Estimating glomerular filtration rate in acute coronary syndromes: Different equations, different mortality risk prediction.
Renal dysfunction is a powerful predictor of adverse outcomes in patients hospitalized for acute coronary syndrome. Three new glomerular filtration rate (GFR) estimating equations recently emerged, based on serum creatinine (CKD-EPIcreat), serum cystatin C (CKD-EPIcyst) or a combination of both (CKD-EPIcreat/cyst), and they are currently recommended to confirm the presence of renal dysfunction. Our aim was to analyse the predictive value of these new estimated GFR (eGFR) equations regarding mid-term mortality in patients with acute coronary syndrome, and compare them with the traditional Modification of Diet in Renal Disease (MDRD-4) formula. 801 patients admitted for acute coronary syndrome (age 67.3±13.3 years, 68.5% male) and followed for 23.6±9.8 months were included. For each equation, patient risk stratification was performed based on eGFR values: high-risk group (eGFR<60ml/min per 1.73m(2)) and low-risk group (eGFR⩾60ml/min per 1.73m(2)). The predictive performances of these equations were compared using area under each receiver operating characteristic curves (AUCs). Overall risk stratification improvement was assessed by the net reclassification improvement index. The incidence of the primary endpoint was 18.1%. The CKD-EPIcyst equation had the highest overall discriminate performance regarding mid-term mortality (AUC 0.782±0.20) and outperformed all other equations (ρ<0.001 in all comparisons). When compared with the MDRD-4 formula, the CKD-EPIcyst equation accurately reclassified a significant percentage of patients into more appropriate risk categories (net reclassification improvement index of 11.9% (p=0.003)). The CKD-EPIcyst equation added prognostic power to the Global Registry of Acute Coronary Events (GRACE) score in the prediction of mid-term mortality. The CKD-EPIcyst equation provides a novel and improved method for assessing the mid-term mortality risk in patients admitted for acute coronary syndrome, outperforming the most widely used formula (MDRD-4), and improving the predictive value of the GRACE score. These results reinforce the added value of cystatin C as a risk marker in these patients.


New drugs for childhood anemia.
New drugs, recently available for treatment of different forms of anaemia, have somehow changed the therapeutic scenario in paediatric haematology. The aim of this review is to focus on the newest molecules discussing indications, clinical usefulness and related problems. Erythropoietin, the specific growth factor of red cell precursors, is now an established option for anaemia of chronic renal failure, prematurity, bone marrow transplantation and chemotherapy. Anti-CD20 monoclonal antibody, a novel cytotoxic molecule for mature B lymphocytes, has proven to be effective in the treatment of refractory autoimmune cytopenias. Haemoglobin analogues are currently under investigation, in order to obtain a synthetic oxygen-carrier that can substitute blood transfusions. Finally drugs that are able to increase the production of haemoglobin F have been used in thalassemias and haemoglobinopathies. For patients with sickle cell disease, hydroxyurea is no longer an experimental tool; it has given rise to several trials, where it has proven to be effective in terms of both clinical and haematological improvement.


Angiotensin in the brain suppresses epinephrine-induced cardiac arrhythmias through CNS opioid mechanisms.
To test the hypothesis that angiotensin II (Ang II) in the central nervous system modulates catecholamine-induced cardiac arrhythmias and to determine whether endogenous opioids are operative in this action, arrhythmias were produced in male Wistar rats, by continuous infusion of epinephrine at incremental doses until the development of fatal arrhythmias that were usually ventricular fibrillation. Rats were instrumented with catheters in the lateral cerebral ventricle, femoral vein and femoral artery. Ang II, 0.5 microgram, in the lateral cerebral ventricle (ICV) markedly and significantly (p less than 0.05) increased the epinephrine dose, at the occurrence of ventricular premature beats compared to the control group 228 +/- 11 (SEM) vs 116 +/- 7 micrograms epinephrine/kg and at the onset of fatal arrhythmias 225 +/- 13 vs 185 +/- 9 micrograms epinephrine/kg. Ang II, 0.5 microgram i.v., did not affect arrhythmia threshold. The angiotensin converting enzyme inhibitor captopril, 1 mg/kg, decreased arrhythmia threshold as ventricular arrhythmias were first noted at 106 +/- 4 and fatal arrhythmias occurred at 118 +/- 4 micrograms epinephrine/kg. The Ang II receptor antagonist saralasin 150 micrograms/kg ICV, blunted and 300 micrograms/kg ICV reversed the effect of Ang II. The mu opioids antagonist naloxone and the kappa opioid antagonist MR 2266, 50 micrograms/kg ICV, prevented the effect of Ang II on fatal arrhythmias. The action Ang II on arrhythmias could not be explained by the effects of Ang II on blood pressure or heart rate. These data indicate a role for Ang II within the CNS to modulate cardiac arrhythmias and that this is mediated in part, by endogenous opioids.


Repair of DNA damage in light sensitive human skin diseases.
Repair of UV-light induced DNA damage and changes in the semiconservative DNA synthesis were studied by in vitro autoradiography in the skin of patients with lightdermatoses (polymorphous light eruption, porphyria cutanea tarda, erythropoietic protoporphyria) and xeroderma pigmentosum as well as in that of healthy controls. In polymorphous light eruption the semiconservative DNA replication rate was more intensive in the area of the skin lesions and in the repeated phototest site, the excision repair synthesis appeared to be unaltered. In cutaneous porphyrias a decreased rate of the repair incorporation could be detected. Xeroderma pigmentosum was characterized by a strongly reduced repair synthesis.


Current concepts in tissue engineering technique for repair of cartilage defect.
Hunter's observation in 1743 that cartilage "once destroyed, is not repaired," has not essentially changed for 250 years. At present, there is no well-established procedure for the repair of cartilage defect with articular cartilage, which has the same biochemical and biomechanical properties as the surrounding normal intact cartilage. In 1994, transplantation of human autologous chondrocytes in suspension, as reported by Brittberg et al., provided a potential procedure for articular cartilage repair. We have improved their procedure and developed a new technique which creates new cartilage-like tissue by cultivating autologous chondrocytes embedded in Atelocollagen gel for 3 weeks before transplantation. These improvements maintained the chondrocyte phenotype, evenly distributed chondrocytes throughout the osteochondral defects, and decreased the risk of leakage of grafted chondrocytes into the defects. Good clinical results suggest that this technique should be a promising procedure for repairing articular cartilage defect.


Droplet-based microfluidic synthesis of anisotropic metal nanocrystals.
A droplet-based microfluidic method for the preparation of anisotropic gold nanocrystal dispersions is presented. Gold nanoparticle seeds and growth reagents are dispensed into monodisperse picoliter droplets within a microchannel. Confinement within small droplets prevents contact between the growing nanocrystals and the microchannel walls. The critical factors in translating macroscale flask-based methods to a flow-based microfluidic method are highlighted and approaches are demonstrated to flexibly fine tune nanoparticle shapes into three broad classes: spheres/spheroids, rods, and extended sharp-edged structures, thus varying the optical resonances in the visible-near-infrared (NIR) spectral range.


Arsenic transforming abilities of groundwater bacteria and the combined use of Aliihoeflea sp. strain 2WW and goethite in metalloid removal.
Several technologies have been developed for lowering arsenic in drinking waters below the World Health Organization limit of 10 μg/L. When in the presence of the reduced form of inorganic arsenic, i.e. arsenite, one options is pre-oxidation of arsenite to arsenate and adsorption on iron-based materials. Microbial oxidation of arsenite is considered a sustainable alternative to the chemical oxidants. In this contest, the present study investigates arsenic redox transformation abilities of bacterial strains in reductive groundwater from Lombardia (Italy), where arsenite was the main arsenic species. Twenty isolates were able to reduce 75 mg/L arsenate to arsenite, and they were affiliated to the genera Pseudomonas, Achromobacter and Rhodococcus and genes of the ars operon were detected. Three arsenite oxidizing strains were isolated: they belonged to Rhodococcus sp., Achromobacter sp. and Aliihoeflea sp., and aioA genes for arsenite oxidase were detected in Aliihoeflea sp. strain 2WW and in Achromobacter sp. strain 1L. Uninduced resting cells of strain 2WW were used in combination with goethite for arsenic removal in a model system, in order to test the feasibility of an arsenic removal process. In the presence of 200 μg/L arsenite, the combined 2WW-goethite system removed 95% of arsenic, thus lowering it to 8 μg/L. These results indicate that arsenite oxidation by strain 2WW combined to goethite adsorption is a promising approach for arsenic removal from contaminated groundwater.


Highly sensitive detection of benzyl free radical in the vapor phase.
The 1(2)B(2)-->3(2)B(2) transition in the absorption spectrum of the benzyl free radical has been recorded in the vapor phase together with a new band at shorter wavelengths, probably the first Rydberg band of the radical in the vapor phase. The photolysis flash was of short duration and it was possible to follow the kinetics of the radicals' decay, which occurred predominantly by bimolecular recombination.


Proximity versus allostery: the role of regulated protein dimerization in biology.
Regulated dimerization of proteins is increasingly understood to be important in many cellular processes, including signaling, transciption and protein degradation. Organic molecules that induce dimerization may offer as much potential to regulate biological processes as those that allosterically induce conformational change.


Technetium-99m labeling of red blood cells: in vitro evaluation of a new approach.
By titration of two different stannous kits for 99mTc labeling of red blood cells (RBC) we found concentrations of 1-2 micrograms tin per ml of blood to give the highest labeling yield. Using a new kit containing 2 micrograms of tin and 0.1% hypochlorite (NaOCl) as an oxidizing agent we labeled RBC with 99mTc avoiding centrifugation of cells. To evaluate this new procedure we assessed the dependency of tin incubation time, and addition of 4.4% EDTA as a chelating agent on labeling efficiency. We also measured the dependency of EDTA on the stability of the label. Optimal conditions for labeling of 1 ml of whole blood using the new stannous kit were: 5-10 min of tin incubation, 0.2 ml of 0.1% hypochlorite, and 15 min of 99mTc incubation. This procedure resulted in a labeling efficiency of at least 96%. The overall effect of EDTA was not an increased labeling efficiency, and EDTA increased the stability of the label with only a few percent. The promising results of this new labeling approach encourage to further laboratory investigations and eventual clinical evaluation of the procedure.


A simple modular aptasensor platform utilizing cucurbit[7]uril and a ferrocene derivative as an ultrastable supramolecular linker.
A simple modular aptamer-based sensor (aptasensor) platform was prepared by combining the merits of the rapid and efficient preparation of a self-assembled monolayer of cucurbit[7]uril (CB[7] SAM) and the strong and specific binding affinity of CB[7] to ferrocenemethylammonium (FA), as an ultrastable supramolecular linker, to immobilize aptamers on CB[7] SAM.


Protein microarrays on hybrid polymeric thin films prepared by self-assembly of polyelectrolytes for multiple-protein immunoassays.
We report here the development and characterization of protein microarrays fabricated on nanoengineered 3-D polyelectrolyte thin films (PET) deposited on glass slide by consecutive adsorption of polyelectrolytes via self-assembly technique. Antibodies or antigens were immobilized in the PET-coated glass slides by electrostatic adsorption and entrapment of porous structure of the 3-D polymer film and thus establishing a platform for parallel analysis. Both antigen and antibody microarrays were fabricated on the PET-coated slides, and direct and indirect immunoassays on protein microarrays for multiple-analyte detection were demonstrated. Microarrays produced on these PET-coated slides have consistent spot morphology and provide performance features needed for proteomic analysis. The protein microarrays on the PET films provide LOD as low as 6 pg/mL and dynamic ranges up to three orders of magnitude, which are wider than the protein microarrays fabricated on aldehyde and poly-L-lysine functionalized slides. The PET films constructed by self-assembly technique in aqueous solution is green chemistry based, cost-effective method to generate 3-D thin film coatings on glass surface, and the coated slide is well suited for immobilizing many types of biological molecules so that a wide variety of microarray formats can be developed on this type of slide.


[Consultative psychiatry--aims, challenges and perspectives].
The consultative psychiatry is the field of scientific research and medical practice connecting biological, psychological and social aspects of mental and somatic disorders. The aim of the study was to discuss the subject area of the consultative psychiatry. Psychiatrist may be asked for consultation by the physician, family or patient. The reason for this may be the need to transport or cam the patient down (emergency), the need to understand the disorder, its dynamics, therapeutic difficulties or difficulties in cooperation with the patient. The introduction to consultation consists of gathering information from the supporting staff, patient's family, main physician or from the disease records. Psychiatric examination should be taking place in peaceful surroundings enduring privacy. Basic examination of mental condition should be carried out. The results of the consultation are required to be shared in writing and they influence further treatment and often, further life of the patient. In difficult situations it is advised to carry out psychiatric consultation several times. In emergencies there is a need to consult the aggressive patients with suicidal tendencies and consciousness disorders. The future of consultative psychiatry is connected with development of medicine in the field of transplantology, oncology, pandemics of contagious diseases, biomedicine, etc.


[Expression and identification of gene Loa22 from the virulent strain of serovar Lai of L. interrogans and its cytotoxicity to macrophages].
To study the function of Loa22 gene from virulent serovar Lai. L. interrogans by expressing its protein. The recombinant plasmid with Loa22 was constructed and its expression was induced by IPTG. The expression product was identified by SDS-PAGE and Western Blotting and purified with GST-affinity chromatography. The purified protein was applied to mice macrophages ANA-1 cells purified by GST-affinity column and exerted to ANA-1 cells. The cytotoxicity of purified protein to ANA-1 was evaluated by detecting LDH activity in culture medium, XTT aborbtion and apoptosis ration. The recombinant plasmid with Loa22 mature peptide was constructed successfully and the protein was purified subsequently. Significant higher level of LDH activity and apoptosis ratio and lower XTT absorption were observed by comparison of expression protein treated cells and those untreated. Loa22 had a toxic effect on ANA-1 and the gene Loa22 might be a virulent-related gene of L. interrogans.


[Wilms' tumor in adults].
The author analyzes the case of a nephroblastoma in an adult and gives an account of the oncogenetic background of this disease based on new ontogenetic findings. He draws attention to the possible association of nephroblastoma and other congenital defects and the possibility of another nephroblastoma which developed on the same ontogenetic background in the other kidney.


Prevention of leucaena toxicosis of cattle in Florida by ruminal inoculation with 3-hydroxy-4-(1H)-pyridone-degrading bacteria.
Ruminal microorganisms in cattle at a Florida agriculture research station did not have the ability to detoxify leucaena by degradation of 3-hydroxy-4(1H)-pyridone (3,4,-DHP), but a DHP isomer (2,3-DHP) was degraded in some cattle. Cattle with microorganisms that degraded 2,3-DHP were mostly Senepol cattle imported from St. Croix, US Virgin Islands, where leucaena is an indigenous species. Hereford cattle at the research station in Florida generally did not degrade 3,4-DHP or 2,3-DHP. An experiment was conducted in which a pure culture of 3,4-DHP-degrading bacteria was inoculated into Hereford cattle (with ruminal fistula) grazing leucaena. The bacteria successfully colonized the rumen of recipient cattle and persisted through the following winter when there was no leucaena in the diet.


Frequency-stabilized, 10-W continuous-wave, laser-diode end-pumped, injection-locked Nd:YAG laser.
We describe an efficient and highly stable injection-locked, laser-diode end-pumped cw Nd:YAG laser. With 22.3-W pump input from two fiber-coupled laser diodes, combined with 700 mW of power injected by a singlefrequency master laser, the injection-locked slave laser emits 10 W of linearly polarized, TEM(00)-mode output in a single longitudinal mode. In addition to high efficiency, the injection-locked laser also possesses excellent output stability. At 300 Hz, the measured relative intensity noise and the frequency-noise spectral density are 2 x 10(-5)/ radicalHz and 50 Hz/ radicalHz, respectively. To improve frequency stability further, we lock the frequency of the injection-locked laser to an external high-finesse reference cavity. When the frequency was stabilized, a minimum frequency-noise spectral density of 40 mHz/ radicalHz was measured at the frequency-stabilization loop error point at 1 kHz.


Auto-regulation of DNA degrading bacteriocins: molecular and ecological aspects.
Colicins, proteinaceous antibiotics produced by Escherichia coli, specifically target competing strains killing them through one of a variety of mechanisms, including pore formation and nucleic acid degradation. The genes encoding colicins display a unique form of expression, which is tightly regulated, involving the DNA damage response regulatory system (the SOS response system), confined to stressful conditions and released by degradation of the producing cell. Given their lethal nature, colicin production has evolved a sophisticated system for repression and expression. While exploring the expression of 13 colicins we identified a novel means of induction unique to strains that kill by DNA degradation: these colicinogenic strains mildly poison themselves inflicting DNA damage that induces their DNA repair system (the SOS system), and their own expression. We established that among the four known DNase colicins (E2, E7, E8 and E9), three act to induce their own production. Using different stresses we show that this form of self-regulation entails high cost when growth conditions are not optimal, and is not carried out by individual cells but is a population-mediated trait. We discuss this novel form of colicins' regulation and expression, and its possible molecular mechanism and evolutionary implications.


Recent demographic bottlenecks are not accompanied by a genetic signature in banner-tailed kangaroo rats (Dipodomys spectabilis).
Single-sample methods of bottleneck detection are now routine analyses in studies of wild populations and conservation genetics. Three common approaches to bottleneck detection are the heterozygosity excess, mode-shift, and M-ratio tests. Empirical groundtruthing of these methods is difficult, but their performances are critical for the accurate reconstruction of population demography. We use two banner-tailed kangaroo rat (Dipodomys spectabilis) populations from southeastern Arizona (USA) that are known to have experienced recent demographic reductions to search for genetic bottleneck signals with eight microsatellite loci. Over eight total sample-years, neither population showed a genetic bottleneck signature. M-ratios in both populations were large, stable, and never fell below a critical significance value (Mc). The mode shift test did not detect any distortion of allele frequencies, and tests of heterozygosity excess were not significant in postbottleneck samples when we used standard microsatellite mutation models. The genetic effects of bottlenecks like those experienced by our study populations should be strongly influenced by rates of mutation and migration. We used genetic parentage data to estimate a relatively high mutation rate in D. spectabilis (0.0081 mutants/generation/locus), but mutation alone is unlikely to explain the temporal distribution of rare alleles that we observed. Migration (gene flow) is a more likely explanation, despite prior mark-recapture analysis that estimated very low rates of interpopulation dispersal. We interpret our kangaroo rat data in light of the broader literature and conclude that in natural populations connected by dispersal, demographic bottlenecks may prove difficult to detect using molecular genetic data.


Environmental influences on cognitive decline in aged rats.
Two experiments are reported in which young and old rats, housed in an impoverished (IE), enriched (EE), or standard (SE), environment, were tested on a series of complex, blind-alley mazes. In Experiment 1, 3-months exposure to IE exacerbated age differences in maze performance, relative to the differences between young and old rats in EE and SE. Old rats in the EE and SE conditions did not differ from each other. In Experiment 2, rats were raised for an additional 3 months in either IE or EE before further maze testing. The main findings were that the maze performance of old rats, transferred from IE to EE, improved significantly, whereas the performance of old rats, transferred from SE or EE to IE, declined. These results indicated that the deleterious effects of an impoverished environment on learning and memory are, at least partly, reversible, and that experience in a stimulating environment can protect old rats from the adverse effects of relocation to a deprived environment. Taken together, the results highlight the impact of environmental influences on cognitive function in old age, and emphasize the need to consider nonbiological factors in understanding the process of cognitive aging.


Evaluation of the accuracy of electronic apex locators Dentaport ZX and Ray Pex 4 under clinical conditions.
The aim of the present study was to compare the accuracy of working endodontic length determination by Dentaport ZX and Ray Pex 4 under clinical conditions. Clinical comparative evaluation of the accuracy of two electronic apex locators, Dentaport ZX and Ray-Pex 4, was carried out in 80 single-rooted teeth with vital pulp tissue planned for extraction as part of the dental treatment and after patient consent had been obtained. The normal procedure was followed, which included anesthesia, a standard endodontic access cavity, pulp removal and irrigation of the root canal with 5.25% NaOCl. The working length was estimated with Dentaport ZX for half of the selected teeth and with Ray-Pex 4 for the other half. K-files #15 were cemented at the measured working length and the teeth were extracted. The apical foramen was examined with a stereomicroscope under x15 magnification. The micrometric system of the microscope allowed precise measurement of distances. The comparison of the estimated working length with the actual length revealed that Dentaport ZX localized the apical foramen in 95% of the cases and the Ray Pex 4 in 92.5% with a clinically acceptable accuracy of +/- 0.5 mm. Dentaport ZX detected the foramen in 97.5% and Ray Pex 4 in 95% of the cases with an accuracy of +/- 1 mm. There was no statistically significant difference between the accuracy of the two electronic apex locators in locating the apical foramen (p < 0.05).


[Comparison of the IL-27 level in gingival crevicular fluid of cross-quadrant and the upper and lower half-mouth subgingival scaling].
To investigate the changes of IL-27 in gingival crevicular fluid (GCF) before and after treatment with different methods for chronic periodontitis. Sixty patients with moderate or severe chronic periodontitis were selected as study group to divide into group A (cross-quadrant) and group B (upper and lower half-mouth) randomly. Another 30 healthy people were selected as group C. Gingival crevicular fluid of group A and B were collected at baseline and each week during treatment. At the same time, the clinical parameters including PD, AL, BI and PLI were recorded. And the levels of IL-27 in GCF were measured by ELISA. SPSS 17.0 software package was used for statistical analysis. The levels of IL-27 in GCF 2 and 3 weeks after treatment were higher in study group compared with those at baseline, while PD, AL, BI and PLI showed significant reduction. The changes except PLI in group A was more obvious than group B, which had a significant difference. After three-week treatment, IL-27 in group A had no remarkable difference compared with group C. There were significantly negative correlation between PD, AL, BI, PLI and IL-27. IL-27 in GCF can be considered as a potential target for prevention and treatment of chronic periodontitis. Compared with the upper and lower half-mouth subgingival scaling, cross-quadrant has more pronounced short-term effect.


[New viewpoints on the clinical picture, diagnosis and pathophysiology of reflex sympathetic dystrophy (Sudeck's disease)].
Reflex sympathetic dystrophy can be elicited by various factors (e. g. trauma, herpes zoster, myocardial infarction). Independent of kind and site of a lesion, symptoms occur most often in the whole distal part of the affected extremity. There in most cases, a triad of autonomic, motor and sensory disturbances can be found clinically. For early diagnosis--beside clinical investigation--a comparative measurement of skin temperatures on both sides of finger or toe tips, respectively, is recommended. Hereby the clinical finding of a warmer or colder extremity can be proved, which supplies evidence of a disturbed skin blood flow. In case, the above mentioned triad and a disturbance of skin circulation is found, diagnosis of sympathetic reflex dystrophy can be made with great certainty. With regard to the underlying pathophysiology, symptoms can be explained at this time satisfactory only by the assumption of a vicious circle. Starting from a painful event (e.g. trauma, mark in a plaster cast, nerve lesion or myocardial infarction) a functional disturbance of the sympathetic nervous system is initiated. This results in a disturbance of the circulation in all of the affected tissues (skin, muscle, bone and joint), which finally gives rise to an abnormal excitation of afferent receptors, particularly of nociceptors. This excitation maintains the disturbance of the sympathetic nervous system at central nervous level (vicious circle). The most relevant pathomechanism in this process seems to be the occurrence of an imbalance between the activity of sympathetic vasoconstrictor neurons supplying arteries and those, supplying veins. A sympatholytic therapy, if applied in time, is able to cut off the vicious circle, which may lead to a restitutio ad integrum. Further investigations will show to what extent psychological factors are involved in developing the central nervous disturbance of the sympathetic nervous system and may also show if in addition the motor system is affected.


Objectives, components and experiences in the development of The IOC Marine Pollution Monitoring System (MARPOLMON).
The Marine Pollution Monitoring System (MARPOLMON) constitutes a marine chemical component of the Global Environment Monitoring System (GEMS). The Programme covers all matters related to marine pollution research and associated monitoring activities required for the assessment of marine pollution. MARPOLMON constitutes the data-gathering activity, being directed to accurately determine levels of selected contaminants in several phases of the marine environment in various regions of the World Ocean. It is envisaged to utlize MARPOLMON generated data for the purposes of construction of mass-balances and making contamination and pollution assessments in regional and global contexts.Data gathering, reporting and exchange requires stringent control of the quality of the information retrieved, which in turn dictates the development and testing of standard methodology, its widespread adoption and intercomparison of methods and feedback-refinement of orogonal methods or hypotheses.


Specificities of human TAP alleles for HLA-B27 binding peptides.
Allelic TAP polymorphism has been linked to susceptibility to Reiter's syndrome and was suggested to influence disease phenotype in HLA-B27 positive patients with ankylosing spondylitis. In the present study, we examined whether the human TAP alleles functionally differ in their translocation specificity for HLA-B27-binding nonamers. TAP translocation of a panel of HLA-B27-binding peptides was measured with a labeled reporter peptide containing an N-linked glycosylation acceptor site in streptolysin O-permeabilized cells with different TAP alleles. The different human TAP alleles tested did not measurably differ in their peptide specificity. The polymorphism of human TAP does not affect the translocated repertoire of HLA-B27 ligands and is therefore unlikely to play a decisive role in the development of HLA-B27-associated disease.


A Multidisciplinary Approach to Improving Appropriate Follow-Up Imaging of Ovarian Cysts: A Quality Improvement Initiative.
Incidental ovarian cysts are frequently detected on imaging. Despite published follow-up consensus statements, there remains variability in radiologist follow-up recommendations and clinician practice patterns. The aim of this study was to evaluate if collaborative ovarian cyst management recommendations and a radiologist decision support tool can improve adherence to follow-up recommendations. Gynecologic oncologists and abdominal radiologists convened to develop collaborative institutional recommendations for the management of incidental, asymptomatic simple ovarian cysts detected on ultrasound, CT, and MRI. The recommendations were developed by modifying the published consensus recommendations developed by the Society of Radiologists in Ultrasound on the basis of local practice patterns and the experience of the group members. A less formal process involved the circulation of the published consensus recommendations, followed by suggestions for revisions and subsequent consensus, in similar fashion to the ACR Incidental Findings Committee II. The recommendations were developed by building on the published work of experienced groups to provide the authors' medical community with a set of recommendations that could be endorsed by both the Department of Gynecology and the Department of Radiology to provide supportive guidance to the clinicians who manage incidental ovarian cysts. The recommendations were integrated into a radiologist decision support tool accessible from the dictation software. Nine months after tool launch, institutional review board approval was obtained, and radiology reports mentioning ovarian cysts in the prior 34 months were retrospectively reviewed. For cysts detected on ultrasound, adherence rates to Society of Radiologists in Ultrasound recommendations were calculated for examinations before tool launch and compared with adherence rates to the collaborative institutional recommendations after tool launch. Additionally, electronic medical records were reviewed to determine the follow-up chosen by the clinician. For cysts detected on ultrasound, radiologist adherence to recommendations improved from 50% (98 of 197) to 80% (111 of 139) (P < .05). Overmanagement decreased from 34% (67 of 197) to 10% (14 of 139) (P < .05). A recommendation was considered "overmanaged" if the radiologist recommended follow-up when it was not indicated or if the recommended follow-up time was at a shorter interval than indicated. Clinician adherence to radiologist recommendations showed statistically nonsignificant improvement from 49% (36 of 73) to 57% (27 of 47) (P = .5034). Management recommendations developed through collaboration with clinicians may help standardize follow-up of ovarian cysts and reduce overutilization.


[Effect of oral cordarone in reversing persistent atrial fibrillation].
To observe the efficacy and safety of oral cordarone dir reversing persistent atrial fibrillation (AF). METHODS; Eighty-two symptomatic chronic AF out-patients without history of acute diseases or severe hepatic/thyroid dysfunction were given oral cordarone at the loading dose of 200 mg thrice a day for 1-4 weeks followed by a twice-daily administration for another 1-4 weeks, with the maintenance dose of 200 or 100 mg once a day. The incidence of stroke and cardiac events and the mortality rate were compared between 43 patients with restored rhythm on cordarone and 39 patients on digoxin and/or betaloc for ventricular rhythm control. Among the 82 patients, sinus rhythm restoration was achieved in 43, with a successful rate of 52%. In 18 patients, the ejection fraction increased from (32+/-8)% to (46+/-10)%, left atrium diameter decreased from (4.6+/-1.1) cm to (4.1+/-0.8) cm. Except for slight T4 increase, QT prolongation and bradycardia in 3 cases, severe side effects were not observed in this study. Only one patient with restored sinus rhythm required rehospitalization after half a year for worsened heart failure, but in patients with controlled ventricular rhythm, 1 developed stroke, 1 experienced heart attack and 1 died of heart failure with bleeding. For patients with symptomatic reversible persistent AF, active treatment with cordarone can be convenient, effective and safe for sinus rhythm restoration.


Sorption of phenanthrene by humic acid-coated nanosized TiO2 and ZnO.
Phenanthrene sorption by nano-TiO2 and nano-ZnO particles was enhanced significantly by coated humic acids (HAs), implying that additional toxicity can be potentially given to these nanooxides by adsorbed HOCs once released to the environment. Phenanthrene isotherms of adsorbed HA on nano-TiO2 and nano-ZnO were more nonlinear than that of their respective bulk HA. Both HA conformation changes and fractionation were observed upon HA adsorption on nano-TiO2 and nano-ZnO, which further affected phenanthrene sorption. Nano-TiO2 and nano-ZnO interacted with differentfunctional groups of HA (i.e., phenolic OH with nano-TiO2, while COOH with nano-ZnO), leading to different conformations of adsorbed HA. Interaction of HA phenolic OH with nano-TiO2 increased the pi-polarity/polarizability of adsorbed HA and, consequently, its phenanthrene adsorption affinity and isotherm nonlinearity. Interactions of COOH groups on HA aromatic rings with nano-ZnO would also increase the pi-polarity/polarizability of adsorbed HA and its phenanthrene adsorption affinity, whereas interactions of COOH groups on HA aliphatic chains with nano-ZnO would make the adsorbed HA be in a more condensed state with lower partitioning affinity. Increase in adsorption and decrease in partitioning were responsible for the more nonlinear phenanthrene isotherms of adsorbed HA than bulk HA.


Falcipain cysteine proteases require bipartite motifs for trafficking to the Plasmodium falciparum food vacuole.
The Plasmodium falciparum cysteine proteases falcipain-2 and falcipain-3 hydrolyze hemoglobin in an acidic food vacuole to provide amino acids for erythrocytic malaria parasites. Trafficking to the food vacuole has not been well characterized. To study trafficking of falcipains, which include large membrane-spanning prodomains, we utilized chimeras with portions of the proteases fused to green fluorescent protein. The prodomains of falcipain-2 and falcipain-3 were sufficient to target green fluorescent protein to the food vacuole. Using serial truncations, deletions, and point mutations, we showed that both a 20-amino acid stretch of the lumenal portion and a 10-amino acid stretch of the cytoplasmic portion of the falcipain-2 prodomain were required for efficient food vacuolar trafficking. Mutants with altered trafficking were arrested at the plasma membrane, implicating trafficking via this structure. Our results indicate that falcipains utilize a previously undescribed bipartite motif-dependent mechanism for targeting to a hydrolytic organelle, suggesting inhibition of this unique mechanism as a new means of antimalarial chemotherapy.


Putative fragile sites in the horse karyotype.
After fluorouracil/5-bromodeoxyuridine synchronization and subsequent FPG-staining, the karyotype of 15 phenotypically normal horses displayed several breaks and gaps. Twelve bands 1q24, 4p12, 8q23, 11p12, 16q21, 17q21, 23q31, 23q32, Xp21, Xq22, Xq25 and Xq27 showed relatively frequent fragility. After thymidine/cytidine synchronization and subsequent GWL-banding the same horses display karyotypes without any fragility. Hence it is suggested that the above listed bands harbour folate and/or 5-bromodeoxyuridine sensitive fragile sites.


Renal hemangiopericytoma: case report and review of the literature.
Hemangiopericytoma is an uncommon perivascular tumor that occurs most frequently in the pelvis, head and neck, and meninges; it is extremely rare in the kidney. We report a kidney hemangiopericytoma in a 43-year-old woman who was treated with a nephron-sparing surgery and review the literature.


Mercaptoethanol poisoning: report of a fatal case and analytical determinations.
A suicide due to oral intake of 2-mercaptoethanol is reported. High concentrations of 2-mercaptoethanol and its metabolite 2-mercaptoacetate were found by gas chromatography in the urine and gastric content of the victim. These compounds were also identified by gas chromatography/mass spectrometry. Increased amounts of inorganic sulfate were furthermore found in the urine. Case history and autopsy findings are presented, and the metabolism of 2-mercaptoethanol is discussed.


Community care--the costs and quality.
There has been much debate in recent years about the implementation of community care policies for people with learning difficulties. The debate has centred on the following points: what the real costs and benefits of community care are, and to whom; what a community care service should look like; who should provide the service and how should it best be funded. This paper presents the results of a study comparing the costs and outcomes to clients of a variety of residential services for people with learning difficulties. The services evaluated range from traditional hospital services to small community based homes, run on 'ordinary life' principles. The purpose of the study was to collect information to aid policy makers and service providers in deciding how best to implement the community care initiative.


Survey of clinicians' attitudes to the anatomical teaching and knowledge of medical students.
There is considerable and ongoing debate surrounding the teaching of anatomy to medical students, and the anatomical knowledge of those medical students once they graduate. Few attempts have been made to gather the opinions of clinicians on this subject. A questionnaire was sent to 362 senior clinicians in hospitals affiliated to the University of Aberdeen. A total of 162 replies were received, with this sample being representative of the population of hospital consultants. Our results indicate that the majority of clinicians feel that the current anatomical education of medical students is inadequate, and below the minimum necessary for safe medical practice. There is widespread support among clinicians for more vertical integration of anatomy teaching throughout the undergraduate curriculum.


Methods of weaning preterm babies <30 weeks gestation off CPAP: a multicentre randomised controlled trial.
Controversy exists whether different continuous positive airway pressure (CPAP) weaning methods influence time to wean off CPAP, CPAP duration, oxygen duration, Bronchopulmonary Dysplasia (BPD) or length of admission. In a multicentre randomised controlled trial, the authors have primarily compared CPAP weaning methods impact on time to wean off CPAP and CPAP duration and secondarily their effect on oxygen duration, BPD and time of admission. Between April 2006 and October 2009, 177 infants <30 weeks gestational age (GA) who fulfilled stability criteria on CPAP were randomised to one of the three CPAP weaning methods (M). M1: Taken 'OFF' CPAP with the view to stay 'OFF'. M2: Cycled on and off CPAP with incremental time 'OFF'. M3: As with m(2), cycled on and off CPAP but during 'OFF' periods were supported by 2 mm nasal cannula at a flow of 0.5 l/min. Based on intention to treat analysis, there was no significant difference in mean GA or birthweight between the groups (27.1 ± 1.4, 26.9 ± 1.6 and 27.3 ± 1.5 (weeks ± 1SD) and 988 ± 247, 987 ± 249 and 1015 ± 257 (grams ± 1SD), respectively). Primary outcomes showed M1 produced a significantly shorter time to wean from CPAP (11.3 ± 0.8, 16.8 ± 1.0, 19.4 ± 1.3 (days ± 1SE) p<0.0001, respectively) and CPAP duration (24.4 ± 0.1, 38.6 ± 0.1, 30.5 ± 0.1 (days ± 1SE) p<0.0001, respectively). All the secondary outcomes were significantly shorter with M1, (oxygen duration: 24.1 ± 1.5, 45.8 ± 2.2, 34.1 ± 2.0 (days ± 1SE) p<0.0001, BPD: 7/56 (12.5%), 29/69 (42%), 10/52 (19%) p=0.011 and length of admission: 58.5 ± 0.1, 73.8 ± 0.1 69.5 ± 0.1 (days ± 1SE) p<0.0001, respectively). Method 1 significantly shortens CPAP weaning time, CPAP duration, oxygen duration, BPD and admission time.


Insulin-like growth factor 1 and corticosteroid modulation of chondrocyte metabolic and mitogenic activities in interleukin 1-conditioned equine cartilage.
To evaluate potential stimulatory or matrix-sparing effects of insulin-like growth factor 1 (IGF-1), alone or in combination with a corticosteroid, in an interleukin 1 (IL-1)-induced model of cartilage degradation. Cartilage from the weightbearing surfaces of trochlea and condyles of clinically normal 2-year-old male horses. Triamcinolone acetonide and IGF-1 effects were evaluated by assessing: matrix responses by sulfated glycosaminoglycan (GAG) assay and [35S]sulfated GAG synthesis; collagen content by hydroxyproline assay; and mitogenic response by [3H]thymidine incorporation into DNA and fluorometric assay of total DNA concentration. Conditioning of cartilage explants with 10 ng of human recombinant IL-1 alpha increased degradation and decreased synthesis of matrix proteoglycans (PG), without affecting matrix collagen content. Human recombinant IGF-1 decreased PG loss and reversed the reduction of PG synthesis in cartilage explants conditioned with IL-1. Given alone, steroids decreased PG concentration and synthetic rate in normal cartilage. However, the previously diminished PG content, attributable to IL-1 conditioning, was not further exacerbated by steroid administration in IL-1-conditioned explants. Combined treatment of normal cartilage explants with IGF-1 and steroids resulted in PG preservation and increase in collagen content. Similar PG and collagen effects were not evident when treating IL-1-conditioned cartilage with IGF-1/steroid combinations. Decrease in chondrocyte proliferation was associated with steroid administration. Exposure to IGF and steroids prevented the decrease in mitogenesis that could lead to cellular loss, particularly in IL-1-conditioned explants. Combination IGF-1 and steroid treatment of normal cartilage cultures indicated substantial ability to override the anabolic suppression associated with steroids alone. Potentially, administration of corticosteroids, followed by IGF-1, may act to decrease propagation of detrimental mediator release while allowing appreciation of the chondroenhancing effects of IGF-1. These beneficial effects were considerably reduced in IL-1-induced cartilage damage.


Association of chronic work stress, psychiatric disorders, and chronic physical conditions with disability among workers.
There appear to be links between psychiatric disorders and work-related stress as well as between psychiatric disorders and physical conditions. This study explores the relationships between chronic work stress, psychiatric disorders, and chronic physical conditions and disability among workers. By doing so, this study sought to understand how these factors are associated with worker disability when they are experienced alone versus in combination with one another. The study population was drawn from the Canadian Community Health Survey 1.2, a national population-based survey that gathered cross-sectional data on health status from 22,118 working respondents. The relationship between chronic work stress, chronic physical conditions, and psychiatric disorders and disability in the past 14 days was examined for working respondents by using logistic regressions controlling for sociodemographic characteristics, region, and occupation. Thirty-one percent of respondents experienced chronic work stress either alone or in combination with a chronic physical condition, a psychiatric disorder, or both. Forty-six percent reported at least one chronic physical condition either alone or in combination. Finally, 11% had a psychiatric disorder. Compared with the group with none of the factors, those with an increasing number of combined conditions had increasing odds of disability after the analysis controlled for sociodemographic characteristics, occupation, and region. The presence of chronic work stress seems to amplify effects of psychiatric disorders and chronic physical conditions on disability. In addition, psychiatric disorders co-occurring with physical illness seem to be associated with significantly higher odds of disability.


Codon usage bias in phylum Actinobacteria: relevance to environmental adaptation and host pathogenicity.
Actinobacteria are Gram-positive bacteria commonly found in soil, freshwater and marine ecosystems. In this investigation, bias in codon usages of ninety actinobacterial genomes was analyzed by estimating different indices of codon bias such as Nc (effective number of codons), SCUO (synonymous codon usage order), RSCU (relative synonymous codon usage), as well as sequence patterns of codon contexts. The results revealed several characteristic features of codon usage in Actinobacteria, as follows: 1) C- or G-ending codons are used frequently in comparison with A- and U ending codons; 2) there is a direct relationship of GC content with use of specific amino acids such as alanine, proline and glycine; 3) there is an inverse relationship between GC content and Nc estimates, 4) there is low SCUO value (<0.5) for most genes; and 5) GCC-GCC, GCC-GGC, GCC-GAG and CUC-GAC are the frequent context sequences among codons. This study highlights the fact that: 1) in Actinobacteria, extreme GC content and codon bias are driven by mutation rather than natural selection; (2) traits like aerobicity are associated with effective natural selection and therefore low GC content and low codon bias, demonstrating the role of both mutational bias and translational selection in shaping the habitat and phenotype of actinobacterial species.


Paraproteinemic neuropathies.
The occurrence of a peripheral neuropathy (PN) in association with a monoclonal gammopathy is quite common and suggests that monoclonal proteins may play a pathogenetic role in peripheral nervous system damage. In fact, paraproteinemic PN constitute an heterogeneous group of disorders related to various pathogenetic factors, and the histopathologic features in peripheral nerve biopsies differ from one condition to another. In several well defined disorders, the responsibility of the monoclonal component in the development of the PN has been evidenced. This is the case for most of the PN associated with an IgM monoclonal gammopathy, either a monoclonal gammopathy of undetermined significance (MGUS) or Waldenstrom's macroglobulinemia. The responsibility of the monoclonal protein in the occurrence of amyloid neuropathy related to multiple myeloma is also recognized. However, most IgG or IgA MGUS, as well as the monoclonal component in POEMS syndrome, have an uncertain causal relationship with the neuropathy. PN associated with monoclonal cryoglobulin (type 1) are occasional and differ from those associated with mixed cryoglobulins (types 2 or 3).


Atopic dermatitis in Italian children: evaluation of its economic impact.
The aim of our study was to evaluate the economic impact of atopic dermatitis (AD) on the family of young children affected by the disease in Italy. Thirty-three families of young children affected by AD were asked to fill in a questionnaire about financial costs associated with providing health care during the past year for their child affected by AD. For each child AD severity was evaluated by using the SCORAD index. By analyzing the questionnaire, an annual average cost of 1254euro (about U.S. $1540) for each family was determined. Main expenses concern the use of moisturizing therapies, particular detergent, and private specialist consultations. Annual family average cost was lower for children with mild AD compared with those with moderate to severe AD. AD has a deep impact on the family budget, with an increasing cost in proportion to the increasing severity of the disease. These data support previous reports suggesting that the management of AD in children is complex and costly, altering the quality of life of children and their families.


Updating Medicare's physician fees: the sustainable growth rate methodology.
Medicare's method to annually update the fees it pays physicians has been under fire for some time--specifically, since the method determined that physician fees should be reduced rather than increased. The update method, called the sustainable growth rate (SGR), was implemented to control the growth in Medicare physician spending. Yet Congress, in response to physician concerns about beneficiary access to care, has acted to avert physician fee cuts since 2003. Although this signals dissatisfaction with the SGR methodology, there is yet to be a widely accepted physician fee update proposal that balances federal budgetary realities with the need to ensure beneficiary access. And the cost of changing the update method continues to mount, adding to the difficulties of developing a solution that meets the needs of all stakeholders. This issue brief describes the SGR methodology, the reasons why projected physician fee updates are negative, and some options that have been proposed to remedy the current situation. This issue brief is the second of two related papers on physician spending and Medicare's sustainable growth rate methodology. The companion paper was published on October 9, 2006 (see Issue Brief 815, available at www.nhpf.org/pdfs_ib/IB815_PhysicianSpending_10-09-06.pdf).


Attenuating CV risk factors in patients with diabetes: clinical evidence to clinical practice.
Individuals with diabetes are at high risk of cardiovascular (CV) disease, a risk that is significantly greater in the presence of traditional CV risk factors (hyperlipidaemia, hypertension, prothrombotic state). Glucose control and management of these risk factors decreases but does not eliminate CV events, reflecting the complexity of atherosclerosis. Novel risk factors (C-reactive protein, lipoprotein a, homocysteine, and endothelial dysfunction) have been proposed and are potentially modifiable. However, clinical trials data are not yet available to guide therapy. At this time, no single agent can achieve adequate risk reduction in patients with diabetes. Even with the use of multiple agents and classes of agents to manage CV risk, 75% of patients with diabetes are expected to die from CV causes. Despite the recent advances in primary and secondary prevention of CV events, new approaches are needed. Data from the Heart Outcomes Prevention Evaluation (HOPE) trial demonstrated that CV risk can be further reduced by the addition of the ACE inhibitor ramipril to the existing treatment regimen of high-risk patients with diabetes.


Corneal response to orthokeratology.
The technique of orthokeratology produces a corneal response to the mechanical pressures exerted by rigid contact lenses. This paper reports a study which investigated the topographic and pachometric corneal changes induced by orthokeratology. Six young myopic subjects (11 eyes) wore "accelerated orthokeratology" lenses (OK-74; Contex Inc., Sherman Oaks, CA) in a high Dk material (AirPerm; Dk = 88) for 28 days. Corneal and epithelial thickness were measured topographically using the Holden-Payor optical micropachometer, and corneal topography was monitored using the EyeSys system. Refractive error change reached 1.71 +/- 0.59 D reduction in myopia after 28 days. After 1 day of lens wear, statistically significant central corneal flattening was noted, which progressed to reach 0.22 +/- 0.07 mm (1.19 +/- 0.38 D) at 28 days. A trend toward central epithelial thinning was apparent, reaching statistical significance on day 28 (7.1 +/- 7.1 microm; 9.6%). Midperipheral corneal thickening was also found approximately 2.5 mm from the corneal center, which was statistically significant by day 14 (13.0 +/- 11.1 microm; 2.4%). Calculations using Munnerlyn's formula indicate that changes in corneal sagittal height based on topographical thickness changes across the flattened central 5.25-mm zone can account for the refractive changes observed. These findings suggest that the initial corneal response to orthokeratology may be explained by redistribution of corneal tissue, rather than by overall bending of the cornea.


Variables affecting proper system grounding for radiofrequency ablation in an animal model.
The authors sought to determine which factors contribute to excessive thermal deposition and burns at the grounding pad site after high-current percutaneous, image-guided radiofrequency (RF) ablation. Radiofrequency (1,000-2,000 mA) was applied for 10 minutes with use of an internally-cooled electrode placed into in vivo pig livers (n = 88). In separate experiments, the number of pads (1, 2, or 4), orientation of pads (horizontal, vertical, or diagonal), and distance between the pads and the electrode (10-50 cm) of mesh or foil grounding pads (12.5 x 8 cm; 100 cm2) were varied. Thermistors measured skin surface temperatures during ablation. Pathologic analysis of skin changes was performed. Temperature elevations at the grounding pad were observed for every trial, with a temperature elevation > or =12 degrees C (as high as 45 degrees C) observed in 60 of 88 trials (68.2%). Temperatures at the grounding site pad were dependent on all variables studied, including the grounding pad surface area, the amount of current deposited in the liver, the orientation of the pad, and the pad's distance from the electrode. Second-degree burns were seen with temperatures exceeding 47 degrees C and third-degree burns were observed when a temperature > or = 52 degrees C was noted. For a given set of RF parameters, reduced heating was observed for trials in which foil grounding pads were used (P < .001). Grounding pad burns did not occur at 2,000 mA (maximum generator output) when four foil pads were placed horizontally > or = 25 cm from the electrode. High-current RF ablation can induce severe burns at the grounding pad site if inadequate precautions are taken. To minimize the risk of burns, multiple large-surface-area foil pads should be placed on well-prepared skin and oriented with the longest surface edge facing the RF electrode.


Knee efforts and weight-bearing asymmetry during sit-to-stand tasks in individuals with hemiparesis and healthy controls.
The asymmetrical weight-bearing distribution of individuals with hemiparesis rising from a chair might be used to produce similar muscular efforts at the lower limbs. The aim of this study was to determine if individuals with hemiparesis have symmetrical levels of effort at the knee during spontaneous sit-to-stand transfers. Nineteen subjects with hemiparesis and 16 healthy controls participated. Their weight-bearing (WB) distribution during sit-to-stand was assessed with a force platform setup while the knee effort distribution was quantified using electromyographic (EMG) data normalized to maximal EMG values then expressed relative to the sum of the bilateral efforts. The healthy individuals presented symmetrical weight-bearing and knee effort distributions during the sit-to-stand transfer. The participants with hemiparesis, classified in three subgroups based on knee extensors' strength asymmetries (mild, moderate and severe), yielded different results. The mild group (n = 6) behaved like the controls, with almost symmetrical WB and knee efforts. The moderate group (n = 7) had similar WB and effort asymmetries while the severe group (n = 6) exhibited a WB distribution difference between sides but had almost symmetrical knee effort. These results for the severe group suggest that a control is exerted on the levels of effort when rising from a chair, which might be required when a certain threshold of effort is reached on the nonparetic side.


Laparoscopic gastric devascularization and splenectomy for sclerotherapy-resistant esophagogastric varices with hypersplenism.
The combination of sclerotherapy with surgical salvage for sclerotherapy-resistant esophagogastric varices has recently received much attention, however, the longterm results after such an operation have yet to be reported. This is a preliminary report of a laparoscopic adaptation of a previously described surgical procedure for the treatment of refractory esophagogastric varices. Laparoscopic gastric devascularization and splenectomy (Hassab's operation) was successfully performed to treat recurrent sclerotherapy-resistant giant esophageal varices (n=4) and recurrent rebleeding gastric varices (n=6). The patients included 8 men and 2 women who ranged in age from 35 to 67 years (average, 54.2 years). The procedure and clinical results were evaluated from various viewpoints. The duration of the operation ranged from 200 to 400 minutes (mean+/-standard deviation; 287.5+/-66.0 minutes) and blood loss from 10 to 1,500 mL (average, 515.5+/-507.9 mL). The weight of the spleen ranged from 500 to 850 g (average 608.0+/-126.6 g). Conversion to minimal open operation with a gasless lifting method was done in 1 patient because of uncontrolled bleeding from the splenic vein. There were no other major complications either intraoperatively or postoperatively. All patients had hypersplenism; preoperative platelet counts ranged from 1.6 to 6.8 x 10(4)/microL (average, 4.5+/-2.7 x 10(4) microL) and the postoperative count was from 5.9 to 36.0 x 10(4)/microL (average, 21.7+/-11.5 x 10(4) microL). Postoperative endoscopy revealed that varices disappeared, and no patient had recurrence of the varices after operation during the mean followup period of 12.8+/-4.1 months (average, 8 to 20 months). The combination of laparoscopic gastric devascularization and splenectomy for sclerotherapy-resistant esophagogastric varices is considered a feasible and relatively safe surgical method for patients with hypersplenism.


Characterization of immune response against Mycobacterium marinum infection in the main hematopoietic organ of adult zebrafish (Danio rerio).
Tuberculosis remains a major global health challenge. To gain information about genes important for defense against tuberculosis, we used a well-established tuberculosis model; Mycobacterium marinum infection in adult zebrafish. To characterize the immunological response to mycobacterial infection at 14 days post infection, we performed a whole-genome level transcriptome analysis using cells from kidney, the main hematopoietic organ of adult zebrafish. Among the upregulated genes, those associated with immune signaling and regulation formed the largest category, whereas the largest group of downregulated genes had a metabolic role. We also performed a forward genetic screen in adult zebrafish and identified a fish line with severely impaired survival during chronic mycobacterial infection. Based on transcriptome analysis, these fish have decreased expression of several immunological genes. Taken together, these results give new information about the genes involved in the defense against mycobacterial infection in zebrafish.


Ovarian carbonyl reductase delayed onset of persistent estrus in the offspring of parathyroidectomized mother rats.
We investigated the effects of maternal parathyroidectomy on day 5 of pregnancy on the ovarian carbonyl reductase (CR) in the offspring of rats. Changes in the ovarian CR of the offspring were examined at 4 and 8 months of age. In 8-month-old female offspring, the ovarian weight and the ovarian CR activity were significantly higher in rats from parathyroidectomized mothers than in rats from sham-operated mothers, and the offspring of the parathyroidectomized mothers showed the regular 4-day estrous cycles at 8 months of age, while the offspring of the sham-operated mothers were in the state of persistent estrus. Furthermore, intense immunostaining was found in the theca interna cells and the interstitial gland cells in the ovary of rats from the parathyroidectomized mothers, whereas in the ovary of the age-matched normal rats, immunostaining was faint. These results suggest that the maternal parathyroidectomy affect the activity and localization of CR in the ovary of female offspring.


Social support, job strain and musculoskeletal pain among female health care personnel.
This study explored the relationship between psychosocial work environment and the musculoskeletal pain among health care personnel. Ninety registered nurses and nurse's aides working in different hospitals in or just outside Stockholm and working in different kinds of care constituted the study group. Data were collected by means of questionnaires, including questions about symptoms (low-back pain, pain in the neck, and pain in the shoulders), the perception of social support from co-workers and superiors, conflicts, feelings of isolation, poor relations with superiors, psychological demands, authority over decisions, and skill utilization (job-strain factors). An ordinal univariate logistic regression analysis showed that psychological demands, authority over decisions, skill utilization, and support at work had a statistically significant effect on symptoms from the lower back, while symptoms from the neck and shoulders were related to support a work only. When support at work and job strain were entered into a multivariate logistic regression model, a difference in the patterns of associations between low-back pain and symptoms from the neck and shoulders was found. Symptoms from the back were significantly related to job strain--the higher the strain, the more symptoms in the low back. Symptoms from the neck and shoulders on the other hand were more associated with social support at work--the lower the support score the more severe the symptoms. Low-back pain seemed to be related to job strain, while symptoms from the neck and shoulders were to a greater extent related to relational and emotional factors.


New insights into the Rh superfamily of genes and proteins in erythroid cells and nonerythroid tissues.
The past decade has seen extensive studies of the erythrocyte Rh30 polypeptides and Rh-associated glycoprotein, which specify the clinically important Rh blood group system. Here we consider recent advances on these and other Rh homologues in the context of gene organization, molecular evolution, tissue-specific expression, protein structure, and potential biological functions. The Rh family is now known to contain a large number of homologues that form a unique branch in the eucarya life domain. The ancient origin and broad distribution imply central roles for the various Rh proteins in maintaining normal cellular and organismal homeostatic conditions. Rh homologues occur in the form of multiple chromosomal loci in mice and humans, but as single-copy genes in unicellular organisms (e.g., green alga and slime mold). While primitive Rh genes vary largely in exon/intron design, the mammalian Rh homologues bear a similar genomic organization. Sequence comparisons have revealed the signatures and a consensus 12-transmembrane fold characteristic of the Rh family. Phylogenetic analysis has placed all Rh homologues as a related cluster that intercepts ammonium transporter (Amt) clusters, indicating an intimate evolutionary and structural relationship between the Rh and Amt families. The biochemical identification and epithelial expression of RhBG and RhCG orthologues in mammalian kidney, liver, skin, testis, and brain suggest that they serve as transporters likely participating in ammonia homeostasis. Further inquires into the structure, function, biosynthesis, and interaction of Rh proteins will shed new light on ammonia homeostasis in a wide range of human physiological and pathological states.


Human herpesvirus 8 and Epstein-Barr virus coinfection in localized Castleman disease during pregnancy.
Castleman's disease is a rare disorder characterized by two distinct entities with similar histology but different time course and therapeutic response. Multicentric plasma cell variant is highly associated with infection by human herpesvirus 8 (HHV-8), but the pathogenesis of the hyaline vascular variant is currently unknown. We report a pregnant patient who develops a localized axillary hyaline-type Castleman's disease in which HHV-8 DNA sequences were detected in the lymph node lesions by nested PCR. In addition, the PCR multiplex also showed positivity for EBV. Immunohistochemical studies confirmed the presence of both viruses. Our results provide the first evidence of the presence of HHV-8 and EBV sequences in localized Castleman's disease, suggesting a possible role of the association of these herpes virus in the pathogenesis of this type of disorder. This case highlights that searching for HHV-8 and EBV sequences in cases of localized Castleman's disease is strongly advised.


Exploring the osteoarthritis-related genes by gene expression analysis.
Osteoarthritis (OA) is a most common chronic degenerative joint lesion, which affects both cartilage and bone. A better understanding of the gene expression profiling of OA may help understanding the pathogenesis of OA and finding the therapy targets for OA treatment. GSE8077 was downloaded from Gene Expression Omnibus (GEO) including 5 OA rats induced by anterior cruciate ligament transection and partial medial meniscectomy and 5 rats that were performed sham surgery as control. Differentially expressed genes (DEGs) between OA group and control group were identified by t-test with p < 0.05 and the coding genes that transcription factors corresponded were screened by TRANSFAC. Then Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis for DEGs and transcription factors were performed. The DEGs and transcription factors were integrated with information from STRING database to construct PPI network. A total of 119 up-regulated genes, 39 down-regulated genes and 9 transcription factors were identified in OA sample. The GO enrichment analysis showed that 119 up-regulated genes were significantly enriched in blood vessel development and KEGG pathway enrichment showed that genes were involved in circadian rhythm pathway. In the PPI network, Cd44, Mmp13, Timp1 and Igf1 showed higher degrees. The screened genes could provide a new and comprehensive view for treatment of OA.


Psychogenic or dissociative fugue: a clinical investigation of five cases.
Dissociative fugue (formerly psychogenic fugue) is a rare and little understood dissociative disorder. Following a review of the pertinent literature, five cases of dissociative fugue are described. These cases were systematically studied with a comprehensive history, mental status examination, physical and neurological evaluation, review of previous medical and psychiatric records, and psychological testing including MMPI, WAIS-R, electroencephalogram, and Dissociative Experiences Scale. An unexpected finding was that, in some cases, associated criminal activity may allow the person with dissociative fugue to continue to function in spite of their loss of memory and original identity.


Increased levels of oxidants and reduced antioxidants in semen of infertile men with varicocele.
Significantly higher levels of oxidants (malonaldehyde and nitric oxide) and reduced levels of antioxidants (superoxide dismutase, glutathione peroxidase, catalase, and ascorbic acid) are seen in semen of infertile men with varicocele. Seminal oxidative stress (OS) seen in men with varicocele is associated with sperm motility and grade of varicocele.


The place of psychodynamic psychotherapy in the integrated treatment of posttraumatic stress disorder and trauma recovery.
Psychodynamic psychotherapists treating posttraumatic stress disorder (PTSD) sufferers can draw on an accumulated body of trauma studies from their own field to guide their work. However, these reports, often based on case studies or conceptual reviews, do not have the same empirical conclusiveness as more recent evidence-based research demonstrating the efficacy of cognitive-behavioral and body-oriented therapies. In this article, a psychodynamic psychotherapist reflects on his treatment of an Israeli man who developed PTSD after enduring 4 terrorist attacks. The author shows how assimilative integration offered him a theory- and research-based model that helped him comfortably combine separate treatment interventions. He also shows how this model helped him locate with some precision the specific contribution of psychodynamic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved).


Variational studies and replica symmetry breaking in the generalization problem of the binary perceptron
We analyze the average performance of a general class of learning algorithms for the nondeterministic polynomial time complete problem of rule extraction by a binary perceptron. The examples are generated by a rule implemented by a teacher network of similar architecture. A variational approach is used in trying to identify the potential energy that leads to the largest generalization in the thermodynamic limit. We restrict our search to algorithms that always satisfy the binary constraints. A replica symmetric ansatz leads to a learning algorithm which presents a phase transition in violation of an information theoretical bound. Stability analysis shows that this is due to a failure of the replica symmetric ansatz and the first step of replica symmetry breaking (RSB) is studied. The variational method does not determine a unique potential but it allows construction of a class with a unique minimum within each first order valley. Members of this class improve on the performance of Gibbs algorithm but fail to reach the Bayesian limit in the low generalization phase. They even fail to reach the performance of the best binary, an optimal clipping of the barycenter of version space. We find a trade-off between a good low performance and early onset of perfect generalization. Although the RSB may be locally stable we discuss the possibility that it fails to be the correct saddle point globally.


TAF1 interacts with and modulates human papillomavirus 16 E2-dependent transcriptional regulation.
High-risk human papillomavirus (HPV) infection is the main etiological factor in the development of cervical cancer and viral type 16 is the most frequently found in this neoplasia. The E2 protein plays a key role in viral DNA replication, transcription and genome maintenance. E2 is a sequence-specific DNA-binding protein that activates or represses the transcriptional activity of promoters depending on the distance from the E2-binding sites to the TATA box. The transactivation properties of E2 are modulated by the interaction with several cellular factors that regulate the recruitment of transcription factor IID. Here, we demonstrate by pull-down assays the in vitro interaction of HPV16 E2 and TAF1. The domain of TAF1 necessary for the binding maps into its amino region, while the carboxy-terminal DNA-binding domain and the transactivation domain of the E2 protein are involved in the interaction. By transient cotransfection assays on C-33 A cells, we demonstrated that TAF1 enhances the activation of an E2-dependent artificial promoter while overexpression of TAF1 alleviates the E2-dependent repression of a high-risk HPV long control region. The specific modification of the transcriptional activity of both promoters by TAF1 suggests that the interaction between these proteins could participate in the modulation of the transregulatory properties of E2, with important biological consequences.


Developing scientific confidence in HTS-derived prediction models: lessons learned from an endocrine case study.
High throughput (HTS) and high content (HCS) screening methods show great promise in changing how hazard and risk assessments are undertaken, but scientific confidence in such methods and associated prediction models needs to be established prior to regulatory use. Using a case study of HTS-derived models for predicting in vivo androgen (A), estrogen (E), thyroid (T) and steroidogenesis (S) endpoints in endocrine screening assays, we compare classification (fitting) models to cross validation (prediction) models. The more robust cross validation models (based on a set of endocrine ToxCast™ assays and guideline in vivo endocrine screening studies) have balanced accuracies from 79% to 85% for A and E, but only 23% to 50% for T and S. Thus, for E and A, HTS results appear promising for initial use in setting priorities for endocrine screening. However, continued research is needed to expand the domain of applicability and to develop more robust HTS/HCS-based prediction models prior to their use in other regulatory applications. Based on the lessons learned, we propose a framework for documenting scientific confidence in HTS assays and the prediction models derived therefrom. The documentation, transparency and the scientific rigor involved in addressing the elements in the proposed Scientific Confidence Framework could aid in discussions and decisions about the prediction accuracy needed for different applications.


Coupled-mode theory for stimulated Raman scattering in high-Q/V(m) silicon photonic band gap defect cavity lasers.
We demonstrate the dynamics of stimulated Raman scattering in designed high-Q/V(m) silicon photonic band gap nanocavities through the coupled-mode theory framework towards optically-pumped silicon lasing. The interplay of other chi((3)) effects such as two-photon absorption and optical Kerr, related free-carrier dynamics, thermal effects, as well as linear losses such as cavity radiation and linear material absorption are included and investigated numerically. Our results clarify the relative contributions and evolution of the mechanisms, and demonstrate the lasing and shutdown thresholds. Our studies illustrate the conditions for continuous-wave and pulsed highly-efficient Raman frequency conversion to be practically realized in monolithic silicon high-Q/V(m) photonic band gap defect cavities.


Loss of the Protein Cystathionine β-Synthase During Kidney Injury Promotes Renal Tubulointerstitial Fibrosis.
Renal tubulointerstitial fibrosis (TIF) is the common pathway of progressive chronic kidney disease. Inflammation has been widely accepted as the major driving force of TIF. Cystathionine β-synthase (CBS) is the first and rate-limiting enzyme in the transsulfuration pathway. CBS is considered to play protective role in liver and pulmonary fibrosis, but its role in TIF remains unknown. The purpose of this study was to investigate the potential role and mechanism of CBS in renal inflammation and TIF. Renal function, tubulointerstitium damage index score, extracellular matrix (ECM) deposition, and the expressions of collagen I, collagen III, fibronectin, CD3, CD68, IL-1β, TNF-α were measured in sham operation and unilateral ureteral obstruction (UUO) rats. Proteomics and gene array analysis were performed to screen differentially expressed molecules in the development of renal inflammation and TIF in UUO rats. The expression of CBS was detected in patients with obstructive nephropathy and UUO rats. We confirmed the expression of CBS using western blot and real-time PCR in HK-2 cells. Overexpression plasmid and siRNA were transfected specifically to study the possible function of CBS in HK-2 cells. Abundant expression of CBS, localized in renal tubular epithelial cells, was revealed in human and rat renal tissue, which correlated negatively with the progression of fibrotic disease. Expression of CBS was dramatically decreased in the obstructed kidney from UUO rats as compared with the sham group (SHM). In addition, knocking down CBS exacerbated extracellular matrix (ECM) deposition, whereas CBS overexpression attenuated TGF-β1-induced ECM deposition in vitro. Inflammatory and chemotactic factors were also increased in CBS knockdown HK-2 cells stimulated by IL-1β. These findings establish CBS as a novel inhibitor in renal fibrosis and as a new therapeutic target in patients with chronic kidney disease.


Physician scientist research pathway leading to certification by the American Board of Pathology.
In 2014, the American Board of Pathology, in response to the pathology community, approved a physician scientist research pathway (PSRP). This brief report summarizes the history of and objectives for creating the physician scientist research pathway and the requirements of the American Board of Pathology for the certification of physician scientist research pathway trainees.


Successful closed reduction of refractured wrist with a bent volar distal radius plate.
A case is presented of a 78-year-old woman who sustained a re-fracture of the distal radius after initial fixation with a volar locking plate. The fracture was located in the mid-portion of the volar plate with palmar apex bending of the plate and signs of median nerve compression. A successful closed reduction was performed without hardware failure. The fracture united uneventfully.


When three is less than two: early developments in children's understanding of fractional quantities.
Four experiments examined young children's understanding of the inverse relation between the number of parts into which a quantity is to be divided and the size of each part. In Experiment 1 5-, 6-, and 7-year-old children tended to judge, incorrectly, that bigger shares would result from sharing with more, rather than fewer, recipients. In Experiment 2, 5-year-olds correctly recognized the inverse effect of additional recipients when the sharing was based on subtraction rather than on equal partitioning. In Experiment 3, a modification of the equal-sharing task from Experiment 1 designed to reduce cognitive complexity successfully elicited correct performance from 7-year-olds but not from 5-year-olds. However, 5-year-olds markedly improved when they were given a chance to compare the outcomes of sharing with different numbers of recipients. Experiment 4 corroborated and extended this evidence of learning.


Regulation of the alkaloid biosynthesis by miRNA in opium poppy.
Opium poppy (Papaver somniferum) is an important medicinal plant producing benzylisoquinoline alkaloids (BIA). MicroRNAs (miRNAs) are endogenous small RNAs (sRNAs) of approximately 21 nucleotides. They are noncoding, but regulate gene expression in eukaryotes. Although many studies have been conducted on the identification and functions of plant miRNA, scarce researches on miRNA regulation of alkaloid biosynthesis have been reported. In this study, a total of 316 conserved and 11 novel miRNAs were identified in opium poppy using second-generation sequencing and direct cloning. Tissue-specific regulation of miRNA expression was comparatively analysed by miRNA microarray assays. A total of 232 miRNAs were found to be differentially expressed among four tissues. Likewise, 1469 target transcripts were detected using in silico and experimental approaches. The Kyoto Encyclopedia of Genes and Genomes pathway analyses indicated that miRNA putatively regulates carbohydrate metabolism and genetic-information processing. Additionally, miRNA target transcripts were mostly involved in response to stress against various factors and secondary-metabolite biosynthesis processes. Target transcript identification analyses revealed that some of the miRNAs might be involved in BIA biosynthesis, such as pso-miR13, pso-miR2161 and pso-miR408. Additionally, three putatively mature miRNA sequences were predicted to be targeting BIA-biosynthesis genes.


[Deproteinization of the influenza virus by infected cells at 4 degrees C].
The process of influenza virus deproteinization was compared in two systems: chick fibroblasts infected with fowl plague virus (FPV) and MDCK cells infected with WSN virus. The cells were infected with 3H-uridine-labeled viruses. Deproteinization of virus structures was studied at 4 degrees C and after incubation of virus-infected cells at 37 degrees C. At 4 degrees C, the bulk of radioactivity of the original virus was found in the perinuclear cytoplasm (the fraction obtained by treatment of triton X-100-purified nuclei with 0.1 M citric acid) and much less radioactivity was found in the nucleus. After incubation at 37 degrees C the level of radioactivity in the nucleus increased and reached or even exceeded that in the perinuclear cytoplasm. A biophysical analysis of the structures showed the perinuclear cytoplasm to contain subviral particles (SVP) similar to nucleoids as well as RNP with a buoyant density of 1.35 g/ml in cesium chloride. The nuclear extract contained RNP with a buoyant density 1.39-1.41 m/ml. The experimental results indicate that the first stage of deproteinization of virus particles to SVP occurs at 4 degrees C. The second stage of deproteinization, to RNP with a buoyant density 1.35 g/ml, also occurs at a low temperature.


Nerve growth factor (NGF) loop 4 dimeric mimetics activate ERK and AKT and promote NGF-like neurotrophic effects.
Previous work indicating that nerve growth factor (NGF) protein loops 2 and 4 interact with TrkA receptors raise the possibility that small molecule mimetics corresponding to TrkA-interacting domains that have NGF agonist activity can be developed. We applied our previously developed strategy of dimeric peptidomimetics to address the hypothesis that loop 4 small molecule dimeric mimetics would activate TrkA-related signal transduction and mimic NGF neurotrophic effects in a structure-specific manner. A loop 4 cyclized peptide dimer demonstrated NGF-like neurotrophic activity, whereas peptides with scrambled sequence, added or substituted residues, or cyclized in monomeric form were inactive. Activity was blocked by the TrkA inhibitors K252a and AG879 but not by NGF p75 receptor blocking antibody. Dimeric, but not monomeric, peptides partially blocked NGF activity. This profile was consistent with that of a NGF partial agonist. ERK and AKT phosphorylation was stimulated only by biologically active peptides and was blocked by K252a. The ERK inhibitor U0126 blocked the neurite- but not the survival-promoting activity of both NGF and active peptide. These studies support the proof of concept that small molecule NGF loop 4 mimetics can activate NGF signaling pathways and can mimic death-preventing and neurite-promoting effects of NGF. This finding will guide the rational design of NGF single-domain mimetics and contribute to elucidating NGF signal transduction mechanisms.


A hypothetical explanation of saccadic oscillations.
Eye movements in a patient with saccadic oscillations (ocular flutter) were recorded and analyzed. Findings were related to recent microelectrode studies in the monkey pontine reticular formation which have identified three types of premotor neurons related to saccadic eye movements: burst, tonic, and pause cells. We incorporated these cell types into a hypothetical circuit that generates saccades by rapidly driving the eye to a designated orbital position rather than preprogramming a distance for movement. Physiological measurements suggest that this neural network is unstable and that the burst neurons must be tonically inhibited to prevent saccadic oscillations during periods of fixation. Pause cells, which discharge tonically except during saccades, when they pause, appear to inhibit burst cells and prevent such saccadic oscillations. Analysis of our patient's behavior indicates that many types of saccadic oscillations can be explained and classified by assuming an abnormality of pause cell control over saccadic burst neurons.


The effect of pars plan vitrectomy on oxygen saturation in retinal vessels--a pilot study.
To determine the effect of pars plana vitrectomy (PPV) on oxygen saturation in retinal vessels. We performed a prospective consecutive interventional case series of 20 eyes of 20 patients with macular hole or epiretinal membrane. We performed automatic retinal oximetry (Oxymap Inc., Reykjavik, Iceland) in each patient 24 hr prior to and 45 days (range 42-49) after PPV (classic 20G or sutureless 23G). We analysed oxygen saturations in retinal arteries and veins. Vessel segments of first or second degree were selected. The same segment was analysed before and after PPV. Oximetry data were compared by paired two-tailed t-test. Pars plana vitrectomy did not alter arterial haemoglobin saturation with oxygen (98±2% prior to the surgery and 98±3% after the procedure, p=0.549). The mean venous haemoglobin saturation with oxygen increased after vitrectomy from 63±10% to 66±8% (p=0.012). Oxygen saturation is higher in retinal veins after pars plana vitrectomy. Further studies are needed to unveil the mechanism of how vitrectomy affects oxygen metabolism in the retina.


Exercise enhances the maintenance of smoking cessation in women.
We examined the effects of physical exercise on smoking relapse. Twenty previously sedentary female smokers were randomly assigned to smoking cessation plus exercise or smoking cessation with frequency contact control. The smoking cessation program included 12 professionally led sessions over 12 weeks. Exercise treatment included three supervised exercise sessions per week for 15 weeks. Contact control included three women's health/wellness lectures per week for 15 weeks. Smoking abstinence was validated by carbon monoxide and saliva cotinine. Mean exercise attendance for exercise subjects was 88% with an increase in estimated VO2 of 25%. The percentage of subjects who quit for 24 hours was 80% for the exercise and 90% for the contact group. One subject in the contact group remained abstinent at the end of the 12-week treatment and at 1-, 3-, and 12-month follow-ups, whereas three subjects in the exercise group were abstinent at these time points. These results suggest that exercise training improves short-term quit rates and may prove a useful strategy for long-term maintenance of smoking cessation.


The technological imperative in tuberculosis care and prevention in Vietnam.
A monocausal bacteriological understanding of infectious disease orients tuberculosis control efforts towards antimicrobial interventions. A bias towards technological solutions can leave multistranded public health and social interventions largely neglected. In the context of globalising biomedical approaches to infectious disease control, this ethnography-inspired review article reflects upon the implementation of rapid diagnostic technology in low- and middle-income countries. Fieldwork observations in Vietnam provided a stimulus for a critical review of the global rollout of tuberculosis diagnostic technology. To address local needs in tuberculosis control, health managers in resource-poor settings are readily cooperating with international donors to deploy novel diagnostic technologies throughout national tuberculosis programme facilities. Increasing investment in new diagnostic technologies is predicated on the supposition that these interventions will ameliorate disease outcomes. However, suboptimal treatment control persists even when accurate diagnostic technologies are available, suggesting that promotion of singular technological solutions can distract from addressing systemic change, without which disease susceptibility, propagation of infection, detection gaps, diagnostic delays, and treatment shortfalls persist.


Age- and site-related bone mineral densities in Korean women with a distal radius fracture compared with the reference Korean female population.
To assess age- and site-related bone mineral density (BMD) values in Korean female patients with a distal radius fracture, and to compare them with those of the community-based general Korean female population. For this study, we recruited 54 consecutive Korean women, 50 to 79 years of age, with a distal radius fracture caused by minor trauma. We performed dual-energy x-ray absorptiometry scans at central sites: the lumbar spine, femoral neck, trochanter, and Ward's triangle, which is a triangular area within the femoral neck. Age- and site-related BMDs were assessed and compared with those of population-based reference data for Korean women. The overall prevalence (defined as meeting the osteoporosis criteria in at least one of the earlier-described measurement areas) of osteoporosis in patients with a distal radius fracture was 57%. The site-related prevalence was 54% at Ward's triangle, 43% at the lumbar spine, 32% at the femoral neck, and 26% at the trochanter, and these values were individually statistically significantly higher than those of the general Korean female population except for the lumbar spine. In patients 50 to 59 and 70 to 79 years of age, patients' mean BMD values at the hip were statistically significantly lower than those of the reference female population of corresponding age groups, but the hip BMD differences were not statistically significant in patients 60 to 69 years of age. There were no statistically significant BMD differences measured at the lumbar spine in any age group. Korean female patients with a distal radius fracture, 50 to 59 and 70 to 79 years of age, had lower BMDs at the hip than the reference Korean female population. However, no statistically significant BMD differences were found in those 60 to 69 years of age. Low BMD may have a greater impact on distal radius fracture in women younger than 60 years of age or over 70 years of age. Considering the young onset of bone loss, patients younger than 60 years of age with a distal radius fracture are a good target group for secondary prevention of osteoporosis.


[Learning difficulties in mathematics in children with attention deficit hyperactivity disorder].
Attention deficit hyperactivity disorder (ADHD) and learning difficulties are two diagnostic categories of great social importance and impact, and which are associated in around 25-35% of cases. One explanation offered by researchers to account for this overlap is a deficit in executive functioning (EF). 1) To compare EF and applied mathematical knowledge in children with ADHD, difficulties in learning mathematics (DLM) or ADHD + DLM, and to identify the deficiencies they experience. 2) To verify whether the phenotype hypothesis is fulfilled in the case of the ADHD + DLM condition. The study involved a quasi-experimental 2 x 2 design, with a sample made up of 78 participants (6-13 years old) who were divided into four groups: ADHD (n = 33), DLM (n = 15), ADHD + DLM (n = 15) and a control group (n = 15). Tests aimed at evaluating different cognitive processes as well as applied mathematical knowledge were administered: inhibitory control (go/no go); verbal working (backward digit-recall and counting memory task) and temporal-visual-spatial memory; short-term memory (direct digit-recall); attention (CPT); calculation speed (Canals) and real-life problems. Taking the variables age, gender and intelligence quotient as covariables, results showed that the three groups with problems displayed a deficit of attention and in working memory; the DLM group stood out from the other owing to the presence of a specific deficiency affecting the ability to recall temporal-visual-spatial information. In contrast, deficits in inhibitory control were seen to be specific to ADHD. Finally, findings did not support the phenotype hypothesis, and it was therefore an accumulative profile.


Behavioural and neurochemical effects induced by chronic mild stress applied to two different rat strains.
Chronic mild stress (CMS) has been reported to induce an anhedonic-like state in rats that resembles some of the symptoms of endogenous depression in humans. In the present study, CMS-induced behavioural responses along with neurochemical alterations in dopaminergic and serotonergic function in prefrontal cortex, striatum, hypothalamus and hippocampus were examined following treatment with imipramine in Wistar and Sprague-Dawley rats. The CMS procedure lasted 7 weeks in total. Once per week, a 1-h preference test for 1% sucrose solution was conducted. Treatment with imipramine (10mg/kg i.p., once daily) commenced after experimental week 3. CMS induced significant reductions in absolute and relative sucrose intake and sucrose preference in both rat strains but their temporal pattern was different especially during the weeks 0-3. These effects were reversed by IMI. An increase in the dopaminergic and a decrease in the serotonergic activity were observed in the prefrontal cortex in both rat strains following CMS. A decrease in the striatal dopaminergic activity and an increased hippocampal serotonergic activity were also seen in both rat strains following CMS. In Wistar rats, dopaminergic and serotonergic activities were enhanced in the hypothalamus whereas in Sprague-Dawley rats no such stress-induced changes were observed. Notably, the clear decrease in sucrose consumption observed in stressed Wistar rats could be directly associated with a respective increase in the dopaminergic hypothalamic activity. Chronic treatment with imipramine normalized all neurochemical alterations induced by CMS. Our results suggest that a specific and regionally differentiated serotonin-dopamine interaction is directly related to the observed stress-induced anhedonia.


Cloning of rat and mouse aquaporin-2 gene promoters and identification of a negative cis-regulatory element.
The promoters of rat and mouse aquaporin-2 (AQP-2) genes were cloned and compared with that of human genes. Nucleotide identity up to -593 bp was 62%, and consensus sequences such as TATA box and adenosine 3',5'-cyclic monophosphate responsive element were conserved. Deoxyribonuclease I footprint assay revealed a footprinted region at -210 to -184 bp in rat AQP-2 gene promoter produced by nuclear extract from nonexpressing (liver) tissue. The sequence of this region included a GATA motif but otherwise showed no homology with any other previously known cis-elements. Electromobility shift assay and ultraviolet cross-linking analysis confirmed that specific binding proteins to this element were present in kidney, spleen, and liver and that these proteins were distinct from GATA factors. Both deletion and mutation of this cis-element abolished the protein DNA binding and increased promoter activity in in vitro reporter gene assay using rat cultured hepatocyte Ac2F cells, suggesting the negative regulatory role of this cis-element. These results indicate that tissue-specific expression of AQP-2 gene may in part be regulated by this novel negative acting cis-element.


Prevalence of measles antibodies in adults with HIV infection: possible risk factors of measles seronegativity.
To determine the prevalence of measles (rubeola) immunity in a group of HIV-1-infected adults and to examine predictors of measles seronegativity in this population. County hospital outpatient clinic and public-health department early HIV intervention clinic. A total of 262 HIV-infected adults presenting to outpatient clinics between September 1990 and January 1991. Patients were screened for the presence of measles immunoglobulin G antibody, as measured by an enzyme-linked immunosorbent assay (ELISA). Pertinent clinical and immunologic information was recorded. Univariate and multivariate analyses were performed to identify possible risk factors for measles seronegativity. Measles seronegativity, as defined by a lack of detectable antibody (ELISA predicted index value < 1.0). Thirteen (5%) patients lacked serologic evidence of immunity. Risk factors for measles seronegativity included year of birth in 1957 or later, Caucasian (non-Hispanic) race and oral hairy leukoplakia. Factors associated with progressive HIV disease (other than hairy leukoplakia) were not associated with a lack of existing immunity. A high prevalence (95%) of measles antibody was found in this large group of HIV-infected adults. Young, white individuals born in 1957 or later were at the greatest risk for measles seronegativity, but declining immunity due to progressive HIV infection did not appear to be associated with a lack of antibody. Self-reported histories of measles infection or immunization were not reliable predictors of measles immunity.


Intravasation of barium sulphate during roentgenography of the Colon. Case Report.
This review presents the case history of a 67-year-old man, referred to hospital with severe ulcerative colitis. Treatment at home with prednisolone enemas had had very poor results. Coloscopy revealed large proctitis ulcerations with two polyps. Pathological anatomical examination: severe colitis, probably ulcerations. Intravasation of barium sulphate into the venous system occurred during roentgenography of the colon. Cardiac arrest occurred, and irreversible brain lesions developed.