Effects of Repetitive Facilitative Exercise on Spasticity in the Upper Paretic Limb After Subacute Stroke.
Repetitive facilitative exercise is an effective method for recovery of the affected limb in stroke patients. However, its effects on spasticity are unknown. We aimed to determine the effects of repetitive facilitative exercise on spasticity using the Modified Ashworth Scale (MAS) and the F-wave, and to determine the relationship between the changes in spasticity and functional recovery of the hemiplegic upper limb. Subacute stroke patients underwent repetitive facilitative exercise (n = 11) or conventional rehabilitation (n = 8) for 4 weeks. We investigated spasticity and functional recovery in a hemiplegic upper limb retrospectively. The MAS, F-wave, Fugl-Meyer Assessment (FMA), and the Action Research Arm Test (ARAT) were assessed immediately before and after the 4-week session. Repetitive facilitative exercise did not change the MAS and decreased F persistence and the F amplitude ratio, and improved both the FMA and the ARAT for the affected upper limb. The reduction of F-wave parameters was not correlated with the improvements in the FMA and ARAT in the repetitive facilitative exercise group. Conventional rehabilitation had no effect on the MAS, F-wave parameters, FMA, or the ARAT. Repetitive facilitative exercise decreases spinal motoneuron excitability and promotes functional recovery. However, there was no correlation between the change in spinal motoneuron excitability and the improvement of upper-limb function. The present results suggest that repetitive facilitative exercise is useful for treating spasticity in the subacute phase of stroke.


Maximum likelihood estimation of correction for dilution bias in simple linear regression using replicates from subjects with extreme first measurements.
The least-squares estimator of the slope in a simple linear regression model is biased towards zero when the predictor is measured with random error. A corrected slope may be estimated by adding data from a reliability study, which comprises a subset of subjects from the main study. The precision of this corrected slope depends on the design of the reliability study and estimator choice. Previous work has assumed that the reliability study constitutes a random sample from the main study. A more efficient design is to use subjects with extreme values on their first measurement. Previously, we published a variance formula for the corrected slope, when the correction factor is the slope in the regression of the second measurement on the first. In this paper we show that both designs improve by maximum likelihood estimation (MLE). The precision gain is explained by the inclusion of data from all subjects for estimation of the predictor's variance and by the use of the second measurement for estimation of the covariance between response and predictor. The gain of MLE enhances with stronger true relationship between response and predictor and with lower precision in the predictor measurements. We present a real data example on the relationship between fasting insulin, a surrogate marker, and true insulin sensitivity measured by a gold-standard euglycaemic insulin clamp, and simulations, where the behavior of profile-likelihood-based confidence intervals is examined. MLE was shown to be a robust estimator for non-normal distributions and efficient for small sample situations.


Impaired insulin signaling upon loss of ovarian function is associated with a reduction of tristetraprolin and an increased stabilization of chemokine in adipose tissue.
Loss of ovarian function can activate inflammation and lead to insulin resistance (IR). IR is also a core feature of obesity and obesity-associated metabolic dysfunction. Tristetraprolin/zinc finger protein 36 (TTP) interferes with TNF-α production by destabilizing TNF-α mRNA, and mice deficient in TTP develop a complex syndrome of inflammatory disease (Carballo et al., 1998; Taylor et al., 1999). We hypothesized that ovariectomy (OVX) might also prime inflammation by reducing tristetraprolin/zinc finger protein 36 (TTP) levels. We used a mouse OVX model to study impaired insulin signaling due to loss of ovarian function by evaluating Akt activity upon insulin stimulus. Impaired insulin signaling was initially detected in adipose tissue (AT) at 4 weeks after OVX, and then spread to liver and muscle, finally resulting in systemic IR at 12 weeks after OVX. OVX decreased TTP protein levels and increased adipocyte size, oxidative stress, chemokine expression and fat mass in AT by 4 weeks after surgery. TTP deficiency due to TTP gene deletion induced aberrant insulin signaling and increased chemokine expression and macrophage numbers in AT but did not increase adipocyte size, oxidative stress, or fat mass, suggesting that it promotes insulin signaling by decreasing AT inflammation independent of oxidative stress and adiposity. OVX, like TTP deficiency, increased the stability of chemokine transcripts as assessed from their half-lives. Our data indicate that the impaired insulin signaling resulting from OVX is due to an OVX-induced reduction of TTP and the resulting stabilization of inflammatory chemokines.


Effects of hindbrain stimulation on lower esophageal sphincter pressure in the cat.
Lower esophageal sphincter (LES) pressure was measured in anesthetized cats during electrical stimulation of the dorsal motor nucleus of the vagus (DMV) and nucleus ambiguus (NA). Stimulation parameters were varied to determine maximal changes in LES pressure and upper gastrointestinal motor responses. LES pressure decreased significantly during DMV and NA stimulation. The LES preferentially was affected over other upper gastrointestinal locations. Bradycardia and increases in blood pressure occurred with stimulation of both nuclei. LES pressure changes could be demonstrated in the absence of other gastrointestinal responses by decreasing hindbrain stimulation parameters. Cervical vagotomy completely eliminated hindbrain stimulation-induced changes in LES pressure, upper gastrointestinal motor activity, and heart rate. Similar frequency-LES pressure response relationships were observed for DMV and NA stimulation, with maximum changes occurring at 25 Hz. Changes in LES pressure occurred at shorter stimulation pulses (0.05 vs. 0.5 ms) and at lower stimulating current strength (30 vs. 60 microA) during DMV as compared with NA stimulation. In addition, stimulation of areas adjacent to the DMV and NA also significantly altered LES pressure, indicating that a large portion of the cat hindbrain associated with the vagal motor nuclei is involved in LES pressure control.


Enhanced cerebral CO2 reactivity during strenuous exercise in man.
Light and moderate exercise elevates the regional cerebral blood flow by approximately 20% as determined by ultrasound Doppler sonography (middle cerebral artery mean flow velocity; MCA V(mean)). However, strenuous exercise, especially in the heat, appears to reduce MCA V(mean) more than can be accounted for by the reduction in the arterial CO(2) tension (P(a)CO(2)). This study evaluated whether the apparently large reduction in MCA V(mean) at the end of exhaustive exercise relates to an enhanced cerebrovascular CO(2) reactivity. The CO(2) reactivity was evaluated in six young healthy male subjects by the administration of CO(2) as well as by voluntary hypo- and hyperventilation at rest and during exercise with and without hyperthermia. At rest, P(a)CO(2) was 5.1 +/- 0.2 kPa (mean +/- SEM) and MCA V(mean) 50.7 +/- 3.8 cm s(-1) and the relationship between MCA V(mean) and P(a)CO(2 )was linear (double-log slope 1.1 +/- 0.1). However, the relationship became curvilinear during exercise (slope 1.8 +/- 0.1; P < 0.01 vs. rest) and during exercise with hyperthermia (slope 2.3 +/- 0.3; P < 0.05 vs. control exercise). Accordingly, the cerebral CO(2) reactivity increased from 30.5 +/- 2.7% kPa(-1) at rest to 61.4 +/- 10.1% kPa(-1) during exercise with hyperthermia (P < 0.05). At exhaustion P(a)CO(2) decreased 1.1+/- 0.2 kPa during exercise with hyperthermia, which, with the determined cerebral CO(2) reactivity, accounted for the 28 +/- 10% decrease in MCA V(mean). The results suggest that during exercise changes in cerebral blood flow are dominated by the arterial carbon dioxide tension.


Application of an indirect fluorescent antibody assay for the detection of African horse sickness virus antibodies.
An indirect fluorescent antibody (IFA) technique was used to screen and quantify antibodies against African horse sickness virus (AHSV) in equine sera. Results obtained with the IFA assay were compared directly with those obtained with standard complement fixation (CF) and virus neutralisation (VN) tests using horse sera from experimental studies and samples from the field. Positive fluorescent antibody titres were detected from as early as 7 days after primary vaccination and persisted for at least six months. The IFA technique offers a clear advantage over CF tests, where the antibodies are often of shorter duration and where sera from donkeys and mules are frequently anticomplementary. The sensitivity and specificity of the IFA test compared with the VN test were 98% and 83.3%, respectively. The IFA test is rapid, relatively easy to perform and inexpensive, and can be recommended as an alternative assay for screening different species of equidae in AHSV control and surveillance programmes.


Meat quality assessment from young goats fed for long periods with castor de-oiled cake.
Diet can influence both the qualitative and quantitative traits of ruminant meat. This study evaluated the effects of castor de-oiled cake on the meat of mixed-breed male goat kids. After 165days of diet treatment, no alterations (p>0.05) were observed in the in vivo performance, anatomic components, dissection and proximate composition of the Longissimus dorsi muscle, as well as in the color and pH of the carcasses. However, diet had an effect (p<0.05) on energy metabolites, fatty acid profile, and expression of certain proteins of the Longissimus dorsi muscle. To conclude, this study showed that the establishment of castor de-oiled cake diet for a long period to goats led to alterations in meat quality, without compromising its consumption qualities.


Cobalt-complexed conjugated diyne salts: a family of rigid masked dielectrophiles. Syntheses, structures, and double nucleophilic substitutions.
A family of dicationic diyne salts of the general formula [(Co2(CO)6)2-mu,eta2,eta2-(Nu-CH2C(triple bond)C-C(triple bond)CCH2-Nu)][BF4]2 [Nu = SMe2 (3); Nu = NC6H7, 3-picoline, (5); Nu = NC9H7, quinoline (7)] were prepared and fully characterized. Three X-ray molecular structures of 3, 5, and the neutral starting material 2,4-hexadiyne-1,6-diol complex [(Co2(CO)6)2-mu,eta2,eta2-(HO-CH2C(triple bond)C-C(triple bond)CCH2-OH)] (1) are presented. Complex 1 crystallizes in the triclinic space group P1 with a = 14.722(2) A, b = 14.571(3) A, c = 14.722(2) A, alpha = 105.17(1) degrees, beta = 113.30(1) degrees, gamma = 99.20(1) degrees, and Z = 4. Complex 3 crystallizes in the monoclinic space group P2(1)/n with a = 12.758(3) A, b = 13.360(3) A, c = 20.494(3) A, beta = 91.44(1) degrees, and Z = 4, and compound 5 also crystallizes in the monoclinic space group P2(1)/n with a = 9.426(2) A, b = 21.739(5) A, c = 18.704(3) A, beta = 94.86(1) degrees, and Z = 4. The X-ray structures provide us with valuable information on the arrangement of the Co2-alkyne units, which have a cis geometry and are in sharp contrast to that observed generally for diyne-tetracobalt compounds. Complex [(Co2(CO)6)2-mu,eta2,eta2-(Me2S-CH2C(triple bond)C-C(triple bond)CCH2-SMe2)][BF4]2 (3) reacts with N-, S-, and P-centered nucleophiles and affords the related substituted complexes in high yields. The stability and reactivity of the disulfonium diyne complex 3 toward nucleophiles are compared to those of the analogous disulfonium-yne complex [(Co2(CO)6)2-mu,eta2,eta2-(Me2S-CH2-C(triple bond)C-CH2-SMe2)][BF4]2 (4).


[Antimicrobial activities of cefteram against recently clinically detected and isolated strains from patients with dental infections].
To investigate the antibiotic activity of cefteram (CFTM), the minimum inhibitory concentrations (MICs) of CFTM and of the control drugs were determined against clinically isolated strains received from November 1991 to April 1993 from 19 dental facilities throughout the country, as well as against clinically isolated strains from samples obtained at this center from patients with dental infectious diseases, and the following results were obtained. 1. 430 strains were detected in 198 cases but identified strains amounted to 425. They are comprised of 204 strains of oral streptococci (48.0%), 81 strains of Peptostreptococcus spp. (19.1%), 10 strains of Bacteroides spp. (2.4%), 23 strains of Prevotella spp. (5.4%), and 9 strains of Porphyromonas spp. (2.1%). The ratios of Gram-positive bacteria v.s. Gram-negative bacteria were 78.4% and 21.6%, respectively, and the Gram-positive bacteria were isolated at higher frequency than Gram-negative bacteria. 2. The MIC90's of CFTM against oral streptococci and Peptostreptococcus spp. were 0.10 microgram/ml and 0.05 microgram/ml, and year to year increases of incidences of resistance against CFTM were not observed. Some strains, however, appeared to have obtained resistance to CFTM. 3. Among Bacteroides spp., Prevotella spp., Porphyromonas spp. which used to belong to genus Bacteroides, there were some strains resistant to CFTM. As a whole, however, no year to year increases in the incidence of CFTM resistance among these strains also. 4. Two strains of 6 Staphylococcus aureus subsp. aureus were methicillin-resistant. 5. The above observations indicate that CFTM still shows strong antimicrobial activity against clinically isolated strains that may be involved in dental infections.


Hospital care of acute nonvariceal upper gastrointestinal bleeding: 1991 versus 1981.
Developments important to the care of upper gastrointestinal (UGI) bleeding occurred in the 1980s. We compared the features, care, and outcome of patients hospitalized with acute nonvariceal UGI bleeding in 1991 (n = 216) and 1981 (n = 105). Most patient characteristics and the hemoglobin values were similar. Final diagnoses differed, mainly because there were more peptic ulcers and fewer unknown diagnoses in 1991. More patients had endoscopy in 1991 (94%); 92% of endoscoped patients had the procedure within 24 h of admission. The hospital stay of patients without surgery or comorbidity in 1991 was 2.8 +/- 0.1 days, significantly shorter than that in 1981. In 1991 only one half of patients received blood transfusion. The hemoglobin values before transfusion (7.2 +/- 0.1 g%) and at discharge (9.8 +/- 0.1 g%) were lower in 1991; transfused patients received similar amounts of blood in the 2 years. Endoscopic hemostatic therapy was used in 25% of patients with ulcers in 1991 and in none in 1981. Rates of rebleeding (including patients readmitted for recurrent bleeding within 1 week of discharge) and surgery were similar. Mortality was 2.8% in 1991, similar to the 1981 death rate. Because of the excellent 1991 patient outcome, we continue to care for most patients with acute nonvariceal UGI bleeding with urgent endoscopy and short hospitalization.


Fractionation of bovine serum albumin and monoclonal antibody alemtuzumab using carrier phase ultrafiltration.
Protein transmission and hence selectivity of separation can be significantly affected by solution pH and ionic strength in protein fractionation using ultrafiltration. Using parameter scanning ultrafiltration, the transmission of bovine serum albumin (BSA) and monoclonal antibody alemtuzumab (Campath-1H) through 300 kDa polyethersulfone (PES) ultrafiltration membranes were studied over a range of pH and salt concentrations, with focus on the likely conditions for achieving "reverse selectivity," i.e., obtaining purified alemtuzumab (approximately 155 kDa) in the permeate. Experimental results demonstrate that the reverse selectivity could be obtained by manipulating the operating conditions such as the solution pH, ionic strength, permeate flux, and system hydrodynamics. With a two-stage batch ultrafiltration process under suitable conditions, the monoclonal antibody alemtuzumab with a purity of > 98% was obtained in the permeate from a feed solution initially containing 0.50 g/l each of BSA and alemtuzumab. Further purity can be expected by selecting more suitable membranes and optimizing operating conditions.


Causes of nephrotic syndrome and nephrotic-range proteinuria are different in adult Chinese patients: A single centre study over 33 years.
The reported causes of nephrotic syndrome (NS) varies between different countries. Less is known about the causes of nephrotic-range proteinuria (NPU). We aimed to evaluate the underlying causes of NS and NPU. This was a single-centre, retrospective study of adult patients who underwent renal biopsy between 1983 and 2015 in a tertiary referral hospital in Hong Kong. We determined the distribution of histopathological diagnoses with regard to the age subgroups and time periods. Among 7456 patients who underwent renal biopsy, 982 and 838 patients had NS and NPU, respectively. The most common diagnosis in NS was minimal change disease (MCD) (33.3%), followed by membranous nephropathy (MN) (23.6%) and lupus nephritis (LN) (12.8%); whereas the most common diagnosis in NPU was LN (27.4%), followed by immunoglobulin A nephropathy (IgAN) (21.4%) and diabetic nephropathy (DN) (9.3%). In the NS group, MCD was the most common diagnosis in young adults while MN was the leading cause in the elderly. On the other hand, LN was the most common pathology in the NPU group until the age of 60. Over the past three decades, there was a trend of decrease in the proportion of IgAN in both NS and NPU group, while a combined pathology of hypertensive nephrosclerosis and diabetic nephropathy (HTNS and DN) increased significantly. The causes of NS and NPU in Chinese adults were different and may represent two distinct pathological identities. The spectrum of renal histopathology among these two groups changed significantly over time.


Factors associated with the postoperative status of donor patients for living donor liver transplantation.
Deceased donor liver transplantation has been an established surgical procedure since the 1960s. More recently, the technique of living donor liver transplantation (LDLT) was introduced, and it is being performed with increasing frequency. However, there is a paucity of information on the clinical outcomes of donor patients. In this study, which was conducted at a single university hospital, the relationship between potentially relevant factors (eg, patient characteristics, preoperative status, and operation characteristics) and postoperative developments in donor patients was examined. We used electronic critical pathways, which are charts of medical process that include favorable states (defined as outcomes) to be achieved during the hospital stay of a patient; predefined outcomes that are not achieved are recorded as variances. With the electronic critical pathway system, objective data about the conditions of patients and relevant clinical processes could be collected readily. Using data from the electronic critical pathways for LDLT donor patients and applying multiple logistic regression analysis, we examined factors that were related to the variance of each outcome measure for postoperative developments. Among the various donor characteristics, the duration of the operation was related to variance in 5 types of health outcomes, age and blood loss volume were related to variance in 2 types of health outcomes, and other characteristics (ie, sex, body surface area, operation urgency, and volume ratio of the remnant liver) were related to variance in 1 type of health outcome. In conclusion, the findings in this study may facilitate improvements in the postoperative status of LDLT donor patients. Further studies that incorporate analogous data from other medical facilities are necessary to verify these findings.


Are the surgeons safe during UV-A radiation exposure in collagen cross-linking procedure?
To quantify the effect of scattered UV-A radiation used in the collagen cross-linking (CXL) procedure and the amount of radiation reaching the surgeon and the surrounding area and to estimate the dampening effect by various protective devices. In this case series, 3 patients [aged 25-30 (±2.5) years] with keratoconus underwent a CXL procedure with UV-A light and riboflavin. Irradiance was measured using a spectrometer (Model USB2000; Ocean Optics, Inc) for various distances from the source, at various angles, and for different durations of radiation. The spectrometer was also used to measure the dampening effect produced by gown, latex gloves, and UV-protective glasses. Maximum UV-A radiation (1.4 × 10(-9) mW/cm(2)) was measured at 2 cm from the limbus, when the probe was held at a 45-degree angle to the floor. UV-A radiation reaching the surgeon's eye and the abdomen was 3.403 × 10(-11) and 2.36 × 10(-11) mW/cm(2), respectively. Gown, latex gloves, and UV-protective glasses showed dampening effects of 99.58%, 95.01%, and 99.73%, respectively. CXL appears to be a safe procedure with respect to UV-A radiation exposure to the surgeon. Further safety can be ensured by UV-protective devices.


Focal therapy in prostate cancer: A review of seven common controversies.
Radical treatments such as prostatectomy and radiotherapy have demonstrated success in terms of biochemical and disease-specific survival for localised prostate cancer. However, whilst the end goal of any cancer treatment is to control or cure disease it must also do so by minimising any side effects that may be experienced by the patient. Focal therapy as a concept aims to redress this established therapeutic ratio by treating areas of the prostate affected by significant disease as opposed to treating the entire gland. However, there are a number of common criticisms of focal therapy - we deem the seven sins - that require further interrogation.


mRNA-expression of often used house-keeping genes and the relation between RNA and DNA are sex steroid-dependent parameters in human myometrium and fibroids.
The content of RNA and DNA in human myometrium and fibroids obtained at different endocrine conditions varied, with the highest RNA/DNA ratio in tissues from pregnant patients, intermediate ratios in women during the menstrual cycle and the lowest in tissues from postmenopausal and GnRHa-treated patients. mRNA expression of two house-keeping genes, gamma-actin and GAPDH, was highest in myometrium from pregnant women, intermediate in untreated women of fertile age and lowest in tissues from GnRHa-treated and postmenopausal women. To control for degradation of nucleic acids when measuring mRNA expression, we suggest additional analysis of gene(s), where the expression pattern is known, and that expression, whenever possible, is related to DNA, which is a more stable parameter than RNA and total nucleic acids, when there are differences in proliferation between tissues and/or groups of patients.


Transplantation of kidneys from HCV-positive donors: a safe strategy?
Hepatitis C Virus (HCV) infection is the most important cause of liver disease after renal transplantation (RT). The impact of HCV on patient and graft survival after RT remains controversial; however, the great majority of studies with large size and adequate follow-up have shown the detrimental impact of HCV on long-term patient and graft survival after RT. The use of kidneys from anti-HCV positive donors could help decrease the continuing disparity between the number of patients on the transplant waiting list and the number of patients receiving a transplant each year. Single-center experiences have suggested transplanting kidneys from anti-HCV positive donors only in anti-HCV positive dialysis patients. Such practice has not demonstrated any adverse effect on the short-term patient survival; the waiting times for RT were shortened. A better alternative seems to be a policy of transplanting kidneys from anti-HCV positive donors only in HCV RNA positive recipients. This requires HCV RNA testing of all anti-HCV positive dialysis patients awaiting RT. Matching donors and recipients for HCV genotype has been suggested; however, the assessment of donor HCV genotype is currently hampered by time constraints. Recent evidence based on large data base demonstrated that RT recipients of HCV-positive donors are at independent increased risk of mortality; unadjusted 3-year patient survival was 85% versus 93% (P=0.01) in all recipients of donor HCV-positive and HCV-negative kidneys, respectively. This was observed in all recipient subgroups including elderly and HCV-positive recipients. In the near future, rapid nucleic acid testing (NAT) of donors and recipients will allow the assessment of the HCV viremic status in order to maximize organ use. With appropriate informed consent, use of a renal graft from an HCV positive donor may be offered to an HCV infected recipient. Additional studies are needed to clarify the link between donor HCV-positive kidneys and patient mortality.


[Analysis of tick-host parasitic specificity. Evaluation of the Madagascar situation and intense samplings].
Ticks are traditionally considered being host-specific parasites. The pattern of tick-host relationship was elucidated by exhaustive collection from a considerable number of potential hosts from numerous sites in the Malagasy mid-altitude forest. It can from the findings be concluded that the Malagasy ticks found on small mammals may be distinguished as either having a broad host-specificity or being highly host-specific. The results may provide important information in respect to phylogenetic studies with regards to the geological history of Madagascar and its endemic fauna.


Platelet accumulation on fibrin-coated polyethylene: role of platelet activation and factor XIII.
Platelet accumulation on small- and medium-calibre vascular grafts plays a significant role in graft occlusion. We examined platelet accumulation on the surface of fibrin-coated polyethylene tubing (internal diameter 0.17 cm) during 10 min flow (10 ml/min) at high wall shear rate (764 s-1). Washed platelets labelled with 51Cr were resuspended in Tyrode solution containing albumin, apyrase and red blood cells (hematocrit 40%). When the thrombin that was used to form the fibrin-coated surface was inactivated with FPRCH2Cl before perfusion of the tubes with the platelet: red blood cell suspension, the accumulation of platelets was 59,840 +/- 27,960 platelets per mm2, whereas accumulation on fibrin with residual active thrombin was 316,750 +/- 32,560 platelets per mm2 (n = 4). When the fibrin on the surface was cross-linked by including recombinant factor XIII (rFXIII) in the fibrinogen solution used to prepare the fibrin-coated surface, platelet accumulation, after thrombin neutralization, was reduced by the cross-linking from 46,974 +/- 9702 to 36,818 +/- 7964 platelets per mm2 (n = 12, p < 0.01). Platelet accumulation on tubes coated with D-dimer was ten times less than on tubes coated with D-domain; this finding also supports the observation that cross-linking of fibrin with the formation gamma-gamma dimers reduces platelet accumulation on the fibrin-coated surface. Thrombin-activated platelets themselves were shown to cross-link fibrin when they had adhered to it during perfusion, or in a static system in which thrombin was used to form clots from FXIII-free fibrinogen in the presence of platelets.(ABSTRACT TRUNCATED AT 250 WORDS)


[Anesthesia and analgesia in obstetrics].
Anesthesia in obstetrics includes the medical attendance of women in the delivery room as well as giving anesthesia for cesarean sections in the operating room. Over the last years the treatment of labor pain with epidural anesthesia has been modified. Whereas a couple of years ago local anesthetics were used almost exclusively, the recent trend goes toward a combination of local anesthetics with opioids. Using this combination the total amount of local anesthetic can be greatly reduced, whilst maintaining most of the motor function during labor. There is evidence the combination of local anesthetics with opioids can reduce the number of operative vaginal deliveries such as vacuum extraction or forceps. The systemic application of opioids remains unaffected by the local application and its significance is unaltered, even though the effectiveness compared to epidural application in managing labor pain is far inferior. Opioids applied systemically often have an unwanted sedative effect in the mother and have the potential for respiratory depression in the newborn. The question, whether epidural anesthesia increases the frequency of cesarean sections remains to be answered. Studies so far present discrepant results and do not show a causal relationship between the use of epidural anesthesia and increase in cesarean section rate. Regarding cesarean sections, there has been a trend in the operative field over the last years towards the use of regional anesthesia. This is the consequence of the fact that anesthesia related mortality during cesarean sections is still mainly due to hypoxia and aspiration during induction of anesthesia. The advantage of spinal anesthesia over epidural anesthesia is faster onset, more reliable sensitive block and a lower failure rate. Downside of the use of spinal anesthesia is a higher incidence of hypotension in the mother, which, however, is not a serious complication if treated adequately. Regarding the continuous application of local anesthetics via a spinal catheter, no definite statements towards benefits compared to other regional techniques can be made due to the lack of adequate amount of patient studies. Theoretically this method seems advantageous as it allows to adjust the administration of local anesthetics and opioids to the individual needs in a very refined way. Emergency situations, such as emergency cesarean sections, life threatening hemorrhage, eclampsia, and HELLP syndrome, are the main risks of the anesthetic practice in obstetrics. Their beneficial outcome is highly dependent on the coordination of logistic problems, good communication and coordination within an interdisciplinary team of obstetricians and anesthesiologists.


Prosthetic reconstruction of a patient with an acquired nasal defect using extraoral implants and a CAD/CAM copy-milled bar.
Traditionally, patients with maxillofacial defects have been challenging to treat. A multitude of challenges associated with maxillofacial prosthetic treatment are not typically seen with patients who need conventional prosthodontic treatment. These types of patients generally require replacement of significant amounts of hard and soft tissues than do conventional prosthodontic patients. Most maxillofacial patients also warrant more emotional support than do conventional prosthodontic patients. Successful maxillofacial prosthetics still need to embrace the traditional goals of prosthodontic treatment: stability, support, retention, and esthetics. It is unlikely that a maxillofacial prosthesis will exactly duplicate the anatomy and function of missing or damaged structures. Although craniofacial implants (CFI's) have lower cumulative survival rates (CSR's) than intraoral endosseous implants, osseointegrated CFI's have proven to be significant adjuncts to improving retention of maxillofacial prostheses. However, CSR's of CFI's have been reported to be lower than CSR's for intraoral endosseous implants. Lately, computer-assisted design and computer-assisted machining (CAD/CAM) has been used in dentistry to facilitate fabrication of implant-supported frameworks. CAD/CAM protocols have numerous advantages over conventional casting techniques, including improved accuracy and biocompatibility, and decreased costs. The purpose of this paper is to review the literature on cumulative survival rates (CSR's) reported for CFI's and to illustrate the treatment of a maxillofacial patient using CFI's and a CAD/CAM copy-milled framework for retention and support of a nasal prosthesis.


Green Synthesis of Red-Emitting Carbon Nanodots as a Novel "Turn-on" Nanothermometer in Living Cells.
Temperature measurements in biology and medical diagnostics, along with sensitive temperature probing of living cells, is of great importance; however, it still faces significant challenges. Herein, a novel "turn-on" carbon-dot-based fluorescent nanothermometry device for spatially resolved temperature measurements in living cells is presented. The carbon nanodots (CNDs) are prepared by a green microwave-assisted method and exhibit red fluorescence (λem =615 nm) with high quantum yields (15 %). Then, an on-off fluorescent probe is prepared for detecting glutathione (GSH) based on aggregation-induced fluorescence quenching. Interestingly, the quenched fluorescence could be recovered by increasing temperature and the CNDs-GSH mixture could behave as an off-on fluorescent probe for temperature. Thus, red-emitting CNDs can be utilized for "turn-on" fluorescent nanothermometry through the fluorescence quenching and recovery processes, respectively. We employ MC3T3-E1 cells as an example model to demonstrate the red-emitting CNDs can function as "non-contact" tools for the accurate measurement of temperature and its gradient inside a living cell.


Using the intrinsic chirality of a molecule as a label-free probe to detect molecular adsorption to a surface by second harmonic generation.
Chiral second harmonic generation (C-SHG) has been used for the label-free detection of (R)-(+)-1,1'-bi-2-naphthol (RBN) and (S)-(+)-1,1'-bi-2-naphthol (SBN) binding to planar-supported lipid bilayers of 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphotidylcholine (POPC) based on the intrinsic chirality of the molecules. C-SHG adsorption isotherms of RBN and SBN reveal Langmuir adsorption behavior with binding constants of 2.7 +/- 0.2 x 10(5) M(-1) and 3.0 +/- 0.1 x 10(5) M(-1), respectively. The kinetics of RBN binding to a POPC bilayer was also measured. It was determined that the adsorption rate for RBN was 5.7 +/- 0.4 x 10(3) s(-1)M(-1) and the desorption rate was 2.1 +/- 0.8 x 10(-2) s(-1). From the kinetic data a binding constant of 2.7 +/- 1.0 x 10(5) M(-1) was calculated, which agrees well with the thermodynamic measurement. The C-SHG technique was correlated with surface tension measurements in order to determine the RBN surface excess within the POPC membrane. The maximum surface excess of RBN in a monolayer of POPC was 4.3 +/- 0.5 x 10(-11) mol cm2. Using the maximum surface excess in conjunction with the C-SHG binding data a lower limit of detection of 1.5 +/- 0.1 x 10(-13) mols cm(-2) was calculated. The results of these studies show that C-SHG is a powerful tool for the study of chiral molecular interactions at surfaces.


Single-shot real-time characterization of chirped-pulse amplification systems by spectral phase interferometry for direct electric-field reconstruction.
We characterize chirped-pulse amplification systems by using spectral phase interferometry for direct electric-field reconstruction. For the first time to the authors' knowledge, single-shot real-time operation has been obtained for this technique, leading to a fast and accurate optimization of these systems.


A magnetic resonance software simulator for the evaluation of myocardial deformation estimation.
This paper proposes a methodology to design a physiologically realistic computer simulator of images of the left ventricle myocardium based on a patient-specific biomechanical model. The simulator takes a magnetic resonance image of a given patient at end diastole, uses a manual segmentation of that image to model the geometry of the myocardium and sets the parameters of the constitutive model used for biomechanical simulation according to a regional labeling of the contractility of the myocardium for that patient. The simulated deformations are used to warp the magnetic resonance dataset throughout the cardiac cycle to generate different image modalities. The simulator is validated by quantifying its ability to model actual deformations in a set of patients affected by an acute myocardial infarction. Specifically a high correlation has been encountered between the ejection fraction derived from the simulated end systolic deformation of the myocardium and the myocardium segmented from actual data. Additionally, most of the parameters that describe the simulated deformation compare well with reported values. Overall, the simulator is intended as a testbed for extensive comparisons of myocardial motion tracking methods due to its ability to relate the impaired myocardial function with the associated ventricular remodeling, a novel contribution in the literature of cardiac image simulators.


High resolution multimer analysis and the PFA-100 platelet function analyser can detect von Willebrand disease type 2A without a pathological ratio of ristocetin cofactor activity and von Willebrand antigen level.
The biological variability of von Willebrand factor and the variability in assays can make diagnosis and subclassification of von Willebrand disease (VWD) difficult. We describe a case series of four patients with a typical history of VWD and prolonged closure time in the platelet function analyser (PFA-100) but initially a normal ratio of ristocetin cofactor activity (VWF:RCo) to von Willebrand factor antigen levels (VWF:Ag) for whom further diagnostics verified VWD type 2A. For the initial VWD diagnostics we measured VWF:Ag, VWF:RCo, platelet aggregation induced by ADP, ristocetin and collagen, closure time in the PFA-100 test, and platelet count. We used VWF multimer analysis and collagen binding capacity for extended diagnostics. VWD diagnostics were carried out as part of extensive laboratory screening to exclude other haemostatic defects. Multimer analysis revealed the absence of ultralarge multimers in all 4 patients. Ristocetin-induced platelet aggregation was consistently diminished in three patients with hereditary VWD 2A but not in a patient with essential thrombocythaemia. After repeat testing, diminished VWF:RCo and collagen binding capacity (VWF:CB) could be identified in all patients. However, all four cases would have been missed if the initial VWD assays had been performed only once. A single measurement of a normal ratio of VWF:RCo/VWF:Ag does not exclude VWD 2A in patients with a typical history of VWD. The PFA-100 is suitable for screening. To ensure that no cases of VWD are missed, multimer analysis and repeat functional testing of platelet aggregation, VWF:RCo, and VWF:CB are necessary.


Safety and health in the petrochemical industry in Map Ta Phut, Thailand.
Petrochemical industries are known as sources of many toxic chemicals. Safety and health risks of the petrochemical workers employed at Map Ta Phut Industrial Estate, located in Rayong, Thailand, are potentially high. The research materials consisted of documents emanating from statutory reports on safety in working with toxic chemicals and the results of interviews by questionnaire among 457 petrochemical workers regarding occupational health and safety issues. Most of workers who were working with toxic chemicals had knowledge and awareness of health risks and chemical hazards at work. We found that safe behavior at work through read the safety information among operational workers less than non-operational workers around 10%. Most of workers had perceived occupational health and safety management in their companies. Some companies revealed that they had not been performing biological monitoring of blood or urine for their health examination reports and that workplace exposure monitoring had not correlated well with health examination of workers. Our study suggested that occupational health and safety for petrochemical industries requires standards and guidelines for workers' health surveillance aimed at protection of workers.


24 hour polysomnographic evaluation in a patient with sleeping sickness.
A 24 h polysomnographic recording was performed in a patient with sleeping sickness presenting an atypical neurological syndrome. Trypanosoma gambiense was found in a lymph gland puncture and the CSF, and a serologic immunofluorescence test was positive. The scoring technique of the polygraphic traces had to be adapted because of the presence of a permanent EEG delta wave activity during the NREM sleep stages, and the method used by Schwartz and Escande (1970) was applied. REM sleep and wakefulness presented normal polygraphic characteristics. The patient had 8 sleep episodes throughout the recording period, occurring during the daytime and at night, forming the classical diurnal sleepiness and nocturnal restlessness of sleeping sickness. All but one episode represented 1-3 complete REM-NREM sleep cycles. On all occasions, REM latency was short and 2 SOREM episodes were observed. The nychthemeral organization of the stages of vigilance differed from one state to another. Wakefulness and REM sleep had a circadian rhythmicity, while NREM sleep, total sleep time and deep sleep (corresponding to stages 3 and 4) had an ultradian periodicity. The concordance between the higher pressure for wakefulness and lower pressure for sleep around 20.00 h defined the time of occurrence of a 'forbidden zone' for sleep.


Visualizing blood flow patterns using streamlines, arrows, and particle paths.
A customized computer program (MRIView) is described for visualizing and quantifying complex blood flow patterns in major vessels, using nongated and cardiac-gated three-dimensional (3D) velocity data obtained with MR velocity-encoded phase pulse sequences. Streamlines, arrows, and particle paths (collectively referred to as "paths") can be computed interactively, using both forward and backward time integration of the velocity field. The program provides interactive cross-sectional and 3D perspective visualization of the paths, with quantification and statistical analysis of average speed, through-plane velocity, cross-sectional area, and flow. Normal flow patterns in the carotid artery, basilar artery tip, ascending aorta, coronary arteries, descending aorta, and renal arteries, as well as abnormal flow patterns in basilar tip aneurysms, have been investigated. The program revealed flow patterns in these regions with features that are well known from Doppler ultrasound and other features that have not been reported previously. The association between specific abnormal flow patterns and development of atherosclerosis suggests that particle paths can be used to assess risk of plaque formation and progression, as well as to evaluate flow dynamics and vascular patency before and after vascular interventions.


Epidemiology of HIV infection in multitransfused hemophilic patients in France. French Study Group in Hemophilia.
A total of 27 hemophilia centers treating patients all over France responded to a questionnaire about the progression of HIV infection in multitransfused patients. Information from 2,049 hemophilic patients was collected. The prevalence of HIV infection in French hemophiliacs was 48%, the same as the percentage in 1985, demonstrating that the methods of viral inactivation of concentrates and screening of blood donors are efficient. However, the number of patients with AIDS increased from 14 to 26 and patients dead from opportunistic infection from 47 to 14 in 1 year. There is also evidence of clinical symptoms of AIDS-related complex and biological symptoms of immunodeficiency in this population of seropositive French hemophiliacs.


The WD protein Rack1 mediates protein kinase C and integrin-dependent cell migration.
The scaffolding protein, Rack1, is a seven-WD-domain-containing protein that has been implicated in binding to integrin beta subunit cytoplasmic domains and to members of two kinase families (src and protein kinase C, PKC) that mediate integrin bidirectional signaling. To explore the role of Rack1 in integrin function we have transfected this protein in Chinese hamster ovary (CHO) cells. We have observed no effect of Rack1 overexpression on inside-out signaling as the ligand binding properties of CHO cells also expressing constitutively active or inactive integrins were not affected. In contrast, we observed that cells stably or transiently overexpressing Rack1 had decreased migration compared to mock transfected cells. Stable Rack1 transfectants also demonstrated an increased number of actin stress fibers and focal contacts. These effects on motility and cytoskeletal organization did not appear to result from Rack1 inhibition of src function as downstream substrates of this kinase were phosphorylated normally. In addition, expression of an active src construct did not reverse the migratory deficit induced by Rack1 overexpression. On the other hand when we overexpressed a Rack1 variant with alanine substitutions in the putative PKC binding site in its third WD domain, we observed no deficit in migration. Thus the ability of Rack1 to bind, localize and stabilize PKC isoforms is likely to be involved in aspects of integrin outside-in signaling.


Prevention by morphine of apomorphine- and oxytocin-induced penile erection and yawning: involvement of nitric oxide.
The possible involvement of nitric oxide in the prevention by morphine of apomorphine- and oxytocin-induced penile erection and yawning was investigated by measuring the concentration of NO2- and NO3- in the dialysate obtained with a vertical microdialysis probe implanted in the paraventricular nucleus of the hypothalamus of male rats. Either apomorphine (80 micrograms/kg s.c.) or oxytocin (30 ng i.c.v.) increased significantly basal NO2- and NO3- concentration in the paraventricular dialysate, penile erection and yawning. Morphine (1.5 and 10 mg/kg i.p.) prevented dose-dependently either apomorphine or oxytocin responses when given 15 min before apomorphine or oxytocin. Prevention by morphine of apomorphine and oxytocin responses was abolished by naloxone (3 mg/kg i.p.) given 15 min before morphine. Morphine prevented apomorphine and oxytocin responses also when given in the lateral ventricles or directly in the paraventricular nucleus. In contrast, the selective agonist of the kappa opioid receptor subtype U-69,593 was found to be ineffective. The present results confirm previous findings showing that morphine acts through mu receptors in the paraventricular nucleus to prevent apomorphine and oxytocin-induced penile erection and yawning and suggest that this morphine effect is mediated by a decreased activity of nitric oxide in the paraventricular nucleus of the hypothalamus.


2D-QSAR and 3D-QSAR simulations for the reaction rate constants of organic compounds in ozone-hydrogen peroxide oxidation.
Synergistic oxidation of ozone (O3) and hydrogen peroxide (H2O2) is an effective water treatment for the elimination of organic pollutants. In this study, 23 organic compounds were conducted to study the reaction rate constants during O3-H2O2 oxidation. Then, two- and three-dimensional quantitative structure-activity relationship (QSAR) models were established to investigate the factors influencing the reaction rate constants by using multiple linear regression method and comparative molecular similarity index analysis (CoMSIA) method, respectively. Both of the two models showed good performance on predicting the reaction rate constants, the associated statistical indices of 2D-QSAR and 3D-QSAR models were R2 = 0.898 and 0.952, q2 = 0.841 and 0.951, Qext2 = 0.968 and 0.970, respectively. But varied in the influence factors, as for the 2D-QSAR model, three quantum chemical parameters, included dipole moment, the largest change of charge in each atom during the nucleophilic attack, the maximum positive partial charge on a hydrogen atom linked with a carbon atom affected the reaction rate. While in the 3D-QSAR model, the electrostatic field played the most important role in evaluating the reaction rate with the contribution of 35.8%, followed by hydrogen bond acceptor and hydrophobic fields with the contribution of 24.9% and 23.2%, respectively. These two models provided predictive tools to study the influencing factors for the degradation of organics and might potentially be applied for estimating the removal properties of unknown organics in O3-H2O2 oxidation process.


Tight control of platelet-derived growth factor B/c-sis expression by interplay between the 5'-untranslated region sequence and the major upstream promoter.
The long and GC-rich 5'-untranslated region (5'-UTR) of the known 3.8-kb platelet-derived growth factor B (PDGF-B)/c-sis mRNA is highly conserved and inhibits its own translation. It has been thought that this 5'-UTR functions by regulating translation possibly using an internal ribosome entry site (IRES)-mediated mechanism. However, in the present study we found no evidence that the 5'-UTR sequence of PDGF-B mRNA contains any IRES activity. Instead, we found that the 5'-UTR sequence of PDGF-B functions as a promoter both constitutively and upon induction in a variety of cell lines. The 5'-UTR sequence contains two promoters (termed P1 and P2) when only the 5'-UTR sequence is analyzed. In the presence of the upstream TATA-box-containing promoter (P0), P1 and P0 promoters are integrated into one promoter, whereas the P2 promoter still functions. The full promoter with combined P0, P1, and P2 produced two transcripts, with the major one having the full-length 5'-UTR and the minor one the short 5'-UTR. The integrated P0/P1 promoter and P2 promoter are likely responsible for producing the endogenous 3.8- and 2.8-kb PDGF-B mRNAs that are detected in cultured human renal microvascular endothelial cells, a few tumor cells, and rat brain tissues. Furthermore, we detected the 2.8-kb PDGF-B mRNA in erythroleukemia K562 cells upon 12-O-tetradecanoylphorbol-13-acetate-induced differentiation. Considering that the 5'-UTR in the 3.8-kb mRNA contains no IRES activity and inhibits cap-dependent translation, we believe that the endogenous 2.8-kb mRNA produced from the 5'-UTR promoter is likely the major template responsible for protein production both constitutively and upon induction. We also found that the transcription from the 5'-UTR P2 promoter might be coordinated by the major upstream P0 promoter upon stimulation. Based on these observations, we propose that the TATA-containing P0 promoter and the 5'-UTR promoter work together to tightly control the expression of PDGF-B.


[Three-dimensional excitation emission matrix fluorescence spectroscopic characterization of loosely bound and tightly bound extracellular polymeric substances of sludge].
Three-dimensional excitation emission matrix fluorescence spectroscopy (3DEEM)was applied to characterize the loosely bound extracellular polymeric substances (LB-EPS) and tightly bound extracellular polymeric substances (TB-EPS) extracted from aerobic sludge in wastewater treatment. The results showed that three fluorescence peaks were identified in threedimensional excitation emission matrix fluorescence spectra of the LB-REPS and TB-EPS: peak B (lamda ex/ lamda em = 270-280 nm/345-360 nm), peak C (lamda ex/ lamda em = 330-340 nm/410-430 nm)and peak D (lamda ex/ lamda em = 390 nm/450-470 nm). The peak B was attributed to the protein-like fluorophores, peak C to the visible fulvic-like fluorophore and peak D to the humic-like fluorophore. Results of the peak intensity showed that the major component of the LB-EPS and TB-EPS is protein-like organic matter, then followed by (from high to low): fulvic-like organic matter and humic-like organic matter. The effects of both pH and concentration were significant to the 3DEEMs of LB-EPS and TB-EPS, but the degree is not the same. LB-EPS has the particular chemical structures which are different from the TB-EPS.


Drilling the near cortex with elongated figure-of-8 holes to reduce the stiffness of a locking compression plate construct.
To compare the stiffness of locking compression plate (LCP) constructs with or without drilling the near cortex with elongated figure-of-8 holes. 24 synthetic bones were sawn to create a 10-mm gap and were fixed with a 9-hole 4.5-mm narrow LCP. In 12 bones, the near cortex of the adjacent holes to the LCP holes was drilled to create elongated figure-of-8 holes before screw insertion. The stiffness of LCP constructs under axial loading or 4-point bending was assessed by (1) dynamic quasi-physiological testing for fatigue strength, (2) quasi-static testing for stiffness, and (3) testing for absolute strength to failure. None of the 24 constructs had subcatastrophic or catastrophic failure after 10 000 cycles of fatigue loading (p=1.000). The axial stiffness reduced by 16% from 613±62 to 517±44 N/mm (p=0.012) in the case group, whereas the bending stiffness was 16±1 Nm2 in both groups (p=1.000). The maximum axial load to catastrophic failure was 1596±84 N for the control group and 1627±48 N for the case group (p=0.486), whereas the maximum bending moment to catastrophic failure was 79±12 and 80±10 Nm, respectively (p=0.919). Drilling the near cortex with elongated figure-of-8 holes reduces the axial stiffness of the LCP construct, without compromising its bending stiffness or strength.


Toward off-the-shelf adoptive T cell therapies.
Artificial thymic organoids may enable more efficient engineered T cell production for immunotherapy.


[Biorhythms and disorders of heart rhythm].
Several factors are involved in the development of derangements of the rhythm of the heart. The role of some of them in the genesis of arrhythmias has not been fully elucidated as yet. It is still an enigma why some individuals develop derangements of the heart rhythm while others fail to do so under apparently equal conditions. Information on the value of biorhythms and their relevance to the development and course of arrhythmias is scarce and even controversial. Insight into these relationships and elucidation of the rhythmic nature of derangements of heart rhythm could be of great value in their prevention and treatment as well as in the prevention of sudden death.


Calcium-triggered short-coupled polymorphous ventricular tachycardia.
We describe a case of an 18-year-old man presenting with syncope found to have short-coupled premature ventricular complexes (PVCs) with subsequent nonsustained polymorphous ventricular tachycardia (PVT). Electrophysiology testing revealed premature PVCs and PVT provoked by calcium but not isoproterenol. It was noted that the earliest triggered event appeared to arise from ventricular muscle with subsequent involvement of the fascicles and these areas were ablated. The potential mechanisms for calcium triggering of these arrhythmias are discussed.


Cleft lip and palate repair: the experience from two West African sub-regional centres.
Compliance with primary surgical treatment in people with cleft lip and palate is a well-known problem, especially in developing countries fraught with poverty and ignorance. Different protocols of treatment exist. In this paper, we retrospectively review a cohort from two centres, with a discussion on the outcome and its implications. The records of all patients with cleft lip and palate seen in the National Orthopaedic Hospital, Enugu, Nigeria, from January 1993 to December 1999, were sought, and all available case notes reviewed retrospectively. This included new cases seen in the period, and also cases operated during this period. Follow up took place until January 2005, when the data were collated. The records of all such patients seen at Ladoke Akintola University Teaching Hospital Osogbo, Nigeria, from September 2004 to June 2006 were also collated and analysed. During this period, 102 patients were seen (93 at Enugu and nine at Osogbo). Fifteen had isolated cleft palate, 42 had isolated cleft lip and 45 had combined cleft lip and palate. Presentation time ranged from 1 day to 43 years. The palate was not repaired in 20 people after lip repair; two patients with cleft lip and palate completely defaulted; and only one person with isolated cleft palate failed to undergo surgery in this period. Two patients in Osogbo absconded. The West African sub-region has a high drop out rate after lip repair.


GAP-43 in adult visual cortex.
GAP-43 was purified from cat brain by a rapid isolation procedure and was used to raise highly specific polyclonal antibodies in rabbits. Immunoblots of proteins from adult cat, monkey and human visual cortex as well as bovine cortex also showed specific staining of a single protein that was present in both soluble and membrane fractions. Immunocytochemistry of both cat and human adult visual cortex showed that GAP-43 has a laminar distribution.


Studies of the inner life: the impact of spirituality on quality of life.
This article defines spirituality and relates the importance of spirituality to understanding quality of life. Spirituality is examined through organizational religious activities, non-organizational activities and/or as an expression of faith. Spirituality as a variable in the study of quality of life is not a new concept; however, it has returned to the scene during recent years, and has gone through an evolutionary process.


Distribution of chloroquine and its metabolite desethyl-chloroquine in human blood cells and its implication for the quantitative determination of these compounds in serum and plasma.
The amount of chloroquine and desethyl-chloroquine was determined in samples of total blood and in blood cell fractions from three normal subjects after one oral dose of 1000 mg of chloroquine diphosphate. About 70-85% of the total whole blood content of chloroquine and its metabolite desethyl-chloroquine were recovered in blood cells isolated from whole blood, indicating that these compounds have a high cell/plasma concentration ratio. They were mainly present in thrombocytes and granulocytes. A study of 40 patients taking chloroquine regularly as a treatment for rheumatoid arthritis showed significantly higher concentrations of chloroquine and desethyl-chloroquine in serum than in plasma. The concentration of chloroquine was about two times higher in serum than in plasma and for desethyl-chloroquine the concentration was about four times higher in serum than in plasma. These differences may be explained by a release of chloroquine and desethyl-chloroquine from thrombocytes during the coagulation of blood. The practical implication of the results is that the samples taken for chloroquine determination must be clearly identified as serum or plasma.


Prenatal diagnosis of genodermatoses: current scope and future capabilities.
The genodermatoses encompass a range of inheritable skin diseases that may be associated with significant mortality and long-term morbidity. In the past, options for prenatal diagnosis of these diseases were limited to fetal skin biopsy. As a result of recent leaps made in genetics and molecular biology, DNA-based prenatal diagnosis is now available for an increasing number of genodermatoses, and newer non-invasive methods are being developed that have the potential for tremendous future impact in dermatology. Dermatologists caring for patients with genodermatoses should be aware of the options for screening and prenatal testing and partake in a multi-disciplinary approach to patient care.


Asymptomatic familial colon cancer with FDG-PET scanning for recurrent disease.
A 57-yr-old female was referred for screening colonoscopy because of a positive family history of colon cancer. A lobulated tumor mass was detected in the sigmoid colon. The resected specimen showed an invasive adenocarcinoma without lymph node involvement. Later colonoscopic evaluations and CT imaging failed to reveal definite evidence of recurrent disease but a late rising carcinoembryonic antigen level led to FDG-PET scanning and the detection of suspect lymph nodes in the retroperitoneum. Further histopathological and immunohistochemical evaluation of resected lymph nodes confirmed metastatic carcinoma from the primary colon carcinoma with extra-nodal spread. This case underscores the ongoing need for additional evidence-based studies on evolving imaging modalities used in the diagnosis and management of colonic cancer.


Accuracy of spin-component scaled ADC(2) excitation energies and potential energy surfaces.
In a recent paper of this Journal (Tajti and Szalay, JCTC 2019, 15, 5523) we have shown that failures of the CC2 method to describe Rydberg excited states, as well as potential energy surfaces of certain valence excited states can be cured by spin- component scaled (SCS) versions SCS-CC2 and SOS-CC2 by a large extent. In this paper, the related and popular Second Order Algebraic Diagrammatic Construction (ADC(2)) method and its SCS variants are inspected with the previously established methodology. The results reflect the similarity of the CC2 and ADC(2) models, showing identical problems in the case of the canonical form and the same improvement when spin-component-scaling is applied.


Hemolytic anemia, recurrent metabolic acidosis, and incomplete albinism associated with glutathione synthetase deficiency.
The clinical and laboratory features of a 3-mo-old black male infant with glutathione (GSH) synthetase deficiency of the generalized type was evaluated. Partial albinism, brisk hemolytic anemia, recurrent febrile episodes, and mental retardation were noted. Also, severe recurrent metabolic acidosis and marked oxoprolinemia and oxoprolinuria were found in the proband but not in his first-degree relatives. The relationship of these disease manifestations to the underlying metabolic defect is discussed.


Computer simulation of occlusal discrepancies resulting from different mounting techniques.
The effect of arbitrary mounting of maxillary casts on occlusal relationships was investigated in this study. Maxillary casts of 31 volunteers were mounted on an articulator by use of two split cast bases. This mounting was done first with the arbitrary face bow and second with a hinge bow. Three reference points were defined and measured on each maxillary cast with a three-dimensional digitizer. The measurements were taken from the arbitrarily mounted cast and from the cast mounted according to the hinge axis. Opening and closing movements that were transferred according to the hinge axis. Opening and closing movements that were transferred from the articulator to the mouth of the patient were simulated by a computer based on measurements of the reference points. The results revealed that the use of an arbitrary face bow causes a deviation of the hinge-axis points from the precise axis of more than 5 mm in 77% of the cases. Resulting occlusal errors depended on the angles between the arbitrary and precise axes and the direction of the axis shifts. The occlusal error is roughly proportional to the shift or tilting of the hinge axis in millimeters or degrees. For a given deviation of the arbitrary and precise axes, the occlusal error is proportional to the record height. For a record height of 2 mm or more, an occlusal error of more than 0.1 mm will occur. An average occlusal error of more than 0.1 mm would most likely lead to the necessity of extensive selective grinding of occlusal discrepancies in the patient's mouth.


Efferent connections of the substantia nigra and ventral tegmental area in the rat.
Small injections of tritiated leucine and proline confined to the ventral tegmental area (AVT) were found to label fibers ascending: (a) to the entire ventromedial half of the striatum, but most massively to the ventral striatal zone that includes the nucleus accumbens; (b) to the thalamus: lateral habenular nucleus, nuclei reuniens and centralis medius, and the most medial zone of the mediodorsal nucleus; (c) to the posterior hypothalamic nucleus and possibly the lateral hypothalamic and preoptic region; (d) to the nuclei amygdalae centralis, lateralis and medialis; (e) to the bed nucleus of the stria terminalis, the nucleus of the diagonal band, and the medial half of the lateral septal nucleus; (f) to the anteromedial (frontocingulate) cortex; and (g) to the entorhinal area. Further AVT efferents descend to the medial half of the midbrain tegmentum including an anterior region of the median raphe nucleus, to the ventral half of the central grey substance including the dorsal raphe nucleus, to the parabrachial nuclei, and to the locus coeruleus. Similar injections centered in the pars compacta of the substantia nigra (SNC) label fibers that are distributed in the striatum in an orderly medial-to-lateral arrangement, and almost entirely avoid the nucleus accumbens and olfactory tubercle. With the exception of the lateral quarter of the substantia nigra, which apparently does not project to the extreme rostral pole of the striatum, each small SNC locus, regardless of its anteroposterior localization, distributes nigrostriatal fibers throughout the length of the striatum. Descending SNC efferents are distributed to the same general regions that receive descending AVT projections, except that no SNC fibers appear to enter the locus coeruleus. Isotope injections confined to the pars reticulata (SNR) label sparse nigrostriatal fibers, and numerous nigrothalamic fibers ascending mainly to the nucleus ventromedialis and in lesser number to the parafascicular nucleus and the paralamellar zone of the nucleus mediodorsalis. Descending SNR fibers leave the nigra as a voluminous fiber bundle that bifurcates into a large nigrotectal and a smaller nigrotegmental component, the latter terminating largely in the pedunculopontine nucleus of the pontomesencephalic tegmentum.


Clinical study of ganglioside (GM) combined with methylprednisolone (MP) for early acute spinal injury.
This paper aims to make an analysis of the effects of ganglioside (GM) combined with methylprednisolone (MP) in early acute spinal injury. Fifty-three patients with acute spinal cord injury were included in this study and they were randomly divided into experimental and control group. Twenty-seven patients in the control group were treated with MP, while the rest 26 patients received more GM based on that. By observing and comparing the clinical responses from patients and recovery time of all indexes, results came out: the curative rates in the experimental and control group were 50.0%, 40.7% respectively, and the total effective rates were 92.3%, 85.2% respectively. There was a remarkable difference between the two groups (P<0.05). Patients in the experimental group took 6.2 ± 1.9d to restore their sphincter function, 11.2 ± 2.8d to recover their muscle forces to over grade II, and 13.8 ± 3.9d to return general activity, while the patients in the other group clearly spent longer time on recovery, that were 12.1 ± 3.2, 19.2 ± 4.6 and 23.9 ± 5.6 respectively. The distinct difference between the two groups was of statistical significance (P<0.05). We conclude that GM has better curative effects than MP, for it is able to promote the recovery of nerve function for patients and greatly improve the prognosis.


The dating and interpretation of a Mode 1 site in the Luangwa Valley, Zambia.
Flake based assemblages (Mode 1) comprise the earliest stone technologies known, with well-dated Oldowan sites occurring in eastern Africa between ~2.6-1.7 Ma, and in less securely dated contexts in central, southern and northern Africa. Our understanding of the spread and local development of this technology outside East Africa remains hampered by the lack of reliable numerical dating techniques applicable to non-volcanic deposits. This study applied the still relatively new technique of cosmogenic nuclide burial dating ((10)Be/(26)Al) to calculate burial ages for fluvial gravels containing Mode 1 artefacts in the Luangwa Valley, Zambia. The Manzi River, a tributary of the Luangwa River, has exposed a 4.7 m deep section of fluvial sands with discontinuous but stratified gravel layers bearing Mode 1, possibly Oldowan, artefacts in the basal layers. An unconformity divides the Manzi section, separating Mode 1 deposits from overlying gravels containing Mode 3 (Middle Stone Age) artefacts. No diagnostic Mode 2 (Acheulean) artefacts were found. Cosmogenic nuclide burial dating was attempted for the basal gravels as well as exposure ages for the upper Mode 3 gravels, but was unsuccessful. The complex depositional history of the site prevented the calculation of reliable age models. A relative chronology for the full Manzi sequence was constructed, however, from the magnetostratigraphy of the deposit (N>R>N sequence). Isothermal thermoluminescence (ITL) dating of the upper Mode 3 layers also provided consistent results (~78 ka). A coarse but chronologically coherent sequence now exists for the Manzi section with the unconformity separating probable mid- or early Pleistocene deposits below from late Pleistocene deposits above. The results suggest Mode 1 technology in the Luangwa Valley may post-date the Oldowan in eastern and southern Africa. The dating programme has contributed to a clearer understanding of the geomorphological processes that have shaped the valley and structured its archaeological record.


Procleix Ultrio transcription-mediated amplification vs. serological blood screening in south-western Greece.
We present here our overall experience after 27 months of performance of the Procleix Ultrio [HIV-1, hepatitis C virus (HCV), hepatitis B virus (HBV)] transcription-mediated amplification (TMA) assay. The aim of this report is to assess the impact of nucleic acid testing (NAT) implementation in blood screening of south-western Greek blood donors. We processed 38,264 units of blood as neat samples with the Procleix Ultrio TMA assay (Chiron/GenProbe, Emeryville/San Diego, CA, USA) between 1 January 2005 and 31 March 2007. NAT results were compared to those obtained from routine serology tests and quantitative polymerase chain reaction (PCR) assays. Overall, 52 units of blood tested positive for HBV (1.4 per thousand), 8 for HCV (0.2 per thousand) and none for HIV or multiple infections. The yield of TMA was 0.183 per thousand for HBV (7/38 264) and 0 for HCV. The TMA HBV-positive donations were tested for HBV DNA by a quantitative PCR assay and were found negative (below the detection limit of the method, 200 copies/mL). Follow-up testing showed that the TMA HBV-positive donations were positive for anti-hepatitis B core antigen immunoglobulin G antibodies. Implementation of the TMA assay in the individual donation configuration increased HBV detection compared to serological screening or a commonly used quantitative PCR assay. Follow-up studies will determine the impact of NAT implementation in HBV transmission in countries with an intermediate HBV incidence.


Xyloglucanases in the interaction between saprobe fungi and the arbuscular mycorrhizal fungus Glomus mosseae.
We studied the production of xyloglucanase enzymes of pea and lettuce roots in the presence of saprobe and arbuscular mycorrhizal (AM) fungi. The AM fungus Glomus mosseae and the saprobe fungi Fusarium graminearum, Fusarium oxysporum-126, Trichoderma harzianum, Penicillium chrysogenum, Pleurotus ostreatus and Aspergillus niger were used. G. mosseae increased the shoot and root dry weight of pea but not of lettuce. Most of the saprobe fungi increased the level of mycorrhization of pea and lettuce, but only P. chrysogenum and T. harzianum inoculated together with G. mosseae increased the dry weight of pea and lettuce respectively. The AM and saprobe fungi increased the production of xyloglucanases by plant roots. The level of xyloglucanase activities and the number of xyloglucanolytic isozymes in plants inoculated with G. mosseae and most of the saprobe fungi tested were higher than when both microorganisms were inoculated separately. The possible relationship between xylogucanase activities and the ability of AM and saprobe fungi to improve the dry weight and AM root colonization of plants was discussed.


Finding the breech: Influence of breech presentation on mode of delivery based on timing of diagnosis, attempt at external cephalic version, and provider success with version.
Breech presentation affects 3-4% of pregnancies at term and malpresentation is the primary indication for 10-15% of cesarean deliveries. External cephalic version is an effective intervention that can decrease the need for cesarean delivery; however, timely identification of breech presentation is required. We hypothesized that women with a fetus in a breech presentation that is diagnosed after 38 weeks' estimated gestational age have a decreased likelihood of external cephalic version attempted and an increased likelihood of cesarean delivery. This was a retrospective cohort study. A chart review was performed for 251 women with breech presentation at term presenting to our tertiary referral university hospital for external cephalic version, cesarean for breech presentation, or vaginal breech delivery. Vaginal delivery was significantly more likely (31.1% vs 12.5%; P<.01) in women with breech presentation diagnosed before 38 weeks' estimated gestational age as external cephalic version was offered, and subsequently attempted in a greater proportion of women diagnosed before 38 weeks. External cephalic version was more successful when performed by physicians with greater procedural volume during the 3.5 year period of the study (59.1% for providers performing at least 10 procedures vs 31.3% if performing fewer than 10 procedures, P<.01). Results support the need for interventions to increase timely diagnosis of breech presentation as well as improved patient counseling and use of experienced providers for external cephalic version.


The mechanical control system of bone in weightless spaceflight and in aging.
Bone loss is notable in elderly persons and in astronauts returning from spaceflight, however, the bone changes in these radically different patient populations appear morphologically similar. Bone structure depends upon several independent basic processes: growth, modeling, and remodeling. Each process follows a stereotyped sequence of steps. Alteration of any step may yield a similar bone loss, although from an entirely different mechanism. Mechanical forces appear to coordinate the fundamental bone shaping processes by a negative feedback control system. Determining how mechanical signals control the mass, architecture, and strength of bone may establish the limits by which exercise can prevent osteoporosis in the elderly and in astronauts despite obvious differences in etiology.


A rapid method for separation and detection of human salivary amylase isoenzymes by isoelectric focusing in polyacrylamide gel.
Human salivary proteins were separated by isoelectric focusing on polyacrylamide gel in flat beds at 1000 V for 40 min. Amylase activity was detected after immersing the gel in 0.4 M tris-HCI buffer pH 7.4 to equilibrate the pH gradient. The enzyme activity was detected after diffusion into an overlayer of agarose gel containing an insoluble dye-starch polymer (Phadebas). Both whole human saliva and parotid saliva from 15 different persons contained four amylase components, except in three cases where only three bands were detected. The bands were all focused within a rather narrow pH range (pH 5.4-7.2) and the results were very reproducible.


The multiplicity of human pancreatic secretory trypsin inhibitor.
Four forms of pancreatic secretory trypsin inhibitor (PSTI; A1, A2, B, and C) were purified from human pancreatic juice. According to sequence results, the primary structure of B was different from that reported earlier (Greene, L.J., et al. (1976) Method Enzymol. 45, 813-825) at two positions, i.e. Asn21----Asp21, Asp29----Asn29. A1 and A2 were deamidated forms of B judging from peptide mappings with Staphylococcus aureus V8 protease. Gln45 in B was replaced by Glu in A1 and Gln51 in B was replaced by Glu in A2. C was an inhibitor lacking five amino acid residues from the amino terminal of B. B and C inhibited human cationic trypsin activity stoichiometrically with similar dissociation constants, but A1 and A2 showed poorer trypsin inhibitory activity than B and C.


Soluble DPP4 induces inflammation and proliferation of human smooth muscle cells via protease-activated receptor 2.
DPP4 is an ubiquitously expressed cell-surface protease that is shedded to the circulation as soluble DPP4 (sDPP4). We recently identified sDPP4 as a novel adipokine potentially linking obesity to the metabolic syndrome. The aim of this study was to investigate direct effects of sDPP4 on human vascular smooth muscle cells (hVSMCs) and to identify responsible signaling pathways. Using physiological concentrations of sDPP4, we could observe a concentration-dependent activation of ERK1/2 (3-fold) after 6h, which remained stable for up to 24h. Additionally, sDPP4 treatment induced a 1.5-fold phosphorylation of the NF-κB subunit p65. In accordance with sDPP4-induced stress and inflammatory signaling, sDPP4 also stimulates hVSMC proliferation. Furthermore we could observe an increased expression and secretion of pro-inflammatory cytokines like interleukin (IL)-6, IL-8 and MCP-1 (2.5-, 2.4- and 1.5-fold, respectively) by the sDPP4 treatment. All direct effects of sDPP4 on signaling, proliferation and inflammation could completely be prevented by DPP4 inhibition. Bioinformatic analysis and signaling signature induced by sDPP4 suggest that sDPP4 might be an agonist for PAR2. After the silencing of PAR2, the sDPP4-induced ERK activation as well as the proliferation was totally abolished. Additionally, the sDPP4-induced upregulation of IL-6 and IL-8 could completely be prevented by the PAR2 silencing. In conclusion, we show for the first time that sDPP4 directly activates the MAPK and NF-κB signaling cascade involving PAR2 and resulting in the induction of inflammation and proliferation of hVSMC. Thus, our in vitro data might extend the current view of sDPP4 action and shed light on cardiovascular effects of DPP4-inhibitors.


Management of the stroke patient with patent foramen ovale: new insights and persistent questions in the wake of recent randomized trials.
Stroke without a known cause, or cryptogenic stroke, accounts for up to 30 % of all ischemic strokes. Paradoxical embolism through a patent foramen ovale (PFO) has been implicated as a potential cause of cryptogenic cerebral ischemia, particularly in young patients. Epidemiological studies have noted an association between PFO and cryptogenic stroke and observational studies have suggested the potential superiority of percutaneous PFO closure over medical therapy. However, until recently, there were no randomized data to test the hypothesis that PFO closure reduces the risk of recurrent cerebral ischemia. The publication of three such trials, all failing to demonstrate a therapeutic advantage for closure over medical therapy in intention-to-treat analyses, provides valuable new data in the field. We review epidemiological evidence linking PFO and stroke and recent observational and randomized trial data evaluating different treatment strategies.


Is the Saudi public aware of Middle East respiratory syndrome?
To limit the spread of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia, the Ministry of Health tried to raise public awareness using different public campaigns. We aimed to measure public awareness of MERS in Saudi Arabia. A cross-sectional study was conducted between May and June 2014 using a newly designed Arabic questionnaire that was distributed and completed online. We analyzed the response of 1149 respondents across Saudi Arabia. We found that 97% of the participants were aware of MERS. In addition, 72% realized that coughing and sneezing could spread the infection. Furthermore, 83% thought that some patients with MERS could be cured. Moreover, 62% knew that no vaccine can prevent the disease. However, only 36% realized that taking antibiotics will not stop the infection, and only 41% recognized that no medication has yet been manufactured to treat it. Regarding protection measures, 74% used hand sanitizers, 43% avoided crowded places, and 11% wore masks in public places. Moreover, only 47% knew that bats and camels are the primary source of the virus. As anticipated, this level of awareness varied between the different categories of the studied population. Female, married, older, and more educated participants were significantly more knowledgeable about the disease. Public awareness of MERS is generally sufficient. However, some false beliefs about treatment were fairly common. In addition, almost half of the population remains unaware that bats and camels are the most likely sources of the virus.


Reliability of amygdalohippocampal volume measured directly on MRI films.
Volume measurement of the amygdalohippocampus on MRI may provide important information for epilepsy surgery. This study investigated the reliability of direct volume assessment (DVA) versus computer-assisted measurement (CAM) of amygdalohippocampus. DVA was carried out by counting the number of squares occupied by amygdalohippocampus in a transparent mm2 overlay used on both sagittal and coronal films. CAM was achieved using the 'thresholding and tracing' automated technique. Seventeen patients undergoing language-dominant left temporal lobectomy were studied. Mean volume as determined by the CAM was 4.99 +/- 1.31. In DVA, the mean volume was 5.05 +/- 1.23 (r = 0.974). Reproducibility of the volume measurement was tested by repeating measurements 5 times on 5 patient samples of amygdalohippocampal complex in DVA, and 3 times on 4 samples in CAM. The mean coefficient of variation for amygdalohippocampal volume was 6.9 +/- 3.2% in DVA and 3.9 +/- 2.0 in CAM. We also tested a more simplified method of assessing amygdalohippocampal volume by calculating the left to right volume ratio from MRI scans (2-40 films for each sample). Volume ratios determined directly from MRI films made in different months (14 samples) and of different sections (coronal and sagittal series, 18 samples) correlated well with each other (p < 0.01). Direct assessment of amygdalohippocampal volume can be used effectively for preoperative evaluation of the patient with epilepsy.


Post-exposure radioprotection by Chlorella vulgaris (E-25) in mice.
Oral administration of an algal mutant C. vulgaris E-25, 1 hr before or immediately after exposure to sublethal gamma-rays increased the number of endogenous spleen colony forming units (E-CFU). The magnitude of radioprotection was dependent on both, the dose of C. vulgaris fed and the time of administration. An optimal E-CFU was observed when 500 mg/kg body wt. of C. vulgaris was fed 1 hr before or immediately after irradiation. Significant recovery was observed in the number of bone marrow cells and the spleen weight. LD50/30 for Chlorella pre- and post-treated mice were 8.66 and 9.0 Gy, respectively compared to the control value of 7.8 Gy. The dose reduction factor (DRF) was 1.11 and 1.15 for pre-treated and post-treated mice respectively.


Impact of local endothelial shear stress on neointima and plaque following stent implantation in patients with ST-elevation myocardial infarction: A subgroup-analysis of the COMFORTABLE AMI-IBIS 4 trial.
Numerous studies have demonstrated an association between endothelial shear stress (ESS) and neointimal formation after stent implantation. However, the role of ESS on the composition of neointima and underlying plaque remains unclear. Patients recruited in the Comfortable AMI-IBIS 4 study implanted with bare metal stents (BMS) or biolimus eluting stents (BES) that had biplane coronary angiography at 13 month follow-up were included in the analysis. The intravascular ultrasound virtual-histology (IVUS-VH) and the angiographic data were used to reconstruct the luminal surface, and the stent in the stented segments. Blood flow simulation was performed in the stent surface, which was assumed to represent the luminal surface at baseline, to assess the association between ESS and neointima thickness. The predominant ESS was estimated in 3-mm segments and was correlated with the amount of neointima, neointimal tissue composition, and with the changes in the underlying plaque burden and composition. Forty three patients (18 implanted with BMS and 25 with BES) were studied. In both stent groups negative correlations were noted between ESS and neointima thickness in BMS (P < 0.001) and BES (P = 0.002). In BMS there was a negative correlation between predominant ESS and the percentage of the neointimal necrotic core component (P = 0.015). In BES group, the limited neointima formation did not allow evaluation of the effect of ESS on its tissue characteristics. ESS did not affect vessel wall remodeling and the plaque burden and composition behind BMS (P > 0.10) and BES (P > 0.45). ESS determines neointimal formation in both BMS and BES and affects the composition of the neointima in BMS. Conversely, ESS does not impact the plaque behind struts irrespective of stent type throughout 13 months of follow-up.


A two-layer gold surface with improved surface enhancement for spectro-electrochemistry using surface-enhanced infrared absorption spectroscopy.
A two-layer gold surface is developed for use with surface-enhanced infrared absorption spectroscopy (SEIRAS) consisting of a conducting underlayer onto which Au nanoparticles (AuNPs) are grown by self-catalyzed electroless deposition. AuNPs are grown on protruding substructures of the 25 nm thin underlayer. The enhancement factor of the two-layer gold surface is controlled by the growth conditions. Cytochrome c adsorbed to a self-assembled monolayer of mercaptoethanol is used as a reference system. Under optimum conditions the absorbance of the amide I band is increased by a factor of 5 versus the classical SEIRAS surface. Reversible reduction/oxidation of cytochrome c on the two-layer gold surface is shown to take place by cyclic voltammetry.


Production of Shiga-like toxins by Escherichia coli O157:H7 can be influenced by the neuroendocrine hormone norepinephrine.
To examine whether the neuroendocrine hormone norepinephrine may influence the production of the Shiga-like toxins (SLTs), several Escherichia coli O157:H7 clinical isolates were grown in the presence or absence of norepinephrine. An in vitro culture system consisting of low (<1500 colony-forming units/ml) initial concentrations of inocula into a serum-based medium was used to more closely approximate in vivo conditions. The growth of all isolates was increased several logs in the presence of norepinephrine, as compared with the growth in controls, during a 24-hour growth period. Controls included additional dextrose as well as the use of the norepinephrine metabolite normetanephrine, which contains one more methyl group than norepinephrine and hence would serve as a better energy source for growth if the effect were solely nutritionally mediated. During the 24 hours of growth, the production of cell-associated SLT-I on a protein-equivalent basis was shown to be increased over 100-fold in norepinephrine-cultured bacteria as compared with controls. SLT-II elaboration into culture supernatants was also greatly increased in norepinephrine-cultured bacteria as compared with controls. Maximal detection of cell-associated SLT-II occurred at least 12 hours before maximum levels were achieved in culture supernatants. Because norepinephrine represents one of the largest pools of monoamines present throughout the small intestine, these results suggest that the neuroendocrine environment of the small intestine may play a role in the growth of O157:H7 and the production of SLTs.


The sub/supra-optimal temperature-induced inhibition of photosynthesis and oxidative damage in cucumber leaves are alleviated by grafting onto figleaf gourd/luffa rootstocks.
Shoot-root communication is involved in plant stress responses, but its mechanism is largely unknown. To determine the role of roots in stress tolerance, cucumber (Cucumis sativus) shoots from plants with roots of their own or with figleaf gourd (Cucurbita ficifolia, a chilling-tolerant species) or luffa (Luffa cylindrica (L.) M. Roem., a heat-tolerant species) rootstocks were exposed to low (18/13°C), optimal (27/22°C) and high (36/31°C) temperatures, respectively. Grafting onto figleaf gourd and luffa rootstocks significantly alleviated chilling and heat-induced reductions, respectively, in biomass production and CO(2) assimilation capacity in the shoots, while levels of lipid peroxidation and protein oxidation were decreased. Figleaf gourd and luffa rootstocks upregulated a subset of stress-responsive genes involved in signal transduction (MAPK1 and RBOH), transcriptional regulation (MYB and MYC), protein protection (HSP45.9 and HSP70), the antioxidant response (Cu/Zn-SOD, cAPX and GR), and photosynthesis (RBCL, RBCS, RCA and FBPase) at low and high growth temperatures, respectively, and this was accompanied by increased activity of the encoded enzymes and reduced glutathione redox homeostasis in the leaves. Moreover, Heat Shock Protein 70 (HSP70) expression in cucumber leaves was strongly induced by the luffa rootstock at the high growth temperature but slightly induced by the figleaf gourd rootstock at low or high growth temperatures. These results indicate that rootstocks could induce significant changes in the transcripts of stress-responsive and defense-related genes, and the ROS scavenging activity via unknown signals, especially at stressful growth temperatures, and this is one of mechanisms involved in the grafting-induced stress tolerance.


Feasibility and effects of home-based smartphone-delivered automated feedback training for gait in people with Parkinson's disease: A pilot randomized controlled trial.
Inertial measurement units combined with a smartphone application (CuPiD-system) were developed to provide people with Parkinson's disease (PD) real-time feedback on gait performance. This study investigated the CuPiD-system's feasibility and effectiveness compared with conventional gait training when applied in the home environment. Forty persons with PD undertook gait training for 30 min, three times per week for six weeks. Participants were randomly assigned to i) CuPiD, in which a smartphone application offered positive and corrective feedback on gait, or ii) an active control, in which personalized gait advice was provided. Gait, balance, endurance and quality of life were assessed before and after training and at four weeks follow-up using standardized tests. Both groups improved significantly on the primary outcomes (single and dual task gait speed) at post-test and follow-up. The CuPiD group improved significantly more on balance (MiniBESTest) at post-test (from 24.8 to 26.1, SD ∼ 5) and maintained quality of life (SF-36 physical health) at follow-up whereas the control group deteriorated (from 50.4 to 48.3, SD ∼ 16). No other statistically significant differences were found between the two groups. The CuPiD system was well-tolerated and participants found the tool user-friendly. CuPiD was feasible, well-accepted and seemed to be an effective approach to promote gait training, as participants improved equally to controls. This benefit may be ascribed to the real-time feedback, stimulating corrective actions and promoting self-efficacy to achieve optimal performance. Further optimization of the system and adequately-powered studies are warranted to corroborate these findings and determine cost-effectiveness.


Optimising mobile phase composition, its flow-rate and column temperature in HPLC using taboo search.
A chemometric methodology is proposed to study the separation of seven p-hydroxybenzoic esters in reversed phase liquid chromatography (RPLC). Fifteen experiments were found to be necessary to find a mathematical model which linked a novel chromatographic response function (CRF) with the column temperature, the water fraction in the mobile phase and its flow rate. The CRF optimum was determined using a new algorithm based on Glover's taboo search (TS). A flow-rate of 0.9 ml min(-1) with a water fraction of 0.64 in the ACN-water mixture and a column temperature of 10 degrees C gave the most efficient separation conditions. The usefulness of TS was compared with the pure random search (PRS) and simplex search (SS). As demonstrated by calculations, the algorithm avoids entrapment in local minima and continues the search to give a near-optimal final solution. Unlike other methods of global optimisation, this procedure is generally applicable, easy to implement, derivative free, conceptually simple and could be used in the future for much more complex optimisation problems.


Intensive versus conventional insulin therapy in nondiabetic patients receiving parenteral nutrition after D2 gastrectomy for gastric cancer: a randomized controlled trial.
This study was used to compare the effects of intensive insulin therapy with conventional insulin therapy on postoperative outcomes among nondiabetic patients receiving parenteral nutrition following D2 gastrectomy for gastric cancer. A total of 248 eligible patients were randomly assigned to receive intensive insulin therapy targeting a blood glucose level between 4.4 and 6.1 mmol/l [intensive group (n = 125)] or conventional insulin therapy targeting a blood glucose level less than 11.0 mmol/l [conventional group (n = 123)] during the postoperative period. Mean blood glucose concentrations were lower in the intensive group than in the conventional group. Severe hypoglycemia defined as blood glucose ≤2.2 mmol/l occurred in eight (6.4%) patients in the intensive group vs one (0.8%) patient in the conventional group (P = 0.036). One (0.8%) patient died in the intensive group vs two (1.6%) patients in the conventional group (P = 0.620). However, intensive insulin therapy significantly reduced overall postoperative complications rate (from 25.2% to 13.6%, P = 0.024). Moreover, both insulin resistance indicated as HOMA-IR and HLA-DR expression on monocytes were improved in the intensive group. Intensive insulin therapy significantly reduced the postoperative short-term morbidity but not mortality among nondiabetic patients receiving parenteral nutrition after D2 gastrectomy. The benefits may be due to the suppression of insulin resistance and improvement of HLA-DR expression on monocytes.


[Building of a method for the assessment of work related risks at the ULSS n.1 company of Belluno].
This paper describes an experimental method of risk assessment in a public hospital. A uniform method of danger checking out, valid for all hospital units was developed, and a objective and standardized system of occupational risk assessment was implemented. In fact, the quantification of risk is expressed in a numerical code that allows computerization of the collected data. The method is based on check list for the danger detection, on worker's data sheet, on criteria for risk factors encoding and for risk quantification. Vantage of this system is applicability into all the hospital units, even in presence of different occupational risks. Another vantage is the involvement of staff in the management of work safety.


Current status of visual field examination in Andalusia, Spain: the SICVA Study.
To ascertain the frequency of visual field examination (VFE) in patients attending public Andalusian hospitals (the SICVA study). This was a multicenter, observational, retrospective study of patients with documented and/or suspected glaucoma subject to campimetric monitoring for longer than 2 years. The numbers of VFEs performed in the first 2 years and in the complete follow-up period were analyzed. Data on VFE reliability were studied and VFE change was collected based on the Glaucoma Staging System 2. A total of 722 eyes (from 467 consecutive patients), 349 with suspected and 373 with documented glaucoma, were included. Mean patient age was 65.9 years (SD = 11.3), and median follow-up time was 56 months (P25 = 36, P75 = 84). Three (P25 = 2, P75 = 4) VFEs were performed in the first 2 years of follow-up in the overall sample, as compared to 2 VFEs (P25 = 2, P75 = 4) in patients with suspected glaucoma, and 3 VFEs (P25 = 2, P75 = 4) in those with documented glaucoma (p<0.001). Based on these results, frequency of VFE in Andalusia differs from the standards recommended by the European Glaucoma Society to assess progression in the first 2 years of patient follow-up.


[The exfoliation syndrome: report of 9 eyes in 7 patients].
The clinical and histological manifestations in 7 patients (9 eyes) with the exfoliation syndrome were discussed, including some symptoms and signs that had not been reported before, e.g. the changes in form and locality of the exfoliation material. The author is of the opinion that glaucoma may be related to the exfoliation syndrome, while cataract is not. Therefore, early diagnosis of the syndrome is significant for the prevention and treatment of glaucoma.


Reduced expression of osteonectin and increased natural killer cells may contribute to the pathophysiology of aplastic anemia.
Normal hematopoiesis involves complex interactions between hematopoietic cells and the bone marrow (BM) microenvironment. The exact causes and mechanisms involved in aplastic anemia (AA) are not known. For better understanding of the pathophysiology of AA, we investigated changes in the hematopoietic stem cell (HSC) compartment and the BM microenvironment in patients with AA by immunohistochemical analysis. A total of 10 AA patients and 10 controls were enrolled. Using BM biopsy specimen, we performed immunohistochemistry for osteopontin, osteonectin, osteocalcin, nestin, stromal-derived factor-1 (SDF-1), lymphocytes, macrophage, and HSCs. Numbers of HSCs and T/B lymphocytes were significantly lower in the AA specimens than the controls, and the AA specimens contained more natural killer cells (CD56(+) cells) (P < 0.01). The 2 groups had similar levels of expression of osteopontin, osteocalcin, nestin, and SDF-1. However, the number of osteonectin(+) cells in the AA specimens was significantly lower than in the control specimens (P<0.01). Our findings support the hypothesis that defects in the stromal cells contribute to the pathogenesis of AA by damaging HSC niche. Immune-mediated natural killer cells may also play a role in the pathogenesis of AA.