The relationship of coping behaviors to depressive symptoms in youth with epilepsy: an examination of caregiver and youth proxy report.
Study aims were to explore evaluation and comparison of measures of coping and the relationship of epilepsy-specific coping responses to depressive symptoms in youth with epilepsy (YWE). Seventy-six YWE ages 9-17 completed the Children's Depression Inventory (CDI) and the Kidcope. Sixty-six caregivers reported on youth coping (CHIC) and seizure activity. Epilepsy variables were abstracted from electronic medical records. There were no significant correlations between the CHIC coping factors and individual Kidcope scores. Only one CHIC factor, "competence/optimism," was significantly negatively correlated with CDI. Regression analyses revealed a significant association between CDI and negative coping (Kidcope) after adjusting for sex, number of AEDs, and seizure severity. On the CDI, 27% of YWE endorsed suicidal ideation. Findings provide preliminary support for use of the Kidcope as a measure of negative epilepsy-specific coping. These results imply that youth coping and suicidal ideation are important to assess in relation to depressive symptoms and that youth report of these symptoms is particularly salient to the evaluation of youth functioning.


Comparative morphology and ontogeny of the thoracolumbar transition in great apes, humans, and fossil hominins.
Variation among extant hominoid taxa in the anatomy of the thoracolumbar vertebral transition is well-established and constitutes an important framework for making inferences about posture and locomotion in fossil hominins. However, little is known about the developmental bases of these differences, posing a challenge when interpreting the morphology of juvenile hominins. In this study, we investigated ontogenetic variation in the thoracolumbar transition of juvenile and adult great apes, humans, and fossils attributed to Australopithecus and early Pleistocene Homo erectus. For each vertebra involved in the transition, we quantified functionally relevant aspects of zygapophyseal form: facet curvature in the transverse plane, facet orientation relative to midline, and the shift in these variables across the thoracolumbar transition, from the antepenultimate rib-bearing thoracic to the first lumbar vertebra (L1). Among extant hominids, adult individuals of Pan and Homo exhibit a greater shift in facet morphology across the thoracolumbar transition in comparison to Gorilla and Pongo. This pattern is driven by interspecific differences in the L1 facets, with those of chimpanzees and humans being more curved and more sagittally oriented. Chimpanzees and humans also experience more change in facet morphology during development relative to gorillas and orangutans. Humans differ from chimpanzees in achieving their adultlike configuration much earlier in development. The fossil specimens indicate that early hominins had adult morphologies that were similar to those of extant Homo and Pan, and that they achieved their adult morphologies early in development, like extant humans. Although it is unclear why adult chimpanzees and hominins share an adult morphology, we speculate that the early acquisition of adultlike L1 zygapophyseal morphology in hominins is an evolutionary novelty related to conferring stability to a relatively long lumbar spine as young individuals are learning to walk bipedally.


Calcium channels: unanswered questions.
Despite decades of intensive research, many questions remain unresolved regarding the structure and function of voltage-dependent calcium channels. This review considers some of those questions: Where is the activation gate? Where are the inactivation gates? How are the voltage sensors coupled to the gates? Are bacterial K+ channels good models for the Ca2+ channel pore? Are protein-protein interactions fundamental to Ca2+ channel function? Do voltage-dependent Ca2+ channels regulate basal intracellular Ca2+? Are N and P/Q channels specialized for fast neurotransmitter release?


Nutritional status as an indicator of impending food stress*.
Famine early warning systems benefit from a variety of indicators which together signal the initial stages of food stress for particular population groups. Anthropometry has been used as an indicator in early warning systems, but there are inherent problems in its use which should be understood. Using data from Turkana pastoralists of northwest Kenya, this paper discusses the problems of: time lag between food shortages and changes in body size and composition; use of reference points; accurate age assessment; and establishment of baseline data. Diet composition data are suggested to be an additional nutrition-oriented indicator of impending food stress and one in which problems associated with anthropometry are not inherent. Both measures may be useful in monitoring a population, but their strengths and weaknesses should be appreciated.


CD44-targeted docetaxel conjugate for cancer cells and cancer stem-like cells: a novel hyaluronic acid-based drug delivery system.
A CD44-targeted macromolecular conjugate of docetaxel was prepared via a pH-sensitive linkage to hyaluronic acid and was characterized using NMR, gel permeation chromatography, and differential scanning calorimetry. The conjugated species were further evaluated in terms of drug release, cytotoxicity, cellular uptake, cell cycle inhibition, and subacute toxicity in mice. Cellular microscopic studies revealed that CD44-expressing cells including MCF-7 cancer stem cells and MDA-MB-231 metastatic breast cancer cells had internalized the conjugates via a selective receptor-mediated mechanism, leading to cell cycle arrest in the G2/M phase. Hyaluronic acid-docetaxel conjugates showed specific toxicity only in CD44-expressing cells in vitro, along with a decreased risk of neutropenia and dose-dependent mortality in vivo. Hyaluronic acid-drug conjugates represent a promising and efficient platform for solubilization of sparingly soluble molecules as well as active and selective targeted delivery to cancer cells and cancer stem cells.


Intravenous methoxy polyethylene glycol-epoetin beta for haemoglobin control in patients with chronic kidney disease who are on dialysis: a randomised non-inferiority trial (MAXIMA).
Conventional treatment with epoetin to manage anaemia in chronic kidney disease needs frequent administrations, changes of dose, and close monitoring of haemoglobin concentrations. We aimed to compare the effectiveness of methoxy polyethylene glycol-epoetin beta, given intravenously at 2-week or 4-week intervals, with epoetin treatment one to three times per week for haemoglobin control in haemodialysis patients. We screened 1115 adult patients from 96 centres who had stable chronic renal anaemia and were on dialysis treatment and intravenous maintenance epoetin. We did an open-label, parallel-group, non-inferiority trial to compare two dosing intervals of methoxy polyethylene glycol-epoetin beta with standard epoetin treatment. We established baseline haemoglobin concentration and eligibility over a 4-week run-in period. 223 patients were randomly assigned to receive methoxy polyethylene glycol-epoetin beta every 2 weeks, and 224 to receive it every 4 weeks. The initial dose was based on the average epoetin dose given during the week before the switch. The primary endpoint was change in haemoglobin concentration between baseline and the assessment period. We analysed patients both by intention to treat and per protocol. This study is registered with ClinicalTrials.gov, number NCT00077610. We excluded 133 of the 673 randomised patients from the per-protocol analysis because they had inadequate iron status or fewer than five haemoglobin measurements during the assessment period or needed red blood cell transfusions. The mean change from baseline haemoglobin for patients who had switched to intravenous methoxy polyethylene glycol-epoetin beta every 2 weeks (-0.71 g/L, 95% CI -2.20 to 0.77) or every 4 weeks (-0.25 g/L, -1.79 to 1.29) was non-inferior to the mean change for patients who continued treatment with epoetin (-0.75 g/L, -2.26 to 0.75) (p<0.0001 for both comparisons). Of the 666 patients who received at least one dose of study drug, the incidence of adverse events or serious adverse events did not differ between groups (p=0.30 and p=0.40, respectively). This long-acting erythropoiesis-stimulating agent is as safe as conventional epoetin treatment, and can maintain anaemia management in haemodialysis patients when given intravenously at 4-week dosing intervals.


[Tear film changes after phacoemulsification].
To evaluate tear film changes after phacoemulsification. This prospective randomized study involved 68 consecutive patients with age-related cataract (79 eyes) who underwent phacoemulsification. Tear break-up time, Schirmer I test (S I t) value, corneal fluorescein staining, tear film pattern by DR-1 tear interfermetry and the height of tear meniscus were measured preoperatively and 1 day and 2, 7, 14, 30, 180 days postoperatively. At 1 day and 2 days postoperatively, the mean tear break-up time reduced greatly, and the number of patients who showed III to V tear film pattern, the mean S I t value, the height of tear meniscus and fluorescein staining scores increased significantly (P < 0.001 for day 1, P < 0.005 for day 2). S I t value at 7 days postoperatively (P = 0.831) and the height of tear meniscus at 14 days returned to their preoperative values (P = 1.000). The tear break-up time, corneal fluorescein staining scores and the grades of tear film pattern all recovered at 30 days postoperatively (P > 0.05). At 30 days postoperatively, 19.3% of patients showed shorter tear break-up time and less S I t value than that of preoperative day. In addition, 1/9 of the patients with normal preoperative tear film experienced dry eye at 30 days postoperatively. The cases with tear break-up time < 10 seconds compared to patients with tear break-up time >/= 10 seconds were more easily to show tear instability postoperatively (relative risk 13.5, 8.25, 20.0, 39.0, 8.6, 3.9 at 1 day and 2, 7, 14, 30, 180 postoperative days, respectively). Phacoemulsification significantly alters the tear break-up time, S I t value, corneal fluorescein staining, tear film pattern and the height of tear meniscus. Some patients with normal tear film may experience dry eye after surgery. Patients with preexisting tear break-up time < 10 seconds are easily at risk of experiencing the tear film instability postoperatively.


[Contraception and its effect on the quality of prenatal care].
Out of a total of 618 followed-up pregnant women, 154 (24.91%) had never used contraception, while 464 (75.08%) had used it until the pregnancy at the time of this study. Among those who came to the first examination only after the 12th week of pregnancy there were 21.98% of the users and as many as 68.83% of the nonusers of contraception. Five or fewer examinations during pregnancy were performed in 11.63% of the users and in 41.55% of the non-users of contraception. There were 9.48% of the users and 27.27% of the non-users of contraception who did not attend prenatal consultation courses. These three parameters were applied for assessing the quality of prenatal care. A better quality of prenatal care in the users of contraception could be explained by their greater concern for the problems of reproduction.


[Control of the efficacy of anti-arrhythmic treatments].
The evaluation of antiarrhythmic drug efficacy can be based on clinical history, ambulatory monitoring and/or clinical electrophysiological investigations. The respective indications for such methods depend mainly on the nature of the arrhythmia, its severity, and the aim of the study. In benign arrhythmias the goal is to improve the patient's symptoms. In chronic arrhythmias Holter monitoring is the best means of quantitating the actual benefit of the treatment. In triggerable paroxysmal arrhythmias electrophysiological methods are very useful even though they do not afford total security as far as long-term follow-up is concerned.


Phyto-extracts in wound healing.
Data generated through systematic investigation, carried out on the evaluation of phyto-extracts on wound healing research during the last 20 years have been compiled. About 450 plant species having wound healing properties have been identified. The present knowledge of the wound healing process comprise coagulation, inflammation, proliferation, formation and accumulation of fibrous tissues, collagen deposition, epithelialization, contraction of wound with formation of granulation tissues, remodeling and maturation. The constituents of the plant extracts modulate one or more of the above stages. It was the endeavor to identify the active constituents responsible for antimicrobial activity, free radical scavenging properties, stimulators of enhanced collagen production and/or angiogenesis promoters with identification of lead scaffold chemical structures. Multiple phytochemicals concentrated and blended in optimal concentrations, are expected to be available in future years to carry out multi-tasking efforts in wound healing as more knowledge about the properties of the key constituents are unveiled.


UK parents' experiences of their child receiving a diagnosis of autism spectrum disorder: A systematic review of the qualitative evidence.
The purpose of this article is to systematically identify, appraise and synthesise qualitative research concerning UK parents' experiences of their child receiving a diagnosis of autism spectrum disorder. In total, 11 articles were located through a systematic search of five databases, reference lists, citations and grey literature. These were critically appraised and their results synthesised using meta-ethnography. The quality scores given to included studies were variable, so suggestions are made to improve reporting of future research. Three third-order constructs were developed: (1) emotional needs, (2) informational needs and (3) relational needs. Each relates to parents' needs as they navigate the process of making sense of their child by seeking and adjusting to a diagnosis of autism spectrum disorder. Parents' experiences of assessment and diagnosis of their children varied, but these needs were evident across the course of the process. Fathers seemed to find it more difficult than mothers to reconcile having a child with autism spectrum disorder, which may have been grounded in a sense of exclusion from the assessment process. The findings should be considered by professionals working with children, particularly those directly involved in diagnosing autism spectrum disorder. Clinical implications emphasise the need for consideration of parents' emotional needs, provision of information to aid understanding, and strong relationships with professionals. Future clinical research, which should be informed by quality standards, might develop and evaluate standards of assessment and diagnosis, including post-diagnostic support.


Regulation and role of myocardial collagen matrix remodeling in hypertensive heart disease.
In hypertensive heart disease, reactive myocardial fibrosis represents as an excessive accumulation of fibrillar collagen within the normal connective tissue structures of the myocardium. The fact, that the myocardium of both ventricles is involved, irrespective of ventricular loading conditions, suggests that circulating factors, and not the hemodynamic load are primary responsible for this adverse response of the myocardial fibrous tissue. In various experimental in vivo models, it has been shown that myocardial fibrosis is always associated with activation of circulating or local renin-angiotensin-aldosterone systems (RAAS). Cardiac collagen metabolism is regulated by cardiac fibroblasts which express mRNAs for types I and III collagens, the major fibrillar collagens in the heart, and for interstitial collagenase or matrix metalloproteinase (MMP) 1 which is the key enzyme for interstitial collagen degradation. In order to elucidate the role of the RAAS effector hormones, angiotensin II (AngII) and aldosterone (ALDO), in the regulation of collagen synthesis or inhibition of MMP 1 production, adult human cardiac fibroblasts were cultured. Collagen synthesis was determined by 3H-proline incorporation, and MMP 1 activity by degradation of 14C-collagen measured under serum-free conditions in confluent fibroblasts after 24 hour-incubation with either AngII or ALDO over a wide range of concentrations (10(-11)-10(-6)M). In addition, the effects of the mineralocorticoid, deoxycorticosterone (DOC), and prostaglandin E2 (PGE2) on cardiac fibroblast function were determined. Compared with untreated control fibroblasts, collagen synthesis, normalized per total protein synthesis, showed a significant and dose-dependent increase after incubation with either mineralocorticoid hormone, ALDO or DOC, or after incubation with AngII. In contrast, collagen synthesis of cardiac fibroblasts was significantly decreased by PGE2 treatment. AngII type 1 or mineralocorticoid receptor antagonists, respectively, were able to completely inhibit the AngII- or mineralocorticoid-mediated increase of collagen synthesis. Furthermore, AngII significantly decreased MMP 1 activity while ALDO or DOC had no effect on cardiac fibroblast-mediated collagen degradation. In contrast, PGE2 significantly increased MMP 1 activity. Thus cardiac fibroblast function is modulated by either effector hormone of the RAAS, AngII and ALDO, via specific receptors that lead to progressive myocardial fibrosis in disease states where circulating or local RAAS is activated, i.e., in hypertensive heart disease. In contrast, PGE2, which would be elevated in myocardial tissue after angiotensin-converting enzyme inhibition, counteracts the fibrotic effects of the RAAS on myocardial tissue.


Thermal balance effects on vigilance during 2-hour exposures to -20 degrees C.
Human mental performance is markedly affected by environmental temperature, body temperature, body heat content, and comfort, but the effects of these different factors are not entirely clear. A liquid conditioning garment (LCG) can be used to manipulate these factors independently. We hypothesized that cold exposure (coldEX) has negative effects on vigilance which can be alleviated by increasing body heat content throughout or prior to coldEX. Subjects (n = 10) were tested for vigilance during a 130-min coldEX to -20 degrees C while warmly clothed; a period of moderate exercise occurred at minutes 64-74. An LCG was used to provide heating either before coldEX (prior heating, PH) or throughout coldEX (heating, H); the control condition involved no heating (NH). There were significant differences among conditions for rectal temperature (PH: 37.3 +/- 0.26 degrees C, H: 37.0 +/- 0.24 degrees C, NH: 37.05 +/- 0.26 degrees C) and mean skin temperature (PH: 33.85 +/- 1.21 degrees C, H: 35.11 +/- 1.35 degrees C, NH: 32.84 +/- 0.65 degrees C). Reaction time decreased significantly after the 45th minute of coldEX in H and NH. At the same time, signal detection criteria in all conditions demonstrated considerable alterations, indicating bias in favor of 'target-present' responses, which were associated with lower mean skin temperature and thermal comfort vote. PH was more effective than H and NH in preserving reaction time and response consistency. Relative to men, women demonstrated increased heat loss and more deteriorated vigilance and signal detection. Vigilance deteriorates in cold conditions within 45 min of exposure. Increasing body heat content prior to coldEX is efficacious in preserving vigilance performance during exposures lasting up to 2 h.


Misuse of intravenous verapamil in patients with ventricular tachycardia.
Intravenous verapamil is effective in the acute termination of supraventricular tachycardia but is also used for broad-complex tachycardia when the diagnosis is uncertain. This study analysed the responses to verapamil in 57 episodes of ventricular tachycardia, incorrectly diagnosed as supraventricular tachycardia, in 32 patients. Diagnostic electrocardiographic features of ventricular tachycardia were present in 81% of episodes. Intravenous verapamil (mean dose 9.8 mg) failed to terminate the tachycardia in 45 episodes (79%). 2 patients sustained cardiac arrest after verapamil (1 ventricular fibrillation, 1 asystole), and in 22 episodes severe hypotension occurred. At least one serious adverse effect occurred in 19 patients (59%). Sinus rhythm was restored after verapamil on 10 occasions in 6 patients. Verapamil is ineffective and potentially hazardous in most patients with ventricular tachycardia. It should not be used to treat broad-complex tachycardia unless a supraventricular origin has been established.


Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists.
Bicycle seat pressure on the perineum may impair arousal and clitoral erection, likely contributing to genital pain and numbness experienced by female cyclists. We aimed to identify the association between genital pain and numbness experienced by female cyclists and female sexual dysfunction (FSD). Female cyclists were recruited to complete an online survey using the Female Sexual Function Index (FSFI), a validated questionnaire to assess FSD. Cyclist demographics, experience, preferred riding style, use of ergonomic cycle modifications, and genital discomfort while riding were also queried. Multivariate logistic regression analysis was used to evaluate risk factors of FSD. The main outcome was FSFI score, which is used to diagnose FSD when the FSFI score is <26.55. Of the survey respondents, 178 (53.1%) completed the survey and FSFI questionnaire. Mean age was 48.1 years (±0.8 standard error [SE]), and the average riding experience was 17.1 years (±0.9 SE). Overall, 53.9% of female cyclists had FSD, 58.1% reported genital numbness, and 69.1% reported genital pain. After adjusting for age, body mass index, relationship status, smoking history, comorbidities, and average time spent cycling per week, females who reported experiencing genital numbness half the time or more were more likely to have FSD (adjusted odds ratio [aOR], 6.0; 95% CI, 1.5-23.6; P = .01), especially if localized to the clitoris (aOR, 2.5; 95% CI, 1.2-5.5; P = .02). Females that reported genital pain half the time or more while cycling also were more likely to have FSD (aOR, 3.6; 95% CI, 1.2-11.1; P = .02). Cyclists experiencing genital pain within the first hour of their ride were more likely to have FSD (aOR, 12.6; 95% CI, 2.5-63.1; P = .002). Frequency and duration of cycling were not associated with FSD. Analysis of FSFI domains found that the frequency of numbness was correlated with decreased arousal, orgasm, and satisfaction during intercourse, whereas the frequency of pain significantly reduced arousal, orgasm, and genital lubrication. Female cyclists that experience numbness and/or pain have higher odds of reporting FSD. Our study includes a validated questionnaire to assess FSD and queries specific characteristics and symptoms of genital pain and genital numbness; however, the study is limited by its cross-sectional survey design. This study highlights the need for cyclists to address genital pain and numbness experienced while cycling, and future studies are required to determine if alleviating these symptoms can reduce the impact of cycling on female sexual function. Greenberg GR, Khandwala YS, Breyer BN, et al. Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists. J Sex Med 2019; 16:1381-1389.


Plant pathogen recognition mediated by promoter activation of the pepper Bs3 resistance gene.
Plant disease resistance (R) proteins recognize matching pathogen avirulence proteins. Alleles of the pepper R gene Bs3 mediate recognition of the Xanthomonas campestris pv. vesicatoria (Xcv) type III effector protein AvrBs3 and its deletion derivative AvrBs3Deltarep16. Pepper Bs3 and its allelic variant Bs3-E encode flavin monooxygenases with a previously unknown structure and are transcriptionally activated by the Xcv effector proteins AvrBs3 and AvrBs3Deltarep16, respectively. We found that recognition specificity resides in the Bs3 and Bs3-E promoters and is determined by binding of AvrBs3 or AvrBs3Deltarep16 to a defined promoter region. Our data suggest a recognition mechanism in which the Avr protein binds and activates the promoter of the cognate R gene.


A homogeneous, high-throughput-compatible, fluorescence intensity-based assay for UDP-N-acetylenolpyruvylglucosamine reductase (MurB) with nanomolar product detection.
A novel assay for the NADPH-dependent bacterial enzyme UDP-N-acetylenolpyruvylglucosamine reductase (MurB) is described that has nanomolar sensitivity for product formation and is suitable for high-throughput applications. MurB catalyzes an essential cytoplasmic step in the synthesis of peptidoglycan for the bacterial cell wall, reduction of UDP-N-acetylenolpyruvylglucosamine to UDP-N-acetylmuramic acid (UNAM). Interruption of this biosynthetic pathway leads to cell death, making MurB an attractive target for antibacterial drug discovery. In the new assay, the UNAM product of the MurB reaction is ligated to L-alanine by the next enzyme in the peptidoglycan biosynthesis pathway, MurC, resulting in hydrolysis of adenosine triphosphate (ATP) to adenosine diphosphate (ADP). The ADP is detected with nanomolar sensitivity by converting it to oligomeric RNA with polynucleotide phosphorylase and detecting the oligomeric RNA with a fluorescent dye. The product sensitivity of the new assay is 1000-fold greater than that of the standard assay that follows the absorbance decrease resulting from the conversion of NADPH to NADP(+). This sensitivity allows inhibitor screening to be performed at the low substrate concentrations needed to make the assay sensitive to competitive inhibition of MurB.


Self-supported SnO2 nanowire electrodes for high-power lithium-ion batteries.
We propose a promising synthetic technique, which we term 'self-supported nanostructuring', for the direct growth of one-dimensional, SnO2 nanowires on the current collector. The technique is based on a vapor-liquid-solid (VLS) mechanism via thermal evaporation at low synthetic temperature (600 degrees C). The as-synthesized SnO2 nanowire electrode did not have any buffer layer prior to the nanowire evolution, and exhibited a single crystalline phase with highly uniform morphology and a thin diameter ranging from 40 to 50 nm with a length of more than 1 microm. The SnO2 nanowire electrode demonstrated stable cycling behaviors and delivered a high specific discharge capacity of 510 mA h g(-1), even at the 50th cycle, which exceeded that of SnO2 nanopowder and Sn nanopowder electrodes. Furthermore, the SnO2 nanowire electrode displayed superior rate capabilities with a rechargeable discharge capacity of 600 mA h g(-1) at 3 C (where 1 C = 782 mA g(-1)), 530 mA h g(-1) at 5 C, and 440 mA h g(-1) at 10 C. Our results support the potential opportunity for developing high-performance Li-ion batteries based on Li-alloying anode materials in terms of high-power density and high-energy density.


Primary orbital leiomyosarcoma.
A 79-year-old woman was presented with a 6-month history of painless proptosis in the left eye. On examination, there was a palpable superotemporal mass displacing the left eye inferomedially. Orbital CT revealed a heterogeneous, lobulated mass occupying the left orbital space with no bone erosion or destruction. MRI showed an extraconal, heterogenous, lobulated orbital mass in the lacrimal gland region of the left eye. The lesion was excised, and the diagnosis of leiomyosarcoma was made by histopathologic examination and immunohistochemistry. Systemic examinations were negative for a primary or a metastatic tumor. There was no evidence of tumor recurrence after 12 months of follow-up. Primary orbital leiomyosarcoma is a rare tumor that mainly occurs in older women and presents with painless proptosis. It should be considered in the differential diagnosis of superotemporal extraconal lesions.


The differential vulnerability of the inner ear end-organs to several external factors.
In a number of recently conducted animal studies, the effect of various external factors such as ototoxic substances, different types of noise and systemic disease on the different end-organs of the inner ear has been investigated. These studies are distinguished by the use of short latency vestibular evoked potentials (VsEPs) (to both linear and angular acceleration), an objective method for directly assessing the function of the different vestibular end-organs. In addition, the well known auditory brainstem response (ABR) was used to assess cochlear function. The studies are reviewed and it appears that the general pattern of effect is as follows: ABR (cochlea) is the most sensitive to the various external factors; angular VsEPs (semicircular canals) the least sensitive; linear VsEPs (otolith organs) intermediate between them.


Evaluating a commercial PCR assay against bacterial culture for diagnosing Streptococcus uberis and Staphylococcus aureus throughout lactation.
The performance of a commercial, real-time PCR assay was compared with traditional bacterial culture for the identification of Streptococcus uberis and Staphylococcus aureus in bovine milk collected at different stages of lactation. Initial validation tests using fresh and frozen quarter milk samples identified factors that affected the success of the PCR. Therefore, the standard protocol was adjusted for samples collected at the first milking postpartum (colostrum) and from clinical mastitis cases. The adjustment involved PCR testing both undiluted and diluted (1 in 10 with sterile water) DNA extracts. The performance comparison between culture and the PCR assay used milk samples collected aseptically from individual quarters of mixed-age spring-calving dairy cows, during early, mid, and late lactation. Bacterial culture results were used to select a subset of samples for PCR testing (n = 315) that represented quarters with a current or prior Strep. uberis or Staph. aureus infection. Compared with culture, PCR had a sensitivity of 86.8% and specificity of 87.7% for detecting Strep. uberis (kappa = 0.74) and 96.4% and 99.7%, respectively, for detecting Staph. aureus (kappa = 0.96). The dilution of DNA extracts for colostrum and clinical samples increased the relative sensitivity from 79.2% to 86.8% for Strep. uberis detection and from 92.9% to 96.4% for Staph. aureus, presumably through diluting unidentified PCR inhibitors. The sensitivity for detecting Strep. uberis using PCR, relative to culture, was similar throughout lactation (85-89%), whereas relative specificity was lowest immediately postcalving (64%) but improved in mid and late lactation (98%). Specificity estimates for samples collected in early lactation can be optimized by reducing the cutoff cycle threshold (Ct) value from the recommended value of 37 to 34. Although using this value improved specificity (77%), it reduced test sensitivity (77%). The PCR assay lacked agreement with culture in early lactation, specifically for diagnosing Strep. uberis. Thus, PCR should not be used as the only tool for diagnosing mastitis in early lactation.


Tuberculous osteitis of clivus.
Tuberculous osteitis of clivus is rare. Its diagnosis is difficult because of the rarity of the site and the non-specific nature of the disease. Management consists of confirmation of diagnosis by biopsy and chemotherapy with anti-tubercular drugs. Meningitis may complicate the clinical course, increase morbidity and mortality.


[Management of catheter-related upper extremity deep vein thrombosis].
Central venous catheters (CVCs) are important tools in the care of patients with acute or chronic diseases, but catheter-related thrombosis and thrombotic occlusions are frequent complications, especially if CVCs are implanted for long-term use. In this review we focus on the management of these complications. Risk factors for catheter-related thrombosis include dislocation of the catheter tip, the presence of malignant disease and hypercoagulability. Catheter-related thrombosis is associated with catheter infection, pulmonary embolism and post-thrombotic syndrome. Catheter-related thromboses which most frequently involve the subclavian vein are usually diagnosed by duplex ultrasound examination and treated with anticoagulation therapy for a minimum of three months or longer if the catheter is left in place. Prevention of catheter-related thrombotic complications includes proper positioning of the CVC with the catheter tip lying in the proximal superior vena cava and regular flushing of the catheter with saline solution or unfractionated heparin. The use of anticoagulants for primary prevention is currently not recommended.


Grb-2-associated binder-1 is involved in insulin-induced egr-1 gene expression through its phosphatidylinositol 3'-kinase binding site.
The Grb2-associated binder-1 (Gab1) is one of the major adapter molecules downstream of growth factor receptor signaling. Even though insulin causes tyrosine phosphorylation of Gab1, its role in insulin signaling has not been identified yet. We have demonstrated that insulin increased expression of early growth response gene-1 (egr-1), which is one of the most important transcription factors involved in cell proliferation and differentiation. In the present study, the possible role of Gab1 in insulin-induced egr-1 expression was studied using Rat1 fibroblasts expressing human insulin receptors and wildtype Gab1 (HIRc/Gab1(WT)), Gab1 with three tyrosines in the phosphatidylinositol (PI) 3'-kinase binding domain mutated to phenylalanine (HIRc/Gab1(DeltaPI3K)), or histidinol resistance only (HIRc/HIS). Insulin-induced egr-1 expression in HIRc/Gab1(DeltaPI3K) cells was much lower than in the other cells, as determined by Northern blot analysis. These results suggest that Gab1 is involved in the signaling pathway for insulin-induced egr-1 expression through increasing PI3'-kinase activity. The MAP kinase activity increased less with insulin treatment in HIRc/Gab1(DeltaPI3K) cells than in other cells. Inhibition of MAP kinase by the MEK inhibitor completely abolished insulin-induced egr-1 expression. These results suggest that Gab1 increases MAP kinase activity through its PI3'-kinase binding site, which then leads to egr-1 expression. Our results indicate that Gab1 is involved in the control of egr-1 expression regulated by insulin.


Commentary: Beyond more of the same - sustaining the benefits of preschool education - reflections on Bierman et al. (2016).
Preschool education is now firmly linked to two aspirational purposes: as the first step on a trajectory of academic and life success for all children and as wise economic policy for the nation. Both purposes are grounded in an assumption that the early developmental boost children receive from preschool will produce lasting impacts. However, efforts to identify enduring impacts of contemporary preschool programs have produced mixed evidence, leading the field to acknowledge that we have yet to adequately understand the essential conditions and processes in early education classrooms that increase the odds that children will flourish in school and thrive in their adult lives.


Plating of proximal humeral fractures.
The optimal treatment for proximal humeral fractures is controversial. Few data exist concerning the influence of the surgical approach on the outcome. The purpose of this study was to evaluate the clinical and radiological outcomes of proximal humeral fractures treated with locking plate fixation through a deltopectoral vs an anterolateral deltoid-splitting approach. Of 86 patients who met the inclusion criteria, 70 were available for follow-up examination. Thirty-three patients were treated through a deltopectoral approach and 37 through an anterolateral deltoid-splitting approach. In all cases, open reduction and internal fixation with a PHILOS locking plate (Synthes, Umkirch, Germany) was performed. Clinical follow-up included evaluation of pain, shoulder mobility, and strength. Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. A clinical neurological examination of the axillary nerve was also performed. Consolidation, reduction, and appearance of head necrosis were evaluated radiographically. After a mean follow-up of 33 months, Constant scores, DASH scores, and American Shoulder and Elbow Surgeons scores showed no significant differences between the groups. Clinical neurologic examination of the axillary nerve revealed no obvious damage to the nerve in either group. Deltopectoral and anterolateral detoid-splitting approaches for plate fixation of proximal humeral fractures are safe and provide similar clinical outcomes. The results of this study suggest that the approach can be chosen according to surgeon preference.


pthG from Pantoea agglomerans pv. gypsophilae encodes an avirulence effector that determines incompatibility in multiple beet species.
SUMMARY Pantoea agglomerans pv. gypsophilae (Pag) causes root and crown gall disease on gypsophila, whereas P. agglomerans pv. betae (Pab) induces the disease on beet as well as gypsophila. Both pathovars harbour a pathogenicity plasmid (pPATH(Pag) or pPATH(Pab)) that determines disease development. We have previously isolated and partially characterized a pleiotropic gene from the pPATH(Pag), designated as pthG, that encodes a virulence factor in gypsophila and an elicitor of a hypersensitive-like response in beet roots. The present study was undertaken to characterize pthG further as an avr gene. The infiltration of beet leaves with strains expressing PthG (i.e. Pag or Pab containing pthG in trans) caused an hypersensitive reaction (HR) response within 48 h, whereas strains lacking intact pthG (i.e. Pab or Pag mutated in pthG) resulted in gall formation after 5 days. A hypersensitive reaction was elicited by PthG on multiple beet species, whereas a marker exchange mutant of Pag in pthG extended its host range on these beet species. A marker exchange mutant of Pag in hrpJ, encoding a component of the Type III secretion system, prevented HR elicitation. Mutations in each of the hrp regulatory genes (hrpY, hrpS and hrpL) substantially reduced the transcriptional activity of pthG in gypsophila cuttings. PthG could only be detected inside Pag cells during over-expression of hrpS or hrpL. Particle bombardment of GFP-PthG fusion caused cell death in beet, but not in non-host (melon) leaves. Present and previous results have established pthG as a broad-host-range avr gene that functions in multiple host plant species and the first functional avr gene in Pantoea spp.


Boys with a simple delayed puberty reach their target height.
Final height in boys with delayed puberty is thought to be below target height. This conclusion, however, is based on studies that included patients with genetic short stature. We therefore studied final height in a group of 33 untreated boys with delayed puberty with a target height >-1.5 SDS. Standing height, sitting height, weight and arm span width were measured in each patient. Final height was predicted by the method of Greulich and Pyle using the tables of Bailey and Pinneau for retarded boys at their bone age (PAH1) and the tables of Bailey and Pinneau for average boys plus six months (PAH2). Mean final height (175.8 +/- 6.5 cm) was appropriate for the mean target height (174.7 +/- 4.5 cm). The prediction method of Bailey and Pinneau overestimated the final height by 1.4 cm and the modified prediction method slightly underestimated the final height (-0.15 cm). Boys with untreated delayed puberty reach a final height appropriate for their target height. Final height was best predicted by the method of Bailey and Pinneau using the tables for average boys at their bone age plus six months.


Clinical prediction rules: A systematic review of healthcare provider opinions and preferences.
The act of predicting clinical endpoints and patient trajectories based on past and current states is on the precipice of a technological revolution. This systematic review summarises the available evidence describing healthcare provider opinions and preferences with respect to the use of clinical prediction rules. The primary goal of this work is to inform the design and implementation of future systems, and secondarily to identify gaps for the development of clinician education programs. Five databases were systematically searched in May 2016 for studies collecting empirical opinions of healthcare providers regarding clinical prediction rule usage. Reference lists were scanned for additional eligible materials and an update search was made in August 2017. Data was extracted on high-level study features, before in-depth thematic analysis was performed. 45 articles were identified from 9 countries. Most studies utilised surveys (28) or interviews (14). Fewer employed focus groups (9) or formal usability testing (4). Three high-level themes were identified, which form the basis of healthcare provider opinions of clinical prediction rules and their implementation - utility, credibility and usability. Some of the objections and preferences stated by healthcare providers are inherent to the nature of the clinical problem addressed, which may or may not be within the designer's capacity to change; however, others (in particular - actionability, validation, integration and provision of high quality education materials) should be considered by prediction rule designers and implementation teams, in order to increase user acceptance and improve uptake of these tools. We summarise these findings across the clinical prediction rule lifecycle and pose questions for the rule developers, in order to produce tools that are more likely to successfully translate into clinical practice.


A villous cell-derived inhibitor of intestinal cell proliferation.
To test the hypothesis that the intestinal villous cell synthesizes a mitotic inhibitor that is specific for crypt cells, we have partially purified an extract from rat intestinal villous cells (VCE) and have demonstrated that it strongly and reversibly inhibits cell division and DNA synthesis in an intestinal epithelial cell line (IEC-6 cells). VCE produced a 60--70% inhibition of [3H]thymidine incorporation into DNA and a similar magnitude of inhibition of labeling of nuclei in autoradiographic studies. This inhibition was not associated with cytotoxicity as assessed by the effect of VCE on 51Cr release, hexose or amino acid uptake, and protein synthesis. VCE appears specific for IEC-6 cells because it did not affect DNA synthesis in 10 other cell lines, and extracts derived from other cell lines and from colonic mucosa did not affect DNA synthesis in IEC-6 cells. VCE may represent a villous cell factor involved in the control of intestinal epithelial cell turnover in vivo.


Partial breast irradiation: targeting volume or breast molecular subtypes?
The eligibility criteria for partial breast irradiation (APBI) are mainly based on histopathological factors, which not always explain the clinical behaviour of breast cancers. International guidelines represent useful platform to collect data for continued refinement of patient selection, but the clinical applicability to APBI series showed some limitations, particularly among the intermediate and high-risk groups. The heterogeneity of APBI techniques, along with the heterogeneity of breast cancer, generates clinical results, where the predictive value of the histopathological factors can assume different weight. There is a need of further refinement and implementation of risk factors. Currently, the impact of breast cancer subtype on local control is matter of investigation, and treatment decision about radiotherapy is generally made without regard to the breast cancer subtype. However, receptor status information is easily available and some histopathological factors have not a definite role, there is no uniform interpretation. As molecular classification becomes more feasible in the clinical practice, it will provide added value to conventional clinical tumour characteristics in predicting local recurrence in breast cancer and may play an important role as predictor of eventual patient outcomes.


Modulation of antiviral activity of interferon and 2',5'-oligoadenylate synthetase gene expression by mild hyperthermia (39.5 degrees C) in cultured human cells.
The antiviral/antiproliferative/antitumor properties of interferon (IFN) are potentiated by a febrile temperature (Heron, I., and Berg, K. (1978) Nature 274, 508-510; Fleischmann, W. R., Fleischmann, C. M., Jr., and Gindhart, T. D. (1986) Cancer Res. 46, 1722-1726; Groveman, D. S., Borden, E. C., Merritt, J. A., Robins, H. I., Steeves, R., and Bryan, G. T. (1984) Cancer Res. 44, 5517-5521). To investigate the role of 2',5'-oligoadenylate (2-5A) synthetase in linking temperature with these biological functions of IFN, antiviral activities and expression of the 2-5A synthetase gene were measured simultaneously in control and type I IFN-treated HL-60 and WISH cells at the selected elevated temperature of 39.5 degrees C +/- 0.5 degrees C (herein referred to as hyperthermia). In both cell lines, the IFN-mediated antiviral effect was enhanced 3-10-fold. Concurrently, enzymatic assays and immunoblot analyses with an anti-40-kDa synthetase antibody clearly gave a 2-3-fold increase of synthetase above that observed at the normal cell culture temperature (37 degrees C). These results suggest that potentiation of 2-5A synthetase must partially account for the enhanced antiviral activity of IFN at the higher cell culture temperature. The supranormal elevation of 2-5A synthetase was accompanied by a parallel increase in the steady-state concentration of 2-5A synthetase mRNA, which is likely to contribute to the observed increase in enzyme level. Transient reporter gene expression studies using plasmid constructs carrying 2-5A synthetase gene promoter linked in tandem with chloramphenicol acetyltransferase showed that IFN-inducible chloramphenicol acetyltransferase activity was not influenced by hyperthermia, suggesting that transcription activation is an unlikely explanation for the observed 2-5A synthetase mRNA level increases. Messenger RNA stability assays showed that the half-life (t1/2) of 2-5A synthetase mRNA was extended from 2 to 4 h at 39.5 degrees C. Under identical conditions, the t1/2 of poly(A)+ RNA remained unchanged whereas the t1/2 of beta-actin mRNA was reduced. Taken together, these results are consistent with the interpretation that selective stabilization of 2-5A synthetase mRNA at the elevated temperature is a major factor contributing to the potentiation of antiviral activity of IFN by hyperthermia.


Treatment of urinary tract infections with varying regimens of sulfisoxazole.
Four therapeutic regimens of sulfisoxazole were compared and contrasted with the antibody-coated bacteria test in patients with acute urinary tract infections. Of 158 college coeds who entered the study 146 completed the randomly assigned regimen. All 146 patients received 2 gm. sulfisoxazole initially and 1 gm. 4 times daily for 3 days in 44 patients (group 1), 7 days in 51 (group 2), 14 days in 29 (group 3) and 21 days in 22 (group 4). The presumptive sites of infection by the antibody-coated bacteria test were kidney (positive test) in 43 per cent of the patients and bladder (negative test) in 51.3 per cent. There was no correlation between the results of the antibody-coated bacteria test with either the presenting symptoms or the therapeutic responses. The bacteriologic cure rates at 2 days after therapy were 100 per cent in all groups and at 4 weeks after therapy they were 88.6 per cent in group 1, 86.3 per cent in group 2, 86.2 per cent in group 3 and 91 per cent in group 4. A 3-day course of sulfisoxazole was as effective as the longer regimens.


Modelling complex survey data with population level information: an empirical likelihood approach.
Survey data are often collected with unequal probabilities from a stratified population. In many modelling situations, the parameter of interest is a subset of a set of parameters, with the others treated as nuisance parameters. We show that in this situation the empirical likelihood ratio statistic follows a chi-squared distribution asymptotically, under stratified single and multi-stage unequal probability sampling, with negligible sampling fractions. Simulation studies show that the empirical likelihood confidence interval may achieve better coverages and has more balanced tail error rates than standard approaches involving variance estimation, linearization or resampling.


Increased spatial resolution in transillumination using collimated light.
In traditional transillumination of the breast (diaphanography), the abundance of diffuse light resulting from the use of extended noncollimated sources reduces the visibility of deep seated lesions. A prototype scanning imaging system has been developed to investigate the effectiveness of thin collimated light beams (1.5 mm cross section) synchronized with a similarly collimated detector to increase contrast in lesions normally lost due to the detection of diffuse light. The study demonstrates that detection of opaque 1.5 mm details is possible in phantoms simulating breast tissues 6 mm thick regardless of depth. This is about 10 times better than images obtained on the same samples using present transillumination methods. Furthermore, this study indicates that internal structures (lesions, cysts) in up to 12 mm thick excised breast sections can be visualized by exploiting their frequency-dependent attenuation. This is accomplished by inserting 50 nm interference filters in the input light path, which can be varied in a stepwise manner in the range of 400 nm to 1000 nm. These results demonstrate for the first time that images of lesion-bearing 1 cm or larger tissues can be obtained, thus opening promising possibilities for whole-breast imaging.


Pertussis toxin B-subunit-induced Ca2(+)-fluxes in Jurkat human lymphoma cells: the action of long-term pre-treatment with cholera and pertussis holotoxins.
The exotoxins of Bordetella pertussis and Vibrio cholera have been used to investigate signal transduction in the human T-cell lymphoma Jurkat. Stimulation of the cells, leading to an increase in cytoplasmic free calcium, could be achieved by the anti-T-cell receptor complex antibody OKT3 and by pertussis holotoxin (PTHT), or its B-subunit (PTB), but not by cholera holotoxin (CTHT) or its B-subunit (CTB). Both holotoxins ADP-ribosylated specifically G-proteins in the plasma membrane of intact cells, while their B-subunits had no ADP-ribosyltransferase activity. Incubation of the cells with CTHT led to a state of unresponsiveness to all stimulants. CTB was without any effect, indicating that the ADP-ribosyltransferase activity of cholera toxin (located in the A-subunit of the holotoxin) was necessary for the inhibition of cellular signalling. The inhibitory effect of cholera toxin on the pertussis toxin action was not due to a blockade of pertussis toxin interaction with the cell surface, because pertussis toxin was still able to ADP-ribosylate membrane proteins in cholera toxin treated intact cells. In addition, the cholera toxin mediated inhibition was not due to elevated levels of cyclic-AMP, as forskolin (a direct activator of the adenylate cyclase) and no inhibitory effect. The stimulating effect of PTHT was independent of its ADP-ribosyltransferase activity, because it could also be obtained by the B-subunit alone. In addition, the increase of cytoplasmic free calcium after stimulation by PTHT clearly preceded the ADP-ribosylation. Pre-treatment with PTHT, PTB or OKT3, led to a long lasting increase in the level of intracellular Ca2+ in Jurkat cells, which could not, therefore, be stimulated further. Inhibition by cholera holotoxin of the stimulation by OKT3 and pertussis toxin (PTHT and PTB) imply that the mitogenic effect of pertussis toxin is perhaps mediated via the T-cell antigen receptor signalling cascade. The presented data do not support the idea that a pertussis toxin-sensitive G-protein is involved in coupling the T-cell antigen receptor to the phospholipase C.


Early Pediatric Nasal Reconstruction Utilizing the Tagliacozzi Flap.
The Tagliacozzi cross arm flap has been historically described for repair of large nasal defects. The authors report what we believe is the youngest case in modern literature of nasal reconstruction with a Tagliacozzi flap, in a 6-year-old girl. Due to her poor face and scalp skin quality, the more modern reconstructive options of a forehead flap or free tissue transfer were not deemed suitable. Two delay procedures and a complex splint were required to position the medial arm fasciocutaneous flap over the nasal construct. The arm was immobilized for 3 weeks to allow for vascularization of the recipient bed. The child successfully tolerated the splint. She has improved breathing and nasal contour.


[Trypanosoma cruzi: differences in the requirement for protein protectors presented by 2 Argentinian strains].
The protein protector requirements for CA-I and RA T. cruzi trypomastigotes were standardized. The CA-I trypomastigotes needed a supplement of 5% serum or 5% bovine albumin in the washing and/or resuspending solutions to preserve their viability. For RA trypomastigotes, requirements were in the order of 1%. Trypomastigotes viability was determined by motility at the fresh microscopic observation and by mouse inoculation. This is a further demonstration of the particular behaviour reported for the CA-I bloodstream forms compared with those of RA.


[Experiences with preoperative and palliative percutaneous transhepatic cholangio-drainage].
In obstructive jaundice PTCD plays an important role as a preoperative or a palliative therapeutic method inspite of the availability of biliary endoprostheses. This study was carried out to assess complications following PTCD, the effect on liver function (serum parameters) and the relationship between duration of preoperative drainage and postoperative complication rate. The results demonstrate that 11-hole pigtail-catheters are useful for intrahepatic location and 32-hole ringcatheters for extrahepatic location due to reduced dislocation rates. The effect of biliary drainage after 7 rsp. 25 days on liver function was significant (p less than 0.05). As a main complication fever episodes could be observed associated with pathologic bile-/bloodcultures in most cases; other complications were similar to those presented in the literature. A prophylactic antibiotic therapy following PTCD seems to be useful, a preoperative biliary drainage is recommended until serum bilirubin levels become constant or at least for 2 weeks.


[Comparison of the occurrence of positive and negative vascular remodeling in patients with stable vs unstable angina pectoris].
The vascular remodelling refers to the increase or decrease in EEM (external elastica membrane) area that occurs during development of atherosclerosis. The positive remodeling, which was thought only as a compensatory factor during atheroma development, was also found as a one of the main features of unstable plaque. The intravascular ultrasound is very good tool to measure different type of arterial remodelling. These findings correlate with histologic post-mortem specimen with excellent results. To correlate the remodelling index from patients suffered from stable angina pectoris (SAP) and from patients suffered from unstable angina (UA). We performed IVUS in 51 patients. In the group of patients with unstable angina were included patients with worsening angina symptoms in last six weeks or with angina in rest. We used IVUS--endosonics In-Vision with 30 MHz probe Awanar with mechanical pull-back. We studied the occurrence of positive remodelling, negative remodeling (an index that describes remodeling is expressed as: lesion EEM CSA/reference EEM CSA. If the lesion EEM area is greater than the reference EEM area, positive remodelling has occurred, and the index will be > 1.0. If the lesion EEM area is smaller than the reference EEM area, negative remodelling has occurred, and the index will be < 1.0). We performed the intravascular ultrasound in 51 patients, 22 patients (43.1%) with unstable angina (UA) and in 29 patients (56.9%) stable angina (SAP). The positive remodelling was found in 14 patients (63.6%) in UA group vs. 5 patients (17.2%) in group with SAP, p < 0.05. The negative remodelling was found in 6 patients (27.3%) in UA group vs. 23 patients (79.3%) in SAP group, p < 0.05. Positive remodelling is more often found in patients with UA vs. in patients with SAP. Positive arterial remodelling is therefore one of the features of unstable atherosclerotic plaque.


Personalizing therapy for older adults with lymphoid malignancies: options and obstacles.
Increasing age is both a risk factor for and a negative prognostic factor in lymphoid malignancies. The disparities in outcomes between older and younger adults with lymphoid malignancies may reflect age-related differences in treatment and in biology of disease. Lymphomas in older adults are biologically more aggressive. Only small age-related differences in the frequency of cytogenetic abnormalities are seen in multiple myeloma. No major differences in the biology of chronic lymphocytic leukemia (CCL) are seen across the age spectrum. Chemotherapy and immunotherapy in older adults with lymphoid malignancies are marked by greater vulnerability to toxicity of therapy. Excessive toxicity can result in poorer outcomes, either directly through treatment-related mortality, or through decreased dose intensity. Thus, new approaches to predict toxicity of therapy and stratified treatment algorithms based on risk of toxicity are needed. Herein we detail some of the promising approaches to predicting toxicity and tailoring treatment for older adults with lymphoid malignancies.


Relation of pre-event use of inhibitors of the renin-angiotensin system with myocardial infarct size in patients presenting with a first ST-segment elevation myocardial infarction.
Agents that block the renin-angiotensin system (RAS), including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, are of proven benefit in patients after ST-segment elevation myocardial infarction (STEMI). However, no studies have evaluated the benefit of pre-event use of RAS inhibitors before STEMI. A retrospective review was performed of patients admitted to a single hospital with the diagnosis of STEMI and without a history of coronary disease or the equivalent, including diabetes mellitus, peripheral vascular disease, or stroke. Patients were stratified according to the use of RAS inhibitors before STEMI. Compared to patients not taking RAS inhibitors, patients who were taking RAS inhibitors had a lower peak troponin I level (79 vs 120 ng/dl, p = 0.016). Of the patients who had medically treated hypertension, those receiving RAS inhibitors had a significantly lower peak troponin I compared to those receiving non-RAS agents (79 vs 130 ng/dl, p = 0.015), despite equivalent blood pressure across the 2 groups. The beneficial effect of RAS inhibitor pretreatment remained when concomitant aspirin and statin use were controlled for. In conclusion, in patients presenting with a first STEMI, pretreatment with RAS inhibitors conferred a cardioprotective effect. The mechanism of this benefit appears to be independent of an effect on blood pressure control and was not wholly due to the effect of concomitant use of other medicines known to be protective in patients with STEMI.


[Coronary stents].
Coronary stents are widely used in percutaneous revascularisation and are associated with excellent primary results in the majority of cases. The anti GPIIb/IIIa molecules and the association of ticlopidine and aspirin are part of the pharmacological environment which contributes to the short-term success of these procedures. The essential problem remains restenosis which, in its diffuse form, is difficult to treat. Physicians should be vigilant with respect to the quality of the stents which they use and should enforce the conditions which the working group of the European Society of Cardiology recently proposed. Finally, in indications not yet validated or in the process of validation, they should be very careful and good results of balloon angioplasty should be respected.


Physiological and biochemical responses of two cultivars of wheat to elevated levels of CO2 and SO2, singly and in combination.
In view of the present increasing trends of anthropogenic emissions of carbon dioxide (CO2) and sulphur dioxide (SO2) throughout the world, the present study was aimed at investigating the long-term influence of elevated concentrations of CO2 and SO2, singly and in combination on the physiological and biochemical characteristics of two cultivars of wheat (Triticum aestivum L. cv. Malviya 234 and HP1209). For this purpose, the plants were grown in open top chambers under field conditions and were fumigated with 600 ppm CO2, 0.06 ppm SO2 and 600 ppm CO2 + 0.06 ppm SO2 separately for 8 h daily (0800-1600 h) from germination to grain maturity. The individual treatment of SO2 advers#ely affected both the cultivars of wheat by reducing protein and starch contents. The respiration rate, total soluble sugars and total phenolics, however, increased in response to SO2. Stimulation of photosynthesis rate and reduction in stomatal conductance and transpiration rate were observed under CO2 treatment. Concentrations of total soluble sugars, starch and total phenolics increased in response to CO2 and CO2 + SO2 treatments. In combined treatment, CO2 modified the plant response to SO2 in both the cultivars. Elevated CO2 increased the photosynthesis rate under combined treatment. Higher levels of starch and soluble sugars under combined treatment provided extra carbon for SO2 detoxification. The pattern of intraspecific response of wheat to different treatments was more or less similar, but the magnitude of response differed significantly.


[Establishment of the vascular intimal model in vitro and its application in studying atherosclerosis].
An endothelial culture model in vitro mimicking the vascular intima in vivo was designed which was composed of an upper and a lower well separated by a layer of amnion membrane, and upon which endothelial cells (ECs) isolated from the human umbilical vein were cultured. The upper well, the subendothelial amnion, and the lower well were analogical to the vascular lumen, the subendothelial tissue and the extravascular space, respectively. In comparison with the ECs cultured on the plastic, dishes, ECs cultured on the amnion membrane maintained more morphologic features as in vivo and could be cultured for up to 15 days without apparent detachment. Monocytes, loaded in the upper wells, were able to adhere to the cytoplasmic membrane of ECs. Furthermore, with the presence of the chemotactic factor (fMLP) in the lower well, monocytes showed active migrating ability passing through the EC junctions. If LDL (100 micrograms/ml) was added in the media simultaneously, monocytes might be aggregated beneath the subendothelial space and some of them took an foamy appearance. In conclusion, the culture model is of value in the study of experimental inflammation and atherosclerosis.


Redesigning rounds: towards a more purposeful approach to inpatient teaching and learning.
Inpatient rotations remain a central component in residency training, particularly in specialties such as internal medicine. However, maintaining the quality of this important learning experience has become a challenge. Recent approaches to redesigning the inpatient rounding experience have included reductions in the number of admissions and in patient census, which may not be feasible or desirable for many programs. The authors designed and implemented an approach to inpatient teaching that maintained the standard patient volume. It had the following five goals: (1) enhance bedside clinical skills, (2) promote a culture of patient safety, (3) emphasize diagnostic reasoning, (4) engage patients, and (5) provide learners with an expanded perspective on patients' experiences of care. This redesign, called the Chiefs' Service (CS) program, was implemented in 2013. The CS team acted as the intervention group in a quasi-experimental design study evaluating and comparing their experiences and outcomes with those of the standard inpatient medical teams not using the CS model. Five key team activities, or elements, were developed, piloted, and refined with learner, attending, and patient feedback. Those elements were morning huddle, bedside rounds, diagnostic "time-outs," day-of-discharge rounds, and postdischarge follow-up rounds. A robust evaluation process is under way; initial impressions from attendings, learners, and patients have been positive. Several educational outcomes also are being measured and compared with those of the standard inpatient medical teams. Further evaluations will guide modifications to the CS program and direct plans for dissemination within the institution and to other institutions.


Protective effect of kombucha on rats fed a hypercholesterolemic diet is mediated by its antioxidant activity.
Kombucha (KT) is claimed to have various beneficial effects on human health, but there is very little scientific evidence available in the literature. The present study investigates the effects of Camellia sinensis (GT) Linn. (Theaceae) and KT, two natural drinks, on cholesterol and antioxidant status using a hypercholesterolemia rat model. The present study compared the free-radical scavenging abilities and polyphenol levels of GT and KT. Wistar rats fed cholesterol-rich diets were given KT or GT (5 mL/kg body weight per day, po) for 16 weeks, then fasted overnight and sacrificed. The plasma lipid levels, thiobarbituric acid reactive substances (TBARS) and aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamyl transpeptidase (GGT) serum levels, antioxidant activities of superoxide dismutase (SOD) and catalase (CAT), and creatinine and urea rats were examined. KT had a phenolic compound of 955 ± 0.75 mg GAE/g) followed, by GT (788.92 ± 0.02 mg GAE/g). The free radical scavenging activity of KT was higher than GT. Compared with GT, KT induced lowered serum levels of TC, TG, VLDL-C, and LDL-C by 26, 27, 28, and 36%, respectively, and increased the serum level of high-density lipoprotein cholesterol (HDL-C). KT induced a 55% decrease of TBARS level in liver and 44% in kidney, compared with those of rats fed a cholesterol-rich diet alone. Moreover, CAT and SOD activities were reduced by 29 and 33%, respectively, in liver and 31 and 35%, respectively, in kidney, after oral administration of KT, compared with those of HCD-fed rats. The findings revealed that KT administration induced attractive curative effects on hypercholesterolemic, particularly in terms of liver-kidney functions in rats. Its effect on humans needs to be studied further.


Effect of Aeration on Extracellular Enzyme Synthesis by Psychrotrophs Growing in Milk During Refrigerated Storage.
Aerating milk markedly reduced proteolysis but increased lipolysis during storage at 6°C. The increase in lipolysis was due to native milk lipoprotein lipase, and aeration conditions could be modified to overcome this deleterious effect. The decrease in proteolysis was due primarily to a decrease in the amount of protease synthesized rather than a change in the bacterial flora of the milk. It was shown that protease and lipase production by psychrotrophs growing in milk was subject to catabolite repression by glucose. Differences in levels of certain metabolites produced by bacteria growing in aerated and non-aerated milks may be a factor contributing to the decrease in protease activity.


Screening analysis of volatile organic contaminants in commercial inorganic coagulants used for drinking water treatment.
A method for quality screening is suggested to detect volatile impurities in inorganic coagulants that are used for drinking water treatment. Static headspace gas chromatography with mass spectrometry detection (HS-GCMS) is sensitive and selective to detect volatiles in low concentrations. This study has discovered that volatile organic impurities are detectable in ferric and aluminium-based coagulants which are used for drinking water treatment. For ferric chloride, 2-propanol was detected at a level of 17-24 microg ml(-1), acetone at 0.7-1.7 microg ml(-1), 1,1,1-trichloroacetone at 0.02-0.04 microg ml(-1), trichloromethane at 0.01-0.02 microg ml(-1) and toluene at 0.01-0.12 microg ml(-1). For ferric chloride sulfate, acetone was detected at a level of 0.12 microg ml(-1), 1,1,1-trichloroacetone at 0.06-0.08 microg ml(-1), trichloromethane at 0.13-0.23 microg ml(-1), bromodichloromethane at 0.04-0.06 microg ml(-1) and dibromochloromethane at 0.04-0.05 microg ml(-1). For aluminium hydroxide chloride, only trichloromethane was detectable, but below the method detection limits (MDL). Although the concentrations of these impurities in commercial coagulants are low, this observation is important and should have impact on water industries for them to pay attention to the chemicals they are using for drinking water production.


Alternative method for calculating right ventricular ejection fraction from first-pass time-activity curves.
Single-beat right ventricular ejection fraction (RVEF) determined using the first-pass method changes with rapid variations in the concentration of radionuclide tracer in the ventricle. Underestimation of single-beat RVEF occurs when radionuclide tracer rapidly enters the ventricle, and overestimation results when the tracer quickly flows out of the ventricle. In order to attenuate this effect, a data processing technique employing the relative "time-volume" curve was proposed. In the present paper, it was assumed that this time-volume curve could be approximated by dividing the original time-activity curve by a gamma variate function representing the time-concentration curve. Each single-beat ejection fraction calculated from the time-volume curve agreed well with the known phantom ejection fraction although the concentration of tracer varied rapidly. This new method was applied to several clinical cases.


[Role of increased vascular permeability in the formation of dimorphic amyloid in mouse myocardium].
Electron-microscopic investigation carried out following the intravenous administration of ferritin revealed an increase in permeability of the myocardium capillary wall in mice in experimental casein amyloidosis. Additionally, a complex electron-microscopic, immunohistochemical and histological investigation of the development of amyloidosis in the myocardium of mice was conducted. It was established that deposits of typical amyloid in the myocardium of mice consisted of two ultrastructural components--granular material and fibrils. It was shown that formation of amyloid with characteristic tinctorial properties was preceded by depositions of specific antigen fibrils of granular ultrastructure.


[Chylomicronemia syndrome complicating type 1 hyperlipoproteinemia with concomitant insulin-dependent diabetes].
The case of chylomicronaemia syndrome complicating clinical course of type-1 hyperlipoproteinaemia and insulin-dependent diabetes is described. The patient required hypoglycaemic and lipid-lowering therapy.


Optimization of eight-element multi-detector row helical CT technology for evaluation of the abdomen.
To evaluate protocols for abdominal imaging with an eight-element multi-detector row computed tomographic (CT) scanner. An eight-element helical CT scanner was used to acquire data in two phantoms with four-element (pitch, 0.75 and 1.5; section thickness, 1.25, 2.5, and 5.0 mm) and eight-element (pitch, 0.625, 0.875, 1.35 and 1.675; section thickness, 1.25 and 2.5 mm) protocols. One phantom was used for low-contrast detectability and streak artifact; the other, for high-contrast performance. Protocols included near constant radiation dose (140 kV and varied tube current, confirmed by using the above protocols to scan a dedicated radiation dose phantom). Data were analyzed by three blinded readers for streak artifacts, contrast-to-noise ratio, and z-axis resolution (contrast-transfer function). Statistical analysis included studentized range tests. Contrast-to-noise ratios for four and eight elements were not consistently different. Qualitative evaluation for streak artifacts revealed fewer artifacts for all eight-element 1.25-mm-thick section protocols, as compared with eight-element 2.5-mm protocols. All eight-element 2.5-mm protocols except that with 27.0 mm per rotation had fewer streak artifacts than did four-element protocols (P =.02-.04). Contrast-transfer functions along the z axis for eight-element protocols were better than those for four-element protocols, demonstrating improved z-axis resolution (P <.05). Images acquired at eight sections per rotation demonstrated no sacrifice of contrast-to-noise ratio, improved z-axis resolution, and fewer streak artifacts, even when radiation dose was similar to that for four-element CT.


Quantum nondemolition measurement of large-spin ensembles by dynamical decoupling.
Quantum nondemolition (QND) measurement of collective variables by off-resonant optical probing has the ability to create entanglement and squeezing in atomic ensembles. Until now, this technique has been applied to real or effective spin one-half systems. We show theoretically that the buildup of Raman coherence prevents the naive application of this technique to larger spin atoms, but that dynamical decoupling can be used to recover the ideal QND behavior. We experimentally demonstrate dynamical decoupling by using a two-polarization probing technique. The decoupled QND measurement achieves a sensitivity 5.7(6) dB better than the spin projection noise.


Wireless sensing systems in clinical environments: improving the efficiency of the patient monitoring process.
Multiple studies suggest that the level of patient care may decline in the future because of a larger aging population and medical staff shortages. Wireless sensing systems that automate some of the patient monitoring tasks can potentially improve the efficiency of patient workflows, but their efficacy in clinical settings is an open question. This article examines the potential of wireless sensor network (WSN) technologies to improve the efficiency of the patient-monitoring process in clinical environments. MEDiSN, a WSN designed to continuously monitor the vital signs of ambulatory patients, is designed. The usefulness of MEDiSN is validated with test bed experiments and results from a pilot study performed at the Emergency Department, Johns Hopkins Hospital. Promising results indicate that MEDiSN can tolerate high degrees of human mobility, is well received by patients and staff members, and performs well in real clinical environments.


Examining overlap of included studies in meta-reviews: Guidance for using the corrected covered area index.
Overlap in meta-reviews results from the use of multiple identical primary studies in similar reviews. It is an important area for research synthesists because overlap indicates the degree to which reviews address the same or different literatures of primary research. Current guidelines to address overlap suggest that assessing and documenting the degree of overlap in primary studies, calculated via the corrected covered area (CCA) is a promising method. Yet, the CCA is a simple percentage of overlap and current guidelines do not detail ways that reviewers can use the CCA as a diagnostic tool while also comprehensively incorporating these findings into their conclusions. Furthermore, we maintain that meta-review teams must address non-independence via overlap more thoroughly than by simply estimating and reporting the CCA. Instead, we recommend and elaborate five steps to take when examining overlap, illustrating these steps through the use of an empirical example of primary study overlap in a recently conducted meta-review. This work helps to show that overlap of primary studies included in a meta-review is not necessarily a bias but often can be a benefit. We also highlight further areas of caution in this task and potential for the development of new tools to address non-independence issues.


Determination of diclofenac in pharmaceutical preparations by diffuse reflectance photometry.
A quantitative analytical method for the determination of diclofenac in pharmaceutical preparations by diffuse reflectance in the visible region of the spectrum is presented. The color reaction is done directly in the measuring cell immediately after mixing, using small volumes of the analyte solution, of the reagent and of the buffer solutions. All reflectance measurements were carried out in a home made reflectometer equipped with a red LED as light source and a LDR as detector. The calibration curves were constructed from 1.0 to 18 mg mL(-1) (about 3.0 x 10(-3) to 5.5 x 10(-2)mol L(-1)) of sodium diclofenac or of potassium diclofenac in the analytical solution, with typical correlation coefficients equal to 0.999. The detection limit was estimated to be about 0.7 mg mL(-1) (2 x 10(-3)mol L(-1)). The method was applied to determine diclofenac in solid and liquid pharmaceutical preparations. The R.S.D. varied from 2% to 4% depending of the sample. The results were compared with those obtained with the HPLC procedure recommended by the United States Pharmacopoeia using the statistical Student's t-test procedure.


Optical density of the crystalline lens.
The optical density for the noncataractous crystalline lens is written as a sum of two terms, each with a specific dependence on wavelength. The first term, proportional to 1/lambda 2, represents all light-scattering processes in the lens. The second term, assumed significant only for lambda less than or equal to 500 nm, accounts for absorption by lens pigments. By analyzing transmittance data on lenses of subjects aged 21 to 63 years, a spectrum for light absorption by lens pigment is derived and it is shown to be essentially the same for all of the lenses.


The role of metabolic reprogramming in γ-herpesvirus-associated oncogenesis.
The γ-herpesviruses, EBV and KSHV, are closely associated with a number of human cancers. While the signal transduction pathways exploited by γ-herpesviruses to promote cell growth, survival and transformation have been reported, recent studies have uncovered the impact of γ-herpesvirus infection on host cell metabolism. Here, we review the mechanisms used by γ-herpesviruses to induce metabolic reprogramming in host cells, focusing on their ability to modulate the activity of metabolic regulators and manipulate metabolic pathways. While γ-herpesviruses alter metabolic phenotypes as a means to support viral infection and long-term persistence, this modulation can inadvertently contribute to cancer development. Strategies that target deregulated metabolic phenotypes induced by γ-herpesviruses provide new opportunities for therapeutic intervention.


Immunological profiles of immune restoration disease presenting as mycobacterial lymphadenitis and cryptococcal meningitis.
A proportion of HIV patients beginning antiretroviral therapy (ART) develop immune restoration disease (IRD). Immunological characteristics of IRD were investigated in a cohort of HIV patients beginning therapy in Kuala Lumpur, Malaysia. Peripheral blood mononuclear cells were collected at weeks 0, 6, 12, 24 and 48 of ART from five patients experiencing IRD [two with cryptococcal and three with Mycobacterium tuberculosis (Mtb) disease], eight non-IRD controls who had begun ART with CD4 T-cell counts of <100 cells/microL and 17 healthy controls. Leukocytes producing interferon-gamma (IFNgamma) were quantified by enzyme-linked immunospot assay after stimulation with purified protein derivative (PPD), early secretory antigenic target-6 (ESAT-6), Cryptococcus neoformans or Cytomegalovirus antigens. Plasma immunoglobulin (IgG) antibodies reactive with these antigens were assessed by enzyme-linked immunosorbent assay. Proportions of activated (HLA-DR(hi)) and regulatory (CD25 CD127(lo) and CTLA-4(+)) CD4 T-cells were quantified by flow cytometry. Plasma HIV RNA declined and CD4 T-cell counts rose within 8-27 weeks on ART. Mtb IRD patients displayed elevated IFNgamma responses and/or plasma IgG to PPD, but none responded to ESAT-6. Cryptococcal IRD occurred in patients with low baseline CD4 T-cell counts and involved clear IFNgamma and antibody responses to cryptococcal antigen. Proportions of activated and regulatory CD4 T-cells declined on ART, but remained higher in patients than in healthy controls. At the time of IRD, proportions of activated CD4 T-cells and regulatory CD4 T-cells were generally elevated relative to other patients. Cryptococcal and Mtb IRD generally coincide with peaks in the proportion of activated T-cells, pathogen-specific IFNgamma responses and reactive plasma IgG. IRD does not reflect a paucity of regulatory CD4 T-cells.


Unclear dose equals toxic dose.
Medication errors are a significant public health issue. Their frequency and severity are currently under increased scrutiny from many perspectives. In 1996, the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) was established to promote the reporting, understanding, and prevention of medication errors. NCCMERP has published prescription writing recommendations to remedy error-prone aspects of prescription writing. An example of a hazardously written medication order and its possible toxicity is provided.


Psychotropic agents in opiate addiction: a brief review.
Psychotropic agents are frequently utilized in the detoxification and maintenance of opiate addicts as well as in the treatment of their underlying psychopathology. Review of reports of studies conducted to data indicates that schizophrenia, depression, and anxiety in opiate addicts appear to respond to appropriate treatment with psychotropic drugs. Although nonaddictive psychoactive compounds cannnot be completely substituted for methadone in detoxification, their effects on the rate of methadone withdrawal warrant further study. To evaluate the results of treatment of addicts with psychoactive compounds, parameters that should be studied include the effects of these compounds on illicit drug use, methadone requirements, relapse and dropout rates, and social behavior.


Pharmacokinetics and pharmacodynamics of protamine zinc recombinant human insulin in healthy dogs.
Protamine zinc insulins are generally considered to be long acting, with slow absorption from subcutaneous tissue. Protamine zinc recombinant human insulin (PZIR) may be useful to treat diabetic dogs. The purpose of this study was to describe the pharmacokinetics and pharmacodynamics of PZIR in dogs. PZIR was administered subcutaneously to 10 healthy Beagles using an incomplete crossover design, at doses of 0.3 or 0.5 U/kg (each n=5), 0.8 U/kg (n=10), or 0.8 U/kg at three separate sites (n=6). Insulin and glucose concentrations were measured over 24 h. The shapes of insulin and glucose curves were variable among dogs, and the relationship between insulin dose, concentration, and glucose-lowering effect was nonlinear. For single-site 0.8 U/kg, median (range) onset of action was 3.5 h (0.5-10 h), time to glucose nadir was 14 h (5 to >24 h), and duration of action was >24 h (16 to >24 h). Mathematical model predictions of times to 50% and 90% insulin absorption, and fraction of insulin absorbed in 24 h, were not significantly different among protocols. Results confirm the tendency toward a late onset and long duration of action for PZIR in dogs. This insulin may be an alternative treatment option for diabetic dogs.


Reduced excision repair cross-complementing 1 expression associates with enhanced papilloma formation and fibroblast transformation after genetic disruption of secreted protein acidic and rich in cysteine.
SPARC (secreted protein acidic and rich in cysteine)/ osteonectin/BM-40 is a matricellular protein implicated in development, cell transformation and tumorigenesis. We have examined the role of SPARC in cell transformation induced chemically with 7,12-dimethylbenz[a]anthracene (DMBA) and 12-tetradecanoylphorbol-13-acetate (TPA) in embryonic fibroblasts and in the skin of mice. Embryonic fibroblasts from SPARCnull mice showed increases in cell proliferation, enhanced sensitivity to DMBA and a higher number of DMBA/TPA-induced transformation foci. The number of DMBA-DNA adducts was 9 times higher in SPARCnull fibroblasts and their stability was lower than wild-type fibroblasts, consistent with a reduction in excision repair cross-complementing 1 the nucleotide excision repair enzyme in these cells. The SPARCnull mice showed an increase in both the speed and number of papillomas forming after topical administration of DMBA/TPA to the skin. These papillomas showed reduced growth and reduced progression to a more malignant phenotype, indicating that the effect of SPARC on tumorigenesis depends upon the transformation stage and/or tissue context. These data reinforce a growing number of observations in which SPARC has shown opposite effects on different tumor types/stages.


Percutaneous radiofrequency ablation for unresectable colorectal liver metastases: time for shadows to disperse.
Despite the advent of combination chemotherapy regimens achieved within the last decade, long term survival of patients with unresectable metastatic disease from colorectal cancer remains poor. Thermal ablation procedures, including radiofrequency ablation (RFA), are considered feasible options in treating unresectable hepatic tumors either primary (hepatocellular carcinoma) or metastatic, the latter mainly arising from colorectal cancer. Percutaneous access is the least invasive RFA procedure. A MEDLINE review unfolded a significant clinical heterogeneity among published series reporting on percutaneous RFA in hepatic metastatic disease from colorectal cancer, regarding study population, optimal time and treatment schemes pre- and post-RFA intervention. Notwithstanding, percutaneous RFA survival figures were consistently better than front line chemotherapy. Furthermore, a pooled analysis of larger series demonstrated a clear benefit in overall survival (HR 0.51, 95% CI 0.44 to 0.58). Albeit optimal indications are still pending, percutaneous RFA should nonetheless be considered a viable option in patients with unresectable metastatic disease, as it may prolong survival rates achieved with standard chemotherapy.


Extracting morphometric information from rat sciatic nerve using optical coherence tomography.
We apply three optical coherence tomography (OCT) image analysis techniques to extract morphometric information from OCT images obtained on peripheral nerves of rat. The accuracy of each technique is evaluated against histological measurements accurate to + / - 1 μm. The three OCT techniques are: (1) average depth-resolved profile (ADRP), (2) autoregressive spectral estimation (AR-SE), and (3) correlation of the derivative spectral estimation (CoD-SE). We introduce a scanning window to the ADRP technique, which provides transverse resolution and improves epineurium thickness estimates-with the number of analyzed images showing agreement with histology increasing from 2 / 10 to 5 / 10 (Kruskal-Wallis test, α = 0.05). A method of estimating epineurium thickness, using the AR-SE technique, showed agreement with histology in 6 / 10 analyzed images (Kruskal-Wallis test, α = 0.05). Using a tissue sample in which histology identified two fascicles with an estimated difference in mean fiber diameter of 4 μm, the AR-SE and CoD-SE techniques both correctly identified the fascicle with larger fiber diameter distribution but incorrectly estimated the magnitude of this difference as 0.5 μm. The ability of the OCT signal analysis techniques to extract accurate morphometric details from peripheral nerves is promising but restricted in depth by scattering in adipose and neural tissues.


A comprehensive school-based clinic: university and community partnership.
To describe the evolution and current status of a university and community partnership engaged in operating an urban elementary school-based clinic (SBC) POPULATION: The children at the school who are eligible to receive care at the SBC include 500 elementary students and 200 adolescents who attend a magnet junior high school housed in the same building. The vast majority of the children attending the school are from families whose incomes are below the national poverty level. Eighty-five percent of the children are black. Fifteen percent are Hispanic, non-white. A variety of services and programs are offered to the children and their families for the promotion of health and the prevention of mental disorders. Service, education, and research occur simultaneously to achieve the multiple goals of the partners and participants. Advanced practice nurses can provide quality health and mental health care services for school-age children and their families through SBCs. Institutional partnerships, capitalizing on each other's strengths, can expand the availability of SBC offerings.


[Percutaneous transluminal angioplasty for experimental carotid artery stenosis. Mechanism and long-term results].
Percutaneous transluminal angioplasty (PTA) is not commonly applied to the carotid artery because of the risk of cerebral embolization and the uncertainty concerning the long-term results. To test its effectiveness and safety, the author performed PTA in dogs with experimentally induced carotid artery stenosis. Under general anesthesia, one carotid artery was exposed by midline incision. Two vascular tourniquets were applied to the artery, 2 to 5 cm apart, and the blood between them was replaced with pentobarbital sodium for 5 minutes. The drug was then removed and the tourniquets released. Angiography revealed the formation of stenotic lesions within 1 to 6 weeks. Histological examination showed the source of stenosis to be thrombi adhering to the vessel wall. PTA was performed 1 week or 3 to 6 weeks after induction of stenosis using either Grüntzig or Dotter catheters. Immediately after PTA, considerable enlargement of stenotic areas was angiographically observed, and no emboli were detected in distal arteries. Histological findings included depressions in the intima, thrombi, and stretching of the internal elastic membrane and tunica media. Angiograms obtained 3 and 6 months after PTA disclosed persistence of dilatation of the carotid lumen and diminution of the inner surface irregularities. Six months after PTA, the histological features included intimal proliferation and rarefaction of the tunica media. On the other hand, stenotic arteries not subjected to PTA were totally occluded by thrombi and intimal proliferation 6 months after induction of stenosis. It is apparent that PTA was effective not only in bringing about dilatation of the carotid artery but also in arresting the progression of stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)


[Are we ready to prescribe a polypill to our patients?].
The all-in-one pill combination (Polypill) of several active components used in primary prevention of cardiovascular disease was a decade ago purposed to reduce the cardiovascular burden by more than 80%. This Polypill could be approved before 2013 in United States. Although controversed, it could answer to the worried situation even observed in Switzerland: the adherence to secondary prevention treatments is clearly insufficient and the cardiovascular events remain in the first row of death's causes. This abstract summarize the results from interventional studies who tried to valid this concept as well as the main stakes to be assessed on the medical side before to consider such a similar approach in Switzerland.


A comparative study of the work involved in measuring profiles using an ion chamber, a linear diode array and film.
In this work a method of using Kodak X-Omat V film to measure beam profiles for dynamically wedged fields is presented. Also, the profiles determined by film measurement are compared with those measured with an ion chamber (0.12 cm3 Scanditronix RFA 300 RK) and an array of silicon diodes (11 channel Scanditronix linear diode array). The beam investigated is a 6 MV photon beam from a Varian 2100 C linear accelerator. The geometric method of positioning film and determining the central axis (CAX) position of the beam yielded results which agreed to within 1 mm with the software determined position of the CAX. The profiles measured by film agreed well with the ion chamber measured profiles in terms of overall field size, position, penumbral width, height and position of maximum and profile shape between the 20% dose levels. Film profiles deviated most from ion chamber profiles in the post-penumbra regions. Linear diode array (LDA) measured profiles matched ion chamber profiles in the post-penumbra regions, field size and general profile shape. In the region of maximum dose differences in dose of up to 4% were seen along with horizontal shifts of around 2 mm between LDA and ion chamber profiles.


Autoclavable physically-crosslinked chitosan cryogel as a wound dressing.
Moist wounds were known to heal more rapidly than dry wounds. Hydrogel wound dressings were suitable for the moist wound healing because of their hyperhydrous structure. Chitosan was a strong candidate as a base material for hydrogel wound dressings because the polymer had excellent biological properties that promoted wound healing. We previously developed physically-crosslinked chitosan cryogels, which were prepared solely by freeze-thawing of a chitosan-gluconic acid conjugate (CG) aqueous solution, for wound treatment. The CG cryogels were disinfected by immersing in 70% ethanol before applying to wounds in our previous study. In the present study, we examined the influence of autoclave sterilization (121°C, 20 min) on the characteristics of CG cryogel because complete sterilization was one of the fundamental requirements for medical devices. We found that optimum value of gluconic acid content of CG, defined as the number of the incorporated gluconic acid units per 100 glucosamine units of chitosan, was 11 for autoclaving. An increased crosslinking level of CG cryogel on autoclaving enhanced resistance of the gels to enzymatic degradation. Furthermore, the autoclaved CG cryogels retained favorable biological properties of the pre-autoclaved CG cryogels in that they showed the same hemostatic activity and efficacy in repairing full-thickness skin wounds as the pre-autoclaved CG cryogels. These results showed the great potential of autoclavable CG cryogels as a practical wound dressing.


Effect of pain control in suspected acute appendicitis on the diagnostic accuracy of surgical residents.
To determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents. A prospective randomized, double-blind, placebo-controlled trial was conducted for patients with suspected appendicitis. The patients were randomized to receive placebo (normal saline intravenous [IV]) infusions over 5 minutes or the study drug (morphine 5 mg IV). All of the clinical evaluations by surgical residents were performed 30 minutes after administration of the study drug or placebo. After obtaining the clinical probability of appendicitis, as determined by the surgical residents, abdominal computed tomography was performed. The primary objective was to compare the influence of IV morphine on the ability of surgical residents to diagnose appendicitis. A total of 213 patients with suspected appendicitis were enrolled. Of these patients, 107 patients received morphine, and 106 patients received placebo saline. The negative appendectomy percentages in each group were similar (3.8% in the placebo group and 3.2% in the pain control group, p=0.62). The perforation rates in each group were also similar (18.9% in the placebo group and 14.3% in the pain control group, p=0.75). Receiver operating characteristic analysis revealed that the overall diagnostic accuracy in each group was similar (the area under the curve of the placebo group and the pain control group was 0.63 v. 0.61, respectively, p=0.81). Early pain control in patients with suspected appendicitis does not affect the diagnostic performance of surgical residents.


Oral tissue response to ovine grafting biomaterial: morphological and morphometric study using scanning electron and light microscopy tissue response to ovine grafting biomaterial.
To evaluate the oral tissue response to an experimental particle ovine biomaterial by scanning electron microscopy (SEM) and light microscopy (LM). Forty-eight rats had surgical periodontal defects treated with either blood clotting (control), bovine biomaterial™ (B), or an experimental ovine biomaterial (O). Data from SEM analysis (defect exposure, root surface exposure, diameter of matrix fibers and bundles, and globuli areas; n = 5) were applied to Shapiro-Wilk, Kruskal-Wallis, and Dunn's test, whereas LM analysis (tissue cicatrization characteristics and diameter defect; n = 3) had data applied to two-way analysis of variance. Animals were monitored for 1 and 3 weeks. By SEM, the O samples showed significant differences from B and C in the area of defect exposure (H(2,15) = 8.66; P < 0.05). In both periods, O and B samples showed similar results for matrix fiber diameters, differently than C samples (H(2,15) = 14.0; P < 0.05). All other SEM variables were considered equivalent among the groups (P > 0.05). Under LM, an acute and chronic granulomatous inflammation was seen in the presence of both biomaterials (B and O, 1 week); both the control and the ovine grafting samples showed mature bone in the repair site (3 weeks); the defect diameter showed similar values among groups, at both monitoring periods (F(2,12) = 1.0401; P > 0.05). The ovine particles of this study showed a favorable response to oral tissue repair, demonstrating to be a potential source for the development of bone grafting biomaterials.