Impact of valve surgery on serum osteopontin levels in patients with mitral regurgitation.
Osteopontin (OPN), a sialoprotein present within atherosclerotic lesions, especially in calcified plaques, is linked to the progression of coronary artery disease and heart failure. We assessed the impact of valve surgery on serum OPN and left ventricular (LV) function in patients with mitral regurgitation (MR). Thirty-two patients with severe MR scheduled for surgery were included in the study. Echocardiography markers were assessed preoperatively and at 3 months following the surgery and matched with the serum OPN levels. Valve surgery was associated with a reduction of the ejection fraction (EF) from 55.2 ± 6.3 to 48.8 ± 7.1% after surgery, p < 0.001. Following surgery, the OPN level was significantly higher than preoperatively (mean 245, range 36-2,284 ng/ml vs. 76, 6-486 ng/ml, p = 0.007). Preoperative OPN exhibited a slight negative correlation with the EF (r = -0.35, p = 0.04), and a moderate correlation with vena contracta (r = -0.38, p = 0.02). There were no other meaningful correlations between conventional echocardiographic parameters and OPN. Following valve surgery due to severe MR, patients exhibited a decrease in EF and an increase in OPN levels. The assessment of preoperative OPN failed to strongly predict probable LV dysfunction.


The role of preoperative radiological assessment of vascular injury on surgical decision making in mutilating injuries of the upper extremity.
Preoperative assessment of the extent of vascular injury is important in patients with mutilating injuries of the upper extremity. The aim of this report was to discuss the influence of computed tomography angiography (CTA) and digital subtraction angiography (DSA) on the operating room decision-making in mutilating injuries and limb-salvage procedures of the traumatic upper extremity. Four DSA and 3 CTA were performed in 7 patients with a mean age of 28.3 (range, 4-48) years. The results of the DSA and CTA altered the preoperative planning. In 5 patients, the reconstructive decision of the type of flap was altered, whereas in all 7 patients, either the level or type of anastomosis was changed after radiologic investigations. The mean follow-up period was 37.8 months. During the follow-up period, all patients underwent subsequent procedures such as sensory restoration, tendon reconstruction, or capsulotomy. The effects of radiologic results in which flap selection, target donor vessel, and level and type of anastomosis have changed are discussed in correlation with intraoperative findings.


Isolation, structure elucidation, and synergistic antibacterial activity of a novel two-component lantibiotic lichenicidin from Bacillus licheniformis VK21.
A novel synergetic lantibiotic pair, Lchalpha (3249.51 Da) and Lchbeta (3019.36 Da), termed lichenicidin VK21, was isolated from the producer strain Bacillus licheniformis VK21. Chemical and spatial structures of Lchalpha and Lchbeta were determined. Each peptide contains 31 amino acid residues linked by 4 intramolecular thioether bridges and the N-terminal 2-oxobutyryl group. Spatial structures of Lchalpha and Lchbeta were studied by NMR spectroscopy in methanol solution. The Lchalpha peptide displays structural homology with mersacidin-like lantibiotics and involves relatively well-structured N- and C-terminal domains connected by a flexible loop stabilized by a thioether bridge Ala11-S-Ala21. In contrast, the Lchbeta peptide represents a prolonged hydrophobic alpha-helix flanked with more flexible N- and C-terminal domains. A lantibiotic cluster of the Bacillus licheniformis VK21 genome which comprises the structural genes, lchA1 and lchA2, encoding the lantibiotics precursors, as well as the gene of a modifying enzyme lchM1, was amplified and sequenced. The mature peptides, Lchalpha and Lchbeta, interact synergistically to possess antibiotic activity against Gram-positive bacteria within a nanomolar concentration range, though the individual peptides were shown to be active at micromolar concentrations. Our results afford molecular insight into the mechanism of lichenicidin VK21 action.


Prader-Willi syndrome: atypical psychoses and motor dysfunctions.
Prader-Willi syndrome (PWS) is the result of a lack of expression of genes on the paternally derived chromosome 15q11-q13 and can be considered as a hypothalamic disorder. Its behavioral phenotype is characterized by ritualistic, stereotyped, and compulsive behaviors as well as motor abnormalities. After adolescence, recurrent affective psychoses are relatively frequent, especially in patients with uniparental disomy. These psychotic states have a subacute onset with complete recovery and comprise an increase of psychomotor symptoms that show resemblance with catatonia. Some evidence has emerged that gamma-aminobutyric acid (GABA) dysfunctionality is involved in both PWS and catatonia. Treatment of these atypical psychoses should preferably include GABA mimetic compounds like lorazepam, valproic acid, and possibly topiramate.


Flex Robotic System in transoral robotic surgery: The first 40 patients.
The Flex Robotic System is a new robotic device specifically developed for transoral robotic surgery (TORS). We performed a prospective clinical study, assessing the safety and efficacy of the Medrobotics Flex Robotic System. A total of 40 patients required a surgical procedure for benign lesions (n = 30) or T1 and T2 carcinomas (n = 10). Access and visualization of different anatomic subsites were individually graded by the surgeon. Setup times, access and visualization times, surgical results, as well as adverse events were documented intraoperatively. The lesions could be exposed and visualized properly in 38 patients (95%) who went on to have a surgical procedure performed with the Flex Robotic System, which were intraoperatively evaluated as successful. No serious adverse events occurred. Lesions in the oropharynx, hypopharynx, or supraglottic larynx could be successfully resected using the Flex Robotic System, thus making the system a safe and effective tool in transoral robotic surgery. © 2016 Wiley Periodicals, Inc. Head Neck 39: 471-475, 2017.


The role of radiotherapy in the treatment of liver metastases.
Radiotherapy has historically played a minor role in the treatment of patients with unresectable liver metastases from colorectal cancer and other malignancies. This can be attributed chiefly to the low tolerance of the whole liver to radiation. High-precision radiotherapy planning techniques have allowed much higher doses of radiation to be delivered safely to focal liver metastases, while sparing most of the normal liver. When combined with hepatic arterial fluorodeoxyuridine, high-dose focal liver radiotherapy is associated with excellent response rates, local control, and survival in patients with unresectable liver metastases from colorectal cancer. Radiotherapy, with and without concurrent systemic chemotherapy, has also been used with encouraging outcomes for patients with liver metastases from colorectal cancer and other cancers. There appears to be a radiation dose response for liver metastases; tumors treated with doses of 70 Gy or greater are likelier to have durable local control. Advancements in tumor imaging, in radiotherapy techniques that will allow the safe delivery of higher doses of radiation, and in novel tumor radiation sensitizers and normal tissue radioprotectors should substantially improve the outcome of patients with unresectable liver metastases treated with radiotherapy.


Acromioclavicular joint injuries in the National Football League: epidemiology and management.
Previous studies investigating acromioclavicular (AC) joint injuries in professional American football players have only been reported on quarterbacks during the 1980s and 1990s. These injuries have not been evaluated across all position players in the National Football League (NFL). The purpose of this study was 4-fold: (1) to determine the incidence of AC joint injuries among all NFL position players; (2) to investigate whether player position, competition setting, type of play, and playing surface put an athlete at an increased risk for this type of injury; (3) to determine the incidence of operative and nonoperative management of these injuries; and (4) to compare the time missed for injuries treated nonoperatively to the time missed for injuries requiring surgical intervention. Descriptive epidemiological study. All documented injuries of the AC joint were retrospectively analyzed using the NFL Injury Surveillance System (NFLISS) over a 12-season period from 2000 through 2011. The data were analyzed by the anatomic location, player position, field conditions, type of play, requirement of surgical management, days missed per injury, and injury incidence. Over 12 NFL seasons, there were a total of 2486 shoulder injuries, with 727 (29.2%) of these injuries involving the AC joint. The overall rate of AC joint injuries in these athletes was 26.1 injuries per 10,000 athlete exposures, with the majority of these injuries occurring during game activity on natural grass surfaces (incidence density ratio, 0.79) and most often during passing plays. These injuries occurred most frequently in defensive backs, wide receivers, and special teams players; however, the incidence of these injuries was greatest in quarterbacks (20.9 injuries per 100 players), followed by special teams players (20.7/100) and wide receivers (16.5/100). Overall, these athletes lost a mean of 9.8 days per injury, with quarterbacks losing the most time to injury (mean, 17.3 days). The majority of these injuries were low-grade AC joint sprains that were treated with nonoperative measures; only 13 (1.7%) required surgical management. Players who underwent surgical management lost a mean of 56.2 days. Shoulder injuries, particularly those of the AC joint, occur frequently in the NFL. These injuries can result in time lost but rarely require operative management. Quarterbacks had the highest incidence of injury; however, this incidence is lower than in previous investigations that evaluated these injuries during the 1980s and 1990s.


Effects of imperfect albinism (sal-s) on growth in a heavy line of chickens.
Four trials compared growth, feed efficiency, and mortality of albino (sal-s) and nonalbino chickens under conditions approximating those used commercially for broilers. Early body weight reductions of albino chicks were substantial, but by a normal market age for broilers in North America, albinos weighed only 3 to 5% less than nonalbinos. The early mortality rate of albinos was elevated. Overall feed efficiency was not affected by the sal-s gene. An increased incidence of lesions of the navel, hocks, and nares was observed, but regression analyses showed them to be relatively unimportant in the determination of body weights. Heritability estimates showed that the lesions would be very difficult to eliminate through selective breeding. It is proposed that the gene could be used to sex either commercial broilers or their dams.


Tussigenic agents in the measurement of cough reflex sensitivity.
Different inhalation methods are used for cough reflex sensitivity (CRS) measurement. The single-breath method of tussigenic agent aerosol inhalation is widely used now. Comparison of two tussigenic agents--citric acid and capsaicin--in cough reflex sensitivity measurement was used in healthy volunteers. In 17 healthy volunteers (7 M, 10 F; mean age 21 years) without respiratory tract infection in last 3 weeks, without cardiovascular, allergic, respiratory metabolic diseases, and with normal spirometry, cough reflex sensitivity was examined by nebuliser ProvoJet Ganshorn Medizin Elektronic, Germany) with doubled concentrations of capsaicin (SIGMA) from 0.49 to 1000 micromol/l and citric acid (LACHEMA) concentrations of 1, 3, 10, 30, 100, 300, 1000 micromol/l. Cough reflex sensitivity was defined as the lowest concentration of tussigenic agents which elicited 2 and 5 coughs (C2, C5). Geometric mean and 95% confidence interval (CI) of citric acid C2 was 454.5 (284.8-725.4) mmol/l in 88.2% of volunteers; citric acid C5 was 1000 micromol/l (0) in 47.1% of volunteers. Capsaicin C2 was 23.5 (8.2-67.5) micromol/l in 100% of volunteers and C5 was 263.7 (111.2-625.1) micromol/l in 76.5% of volunteers. We conclude that capsaicin single-breath test is more relevant for cough reflex sensitivity measurement in healthy volunteers than citric acid cough test.


Acetazolamide or not, prior to ascent?
Special Operation Soldiers must be prepared to work in all environmental extremes, frequently with little or no preparation time. While working in extreme heat or cold is uncomfortable, little preparation is necessary as long as reasonably fit Soldiers remain properly nourished, hydrated, or clothed. Working at high altitude poses additional risks that can be pharmacologically mitigated. While new prophylactic therapies are appearing on the scene in mountaineering and high-altitude climbing circles, acetazolamide still appears to be the preferred drug for the prevention of altitude related illness.


Pregnancy outcomes in solid organ transplant recipients with exposure to mycophenolate mofetil or sirolimus.
Animal and limited human studies have raised concerns as to the safety of in utero exposure to mycophenolate mofetil (MMF) and sirolimus (SRL) in transplant recipients. This study examined the outcomes of pregnancies with exposure to MMF or SRL from 30 female transplant recipients (39 pregnancies) who have reported pregnancies to the National Transplantation Pregnancy Registry. Data were collected via questionnaires, phone interviews and medical records. There were 18 kidney recipients reporting 26 pregnancies with exposure to MMF: 15 livebirths (LB), 11 spontaneous abortions (SA). Structural malformations were reported in four of the 15 children (26.7%) including: hypoplastic nails and shortened fifth fingers (one), microtia with cleft lip and palate (one), microtia alone (one), and neonatal death with multiple malformations (one). One kidney/pancreas (K/P) recipient reported one SA. Three liver recipients reported three pregnancies; two LB (no malformations), and one second trimester SA. Two heart recipients reported one LB (no malformations) and two SA. SRL exposures included seven recipients (four kidney, one K/P and two liver) reporting four LB (one infant whose mother was switched from MMF to SRL during late pregnancy had cleft lip and palate and microtia) and three SA. A higher incidence of structural malformations was seen with MMF exposures during pregnancy compared to the overall kidney transplant recipient offspring, while no structural defects have as yet been reported with early pregnancy sirolimus exposures. Centers are encouraged to report all pregnancy exposures in transplant recipients.


A Population-Based Survey to Determine Association of Perceived Social Support and Self-Efficacy With Self-Care Among Elderly With Diabetes Mellitus (Kerman City, Iran).
This survey examined association between social support and self-efficacy with self-care in elderly with diabetes. A total of 374 subjects were identified in Kerman city, Iran who responded to questionnaires on self-care, social support, and self-efficacy. Data were analyzed by using SPSS. Along with customary descriptive statistics, we also determined group difference for self-care, and Pearson correlation, and prediction value of various variables by using hierarchical multiple regression. And 67.37% of subjects were classified as poor adherence to self-care; 55.9% patients reportedly had good foot care habits, while 68.4% patients were not taking adequate physical activity. There was a significant correlation between self-care with social support and self-efficacy. Independent variables accounted for 44.3% of the variance in self-care. Diabetes care programs should aim to implement (a) weekly free-of-cost mass physical activity programs, (b) mass education adapted for gender- and age-based needs, and


Efficient RNA structure comparison algorithms.
Recently proposed relative addressing-based ([Formula: see text]) RNA secondary structure representation has important features by which an RNA structure database can be stored into a suffix array. A fast substructure search algorithm has been proposed based on binary search on this suffix array. Using this substructure search algorithm, we present a fast algorithm that finds the largest common substructure of given multiple RNA structures in [Formula: see text] format. The multiple RNA structure comparison problem is NP-hard in its general formulation. We introduced a new problem for comparing multiple RNA structures. This problem has more strict similarity definition and objective, and we propose an algorithm that solves this problem efficiently. We also develop another comparison algorithm that iteratively calls this algorithm to locate nonoverlapping large common substructures in compared RNAs. With the new resulting tools, we improved the RNASSAC website (linked from http://faculty.tamuc.edu/aarslan ). This website now also includes two drawing tools: one specialized for preparing RNA substructures that can be used as input by the search tool, and another one for automatically drawing the entire RNA structure from a given structure sequence.


Do patients with juvenile idiopathic arthritis in remission exhibit active synovitis on joint ultrasound?
The aim of the study was to assess the presence and characteristics of subclinical synovitis using power Doppler (PD) ultrasonography on patients with juvenile idiopathic arthritis (JIA) in clinical remission and compare the findings with those of healthy children. A cross-sectional study was carried out involving the clinical (physical exam, functional capacity and laboratory tests) and ultrasonography evaluation of 34 joints (synovial fluid/hypertrophy, PD signal and bone erosion). Subclinical synovitis was defined as the presence of synovial hypertrophy/joint effusion with or without any PD signal. Thirty-six patients (11.5 ± 3.74 years) and 36 controls (sex and age matched) were evaluated (2,448 joints). Twenty-seven patients were in remission on medication (mean duration: 1.8 ± 2.2 years). Subclinical synovitis was detected in 41.7% patients and 11.1% controls (p = 0.003). Erosion was detected in three patients (8.3%). Subclinical synovitis was found in 38/1,224 (3.1%) joints in the patients (most affected: radiocarpal wrist, anterior elbow and tibiotalar ankle) and 8/1,224 (0.6%) joints in the controls (most affected: radiocarpal wrist). Differences in subclinical synovitis between patients and controls were found in the elbows (p = 0.033) and ankles (p = 0.006). A greater frequency of subclinical synovitis was found in patients with the extended oligoarticular or polyarticular subtypes (p = 0.013), those at an older age at disease onset (p = 0.007) and using methotrexate (p = 0.049). Patients with JIA in remission exhibit subclinical synovitis more frequently than controls. Subclinical synovitis was more frequent in patients with the polyarticular involvement and those at an older age at disease onset.


[Prevalence of malnutrition in not critically ill inpatients].
Malnutrition is a frequent issue in our hospitals, and it is associated with an increase in morbi- mortality and financial costs, together with a decline in the patients' quality of life. This study is aimed at establishing the prevalence of malnutrition in our health centre, as much at admission as at discharge. Transversal observational study assessing 277 adult patients, who were admitted consecutively, and applying the Nutritional Risk Screening 2002 (NRS-2002) in the first 48 hours from admission and then again at discharge. Cancer patients were also submitted the Patient Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment Short Form (MNA-SF) was applied to the population of 65 and over. 32.49% of patients were at malnutrition risk according to the results of NRS-2002 at admission. This percentage increased up to 40.98% at discharge. The NRS-2002 showed that 31.15% of cancer patients presented with nutritional risk; however, according to VGS-GP, 52.54% of the cases presented with nutritional risk to a certain extent (38.98% with moderate malnutrition and 13.56% with serious malnutrition). Among patients aged 65 and over, 29.31% were considered at risk according to the NRS-2002; the MNA-SF revealed nutritional alteration in 70.35% (54.65% with malnutrition risk, 15.7% with malnutrition). There are different groups of patients: 65 years old and over, transferred from the emergency department, multi-medicated, cancer patients and patients with heart failure, who present with a higher risk of nutritional deterioration at admission (p<0.05). There is a very high percentage of patients at nutritional risk in our centre, as much at admission as at discharge. It is therefore necessary to install a systematic screening of the nutritional status for all inpatients.


Impact of high spinal anesthesia technique on fast-track strategy in cardiac surgery: retrospective study.
Although high spinal anesthesia (HSA) has been used in cardiac surgery, the technique has not yet been widely accepted. This retrospective study was designed to investigate the impact of HSA technique on fast-track strategy in cardiac surgery. Elective cardiac surgery cases (n=1025) were divided into two groups: cases with HSA combined with general anesthesia (GA) (HSA group, n=188) and cases with GA only (GA group, n=837). In the HSA group, bupivacaine and morphine were intrathecally administered immediately before GA was induced. Outcomes included fast-track extubation (less than 6 hours), extubation in the operating room, fast-track discharge from the intensive care unit (ICU) (less than 48 hours) and hospital (less than 7 days). In the HSA group, 60.1% were extubated in less than 6 hours after ICU admission, as compared with 39.9% in the GA group (p<0.001). In the HSA group, 33.0% were extubated in the operating room, as compared with 4.4% in the GA group (p<0.001). LOS in the ICU was less than 48 hours in 67.6% in the HSA group, as compared with 57.2% of those in the GA group (p=0.033). LOS in the hospital was less than 7 days in 63.3% in the HSA group, as compared with 53.5% in the GA group (p=0.084). HSA technique combined with GA in cardiac surgery increased the rate of fast-track extubation (less than 6 hours) when compared with GA only.


Gas chromatographic determination of noxyptyline in substance, tablets and in biological material.
Noxyptyline, i.e. 5-(2-dimethylaminoethyloxyimine)-5H-dibenzo[a,b] cyclohepta-1,4-diene hydrochloride, is an antidepressant. A new, direct method for its determination in substance and in tablets by means of gas chromatography has been developed. The results were compared with those of the spectrophotometric method, and the systematic errors(coefficient of variation) were 2.19% and 2.49%, respectively. Appropriate conditions were developed for the extraction of noxyptyline from plasma and urine, and the gas chromatographic method was applied for its determination. Within the concentration range 0.5-10 microgram/cm3, the systematic error after extraction from plasma was 4.61%, and after extraction from urine it was 2.08%. The recovery from plasma was 71.12 +/- 8%, and from urine it was 90.94 +/- 1.5%.


Directed differentiation of periocular mesenchyme from human embryonic stem cells.
Corneal tissue is the most transplanted of all body tissues. Currently, cadaveric donor tissues are used for transplantation. However, a global shortage of transplant grade material has prompted development of alternative, cell-based therapies for corneal diseases. Pluripotent stem cells are attractive sources of cells for regenerative medicine, because large numbers of therapeutically useful cells can be generated. However, a detailed understanding of how to differentiate clinically relevant cell types from stem cells is fundamentally required. Periocular mesenchyme (POM), a subtype of cranial neural crest, is vital for development of multiple cell types in the cornea, including clinically relevant cells such as corneal endothelium and stromal keratocytes. Herein, we describe protocols for differentiation of POM from pluripotent stem cells. Using defined media containing inhibitors of TGFβ and WNT signalling, we generated neural crest cells that express high levels of the POM transcription factors PITX2 and FOXC1. Furthermore, we identified cells resembling POM in the adult cornea, located in a niche between the trabecular meshwork and peripheral endothelium. The generation and expansion of POM is an important step in the generation of a number of cells types that could prove to be clinically useful for a number of diseases of the cornea.


Tetanus surveillance--United States, 1998--2000.
Tetanus is a severe and often fatal infection. The incidence of reported cases in the United States has declined steadily since introduction of tetanus toxoid vaccines in the 1940s. This report covers surveillance data for 1998--2000. Physician-diagnosed cases of tetanus were reported to CDC's National Notifiable Disease Surveillance System. Supplemental clinical and epidemiologic information were provided by states. During 1998--2000, an average of 43 cases of tetanus was reported annually; the average annual incidence was 0.16 cases/million population. The highest average annual incidence of reported tetanus was among persons aged >60 years (0.35 cases/million population), persons of Hispanic ethnicity (0.37 cases/million population), and older adults known to have diabetes (0.70 cases/million population). Fifteen percent of the cases were among injection-drug users. The case-fatality ratio was 18% among 113 patients with known outcome; 75% of the deaths were among patients aged >60 years. No deaths occurred among those who were up-to-date with tetanus toxoid vaccination. Seventy-three percent of 129 cases with known injury information available reported an acute injury; of these, only 37% sought medical care for the acute injury, and only 63% of those eligible received tetanus toxoid for wound prophylaxis. The majority of tetanus cases occurred among persons inadequately vaccinated or with unknown vaccination history who sustained an acute injury. Adults aged >60 years were at highest risk for tetanus and tetanus-related death. Tetanus is preventable through routine vaccination (i.e., primary series and decennial boosters) and appropriate management. A shortage of tetanus and diphtheria toxoids vaccine that began during 2000 ended in 2002. Efforts by health-care providers are warranted to vaccinate persons with delayed or incomplete vaccination, with emphasis on older persons and persons with high-risk conditions.


Therapeutic drug monitoring of clozapine in relapse prevention: a five-year prospective study.
Twenty-three outpatients with schizophrenia (ICD-10 F20.xx) treated with clozapine (CZ) as monotherapy entered a prospective study on relapse prevention. Every 4 weeks, psychopathology was assessed by the Brief Psychiatric Rating Scale (BPRS), and plasma CZ and norclozapine levels were measured. Patients were enrolled after complete remission of positive symptoms for at least 4 months according to the psychosis cluster of the BPRS and at a mean of 3.3 years after their last hospitalization. At the time of enrollment, the median BPRS total score was 29 points (range, 19-48). Within 4 months, the baseline CZ plasma level was established as the mean of CZ levels from at least four subsequent measurements. These baseline plasma levels were considered as the optimal relapse-preventing plasma CZ levels in the individual patients. When the patients were enrolled, they were considered to be prone to relapse. Relapse was defined as clinical deterioration, hospitalization, or both. Plasma levels were considered a prognostic factor, and patients were defined as at increased risk if plasma levels decreased by more than 40% from baseline CZ plasma level. The effect of plasma CZ levels on clinical outcome was evaluated by a Cox regression with plasma level as a time-dependent covariate. Within 46 months of enrollment, 32 episodes of relapse events in 10 patients were available for evaluation. Seventeen patients had a plasma level decrease of more than 40% at some point. In 12 of these, the decrease was present for more than 12% of the observation period. Eight patients of this group relapsed, and three of these had to be rehospitalized. Two patients relapsed, although their plasma levels decreased by more than 40% for less than 12% of the observation period. Within the first 2 years, relapse-free survival curves illustrate that both groups (episodes under elevated risk and episodes not under elevated risk) had identical relapse patterns, but from then on the relapse risk increased rapidly in the group with longer exposure to elevated risk. In a Cox model with a 40% decrease of plasma CZ levels as a dichotomous time-varying explanatory covariate, the risk ratio is 6 (95% confidence interval = 2-19, p = 0.003). The 10 patients who relapsed exhibited safe plasma levels (less than a 40% decrease from their baseline levels) for only 210 months, and 13 nonrelapsing patients had plasma levels defined as safe for 426 months.


A combined horseradish peroxidase and Golgi study on the afferent connections of the ventrobasal complex of the thalamus in the cat.
Afferent connections to the ventrobasal complex (VB) of the thalamus were studied by means of retrograde transport of horseradish peroxidase (HRP) and by the Golgi-method. After HRP-injection into the VB, peroxidase-positive cells were observed contralaterally in the dorsal column nuclei (DCN), in the trigeminal nuclei and in the lateral cervical nucleus (LCN), and ipsilaterally in the somatosensoty I (SI) and II (SII) cortical areas. Labeled cells of different shape and size were compared with neurons impregnated by the Golgi-technique. On tn size and shape even within one region and that they correspond to the relay or efferent neurons observed in the Golgi-material.


Quantification of spatial blood flow distribution in isolated canine lung.
Single photon emission computed tomography (SPECT) in intact dogs and humans suggests that blood flow in the lung (Qr) is distributed so that at isogravity a large gradient in Qr exists between the core and the periphery. To confirm such findings, we injected (IV) six anesthetized healthy dogs (approximately 30 kg) with 20 mCi technetium-99m (Tc-99m)-labeled albumin macroaggregates. At injection, the dogs were in the supine position and breathing spontaneously. Injections were given at end expiration. The animals were killed and their chests opened; their lungs were removed and dissected free of other tissue, and the blood was drained. The lungs were inflated to full capacity, and warm (50 degrees C) air was blown into them for about 18 hours to dry them. The fully inflated and dry lungs were placed supine, and SPECT was performed to determine the 3-D distribution of activity. After SPECT was completed, either a coronal slice or a sagittal slice (1 cm thick) was cut and imaged directly by placing it against the gamma camera collimator for 6 minutes. The tomographic images of flow distribution in coronal slices (isogravity) revealed that independent of gravity, Qr in the central region of the lungs was greater than that in the periphery. Furthermore, the central-peripheral gradient was discernible within the individual lobes. The direct images of slice confirmed these findings. Tomographic images of sagittal slices showed that heterogeneities in Qr in the vertical (direction of gravity) and horizontal direction (isogravity) were comparable.(ABSTRACT TRUNCATED AT 250 WORDS)


Role of adipocytokines on the pathogenesis of atherosclerosis in visceral obesity.
Obesity which is defined as accumulation of excess body fat, is a major cause of atherosclerotic vascular disease in industrial countries. Recent advances in the biology of adipose tissue have revealed that adipose tissue is not simply an energy storage organ but it also secretes a variety of molecules which affect the metabolism of the whole body. Through a systematic search of active genes in adipose tissue, we found that adipose tissue, especially visceral fat expressed numerous genes for secretory proteins (about 30% of total genes analyzed). Among them, plasminogen activator-1 (PAI-1), which is a regulator of the fibrinolytic system, was overexpressed in the visceral fat in an animal model of obesity. Plasma levels of PAI-1 were closely correlated with visceral fat adiposity. Thus, PAI-1 secreted from visceral fat may play some role in thrombotic vascular disease in visceral obesity. Adiponectin, a novel adipose-specific gene product, which has a matrix-like structure, is abundantly present in the bloodstream. Dysregulated secretion of adiponectin may be related to vascular disease in obesity. Biologically active molecules secreted from adipose tissue (adipocytokines) may have important roles in the development of atherosclerotic disease in obesity.


Time sequential single photon emission computed tomography studies in brain tumour using thallium-201.
Time sequential single photon emission computed tomography (SPECT) studies using thallium-201 were performed in 25 patients with brain tumours to evaluate the kinetics of thallium in the tumour and the biological malignancy grade preoperatively. After acquisition and reconstruction of SPECT data from 1 min post injection to 48 h (1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 15-20 min, followed by 4-6, 24 and 48 h), the thallium uptake ratio in the tumour versus the homologous contralateral area of the brain was calculated and compared with findings of X-ray CT, magnetic resonance imaging, cerebral angiography and histological investigations. Early uptake of thallium in tumours was related to tumour vascularity and the disruption of the blood-brain barrier. High and rapid uptake and slow reduction of thallium indicated a hypervascular malignant tumour; however, high and rapid uptake but rapid reduction of thallium indicated a hypervascular benign tumour, such as meningioma. Hypovascular and benign tumours tended to show low uptake and slow reduction of thallium. Long-lasting retention or uptake of thallium indicates tumour malignancy.


Intracellular sites of toxic metals.
In summary, this brief overview of the cellular localization of toxic metals in renal tubular cells demonstrates a spectrum of mechanisms for the sequestration of the metals. Common features are affinity for a metal-binding protein, such as insoluble acidic nuclear proteins or the soluble, low-molecular weight metallothionein. Accumulation in lysosomes follows assimilation of metal containing protein by lysosomes or autophagocytosis of degenerating metal containing mitochondria. Currently available methods have not demonstrated the presence of metals in immune complex deposits in glomerular basement membrane and epithelial cells. The principal methods employed for the localization of metals within cells have been X-ray microanalysis of thin preparation of tissue, or direct analysis of subcellular fractions by atomic absorption spectroscopy or detection of radioactive metal.


Serial quantitative liver function tests in patients with primary biliary cirrhosis: a prospective long-term study.
Primary biliary cirrhosis (PBC) is a rare chronic cholestatic disorder of unknown origin that can now be treated effectively with ursodeoxycholic acid (UDCA). The clinical course of PBC is very variable, but a significant proportion of patients eventually die or undergo liver transplantation. In this single-center prospective long-term study, we analyzed the effect of UDCA therapy (10 mg/kg b.w./day) on conventional liver function tests and we also investigated whether serial quantitative liver function tests are useful in the clinical management of patients with PBC. Fifteen patients, most of them in an early disease stage, were followed up for either 4 (n = 7) or 5 (n = 8) years. In addition to regular conventional liver function tests, every 12 months quantitative liver function tests were performed. Thus we measured galactose elimination capacity, indocyanine green half-life and lidocaine half-life. Quantitative liver function tests were also performed once in healthy volunteers. Treatment with UDCA significantly improved conventional liver function tests, and this effect was maintained for several years (values in U/l before therapy and 4 years after therapy: AP = 1,346 +/- 317 vs. 516 +/- 93; gammaGT 378 +/- 80 vs. 144 +/- 30; LAP 122 +/- 10 vs. 71 +/- 9; AST 61 +/- 19 vs. 34 +/- 12; ALT 90 +/- 19 vs. 68 +/- 35; GLDH 14.3 +/- 1.9 vs. 8.2 +/- 1.9). Quantitative liver function tests were not significantly different between healthy volunteers and patients (GEC 6.8 +/- 0.3 vs. 7.0 +/- 0.3 mg/kg x min; ICG half-life 4.2 +/- 0.4 vs. 3.7 +/- 0.3 min; lidocaine half-life 75 +/- 8 vs. 79 +/- 6 min). In the patients, results of quantitative liver function tests (GEC, ICG and lidocaine half-lives) were not affected by UDCA therapy and remained constant over time. In the 1 patient who was transplanted, serial quantitative liver function tests did not indicate deteriorating liver function earlier than the patient's progressive symptoms or conventional liver function tests. Thus UDCA therapy markedly improved conventional liver function tests in patients with PBC, and this effect was maintained for at least 4-5 years. Possibly due to the fact that most of the patients were in an early disease stage, serial quantitative liver function tests provided little additional information that was relevant for planning therapy in the individual patient.


A validation study of the Dementia Questionnaire.
To determine the validity of the Dementia Questionnaire (a semistructured informant interview) for the diagnosis of dementia. Comparison of dementia status determined by a telephone-administered informant questionnaire with the criterion standard of clinical diagnosis established by examination and laboratory studies. Gerontology Research Center, the Baltimore Longitudinal Study of Aging. Volunteer cohort of 42 men and 32 women aged 68 to 97 years. Subjects were selected from strata defined by Blessed Information Memory Concentration Test scores, with oversampling of borderline scores (3 to 10). Sensitivity and specificity of the Dementia Questionnaire in comparison with the criterion standard of clinical diagnosis. Interrater reliability (kappa coefficient). Sensitivity and specificity for dementia were 100% and 90%, respectively. Most false-positive findings were from subjects with cognitive impairment that did not meet criteria for dementia (Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Interrater reliability was high (kappa = 0.83). The Dementia Questionnaire can be used effectively in research studies to screen for dementia.


[Management of cytomegalovirus infection after hematopoietic stem cell transplantation].
Various types of infectious complications could develop after allogeneic hematopoietic stem cell transplantation (HSCT) due to the associated intensive immunosuppression. Cellular immunity is also impaired, resulting in a higher incidence of viral infections when compared with standard chemotherapy. Cytomegalovirus (CMV) reactivates in seropositive patients under immunosuppression after allogeneic HSCT, causing complications, such as pneumonitis, gastroenteritis, and retinitis. Because intervention before the onset of disease, rather than after, can improve prognosis, preemptive therapy guided by early detection of CMV reactivation has been extensively used. Recently, the introduction of a less myelotoxic agent, letermovir, has enabled prophylactic therapy to be administered safely and effectively. In addition, prophylactic letermovir is expected to reduce transplant-related mortality. However, the onset of CMV infection/disease as either a breakthrough infection or after the discontinuation of letermovir is still problematic. In this section, the management tips for CMV infection after allogeneic HSCT have been summarized.


Ultrastructure of retinal ganglion cell death after axotomy in chick embryos.
Axotomy often leads to neuronal death, which occurs after a particularly short delay in immature animals. Tectal lesions were made in embryonic day (E) 12 chick embryos, thereby axotomizing the retinal ganglion cells of the contralateral eye, which then died within 3 days. We here describe the ultrastructural changes in the axotomized ganglion cells. The main changes were nuclear invagination and type 3B (cytoplasmic type) cell death characterized by dilation of the perinuclear space, endoplasmic reticulum, and Golgi apparatus. However, nuclear invagination was never seen in type 3B dying cells. All the axotomy-induced retinal ganglion cell death appears to have been of type 3B; apoptosis was not induced by axotomy, as was confirmed by additional light microscopic experiments showing that it did not increase the frequency of apoptotic markers revealed by terminal deoxynucleotidyl transferase-mediated biotinylated UTP nick end labeling (the TUNEL method) labeling and immunoreactivity for activated caspase-3. However, the latter methods did show small numbers of apoptotic cells dying naturally even in control retinas. After the death of the axotomized ganglion cells, they were phagocytosed mainly in Müller processes. The present findings open up the chick tectal lesion model as a system for analyzing type 3B neuronal death in vivo.


Taguchi design-based enhancement of heavy metals bioremoval by agroindustrial waste biomass from artichoke.
The Taguchi method of designing experiments is based on a system of tabulated designs (arrays) that enables the maximum number of variables to be estimated in a neutral (orthogonal) balanced manner with a minimum number of experimental sets. Heavy metals remediation of aqueous streams is of special concern due to its highly toxic and persistent nature. Taguchi approach was used for enhanced bioadsorptive removal of Pb(II), Cu(II) and Cd(II) from aqueous solutions using agroindustrial waste biomass from globe artichoke as inexpensive sorbent. Sorbent biomass was characterized as to its chemical composition by infrared spectroscopy (FTIR), revealing the presence of hydroxyl, carboxyl, sulphonic and amine functional groups. Ranks of four factors (pH, temperature, sorbent dosage and initial metal concentration) at three levels each, in a L9 array were conducted, in batch sorption tests, for the individual metal ions of concern. The sorption capacity (qe) values were transformed into an accurate signal-to-noise (S/N) ratio for a "higher is better" response. The best conditions for individual heavy metal sorption were determined reaching up to 86.2 mg·g-1 for Pb, 35.8 mg·g-1 for Cd and 24.4 mg·g-1 for Cu. This paper also discusses the equilibria and kinetic aspects of the sorption process. Sorption isotherms were successfully described by the Sips model. In addition, the experimental data showed that the uptake kinetic profiles of the three metal ions closely fitted the pseudo-second order model. Conclusively, the agroindustrial waste biomass from globe artichoke represents a potentially viable sorbent for the bioremoval of Pb(II), Cu(II) and Cd(II) ions from aqueous systems.


[New stereoselective catalysts in doxycycline synthesis].
Formation of the doxycycline diastereoisomer along with doxycycline during hydrogenation of the methacycline exocyclic double bond lowered the yield of the main product. The use of tris-(triphenylphosphine)-rhodium chloride (Wilkinson catalyst) as a catalyst provided higher stereoselectivity of the hydrogenation and resulted in predominant production of doxycycline. Inclusion of some ligands such as hydrazine or others into the composition of the compound rhodium catalyst increased its activity. The stereoselectivity during hydrogenation of the methacycline exocyclic double bond can be explained by different rates of hydrogen attachment to the two enantiomeric products of the compound rhodium catalyst addition to the exocyclic double bond.


Peroxisome Proliferator-Activated Receptor β/δ Alleviates Early Brain Injury After Subarachnoid Hemorrhage in Rats.
Early brain injury is proposed to be the primary cause of the poor outcome after subarachnoid hemorrhage (SAH), which is closely related to the neural apoptosis. To date, the relationship between peroxisome proliferator-activated receptor β/δ (PPARβ/δ) and nuclear factor-κB/matrix metalloproteinase-9 (NF-κB/MMP-9) pathway, both of which are closely related to apoptotic effects, has been poorly studied in SAH. The present study was undertaken to evaluate the effects of PPARβ/δ on early brain injury and NF-κB/MMP-9 pathway after SAH in rats. SAH model was established by injecting nonheparinized autologous arterial blood into the prechiasmatic cistern in male Sprague-Dawley rats. Adenoviruses or small interfering RNAs were injected into the right lateral cerebral ventricle to, respectively, up- or downregulate PPARβ/δ expression before SAH. All animals were assessed with a neurological score and then killed at 24 hours after SAH surgery. The indexes of brain water content, blood-brain barrier permeability, and apoptosis were used to detect brain injury. The expression of PPARβ/δ, NF-κB, and MMP-9 were measured by immunohistochemistry, gelatin zymography, and Western Blot methods, respectively. In addition, GW0742, a specific agonist of PPARβ/δ, was used to treat SAH in rats, the effects of which were evaluated by neurological scoring and Evans blue extravasation. Overexpression of PPARβ/δ by adenoviruses treatment significantly ameliorated brain injury with improvement in neurological deficits, brain edema, blood-brain barrier impairment, and neural cell apoptosis at 24 hours after SAH in rats, whereas downregulation of PPARβ/δ by small interfering RNAs administration resulted in the reverse effects of the above. The expression levels of NF-κB and MMP-9 were markedly downregulated when PPARβ/δ increased after PPARβ/δ adenovirus transfection and upregulated when PPARβ/δ decreased by PPARβ/δ small interfering RNAs treatment. Moreover, GW0742 improved neurological deficits and reduced Evans blue extravasation at 24 hours after SAH. PPARβ/δ's overexpression may attenuate early brain injury after rats' SAH administration, which reduces neural apoptosis possibly through blocking NF-κB/MMP-9 pathway.


Autologous primary muscle-derived cells transfer into the lower urinary tract.
The goal of these experiments was to establish the basic methodology for future clinical applications of muscle-derived cells (MDC) tissue engineering and gene transfer for the treatment of urological dysfunction. Primary MDC isolated via preplating techniques from adult female SD rats were transduced with retrovirus encoding the expression of beta-galactosidase reporter gene. The MDC were injected into the right and left lateral walls of the bladder and proximal urethra of the autologous animals (n = 6) with a 10 microl Hamilton micro syringe. The amount of injected MDC ranged from 1 to 2 x 10(6) cells. The injected tissue was harvested after 7, 14, and 28 days, sectioned and examined histologically for beta-galactosidase and immunohistochemically for fast myosin heavy chain specific to skeletal muscle. The tissues were also stained for anti-CD4 and anti-CD8 antibodies to assess for cellular immune reaction. We have detected a large number of autologous MDC expressing beta-galactosidase and positively stained for fast myosin heavy chain in the bladder and urethral wall. Many injected myoblasts and myotubes were also seen in the bladder and urethral wall at each time point. Staining of lymphocytes with anti-CD4 and anti-CD8 antibodies was negative after MDC injection at each time point. We have demonstrated the long-term survival of autologous MDC and MDC mediated gene transfer into the bladder and urethral wall. Autologous MDC and MDC mediated gene transfer may be a promising treatment to augment bladder and urethral sphincter function.


An Overview of the Orphan Medicines Market in Turkey.
The health policies of many countries and regions have already defined orphan drugs for rare diseases. Although there is no official definition of orphan drugs in Turkey, all orphan drugs are covered by reimbursement, regardless of their market authorization status. Thus, a pharmacoeconomic analysis does not have to be presented to the Social Security Institution (Sosyal Güvenlik Kurumu) for reimbursement decisions on orphan drugs. The aim of this study was to shed light on the use of orphan drugs to aid classifications of rare diseases and assessments of orphan drugs in Turkey. Data for sales of authorized orphan drugs and all other drugs were extracted from the IMS Turkey for 2008, 2009, and 2010. Nonauthorized orphan drug sales data were extracted from records of the Turkish Pharmacists' Association for the same years. Government prices were obtained from the Sosyal Güvenlik Kurumu. The European Medicines Agency has classified more than 60 orphan drugs for rare diseases. Of these, 50 entered the Turkish market in recent years, half of which were authorized. The remaining drugs were imported through the early access procedure. Antineoplastic agents accounted for the largest percentage of orphan drugs, with 58% of the total market share. In 2010, there were 18 such agents in use, at a cost of €120 million. Although legislation is not yet in place for orphan drugs in Turkey, recognized pricing and reimbursement policies are in operation. This situation facilitates an analysis of orphan drug prices and reimbursement policies in Turkey.


Hope makes a difference.
Hope. It is a word that is often used but one which we do not stop to think intentionally about. It may be difficult to define, and frequently many come to know it more by its absence. Nurses espouse the value of hope, but it is a concept that often seems elusive when one is trying to put it into practice. The author suggests that hope is at the heart of psychiatric nursing practice and provides insights and reflections about how it has made a difference in the lives of individuals.


Spatial solitons in centrosymmetric photorefractive media.
We predict spatial solitons in photorefractive centrosymmetric media driven by the dc Kerr effect.


Flavonoids as superoxide scavengers and antioxidants.
The superoxide anions scavenging activity and antioxidation of seven flavonoids--quercetin, rutin, morin, acacetin, hispidulin, hesperidin, and naringin--were studied. The superoxide anions were generated in a phenazin methosulphate-NADH system and were assayed by reduction of nitroblue tetrazolium. The scavenging activity ranked: rutin was the strongest, and quercetin and naringin the second, while morin and hispidulin were very weak. The concentration values yielding 50% inhibition of lipid peroxidation in mouse liver homogenate were in order of 10(-6) M for quercetin, rutin, and morin; and of 10(-5) M for acacetin and hispidulin, while naringin and hesperidin had no antioxidative action. In comparison with the antioxidative and scavenging activities of flavonoids, there are no correlations.


Copper-oxide tip functionalization for submolecular atomic force microscopy.
Establishing submolecular imaging in real-space by non-contact atomic force microscopy (NC-AFM) has been a major breakthrough in the field of organic surface chemistry. The key for the drastically increased resolution in these experiments is to functionalize a metallic tip apex with an inert probe particle. However, due to their weak bonding at the metal apex, these probe particles show a pronounced dynamic lateral deflection in the measurements. This constitutes a major limitation of this approach as it involves image distortions, an overestimation of bond lengths, and even artificial bond-like contrast features where actually no bonds exist. In this contribution, recent progress by using an alternative approach by copper-oxide tip functionalization is reviewed. Copper-oxide tips (CuOx tips) consist of a bulk copper apex, terminated by a covalently connected single oxygen atom, which chemically passivates the tip. Such CuOx tips can be identified by contrast analysis at specific surface sites and allow for submolecular resolution. A comparative analysis of data recorded with flexible tips allows a detailed discussion of the contrast mechanisms and related artificial effects. It is concluded with an assessment of limitations, future challenges and opportunities in such experiments.


A "sample-and-hold" pulse-counting integrator as a mechanism for graded memory underlying sensorimotor adaptation.
The mechanisms behind the induction of cellular correlates of memory by sensory input and their contribution to meaningful behavioral changes are largely unknown. We previously reported a graded memory in the form of sensorimotor adaptation in the electromotor output of electric fish. Here we show that the mechanism for this adaptation is a synaptically induced long-lasting shift in intrinsic neuronal excitability. This mechanism rapidly integrates hundreds of spikes in a second, or gradually integrates the same number of spikes delivered over tens of minutes. Thus, this mechanism appears immune to frequency-dependent fluctuations in input and operates as a simple pulse counter over a wide range of time scales, enabling it to transduce graded sensory information into a graded memory and a corresponding change in the behavioral output. This adaptation is based on an NMDA receptor-mediated change in intrinsic excitability of the postsynaptic neurons involving the Ca2+-dependent activation of TRP channels.


[HLA genetic markers and auto-antibody profile in a Mapuche family with a case affected of type 1 diabetes].
Type 1 diabetes (DM1) is caused by an autoimmune process that destroys beta cells of pancreas. Not all carriers of susceptible HLA genes and positive for autoantibodies develop the disease. Environmental factors play a role in triggering the autoimmune process. To analyze an exceptional case of DM1 in a Mapuche family in the context of genetic, immunological and environmental factors. A study of a family with an affected female child was carried out in a Mapuche community in Southern Chile (VIII region). This is an unique and sporadic DM1 case with Mapuche heritage. Nutritional and viral infections data were collected by interview and clinical records. A genetic analysis by PCR was done to detect class I and II HLA genes by reverse dot blot. The proband, her mother and sister had positive islet cell antibodies (ICA). Her father and brother were negative. All thefamily was positive for anti glutamic decarboxylase antibodies (GAD65). All subjects had HLA-DRB1 0407/0407 and HLA-DQB1 0302/0302 alleles. The index case and her father were homozygotes for the HLA-A1:A*68012/A*68012 allele. Mean breastfeeding lapse was 18 months in all children. No evidences for viral infections such as rubella, mumps or measles were found in this family. There was an altered profile of autoantibodies in the family of the index case. All genotypes were comparable with the European population where the diabetogenic combination DR4/DQB1*0302 is the most prevalent. No environmental factors could be incriminated as triggers of the disease.


Accessory ossicles in the elbow.
Accessory ossicles in the elbow are often diagnosed as osteochondritis dissecans or chondromatosis, but no terminologic agreements seem to exist in the literature. Our study of 5 patients suggests that accessory ossicles in the fossa olecrani or coronoidea may represent anatomic variants, perhaps best described as os supratrochleare anterius and posterius, respectively.


[Design and trial of computer test system for experiment courses of human parasitology].
Based on the traditional experimental test of human parasitology, a reform was conducted to avoid the shortage of specimens and a disclosure of test questions. An experimental test system of human parasitology based on client/server (C/S) structure was therefore developed. This practicable system can increase the efficiency and fairness of examination and reduce cost.


Bispectrum analysis of electroencephalogram signals during waking and sleeping.
The degree of interaction of component waves making up a single electroencephalogram trace was strongly correlated with alpha activity, lead placement, and state of consciousness. Significant quadratic coupling of the waves was found only for awake subjects with high alpha activity. For these subjects about 50 percent of beta activity can be attributed to harmonic coupling with the alpha peak. During sleep, the degree of interaction was of borderline significance and did not follow a consistent pattern with respect to subject, frequency, state, or lead.


20(S)-ginsenoside Rh2, a newly identified active ingredient of ginseng, inhibits NMDA receptors in cultured rat hippocampal neurons.
Most herbal medicines that are orally administrated have been known to be metabolized before they are absorbed from the gastrointestinal tract. We, therefore, examined the effects of 20(S)-ginsenosides Rb1, Rg1 and Rg3, the three most commonly studied ginsenosides in the central nervous system, and their main metabolites on NMDA receptors using fura-2-based digital imaging and perforated whole-cell patch-clamp techniques. Among the nine ginsenosides tested, 20(S)-ginsenoside Rh2 (20(S)-Rh2) along with 20(S)-ginsenoside Rg3 (20(S)-Rg3) produced the highest inhibitory effect in cultured hippocampal neurons. Although 20(S)-Rg3 and 20(S)-Rh2 selectively targeted NMDA receptors with similar potency, they produced additive effects and seemed to modulate different NMDA receptor regulatory sites. As a competitive antagonist, 20(S)-Rh2 seems to inhibit the receptor via its interaction with polyamine-binding sites, and 20(S)-Rg3 does so using glycine-binding sites. Therefore, these results suggest that the treatment of 20(S)-Rh2, a newly identified active ingredient of ginseng, might be a novel preventive candidate in treating neurodegenerative disorders.


Interaction of lipogenic substrates in porcine adipose tissue in vitro.
1. Porcine adipose tissue was incubated with radiolabeled glucose, acetate or lactate. Saturation curves indicated that lactate greater than glucose greater than acetate in providing two-carbon units for fatty-acid synthesis. 2. Competition between individual substrates indicated that lactate was the best lipogenic substrate. 3. Incubation of all three substrates at concentrations observable in serum indicated that at 5.56 mM, glucose was the preferred lipogenic substrate in the presence of 0.1 mM acetate and 1.0 mM lactate. 4. At elevated concentrations (18.52 mM glucose, 1.0 mM acetate and 10.0 mM lactate), acetate and lactate were preferred to glucose as lipogenic substrates.


Co-administration of ethanol transiently inhibits urethane genotoxicity as detected by a kinetic study of micronuclei induction in mice.
Urethane (ethyl carbamate) is a genotoxic carcinogen that requires metabolic activation. Ethanol is known to inhibit urethane metabolism and genotoxicity. Since ethanol is eliminated rapidly in animals, the persistence of ethanol inhibition was studied in a mouse bone marrow and a peripheral blood micronucleus assays. In the bone marrow assay, male CD-1 mice were injected intraperitoneally (i.p.) with water (vehicle), urethane (1000 mg/kg), ethanol (2500 mg/kg) or urethane and ethanol (1000 and 2500 mg/kg, respectively) in single injections. Polychromatic erythrocytes (PCE) from bone marrow were obtained at 24 and 48 h after injection and scored for micronuclei. Urethane induced an increase of micronucleated PCE (MN PCE) frequency from 0.19% in the control to 8.63% at 24 h, followed by a decrease to 6.98% at 48 h. When urethane was co-administered with ethanol, the MN PCE frequency was suppressed to 0.49% at 24 h, but markedly increased to 7.35% at 48 h. This delay of MN PCE occurrence indicated that ethanol inhibition was transient. To pinpoint the duration of this delay, a peripheral blood micronucleus assay was conducted to monitor the kinetics of MN PCE induction. In this assay, male CD-1 mice were injected i.p. with water, ethanol, urethane, or urethane and ethanol as described above. Peripheral blood was scored for MN PCE at 8-h intervals for 4 days. Two additional dose groups injected with urethane or urethane and ethanol were also scored for MN PCE at 8 h intervals, but each blood sampling time was staggered 4 h later from the first four dose groups. The combined data provided MN PCE frequencies at 4-h intervals from 24 to 100 h after injection. Urethane alone induced a peak MN PCE frequency of 11.6% at 52 h. Urethane and ethanol induced a peak MN PCE frequency of 11.2% at 64 h, a delay of 12 h. Thus, ethanol delays but does not diminish urethane genotoxicity.


Drug prohibition in the United States: costs, consequences, and alternatives.
"Drug legalization" increasingly merits serious consideration as both an analytical model and a policy option for addressing the "drug problem." Criminal justice approaches to the drug problem have proven limited in their capacity to curtail drug abuse. They also have proven increasingly costly and counterproductive. Drug legalization policies that are wisely implemented can minimize the risks of legalization, dramatically reduce the costs of current policies, and directly address the problems of drug abuse.


Discrete solitons and vortices on anisotropic lattices.
We consider the effects of anisotropy on solitons of various types in two-dimensional nonlinear lattices, using the discrete nonlinear Schrödinger equation as a paradigm model. For fundamental solitons, we develop a variational approximation that predicts that broad quasicontinuum solitons are unstable, while their strongly anisotropic counterparts are stable. By means of numerical methods, it is found that, in the general case, the fundamental solitons and simplest on-site-centered vortex solitons ("vortex crosses") feature enhanced or reduced stability areas, depending on the strength of the anisotropy. More surprising is the effect of anisotropy on the so-called "super-symmetric" intersite-centered vortices ("vortex squares"), with the topological charge equal to the square's size : we predict in an analytical form by means of the Lyapunov-Schmidt theory, and confirm by numerical results, that arbitrarily weak anisotropy results in dramatic changes in the stability and dynamics in comparison with the degenerate, in this case, isotropic, limit.


Potential movements of capital and labor in northeast Asia.
"This paper provides background information for potential movements of capital and labor within Northeast Asia. First, it reviews recent geopolitical changes...and the current state of capital and labor movements between the countries of Northeast Asia along the broad theme of regional cooperation. Second, the paper assesses potential movements of capital and labor in the near future based on planned or anticipated development projects in the region. Finally, political and social barriers to movements of capital and labor and some measures to facilitate such...movements are discussed."


[Regulation effects of reverse-slope level terrace on the runoff and sediment yield in sloping farmland].
A dynamic monitoring on the rainfall-runoff process and the surface runoff and sediment yield in a sloping farmland was conducted at a natural rainfall runoff plot in the watershed of Jianshan River, the first tributary of Fuxian Lake, Chengjiang, aimed to study the regulation effects of reverse-slope level terrace on the runoff and sediment yield in red soil sloping farmlands of Yunnan. The regulation rates of runoff and sediment yield by the reverse-slope level terrace were 49.5%-87.7% and 56.7%-96.1%, averagely 65.3% and 80.7%, respectively, showing that the regulation effects of reverse-slope level terrace on the runoff and sediment yield, especially the latter in sloping farmland were prominent. The variation coefficients of the test parameters for undisturbed sloping farmland and reverse-slope level terrace were in the order of sediment yield > runoff > rainfall. Comparing with undisturbed sloping farmland, reverse-slope level terrace had smaller surface runoff and smaller relative deviation degree of sediment yield, demonstrating its remarkable effect in controlling runoff and sediment yield in sloping farmland.


Use of CTG monitoring: are recommendations suitable?
The National Institute for Clinical Excellence (NICE) guideline for cardiotocograph (CTG) monitoring in labour (NICE, 2001) recommends intermittent monitoring for low-risk labours and discourages the use of an admission CTG. The guideline sets out risk factors that would classify a labour as high risk, for which it recommends continuous CTG monitoring. An audit conducted in a consultant-led maternity unit found that nearly a half of the labours were classified as high risk at the onset of labour. Of those classified as low risk, almost half of them went on to have continuous CTG during the course of labour. The majority of the reasons given by the midwives agree with indications specified by NICE. Midwives in the unit where the audit took place showed good compliance with the guidelines, except in the case of admission CTGs. Just under half those classified as low risk were found to have had an admission CTG.


Pattern of childhood visual impairment and blindness among students in schools for the visually impaired in Lagos State: An update.
The aim of this study was to determine the pattern of childhood visual impairment and blindness (VI and BL) among students attending schools for the visually impaired in Lagos State, with a view to providing information on avoidable causes as well as emerging trends that would be useful to policy-makers for the planning and implementation of strategies for the control of avoidable childhood BL in Lagos State. The study was conducted among students enrolled in two schools for the visually impaired in Lagos State who developed VI/BL before the age of 16 years. Participants and their parents/guardians were interviewed to obtain medical history. Ocular and systemic examinations were also performed. Information was recorded using a modified World Health Organization/Prevention of BL Eye Examination Record for Children with BL and Low Vision and analysed using the Statistical Package for the Social Sciences version 23.0. Z-test determined differences in the proportions of the causes of VI/BL between this study and an earlier study. A total of 116 students were enrolled in this study of which 65 (56.0%) were males. Avoidable causes accounted for 58.5% of VI/BL. Preventable causes predominated with measles (15; 12.9%) accounting for the largest proportion. Surgical complications (16; 13.8%) were the largest cause of VI/BL. A statistically significant decrease (P = 0.004; 95% confidence interval = 0.09-0.50) in the proportion of avoidable BL between a previous study carried out in Lagos State and this study was found. Hereditary cataract and cortical VI were the findings of this study not recorded in the previous study. Avoidable causes of childhood VI/BL still predominate among students in the schools for the visually impaired in Lagos State; however, there is a statistically significant decrease.


Dental Pathology of the Iberian Lynx ( Lynx pardinus), Part I: Congenital, Developmental, and Traumatic Abnormalities.
The Iberian lynx is an endangered felid that has been subject to an intensive ongoing conservation program in an attempt to save it from extinction. Identification of dental pathologies could play an important role in the survival of this endangered species. The objective of this study is to evaluate the dental pathologies (congenital, developmental, and traumatic abnormalities) of this species of felid. Skulls of 88 adult specimens of the Iberian lynx ( Lynx pardinus) from the Doñana Biological Station [Estación Biológica de Doñana-Consejo Superior de Investigaciones Científicas] (EBD-CSIC), Seville, Spain, were examined macroscopically, and full-mouth dental radiographs of all specimens were performed. Presence, absence, form of teeth, number of roots, supernumerary teeth, and persistent deciduous teeth were evaluated. The presence of attrition/abrasion, tooth fractures, enamel hypoplasia/hypomineralization, endodontic disease, intrinsically stained teeth, and other traumatic findings were also evaluated. Abnormal grooves and dilacerations were the most common abnormalities seen in the roots of teeth. Two hundred and fifteen fractured teeth (11.3% of evaluated teeth) were detected, and mainly complicated fractures were noted in maxillary canine teeth (24.2% of fractured teeth) and mandibular canine teeth (16.7% of fractured teeth). Endodontic disease was present in 3.9% of the teeth examined. Intrinsic tooth staining was assessed in 8.5% of evaluated teeth. Of all teeth examined, 831 teeth (43.7% of evaluated teeth) exhibited some type of attrition/abrasion. Our study concluded that there is a high prevalence of dental fractures and attrition/abrasion with associated endodontic disease that could lead to impaired hunting ability as well as a threat to overall health and subsequent survival of this endangered species.


Association of Social Networks and Physical Activity in South Asians: The Mediators of Atherosclerosis in South Asians Living in America Cohort Study.
Eliminating racial/ethnic disparities in physical activity remains a challenge in the United States. South Asian immigrants in the United States have particularly low physical activity levels, and evidence suggests that social context may be important. This study examined associations between personal social networks and moderate to vigorous leisure-time physical activity (MVPA) among South Asians in the United States. We used cross-sectional data (2014-2017) from 689 South Asians (aged 43-85 y) who participated in the Mediators of Atherosclerosis in South Asians Living in America study. Self-reported physical activity and egocentric network data were collected from participants about their network members. Regression models were used to determine associations between social network characteristics and participants' MVPA. Participants were on average 59 years old (SD = 9) and reported 1335 metabolic equivalent minutes per week of MVPA (interquartile range = 735, 2212). Having network members who exercised or who were exercise partners associated with increased MVPA in men (β coefficient = 241 MET min/wk [95% confidence interval, 63 to 419] and β = 520 MET min/wk [95% confidence interval, 322 to 718], respectively). For women, the association was only significant if the exercise partner was a spouse. Physical activity interventions utilizing network members as exercise partners may have potential in South Asians but must consider gender differences.


The concept of difference and the experience of China-educated nurses working in Australia: a symbolic interactionist exploration.
The migration of registered nurses as a response to a global nurse shortage has seen a growth in research interest in this area. Much of the research focuses on differences in language and culture which are posed as the attributes of the immigrant nurse. In reporting on an analysis of data drawn from China-educated nurses working in the Australian health care system, this paper explores the social construction of difference and the related intersection of difference and racialisation. A symbolic interactionist approach informed 46 in-depth interviews with 28 China-educated nurses. The method of analysis was initial and focused coding and constant comparison of data. The focus of interpretation was on human action and interaction as contextual and thus structural factors were critical to the analysis. Two levels of meaning were depicted in this study: difference as "you are you and I am I" and difference as "incompetence". Negative meanings were ascribed to difference which in turn legitimised inequality and held the potential to perpetuate racism. We argue that it is problematic to conceptualise difference as individual attributes. Difference needs to be contextualised and thus explored as a complex and socially constructed concept that in its application has social and political implications for immigrant nurses in Australia and elsewhere.


Nutritional and health consequences are associated with food insecurity among U.S. elderly persons.
The purpose of this study was to examine the consequences associated with food insecurity for the nutritional and health status of the elderly in the United STATES: The data analyzed were from the Third National Health and Nutrition Examination Survey (1988-1994) and the Nutrition Survey of the Elderly in New York State (1994). Multiple logistic and linear regression analyses were used to assess the extent to which food-insecure elderly were likely to have lower nutrient intake, skinfold thickness, self-reported health status and higher nutritional risk. Regardless of food insecurity status, older people consumed less than the recommended dietary allowance for eight nutrients. Food-insecure elderly persons had significantly lower intakes of energy, protein, carbohydrate, saturated fat, niacin, riboflavin, vitamins B-6 and B-12, magnesium, iron and zinc, as well as lower skinfold thickness. In addition, food-insecure elderly persons were 2.33 (95% confidence interval: 1.73-3.14) times more likely to report fair/poor health status and had higher nutritional risk. These results indicate that food-insecure elderly persons have poorer dietary intake, nutritional status and health status than do food-secure elderly persons. It is necessary to ensure the nutritional well-being of all elderly persons who are at nutritional and health risk, including those who are food insecure and have even poorer nutritional and health status than those who are food secure.


Living-donor lobar lung transplantation for primary ciliary dyskinesia.
A ventilator-dependent patient with primary ciliary dyskinesia underwent successful living-donor lobar lung transplantation. The case was a 24-year-old woman who had developed recurrent lower respiratory infection and became ventilator-dependent due to severe bronchiectasis. Transmission electron microscopy of the resected bronchus demonstrated inner dynein arm deficiency.


Neurological symptoms associated with cerebral hyperperfusion syndrome after CEA and CAS--one centre study.
There are two equivalent in efficacy methods of the treatment of carotid artery stenosis: endarterectomy (CEA) and stenting (CAS), in which the blood flow increases in most patients by 20-40% over baseline, in some exceeding 100% and being symptomatic and leading to cerebral hyperperfusion syndrome (CHS). The aim of this study is to analyze the structure of neurological symptoms associated with CHS in patients with carotid artery revascularization. Retrospective analysis included 1386 consecutive patients treated in the Department of General and Vascular Surgery between 2005 and 2011, with 625 of them were subjected to CEA and 761 to CAS. If neurological symptoms occurred, patients were consulted by a neurologist and ultrasonography (USG) examination and CT were performed. Neurological symptoms in patients with new onset of headache ipsilateral to the carotid revascularization were extracted from medical records and nursing documentation. Neurological symptoms attributed to CHS were observed in 66 (10.6%) of CEA and 61 (8.0 %) of CAS group. The frequency was similar in both groups (p = 0.43). The occurrence of epileptic attacks was similar in both study groups. The only difference was the less frequent falling of the lip in CAS group. Transient bradycardia and/or hypotension were observed in CAS (8.8% vs. 10.4% and 1.3% vs. 1.3%, respectively). No difference in stroke appearance between groups were found. The occurrence of neurological symptoms attributable to cerebral hyperperfusion syndrome after carotid artery revascularization in short term observation is similar regardless of the method used.


The OIG's model compliance program.
Home care agencies face never-ending and hard-to-track list of rules. The Office of the Inspector General has provided guidelines for agencies on implementing a voluntary compliance program to prevent fraud, abuse, and waste. Through the development of internal controls, which promote adherence to federal and state laws, agencies safeguard themselves from problems.


The carboxyl terminus of the human calcium receptor. Requirements for cell-surface expression and signal transduction.
The G-protein-coupled calcium receptor plays a key role in extracellular calcium homeostasis. To examine the role of the membrane-spanning domains and the approximately 200-residue cytoplasmic carboxyl terminus of the calcium receptor in cell-surface expression and signal transduction, we transfected HEK-293 cells with a series of truncation and carboxyl-terminal missense mutants and analyzed expression by immunoblotting, glycosidase digestion, intact cell immunoassay, and extracellular calcium-stimulated phosphoinositide hydrolysis assay. Two truncation mutants terminating at residues 706 and 802 within the second and third intracellular loops, respectively, were not properly glycosylated, failed to reach the cell-surface, and showed no calcium response, indicating that mutant receptors with the full extracellular domain but only three or five transmembrane domains are improperly folded and/or processed. Truncation mutants terminating at residues 888 and 903 within the carboxyl terminus were equivalent to the wild type in all assays, whereas mutants truncated at residues 865 and 874 showed no response to calcium, despite only approximately 25% reduction in cell-surface expression. Mutants with a full-length carboxyl terminus but with residues between positions 874 and 888 replaced with alanines showed either no (Ala875, Ala876, and Ala879) or significantly reduced (Ala881-Ala883) calcium response at levels of cell-surface expression equivalent to those of the wild-type receptor. These results indicate that deletion of the majority of the carboxyl terminus is compatible with normal processing, cell-surface expression, and signal transduction of the receptor. The truncation and alanine substitution mutants identify a small region between residues 874 and 888 critical for normal signal transduction by the receptor.


Morphological study on the thebesian veins of the right cavities of the heart in the dog.
The authors studied 48 dog hearts, using the injection-corrosion-fluorescence method to study the topography of thebesian veins in all the walls of the cardiac cavities. The thebesian veins are small, situated deep in the myocardium, opening after a short course into the cardiac cavities, by small openings with diameters in general not exceeding 1 mm, known 'foraminula'. They have a centripetal course, while every other vein in the heart has a centrifugal one, to reach the subepicardial zone. In the heart of the dog five types of thebesian veins were served: arboriform, sinuous, brush-like, canaliculated and stellate. The thebesian veins are almost regularly found in every wall of the cardiac cavities. The authors also observed that they predominated in the right ventricle (81.24%) and in the right atrium (77.43%).


Improved interpretation of dobutamine stress echocardiography following 4 months of systematic training in patients following acute myocardial infarction.
Interpretation of stress echocardiography is subjective, and highly dependent on the experience of the interpreter. We sought to evaluate whether a cardiologist without any previous experience in stress echocardiography could adequately learn the skills of interpreting dobutamine stress echocardiograms (DSE) in post-infarct patients, after a period of systematic training. A trainee in cardiology blindly reported 51 consecutive DSEs from a database of post-infarction studies, after 2 and 4 months of systematic training. We compared his interpretation with that of an expert. Agreement between the trainee and the expert improved significantly from 2 to 4 months of training in the left anterior descending artery territory for the overall scan interpretation (from kappa = 0.58 to kappa = 0.73; p = 0.03), wall thickening assessment in individual segments (from kappa = 0.40 to kappa = 0.55; p < 0.01) and the diagnosis of viable myocardium (from kappa = 0.11 to kappa = 0.43; p = 0.01). Similar improvement was observed in left circumflex, but not in the right coronary artery territory. Agreement in identifying inducible ischaemia also remained poor. This study suggests that systematic training can significantly reduce interobserver variability in a short time frame (4 months) and may improve the interpretation of DSE by a trainee. But improvements in image quality and use of predefined reading criteria are necessary to improve interobserver agreement further in myocardial regions where conformity in dobutamine stress echocardiographic interpretation is low.


Quality of life and outcomes for femoral hernia repair: does laparoscopy have an advantage?
Due to their relative scarcity and to limit single-center bias, multi-center data are needed to study femoral hernias. The aim of this study was to evaluate outcomes and quality of life (QOL) following laparoscopic vs. open repair of femoral hernias. The International Hernia Mesh Registry was queried for femoral hernia repairs. Laparoscopic vs. open techniques were assessed for outcomes and QOL, as quantified by the Carolinas Comfort Scale (CCS), preoperatively and at 1, 6, 12, and 24 months postoperatively. Outcomes were evaluated using the standard statistical analysis. A total of 80 femoral hernia repairs were performed in 73 patients: 37 laparoscopic and 43 open. There was no difference in mean age (54.7 ± 14.6 years), body mass index (24.2 ± 3.8 kg/m2), gender (60.3 % female), or comorbidities (p > 0.05). The hernias were recurrent in 21 % of the cases with an average of 1.23 ± 0.6 prior repairs (p > 0.1). Preoperative CCS scores were similar for both groups and indicated that 59.7 % of patients reported pain and 46.4 % had movement limitations (p > 0.05). Operative time was equivalent (47.2 ± 21.2 vs. 45.9 ± 14.8 min, p = 0.82). There was no difference in postoperative complications, with an overall 8.2 % abdominal wall complications rate (p > 0.05). The length of stay was shorter in the laparoscopic group (0.5 ± 0.6 vs. 1.3 ± 1.6 days, p = 0.02). Follow-up was somewhat longer in the open group (23.8 ± 10.2 vs. 17.3 ± 10.9 months, p = 0.02). There was one recurrence, which was in the laparoscopic group (3.1 vs. 0 %, p = 0.4). QOL outcomes at all time points demonstrated no difference for pain, movement limitation, or mesh sensation. Postoperative QOL scores improved for both groups when compared to preoperative scores. In this prospective international multi-institution study of 80 femoral hernia repairs, no difference was found for operative times, long-term outcomes, or QOL in the treatment of femoral hernias when comparing laparoscopic vs. open techniques. After repair, QOL at all time-points postoperatively improved compared to QOL scores preoperatively for laparoscopic and open femoral hernia repair. While international data supports improved outcomes with laparoscopic approach for femoral hernia repair, no data had existed prior to this study on the difference of approach impacting QOL. In the setting where recurrence and complication rates are equal after femoral hernia repair for either approach, surgeons should perform the technique with which they are most confident, as the operative approach does not appear to change QOL outcomes after femoral hernia repair.


Temporal order judgment in mice.
A temporal order judgment task was developed for mice. After training male mice (C57BL6NCrj, n=15) to poke their noses into a hole, two stimuli (brief puffs of air) were delivered to the whiskers with a fixed interval of 750 ms in one of four orders: right (R)-left (L), L-R, L-L, and R-R. The mice were rewarded when they oriented their heads toward the first (n=5) or second (n=10) stimulus after a visual go signal. The mice were trained for up to 50 days. All mice met the criterion for task achievement (daily correct response rate >70% on 3 consecutive days) in response to unilateral stimuli (L-L and R-R), and 9 of the 15 mice met the criterion for task achievement in response to bilateral stimuli (L-R and R-L). The median periods for task achievement were 15 and 34 days for unilateral and bilateral stimuli, respectively. The correct response rate dropped to approximately the chance level after all whiskers had been removed. The nine successful mice were trained further and tested with smaller interstimulus intervals. The probability of right-first judgment plotted against the stimulation interval was fitted with a sigmoid function (r2=0.92) with asymptotes of 0.29 and 0.73 and a temporal resolution of 160 ms. The sigmoid curve was biased horizontally by 133 ms, reflecting the fact that stimuli delivered simultaneously were judged as left-first rather than right-first. The results show that mice can be trained to judge the temporal order of tactile stimuli delivered to whiskers and that such judgment might be lateralized to the right hemisphere.


Lung vagal afferent activity in rats with bleomycin-induced lung fibrosis.
Bleomycin treatment in rats results in pulmonary fibrosis that is characterized by a rapid shallow breathing pattern, a decrease in quasi-static lung compliance and a blunting of the Hering-Breuer Inflation Reflex. We examined the impulse activity of pulmonary vagal afferents in anesthetized, mechanically ventilated rats with bleomycin-induced lung fibrosis during the ventilator cycle and static lung inflations/deflations and following the injection of capsaicin into the right atrium. Bleomycin enhanced volume sensitivity of slowly adapting stretch receptors (SARs), while it blunted the sensitivity of these receptors to increasing transpulmonary pressure. Bleomycin treatment increased the inspiratory activity, while it decreased the expiratory activity of rapidly adapting stretch receptors (RARs). Pulmonary C-fiber impulse activity did not appear to be affected by bleomycin treatment. We conclude that the fibrosis-related shift in discharge profile and enhanced volume sensitivity of SARs combined with the increased inspiratory activity of RARs contributes to the observed rapid shallow breathing of bleomycin-induced lung fibrosis.


Identification of the putative proton donor residue of lacto-N-biose phosphorylase (EC 2.4.1.211).
Two lacto-N-biose phosphorylase (LNBP) isozyme genes were cloned from Bifidobacterium bifidum JCM1254. Alignment of the amino acid sequences of LNBP and its homologs identified 24 completely conserved acidic amino acid residues. All single mutants of Bifidobacterium longum LNBP at residues other than D313N retained considerable activity, suggesting that Asp313 is the putative proton donor residue in LNBP.


Cefamandole concentrations in the anterior chamber of the eye in rabbits and humans.
Cefamandole concentrations were determined in the aqueous humor of the anterior chamber of the eye in 10 rabbits and in 15 patients undergoing cataract extraction. The rabbits received 50 mg of cefamandole per kilogram of body weight in the ear vein and humans received 2 g of cefamandole by intravenous injection before operation. The levels recovered were several times higher than the minimum inhibitory concentrations (MICs) against the bacteria that are most often responsible for ocular infections.


Three-dimensional volume-rendered helical CT before laparoscopic adrenalectomy.
Use of three-dimensional (3D) volume-rendered helical computed tomography (CT) in surgical planning before laparoscopic adrenalectomy was evaluated in a retrospective study. In 35 consecutive patients before laparoscopic adrenalectomy, 3D volume-rendered CT scans were created from helical CT scans. Videotapes that showed anterior, lateral, posterior, and posterocephalic approaches were assessed retrospectively. The relationship (not contacting, abutting, displacing, or invading) of adrenal masses to adjacent organs (diaphragm, liver, spleen, kidneys, stomach, pancreas, and vessels) was recorded and compared with findings in surgery reports. When such findings were available, they corresponded to those in the videotape. Three-dimensional volume-rendered CT successfully displayed the relationship of adrenal masses to adjacent anatomic structures and organs before laparoscopic adrenalectomy.


Improvement of Decellularization Efficiency of Porcine Aorta Using Dimethyl Sulfoxide as a Penetration Enhancer.
Decellularization of tissues and organs enables researchers to obtain extracellular matrix (ECM) with the natural conformation and chemical composition of specific tissues. However, drawbacks exist such as the structural alteration of ECM or loss of some important components in ECM due to overexposure to chemicals during the decellularization process. In this study, porcine aorta was decellularized by sodium dodecyl sulfate (SDS). Dimethyl sulfoxide (DMSO) was used as a penetration enhancer in the decellularization process to enhance the penetration of SDS, consequently reducing the exposure time of SDS to treated tissues. It is revealed that by addition of DMSO to the decellularization process 64.4% more DNA was removed when compared with just SDS exposure within a 3 h reaction. Cross-validation by DAPI staining showed that, in the presence of DMSO, the penetration of SDS was improved and almost all cells were removed from the aorta within the 3 h exposure time. Collagen staining revealed that just SDS treatment showed less polarized collagen fibers, while the DMSO addition groups revealed denser and organized collagen fibers. Moreover 77% glycosaminoglycan content was preserved by addition of DMSO in resultant tissues. Scanning electron microscopy analysis of decellularized aortic matrix showed that ECM components remained in the adventitia layer with the addition of DMSO treatment, while the layer was removed with just SDS treatment. Biocompatibility assays proved that after washing the decellularized samples with media supplemented with 3% antibiotic and antimycotic solution for 2 days there was no cytotoxic effect related to the SDS + DMSO decellularization protocol. This study demonstrates that the new decellularization protocol not only improves the removal efficiency of cellular components but also protects the crucial ECM components.


Blood pressure biofeedback exerts intermediate-term effects on blood pressure and pressure reactivity in individuals with mild hypertension: a randomized controlled study.
This randomized controlled study examined whether a 4-week blood pressure (BP) biofeedback program can reduce BP and BP reactivity to stress in participants with mild hypertension. Participants in the active biofeedback group (n=20) were trained in 4 weekly laboratory sessions to self-regulate their BP with continuous BP feedback signals, whereas participants in the sham biofeedback group (n=18) were told to manipulate their BP without feedback signals. BP, skin temperature, skin conductance, BP reactivity to stress, body weight, and state anxiety were assessed before training and repeated at the eighth week after the training. The decreases in systolic (12.6 +/- 8.8 versus 4.1 +/- 5.7) and mean BP (8.2 +/- 6.9 versus 3.3 +/- 4.9) from baseline at week 12 follow-up were significantly greater in the active biofeedback group compared with the sham biofeedback group (p=0.001 and 0.017, respectively). Results from analysis of covariance with the follow-up systolic blood pressure (SBP) (or mean arterial pressure [MAP]) as the dependent variable, baseline SBP (or MAP) as the covariate, and group as the independent variable showed that biofeedback training effectively lowered SBP and MAP (p=0.013 and 0.026, respectively). The pre-to-post differences in skin conductance and SBP reactivity were statistically significant for the biofeedback group (p=0.005 and 0.01, respectively), but not for the control group. For the sample as a whole and for the biofeedback group, the state anxiety score and body weight remained unchanged. BP biofeedback exerts a specific treatment effect in reducing BP in individuals with mild hypertension, possibly through reducing pressor reactivity to stress.


Creatine biosynthesis during embryonic development. False feedback suppression of liver amidinotransferase by N-acetimidoylsarcosine and 1-carboxymethyl-2-iminoimidazolidine (cyclocreatine).
The level of arginine:glycine amidinotransferase in liver of the developing chick embryo is partially suppressed following injection of arginine into the yolk, and the level can be completely suppressed following injection of guanidinoacetate or creatine (Walker, J.B. (1963), Proc. Soc. Exp. Biol. Med. 112, 245; Walker, J.B., and Wang, S.-H. (1964), Biochim, Biophys. Acta 81, 435). In this investigation structural requirements for the physiological suppressor were examined by testing certain analogues of creatine and its biosynthetic precursors for their ability to suppress liver amidinotransferase levels in developing chick embryos and growing chicks. The creatine analogues, N-acetimidoylsarcosine and 1-carboxymethyl-2-iminoimidazolidine (cyclocreatine), were found to suppress liver amidinotransferase levels of both developing embryos and growing chicks. Compounds ineffective as suppressors included: the arginine analogue, N5-acetimidoylornithine; the guanidinoacetate analogue, N-acetimidoylglycine; and the creatine analogue, 1-carboxymethyl-2-iminohexahydropyrimidine. Our findings suggest that (i) arginine and guanidinoacetate must be converted to creatine before serving as a suppressor, and (ii) creatine, not phosphocreatine, is most closely related to the physiological suppressor of amidinotransferase.


OC31 - Tobacco consumption by adolescents: a study in the north of Portgual.
Theme: School health. To characterize the adolescents' habits of smoking in a Portuguese School; to identify if the adolescents have information on the harmful effects of tobacco and their health education needs. Quantitative, exploratory and descriptive study. Data collection in 2011 through a self-answered questionnaire. The sample comprised 441 students; mean age of 14.5 years old; 53.1% were male; 18,6% were smokers; boys smoked more than girls; they started to smoke between 7-18; the tobacco consumption is significantly related with: age (p<0,001); gender (p=0,002); interest of the family about the adolescents' problems (p=0,028) among others. The adolescents have information about the harmful effects of tobacco and the ones interested in receiving more information wanted it from the health professionals. Prevention and delaying the age of initiation of consumption should be taken into account in a target intervention plan, which should be led by the school health nurse.


Duodenum-preserving total pancreatectomy for end stage chronic pancreatitis.
The classical Whipple procedure for chronic pancreatitis has been associated with significant long term postoperative morbidity. The pylorus-preserving procedure of Longmire has reduced but not eliminated the long-term morbidity. Preservation of the whole duodenum with total pancreatectomy has been introduced for the treatment of patients with end-stage chronic pancreatitis after favourable experience with this procedure in infants for nesidioblastosis. Fourteen patients with chronic pancreatitis have had a total pancreatectomy with preservation of the duodenum and the bile duct. All patients are still alive (median follow-up 9.5 months) and none suffered major complications in the perioperative period. One patient developed a biliary stricture at 3 months, requiring biliary reconstruction. Six of the patients have returned to full-time work; nine require no analgesia. All patients require pancreatic enzyme replacement, and all patients have gained weight postoperatively. Diabetic control is satisfactory with a twice daily insulin regime. Duodenum-preserving total pancreatectomy is feasible in the adult without mortality or high morbidity; early experience suggests that preserving the duodenum improves gastrointestinal function with easier control of the diabetes.


Differential effects of mitochondrial inhibitors on porcine granulosa cells and oocytes.
Oocytes and granulosa cells rely primarily on mitochondrial respiration and glycolysis for energy production, respectively. The present study examined the effect of mitochondrial inhibitors on the ATP contents of oocytes and granulosa cells. Cumulus cell-oocyte complexes (COCs) and granulosa cells (GCs) were collected from the antral follicles of porcine ovaries. Treatment of denuded oocytes with either carbonyl cyanide m-chlorophenyl hydrazine (CCCP), antimycin, or oligomycin significantly reduced ATP content to very low levels (CCCP, 0.12 pM; antimycin, 0.07 pM; and oligomycin, 0.25 pM; P < 0.05), whereas treatment with a glycolysis inhibitor (bromopyruvic acid, BA) had no effect. Conversely, the ATP content of granulosa cells was significantly reduced by treatment with the glycolysis inhibitor but was not affected by the mitochondrial inhibitors (ATP/10,000 cells; control, 1.78 pM and BA, 0.32 pM; P < 0.05). Reactive oxygen species (ROS) generation after CCCP treatment was greater in oocytes (1.6-fold) than that seen in granulosa cells (1.08-fold). Oocytes surrounded by granulosa cells had higher ATP levels than denuded oocytes. Treatment of COCs with CCCP reduced, but did not completely abolish, ATP content in oocytes (control, 3.15 pM and CCCP, 0.52 pM; P < 0.05), whereas treatment with CCCP plus a gap junction inhibitor, 18α-glycyrrhetinic acid, and CCCP decreased the ATP content to even lower levels (0.29 pM; P < 0.05). These results suggest that granulosa cells are dependent on glycolysis and provide energy to oocytes through gap junctions, even after treatment with CCCP.