Influence of Genotype on Structural Atrial Abnormalities and Atrial Fibrillation or Flutter in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy.
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is associated with desmosomal mutations. Although desmosomal disruption affects both ventricles and atria, little is known about atrial involvement in ARVD/C. To describe the extent and clinical significance of structural atrial involvement and atrial arrhythmias (AA) in ARVD/C stratified by genotype. We included 71 patients who met ARVD/C Task Force Criteria and underwent cardiac magnetic resonance (CMR) imaging and molecular genetic analysis. Indexed atrial end-diastolic volume and area-length-ejection-fraction (ALEF) were evaluated on CMR and compared to controls with idiopathic right ventricular outflow tract tachycardia (n = 40). The primary outcome was occurrence of AA (atrial fibrillation or atrial flutter) during follow-up, recorded by 12-lead ECG, Holter monitoring or implantable cardioverter defibrillator (ICD) interrogation. Patients harbored a desmosomal plakophilin-2 (PKP2) (n = 37) or nondesmosomal phospholamban (PLN) (n = 14) mutation. In 20 subjects, no pathogenic mutation was identified. Compared to controls, right atrial (RA) volumes were reduced in PKP2 (P = 0.002) and comparable in PLN (P = 0.441) mutation carriers. In patients with no mutation identified, RA (P = 0.011) and left atrial (P = 0.034) volumes were increased. Bi-atrial ALEF showed no significant difference between the groups. AA were experienced by 27% of patients and occurred equally among PKP2 (30%) and no mutation identified patients (30%), but less among PLN mutation carriers (14%). Genotype influences atrial volume and occurrence of AA in ARVD/C. While the incidence of AA is similar in PKP2 mutation carriers and patients with no mutation identified, PKP2 mutation carriers have significantly smaller atria. This suggests a different arrhythmogenic mechanism.


Regulated expression of an osteonectin variant in bovine aortic endothelial cells.
Using a mouse SPARC (Secreted Protein, Acidic and Rich in Cysteine) cDNA clone as the probe, three clones were isolated from a cDNA library of bovine aortic endothelial cells (BAEC). Inserted sequences in them were identical with that of bovine bone osteonectin except for the deletion of the TGC codon encoding Cys-193. Northern blot analysis and metabolic radio-labeling of BAEC showed that gene expression and synthesis of the osteonectin variant is stimulated by transforming growth factor (TGF) beta, a basic fibroblast growth factor (FGF), or a naturally occurring splicing variant of hepatocyte growth factor (varHGF).


An Update on Bariatric Surgery.
Obesity is a serious problem facing patients and healthcare providers around the globe. Bariatric surgery has been an increasingly popular choice in the management of obesity, and the last five years have seen an enormous amount of research on the various procedures. Recently bariatric surgery has been recognized as an important modifier of the metabolic and hormonal states associated with obesity's comorbidities. Consequently, research regarding the effect of bariatric procedures on type 2 diabetes mellitus, dyslipidemia, and the inflammatory state has become more plentiful. As bariatric surgery has matured, a growing body of evidence and experience has accrued. A change in the relative popularity of the four major laparoscopic bariatric procedures; sleeve gastrectomy, roux-en-Y gastric bypass, adjustable gastric band, and biliopancreatic diversion with duodenal switch has taken place. This has been driven by technical factors, as well as the individual procedures' efficacy in weight-loss and improvement in comorbidities. Weight recidivism is an increasingly recognized problem as patients are followed for longer periods following their bariatric operations. This important and costly problem has roots in both technical and patient related factors.


Regulation of glnB gene promoter expression in Azospirillum brasilense by the NtrC protein.
In Azospirillum brasilense the glnB and glnA genes are clustered in an operon regulated by three different promoters: two located upstream of glnB (glnBp1-sigma(70), and glnBp2-sigma(N)) and one as yet unidentified promoter, in the glnBA intergenic region. We have investigated the expression of the glnB gene promoter using glnB-lacZ gene fusions, mutation analysis, heterologous expression and DNA band-shift assays. Deletion of the glnB promoter region showed that NtrC-binding sequences were essential for glnB expression under nitrogen limitation. The A. brasilense NtrC protein activated transcription of glnB-lacZ fusions in the heterologous genetic background of Escherichia coli. Expression of glnB-lacZ fusions in two A. brasilense ntrC mutants differed from that in the wild-type strain. In vitro studies also indicated that the purified NtrC protein from E. coli was able to bind to the glnB promoter region of A. brasilense. Our results show that the NtrC protein activates glnBglnA expression under nitrogen limitation in A. brasilense.


The "cost" of operative training for surgical residents.
There is an increase in the amount of time required to perform an operation when the procedure involves training a surgical resident. This increased time does not translate into a financial burden for the hospital. Retrospective review of prospectively collected data. During the study period, surgeons and residents were blinded to the study's intent. We compared the operative times of academic surgeons performing 4 common surgical procedures before and after the introduction of a postgraduate year 3 resident into a community teaching hospital. Between January 1, 2001, and June 30, 2002, 4 academic surgeons performed operations without a resident in a community hospital that was recently integrated into a tertiary medical center system. During that period, surgeons operated alone (hernia surgery) or assisted one another (laparoscopic cholecystectomy, colectomy, and carotid endarterectomy). From July 1, 2002, through March 31, 2003, these same 4 surgeons were assisted by a postgraduate year 3 resident on similar procedures. Community hospital recently integrated into a tertiary medical center system. Four experienced academic surgeons operating in the community setting and patients undergoing 1 of 4 surgical procedures (inguinal hernia repair, laparoscopic cholecystectomy, partial colectomy, or carotid endarterectomy) from January 1, 2001, through March 31, 2003. The introduction of a postgraduate year 3 surgical resident rotation into a community hospital in which the same academic surgeons had been performing operations without a resident for 18 months. Mean operating time with and without a postgraduate year 3 resident participating in 4 common surgical procedures. Result For the 4 procedures studied, there was a significant increase in the operative time required to complete such procedures. There is an increased time cost associated with the operative training of surgical residents. This "cost" primarily impacts the attending surgeon.


Maternal HIV-1 DNA load and mother-to-child transmission.
While many factors contribute to mother-to-child transmission (MTCT) of HIV-1, maternal plasma HIV-1 RNA viral load (RNA-VL) has been consistently found as the main risk factor, including when antiretroviral prophylaxis was used to prevent MTCT. However the predictive value of RNA-VL is poor. A recent study of HIV-1-positive pregnant women who did not receive antiretroviral prophylaxis reported an association between HIV-1 DNA viral load (DNA-VL) and MTCT that was stronger than the association between RNA-VL and MTCT. We sought to determine if HIV-1 DNA-VL was independently associated with MTCT of HIV in a population of women who received zidovudine prophylaxis during pregnancy and whose infants received zidovudine after birth. Patients were 33 non-breastfeeding transmitting (TR) and 33 nontransmitting mothers (NTR) from Perinatal HIV Prevention Trial (PHPT-1), a multicenter clinical trial conducted in Thailand comparing zidovudine prophylaxis durations to prevent MTCT. TR and NTR mothers were matched according to baseline RNA-VL. Maternal peripheral blood mononuclear cell (PBMC)-associated HIV-1 DNA was extracted from whole blood, and DNA-VL was established by quantitative real-time polymerase chain reaction. We found that TR had a significantly higher cell-associated HIV-1 DNA viral load than did NTR. Median TR DNA-VL was 2.54 log(10) copies per microgram PBMC DNA, while it was 2.28 log(10) copies per microgram PBMC DNA in NTR (Wilcoxon p = 0.02). In summary, HIV-1 DNA viral load was associated with MTCT in a population of women who received antiretroviral prophylaxis during pregnancy, independently from RNA viral load.


Effects of demographic factors on cortical thickness in Alzheimer's disease.
The aim of this study was to investigate the effect of demographic factors (age of onset, sex and years of education) on the distribution of cortical thickness in a large sample of patients with Alzheimer's disease (AD). The study participants consisted of 193 AD patients and 142 controls with no cognitive impairment (NCI) that were measured with cortical thickness across the entire brain. The effects of demographic factors on cortical thickness were analyzed by applying linear regression after controlling confounding factors. Older individuals in NCI group showed more cortical thinning in frontal, temporal association cortices and insula than younger participants. Early onset AD was associated with cortical thinning in the parietal lobe, whereas late onset AD was associated with cortical thinning in the medial temporal region. The NCI group demonstrated sex-related differences in cortical thickness, although those differences were not present in the AD group. While the education effect was absent in NCI individuals, high levels of education in the AD group correlated with cortical thinning in the frontal and temporoparietal association cortices. Our results show that AD with earlier onset and higher education had suffered more pronounced cortical atrophy in specific parts of the brain than their counterparts, which may be related to cognitive reserve theory.


Mammography equipment: principles, features, selection.
1. Three-phase and constant potential generators may offer advantages over single-phase generators. These include shorter exposure times with less chance for motion unsharpenss, more adequate exposure and possible lower dose, and longer tube life. 2. Control of tube voltage in increments of 1 kVp are desirable for screen-film mammography and 2 kVp for xeromammography. 3. Tube loading limitations should be capable of allowing an adequate mA and mAs output. A mammography unit with a lower mA output may require longer exposure times with consequent motion unsharpness and/or higher dose. The maximum mA output is limited by the power rating of the tube and not by the power rating of the generator, which is usually much higher. Thus, tube rating charts rather than generator power rating should be used to compare the mA output of different mammography units. 4. Phototimer capability can reduce exam time, facilitate proper exposure, and reduce radiation dose. Units with a greater number of density steps and three or more photocell locations, one of which is near the edge of the film holder, provide better phototimer results. 5. A molybdenum target, beryllium window tube with 0.03 mm molybdenum added filtration is presently preferred for screen-film mammography. A tungsten target tube with 1 to 2 mm added aluminum filtration is advised for xeromammography. 6. Effective local spot size for contact mammography should be in the range of 0.2 to 0.5 mm. However, high resolution also requires sufficiently long source-to-image-receptor distances. Using measured focal spot size and source-to-image-receptor distance, it has been shown that some mammography units do not fully utilize the resolution capabilities of some available screen-film systems. On the other hand, a focal spot that is too small may limit the field size and lead to uneven energy distribution in the x-ray field. 7. In order to perform standard and supplementary mammographic projections, the C arm assembly must be capable of being located at multiple positions within a 180 degrees rotation. Greater degrees of rotation are not required. 8. The heat dissipation capability should be adequate to accommodate the anticipated work-load in terms of number of patients and patient scheduling. A mammographic unit with an anode heat capacity of 90,000 heat units or more should be adequate for most practices. A mammography unit with a heat capacity of 20,000 heat units or less may require waiting time between exposures or studies in a high-volume mammography practice. 9. The compression plate should be made of plastic, usually 1 to 4 mm thick.(ABSTRACT TRUNCATED AT 400 WORDS)


Human cytomegalovirus persistent infection in a human central nervous system cell line: production of a variant virus with different growth characteristics.
The susceptibility of human central nervous system cell lines to human cytomegalovirus (HCMV) and the fate of infected cultures were studied. Significant amounts of infectious progeny virus were produced in 118MGC glioma and IMR-32 neuroblastoma, but not in KGC oligodendroglioma cells when the cultures were infected with wild-type virus (HCMVwt) at an m.o.i. of 10 p.f.u. per cell. Further passage of infected 118MGC cells resulted in the establishment of a long-term persistent infection. This infection, designated 118MGC/Towne, continuously produced infectious virus (HCMVpi) with titres ranging from 10(2) to 10(5) p.f.u./10(6) cells up to 360 days post-infection (corresponding to 50 subcultures). Since no temperature-sensitive mutants, defective interfering particles or interferon-like activity were found in the 118MGC/Towne cultures, maintenance of the persistent infection seemed to be due to a balance between the release of infectious virus and the growth of uninfected cells. The HCMVpi produced in long-term persistently infected cultures was shown to be different from the HCMVwt originally used to infect by the following characteristics: HCMVpi replicated slowly and yielded lower amounts of progeny virus than HCMVwt; HCMVpi induced a 73,000 mol. wt. immediate early protein that was not synthesized in HCMVwt-infected cells; HCMVpi had a different DNA structure from that of HCMVwt. These results suggest that HCMVpi is a slower growing variant of HCMVwt and probably plays an important role in the maintenance of the persistent infection.


Personality aspects in multiple sclerosis.
To test the claim that peculiar personality bias is detectable in multiple sclerosis (MS) we used the Szondi test to investigate the psychodynamic aspects of 110 MS patients in comparison with 200 healthy subjects. MS patients appeared to have a greater need for love in a passive form than normal people, rigid defense mechanisms, difficulty in resolving their inner conflicts either by sublimation or by internalization of satisfactory new emotional experiences, feelings of autoaggressiveness, and many symptoms of depression. Some of these aspects correlate with the severity of the disease, others seem to date back to early childhood as peculiar personality patterns. An investigation of childhood events in 110 controls confirmed that MS patients had had many more unhappy experiences in childhood than might commonly be expected. Further, the oft-reported psychiatric troubles preceding MS clinical onset suggest that at least in some MS patients there are specific gaps in personality structure dating back to early phases of their development.


Growth hormone secretion in the guinea-pig.
The guinea-pig is unusual in that it continues to grow at a normal rate after hypophysectomy. Although its pituitary gland appears to contain a GH, this has not been isolated or characterized, and nothing is known about its secretion or physiological control. We have identified guinea-pig GH, established a sensitive heterologous radioimmunoassay and adapted our automatic blood microsampling method to study spontaneous GH secretion in this species. In male guinea-pigs, GH is released in an episodic pattern, reminiscent of the rat. Large multicomponent pulses of GH secretion occur every 3-4 h between periods of low or undetectable GH release, whereas most females showed a more uniform pulsatile pattern with pulses every 1-2 h. GH was released in response to GH-releasing factor (GRF) injections (2, 10 or 20 micrograms [Nle27]-GRF(1-29)NH2) in a dose-dependent fashion, and i.v. infusion of somatostatin (50 micrograms/h) blocked spontaneous GH pulses, eliciting a rebound release (from 2.0 +/- 0.8 (S.E.M.) to 36 +/- 17 micrograms/l 30 min after stopping the infusion). Infusions of a GH-releasing hexapeptide (100 or 400 micrograms/h for 4 h) also released GH. These results provide the first description of the pattern of GH release in the guinea-pig, and suggest that the striking episodic pattern is controlled by the same hypothalamic peptides that regulate GH in other species. Since the guinea-pig grows well in the absence of GH, this species may use GH for its metabolic, rather than growth-promoting actions. The guinea-pig may well prove a useful model, now that methods are available for studying its endogenous GH secretion.


Examination of expert and novice teachers' constructivist-oriented teaching practices using a movement approach to elementary physical education.
The purpose of this study was to describe the characteristics of expert and novice teachers' constructivist-oriented teaching practices while using a movement approach to teach elementary physical education. Three expert and three novice teachers' constructivist-oriented teaching practices (18 lessons, 3 each) were evaluated using the Educational Games Observation Rubric (EGOR), a rubric specifically designed and validated for this study. Data sources included transcripts of two formal interviews with each teacher, transcripts of the 18 videotaped lessons, and coding from the EGOR. The expert teachers were more likely than the novice teachers to facilitate students' self-regulation and critical thinking about movement quality, to link new learning to students' prior knowledge and emerging relevance, and to guide students' social interaction. As with the expert teachers, the novice teachers encouraged students to engage in, elaborate on, and share ideas about movement variety tasks.


Second-order time correlations within a polariton Bose-Einstein condensate in a CdTe microcavity.
Second-order time correlations of polaritons have been measured across the condensation threshold in a CdTe microcavity. The onset of Bose-Einstein condensation is marked by the disappearance of photon bunching, demonstrating the transition from a thermal-like state to a coherent state. Coherence is, however, degraded with increasing polariton density, most probably as a result of self-interaction within the condensate and scatterings with noncondensed excitons and polaritons. Such behavior clearly differentiates polariton Bose condensation from photon lasing.


Here to stay: clinician investigator training in a changing environment.
Clinician investigators (CI) are a growing sector within the research community. Given the emphasis on patient-oriented research, the need for more physicians with the aptitude to conduct translational research has never been greater. Despite this, there is limited literature on the current Canadian CI training programs. The Clinician Investigator Trainee Association of Canada (CITAC) has a significant interest in ensuring the training of clinician instigators, at both the undergraduate and residency levels, remains adept at meeting the challenges of today's health care system. In the August issue of Clinical Investigative Medicine, Appleton et al. published the first document reporting on the data collected by CITAC on the basic demographics of Canadian CI trainees [3]. The authors captured census data from each CI training program. This collaborative and national effort is a first and crucial step in understanding the strengths and potential pitfalls of Canadian CI training programs. The data presented will be used as a reference resource to improve training programs and facilitate future research.


Induction of nuclear deoxyribopyrimidine triphosphatase and sensitivity of clinical isolates of herpes simplex virus to (E)-5-(2-bromovinyl)-2'-deoxyuridine.
In a blind study, 21 clinical isolates of herpes simplex virus which had been typed using differential growth on guinea pig embryo versus chicken embryo cells were tested for the presence of the viral deoxyribopyrimidine triphosphatase. In all isolates of type 1, the triphosphatase was present in the nuclei of the infected cells, while none of the HSV-2 isolates induced a nuclear enzyme. In all isolates there was a complete correlation between the presence of nuclear deoxyribopyrimidine triphosphatase and sensitivity to 0.7 microgram/ml of E-5-(2-bromovinyl)-2'-deoxyuridine. The study suggests that the type-specific distribution of the triphosphatase is of general validity, including clinical isolates of herpes simplex virus, and could be used as a type-specific enzyme marker.


Functions of the extracellular matrix and matrix degrading proteases during tumor progression.
Cell interactions with extracellular matrices are important to pathological changes that occur during cell transformation and tumorigenesis. Several extracellular matrix proteins including fibronectin, thrombospondin-1, laminin, SPARC, and osteopontin have been suggested to modulate tumor phenotype by affecting cell migration, survival, or angiogenesis. Likewise, proteases including the matrix metalloproteinases (MMPs) are understood to not only facilitate migration of cells by degradation of matrices, but also to affect tumor formation and growth. We have recently demonstrated an in vivo role for the RGD-containing protein, osteopontin, during tumor progression, and found evidence for distinct functions in the host versus the tumor cells. Because of the compartmentalization and temporal regulation of MMP expression, it is likely that MMPs may also function dually in host stroma and the tumor cell. In addition, an important function of proteases appears to be not only degradation, but also cleavage of matrix proteins to generate functionally distinct fragments based on receptor binding, biological activity, or regulation of growth factors.


Energy research: accelerator builders eager to aid fusion work.
Useful fusion energy may be generated by means of heavy ion accelerator driven implosions if the contraints dictated by the physics and economics of thermonuclear targets and reactors can be satisfied.


The operating room--perceptions of a change in working environment.
The questionnaire surveyed OR staff on themes such as design, security, and workload. Surgical nurses had greater expectations for their roles and functions in the new facility. Levels of physical comfort improved; however, mood was not affected positively.


[Preparation of egg yolk immunoglobulin (IgY) against p53 protein expressed in E.coli].
To isolate immunoglobulin (IgY) from egg yolk of p53 protein-immunized hens and to study its reactivity to the antigens. Immunization of egg-laying hens was performed for 3 times at the interval of 14 days with purified p53 protein that had been expressed in E.coli. The eggs laid by these immunized hens were then collected during the whole period of the experiment to prepare IgY from egg yolk by ammonium sulfate precipitation. Final purification and identification of the IgY were performed using SDS-PAGE, enzyme-linked immunosorbent assay and Western blotting. All immunized hens developed specific antibodies to p53 protein in contrast to the control ones. The highest titers of the IgY occurred 4 weeks after the first immunization and reached 1:10(6), which remained stable for up to 3 months. IgY technology is less costly, non-invasive, fast, simple and highly efficient to generate polyclonal antibodies.


Intravenous magnesium sulfate may relieve restless legs syndrome in pregnancy.
We report a case of restless legs syndrome that improved after intravenous magnesium sulfate administration. A 34-year-old gravida 1 para 0 woman, with a 13-year history of restless legs syndrome, was prescribed bed rest due to pre-term labor at 26 weeks. While at rest, the subject experienced severe restless legs syndrome. The subject was later admitted to the hospital for pre-term labor. Treatment for pre-term labor included intravenous magnesium sulfate. RLS symptoms completely resolved during treatment, beginning the first day of administration. Studies involving intravenous magnesium treatment for restless legs syndrome have not included pregnant women. The authors propose that intravenous magnesium sulfate may alleviate restless legs syndrome in some pregnant women.


Relationships between densitometric and morphological parameters as measured by peripheral computed tomography and the compressive behavior of lumbar vertebral bodies from macaques (Macaca fascicularis).
The measured maximum compressive force and stress of lumbar vertebral bodies from cynomolgus monkeys were compared with peripheral quantitative computed tomography (pQCT) derived densitometric and morphologic vertebral parameters. To determine, which pQCT parameters were predictive of vertebral mechanical behavior, and of these, identify those that were the best predictors of vertebral load capacity. A secondary objective was to test the suitability of a multiple parameter-based approach for predicting vertebral mechanical load response. Noninvasive methods for identifying and diagnosing changes in skeletal load tolerance are imperative for early detection of bone diseases such as osteoporosis. It is currently unclear, which densitometric and morphologic parameters are the best predictors of the mechanical performance of bone tissues. Seventy-seven monkey lumbar vertebrae from the species Macaca fascicularis were tested. Following midbody cross-sectional pQCT scans of each specimen, specimens were loaded in axial compression until failure. The pQCT parameters were evaluated independently for correlation with the mechanical response of the vertebral bodies. The parameters were also incorporated in a stepwise linear regression analysis to determine their correlation with the mechanical behavior of the vertebrae. Several pQCT parameters correlated significantly with mechanical behavior. Of these, the trabecular area and the cortical/subcortical area had the strongest associations with the maximum load and stress magnitudes, respectively. The stepwise inclusion of additional predictors, while able to explain additional variance, did not significantly improve predictions of the response of the vertebral bodies to loading. pQCT parameters are quantitatively related to tissue mechanical behavior. The parameters often used in clinical evaluations were not found to be superior to some other pQCT parameters, and inferior to others. This suggests that the inclusion of additional morphologic parameters would improve estimates of the tissue mechanical tolerance over using densitometric parameters alone.


Polycystic nephropathy in slender lorises (Loris lydekkerianus).
In a colony of slender lorises, 20 deaths that occurred over a period of 11 years were investigated postmortem. Juvenile/adult polycystic nephropathy was observed in one newborn and 13 adult slender lorises. Although polycystic kidney disease (PKD) in humans and other animals is known to be inherited, it is not clear whether kidney alterations in slender lorises are genetically transmitted, stress related, or induced by microbiological influences.


Latanoprost induces matrix metalloproteinase-1 expression in human nonpigmented ciliary epithelial cells through a cyclooxygenase-2-dependent mechanism.
Prostaglandins (PGs) have been implicated in the regulation of intraocular pressure (IOP) by facilitating the remodeling of tissues involved in aqueous humor outflow. A contribution of cyclooxygenase-2 (COX-2)-dependent PGs to this process was emphasized by a recent study showing an impaired COX-2 expression in the nonpigmented ciliary epithelium (NPE) of patients with primary open-angle glaucoma. With the use of human NPE cells (ODM-2), the present study therefore investigated the effect of the antiglaucomatous drug latanoprost (PGF2alpha analog) on the expression of COX-2 and its association with the induction of matrix metalloproteinases (MMPs). In NPE cells, latanoprost led to a concentration- and time-dependent increase of COX-2 mRNA levels. Up-regulation of COX-2 expression was accompanied by phosphorylations of p38 mitogen-activated protein kinase (MAPK) and p42/44 MAPK and was abrogated by specific inhibitors of both pathways. PGE2 formation by latanoprost was abolished by the selective COX-2 inhibitor NS-398 and by the F-prostaglandin receptor antagonist AL-8810. Moreover, latanoprost led to a delayed up-regulation of MMP-1 mRNA, whereas the expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 remained unchanged. Latanoprost-induced MMP-1 mRNA and protein expression was abolished by NS-398 and by COX-2-silencing small-interfering RNA. In line with this finding, MMP-1 expression was also induced by PGE2, a major COX-2 product. As a whole, our results show that MMP-1 expression by latanoprost requires prior up-regulation of COX-2. Induction of COX-2- and subsequent MMP-1 expression in the NPE may represent a potential mechanism underlying the IOP-lowering and antiglaucomatous action of latanoprost.


MR appearance of gallstones in vitro at 1.5 T: correlation with chemical composition.
Gallstones from 63 patients were evaluated by in vitro 1.5-T MR imaging, with T1- and T2-weighted images, and in 14 cases, a fat-suppression sequence (short-T1 inversion recovery imaging). Subsequent chemical analysis was performed on 43 gallstones. In vitro proton MR spectroscopy was performed on 14 stones. On T1-weighted MR images, foci of increased signal were seen in 46 of 63 stones (faint in 17, moderate in nine, and bright in 20). T2-weighted images showed areas of increased signal in 18 of 63 stones (faint in 15, moderate in three). T1-weighted MR imaging patterns were homogeneously dark (17), homogeneously bright (two), homogeneously faint (three), rimmed (dark rim and bright center, 32), and laminated (nine). Short-T1 inversion recovery imaging suppressed the foci of increased signal in 13 of 14 cases. Despite imaging characteristics suggestive of high lipid content, spectroscopy revealed only a single peak corresponding to a large water-proton signal. The T1 relaxation times of the water were shortened, ranging from 0.006 to 0.92 sec, explaining the increased signal seen on MR images of the gallstones. MR imaging characteristics (signal intensity, relative signal area, or imaging patterns) did not correlate with chemical composition. We hypothesize that different structural relationships must exist within gallstones of similar chemical content that alter the water bonding and hence the MR imaging characteristics.


Inflammatory markers are altered in severe mental disorders independent of comorbid cardiometabolic disease risk factors.
Inflammation and immune activation have been implicated in the pathogenesis of severe mental disorders and cardiovascular disease (CVD). Despite high level of comorbidity, many studies of the immune system in severe mental disorders have not systematically taken cardiometabolic risk factors into account. We investigated if inflammatory markers were increased in schizophrenia (SCZ) and affective (AFF) disorders independently of comorbid CVD risk factors. Cardiometabolic risk factors (blood lipids, body mass index and glucose) and CVD-related inflammatory markers CXCL16, soluble interleukin-2 receptor (sIL-2R), soluble CD14 (sCD14), macrophage inhibitory factor and activated leukocyte cell adhesion molecule (ALCAM) were measured in n = 992 patients (SCZ, AFF), and n = 647 healthy controls. We analyzed the inflammatory markers before and after controlling for comorbid cardiometabolic risk factors, and tested for association with psychotropic medication and symptom levels. CXCL16 (p = 0.03) and sIL-2R (p = 7.8 × 10-5) were higher, while sCD14 (p = 0.05) were lower in patients compared to controls after controlling for confounders, with significant differences in SCZ for CXCL16 (p = 0.04) and sIL-2R (p = 1.1 × 10-5). After adjustment for cardiometabolic risk factors higher levels of sIL-2R (p = 0.001) and lower sCD14 (p = 0.002) remained, also in SCZ (sIL-2R, p = 3.0 × 10-4 and sCD14, p = 0.01). The adjustment revealed lower ALCAM levels (p = 0.03) in patients. We found no significant associations with psychotropic medication or symptom levels. The results indicate that inflammation, in particular enhanced T cell activation and impaired monocyte activation, are associated with severe mental disorders independent of comorbid cardiometabolic risk factors. This suggests a role of novel pathophysiological mechanisms in severe mental disorders, particularly SCZ.


Extended lymphadenectomy in colon cancer is debatable.
Extended lymphadenectomy has gained considerable attention as an adjunct to conventional colon cancer surgery with the hope that it may potentially decrease local recurrence rates and improve cancer-specific outcome measures. Despite the enthusiasm surrounding these techniques, it is difficult to establish any additional survival benefit associated with more comprehensive lymphadenectomy strategies when these are performed in addition to conventional colon cancer surgery. Furthermore, these techniques remain unproven by large randomized clinical trials. The appropriate indications for performing extended lymphadenectomy also remain unclear, and there is a lack of standardization with regard to surgical technique. Moreover, there are a number of confounding factors that frequently receive little attention when oncological outcome measures are reported following extended lymphadenectomy in the setting of colon cancer. The purpose of this review is to outline these confounding issues and discuss their impact on reports describing cancer-specific outcome measures following the use of extended lymphadenectomy techniques. Furthermore, this review proposes that in light of the available published evidence, the role of radical lymphadenectomy is currently unproven, with large randomized clinical trials required in the future to determine whether there is a survival benefit for colon cancer patients.


Information loss in the continuum limit and Schrödinger's equation in an electromagnetic field.
Since the time of Einstein's work on Brownian motion it has been known that random walks provide a microscopic model for the diffusion equation. Less well known is the fact that some instances of Schrödinger's equation occur naturally in the description of the statistics of these same walks and thus have classical contexts which are distinct from their usual association with quantum mechanics. An interesting feature of these models is the fact that the information which relates Schrödinger's equation to its classical context is not contained in the partial differential equation itself, but is lost in the continuum limit which gives rise to the equation. In this article we illustrate the above by showing that Schrödinger's equation for a particle in an electromagnetic field in 1 + 1 dimension occurs as a continuum limit of a description of a classical system of point particles on a lattice. The derivation shows that the information lost in the continuum limit is necessary to link the mathematics to the physical context of the equation.


Purinergic actions on neurons that modulate nociception in the rostral ventromedial medulla.
The rostral ventromedial medulla (RVM) serves as a critical link in bulbo-spinal nociceptive modulation. Within the RVM, 'off-cells' pause and 'on-cells' discharge immediately prior to a nocifensive reflex. These neurons are also activated and inactivated, respectively, by local or systemic application of opioids. Off-cell activation leads to behavioral anti-nociception and on-cell activation to hyperalgesia. Thus, on- and off-cell populations allow bi-directional modulation of nociception by the RVM. A third neuronal population, neutral cells, shows no reflex-related change in discharge. The role of neutral cells in nociception, if any, is unknown. We investigated the responses of on-, off- and neutral cells to the iontophoretic application of purinergic ligands in lightly anesthetized rats. On-cell firing increased rapidly in response to application of ATP and to the P2X-receptor agonist, alpha,beta-methylene ATP. Off-cell firing increased gradually in response to ATP and to the P2Y-receptor agonist, 2-methylthio-ATP. All of these responses were attenuated or reversed by the non-specific P2-receptor antagonists, suramin and pyridoxal-phosphate-6-azophenyl-2',4'-disulfonic acid (PPADS). Activation of off-cells was preferentially antagonized by the relatively selective P2Y antagonist, MRS2179. By contrast with activation of on- and off-cells by ATP, neutral cell firing was depressed by ATP, adenosine and the P1-receptor agonist, 5'-(N-ethylcarboxamido) adenosine (NECA). Neutral cell responses to these agonists were at least partially reversed by the adenosine-receptor antagonist, 8-phenyltheophylline (8PT). These data imply that on-cells preferentially express P2X-receptors, off-cells P2Y-receptors and neutral cells P1-receptors. Immunohistochemical localization of purinergic receptors confirms the presence of some subtypes of P2X, P2Y and A1 receptors on neuronal cell bodies and fibers within the RVM. The differential responses of on-, off- and neutral-cells to purinergic ligands highlight the value of pharmacological signatures in further delineation of the anatomy, connectivity and function of this therapeutically important system.


Telephone-administered cognitive behavioral therapy for veterans served by community-based outpatient clinics.
Multiple trials have found telephone-administered cognitive behavioral therapy (T-CBT) to be effective for the treatment of depression. The aim of this study was to evaluate T-CBT for the treatment of depression among veterans served by community-based outpatient clinics (CBOCs) outside of major urban areas. Eighty-five veterans meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for major depressive disorder were randomized to receive 16 sessions of T-CBT over 20 weeks or treatment as usual through the CBOC. Veterans were assessed at baseline, 12 weeks, 20 weeks (posttreatment), and 6-month follow-up using the Hamilton Depression Rating Scale (Hamilton, 1960), the Patient Health Questionnaire-9 (Kroenke, Spitzer, & Williams, 2001), and a standardized psychiatric interview. There were no significant Time × Treatment effects (ps > .20). Patients were compliant, with 38 (92.7%) completing at least 12 sessions, and 32 (78.0%) having no missed sessions whatsoever. Ratings of audiotaped sessions showed the therapists to be highly competent. This trial yielded negative results for an intervention that has been shown to be effective under other circumstances. We speculate that veterans served within the Veterans Affairs system are more refractory to treatment than other populations, and they may require a more rigorous intervention. clinicaltrials.gov NCT00223652.


[Water-electrolyte and acid-base changes. IV. Water metabolism and water balance].
Two interrelated physiologic feedback systems, thirst and antidiuretic hormone, serve to regulate water balance, and thereby body fluid osmolality. These two systems share at least one common receptor component: a device for sensing body fluid tonicity, the hypothalamic osmoreceptor. The output of the osmoregulatory system is subserved by two distinct effector components: oral water ingestion and renal water excretion. Acting in concert, these two processes serve to maintain body fluid osmolality. Under normal circumstances body fluid osmolality is carefully maintained within precisely defined limits. For body fluid osmolality to remain constant, the amount of water lost each day (by insensible, gastrointestinal, and renal routes), must be replenished by the ingestion of water and, to a lesser extent, by the production of "metabolic" water from the catabolism of foodstuffs.


Fringe phenotypes in autism: a review of clinical, biochemical and cognitive studies.
Progress in identifying the genetic vulnerability factors in autism requires correct identification of the inherited phenotype(s). This can be achieved not only by the accurate description of the affected subject but also by the identification of vulnerability traits in non-affected relatives of autistic probands. This review will focus on this last strategy and principally on clinical, biochemical and cognitive traits.


The outcome of fractures of the distal radius in young adults.
Fractures of the distal radius in young adults are not uncommon, but have received little attention in the literature. This paper reports a series of 40 fractures of the distal radius. The quality of reduction was found to relate directly to the final result. The authors suggest that open reduction and internal fixation be used more frequently in the management of this fracture.


The use of pupillometry in the study of on-line verbal processing: evidence for depths of processing.
The effect of context and task demand upon the perception and resolution of lexical ambiguities was investigated in three experiments using pupillary measurements. Sentence type (ambiguous, disambiguous, and control) was tested under three conditions ("recall," "define word," and "choose best meaning"). All types of ambiguous sentences had higher pupillary curves than unambiguous sentences, with a particularly sharp rise in pupil size following the homophone. In addition, differences were observed in total sentence rise among the three task demands, such that the definition task was higher than recall, while the "choice" task exhibited a continuing rise after the sentence, which both other tasks did not have. Results are discussed in relation to putative processing stages of sentences, such as lexical search and sentence integration, and the more general issue of depths of processing.


[Bulge of the scapholunate ligament: an arthro-CT sign of traumatic scapholunate instability].
Tears of the scapholunate ligament are usually diagnosed during an arthro-CT or arthro-MRI examination. Typically, the contrast agent passes from one joint to the other. In certain cases, fibrous scar tissue devoid of any mechanical effect may block the passage and lead to an erroneous interpretation of the images. We reviewed retrospectively patients who underwent arthroscopic treatment for scapholunate tears and who had normal arthro-CT images. We searched for specific aspects suggestive of ligament injury. Analysis of the arthro-CT images demonstrated that a bulge of the scapholunate ligament could be noted in patients whose diagnosis of scapholunate ligament injury was established arthroscopically. We propose that appropriate lecture of wrist images can identify scapholunate ligament injury in patients wrongly considered to be free of wrist injury, but who actually have an occult injury to the scapholunate ligament.


Intestinal hydrolysis of pyridoxal 5'-phosphate in vitro and in vivo in the rat: effect of ethanol.
The effect of ethanol on intestinal hydrolysis of pyridoxal 5'-phosphate (PLP), the first step in PLP absorption, was evaluated in the rat. Models included PLP decay during in vitro incubation and PLP luminal disappearance during in vivo perfusion of jejunal segments. Ethanol inhibited PLP in vitro decay (pH = 7.4 and 3.0) and in vivo disappearance (pH = 7.4) in a concentration-dependent manner (1-4% w/v). At pH = 7.4, 4% w/v ethanol inhibited in vitro PLP decay by 48% (p less than 0.001) and in vivo PLP disappearance by 55% (p less than 0.001). This inhibition was reproduced in vitro with other alcohols but not with osmotic controls, paralleled in vitro changes in phosphatase activity in the presence of ethanol, and was completely reversed in vivo after ethanol was removed from the perfusing solution. The inhibition of intestinal PLP hydrolysis may possibly be one of the mechanisms by which a high percentage of alcoholics become biochemically vitamin B6 deficient.


Cytogenetic studies of 11 meningiomas and their clinical significance. II.
Cytogenetic analyses of 11 consecutive cases of meningiomas from 7 female and 4 male patients are reported. Chromosomal abnormalities were found in all cases. Only two of the cases showed cells with normal karyotype in addition to the abnormal stemline. Two of the cases displayed a more aggressive growth pattern than is usually seen in meningiomas. The first case was characterized by tumor invasion into the bone, a stemline with monosomy 22 and a hyperhaploid sideline. The second case was characterized by recurrency and a hypodiploid stemline. Extended clonal evolution was observed in one case.


[Mortality in a cohort of intravenous drug users before the introduction of potent HIV therapy].
The HIV/AIDS epidemics has contributed to an excess of morbidity and mortality in injecting drug users. The main goal of this study is to estimate incidence and factors associated with mortality from different causes among intravenous drug users. Prospective study of patients admitted to a detoxification unit between 1987 and 1990. At baseline they underwent interviews (drug injecting patterns) and venipuncture for HIV and other parameters including T-cell subsets. Viral status was determined for those who returned at least once. Cumulative incidence, overall and cause-specific mortality rates were calculated according to gender, HIV at admission and length of injecting drugs. 420 patients (334 men, 86 women), 69.6% HIV+, were admitted to treatment; the mean age of participants was 26 years and the mean duration of injecting drugs was 73 months. Three hundred and eighty seven patients were followed-up (92% of the initial cohort) for 2,029 persons-years and 101 deaths occurred. The overall mortality rate was 50/1000 persons-year (52/1000 for men and 40/1000 for women). The relative risk (RR) for death among women compared with men was 1.3 (95% CI = 0.8-2.2). The mortality rates for HIV+ was 60/1000 persons-year and 29/1000 persons-year for the seronegatives (RR: 2.1; 95% CI = 1.2-3.4). The HIV+ patients with CD4/microliter < or = 500 showed a threefold increase in mortality rates compared to HIV+ patients without immunosuppression (CI = 1.7-5.3). The cause-specific mortality rates were 27/1000 persons-year for HIV/AIDS, 15/1000 persons-year for drug overdose, 3/1000 persons-year for violence/trauma and 1/1000 persons-year for non-AIDS conditions. In this hospital cohort, HIV/AIDS and overdose have had a marked effect on mortality among intravenous drug users. Detoxification units may provide clinical services and extensive use of antiretroviral treatment for HIV infected drug users as a strategy to reduce the risk of death from AIDS.


ASSESSMENT OF THE DIAGNOSTIC AND PROGNOSTIC ROLE OF CEREBEROSPINAL FLUID INTERLEUKIN-8 LEVEL IN ADULT PATIENTS WITH MENINGITIS.
Meningitis necessitates immediate diagnosis and therapy. It is important to distingu- ish bacterial from aseptic meningitis, as this help to avoid complications and unnece- ssary antibiotic use. This work assessed the diagnostic and prognostic role of cerebro-spinal fluid interleukin-8 (IL-8) level in adult patients with meningitis. Ninety adult patients with meningitis were studied. They were divided into 3 groups: bacterial, tuberculous and aseptic meningitis. Full clinical examination and laboratory workup of meningitis were done. Cerebrospinal fluid (CSF) IL-8 levels were assessed. Patients were followed up till discharge or death. CSF IL-8 level was significantly higher in bacterial and tuberculous meningitis in comparison to aseptic meningitis. At cut off value 121.77 pg/ml, the area under ROC curve was 0.774 with efficacy 69% for differentiating viral from non-viral meningitis. The test efficacy is low in differentiating tuberculous from bactedal meningitis. There is no correlation of CSF IL-8 levels and disease severity or prognosis.


The influence of growth patterns on sexual size monomorphism in lemurs.
The lack of sexual size dimorphism among lemurs is puzzling given the high degree of polygyny in this clade. It has been proposed that the unique ecological conditions of Madagascar favour rapid completion of growth, limiting the opportunities for bimaturism and sexual size dimorphism in lemurs. Using recently compiled large data sets on many species across the lemur clade, I examined the prevalence of sexual size monomorphism of body mass among lemurs and tested the hypothesis that limited growth durations constrain sexual size dimorphism. I used segmented regression analyses to accurately model growth in each species. The majority of species analysed exhibited a period of rapid growth followed by a distinct period of slow growth prior to attainment of adult body mass. Whereas the first period of growth was constrained by the need to attain the majority of adult body mass prior to the onset of the infant's first dry season, the subsequent period of slow growth was unconstrained and sufficiently long to promote sexual bimaturism. Sex differences in the duration and rate of growth during this second growth phase appeared to account for the sexual size dimorphism exhibited by three lemur species. Therefore, constraints on growth processes do not limit sexual size dimorphism in lemurs, and other explanations for the prevalence of sexual size monomorphism in this clade should be examined. The importance of considering ontogeny in future investigations of sexual size monomorphism in lemurs is highlighted.


Results of treatment of 500 patients with civilian blood vessel trauma.
Results of treatment of 500 patients with blood vessel trauma are analyzed depending on trauma nature, shock severity, regional ischemia, technique of restorative surgery. Biochemical and ultrastructural changes in muscles are described in experimental conditions in ischemia of different degrees of severity to prognosis the reversibility of disorders. Restoration of blood circulation has been achieved in 82% of patients (5.1% mortality). Beside open and closed vessel trauma, it is expedient to distinguish between penetrating and non-penetrating injuries. Results of treatment of blood vessel trauma should be differentiated depending on the degree of regional ischemia, severity of traumatic shock and blood loss, combination of trauma and injury localization. Mechanical suture improves anastomosis quality, simplifies technique and reduces time of intervention. Introduction of microsurgery principles widens possibilities of vessel restorative surgery. The authors suggest classification of iatrogenic injuries of vessels, which promotes accurate diagnosis and choice of optimal surgical technique.


The composition of cell wall skeleton and outermost lipids of Mycobacterium vaccae is modified by ethambutol treatment.
Ethambutol (EMB) is a first line drug in tuberculosis treatment inhibiting the biosynthesis of arabinogalactan, which is a component of the mycobacterial cell wall. The growth of Mycobacterium vaccae cells in the presence of EMB increases cell wall permeability, which was monitored by beta-sitosterol biotransformation. GC/MS and GLC/MS (gas chromatography/mass spectrometry) analysis revealed dramatic changes in the content of covalently bound mycolic acids and in molar ratio galactose (Gal) to arabinose (Ara) in the cell envelopes of EMB-treated cells. The detected variations in the compositions of fatty acids indicate that both the cell wall skeleton and outer layer (free lipids) are decomposed due to EMB treatment.


The unstable dynamics of multiple alternative reproductive tactics.
Although negative frequency-dependent fitness is argued to allow the stable coexistence of two alternative reproductive types (such as resource defenders and reproductive parasites), no existing theory has considered a third strategy where resource defenders invest differentially in defence against reproductive parasites. Here, we present the results of a three-strategy game, where reproductive parasites interact with two resource defenders: 'Susceptibles' defend more resources but lose more reproductive success to parasites. 'Immunes' lose less to parasites, but immunity carries a reproductive cost. We show that the inclusion of a third strategy dramatically changes the evolutionary dynamics, such that for a wide range of parameter values, our model predicts the continuous sequential invasion of the three strategies instead of stable coexistence. Our results therefore limit the generality of the prediction that frequency-dependent fitness necessarily allows alternative reproductive tactics to coexist at equilibrium and may also explain the observed dynamics of some multiple-strategy systems.


Neutral atom frequency reference in the deep ultraviolet with fractional uncertainty = 5.7×10(-15).
We present an assessment of the (6s2) (1)S0 ↔ (6s6p)(3)P0 clock transition frequency in 199Hg with an uncertainty reduction of nearly 3 orders of magnitude and demonstrate an atomic quality factor Q of ∼10(14). The 199Hg atoms are confined in a vertical lattice trap with light at the newly determined magic wavelength of 362.5697±0.0011 nm and at a lattice depth of 20E(R). The atoms are loaded from a single-stage magneto-optical trap with cooling light at 253.7 nm. The high Q factor is obtained with an 80 ms Rabi pulse at 265.6 nm. We find the frequency of the clock transition to be 1,128,575,290,808,162.0±6.4(syst)±0.3(stat) Hz (i.e., with fractional uncertainty=5.7×10(-15)). Neither an atom number nor second order Zeeman dependence has yet been detected. Only three laser wavelengths are used for the cooling, lattice trapping, probing, and detection.


The combined use of Paracoccidioides brasiliensis Pb40 and Pb27 recombinant proteins enhances chemotherapy effects in experimental paracoccidioidomycosis.
Paracoccidioides brasiliensis is the etiological agent of paracoccidioidomycosis (PCM), a chronic granulomatous mycosis prevalent in Latin America, and cell-mediated immunity represents the main mode of protection against this fungal infection. The conventional treatment for this mycosis involves long periods of therapy resulting in sequels and a high frequency of relapse. The search for new alternative methods of treatment is thus necessary. With this aim, the objective of this work was to evaluate the potential of rPb27 and rPb40 immunization to reduce treatment length and the frequency of relapse when used as an adjuvant to fluconazole chemotherapy in experimental PCM. Combined treatment with the drug and the two proteins reduced CFUs in the lung, liver and spleen to undetectable levels and largely preserved the tissue structure of these organs. At the same time, IFN-γ and TNF-α levels were higher in mice treated as described above than in infected-only mice, while very low production of IL-10 and TGF-β was observed in this treated group. Thus, the combined treatment, using immunization with the two recombinant proteins in addition to fluconazole chemotherapy, showed an additive protective effect after intratracheal challenge. These results provide new prospects for immunotherapy as a treatment for PCM.


New Protocol Avoiding Tube Feed Interruptions in Critically Ill Patients Requiring Tracheostomy.
Current anesthesia guidelines require tube feed (TF) interruption for at least four hours before tracheostomy. We hypothesized that preprocedural TF interruption is not required before tracheostomy. We developed a protocol allowing continued feeding. Fifty-six patients undergoing tracheostomy with or without percutaneous endoscopic gastrostomy placement were included. Eleven patients underwent tracheostomy without TF interruption (TF group); the remaining 45 patients had TFs held per the existing anesthesia protocol (nil per os group). Data were collected by retrospective chart review. The groups were similar with regard to age, sex, race, risk of mortality, and preoperative albumin levels (3.2 vs 2.9 g/dL). There was no difference in pulmonary complications. No intraoperative aspiration occurred in either group, and there was no increase in mortality in the TF group (9.1 vs 22.2%, P = 0.43). The TF group had feeds held for 9.5 ± 6.3 vs 25.4 ± 19.0 hours (P = 0.0018). The TF group had a decreased missed caloric intake [761.5 ± 566.6 vs 1983.5 ± 1590.8 kcal (P = 0.0039)]. The TF group had a shorter time from consultation [40.4 vs 50.6 hours (P = 0.54)] and case booking [7.9 vs 12.8 hours (P = 0.40)] to the OR. The average length of stay for the TF group was 26.3 versus 31.1 days (P = 0.45). There was no increase in pulmonary complications or mortality in the fed patients, who experienced less procedural delays. Meanwhile, patients kept nil per os sustained a substantial caloric deficit. Tracheostomy without TF interruption is feasible and reduces malnutrition.


Characteristics of synaptic currents in frog muscle fibers of different types.
A study was made of synaptic currents in voltage-clamped muscle fibers of the frog. Fast, submaxillaris, and slow muscle fibers are innervated by nerve fibers of different conduction velocities. To avoid spatial complications, transmitter release by nerve impulses was restricted to the site of recording and reduced to single quanta (unitary endplate currents: uepc). Following nerve stimulation, the time course of transmitter release was longer and more variable in slow and submaxillaris muscle fibers than in the fast fibers. The time constant of decay of uepc in submaxillaris and slow fibers was, respectively, about 1.8 and 2.9 times slower than the decay of uepc in fast fibers. This is due mainly to differences in the lifetime of the channels opened by acetylcholine. The neuromuscular junctions in submaxillaris muscle fibers are bouton-like or longer branched contacts; and the unitary currents in the bouton junctions have a slower time course. It is concluded that the synaptic membrane in the different types of muscle fibers has synaptic acetylcholine-operated channels that have different kinetic properties, and that these properties are determined by the type of axon that innervates the muscle fiber.


Biochemical effect of intravenous arginine butyrate in X-linked adrenoleukodystrophy.
To determine the biochemical and clinical effects of intravenous arginine butyrate in X-linked Adrenoleukodystrophy (X-ALD). Arginine butyrate was intravenously infused over a 4-month period in a patient with the rapid cerebral form of X-ALD. Very long chain fatty acids (VLCFA), complete blood counts, and serum chemistries were monitored, and serial MRI of the brain and clinical neurologic examinations were performed. All blood chemical and hematologic values remained within the normal range for age throughout the therapy. After completion of the first day of infusion, the C 26:0 value fell from 1.01 microg/mL to 0.445 microg/mL, which is below the mean value for an X-ALD heterozygote. Throughout the remainder of the trial, all C26:0 levels fell below the mean -1 SD for X-ALD hemizygotes (mean, 1.18 microg/mL, 1 SD = 0.53), ranging from 0.321 to 0.565 microg/mL. Despite reduction of the plasma VLCFA, the patient continued to deteriorate neurologically. Intravenous arginine butyrate resulted in a rapid decrease in plasma VLCFA but no effect on the neurologic progression of the disease in this patient. Additional studies are needed to determine minimum effective dosage and interval, what proportion of patients respond, and whether the agent can prevent neurologic degeneration.


The effects of microgravity on the skeletal system--a review.
Exposure of astronauts to microgravity leads to the loss of calcium from weightbearing bones. Prolonged exposure, e.g., during a journey to Mars, may present problems on return to Earth, with increased risk of fractures and premature osteoporosis in later life. The precise mechanisms of calcium loss have yet to be determined although a key feature is the absence of mechanical loading. Countermeasures aimed at reducing calcium loss to acceptable levels include the use of exercise, drugs, dietary modifications and inertia suits such as the Soviet "Penguin" suit. Missions of a number of years may, however, require the development of artificial gravity on a spacecraft. The country that first solves the physiological problems of man in space and, in particular, skeletal calcium loss, will almost certainly be the first to be able to put a man on Mars.


[Long-term follow-up of implantation of foldable silicon posterior lenses].
Prospective analysis of long-term results after small incision no-stitch phacoemulsification with implantation of foldable silicone IOL. In 100 consecutive patients we implanted through a 3.2 mm incision a STAAR-silicone IOL model AA4203. Uncorrected and best-corrected visual acuity, surgically induced astigmatism and postoperative complications were examined at 1 day, 3 months and 1 year after surgery. On day 1 postop. 75% of the patients achieved uncorrected visual acuity of 0.5 or more. The mean best corrected visual acuity at day 1 was 0.75 (0.22 SD). The vector analysis of the surgically induced astigmatism does not show any difference between day 1 and 1 year postop. with a mean induced astigmatism of 0.73 dpt. 12 Months after surgery we found 3 cases of cystoid macula edema and 3 cases of clinically significant secondary cataract. The clinical long-term results after implantation of foldable silicon-IOL are comparable with the results after implantation of rigid PMMA lenses. The optical rehabilitation is much faster and contributes to lower the costs of modern cataract surgery.


Recent Insights on Hydrogen Atom Transfer in the Inhibition of Hydrocarbon Autoxidation.
Autoxidation, the free radical chain reaction that nominally inserts O2 into hydrocarbons to give peroxides, is primarily responsible for the degradation of all organic materials. Peroxyl radicals propagate autoxidation mainly by abstraction of labile H-atoms from the hydrocarbons, whereas radical-trapping antioxidants (RTAs) inhibit autoxidation by donating an H-atom to the peroxyl radical to give a nonpropagating radical. As such, a detailed understanding of the kinetics and thermodynamics of H-atom transfer (HAT) reactions to peroxyl radicals, and the effects of sterics, electronics, and medium thereupon, is key to understanding the mechanisms and products of autoxidation and the ability of RTAs to inhibit it. Due to their relatively weak O-H and N-H bonds, phenols and aromatic amines have long been utilized as RTAs, but only phenols have been extensively optimized to maximize their reactivity. Amines offer greater structural variability owing to their trivalent central nitrogen atom. Simply linking the two aromatic rings of a diarylamine to afford a phenoxazine offers profound differences in HAT reactivity: 1000-times greater than diphenylamine and 10-fold more reactive than α-tocopherol, Nature's optimized phenolic RTA. Thus, phenoxazines are an exciting scaffold for RTA development. Indeed, we have recently shown that ring substitution of phenoxazine or 2,4-diazaphenoxazine can yield compounds that undergo barrierless HAT reactions with peroxyl radicals. Amines also have the distinct advantage that they can react with peroxyl radicals to yield nitroxides, which can inhibit autoxidation in a catalytic manner utilizing the substrate itself as the stoichiometric reductant. Herein we provide an account of our recent efforts to understand how they manage this feat, which have revealed at least four mechanisms depending on the specific reaction conditions (i.e., saturated hydrocarbons at elevated temperatures, unsaturated hydrocarbons, acidic media, aqueous media/lipid dispersions). We also reiterate how their impressive RTA activity translates from solution to mammalian cell culture, wherein we have demonstrated that diarylamines and their derived nitroxides are potent inhibitors of ferroptosis, a recently characterized form of cell death associated with lipid peroxidation (autoxidation). In addition to phenols and amines, organosulfur compounds have long been used as antioxidants. The prevailing view has been that they undergo ionic reactions with product peroxides, preventing the initiation of further chain reactions. In recent years, we have found that many organosulfur compounds exhibit very good RTA activity. In particular, sulfenic acids (RSOH) and hydropersulfides (RSSH) are found to be among the best HAT agents known, particularly to peroxyl radicals where secondary orbital interactions are found to play a significant role. Consequently, oxidation of the sulfenic acid to a sulfinic acid greatly diminishes its HAT reactivity to peroxyls. Polysulfides and their oxides also undergo direct reactions with peroxyl radicals, thereby inhibiting autoxidation, but do so by homolytic substitution reactions. These insights suggest that the RTA activity of organosulfur compounds may be as important to the inhibition of hydrocarbon autoxidation, if not more so, than their ionic reactions.


Costing vascular surgery: A review of current reporting practice.
The objective of this study was to assess the level of reporting in economic studies in the area of peripheral vascular disease. Adequate reporting of data is necessary to judge the quality of economic studies by means of critical appraisal criteria. A systematic review of the journal literature between 1986 and the first half of 1997 was undertaken. Studies that have attempted to estimate the resource consequences of one or more vascular procedure were the focus of the review. The extent of reporting in each study was assessed by using published guidelines. The review identified 30 articles from nine different countries for inclusion in the study. Of these, more than half were published in the last 2(1/2) years of the search period, indicating a recent and rapid growth in economic studies in this area. When subjected to the reporting guidelines, the studies performed rather poorly overall. Although the vascular studies can be criticized for inadequate reporting of economic data, it appears from the limited evidence from elsewhere that inadequate reporting is a problem in other clinical areas. In view of the importance of reporting to the ability to critically assess studies-and thus separate the "good" from the "bad"-there is a need for reporting to improve future published studies.


Pulmonary artery pseudoaneurysm after Swan-Ganz catheter placement: embolization with vascular plugs.
Three patients who presented with massive hemoptysis after the insertion of a Swan-Ganz catheter for cardiac surgery are reported. Pulmonary artery pseudoaneurysms were diagnosed and successfully treated by embolization with a vascular plug. Follow-up at 15 months showed no recurrence of hemoptysis, and computed tomography helped confirm complete occlusion of the pseudoaneurysms.


New approaches to augment fungal biotransformation.
The possibility of using solid supports and intermittent substrate feeding to manipulate biotransformation by fungi was examined, with amoxapine as a model compound. Cunninghamella elegans ATCC 8688a grown as free cells in six-well plates showed 7-hydroxyamoxapine as the major metabolite of amoxapine biotransformation. However, when cells were grown in the presence of activated carbon, N-formyl-7-hydroxyamoxapine was formed as the major metabolite. Intermittent feeding of amoxapine also favored the formation of N-formyl-7-hydroxyamoxapine.


Alternative stable scroll waves and conversion of autowave turbulence.
Rotating spiral and scroll waves (vortices) are investigated in the FitzHugh-Nagumo model of excitable media. The focus is on a parameter region in which there exists bistability between alternative stable vortices with distinct periods. Response functions are used to predict the filament tension of the alternative scrolls and it is shown that the slow-period scroll has negative filament tension, while the filament tension of the fast-period scroll changes sign within a hysteresis loop. The predictions are confirmed by direct simulations. Further investigations show that the slow-period scrolls display features similar to delayed after-depolarization and tend to develop into turbulence similar to ventricular fibrillation (VF). Scrolls with positive filament tension collapse or stabilize, similar to monomorphic ventricular tachycardia (VT). Perturbations, such as boundary interaction or shock stimulus, can convert the vortex with negative filament tension into the vortex with positive filament tension. This may correspond to transition from VF to VT unrelated to pinning.


[Working ability of patients with various forms and stages of glaucoma].
Authors evaluated the questionnaries filled by patients with glaucoma of different type treated on the Prague Second Eye Clinic. These were completed by clinical data as state of visual functions and modes and course of the treatment. Different types of glaucoma were present: open-angle glaucoma (74), angular glaucoma (34), pigmentary glaucoma (12), exfoliative glaucoma (4), congenital glaucoma (13). Operations were performed in 26.5% of eyes, laser trabeculoplasty 18.8% and laser irodotomy 15.7%, and pharmacotherapy was applied in remaining patients. Ocular disease was the cause of the change of employment in 11.6%, the total disability pension and the partial one, were acknowledged in 3.6% and, 6.6%, resp. On contrary to the previous data, the number of patients with working disability was significantly decreased in comparison with the previous data. This fact could be explained by the use of the non-miotic antiglaucomatics, laser surgery, microsurgical operations and more precise diagnostics of the earlier stages of glaucoma.


Genotyping of human Campylobacter jejuni isolates in Greece by pulsed-field gel electrophoresis.
Pulsed-field gel electrophoresis (PFGE) typing has been recognized by several groups as a relatively simple and quick method for genotyping of Campylobacter jejuni (C. jejuni). The present study was carried out to determine the genetic variations among clinical isolates of C. jejuni from Greece and to establish a database, which could be used for future epidemiological and clinical studies. A total of 93 C. jejuni clinical isolates of known flagellin subunit A (flaA) genotype, serotype, and antimicrobial susceptibility pattern, were collected from a general hospital in the Attica region of Greece, between the years 2000 and 2003. The PFGE profiles of SmaI DNA digests of each strain were compared using a bin analysis based on 44 molecular size intervals. Forty-three different PFGE types, designated as C. jejuni (C. j.) 1 Greece (GR) to C. j. 43 GR, were identified. There was no statistically significant association of PFGE type with flaA genotype, serotype, or antimicrobial susceptibility pattern. However, PFGE typing did show a remarkable discriminatory ability within the non-serotypable group. Evaluating our results, we observed that (i) there was no statistically significant clonality of a certain PFGE type among the strains examined, and (ii) the discriminatory ability of PFGE typing was much better than that of the other typing methods. This is the first report of the use of bin patterns to compare the PFGE genotypes identified.


Positive association of dopamine D2 receptor polymorphism with bipolar affective disorder in a European Multicenter Association Study of affective disorders.
Convincing evidence for a genetic component in the etiology of affective disorders (AD), including bipolar affective disorder (BPAD) and unipolar affective disorder (UPAD), is supported by traditional and molecular genetic studies. Most arguments lead to the complex inheritance hypothesis, suggesting that the mode of inheritance is probably not Mendelian but most likely oligogenic (or polygenic) and that the contribution of genes could be moderate or weak. The purpose of the present European multicenter study (13 centers) was to test the potential role in BPAD and UPAD of two candidate dopaminergic markers, DRD2 and DRD3, using a case-control association design. The following samples were analyzed for DRD2: 358 BPAD/358 control (C) and 133 UPAD/ 133 C subjects, and for DRD3: 325 BPAD/ 325 C and 136 UPAD/136 C subjects. Patients and controls were individually matched for sex, age ( plus minus five years) and geographical origin. Evidence for significant association between BPAD and DRD2 emerged, with an over-representation of genotype 5-5 (P=0.004) and allele 5 (P=0.002) in BPAD cases compared to controls. No association was found for DRD2 in UPAD, and for DRD3 neither in BPAD or UPAD. Our results suggest that the DRD2 microsatellite may be in linkage disequilibrium with a nearby genetic variant involved in the susceptibility to BPAD. Our large European sample allowed for replicating of some previous reported positive findings obtained in other study populations.


Considering alternatives: student nurses slipping directly from lay beliefs to the medical model of mental illness.
When student nurses enter higher education establishments to commence their nurse education it is expected that they would hold lay beliefs of mental health and mental illness. Lay beliefs are generally informed by the medical model of mental health. It is argued that there are many other beliefs and approaches to mental health that student nurses (of all branches) should consider before graduating into the health care world dominated by the medical model of mental health and mental illness. A number of other approaches and theories are summarised and offered as examples to student nurses for their consideration.


The Haglund painful heel syndrome. Experimental investigation of cause and therapeutic implications.
Haglund syndrome, a common cause of pain in the posterior heel, consists of a painful swelling of the local soft tissues (the so-called pump bump) and prominence of the calcaneal bursal projection. The condition is caused by compression of the distal Achilles tendon and surrounding soft tissue between the os calcis and the posterior shoe counter. Osseous plantar projections appear to be a critical etiologic factor in Haglund syndrome. With an experimental model, it has been demonstrated that osseous projections on the plantar surface of the calcaneus adversely influence the bone-soft tissue relation of the posterior heel. Shoe heel elevation has been shown to be clinically effective in alleviating symptoms. It is demonstrated with an experimental model that elevation of the shoe heel decreases the pitch angle. This diminishes the prominence of the bursal projection and allows the foot to slip forward, displacing the posterior calcaneus away from the shoe counter.


Chalcogenide Phase Change Material for Active Terahertz Photonics.
The strikingly contrasting optical properties of various phases of chalcogenide phase change materials (PCM) has recently led to the development of novel photonic devices such as all-optical non-von Neumann memory, nanopixel displays, color rendering, and reconfigurable nanoplasmonics. However, the exploration of chalcogenide photonics is currently limited to optical and infrared frequencies. Here, a phase change material integrated terahertz metamaterial for multilevel nonvolatile resonance switching with spatial and temporal selectivity is demonstrated. By controlling the crystalline proportion of the PCM film, multilevel, non-volatile, terahertz resonance switching states with long retention time at zero hold power are realized. Spatially selective reconfiguration at sub-metamaterial scale is shown by delivering electrical stimulus locally through designer interconnect architecture. The PCM metamaterial also features ultrafast optical modulation of terahertz resonances with tunable switching speed based on the crystalline order of the PCM film. The multilevel nonvolatile, spatially selective, and temporally tunable PCM metamaterial will provide a pathway toward development of novel and disruptive terahertz technologies including spatio-temporal terahertz modulators for high speed wireless communication, neuromorphic photonics, and machine-learning metamaterials.


The shortest isoform of C/EBPβ, liver inhibitory protein (LIP), collaborates with Evi1 to induce AML in a mouse BMT model.
Ecotropic viral integration site 1 (Evi1) is one of the master regulators in the development of acute myeloid leukemia (AML) and myelodysplastic syndrome. High expression of Evi1 is found in 10% of patients with AML and indicates a poor outcome. Several recent studies have indicated that Evi1 requires collaborative factors to induce AML. Therefore, the search for candidate factors that collaborate with Evi1 in leukemogenesis is one of the key issues in uncovering the mechanism of Evi1-related leukemia. Previously, we succeeded in making a mouse model of Evi1-related leukemia using a bone marrow transplantation (BMT) system. In the Evi1-induced leukemic cells, we identified frequent retroviral integrations near the CCAAT/enhancer-binding protein β (C/EBPβ) gene and overexpression of its protein. These findings imply that C/EBPβ is a candidate gene that collaborates with Evi1 in leukemogenesis. Cotransduction of Evi1 and the shortest isoform of C/EBPβ, liver inhibitory protein (LIP), induced AML with short latencies in a mouse BMT model. Overexpression of LIP alone also induced AML with longer latencies. However, excision of all 3 isoforms of C/EBPβ (LAP*/LAP/LIP) did not inhibit the development of Evi1-induced leukemia. Therefore, isoform-specific intervention that targets LIP is required when we consider C/EBPβ as a therapeutic target.


Synergistic stimulation of Swiss mouse 3T3 fibroblasts by epidermal growth factor and other factors in human mammary secretions.
The concentration of epidermal growth factor (EGF) in human mammary secretions was about 50 nmol/l for several weeks prepartum. It then fell to about 13 nmol/l within 4 days after parturition, in parallel with the decrease in protein concentration which is associated with the onset of lactation. In contrast, the concentration of EGF in urine samples from the same donors remained constant throughout this period. All the immunoreactive EGF in mammary secretions competed at the EGF receptors on Swiss mouse 3T3 fibroblasts. The stimulation of these cells by samples of mammary secretions was, however, much greater than that induced by EGF alone, indicating the presence of other factors which synergize with EGF. Gel filtration of mammary secretions revealed two major peaks of mitogenic activity, corresponding to EGF and a factor of higher molecular weight. The latter could synergize with added EGF, insulin or bombesin, and thus falls into a different functional class from any of these factors.


White-light interference microscopy: effects of multiple reflections within a surface film.
The effects of the presence of a transparent thin film on a test surface in white-light interferometric surface profiling are investigated. An expression is obtained for the output intensity variations in a Michelson interferometer which includes the effect of multiple reflections within the thin film. The number of reflections that need to be considered to obtain good convergence to the correct solution is discussed.


Calcium oxalate crystallization in untreated urine, centrifuged and filtered urine and ultrafiltered urine.
Centrifuged and filtered urine is often used to evaluate in vitro the crystallization processes of calcium oxalate (CaOx), but even such simple manipulations can alter the composition of the urine, as regards its protein and lipid concentrations. In urine samples taken from 17 normal male adults, we evaluated CaOx crystallization by simultaneously using three different types of urine: untreated (U), centrifuged at 2000 rpm (800 g) and filtered at 0.22 microm (CF), and centrifuged-filtered and ultrafiltered at 10 000 Da (CFU). The addition of 1.2 mmol/l of oxalate to each type of urine produced notably different results. The total amount of CaOx crystals (expressed as calcium oxalate dihydrate crystals (COD) + oxalate monohydrate crystals (COM) area/total area x 100) was on average 13.2% in U urine, 70.7% in CF urine and 11.1% in CFU urine (CF > U and CFU, U = CFU); the relative prevalence of COD and COM (expressed as COD area/COM area) was on average 71.4 in U urine, 0.0026 in CF urine and 5.5 in CFU urine (U > CF and CFU, CFU > CF); the diameter of COD (expressed in microns) was on average 15.2 in U urine, 3.7 in CF urine and 24.3 in CFU urine (CFU > U and CF, U > CF); the diameter of COM (expressed in microns) was on average 5.2 in U urine, 2.6 in CF urine and 8.9 in CFU urine (CFU > U and CF, U > CF); the total amount of CaOx aggregates (expressed as CaOxAgg area/total area x 100) was on average 8.5% in U urine, 22.1% in CF urine and 2.9% in CFU urine (CF > U and CFU, U > CF). We conclude that CaOx crystallization processes in manipulated urine are extremely different, probably due to changes in macromolecular compounds.


Double-blind evaluation of effectiveness and safety of flunisolide aerosol for treatment of bronchial asthma in children.
A double-blind study was carried out in 20 asthmatic children in order to evaluate the therapeutic efficacy and safety of inhaled corticosteroid flunisolide. 0.5 mg of the drug was administered by a jet nebulizer twice daily for 2 months. Respiratory symptoms, pulmonary function values and methacholine PC20-FEV1 were evaluated, as also morning cortisol levels, plasma cortisol increase after ACTH test, and 24-h urinary cortisol excretion. The data obtained show the efficacy of the drug in reducing symptoms. No significant difference was observed in pulmonary function values and in bronchial reactivity results between the two groups. No effect of flunisolide was observed on hypothalamic-pituitary-adrenal function. This study confirms the efficacy and safety of flunisolide (0.5 mg b.i.d.) in the treatment of asthmatic children.


[Studies on sesquiterpene lactones from Carpesium faberi].
By using various chromatographic techniques,18 sesquiterpene lactones were isolated from the acetone extract of Carpesium faberi. Their structures were identified on the basis of comprehensive spectroscopic data, involving 2 carabrane sesquiterpenoids [carabrone(1), 4R-carabrol(2)], 3 eudesmane sesquiterpenoids [granilin(3), 3-epi-isotelekin(4), 1α-hydroxypinatifidin(5)], 8 guaiane sesquiterpenoids [4β,10α-dihydroxy-5α(H)-1,11(13)-guaidien-8α,12-olide(6), 8-epi-helenium lactone(7), 4-epi-isoinuviscolide(8), 9β,10β-epoxy-4α-hydroxy-1β-H,11α-H-guaian-8α,12-olide(9), 4α,10α-dihydroxy-1β(H),5β(H)-guaian-11-(13)-en-8α,12-olide(10), 4α-hydroxy-9β,10β-epoxy-11β-H,5α-H-guaian-11(13)-en-8α,12-olide(11), 4α-hydroxy-1β,5α,11α-H-guaian-9(10)-en-8α,12-olide(12), inuviscolide(13)], 1 pseudoguaiane sesquiterpenoid [(+)-confertin(14)], 3 germacrane sesquiterpenoids [madolin B(15), carabrolactone A(16),11(13)-dehydroivaxillin(17)], 1 xanthane sesquiterpenoid [tomentosin(18)]. Furthermore, the absolute configuration of 1 was confirmed by Cu-Kα X-ray crystallographic analysis,and the R-configuration of the chiral center at C-4 in 2 was established by the modified Mosher's method.The compounds 2-5, 7 and 9-15 were isolated from this plant for the first time, and compounds 4-5, 7, and 12-15 were isolated from this genus for the first time.In addition, the neurotrophic activity of compounds 1-3, 6 and 17 were evaluated by morphological observation and statistical analysis of cells differentiation, using rat pheochromocytoma(PC12)cells as a model system. However, all compounds were inactive.


Transurethral microwave thermotherapy for treatment of benign prostatic hyperplasia: results obtained with the Prostalund device.
The 6-month results of treatment with transurethral microwave thermotherapy (Prostalund) of 28 patients with lower urinary tract symptoms (LUTS) due to benign hyperplasia of the prostate are reported. The median International Prostate Symptom Score (I-PSS) fell from 16.5 (range 9-33) to 10.5 (range 3-30; P < 0.00005). Quality-of-life assessment improved from a median value of 4 (range 2-6) to 2 (range 1-5; P = 0.0001). In the Danish Prostate Symptom Score (DAN-PSS) the median total score fell from 20 (range 5-55) to 5 (range 0-43; P = 0.001). The median peak urinary flow increased from 10.6 to 11.5 ml/s (P = 0.20). Pressure-flow studies revealed no decrease in the median detrusor pressure at peak uroflow (PdetQmax) from 56 cmH2O preoperatively to 56 cmH2O after 6 months (P = 0.36). No change was found in postvoid residual urinary volume or in the calculated prostate volume. Complications included hematuria in most patients, urinary tract infections in 6 (21.4%) patients, and transient retention in 3 (10.7%) patients. In all, 20 (71.4%) patients responded to treatment with good symptomatic relief, but only minor changes were observed in urodynamic parameters.


Biological markers of oxidative stress induced by ethanol and iron overload in rat.
Studies on rats treated for 15 months with ethanol (10%, w/v, solution in drinking water) revealed that the stimulation of hepatic cytochrome P-450 monooxygenases activity was accompanied by enhanced microsomal malondialdehyde formation, a lipid peroxidation index and a decreased level of the antioxidant, alpha-tocopherol. The other components of the prooxidant/antioxidant system, diene conjugates and catalase, glutathione peroxidase and superoxide dismutase activities were unaffected. Oxidative stress in blood was shown by a significant decrease in the alpha-tocopherol level whereas lipid peroxidation and antioxidant enzyme activity remained unchanged. The prooxidative effect of ethanol was catalytically promoted by an iron overload (Fe-saccharate, 100 mg Fe3+/kg body wt. intraperitoneally, 2, 5 and 7 day before test) to simulate the effect of alcoholic hemochromatosis. Thus, the level of malondialdehyde and alpha-tocopherol in the serum may be recommended as biological markers of ethanol-provoked oxidative stress, which is especially useful in the evaluation of the combined effect of ethanol and other chemicals that affect the redistribution of active iron complexes.


Creatine Usage and Education of Track and Field Throwers at National Collegiate Athletic Association Division I Universities.
The purpose of this study was to analyze the level of creatine use along with the perceived benefits and barriers of creatine use among collegiate athletes who participate in throwing events within the sport of track and field. A total of 258 throwers from National Collegiate Athletic Association Division I institutions completed an online survey regarding creatine. The results provided baseline levels of creatine use and allowed for the analysis of factors related to athletic conference affiliation. Results indicate that creatine use remains to be a common (32.7%) practice among throwers with significantly higher levels of use among Football Bowl Subdivision (FBS) conference athletes (44.6%) than Football Championship Subdivision (FCS) conference athletes (28.8%), χ² = 5.505, p = 0.019. The most common reasons for using creatine included a desire to improve/increase: strength (83.3%), recovery time (69.0%), and performance (60.7%). The most common perceived obstacles included contamination/quality control (39.5%), cost (33.3%), inconvenience (16.7%), and cramping (14.3%). A desire for additional education and training was noted through an expression of interest (55.6%) with significantly higher levels of interest from FBS athletes (65.6%) than FCS athletes (52.2%), χ² = 6.425, p = 0.039. However, the athletic departments provide nutritional supplement counseling at only 26.6% of the schools. Although the access to full-time nutritionist counsel was available at 57.3% of the schools, there was a significant difference (χ² = 9.096, p = 0.003) between FBS schools (73.7%) and FCS schools (51.7%).


[Effects of calcium on biological characteristics of wheat seedlings under ultraviolet-B radiation stress].
Under simulated ultraviolet-B radiation (UV-B, 280-320 nm), effect of calcium on biological characteristics of wheat seedlings was studied with pot culture experiment. The results showed that the growth indexes of wheat seedlings on ground and underground in calcium concentration 2 mmol/L treated group were obviously reduced than that of wheat seedlings in control treated group (the descending range of 8.1%-36.1%) under UV-B stress (0.35 W/m2, 6 h per day, for 7 day). And the decreasing degree of growth indexes (3.2%-28.6%) for wheat seedlings in calcium concentration 6 mmol/L treated group were lower than in calcium concentration 2 mmol/L treated group. The experiment proved that calcium can mitigate the damage of ultraviolet-B radiation on wheat seedlings, and this effect was related to that calcium affected physiological and biochemical characteristics of wheat seedlings.


Drug therapy for geriatric depression.
Depression is a common problem in elderly patients. The identification and treatment of depression may be more complex in older than in younger patients because of co-existing illnesses and concurrent drug therapy. In addition, a variety of medical conditions and drugs can cause depression. The pharmacology and pharmacokinetics of the cyclic antidepressants have been extensively studied. These agents are hepatically metabolised, often to an active agent. The clearance of the parent compound and the active metabolite(s) may be reduced in elderly patients, causing drug accumulation and increased toxicity. The cyclic antidepressants interact with a variety of neurotransmitters and their receptors. While these effects explain many of the adverse effects of the cyclic antidepressants, it is not clear whether the noradrenergic and serotoninergic effects of such drugs explain their antidepressant effects. Cyclic antidepressant therapy is associated with a variety of adverse effects, including sedation, anticholinergic effects and effects caused by alpha-adrenergic blockade. The cyclic antidepressants differ in their relative ability to cause these adverse effects. The newer cyclic antidepressants such as the selective serotonin reuptake inhibitors are relatively free of sedative and anticholinergic effects, but cause insomnia, nausea and possibly cardiac arrhythmias. All cyclic antidepressants appear to be equally effective. Therefore, the choice of a cyclic antidepressant for a specific patient must be based on several factors, including the risk of adverse effects. In elderly patients, the initial dose of cyclic antidepressants should be lower than the usual dose recommended for younger adults, and titrated slowly. All antidepressants require at least 2 to 3 weeks for their antidepressant effects to be seen. Because depression is a relapsing disease, maintenance antidepressant therapy may be indicated to reduce the risk of recurrent depression. The monoamine oxidase (MAO) inhibitors are effective antidepressants, especially in atypical depression. However, the adverse effects and risk of potentially lethal drug interactions of the older agents preclude their routine use. However, the new reversible MAO inhibitors may prove to be a well tolerated alternative in older patients. Antidepressant therapy should not be avoided simply because of a patient's age. However, the clinician must be conservative in the use of cyclic antidepressants in elderly patients and monitor closely for adverse drug reactions.


The use of smartphones in clinical practice.
The use of smartphones and applications or 'apps' in clinical practice among nurses and doctors is on the increase. This article discusses the results of a survey undertaken as part of a service improvement project to develop an 'app' for use by junior doctors. The survey asked nurses and doctors to share information about how they used their smartphones at work, what they used them for and how and if they risk assessed the apps they use. Responses from 82 nurses and 334 doctors show a high level of users of text books, formularies, clinical decision tools and calculators, with less than one quarter of these users performed any risk assessment before use.


[Treatment of shoulder dislocation].
Dislocation of the shoulder joint occurs usually for a young man during a sports or leisure accident. The diagnosis should be confirmed by radiography, and reposition of an acute dislocation should be commenced without unnecessary delay. The starting point for a successful procedure is good muscle relaxation and pain management either with systemic or topical medication. Use of excessive power should be avoided during reposition and success of the procedure must always be verified by radiography. Excessive immobilization should be avoided after the reposition, and rehabilitation should be carried out in a controlled manner.


The lateral posterior-pulvinar complex modulation of stimulus-dependent oscillations in the cat visual cortex.
It has been suggested that binding coherent targets depends on the capacity of excited cortical cells to fire in synchrony at approximately 40 Hz. However, the origin of stimulus-related cortical oscillations is still not clear. We hypothesized that 40 Hz oscillations might propagate to the visual cortex from the lateral posterior-pulvinar complex (LP-P) whose cells send fibers to the visual cortex and have a tendency to exhibit oscillations. To test our hypothesis, we recorded single unit activity in areas 17 and 18 of anaesthetized cats. The activity of neurons which showed oscillations evoked by optimal visual stimuli was analysed before, during and after a reversible inactivation of the LP-P with GABA. Such inactivation was found to markedly modify the strength of oscillatory activity of cortical neurons whose visual responses were affected by LP-P blockade. In contrast, the oscillation frequencies of cortical neurons were not modified by such inactivation. However, in some cells (three of nine), oscillatory activity was found to be completely abolished by injection of GABA into the LP-P. Collectively, these findings demonstrate that inputs from the LP-P play a key role in modulating the oscillatory activity of visual cortex neurons. Assuming that cortical neurons utilize oscillatory activity to encode perceptual aspects of the visual stimulus, our findings underscore the contribution of the LP-P in this process.


Accuracy of diagnostic codes for identifying patients with ulcerative colitis and Crohn's disease in the Veterans Affairs Health Care System.
International Classification of Diseases-9 (ICD-9) codes are useful in clinical research; however, the validity of ICD-9 codes for inflammatory bowel disease (IBD) patients in multiple centers in the Veterans Affairs Health Care Systems (VA) has not been established. Our aim was to determine the accuracy of ICD-9 codes for Crohn's disease (CD) and ulcerative colitis (UC) in the VA. Patients with a diagnosis of IBD during 1999-2009 were identified by at least one ICD-9 code for CD (555.x) or UC (556.x) at the Houston and Ann Arbor VA Medical Centers and confirmed by chart review. A diagnosis of CD, UC, and IBD, unspecified (IBDU) was determined based on structured review of data in the VA medical records. Positive predictive values (PPV) were calculated for the codes using previously published ICD-9 algorithms. A total of 1,871 patients were identified with ICD-9 codes for IBD. Of these patients, 1,298 (69 %) were confirmed to have IBD, with 541 CD (41 %), 707 UC (55 %), and 50 IBDU (4 %) patients. An algorithm of 2 or more codes with at least one from an outpatient encounter improved the PPV (0.83 and 0.89 for CD and UC, respectively) compared a single code algorithm (PPV 0.59 and 0.66, respectively). Single ICD-9 codes are inadequate to accurately define IBD patients; however, ICD-9 code algorithms can be used to identify patients with UC or CD with high positive predictive value. The 2 code, at least 1 outpatient code algorithm was observed to have a high PPV and low miss rate.


Xanthohumol inhibits growth and vascularization of developing endometriotic lesions.
Xanthohumol is a prenylated flavonoid isolated from hops, which is known to act as a pleiotropic cancer chemopreventive agent owing to its anti-proliferative, anti-inflammatory and anti-angiogenic properties. In the present study, we analyzed, for the first time, whether this dietary compound may also be used for the treatment of endometriosis. Peritoneal and mesenteric endometriotic lesions were surgically induced in BALB/c mice by uterine tissue transplantation into the abdominal cavity. The animals were treated daily with 100 µM xanthohumol (n= 8) or vehicle (control, n= 8) via the drinking water, starting 3 days before tissue transplantations. Lesion growth, cyst formation and vascularization were subsequently analyzed by means of high-resolution ultrasound imaging (at Day 0 and then once per week for 28 days), caliper measurements, western blotting, histology and immunohistochemistry over 4 weeks. In the treatment and control groups, uterine grafts developed typical endometriotic lesions with cyst-like dilated glands surrounded by a vascularized endometrial stroma. However, xanthohumol efficiently decreased the size of these lesions at Day 28, independent of their localization within the peritoneal cavity, compared with control (peritoneal: P =0.041; mesenteric: P =0.038). This was associated with a reduced level of phosphoinositide 3-kinase protein. Moreover, vascularization of xanthohumol-treated lesions was suppressed, as indicated by a significantly lower microvessel density at Day 28 when compared with vehicle-treated controls (peritoneal: P =0.026; mesenteric: P =0.004). Additional analyses revealed that treatment with xanthohumol did not affect the histomorphology, proliferation and vascularization of the uterine horns and ovaries. Taken together, these experimental findings suggest that xanthohumol inhibits the development of endometriotic lesions in mice without inducing serious side effects in the reproductive organs. Thus, xanthohumol represents a promising dietary phytochemical that, after further testing, may be considered for the use in the selective treatment of endometriotic lesions.