Current Status and Future Directions of Immunotherapy in Renal Cell Carcinoma.
Renal cell carcinoma (RCC) was recognized as an immunologically sensitive cancer over 30 years ago. The first therapies to affect the course of RCC were cytokines (interferon alfa-2B and interleukin-2). Subsequently, drugs that inhibit HIF (hypoxia-inducible factor)/VEGF (vascular endothelial growth factor) signaling demonstrated overall survival advantages (tyrosine kinase inhibitors and mTor inhibitors). In the last 3 years, the immune checkpoint inhibitors (ICIs) have become the standard of care treatments in the first and second lines for RCC. Emerging data show that combinations of ICI, HIF signaling inhibitors, and cytokines are potentially powerful regimens. How to combine and sequence these types of therapies and how to integrate new approaches into the management of RCC are now the key questions for the field. Treatment of RCC is likely to change dramatically in the next few years.


Optimality of collective choices: a stochastic approach.
Amplifying communication is a characteristic of group-living animals. This study is concerned with food recruitment by chemical means, known to be associated with foraging in most ant colonies but also with defence or nest moving. A stochastic approach of collective choices made by ants faced with different sources is developed to account for the fluctuations inherent to the recruitment process. It has been established that ants are able to optimize their foraging by selecting the most rewarding source. Our results not only confirm that selection is the result of a trail modulation according to food quality but also show the existence of an optimal quantity of laid pheromone for which the selection of a source is at the maximum, whatever the difference between the two sources might be. In terms of colony size, large colonies more easily focus their activity on one source. Moreover, the selection of the rich source is more efficient if many individuals lay small quantities of pheromone, instead of a small group of individuals laying a higher trail amount. These properties due to the stochasticity of the recruitment process can be extended to other social phenomena in which competition between different sources of information occurs.


Adult lingual orthodontics: a shift in our everyday routine.
Adult demand for orthodontics has grown considerably over the past 10 years. Three main factors account for this development: (i) health has become a major concern; (ii) facial appearance, and particularly the smile, is all-important; (iii) the introduction of invisible appliances bonded to the lingual surfaces. Adult patients need to be received and treated differently from young children. The aim of this article is to analyze the differences between adult and children's orthodontics and to offer solutions. The latter will embrace orthodontic technique and office organization. We will address all the issues which make adult orthodontics an area apart.


[Osteoid osteoma of the ethmoid bone (author's transl)].
Osteoid osteoma can be distinguished from compact osteoma by the presence in its centre of a cavity (nidus) which is distinctly visible on tomography or CT scans. Contrary to osteomas, osteoid osteomas are rarely found in facial sinuses. The authors report on one exceptional case located in the ethmoid bone and review the clinical and anatomicopathological features of this benign tumour.


Relation between height and clinical course in Duchenne muscular dystrophy.
We have evaluated the relation between height and rate of clinical progression in boys with Duchenne muscular dystrophy (DMD). In all, 111 DMD patients with age ranging from 2 to 23 years (mean 8.2 +/- 3.4 years) were assessed; of these patients, 92 had their height measured. Clinical course was determined through Vignos scale of functional disability, motor ability, and timed functional tests. All patients had grossly elevated serum creatine-kinase (CK) and pyruvate-kinase (PK) levels. When height was adjusted for patients' age, a statistically significant correlation was found between height and clinical course (positive with Vignos scale and negative with motor ability), suggesting that smaller boys have a better clinical course than taller patients of comparable age. These results support our previous hypothesis and suggest that growth inhibition seems to be effective in diminishing the progression of DMD.


Can physical joint simulators be used to anticipate clinical wear problems of new joint replacement implants prior to market release?
One of the most important mandates of physical joint simulators is to provide test results that allow the implant manufacturer to anticipate and perhaps avoid clinical wear problems with their new products. This is best done before market release. This study gives four steps to follow in conducting such wear simulator testing. Two major examples involving hip wear simulators are discussed in which attempts had been made to predict clinical wear performance prior to market release. The second one, involving the DePuy ASR implant systems, is chosen for more extensive treatment by making it an illustrative example to explore whether wear simulator testing can anticipate clinical wear problems. It is concluded that hip wear simulator testing did provide data in the academic literature that indicated some risk of clinical wear problems prior to market release of the ASR implant systems. This supports the idea that physical joint simulators have an important role in the pre-market testing of new joint replacement implants.


Water soluble molybdenocene complexes: synthesis, cytotoxic activity and binding studies to ubiquitin by fluorescence spectroscopy, circular dichroism and molecular modeling.
Four new molybdenocene complexes, Cp2Mo(l-ascorbato), Cp2Mo(6-O-palmitoyl-l-ascorbato), [Cp2Mo(ethyl maltolato)]Cl and Cp2Mo((2S)-2-amino-3-methyl-3-thiolato-butanoato), were synthesized and structurally characterized by standard analytical methods. The cytotoxicity of these complexes was assessed on colon HT-29 and breast MCF-7 cancer cell lines using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. A higher cytotoxic activity was shown by all the new complexes on the MCF-7 cells over the Cp2MoCl2 complex. The complexes Cp2Mo(l-ascorbato), Cp2Mo(6-O-palmitoyl-l-ascorbato) and [Cp2Mo(ethyl maltolato)]Cl displayed a stronger cytotoxic activity on colon cancer HT-29 cell line, over the molybdenocene dichloride (Cp2MoCl2). In contrast, Cp2Mo((2S)-2-amino-3-methyl-3-thiolato-butanoato) exhibited proliferative properties on this cell line. Ubiquitin (Ub)-molybdenocene interactions were investigated using cyclic voltammetry, fluorescence quenching spectroscopy, circular dichroism (CD) and molecular modeling. The thermodynamic parameters (ΔH and ΔS) obtained using fluorescence quenching spectra and van't Hoff plot indicate the Ub-molybdenocene interactions are mainly hydrophobic. The CD data also support hydrophobic interactions with conformational changes in the Ub protein. Docking studies using molecular modeling revealed the amino acids involved in the Ub-molybdenocene interactions and corroborated the hydrophobic nature of the binding combined with hydrogen bonding.


Spectrophotometric determination of vitamin E (alpha-tocopherol) using copper(II)-neocuproine reagent.
The possibility of the utilization of the copper(II)-neocuproine spectrophotometric method, which has previously been shown to permit the determination of various reducing agents, to the determination of vitamin E was investigated. The molar absorptivity for vitamin E was found to be (2.1 +/- 0.1) x 10(4)l mol(-1)cm(-1) and Beer's law was obeyed between 2.4 x 10(-6) and 9.0 x 10(-5)M concentrations of alpha-tocopherol. The relative standard deviation of the slope of the absorbance vs. concentration plot was 2.1%. The results obtained by the copper(II)-neocuproine method were compared with those achieved by both the standard HPLC and the widely used iron(III)-bathophenanthroline method by means of a t-test which showed that the precision of the developed method was not essentially different from those of the others. The developed method was successfully applied to three commercial samples, two in dragée and one in ampoule form. The alpha-tocopheryl acetate contained in the samples, which did not respond directly to the Cu(II)-neocuproine reagent, was subjected to alkaline hydrolysis prior to the analysis of the hydrolysis product, i.e., alpha-tocopherol. The molar absorptivity due to Cu(I)-neocuproine at 450 nm against a reagent blank indicated a two-electron oxidation of vitamin E by Cu(II)-neocuproine, which may be slightly enhanced by solvent effects. Copper(II)-neocuproine is an oxidant of strength comparable to that of Fe(III)-bathophenanthroline. The developed method, although less sensitive, is easy to use in conventional laboratories, unlike the Fe(III)-bathophenanthroline method, which requires specially prepared reagents and solvents. The method is free from interferences from such common reductants as ascorbic acid and Fe(II) salts, found in pharmaceutical formulations, after washing the formulation with water and collecting vitamin E in the ether extract for subsequent analysis.


Step length reductions in advanced age: the role of ankle and hip kinetics.
Aging is associated with a reduction in gait velocity, which is due to a shortened step length. This study investigated the relationship between joint kinetics and step length. Three-dimensional gait kinematics and kinetics were measured during usual pace gait in 26 older subjects (average age 79) and in 32 young subjects (average age 26). Gait measures were obtained at maximal velocity in five older subjects. Lower extremity strength was measured in the older subjects on an isokinetic dynamometer. Older persons had a 10% shorter step length during usual gait, when corrected for leg length (.65 +/- .07, .74 +/- .04/leg length, respectively, p < .001). Older persons had reduced ankle plantarflexion during late stance (13 +/- 5 degrees, 17 +/- 5 degrees, p = .02) and lower ankle plantarflexor power (2.9 +/- 0.9 W kg-1, 3.5 +/- 0.9 W kg-1, respectively, p = .007). Ankle strength was associated with plantarflexor power developed during late stance (r = .49, p < .001). When gait kinetics were corrected for step length, the older subjects developed 16% greater hip flexor power during late stance than younger subjects (estimate of effect: .15 W kg-1, p = .002). Older subjects were unable to increase ankle plantarflexor power at maximal pace, but increased hip flexor power 72% (1.1 +/- 0.3 W kg-1 to 1.9 +/- 1.0 W kg-1, p = .02). Older subjects had lower ankle plantarflexor power during the late stance phase of gait and appeared to compensate for reductions in plantarflexor power by increasing hip flexor power. Appropriate training of ankle plantarflexor muscles may be important in maintaining step length in advanced age.


Problem-oriented drug information: physicians' expectations and impact on clinical practice.
Problem-oriented drug information (POD) is a service in which health professionals provide evidence-based answers to clinical questions posed by physicians. The objective of this study was to evaluate the user satisfaction and clinical impact of POD, to investigate predictors for use and to examine the kind of sources physicians search before applying for POD. To evaluate POD, a questionnaire was distributed with problem-oriented answers sent from a drug information centre to physicians during the period of April 2006 to March 2007. Of 197 questionnaires, 183 (93%) were returned. The information from the POD service was highly valued by the physicians, and 90% of the answers led to reported impact on clinical practice in the specific clinical situation. Furthermore, 74% of the answers were intended to be used in a wider context either for future patients (67%) or for dissemination to colleagues (51%). Secondary-care physicians more often than general practitioners (GPs) used the information for dissemination to colleagues (63 vs. 39%, P = 0.0008), while GPs more often used the answer to support patient information (88 vs. 70%, P = 0.0029). The most prominent motive for applying for POD was a request for evidence-based information (78%), and the service was used to overcome barriers to practicing evidence-based medicine such as lack of time (36%), skills for searching (26%), and appraising the literature (13%). Before inquiring, 74% of the physicians had tried other information sources; the most frequent sources used were a drug reference (68%) and consulting a colleague (24%). Secondary-care physicians reported fewer barriers than GPs when seeking information, and secondary-care physicians searched other sources more often than GPs before contacting the service (81 vs. 67%, P = 0.031). POD represents a useful source for acquiring evidence-based drug information by physicians. POD is highly valued by the users. It was reported to have an impact on clinical practice for the specific patient but is also intended to be used in a wider context for future patients or for dissemination to colleagues. GPs' and secondary-care physicians' use of POD differs with GPs having more focus on patient information and secondary-care physicians having more focus on dissemination of the information to colleagues.


Hybrid artificial neural network segmentation and classification of dynamic contrast-enhanced MR imaging (DEMRI) of osteosarcoma.
The evaluation of pediatric osteosarcoma has suffered from the lack of an accurate imaging measure of response. One major problem is that osteosarcoma do not shrink in response to chemotherapy; instead, viable tumor is replaced by necrotic tissue. Currently available techniques that use dynamic contrast-enhanced magnetic resonance imaging to quantitatively evaluate tumor response fail to assess the percentage of necrosis. At present, histopathologic evaluation of resected tissue is the only means of measuring the percentage of necrosis in treated osteosarcoma. The current study presents a non-invasive method to visualize necrotic and viable tumor and quantitatively assess the response of osteosarcoma. Our technique uses a hybrid neural network consisting of a Kohonen self-organizing map to segment dynamic contrast-enhanced magnetic resonance images and a multi-layer backpropagation neural network to classify the segmented images. Because the hybrid neural network is completely automated, our technique removes both inter- and intra-operator error. An analysis comparing the percentage of necrosis from our technique to the histopathologic analysis revealed a highly significant Spearman correlation coefficient of 0.617 with p < 0.001.


Juxtafacet cysts of the cervical spine.
We report a retrospective series of 13 patients who presented with symptoms and signs caused by cervical juxtafacet cysts. Clinical findings, radiographic features, surgical management strategies, and possible causes are reported and discussed. We reviewed clinical histories, radiographic studies, surgical notes, and pathological records of all 13 patients who underwent surgery for subaxial cervical juxtafacet cysts from 1984 to 1997 at the Mayo Clinic in Rochester, MN. During the summer of 1997, surgical outcomes were assessed by direct or telephone interview. Nine patients were men and four were women. The average age at the time of presentation was 66 years. One patient had undergone a previous anterior cervical fusion below the level of the cyst. Ten patients presented with radiculopathies. Two patients presented with myeloradiculopathies. One patient presented with a cervical myelopathy. Computed tomographic myelography and magnetic resonance imaging were essential in establishing a preoperative diagnosis. The cysts were located at C7-T1 in nine patients, at C4-C5 in two patients, at C6-C7 in one patient, and at C3-C4 in one patient. All patients underwent posterior laminectomy or hemilaminectomy, excision of the cyst, and decompression of the thecal sac and/or nerve root. Two patients underwent concurrent posterior fusion procedures for instability. All patients experienced good to excellent relief of their radicular pain. All three myelopathies stabilized after surgery. There were no major complications or recurrences. Juxtafacet cysts seem to be a degenerative change of the cervical spine rather than a traumatic event. Similar to their counterparts in the lumbar spine, they tend to arise in segments with increased mobility. Surgical treatment is effective.


Epidemiology of hepatitis B virus infection among young adults in Taiwan, China after public vaccination program.
The public vaccination program of hepatitis B virus (HBV) was launched during 1984 in Taiwan, China. However, the long-lasting protective efficacy of HBV vaccination among adolescents older than 15 years of age was seldom recorded. A seroepidemiological survey was conducted among 4575 first-year university students in Taiwan, China during 2000 to 2003, including the serological data of HBV by testing HBV surface antigen (HBsAg), surface antibody (anti-HBs), HBV core antibody (anti-HBc) and demographic information. HBsAg carrier rate among male university students born before the initiation of the HBV vaccination program decreased from 12.8% to 4.8% among those born after the vaccination program (P < 0.001, chi(2) test for linear trend). Similarly, HBsAg carrier rate among female university students born before the initiation of the HBV vaccination program decreased from 8.1% to 2.7% among those born after the vaccination program (P < 0.001, chi(2) test for linear trend). Both male and female students in eastern Taiwan had the highest HBsAg carrier rate compared with the other places. Using multiple logistic regression analysis, compared with students born after July 1984, the adjusted OR of HBsAg carrier rate decreased from 3.10 for students born before June 1981 to 1.56 for students born from July 1983 to June 1984 (95% CI 1.96 - 4.91, P < 0.001; 95% CI 1.06 - 2.28, P = 0.024; respectively). Public vaccination provides long-lasting protection again HBV infection among the university students in Taiwan, China older than 18 years of age. There is a geographic variation of HBV infection among young adults in Taiwan, China.


Pancreatoblastoma in an older adult.
We present a case of pancreatoblastoma in a 61-year-old man. To our knowledge, this is the oldest patient with this tumor to be reported. Originally regarded as a microadenocarcinoma, the tumor was composed of small cells, sometimes in acinar groups with clusters of squamoid cells. It also showed acinar and neuroendocrine features by immunohistochemistry. Staining for trypsin and several neuroendocrine markers was widespread and intense in the smaller, majority-type cells. There was faint staining for some neuroendocrine markers in the larger squamoid cells. By electron microscopy both exocrine secretory and neurosecretory dense core granules were found. Modern methods of immunohistochemistry and greater understanding of rare tumor types allowed reclassification of this tumor.


Volatile organic compounds of Bacillus atrophaeus HAB-5 inhibit the growth of Colletotrichum gloeosporioides.
The use of fungicides to control plant diseases creates a potential health risk. One alternative to this problem is the biological control, which has been succesfully applied to control plant diseases. Bacillus atrophaeus HAB-5 exhibits a high inhibitory acitivities against different fungal pathogens and suppresses them. The aim of current studies is to produce and identify the antifungal compounds produced by the strain HAB-5. We found that the submerge fermentation harvested from Luria-Bertani (LB) medium had the highest activity against Colletotrichum gloeosporioides. The petroleum ether crude extract was strongly bioactive and its activity was stable after heat treatment, pH treatment, illuminated light as well as ultra violet exposition. The antifungal compounds were purified using gel chromatography column. Based on Gas Chromatography-Mass Spectrometry (GC-MS) analysis, nineteen different volatile organic compounds (VOCs) were identified included the range of alkanes, alkenes, alcohols, and organics acid. Among these identified compounds, Chloroacetic acid, tetradecyl esters followed by Octadecane and Hexadecanoic acid, methyl ester showed antifungal activity against C. gloeosporioides. Our results clearly showed Chloroacetic acid, tetradecyl esters; Octadecane and Hexadecanoic acid, methyl ester are key inhibitory compounds produced by Bacillus atrophaeus HAB-5 against C. gloeosporioides.


Vascular trauma in New Zealand: an 11-year review of NZVASC, the New Zealand Society of Vascular Surgeons' audit database.
To describe vascular trauma in New Zealand: its management and early outcomes. Patients suffering vascular trauma between January 1993 and December 2003 were analysed using data collected prospectively by the New Zealand Society of Vascular Surgeons' database (NZVASC). There were 549 cases of vascular trauma amongst 45,759 vascular admissions collected by the database in the 11-year period. This study confirmed the findings in international studies that younger adult males were more likely to suffer vascular trauma. Elderly patients, especially females, were most at risk of iatrogenic vascular injury, which accounted for 22% of cases in this study. Complication rates reported by rural vascular surgeons in New Zealand were comparable to results in the main centres and to international reports. While programmes to slow down and sober up road users help reduce injuries in the younger age groups, it lies in the hands of our own profession to reduce the iatrogenic injuries in the older patients.


Do high-status people really have fewer children? : Education, income, and fertility in the contemporary U.S.
Evolutionary discussions regarding the relationship between social status and fertility in the contemporary U.S. typically claim that the relationship is either negative or absent entirely. The published data on recent generations of Americans upon which such statements rest, however, are solid with respect to women but sparse and equivocal for men. In the current study, we investigate education and income in relation to age at first child, childlessness, and number of children for men and women in two samples-one of the general American population and one of graduates of an elite American university. We find that increased education is strongly associated with delayed childbearing in both sexes and is also moderately associated with decreased completed or near-completed fertility. Women in the general population with higher adult income have fewer children, but this relationship does not hold within all educational groups, including our sample with elite educations. Higher-income men, however, do not have fewer children in the general population and in fact have lower childlessness rates. Further, higher income in men is positively associated with fertility among our sample with elite educations as well as within the general population among those with college educations. Such findings undermine simple statements on the relationship between status and fertility.


Adherence to tuberculosis care in Canadian Aboriginal populations, Part 2: a comprehensive approach to fostering adherent behaviour.
In a 2-part series, the current literature with respect to adherence to tuberculosis care among Canadian Aboriginal populations is reviewed. In the current paper, which comprises part 2 of this review, strategies to remove barriers to TB adherence and to sustain and improve adherence are explored. Study design. Literature review. The biomedical and social science literature, including electronic databases (PubMed, PsychINFO, MEDLINE, Native Health Database. Scopus, Social Science Citation Index) were searched and reviewed with regard to relevant studies on adherence to health care, and to tuberculosis care specifically. The majority of published studies of interventions to remove barriers to TB adherence are focused on the health service system and on the individual. The former include enhanced programs of directly observed therapy and directly observed preventive therapy, as well as "permeable" health services that require minimal negotiation. At the personal level, effort must be made to develop a shared knowledge of and care plan for TB, which includes Indigenous and Western scientific health beliefs and practice. The quality of the relationship between health care provider and patient is critical to the outcome of educational efforts that support adherence. Few studies address interventions within the social context, and few have used participatory methodologies in partnership with families and communities. Social supports such as assistance with childcare, transportation and shelter have been shown to be associated with improved adherence to care for other conditions. TB programs may wish to use techniques used in other health programs, such as the identification of patient "sponsors" or mentors, or the use of verbal and/or written "contracts." Many of the interventional studies addressing health system barriers to TB adherence are grounded in the view that the problem rests with the patient. What is required is an approach that is responsive to the patient's needs while holding the patient to his or her personal and societal responsibilities. Adherence to therapy is unlikely to improve in a substantial way unless Indigenous beliefs about causation and care are incorporated into a program which has meaning for the patient.


Detection and molecular characterization of filamentous actinobacteria and thermoactinomycetes present in water-damaged building materials.
In this study the dominant filamentous actinobacteria occurring in water-damaged building materials were detected by culture and characterized by automated ribotyping and 16S rRNA gene sequencing. Fifty-two samples were taken from 20 water-damaged houses in four different countries. A total of 122 bacterial isolates were analyzed. Actinobacteria or thermoactinomycetes were present in 48% of the samples. The dominant genus was Streptomyces (58% of isolates), followed by Thermoactinomyces (23%), Laceyella (14%), Nocardiopsis (3%), Pseudonocardia (1%) and Saccharomonospora (1%). The most frequently detected species was the thermophilic Thermoactinomyces vulgaris (14 samples/4 countries). The most common streptomycetes were closely related to the heterogeneous species Streptomyces microflavus (7/2) or Streptomyces griseus (6/2). Automated ribotyping was a rapid tool for reliable characterization of these isolates. The spores of thermoactinomycetes and toxic substances of Nocardiopsis species and S. griseus may constitute a risk for human health. Harmful microbes in indoor environments are a cause of public concern. To develop rapid and simple-to-use molecular biological methods to detect the presence of harmful actinobacterial species in water-damaged buildings more information about their occurrence in those materials is needed, which this study provides.


Microbial contamination of weaning foods.
A survey was conducted to determine the prevalence rate of Escherichia coli in different foods being fed to children in the weaning age group. The samples were collected from middle income group (MIG) and high income group (HIG) houses in different localities in Chandigarh. A total of 530 MIG and 525 HIG houses were selected on the basis of availability of children in the weaning age group. A total of 2,016 samples of weaning foods were collected. Isolation of Escherichia coli from MIG and HIG houses was 66.75% and 8.5% respectively. Enterotoxigenic Escherichia coli were detected in 61.47% and 43.5% of the total Escherichia coli isolates from MIG and HIG houses respectively. 'O' serogrouping of the isolates was done and the predominant serotypes found were 06, 0106, 043, 057, 01. The laboratory studies showed that almost all weaning food samples prepared in the laboratory supported the growth of known enterotoxigenic Escherichia coli.


The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis.
To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace. Qualitative research methodology comprising a series of semistructured interviews. Community-based setting. Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews. Not applicable. Accounts of personal experiences related to employment. Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working. Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.


Isoagglutinin-reduced immunoglobulin retains efficacy in mouse models of immune thrombocytopenia and rheumatoid arthritis and is less likely to cause intravenous immunoglobulin-associated hemolysis.
Immunoglobulin therapy including intravenous immunoglobulin (IVIg) has been used as an effective treatment for autoimmune/inflammatory conditions with few side effects. However, high-dose IVIg (1-2 g/kg) has been recognized as a cause of hemolytic anemia in non-blood group O patients. Hemolysis when observed has been due to anti-A/anti-B isoagglutinins contained in the IVIg. Recently, an isoagglutinin-reduced IVIg, whereby the anti-A and anti-B titers have been reduced by immunoaffinity chromatography, has been introduced; however, whether this new product is as efficacious as nonreduced immunoglobulin (Ig) or will result in less IVIg-associated hemolysis has not been resolved. We used in vitro phagocytosis by monocytes and proinflammatory/anti-inflammatory macrophages, with isoagglutinin-reduced and -nonreduced Ig opsonized group A1 , B, and A1 B red blood cells, to estimate clinical significance of the IgG isoagglutinins. We also used immune thrombocytopenia (ITP) and rheumatoid arthritis (RA) mouse models to examine the in vivo efficacy of isoagglutinin-reduced versus -nonreduced Ig on the amelioration of the diseases. In contrast to nonreduced Ig, phagocytosis was largely absent when isoagglutinin-reduced Ig was used at a concentration equivalent to a patient receiving 2 g/kg. The in vivo efficacy of isoagglutinin-reduced versus nonreduced Ig on the amelioration of experimental ITP and RA was similar, indicating no loss of efficacy due to the chromatographic removal of isoagglutinins. Isoagglutinin-reduced Ig should have efficacy similar to nonreduced Ig and result in less IVIg-associated hemolysis.


Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy.
Real-time endobronchial ultrasound has increased the accuracy of conventional transbronchial needle aspiration biopsy in sampling mediastinal lymph nodes. Nevertheless, direct comparisons with mediastinoscopy are not available to determine the role of endobronchial ultrasound in pathologic staging. To compare the diagnostic yield of endobronchial ultrasound against cervical mediastinoscopy in the diagnosis and staging of radiologically enlarged mediastinal lymph nodes stations accessible by both modalities in patients with suspected nonsmall cell lung cancer. Prospective, crossover trial with surgical lymph node dissection used as the accepted standard. Biopsy results of paratracheal and subcarinal lymph nodes were compared. Sixty-six patients with a mean age 60 +/- 10 years were studied. The prevalence of malignancy was 89% (59/66 cases). Endobronchial ultrasound had a higher overall diagnostic yield (91%) compared with mediastinoscopy (78%; p = 0.007) in the per lymph node analysis. There was disagreement in the yield between the two procedures in the subcarinal lymph nodes (24%; p = 0.011). There were no significant differences in the yield at other lymph node stations. The sensitivity, specificity, and negative predictive value of endobronchial ultrasound were 87, 100, and 78%, respectively. The sensitivity, specificity, and negative predictive value of mediastinoscopy were 68, 100, and 59%, respectively. No significant differences were found between endobronchial ultrasound (93%) and mediastinoscopy (82%; p = 0.083) in determining true pathologic N stage (per patient analysis). In suspected nonsmall cell lung cancer, endobronchial ultrasound may be preferred in the histologic sampling of paratracheal and subcarinal mediastinal adenopathy because the diagnostic yield can surpass mediastinoscopy.


[Studies of sound condition in the reconstructed middle ear with a hydrophone. Initial results].
The acoustic result following reconstruction of the middle ear is often disappointing and unpredictable. Apart from biologic factors, this is due to insufficient knowledge of the mechanism of sound transmission through the operated middle ear. Therefore, temporal bone experiments with simulated middle ear operations were set up to investigate the sound transmission following different prosthesis' designs, materials, etc. We developed a tiny hydrophone which has a frequency range from 100 Hz to 10 kHz in order to measure the sound pressure in the cochlear fluid. By comparing the sound pressure in the inner ear with the sound pressure at the drum membrane, we were able to analyze the transfer function of the manipulated middle ear. First results with different reconstruction techniques, prosthesis' designs and attachments demonstrated the usefulness of this measuring technique for the development of acoustically better middle ear reconstructions.


The effect of inhaled corticosteroids on bone mineral density measured by quantitative ultrasonography in an older population.
Prolonged use of systemic corticosteroids leads to reduced bone mineral density and osteoporosis, in turn increasing the risk of minimal trauma fractures with their associated morbidity and mortality in elderly populations. However, the effect of inhaled corticosteroids on bone mineral density has been debated in the medical literature. We aimed to determine the effect of inhaled corticosteroids on bone mineral density measured using calcaneal quantitative ultrasonography in a cohort of older Australians. Data was collected from the Hunter Community Study, a longitudinal cohort of Australians aged 55-85. Simple and multiple linear regression methods were used to test the cross-sectional association between inhaled corticosteroids and calcaneal bone mineral density measured with quantitative ultrasound at baseline. A causal diagram was used to determine the minimally sufficient number of co-variates necessary to determine the unconfounded effect of inhaled corticosteroids on bone mineral density; these included gender, body mass index, smoking, asthma, alcohol use, age, physical activity, and diet. There were 152 (6.8%) patients on inhaled corticosteroids and 2098 (93%) controls. Simple and multiple linear regression methods showed a non-significant effect of inhaled steroids on BMD with slight decrease of BMD -0.010 g/cm2 (95% CI -0.042 to 0.022, P = .55) and -0.013 g/cm2 (95% CI -0.062 to 0.036, P = .61) respectively. Age, gender, body mass index, and smoking were stronger predictors of BMD. No statistically significant relationship was detected between the use of inhaled corticosteroids and reduced bone mineral density in this observational study of a cohort of older Australians.


Observation of S = 1/2 quasi-1D magnetic and magneto-dielectric behavior in a cubic SrCuTe2O6.
We investigate the magnetic, thermal, and dielectric properties of SrCuTe2O6, which is isostructural to PbCuTe2O6, a recently found, Cu-based 3D frustrated magnet with a corner-sharing triangular spin network having dominant first and second nearest neighbor (nn) couplings (Koteswararao et al 2014 Phys. Rev. B 90 035141). Although SrCuTe2O6 has a structurally similar spin network, the magnetic data exhibit the characteristic features of a typical quasi-1D magnet, which mainly resulted from the magnetically dominant third nn coupling, uniform chains. The magnetic properties of this system are studied via magnetization (M), heat capacity (C p ), dielectric constant ([Formula: see text]), and measurements along with ab initio band structure calculations. The magnetic susceptibility [Formula: see text] data show a broad maximum at 32 K and the system orders at low temperatures [Formula: see text] K and [Formula: see text] K, respectively. The analysis of the [Formula: see text] data gives an intra-chain coupling, [Formula: see text], to be about ≈ - 42 K with non-negligible frustrated inter-chain couplings ([Formula: see text] and [Formula: see text]). The hopping parameters obtained from the LDA band structure calculations also suggest the presence of coupled uniform chains. The observation of simultaneous anomalies in [Formula: see text] at [Formula: see text] and [Formula: see text] suggests the presence of a magneto-dielectric effect in SrCuTe2O6. A magnetic phase diagram is also built based on the M, C p , and [Formula: see text] results.


Bovine brain clathrin light chains impede heavy chain assembly in vitro.
Intact bovine brain clathrin triskelia, comprising three heavy and three light chains, require either 2 mM calcium or the assistance of protein co-factors for efficient assembly into regular cage structures (Keen, J. H., Willingham, M. C., and Pastan, I. (1979) Cell 16, 303-312). In contrast light chain-free heavy chains assemble readily in the absence of co-factors or calcium. Reconstitution of intact clathrin from heavy and light chains restores the calcium requirement. Our data indicate that light chains impede assembly by creating a kinetic trap rather than by perturbing the affinity of heavy chains for each other. This property suggests a function for light chains as regulatory subunits for clathrin assembly.


Reductions in CI amplitude after repetitive transcranial magnetic stimulation (rTMS) over the striate cortex.
Slow repetitive transcranial magnetic stimulation (rTMS) is a method capable of transiently inhibiting cortical excitability and disrupting information processing in the visual system. This method can be used to topographically map the functional contribution of different cortical brain areas in visual processing. An early electrophysiological component, the CI is argued to reflect early visual processing. In addition, source-localization studies have provided evidence for the assumption that the striate cortex is the underlying neural generator of CI. In the present placebo-controlled, crossover study, slow rTMS was applied in order to further investigate the relationship between the striate cortex and the CI component. Based on the inhibitory effects of slow rTMS, a reduction in CI amplitude and an increase in latency were expected. Compared to placebo stimulation, slow rTMS over the striate cortex resulted in significant decreases of the CI amplitude, but did not affect latency. The present study provides causal evidence for the involvement of the striate cortex in generating the CI component.


Phalangeal morphology of Shanghuang fossil primates.
Here, we describe hundreds of isolated phalanges attributed to middle Eocene fossil primates from the Shanghuang fissure-fillings from southern Jiangsu Province, China. Extending knowledge based on previous descriptions of postcranial material from Shanghuang, this sample of primate finger and toe bones includes proximal phalanges, middle phalanges, and over three hundred nail-bearing distal phalanges. Most of the isolated proximal and middle phalanges fall within the range of small-bodied individuals, suggesting an allocation to the smaller haplorhine primates identified at Shanghuang, including eosimiids. In contrast to the proximal and middle phalanges from Shanghuang, there are a variety of shapes, sizes, and possible taxonomic allocations for the distal phalanges. Two distal phalangeal morphologies are numerically predominant at Shanghuang. The sample of larger bodied specimens is best allocated to the medium-sized adapiform Adapoides while the smaller ones are allocated to eosimiids on the basis of the commonality of dental and tarsal remains of these taxa at Shanghuang. The digit morphology of Adapoides is similar morphologically to that of notharctines and cercamoniines, while eosimiid digit morphology is unlike living anthropoids. Other primate distal phalangeal morphologies at Shanghuang include grooming "claws" as well as specimens attributable to tarsiids, tarsiiforms, the genus Macrotarsius, and a variety of adapiforms. One group of distal phalanges at Shanghuang is morphologically indistinguishable from those of living anthropoids. All of the phalanges suggest long fingers and toes for the fossil primates of Shanghaung, and their digit morphology implies arboreality with well-developed digital flexion and strong, grasping hands and feet.


Mental health and social security: the case of the Incapacity Benefit in Northern Ireland.
Although mental illness affects people from all income levels, a significant proportion of discharged psychiatric patients rely heavily on the benefit system. Therefore, changes in benefit entitlement are of great concern to these people who already find this system difficult to use. In the summer of 1995, using both focus groups and individual interviews, the views of 35 individuals with mental health problems and of five organizations involved in advocacy work were sought on the introduction of the Incapacity Benefit. These views raised serious questions about the extent to which the benefit system meets the needs of claimants with mental health problems, on the relevance of the models of disability used in sickness benefits, and on the impact of the Incapacity Benefit and the Job Seeker's Allowance on people with mental health problems and confirmed the need for further research.


Strain and Age Effects on Aqueous Humor Dynamics in the Mouse.
We evaluated differences in aqueous humor dynamics (AHD) among several mouse strains within younger and older age groups. Albino (A/J, BALB/cJ) and pigmented (C3H/HeJ, C57-BL/6J) mice (young [2½-4½ months] and aged [10-12 months]) were studied. Intraocular pressure (IOP) was measured. In cannulated eyes, episcleral venous pressure (Pe) was assessed (blood reflux). Other AHD parameters (outflow facility [C], aqueous humor formation rate [Fin]) were assessed (constant flow infusion). Uveoscleral outflow rate (Fu) was obtained by calculation (Fu(calc)) using the modified Goldmann equation, and in additional eyes (for comparison), by FITC-dextran perfusion (Fu(FITC-dex)). Intraocular pressure was higher in pigmented strains, but did not exhibit age-dependence, except in the C57-BL/6J strain. Fu(calc) decreased with age in BALB/cJ (↓83.3%), C3H/HeJ (↓78.0%), and C57-BL/6J (↓85.0%) strains. In the A/J strain, Fu(calc) decreased with age (↓70.0%), but not significantly. Fin decreased with age in the C3H/HeJ (↓53.6%) strain. In C57-BL/6J and A/J strains, Fin decreased with age, but not significantly. C in the BALB/cJ strain increased with age (↑62.5%). In C3H/HeJ and C57-BL/6J strains, C increased with age, but not significantly. Episcleral venous pressure ranged from 6.0 to 6.6 mm Hg (albino strains) to 8.5 to 8.9 mm Hg (pigmented strains). Pe was not age dependent, but was higher in pigmented animals. In mouse, Fu and Fin diminish with age. C tends to increase as animals progress to middle life. There are strain differences in Fu, IOP, C, Fin, and Pe. The current findings provide an important foundation for comparisons among different strains in different study reports.


31P-NMR spectroscopy, rsEMG, and histochemical fiber types of human wrist flexor muscles.
The metabolic response to graded rhythmic forearm exercise determined by phosphorus-31 nuclear magnetic resonance (31P-NMR) spectroscopy was evaluated with respect to recruitment pattern of muscles and to fiber type composition of the nondominant arm in 14 untrained subjects. Rectified smoothed surface electromyography (rsEMG) over finger and wrist flexor muscles increased similarly and progressively at 30, 45, and 60% of maximal exercise intensity. On the basis of the 31P-NMR response pattern during exercise, subjects were separated into three groups: H group (n = 4), with a single high-pH P(i) peak; M group (n = 7), with two P(i) peaks reflecting two pH components; and L group (n = 3), with a single low-pH P(i) peak. The H group demonstrated a faster recovery of P(i) and phosphocreatine than the L group (P < 0.05). The M group displayed both types of P(i) recovery and an intermediate resynthesis rate of phosphocreatine. The M group had an even distribution of slow- and fast-twitch fibers in the flexor carpi radialis muscle, whereas subjects in the H and L groups possessed a predominance of slow- and fast-twitch fibers, respectively. The results suggest that during rhythmic forearm exercise the interindividual NMR variation in energy metabolism is related closely to fiber type composition of the muscle.


Phase control of double-pass cascaded SHG/DFG wavelength conversion in Ti:PPLN channel waveguides.
The efficiency of wavelength conversion by cascaded second harmonic generation / difference frequency generation (cSHG/DFG) in Ti:PPLN waveguides can be considerably improved by using a double-pass configuration. However, due to the wavelength dependent phase change by the dielectric folding mirror phase compensation is required to maintain an optimum power transfer. We experimentally investigated three different approaches and improved the wavelength conversion efficiency up to 9 dB in comparison with the single-pass configuration.


Changing trends in the management of salivary tumors.
Fine-needle aspiration biopsy (FNAB) and computed tomography (CT) or magnetic resonance imaging (MRI) are useful in the evaluation of salivary gland tumors, but they are not essential for treatment planning in every patient. The mainstay of therapy is a well-planned and carefully executed surgical procedure which adequately excises the tumor. Disease-free survival is very likely in patients with early stage malignant tumors. When treatment is delayed until the tumor is extensive (Stage 3,4), local recurrence and distant metastases are common and survival rates are low. Adjunctive postoperative radiation therapy can enhance locoregional control in the latter patients, but does not invariably lead to better survival. No consistently effective chemotherapy agents or combinations are presently available. Early diagnosis and consistent, high quality treatment offer the best hope for improved survival.


Suture closure of femoral arterial puncture sites after coronary angioplasty followed by same-day discharge.
The purpose of this study was to determine whether immediate suture closure of 8F femoral arterial puncture sites can facilitate same-day discharge after coronary angioplasty. After coronary angioplasty, 100 patients were randomly assigned to immediate sheath removal with the double-suture Prostar-Plus device or delayed sheath removal with application of a c-clamp. After suture closure, mobilization at 4 hours after sheath removal and discharge 4 hours later were planned. Patients treated with the c-clamp had sheaths removed 4 hours after percutaneous transluminal coronary angioplasty, were mobilized 6 hours later, and discharged the following day. Patients were assessed for groin complications at 8, 24, and 72 hours. Overall, patients who received suture closure were mobilized at 7.1 +/- 5.3 hours and discharged 11. 15 +/- 6.22 hours after sheath removal versus 15.49 +/- 3.9 hours and 21.9 +/- 3.8 hours for patients with the c-clamp (P <.001). Initial failure of the suture device occurred in 5 patients, with 1 requiring surgery for an entrapped device. After the procedure, patients with suture closure more frequently had an ooze of blood (55% vs 24%, P <.001) and a trend to more overt external bleeding (10% vs 2%, P = not significant). Hematomas were reported by 20% of patients in both groups at 72 hours. Overall, patients preferred the suture closure method of sheath removal when assessed by a simple questionnaire. An economic analysis by cost minimization demonstrated potential hospital cost saving. Suture closure of 8F arterial puncture sites can facilitate early mobilization and same-day discharge and is considered acceptable by more patients compared with application of the c-clamp. There is potential to realize cost savings with a strategy of same-day discharge.


Rates of synthesis of actomyosin in atria and ventricles of the perfused working rat heart.
Actomyosin from hearts perfused in vitro with [U-14C] phenylalanine and the remaining plasma amino acids was purified by standard techniques. The rate of actomyosin synthesis was expressed relative to actomyosin protein, to total protein and to total RNA. The rate of atrial total protein synthesis was twice the ventricular rate correlating with the RNA/protein ratios of the compartments. The actomyosin contents relative to total protein were not significantly different in atria and ventricles. The rate of actomyosin synthesis in atria was 2 to 3 times greater than in the ventricles when expressed relative to actomyosin or total protein. Synthesis rates of actomyosin expressed relative to total RNA were similar in the two compartments. These results suggest that the rate of turnover of actomyosin in the atria is 2 to 3 times the ventricular rate and that the greater rate of synthesis of total protein synthesis in atria is reflected in the rate of synthesis of specific intramyocytic proteins.


An evaluation of orthopaedic nurses' participation in an educational intervention promoting research usage--a triangulation convergence model.
To describe the orthopaedic nurses' experiences regarding the relevance of an educational intervention and their personal and contextual barriers to participation in the intervention. One of the largest barriers against nurses' research usage in clinical practice is the lack of participation. A previous survey identified 32 orthopaedic nurses as interested in participating in nursing research. An educational intervention was conducted to increase the orthopaedic nurses' research knowledge and competencies. However, only an average of six nurses participated. A triangulation convergence model was applied through a mixed methods design to combine quantitative results and qualitative findings for evaluation. Data were collected from 2013-2014 from 32 orthopaedic nurses in a Danish regional hospital through a newly developed 21-item questionnaire and two focus group sessions. Data were first analysed using descriptive statistics (stata 12.0) and qualitative manifest content analysis. Second, the results were compared, contrasted and interpreted using international literature. The nurses experienced the intervention as a new way to focus on nursing research in practice. However, some nurses were not able to see the relevance of research usage in clinical practice. Nursing research was not a top priority for the nurses and their personal barriers for research usage during their working day were prioritising patients' and colleagues' well-being. Their colleagues' and head section nurses' lack of acceptance regarding participation in the teaching session was a contextual barrier for the nurses. The nurses were interested in participating in the intervention. However, some felt restricted by the research-practice gap and by diverse personal and contextual barriers. The knowledge derived from this study has high clinical and practical relevance and is currently used to facilitate the nurses' research usage in the orthopaedic department setting, by working around the perceived barriers.


Prevalence of Campylobacter concisus in diarrhoea of immunocompromised patients.
The importance of Campylobacter species other than C. jejuni/coli in diarrhoeal disease is largely unknown. We wished to determine the prevalence and clinical presentation of C. concisus infection in patients with enteric disease in a tertiary hospital. Stool specimens were routinely tested for the presence of Campylobacter species, by use of the filter isolation method. The medical records of the C. concisus-positive patients were reviewed. Of 224 Campylobacter isolates obtained, 110 were identified as C. concisus. Concomitant infection occurred in only 27% of cases. By means of protein profiling we assigned C. concisus into 2 groups. The predominant C. concisus group 2 was the only strain to infect immunocompetent patients and children: 71% of the infected patients were immunocompromised, the majority being adults (84%). C. concisus may be a frequent cause of diarrhoea in immunocompromised patients. Two groups of C. concisus were found and these groups possibly vary in their pathogenic potential.


Quantitative analysis of adsorbed proteins by X-ray photoelectron spectroscopy.
Protein adsorption at solid surfaces is central to many phenomena of medical and technological interest. The determination of the amount of protein attached to the surface is a critical measurement performed by using a wide range of methods. X-ray photoelectron spectroscopy (XPS) is able to provide a straightforward quantitative analysis of the amount of protein adsorbed as an overlayer on a material surface. While XPS is commonly employed to assess qualitatively the amount of adsorbed protein, this is usually expressed in terms of the elemental fraction (or at. %) of nitrogen calculated using an assumption of depth homogeneity despite the fact that this does not linearly scale with the amount of protein. In this paper, we have shown that thicknesses derived from XPS data linearly correlated with spectroscopic ellipsometry data on the same samples with a scatter of 10%. A straightforward equation to convert the concentration of nitrogen from XPS into an equivalent thickness of a protein film is presented. We highlight some discrepancies in the absolute thicknesses determined by XPS and ellipsometry on dried films and quartz crystal microbalance on wet films, which appear likely to result from the inclusion of a contribution from water in the latter two techniques.


What do I need to know about aminoglycoside antibiotics?
The aminoglycosides are broad-spectrum, bactericidal antibiotics that are commonly prescribed for children, primarily for infections caused by Gram-negative pathogens. The aminoglycosides include gentamicin, amikacin, tobramycin, neomycin, and streptomycin. Gentamicin is the most commonly used antibiotic in UK neonatal units. Aminoglycosides are polar drugs, with poor gastrointestinal absorption, so intravenous or intramuscular administration is needed. They are excreted renally. Aminoglycosides are concentration-dependent antibiotics, meaning that the ratio of the peak concentration to the minimum inhibitory concentration of the pathogen is the pharmacokinetic-pharmacodynamic index best linked to their antimicrobial activity and clinical efficacy. However, due to their narrow therapeutic index, the patient's renal function should be monitored to avoid toxicity, and therapeutic drug monitoring is often required. Here we provide a review of aminoglycosides, with a particular focus on gentamicin, considering their pharmacokinetics and pharmacodynamics, and also practical issues associated with prescribing these drugs in a paediatric clinical setting.


A comparison of thromboembolic prophylaxis in gynecologic oncology patients.
The objective of this study was to compare two methods of thromboembolic prophylaxis: sequential compression devices alone (SCDs) vs. SCDs with subcutaneous low-dose unfractionated heparin (UH). A retrospective cohort study was conducted of 168 patients who had undergone surgery for suspected gynecological malignancies. These patients were examined for associated risk factors, method of prophylaxis, and incidence of clinically significant thromboembolic events. Of these patients, 94 (56%) received perioperative and postoperative sequential compression devices alone, while 74 (44%) received both SCDs and subcutaneous low-dose UH. The postoperative course of these patients, while in the hospital and after discharge, was followed for clinically evident thromboembolic complications. Univariate and multivariate analyses were performed. The two groups were comparable in terms of most risk factors, including age, stage, height, weight, body surface area, estimated blood loss, total anesthesia time, and nodal disease. Six of 94 patients (6.4%) in the SCDs group suffered from venous thromboembolism, while four of 74 patients (5.4%) who received both SCDs and low-dose UH had a thromboembolic event (chi2 P = 0.79). There was no difference in postoperative changes in platelet counts between the two groups. Heparin added additional cost, 105 extra minutes of nursing time per patient per admission, and additional pain for the patient. In conclusion, the addition of subcutaneous low-dose unfractionated heparin to SCDs for prophylaxis against deep venous thrombosis in women undergoing surgery for gynecologic malignancies does not improve the outcome. Adding heparin was more expensive, time consuming, and painful. Heparin should not be used with SCDs unless an additional benefit can be demonstrated in a randomized controlled trial.


Role of secondary hormonal therapy in the management of recurrent prostate cancer.
Androgen ablation remains the cornerstone of the systemic management of prostate cancer. After initial androgen deprivation, clinical outcomes vary considerably. For the patient with progressive disease after androgen deprivation, multiple therapeutic options are available and include antiandrogen withdrawal, chemotherapy, and secondary hormonal agents. Multiple secondary hormonal agents have clinical activity and the sequential use of these agents may lead to prolonged periods of clinical response. In addition to the use of oral antiandrogens, active secondary hormonal therapies include adrenolytic agents such as ketoconazole and aminoglutethimide, corticosteroids and estrogenic compounds. This article reviews the clinical trial data for these various agents and discusses their role in the management of patients with advanced prostate cancer.


Frequency of successful intra-articular puncture of finger joints: influence of puncture position and physician experience.
Physicians and specialists routinely perform IA punctures and injections on patients with joint injuries, chronic arthritis and arthrosis to release joint effusion or to inject drugs. The purpose of this study was to investigate the frequencies of intra- and peri-articular cannula positioning during this procedure. A total of 300 cadaveric finger joints were injected with a methyl blue-containing solution and subsequently dissected to distinguish intra- from peri-articular injections. To assess the influence of puncture position on successful injection, half of the joints were injected dorsally and the other half dorso-radially. To assess the importance of practical experience for a positive outcome, half of the injections were performed by an inexperienced resident and half by a skilled specialist. The overall frequency of occurrence of peri-articular injections was much higher than expected (overall: 23%, specialist: 15%, resident: 32%) The failure rate was significantly higher than the average with the joints of the little finger and the DIP joints of each phalanx. Even skilled specialists cannot guarantee to insert the cannula into the joint in every case. Unintended peri-articular drug injection moreover may affect the surrounding ligaments or tendons, leading to serious complications. Correct positioning of the needle in the joint may be facilitated by fluoroscopy in doubtful cases.


Melanotic schwannoma of the pancreas: report of a case.
We report a case of pancreatic melanotic schwannoma mimicking an epithelial cystic neoplasm of the pancreas. A 67-year-old Japanese woman underwent routine ultrasonography, which showed a large cystic mass in the head of the pancreas. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) showed an inhomogeneous, round cystic mass, which was encapsulated, in the head of the pancreas. We performed pyrolus-preserving pancreatoduodenectomy under the tentative diagnosis of a cystic neoplasm of the pancreas. The histopathologic diagnosis was benign melanotic schwannoma. The patient is now well after 43 months of follow-up. We describe the CT and MRI findings in detail, and review the literature on previously reported cases of pancreatic schwannoma.


A2A adenosine receptors are located on presynaptic motor nerve terminals in the mouse.
Extracellular adenosine is present at the mammalian neuromuscular junction (NMJ) by virtue of its release from activated nerve terminals and muscle fibers, and as a metabolite of adenosine tri-phosphate, which is coreleased with acetylcholine. Two activities for adenosine have been described: an inhibitory effect presumed to be modulated by the A1 receptor subtype, and a facilitatory effect mediated by the A2A receptor subtype. To date, only pharmacological evidence is available for these actions. We have used an antibody against the A2A receptor subtype, and demonstrated that A2A receptors are present on presynaptic motor nerve terminals at NMJs but not on associated glial or muscle cells, in the mouse. These results therefore provide additional evidence that there are multiple adenosine receptors present at the NMJ, and that stimulation of quantal and nonquantal release of acetylcholine (ACh) could be mediated by A2A receptors.


Health promoting behaviors, quality of life, and hospital resource utilization of patients receiving kidney transplants.
Despite the value of kidney transplantation for patients with renal failure, transplantation is sometimes accompanied by untoward consequences and considerable resource utilization. The identification of modifiable factors contributing to resource utilization is, therefore, important. This exploratory study of kidney transplant patients had two purposes: (a) to describe health-promoting behaviors and health-related quality of life (HRQOL) pretransplant and hospital resource utilization posttransplant and (b) to investigate relationships between these and other variables. Subjects were 44 patients who (before transplantation) completed the Health-Promoting Lifestyle Profile (HPLP) to quantify health-promoting behavior and the Medical Outcome Study Short Form (SF)-36 to measure HRQOL. Hospital resource utilization was characterized using transplant length of stay and charges and posttransplant emergency department visits, readmissions, and charges. The HPLP scores of the subjects were similar to those reported for middle-aged adults and patients with other diseases. The SF-36 subscale and summary scores were lower than those reported for the general population. Hospital resource utilization varied widely. Significant correlations were found between 52.9% of the HPLP and SF-36 scores. However, no HPLP score correlated significantly with any utilization measure. Of the SF-36 measures, only vitality correlated significantly with most utilization measures (greater vitality was associated with less posttransplant utilization). While many aspects of health-promoting behavior and HRQOL are related before transplant, neither HPLP, SF-36, nor any other measured variable strongly and consistently predicted hospital resource utilization.


Geobacillus lituanicus sp. nov.
Obligately thermophilic, aerobic, proteolytic, endospore-forming strain N-3(T) was isolated from a high-temperature oilfield in Lithuania. 16S rRNA gene sequence analysis placed this strain in genetic group 5 of the endospore formers. Geobacillus thermoleovorans appeared to be the closest phylogenetic neighbour (99.4 % sequence similarity). The G+C content of strain N-3(T) was 52.5 mol% and matched the range established for the genus Geobacillus. Studies of DNA-DNA relatedness and morphological and physiological analyses enabled strain N-3(T) to be described as a member of the genus Geobacillus, but could not assign this strain to any other known species of this genus. Results of this polyphasic study allowed characterization of strain N-3(T) as a novel species in the genus Geobacillus - Geobacillus lituanicus sp. nov. This species can be distinguished from G. thermoleovorans and Geobacillus stearothermophilus on the basis of 16S rRNA gene PCR-RFLP assays with the restriction endonucleases AluI, HaeIII and TaqI. The type strain of the novel species is N-3(T) (=DSM 15325(T)=VKM B-2294(T)).


Oocyte quality in patients with severe ovarian hyperstimulation syndrome.
To study the oocyte quality in patients with ovarian hyperstimulation syndrome (OHSS). Retrospective study. The Egyptian IVF-ET Center. Forty-two patients who developed severe OHSS (group A) were studied for the mean number of oocytes retrieved, percentage of high-quality oocytes, embryo quality, and fertilization, implantation, and pregnancy rates; these patients were compared with an age-matched control group who did not develop OHSS (group B; n = 183) after superstimulation for IVF or intracytoplasmic sperm injection. In vitro fertilization and ICSI. Fertilization and pregnancy rates. In group A, the mean number of oocytes retrieved was significantly higher, whereas the percentage of high-quality oocytes and the fertilization rate were significantly lower than that in group B. There were no statistically significant differences in the quality of embryos transferred or the implantation or pregnancy rate between the groups. The percentage of high-quality oocytes and the fertilization rate were significantly lower in patients with polycystic ovaries (PCO) in both groups. The inferior quality and maturity of oocytes in OHSS reduced the fertilization rate but did not affect the quality or the number of embryos transferred or the pregnancy rate. The effect on oocyte quality could be due to the prevalence of PCO in this group of patients.


Alzheimer's treatment in nursing homes: room for improvement.
Managing Alzheimer's disease (AD) continues to challenge long-term care physicians and administrators. Although pharmacologic treatment can substantially benefit AD patients in the nursing home setting, common misconceptions and skepticism about its value are barriers to treatment use. Aggressive treatment for AD maximizes patient function and independence and is cost-effective. Herein we discuss state-of-the-art treatment of AD with a view to providing nursing home physicians a framework from which to make treatment decisions.


C-19393 S2 and H2, new carbapenem antibiotics. I. Taxonomy of the producing strain, fermentation and antibacterial properties.
C-19393 S2 and H2 are new carbapenem antibiotics produced by a streptomycete. The producing strain was taxonomically studied and named Streptomyces griseus subsp. cryophilus. Cobaltous compounds were necessary for production of the antibiotics. C-19393 S2 and H2 showed a broad spectrum of antibacterial activities with C-19393 H2 being 8 approximately 120 times more active than C-19393 S2. They also exhibited beta-lactamase-inhibiting activities and acted synergistically with ampicillin and cefotiam against clinical isolates resistant to beta-lactam antibiotics.


[Molecular differentiation and taxonomy of the sunwatcher toadheaded agama species complex Phrynocephalus superspecies helioscopus (Pallas, 1771) (reptilia: agamidae)].
Lizards of the sunwatcher toad-headed agama species complex Phrynocephalus superspecies helioscopus, mostly distributed in Middle Asia and Middle East, were examined using analysis of variation at the mitochondrial cytochrome oxidase c subunit I gene fragment and fingerprint analysis of nuclear DNA (inter-SINE PCR technique). A total of 86 individual tissue samples from 53 populations, to the full extent representing different parts of the species complex range, were subjected to molecular genetic examination, and surprisingly deep differentiation was revealed. The populations analyzed split into 12 isolated phylogroups, many of which were characterized by a narrow range and genetic isolation. Monophyly of sunwatcher (Ph. helioscopus) and Persian (Ph. persicus) toad-headed agamas was confirmed. However, both of these species probably represent the species complexes. Zoogeography of Middle Asiais discussed.


Accuracy of CAD/CAM mandibular reconstruction: A three-dimensional, fully virtual outcome evaluation method.
Computer-aided design/computer-aided manufacturing (CAD/CAM) methods for mandibular reconstruction have improved both functional and morphological results. We evaluated the accuracy of the CAD/CAM method for mandibular reconstruction and assessed the quantitative and qualitative reproducibility of virtual preoperative planning. A total of 34 consecutive patients treated with mandibular reconstruction using the CAD/CAM method between January 2011 and October 2017 were included in this study. The accuracy of the reconstruction was assessed using the automated Hausdorff distance function of the simulation software, which set the postoperative mesh as the target. This made it possible to calculate the minimum error, the maximum error, and the mean error for each reconstruction in exactly the same way and with the same settings as the difference between the postoperative mesh and virtual planning. Finally, the coloured quality mapper function was applied to superimposition of the STL files, allowing us to visually render the obtained data on differences between preoperative planning and surgical outcome. The average mean error obtained after performing an accuracy evaluation of our reconstructions was 1 mm (range 0.4-2.46 mm). Based on the colour map areas, the maximum error was located in the symphysis area. The body and ramus areas showed the greatest accuracy in terms of planning reproducibility. This is the first study to assess the three-dimensional reproducibility of virtual planning using the CAD/CAM method for mandibular reconstruction, in a homogeneous sample of 34 cases. Our data suggest that CAD/CAM microvascular reconstruction can result in a very high degree of reproducibility. This occurs in complex areas as well as the condylar region and in the case of extensive mandibular reconstructions.


Cost-effective analysis of unilateral cochlear implantation under the Taiwan national healthcare insurance.
Objective: The value of cochlear implantation (CI) has not been established in Taiwan. The purpose of this study was to evaluate the cost-effectiveness of paediatric CI within the context of Taiwan's national health insurance (NHI) programme. Design: A Markov model-based cost-utility analysis (CUA) was conducted to evaluate the cost-effectiveness of a unilateral CI (UCI) with a contralateral acoustic hearing aid (UCI-HA) compared with a bilateral HA. We performed one-way sensitivity analyses to identify the cost variables that affected the incremental cost-effectiveness ratio (ICER) the most. Monte Carlo simulation was used to explore the simultaneous effect of all uncertain parameters on cost-effectiveness. Study sample: Not applicable. Results: Compared with bilateral HAs, the ICER for UCI-HA was $6487 per quality-adjusted life year (QALY) gained. The ICERs were consistently below $7000 per QALY gained and were most sensitive to the selling price of the external CI device. When this selling price increased by 10%, the ICER of UCI-HA would increase to $6954 per QALY gained. UCI-HA has a probability greater than 50% of being cost-effective if the cost-effectiveness threshold exceeds approximately $10,000 per QALY. Conclusions: Our analysis suggested that within the context of Taiwan's NHI programme, UCI is highly cost-effective for deaf children.


Effects of a portacaval or peritoneovenous shunt on renin in the hepatorenal syndrome.
Ten patients with hepatorenal syndrome were evaluated before and after creation of a side-to-side portacaval shunt or insertion of a peritoneovenous shunt, procedures which produced an increase in plasma volume and cardiac output. In the seven patients who survived surgery, renal function improved significantly, plasma renin activity fell from high to normal levels, and low levels of plasma renin substrate increased. Prior to surgery, blockade of angiotension II by saralasin produced hypotension and an increase in plasma renin activity, whereas after surgery, saralasin had no effect on blood pressure or renin. Our findings suggest that decreased "effective" plasma volume may be important in the stimulation of renin release and possibly in the pathophysiology of renal failure in the hepatorenal syndrome.


A cognitive behavioural approach to working with parents and families.
This article examines the difference between cognitive behavioural therapy (CBT) and the cognitive behaviour approach (CBA) in relation to its use in health visiting practice and school nursing. Two areas of practice are illustrated: support in postnatal depression; and support with positive parenting. The 'Five Areas' approach to assessment and intervention is discussed alongside behavioural activation, cognitive restructuring and problem solving to reduce avoidance strategies.


Tumor inhibition by ferricenium complexes: systemic effect in vivo and cell growth inhibition in vitro.
The antiproliferative activity of divers ferricenium complexes [Cp2Fe]+X-(X- = [CC13COO]- X CC13COOH (I); X- = [CC13COOH]- X 2 CC13COOH (II); X- = 1/2 [C13FeOFeC13]2- (III); X- = [FeC14]- (IV); X- = [2,4,6-(NO2)3C6H2O]- (V)) was investigated against solid, subcutaneously growing Ehrlich ascites tumor (EAT) in vivo as well as against EAT cells cultivated in vitro as permanent suspension culture. In vivo, triple intraperitoneal injections of the complexes II (3 X 200 mg/kg), III (3 X 100, 140, 180 mg/kg) or IV (3 X 160 mg/kg) markedly suppressed tumor development thus that the sizes of treated tumors were reduced to 42-48% related to control tumors (100%); these results point to the systemic character of the antitumor action by ferricenium complexes in vivo. In vitro, all ferricenium complexes inhibited cellular proliferation to an equal extent; application of 10(-5) M diminished the increase in cell number by 20-40%, application of 10(-4) M resulted in a total cessation of cellular proliferation. In comparison to cis-diamminedichloroplatinum(II), the cell growth-inhibiting effect of ferricenium complexes was less pronounced and required 10- to 50-fold higher concentration levels to evoke equivalent cytostasis.


First Report of Cassava Common Mosaic Potexvirus Infecting Chaya (Cnidoscolus chayamansa) in Tuvalu.
Chaya (Cnidoscolus chayamansa McVaugh) was introduced into Tu-valu as a leaf vegetable in the early 1990s (1) with the primary objective of alleviating vitamin A and C deficiencies, which at that time were prevalent throughout the population. Although there are no definitive quarantine records, we believe that the crop originated from vegetative cuttings introduced into Funafuti atoll from Kiribati. In the years following its introduction, chaya was distributed as cuttings taken from the original, introduced germplasm, to other islands and atolls of Tuvalu. The occurrence of yellow patches on the mature leaves of chaya cultivated in Funafuti had previously been attributed to iron deficiency, which was the inevitable consequence of growing the crop on coral atoll soils that are well known to be poor sources of metallic ions, notably iron, zinc, and copper. Following heavy cyclonic rains in March 1997, young, emerging chaya leaves were noted to exhibit an angular mosaic of the leaf lamina, characteristic of virus infections. Negatively stained sap from mosaic-affected leaves, when examined in the transmission electron microscope, was found to contain many rod-shaped virus particles similar in morphology to those of the Potexviridae (approximately 510 × 15 nm). The virus was transmitted mechanically to Chenopodium amaranticolor, in which it induced local lesion symptoms. The virus was found to be more closely related serologically to cassava common mosaic potexvirus (CsCMV) from Brazil than to that from Colombia, by immunosorbent electron microscopy with antisera kindly provided by F. Morales. Recently, CsCMV particles have been found in mosaic-affected chaya derived from the original Funafuti mother plants on Vaitupu Island. Similar symptoms have been observed on chaya being cultivated in Nui and Nanumaga islands. We conclude that CsCMV must now have been distributed throughout the atolls and islands of Tuvalu by infected planting material. We believe this to be the first report of the occurrence of CsCMV outside Central America and the first record of a plant virus from Tuvalu. Reference: (1) C. Howells and M. Bainbridge. 1996. South Pacific Commission, Pacific Island Forests and Trees. Page 10.


Monoclonal anti-idiotypic antibodies against human anti-thyroglobulin autoantibodies recognize idiotopes shared by disease-associated and natural anti-thyroglobulin autoantibodies.
Monoclonal murine anti-idiotypic antibodies generated against purified human anti-thyroglobulin (TG) antibodies from a patient with Hashimoto's thyroiditis recognized two major clusters of idiotopes (1C2 and 1B1) on human anti-thyroglobulin antibodies which were framework and paratope-related. A survey of affinity-purified autoantibodies from Hashimoto's patients indicated that the 1C2 and 1B1 idiotopes are expressed on the disease-associated anti-TG antibodies from several patients. 1C2 and 1B1 idiotopes are also detected on affinity-purified anti-TG antibodies isolated from serum of healthy donors and with therapeutic preparations of immunoglobulins obtained from plasma pools of healthy individuals. The observation that both framework and paratope-related idiotopes are shared by natural and patients' autoantibodies suggests that the anti-TG autoantibodies found in sera of patients with Hashimoto's disease represent an abnormal expansion of normal autoreactive B cell clones rather than the emergency of an antigen-driven, disease-specific B cell response.


Role for Fe(III) minerals in nitrate-dependent microbial U(IV) oxidation.
Microbiological reduction of soluble U(VI) to insoluble U(IV) is a means of preventing the migration of that element in groundwater, but the presence of nitrate in U(IV)-containing sediments leads to U(IV) oxidation and remobilizaton. Nitrite or iron(III) oxyhydroxides may oxidize U(IV) under nitrate-reducing conditions, and we determined the rate and extent of U(IV) oxidation by these compounds. Fe(III) oxidized U(IV) at a greater rate than nitrite (130 and 10 microM U(IV)/day, respectively). In aquifer sediments, Fe(III) may be produced during microbial nitrate reduction by oxidation of Fe(II) with nitrite, or by enzymatic Fe(II) oxidation coupled to nitrate reduction. To determine which of these mechanisms was dominant, we isolated a nitrate-dependent acetate- and Fe(ll)-oxidizing bacterium from a U(VI)- and nitrate-contaminated aquifer. This organism oxidized U(IV) at a greater rate and to a greater extent under acetate-oxidizing (where nitrite accumulated to 50 mM)than under Fe(II)-oxidizing conditions. We showthatthe observed differences in rate and extent of U(IV) oxidation are due to mineralogical differences between Fe(III) produced by reaction of Fe(II) with nitrite (amorphous) and Fe(III) produced enzymatically (goethite or lepidocrocite). Our results suggest the mineralogy and surface area of Fe(III) minerals produced under nitrate-reducing conditions affect the rate and extent of U(IV) oxidation. These results may be useful for predicting the stability of U(IV) in aquifers.


Innervated Reverse Digital Artery Island Flap through Bilateral Neurorrhaphy using Direct Small Branches of the Proper Digital Nerve.
The reverse digital artery flap uses the radial or ulnar surface of the proximal phalanx of the involved digit and has been applied to sensate flaps using the superficial sensory nerve branch and the dorsal branch of the proper digital nerve. As these nerve branches innervate the dorsal surface of the finger, however, hypesthesia of the dorsal side of the middle phalanx is inevitable. Thirty fingers of 25 patients who had the innervated reverse digital artery flap using direct small branches of the proper digital nerve were included in this study. The minimum follow-up duration was 24 months, and the average defect size was 2.8 cm(2). In all cases, the pulp defects were successfully reconstructed with this flap. The average size of the donor flap was 3.9 cm(2). At 6 months after surgery, the average static two-point discrimination value was 5.9 mm, the average moving two-point discrimination value was 5.0 mm, and the average Semmes-Weinstein monofilament score was 3.79. At 1 year postoperatively, the average Cold Intolerance Severity Score was 20. The percentage total active motion was measured at 99 percent 2 years after surgery. Because this flap does not sacrifice the proper digital nerve or dorsal branch of the nerve, the sensibility of the dorsal aspect of the proximal and middle phalanx can be preserved. This flap is cosmetically excellent, as it uses a donor flap similar to the injured fingertip and the donor scar can be hidden by adjacent fingers. Therapeutic, IV.


Characteristics of chromosomes in polarized normal human bronchial cells provide a blueprint for nuclear organization.
In normal human terminally differentiated and polarized bronchial cells, the fluorescent "painting" technique (FISH) for all chromosomes (except Y) documented that each homologue of each chromosome occupies a distinct, separate domain within the nucleus. The homologues are distributed along the nuclear membrane. In most cells and chromosomes studied, the two homologues were not identical: one was usually more "compact" than the other which was more "open," displaying fiber-shaped extensions. The differences between the territories of homologues 1 and 7 were shown to be statistically valid (P < 0.0001 by Wilcoxon sign rank test), as has been previously documented for the two X chromosomes (Eils et al., 1996). In some parallel arrays of bronchial cells, the position of the chromosomes in the nuclei was either identical or formed a mirror image, suggesting that the position of the chromosomes in polarized nuclei may be constant. To confirm this observation, the angles formed by the two homologues in the polarized oval nuclei were measured for chromosomes 1, X, and 7. The measurements disclosed that, in about two-thirds of the nuclei, the two homologues formed angles of 150 degrees, 157 degrees and 148 degrees, nearly identical to those formed by the same three chromosomes in prometaphase rosettes of cultured diploid human fibroblasts (Nagele et al., 1995). In about one third of the nuclei, the same homologues formed angles of 89 degrees, 72 degrees, and 94 degrees, and occasionally an angle of 180 degrees. A three-dimensional computer reconstruction of the nuclei was performed using the data for the X chromosomes. By cinematographic technique, it could be documented that the angles separating the two homologues depended on the rotation of the nucleus along the axes X, Y, and Z. The cause of the rotation is speculative at this time. Because of the concordance of these data in terminally differentiated epithelial cells with prior observations on prometaphases of human diploid fibroblasts, it is suggested that the position of chromosomes in all human cells is constant throughout the cell cycle. The possible significance of these observations is discussed.


The roles of ABA, reactive oxygen species and nitric oxide in root growth during osmotic stress in wheat: comparison of a tolerant and a sensitive variety.
The effects of PEG 6000-induced osmotic stress (-0.976 MPa) on the root growth of young plants, and the changes in abscisic acid (ABA), reactive oxygen species (ROS) and NO contents were investigated in the root tips of a drought-tolerant and a drought-sensitive wheat cultivar (Triticum aestivum L. cvs. MV Emese and GK Élet, respectively). The root length of cv. MV Emese was more effectively reduced than that of GK Élet by osmotic stress. Concomitantly, the ABA content of the 15-mm apical zone of the roots remained at the control level in GK Élet cultivar, but in MV Emese it decreased significantly after the early phase of the experiment, indicating that the accumulation of ABA is necessary for the maintenance of root growth under osmotic stress. The extent of ROS accumulation relative to the respective control was more pronounced in the elongation zone of roots in MV Emese in the later stages of the experiment, while NO concentrations increased significantly early after PEG exposure, suggesting that high concentrations of ROS and NO were unfavourable for root expansion. In contrast, in cv. Élet, the high NO content in the elongation zone declined to the control level under osmotic stress within 4 days. The changes in root growth due to osmotic stress did not exhibit a correlation with the drought tolerance of the genotypes defined on the basis of the crop yield.


Domestic dogs (Canis familiaris) coordinate their actions in a problem-solving task.
Cooperative hunting is a cognitively challenging activity since individuals have to coordinate movements with a partner and at the same time react to the prey. Domestic dogs evolved from wolves, who engage in cooperative hunting regularly, but it is not clear whether dogs have kept their cooperative hunting skills. We presented pairs of dogs with a reward behind a fence with two openings in it. A sliding door operated by the experimenter could block one opening but not both simultaneously. The dogs needed to coordinate their actions, so that each was in front of a different opening, if one of them was to cross through and get food. All 24 dog pairs solved the problem. In study 1, we demonstrated that dogs understood how the apparatus worked. In study 2, we found that, although the performance of the pairs did not depend on the divisibility of the reward, pairs were quicker at coordinating their actions when both anticipated rewards. However, the dogs did not monitor one another, suggesting that their solutions were achieved by each individual attempting to maximize for itself.


Cardiovascular effects of intravenous indoramin hydrochloride in man.
Haemodynamic effects of intravenous indoramin (5-20 mg) were measured in ten healthy volunteers. Slight falls in arterial and central venous blood pressures were noted but no significant changes in heart rate, right atrial pressure, cardiac output or derived values occurred, except for a fall in peripheral vascular resistance in three cases. An increase in skin blood flow to the feet was observed. An attempt was made to determine the mechanisms of these responses and it was concluded that the drug was an alpha adrenoceptor blocking agent which appeared to act preferentially on those receptors controlling blood flow to the skin of extremities.


Neurons and behavior: ex uno, plures.
Li et al. demonstrate that a single interneuron can regulate analog- and digital-like behaviors guided by two different postsynaptic neurons. Releasing a single neurotransmitter onto downstream neurons that express receptors with distinct biophysical properties enables a small set of neurons to direct a range of functional responses.


Analysis of 99mTc-pyridoxylidene-glutamate complex formation and its preparation with tin-adsorbed-resin: Sn-Resin kit method.
99mTc-Pyridoxylidene-glutamate (Tc-PG) was introduced in 1975 by Baker et al. as a cholescintigraphic agent. Nevertheless its routine use has been limited due to the autoclaving process involved. To shorten the labeling procedure, an analysis of Tc-PG complex formation using the stannous chloride method was carried out. Sn-Resin (stannous ion adsorbed onto cation exchange resin) was used for labeling a stable Tc-PG with high efficiency. A preautoclaved complex of pyridoxal and glutamate was required but the labeling procedure took only 10-15 min after the elution of 99m-TcO4- from the generator. Formation of a complex other than a 99mTc-complex of the Schiff -base ligand pyridoxylidene-glutamate is discussed. The new formulation of a Tc-PG kit (Sn-Resin) simplified the labeling method and reproducible data to that already reported by Baker was obtained in chromatographic studies. Its suitability in hospital departments has already been shown in clinical studies.


Human respiratory tract model for radiological protection: a revision of the ICRP Dosimetric Model for the Respiratory System.
In 1984, the International Commission on Radiological Protection (ICRP) appointed a task group of Committee 2 to review and revise, as necessary, the ICRP Dosimetric Model for the Respiratory System. The model was originally published in 1966, modified slightly in Publication No. 19, and again in Publication No. 30 (in 1979). The task group concluded that research during the past 20 y suggested certain deficiencies in the ICRP Dosimetric Model for the Respiratory System. Research has also provided sufficient information for a revision of the model. The task group's approach has been to review, in depth, morphology and physiology of the respiratory tract; deposition of inhaled particles in the respiratory tract; clearance of deposited materials; and the nature and specific sites of damage to the respiratory tract caused by inhaled radioactive substances. This review has led to a redefinition of the regions of the respiratory tract for dosimetric purposes. The redefinition has a morphologic and physiological basis and is consistent with observed deposition and clearance of particles and with resultant pathology. Regions, as revised, are the extrathoracic (E-T) region, comprising the nasal and oral regions, the pharynx, larynx, and upper part of the trachea; the fast-clearing thoracic region (T[f]), comprising the remainder of the trachea and bronchi; and the slow-clearing thoracic region (T[s]), comprising the bronchioles, alveoli, and thoracic lymph nodes. A task group report will include models for calculating radiation doses to these regions of the respiratory tract following inhalation of representative alpha-, beta-, and gamma-emitting particulate and gaseous radionuclides. The models may be implemented as a package of computer codes available to a wide range of users. This should facilitate application of the revised human respiratory tract model to worldwide radiation protection needs.


Using titanium mesh to replace the bone flap during decompressive craniectomy: A medical hypothesis.
Decompressive craniectomy (DC) plays a significant role in treating refractory intracranial hypertension. During this surgical procedure, part of the skull is removed and the underlying dura mater is open, which can effectively release intracranial pressure. However, in some cases, the decision whether or not to remove the bone flap relies on the surgeon's personal experience. Positive decisions are usually made to avoid massive postoperative cerebral edema and infarction, which can lead to overtreatment. The procedure is related to many side-effects, which may affect the recovery of neurological function. Patients who have survived have to be anesthetized and undergo secondary cranioplasty 3 or 6 months later. Despite its technical simplicity, complications associated with cranioplasty are hard to ignore. Therefore, there is a need for a new surgical procedure combining decompressive craniectomy and cranioplasty. Acute expansion of the skin flap is limited, and the compensatory capacity of the skull after DC depends on the volume of the bone flap at the early stage. The titanium mesh is thin and strong, does not take up extra space provided by bone flap. Therefore, we put forward the concept of Decompressive Bone Flap Replacement. During this procedure, neurosurgeons resect the massive bone flap, open the dura mater, remove the hematoma in a similar manner to a standard craniotomy and then use titanium mesh shaped appropriately to replace the bone flap. Compared with traditional DC, it can ensure the integrity of the skull without affecting the effect of decompression. This paper presents 2 cases of DC and reviews the literature sustaining our hypothesis.


Paxillin.
Paxillin is a 68 kDa cytoplasmic protein that localizes to discrete sites of cell attachment to the extracellular matrix called focal adhesions. It is a multi-domain adapter protein capable of interacting with several structural and signaling proteins including vinculin, FAK, PYK2, Src and Crk. Phosphorylation of paxillin in response to integrin-mediated cell adhesion and growth factor stimulation regulates some of these interactions. Thus, paxillin functions as a scaffold for the recruitment of molecules into a signal transduction complex that is closely apposed to the plasma membrane. This is likely to facilitate the efficient processing of external stimuli that modulate important cellular events including cell adhesion, cell motility and growth control. Since paxillin interacts with several proteins known to cause cell transformation, the binding sites for these proteins on paxillin represent potential targets for therapeutic agents.


Signal propagation via gap junctions, a key step in the regulation of liver metabolism by the sympathetic hepatic nerves.
Cell-to-cell communication via gap junctions has been proposed to be involved in the metabolic actions of sympathetic liver nerves in the rat. The effects of hepatic nerve stimulation and noradrenaline-, PGF2 alpha- and glucagon infusion on glucose metabolism and perfusion flow were studied in perfused rat liver in the absence and presence of the gap junctional inhibitors, heptanol, carbenoxolone and (4 beta)phorbol 12-myristate 13-acetate (4 beta PMA). (i) Stimulation of the hepatic nerve plexus increased glucose output, decreased flow and caused an overflow of noradrenaline into the hepatic vein. (ii) Heptanol completely inhibited not only the nerve stimulation-dependent metabolic and hemodynamic alterations but also the noradrenaline overflow. Thus the heptanol-dependent inhibitions were caused primarily by a strong impairment of transmitter release. (iii) Carbenoxolone inhibited the effects of neurostimulation on glucose metabolism partially by about 50%, whereas it left perfusion flow and noradrenaline overflow essentially unaltered. (iv) 4 beta PMA reduced the nerve stimulation-dependent enhancement of glucose release by about 80% but the noradrenaline-dependent increase in glucose output only by about 30%; the increase in glucose release by PGF2 alpha and by glucagon remained essentially unaltered. 4 beta PMA reduced the nerve stimulation-dependent decrease in portal flow by about 35% but did not affect the noradrenaline-and PGF2 alpha-elicited alterations, nor did it alter noradrenaline overflow. The results allow the conclusion that gap junctional communication plays a major role in the regulation of hepatic carbohydrate metabolism by sympathetic liver nerves, but not by circulating noradrenaline, PGF2 alpha or glucagon.


Statistical properties of ABR amplitudes and latencies. Implications for computation of reference limits and relation to click phase.
A method for statistical analysis and computation of reference limits for ABR latency and amplitude variables is presented. Condensation and rarefaction ABRs from 47 healthy controls aged 4-58 years were investigated. With respect to gaussianity of distributions, the square root transformation was superior to the logarithmic transformation for amplitudes, while the logarithmic transformation performed better for amplitude ratios. Wave V latency and the I-V interpeak latency were nearly normally distributed, while other latencies and inter-peak latencies displayed varying displacement from a normal distribution. Rarefaction ABR distributions were slightly closer to normality than were condensation ABRs. Amplitude vs. following amplitude and latency vs. amplitude correlation coefficients were larger for R than for C click ABRs; thus R clicks seem to evoke a better synchronized neural volley. Most of the correlation between amplitude and latency could be explained by the influence of age and sex. Hence, age and sex matched reference limits for ABR amplitudes, without correction for latency, seem to be adequate in practical clinical work.


Blackcurrant (Ribes nigrum) Prevents Obesity-Induced Nonalcoholic Steatohepatitis in Mice.
With increasing prevalence of nonalcoholic steatohepatitis (NASH), effective strategies to prevent NASH are needed. This study investigated whether the consumption of blackcurrant (Ribes nigrum) can prevent the development of obesity-induced NASH in vivo. Male C57BL/6J mice were fed a low-fat control diet, a low-fat diet with 6% whole blackcurrant powder, an obesogenic high-fat/high-sucrose control diet (HF), or a high-fat/high-sucrose diet containing 6% whole blackcurrant powder (HF-B) for 24 weeks. HF significantly increased, whereas HF-B markedly decreased, liver weights and triglyceride. Furthermore, blackcurrant attenuated obesity-induced infiltration of macrophages in the liver, in particular, the M1 type, and also suppressed the hepatic expression of fibrogenic genes and fibrosis. Flow cytometric analysis showed that HF significantly increased the percentages of monocytes of total splenocytes, which was markedly attenuated by blackcurrant. HF-B decreased lipopolysaccharide-stimulated mRNA expression of interleukin 1β and tumor necrosis factor α in splenocytes, compared with those from HF controls. Moreover, the levels of circulating and hepatic miR-122-5p and miR-192-5p, known markers for nonalcoholic fatty liver disease, were significantly increased by HF but decreased by HF-B. The study's findings indicate that blackcurrant consumption prevents obesity-induced steatosis, inflammation, and fibrosis in the liver.