Cheek mass as a presentation of metastatic rectal cancer.
Cheek metastasis from colorectal cancer is very unusual. We report on a 79-year-old female rectal cancer patient who underwent low anterior resection and lymph node dissection. The initial stage for this patient was T3N0M0 (by AJCC 1997). Postoperatively 49 months later, she presented with a right cheek mass that progressively enlarged within 2 weeks. Computed tomographic (CT) scan showed a well-defined 5 x 5-cm mass over the right parotid space and infratemporal fossa. The tumor was noted to be displacing the right masseter muscle laterally with obliteration of the medial border. In addition, destruction of the right mandible was also noted. Histology of this right cheek mass revealed it to be a metastatic adenocarcinoma, which was similar to that of the primary rectal adenocarcinoma. Multiple metastases including to the bone, lung, and liver were also found. The patient only underwent radiotherapy to the right cheek mass because of its rapid growth. Chemotherapy was not considered due to her advanced age. She did not complete the entire radiation therapy course because she expired. In our review, this is a very rare case presenting with cheek mass metastasis from rectal carcinoma. It was associated with widespread and aggressive disease due to rectal cancer.


Functional genomics and its implications for molecular medicine.
Technological development in genetics and genomics provides unprecedented possibilities to identify the underlying molecular basic of many common diseases. With the availability of the human genome sequence and growing information on the most frequent DNA variations combined with the molecular analysis on the RNA expression and protein level, diseases might be characterized in the future at the molecular level. Describing gene function anf the specific role of DNA, RNA, and proteins in the disease process provides novel diagnosis tools and treatment. Ultimately how the unique genetic signature of an individual influences the risk and prognosis of disease will be the basis for individualized medicine in the years to come.


Pitfalls of insulin-like growth factor-i and growth hormone assays.
Accurate measurement of growth hormone (GH) and insulin-like growth factor-I (IGF-I) are the key to correct diagnosis of acromegaly and GH deficiency. Unfortunately, there is much variation involved when these hormones are measured at different sites and using different assay methods. There is an ongoing global effort to standardize the measurement process to obtain more comparable results in the future. This review discusses common pitfalls in the measurement of GH and IGF-I and guides laboratories in their analyses of these hormones.


Long-lasting deficits in hedonic and nucleus accumbens reactivity to sweet rewards by sugar overconsumption during adolescence.
Adolescence is a critical period characterized by major neurobiological changes. Chronic stimulation of the reward system might constitute an important factor in vulnerability to pathological development. In spite of the dramatic increase in the consumption of sweet palatable foods during adolescence in our modern societies, the long-term consequences of such exposure on brain reward processing remain poorly understood. Here, we investigated in rats the long-lasting effects of sugar overconsumption during their adolescence on their adult reactivity to the hedonic properties of sweet rewards. Adolescent rats with continuous access to 5% sucrose solution (from postnatal day 30-46) showed escalating intake. At adulthood (post-natal day 70), using two-bottle free choice tests, sucrose-exposed rats showed lower intake than non-exposed rats suggesting decreased sensitivity to the rewarding properties of sucrose. In Experiment 1, we tested their hedonic-related orofacial reactions to intraoral infusion of tasty solutions. We showed that sucrose-exposed rats presented less hedonic reactions in response to sweet tastes leaving the reactivity to water or quinine unaltered. Hence, in Experiment 2, we observed that this hedonic deficit is associated with lower c-Fos expression levels in the nucleus accumbens, a brain region known to play a central role in hedonic processing. These findings demonstrate that a history of high sucrose intake during the critical period of adolescence induces long-lasting deficits in hedonic treatment that may contribute to reward-related disorders.


Cronobacter sakazakii bacteremia in a heart transplant patient with polycystic kidney disease.
Infections with Cronobacter sakazakii are mainly described among neonates and infants, with contaminated powdered infant formulas most often incriminated as the cause. We describe here a case of C. sakazakii bacteremia secondary to a suspected cyst infection in a heart-and-kidney transplant patient with polycystic kidney disease.


Effect of treatment with iloprost with or without bosentan on nailfold videocapillaroscopic alterations in patients with systemic sclerosis.
Vascular involvement plays a decisive role in systemic sclerosis (SSc) pathogenesis; it is responsible for some important clinical manifestations of the disease such as Raynaud's phenomenon and digital ulcers (DU). Bosentan, a dual receptor endothelin antagonist, and iloprost, often in combination therapy, seems to be able to interfere with the scleroderma microangiopathy. Aim of the study was to evaluate the effect of bosentan and iloprost on scleroderma microangiopathy, analyzed by means of capillaroscopic skin ulcer risk index (CSURI), in SSc patients treated for the prevention of DU. Nailfold videocapillaroscopy (NVC) was performed in 95 SSc patients, treated with iloprost alone (group 1) or combination therapy with iloprost and bosentan (group 2), at baseline and after one year. In all patients CSURI was calculated according to the formula "diameter × number of megacapillaries/(total number of capillaries)2": in addition, total number of capillaries, giant capillaries, micro-hemorrhages, disorganization of the vascular array, and ramified capillaries were evaluated by means of a semiquantitative score. After 12 months, we observed a reduction of the number of giant capillaries in both groups, while an increase of ramified capillaries was recorded only in group 2. CSURI improved slightly in group 2 without statistical significance; on the contrary, in group 1 a significant worsening was recorded (p ≤ 0.001). Our study confirms the effectiveness of bosentan, in combination with iloprost, in SSc microangiopathy observed to NVC. Moreover, the observed findings further support the role of CSURI in the evaluation and monitoring of SSc microangiopathy.


Psychiatric morbidity in school-age children with congenital human immunodeficiency virus infection: a pilot study.
This study examined the relationship between human immunodeficiency virus (HIV) infection and psychiatric morbidity within the context of prenatal drug exposure. Twenty-six HIV-infected, 14 seroreverted, and 20 control (non-HIV-exposed) children were studied; the sample consisted of nonreferred children living in foster placement who had been exposed to maternal drug addiction. Each child received a psychiatric diagnostic evaluation which included completion by the caretaker of a structured diagnostic interview and a behavior checklist on the child as well as a child self-report on a pictorial interview. Age, ethnicity, and IQ were controlled in the analyses because of group differences. There were high rates of behavioral and psychiatric morbidity, especially with respect to disruptive behavior disorders, in this sample of school-age children with HIV infection, but similarly high rates were found in the seroreverted and non-HIV-exposed children. There was some suggestion that the HIV-infected children were experiencing higher levels of subjective distress than either the nonexposed or seroreverted children. The possible relevance of drug exposure to the behavioral outcomes observed here is discussed, as well as the importance of using age-appropriate materials to elicit subjective distress in HIV-infected school-age children. Clinical implications and directions for further research are discussed.


Expression and function of cyclooxygenase-2 is necessary for hamster blastocyst hatching.
Blastocyst hatching is critical for successful implantation leading to pregnancy. Its failure causes infertility. The phenomenon of blastocyst hatching in humans is poorly understood and the available information on this stems from studies of rodents such as mice and hamsters. We and others showed that hamster blastocyst hatching is characterized by firstly blastocyst deflation followed by a dissolution of the zona pellucida (zona) and accompanied by trophectodermal projections (TEPs). We also showed that embryo-derived cathepsins (Cat) proteases, specifically Cat-L, -B and -P act as zonalysins and are responsible for hatching. In this study, we show the expression and function of one of the potential regulators of embryogenesis, cyclooxygenase (COX)-2 during blastocyst development and hatching. The expression of COX-2 mRNA and protein was observed in 8-cell through hatched blastocyst stages and it was also localized to blastocyst's TEPs. Specific COX-2 inhibitors, NS-398 and CAY-10404, inhibited blastocyst hatching; percentages achieved were only 28.4 ± 5.3 and 32.3 ± 5.4%, respectively, compared with >90% with untreated embryos. Interestingly, inhibitor-treated blastocysts failed to deflate, normally observed during hatching. Supplementation of prostaglandins (PGs)-E2 or -I2 to cultured embryos reversed the inhibitors' effect on hatching and also the deflation behavior. Importantly, the levels of mRNA and protein of Cat-L, -B and -P showed a significant reduction in the inhibitor-treated embryos compared with untreated embryos, although its mechanism remains to be examined. These data provide the first evidence that COX-2 is critical for blastocyst hatching in the golden hamster.


Peroxisome development in yeast is associated with the formation of Pex3-dependent peroxisome-vacuole contact sites.
Using electron and fluorescence microscopy techniques, we identified various physical contacts between peroxisomes and other cell organelles in the yeast Hansenula polymorpha. In exponential glucose-grown cells, which typically contain a single small peroxisome, contacts were only observed with the endoplasmic reticulum and the plasma membrane. Here we focus on a novel peroxisome-vacuole contact site that is formed when glucose-grown cells are shifted to methanol containing media, conditions that induce strong peroxisome development. At these conditions, the small peroxisomes rapidly increase in size, a phenomenon that is paralleled by the formation of distinct intimate contacts with the vacuole. Localization studies showed that the peroxin Pex3 accumulated in patches at the peroxisome-vacuole contact sites. In wild-type cells growing exponentially on medium containing glucose, peroxisome-vacuole contact sites were never observed. However, upon overproduction of Pex3 peroxisomes also associated to vacuoles at these growth conditions. Our observations strongly suggest a role for Pex3 in the formation of a novel peroxisome-vacuole contact site. This contact likely plays a role in membrane growth as it is formed solely at conditions of strong peroxisome expansion.


Heart rate response to intravenous catheter placement.
To investigate the relationship between change in heart rate and pain and anxiety caused by intravenous catheter (IV) placement. An observational study was performed in a university-based tertiary care emergency department. Patients who required IV placement as part of their management were considered as possible subjects. Heart rates were recorded at the following times: baseline, tourniquet placement, and IV placement. Immediately after IV placement, subjects recorded pain and anxiety scores using 100-mm visual analog scales. Percentage change in heart rate (compared with baseline) was calculated at time of tourniquet placement (anxiety) and IV placement (pain). Simple linear regression analyses were performed comparing pain scores with percent change in heart rate at the time of IV and tourniquet placement. Significance was defined as p < 0.05. Ninety subjects were enrolled. Subjects had a mean age of 48 years, and 54% were women. There was a normal distribution of heart rate changes, with greater than 80% of all subjects having a 10% or less change in heart rates. The results of the analysis of pain scores versus percentage change in heart rate at IV placement yielded a Pearson correlation coefficient of 0.13 (p = 0.2). The results of the analysis of anxiety scores versus percentage change in heart rate at tourniquet placement yielded a Pearson correlation coefficient of 0.014 (p = 0.9). Changes in heart rate do not correlate with pain and anxiety associated with IV placement.


Anatomical basis of sleep-related breathing abnormalities in children with nasal obstruction.
To define, in a group of children with nasal obstruction, the anatomical differences that differentiate those with quiet, unobstructed nocturnal respiration from those with obstructive sleep-related breathing abnormalities (snoring and obstructive sleep apnea). Case series. Fifty-nine children aged 3 to 13 years (35 boys and 24 girls) with nasal obstruction and without tonsillar hypertrophy, known craniofacial syndromes, or neuromuscular diseases were included in the study. Each patient was categorized as to severity of nocturnal obstructive breathing symptoms. Angular and linear cephalometric measurements were used for assessment of craniofacial features. Clinical symptom scores were correlated with the cephalometric measurements. Significant craniofacial abnormalities were identified in patients prone to obstructive breathing patterns: increased flexure of the cranial base and bony nasopharynx, opening of the gonial angle, shortened mandibular length, dorsocaudal location of the hyoid, reduced posterior airway space, and increased velar thickness. A number of anatomical abnormalities may contribute to sleep-related abnormal breathing in otherwise normal children with nasal obstruction. Our results suggest that symptomatic children show some of the same skeletal and soft-tissue configurations that are found in adults with obstructive sleep apnea. While adenoidectomy is generally an effective treatment in children with obstructive sleep-related breathing abnormalities, the underlying craniofacial variances that remain after adenoidectomy may predispose these patients to redevelopment of obstructive breathing abnormalities in adulthood.


No new state tax: universal health care coverage for children in Florida.
Florida, which this year passed a sweeping health reform measure, is considering use of a Medicaid expansion option to revamp health care delivery for its children.


Benefits of an electronic consultation-liaison note system: better notes faster.
The authors determined the efficiency of electronic documentation in consultation-liaison psychiatry. An electronic note system was customized for a psychiatric consultation note. Specific attention given to common diagnoses permitted rapid documentation. Residents learned the system quickly. The standardized nature of the system ensured thorough documentation. Notes were immediately available and more legible. A survey indicated that this system was well received and saved time. Among the eight residents who used both handwriting and typing, an estimated average of 17.5 minutes per note was saved by typing. This program had clear benefits in reinforcing more complete documentation.


Hybrid trans-apical device closure of left ventricular pseudoaneurysm under trans-oesophageal echocardiographic guidance.
Left ventricular pseudo aneurysm (LVPA) results from contained left ventricular free wall rupture following either myocardial infarction or cardiac surgery. Untreated LVPA carries approximately 30-45% risk of rupture in the first year. Conventional treatment for LVPA is surgery which carries a mortality of about 20%. Interventional closure of LVPA has been reported from trans-arterial and trans-apical routes. Here we report successful hybrid closure of a LVPA under trans-oesophageal echocardiogram (TEE) guidance.


Antithrombin replacement during extracorporeal membrane oxygenation.
Heparin remains the predominant anticoagulant during extracorporeal membrane oxygenation (ECMO). Heparin acts by potentiating the anticoagulant effect of antithrombin (ATIII). Acquired ATIII deficiency, common in pediatric patients requiring ECMO, may result in ineffective anticoagulation with heparin. ATIII replacement may result in increased bleeding. Our objective is to determine ATIII's effect on anticoagulation and blood loss during ECMO. A retrospective chart review was performed of all patients at Children's Hospital of Wisconsin who received ATIII while supported on ECMO in 2009. ATIII activity levels, heparin drip rate, and activated clotting times (ACT) were compared before, 4, 8, and 24 h after ATIII administration. Chest tube output and packed red blood cell (pRBC) transfusion volume were compared from 24 h before ATIII administration to 24 h after. Twenty-eight patients received ATIII as a bolus dose during the course of 31 separate times on ECMO support. The median age of these patients was 0.3 years (range 1 day-19.5 years). ATIII activity increased significantly at 8 and 24 h after administration. No significant difference was noted in heparin drip rate, ACT levels, chest tube output, or pRBC transfusion volume. ATIII administration resulted in higher ATIII activity levels for 24 h without a significant effect on heparin dose, ACT, or measures of bleeding.


Novel technique for a single-incision laparoscopic surgery (SILS) approach to cholecystectomy: single-institution case series.
Multiple case series managed by a single-incision laparoscopic surgery (SILS) approach to cholecystectomy have been published, reporting that this new procedure is easily reproducible and safe. Currently, variations on surgical technique are being tested. This report describes the largest series of single-skin- and single-fascial-incision cholecystectomies using a multichannel port. Between July 2008 and December 2009, 55 patients underwent SILS cholecystectomy by two experienced general surgeons at a single institution. The operative time, surgical technique, conversion rate, specimen pathology, and postoperative complications were reported. The reported series consisted of 43 women (78%) and 12 men (22%) with a mean age of 44.2 years (range, 22-89 years). The body mass index (BMI) of the patients ranged from 16.1 to 46.8 kg/m2 (mean, 29.1 kg/m2). The mean operating room (OR) time was 66.5 min (range, 30-140 min). An improvement in OR time was observed over the course of the study. The first 19 cases were managed through a single incision but with two fascial defects for port placement. The last 36 cases were performed through a single skin incision with a single fascial incision. In five cases, an extra port had to be placed, and one case was converted to open surgery. To date, no port-site hernias, wound infections, small bowel obstructions, or other postoperative complications have been observed. The authors believe that the single-skin- and single-fascial-incision technique will prove superior to creation of multiple fascial defects in terms of future port-site hernias and will replace prior techniques using multiple fascial incisions.


Faster Heart Rate Recovery Correlates With High-Intensity Match Activity in Female Field Hockey Players-Training Implications.
Harry, K and Booysen, MJ. Faster heart rate recovery correlates with high-intensity match activity in female field hockey players-training implications. J Strength Cond Res XX(X): 000-000, 2019-The physical match demands of female field hockey are intense and may differ according to playing positions. In addition, conducting sports-specific field tests can assist coaches in determining their players' preparedness for competition. There is limited research regarding the match demands and relevance of field testing at premier league levels. Therefore, the aims were to describe the physical match demands of female premier league (amateur) field hockey, and to determine the relationships between match activity patterns and physical performance tests. Match activity and heart rate data were collected from 32 female participants using the Zephyr BioHarness 3 system. Participants also performed the Yo-Yo intermittent recovery (level 1) (n = 22), repeated sprint ability (n = 21), and the heart rate recovery (n = 16) tests. Moderate to large effect sizes were observed when defenders were compared with midfielders and forwards for time spent (%) in standing/walking and jogging (d = 0.64-1.30) in addition to the playing time (%) spent in the low-to-moderate and very high heart rate zones (d = 0.69-0.85). Heart rate recovery (10 s) correlated with the playing time (%) spent in sprinting (r = 0.73, p = 0.002). Heart rate recovery (60 s) and the Yo-Yo intermittent recovery test both correlated with the playing time (%) spent in running (r = 0.77, p = 0.0006 and r = 0.54, p = 0.01). The differences in physical match demands between positions emphasize the importance of training specificity at premier league levels. The heart rate recovery test can be used to assess a female field hockey player's capability to perform high-intensity match activity.


The usage of a lactobacilli probiotic in the non-surgical therapy of peri-implantitis: A randomized pilot study.
Examine the clinical and microbiological benefits of a dual-strain Lactobacillus reuteri probiotic on the non-surgical therapy of initial peri-implantitis. This randomized, double-blind study targeted patients with initial peri-implantitis, that is peri-implantitis with a maximum mean probing pocket depth of 6 mm and maximum 3 mm bone loss compared with loading. A full-mouth prophylaxis was performed and the peri-implantitis sites were debrided. Subsequently, local application of the study drops was carried out at the peri-implantitis sites and the study lozenges were handed out. The patients in the probiotic group received drops and lozenges containing L. reuteri (ATCC PTA 5289 & DSM 17938), those in the control group received placebo products. At the implant level the measurements of interest were bleeding, probing pocket depth and plaque. Full-mouth bleeding and plaque scores were also recorded. Microbiological samples were taken from the tongue, saliva and subgingivally around the implants. All clinical parameters were significantly decreased after 12 and 24 weeks. At the implant level the only statistically significant difference was a greater decrease in plaque levels in the probiotic versus the control group (p = .002 at 24 weeks). At the full-mouth level, the only intergroup difference was the greater decrease in full-mouth bleeding on probing sites in the probiotic group compared with the control group (p < .001 at 24 weeks). Concerning the microbiological outcomes, no significant differences could be found at any time point, neither intra- nor intergroup. No adjunctive effects of the use of L. reuteri probiotics in the treatment of peri-implantitis were found.


Clonal growth of carp (Cyprinus carpio) T cells in vitro: long-term proliferation of Th2-like cells.
Carp kidney leukocytes co-cultured with a supporting cell layer resulted in proliferation of polyclonal CD4(+) αβT cells as described previously. These bulk-cultured T cells expressed transcripts for both T helper 1 cells (Th1) master regulator (T-bet) and T helper 2 cells (Th2) master regulator (GATA-3). To identify the Th subsets in bulk-cultured T cells, single cells were picked up from the bulk culture, proliferated, and characterized. The majority of the clones displayed characteristics consistent with CD4(+) αβT cell identity. These clones expressed both TCRα and TCRβ, but could not produce a TCRγδ heterodimer since they typically only expressed either TCRγ or TCRδ. These clones also expressed the TCR co-receptor genes CD4-1 or CD4-2, whereas they did not express CD8α or CD8β. In addition, GATA-3 was expressed whereas T-bet was not. Among these clones, one clone (KoThL5) continued to proliferate on the supporting cells and was successively transferred for more than 10 months and 90-100 passages. To characterize the KoThL5 cells by their cytokine production profile, they were stimulated with PHA and investigated by real-time RT-PCR. mRNA expression of Th2-related cytokine (IL-4/13B) was only enhanced in KoThL5 cells whereas both Th1-related cytokine (IFNγ) and Th2-related cytokines (IL-4/13A and IL-4/13B) were significantly enhanced in bulk-cultured T cells. Taken together, KoThL5 cells share some features with mammalian Th2 cells. This is the first study to describe in vitro cultures of teleost cell with Th2-like features. The KoThL5 cell line has considerable potential for addressing questions concerning the properties of teleost Th2 cells.


On the midway to epilepsy: is cortical excitability normal in patients with isolated seizures?
Paired pulse transcranial magnetic stimulation was used to investigate differences in cortical excitability between patients with isolated (unrecurrent, unprovoked) seizures and those with epilepsy. Compared to controls, cortical excitability was higher in the isolated seizure group at 250-300 ms. Compared to epilepsy, cortical excitability was lower in patients with isolated seizures also at 250 and 300 ms. Lowered seizure threshold caused by disturbances within inhibitory circuits is present in patients who experience a seizure even if no further seizures occur.


Application of molecular imprinting to the development of aqueous buffer and organic solvent based radioligand binding assays for (s)-propranolol.
Antibody mimics have been prepared by molecular imprinting of (S)-propranolol and applied in the development of radioligand binding assays for the imprint species. In the assays, polymer particles, radioligand, and analyte were incubated either in an organic solvent or an aqueous buffer, with similarly high sensitivity under both set of conditions. Optimization of the assay conditions led to 100-1000-fold improvements in the limit of determination and 100-1000-fold reductions of the amount of imprinted polymer used, compared with previous studies of this novel type of assay. The present assay uses only 10-50 μg of polymer, and the limit of determination is about 6 nM. The toluene-based assay showed excellent enantioselectivity, the cross-reactivity of the R enantiomer being only 1%, which is better than that demonstrated by biological antibodies. The aqueous buffer based assay showed high substrate selectivity for propranolol in the presence of structurally similar β-blockers. The different selectivity profiles obtained are due to a different balance between hydrophobic and polar interactions in toluene and water, since polar interactions, such as hydrogen bonds, are strong in apolar solvents and hydrophobic interactions are strong in water.


The role of photodynamic therapy in the esophagus.
Photodynamic therapy (PDT) is a drug and device therapy using photosensitizer drugs activated by laser light for mucosal ablation. Porfimer sodium PDT has been used extensively with proven long-term efficacy and durability for the ablation of Barrett esophagus and high-grade dysplasia. and early esophageal adenocarcinoma. However, continued use is hampered by an associated stricture risk and prolonged photosensitivity (4-6 weeks). Promising single-center European studies using other forms of PDT, such as aminolevulinic acid PDT, have not been replicated elsewhere, limiting the widespread use of other forms of PDT. Future use of PDT in esophageal disease depends on the development of improved dosimetry and patient selection to optimize treatment outcomes, while minimizing adverse events and complications.


Simultaneous and Efficient Capture of Inorganic Nitrogen and Heavy Metals by Polyporous Layered Double Hydroxide and Biochar Composite for Agricultural Nonpoint Pollution Control.
Agricultural nonpoint pollution has been recognized as the main source of aquatic contaminants worldwide, such as inorganic nitrogen (ION) and heavy metals (HMs). It is an important challenge to simultaneously and efficiently immobilize soil ION and HMs in farmland. Herein, we present a polyporous Mg/Fe-layered double hydroxide and biochar composite (Mg/Fe-LDH@biochar) with the efficient coadsorption capacity of ION and HMs for the mitigation of agricultural nonpoint pollution toward aquatic systems. The Mg/Fe-LDH@biochar showed strong adsorption toward ION (i.e., NH4+-N and NO3--N) and HMs (i.e., Cu, Zn, Ni, Pb, and Cd), with maximum capacity of 98.53 mg of NH4+-N/g, 27.09 mg of NO3--N/g, 295.80 of mg Cu/g, 141.70 mg of Zn/g, 75.59 mg of Ni/g, 1264.10 mg of Pb/g, and 126.30 mg of Cd/g, respectively. More attractively, by deionized water extraction, the adsorbed ION on the composite was more easily rereleased, with a desorption percentage of about 42.33 ± 6.87% NO3--N and 1.42 ± 0.78% NH4+-N, than that of HMs (<1.0%). This difference is primarily related with the strength of bonding forces of ION and HMs when adsorbed on Mg/Fe-LDH@biochar, in the sequence of NO3--N (van der Waals force and electrostatic attraction) < NH4+-N (hydrogen bonding) < HMs (ionic/coordinate bonding). Finally, to examine the performance of Mg/Fe-LDH@biochar for practical applications in farmland, column leaching experiments were successfully conducted by stimulated rainfall events. The addition of Mg/Fe-LDH@biochar into soils could greatly reduce the leaching of ION and HMs simultaneously, with reduction ratios of >60, >40, and >90% for NH4+-N, NO3--N, and HMs, respectively, at 3.0% addition. Moreover, there was no leaching risk of Fe ions into the water body from Mg/Fe-LDH@biochar-amended soils.


Infantile polymyoclonus: Its occurrence in second cousins.
Two second cousins with infantile polymyoclonus are described. All other published cases in the literature are sporadic,and the occurrence of two cases of this exceedingly rare disorder in one family raises the possibility of genetic transmission. Careful examination of the family pedigree is indicated in this disorder.


Comparison of radiofrequency tissue volume reduction and submucosal resection with microdebrider in inferior turbinate hypertrophy.
To compare the efficacy of submucosal temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) and resection with microdebrider (SMRM) in chronic inferior turbinate hypertrophy. Prospective, randomized, and single-blinded clinical trial. The study group consisted of 30 symptomatic patients who underwent simultaneous TCRFTVR and SMRM for consecutive sides. Visual analogue scale (VAS) and acoustic rhinometry (ARM) were made preoperatively and at 12th week and 6th month postoperatively; saccharine transport time (STT) and ciliary beat frequency (CBF) were performed at 12th week and 6th month postoperatively. The rate of the need for the revision operation was determined between 6 and 12 months period postoperatively. Significant improvement was achieved in VAS scores and ARM measurements after both procedures, whereas both parameters did not differ significantly between two procedures postoperatively. STT and CBF showed no significant post-treatment variation in comparison of the intergroup measurements. The rates of the need for revision operation were not significantly different. Identical results in objective and subjective parameters were observed for both techniques.


A convolution method for calculating 10-MV x-ray primary and scatter dose including electron contamination dose.
This paper has improved some of the weak points appearing in a previous article [A. Iwasaki, Med. Phys. 17, 203-211 (1990)] dealing with the calculation of 10-MV x-ray primary and scatter dose. The main improved points are as follows: (i) A pair of new functional equations expressing the primary dose spread array has been yielded. Consequently, the accuracy of the primary dose calculation both in the aluminum layer and in the soft tissue layer beyond the aluminum has been improved. (ii) A new functional equation expressing the backscatter factor has been developed. It has been utilized in the differential backscatter factor equation. Consequently, the calculated scatter dose spread array has been improved. (iii) A method of calculating the dose due to electron contamination has been introduced. With respect to the primary dose, the primary plus scatter dose, and the primary plus scatter plus electron contamination dose, it has been shown how the depth of maximum dose (dmax) varies with field size.


[Rare form of uveitis with neurological symptoms: the Vogt-Koyanagi-Harada uveomeningoencephalitic syndrome].
A 51-year-old Italian woman developed migraine-like headaches with increasing frequency 5 years after menopause. The simultaneous onset of severe bilateral uveitis, neurological signs such as vertigo, hearing loss, small sensomotor hemisyndrome, cognitive brain dysfunction and lymphocyte liquor pleocytosis confirmed the diagnosis of Vogt-Koyanagi-Harada syndrome, a rare disease of probably autoimmune origin with destruction of pigment containing neuroepithelium. Other vasculitic diseases, especially those of infectious or rheumatologic origin, were excluded. Systemic corticoid treatment suppressed the activity of the illness but on dose reduction relapses occurred. Additional immunosuppressive medication prevented uveitic relapses and made it possible to reduce the corticoid dose.


Epithelial injury induces an innate repair mechanism linked to cellular senescence and fibrosis involving IGF-binding protein-5.
Fibrosis is associated with epithelial repair. It involves the activation of fibroblasts, increased production of extracellular matrix proteins and transdifferentiation to contractile, myofibroblasts that aid in wound contraction. This provisional matrix plugs the injured epithelium and provides a scaffold for epithelial cell migration, involving an epithelial-mesenchymal transition (EMT). When epithelial injury involves blood loss, this leads to platelet activation, the production of several growth factors and an acute inflammatory response. Under normal circumstances, the epithelial barrier is repaired and the inflammatory response resolves. However, in fibrotic disease, the fibroblast response continues, resulting in unresolved wound healing. The fibrotic diseases range from scleroderma, where the problem may be restricted to the skin and where it is not life-threatening, through to systemic forms that can manifest as, for example, idiopathic pulmonary fibrosis, in which death is inevitable within 3-5 years. Anti-inflammatory treatments have failed to ameliorate the disease condition and focus has instead turned to transforming growth factor-beta1 (TGFB1), since it induces many of the processes involved, including fibroblast activation and EMT. Most recently, however, a new player in this process has been described, IGF-binding protein-5 (IGFBP5). IGFBP5 has also been shown to induce similar effects to TGFB1, but, in addition, it is strongly implicated in the process of senescence which is now believed to be a significant factor in these diseases. We examine the evidence for this role of IGFBP5 and identify some of the therapeutic targets which might be used to ameliorate these diseases of unknown cause.


Detecting malnutrition's warning signs with simple screening tools.
Nutrition problems of aging adults can be prevented, controlled, or treated, but the warning signs of malnutrition are often overlooked. Untreated malnutrition can lead to a spiral of infection, further malnutrition, and death. Simple assessment tools developed and distributed by the Nutrition Screening Initiative (NSI) can be used during an office visit to identify risk factors for poor nutritional status. These include advanced age, depression, social isolation, physical or cognitive impairment, and low income. Patients who are identified as being at high risk require immediate intervention, including medical and psychological evaluations. Often, an older adult without cognitive impairment can resume independent function when proper support is provided to correct the causes of malnutrition.


Amplification of human papillomavirus types 16 and 18 in invasive cervical cancer.
The distribution and amplification patterns of human papillomavirus were studied in 15 human papillomavirus (HPV) 16- and six HPV18-positive cervical carcinomas by colorimetric in situ hybridization (ISH). The findings were correlated with the viral copy number and status of E1/E2 viral genes in the tumor DNA, as studied by dot blot analysis and the polymerase chain reaction, respectively. The tumors were classified according to the ISH signal into single dot, multidot, diffuse, and mixed patterns. The signal was homogeneously distributed only in single dot tumors and was clearly heterogeneous in tumors with mixed nuclear signal patterns, including both dot and diffuse signals. The single dot pattern predominated in HPV 18-positive tumors (83%), whereas the multidot pattern was most frequent in HPV 16-positive tumors (47%). Diffuse and mixed patterns were noted only in HPV 16-positive tumors (33%). The lowest mean copy of number per cell was observed in single dot tumors (25 +/- 15) with an ascendent trend toward the diffuse signal tumors (2832 +/- 2281). E1/E2 genes were disrupted in 75% of the single/multidot tumors and in none of the diffuse/mixed tumors. These data suggest diffuse signals originate by episomal amplification and dot signals originate by viral integration. Diffuse and dot patterns suggest different mechanisms of viral transformation.


Frequency of risk factors, vaccination status and outcome of tetanus in children at the Children's Hospital Lahore.
To determine the frequency of risk factors, vaccination status and outcome of tetanus in children beyond neonatal age at a tertiary care centre. The prospective observational study was conducted at The Children's Hospital, Lahore, Pakistan, from January 2012 to December 2014, and comprised children aged between 1 month and 15 years of either gender admitted with diagnosis of tetanus. Variables recorded included age, gender, vaccination status in terms of number of diphtheria, tetanus and pertussis vaccine doses received per routine infant immunisation and booster doses of tetanus toxoid, risk factors as trauma, ear discharge, ear prick and duration of hospitalisation and outcome. Data was analysed using SPSS 16. Of the 74 patients, there were 47(63.5%) males and 27(36.5%) females. Overall, the mean age was 6.56+3.15 years 50(67%) were unvaccinated, none (0%) had received booster dose and posttrauma immune prophylaxis. Besides, trauma was the most common risk factor in 33(44.6%) cases followed by ear discharge 15 (20.3%) and ear/nose prick 2(2.7%), while the risk factor was unknown in 24(32.4%) cases. Mean duration of hospitalisation was 14.35±11.65. Mortality rate 16(21.6%) was significantly associated with shorter duration of stay (p<0.001). Mortality was high among unvaccinated children compared to vaccinated children (p=0.01). Vaccination coverage was found to be inadequate and post-trauma immune prophylaxis had been ignored..


Cervical ripening with Foley catheter for induction of labor after cesarean section: a cohort study.
To evaluate spontaneous vaginal delivery and complication rates after induction of labor with a transcervical Foley catheter in women with a previous cesarean delivery. Retrospective cohort study. Secondary teaching hospital in the second largest city of the Netherlands. Women with a history of cesarean delivery (n = 208), undergoing induction of labor with a Foley catheter in a subsequent pregnancy. The women who had induction of labor with a transcervical Foley catheter in the Ikazia Hospital, Rotterdam, between January 2003 and January 2012, were identified in a computerized database. Patient's records were checked for accuracy. Vaginal delivery rate, cesarean section rate, uterine rupture and maternal and neonatal (infectious) morbidity. Of the women 60% had a spontaneous vaginal delivery and 11% were delivered by vacuum extraction. Uterine rupture occurred in one woman. Postpartum hemorrhage was the most common maternal complication (12%). Maternal intrapartum and postpartum infections occurred in 5% and 1%. Proven neonatal infection was found in 3% of the cases. Two perinatal deaths occurred (1%), of which one was related to uterine rupture. Induction of labor with a transcervical Foley catheter is an effective method to achieve vaginal delivery in women with a previous cesarean delivery. There is a low risk of uterine rupture and maternal and neonatal (infectious) morbidity in this cohort.


Surface anatomy of the face in Down's syndrome: age-related changes of anthropometric proportion indices in the craniofacial regions.
The purpose of the study was to determine the age-related changes in normal and abnormal proportion indices in Down's syndrome patients between 1 to 5, 6 to 15, and 16 to 36 years of age. Nine indices were analyzed in five craniofacial regions of 125 subjects: 70.2% to 79.0% were normal and 21.0% to 29.8% abnormal. Proportionate indices increased in frequency in all age groups in a much higher percentage than disproportionate ones. In the oldest group, the frequency of normal proportions significantly increased in the head and trended higher in the facial, orbital, and nasal regions, and lower in the ear. Disproportions showed a similar pattern, with a decreasing frequency in all regions except the ear. The variations of harmony and disharmony in normal proportions, and moderate and severe in disproportions, helped clarify the morphological changes influencing the craniofacial design. Among proportionate ratios, harmony ranged from 45% to 65.5% in age group 1 and from 30% to 87.5% in group 3. No cases of severe subnormal disproportions were seen in the nasal tip protrusion-nose width and nasal root depth indices in age group 1, and none in the cephalic index, midface-lower face depth, and nasal tip protrusion-nose width indices in group 3. The 20-year age range of group 3 helped show the post-maturation improvements of the face and the remedying effect of the extended growth rate on some initial facial disproportions.


Electron force balance in steady collisionless-driven reconnection.
Steady collisionless-driven reconnection in an open system is investigated by means of full-particle simulations. A long thin electron current sheet extends towards the outflow direction when the system relaxes to a steady state. Although the pressure tensor term along the reconnection electric field contributes to the violation of the electron frozen-in condition, a new force balance in the inflow direction is realized between the Lorentz and electrostatic forces, which is quite different from that in Harris equilibrium. The strong electrostatic field is generated through the combined effect of the Hall term and a driving inflow. This new force balance is more evident in the three-dimensional case due to the growth of an instability along the reconnection electric field. It is also found that the normalized charge density is in proportion to the square of the electron Alfvén velocity averaged over the electron dissipation region.


Non-invasive assessment of infarct reperfusion: the predictive power of the time to peak value of myoglobin, CKMB, and CK in serum.
Intravenous thrombolytic therapy has become a routine therapeutic intervention in acute myocardial infarction. In order to evaluate its success in the general hospital community noninvasive methods are needed. Therefore, the effect of infarct reperfusion on the times to peak value of myoglobin, CKMB, and CK were studied in patients with acute myocardial infarction. Recanalization of the occluded coronary artery was achieved by intracoronary infusion of streptokinase in eight patients within 3.5 h, and in 18 patients more than 3.5h after onset of pain. In 10 patients, the coronary artery remained occluded, and in eight patients thrombolysis was not attempted. Analyzing the times to peak value of myoglobin, CKMB, and CK, the probability of correct classification of infarct reperfusion varied between 1 and 0.9, if recanalization was achieved within 3.5 h after onset of pain. The predictive power could be improved further by a combined analysis of the times to peak value of both myoglobin and CK. In cases where reperfusion was achieved more than 3.5 h after the onset of pain, the probability of correct classification of infarct reperfusion varied between 0.99 and 0.05. Among the marker proteins analyzed, myoglobin allowed the earliest and best discrimination between reperfusion or no reperfusion. Thus, by applying the time to peak value analysis, infarct reperfusion can only be predicted reliably if it is achieved early after onset of pain.


Microalgae screening under CO2 stress: Growth and micro-nutrients removal efficiency.
Algae are one of the promising agents for greenhouse gas reduction and biofuel production. Different technologies have been developed and introduced in last decades for algae growth. Algae plays a very imperative role in the aquatic ecosystem regarding CO2 reduction and micro-nutrient removal. In present investigation, eight locally isolated (microalgae) strains and two pure strains were studied. The selected microalgae were grown under variable CO2 concentration and CO2 biofixation efficiencies along with micro-nutrient removal were monitored. Among selected strains, three strains (UMN266, UMN268 and UTEX 2714 showed adaptability up to 20% CO2 concentration with high biomass production of 1.3, 1.4 and 1.21g/L, respectively, whereas UTEX 78 and UMN 230 growth was slow under high CO2 concentration (20% CO2). However, in step wise CO2 feeding, the growth of UTEX 78 and UMN 230 improved considerably and up to 0.9 and 0.97 (g/L) biomasses were recorded, respectively. All algae strains showed high growth rate at 2% CO2 feeding and nitrogen, phosphorus and ammonia removal from the simulated media were also significant. The fast-growing microalgae species tolerant up to 20% CO2 concentration and could be used for flue gas mitigation and valuable products production. These results can contribute to understand the nature of CO2 bio-fixation and microalgae could be a potential alternative for CO2 fixation.


Opposing effects of cortisol and dehydroepiandrosterone on the expression of the receptor for Activated C Kinase 1: implications in immunosenescence.
Aging is associated to a decline in immune functions that are in part related to a defective protein kinase C dependent signal transduction machinery. RACK-1 (Receptor for Activated C Kinase 1) is a scaffold protein for different kinases and membrane receptors. We have previously demonstrated, in the elderly, a defective PCKβII (Protein Kinase C βII) translocation related to a decrease in RACK-1 protein expression, which is correlated to the age-associated decline in DHEA (dehydroepiandrosterone) levels. As a consequence of this signal transduction impairment, a significant decrease in immune cells functionality was observed. Furthermore, we could demonstrate that in vivo and in vitro DHEA administration restored RACK-1 level and immune functions, indicating that this hormone behaved as a positive RACK-1 regulator. We have most recently characterized the human GNB2L1 promoter region, coding for RACK-1 protein. Although no direct DHEA responsive elements were found, a glucocorticoid responsive element (GRE) was identified. The purpose of this work was to investigate, in the human pro-myelocytic cell line THP-1, whether physiological cortisol concentrations were able to modulate GNB2L1 promoter activity, RACK-1 transcription as well as cytokine production. As DHEA is endowed of anti-glucocorticoid properties in several cellular systems, and as cortisol:DHEA ratio imbalance is relevant in aging, we also investigated their possible interaction at the RACK-1 expression level. We could demonstrate that cortisol acted in a dose-related manner as a GNB2L1 promoter repressor, reducing RACK-1 mRNA expression and protein level. Probably by interfering with glucocorticoid receptor binding to GRE sequence, prolonged DHEA exposure counteracted cortisol effects, restoring RACK-1 levels and cytokine production, as assessed by LPS-induced TNF-α release.


Cognitive predictors of posttraumatic stress symptoms six months following acute coronary syndrome.
This study examined patients' illness representations assessed shortly after an acute coronary syndrome (ACS) as predictors of posttraumatic stress symptoms six months later. Illness representations were assessed in ACS patients using standard measures at a home visit three weeks after discharge from hospital. Posttraumatic stress symptoms were assessed at the same time, and again six months later. Patients were aged 61 years on average, the majority being men (89.8%) of white European decent (89%). Greater posttraumatic symptoms at six months were associated with beliefs that the illness would last a long time (timeline), that it had an unpredictable time course (timeline--cyclical), greater consequences, less personal and treatment control, poorer illness coherence and stronger negative emotional representations (emotional upset relating to the illness; p < 0.05). In multiple regression analyses, controlling for demographic, clinical and psychological factors (age, gender, ethnicity, social deprivation, ACS severity, negative affectivity and cardiac symptom recurrence), more intense emotional representations (β = 0.146, p = 0.041) and reduced illness coherence (β = -0.133, p = 0.029), emerged as independent predictors of posttraumatic symptom severity at six months. There was a near significant effect for personal control (β = -0.113, p = 0.058). These results demonstrate the importance of illness representations of ACS in predicting longer-term posttraumatic stress symptoms.


Improved left ventricular relaxation during short-term right ventricular outflow tract compared to apical pacing.
Pacing-induced asynchrony may deteriorate left ventricular function; however, limited data exists in humans. The aim of our study was to compare left ventricular hemodynamics during short-term atrioventricular sequential pacing from the right ventricular apex and from the outflow tract of the right ventricle. Three 5-min pacing intervals were applied in a random order, at a rate of 15 beats/min above the resting sinus rate. Atrioventricular sequential pacing from the two sites was compared with atrial pacing. During each pacing mode, left ventricular pressure was recorded, and cardiac output was calculated using Doppler echocardiography. Cardiac catheterization laboratory. Twenty patients (18 male, mean age 62 +/- 11 years) without structural heart disease were studied. During atrial pacing, maximum negative first derivative of pressure (dp/dt) was 1,535 +/- 228 mm Hg/s; during pacing from the apex it decreased to 1,221 +/- 294 mm Hg/s (p = 0.0001), but was not significantly different during pacing from the outflow tract (1,431 +/- 435 mm Hg/s, p > 0.05). Isovolumic relaxation time constant (tau) during atrial pacing was 39.7 +/- 11.9 ms; during pacing from the apex, it increased to 47.9 +/- 14.0 (p = 0.001), but was not significantly different during pacing from the outflow tract (42.5 +/- 11.2, p > 0.05). Peak systolic pressure decreased significantly during atrioventricular sequential pacing from either site; however, it did not differ between the two sites. No differences in end-diastolic pressure, maximum positive dp/dt, or cardiac output could be demonstrated. In patients with no structural heart disease, short-term right ventricular outflow tract pacing is associated with more favorable diastolic function, compared to right ventricular apical pacing.


[Effect of blood levels of carboxyhemoglobin (COHb) on erythrocyte filtration time in young smokers].
The effects of chronic exposure to carbon monoxide on some rheologic parameters (erythrocyte filtration time in particular) and on FEV1, and on FEF25-50 were studied in young smokers. A positive correlation among number of cigarettes day, COHb blood levels and erythrocyte filtration time was found. Packed red cell volume, fibrinogen concentration and platelet count were unaffected; no evidence of small-airway obstruction was observed. The alteration of erythrocyte deformability may be an early sign of hemorheological impairment which can progressively worse if high COHb blood levels are chronically maintained, with damaging effects on vessel function.


Topographic deformation patterns of knee cartilage after exercises with high knee flexion: an in vivo 3D MRI study using voxel-based analysis at 3T.
To implement a novel voxel-based technique to identify statistically significant local cartilage deformation and analyze in-vivo topographic knee cartilage deformation patterns using a voxel-based thickness map approach for high-flexion postures. Sagittal 3T 3D-T1w-FLASH-WE-sequences of 10 healthy knees were acquired before and immediately after loading (kneeling/squatting/heel sitting/knee bends). After cartilage segmentation, 3D-reconstruction and 3D-registration, colour-coded deformation maps were generated by voxel-based subtraction of loaded from unloaded datasets to visualize cartilage thickness changes in all knee compartments. Compression areas were found bifocal at the peripheral medial/caudolateral patella, both posterior femoral condyles and both anterior/central tibiae. Local cartilage thickening were found adjacent to the compression areas. Significant local strain ranged from +13 to -15 %. Changes were most pronounced after squatting, least after knee bends. Shape and location of deformation areas varied slightly with the loading paradigm, but followed a similar pattern consistent between different individuals. Voxel-based deformation maps identify individual in-vivo load-specific and posture-associated strain distribution in the articular cartilage. The data facilitate understanding individual knee loading properties and contribute to improve biomechanical 3 models. They lay a base to investigate the relationship between cartilage degeneration patterns in common osteoarthritis and areas at risk of cartilage wear due to mechanical loading in work-related activities. • 3D MRI helps differentiate true knee-cartilage deformation from random measurement error • 3D MRI maps depict in vivo topographic distribution of cartilage deformation after loading • 3D MRI maps depict in vivo intensity of cartilage deformation after loading • Locating cartilage contact areas might aid differentiating common and work-related osteoarthritis.


Histological sexing of a reticulum cell sarcoma arising after liver transplantation.
Nuclear sex determination, based on both X and Y chromatin counts in a reticulum cell sarcoma which arose in the liver 5 months after orthotopic grafting, clearly showed that the tumor was of host origin. The Kupffer cells of the graft were also found to be of host origin, demonstrating that their replacement may occur within 6 months of operation.


Adjuvant systemic therapy for intermediate and large gastric gastrointestinal stromal tumors (GISTs): Is there a survival benefit following margin negative surgical resection?
The value of adjuvant systemic therapy after margin-negative resection for gastric gastrointestinal stromal tumors (GISTs) remains unclear. The National Cancer Data Base was queried to identify patients undergoing margin negative resections for gastric GISTs >2 cm between 2010 and 2015. Patients were stratified by tumor size (small: 2.1-5 cm, intermediate: 5.1-10 cm, large: >10 cm), histologic grade (low: ≤5 mitoses/50 HPF and high: >5 mitoses/50 HPF), and use of adjuvant therapy. Multivariable cox proportional hazard methods were used to compare overall survival (OS). 3520 patients met inclusion criteria. Adjuvant therapy was associated with a statistical improvement in OS (86% vs. 76%, p = 0.014) for those with large tumors but had no measurable effect in patients with small or intermediate sized tumors. On multivariable analysis, this association was independent of grade. Adjuvant therapy is associated with improved OS for patients with gastric GISTs >10 cm but provides no statistically significant benefit in OS for those with GISTs 2-10 cm.


Biosynthesis and palmitoylation of endothelial nitric oxide synthase: mutagenesis of palmitoylation sites, cysteines-15 and/or -26, argues against depalmitoylation-induced translocation of the enzyme.
The presence of myristoylated endothelial nitric oxide synthase (eNOS) in cytosolic fractions of bovine aortic endothelial cells (BAEC) suggests that N-myristoylation of eNOS is not sufficient for membrane localization. Therefore, we examined if posttranslational palmitoylation was another molecular signal for the membrane attachment of eNOS. Metabolic labeling showed incorporation of [3H]palmitic acid into the membrane-bound, but not the cytosolic, form of eNOS. Fatty acid analysis demonstrated the labeled fatty acid incorporated into eNOS was palmitate, linked via a hydroxylamine-labile thioester bond. Biosynthesis and turnover studies show that the turnover of palmitate is much faster than the protein itself. However, the rates of palmitoylation and depalmitoylation were not affected by bradykinin or ionomycin treatment of BAEC. To examine the contribution of palmitoylation to the membrane association of eNOS, we mutated cysteine-15 and -26. Both mutations markedly diminished palmitoylation of eNOS, but did not significantly alter its membrane association. Additionally, [3H]palmitic acid was not incorporated into nonmyristoylated mutant eNOS (G2A eNOS), suggesting that myristoylation is necessary for subsequent palmitoylation of the enzyme. Taken together, our data imply that palmitoylation does not play a major role in membrane association of eNOS and other amino acid sequences, in conjunction with N-myristoylation, are necessary and sufficient for membrane association of the enzyme.


Pregnancy interceptive activity of Melia azedarach Linn. in adult female Sprague-Dawley rats.
Ethanolic extract of the root of Melia azedarach Linn. (family: Meliaceae) collected from the Institute campus intercepted pregnancy in 60% and 75% adult female rats when administered at 250 and 500 mg/kg daily doses, respectively, on Days 1-10 post-coitum by the oral route. On fractionation, the activity was localized in the chloroform fraction of the ethanolic extract, which showed 80-100% activity at 250 mg/kg daily dose in repeat tests. In animals that became pregnant, there was also a significant reduction in mean number of implantations and all the implantations exhibited signs of resorption. Of the four major compounds isolated in sufficient quantity and characterized from the active chloroform fraction, two compounds showed only marginal (50%) contragestational effect. Further exploration of the active chloroform fraction, which is also devoid of estrogen agonistic activity at the contraceptive dose in immature rat bioassay, is being undertaken to identify and characterize the active principle(s).


Side branch healing patterns of the Tryton dedicated bifurcation stent: a 1-year optical coherence tomography follow-up study.
The bare-metal Tryton Side Branch (SB) Stent™ (Tryton Medical, Durham, NC, USA) is used with a drug-eluting stent (DES) in the main branch (MB) to treat bifurcation lesions. It is argued that a drug-eluting Tryton-version is needed to improve clinical outcomes, although previous registries have shown good clinical results. More insights in neo-intimal hyperplasia (NIH) growth patterns of the Tryton treatment strategy are needed to decide if and where to drug-coat the stent. Ten patients returned for follow-up angiography (mean follow-up time 393 ± 103 days) and optical coherence tomography (OCT) pullbacks from the MB were obtained in all patients and from the SB in six patients. A per-strut analysis showed an uncovered strut rate of 0.7 % and an incompletely-apposed strut rate of 0.8 %. Most incompletely-apposed struts were found at the bifurcation region, in the luminal half facing towards the SB. Mean NIH thickness in the proximal MB, distal MB and SB were 0.14 ± 0.11, 0.19 ± 0.11, and 0.34 ± 0.19 mm, respectively, with a variety of growth patterns observed in the SB. We found good vascular healing of the DES in the MB, while healing was less favourably in the SB part. Furthermore, we observed a variety of NIH growth patterns in this SB part and more studies are needed to investigate the relation between growth patterns and clinical outcomes.


Effects of temperature and salinity on the life history of the sailfin molly (Pisces: Poeciliidae): lipid storage and reproductive allocation.
While the life history traits of animals usually exhibit substantial phenotypic plasticity, such plasticity might reflect either a simple alteration in the level of energy accrual and use or a genuine shift in energy allocation tactics between environmental conditions. The latter would represent genuine plasticity in the life history itself, and thus it is important to distinguish which of these two processes underlies the observed plasticity of life history traits. We investigated this issue by examining the effects of temperature and salinity variation during ontogeny on the allocation of biomass and lipid storage in male sailfin mollies, Poecilia latipinna. We raised males from four natural populations from birth to maturity in controlled laboratory conditions. Neither distinct temperatures (23 or 29°C) nor different salinity regimes (2, 12, or 20 parts per thousand) affected body mass, although males from different populations differed substantially in body mass. However, males raised at the higher temperature had a greater allocation of biomass to testis and a lower allocation to viscera mass. The amount of stored lipid was altered by temperature variation but the direction and magnitude of the effect varied substantially among males from the different populations. Salinity variation affected neither biomass allocation nor the level of lipid storage. These results indicate that male mollies possess a flexible developmental program with respect to temperature that canalizes body size and alters the allocation of biomass among competing demands for reproductive readiness and capacity for energy storage.


[Pre- and postcapillary resistance and transcapillary fluid exchange in the intestine under the effect of hypoxic and hypothermic stimuli in the body].
In increase of pre- and postcapillary resistance due to hypothermia, hypoxia induced no considerable shifts in back-ground values of the organ hemodynamics in the cat small intestine preparations constantly perfused with own blood.


HIV-TAT mediated protein transduction of heme oxygenase-1 protects HaCaT cells from ionizing radiation.
To elucidate the effects of human keratinocyte-derived HaCaT cells (HIV-TAT) protein transduction domains (PTD) coupled heme oxygenase-1 (HO-1) fusion protein (TAT-HO-1) on radiation-induced human keratinocyte-derived HaCaT cells. This study was conducted between May 2010 and February 2013 in the School of Radiation Medicine and Protection, Soochow University, Suzhou, China. This experimental study was designed to explore the protective role of TAT-HO-1 in skin cells. The human HO-1 gene was fused with a gene fragment encoding TAT PTD to produce in-frame TAT-HO-1. The distribution of TAT-HO-1 was measured by immunostaining and Western blot. The radioprotection for TAT-HO-1 was determined using clonogenic assay. Alterations in apoptosis were analyzed by flow cytometry. The expressed and purified TAT-HO-1 recombinant protein could be incorporated into human HaCaT cells. We then evaluated the protective role of TAT-HO-1 against ionizing radiation. The TAT-HO-1 attenuated the generation of reactive oxygen species and decreased HaCaT cell radiosensitivity to irradiation. Moreover, HaCaT cells pretreated with TAT-HO-1 resulted in less apoptosis by radiation. In addition, TAT-HO-1 could penetrate rat skin. These results suggest that TAT-HO-1 can protect HaCaT cells from ionizing radiation.


Impact of Threat Level, Task Instruction, and Individual Characteristics on Cold Pressor Pain and Fear among Children and Their Parents.
The cold pressor task (CPT) is increasingly used to induce experimental pain in children, but the specific methodology of the CPT is quite variable across pediatric studies. This study examined how subtle variations in CPT methodology (eg. provision of low- or high-threat information regarding the task; provision or omission of maximum immersion time) may influence children's and parents' perceptions of the pain experience. Forty-eight children (8 to 14 years) and their parents were randomly assigned to receive information about the CPT that varied on 2 dimensions, prior to completing the task: (i) threat level: high-threat (task described as very painful, high pain expressions depicted) or low-threat (standard CPT instructions provided, low pain expressions depicted); (ii) ceiling: informed (provided maximum immersion time) or uninformed (information about maximum immersion time omitted). Parents and children in the high-threat condition expected greater child pain, and these children reported higher perceived threat of pain and state pain catastrophizing. For children in the low-threat condition, an informed ceiling was associated with less state pain catastrophizing during the CPT. Pain intensity, tolerance, and fear during the CPT did not differ by experimental group, but were predicted by child characteristics. Findings suggest that provision of threatening information may impact anticipatory outcomes, but experienced pain was better explained by individual child variables.


Enhanced and durable protective immune responses induced by a cocktail of recombinant BCG strains expressing antigens of multistage of Mycobacterium tuberculosis.
Although Bacillus Calmette-Guérin (BCG) vaccine confers protection from Mycobacterium tuberculosis infection in children, its immune protection gradually wanes over time, and consequently leads to an inability to prevent the reactivation of latent infection of M. tuberculosis. Therefore, improving BCG for better control of tuberculosis (TB) is urgently needed. We thus hypothesized that recombinant BCG overexpressing immunodominant antigens expressed at different growth stages of M. tuberculosis could provide a more comprehensive protection against primary and latent M. tuberculosis infection. Here, a novel cocktail of recombinant BCG (rBCG) strains, namely ABX, was produced by combining rBCG::85A, rBCG::85B, and rBCG::X, which overexpressed respective multistage antigens Ag85A, Ag85B, and HspX of M. tuberculosis. Our results showed that ABX was able to induce a stronger immune protection than individual rBCGs or BCG against primary TB infection in C57BL/6 mice. Mechanistically, the immune protection was attributed to stronger antigen-specific CD4(+) Th1 responses, higher numbers of IFN-γ(+) CD4(+) TEM and IL-2(+) CD8(+) TCM cells elicited by ABX. These findings thus provide a novel strategy for the improvement of BCG efficacy and potentially a promising prophylactic TB vaccine candidate, warranting further investigation.


Effect of calcium hydroxide dressing on microleakage of composite restorations in endodontically treated teeth subsequent to bleaching.
This study evaluates the effect of calcium hydroxide dressing on microleakage of composite restorations following non-vital bleaching. A total of 45 sound extracted human maxillary central incisors underwent endodontic treatment. The teeth were randomly divided into three groups (n=15). In group 1, access cavities were restored with composite. In group 2, the teeth underwent a bleaching procedure for one week before being restored with composite. In group 3, following a bleaching procedure, calcium hydroxide paste was placed in the pulp chamber for one week. The teeth were then restored with composite. The specimens were subjected to a dye leakage test. The data was analyzed using Kruskal-Wallis and Mann-Whitney U tests. There were significant differences between the groups (P<0.0005). No statistically significant differences were found between groups 2 and 3, while the differences between other groups were significant. The bleaching agent increased microleakage of composite restorations in non-vital bleaching, whereas microleakage was not found to be increased by calcium hydroxide.


Chitinases in biological control.
The public concern over the harmful effects of chemical pesticides on the environment and human health has enhanced the search for safer, environmentally friendly control alternatives. Control of plant pests by the application of biological agents holds great promise as an alternative to the use of chemicals. It is generally recognized that biological control agents are safer and more environmentally sound than is reliance on the use of high volumes of pesticides. Due to the importance of chitinolytic enzymes in insect, nematode, and fungal growth and development, they are receiving attention in regard to their development as biopesticides or chemical defense proteins in transgenic plants and microbial biocontrol agents. In this sense, biological control of some soil-borne fungal diseases has been correlated with chitinase production. Fungi- and bacteria-producing chitinases exhibit antagonism against fungi, and inhibition of fungal growth by plant chitinases has been demonstrated. Insect pathogenic fungi have considerable potential for the biological control of insect pests. Entomopathogenic fungi apparently overcome physical barriers of the host by producing multiple extracellular enzymes including chitinolytic enzymes, which help to penetrate the cuticle and facilitate infection. In this chapter, the role of chitinases in biological control and their potential use in the improvement of biocontrol agents and crop plants by genetic engineering is analyzed in view of recent findings.


Ketone-Functionalized Polymer Nano-Objects Prepared via Photoinitiated Polymerization-Induced Self-Assembly (Photo-PISA) Using a Poly(diacetone acrylamide)-Based Macro-RAFT Agent.
Herein, ketone-functionalized diblock copolymer nano-objects are prepared by photoinitiated reversible addition-fragmentation chain transfer (RAFT) dispersion polymerization of tert-butyl acrylate (tBA) using a poly(diacetone acrylamide) (PDAAM)-based macromolecular RAFT (macro-RAFT) agent in ethanol/water (60/40, w/w) at room temperature. A high polymerization rate is observed via the exposure of visible light (λmax = 405 nm, 0.45 mW cm-2 ) with near quantitative monomer conversion being achieved within 60 min. A morphological phase diagram is constructed by changing the degree of polymerization (DP) of PtBA and the monomer concentration. The morphologies of polymer nano-objects are further tuned by incorporating isobornyl acrylate (IBOA) into the core-forming block. The ketone-functionalized diblock copolymer nano-objects can be shell-cross-linked by reacting with a diamine. Finally, the shell-cross-linked polymer nano-objects are further hydrolyzed and employed as a template for the synthesis of silver composites.


Development and characterization of a hypomorphic Smith-Lemli-Opitz syndrome mouse model and efficacy of simvastatin therapy.
Smith-Lemli-Opitz syndrome (SLOS) is a genetic syndrome caused by mutations in the 3beta-hydroxysterol Delta(7)-reductase gene (DHCR7). SLOS patients have decreased cholesterol and increased 7-dehydrocholesterol (7-DHC) levels. Dietary cholesterol supplementation improves systemic biochemical abnormalities; however, because of the blood-brain barrier, the central nervous system (CNS) is not treated. Simvastatin therapy has been proposed as a means to treat the CNS. Mice homozygous for a null disruption of Dhcr7, Dhcr7(Delta3-5/Delta3-5), die soon after birth, thus they cannot be used to study postnatal development or therapy. To circumvent this problem, we produced a hypomorphic SLOS mouse model by introducing a mutation corresponding to DHCR7(T93M). Both Dhcr7(T93M/T93M) and Dhcr7(Delta3-5/T93M) mice are viable. Phenotypic findings in Dhcr7(T93M/Delta3-5) mice include CNS ventricular dilatation and two to three syndactyly. Biochemically, both Dhcr7(T93M/T93M) and Dhcr7(T93M/Delta3-5) mice have elevated tissue 7-DHC levels; however, the biochemical defect improved with age. This has not been observed in human patients, and is due to elevated Dhcr7 expression in mouse tissues. Dietary cholesterol therapy improved sterol profiles in peripheral, but not CNS tissues. However, treatment of Dhcr7(T93M/Delta3-5) mice with simvastatin decreased 7-DHC levels in both peripheral and brain tissues. Expression of Dhcr7 increased in Dhcr7(T93M/Delta3-5) tissues after simvastatin therapy, consistent with the hypothesis that simvastatin therapy improves the biochemical phenotype by increasing the expression of a Dhcr7 allele with residual enzymatic activity. We conclude that simvastatin treatment is efficacious in improving the SLOS-associated sterol abnormality found in the brain, and thus has the potential to be an effective therapeutic intervention for behavioral and learning problems associated with SLOS.


A strategy for turning conflict into collaboration.
The factors that all too frequently make for divisiveness between the hospital board, the medical staff, the nursing staff, and the administration may be effectively countered with the right combination of leadership, energy, and planning. One hospital's strategy was to bring together representatives of each group to collaborate on developing improvements in hospital operations as a vehicle for achieving a new level of mutual trust and understanding.


Compications in acoustic neuroma surgery.
The findings in a series of 80 cerebellopontine angle tumors are presented. Complications and results are covered in detail. A new method of controlling postoperative cerebrospinal fluid (CSF) leak is presented. Care of the eye in postoperative facial paralysis is emphasized, and a new type of moisture chamber is introduced.


The effects of dietary cholesterol on experimental diabetic nephropathy.
Hyperlipidaemia has been previously shown to accelerate various models of renal disease. The present study has evaluated the effects of dietary cholesterol supplementation on functional and structural aspects of experimental diabetic nephropathy. Control and streptozotocin diabetic male Sprague Dawley rats were randomized to receive a normal diet or a high cholesterol (4% cholesterol + 1% cholic acid) diet. After 32 weeks, serum lipids, glycaemic control, urinary albumin excretion and glomerular ultrastructural parameters were evaluated in the 4 groups. Diabetes was associated with increased total cholesterol and triglyceride levels. Cholesterol supplementation increased total and decreased HDL-cholesterol in control and diabetic rats. Diabetes increased albuminuria but cholesterol supplementation did not influence urinary albumin excretion. In diabetic rats, glomerular basement membrane thickness and glomerular volume were increased but cholesterol supplementation did not influence any glomerular ultrastructural parameter. In control rats, increased dietary cholesterol intake led to an increase in blood pressure and glomerular volume. In contrast to other models of renal disease, experimental diabetic nephropathy does not appear to be exacerbated by dietary cholesterol supplementation.


[Difference and variation of the sef14 operon gene clusters in S. enteritidis and closed serogroup-D Salmonella].
In order to reveal why SEF14 fimbriae are restrictively expressed on strains of serogroup D salmonella, mainly S. enteritidis and S. dublin, the difference and variation of the sef14 operon gene clusters in S. enteritidis and related serogroup-D Salmonella were analyzed. The genes encoding subunits of sefA, sefD and sefR in S. pullorum, S. enteritidis and S. dublin were amplified by PCR method and then sequenced to analyze the the difference and variation, respectively. The results of PCR amplification showed that prevalence of sefA, sefD and sefR genes in S. enteritidis and S. dublin was 100%. In 18 isolates of S. pullorum, the prevalence of sefA gene was 100%,while the prevalence of sefD and sefR genes was 38.9% (7/18), and 11 strains isolated after 1980s did not contain any gene sefDor sefR. The sequencing data of PCR products revealed that sequences of sefA, sefD and sefR genes in S. enteritidis and S. dublin were identical with those those from NCBI GenBank data which accession number were L11008, U07129 and AF233854, respectively. Interestingly, among the 7 strains of S. pullorum before 1980s, the sefD sequence has a missing base pair at position 196 and caused open reading frame (ORF) shift, resulting in a stop codon (TAG) at position 71 amino acid residual (Leu of TTA at position 214 - 216 shift into stop codon of TAG at position 215 - 217). Unlike S. pullorum, all S. enteritidis and S. dublin tested could express SEF14 fimbriae in vitro. Based on the data of the difference and variation of sef14 operon gene clusters between S. enteritidis and S. pullorum, we may explain why SEF14 fimbriae in S. pullorum could not be expressed.


Acellular pertussis vaccines--a question of efficacy.
Whole cell pertussis vaccine is considered to offer at least 80% protection against typical whooping cough. The quest for an equally effective but less reactogenic vaccine is now drawing to a close. During the forthcoming year a number of efficacy trials of acellular pertussis vaccines will be terminated. A variety of vaccines containing one, two, three or five purified pertussis antigens are being tested in Germany, Italy, Senegal and Sweden. About 30,000 infants have been enrolled in placebo-controlled studies and more than 100,000 in whole cell vaccine-controlled trials. The final plans for analysis of a Swedish placebo-controlled trial of whole cell and acellular vaccines is presented. Due to the unexpected high incidence of pertussis in Sweden during 1993-1994, relative risk comparisons between vaccines will be attempted in that trial, in addition to estimating absolute efficacy. A crucial issue is to what extent data may be compared between trials, given differences in design, vaccination schedules, and chosen endpoints. A primary case definition of laboratory-confirmed pertussis with at least 21 days of paroxysmal cough have been adopted in most trials. Pre-planned meta-analysis using this single endpoint will facilitate comparisons between vaccines. Serological correlates to protection in individuals will be sought in the ongoing placebo-controlled trials. The concept of a serological correlate valid for a vaccinated population but not necessarily for the vaccinated individual, as is the case with Hib vaccines, may turn out to be the only alternative to performing large efficacy trials in the future.


Jejunal absorption of trypsin in rat and guinea pig.
Gut absorption is one of the first requirements for the study of the mechanism of a possible anti-inflammatory action of proteases, such as orally administered trypsin. Porcine trypsin absorption was studied in isolated jejunal loops of rats (female Holtzman and male Wistar) and guinea pigs (males) by open-loop perfusion. Trypsin was dissolved in Tyrode solution and the solution perfused at a rate of 0.5 ml/min, at 37 degrees C. Trypsin activity, total protein, and sodium and potassium concentrations were assayed in the jejunal effluent; the values were unchanged throughout the experiments, which lasted 45 to 120 min. Using a high sensitivity ELISA (i.e. pg/ml), trypsin absorption could be demonstrated by determination of the enzyme in the mesenteric venous blood (samples of 0.5 ml); the enzyme concentration increased with time of perfusion. The linear range-specificity for intact trypsin varied from 1 to 500 ng/well. In this assay polyclonal antibodies prepared against trypsin-TLCK were utilized. Whereas trypsin concentration in the perfused lumen was practically constant at 0.12 mg/ml, the concentration of absorbed trypsin in mesenteric vein blood increased from about 100 ng/ml at time zero to 1.8 micrograms/ml, after 45 min of perfusion. Histological and ultrastructural examination of the jejunal mucosa before and after perfusion revealed that the brush-border, basal membrane, and junctional complexes were fully preserved, thus eliminating the possibility that trypsin might have destroyed the structures, thereby reaching the blood circulation. The present data indicate that micrograms quantities of trypsin were absorbed by the isolated jejunal loop of the rat.


[Mycobacterium ulcerans infection treated by Rifater, pyrazynamide, Myambutol, and surgery: a case report with a 6-year follow-up].
The author reports a case of pleuritis associated with a large homolateral Buruli thorax ulcer in a nine-year old female patient, in the Democratic Republic of Congo. Smears on Ziehl-Neelsen revealed acid-alcohol-resistant bacilli. The pathological histology confirmed a Mycobacterium ulcerans infection (Buruli ulcer). The treatment was surgical (excision-dressing-grafting) associated to antibiotic therapy (Rifater, Pyrazynamide, and Myambutol). After six years of follow up, no relapse was observed.


Acoustic analysis of diplophonia: a follow-up report.
Additional information on the physiology of the diplophonic speech produced by an adult female is provided. Direct endoscopic examination of the subject's laryngeal mechanism showed her diplophonia was produced by exerting differential tension on her vocal folds. The ventricular folds were not directly involved.


Influence of different wild-garlic (Allium ursinum) extracts on the gastrointestinal system: spasmolytic, antimicrobial and antioxidant properties.
As there are no previous studies of the European wild-garlic (Allium ursinum) effects on the gastrointestinal system, despite its traditional applications in gastrointestinal disorders' treatment and regular use in the human diet, we have quantified and compared spasmolytic, antimicrobial and antioxidant activities of its different leaf extracts. Wild-garlic extracts were tested for spasmolytic activity on isolated rat ileum, antimicrobial activity on selected Gram-positive and Gram-negative bacteria and fungi by microdilution method and antioxidant capacity by DPPH radical-scavenging assay. Wild-garlic extracts were found to decrease ileal basal tone. As the relaxation of K+ -induced contractions was similar to one caused by papaverin, the observed spasmolytic effect was most likely mediated through Ca2+ -channel inhibition. Ethanolic extract (with the highest phenolic and high alk(en)yl cysteine sulphoxides' levels) produced the strongest spasmolytic activity. In case of acetylcholine-induced contractions, only hydromethanolic extract showed no statistical difference in comparison with positive control. All samples exhibited certain antioxidant potential and strong antimicrobial activity against tested enteropathogenic strains (Salmonella enteritidis was the most sensitive, followed by Escherichia coli, Proteus mirabilis and Enterococcus faecalis). Besides other already established health-promoting effects, wild garlic could be useful in treatment of mild gastrointestinal disturbances.


Supplementary Anal Imaging by Magnetic Resonance Enterography in Patients with Crohn's Disease Not Suspected of Having Perianal Fistulas.
Few data are available to guide the use of anal imaging for patients with Crohn's disease (CD) who are not suspected of having perianal fistulas. We aimed to evaluate the role of anal imaging supplementary to magnetic resonance enterography (MRE) in these patients. In a prospective study, we added a round of anal MR imaging (MRI), collecting axial images alone, to MRE evaluation of 451 consecutive adults who were diagnosed with or suspected of having CD but not believed to have perianal fistulas. Images were examined for perianal tracts; if present, colorectal surgeons reexamined patients to identify external openings or perianal inflammation or abscess. Patients were followed and data were collected on dedicated treatment for perianal fistulas or abscess. We calculated the diagnostic yield for anal MRI, associated factors, and outcomes of MRI-detected asymptomatic perianal tracts. A total of 440 patients (mean age, 29.6±8.9 years) met the inclusion criteria. Anal MRI revealed perianal tracts in 53 patients (12%; 95% CI, 9.3%-15.4%). Surgeons however did not identify any lesions that required treatment. The asymptomatic tracts were mostly single unbranched (83%), inter-sphincteric (72%), or had a linear dark signal at the tract margin (79%). Younger age at MRE, female sex, and CD activity index scores of 220-450 were independently associated with detection of perianal tracts. MRI detection of asymptomatic tracts was independently associated with later development of perianal fistulas or abscess that required treatment: 17.8% cumulative incidence at 37 months and an adjusted hazard ratio of 3.06 (95% CI, 1.01-9.27; P=.048). In a prospective study of patients with CD, we found that adding anal MRI evaluation to MRE resulted in early identification of patients at risk for perianal complications.


[The initial morphological state in the basally pneumatized maxillary sinus--a radiological-histological study in man].
Twenty human autopsy specimens of the lateral maxilla with radiologically diagnosed extended basal maxillary sinus were prepared either in the horizontal, sagittal or transversal plane. Generally the cortical bone of the maxillary sinus showed a thickness up to 1000 microns. In areas with root contact histological findings could be described as follow: reduction of thickness, bone perforations, bone perforations combined with apical and or lateral root resorptions and root resorptions without bone perforations. These morphological findings could not be verified by X-ray examination.


A familial form of benign paroxysmal positional vertigo maps to chromosome 15.
Benign positional paroxysmal vertigo (BPPV) is characterized by short-lived episodes of vertigo in association with rapid changes in head position, most commonly extension and rotation of the neck while supine. It has been clinically observed that there is a subgroup of patients in whom the BPPV disease is inherited in an autosomal dominant fashion. However, little is known about the familial/genetic factors that may contribute to a predisposition to develop the disease. We ascertained and performed a genome-wide scan on a three-generation family in which multiple family members developed BPPV. We performed whole genome mapping with 400 microsatellite repeat markers and analyzed this trait using both autosomal dominant and recessive models of inheritance. Two point linkage analysis showed LOD scores of one or greater than one on chromosomes 7, 15, 16 and 20. Independent of the model of inheritance, the highest two-point LOD scores localized to same marker on chromosome 15. Multipoint linkage analysis showed the highest LOD score of 2.84 to markers on chromosome 15 with the autosomal dominant model. Haplotype reconstruction indicates that the BPPV gene in this family maps to a critical chromosomal 15 interval between markers GATA151F03N and GATA85D02. Discovery of a BPPV gene (or genes) will facilitate a better understanding of not only BPPV, but also the vestibular system. In addition, with improved understanding of the pathophysiology the potential development of alternative therapies for BPPV may be possible.


Dissonance-based eating disorder program reduces cardiac risk: A preliminary trial.
We conducted a randomized, controlled preliminary trial to examine the effect of a dissonance-based eating disorder program on eating disorder symptoms and cardiac risk indices in a community sample of women with subclinical and clinical symptoms (N = 47), examining the efficacy of the program in both the indicated prevention and treatment realms. Eating disorder symptoms, body mass index, and biomarkers of cardiac risk were examined in dissonance and assessment-only control conditions at baseline, postintervention, and 2-month follow-up. Specifically, we assessed mean R wave amplitude, QT interval length, vagal tone (high frequency spectral power of heart rate variability), and sympathetic tone (low/high frequency spectral power ratio) via electocardiography (ECG) at each assessment period. We predicted a statistically significant 2 (condition: control, dissonance) × 3 (time: baseline, postintervention, 2-month follow-up) interaction in the mixed factorial MANOVA results. Results confirmed this hypothesis. Eating disorder symptoms and cardiac risk indices decreased significantly among participants in the dissonance condition at postintervention and 2-month follow-up compared with baseline. Results provide support for the efficacy of a dissonance-based program in the reduction of eating disorder symptoms and cardiac risk indices among women with subclinical and clinical eating disorder symptoms. Findings establish the efficaciousness of this dissonance-based approach in the indicated prevention and treatment realms and establish its efficacy in reducing cardiac risk indicators. (PsycINFO Database Record


[Handling of patients with dementia--scenario 2050].
The relationship between social attitudes, normative ethics, health care elite's and individual failure has been highlighted in a scenario for patients with dementia. Inhuman abuse may be protected by sense of responsibility, duty to social being, inclusion of psychiatric patients, and the foundation of human dignity.


Cutaneous T-cell lymphoma presenting as facial swelling: report of a case and review of the literature.
This paper describes the case of a primary cutaneous T-cell lymphoma (CTCL) which presented on the cheek of a 69-year-old man. Contemporary theories of the pathogenesis and immunologic basis of CTCL are discussed along with recent advances in its diagnosis, classification, and treatment.


Differential role of endothelial function on vasodilator responses in series-arranged arterioles.
Both in vitro and in vivo studies have revealed that removal of vascular endothelial cells abolishes the vasodilation to acetylcholine (Ach) but not sodium nitroprusside (SNP). Differential properties of endothelial cells in the series-arranged arterioles to vasodilator responses have not been studied. In this study, the cheek pouch microcirculation from the golden syrian hamster anesthetized with sodium pentobarbital (6 mg/100 g body wt, ip) was prepared for intravital microscopy. Measurements of lumen diameters of small series-arranged arterioles (2nd- and 4th-order) were made before, during, and after topical microapplication of different doses of either Ach or SNP. After control measurements, a light-dye (L-D) technique utilizing sodium fluorescein (FITC-dextran(150K), 50 mg/100 g body wt, iv) and illuminating a discrete area of the arteriole with 490-nm-wavelength light for 3 (4th) or 10 (2nd) min was used to impair endothelial cell function without damaging vascular smooth muscle cells. Responses to vasoactive substances for both 4th-order (10-20 microns) and second-order (30-50 microns) arterioles were retested. Vasodilatory responses to 10(-7) M Ach and SNP also were tested with and without the presence of NG-monomethyl L-arginine (L-NMMA), an inhibitor of EDRF/NO formation. In the control state, Ach and SNP produced a focal, dose-dependent increase in diameter in all arterioles tested. Endothelial impairment by L-D treatment significantly suppressed the vasodilator response to Ach in 4th- but not 2nd-order arterioles, whereas the SNP response was not significantly affected. Consistent with these observations, L-NMMA treatment significantly attenuated Ach-induced vasodilation in 4th-order arterioles, but it had no effect on 2nd-order arterioles. These studies document further the role of the endothelium in local modulation of arteriolar diameter in response to acetylcholine and demonstrate a differential effect for this response in series-arranged microvessels. Thus, there may be a heterogeneous distribution of endothelial cell functions for modulating vasodilator activity in microvessels.


Smoking as a risk factor in hepatocellular carcinoma. A case-control study in southern African blacks.
Two hundred forty southern African black patients with hepatocellular carcinoma and control subjects matched for race, sex, age, and urban or rural background were questioned about their smoking habits. Patients with hepatocellular carcinoma were not more likely to smoke or to smoke heavily than the control subjects. This was also true of the subgroups: men and women, and urban and rural background. There was a slightly increased relative risk associated with smoking in all patients who showed no serum markers of current or past hepatitis-B virus infection and in patients older than 50 years who did not have markers of current or past hepatitis-B virus infection. However, this was not statistically significant, and was not supported by a linear trend, the risk in heavy smokers being less than 1. Rural black patients, who have a higher incidence of hepatocellular carcinoma than urban black patients, smoked less than their urban counterparts. We conclude that smoking is not an unqualified risk factor for hepatocellular carcinoma in southern African black patients. There may, however, be a trend toward smoking playing an etiologic role in patients without hepatitis-B virus infection, especially in older patients.


Local recurrence of cutaneous mixed tumor (chondroid syringoma) as malignant mixed tumor of the thumb 20 years after initial diagnosis.
Benign cutaneous mixed tumor (chondroid syringoma) is the cutaneous counterpart of the benign mixed tumor (pleomorphic adenoma) of salivary glands, consisting of both epithelial and mesenchymal elements. The incidence of cutaneous mixed tumor is rare, composing <0.01% of all primary skin tumors. Herein, we report a case of malignant mixed tumor which recurred in the right thumb 20 years after the reported initial diagnosis of a benign mixed tumor at this site. Histologically, the lesion consisted of highly atypical and infiltrative cells in cords and ductal structures, with an adjacent focus of residual benign mixed tumor present. Perineural invasion of multiple dermal and subcutaneous nerves was also seen. Immunohistochemical staining was strongly and diffusely positive for CK5/6 and p63, with patchy positive S100 and CK7 staining. Wide excision was performed, with no evidence of recurrence or metastasis 5 years later.


Kinetics of phosphorus absorption and expressions of related transporters in primary cultured duodenal epithelial cells of chick embryos.
Two experiments were conducted to investigate the kinetics of phosphorus (P) absorption and expressions of type IIb sodium-dependent phosphate cotransporter (NaP-IIb), inorganic phosphate transporters 1 and 2 (PiT-1 and PiT-2) in primary cultured duodenal epithelial cells of chick embryos. In experiment 1, the P absorptions across duodenal epithelial cell monolayers at different incubation time points (0, 10, 20, 40, 60, 80, 100 and 120 min) were compared. In experiment 2, the kinetics of P absorption was performed at 40 min after incubation of duodenal epithelial cells with the media containing 0, 0.75, 1.5, 3.0, 6.0, 12.0, 24.0 and 48.0 mmol P/L as KH2 PO4 , and the mRNA and protein expression levels of NaP-IIb, PiT-1 and PiT-2 in duodenal epithelial cells with the media containing 0, 6.0 and 48.0 mmol P/L were determined at 87 min after incubation. The results from experiment 1 showed that the P absorption increased linearly (p < .0001) from 0 to 80 min and the fastest increase occurred at 40 min; the asymptotic model was shown to have the best fit degree, and the optimal incubation time for saturable P absorption was determined to be 87 min. The kinetic curves of P absorption from experiment 2 demonstrated that P absorption was a mixed process of a non-saturable diffusion plus a saturable carrier-mediated transport across the duodenal epithelial cells. The high P concentration (48.0 mmol/L) decreased (p < .05) NaP-IIb and PiT-1 mRNA and protein levels and increased (p < .0001) PiT-2 mRNA level. These results indicated that the P absorption across primary cultured duodenal epithelial cell monolayers of chick embryos was a mixed process of a non-saturable diffusion plus a saturable carrier-mediated transport and could be restricted by reducing the NaP-IIb and PiT-1 expressions while increasing the PiT-2 expression at a high P concentration.


tBOOH acts as a suicide substrate for catalase.
The effects of t-butyl hydroperoxide (tBOOH) on bovine liver catalase were investigated. tBOOH is accepted as a substrate of catalase and in the absence of hydrogen donors leads to a destruction of the enzyme via compound II formation. During the decomposition of this enzyme-substrate complex catalase serves as internal hydrogen donor which results in destruction of the enzyme. Evidence for this destruction is given by: a decrease of the Soret band in the uv/vis spectrum, iron release from the enzyme, decrease of the catalatic activity of the enzyme measured by oxygen release from hydrogen peroxide. Hydrogen donors like NADH and o-dianisidine have been found to protect the enzyme from destruction by tBOOH but lead to a structural alteration of the enzyme, shown by alteration of the electrophoretic mobility. In the presence of the hydrogen donor tBOOH is completely reduced to t-butanol, which is thought to proceed in a peroxidase-like reaction.