Wnt pathway is involved in advanced gastric carcinoma.
The Wnt/beta-catenin signaling pathway is tightly regulated and has important functions in development, tissue homeostasis, and regeneration. Deregulation of Wnt/beta-catenin signaling is frequently found in various human cancers. This study evaluated the relationship between the expression of Wnt-1, beta-catenin and E-cadherin in gastric cancer and gastric cancer clinicopathological characters. The cancerous tissues from 180 gastric cancer patients and the adjacent normal tissues from 30 gastric cancer patients hospitalized in our hospital from Jan 2000 to June 2001 were collected. The immunohistochemical SP method was carried out to detect Wnt-1, beta-catenin and E-cadherin. The pathological stage of gastric cancer was evaluated in hematoxylin-eosin staining by the same pathologist. In the gastric cancerous tissues, the expression percentage of Wnt-1, beta-catenin and E-cadherin is 54.4%, 45.6%, 47.2%, respectively, which is significantly higher than the percentage expression of these genes in normal tissues (p<0.01). The expression levels of these three genes are significantly related to tumor size, tumor invasive depth, lymph node metastasis, pTNM stage, differentiation and five-year survival rate. Wnt-1, beta-catenin and E-cadherin play an important role in the differentiation, progression, invasion and metastasis in gastric cancer; they are good indicators for evaluating the biological behaviors of gastric cancer. And also, they will be promising targets for developing anti-cancer drug in gastric cancer.


Unsupervised brain computer interface based on inter-subject information.
This paper presents an unsupervised subject modeling technique and its application to a P300-based word speller. Due to EEG variations across subjects, a special training procedure is required to learn a subject-specific classification model (SSCM). To deal with the inter-subject variation, we first study a subject independent classification model (SICM) that is learned from EEG of a pool of subjects. Next we further adapt the SICM by learning from a subset of the pooled EEG that is automatically selected based on its similarity to the EEG of a new subject. Experiments over ten healthy subjects show that the SICM learned from all pooled EEG outperforms the cross-subject models greatly. More importantly, the adapted SICM achieves virtually the same performance as the SSCM, hence removing the complicated and tedious training procedure.


Nano CuAl2O4 spinel mineral as a novel antibacterial agent for PVDF membrane modification with minimized copper leachability.
The employment of copper-containing antibacterial agents for membrane modification can constrain undesirable bacterial adhesion and growth in an effective and economical way. However, copper ion may be leached out and cause further toxicity after applying those materials for membrane processes. Therefore, in this study, nano CuAl2O4 spinel was synthesized as a novel copper-containing material which was expected to have good antibacterial activity and simultaneously stabilize copper ions by its intrinsic structure. The obtained nano spinel was applied for membrane modification via both doping and coating methods. Results show that the addition of nano CuAl2O4 spinel during doping process can change polyvinylidene fluoride (PVDF) membrane properties (crystallization, tensile strength, porosity, pore size distribution, permeate flux and bovine serum albumin (BSA) rejection) obviously, but no obvious change was observed for the coated membrane except increased hydrophilicity and permeate flux. Most importantly, the amount of bacteria attachment was found to reduce significantly (˜68%) on the membrane coated with nano spinel, which indicates the successful application of nano CuAl2O4 spinel as a novel antibacterial agent for membrane modification without extra concern of copper toxicity.


Effects of intraoral aging on surface properties of coated nickel-titanium archwires.
To evaluate the effects of intraoral aging on surface properties of esthetic and conventional nickel-titanium (NiTi) archwires. Five NiTi wires were considered for this study (Sentalloy, Sentalloy High Aesthetic, Superelastic Titanium Memory Wire, Esthetic Superelastic Titanium Memory Wire, and EverWhite). For each type of wire, four samples were analyzed as received and after 1 month of clinical use by an atomic force microscope (AFM) and a scanning electronic microscope (SEM). To evaluate sliding resistance, two stainless steel plates with three metallic or three monocrystalline brackets, bonded in passive configuration, were manufactured; four as-received and retrieved samples for every wire were pulled five times at 5 mm/min for 1 minute by means of an Instron 5566, recording the greatest friction value (N). Data were analyzed by one-way analysis of variance and by Student's t-test. After clinical use, surface roughness increased considerably. The SEM images showed homogeneity for the as-received control wires; however, after clinical use esthetic wires exhibited a heterogeneous surface with craters and bumps. The lowest levels of friction were observed with the as-received Superelastic Titanium Memory Wire on metallic brackets. When tested on ceramic brackets, all the wires exhibited an increase in friction (t-test; P < .05). Furthermore, all the wires, except Sentalloy, showed a statistically significant increase in friction between the as-received and retrieved groups (t-test; P < .05). Clinical use of the orthodontic wires increases their surface roughness and the level of friction.


Prolonged duration of peritoneal dialysis catheter embedment does not lower the catheter success rate.
Since 2000, we have used the Moncrief-Popovich technique as our standard method for peritoneal dialysis (PD) catheter insertion. The subcutaneous portion of the catheter is externalized immediately before initiation of PD. We undertook the present review to investigate whether duration of catheter embedment affects catheter or patient outcome. All catheters inserted beginning 1 January 2000 and externalized by 31 December 2008 were included. The primary outcome was catheter survival. Secondary outcomes were catheter patency (no fibrin plug or omental wrap) and complications within 90 days after externalization. A standard peritoneal equilibration test was used to classify peritoneal membrane transport status. Proportional hazards regression models were used to test whether duration of embedment affected catheter outcomes. The models treated embedment duration as both a continuous predictor and a categorical predictor categorized by tertile. A total of 134 catheters were implanted and externalized. Twelve patients received 2 catheters each. To ensure statistical independence of the observations, 12 of the latter 24 catheters were excluded (1 chosen randomly from each patient), resulting in a useable sample size of 122 catheters. The total duration of observation was 2359 patient-months. The median duration of catheter embedment was 40.5 days (range: 2 - 788 days). After controlling for sex, race, age, and diabetes status, embedment duration did not have a significant effect on catheter survival as a continuous predictor or as a categorical predictor. Additionally, the 95% confidence interval for the 30-day effect of embedment duration ruled out a change of more than 20.6% in the hazard of catheter malfunction or infection. Of the studied catheters, 89.3% were patent and functioned properly immediately upon externalization. The remaining 13 catheters (10.7%) lacked patency on externalization because of fibrin plug or kinking (n = 10) or omental wrap (n = 3); however, 12 of the 13 non-patent catheters were corrected laparoscopically, and the patients resumed PD. Only 1 patient transferred to hemodialysis. Overall, 121 of 122 buried catheters (99.2%) were used for PD. Other complications within 90 days of catheter externalization included incision site and tunnel infection in 2 cases (1.6%), exit-site leak in 2 cases (1.6%), and coagulase-negative staphylococcal peritonitis in 1 case (0.8%). Duration of catheter embedment before externalization did not affect catheter survival and did not influence subsequent peritoneal membrane transport status. The overall effect of increasing embedment duration by 30 days is, at most, a 20.6% increase or decrease in the hazard of catheter failure, but the actual hazard may be much smaller or nonexistent. Larger studies are needed to further explore the ideal duration of embedment.


The dexamethasone suppression test in patients with alcoholism.
It is unknown whether the dexamethasone suppression test (DST) can be used to help identify patients with major depressive disorder if they have recently been abusing alcohol. We evaluated 38 male alcoholics with Research Diagnostic Criteria (RDC), the Beck Depression Inventory (BDI), and the standardized overnight 1-mg DST, administered after 3-4 weeks of detoxification. Eighty-two percent had a normal suppressive DST response. The DST may be useful in aiding identification of patients with a profile of major depressive disorder and continued depression after alcohol detoxification. The test might facilitate a rational selection of alcoholics who may benefit from antidepressants. However, the possibility of false positive results must be further investigated.


Use of surrogate markers to predict the HIV disease stage and time to initiate antiretroviral therapy in developing countries.
CD4 counting is the standard method for determining eligibility for antiretroviral therapy (ART) and HIV disease progression, but it is not widely available in developing countries. The aim of this study was to correlate the levels of beta-2 microglobulin and total lymphocyte count (TLC) with CD4 counts for monitoring disease progression and identify patients who require ART. The authors measured CD4 T-cell counts, TLC, and beta-2 microglobulin levels in 119 HIV seropositive patients. There was a significant negative correlation between CD4 counts and beta-2 microglobulin levels and significant positive correlation between TLC and CD4 counts. Taking a TLC cutoff of < or = 1600 and beta-2 microglobulin levels > or = 3.5 mg/l, the authors could identify 90.4% of patients with CD4 count < or = 200 cells/microl. These assays may allow reduction in the annual number of CD4 cell evaluation and the cost associated with monitoring the immune status of HIV-positive patients.


The influence of reovirus sigma C protein diversity on vaccination efficiency.
Avian reovirus (ARV) is a disease agent that causes economic losses in the poultry industry. The available vaccines do not confer full protection. One possible reason is the existence in the field of many virulent serotypes with no cross protection. Several ARV strains have been isolated in Israel in the last few years. In this study, we investigated the diversity of the sigma C protein of ARV because this is the most variable protein in the virus and it induces the production of neutralizing antibodies. Sigma C from two virulent isolates was sequenced, cloned, and expressed. The protein sequence differed from the attenuated vaccine strain (strain 1133) but was similar to a U.S. virulent strain (strain 1733). Those differences led to a change in the antigenic index of the protein, mainly at three sites. Sera of infected birds in a field trial and of birds in a controlled experiment vaccinated with the recombinant sigma C protein showed high titers in enzyme-linked immunosorbent assay to the recombinant protein and lower titers to the attenuated vaccine strain. This means that sigma C can be used as a diagnostic tool for the detection of antibodies relevant for protection and in the future as a subunit vaccine. The results of this study highlight the need to reconsider vaccinations against ARV in terms of the strains to be used and of the method of identifying protective antibodies transferred to progeny.


Management of transcatheter aortic valve embolization into the left ventricle.
Embolization of transcatheter aortic valve replacement (TAVR) prostheses is a rare and serious procedural complication. While embolization into the aorta can sometimes be managed by transcatheter techniques, embolization into the left ventricle (LV) often requires immediate open heart surgery. We report three TAVR cases complicated by LV embolization. In each case, successful implantation of a second transcatheter prosthesis was accomplished, followed by surgical removal of the first embolized device.


The weight and fitness status of United States children.
Although the prevalence of overweight and obesity among US children is a concern for many health care professionals, incidence rates over time seem to be variable, depending on the assessment measurements used. It is difficult to determine the associated health implications of pediatric obesity or overweight, especially the type that might result in adult obesity or overweight. This review examines the various factors that contribute to the weight and fitness status of children, including anthropometric factors, nutrient intake, the level of physical activity, and nutrition knowledge. Nutrient intake data of the past decade show that the energy and fat intakes of children in the United States have been fairly constant. However, data also indicate that their physical activity has declined. The data strongly suggest that the apparent prevalence of pediatric overweight may not be so much a function of nutrient intake as of a decrease in physical activity leading to an imbalance of energy input and output.


Do Patients Suffering an Out-of-Hospital Cardiac Arrest Present to the Ambulance Service With Symptoms in the Preceding 48hrs ?
In-hospital cardiac arrests are often preceded by a period of physiological deterioration that has often gone unnoticed. We proposed that the same might be true for out-of-hospital cardiac arrests (OHCA) where ambulance crews leave patients at home who then subsequently go on to suffer a cardiac arrest. We identified all OHCA over a 12-month period that had been seen and assessed by an ambulance crew within the 48 hrs preceding their cardiac arrest. We retrospectively calculated the patient's NEWS2 score at the time of their initial assessment as a marker of their physiological status and need for hospital admission.Of 1,960 OHCA patients, 184 (9.4%) had been assessed by ambulance crews within the preceding 48 hours. Excluding those who had been taken to hospital (and then discharged), declined hospital conveyance or were on end-of-life care pathways, 79 (56% of total) were left at home through crew discretion. 34/79 (43%) patients not conveyed had either a NEWS score of 3 in a single parameter or a score of ≥ 5, which in hospital would mandate an urgent medical review. The most overlooked observation was respiratory rate. 1.7% of all OHCA had been assessed in the previous 48 hrs and inappropriately left at home by ambulance crews. This represents a missed opportunity to avert cardiac arrest. NEWS scoring has the potential to improve pre-hospital triage of these patients and avoid missing the deteriorating patient.


[Photodamage and photoaging--prevention and treatment].
The exposure of human skin to environmental and artificial ultraviolet irradiation has increased significantly. This is not only due to an increased solar UV irradiation as a consequence of the stratospheric ozone depletion, but also the result of an inappropriate social behaviour with the use of tanning parlors being very popular. Besides this, leisure activities and living style with travelling to equatorial regions also add to the individual annual UV load. Since the population in industrialised countries shows an increasing total life span, in parallel the cumulative life time dose of solar and artificial UV-irradiation is dramatically augmented. In addition to the common longterm detrimental effects like immunosuppression and skin cancer, the photooxidative damage due to energy absorption of UV photons in an oxygenized environment leads to alterations of cells, subcellular compartments and macromolecules. The clinical manifestations of UV/ROS induced disturbances result in photoaged skin with wrinkle formation, laxity, leathery appearance as well as fragility, impaired wound healing and higher vulnerability. Strategies to prevent or to minimize photoaging and intrinsic aging of the skin necessarily include protection against UV irradiation and antioxidant homoeostasis. New developments of therapeutic interventions including DNA repair enzymes will be discussed.


Intrathecal chemotherapy for patients with meningeal carcinomatosis.
Meningeal carcinomatosis (MC) is increasing, and these patients have a poor prognosis. We analyzed the effects of intrathecal (IT) chemotherapy for these patients. Patients received both methotrexate (MTX) (15 mg/m(2)) and prednisolone (10 mg/m(2)) 6 times in 2 weeks by Ommaya reservoir, along with cytosine arabinoside (10 mg/m(2)) for 4 doses of MTX. A cycle consisted of a 2-week period during which patients received these drugs and then 2 weeks off. Treatments were repeated 3 to 6 cycles depending on the clinical status. Cerebrospinal fluid (CSF) samples were also analyzed for cytology and a few markers. Of the 58 patients treated the most common tumor was lymphoma (30 patients), followed by lung and breast. Elevated soluble IL-2 receptor levels were observed in 23 of 30 patients with lymphomatous meningitis. Median survival of MC patients with malignant lymphoma, lung cancer, and breast cancer was 32.8 +/- 9.8, 13.0 +/- 4.1, and 18.4 +/- 7.4 months, respectively. Thus, the patients with lymphoma responded best, both by clearing the CSF and clinically. Our treatment regimen can improve the neurologic status of patients with MC. In particular, early IT chemotherapy can be effective for patients with lymphoma.


Synergistic Effect of Hyperglycemia and Helicobacterpylori Infection Status on Colorectal Adenoma Risk.
Both Helicobacter pylori and type 2 diabetes mellitus are possible risk factors for colon adenoma. The purpose of this study was to assess the interaction between H. pylori and hyperglycemia status on the risk of colon adenoma. This was a cross-sectional, retrospective study conducted at the MacKay Memorial Hospital, Taiwan. The study included 3943 subjects aged >40 years undergoing bidirectional gastrointestinal endoscopy on the same day between July 2006 and June 2015. All subjects had a gastric biopsy specimen tested for H. pylori. Colon adenoma with and without H. pylori infection at different hemoglobin A1c (HbA1c) levels. The prevalence of colorectal adenomas in patients who were H. pylori-positive and H. pylori-negative was 37.3% and 27.29%, respectively. Multivariate logistic regression analysis identified male sex, age, body mass index, H. pylori infection, and HbA1c ≥6.5% as independent risk factors for adenoma; use of hypoglycemic agents decreased this risk. The prevalence of adenoma was increased with elevated HbA1c levels regardless of H. pylori status. The odds ratio (OR) for adenoma was 1.44 (95% confidence interval [CI], 1.20 to 1.73) if H. pylori was present or 1.68 (95% CI, 1.05 to 2.70) in patients who were H. pylori-negative but had HbA1c ≥7.0%. If both conditions were present, the OR was 4.79 (95% CI, 2.92 to 7.84). A 1% increase in HbA1c was associated with an increased prevalence of adenoma by 42.4% in H. pylori-positive subjects. The combination of H. pylori infection and elevated HbA1c is associated with an increased risk of colon adenoma.


Light-scattering efficiency of starch acetate pigments as a function of size and packing density.
We study theoretically the light-scattering efficiency of paper coatings made of starch acetate pigments. For the light-scattering code we use a discrete dipole approximation method. The coating layer is assumed to consists of roughly equal-sized spherical pigments packed either at a packing density of 50% (large cylindrical slabs) or at 37% or 57% (large spheres). Because the scanning electron microscope images of starch acetate samples show either a particulate or a porous structure, we model the coatings in two complementary ways. The material can be either inside the constituent spheres (particulate case) or outside of those (cheeselike, porous medium). For the packing of our spheres we use either a simulated annealing or a dropping code. We can estimate, among other things, that the ideal sphere diameter is in the range 0.25-0.4 microm.


Learning retardation and enhanced ethanol preference produced by postnatal pretreatments with ethanol in adult rats.
Male neonates of Wistar strain rats were given 0.63-2.50 g/kg/day of ethanol, i.p., for 7 successive days from day 6 to 12 after birth. The acquisition processes of the discriminated lever-press avoidance response (intertrial interval: 25 sec, warning stimuli presentation: 5 sec, foot shock intensity: 110V, 0.5 mA, 50 Hz, AC) were investigated for 20 separate sessions from day 60 after birth. The preference test for ethanol was done beginning at 120 days of age. No significant differences in body weights were detected between saline- and ethanol-pretreated groups. However, learning retardation was observed in all groups pretreated with ethanol. In these groups, slow responses to warning stimuli followed by escape responses from shocks delivered were often observed in early training sessions. An enhanced preference for ethanol was observed in all groups pretreated with ethanol for 7 successive days at maturity. These results suggest the possibility that learning ability and preference for ethanol in adult rats are strongly influenced by pretreatments with ethanol during the early postnatal period.


Nickel-induced histone hypoacetylation: the role of reactive oxygen species.
The carcinogenicity of specific insoluble nickel compounds is mainly due to their intracellular generation of Ni2+ ion and its suppression on gene transcription, while the inhibition of Ni2+ on histone acetylation plays an important role in the suppression or silencing of genes. Recent studies on Ni2+ and histone H4 acetylation suggest that Ni2+ inhibits the acetylation of histone H4 through binding with its N-terminal histidine-18. It is well known that bound Ni2+ readily produces reactive oxygen species (ROS) in vivo, a critical factor inversely related with the occurrence of resistance of mammalian cells to Ni2+. Thus, we tried to find the possible role of ROS in the induction of Ni2+ on histone acetylation in the present study. We found that a high concentration of Ni2+ (no less than 600 microM) caused a significant decrease of histone acetylation in human hepatoma cells. This inhibition was shown to result mainly from the influence of Ni2+ on the overall histone acetyltransferase (HAT) activity indicated by the histone acetylation assay with the presence of a specific histone deacetylase (HDAC) inhibitor, trichostatin A (TSA). The in vitro HAT and HDAC assays further confirmed this result. At the same time, we found that the exposure of hepatoma cells to Ni2+ generated ROS. Coadministration of hydrogen peroxide with Ni2+ generated more ROS and more histone acetylation inhibition. Addition of the antioxidants 2-mercaptoethanol (2-ME) at 2 mM or N-acetyl-cysteine (NAC) at 1 mM, with Ni2+ together, completely suppressed ROS generation and significantly diminished the induced histone hypoacetylation. The data presented here prove that the ROS generation plays a role in the inhibition of histone acetylation, and, hence, the gene suppression and carcinogenesis caused by Ni2+ exposure, providing a new door for us to continuously understand the mechanism of ROS in the carcinogenicity of Ni2+ and the resistance of mammalian cells to Ni2+.


Larvicidal and residual activity of imidazolium salts against Aedes aegypti (Diptera: Culicidae).
Aedes aegypti is an important mosquito species that can transmit several arboviruses such as dengue fever, yellow fever, chikungunya and zika. Because these mosquitoes are becoming resistant to most chemical insecticides used around the world, studies with new larvicides should be prioritized. Based on the known biological profile of imidazolium salts (IS), the objective of this study was to evaluate the potential of six IS as larvicides against Ae. aegypti, as tested against Ae. aegypti larvae. Larval mortality was measured after 24 and 48 h, and residual larvicidal activity was also evaluated. Promising results were obtained with aqueous solutions of two IS: 1-n-octadecyl-3-methylimidazolium chloride (C18 MImCl) and 1-n-hexadecyl-3-methylimidazolium methanesulfonate (C16 MImMeS), showing up to 90% larval mortality after 48 h exposure. C18 MImCl was more effective than C16 mIMeS, causing mortality until day 15 after exposure. An application of C18 MImCl left to dry under ambient conditions for at least 2 months and then dissolved in water showed a more pronounced residual effect (36 days with 95% mortality and 80% mortality up to 78 days). This is the first study to show the potential of IS in the control of Ae. aegypti. Further studies are needed to understand the mode of action of these compounds in the biological development of this mosquito species. © 2017 Society of Chemical Industry.


[An automated system for the integral assessment of the functional reserves of servicemen].
A review of issues of application of IBM-compatible PC and information systems of medical appointment for decision-making on professional reliability of military specialists with a base of set of objective criteria of various functional systems in human organisms, in particular, for standardization of adequate loading on servicemen during their combat training. Principles of expert evaluations of determination of functional resources of servicemen in situations of high intensity and psychophysiological tension of work.


Lipid abnormalities in the brain in adult Down's syndrome and Alzheimer's disease.
Quantitative analysis by HPTLC of the major lipid classes and dolichol, and of fatty acyl groups of separated phosphoglycerides by capillary GLC, has been carried out on the gray matter of frontal cerebral cortex of brains from six Down's syndrome (DS) and six Alzheimer's disease (AD) adults, and six each of two corresponding sets of age-matched controls; specimens of DS and control cerebellum and corpus callosum were also analyzed. In DS frontal cortex, but not in AD frontal cortex, compared to their respective controls there was a decrease in the fraction of phosphatidylethanolamine (PE) and an increase in the fractions of sphingomyelin (SPM) and phosphatidylserine (PS). Abnormalities were not found in the proportions of major lipid classes in DS cerebellum or corpus callosum. The concentration of dolichol was elevated for age in the frontal cortex of DS and of AD. In the phosphoglycerides of DS frontal cortex, the fatty acyl composition showed small, but statistically significant, differences from those of age-matched controls, and some slight abnormalities were also detected in DS corpus callosum. The alterations in DS frontal cortex included decreases in (n-6) and increases in (n-3) groups in choline and ethanolamine phosphoglycerides (CPG and EPG), as had previously been found in EPG and serine phosphoglyceride (SPG) of the DS fetal brain. In DS frontal cortex, the proportion of 22:4(n-6) groups was decreased in SPG, and in inositol phosphoglyceride (IPG) 18:1(n-9) was increased. There were also small but significant alterations in DS frontal cortex in the fractions of shorter chain groups in CPG. In marked contrast, most of the fatty acyl abnormalities seen in DS were absent in the AD frontal cortex. It is therefore suggested that some abnormalities in the composition of cerebral membranes present prenatally in DS may persist into adulthood, and are not directly related to AD-type pathology.


[ESPED-Survey: TSC-disease in children and adolescents: preliminary results from a German epidemiological survey].
Tuberous sclerosis complex (TSC) disease is a rare genetic, multi-organ disorder characterized by the occurrence of multiple hamartoma. In cooperation with ESPED, Germany, a prospective, epidemiological study was performed to assess the incidence of newly diagnosed TSC disease in patients ≤18 years in Germany. Moreover, the following parameters were assessed: 1. Age distribution at initial diagnosis; 2. Percentage of patients with in utero diagnosis of TSC; 3. Detailed description of pathological clinical findings; 4. Results from genetic testing. In this one-year interim analysis, 84 electronic questionnaires were received, 17 of which did not contain complete sets of data and were not included in data analysis. Twenty-three of 67 questionnaires did not report TSC patients and 3 reports contained redundant data sets and were excluded. In total, 41 reports were included into data analysis (female: 23; male: 18); median age at first diagnosis was 6 months (range: 0-151 months). The three most common symptoms were: central nervous affection: 31/41 patients ((75.6 %); 29/31 with seizures); rhabdomyoma: in 20/41 (48.8 %); cutaneous affection: hypomelanotic maculae ("white spots"): 20/41 (48.8 %). The three following organ manifestations were seen most often in a comprehensive diagnostic work-up: rhabdomyoma: 23/41 ((56.1 %); cortical dysplasia: 22/41 (53.7 %); "white spots"): 20/41 (48.8 %). In 11/41 patients, cardiac rhabdomyoma were detected by ultrasonography prenatally. In 6 patients, a TSC-2 mutation was found while in 4 patients a TSC-1 mutation was noted; in 1 patient, genetic testing was negative. Based on our preliminary findings, the annual incidence rate for TSC disease is estimated at approximately 1:12,300 live births, but this is a very rough approximation.


Poultry: the most common food in outbreaks with known pathogens, United States, 1998-2012.
As poultry consumption continues to increase worldwide, and as the United States accounts for about one-third of all poultry exports globally, understanding factors leading to poultry-associated foodborne outbreaks in the United States has important implications for food safety. We analysed outbreaks reported to the United States' Foodborne Disease Outbreak Surveillance System from 1998 to 2012 in which the implicated food or ingredient could be assigned to one food category. Of 1114 outbreaks, poultry was associated with 279 (25%), accounting for the highest number of outbreaks, illnesses, and hospitalizations, and the second highest number of deaths. Of the 149 poultry-associated outbreaks caused by a confirmed pathogen, Salmonella enterica (43%) and Clostridium perfringens (26%) were the most common pathogens. Restaurants were the most commonly reported location of food preparation (37% of poultry-associated outbreaks), followed by private homes (25%), and catering facilities (13%). The most commonly reported factors contributing to poultry-associated outbreaks were food-handling errors (64%) and inadequate cooking (53%). Effective measures to reduce poultry contamination, promote safe food-handling practices, and ensure food handlers do not work while ill could reduce poultry-associated outbreaks and illnesses.


Is choledocholithiasis a late complication of nonresectional therapies for hepatocellular carcinoma?
We present 3 patients who developed choledocholithiasis 10, 13, and 12 months after percutaneous ethanol injection and/or transcatheter arterial chemoembolization for hepatocellular carcinoma. Since none of these patients had stones in the gallbladder or in the bile ducts before treatment, bile duct stones might have resulted from local injury in the bile ducts by percutaneous ethanol injection and/or transcatheter arterial chemoembolization. Choledocholithiasis may be a late complication of nonresectional and local therapies for hepatocellular carcinoma tumors.


Intragraft drug infusion as an adjunct to balloon catheter thrombectomy for salvage of thrombosed infragenicular vein grafts: a preliminary report.
Early infragenicular vein graft thrombosis is associated with poor secondary patency, particularly when no correctable defect is identified. We have attempted to improve patency of thrombosed vein grafts by direct infusion of vasodilator and anticoagulant drugs after surgical thrombectomy. Among 212 infragenicular vein grafts, 16 (7.5%) required thrombectomy within 30 days of surgery (14 in situ saphenous vein, 1 composite vein, and 1 cephalic vein graft). Causes for failure were corrected in four (graft twist, intimal tear, suture failure, and external compression), resulting in prolonged patency. No cause for failure was apparent in the 12 remaining grafts after balloon catheter thrombectomy and arteriography. Two of these grafts occluded within 10 days despite multiple attempts at vein patch angioplasty, distal graft extension, and repeat thrombectomy with systemic anticoagulation. In the remaining 10 grafts, a small polyethylene catheter was placed in a proximal vein branch for direct intragraft drug infusion. Heparin (10 units/min) and nitroglycerin (50 micrograms/min) were the agents infused most frequently, for a mean duration of 52 hours after thrombectomy. Of these 10 infused grafts, 8 remained patent during a mean 17-month follow-up (range, 6 to 38 months). This was accomplished despite previous and repeated failures of thrombectomy and systemic anticoagulation in seven of these eight grafts. Two infused grafts rethrombosed within 30 days of infusion, resulting in amputation. No catheter-related complications occurred. Increased thrombogenicity, intimal injury, and spasm after balloon catheter thrombectomy may contribute to vein graft rethrombosis in the absence of technical defects. Direct intragraft infusion of nitroglycerin and heparin contributed to prolonged salvage of 80% of thrombosed vein grafts in this preliminary experience.


Appropriate treatment of malaria? Use of antimalarial drugs for children's fevers in district medical units, drug shops and homes in eastern Uganda.
To evaluate the quality of pharmaceutical care of malaria for children in eastern Uganda prescribed at government health units and drug shops, and administered by caretakers at home; and to assess its appropriateness in relation to national treatment guidelines, which recommend chloroquine over 3 days. We followed 463 children under 5 years whose caretakers attended two drug shops and two government health units to seek treatment for fever. The children were examined and the caretakers interviewed on the day of enrollment in the study (day 0), and in their homes on days 3 and 7. Data was collected on drug use prior to attending the shop or health unit, the treatment provided at these study sites, and the administration of drugs at home over the following 3 days. Before attending the study sites, 72% of children had already been given some biomedical drugs, and 40% had received the recommended drug, chloroquine. Health workers prescribed chloroquine for 94% of the children, but only 34% of the recommended doses followed guidelines. Two-thirds of the children were prescribed an injection of chloroquine. By day 3, according to caretaker reports, about 38% of the children had received chloroquine in compliance with the instructions given by the health workers and drug shop attendants. Only 28% of the children had received chloroquine at the optimal dose of 20-30 mg/kg recommended by national policy. The methods were useful for examining adherence of both caretakers and health care providers to national guidelines and the extent to which caretakers were compliant with providers' prescriptions. Chloroquine and antipyretics were the drugs of choice for fever in these areas of rural eastern Uganda. But children did not receive the recommended dosage of chloroquine because of lack of compliance on the parts of providers as well as users of health care.


Confocal microscopy by aperture correlation.
Most confocal microscopes do not produce images in real time with nonlaser light sources. The tandem scanning confocal microscope does produce such images but, because the pinhole apertures of the Nipkov disk must be placed far apart to reduce cross talk between neighboring pinholes, only 1% or less of the light available for imaging is used. We show that, by using aperture correlation techniques and relaxing the requirement to obtain a pure confocal image directly, one can obtain real-time confocal images with a dramatically increased (25% or even 50%) light budget.


Long-term melatonin treatment prolongs interestrus, but does not delay puberty, in domestic cats.
The objective was to assess the efficacy and safety of long-term administration of melatonin (either as an implant or given orally) on interestrus intervals in domestic cats. Additionally, the effect of melatonin implants on puberty postponement was studied. For these purposes, two randomized controlled trials were conducted. In the first, 68 interestrus intervals (in 28 postpubertal queens) were studied, and in the second, 32 prepubertal female cats were used. During anovulatory interestrus intervals (27 ovulatory interestrus intervals were excluded), postpubertal cats were assigned to the following three treatments: melatonin implant 18 mg/cat SC (n = 17; MEI); melatonin tablets, 4 mg/cat/d orally until the onset of estrus (n = 12; MEO); or control (n = 12; CTL). Prepubertal females were randomly assigned to the following three treatments: melatonin 18 mg/cat sc implants at either 1.9 ± 0.3 kg (MEI-A; n = 12) or 1.5 ± 0.3 kg (MEI-B; n = 10) body weight; or control (CTL; n = 10). Interestrus intervals in postpubertal MEI, MEO, and CTL groups were 63.8 ± 5.4, 63.0 ± 5.3 and 19.2 ± 1.4 d (P < 0.05), respectively. In these groups, intervals between onset of treatment and the first estrus cycle were 51.0 ± 4.7, 50.0 ± 6.1, and 12.6 ± 1.1 d (P < 0.05). In the second experiment, neither age (MEI-A: 232.4 ± 10.5, MEI-B: 208.6 ± 13.0 and CTL: 192.4 ± 20.1 d; P > 0.1) nor body weight (P > 0.1) at puberty differed among groups. None of the cats in either study had clinically apparent side effects. We concluded that long-term melatonin treatment of domestic cats slightly prolonged interestrus intervals, but did not postpone puberty.


Subhertz-linewidth Nd:YAG laser.
Light from a Nd:YAG laser at 1064 nm is independently stabilized to two Fabry-Perot etalons situated on separate vibration-isolation platforms. A heterodyne beat measurement shows their relative frequency stability to be at the part-in-10(15) level at 5 s and the relative linewidth to be less than 1 Hz.


The polymorphic phototest reaction.
One hundred tem patients with polymorphic light eruption (PMLE) and 58 control subjects were tested with an overdose of erythemogenic radiation. A morphologically abnormal phototest reaction was demonstrable in 72% of the patients with PMLE and in 9% of the control subjects. On the average, a dose of 3.8 times the patient's minimal erythemal dose was needed to produce the reaction. The most common findings in positive phototest reaction sites were edema and itching. A medium-pressure mercury lamp was shown to be as effective as a xenon arc lamp in producing the phototest reaction. The time of the reaction varied considerably in different patients, and frequent inspections of test sites were necessary to detect positive phototest reactions. When properly performed and interpreted, phototesting is a valuable diagnostic procedure for PMLE.


In vitro thermal profile suitability assessment of acids and bases for thermochemical ablation: underlying principles.
To measure and compare temperature changes in a recently developed gel phantom for thermochemical ablation as a function of reagent strength and concentration with several acids and bases. Aliquots (0.5-1 mL) of hydrochloric acid or acetic acid and sodium hydroxide or aqueous ammonia were injected for 5 seconds into a hydrophobic gel phantom. Stepwise increments in concentration were used to survey the temperature changes caused by these reactions. Injections were performed in triplicate, measured with a thermocouple probe, and plotted as functions of concentration and time. Maximum temperatures were reached almost immediately in all cases, reaching 75 degrees C-110 degrees C at the higher concentrations. The highest temperatures were seen with hydrochloric acid and either base. More concentrated solutions of sodium hydroxide tended to mix incompletely, such that experiments at 9 M and higher were difficult to perform consistently. Higher concentrations for any reagent resulted in higher temperatures. Stronger acid and base combinations resulted in higher temperatures versus weak acid and base combinations at the same concentration. Maximum temperatures obtained are in a range known to cause tissue coagulation, and all combinations tested therefore appeared suitable for further investigation in thermochemical ablation. Because of the loss of the reaction chamber shape at higher concentrations of stronger agents, the phantom does not allow complete characterization under these circumstances. Adequate mixing of reagents to maximize heating potential and avoid systemic exposure to unreacted acid and base must be addressed if the method is to be safely employed in tissues. In addition, understanding factors that control lesion shape in a more realistic tissue model will be critical.


Anti-angiogenic action of the C-terminal domain of tenomodulin that shares homology with chondromodulin-I.
Tenomodulin (TeM) is a type II transmembrane glycoprotein that contains a C-terminal domain with homology to the mature, secreted form of chondromodulin-I (ChM-I), a cartilage-derived angiogenesis inhibitor. TeM transcripts have been found in hypovascular tissues such as tendons and ligaments but the biological activity of TeM has not yet been fully explored. Using an adenovirus expression system, we utilized the forced expression and subsequent secretion of the human TeM C-terminal 116 amino acids (Ad-shTeM) in human umbilical vein endothelial cells (HUVECs) to assess the anti-angiogenic properties of TeM. The C-terminal 120 amino acids of the human ChM-I precursor (Ad-shChM-I) was similarly expressed in HUVECs as a comparison study. Transduction of both Ad-shTeM and Ad-shChM-I resulted in significant impairment of the tube-forming activity of HUVECs, when cultured in Matrigel. Similarly, conditioned medium from COS7 cells, transfected with plasmid DNA encoding shTeM or shChM-I, inhibited tube formation of HUVECs when compared to medium derived from either COS7 cells transfected with control vector or from non-transfected cells. Upon infection of HUVECs with Ad-shTeM or Ad-shChM-I, DNA synthesis stimulated by vascular endothelial growth factor (VEGF) was reduced to 40-50% of normal levels. Additionally, in a modified Boyden chamber assay, migration of HUVECs in response to VEGF was significantly affected following transduction of either Ad-shTeM or Ad-shChM-I and these transduced HUVECs were found to spread well on type I collagen or fibronectin, but not on vitronectin. Furthermore, the transduction of either Ad-shTeM or Ad-shChM-I in human melanoma cells resulted in suppression of tumor growth in association with decreased vessel density in vivo. Hence, we have demonstrated that, similarly to ChM-1, the C-terminal domain of TeM exhibits both anti-angiogenic and anti-tumor activities when expressed in a secreted form.


Effects of dexamethasone on protein degradation and protease gene expression in rat L8 myotube cultures.
We examined the effects of a synthetic glucocorticoid (dexamethasone; Dex) on protoeolysis and on protease messenger RNA (mRNA) concentrations in rat L8 skeletal myotube cultures. Protein degradation was measured as release of radioactive trichloroacetic acid-soluble material from intracellular proteins pre-labelled with [3H]tyrosine. Dex (1 microM) stimulated protein degradation (P < 0.01). This effect was entirely blocked by the glucocorticoid antagonist, RU38486 (mifepristone; P < 0.01). Hence, actions of Dex on muscle protein degradation are mediated via intracellular glucocorticoid receptors. Molecular mechanisms by which glucocorticoids stimulate protein degradation in skeletal muscle are not known. Here, we investigated the regulation of protease (cathepsin B, cathepsin D, proteasome C2 subunit and m-calpain) mRNA concentrations by Dex in cultured L8 muscle cells. Cathepsin B mRNA concentration was enhanced 3.3-fold by Dex. This effect was blocked by RU38486. RU38486 alone did not affect cathepsin B mRNA concentration or mRNAs of other proteases. Concentrations of cathepsin D and m-calpain mRNAs were also increased by Dex. These effects were also abolished by RU38486. Proteasome C2 mRNA was unaffected by Dex and Dex reduced alpha-tubulin mRNA. Thus, glucocorticoids specifically regulate the concentrations of mRNAs encoding some proteases in muscle cells. The regulation of protease mRNA concentration is mediated via interaction between Dex with glucocorticoid receptors and is independent of the actions of Dex on mRNA encoding house-keeping proteins. These changes may underlie glucocorticoid-dependent control of proteolysis in muscle.


Immunologically mediated transport of ions and macromolecules.
There is increasing evidence supporting the involvement of immune cells and mediators in the control of intestinal physiology. Cell coculture systems and epithelial cell lines have provided convenient model systems for the study of immunomodulation of epithelial function. Abundant cytokines and immune mediators have been shown to directly or indirectly alter epithelial transport of ions and macromolecules. Animal models of hypersensitivity have shown that luminal antigen challenge in the intestine of sensitized rats induces a rapid ion secretory response due to enhanced transepithelial transport of antigen. Transport of ions and macromolecules is highly regulated and an important component of host defense. Dysregulation of epithelial function may play a role in several intestinal disorders, such as inflammatory bowel diseases and food allergy.


Population doublings and percentage of S100-positive cells as predictors of in vitro chondrogenicity of expanded human articular chondrocytes.
The aim of this study was to investigate the interconnection between the processes of proliferation, dedifferentiation, and intrinsic redifferentiation (chondrogenic) capacities of human articular chondrocyte (HAC), and to identify markers linking HAC dedifferentiation status with their chondrogenic potential. Cumulative population doublings (PD) of HAC expanded in monolayer culture were determined, and a threshold range of 3.57-4.19 PD was identified as indicative of HAC loss of intrinsic chondrogenic capacity in pellets incubated without added chondrogenic factors. While several specific gene and surface markers defined early HAC dedifferentiation process, no clear correlation with the loss of intrinsic chondrogenic potential could be established. CD90 expression during HAC monolayer culture revealed two subpopulations, with sorted CD90-negative cells showing lower proliferative capacity and higher chondrogenic potential compared to CD90-positive cells. Although these data further validated PD as critical for in vitro chondrogenesis, due to the early shift in expression, CD90 could not be considered for predicting chondrogenic potential of HAC expanded for several weeks. In contrast, an excellent mathematically modeled correlation was established between PD and the decline of HAC expressing the intracellular marker S100, providing a direct link between the number of cell divisions and dedifferentiation/loss of intrinsic chondrogenic capacity. Based on the dynamics of S100-positive HAC during expansion, we propose asymmetric cell division as a potential mechanism of HAC dedifferentiation, and S100 as a marker to assess chondrogenicity of HAC during expansion, of potential value for cell-based cartilage repair treatments.


Edge restenosis after implantation of high activity (32)P radioactive beta-emitting stents.
A high restenosis rate has been reported at the edges ("edge restenosis") of (32)P radioactive stents with an initial activity level of 3 to 12 microCi. This edge effect might be due to balloon injury and to a low dose of radiation at the stent margins. The aim of this study was to evaluate whether the implantation of (32)P radioactive stents with a higher activity level (12 to 21 microCi) combined with a nonaggressive stent implantation strategy could solve the problem of edge restenosis. We compared the results of lesions treated with single radioactive BX stents with an activity of 12 to 21 microCi (group 2, n = 54 lesions) with the results of lesions treated by single radioactive BX stents with an initial activity level of 3 to 12 microCi (group 1, n = 42 lesions). There were no procedural events. At the 6-month follow-up, no myocardial infarctions, deaths, or stent thromboses had occurred. Intrastent binary restenosis was 0% in group 1 versus 4% in group 2 (n = 2, both at the ostium of the right coronary artery, P = NS). Intrastent neointimal hyperplasia was significantly lower in group 2 than in group 1. The intralesion (intrastent plus peri-stent) restenosis rate was 38% in group 1 versus 30% in group 2 (P = NS). Conclusions-Single (32)P radioactive stents with an initial activity level of 12 to 21 microCi reduced intrastent neointimal hyperplasia compared with stents of 3 to 12 microCi, but they did not solve the problem of edge restenosis, even if a nonaggressive stent implantation strategy was used.


What matters in "multimorbidity"? Arguably resilience and personal health experience are central to quality of life and optimizing survival.
Much is written about "multimorbidity" as it is a difficult problem for health systems, as it reflects a complex phenomenon unique to each individual health journey and health service context. This paper proposes the adoption of 2 constructs or knowledge streams into mainstream "multimorbidity" care which are arguably most important to person-centered care-personal health perceptions and resilience. "Multimorbidity" is the manifestation of multiple nonlinear physical, psychosocial, and environmental phenomena in an individual health journey. Multimorbidity encompasses very stable states for the most part together with highly unstable phases that are difficult to manage. Averting or controlling the underlying loss of resilience in instability can be challenging without early warning signals pointing towards tipping points. Monitoring resilience and early warning signals for tipping points is new to health care. Yet what should we monitor in the complexity of multimorbidity? There are multiple and competing health service features and biometrics that can be measured. However, an expanding of literature endorses importance of simply asking a person about their self-rated health in order to provide predictions of their resilience and survival. Interoception, exemplified as self-rated health, arises from internal neurocognitive self-monitoring functions of different internal and external phenomena. Interoception is being to be recognized as predictors and barometers of resilience and survival. Two phenomena of human systems-interoception and resilience-can guide care in the complex nature of multimorbidity in unstable health journeys and should be incorporated into clinical practice.


[Griscelli syndrome in México. Description of a case with neurological manifestations].
Griscelli syndrome is a pathological condition with immunodeficiency and is characterised by hepatosplenomegaly, silvery hair, progressive neurological deterioration, hypogammaglobulinemia and pancytopenia. It is inherited by autosomal recessive transmission and is diagnosed using the histopathological findings from a skin biopsy, characterised by hyperpigmentation with accumulations of melanin, associated to the manifestations described. We report on the first case identified in Mexico: the patient, who presented silvery hair, hepatosplenomegaly and pancytopenia, was a member of a family with two children and had no noteworthy antecedents. From the ninth month onwards there was a fast progression of the neurological deterioration, which was characterised by epileptic seizures and flaccid quadriparesis that progressed quickly to a state of coma. Magnetic resonance imaging revealed demyelination of the white matter, mainly in the bilateral frontotemporal area; skin biopsy showed hyperpigmentation with accumulations of melanin. Immunodeficiencies are serious problems, but associated with dermatological, haematological and neurological data, accompanied by findings obtained by paraclinical haematological explorations, by neuroimaging and skin biopsies, it is possible to establish the proper diagnosis in order to improve quality of life and the progress of the disease. This can be achieved by bone marrow transplant (until now the only therapy available) but it must be performed early and not when the disease is at an advanced stage, when the possibility of recovery becomes more remote


Absolute calibration of the intramolecular site preference of 15N fractionation in tropospheric N2O by FT-IR spectroscopy.
Nitrous oxide (N(2)O) plays important roles in atmospheric chemistry both as a greenhouse gas and in stratospheric ozone depletion. Isotopic measurements of N(2)O have provided an invaluable insight into understanding its atmospheric sources and sinks. The preference for (15)N fractionation between the central and terminal positions (the "site preference") is particularly valuable because it depends principally on the processes involved in N(2)O production or consumption, rather than the (15)N content of the substrate from which it is formed. Despite the value of measurements of the site preference, there is no internationally recognized standard reference material of accurately known and accepted site preference, and there has been some lack of agreement in published studies aimed at providing such a standard. Previous work has been based on isotope ratio mass spectrometry (IRMS); in this work we provide an absolute calibration for the intramolecular site preference of (15)N fractionation of working standard gases used in our laboratory by a completely independent technique--high-resolution Fourier transform infrared (FT-IR) spectroscopy. By reference to this absolute calibration, we determine the site preference for 25 samples of tropospheric N(2)O collected under clean air conditions to be 19.8 per thousand +/- 2.1 per thousand. This result is in agreement with that based on the earlier absolute calibration of Toyoda and Yoshida (Toyoda , S. , and Yoshida , N. Anal. Chem. 1999 , 71, 4711-4718 ) who found an average tropospheric site preference of 18.7 per thousand +/- 2.2 per thousand. We now recommend an interlaboratory exchange of working standard N(2)O gases as the next step to providing an international reference standard.


Epiglottitis: a recurrent episode in a youth.
Epiglottitis should be suspected in the adolescent with throat pain and dysphagia out of proportion to pharyngeal inflammation. Endolateral neck radiographs or indirect laryngoscopy will confirm the diagnosis. Blood and throat or epiglottic cultures always should be obtained. Therapy consists of airway stabilization and antibiotic administration. Although epiglottitis in adolescents is often less acute and less severe than in younger children, it may be life-threatening.


Simultaneous peripheral tuberculous lymphadenitis and a tuberculous liver abscess in a hemodialysis patient.
A tuberculous liver abscess is an extremely rare condition. However, extrapulmonary tuberculosis is more common in end-stage renal disease patients. We report a 64-year-old woman on hemodialysis with liver cirrhosis. She had no evidence of pulmonary or intestinal tuberculosis on the chest radiograph, abdominal computed tomography (CT), or colonoscopy. She had fever and an enlarged right supraclavicular lymph node. A CT showed several cystic ring-enhancing nodules in the liver. Histopathologic examinations were performed on the enlarged lymph node and a cystic nodule in the liver, which revealed caseating granulomas. Systemic antituberculous therapy was started immediately. A subsequent sonographic examination of the lesion in the liver showed improvement. In end-stage renal disease patients, we should be concerned with extrapulmonary tuberculosis. The diagnosis and antituberculous therapy must be performed promptly.


Varicella zoster virus associated acute aseptic meningitis without exanthem in an immunocompetent 14-year-old boy.
Neurologic complications can occur with varicella-zoster virus (VZV) infection, usually after vesicular exanthem. We report the case of a previously healthy 14-year-old boy with aseptic meningitis as a result of reactivated-VZV infection without exanthem. Diagnosis was made by detection of VZV-DNA in cerebrospinal fluid. VZV should be considered in cases of aseptic meningitis, even without a history of exanthem or immune compromise.


Interactive effects of silicon and arbuscular mycorrhiza in modulating ascorbate-glutathione cycle and antioxidant scavenging capacity in differentially salt-tolerant Cicer arietinum L. genotypes subjected to long-term salinity.
Salinity is the major environmental constraint that affects legume productivity by inducing oxidative stress. Individually, both silicon (Si) nutrition and mycorrhization have been reported to alleviate salt stress. However, the mechanisms adopted by both in mediating stress responses are poorly understood. Thus, pot trials were undertaken to evaluate comparative as well as interactive effects of Si and/or arbuscular mycorrhiza (AM) in alleviating NaCl toxicity in modulating oxidative stress and antioxidant defence mechanisms in two Cicer arietinum L. (chickpea) genotypes-HC 3 (salt-tolerant) and CSG 9505 (salt-sensitive). Plants subjected to different NaCl concentrations (0-100 mM) recorded a substantial increase in the rate of superoxide radical (O2 (·-)), H2O2, lipoxygenase (LOX) activity and malondialdehyde (MDA) content, which induced leakage of ions and disturbed Ca(2+)/Na(+) ratio in roots and leaves. Individually, Si and AM reduced oxidative burst by strengthening antioxidant enzymatic activities (superoxide dismutase (SOD), catalase (CAT) and guaiacol peroxidase (GPOX)). Si was relatively more efficient in reducing accumulation of stress metabolites, while mycorrhization significantly up-regulated antioxidant machinery and modulated ascorbate-glutathione (ASA-GSH) cycle. Combined applications of Si and AM complemented each other in reducing reactive oxygen species (ROS) build-up by further enhancing the antioxidant defence responses. Magnitude of ROS-mediated oxidative burden was lower in HC 3 which correlated strongly with more effective AM symbiosis, better capacity to accumulate Si and stronger defence response when compared with CSG 9505. Study indicated that Si and/or AM fungal amendments upgraded salt tolerance through a dynamic shift from oxidative destruction towards favourable antioxidant defence system in stressed chickpea plants.


Medication and health care service utilization related to depressive symptoms in older adults with psoriasis.
This study examined the relationship between depressive symptoms and related medication adherence and health care costs in older adults (age > or = 65 years) with psoriasis. Prospective longitudinal cohort study over a 2-year post enrollment period in a population of older adults with psoriasis enrolled in managed care. A Medicare Health Maintenance Organization (HMO) in southeastern United States with prescription benefits. Sixty-three older adults with psoriasis using topical corticosteroids therapy and enrolled in a Medicare HMO for a 2-year continuous period. Upon enrollment, each enrollee was mailed a comprehensive health status assessment battery, which included the Center for Epidemiologic Studies Depression (CES-D) scale. Information on medication adherence (using medication possession ratio) and total health care utilization/costs following enrollment were retrieved from the Medicare HMO database. Nearly one-fifth of the patient population had depressive symptoms. Patients with psoriasis who had depressive symptoms at the time of enrollment were less likely to be adherent to topical corticosteroid medication (r= -0.29, p<0.01) and less likely to utilize health care resources as evidenced by lower health care costs (r= -0.27, p<0.05), after confounder adjustment. The prevalence of depressive symptoms in older adults with psoriasis is commonplace, with strong, yet unexplained correlations between presence of depressive symptoms and lower rates of medication and health care service use among these patients.


Validity of glucose measurements in the blood by a glucometer reagent strip in critically ill infants.
Hypoglycemia in critically ill infants is a frequent metabolic disorder which is often due to defective glucose homeostasis. If not recognized annotated early, it can result in severe neurological damage with high mortality and morbidity. Today, glucometer is recommended for fast measuring blood glucose. The aim of this study was to evaluate the accuracy of glucometer for early diagnosis of hypoglycemia in the acutely ill infant. This study evaluates 130 critically ill infants less than 1year of age who were admitted to Besat hospital - Sanandaj - IRAN. Blood sugar was measured by standard serum method (glucose oxidase) and glucometer reagent strip. The overall means of blood sugar were 115.6 ± 1.75 with serum method and 119.1 ± 1.56 with glucometer method. The rates of sensitivity, specificity, positive predictive value and negative predictive value with glucometer method and with serum glucose method were 72%, 53%, 62%, and 77% respectively. The correlation between the two methods was significant (p < 0.001). Kappa statistics for the two methods was 42%. The results showed that in general, glucometer may be appropriate for rapid screening in emergency situations and when frequent blood glucose monitoring is needed but it cannot be regarded as a very suitable and reliable tool for diagnosis of hypoglycemia in critically ill infants.


Hepatitis C and hemodialysis: a review.
Hepatitis C is a serious public health problem throughout the world; chronic renal patients are highly exposed to this infection. This could be due to a failure to identify carriers of this disease or because of a lack of truly effective biosafety measures implemented in the dialysis units. Molecular biology techniques have allowed for the understanding of this virus in detail, including its replication mechanisms. Epidemiological studies have been made throughout the world, with the goal of determining the dissemination dynamics of this agent, in addition to examining the predominance of the different genotypes, and the possible mutants that are involved. Many questions must still be answered concerning infection by Hepatitis C virus (HCV); this is especially important for immunosuppressed patients.


Gastrointestinal symptoms rating scale in coeliac disease patients on wheat starch-based gluten-free diets.
A wheat starch-based gluten-free diet is widely adopted in the treatment of coeliac disease, even though the products contain trace amounts of gluten. The aim here was to establish whether such a diet sustains abdominal symptoms. The Gastrointestinal Symptom Rating Scale (GSRS) was applied to 58 coeliac disease patients on gluten-free diets and 110 non-coeliac controls. An estimate was made of daily dietary fibre and wheat starch-derived gluten. Psychological well-being was evaluated by a structured interview. Twenty-three coeliac patients consented to small-bowel biopsy. The mean GSRS score in coeliac disease patients did not differ from that in control subjects. Poorer psychological well-being was associated with abdominal symptoms in coeliac patients, whereas the daily amount of wheat starch had no effect on GSRS score. Overall dietary compliance was good, and villous atrophy was found in only 2 out of 23 patients. The average fibre consumption, 13 g per day, was lower than recommended. Wheat starch-based gluten-free products are well-tolerated in coeliac disease patients, provided that their diets are otherwise strict.


The ConNECtion Between Abdominal Signs and Necrotizing Enterocolitis in Infants 501 to 1500 g.
Necrotizing enterocolitis (NEC) can become severe quickly, making early recognition a priority and understanding the occurrence of abdominal and clinical signs of impending NEC important. The purpose of this study was to examine relationships of abdominal signs up to 36 hours before diagnosis of NEC within subgroups treated medically, surgically, or those who died. A 3-site, descriptive correlational case-control design with retrospective data collection was used matching each NEC case to 2 controls (N = 132). NEC cases were exposed to less human milk and fed later. Among them, 61% (n = 27) had at least 1 abdominal sign 36 hours before diagnosis, with fewer numbers having 2 (18%; n = 8) or 3 (5%; n = 2). At 36 hours before NEC, abdominal distension, duskiness, higher gastric residual, and greater count of abdominal signs were associated with severe NEC. No medical NEC cases had abdominal signs 36 or 24 hours before diagnosis. Highest severity of NEC was related to more abdominal signs at the times leading up to and at diagnosis of NEC. Gastric residuals were largely unrelated to NEC except for the most severe NEC at 36 hours before diagnosis. Communicating a count of abdominal signs may support earlier recognition and treatment of NEC. More research is needed to explore timing for clinical worsening of status (eg, surgical and NEC leading to death) and to study effective clinical approaches targeting early recognition to support timely action.


High Intracellular Seed Train BiP Levels Correlate With Poor Production Culture Performance in CHO Cells.
Consistent cell culture performance is a prerequisite to ensure product quality consistency and achieve productivity goals for the manufacture of recombinant protein therapeutics, including monoclonal antibodies. Here a peculiar observation is reported where high levels of intracellular BiP in seed train cultures are consistently predictive of poor cell culture performance in the subsequent inoculum and production cultures for a monoclonal antibody produced in CHO cells. This investigation suggests that in this cell line the high intracellular BiP levels in the seed train are triggered by a slightly lower culture pH, which interferes with proper antibody folding and secretion. While the seed train culture does not display any obvious signs of the problem at slightly lower culture pH, inoculum trains, and production cultures sourced from these low pH seed trains display significantly lower cell growth and cell size. High intracellular BiP levels may interfere with UPR signaling, thereby hampering a proper and timely UPR response in the production media. Studies of other problematic cell lines have shown a similar correlation between intracellular BiP accumulation and poor production performance. The authors believe intracellular BiP levels in seed train should hence be low in order to increase the success rate in production.


Failure of deep brain stimulation of the posterior inferior hypothalamus in chronic cluster headache - report of two cases and review of the literature.
Deep brain stimulation (DBS) has become a standard procedure for movement disorders such as Parkinson's disease, essential tremor or dystonia. Recently, deep brain stimulation of the posterior hypothalamus has been shown to be effective in the treatment of drug-resistant chronic cluster headache. DBS of the posterior inferior hypothalamus was performed on two patients with chronic cluster headaches, one 55-year-old man with medically intractable chronic cluster headache since 1996, and one 31-year-old woman with a chronic form since 2002. Both patients showed continuous worsening headaches in the last years despite high dose medical treatment. The patients fulfilled the published criteria for DBS in chronic cluster headaches. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to the published coordinates (2 mm lateral, 3 mm posterior, 5 mm inferior) referenced to the mid-AC-PC line. The intra- and postoperative course was uneventful and postoperative MRI control documented regular position of the DBS electrodes. The current stimulation parameters were at 12 months postoperatively 0 neg., G pos.; 5.5 V; 60 micros; 180 Hz (Case 1) and 0 neg., G pos.; 3.0 V; 60 micros; 185 Hz, at 3 months postoperatively (Case 2). Surgery- or stimulation-related side effects were not observed. Both patients showed initial pain reduction in the first days whereas 12 respectively 3 month follow-up did not show a significant reduction in attack frequency or intensity. Deep brain stimulation of the posterior inferior hypothalamus is an experimental procedure and should be restricted to selected therapy-refractory patients and should be performed in centers experienced in patient selection and performance of DBS as well as postoperative pain treatment. A prospective multi-centre study is necessary to evaluate its effectiveness.


A systematic review of antidepressant placebo-controlled trials for geriatric depression: limitations of current data and directions for the future.
Depression in the elderly is a major public health problem as untreated depression adversely impacts comorbid illnesses. It is important to develop safe and effective antidepressant therapies for older individuals. We performed a systematic review of all published randomized, placebo-controlled antidepressant medication trials in populations over age 55 years. Papers were obtained via MEDLINE (1966-August 2003) and PSYCINFO (1872-August 2003). Unpublished trials, trials examining nonpharmacologic interventions, and papers reporting post hoc analyses were not included in this review unless they provided new insights. A total of 18 placebo-controlled trials examining acute efficacy met our criteria. The combined sample size in these studies was 2252. The mean sample size was 51 (range 20-728) and mean trial duration was 7 weeks. A total of 12 trials examined tricyclic antidepressants (TCAs), five trials examined selective serotonin reuptake inhibitors (SSRIs), two trials examined bupropion, and one trial examined mirtazapine. There were no published trials of venlafaxine or nefazodone. In all, 71.5% of trials reported significantly greater efficacy with drug than placebo. In conclusions, there is a paucity of published controlled antidepressant trials in the elderly. Most published studies examine small sample sizes and do not include common comorbid conditions. Efficacy studies examining relapse prevention are lacking. Large placebo response rates, lack of controlled head to head comparisons, and other methodological design differences make crosstrial comparisons difficult. Large simple studies are urgently needed to address the unmet needs for data on safety and efficacy of antidepressants in this population.


Geriatric hearing loss: management strategies for nurses.
Communication with the hearing impaired is sometimes difficult. Nurses can become more sensitive to the communication disorders of the elderly and use their knowledge to avoid creating unnecessary barriers to the nurse-patient relationship.


Reduction of chlorinated methanes with nano-scale Fe particles: effects of amphiphiles on the dechlorination reaction and two-parameter regression for kinetic prediction.
The influences of amphiphiles, including humic acid (HA) and various types of surfactants, on dechlorination of carbon tetrachloride (CTC) and chloroform (CF) by the nano-scale Fe particles were investigated. Since the amphiphiles would modify the surface tension between the liquid-liquid and solid-liquid interface, in the presence of amphiphile matrix solution the Fe corrosion rate and the parent compound dechlorination rate would be different from those in the ultrapure water. Among the four amphiphile solutions, Fe corrosion rate was the highest in the anionic surfactant sodium dodecyl sulfate (SDS) solution, presumably due to the existence of chemisorption between the hydrophilic head of SDS and Fe particles. The dechlorination rates of CTC and CF could be described with the pseudo-first order kinetic model. The influences of amphiphiles on the dechlorination reaction rate were related to the species of parent compound and concentration of the matrix solution. The influences of HA on the dechlorination of CTC and CF were the most significant compared to other matrix solutions. At relatively low HA concentration (<0.1 g L(-1)), the HA molecules (serving as electron transfer mediator) would significantly accelerate the dechlorination rate of CF. The two-parameter regression with energy of the lowest unoccupied molecular orbital (E(LUMO)) and HA concentration as the descriptors was developed to predict the specific reduction rate constants of chlorinated methanes in HA solution. The analysis of variance (ANOVA) indicated the existence of significant relationship between the dechlorination rate constants and the two descriptors.


Investigation of possible risk factors for depression in Alzheimer's disease: A systematic review of the evidence.
Depression is common in people with Alzheimer's disease (AD), and is associated with increased risk of institutionalization and mortality. Understanding risk factors for depression in AD is key to its development and treatment. We searched the MEDLINE, EMBASE, PsycINFO, and CINAL databases for longitudinal prospective cohort studies that evaluated risk factors for depression in people with AD. Two authors independently selected articles for inclusion and assessed quality of studies using predetermined criteria. In seven studies that met the inclusion criteria, 2029 participants were followed up for a median of 5 years. Gender and educational attainment were not predictors of depression risk. History of a past psychiatric disorder and greater cognitive impairment predicted increased risk of depression in more than one study. In single studies, younger age, having a family history of psychiatric disorder, neuroticism, functional decline, presence of sleep disturbance and aggression, and increased cardiovascular risk predicted depression risk. Not being within 6 months of dementia onset and, counterintuitively having two comorbid disorders were protective factors in one study. A small number of studies exist overall and only a few have examined the same risk factors. Most of the studies have measured depression using scales that are not validated in AD. These results inform a preliminary model of depression risk in people with AD. Unlike in the general population, men and women and those with higher and lower educational levels of attainment may be equally at risk of depression. Clinicians should be aware of these possible differences in the risk profile for depression in AD populations, to assist detection and enable early treatment. Interventions to delay cognitive and functional decline may reduce depression risk.


[Metastasis of a malignant melanoma simulating a primary mandibular sarcoma].
The rare case reported here was a mandibular metastasis of a malignant melanoma located in the nape of the neck and surgically removed. 4 years later, occurred a fibrosarcomatous mandibular tumour without local recurrence. The metastatic nature of this tumour was difficult to prove by means of immunohistochemical and ultrastructural methods. This case illustrated the eventuality of a desmoplastic change in metastasis of a common malignant melanoma. The histogenesis of this rare type of melanoma was discussed.


Detection of c-kit-activating mutations in gastrointestinal stromal tumors by high-resolution amplicon melting analysis.
High-resolution amplicon melting analysis was used to scan for c-kit-activating mutations in exons 9, 11, 13, and 17 in 29 neoplasms diagnosed as gastrointestinal stromal tumors (GISTs). Immunohistochemically, 7 of 29 did not show strong CD 17 positivity and might represent true smooth muscle tumors or c-kit-negative GISTs. No c-kit-activating mutations were detected in the 7 CD117- cases by high-resolution amplicon melting analysis or direct DNA sequencing. Alterations in the remaining 22 CD117+ cases included 13 (59%) in exon 11, 2 (9%) in exon 9, 1 (5%) in exon 13, and none in exon 17. The genetic alterations consisted of point mutations and in-frame insertions, duplications, and deletions. In exon 11, 7 (54%) of 13 alterations have not been described previously. In 2 cases, the identical exon 11 mutation was observed in the primary tumor and a metastatic/recurrent lesion. In all cases, direct DNA sequencing confirmed that polymerase chain reaction products with an abnormal melting curve contained a mutation and products with a normal melting curve, a normal DNA sequence. High-resolution melting analysis can be used to scan DNA for potential c-kit-activating mutations and can aid in the diagnosis of GISTs.


Unrestricted usage of immunoglobulin heavy chain genes in B cells infiltrating the wall of atherosclerotic abdominal aortic aneurysms.
The aim of this study was to provide evidence for the hypothesis that the B cell rich infiltrate concentrated in the adventitia of atherosclerotic abdominal aortic aneurysms is an autoimmune response to specific tissue antigens. Detailed histological examination of biopsies from 26 atherosclerotic abdominal aortic aneurysms showed in the adventitia, the presence of lymphoid follicles in 7/26 (27%) and of plasma cells in all cases. DNA prepared from the outer aneurysm wall (n = 25) was amplified using the polymerase chain reaction to investigate the repertoire of the immunoglobulin heavy chain (VH) genes used. Amplification of the VDJ region of VH, using both framework 2 and 3 primers, revealed unrestricted usage of the VH gene in 24/25 cases. The only case where restricted usage of the VH genes was observed, might have been attributable to severe virally-induced tissue inflammation. These results indicate that, in the vast majority of atherosclerotic abdominal aortic aneurysms, the B cell rich adventitial infiltrates are not an autoimmune response to a limited repertoire of tissue antigens.


Some infectious and parasitic diseases in Oklahoma raptors.
Blood films and sera samples from wild Oklahoma raptors (Strigiformes--36 birds, 3 species; Falconiformes--50 birds, 7 species) were examined for hematozoa and tested for serologic antibody response to Newcastle Disease Virus (NDV), encephalitis (EEE and WEE), ornithosis, and influenza. Twenty-nine of 36 (80.5) Strigiformes and 24 of 50 (48.0%) Falconiformes showed the presence of one or more hematozoa. Serologic testing revealed the serum of one adult male red-tailed hawk positive for antibody to NDV and one additional adult male red-tailed hawk positive for antibody to type-A influenza.


Attempted transmission of Ehrlichia chaffeensis among white-tailed deer by Amblyomma maculatum.
A deer was needle-exposed intravenously to Ehrlichia chaffeensis (Rickettsiales: Ehrlichieae) in canine macrophage (DH82) cells and 7 days later was infested with laboratory-reared Amblyomma maculatum (Koch) (Acari:Ixodidae) nymphs for acquisition feeding. After molting, the adult ticks were allowed to feed on a naive deer. The organism was reisolated from the needle-exposed deer by cell culture and E. chaffeensis DNA was detected in the deer's blood by PCR. Similar isolation/recovery techniques were used for the tick-exposed deer and no evidence of infection was found. Although these findings must be considered as preliminary owing to inadequate controls, the data suggest that A. maculatum is probably not a suitable vector for E. chaffeensis.


Storage and quality assessment of platelets.
Platelet concentrates stored for 5 days under currently optimal conditions at 22 C demonstrate approximately a 20-30% loss of viability as determined by CCI measurements in thrombocytopenic patients and radiolabeling studies with healthy volunteers. The functionality of platelets is substantially lost during storage. This loss appears, for most part, to be reversible upon infusion. In view of this, stored platelets should be acceptable for prophylactic treatment of thrombocytopenic patients in whom immediate hemostatic function is not critical. However, whether stored platelets are functionally adequate for immediate arrest of perioperative bleeding in surgical patients remain uncertain. Currently, a fully adequate and appropriate test that evaluates the hemostatic function of a stored platelet product is not available. In view of this, a desired goal in research and development of new platelet products may then be to attain a platelet product that is similar to fresh platelets in various haemostatic functions. Whether this is an obtainable or relevant goal remains to be seen.


Experimentally nonylphenol-polluted diet induces the expression of silent genes VTG and ERα in the liver of male lizard Podarcis sicula.
Endocrine Disruptor Chemicals (EDCs) with estrogen-like properties i.e nonylphenol (NP) induce vitellogenin (VTG) synthesis in males of aquatic and semi-aquatic species. In the oviparous species VTG is a female-specific oestrogen dependent protein. Males are unable to synthesize VTG except after E2 treatment. This study aimed to verify if NP, administered via food and water, is able to induce the expression of VTG even in males of vertebrates with a terrestrial habitat such as the lizard Podarcis. By means of ICC, ISH, W/B and ELISA we demonstrated that NP induces the presence of VTG in the plasma and its expression in the liver. VTG, undetectable in untreated males, reaches the value of 4.34 μg/μl in the experimental ones. Expression analysis and ISH in the liver showed that an NP-polluted diet also elicits the expression of ERα in the liver which is known to be related to VTG synthesis in Podarcis.


A comparison of the Glasgow Coma Scale and the Reaction Level Scale (RLS85).
The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS85) were compared for rating neurosurgical patients in regard to ranking order of deficit severity, interobserver variability, and coverage for relevant factors. Four physicians, four registered nurses, and four assistant nurses performed 72 pairwise ratings on 47 neurosurgical patients. The rank correlation between the GCS sum score and the RLS85 was -0.94, suggesting the same ranking order of severity and indicating that the underlying concepts of somnolence, delirium, and motor responses in coma are evaluated in the same way. By the sign test, the RLS85 was shown to have better interobserver agreement than the GCS sum score and the eye-motor-verbal (EMV) profile. The interobserver grading disagreements in both scales were distributed over the entire range of responsiveness, and for the GCS sum score they were slanted to combined segments 9 to 15. The RLS85 showed full coverage of relevant factors, while 43 (60%) of the 72 test occasions in the GCS sum score and the EMV profiles showed untestable features, most often because of patient intubation. The pseudoscore (that is, the choice of value given to untestable features) affects interobserver agreement as well as the estimated overall patient responsiveness in the GCS sum score. Assessment by the order of applying the scales showed a significant effect on the GCS eye-opening scale (p = 0.01) and the GCS sum score (p = 0.03), indicating a sensitivity to environmental stimuli unrelated to the patient's status. This study demonstrates that basically the same information as that found in the separate eye, motor, and verbal scales of the GCS can be combined directly into the RLS85, which has better interobserver agreement and better coverage than the GCS sum score.


[To how much strain are families with asthmatic children exposed?].
Children with bronchial asthma may have coping problems which involve the whole family. The aim of this study was to find out what strain such families may experience. A questionnaire was sent to all children who, during a five year period, were registered as having a diagnosis of bronchial obstruction in the Department of Paediatrics, Innherred Hospital, Norway. The parents of a sample of the children were interviewed, and the parents of 42 children also answered a questionnaire about coping problems and strain. The results showed that the prevalence of coping problems and strain was low for these families at the time of the interview. Coping problems were greater during the first two years after asthma debut. Mothers felt more strain than the fathers during the two first years.


Molecular and cellular biology of von Willebrand factor.
Von Willebrand factor (vWF), a central protein in the regulation of blood coagulation, serves as a major adhesive link between platelets and the blood vessel wall and also functions as a carrier in plasma for factor VIII. Abnormalities of vWF result in von Willebrand disease (vWD), a common inherited human bleeding disorder. Deficient von Willebrand factor function has been proposed as potentially protective against the development of coronary vascular disease and several recent investigational therapies are directed at the vWF-platelet interaction. This review summarizes the current state of knowledge regarding the biosynthesis and processing of vWF and the relationship of vWF structure to function. Finally, recent progress in identifying specific genetic mutations responsible for the many variants of vWD is discussed.


Effect of micro lesions of the basal ganglia on ballistic movements in patients with deep brain stimulation.
Bradykinesia and hypokinesia are the prominent symptoms of substantia nigra degeneration in Parkinson's disease (PD). In segmental dystonia, movements of not affected limbs are not impaired. Here we studied the impact of the mere implantation of stimulation electrodes on the performance of fast movements in these two groups. We investigated 9 PD patients with subthalamic electrodes and 9 patients with segmental dystonia with electrodes in the globus pallidus internum. Patients were studied on the first postoperative day without electrical stimulation of the electrodes. Subjects had to perform boxing movements with either touching the target or stopping the fist in front of the target. PD subjects performed significantly faster movements in the touch-task only as compared to dystonic patients. No difference was seen in the stopping task. In conclusion, our findings suggest that a small subthalamic lesion in individuals with PD specifically reverses bradykinesia during simple ballistic movements (touch) but not during complex ones requiring more pre-programming (no-touch paradigm).


Bovine milk kininogen fragment 1.2 promotes the proliferation of osteoblastic MC3T3-E1 cells.
The active component on the proliferation of osteoblastic MC3T3-E1 cells was purified and identified from bovine milk. The growth-promoting activity was measured by [(3)H]thymidine incorporation on the cell. The purified protein showed a molecular size of 17 kDa on SDS-PAGE. Its amino-terminal amino acid sequence was very similar to the internal sequence of bovine high molecular weight (HMW) kininogen, which comprises fragment 1.2. The promotion of proliferation was specific for osteoblastic MC3T3-E1 cells, not for fibroblast BALB/3T3 cells. In blood coagulation, HMW kininogen is considered to be cleaved by a specific enzyme kallikrein. HMW kininogen then releases two peptides, a biologically active peptide bradykinin and fragment 1.2, but the fate of fragment 1.2 is unknown. This milk-derived protein that comprises to fragment 1.2 showed a growth-promoting activity of osteoblasts. We propose the possibility that milk plays an important role in bone formation by supplying the active agent for osteoblasts as well as supplying calcium.


Dynamic Article: Tandem Robotic Technique of Extralevator Abdominoperineal Excision and Rectus Abdominis Muscle Harvest for Immediate Closure of the Pelvic Floor Defect.
Extralevator abdominoperineal excision for distal rectal cancers involves cylindrical excision of the mesorectum with wide division of the levator ani muscles. Although this technique has been shown to decrease local cancer recurrence and improve survival, it leaves the patient with a considerable pelvic floor defect that may require reconstruction. We developed an innovative technique of robotic extralevator abdominoperineal excision combined with robotic harvest of the rectus abdominis muscle flap for immediate reconstruction of the pelvic floor defect. This was a retrospective review pilot study. This study was conducted at a tertiary care cancer center. Three patients who underwent robotic extralevator abdominoperineal excision with robotic rectus abdominis flap harvest for distal rectal adenocarcinoma were included. Intraoperative and postoperative outcomes included operative time, intraoperative complications, length of hospital stay, wound complications, incidence of perineal hernia, persistent pain, and functional limitations. Three patients underwent this procedure. The median operative time was 522 minutes with median hospital stay of 6 days. One patient experienced perineal wound complication requiring limited incision and drainage followed by complete healing of the wound by secondary intention. The other 2 patients did not experience any wound complications. Longest follow-up was 16 months. None of the patients developed perineal hernias during this time period. The small sample size and retrospective nature were limitations. This technique confers multiple advantages including improved visualization and dexterity within the pelvis and accurate wide margins at the pelvic floor. An incisionless robotic flap harvest with preservation of the anterior rectus sheath obviates the risk of ventral hernia while providing robust tissue closure of the radiated abdominoperineal excision wound. This technique may result in faster postoperative recovery, decreased morbidity, improved functional outcomes and cosmesis. Further studies are needed to prospectively analyze this approach (Supplemental Digital Content 1, video abstract, http://links.lww.com/DCR/A188).


Hemimelia in Brachmann-de Lange syndrome (BDLS): a patient with severe deficiency of the upper and lower limbs.
We report on a male infant with Brachmann-de Lange syndrome (BDLS) and ulnar hemimelia and monodactyly but also absence of both tibiae, the right distal femur being bifurcated. One similar observation was published earlier. The question is raised whether these malformations are coincidental or a rare component of BDLS.


[Use of long-acting L-asparaginase (PEG-asparaginase) in acute lymphoblastic leukemia].
Twenty-five patients with acute lymphoblastic leukemia [15 adults and 10 children] received standard treatment in which regular L-asparaginase was replaced for L-asparaginase of prolonged action [PEG-asparaginase]. The drug was administered once in two weeks in a dose 2500 IU/m2 for remission induction and consolidation or as a component of maintenance therapy. It was found that the response to primary PEG-asparaginase treatment or its use in the disease relapses produced the same response as regular L-asparaginase, being superior in convenience and feasibility of outpatient use. Side effects in the form of hypoproteinemia, hepatic toxicity and toxic pancreatitis [in children, 9 and 1 adults, respectively] were moderate and disappeared after 10-20-day discontinuation of the drug.


Use of the omentum flap as additional soft-tissue cover for abdominal wall defects reconstructed with Gore-Tex.
Use of alloplastic materials such as Gore-Tex and locoregional flaps for reconstruction of large abdominal wall defects has been well described. The purpose of this article is to present a novel technique of using the omentum as an interpositional flap to protect the Gore-Tex repair of the abdominal wall. Four patients with large abdominal wall defects underwent reconstruction with Gore-Tex and omentum flap. These defects resulted from tumor resection and recurrent incisional hernia. Their dimensions ranged from 15 x 10 cm to 25 x 27 cm. The Gore-Tex patch was inset using an underlay technique. The omentum was tunneled through a separate opening in the abdominal wall into the subcutaneous plane and used to cover the Gore-Tex. Skin coverage was accomplished by direct closure or myocutaneous flaps. The mean follow-up was 17 months. All wounds healed, with no hernias. One patient developed a subcutaneous abscess 6 months postoperatively, and this was treated successfully by percutaneous drainage, as the omentum had walled-off the abscess. The omentum flap served as an additional soft-tissue cover over the Gore-Tex repair to prevent exposure in the event of infection or flap breakdown. This technique is useful in situations in which delayed wound healing is anticipated or when large quantities of prosthetic material are used.


[Unilateral congenital aplasia of the submandibular gland].
Aplasia of the major salivary glands is very uncommon, whereas isolated aplasia of unilateral submandibular gland is even rarer. In this article, we report a 55-year-old female case in whom unilateral aplasia of the left submandibular gland was detected incidentally by ultrasonography with no other congenital comorbidities in the light of literature data.


Treatment of obstetric and gynecologic infections with cefamandole.
Cefamandole nafate is a derivative of 7-aminocephalosporanic acid which has been shown to have good in vitro activity against aerobes traditionally susceptible to cephalosporins as well as many anaerobes, including B. fragilis. One hundred women with obstetric or gynecologic infections completed treatment with cefamandole: 53 had post-cesarean section infections: 24, acute pelvic inflammatory disease: 16, posthysterectomy cuff cellulitis/abscess; and seven, vulvar or abdominal wound abscess. Almost 90% of these women had either polymicrobial aerobic/anaerobic bacterial infections or an anaerobic infection alone. Ninety women responded to cefamandole alone; in 10 cases chloramphenicol was added, but in addition five of these women required surgical therapy for eradication of infection. Mild to severe phlebitis at the infusion site that responded to conservative therapy was demonstrated in 14 women. Of 312 bacterial isolates from these women, 89% were sensitive to cefamandole at 32 microgram/ml, an easily achievable serum level; 93% of anaerobic streptococci, the most common isolates, were sensitive at 32 microgram/ml. Also, 90% of all Bacteroides species were susceptible at 32 microgram/ml; 82% of B. fragilis were susceptible at this concentration. These data indicate that cefamandole is safe and effective for treatment of women with polymicrobial pelvic infections but that approximately 5% of these women will require surgical exploration in addition to antimicrobial administration.


Alternative modes of ventilation. Part I. Disadvantages of controlled mechanical ventilation: intermittent mandatory ventilation.
Controlled mechanical ventilation is an accepted therapy for acute respiratory failure but by virtue of the increase in intrathoracic pressure has a large number of disadvantages. It is to overcome these disadvantages that alternative modes of ventilation have been introduced. These aim to reduce the effects of abnormally high airway pressure on the lung whilst recruiting solid alveoli and at the same time maintaining effective blood volume. Intermittent mandatory ventilation is a mode of ventilation first introduced to aid weaning which may reduce the need for sedation, permit better tolerance of high levels of PEEP and maintain urine osmolar output. High frequency ventilation utilising low airway pressures can maintain pulmonary gas exchange whilst reducing the effects of stretch on the lung. Its major role would seem to be in cases of bronchopleural fistula and necrotising pneumonia where a low mean airway pressure is essential. Low frequency positive pressure ventilation with extra corporeal CO2 removal, whilst a very labour intensive technique, has produced a favourable outcome in patients with terminal respiratory failure. Use of PEEP is associated with further deleterious haemodynamic effects which are largely overcome with use of continuous positive airway pressure during spontaneous respiration. PEEP is widely used. Its effect on pulmonary compliance, dead space and oxygen delivery are unpredictable making haemodynamic monitoring mandatory. Inversed ratio ventilation requires further evaluation whereas differential lung ventilation is logical, complicated but very valuable where the time constants for each lung are significantly different.


A mitochondrial tRNA aspartate mutation causing isolated mitochondrial myopathy.
Several mutations in mitochondrial transfer RNA (tRNA) genes can cause mitochondrial myopathy. We describe a young girl who presented with pronounced exercise intolerance. The anaerobic threshold and the maximal oxygen consumption were decreased. She had decreased complex I and IV enzyme activity and ragged red fibers on muscle biopsy. An A to G transition at nucleotide position 7526 in tRNA Aspartate (tRNA(Asp)) gene was heteroplasmic in several of the patient's tissues. We were unable to detect the mutation in muscle tissue from the patient's mother. This case adds a new genetic etiology for mitochondrial myopathy. It also illustrates for patients with combined deficiency of the complex I and IV enzyme activity the value of sequencing in the affected tissue muscle, and not only in blood, all mitochondrial tRNA genes including those not commonly affected, such as in this case mt tRNA(Asp).