Factors influencing personal magnetic field exposure: preliminary results for power utility and office workers.
Epidemiological studies and laboratory research suggest that exposure to extremely low frequency (< 300 Hz) magnetic fields is associated with an increase in risk of developing a number of rare diseases including leukaemia. Overall the risks to health appear to be small but a more accurate exposure assessment technique would help evaluate the true extent of any health effects. In this pilot study we aimed to identify and evaluate personal, work and environmental factors and their influence on measured exposure levels with a view to developing a method of reconstructing exposure. Office workers and power utility workers were studied using personal dosimeters to measure magnetic field exposure, along with frequent observation or measurement of factors related to exposure. Factors such as average and closest distance to source, time at position and current flow were combined in a series of metrics to investigate simple models of personal exposure. The results indicate that mean and peak magnetic field exposure levels are linked to current flow and the average distance of a worker from the source of the magnetic field. These factors are more accurate predictors of high exposures than they are of lower and average levels. It may be possible, with further work, to produce a model of exposure to magnetic fields for use in epidemiological studies.


Direct comparison of tricyclic and serotonin-reuptake inhibitor antidepressants in randomized head-to-head trials in acute major depression: Systematic review and meta-analysis.
A comparison across trials conducted over several decades suggested superior efficacy of tricyclic antidepressants (TCAs) over selective serotonin-reuptake inhibitors (SSRIs). However, this outcome may reflect a selective secular decline of responses after randomization to placebo. Remaining uncertainty encouraged direct comparison of the drug-types in trials involving randomized, head-to-head comparisons. We systematically identified reports of randomized trials of TCAs versus SSRIs for major depression in several digital databases, and applied standard meta-analytic and multiple-factor regression methods to analyze and pool the findings. In 89 head-to-head trials, there was no detectable overall difference in responder rates or percent-improvement between TCAs and SSRIs. In addition to non-difference between drug-types, outcomes were unrelated to reporting-year, trial-size or nominal duration, proportion of women participants, initial depression ratings, rating scales, subjects/arm, imipramine-equivalent mg/day drug dose, or dropout rate. Trial size and duration increased significantly over the years 1980-2016. Previous evidence suggesting superior benefits of TCAs over SSRIs for the treatment of acute major depression is probably an artifact of a selective secular decline in responses to placebo, as no difference was found in a large series of direct comparisons of these antidepressant-types.


Effect of aminophylline on exercise performance in patients with irreversible airway obstruction.
Thirteen clinically stable male patients aged 63 +/- 3 years with irreversible airway disease were given aminophylline and placebo in a randomized crossover fashion on two consecutive days while receiving beta-agonists. During incremental exercise the maximal heart rate (139.0 +/- 22.1 vs 128.0 +/- 16.4 beats per minute) and minute ventilation (41.9 +/- 6.9 vs 38.1 +/- 8.2 L/min) were significantly higher and the arterial carbon dioxide pressure (34.6 +/- 5.0 vs 38.6 +/- 7.7 mm Hg) was significantly lower during aminophylline administration than during placebo administration. However, spirometric findings, maximal inspiratory pressures, maximal oxygen consumption, work rate, and arterial oxygen pressure were similar on both regimens. We concluded that the major effect of aminophylline is to increase ventilatory drive in patients with irreversible airway obstruction. Unless an objective change in spirometric data or exercise capacity can be documented, we believe that aminophylline therapy is not warranted in these patients.


Genetic linkage of the human gene for phenylethanolamine N-methyltransferase (PNMT), the adrenaline-synthesizing enzyme, to DNA markers on chromosome 17q21-q22.
We have determined the genetic location of the human gene encoding phenylethanolamine N-methyltransferase (PNMT), the terminal enzyme of the catecholamine pathway catalyzing the synthesis of epinephrine (adrenaline) from norepinephrine. This gene is linked to DNA markers on the long arm of chromosome 17, q21-q22, most closely to the DNA markers MFD15 (D17S250) (Zmax = 15.0, theta = 0.065) and fLB17.1 (Zmax = 14.6, theta = 0.045). Multipoint linkage analysis placed the PNMT locus in the interval fLB17.1-CMM86 (D17S74), at 4 centiMorgans (cM) distal to fLB17.1, and at 17 cM proximal to CMM86. Mapping of the PNMT gene will provide the basis for genetic linkage studies in families with disease which might pathogenetically involve this enzyme. The human chromosomal region 17q21-22 identified here to harbour the PNMT gene may be syntenic to the chromosomal region in the stroke-prone spontaneously hypertensive rat (SHR-SP) recently linked to blood-pressure regulation. As an increase of PNMT activity has been associated with the development of hypertension in SHR-SP, it will be of interest to perform comparative mapping of the PNMT gene.


[Genetic analysis of sacB, the structural gene of a secreted enzyme, levansucrase of Bacillus subtilis Marburg].
The structural gene sacB encoding B. subtilis levansucrase, a secreted enzyme, expresses in E. coli. E. coli hosts of the sacB gene are poisoned by sucrose. This property allowed a powerful selection of mutants affected in the cloned gene. The plasmidic mutations were readily introduced in the B. subtilis chromosome. Using a collection of plasmids bearing various deletions extending in sacB we developed a technique of deletion mapping based on plasmid integration in the chromosome of B. subtilis. A generalization of this technique is discussed.


[Modeling of peptides and proteins in membrane environment. I. A solvation model mimicking a lipid bilayer].
A theoretical solvation model of peptides and proteins that mimics the heterogeneous membrane-water system was proposed. Our approach is based on the combined use of atomic parameters of solvation for water and hydrocarbons, which approximates the hydrated polar groups and acyl chains of lipids, respectively. This model was tested in simulations of several peptides: a nonpolar 20-mer polyleucine, a hydrophobic peptide with terminal polar groups, and a strongly amphiphilic peptide. The conformational space of the peptides in the presence of the membrane was studied by the Monte Carlo method. Unlike a polar solvent and vacuum, the membrane-like environment was shown to stabilize the alpha-helical conformation: low-energy structures have a helicity index of 100% in all cases. At the same time, the energetically most favorable orientations of the peptides relative to the membrane depend on their hydrophobic properties: nonpolar polyleucine is entirely immersed in the bilayer and the hydrophobic peptide with polar groups at the termini adopts a transbilayer orientation, whereas the amphiphilic peptide lies at the interface parallel to the membrane plane. The results of the simulations agree well with the available experimental data for these systems. In the following communications of this series, we plan to describe applications of the solvation model to membrane-bound proteins and peptides with biologically important functional activities.


Current perspectives on hematospermia: a review.
Hematospermia is a disconcerting symptom that produces extreme anxiety in sexually active male patients. To understand the pathophysiology of hematospermia, the anatomy of the ejaculatory system and neurophysiology of emission and ejaculation is essential. Emission and ejaculation must be present for hematospermia to occur. Hematospermia may be the result of inflammation, infection, ductal obstruction or cysts, neoplasms, vascular abnormalities, and systemic or iatrogenic factors. Most patients promptly consult a urologist after an episode of hematospermia. History and physical examination are often unrevealing and the judicious use of imaging modalities, such as transrectal ultrasound, MRI, and rigid or flexible endoscopy may be diagnostic. Unless the specific etiology is defined, most cases are managed expectantly. We review the etiology of hematospermia and an algorithm is provided for the diagnosis and management.


Knee pain in competitive swimming.
The high volume of training in competitive swimming results in cumulative overload injuries. Knee pain ranks second to shoulder pain as a common complaint in competitive swimmers. Most knee pain occurs on the medial side of the knee and, most commonly, in breaststroke swimmers; however, knee pain may accompany all strokes. This article reviews the incidence of knee pain, the biomechanic and anatomic factors predisposing to injury, specific injury patterns, injury diagnosis, and the treatment and prevention of injury to the knee in swimmers.


Radiation dose reduction through combining positron emission tomography/computed tomography (PET/CT) and diagnostic CT in children and young adults with lymphoma.
Both [F-18]2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and diagnostic CT are at times required for lymphoma staging. This means some body segments are exposed twice to X-rays for generation of CT data (diagnostic CT + localization CT). To describe a combined PET/diagnostic CT approach that modulates CT tube current along the z-axis, providing diagnostic CT of some body segments and localization CT of the remaining body segments, thereby reducing patient radiation dose. We retrospectively compared total patient radiation dose between combined PET/diagnostic CT and separately acquired PET/CT and diagnostic CT exams. When available, we calculated effective doses for both approaches in the same patient; otherwise, we used data from patients of similar size. To confirm image quality, we compared image noise (Hounsfield unit [HU] standard deviation) as measured in the liver on both combined and separately acquired diagnostic CT images. We used t-tests for dose comparisons and two one-sided tests for image-quality equivalence testing. Mean total effective dose for the CT component of the combined and separately acquired diagnostic CT exams were 6.20±2.69 and 8.17±2.61 mSv, respectively (P<0.0001). Average dose savings with the combined approach was 24.8±17.8% (2.60±2.51 mSv [range: 0.32-4.72 mSv]) of total CT effective dose. Image noise was not statistically significantly different between approaches (12.2±1.8 HU vs. 11.7±1.5 HU for the combined and separately acquired diagnostic CT images, respectively). A combined PET/diagnostic CT approach as described offers dose savings at similar image quality for children and young adults with lymphoma who have indications for both PET and diagnostic CT examinations.


Sweet blood and social suffering: rethinking cause-effect relationships in diabetes, distress, and duress.
I draw upon anthropological engagements with bioscience and embodiment in order to unpack current approaches to defining and preventing diabetes mellitus. The analysis stems from the conviction that carefully considering the symbolic frames through which we conceive of diseases, their origins, their distribution, and their consequences will assist us in planning and implementing interventions to improve population health. I argue that research and interventions focused on the sweetness of blood would benefit from rethinking intersections between diabetes, distress, and duress. In many instances, the lived experience of diabetes is consonant with an understanding of distress (i.e., "social suffering") that expands conventional understandings of population health problems. Diabetes incidence is rising worldwide, but it is rising especially rapidly in Aboriginal and other disadvantaged populations. Notably, diabetes is now three to five times more common in Canada's First Nations population than it is in its non-Aboriginal population. Yet as recently as 50 years ago, diabetes and associated health problems were rare in these groups. To come to grips with such transformations and disparities is to advance the population health research agenda.


Serum thromboxane B2 compared to five other platelet function tests for the evaluation of aspirin effect in stable cardiovascular disease.
To assess the role of serum thromboxane B(2) (TXB(2)) measurements and the correlation between platelet function studies, in patients with stable cardiovascular disease on aspirin or clopidogrel. 76 patients (47 on aspirin, 16 clopidogrel, 13 both) underwent assessment of TXB(2), whole blood aggregometry (WBA) after stimulation with (i) arachidonic acid (0.5mM), (ii) ADP (5 microM), (iii) collagen (1 and 5 microg/ml), PFA-100, and Cone and Plate Analyzer. Clopidogrel patients were additionally assessed by the VerifyNow System. TXB(2) values ranged between 0.2 and 56.2 ng/ml, with significant separation between those taking aspirin, clopidogrel and controls (0.45 ng/ml vs 6.85 ng/ml vs 12.97 ng/ml, p<0.001). There was moderate correlation between WBA-AA and TXB(2) (r=0.487, p<0.001), PFA-100((R)) (r=0.599, p<0.001), WBA-Col1 (r=0.424, p<0.001), WBA-Col1:5 (r=0.417, p<0.001), and between TXB(2) and PFA-100((R)) (r=0.509, p<0.001). The prevalence of aspirin non-responders for WBA-AA, TXB(2), PFA-100((R)), CPA and Coll1:5 was 13.1%, 8.2%, 14.8%, 9.7% and 16.4% respectively. Individual patients were not consistently classified as aspirin non-responders in all tests. Those with inadequate aspirin response on > or =3 tests had higher TXB(2) levels (mean 1.57+/-1.66, range 0.553-4.45 vs mean 0.45+/-0.18, range 0.23-1.50) (p=0.001). Clopidogrel suppressed TXB(2) (p=0.02), WBA-AA (p<0.001), WBA-Col1 (p=0.012) and WBA-ADP (p<0.001) compared to controls. TXB(2) in patients ingesting fish oil tablets was lower compared to those without (0.4 ng/ml vs 0.52 ng/ml, p=0.004). Obesity was associated with higher TXB(2) values (0.61 vs 0.41, p=0.01). Serum TXB(2) measurements are a direct measure of the pharmacological effect of aspirin, are easily performed and correlate with other measures of platelet function. Serum TXB(2) measurements could be a useful sole measure of aspirin non-response, and may be even more predictive when performed in tandem with a global measure of platelet function. Aspirin and clopidogrel both suppressed several platelet pathways.


Invented rule with English language learners.
The purpose of this study was to utilize an invented rule with English language learners (ELLs) in a clinical setting to determine differences based on language and age of the children. The performance was correlated with teacher reports of strong and weak language learning. Using a within-participants design, ELLs of age three to five were taught to apply a nonsense morpheme to signal a semantic difference. The invented rule was taught and responses were elicited in both English and English with Spanish interpretation. No significant difference for language was identified. Effect sizes for age were large (English, eta = 0.389, and English + Spanish, eta = 0.430) with five-year-old participants more likely to apply the rule to novel stimuli regardless of language. The performance of the majority of the participants correlated with teacher reports. The invented rule may provide a mechanism for assessing processing independent of prior language knowledge.


Impact of initiating carvedilol before angiotensin-converting enzyme inhibitor therapy on cardiac function in newly diagnosed heart failure.
The purpose of this research was to evaluate the therapeutic value of initiating a beta-blocker before an angiotensin-converting enzyme inhibitor (ACEI) in the treatment of heart failure. Although ACEI and carvedilol produce benefits in heart failure, whether the order of initiation of therapy determines the impact on left ventricular (LV) function and New York Heart Association functional class (NYHA FC) has not been determined. A single-center, prospective, randomized, open-label study was performed. We evaluated whether initiation of therapy with carvedilol either before (n = 38) or after (n = 40) perindopril therapy in newly diagnosed patients in NYHA FC II to III heart failure with idiopathic dilated cardiomyopathy, with the addition of the alternative agent after six months, determined subsequent changes in NYHA FC and LV function (echocardiography and radionuclide ventriculography). Study drugs were titrated to maximum tolerable doses. There were no differences in baseline characteristics between the study groups. After 12 months 11 patients died (6 in the group where the ACEI was initiated). At 12 months the group receiving carvedilol as initial therapy achieved a higher tolerable dose of carvedilol (43 +/- 17 mg vs. 33 +/- 18 mg, p = 0.03); a lower dose of furosemide (p < 0.05); and better improvements in symptoms (NYHA FC, p < 0.002), LV ejection fraction (radionuclide: 15 +/- 16% vs. 6 +/- 13%, p < 0.05; echocardiographic, p < 0.01), and plasma N-terminal pro-brain natriuretic peptide concentrations (p < 0.02). As opposed to the conventional sequence of drug use in the treatment of heart failure, initiation of therapy with carvedilol before an ACEI results in higher tolerable doses of carvedilol and better improvements in FC and LV function.


Towards accurate numerical method for monodomain models using a realistic heart geometry.
The simulation of cardiac electrophysiological waves are known to require extremely fine meshes, limiting the applicability of current numerical models to simplified geometries and ionic models. In this work, an accurate numerical method based on a time-dependent anisotropic remeshing strategy is presented for simulating three-dimensional cardiac electrophysiological waves. The proposed numerical method greatly reduces the number of elements and enhances the accuracy of the prediction of the electrical wave fronts. Illustrations of the performance and the accuracy of the proposed method are presented using a realistic heart geometry. Qualitative and quantitative results show that the proposed methodology is far superior to the uniform mesh methods commonly used in cardiac electrophysiology.


Synthesis and Structure of a Stable Bis(methylene)-λ4 -sulfane.
Bis(methylene)-λ4 -sulfane 1, a >C=S=C< heterocumulene, was obtained as a red crystalline solid from the reaction between elemental sulfur and a carbenoid that contains sterically demanding silylalkyl groups. Under atmospheric conditions, and even at elevated temperatures, 1 exhibits extraordinary stability. The molecular structure and electron-density distribution of 1 were analyzed by single-crystal X-ray diffraction analysis, which revealed a bent C=S=C geometry with C=S=C π-bonds. These results, combined with those of variable-temperature NMR measurements and theoretical calculations suggest a slow rotation of the S=C moieties in 1, the stability and structure of which were further examined by theoretical calculations.


Internet mailing lists: a primer.
The widespread availability of new electronic sources of information has exponentially increased the amount of information available to the surgeon in recent years. These new sources of information come in various forms, each of which have their own rules and regulations. This article focuses on Internet mailing lists. The practicalities of mailing lists are discussed, with guidelines to help users find lists of interest, join and contribute to, and use this medium effectively while minimising the time spent on it. Pointers to starting one's own list are provided for the motivated reader.


Fixations of the HIV-1 env gene refute neutralism: New evidence for pan-selective evolution.
We examined 103 nucleotide sequences of the HIV-1 env gene, sampled from 35 countries and tested: I) the random (neutral) distribution of the number of nucleotide changes; II) the proportion of bases at molecular equilibrium; III) the neutral expected homogeneity of the distribution of new fixated bases; IV) the hypothesis of the neighbor influence on the mutation rates in a site. The expected random number of fixations per site was estimated by Bose-Einstein statistics, and the expected frequencies of bases by matrices of mutation-fixation rates. The homogeneity of new fixations was analyzed using χ² and trinomial tests for homogeneity. Fixations of the central base in trinucleotides were used to test the neighbor influence on base substitutions. Neither the number of fixations nor the frequencies of bases fitted the expected neutral distribution. There was a highly significant heterogeneity in the distribution of new fixations, and several sites showed more transversions than transitions, showing that each nucleotide site has its own pattern of change. These three independent results make the neutral theory, the nearly neutral and the neighbor influence hypotheses untenable and indicate that evolution of env is rather highly selective.


Mass Spectrometry for Paper-Based Immunoassays: Toward On-Demand Diagnosis.
Current analytical methods, either point-of-care or centralized detection, are not able to meet recent demands of patient-friendly testing and increased reliability of results. Here, we describe a two-point separation on-demand diagnostic strategy based on a paper-based mass spectrometry immunoassay platform that adopts stable and cleavable ionic probes as mass reporter; these probes make possible sensitive, interruptible, storable, and restorable on-demand detection. In addition, a new touch paper spray method was developed for on-chip, sensitive, and cost-effective analyte detection. This concept is successfully demonstrated via (i) the detection of Plasmodium falciparum histidine-rich protein 2 antigen and (ii) multiplexed and simultaneous detection of cancer antigen 125 and carcinoembryonic antigen.


Epidermotropic primary neuroendocrine (Merkel cell) carcinoma of the skin with Pautrier-like microabscesses. Report of three cases and review of the literature.
Three cases of primary cutaneous neuroendocrine carcinoma involving the face are reported. In the first patient the tumor developed in the scar of a previously excised basal cell carcinoma of the nose, recurred locally, and metastasized to a regional lymph node 2 1/2 years after initial treatment. In the second and third patients the tumors were located on the forehead and were removed with a wide excision. In the second patient the tumor metastasized to regional lymph nodes 1 month after treatment. Light microscopic examination in all patients showed an undifferentiated, small cell, dermal tumor with prominent epidermotropism, forming Pautrier-like microabscesses. Immunohistochemical staining for neuron-specific enolase was positive, and ultrastructural examination revealed numerous cytoplasmic neurosecretory granules and paranuclear aggregates of intermediate-sized filaments. The literature concerning epidermal involvement by primary neuroendocrine carcinoma of the skin is reviewed; the relation with basal cell carcinoma and treatment are discussed.


Fractional Exhaled Nitric Oxide Measurements and Screening of Obstructive Sleep Apnea in a Sleep-Laboratory Setting: A Cross-Sectional Study.
Obstructive sleep apnea (OSA) is a common condition characterized by repetitive collapse of the upper airways and intermittent oxygen desaturation, which may lead to airway inflammation. Here, we explored whether fractional exhaled nitric oxide (FeNO) levels provide a non-invasive screening tool of OSA. Over a 3-month period, FeNO levels were measured in consecutive non-smoking patients referred for a sleep laboratory. All patients underwent full polysomnography. OSA severity was classified based on the apnea/hypopnea index: ≥ 5.0/h as any OSA, ≥ 15.0/h as moderate/severe OSA, and ≥ 30.0/h as severe OSA. FeNO was measured by a portable device (NIOX-MINO®; Aerocrine AB, Solna, Sweden) and expressed as parts per billion (ppb). Discrimination by area under the curve (AUC) and binary logistic regression were performed. A total of 229 subjects were evaluated. Mean FeNO values were similar among subjects without OSA or with OSA: 16.9 ± 10.6 ppb versus 20.2 ± 14.5 ppb, p = 0.221; respectively. FeNO was not an inclusionary parameter to predict any OSA, moderate/severe OSA, and severe OSA: odds ratio (OR) 1.023 (95% confidence interval [CI]: 0.986-1.062); OR 1.012 (95% CI: 0.991-1.034); and OR 0.999 (95% CI: 0.980-1.018), respectively. The AUC values for FeNO in the diagnosis of any OSA, moderate/severe OSA, and severe OSA showed no discriminatory properties: AUC: 0.567 (95% CI: 0.464-0.670), AUC: 0.541 (95% CI: 0.465-0.618), and AUC: 0.535 (95% CI: 0.459-0.610); respectively. In a sleep-lab setting, our findings suggest that FeNO measurements are inconsequential in the screening of OSA in adults.


Patterns of disease modifying antirheumatic drug use in a Spanish cohort of patients with rheumatoid arthritis.
To determine the adequacy of disease modifying antirheumatic drug (DMARD) prescription to disease activity in patients with rheumatoid arthritis (RA) and to assess whether the reasons for DMARD discontinuation agree with published evidence. Cross-sectional analysis of the baseline year of a RA cohort (n = 788) randomly selected from the clinical registries of 34 centers. Data about current and previous DMARD use was collected from medical records and confirmed by the patient. Disease activity score (DAS), Health Assessment Questionnaire (HAQ) and Larsen scores, and other clinical data were obtained during the study visit. At baseline visit, 607 patients (77%) were receiving one or more DMARD. Mean DAS, HAQ, and Larsen scores (+/- SD) were: 3.40 +/- 1.22, 1.6 +/- 0.4, and 54.68 +/- 26.37, respectively. Methotrexate (MTX) was the most frequently prescribed DMARD and parenteral gold salts (GS) showed the highest rate of discontinuation. MTX was used as single therapy in a significantly higher proportion (64.3%) than other DMARD (< 50%) and treatment discontinuation due to inefficacy was significantly less frequent (25.5%) than with other DMARD (> 40%). However, the DAS28 was significantly worse in the group treated with MTX in single therapy than in the group treated with GS alone (4.13 vs 3.43; p = 0.032). Despite the high use of DMARD among Spanish patients with RA, a significant number of them still have poor control of the disease. In addition, our data show a different perception of ineffectiveness depending on the DMARD used. A non-systematic use of objective quantitative tools for assessment of RA activity and some non-evidence based decisions on the management of DMARD may account for these findings.


[Example of rectification for infusion pump on the radiated emission test].
This article describes the measure to decrease the emission of a domestic infusion pump which can't pass the radiated emission test when performing EMC tests. Then optimizes the measure and evaluates whether these measures affect the original electrical safety of the pump.


Adverse effects of temazepam in older adults with chronic insomnia.
Benzodiazepine-hypnotics are frequently used for treating insomnia in older adults; however, there is little information about adverse effects associated with their usage over several weeks, particularly in this segment of the population. This study reports on the incidence of adverse effects of temazepam in older adults with chronic insomnia and examines whether the addition of cognitive-behaviour therapy (CBT) is associated with less drug used and fewer adverse effects. Sixty patients with chronic and primary insomnia were randomized to temazepam (n = 20), placebo (n = 20) or temazepam plus CBT (n = 20). Data from the physicians' weekly assessments and patients' sleep diaries were used to evaluate adverse effects, the dose (7.5-30 mg) at which they occurred, and drug use patterns over the 8-week course of treatment. The incidence of adverse effects was infrequent, as shown by the low percentages of complaints reported by patients in the temazepam (7.8%), placebo (10.8%) and combination groups (8.3%). The severity of adverse events was mild and decreased over the course of treatment. The maximum dose was reached by 10 patients receiving temazepam, 14 placebo and 7 in the combined treatment. The average nightly dosage used was 20 mg for both the temazepam and placebo groups and 16 mg for the combined condition. Patients receiving temazepam plus CBT used less drugs, with approximately the same incidence of adverse effects. Temazepam is a safe hypnotic for use by older adults over an 8-week treatment period. There are few adverse effects and behavioural tolerance to those effects develop over time. The addition of cognitive-behavioural intervention reduced both the amount of medication used and the incidence of adverse effects, with comparable sleep improvements.


Image denoising using the ridgelet bi-frame.
We are concerned with the performance evaluation of the ridgelet bi-frame for image denoising application. The ridgelet bi-frame is a new (as far as we know) bi-frame system that can efficiently deal with straight singularities in two dimensions. We show that, for images dominated by straight edges, the ridgelet bi-frame can obtain much better restoration results than wavelet systems. We also investigate the statistical properties of the ridgelet bi-frame coefficients of these images. Results indicate that the marginal distribution of ridgelet bi-frame coefficients has higher kurtosis than that of wavelet coefficients of the same images. We describe a simple method through which statistical denoising algorithms previously developed in the wavelet domain can be conveniently introduced into the ridgelet bi-frame domain. In addition, we use the ridgelet bi-frame to construct another new bi-frame system referred to as the curvelet bi-frame, which can be viewed as a generalized version of the curvelet. Experiment results show that the simple hard-threshold procedure in the curvelet bi-frame domain produces restoration results comparable with those due to the state-of-the-art denoising methods.


[Response of isolated segments of hepatic arteries to serotonin in the presence of methergoline].
The effect of metergoline (an anti 5-HT drug) on strips of calf hepatic arteries was investigated. Metergoline prevents or antagonizes the contraction induced by 5-Hydroxytryptamine. The inhibitory effect is dose-dependent.


Formaldehyde cytotoxicity in three human cell types assessed in three different assays.
International standards for preclinical screening of the cytotoxicity of dental materials so far recommend the use of established cell lines. The aim of this study was to assess the relative susceptibility of human dental pulp fibroblasts (HPF), human buccal epithelial cells (HBE) and HeLa cervix cancer cells exposed to identical cytotoxic challenges. Formaldehyde, which may be released from dental materials such as dental composites, glassionomer cements, and endodontic sealers, was used as test chemical. Cytotoxicity data including dose-response relations and TC(50) values were assessed in three different assays: BrdU incorporation, neutral red uptake and MTT assays. HBE and HPF demonstrated statistically significant lower TC(50) values in both the neutral red and the BrdU assay in comparison to HeLa cells. In the MTT assay no statistically significant differences were observed between the cell types. In the two target-tissue cell types (HPF and HBE) the Neutral Red assay revealed lower TC(50) values in comparison to the BrdU assay. In HeLa cells no statistically significant differences were observed between the assays. In conclusion, the present study confirms that cytotoxicity data obtained by cell culture studies are influenced by both cell culture model and choice of assay. Under identical experimental conditions, human target tissue cells appeared to be more sensitive to formaldehyde toxicity than human HeLa cancer cells.


Imaging of cellular spread on a three-dimensional scaffold by means of a novel cell-labeling technique for high-resolution computed tomography.
Computed tomography (CT) represents a truly three-dimensional (3D) imaging technique that can provide high-resolution images on the cellular level. Thus, one approach to detect single cells is X-ray absorption-based CT, where cells are labeled with a dense, opaque material providing the required contrast for CT imaging. Within the present work, a novel cell-labeling method has been developed showing the feasibility of labeling fixed cells with iron oxide (FeO) particles for subsequent CT imaging and quantitative morphometry. A biotin-streptavidin detection system was exploited to bind FeO particles to its target endothelial cells. The binding of the particles was predominantly close to the cell centers on 2D surfaces as shown by light microscopy, scanning electron microscopy, and CT. When cells were cultured on porous, 3D polyurethane surfaces, significantly more FeO particles were detected compared with surfaces without cells and FeO particle labeling using CT. Here, we report on the implementation and evaluation of a novel cell detection method based on high-resolution CT. This system has potential in cell tracking for 3D in vitro imaging in the future.


Fusion and sorting of two parallel trains of droplets using a railroad-like channel network and guiding tracks.
We propose a robust droplet fusion and sorting method for two parallel trains of droplets that is relatively insensitive to frequency and phase mismatch. Conventional methods of droplet fusion require an extremely precise control of aqueous/oil flows for perfect frequency matching between two trains of droplets. In this work, by combining our previous two methods (i.e., droplet synchronization using railroad-like channels and manipulation of shape-dependent droplets using guiding tracks), we realized an error-free droplet fusion/sorting device for the two parallel trains of droplets. If droplet pairs are synchronized through a railroad-like channel, they are electrically fused and the fused droplets transit to a middle guiding track to flow in a middle channel; otherwise non-synchronized non-fused droplets will be discarded into the side waste channels by flowing through their own guiding tracks. The simple droplet synchronization, fusion, and sorting technology will have widespread application in droplet-based chemical or biological experiments, where two trains of the chemically or biologically treated or pre-formed droplets yield a train of 100% one-to-one fused droplets at the desired outlet channel by sorting all the non-synchronized non-fused droplets into waste outlets.


15-Year experience in the treatment of rectal prolapse in children.
Rectal prolapse is a common and usually self-limited condition in children. Several surgical techniques have been advocated for refractory prolapse. We reviewed our experience with treatment and the outcome of refractory rectal prolapse. Retrospective review was conducted on patients undergoing surgery for rectal prolapse from January 1993 to March 2009. Patients with imperforate anus/cloacal abnormalities, Hirschsprung disease, spina bifida, or prior pull-through were excluded. Twenty patients underwent 23 procedures for rectal prolapse. There were 10 posterior sagittal rectopexies, 6 transabdominal rectopexies, 5 laparoscopic rectopexies, 1 hypertonic saline injection, and 1 anal cerclage. The mean duration of symptoms was 1.6 years (range, 1-10 years). The mean age at operation was 6.8 years (range, 4 months-19 years), with a 5:1 male predominance. There was no operative or perioperative mortality. Median length of follow-up was 7.2 months; 2 patients were lost to follow-up. The overall recurrence rate was 35%. All recurrences followed posterior sagittal rectopexies, which had a 70% recurrence rate. Four patients required reoperation, all done transabdominally (2 open and 2 laparoscopically). None of the 3 remaining patients with mild recurrences required reoperation. A variety of options for management of refractory rectal prolapse in children exist. Laparoscopic rectopexy seems to be safe and a comparatively successful option in these children.


Gilles de la Tourette's syndrome: case report.
An adult patient sought help because he was unable to stop making noises and movements which were antisocial. The grotesque complaint proved to be a case of Gilles de la Tourette's syndrome. Treatment with haloperidol produced a marked improvement in the symptoms, some of which are seldom reported.


Impaired nitrergic relaxation of the sphincter of Oddi of hyperlipidaemic rabbits.
Field stimulation relaxed the sphincter of Oddi muscle rings of the rabbit after incubation with phentolamine, oxprenolol and atropine (all 1 microM). The relaxation was blocked by NG-nitro-L-arginine methyl ester (30 microM) and was reversed by 3 mM L-arginine but not D-arginine. Sphincter of Oddi preparations from hypercholesterolaemic rabbits exhibited contractions under the same conditions. We conclude that nitrergic relaxation is impaired in the sphincter of Oddi from hypercholesterolaemic rabbits.


Influence of Naloxone on the cellular immune response to head-up tilt in humans.
To evaluate a possible role for beta-endorphin in the stress-induced modulation of natural killer (NK) cells, immunologically competent blood cells were followed in eight male volunteers administered either Naloxone or saline (control) during head-up tilt maintained until the appearance of presyncopal symptoms (PS). The PS appeared more rapidly with Naloxone compared to control [5.7 (SEM 1.1) vs 22.3 (SEM 5.1) min; P = 0.01]. The NK cell activity increased threefold during PS partly due to an increase in CD16+ and CD56+ NK cells in blood. In support, NK cell activity boosted with interferon-alpha and interleukin 2 rose in parallel with unboosted NK cell activity and NK cell concentration and activities returned to the baseline level after 105 min. The total lymphocyte count and the concentrations of CD3+, CD4+, CD8+, CD16+, and CD56+ cells increased during PS. Head-up tilt also induced an increase in plasma adrenaline concentration during control PS and a rise in plasma cortisol and adrenocorticotropic hormone concentrations up to 30 min thereafter, whereas no significant changes were found in plasma concentrations of noradrenaline, growth hormone, or beta-endorphin. The results would indicate an influence of endorphin on the increase in plasma adrenaline concentration during head-up tilt and at the same time contra-indicate a significant role for adrenaline in the provocation of PS. The influence of head-up tilt on plasma beta-endorphin was too small to influence the modulation of the cellular immune system.


Patients at high risk for renal artery stenosis: a simple method of renal scintigraphic analysis with Tc-99m DTPA and captopril.
Fifty patients with suspected renal artery stenosis (RAS) were studied with renal scintigraphy before and after administration of captopril. Twenty-three patients had RAS (greater than or equal to 75% RAS or greater than or equal to 50% RAS with poststenotic dilatation) and 27 had normal renal arteries at angiography. Angiotensin-converting enzyme inhibitors were discontinued 24 hours prior to renal scintigraphy; all other medications were continued. Each patient was evaluated with a simplified captopril renal scintigraphic protocol: renal imaging after administration of 12 mCi (444 MBq) of technetium-99m diethylenetriaminepentaacetic acid (DTPA), a 3-hour wait, oral administration of 50 mg of captopril, a 1-hour wait, and another scintigram obtained after administration of 12 mCi (444 MBq) of Tc-99m DTPA. Times of peak renal activity (Tmax) were determined from renal time-activity curves, and glomerular filtration rates (GFRs) were calculated with the Gates technique. A Tmax greater than or equal to 11 minutes after injection or a GFR ratio (larger GFR/smaller GFR) greater than 1.5 enabled detection of RAS with 91% sensitivity, 93% specificity, and 92% accuracy. Renal scintigraphy without captopril had only 43%-68% sensitivity in detecting RAS, depending on the criteria used.


[Clinical study of Silver Lubricath Foley catheter].
We evaluated the Silver Lubricath Foley Catheter (silver catheter) coated with silver and hydrogel developed to prevent urinary infection, in comparison with the silicone-coated catheter (silicone catheter). Twelve patients ranging from 71 to 95 years of age (median age, 82 years) were catheterized and the 16 of 18F catheter was replaced every 2 weeks. They answered a questionnaire which included inquiry about the treatment with urinary catheter. Because of less leakage and discomfort to the urethra, the silver catheter had advantages over the silicone catheter. The risk of bacteriuria after 14 days of catheterization was not significantly different between the two types of catheter. Scanning electron microscopic analysis revealed that bacterial biofilm developed on the inner surface of both catheters after 14 days of catheterization. On the other hand, the amount of bacterial biofilm on the outer surface of a silver catheter was less than that on the outer surface of a silicone catheter.


Family nursing in community-oriented primary health care.
Renowned for its innovative approach to community health promotion and the key role of the nurse in treatment, prevention, teaching and research, the Philip and Sally Lown Hadassah Community Health Centre in Jerusalem is a model where the nurse is a member of a comprehensive multidisciplinary team that comprises family and paediatric physicians, epidemiologists, psychologist, statistician, social worker, health educator, health recorder, dietician and other public health specialists. As such, the nurse actively participates in the planning, implementation and evaluation of all new programmes, improvements and policy changes. Below, how the nurse works as a team member in the community centre.


Modelling land use change with generalized linear models--a multi-model analysis of change between 1860 and 2000 in Gallatin Valley, Montana.
This paper develops an approach to modelling land use change that links model selection and multi-model inference with empirical models and GIS. Land use change is frequently studied, and understanding gained, through a process of modelling that is an empirical analysis of documented changes in land cover or land use patterns. The approach here is based on analysis and comparison of multiple models of land use patterns using model selection and multi-model inference. The approach is illustrated with a case study of rural housing as it has developed for part of Gallatin County, Montana, USA. A GIS contains the location of rural housing on a yearly basis from 1860 to 2000. The database also documents a variety of environmental and socio-economic conditions. A general model of settlement development describes the evolution of drivers of land use change and their impacts in the region. This model is used to develop a series of different models reflecting drivers of change at different periods in the history of the study area. These period specific models represent a series of multiple working hypotheses describing (a) the effects of spatial variables as a representation of social, economic and environmental drivers of land use change, and (b) temporal changes in the effects of the spatial variables as the drivers of change evolve over time. Logistic regression is used to calibrate and interpret these models and the models are then compared and evaluated with model selection techniques. Results show that different models are 'best' for the different periods. The different models for different periods demonstrate that models are not invariant over time which presents challenges for validation and testing of empirical models. The research demonstrates (i) model selection as a mechanism for rating among many plausible models that describe land cover or land use patterns, (ii) inference from a set of models rather than from a single model, (iii) that models can be developed based on hypothesised relationships based on consideration of underlying and proximate causes of change, and (iv) that models are not invariant over time.


Biomarkers in sepsis: towards precision medicine for the prevention of adverse outcomes.


Statistical evaluation of manual segmentation of a diffuse low-grade glioma MRI dataset.
Software-based manual segmentation is critical to the supervision of diffuse low-grade glioma patients and to the optimal treatment's choice. However, manual segmentation being time-consuming, it is difficult to include it in the clinical routine. An alternative to circumvent the time cost of manual segmentation could be to share the task among different practitioners, providing it can be reproduced. The goal of our work is to assess diffuse low-grade gliomas' manual segmentation's reproducibility on MRI scans, with regard to practitioners, their experience and field of expertise. A panel of 13 experts manually segmented 12 diffuse low-grade glioma clinical MRI datasets using the OSIRIX software. A statistical analysis gave promising results, as the practitioner factor, the medical specialty and the years of experience seem to have no significant impact on the average values of the tumor volume variable.


Computerized physician order entry: a prescription for patient safety.
Clinician adoption of CPOE/CDS solutions is crucial to helping caregivers reduce medical errors and enhance patient safety. The LeapFrog Group CPOE/CDS report can be a helpful guide, but as clinicians concerned about the quality of health care and the well-being of our patients, we must play an active role in the successful adoption of these solutions by: 1. Making sure that your institution is committed to having the appropriate people involved in the entire process, including nurse leaders. 2. Selecting a vendor that has the knowledge and clearly understands the importance of implementing this type of system. 3. Ensuring that your organization is selecting a system that actually meets the criteria defined by the LeapFrog Group.


Estimating the Marginal Productivity of the English National Health Service From 2003 to 2012.
Estimates of the marginal productivity of the health sector are required for a wide range of resource allocation decisions. Founding these estimates on robust empirical analysis can inform these decisions and improve allocative efficiency. This article estimates the annual marginal productivity of the English NHS over a 10-year period (between 2003 and 2012). Data on expenditure and mortality by program budget category are used in conjunction with socioeconomic and demographic variables from the censuses for 2001 and 2011. This article applies an econometric strategy that employs an established instrumental variable approach, which is then subjected to a number of sensitivity analyses. The results of the econometric analysis, along with additional data on the burden of disease, are used to generate an estimate of the marginal productivity for each of the study years. We find that an additional unit of health benefit has cost between £5000 and £15 000 per quality-adjusted life-year from 2003 to 2012. Over this period these estimates (all in current prices) have increased at a faster rate than NHS price inflation, suggesting an increase in real terms. These results are discussed in the context of the existing literature, and the potential policy implications for decisions about resource allocation are explored.


Hepatocyte nuclear factor-kappa beta (NF-kappaB) activation is protective but is decreased in the cholestatic liver with endotoxemia.
Obstructive jaundice (OJ) is an important clinical consideration associated with a high risk of bacteremia. Hepatocyte nuclear factor-kappa B (NF-kappaB) activation confers an antiapoptotic function. Although the occurrence of hepatocyte apoptosis has been shown in OJ, the activation and role of NF-kappaB over the time course of OJ in conjunction with endotoxemia have not yet been well defined. We hypothesized that NF-kappaB activation may be decreased over the time course of OJ and endotoxemia, which leads to severe liver injury. The aim of the current study was to examine whether NF-kappaB activation can decrease hepatocyte apoptosis and liver injury over the time course of OJ in response to lipopolysaccharide (LPS) administration. Male C57BL/6 mice were subjected to bile duct ligation and were administered LPS intravenously at 3 days (OJ3) or 14 days (OJ14) after bile duct ligation. NF-kappaB activation; protein expressions of NF-kappaB p65, IkappaB-alpha, Ikappabeta-b, and Pin1; immunohistochemistry of poly adenosine diphosphate (ADP)-ribose polymerase p85 fragment (PARP); and serum alanine transaminase (ALT) levels were examined. Hepatocyte NF-kappaB activation was observed during OJ. After LPS administration, the hepatic NF-kappaB activation defined by electrophoretic mobility shift assay was decreased in the OJ14 group compared with the OJ3 group, which is consistent with a decrease in NF-kappaB p65 protein expression. Changes in phosphorylated Ikappa-B-beta but not phosphorylated IkappaB-alpha mirrored these results. Significant hepatocyte apoptosis defined by PARP immunohistochemistry was observed in the LPS-treated OJ14 relative to the LPS-treated OJ3. Hepatic expressions of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in the LPS OJ14 mice were upregulated relative to those in the LPS OJ3. Serum ALT levels increased significantly in the LPS OJ14 relative to other mice. The survival rate was significantly less in the LPS OJ14 relative to other mice. After prolonged OJ, exposure to endotoxemia was associated with a decrease in hepatocyte NF-kappaB activation and an increase in hepatocyte apoptosis and secondary necrosis, thus resulting in liver dysfunction.


Incorporating medication indications into the prescribing process.
The incorporation of medication indications into the prescribing process to improve patient safety is discussed. Currently, most prescriptions lack a key piece of information needed for safe medication use: the patient-specific drug indication. Integrating indications could pave the way for safer prescribing in multiple ways, including avoiding look-alike/sound-alike errors, facilitating selection of drugs of choice, aiding in communication among the healthcare team, bolstering patient understanding and adherence, and organizing medication lists to facilitate medication reconciliation. Although strongly supported by pharmacists, multiple prior attempts to encourage prescribers to include the indication on prescriptions have not been successful. We convened 6 expert panels to consult high-level stakeholders on system design considerations and requirements necessary for building and implementing an indications-based computerized prescriber order-entry (CPOE) system. We summarize our findings from the 6 expert stakeholder panels, including rationale, literature findings, potential benefits, and challenges of incorporating indications into the prescribing process. Based on this stakeholder input, design requirements for a new CPOE interface and workflow have been identified. The emergence of universal electronic prescribing and content knowledge vendors has laid the groundwork for incorporating indications into the CPOE prescribing process. As medication prescribing moves in the direction of inclusion of the indication, it is imperative to design CPOE systems to efficiently and effectively incorporate indications into prescriber workflows and optimize ways this can best be accomplished.


Inhibition of α-amylase activity by cellulose: Kinetic analysis and nutritional implications.
We report on inhibition of α-amylase activity by cellulose based on in vitro experiments. The presence of cellulose in the hydrolysing medium reduced the initial velocity of starch hydrolysis in a concentration dependent manner. α-Amylase adsorption to cellulose was reversible, attaining equilibrium within 30min of incubation, and showed a higher affinity at 37°C compared to 20 and 0°C. The adsorption was almost unchanged in the presence of maltose (2.5-20mM) but was hindered in the presence of excess protein, suggesting non-specific adsorption of α-amylase to cellulose. Kinetic analyses of α-amylase hydrolysis of maize starch in the presence of cellulose showed that the inhibition is of a mixed type. The dissociation constant (Kic) of the EI complex was found to be ca. 3mg/mL. The observed inhibition of α-amylase activity suggests that cellulose in the diet can potentially attenuate starch hydrolysis.


Longitudinal monitoring of sex steroid hormones in excrement of spectacled eiders (Somateria fischeri).
From the 1970s to the 1990s, the breeding population of spectacled eiders (Somateria fischeri) in western Alaska declined by 96%, which led to the listing of this species as threatened under the Endangered Species Act in 1993. Since then, the population has stabilized, but has not recovered to pre-decline numbers. While little is known about reproductive endocrinology in spectacled eiders, in other avian species, estrogen and testosterone are known to initiate and modulate various reproductive processes including yolk protein synthesis, reproductive behaviors and secondary sex characteristics. Measurement of the metabolites of estrogen and testosterone (EM and TM, respectively) in excrement reflect circulating hormone concentrations and provide a non-invasive method to monitor reproductive physiology. We measured concentrations of excreted EM in captive females and TM in males to (1) determine the efficacy of commercially available radioimmunoassay kits to detect EM and TM, (2) describe annual profiles of EM and TM concentrations, and (3) define the reproductive season of captive spectacled eiders using endocrine status. Excrement samples were collected from captive female and male spectacled eiders three times per week throughout 1 year. Female EM and male TM levels were quantified using radioimmunoassay. Mean female EM profile exhibited values exceeding the threshold for "peak" values (EM>193.3 ng/g) from mid-February to early July, and again in September. Additionally, the highest average concentrations of EM were seen in March, May and September. Elevated TM concentrations occurred in mid March, mid May and late June. These data suggest that levels of excreted sex steroids reflect patterns predicted by breeding landmarks in the annual cycle and will assist in field monitoring and captive breeding programs for spectacled eiders.


Localized deoxygenation and direct patterning of graphene oxide films by focused ion beams.
Exposure to controlled doses (~4.65 × 10(-3) to 2.79 × 10(-2) nC/μm(2) ion fluence) of Ga ions via a focused ion beam (FIB) deoxygenates graphene oxide (GO) and increases the electrical conductivity in 100 × 100 μm(2) patches by several orders of magnitude compared to that in unexposed GO. Raman spectra and the carbon/oxygen ratio in exposed areas are indicative of chemically reduced graphene oxide (rGO). This novel FIB-induced conversion technique is harnessed for the direct imprinting of complex micrometer-scale shapes and sub-20-nm lines of rGO in insulating films and flakes of GO establishing the capability of generating features varying in size from approximately tens of nanometers to approximately hundreds of micrometers in a maskless, efficient manner.


Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy.
We compared outcomes between patients treated with nephron sparing surgery (NSS) without imperative indications for renal preservation and radical nephrectomy (RN) for 4 to 7 cm renal cell carcinoma (RCC). We identified 91 patients treated with NSS and 841 patients treated with RN for 4 to 7 cm RCC between 1970 and 2000. Cancer specific, distant metastases-free and recurrence-free survivals were estimated using the Kaplan-Meier method. Cancer specific survival rates at 5 years for patients treated with NSS and RN for 4 to 7 cm RCC were 98% and 86%, respectively. On univariate analysis patients treated with RN for 4 to 7 cm RCC were more likely to die of RCC compared to patients treated with NSS. However, after adjusting for features associated with death from RCC including stage, grade, histological tumor necrosis and histological subtype, this difference was no longer statistically significant (risk ratio 1.60, 95% CI 0.50-5.12, p = 0.430). Distant metastases-free survival rates at 5 years for patients treated with NSS and RN were 94% and 83%, respectively. On univariate analysis patients treated with RN were more likely to have tumors that metastasized compared to patients treated with NSS, although this difference was no longer significant after adjusting for the features listed previously (risk ratio 1.76, 95% CI 0.64-4.83, p = 0.273). Recurrence-free survival rates at 5 years for patients treated with NSS and RN were 94% and 98%, respectively. On univariate analysis patients treated with RN were less likely to have recurrence compared to patients treated with NSS (risk ratio 0.32, 95% CI 0.12-0.85, p = 0.022). There were no statistically significant differences in cancer specific survival and distant metastases-free survival between patients treated with NSS and RN for 4 to 7 cm RCC after adjusting for important pathological features. NSS for 4 to 7 cm RCC results in excellent outcome in appropriately selected patients.


Synthesis and hypoglycemic activity of some new theophylline derivatives.
Thirty-one new theophylline derivatives have been synthesized and evaluated for their hypoglycemic activity. Compounds 24 (56% reduction) and 31 (57% reduction) showed better hypoglycemic activity than the standard drug glibenclamide which showed 52% reduction in serum glucose level. Compound 27 remarkably reduced serum glucose level by 53%. Ten compounds showed varying degrees of hypoglycemic activity ranging from 20 to 37% reduction in serum glucose level compared to the standard drug. The aromatic amide functionality is the common feature of these theophylline hypoglycemic derivatives. However, anthranilamide and or aliphatic amides proved to be the least active compounds in the present series.


Glycine prevents metabolic steatohepatitis in diabetic KK-Ay mice through modulation of hepatic innate immunity.
Strategies for prevention and treatment of nonalcoholic steatohepatitis remain to be established. We evaluated the effect of glycine on metabolic steatohepatitis in genetically obese, diabetic KK-Ay mice. Male KK-Ay mice were fed a diet containing 5% glycine for 4 wk, and liver pathology was evaluated. Hepatic mRNA levels for lipid-regulating molecules, cytokines/chemokines, and macrophage M1/M2 markers were determined by real-time RT-PCR. Hepatic expression of natural killer (NK) T cells was analyzed by flow cytometry. Body weight gain was significantly blunted and development of hepatic steatosis and inflammatory infiltration were remarkably prevented in mice fed the glycine-containing diet compared with controls. Indeed, hepatic induction levels of molecules related to lipogenesis were largely blunted in the glycine diet-fed mice. Elevations of hepatic mRNA levels for TNFα and chemokine (C-C motif) ligand 2 were also remarkably blunted in the glycine diet-fed mice. Furthermore, suppression of hepatic NK T cells was reversed in glycine diet-fed KK-Ay mice, and basal hepatic expression levels of NK T cell-derived cytokines, such as IL-4 and IL-13, were increased. Moreover, hepatic mRNA levels of arginase-1, a marker of macrophage M2 transformation, were significantly increased in glycine diet-fed mice. In addition, dietary glycine improved glucose tolerance and hyperinsulinemia in KK-Ay mice. These observations clearly indicate that glycine prevents maturity-onset obesity and metabolic steatohepatitis in genetically diabetic KK-Ay mice. The underlying mechanisms most likely include normalization of hepatic innate immune responses involving NK T cells and M2 transformation of Kupffer cells. It is proposed that glycine is a promising immunonutrient for prevention and treatment of metabolic syndrome-related nonalcoholic steatohepatitis.


Nonmetals in the argon-inductively coupled plasma-optical emission spectrometry: I. Phosphorus, sulfur and carbon.
The behavior of phosphorus, sulfur and carbon in the argon-ICP-OES was systematically investigated for a wide range of nebulizer gas flows and observation heights. Five lines of phosphorus, four lines of sulfur and three lines of carbon, which have analytical usable detection limits, were taken into consideration. The further parameter set was inspired by the needs of every-day-analysis in the laboratory, especially the low integration time that is necessary for analysis of large amounts of samples. For each element line a signal-to-noise plot was obtained with a method described earlier. The optimum conditions for the combined analysis were determined from signal-to-noise plots of those element lines with the lowest detection limits. The lowest detection limits for phosphorus (0.13 mg/L) and carbon (0.01 mg/L) are useful for solving many analytical problems. However, even the best detection limit for sulfur (2.97 mg/L) is only of limited use without further preconcentration. A major problem was the background of carbon, most probably from carbon dioxide, which increased the available detection limit to about 0.04 mg/L. Surprisingly, the best detection limits were obtained at very low observation heights, which were only a couple of millimeters above the load coil. Fortunately, all elements showed a similar behavior and so the detection limits at compromise conditions were only slightly higher compared with the single-element detection limits.


Candidemia and the susceptibility pattern of Candida isolates in blood.
Candida species has become one of the most common blood isolates as well as one of the leading causes of nosocomial bloodstream infections. The purpose of our study was to determine the prevalence of Candida species among our bloodstream infecting organisms and the susceptibility pattern of the Candida isolates to antifungal agents. A prospective study was carried out in the Division of Microbiology, King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia of all positive blood cultures for Candida species. The study took place from 1st January 1998 to March 2002. Identification and susceptibility pattern of isolates were determined by the Candifast technique to amphotericin B, fluconazole, nystatin, Flucytosine, econazole, ketoconazole and miconazole. Over a 2-year period, 17,916 blood cultures were performed in our hospital. There were 2,972 positive cultures, of which 83 (2.8%) patients had Candida species isolated from their bloodstream. Of these, 38 (46%) were Candida albicans (C.albicans). The remaining 45 strains were made up of Candida tropicalis 9 (10.8%); Candida parapsilosis 9 (10.8%); Candida species 9 (10.8%); Candida guilliermondi 6 (7.2%); Candida krusei 5 (6%); Candida glabrata 4 (4.8%); Candida pseudotropicalis 2 (2.4%) and Trichosporon species 1 (1.2%). All Candida species were susceptible to amphotericin B. However, only 18 (47%) out of 38 C.albicans were susceptible to fluconazole, while only 8 (17.7%) of 45 non-C.albicans strains were susceptible to this drug. The susceptibility of C.albicans to fluconazole in our hospital using the Candifast method is very low (47%). These results need to be confirmed by carrying out the Etest or the NCCLS M27-A method to confirm the true susceptibilities of Candida strains in our locality.


Scophthalmus maximus cystatin B enhances head kidney macrophage-mediated bacterial killing.
Cystatins form a large family of cysteine protease inhibitors found in a wide arrange of organisms. Studies have indicated that mammalian cystatins play important roles under both physiological and pathological conditions. However, much less is known about fish cystatins. In this report, we described the identification and analysis of a cystatin B homologue, SmCytB, from turbot Scophthalmus maximus. The open reading frame of SmCytB is 300bp, which encodes a 99-residue protein that shares high levels of sequence identities with the cystatin B of a number of fish species and contains the conserved cysteine protease inhibitor motif of cystatin B. Constitutive expression of SmCytB is high in muscle, brain, heart and liver, and low in spleen, blood, gill and kidney. Bacterial infection upregulates SmCytB expression in kidney, spleen, liver and brain but not in muscle or heart. Functional analysis showed that recombinant SmCytB purified from Escherichia coli exhibits apparent cysteine protease inhibitor activity. Transient overexpression of SmCytB in head kidney macrophages enhances macrophage bactericidal activity probably through a nitric oxide-independent mechanism. These results indicate that SmCytB is involved in the immune defense of turbot against bacterial infection.


How good is my test?
Instructors must appraise the quality of their examinations, laboratory ratings, and any other test data upon which grade decisions are made. The basic concepts of test theory are reviewed to provide some support for making these appraisals. Four types of validity are discussed. The concept of reliability is presented along with a summary of various reliability coefficients and limitations on the interpretation of reliability. Practical suggestions are offered for instructors seeking to gauge the quality of their tests. The use of the standard error of measurement for estimating the likelihood of misgrading a student is demonstrated.


Intracranial hypertension secondary to abdominal compartment syndrome in a girl with giant ovarian cystic mass.
The abdominal compartment syndrome (ACS) is a potentially fatal entity that occurs as a result of an acute increase in intra-abdominal pressure (IAP). The authors report on a girl with a giant ovarian cystic mass, and clinical signs of ACS and intracranial hypertension (ΙΗ). The possible mechanism of IH secondary to ACS is discussed.


Sleep-endocrine profile of the antidepressant mianserin.
The effects of mianserin, a tetracyclic antidepressant, on sleep stages and on the nocturnal secretion of cortisol, ACTH, growth hormone, prolactin and tryptophan were studied on 11 normal male volunteers in a double-blind, placebo-controlled study. Mianserin increased Stage 3 time (p less than 0.001) and Stage 4 time (p less than 0.01). It reduced the number of REM periods (p less than 0.001), the REM latency after sleep onset (p less than 0.01) and both the total and percentage REM time (p less than 0.05). A reduction in both the total sleep time (p less than 0.05) and the percentage of total time in bed (p less than 0.05) were the only significantly carry-over effects from the drug treatment period. No significant difference in any biochemical measurement was found between placebo and drug treatment.


Effect of microgravity on the cell cycle in the lentil root.
Characteristics of the cell cycle in cortical regions (0-0.6 mm from the root-cap junction) of the primary root of lentil (Lens culinaris L.) during germination in the vertical position on earth were determined by iododeoxyuridine labelling and image analysis. All cells were in the G1 phase at the beginning of germination and the duration of the first cell cycle was about 25 h. At 29 h, around 14% of the cortical nuclei were still in the G2 or M phases of the first cell cycle, whereas 53 and 33% of the nuclei were respectively in the G1 or S phase of the second cell cycle. In parallel, the cell cycle was analysed in root tips of lentil seedlings grown in space during the IML 2 mission (1994), (1) on the 1-g centrifuge for 29 h, (2) on the l-g centrifuge for 25 h and placed in microgravity for 4 h, (3) in microgravity for 29 h, (4) in microgravity for 25 h and placed on the 1-g centrifuge for 4 h. The densitometric analysis of nuclear DNA content showed that in microgravity there were less cells in DNA synthesis and more cells in G1 than in the controls on the 1-g centrifuge (flight and ground). The comparison of the sample grown continuously on the 1-g centrifuge in space and of the sample grown first in l-g and then in microgravity indicated that 4 h of microgravity modified cell cycle, increasing the percentage of cells in the G1 phase. On the contrary, the transfer from microgravity to the 1-g centrifuge (for 4 h) did not provoke any significant change in the distribution of the nuclear DNA content. Thus the effect of microgravity could not be reversed by a 4 h centrifugation. As the duration of the first cell cycle in the lentil root meristem is about 25 h, the results obtained are in agreement with the hypothesis that the first cell cycle and/or the second G1 phase was lengthened in absence of gravity. The difference observed in the distribution of the nuclear DNA content in the two controls could he due to the fact that the 1g control on board was subjected to a period of 15 min of microgravity for photography 25 h after the hydration of the seeds, which indicated an effect of short exposure to weightlessness. The mitotic index of cortical cells was greater on the 1-g centrifuge in space than in any other sample (flight and ground) which could show an effect of the centrifugation on the mitosis.


[The impact of regular physical activity on physical and mental health: how motivate the patient?].
A sedentary lifestyle is associated with the development of numerous diseases and seems to increase in western societies. The influence of a regular physical activity in the prevention of cardiovascular diseases, diabetes, obesity, cancers, anxious and depressive disturbances is summarized. Potential mechanisms of its positive influence are discussed and prescription recommendations are made.


Potentially modifiable predictors of mortality in patients treated with long-term oxygen therapy.
Anemia is considered a systemic manifestation of Chronic Obstructive Pulmonary Disease (COPD); however, few studies have described its influence on chronic respiratory failure (CRF) prognosis. We aimed to test the hypotheses that anemia negatively influences survival and also to identify the cut-off points of hematocrit (Htc) and hemoglobin (Hb) associated with higher mortality in CRF patients using long-term oxygen therapy (LTOT). One-hundred forty two patients with CRF in use of LTOT were evaluated at baseline and followed for three years or until death. Baseline assessment included identification, diagnosis, body composition, dyspnea, health status (HS), spirometry, arterial blood gases, Hb and Htc. Univariate and Cox proportional hazard models were used to evaluate predictors of mortality. We performed ROC curve to identify the best cut-off point of the variables related to survival to construct the Kaplan-Meier curves. Eight-three patients (58%) died after three years. Baseline values of Hb and Htc were significantly lower in the non-survivors group and both, Htc (HR, 0.96; 95%CI 0.91-0.99; p = 0.04), Hb (HR, 0.86; 95%CI 0.76-0.98; p = 0.02) were selected as predictors of mortality after three years. The cut-off points determined were: the value of HB is < 11 g/dl (sensitivity 95% specificity 85%), Htc ≤ 33% (sensitivity 97% specificity 89%). Other prognostic factors were: male gender, low PaCO(2) and SpO(2), higher dyspnea perception and impairment of HS. Our study shows that anemia is a predictor of mortality in patients with CRF under LTOT treatment. Although anemia is potentially modifiable, the effects of raising hemoglobin on mortality remain undetermined.


[Various problems of dynamics of the defense mechanisms of the body, the mechanism of development of infection and formation of metastases during infection].
Based on the study of the bactericidal activity of the purulent fluid and cytograms of 55 patients with suppurative processes and 19 patients with sepsis the authors explain the character of the antimicrobial "struggle" of the macroorganism in the infected wound and formation of septicopyemic metastases during sepsis. A test for diagnosing sepsis is suggested.


Dynamics and orientation of amphipathic peptides in solution and bound to membranes: a steady-state and time-resolved fluorescence study of staphylococcal delta-toxin and its synthetic analogues.
The environment of both the hydrophilic and hydrophobic sides of alpha-helical delta-toxin are probed by tryptophanyl (Trp) fluorescence, when self-association occurs in solution and on binding to membranes. The fluorescence parameters of staphylococcal delta-toxin (Trp15 on the polar side of the amphipathic helix) and synthetic analogues with single Trp at position 5 or 16 (on the apolar side) were studied. The time-resolved fluorescence decays of the peptides in solution show that the local environment of their single Trp is always heterogeneous. Although the self-association degree increases with concentration, as shown by fluorescence anisotropy decays, the lifetimes (and their statistical weight) of Trp16 do not change, contrary to what is observed for Trp15. The first step of self-association is then driven by hydrophobic interactions between apolar sides of alpha-helices, whilst further oligomerization involves their polar side (Trp15) via electrostatic interactions. This is supported by dissociation induced by salt. For all self-associated peptides, the polarity of the Trp microenvironment was not significantly modified upon binding to phospholipid vesicles, as indicated by the small shifts of the fluorescence emission spectra and lifetime values. However, the relative populations of the lifetime classes vary with bound-peptide density similar to the rates of their global motions in bilayers or smaller particles. Quenching experiments by water or lipid-soluble compounds show changes of the orientation of membrane-inserted peptides, from probably dimers lying flat at the interface at low peptide density, to oligomers spanning the membrane and inducing membrane fragmentation at high peptide density.


ChIC and ChEC; genomic mapping of chromatin proteins.
To map the genomic interaction sites of chromatin proteins, two related methods were developed and experimentally explored in Saccharomyces cerevisiae. The ChIC method (chromatin immunocleavage) consists of tethering a fusion protein (pA-MN) consisting of micrococcal nuclease (MN) and staphylococcal protein A to specifically bound antibodies. The nuclease is kept inactive during the tethering process (no Ca2+). The ChEC method (chromatin endogenous cleavage) consists of expressing fusion proteins in vivo, where MN is C-terminally fused to the proteins of interest. The specifically tethered nucleases are activated with Ca2+ ions to locally introduce double-stranded DNA breaks. We demonstrate that ChIC and ChEC map proteins with a 100-200 bp resolution and excellent specificity. One version of the method is applicable to formaldehyde-fixed nuclei, another to native cells with comparable results. Among various model experiments, these methods were used to address the conformation of yeast telomeres.


Selective protein transport: identity of the solubilized phosvitin receptor from chicken oocytes.
By two independent methods, the solubilized receptor for phosvitin (PV) has a subunit MW of 116K. Affinity chromatography, showed that only 2 of the more than 25 proteins present in the total detergent solubilized oocyte membrane extract were retained on a PV-agarose column. These proteins of MW of 116K and 100K could be eluted from PV-agarose with free PV. By gel exclusion chromatography, the receptor-125I-PV complexes elute in the void volume of a Biogel A-1.5 column. When these void fractions were assayed gy SDS-PAGE only a single protein of MW of 116K was observed in addition to 125I-PV.


Profiling of trans-azetidine-2,4-dicarboxylic acid at the human metabotropic glutamate receptors mGlu1b, -2, -4a and -5a.
We have tested the two enantiomers of trans-azetidine-2,4-dicarboxylic acid, (2S,4S)-azetidine-2,4-dicarboxylic acid ((2S,4S)-ADA) and (2R,4R)-azetidine-2,4-dicarboxylic acid ((2R,4R)-ADA) for activity at the human metabotropic glutamate receptors mGlu1b, mGlu2, mGlu4a and mGlu5a expressed in mammalian cells. In Chinese hamster ovary (CHO) cells expressing human mGlu2 receptors, 500 microM (2S,4S)-ADA inhibited forskolin-stimulated cAMP accumulation by 33 +/- 3% while 100 microM (1S,3R)-1-Aminocyclopentane-1,3-dicarboxylic acid induced an inhibition by 66 +/- 5%. The (2R,4R)-ADA enantiomer was inactive at human mGlu2 receptors. In CHO cells expressing human mGlu4a receptors, 10 microM L-AP4 inhibited forskolin-stimulated cAMP levels by 37 +/- 4% whereas both ADA enantiomers of trans-azetidine-2,4-dicarboxylic acid (500 microM) had no such effect. In CHO cells expressing human mGlu1b receptors and L cells expressing human mGlu5a receptors, both enantiomers, applied at 500 microM or 1 mM, were ineffective in stimulating inositolmonophosphate accumulation and did not affect quisqualate-stimulated inositolmonophosphate accumulation. We conclude that (2S,4S)-azetidine-2,4-dicarboxylic acid is a weak human mGlu2 receptor agonist and that (2R,4R)-azetidine-2,4-dicarboxylic acid is inactive at human mGlu2 receptors. Trans-azetidine-2,4-dicarboxylic acid has no significant agonistic effect on human mGlu4a receptors and neither agonistic nor antagonistic effects on human mGlu1b and mGlu5a receptors.


[Ureteral injury in gynecologic laparoscopies].
To investigate the ureteral injury in gynecological laparoscopies and discuss its diagnosis, treatment and prevention. Ureteral injury in gynecological laparoscopies during the past 13 years was reviewed retrospectively. The clinical features of initial operations including the types of disease, uterine size, pelvic adhesion, operative procedures and the methods of diagnosis, treatment and prognosis of ureteral injury were studied. There were 8 ureteral injuries (0.14%) in 5 541 gynecological laparoscopies with seven in laparoscopically assisted vaginal hysterectomy (LAVH)/total laparoscopic hysterectomy (TLH) (0.45%) and one in non-LAVH (0.03%). The main gynecological disorders included adenomyosis, endometriosis and leiomyoma. All patients had pelvic adhesions and 4 had previous pelvic operations. Uterine enlargement was found in 7. Patients presented increased vaginal drainage, flank pain, increased volumes of vaginal discharge, nausea and vomiting, fever, edema, or peritonitis from 0 to 13 days postoperatively. Ureteral injuries were mainly diagnosed via excretory urogram (IVP). The sites of injury were near the inferior margin of the sacroiliac joint in two women and at the inferior part of ureter (near the uterine vessel, uterosacral ligament and ureterovesical junction) in 6. Two patients whose injuries were found soon after operation received ureteral repair by laparotomy successfully. Two of the six patients whose injuries were found several days later were treated with internal ureteral stenting successfully, the other four failed with ureteral stenting and received ureteral repair by laparotomy. Outcomes were good in all cases. Ureteral injury is an uncommon and severe complication in gynecological laparoscopies. Symptoms like abnormally increased drainage, fever, flank pain, abnormal vaginal discharge and peritonitis after operation should be paid attention to and ureteral injury be considered. Surgical repair is the primary treatment.


Laparoscopic repair of Morgagni hernia.
Morgagni hernia is a rare type of diaphragmatic hernia which represents less than 5% of all congenital diaphragmatic hernias. Patients are generally asymptomatic and are diagnosed incidentally. When symptomatic, it generates symptoms due to the compression of thoracic organs or compression of herniated intraabdominal organs. Once diagnosed, the condition requires prompt surgical correction. The defect is repaired either by primary suture or by the use of a prosthetic mesh. In adults, prosthetic mesh repair is preferred. Recently, laparoscopic repair of Morgagni hernia has been introduced and gained wide acceptance. Between 2002 and 2004, 5 patients with Morgagni hernia were treated laparoscopically at our department. Female/male ratio was 3/2. Mean age was 56 years (range 41 to 69 y). Diagnosis were made by chest x-ray and CT scan. Herniation was on the left in 2 patients, and on the right in 3. The content of hernial sac was transverse colon and stomach. There were 2 separate defects in a patient with left-sided hernia. All cases were laparoscopically treated using prosthetic material. All operations were completed laparoscopically. The postoperative hospital stay was 3 to 5 days with a mean of 4 days. None of the patients developed any complication in the early postoperative period. The mean follow-up period is 7 months (range 3 to 24 mo). All patients are actually in good health and without recurrence. Laparoscopic repair of Morgagni hernia is a safe, simple, and reliable procedure which presents all the advantages of the minimally invasive surgery.


Investigation of the HLA-DRB1 locus in alopecia areata.
To further evaluate the nature of the HLA association with alopecia areata (AA), we investigated the HLA-DRB1 locus in 161 AA patients and 165 matched controls from Belgium and Germany. HLA-DRB1 typing was performed using a recently established method that employs a combination of PCR-SSP (sequence specific priming) and Pyrosequencing(TM) technology. No significant differences were observed for HLA allele groups DRB1 *01, *07, *08, *09, *10, *11, *13, *14, *15, and *16. HLA-DRB1*03 was found to confer a protective effect (7.5% versus 13.6%, p = 0.011). Additional genotyping at the allelic level revealed a significant difference in HLA-DRB1*0301 between patients and controls (6.8% versus 11.2%, p = 0.048). The DRB1*04 allele group was confirmed as a risk factor for the development of AA (20.8% versus 13.3%, p = 0.012), with the allele DRB1*0401 accounting for the greatest proportion of the effect (13.4% versus 7.3%, p = 0.014). Results obtained after subgrouping of the patients according to age at onset, severity and family history of the disease suggests that the genetic effects of the HLA system are strongest in familial cases of the disease.


Efficacy of hexafluorine for emergent decontamination of hydrofluoric acid eye and skin splashes.
Hexafluorine is an amphoteric, hypertonic, polyvalent compound for decontaminating hydrofluoric acid (HF) eye and skin splashes. In a German metallurgy facility during the period of 1994-1998, all eye or skin splashes with 40% HF alone or with a 6% HF/15% HNO3 mixture were initially decontaminated with Hexafluorine within 2 min following the splash at the accident site by the victims themselves or co-workers who witnessed the accident. Eleven workers using 40% HF or a 6% HF/15% HNO3 mixture sustained eye (2 cases) or skin (10 cases) splashes (1 combined) during 1994-1998. Hexafluorine was used within 2 min, and a second Hexafluorine decontamination was done on arrival at the plant infirmary. No further medical or surgical treatment was needed, no workers developed chemical burns, and none lost work time. These II cases demonstrate the efficacy of Hexafluorine in decontaminating HF or combined HF/HNO3 splashes.


Direct embryogenesis from single mesophyll protoplasts in alfalfa (Medicago sativa L.).
We used a tetraploid clone derived from an anther culture operation of 'Ladak' alfalfa to study the pathway of direct embryogenesis from leaf-mesophyll protoplasts. About 72% of the protoplasts divided, and 7% of those produced proembryos. Approximately 38% of the proembryos developed into green embryos, and 33% initiated calluses. Other proembryos dedifferentiated into calluses which later redifferentiated embryos. Sixteen percent of the embryos developed directly into plants, whereas 81% produced plants indirectly via secondary embryos. The remaining 3% of the primary embryos failed to develop into plants. The lowest plating efficiency for direct embryogenesis was 0.3%. The high percentage of direct embryogenesis observed was related to the genetic nature of the clone, low density of liquid medium, low protoplast culture density, and the composition of culture media.


Analytical capillary isotachophoresis of total plasma lipoproteins: a new tool to identify atherogenic low density lipoproteins.
Plasma low density lipoproteins from 20 patients were separated by capillary isotachophoresis (ITP). In each patient the apparent diameter of the predominant LDL peak on whole plasma was also determined by nondenaturing gradient gel electrophoresis. Furthermore the concentration of the more electronegatively charged in vivo oxidized LDL- was accomplished using anion exchange high pressure liquid chromatography. By analytical capillary ITP of whole plasma lipoproteins, prestained with a lipophilic dye, LDL were separated into four subfractions. Usually, the predominant subfraction was the slow migrating LDL4, followed by LDL3, and then by the faster LDL2 and LDL1. Slow migrating LDL4 correlated negatively with plasma triglycerides and LDL- and positively with plasma high density lipoprotein (HDL) cholesterol and with the LDL diameter, while the faster LDL1 showed an inverse behavior. The LDL1 + LDL2 to LDL3 + LDL4 ratio showed a strong positive correlation with LDL- concentration (r = 0.87; P < 0.001) and a highly significant inverse correlation with the LDL particle diameter (r = -0.74; P < 0.001). At least three highly atherogenic LDL that could be found in human plasma, namely oxidized, glycated and small-dense, are characterized by a greater electric charge. The LDL profile from capillary ITP and the relative prevalence of faster or slower migrating LDL fractions could indicate the presence of more atherogenic LDL.


Human tears: glucose instabilities.
Using a photometric method, a comparative analysis based on 717 human tear samples was made between systematically collected non-reflex, open eye tears and tears associated with prolonged eye closure (sleep), as well as for certain reflex provoking conditions (mild mechanical irritation, irritating vapours and osmotic imbalance). Although the closed eye tear glucose mean for the 8 young adults studied was found to be less that their open eye mean (5.01 versus 7.00 mg%), those 2 values were not found to be significantly different. However, statistical comparisons made between non-reflex open eye tears and the mechanical, irritating vapour and osmotic responses were found to be different at the P less than 0.05 level of significance, a higher mean concentration being found for the mechanical and osmotic conditions, and a lower mean concentration of the vapour induced condition.


Can your next pediatric patient hear you?
Communication with pediatric patients can be complicated when the child has diminished hearing capacity. The prevalence of this problem in various population groups is provided in an effort to assist practitioners as they increase care to diverse population groups.


BACTERIOLOGICAL EXAMINATION OF THE ABDOMINAL EFFUSION IN BACTERIAL PERITONITIS.
This study provides a contemporary epidemiology of aspirates taken during surgery from the abdominal cavity among patients with bacterial peritonitis to identify the isolates and study their sensitivity to antibiotics. Our bacteriology investigations included isolation of poor cultures, and detection of microbes was conducted using a rapid identification system (API20E, API Staph, API Strep, API Ana, BioMerieux). Rapid tests for detection of oxidase and catalase activity were also used. Susceptibility of microorganisms to antibiotics was defined by the disc-diffusion method using standard discs (EUCAST guidelines 2015) according to Clinical Laboratory Standard Institute (CLSI) protocols (ATB strips: ATB G, ATB Staph, ATBANA, ATBPse, ATBStrep. BioMerieux). The recovery rate from the clinical samples was good, likely because our protocol immediately inoculated study material into the thioglycollate broth which is an appropriate medium both for aerobic and anaerobic bacteria. Among the 36 patients with monomicrobial growth by bacteriological investigation, Gram-negative bacteria prevailed; Escherichia coli was recovered in 14 patients and Enterobacter cloacae in 9 patients. Among the Gram-positive bacteria, D-group Streptococci were prevalent, Enterococcus faecalis was found in six patients, Staphylococcus aureus in three patients, Candida albicans in two patients. In one patient, we observed dual colonization of two Gram-negative anaerobes Bacteroides fragilis and Fusobacterium spp. Polymicrobial growth was evident in three cases in the following combinations: Candida albicans and Escherichia coli, Enterobacter cloacae and Candida albicans, Escherichia coli and Bacteroides fragilis. Antibiotic susceptibility testing indicated that 12% of Gram-negative bacteria were resistant to quinolones and 19% to third-generation cephalosporins. No evidence of methicillin-resistant Staphylococcus aureus was found in Gram-positive specimens. The timely identification of microbes and administration of appropriate therapy based on antibiotic sensitivity profiles is important to optimizing clinical outcomes in bacterial peritonitis.


The HIV-1 leader RNA conformational switch regulates RNA dimerization but does not regulate mRNA translation.
The untranslated leader RNA is the most conserved part of the human immunodeficiency virus type I (HIV-1) genome. It contains many regulatory motifs that mediate a variety of steps in the viral life cycle. Previous work showed that the full-length leader RNA can adopt two alternative structures: a long distance interaction (LDI) and a branched multiple-hairpin (BMH) structure. The BMH structure exposes the dimer initiation site (DIS) hairpin, whereas this motif is occluded in the LDI structure. Consequently, these structures differ in their capacity to form RNA dimers in vitro. The BMH structure is dimerization-competent, due to DIS hairpin formation, but also presents the splice donor (SD) and RNA packaging (Psi) hairpins. In the LDI structure, an extended RNA packaging (Psi(E)) hairpin is folded, which includes the splice donor site and gag coding sequences. The gag initiation codon is engaged in a long distance base pairing interaction with sequences in the upstream U5 region in the BMH structure, thus forming the evolutionarily conserved U5-AUG duplex. Therefore, the LDI-BMH equilibrium may affect not only the process of RNA dimer formation but also translation initiation. In this study, we designed mutations in the 3'-terminal region of the leader RNA that alter the equilibrium of the LDI-BMH structures. The mutant leader RNAs are affected in RNA dimer formation, but not in their translation efficiency. These results indicate that the LDI-BMH status does not regulate HIV-1 RNA translation, despite the differential presentation of the gag initiation codon in both leader RNA structures.


Preoperative placement of retreivable inferior vena cava filters in bariatric surgery.
Postoperative pulmonary embolism (PE) is a major source of mortality after bariatric surgery. In conjunction with pharmacologic thromboprophylaxis, lower extremity pneumatic compression devices, and early ambulation, preoperative placement of a retrievable inferior vena cava (IVC) filter may reduce the risk of thromboembolic complications. From June 2003 to October 2005, 652 patients underwent mini-open Roux-en-Y gastric bypass. Of the 652 patients, 557 were women and 95 were men. The mean patient age was 40.7 +/- 3.6 years (range 18-67), mean body mass index was 44.7 +/- 4.6 kg/m(2) (range 35-78), and mean operative time was 60.2 +/- 5.3 minutes (range 42-79). The high-risk PE group consisted of 27 patients (4.1%; 9 men and 18 women) who received preoperative retrievable IVC filters placed by the interventional radiology staff 2 hours before bypass surgery. Their mean age was 47 +/- 4.4 years (range 31-66) and mean body mass index 48.7 +/- 4.2 kg/m(2) (range 38-75). The indications for filter placement were previous deep vein thrombosis/PE, thrombophlebitis, a hypercoagulable state, pulmonary hypertension, an inability to ambulate, a body mass index >65 kg/m(2), and the presence of severe sleep apnea. The filters were removed 18.2 +/- 2 days (range 15-21) postoperatively. All 27 patients who received a prophylactic IVC filter tolerated the procedure well, without major complications. One retrievable filter was not removed because of prolonged hospitalization secondary to small bowel obstruction. No thromboembolic complications occurred in this high-risk group. Preoperative placement of retrievable IVC filters is a safe measure for the prophylaxis of PE in high-risk bariatric patients. The filters can be placed efficiently just before surgery, and most filters can be removed 2-3 weeks postoperatively. Additional investigation is necessary to prove the effectiveness of retrievable IVC filters in bariatric surgery.


[The role of brain glucose metabolism in the development of cognitive dysfunctions in patients with remitting and secondary-progressive multiple sclerosis].
To study mechanisms of development of cognitive dysfunctions in multiple sclerosis (MS), brain glucose metabolism has been investigated using PET method. We have studied 61 patients with different types of MS course. Correlations between cognitive dysfunctions and regional glucose metabolic rate were revealed. The authors suggest that metabolic dysfunctions of the grey matter play the important role in the pathogenesis of cognitive disturbances in MS.


Biodegradation behavior and modelling of soil burial effect on degradation rate of PLA blended with starch and wood flour.
The biodegradation behavior of Poly (lactic acid) (PLA) blended with starch and wood flour in outdoor soil was investigated comprehensively. As a result, starch provided a biological fuel for the growth of microorganisms in the soil which accelerated the degradation rate of PLA more obviously than wood flour. With the increase of starch content, the weight loss increased and the morphology exhibited more gullies and cavities. X-ray Photoelectron Spectroscopy (XPS) analysis indicated that the variation of O/C ratio was controlled by starch biodegradation and PLA hydrolysis and they were a concomitant process. The mechanical strengths of all the blends showed similar trend and fitted a first-order exponential decay model. The model is shown in good agreement with experimental results as the correlation coefficient is higher than 0.99, and the model can support an efficient method to estimate the durability of starch/wood flour/PLA blends.


Wide bite angle diphosphines: xantphos ligands in transition metal complexes and catalysis.
The reactivity of organotransition metal complexes is dependent on the ligand environment of the metal. This Account describes the development and application of new diphosphine ligands, designed to induce large P-M-P angles in transition metal complexes. Aided by computational chemistry, a homologous range of diphosphines based on rigid heterocyclic aromatic backbones of the xanthene-type with natural bite angles of approximately 100-134 degrees have been developed. The special structure of the ligands has an enormous impact on stability and reactivity of various transition metal complexes. Highly active and selective catalysts have been obtained by influencing this reactivity.


Enhancement of thermoelectric efficiency in PbTe by distortion of the electronic density of states.
The efficiency of thermoelectric energy converters is limited by the material thermoelectric figure of merit (zT). The recent advances in zT based on nanostructures limiting the phonon heat conduction is nearing a fundamental limit: The thermal conductivity cannot be reduced below the amorphous limit. We explored enhancing the Seebeck coefficient through a distortion of the electronic density of states and report a successful implementation through the use of the thallium impurity levels in lead telluride (PbTe). Such band structure engineering results in a doubling of zT in p-type PbTe to above 1.5 at 773 kelvin. Use of this new physical principle in conjunction with nanostructuring to lower the thermal conductivity could further enhance zT and enable more widespread use of thermoelectric systems.


[Understanding of the lower mediastinal lymph node dissection in the adenocarcinoma of the esophagogastric junction through abdomino-transhiatal approach].
In recent years, the incidence of adenocarcinoma of esophagogastric junction (AEG) keeps increasing. Siewert type II and type III AEG invades at 2-4 cm in the lower esophagus, and it has a higher rate of lower mediastinal lymph node metastasis. Lower mediastinal lymph node clearing through the abdomino-transhiatal (TH) approach is preferred, which can be accomplished by entering the lower mediastinum through the hiatus and mobilize the esophagus upward and the surrounding lymph and connective tissue for approximately 6.5 cm. Using the infracardiac bursa (IBC) as an anatomical landmark improves the safety and operability of the thorough dissection of the lower mediastinum. Total resection of the mesenterium at the esophagogastric junction can entirely dissect the lower mediastinal lymph nodes, which conforms to the safety principles in oncology.


Spermatic cord abscess with concurrent prostatic abscess involving the seminal vesicle.
Prostatic abscess involving the seminal vesicle has become rare following the development of effective antibiotic treatments. To our knowledge, we report the first case in the English-language literature of a patient with a spermatic cord abscess and a concurrent prostatic abscess. We examined an 81-year-old man for swelling and pain in the left inguinal region and performed computed tomography (CT) that later confirmed the suspected diagnosis of left inguinal hernial strangulation. We performed urgent surgical drainage of a left spermatic cord abscess; and under the correct diagnosis by CT, he was successfully treated further with antibiotics and transperineal drainage of a prostatic abscess extending to the seminal vesicle. We highlight that familiarity with such a rare condition is overwhelmingly essential for patient management and that CT is the most valuable imaging procedure for diagnosing such cases.