[THe video laparoscopic experience of the general surgeon in cholecystectomy in childhood].
Despite the exponentially increasing number of laparoscopic cholecystectomies on adults to date, there is a paucity of reports in the literature about this new technique in pediatric patients. From September 1992 to February 1995, 140 patients underwent laparoscopic cholecystectomy. Since July 1993, in our institution, five pediatric patients (three females and two males) with a diagnosis of cholelithiasis underwent laparoscopic cholecystectomy. The age of the patients ranged from 6 to 15 years (mean 8.8 years) and they weighed 18-58 kg (mean 28.4 kg). All five patients had biliary cholic and ultrasound evidence of cholelithiasis. One patient had associated hematological disease (sickle cell disease). All 5 children were operated using the laparoscopic approach technique. Operative cholangiography was performed in cases with ductal and vascular intraoperative anatomy unclear. No operation was converted to open cholecystectomy. Intraoperative cholangiography was performed successfully (100%). The mean time of surgery was 50.2 minutes (range from 38 to 68). There were no operative complications. The mean hospital stay was 2.2 days (range 2 to 3 days). All five returned to their activity within a week. No long-term complications were seen in all patients throughout an average follow-up period of 10.6 months (range 8-14). The benefits of laparoscopic cholecystectomy in children are clear and obvious. It is safe and effective and should now be the treatment of choice for cholelithiasis in pediatric patients.


Dietary omega-3, omega-6, and omega-9 unsaturated fatty acids and growth factor and cytokine gene expression in unstimulated and stimulated monocytes. A randomized volunteer study.
Dietary omega-3 fatty acids retard coronary atherosclerosis. Previously, we demonstrated that dietary omega-3 fatty acids reduce platelet-derived growth factor (PDGF)-A and PDGF-B mRNA levels in unstimulated, human mononuclear cells (MNCs). In a randomized, investigator-blinded intervention trial, we have now compared the effect of ingestion of 7 g/d omega-3, omega-6, or omega-9 fatty acids for 4 weeks versus no dietary intervention on PDGF-A, PDGF-B, heparin-bound epidermal growth factor (HB-EGF), monocyte chemoattractant protein-1 (MCP-1), and interleukin-10 gene expression in unstimulated MNCs and in monocytes that were adherence-activated ex vivo in a total of 28 volunteers. In unstimulated MNCs, mRNA steady-state levels of PDGF-A, PDGF-B, and MCP-1 were reduced by 25+/-10%, 31+/-13%, and 40+/-14%, respectively, after omega-3 fatty acid ingestion, as assessed by quantitative polymerase chain reaction (all P<0.05). In monocytes that were adherence-activated ex vivo for 4 and 20 hours, mRNA steady-state levels of PDGF-A, PDGF-B, and MCP-1 were reduced by 25+/-13%, 20+/-15%, and 30+/-8%, respectively (all P<0.05). Interleukin-10 and HB-EGF mRNA steady-state levels were not influenced by omega-3 fatty acid ingestion. Expression of all respective mRNAs in control volunteers or in those ingesting omega-6 or omega-9 fatty acids were not altered. We conclude that human gene expression for PDGF-A, PDGF-B, and MCP-1, factors thought relevant to atherosclerosis, is constitutive, is constant, and can be reduced only by dietary omega-3 fatty acids in unstimulated and adherence-activated monocytes.


Use of borate complexation for the separation of non-UV-absorbing calystegines by capillary electrophoresis.
A capillary zone electrophoresis method was developed for the simultaneous analysis of seven closely related polyhydroxyalkaloids called calystegines. Successful results were obtained with a fused-silica capillary, 80 mM sodium tetraborate at pH 9.2 and temperature of 50 degrees C. Detection of non-UV-absorbing calystegines was achieved through in-situ complexation with borate ions. To further improve method sensitivity, a capillary with a bubble cell was used and detection performed at low wavelength (191 nm). Effects of buffer concentration, pH and temperature on migration times and efficiency are discussed. Migration behavior of selected compounds was significantly affected by their chemical structure (i.e., number and position of hydroxy groups). Under optimized conditions, baseline separation of the selected compounds was achieved in less than 12 min. Precision was evaluated by measuring repeatability and intermediate precision of migration times and corrected peak areas. Finally, the method was applied to the qualitative analysis of calystegines in plant extracts and results were confirmed by GC-MS.


Consolidated bioprocessing of sugarcane bagasse and chicken manure to ammonium carboxylates by a mixed culture of marine microorganisms.
The MixAlco process, an example of consolidated bioprocessing (CBP), was utilized for anaerobic fermentation of 80% lime-treated sugarcane bagasse/20% chicken manure at 55 degrees Celsius by a mixed culture of marine microorganisms. NH(4)HCO(3) was recommended by this study to replace CaCO(3) buffer to neutralize the produced carboxylic acids. The resulting ammonium carboxylates can be converted to gasoline or mixed alcohol fuels by downstream processing. Four-stage countercurrent fermentations at various volatile solids loading rates (VSLR) and liquid residence times (LRT) showed the highest acid productivity (1.27 g/(L x day)) and highest conversion (76%) occurred at a total acid concentration of 24.4 and 31.3g/L, respectively. The Continuum Particle Distribution Model (CPDM) predicted the experimental total acid concentrations and conversions within 9.05% and 14.39%, respectively. The CPDM "map" indicates that both high acid concentrations (>50 g/L) and high conversions (>72%) are possible with 300 g substrate/(L liquid) concentration, 30 days liquid residence time, 5.4 g/(L x day) solid loading rate, and NH(4)HCO(3) buffer. The present study suggests that mixed culture biotechnology in the MixAlco process provides an alternative "carboxylate platform" for biomass conversion.


Overexpression of LC3A autophagy protein in follicular and diffuse large B-cell lymphomas.
Autophagy is a self-degradation mechanism induced under stress conditions in all eukaryotic cells. Its activity in human lymphomas has not been studied as yet. In this study, the autophagic activity of lymphoid cells was investigated in follicular lymphomas (FL; 48 cases), diffuse large B-cell lymphomas (DLBCL; 78 cases), and in reactive follicular hyperplasias (41 cases), using the light chain 3A (LC3A) antibody and a standard immunohistochemical technique. In all cases, the pattern of LC3A reactivity was uniformly diffuse cytoplasmic, but expressed more frequently in FLs (68.8%) than in DLBCLs (41%) (p=0.02), and much more commonly in DLBCLs than in reactive lymph nodes (24.3%) (p<0.006). Interestingly, FLs expressing LC3A in >10% of lymphoid cells (high reactivity) were associated with the hypoxia-related protein HIF1α and the enzyme of anaerobic metabolism lactate dehydrogenase LDH5 (p=0.004 and p=0.003, respectively). Such associations, however, were not a feature in DLBCLs of increased LC3A activity. LC3A expression in FLs is hypoxia-induced, whereas its expression in DLBCLs may be regulated by other molecular mechanisms. The current study provides a tool for further assessment of autophagic activity in translational and autophagy targeting therapy studies.


Endoscopically Assisted Middle Cranial Fossa Reconstruction Following Traumatic Intracranial Intrusion of the Mandibular Condyle.
Traumatic intracranial intrusions of the mandibular condyle are a rare injury pattern that carries significant morbid outcomes due to potential for neurological, otological, temporomandibular joint damage, or joint ankylosis. Treatment modalities involve either closed reduction, open approaches via transcranial or subtemporal approaches, or delayed total joint replacement. This paper presents a clinical report of a traumatic intracranial intrusion of the mandibular condyle treated with an endoscopically assisted preauricular approach to reconstruct the middle cranial fossa and temporomandibular articular disc. Endoscopically assisted techniques allow for minimally invasive and less morbid surgical interventions to this pathology, with greater precision than closed reduction techniques.


[Studies on coagulation-fibrinolytic system in diabetic nephropathy--with reference to plasma TAT and alpha 2PIC].
Coagulation-fibrinolytic system is known to be one of the exacerbating factors in patients with diabetic nephropathy. The aim of the present study was to evaluate whether coagulation-fibrinolytic system in patients with diabetic nephropathy were significantly correlated with the development of this disease using new parameters of plasma thrombin antithrombin III complex (TAT) and plasmin alpha 2 plasmin inhibitor complex (alpha 2PIC). Fifty-six patients with NIDDM were examined. None of these patients showed more than 1.3 mg/dl of serum creatinine levels. These patients were divided into three groups according to the levels of albumin creatinine ratio (ACR) in urine as follows: 1) group I had ACR of less than 30 mg/g.Cr; 2) group II had ACR of greater than 30 mg/g.Cr and less than 100 mg/g.Cr; 3) group III had ACR of greater than 100 mg/g.Cr. Correlations of levels of plasma TAT and alpha 2PIC, levels of HbAlc, duration of diabetes, and presence of retinopathy were determined in these groups. The levels of plasma TAT and alpha 2PIC increased as the levels of urinary ACR increased regardless of presence of retinopathy. The levels of TAT and alpha 2PIC with retinopathy increased compared with those without retinopathy. There was a significantly positive correlation between plasma TAT and alpha 2PIC (r = 0.52, p less than 0.01). The levels of HbAlc and duration of diabetes did not significantly correlate to plasma TAT and alpha 2PIC. These data suggest that the existence of increase in coagulation-fibrinolytic system seem to be one of the exacerbating factors in patients with diabetic nephropathy.(ABSTRACT TRUNCATED AT 250 WORDS)


Quantitative retention relationships as a function of mobile and C18 stationary phase composition for non-cogeneric solutes.
Twelve non-homologous solutes with a wide range of functional groups were chromatographed on a series of well-characterized stationary phases with a range of methanol-water mobile phases. Retention correlations were found for quantum mechanically calculated molecular parameters. These parameters, the total molecular energy, and the maximal excess electronic charge difference, were found to be better descriptors of retention than the dipole moment or fragmental constants. The implication of these results in terms of retention mechanisms on reversed-phase materials are discussed.


Theta rotation and serial registration of light microscopical images using a novel camera rotating device.
An electromechanical video camera coupler was developed to rotate a light microscope field of view (FOV) in real time without the need to physically rotate the stage or specimen. The device, referred to as the Camera Thetarotator, rotated microscopical views 240 degrees to assist microscopists to orient specimens within the FOV prior to image capture. The Camera Thetarotator eliminated the effort and artifacts created when rotating photomicrographs using conventional graphics software. The Camera Thetarotator could also be used to semimanually register a dataset of histological sections for three-dimensional (3D) reconstruction by superimposing the transparent, real-time FOV to the previously captured section in the series. When compared to Fourier-based software registration, alignment of serial sections using the Camera Thetarotator was more exact, resulting in more accurate 3D reconstructions with no computer-generated null space. When software-based registration was performed after prealigning sections with the Camera Thetarotator, registration was further enhanced. The Camera Thetarotator expanded microscopical viewing and digital photomicrography and provided a novel, accurate registration method for 3D reconstruction. The Camera Thetarotator would also be useful for performing automated microscopical functions necessary for telemicroscopy, high-throughput image acquisition and analysis, and other light microscopy applications.


Adult mortality from leukemia, brain cancer, amyotrophic lateral sclerosis and magnetic fields from power lines: a case-control study in Brazil.
Recent publications renewed interest in assessing potential health risks for subjects living close to transmission lines. This study aimed at evaluating the association of both distance of home address to the nearest overhead transmission line and of the calculated magnetic fields from the power lines and mortality from leukemia, brain cancer, and amyotrophic lateral sclerosis. We carried out a death certificate based case-control study accessing adult mortality in the Metropolitan Region of São Paulo, in Brazil. Analysis included 1,857 cases of leukemia, 2,357 of brain cancer, 367 of amyotrophic lateral sclerosis, and 4,706 as controls. An increased risk for mortality from leukemia among adults living at closer distances to transmission lines compared to those living further then 400 m was found. Risk was higher for subjects that lived within 50 m from power lines (OR=1.47; 95% CI=0.99-2.18). Similarly, a small increase in leukemia mortality was observed among adults living in houses with higher calculated magnetic fields (OR=1.61; 95% CI=0.91-2.86 for those exposed to magnetic fields >0.3 µT). No increase was seen for brain tumours or amyotrophic lateral sclerosis. Our findings are suggestive of a higher risk for leukemia among subjects living closer to transmission lines, and for those living at homes with higher calculated magnetic fields, although the risk was limited to lower voltage lines.


Maternal employment and indicators of child health: a systematic review in pre-school children in OECD countries.
The aim of the study was to determine whether maternal employment is associated with two indicators of family health behaviour in pre-school children--childhood vaccination uptake, and childhood overweight including obesity--in OECD countries. Narrative systematic review of nine medical/social science databases (1980-2007), relevant websites, retrieved article reference lists and consultation with experts. Relevant articles in English published from 1980 were included; studies of pregnancy, single occupational groups and non-OECD countries were excluded. 8924 abstracts yielded 21 eligible articles: 15 on vaccination and 6 on overweight. Meta-analysis was not possible. Vaccination uptake appeared at least as good or better for children of employed as unemployed mothers. Child overweight may be more prevalent with maternal employment, particularly if long hours are worked. Maternal employment may have variable effects on pre-school children's health. Policies promoting parental employment should monitor and evaluate the effect on the health and wellbeing of all members of the family.


Evaluation of toxicity and sex-related variation of PCB levels in Mediterranean striped dolphins affected by an epizootic.
Individual PCB congener concentrations, including non-ortho chloro substituted, were determined in 30 striped dolphins (Stenella coeruleoalba) affected by the 1990-92 Mediterranean epizootic to investigate their toxic potential. PCB congener concentrations in these dolphins were among the highest ever found in comparable studies on marine mammals. Concentrations in males and females were significantly different because of pollutant transfer to offspring by females. Thus, PCB concentrations and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) toxic equivalents (TEQ) in males were approximately double those in females. Non-ortho, mono-ortho and di-ortho coplanar congeners accounted for approximately one third of the overall toxicity assessed through toxic equivalent factors (TEFs), as defined by Ahlborg et al. (1994). Di-ortho congener 170 and non-ortho congener 126 were the major contributors to TEQ (33% and 30% respectively).


Inhibition of tumor necrosis factor-stimulated human peripheral blood polymorphonuclear cell iodination by sera from various cancer patients.
Tumor necrosis factor (TNF) dose- and time-dependently stimulated the iodination (incorporation of radioactive iodine into an acid-insoluble fraction) of human peripheral blood polymorphonuclear cells (PMN). The addition of sera obtained from patients with brain tumors, or gastric, pancreatic, hepatocellular, common bile duct or lung carcinoma significantly inhibited TNF-stimulated PMN iodination, whereas sera of normal volunteers were, in general, not inhibitory. TNF-stimulated iodination of human peripheral blood monocytes was almost eliminated by brain tumor patient sera, but was significantly enhanced by normal human sera. Specific [135I] TNF binding to the PMN receptors was significantly increased in the presence of either patient sera or normal sera. These data suggest some mechanism other than modification of TNF receptor binding for expression of the inhibitory action of cancer patient serum.


Tumour necrosis factor in surgical illness.
TNF is a multipurpose molecule which works alongside other cytokines to stimulate and coordinate immune and inflammatory responses to antigenic challenges. It is extremely well conserved throughout all mammal species, and obviously confers considerable survival advantage. There are circumstances, however, in which TNF itself can be a source of tissue injury. This occurs in septic shock when the magnitude of the host response is overwhelming. TNF also initiates the energy substrate mobilization required to meet the heightened fuel demands associated with immunological, inflammatory and wound-healing activities. In chronic infection and malignancy this may lead to severe depletion of host tissues with its own attendant morbidity and mortality. At present our understanding of the host response is expanding rapidly. The challenge for the future will be to manipulate this response selectively, to maximize its influence on the disease while minimizing its negative impact on the host.


Subcutaneous nodules and infectious complications in renal allograft recipients.
Renal transplant recipients are at increased risk of infectious diseases and subject to cutaneous infections because of the effects of immunosuppressive therapy. Some long-term descriptive follow-up studies confirm that skin infections are common among renal transplant recipients. We report the development of subcutaneous nodules among patients receiving renal transplantations from 1991 to 2009. Transplant recipients were followed by the Nephrology Unit at control visits according to the American Society Nephrology guidelines. Between 1991 to 2009, subcutaneous nodules were identified in 7 out of 774 renal transplant recipients. The male:female ratio was 5:2; median age at renal transplantation was 52 years (range 28-59). Subcutaneous nodules were identified at a median 3 years after transplantation. The 7 patients had the following diagnoses: systemic scedosporiasis (n = 1); Mycobacterium avium complex infection (n = 2) disseminated tuberculosis (n = 2) Sporothrix schenckii infection (n = 1); Trichophyton rubrum infection (n = 1). Four patients died due to sepsis from disseminated infection. Subcutaneous nodules may reflect a systemic infectious pathology. In some cases, the investigation of cutaneous lesions is important to reach a definitive diagnosis for possible future disseminated infections.


Hemobilia complicating a liver abcess.
We present the case of an 11-year-old female, with a history of colicky pain abdomen fever, and episode of massive hematemesis and melena. The child was presented to the medical emergency with features of shock. Coagulation profile of the child was normal. Ultrasonography demonstrated multiple liver abscess. Repeated endoscopies ruled out the possibility of gastric or upper gastrointestinal causes of bleed where in the possibility of hemobilia, was considered. Endoscopic retrograde cholangiography demonstrated the presence of bleeding from the biliary tract. Angiography demonstrated the presence of the communication of the biliary radicles with the hepatic vessels and also aided with therapeutic embolization. Hemobilia is a rare cause of upper gastrointestinal hemorrhage with an increasing incidence because of the widespread use of invasive hepatobiliary procedures and improved recognition. In the majority of cases the cause is iatrogenic and those associated with the liver abscess are scantily reported in the English literature. Persistent bleeding sometimes requires urgent therapeutic intervention, such as angiography or surgery.


Complete Ag4M2(DMSA)4 (M = Ni, Pd, Pt, DMSA = Dimercaptosuccinic Acid) Cluster Series: Optical Properties, Stability, and Structural Characterization.
The cluster series Ag4M2(DMSA)4 (M = Ni, Pd, Pt) has been synthesized and the optical spectra and stability have been examined as a function of the metal, M. We have also obtained the structure of Ag4Ni2(DMSA)4 using X-ray crystallography, confirming the previously calculated structure. In the optical spectrum, there is a significant blue shift as the substituted metal M progresses down the periodic table. Theoretical calculations suggest that the blue shift is due to the lowering in energy of the d orbitals of the transition metal, M; however the expected metal-metal excitations are optically weak, and the spectra are dominated by metal-ligand excitations. The Ag4Pd2(DMSA)4 species has exceptionally high stability relative to the previously reported Ni and Pt analogues.


Infection and seroconversion of cats exposed to cat fleas (Ctenocephalides felis Bouché) infected with Rickettsia felis.
Cats with no prior exposure to cat fleas were exposed to fleas infected with Rickettsia felis and monitored monthly for seroconversion via an indirect fluorescent assay (IFA). Each of 12 cats continually infested with fleas, seroconverted by four months post-exposure. Three of six cats fed on by 50 fleas for 15 minutes once per week also seroconverted by month four. Rickettsia felis DNA was detected by PCR in the blood of five of the 16 cats.


The sensory innervation of the periodontium of the third premolar in Monodelphis domestica.
Location and structure of sensory nerve endings in the periodontium of the third premolar in Monodelphis domestica have been investigated by means of light and electron microscopy. The periodontal cleft of the tooth is apically enlarged. The number of nerve endings increases towards apex. Three types of sensory nerve endings have been observed: free nerve endings, Ruffini nerve endings and lamellated corpuscles. Free nerve endings could only be identified by electron microscopy. Ruffini nerve endings are only incompletely surrounded by lamellae of the terminal Schwann cell. Protrusions of nerve terminals of the Ruffini corpuscles are anchored between bundles of collagen fibers. Small lamellated corpuscles occur exclusively in the apical portion of the periodontium. Ruffini and lamellated corpuscles are considered as part of a masticatory reflex feedback control system. Ruffini corpuscles detect tension, rapidly adapting lamellated corpuscles detect pressure and vibration in the periodontium. Free nerve endings may function as thermoreceptor or nociceptor.


Evidence against deacetylation and for cytochrome P450-mediated activation in acetaminophen-induced nephrotoxicity in the CD-1 mouse.
Acetaminophen (APAP) administration (600 mg/kg, po) results in proximal tubular necrosis in 18-hr fasted, 3-month-old male CD-1 mice. This study was undertaken to determine if deacetylation of APAP to p-aminophenol (PAP) is a prerequisite to nephrotoxicity in the mouse, as it is in the Fischer rat. Administration of either APAP or PAP to mice resulted in significant elevations of plasma urea nitrogen and marked proximal tubular necrosis at 12 hr after dosing. Prior inhibition of APAP deacetylation by the carboxylesterase inhibitors bis(p-nitrophenyl) phosphate or tri-o-tolyl-phosphate did not alter APAP hepatotoxicity or nephrotoxicity. By contrast, pretreatment with the MFO inhibitor piperonyl butoxide decreased APAP nephrotoxicity but not that of PAP. Immunochemical analysis of kidneys from APAP-treated mice demonstrated covalently bound APAP but no binding was detected after mice were treated with a nephrotoxic dose of PAP. Since the antibody used has been characterized as being directed primarily against the N-acetyl moiety of bound APAP metabolite and since it did not react with kidney proteins of mice given a nephrotoxic dose of PAP, it is unlikely that APAP deacetylation preceded binding or that acetylation of bound PAP occurred. Taken together, these findings indicate that in the CD-1 mouse, APAP-induced nephrotoxicity differs from that previously described for the Fischer rat and likely involves cytochrome P450-dependent activation and subsequent covalent binding of a metabolite without prior deacetylation.


[Present situation of prenatal diagnosis of neural tube defects].
Anencephaly and spina bifida both are malformations of unknown etiology which are caused by an absent or incomplete closure of the neural tube. The risk of recurrence for the malformations is 5% in families with one child with a neural tube defect and 10%, if two such children have already been born. Neural tube defects can be diagnosed already before 20th week of gestation by ultrasonics and alpha-fetoprotein measurement in amniotic fluid, if an underdeveloped neurocranium or a free communication between amniotic and cerebrospinal fluid is present. By these diagnostic techniques and possibly following interruption the probability in risk families can be significantly lowered.


Online colour training system for dental students: a comprehensive assessment of different training protocols.
The purpose of this study was to evaluate the training effect and to determine the optimal training protocol for a recently developed online colour training system. Seventy students participated in the evaluation. They first completed a baseline test with shade guides (SGT) and the training system (TST), and then trained with one of the three system training methods (Basic colour training for group E1, Vitapan Classical for E2, and Vitapan 3D-Master for E3) or shade guides (group C1) for 4 days. The control group (C2) received no training. The same test was performed after training and they finally completed a questionnaire. The correct matches after training increased in three experimental groups and group C1. Among experimental groups, the greatest improvement of correct matching number was achieved by group E3 (4·00 ± 1·88 in SGT, 4·29 ± 2·73 in TST), followed by E2 (2·29 ± 2·73 in SGT, 3·50 ± 3·03 in TST) and E1 (2·00 ± 2·60 in SGT, 1·93 ± 2·96 in TST). The difference between E3 and E1 was statistically significant (P = 0·036 in SGT, 0·026 in TST). The total average training time was shorter in group E2 (15·39 ± 4·22 min) and E3 (17·63 ± 5·22 min), with no significant difference between them. Subjective evaluations revealed that self-confidence in colour matching were improved greater in group C1 and E3. In conclusion, all tested sections of the system effectively improved students' colour-matching ability. Among system training methods, Vitapan 3D-Master showed the best performance; it enabled greater shade-matching improvement, it saved time and was superior in subjective evaluations.


Assessment of the functionality of a pilot-scale reactor and its potential for electrochemical degradation of calmagite, a sulfonated azo-dye.
Electrochemical degradation (ECD) is a promising technology for in situ remediation of diversely contaminated environmental matrices by application of a low level electric potential gradient. This investigation, prompted by successful bench-scale ECD of trichloroethylene, involved development, parametric characterization and evaluation of a pilot-scale electrochemical reactor for degradation of calmagite, a sulfonated azo-dye used as a model contaminant. The reactor has two chambers filled with granulated graphite for electrodes. The system has electrical potential, current, conductivity, pH, temperature, water-level and flow sensors for automated monitoring. The reactor supports outdoor and fail-safe venting, argon purging, temperature regulation and auto-shutdown for safety. Treatment involves recirculating the contaminated solution through the electrode beds at small flow velocities mimicking low fluid-flux in groundwater and submarine sediments. The first phase of the investigation involved testing of the reactor components, its parametric probes and the automated data acquisition system for performance as designed. The results showed hydraulic stability, consistent pH behavior, marginal temperature rise (<5 degrees C) and overall safe and predictable performance under diverse conditions. Near complete removal of calmagite was seen at 3-10V of applied voltage in 8-10h. The effects of voltage and strength of electrolyte on degradation kinetics have been presented. Further, it was observed from the absorption spectra that as calmagite degrades over time, new peaks appear. These peaks were associated with degradation products identified using electrospray ionization mass spectrometry. A reaction mechanism for ECD of calmagite has also been proposed.


Reductive cleavage of O-, S-, and N-organonitroso compounds by nickel(I) beta-diketiminates.
An electron-rich nickel(I) beta-diketiminate cleaves the E-NO bond of O-, S-, and N-organonitroso species to give the nickel nitrosyl [Me 3NN]NiNO along with dimeric nickel(II) alkoxide or thiolate complexes {[Me 3NN]Ni} 2(mu-E) 2 or the mononuclear nickel(II) amide [Me 3NN]NiNPh 2. This diamagnetic three-coordinate amide exhibits temperature-dependent NMR spectra due to a low-lying triplet state.


Characteristics of falls and risk of injury in children younger than 2 years.
Although many studies have shown that short falls by children rarely result in serious injury, no recent study in the United States has assessed the prevalence and the characteristics of such falls. Because the history of a short fall often is given in the instance of suspected child abuse, data addressing the characteristics, the frequency, and the severity of such falls would assist in abuse investigations. Anonymous questionnaires were distributed at primary care offices to parents of children younger than 5 years. Parents answered a series of questions regarding any falls their children had sustained before the age of 2 years. Information gathered included the age of the child at the time of the fall, the details about the fall, the medical attention sought, and any injuries sustained. We received a total of 307 eligible surveys. There were 209 falls reported for 122 children. Only 24% of those children sustained any injury as a result of the fall. Most (85%) of the children who sustained injuries had a bruise or a bump. Of the 20% (40 children) who were brought for medical care, only 13 children received medical treatment. The most severe injuries were in 2 children who sustained concussions; only 4 children had permanent injury (cutaneous scars). Children who fell on a hard surface were 6 times more likely to have an injury compared with children who fell on a soft surface (P = 0.001) In addition, for every 1 unit increase in fall height, risk of injury increased by a factor of 2.3. In short falls, ground surface and fall height were significant predictors of injury risk. The results of this study also support the opinion that short falls rarely cause injury. Therefore, a history of a short fall in a seriously injured child should raise the suspicion of child abuse.


Exposures and idiopathic lung disease.
Of the idiopathic lung diseases, idiopathic pulmonary fibrosis (IPF) and sarcoidosis have been the focus of a growing number of epidemiological investigations on the risk of environmental and occupational exposures. To date, the consistency of epidemiological evidence is suggestive of a causal relationship between several environmental exposures and IPF, with the strongest evidence for cigarette smoking and metal dust. Current knowledge about pathogenesis provides further support for a causal link. However, scant epidemiological evidence for dose-response and temporality weaken the case for making causal inferences. In contrast to IPF, the quantity of epidemiological evidence for environmental exposures and sarcoidosis is smaller. Two studies provide consistent evidence for exposures to agricultural dust and musty odor/mold/mildew, and studies among military personnel and firefighters suggest mixed dust and fume exposures as risk factors for sarcoidosis. Although studies of the pathogenesis of sarcoidosis also provide evidence supporting environmental causation, more epidemiological studies are needed to establish consistency of associations, dose-response, and temporality. Future investigations, of gene-environment interaction offer the potential for strengthening the evidence of causation between several environmental and occupational exposures and idiopathic lung diseases.


[Network meta-analysis on selecting Chinese medical injections in radiotherapy for esophageal cancer].
To assess the clinical effect and safety of Chinese traditional medicine injection combined with radiotherapy for esophageal cancer. The relative randomized controlled trials (RCTs) of Chinese medical injections (CMI) combined with radiotherapy as well as simple radiotherapy for esophageal cancer were searched from PubMed, Cochrane Library, EMBASE, Chinese Biomedical Literature Database(CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database and VIP Database as at September 2014. Two researchers completed the data extraction and quality evaluation independently. The data were analyzed by GeMTC 0.14.3 and Stata 12. 0 software. Finally, 43 RCTs involving 3 289 patients were finally included. The star network was constructed by different comparison groups. The results of network meta-analysis showed that the seven CMIs combined with radiotherapy was superior to simple radiotherapy in the treatment of esophageal cancer in efficacy, quality of life, and reduction in the incidence of nausea and leucopenia, but with no significant difference among the seven CMIs. Probability ranking result showed a great possibility for Shenqi Fuzheng and astragalus polysaccharide injections in improving the overall response rate and quality of life, which were followed by cinobufagin and kangai injections. However, only one study was included for Shenqi Fuzheng and astragalus polysaccharide injections. Therefore, cinobufagin or kangai injections were preferred in improving the overall response rate and quality of life. Aidi or compound sophora injections were better than other CMIs in reducing? the incidences of nausea (III-IV) and leukopenia. More RCTs of Shenqi Fuzheng and astragalus polysaccharide injections combined with radiotherapy for patients with esophageal cancer were expected in the future to confirm our results. Moreover, study findings will be reported, particularly for the adverse events in radiotherapy for esophageal cancer.


Comparative bioethics in bipolar and epilepsy research.
AEDs are increasingly evaluated for efficacy in bipolar disorders utilizing double-blind, placebo-controlled, randomized clinical trials (RCTs) as required by the FDA. However, the risk to patients is under-estimated in trial design. Bipolar depression has a significant risk for suicide; bipolar episodes can lead to kindling with increased long-term morbidity; rapid regression may occur during the placebo phase or during dose ranging trials with resultant active suicide status. The associated risks mandate that the ethics of FDA-required protocols are addressed. Comparative analysis and literature review of bipolar and epilepsy research designs. In psychiatry, all INDs require RCTs for approval. In epilepsy, AEDs are initially approved as add-on agents only. Once AEDs have demonstrated add-on efficacy, cross-over studies comparing active AEDs, sub-optimal dosing paradigms, new-onset, and pre-surgical inpatient placebo trials are utilized to prove efficacy of the new AED in monotherapy. Ethical considerations to avoid seizures and to minimize risks to subjects have led to newer clinical trial designs. The FDA initially requires add-on studies with new AEDs due to the risk of seizures during the placebo phase. The author argues that bipolar research warrants similar add-on studies to prove efficacy because the risk of suicide and increased long-term morbidity in the bipolar population is as significant as the risk of seizures in the epilepsy population. Although the number of patients needed to prove statistical efficacy would increase, the safety of such research would also markedly increase. The author further concludes that with the risk of suicide during bipolar research, ethical considerations require increased frequency of patient contact with a significant other co-signing the informed consent for research and serving as a contact for the coordinator.


Characteristics associated with hepatitis A vaccination initiation and completion among adults traveling to a country of high or intermediate endemicity.
Hepatitis A (HepA) vaccine is recommended for adults traveling to a country of high or intermediate endemicity. The data from the 2016 and 2017 National Health Interview Survey were pooled in this analysis, and the weighted logistic regression model was adopted. Characteristics independently associated with HepA vaccination initiation (≥1 dose) (in descending order by odds ratio) include age, receipt of pneumococcal and influenza vaccine, education, sexual orientation, region, number of physician visits in the past 12 months, physical activity, marital status, computer use, ratio of family income to the poverty threshold, Hispanic ethnicity, and class of worker. Characteristics independently associated with HepA vaccination completion (≥2 doses) (in descending order by odds ratio) include age, receipt of pneumococcal and influenza vaccine, sexual orientation, education, region, marital status, number of physician visits in the past 12 months, ratio of family income to the poverty threshold, physical activity, Hispanic ethnicity, and computer use. HepA vaccination initiation and completion was associated with a number of characteristics, which can be used to develop strategies to increase HepA vaccination coverage among adults traveling to a country of high or intermediate endemicity.


Bayesian linkage and segregation analysis: factoring the problem.
Complex segregation analysis and linkage methods are mathematical techniques for the genetic dissection of complex diseases. They are used to delineate complex modes of familial transmission and to localize putative disease susceptibility loci to specific chromosomal locations. The computational problem of Bayesian linkage and segregation analysis is one of integration in high-dimensional spaces. In this paper, three available techniques for Bayesian linkage and segregation analysis are discussed: Markov Chain Monte Carlo (MCMC), importance sampling, and exact calculation. The contribution of each to the overall integration will be explicitly discussed.


Changes in liver membrane antigenicity and intracellular viral antigens expression in hepatitis B virus-infected hepatocytes.
In this paper we studied the presence of HBsAg and immunoglobulin G on the liver cell surface in patients with chronic HBV infection. For this purpose we developed a double immunofluorescence technique which allowed the contemporary detection of membrane antigens and the intracellular expression of HBV antigens (HbsAg and HBcAg) within the same hepatocyte. In 16 selected patients (10 with CAH and 6 with normal liver or NSRH) we found that the presence of membranous HBsAg is associated to the healthy carrier state of the infection and it correlates with the presence of abundant HBsAg in the cytoplasm of liver cells. On the contrary, membrane-bound IgG was found in patients with active virus replication and its presence correlates with nuclear HBcAg. On the basis of these results a modulatory effect of the cytophilic IgG on HBV cellular expression is proposed.


Meralgia paresthetica: etiology, diagnosis, and outcome of surgical decompression.
Entrapment of the lateral femoral cutaneous (LFC) nerve as a source of anterolateral thigh dysesthesias has been recognized for 100 years. Despite this historic recognition, its diagnosis today is often delayed, and definitive treatment of refractory cases by surgical decompression rarely reported. This study describes 26 LFC entrapments in 23 patients whose etiologies include iliac crest bone graft harvesting, seat belt injury associated with motor vehicle accident, and diabetes. Twenty-two of the 23 patients (25 of the 26 entrapments) achieved good to excellent outcomes following surgical decompression of the LFC nerve.


A network of dynamically conserved residues deciphers the motions of maltose transporter.
The maltose transporter of Escherichia coli is a member of the ATP-binding cassette (ABC) transporter superfamily. The crystal structures of maltose transporter MalK have been determined for distinct conformations in the presence and absence of the ligand ATP, and other interacting proteins. Using the distinct MalK structures, normal mode analysis was performed to understand the dynamics behavior of the system. A network of dynamically important residues was obtained from the normal mode analysis and the analysis of point mutation on the normal modes. Our results suggest that the intradomain rotation occurs earlier than the interdomain rotation during the maltose-binding protein (MBP)-driven conformational changes of MalK. We inquire if protein motion and functional-driven evolutionary conservation are related. The sequence conservation of MalK was analyzed to derive a network of evolutionarily important residues. There are highly significant correlations between protein sequence and protein dynamics in many regions on the maltose transporter MalK, suggesting a link between the protein evolution and dynamics. The significant overlaps between the network of dynamically important residues and the network of evolutionarily important residues form a network of dynamically conserved residues.


Neonatal Abstinence Syndrome Due to Maternal Kratom Use.
Neonatal abstinence syndrome (NAS) is increasing in incidence and most commonly associated with maternal opioid use during pregnancy. Nonopioid alternatives to treat opioid dependence are highly sought after in the country's current opioid epidemic. Whether Kratom, a legal, widely available herbal supplement, should be classified as an opioid is contentious. Although the US Food and Drug Administration has recently addressed this controversy, Kratom continues to be marketed as a nonopioid remedy for opioid withdrawal. Its use is increasing in the United States. We describe an infant with NAS born to a mother with daily Kratom tea ingestion to self-treat opioid dependence. Pediatricians and parents should be aware of the risk of NAS due to Kratom use during pregnancy.


A Neural Network to Locate the Copper-binding sites of Metalloprotein.
This paper presents an application of neural networks in location of the copper-binding sites of metalloprotein. Using annotated metalloprotein downloaded from PDB, sequences including copper-binding sites were extracted. By further finding the particular core segments of copper-binding sites, the input and output information for training is polished. Moreover, this paper investigates the number of input nodes whose input information was coded by the residues' hydrophobic values, the number of hidden nodes, the size of training window. Back propagation algorithms were chosen for training neural networks. Results showed that the method was capable of efficiently identifying copper-binding proteins and predicting copper-binding sites at a very high accuracy.


Experimental study of the reproduction of Karshi virus (Togaviridae, flavivirus) in some species of mosquitoes and ticks.
The strain Kaz-816 of Karshi virus was isolated in 1976 from H. asiaticum ticks collected in the North of Central Asia (Alma-Ata region of the Kazakh Soviet Socialist Republic). Both ticks and mosquitoes can be vectors of Karshi virus as proved experimentally by reproduction of the virus in Hyalomma asiaticum and Dermacentor daghestanicus ticks and Culex pipiens molestus, Anopheles atroparvus an Aedes aegypti mosquitoes as well as by transmission to newborn mice by the bite of infected mosquitoes.


Electrical determination of water content and concentration profile in a simulation model of in vivo stratum corneum.
Because of its efficient water-holding capacity, healthy stratum corneum (SC) can stay soft and flexible under any environmental conditions. There may be, however, a great difference in water content within the SC between the lowermost layer that faces the wet underlying living tissue and the superficial portion of the SC that is exposed to the relatively dry ambient atmosphere. To better understand the water profile of the SC and also to verify the accuracy of measurements of high frequency conductance used to evaluate the hydration state of the skin surface, we devised a simple and convenient in vitro model of the SC that stimulates the in vivo setting of the SC. It consists of an isolated sheet of SC whose lower surface covers a pad of water-saturated filter paper, and its upper surface is exposed to the ambient atmosphere. By placing this model in environments with different relative humidities (RH), we confirmed that the recorded conductance values correlated well with the actual water content of the SC (r = 0.94). Using a model having five layers of SC sheets, the water content of the innermost portion of the SC was estimated to be equivalent to about 90% of its dry weight; this level of water content remaining relatively constant over a wide range of ambient RH except in extraordinarily humid environments above 90% RH when water began to accumulate excessively in the whole SC. Using this five SC-sheet model, it was clearly demonstrated that there was an almost straight water concentration gradient from the lowermost layer to the uppermost layer of the SC. We also confirmed that the skin conductance of the high frequency current correlated well with the water content of the superficial portion of the SC as well as with that of the whole SC, therefore, it is a good parameter of the hydration state of the superficial layer of the SC.


Postmarketing surveillance versus clinical trials: which benefits the patient?
Both randomized controlled clinical trials and observational postmarketing surveillance studies have a place in providing information to physicians and patients on effectiveness and safety of new medicines. Prelicensing is the realm of the basic scientist producing a medicine which is available for investigation by clinical trial. In this context, manufacturers attempt to define the efficacy for desired indications and to establish an appropriate dosage for the drug. To do so, they usually confine attention to idealized standard patients, excluding all complex problems, such as pregnancy, renal or other organ failure, comorbidity, the elderly, the child, and so forth. Postmarketing surveillance covers the range of observational studies undertaken after marketing including cohort studies, case-control studies, and spontaneous reports of suspected adverse drug reactions. These observational studies are less rigorous than clinical trials, but have the potential to provide information from a representative sample of 'real-life' patients. Neither postmarketing surveillance studies nor clinical trials are capable of answering questions fully. In future, record linkage techniques may play a greater role by providing information on data linking drug exposures and outcomes in general practice.


Acute and long-term mental and physical sequelae in the aftermath of traumatic exposure - some remarks on "the body keeps the score".
Traumata, by definition, refer to exterior events that expose a person to experiences of overwhelming threat and catastrophe and elicit feelings of death anxiety, panic, horror, helplessness, loss of personal control, and intractability. Most affected persons respond with at least some distressing symptoms of trauma-related memory intrusions, autonomic hyperarousal, dissociation, and depression in the acute aftermath. Fortunately, the majority of traumatized individuals succeed in coping with this major stress quite well during the following weeks and months unless the process of recovery is hampered by additional adverse psychosocial circumstances, psychological disposition or biological vulnerability. In a subgroup of persons a transition to acute and posttraumatic stress disorder or other major psychiatric disorders, e.g. depressive, anxiety, substance-related disorders may be observed. Posttraumatic stress disorders very often run a chronic course of illness enduring for many years or even life-long. The typical course of illness in PTSD is characterized not only by major psychiatric comorbidities contributing to a dramatically reduced health-related quality of life, to many deficits of psychosocial adaptation and a heightened suicide risk. It is also associated with a lot of major somatic health problems both in acute and long-term stages. The main focus here is on this special dimension of physical comorbidities in posttraumatic disorders. Empirical evidence underscores that trauma exposure, and in particular PTSD is significantly associated with major physical health problems in addition to well-known PTSD-related psychological, behavioural, and psychosocial impairments. Both self-report-based and objective assessments emphasized significantly increased rates of somatoform/functional syndromes and physical comorbidities, premature all-cause and specific mortality rates, heightened medical utilization behaviours, major socioeconomic costs, and reduced health-related quality of life in the aftermath of trauma exposure and posttraumatic stress disorders, thus defining a major challenge to any medical care system. Complex psycho-behavioural-somatic and somato-psycho-behavioural models are needed to better understand both acute and long-term effects of a perpetuating stress system on physical health.


The clinical relevance of extreme dipping.
Hypertensive patients who demonstrate an exaggerated circadian blood pressure rhythm are known as 'extreme dippers'. 'Non-dippers' are those patients whose blood pressure remains elevated throughout the night. There are many cross-sectional studies in which greater hypertensive target organ damage has been seen in non-dippers. However, almost as many studies have demonstrated a positive association between organ damage and the magnitude of the circadian change in blood pressure. This apparent paradox may be explained by both nighttime pressure and the daytime rise in blood pressure being independently and positively associated with severity of hypertensive target organ damage. More recently, a number of prospective cohort studies have suggested that 'extreme dippers' are at a greater risk of cardiovascular events than those with more moderate circadian rhythms. These small studies have been criticised as being likely to include significant random and systematic errors. Large prospective studies will need to address issues such as optimal quantification of circadian rhythms, poor reproducibility and the likely confounding of results due to diverse antihypertensive therapies, if the association between dipping and adverse cardiovascular outcome is to be further clarified.


[Optimized-design of spectral discriminator for infrared spectra of polluted gases].
According to the spectral features of polluted-gases infrared spectra, a mixed multi-branch spectral discriminator is proposed. Experimental results indicate that the spectral discriminator not only has simple structure and high veracity for classification and recognition, but also has remarkable flexibility and stability. So it is a high-efficiency discriminator for real-time identified infrared spectra of polluted gases.


[Changes in plasma interleukin-33 concentration in sepsis and its correlation with seriousness of sepsis].
To observe the changes in plasma interleukin-33 (IL-33) in patients with sepsis and its regularity, the association between IL-33 and the infection, and the significance of IL-33 in predicting the prognosis of sepsis. A prospective single-center single-blind clinical study was conducted. Forty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medical University from May 2012 to January 2013 were enrolled. The patients were divided into general sepsis, severe sepsis and septic shock groups according to the severity of systemic infection and presence of organ dysfunction. The sepsis patients were again divided into 28-day death group and survival group. Ten healthy volunteers and 11 patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups. The levels of procalcitonin (PCT), IL-33, IL-6, IL-1β, tumor necrosis factor-α (TNF-α), and IL-33 receptor sST2 were determined with enzyme linked immunosorbent assay (ELISA) within 3 hours, and 24 hours and 5 days after enrollment to ICU. The acute physiology and chronic health evaluation II (APACHE II) score was calculated. The clinical outcome, length of stay in ICU, and duration of mechanical ventilation were recorded. The relationship between IL-33 and each parameter was analyzed by Spearman analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate IL-33 in predicting the outcome of sepsis. Plasma IL-33 in sepsis patients within 3 hours after admission was significantly increased compared with that of the healthy controls and SIRS group (ng/L: 15.43±7.22 vs. 0.67±0.24, 1.25±1.09, both P < 0.01). Compared with SIRS group, PCT in sepsis group was significantly increased [μg/L: 52.23 (19.69, 73.37) vs. 1.22 (0.69, 3.73), Z = -2.447, P < 0.001]. With exacerbation of illness, APACHE II score, the values of PCT and IL-33 were gradually increased in general sepsis, severe sepsis and septic shock groups, while the length of stay in ICU and the duration of mechanical ventilation were gradually prolonged (P < 0.05 or P < 0.01). The concentration of IL-33 (ng/L) of sepsis patients admitted to ICU within 3 hours, and 24 hours and 5 days of the illness was 15.43±7.22, 11.82±6.16, 5.55±2.25, respectively (F = 4.823, P = 0.004). There was a positive correction between IL-33 within 3 hours after ICU admission and APACHE II score (r = 0.351, P = 0.031), PCT (r = 0.412, P = 0.005), IL-6 (r = 0.535, P = 0.030), IL-1β (r = 0.674, P = 0.030), TNF-α (r = 0.250, P = 0.030), sST2 (r = 0.620, P < 0.001), and length of stay in ICU (r = 0.296, P = 0.013), duration of mechanical ventilation (r = 0.385, P = 0.011). Decreased plasma IL-33 level could be found in the survivors (n = 37, F = 7.798, P < 0.01), and its level in non-survivors (n = 3) was increased (F = 37.283, P > 0.05). The area under the ROC curve (AUC) of IL-33 and PCT in ROC curve were 0.821, 0.829. When the cut-off value of IL-33 was 13.79 ng/L, the sensitivity was 74.2%, the specificity was 79.6%; when the cut-off value of PCT was 4.70 μg/L, the sensitivity was 87.5%, and the specificity was 81.4%. The concentration of IL-33 3 hours after ICU admission was obviously increased in sepsis patients, and it was positively correlated with PCT, therefore it is valuable in the diagnosis of the infection. In addition plasma IL-33 is related to the severity of sepsis. Its trend of change is valuable in predicting the outcome and in distinguishing sepsis from SIRS.


Selective determination of sultopride in human plasma using high-performance liquid chromatography with ultraviolet detection and particle beam mass spectrometry.
We developed a sensitive and selective method for determining levels of sultopride, a neuroleptic drug of the substituted benzamide, in human plasma using high-performance liquid chromatography (HPLC) combined with UV detection and particle beam mass spectrometry (PBMS). Sultopride was extracted with tert.-butylmethyl ether using a salting-out technique. Tiapride served as an internal standard (I.S.). Sultopride and I.S. were separated by HPLC on a silica column with a mobile phase of acetonitrile-0.1 M ammonium acetate (94:6, v/v). The calibration curves were linear over the concentration range from 5 to 1000 ng/ml by HPLC with UV detection and from 10 to 1000 ng/ml with PBMS detection. The limit of quantitation was 5 ng/ml with UV detection and 10 ng/ml with PBMS detection. The absolute recovery was 92% and the within-day coefficients of variation were 2.9-7.1% at plasma concentrations from 50 to 500 ng/ml, determined by HPLC with UV detection. Using this method, we measured the plasma concentrations of sultopride with replicate analyses in four hospitalized patients and steady-state plasma levels were determined to be 161.6 +/- 30.8, 321.1 +/- 93.7, 726.5 +/- 143.1 and 1273.6 +/- 211.2 ng/ml, respectively.


[Untoward side effects of chemoradiotherapy in children with malignant brain tumors].
Untoward side-effects of chemoradiotherapy were compared in 48 children treated for brain tumors and those in remission lasting from less than 12 months to 11 years. The investigation concerned disturbances in the neurologic, endocrine, cardiovascular, urinary, hepatobiliary and psychic systems; neurologic ones proved the most frequent. No cases of heart failure were reported among patients with brain tumors during remission. Hormonal study revealed inhibited thyroid function in brain tumor sufferers.


Construction and characterization of vaccinia direct ligation vectors.
Poxvirus vectors are extensively used as expression vehicles for protein and antigen expression in eukaryotic cells. Customarily, the foreign DNA is introduced into the poxvirus genome by homologous recombination. An alternative method using direct ligation vectors has been used to efficiently construct chimeric genomes in situations not readily amenable for homologous recombination. We describe the construction and characterization of a new set of direct ligation vectors designed to be universally applicable for the generation of chimeric vaccinia genomes. These vectors contain the pair of unique restriction sites NotI and ApaI to eliminate religation of poxvirus arms and fix the orientation of the insert DNA behind strongly expressing constitutive vaccinia promoters. The insertion cassette has been placed at the beginning of the thymidine kinase gene in vaccinia to use drug selection in the isolation of recombinants. These viruses provide a set of universally applicable direct ligation poxvirus cloning vectors, extending the utility of poxvirus vectors for construction and expression of complex libraries.


Claims for contraceptive services among young women filling chronic opioid prescriptions.
To describe claims for contraceptive services among reproductive-aged women filling chronic opioid prescriptions. Using a large US commercial claims database, IMS Lifelink+, we identified women aged 15-44 years who filled chronic opioid prescriptions (defined as a 90-day supply of opioids without a 30-day gap over a 180-day time period) and had continuous pharmacy and medical enrollment for at least 90 days prior to and 180 days following their index opioid prescription. After excluding women with any claims for pregnancy-related services, we describe claims for contraceptive prescriptions. We identified 16,074 women with claims for chronic opioids who had filled an average of 135±28-day supply of opioids over a 180-day period. Of these, 23.4% (n=3759) had a claim for prescription contraception in the 90 days prior or 180 days following their index opioid claim. Of those who had claims for prescription contraception, 70% (n=2642) received oral contraceptives; only 2% had claims related to a long-acting reversible contraceptive (i.e., a contraceptive implant or intrauterine device). Commercially insured women filling chronic opioid prescriptions may have unmet needs for prescription contraception. Efforts are needed to ensure that the reproductive health needs of women filling chronic opioid prescriptions are met.


The effect of pelvic factures on future stress incontinence and pelvic organ prolapse surgery.
Pelvic fractures in women significantly disrupt the pelvic floor, which may cause stress urinary incontinence (SUI) or pelvic organ prolapse (POP). Our objective was to assess the incidence of operative treatment for SUI and POP after pelvic fracture. We used administrative data from Ontario, Canada, to conduct a retrospective cohort study. Female patients who underwent operative repair of a pelvic fracture between 2002 and 2010 were identified. The primary outcomes were the subsequent surgical treatment of SUI or POP. To compare the incidence with that of the general population, patients who had operative repair of a pelvic fracture were matched (1:2) to a person in the general population (with a propensity score to account for measurable potential confounders). Our primary analysis was a Cox proportional hazards model to compare hazard ratios (HR) in subjects with a pelvic facture and those without. We identified 390 female patients with a median age of 47 (IQR 30-67) years. Our median follow-up period was 5.9 (4.1-8.3) years. The absolute risk of SUI surgery after pelvic fracture was 3.3 % (13 out of 390) compared with 1.0 % (8 out of 769) in the matched general population sample. The HR for SUI surgery was 5.8 (95 % CI 2.2-15.1). The absolute risk of POP surgery after pelvic fracture was 1.8 % (7 out of 390) compared with 0.9 % (7 out of 769) in the matched general population. The HR for POP surgery was 2.3 (95 % CI 0.9-5.8). Among patients who had a pelvic fracture requiring operative repair, there appears to be a significantly increased chance of surgery for SUI, but not for POP.


Genomic organization of repetitive DNAs in the cichlid fish Astronotus ocellatus.
To contribute to the knowledge of fish genomes, we identified and characterized by means of nucleotide sequencing and physical chromosome mapping, three classes of repetitive DNAs in the genome of the South American cichlid fish Astronotus ocellatus. The first class corresponds to a satellite DNA family (AoSat) that shares similarity with a centromeric satellite DNA of the pufferfish Tetraodon nigroviridis. The second repetitive DNA class (AoRex3) is related to the retrotransposon Rex3, which is widely distributed among teleost fishes. The last repetitive element (AoLINE) shows a high similarity to the CR1-like LINE element of other teleosts. The three isolated repetitive elements are clustered in the centromeric heterochromatin of all chromosomes of the complement. The repetitive sequences are not randomly distributed in the genome, suggesting a pattern of compartmentalization on chromosomes.


[Surgical treatment of choledochal cyst].
Our experience with 11 cases of cystic dilation of the biliary tract is reported. 10 children with choledochal cyst were treated by cystduodenostomy (5 cases) and excision of the cyst with hepaticojejunostomy (5 cases). 1 patient who presented with Caroli's disease was not operated. At long term follow-up, all patients except 1 are asymptomatic. A 16-year-old girl who presented with acute pancreatitis 13 years following cystduodenostomy, early in our experience, underwent excision of the choledochal cyst and hepaticojejunostomy, with uneventful postoperative course. We conclude that in the era of modern imaging, accurate preoperative diagnosis may contribute to better planning and outcome of the surgical treatment of these relatively rare congenital biliary anomalies.


Conversion of CHF(3) to CH(2)CF(2) via reaction with CH(4) in the presence of CBrF(3): An experimental and kinetic modelling study.
Gas-phase reaction of CHF(3) (HFC 23) with CH(4) in the presence of CBrF(3) (halon 1301) to produce CH(2)CF(2) (VDF) is presented. Experiments were carried out in a plug-flow reactor at temperatures between 873 and 1173 K. Under these conditions, CH(2)CF(2) was a dominant product observed, with CH(2)F(2), C(2)H(2), CH(2)CHF, C(2)F(4), C(2)H(6) and CHFCF(2) also detected. In the presence of less than 6000 ppm of CBrF(3), the rate of formation of CH(2)CF(2) is significantly enhanced, and a much lower rate of formation of the major by-product, C(2)F(4) is observed. Further increasing the proportion of CBrF(3) in the feed resulted in an even higher rate of formation of CH(2)CF(2). Experimental results are fitted very well by a model derived from the NIST and GRI-Mech 3.0 mechanisms, modified to include additional published kinetic data.


Electrospun polyphosphazene nanofibers for in vitro rat endothelial cells proliferation.
A large variety of natural and synthetic polymers have been explored as scaffolds for the seeding and growth of different types of cells. To fabricate a scaffold that can be used as a synthetic extracellular matrix (ECM), it is important to replicate the nanoscale dimensions of natural ECM. The electrospinning process allows to produce ultrathin fibers so that this method represents a suitable approach to scaffold fabrication for tissue engineering applications. In this work, the feasibility of obtaining flat or tubular matrices from biocompatible poly[(ethyl phenylalanato)(1.4) (ethyl glycinato)(0.6) phosphazene] by electrospinning was evaluated and the effect of process parameters on the diameter of nanofibers was examined. The adhesion and growth of rat neuromicrovascular endothelial cells cultured on sheets and tubes composed by the polymer with an average fiber diameter of 850 +/- 150 nm were also reported. Microscopic examination of the seeded tubes demonstrated that, after 16 days of incubation, endothelial cells formed a monolayer on the whole surface. These results are the first step to demonstrate that tubes of biodegradable polyphosphazenes might be a feasible model to construct human tissues such as vessels or cardiac valves.


Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review.
Sacrectomy is a highly demanding surgery representing the main treatment for primary tumors arising in the sacrum and pelvis. Unfortunately, it is correlated with loss of important function depending on the resection level and nerve roots sacrificed. The current literature regarding residual function after sacral resection comes from several small case series. The goal of this review is to appraise residual motor function and gait, sensitivity, bladder, bowel, and sexual function after sacrectomies, with consideration to the specific roots sacrificed. An exhaustive literature search was conducted. All manuscripts published before May 2015 regarding residual function after sacrectomy were considered; if a clear correlation between root level and functioning was not present, the paper was excluded. The review identified 15 retrospective case series, totaling 244 patients; 42 patients underwent sacrectomies sparing L4/L4, L4/L5 and L5/L5; 45 sparing both L5 and one or both S1 roots; 8 sparing both S1 and one S2; 48 sparing both S2; 11 sparing both S2 and one S3, 54 sparing both S3, 9 sparing both S3 and one or both S4, and 27 underwent unilateral variable resection. Patients who underwent a sacrectomy maintained functionally normal ambulation in 56.2 % of cases when both S2 roots were spared, 94.1 % when both S3 were spared, and in 100 % of more distal resections. Normal bladder and bowel function were not present when both S2 were cut. When one S2 root was spared, normal bladder function was present in 25 % of cases; when both S2 were spared, 39.9 %; when one S3 was spared, 72.7 %; and when both S3 were spared, 83.3 %. Abnormal bowel function was present in 12.5 % of cases when both S1 and one S2 were spared; in 50.0 % of cases when both S2 were spared; and in 70 % of cases when one S3 was spared; if both S3 were spared, bowel function was normal in 94 % of cases. When even one S4 root was spared, normal bladder and bowel function were present in 100 % of cases. Unilateral sacral nerve root resection preserved normal bladder function in 75 % of cases and normal bowel function in 82.6 % of cases. Motor function depended on S1 root involvement. Total sacrectomy is associated with compromising important motor, bladder, bowel, sensitivity, and sexual function. Residual motor function is dependent on sparing L5 and S1 nerve roots. Bladder and bowel function is consistently compromised in higher sacrectomies; nevertheless, the probability of maintaining sufficient function increases progressively with the roots spared, especially when S3 nerve roots are spared. Unilateral resection is usually associated with more normal function. To the best of our knowledge, this is the first comprehensive literature review to analyze published reports of residual sacral nerve root function after sacrectomy.


Decisions regarding pregnancy termination among Bedouin couples referred to third level ultrasound clinic.
To identify predictors of parental decision whether to terminate a pregnancy after a diagnosis of a major congenital malformation in a traditional society. The Bedouin Arabs in southern Israel are a traditional society, with a high incidence of congenital disorders. Data were abstracted from medical records of 295 families who sought counseling in the third level ultrasound clinic between 1990 and 1996. Statistical analysis included univariate and multiple logistic regression. The diagnosis of a major malformation was confirmed in 64% of the cases. Pregnancy termination was a realistic option for 125 women (66.5%) as the rest were too advanced in their pregnancy. Such a delay was less common in cases of multiple malformations than in a single malformation (19.2% versus 39.0% respectively, P < 0.01). Forty-nine of the 125 women (39.2%) chose to terminate their pregnancy. The only significant predictors of termination decision were earlier gestational week at diagnosis and previous uncompleted pregnancies. These findings indicate the importance of promoting early genetic counseling and early prenatal diagnosis, for any population where abortions are not readily acceptable.


Evaluation of magnetic resonance angiography in detection of gastric varices.
We evaluated the detection of gastric varices, inflowing blood vessels to gastric varices, and outflowing blood vessels from gastric varices via magnetic resonance (MR) angiography in 31 patients with gastric varices. Twenty-four patients had F2 type varices and 7 had F3 type, classified according to the Japanese Research Society for Portal Hypertension. Seventeen patients had cardiofornical varices, and 14 had fundal varices. All patients were examined with an MR system operating at 1.5T. MR angiography was performed using the two-dimensional time-of-flight method. With MR angiography, the imaging of gastric varices was clearly delineated in 28 of the 31 patients (90.3%). From the images of MR angiography, flow direction itself cannot be determined. The outflowing blood vessels of gastric varices were reported to be the gastro-renal shunt and the subphrenic vein, and angiographic findings have shown the inflowing blood vessels to be the left gastric vein (LGV), the short gastric vein (SGV), and the posterior gastric vein (PGV). In 25 of the 31 patients (80.7%), the outflowing blood vessels from gastric varices were detected (gastro-renal shunt in 24; subphrenic vein in 1). MR angiography provided clear images of the inflowing blood vessels to gastric varices in 18 of the 31 patients (58.1%). These inflowing vessels were categorized as SGV in 7 patients, LGV in 5, LGV and SGV in 4, and LGV and PGV in 2. We suggest that MR angiography be used as a routine method for detecting and diagnosing collateral veins in patients with gastric varices.


ABC Transporters in Neurological Disorders: An Important Gateway for Botanical Compounds Mediated Neuro-Therapeutics.
Neurodegeneration is a distinguishing feature of many age related disorders and other vector borne neuroinflammatory diseases. There are a number of factors that can modulate the pathology of these disorders. ATP-binding cassette (ABC) transporters are primarily involved in the maintenance of normal brain homeostasis by eliminating toxic peptides and compounds from the brain. Also, ABC transporters protect the brain from the unwanted effects of endogenous and exogenous toxins that can enter the brain parenchyma. Therefore, these transporters have the ability to determine the pathological outcomes of several neurological disorders. For instance, ABC transporters like P-glycoprotein (ABCB1), and BCRP (ABCG2) have been reported to facilitate the clearance of peptides such as amyloid-β (Aβ) that accumulate in the brain during Alzheimer's disease (AD) progression. Other members such as ABCA1, ABCA2, ABCC8, ABCC9, ABCG1 and ABCG4 also have been reported to be involved in the progression of various brain disorders such as HIV-associated dementia, Multiple sclerosis (MS), Ischemic stroke, Japanese encephalitis (JE) and Epilepsy. However, these defective transporters can be targeted by numerous botanical compounds such as Verapamil, Berberine and Fascalpsyn as a therapeutic target to treat these neurological outcomes. These compounds are already reported to modulate ABC transporter activity in the CNS. Nonetheless, the exact mechanisms involving the ABC transporters role in normal brain functioning, their role in neuronal dysfunction and how these botanical compounds ensure and facilitate their therapeutic action in association with defective transporters still remain elusive. This review therefore, summarizes the role of ABC transporters in neurological disorders, with a special emphasis on its role in AD brains. The prospect of using botanical/natural compounds as modulators of ABC transporters in neurological disorders is discussed in the latter half of the article.


[Clinical characteristics of psoriasis in middle-aged and elderly subjects].
Clinical features of psoriasis have been examined in 113 elderly and senile patients. The incidence rate of complicated forms of the dermatoses, associated with manifest subjective sensations, is higher in this patient population than generally in psoriasis. Clinical and laboratory studies have revealed a number of concomitant diseases contributing to the severe course of psoriasis. Combined therapy of elderly and senile patients suffering from psoriasis included drugs normalizing metabolic processes, improving the functions of the liver, cardiovascular and nervous systems.


DNA microarraying on compact disc surfaces. Application to the analysis of single nucleotide polymorphisms in Plum pox virus.
The potential of using compact discs as high throughput screening platforms for DNA microarraying is discussed and applied to discriminate genetic variations of Plum pox virus.


The influence of water temperature on induced liver EROD activity in Atlantic cod (Gadus morhua) exposed to crude oil and oil dispersants.
Juvenile Atlantic cod were exposed to either the water-accommodated fraction (WAF) or the chemically enhanced water-accommodated fraction (CEWAF) of Mediterranean South American (MESA), a medium grade crude oil at three different temperatures. Two concentrations of each mixture were tested, 0.2% and 1.0% (v/v) at 2, 7 and 10°C. Corexit 9500 was the chemical dispersant tested. The liver enzyme ethoxyresorufin-O-deethylase (EROD) was measured during a 72-h exposure. The WAF of oil had significant (P<0.05) effect on enzyme activity compared to controls at only one sampling time: 48 h at 10°C. Exposure of CEWAF of oil resulted in significantly (P<0.05) elevated EROD activity compared to controls. The level of EROD induction was temperature related with higher induction being observed in cod exposed to CEWAF at higher temperatures. Total polycyclic aromatic hydrocarbon (PAH) concentrations in exposure water were significantly higher in chemically dispersed mixtures. While PAH concentrations were lower in the 2°C water compared to 7 or 10°C (8.7 vs 11.9 μg mL(-1)), the level of EROD induction was approximately 9 and 12 times lower at 2°C compared to 7 or 10°C, respectively, suggesting the metabolic rate of the cod plays a role in the enzyme response. These data suggest the risk of negative impacts associated with exposure to chemically dispersed oil may be affected by water temperature and that risk assessment of potential effects of WAF or CEWAF should consider the effects of water temperature on the physiology of the fish as well as the effectiveness of dispersants.


[Central prolapse of the Th12 -L1 nucleus pulposus with radiological signs of tumor of the conus medullaris].
The authors report a 42-year-old patient with excruciating pains felt in the interscapular and lumbar regions and both lower extremities without symptoms of root involvement. Myelography suggested presence of a tumour of the conus medullaris or epidural tumour in this area, at the Th12--L1 level. During the operation a central prolapse of the nucleus pulposus was found in the midline on the anterior wall of the vertebral canal below the longitudinal ligament. After operation all symptoms disappeared and the patient resumed work.


Ligand binding properties of human galanin receptors.
The galanin receptor family comprises of three members, GalR1, GalR2 and GalR3, all belonging to the G-protein-couple receptor superfamily. All three receptors bind the peptide hormone galanin, but show distinctly different binding properties to other molecules and effects on intracellular signaling. To gain insight on the molecular basis of receptor subtype specificity, we have generated a three-dimensional model for each of the galanin receptors based on its homologs in the same family. We found significant differences in the organization of the binding pockets among the three types of receptors, which might be the key for specific molecular recognition of ligands. Through docking of fragments of the galanin peptide and a number of ligands, we investigated the involvement of transmembrane and loop residues in ligand interaction.


Salvage external beam radiotherapy for local recurrence without systemic progression or prostate specific antigen recurrence of prostate cancer after initial hormonal therapy: is it possible to identify patients likely to have good treatment outcomes?
We attempted to identify factors that predict the outcomes of salvage external beam radiotherapy (sEBRT) in patients who showed local recurrence without systemic progression or isolated prostate specific antigen (PSA) recurrence after initial hormonal therapy. The subjects were 33 patients who were diagnosed as having local recurrence without systemic progression (30 cases) or isolated PSA recurrence (three cases). Of these patients, those with continuously decreasing PSA levels, which were 1.0 ng/ml or less 1-1.5 years after sEBRT, were regarded as good responders (GR) whereas the remaining patients were regarded as poor responders (nGR). Survival rates in these patients and factors that distinguish GR from nGR were evaluated retrospectively. The cancer-specific 10-year survival rate was 82.4% in the 33 patients, 100% in the 21 GR patients and 55% in the 12 nGR patients (P < 0.0001). Stepwise variable selection to discriminate between GR and nGR revealed that the time from sEBRT initiation to the nadir PSA was the most significant factor (P = 0.000097). Before sEBRT, GR can be predicted in patients with pre-sEBRT PSA <30.0 ng/ml and PSA doubling time (PSADT) >7.0 months, with a sensitivity of 95.2% (20/21), a specificity of 100% and an accuracy of 97.0%. Good responses to sEBRT can be expected in patients with local recurrence without systemic progression or isolated PSA recurrence after initial hormonal therapy when the patients show both pre-sEBRT PSA <30.0 ng/ml and PSADT >7.0 months.


Arginine-stabilized mPEG-PDLLA (50/50) polymeric micelles of docetaxel by electrostatic mechanism for tumor-targeted delivery.
Arginine-stabilized, docetaxel-loaded polymeric micelles (AR-DTX-PM) were prepared to enhance the physical stability of micelles and control the degradation of docetaxel (DTX). Amphiphilic diblock copolymers, methoxy-(Polyethylene Glycol)-block-Poly (D, L-lactide) (mPEG-PDLLA) were synthesized and used for the formulation of lyophilized DTX-PM powders. The micelles were found to have diameters of 20-30 nm with narrow polydispersity, and the entrapment efficiency was 90-100%. The accumulative release of AR-DTX-PM was higher than that of glucose-dispersed DTX-PM (Glu-DTX-PM). The results of both physical and chemical stability studies showed that the concentration of arginine required for optimum stability was 2.0 mg/ml. Preliminary investigation of the mechanisms of stabilization by arginine suggested that it is due to the electrostatic interaction as well as hydrogen bonds between DTX and arginine. The acute toxicity studies demonstrated that AR-DTX-PM was better tolerated in beagle dogs than DTX injection. However, the pharmacokinetic studies revealed no significant difference in Cmax and AUC of AR-DTX-PM compared to DTX injection. When AR-DTX-PM was administrated at a dose of 30 mg/kg, the antitumor effect was stronger than that of commercial DTX injection at 10 mg/kg, and the increase of administration dose did not cause higher toxicity. The in vivo imaging test showed that the residence time of AR-DTX-PM at tumor sites was longer than its commercial formulation. In a word, it is expected that AR-DTX-PM can reduce systemic toxicity while retaining antitumor efficacy in cancer patients.


Parent- and adolescent-reported barriers to participation in an adolescent overweight and obesity intervention.
This study explored reported barriers to treatment completion in a sample of adolescents and their parents who either completed or did not complete family-based cognitive behavioral lifestyle intervention for overweight and obese adolescents. The sample comprises 56 overweight or obese adolescents (52% female) aged 11.5-18.9 years (mean = 14.5, s.d. = 1.8) and a parent. 57% of families did not complete treatment and maintenance phases of the intervention. A telephone-administered questionnaire assessing barriers to participation was completed by 96% of adolescents and 91% of parent completers and 100% of adolescents and 94% of parent noncompleters. Adolescents and parents most commonly reported barriers to participation related to research demands, treatment approach, program components/strategies, practical barriers, and other individual/family demands. Parents also noted adolescent effort, parent-adolescent conflict, and adolescent unhappiness as barriers to participation. While both completers and noncompleters experienced barriers to participation, families who discontinued treatment reported experiencing more treatment barriers. Findings of the current study suggest that adolescents and parents may find it easier to participate in adolescent overweight and obesity interventions if research and out-of-session program demands are minimized, efforts are made to enhance adolescent motivation, and treatment is offered in a convenient location and scheduled around school holidays and other family demands. Results also suggest that targeting adolescent unhappiness, family stressors, and parent-adolescent conflict in treatment may improve retention. Future research should explore the impact of these modifications on treatment completion and outcomes.


[Surgical management of Barrett's esophagus].
Barrett's esophagus is a complication of gastroesophageal reflux disease in which metaplastic, intestinal-type epithelium containing mucin-producing goblet cells with characteristic staining on histology replaces the squamous epithelium normally found in the esophagus. This condition is named after the British thoracic surgeon, N. R. Barrett. Treatment in various stages of the disease continues to provoke controversy. Different surgical procedures are suggested in dysplasia free patients, in low grade dysplasia, high grade dysplasia and adenocarcinoma. Instead of the widely accepted surgical procedure with high grade dysplasia and early carcinoma we suggest an intervention which is oncologically radical, functionally adequate and less inconvenient and stressing for the patients: left side thoraco-laparotomy, distal esophageal and proximal (lesser curvature) gastric resection with adequate lymphadenectomy and reconstruction with esophago-jejuno-gastric interposition.


Syntheses of 23-deoxy-23-N-ethyl-23-(2-fluoro-, 2,2-difluoro-, and 2,2,2-trifluoroethyl)amino derivatives of mycaminosyl tylonolide and 4'-deoxymycaminosyl tylonolide.
Derivatives of mycaminosyl tylonolide (1) and 4'-deoxymycaminosyl tylonolide (2) containing N-ethyl-2-fluoro-, 2,2-difluoro- and 2,2,2-trifluoroethylamino groups at their C-23 have been prepared by treating 23-deoxy-23-ethylaminomycaminosyl tylonolide diethyl acetal (14) and its 4'-deoxy analog 15 with 2-fluoro-, 2,2-difluoro- and 2,2,2-trifluoroethyl trifluoromethanesulfonates. The relationship between the antibacterial activity and the numbers of the fluorine atoms introduced in the final products is discussed.


Knowledge, attitudes and practices of health care workers regarding needle stick injuries at a tertiary care hospital in Pakistan.
To assess the knowledge, attitude and practices of HCWs regarding needle stick injuries at the Aga Khan University Hospital. A cross-sectional study was conducted on medical personnel. A structured pre-tested questionnaire was administered during June-July 2003. The data was analysed by SPSS 13.0. Percentages of the categorical variables were computed and compared by Chi square test at a 5% level of significance. Odds ratios and their 95% CIs were also computed. Of 80 participants, 29 were doctors and 51 were registered nurses. About 45% reported having a needle stick injury in the past. Frequency of injury was significantly higher among doctors (p < 0.001). The most common reason identified was stress or being over burdened followed by careless attitude. More than 50% of the injuries occurred while injecting or drawing blood samples. The risk of getting infections was well known amongst both the groups. Two third of participants were familiar with the prevention protocols and practices of nurses were generally safer than doctors (p < 0.001). Despite knowing the risks, frequency of needle stick injury was generally higher especially among doctors reflecting bad practice and careless attitude towards work. Mandatory reporting, proper follow-up and constant reinforcement are recommended to reduce the rate of nosocomial transmission to health care workers.


[Cardura (doxazosin) in the treatment of prostatic adenoma].
The author submits analysis of treatment of 20 patients with adenoma of the prostate gland with the selective alpha 1-adrenoblocker doxazosin (Cardura, Pfizer, USA). The above drug was found to be more efficacious than placebo, as evidenced by reduction of disease symptoms and acceleration of rate of urination. There were no unfavourable side effects, drop of blood pressure or worsening of the sexual function. Doxazosin on a single-administration basis daily was also found to be a satisfactory and worth-while exercise. The results obtained suggest usefulness of Cardura as a non-surgical alternative treatment option for adenoma of the prostate gland.


Contractile proteins in myocardial cells are regulated by factor(s) released by blood vessels.
The importance of perfusion of the coronary vasculature in the regulation of ATPase activity of myosin in rat myocardial cells has been studied. Quantitative histochemistry was used to determine the activity of the enzyme among cells in tissues that had been either perfused through the coronary system or superfused over the surface of the tissue. Enzymatic activity was measured in cryostatic sections from three different preparations: 1) hearts frozen immediately after removal from the animal; 2) isolated hearts frozen after they had been perfused through the coronary circulation; and 3) isolated papillary muscles or trabeculae that had been superfused after dissection and then frozen. ATPase activity was measured in the isolated tissues at different times after dissection. Both calcium- and actin-activated myosin ATPase activities were uniform among cells in both the ventricles of the hearts frozen immediately after dissection and those that had been perfused through the coronary system. In the superfused tissues, although calcium-activated myosin ATPase activity was uniform, actin-activated ATPase activity was not uniform for about 90 minutes after the dissection, the period required for stabilization of the contraction. The pattern of nonuniformity was complex. In all bundles the lowest enzymatic activity was found in the most superficial cells. In very thin bundles, the cells in the center had the highest activity. In the medium and thicker bundles, there were three concentric zones of actin-activated ATPase activity, the superficial zone with the lowest activity, an intermediate zone with high activity, and a central zone with lower activity. Within each zone, the activity was often greatest in myocardial cells immediately next to blood vessels even though the blood vessels had not been perfused. The transverse distribution of ATPase activity of myosin could be explained by a mechanism in which cells in blood vessels (presumably endothelium) release a substance that upregulates myosin ATPase activity, with the rate of release being related to the local oxygen tension. A downregulating substance may also be produced. The period of stabilization of the contraction coincides with the time during which the pattern of actomyosin ATPase activity is nonuniform. These data suggest that the contractile proteins are regulated by a substance produced by blood vessels in proportion to the local PO2, and possibly in relation to shear force on the vascular endothelium.


The contribution of motor unit pairs to the correlation functions computed from surface myoelectric signals.
The contribution of motor unit action potential trains (MUAPT) of distinct motor units (MU) to the crosscorrelation function between myoelectric signals (MES) recorded at the skin surface is studied. In specific, the significance of the correlation between the firing activity of concurrently active MUs (which results in cross-terms in the overall correlation function) is compared to the representation obtained using the contributions of single MUs at each recording site (auto-terms). A model for the generation of surface MUAPs is combined with the generation of MU firing statistics in order to obtain surface MUAPTs. MU firing statistics are simulated to incorporate MU synchronization levels reported in the literature. Alternatively, experimental firing statistics are fed to the model generating the MUAPTs. The contribution of individual MU pairs to the global myoelectric signal correlation function is assessed. Results indicate that the cross-terms from different MUs decrease steadily contributing very little to the overall correlation for record lengths as short as 30 s. Thus, the error expected when computing the crosscorrelation function between two channels of MES as the superposition of the auto-terms contributed by single MUs (i.e., ignoring the cross-terms from different MUs) is shown to be very small.


Ten-year results of the Oregon program with 295 consecutive heart transplants in the Pacific Northwest.
The Oregon Cardiac Transplant Program provides a regional service. Since December 4, 1985, 284 patients, including 14 children, from Oregon, Washington, Idaho, Alaska, and Hawaii, underwent 295 orthotopic heart transplantation procedures at the Oregon Health Sciences University. Eleven patients underwent transplantations twice. Detailed, up-to-date follow-up data were available on all patients. All patients have been followed up prospectively for transplant-related complications. The most common recipient diagnoses were coronary artery disease (50%) or idiopathic cardiomyopathy (33%). The mean age of the recipients was 48 +/- 15 years (range, 3 months to 68 years). Donor hearts were retrieved from a procurement area of a 1,500-mile radius that involved Oregon, Washington, Idaho, Nevada, Utah, California, and Canada. The mean donor age was 28 +/- 11 years and the donor heart ischemia time was 180 +/- 56 minutes. The median recipient waiting time was 75 days. Operative mortality was 6%. One-year, 5-year, and 10-year actuarial patient survival rates are 86 +/- 2%, 74 +/- 3%, and 59 +/- 5%, respectively. The majority of survivors are in very good functional status. Now, more than 10 years into its existence, the Oregon Heart Transplant Program has fulfilled its goal of providing a most effective treatment option for patients with end-stage heart disease in the region.


Does chronic nociceptive stimulation alter the development of morphine tolerance?
Conflicting results exist concerning the issues of whether chronic nociceptive stimulation (a) increases or decreases the effectiveness of morphine analgesia, and (b) facilitates or inhibits the development of narcotic tolerance. We carried out a series of experiments with appropriate controls in order to examine these two issues and their possible relationship. In experiment 1, rats received complete Freund's adjuvant (CFA), a chronic nociceptor, injected into a single hind paw or anesthesia without injection, together with morphine or placebo pellets in a 2 x 2 study design. The data indicate that the presence of the chronic nociceptive stimulus significantly facilitated the development of tolerance to morphine analgesia as measured using tail-flick latency (TFL) testing. Experiment 2 was designed to compare the analgetic effectiveness of an acute injection of morphine in rats experiencing chronic nociceptive stimulation and in controls. CFA was injected in the right hindpaw, and nine days later TFLs were tested after morphine doses of 1 and 2 mg/kg s.c. The data obtained showed that chronic nociceptive stimulation significantly reduced the effectiveness of morphine at the 1 mg/kg dose. However, baseline TFLs appeared to be shorter in rats treated with CFA, suggesting that the decrease in morphine effectiveness could be due to a general increase in pain sensitivity. Therefore, a third experiment was performed, using a less intense thermal stimulus to prolong baseline TFLs and accentuate any potential differences. Sixteen rats either received CFA or served as controls. TFLs were then measured at baseline and one hour after a 0.5 mg/kg dose of morphine.(ABSTRACT TRUNCATED AT 250 WORDS)


MEASUREMENT AND REPORTING OF RADON EXPOSURES.
Lung cancer risk caused by the inhalation of radon (222Rn) and its short-lived progeny is related to lung dose, which cannot be directly measured. The only measurable parameters which allow the determination of lung doses are the radon and radon progeny activity concentrations and related size distributions. Although lung cancers are caused by the inhaled short-lived radon progeny and not by the radon gas, it is the radon gas which is commonly measured and not its progeny. Since radon gas measurements are much easier to carry out, require less expensive equipment and are especially suited for long-term measurements, the report focuses on the measurement of the radon gas for specific exposure conditions in homes and workplaces. The first objective of this report is to provide information on how to measure radon, covering measurement techniques of radon in air and water, currently available detection systems, and measurement strategies most appropriate for the desired goal of a measurement campaign. Critical measurement strategy decisions are the selection of the measured radionuclide (i.e., radon gas or radon progeny and related size distributions), choice of the measurement period (i.e., short-term or long-term measurements), the choice of detector and its deployment, the type of measurement (i.e., areal or personal measurements), the survey strategy (i.e., integral or time-resolved measurements), or the strategy to accomplish the specific goal of a survey (i.e., measurements describing the current status or retrospective measurements). The choice of a specific strategy depends on the purpose of the survey, and differs therefore between the demands of a nation-wide indoor radon survey or an epidemiological study.The second objective of this report is how to interpret and report the results of these measurements, the associated uncertainties, and the resulting dosimetric estimates. Care should be taken when reporting and interpreting radon measurements because measured radon activity concentrations exhibit significant spatial variations (i.e., local and areal), and temporal variations (i.e., diurnal, seasonal, and annual). Consequently,estimates of the average annual radon activity concentrations are typically used for radon surveys and are compared with reference levels for radiation protection purposes. Other factors that may affect the interpretation of radon measurement results and the related dose estimates include thoron (220Rn) interference on radon detection systems, variations of aerosol parameters, equilibrium factor, duration of exposure (i.e., occupancy times in a building or location) and breathing rates. Often encountered problems are the uncertainties in extrapolating short-term measurements carried out at different locations within a building, or at different times during a year or in different years to statistically reasonable average values.Finally, the third objective of this report is to provide recommendations on optimal measurement strategies,measurement techniques, recording and reporting of measurements for different measurement objectives,such as individual exposure, average population exposure in a region or country, epidemiological studies or compliance with reference levels in radiation protection.