Analysis of responses to pituitary adenylate cyclase activating polypeptide-38 in the feline hindquarters vascular bed.
Responses to pituitary adenylate cyclase activating polypeptide (PACAP)-38 were investigated and compared with responses to PACAP-27 and vasoactive intestinal polypeptide (VIP) in the hindquarters vascular bed of the cat under constant flow conditions. Injections of PACAP-38 into the hindquarters perfusion circuit caused dose-related, biphasic changes characterized by initial decreases followed by increases in both hindquarters perfusion and systemic arterial pressure. In relative terms, PACAP-38 was less potent then PACAP-27 and VIP in dilating the hindquarters vascular bed, with the order of related potency being VIP > PACAP-27 > PACAP-38 when the doses required to decrease hindquarters perfusion pressure by 25 mm Hg were compared. When comparing the relative vasoconstrictor activity of PACAP-38 to that of PACAP-27 and norepinephrine, PACAP-38 was approximately 3-fold less potent than PACAP-27 and 10-fold less potent than norepinephrine. The vasoconstrictor component of the response to PACAP-38 and, as shown previously, for PACAP-27 was blocked by phentolamine in a dose that significantly reduced pressor responses to norepinephrine in the hindquarters vascular bed. The present data show that PACAP-38 has significant vasodilator and vasoconstrictor activity in the hindquarters vascular bed of the cat, and that the 27 amino acid form of the peptide has greater depressor and pressor activity than PACAP-38.


Characterization and developmental expression of AmphiNk2-2, an NK2 class homeobox gene from Amphioxus. (Phylum Chordata; Subphylum Cephalochordata).
The genome of amphioxus includes AmphiNk2-2, the first gene of the NK2 homeobox class to be demonstrated in any invertebrate deuterostome. AmphiNk2-2 encodes a protein with a TN domain, homeodomain, and NK2-specific domain; on the basis of amino acid identities in these conserved regions, AmphiNk2-2 is a homolog of Drosophila vnd and vertebrate Nkx2-2. During amphioxus development, expression of Amph- iNk2-2 is first detected ventrally in the endoderm of late gastrulae. In neurulae, endodermal expression divides into three domains (the pharynx, midgut, and hindgut), and neural expression commences in two longitudinal bands of cells in the anterior neural tube. These neural tube cells occupy a ventrolateral position on either side of the cerebral vesicle (the probable homolog of the vertebrate diencephalic forebrain). The dynamic expression patterns of AmphiNkx2-2 suggest successive roles, first in regionalizing the endoderm and nervous system and later during differentiation of specific cell types in the gut (possibly peptide endocrine cells) and brain (possibly including axon outgrowth and guidance).


Persistent infection by Salmonella enterica servovar Typhimurium: are synbiotics a therapeutic option? - a case report.
Little is known about the prevalence of persistent human infections by nontyphoidal Salmonella (NTS). Recently published study results indicate that a small fraction (at least 2.2%) of NTS-infected patients continue to shed Salmonella for an extended period of time (up to years). Despite the recommendation not to use antibiotics for the treatment of uncomplicated NTS-Salmonella infection, little treatment guidance is available. Clinical findings from a NTS-patient indicate that administration of synbiotics (probiotic bacteria plus prebiotic) might be considered as a treatment option. We report data of a patient who was treated with a synbiotic preparation containing nine different probiotic bacteria and the prebiotic fructooligosaccharides (FOS). Starting from day one of the treatment, the patient experienced an improvement of symptoms and was symptom-free at the end of a 10 days treatment course. After finishing the treatment, the stool proved to be Salmonella enterica serovar Typhimurium negative. In vitro pathogenic inhibition studies showed the inhibitory effects of the multistrain synbiotic mixture against S. Typhimurium. Growth of S. Typhimurium was also inhibited by individual bacterial strains making part of the composition of the mixture. However, he inhibitory effects of individual strains varied significantly, with those of Streptococcus thermophilus St-21 and Lactobacillus helveticus SP-27 exhibiting the strongest inhibitory effect. Persistent infections by S. Typhimurium are a severe concern for the affected patients. Besides the symptomatic burden, infected persons are banned from work in certain areas (e.g. food related service). In addition, patients with persistent S. Typhimurium infections are a threat for the public health in general, as they serve as a reservoir for NTS transmission. The findings indicate that treatment with a synbiotic preparation might provide a treatment option for persistent S. Typhimurium infections. More clinical data have to be gathered to confirm the relevance of this potential treatment approach.


Development of SHIVs with circulating, transmitted HIV-1 variants.
SHIV/macaque model is critical for pre-clinical HIV-1 research. The ability of this model to predict efficacious intervention(s) in humans depends on how faithfully the model recapitulates key features of HIV-1 transmission and pathogenesis. Here, we provide insights for rationally designing SHIVs with transmitted HIV-1 variants for vaccine and prevention research.


Effect of local gentamicin application on healing and wound infection in patients with modified radical mastectomy: a prospective randomized study.
This study investigated the effects of Gentacoll implants on healing in patients (n = 44) undergoing modified radical mastectomy and axillary dissection. Group I, the Gentacoll group (n = 22), underwent surgery followed by insertion of 10 × 10 × 0.5 cm Gentacoll implants (280 mg collagen sponge plus 200 mg gentamicin sulphate) into the axillary area and under the flap area of the breast before wound closure. Group II, the control group (n = 22), underwent surgery without the application of Gentacoll. Neither group received oral or parenteral post-operative antibiotic therapy. Outcome measures included wound infection, seroma formation, total drainage volumes, drain removal time and duration of hospital stay. Post-operative infection rate, seroma formation, drainage volumes and duration of hospital stay were significantly reduced in the Gentacoll group compared with the control group. In conclusion, the application of Gentacoll significantly improved post-operative outcomes in patients undergoing modified radical mastectomy.


Six years' experience of using the BacT/ALERT system to screen all platelet concentrates, and additional testing of outdated platelet concentrates to estimate the frequency of false-negative results.
Approximately 1 in every 2000 units of platelets is contaminated with bacteria. The BacT/ALERT automated blood culture system can be used to screen platelet concentrates (PCs) for bacterial contamination. Data were collected from May 1998 until May 2004. The number of PCs tested during this period was 36 896, most of which were produced from pools of four buffy-coats. On the day following blood collection or platelet apheresis, a 5-10 ml sample of the PC was aseptically transferred to a BacT/ALERT culture bottle for detection of aerobic bacteria. The sample was monitored for bacterial growth during the entire storage period of the PC (6.5 days). When a positive signal was generated, the culture bottle, the PC and the erythrocyte concentrates were tested for bacterial growth. In order to determine the frequency of false-negative BacT/ALERT signals, 1061 outdated PCs were tested during the period from May 2002 to May 2004. Eighty-eight positive signals were detected by the BacT/ALERT system, of which 12 were interpreted as truly positive. Fourteen signals were interpreted as truly false positive. Thirty-three signals were interpreted to be probably false positive. Two of 1061 outdated units tested positive, and Bacillus spp. and Staphylococcus epidermidis, respectively, were isolated from these PCs. Between 0.03% and 0.12% of the PCs were contaminated with bacteria. BacT/ALERT is an efficient tool for monitoring PCs for bacterial contamination; however, it is important to realize that false-negative results may occur.


Differential ligand binding specificities of recombinant CD11b/CD18 integrin I-domain.
The alpha subunits of leukocyte CD11/CD18 integrins contain an approximately 200-amino acid "inserted" domain (I-domain) that may be important for multivalent adhesive recognitions. A recombinant form of the I-domain of CD11b/CD18 was generated and analyzed directly for interaction with complementary integrin ligands. CD11b I-domain bound the activation-dependent monoclonal antibody 7E3, and the functionally blocking anti-CD11b monoclonal antibodies OKM9, 60.1, and LM2/1, but not OKM1 or M1/70. Fibrinogen or soluble intercellular adhesion molecule-1 associated with CD11b I-domain in a concentration-dependent manner. Binding of 125I-fibrinogen to recombinant CD11b I-domain was saturable, governed by a Kd of approximately 0.22 +/- 0.06 microM, and fully inhibited by molar excess of unlabeled fibrinogen, or by the P1 peptide (KY)GWTVFQKRLDGSV (IC50 approximately 2.5-5 microM), duplicating the fibrinogen gamma chain sequence Gly190-Val202. In contrast, 125I-factor X binding to CD11b I-domain was only partially inhibited (50-60%) by a molar excess of unlabeled factor X, and entirely unaffected by functionally blocking anti-CD11b monoclonal antibodies or by factor X-derived synthetic peptidyl antagonists. We conclude that the I-domain of CD11b participates in qualitative mechanisms of receptor activation and contains the binding site(s) for the CD11b/CD18 ligands fibrinogen and intercellular adhesion molecule-1, while it is only minimally implicated in the recognition of factor X.


Osteosarcoma with multiple skeletal metastases. A case of "nonstochastic" metastasis.
Osteosarcoma of the thoracic spine developed in a 15-year-old Japanese boy. After his first admission with paralysis, multiple skeletal metastases were demonstrated in the absence of pulmonary metastasis. This rare condition may possibly be considered as a unicentric osteosarcoma with bone metastases, since there were no precursor lesions or history of exposure to radioactive materials or chemical agents. These multiple lesions may be an example of so-called "organ-specific metastasis," although this "nonstochastic" process is rare.


[Precariousness, DRG's and health planning: pilot study at the Lariboisière hospital in Paris].
This paper considers the specific administrative procedures set up by managers of public healthcare establishments and those responsible for health and welfare policies to care for low-income pregnant women for whom 100% of the "price per act" (T2A) is refunded. What are the limitations and what improvements can be suggested? The results are based on an analysis of data from semi-structured interviews, legislation and documents. The State, health insurance systems, public health establishments, local authorities, charities and outpatient services are involved in handling low-income parturients in different services and different establishments, both locally and regionally. A health and welfare policy comprising specific, coordinated actions and measures has been developed. The T2A "price per act" system may threaten its survival: the limited number of front-line facilities is often saturated and demand is increasing, treatment is often reduced to reactive management leading to unwanted readmissions, ethics are sometimes called into question and there is a risk of patient selection. This pilot study provided some encouraging information but also indicated the limitations of the approach adopted. However, it was still of interest to see whether it was possible to use this approach, which did not require considerable resources, to reveal useful markers. This appeared to be the case. Regional Health Agencies (ARS) and local authorities could support the system. Additional funding is needed.


Feeling what you hear: auditory signals can modulate tactile tap perception.
We tested whether auditory sequences of beeps can modulate the tactile perception of sequences of taps (two to four taps per sequence) delivered to the index fingertip. In the first experiment, the auditory and tactile sequences were presented simultaneously. The number of beeps delivered in the auditory sequence were either the same as, less than, or more than the number of taps of the simultaneously presented tactile sequence. Though task-irrelevant (subjects were instructed to focus on the tactile stimuli), the auditory stimuli systematically modulated subjects' tactile perception; in other words subjects' responses depended significantly on the number of delivered beeps. Such modulation only occurred when the auditory and tactile stimuli were similar enough. In the second experiment, we tested whether the automatic auditory-tactile integration depends on simultaneity or whether a bias can be evoked when the auditory and tactile sequence are presented in temporal asynchrony. Audition significantly modulated tactile perception when the stimuli were presented simultaneously but this effect gradually disappeared when a temporal asynchrony was introduced between auditory and tactile stimuli. These results show that when provided with auditory and tactile sensory signals that are likely to be generated by the same stimulus, the central nervous system (CNS) tends to automatically integrate these signals.


Preparation of non-sintered permeable bricks using electrolytic manganese residue: Environmental and NH3-N recovery benefits.
The present study aims to prepare non-sintered permeable bricks using significant amount of electrolytic manganese residue (EMR), discharged by electrolytic metal manganese industry. Mechanical and environmental properties were investigated. The microstructure was analyzed by means of XRD, FTIR, TG-DSC and SEM-EDS. It was observed that the splitting tensile strength and permeability coefficient of the optimum proportion were 3.53 MPa and 3.2 × 10-2 cm/s respectively. The main hydration products were found to be ettringite, C-S-H, aluminosilicates and C-A-S-H. The leaching test showed that Mn, Pb, Cd, total Cr and NH3-N in the non-sintered permeable bricks were solidified up to concentrations lower than groundwater standard. In addition to that, the NH3-N produced during the process was transformed into ammonia water which was in turn recycled and reused in manganese electrolysis. Besides, non-sintered permeable bricks have been produced at large scale and applied successfully as pavement materials in Songtao, China. Therefore, the use of EMR to produce non-sintered permeable bricks possesses important environmental and economic significance because the process not only utilizes large quantities of EMR and saves EMR disposal cost, but also saves a lot of natural resources and improves the urban environment.


[Value of sonographic ileus diagnosis].
Patients in an early state of mechanical bowel obstruction, with unspecific clinical symptoms, negative laboratory findings and no evidence of ileus in plain abdominal X-ray, are a pitfall for diagnosis and therapeutic decisions. In a partly retrospective, partly prospective study 11% (n = 13) of ileus patients admitted to our hospital met these criteria of "early state" bowel obstruction. Using conventional methods of diagnosis, in 6% (n = 7) false negative diagnosis was obtained; 4% (n = 5) were primarily admitted to the internal medical department. In all these cases, abdominal sonography yielded a correct diagnosis by demonstrating specific criteria of bowel obstruction even at onset of disease. The correct diagnosis was uniformly confirmed by early operation.


Palladium-Catalyzed Oxidative Carbonylative Coupling of Arylallenes, Arylboronic Acids, and Nitroarenes.
In this Letter, a palladium-catalyzed multicomponent procedure for the selective synthesis of α-substituted α,β-unsaturated ketones has been developed. With readily available allenes, arylboronic acids, and nitroarenes as the substrates, the reaction proceeds selectively to the desired α-substituted enones. Notably, no manipulation of carbon monoxide gas is needed here, and Mo(CO)6 has been applied as a stable solid CO source instead. Additionally, as an oxidative coupling reaction, nitroarenes are used as both the amine source and the oxidant to regenerate the active palladium species.


[Cat-scratch disease or benign inoculation lymphoreticulosis. A continuous quest for the etiological agent].
This infection usually results from transmission to humans by the scratch of a cat, but may also follow spine stings or cuts from fresh bones of various animals, this explaining the ubiquity of the causative agent and its resistance to various physical agents. The primary lesion develops in the skin at the inoculation site, to be followed by the appearance of one or several satellite adenopathies, of regional distribution and evolving towards suppuration. Apart from some rare nervous manifestations the prognosis is usually good, but regression of the adenopathy is a slow process. Histology shows tumefaction of massed reticular cells with central necrosis, leucocyte diapedesis and ultimate abscess formation. Diagnosis is by evidence of allergy to a specific antigen formed of the pus from infected glands after sterilization. The responsibility of a gram-positive bacterium of the genus Rothia has just been demonstrated.


[Lipid evaluation in cerebral infarction in its early phase and in the 4th month. Practical consequences].
Plasma lipid values studied in 30 subjects with stroke at days 1, 2 and 4 of the early phase indicated a significant decrease in total cholesterol, HDL-cholesterol and apolipoprotein A1 from day 1 to 4. However, there was no significant difference between values at day 1 and during the 4th month of convalescence. Since some patients admitted to hospital are never followed up later in a hospital environment, it would seem advisable, for practical purposes, to perform plasma lipid analysis on the first day of admission.


Epidemiology of needlesticks and other sharps injuries and injection safety practices in the Dominican Republic.
Contaminated sharps, such as needles, lancets, scalpels, broken glass, specimen tubes, and other instruments, can transmit bloodborne pathogens such as HIV, hepatitis B (HBV), and hepatitis C viruses (HCV). Observation of facilities and injections and questionnaire-guided interviews were conducted in 2005 among health care workers (HCWs) in 2 public hospitals in Santo Domingo and 136 public immunization clinics (IC) in the Dominican Republic. Injection practices and sharps injuries (SIs) in health care facilities in the Dominican Republic were assessed in cross-sectional surveys to identify areas in which preventive efforts might be directed to make injection practices safer. Of the 304 hospital HCWs and 136 ICs HCWs interviewed, 98 (22.3%) reported > or =1 SIs during the previous 12 months. ICs had a lower incidence (13 per 100 per person-years [p-y]) of SIs than hospitals (65 per 100 p-y) (P < .0001). Unsafe needle recapping was observed in 98% of all injections observed at hospitals but in only 12% of injections at ICs (P < .0001). Sharps were observed improperly disposed in regular waste containers in 24 (92%) of 26 areas at which injections are prepared at the hospitals but in only 11 (8%) of 136 ICs (P < .0001). Training in injection safety was received by 4% of HCWs in hospitals but by 77% in ICs (P < .001). Of 425 HCWs, 247 (58%) were fully immunized against hepatitis B. There was a higher risk of SIs among staff dentists (adjusted relative risks [aRR], 5.9; 95% confidence interval [CI]: 2.8-12.6), resident physicians (aRR, 3.5; 95% CI: 1.8-6.9), and those who gave > or =11 therapeutic injections per day (aRR, 1.6; 95% CI: 1.1-2.4). Injection practices at ICs were safer than those found at public hospitals. Preventive strategies to lower SIs in public hospitals should include regular training of hospital staff to minimize needle recapping and improper disposal, among other interventions to reduce the dangers of needles.


Nitrogen-fixing bacterium Burkholderia brasiliensis produces a novel yersiniose A-containing O-polysaccharide.
Burkholderia brasiliensis, a Gram-negative diazotrophic endophytic bacterium, was first isolated from roots, stems, and leaves of rice plant in Brazil. The polysaccharide moiety was released by ammonolysis from the B. brasiliensis lipopolysaccharide (LPS), allowing the unambiguous characterization of a 3,6-dideoxy-4-C-(1-hydroxyethyl)-D-xylo-hexose (yersiniose A), an uncommon feature for Burkholderia LPS. The complete structure of the yersiniose A-containing O-antigen was identified by sugar and methylation analyses and NMR spectroscopy. Our results show that the repeating oligosaccharide motif of LPS O-chain consists of a branched tetrasaccharide with the following structure:-->2-alpha-d-Rhap-(1-->3)-[alpha-YerAp-(1-->2)]-alpha-D-Rhap-(1-->3)-alpha-D-Rhap-(1-->.


Performance of two predictive methods for calculation of the key pharmacokinetic parameters for gentamicin dosage individualization.
Performance of two methods for determination of the apparent volume of distribution (Vd) and the elimination half-life (t1/2) for gentamicin was evaluated in 20 non-obese acutely ill patients. The patients had varying degrees of renal function. Initial creatinine clearance ranged from 22.7-103.1 ml/min, with a mean value (+/- SEM) of 63.26 (+/- 5.74) ml/min, and serum creatinine concentration was 1.37 (+/- 0.13) mg/dl, with a range of 0.70-3.0 mg/dl. The total daily dose of gentamicin ranged from 1.85-4.71 mg/kg. Two different methods were used for Vd calculation: the Hull-Sarubbi method and Chiou midpoint-back-extrapolation method. For t1/2 estimation, the Hull-Sarubbi and Cutler methods were used. These values were compared with the values obtained by the Sawchuk-Zaske method. Mean predicted error (ME), mean absolute error (MAE), and root mean squared error (RMSE) were calculated for each method. Prediction bias and precision were compared statistically between each method by calculating the 95% confidence intervals of the delta MA and delta MAE, respectively. The MAEs revealed that the precision of Vd predictions were within 1.04 litre and 0.62 litre for the Hull-Sarubbi and Chiou methods, respectively. For the elimination half-life, none of the methods performance exhibited substantial bias. The Hull-Sarubbi method, however, was less biased and more precise than the Cutler method.


The filtered Fourier difference spectrum predicts psychophysical letter discrimination in the peripheral retina.
We wished to devise a measure of dissimilarity (D) which could predict psychophysical discrimination performance for Snellen letter pairs in peripheral vision. Threshold size for discriminating 33 pairs of Snellen letters was measured at 30 degrees eccentricity in the nasal retina for two subjects. D was computed for each pair by performing an overlap subtraction in the spatial domain, followed by a Fast Fourier Transform on this difference image, and dividing the total power in the resultant 'difference spectrum' by the sum of the powers of the individual letter spectra. A plot of D vs. psychophysical threshold letter size gave a mean correlation of R = -0.81. When D was calculated for letters that were low-pass filtered at different cut-off frequencies, the correlation with psychophysical performance was greatest when cut-off was between 1.25-1.9 cycles/letter (R = -0.85). Conversely, when the difference spectrum was high-pass filtered at different cut-off frequencies, the correlation decreased continuously as the cut-off increased. These results imply that the band of frequencies between zero and 1.25 cycles/letter are most important for letter discrimination in peripheral vision.


Bioaccumulation and speciation of selenium in fish and insects collected from a mountaintop removal coal mining-impacted stream in West Virginia.
A major contaminant of concern for mountaintop removal/valley fill (MTR/VF) coal mining is selenium (Se), an essential micronutrient that can be toxic to fish. Creek chubs (Semotilus atromaculatus), green sunfish (Lepomis cyanellus), and composite insect samples were collected in March-July, 2011-2013 at two sites within the Mud River, West Virginia. One site (MR7) receives MTR/VF coal mining effluent, while the reference site (LFMR) does not. MR7 water had significantly higher concentrations of soluble Se (p < 0.01) and conductivity (p < 0.005) compared to LFMR. MR7 whole insects contained significantly higher concentrations of Se compared to LFMR insects (p < 0.001). MR7 creek chubs had significantly higher Se in fillets, liver, and ovary tissues compared to LFMR samples (p < 0.0001, p < 0.0001, and p < 0.02, respectively). MR7 green sunfish fillets contained significantly higher Se (p < 0.0001). Histological examination showed LFMR creek chub gills contained a typical amount of parasitic infestations; however MR7 gills contained minimal to no visible parasites. X-ray absorption spectroscopic analyses revealed that MR7 whole insects and creek chub tissues primarily contained organic Se and selenite. These two species of Mud River fish were shown to specifically accumulate Se differently in tissues compartments. Tissue-specific concentrations of Se may be useful in determining potential reproductive consequences of Se exposure in wild fish populations.


A Phase I Clinical Trial and Independent Patient-Derived Xenograft Study of Combined Targeted Treatment with Dacomitinib and Figitumumab in Advanced Solid Tumors.
Purpose: This phase I, open-label, single-arm trial assessed the safety and tolerability of dacomitinib-figitumumab combination therapy in patients with advanced solid tumors.Experimental Design: A standard 3 + 3 dose escalation/de-escalation design was utilized. Starting doses were figitumumab 20 mg/kg administered intravenously once every 3 weeks and dacomitinib 30 mg administered orally once daily. We also performed an independent study of the combination in patient-derived xenograft (avatar mouse) models of adenoid cystic carcinoma.Results: Of the 74 patients enrolled, the most common malignancies were non-small cell lung cancer (24.3%) and colorectal cancer (14.9%). The most common treatment-related adverse events in the 71 patients who received treatment across five dose levels were diarrhea (59.2%), mucosal inflammation (47.9%), and fatigue and acneiform dermatitis (45.1% each). The most common dose-limiting toxicity was mucosal inflammation. Dosing schedules of dacomitinib 10 or 15 mg daily plus figitumumab 20 mg/kg every 3 weeks after a figitumumab loading dose were tolerated by patients over multiple cycles and considered recommended doses for further evaluation. Objective responses were seen in patients with adenoid cystic carcinoma, ovarian carcinoma, and salivary gland cancer. Pharmacokinetic analysis did not show any significant drug-drug interaction. In the adenoid cystic carcinoma xenograft model, figitumumab exerted significant antitumor activity, whereas dacomitinib did not. Figitumumab-sensitive tumors showed downregulation of genes in the insulin-like growth factor receptor 1 pathway.Conclusions: Dacomitinib-figitumumab combination therapy was tolerable with significant dose reductions of both agents to less than the recommended single-agent phase II dose of each drug. Preliminary clinical activity was demonstrated in the potential target tumor adenoid cystic carcinoma. Clin Cancer Res; 23(5); 1177-85. ©2016 AACRSee related commentary by Sundar et al., p. 1123.


Intrusive thoughts and auditory hallucinations: a comparative study of intrusions in psychosis.
Several theories of auditory hallucinations implicate the involvement of intrusive thoughts and other theories suggest that the interpretation of voices determines the distress associated with them. This study tested the hypotheses that patients who experience auditory hallucinations will experience more intrusive thoughts and be more distressed by them and interpret them as more uncontrollable and unacceptable than the control groups. It also examines whether the interpretation of hallucinations is associated with the distress caused by them and whether there are differences in the way that patients respond to and interpret their thoughts and voices. A questionnaire examining the frequency of intrusive thoughts and the reactions to them was administered to a group of patients with a diagnosis of schizophrenia who experienced auditory hallucinations, a psychiatric control group and a non-patient control group. In addition, the patients in the first group completed a similar questionnaire in relation to their voices. Analyses of covariance showed that patients who experienced auditory hallucinations had more intrusive thoughts than the control groups and that they found their intrusive thoughts more distressing, uncontrollable and unacceptable than the control groups. Correlational analyses revealed that patients' interpretations of their voices were associated with the measures of distress in relation to them. Repeated measures analyses of covariance found no differences between thoughts and voices on the dimensions assessed. The theoretical and clinical implications of these findings are discussed.


Possible biotransformation mechanism of 3-aminopropionitrile by means of free radicals.
The possible role of free radicals in the transformation of 3-aminopropionitrile giving rise to the liberation of cyanide was studied. Rat liver homogenates were cellularly fractionated. It was confirmed that the transformation occurred mainly in the microsomal fraction. The different isozyme forms of cytochrome P-450 were then partially purified and their velocity and affinity constants determined. It could be deduced that the cyanide-forming activity was mainly due to the LM3C cytochrome form. Dimethylsulfoxide was a potent competitive transformation inhibitor while mannitol was a moderate one. An OH radical generator inorganic system was also shown to liberate cyanide from 3-aminopropionitrile. In view of these results, a transformation mechanism of 3-aminopropionitrile by means of OH free radicals is suggested with the formation of cyanide anion in a cell-free organic system as well as in the microsomal fraction of rat liver.


Nicotine addiction.
Addiction to nicotine is the most common serious condition in medicine today. This chemical dependency has produced the largest epidemic of disease in this century, an epidemic that is beginning to wane in the United States but which is accelerating in the Third World. Widespread cultural acceptance of tobacco and the malignant fostering of use by cigarette merchants has perpetuated the epidemic. Nicotine regularly causes addiction in its users. This condition is best viewed as a chronic disease with remissions and exacerbations. It is highly amenable to treatment, and primary-care physicians are ideally situated to manage this fascinating condition. Physicians have a larger role to play, as well, in the many opportunities that exist to prevent this condition in the young and to protect non-smokers from tobacco smoke pollution.


Value-based insurance design: embracing value over cost alone.
The US healthcare system is in crisis, with documented gaps in quality, safety, access, and affordability. Many believe the solution to unsustainable cost increases is increased patient cost-sharing. From an overall cost perspective, reduced consumption of certain essential services may yield short-term savings but lead to worse health and markedly higher costs down the road--in complications, hospitalizations, and increased utilization. Value-based insurance design (VBID) can help plug the inherent shortfalls in "across-the-board" patient cost-sharing. Instead of focusing on cost or quality alone, VBID focuses on value, aligning the financial and nonfinancial incentives of the various stakeholders and complementing other current initiatives to improve quality and subdue costs, such as high-deductible consumer-directed health plans, pay-for-performance programs, and disease management. Mounting evidence, both peer-reviewed and empirical, indicates not only that VBID can be implemented, but also leads to desired changes in behavior. For all its documented successes and recognized promise, VBID is in its infancy and is not a panacea for the current healthcare crisis. However, the available research and documented experiences indicate that as an overall approach, and in its fully evolved and widely adopted form, VBID will promote a healthier population and therefore support cost-containment efforts by producing better health at any price point.


The relationship of age to performance on the Luria-Nebraska Neuropsychological Battery.
The effect of age upon the Luria-Nebraska Neuropsychological Battery (LNNB) was studied by administering the LNNB and the Wechsler Adult Intelligence Scale to three groups of subjects: A group aged 17-30, a group aged 50-55, and a group aged 65 and older. No subject had any history of brain pathology or psychotic emotional disturbance. Two of the Luria-Nebraska subtests, the Motor and Visual, showed a significant sex-effect in that males performed better than females. Age was related significantly to performance on 11 of 16 Luria Nebraska subscales; older subjects rather consistently showed poorer performance than younger subjects. When intelligence (i.e., Wechsler IQs) and education were controlled statistically, partial correlations still revealed that age had significant effects upon 13 of 16 Luria-Nebraska subscales. These results closely parallel earlier data that concern age-effects on the Luria-Nebraska Battery.


MicroRNA profile analysis of human prostate cancers.
We examined the microRNA (miRNA) expression profile of 40 prostatectomy specimens from stage T2a/b, early relapse and non-relapse cancer patients, to better understand the relationship between miRNA dysregulation and prostate oncogenesis. Paired analysis was carried out with microdissected, malignant and non-involved areas of each specimen, using high-throughput liquid-phase hybridization (mirMASA) reactions and 114 miRNA probes. Five miRNAs (miR-23b, -100, -145, -221 and -222) were significantly downregulated in malignant tissues, according to significance analysis of microarrays and paired t-test with Bonferroni correction. Lowered expression of miR-23b, -145, -221 and -222 in malignant tissues was validated by quantitative reverse transcription (qRT)-PCR analyses. Ectopic expression of these miRNAs significantly reduced LNCaP cancer cell growth, suggesting growth modulatory roles for these miRNAs. Patient subset analysis showed that those with post-surgery elevation of prostate-specific antigen (chemical relapse) displayed a distinct expression profile of 16 miRNAs, as compared with patients with non-relapse disease. A trend of increased expression (>40%) of miR-135b and miR-194 was observed by qRT-PCR confirmatory analysis of 11 patients from each clinical subset. These findings indicate that an altered miRNA expression signature accompanied the prostate oncogenic process. Additional, aberrant miRNA expression features may reflect a tendency for early disease relapse. Growth inhibition through the reconstitution of miRNAs is potentially applicable for experimental therapy of prostate cancer, pending molecular validation of targeted genes.


Neuroepithelial bodies in the lung of Melanophryniscus stelzneri stelzneri (Anura, Bufonidae).
Electron microscopy of the lungs of Melanophryniscus stelzneri stelzneri (Anura) revealed the presence of a complex pattern of corpuscular cells (CCs). The respiratory surface over the septa presents small areas where the CCs are grouped forming neuroepithelial bodies (NEBs). These corpuscular structures can also be localized in the inner layer of the lung wall. Although in both cases NEBs protrude slightly into the airway lumen, they are separated from the airway lumen and the basal connective tissue by thin apical and basal cytoplasmic processes of neighbouring pneumocytes. Ultrastructurally, the CCs possess a large nucleus, clear cytoplasm and vesicles of variable morphology and size, containing an electron dense material surrounded by a lucent space in some cases. The size of these dense-core vesicles (DCVs) ranged from 40 to 100 nm. The NEBs are associated with afferent and efferent terminal nerves. These types of nerve endings are located between the CCs and in the basal part of the NEBs. The location of the NEBs in strategic positions on the septa and in the wall of the lung, the presence of the DCVs in the basolateral region of the CCs, the occurrence of synaptic contacts between nerve endings and the CCs and the occurrence of capillaries close to the NEBs, suggest a receptosecretory function for NEBs in the lung of M.s. stelzneri.


Immunosuppressive therapy for canine immune-mediated hemolytic anemia.
The mortality for dogs with severe immune-mediated hemolytic anemia (IMHA) is unacceptably high, and better immunosuppressive regimens are needed to increase survival. Understanding the basic immunology of the disease and the mechanisms of action of the available immunosuppressive therapies will help clinicians choose an appropriate immunosuppressive protocol. Prospective, randomized clinical studies must be conducted to evaluate the efficacy and safety of different combined immunosuppressive modalities to treat canine IMHA and improve patients' outcomes.


Evaluation of ceftazidime in experimental Klebsiella pneumoniae pneumonia: comparison with other antibiotics and measurement of its penetration into respiratory tissues and secretions.
The activity of ceftazidime was examined in a murine model of Klebsiella pneumoniae pneumonia in which the antibiotic was administered subcutaneously 6 h after intranasal infection and then twice daily for the next three days (i.e. seven doses). In a series of experiments using this test, the dose of ceftazidime giving 50% survival relative to controls (SD50) ranged from 1.0-9.0 mg/kg/dose while the dose required to reduce the log10 cfu/lung by 50% (CD50) ranged from 24-64 mg/kg/dose. Ceftazidime was considerably more effective than cefotiam, amoxycillin-clavulanic acid or kanamycin in the test. Pharmacokinetic studies with ceftazidime showed that no differences in respiratory tract penetration existed between uninfected mice and mice infected for 48 h with K. pneumoniae. The percentage penetration of ceftazidime from serum was 73% for pleural fluid, 44% for tracheal fluid, 27% for tracheal wall tissue and 17% for whole lung tissue after a subcutaneous injection of 100 mg/kg. At this dose, ceftazidime remained at supra-MIC concentrations for 2-3 h in all compartments examined.


POPFNN: A Pseudo Outer-product Based Fuzzy Neural Network.
A novel fuzzy neural network, called the pseudo outer-product based fuzzy neural network (POPFNN), is proposed in this paper. The functions performed by each layer in the proposed POPFNN strictly correspond to the inference steps in the truth value restriction method in fuzzy logic [[Mantaras (1990)] Approximate reasoning models, Ellis Horwood]. This correspondence gives it a strong theoretical basis. Similar to most of the existing fuzzy neural networks, the proposed POPFNN uses a self-organizing algorithm ([Kohonen, 1988], Self-organization and associative memories, Springer) to learn and initialize the membership functions of the input and output variables from a set of training data. However, instead of employing the popularly used competitive learning [[Kosko (1990)] IEEE Trans. Neural Networks, 3(5), 801], this paper proposes a novel pseudo outer-product (POP) learning algorithm to identify the fuzzy rules that are supported by the training data. The proposed POP learning algorithm is fast, reliable, and highly intuitive. Extensive experimental results and comparisons are presented at the end of the paper for discussion. Copyright 1996 Elsevier Science Ltd.


Determining geographical variations in Ascaris suum isolated from different regions in northwest China through sequences of three mitochondrial genes.
The sequence diversities in three mitochondrial DNA (mtDNA) regions, namely portions of NADH dehydrogenase subunit 1 (pnad1), cytochrome c oxidase subunit 1 (pcox1), and NADH dehydrogenase subunit 4 (pnad4), were investigated in all Ascaris suum samples isolated from four regions in northwestern China. Those genes were amplified by PCR method and the lengths of pnad1, pcox1, and pnad4 were 419 bp, 711 bp, and 723 bp, respectively. The intraspecific sequence variations within A. suum samples were 0-2.9% for pnad1, 0-2.1% for pcox1, and 0-3.1% for pnad4. Phylogenetic analysis combined with three sequences of mtDNA fragments showed that all A. suum samples were monophyletic groups, but samples from the same geographical origin did not always cluster together. The results suggested that the three mtDNA fragments could not be used as molecular markers to identify the A. suum isolates from four regions, and have important implications for studying molecular epidemiology and population genetics of A. suum.


Intraarterial propofol is not directly toxic to vascular endothelium.
To determine if accidental intraarterial injection of propofol results in vascular damage, the effect of bolus administration of propofol on vascular smooth muscle and the endothelium was investigated using the isolated rabbit ear artery. Ear artery segments, removed from urethane anesthetized rabbits, were perfused with Krebs solution (1 ml.min-1) and pressurized to 60 mmHg before being constricted with extraluminal norepinephrine (1.8-4.2 x 10(-6) M). The external diameter of the vessel was measured by an array of light-dependent diodes. Functional responsiveness was determined by the degree of constriction to norepinephrine and the subsequent dilatation of the artery to intraluminal acetylcholine (2 x 10(-6) M) and glyceryl trinitrate (2 x 10(-6) M), and by the myogenic reactivity to a pressure increase from 60 to 100 mmHg. These responses were measured before and after perfusion with 1% propofol for 120 s. Administration of propofol did not result in any vasoactivity nor did it increase the sensitivity to norepinephrine. Vessels maintained their capacity to dilate to both agents, while the myogenic activity was unaffected. Histologic examination of the propofol exposed vessels showed no changes to smooth muscle structure, and the endothelial layer remained intact.


Pulmonary angiography and embolization for severe hemoptysis due to cavitary pulmonary tuberculosis.
To identify the role of pulmonary angiography in the diagnosis and treatment of severe hemoptysis due to cavitary pulmonary tuberculosis. Selective pulmonary angiography was performed on eight patients with severe hemoptysis uncontrolled by previous bronchial and systemic arterial embolization. Three (38%) patients had Rasmussen aneurysms, which were successfully embolized with steel coils. Five patients demonstrated pulmonary arterial hypoperfusion in the diseased lung. We recommend pulmonary angiography in cavitary tuberculous patients with severe hemoptysis who do not respond to systemic arterial embolization. Rasmussen aneurysms are effectively treated by steel coil occlusion.


Influence of VKORC1 gene polymorphisms on the effect of oral vitamin K supplementation in over-anticoagulated patients.
Significant inter-individual variability on the effect of vitamin K to reverse overanticoagulation has been identified. Genetic polymorphisms of the vitamin K epoxide reductase complex subunit 1 (VKORC1) gene might explain in part this variability. The objective of this study was to evaluate the influence of VKORC1 -1639G>A and 3730G>A polymorphisms on the effect of oral vitamin K supplementation in overanticoagulated patients. We performed an interventional trial of oral vitamin K supplementation in over-anticoagulated outpatients (international normalized ratio [INR] ≥ 4). Subjects received vitamin K (2.5-5.0 mg) according to baseline INR and were genotyped by real time polymerase chain reaction (PCR). INR values were determined at 3, 6, 24 and 72 h after supplementation. We evaluated 33 outpatients, 61 % were males, with a mean age of 62 ± 12 years old. There was a significant decrease in INR values over time for both polymorphisms after oral vitamin K. At 3 h after supplementation, patients carrying the G allele for the -1639G>A polymorphism had a greater decrease in INR values compared to AA patients (p < 0.05 for difference among groups; p < 0.001 for time variation; p = 0.001 for time × group interaction), with differences of -1.01 for GG versus AA (p = 0.003) and -0.84 for GA versus AA (p = 0.024). Mean INR value at 24 h was 1.9 ± 0.6 and at 72 h was 2.1 ± 0.7, with no differences among genotypes. No significant interaction was identified between the 3730G>A polymorphism and vitamin K supplementation. Our study indicated that the VKORC1 -1639G>A polymorphism plays a role in the response to acute vitamin K supplementation in over-anticoagulated patients, with faster decrease of INR value in patients carrying the G allele.


Analyzing transcription factor activity using near infrared fluorescent bridge polymerase chain reaction.
This study has developed a new method, near infrared fluorescent bridge polymerase chain reaction (NIRF-bPCR), for analyzing transcription factor (TF) activity. This method was first used to detect the activity of purified nuclear factor kappa B (NF-κB) p50. The results demonstrated that this method could quantitatively detect the activity of p50 protein at less than 115ng (∼ 2320fmol), and the detection limit reached as little as 6.94ng (∼ 140fmol) of p50 protein. This method was then used to detect TF activity in cell extracts. The results revealed that this method could specifically detect NF-κB activity in HeLa cell nuclear extracts. Finally, this method was used to detect the activities of multiple TFs in a protein sample. The results showed that this method could detect the activities of six TFs-NF-κB, AP-1, TFIID, CREB, NF-E2, and p53-in the TNFα-induced and -uninduced HeLa cell nuclear extracts. Calculation of the fold induction of six TFs revealed that NF-κB, CREB, and AP1 were activated by TNFα induction in HeLa cells, in agreement with the detection results of other methods. Therefore, this study provides a new tool for analyzing TF activity. This study also revealed that NIRF-bPCR may be used as a new method for detecting DNA molecules.


Use of major therapeutic procedures: are Hispanics treated differently than non-Hispanic Whites.
This study examines whether Hispanics and non-Hispanic White patients, hospitalized with one of a wide range of conditions, receive major therapeutic procedures at the same rates. The study examined hospital stays of Hispanic and non-Hispanic White adults using 1993 discharge abstract data from the Healthcare Cost and Utilization Project State Inpatient Database for California, Florida and New York, states containing half the Hispanic population in the country. Logistic regression modeling was used to identify the effect of ethnicity on the likelihood of receiving a major therapeutic procedure separately for 63 conditions, controlling for age, gender, disease severity, health insurance, income level of patient's community, and hospital characteristics. Hispanics are less likely than non-Hispanic Whites to receive major therapeutic procedures for 38% of the 63 conditions examined and more likely for 6% of the conditions. This study identified many conditions with apparent variations in treatment based on patient ethnicity. Future studies should examine reasons for disparities between ethnic groups, why these disparities occur for some conditions and not others, and appropriateness of procedures received.


Mitogenic and protein synthetic activity of tissue repair cells: control by the postsurgical macrophage.
It is well known that fibroblasts are a main source of extracellular matrix synthesis necessary for tissue repair. In addition, macrophages secrete products that are known to modulate synthesis of extracellular matrix. Accordingly, we studied the incorporation of [3H]thymidine, [3H]proline, and [35S]sulfate into macromolecules produced by fibroblasts recovered from the site of peritoneal tissue repair cultured with and without spent media from postsurgical peritoneal macrophages. Rabbits underwent resection and reanastomosis of their small intestines. Peritoneal exudative cells (PEC) were then collected on postsurgical day 5 and day 10 as well as from nonsurgical controls, separated by discontinuous Percoll gradient centrifugation, and cultured for 48 h. A second group of rabbits underwent peritoneal wall abrasion from which fibroblast tissue repair cells (TRC) were collected from the site of injury at postsurgical day 7 and maintained in culture for varying times. Incorporation of radiolabeled precursors into DNA, collagen, and sulfated proteoglycans was determined. Incorporation of [3H]thymidine and [3H]proline into untreated TRC gradually decreased with culture duration. Conversely, [35S]sulfate incorporation gradually increased during prolonged culture. Macrophage spent media increased the levels of [3H]thymidine incorporation by the TRC. [3H]Proline and [35S]sulfate incorporation into TRC were also stimulated by macrophage spent media. However, this stimulation may be due to the enhanced proliferation of TRC by macrophage spent media. In conclusion, tissue repair fibroblasts are activated for postsurgical repair at the site of injury by many factors including secretory products from postsurgical macrophages.


Monoclonal anti-Ia murine alloantibodies crossreactive with the Ia-homologues of other mammalian species including humans.
Two murine monoclonal anti-Ia alloantibodies (ISCR2 and ISCR3) crossreactive with lymphocytes of other mammalian species including humans have been established. These hybridomas were derived from A.TH mice immunized with A.TL lymphocytes, and they reacted with murine Ia antigens, as judged by complement-dependent cytotoxicity assays and chemical analysis. Genetic mapping analysis suggested that ISCR2 recognizes the allotypic determinants shared between the I-A and the I-E molecules. On the other hand, the specificity of ISCR3 was shown to correspond to the serological specificity Ia.7 and directed to the I-E subregion gene product (E alpha). The genetic specificity of ISCR3 was also confirmed by sequential precipitation analysis performed on the internally labeled B10.BR spleen cell antigen. These antibodies showed interspecies crossreactions with non-murine lymphocytes. ISCR2 showed reactivity on human and dog lymphocytes, but not with rat lymphocytes. ISCR3 reacted with human, dog, and rat lymphocytes but not with chicken or frog lymphocytes. Furthermore, ISCR3 was shown to be capable of eliminating a population of cells necessary for induction of human allogeneic killer cells in vitro. Treatment of stimulator cells with ISCR3 and complement drastically reduced the induction of the killer activity.


Harmonic-resonator-based triboelectric nanogenerator as a sustainable power source and a self-powered active vibration sensor.
A harmonic-resonator-based triboelectric nanogenerator (TENG) is presented as a sustainable power source and an active vibration sensor. It can effectively respond to vibration frequencies ranging from 2 to 200 Hz with a considerably wide working bandwidth of 13.4 Hz. This work not only presents a new principle in the field of vibration energy harvesting but also greatly expands the applicability of TENGs.


Surgeons weigh effects of primary care trend.
Surgeons who attended the annual meeting of the American College of Surgeons questioned the future of their specialty in an era when government agencies are emphasizing primary care. What will the role of future surgeons be? Will they find themselves competing with family practitioners for hospital privileges? How much surgical training should be included in family practice residencies? These questions were posed, but answers were scarce.


Calculation of inelastic scattering processes of relativistic electrons in oriented crystals.
The inelastic scattering of electrons in oriented crystals has been used to determine the positions of atoms within a crystal, to obtain site-dependent electron energy loss spectra and, more recently, to obtain an energy loss signal corresponding to the circular dichroism in X-ray absorption spectroscopy. The theoretical approaches currently used for the description of these processes are based on the nonrelativistic Schrödinger equation. Nowadays many experiments, however, are conducted with incident energies of 200 or 300 keV. Therefore it is indispensable to use a relativistic description for such processes based on the Dirac equation. Using the Coulomb gauge it is shown, that the fully relativistic cross sections for plane wave scattering are given by the modulus square of a sum of two terms: one describing the electrostatic interactions similar to the nonrelativistic theory plus one additional term describing the interaction of the specimen with the magnetic field produced by the incident electron. In crystals both terms can interfere leading to large deviations from nonrelativistic theory.


Management of postpneumonectomy bronchopleural-cutaneous fistula with a single free flap.
A variety of local flaps have been described for chest wall and bronchopleural fistula reconstruction. When local options cannot be used because of previous surgery, trauma, radiation, or body habitus, free flaps become an acceptable option. The authors report a case of persistent bronchopleural-cutaneous fistula treated with a free latissimus dorsi musculocutaneous flap that obliterated the right chest cavity, closed the site of empyema drainage, and aided healing of a bronchopleural fistula. Surgical technique including anastomosis to the innominate vein is described.


TB and MDR/XDR-TB in European Union and European Economic Area countries: managed or mismanaged?
In spite of the growing awareness of emerging drug-resistant Mycobacterium tuberculosis, the extent of inappropriate tuberculosis (TB) case management may be underestimated, even in Europe. We evaluated TB case management in the European Union/European Economic Area countries, with special focus on multidrug-resistant (MDR) and extensively drug-resistant (XDR)-TB, using a purposely developed, standardised survey tool. National reference centres in five countries representing different geographical, socioeconomic and epidemiological patterns of TB in Europe were surveyed. 40 consecutive, original clinical TB case records (30 MDR/XDR-TB cases) were reviewed in each of the five countries. The findings were recorded and, through the survey tool, compared with previously agreed and identified international standards. Deviations from international standards of TB care were observed in the following areas: surveillance (no information available on patient outcomes); infection control (lack of respiratory isolation rooms/procedures and negative-pressure ventilation rooms); clinical management of TB, MDR-TB and HIV co-infection (inadequate bacteriological diagnosis, regimen selection and treatment duration); laboratory support; and diagnostic/treatment algorithms. Gaps between present international standards of care and the management of MDR/XDR-TB patients were identified. Training, increased awareness, promotion of standards and allocation of appropriate resources are necessary to ensure appropriate care and management as well as to prevent further emergence of drug resistance.


Premedication for neonatal intubation.
The incidence of complications was recorded for 269 consecutive neonatal endotracheal intubations after instituting a routine policy of premedication. Two hundred and fifty-three of the intubations were premedicated with a combination of atropine, fentanyl and succinylcholine, 194 were without incident, 28 required two attempts, 22 required more than two attempts, and 9 required a second attempt with a smaller endotracheal tube. All infants were successfully intubated. We conclude that a policy of routine neonatal premedication for intubation is safe, feasible, and humane.


Prognostic determinants in patients with uterine and ovarian clear cell carcinoma: a SEER analysis.
The purpose of this study is to analyze and compare the demographics, treatment, and survival rates in patients with uterine clear cell carcinoma (UCCC) and ovarian clear cell carcinoma (OCCC). The Surveillance, Epidemiology and End Results (SEER) program data for all 18 registries from 1988 to 2010 was reviewed to identify women with OCCC and UCCC. Demographic and clinical data were compared, and the impact of tumor site on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model. The final study group consisted of 5421 women with clear cell histopathology. 3631 (67%) had OCCC and 1790 (33%) had UCCC. The mean age at diagnosis was 56 (± 12) years for women with OCCC and 67.7 (± 12.0) years for UCCC (P<0.001). Patients with OCCC had a higher rate of late stage disease (38.9% vs. 21.2%; P<0.001). Over the entire study period, after adjusting for known variables, there was no significant difference in cancer specific mortality between UCCC and OCCC, HR 1.05 (0.92-1.19). In the subset analysis by staging, in women with localized disease there was an improved survival in UCCC compared to OCCC. In contrast, in women with distant disease there was an increased mortality in women with UCCC. In the entire population, there was no significant difference in cancer related mortality between the groups. However, in women with localized disease, UCCC had improved survival, but increased mortality in distant disease compared to OCCC.


Vaginal hysterectomy for the enlarged uterus.
To evaluate the effect of uterine weight on the perioperative outcomes of vaginal hysterectomy for benign gynecological conditions. The medical records of 312 consecutive women who underwent vaginal hysterectomies for benign gynecological conditions without major pelvic reconstruction at Temple University Hospital between March 1994 and August 1999 were reviewed. 88 women with uterine weights > or =250 g were compared with 224 women with uterine weights <250 g. The risk of perioperative complications, operative time, perioperative hemoglobin change, length of postoperative hospital stay, and readmission were evaluated between the groups. Groups were similar with respect to age, parity, history of previous pelvic surgery and concurrent adnexal removal. Operative time was significantly increased for women with uteri weighing > or =250 g. Women with uterine weight > or =250 g had a higher risk for postoperative febrile morbidity. The risks of all other major complications, perioperative change in hemoglobin concentration, length of stay, and readmission risk were not statistically different between the groups (p < 0.05). Despite the increased postoperative febrile morbidity and prolonged operative time, women with uteri weighing > or =250 g who underwent vaginal hysterectomy were discharged from the hospital without any increase in other complications when compared to women with a smaller uterus.


Physico-chemical characteristics and methanogen communities in swine and dairy manure storage tanks: spatio-temporal variations and impact on methanogenic activity.
Greenhouse gas emissions represent a major environmental problem associated with the management of manure from the livestock industry. Methane is the primary GHG emitted during manure outdoor storage. In this paper, the variability of two swine and two dairy manure storage tanks was surveyed, in terms of physico-chemical and microbiological parameters. The impact of the inter-tank and spatio-temporal variations of these parameters on the methanogenic activity of manure was ascertained. A Partial Least Square regression was carried out, which demonstrated that physico-chemical as well as microbiological parameters had a major influence on the methanogenic activity. Among the 19 parameters included in the regression, the concentrations of VFAs had the strongest negative influence on the methane emission rate of manure, resulting from their well-known inhibitory effect. The relative abundance of two amplicons in archaeal fingerprints was found to positively influence the methanogenic activity, suggesting that Methanoculleus spp. and possibly Methanosarcina spp. are major contributors to methanogenesis in storage tanks. This work gave insights into the mechanisms, which drive methanogenesis in swine and dairy manure storage tanks.


Abnormalities in ureter and kidney development in mice given acetazolamide-amiloride or dimethadione (DMO) during embryogenesis.
These experiments more accurately define the effects of the combination acetazolamide-amiloride or a single dose of dimethadione (DMO), the active metabolite of trimethadione, on the development of the ureter. When acetazolamide-amiloride was administered in C57BL/6NCrlBR mice on day 9, 9.5, or 10 of gestation (plug = day 0) a second ureter was formed, anterior to the original ureter, inducing a second kidney. The second ureter then fails to make a connection with the developing bladder and remains attached to the mesonephric duct. The mesonephric duct becomes the vas deferens in the male and deteriorates completely in the female leading to either a restricted ureter or a blocked ureter depending on the sex of the fetus. Administration of a single dose of DMO between gestational day 9 and 10.3 produced both renal agenesis and ureters of varying lengths. Some ureters were of normal length with a tuft of one or two nephrons at their tip, while others were one half or one quarter of their normal length. In some instances the ureter was completely absent. The reason for this strong effect on the ureter is unknown.


Implications of oxidative stress in the pathophysiology of obstructive uropathy.
Although the functional and clinical alterations occurring in patients with obstructive uropathy are not well understood, it has been suggested that oxidative stress could contribute in the mechanism responsible for the impairment of sodium and water balance. This study aimed to test the hypothesis that red wine administration causes an amelioration of both the renal damage and impairment of renal Na(+), K(+)-ATPase activity occurring after ureteral obstruction in the rat. Twenty-four male Wistar adult rats weighting 200-250 g were used. Half of them received a 10-week treatment with wine as the sole fluid source, while the other group received water. Both groups were subjected to 24-h unilateral ureteral obstruction (UUO). Kidney tissue was collected following the relief of the ligature to perform the biochemical assessments. Urine and blood samples were taken at baseline and after the relief. Results show that the treatment with red wine significantly enhances the activity of antioxidant enzymes, and thus reduces renal lipid peroxidation secondary to UUO, which correlated negatively with Na(+), K(+)-ATPase activity. Based on this and other previous data, it could be suggested that red wine administration may prevent renal damage secondary to UUO by inducing enhanced antioxidant potential.


Differences in levels of social integration among older women and men in Egypt.
The current study explores factors underlying the observed gender differences in levels of social integration among older adults within the context of the Arab countries. Reports on older adults' engagement in social activities were classified into two broad categories; "private activities that are child-centered" and "public activities that are adult-centered and extend beyond the realm of the family's children." Findings revealed that gender differences in older adults' involvement in both types of activities were found to be insignificant, a result that indicates older women's withdrawal from shouldering private-type activities and their increase engagement in public-type activities. Patrilocal residence, which is very common in the Arab countries, exhibited two different patterns of effects on levels of social integration. It increased older adults' reports of involvement in private-type activities in general, but decreases older women's reports of their involvement in these activities. Modernization and its impact on older adults' levels of social integration were also investigated in terms of both education and urban/rural residence. Education was positively correlated with older adults' engagements in private-type activities, but not public-type activities. Urban residence and living in a less restricted social environment in general was associated with decreases in older adults' reports of their involvement in private-type activities. Nevertheless, older women residing in urban settings were found to report more involvement in both private and public activities. The current study highlights the need for more future studies that explore aspects of older adults' integration within the family and the community, the interplay between attributes of older adults and members of their social network as well as the impact of social integration on the well-being of older adults within various normative cultural contexts.


Use of percutaneous transpedicular external fixation pins to measure intervertebral motion.
Direct measurement of intervertebral motion was compared to motion determined by measuring the position of the exposed ends of the external fixation pins. To verify the accuracy of this technique, so that this protocol can be used to study intervertebral motion in the clinical setting. The transpedicular external fixation test has been shown to be a test that can predict the outcome of spinal fusion. In patients who are candidates for this test, intervertebral motion can be calculated from motion at the external ends of these pins. Six fresh cadaveric spinal segments from L2 to L5 were instrumented with titanium Schanz screws. Reflective markers were placed on the tips of the pins, and intervertebral motion was measured using a noncontacting camera system. Computed tomography data were used to determine the position of the vertebra relative to the reflective markers. Intervertebral distances were calculated and compared with direct measurements obtained using a three-dimensional digitizing arm. There was an excellent correlation (r2 = 0.931) between the directly measured intervertebral motions and those that were indirectly calculated from measurements of motion at the end of the Schanz screws. Intervertebral motion can be measured by monitoring motion of the ends of transpedicular external fixation pins. Motion of anatomic landmarks on the vertebrae can be calculated from the pin end's motion if computed tomography data are used to determine the geometric relation between the vertebrae and the external fixation pins. This validation study supports the use of this method in clinical investigations of intervertebral motion in patients with low back pain and external fixation.


Martian Redox Chemistry: Oxygen Reduction in Low-Temperature Magnesium Perchlorate Brines.
NASA has a mandate to send humans to Mars by 2033. Recent discoveries regarding Mars include the likely presence of low-temperature liquid brines on the planet's surface. This work investigates redox chemistry in near saturated aqueous 2.8 M Mg(ClO4)2 at temperatures as low as -34 °C. These conditions are comparable to those thought to be found on the Martian surface. In particular, electro-reduction of oxygen is studied, and the diffusion coefficient and solubility of this important redox species are established.


α-Hydroxy Ketones as Masked Ester Donors in Brønsted Base Catalyzed Conjugate Additions to Nitroalkenes.
The catalyst-controlled enantioselective direct addition reaction of enolizable esters and related carboxylic acid derivatives to π electrophiles remains a difficult synthetic transformation. In this study, the suitability of α-hydroxy ketones as ester equivalents capable of being activated by bifunctional Brønsted base catalysts in the context of conjugate addition reactions to nitroolefins is demonstrated. The scope of the reaction, which affords the corresponding Michael adducts with very high stereoselectivity (diastereomeric ratio (d.r.) ≥95:5, up to 99 % enantiomeric excess (ee)), and its limitations are explored, as is the aftermath elaboration of adducts into densely functionalized enantioenriched products.


Histochemical and electron-microscopic aspects of bone tumor diagnosis.
In recent years, histochemistry and electron microscopy have been applied more and more to the investigation of bone tumors. The contributions and limitations of these methods in differential diagnosis are discussed. The levels of glycosaminoglycans in cartilaginous tumors display distinct differences between slow- and fast-growing types. All cartilaginous tumors are poor in phosphatase activity. Demonstration of these enzymes at acid and alkaline pH in bone-forming conditions reveals differences between benign and malignant tumors. Osteosarcomas display a rich activity of both phosphatases in bone-forming and in bone-free regions. Acid phosphatase may play a rôle in the breakdown of the host tissue infiltrated by the tumor. Electron microscopy of bone tumors has brought out some interesting findings. In fibrous dysplasia a particular kind of very fine fibrillar structures was observed besides the regular collagen fibrils. This may indicate retardation of collagen maturation. Cell organelles in benign and malignant bone tumors usually differ quantitatively. They resemble active fibroblasts. In bone- and in cartilage-forming tumors we observed large quantities of microfilaments in the cytoplasm. Nuclear indentations and invaginations probably indicate increased nuclear activity. The intense acid phosphatase activity demonstrated histochemically seems inconsistent with the low number of lysosomes in the cytoplasm of osteosarcoma cells, but other organelles (Golgi apparatus and vesicles) may also contain the enzyme. Virus-like particles have not been observed in human osteosarcomas up to now. Other authors have observed a correlation between the number of cell organelles and the grade of differentiation, but this was not detected in our sample of benign and malignant cartilaginous tumors. Histochemistry and electron microscopy of bone tumors are still in the early stage of material gathering. Some histochemical findings, however, can already be used as diagnostic tools.


Investigation of the Association Between Total and Free Plasma and Saliva Mycophenolic Acid Concentrations Following Administration of Enteric-Coated Mycophenolate Sodium in Adult Kidney Transplant Recipients.
Mycophenolic acid (MPA) is commonly used following renal transplant. Saliva MPA concentrations may reflect the pharmacologically active form of MPA in plasma. Therapeutic drug monitoring using saliva is convenient and non-invasive. This study examined the correlation between total and free plasma and saliva MPA concentrations following enteric-coated mycophenolate sodium (EC-MS) administration in renal transplant recipients. Total and free plasma and saliva MPA concentrations were measured simultaneously in 20 adult renal transplant recipients 1-2 months' post-transplant. Thirteen samples were taken pre-dose and at specified time points up until 12 h post-dose. When considering all time points, correlation between total plasma and saliva MPA was r2 = 0.51 and between free plasma and saliva MPA concentrations r2 = 0.41. The correlation between total plasma MPA area under the concentration-time curve (AUC) or free plasma AUC and saliva MPA AUC was r2 = 0.25 and r2 = 0.13, respectively. The correlation between total plasma MPA AUC and total plasma MPA trough (C0) concentrations was r2 = 0.51, and between total plasma MPA AUC and saliva MPA trough concentrations, r2 = 0.03. Measurement of MPA concentration in saliva cannot currently replace plasma measurement for therapeutic drug monitoring of MPA following EC-MS administration. Additional studies are required to examine the relationship between MPA saliva concentrations and patient outcomes.


H2O2 plays different roles in determining penetration failure in three diverse plant-fungal interactions.
Fungal plant pathogens that attempt to penetrate and feed on living cells frequently trigger a localized plant defence response that results in fungal penetration failure. In the current study we demonstrate that breakdown products of the cell wall released by the localized application of hemicellulase elicit localized responses including, sequentially, extracellular H2O2 generation; accumulation of phenolic compounds; and cross-linking of proteins in the cell wall. In a detailed time-course study of three plant-fungus interactions that result in a high frequency of penetration failure, only one plant-fungus combination displayed a similar profile of responses to that induced by localized cell-wall degradation. The additional generation of extracellular O2- in one interaction, and the absence of phenolic compounds in the cell wall in another, demonstrate that plant responses to the penetration process may be influenced by activities of the penetrating fungus. Significantly, H2O2 generation was the only response detected in all three plant-fungal combinations at the correct time and place to account for penetration failure, and in all three combinations the enzymatic removal of H2O2 resulted in increased penetration success. Pharmacological studies suggest that in two of the three interactions, H2O2 generation required cytoskeletal involvement but was independent of transcription or translation, although inhibition of the latter processes increased fungal penetration. In at least one of these two interactions, the data suggest that H2O2 generation and new gene expression act within the same penetration-inhibiting pathway, possibly through the involvement of phenolic materials. However, enzymatic removal of H2O2 from the third interaction almost completely eliminated penetration failure, while interference with cytoplasmic processes had no effect, suggesting that H2O2 generation in this system did not require protoplast involvement and, alone, was necessary and sufficient to account for fungal penetration failure.


[Effect of increased motor activity on changes in posture during puberty].
The purpose of this longitudinal study was to investigate the dynamics of changes of anteroposterior curvatures and scoliosis during puberty in relation to the level of physical activity. The material consisted of 111 children. Their mean age was 11.5 years at the beginning of the study. One group (n = 53) was from a sport's class (athletics, rowing-- 2 hours training, 4-5 times a week), and the other (n = 58) from a control class. The anthropostereometric method, according to Jachowicz was used to determine the posture. Measurements were taken once a year for a period of 3 years. The analysis of the material showed a great individual variations in values and dynamics of changes of anteroposterior curvatures. Differences between trained and untrained children were observed. The results suggest a certain "stability" of stature in trained children (especially boys), probably due to increased muscular mass. During 3 years of study a lability of posture and appearance of structural defects (especially scoliosis) were observed. This indicates the need for regular control of posture and in some cases corrective exercises in the training programme. It was found, that the graphic method of evaluation of defects is more useful in practice than the descriptive one.


A study of pre- and postganglionic fibres in the intestinal nerve (Remark's nerve) of the chicken.
The mean peak CV's of two electrophysiologically defined groups of fibres in the intestinal nerve of the chicken have been determined. One group of fibres is constituted by the processes of enteric cholinergic neurones which project along the side branches of the intestinal nerve and synapse within the nerve trunk. These preganglionic fibres have a mean peak CV (at 40 degrees C) of 0.31 m x s-1. The other group is made up of fibres of postganglionic neurones which project orally along the nerve trunk. The results suggest that some postganglionic neurones project only as far as the next ganglion whilst others project beyond the next two ganglia for distances greater than 5 mm. The postganglionic fibres have a mean peak CV (at 40 degrees C) of 0.71 m X s-1. These figures demonstrate that both pre- and postganglionic fibres are unmyelinated. The temperature coefficient (Q10) for the CV of unmyelinated fibres in the intestinal nerve was 1.57.


Transmuscular migration and straddling of the cornea by an encircling buckle.
Postoperative complications of scleral buckling surgery are various. The anterior migration through the rectus muscles and positioning in the corneoscleral junction is an atypical and undocumented complication. The authors describe a patient with a migration and straddling of the encircling buckle in the corneoscleral junction 2 years after a classic retinal surgery with an encircling solid silicone buckle. Many predisposing factors can lead to this situation.


Effect of Creatine and Glucose on Formation of Heterocyclic Amines in Grilled Chicken Breasts.
The occurrence of heterocyclic amines (HAs) in grilled chicken breasts was investigated. All samples contained HAs, including MeIQx, PhIP, and the β-carbolines harman and norharman. In particular, PhIP was found in concentrations of 1.5-9.1 ng/g, and MeIQx was detected at very low concentrations (n.d.-1.1 ng/g). The concentrations of two co-mutagenic β-carbolines, harman and norharman, ranged from 0.8 to 2.3 ng/g when the content of the precursor glucose was varied from 100 to 620 mg/kg. In contrast, the content of the precursor creatine in non-grilled chicken breasts varied by only 8.6%. A significant linear correlation existed between the molar concentration of PhIP and the molar ratio of creatine/glucose (r = 0.88, p < 0.001). We, thus, conclude that the formation of PhIP may be inhibited with increasing concentrations of glucose in chicken breast. Chicken patties coated with ribose or glucose-containing water in oil emulsions confirmed that both reducing sugars decreased PhIP formation with the preferred concentrations (sensory analysis) of 0.5-1% for ribose and 1% for glucose leading to a reduction of PhIP formation by 28-34% and 39%, respectively.


The effect of intravesical mitomycin C on recurrence of newly diagnosed superficial bladder cancer: a further report with 7 years of follow up.
We determined the role, if any, of 1 and 5 instillations of intravesical mitomycin C in the treatment of newly diagnosed superficial bladder cancer. A multicenter randomized clinical trial was done involving 502 patients with newly diagnosed superficial bladder cancer. After complete transurethral resection patients with newly diagnosed superficial bladder cancer. After complete resection patients were randomized into 1 of 3 treatment arms: no further treatment, 1 instillation of mitomycin C at resection and 1 instillation at resection and at 3-month intervals for 1 year (total 5 instillations). The dose of mitomycin C used was 40 mg./40 ml. water. End points were interval to first superficial recurrence, recurrence rate (defined as the number of positive cystoscopies per year) and progression-free interval rate (progression defined as the development of muscle invasive or metastatic disease, or death from bladder cancer). After median followup of 7 years 1 and 5 instillations of mitomycin C resulted in decreased recurrence rates and increased recurrence-free interval. The benefit of mitomycin C was observed in patients at low, medium and high risk for subsequent recurrence. There was suggestive but not conclusive evidence that 5 instillations of mitomycin C offered a slight advantage over 1 instillation. Our analysis confirms the positive benefit of mitomycin C to decrease the number of subsequent recurrences and increase the recurrence-free interval.


Pediatric shopping-cart-related injuries treated in US emergency departments, 1990-2011.
This study investigates the effect of the 2004 US shopping cart safety standard on shopping-cart-related injuries among children younger than 15 years of age by retrospectively analyzing data from the National Electronic Injury Surveillance System. An estimated 530 494 children younger than 15 years were treated in US emergency departments for shopping-cart-related injuries from 1990 to 2011, averaging 24 113 children annually. The most commonly injured body region was the head (78.1%). The annual concussion/closed head injury rate per 10 000 children increased significantly (P < .001) by 213.3% from 0.64 in 1990 to 2.02 in 2011. Although a shopping cart safety standard was implemented in the United States in 2004, the overall number and rate of injuries associated with shopping carts have not decreased. In fact, the number and rate of concussions/closed head injuries have continued to climb. Increased prevention efforts are needed to address these injuries among children.


Ascorbic acid spares alpha-tocopherol and prevents lipid peroxidation in cultured H4IIE liver cells.
Ascorbic acid, or vitamin C, can recycle alpha-tocopherol in lipid bilayers, but even sparing of alpha-tocopherol has not been a consistent finding in intact cells. Therefore, we tested the ability of ascorbate loading to spare alpha-tocopherol and to prevent lipid peroxidation of cultured H4IIE rat liver cells. Although alpha-tocopherol was undetectable in H4IIE cells, its cell content was increased by overnight incubation with alpha-tocopherol in culture. Cells incubated with ascorbate 2-phosphate accumulated ascorbate to concentrations as high as 0.6 mM after overnight loading, but also released ascorbate into the medium. Ascorbate loading of alpha-tocopherol-treated cells spared alpha-tocopherol in a concentration-dependent manner during overnight incubation. Lipid peroxidative damage, measured as a decrease in fluorescence of cell-bound cis-parinaric acid, was decreased in cells loaded with either alpha-tocopherol or ascorbate 2-phosphate, and showed an additive effect. These results suggest that ascorbate loading of H4IIE cells spares cellular alpha-tocopherol and either directly or through recycling of alpha-tocopherol prevents lipid peroxidative damage due to oxidant stress in culture.


Fate of mycotoxins during beer brewing and fermentation.
Mycotoxins are frequent contaminants of grains, and breweries need, therefore, to pay close attention to the risk of contamination in beer made from such grains as barley and corn. The fate of 14 types of mycotoxin (aflatoxins, fumonisins, ochratoxin A, patulin, trichothecenes, and zearalenone) during beer brewing was investigated in this study. Malt artificially spiked with each mycotoxin was put through the mashing, filtration, boiling and fermentation processes involved in brewing. After brewing, the levels of aflatoxins, ochratoxin A, patulin, and zearalenone were found to have decreased to less than 20% of their initial concentration. They had been adsorbed mainly to the spent grain and removed from the unhopped wort. Additionally, as zearalenone was known, patulin was metabolized to the less toxic compound during the fermentation process. The risk of carry-over to beer was therefore reduced for half of the mycotoxins studied. However, attention still needs to be paid to the risk of trichothecene contamination.


Beneficial effects of bio-controlling agent Bacillus cereus IB311 on the agricultural crop production and its biomass optimization through response surface methodology.
Disease in agricultural field is a big problem that causes a massive loss in production. In this present investigation, we have reported a soil-borne bacterium Bacillus cereus IB311 which is antagonistic to plant pathogens (Pseudomonas syringae and Agrobacterium tumefaciens), and could make a substantial contribution to the prevention of plant diseases. To prove the practical application, the strain was directly applied in agricultural field. The results demonstrated that B. cereus IB311 has increased the production (20% and 26% in term of average pod number per plant, average seed number per pod, and seed yield per experimental plot) in ground nut (Arachis hypogaea var. Koushal, G201) and sesame (Sesamum indicum var. Kanak), respectively. To reduce the production cost, the biomass production was optimized through response surface methodology (RSM). Interactions of three variables (glucose, beef extract and inoculum) were studied using Central Composite Design. According to our analysis, optimum production of Bacillus cereus IB311 (5.383 µg/ mL) may be obtained at glucose 1.985%, beef extract 1.615% and inoculums size 0.757%. Therefore, we strongly believe that the application of this strain in agricultural field as bio-controlling agent will definitely enhance the production yield and will reduce the disease risk.


The control mechanisms of gastric emptying are not overridden by motor stimulants.
We wanted to determine if an acceleration of the normal emptying rate by motor stimulants interfers with control mechanisms limiting gastric emptying. Therefore, we studied the effects of 5-hydroxytryptophane (5-HTP) and cisapride on canine gastrointestinal motility and gastric emptying after ingestion of viscous acaloric and nutritive meals. Prolonged contractions and relaxations that change lumen size (isotonic component) and wall tension (isometric component) are defined as "basal contractions" and "basal relaxations", respectively. The nutrient meal emptied much slower than the acaloric meal due to several alterations of gastric, pyloric, and duodenal motility. Both drugs stimulated antral motility but failed to accelerate gastric emptying of the nutrient meal. The main causes for the failure were a basal relaxation of the proximal antrum and a basal contraction of the duodenum. In conclusion, basal contractions of the proximal antrum and duodenum play an important role in the process of gastric emptying, and under physiological conditions the control mechanisms of gastric emptying provide an optimal emptying rate that cannot be markedly accelerated by 5-HTP and cisapride.


Sources of top-down control in visual search.
Endogenous control of visual search can influence search guidance at the level of a supradimensional topographic saliency map [Wolfe, J. M. Guided Search 2.0: A revised model of visual search. Psychonomic Bulletin & Review, 1, 202-238, 1994], and modulate nonspatial mechanisms coding saliency in dimension-specific input modules [Müller, H. J., Reimann, B., & Krummenacher, J. Visual search for singleton feature targets across dimensions: Stimulus- and expectancy-driven effects in dimensional weighting. Journal of Experimental Psychology: Human Perception and Performance, 29, 1021-1035, 2003]. The current experiment used fMRI to dissociate these mechanisms in a singleton feature search task in which the likely target dimension (color or orientation) was semantically precued and target saliency in each dimension was varied parametrically. BOLD signal increases associated with increased demands for top-down guidance were observed within the fronto-parietal attention network and in the right anterior middle frontal gyrus. Decreasing requirements for top-down control led to BOLD signal increases in medial anterior prefrontal cortex, consistent with a gating mechanism in favor of stimulus-related processing [Burgess, P. W., Dumontheil, I., & Gilbert, S. J. The gateway hypothesis of rostral prefrontal cortex (area 10) function. Trends in Cognitive Sciences, 11, 290-298, 2007]. Another network of brain areas consisting of left lateral fronto-polar cortex, the left supramarginal gyrus, and the cerebellum, as well as a bilateral network consisting of the posterior orbital gyrus, the inferior frontal gyrus, and the pre-SMA were associated with top-down dimensional (re-) orienting. These data argue in favor of distinct endogenous control systems for visuospatial and dimension-based attentional processing. Finally, cue validity modulated saliency processing in the left temporo-parietal junction (TPJ), pointing to a crucial role of the left TPJ in integrating an endogenous dimension-based attention set with bottom-up saliency signals.


Monitoring genetic diversity of influenza A(H1N1)pdm09 virus circulating during the post-pandemic period in Turkey.
The aimes of the present study were to monitor genetic alterations in the hemagglutin (HA) gene and oseltamivir resistance-related alterations in the neuraminidase (NA) gene of influenza A(H1N1)pdm09 viral isolates detected during the post-pandemic period in Turkey. A total of 2601 clinical specimens obtained from suspected cases of influenza A(H1N1)pdm09 viral infections were analyzed by real-time reverse transcription polymerase chain reaction. Viral RNA was detected in 233 (9%) clinical specimens. Sequence analysis of the HA gene in 16 random isolates showed >98.7% homology among each other and with the A/California/07/2009 vaccine strain. These 16 isolates had common (75%-100%) amino acid substitiutions at positions P83S, D97N, S203T, R205K, I216V, V249L, I321V, and E374K in the HA gene. In addition, two additional rare mutations were also observed at positions S162N (addition of a glycosylation site, 6.25%) and A186T (receptor binding region, 6.25%). On the basis of amino acid substitutions in the HA1 domain, majority of the Turkish isolates were classified in the genetic group v and others in the genetic groups ii, iii, and vi. In the present study, we observed an increase in the variety and ratio of mutations detected in the HA1 and HA2 domains of the HA gene; however, these alterations have not yet resulted in vaccine escape mutants in Turkey. In addition, analysis of the NA regions of the isolates revealed that oseltamivir resistance was not an issue in Turkey.


Nurses win RCT battle, but war isn't over.
Organized nursing outflanked the American Medical Assn. on the issue of physician-controlled bedside workers in hospitals, but other battles over nursing care will be fought in the arenas of home healthcare and long-term care.


Brachymesophalangia V in Hottentot and "Cape Colored" children in Namibia (South West Africa) and South Africa.
In order to determine the incidence of Brachymesophalangia V, an inspectional and metrical analysis was made of radiographs of 67 Nama-speaking Hottentots aged 2 to 17.5 years, and 210 Rehoboth Basters (in Namibia) and Cape Colored children (near Cape Town) aged 1.5 to 21 years. None of the children displayed cone-shaped epiphysis or early union, and none showed Brachymesophalangia V. It was confirmed that the incidence of Brachymesophalangia V is considerably higher in Mongoloid populations than in Caucasoid or Negroid groups, including Hottentots.


Arsenic and selenium interactive effect on alga Desmodesmus quadricauda.
Substances known to be toxic in one-component solutions often exhibit unexpected effects when present in mixtures. Only a few efforts have been made to assess the effect of As-Se mixture in algae or plants in general. Due to the lack of information on this topic, the aim of this study was to examine the As-Se interactive effect in the alga species Desmodesmus quadricauda. The initial density of algal cells was 1.9×10(4), cultures were permanently illuminated (70μEm(-2)s(-1)) and As and Se adverse effect was expressed as EC (effective concentration) value. For all experiments three EC (EC(10), EC(20), EC(50)) values for both metalloids were used: for As 26.20, 29.05, 35.38mg L(-1) and for Se 1.93, 3.65, 12.24mg L(-1), respectively. During this study algal biomass growth, lipid peroxidation and protein-bound thiol content parameters were used to assess the As-Se interactions. The reciprocal effect of the elements on their uptake by the alga was also determined. The As-treated algae supplemented with Se exhibited impaired growth indicating a synergistic interaction between the two elements. In samples treated with As-Se mixture, the total algal As content showed marked increase depending on the Se concentration in the mixture. Se uptake was also positively affected by rising As concentrations in the mixture. Consequently, the As-Se-treated algae experienced greater damage to membranes, evidenced by marked elevation of the TBARS (thiobarbituric acid reactive substances) content. The TBARS content increased to a maximum level by 29.05mg L(-1) of As and 3.65mg L(-1) of Se, which was around 70 percent higher than that of the control. The thiol content was very close to that of the control treatment over the entire concentration range and for all As and Se combinations tested. Possible explanation for the synergism observed in D. quadricauda, is that the elevated uptake of As and Se upon their interaction and impaired antioxidant system, has added to the toxicity of the elements.


Indoor air problems and the perceived social climate in schools: A multilevel structural equation analysis.
Indoor air problems in schools appear to influence learning outcomes and absence rates. However, previous research has not investigated whether indoor air problems influence the social climate of schools. Therefore, we studied whether indoor air problems observed in schools associate with students' perceptions of the teacher-student relationship and class spirit. The nationwide sample of Finnish schools (N=194 schools/27153 students) was analyzed using multilevel structural equation modeling. Data on the schools' social climate collected from students were merged with independently collected data on observed indoor air problems from school principals. We found that the teacher-student relationship was reported to be worse in schools with observed indoor air problems compared to those without observed indoor air problems. Furthermore, the reported class spirit was worse in schools with observed indoor air problems, but only among students with a high grade point average. Our findings indicate that indoor air problems may affect the student-perceived social climate.


Thoracic and lumbar paravertebral blocks for outpatient lithotripsy.
Paravertebral nerve block has been used for a variety of surgical procedures to provide unilateral anesthesia and postoperative analgesia. We report the successful application of this regional anesthesia modality for outpatient lithotripsy. Preoperatively, thoracic and lumbar paravertebral nerve blocks with 0.5% ropivacaine were placed with ultrasound and nerve stimulator guidance for two patients with ureteral calculi. One patient scheduled for cystoscopy and ureteroscopy with laser lithotripsy received general anesthesia intraoperatively. The second patient underwent extracorporeal shock wave lithotripsy with propofol intravenous sedation. Postoperatively, both patients reported pain scores of zero (Visual Analog Scale) for 24 hours and required no opioid rescue analgesia.


Alcohol problems in a general hospital--a prevalence study.
The prevalence of problem drinking among medical and surgical in-patients in a general hospital was studied using the CAGE questionnaire. Almost a quarter (23.3%) of the in-patients had associated drinking problems which were more among medical than surgical in-patients. In a large majority of these patients, the associated problem drinking was not recognised by the treating medical professionals. Routine administration of instruments like CAGE which are brief and easy to use would contribute to the early detection and management of alcohol problems in the general hospital setting.


The infant with Pierre Robin sequence: review and implications for nursing practice.
Pierre Robin sequence (PRS) is associated with long-term respiratory, nutritional, and developmental difficulties. Hypoxic complications, including cerebral impairment, cor pulmonale, and failure to thrive may be prevented or minimized with early detection and comprehensive care. This article reviews the embryological development of PRS and outlines the medical and nursing implications for treatment. Partnership with parents and a coordinated community care team are essential for successful management of infants and children with PRS.


Short- and medium-term duplex sonography follow-up of deep venous thrombosis of the lower limbs.
We conducted this study to assess the progression or regression of venous thrombi during and after treatment and to search for criteria of embolism risk. We prospectively studied 75 patients with lower limb deep venous thrombosis. We used B-mode sonography for the diagnosis and follow-up of these thrombi. Pulmonary scintigraphy was performed at days 1 and 10. We evaluated the topography, echogenicity, and structure of the thrombus; the location and wall attachment of its head; and the vein diameter. Each venous segment was semiquantitatively scored as follows: 0, no thrombosis; 1, partially obstructive thrombosis; or 2, complete thrombosis. The decreases in the total thrombosis score were 4%, 11%, 51%, 72%, and 84% on days 5, 10, 30, 90, and 365 (1 year), respectively. Pulmonary embolism occurred in 27 patients, of whom 16 were asymptomatic. Thrombi in iliac veins exhibited a slower regression rate than those in calf and femoral veins. Pulmonary embolism occurred in 54% of patients with versus 24% of patients without a floating thrombus head. Sonography is useful for the early detection of thrombus progression and the evaluation of embolism risk, which seems to be greater in patients with a floating thrombus head.


[A case report of stage IV inoperable gastric cancer demonstrating a cCR treated with S-1/Paclitaxe (l PTX) therapy].
We report a case of Stage IV inoperable gastric cancer demonstrating a cCR treated with S-1/PTX. The patient was a 65-year-old female with advanced gastric cancer. CT scan suggested an invasion of tumor into a pancreatic body, jejunum and transverse colon. Staging laparoscopy showed it to be positive with peritoneal washing cytology and peritoneal dissemination. The surgical findings were T4a (SE) N2M1H0P1CY1, Stage IV. Chemotherapy was conducted with a combination of S-1/CDDP. After 2 courses of this regimen, the endoscopy findings did not show an improvement, so we decided to change the chemotherapy to S-1/PTX as second-line treatment. After 2 courses of this regimen, the endoscopy findings revealed a reduction of the primary tumor. After 19 courses, histopathological examination of biopsy specimen showed Group 1. Second-line chemotherapy was continued for 28 courses. The patient has had no recurrence without chemotherapy and been alive for 91 months after diagnosis.