Biopolitics, Terri Schiavo, and the sovereign subject of death.
Humanity does not gradually progress from combat to combat until it arrives at universal reciprocity, where the rule of law finally replaces warfare; humanity installs each of its violences in a system of rules and thus proceeds from domination to domination. (Foucault, 1984, 85) In this essay, I take a note from Michel Foucault regarding the notion of biopolitics. For Foucault, biopolitics has both repressive and constitutive properties. Foucault's claim is that with the rise of modern government, the state became exceedingly concerned about the body politic, the bodies that make up the polis, including the health of those bodies. However, Giorgio Agamben claims that Foucault and all western political philosophy misses the relationship between power and Sovereignty, with disastrous results and totalizing tendencies. I explore the case of Terri Schiavo claiming that the social conservatives have attempted to politicize bare life in its legal maneuverings, but I also show how the social liberals open an uncontrollable space between life and death. Both the left and the right miss the aporia at the heart of western political philosophy, and bioethics is complicit in the totalizing effects of contemporary medicine.


Understanding advanced practice nursing.
The Canadian Health Services Research Foundation (CHSRF) is proud to be one of the supporters of this special issue on advanced practice nursing, which represents several decades of research and programming related to the role of nurses in the health system.


Social class shapes the form and function of relationships and selves.
Social class shapes relational realities, which in turn situate and structure different selves and their associated psychological tendencies. We first briefly review how higher class contexts tend to foster independent models of self and lower class contexts tend to foster interdependent models of self. We then consider how these independent and interdependent models of self are situated in and adapted to different social class-driven relational realities. We review research demonstrating that in lower social class contexts, social networks tend to be small, dense, homogenous and strongly connected. Ties in these networks provide the bonding capital that is key for survival and that promotes the interdependence between self and other(s). In higher social class contexts, social networks tend to be large, far-reaching, diverse and loosely connected. Ties in these networks provide the bridging capital that is key for achieving personal goals and that promotes an independence of self from other. We conclude that understanding and addressing issues tied to social class and inequality requires understanding the form and function of relationships across class contexts.


Heterosexual, autosexual and social behavior of adult male rhesus monkeys with medial preoptic-anterior hypothalamic lesions.
Bilateral radiofrequency lesions were made in the medial preoptic-anterior hypothalamic (MP-AH) area of 6 adult male rhesus monkeys; 5 sham-lesioned subjects served as controls. Behavioral analysis consisted of observations on copulatory behavior, yawning, masturbation and some aspects of social behavior. MP-AH lesions reduced or completely eliminated the display of manual contacts of the partner, mounts, intromissions and ejaculations without interfering with masturbation. Yawning, a sexually dimorphic behavior, was not affected either, Measure of several social behaviors indicated no evidence of social withdrawal or other aberrance of social interactions, which might have led to the decline in heterosexual behavior. The results with regard to copulatory behavior were consistent with the effects of MP-AH lesions in rats, cats and dogs. In rhesus monkeys it appears as though the MP-AH region is specifically involved in the mediation of heterosexual copulation and is not vital to the performance of other forms of male sexual activity such as masturbation. Also the MP-AH is not critical for the display of all sexually dimorphic behaviors. The types of behavioral change in MP-AH lesioned subjects differed to some extent from those following castration, indicating that the effects of the lesions cannot be explained as basically that of functional castration.


High-temperature continuous molecular beam source for aggressive elements: An example of zinc.
Expansion of Zn2 or ZnRg (Rg = rare gas atom) in a molecular supersonic beam constitutes a considerable technical challenge due to the high zinc melting point and high zinc reactivity with stainless steel at high temperatures. In order to overcome these difficulties and meet the requirements for spectroscopy of van der Waals molecules containing zinc, a high-temperature source-module of the supersonic molecular beam for aggressive elements was designed. The module was tested in the laser-induced fluorescence excitation spectroscopy experiment using the b30u +43P1←X10g +(41S0) bound ← bound transitions in Zn2. The new source-module can be used for other aggressive elements for which a laser-vaporization technique has been used to date.


Novel technique for stent delivery in tortuous coronary arteries: report of three cases.
We present a novel technique for stent delivery across tortuous lesions. Gentle forward pressure was applied on the stent balloon while the balloon was inflated to 2-3 atm. This resulted in the balloon and stent crossing the impeding segment and settling in the target site where it was deployed with excellent angiographic outcome.


Interleukin-6 and CAAT/enhancer binding protein beta-deficient mice act as tools to dissect the IL-6 signalling pathway and IL-6 regulation.
Interleukin-6 (IL-6) is a pleiotropic cytokine playing important roles in immunity, hemopoiesis and inflammation. IL-6 signalling is known to involve the activation of two independent transcription factors: Stat3 (through phosphorylation by Jak kinases) and C/EBP beta (through activation of the ras pathway). In addition, C/EBP beta is believed to act as a transcriptional activator of the IL-6 gene itself. Making use of IL-6-deficient mice, we have recently demonstrated that IL-6 is essential for the induction of acute phase mRNAs in the liver upon localized tissue damage, but not upon systemically induced inflammation. Here we show that the defective mRNA induction is paralleled by a defective activation of Stat3, thus establishing a direct relationship between IL-6 function, Stat3 activation and acute phase genes induction. On the other hand, making use of C/EBP beta-deficient mice, we show that the induction of IL-6 by a variety of stimuli does not require C/EBP beta activity. In contrast to the predicted activating role of C/EBP beta, IL-6 levels are increased in the C/EBP beta-deficient mice, suggesting that C/EBP beta may act as a down-modulator of the IL-6 gene. Through the generation of C/EBP beta, IL-6 double mutant mice we show that IL-6 hyperproduction is responsible for the development of the Castleman's like lymphoproliferative disease described in the C/EBP beta-deficient mice, since the disorder is completely blocked by inactivating the IL-6 gene.


Involvement of NF-kappa B activation in thrombin-induced human vascular smooth muscle cell proliferation.
A thrombin receptor has been cloned and is thought to mediate a variety of thrombin-induced responses. However, the transcription factors important for postreceptor signaling have been little clarified. The post-receptor signals are mediated by several protein kinases responsible for NF-kappa B activation, and most thrombin-inducible genes have the kappa B sequence in the regulatory elements. The possibility that NF-kappa B may participate in thrombin signaling was therefore investigated in cultured human vascular smooth muscle cells (VSMCs). Thrombin receptor stimulation resulted in activation of NF-kappa B. Furthermore, treatment of cells with antisense p65 ODNs of NF-kappa B inhibited thrombin-stimulated growth of VSMC in vitro. Results indicate that the activation of NF-kappa B is involved in thrombin signaling and that this pathway causes the proliferation of VSMC induced by thrombin. Therapeutic potential of antisense NF-kappa B ODNs for the treatment with atherosclerosis and restenosis is also indicated.


Early detection of cerebral ischemia during carotid endarterectomy using transcranial Doppler sonography and somatosensory evoked potentials.
Cerebral function during carotid endarterectomy can reliably be monitored using somatosensory evoked potentials (SEP). Transcranial Doppler sonography (TCD) is a noninvasive method providing on-line data about cerebral hemodynamics. The combination of both techniques during carotid surgery is helpful in evaluating the hemodynamic ("input") and the functional ("output") consequences of carotid clamping within a short time. In the present report, combined TCD and SEP monitoring early detected left hemispheric ischemia in a 68-year-old woman subjected to left carotid endarterectomy. The impairment of cerebral perfusion occurred before carotid clamping due to an intraoperative thrombosis of the left internal carotid artery as could be revealed after declamping. A temporary shunt was not inserted. Postoperatively, the patient had a new transient neurological deficit. In this case, TCD correctly indicated cerebral ischemia as confirmed by SEP recording. For carotid artery surgery, combined TCD and SEP may be helpful in detecting those patients who will profit from temporary shunting if this is not done routinely.


A comparison of critical care research funding and the financial burden of critical illness in the United States.
To estimate federal dollars spent on critical care research, the cost of providing critical care, and to determine whether the percentage of federal research dollars spent on critical care research is commensurate with the financial burden of critical care. The National Institutes of Health Computer Retrieval of Information on Scientific Projects database was queried to identify funded grants whose title or abstract contained a key word potentially related to critical care. Each grant identified was analyzed by two reviewers (three if the analysis was discordant) to subjectively determine whether it was definitely, possibly, or definitely not related to critical care. Hospital and total costs of critical care were estimated from the Premier Database, state discharge data, and Medicare data. To estimate healthcare expenditures associated with caring for critically ill patients, total costs were calculated as the combination of hospitalization costs that included critical illness as well as additional costs in the year after hospital discharge. Of 19,257 grants funded by the National Institutes of Health, 332 (1.7%) were definitely related to critical care and a maximum of 1212 (6.3%) grants were possibly related to critical care. Between 17.4% and 39.0% of total hospital costs were spent on critical care, and a total of between $121 and $263 billion was estimated to be spent on patients who required intensive care. This represents 5.2% to 11.2%, respectively, of total U.S. healthcare spending. The proportion of research dollars spent on critical care is lower than the percentage of healthcare expenditures related to critical illness.


X-ray structure of a blue copper nitrite reductase at high pH and in copper-free form at 1.9 A resolution.
Copper-containing nitrite reductases possess a trimeric structure where the catalytic Cu site, located at the monomer-monomer interface, resembles the catalytic sites of a number of Zn enzymes. Nitrite reductase from Alcaligenes xylosoxidans has optimum activity at pH 5.2 which decreases to a negligible level at pH 8. The structure of this nitrite reductase has previously been determined at pH 4.6. It has now been crystallized under new conditions at pH 8.5. Its crystallographic structure provides a structural explanation for the greatly reduced activity of the enzyme at high pH. Characterization of overexpressed protein in solution by EXAFS suggested that the protein lacked Cu in the catalytic type 2 Cu site and that the site was most probably occupied by Zn. Using the anomalous signals from Cu and Zn, the crystal structure revealed that the expressed protein was devoid of Cu in the catalytic site and that only a trace amount (<10%) of Zn was present at this site in the crystal. Despite the close structural similarity of the catalytic site to a number of Zn enzymes, these data suggest that Zn, if it binds at the catalytic copper site, binds weakly in nitrite reductase.


Career clue: an interactive teaching strategy to introduce beginning students to the nursing profession.
An assignment incorporating active learning, computerized technology, and contact with RNs or Real Nurses was created to educate, enthuse, and heighten the awareness of nursing students about the world of nursing that exists beyond the classroom walls. Students gather information about an assigned field of nursing and share findings with classmates by giving clues about their mystery careers related to educational background, practice location, clientele, responsibilities, rewards, and challenges associated with the area of practice. Access to Web sites, RN e-mails, and guidelines are provided via an online Blackboard(®) learning system. Students benefit by gaining experience in the use of different types of computerized technology while being educated about the extensive career options available in nursing. The Career Clue assignment is a creative teaching strategy that has been used since 2003 and has consistently received positive feedback from students.


Effects of chronic elevated ozone concentration on the redox state and fruit yield of red pepper plant Capsicum baccatum.
Ozone (O3) is one of the most harmful air pollutants to crops, contributing to high losses on crop yield. Tropospheric O3 background concentrations have increased since pre-industrial times reaching phytotoxic concentrations in many world regions. Capsicum peppers are the second most traded spice in the world, but few studies concerning the O3 effects in this genus are known. Thereby, the aim of this work was to evaluate the effects of chronic exposure to elevated O3 concentrations in red pepper plant Capsicum baccatum L. var. pendulum with especial considerations on the leaf redox state and fruit yield. Fifteen C. baccatum plants were exposed to O3 in open-top chambers during fruit ripening (62 days) at a mean concentration of 171.6 µg/m(3) from 10:00 am to 4:00 pm. We found that O3 treated plants significantly decreased the amount and the total weight of fruits, which were probably a consequence of the changes on leaf oxidative status induced by ozone exposure. Ozone exposed plants increased the reactive oxygen species (ROS) levels on the leaves, which may be associated with the observed decrease on the activity of enzymatic antioxidant defense system, as well with lower levels of polyphenol and reduced thiol groups. Enhanced ROS production and the direct O3 reaction lead to biomacromolecules damages as seen in the diminished chlorophyll content and in the elevated lipid peroxidation and protein carbonylation levels. Through a correlation analysis it was possible to observe that polyphenols content was more important to protect pepper plants against oxidative damages to lipids than to proteins.


Garden walking and art therapy for depression in older adults: a pilot study.
The purpose of this pilot study was to compare garden walking (either alone or guided) with art therapy in older adults with depression. Depression was measured using the Geriatric Depression Scale (GDS) and stories of sadness/joy. Prior to the intervention, 47% of participants had depression scores in the severe range and 53% in the mild range. At the end of the intervention, none of the participants had scores in the severe range, 89% had scores in the mild range, and 11% had scores in the normal range. Results of the GDS data using repeated measures analysis of variance indicated significant decreases in depression for all three groups from pretest to posttest. All participants, regardless of group assignment, had a lower percentage of negative-emotion word use and a higher percentage of positive-emotion word use over time. This study provides evidence for nurses wishing to guide older adults in safe, easy, and inexpensive ways to reduce depression.


The role of an endothelial cell lining in limiting distal anastomotic intimal hyperplasia of 4-mm-I.D. Dacron grafts in a canine model.
The effect of an endothelial cell (EC) lining on intimal hyperplasia at the distal anastomosis of Dacron grafts was assessed in a canine model. Enzymatically derived autologous EC were used to seed 14 to 17 cm long, 4 mm I.D., knitted Dacron aortoiliac grafts implanted in an end-to-side manner in six dogs (Group I). Unseeded grafts were similarly implanted in six control dogs (Group II). All animals received acetylsalicylic acid (325 mg po qd) 24 h prior to graft placement and for 2 weeks postoperatively. Distal anastomotic intimal hyperplasia (AIH) and luminal surface EC coverage were quantitated at the conclusion of a 16-week study period. Patency for Group I and Group II grafts were 90% and 55%, respectively (p = 0.07). Maximum AIH, defined as the maximum reduction of luminal cross-sectional area at the distal anastomosis, was not significantly different between Group I (13.1 +/- 8.0%) and Group II (15.1 +/- 7.3%) conduits. However, AIH was inversely related to the extent of luminal EC coverage (r = -0.6, p less than 0.05), thus greater endothelialization was associated with decreased AIH. These data support the idea that EC coverage of the luminal surface of prosthetic vascular grafts may limit the development of AIH.


The orofacial formalin test.
The subcutaneous injection of formalin into the rat upper lip generates behavioral responses that last several minutes. The time course of the response is similar to what is observed following formalin injection into the paw, i.e. biphasic, with an early and short-lasting first phase followed, after a quiescent period by a second, prolonged (tonic) phase. The applied chemical stimulus (formalin) can be qualified as noxious since it produces tissue injury, activates Adelta and C nociceptors as well as trigeminal and spinal nociceptive neurons and is felt as painful in man. In addition, increasing the concentration of formalin causes a parallel aggravation of histological signs of tissue inflammation and injury. The measured behavioral response (face rubbing) is a relevant end-point: prolonged face rubbing is evoked by formalin but not saline injection and a positive relationship between the amplitude of the response and the formalin concentration is observed, at least up to 2.5%. At higher formalin concentrations, the use of other or additional end-points should be considered. Finally, the behavioral response in the orofacial formalin test is sensitive to various opioid and non-opioid analgesics. The orofacial formalin test can then be considered as a reliable way of producing and quantifying nociception in the trigeminal region of the rat.


Health promotion and lay epidemiology: a sociological view.
In this paper two fears about health promotion are identified. The first concerns the ability to choose between proliferating expert advice, and the second concerns the fear of government interference in personal life. The paper goes on to outline the current place of health promotion in British health policy, and to discuss the relevance of recent research on health beliefs. The paper argues that work on 'lay epidemiology' has been overlooked by both critics and supporters of health promotion. From this vantage point the fears about health promotion can be seen to be exaggerated.


T cell priming against vesicular stomatitis virus analyzed in situ: red pulp macrophages, but neither marginal metallophilic nor marginal zone macrophages, are required for priming CD4+ and CD8+ T cells.
Since extensive degradation may be required to present complex Ags, we addressed whether macrophages (M phi) might function as APC for anti-viral cell-mediated immune responses. To study this question, murine splenic M phi were depleted by i.p. administration of liposome-encapsulated dichloromethylene diphosphonate (Cl2MDP-liposomes or clodronate-liposomes) before priming mice with vesicular stomatitis virus (VSV). Cl2MDP-liposome treatment resulted in the rapid (1-day) depletion of splenic M phi that was associated with a suppression of the ability of M phi-deficient mice to generate secondary anti-VSV CTL and Th cell proliferative responses in vitro. Control studies demonstrated that splenic dendritic cells were not adversely affected by treatment with Cl2MDP-liposomes. To assess the contribution of splenic M phi subpopulations to T cell priming against this virus, priming was delayed following treatment with Cl2MDP-liposomes until specific M phi subsets had repopulated the spleen. This analysis revealed that repopulation by red pulp M phi, but not with other splenic M phi subsets, was associated with the ability to mount normal secondary CTL and Th cell responses against VSV. Depletion of splenic, but not resident, peritoneal M phi by i.v. injection of Cl2MDP-liposomes did not rescue T cell priming in VSV-infected mice. Thus, only red pulp M phi, and not other splenic or peritoneal M phi populations, are necessary for T cell priming to VSV, a biochemically complex Ag.


Effect of ovarian steroids on nitric oxide synthase in the rat uterus, cervix and vagina.
The effects of estrogen (E2), progesterone (P) and E2 and P (E2 + P) were examined on nitric oxide synthase (NOS) activity in both cytosolic and particulate fractions isolated from the rat uterus, vagina, cervix and cerebral cortex. Additionally plasma nitrate + nitrite (NO3 + NO2) levels were measured in control and hormone treated rats. Cytosolic NOS was the predominant form being approximately 80% of the total in all four tissues. NOS activity in both fractions from all tissues was highly Ca-dependent (> 90%). Among the reproductive tract tissues, the highest activity was found in the cervix, which was nearly 5- and 2-fold higher than the uterus and vagina, respectively. NOS activity in the cerebral cortex was by far the highest being 5-fold higher than in the cervix. In contrast to the cortex, E2 treatment downregulated cytosolic NOS in all reproductive tract tissue, but this was statistically significant in only uterus. When compared with E2 treated rats, P increased cytosolic NOS in uterus, vagina, and particulate NOS in the cervix. The data do not give any indication whatsoever of differential effects of P in the uterus and cervix.


After treat-to-target: can a targeted ultrasound initiative improve RA outcomes?
For patients with rheumatoid arthritis (RA), remission can be achieved with tight control of inflammation and early use of disease modifying agents. The importance of remission as an outcome has been recently highlighted by European League Against Rheumatism recommendations. However, remission when defined by clinical remission criteria (disease activity score, simplified disease activity index, etc) does not always equate to the complete absence of inflammation as measured by new sensitive imaging techniques such as ultrasound (US) . There is evidence that imaging synovitis is frequently found in these patients and associated with adverse clinical and functional outcomes. This article reviews the data regarding remission, ultrasound imaging and outcomes in patients with RA to provide the background to a consensus statement from an international collaboration of ultrasonographers and rheumatologists who have recently formed a research network - the Targeted Ultrasound Initiative (TUI) group. The statement proposes that targeting therapy to PD activity provides superior outcomes compared with treating to clinical targets alone and introduces the rationale for a new randomised trial using targeted ultrasound in RA.


Precedent-setting professional liability claims involving optometry.
For optometrists, malpractice claims are relatively rare and seldom result in litigation. Therefore, there are very few reported court cases dealing with the optometric malpractice issue. In fact, within the last ten years there have been only five reported cases. Claims involving failure to diagnose have been the most devastating to optometrists, and have resulted in the five recently reported court cases. This paper discusses the facts of these five cases and considers their relevance to contemporary optometric practice.


Sumatriptan-induced cerebral vasoconstriction as treatment of experimental intracranial hypertension.
Increased intracranial pressure (ICP) is a major cause of mortality in severe head injuries and pharmacologically induced cerebral vasoconstriction has been suggested as a possible treatment. In the present study a porcine model of increased ICP was utilized to study the changes in cerebral haemodynamics and energy metabolism induced by a selective 5-hydroxytryptamine1 agonist (sumatriptan). ICP was raised by inflation of two balloons covering both parieto-occipital regions extradurally. The animals were randomized into four groups receiving sumatriptan. 0.01 mg.kg-1 (A), 0.03 mg.kg-1 (B), 0.1 mg.kg-1 (C), and 0.5 mg.kg-1 (D) intravenously over 10 min. Measurements of cerebral blood flow (CBF), arterio-venous oxygen content difference (CavO2), and jugular venous pH (vpH) were performed 5, 20, 40, 60, and 75 min after start of the infusion. ICP, mean arterial pressure, and EEG were recorded continuously. Direct effects of sumatriptan were also compared in cortical arteries and veins in vitro. Significant decreases in ICP were obtained in groups A, B, and C while group D exhibited a progressive increase in ICP. Significant reductions in CBF, increase in CavO2, and slowing of EEG were observed in groups B, C, and D. Sumatriptan caused moderate constriction of the arteries and a more pronounced dilatation of veins in vitro. The results indicate that a low dose of sumatriptan has the potential to reduce a raised ICP. High doses of sumatriptan cause a further increase of ICP possibly by dilatation of intracerebral veins.


Electrophysiological effect of varied rate and extent of acute in vivo left ventricular load increase.
The aim was to determine whether the rate, the magnitude, or both, of increased left ventricular wall stress in vivo has consistent and prominent effects on repolarisation, afterdepolarisations, or arrhythmogenicity. Ten anaesthetised dogs underwent transient proximal aortic occlusion. Wall stress was estimated from pressure-volume data obtained by volume catheter, normalised to preocclusion values, and correlated with simultaneously determined changes in monophasic action potential duration (MAPd). Data were obtained during both fast (greater than 50% rise in wall stress within two beats) and slow occlusions, as well as during innervated and denervated conditions. Adult mongrel dogs (20-25 kg) were used. Two- to threefold increases in wall stress resulted in less than 5 ms shortening in MAPd and there was little correlation between wall stress and MAPd shortening. The strongest relation between normalised wall stress (EWSnorm) and MAPd was observed under denervated conditions during rapid aortic occlusion (delta MAPd = -2.5 x EWSnorm +2.1, r2 = 0.44, p less than 0.001). Afterdepolarisations were observed in fewer than 10% of occlusions and were not related to the magnitude or rate of loading change. Ventricular ectopy occurred more frequently during rapid than slow occlusions (87% v 56%, p = 0.01), but was unrelated to the level of wall stress increase or the presence of afterdepolarisations. Marked acute increases in left ventricular loading in vivo minimally alter repolarisation, and rarely lead to afterdepolarisations. The speed rather than magnitude of load change appears more important in the development of ventricular ectopy. These findings suggest that load induced ventricular ectopy is due to stretch induced automaticity rather than triggered activity or re-entry.


Serological markers associated with disease behavior and response to anti-tumor necrosis factor therapy in ulcerative colitis.
Information is limited on the relationship between serological markers and disease behavior and anti-tumor necrosis factor-α (anti-TNF) therapy response in ulcerative colitis (UC). This study aimed to determine the association between serological markers and unfavorable UC behavior defined as need for colectomy or UC-related hospitalization. The association between serological markers and requirement for and outcome of anti-TNF therapy was also evaluated. Two hundred thirty patients were studied. Requirement for colectomy, UC-related hospitalization, and anti-TNF therapy were documented. Response to anti-TNF therapy at 1 year and rates of therapy discontinuation were recorded. Titers of perinuclear anti-neutrophil cytoplasmic antibodies (pANCAs), anti-Saccharomyces cerevisiae antibody (ASCA), and antibody to Escherichia Coli outer membrane porin (anti-OmpC) were determined. Antibody reference ranges were used to dichotomize subjects into seropositive and seronegative groups. Where multiple tests were performed, P-values were Bonferroni corrected (pcorr). Extensive colitis was associated with requirement for colectomy and UC-related hospitalization, HR 7.7 (95% confidence interval [CI] 1.9-32.2) pcorr = 0.03 and HR 2.7 (95% CI 1.5-4.6), pcorr = 0.006, respectively. No serological variable was associated with unfavorable UC behavior. Anti-OmpC positivity was associated with a lack of response to anti-TNF therapy at 1 year (odds ratio 0.14 [95% CI 0.03-0.60], pcorr = 0.04) and increased likelihood of therapy discontinuation (HR 2.2 [95% CI 1.1-4.7], P = 0.03). Extensive colitis is associated with unfavorable disease course in UC. Anti-OmpC holds promise as a biomarker of anti-TNF therapy response in UC; however, prospective studies are required before it can be incorporated into routine clinical practice.


Rosai-Dorfman disease presenting as a pulmonary artery mass.
Rosai-Dorfman disease is rare and typically presents with cervical lymphadenopathy, but may manifest as extranodal disease. This disease is generally indolent and self-limited, but it carries a poor or fatal prognosis when it is advanced or when it involves and compresses vital structures. We present a case of Rosai-Dorfman disease affecting the pulmonary arteries in a 22-year-old woman with severe, symptomatic right heart failure.


[Effect of bariatric surgery on obstructive sleep apnea hypopnea syndrome with obesity in China].
Obesity has become one of the greatest public health concerns especially in China and obstructive sleep apnea-hypopnea syndrome (OSAHS) is prevalent among morbidly obese patients. Metabolic and bariatric surgery has been proved to be a typical multidisciplinary strategy for obese patients with OSAHS but no related bariatric surgical guideline for OSAHS was found by now. In this paper, we extend to share our preliminary single-center experiences in the multidisciplinary treatment of severe obese with OSAHS.


Intimin from enteropathogenic Escherichia coli mediates remodelling of the eukaryotic cell surface.
Adhesion to cultured epithelial cells by enteropathogenic Escherichia coli (EPEC) is associated with extensive rearrangement of the host cell cytoskeleton. Evidence has been presented that EPEC adhesion is associated with activation of signal transduction pathways leading to production of a characteristic histopathological feature known as the attaching and effacing (A/E) lesion. A/E lesion formation requires intimin, an EPEC adhesion molecule and several EPEC secreted proteins (EspA, B, D and Tir) involved in cell signalling and protein translocation. In this study it is shown that HEp-2 cells respond during the early stages of infection with two wild-type EPEC strains (B171 and E2348/69) by producing microvillus-like processes (MLP) at the site of initial bacterial adherence. Intimin appears to play a key role in MLP elongation. At later stages of infection with these wild-type EPEC strains, when A/E lesions have formed, the MLP were reduced in number and length to appear as at time zero, and the cell surface in the vicinity of bacterial clusters appeared unaffected. In contrast, infection with EspA- or EspB-negative, but intimin-positive, EPEC strains (UMD872 and UMD864, respectively) resulted in enhanced MLP proliferation and formation of 'cage-like' structures engulfing the bacteria. Inoculating HEp-2 cells with intimin-coated latex spheres induced similar 'cage-like' structures. Caco-2 cells did not show intimin-induced microvillus elongation in response to EPEC infection, although microvillus effacement and reduction in number occurred. Similar phenomena appeared on B171 and E2348/69 infection of paediatric intestine using in vitro organ culture, i.e. elongated microvilli were seen in association with small colonies and at the periphery of large localized colonies, along with evidence of microvillus breakdown and debris in the colony centre. These results show that intimin activates signal transduction pathways involved in the remodelling of the eukaryotic cell surface, probably via binding to a receptor encoded by the host cell.


Reconstitution of the holoenzyme form of Escherichia coli porphobilinogen deaminase from apoenzyme with porphobilinogen and preuroporphyrinogen: a study using circular dichroism spectroscopy.
Porphobilinogen deaminase (PBG-D), an early enzyme of the tetrapyrrole biosynthetic pathway, catalyzes the formation of a tetrapyrrole chain, preuroporphyrinogen, from four molecules of porphobilinogen (PBG). The PBG-D apoenzyme is responsible for the autocatalytic synthesis and covalent attachment of a dipyrromethane cofactor at its active site. In this paper an efficient method for the purification of Escherichia coli PBG-D apoenzyme using an affinity chromatography resin is reported. Circular dichroism (CD) spectra of apoenzyme and holoenzyme were recorded and significant differences in both the backbone and aromatic region of the spectra were observed. The differences in the spectra allowed the reconstitution of holoenzyme from purified apoenzyme with PBG and preuroporphyrinogen in solution to be monitored separately by CD. Apoenzyme incubated with preuroporhyrinogen gave a CD spectrum that was much more like the CD spectrum of holoenzyme than apoenzyme incubated with PBG. The results showed clearly that the cofactor was generated much more rapidly from preuroporphyrinogen than from PBG. Changes in the CD spectrum associated with the aromatic side-chain region, in particular the contribution assigned to phenylalanine-62, were found to correlate well with the activity of the reconstituted enzyme. Phenylalanine-62 is located in close proximity to the cofactor and acts as a sensitive probe to active-site changes. The stability of the holoenzyme and apoenzyme were compared with respect to both heat and susceptibility to proteolysis. The results were consistent with a model for the apoenzyme in which, in the absence of the cofactor, the three domains of the protein are held less rigidly together, thereby making the protein more susceptible to heat denaturation and proteolysis. The CD spectrum of the holoenzyme was found to be similar at both pH 5.1 and 7.4, suggesting that the crystal structure, determined at pH 5.1, is likely to be similar at physiological pH values.


Thiamin.
Starting with a brief history of beriberi and the discovery that thiamin deficiency is its cause, the symptoms and signs are reviewed. None are pathognomonic. The disease has a low mortality and a long morbidity. The appearance of the patient can be deceptive, often being mistaken for psychosomatic disease in the early stages. The chemistry of thiamin and the laboratory methodology for depicting its deficiency are outlined. The diseases associated with thiamin deficiency, apart from malnutrition, include a number of genetically determined conditions where mutations, either in the cofactor relationship or a transporter, provide the etiology. It is emphasized that such mutations are often epigenetically responsive to megadoses of thiamin or one of its derivatives. The use of thiamin in clinical practice requires a high index of suspicion on the part of the clinician since it has a part to play in eating disorders, diabetes, neurodegenerative disease, and cancer. A high rate of critical illness and postsurgery thiamin deficiency have been reported, particularly those associated with gastrointestinal bypass. Emphasis is placed on thiamin deficiency as a major cause of asymmetric dysautonomia, because of the high degree of sensitivity to thiamin deficiency in the brainstem, cerebellum, and hypothalamus. The relationship of thiamin with regional pain syndrome, eosinophilic esophagitis, its analgesic capacity, and its preventive use in obstetrics is raised as a potential issue. The role of thiamin in SIDS and autism is outlined. It is emphasized that megadose thiamin is being used as a drug, either in stimulating the damaged cofactor/enzyme combination, or mitochondria.


Effects of UV exclusion on the physiology and phenolic composition of leaves and berries of Vitis vinifera cv. Graciano.
Ultraviolet (UV) radiation induces adaptive responses that can be used for plant production improvement. The aim of this study was to assess the effect of solar UV exclusion on the physiology and phenolic compounds of leaves and berry skins of Vitis vinifera L. cv. Graciano under field conditions. Phenolic compounds were analyzed globally and individually in both the vacuolar fraction and, for the first time in grapevine, the cell wall-bound fraction. These different locations may represent diverse modalities of phenolic response to and protection against UV. UV exclusion led to a decrease in Fv /Fm in leaves, revealing that solar UV is needed for adequate photoprotection. Only p-caffeoyl-tartaric acid from the soluble fraction of leaves and myricetin-3-O-glucoside from the soluble fraction of berry skins were significantly higher in the presence of UV radiation, and thus they could play a role in UV protection. Other hydroxycinnamic acids, flavonols, flavanols and stilbenes did not respond to UV exclusion. UV exclusion led to subtle changes in leaves and berry skins of Graciano cultivar, which would be well adapted to current UV levels. This may help support decision-making on viticultural practices modifying UV exposure of leaves and berries, which could improve grape and wine quality.


Assessment of the suitability of phytotoxkit plastic vertical containers compared with petri dishes for standard seedling growth tests.
This study compares two cultivation methods (Petri dishes vs. Phytotoxkit containers; tap water vs. Knop's solution) for standard seedling growth tests. Seeds and young seedlings of Sinapis alba and Hordeum vulgare were used as study subjects and the adverse effect of Cd was assessed. Under testing conditions, only H. vulgare showed a significant decrease in seed germination in Petri dishes when tap water was used as the growth medium (70.8 % ± 46.4 %). No significant differences in IC50 values were found in either plant type for root growth between plants cultivated in Phytotoxkit containers and those cultivated in Petri dishes. The same findings were confirmed for shoot growth in H. vulgare, but not in S. alba. Suitability of Phytotoxkit containers over traditionally used Petri dishes for phytotoxicity determination was confirmed by higher correlation coefficients for all tests.


[Occupational burnout, understanding and acting].
Occupational burnout is a phenomenon which affects a person's health at work and which is expressed through an acceleration of the ageing process. It is combined with natural biological ageing and can contribute to so-called premature exhaustion. This is conveyed through a decline in health which is faster than a natural decline, meaning a decrease in functional capacities, which may or not be generated by work.


Therapy-related myelodysplasia in a patient with Rothmund-Thomson syndrome.
Rothmund-Thomson syndrome (RTS) is a rare autosomal recessive disorder of which approximately 300 cases have been reported in the literature. Patients with RTS often present early in life with skeletal and dental abnormalities, short stature, juvenile cataracts, and a characteristic poikilodermal rash. They are at increased risk for the development of osteosarcoma that usually presents by the second decade of life. The genetic defects underlying RTS are truncating mutations in RECQL4, a gene involved with chromosomal stability. Several cases of primary hematological malignancies have been reported in RTS, but it is unclear whether patients with RTS are at higher risk to develop either primary or secondary hematological malignancies. We report a patient with RTS who presented to our clinic at the age of 7, subsequently developed multifocal and recurrent osteosarcoma that was followed by the development of a myelodysplastic syndrome with subsequent progression to acute myeloid leukemia.


Pathologic characteristics of immunologic injury in primary cultured rat hepatocytes and protective effect of glycyrrhizin in vitro.
To explore the pathologic characteristics of immunologic injury in primary cultured rat hepatocytes, and to evaluate the protective effect of glycyrrhizin (Grz) in vitro. Sprague-Dawley rats were initiated with BCG vaccine in vivo, and then the primary cultured rat hepatocytes were stimulated with lipopolysaccharides (LPS) 10 mg/L in vitro (BCG+LPS treatment), the hepatoprotection by Grz was evaluated in the hepatocytes treated as above. Supernatant AST and LDH activities were measured, and nitric oxide (NO) was evaluated by Giress reaction. Aminoguanidine was used to confirm the target of Grz action. Expression of intercellular adhesion molecular-1 (ICAM-1) was determined by immunocytochemistry. Percentage of apoptosis was detected with fluorescence microscope and flow cytometer. In LPS-treated group, supernatant AST was not increased compared with that in control, while supernatant AST and LDH in BCG+LPS treatment were increased significantly (P<0.05). The enhancements of AST and LDH were inhibited by co-culture with Grz (P<0.05). Both supernatant NO and ICAM-1 expression, and percentage of apoptosis in hepatocytes were elevated by BCG+LPS treatment (P<0.01), and these elevations could be decreased by Grz co-incubation either (P<0.05). The NO generation could be decreased by aminoguarnidine treatment (P<0.05). The elevations of supernatant NO, ICAM-1 expression, and apoptosis in hepatocytes could be taken as three important pathologic changes in the immunologic hepatotoxicity induced by BCG+LPS treatment in primary cultured rat hepatocytes. NO synthesis mechanism was involved in the immunologic hepatotoxic process. Grz could downregulate both supernatant NO and hepatocyte apoptosis in the culture system.


[Total hip arthroplasty in the treatment of developmental dysplasia of the hip].
Total hip arthroplasty (THA) is the preferred treatment for patients with severe arthritis of the hip secondary to developmental hip dislocation or dysplasia. However, THA may be difficult due to bone and soft tissue problems that arise from hip dislocation or dysplasia. Another problem is that patients are usually young, which may affect the long-term survival of the prosthesis. Either cemented or uncemented components can be used depending on bone structure and bone stock. Uncemented components are more preferable because of the young age of the patients. From a biomechanical standpoint, the placement of the acetabular component in its true anatomical location is the main goal for survival and better functional results of THA. To ascertain the stability of the acetabular component, superior grafting, controlled medial wall perforation (medialization), or giving the position of a high hip center may be used. On the femoral side, various femoral components may be used with or without a shortening osteotomy. In this article, reconstruction options for developmental hip dysplasia are discussed depending on acetabular and femoral features of the deformity.


Ultrastructural features and synaptic connections of hilar ectopic granule cells in the rat dentate gyrus are different from those of granule cells in the granule cell layer.
Several investigators have shown the existence of dentate granule cells in ectopic locations within the hilus and molecular layer using both Golgi and retrograde tracing studies but the ultrastructural features and synaptic connections of ectopic granule cells were not previously examined. In the present study, the biocytin retrograde tracing technique was used to label ectopic granule cells following injections into stratum lucidum of CA3b of hippocampal slices obtained from epileptic rats. Electron microscopy was used to study hilar ectopic granule cells that were located 20-40 microm from the granule cell layer (GCL). They had ultrastructural features similar to those of granule cells in the GCL but showed differences, including nuclei that often displayed infoldings and thicker apical dendrites. At their origin, these dendrites were 6 microm in diameter and they tapered down to 2 microm at the border with the GCL. Both biocytin-labeled and unlabeled axon terminals formed exclusively asymmetric synapses with the somata and proximal dendrites of hilar ectopic granule cells. The mean number of axosomatic synapses for these cells was three times that for granule cells in the GCL. Together, these data indicate that hilar ectopic granule cells are postsynaptic to mossy fibers and have less inhibitory input on their somata and proximal dendrites than granule cells in the GCL. This finding is consistent with recent physiological results showing that hilar ectopic granule cells from epileptic rats are more hyperexcitable than granule cells in the GCL.


Effect of umbilical cord mesenchymal stromal cells on motor functions of identical twins with cerebral palsy: pilot study on the correlation of efficacy and hereditary factors.
The objective of this study was to compare the impact of umbilical cord-derived mesenchymal stromal cell (UCMSC) transplantation on the motor functions of identical twins with cerebral palsy (CP) and to analyze the correlation between the efficacy and hereditary factors. Eight pairs (16 individuals) of identical twins with CP were recruited and received allogenic UCMSC transplantation by means of subarachnoid injection. The gross motor function measure (GMFM) and the fine motor function measure (FMFM) were performed before and 1 and 6 months after the treatment to analyze the results of individuals before and after the therapy, between two individuals of an identical twin and among twin pairs. Repeated-measured data variance was used to analyze the GMFM and FMFM scores of patients before and 1 and 6 months after the therapy. Eight pairs (16 individuals) of children with CP had significant improvement in the GMFM at the end of the 1st and 6th months after the therapy compared with that before the therapy, whereas the amelioration of the FMFM was not statistically significant. The improvements in motor functions between two individuals of an identical twin but not among twin pairs were correlated. UCMSC transplantation significantly improves GMFM in children with CP; motor function improvements in the GMFM between two individuals of an identical twin were closely correlated, but improvements among twin pairs were not correlated. We hypothesize that hereditary factors contribute to the mechanisms of UCMSC transplantation in motor function improvement in children with CP.


New method for removing type 2 copper from Rhus laccase.
A new procedure is described for preparing tree laccase that is missing the type 2 copper. The derivative has only about 5% of the activity of the native enzyme, and some, or all, of the residual activity could be due to traces of holoprotein. The type 1 copper is fully oxidized in the purified type-2-depleted protein, while the type 3 site is reduced to the extent of at least 85%. However, the type 3 coppers can be reoxidized by treatment with excess H2O2. Reconstitution is achieved by incubation with Cu(I), and the remetalated protein exhibits the activity and the spectral properties of the native enzyme. The type 2 copper is removed by dialysis against a redox buffer containing ferri- and ferrocyanide ions as well as EDTA. More than 25% of the total copper is removed from laccase during the procedure, but the type-2-depleted fraction is readily isolated by means of an ion-exchange column. The practical advantages of this procedure are described. Finally, the simplicity of the method raises hopes that the mechanism of depletion can be defined.


Sex-dependent metabolism and biliary excretion of [2,4-14C] dinitrotoluene in isolated perfused rat livers.
The incidence of hepatocellular carcinoma is higher in male rats fed 35 mg of dinitrotoluene (DNT) per kg than in female rats fed the same dose. Sex differences in DNT disposition and/or metabolism may account for this difference. This study characterized the metabolism and biliary excretion of 2,4-DNT in male and female isolated perfused rat livers. Livers from both sexes displayed a capacity for oxidation, reduction, acetylation and conjugation of 2,4-DNT (or its metabolites). Oxidation of 2,4-DNT to 2,4-dinitrobenzyl alcohol followed by glucuronidation to 2,4-dinitrobenzyl alcohol glucuronide (DNBalcG) was the major route of 2,4-DNT metabolism in both sexes. Formation of DNBalcG accounted for 10 to 30% of the total initial 2,4-DNT concentration in perfusates. After perfusion with 20 microM 2,4-DNT, male livers excreted larger quantities of DNBalcG in the bile (392 nmol) than female livers (172 nmol); at the same 2,4-DNT concentration, perfusates from female livers contained over 3 times as much DNBalcG as male perfusates. These data suggested that female livers transported DNBalcG into the bile at slower rates than male livers. The transport of DNBalcG into the bile of male, but not female, livers appeared to be saturated after perfusion with 20 micro M 2,4-DNT. No sex differences in the hepatic macromolecular covalent binding were observed after perfusion of livers with either 20 or 70 micro M 2,4-DNT. These data suggest that the major difference in the in vitro metabolism of 2,4-DNT between male and female rats is the larger quantities of DNBalcG excreted in the bile of male rats than female rats.


Evaluating Alternative Materials for the Treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse: A Comparison of the In Vivo Response to Meshes Implanted in Rabbits.
Serious complications can develop with the mesh implants used for stress urinary incontinence and pelvic organ prolapse surgery. We evaluated 2 materials currently in clinical use and 2 alternative materials using a rabbit abdominal model to assess host response and biomechanical properties of the materials before and after implantation. Poly-L-lactic acid and polyurethane meshes were electrospun to be compared to commercially available polypropylene and polyvinylidene fluoride meshes. A total of 40 immunocompetent full-thickness abdominal wall defect rabbit models were used, including 8 in each of the poly-L-lactic acid, polyurethane, polyvinylidene fluoride and polypropylene experimental groups, and sham controls. Two 20 mm defects were created per animal and primarily repaired. The experimental groups then underwent onlay of each repair material while sham controls did not. Four rabbits per group were sacrificed at days 30 and 90. Abdominal wall specimens containing the defect with or without repair material were explanted to be assessed by histology (hematoxylin and eosin staining, and immunohistochemistry) and biomechanical testing at 30 and 90 days. At 90 days of implantation tissues repaired with all 4 materials showed biomechanical properties without significant differences. However, polypropylene and polyvinylidene fluoride meshes demonstrated a sustained chronic inflammatory response profile by 90 days. In contrast, poly-L-lactic acid and polyurethane meshes integrated well into host tissues with a decreased inflammatory response, indicative of constructive remodeling. Poly-L-lactic acid and polyurethane alternative materials achieved better host integration in rabbit models than current synthetic repair materials.


Treating grouped data as continuous in alcohol consumption measures.
In quantity-frequency methods used for self-report measurement of alcohol intake (or other exposures), respondents mark the appropriate ranges, e.g. '5 to 8 drinks', '5 or 6 times per week'. To calculate average consumption only single values, not ranges, can be multiplied, and midpoints are commonly used. This results in bias if the range lies in the tail of a distribution, as often happens with drinks per occasion. The same bias occurs when risk, for example, is plotted against consumption levels, which inevitable are grouped into ranges. Consequently, estimates of aggregate consumption can be exaggerated and curves of risk against exposure level can be misleading. A method is described to calculate a relatively unbiased representative value for a range, requiring only knowledge of the normal distribution table, the log-normal distribution, and basic arithmetic. Part of the procedure is also useful for estimating percentile points in data that have been grouped differently, such as income in dollar groups.


Bandwidth-adaptable silicon photonic differentiator employing a slow light effect.
A photonic differentiator (DIFF) plays a crucial role in photonic circuits. Despite the fact that a DIFF having a terahertz bandwidth has been reported, the practical bandwidth is limited to being a bandpass response. In this Letter, we propose the concept of a bandwidth-adaptable DIFF, which exploits the slow light effect in a photonic crystal waveguide (PhCW) to overcome the inherent bandwidth limitation of current photonic DIFFs. We fabricated a PhCW Mach-Zehnder interferometer (PhCW-MZI) on the silicon-on-isolator material platform to validate our concept. Input Gaussian pulses with full width to half-maximums (FWHMs) ranging from 2.7 to 81.4 ps are accurately differentiated using our PhCW-MZI. Our all-passive scheme circumvents the bandwidth bottlenecks of previously reported photonic DIFFs and can greatly broaden the application area of photonic DIFFs.


Measurement of Microvascular Endothelial Barrier Dysfunction and Hyperpermeability In Vitro.
Loss of microvascular endothelial barrier integrity leads to vascular hyperpermeability and vasogenic edema in a variety of disease processes including trauma, ischemia and sepsis. Understanding these principles gives valuable information on pathophysiology and therapeutic drug development. While animal models of traumatic and ischemic injuries are useful to understand vascular dysfunctions associated with such injuries, in vitro barrier integrity assays are reliable and helpful adjuncts to understand the cellular and molecular changes and signaling mechanisms that regulate barrier function. We describe here the endothelial monolayer permeability assay and transendothelial electrical resistance (TEER) measurement as in vitro methods to test changes in microvascular integrity and permeability. These in vitro assays are based on either the measurement of electrical resistance of the monolayer or the quantitative evaluation of fluorescently tagged molecules (e.g., FITC-dextran) that pass through the monolayer when there is damage or breakdown.


Serotonin modulates expression of VIP and GRP mRNA via the 5-HT(1B) receptor in the suprachiasmatic nucleus of the rat.
The expression of vasoactive intestinal peptide (VIP) and gastrin-releasing peptide (GRP) in the suprachiasmatic nucleus (SCN) changes depending on light. VIP mRNA increases and GRP mRNA decreases in the light phase, while they do not show change without light. In the present study we investigated the involvement of serotonin (5-HT) in the expression of VIP and GRP messenger RNA in the SCN of the rat. The decrease in VIP mRNA and the increase in GRP mRNA in the light phase were amplified by 5-HT depletion using 5,6-dihydroxytryptamine injected into the lateral ventricle. These enhancements due to 5-HT depletion were reversed to control levels by applying 5-HT(1B) agonists TFMPP and CGS12066A, but not a 5-HT(1A)/5-HT(7) agonist, 8-OH-DPAT. The 5-HT(1B) receptor is known to exist on the terminals of the retinohypothalamic tract (RHT). Therefore, next we investigated the morphological relationship of RHT and 5-HT terminals by double-labeling immunocytochemistry and demonstrated that 5-HT-immunoreactive fibers and cholera toxin B subunit-labeled RHT terminals were intermingled in the ventrolateral SCN, and 5-HT axon processes had close contact with RHT terminals. Collectively, these pharmacological and morphological results suggest that 5-HT afferents from raphe nuclei modulate VIP and GRP expression in neurons of the ventrolateral SCN by activating the 5-HT(1B) receptor in the RHT.


Atypical squamous cells as a diagnostic pitfall in pulmonary Wegener's granulomatosis. A case report.
Wegener's granulomatosis (WG) is characterized by systemic, necrotizing, granulomatous inflammation accompanied by vasculitis. It classically involves the triad of the upper respiratory tract, lungs and kidneys. Isolated pulmonary lesions of WG may present in some patients as pulmonary masses, simulating neoplasms. The features of WG can be suggested by cytologic study. Atypical epithelial cells associated with WG have previously been reported as a cause of a false positive diagnosis of bronchoalveolar carcinoma. In this case the cytologic findings included atypical squamous cells in a background of acute, chronic and granulomatous inflammation. In several respiratory specimens the atypical squamous cells were incorrectly interpreted as diagnostic of squamous cell carcinoma. The correct diagnosis of WG was confirmed with open lung biopsy, which demonstrated necrotizing granulomatous inflammation with geographic necrosis and associated vasculitis. Markedly atypical squamous cells mimicking squamous cell carcinoma can be found accompanying the inflammatory process associated with WG and are a possible diagnostic pitfall. The possibility of WG as well as other inflammatory processes should always be considered in the differential diagnosis of squamous cell carcinoma of the lung. This case is the only reported case of WG in which atypical squamous cells were a diagnostic pitfall, initially suggesting a diagnosis of squamous cell carcinoma.


Comparison of the nuclear magnetic resonance and infrared spectroscopic methods for the quantitative analysis of polydimethylsiloxane.
A method based on nuclear magnetic resonance spectroscopy is described for the quantitative determination of polyimethylsiloxane (PMS) in a variety of pharmaceutical preparations. An extraction procedure using deuterochloroform within the sample tube was devised. In the presence of an internal standard, the PMS concentration was determined directly using integrated peak areas, without the necessity of establishing calibration curves. Accurate quantitative results were achieved with sample, containing at least 2mg PMS, extracted from formulations containing greater than 0.5% PMS. The extraction procedure and nmr assay were both more efficient and convenient than the B.P.C. method.


Prescription for trouble: Medicare Part D and patterns of computer and internet access among the elderly.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 specifically encourages Medicare enrollees to use the Internet to obtain information regarding the new prescription drug insurance plans and to enroll in a plan. This reliance on computer technology and the Internet leads to practical questions regarding implementation of the insurance coverage. For example, it seems unlikely that all Medicare enrollees have access to computers and the Internet or that they are all computer literate. This study uses the 2003 Current Population Survey to examine the effects of disability and income on computer access and Internet use among the elderly. Internet access declines with age and is exacerbated by disabilities. Also, decreases in income lead to decreases in computer ownership and use. Therefore, providing prescription drug coverage primarily through the Internet seems likely to maintain or increase stratification of access to health care, especially for low-income, disabled elderly, who are also a group most in need of health care access.


When the report is dizziness.
The complaint of "I'm dizzy," is a familiar one heard from those over age 60 by nurses in any health care setting. This complaint requires assessing subjective reports and determining potential causes to assist in obtaining appropriate interventions. Specialized testing may be required, as well as review of the person's activity, medications, diagnoses, and potential environmental and emotional situation. The end goal in nursing care is to prevent injury and promote physical and psychosocial well-being.


Screen3D: a novel fully flexible high-throughput shape-similarity search method.
3D shape- or volume-based virtual screening is a broadly used approach in drug discovery. In recent years a large number of publications have appeared in which these tools were compared not only to competitive methods but to docking studies as well. Studies often showed that the effectiveness of docking could be highly variable due to a large number of possible confounding factors, while ligand-based, shape-based approaches were more consistent. Here, we describe a novel, fully flexible shape-based virtual screening algorithm that does not require previous 3D conformation or conformer generation. Due to its solid consistency it can easily be used on desktop computers by non-expert scientists. The algorithm is demonstrated in a study for the investigation of β-secretase inhibitors and benchmarked on the Directory of Useful Decoys data set.


Rifaximin treatment of pathogen-negative travelers' diarrhea.
Antibacterial drugs appear to be effective in shortening the illness of a majority of cases of travelers' diarrhea. This was a subanalysis from two randomized, double-blind, placebo-controlled trials in adult travelers with acute diarrhea treated with rifaximin 200 mg three times a day or placebo for 3 days. Efficacy was assessed by the interval beginning with the first dose of medication and ending with the last unformed stool passed after becoming well [time to last unformed stool (TLUS)]; number of unformed stools passed; percent with clinical improvement; and incidence of wellness achieved. Stool pathogens were not identified in pretreatment samples in 122 of 322 (38%) patients and 106 of 230 (46%) randomized to rifaximin and placebo, respectively. Among pathogen-negative patients, rifaximin was more effective than placebo for median TLUS (33 vs 68 h, p < 0.005), mean number of unformed stools passed (6.5 vs 8.6, p < 0.0001), and clinical wellness (77% vs 61%, p = 0.01). The adverse-event profiles between rifaximin and placebo were similar. More than one third of patients with travelers' diarrhea had pathogen-negative illness. Rifaximin was effective in treating the illness without associated side effects. These results are consistent with the hypothesis that undetected bacterial pathogens are the most likely cause of travelers' diarrhea without definable cause.


Measuring tongue volumes and visualizing the chewing and swallowing process using real-time TrueFISP imaging--initial clinical experience in healthy volunteers and patients with acromegaly.
This study assessed both two-dimensional (2D) TrueFISP imaging for quantifying tongue volume and real-time TrueFISP imaging for evaluating chewing and swallowing in healthy volunteers and patients with acromegaly. In 50 healthy volunteers, tongue volumes were measured using a 2D TrueFISP sequence. Chewing and swallowing were visualized using a real-time TrueFISP sequence. Ten patients with acromegaly were examined twice with the same magnetic resonance imaging protocol: once prior to therapy and a second time 6 months after therapy. Prior to therapy, healthy volunteers had an average tongue volume of 140 ml for men and 90 ml for women, and patients with acromegaly had an average tongue volume of 180 ml for men and 145 ml for women. However, 6 months after therapy the mean tongue volumes in patients with acromegaly had decreased to 154 ml in the men and to 125 ml in the women. The chewing and swallowing process was normal in all volunteers. Prior to therapy, just two patients showed a chewing and swallowing pathology, which disappeared after therapy. Patients with acromegaly had larger tongue volumes than healthy volunteers, and TrueFISP imaging proved feasible for visualizing chewing and swallowing in real time and is capable of detecting possible pathologies. Furthermore, TrueFISP imaging can be used to monitor therapeutic approaches in patients with acromegaly.


A review of recently-developed ligands for neuronal benzodiazepine receptors and their pharmacological activities.
There has recently been a large increase in the number of new benzodiazepine receptor ligands, some with benzodiazepine structures, but many with other chemical structures. The pharmacological activities of these ligands have been interpreted on the basis of a continuum of efficacy ranging from full agonist through different degrees of partial agonism to antagonist and through partial to full inverse agonists. Inconsistencies with this hypothesis are considered in terms of alternative hypotheses, particularly the existence of functionally separable receptor subtypes. The potential of partial agonists as non-sedative anxiolytic agents with reduced potential of dependence and of weak partial inverse agonists as pro-cognitive agents is discussed. A pharmacophore for benzodiazepine receptors is proposed and supporting evidence presented.


Transcriptional activation by the v-myb oncogene and its cellular progenitor, c-myb.
The v-myb oncogene, like its cellular progenitor c-myb, encodes a short-lived nuclear protein involved in processes affecting growth and differentiation in a number of cell types. Fusion proteins, in which v-myb sequences are linked to the DNA binding domain of the yeast transcriptional activator GAL4, can activate transcription from a reporter gene linked in cis to a GAL4 binding site. The domain of v-myb responsible for transcriptional activation is located between residues 204 and 254, and is both necessary and sufficient for activation. Intact v-myb and c-myb proteins can also activate transcription, via a myb binding site linked in cis to a reporter gene. A v-myb protein bearing a deletion in the activator domain is no longer capable of stimulating transcription.


[Acid reduction after SPV and after H2 receptor blocking substance cimetidine. Comparative studies in Shay-rats)].
The effect of a complete selective proximal vagotomy on stomach acidity has been compared experimentally to that of the H2 receptor blocking agent cimetidine in the rat. Both methods produced a significant reduction of total acid as compared to controls, a reduction to 0.5 % for cimetidine and to 0.1 % for SPV. The acid reduction following SPV is a result of decreased production of stomach fluid as well as a decrease in degree of acidity. The acid reduction following administration of cimetidine is mainly a result of an increase in pH without any change in volume of stomach fluid production.


Correction of limb-length inequality during total hip arthroplasty.
Although several methods of intraoperative limb-length measurements have been described, their success in predicting the limb-length correction is not well documented. A new technique of measuring intraoperative limb lengthening using a vertical Steinmann pin at the infracotyloid groove of the acetabulum was studied in 100 consecutive primary total hip arthroplasties. Correlation of the predicted intraoperative correction was done with the postoperative radiographic measurements. Preoperative limb-length inequality ranged from -24 mm (short) to +2 mm (long) (mean, -4.2 mm). Intraoperative measurement of lengthening ranged from 0 to 15 mm (mean, 5.9 mm). Radiographic measurements of postoperative radiographs showed lengthening ranging from 0 to 17 mm (mean, 7.4 mm). There was significant correlation between the 2 values (r =.84). Postoperative limb-length inequality ranged from -7 mm to +8 mm (mean, 1.9 mm). None of the patients had to use shoe lifts for equalization of limb lengths.


Dietary supplementation with Lactobacillus plantarum dy-1 fermented barley suppresses body weight gain in high-fat diet-induced obese rats.
Cereal fermentations have shown significant potential in improvement and design of the nutritional quality and health effects of foods and ingredients. In the present study, the effect of supplementary Lactobacillus plantarum dy-1 fermented barley (LFB) on obesity in high-fat diet (HFD)-induced obese rats was investigated. LFB treatment showed a lower rate of increase in body weight and percentage of body fat and a reversal of HFD-induced glucose intolerance, with ameliorated hyperinsulinemia, decreased levels of triglycerides and total cholesterol, and inhibited concentration of interleukin (IL)-1β, IL-6 and tumor necrosis factor-α. Moreover, LFB treatment also showed the strongest inhibition of nuclear factor (NF)-kB activation and exhibited the greatest effects in blocking the degradation of the inhibitor of NF-kB and inhibiting p38 and JNK1 phosphorylation compared with HFD and raw barley treatment. It was clear that Lactobacillus plantarum dy-1 fermentation significantly improves the anti-obesity properties of barley. The results establish the foundation for ameliorating diet-induced obesity of product with LFB as nutritional supplements. © 2016 Society of Chemical Industry.


Sequential synthesis of amino-1,4-naphthoquinone-appended triazoles and triazole-chromene hybrids and their antimycobacterial evaluation.
A general method for the synthesis of a library of hitherto unreported amino-1,4-naphthoquinone-appended triazoles was accomplished via a sequential three-component reaction of substituted N-propargylaminonaphthoquinones with variously substituted alkyl bromides/2-bromonaphthalene-1,4-dione and sodium azide in the presence of Et3N/CuI in water. Aminonaphthoquinone-appended iminochromene-triazole hybrid heterocycles were also synthesized from the amino-1,4-naphthoquinone-appended-1,2,3-triazolylacetonitriles. All the triazole hybrids were screened for their in vitro activity against Mycobacterium tuberculosis H37Rv (MTB). Among the triazoles, 2-(((1-benzyl-1H-1,2,3-triazol-4-yl)methyl)(4-(trifluoromethyl)phenyl)amino)naphthalene-1,4-dione (7d) emerged as the most active one with IC50 = 1.87 μM, being more potent than the anti-TB drugs, cycloserine (6 times), pyrimethamine (20 times) and equipotent as the drug ethambutol (IC50 < 1.56 μM).


Novel insights on the role of the innate immune system in systemic sclerosis.
Over the last several years the involvement of the innate immune system in the pathogenesis of autoimmune diseases such as systemic lupus erythematosus (SLE) has become well established. As systemic sclerosis (SSc; scleroderma) shares clinical features and autoantibodies with SLE, investigation has recently focused on the role of innate immunity in SSc. This has been supported by recent genetic studies. However, unlike SLE and other related autoimmune diseases, SSc patients suffer from pathologic fibrosis of skin and internal organs. The fibrotic component of SSc shares several features with syndromes following environmental exposures to agents such as organic solvents, silica dust and bleomycin. Recent work in SSc and these related fibrotic diseases have identified several areas in which innate immunity can stimulate inflammation as well as fibrosis. This article will focus on the recent discoveries identifying a prominent role of cells of the innate immune system, pattern recognition receptors, and activation of dendritic cells in the pathogenesis of SSc.


A layer-recursive formula for the medium filter for volume conductor problems in radially symmetric layered media.
Simplified algorithms for the computation of the filter coefficients used in solutions of the forward and inverse volume conductor problems in a multilayered cylindrical geometry are derived. The new algorithms are layer-recursive, as opposed to previous algorithms which were specific for the structure studied. The new algorithms not only eliminate the need to derive algebraically cumbersome filter expressions, but also speed up their numerical evaluation.


Next-generation transcriptome analysis in transgenic birch overexpressing and suppressing APETALA1 sheds lights in reproduction development and diterpenoid biosynthesis.
Overexpression of BpAP1 could cause early flowering in birch. BpAP1 affected the expression of many flowering-related unigenes and diterpenoid biosynthesis in transgenic birch, and BpPI was a putative target gene of BpAP1. APETALA1 (AP1) is an MADS-box transcription factor that is involved in the flowering process in plants and has been a focus of genetic studies examining flower development. Here, we carried out transcriptome analysis of birch (Betula platyphylla Suk.), including BpAP1 overexpression lines, BpAP1 suppression lines, and non-transgenic line (NT). Compared with NT, we detected 8302 and 7813 differentially expressed unigenes in 35S::BpAP1 and 35S::BpAP1RNAi transgenic lines, respectively. Overexpression and suppression of BpAP1 in birch affected diterpenoid biosynthesis and altered expression of many flowering-related unigenes. Moreover, combining information from the RNA-seq database and the birch genome, we predicted downstream target genes of BpAP1. Among the 166 putative target genes of BpAP1, there was a positive correlation between BpAP1 and BpPI. These results provide references for further examining the relationship between BpAP1 and its target genes, and reveal that BpAP1 functions as a transcription regulator in birch.


Validation of the school lunch recall questionnaire to capture school lunch intake of third- to fifth-grade students.
Children's dietary intake is a key variable in evaluations of school-based interventions. Current methods for assessing children's intake, such as 24-hour recalls and meal observations, are time- and resource-intensive. As part of a study to evaluate the impact of farm-to-school programs, the school lunch recall was developed from a need for a valid and efficient tool to assess school lunch intake among large samples of children. A self-administered paper-and-pencil questionnaire, the school lunch recall prompts for school lunch items by asking children whether they chose a menu item, how much of it they ate, how much they liked it, and whether they would choose it again. The school lunch recall was validated during summer school in 2008 with 18 third- to fifth-grade students (8 to 11 years old) in a North Carolina elementary school. For 4 consecutive days, trained observers recorded foods and amounts students ate during school lunch. Students completed the school lunch recall immediately after lunch. Thirty-seven total observation school lunch recall sets were analyzed. Comparison of school lunch recalls against observations indicated high accuracy, with means of 6% for omission rate (items observed but unreported), 10% for intrusion rate (items unobserved but reported), and 0.63 servings for total inaccuracy (a measure that combines errors for reporting items and amounts). For amounts, accuracy was high for matches (0.06 and 0.01 servings for absolute and arithmetic differences, respectively) but lower for omissions (0.47 servings) and intrusions (0.54 servings). In this pilot study, the school lunch recall was a valid, efficient tool for assessing school lunch intake for a small sample of third- to fifth-grade students.


Nuclear morphometry in experimental oral mucosal carcinogenesis.
The area, perimeter and diameter of basal cell nuclei of rat palatal epithelium were measured and the deviation of the basal cell nuclear profile from the form of a sphere was assessed after the application of the carcinogen 4-nitroquinoline-1-oxide (4NQO). After a 24-week treatment-free period, designed to eliminate the irritant effect of the carcinogen, the rats were killed, the palatal mucosa was recovered and processed and the nuclear histometry was assessed with image analysis techniques. The basal cell nuclear area increased as the epithelium became dysplastic and then decreased as carcinoma developed, but there were significant variations in this parameter in the control groups. Basal cell nuclei from moderately or severely dysplastic epithelium, and from epithelium adjacent to areas of invasive carcinoma, were significantly less regular in profile by comparison with control nuclei. Variations in nuclear profile, but not nuclear area, perimeter or diameter, might reflect fundamental nuclear alterations of significance during the process of carcinogenesis.


Linear and cyclic aliphatic carboxamides of the Murchison meteorite: hydrolyzable derivatives of amino acids and other carboxylic acids.
Analyses of fractionated aqueous extracts of the Murchison meteorite by gas chromatography-mass spectrometry after silylation with N-methyl-N (tert-butyldimethylsilyl) trifluoroacetamide have revealed an extensive series of linear and cyclic aliphatic amides. These include monocarboxylic acid amides, dicarboxylic acid monoamides, hydroxy acid amides, lactams, carboxy lactams, lactims, N-acetyl amino acids, and substituted hydantoins. Numerous isomers and homologues through at least C8 were observed in all cases, except for the N-acetyl amino acids and hydantoins. Carboxy lactams, lactams, hydantoins, and N-acetyl amino acids are converted to amino acids by acid hydrolysis, thus, these compounds qualitatively account for the earlier observation of acid-labile amino acid precursors in meteoritic extracts. Laboratory studies of the spontaneous decomposition of N-carbamyl-alpha-amino acids and their dehydration products, the 5-substituted hydantoins, have led to the recognition of a series of aqueous phase reactions by which amino acids and cyanic acid/cyanate ion in the primitive parent body might have given rise to several of the observed classes of amides, as well as to monocarboxylic acids, dicarboxylic acids, and hydroxy acids. A previously undescribed reaction of 5-substituted hydantoins with cyanic acid/cyanate ion to give carboxamides of the 5-substituent groups was observed in the course of these studies. The presence of an extensive suite of amides in a CM chondrite appears to be consistent with the interstellar-parent body formation hypothesis for the organic compounds of these meteorites. The presence of carboxy lactams and lactams along with free amino acids suggests the possibility of further chemical evolution of meteorite amino acids by thermal polymerization. The cyclic amides, given their potential for hydrogen-bonded pair formation, might be considered candidate bases for a primitive sequence coding system.


Molecular evolution constraints in the floral organ specification gene regulatory network module across 18 angiosperm genomes.
The gene regulatory network of floral organ cell fate specification of Arabidopsis thaliana is a robust developmental regulatory module. Although such finding was proposed to explain the overall conservation of floral organ types and organization among angiosperms, it has not been confirmed that the network components are conserved at the molecular level among flowering plants. Using the genomic data that have accumulated, we address the conservation of the genes involved in this network and the forces that have shaped its evolution during the divergence of angiosperms. We recovered the network gene homologs for 18 species of flowering plants spanning nine families. We found that all the genes are highly conserved with no evidence of positive selection. We studied the sequence conservation features of the genes in the context of their known biological function and the strength of the purifying selection acting upon them in relation to their placement within the network. Our results suggest an association between protein length and sequence conservation, evolutionary rates, and functional category. On the other hand, we found no significant correlation between the strength of purifying selection and gene placement. Our results confirm that the studied robust developmental regulatory module has been subjected to strong functional constraints. However, unlike previous studies, our results do not support the notion that network topology plays a major role in constraining evolutionary rates. We speculate that the dynamical functional role of genes within the network and not just its connectivity could play an important role in constraining evolution.


Ten-year experience with the Medtronic Hall valvular prosthesis. A study of 1,104 patients.
The Medtronic Hall valvular prosthesis was introduced in 1977 and was used for the first time in Oslo in June of that year. We report here our 10-year experience with this prosthesis, based on studies of all 1,104 consecutive patients who were operated on from June 1977 to August 1987. There were 816 aortic (AVR), 187 mitral (MVR), and 101 combined mitral and aortic (double, DVR) valve replacements. Cumulative follow-up was 5,061 patient-years, with a mean follow-up of 4.6 years. Early mortality was 3.8% after AVR, 7.5% after MVR, and 10.0% after DVR. The probability of surviving 10 years after AVR was 72%; after MVR, 56%; and after DVR, 60%. Early and late survival reflected the patient's preoperative status and nonvalvular cardiac disease. Thromboembolism occurred at linearized rates of 1.3%, 1.3%, and 1.8%/yr after AVR, MVR, and DVR, respectively. There were five cases of valvular thrombosis, none fatal, resulting in a linearized rate of 0.1%, 0.1%, and 0.2%/yr after AVR, MVR, and DVR, respectively. There were no instances of structural failure. Morbidity from anticoagulant-related hemorrhage was 0.7%/yr, with seven fatal events, all of cerebral origin. The long-term experience with the Medtronic Hall valve indicates that, in addition to its previously demonstrated excellent hemodynamic performance, there are low risks of thromboembolism and thrombosis and no instances of primary structural failure.


V1 spinal neurons regulate the speed of vertebrate locomotor outputs.
The neuronal networks that generate vertebrate movements such as walking and swimming are embedded in the spinal cord. These networks, which are referred to as central pattern generators (CPGs), are ideal systems for determining how ensembles of neurons generate simple behavioural outputs. In spite of efforts to address the organization of the locomotor CPG in walking animals, little is known about the identity and function of the spinal interneuron cell types that contribute to these locomotor networks. Here we use four complementary genetic approaches to directly address the function of mouse V1 neurons, a class of local circuit inhibitory interneurons that selectively express the transcription factor Engrailed1. Our results show that V1 neurons shape motor outputs during locomotion and are required for generating 'fast' motor bursting. These findings outline an important role for inhibition in regulating the frequency of the locomotor CPG rhythm, and also suggest that V1 neurons may have an evolutionarily conserved role in controlling the speed of vertebrate locomotor movements.


The use of competitive PCR for quantitation of HSV-1 DNA.
Polymerase chain reaction (PCR) detects the genomic materials of etiological agents with high specificity and sensitivity. However, in herpes simplex virus type 1 (HSV-1) infection, the clinical significance of the results often poses controversy because of the subclinical viral shedding during latent infection. Quantitative PCR might provide additional information to help clinical evaluation of the results. Virus DNA was extracted from high titer stock of human HSV-1 (FK 25) by phenol/chloroform treatment. Construct (p/HSV-1) was made by inserting the glycoprotein D gene obtained from virus DNA into p(GEM-T) vector. Competitor (p/DeltaHSV-1) was made by deleting the inner 40 bp of construct (p/HSV-1) with restriction enzyme. Competitive PCR was performed using primers that amplify the glycoprotein D gene, and a template made of a 1:1 molar mixture of HSV-1 DNA and the competitor. The PCR product reflected the initial template dose from 20 to 30 cycles. Minimum detection level of HSV-1 DNA was 0.01 ng. Competitive PCR can quantitate HSV-1 DNA.


Central connections of Limulus ventral photoreceptors revealed by intracellular staining.
We stained the central terminations of Limulus ventral photoreceptors by intracellular injection of cobalt chloride into the cell bodies. Axons of these photoreceptors enter the protocerebrum via the ventral optic nerve and pass to the medulla. As they reach the surface of the medullar neuropil they branch profusely in fine processes with intermittent varicosities. Each axonal arborization covers about 0.01-0.02 mm2 of this surface immediately adjacent to the medullar ganglion cell layer. Each point on the surface of the medullar neuropil receives, on the average, input from about 6 ventral photoreceptor axons.


[Zinc in prostatic physiopathology. I. Role of zinc in the physiology and biochemistry of the prostatic gland].
To sum up the role of zinc in prostatic physiology and biochemistry: a) Zinc is found in normal prostate tissue in a greater concentration than in any other organ in the economy, ranging between 0.70 and 1 mgm/gm. of dry tissue. b) The concentration of prostate liquid and semen is greater than that in any other organic liquid. c) It appears that the prostate gland is a zinc storing organ (or deposit). d) The zinc concentration in prostatic tissue is directly proportional to the amount of alveolar tissue existing in the gland. e) It has been shown that the Zn concentration is greater in the nuclear sediment of the different subcellular fractions of the human prostate gland. f) The prostate gland seems to supply zinc to the human sperm and plays an important role in the metabolic activity of the spermatozoid. g) There seems to be a clear difference between the distribution and absorption of radioactive zinc in the different lobes of the prostate gland. h) Zinc also plays an important part in the enzymatic activity of the prostate gland and in the polymeric organization of the RNA and DNA and is vital for cell division. i) Prostatic Zn has a clear hormonal dependency.


Middle cerebral artery occlusion increases cerebral capillary permeability.
One hour after middle cerebral artery occlusion, the regional blood to brain transfer coefficient of alpha-aminoisobutyric acid was determined in eight barbiturate anaesthetized rats. The transfer coefficient (microliter/min-1/g-1) was significantly higher in the ischaemic cortex (10.6 +/- 2.3) than in the contralateral cortex (6.5 +/- 1.0). Cerebral regional capillary surface area was determined in another group of twelve rats using an alkaline phosphatase stain for the total capillary bed and fluorescein isothiocyanate-dextran to visualize the perfused capillaries. Perfused capillary surface area (cm2/cm3) was lower in the ischaemic cortex (141 +/- 31) than in the contralateral cortex (426 +/- 32). Using these values for the transfer coefficient, surface area and our previously published data of regional cerebral blood flow after middle cerebral artery occlusion, we calculated the extraction fraction of alpha-aminoisobutyric acid, the permeability-surface area product and the permeability of cerebral regional capillary beds. Although, there are numerous reports of permeability-surface area product of brain capillaries, to our knowledge, the permeability has never been determined before. The calculated extraction fraction ratio for alpha-aminoisobutyric acid for ischaemic cortex/contralateral cortex was 3.1. Similar ratios for permeability-surface area product and capillary permeability were 1.6 and 4.4, respectively. Thus, there was a more than four fold increase in capillary permeability to small molecules in the ischaemic cortex one hour after middle cerebral artery occlusion.


Implementing a surgical checklist: more than checking a box.
Perioperative checklists are mandated by many hospitals as determined by the reduction in morbidity and mortality seen with the use of the World Health Organization's Surgical Safety Checklist. An adapted perioperative checklist was implemented within our hospital system, and compliance with the checklist was reported to be 100%. We hypothesized that compliance does not measure the fidelity of implementation. During a 7-week period, a prospective study was performed to evaluate the completion of all preincision components of the surgical checklist. Pediatric surgical operations were selected for direct observation. In addition, a poststudy survey was used to assess perception and understanding of the checklist process. A total of 142 pediatric surgical cases were observed. Hospital reported data demonstrated 100% compliance with the preincision phase of the checklist for these cases. None of the cases completely executed all items on the checklist, and the average number of checklist items performed in the observed cases was 4 of 13. The most commonly performed checkpoint were the confirmation of patient name and procedure (99%) and the "timeout" at the start of the checklist (97%). The rest of the checkpoints were performed in less than 60% of cases. Adherence did not increase during the observation period. These data show that despite the 100% documented completion of the preincision phase of the checklist; most of the individual checkpoints are either not executed as designed or not executed at all. These findings demonstrate lack of checklist implementation fidelity, which may be a reflection a poor implementation and dissemination strategy.


[Determination of fetal lung maturity using the Shake Test by Clements and the L/S ratio].
By analysing 214 samples of amniotic fluid from the 9th to 44th week of gestation fetal lung maturity was determined by the shake test (Clements) and by the L/S ratio (Gluck). 20 women had repeated amniocenteses. The results of both tests coincided in 73%. In 90 out of 144 newborns the tests took place within 24 hours before delivery. In these cases lung maturity was predicted exactly in 74% by the L/S ratio and in 46% by the shake test. No child with a test result indicating lung maturity developed a respiratory distress syndrome. On the other hand the lung often was mature with a negative test. These false negative results, the cases with respiratory distress syndrome and the test result in a pregnancy with an anencephalic fetus are discussed.


Task performance in standard laparoscopy in comparison with single-incision laparoscopy in a modified skills trainer.
Single-incision laparoscopy (SIL) is similar to conventional laparoscopic surgery (LAP), but carries specific technical challenges due to lack of triangulation, reduced dexterity, conflicts due to inline instrumentation, and impaired visualization. This study was designed to evaluate technical skill performance of SIL versus LAP surgery in a simulated environment. We developed a modified laparoscopic skills trainer for SIL based upon the fundamentals of laparoscopic surgery (FLS) model. This includes a standard laparoscopic tower for visualization, allowing replication of the conflicts between scope and instruments. It also has a modified trainer box allowing use of different access devices and instruments for SIL. Sixteen subjects at different levels of training (novice through expert) completed four FLS tasks with standard LAP techniques. They then practiced the same tasks using SIL technique until they reached a steady state of performance. The first and last SIL trials were recorded. Baseline SIL peg transfer was worse than FLS (254 ± 157 s vs 99 ± 27, p < 0.0002). Final SIL time was still significantly worse than FLS (173 ± 130, p < 0.02). FLS, baseline SIL, and final SIL circle cutting were not significantly different (p = 0.058). Final SIL loop ligation was significantly faster than FLS (48 ± 19 vs 70 ± 42, p < 0.05). FLS suturing was faster than SIL suturing (281 ± 188 vs. 526 ± 105, p < 0.01). There was substantial dropout due to frustration with SIL, and only two surgeons were able to successfully complete SIL suturing. There are technical challenges with SIL that vary depending on task. Peg transfer and suturing were significantly impaired in SIL, while circle cutting was not significantly affected, and ligating loop was faster with SIL than LAP. These challenges may impact clinical outcomes of SIL and should influence training in SIL as well as future product development.


Cryptorchidism and delayed testicular descent in Florida black bears.
Retained testes were found in 11 (16%) of 71 black bears (Ursus americanus) examined over a 3-year period in Florida (USA). Four of the 11 bears were older than one year and weighed more than 32 kg; therefore, they were considered to be cryptorchid. The remaining seven bears may have had delayed testicular descent due to their apparent normal immature development. This is the first known published report of the prevalence of cryptorchidism and apparently normal delayed testicular descent in a black bear population.


Influence of vestibular and visual climbing fiber signals on Purkinje cell discharge in the cerebellar nodulus of the rabbit.
Extracellular recordings of the climbing fiber responses (CFRs) of single Purkinje cells were made in the cerebellar nodulus and ventral uvula of anesthetized pigmented rabbits. Natural vestibular and optokinetic stimuli were used to evoke responses from these Purkinje cells. Using a null response technique we sorted vestibularly-evoked CFRs into two canal-related categories. CFRs were related to either the ipsilateral anterior and contralateral posterior semicircular canal (iAC+cPC) or to the ipsilateral posterior and contralateral anterior semicircular canal (iPC+cAC). Both canal-related CFRs also responded to downward optokinetic stimulation.


Schizophrenic vs. brain-damaged performance on the Holtzman Inkblot Technique.
The HIT standard scoring variables failed to differentiate between the brain-damaged and schizophrenic Ss, as perhaps would be expected from past studies of the Rorschach on the subject. This failure to discriminate may reflect the behavioral similarities encountered in these two complex syndromes, and it should be borne in mind that both groups consisted of chronic individuals with lowered productivity levels. As neither schizophrenia nor organicity are unitary syndromes, it is possible that future studies that compare the inkblot performance of different types of brain-damaged vs. schizophrenic Ss may be more productive in obtaining differences between the syndromes.


Effects of skin extract on sebaceous gland function in the rat.
The subcutaneous injection of a rat skin extract inhibits sebum excretion. The mitotic rate in the sebaceous glands is reduced. Therefore, a chalone of the sebaceous gland seems to exist. The regulation of sebum excretion is discussed.


Interactions among polymorphisms in folate-metabolizing genes and serum total homocysteine concentrations in a healthy elderly population.
Homocysteine concentrations are influenced by vitamin status and genetics, especially several polymorphisms in folate-metabolizing genes. We examined the interactions and associations with serum total homocysteine (tHcy) and folate concentrations of polymorphisms in the following folate-metabolizing genes: methylenetetrahydrofolate reductase (MTHFR), reduced folate carrier 1 (RFC1), and glutamate carboxypeptidase II (GCPII). Healthy volunteers (436 men and 606 women; mean age: 77.9 y) were randomly selected from among residents of Oxford, United Kingdom. We determined the individual effects and interactions of the MTHFR 677C-->T, MTHFR 1298A-->C, RFC1 80G-->A, and GCPII 1561C-->T polymorphisms on serum tHcy and folate concentrations. Subjects with the MTHFR 677TT genotype had higher serum tHcy concentrations than did those with the MTHFR 677CC genotype (P < 0.001), and this effect was greater in subjects with low serum folate status (P for interaction = 0.026). The MTHFR 1298A-->C, RFC1 80G-->A, and GCPII 1561C-->T polymorphisms had no individual effects on serum tHcy or folate concentrations. There was no interactive effect of the MTHFR 677C-->T and MTHFR 1298A-->C polymorphisms on tHcy concentrations. An interaction (P = 0.05) was observed between the MTHFR 677TT and RFC1 80GG genotypes, whereby persons with this genotype combination had a mean (+/-SEM) serum tHcy concentration (18.5 +/- 1.2 micromol/L) that was 5.1 micromol/L greater than the mean value of 13.4 +/- 0.2 micromol/L for the whole population. Folate and tHcy concentrations were not affected individually by the MTHFR 1298A-->C, RFC1 80G-->A, or GCPII 1561C-->T polymorphisms or by combinations of the MTHFR 677C-->T and MTHFR 1298A-->C genotypes. An interaction between the MTHFR 677TT and RFC1 80GG genotypes was observed whereby persons with this combination had higher serum tHcy.