in either human monocyte derived macrophages (MDM) or hamster microglia from primary cultures. Since NO is known to protect membrane lipids and scavenge superoxide anion, the lack of A beta-mediated induction of NO production in human microglia and macrophages may be as deleterious as the over-production of superoxide anion induced by chronic exposure to A beta peptides.


Metal-ligand bonds of second- and third-row d-block metals characterized by density functional theory.
This paper presents systematic data for 200 neutral diatomic molecules ML (M is a second- or third-row d-block metal and L = H, F, Cl, Br, I, C, N, O, S, or Se) computed with the density functionals TPSSh and BP86. With experimental structures and bond enthalpies available for many of these molecules, the computations first document the high accuracy of TPSSh, giving metal-ligand bond lengths with a mean absolute error of approximately 0.01 A for the second row and 0.03 A for the third row. TPSSh provides metal-ligand bond enthalpies with mean absolute errors of 37 and 44 kJ/mol for the second- and third-row molecules, respectively. Pathological cases (e.g., HgC and HgN) have errors of up to 155 kJ/mol, more than thrice the mean (observed with both functionals). Importantly, the systematic error component is negligible as measured by a coefficient of the linear regression line of 0.99. Equally important, TPSSh provides uniform accuracy across all three rows of the d-block, which is unprecedented and due to the 10% exact exchange, which is close to optimal for the d-block as a whole. This work provides an accurate and systematic prediction of electronic ground-state spins, characteristic metal-ligand bond lengths, and bond enthalpies for many as yet uncharacterized diatomics, of interest to researchers in the field of second- and third-row d-block chemistry. We stress that the success of TPSSh cannot be naively extrapolated to other special situations such as, e.g., metal-metal bonds. The high accuracy of the procedure further implies that the effective core functions used to model relativistic effects are necessary and sufficient for obtaining accurate geometries and bond enthalpies of second- and third-row molecular systems.


Optical evidence of a quantum well channel in low temperature molecular beam epitaxy grown Ga(AsBi)/GaAs nanostructure.
A Ga(AsBi) quantum well (QW) with Bi content reaching 6% and well width of 11 nm embedded in GaAs is grown by molecular beam epitaxy at low temperature and studied by means of high-resolution x-ray diffraction, photoluminescence (PL), and time-resolved PL. It is shown that for this growth regime, the QW is coherently strained to the substrate with a low dislocation density. The low temperature PL demonstrates a comparatively narrow excitonic linewidth of ∼ 40 meV. For high excitation density distinct QW excited states evolve in the emission spectra. The origins of peculiar PL dependences on temperature and excitation density are interpreted in terms of intra-well optical transitions.


Drug selection in a patient with a history of hypersensitivity reactions: a practical approach for the orthopedist.
Drug allergies are specific to characteristics of the medication's chemical structure.


[Changes in the kinetic characteristics of reactions catalyzed by erythrocyte delta-aminolevulinate dehydratase in experimental lead poisoning in rats].
An increase in values of both kinetic parameters (Km and Vmax) of the delta-aminolevulinate dehydratase reaction was observed in blood of rats poisoned with lead. The Km value of the reaction was increased, while Vmax--decreased, after addition of Pb2+ into rat blood in vitro. The results obtained as well as the data published in literature suggest that a compensatory mechanism appears to function in vivo, where a substrate, delta-aminolevulenic acid, plays a triggering role.


Exploration of hirsutism: elements for a strategy.
50 women complaining of hirsutism were investigated in order to establish an optimal strategy for hirsutism exploration. Basal hormonal evaluations were of great value, especially serum testosterone and, to a lesser degree, DHA-S and LH. LH response to LHRH stimulation appeared of little diagnostic value. ACTH stimulation tests may be useful in detecting enzyme deficiencies in patients with normal basal values. The origin of hyperandrogenism can hardly be detected by the inhibition tests. However, these tests allow to determine whether the androgen secretion is still under ACTH and/or LH control.


Family food insecurity and nutritional risk in adolescents from a low-income area of Rio de Janeiro, Brazil.
The study objective was to analyse the association between food insecurity and the weight and height status of adolescents from a low-income area in the metropolitan region of Rio de Janeiro, Brazil. The population-based cross-sectional survey included 523 adolescents aged 12-18 years, selected by a three-stage cluster sample. Dietary intake was ascertained with a food frequency questionnaire and family food insecurity was assessed with a validated questionnaire. The analysis estimated weighted means of energy and nutrient intakes by families' socioeconomic characteristics and the association between dietary intake with overweight and stunting. The prevalence of mild family food insecurity was 36%, and 24% of the families reported moderate or severe food insecurity. Overweight prevalence was 24%, and the prevalence of stunting was 9%, with no significant differences between sex or age groups. Family food insecurity was associated with unfavourable socioeconomic characteristics, but there was no association between socioeconomic characteristics (including family food insecurity) and overweight or stunting. Moderate or severe family food insecurity was inversely associated with intake of protein and calcium. In addition, stunting was associated with low calcium and iron intake. The co-existence of family food insecurity with overweight and stunting implies a high nutritional risk for adolescents from poor areas of Rio de Janeiro. Nevertheless, the observed absence of a statistical association between family food insecurity and weight status attests to the complexity of this issue.


Surgical techniques for augmentation in the horizontally and vertically compromised alveolus.
The deficient alveolar ridge has been an impediment to the placement of dental implants in the past. A greater comprehension of bone biophysiology and biotechnology has greatly increased the surgical options available to rehabilitate these patients. Technology and regenerative science has also allowed clinicians to simplify some of the approaches to these patients. This article presents the authors' perspective on the current surgical treatment methodologies that have been most beneficial in reconstructing atrophic alveolar bone.


Application of electrospray ionization MS/MS and matrix-assisted laser desorption/ionization-time of flight mass spectrometry to structural analysis of the glycosyl-phosphatidylinositol-anchored protein.
We applied the improved sensitivity and soft ionization characteristics of electrospray Ionization (ESI)-MS/MS and matrix-assisted laser desorption/ionization(MALDI)-time of flight (TOF) mass spectrometry (MS) to analysis of the GPI-anchored C-terminal peptide derived from 5'-nucleotidase. ESI-MS/MS analysis was applied to the core structure (MW, 2,743). In the collision-induced dissociation (CID) spectrum, single-charged ions such as m/z 162 (glucosamine), 286 (mannose-phosphate-ethanolamine), and 447 ([mannose-phosphate-ethanolamine]-glucosamine) were clearly detected as characteristic fragment ions of the GPI-anchored peptide. On MALDI-TOF-MS analysis, heterogeneous peaks of GPI-anchored peptides were detected as single-charged ions in the positive mode. Product ions were obtained by post-source decay (PSD) of m/z 2,905 using curved field reflectron of TOF-MS. Most of the expected product ions derived from the GPI-anchored peptide, containing the core structure and an additional mannose side chain, were successively obtained. Thus, ESI-MS/MS and MALDI-TOF-PSD-MS proved to be effective and sensitive methods for analyzing the GPI-anchored peptide structure with less than 10 pmol of sample. These characteristic fragments or fragmentation patterns seem to be very useful for identification of GPI-anchored C-terminal peptides derived from any kind of GPI-anchored protein.


[Painful extensor digitorum brevis].
A boxer suffered from a painful extensor digitorum brevis muscle. The pathology involved the proximal insertion on the lunate and caused a specific form of carpal instability. On excision of the muscle the pain disappeared.


Evidence for a neural signature of musical preference during silence.
One of the most basic and person-specific affective responses to music is liking. The present investigation sought to determine whether liking was preserved during spontaneous auditory imagery. To this purpose, we inserted two-second silent intervals into liked and disliked songs, a method known to automatically recreate a mental image of these songs. Neural correlates of musical preference were measured by high-density electroencephalography in twenty subjects who had to listen to a set of five pre-selected unknown songs the same number of times for two weeks. Time frequency analysis of the two most liked and the two most disliked songs confirmed the presence of neural responses related to liking. At the beginning of silent intervals (400-900 ms and 1000-1300 ms), significant differences in theta activity were originating from the inferior frontal and superior temporal gyrus. These two brain structures are known to work together to process various aspects of music and are also activated when measuring liking while listening to music. At the end of silent intervals (1400-1900 ms), significant alpha activity differences originating from the insula were observed, whose exact role remains to be explored. Although exposure was controlled for liked and disliked songs, liked songs were rated as more familiar, underlying the strong relationship that exists between liking, exposure, and familiarity.


Microbial exo-xylanases: a mini review.
Exo-xylanases are a class of glycosyl hydrolases and play an important role in hydrolysis of xylan to xylose. They belong to glycosyl hydrolase (GH) family 8 with a characteristic (α/α)6 barrel fold in their molecular structures. These enzymes are generally produced by bacteria. Exceptionally, the endo-xylanases from Trichoderma reesei Rut C-30 and a few bacterial strains also show considerable exo-xylanase activities. Exo-xylanases are active on natural xylan substances, hydrolyzing long-chain xylo-oligomers from the reducing end to produce short-chain xylo-oligomers and xylose. Exo-xylanases usually show multiple enzyme functions such as β-xylosidase, exo-glucanase, β-glucosidase, and arabinofuranosidase activities, which are helpful for more efficient hydrolysis of xylan. The combined use of exo- and endo-xylanases can increase the xylose yield compared to using either of them alone. Screening new exo-xylanase-producing microbes, mining the enzyme coding sequences, genetically engineering the enzymes, and producing them in a large scale are recommended for their commercial applications in lignocellulose-based biorefinery.


Congenital cholesteatomata with other anomalies.
Congenital (primary) cholesteatomata may arise in the petrous apex, mastoid, middle ear, or external auditory canal. Histological studies of the temporal bones of a 20-year old man with bilateral combined deafness show bilateral congenital cholesteatomata of the middle ears associated with dalivary choristomata and other anomalies of the middle and inner ears.


Pharmacological modifications in dopaminergic neurotransmission affect the quinpirole-evoked suppression of serotonin N-acetyltransferase activity in chick retina: an impact on dopamine D4-like receptors.
Dopamine (DA) plays an important role in the regulation of melatonin biosynthesis in retinas of several vertebrate species. In the retina of chick, the DA receptor controlling melatonin production represents a D4-like subtype. Stimulation of this receptor by quinpirole (QNP) results in a dose-dependent decline of the nighttime activity of serotonin N-acetyltransferase (NAT; a key regulatory enzyme in melatonin biosynthesis) and melatonin level of chick retina. The present study was undertaken to determine whether long-term treatment with antipsychotic drugs (clozapine-30 mg/kg, i.m.; sulpiride-100 mg/kg, i.m.; and raclopride-10 mg/kg, i.p., once daily for 21 days) and L-DOPA (80 mg/kg, i.p., once daily for 7 days) affects the response of the melatonin generating system of chick retina to the suppressive effect of QNP. Chronic administration to chicks of clozapine and sulpiride, but not raclopride, resulted in a markedly increased response of retinal NAT activity to the action of QNP. ED50 values for QNP were 3-times (clozapine) and 4-times (sulpiride) lower than those in the respective vehicle-treated control groups. On the other hand, QNP was significantly less potent in retinas of birds treated with L-DOPA than in control animals; the ED50 value for QNP was 3-times higher in birds injected with L-DOPA than in the vehicle-treated group. These results indicate that long-term treatment with clozapine, sulpiride and L-DOPA may modify the reactivity of D4-like DA receptors regulating NAT activity of chick retina. A possibility of modifications of circadian and electrophysiological processes within the eye following prolonged administration of DA-ergic drugs is discussed.


Determination of an appropriate size of unrelated donor pool to be registered for HLA-matched platelet transfusion.
HLA-matched platelet transfusions from related or unrelated donors are effective in correcting bleeding tendencies of alloimmunized thrombocytopenic patients. To supply HLA-matched platelets, registration of unrelated HLA-typed donors and selection of compatible donors are necessary and practical considering HLA polymorphism. In this study, the frequencies of each possible HLA phenotype and of corresponding possible compatible donors were calculated with a computer from the table of frequencies of HLA-A and -B haplotypes. Appropriate sizes of such donor pools were theoretically evaluated in Japanese as well as in European Caucasoid and in North American Caucasoid populations. To enable more than 80 percent of patients to get more than five completely compatible donors, only 5000 donor candidates would be necessary for the Japanese population, whereas 18,000 and 25,000, respectively, would be required for European Caucasoid and North American Caucasoid populations.


The collaborative study on typing group-specific component in casework bloodstains.
Casework bloodstains were typed for group-specific component (GC) at eight forensic laboratories. Approximately 600 bloodstains were examined of which a mean of 62.7% gave results. This is comparable to other blood grouping systems in current use. Stains that were over three-months old were successfully typed in six of the laboratories. A wide variety of substrates was examined; these included many items of clothing as well as metal blades, concrete, paint, cement, glass and grass. Of substrates that were examined several times, none consistently gave problems with GC typing. The GC system has been shown, therefore, to be an effective test in operational forensic science.


[A chance finding during the sterilization of a cat: a mummified fetus in the abdominal cavity].
While sterilizing a cat, a mummified pup is found in her abdominal cavity. Further examinations suggest that a primary abdominal pregnancy can be excluded, although no perforation or scar of the uterine wall is noticed during operation.


Outcomes measurement: compliance tool or strategic initiative?
This article explores how hospitals are using outcomes measurement to deal with their changing environment. Based on interviews at thirty-one hospitals, the study reveals three very different management approaches and three different uses of the same outcomes measurement tool.


Importance of early postnatal germ cell maturation for fertility of cryptorchid males.
Twenty-seven adults who underwent an orchidopexy before 2 years of age have recently had their spermiograms analyzed. Sixty-three percent of them had a normal sperm count; their germ cells had undergone the second stage of maturation and adult dark (Ad) spermatogonia were present at the time of surgery 20-25 years earlier. In contrast, 37% of them were infertile despite a seemingly successful orchidopexy; they had impaired second-step germ cell maturation and Ad spermatogonia were absent at orchidopexy. Transformation of gonocytes into Ad spermatogonia is crucial for fertility. This underscores the importance of a testicular biopsy at orchidopexy in order to identify those who could benefit from early LH-RH treatment after orchidopexy.


Sleep and inflammation.
Among adults in the United States, sleep durations appear to have decreased in recent years. Inadequate sleep and sleep deprivation cause numerous neurobehavioral and physiological changes. A number of recent studies have reported associations between disrupted sleep/sleep deprivation and inflammatory responses, although the physiological mechanisms underlying these relationships remain unclear. Alterations in sleep due to lifestyle factors, the aging process, and disease states have all been associated with increases in a range of inflammatory markers. Several of these inflammatory processes have been associated with reduced health status (e.g., C-reactive protein and cardiovascular disease). Thus, maintaining adequate sleep duration and quality through good sleep habits and treatment of sleep disorders may reduce inflammatory processes associated with aging and increase the wellness phenotype.


Alfaxalone-butorphanol versus alfaxalone-morphine combination for immersion anaesthesia in oriental fire-bellied toads (Bombina orientalis).
Oriental fire-bellied toads (Bombina orientalis) are small semi-aquatic anuran species popular as both pets and laboratory animals. Although they are commonly anaesthetized to undergo clinical and experimental procedures, very little is known about their anaesthetic management. The aims of this prospective, randomized, cross-over experimental trial were to establish effective butorphanol and morphine concentrations to be added to alfaxalone for immersion anaesthesia (pilot study), and to compare the anaesthetic and antinociceptive effects of the two drug mixtures (alfaxalone-butorphanol and alfaxalone-morphine), in Bombina orientalis toads. For the actual trial, the toads were randomly assigned to one of two treatment groups: AB and AM, with seven animals in each group, which received alfaxalone-butorphanol and alfaxalone-morphine combinations, respectively, at the concentrations established during the pilot study. Heart rate, respiratory rate, von Frey filament threshold and response to nociceptive withdrawal (NWR), righting and myotactic reflexes were measured at 5 min intervals until return of righting reflex was observed. The investigator who carried out all the measurements was blinded to the treatment. Any undesired effect or complication was noted and recorded. The two treatments were found to be comparable in terms of onset and duration of anaesthesia, and occurrence of undesired effects. However, group AM resulted in lower NWR scores and higher von Frey filament thresholds than group AB. It is concluded that, at the investigated concentrations and in combination with alfaxalone by immersion, morphine provides better antinociception than butorphanol in oriental fire-bellied toads.


One-pot multi-component asymmetric cascade reactions catalyzed by soluble star polymers with highly branched non-interpenetrating catalytic cores.
Non-interpenetrating star polymer catalysts designed to mimic the site isolation characteristics of enzymes enable the one-pot combination of multiple otherwise incompatible catalysts for asymmetric cascade reactions that involve iminium, enamine, and H-bonding catalysis. Control experiments replacing star polymer catalysts with the corresponding small molecule or linear polymer analogues lead to little or no cascade reaction. Our strategy also allows straightforward access to all possible stereoisomers of the cascade product individually by proper choice of catalyst chirality. To our knowledge, this work represents the most sophisticated study of soluble polymers for site isolation, enzyme-like catalysis that generates cascade products with multiple chiral centers.


A randomized controlled trial on office spirometry in asthma and COPD in standard general practice: data from spirometry in Asthma and COPD: a comparative evaluation Italian study.
To evaluate whether office spirometry by general practitioners (GPs) is feasible and may improve the diagnosis of asthma and COPD. A prospective, randomized, comparative trial was planned involving 57 Italian pulmonology centers and 570 GPs who had to enroll consecutive subjects aged 18 to 65 years with symptoms of asthma or COPD without a previous diagnosis. Patients were randomized 1:1 into two groups with an interactive voice responding system: conventional evaluation alone vs conventional evaluation and spirometry. Office spirometry was performed by GPs who were trained by reference specialists using a portable electronic spirometer (Spirobank Office; MIR; Rome, Italy). Diagnosis was confirmed by the reference specialist center in blind fashion. Seventy-four GPs complied to the trial. Of 333 patients enrolled, 136 nonrandom violators completed the protocol. Per-protocol analysis showed a concordant diagnosis between GPs and specialists in 78.6% of cases in the conventional evaluation-plus-spirometry group vs 69.2% in the conventional evaluation group (p = 0.35). In the intention-to-treat analysis, the respective percentages of concordant diagnosis were 57.9 and 56.7 (p = 0.87). Office spirometry by GPs is feasible, but frequent protocol violation and inadequate sample size did not allow us to prove a significant advantage of office spirometry in improving the diagnosis of asthma and COPD in standard general practice as organized at present in Italy, thus reinforcing the need for close cooperation between GPs and specialists in respiratory medicine.


A single dose of esmolol blunts the increase in bispectral index to tracheal intubation during sevoflurane but not desflurane anesthesia.
Activation of the peripheral nerve system by endotracheal intubation is accompanied by an increase in bispectral index (BIS). Esmolol produces a dose-dependent attenuation of the adrenergic response to endotracheal intubation. Desflurane increases sympathetic nerve activity and plasma norepinephrine relative to sevoflurane. The authors hypothesized that esmolol might blunt the BIS response to endotracheal intubation more during sevoflurane anesthesia than desflurane anesthesia. In this double blind, randomized study, after the induction of anesthesia, patients were mask-ventilated with either sevoflurane or desflurane (end-tidal 1 minimum alveolar concentration) and received normal saline or esmolol (0.5 mg/kg) 1 minute before intubation (sevoflurane-control, sevoflurane-esmolol, desflurane-control, and desflurane-esmolol groups, n=20/group). BIS, mean arterial pressure, and heart rate were measured before the induction of anesthesia (awake), before esmolol injection (time point -1), immediately before intubation (time point 0), and every minute for 5 minutes after tracheal intubation (time point 1 to 5). Compared with preintubation, esmolol attenuated the increase in BIS at 1 minute after intubation during sevoflurane anesthesia (5.1% for esmolol and 31.7% for control) but not during desflurane anesthesia (28.6% for esmolol and 30.8% for control). Mean arterial pressure and heart rate increased after intubation in all groups but the changes were greater in the control groups than the esmolol groups. In conclusion, a single dose of esmolol blunted the increase in BIS to tracheal intubation during sevoflurane but not desflurane anesthesia.


Evaluation of Hemolysis as a Severe Feature of Preeclampsia.
Hemolysis predisposes to adverse pregnancy outcomes. Yet, there are limited data on hemolysis in hypertensive disorders of pregnancy other than hemolysis, elevated liver enzymes, and low platelet count syndrome. To evaluate the prevalence and impact of hemolysis in hypertensive disorders of pregnancy, we performed a retrospective cohort study at a single center (October 2013-May 2017), among women screened for hemolysis using lactate dehydrogenase (LDH) levels. We compared LDH levels by hypertensive disorder (chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia with severe features) and evaluated impact on adverse pregnancy outcomes. Data were analyzed by χ2 or t test, ANOVA, test of medians, and logistic regression. Among 8645 deliveries, 1188 (13.7%) had a hypertensive disorder. Of these, 812 (68.4%) had LDH measurement before delivery: chronic hypertension (n=152); gestational hypertension (n=209); preeclampsia (n=216); and preeclampsia with severe features (n=235). LDH ≥400 U/L (≥1.6× normal) was more common in preeclampsia with severe features compared with other hypertensive disorders of pregnancy (9.8% versus 2.3%; P<0.001); adjusted odds ratio 4.52 (95% confidence interval, 2.2-9.2; P<0.001). LDH ≥400 U/L was associated with adverse maternal outcomes (41.7% versus 15.3%; P<0.001), adjusted odds ratio 3.05 (95% confidence interval, 1.4-6.7; P=0.006), and adverse neonatal outcomes (eg, preterm birth 59.4% versus 22.5%; P<0.001). We find that elevated LDH levels are associated with adverse maternal and neonatal outcomes in hypertension and preeclampsia, independent of hemolysis, elevated liver enzymes, and low platelet count syndrome. Therefore, elevated LDH levels (≥1.6× normal or ≥400 U/L) may be considered a severe feature of preeclampsia.


[Institutionalized communication].
This paper is analysing the psychological interaction of communication and institutions. Seeking power and success are mentioned as important motivation factors. The personal situation as lecturer is interpreted as an example of psychological relations within structured communication.


[Subclinical hypothyroidism; the start of a clinical trial into the usefulness of treatment with radioactive iodine].
Subclinical hyperthyroidism is defined as the presence of serum free thyroxine (T4) and triiodothyronine (T3) levels within the reference range and a reduced serum thyrotrophin (TSH) level. Evidence is accumulating that it has important clinical effects. Randomised clinical trials are needed to answer the question whether or not treatment of subclinical hyperthyroidism prevents cardiac problems, especially atrial fibrillation, and preserves bone mineral density. A randomised, Dutch multicentre trial has recently been started. Its goal is to study whether radioiodine treatment prevents the development of atrial fibrillation and prevents decreases in bone mineral density.


The role and value of pharmaceutical marketing.
Pharmaceutical marketing is the last element of an information continuum, where research concepts are transformed into practical therapeutic tools and where information is progressively layered and made more useful to the health care system. Thus, transfer of information to physicians through marketing is a crucial element of pharmaceutical innovation. By providing an informed choice of carefully characterized agents, marketing assists physicians in matching drug therapy to individual patient needs. Pharmaceutical marketing is presently the most organized and comprehensive information system for updating physicians about the availability, safety, efficacy, hazards, and techniques of using medicines. The costs of pharmaceutical marketing are substantial, but they are typical of high-technology industries that must communicate important and complex information to sophisticated users. These costs are offset by savings resulting from proper use of medicines and from lower drug costs owing to price competition.


The anatomical connections of the macaque monkey orbitofrontal cortex. A review.
The orbitofrontal cortex (OfC) is a heterogeneous prefrontal sector selectively connected with a wide constellation of other prefrontal, limbic, sensory and premotor areas. Among the limbic cortical connections, the ones with the hippocampus and parahippocampal cortex are particularly salient. Sensory cortices connected with the OfC include areas involved in olfactory, gustatory, somatosensory, auditory and visual processing. Subcortical structures with prominent OfC connections include the amygdala, numerous thalamic nuclei, the striatum, hypothalamus, periaqueductal gray matter, and biochemically specific cell groups in the basal forebrain and brainstem. Architectonic and connectional evidence supports parcellation of the OfC. The rostrally placed isocortical sector is mainly connected with isocortical areas, including sensory areas of the auditory, somatic and visual modalities, whereas the caudal non-isocortical sector is principally connected with non-isocortical areas, and, in the sensory domain, with olfactory and gustatory areas. The connections of the isocortical and non-isocortical orbital sectors with the amygdala, thalamus, striatum, hypothalamus and periaqueductal gray matter are also specific. The medial sector of the OfC is selectively connected with the hippocampus, posterior parahippocampal cortex, posterior cingulate and retrosplenial areas, and area prostriata, while the lateral orbitofrontal sector is the most heavily connected with sensory areas of the gustatory, somatic and visual modalities, with premotor regions, and with the amygdala.


Accessory nerve electroneurography by magnetic stimulation in normal subjects.
An electroneurographic study was made of the accessory nerve in 15 healthy subjects by conventional peripheral electrical stimulation and transcranial magnetic stimulation at three different levels: cortical contralateral (frontoparietal), homolateral occipital and at the base of the skull. The motor evoked potential (MEP) obtained by magnetic stimulation at the skull base exhibited greater latency and amplitude than that recorded by conventional peripheral electrical stimulation. The MEP obtained by stimulating at occipital level again exhibited a greater latency than that corresponding to skull base stimulation, but the amplitude was smaller. Finally, the MEP resulting from cortical stimulation failed to appear uniformly in all of the individuals studied. Its amplitude was smaller than in the previous cases, with a mean latency of 11.76 ms and a central conduction time of 7.5 ms. The magnetic stimulation technique allowed the efficient, painless, non-invasive and easily reproducible study of the motor pathway of the spinal nerve over its entire trajectory (motor cortex-motor neuron-muscle).


Measurement of K cell activity: use of human OR1R1 red cells and anti-D to study the role of different leucocytes as effector cells.
A method for quantitative assay of K cell activity (KCA) with an allogenic combination of human OR1R1 red cells and anti-D (IgG, incomplete antibody) as target cells is described. Lymphocytes alone have been shown to cause lysis of these target cells. Fc receptor-bearing lymphocytes appear to be the chief mediators of KCA. This sub-population is a heterogeneous mixture of sub-sets of other sub-populations defined on the basis of different surface markers and likely to show variable expression of Fc receptors by the EA gamma rosette method. Monocytes and neutrophils (and possibly eosinophils), most of which bear Fc receptors, are ineffective as effector cells. Monocytes may in some instances have an inhibitory effect on the expression of KCA of lymphocytes. The method described has the advantage of simplicity (easy availability of OR1R1 cells and anti-D) and a high degree of sensitivity (marked lysis at low L/T ratio) and appears suitable for routine use in clinical practice.


Testicular aging involves mitochondrial dysfunction as well as an increase in UCP2 levels and proton leak.
To address the possibility that mitochondria are involved in the age-related loss of testicular function, we characterized mitochondrial bioenergetics in rat testis. A peak of mitochondrial functionality was detected in adult animals, with a decrease in both young and older animals. In the latter group a decrease in mitochondrial function was matched with an increase in proton leak and expression and activity of uncoupling protein 2 (UCP2), suggesting that proton leak may be involved in managing age-dependent mitochondrial dysfunction.


Puromycin: two distinct behavioral effects with different temporal parameters in the pigeon.
Pigeons were injected intracerebrally with either puromycin (PM) or control saline solution following training for one 12-min session on a visual discrimination. Injections were made either immediately following training, 1 hr later or 24 hr later. Retention testing 3 days after training showed that PM produced marked amnesia in the first two groups, but had no effect in the 24 hr condition. However, all PM groups were retarded subsequently in the number of days required to reach a 90% discimination criterion. This differentiation of two separate behavioral effects with different temporal gradients suggests that PM may be working through two distinct physiological mechanisms.


The Impact of Aerobic Exercise on Quality of Life in Women with Breast Cancer: A Randomized Controlled Trial.
The women with breast cancer experience high rates of morbidity due to different treatments. The objective of this study was to evaluate the role of aerobic exercise in the quality of life (QoL) among women suffering from breast cancer in Hamadan, western Iran. Participants who had consummated the eligibility criteria were randomly assigned in exercise group (n=30) and control group (n=30). Written informed consent was obtained from all participants. The mean age was 42.70 ±9.6 and 43.50 ±8.60 yr old in exercise and control groups, respectively. The quality of life was assessed by two widely used standard questionnaires (EORTC QLQ-C30 and EORTC QLQ-BR23). The exercise group received supervised exercise 2 days per week for 10 weeks. Through two stages (before and after intervention) these groups were evaluated. Analyzing the data was performed by SPSS/20.0, using t-test, chi-squared and ANCOVA. P<0.05 was regarded as significant level. The global health status QoL, based on EORTC QLQ-C30, developed significantly in the exercise group (48.76±24.96 vs. 81.79±16.34) in comparison with the controls (47.75 ±15.73 vs. 52.88 ±14.51) (P<0.001). The exercise intervention was associated with substantial development in total score of functions and symptoms of QoL using EORTC QLQ-BR23 (P<0.001). The statistically and clinically crucial developments were indicated in functions and symptoms of QoL in response to exercise in breast cancer women.


A practical algorithm for topical treatment of atopic dermatitis in the Middle East emphasizing the importance of sensitive skin areas.
Background There is a need for safe, effective treatment for atopic dermatitis (AD) in the Middle East. Objective To propose a practical algorithm for the treatment of AD throughout the Middle East. Methods An international panel of six experts from the Middle East and one from Europe developed the algorithm. The practical treatment guide was based on a review of published guidelines on AD, an evaluation of relevant literature published up to August 2016 and local treatment practices. Results Patients with an acute mild-to-moderate disease flare on sensitive body areas should apply the topical calcineurin inhibitor (TCI), pimecrolimus 1% cream twice daily until clearance. For other body locations, a TCI, either pimecrolimus 1% cream, tacrolimus 0.03% ointment in children or 0.1% ointment in adults, should be applied twice daily until clearance. Emollients should be used as needed. Patients experiencing acute severe disease flares should apply a topical corticosteroid (TCS) according to their label for a few days to reduce inflammation. After clinical improvement, pimecrolimus for sensitive skin areas or TCIs for other body locations should be used until there is a complete resolution of lesions. Conclusions These recommendations are expected to optimize AD management in patients across the Middle East.


Wnt, Frizzled, and sFRP gene expression patterns during gastrulation in the starfish Patiria (Asterina) pectinifera.
By the initial phase of gastrulation, Wnt pathway regulation mediates endomesoderm specification and establishes the animal-vegetal axis, thereby leading to proper gastrulation in starfish. To provide insight into the ancestral mechanism regulating deuterostome gastrulation, we identified the gene expression patterns of Wnt, Frizzled (Fz), and secreted frizzled-related protein (sFRP) family genes, which play a role in the initial stage of the Wnt pathway, in starfish Patiria (Asterina) pectinifera embryos using whole mount in situ hybridization. We identified ten Wnt, four Fz, and two sFRP paralogues. From the hatching blastula to the late gastrula stage, the majority of the Wnt genes and both Fz5/8 and sFRP1/5 were expressed in the posterior and anterior half of the embryo, respectively. Wnt8, Fz1, and Fz4 showed restricted expression in the lateral ectoderm. On the other hand, several genes were expressed de novo in the restricted domain of the archenteron at the late gastrula stage. These results suggest that the canonical and/or non-canonical Wnt pathway might implicate endomesoderm specification, anterior-posterior axis establishment, anterior-posterior patterning, and archenteron morphogenesis in the developmental context of starfish embryos. From comparison with the expression patterns observed in Patria miniata, we consider that the Wnt pathway is conserved among starfishes.


Higher Thrombin-Antithrombin III Complex Levels May Indicate Severe Acute Pancreatitis.
Coagulation disorders may develop in association with severe acute pancreatitis (AP). Plasma thrombin-antithrombin III complex (TAT) levels are one of the principal markers of coagulation disorder. The purpose of this study was to evaluate TAT and other hemostatic parameters in patients with AP and to examine whether or not these parameters indicate the severity of AP. Forty-six patients with AP (14 severe, 32 non-severe) and a 30-member healthy control group were recruited. The severity of AP was determined using the revised Atlanta classification. ELISA was used to measure patients' plasma TAT levels. The TAT levels of AP patients at presentation were higher than those of the control group (p = 0.005). The plasma TAT levels of patients with severe AP were also significantly higher than those of patients with non-severe AP (p = 0.05) and of the control group (p < 0.001). The general accuracy, sensitivity and specificity of TAT levels in predicting the severity of AP were 77.4, 77.8, and 77.3% respectively. The coagulation cascade was activated in the AP patients in our study, and this was shown to become more pronounced as severity of the disease increased. Plasma TAT levels at the time of presentation in patients with AP can be used as a marker for predicting the severity of the disease.


Aberrant expression of novel and previously described cell membrane markers in human breast cancer cell lines and tumors.
In a previous gene expression array study, we identified some 300 genes that were differentially expressed in human epidermal growth factor receptor tyrosine kinase 2 (HER2)-positive versus HER2-negative breast cancer cells. We have now done validation experiments on a group of three cell membrane components that had previously not been implicated in breast cancer. We also studied the expression of three other cell membrane proteins known to play a role in mammary neoplasia. By immunohistochemistry, we examined up to 130 archival breast carcinomas for Celsr2, E-cadherin, Kai1, and CD9 expression. The expression levels of NET-6 and TROP-2 were determined by quantitative reverse transcription-PCR in a subset of frozen tumors. We also studied fresh pellets and paraffin-embedded cell buttons of nine human breast cell lines. The relationship between the expression of all six membrane proteins and a variety of pathologic and biological variables, including estrogen receptor, HER2, and epidermal growth factor receptor status, was also examined. The NET-6 gene was transfected into a low-expressing cell line, and the effect on cellular morphology, growth, and invasion in vitro was recorded. Celsr2 was down-regulated in one cell line and in 7% of breast cancers. E-cadherin, Kai1, and CD9 were down-regulated in 35%, 76%, and 79% of tumors, respectively, confirming the important role of these markers in human mammary neoplasia. In breast cancer cell lines and tissues, TROP-2 was generally expressed at low levels, although a few specimens showed relative overexpression. NET-6 levels were lower in HER2-negative breast carcinoma cells. In addition, NET-6 was markedly down-regulated in estrogen receptor-negative breast cancers, and expression was lowest in "basal-like" tumors. Ectopic expression of NET-6 in low-expressing MDA-MB-231 cells altered cellular morphology, inhibited growth in vitro, and decreased invasion in a Boyden chamber assay. We have confirmed the expression of three new membrane markers that had previously not been implicated in human breast cancer, and one of them (NET-6) was correlated with HER2 and estrogen receptor status. NET-6 levels were decreased in estrogen receptor-negative and high-grade tumors, and ectopic expression of this gene had an inhibitory effect on proliferation and invasion. Thus, NET-6 may represent a novel breast cancer suppressor gene.


Gliosarcoma with features of chondroblastic osteosarcoma.
The occurrence of osteoid-chondral elements in gliosarcoma is extremely rare and has been reported in only two cases. A new, rare case of gliosarcoma with osteosarcomatous differentiation in a 55-year-old man and histogenesis of osteoid-chondral tissue in gliosarcoma is discussed. Surgically removed tumor tissues were examined immunohistochemically and electron microscopically, and a histologic examination was performed. Immunohistochemical and electron microscopic studies confirmed the presence of glial, fibroblastic, and osteoid-chondral elements. A major part of the sarcomatous tissue was undifferentiated and stained only by vimentin. Some areas of osteoid-chondral tissue were positive for glial fibrillary acidic protein (GFAP). These data suggest that osteoid-chondral elements came from the sarcomatous portion and GFAP positivity is not restricted to astrocytes and has been seen particularly in chondroid areas of non-glial tumors.


[Persistence and frequency of prescriptions of subcutaneous allergen-specific immunotherapy (SCIT) prescribed within the German statutory health insurance].
In accordance with guidelines subcutaneous allergen-specific immunotherapy (SCIT) should be continued for at least 3 consecutive years, which makes compliance to an issue of special importance. Measuring this compliance poses a methodological challenge. The aim of this study is to analyze persistence (reuptake of SCIT in the following years) and frequency (mean number of prescriptions) with the help of secondary data. The sample, which was taken from a regional prescription database, includes all members of the German statutory health insurance, who received at least one prescription of selected allergen extracts between January 1, 2003 and June 30, 2006. In addition to persistence, average prescriptions for each year of therapy were used to compare long-term SCIT and short-term SCIT. Based on mean number of prescriptions per year, it was examined whether persistence is higher in short-term than in long-term SCIT. Mean number of prescriptions is significantly different in the 1st (2nd; 3rd) year of therapy: 1.50 (1.31; 1.28) prescriptions for long-term SCIT, 1.30 (1.42; 1.42) prescriptions for short-term SCIT, and 1.10 (1.12; 1.14) prescriptions for a shortened therapy regimen with an adjuvant-supported allergoid. As presented, persistence is decreasing. Altogether 45% of SCIT patients continue therapy in the 2nd year. In the 3rd year of therapy, there are only 24% of patients remaining. Persistence rates to a certain degree seem to be dependent on the application form. The analysis of this secondary dataset has found that nonpersistence may jeopardize the therapy according to guidelines to a greater extent than expected from the literature. Except for one allergen extract the differentiation between long-term and short-term SCIT seems diffuse. Packages for consecutive treatment are used not only in long-term SCIT, but also in short-term SCIT regimens, if they are available. The analysis provides first hints that a shorter therapy regimen supports persistence of SCIT during the 2nd and 3rd year of therapy.


Pretranslational regulation of two cardiac glucose transporters in rats exposed to hypobaric hypoxia.
To investigate the mechanism by which cardiac glucose utilization increases during hypoxia and increased work load, we studied the effect of 2 and 14 days of hypobaric hypoxia on the expression of two subtypes of the facilitative D-glucose transporter, the GLUT-4 or "insulin-regulatable" isoform and the GLUT-1 isoform thought to mediate basal transport. Rats lose weight when exposed to hypobaric hypoxia, so fasting controls were used in the 2-day studies and pair-fed controls in the 14-day experiments. Hypobaric hypoxia (PO2 69 mmHg) resulted in right ventricular (RV), but not left ventricular (LV), hypertrophy. RV and LV GLUT-1 mRNA levels increased 2- to 3-fold after 2 days and 1.5- to 2-fold after 14 days of hypobaric hypoxia compared with both fasted rats and normal controls. RV GLUT-1 protein increased approximately 3-fold and LV GLUT-1 protein increased 1.5-fold after 14 days of hypobaric hypoxia vs. both pair-fed and normal controls. RV GLUT-4 mRNA decreased to 26% and RV GLUT-4 protein decreased to 54% of normal control levels as a result of 2 days of hypobaric hypoxia. RV GLUT-4 mRNA decreased to 64% of normal control levels with no change in RV GLUT-4 protein as a result of 2 days of fasting. We conclude that hypobaric hypoxia increases cardiac GLUT-1 expression at the pretranslational level in both ventricles. The greater increase in GLUT-1 protein on the right suggests an additive effect of pressure overload. GLUT-4 expression is reduced early in the development of RV hypertrophy.


Detecting EGFR alterations in clinical specimens-pitfalls and necessities.
We investigated the epidermal growth factor receptor (EGFR) status in early stage lung cancer in Southern Sweden, a population for which there are no previous reports on the EGFR mutation frequency. Three hundred fifty small cell lung cancers, adenocarcinomas (AC), squamous cell carcinomas (SqCC), and large cell carcinomas were analyzed using a combination of techniques for the analysis of protein expression, gene copy numbers, and mutations. Immunohistochemical (IHC) staining with antibodies for the EGFR mutations L858R and del E746-A750 revealed intratumoral heterogeneity and several discrepant cases when compared to mutation-specific polymerase chain reaction (PCR)-based analysis. The frequencies of these two mutations, when considering IHC staining with mutation-specific antibodies in a cohort of 298 cases and subsequent confirmation by PCR, were 10 % in AC and <2 % in SqCC. Furthermore, screening by sequencing of EGFR in a cohort of 52 lung AC and squamous carcinomas demonstrated a more diverse mutation spectrum, not covered by the mutation-specific antibodies. High expression of total EGFR protein was correlated to high gene copy numbers but did not reflect the mutational status of the tumors. We believe that the mutation spectra in a Southern Swedish population is too diverse to be covered by the mutation-specific antibodies, and we also raise some other issues regarding the use of the mutation-specific antibodies, for example concerning heterogeneous expression of the mutated protein, optimal antibody dilution, and discrepancies between staining results and PCR.


Familial Gerstmann-Sträussler-Scheinker disease with neurofibrillary tangles.
Patients affected with Gerstmann-Sträussler-Scheinker disease from two families, one from Indiana and one of Swedish origin, have been studied. The patients are clinically characterized by cerebellar ataxia, extrapyramidal signs, and dementia. Accumulation of amyloid deposits and neurofibrillary tangles are the most conspicuous neuropathologic features. In the patients from the Indiana family, the amyloid contains an 11-kDa peptide, an amyloidogenic degradation product of the prion protein. The neurofibrillary tangles are composed of paired helical filaments and immunoreact with antibody to A68, an abnormally phosphorylated form of the microtubule-associated protein tau. In these families, the disease is caused by a point mutation in the PRNP gene. In the Indiana family, the mutation is at codon 198, and in the Swedish family at codon 217.


A new antibiotic, okicenone. I. Taxonomy, fermentation, isolation and biological characteristics.
A new antibiotic, okicenone was isolated from the culture broth of Streptomyces sp. KO-3599. The antibiotic possesses cytocidal activity against mammalian tumor cells in vitro at concentrations of 0.53-11.0 micrograms/ml whereas the antibiotic showed no antimicrobial activities against Gram-positive and Gram-negative bacteria, fungi or yeast at a concentration of 1,000 micrograms/ml.


Ewing's sarcoma of the inferior vena cava.
Ewing's sarcoma most commonly arises from bone but may also arise from soft tissues. Sarcoma of the inferior vena cava is a rare entity that requires multimodal therapy including surgical resection and vascular reconstruction. We describe the first reported case of Ewing's sarcoma of the inferior vena cava.


Radionuclide antibody-conjugates, a targeted therapy towards cancer.
Targeted alpha therapy (TAT) is an investigational procedure which utilises monoclonal antibodies (mAbs), peptide conjugates and/or other chemical compounds. These bio-vectors are able to transport a dose of alpha particles to destroy cancer cells. Radionuclide antibody-conjugates (RACs), labelled with beta emitters, have already been used in humans. More recently, TAT has been introduced to treat oncological diseases mainly leukaemia and lymphoma. Encouraging results have also been obtained in solid neoplasms with the administration of anti-tenascin. This chimeric antibody labelled with astatine-211 was delivered in patients with recurrent brain tumours into a surgically created cavity. Conversely, a clinical trial using a standard TAT approach to treat patients with metastatic melanoma, observed the shrinkage of the solid tumour mass. This response in melanoma may lead to an alternative mechanism for TAT, called tumour-antivascular- alpha-therapy (TAVAT), and forms the basis of a novel approach to the treatment of cancer disease states. In this paper, we will concentrate mainly on the application of TAT using antibodies. In particular, an investigation into the major general features connected with the use of alpha emitters in cancer therapy will be discussed. The prospective role of TAT with RACs will also be outlined briefly, especially focussing on the most important therapeutic strategies to date based on antibodies radiolabelled with beta emitters.


Reduced cerebrospinal fluid levels of immunoreactive pro-opiomelanocortin related peptides (including beta-endorphin) in anorexia nervosa.
The discovery that the endogenous opioid peptides contribute to the modulation of appetitive behavior and neuroendocrine function has raised questions as to whether disturbances of opioids contributes to the pathophysiology of eating disorders. To assess central nervous system (CNS) beta-endorphin in patients with anorexia nervosa we measured cerebrospinal fluid (CSF) beta-endorphin concentrations before, and at intervals after weight correction. In addition, we measured three sister peptides (beta-lipotropin, adrenocorticotropic hormone (ACTH), and the N-terminal fragment) derived from the same precursor molecule, pro-opiomelanocortin (POMC) to determine whether possible disturbances might extend to sister peptides. Underweight anorectics (58 +/- 5% of average body weight (ABW), n = 10) had significantly lower CSF concentrations of all 4 peptides compared to healthy controls (102 +/- 10% ABW, n = 11). CSF concentrations of all 4 POMC-related peptides were found to be significantly increased when the same anorectics were restudied 4 to 6 weeks after weight gain (83 +/- 4% ABW). After weight gain, levels of CSF beta-endorphin, beta-lipotropin, and ACTH were similar to controls, whereas levels of CSF N-POMC remained significantly less than controls. Another group of women, previously underweight with anorexia nervosa, but weight-restored (93 +/- 11% ABW, n = 12) for greater than 1 year had CSF concentrations of all 4 POMC-related peptides that were similar to controls. We conclude that underweight anorectics have state-associated disturbances of CNS beta-endorphin as well as other POMC-related peptides. These abnormalities are part of the neurobiological syndrome of anorexia nervosa and may contribute to the characteristic alterations in behavior and neuroendocrine function.


Three types of postsynaptic glutamatergic receptors are activated in DMNX neurons upon stimulation of NTS.
While it is widely accepted that parasympathetic activity plays a significant role in cardiovascular, bronchomotor, and gastrointestinal function, little is known about the synaptic control of parasympathetic vagal neurons. In this study, we identified the neurotransmitter(s) and postsynaptic responses in dorsal motor nucleus of the vagus (DMNX) neurons upon stimulation of the nucleus of the solitary tract (NTS). Neurons were visualized in rat brain stem slices, and perforated patch-clamp techniques were used to record postsynaptic currents. NTS stimulation activated glutamatergic currents in DMNX that were separated into N-methyl-D-aspartate (NMDA) and non-NMDA components using D-2-amino-5-phosphonovalerate and 6-cyano-7-nitroquinoxaline-2,3-dione, respectively. The non-NMDA component was further characterized using cyclothiazide and concanavalin A to block desensitization of DL-alpha-amino-3-hydroxy-5-methylisoxazole-propionic acid (AMPA) and kainate receptors, respectively. Cyclothiazide increased the postsynaptic amplitude, whereas concanavalin A augmented duration, suggesting kainate, but not AMPA, currents are curtailed by desensitization. High frequency stimulations did not alter synaptic efficacy. In conclusion, this study demonstrates the existence of a monosynaptic glutamatergic pathway from NTS that activates NMDA, kainate, and AMPA postsynaptic receptors in DMNX neurons.


Measuring attentional bias to peripheral facial deformities.
Introduce a novel method for objectively evaluating attentional bias to peripheral facial deformities using an established metric of attention. The SMI eye-tracker system (SensoMotoric Inc., Boston, MA) was used to record the eye movement patterns, called scanpaths, of eight naïve observers gazing at pictures of faces with or without peripheral surgical deformities. The scanpaths of observers gazing on those novel faces were compared, and the fixation durations for different facial regions were compared between faces. There were statistically significant differences in the mean fixation times between the faces considered normal and those considered abnormal (those with an obvious defect). When multivariate analysis of variance was performed with dependent variables total fixation time, fixation time in central triangle, and fixation time in the defect region and the independent variable face, all four tests were highly statistically significant. When univariate analysis of variance was performed to test the hypothesis that defect fixation times varied by face, the results were highly statistically significant (F = 8.79, P = .0003). Observers gazing on faces typically focus their attention on discriminating features, such as eyes, nose, and mouth. The well-established method of eye movement recordings was applied in a novel way to provide quantitative data showing changes in observer gaze patterns to focus on deformities. These gaze patterns are a direct reflection of observer attention. This is the first objective method to quantify the amount of distraction caused by peripheral facial deformities and may provide insight into the perception of facial deformity.


Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study.
In most patients, severity of valvular aortic stenosis can be accurately assessed non-invasively by echocardiography. However, retrograde catheterisation of the aortic valve is often undertaken. This procedure has a potential risk of neurological complications, with an unknown incidence of clinically silent embolism. We aimed to establish the frequency of clinically apparent and silent cerebral embolism after this procedure. We prospectively randomised 152 consecutive patients with valvular aortic stenosis at a German university hospital to receive either cardiac catheterisation with (n=101) or without (n=51) passage through the aortic valve. Patients underwent cranial MRI and neurological assessment within 48 h before and after the procedure to assess cerebral embolism. Controls were 32 patients without valvular aortic stenosis who underwent coronary angiography and laevocardiography. 22 of 101 patients (22%) who underwent retrograde catheterisation of the aortic valve had focal diffusion-imaging abnormalities in a pattern consistent with acute cerebral embolic events after the procedure; three of these patients (3%) had clinically apparent neurological deficits. By contrast, none of the patients without passage of the valve, or any of the controls, had evidence of cerebral embolism as assessed by MRI. Patients with valvular aortic stenosis who undergo retrograde catheterisation of the aortic valve have a substantial risk of clinically apparent cerebral embolism, and frequently have silent ischaemic brain lesions. Patients should be informed about these risks, and this procedure should be used only in patients with unclear echocardiographical findings when additional information is necessary for clinical management.


[POPULATION AND CLUSTER APPROACH TO ASSESSMENT OF REPRODUCTIVE HEALTH OF WOMEN].
The purpose of this study was to explore the possibility of using a population approach to assessing the risk of reproductive health disorders in women of childbearing age. We observed 240 clinically healthy women aged 20 to 43 years, half of them lived in the Middle Black Earth region of Russia, and 120 women lived in Tajikistan. The study identified population differences in women with different ethnic backgrounds and regions of residence according to a set of genetic, hormonal, and immune signs. All women underwent venous blood sampling for the purpose of HLA typing by molecular genetic analysis and determining the range of normative values of hormonal and immune status parameters. DNA samples were obtained from peripheral blood lymphocytes using reagent kits and a protocol for isolating DNA from various biological materials from DLAtomTM DNAPrep 100 (Russia). Hormonal status was studied in terms of follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, progesterone, 17-OH-progesterone; Thyroid hormones - thyroid-stimulating hormone, total triiodothyronine, total thyroxine; Androgens - testosterone, dihydroepiandrosterone; Steroid hormone-cortisol. In order to exclude the variability of the data, the examination was carried out on the 3-5th days of the menstrual cycle: luteinizing hormone, follicle-stimulating hormone, estradiol, prolactin, testosterone and on the 20-22nd Day of the progesterone cycle. Statistical data processing was carried out on the basis of SPSS programs and included descriptive and comparative nonparametric statistics, discriminant, regression analysis, one - factorial analysis of variance, calculation of 95% confidence intervals, construction of ROC curves. The study included the determination of allelic variants at the three loci of the HLA-D genes (HLA-DRB1, HLA-DQA1, HLA-DQB1) controlling the immune response. Population differences in the locus of the HLA-DRB1 gene were determined. The HLA-DRB1 * 08 and HLA-DRB1 * 12 alleles are found in the Russian women's population, and the HLA-DRB1 * 04 and HLA-DRB1 * 17 alleles are more reliably detected in the Tajik women's population, while the HLA-DRB1 * 04 allele Is associated with a higher incidence of miscarriage. The population characteristics of the HLA-DQA1 gene locus were also established. In the group of women of the Russian population, the incidence of HLA-DQA1 * 0101 and HLA-DQA1 * 0103 alleles is significantly higher, of which the former is associated with protective properties for reproductive pathology, and the latter, on the contrary, with miscarriage. At the same time, the alleles HLA-DQA1 * 0201 and HLA-DQA1 * 0301 were significantly more often detected in the compared with the population of Tajik women. As in the previous case, for the HLA-DQA1 * 0201 allele reproductive health disorders are not characteristic, and in the case of the HLA-DQA1 * 0301 allele they accompany it. Our studies have revealed that there are differences between the populations of Russian and Tajik women in a number of parameters of the hormonal and immune status, as well as at the level of allelic variants of genes that control the immune response. The population approach, based on the use of discriminant analysis, is a highly effective way of grouping women according to their reproductive health status and the risk factors that caused reproductive damage. The risk factors that caused the reproductive failure are different in combination and manifestation in the populations of Russian and Tajik women, except for the adverse allelic variants of the HLA-DRB1 * 04 and HLA-DQA1 * 0103 genes, which are the same in both populations. The obtained data also show that in different populations in the evaluation of reproductive health a differentiated approach is needed both to establish physiological norms in these categories of parameters and to assess the reproductive health of women.


Lamellar-in-lamellar structure of binary linear multiblock copolymers.
A theoretical description of the lamellar-in-lamellar self-assembly of binary A-b-(B-b-A)(m)-b-B-b-A multiblock copolymers in the strong segregation limit is presented. The essential difference between this binary multiblock system and the previously considered C-b-(B-b-A)(m)-b-B-b-C ternary multiblock copolymer system is discussed. Considering the situation with long end blocks, the free energy of the lamellar-in-lamellar self-assembled state is analyzed as a function of the number k of "thin" internal lamellar domains for different numbers m of repeating (B-b-A) units and different values of the Flory-Huggins chi(AB) interaction parameter. The theoretical predictions are in excellent agreement with the available experimental data.


Aspergillosis osteomyelitis and joint infection in a renal transplant recipient.
Invasive Aspergillosis occurs in almost every human organ, most commonly in the lungs. Bone involvement classically has been considered exceedingly rare for both immunocompromised and immunocompetent hosts, however, there are limited data in transplant recipients. We report an unusual case of osteomyelitis and joint infection of the ankle caused by Aspergillus fumigatus in a renal transplant recipient.


Patient-reported outcomes from a randomized, crossover trial comparing a pen injector with insulin degludec versus a pen injector with insulin glargine U100 in patients with type 2 diabetes.
Type 2 diabetes (T2D) is associated with insulin resistance and deteriorated glycemic control that can be restored with insulin injections. Choice of insulin pen injector may affect complexity, adherence, efficacy of treatment and health-related quality of life. We describe detailed patient-reported outcomes (PROs) on treatment impact and preference comparing insulin degludec (degludec) using FlexTouch 1 versus insulin glargine U100 (glargine U100) with SoloStar 2 pen injector. In this randomized, multicenter (USA), open-label, crossover, treat-to-target study (NCT01570751), patients with T2D using high-dose insulin (≥81 U/day from vials) were randomized (n = 145) 1:1 to 16 weeks of degludec U200 (3 mL FlexTouch) followed by 16 weeks of glargine U100 (3 mL SoloStar) or vice versa. PRO questionnaires assessed treatment impact and patient preference of pen injectors. Significantly more patients (p < .01) considered FlexTouch "extremely easy" for learning (62.5 vs. 43.0%), maintaining (63.2 vs. 42.2%) and adjusting the dose (63.2 vs. 44.4%), and significantly more were "very" or "extremely confident" in using the device (60.3 vs. 36.3%) and in its accuracy (50.7 vs. 30.4%) versus SoloStar. Significantly more were "not at all bothered" by device discomfort (74.3 vs. 54.1%), whereas device size (83.8 vs. 80.0%) or public use (69.9 vs. 60.7%) were numerically in favor of FlexTouch. Significantly more patients preferred degludec treatment with FlexTouch (59 vs. 22%), preferred to continue (67 vs. 15%) and recommend (67 vs. 14%) use of FlexTouch compared with SoloStar with glargine U100. In this randomized, crossover trial, lower treatment impact and higher patient preference were reported for FlexTouch versus SoloStar pen injectors.


Biological characteristics of chicken anemia virus regenerated from clinical specimen by PCR.
Our previous genetic characterization of chicken anemia virus (CAV) in commercial broiler chickens in Alabama revealed a previously undetected polymorphism: a glutamine codon at VP1 position 22, in 7 of the 14 sequences. The novel glutamine codon was always found in association with a VP1 "hypervariable region" identical to CAV field isolates that replicate poorly in culture. The complete genome of CAV73, representative of the sequences with the novel polymorphism, was generated from cloned polymerase chain reaction (PCR) fragments amplified directly from naturally infected tissues. CAV73 had been detected in 31-day-old broilers submitted for examination for reasons unrelated to anemia. After electroporation of the cloned genomes into MDCC-CU147 lymphoblastoid cells, the regenerated CAV caused the culture to fail within 9 days, and the medium contained 5 X 10(6) TCID50 CAV/ml. Use of MDCC-CU147 cells was essential, as identical electroporation of MDCC-MSB1 cells failed to generate CAV able to destroy the culture within 8 wk. Regenerated CAV73 produced anemia and severe lymphocytic depletion of the thymus when inoculated into susceptible 3-day-old chickens and was reisolated from these chickens. Furthermore, it replicated in low- and high-passage MDCC-MSB1 cells similarly to a low-passage CAV field isolate that contains a different VP 1 "hypervariable region." The regeneration of CAV from PCR products directly from naturally infected carcasses, as performed in this study, provides a tool for the evaluation of distinct genetic polymorphisms that may be detected in specimens where infective virions are no longer available. Our results also provide some insight into the differential susceptibility of cell lines for low-passage CAV field isolates.


Assessing spirituality and religiousness in advanced cancer patients.
The aim of this study was to translate the Spiritual Involvement and Beliefs Scale into the Greek language and validate its psychometric properties in a sample of advanced cancer patients treated in a palliative care unit. The scale was translated into Greek with the "forward-backward" procedure. It was administered twice, with a 3-day interval, to 82 patients with advanced cancer. Patients completed the Spiritual Involvement and Beliefs Scale and the Greek Hospital Anxiety and Depression Scale. The scale had an overall Cronbach alpha of 0.89. Overall test-retest reliability was satisfactory at P<.0005. Satisfactory construct validity was supported between the Spiritual Involvement and Beliefs Scale subscales and Hospital Anxiety and Depression subscales. Interscale and interitem correlations were found satisfactory at P<.0005. These results support that the Spiritual Involvement and Beliefs Scale is an instrument with satisfactory psychometric properties and is a valid research tool for spirituality in advanced cancer patients.


Incidence of Multiple Sclerosis in Germany: A Cohort Study Applying Different Case Definitions Based on Claims Data.
Data on the incidence of multiple sclerosis (MS) on the national level is scarce. We aimed to estimate the incidence of MS in Germany and to compare different MS case definitions based on claims data. We conducted a cohort study with the German Pharmacoepidemiological Research Database in 2012 and calculated age- and gender-standardized incidence rates (sIRs) for 3 case definitions. In addition, the effect of stepwise reduction of the look-back period without MS diagnosis on the incidence rate was evaluated. Our cohort comprised 4,175,877 individuals. The first case definition based on ICD-10 diagnoses yielded an sIR of 21.8 (95% CI 20.2-23.5) per 100,000 person years, whereas the second and third case definitions with additional requirements for drug treatment and diagnostic tests resulted in lower sIRs of 10.1 (9.1-11.3) and 6.6 (5.8-7.6) respectively. We observed a higher incidence for shorter look-back periods. The incidence of MS in Germany might be substantially higher than suggested in earlier studies. In addition, our study highlights the importance of a look-back period of at least 36 months to identify incident MS cases based on claims data.


Designing for patients.
In February 1992, Health Services Management (HSM) readers were invited to submit details of a proposed project that needed a designer. HSM teamed up with design consultants, the PDI Group, which offered 10,000 pounds-worth of design and project management to the reader submitting the most challenging design problem. Such was the quality of the entrants that two prizes were awarded, divided equally between The Eric Burden Community Unit at Littlemore Hospital, Oxford, and the Perth Royal Infirmary Community Unit project.


[The value of multislice spiral computed tomography in demonstrating the relationship between bronchus and peripheral lung cancer].
To investigate the value of multislice spiral computed tomography (MSCT) in demonstrating the relationship between bronchus and peripheral lung cancer. We prospectively performed volumetric targeted scans of 0.5 mm collimation with MSCT and reconstructed images of multiplanar reconstruction (MPR), curved multiplanar reformations (CMPR) and surface shaded display (SSD) in 53 peripheral lung cancers. The results were compared with macroscopic and microscopic specimens. (1) The third- to seventh-order branches of the bronchi were clearly shown in all patients by the designed protocol. CT demonstrated the tumor-bronchus relationship in 29 (96.7%) adenocarcinomas and 13 (76.5%) squamous-cell carcinomas. Statistic analysis showed that there was no significant difference between the two groups (chi(2) = 2.8, P > 0.05). (2) The tumor-bronchus relationship was identified as four types with MSCT. Type I: bronchus was obstructed abruptly by the tumor, type II: bronchus penetrated into the tumor with tapered narrowing and interruption, type III: bronchus lumen shown within tumor was patent and intact, type IV: bronchus ran at the periphery of the tumor with intact or narrowed lumen. (3) Type I was shown in 31 of 53 (58.5%) tumors with squamous-cell carcinoma slightly more common than adenocarcinoma. Type II and type III were seen equally in 8 of 53 (15.1%) tumors which occurred only in adenocarcinomas. Type IV was seen in 15 of 53 (28.3%) tumors with adenocarcinoma being slightly more frequent than squamous cell carcinoma. (4) The tumor at the fourth-order bronchus was more common in squamous cell carcinoma, whereas that at the fixth-order bronchus was more likely in adenocarcinoma. Volumetric targeted scan of ultra-thin section with MSCT and followed by MPR, CMPR and SSD reconstruction can greatly improve the manifestation of the bronchioles and accurately demonstrate the patterns of tumor-bronchus relationship, thereby reflecting pathologic changes to some extent.


Efficacy and safety of zero-fluoroscopy ablation for supraventricular tachycardias. Use of optional contact force measurement for zero-fluoroscopy ablation in a clinical routine setting.
Conventional catheter ablation of cardiac arrhythmias is associated with radiation risks for patients and laboratory personnel. Widespread use of zero-fluoroscopic catheter ablation in clinical routine is limited by safety concerns. This study investigated the feasibility of zero-fluoroscopy catheter ablation using a three-dimensional mapping system and optional catheter contact force technology for an all-comers collective. The study comprised 184 patients; 91 patients, including 29 pediatric patients, underwent a zero-fluoroscopic electrophysiology (EP) study using the EnSite NavX system with real-time visualization of all electrodes. These patients were matched to a control group, which was treated using fluoroscopy in the same period. Inclusion criteria were documented supraventricular tachycardia or a history of symptomatic paroxysmal supraventricular tachycardia. Transseptal access, if necessary, was achieved under transesophageal echocardiographic guidance for ablation of left-sided arrhythmias. Radiofrequency (using optional contact force measurement) or a cryotechnique was used for ablation. We observed no major acute complications. There were no significant differences between the two groups in the follow-up period. Zero-fluoroscopic catheter ablation is generally feasible in right-sided cardiac arrhythmias. Safety concerns regarding left atrial substrates or children can be overcome with optional real-time contact force measurement.


Intra-arterial angiolymphoid hyperplasia with eosinophilia.
Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare skin disorder of unknown etiology. This paper describes the case of a 34-year-old man with a lesion located on the right part of his forehead. Microscopically, it displayed a typical morphology of ALHE. However, it was exceptional by its intra-arterial location and its prominent lymphocytic rim-like component. Differential diagnoses, with special emphasis to organized thrombosis and juvenile arteritis, are discussed here.


Externally cued and internally generated selection: differences in distractor analysis and inhibition.
In most studies of selective attention, the experimenter informs the participant what the target is and what action is required. For example, participants may be told to name the red drawing. The present study shows that under such conditions of external selection, distractor inhibition is used to ensure that selection is efficient. In external selection, analysis of distractors is limited, causing later recognition of distractor items to be poor. In contrast, during real-world selection a person may be confronted with a number of potential targets and may have to decide what will be the target for action. Under these conditions of internal selection, inhibition of distracting information does not occur. Moreover, distractors are more fully analyzed and thus better recognized at a later test.


Percutaneous computed tomography-guided stabilization of posterior pelvic fractures.
Nineteen patients with 21 unstable fractures of the posterior pelvic complex were treated with percutaneous computed tomography (CT)-guided posterior stabilization. CT allowed satisfactory visualization of the fracture and direction and length of the screw. It also allowed the authors to perform the procedure percutaneously, while causing only minimal blood loss. CT cuts that showed the best and safest sites for screw placement were selected. The length and direction of the screw was identified, and the skin entry site was determined. The guide pin was inserted across the fracture or disrupted sacroiliac joint; its correct position was confirmed and a cannulated screw was inserted over the pin. In the majority of patients, a pelvic external fixator was applied in the CT suite. Although assessing the deformity was possible, reduction was difficult but ultimately acceptable. All patients maintained reduction of their sacroiliac complex without loss of fixation, and all fractures healed without clinical or radiographic signs of pelvic instability. This technique was not associated with neurologic injury or deep infection. All but 2 patients returned to preinjury levels of activity and function. Two patients had associated injuries that affected their final functional outcome.


Osteoarticular allografts.
Over the past eighty years, osteoarticular allografts have provided the possibility of limb-sparing procedures in tumor surgery. Several authors have now reported up to 80 per cent successful use of these types of grafts, and large well-documented series give evidence that limb reconstruction following extensive resection of bone and joints has been possible with their use. In conjunction with their successful applications, studies of the fate of osteoarticular allografts have provided useful information on their associated problems. Infection has been a major complication, affecting up to 12 per cent of recipients and frequently resulting in re-operations and occasionally amputations. Studies have suggested however that almost half of these infections are due to soft-tissue complications rather than to the allografts. Fractures and non-unions, affecting up to 10 per cent of recipients, have proven easier to treat, and few if any patients lose their grafts after fractures. A recent study of retrieved osteoarticular allografts has shown that incorporation of these massive bone segments is slow but progressive, and ultimate incorporation of the grafts can be expected in most patients. The fate of the cartilaginous portion of the grafts has also been evaluated. Our laboratory has suggested that although cryopreservation of the articular portion of the grafts appears feasible in vitro, the fate of transplanted cryopreserved cartilage is dependent on many factors, including accurate sizing and ligamentous reconstruction around the replaced joints. In determining indications for massive osteoarticular allografts, we have found that these grafts are not a panacea for all problems encountered in bone tumor resection, but should be used advisedly for the treatment of specific problems.(ABSTRACT TRUNCATED AT 250 WORDS)


Comparison of foeto-maternal outcome in pregnant women with hepatitis E - A review of 12 years.
To compare adverse maternal and foetal outcome in pregnant women with hepatitis E immunoglobulin M reactive versus non-reactive. This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of pregnant patients at any gestational age with clinical and biochemical evidence of hepatitis E from January 2002 and December 2014. . Maternal and perinatal outcome of the subjects were analysed. SPSS 20 was used for data analysis. Out of the 200 subjects, 168(84 %) were hepatitis E immunoglobulin M reactive and 32(16%) were non-reactive. The overall mean age was 26.7±4.5 years. Also, 12(7%) patients in the immunoglobulin M reactive group were admitted to intensive care unit compared to no one from the non-reactive group. Similarly fulminant hepatic failure was seen in 12(7.1%) patients in the immunoglobulin M reactive group compared to no one in the other group. Post-partum haemorrhage was more frequent in the immunoglobulin M reactive group compared to the non-reactive group. There were 5(3%) maternal deaths in the reactive group compared to no death in the other group. Moreover, 34(20.2%) neonates of the immunoglobulin M reactive group needed neonatal intensive care unit admission compared to none in the non-reactive group. There were 4(2.4%) neonatal deaths in the reactive group. Participants in the immunoglobulin M reactive group had a higher percentage of adverse foeto-maternal outcomes compared to the non-reactive group.


Endothelium-Derived Semaphorin 3G Regulates Hippocampal Synaptic Structure and Plasticity via Neuropilin-2/PlexinA4.
The proper interactions between blood vessels and neurons are critical for maintaining the strength of neural circuits and cognitive function. However, the precise molecular events underlying these interactions remain largely unknown. Here, we report that the selective knockout of semaphorin 3G (Sema3G) in endothelial cells impaired hippocampal-dependent memory and reduced dendritic spine density in CA1 neurons in mice; these effects were reversed after restoration of Sema3G levels in the hippocampus by AAV transfection. We further show that Sema3G increased excitatory synapse density via neuropilin-2/PlexinA4 signaling and through activation of Rac1. These results provide the first evidence that, in the central nervous system, endothelial Sema3G serves as a vascular-derived synaptic organizer that regulates synaptic plasticity and hippocampal-dependent memory. Our findings highlight the role of vascular endothelial cells in regulating cognitive function through intercellular communication with neurons in the hippocampus.