[Functional aging and compensation of elder workers and ergonomic design].
It was probably inappropriate to use chronological age as the only index for assessing the functional capacities of elder workers. In fact, some functions of elder workers were remained or improved for compensation. The characteristics of functional aging of elder workers were summed up and analyzed. The compensatory mechanisms of accommodation and strategy change, experience and expertise, environmental and social support, and skill learning and retraining were discussed. Finally, the perspective of elder worker ergonomics was depicted in the paper. It is believed that functional age, rather than chronological age, is a scientific index in evaluating the working capacities of elder workers.


Intraosseous ganglion of the lunate.
Intraosseous ganglion of the lunate is a relatively rare entity. Two cases are reported, in one of which a communication with the scapholunate joint was demonstrated by polytomography. Curettage and bone grafting resulted in complete relief of pain.


Trans-Atlantic hospital agreement in reading first day radiographs of clinically suspected scaphoid fractures.
The purpose of this study was to describe the agreement between two hospitals on either side of the Atlantic Ocean in reading first day plain radiographs of suspected scaphoid fractures. Two groups of observers, one North American and one European, consisting of observers at various levels of training were compared. Kappa statistics were used to determine inter- and intra-observer agreement. The receiver-operating characteristics (ROC) curves and area under this curve (AUC) for each observer were calculated to determine test performance. Scaphoid radiographs of 80 consecutive patients seen with clinically suspected scaphoid fracture were included in the study. The results of the bone scan were used as the reference standard. There is an acceptable agreement between the USA and Europe for both radiologists and orthopaedic surgeons at various levels of training (kappa 0.45-0.88). Intra-observer agreement is acceptable as well (kappa 0.46-0.86). Considering all normal or equivocal radiographs, there is slight to moderate agreement at all levels of training in and between both centres and specialities (kappa 0-0.64). Overall test performance was acceptable for all consecutive radiographs (AUC 0.65-0.82) and poor for the normal radiographs (AUC 0.46-0.65). We could not detect differences in performance due to location of the readers' hospital or institution of training. The use of more sensitive techniques should be restricted to patients with negative or equivocal radiographs in clinically suspected scaphoid fractures.


Comparison of Short-Term Effects of Diquafosol and Rebamipide on Mucin 5AC Level on the Rabbit Ocular Surface.
To investigate the short-term effects of 2 new secretagogue eye drops for dry eye, 3% diquafosol tetrasodium ophthalmic solution (diquafosol) and 2% rebamipide ophthalmic suspension (rebamipide), on the concentration of mucin 5AC (MUC5AC) in rabbit tear fluid and conjunctival goblet cells. One dose of artificial tears, diquafosol or rebamipide, was instilled into 8 eyes of Japanese white rabbits. MUC5AC concentration in the tear fluid was examined using the enzyme-linked immunosorbent assay 15 min after instillation and compared with 8 untreated controls. Impression cytology was performed to measure the number of periodic acid Schiff (PAS)-positive cells and the ratio of the PAS-positive area using image analysis software. Statistical comparison was performed using ANOVA with post hoc analysis with the Tukey's test. After 15 min, only diquafosol significantly (P ≤ 0.01) increased the MUC5AC level in the tear fluid. Although no drug affected the number of PAS-positive cells, the ratio of the PAS-positive area decreased significantly (P ≤ 0.01) only in the diquafosol group. These data indicated that more PAS-positive MUC5AC was released into the tear fluid from the goblet cells by diquafosol than by rebamipide. There is a difference in the induction pattern of MUC5AC into the tears from the goblet cells between these eye drops.


Aborted suicide attempts: a new classification of suicidal behavior.
With the goal of ultimately finding early suicide predictors, the authors undertook a study of aborted suicide attempts. They defined such an attempt as an event in which an individual comes close to attempting suicide but does not complete the act and thus sustains no injury. The authors interviewed a random sample of 135 adult psychiatric inpatients concerning their past suicidal behavior. Using standardized scales, they assessed suicidal intent for aborted suicide attempts and actual suicide attempts, as well as degree of injury for actual attempts. Over half of the 135 subjects reported making at least one aborted suicide attempt. Aside from younger age, no demographic characteristics were associated with aborted attempts. Aborted attempts were reported more often in subjects with a diagnosis of borderline personality disorder than in subjects with other diagnoses. Intent scores for aborted attempts were comparable to those for actual suicide attempts. Subjects who had made an aborted attempt were nearly twice as likely to have made an actual suicide attempt as subjects with no aborted attempts. Among subjects with both aborted and actual attempts, the first aborted attempt preceded the first actual attempt approximately half the time. Aborted suicide attempts were reported commonly by psychiatric inpatients, had a similar level of intent as actual attempts, and were highly associated with actual attempts. Thus, clinicians should specifically ask patients about aborted attempts as a part of the suicide history. Further study is needed to examine the association between aborted suicide attempts and suicide.


The adolescent dyslexic: Strategies for spelling.
The adolescent dyslexic student's problems with spelling are very different from those of a young dyslexic child, as he already has considerable knowledge of the English spelling system. But this knowledge is very often random and confused, so he needs to acquire a logical structure which will enable him to generate spelling for himself and to communicate effectively in writing.It will be suggested that accuracy is not always attainable, but the student can be taught to recognize and use the main components of the spelling system and can learn to employ all available resources. The general aim is to provide the dyslexic adolescent with the tools he needs to cope with his spelling requirements, both in school and outside; to make informed deductions; to think for himself. In short, to spell independently and logically.


A novel gene, ANKRD28 on 3p25, is fused with NUP98 on 11p15 in a cryptic 3-way translocation of t(3;5;11)(p25;q35;p15) in an adult patient with myelodysplastic syndrome/acute myelogenous leukemia.
We identified a novel gene fusion of ANKRD28 (ankyrin repeat domain 28) on 3p25 to NUP98 on 11p15 in a patient with adult myelodysplastic syndrome/acute myelogenous leukemia. A partially cryptic 3-way translocation, t(3;5;11)(p25;q35;p15), that had initially been supposed to be t(3;5)(p25;q35) was revealed by precise breakpoint mapping via fluorescence in situ hybridization analysis with bacterial artificial chromosome clones. This translocation produces the expression of 2 in-frame fusion transcripts, the novel ANKRD28-NUP98 and NUP98-NSD1, and 1 out-of-frame NSD1-ANKRD28 transcript. Transient overexpression of ANKRD28-NUP98 in NIH/3T3 cells, but not the C-terminal deletion mutant of ANKRD28 (DeltaC-ANKRD28), caused significantly increased focus formation compared with mock-transfectant controls. ANKRD28-NUP98 was localized in the nucleolus and cytoplasm, whereas ANKRD28 and DeltaC-ANKRD28 were found exclusively in the cytoplasm. Alteration of the subcellular localization of ANKRD28 might have contributed to the leukemogenesis in this case. This report is the first of ANKRD28 as an NUP98 fusion partner, and this case implies that this fusion may be responsible for hematologic malignancies.


The hepatitis C virus NS5B RNA-dependent RNA polymerase activity and susceptibility to inhibitors is modulated by metal cations.
The aim of this study was to understand the effect of metal cations on the hepatitis C virus (HCV) NS5B in vitro RNA-dependent RNA polymerase (RdRp) activity and its susceptibility to various inhibitors. A recombinant full-length HCV NS5B protein was expressed in insect cells and purified to homogeneity. RdRp activity was assessed using standard filtration or polyacrylamide gel-based assays. Efficient inhibition of the HCV NS5B RdRp activity by gliotoxin, as well as by various substrate analogs, occurs in the presence of Mn2+, but not of Mg2+. Assays performed in the presence of both cofactors suggest that, in vitro, the enzyme's affinity for Mn2+ is higher than that for Mg2+. In addition, the RdRp activity, displayed in the presence of heteropolymeric templates, is significantly increased when the metal cofactor consists of Mn2+. Finally, steady state kinetics showed that the velocity of the reaction, as well as the affinity of the enzyme for its substrate, could both be affected by the nature of the divalent metal cation used.


Impact of acute geriatric care in elderly patients according to the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria in northern France.
In France, over 20% of hospitalizations of elderly people are a result of adverse drug events, of which 50% are considered preventable. Tools have been developed to detect inappropriate prescriptions. The Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria are innovative and adapted to French prescriptions. This is one of the first French prospective studies to evaluate the impact of acute geriatric care on prescriptions at discharge in elderly patients using the STOPP/START criteria. The evaluation of prescriptions according to STOPP/START was carried out on admission and at discharge of patients in acute geriatric units at three hospitals in the Nord-Pas de Calais region, France. A total of 202 elderly hospitalized patients were included during the 4.5 months of the study (1.5 months per center). The mean number of drugs was seven on admission and at discharge. Over half of the prescriptions at admission contained at least one potentially inappropriate medication or one potential prescription omission. The prescriptions at discharge contained significantly fewer potentially inappropriate medications than prescriptions on admission (P < 0.001). In contrast, there was no difference between prescriptions at discharge in terms of potential prescription omissions. Acute geriatric hospitalization in France improves prescriptions in terms of potentially inappropriate medication, but has no impact on potential prescription omissions. Further studies must be carried out to see if STOPP/START could be used as a tool in French prescription.


Policy options to support biofuel production.
Biofuels for use in the transportation sector have been produced on a significant scale since the 1970s, using a variety of technologies. The biofuels widely available today are predominantly sugar- and starch-based bioethanol, and oilseed- and waste oil-based biodiesel, although new technologies under development may allow the use of lignocellulosic feedstocks. Measures to promote the use of biofuels include renewable fuel mandates, tax incentives, and direct funding for capital projects or fleet upgrades. This paper provides a review of the policies behind the successful establishment of the biofuel industry in countries around the world. The impact of direct funding programs and excise tax exemptions are examined using the United States as a case study. It is found that the success of five major bioethanol producing states (Illinois, Iowa, Nebraska, South Dakota, and Minnesota) is closely related to the presence of funding designed to support the industry in its start-up phase, while tax exemptions on bioethanol use do not influence the development of production capacity. The study concludes that successful policy interventions can take many forms, but that success is equally dependent upon external factors, which include biomass availability, an active industry, and competitive energy prices.


The novel function of the Ph1 gene to differentiate homologs from homoeologs evolved in Triticum turgidum ssp. dicoccoides via a dramatic meiosis-specific increase in the expression of the 5B copy of the C-Ph1 gene.
The Ph1 gene is the principal regulator of homoeologous chromosome pairing control (HECP) that ensures the diploid-like meiotic chromosome pairing behavior of polyploid wheat. The HECP control was speculated to have evolved after the first event of polyploidization. With the objective to accurately understand the evolution of the HECP control, wild emmer wheat accessions previously known to differ for HECP control were characterized for the structure and expression of the candidate Ph1 gene, C-Ph1. The C-TdPh1-5A and 5B gene copies of emmer wheat showed 98 and 99% DNA sequence similarity respectively with the corresponding hexaploid wheat copies. Further, the C-TdPh1-5B carried the C-Ph1-5B specific structural changes and transcribed three splice variants as observed in the hexaploid wheat. Further, single nucleotide changes differentiating accessions varying for HECP control were identified. Analyzed by quantitative expression analysis, the wild emmer accessions with HECP control showed ~ 10,000-fold higher transcript abundance of the C-TdPh1-5B copy during prophase-I compared to accessions lacking the control. Differential transcriptional regulation of C-TdPh1-5B splice variants further revealed that C-Ph1-5Balt1 variant is mainly responsible for differential accumulation of C-Ph1-5B copy in accessions with HECP control. Taken together, these results showed that the HECP control evolved via transcriptional regulation of splice variants during meiosis.


Long non-coding RNA NEAT1 plays an important role in sepsis-induced acute kidney injury by targeting miR-204 and modulating the NF-κB pathway.
This study aimed to explore the role of long non-coding RNA NEAT1 in sepsis-induced acute kidney injury (AKI). The expression levels of NEAT1 in sepsis-induced AKI patients were detected. The rat mesangial cells (RMCs) were treated with lipopolysaccharide (LPS) to induce cell injury. Then, the effects of NEAT1 suppression on the cell viability, apoptosis, cytokines expression, and oxidative stress in the LPS-stimulated RMCs were tested. The regulatory miRNA of NEAT1, as well as the target genes of this miRNA, were investigated. Moreover, the regulatory relationship between NEAT1 and the NF-κB pathway was explored. The results demonstrated that NEAT1 was significantly upregulated in the sepsis-induced AKI patients. Moreover, the upregulation of NEAT1 was associated with the serious degrees of AKI in sepsis patients. In addition, the suppression of NEAT1 alleviated LPS-induced injury in RMCs. MiR-204 was negatively regulated by NEAT1. Suppression of NEAT1 alleviated LPS-induced injury by overexpression of miR-204. Moreover, IL-6R was a target of miR-204, and the effects of the suppression of NEAT1 on LPS-induced cell injury were caused by inactivating the NF-κB pathway. In conclusion, upregulation of NEAT1 may aggravate the LPS-induced injury by targeting miR-204 and activating the NF-κB pathway. NEAT1 may serve as an important diagnostic marker and therapeutic target in sepsis-induced AKI.


Arthritis in the prehistoric Southeastern United States: biological and cultural variables.
Recent research shows that a bacterial life form, Erysipelothrix insidiosa, can produce rheumatoid arthritis in deer, swine, and dogs, and that a number of animals, including man, birds, and fish, may be infected by the organism. Examination of the archaeological record suggests that both cultural and biological variables may be interrelated in the maintenance of some forms of arthritis over long periods of time in geographically disparate populations. Re-examination of Cherokee folk beliefs concerning arthritis suggests that they had some recognition of this connection, and it also suggests that they had some recognition of this connection, and it also suggests that the term "magical" may relate more to the world view of the observer than to any actual inability of preliterate peoples to draw causal relations on the basis of their own intimate knowledge of their environments.


Effect of verbal cues on recognition memory and pleasantness evaluation of unfamiliar odors.
The experiment investigated the effect of verbal cues on recognition memory for unfamiliar odors. 58 participants learned 20 odors of chemical substances. The control group learned the odors without accompanying verbal labels whereas two other groups learned the odors with accompanying verbal labels. The labels referred to relatively pleasant or unpleasant odor sources. On a memory test, administered 15 min. and also 1 wk. after the learning phase, participants were asked to recognize 10 learned odors from 10 unlearned odors and to evaluate each odor's pleasantness. Analysis showed (a) the verbal labels did not facilitate recognition of the unfamiliar odors, (b) recognition performance was lower after 1 wk. than after 15 min., and (c) rated pleasantness tended to be affected by the verbal label assigned to the odor in the learning phase.


Exploiting Molecular Weight Distribution Shape to Tune Domain Spacing in Block Copolymer Thin Films.
We report a method for tuning the domain spacing ( Dsp) of self-assembled block copolymer thin films of poly(styrene- block-methyl methacrylate) (PS- b-PMMA) over a large range of lamellar periods. By modifying the molecular weight distribution (MWD) shape (including both the breadth and skew) of the PS block via temporal control of polymer chain initiation in anionic polymerization, we observe increases of up to 41% in Dsp for polymers with the same overall molecular weight ( Mn ≈ 125 kg mol-1) without significantly changing the overall morphology or chemical composition of the final material. In conjunction with our experimental efforts, we have utilized concepts from population statistics and least-squares analysis to develop a model for predicting Dsp based on the first three moments of the MWDs. This statistical model reproduces experimental Dsp values with high fidelity (with mean absolute errors of 1.2 nm or 1.8%) and provides novel physical insight into the individual and collective roles played by the MWD moments in determining this property of interest. This work demonstrates that both MWD breadth and skew have a profound influence over Dsp, thereby providing an experimental and conceptual platform for exploiting MWD shape as a simple and modular handle for fine-tuning Dsp in block copolymer thin films.


Essential tremor: phenotypes.
Classically, essential tremor (ET) was defined by the Movement Disorder Society Consensus Statement on Tremor (1998) as "a bilateral, largely symmetric postural or kinetic tremor involving hands and forearms that is visible and persistent". Additional or isolated tremor of the head may occur but in the absence of abnormal posture. Duration is more than 5 years and the neurological examination is normal, with exception of the cogwheel phenomenon. In the last years ET has evolved into two different meanings. First of all, the classical ET, as a monosymptomatic disorder, and second, a heterogeneous disorder, the Essential Tremors, or a family of diseases. Nowadays, ET can be classified with both motor and non-motor elements. Tremor may occur also in the legs, feet, trunk, jaw, chin, tongue, and voice. Although postural and kinetic tremors are the main features of ET, intentional tremor and tremor at rest may also occur in some patients. Other motor features described in patients with ET are gait ataxia, postural instability and eye-motion abnormalities. Non-motor features include cognitive (memory and executive problems and dementia), psychiatric (anxiety, depression and social phobia), and sensory abnormalities (olfactory deficits, hearing loss).


[Successful microdissection testicular sperm extraction in patients with nonmosaic Klinefelter syndrome: three cases report].
To discuss the method for patients with nonmosaic Klinefelter syndrome (KS) to father children. Microdissection testicular sperm extraction (micro-TESE) was performed for three patients with nonmosaic KS in our hospital. Three patients (their ranging from 23 years to 36 years), were diagnosed with azoospermia after several semen analyses. By palpation, their testis size was estimated about 3 mL,1 mL, and 4 mL, respectively. Follicle-stimulating hormone (FSH) was 37.2 IU/L, 42.2 IU/L, and 30.5 IU/L, respectively. Luteinizing hormone (LH) was 15.5 IU/L, 11.2 IU/L, and 10.1 IU/L, respectively. Testosterone was 1.2 nmol/L, 5.6 nmol/L, and 8.2 nmol/L, respectively. The volume of semen was 0.8 mL, 0.2 mL, and 0.5 mL, respectively. There was no sperm and fructose was positive. The transrectal B-bilateral showed vas deferens and seminal vesicles were not abnormal. And all the patients had a uniform 47, XXY karyotype. During the operation, normal formation sperms were found in two patients. They only underwent one-side micro-TESE. Active sperms were found after being cultured. The sperms were kept under cryopreservation. The other patient underwent two-side micro-TESE. No sperm was found during the operation. After the operation, a few deformity sperms were found during the second searching. No active sperm was found after being cultured. The sperm wasn't kept under cryopreservation. Although patients with nonmosaic KS have small testis and decreased spermatogenesis, some of them can obtain sperms by micro-TESE instead of accepting artificial insemination by donors.


Contrast-enhanced MR imaging for evaluation of coronary artery disease before elective repair of aortic aneurysm.
To prospectively evaluate the accuracy of first-pass contrast material-enhanced magnetic resonance (MR) imaging during stress and delayed contrast-enhanced MR imaging in the detection of significant coronary artery disease in patients before elective repair of aortic aneurysm. The study was approved by the institutional ethics committee, and informed consent was obtained from all patients. MR imaging was performed in 49 patients (42 men and seven women; mean age, 72.2 years; age range, 58-85 years) before the elective repair of atherosclerotic aortic aneurysms. Thirty-two patients had an abdominal aneurysm, 12 had a thoracic aneurysm, and five had a thoracoabdominal aneurysm. First-pass contrast-enhanced MR images were obtained with short-axis sections encompassing the entire left ventricular myocardium in the resting state and during pharmacologic stress. Inversion-recovery-prepared delayed contrast-enhanced MR images were obtained with breath holding to evaluate for the presence of infarction. All patients underwent coronary angiography within 2 weeks of MR imaging, and these findings were used as the standard of reference. The diagnostic results of first-pass contrast-enhanced MR imaging, delayed contrast-enhanced MR imaging, and a combination of both MR imaging methods in the detection of significant coronary artery disease were expressed as sensitivity, specificity, and accuracy. Coronary angiography depicted a clinically significant stenosis (>70% luminal diameter narrowing) in the coronary artery in 34 of the 49 patients (69%). First-pass contrast-enhanced MR imaging depicted stress-induced hypoenhancement in 27 of those 34 patients (79%). Delayed myocardial enhancement was observed in 17 of the 34 patients (50%). The overall sensitivity of rest-stress first-pass contrast-enhanced MR imaging and delayed contrast-enhanced MR imaging combined in the prediction of at least one coronary artery with significant stenosis was 88% (30 of 34 patients). The specificity and accuracy of MR imaging were 87% (13 of 15 patients) and 88% (43 of 49 patients), respectively. Contrast-enhanced MR imaging had an accuracy of 88% in the detection of significant coronary artery disease in patients with aortic aneurysm.


Structural and functional consequences of bypass grafting with autologous vein.
An understanding of the consequences of autologous vein grafting reveals both the reasons why cryopreserved allogenic veins are being used clinically and how they are most likely to be expected to fail. Autologous vein bypass grafts are characterized by a series of distinct biological properties that influences their in vivo patency. Current surgical practice ensures that the endothelium of vein grafts is preserved at the time of implantation and that there is minimal damage to the smooth muscle cells. After implantation, the endothelial cells show varying degrees of morphological changes that are maximal within the first 3 days after grafting. In autografts, extensive endothelial denudation does not appear to occur. During the initial grafting period, the smooth muscle cells change from a contractile phenotype to a synthetic phenotype, migrate from the media, proliferate in the intima, and lay down connective tissue. Thereafter, endothelial cell changes regress and the smooth muscle cells return to their contractile phenotype. Perioperative manipulation of vein grafts results in decreased endothelial cell function but preservation of smooth muscle cell responsiveness. Postoperatively endothelial cell-mediated relaxation to acetylcholine is lost and smooth muscle cell contractility is decreased. Within 7 days after implantation, smooth muscle cell contractility returns and, with time, becomes markedly greater than that of the control vein. Endothelium-mediated relaxation to acetylcholine never returns in vein grafts and this loss of endothelial cell function appears to be related to receptor-coupled G-protein defects. Smooth muscle cell contractility remains abnormal. Many of the intimal hyperplastic lesions in vein grafts progress to stenosis or become sites of accelerated atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)


Linking industrial hygiene and health records.
This report presents methodology used in a large chemical company for linking historical industrial hygiene sampling data and employee health data through the personnel record system. The problems encountered are described to alert investigators to the need for careful planning of systems for linking the three data bases.


In search of 'low health literacy': threshold vs. gradient effect of literacy on health status and mortality.
Studies have demonstrated significant associations between limited literacy and health outcomes. Yet differences in literacy measurement and the cutoffs used for analysis have made it difficult to fully understand the relationship between literacy and health across the entire spectrum of literacy (i.e., whether the relationship is continuous and graded or whether a threshold exists below which literacy is independently associated with health). To analyze this question, we re-examined the relationship between literacy, baseline physical functioning and mental health, and all-cause mortality for a cohort of 3260 US community-dwelling elderly who were interviewed in 1997 to determine demographics, socioeconomic status, chronic conditions, self-reported physical and mental health (SF-36 subscales), health behaviors, and literacy based upon the Short Test of Functional Health Literacy in Adults (S-TOFHLA). All-cause mortality was determined using data from the US National Death Index through 2003. Seven categories of S-TOFHLA literacy scores were created and used in this analysis instead of the existing three categories identified with the measure. In multivariate analyses, a continuous, graded relationship between literacy and baseline physical functioning was identified. However, participants scoring below the third literacy category had significantly worse mental health compared to the highest literacy category, displaying a notable threshold. Finally, all six literacy categories were significantly associated with greater all-cause mortality risk compared to the highest literacy category, but again there was a marked threshold below the third category at which the adjusted mortality rate significantly increased compared to all other categories. We conclude that the nature of the relationship between literacy and health may vary depending upon the outcome under examination.


Expanding Treatment Opportunities for Hospitalized Patients with Opioid Use Disorders.
The prevalence of opioid use disorders (OUDs) is rising across the United States. Patients with OUDs are often hospitalized for medical conditions other than addiction, such as infection, injury, or pregnancy. These hospital admissions provide an opportunity for healthcare providers to initiate opioid agonist therapy with methadone or buprenorphine. Randomized trials have demonstrated the superior effectiveness of this treatment strategy, but its adoption by hospital providers has been slow. A number of barriers have impeded its implementation, including misperceptions about the regulation of opioid prescribing, limited resources for the transition to community- based treatment, and a lack of familiarity among clinicians about the appropriate initiation and dose adjustment of these opioid agonists for maintenance therapy. We discuss changes in policy and practice to expand opportunities to engage patients with OUDs in opioid agonist treatment during their inpatient hospitalizations.


Safety and efficacy of donor lymphocyte infusions following mismatched stem cell transplantation.
The use of a mismatched allograft necessitates T cell depletion for prevention of uncontrolled graft-versus-host disease (GVHD), thus impairing a graft-versus-leukemia effect. Data on donor lymphocyte infusion (DLI) after mismatched stem cell transplantation are lacking. Our experience with 28 patients (treated with 59 mismatched DLIs; range, 1-7) is described. The procedure was prophylactic in 6 patients (9 DLIs) and therapeutic in 22 (50 DLIs). DLI dose ranged from 10(2) to 1.5 x 10(9) T cells/kg. In the 6 patients receiving prophylactic DLI, complete remission was maintained in 5; however, 2 died from GVHD. Clinical response to therapeutic DLI was seen in 6 of 22 (27.3%) patients; a greater tumor burden produced a lower response. GVHD appeared in 13 of 28 patients. Surprisingly, a greater HLA mismatch was associated with a lower risk of GVHD, with 3 of 19 DLIs in 3/6 matching and 16 of 29 DLIs in 5/6 matching with similar follow-up. Nevertheless, no correlation between efficacy and HLA mismatching was noted. Death was frequent and usually related to the basic disease rather than to DLI complications. We conclude that mismatched DLI is feasible and may be effective, especially if given soon after transplantation. Future developments using cell therapy with selective or targeted anticancer activity are warranted, with special attention to prophylactic treatment of T cell depleted mismatched allografts recipients.


An enhanced electrical impedance imaging algorithm for hyperthermia applications.
Electrical impedance imaging is a technique which is under investigation as a noninvasive method of tracking subsurface temperature distributions and/or associated cellular response during hyperthermia. In previous work, a finite element image reconstruction algorithm for converting surface potential distributions recorded at discrete electrode positions into spatial maps of conductivity values was developed. This paper reports on a series of significant improvements in the basic image reconstruction approach. Specifically, the ability to recover both the resistive and capacitive components of tissue electrical impedance have been incorporated. In addition, the image enhancement schemes of (1) total variation minimization, (2) dual meshing, and (3) spatial low-pass filtering, have been added. Through a series of simulation studies involving both phantom-like and clinically-relevant geometries having discrete regions and continuously-varying electrical property profiles, a significantly improved ability to recover spatial images of electrical properties in the impedance imaging context is demonstrated. The results show that the new algorithm is much more tolerant of measurement noise with levels up to 1% causing relatively modest degradations in image quality (compared to 0.1% which was needed previously in order to produce high quality images). The recovered electrical properties, themselves, both resistive and capacitive, are also found to be quantitative in value with errors in the 10-20% range occurring in the majority of cases, although deviations can reach 40% or more when noise levels as high as 10% are used. Temperature estimation simulations show that maximum temperature errors are significantly reduced (to approximately 2 degrees C relative to more than 10 degrees C in previous thermal simulations) with the new algorithm; however, temperature accuracies of better than 0.5 degree C on average are still found to be difficult to achieve with electrical impedance imaging even when the enhanced image reconstruction approach is used.


Factors associated with pre-eclampsia and quality care of affected teenagers during labour within health region H. in Kwa-Zulu Natal.
This is a descriptive, exploratory study which aimed at identifying the factors that are associated with pre-eclampsia in teenagers. The study also aimed at assessing the quality of midwifery care during labour in teenagers with pre-eclampsia so that recommendations can be made based on empirical findings. The study was done within Health Region H of KwaZulu-Natal Province in South Africa. A structured interview schedule was designed to tap information from pre-eclamptic teenagers in an attempt to identify factors associated with pre-eclampsia. A checklist was also designed and administered to assess the care of a pre-eclamptic teenager during labour. The study revealed that factors like age, nulliparity and socio-economic status were associated with pre-eclampsia. In as far as the rest of the factors, there was no relationship as indicated in previous studies. The study also revealed that teenagers affected by pre-eclampsia delayed in attending the antenatal clinic resulting in the control of the disease being difficult. In as far as midwifery care, the study revealed that psychological and social care, as well as the hygienic state of patients was not satisfactory. Based on the findings of the study, it is recommended that health education on prevention of pre-eclampsia should be done on an ongoing process, while carers for teenage mothers should be given inservice education programmes on psychosocial care. The physical environment for maternity units must be improved.


Allelic loss at chromosome band 6q14 correlates with favorable prognosis in hepatocellular carcinoma.
Cytogenetic and molecular studies have frequently shown chromosome 6q deletions in non-Hodgkin lymphoma and several human cancers. There have been few studies concerning chromosome 6q deletion in hepatocellular carcinoma (HCC), and most of these studies have focused on region 6q26-27. We previously described frequent allelic loss at 6q14 in HCC. As a step toward narrowing the scope of search for tumor suppressor genes, we used a series of yeast artificial chromosome clones that map to the long arm of chromosome 6 (6q14-6q22) by fluorescence in situ hybridization (FISH) to define the minimal common region of allelic loss in 25 cases of HCC. Altogether, 12 tumors had allelic loss on 6q (48%). Eleven of the 12 tumors had polysomy of chromosome 6 with evident intratumor cytogenetic heterogeneity. The minimal common region of allelic loss lies within a 2-cM region at 6q14, flanked by D6S458 (849_d_8) and D6S275 (911_a_3). Clinicopathologic correlation between the 12 patients with allelic loss at 6q and the 13 patients without allelic loss showed no significant differences in any basic characteristics except survival. Patients with allelic loss at 6q had a much longer median survival time than those without allelic loss (50 months vs. 11 months, P = 0.0019). Only 5 of the 25 HCC patients were still alive at the time of this study, and all of them had allelic loss at 6q, which is also statistically significant (P = 0.037, alive vs. dead). The association of allelic loss at 6q with polysomy implies that this may be a progression-associated event in HCC. The correlation of allelic loss at 6q with long survival suggests a complex mechanism of tumorigenesis in HCC and is worthy of further investigation.


Responses of bacterial community to dibutyl phthalate pollution in a soil-vegetable ecosystem.
Phthalate esters (PAEs) are a type of plasticizer that has aroused great concern due to their mutagenic, teratogenic, and carcinogenic effects, wherefore dibutyl phthalate (DBP) and other PAEs have been listed as priority pollutants. In this study, the impacts of DBP on a soil-vegetable ecosystem were investigated. The results showed that DBP could accumulate within vegetable tissues, and the accumulative effect was enhanced with higher levels of DBP contamination in soils. DBP accumulation also decreased vegetable quality in various ways, including decreased soluble protein content and increased nitrate content. The diversity of bacteria in soils gradually decreased with increasing DBP concentration, while no clear association with endophytic bacteria was observed. Also, the relative abundance, structure, and composition of soil bacterial communities underwent successional change during the DBP degradation period. The variation of bulk soil bacterial community was significantly associated with DBP concentration, while changes in the rhizosphere soil bacteria community were significantly associated with the properties of both soil and vegetables. The results indicated that DBP pollution could increase the health risk from vegetables and alter the biodiversity of indigenous bacteria in soil-vegetable ecosystems, which might further alter ecosystem functions in agricultural fields.


In-situ emergency paediatric surgery in the intensive care unit.
The role of surgery in the intensive care unit (ICU) remains unclear. Although previously shown not to increase morbidity for patent ductus arteriosus ligation, Broviac catheter insertion, and recently, general neonatal and paediatric surgery, there remains a reluctance to operate on sick patients in the ICU (in-situ surgery, ISS). A retrospective study of 25 critically ill children and neonates who underwent ISS was performed. Surgery was aided by operating loupes and a high-intensity headlight. ISS was not associated with any morbidity, and although a 36% mortality occurred in this small series, in no case was this due to ISS. ISS avoids the risks of transfer to the operating theatre and the potential delays in theatre access. Our results suggest that ISS in a tertiary-level paediatric surgical hospital is safe and does not impact adversely on clinical outcome.


Prenatal diagnosis: evolution in craniofacial surgery.
Prenatal diagnosis of craniomaxillofacial malformations permits early surgery, before 6 months of life and possibly, in the near future, in utero, thereby obtaining the best aesthetic and functional results. Increased knowledge of embryology has largely improved the diagnosis of craniomaxillofacial anomalies, their classification, and therapeutic protocols. We analyzed nine pregnancies (one twin) in which cleft lip and palate (CLP)--isolated or associated with, for example, holoprosencephaly, hypertelorism, and micrognathia--was diagnosed by ultrasonography. Only one fetus of these pregnancies was later operated on in our unit. This patient, with 7 years follow-up, represents our clinical case. For these cases, early diagnosis of CLP allowed informed parental choice regarding the continuation or termination of the affected pregnancy and planning of surgical procedures to correct the malformation. This is demonstrated by the presented clinical case involving an infant operated on within 6 months with success.


Mortality rates from size distributions : The application of a conservation law.
A population model explicitly describing the dynamics of an arbitrary population size distribution is presented. One consequence of the model is an equation for the exact shape of the size distribution of a stationary or steady-state population. The shape is expressed as a function of sizespecific mortality and growth rates. From the equation, various mortality estimation formulas can be derived, two of which are discussed in detail. One of the methods permits estimation of size-specific mortality rates without the assumption of a theoretical growth model.


Opiate receptor binding and analgesic effects of the tetrahydroisoquinolines salsolinol and tetrahydropapaveroline.
Salosolinol and tetrahydropapaveroline bind to opiate receptors in rat brain with affinities of 6.2 and 1.95 x 10(-5)M respectively. Their ability to displace 3H-naloxone is decreased about 4-fold by 100 mM sodium ion. Both of these agents have antinociceptive effects when given to rats intraventricularly. Their potency is comparable to the enkephalins, and their effect is blocked by naloxone.


Leukocytosis at diagnosis and the risk of subsequent thrombosis in patients with low-risk essential thrombocythemia and polycythemia vera.
Advanced age and a history of thrombosis were well-established risk factors for thrombosis in essential thrombocythemia (ET) and polycythemia vera (PV); cytoreductive therapy was indicated in their presence. Recent studies have suggested leukocytosis as an additional risk factor; however, such an association would be treatment-relevant in the context of low-risk disease. In this retrospective study, a Cox proportional hazards model was used to determine the impact of various clinical and laboratory variables, including leukocytosis, on thrombosis-free survival (TFS). Arterial-specific or venous-specific TFS curves for different leukocyte count-defined risk groups were constructed by the Kaplan-Meier method and compared using the log-rank test. A total of 407 low-risk patients (254 with ET and 153 with PV) were considered. After a respective median follow-up of 104 months and 130 months, respectively, 47 (19%) patients with ET and 41 (27%) with PV experienced a total of 55 (41 arterial and 14 venous) and 46 (22 arterial and 24 venous) thrombotic events, respectively. Leukocytosis at the time of diagnosis, defined by a cutoff level of either 15 or 9.4x10(9)/L, did not appear to be predictive of either arterial or venous thrombosis during follow-up; similar results were obtained when analysis was restricted to patients with platelet counts of <1000x10(9)/L. Instead, advanced age was found to be significantly associated with arterial thrombosis in patients with PV and higher hemoglobin level with venous thrombosis in patients with ET. In the current retrospective study, leukocytosis at diagnosis did not appear to influence the risk of thrombosis in either ET or PV. However, a prospective study is required before leukocytosis is taken into account during treatment decisions in these disorders.


Automated Repulsive Parametrization for the DFTB Method.
The density-functional-based tight-binding method is an efficient scheme for quantum mechanical atomistic simulations. While the most relevant part of the chemical energies is calculated within a DFT-like scheme, a fitted correction function-the repulsive energy-is used to achieve results as close to ab initio counterparts as possible. We have developed an automatic parametrization scheme to ease the process of the repulsive energy fitting, offering a more systematic and much faster alternative to the traditional fitting process. The quality of the resulting repulsives can be tuned by selecting and weighting the fit systems and the important physical properties (energy, force, Hessian) of them. Besides driving DFT calculators in the fitting process automatically, the flexibility of our scheme also allows the usage of external data (e.g., molecular dynamics trajectories or experimental data) as a reference. Results with several elements show that our procedure is able to produce parameter sets comparable to handmade ones, yet requiring far less human effort and time.


Pregnancies during and after homologous intrauterine insemination cycles.
Results of intrauterine insemination (IUI) in 39 couples are presented. Indications were male subfertility, cervical factor, unexplained infertility and immunological factor. The patients received a total of 119 treatment cycles. Nine pregnancies were achieved (23.1%) during IUI treatment. The monthly fecundity rate (MFR) during treatment was 7.6%. After stopping IUI, within a follow-up of 1 year 13 pregnancies occurred. Seven pregnancies occurred spontaneously without invasive treatment methods. The MFR was calculated to be 4.8% for this group. We conclude that couples with IUI treatment do achieve pregnancies more quickly, but IUI does not influence a patient's eventual chance to become pregnant.


[Prediction of potential suitable distribution area of Flaveria bidentis in China based on niche models].
Based on the distribution records of Flaveria bidentis in China, and by using five ecological niche models (GARP, Maxent, ENFA, Bioclim, and Domain), 32 eco-geographical variables were chosen to simulate the potential suitable distribution area of F. bidentis in the country, and the simulation precision of the models was assessed by the method of Receiver Operating Characteristic (ROC) curve analysis. Among the models adopted, Maxent model had the best simulation precision. Its prediction showed that the potential suitable distribution area of F. bidenti in this country accounted for 7. 5% of the total, with the central and southern Hebei, Beijing, Tianjin, Henan, Shandong, Anhui, and Jiangsu having high potential invasion risk.


An Unfulfilled Promise: Changes Needed to the Drug Approval Process to Make Personalized Medicine a Reality.
The widespread availability of drugs for personalized medicine has been an aspiration since before the human genome was sequenced. Recently, there is renewed interest; personalized medicine is much in the news. Legislation has been considered with the goal of smoothing, shortening and incentivizing the approval process for therapeutic products. President Obama mentioned the need for new initiatives to achieve such goals in the State of the Union address. But most of these initiatives do not consider the fundamental changes that personalized medicine demands. It requires a statutory structure designed for the development of products applicable for small subpopulations that is very different from our current model which is designed for the development of products for large populations. The current approval process is purposely not designed to consider individual efficacy. It is designed to incentivize reduced variation in clinical trials rather than embracing variation. In addition, it is based on twentieth-century notions of disease focused on phenotype rather than on pathophysiologic pathways. Current foci on the development of companion diagnostics, orphan drugs and post-approval study are important but insufficient. FDA does not have the authority to require the type of standardization, clinical trial design and extensive data reporting and sharing that. is needed to achieve the goals for personalized medicine. In addition, FDA's current drug approval process is too lengthy and cumbersome to deal with the iterative responses personalized medicine entails. If we are serious about wanting to achieve these goals, we will need to entertain such fundamental changes in authority.


Erythropoietin receptor expression in normal and neoplastic choroid plexus.
The erythropoietin receptor (EpoR) is expressed widely throughout the human CNS, including the choroid plexus. Recent studies have shown that EpoR is also expressed in various human tumors, including carcinomas, meningiomas and gliomas. Thereby, the Epo-EpoR pathway plays a role in inhibition of apoptosis and tumor growth, infiltration, angiogenesis and metastasis as well as treatment resistance and is a potential target in oncological treatment. Lower levels of EpoR have been associated with shorter survival in high grade gliomas and higher risk of tumor recurrence in meningiomas. Since the EpoR status in human choroid plexus tumors (CPT) is not known, we investigated 57 CPT from 43 cases including 14 recurrent tumors and compared them with 23 samples of normal choroid plexus (CP). CPT samples consisted of choroid plexus papillomas/CPP (n = 41), atypical CPP (n = 15) and choroid plexus carcinoma/CPC (n = 1). EpoR expression was determined by immunohistochemistry using semi-quantitative scoring for staining intensity and was validated in exemplary cases using western blot and RT-PCR. EpoR expression was observed in all samples of normal and neoplastic CP with significantly lower expression levels in CPT (p < 0.001). No significant correlation was found between EpoR expression and age, gender, WHO grade, number of mitosis or tumor recurrence. EpoR expression in CPT is in line with its expression in normal CP and with previous reports on EpoR expression in other glial neoplasms. Association of EpoR levels in CPT with survival, as known in astrocytic gliomas, remains to be determined.


Determining the Fate of a Non-Heme Iron Oxidation Catalyst Under Illumination, Oxygen, and Acid.
We analyze the stability of the non-heme water oxidation catalyst (WOC), Fe(bpmcn)Cl2 toward oxygen and illumination under nonaqueous and acidic conditions. Fe(bpmcn)Cl2 has been previously used as a C-H activation catalyst, a homogeneous WOC, and as a cocatalyst anchored to WO3 for photoelectrochemical water oxidation. This paper reports that the ligand dissociates at pH 1 with a rate constant k = 19.8(2) × 10-3 min-1, resulting in loss of catalytic activity. The combination of UV-vis experiments, 1H NMR spectroscopy, and cyclic voltammetry confirm free bpmcn and Fe2+ present in solution under acidic conditions. Even under nonaqueous conditions, both oxygen and illumination together show slow oxidation of iron over the course of a few hours, consistent with forming an Fe3+-O2- intermediate as corroborated by resonance-enhanced Raman spectroscopy, with a rate constant of k = 3.03(8) × 10-3 min-1. This finding has implications in both the merits of non-heme iron complexes as WOCs as well as cocatalysts in photoelectrochemical schemes: the decomposition mechanisms may include both anchoring group hydrolysis and instability under illumination.


[Nurse's role in primary care for people with common mental disorders].
The prevalence of common mental disorders (CMD) increases both in Quebec and in the world. Governments, researchers and clinicians are in search of the best practices to improve the services offered to clients with CMD. The data suggest that these services should be primarily offered in primary care, but their current organization in Quebec does not adequately address the needs of people with CMD as well as those of their relatives. Over the next few years, different types of nurses will have an expanded role in primary care and will represent a larger portion of the workforce at this level, potentially improving access to services. Nurses and other clinicians are not always aware of the role of nurses in mental health and their contribution to all phases of the continuum of care. Interprofessional collaboration is fundamental to improving mental primary care services and is based on a fair understanding of roles among all members of a team. The objectives of this article are to: 1) describe best practices in primary care for interprofessional collaboration in mental health; 2) discuss the roles of nurses in CMD; and (3) to present avenues of intervention to extend these roles. A conceptualization of nursing roles well integrated into an multiprofessional primary care practice in mental health is presented in this article.


A novel flavonoid from Sophora flavescens.
A new dihydroflavonol named kosamol A (1) has been isolated from the roots of Sophora flavescens (Leguminosae) along with twelve related flavonoids. The structure of 1 was determined to be (2R,3R)-5,7,2'4'-tetrahydroxy-6-(3-hydroxy-3-methylbutyl)-8-lavandulylflavanonol on the basis of spectral analyses.


Nonlocal magnetic field-tuned quantum criticality in cubic CeIn(3-x)Sn(x) (x = 0.25).
We show that antiferromagnetism in lightly (approximately 8%) Sn-doped CeIn3 terminates at a critical field mu0H(c) = 42 +/- 2 T. Electrical transport and thermodynamic measurements reveal the effective mass m* not to diverge, suggesting that cubic CeIn3 is representative of a critical spin-density wave (SDW) scenario, unlike the local quantum critical points reported in anisotropic systems such as CeCu(6-x)Au(x) and YbRh2Si(2-x)Ge(x). The existence of a maximum in m* at a lower field mu0H(x) = 30 +/- 1 T may be interpreted as a field-induced crossover from local moment to SDW behavior as the Néel temperature falls below the Fermi temperature.


Patterns of spatial functioning in Turner's syndrome.
This paper presents results from a study of task performance on a variety of spatial tasks in 9-11 year-old children with Turner's Syndrome (T.S.), divided into those with genotype 45XO and those with Mixed genotypes, including isochromosomes of X and mosaicism. There was a significant overall effect of group reflecting impaired spatial cognition in T.S. with greater decrement in the 45XO group. Further investigation of the significant group by task interaction indicated that the group effects appeared on a visuo-perceptual task and on three visuo-constructional tasks but that there were no specific deficits in the T.S. groups on visuo-spatial or tactile-spatial tasks. In T.S., visuo-perceptual and visuo-constructive sub-systems of spatial skill may be more vulnerable than other components of spatial cognition, to the neuro-biological influences which contribute to the disorder. Such dissociation supports theories of modularity in the development of spatial skill. The spatial tasks which create difficulty overlap only partially with those for which there are sex differences amongst normal children and do not represent a simple exaggeration of normal male-female differences.


When Equal Chances = Good Chances: Verbal Probabilities and the Equiprobability Effect.
When six equally qualified candidates compete for the same position, p = 1/6 for each. People seem to accept this principle more readily for numerical than for verbal probabilities. Equal chances with three to six alternatives are often verbally described in a positive vein as "entirely possible" or "a good chance" and rarely negatively as "doubtful" or "improbable." This equiprobability effect of verbal probabilities is demonstrated in five studies describing job applicants, lottery players, competing athletes, and examination candidates. The equiprobability effect is consistent with a causal (propensity) view of probabilities, where chances are believed to reflect the relative strength of facilitating and preventive causes. If important conditions in support of the target outcome are present (the candidate is qualified for the position), and there is little to prevent it from occurring (no stronger candidates), chances appear to be good. In the presence of obstacles (one stronger candidate), or in the absence of facilitating conditions (the candidate is poorly qualified), chances appear to be poor, even when numerical p values remain constant. The findings indicate that verbal and numerical probability estimates can reflect different intuitions. Copyright 2001 Academic Press.


[Ablation of liver metastases by radiofrequency].
Radiofrequency is a thermal ablative technique that is most often used percuteanously under image guidance. Thermal damage is obtained through frictional heating of a high frequency current. The maximal volume of destruction obtained in one radiofrequency delivery is around 4 cm and consequently, best indication for treatment are tumours below 3 cm. When compared, radiofrequency and surgical removal for tumours below 25 mm in diameter demonstrated a rate of incomplete resection/ablation of 6% and 7.3% respectively. Median survival after the first radiofrequency of a liver metastasis of CRC is reported to be 24 to 52 months with a 5 years overall survival of 18 to 44%. The median overall survival increases from 22 to 48 months depending on the use of radiofrequency ablation as rescue treatment after failure of others, or as a first line treatment. For patients with a single tumour, less than 4 cm, the survival rates at 1, 3, and 5 years are respectively 97%, 84% and 40%, with a median survival of 50 months. Follow-up imaging requires to use contrast-enhanced CT or MRI, looking for local recurrences evidenced by local foci of enhancement at the periphery of the ablation zone.


The inheritance of albinism in a freshwater snail, Physa heterostropha.
Complementation tests revealed that albinism in four laboratory strains of Physa (Physella) heterostropha pomilia resulted from two recessive, nonallelic genes. F2 dihybrid progeny displayed the 9:7 ratio classically associated with reciprocal recessive epistasis between unlinked loci. This offers a contrast to the situation in the better known planorbid snails and provides a valuable tool for the study of reproductive biology in these facultatively self-fertilizing hermaphrodites.


Multiple-beam interference patterns in optical fiber generated with ultrafast pulses and a phase mask.
We compare the cladding patterns present in grating structures fabricated with an ultrafast laser and a phase mask with a cw beam interference model. We find that the observed patterns agree well with the model results for picosecond pulses; however, for femtosecond pulses, we show that the full bandwidth and the pulsed nature of the sources must be considered because the pattern can be affected by group-velocity walk-off. An interesting consequence of order walk-off is the possibility of pure two-beam interference generation with a phase mask in the femtosecond pulse regime.


Rapid in vitro screening of drug-metal ion interactions.
ABSTRACT The toxic side effects of synthetic drugs may, in part, be arising due to their interactions with essential metal ions, especially when the metal ions are administered along with the drug as mineral supplements. In this paper we report the feasibility of establishing such drug-metal ion interactions through in vitro spectrophotometric studies, which are rapid and can be used for routine screening prior to clinical studies. The interaction of the drugs levothyroxine and ranitidine with eight metal ions, copper(II), chromium(III), molybdenum(VI), magnesium(II), calcium(II), iron(II), manganese(II), and zinc(II), commonly used in mineral supplements, was verified through in vitro UV-visible spectrophotometric studies. The experiments were carried out at the physiological pH values 1.5, 7.4, and 8.0 and the concentrations of the drugs and mineral supplements used were comparable to those in their usual doses. These studies indicated interaction between ranitidine and calcium(II), magnesium(II), and iron(II) ions and between levothyroxine and copper(II) and iron(II) ions. A comparison of the results with those reported from clinical studies demonstrated the efficacy of this method.


Computed Tomographic Angiography Used for Localization of the Cutaneous Perforators and Selection of Anterolateral Thigh Flap "Bail-Out" Branches.
The purpose of this study was to evaluate the territory supplied by the lateral circumflex femoral artery for the consistency of a proximal perforator that could be used as an alternative pedicle for the anterolateral thigh flap if a tedious intramuscular course is encountered during elevation of the perforator used to develop the initial surgical plan. It is hypothesized that a consistent "bail-out" perforator supplying the proximal thigh would facilitate a simpler anterolateral thigh flap harvest, with minimal modification to flap design. Computed tomographic images of 9 fresh cadavers were imported using Materialize's Interactive Medical Imaging Control System software to create surface-rendered 3-dimensional reconstructions of 15 lower limbs. Perforators emerging proximally and laterally to a 3-cm radius circle drawn at the midpoint of the anterior superior iliac spine and superolateral patella were considered potential bail-out perforators and evaluated for their number emerging diameter, length, course, and location relative to the anterior superior iliac spine. An average of 2.9 ± 1.8 perforators per limb were identified. Mean pedicle length was 111 ± 20 mm, measured from the origin in the lateral circumflex femoral artery to where the perforators emerged through the deep fascia directly overlying the thigh muscles. Average diameter at origin in the lateral circumflex femoral artery was 2.8 ± 0.8 mm, and that at emergence through the deep fascia was 1.1 ± 0.3 mm. Vessel course was predominantly musculocutaneous (90%). A significant bail-out perforator routinely supplies the proximal anterolateral thigh and may be used as an alternative vascular pedicle for an anterolateral thigh flap if a tedious intramuscular course is encountered during elevation of a perforator identified within the conventional landmarks (3-cm radius circle at the midpoint of the anterior superior iliac spine and superolateral patella).


Climate change and health: Priorities for the CAM community.
This article builds on recent discussions published in academic journals on climate change and health. It introduces four categories within which the CAM community might establish priorities - tactics, specialties, places, research. Within each category, the most pressing issues are highlighted and the ways in which individuals and the sector might respond.


[Effect of total cholesterol level on platelet aggregation in patients with migraine].
In 34 women with simple migraine the total cholesterol concentration in the serum and the platelet aggregation index according to Wu and Hoak were determined. The blood cholesterol levels differed in them. Two groups of patients were isolated: group I with cholesterol level above the upper normal range and group II with cholesterol within this range. The mean concentration of this lipid differed significantly between these groups (p less than 0.001). The platelet aggregation index in group I was significantly lower than in the group with normal cholesterol level (p less than 0.05). During migraine attack a further fall was observed in the platelet aggregation index in the group with high cholesterol level (p less than 0.01). The authors suppose that cholesterol concentration may be one of the factors determining differences in platelet behaviour in migraine patients.


Pollution characteristics and environmental risk assessment of typical veterinary antibiotics in livestock farms in Southeastern China.
Scientific interest in pollution from antibiotics in animal husbandry has increased during recent years. However, there have been few studies on the vertical exposure characteristics of typical veterinary antibiotics in different exposure matrices from different livestock farms. This study explores the distribution and migration of antibiotics from feed to manure, from manure to soil, and from soil to vegetables, by investigating the exposure level of typical antibiotics in feed, manure, soil, vegetables, water, fish, and pork in livestock farms. A screening environmental risk assessment was conducted to identify the hazardous potential of veterinary antibiotics from livestock farms in southeast China. The results show that adding antibiotics to drinking water as well as the excessive use of antibiotic feed additives may become the major source of antibiotics pollution in livestock farms. Physical and chemical properties significantly affect the distribution and migration of various antibiotics from manure to soil and from soil to plant. Simple migration models can predict the accumulation of antibiotics in soil and plants. The environmental risk assessment results show that more attention should be paid to the terrestrial eco-risk of sulfadiazine, sulfamethazine, sulfamethoxazole, tetracycline, oxytetracycline, chlorotetracycline, ciprofloxacin, and enrofloxacin, and to the aquatic eco-risk of chlorotetracycline, ciprofloxacin, and enrofloxacin. This is the first systematic analysis of the vertical pollution characteristics of typical veterinary antibiotics in livestock farms in southeast China. It also identifies the ecological and human health risk of veterinary antibiotics.


Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind, randomized, placebo-controlled study.
In 1994, the Massachusetts Male Aging Study presented an inverse correlation of the serum levels of dehydroepiandrosterone (DHEA) and the incidence of erectile dysfunction (ED). We evaluated the efficacy of DHEA replacement in the treatment of ED in a prospective, double-blind, randomized, placebo-controlled study. The inclusion criteria included ED, normal physical and neurologic examinations, serum levels of testosterone, dihydrotestosterone, prolactin, and prostate-specific antigen (PSA) within the normal range, and a serum DHEA sulfate level below 1.5 micromol/L. Also all patients had a full erection after a pharmacologic erection test with 10O microg prostaglandin E1; pharmacocavernosography showed no visualization in corporeal venous structures. Forty patients from our impotence clinic were recruited and randomly divided into two groups of 20 patients each. Group 1 was treated with an oral dose of 50 mg DHEA and group 2 with a placebo one time a day for 6 months. The International Index of Erectile Function (IIEF), a 15-item questionnaire, was used to rate the success of this therapy. Therapy response was defined as the ability to achieve or maintain an erection sufficient for satisfactory sexual performance according to the National Institutes of Health Consensus Development Panel on Impotence. DHEA treatment was associated with higher mean scores for all five domains of the IIEF. There was no impact of DHEA treatment on the mean serum levels of PSA, prolactin, testosterone, the mean prostate volume, and the mean postvoid residual urine volume. Our results suggest that oral DHEA treatment may be of benefit in the treatment of ED. Although our patient data base is too small to do relevant statistical analysis, we believe that our data show a biologically obvious trend that justifies further extended studies.


The role of physical activity in improving physical fitness in children with intellectual and developmental disabilities.
One in three children in North America are considered overweight or obese. Children with intellectual and developmental disabilities (IDD) are at an increased risk for obesity than their typically developing peers. Decreased physical activity (PA) and low physical fitness may be contributing factors to this rise in obesity. Because children with IDD are at an increased risk of diseases related to inactivity, it is important to improve health-related physical fitness to complete activities of daily living and improve health. The focus of this research is on improving the performance of physical fitness components through physical activity programming among a group of children with IDD, ages 7-12 years. The Brockport Physical Fitness Test was used assess levels of physical fitness of 35 children with IDD (25 boys, 10 girls) before and after participation in a 10-week program. The results of paired sampled t-tests showed participation in 15-h PA program can significantly increase aerobic capacity and muscular strength and endurance in children with IDD. This study is aimed at understanding the role of PA in helping children with IDD to develop the fitness capacities essential to participation in a wide variety of activities.


Activation of ischemia- and reperfusion-sensitive abdominal visceral C fiber afferents. Role of hydrogen peroxide and hydroxyl radicals.
Abdominal ischemia and reperfusion evoke reflex excitation of the cardiovascular system and generate reactive oxygen species. We have shown previously that the reactive oxygen species hydrogen peroxide (H2O2) elicits reflex excitation of the cardiovascular system after serosal application to abdominal organs. However, it is not known if ischemia-sensitive afferents respond to reactive oxygen species or if scavengers such as dimethylthiourea (DMTU) inhibit the response of these afferents to ischemia or reperfusion. Therefore, to provide more information on the neurophysiological mechanisms underlying the activation of these afferents, we studied their responses to H2O2 applied to the receptive field during recordings of single-unit activity of ischemia-insensitive or -sensitive abdominal visceral C fiber afferents in anesthetized cats. Additionally, we recorded single-unit activity of ischemia and reperfusion-sensitive afferents before and after treatment with DMTU (10 mg/kg), which scavenges H2O2 and hydroxyl radicals or the iron chelator deferoxamine (DEF, 10 mg/kg), which inhibits hydroxyl radical formation. Application of 44 mumol H2O2 to afferent endings increased the discharge frequency in nine of 11 ischemia-sensitive units, from 0.01 +/- 0.01 to 0.67 +/- 0.16 impulses per second. In contrast, only one of 10 ischemia-insensitive C fibers responded to H2O2 application. In an additional 13 ischemia-sensitive C fibers, DMTU significantly (p < 0.05) attenuated ischemia-induced increases in discharge frequency from 0.42 +/- 0.18 to 0.24 +/- 0.1 impulses per second (ischemia versus DMTU + ischemia, respectively). In eight additional C fibers, we found that reperfusion after 5 minutes of ischemia was associated with an increase in discharge activity from a baseline activity of 0.02 +/- 0.01 to 0.44 +/- 0.07 impulses per second. DMTU significantly attenuated the reperfusion-induced increases in discharge frequency from 0.08 +/- 0.04 to 0.18 +/- 0.06 impulses per second. DEF significantly (p < 0.05) attenuated the increased discharge activity from 0.39 +/- 0.07 to 0.10 +/- 0.04 impulses per second (ischemia versus DEF + ischemia, respectively) in an additional 11 ischemia-sensitive C fibers. In contrast, iron-saturated DEF did not attenuate ischemia- and reperfusion-induced increases in impulse activity. Thus, ischemia-sensitive but not ischemia-insensitive abdominal visceral afferents respond to H2O2. Furthermore, ischemia- and reperfusion-sensitive afferents decreased their impulse activity to a repeated period of ischemia or reperfusion after DMTU or DEF treatment. These data suggest that reactive oxygen species, particularly H2O2 and hydroxyl radicals, activate abdominal visceral C fibers in the cat during brief periods of ischemia and reperfusion.


Dynamic covalent chemistry of the Nicholas ether-exchange reaction.
The Nicholas ether-exchange reaction was found to be reversible and can be used to synthesize complex molecules in dynamic covalent chemistry (DCC). The Nicholas ether-exchange reaction is used to prepare 20-Crown-6 ether in the presence of potassium salt at low temperature.


Ligation Technologies for the Synthesis of Cyclic Peptides.
Cyclic peptides have been attracting a lot of attention in recent decades, especially in the area of drug discovery, as more and more naturally occurring cyclic peptides with diverse biological activities have been discovered. Chemical synthesis of cyclic peptides is essential when studying their structure-activity relationships. Conventional peptide cyclization methods via direct coupling have inherent limitations, like the susceptibility to epimerization at the C-terminus, poor solubility of fully protected peptide precursors, and low yield caused by oligomerization. In this regard, chemoselective ligation-mediated cyclization methods have emerged as effective strategies for cyclic peptide synthesis. The toolbox for cyclic peptide synthesis has been expanded substantially in the past two decades, allowing more efficient synthesis of cyclic peptides with various scaffolds and modifications. This Review will explore different chemoselective ligation technologies used for cyclic peptide synthesis that generate both native and unnatural peptide linkages. The practical issues and limitations of different methods will be discussed. The advance in cyclic peptide synthesis will benefit the biological and medicinal study of cyclic peptides, an important class of macrocycles with potentials in numerous fields, notably in therapeutics.


L-1416, a novel MDR reversing agent with possible reduced calcium antagonism.
Multidrug efflux transporter P-glycoprotein (P-gp) is highly expressed on membrane of tumor cells and supposed to be implicated in the resistance to tumor chemotherapy. However, currently none of P-gp inhibitors has been approved by Food and Drug Administration not only due to toxicity but also lack of efficacy in clinical trials. To solve the problem, our lab synthesized a novel compound named 1416 [1-(2,6-dimethylphenoxy)-3,4-dimethoxyphenylethylamino) propane hydrochloride] with the hope of high P-gp inhibition and low side effects. Caco-2 cell monolayer and tumor bearing mice were used to evaluate the P-gp inhibition of 1416 in vitro and in vivo, respectively. One of its potential side effects, calcium antagonism was also evaluated. Results showed that 1416 showed a similar P-gp inhibition as verapamil in Caco-2 cell monolayer. No significant difference was observed in antitumor enhancement when the optical isomers of 1416 (D-1416 and L-1416) were co-administered with vinblastine. In calcium antagonism, L-1416 showed less calcium inhibition than both D-1416 and verapamil. The novel compound 1416 could significantly increase the antitumor effects of cytotoxic drugs and one of its optical isomers, L-1416, might be more promising due to its potential low calcium antagonism.


A new compound against Peries rapae from Stellera chamaejasme.
The ethanol extract of Stellera chamaejasme roots exhibited significant bioactivity against Peries rapae. In the course of a search for the active compounds, S-(+)-1,5-diphenyl-3-hydroxy-1-pentanone (1) was isolated and this compound has never been found before in S. chamaejasme as far as we known. The structure was established on the basis of various spectral data, including IR, UV, 1H NMR, 13C NMR, EIMS, and chemical synthesis. Mortality against P. rapae was also determined.


[Paternity probability in the cases of incest].
To calculate the paternity probability in the cases of incest where the alleged father was either the father or the brother of the plaintiff's mother, some algebraic expressions applicable to a simple codominant diallelic genetic marker system were derived by modifying the formulas of Essen-Möller and Komatsu (the both formulas gave the same result). The paternity probability in the incest case is generally lower than that in usual case, because in the former case an allele present in the mother is sometimes found in both the alleged father and the child (plaintiff), even if the alleged father is not true father. The paternity probability in the incest case, however, becomes higher than that in usual case when an allele is common to both the alleged father and the child but not to the mother. The mean value of paternity probability becomes lower, as the relationship becomes closer between the alleged father and the mother.


Early Course of Inflammatory Bowel Disease in a Population-Based Inception Cohort Study From 8 Countries in Asia and Australia.
The incidence of inflammatory bowel disease (IBD) is increasing in Asia, but little is known about disease progression in this region. The Asia-Pacific Crohn's and Colitis Epidemiology Study was initiated in 2011, enrolling subjects from 8 countries in Asia (China, Hong Kong, Indonesia, Sri Lanka, Macau, Malaysia, Singapore, and Thailand) and Australia. We present data from this ongoing study. We collected data on 413 patients diagnosed with IBD (222 with ulcerative colitis [UC], 181 with Crohn's disease [CD], 10 with IBD unclassified; median age, 37 y) from 2011 through 2013. We analyzed the disease course and severity and mortality. Risks for medical and surgical therapies were assessed using Kaplan-Meier analysis. The cumulative probability that CD would change from inflammatory to stricturing or penetrating disease was 19.6%. The cumulative probabilities for use of immunosuppressants or anti-tumor necrosis factor agents were 58.9% and 12.0% for patients with CD, and 12.7% and 0.9% for patients with UC, respectively. Perianal CD was associated with an increased risk of anti-tumor necrosis factor therapy within 1 year of its diagnosis (hazard ratio, 2.97; 95% confidence interval, 1.09-8.09). The cumulative probabilities for surgery 1 year after diagnosis were 9.1% for patients with CD and 0.9% for patients with UC. Patients with CD and penetrating disease had a 7-fold increase for risk of surgery, compared with patients with inflammatory disease (hazard ratio, 7.67; 95% confidence interval, 3.93-14.96). The overall mortality for patients with IBD was 0.7%. In a prospective population-based study, we found that the early course of disease in patients with IBD in Asia was comparable with that of the West. Patients with CD frequently progress to complicated disease and have accelerated use of immunosuppressants. Few patients with early stage UC undergo surgery in Asia. Increasing our understanding of IBD progression in different populations can help optimize therapy and improve outcomes.


[ABO-incompatible liver transplantation for liver failure].
To evaluate the efficacy of ABO-incompatible orthotopic liver transplantation (OLT) in treatment of liver failure. The clinical data of 66 cases of OLT, including 21 cases of ABO-incompatible OLT, for liver failure were retrospectively analyzed. The 3-month, and 1-, 2-, and 3-year survival rates of the ABO-identical group were 84.2%, 77.4%, 67.6%, and 60.1%, respectively, while those of the ABO-incompatible group were 75.6%, 64.0%, 58.2%, and 58.2%, respectively. The mean survival time of the ABO-identical group was (806.0+/-70.0) d, not significantly different from that of the ABO-incompatible group (720.3+/-118.5 d, P=0.417). The acute rejection rate of the ABO-identical group was 8.9%, not significantly different from that of ABO-incompatible group (9.0%, P=0.253). The biliary tract complication rate and infection rate of the ABO-incompatible group were 76.2% and 28.6% respectively, both significantly higher than those of the ABO-identical group (48.9% and 8.9% respectively, P=0.037 and P=0.038). The major causes of death in the ABO-incompatible group were serious infection (5/21) and renal failure (4/21). ABO-incompatible OLT is an acceptable option to cure liver failure in emergency. Intensive perioperative supervision is essential to improve the effect of ABO-incompatible OLT.


The synergy between radiographic and macroscopic observation of skeletal lesions on dry bone.
The diagnosis of bone lesions is a fundamental part of the study of skeletal remains, both in the archeological and forensic context. On the one side, the literature proved the relevance of radiography for the detection of bone lesions; on the other side, the careful macroscopic observation of the morphology of bone lesions is often underestimated. For this study, we examined and performed plain radiography on 14 skeletons of the CAL Milano Cemetery Skeletal Collection diagnosed with rheumatoid arthritis, diabetes, multiple myeloma, metastatic cancer, and osteomalacia to compare the macroscopic morphology and radiographic visualization of bone lesions. At least 200 osteolytic lesions and 65 areas of proliferative bone reaction (either spongiosclerotic or periosteal) were studied. We realized "comparative sets" of macroscopic pictures and radiographic imaging of the same skeletal elements to allow comparisons of detection and recognition of bone lesions. As a result, while trabecular lesions may be lost through naked eye observation, many lesions can also be unperceived on radiographs due to contrast, including periosteal reactions, osteolytic lesions, and spongiosclerosis. The aim of this research was to investigate the strengths and pitfalls of digital radiography and macroscopic analysis and to demonstrate the synergy of a complementary approach between the two methods for lesion analysis in dry bone.


High-resolution computed tomography for the comparative study of fossil and extant bone.
Special methods have been developed to use computed tomography (CT) for 3-dimensional imaging of both fossil and extant bones. Most commercial CT scanners cannot display the internal structure of fossils because the very high density is beyond the upper limits of the normal CT number scale (Hounsfield scale) of the scanners. X-ray projections from CT scans of fossils were modified by scaling the data to provide an expanded CT number scale, allowing the internal structure of highly fossilized objects to be visualized. These images were compared with state-of-the-art, high-resolution CT images of extant bone. Special image reformatting software was used to provide qualitative and quantitative 3-dimensional imaging. The recent rapid advances in CT technology have made this imaging modality the procedure of choice in much of diagnostic radiology. Use of this tool in paleoanthropology has been limited in the past by restricted access to scanners. However, new developments in CT will make this technique available to many researchers in the near future.


Necrotizing otitis externa, otitis media, peripheral facial paralysis, and brain abscess in a thalassemic child after allogeneic BMT.
Severe infection is one of the major complications in the early and late post-bone marrow transplantation period. The authors report a thalassemic child who developed necrotizing otitis externa and otitis media, a very rare complication after bone marrow transplantation, and then peripheral facial nerve paralysis and brain abscess in the early period of bone marrow transplantation despite antibacterial and antifungal prophylaxis. Necrotizing otitis media is characterized by necrosis and sloughing of considerable areas in the middle ear and adjacent tissues and is an unusual disorder because of today's antibiotics. Granulocytopenia and background ear tissue exposed to previous repeated otitis media attacks may be the predisposing factors in this case. The authors conclude that the children with previous histories of recurrent otitis media should be prepared and monitored very carefully during bone marrow transplantation because of the risk of necrotizing otitis media, especially in the granulocytopenic period.


Impact of intravenous loop diuretics on outcomes of patients hospitalized with acute decompensated heart failure: insights from the ADHERE registry.
The optimal use of diuretics in decompensated heart failure remains uncertain. We analyzed data from the ADHERE registry to look at the impact of diuretic dosing. 62,866 patients receiving <160 mg and 19,674 patients > or =160 mg of furosemide were analyzed. The patients receiving the lower doses had a lower risk for in-hospital mortality, ICU stay, prolonged hospitalization, or adverse renal effects. These findings suggest that future studies should evaluate strategies for minimizing exposure to high doses of diuretics.


Management of schizophrenia with medical disorders: cardiovascular, pulmonary, and gastrointestinal.
Medical illnesses are particularly common in patients who have schizophrenia and one of the major tasks for consultation-liaison psychiatrists, and others, is to determine which medications are safest in which co-morbid condition. The authors review the relative risks for various antipsychotics, especially focusing on cardiovascular, pulmonary, and gastrointestinal co-morbid illnesses. The authors further review the atypical antipsychotics' cardiovascular risks, especially for prolonging QT intervals, in trying to avoid the risk for torsades de pointes. The relative risk for anticholinergic actions for these medicines is also reviewed, as this is especially important in the medically ill or elderly. The authors also review the relative safety of antipsychotics in patients who have liver disease and pulmonary disease. Finally, the authors review specific drug interactions that may be problematic when treating the medically ill with atypical antipsychotics.


Interface controlled electronic charge inhomogeneities in correlated heterostructures.
For heterostructures of ultrathin, strongly correlated copper-oxide films and dielectric perovskite layers, we predict inhomogeneous electronic interface states. Our study is based on an extended Hubbard model for the cuprate film. The interface is implemented by a coupling to the electron and phonon degrees of freedom of the dielectric oxide layer. We find that electronic ordering in the film is associated with a strongly inhomogeneous polaron effect. We propose to consider the interfacial tuning as a powerful mechanism to control the charge ordering in correlated electronic systems.


Age-related difference in health care use and costs of patients with chronic kidney disease and matched controls: analysis of Dutch health care claims data.
The financial burden of chronic kidney disease (CKD) is increasing due to the ageing population and increased prevalence of comorbid diseases. Our aim was to evaluate age-related differences in health care use and costs in Stage G4/G5 CKD without renal replacement therapy (RRT), dialysis and kidney transplant patients and compare them to the general population. Using Dutch health care claims, we identified CKD patients and divided them into three groups: CKD Stage G4/G5 without RRT, dialysis and kidney transplantation. We matched them with two controls per patient. Total health care costs and hospital costs unrelated to CKD treatment are presented in four age categories (19-44, 45-64, 65-74 and ≥75 years). Overall, health care costs of CKD patients ≥75 years of age were lower than costs of patients 65-74 years of age. In dialysis patients, costs were highest in patients 45-64 years of age. Since costs of controls increased gradually with age, the cost ratio of patients versus controls was highest in young patients (19-44 years). CKD patients were in greater need of additional specialist care than the general population, which was already evident in young patients. Already at a young age and in the earlier stages of CKD, patients are in need of additional care with corresponding health care costs far exceeding those of the general population. In contrast to the general population, the oldest patients (≥75 years) of all CKD patient groups have lower costs than patients 65-74 years of age, which is largely explained by lower hospital and medication costs.


One-carbon metabolism markers are associated with cardiometabolic risk factors.
Alterations to one-carbon metabolism, especially elevated plasma homocysteine (Hcy), have been suggested to be both a cause and a consequence of the metabolic syndrome (MS). A deeper understanding of the role of other one-carbon metabolites in MS, including s-adenosylmethionine (SAM), s-adenosylhomocysteine (SAH), and the methylation capacity index (SAM:SAH ratio) is required. 118 men and women with MS-risk factors were included in this cross-sectional study and cardiometabolic outcomes along with markers of one-carbon metabolism, including fasting plasma SAM, SAH, Hcy and vitamin B12 concentrations, were analysed. Multiple linear regression models were also used to examine the association between plasma one-carbon metabolites and cardiometabolic health features. We found that fasting plasma concentrations of Hcy, SAM and SAH were all positively correlated with markers of adiposity, including BMI (increase in BMI per 1-SD increase in one-carbon metabolite: 0.92 kg/m2 95% CI (0.28; 1.56), p = 0.005; 0.81 (0.15; 1.47), p = 0.02; 0.67 (-0.01; 1.36), p = 0.05, respectively). Hcy, but not SAM, SAH or SAM:SAH ratio was associated with BMI and body fat percentage after mutual adjustments. SAM concentrations were associated with higher fasting insulin (9.5% 95% CI (0.3; 19.5) per SD increase in SAM, p = 0.04), HOMA-IR (10.8% (0.8; 21.9), p = 0.03) and TNF-α (11.8% (5.0; 19.0), p < 0.001). We found little evidence for associations between SAM:SAH ratio and cardiometabolic variables, but higher plasma concentrations of SAM, SAH and Hcy are related to an overall higher risk of metabolic dysfunctions. The studies were registered at www.clinicaltrials.gov (NCT01719913 &NCT01731366).


Aluminum oxide ceramic ossicular replacement prosthesis.
Two different prototypes of columella materials made from aluminum oxide ceramics were newly designed by the author for ossicular reconstruction. CORP-P (ceramic ossicular replacement prosthesis-partial) is used as a columella to fit onto the stapes head, and CORP-T (ceramic ossicular replacement prosthesis-total) is used as a columella placed onto the footplate of the stapes. In addition to the general properties of ceramic implants, CORP has these two characteristics: the unique shape of its head, which allows easy and smooth contact with the fascia graft, and the radiopacity, which makes it possible to confirm the position of the implants by x-ray examination after implantation.


International pediatric liver cancer pathological classification: current trend.
This review describes the pathological classification of pediatric liver cancer types and subtypes proposed at the recent international symposium (March 2011, Los Angeles, USA) and meetings involving pathologists serving as central reviewers for the Children's Oncology Group, Société Internationale d'Oncologie Pédiatrique, Gesellschaft für Pädiatrische Onkologie und Hämatologie, or Japanese Study Group for Pediatric Liver Tumors, and pediatric oncologists/surgeons specializing in liver cancers, as well as immunohistochemical panels, recommendations for submission, sampling and evaluation of diagnostic specimens. The pathological classification is intended to be standardized and clinically meaningful, thus improving future patient management and prognosis. The most common pediatric liver cancer is hepatoblastoma (HBL). HBL has two types, the wholly epithelial type and the mixed epithelial and mesenchymal (MEM) type. The wholly epithelial type was subdivided into well-differentiated fetal (pure fetal with low mitotic activity), crowded fetal (mitotically active), embryonal, epithelial mixed, small cell undifferentiated, and cholangioblastic. A macrotrabecular pattern and a pleomorphic epithelial pattern were recognized as supplemental features of epithelial components. The MEM type was subdivided into MEM without teratoid features and MEM with teratoid features. Other liver cancers in children were divided into hepatocellular carcinoma (classic hepatocellular carcinoma and fibrolamellar carcinoma) and hepatocellular malignant tumor not otherwise specified. This classification is basically applied to pretreatment specimens; the evaluation of post-chemotherapy specimens will be the subject of further studies.


Comparative study of fully three-dimensional reconstruction algorithms for lens-free microscopy.
We propose a three-dimensional (3D) imaging platform based on lens-free microscopy to perform multiangle acquisitions on 3D cell cultures embedded in extracellular matrices. Lens-free microscopy acquisitions present some inherent issues such as the lack of phase information on the sensor plane and a limited angular coverage. We developed and compared three different algorithms based on the Fourier diffraction theorem to obtain fully 3D reconstructions. These algorithms present an increasing complexity associated with a better reconstruction quality. Two of them are based on a regularized inverse problem approach. To compare the reconstruction methods in terms of artefact reduction, signal-to-noise ratio, and computation time, we tested them on two experimental datasets: an endothelial cell culture and a prostate cell culture grown in a 3D extracellular matrix with large reconstructed volumes up to ∼5 mm3 with a resolution sufficient to resolve isolated single cells. The lens-free reconstructions compare well with standard microscopy.


Comparative analysis of upper ureteral stones (> 15 mm) treated with retroperitoneoscopic ureterolithotomy and ureteroscopic pneumatic lithotripsy.
To investigate an appropriate treatment for patients with upper ureteral stones, > 15 mm in size, by comparing the therapeutic outcomes for those undergoing retroperitoneoscopic ureterolithotomy (RPUL) and rigid ureteroscopic pneumatic lithotripsy (URSPL) retrospectively. During the study period, 81 patients with a large upper ureteral stone (> 15 mm) were divided into two groups. RPUL was performed with retroperitoneal approach, and the stone was removed in group A. URSPL was conducted using a rigid ureteroscope, and pneumatic probe was used for lithotripsy in group B. The patient characteristics, success rate, stone-free rate, operation time, and complications were analyzed prospectively in the two groups. The success rates of operation were 94.5% (34/36) in group A and 88.8% (40/45) in group B, but there were no significant differences between two groups (P > 0.05). After 4 weeks of follow-up, the stone-free rate after RPUL (100%, 34/34) and URSPL (77.5%, 31/40) groups were statistically different (P = 0.006). Furthermore, simultaneous ureterolithotomy and ureteroplasty by retroperitoneal laparoscopic surgery were performed on four patients combined with ureteral stricture. However, the mean operation time and hospital staying time after surgery in group A were longer than that in group B, and the differences were statistically significant (P < 0.05). The complication rate after RPUL (17.6%, 6/34) was lower than that after URSPL (20%, 8/40), but the differences were not statistically significant (P > 0.05). RPUL is a safe and effective treatment technique for large, impacted, upper ureteral stones >15 mm in size when first-line treatments have failed or are unlikely to be effective. It can handle with combined pathologies simultaneously.


Aqueous misdirection syndrome after pars plana vitrectomy for retinal detachment.
Aqueous misdirection syndrome (AMS) typically occurs after surgery for angle closure glaucoma, or surgery in hyperopic eyes with narrow angles. Pars plana vitrectomy (PPV) is often considered the definitive treatment for AMS. The authors describe a rare case of AMS developing de novo after PPV in an eye without any prior history of AMS, angle closure glaucoma, or narrow angles. Interventional case report. A 72-year-old woman with vitreomacular traction syndrome developed an acute rhegmatogenous retinal detachment and underwent an uneventful PPV, posterior hyaloid peel, cryopexy, and C3F8 gas insertion. Initial postoperative raised intraocular pressure (IOP) was successfully managed medically. She returned 6 days postoperatively with a highly elevated IOP refractory to medical treatments, and signs of AMS. She therefore underwent emergency C3F8 removal, phacoemulsification, posterior chamber IOL insertion, anterior vitrectomy, peripheral irido-capsulo-hyaloidectomy, and retamponade with 30% SF6. In 2 years of follow-up, there has been no recurrence of AMS and her IOP has remained normal. This case demonstrates that AMS can develop in vitrectomized eyes without a pre-existing history of AMS, angle closure glaucoma, or narrow angles. AMS should therefore be considered as a potential cause of raised IOP in association with a shallow anterior chamber following vitrectomy.


Cellular gene expression induced by parasite antigens and allergens in neonates from parasite-infected mothers.
Prenatal exposure to parasite antigens or allergens will influence the profile and strength of postnatal immune responses, such contact may tolerize and increase susceptibility to future infections or sensitize to environmental allergens. Exposure in utero to parasite antigens will distinctly alter cellular gene expression in newborns. Gene microarrays were applied to study gene expression in umbilical cord blood cell (UCBC) from parasite-exposed (Para-POS) and non-exposed (Para-NEG) neonates. UCBC were activated with antigens of helminth (Onchocerca volvulus), amoeba (Entamoeba histolytica) or allergens of mite (Dermatophagoides farinae). When UCBC from Para-POS and Para-NEG newborns were exposed to helminth antigens or allergens consistent differences occurred in the expression of genes encoding for MHC class I and II alleles, signal transducers of activation and transcription (STATs), cytokines, chemokines, immunoglobulin heavy and light chains, and molecules associated with immune regulation (SOCS, TLR, TGF), inflammation (TNF, CCR) and apoptosis (CASP). Expression of genes associated with innate immune responses were enhanced in Para-NEG, while in Para-POS, the expression of MHC class II and STAT genes was reduced. Within functional gene networks for cellular growth, proliferation and immune responses, Para-NEG neonates presented with significantly higher expression values than Para-POS. In Para-NEG newborns, the gene cluster and pathway analyses suggested that gene expression profiles may predispose for the development of immunological, hematological and dermatological disorders upon postnatal helminth parasite infection or allergen exposure. Thus, prenatal parasite contact will sensitize without generating aberrant inflammatory immune responses, and increased pro-inflammatory but decreased regulatory gene expression profiles will be present in those neonates lacking prenatal parasite antigen encounter.