Sleep quality in adult patients with attention deficit hyperactivity disorder (ADHD).
Sleep disorders are common in adults with attention deficit/hyperactivity disorder (ADHD). Two sleep questionnaires; the Brown ADD Scale, the Symptom-Checklist-90-R, and a self-developed symptom questionnaire were administered in this study. In a sample of 61 patients without comorbidity, current substance abuse and medication intake, sleep problems were reported more often than in healthy controls. A lack of being refreshed in the morning was very closely associated with ADHD symptomatology whereas insomnia was related to the presence of comorbidity and depressive symptoms. In the total sample (N = 120), medication intake (mainly stimulants) was not related to any of the sleep parameters. It seems important to screen adult patients with ADHD for the presence of sleep disorders, especially insomnia, restless legs syndrome, and sleep-related breathing disorders (the last in conjunction with the body mass index). Since primary sleep disorders are associated with cognitive impairment, one might expect that ADHD symptomatology may improve if comorbid sleep disorders are adequately treated in addition to the specific ADHD treatment.


Pharmacologic treatment of hand-, knee- and hip-osteoarthritis.
Osteoarthritis (OA) is a joint disease of high prevalence and affects > 90 % of the population, depending on several risk factors. Symptomatic OA is less frequent, but requires an individually tailored therapeutic regimen consisting of non-pharmacological and pharmacological treatment modalities. Pharmacologic therapy, however, is mainly limited to analgetic and anti-inflammatory agents; structure modifying remedies do not exist. The therapeutic approach to hand-, knee- and hip-OA is basically similar and differs only at some minor points. Generally, topical agents or paracetamol are recommended as first-line agents. If unsuccessful oral non-steroidal anti-inflammatory drugs (NSAIDs) or COX-2-selctive inhibitors should be introduced. Tramadol is an option in the case patients will not respond satisfactorily to NSAIDs. Glucosamine and chondroitine sulphate are no longer recommended in knee and hip OA, but chondroitine might be efficient in treating hand OA. Oral NSAIDs should be prescribed with caution due to potential side effects. Opioids are not recommended as their benefits are outweighed by an increased risk for serious adverse events.


How postpartum women explain their lack of obtaining adequate prenatal care.
The quality of life for infants and children is often dependent on the adequacy of the prenatal care pregnant women receive. From July through to December 1985, 15% of pregnant women in one Midwestern county were identified as having inadequate prenatal care. The purposes of the study were to identify and analyse the reasons women in that county gave for not obtaining adequate prenatal care. In addition, chi-square was used to determine the relationship between the reasons given and the three variables, age, time between knowledge of pregnancy and making an appointment for care, and source of payment. A convenience sample (n = 44) was used in a study over a 5-month period at three locations. The Health Belief Model was the conceptual framework for this study. Insufficient money to pay for care was the primary reason given for not obtaining adequate prenatal care (81%). Other reasons included motivational issues (45%) and access or lack of transportation (19%). There was a significant relationship (P = 0.05) with four reasons to the variable of age and with three reasons to both the variables of time and source of payment. The following recommendations were identified as a result of this research: the need for subsidized prenatal care and the need for a community-wide education campaign regarding the need for adequate prenatal care and the consequences of inadequate care. Prenatal care is sometimes not available to all in the United States in spite of the relationship of infant mortality and the quality of life for infants and children to adequate prenatal care.


Effect of substitution of starch for fiber and fat in isoenergetic diets on nutrient digestibility and reproductive performance of rabbits.
The optimal level of starch in diets for rabbit does was investigated. Five isoenergetic and isoproteic diets containing 26.6, 24.6, 19.0, 16.8, or 13.0% starch and 31.2, 33.4, 36.0, or 41.2% NDF, respectively (DM basis), were made by substitution of starch for NDF and fat. The effect of diet on nutrient digestibility was determined in fattening and nonlactating and lactating adult does using a total of 105 rabbits. Increasing dietary starch content linearly increased (P < .001) DM, GE, CP (P = .07), and starch digestibilities but decreased (P < .001) NDF digestibility. Nutrient digestibility was higher (P < .05), except for CP, in adult does than in fattening rabbits. Dry matter and GE digestibilities were higher (P = .08) for nonlactating than for lactating does. A lactation trial using 440 rabbit does was conducted over a 6-mo experimental period. Milk production and milk composition were measured in 70 lactations. A decrease in dietary starch content did not improve pup mortality before weaning but impaired (linear, P < .001) dry feed intake and pup growth from 21 d until weaning. Diet did not influence does' feed intake, milk DM, ether extract, and CP contents or prolificacy. However, diet had quadratic effects on milk production (P = .15), milk lactose content (P = .07), parturition interval (P = .02), and feed conversion efficiency (P = .02), expressed both per weight or number of pups weaned. Optimal values were reached for dietary starch and NDF contents at approximately 20 and 35.5% (DM basis), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


Occupational diseases in Italian national priority contaminated sites.
The aim of this study was to evaluate the occupational health risks in the Italian National Priority Contaminated Sites (NPCSs). Established cases of occupational diseases in 2010-2014 were extracted from the Italian National Institute for Insurance against Accidents at Work (INAIL) archives. Standardized incidence ratios with 95% confidence intervals were estimated by site and by disease group separately for genders. In the 44 NPCSs evaluated, 11 015 cases of occupational diseases (8877 in men and 2138 in women) were ascertained. Overall, an excess of occupational diseases with respect to expected cases of 24.2% was found in men residing in NPCSs. An increased occurrence was detected in 21 NPCSs for men and in eight for women. The findings suggest a role of occupational diseases in the health profile of NPCSs, reinforcing the need for a permanent surveillance system.


Real-time continuous image registration enabling ultraprecise 2-D motion tracking.
In this paper, we present a novel continuous image registration method (CIRM), which yields near-zero bias and has high computational efficiency. It can be realized for real-time position estimation to enable ultraprecise 2-D motion tracking and motion control over a large motion range. As the two variables of the method are continuous in spatial domain, pixel-level image registration is unnecessary, thus the CIRM can continuously track the moving target according to the incoming target image. When applied to a specific target object, measurement resolution of the method is predicted according to the reference image model of the object along with the variance of the camera's overall image noise. The maximum permissible target speed is proportional to the permissible frame rate, which is limited by the required computational time. The precision, measurement resolution, and computational efficiency of the method are verified through computer simulations and experiments. Specifically, the CIRM is implemented and integrated with a visual sensing system. Near-zero bias, measurement resolution of 0.1 nm (0.0008 pixels), and measurement of one nanometer stepping are demonstrated.


Intrasacral rod fixation for pediatric long spinal fusion: results of a prospective study with a minimum 5-year follow-up.
Lumbosacral fusion is often needed in cases of pediatric neuromuscular spinal deformities. Despite the numerous fixation techniques described, the procedure remains challenging. Jackson has described a method of intrasacral fixation providing immediate 3-dimensional stability and promising clinical results. The purpose of this study was to report our experience with long spinal fusion using Jackson intrasacral fixation in pediatric patients. All patients with at least 5 years of follow-up were reviewed. No brace was used postoperatively. Clinical data and radiographs were collected and analyzed preoperatively, postoperatively, and at latest follow-up. Intraoperative and postoperative complications were reported. Paired t test was used for statistical analysis. Fifty-six patients were included. The average age at surgery was 15.3 years. Mean follow-up period was 10.3 years and no patient was lost to follow-up. All radiographic parameters (frontal balance, frontal Cobb angle of the primary curve, iliolumbar angle, pelvic obliquity, sagittal balance, lumbosacral lordosis, and sacral slope) were significantly improved postoperatively (P<0.001), without significant loss of correction at latest follow-up. Four early infections, 1 pressure sore, and 4 cases of radicular pain, which resolved without intervention, were reported postoperatively. At latest follow-up, no patient complained of lumbar pain, and neither ambulatory status nor activity level ability worsened in any case. Sixteen of the 20 patients who needed a sitting orthosis preoperatively achieved a functional sitting posture without bracing. Jackson fixation is a safe and reliable technique providing immediate stability. In our series, no mechanical complication occurred and no loss of correction was observed, despite immediate unprotected mobilization. The method provides reliable good sacral fixation for pediatric neuromuscular spinal deformities, especially when the correction of severe pelvic obliquity is necessary. This consecutive series provides level IV evidence.


The degree of processing of foods which are most widely consumed by the French elderly population is associated with satiety and glycemic potentials and nutrient profiles.
Food processing impacts both food structure and nutritional density. The effect of food structure on satiety and glycemic potentials is well recognized. However, the association between processing, satiety and glycemic potentials and nutrient profiles has not been much studied, especially in the diets of the elderly. Therefore, this study aimed at exploring relations between the level of food processing, consumption and nutrient profiles and satiety and glycemic potentials among 6686 French elderly people (≥65 years). Dietary assessment was realized through a web-based 24 h dietary record tool. Among a total of 2688 foods, 280 generic foods were aggregated based on a consumption threshold of at least 5% by the population. The satiety potential was calculated using the Fullness Factor equation, and the glycemic potential using the glycemic index and the glucose glycemic equivalent. Foods and dishes were ranked according to an adapted international NOVA classification as raw/minimally-processed (G1), processed (G2) and ultra-processed (G3). ANOVA and correlation analyses showed that the more food is processed, the lower its satiety potential and nutrient density and the higher its glycemic impact, especially when comparing G1 and G3. Besides, the foods consumed in the greatest quantity daily tend to be the most satiating, and ultra-processed foods were among the less frequently consumed both in terms of percentage and daily quantity (around two-fold difference between minimally- and ultra-processed foods). In conclusion, because it is partly related to health food potential, the degree of processing, especially for ultra-processed products, should be taken into consideration more when evaluating consumption profiles of different populations.


Duodenal ulcer treated with Helicobacter pylori eradication: seven-year follow-up.
The long-term benefits of Helicobacter pylori-eradication treatment (HET) in H pylori-associated duodenal ulcer are unclear. We followed up patients with duodenal ulcers from a trial of H pylori eradication in 1985-86. 63 of 78 patients (81%) were reviewed clinically and had upper gastrointestinal endoscopy with gastric antral biopsy. Of 35 patients previously rendered H pylori negative, 32 (92%) remained H pylori negative after 7.1 years (mean). All patients initially H pylori positive remained infected, unless HET was given in the interim. Duodenal ulceration was found in 20% (5 out of 25) of patients remaining H pylori-positive, compared with 3% (1 of 38) of H pylori-negative patients (p < 0.05). The reduction of duodenal ulcer relapse obtained from H pylori eradication in H pylori-associated duodenal ulcer extends to at least 7 years after treatment, and is likely to be due to freedom from H pylori infection. However, duodenal ulcer may recur in patients rendered H pylori negative, due to factors other than reinfection with H pylori.


An early- and late-stage convolution model for disease natural history.
The standard convolution model of disease natural history posits an asymptomatic (preclinical) and a symptomatic (clinical) state. An augmented model includes, in both the preclinical and clinical states, an early and late stage of disease. In the case of cancer, the early stage would generally correspond to the organ-confined stages before there is evidence of cancer spread. We compute the number of screen-detected (preclinical) and clinical cases in the early and late stages expected under a given screening program and show how the model can be fit to data from a screening trial using maximum likelihood. We also develop expressions for sojourn time, lead time, and overdiagnosis in the context of the model, where each of the above concepts incorporates disease stage. As an example, we fit the model to data from the Mayo Lung Cancer Screening trial.


Factors affecting molecular weight conversion of renin.
Our recent findings on molecular weight conversion in the case of renin are summarized and reviewed herein. The molecular weight of renin extracted from isolated renin granules from dogs and rats is approximately 40,000. This renin reacts with a constituent of kidney extract to form a high molecular weight renin of approximately 60,000. This constituent was termed a renin binding substance. This substance is probably contained in the cytosol of kidney cortex, and its characteristics are (1) heat instability, (2) non-dialyzability, (3) loss of binding ability by acidification at pH 3.0 and (4) apparent molecular weight is over 47,000. The binding reaction is mediated in two different ways; thiol oxidation with sodium tetrathionate and exposure of the reaction mixture at 0 degrees C for several days without thiol oxidation.


Leading through meetings.
Whether formal or informal, meetings reflect relational opportunities that are critical to effective leadership. Professional development educators can influence the quality, cost, and impact of meetings by emphasizing their structure, conduct, and behavioral dynamics.


Reduced soluble transferrin receptor concentrations in acute malaria in Vanuatu.
Soluble transferrin receptor (sTfR) concentration is a sensitive index of iron deficiency when used in conjunction with ferritin measurements in adults. One advantage of this assay is that unlike ferritin it does not appear to be affected by a range of infectious and inflammatory conditions or by pregnancy, rendering it a promising adjunct to the diagnosis of iron deficiency in tropical populations. We have measured plasma sTfR concentrations in a group of malaria patients (n = 21) and asymptomatic (18) and aparasitemic (76) controls in Vanuatu. Plasma sTfR concentration was significantly reduced in individuals with acute malaria (P = 0.003). While this observation provides evidence that erythropoeitic suppression may be an important etiologic component in malarial anemia, it also suggests that malaria may be a confounding factor when interpreting sTfR concentrations in such populations. The role of sTfR in the diagnosis of iron deficiency in tropical populations remains to be established.


The fermionic hanbury brown and twiss experiment
A Hanbury Brown and Twiss experiment for a beam of electrons has been realized in a two-dimensional electron gas in the quantum Hall regime. A metallic split gate serves as a tunable beam splitter to partition the incident beam into transmitted and reflected partial beams. In the nonequilibrium case the fluctuations in the partial beams are shown to be fully anticorrelated, demonstrating that fermions exclude each other. In equilibrium, the cross-correlation of current fluctuations at two different contacts is also found to be negative and nonzero, provided that a direct transmission exists between the contacts.


[Delayed post-operative epileptic seizure after carotid endarterectomy: a case of cerebral hyperperfusion syndrome?].
The so-called cerebral hyperperfusion syndrome is basically due to a lack of cerebral autoregulation, inability to control the restoring of flow after revascularisation surgery. It present clinically as intense migraine, epileptic seizures, or neurological focality. It may even progress to an intracerebral haemorrhage. It usually appears a few days after surgery. We present the case of a patient subjected to a carotid endarterectomy, who had an epileptic episode in the late post-operative period. We attributed a cerebral hyperperfusion syndrome as the most likely cause. Knowledge of this syndrome may help to correctly orientate and treat the neurological complications that appear after this type of surgery.


Statistical, epidemiological, and risk-assessment approaches to evaluating safety of vaccines throughout the life cycle at the Food and Drug Administration.
The public health community faces increasing demands for improving vaccine safety while simultaneously increasing the number of vaccines available to prevent infectious diseases. The passage of the US Food and Drug Administration (FDA) Amendment Act of 2007 formalized the concept of life-cycle management of the risks and benefits of vaccines, from early clinical development through many years of use in large numbers of people. Harnessing scientific and technologic advances is necessary to improve vaccine-safety evaluation. The Office of Biostatistics and Epidemiology in the Center for Biologics Evaluation and Research is working to improve the FDA's ability to monitor vaccine safety by improving statistical, epidemiologic, and risk-assessment methods, gaining access to new sources of data, and exploring the use of genomics data. In this article we describe the current approaches, new resources, and future directions that the FDA is taking to improve the evaluation of vaccine safety.


Epitaxy of nanocrystalline silicon carbide on Si(111) at room temperature.
Silicon carbide (SiC) has unique chemical, physical, and mechanical properties. A factor strongly limiting SiC-based technologies is the high-temperature synthesis. In this work, we provide unprecedented experimental and theoretical evidence of 3C-SiC epitaxy on silicon at room temperature by using a buckminsterfullerene (C(60)) supersonic beam. Chemical processes, such as C(60) rupture, are activated at a precursor kinetic energy of 30-35 eV, far from thermodynamic equilibrium. This result paves the way for SiC synthesis on polymers or plastics that cannot withstand high temperatures.


Whey protein supplementation 2 hours after a lower protein breakfast restores plasma essential amino acid availability comparable to a higher protein breakfast in overweight adults.
Amino acids from meals peak in the plasma at ~180 minutes postprandial. Conversely, amino acids from rapidly digestible whey protein appear in the plasma within 15 minutes and peak at 60 minutes postprandial. Therefore, we hypothesized that consuming a 20-g whey protein snack 2 hours after a standard mixed-macronutrient, lower protein breakfast (10 g) would result in peak and composite postprandial plasma essential amino acid (EAA) responses that were not different from consuming a 30-g protein breakfast alone. Using a randomized, crossover design, 12 subjects (6 men, 6 women; age: 29 ± 1 y; BMI: 26.0 ± 1.0 kg/m2; mean ± SE) completed three 330-minute trials in which they consumed breakfasts containing (i) 10 g of protein (10-PRO, control), (ii) 30 g of protein (30-PRO), and (iii) 10 g of protein followed by 20 g of whey protein isolate 120 minutes later (10/20-PRO). For both 30-PRO and 10/20-PRO, EAA peaked 180 minutes after breakfast, with greater peak concentrations for 10/20-PRO than 30-PRO (Tukey adjusted, P < .0001). Essential amino acid positive incremental areas under the curve (iAUCpos) over 300 minutes were not different between 30-PRO and 10/20-PRO. Consuming a rapidly digested whey protein snack 2 hours after a slowly digested, lower protein breakfast resulted in a greater peak plasma EAA concentration but comparable plasma EAA availability than consuming a single higher protein breakfast.


Tetrahydroquinoline derivatives as CRTH2 antagonists.
A series of tetrahydroquinoline-derived inhibitors of the CRTH2 receptor was discovered by a high throughput screen. Optimization of these compounds for potency and pharmacokinetic properties led to the discovery of potent and orally bioavailable CRTH2 antagonists.


Polyphenolic Substance of Mytilus edulis: Novel Adhesive Containing L-Dopa and Hydroxyproline.
The fouling marine mussel Mytilus edulis attaches itself to various substrates by spinning byssal threads, the adhesive discs of which are rich in the amino acid 3,4-dihydroxyphenylalanine (dopa). An acid-soluble protein was extracted and purified from the phenol gland located in the byssus-secreting foot of the animal. This protein is highly basic and contains large amounts of lysine, dopa, and 3- and 4-hydroxyproline. The composition of this protein and its sticky tendencies in vitro strongly suggest that it contributes to byssal adhesion.


Doublecortin immunoreactivity in giant cells of tuberous sclerosis and focal cortical dysplasia.
Cerebral cortical lesions of tuberous sclerosis (TSC) and focal cortical dysplasia (FCD) show disturbances in laminar architecture and cellular differentiation. We immunohistochemically studied the expression of doublecortin, a fetal neuronal protein that regulates neuronal migration, in the surgical specimens of five TSC and eight FCD patients. In both TSC and FCD, bizarre giant cells showed a variable degree of doublecortin immunoreactivity. Both cytomegalic neurons and balloon cells were positive. The staining tended to be more intense in TSC than in FCD, although there were exceptional cases in both groups. Doublecortin immunoreactivity of normal-sized neural cells was restricted to a small number of astrocytes, and comparable to that in control patients. The persistent expression of doublecortin by giant cells in the postnatal cerebrum is additional evidence of abnormal differentiation, which may be relevant to the pathogenesis of cortical disarray in TSC and FCD.


Nepenthe-Like Indole Alkaloids with Antimicrobial Activity from Ervatamia chinensis.
Two monoterpenoid indole alkaloid erchinines A (1) and B (2), possessing unique 1,4-diazepine fused with oxazolidine architecture and three hemiaminals, were isolated from Ervatamia chinensis. Their structures were elucidated on the basis of intensive spectroscopic analysis, and a plausible biosynthetic pathway from ibogaine was proposed. Both compounds exhibited significant antimicrobial activity against Trichophyton rubrum and Bacillus subtilis, and their activities were comparable to the first line antifungal drug griseofulvin and antibiotic cefotaxime.


[Trend in the prevalence of mental disorders in population of big industrial center under conditions of social and economic changes].
The prevalence and incidence rates of mental disorders in outpatient contingent were analyzed during 1985-1995 years. Their dynamics was examined in terms of nosology, sex, age and social aspects. The dependence was observed between the prevalence and incidence rates and the conditions of financial support of psychiatric departments, social and economic situation in the country, pecullarities of organization and resources of psychiatric services.


Managing radiation risk in the evaluation of the pediatric trauma patient.
Pediatric trauma is usually a nonoperative experience for the pediatric general surgeon. The pediatric trauma surgeon resuscitates the child and then evaluates and triages the identified injuries. A common diagnostic tool is the computed tomography (CT) scan. Most children who require evaluation for significant trauma will get a CT scan, but there are no national guidelines directing the assessment. Injuries to the head, cervical spine, chest, and abdomen can all be imaged with a CT scan; the question is whether the liberal approach to imaging children is appropriate. Over the past decade, concern has arisen about the radiation dose delivered by CT. This concern has generated a national campaign to "image gently." This article reviews the data involving the risk of medical radiation exposure and discusses strategies for managing the risk.


Decreased contribution from afferent feedback to the soleus muscle during walking in patients with spastic stroke.
We investigated the contribution of afferent feedback to the soleus (SOL) muscle activity during the stance phase of walking in patients with spastic stroke. A total of 24 patients with hemiparetic spastic stroke and age-matched healthy volunteers participated in the study. A robotic actuator attached to the foot and leg was used to apply 3 types of ankle perturbations during treadmill walking. First, fast dorsiflexion perturbations were applied to elicit stretch reflexes in the SOL muscle. The SOL short-latency stretch reflex was facilitated in the patients (1.4 +/- 0.3) compared with the healthy volunteers (1.0 +/- 0.3, P = .05). Second, fast plantar flexion perturbations were applied during the stance phase to unload the plantar flexor muscles, thus, removing the afferent input from these muscles to the SOL motoneurons. These perturbations produced a distinct decrease in SOL activity that was significantly smaller in the patients (-30 +/- 3%) compared with the control subjects (-43 +/- 4%, P = .03). Third, slow-velocity, small-amplitude ankle trajectory modifications mimicking small deviations in the walking surface were applied to evaluate the afferent-mediated amplitude modulation of the locomotor SOL electromyogram (EMG). In the healthy volunteers these perturbations generated gradual increments and decrements on the SOL EMG; however, in the patients the SOL EMG modulation was significantly depressed (P = .04). Moreover, this depression was related to the spasticity level measured by the Ashworth score. These results indicate that although the stretch reflex response is facilitated during spastic gait, the contribution of afferent feedback to the ongoing locomotor SOL activity is depressed in patients with spastic stroke.


Exergames-based intervention for assisted living residents: a pilot study.
The physical and psychosocial benefits of exergames have been reported in various literature. A pre-posttest, single-group design was used to test the effects of an exergames-based intervention on cognition, depression, and health-related quality of life (QOL) in assisted living residents. Bandura's self-efficacy theory was applied. Seven residents (mean age = 86, SD = 5 years) participated in the program two times per week for 8 weeks. Outcome measures included cognition, depression, and health-related QOL. No statistically significant differences were found in any of the outcomes after the intervention. A tendency toward improved cognition occurred, but the outcomes of depression and health-related QOL did not follow a similar trend. However, improved socialization and motivation to exercise were reported. Continued research is needed to investigate the cognitive and psychosocial effects of exergames on this population. Nurses can collaborate with other health care professionals to engage residents in exercise and thus improve residents' QOL.


Use of Read-Across Tools.
Read-across has become popular since the introduction of regulations, such as the European REACH regulation. This chapter provides instructions on how to use ToxRead, new freely available software for read-across analysis, and on how to interpret its output predictions for mutagenicity assessments.This tool offers two seminal sources: a set of rules/structural alerts, which may explain the toxicity, and a similarity tool, associated with a large database of chemicals with their properties.


The role of D-amino acids in amyotrophic lateral sclerosis pathogenesis: a review.
A potential role for D-amino acids in motor neuron disease/amyotrophic lateral sclerosis (ALS) is emerging. D-Serine, which is an activator/co-agonist at the N-methyl-D-aspartate glutamate receptor subtype, is elevated both in spinal cord from sporadic cases of ALS and in an animal model of ALS. Furthermore, we have shown that a mutation in D-amino acid oxidase (DAO), an enzyme strongly localized to spinal cord motor neurons and brain stem motor nuclei, is associated with familial ALS. DAO plays an important role in regulating levels of D-serine, and its function is impaired by the presence of this mutation and this may contribute to the pathogenic process in ALS. In sporadic ALS cases, elevated D-serine may arise from induction of serine racemase, its synthetic enzyme, caused by cell stress and inflammatory processes thought to contribute to disease progression. Both these abnormalities in D-serine metabolism lead to an increase in synaptic D-serine which may contribute to disease pathogenesis.


Evolution of myocardial perfusion during primary angioplasty in spontaneously reperfused infarct-related artery: impact on long-term clinical outcomes and left ventricular function recovery.
TIMI myocardial perfusion grade (TMPG) reflects the integrity of microvasculature in ST-elevation myocardial infarction (STEMI). We sought to investigate whether TMPG evolution during primary angioplasty (pPCI) in spontaneously reperfused STEMI patients might predict long-term outcomes. 392 patients with TIMI-3 flow before pPCI were analyzed. According to pre- and post-pPCI TMPG four reperfusion patterns were created: A. TMPG deterioration from grade 2/3 to 0/1 after pPCI (n = 55, 14.0%), B. TMPG-0/1 before and after pPCI (n = 111, 28.3%), C. TMPG improvement from grade 0/1 to 2/3 (n = 52, 13.3%), D. TMPG-2/3 before and after pPCI (n = 174, 44.4%). 30-day and 1-year mortality and heart failure requiring hospitalization (HF-hosp) were recorded. Left ventricular ejection fraction (LVEF) was measured at first day (1D) and after 6 months (6M). 1D-LVEF was similar in A-D groups. After 6M, LVEF improved in pattern D (7.5 ± 5.4%, p<0.01) and C (3.7 ± 3.4%, p < 0.05), deteriorated in pattern A (5.2 ± 3.9%, p<0.01) and did not change in pattern B. 6M-LVEF increased (p < 0.001) and frequency of 1-year HF-hosp decreased (p < 0.001) in stepwise fashion among A-D patterns. A 30-day mortality rate for A-D patterns was 9.1%, 2.7%, 1.9% and 0%, respectively (p < 0.001). 1-year mortality was 16.3%, 7.2%, 5.8% and 0.6%, respectively (p < 0.001). By multivariate analysis (c-index = 0.79), TMPG evolution was independent predictor of 1-year mortality (HR = 2.5, 95%CI 1.3-4.0, p = 0.006). Maintaining TMPG-2/3 or improving TMPG-0/1 through pPCI in STEMI implies LV function recovery and good long-term survival. In contrast, substantial deterioration of TMPG is associated with lack of LV function recovery, and the highest mortality rate.


Kinetics for ammonium ion removal using a three-dimensional electrode system.
Electrochemical oxidation of ammonium ions (NH(4)(+)) by using a three-dimensional electrode (TDE) composed of IrO(2)-Ta(2)O(5)/Ti anode and bamboo carbon was carried out in this paper. Experimental results reveal that the NH(4)(+) oxidation follows first-order kinetics at lower NH(4)(+) concentration and the rate constant is highly dependent on the applied current density, dosage of chlorine ions and initial NH(4)(+) concentration. In addition, increasing current density, more Cl(-) dosage and higher initial NH(4)(+) concentration are beneficial for NH(4)(+) removal. By inspecting the relation between rate constant and those operating factors, an overall empirical equation for estimation of the rate constant of NH(4)(+) oxidation is presented. The estimated model is in good agreement with the experimental results and it could also be used for accurate design of the TDE system.


Ethanol inhibits voltage-gated sodium channels in cultured superior cervical ganglion neurons.
To determine whether actions on sodium channels contribute to ethanol's depressant effects on the autonomic nervous system, the acute effects of ethanol on Na+ currents in primary cultured superior cervical ganglion were examined by whole-cell patch clamp recordings. Ethanol inhibited Na+ currents concentration dependently, and decreased action potential firing. Ethanol (100 mM) did not affect activation curve, but resulted in a left shift of the inactivation curve and prolonged the recovery from inactivation. This finding indicates that the channels in the inactivated state are more susceptible to ethanol than those in the resting state. For the first time, this study demonstrates acute inhibitory effects of ethanol on sodium channel gating in sympathetic neurons.


Synergistic action of resveratrol, an ingredient of wine, with Ara-C and tiazofurin in HL-60 human promyelocytic leukemia cells.
Resveratrol, a naturally occurring stilbene derivative, is a potent free-radical scavenger causing a number of biochemical and antineoplastic effects. It was shown to induce differentiation and apoptosis in leukemia cells. Resveratrol was also identified as an inhibitor of ribonucleotide reductase (RR), a key enzyme of DNA synthesis. We report about the biochemical effects of resveratrol on the concentration of deoxyribonucleoside triphosphates (dNTPs), the products of RR, and on the incorporation of 14C-labeled cytidine into the DNA of HL-60 human promyelocytic leukemia cells. Incorporation of 14C-labeled cytidine into the DNA of resveratrol-treated HL-60 cells was measured. Concentration of dNTPs was determined by a HPLC method. Cytotoxic effects of resveratrol, Ara-C, and tiazofurin were analyzed using growth inhibition and clonogenic assays. Induction of apoptosis was studied using a Hoechst/propidium iodide staining method. We found that resveratrol effectively inhibited incorporation of 14C-labeled cytidine into DNA. Furthermore, incubation of HL-60 cells with resveratrol significantly decreased intracellular dCTP, dTTP, dATP, and dGTP concentrations. Based on these results, we investigated the combination effects of resveratrol with Ara-C or tiazofurin, both antimetabolites, which are known to exhibit synergistic effects in combination with other inhibitors of RR. In growth inhibition, apoptosis, and clonogenic assays, resveratrol acted synergistically with both Ara-C and tiazofurin in HL-60 cells. We conclude that resveratrol could become a viable candidate as one compound in the combination chemotherapy of leukemia and therefore deserves further testing.


Peripheral embolization complicating bilateral renal infarction with gelfoam.
Selective arterial embolization is a technique with wide therapeutic applicability. However, regardless of the nature of the embolic particles, reflux into the aorta with peripheral embolization is a serious potential complication. A case is described in which this complication occurred. We recommend that all such embolizations be performed with a balloon catheter occluding the target artery.


Brainstem tegmental necrosis and olivary hypoplasia: raising awareness of a rare neuropathologic correlate of congenital apnea.
This case study describes an instance of death in an early term female newborn with congenital apnea in the clinical setting of multiple congenital anomalies (retrognathia, posteriorly rotated ears, camptodactyly, and arthrogryposis) and prenatal history of polyhydramnios. Postmortem neuropathologic findings were significant for tegmental necrosis in the caudal pons and medulla characterized by a coalescence of microcalcifications accompanied by neuronal loss, axonal spheroids, gliosis, and a concomitant hypoplasia of the inferior olives. This report raises awareness of the rare lethal entity of brainstem tegmental necrosis and olivary hypoplasia and its nosological relationship to the Möbius syndrome in the context of differential diagnosis of congenital apnea owing to central respiratory dysfunction.


Does patient satisfaction with foot surgery change over time?
The national podiatric surgery audit tool PASCOM has a key role in determining patient satisfaction with service received and outcomes. The study aim was to examine the effects of time after surgery on satisfaction scores, by undertaking a retrospective longitudinal study utilising the patient satisfaction questionnaire known as the PSQ-10. A secondary objective was to examine test-retest reliability, since this has not been previously reported. NHS and private patients having undergone forefoot surgery were sent a further PSQ-10 satisfaction questionnaire after the standard 6-month PSQ-10 had been completed. The main outcome measure reflected a change in the score between the original and repeat PSQ-10 response. Internal consistency was measured by correlation between baseline questions for a subset of patients who were sent the second questionnaire within 6 months of the first. Of a total cohort of 204 patients, no significant differences were seen in overall scores. 46% showed increased satisfaction at the stage of the repeat questionnaire, with 41% a decline in score and 13% no change. Neurectomy patients improved the most with time and digital surgery was associated with the greatest decline in score. Significant correlations were demonstrated between all baseline questions for the test-retest cohort (13 patients). Time does not significantly influence patient satisfaction after discharge. There was satisfactory consistency between PSQ-10 responses. Further investigation into digital procedure outcomes is required.


Ethnic differences in trichotillomania: phenomenology, interference, impairment, and treatment efficacy.
In this Internet study, we explore differences among minority and Caucasian participants in the phenomenology of, interference and impairment related to, and perceived efficacy of treatments for trichotillomania (TTM) symptoms. A demographic difference was found for number of children only. Results indicate that the minority sample was less likely to report pulling from their eyebrows and eyelashes than the Caucasian sample. Minorities were less likely to report increased tension before a pulling episode. Minorities reported high levels of TTM interference with home management but Caucasians reported higher TTM interference with their academic life. Caucasians with TTM reported higher daily stress than their minority counterparts. Although minorities were less likely to utilize treatment, no significant differences were found for treatment improvement. This Internet study sheds important light on differences in TTM symptoms among minorities and Caucasians. The lack of economic and education differences between groups is a strength of this research.


Altered expression of the early mitotic checkpoint protein, CHFR, in breast cancers: implications for tumor suppression.
Checkpoint with FHA and Ring Finger (CHFR) is hypothesized to mediate a delay in cell cycle progression early in mitosis in response to microtubule stress, independent of the spindle assembly checkpoint. As a potential regulator of cell cycle progression, CHFR naturally becomes an interesting target for understanding cancer cells. In recent years, there has been increasing evidence supporting the role of CHFR as a tumor suppressor, most of which report loss of expression, occasionally due to promoter hypermethylation, in cancers compared with patient-matched normal tissues. We studied both a panel of breast cancer cell lines as well as primary tissue samples from breast cancer patients to investigate CHFR as a relevant tumor suppressor in breast cancer and to determine whether CHFR expression was associated with clinical and pathologic variables. We report that 41% of cell lines and 36% of patient samples showed low or negative CHFR protein expression or staining. In addition, lack of CHFR detection was associated with increased tumor size and weakly correlated with estrogen receptor-negative tumors from patients. To study the effects of low CHFR expression in vitro, we stably expressed a short hairpin RNA construct targeting CHFR in two lines of immortalized human mammary epithelial cells. Notably, decreased CHFR expression resulted in the acquisition of many phenotypes associated with malignant progression, including accelerated growth rates, higher mitotic index, enhanced invasiveness, increased motility, greater aneuploidy, and amplified colony formation in soft agar, further supporting the role of CHFR as a tumor suppressor in breast cancer.


Metastasis of hepatocellular carcinoma into the mandible with radiographic findings mimicking a radicular cyst: a case report.
Hepatocellular carcinoma (HCC) is a common neoplasm worldwide, with more than half of the tumors associated with regional metastasis. Extrahepatic metastasis is also common, and the most frequently affected sites are the lungs, abdominal lymph nodes, diaphragm, and bone. However, HCC metastasis to the mandible is rare, with approximately 50 cases reported in the literature. In this report, we describe a case of HCC metastasis to the mandible at the apex of #18 root in a 62-year-old man. This patient had already been diagnosed with metastasis to pancreatic caput lymph node. The radiographic features of the mandible resembled radicular cyst and did not show typical findings of malignancy. Under the first diagnosis of radicular cyst, root canal treatment was initially performed, and then surgical treatment of the removal of the cystic lesion and #18 extraction were performed. Finally, the lesion was diagnosed as HCC metastasis from pathological examination. Consequently, he received constitutional chemotherapy in the hepatitis unit and is now in remission. This case shows the importance of considering the differential diagnosis of malignancy.


Glucocorticoid receptor immunoreactivity in neurons and pituitary cells implicated in reproductive functions in rainbow trout: a double immunohistochemical study.
In order to identify the nature of the glucocorticoid receptor (GR)-expressing neurons and pituitary cells that potentially mediate the negative effects of stress on reproductive performance, double immunohistochemical stainings were performed in the brain and pituitary of the rainbow trout (Oncorhynchus mykiss). To avoid possible cross-reactions during the double staining studies, combinations of primary antibodies raised in different species were used, and we report here the generation of an antibody raised in guinea pig against the rainbow trout glucocorticoid receptor (rtGR). The results obtained in vitellogenic females showed that GnRH-positive neurons in the caudal telencephalon/anterior preoptic region consistently exhibited rtGR immunoreactivity. Similarly, in the anterior ventral preoptic region, a group of tyrosine hydroxylase-positive neurons, known for inhibiting gonadotropin (GTH)-2 secretion during vitellogenesis, was consistently shown to strongly express GR. Finally, we show that a large majority of the GTH-1 (FSH-like) and GTH-2 (LH-like) cells of the pituitary exhibit rtGR immunoreactivity. These results indicate that cortisol may affect the neuroendocrine control of the reproductive process of the rainbow trout at multiple sites.


[Reduction of the prereplicative period of the mitotic cycle in hepatocytes on repeated stimulation of divisions].
Repeated stimulation of division soon after the primary one (2--3 days later) induces a shorteining of the prereplicative phase of the mitotic cylce of hepatocytes to 9--10 hours in the regenerating rat liver. The cells dividing repeatedly after one stimulation were found to pass through the G1-phase of the second mitotic cycle during the same period. It may be suggested that the cells with the minimal duration of the prereplicative phase failed to pass through the transformation period. With increase of the time interval between the successive stimulation of divisions (to 4--5 days) increases the resting time state for most hepatocytes, and they lose the capacity to pass through the reduced prereplicative phases.


The direct transport of oxygen in insects by large tracheae.
Vast numbers of large and small tracheae in the abdomen of adult Calliphora are so modified that they can transfer oxygen directly by diffusion to the developing ovaries. Tracheoles are scarce but. instead, a system of distended tubules, evaginated into the cytoplasmic surface of the trachea, cover the entire tracheal surface with permeable tubes diffusing oxygen to the developing tissues. A similar development occurs also in the male fly.


Pharmacists' perceptions of a set of pharmaceutical care practice standards.
This study assessed pharmacists' perceptions of the feasibility and relevance of a set of community-based pharmaceutical care practice standards. Practice standards generated in a Delphi study were rated for feasibility of implementation and relevance to improving therapeutic outcomes by a randomized sample of 315 pharmacists on two 7-point Likert-type scales. These ratings were compared with assessments by Delphi panel experts. Pharmacists judged many of the standards favorably; however, Kruskal-Wallis ANOVA revealed that they were less confident in the standards' feasibility of implementation and relevance to improving patient outcomes than were the Delphi panel experts. Pharmacists appear ready to accept a majority of the practice standards used in this study. The lower ratings by respondent pharmacists may be indicative of apprehension about embracing a new practice paradigm and a belief that the provision of pharmaceutical care services has a limited impact on therapeutic outcomes.


[Determination of costs of examinations and paraclinical health service procedures and public health on the basis of their work intensity].
Methodological approaches to the estimation of cost (prices, tariffs) of investigations and procedures of auxiliary curative and diagnostic service according to their technological and complex labour-consuming nature are provided. Using the unified norms of time and production for estimations would help define unified prices for medical services of analogical type and provide performance-related incentives for health workers.


Chromosome analyses in cell cultures of the Chinese hamster after application of cadmiumsulphate.
Cell cultures of a Chinese hamster cell line were treated with CdSO4 in concentrations of between 10(-4) and 10(-8) mol/l for different time periods. After a treatment of 16 h the mitotic index was reduced. Strong stickiness and pycnosis of chromosomes occurred at the highest concentrations. A treatment period of 3 h with concentrations of 10(-5) and 10(-4) mol/l without additional application of Colcemid and hypotonic solution yielded a stathmokinetic effect. The mitotic index increased, mitoses were blocked in metaphase stage and "initial C-mitoses'' and "C-mitoses'' were present. Structural chromosome aberrations were present in the recovery period of more than 12 h following a treatment of 1 h with 10(-4) mol/l CdSO4. The observed aberrations were mainly of the chromatid type.


Gianotti-Crosti syndrome following childhood vaccinations.
A 19-month-old boy was evaluated for a skin eruption after recent vaccinations. Clinical and histopathologic findings supported a diagnosis of Gianotti-Crosti syndrome (GCS). This case report examines the link between GCS and vaccinations, particularly the diphtheria, tetanus, and pertussis vaccine and the varicella virus live vaccine.


S-100 protein plasma levels after aneurysmal subarachnoid haemorrhage.
We investigated the level of S-100 protein in blood as an indicator of brain damage in 71 patients suffering from subarachnoid haemorrhage (SAH) due to ruptured aneurysms. Concentrations of S-100 protein were determined by micro-titre based immunofluorometic assay detecting predominantly S-100b on blood samples obtained 24 hours, 3 days and 7 days after onset of symptoms in patients with SAH and from 120 healthy control subjects. Neurological status was assessed using the Hunt and Hess (HH) scale on admission and by the Glasgow Outcome Scale (GOS) 6 months later. Mean concentrations of S-100 protein in blood were significantly (p < 0.0001) higher in patients 24 hours (0.263 +/- 0.387 microgram/l), 3 days (0.192 +/- 0.288 microgram/l) and 7 days (0.256 +/- 0.442 microgram/l) after onset of SAH symptoms compared to controls (0.050 +/- 0.081 microgram/l). More severe neurological symptoms (higher HH scale scores) on admission correlated with higher S-100 levels on admission (R = 0.70) and Day 3 (R = 0.66) (p < 0.0001). Worse outcome (lower GOS score) 6 months after SAH was also associated with higher plasma concentration of S-100 in the first week after SAH. In summary, this study showed that in patients with SAH due to ruptured aneurysm, S-100 protein levels correlate with early neurological deficit and are as sensitive as HH scores in predicting neurological outcome (GOS scores). Measurement of S-100 protein in blood is a reliable non-invasive method and may be clinically useful to screen for and monitor progression of central nervous system diseases of various origins.


Detection of exercise-induced silent ischemia and the sequence of ischemic events in coronary artery disease by radionuclide ambulatory ventricular function monitoring.
Twenty-seven patients with stable coronary artery disease were continuously monitored with an ambulatory radionuclide ventricular function monitor (VEST) during exercise to determine the prevalence of silent ischemia and the temporal sequence of events during ischemic episodes. Exercise-induced ejection fraction abnormality was considered a < 6% increase in the control value lasting for more than 60 sec. Patients performed exercise for 424 +/- 111 sec during VEST recording. Seventeen exercise-induced ejection fraction abnormalities were observed in 17 patients, of which eight (47%) were silent electrocardiographically and 12 (71%) were silent symptomatically. In all of the patients, exercise-induced ischemia occurred in a temporal sequence of ejection fraction abnormalities, ST depressions and then symptoms. In nine patients with ejection fraction and ST abnormalities, ejection fraction abnormalities occurred earlier (199 +/- 87 sec) than ST depressions (321 +/- 117 sec; p < 0.01). In five patients with symptoms (399 +/- 151 sec), the sequence was ejection fraction abnormalities (205 +/- 64 sec; P < 0.05) followed by ST depressions (266 +/- 101 sec; P < 0.05) and symptoms (399 +/- 151 sec; P < 0.01). After termination of exercise, ejection fraction (49 +/- 12 sec) recovered sooner than symptoms (102 +/- 27 sec; p < 0.01) or ST abnormalities (191 +/- 96 sec; p < 0.01). Thus, hemodynamic monitoring by VEST may be helpful in detecting ischemic episodes in coronary artery disease which remain electrocardiographically or symptomatically silent. Furthermore, exercise-stress induces a cascade of temporal changes in ischemic events which may be helpful in understanding the pathophysiology of ischemia.


Urinary arsenic, heavy metals, phthalates, pesticides, polyaromatic hydrocarbons but not parabens, polyfluorinated compounds are associated with self-rated health: USA NHANES, 2011-2012.
Links between environmental chemicals and human health have emerged, but the effects on self-rated health were less studied. Therefore, it was aimed to study the relationships of different sets of urinary environmental chemicals and the self-rated health in a national and population-based study in recent years. Data was retrieved from the US National Health and Nutrition Examination Surveys, 2011-2012, including demographics, serum measurements, lifestyle factors, self-rated health (with two grouping approaches) and urinary environmental chemical concentrations. T test and survey-weighted logistic regression modeling were performed. Among American adults aged 12-80 (n = 6833), 5892 people had reported their general health condition. Two thousand three hundred sixty-nine (40.2 %) people reported their general health condition as excellent or very good while 3523 (59.8 %) reported good, fair, or poor. People who reported their general health condition as good, fair, or poor had higher levels of urinary arsenic, heavy metals (including cadmium, cobalt, manganese, molybdenum, lead, antimony, strontium, tungsten and uranium), phthalates, pesticides and polyaromatic hydrocarbons but lower levels of benzophenone-3 and triclosan. There were no associations with urinary parabens, perchlorate, nitrate, thiocyanate or polyfluorinated compounds. However, only urinary cadmium, benzophenone-3, triclosan, and 2-hydroxynaphthalene remained significant when comparing between "good to excellent" and "poor to fair." This is the first time observing risk associations of urinary arsenic, heavy metal, phthalate, pesticide, and hydrocarbon concentrations and self-rated health in people aged 12-80, although the causality cannot be established. Further elimination of these environmental chemicals in humans might need to be considered in health and environmental policies.


[Effects of norepinephrine on the proliferation and activation of rat hepatic stellate cells].
To elucidate the relationship between rat hepatic stellate cells (HSC) and sympathetic neurotransmitter norepinephrine (NE) during liver fibrosis. Using immunofluorescence and RT-PCR, the expressions of a1 and b2-adrenoceptors in activated HSC were detected. Methyl thiazolyl tetrazolium (MTT) was adopted to investigate the effect of NE on the proliferation of HSC. Meanwhile, the expressions of collagen-1, transforming growth factor beta (TGFb) and smooth muscle a-actin (a-SMA) in NE-stimulated HSC were detected by RT-PCR. The contents of NE in HSC were determined by high performance liquid chromatography-electrochemical detector (HPLC-ECD). The a1 and b2-adrenoceptors were expressed in HSC. NE markedly stimulated the proliferation of HSC in a concentration-dependent manner (F = 140.464, P less than 0.05). NE induced the mRNA expressions of collagen-1, TGFb and a-SMA in HSC (t= -4.160; t= -8.763; t= -17.651, P less than 0.05). HSC were synthesizing and releasing NE, especially when stimulated with platelet-derived growth factor (PDGF) (10 ng/ml) (t= -32.907, P less than 0.05). Our findings show that HSC are direct targets of NE and HSC are hepatic neuroglial cells that produce and respond to sympathetic neurotransmitter norepinephrine, suggesting that interrupting sympathetic nervous system signaling may be useful in the treatment of liver fibrosis.


The recognition of dementia in "non-EMI" nursing home residents in South East England.
To estimate the agreement between nursing staff's recognition of dementia and results of MMSE assessment in a probability sample of non-specialist nursing home residents in South East England, and to identify correlates of disagreement. Prospective survey. The most senior nurse on duty was interviewed about each resident sampled, and optionally about their own training and experience. Residents were interviewed using the MMSE, and assessed using the Cornell Scale for Depression in Dementia, the Barthel ADL index, and the Behave-AD scale for behavioural problems. 135 nurses were interviewed about 445 residents-116 reported on of the 291 residents scoring 23 or less on the MMSE-34% of these were acknowledged to have dementia. 46.4% of those with MMSE scores of 15 or less were acknowledged to have dementia. "Missed dementia" was associated with higher MMSE and lower Behave-AD scores, and inversely associated with RMN training and private home ownership for profit. It was not associated with training or duration of staff employment. Most cognitive impairment in non-specialist nursing homes appeared to be unrecognised. This has implications for the prospects of good dementia care in these homes.


Isolation of cDNA clones corresponding to the Mr = 150,000 subunit of chick type VI collagen.
Type VI collagen is a disulfide-bonded protein with an unusual structure in that the molecule contains three short triple-helical domains and very extended non-collagenous regions. The molecule is a heterotrimer composed in the chick of two polypeptides of similar apparent size in SDS-PAGE (Mr = 140- and 150,000) but different structure, and a third component that is much larger (Mr = 260,000) than the other two chains. We report here on the isolation of several overlapping cDNA clones from a chicken aorta mRNA expression library in the plasmid vector pEX1. Antibodies affinity purified onto the fusion proteins recognized the chick type VI collagen Mr = 150,000 subunit. Northern blots using the cDNA inserts from the above clones revealed a single RNA species of about 4,600 nucleotides sufficient to code for a protein with the size of the Mr = 150,000 subunit.


[Differentiated thyroid carcinoma in childhood].
We report the cases of 6 patients, all younger than 14 years of age, with differentiated thyroid carcinoma. None of the patients had a previous history of radiation exposure. All patients presented with an enlarged thyroid gland as a solitary nodule, with or without cervical nodes. The fine-needle aspiration cytological examination was found to be the most sensitive and specific, evidencing 5 pure papillary adenocarcinoma and 1 follicular. Our standard preoperative evaluation included thyroid scintiscan and ultrasound examination, laboratory studies of thyroid function and serum calcitonin, chest x-ray, fine needle aspiration and vocal cord examination. The treatment was total thyroidectomy and bilateral modified neck dissection. A whole body scan (WBS) with 131I was performed 6 weeks after surgery, followed by radioiodine therapy for ablation of thyroid remnants and treatment of metastases when present. Patients then began thyroid replacement treatment. The follow-up of the patients consisted of thyroglobulin and WBS. The microscopic carcinoma was found in the contralateral lobe in 100%. Lung metastases were detected in 2 patients. All of the patients have survived during a follow-up period ranging from 6 to 108 months.


Oral carcinoma associated with betel nut chewing in the Pacific: an impending crisis?
In Western populations, tobacco and alcohol use are the major etiologic factors associated with oral cavity cancers. In developing countries of Asia and the South Pacific, however, oral cancer is increasingly associated with the chewing of betel nut. As the population of Asia and the South Pacific immigrates, Head and Neck surgeons in North America are likely to see more patients with oral carcinoma induced by betel nut chewing. Tumor Registry records from 1977-2003 from a tertiary care, referral medical center were reviewed. All patient charts (27) demonstrating betel quid use of greater than 20 years and carcinoma of the upper aerodigestive tract were entered into the study. Five-year disease-free rates by stage were as follows: Stage 1: 100% (2/2); Stage 11: 50% (2/4); Stage III: 36% (4/9): Stage IV: 25% (3/12). Despite the prevalent misperception in the Pacific region that betel nut chewing is a harmless habit, betel nut-induced oral carcinomas are aggressive malignancies requiring aggressive treatment and long-term follow-up.


Influence of anti-inflammatory flavonoids on degranulation and arachidonic acid release in rat neutrophils.
We assessed the effects of 24 flavonoid derivatives, reported as anti-inflammatory, on lysosomal enzyme secretion and arachidonic acid release in rat neutrophils. Amentoflavone, quercetagetin-7-O-glucoside, apigenin, fisetin, kaempferol, luteolin and quercetin were the most potent inhibitors of beta-glucuronidase and lysozyme release. The first compound was also able to inhibit basal release. These flavonoids besides chrysin and to a reduced extent, naringenin, significantly inhibited arachidonic acid release from membranes. A correlation between degranulation and arachidonic acid release was found for this series of compounds. Structure-activity relationships and implications for the anti-inflammatory effects of these flavonoids were discussed.


Hemoglobin (Hb) Val de Marne (Hb Footscray) in Brazil: the first case report.
Hemoglobin (Hb) variants involving alpha-chains are less common in the global population than Hb variants resulting from beta-chain alterations. Generally, alpha-chain Hb variants are caused by point mutations affecting alpha-1 and/or alpha-2 genes of the alpha-globin cluster (HBA1 and HBA2). In Brazil, the most prevalent alpha-chain Hb variant is Hb Hasharon. In this study, we present the first case of an Hb Val de Marne variant in the Americas, specifically in Brazil.


Review of methods of identification of high caries risk groups and individuals. Fédération Dentaire Internationale Technical Report No. 31.
The search for methods of predicting dental caries activity began during the last century. The purpose of this review was to update the report on methods of caries prediction which resulted from the 1977 workshop, sponsored by the National Institutes of Health, Washington, DC, and also to identify the methods most likely to provide effective prediction of caries risk which should be given high priority in future research. The factors that need to be considered in assessing the value of a method of predicting caries risk are the correlation coefficient between the predictions and the final caries scores and in particular an assessment of the ability of the method to recognize subjects who will develop caries (sensitivity) and to exclude those who will not (specificity). The predictive power of the method should also be known. There is, however, the risk that when predictive tests are applied to a population with decreasing caries prevalence the number classified as false positive could be increased. This may limit the cost-effectiveness of preventive technique. The requirements of a good method of predicting dental caries are that the method should be simple, inexpensive and rapid and should identify subjects who will become diseased and exclude subjects who will remain healthy. To date, a wide variety of factors have been considered in the search for an effective method of predicting caries risk, but only a few have had some success. Certain epidemiological methods have shown reasonable sensitivity but less specificity. Measures in this category include specific indicator surfaces and DMFT increment in the previous year. Among the more useful specific tests have been mutans streptococci and lactobacillus counts and measurement of saliva buffering capacity. Other methods that show some promise include the physical measurement of incipient carious lesions of enamel. The measurement of possible determinants of a multifactorial disease is extremely difficult and regardless of which single method has been tried the authors have usually concluded that it is difficult to develop a reliable method of identifying caries susceptible individuals from the method. To a lesser extent the same conclusions have been applied to methods for identifying risk groups. There does, however, appear to have been little research in which a combination of tests or methods have been used, particularly combinations of tests that involve different scientific disciplines.(ABSTRACT TRUNCATED AT 400 WORDS)


Spherical carbon capsules with hollow macroporous core and mesoporous shell structures as a highly efficient catalyst support in the direct methanol fuel cell.
Carbon capsules with hollow core and mesoporous shell (HCMS) structures were used as a support material for Pt(50)-Ru(50) catalyst, and the catalytic performance of the HCMS supported catalyst in the direct methanol fuel cell was described; the HCMS carbon supported catalysts exhibited much higher specific activity for methanol oxidation than the commonly used E-TEK catalyst by about 80%, proving that the HCMS carbon capsules are an excellent support for electrode catalysts in DMFC.


[Sequence difference of ribosomal DNA second internal transcribed spacer in Anopheles minimus in different localities].
To compare the sequence difference of the ribosomal DNA second internal transcribed spacer (ITS2) in Anopheles minimus from Yunnan, Hainan, Guangxi of China and from Thailand. Single mosquito's legs were digested to extract DNA; the rDNA-ITS2 region was amplified by specific primers and the PCR products were purified, sequenced and analysed. Two different kinds of ITS2 sequences, temporarily named as An. minimus A and An. minimus C, were found in this study. The length and GC contents of ITS2 region in species A and species C are 481 bp, 54.04% and 483 bp, 54.23%, respectively. Two species differed by 5.8% in the ITS2 sequences owing to 22 fixed nucleotide substitutions and indels. Two cryptic species, An. minimus A and An. minimus C, were found in the research localities.


Structure and function of the estrogen receptor.
The hormone binding domain of the estrogen receptor is required not only for binding estradiol but also to form stable homodimers of the protein and mediate transcriptional activation by the receptor. Residues that are essential for estrogen binding are also involved in dimerization, suggesting that the hormone-binding pocket is at or near the dimer interface. Distinct hydrophobic and charged residues are essential for hormone-dependent transcriptional activation, and these appear to be conserved by other members of the nuclear receptor family. We have found that the pure antiestrogens ICI 164384 and ICI 182780 increase the turnover of the receptor compared with that in the presence of estradiol. Because it is likely that the pure antiestrogens bind to a similar region of the receptor as that of estradiol, we propose that they inhibit receptor dimerization by means of their 7 alpha alkyl-amide extension. It appears that as a consequence nuclear uptake is inhibited and the receptor more rapidly degraded in the cytoplasm.


Probing chiral amino acids at sub-picomolar level based on bovine serum albumin enantioselective films coupled with silver-enhanced gold nanoparticles.
A novel electrochemical sensor with capability of probing chiral amino acids with gold nanoparticle (n-Au) labels using bovine serum albumin (BSA) as a chiral selector and subsequent signal amplification step by silver enhancement is introduced. The assay relies on the stereoselectivity of BSA embedded in ultrathin gamma-alumina sol-gel film coated on the surface of the glassy carbon electrode (GCE). The recognition to the n-Au-labeled L- or D-amino acids for BSA-GCE could be monitored by the differential pulse voltammetry (DPV), while the DPV signal was greatly amplified by the anchored silver atoms on the n-Au, leading to a new way of quantitatively analysis of chiral amino acids electrochemically at sub-picomolar level. With L-tryptophan as the probe solute, the linear concentration range was from 1.33 x 10(-12) to 1 x 10(-9)mol L(-1) and detection limit was 5 x 10(-13)mol L(-1). For tryptophan enantiomers, the enantioselectivity coefficient 2.3 was obtained.


Legislating Weight Loss: Are Antiobesity Public Health Policies Making an Impact?
Obesity affects America's children both in childhood and into their adult years. Unfortunately, a long history of public policy has done little to effectively reduce obesity among children. Federal programs including the National School Lunch Program, School Breakfast Program, and the School Meals Initiative for Healthy Children have proven to be less than effective in reducing obesity rates among school-aged children. Studies find that children participating in these programs are more likely to be overweight than their brown-bag peers while nutritional targets are missed. Various iterations of school-based nutrition programs have proven to be ineffective and wasteful, yet policy leaders continue to consume tax dollars with their implementation. Although strict guidelines for evaluating scientific evidence were historically used to ensure rigorous reviews were conducted, recent relaxation of those guidelines jeopardizes the integrity of the scientific platform. Consequently, recommendations that were once rooted in science may be less reliable due to a compromise of the scientific literature review process, and the conclusions drawn by the Dietary Guidelines Advisory Committee may be somewhat questionable. Public policy must be augmented by scientific evidence and any further obesity reduction initiatives must be well-grounded in research that has been rigorously reviewed and evaluated.


Vignette of medical history: Lazaretto Point.
During the Black Death's reign in the fifteenth century, a number of installations providing care for lepers were converted into quarantine stations. Known as lazarettos or pesthouses, they served as disinfection way stations for travelers and, later, as hospitals for those diagnosed with pestilential diseases (e.g., smallpox, typhus, cholera). Beginning in the late 1700s, quarantine stations and pesthouses were established in the Baltimore area, including Hawkins Point, Lazaretto Point, Fairfield, and Leading Point.


Comparison of the costs of active surveillance and immediate surgery in the management of low-risk papillary microcarcinoma of the thyroid.
The incidence of thyroid cancer is increasing rapidly in many countries, resulting in rising societal costs of the care of thyroid cancer. We reported that the active surveillance of low-risk papillary microcarcinoma had less unfavorable events than immediate surgery, while the oncological outcomes of these managements were similarly excellent. Here we calculated the medical costs of these two managements. We created a model of the flow of these managements, based on our previous study. The flow and costs include the step of diagnosis, surgery, prescription of medicine, recurrence, salvage surgery for recurrence, and care for 10 years after the diagnosis. The costs were calculated according to the typical clinical practices at Kuma Hospital performed under the Japanese Health Care Insurance System. If conversion surgeries were not considered, the 'simple cost' of active surveillance for 10 years was 167,780 yen/patient. If there were no recurrences, the 'simple cost' of immediate surgery was calculated as 794,770 yen/patient to 1,086,070 yen/patient, depending on the type of surgery and postoperative medication. The 'simple cost' of surgery was 4.7 to 6.5 times the 'simple cost' of surveillance. When conversion surgeries and recurrence were considered, the 'total cost' of active surveillance for 10 years became 225,695 yen/patient. When recurrence were considered, the 'total cost' of immediate surgery was 928,094 yen/patient, which was 4.1 times the 'total cost' of the active surveillance. At Kuma Hospital in Japan, the 10-year total cost of immediate surgery was 4.1 times expensive than active surveillance.


CD-30 positive peripheral T-cell lymphoma of the Waldeyer's ring.
We describe a patient with peripheral T cell lymphoma of the Waldeyer's ring that ran a highly aggressive course. This is followed by a discussion on the differential diagnoses of nasal T/NK cell lymphoma and Ki-1 ALCL, based on clinical and pathological features.


The President Kennedy assassination and the male to female birth ratio.
Male live births occur slightly in excess of female. This ratio is expressed as M/F. Terrorist attacks induce stress which transiently lowers M/F three to five months later due to increased male foetal losses. A previous study had shown that the assassination of President John F. Kennedy in November 1963 was associated with a significant dip in M/F in the United States for 1964 due to a dip confined to March 1964. This study was carried out in order to ascertain whether the assassination influenced M/F in the rest of the world. Annual male and female live births were obtained from a World Health Organisation Mortality database for all countries reporting. Comparisons were made between 1964, the year after the assassination, and the preceding five years (1959-1963) and following five years (1965-1969). Monthly data was only available for Malta, for the period 1958-1968. There were 159,339,564 live births (82,066,005 males, 77,273,559 females, M/F 0.5150; 95% CI 0.5150-0.5151). No dip was present for 1964 for any country, nor for the amalgamation of European countries, for the Far East, the North American continent, or for the amalgamation of the total. Data for Malta showed a significant decline in March 1964 (M/F 0.4661, p=0.0175), translating to a loss of 56 boys (estimated at 6.3/1000 births). These findings replicate the findings for the United States following the assassination of President Kennedy. The March M/F dip transiently exceeded the modern expected rate for perinatal mortality, making terrorist attacks Public Health issues.


Another turn of the screw in shaving Gram-positive bacteria: Optimization of proteomics surface protein identification in Streptococcus pneumoniae.
Bacterial surface proteins are of outmost importance as they play critical roles in the interaction between cells and their environment. In addition, they can be targets of either vaccines or antibodies. Proteomic analysis through "shaving" live cells with proteases has become a successful approach for a fast and reliable identification of surface proteins. However, this protocol has not been able to reach the goal of excluding cytoplasmic contamination, as cell lysis is an inherent process during culture and experimental manipulation. In this work, we carried out the optimization of the "shaving" strategy for the Gram-positive human pathogen Streptococcus pneumoniae, a bacterium highly susceptible to autolysis, and set up the conditions for maximizing the identification of surface proteins containing sorting or exporting signals, and for minimizing cytoplasmic contamination. We also demonstrate that cell lysis is an inherent process during culture and experimental manipulation, and that a low level of lysis is enough to contaminate a "surfome" preparation with peptides derived from cytoplasmic proteins. When the optimized conditions were applied to several clinical isolates, we found the majority of the proteins described to induce protection against pneumococcal infection. In addition, we found other proteins whose protection capacity has not been yet tested. In addition, we show the utility of this approach for providing antigens that can be used in serological tests for the diagnosis of pneumococcal disease.


Boron nitride nanotubes as vehicles for intracellular delivery of fluorescent drugs and probes.
To evaluate the response of cells to boron nitride nanotubes (BNNTs) carrying fluorescent probes or drugs in their inner channel by assessment of the cellular localization of the fluorescent cargo, evaluation of the in vitro release and biological activity of a drug (curcumin) loaded in BNNTs. Cells treated with curcumin-loaded BNNTs and stimulated with lipopolysaccharide were assessed for nitric oxide release and stimulation of IL-6 and TNF-α. The cellular trafficking of two cell-permeant dyes and a non-cell-permeant dye loaded within BNNTs was imaged. BNNTs loaded with up to 13 wt% fluorophores were internalized by cells and controlled release of curcumin triggered cellular pathways associated with the known anti-inflammatory effects of the drug. The overall findings indicate that BNNTs can function as nanocarriers of biologically relevant probes/drugs allowing one to examine/control their local intracellular localization and biochemical effects, leading the way to applications as intracellular nanosensors.


Characterization of regional and local deposition of inhaled aerosol drugs in the respiratory system by computational fluid and particle dynamics methods.
The present work describes the local deposition patterns of therapeutic aerosols in the oropharyngeal airways, healthy and diseased bronchi and alveoli using computational fluid and particle dynamics techniques. A user-enhanced computational fluid dynamics commercial finite- volume software package was used to compute airflow fields, deposition efficiencies, and deposition patterns of therapeutic aerosols along the airways. Adequate numerical meshes, generated in different airway sections, enabled us to more precisely define trajectories and local deposition patterns of inhaled particles than before. Deposition patterns show a high degree of heterogeneity of deposition along the airways, being more uniform for nanoparticles compared to micro-particles in the whole respiratory system at all inspiratory flow rates. Extrathoracic and tracheobronchial deposition fractions of nanoparticles decrease with increasing flow rates. However, vice versa happens to the micron-size particles, that is, the deposition fraction is higher at high flow rates. Both airway constrictions and the presence of tumors significantly increased the deposition efficiencies compared to the deposition efficiencies in healthy airways by a factor ranging from 1.2 to 4.4. In alveoli, the deposition patterns are strongly influenced by particle size and direction of gravity. This study demonstrated that numerical modeling can be a powerful tool in the aerosol drug delivery optimization. Present results may be integrated in future aerosol drug therapy protocols.


Evaluation of a novel 5-group classification system of sepsis by vasopressor use and initial serum lactate in the emergency department.
Prognostication in sepsis is limited by disease heterogeneity, and measures to risk-stratify patients in the proximal phases of care lack simplicity and accuracy. Hyperlactatemia and vasopressor dependence are easily identifiable risk factors for poor outcomes. This study compares incidence and hospital outcomes in sepsis based on initial serum lactate level and vasopressor use in the emergency department (ED). In a retrospective analysis of a prospectively identified dual-center ED registry, patients with sepsis were categorized by ED vasopressor use and initial serum lactate level. Vasopressor-dependent patients were categorized as dysoxic shock (lactate >4.0 mmol/L) and vasoplegic shock (≤4.0 mmol/L). Patients not requiring vasopressors were categorized as cryptic shock major (lactate >4.0 mmol/L), cryptic shock minor (>2.0 and ≤4.0 mmol/L), and sepsis without lactate elevation (≤2.0 mmol/L). Of 446 patients included, 4.9% (n = 22) presented in dysoxic shock, 11.7% (n = 52) in vasoplegic shock, 12.1% (n = 54) in cryptic shock major, 30.9% (n = 138) in cryptic shock minor, and 40.4% (n = 180) in sepsis without lactate elevation. Group mortality rates at 28 days were 50.0, 21.1, 18.5, 12.3, and 7.2%, respectively. After adjusting for potential confounders, odds ratios for mortality at 28 days were 15.1 for dysoxic shock, 3.6 for vasoplegic shock, 3.8 for cryptic shock major, and 1.9 for cryptic shock minor, when compared to sepsis without lactate elevation. Lactate elevation is associated with increased mortality in both vasopressor dependent and normotensive infected patients presenting to the emergency department (ED). Cryptic shock mortality (normotension + lactate >4 mmol/L) is equivalent to vasoplegic shock mortality (vasopressor requirement + lactate <4 mmol/L) in our population. The odds of normotensive, infected patients decompensating is three to fourfold higher with hyperlactemia. The proposed Sepsis-3 definitions exclude an entire group of high-risk ED patients. A simple classification in the ED by vasopressor requirement and initial lactate level may identify high-risk subgroups of sepsis. This study may inform prognostication and triage decisions in the proximal phases of care.


Chlorpyrifos induced testicular damage in rats: ameliorative effect of glutathione antioxidant.
This study investigated the induction of oxidative stress in the testes of adult rats exposed to chlorpyrifos (CPF). CPF was administered orally, in a dose of 30 mg/kg body weight to male rats for 90 days, twice weekly. Coadministration of water-soluble nonenzymatic antioxidant glutathione (GSH) was performed in a dose of 100 mg/kg body weight, orally, for the same period. Another two groups of male rats were administered GSH and corn oil, respectively. The activities of superoxide dismutase and GSH reductase were decreased while the levels of lipid peroxidation were increased in the testicular tissues of the exposed animals. Testosterone level in the serum was significantly decreased. A decrease in the histochemical determination of testicular alkaline phosphatase was observed in CPF-treated rats. A significant decrease in all stages of spermatogenesis in the seminiferous tubules was recorded in the exposed animals. Coadministration of GSH restored these parameters.


BMP9 Promotes the Extracellular Matrix of Nucleus Pulposus Cells via Inhibition of the Notch Signaling Pathway.
Intervertebral disk degeneration (IDD) is a common disease that is caused by degeneration of the nucleus pulposus (NP). One goal in the treatment of IDD is delaying or reversing the degeneration of NP via the transformation of exogenous genes. This study first investigated the role of BMP9 in the extracellular matrix (ECM) of nucleus pulposus cells (NPCs) and its mechanism. We found that BMP9 promotes the expression of ECM in NPCs, and the key molecules of Notch signaling, namely, NICD-1, hes and hey, and it was significantly altered in BMP9-transfected NPCs, which suggests that BMP9 may regulate the ECM via the Notch signaling pathway. We verified the expression of Notch ligands and receptors in NPCs infected with Ad-BMP9 and demonstrated a significant decrease in DLL1 and Notch1; then, NPCs were transfected with Ad-dnNotch1, Ad-Jagged1, and Ad-DLL1, and different multiple groups were established to further identify the ligands or receptors that affected ECM expression. The results demonstrated that Ad-dnNotch1, Jagged1 and DLL1 inhibited ECM expression, and dnNotch1 promoted expression. Therefore, we demonstrated that BMP9 promoted the expression of ECM in NPCs via inhibition of Notch1 and DLL1. This study provides a possible method for IDD treatment.


Broad-band ultraviolet B phototherapy in zoster patients may reduce the incidence and severity of postherpetic neuralgia.
Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN. This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm(2) and gradually increasing the dose by 10 mJ/cm(2) each session to a maximum dose of 100 mJ/cm(2). Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0-4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol. A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47-82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief. UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN. Treatment after 3 months does not seem to have a significant beneficial effect.


MeetingVis: Visual Narratives to Assist in Recalling Meeting Context and Content.
In team-based workplaces, reviewing and reflecting on the content from a previously held meeting can lead to better planning and preparation. However, ineffective meeting summaries can impair this process, especially when participants have difficulty remembering what was said and what its context was. To assist with this process, we introduce MeetingVis, a visual narrative-based approach to meeting summarization. MeetingVis is composed of two primary components: (1) a data pipeline that processes the spoken audio from a group discussion, and (2) a visual-based interface that efficiently displays the summarized content. To design MeetingVis, we create a taxonomy of relevant meeting data points, identifying salient elements to promote recall and reflection. These are mapped to an augmented storyline visualization, which combines the display of participant activities, topic evolutions, and task assignments. For evaluation, we conduct a qualitative user study with five groups. Feedback from the study indicates that MeetingVis effectively triggers the recall of subtle details from prior meetings: all study participants were able to remember new details, points, and tasks compared to an unaided, memory-only baseline. This visual-based approaches can also potentially enhance the productivity of both individuals and the whole team.


Therapy for renal calculi via percutaneous nephrostomy: dissolution and extraction.
Nephrostomy catheters offer nonsurgical modes of therapy for some renal stones. Continuous lavage of the stones using hemiacidrin (Renacidin) for struvite stones, THAM-E or acetylcysteine for cystine stones, and bicarbonate solution for uric acid stones may dissolve either entire stones or stone fragments remaining after surgery. Although irrigation is not without potential complications, recent developments in technique have minimized these. Nephrostomy tubes can also be used to transmit stone baskets through steerable catheters to snare stones from the upper collecting system or from the ureter; any stone that can be engaged and withdrawn through the tube tract can be removed; stones larger than those which can be safely extracted through the ureterovesical junction can be so treated. Neither of these procedures requires general anesthesia, the rate of serious morbidity is low, and the required hospital stay is often less than that for surgery; these modes of therapy are therefore valuable for certain patients.


Full-face injections of variable total doses of abobotulinum toxin type A: A randomized, phase IV clinical trial of safety and efficacy.
Botulinum toxin type A (BoNT-A) has been used for almost 20 years in cosmetic dermatology to reduce dynamic wrinkles on single or multiple facial areas. To evaluate the safety and efficacy of full-face treatments with various total doses of abobotulinum toxin A (ABO). A total of 90 participants were enrolled. Subjects had at least two indications for BoNT-A treatments on each third of the face (upper, middle and lower). They were randomized into 3 groups, with pre-defined total dose range of ABO, varying from 120 to 250 U. Most of the subjects were women (96.5%). The statistically significant improvement from baseline lasted for more than 24 weeks for glabellar lines, and more than 16 weeks for forehead wrinkles and crow's feet, all P<0.001, with no differences between groups. The most frequent adverse event (excessive perioral weakness) was related to high dose in the perioral area. This is the first study to compare safety and efficacy of different doses of ABO administered to the entire face simultaneously. As long as the recommended doses are used, concomitant injections of ABO are safe and efficient, with no increase in adverse events.


Novel Anticoagulants in Atrial Fibrillation: A Primer for the Primary Physician.
Atrial fibrillation is a common arrhythmia encountered in clinical practice. The prevalence increases with age. A devastating complication of atrial fibrillation is cardioembolic stroke with central nervous system sequelae. Based on stroke risk scores (CHADS and CHA2DS2VASc) and bleeding risk (HAS-BLED), the optimal use of anticoagulation in atrial fibrillation is feasible. Warfarin is a proven medication for this specific indication but requires frequent monitoring and dose adjustments, and it has multiple food, drug, and disease-state interactions. In addition, management of anticoagulation during the perioperative period may be challenging. In this regard, novel oral anticoagulants (NOACs) have shown promise in the shift toward the "ideal" anticoagulant therapy, in that fixed dosing is the norm, drug interactions are few, food interactions are absent, onset is fairly immediate and offset predictable, and, in the majority of patients, therapeutic monitoring is not required. This article provides a review of recent published trials of the use of NOACs in atrial fibrillation. Practical points on indications, contraindications, mechanism of action, interactions, and perioperative management tips are discussed with a view toward the safe and effective use of these new medications. When patients are transitioned between different anticoagulant medications, the risks of thrombosis and bleeding need to be considered. When switching from warfarin to a NOAC, the NOAC can be started once the international normalized ratio is ≤2.0.


Prognostic Value of Circulating Tumor Cells in Castration Resistant Prostate Cancer: A Meta-analysis.
The prognostic value of circulating tumor cells (CTC) detected in castration-resistant prostate cancer(CRPC) is currently under debate. The aim of our meta-analysis was to evaluate the prognostic effect of CTC andto elucidate whether the detection of CTC in the peripheral blood (PB) of patients diagnosed with CRPC can beused as an independent prognostic factor for survival. The Pubmed, Science Citation Index, Cochrane Database, Embase Cell Research databaseand the references in relevant studies were systematically searched. Hazard ratios (HRs) for overall survival(OS) with 95% confidence intervals (CIs), subgroup analysis, sensitivity analysis, meta-regression analysis waspooled and publication bias were conducted. Ten eligible studies enrolling 1206 patients were identified for final analysis. To decrease the heterogeneityof this meta-analysis we excluded two studies after sensitivity analysis. Remained eight studies were enrolledin the pooled analysis and the result revealed that CTC positivity (presence of 5 or more CTCs per 7.5mL PB) wassignificantly associated with a poor OS (HR = 2.76, 95%CI: 2.28-3.34, P < .0001). Our study demonstrated that CTC positivity indicates poor prognosis in patients with CRPC. CTCcounts can be used as an independent prognostic factor of survival rate in patients with CRPC.


Prognostic Value of Cardiac MR Imaging for Preoperative Assessment of Patients with Severe Functional Tricuspid Regurgitation.
Purpose To explore the prognostic value of cardiac magnetic resonance (MR) imaging in predicting postoperative cardiac death in patients with severe functional tricuspid regurgitation (TR). Materials and Methods This study was approved by the institutional review board, and written informed consent was obtained from all patients. Prospectively collected data included cardiac MR images, New York Heart Association (NYHA) functional class, a comprehensive laboratory test, and clinical events over the follow-up period in 75 consecutive patients (61 women and 14 men; mean age ± standard deviation, 59 years ± 9) undergoing corrective surgery for severe functional TR. Cox proportional hazards models were used to assess the association between cardiac MR parameters and outcomes. Results During a median follow-up period of 57 months (range, 21-82 months), cardiac mortality and all-cause mortality were 17.3% and 26.7%, respectively, with a surgical mortality of 6.7%. Cardiac death risk was lower with a higher right ventricular (RV) ejection fraction (EF) on cardiac MR images (hazard ratio per 5% higher EF = 0.790, P = .048). By adjusting for confounding variables, RV EF remained a significant predictor for cardiac death (P < .05) and major postoperative cardiac events (P < .05). The area under the receiver operating characteristic curve (AUC) confirmed the incremental role of RV EF on cardiac MR images in the prediction of postoperative cardiac death (AUC, 0.681-0.771; P = .041) and major postoperative cardiac events (AUC, 0.660-0.745; P = .044) on top of NYHA class. RV end-systolic volume index was also independently associated with these outcomes but failed to increase the AUC significantly. Conclusion Preoperative assessment of cardiac MR imaging-based RV EF provides independent and incremental prognostic information in patients undergoing corrective surgery for severe functional TR. (©) RSNA, 2016 Online supplemental material is available for this article.


[Effect of ladasten on antenatal and postnatal development].
Positive effects of ladasten on both antenatal and postnatal development have been established in experiments on pregnant female rats. Under the action of this drug, the number of resorption events decreases and process of antenatal development of fetuses is activated. In the postnatal period, increased weight gain and accelerated physical development has been observed in the progeny of rats treated with ladasten.


Is implementation of the 2013 Australian treatment guidelines for posttraumatic stress disorder cost-effective compared to current practice? A cost-utility analysis using QALYs and DALYs.
To assess, from a health sector perspective, the incremental cost-effectiveness of three treatment recommendations in the most recent Australian Clinical Practice Guidelines for posttraumatic stress disorder (PTSD). The interventions assessed are trauma-focused cognitive behavioural therapy (TF-CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of PTSD in adults and TF-CBT in children, compared to current practice in Australia. Economic modelling, using existing databases and published information, was used to assess cost-effectiveness. A cost-utility framework using both quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted was used. Costs were tracked for the duration of the respective interventions and applied to the estimated 12 months prevalent cases of PTSD in the Australian population of 2012. Simulation modelling was used to provide 95% uncertainty around the incremental cost-effectiveness ratios. Consideration was also given to factors not considered in the quantitative analysis but could determine the likely uptake of the proposed intervention guidelines. TF-CBT is highly cost-effective compared to current practice at $19,000/QALY, $16,000/DALY in adults and $8900/QALY, $8000/DALY in children. In adults, 100% of uncertainty iterations fell beneath the $50,000/QALY or DALY value-for-money threshold. Using SSRIs in people already on medications is cost-effective at $200/QALY, but has considerable uncertainty around the costs and benefits. While there is a 13% chance of health loss there is a 27% chance of the intervention dominating current practice by both saving dollars and improving health in adults. The three Guideline recommended interventions evaluated in this study are likely to have a positive impact on the economic efficiency of the treatment of PTSD if adopted in full. While there are gaps in the evidence base, policy-makers can have considerable confidence that the recommendations assessed in the current study are likely to improve the efficiency of the mental health care sector.