HLA associations in juvenile arthritis.
This review of the current status of HLA associations in juvenile arthritis begins with a discussion of the terms used to identify these patients and an approach for their clinical classification. The authors suggest that seven different types should be identified on the basis of clinical features and associated immunogenetic factors and that each of them should be recognized and called by a separate name. Different combinations of patients have been included in the studies performed in different cities and this fact may explain some of the observed differences in HLA associations in various reports. Results from an on-going study in Dallas are compared with published reports from Prague, Cincinnati, and Houston. HLA alleles associated with susceptibility in pauciarticular patients include certain DR and DQ alleles, one DP allele (DPB1*0201) and one HLA class I allele (HLA-A*0201). Susceptibility for polyarticular onset disease was found by the authors to be uniquely associated with DPB1*0301. Important interactions were observed between alleles at the different loci, with markedly increased odds ratios when combinations of susceptibility alleles were analyzed. The possibility that interaction between class I and class II susceptibility factors might be due to the effect of an allele at one of the TAP loci was examined by probing for polymorphic variants of the TAP1 and TAP2 genes. In addition, class I alleles associated with resistance for the development of juvenile arthritis were discussed. The main allele associated with rheumatoid arthritis (DRB1*0401) appears to be protective for the development of several forms of arthritis prevalent in children.


High levels of nitrifying bacteria in intermittently aerated reactors treating high ammonia wastewater.
Changes in the fractions of ammonia-oxidizing bacteria and nitrite-oxidizing bacteria in two laboratory-scale reactors were investigated using 16S rRNA probe hybridizations. The reactors were operated in intermittent aeration mode and different aeration cycles to treat anaerobically digested swine wastewater with ammonia concentrations up to 175 mg NH(3)-N/L. High ammonia removals (>98.8%) were achieved even with increased nitrogen loads and lower aeration: non-aeration time ratios of 1h:3h. Nitrosomonas/Nitrosococcus mobilis were the dominant ammonia-oxidizing bacteria in the reactors. Nitrospira-like organisms were the dominant nitrite-oxidizing bacteria during most of the investigation, but were occasionally outcompeted by Nitrobacter. High levels of nitrifiers were measured in the biomass of both reactors, and ammonia-oxidizing bacteria and nitrite-oxidizing bacterial levels adjusted to changing aeration: non-aeration time ratios. Theoretical ammonia-oxidizer fractions, determined by a mathematical model, were comparable to the measured values, although the measured biomass fractions were different at each stage while the theoretical values remained approximately constant. Stable ammonia removals and no nitrite accumulation were observed even when rRNA levels of ammonia oxidizers and nitrite-oxidizers reached a minimum of 7.2% and 8.6% of total rRNA, respectively. Stable nitrogen removal performance at an aeration: non-aeration ratio of 1h:3h suggests the possibility of significant savings in operational costs.


Visible-Light-Induced Intermolecular Dearomative Cyclization of 2-Bromo-1,3-dicarbonyl Compounds and Alkynes: Synthesis of Spiro[4.5]deca-1,6,9-trien-8-ones.
A visible-light-induced photocatalytic intermolecular dearomative cyclization of 2-bromo-1,3-dicarbonyl compounds and alkynes afforded biologically important spirocarbocycle structures in moderate to good yields via a 5-exo-dig radical cyclization under mild reaction conditions. A 5.0 mmol scale dearomatization reaction proceeded smoothly with 95% yield even when the catalyst loading was reduced to 0.1 mol %, suggesting that this method was suitable for large-scale synthesis.


The 5' zebrafish scl promoter targets transcription to the brain, spinal cord, and hematopoietic and endothelial progenitors.
The stem cell leukemia (SCL) gene encodes a basic helix-loop-helix transcription factor and is essential for embryonic angiogenesis, hematopoietic stem cell specification, and erythrocyte maturation. Here, we report the isolation and characterization of the zebrafish scl promoter. We show that a 5-kilobase (kb) genomic fragment immediately upstream of the translation start site is capable of targeting the enhanced green fluorescence protein (EGFP) expression to the anterior and posterior lateral mesoderm where the endogenous scl normally expresses. Detailed analysis of the stable transgenic fish reveals that this 5-kb upstream sequence is sufficient to direct the EGFP transcription to the brain, spinal cord, and hematopoietic-endothelial progenitors, possibly the hemangioblast, but not primitive erythrocyte, suggesting that the zebrafish scl transcription in hematopoietic-endothelial progenitors and erythrocyte is regulated by distinct cis element(s). Our study has defined the cis regulatory element(s) for zebrafish scl expression in the brain, spinal cord, and hematopoietic-endothelial progenitors and established a valuable transgenic line Tg(5'5kbscl:EGFP) for studying hematopoietic lineage development.


Lateral thoracic perforator flap: additional perforator flap option from the lateral thoracic region.
Perforator flaps from the lateral thoracic region have not been as popular as other donor sites because of the misconception that the vascular anatomy in this region is less than predictable. However, the skin over the lateral thoracic region is vascularised by three rows of perforators of varied vascular dominance. Two perforator flaps from this region based on the middle and the posterior row of perforators from the thoracodorsal artery have been described. The lateral thoracic perforator flap based on the anterior row of perforators is another useful option. Nine patients underwent reconstructions using the lateral thoracic perforator flap for various defects in the head and neck region and lower limbs as a result of tumour extirpation, crush injury and chronic wound with osteomyelitis. All flaps were raised in the supine position. Three flaps were raised in a chimaeric fashion. The largest flap was 20×12 cm and the mean size was 106 cm2. All flaps survived without major complication. The lateral thoracic perforator flap is a reliable reconstructive option. It can be readily configured in terms of size, thickness and tissue composition. However, it is not the first-choice flap from this region because the resultant donor scar tends to extend visibly beyond the anterior axillary fold and the arterial and venous pedicles frequently have separate courses. The lateral thoracic region has become a versatile and universal donor site for free-style flap harvest with this additional flap option.


Understanding the fibromyalgia syndrome.
The fibromyalgia syndrome (FMS) is the most frequent cause of chronic, widespread pain. This review, which is targeted at the psychiatry and psychopharmacology communities, summarizes the state-of-the-art as it relates to both the pathophysiology and treatment of FMS. Toward this end, the anatomy and physiology of pain pathways are summarized, followed by a review of the altered biology of pain processing, neurotransmitter function, and neuroendocrine systems in FMS. The categories of current drugs employed to treat the disorder are detailed, along with a critical review of the literature supporting such use.


General practitioner surgery: anyone interested?
We sought to assess awareness of, exposure to and interest in general practitioner (GP) surgery and enhanced surgical skills (ESS) among family practice residents in British Columbia, Alberta and Saskatchewan. We distributed a survey to all family practice residents at 4 universities in BC, Alberta and Saskatchewan. The survey assessed demographic information, awareness of and exposure to GP surgery or ESS during training, and interest in pursuing formal ESS training. We received 174 responses (27.2% response rate). Numerous respondents were unaware of GP surgery (9.9% ± 4.5%) and ESS (17.9% ± 5.7%). Awareness was higher among respondents from rural hometowns (GP surgery and ESS awareness 100% and 94.1%, respectively), and with prior exposure to GP surgery (GP surgery and ESS awareness 96.9% and 95.4%, respectively). A minority (38.2%) had been exposed to GP surgery, with exposure higher in respondents from rural training sites and in their second postgraduate year (72.5% and 47.4%, respectively). A quarter (25.1%) of respondents were considering ESS training. Factors encouraging training included increased procedures, challenging medicine and impact on patient outcomes. The importance of ESS training opportunities and service was rated highly. Many respondents were unaware of ESS as a career option. Exposure to GP surgery during training was associated with increased awareness. Furthermore, exposure fostered interest in this important field. These results may be helpful in the development of formal ESS training programs and in curricula for family practice residency programs.


Plasma cytokine levels in cardiac chambers of patients with mitral stenosis with congestive heart failure.
To ascertain whether elevated levels of circulating proinflammatory cytokines in patients with advanced heart failure are due to congestive heart failure or due to cachexia or infection complicating heart failure, we measured prospectively plasma concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), interleukin 2 (IL-2), and interleukin-6 (IL-6) in 12 patients with mitral stenosis with moderate congestive heart failure, but not with cachexia or infection. Blood samples were obtained from the peripheral vein and right and left atria of the patients during percutaneous mitral valvuloplasty. Levels of TNF-alpha, IL-1 beta, IL-2, and IL-6 in the plasma form the peripheral vein and right and left atria of these patients were not elevated compared with those from the peripheral vein of a control group of 10 normal subjects. On the other hand, plasma levels of TNF-alpha but not IL-1 beta, IL-2 or IL-6, were elevated in 4 of 9 patients with congestive heart failure complicated with cachexia and/or infection. Our results suggest that proinflammatory cytokine levels are not elevated in congestive heart failure uncomplicated with cachexia or infection.


Quality of life issues for fibromyalgia patients.
To collect information from patients with fibromyalgia syndrome (FMS) in regard to quality of life, impact of FMS, coping strategies, and what they want from their health care providers. Two hundred seventy support group members in Washington, Illinois, and Pennsylvania completed an 85-item questionnaire. On a scale from 1 to 10 (10 being highest positive rating), patients ranked past quality of life as 8.6, present quality of life as 4.8, and future quality of life without FMS as 9.2. Respondents indicated that FMS has had a negative impact on personal relationships, career, and mental health. Many also reported a lack of social support. Most respondents reported a variety of coping responses including talking to friends, praying, exercise, hobbies, relaxation techniques, talking to a professional, and meditation. Patients reported needing more support, better educated health professionals, for people to believe that this disease exists, more funding for research, and better diagnostic tools. Health care workers need to be cognizant of the effect FMS has on quality of life. Treatment options should not be limited to prescription medication therapy. Patients are using a variety of methods to cope with their FMS symptoms, some positive, but others that are negative, and health care providers need to be alert to negative coping strategies such as alcohol and nonprescription medication abuse.


Synergistic effect of sorafenib with ionizing radiation on human oral cancer cells.
Although anticancer effects of sorafenib on renal, liver and colon carcinomas are well-known, its combination effect with ionizing radiation on oral squamous cell carcinoma (OSCC) is unclear. Herein human SAS cells, an OSCC cell line, were used in order to elucidate this combination effect. Both SAS and SAS/nuclear factor kappa-B-luciferase (SAS/NF-κB-luc2) cell lines were used in the study. Cell viability, NF-κB activation, and protein expression of NF-κB downstream effectors were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, NF-κB-luc2 reporter gene system, NF-κB/DNA binding activity and western blotting. Sorafenib significantly increased radiation-induced cytotoxicity and apoptosis via both mitochondrial-dependent and independent pathways. In addition, NF-κB activity and downstream effector protein expression induced by radiation was suppressed by sorafenib in SAS/NF-κB-luc2 cells. Combination of sorafenib with radiation for the treatment of human OSCC shows a synergistic effect via suppression of radiation-induced NF-κB activity and its regulated downstream effector proteins.


How does the Environment Influence a Given Cation? A Systematic Investigation of [Co(CO)5 ]+ in Gas Phase, Solution, and Solid State.
IR spectroscopic studies of the gaseous metal carbonyl cations [Co(CO)5 ]+ ⋅mCO (m=1-4) indicated that the weakly bound CO molecules in a second coordination sphere perturb the structure of [Co(CO)5 ]+ causing the CO stretching frequencies ν(CO) to become noticeably redshifted. In this work, we aimed to establish the relationship between such gas phase IR spectra and those recorded in condensed phases, either as a solid salt or as a solution in the weakly basic solvent o-difluorobenzene. For this purpose, a series of [Co(CO)5 ]+ [WCA]- salts (WCA=weakly coordinating anion), with the counterions varying between more coordinating (WCA=F-Al(ORF )3 , (RF O)3 Al-F-Al(F)(ORF )2 ; RF =C(CF3 )3 ) and almost non-coordinating (WCA=Al(ORF )4 , F{Al(ORF )3 }2 ), were synthesized and characterized by vibrational spectroscopy as well as X-ray structure analysis. The experimental spectra differ considerably from that of the undisturbed gaseous [Co(CO)5 ]+ ion, as the structural deformation of [Co(CO)5 ]+ requires very little energy. Together with previously reported data, the perturbed condensed phase [Co(CO)5 ]+ ions were analyzed and compared with the gaseous [Co(CO)5 ]+ ⋅mCO ions. DFT calculations were performed on simply adapted [Co(CO)5 ]+ structures to allow the assignment of all the ν(CO) modes and a qualitative interpretation of structural deformations by external influences as a function of the environment (ligands, solvation, crystal packing). The analysis showed that especially the degenerate E' mode νe and the averaged asymmetric equatorial CO stretch ν ‾ e , which originates from a split of the E' mode, are a function of the interaction with the environment. Whereas for the more coordinating counterions ν ‾ e values of 2112-2120 cm-1 were obtained, for the less coordinating counterions ν ‾ e values of up to 2133 cm-1 were found, which is very close to that of gaseous [Co(CO)5 ]+ ⋅4CO, with a ν ‾ e value of 2135 cm-1 . This indicates the possibility of approximating the gas phase conditions in the condensed phases with the [Co(CO)5 ]+ ion probably being the prototypical probe molecule for investigating the strengths of interactions in different environments.


Evaluating the use of house sparrow nestlings as sentinels for West Nile virus in Saskatchewan.
This study evaluated the use of house sparrow (Passer domesticus) nestlings as sentinels of West Nile virus (WNV) in the prairie grasslands of Saskatchewan. In the summer of 2006, 600 house sparrow nestlings were collected and pooled tissues tested by reverse transcriptase-polymerase chain reaction. All tested negative for WNV. During the same period, no WNV was detected by mosquito surveillance in the study area and 15 WNV-infected pools were collected from the nearby city of Estevan. Six percent of avian carcasses collected from Regina, a city 100 km from the study area in the same ecozone, were infected with WNV. In 2007, 200 house sparrow nestlings were collected and 4 tested positive for WNV, a prevalence of 2%. Ninety-seven house sparrow eggs were also collected and WNV antibodies were measured in the yolk. Seven eggs had measurable titers, a prevalence of 7.2%. Combined WNV surveillance showed high levels of WNV transmission in 2007; 112 WNV-infected mosquito pools were collected from nearby cities of Estevan and Weyburn, and the proportion of WNV infected avian carcasses from Regina was 78%. There were 1456 human cases of WNV in Saskatchewan in 2007, compared to 19 cases in 2006. The study concluded that house sparrow nestlings are not useful as an early warning of WNV circulation, or as a measure of the intensity of WNV activity in the prairie grasslands. Also, the study determined that maternally derived antibody did not have a significant limiting effect on WNV transmission to house sparrow nestlings in 2007, a year of epidemic WNV activity in the study area.


A dose-escalation study of irinotecan (CPT-11) in combination with gemcitabine in patients with advanced non-small cell lung cancer previously treated with a cisplatin-based front line chemotherapy.
CPT-11 and gemcitabine are both active agents against non-small cell lung cancer (NSCLC). We conducted a phase I study to determine the maximum-tolerated dose (MTD) and the dose-limiting toxicities (DLTs) of their combination in patients with previously treated advanced NSCLC. Twenty-seven patients with histologically confirmed NSCLC, who had failed cisplatin-based front-line chemotherapy, were enrolled. The patients' median age was 56 years, 24 were male and 22 had a performance status (WHO) 0-1. Gemcitabine was administered on days 1 and 8, as a 30-minute i.v. infusion, at escalated doses ranging from 900 to 1200 mg/m2. CPT-11 was given over a 60-minute i.v. infusion on day 8 at escalated doses ranging from 200 to 350 mg/m2, following gemcitabine administration. The treatment was repeated every three weeks. The MTD was exceeded at dose-level 7 with CPT-11 350 mg/m2 and gemcitabine 1200 mg/m2, where all three enrolled patients presented DLTs (one patient grade 4 thrombocytopenia, one grade 3 diarrhea and one grade 3 asthenia). The recommended doses for future phase II studies are CPT-11 300 mg/m2 on day 8 and gemcitabine 1200 mg/m2 on days 1 and 8. A total of 107 treatment cycles were administered. Grade 3/4 neutropenia was observed in 13 (13%) cycles, febrile neutropenia in 3 (3%) and grade 3/4 thrombocytopenia in 2 (2%). Grade 2/3 diarrhea was seen in 6 (6%) cycles, grade 2/3 nausea and vomiting in 13 (13%) and grade 2/3 asthenia in 8 (8%). Other toxicities were mild. Among 23 patients evaluable for response, PR was achieved in one (4.5%), SD in 12 (52.5%) and PD in 10 (43%). The results of this phase I study clearly demonstrate that gemcitabine and CPT-11 can be efficiently combined in a low-toxicity regimen with doses equal or near monotherapy levels. Further studies are needed to evaluate the efficacy of this combination in both chemotherapy-naive and pre-treated patients with advanced NSCLC.


Oseltamivir analog with boron cluster modulator.
Synthesis of novel neuraminidase inhibitor -- carborane ester of oseltamivir carboxylic acid is described, and its physicochemical and spectral characteristics is provided. Surprisingly, carborane analog of oseltamivir is of an order of magnitude less active than its precursor, the corresponding ethyl ester, which is the active principle of pharmaceutical preparations used in influenza prophylactics and therapy.


Molecular Dynamics Simulations of a Characteristic DPC Micelle in Water.
We present the first comparative molecular dynamics investigation for a dodecylphosphocholine (DPC) micelle performed in condensed phase using the CHARMM36, GROMOS53A6, GROMOS54A7, and GROMOS53A6/Berger force fields and a set of parameters developed anew. Our potential consists of newly derived RESP atomic charges, which are associated with the Amber99SB force field developed for proteins. This new potential is expressly designed for simulations of peptides and transmembrane proteins in a micellar environment. To validate this new ensemble, molecular dynamics simulations of a DPC micelle composed of 54 monomers were carried out in explicit water using a "self-assembling" approach. Characteristic micellar properties such as aggregation kinetic, volume, size, shape, surface area, internal structure, surfactant conformation, and hydration were thoroughly examined and compared with experiments. Derived RESP charge values combined with parameters taken from Amber99SB reproduce reasonably well important structural properties and experimental data compared to the other tested force fields. However, the headgroup and alkyl chain conformations or the micelle hydration simulated with the Amber99SB force field display some differences. In particular, we show that Amber99SB slightly overestimates the trans population of the alkyl Csp(3)-Csp(3)-Csp(3)-Csp(3) dihedral angle (i.e., CCCC) and reduces the flexibility of the DPC alkyl chain. In agreement with experiments and previously published studies, the DPC micelle shows a slightly ellipsoidal shape with a radius of gyration of ∼17 Å for the different potentials evaluated. The surface of contact between the DPC headgroup and water molecules represents between 70% and 80% of the total micelle surface independently of the force field considered. Finally, molecular dynamics simulations show that water molecules form various hydrogen-bond patterns with the surfactant headgroup, as noted previously for phospholipids with a phosphatidylcholine headgroup.


A comparison of two sets of microarray experiments to define allergic asthma expression pattern.
Allergic asthma is a complex trait. Several approaches have been used to identify biomarkers involved in this disease. This study aimed at demonstrating the relevance and validity of microarrays in the definition of allergic asthma expression pattern. The authors compared the transcript expressions of bronchial biopsy of 2 different microarray experiments done 2 years apart, both including nonallergic healthy and allergic asthmatic subjects (n = 4 in each experiment). U95Av2 and U133A GeneChips detected respectively 89 and 40 differentially expressed genes. Fifty-five percent of the U133A genes were previously identified with the U95Av2 arrays. The immune signaling molecules and the proteolytic enzymes were the most preserved categories between the 2 experiments, because 3/4 of the genes identified by the U133A were also significant in the U95Av2 study for both categories. These results demonstrate the relevance of microarray experiments using bronchial tissues in allergic asthma. The comparison of these GeneChip studies suggests that earlier microarray results are as relevant as actual ones to target new genes of interest, particularly in function categories linked to the studied disease. Moreover, it demonstrates that microarrays are a valuable technology to target novel allergic asthma pathways as well as biomarkers.


Emergency departments (EDs) in the United Kingdom (UK) are not prepared for emerging biological threats and bioterrorism.
To assess the preparedness of emergency departments (EDs) in the United Kingdom (UK) for the management of potential biological incidents. We telephoned all hospitals in the UK listed as having a major ED. We surveyed their ED facilities and procedures for managing patients with infectious diseases. We determined how many of the EDs had an isolation room available and, if present, whether this had an independent ventilation system and separate access from outside the ED. In addition, we determined how many of the EDs would isolate patients with suspected cases of chickenpox, tuberculosis (TB), severe acute respiratory syndrome (SARS) and other suspicious infections. We obtained complete data from 203 (79%) of the 257 hospitals approached. Only 49 (24%) of these hospitals had isolation facilities available in the ED. Of these 49 EDs, 30 (61%) reported an independent ventilation system and 18 (37%) reported a separate access from outside the ED. The majority of EDs would isolate patients with potential infectious diseases, however, 47 (23%) would not isolate patients with suspected chickenpox, 37 (18%) EDS would not isolate patients with suspected TB, 12 (6%) EDS would not isolate patients with suspected SARS and 55 (27%) EDS would not isolate patients with other suspicious infections. EDs in the UK are not prepared for emerging biological threats and bioterrorism. With current facilities and procedures it is highly likely that an infectious agent will spread to staff and other patients in any future biological incident.


Spontaneous closure of the hymen during pregnancy.
Imperforate hymen is a rare disorder that is usually discovered at the onset of menstruation. In the literature, secondary closure of the hymen has been reported in 2 cases, both of which occurred subsequent to surgical procedures that involved the hymen. We report an interesting case of the spontaneous formation of an imperforate hymen during pregnancy in the absence of previous surgical procedures. Electron microscopic findings indicate hymenal tissue reorganization.


Dynamics of leukocyte receptors after severe burns: an exploratory study.
Patients with burns are susceptible to organ failure, and there is indirect evidence that leukocytes may contribute to this process. They may change the expression of cell-surface receptors after certain stimuli, for example, the burn. We therefore aimed to assess the changes induced by the burn in the expression of leukocyte cell-surface receptors CD11b, CD14, CD16, and CD62L on the surface of PMNs and monocytes. We also wanted to examine the dynamics of this activation during the first week after the burn, and to relate it to the size of the injury. Ten patients with burns of >15% (TBSA) were included in the study. Blood samples were collected on arrival and every consecutive morning during the first week. Healthy volunteers acted as controls. PMN CD11b expression was increased. The extent of PMN CD11b expression correlated negatively to the size of the full thickness burn. Monocyte CD14 expression increased initially but there was no relation to the size of the burn. PMN CD16 expression decreased initially during the first days and the decrease was related to burn size. CD62L did not vary depending on the burn in either PMN or monocytes during the first week after the burn. This study showed that specific receptors on the surface of leukocytes (PMN CD11b, monocyte CD14 and PMN CD16) are affected by the burn. Expression of PMN CD11b and CD16 are related to burn size. Burn-induced effects on the expression of PMN receptors, such as PMN CD11b and CD16, may contribute to burn-induced infection susceptibility.


Vasopressor magnitude predicts poor outcome in adults with congenital heart disease after cardiac surgery.
High levels of vasoactive inotrope support (VIS) after congenital heart surgery are predictive of morbidity in pediatric patients. We sought to discern if this relationship applies to adults with congenital heart disease (ACHD). We retrospectively studied adult patients (≥18 years old) admitted to the intensive care unit after cardiac surgery for congenital heart disease from 2002 to 2013 at Mayo Clinic. Vasoactive medication dose values within 96 hours of admission were examined to determine the relationship between VIS score and poor outcome of early mortality, early morbidity, or complication related morbidity. Overall, 1040 ACHD patients had cardiac surgery during the study time frame; 243 (23.4%) met study inclusion criteria. Sixty-two patients (25%), experienced composite poor outcome [including eight deaths within 90 days of hospital discharge (3%)]. Thirty-eight patients (15%) endured complication related early morbidity. The maximum VIS (maxVIS) score area under the curve was 0.92 (95% CI: 0.86-0.98) for in-hospital mortality; and 0.82 (95% CI: 0.76-0.89) for combined poor clinical outcome. On univariate analysis, maxVIS score ≥3 was predictive of composite adverse outcome (OR: 14.2, 95% CI: 7.2-28.2; P < 0.001), prolonged ICU LOS ICU LOS (OR: 19.2; 95% CI: 8.7-42.1; P < 0.0001), prolonged mechanical ventilation (OR: 13.6; 95% CI: 4.4-41.8; P < 0.0001) and complication related morbidity (OR: 7.3; 95% CI: 3.4-15.5; P < 0.0001). MaxVIS score strongly predicted adverse outcomes and can be used as a risk prediction tool to facilitate early intervention that may improve outcome and assist with clinical decision making for ACHD patients after cardiac surgery.


Nanosecond simulations of the dynamics of C60 excited by intense near-infrared laser pulses: impulsive Raman excitation, rearrangement, and fragmentation.
Impulsive Raman excitation of C(60) by single or double pulses of near-infrared wavelength λ = 1800 nm was investigated by using a time-dependent adiabatic state approach combined with the density functional theory method. We confirmed that the vibrational energy stored in a Raman active mode of C(60) is maximized when T(p) ~ T(vib)/2 in the case of a single pulse, where T(p) is the pulse length and T(vib) is the vibrational period of the mode. In the case of a double pulse, mode selective excitation can be achieved by adjusting the pulse interval τ. The energy of a Raman active mode is maximized if τ is chosen to equal an integer multiple of T(vib) and it is minimized if τ is equal to a half-integer multiple of T(vib). We also investigated the subsequent picosecond or nanosecond dynamics of Stone-Wales rearrangement (SWR) and fragmentation by using the density-functional based tight-binding semiempirical method. We present how SWRs are caused by the flow of vibrational kinetic energy on the carbon bond network of C(60). In the case where the h(g)(1) prolate-oblate mode is initially excited, the number of SWRs before fragmentation is larger than in the case of a(g)(1) mode excitation for the same excess vibrational energy. Fragmentation by C(2) ejection C(60) → C(58) + C(2) is found to occur from strained, fused pentagon/pentagon defects produced by a preceding SWR, which confirms the earliest mechanistic speculations of Smalley et al. [J. Chem. Phys. 88, 220 (1988)]. The fragmentation rate of C(2) ejection in the case of h(g)(1) mode excitation does not follow a statistical description as employed for instance in the Rice-Ramsperger-Kassel (RRK) theory, whereas the rate for a(g)(1) mode excitation does follow the prediction by RRK. We also found for the h(g)(1) mode excitation that the nonstatistical nature affects the distribution of barycentric velocities of fragments C(58) and C(2). This result suggests that it is possible to control rearrangement and subsequent bond breaking in a "nonstatistical" way by initial selective mode excitation.


Design and synthesis of new ruthenium polypyridyl complexes with potent antitumor activity in vitro.
We herein report the synthesis, characterization and anticancer activity of BTPIP (2-(4-(benzo[b]thiophen-2-yl)phenyl)-1H-imidazo[4,5-f][1,10]phenanthroline) and its four ruthenium(II) polypyridyl complexes [Ru(NN)2(BTPIP)](ClO4)2 (N-N = bpy = 2,2'-bipyridine, Ru(II)-1; phen = 1,10-phenanthroline, Ru(II)-2; dmb = 4,4'-dimethyl-2,2'-bipyridine, Ru(II)-3; dmp = 2,9-dimethyl-1,10-phenanthroline, Ru(II)-4). The DNA binding behaviors reveal that the complexes bind to calf thymus DNA by intercalation. Cytotoxicity of the complexes against A549, HepG-2, SGC-7901 and Hela cells were evaluated in vitro. Complexes Ru(II)-1, Ru(II)-2, Ru(II)-3, Ru(II)-4 show moderate activity on the cell proliferation in A549 cells with IC50 values of 9.3 ± 1.2, 12.1 ± 1.6, 10.3 ± 1.6, 8.9 ± 1.2 μM, respectively. Apoptosis assessment, intracellular mitochondrial membrane potential (MMP), location in mitochondria, reactive oxygen species (ROS), cell invasion assay and cell cycle arrest were also performed to explore the mechanism of this action. When the concentration of the ruthenium(II) complexes is increased, the amount of reactive oxygen species increases obviously and the mitochondrial membrane potential decreases dramatically in A549 cells. Most importantly, the ruthenium(II) polypyridyl complexes could arrive the cytoplasm through the cell membrane and accumulate in the mitochondria. These results showed that the ruthenium(II) complexes could induce apoptosis in A549 cells through an ROS-mediated mitochondrial dysfunction pathway.


Single-incision laparoscopic endorectal pull-through (SILEP) for hirschsprung disease.
Over the last 15 years, the laparoscopic-assisted endorectal pull-through procedure first described by Georgeson has become the standard treatment for Hirschsprung disease in many centers around the world. We report the first six patients who were operated using a single-incision endosurgical approach. Six infants (one female) diagnosed with Hirschsprung disease underwent laparoscopic endorectal pull-through via a single 1 cm horizontal skin incision in the umbilicus. Firstly, laparoscopic seromuscular leveling biopsies of the rectum and sigmoid were obtained. The affected rectosigmoid colon and rectum was then mobilized distally beyond the peritoneal reflection, facilitating the subsequent perineal dissection, pull-through, and coloanal anastomosis. Operative variables were compared between single-incision and conventional laparoscopic endorectal pull-through. The patients' average age and weight was 28 days and 3.8 kg, respectively. Operative time ranged from 90 to 220 min, with a mean estimated blood loss of 3.7 ml. There were no intraoperative complications. Postoperatively, all six patients recovered uneventfully and were discharged home on full feeds after a median of 7 days. On follow-up, the patients had virtually no appreciable scar, were feeding well, stooling, and gaining weight appropriately. The results were similar to those of conventional laparoscopic endorectal pull-through. Although technically challenging, laparoscopic-assisted endorectal pull-through in infants with Hirschsprung disease can be performed safely through a single umbilical incision with good postoperative results and excellent cosmesis.


Kaposi's sarcoma in Zimbabwe. II. Peripheral lymphocytes, immunoglobulin G levels and HIV antibody positivity.
Patients with Kaposi's Sarcoma (KS) were grouped according to their clinical symptoms into "indolent", "locally aggressive", "endemic generalised aggressive" and "epidemic generalised aggressive" disease. Only the patients in the epidemic generalised aggressive disease group had serum antibodies to HIV. Complete peripheral blood counts, including lymphocyte subsets, and serum IgG assays were performed on all patients before treatment was initiated. In all the aggressive disease groups there was evidence of immune deficiency in that T helper/inducer (T4) cells were reduced leading to reduced T4,T8 (suppresser/cytotoxic) ratio. All patient groups had increased levels of serum IgG. Although immune deficiency and aggressive KS can be explained in the HIV infected patients no underlying cause has been found in the HIV negative patients with aggressive KS.


Keys for identification of species of family Calliphoridae (Diptera) in Egypt.
The present taxonomic study assists in the recognition of all known Egyptian species of Calliphoridae by keys to genera and species accompanied by synonyms in the light of modern taxonomic concepts. Eight genera are recorded in A.R. Egypt including 14 species. Hemipyrellia pulchra (Wied) is recorded for the first time in Egypt. Chrysomyia chloropyga (Wied) was recorded by Pont (1979) in his study of Synanthropic flies in Saudi Arabia, this species was not recorded or mentioned before him in Egypt and is not represented in our collections.


High burden of rotavirus gastroenteritis in young children in rural western Kenya, 2010-2011.
Diarrhea is a leading cause of hospitalization and death in children <5 years of age. To facilitate evaluation of the impact of rotavirus vaccine introduction in western Kenya, we estimated baseline rates of rotavirus-associated hospitalization and mortality among children <5 years of age. From January 2010 to December 2011, we collected demographic, clinical and laboratory data for children <5 years of age seeking care at the district hospital and 2 outpatient facilities within a Health and Demographic Surveillance System (HDSS). Children with acute gastroenteritis (AGE), defined as ≥3 loose stools and/or ≥1 episode of unexplained vomiting followed by loose stool within a 24-hour period, were asked to provide a stool sample for rotavirus ELISA testing. Rates of rotavirus-associated hospitalization and mortality were estimated using time of residence in the HDSS to calculate person-years of observation. To estimate the rotavirus-associated mortality rate, we applied the percentage positive for rotavirus among AGE hospitalizations to verbal autopsy estimates of diarrhea deaths in the HDSS. There were 4991 hospitalizations of children <5 years of age; 1134 (23%) were for AGE and stool specimens were obtained from 790 (70%). Rotavirus was detected in 211 (27%) specimens. Among 4951 <5 outpatient sick visits, 608 (12%) were for AGE; 320 (51%) provided specimens and 62 (20%) were positive for rotavirus. Rotavirus AGE accounted for 501 <5 hospitalizations per 100,000 person-years of observation. Rotavirus-associated <5 mortality was 136 deaths per 100,000 person-years of observation. Continued surveillance of rotavirus AGE will provide timely data on the population-level impact of rotavirus vaccine following its likely introduction in 2014.


Neutral D→KK^{*} Decays as Discovery Channels for Charm CP Violation.
We point out that the CP asymmetries in the decays D^{0}→K_{S}K^{*0} and D^{0}→K_{S}K[over ¯]^{*0} are potential discovery channels for charm CP violation in the standard model. We stress that no flavor tagging is necessary, the untagged CP asymmetry a_{CP}^{dir}(D[over (-)]→K_{S}K^{*0}) is essentially equal to the tagged one, so that the untagged measurement comes with a significant statistical gain. Depending on the relevant strong phase, |a_{CP}^{dir,untag}| can be as large as 0.003. The CP asymmetry is dominantly generated by exchange diagrams and does not require nonvanishing penguin amplitudes. While the CP asymmetry is smaller than in the case of D^{0}→K_{S}K_{S}, the experimental analysis is more efficient due to the prompt decay K^{*0}→K^{+}π^{-}. One may further search for favorable strong phases in the Dalitz plot in the vicinity of the K^{*0} peak.


Hepatocarcinogenesis in p53-deficient mice.
To determine whether a constitutive p53 deficiency would enhance the rate of development of chemically induced hepatocellular carcinoma, we treated groups of wild-type, p53-heterozygous (+/-), and null (-/-) male mice with a single dose of diethylnitrosamine at 12 d of age. Although the null mice had to be killed very early, at 15 wk of age because of the development of nonliver tumors, hemangiosarcoma of the liver had already developed in two of seven mice. More detailed analysis of the wild-type and heterozygous mice showed no difference in the number, size, or growth rate of early microscopic lesions or in the number or apparent malignancy of hepatocellular adenomas or carcinomas at later time points. Thus, germline p53 deficiency does not enhance the rate of development of diethylnitrosamine-induced hepatocellular adenoma or carcinoma but may instead favor development of hepatic hemangiosarcoma.


Eighteenth Daniel C. Baker, JR, Memorial Lecture. Art and science of laryngeal photography.
Photography of the pharynx, larynx, and trachea has exercised the ingenuity of laryngologists and photographers for 100 years. There have been many successful methods. The most reliable and versatile modern system uses a 35-mm single frame, single lens reflex camera with Hopkins telescopes and a synchronized, automatic exposure, computer-controlled, remote electronic flash generator. The technique described, which has been used by the author for many years, not only allows excellent visualization and reliable documentation, but yields consistently reproducible photographs under all conditions.


Antioxidant defenses of cultured colonic epithelial cells against reactive oxygen metabolites.
Reactive oxygen metabolites produce colonic epithelial cellular injury. The present study evaluated the protective role of cellular superoxide dismutase, catalase, and glutathione (GSH) redox cycle in cultured rabbit colonic cells. Cultured rabbit colonic epithelial cells were exposed to reactive oxygen metabolites generated by hypoxanthine (1 mM) and xanthine oxidase (1 mU/ml) for up to 5 h. Cytotoxicity was quantified by measuring 51Cr release from prelabeled cells. Pretreatment with diethyldithiocarbamate (inhibitor of superoxide dismutase) reduced activity of cellular superoxide dismutase and increased 51Cr release caused by hypoxanthine/xanthine oxidase from colonic cells. Pretreatment with diethyl maleate (covalently binds GSH as catalyzed by GSH transferase), or buthionine sulfoximine (inhibitor of gamma-glutamylcysteine synthetase) decreased cellular GSH and enhanced reactive oxygen metabolites induced injury. Pretreatment with bis(chloroethyl)-nitrosourea (inhibitor of GSH reductase) inhibited activity of GSH reductase and increased 51Cr release from colonic cells. Preincubation with aminotriazole (inhibitor of catalase) reduced cellular catalase, but did not affect cellular injury. Therefore, we concluded that both cellular superoxide dismutase and the GSH redox cycle appeared to play a role in detoxifying reactive oxygen metabolites and that cellular catalase may be less important in rabbit colonic epithelial cells.


[Therapeutic trial in facial hemispasm. Initial results (author's transl)].
The authors propose an original easy technic of hemi-facial spasm. They take a drain on the emergence of facial nerve (stylo mastoïd hole). The, they proceed at successif alcoholizations. The first results are more favorable than formes tecnicals.


Single amino acid substitutions in one Ca2+ binding site of uvomorulin abolish the adhesive function.
We show that a synthetic peptide corresponding to the sequence of one putative Ca2+ binding motif of the cell adhesion molecule uvomorulin is able to complex Ca2+. This function is abolished if the first Asp in the peptide is replaced by Lys. Accordingly, we expressed in L cells mutant uvomorulin with a replacement of Asp to Lys or Ala. Mutant protein was resistant to Ca2+/trypsin under mild conditions but became susceptible at or near the site of replacement at higher concentrations, leaving the remaining Ca2+ binding domains protected. Remarkably, in cell aggregation assays both mutant uvomorulins failed to mediate cell adhesiveness, demonstrating that a single amino acid substitution in one Ca2+ binding site inactivates the adhesive function.


Collateral reinnervation of taste buds after chronic sensory denervation: a morphological study.
Peripheral transganglionic transport of horseradish peroxidase (HRP) was used to label afferent fibers in the taste buds and lingual epithelium 2-12 weeks after chronic chorda tympani or combined chorda tympani-lingual nerve lesions. From 4-12 weeks after a chronic chorda tympani lesion, taste buds could be found. These were innervated by fibers from the ipsilateral lingual nerve. From 8-12 weeks after a chronic chorda tympani-lingual nerve lesion, nerve fibers from the contralateral lingual nerve could be found in a few taste buds on the denervated side of the tongue. Thus, collateral sprouting took place over the midline in this instance. These findings indicate that intact gustatory axons do not sprout into denervated taste buds, but trigeminal fibers in the lingual nerve do have this ability.


Analysis and simulation of entirely saturated unilateral laser spot tails in BCCD.
A new phenomenon involving the entire saturation of unilateral tails of buried channel charge-coupled devices (BCCDs) under laser radiation is observed in this study. A physical model related to this phenomenon is constructed based on the assumption that the charge transfer inefficiency of BCCD is a jump function of signal charge quantity. The profile of a spot tail under laser radiation is simulated using this self-developed model. The simulation results are compared with experimental findings to validate this model.


Outbreak of staphylococcal food intoxication after consumption of pasteurized milk products, June 2007, Austria.
On June 13, 2007, the public health authority informed the Austrian Agency for Health and Food Safety about 40 children from two neighboring elementary schools who had fallen ill with abdominal cramps and vomiting on June 8. School milk products consumed on June 8 were suspected as the source of the outbreak. On June 8, the milk products provided by local dairy X to eight elementary schools and two nurseries. The short incubation period - all cases fell ill on the day on which the products were consumed - and the short duration of illness (1-2 days) strongly suggested intoxication. In order to identify the causative pathogen, its reservoir and the mode of transmission, a descriptive-epidemiological and microbiological investigation and a retrospective cohort study were conducted. Six of the 10 institutions served by dairy X completed questionnaires on demographics and food consumption. One school had a 79% response rate (203/258) and was chosen as the basis for our cohort study. A total of 166 of the 1025 children (16.2%) at the 10 institutions fulfilled the case definition. Consumption of milk, cacao milk or vanilla milk originating from dairy X was associated with a 37.8 times higher risk of becoming a case (95% CI: 2.3-116.5). Unopened milk products left over at the affected institutions yielded staphylococcal enterotoxins A and D. Six out of 64 quarter milk samples from three of 16 cows producing milk for dairy X tested positive for S. aureus. The isolates produced enterotoxins A and D, yielded genes encoding enterotoxins and D, and showed spa type t2953. S. aureus isolated from the nasal swab of the dairy owner harbored genes encoding enterotoxins C, G, H and I, and showed spa type t635. Our investigation revealed that the milk products produced in dairy X on June 7 were the source of the outbreak on June 8. The cows - not the dairy owner - the likely reservoir of the enterotoxin-producing S. aureus. From the risk assessment of the production process at the dairy, we hypothesize that staphylococcal toxin production took place during a 3-day period of storage of pasteurized milk prior to repasteurization for the production batch of 7.


Testicular adrenal rest tumors in patients with congenital adrenal hyperplasia: 6 years of follow-up.
Background Testicular adrenal rest tumors (TARTs) leading to primary gonadal failure are the main etiology of infertility in congenital adrenal hyperplasia (CAH). We aimed at identifying the evolution of TART and related findings in young CAH patients. Methods Twelve male patients (3-23 years old) with 21-hydroxilase deficiency (11 with classic salt-wasting form) were included. Testicular ultrasonography (US) was performed in two moments, by a single blinded specialist in pediatric diagnostic imaging. Tumor progression was classified according to the Response Evaluation Criteria in Solid Tumors (RECIST). The clinical and laboratory data were retrieved from medical records. Serum 17-OH-progesterone (17OHP) and androstenedione concentrations were evaluated during the whole period of follow-up, from the CAH diagnosis. A logistic regression model with repeated measures was developed for the analysis. Results The prevalence of TART was 41.6% (n = 5) in the initial US evaluation and 66.6% (n = 8) after 6 years of follow-up. Tumor progression was detected in 4 of the 5 patients, and 1 presented with a stable tumor. Three patients presented with new tumors in the second evaluation. Most of the patients (n = 11) were pubertal, including a 7-year-old child with TART who presented with central precocious puberty. At regression analysis, it was observed that an inadequate hormonal control led to a 16 times greater chance of a patient to present with TART (OR = 16.08; confidence interval [CI] 95% = 2.38-108.81; p = 0.004). Conclusions We found a high prevalence of progressive TART in young pubertal subjects. US testicular screening should help in improving therapeutic optimization in CAH patients to reduce future impairment in fertility.


[A case of primary diffuse large B-cell lymphoma of the brain].
The paper describes a case of primary extranodal diffuse large B-cell lymphoma of the cerebral hemispheres, which was regarded as an inflammatory disease of the brain during life and diagnosed only posthumously in the microscopically examination of the autopsy material by immunohistochemical studies.


[Tunnelled central venous line-associated infections in patients with pulmonary arterial hypertension treated with intravenous prostacyclin].
Intravenous prostacyclins are a valuable treatment for patients with severe pulmonary arterial hypertension, leading to improved exercise capacity, haemodynamics, quality of life and survival. Unfortunately, due to the short half-life of these drugs, they need to be administered continuously through central venous catheters. Despite aseptic technique, regular dressing changes, tunneled central venous catheters and patient education, patients are exposed to central venous catheter associated infections. These infections cause significant morbidity and mortality. The clinical presentation, microbiology, consequences and management of these central venous catheter associated infections in pulmonary arterial hypertension patients treated with intravenous prostacyclins are discussed.


Alleviation of the heat load on lactating goats with the use of diuretics and drinking cool water.
The effect was studied of different heat loads connected with the application of diuretics and of 10 to 15 degrees C drinking water on the milk production and some related physiological parameters of 19 Egyptian Baladi goats under experimental conditions. The increase in heat stress increased the respiration rate, rectal temperature, and serum prolactin concentration significantly, while it significantly decreased the milk production, the content of alkaline, and acid phosphatases creatinine, urea, red blood cells, and haemoglobin concentration. The diuretic Thiameterine and cool drinking water under hot conditions improved the milk yield and had a positive effect on the physiological status of the animals, especially their blood composition. The higher mill production by the goats (14.7% in the experiment) is attributed to the increased feed uptake caused by the treatments.


Increased expression of transferrin receptors and iron in amoeboid microglial cells in postnatal rats following an exposure to hypoxia.
This study was aimed to ascertain the effects of hypoxia on regulation of iron in the brain of newborn rats. At 3 h and 1 day after hypoxic exposure transferrin receptor expression as detected immunohistochemically with the antibody OX-26, and the iron content as shown by Perls' staining of amoeboid microglial cells was markedly increased. The induced changes, however, were not evident at 10 min and in longer surviving rats killed at 3 and 7 days. It is suggested that the upregulation of transferrin receptor expression coupled with iron uptake by amoeboid microglial cells in the periventricular regions is a protective mechanism to facilitate the sequestration of excess iron that may have been released either from the iron-rich oligodendrocytes, or accumulated due to a disruption of its normal transportation following the hypoxic insult. This would help protect the brain from harmful effects of iron.


Plasmon induced polymerization using a TERS approach: a platform for nanostructured 2D/1D material production.
Plasmon-induced chemical reactions have recently attracted great attention as a promising method for high efficiency light-energy conversion and proved to be useful in a wealth of different domains of chemistry and physics. One of the interesting and, so far, less explored avenues of such reactions is their potential for efficient, highly localized and controlled polymer production. Here, we present the first example of a localized, directed plasmon catalyzed polymerization process of a self-assembled monolayer on both silver and gold surfaces monitored by surface- and tip-enhanced Raman spectroscopy (SERS and TERS). As a proof-of-concept, a bi-functionalized dibenzo(1,2)dithiine-3,8-diamine (D3ATP) molecule that undergoes a well-known plasmon-induced coupling via the amino group into an azo group has been used. Initial dimerization is demonstrated using established marker bands associated with the formation of the azo group. A subsequent indicator for a polymerization reaction, the appearance of a new characteristic band, is monitored by time-dependent SERS and TERS experiments. We demonstrate that the dimerization reaction and hence, the subsequent polymerization, can be induced by a plasmonic feature, e.g. a TERS tip, at specific nanoscale locations and, at a much larger micron scale, by continuously scanning the plasmonic probe. The presented results provide the basis for designing further plasmonic catalysis experiments in general, and offer a new platform for producing ultra-thin polymer films with a defined structural dimension.


High enzyme activity UGT1A1 or low activity UGT1A8 and UGT2B4 genotypes increase esophageal cancer risk.
Esophageal cancer (EC) has a globally increasing incidence with poor curative treatment options and survival rates. Environmental and dietary factors have crucial roles in esophageal carcinogenesis. Polymorphisms in the UGT genes, a superfamily of enzymes essential for the detoxification of carcinogens, may alter enzyme activity and subsequently may play a role in EC etiology. Rather than solely establishing differences in genotype distribution, we investigated whether functional polymorphisms in UGT genes that can predict enzyme activity in vivo, may influence EC risk. A case-control study including 351 Caucasian EC patients and 592 Caucasian controls was conducted and polymorphisms in seven UGT genes were determined, using the polymerase chain reaction. On the basis of allelic in vitro enzyme activity measurements, genotypes were categorized according to their predicted in vivo enzyme activity into high, medium and low categories. Predicted enzyme activity groups were combined and compared between patients and controls. The UGT1A1 and UGT1A8 predicted high enzyme activity genotypes were significantly more (OR=1.62; 95% CI, 1.02-2.56) and less frequent (OR=0.36; 95% CI, 0.15-0.84) among patients with esophageal squamous cell carcinoma (ESCC), respectively. High (OR=0.42; 95% CI, 0.22-0.84) and medium (OR=0.25; 95% CI, 0.12-0.52) activity UGT2B4 genotypes were significantly less often present in ESCC patients. No association was detected between UGT genotypes and esophageal adenocarcinoma (EAC) risk. Polymorphisms in UGT genes, resulting in altered enzyme activity genotypes, do not seem modifiers of EAC risk. However, the predicted high activity UGT1A1 genotype, associated with low serum levels of the antioxidant bilirubin, was associated with an increased ESCC risk. The UGT1A8 and UGT2B4 genotypes associated with decreased predicted enzyme activities, were significantly associated with an increased risk of ESCC, probably by a decreased detoxification of carcinogens.


Realpolitik versus fair process: moderating effects of group identification on acceptance of political decisions.
Three studies examined the effects of perceived procedural justice and the favorability of a group-level outcome on the endorsement of a group-level decision and the evaluation of the authority responsible for the decision. Results showed that, contrary to findings usually seen with individual-level decisions, collective outcome favorability was more important than procedural justice in influencing the endorsement of the decision. Furthermore, increased identification with the group reduced the importance of procedural justice but accentuated the importance of collective outcome favorability. With regard to the evaluation of the authority, the results were similar to those obtained in individual-level decisions: Procedural fairness mattered more than collective outcome favorability.


Polymer-Decorated Filter Material for Wastewater Treatment: In Situ Ultrafast Oil/Water Emulsion Separation and Azo Dye Adsorption.
Aiming to realize the wastewater treatment of various pollutants simultaneously, a dual-functional poly(ether amine)-polydopamine (PEA-PDA)-modified filter material was fabricated in this work for in situ separation of stable oil-in-water emulsion and adsorption of anionic azo dyes. PEA and PDA could be copolymerized via the Michael addition reaction on a polyurethane sponge substrate firmly. The as-prepared filter shows superhydrophilic and underwater superoleophobic wettability. After being squeezed in a glass tube, the material could separate different kinds of stabilized oil-in-water emulsions with high flux and efficiency. Besides, the PEA-PDA copolymer endows the material with the ability to adsorb large amounts of anionic azo dyes during the separation of emulsions with good adsorption capacity. Moreover, adsorbed dyes in the filter material could be easily desorbed in base aqueous solution and the whole process is conducted under gravity without external aid. This dual-functional material shows great potential for the application in industrial field because of its ability for the complex wastewater treatment.


Equipotent doses of daunorubicin and idarubicin for AML: a meta-analysis of clinical trials versus in vitro estimation.
In the treatment of acute myeloid leukemia (AML), the "7 + 3"-based strategy, combining cytarabine 100-200 mg/m2 for 7 days with an anthracycline for 3 days, remains the standard of care for younger and medically fit patients. Daunorubicin (DNR) and idarubicin (IDA) are the two anthracyclines most commonly used. DNR and IDA are used interchangeably with different conversion factors, as there is no high-level evidence on the equipotency of these two agents for AML treatment. To determine the equipotent doses of DNR and IDA, we first systematically reviewed studies directly comparing the clinical outcomes of AML induction therapy utilizing DNR and IDA. We found 15 articles that met our inclusion criteria and compared time-to-event survival end points as well as complete remission rates post-induction. The DNR:IDA equipotency ratio was estimated at 5.90 with 95% confidence interval (CI) 1.7-20.7. To validate the estimate from our meta-analysis biologically, we conducted in vitro tests comparing anti-AML activity of DNR and IDA against six AML cell lines and two primary AML cells from patients with different cytogenetic and molecular characteristics. Based on these in vitro data, the equipotency dose ratio between DNR and IDA was 4.06 with 95% CI 3.64-4.49. Combining the estimates from the meta-analysis and the in vitro data using inverse-variance weighting, the current best estimate of the DNR:IDA equipotent ratio is 4.1 with 95% CI 3.9-4.3. This estimate, however, is largely driven by the in vitro chemo-sensitivity data. Given clinical studies demonstrating the safety of IDA at higher doses, our work implies that dose intensification of IDA could be investigated in future clinical trials in AML.


Unexpected findings with the new chromosome banding techniques in a patient formerly diagnosed as having G-deletion syndrome II.
A girl is described, who, upon her first admission to our pediatric department in 1965, was supposed to have G-deletion syndrome II on the base of the chromosome findings in routine orcein-stained preparations and her clinical aspect. When, however, in 1972 a Q- and G-banding analysis was performed, the patient seemed to be a t(14q+; 22q-) translocation carrier. These findings are discussed in relation to the known heterogeneity of the clinical picture of patients previously reported as having a G-deletion syndrome and in whom no banding studies were done. Finally, the need for more extensive studies with the different techniques is stressed, particularly, in cases of Gq- chromosomes, of which the familial occurrence is suggestive of a hidden reciprocal translocation.


Estrogen effects on thyroid iodide uptake and thyroperoxidase activity in normal and ovariectomized rats.
Sex steroids interfere with the pituitary-thyroid axis function, although the reports have been controversial and no conclusive data is available. Some previous reports indicate that estradiol might also regulate thyroid function through a direct action on the thyrocytes. In this report, we examined the effects of low and high doses of estradiol administered to control and ovariectomized adult female rats and to pre-pubertal females. We demonstrate that estradiol administration to both intact adult and pre-pubertal females causes a significant increase in the relative thyroid weight. Serum T3 is significantly decreased in ovariectomized rats, and is normalized by estrogen replacement. Neither doses of estrogen produced a significant change in serum TSH and total T4 in ovariectomized, adult intact and pre-pubertal rats. The highest, supraphysiological, estradiol dose produced a significant increase in thyroid iodide uptake in ovariectomized and in pre-pubertal rats, but not in control adult females. Thyroperoxidase activity was significantly higher in intact adult rats treated with both estradiol doses and in ovariectomized rats treated with the highest estradiol dose. Since serum TSH levels were not significantly changed, we suggest a direct action of estradiol on the thyroid gland, which depends on the age and on the previous gonad status of the animal.


Isolation of antigen-specific T cell clones from nonresponder mice.
The mechanisms responsible for major histocompatibility complex (MHC)-linked unresponsiveness are still poorly understood. Here we examine the cellular events that follow when B10. A mice are immunized with cow insulin, an antigen to which they make no apparent immunologic response. Despite the fact that there is no detectable antibody or T cell proliferative response to cow insulin, we have been able to clone out responding T cells after priming and restimulating in vitro with this "nonimmunogenic" antigen. These cells are L3T4+, and co-recognize specific antigen and class II MHC gene products. The data demonstrate that "nonresponder" mice to cow insulin have both the capacity to present antigen and T cells capable of recognizing that antigen. The diversity within this population was investigated by analyzing various parameters of cellular activation. These include fine specificity of both antigen and MHC recognition, as well as recognition of allogeneic MHC and M1s determinants. In addition, the antigen-presenting cell requirements were studied. The results demonstrate that this population comprise a surprisingly heterogeneous group in terms of its repertoire of receptors.


[Reimbursement of public dental care in Germany, the United Kingdom, Hungary and Poland].
Dental treatments have the highest rate among medical interventions and their reimbursement is also significant. The aim of the study was to compare the outcome of the reformed healthcare system process on public dental services in four European countries. Assessment base for the comparison of reimbursement of dental treatments and dental fee schedules provided by the health insurance funds were used. The following indicators were examined: the ratio of public dental services and the main oral health indicators. Among dental fee schedules, reimbursement of general dental activity, prevention, operative dentistry, endodontic and oral surgery were selected. The lowest value of population to active dentist ratio was found in Germany (population to active dentist ratio: 1247) and the highest in Hungary (population to active dentist ratio: 2020). Oral health indicators showed significant differences between the West-European and East-European countries. On the other hand, the ratio of completely edentulous people at the age of 65yrs did not show great variations. Reimbursement of public dental treatments indicated significantly higher value in Germany and the United Kingdom compared to the other countries. Reimbursement of public dental services varies considerably in the selected European countries.


Post-operative cardiovascular complications and time to recurrence in meningioma patients treated with versus without pre-operative embolization: a retrospective cohort study of 741 patients.
Preoperative embolization of radiographically suspected meningiomas is often performed to facilitate tumor resection. Its effects on the subsequent disease course of meningioma patients have not been studied in detail and randomized trials are lacking. The purpose of this study was to explore associations of preoperative meningioma embolization with postoperative outcome. Patients undergoing resection of an intracranial meningioma at the University Hospital Zurich 2000-2013 (N = 741) were reviewed for the inclusion of pre-operative embolization in the management strategy. Annotations included demographics, radiographic, surgical, histological and hematological parameters, cardiovascular risk factors, pre- and postoperative neurological function and gene methylation-based classification. Binary regression and Cox proportional hazards models were applied to determine factors associated with outcome. Pre-operative embolization was performed in 337 patients (42%). Cardiovascular events after surgery comprised mostly deep vein thrombosis (N = 39) and pulmonary embolisms (N = 64). On multivariate analyses of post-operative cardiovascular adverse events controlling for established risk factors, there were associations with embolization (OR 2.38, 95% CI 1.37-4.00), and with female gender (OR 2.18, 95% CI 1.17-4.08). Recurrence-free survival (RFS) of embolized patients was less favorable among patients with WHO grade II or grade III meningiomas (median RFS: 4.3 vs. 7.0 years, P = 0.029) or in patients with intermediate or malignant gene methylation subtype meningiomas (median RFS: 2.0 vs. 8.2 years, P = 0.005). Pre-operative meningioma embolization may cause adverse outcomes. Randomized trials to determine benefit-risk ratios are warranted to clarify the role of pre-operative embolization for the treatment of meningioma patients.


Synthesis and Preclinical Evaluation of 11C-UCB-J as a PET Tracer for Imaging the Synaptic Vesicle Glycoprotein 2A in the Brain.
The synaptic vesicle glycoprotein 2A (SV2A) is found in secretory vesicles in neurons and endocrine cells. PET with a selective SV2A radiotracer will allow characterization of drugs that modulate SV2A (e.g., antiepileptic drugs) and potentially could be a biomarker of synaptic density (e.g., in neurodegenerative disorders). Here we describe the synthesis and characterization of the SV2A PET radiotracer (11)C-UCB-J ((R)-1-((3-((11)C-methyl-(11)C)pyridin-4-yl)methyl)-4-(3,4,5-trifluorophenyl)pyrrolidin-2-one) in nonhuman primates, including whole-body biodistribution. (11)C-UCB-J was prepared by C-(11)C-methylation of the 3-pyridyl trifluoroborate precursor with (11)C-methyl iodide via the Suzuki-Miyaura cross-coupling method. Rhesus macaques underwent multiple scans including coinjection with unlabeled UCB-J (17, 50, and 150 μg/kg) or preblocking with the antiepileptic drug levetiracetam at 10 and 30 mg/kg. Scans were acquired for 2 h with arterial sampling and metabolite analysis to measure the input function. Regional volume of distribution (VT) was estimated using the 1-tissue-compartment model. Target occupancy was assessed using the occupancy plot; the dissociation constant (Kd) was determined by fitting self-blocking occupancies to a 1-site model, and the maximum number of receptor binding sites (Bmax) values were derived from baseline VT and from the estimated Kd and the nondisplaceable distribution volume (VND). (11)C-UCB-J was synthesized with greater than 98% purity. (11)C-UCB-J exhibited high free fraction (0.46 ± 0.02) and metabolized at a moderate rate (39% ± 5% and 24% ± 3% parent remaining at 30 and 90 min) in plasma. In the monkey brain, (11)C-UCB-J displayed high uptake and fast kinetics. VT was high (∼25-55 mL/cm(3)) in all gray matter regions, consistent with the ubiquitous expression of SV2A. Preblocking with 10 and 30 mg/kg of levetiracetam resulted in approximately 60% and 90% occupancy, respectively. Analysis of the self-blocking scans yielded a Kd estimate of 3.4 nM and Bmax of 125-350 nM, in good agreement with the in vitro inhibition constant (Ki) of 6.3 nM and regional Bmax in humans. Whole-body biodistribution revealed that the liver and the brain are the dose-limiting organs for males and females, respectively. (11)C-UCB-J exhibited excellent characteristics as an SV2A PET radiotracer in nonhuman primates. The radiotracer is currently undergoing first-in-human evaluation.


Magnetic resonance imaging as an alternative to computed tomography in select patients with traumatic brain injury: a retrospective comparison.
Traumatic head injury (THI) is a highly prevalent condition in the United States, and concern regarding excess radiation-related cancer mortality has placed focus on limiting the use of CT in the evaluation of pediatric patients with THI. Given the success of rapid-acquisition MRI in the evaluation of ventriculoperitoneal shunt malfunction in pediatric patient populations, this study sought to evaluate the sensitivity of MRI in the setting of acute THI. Medical records of 574 pediatric admissions for THI to a Level 1 trauma center over a 10-year period were retrospectively reviewed to identify patients who underwent both CT and MRI examinations of the head within a 5-day period. Thirty-five patients were found, and diagnostic images were available for 30 patients. De-identified images were reviewed by a neuroradiologist for presence of any injury, intracranial hemorrhage, diffuse axonal injury (DAI), and skull fracture. Radiology reports were used to calculate interrater reliability scores. Baseline demographics and concordance analysis was performed with Stata version 13. The mean age of the 30-patient cohort was 8.5 ± 6.7 years, and 63.3% were male. The mean Injury Severity Score was 13.7 ± 9.2, and the mean Glasgow Coma Scale score was 9 ± 5.7. Radiology reports noted 150 abnormal findings. CT scanning missed findings in 12 patients; the missed findings included DAI (n = 5), subarachnoid hemorrhage (n = 6), small subdural hematomas (n = 6), cerebral contusions (n = 3), and an encephalocele. The CT scan was negative in 3 patients whose subsequent MRI revealed findings. MRI missed findings in 13 patients; missed findings included skull fracture (n = 5), small subdural hematomas (n = 4), cerebral contusions (n = 3), subarachnoid hemorrhage (n = 3), and DAI (n = 1). MRI was negative in 1 patient whose preceding CT scan was read as positive for injury. Although MRI more frequently reported intracranial findings than CT scanning, there was no statistically significant difference between CT and MRI in the detection of any intracranial injury (p = 0.63), DAI (p = 0.22), or intracranial hemorrhage (p = 0.25). CT scanning tended to more frequently identify skull fractures than MRI (p = 0.06). MRI may be as sensitive as CT scanning in the detection of THI, DAI, and intracranial hemorrhage, but missed skull fractures in 5 of 13 patients. MRI may be a useful alternative to CT scanning in select stable patients with mild THI who warrant neuroimaging by clinical decision rules.


Celiac disease and dermatitis herpetiformis in Brazilian twins: a long-term follow-up and screening of their relatives.
To investigate three pairs of twins with celiac disease (CD) concerning clinical presentation, diagnostic procedures, and long-follow-up, besides screening CD in their first-degree relatives. CD was diagnosed in childhood by endoscopic duodenal biopsy in two monozygotic (MZ) female pairs (A1 and A2, B1 and B2) and one dizygotic (DZ) pair, in which the male (C1) had CD and the female (C2) was negative. The patients had periodic evaluations after a gluten-free diet (GFD) for 16 to 21 years. Nine first-degree relatives were screened by serological tests and when positive, referred for intestinal biopsies. At diagnosis, all CD patients had the classic presentation. A1/A2: scalloped duodenal mucosa with atrophic areas, Marsh III-b, after 16 years of GFD was antiendomysium antibody (EmA) negative, normal mucosa. B1/B2 at diagnosis: mucosal atrophy, Marsh III-b, after 21 years was EmA negative, decreased folds. Patient C1: decreased folds, Marsh III-b, after 16 years was EmA positive, decreased folds, admitted to gluten ingestion. A1, A2, and B1 presented dermatitis herpetiformis. The father of A1/A2 and the mother of C1/C2 were celiac. The long-term follow-up of the patients allowed some observations such as the concordance for CD in MZ twins, both in relation to the time of onset and the severity of the disease. Also, the findings of serological, endoscopic, and histological analyses were similar. Dermatitis herpetiformis was present in patients with CD, with partial concordance in MZ twins.


[The effect of some medications used in the treatment of cerebrovascular diseases on free radical oxidation in the model systems].
The effect of 5 medications used in the treatment of ischemic brain lesions on free radical oxidation was studied. The efficacy level was evaluated by chemoluminescent changes in the model systems generating active oxygen species and lipid peroxides radicals. The most active antioxidants inhibiting chemo luminescence proved to be mexidol, cavinton, instenon. Piracetam acts less effectively. Actovegin did not practically display any antioxidant activity. Thus, the medications studied have different effect on free radical oxidation, dysregulation of which underlies many neurological diseases i.e. ischemic blood circulation disorders.


Antiphospholipid antibodies bind to activated but not resting endothelial cells: is an independent triggering event required to induce antiphospholipid antibody-mediated disease?
Antiphospholipid antibodies (aPL) cause thrombotic disease and recurrent pregnancy loss. Despite their name it is now clear that the antigen for most antiphospholipid antibodies is the phospholipid-binding protein beta(2) glycoprotein I (beta(2)GPI). However, beta(2) glycoprotein I is only antigenic for antiphospholipid antibodies when the protein is immobilised on a suitable surface such as phosphatidyl serine. It has been suggested that antiphospholipid antibodies bind to beta(2) glycoprotein I on the surface of resting endothelial cells and this in turn leads to endothelial activation and the initiation of thrombosis. However, as phosphatidyl serine is absent from resting endothelial cell membranes, we questioned this hypothesis. The ability of human antiphospholipid antibody-containing sera and monoclonal antiphospholipid antibodies to interact with endothelial cells was examined using cell-based ELISAs employing human umbilical vein endothelial cells (HUVECs) as the antigen. The expression of adhesion molecules in response to treatment with antiphospholipid antibodies was also measured by a cell-based ELISA. Activation of NF kappa beta was examined using electrophoretic mobility shift assays (EMSAs). Neither monoclonal antiphospholipid antibodies nor human sera containing antiphospholipid antibodies bound to resting endothelial cells. In contrast, one monoclonal antiphospholipid antibody did bind to both activated and apoptotic endothelial cells. Antiphospholipid antibodies do not bind to resting endothelial cells nor do antiphospholipid antibodies activate resting endothelial cells. Rather, an independent triggering event is required to activate endothelial cells and subsequently some antiphospholipid antibodies may then bind to the activated endothelial cells and initiate a thrombogenic process.


[Managed health care: scope, concept and strategic management potentials from the viewpoint of the Swiss Accident Insurance Fund].
The following item presents briefly the cost relevant factors in health care in Switzerland. The principal key issues and reasons for managed health care programs are dealt with by recognizing the new health care law. In order to present the central strategies for improvement in managed care from an integral point of view, managed health care is being treated in the context of a widely founded conceptional framework. A very detailed and medically complete as well as performance oriented case statistic of medical treatments is a strategic success and key factor. The author represents the thesis that the given opportunities and micro-management tools could be much more widely used, that they should be extended and that, therefore, the strength of our independent and liberal health care system could be much better integrated in the context of a necessary social acceptance. This shall not only be reached by maximising the individual revenues, but by optimizing structures and increasing organizational effectiveness in medical health care. The existing readiness of the health care suppliers, especially the physicians, to take over responsibility in improving health care outcome is the core to this strategy.


Generation of non-classical states of mirror motion in the single-photon strong-coupling regime.
When a trichromatic laser field is applied to a cavity optomechanical system within the single-photon strong-coupling regime, we find that the motion of mirror can evolve into a dark state such that the cavity field mode cannot absorb energy from the external field. Via tuning three components of the pumping field to be resonant to the carrier, red-sideband and blue-sideband transitions in the displaced representation respectively, the state of mirror motion can exhibit non-classical properties, such as that in the Lamb-Dicke limit, the state evolves into a squeezed coherent state, and beyond the limit, the state can become a squeezed non-Gaussian state.


Purification, crystallization and preliminary X-ray diffraction studies of disintegrin (schistatin) from saw-scaled viper (Echis carinatus).
This is the first report of crystallographic data on a disintegrin molecule from any source. The heterodimeric disintegrin with a molecular weight of 14 kDa from Echis carinatus venom is a potent antagonist of alpha4 integrins. The intact disintegrin, containing two subunits A and B, was isolated and purified using affinity and ion-exchange columns. It has been crystallized using 1.6 M ammonium sulfate as a precipitating agent. The crystals grew to dimensions of 0.25 x 0.20 x 0.20 mm and diffracted to 2.5 A resolution. The crystals belong to space group I4(1)22, with unit-cell parameters a = b = 91.7, c = 55.1 A. Assuming a molecular weight of 14 kDa, a V(M) of 2.1 A(3) Da(-1) is obtained for one molecule of disintegrin in the asymmetric unit.


Disruption of thalamic connectivity in Alzheimer's disease: a diffusion tensor imaging study.
The aim of this study was to evaluate the structural integrity of the thalamic connectivity of specific fiber tracts in different stages of Alzheimer's disease (AD) using diffusion tensor imaging (DTI). Thirty-five patients with AD and 22 normal control (NC) subjects were recruited. Based on Mini Mental State Examination score, the AD patients were divided into three subgroups for comparison with the NC group: mild (mi-AD, n = 14), moderate (mo-AD, n = 12), and severe (se-AD, n = 9) AD. The fornix (FX), anterior thalamic radiation (ATR), and posterior thalamic radiation (PTR) were selected to represent the thalamic connectivity with other brain regions. The fornix was divided into the column and body of the fornix (FX-1) and the bilateral fornix (crus)/stria terminalis (FX-2/ST) based on the atlas. Through the atlas-based analysis and fiber tracking method, we measured fractional anisotropy (FA), mean diffusivity (MD), and tract volume to reflect the microstructural and macrostructural changes of these fibers during AD progression. There were significant differences in the FA and MD of all fibers, except the right PTR, between the AD and NC subjects. Further subgroup analyses revealed that the mi-AD subgroup had decreased FA only in the FX-1 and increased MD in the FX-1 and bilateral ATR, the mo-AD subgroup showed declined FA and increased MD in the FX-1, bilateral FX-2/ST and ATR; the se-AD subgroup exhibited lower FA and higher MD values in all fibers except the right PTR. We also found reduced tract volume values in the FX and left ATR in the AD patients. Further subgroup analyses revealed that these differences only existed in the se-AD patients. Our DTI analyses indicate that the integrity of thalamic connectivity is progressively disrupted following cognitive decline in AD and that DTI parameters in the column and body of the fornix show promise as potential markers for the early diagnosis of AD and for monitoring disease progression.


[Estimation of 99mTc-GSA receptor amount by non-linear 3-compartment model: ligand-receptor binding model without blood sampling].
99mTc-GSA (galactosyl serum albumin) receptor amount (Ro) was estimated by a non-linear 3-compartment model of the ligand-receptor binding without blood sampling. Forward/reverse rate constants and receptor amount were assumed to be variable. Relationship between this parameter and other conventional parameters including ICG R15 (15-minutes retention rate of indocyanine green) was evaluated for 43 surgical candidates with liver tumors. Linear relationships between Ro and HH15 and LHL15 were R2 = 0.73 and 0.72, respectively. Linear relationship between Ro and Rmax, the maximum removal rate, is also good (R2 = 0.84), and the regression line (y = 0.038x + 0.066) was slightly over 0 at y-interception. Linear relationship between Ro and ICG R15, was poor (R2 = 0.39) and relationship was rather a concave shape. Linear relationship of reduction rate between Ro and non-tumor tissue volume of the liver, which assessed at the same day of two weeks after the operation, was y = 1.09x - 0.01 (R2 = 0.82). GSA receptor amount, Ro, seems to change proportional to non-tumor liver tissue volume changing before and after hepatectomy. Complementary to ICG R15, it may be an useful and intuitive parameter for hepatectomy.


CD43, a molecule defective in Wiskott-Aldrich syndrome, binds ICAM-1.
THE protein CD43 (also known as sialophorin, leukosialin, large sialoglycoprotein or gp115) is expressed on the surface of T lymphocytes, monocytes, neutrophils, platelets and some B lymphocytes. Expression of CD43 is deficient and/or defective in the X-chromosome-linked immunodeficiency disorder Wiscott-Aldrich syndrome, suggesting that CD43 might have a role in T-cell activation. We have shown that expression of human CD43 in an HLA-DR-specific murine T-cell hybridoma enhances the antigen-specific response to stimulation by the human lymphoblastoid cell line Daudi, and that Daudi cells bind specifically to purified immobilized CD43. These data indicate that the specific interaction of CD43 with a ligand on the surface of Daudi cells might contribute to T-cell activation. Here we report evidence that intercellular adhesion molecule-1 (ICAM-1, or CD54), is a ligand for CD43.


Copper nanoflowers as effective antifungal agents for plant pathogenic fungi.
Flower-shaped copper nanoparticles were synthesised by a green and ecofriendly chemical reduction approach using copper sulphate and cytyltrimethal ammonium bromide. The UV-vis spectrophotometer analysis showed maximum absorption at about 552 nm, which is specifically reported for copper nanoparticles. The crystal lattice structure of copper nanoflowers was confirmed by X-ray diffraction analysis. Further, the transmission electron microscopic studies revealed the flower shape copper nanoparticles in the size range of 100-500 nm. The stability of thus synthesised copper nanoflowers was assessed by zeta potential analysis, which was found to be 35 mV indicating the most stable nature of nanoflowers. The antifungal activity of these copper nanoflowers was evaluated by Kirby-Bauer disk diffusion method against selected common plant pathogenic fungi. It was found that the chemosynthesised copper nanoflowers demonstrated significant inhibitory activity against the plant pathogenic Aspergillus niger, Fusarium moniliforme, F. culmorum, F. oxysporum and F. tricinctum. The maximum antifungal activity was shown against A. niger followed by F. moniliforme, F. oxysporum and F. tricinctum, whereas the minimum activity was reported against F. culmorum. Similarly, the effect of the copper nanoflowers was also evaluated in combination with commercial antifungal agent (ketoconazole), which demonstrated the enhanced activity of antifungal agent.


Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure.
The AVOID-HF (Aquapheresis versus Intravenous Diuretics and Hospitalization for Heart Failure) trial tested the hypothesis that patients hospitalized for HF treated with adjustable ultrafiltration (AUF) would have a longer time to first HF event within 90 days after hospital discharge than those receiving adjustable intravenous loop diuretics (ALD). Congestion in hospitalized heart failure (HF) patients portends unfavorable outcomes. The AVOID-HF trial, designed as a multicenter, 1-to-1 randomized study of 810 hospitalized HF patients, was terminated unilaterally and prematurely by the sponsor (Baxter Healthcare, Deerfield, Illinois) after enrollment of 224 patients (27.5%). Aquadex FlexFlow System (Baxter Healthcare) was used for AUF. A Clinical Events Committee, blinded to the randomized treatment, adjudicated whether 90-day events were due to HF. A total of 110 patients were randomized to AUF and 114 to ALD. Baseline characteristics were similar. Estimated days to first HF event for the AUF and ALD group were, respectively, 62 and 34 (p = 0.106). At 30 days, compared with the ALD group, the AUF group had fewer HF and cardiovascular events. Renal function changes were similar. More AUF patients experienced an adverse effect of special interest (p = 0.018) and a serious study product-related adverse event (p = 0.026). The 90-day mortality was similar. Compared with the ALD group, the AUF group trended toward a longer time to first HF event within 90 days and fewer HF and cardiovascular events. More patients in the AUF group experienced special interest or serious product-related adverse event. Due to the trial's untimely termination, additional AUF investigation is warranted.


Older adults' perceptions of weakness and ageing.
Age-related weakness, or sarcopenia, has been related to functional disability, falls, frailty and mortality. Although it is one of the most common symptoms older adults link to their functional abilities, to date, no studies have explored older adults' perceptions of weakness and its association with ageing. To understand the meaning of weakness for older adults' and their perceptions of its association with ageing. A qualitative descriptive design involved in-depth interviews with 13 community-dwelling older adults. Weakness was described primarily in two ways: (i) inability and (ii) inward turning. The extreme of weakness, as giving up and giving in, which older adults applied to others, not themselves, prompted them to engage in several efforts at staying strong. These included motivating self-talk, achieving balance, keeping busy and active, and self-validating as a strong person. Older adults' perceptions of the association between weakness and ageing were variable and characterized by considerable ambiguity. Nurses must be alert to both the visible and subtler dimensions of weakness. It is important to engage older adults in active strategies that enhance muscle strength while capitalizing on their self-motivating and validating efforts at staying strong.


Importance of confirmatory testing in donated blood.
During the period from January 1995 to January 1996 blood units from 8747 blood donors were screened for blood-borne viruses at King Khalid University Hospital, Riyadh, Saudi Arabia. These tests included HBsAg, antibodies to hepatitis C virus (anti-HCV), antibodies to human immunodeficiency viruses (anti-HIV-1/2). During the same period 1500 blood units were screened for antibodies to human T-cell lymphotropic virus type 1 (anti-HTLV-1). Among the 8747 blood donors, 2.7% were found to be HBsAg-positive on initial screening but 2.2% were confirmed as HBsAg-positive. Regarding HCV, 2.8% were anti-HCV-positive on initial screening but the percentage dropped down to 1.6% on confirmation and only 12 (0.14%) were considered indeterminant by line immunoassay. None of the donors was confirmed anti-HIV- positive but five were diagnosed as indeterminant by western blot. Only four were anti-HTLV- I - positive on initial screening but were diagnosed as indeterminant by western blot. In total, 492 (5.6%) of the blood units tested were reactive for any one of the four viruses on screening but only 327 (3.7%) were confirmed positive. All 492 blood units were not recommended for transfusion. This raises the question of the usefulness of confirmatory testing in blood donation. We believe the confirmation is only important for counseling the donor and a non-reactive result on confirmation should not interfere with the decision of not recommending the blood for transfusion.


Population-based trends in treatment rates in psychiatry in Oxfordshire, 1975-1986.
Routinely collected abstracts of medical records for patients in Oxfordshire were used to identify each individual's first contact with specialist psychiatric in-patient, out-patient or community care services over a 12-year period (1975-1986). During this period first-contact rates for people under 65 years of age declined by 3.3 per cent. The decline was observed for contacts with specialist care outside hospital as well as for in-patient care. It is therefore not attributable simply to a shift away from in-patient care. The decline was seen in most major diagnostic groups including schizophrenia, affective psychosis and the neuroses, and it is therefore not attributable to changing diagnostic practices between these groups. Increases in first-contact rates in this age group were found for alcohol-related disorders in women and self-harm in men. First-contact rates for people aged 65 years and over increased by 3 per cent per year. The condition that mainly accounted for the increase over time was dementia, which was by far the commonest recorded psychiatric diagnosis in this age group. Although the increase was seen in all modes of care, it was the domiciliary visiting service that contributed most to the upward trend. The implications of these trends for service planning and their limitations as measures of changes in morbidity are discussed.


Undernutrition during the gestation and suckling periods does not cause any loss of pyramidal neurons in the CA2-CA3 region of the rat hippocampus.
The total number of hippocampal pyramidal cells in the CA2-CA3 region are reported to be unaffected by undernutrition during the gestation period. We hypothesised that this may not be the case in animals subjected to a lengthier period of undernutrition. Wistar rats were undernourished from conception until 21 post-natal days-of-age and killed for examination at 21 and 62 days-of-age. There were between 180-212 thousand pyramidal cells in control animals at both 21 and 62 days of age. Twenty-one-day-old undernourished rats had about 152 thousand such cells and this increased to about 206 thousand by 62 days-of-age. Analysis of variance tests on these data revealed a significant main effect of age but no group or interaction effects. Our experiments, therefore, confirm that these hippocampal pyramidal neurons are relatively spared the adverse effects of undernutrition during early life, even when this is extended to include both the gestation and suckling periods.


[The relationship between hyperinsulinemia and hypokalemic periodic paralysis in overweight/obesity subjects].
To study the relationship between hyperinsulinemia and primary periodic paralysis in overweight/obesity people. Overweight/obesity people with primary hypokalemic periodic paralysis were administrated as disease group. Serum potassium, insulin and glucose were analyzed at different time (0 h, 1 h, 2 h, 3 h, 4 h) after taking 100 g carbohydrates and the results were compared with that of control group matched by gender, age and body mass index (BMI). (1) Males were much more than females in disease group (14 males and 2 females), the onset age ranged from 20 to 50 years old. (2) Both the highest insulin level and the lowest potassium level appeared at one hour after taking the carbohydrates. And the highest insulin level of disease group was significant higher than that of control group. (3) The area under the curve of insulin and insulin/potassium of disease group was significant higher than that of control group. The postprandial hyperinsulinemia was an important factor in overweight/obesity people with hypokalemic periodic paralysis.


Late evaluation of patients undergoing valve replacement with the Björk-Shiley prosthesis.
This study analyzes 484 patients who survived mitral, aortic, or mitral and aortic valve replacement using the Björk-Shiley prosthesis from January, 1970, through December 31, 1974. Long-term follow-up of 1 1/2 to 6 1/2 years (mean, 3.67 yr) was done on 435 patients (98.2%). Eighty to 85% of the patients have improved noticeably. Thromboembolic problems occurred in 6.9%, representing 1.5 emboli per 1,000 patient-months. Anticoagulant bleeding problems occurred in 6.4% of the patients; late mortality was 15%. Actuarial survival curves showed patients at risk to 6 years having a 79% chance of survival. The same analysis according to preoperative New York Heart Association Functional Classification showed a striking reduction in survival in class IV patients. The Björk-Shiley prosthesis is a good choice for valve replacement today. Earlier diagnosis and treatment are needed to obtain better long-term survival.


Predictors and outcomes associated with trajectories of revenge goals from fourth grade through seventh grade.
The present study identified longitudinal trajectories of revenge goals in a sample of at-risk youth (N = 240; 63.3% male) followed from fourth grade through seventh grade. Three revenge goal trajectory groups were identified: a low-stable group, an increasing group, and a decreasing group. The increasing and decreasing groups were initially more behaviorally and affectively dysregulated and believed that aggression would gain them more rewards relative to the low-stable group. The increasing group was also more fearfully reactive compared to the decreasing group. Revenge goal trajectory groups also predicted trajectories of reactive and proactive aggression from 4th through 7th grade. The increasing group was more reactively aggressive and depressed and had poorer social skills in 8th grade compared to the other groups. Together, results highlight the importance of considering revenge motivations as an indicator of risk and a potential focus for intervention.


APC haploinsufficiency, but not CTNNB1 or CDH1 gene mutations, accounts for a fraction of familial adenomatous polyposis patients without APC truncating mutations.
Familial adenomatous polyposis (FAP) is an autosomal dominant condition characterized by the development of hundreds to thousands of colorectal adenomatous polyps. In addition to the classic form, there is also attenuated polyposis (attenuated adenomatous polyposis coli; AAPC), which is characterized by a milder phenotype. FAP/AAPC is caused by germline mutations in the adenomatous polyposis coli (APC) gene. Very recently, germline mutations in the base-excision repair gene MYH have been associated with recessive inheritance of multiple colorectal adenomas in a subset of patients. APC pathogenic alterations are mostly (>95%) represented by frameshift or nonsense mutations leading to the synthesis of a truncated protein. We identified 20 APC truncating mutation carriers out of 30 FAP/AAPC patients from different Italian kindreds. In the remaining 10 patients, we searched for alterations other than truncating mutations by enzymatic mutation detection, real-time quantitative RT-PCR, and genotyping of polymorphic markers encompassing the APC locus. Moreover, to assess whether mutations of genes interacting with APC can substitute or act in association with APC alterations, we sequenced both CTNNB1 (beta-catenin) and CDH1 (E-cadherin) genes. No CTNNB1 or CDH1 mutations were found. On the contrary, four patients showed a reduced APC gene expression compared with healthy subjects. In three of the four cases, genotyping results were compatible with a constitutive allelic deletion. In one case this conclusion was confirmed by haplotype segregation analysis. Our results support the notion that FAP/AAPC can result from APC constitutive haploinsufficiency, with gene deletion being a possible cause of reduced gene expression.