Continuous veno-venous hemofiltration without anticoagulation in high-risk patients.
To study the safety and operative efficacy of continuous veno-venous hemofiltration (CVVH) without anticoagulation in patients at high risk of bleeding. Prospective cohort study and comparison to control group. Tertiary, multidisciplinary intensive care unit. Forty hemofiltration circuits in 12 patients with severe acute renal failure (ARF) deemed at high risk of bleeding. Forty control circuits in 14 patients treated with low-dose pre-filter heparin infusion. CVVH at 21/h of pump-controlled ultrafiltration without anticoagulation or saline flush in patients at high risk of bleeding. Collection of data at the bedside. Mean circuit life was 32 h (95% CI: 20-44.4) in patients receiving CVVH without anticoagulation. Forty-three per cent of filters lasted longer than 30 h. Circuit lifespan did not correlate with international normalized ratio (INR), activated partial thromboplastin time (APTT) or platelet count. There were no bleeding complications and azotemic control was not compromised by lack of circuit anticoagulation with a mean serum urea of 16.0 mmol/l (95% CI: 14.9-18.1) during treatment. A control group of consecutive similarly ill patients not at high risk of bleeding received low-dose pre-filter heparin (mean dose 716 IU; 95% CI: 647-785). Their mean filter life was 19.5 h (95% CI: 14.2-23.8), significantly shorter than in the study patients (p = 0.017). Critically ill patients at high risk of bleeding who require continuous renal replacement therapy (CRRT) can be safely managed without circuit anticoagulation. This strategy minimizes bleeding risks and is associated with an acceptable filter life. CRRT without anticoagulation should be strongly considered in high-risk patients.


Effect of Viagra on the foveolar choroidal circulation of AMD patients.
To investigate the effects of sildenafil citrate (Viagra) on foveolar choroidal circulation in patients with age related macular degeneration (AMD). Double-blinded, randomized, placebo-controlled, crossover study. Fifteen male AMD patients received a dose of 100 mg of sildenafil or matching placebo on two separate days. Laser Doppler flowmetry was performed to assess relative choroidal blood velocity (ChB(Vel)), volume (ChB(Vol)) and flow (ChB(Flow)) in the study eye prior to administration of the drug at baseline and 30, 90, 180, 300 min after dosing. Best corrected visual acuity (BCVA), contrast sensitivity (CS), mean arterial blood pressure (BPm), heart rate (HR), intraocular pressure (IOP) and ocular perfusion pressure (PP) were determined. In comparison to placebo, sildenafil did not cause any statistically significant changes in mean ChB(Vel) (ANOVA, P=0.12), ChB(Vol) (ANOVA, P=0.24) or ChB(Flow) (ANOVA, P=0.46). There were no statistically significant changes in CS (ANOVA, P=0.59), BCVA (P=0.58), IOP (P=0.81) or HR (P=0.07) throughout the study. Significant decreases in BPm (P=0.006) and PP (P=0.006) were observed at 30 min after sildenafil. Administration of sildenafil citrate didn't cause any statistically significant changes in the foveolar choroidal circulation of AMD patients.


Photodynamics of Zr-based MOFs: effect of explosive nitroaromatics.
The present work describes the spectroscopic and photodynamics of two different Zr mixed-linkers MOFs (Zr-NDC/Tz and Zr-NDC/CN) and their interaction with nitroaromatics. Both MOFs exhibit comparable spectroscopic behaviours, with a broad emission band mainly due to the naphthalene excimers within their three-dimensional structure. Flash photolysis experiments show a slow radiative electron-hole (e--h+) recombination, reflected as a large negative absorption band. The interaction with the selected nitroaromatic compounds produces a static fluorescence quenching of Zr-NDC/Tz. Interestingly, the addition of trinitrophenol (TNP) induces the formation of a charge-transfer complex, helped by intermolecular H-bonds formation, as shown by the steady-state and ps-time-resolved emission experiments. Remarkably, the (e--h+) recombination is strongly affected due to the inhibition of the ligand-to-cluster charge transfer process within the MOF. The quenching constants for the nitroaromatics lacking -OH groups are in the order of 102 M-1, while it is two orders of magnitude higher for the TNP (1.8 × 104 M-1). Both MOFs are highly selective toward TNP. We also demonstrate the possibility to recycle these MOFs without significant loses in their ability to detect TNP. Our findings give the clues to understand the fluorescence quenching mechanism of new Zr-based MOFs in presence of explosive-like molecules, opening the way to improve these nanomaterials as highly selective sensor of nitroaromatics.


Sensorically and antimicrobially active metabolite production of Lactobacillus strains on Jerusalem artichoke juice.
In the tubers of Jerusalem artichoke (Helianthus tuberosus L.) the main carbohydrate is the well-known prebiotic inulin, which is a good growth substrate for gut microorganisms. Jerusalem artichoke tuber is traditionally consumed boiled or pickled rather than in fermented form. Lactic acid bacteria are traditionally used in the production of fermented foods; nevertheless their behavior and metabolite production are considerably influenced by the substrate. The purpose of this study was to investigate the growth and production of the most important sensorically and antimicrobially active metabolites of different Lactobacillus strains on Jerusalem artichoke juice. All investigated strains grew well (in the range 10(9) cfu mL(-1) ) in the media. The organic acids (lactic acid, 110-337 mmol L(-1) ; acetic acid, 0-180 mmol L(-1) ; and succinic acid, 0-79 mmol L(-1) ), hydrogen peroxide (0.25-1.77 mg L(-1) ), mannitol (0.06-3.24 g L(-1) ), acetoin and diacetyl production of strains varies not only according to the species but also from strain to strain, which will be demonstrated and discussed in the paper. Our results showed that lactobacilli can be used for the fermentation of Jerusalem artichoke, which in this form could be used, alone or mixed with other raw food material, as a new synbiotic functional food.


Vitamin and mineral status: effects on physical performance.
Public health recommendations encourage the selection of a balanced diet and increasing physical activity to foster health and well-being. Whereas the adverse effects of restricted intakes of protein, fat, and carbohydrate on physical performance are well known, there is limited information about the impact of low intakes of vitamins and minerals on the exercise capacity and performance of humans. Physically active people generally consume amounts of vitamins and minerals consistent with the recommendations for the general public. However, when intakes are less than recommendations, some noticeable functional impairments occur. Acute or short-term marginal deficiencies, identified by blood biochemical measures of vitamin B status, had no impacts on performance measures. Severe deprivation of folate and vitamin B12 result in anemia and reduce endurance work performance. Evidence of vitamin A and E deficiencies in athletic individuals is lacking apparently because body storage is appreciable. In contrast to vitamins, marginal mineral deficiencies impair performance. Iron deficiency, with or without anemia, impairs muscle function and limits work capacity. Magnesium deprivation increases oxygen requirements to complete submaximal exercise and reduces endurance performance. Use of vitamin and mineral supplements does not improve measures of performance in people consuming adequate diets. Young girls and individuals participating in activities with weight classifications or aesthetic components are prone to nutrient deficiencies because they restrict food intake and specific micronutrient-rich foods. This information will be useful to professionals who counsel physically active people and scientific groups who make dietary recommendations to improve health and optimize genetic potential.


[A study of CDDP in the treatment of patients with gastric and esophageal cancers, with special reference to the evaluation of renal functions before and after CDDP administration].
Although CDDP has been widely used for cancer chemotherapy in recent years, the problem is that it causes a renal dysfunction as a side effect. As briefly reported here, we have currently used this drug for the treatment of stomach esophageal cancers as a part of multidepartmental therapy, and obtained a finding on the therapeutic usefulness, particularly for monitoring the renal function before and after administration. The subjects were 6 patients with stomach and 11 with esophageal cancer given CDDP at the dose of 50 mg 2 courses, in principle, a single course per week. Blood transfusion was carried out in an amount of 1,000 ml before administration, 2,500 ml on the day of treatment and 1,000 ml for 3 days after administration. When the effects of CDDP on urinary BUN, Na, K, Cl, Mg, NAG, beta 2 microglobulin, Ccr and FENa levels were measured for the determination of renal functions before and after administration, NAG and beta 2 microglobulin levels were conceivably found to be useful indices.


Effect of high-frequency repetitive transcranial magnetic stimulation on brain excitability in severely brain-injured patients in minimally conscious or vegetative state.
Repetitive transcranial magnetic stimulation (rTMS) induces prolonged functional changes in the cerebral cortex in normal conditions and in altered states of consciousness. Its therapeutic effects have been variously documented. The aim of this study was to investigate the reactivity of electroencephalography (EEG) and the clinical response in six severely brain-injured patients in an altered state of consciousness (minimally conscious state [MCS] or vegetative state [VS]). EEG rhythm and brain excitability were measured before and after a protocol of high-frequency rTMS. All six patients underwent clinical and neurophysiological evaluation before rTMS and immediately thereafter. EEG data in resting state were acquired at the beginning of the exam (T0), after rTMS (T1), and 38 min after rTMS (T2). From these data the power values were computed using Fast Fourier Transform. rTMS over the motor cortex induced long-lasting behavioral and neurophysiological modifications in only one patient in MCS. No significant clinical or EEG modifications were detected in any of the other patients, except for changes in motor threshold and motor evoked potential amplitude over the stimulated motor areas. The main finding of the study is the correlation between EEG reactivity and clinical response after rTMS. Reappearance of fast activity and an increase in slow activity were noted in the one patient with transitory arousal, whereas no significant reliable changes were observed in the other patients showing no clinical reactivity.


Effects of tetracycline HCl conditioning and fibrin-fibronectin system application in the treatment of buccal gingival recession with guided tissue regeneration.
A split-mouth clinical trial was designed to evaluate the effect of treating deep wide buccal gingival recession with guided tissue regeneration using expanded polytetrafluoroethylene membrane combined with tetracycline HCl (TTC) root conditioning and fibrin-fibronectin sealing system (FFSS) application. Eight patients, aged 25 to 57 years, each presenting two similar mucogingival defects, were selected. The two bilateral recessions were randomly assigned in each patient to either test or control treatment procedure. After initial therapy, each patient was examined for assessment of plaque, gingivitis, recession depth (RD), probing depth (PD), probing attachment level (PAL), and keratinized tissue width (KT). The test procedure included the elevation of mucoperiosteal flap at the buccal aspect of the alveolar process. The root was debrided and demineralized with 100 mg/ml TTC solution for 4 minutes using a burnishing technique with cotton pellets. A teflon membrane was secured and a film of FFSS was applied between the membrane and the root surface. The buccal flap was sutured to completely submerge the membrane. Control treatment included gingival flap surgery with barrier membrane alone. After 6 weeks, the membrane was removed. Healing was evaluated 6 months after surgery. Both test and control procedures resulted in highly significant recession reduction (3.0 mm +/- 1.1 and 2.6 mm +/- 1.2, respectively) and attachment gain (3.6 mm +/- 1.7 and 2.6 mm +/- 1.1, respectively). Mean root coverage was of 67% in the TTC + FFSS treated sites and 60% in membrane-only treated sites. However, only treatment with TTC + FFSS significantly reduced PD and increased KT (P < 0.05). When treatments were compared, changes in PD and PAL were significantly greater in TTC + FFSS treated sites (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)


Inhibitor of nuclear factor kappaB kinase deficiency enhances oxidative stress and prolongs c-Jun NH2-terminal kinase activation induced by arsenic.
Stress signals activate both inhibitor of nuclear factor-kappaB kinase (IKKbeta) and c-Jun NH(2)-terminal kinase (JNK). It was shown recently that IKK-dependent nuclear factor kappaB activation results in attenuation of tumor necrosis factor alpha-induced JNK activation. How that negative cross-talk between nuclear factor kappaB and JNK occurs is not well-understood. By using wild-type and Ikkbeta gene knockout (Ikkbeta(-/-)) mouse embryo fibroblasts, we found that IKKbeta deficiency results in prolongation of arsenic-induced JNK activation, which was not due to the decreased expression of GADD45beta or X-linked Inhibitor of Apoptosis (XIAP), as suggested previously for RelA(-/-) cells treated with tumor necrosis factor alpha. This enhanced JNK activation was largely associated with an oxidative stress response as indicated by elevated expression of heme oxygenase-1 and the accumulation of H(2)O(2) in Ikkbeta(-/-) cells. Expression profiling experiments revealed an increased expression of p450 family CYP1B1 mRNA in Ikkbeta(-/-) cells compared with wild-type cells. Inhibition of CYP1B1 reduced both oxidative stress and arsenic-stimulated JNK activation. Thus, increased CYP1B1 expression is central to and seems to be responsible for sensitizing Ikkbeta(-/-) cells to stress-induced JNK activation.


Preoperative assessment of extrahepatic bile duct carcinoma using three-dimensional intraductal US.
We investigated the utility of a new imaging modality, three-dimensional intraductal ultrasonography (US), for staging bile duct cancer. In eight patients with extrahepatic bile duct carcinoma, two- and three-dimensional intraductal US was used to assess tumor invasion of the right hepatic artery, portal vein, and pancreatic parenchyma before resection. The findings were correlated with histologic information from the resected specimen. Three-dimensional intraductal US enabled accurate assessment of tumor invasion of the right hepatic artery in 88% of cases, the portal vein in 100%, and pancreatic parenchyma in 100%. Two-dimensional intraductal US enabled accurate assessment of invasion of these structures in 88%, 88%, and 88% of cases. Three-dimensional intraductal US is useful in assessing tumor stage in bile duct carcinoma.


Viscoelasticity and temperature variations decrease tension and stiffness of hamstring tendon grafts following anterior cruciate ligament reconstruction.
Hamstring tendon grafts used for anterior cruciate ligament reconstruction are typically harvested early in the surgical procedure and are preconditioned prior to reimplantation. Postoperatively, the grafts undergo stress relaxation and warm from the temperature of the operating room to body temperature. The hypothesis of this study was that the tension within semitendinosus and gracilis tendon grafts and the stiffness of the grafts significantly decrease postoperatively because of both stress relaxation and an increase in temperature. Double-strand grafts were created from six semitendinosus tendons and six gracilis tendons harvested from cadaver specimens. The grafts were loaded to 65 N while at operating-room temperature (20 degrees C). After fifteen minutes of stress relaxation, graft tension was measured and the grafts were stretched by 0.1 mm to determine stiffness. The tension and stiffness measurements represented graft properties immediately following reconstruction. Additional tension and stiffness measurements were made following three hours of stress relaxation and after increasing the temperature to the body temperature at the knee (34 degrees C). Both types of graft were examined for differences in stiffness and tension due to stress relaxation and the temperature increase. For both types of graft, the tension and stiffness decreased following stress relaxation to approximately 50% and 80%, respectively, of the value immediately after reconstruction. Increasing the temperature decreased the tension and stiffness further to approximately 40% and 70%, respectively, of the value after reconstruction for both types of graft. All changes in tension and stiffness were significant (p < 0.01). Graft tension and stiffness achieved immediately following reconstruction are not maintained postoperatively because of stress relaxation and a temperature increase. This could lead to increased knee laxity.


Effect of suramin on the activities of degradative enzymes of sphingolipids in rats.
Three to nine days after administration of suramin, 500 mg/kg intravenously in rats, a small amount of the drug (about 0.25 micromoles/g tissue) was retained by the liver and spleen, and a larger amount (about 1.2 micromoles/g tissue) was retained by the kidneys. The activities of the sphingolipid hydrolases beta-hexosaminidase and GM3-sialidase were strongly inhibited by suramin in vitro. The activity of beta-hexosaminidase was inhibited 70% by 10(-5M) and 85% by 10(-4M) suramin, and the activity of GM3-sialidase was inhibited 80% by 10(-4M) suramin. The activities of sphingomyelinase and beta-galactosidase were also inhibited by suramin but at higher concentrations of the drug. Suramin, in vitro is a weak inhibitor of glucocerebrosidase, galactocerebrosidase, alpha-galactosidase and arylsulfatase A (less than 50% inhibition at 10(-3M) concentration of the drug). The inhibition of beta-hexosaminidase by suramin was non-competitive. Inhibition of beta-hexosaminidase and GM3-sialidase may explain the accumulation of GM2 and GM3 gangliosides in the brains of rats treated intracerebrally with suramin (Constantopoulos et al, 1980).


Ocular surface inflammation, and nerve growth factor level in tears in active thyroid-associated ophthalmopathy.
To measure tear nerve growth factor (NGF) concentrations in cases of active thyroid-associated ophthalmopathy (TAO) before and after glucocorticoid treatment, and to correlate NGF levels with disease inflammatory activity and thyroid autoantibody concentration. The study involved 20 patients with active TAO and 20 age- and gender-matched controls. Tear break-up time (BUT) was obtained, the Schirmer test was performed, and tear NGF/total protein ratio was measured in control subjects and patients with active TAO before, and 2 and 4 weeks after, steroid treatment. Tear BUT and Schirmer values significantly increased after 2 and 4 weeks of steroid treatment (p < 0.001 and p = 0.004 respectively). Baseline tear NGF/total protein ratio was higher in patients with active TAO than in control subjects, and the ratio significantly decreased after 2 and 4 weeks of steroid treatment (p < 0.001). Tear NGF/total protein ratio did not correlate with inflammatory activity score, exophthalmos value and thyroid binding inhibiting immunoglobulin (TBII) level (p > 0.05). Tear NGF may have a specific role in ocular surface inflammation, which protects against ocular surface damage in patients with active TAO. Anti-inflammatory treatment significantly reduced the level of NGF in tears, increased tear film stability and production, and decreased congestive symptoms.


Continuous flow atomic force microscopy imaging reveals fluidity and time-dependent interactions of antimicrobial dendrimer with model lipid membranes.
In this paper, an amphiphilic peptide dendrimer with potential applications against multi-resistant bacteria such as Staphylococcus aureus was synthesized and studied on model cell membranes. The combination of quartz crystal microbalance and atomic force microscopy imaging during continuous flow allowed for in situ monitoring of the very initial interaction processes and membrane transformations on longer time scales. We used three different membrane compositions of low and high melting temperature phospholipids to vary the membrane properties from a single fluid phase to a pure gel phase, while crossing the phase coexistence boundaries at room temperature. The interaction mechanism of the dendrimer was found to be time-dependent and to vary remarkably with the fluidity and coexistence of liquid-solid phases in the membrane. Spherical micelle-like dendrimer-lipid aggregates were formed in the fluid-phase bilayer and led to partial solubilization of the membrane, while in gel-phase membranes, the dendrimers caused areas of local depressions followed by redeposition of flexible lipid patches. Domain coexistence led to a sequence of events initiated by the formation of a ribbon-like network and followed by membrane solubilization via spherical aggregates from the edges of bilayer patches. Our results show that the dendrimer molecules were able to destroy the membrane integrity through different mechanisms depending on the lipid phase and morphology and shed light on their antimicrobial activity. These findings could have an impact on the efficacy of the dendrimers since lipid membranes in certain bacteria have transition temperatures very close to the host body temperature.


Hormonally active ovarian tumors.
Steroid-hormone-producing ovarian tumors include those in which the neoplastic cells secrete hormones as well as a wide variety of tumors in which the neoplastic cells stimulate the ovarian stroma or adjacent hilus cells to become hormonally active.


Epidemiological studies of nasopharyngeal cancer in the Guangzhou area, China. Preliminary report.
In the city of Guangzhou (Canton) and its surroundings nasopharyngeal cancer (NPC) constitutes about 32% of all cancer and is therefore the most common kind of cancer. Three types of etiological factors seem to be involved: 1) a hereditary factor, 2) Epstein-Barr virus, and 3) external factors in food and water. An epidemiological study has been started in the Guangzhou area with interviews of NPC cases, matching controls and mothers of the cases and controls concerning especially food and environmental factors and infections in childhood. The questions put to the controls and cases covered the last seven years and the age of ten, while those to the mothers covered the first three years of life and the age of ten for the controls and cases. Results are now available for 140 cases, 140 controls and the corresponding living mothers. They indicate that salted fish, particularly of Cantonese style, was consumed more by NPC cases than by controls and also had more frequently been given to weaning children in whom NPC later developed. Furthermore, salted vegetables and salted pork were consumed to a greater extent by NPC cases than by controls. Drinking of polluted water in childhood was more common among the NPC cases. Consumption of fresh fruit was more rare among the cases. Most of the NPC cases had a positive VCA-IgA titre.


Self-reported prenatal influenza vaccination and early childhood vaccine series completion.
No studies have examined associations between prenatal vaccination and childhood vaccination. Mothers who refuse influenza vaccinations during pregnancy report similar attitudes and beliefs to those who refuse vaccinations for their children. The objective of this study was to examine the association between self-reported prenatal influenza vaccination and early childhood vaccination. A retrospective cohort study was conducted with existing surveillance data from 4022 mothers who responded to the 2009-2011 Minnesota Pregnancy Risk Assessment Monitoring System survey and child vaccination records from the Minnesota Immunization Information Connection database. The childhood vaccine series outcome included the following vaccines: diphtheria, tetanus, and pertussis; poliovirus; measles, mumps, and rubella; Haemophilus influenzae type b (Hib); hepatitis B; varicella; and pneumococcal conjugate. To evaluate the association between self-reported prenatal influenza vaccination and early childhood vaccination, unadjusted and adjusted logistic regression was used to estimate log odds for childhood vaccination status, while margins post-estimation commands were used to obtain predicted probabilities and risk differences. Vaccine series completion was 10.86% higher (95% confidence interval (CI) 7.33%-14.40%, adjusted and weighted model) in children of mothers who had a prenatal influenza vaccine compared to those who did not. For individual vaccines in the recommended series, risk differences ranged from 7.83% (95% CI 5.37%, 10.30%) for the Hib vaccine to 10.06% (95% CI 7.29%, 12.83%) for the hepatitis B vaccine. Self-reported prenatal influenza vaccination was associated with increased early childhood vaccination. More research is needed to confirm these results and identify potential intervention strategies.


Congenital hypopituitarism due to POU1F1 gene mutation.
POU1F1 (Pit-1; Gene ID 5449) is an anterior pituitary transcriptional factor, and POU1F1 mutation is known to cause anterior pituitary hypoplasia, growth hormone and prolactin deficiency and various degree of hypothyroidism. We report here a patient who presented with growth failure and central hypothyroidism since early infancy. However, treatment with thyroxine gave no effect and he subsequently developed calf muscle pseudohypertrophy (Kocher-Debre-Semelaigne syndrome), elevation of creatinine kinase, dilated cardiomyopathy and pericardial effusion. Final diagnosis was made by combined pituitary function test and sequencing analysis that revealed POU1F1 gene C.698T > C (p.F233S) mutation. The rarity of the disease can result in delayed diagnosis and treatment.


[The knowledge and application of regulations on smoking in secondary teaching centers].
Despite the growing body of legal and normative regulations regarding promotion, sales and consumption of cigarettes, a few studies have already pointed to a low enforcement and commitment of these restrictions. This study explores the degree of awareness and compliance of these norms in the secondary school. Cross-sectional, observational study. A telephone survey was carried out. A simple of school principals or deputy principal was surveyed. A questionnaire was designed to obtain respondents knowledge of the current policies regarding smoking, as well as on the existence of visible signals in the school wards. Besides, opinion on tolerance towards smoking behavior among the school teachers was ascertained. Virtually at the respondents (98.8%) declared to know the existence of the regulations, although only 74.4% declared to have specific regulations at the school level. Smoking by teachers was allowed in their own offices in 61.6% of the centers. In open grounds, only 4.7% of the centers authorized adults to smoke while 18.6% permitted to smoke to the students. Public centers were less restrictive than private centers. Principals of secondary schools are aware of the existing, policy, and in most cases largely restrict public consumption. However, there are still some important gaps regarding signals, consumption in outdoor public spaces and teachers consumption in their own offices. Specific interventions seem to be necessary to overcome this situation.


Digital three-dimensional reconstruction and ultrastructure of the mouse proximal tubule.
Mice are prime targets of experimental gene modification and have become object of an increasing number of biologic studies in renal physiology, development, and molecular biology. Phenotypic changes in response to gene modification require detailed information on normal structure. However, detailed analyses of normal mouse kidney structure and organization are lacking. This study describes the 3D organization and ultrastructural, segmental variation of the mouse kidney proximal tubule. A total of 160 proximal tubules in three C57/BL/6J mouse kidneys were analyzed on 800 serial sections from each kidney from the surface to the inner stripe of the outer zone of medulla. All tubules were reconstructed in 3D and visualized by interactive computer graphics. A quantitative ultrastructural analysis of the mouse proximal tubule at every 300 to 400 micro m was performed. The 3D representation revealed a distinct organization of the mouse proximal tubule, each occupying a separate domain within the cortex. Superficial proximal tubules have long straight parts converging into clusters within the medullary rays. Tubules originating deeper within the cortex become longer and increasingly tortuous. In the medullary rays, these are arranged in layers outside the clusters of more superficial tubules. In contrast to rat and human kidney, no major segmental variation in the ultrastructure of the proximal tubule was identified, and no parameters enabled definition of distinct segments in this strain of mice. In conclusion, significant new information on the 3D organization of the murine proximal tubule has been obtained. Quantitative, ultrastructural analyses of mouse proximal tubules reveal substantial differences compared with other species.


Final-year-of life pacemaker recipients.
Older persons who have initial cardiac pacemakers implanted during their final year of life have not been characterized as a group, which makes it difficult to evaluate the suitability of some of their health services utilizations. To help determine how prudently pacemakers are used in this group, we assessed its pacemaker candidates from the perspective of health and ability to perform physical activities of daily living. A retrospective, population-based, cross-sectional study. The 1993 National Mortality Followback Survey. An estimated 1,647,955 persons aged 65 years or older who died in the US in 1993. Demographic and cause-of-death frequencies obtained by analyzing age, sex, race, and underlying cause-of-death variables in the survey. For persons who had initial pacemakers implanted during their last year of life, we determined the percent of persons, within 10-year age groups, who had no difficulty at any time during their final year of life performing 11 specific physical activities of daily living (e.g., climbing stairs, preparing meals, bathing). These data were obtained from negative responses to questions that asked if the decedents, at any time during their last year of life, had difficulty performing the specific activities. Of the estimated 78,941 persons aged 65 years or older with a pacemaker who died in the US in 1993, 14,158 (18%) had their first pacemaker implanted during their last year of life. Estimated median survival of the final-year-of-life recipients of pacemakers after pacemaker implantation was 5 months. Compared with the general older population that died in 1993, the final-year-of-life recipients of pacemakers group had higher percentages of persons who died of acute disorders (49% vs 19%) and who lived alone in a private home (47% vs 20%), and a lower percentage of persons with Alzheimer's disease (1% vs 7%). The age-stratified means of the percentages of final-year-of-life recipients of pacemakers who had no difficulty performing each physical activity of daily living were all greater than 50. Our results suggest that older persons who had initial pacemakers implanted during their final year of life and who died in 1993 were not terminally ill, inactive pacemaker candidates, in general, but relatively independent, physically functional candidates who frequently died abruptly. The physical, mental, and life expectancy factors recommended for consideration by expert guidelines for the implantation of cardiac pacemakers were generally applied to persons in this subgroup.


Selective degeneration by capsaicin of a subpopulation of primary sensory neurons in the adult rat.
The morphological effects of systemic capsaicin treatment have been studied in adult rats. Light and electron microscopy revealed that a subpopulation of small-to-medium sized B-type primary sensory neurons, representing about 17% of the total neuronal population in the 4th lumbar spinal ganglion, underwent rapid degeneration after the administration of capsaicin. Quantitative electron microscopy demonstrated a decrease of about 45% in the number of unmyelinated axons in the saphenous nerve. Light microscopy showed extensive axon terminal degeneration in the brainstem and spinal cord confined to the central projection areas of capsaicin-sensitive afferent fibers, as has already been revealed in the newborn rat. The present results furnish evidence for a hitherto unrecognized selective neurodegenerative action of capsaicin in the adult rat.


Cloning and sequencing of the gene for the Thiobacillus ferrooxidans ATCC33020 glutamate synthase (GOGAT) small subunit and complementation of an Escherichia coli gltD mutant.
A recombinant plasmid which contains the gltD gene coding for the glutamate synthase (GOGAT) small subunit was isolated from a Thiobacillus ferrooxidans ATCC33020 gene bank by complementation of an Escherichia coli gltD mutant. The sequence of gltD was determined. The deduced amino acid sequence shows strong similarity to the two other prokaryote gltD sequences available, namely those of E. coli and A. brasilense (53% and 45% identity, respectively). A cosmid containing the gltBD region was isolated from a T. ferrooxidans cosmid gene bank, but was unable to complement an E. coli gltB mutant.


Prognostic value of non-invasive stress testing for coronary artery disease in obese patients.
Detecting coronary artery disease (CAD) in obese patients remains a challenge but can have substantial prognostic implications for this patient group. Until now, sufficient data was not available on which to base the selection of the imaging modality in obese patients. The decision on which imaging modality to use should therefore follow the general guidelines. In this article, the authors discuss the prognostic value of the different non-invasive stress testing methods for CAD in obese patients.


Progress toward poliomyelitis eradication--Afghanistan and Pakistan, 2008.
Afghanistan and Pakistan, two of the four remaining countries where wild poliovirus (WPV) transmission has never been interrupted, represent one epidemiologic reservoir. During 2008, both countries continued to conduct coordinated supplemental immunization activities (SIAs) against type 1 WPV (WPV1) and type 3 WPV (WPV3) using oral polio vaccine (OPV). Much of Afghanistan remained polio-free in 2008, with the exception of the conflict-affected South Region. In Pakistan, however, WPV transmission increased, particularly after WPV1 reintroduction into polio-free areas of Punjab Province. In total, 149 WPV cases (31 in Afghanistan and 118 in Pakistan) were confirmed in 2008, compared with 49 cases in 2007. Serious security problems in areas along the common border limited access by vaccination teams to large numbers of children in the two countries. In Pakistan, continued managerial and operational problems impeded full implementation of SIAs and adversely affected vaccination coverage in areas not affected by security problems. This report updates previous reports and describes polio eradication activities in Afghanistan and Pakistan during January--December 2008. Further progress toward interruption of WPV transmission in Afghanistan and Pakistan will require continued measures to overcome access problems in conflict-affected areas of both countries and improvements in the quality of SIAs and delivery of routine immunization services in Pakistan.


In situ light dosimetry during photodynamic therapy of Barrett's esophagus with 5-aminolevulinic acid.
Previous studies with PhotoDynamic Therapy (PDT) in bladder and bronchi have shown that due to scattering and reflection, the actually delivered fluence rate on the surface in a hollow organ can be significantly higher than expected. In this pilot study, we investigated the differences between the primary calculated and the actual measured fluence rate during PDT of Barrett's Esophagus (BE) using 23 independent clinical measurements in 15 patients. A KTP-dye module laser at 630 nm was used as light source. Light delivery was performed using a cylindrical light diffuser inserted in the center of an inflatable transparent balloon with a length corresponding to the length of the Barrett's epithelium. The total light output power of the cylindrical diffuser was calibrated using an integrating sphere to deliver a primary fluence rate of 100 mW cm(-2). Two fiber-optic pseudo sphere isotropic detectors were placed on the balloon and were used to measure fluence rate at the surface of the esophageal wall during PDT. The actual fluence rate measured was 1.5-3.9 times higher than the primary fluence rate for 630 nm. In general, the fluence rate amplification factor decreased with increasing redness of the tissue and was less for shorter diffusers. Fluence rate variations in time were observed which coincided with patients coughing, movement, and esophageal spasms. These factors combined with inter patient variability of the fluence rate measured appears to justify the routine application of this technique in PDT of BE.


Relations of motor and vocal milestones in typically developing infants and infants with Down syndrome.
We measured the ages at which typically developing infants and infants with Down syndrome achieved an important vocal milestone (canonical babbling), a rhythmic motor milestone (hand-banging), and six other motor milestones. The interrelations of the milestone onsets, and their relations with Down syndrome, were assessed quantitatively. Hand-banging and canonical babbling were associated and were somewhat delayed by Down syndrome. Stepping, standing, sitting, and creeping/crawling were associated and were severely delayed by Down syndrome. Rolling and reaching were also delayed by Down syndrome, though they were not strongly associated with other milestones or with one another. These results suggest that the rhythmic behaviors (canonical babbling and hand-banging) may be internally linked by common neuromuscular underpinnings and that the postural behaviors may be similarly linked.


Giant Exchange Coupling Evidenced with a Magnetization Jump at 52 T for a Gadolinium-Nitroxide Chelate.
The Gd-radical complex [GdIII(hfac)3(6bpyNO)] (6bpyNO = 2,2'-bipyridin-6-yl tert-butyl nitroxide; Hhfac = 1,1,1,5,5,5-hexafluoropentane-2,4-dione) showed a magnetization jump at 52 T observed in a pulsed-field facility, corresponding to an exchange coupling constant of -17.4 K. Furthermore, hysteretic behavior due to a relatively slow magnetization reversal was recorded around 2 T. From the high-frequency EPR study, the exchange coupling between Gd and radical spins accompanies an anisotropic character, which is responsible for both the broad jump and the slow magnetization reversal.


Effects of a sublethal concentration of sodium lauryl sulphate on the morphology and Na+/K+ ATPase activity in the gill of the ornate wrasse (Thalassoma pavo).
We analysed the morphology and ultrastructure of the gill apparatus of the ornate wrasse, Thalassoma pavo, under normal conditions and after exposure to a sublethal concentration of sodium lauryl sulphate (3.5 mg/l, which is one-third of the 96LC99 value). To identify the biochemical mechanisms affected by this pollutant, we evaluated and compared the localisation of Na(+)/K(+) ATPase in normal and experimental conditions. Immunocytochemical analysis revealed that this enzyme was active in the chloride cells (CCs), which were distributed in clusters in the interlamellar region of the filament. Ultrastructural analysis revealed conspicuous alterations on the epithelium after 96 and 192 h of exposure to sodium lauryl sulphate: structural features of the surface cells were lost, the appearance of intercellular lacunae changed, and cellular degeneration occurred. Statistical analysis comparing the number and dimensions of CCs in normal conditions and after 96 h of exposure showed that the CC area decreased after exposure to the detergent.


Neighborhood context and residential mobility.
This paper extends the search for neighborhood contextual effects to residential mobility. We propose that neighborhood consists of subjective and objective domains, both of which are crosscut by substantive (social/physical) and temporal (current/change) dimensions. Measures of neighborhood characteristics consistent with our conceptualization are used to estimate the impact of context on mobility thoughts and on actual mobility in a sample of Nashville residents. Although individual statuses such as age and tenure remain important antecedents of mobility, subjective features of neighborhood context also play a role--albeit limited and indirect--in the decision to move or to stay.


Diuretic therapy for mild hypertension: the "real" cost of treatment.
The benefit of any medical intervention, particularly drug therapy, must be weighed against its cost. These costs are not only dollar expenditures but effects on lifestyle and overall health. Diuretic therapy for hypertension has been in use long enough to allow long-term clinical evaluation. It is clear from the numerous prospective drug intervention trials involving hypertensive patients that diuretic therapy is not free of "costs." Aside from the fact that 15 to 20% of diuretic-treated patients reportedly drop out of trials because of side effects, including exertional dyspnea, fatigability, lethargy and impotence, numerous metabolic derangements have been reported with these drugs, i.e., potassium, uric acid, lipid, sodium, glucose and magnesium alterations. Perhaps most important are the changes in lipid fractions, which may be responsible for the failure of antihypertensive therapy to decrease the risk of coronary heart disease. Thus, although diuretics are somewhat less expensive than other antihypertensive drugs in terms of dollars, their overall costs are high. The major alternatives, such as the alpha-blocker prazosin or the central nervous system agent clonidine, are preferable, do not impair a patient's lifestyle and are recommended to be used along with changes in diet and an exercise program for control of mild to moderate hypertension.


Inhibitors of lactate dehydrogenase isoforms and their therapeutic potentials.
In many different species, lactate dehydrogenase (LDH) constitutes a major checkpoint of anaerobic glycolysis, by catalyzing the reduction of pyruvate into lactate. This enzyme has recently received a great deal of attention since it may constitute a valid therapeutic target for diseases so different as malaria and cancer. In fact, the isoform expressed by Plasmodium falciparum (pfLDH) is a key enzyme for energy generation of malarial parasites. These species mostly depend on anaerobic glycolysis for energy production, since they lack a citric acid cycle for ATP formation. Therefore, inhibitors of pfLDH would potentially cause mortality of P. falciparum and, to this purpose, several small organic molecules have been recently designed and developed with the aim of blocking this new potential antimalarial chemotherapeutic target. Moreover, most invasive tumour phenotypes show a metabolic switch (Warburg effect) from oxidative phosphorylation to an increased anaerobic glycolysis, by promoting an upregulation of the human isoform-5 of lactate dehydrogenase (hLDH-5 or LDH-A), which is normally present in muscles and in the liver. Hence, inhibition of hLDH-5 may constitute an efficient way to interfere with tumour growth and invasiveness. This review provides an overview of the LDH inhibitors that have been developed up to now, an analysis of their possible isoform-selectivity, and their therapeutic potentials.


[Remaxol restores the liver antioxidant protection system in experimental cyclophosphan-induced injury].
It is established that remaxol influences the main links of cells antioxidant system in case of experimental drug-induced liver damage. The injection of remaxol to animals with hepatotoxic damage increases the level of restored glutathione and maintains the concentration of SH groups of proteins in liver tissues on the level typical of intact animals. Remaxol helps to keep intact the energetic substrates of hepatocytes by saving the activity of glucose-6-phosphatedehydrogenase (which increases restored NADPH and glutathione enzymes), thus preventing the oxidative destruction of glutathione reductase and glutathione S-transferase. The antioxidant effect has been also confirmed by the study of catalase and glutathione peroxidase activity, the concentration of which under the action of remaxol increased above the normal level. Additional evidence is a remaxol-induced decrease in concentration of the final products of lipid peroxidation.


Immunohistochemical study of tumor-infiltrating lymphocytes before and after intravesical bacillus Calmette-Guérin treatment for superficial bladder cancer.
This study investigated changes in the phenotypic characteristics of tumor-infiltrating lymphocytes during intravesical bacillus Calmette-Guérin (BCG) treatment using an immunohistochemical technique. A total of 16 patients with superficial bladder cancer underwent intravesical BCG treatment for therapeutic purposes. Tissue specimens were obtained from these patients before and after BCG treatment by cold cup biopsies. The numbers of CD3+ cells, CD4+ cells, CD8+ cells, and CD19+ cells significantly increased after treatment compared with numbers before treatment (P < 0.01). Although gamma/delta T cells were not observed before treatment, they appeared after treatment in 6 patients. In all these patients, the tumors disappeared or their size was reduced by more than 50%, and none of the tumors recurred. The induction of CD25+ cells after treatment was seen in 11 of the 16 patients. gamma/delta T cells may play an important role in the immune response of the host to the tumor in intravesical BCG treatment (although this correlation was statistically insignificant.


The Effect and Use of Milestones in the Assessment of Neurological Surgery Residents and Residency Programs.
The purpose of this study was to determine the effect of the Accreditation Council for Graduate Medical Education Milestones on the assessment of neurological surgery residents. The authors sought to determine the feasibility, acceptability, and utility of this new framework in making judgments of progressive competence, its implementation within programs, and the influence on curricula. Residents were also surveyed to elicit the effect of Milestones on their educational experience and professional development. In 2015, program leadership and residents from 21 neurological surgery residency programs participated in an online survey and telephone interview in which they reflected on their experiences with the Milestones. Survey data were analyzed using descriptive statistics. Interview transcripts were analyzed using grounded theory. Response themes were categorized into 2 groups: outcomes of the Milestones implementation process, and facilitators and barriers. Because of Milestones implementation, participants reported changes to the quality of the assessment process, including the ability to identify struggling residents earlier and design individualized improvement plans. Some programs revised their curricula based on training gaps identified using the Milestones. Barriers to implementation included limitations to the adoption of a developmental progression model in the context of rotation block schedules and misalignment between progression targets and clinical experience. The shift from time-based to competency-based evaluation presented an ongoing adjustment for many programs. Organized preparation before clinical competency committee meetings and diverse clinical competency committee composition led to more productive meetings and perceived improvement in promotion decisions. The results of this study can be used by program leadership to help guide further implementation of the Milestones and program improvement. These results also help to guide the evolution of Milestones language and their implementation across specialties.


Synthesis of 1-(D-glucopyranosyl)-1,2,3-triazoles and their evaluation as glycogen phosphorylase inhibitors.
1-(D-Glucopyranosyl)-1,2,3-triazoles were prepared from per-O-acetylated alpha- and beta-D-glucopyranosyl azides as well as per-O-benzoylated (beta-D-gluco-hept-2-ulopyranosylazide)onamide and onic acid methylester by using azide-alkyne cycloaddition catalysed by in situ generated Cu(I) under aqueous conditions. The O-acyl protecting groups were removed by the Zemplén protocol. The test compounds were assayed against rabbit muscle glycogen phosphorylase b to show that the beta-D-glucopyranosyl derivatives were superior inhibitors as compared to the two other series of triazoles.


Palytoxin detection and quantification using the fluorescence polarization technique.
Palytoxin (PLT) is a highly toxic nonpeptidic marine natural product, with a complex chemical structure. Its mechanism of action targets Na,K-ATPase. Fluorescence polarization (FP) is a spectroscopic technique that can be used to determine molecular interactions. It is based on exciting a fluorescent molecule with plane-polarized light and measuring the polarization degree of the emitted light. In this study, FP was used to develop a detection method based on the interaction between the Na,K-ATPase and the PLT. The Na,K-ATPase was labeled with a reactive succinimidyl esther of carboxyfluorescein, and the FP of protein-dye conjugate was measured when the amount of PLT in the medium was modified. The assay protocol was first developed using ouabain as a binding molecule. The final result was a straight line that correlates FP units and PLT concentration. Within this line the PLT equivalents in a natural sample can be quantified. A selective cleaning procedure to mussel samples and dinoflagellates cultures was also developed to avoid the matrix effect. The LOQ (limit of quantification) of the method is 10nM and the LOD (limit of detection) is 2 nM. This new PLT detection method is easier, faster, and more reliable than the other methods described to date.


Curcuminoids Lower Plasma Leptin Concentrations: A Meta-analysis.
Curcumin is a naturally occurring polyphenol that has been suggested to improve several metabolic diseases. Leptin is an adipokine involved in metabolic status and appetite, with marked crosstalk with other systems. Available data suggest that curcumin may affect leptin levels; therefore, this meta-analysis was performed to evaluate this. A systematic review and meta-analysis were undertaken on all randomized controlled trials of curcumin studies that included the measurement of leptin. The search included PubMed-Medline, Scopus, ISI Web of Knowledge, and Google Scholar databases. Quantitative data synthesis was performed by using a random-effects model, with standardized mean difference and 95% confidence interval as summary statistics. A funnel plot, Begg's rank correlation, and Egger's weighted regression tests assessed the presence of publication bias. Four eligible articles comprising five treatment arms were selected for the meta-analysis. Meta-analysis showed a significant decrease in plasma leptin concentrations following curcumin treatment (standardized mean difference: -0.69, 95% confidence interval: -1.16, -0.23, p = 0.003; I2 = 76.53%). There was no evidence of publication bias. This meta-analysis showed that curcumin supplementation is associated with a decrease in leptin levels that may be regarded as a potential mechanism for the metabolic effects of curcumin. Copyright © 2017 John Wiley & Sons, Ltd.


Protective effect of creatine supplementation and estrogen replacement on cardiac reserve function and antioxidant reservation against oxidative stress in exercise-trained ovariectomized hamsters.
The combined effect of creatine (Cr) or estrogen (E(2)) with exercise training on cardiac reserve function and antioxidant reservation against oxidative stress were investigated in ovariectomized female Golden Syrian hamsters. One hundred animals were divided into nonexercise and exercise-trained groups, in which each group was separated into the control and 4 treatments of Cr depletion (Cr-), Cr supplementation (Cr+), E(2) replacement (E(2)), and Cr supplementation combined with E(2) replacement (Cr+E (2)). In the exercise-trained group, wheel-running exercise (10 minutes a day, 5 days a week) was imposed for 9 weeks. After the animals were sacrificed, several indicators of cardiac function, specifically the corrected QT interval, left ventricular developed pressure (LVDP), and maximum rate of rise (dP/dt(max)) against a hydrogen peroxide (H(2)O(2)) stress test were measured in isolated hearts using the Langendorff apparatus. Markers of oxidative stress, in other words, reduced glutathione (GSH), oxidized glutathione (GSSG), and an antioxidant enzyme, glutathione peroxidase (GPx) were determined. Exercise-trained animals could restore cardiac reserve function and antioxidant levels against oxidative damage (P<0.05). Cr+, E(2) , and Cr+E(2) combined with exercise training showed highly protected cardiac reserve function against oxidative stress compared to Cr+, E(2) , and Cr+E(2) without exercise (P<0.05). The myocardial antioxidant levels were improved greatly in E(2) and Cr+E(2) combined with exercise training (P<0.05). In conclusion, estrogen replacement and creatine supplementation plus estrogen replacement when combined with exercise training show significant protective effects for cardiac reserve function and antioxidant reservation against oxidative stress in estrogen-deficient hamsters.


[Problems in the prognosis of paroxysmal schizophrenia with onset in adolescence and young adulthood].
In 248 patients with juvenile schizophrenia lasting over 10 years since the first manifestation of the psychosis statistically significant criteria for probable prognosis of the disease outcome were determined using clinico-statistical methods. It was found that the most informative among those criteria were the characteristics of the initial stage of the disease and the premorbid period; the hereditary and genetic background, as well as the character of the disease onset and some pictures of the manifest psychosis. The criteria determined enable one to forecast with a high degree of statistical significance the intensity of the morbid process progress at the initial stages of paroxysmal schizophrenia.


[Differential reactivities of three kinds of carbon dioxide absorbents with sevoflurane].
The differential reactivities of three kinds of carbon dioxide absorbents, Soda lime, Soda lime A, and Baralyme with sevoflurane were investigated. Sevoflurane was made to react with each carbon dioxide absorbents in a glass vial or in a closed system under administration of carbon dioxide. Glass vials were kept at 55 degrees C and 70 degrees C, and three kinds of carbon dioxide absorbents were compared regarding their reactivity under each temperature. In a closed system, we also monitored the temperature of glass container which was filled with each carbon dioxide absorbent. In a glass vial, the highest reactivity of sevoflurane was found with Baralyme. Although Soda lime A decomposed sevoflurane less than Baralyme or Soda lime in glass vial, the highest reactivity of sevoflurane in a closed system was found with Soda lime A. On the other hand, Soda lime A increased the temperature of glass container most. As increasing temperature tends to promote reaction, the possibility that the high temperature of the glass container contributes to the reactivity of sevoflurane with carbon dioxide absorbents exists. These results suggest that the highest reactivity of Soda lime A with sevoflurane was caused by the highest temperature of glass container although its chemical composition makes it most reactive with sevoflurane than the others.


[The accuracy and reproducibility of the measurement of bone mineral content by single-photon absorptiometry (125I). The effect of source strength].
This study was aimed at verifying whether accuracy and reproducibility of mineral content measurements of bone phantoms by single-photon absorptiometry change as a function of source strength, and whether these changes depend on the phantom's width. To these purposes, the Norland 2780 bone mineralometer was used. With this unit, the mineral contents of two cylindrical phantoms of different diameter and of known mineral content were measured every week, 5 times on the whole, up to exhaustion of the source. Both accuracy and reproducibility decreased as source strength decreased. The lowest reproducibility was observed for the measurement of the smaller phantom with low source strength. It was therefore concluded that when source strength reaches the threshold value of 2000 cps, the measurement is so much affected as to jeopardize the reliability of short-term longitudinal studies of bone mineral content in patients.


Optical feedback controlled scleral remodeling as a mechanism for myopic eye growth.
Experimental studies of myopia have demonstrated that optical errors imposed on a developing eye will stimulate elongation of the globe, although the mechanism of axial growth is not well understood. In this study, a mathematical model of eye growth is presented in which expansion of the globe occurs as the elastic deformations of the scleral shell are incorporated into the zero stress configuration of the eye during the scleral remodeling process. The rate of remodeling is determined by the retinal blur and the amplitude of accommodation, which provide feedback loops for both unilateral and bilateral hyperopic refractive error-compensation. Normal eye growth and experimental myopia are simulated in tree shrews, a small mammal related to primates. The model demonstrates that the rate of ocular elongation in experimental myopia may be controlled by regulating the rate of soft tissue remodeling in the scleral shell.


Mapping critical sites in collagen II for rational design of gene-engineered proteins for cell-supporting materials.
Collagen II is the most abundant protein of cartilage and forms a network of fibrils extended by proteoglycans that enables cartilage to resist pressure. The surface of the collagen fibril serves as a platform for the attachment of collagen IX, growth factors, and cells. In this study we examined the mechanism of the interaction of chondrocytes with recombinant versions of procollagen II, in which one of the four blocks of 234 amino acids that define repeating D periods of the collagen triple helix has been deleted. Analysis of the attachment of chondrocytes to collagen II variants with deleted D periods indicated that the collagen II monomer contains randomly distributed sites critical for cell binding. However, as was shown by spreading and migration assays, the D4 period, which is between residues 703 to 936, contains amino acids critical for cell motility. We also showed that binding, spreading, and migration of chondrocytes through three-dimensional nanofibrillar collagenous matrices are controlled by an interaction of the collagen triple helix with beta1 integrins. The results of this study provide a basis for the rational design of a scaffold containing genetically engineered collagen with a high density of specific sites of interaction.


[Diffusion MRI study of cerebral white matter lesions in patients with Binswanger's disease].
We performed diffusion MRI studies in 14 patients with extensive ischemic leukoencephalopathy, including 9 with dementia (diagnosed as Binswanger's disease), and 5 without dementia, and 8 age-matched controls. Apparent diffusion coefficients (ADCs) in anterior and posterior periventricular white matter were significantly higher in demented and non-demented patients than in the controls, and diffusion anisotropy disappeared in patients because of the high ratio of the diffusion coefficients perpendicular to the nerve fibers to those parallel to the nerve fibers. ADCs in the corpus callosum were significantly higher in demented patients that in non-demented patients and controls. Therefore, diffusion anisotropy disappeared only in demented (Binswanger's disease) patients. These results suggest that the cerebral white matter lesions in Binswanger's disease reflect a decrease of nerve fibers and diffuse myelin loss, and that the loss of nerve fibers in the corpus callosum may play a role in inducing cognitive decline. Diffusion MRI may be useful in the pathophysiological evaluation of cerebral white matter lesions.


Antibiotic prophylaxis in elective gastro-intestinal tract surgery: a comparison of single-dose pre-operative cefotaxime and multiple-dose cefoxitin.
In a prospective trial conducted at five medical centres, 136 patients aged 18 to 75, undergoing elective gastro-intestinal surgery were randomized to receive a single dose of cefotaxime, 1 g preoperatively, or cefoxitin, 2 g preoperatively followed by 2 g every 6 h for no more than 24 h. Overall infection rates with both regimens were approximately 10%. There were no significant differences in the infection rates between subgroups. Thus, a single preoperative 1 g dose of cefotaxime is as efficacious as, but considerably more cost-effective than, multiple 2 g doses of perioperative cefoxitin in the prevention of infection following elective gastrointestinal tract surgery.


Is More than One Hour of Selective Antegrade Cerebral Perfusion in Moderate-to-Mild Systemic Hypothermic Circulatory Arrest for Surgery of Acute Type A Aortic Dissection Safe?
Surgery for acute type A aortic dissection (AAD) remains a surgical challenge with considerable risk of morbidity and mortality. Antegrade cerebral perfusion (ACP) has been popularized, offering a more physiologic method of brain perfusion during complex aortic arch repair, often necessary in setting of AAD. The safe limits of this approach under moderate-to-mild systemic hypothermic circulatory arrest (≥ 28°C) are yet to be defined. Thus, the current study investigates our clinical results after surgical treatment for AAD in patients with a selective ACP and systemic circulatory arrest time of ≥ 60 minutes in moderate-to-mild hypothermia (≥ 28°C). Between January 2000 and April 2016, 63 consecutive patients underwent surgical treatment for AAD employing selective ACP during moderate-to-mild systemic hypothermia (≥ 28°C) with prolonged ACP and circulatory arrest times. Patients' mean age was 59 ± 15 years, and 39 patients (62%) were men. Hemiarch replacement and total arch replacement were performed in 13 (21%) and 50 (79%) patients, respectively. Frozen elephant trunk, arch light, and elephant trunk technique were performed in nine (14%), six (10%), and three patients (5%), respectively. Clinical data were prospectively entered into our institutional database. Mean late follow-up was 6 ± 4 years and was 98% complete. Cardiopulmonary bypass time accounted for 245 ± 81 minutes and the myocardial ischemic time accounted for 140 ± 43 minutes. Mean duration of ACP was 74 ± 12 minutes. The mean lowest core temperature accounted for 28.9 ± 0.8°C. Unilateral ACP was performed in 44 patients (70%); bilateral ACP was used in the remaining 19 patients (30%). Intensive care unit stay reached 6 ± 5 days. New onset of acute renal failure requiring hemofiltration was observed in 8% of patients (n = 5). New postoperative permanent neurologic deficits were found in five patients (8%) and transient neurologic deficits in six patients (10%). There was one case of paraplegia. Thirty-day mortality and in-hospital mortality were 8 (n = 5) and 11% (n = 7), respectively. Overall survival at 5 years was 76 ± 9%. Our preliminary data suggest that selective ACP during moderate-to-mild systemic hypothermic circulatory arrest (≥ 28°C) can safely be applied for more than 1 hour even in the setting of AAD.


Changing cleft widths: a problem revisited.
A study was undertaken to evaluate changing cleft widths and the timing of surgical repair of the lip in so far as it affects the types of cross-bite occlussion that result in cases treated by presurgical orthopedics (as practiced at Tufts-New England Medical Center Hospitals) and by purely surgical intervention. On the basis of the analyses carried out, the following conclusions were reached: 1. Both the alveolar cleft width prior to lip surgery and the arch form following lip surgery are significantly related, and are predictors of, the type of cross-bite occlusion that will result from purely surgical intervention. 2. Neither the alveolar cleft width prior to lip surgery nor the arch form following lip surgery is significantly related to, or is a predictor of, the type of cross-bite occlusion that will result from presurgical orthopedics. 3. For both presurgical orthopedic treatment programs and purely surgical treatment programs, there is a significant relationship between the arch form following palate surgery and the type of cross-bite occlusion that will result. 4. In cases treated by presurgical orthopedics there is a higher probability of achieving favorable occlusal relationships than in cases treated by purely surgical intervention. 5. In a period of 6 months following birth, but prior to lip surgery, presurgical orthopedics results in a smaller percentage reduction in alveolar cleft width than does treatment without the use of an appliance. However, the posterior cleft widths and posterior palate widths show comparable changes in size. 6. The larger anterior cleft width maintained by the use of presurgical orthopedics prior to lip surgery is completely compensated for following lip surgery, so that no significant difference remains between cases treated by presurgical orthopedics and those treated by purely surgical intervention. 7. Since previous findings showed a larger reduction in posterior cleft width in cases treated by presurgical orthopedics than in cases treated by purely surgical intervention and these results show that there is a comparable reduction in posterior cleft width when lip surgery is delayed until the age of 6 months, then early lip surgery tends to limit the natural reduction of the posterior cleft width. 8. Additional studies are needed. These studies must be based on as complete a description of the cleft and the treatment program as possible. It is the total implication for patient rehabilitation that must be considered in the evaluation of treatment outcomes.


Feasibility and accuracy of teleconcussion for acute evaluation of suspected concussion.
To assess the feasibility and accuracy of telemedical concussion evaluations (teleconcussion) for real-time athletic sideline assessment of concussion, as such assessment may address the gap in access some populations of athletes have to providers with expertise in concussion evaluation. A cohort of 11 consecutive male collegiate football players with suspected concussion was assessed using Standardized Assessment of Concussion (SAC), King-Devick test (K-D), and modified Balance Error Scoring System (mBESS). A remote neurologist assessed each athlete using a telemedicine robot with real-time, 2-way audiovisual capabilities, while a sideline provider performed a simultaneous face-to-face assessment. After the assessment, a remove-from-play (RFP) determination was made. The remote and the face-to-face providers were blinded to each other's examination findings and RFP decision until the end of the assessment. The teleconcussion and face-to-face SAC were in agreement 100% of the time (6/6; 95% confidence interval [CI] 54%-100%). The mean (SD) difference between remote and sideline K-D times was 0.7 (1.4) seconds. Remote and sideline K-D times were within a 3-second difference 100% of the time (11/11; 95% CI 72%-100%). Remote and sideline mBESS scores were within 3 points 100% of the time (6/6; 95% CI 54%-100%). RFP decisions were in agreement 100% of the time (11/11; 95% CI 72%-100%). The aim of this study was to investigate the feasibility of teleconcussion for sideline concussion assessments. These data suggest a high level of agreement between remote and face-to-face providers with regard to examination findings and RFP determinations.


[Users and the technological transition in the supplemental health sector: case study of a health insurance plan company].
This paper presents the results obtained from qualitative research conducted with a group of users involved in Case Management, a program which was developed by a company of a medical group to provide healthcare for patients in situations of high vulnerability. The study sought to create a perspective in which the experience of the user, instead of representing merely additional or superimposed information upon the quality of services, is considered an inherent part of the arrangement under scrutiny, with the ability to highlight its internal qualities and contradictions. The results show how patients attribute high value to the healthcare they receive, with special emphasis on the bond that is created with the health team in charge, even when contact is only by telephone. Simultaneously, they are able to perceive the double-sided aspect presented by the regulation/assistance model found in the technological arrangement at issue, notably in relation to the prominent role played by the economic bias towards cost reduction--which lies in the forefront of its operationalization--and the final impact it has upon the final quality of healthcare.


Redox inactive metal ion promoted C-H activation of benzene to phenol with Pd(II)(bpym): demonstrating new strategies in catalyst designs.
Al in: A new strategy was introduced to modify the electronics and steric hindrance of the Pd(II) ion in order to change its reactivity towards benzene hydroxylation. In trifluoroacetic acid, free Pd(II) ions provide dominantly biphenyl, with phenol as minor product. Ligation of bpym to the Pd(II) ion results in its deactivation with regard to benzene functionalization. The addition of the redox inactive Al(III) ion to the Pd(II)(bpym) complex recovers its catalytic activity, and alters the reactivity of Pd(II) ion from benzene coupling to hydroxylation.


Potential antidepressive properties of amantadine, memantine and bifemelane.
The effects of amantadine, its dimethyl derivative, memantine and the chemically unrelated compound bifemelane were tested for antidepressant activity. Reserpine-induced hypothermia and the forced swim test (Porsolt test) were selected for this purpose. In the former test amantadine and bifemelane but not memantine were effective. In the forced swim test all three agents produced antidepressive-like activity (decreased immobility time), but in case of bifemelane it was less pronounced. The effect in the forced swim test was specific i.e. it was apparently not the result of an increase in general activity as evidenced by control experiments in the open field. The mechanism of amantadine and memantine action may involve indirect dopaminomimetic activity resulting from the blockade of NMDA receptors. However in reserpine-induced hypothermia this explanation is not valid considering the lack of effect of memantine and positive action of amantadine. Hence, amantadine may have an additional central sympathomimetic action that memantine is lacking. Bifemelane antidepressant-like activity might be attributed to an enhancement of noradrenergic transmission. We suggested that amantadine and bifemelane could be particularly useful therapeutically when depressive symptoms are present in patients suffering from Parkinson's disease and dementia.


Feasibility and safety of a novel technology for pacing without leads.
Pacemaker lead complications and failures remain clinical problems. New devices incorporating three leads are associated with even greater limitations. The purpose of this study was to investigate the feasibility and safety of a technology enabling cardiac pacing without leads in an acute porcine model. The system is composed of an ultrasound transmitter delivering energy from the chest wall to a receiver-electrode in contact with the myocardium that then converts the ultrasound energy to electrical energy sufficient to pace. In five feasibility studies, the receiver-electrodes were attached to the tip of a catheter to facilitate intracardiac positioning at pacing sites. In six safety studies (five treatment and one sham), ultrasound energy was transmitted to both chest walls, and histopathologic examinations were performed to evaluate bioeffects due to ultrasound energy transmission. In five feasibility studies, direct and ultrasound-mediated electrical pacing was demonstrated at 30 sites in the right atrium, right ventricle, and left ventricle, at direct electrical pacing outputs of 1.4 +/- 0.6 V and ultrasound-mediated electrical pacing outputs of 1.8 +/- 0.9 V. The mechanical index was 0.6 +/- 0.4 at the receiver site during ultrasound-mediated pacing at a depth of 11.2 +/- 2.4 cm from the chest wall. Using two receiver-electrode catheters, biventricular pacing was demonstrated in all studies. In five safety study treatment animals at a similar depth, the peak mechanical index was 2.3, and the thermal index was 0.4. Microscopic evaluation revealed no evidence of mechanical or thermal bioeffects. The feasibility and safety of this novel technology for pacing without leads has been demonstrated acutely in animals.


Trends in the consumption of opioid analgesics in Spain. Higher increases as fentanyl replaces morphine.
During the past few years there have been changes in the availability of opioids in Spain, and new policies on palliative care have been implemented. The aim of this study was to describe the new pattern of opioid consumption in Spain and the associated economic impact. A search in the ECOM (Especialidades Consumo de Medicamentos) database of the Ministry of Health and Consumer Affairs for the 1992-2006 period was carried out. This database contains information on prescriptions of primary care medicines that are covered by the National Health System in Spain. Since 1992, overall opioid consumption has increased 14-fold, from 0.3 DDD/1000 inhabitants per day to 4.4 DDD/1000 inhabitants per day. For the six drugs that require a special prescription form--morphine, methadone, oxycodone pethidine, tilidine and fentanyl--consumption increased from 0.1 DDD/1000 inhabitants per day in 1992 to 1.2 in 2006. During this same period, the total costs of these prescriptions increased by 36.8-fold, and the cost per day and per patient doubled. A huge increase in opioid consumption has occurred during the time period covered by this study, with fentanyl consumption accounting for most of that increase. Although oral morphine is the first-choice drug among strong opioids, fentanyl is currently the most consumed.


[Spectral curve shape feature-based hyperspectral remote sensing image retrieval].
With the rapid development of technology of sensors and data transmission, using all kinds of airplane sensors and satellite sensors, the authors can get different voluminous remote sensing image data of earth. Those voluminous remote sensing image data bring problems of data storage and management. It is becoming increasingly necessary to retrieve some information the authors need from those voluminous image data. Image retrieval was proposed by CHANG firstly in 1980 and can be regarded as expansion of traditional information retrieval. Oriented to the demands of efficient retrieval for voluminous remote sensing image, and considering that there are many bands in hyperspectral remote sensing image, the authors first analyzed image distance function and similarity measure in image retrieval. The most crucial issues in retrieval are spectral features extraction and similarity measure. In the present paper, the authors used classical Douglas-Peucker algorithm (hereinafter referred to DP algorithm) for curve simplification to extract shape features of spectral curve, in order to speed up hyperspectral remote sensing image retrieval. And the authors proposed a new method of spectral curve and remote sensing image retrieval, called Douglas-Peucker Spectral Retrieval algorithm (hereinafter referred to DPSR algorithm). Spectral shape features were used in image retrieval. DPSR used features of spectral curve, reduced the computation amount, realized match and retrieval efficiently, and is suitable for spectral curve retrieval in hyperspectral remote sensing image. The authors selected four ground features (grass, apple garden, grape garden and pond) in OMISI hyperspectral remote sensing image to compute similarity measure results, in order to test the effect of DPSR algorithm. Compared with traditional analysis method such as spectral angle match (SAM) and spectral information divergence (SID), DPSR can maintain high precision of results with less amount of computation, and then a new efficient image spectral retrieval method is provided. Besides some additional work the authors need to do in the future, for example, the relationship between threshold, retrieval precision rate and retrieval speed.


Actomyosin-driven left-right asymmetry: from molecular torques to chiral self organization.
Chirality or mirror asymmetry is a common theme in biology found in organismal body plans, tissue patterns and even in individual cells. In many cases the emergence of chirality is driven by actin cytoskeletal dynamics. Although it is well established that the actin cytoskeleton generates rotational forces at the molecular level, we are only beginning to understand how this can result in chiral behavior of the entire actin network in vivo. In this review, we will give an overview of actin driven chiralities across different length scales known until today. Moreover, we evaluate recent quantitative models demonstrating that chiral symmetry breaking of cells can be achieved by properly aligning molecular-scale torque generation processes in the actomyosin cytoskeleton.


Nitrogen balance response in young men given one of two isolated soy proteins or milk proteins.
The protein nutritional value of two isolated soy proteins was compared with that of dried skim milk proteins in healthy young men. Eight subjects received one of the isolated soy proteins and six subjects received the dried skim milk as the test protein source. Each protein was tested at intakes of 0.35, 0.45, 0.55 and 0.65 g protein (N X 6.25) per kilogram per day during 10-day diet periods separated by break periods of 3 days and a 1-day protein-free period. Nitrogen balances were determined for the final 5 days of each experimental diet period. From regression analysis of nitrogen intake minus nitrogen output data, intakes of each protein source to meet mean nitrogen requirements were 124, 146 and 144 mg N/kg per day for the two isolated soy proteins and skim milk protein, respectively. It is concluded that well-processed isolated soy proteins are indistinguishable from milk as a protein source for maintenance of short-term N balance in adult human nutrition.


Absence of symptoms in silver refiners with raised blood silver levels.
Silver has been implicated as a cause of ill health, related largely to its use in the medical setting as a treatment for burns and in prosthetic cements. This report discusses occupational silver exposure in two workers with blood silver levels of 49 micrograms/l and 74 micrograms/l who were asymptomatic and showed no signs of argyric neuropathy which has previously been described at blood silver levels as low as 10 micrograms/l. One of the men showed non-characteristic clinical signs of argyrosis. The clinical findings, results of environmental monitoring and effects of environmental improvements on blood silver levels are discussed.


Thrombopoietin serum levels at the start of mobilization, collection, and transfusion of autologous peripheral blood stem cells.
Thrombopoietin (TPO) serum levels in 14 patients (9 male and 5 female, mean age 36 years, range 16 to 55 years) with breast cancer (n = 5), testicular cancer (n = 7), or lymphoma (n = 2), undergoing high dose chemotherapy with peripheral blood stem cell (PBSC) transplantation, were evaluated at the first day of the mobilization chemotherapy (1), at the day of the first apheresis (2), and at the day of stem cell transfusion (3). All patients have been pretreated (one to four regimens) and received chemotherapy and granulocyte colony stimulating factor (G-CSF) or granulocyte-macrophage colony stimulating factor (GM-CSF) both at 5 microg/kg body weight (bw). for stem cell mobilization. TPO was measured with a human TPO immunoassay. Mean TPO serum levels were: (1) 274+/-248.8 pg/ml (range 0 to 953 pg/ml), (2) 518+/-399.1 pg/ml (range 118 to 1,283 pg/ml), and (3) 556+/-506.4 pg/ml (range 147 to 1,570 pg/ml). The CD34+ cell concentration in the peripheral blood at the time of apheresis was 65+/-48.2/microl (7 to 148/microl), and the number of transfused CD34+ cells was 3.0+/-1.0x10(6)/kg bw (1.7 to 5.5x10(6)/kg bw). TPO levels showed some weak inverse correlation (r = -0.64) with the platelet counts at the day of the first apheresis that increased to -0.70 if a semilog correlation was done (plt[log] vs. TPO). The number of platelet transfusions after HDCT correlated to some degree (r = 0.61) with the TPO serum level at the day of PBSC transfusion. There was no correlation between any TPO serum level and the CD34+ cell concentration in the peripheral blood or neutrophil and platelet engraftment. We conclude from this study that TPO serum levels do not seem to correlate with the CD34+ cell concentration in the peripheral blood and the time to engraftment, although there was some weak correlation with the number of platelet transfusions.


[Anemia and immunotherapy].
Immunotherapy of cancer is an old concept and specific or non specific approaches have been developed for decades. These early trials have never demonstrated any benefit and have largely been abandoned. The advent of recombinant techniques allowing to produce large amounts of cytokines, the recent description of tumour antigens expressed by tumor cell surface, the rapid increase in immunological knowledge and the development of molecular biology have rekindled interest in immunological therapy of cancer. Extensive clinical experience using cytokines and more recently monoclonal antibodies is now available and allows us to report on immunotherapy-induced anemia.


Surgical treatment of aortic regurgitation due to Takayasu arteritis: long-term morbidity and mortality.
The goal of this retrospective study was to determine the late outcome of surgical treatment for aortic valve regurgitation due to Takayasu arteritis and correlate it with evidence of inflammation on pathological examination. Ninety consecutive patients who underwent surgery for aortic valve regurgitation due to Takayasu arteritis between 1979 and 2003 were studied. Intraoperative pathological specimens of the aortic wall from 69 patients were retrospectively examined for inflammation. Aortic valve replacement was performed in 63 patients (group A) and composite graft repair in 27 patients (group B). The aortic root diameter was 39.9+/-9.5 mm in group A and 54.4+/-13.6 mm in group B (P<0.0001). Preoperative steroid therapy was performed in 40 patients (44.4%). Hospital mortality was 4.8% (3/63) in group A and 7.4% (2/27) in group B. The overall 15-year survival rate was 76.1%. Detachment of the valve or graft occurred in 11.1% (7/63) of group A and in 3.7% (1/27) of group B patients (P=0.43). Late dilatation (>50 mm) of the residual ascending aorta occurred in 11.1% (7/63) of group A and in 3.7% (1/27) of group B patients (P=0.43). Active inflammation was confirmed in intraoperative pathological specimens of 10 patients, and detachment of the valve or graft occurred in 4 of these patients. Univariate analysis of background variables revealed active inflammation to be a risk factor for detachment (P=0.0001; risk ratio 55). Late dilatation of the ascending aorta after aortic valve replacement is a clinically important finding. Active inflammation could be related to valve or graft detachment.


[America Manna: women and migration in a global perspective].
This article considers the role of migrant women in light of the contribution to the demographic, social, and economic development of the receiving country. The high level of development for these areas has always been fostered by the ready availability of a salaried work force and its easy replacement. The cost of labor in the country of origin is different from that in the receiving country and thus often results in a parallel work force and fosters forms of discrimination. With the crisis of the "rotation" model in the 1970s, the cost of replacing the work force has been concentrated in the countries of origin while official politics, which limited the immigration of family members, placed a greater burden on the women and the children of the emigrants, and increased the danger of their gradual marginalization.


Room temperature Stille cross-coupling reaction of unreactive aryl chlorides and heteroaryl chlorides.
Phosphanyl-beta-ketoiminate Pd complexes serve as highly effective catalysts in the Stille coupling reaction of aryl chlorides and heteroaryl chlorides with organostannanes at room temperature.


Manual compared with electric vacuum aspiration for abortion at less than 6 weeks of gestation: a randomized controlled trial.
To evaluate whether manual or electric vacuum aspiration results in greater immediate confirmation of completed abortion at less than 6 weeks of gestation. Five hundred pregnant women presenting for surgical abortion with mean gestational sac diameter of less than 12 mm or no visible sac on ultrasonography were randomized to manual or electric vacuum aspiration. Tissue examination was performed by operating physicians, not blinded to group assignment, and by trained medical assistants, blinded to group assignment. Patients with no products of conception on gross inspection underwent repeat aspiration as necessary and serial human chorionic gonadotropin monitoring. All patients were scheduled for follow-up visits. The primary outcome was detection of products of conception in patients with subsequently confirmed completed abortion. From April 2010 to October 2011, 252 patients were randomized to manual vacuum aspiration and 248 to electric vacuum aspiration. One hundred eighty-two (82%) patients in the manual vacuum aspiration group had products of conception identified and subsequently confirmed completed abortion compared with 164 (76%) patients undergoing electric vacuum patients (P=.13, relative risk 0.83, 95% confidence interval [CI] 0.64-1.07). In pregnancies of sac size 3 mm or less, including no visible sac, five of 29 (17%) patients undergoing manual vacuum aspiration had accurate identification of products of conception compared with four of 31 (13%) patients undergoing electric vacuum aspiration (P=.64, relative risk 0.85, 95% CI 0.44-1.63). Tissue reports of physicians and medical assistants had 90% concordance. Seventy-nine (16%) patients required human chorionic gonadotropin monitoring to confirm completed abortion. There were seven (1.4%) ongoing pregnancies, including four false-positive products of conception results and, among the latter, one presumed ectopic pregnancy. Our study supports providing abortions to women who request them before 6 weeks of gestation using either manual or electric vacuum aspiration. Early aspiration is highly effective, although human chorionic gonadotropin monitoring may be necessary to confirm complete abortion. I.


Giant Cell Arteritis: Beyond Corticosteroids.
Giant cell arteritis (GCA) is a large-vessel vasculitis predominantly affecting older people, with a peak incidence between 70 and 79 years of age. If untreated, ischaemic complications can be catastrophic for the patient, including blindness. We review the current treatment paradigms for this condition, the mainstay of which is immediate high-dose glucocorticoid therapy with a gradual dose tapering. Adverse events of glucocorticoid therapy are often observed after 12-24 months and corticosteroid-sparing adjuvant therapies are used in severe disease, multiple flares or patients at high risk of prolonged therapy. The current understanding of the pathogenesis of GCA is explored. This has informed the identification of new potential targets and approaches to treatment. Blockade of interleukin (IL)-6 (tocilizumab) and IL-1 (gevokizumab) are being evaluated in phase III clinical trials. It is hoped that improved risk stratification of organ damage and relapses will be developed using imaging and biomarkers, allowing for individualised treatment for patients; however, there remains further work to be done before this becomes a reality.


The impact of the site of origin and rate of tumour growth on clinical outcome in children with craniopharyngiomas.
Data on many predictors of hypothalamic-pituitary axis dysfunction associated with childhood craniopharyngioma (CP) are rather inconsistent, probably reflecting the variable but as yet unclarified growth pattern of these tumours. The aim of this study was to define the determinative role of tumour growth pattern on hypothalamic-pituitary axis function and outcomes for childhood CPs. The authors retrospectively analysed the records of 81 consecutive children with primary CP who underwent a uniform treatment paradigm of attempted radical resection performed by a single surgeon. The patients were divided into two subgroups based on tumour location and growth patterns: group A (infra-diaphragmatic sellar tumours: 34 cases) and group B [third ventricular floor (3rd VF) tumours: 47 cases]. The children's pre- and postsurgical endocrinological and hypothalamic disturbances were compared. Pituitary function and hypothalamic statues were quantitatively assessed using classification systems proposed in the previous studies. Preoperative pituitary function was more severely compromised in patients in group A than those in group B and deteriorated significantly following resection in both groups. (Average pituitary function scores increased from 2·19 ± 0·83 to 3·31 ± 0·74, P < 0·001). At the last follow-up, children with 3rd VF tumours had more prevalent weight gain (median body mass index: 23·1 kg/m(2) in group B vs 19·7 kg/m(2) in group A, P < 0·001) and increased hypothalamic dysfunction (average hypothalamic status scores: 2·04 ± 0·97 in group B vs 1·29 ± 0·57 in group A, P < 0·001). Children with 3rd VF tumours had a significantly lower probability of recurrence-free survival than those with sellar tumours (at 5 years: 74%vs 49%, respectively; at 10 years: 66%vs 32%, respectively; P = 0·02). Substantial differences in the outcome of childhood CP with different tumour growth patterns and locations were found, which suggested that diverse therapeutic considerations, especially endocrinological substitution, might be emphasized.


Trace elements and butyltins in a Dall's porpoise (Phocoenoides dalli) from the Sanriku coast of Japan.
Concentrations and body burdens of 14 trace elements (Hg, Cr, Mn, Co, Cu, Zn, Sr, Ag, Cd, V, Se, Pb, Mo, and Fe) and butyltins (BTs) (tributyltin TBT, dibutyltin DBT, and monobutyltin MBT) were determined in various tissues of a mature male Dall's porpoise (Phocoenoides dalli) collected off the Sanriku coast of Japan. Selective accumulation in this porpoise was observed for Hg, Mn, Cu, Ag, Mo, Fe, and total BTs (TBT, DBT, and MBT) in the liver, Cd in the kidney, Zn, Sr, V, Pb, and Co in the bone, and Se in the skin. In contrast, Cr concentrations in all tissues were similar. This distribution pattern in this mature porpoise was in general agreement with the accumulation characteristics of trace elements and butyltins reported for other marine mammals. The whole body of the porpoise contained approximately 62 g Fe, 8.8 g Zn, 4.0 g Sr, 0.6g Se, 0.41 g Cu, 0.19 g Hg, 0.17 g Cd, 0.16 g Mn, 0.05 g Cr, 0.009 g Ag, 0.008 g Mo, 0.005 g Pb, 0.004 g Co, and 0.7 mg of BTs (0.4 mg TBT, 0.2 mg DBT, and 0.1 mg MBT). Metabolism of TBT to its breakdown products of this porpoise seems to be limited, since TBT still accounted for about half of the total burden of BTs. As in the cases of Hg, Mn, Cu, Se, and Fe, the muscle was the most important reservoir (43%) for the whole body burden of total BTs, 80% of which was TBT, and thus muscle played a crucial role in the higher body composition of TBT in this Dall's porpoise.


Isolation of an ompC-like outer membrane protein gene from Salmonella typhi.
We have isolated the structural gene for an outer membrane protein of Salmonella typhi, from a genomic library constructed in bacteriophage lambda 1059, using the Escherichia coli ompC gene as a heterologous probe. E. coli ompC codes for an outer membrane pore protein (porin) that is induced preferentially at high osmolarity and high temperature. The S. typhi ompC-like gene was subcloned in pBR322 and introduced into E. coli HB101 and into P678-54, a minicell-producing strain. In both strains it expressed a 38.5-kDa protein, which was incorporated into the outer membrane envelope and comigrated with an S. typhi outer membrane protein which was expressed both at low and high osmolarity in vivo.


The Stromeyer hook--life and work of the man behind the eponym.
Georg Friedrich Stromeyer (1804-1876) is generally known as one of the founders of orthopedics and orthopedic surgery and a pioneer of modern military medicine. Every oral maxillofacial surgeon in Germany knows him because of the "Stromeyer hook" for the elevation of zygomatic arch fractures. The present paper focuses on this particular aspect of maxillofacial surgery as well as on Stromeyer's biography.


Effects of dopaminergic drugs, occlusal disharmonies, and chronic stress on non-functional masticatory activity in the rat, assessed by incisal attrition.
Observational methods and the recording of nonspecific jaw movements or masticatory muscle activity have been used to evaluate oral parafunctional movements in animal models of bruxism. In this study, we have used a new approach in which the non-functional masticatory activity in the rat was assessed by the measurement of incisal attrition, with the aim of investigating the role of diverse factors involved in the etiology of bruxism. We quantified the attrition rate weekly by making superficial notches in the lower incisors and measuring the distances to the incisor edges. Repeated stimulation of the dopaminergic system with apomorphine led to an enhancement of the non-functional masticatory activity (p < 0.0001). The severity of the apomorphine-induced oral behavior was positively correlated (r(s) = 0.69, p < 0.01) with an increase in the incisal attrition rate (20.9%, p < 0.0001). Apomorphine-induced non-functional masticatory activity was strongly enhanced by the placement of an acrylic cap on both lower incisors (306%, p < 0.0001), but not by the cutting of a lower incisor. Repeated cocaine administration also increased the attrition rate (22.5%, p < 0.0001). However, neither chronic blockade of dopaminergic receptors with haloperidol, nor its withdrawal, modified attrition. In addition, since emotional disturbances are considered to be causal factors of bruxism, we tested whether experimental stress might accelerate tooth wear. Exposure to two different chronic stress regimes did not induce significant changes in incisal attrition. Moreover, exposure to chronic stress after the withdrawal of chronic haloperidol treatment did not alter attrition either. These results partially support the role of the central dopaminergic system in bruxism and suggest that stress, in general, may not be a relevant factor in tooth wear.


Pain after percutaneous radiofrequency ablation of renal tumors.
Most patients have minimal pain after percutaneous radiofrequency ablation (RFA) of a renal tumor. However, anecdotally, there is some variation in the amount of patient discomfort. Our goal was to identify relevant patient factors and characteristics of their renal tumors that may influence pain after percutaneous RF ablation. We performed a retrospective chart review of 59 sequential patients who received percutaneous RFA between 2001 and 2005 at a single institution. Data on patient age, sex, body mass index (BMI), and narcotic administration in the periprocedural period were available for 46 patients. Preoperative imaging (CT or MRI) was reviewed to determine tumor size and location, as well as the shortest distance of the mass to the body-wall musculature. The distance from the renal mass to the body-wall musculature was significantly correlated with the total narcotics received in the periprocedural period. This measured distance did not correlate with the patient's BMI. No other relations between patient factors or tumor characteristics and peri-procedural narcotic usage were identified. Patients whose tumors lie close to their body-wall musculature have greater narcotic requirements in the periprocedural period. Knowledge of this correlation should result in better patient counseling and help anticipate periprocedural analgesia requirements.