Contemporary use of the cold pressor task in pediatric pain research: a systematic review of methods.
The cold pressor task (CPT) is an ethical experimental pain task widely used by pediatric pain researchers to examine a variety of important theoretical and clinical questions. The purpose of this systematic review was to describe contemporary use of the CPT in pediatric pain research to identify possible methodological and procedural inconsistencies and inform future research. All papers using the CPT to examine pain-related outcomes in children ≤18 years old published after 2005 were identified, 2005 being when published pediatric CPT studies were last reviewed and guidelines for pediatric use of the CPT were published. Information related to samples, CPT methodology, and pain outcomes was recorded. Thirty-six published papers, involving 2,242 children (aged 3-18 years) from both healthy and clinical samples, met review inclusion criteria. Several aspects of CPT methodology with significant potential to impact pain outcomes were found to be inconsistently implemented and reported, including water temperature, use of informed versus uninformed ceilings, and the presence of observers during the CPT. Self-report child pain intensity and pain tolerance were common outcomes. A number of refinements for use of the CPT in pediatric pain research are suggested. The cold pressor task is a commonly used experimental method in pediatric pain research. This systematic review reveals important methodological inconsistencies in its use and suggestions for improvements to previously published guidelines.


Scalp flap rotation with primary donor site closure.
A 57-year-old man with a 7-cm defect of the left temple underwent reconstruction with a large scalp rotation flap that shifted the donor defect to the back of the neck so that it could be closed primarily. This approach, also used successfully in 7 other patients with similar defects, avoided the need for an unsightly skin graft in the donor site while providing tissue with a color and texture that blended well with the surrounding forehead and facial skin. Primary closure of the donor site reduces scalp flap morbidity and improves the overall aesthetic outcome.


Reactivity of monoclonal antibodies to species-specific antigens of Entamoeba histolytica.
Twenty monoclonal antibodies were produced against trophozoites of Entamoeba histolytica strains HK-9 and HM-1: IMSS. When reactivity to various enteric protozoa was examined by an indirect fluorescence antibody test, 15 of the monoclonal antibodies were strongly reactive with E. histolytica trophozoites. Species-specific antigens recognized by these monoclonal antibodies were located on the plasma membrane, nucleus, cytoplasm, and cytoskeletal structures of the trophozoites. Two of the remaining five monoclonals reacted strongly with trophozoites of the E. histolytica-like Laredo strain. The determinant antigen was located in the cytoplasm. The three remaining monoclonal antibodies were found to recognize cross-reactive antigens between E. histolytica and E. histolytica-like Laredo, E. hartmanni, E. coli, Dientamoeba fragilis, Giardia lamblia, and Trichomonas hominis. These three antibodies were also reactive with T. vaginalis and mammalian cells such as HeLa cells. Thus, the combined use of monoclonal antibodies seems capable of distinguishing E. histolytica and/or E. histolytica-like Laredo from other enteric protozoa.


Degenerate four-wave mixing with a tunable excimer laser.
We use a simple, forward-geometry degenerate four-wave mixing setup to monitor weak absorptions of various gas-phase molecules with a tunable excimer laser. With this technique, state-selective detection of H(2), CO, H(2)O, and O(2) is demonstrated. The dependence of the forward-geometry degenerate four-wave mixing signals on various experimental parameters (e.g., pressure, laser power) is determined. Several mechanisms for the generation of the observed signals are discussed, including diffraction from density gratings or thermal gratings and two-photon degenerate four-wave mixing.


Parasellar meningiomas in pregnancy: surgical results and visual outcomes.
Rapid visual deterioration may occur as the result of the quick growth of parasellar meningiomas in the high-hormone/increased fluid retention milieu of pregnancy; however, surgery before delivery entails increased maternal-fetal risk. We present our experience in the management of parasellar meningiomas that compress the optic apparatus during pregnancy, with a focus on decisions regarding the timing of surgery. Serial visual examinations and other clinical data for 11 women presenting from 2002 to 2012 with visual deterioration during pregnancy or delivery as the result of parasellar meningiomas involving the optic apparatus were reviewed. Indications for surgery during pregnancy included severely compromised vision, rapid visual deterioration, and early-to-midstage pregnancy with the potential for significant tumor growth and visual decrease before delivery. All patients underwent surgery with the use of skull base techniques via pterional craniotomy. An advanced extradural-intradural (i.e., Dolenc) approach, with modifications, was used in seven. All women achieved a Glasgow Outcome Score of 5 at discharge with no new neurologic deficits; all children are developing normally at a mean 4.5 years of age (range, 1-9.5 years). Surgery during pregnancy was recommended for six women: four operated at gestational weeks 20-23 had excellent postoperative visual recovery; two who delayed surgery until after delivery have permanent unilateral blindness. Among five others operated after delivery, four had good visual recovery and one has pronounced but correctable deficits. Three of five women diagnosed at gestational weeks 32-35 experienced spontaneous visual improvement after delivery, before surgery. We recommend that surgery be offered to patients during pregnancy when a delay may result in severe permanent visual impairment.


[Accuracy of femur mechanical axis in computer-assisted total knee replacement].
The location of the center of the femoral head and the mechanical axis of femur were obtained by using optical tracking localizer in computer-assisted total knee replacement (TKR). The 3-D reconstruction model of femur was used firstly in the accuracy verification of mechanical axis of femur. The results showed that the accurate mechanical axis of femur can be defined by tracking the reference frame pinned at the distal femur. Compared to the intramedullary rods locating, this method introduces mechanical axis error less that 1 and the accuracy and repeatability of mechanical axis definition have been improved greatly.


Media and young children's learning.
Electronic media, particularly television, have long been criticized for their potential impact on children. One area for concern is how early media exposure influences cognitive development and academic achievement. Heather Kirkorian, Ellen Wartella, and Daniel Anderson summarize the relevant research and provide suggestions for maximizing the positive effects of media and minimizing the negative effects. One focus of the authors is the seemingly unique effect of television on children under age two. Although research clearly demonstrates that well-designed, age-appropriate, educational television can be beneficial to children of preschool age, studies on infants and toddlers suggest that these young children may better understand and learn from real-life experiences than they do from video. Moreover, some research suggests that exposure to television during the first few years of life may be associated with poorer cognitive development. With respect to children over two, the authors emphasize the importance of content in mediating the effect of television on cognitive skills and academic achievement. Early exposure to age-appropriate programs designed around an educational curriculum is associated with cognitive and academic enhancement, whereas exposure to pure entertainment, and violent content in particular, is associated with poorer cognitive development and lower academic achievement. The authors point out that producers and parents can take steps to maximize the positive effects of media and minimize the negative effects. They note that research on children's television viewing can inform guidelines for producers of children's media to enhance learning. Parents can select well-designed, age-appropriate programs and view the programs with their children to maximize the positive effects of educational media. The authors' aim is to inform policymakers, educators, parents, and others who work with young children about the impact of media, particularly television, on preschool children, and what society can do to maximize the benefits and minimize the costs.


Influence of LRH on gonadotrophin and testosterone levels in the foetal male rat.
Gonadotrophin and testosterone levels were measured in male foetal rats at the 21st day of gestation 30 min following administration of LRH. The releasing hormone was administered by 3 different routes: subcutaneously as a single injection to the pregnant rat; subcutaneously as 12 times repeated injection to the pregnant rat from 16th-21st day of gestation; direct injection into the amniotic cavity. Three different doses of 1, 5, and 10 microgram/kg were used. The single administration to the dam was without effect. Repeated doses resulted in a significant dose-dependent elevation of mean foetal LH: 163 ng/ml in the control animals and 133,256, and 363 ng/ml in the 1, 5, and 10 microgram/kg LRH group resp. Intra animal injections significantly increased FSH and LH levels, but only those of FSH were clearly dose-dependent. A mean of 390 ng/ml in the control group was observed, with 1 microgram/kg LRH FSH was elevated to 723 ng/ml, at 5 microgram/kg to 928 and at 10 microgram/kg to 1017 ng/ml. Testosterone levels were not significantly altered. Our results demonstrate that the pituitary of foetal rats is able to respond to LRH in the same manner as adult animals.


Effect of naloxone on oxytocin and vasopressin release during vaginocervical stimulation in the goat.
We have investigated the secretion of oxytocin and arginine vasopressin (AVP) during vaginocervical stimulation in the conscious goat and examined the effect of the opioid antagonist naloxone on peptide release to this stimulus. Goats were implanted with guide tubes overlying the cisterna magna under anaesthesia and allowed to recover. Vaginocervical stimulation for 60 s resulted in a marked (P less than 0.01) release of oxytocin into the plasma but neither plasma AVP nor cerebrospinal fluid (CSF) concentrations of oxytocin changed significantly. In a second series of experiments, unoperated goats were infused with saline or naloxone (4 mg bolus + 12 mg/h) in random order on two separate occasions. Infusion of naloxone had no effect on basal plasma concentrations of oxytocin or AVP. There was a marked and significant (P less than 0.01) potentiation of oxytocin secretion following vaginocervical stimulation in animals infused with naloxone. Naloxone-infused animals showed a significant (P less than 0.01) rise in plasma AVP after stimulation but plasma AVP did not change in the saline-infused controls. We conclude that vaginocervical stimulation leads to the selective release of oxytocin from the neurohypophysis without affecting concentrations of oxytocin in the CSF. Endogenous opioids inhibit the stimulated secretion of oxytocin and AVP in vivo in response to vaginocervical stimulation in the goat.


Increasing trend of bilateral neck exploration in primary hyperparathyroidism.
Bilateral neck exploration was the standard operation for primary hyperparathyroidism. With improvements in preoperative localization and use of intraoperative PTH (ioPTH) monitoring, minimally invasive unilateral neck exploration has been widely adopted. This study evaluates the trend in parathyroidectomies for primary hyperparathyroidism. Parathyroidectomy for sporadic primary hyperparathyroidism was analyzed from 2010 to 2017. Exclusion criteria included previous neck surgery and concomitant procedures. The operations were classified as unilateral exploration (UE), UE converted to bilateral exploration (BE), or BE. Variables included preoperative and intraoperative factors. Outcomes included persistence, recurrence, permanent hypocalcemia and recurrent laryngeal nerve (RLN) injury. Four hundred thirty-one patients were reviewed. Since 2010, the rate of BE has increased from 30% to 50%. Disease duration, presence of bone disease, negative localization, baseline ioPTH <100, and ≥2 abnormal glands have increased. Mean operative time has not changed over time. Two percent of patients had persistent disease, <1% had recurrent disease, and 2% have had reoperation. Nine percent had temporary hypoparathyroidism, and 15 patients had temporary RLN injury. This study shows an increasing trend in BE for primary hyperparathyroidism. This increase was associated with lower baseline intraoperative parathyroid hormone (ioPTH) levels and smaller gland size. The operative approach for parathyroidectomy should be individualized and surgeons should not hesitate to perform BE when needed.


Treatment of scoliosis in the adult.
With the increasing awareness in both the medical community, as well as the general public of the progressive nature of adult scoliosis, more patients with this condition are coming to the attention of the spinal surgeon. With recent technical developments, the surgical armamentarium currently available has certainly improved, yet these patients remain a challenging population of patients. Infantile, juvenile, and adolescent idiopathic scoliosis are defined by their age of presentation. Similarly, adult scoliosis is defined as a presentation of scoliosis after skeletal maturity. Yet most studies in the literature define adult scoliosis arbitrarily as scoliosis existing in a patient age 18 or older. The majority of these patients, therefore, have curves which have persisted through adolescence into adult life with etiologies which mirror those of a younger patient population. Degenerative scoliosis related to osteoporosis and iatrogenic causes are additional etiologies of deformity which more typically present in adult patients. The indications for treatment in the adult patient are similar to those in the adolescent: progression of the deformity, pain, deterioration of pulmonary function, and perhaps cosmesis. The complications encountered during the surgical management of these patients is quite high (50-80%) when compared to their adolescent counterparts. Complications include pseudoarthrosis, loss of lumbar lordosis, thromboembolic disease, instrumentation failure, neurologic deficits, and wound infections. Therefore, even with the recent advances in surgical technique the decision of whether or not to operate on a given patient remains the single most critical decision.


ETS transcription factor Erm controls subsynaptic gene expression in skeletal muscles.
Accumulation of specific proteins at synaptic structures is essential for synapse assembly and function, but mechanisms regulating local protein enrichment remain poorly understood. At the neuromuscular junction (NMJ), subsynaptic nuclei underlie motor axon terminals within extrafusal muscle fibers and are transcriptionally distinct from neighboring nuclei. In this study, we show that expression of the ETS transcription factor Erm is highly concentrated at subsynaptic nuclei, and its mutation in mice leads to severe downregulation of many genes with normally enriched subsynaptic expression. Erm mutant mice display an expansion of the muscle central domain in which acetylcholine receptor (AChR) clusters accumulate, show gradual fragmentation of AChR clusters, and exhibit symptoms of muscle weakness mimicking congenital myasthenic syndrome (CMS). Together, our findings define Erm as an upstream regulator of a transcriptional program selective to subsynaptic nuclei at the NMJ and underscore the importance of transcriptional control of local synaptic protein accumulation.


Structure of the hair rootlets on cochlear sensory cells by tannic acid fixation.
Rootlets of the sensory hairs of the basal turn of the guinea pig cochlea were investigated using the tannic acid fixation method under transmission electron microscopy (TEM). The fine structure of the rootlet was enhanced by adding tannic acid to the prefixative for the specimen. By using the tannic acid fixation method, it is possible to observe the finer filamentous structure of the rootlet in greater detail than is revealed by using the ordinary glutaraldehyde-osmium fixation method. TEM observation by the tannic acid method reveals that the rootlet consists of 50 A diameter protofilaments and an electron-dense background substance. These protofilaments are arranged in an extremely regular pattern. They are considered to be modified microfilaments.


Identification of 16 sulfamidase gene mutations including the common R74C in patients with mucopolysaccharidosis type IIIA (Sanfilippo A).
Mucopolysaccharidosis type IIIA (MPS IIIA or Sanfilippo A disease) is a storage disorder caused by deficiency of the lysosomal enzyme sulfamidase. Mutation screening, using SSCP/heteroduplex analyses on cDNA and genomic DNA fragments, was performed in a group of 42 European patients. Sixteen of the 17 different gene mutations characterized have not been previously described. The spectrum of gene lesions consists of two 1-bp deletions (1091delC, 1093delG), an 18-bp duplication (421ins18), a splice site mutation (IVS2-2A-->G), and 13 different missense point mutations. As in other lysosomal storage disorders, the phenotypic heterogeneity is associated with a considerable genetic heterogeneity. The missense mutation R74C, which alters an evolutionary conserved amino acid in the active site of the enzyme, was found on 56% of alleles of 16 Polish patients, whereas it was less frequent among German patients (21% of disease alleles). R245H, a previously reported common mutation, represents 35% of disease alleles in German patients, but only 3% in Polish patients. As the combined frequency of the common mutations (R74C and R245H) in German and Polish populations exceeds 55%, screening for these two mutations will assist molecular genetic diagnosis of MPS IIIA and allow heterozygote testing in these populations.


[The clinical outcome of proximal fibular osteosarcoma with en-bloc resection].
To evaluate the local recurrence and 5-year survival of proximal fibular osteosarcoma. From October 1997 to July 2005, 12 patients with proximal fibular osteosarcoma were treated. There were 9 males and 3 females. The mean age at diagnosis was 16 (9-23) years old. Histopathological diagnosis were obtained by trut-cut biopsy, Enneking surgical stages of 12 lesions were as follows: 11 grade II B and 1 grade III. Induction chemotherapy was applied to all patients except one who left the hospital after the biopsy. Of 11 patients, 8 were performed Malawer type I resection, and 3 type II. All patients continued to get postoperative chemotherapy. Regular follow-up was applied. Only 1 patient was found local recurrence one year after operation and received re-resection, the others did not. Four patients died of lung metastases, including the one who did not get treated, one stage III and two II B patients. The range of follow up was 6 to 117 months. The evaluated 5 year disease-free survival of 11 patients who got treated was 72.7% by using Kaplan Meier survival analysis. The local recurrence is low, and 5 year disease-free survival is acceptable, in accordance with present point that marginal resection may not impact survival for fibular osteosarcoma. No knee instability is found in this group after great care is taken for proper reconstruction of lateral collateral ligament and reinsertion of biceps femoris tendon on the lateral condyle of tibia.


Benzoic acid as a selector-modulator in the synthesis of MIL-88B(Cr) and nano-MIL-101(Cr).
The concentration of benzoic acid was found to exercise efficient control over the formation of either MIL-101(Cr) or MIL-88B(Cr) under otherwise similar hydrothermal synthetic conditions. Nanocrystals of MIL-101(Cr) with ∼100 nm average size and excellent SBET = 3467 m2 g-1 are obtained at lower concentrations of benzoic acid, while at higher concentrations the microparticulated MIL-88B(Cr) product is formed. Hereby a new efficient synthetic method towards the elusive MIL-88B(Cr), yet reported only once without synthetic details, is proposed. The obtained MIL-88B(Cr) has an interesting and potentially valuable property of retaining its high-volume form (Vcell ∼ 2000 Å3) after thermal activation. The degassing of MIL-88B(Cr) in a vacuum at 250 °C yields a porous material with a SBET area of 1136 m2 g-1, which is around the theoretical maximum. The transition to the denser 'closed' form (Vcell ∼ 1500 Å3) occurs only at 350 °C, when all of the benzoate/benzoic acid, hindering the process, is removed.


In vitro degradation of resin-dentin bonds analyzed by microtensile bond test, scanning and transmission electron microscopy.
Our knowledge of the mechanisms responsible for the degradation of resin-dentin bonds are poorly understood. This study investigated the degradation of resin-dentin bonds after 1 year immersion in water. Resin-dentin beams (adhesive area: 0.9mm(2)) were made by bonding using a resin adhesive, to extracted human teeth. The experimental beams were stored in water for 1 year. Beams that had been stored in water for 24h were used as controls. After water storage, the beams were subjected to microtensile bond testing. The dentin side of the fractured surface was observed using FE-SEM. Subsequently, these fractured beams were embedded in epoxy resin and examined by TEM. The bond strength of the control specimens (40.3+/-15.1MPa) decreased significantly (p<0.01) after 1 year of water exposure (13.3+/-5.6MPa). Loss of resin was observed within fractured hybrid layers in the 1 year specimens but not in the controls. Transmission electron microscopic examination revealed the presence of micromorphological alterations in the collagen fibrils after 1 year of water storage. These micromorphological changes (resin elution and alteration of the collagen fibrils) seem to be responsible for the bond degradation leading to bond strength reduction.


Toward meaningful snag-management guidelines for postfire salvage logging in North American conifer forests.
The bird species in western North America that are most restricted to, and therefore most dependent on, severely burned conifer forests during the first years following afire event depend heavily on the abundant standing snags for perch sites, nest sites, and food resources. Thus, it is critical to develop and apply appropriate snag-management guidelines to implement postfire timber harvest operations in the same locations. Unfortunately, existing guidelines designed for green-tree forests cannot be applied to postfire salvage sales because the snag needs of snag-dependent species in burned forests are not at all similar to the snag needs of snag-dependent species in green-tree forests. Birds in burned forests have very different snag-retention needs from those cavity-nesting bird species that have served as the focus for the development of existing snag-management guidelines. Specifically, many postfire specialists use standing dead trees not only for nesting purposes but for feeding purposes as well. Woodpeckers, in particular specialize on wood-boring beetle larvae that are superabundant in fire-killed trees for several years following severe fire. Species such as the Black-backed Woodpecker (Picoides arcticus) are nearly restricted in their habitat distribution to severely burned forests. Moreover existing postfire salvage-logging studies reveal that most postfire specialist species are completely absent from burned forests that have been (even partially) salvage logged. I call for the long-overdue development and use of more meaningful snag-retention guidelines for postfire specialists, and I note that the biology of the most fire-dependent bird species suggests that even a cursory attempt to meet their snag needs would preclude postfire salvage logging in those severely burned conifer forests wherein the maintenance of biological diversity is deemed important.


Influence of conditioned psychological stress on immunological recovery in mice exposed to low-dose X irradiation.
A study was initiated to determine the effects of psychological stress on the immune response in BALB/c mice recovering from exposure to a low dose of ionizing radiation. Mice were first subjected to conditioning training for 12 days, then exposed to 200 R, subjected to psychological stress for 14 days, and assessed for peak anti-sheep RBC response. The seven treatment groups included two unirradiated groups and five irradiated groups. Mice exposed to 200 R and then subjected to conditioned psychological stress responded less vigorously to antigenic stimulation than those of the other irradiated groups. The psychological stress imposed upon these mice did not influence the antibody-forming capacity of unirradiated mice. These results indicate that a psychological stress which did not affect the immunological activity of unirradiated mice can curtail the immunological recovery of mice exposed to low doses of ionizing radiation.


Repeat mammography screening among low-income and minority women: a qualitative study.
Regular mammography screening can reduce breast cancer mortality, yet low-income African American and Hispanic women underutilize mammography screening and are often diagnosed at a later stage, resulting in increased mortality. We used qualitative research methods to identify factors influencing regular breast cancer screening among African American and Hispanic women. Predisposing factors (including fear of mastectomy and lack of knowledge), enabling factors (including cost and social support) and a reinforcing factor were identified and categorized utilizing the PRECEDE framework. The study identified factors associated with the decision to complete regular mammography screening, and examined differences between African American and Hispanic women who participated in the interviews. Future research should seek to better understand the influence of family/friends, risk perception, and fatalistic beliefs on the decision to obtain regular mammograms.


Antitumor diarylsulfonylureas: novel agents with unfulfilled promise.
Diarylsulfonylureas represent a class of antitumor agent with significant therapeutic efficacy against rodent and human models of cancer. Despite the exciting preclinical activity of sulofenur, the prototypic agent, clinical activity was poor. Here we review the activity of sulofenur and a second generation diarylsulfonylurea, LY295501 N-[5-(2, 3-dihydrobenzofuryl) sulfonyl]-N'-(3,4-dichlorophenyl)urea, against colon tumor xenografts, and some of the cellular pharmacology of this class of antitumor agents.


Biochemical and hematologic alterations following percutaneous cryoablation of liver tumors: experience in 48 procedures.
To retrospectively determine the frequency and severity of various abnormal laboratory test values following percutaneous cryoablation of liver tumors and to estimate the correlation between laboratory test values and tumor and ablation volumes. This HIPAA-compliant study had institutional review board approval. Informed consent was waived. Biochemical and hematologic laboratory values from 48 procedures in 39 patients (18 men and 21 women; age range, 29-86 years) who underwent magnetic resonance (MR) imaging-guided percutaneous cryoablation of 65 liver tumors (62 metastases, three hepatocellular carcinomas) were retrospectively reviewed. Changes in laboratory values at baseline and 0-6 hours and 1-2 weeks after the procedure were analyzed with respect to tumor and ablative margin volumes by using generalized estimating equations. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were correlated with percent maximal decrease in platelet count. Mean ablation zone volume was 67.3 cm(3) +/- 41.2 (standard deviation) (range, 7.3-191.4 cm(3)). AST and ALT values increased after all procedures and peaked at 6 hours (median change in AST value, +835 U/L; median change in ALT value, +614.5 U/L). Platelet count decreased after 47 procedures (mean maximal decrease, 92.3 x 10(9)/L [38%]), reaching a nadir at 12-24 hours after 24 procedures (50%) and returning to normal in 31 (84%) of 37 procedures at 1-2 weeks. One procedure was complicated by disseminated intravascular coagulation that necessitated transfusion and arterial embolization. Myoglobin values increased after 21 (44%) of 48 procedures and peaked at 6 hours (trimmed-mean value, 183.4 mug/L). Ablative margin volumes were predictive of changes at 0-6 hours in AST (P = .02), ALT (P = .003), and myoglobin (P < .001) values. Percent maximal decrease in platelet count correlated with peak change in AST (r = 0.72) (P < .001). Following percutaneous cryoablation of liver tumors, alterations in liver enzymes, myoglobin, and platelet count are common, are usually self-limited, and correlate with ablative margin volume--except for changes in platelet count, which correlate with changes in AST and ALT.


A difference between front-loaded streptokinase and standard-dose recombinant tissue-type plasminogen activator in preserving left ventricular function after acute myocardial infarction (the Central Illinois Thrombolytic Therapy Study).
A blinded, randomized trial compared the effects of front-loaded streptokinase with those of the conventional dose of intravenous recombinant tissue-type plasminogen activator (rt-PA) on left ventricular (LV) function after acute myocardial infarction (AMI). Thrombolytic therapy was administered in the emergency departments of 30 community hospitals in central Illinois, and subsequent studies were performed at 1 tertiary referral center. Patients aged < or = 75 years with a first AMI who could be treated within 4 hours of the onset of chest pain were randomly assigned to receive either streptokinase (375,000 IU bolus, followed by 1,125,000 IU over 1 hour) or rt-PA (10 mg bolus, followed by 50 mg in the first hour, and 20 mg/hour for the next 2 hours). All patients were treated with aspirin (325 mg) and intravenous heparin. Patients were transferred for angiography within 24 hours. During the 30-month study, 253 patients were treated with intravenous thrombolytic therapy 2.4 +/- 1.0 hour after the onset of AMI. In patients with anterior wall AMI (n = 90), global LV ejection fraction measured by angiography within 24 hours was 45 +/- 12% with rt-PA, and 39 +/- 13% with streptokinase (p < 0.03). Convalescent radionuclide angiography documented a persistent beneficial effect of rt-PA on LV regional wall contractility, but not global ejection fraction. There were no differences between rt-PA and streptokinase in preserving global or regional LV function in patients with inferior wall AMI.


One-layer vasovasostomy: microsurgical versus loupe-assisted.
To compare the outcomes of microsurgical versus loupe-assisted technique for vasectomy reversal. Retrospective comparative study with randomization. University hospital male infertility clinic. Fifty men with obstructive azoospermia after vasectomy. One-layer vasovasostomy with microscope (group I) or optical loupe (group II). Patency, pregnancy, operation time, postoperative stricture. Mean operation time was 106.4±10.3 minutes in group I and 78.3±5.7 minutes in group II, showing a statistically significant difference. Analysis of semen sampled from men, who succeeded in getting vasal patency, was performed finally at the sixth month after surgery and showed sperm concentrations of 21.5 million/mL and 20.7 million/mL and sperm motilities of 32.5% and 30.8% in groups I and II, respectively, without a statistical significance. Patency rates were 96% (24 out of 25) in group I and 72% (18 out of 25) in group II, showing a statistically significant difference. Pregnancy rates were 40% (10 out of 25) in group I and 28% (7 out of 25) in group II. There was no statistically significant difference in pregnancy rate between the two groups. Postoperative vasal stricture occurred in four patients, all of them from group II. There was no operation-related complication, such as hematoma or wound infection. Microscopic technique yielded a higher patency rate than loupe-assisted technique, possibly by reducing the chance of postoperative vasal stricture.


One-step ethanol ablation of viscous cystic thyroid nodules.
The purpose of this study was to evaluate the efficacy and safety of one-step ethanol ablation in the management of viscous cystic thyroid nodules. Viscous cystic thyroid nodules are defined as nodules that cannot be aspirated with an 18-gauge needle. Nine euthyroid patients underwent one-step ethanol ablation of benign single compressive viscous cystic thyroid nodules (cystic portion > 90%). The thick content of the nodules was removed with either a 16-gauge needle (n = 8) or an 8.5-French pigtail catheter (n = 1) connected to a suction pump. An injection of 99% sterile ethanol then was administered. After 10 minutes, all of the injected ethanol was withdrawn. Additional treatment was prescribed if the cystic portion of the nodule remained larger than 1 mL. Follow-up sonography was performed 1 and 6 months after treatment. At each follow-up examination, nodule volume, symptom score (centimeter visual analog scale, 0-10), cosmetic grade (grade 1-4), and complications were evaluated. The mean volume of index nodules was 24.4 +/- 20.3 (SD) mL (range, 4.5-57.4 mL). The mean amount of ethanol injected was 11.8 +/- 10.1 mL (range, 2-27 mL). The mean total procedure time was 27.8 +/- 10.4 minutes (range, 15-45 minutes). One month after ablation, the mean volume of the nodules had decreased significantly (7.2 +/- 9.4 vs 24.4 +/- 20.3 mL, p = 0.008). Additional reduction was found at the 6-month follow-up examination, the mean nodule volume being 2.1 +/- 3.8 mL (p = 0.008). The mean volume reductions at 1 and 6 months were 78.4% +/- 14.4% and 93.6% +/- 6.8%. The mean symptom score decreased from 3.2 +/- 1.5 to 0.4 +/- 1.0 (p < 0.05) and the mean cosmetic grade from 3.9 +/- 0.3 to 1.3 +/- 0.7 (p < 0.05). No major complications were encountered. One-step ethanol ablation is an effective and safe method of management of viscous cystic thyroid nodules.


[The torus palatinus].
The existing investigations about the Torus palatinus are not comparable. The tori are not described in all morphological details and very often without quantitative registrations. The present paper tries to show an economic way of quantifying and describing the Torus palatinus. Skulls from Griesheim (Kreis Darmstadt-Dieburg, Western Germany; "Fränkisches Gräberfeld"), Langd (Kreis Giessen, West Germany; "Alter Friedhof"), India and Pakistan, as well as crania of a population of chimpanzees from Eastern Liberia have been investigated. In the series from Griesheim and Langd the Torus palatinus was found in 32.7% and 34.5% respectively, in the examined crania from India and Pakistan the torus appears only in 3.7% of the individuals. The skulls of the chimpanzees from Eastern Liberia show the Torus palatinus much more frequently than it has been observed until now (in 17% of the crania).


[The behavior of hemodynamic parameters during surgery in childhood].
Mechanical cardiographic analyses of the circulation were carried out intraoperatively and directly after the operation on 130 children of 11/12 to 15 2/12 years of age. Essential haematodynamic changes are represented by a rise in the cardiac rate, decline of stroke volume, changes in cardiac work and output, and in speed of contraction compared with initial preoperative values. Triggering factors are discussed. A healthy normal circulatory system will tolerate these reversible disturbances. Decompensation may occur in children with a primary decline in cardiac output.


DC-SIGN binds ICAM-3 isolated from peripheral human leukocytes through Lewis x residues.
Intercellular adhesion molecule-3 (ICAM-3) binds to the alpha(L)beta(2) integrin and mediates the contact between T cells and antigen-presenting cells. It has been suggested that dendritic cell-specific ICAM-3 grabbing nonintegrin (DC-SIGN), a C-type lectin of macrophages and DCs, is an additional ligand of ICAM-3. So far, the glycan structure mediating the interaction of native ICAM-3 with DC-SIGN is undefined. Here, we demonstrate that native ICAM-3 from human peripheral leukocytes binds recombinant DC-SIGN, is recognized by monoclonal Lewis x antibodies, and specifically interacts with DC-SIGN on immature DCs. The presence of Lewis x residues on ICAM-3 was confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectroscopy. Investigations on different peripheral blood cell populations revealed that only ICAM-3 from granulocytes bound DC-SIGN. Cotransfection studies demonstrated that fucosyltransferase (FUT) IX and, to a significantly lesser extent, FUT IV, but not FUTs III and VII, mediate the synthesis of Lewis x residues on ICAM-3. These findings indicate that FUT IX is the main FUT mediating the synthesis of Lewis x residues of ICAM-3 in cells of the myeloid lineage, and that these residues bind DC-SIGN. The results suggest that ICAM-3 assists in the interaction of granulocytes with DC-SIGN of DCs.


An environmental (pre)history of European fishing: past and future archaeological contributions to sustainable fisheries.
This paper explores the past and potential contribution of archaeology to marine historical ecology. The primary focus is European fishing of marine and diadromous taxa, with global comparisons highlighting the wider applicability of archaeological approaches. The review illustrates how study of excavated fish bones, otoliths and shells can inform our understanding of: (a) changes in biogeography, including the previous distribution of lost species; (b) long-term fluctuations in the aquatic environment, including climate change; (c) the intensity of exploitation and other anthropogenic effects; (d) trade, commodification and globalisation. These issues are also relevant to inform fisheries conservation and management targets. Equally important, the long (pre)history of European fishing raises awareness of our ecological heritage debt, owed for centuries of wealth, sustenance and well-being, and for which we share collective responsibility. This debt represents both a loss and a reason for optimism, insofar as it is a reservoir of potential to be filled by careful stewardship of our rivers, lakes, seas and oceans.


C-C chemokines in allergen-induced late-phase cutaneous responses in atopic subjects: association of eotaxin with early 6-hour eosinophils, and of eotaxin-2 and monocyte chemoattractant protein-4 with the later 24-hour tissue eosinophilia, and relationship to basophils and other C-C chemokines (monocyte chemoattractant protein-3 and RANTES).
The relationship of expression of the C-C chemokines eotaxin, eotaxin 2, RANTES, monocyte chemoattractant protein-3 (MCP-3), and MCP-4 to the kinetics of infiltrating eosinophils, basophils, and other inflammatory cells was examined in allergen-induced, late-phase allergic reactions in the skin of human atopic subjects. EG2+ eosinophils peaked at 6 h and correlated significantly with eotaxin mRNA and protein, whereas declining eosinophils at 24 h correlated significantly with eotaxin-2 and MCP-4 mRNA. In contrast, no significant correlations were observed between BB1+ basophil infiltrates, which peaked at 24 h, and expression of eotaxin, eotaxin-2, RANTES, MCP-3, and MCP-4 or elastase+ neutrophils (6-h peak), CD3+ and CD4+ T cells (24 h), and CD68+ macrophages (72 h). Furthermore, 83% of eosinophils, 40% of basophils, and 1% of CD3+ cells expressed the eotaxin receptor CCR3, while eotaxin protein was expressed by 43% of macrophages, 81% of endothelial cells, and 6% of T cells (6%). These data suggest that 1) eotaxin has a role in the early 6-h recruitment of eosinophils, while eotaxin-2 and MCP-4 appear to be involved in later 24-h infiltration of these CCR3+ cells; 2) different mechanisms may guide the early vs late eosinophilia; and 3) other chemokines and receptors may be involved in basophil accumulation of allergic tissue reactions in human skin.


The roles of mesenchymal stem cells (MSCs) therapy in ischemic heart diseases.
Growing cell-based myocardial therapies which could lead to successful myocardial repair attracts medical interest. Even more intriguing is the observation that MSCs appears to be a more potent material among kinds of stem cells for the transplantation, the mechanism for this benefit remains unclear. However, the therapeutic contribution of MSCs to myocardial repair can be caused by multiple factors including: direct differentiation into cardiac tissue including cardiomyocytes, smooth muscle cell, and vascular endothelial cells; secreting a variety of cytokines and growth factors that have paracrine activities; spontaneous cell fusion; and stimulating endogenous repair. In addition, MSCs possess local immunosuppressive properties, and MSCs mobilization is widely used clinically for transplantation. We will discusses the potential mechanisms of MSCs repair for ischemic heart diseases.


Fat cells: afferent and efferent messages define new approaches to treat obesity.
For a long time neural and endocrine messages were studied for their impact on adipocyte metabolism and control of storage/release of fatty acids. In fact, bidirectional communication exists between adipocytes and other tissues. Several molecules secreted from adipocytes are involved in fat cell signaling to other tissues. Adipocyte products could initiate antagonistic effects on target tissues. Fat cells produce peptides that can elicit insulin resistance, such as tumor necrosis factor-alpha and resistin, as well as hormones that can improve insulin resistance, such as leptin and adiponectin. Secretion of complement proteins, proinflammatory cytokines, procoagulant, and acute phase reactant proteins have also been observed in adipocytes. There is much to learn about how these signals function. It is unlikely that all the adipocyte's endocrine and paracrine signals have been identified. Putative pharmacological strategies aiming at modulation of afferent and efferent fat cell messages are reviewed and discussed.


Evaluation of the safety of two attenuated oral rabies vaccines, SAG1 and SAG2, in six Arctic mammals.
The safety of two attenuated oral rabies vaccines was evaluated in mink and in five species of rodents which occur in the Arctic. A 0.03 ml sample of liquid vaccine was installed directly into the mouth of voles and lemmings and 0.1 ml into the mouth of Arctic ground squirrels and mink. Animals were euthanized at 36 and 46 days postexposure; brain tissue was analyzed by FAT and serum by RFFIT. No rabies deaths occurred in 47 animals tested. Four animals representing three rodent species seroconverted, the highest titer being 0.5 IU ml-1. The absence of rabies virus in brain tissue indicates the safety of these vaccines in these species. The replacement of arginine with glutamic acid at position 333 reduces the pathogenicity of these vaccines, thereby presumably preventing the deleterious effect of viral entry into CNS neurons.


Lewis acid catalyzed cycloaddition of methylenecyclopropanes with salicylaldehydes.
Lewis acid catalyzed cycloaddition of methylenecyclopropanes (MCPs) with o-quinonemethide analogues, derived from the corresponding salicylaldehydes and CH(OEt)(3), produces the corresponding cycloadducts 3 in moderate to high yields at room temperature (20 degrees C). Moreover, the compounds 3 can be transformed to the indene derivatives 5 at high temperature. Plausible mechanisms have been proposed on the basis of control experiments.


Transmembrane domains confer different substrate specificities and adenosine diphosphate hydrolysis mechanisms on CD39, CD39L1, and chimeras.
Members of the ecto-nucleoside triphosphate diphosphohydrolase (eNTPDase) family exhibit distinctive substrate specificities, but how such specificities are achieved by enzymes with identical putative catalytic domains is unknown. Previously we showed that H59G substitution changes CD39 from an apyrase to an adenosine diphosphatase (ADPase) in a manner that depends on intact associations of both transmembrane domains with the membrane. Here we show that the extracellular domain of CD39L1 ecto-adenosine triphosphatase (ecto-ATPase) has the same 3:1 ATP:ADP hydrolysis ratio as the extracellular domain of CD39, suggesting that the transmembrane domains are required to confer the native substrate specificities on each enzyme. As in CD39, H50G substitution has little effect on the activity of the CD39L1 extracellular domain or solubilized monomers. However, H50G substitution diminishes both ATPase and ADPase activities of native CD39L1, in contrast to its selective effect on ATPase activity in CD39, suggesting that the transmembrane domains confer different ADP hydrolysis mechanisms on CD39 and CD39L1. We then show that the transmembrane domains of CD39L1 can substitute for those of CD39 in conferring native CD39 substrate specificity and regulation of H59 but that the transmembrane domains of CD39 confer neither CD39 nor CD39L1 properties on the CD39L1 extracellular domain. These results suggest that non-apyrase conserved region residues in the extracellular domain contain the information specifying CD39 native properties but have a nonspecific requirement for two transmembrane domains to manifest the information.


Accommodation to uncomfortable patterns.
Grating patterns can cause discomfort and perceptual distortions. Individuals who experience discomfort and are susceptible to these distortions generally show weaker accommodation than those who are less susceptible. We measured the accommodative response to grating patterns known to differ in the discomfort they evoke because of differences in their colour, motion, or spatial frequency. The parameters known to affect discomfort and distortion had no influence on the mean or variance in the accommodative response, even when accommodative demand was manipulated systematically and the accommodative response varied as expected.


Diabetes prevalence among American Indians and Alaska Natives and the overall population--United States, 1994-2002.
Diabetes affects American Indians/Alaska Natives (AI/ANs) disproportionately compared with other racial/ethnic populations and has been increasing in prevalence in AI/AN populations during the past 16 years. To examine trends in diabetes prevalence among AI/ANs and the overall U.S. population and to describe disparities among these two populations, CDC analyzed data from the Indian Health Service (IHS) and the Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that diabetes continues to affect AI/ANs disproportionately and is becoming more common among younger populations. To combat this epidemic, knowledge and interventions from clinical trials and best-practice models should be translated to community-based prevention programs within AI/AN communities.


[Effect of water-soluble C(60) fullerenes on pulmonary fibrosis induced by bleomycin in mice].
Objective: To evaluate the role of water-soluble C(60) fullerenes in mice model of lung injury and fibrosis that induced by bleomycin. Methods: A total of 20 healthy C57BL/6J mice were randomly divided into normal control group, bleomycin group, high dose C(60) group, low dose C(60) group, each group with 5 mice. Mice were induced pulmonary fibrosis by intratracheal injection of bleomycin except the normal control group, which was induced by saline instead. In low dose C(60) group and high dose C(60) group, 1 mg·kg(-1)·d(-1) and 10 mg·kg(-1)·d(-1) water-soluble C(60) fullerenes was injected into mice intraperitoneally every day, which began from one day before intratracheal instillation of bleomycin until the end of observation. Saline was given to mice in the same way in normal control and bleomycin group. This study investigated the variation of weight and survival rate of mice for 14 d. HE-staining and Masson's trichrome staining were used to assess the severity of fibrosis according to the method proposed by Ashcroft at 14th day. Total lung collagen content was determined by hydroxyproline assay. The changes of transforming growth factor-β(1) (TGF-β(1)) and tumor necrosis factor α (TNF-α) in plasma, bronchial alveolar lavage fluid (BALF) and lung tissue were measured by enzyme-linked immunosorbent assay (ELISA). And, the amount of reactive oxygen species (ROS) was tested by 2, 7-dichlorofuorescin diacetate (DCFH-DA), and determined by the ratio of fluorescence intensity and protein content (OD/μg). Results: C(60) can protect mice that injured by bleomycin from weight loss. According the method proposed by Ashcroft et al.HE and Masson's trichrome staining showed that collagen deposition in lung tissue were markedly attenuated in C(60) (1 mg·kg(-1)·d(-1) and 10 mg·kg(-1)·d(-1)) treated mice compared with bleomycin model mice[(4.08±0.52), (3.00±0.41) vs (6.75±0.75) points, both P<0.01]. In low dose C(60) group and high dose C(60) group, the content of hydroxyproline in lung tissue were significantly lower than that in bleomycin group[(0.36±0.06), (0.35±0.08) vs (0.55±0.16) μg/mg, both P<0.05]. The level of TGF-β(1) in BALF and lung tissue were also decreased in mice treated with C(60) (10 mg·kg(-1)·d(-1)) compared with bleomycin model mice, but the difference had no statistical significance[(9.38±5.32) vs (23.60±8.96) pg/ml, (2.89±0.35) vs (6.44±2.95) pg/mg, both P>0.05]. Also, in high dose C(60) group, the content of TNF-α in plasma, BALF and lung tissue were significantly lower than those in bleomycin group[(4.56±0.73) vs (7.21±2.26) pg/ml, (34.58±23.30) vs (151.00±27.34) pg/ml, (22.99±5.83) vs (122.90±22.04) pg/mg, all P<0.05]. In addition, Compared with bleomycin group, ROS in lung tissue was significantly decreased after treatment with C(60) (10 mg·kg(-1)·d(-1))[(19.68±0.91) vs (22.92±1.71) OD/μg, P<0.05]. Conclusion: Water-soluble C(60) fullerenes reduce the severity of pulmonary fibrosis induced by bleomycin in mice.


Plexiform granular cell tumor. A report of two cases.
A previously undescribed variant of granular cell tumor with an interesting plexiform pattern was found in the lower leg of a 10-year-old girl and on the back of a 12-year-old girl. Clinically, the patients presented with intradermal plaques that were accompanied by variable degrees of pain or tenderness. Histopathologic examination revealed granular cell tumors with various sized fascicles, particularly around nerve bundles, in a plexiform pattern. Cytoplasmic granules were PAS positive. Immunohistochemical studies showed tumor cells to be strongly positive with S-100 protein and weakly positive with alpha-1-antichymotrypsin and vimentin. These findings offer further support for a neural origin for granular cell tumors.


Resident training and endoscopic hospital privileging.
Laparoscopic techniques were originally confined to female sterilization. As both instrumentation and methodology improved, gynecological endoscopy was applied to more complex processes, including salpingostomy or salpingectomy for ectopic pregnancy, and ovarian cystectomy or oophorectomy for benign conditions. Now, the laparoscopic treatment of adhesions, endometriosis and hysterectomy is almost commonplace. More sophisticated endoscopic procedures include the management of pelvic floor disease, incontinence and malignancies. However, at least two problems have become readily apparent: (i) there is often limited basic laparoscopic and hysteroscopic teaching during residency and fellowship training; and (ii) there is no standard by which to privilege or train physicians who may not have had any significant endoscopic training during residency. In this article we describe current learning theories and identify goals and specific objectives for residents in implementing a successful training program. We also discuss the mechanisms by which to privilege attending staff for gynecological procedures and the important clinical outcomes that can be improved. Finally, we raise concerns about creating algorithms by which to renew clinical privileges in endoscopic procedures.


Influence of dietary alfalfa:orchardgrass hay and lasalocid on in vitro estimates of dry matter digestibility and volatile fatty acid concentrations of cecal contents and rate of digesta passage in sows.
Four mature crossbred sows were fistulated in the cecum, with two sows fed a corn-alfalfa:orchardgrass hay (46%) diet (CH) and two fed a corn-soybean meal diet (CS). Four experiments were conducted to evaluate buffers, incubation times, buffer pH and substrate and inocula sources in an in vitro, anaerobic, mixed-culture system. In vitro dry matter digestibility (IVDMD) and substrate solubility in buffer (SS) were determined. In Exp. 1, substrates were CH and CS diets with cecal inocula obtained from CH- and CS-fed sows. The bicarbonate (B) buffer resulted in lower (P less than .01) and less variable SS for all treatments. In vitro dry matter digestibility was higher (P less than .01) for the CS diet at both 24 and 48 h incubation. Use of the B buffer also resulted in higher (P less than .001) IVDMD values. In Exp. 2, substrates were either as in Exp. 1 or were freeze-dried cecal contents (CC) from CH- or CS-fed sows. In vitro dry matter digestibility of CC was lower (P less than .006) than IVDMD of diet, while IVDMD was higher (P less than .02) with cecal inocula than fecal inocula. In Exp. 3, substrate-inocula treatments were CH-CH, CH-CS, CS-CH and CS-CS. Substrate solubility was lower (P less than .05) at pH 5.8 than at pH 6.8. In vitro dry matter digestibility was higher when substrate and inocula were from the same source and at pH 5.8. In Exp. 4, CC and inocula were from sows fed CH and CS diets with or without lasalocid. In vitro dry matter digestibility was higher with CC from lasalocid-fed sows and inocula from sows fed no lasalocid. The CH diet resulted in higher acetate (Ac) and lower propionate (Pr) molar proportions than did the CS diet, while lasalocid increased molar proportion Pr and decreased molar proportion Ac in cecal contents from sows fed either diet. Corn-alfalfa:orchardgrass hay-fed sows had a faster rate of digesta passage and shorter cecal retention time than did CS-fed sows.


Increased interleukin-12 release from peripheral blood mononuclear cells in nephrotic phase of minimal change nephrotic syndrome.
The pathogenesis of minimal change nephrotic syndrome (MCNS) is still not clear. Several studies indicate that MCNS is a systemic disorder of cell-mediated immunity. IL-12 is a pleiotropic cytokine that is produced primarily by macrophage and plays a primary role in the induction of Th1-mediated immunity. The purpose of this study is to explore the relationship of in vivo IL-12 levels in both sera and urine, and in vitro IL-12 production in stable or nephrotic clinical condition patients with MCNS. In vitro IL-12 production was detected from LPS-stimulated peripheral blood mononuclear cells (PBMNCs) of 20 MCNS patients during nephrotic and remission stages, levels of sera and urinary IL-12 were measured by commercially available ELISA kits (R & D Systems, Minneapolis). The results showed sera IL-12 levels and LPS-stimulated IL-12 productions for PBMNCs were significantly increased as compared with those of normal controls and in remission stage. However, there was also statistical difference of urinary IL-12 levels among MCNS patients during nephrotic and remission stage and controls. This study demonstrates a correlation between in vitro IL-12 release by PBMNCs and in vivo sera IL-12 level from MCNS patients as well as correlation with disease activity. The study contributes to the understanding of the pathogenesis of MCNS.


Assessment of the protective potential of Premna tomentosa (L. Verbenaceae) extract on lipid profile and lipid-metabolizing enzymes in acetaminophen-intoxicated rats.
The liver is often damaged by environmental toxins, poor eating habits, alcohol and over-the-counter drug use that damage and weaken the liver, leading to important public health problems such as hepatitis, cirrhosis, and alcoholic liver diseases. It is cardinal to treat liver disorders, because it affects the biochemistry of the cell directly. Damage to the liver can be prevented by including a balanced diet that includes nutrients and herbs that support a healthy liver. Premna tomentosa (PT) is one such herbal drug used widely in India for the treatment of liver disorders, and we have already reported the hepatoprotective potential and antioxidant property of methanolic extract of PT leaves. Because injury to the liver can promote a variety of reactions with consequent effect on lipids, the present study was designed to elucidate the hypolipidemic effect of PT extract in acetaminophen (AA)-induced hepatotoxicity in rats. Animals were pretreated with PT extract (750 mg/kg, orally) for 15 days and then induced with hepatotoxicity by AA (640 mg/kg, intraperitoneally). PT extract pretreatment significantly inhibited induced alterations in the levels of cholesterol, triglycerides, free fatty acids, phospholipids, serum lipoproteins, and lipid-metabolizing enzymes. The results indicate that PT extract improves lipid metabolism and has the potential for use in hepatic disorders.


[Epidemiology and risk factors of hepatocellular carcinoma].
The incidence of hepatocellular carcinoma (HCC) has increased over the past decades as a result of alcoholic liver disease, the metabolic syndrome and the increasing incidence of viral hepatitis B and C. An evaluation of the epidemiology of HCC, presentation and discussion of the risk factors for the development of HCC. This study was based on a literature review, analysis of the statistics of the World Health Organization (WHO), discussion of current basic research and expert recommendations. The results show that HCC already represents the fifth most common malignancy in men and the ninth most common malignancy in women, and the incidence is still rising. The pronounced regional differences in prevalence and underlying risk factors are mainly, but not exclusively, due to the prevalence of chronic viral hepatitis B. Hepatocellular carcinoma is a major medical problem. Primary prevention measures and suitable screening algorithms are gaining more and more importance.


Full publication of results initially presented in abstracts. A meta-analysis.
To estimate the rate of full publication of the results of randomized clinical trials initially presented as abstracts at national ophthalmology meetings in 1988 and 1989; and to combine data from this study with data from similar studies to determine the rate at which abstracts are subsequently published in full and the association between selected study characteristics and full publication. Ophthalmology abstracts were identified by review of 1988 and 1989 meeting abstracts for the Association for Research in Vision and Ophthalmology and the American Academy of Ophthalmology. Similar studies were identified either from reports contained in our files or through a MEDLINE search, which combined the textword "abstract" with "or" statements to the Medical Subject Headings ABSTRACTING & INDEXING, CLINICAL TRIALS, PEER REVIEW, PERIODICALS, MEDICAL SOCIETIES, PUBLISHING, MEDLINE, INFORMATION SERVICES, and REGISTRIES. Ophthalmology abstracts were selected from the meeting proceedings if they reported results from a randomized controlled trial. For the summary study, similar studies were eligible for inclusion if they described followup and subsequent full publication for a cohort of abstracts describing the results of any type of research study. All studies had to have followed up abstracts for at least 24 months to be included. Authors of ophthalmology abstracts were contacted by letter to ascertain whether there was subsequent full publication. Other information, including characteristics of the study design possibly related to publication, was taken from the abstract. For the summary study, rates of full publication were taken directly from reported results, as were associations between study factors (ie, "significant" results and sample size) and full publication. Sixty-six percent (61/93) of ophthalmology abstracts were published in full. Combined results from 11 studies showed that 51% (1198/2391) of all abstracts were subsequently published in full. Full publication was weakly associated with "significant" results and sample size above the median. Approximately one half of all studies initially presented in abstract form are subsequently published as full-length reports. Most are published in full within 2 years of appearance as abstracts. Full publication may be associated with "significant" results and sample size.


The slipping rib syndrome.
The slipping rib syndrome is a cause of upper abdominal pain that is not widely known, possibly because of failure of recognition rather than infrequent occurrence. The syndrome should be suspected when pain can be reproduced by a rib-hooking maneuver. However, a thorough evaluation including intercostal nerve blocks is necessary both to eliminate coexistent gastrointestinal and psychiatric disorders as a cause of pain and to assure adequate treatment and a good prognosis. Patients with obvious slipping ribs appear to benefit from surgical excision.


A possible difference in the mechanism for postprandial hypoglycemia associated with dumping syndrome between patients with and without type 2 diabetes.
Dumping syndrome is a complication of gastric surgery including bariatric surgery, and which is induced by rapid gastric emptying and increased intestinal motility. We should note that hypoglycaemia due to dumping syndrome can occur in patients with type 2 diabetes. However, the pathogenesis of dumping syndrome in patients with type 2 diabetes is not fully investigated. We investigated the changes in plasma glucose, serum insulin, plasma glucagon, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) by the 75 g oral glucose tolerance test (OGTT) in 3 patients with and without type 2 diabetes who had gastric surgery. Significant hyperinsulinemia was observed in non-diabetic patients, but not in a diabetic patient. On the other hand, plasma GLP-1 levels significantly increased after glucose intake in a diabetic patient. Increased secretion of GLP-1 may have caused reactive hypoglycaemia in patients with type 2 diabetes undergoing gastric surgery.


An analysis of venom ontogeny and prey-specific toxicity in the Monocled Cobra (Naja kaouthia).
Venoms of snakes of the family Elapidae (cobras, kraits, mambas, and relatives) are predominantly composed of numerous phospholipases A2 (PLA2s) and three-finger toxins (3FTxs), some of which are lethal while others are not significantly toxic. Currently, the only identified prey-specific toxins are several nonconventional 3FTxs, and given the large diversity of 3FTxs within Monocled Cobra (Naja kaouthia) venom, it was hypothesized that several 3FTxs, previously found to be non-toxic or weakly toxic 3FTxs in murine models, could potentially be toxic towards non-murine prey. Additionally, it was hypothesized that ontogenetic dietary shifts will be correlated with observable changes in specific 3FTx isoform abundance. Adult and juvenile N. kaouthia venom composition was investigated using ion-exchange FPLC, 1D and 2D SDS-PAGE, mass spectrometry, and various enzymatic and LD50 assays. Alpha-cobratoxin (α-elapitoxin) was the only significantly toxic (LD50 < 1 μg/g) 3FTx found in N. kaouthia venom and was equally toxic toward both lizard and mouse models. The abundance and diversity of 3FTxs and most enzyme activities did not vary between adult and juvenile cobra venoms; however, total venom PLA2 activity and specific PLA2 isoforms did vary, with juveniles lacking several of the least acidic PLA2s, and these differences could have both biological (related to predation) and clinical (antivenom efficacy) implications. Nevertheless, the ubiquitous presence of α-cobratoxin in both adult and juvenile cobra venoms, with high toxicity toward both reptiles and mammals, represents a venom compositional strategy wherein a single potent toxin effectively immobilizes a variety of prey types encountered across life history stages.


The role of the supplementary motor area for speech and language processing.
Apart from its function in speech motor control, the supplementary motor area (SMA) has largely been neglected in models of speech and language processing in the brain. The aim of this review paper is to summarize more recent work, suggesting that the SMA has various superordinate control functions during speech communication and language reception, which is particularly relevant in case of increased task demands. The SMA is subdivided into a posterior region serving predominantly motor-related functions (SMA proper) whereas the anterior part (pre-SMA) is involved in higher-order cognitive control mechanisms. In analogy to motor triggering functions of the SMA proper, the pre-SMA seems to manage procedural aspects of cognitive processing. These latter functions, among others, comprise attentional switching, ambiguity resolution, context integration, and coordination between procedural and declarative memory structures. Regarding language processing, this refers, for example, to the use of inner speech mechanisms during language encoding, but also to lexical disambiguation, syntax and prosody integration, and context-tracking.


Cerebral blood flow effects of acute intravenous heroin administration.
We examined acute effects of intravenous diacetylmorphine (heroin) administration - which induces a characteristic biphasic response: A short rush-sensation associated with intense pleasurable feelings followed by a subjectively different period of euphoria on cerebral blood flow. This was assessed in nine male heroin dependent patients participating in a heroin maintenance program in a setting resembling everyday pattern of heroin abuse. 99mTc-HMPAO was administered 45 s (rush) and 15 min (euphoria) after administration of i.v. heroin and 45 s after administration of saline (placebo). Plasma concentration of diacetylmorphine and its metabolites were measured with high-pressure liquid chromatography (HPLC). Compared to the euphoria condition, rush was associated with blood flow increase in the left posterior cerebellar lobe, left anterior cingulate gyrus and right precuneus. Our results are in line with recent reports indicating that the cerebellum is an important component in functional brain systems subserving sensory and motor integration, learning, modulation of affect, motivation and social behaviour, which all play important roles in reinforcing properties of opioids.


Engaging Copper(III) Corrole as an Electron Acceptor: Photoinduced Charge Separation in Zinc Porphyrin-Copper Corrole Donor-Acceptor Conjugates.
An electron-deficient copper(III) corrole was utilized for the construction of donor-acceptor conjugates with zinc(II) porphyrin (ZnP) as a singlet excited state electron donor, and the occurrence of photoinduced charge separation was demonstrated by using transient pump-probe spectroscopic techniques. In these conjugates, the number of copper corrole units was varied from 1 to 2 or 4 units while maintaining a single ZnP entity to observe the effect of corrole multiplicity in facilitating the charge-separation process. The conjugates and control compounds were electrochemically and spectroelectrochemically characterized. Computational studies revealed ground state geometries of the compounds and the electron-deficient nature of the copper(III) corrole. An energy level diagram was established to predict the photochemical events by using optical, emission, electrochemical, and computational data. The occurrence of charge separation from singlet excited zinc porphyrin and charge recombination to yield directly the ground state species were evident from the diagram. Femtosecond transient absorption spectroscopy studies provided spectral evidence of charge separation in the form of the zinc porphyrin radical cation and copper(II) corrole species as products. Rates of charge separation in the conjugates were found to be of the order of 10(10) s(-1) and increased with increasing multiplicity of copper(III) corrole entities. The present study demonstrates the importance of copper(III) corrole as an electron acceptor in building model photosynthetic systems.


Sonochemically synthesized MnO2 nanoparticles as electrode material for supercapacitors.
In this study, manganese oxide (MnO2) nanoparticles were synthesized by sonochemical reduction of KMnO4 using polyethylene glycol (PEG) as a reducing agent as well as structure directing agent under room temperature in short duration of time and characterized by powder X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), Scanning electron microscope (SEM), Transmission electron microscopy (TEM) and Brunauer-Emmett-Teller (BET) analysis. A supercapacitor device constructed using the ultrasonically-synthesized MnO2 nanoparticles showed maximum specific capacitance (SC) of 282Fg(-1) in the presence of 1M Ca(NO3)2 as an electrolyte at a current density of 0.5mAcm(-2) in the potential range from 0.0 to 1.0V and about 78% of specific capacitance was retained even after 1000 cycles indicating its high electrochemical stability.


Recovery of abnormal ejaculation by intermittent tamsulosin treatment.
We assessed the impact of intermittent tamsulosin treatment on abnormal ejaculation. This prospective study was performed between January 2001 and December 2004. It included 405 patients who were at least 50 years old with lower urinary tract symptoms. This study was divided into 2 phases. In phase 1 patients received a 0.4 mg tamsulosin capsule daily after breakfast for at least 3 months. The second phase of this study was performed in the 30 patients with abnormal ejaculation. In this phase these patients received 0.4 mg tamsulosin once daily every other day. Patients were assessed at study entry and at study week 6. Abnormal ejaculation was reported as retrograde ejaculation by 18 patients, as decreased volume by 7 and as absent ejaculate by 5. Ejaculatory function recovered during intermittent tamsulosin treatment in 12 patients with retrograde ejaculation and in 7 with decreased volume or absent ejaculate. As a result, 19 of 30 patients (63.3%) with abnormal ejaculation recovered. A significant improvement in retrograde ejaculation was found after intermittent tamsulosin treatment (p = 0.02). Although there were improvements in decreased volume or absent ejaculate at week 6 of intermittent treatment, these differences were not statistically significant (p = 0.42 and 0.61, respectively). The results of the current study, which to our knowledge is the first report of the effect of intermittent tamsulosin treatment on abnormal ejaculation, show that this treatment modality is well tolerated and provides comparable improvements for abnormal ejaculation.


Discoloration of dental pellicle by tannic acid.
The ability of tannic acid to discolor pellicle was studied in vitro and in vivo. Freshly extracted teeth were submerget in solutions of tannic acid, and in the clinical study individuals rinsed three times daily with 0.1% or 0.2% tannic acid. It was fount that 0.2% tannic acid caused brownish discolorations within 10-12 days both in vitro and in vivo. Discolored pellicle material collected from the in vivo test group was shown to contain furaldehyde after hydrolysis. The origin of the furaldehyde is not ascertained, but could be due to the presence of dietary deposits, transformation of pellicle pentoses, or from reactions between reducing sugars and amino compounds.


Nonarteritic anterior ischemic optic neuropathy: clinical characteristics in diabetic patients versus nondiabetic patients.
To investigate various aspects of nonarteritic anterior ischemic optic neuropathy (NA-AION) in patients with diabetes mellitus and to compare them with those in patients without diabetes mellitus. Cohort study. A total of 655 consecutive patients (931 eyes) with NA-AION, first seen in the clinic from 1973 to 2000. At the first visit, all patients had a detailed ophthalmic and medical history and comprehensive ophthalmic evaluation, including color fundus photography and fluorescein fundus angiography. Visual evaluation was done by recording visual acuity with the Snellen visual acuity chart and visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit, except for fluorescein fundus angiography. Of this cohort, 528 eyes (345 patients) were treated with systemic corticosteroid therapy during the initial stage. Demographic and clinical differences between diabetic patients and nondiabetic patients with NA-AION. Comparison of various clinical features of NA-AION in diabetic and nondiabetic patients showed no significant difference in age, but slightly more women than men (45% vs 38%; P = 0.078) were diabetic and had a higher prevalence of hypertension (P<0.0001), ischemic heart disease (P = 0.0001), transient ischemic attacks (P = 0.0003), and second eye involvement by NA-AION (P = 0.003). Initial visual acuity did not differ significantly between diabetic and nondiabetic patients; however, of those seen within 2 weeks of onset of NA-AION, diabetic patients had less severe visual field defect (P = 0.010). At 6 months from onset, there was no significant difference in visual acuity and visual field improvement between diabetic and nondiabetic patients. Time to optic disc edema resolution in NA-AION was (P = 0.003) longer in diabetic patients than in nondiabetic patients. The optic disc of diabetic patients usually has characteristic diagnostic dilated telangiectatic vessels during the early stages of NA-AION. Diabetic patients with NA-AION show several demographic and clinical differences from nondiabetic patients, which has led to controversy about its diagnosis and management.


[Bacterial skin infections in the dog (author's transl)].
The most common bacterial skin conditions in dogs are reviewed in the present paper. An introductory part on the pathogenesis of pyoderma and some universal morphological dermatological concepts is followed by a systematic study of superficial and deep forms of pyoderma. In addition to the bacterial diagnosis, the results of bacteriological examination of fifty-three dogs with pyoderma submitted to the University Clinic of small animal medicine are reported. Moreover, a guide to the institution of adequate therapy is suggested.


Expression of adropin in rat brain, cerebellum, kidneys, heart, liver, and pancreas in streptozotocin-induced diabetes.
We have investigated how diabetes affects the expression of adropin (ADR) in rat brain, cerebellum, kidneys, heart, liver, and pancreas tissues. The rats in the diabetic group were administered an intraperitoneal (i.p.) injection of a single dose of 60 mg/kg streptozotocin (STZ) dissolved in a 0.1 M phosphate-citrate buffer (pH 4.5). The rats were maintained in standard laboratory conditions in a temperature between 21 and 23 °C and a relative humidity of 70 %, under a 12-h light/dark cycle. The animals were fed a standard commercial pellet diet. After 10 weeks, the animals were sacrified. ADR concentrations in the serum and tissue supernatants were measured by ELISA, and immunohistochemical staining was used to follow the expression of the hormones in the brain, cerebellum, kidneys, heart, liver, and pancreas tissues. The quantities were then compared. Increased ADR immunoreaction was seen in the brain, cerebellum, kidneys, heart, liver, and pancreas in the diabetes-induced rats compared to control subjects. ADR was detected in the brain (vascular area, pia mater, neuroglial cell, and neurons), cerebellum (neuroglial cells, Purkinje cells, vascular areas, and granular layer), kidneys (glomerulus, peritubular interstitial cells, and peritubular capillary endothelial cells), heart (endocardium, myocardium, and epicardium), liver (sinusoidal cells), and pancreas (serous acini). Its concentrations (based on mg/wet weight tissues) in these tissues were measured by using ELISA showed that the levels of ADR were higher in the diabetic rats compared to the control rats. Tissue ADR levels based on mg/wet weight tissues were as follows: Pancreas > liver > kidney > heart > brain > cerebellar tissues. Evidence is presented that shows ADR is expressed in various tissues in the rats and its levels increased in STZ-induced diabetes; however, this effect on the pathophysiology of the disorder remains to be understood.


Structure related effects of flavonoid aglycones on cell cycle progression of HepG2 cells: Metabolic activation of fisetin and quercetin by catechol-O-methyltransferase (COMT).
Dietary flavonoids are abundant in the Plant Kingdom and they are extensively studied because of their manifold pharmacological activities. Recent studies highlighted that cell cycle arrest plays a key role in their antiproliferative effect in different tumor cells. However, structure-activity relationship of flavonoids is poorly characterized. In our study the influence of 18 flavonoid aglycones (as well as two metabolites) on cell cycle distribution was investigated. Since flavonoids are extensively metabolized by liver cells, HepG2 tumor cell line was applied, considering the potential metabolic activation/inactivation of flavonoids. Our major observations are the followings: (1) Among the tested compounds diosmetin, fisetin, apigenin, lutelin, and quercetin provoked spectacular extent of G2/M phase cell cycle arrest. (2) Inhibition of catechol-O-methyltransferase enzyme by entacapone decreased the antiproliferative effects of fisetin and quercetin. (3) Geraldol and isorhamnetin (3'-O-methylated metabolites of fisetin and quercetin, respectively) demonstrated significantly higher antiproliferative effect on HepG2 cells compared to the parent compounds. Based on these results, O-methylated flavonoid metabolites or their chemically modified derivatives may be suitable candidates of tumor therapy in the future.


Endoscopic injection sclerotherapy for esophageal variceal hemorrhage in a patient with idiopathic myelofibrosis.
A 74-year-old female with idiopathic myelofibrosis (IMF) was admitted to our hospital because of massive hematemesis and melena. Immediate upper gastrointestinal endoscopy revealed an intermittent spurting hemorrhage from extensive esophageal varices. Endoscopic injection sclerotherapy (EIS) was carried out and the bleeding ceased. After five courses of EIS, all the esophageal varices were eradicated. About 15 months later, the patient died, due to a cerebral hemorrhage, without further variceal bleeding. A postmortem examination was carried out and the portal hypertension was considered to be due not only to extramedullary hematopoiesis in the sinusoids, but also to increased splenic blood flow. We are confident that EIS is an effective therapeutic procedure for patients with IMF showing esophageal variceal hemorrhage. EIS should be the preferred choice of treatment for esophageal varices in patients with IMF, since it is less invasive than splenectomy.


Emerging functions of mammalian and plant mTERFs.
Organellar gene expression (OGE) is crucial for plant development, respiration and photosynthesis, but the mechanisms that control it are still largely unclear. Thus, OGE requires various nucleus-encoded proteins that promote transcription, splicing, trimming and editing of organellar RNAs, and regulate their translation. In mammals, members of the mitochondrial transcription termination factor (mTERF) family play important roles in OGE. Intriguingly, three of the four mammalian mTERFs do not actually terminate transcription, as their designation suggests, but appear to function in antisense transcription termination and ribosome biogenesis. During the evolution of land plants, the mTERF family has expanded to approximately 30 members, but knowledge of their function in photosynthetic organisms remains sparse. Here, we review recent advances in the characterization of mterf mutants in mammals and photosynthetic organisms, focusing particularly on the progress made in elucidating their molecular functions in the last two years. This article is part of a Special Issue entitled: Chloroplast biogenesis.


Modern imaging techniques in GH secretory disorders.
Magnetic resonance images of the pituitary-hypothalamic area in patients with GH secretory disorders, divided into two groups (hypersecretory and hyposecretory), were studied. In the first group there were 42 patients with pituitary adenoma; size, signal characteristics, direction of growth, and type of enhancement were analyzed and compared with similar studies in 40 age and sex matched control patients with non-GH secreting pituitary adenomas. No significant differences were found except for a higher frequency of chiasm involvement and a more pronounced contrast enhancement in the control group. The hyposecretory group was composed of 101 patients with congenital idiopathic growth hormone deficiency (CIGHD). MR revealed morphological abnormalities consisting of hypoplastic anterior pituitary and ectopic posterior pituitary (PPE) in 59 patients, without evidence of a complete pituitary stalk; in 42 patients the posterior pituitary was in normal position and the pituitary stalk visible. The group with PPE showed a greater frequency of multiple pituitary hormone deficiency (51% vs 12%), breech delivery (30% vs 7%) and associated congenital brain anomalies (12% vs 7%). These data suggest that CIGHD could be the result of a congenital midline brain anomaly in a significant proportion of patients.


Prevalence and incidence of urinary tract and genital infections among patients with and without type 2 diabetes.
Epidemiological data on genitourinary infections (GUIs) comparing patients with and without type 2 diabetes (T2DM) is scant. We aimed to estimate the incidence of urinary tract infections (UTIs), genital infections (GIs), or any GUI in total and stratified by history of GUI and sex. We identified 39,295 patients in the Kaiser Permanente Northwest health plan with T2DM and an equal number of age and sex matched patients without diabetes. The cohort was followed for up to 9years (2006-2014). We calculated incidence rates and corresponding 95% confidence intervals (CI) of any GUI, UTIs and GIs adjusting for age, sex, race, BMI, presence of chronic kidney disease, annual number of outpatient visits, and diuretic use. Adjusted incidence of any GUI was 97.2/1000person-years (p-y) (95% CI 95.5-98.8) among the T2DM cohort vs. 79.7/1000 p-y (78.3-81.2) among those without diabetes. T2DM was associated with an adjusted 25% increased risk of UTI (rate ratio 1.25, 95% CI 1.22-1.29), a 26% increased risk of GI (1.26, 1.22-1.31) and a 22% increased risk of any GUI (1.22, 1.19-1.25). Incidence rates were lower among those with no GUI history, but the relative risks were similar. Women in both groups had higher incidence rates of GUIs than men. T2DM was associated with increased risks of any GUI, UTIs and GIs. Incidence rates of UTIs were higher than rates of GIs, but the relative risk of GIs was essentially identical. A similar pattern was observed when stratifying by sex. RESEARCH QUESTIONS.


[Prokaryotic expression and purification of N-terminal and C-terminal fragments of histone deacetylase 4].
To express and purify the fusion proteins of glutathione S-transferase (GST)-N-terminal of histone deacetylase4 (HDAC4-N') (1-1952 bp) and GST- C-terminal of HDAC4 (HDAC4-C') (1708-3255 bp) in E.coli. The DNA fragments (HDAC4-N' and HDAC4-C') amplified by PCR were ligated into GST fusion vector (pGEX-6P-1) to construct the recombinant plasmids. After identification with restriction digestion and DNA sequencing, the recombinant plasmids were transformed into E.coli BL21 and induced by IPTG for their expression. After identification by SDS-PAGE and Western blotting, the target proteins were purified by glutathione sepharose 4B. The results of restriction digestion and DNA sequencing confirmed successful construction of the recombinant plasmids. The relative molecular masses of the fusion proteins were approximately 110500 and 93080 as shown by SDS-PAGE. Western blotting demonstrated that the fusion proteins could be recognized by the specific anti-HDAC4 antibody. We have successfully constructed the recombinant expression vectors of pGEX-6P-1/HDAC4-N' and pGEX-6P-1/HDAC4-C' and induced the expression of the fusion proteins, which may facilitate functional studies of HDAC4 with other proteins.


Central effects of cromoglycate sodium salt in rats treated with lipopolysaccharide.
In 24-h water- and food-deprived rats, we have evaluated the effects of cromoglycate sodium salt, an inhibitor of the mast cell degranulation with anti-inflammatory and membrane-stabilizating activity, on the central effects induced by Escherichia coli lipopolysaccharide (LPS). Intraperitoneal (i.p.) injection of LPS (0.25, 0.50 and 1 mg/kg) induced a dose-dependent inhibition of water and food intake, fever, reduction in locomotor activity as well as increased anxiety levels. All these LPS effects were antagonized by a prior intracerebroventricular (i.c.v.) injection of cromoglycate sodium salt (100, 150 and 200 microg/rat). Our findings suggest that peripheral LPS administration may activate brain mast cells and indicate an involvement of these cells in brain pathophysiology.


A comparison of enzyme-linked immunosorbent assay and indirect fluorescent antibody test in the sero-diagnosis of cutaneous and visceral leishmaniasis in Iran.
ELISA AND IFAT have been applied to the sero-diagnosis of cutaneous and visceral leishmaniasis and the levels of leishmanial antibody detected by Leishmania donovani antigens in both tests have been compared. From the results it appears that ELISA is a little more sensitive than IFAT, but IFAT seems to be more specific in detecting leishmanial antibodies. In both tests reactions between leishmanial antigen and some other infections, such as malaria and typhoid, were observed. These non-specific reactions reduce the validity of both tests, especially ELISA, in the sero-diagnosis of cutaneous leishmaniasis but, in visceral leishmaniasis, the leishmanial antibody levels were high enough to be unaffected by non-specific reactions. In general, ELISA is as good as IFAT and more practical in the sero-diagnosis and mass screening surveys for kala-azar.


Carbon Ion Reirradiation for Recurrent Head and Neck Cancer: A Single-Institutional Experience.
This study aimed to assess the feasibility of carbon ion reirradiation (CIR) for recurrent head and neck cancer (HNC). This retrospective study included 229 patients with recurrent HNC who were treated with CIR between 2010 and 2017. We assessed progression-free survival, overall survival, pattern of failure, and toxicity. Of the primary tumors, 54.1% were adenoid cystic carcinomas, 26.2% were squamous cell carcinomas, 8.3% were adenocarcinomas, and 11.4% were other tumor entities. The median radiation therapy interval was 3.9 years (range, 0.3-46.5 years), and patients received a median dose of 51 Gy (relative biological effectiveness [RBE]; range, 30-66 Gy [RBE]) in 3 Gy (RBE) fractions. The median cumulative lifetime dose after CIR was 132.8 Gy (range, 88.8-155.0 Gy). The median local progression-free survival after CIR was 24.2 months (95% confidence interval, 19.4-29.0 months), and the median overall survival was 26.1 months (95% confidence interval, 21.9-30.3 months). Serious acute toxicity (grade ≥3) after CIR included laryngeal edema, grade 4 (n = 2; 0.9%); dysphagia, grade 3 (n = 3; 1.3%); fistula, grade 3 (n = 1; 0.4%); and impaired hearing, grade 3 (n = 1; 0.4%). Late toxicities of grades 3 or higher (n = 18; 14.5%) included central nervous system necrosis, grades 4/3 (n = 1; 0.8%/n = 5; 4.0%); optic nerve disorder, grades 4/3 (n = 2; 1.6%/n = 2; 1.6%); impaired hearing, grade 3 (n = 5; 4.0%), osteonecrosis, grade 3 (n = 1; 0.8%); and carotid blowout, grade 4 (n = 1; 0.8%). In patients with locally recurrent HNC, CIR was a feasible, effective treatment with acceptable toxicity and good local control. Thus, CIR represented a valuable alternative to surgical salvage and palliative chemotherapy in selected patients.


Infection control and prevention strategies in the ICU.
Although only 5-10% of all hospitalized patients are treated in ICUs, they account for approximately 25% of all nosocomial infections, and the incidence of nosocomial infections in ICUs is 5-10 times higher than that observed in general hospital wards. Systemic and respiratory infections are far more common than in general wards, and most epidemics originate in ICUs. Nosocomial infections are the primary focus of most infection control programmes because they are the cause of high mortality rates in ICUs. Effective programmes are usually based on the cooperation of the intensive care physician, the infectious disease specialist, the microbiologist and the clinical epidemiologist. The infectious disease specialist develops specific guidelines for the antimicrobial therapy of typical infections which minimize the selective pressure for microorganisms within the ICU. The microbiologist provides rapid and accurate diagnosis of the pathogens involved. The clinical epidemiologist identifies epidemics at early stages, using epidemiological tools and molecular typing methods, as well as summarizing trends of antimicrobial susceptibility patterns and setting standards for isolation practices. A simple and inexpensive way to reduce nosocomial infections in ICUs is to ensure that staff disinfect their hands after dealing with a patient. Intravascular devices, mechanical ventilation and urinary catheterization are major risk factors for nosocomial infections, and their use should be evaluated daily and discontinued as soon as clinically possible. Selective decontamination of the digestive tract and the use of standard immunoglobulin for prophylaxis are still controversial and need further investigation.(ABSTRACT TRUNCATED AT 250 WORDS)


Comparative study of Misgav-Ladach and Pfannenstiel-Kerr cesarean techniques: a randomized controlled trial.
To compare Pfannenstiel-Kerr (PKM) and Misgav-Ladach (MLM) methods in terms of operation-related features and neonatal outcome in primary cesarean deliveries. A total of 180 pregnant women randomized into PKM (n = 90) or MLM (n = 90) groups were included in this study. Primary outcome measures were total operative and extraction times, Apgar score, blood loss, wound complications, and the suture use. Secondary outcome measures were wound seroma and infection incidence, time of bowel restitution, and the perceived pain. Total operation and extraction times were significantly shorter and less suture material was used in the MLM group than the PKM group (p < 0.001). Initially, higher scores obtained for 6 h-VAS in the MLM group (p < 0.05) were normalized after 24 h of the operation. PKM and MLM were similar in terms of preoperative and postoperative levels of hemoglobin and hematocrit, wound complication, bowel restitution, fever, seroma, infection, wound dehiscence and the need for transfusion, antibiotic, and analgesics. The operation-related morbidity of the MLM and PKM for primary C/S seem to be comparable; however, the MLM seems to be superior in terms of operation time and the amount of suture usage but inferior in pain scores in the early postoperative period.


Hypomagnesaemia, hypoalbuminaemia and plasma lipid changes in rats following the oral administration of ciclosporin.
1. The effects of orally administered ciclosporin (40, 50 or 80 mg/kg body wt) on plasma magnesium, albumin, total cholesterol and triglycerides have been studied in male Wistar rats. 2. Plasma magnesium and albumin were significantly lower in rats dosed with ciclosporin (40, 50 or 80 mg/kg) after 14 days. 3. Variable changes of plasma cholesterol and triglycerides were observed. Some implications of the inter-relationships of magnesium, albumin and plasma lipids in ciclosporin treatment are discussed.


Developing critical thinking skills from clinical assignments: a pilot study on nursing students' self-reported perceptions.
Clinical assignments in nursing education provide opportunities for students to develop thinking skills vital to the effective delivery of patient care. The purpose of the present study was to examine students' perceived levels of confidence for using thinking skills when completing two types of clinical assignments. Clinical educators and managers are challenged to develop teaching and learning strategies that help students think critically and reflectively and transfer these skills into sound nursing practice. This study is based on the theoretical framework of critical thinking within the nursing process framework. Undergraduate nursing students (n=51) completed surveys indicating their confidence in using seven thinking skills for nursing care. Students indicated significantly more confidence when implementing the journal format as compared with the care plan format when analysing information, determining relevance, making connections, selecting appropriate information, applying relevant knowledge and evaluating outcomes. The findings of the present study propose a new approach for enhancing students' thinking skills. Journaling is an effective strategy for enhancing students' thinking skills. Nursing managers are in key organisational positions for supporting and promoting the use of the journal format and building supportive and collaborative learning environments for students to develop thinking skills for managing patient care.


Association between reflux esophagitis and/or hiatus hernia and gastric mucosal atrophy level in Japan.
The mechanisms involved in reflux esophagitis (RE) are mainly esophageal motor dysfunction and abnormal esophageal acid exposure. Therefore the extent of gastric mucosal atrophy (GMA), which is related to gastric acid secretion, is an important factor in the development of RE. The aim of this study was to evaluate the prevalence of RE and hiatus hernia (HH) according to level of GMA. A total of 1897 prospective, consecutive endoscopic examinations were performed by the same endoscopist to investigate the prevalence of RE and HH in patients with closed or open-type GMA. The patients were divided into four age groups: under 44, 45-54, 55-64 and over 65 years. The prevalence of RE and HH in patients with closed-type GMA was significantly higher than that of open-type GMA in the 45-54, 55-64 and over 65 age groups. In patients with open-type GMA, the prevalence of RE in each age group was similar at 5.0-7.4%, and the prevalence of HH in the over 65 age group was significantly higher than that of the 55-64 age group. In patients with closed-type GMA, the prevalence of RE and HH in the over 65 age group was significantly higher than that of other age groups. The existence of closed-type GMA and age over 65 years were important factors in the development of RE and HH.


Are mast cells implicated in asphyxia?
In a previous immunohistochemical (IHC) study, we documented the reaction of lung tissue vessels to hypoxia through the immunodetection of HIF1-α protein, a key regulator of cellular response to hypoxic conditions. Findings showing that asphyxia deaths are associated with an increase in the number of mast cell (MC)-derived tryptase enzymes in the blood suggests that HIF1-α production may be correlated with MC activation in hypoxic conditions. This hypothesis prompted us to investigate the possible role of pulmonary MC in acute asphyxia deaths. Lung of 47 medico-legal autopsy cases (35 asphyxia/hypoxia deaths, 11 controls, and 1 anaphylactic death) were processed by IHC analysis using anti-CD117 (c-Kit) antibody to investigate peri-airway and peri-vascular MC together with their counts and features. Results showed a significant increase in peri-vascular c-kit(+) MC in some asphyxia deaths, such as hanging, strangulation, and aspiration deaths. A strong activation of MC in peri-airway and peri-vascular areas was also observed in lung samples from the anaphylaxis case, which was used as a positive control. Our study points to the potential role of MC in hypoxia and suggests that an evaluation of MC in the lungs may be a useful parameter when forensic pathologists are required to make a differential diagnosis between acute asphyxia deaths and other kinds of death.


A proton pumping pyrophosphatase in acidocalcisomes of Herpetomonas sp.
Acidocalcisomes are acidic calcium storage organelles found in several microorganisms. They are characterized by their acidic nature, high electron density, high content of polyphosphates and several cations. Electron microscopy contrast tuned images of Herpetomonas sp. showed the presence of several electron dense organelles ranging from 100 to 300 nm in size. In addition, X-ray element mapping associated with energy-filtering transmission electron microscopy showed that most of the cations, namely Na, Mg, P, K, Fe and Zn, are located in their matrix. Using acridine orange as an indicator dye, a pyrophosphate-driven H+ uptake was measured in cells permeabilized by digitonin. This uptake has an optimal pH of 6.5-6.7 and was inhibited by sodium fluoride (NaF) and imidodiphosphate (IDP), two H+-pyrophosphatase inhibitors. H+ uptake was not promoted by ATP. Addition of 50 microM Ca2+ induced the release of H+, suggesting the presence of a Ca2+/H+ countertransport system in the membranes of the acidic compartments. Na+ was unable to release protons from the organelles. The pyrophosphate-dependent H+ uptake was dependent of ion K+ and inhibited by Na+ Herpetomonas sp. immunolabeled with monoclonal antibodies raised against a Trypanosoma cruzi V-H+-pyrophosphatase shows intense fluorescence in cytoplasmatic organelles of size and distribution similar to the electron-dense vacuoles. Together, these results suggest that the electron dense organelles found in Herpetomonas sp. are homologous to the acidocalcisomes described in other trypanosomatids. They possess a vacuolar H+-pyrophosphatase and a Ca2+/H+ antiport. However, in contrast to the other trypanosomatids so far studied, we were not able to measure any ATP promoted H+ transport in the acidocalcisomes of this parasite.