[Emergency room services utilization in the province of Reggio Emilia: a comparison between immigrants and Italians].
The aim of the study is to compare Italian and immigrant accesses to Emergency Room (ER) Services in the province of Reggio Emilia, with particular attention to time differences and to potentially inappropriate accesses. the database of ER accesses in the province of Reggio Emilia was analyzed for the years 2007- 2010. In the analysis of the resident population all autochthonous citizens and all immigrants from Developed Countries were considered Italians, while citizens from Developing Countries were Immigrants. Temporary Immigrants were those immigrants with residence and citizenship in a Developing Country. A descriptive analysis was conducted using demographic variables related to patients (age, gender, citizenship and residence) and variables related to access (admission emergency codes, cause of admission, hour, day of the week, month and discharge modality). Standardized access Ratios (SRs) were calculated for the resident population, together with 95%Confidence Intervals (95% CI). The SRs were calculated separately for children and for adults. In the years 2007-2010, 562,658 accesses to ER were recorded for Italians, 95,300 accesses for Immigrants and 6,800 for the Temporary Immigrants. Access rates for resident Immigrants were higher than Italian ones. In 2010, the SR for men was 1.24 (95%CI 1.22-1.27) while for women it was 1.18 (95%CI 1.15-1.27). Considering only non-urgent accesses, the SRs were even higher (SR men=1.65, 95% CI 1.58-1.72, women=1.43, 95% CI 1.36-1.50). Similar findings were observed in children. Immigrants access the ER services more than Italians do.They also show more non-urgent accesses in comparison with Italians. This finding is consistent with results of studies conducted in other European countries and it underlines the necessity to reorganize primary care in order to better meet immigrants' needs.


Neural correlates of social motivation: an fMRI study on power versus affiliation.
Power versus affiliation motivations refer to two different strivings relevant in the context of social relationships. We used functional magnetic resonance imaging (fMRI) to determine neural structures involved in power versus affiliation motivation based on an individual differences approach. Seventeen participants provided self-reports of power and affiliation motives and were presented with love, power-related, and control movie clips. The power motive predicted activity in four clusters within the left prefrontal cortex (PFC), while participants viewed power-related film clips. The affiliation motive predicted activity in the right putamen/pallidum while participants viewed love stories. The present findings extend previous research on social motivations to the level of neural functioning and suggest differential networks for power-related versus affiliation-related social motivations.


Streptococcus mutans and dental caries in urban and rural schoolchildren in Thailand.
Two groups of Thai schoolchildren aged 11-13 yr were examined for dental caries, dental fluorosis and Streptococcus mutans. One hundred children lived in an urban district, Bangkok, and 71 children in a rural district, Petchaboon. Saliva samples were analyzed for S. mutans by the spatula method. The fluoride content of the drinking waters was also determined. The prevalence of caries, diagnosed according to WHO, was 89% in Bangkok and 18% in the rural district. Mean DMFT was 3.46 and 0.38 respectively. S. mutans was found in 98% of the urban children and in 82% of the rural. The differences in distribution between S. mutans and DMFT classes were statistically significant for the total sample. Mild fluorosis was present in some of the rural children.


[Impact of suicide of the elderly on their families].
The scope of this paper is an analysis of suicide of elderly people and the impact on the dynamics of their families is presented. The method used is of the qualitative research type known as psychosocial autopsy and is based on interviews with the family members of 51 elderly people who committed suicide in 10 Brazilian cities. The study in these cities was defined by epidemiological research that revealed the relevance of this phenomenon. Many themes were analyzed in the investigation. However, this text focuses on how the families coped with the death of the elderly person, their impressions regarding the act, and the repercussions on family members and the social network. Pursuant to a comprehensive analysis of the testimonies, the following nuclei of significance were revealed: feelings of guilt for the act; social isolation and its manifestations on health; social stigma and prejudice; prospects of overcoming family suffering; anger and feelings of the improbability of the act; and care for the family members. The families manifested suffering, sadness, and perplexity at the death of the elderly person, which influences and has repercussions on their dynamics and at an individual level. Such consequences are different in each area researched depending on the experiences the family has had with acts of this nature.


The in vitro radiosensitization of human glioblastoma with pentoxifylline.
There is evidence that pentoxifylline may be both a radioprotector of normal tissue and a radiosensitizer of tumor cells. This article reviews this evidence and then describes our own laboratory study to determine whether pentoxifylline is a radiosensitizer of human glioblastoma cells in vitro. Human glioblastoma multiforme cells (SNB19 cell line) were irradiated in vitro with and without pentoxifylline. Regression of the log ratios (quotient of surviving colonies) revealed greater tumor cell kill in the PTX group, and the difference increased as the radiation dose increased (p < 0.01 at the 750 and 1000 cGY doses). Before the hypothesis that PTX is a radiosensitizer of hypoxic tumor cells can be confirmed or denied, it must be determined if the agent also has a separate mechanism of tumoricidal activity. Whereas in vivo models allow the well-documented rheologic, immunologic and oxygen-related effects of PTX to be active simultaneously, the in vitro model described herein excludes the effects of such systemic actions and focuses on mechanisms at the cellular or subcellular level. These data suggest there exists such a mechanism of tumoricidal activity of PTX that has not been previously identified.


A comparison of two methods for determining nasal irritant sensitivity.
Nasal irritation and irritant-induced reflexes (rhinorrhea and congestion) are prominent symptoms associated with indoor and ambient air pollution, and marked heterogeneity in individual sensitivity has been suggested. Nevertheless, there is currently no generally accepted functional index of nasal irritant sensitivity available for clinical use. To address this issue, we compared two objective measures of nasal irritant sensitivity: a CO2 detection task, and CO2-induced transient disruption of respiratory pattern (pulsed CO2 acting as an odorless irritant). Using a respiratory flow thermocouple to produce a continuous recording of respiratory pattern, we challenged 20 normal adult volunteers (13 males and 7 females, average age 39.4 years) with brief (approximately 3 second) pulses of the odorless irritant carbon dioxide. Increasing levels of CO2 (10-70%, vol/vol), paired with filtered air in random order, were presented unilaterally by nasal cannula of fixed geometry, synchronized with the inspiratory phase of the respiratory cycle. All subjects yielded CO2 detection thresholds, whereas within the constraints of the testing method (subjective irritation rating < or = "very strong"), only 13 of 20 subjects (65%) exhibited transient disruption of their breathing pattern. Further, although decreased respiratory volume (indirectly measured) appeared to be a common feature, several distinct patterns of respiratory alteration were observed, rendering objective scoring more difficult. Finally, some subjects showed CO2-induced respiratory disruption intermittently from trial to trial, implying that rapid adaptation occurs. Determination of the CO2 detection threshold therefore appears to be the more objective and consistently applicable endpoint for determining individual nasal irritant sensitivity.


Quantitation of platelet-derived growth factor receptors in human arterial smooth muscle cells in vitro.
Platelet-derived growth factor (PDGF) is suggested to play an important role in the development of atherosclerosis as a migratory and mitogenic stimulus to arterial smooth muscle cells (ASMCs). Stimulated and unstimulated ASMCs were studied with respect to PDGF receptor (PDGF-R) mRNA and protein expression. Quantitative RT-PCR was developed for simultaneous evaluation of both PDGF-R alpha and -R beta mRNA expression and a quantitative ELISA for estimation of corresponding PDGF-R subunits. On the mRNA level, the overall PDGF-R beta expression was approximately 100 times lower than that of PDGF-R alpha. Furthermore, although PDGF-R alpha mRNA levels were high irrespective of hASMC phenotype, PDGF-R beta mRNA was influenced by serum stimulation with lower copy numbers in proliferating and confluent cells compared with quiescent cells. On the protein level, quiescent hASMCs expressed 10 times more PDGF-R beta than PDGF-R alpha. Serum stimulation decreased cell surface PDGF-Rs, with most prominent loss of PDGF-R alpha (ELISA and immunohistochemistry). Our results suggest a differential regulatory pattern for PDGF-R alpha and -R beta and are compatible with the usage of alternative promoters for regulation of -R alpha expression. Further, it seems that the number of available receptor subunits is not the only determinant of variations in cell stimulation with different PDGF isoforms.


The role of ecotype-environment interactions in intraspecific trophic niche partitioning subsequent to stocking.
Worldwide, stocking of fish represents a valuable tool for conservation and maintenance of species exploited by recreational fishing. Releases of hatchery-reared fish are more and more recognized to have numerous demographic, ecological, and genetic impacts on wild populations. However, consequences on intraspecific trophic relationships have rarely been investigated. In this study, we assessed the impacts of supplementation stocking and resulting introgressive hybridization on the trophic niches occupied by stocked, local, and hybrid lake trout (Salvelinus namaycush) within populations of piscivorous and planktivorous ecotypes stocked from a wild piscivorous source population. We compared trophic niches using stable isotope analysis (δ13 C and δ15 N) and trophic position among the three genetic origins. Putative genetic effects were tested with phenotype-genotype association of "life history" ecological traits (body size, growth rate, condition index, and trophic niche) and genotypes (RADseq SNP markers) using redundant discriminant analysis (RDA). Results showed that sympatry resulting from the stocking of contrasting ecotypes is a risk factor for niche partitioning. Planktivorous populations are more susceptible to niche partitioning, by competitive exclusion of the local fish from a littoral niche to an alternative pelagic/profundal niche. Observed niche partitioning is probably a manifestation of competitive interactions between ecotypes. Our results emphasize that ecotypic variation should be considered for more efficient management and conservation practices and in order to mitigate negative impact of supplementation stocking.


Structural determination of unknown subsidiary colors in food yellow no. 5 (Sunset yellow FCF).
Major unknown subsidiary colors A (Sub A) and B (Sub B) in commercial Sunset Yellow FCF (Food Yellow No. 5 in Japan) have been isolated by preparative HPLC. Spectroscopic analyses of Sub A and Sub B revealed that their structures are trisodium salt of 6-hydroxy-7-(4-sulfophenyl)-5-(4-sulfophenylazo)-2-naphthale nesulfonic acid, and disodium salt of 3-hydroxy-4-(4-sulfophenylazo)-2-naphthalenesulfonic acid, respectively.


Epileptic discharges induced by pentylenetetrazol: ultrastructural alterations in identified neurons and glial cells (Helix pomatia).
The effects of sustained epileptic activity induced by pentylenetetrazol on morphology of buccal ganglia of Helix pomatia were investigated. Neuronal somata and processes as well as glial cells were evaluated after 5 hours of epileptic activity and after 5 hours under control conditions. After epileptic activity neurons showed signs of degeneration consisting of condensation of nuclear chromatin, decreased activity of Golgi apparatus, increased numbers of lamellar bodies and multivesicular bodies, clusters of vesicles and vacuoles, loss of microtubuli, and scattered lamellar bodies. Neuronal somata and large neuronal processes appeared less affected than the smaller processes. Glial cells showed signs of phagocytotic activity as increased cell size, numerous degenerating neuronal processes within the cytoplasm as well as lysosome like bodies and vacuoles. The changes developing along with epileptic activity were interpreted to indicate degeneration and subsequent phagocytotic activity of neuronal processes in synaptic regions of the ganglia. Thus, evidence is presented for synaptically induced degenerative processes in an intact nervous tissue that is not affected by seizure-induced alterations of respiration or systemic circulation.


Implementation, generalization and long-term results of the "choosing well" diabetes self-management intervention.
Prerequisites for translating intervention research findings into practice are maintenance of results, generalization of effects and consistency of implementation. This report presents 12 months follow-up information on a randomized 2x2 factorial trial evaluating the incremental effects of adding (1) telephone follow-up or (2) a community resources utilization component to a basic touchscreen computer-assisted dietary goal-setting intervention for 320 type 2 diabetes patients. All conditions evidenced significant improvement from baseline to the 12 months follow-up across behavioral, biological and psychosocial measures. There were few consistent differences between conditions, but results were robust across interventionists and clinics. The telephone follow-up component appeared to enhance long-term results on some measures. When considered along with earlier results from a randomized trial that included a control condition without goal setting, it is concluded that this basic goal-setting intervention can be consistently implemented by a variety of interventionists and produce lasting improvements.


Ca2+-dependent exocytosis of L-glutamate by alphaTC6, clonal mouse pancreatic alpha-cells.
Pancreatic islet cells express receptors and transporters for L-glutamate and are thus believed to use L-glutamate as an intercellular signaling molecule. However, the mechanism by which L-glutamate appears in the islets is unknown. In the present study, we investigated whether L-glutamate is secreted through exocytosis by alphaTC6 cells (clonal mouse pancreatic alpha-cells). An appreciable amount of L-glutamate was released from cultured cells after the addition of KCl or A23187 in the presence of Ca2+ and 10 mmol/l glucose in the medium. The KCl-induced glutamate release was significantly reduced when assayed in the absence of Ca2+ or when the cells were pretreated with EGTA-AM. The KCl-induced Ca2+-dependent glutamate release was inhibited approximately 40% by voltage-gated Ca2+ channel blockers, such as nifedipine at 20 micromol/l. The degree of KCl-induced Ca2+-dependent glutamate release was correlated with an increase in intracellular [Ca2+], as monitored by fura-2 fluorescence. Botulinum neurotoxin type E inhibited 55% of the KCl-induced Ca2+-dependent glutamate release, followed by specific cleavage of 25 kDa synaptosomal-associated protein. Furthermore, bafilomycin A1, a specific inhibitor of vacuolar H+-ATPase, inhibited 40% of the KCl-induced Ca2+-dependent glutamate release. Immunoelectronmicroscopy with antibodies against synaptophysin, a marker for neuronal synaptic vesicles and endocrine synaptic-like microvesicles, revealed a large number of synaptophysin-positive clear vesicles in cells. Digitonin-permeabilized cells took up L-glutamate only in the presence of MgATP, which is sensitive to bafilomycin A1 or 3,5-di-tert-butyl-4-hydroxybenzylidene-malononitrile (a proton conductor) but insensitive to either oligomycin or vanadate. From these results, it was concluded that alphaTC6 cells accumulate L-glutamate in the synaptophysin-containing vesicles in an ATP-dependent manner and secrete it through a Ca2+-dependent exocytic mechanism. The Ca2+-dependent glutamate release was also triggered when cells were transferred in the medium containing 1 mmol/l glucose, suggesting that low glucose treatment stimulates the release of glutamate. Our results are consistent with the idea that L-glutamate is secreted by alpha-cells through Ca2+-dependent regulated exocytosis.


Pneumocystis carinii pneumonia in young children with AIDS.
We present our experience with 54 episodes of Pneumocystis carinii pneumonia in 50 young children with AIDS, all but one representing congenitally acquired infection. Findings at history and physical examination are not helpful in suggesting the diagnosis. The diagnosis is suggested by marked hypoxemia, diffuse disease on chest radiograph, and elevated serum LDH level. Because important aspects of the history may be withheld, a high index of suspicion may be necessary for the correct diagnosis. The mortality rate for ventilated patients was 50%.


Childhood sexual abuse in women with bulimia.
In a study of the family environments and psychiatric histories of 35 bulimic women, the authors found that 12 (34.3%) of the 35 women had been sexually abused or had a sister who had been sexually abused. That rate is comparable to estimates from other studies of women with eating disorders and of female psychiatric patients, but is apparently higher than the rate found in the general population. Bulimic women from families in which sexual abuse occurred were more likely than bulimic women with no personal or family history of sexual abuse to have a personal history of major depression, relatives who abused drugs, and a disturbed family environment. The presence of bulimia should alert clinicians to screen for concomitant depression, suicidality, and substance abuse as well as the possibility of severe, if hidden, familial pathology and environmental disruption including sexual abuse, parental psychopathology, and character deficits.


Investigating C. elegans development through mosaic analysis.
The analysis of genetically mosaic worms, in which some cells carry a wild-type gene and others are homozygous mutant, can reveal where in the animal a gene acts to prevent the appearance of a mutant phenotype. In this primer article, we describe how Caenorhabditis elegans genetic mosaics are generated, identified and analyzed, and we discuss examples in which the analysis of mosaic worms has provided important information about the development of this organism.


Children's Cancer Network: providing hope and healing to children and families.
Children's Cancer Network is an Arizona-based nonprofit organization that provides financial and psychosocial assistance to children and families dealing with pediatric cancer. Through patient and family services and/or patient and family education, this organization strives to address the needs of this special population identified by the pediatric oncology healthcare professionals. The outcome of these programs has been overwhelmingly positive for the patients and families.


The prevalence of prenatal death in the community of Viborg, Denmark.
In order to lower the perinatal mortality rate, it is necessary to acquire a specific fetal diagnosis in all late abortions and stillbirths. A uniform classification for the maternal/fetal diagnosis is needed for comparison of progress in maternity care program between the different countries. We have studied 86 consecutive cases of late abortion and stillbirth at Viborg Hospital, Denmark, and made a comparison with the modified Aberdeen classification of fetal death.


Exploring a methodology for eHealth indicator development.
Indicators provide a practical method to monitor and benchmark eHealth progress towards objectives set in local, national and international policies, and to offer evidence for eHealth management. There is no agreed methodology to develop and define these indicators. The purpose of this paper is to present a proposal for an indicator development methodology and indicator classification. This proposal combines expert-led top-down and community-based bottom-up approaches. It offers a holistic approach for developing indicators for measuring progress and impacts of eHealth development consisting of four phases: (1) defining the context for measurement, (2) defining the goal of measurement, (3) defining the methods for indicator selection and indicator categorization and (4) defining the data to be collected and analyzed to calculate the indicator. Our preliminary results will be used as a starting point for developing a more detailed description of methods for indicator development and for identifying and classifying eHealth indicators and on testing them in practice.


NMR relaxation time studies of large bowel neoplasms.
The purpose of the study was to determine if measurements of the NMR relaxation times could be useful in distinguishing healthy from neoplasmatic tissue in in vitro study of the slices from the large bowel obtained during surgery before histological examination. Tissue samples taken from the center of the tumor and from the distal part of the excised large bowel segment were stored at 4 degrees C in closed tubes not longer than 24 hours. The measurements were performed at 37 degrees C using a pulse spectrometer operating at 27 MHz. After NMR investigation all the tissue samples were preserved and carefully examined by conventional histopathological techniques. Both for the T1 and the T2 the mean values of the relaxation time for the respective neoplasmatically changed group and normal, non-changed group, were statistically different. However, the differences in measured relaxation times are too small to use the NMR method alone for diagnosis. The NMR method can be useful only for an initial selection of tissue samples with possible cancer changes but histopathological examination is required to verify that cancer is present in the tissue.


Effects of a local anaesthetic and NSAID in castration of piglets, on the acute pain responses, growth and mortality.
The present study addresses the questions whether on-farm use of local anaesthesia with lidocaine leads to a reduction in pain responses during castration, and whether the non-steroidal anti-inflammatory drug meloxicam improves technical performance after castration of piglets. Five treatments were included in the study: (1) castration without anaesthesia or analgesia (CAST), (2) castration after local anaesthesia with lidocaine (LIDO), (3) castration after administration of meloxicam (MELO), (4) castration after lidocaine and meloxicam (L + M) and (5) sham castration (SHAM). To reduce litter influences, each treatment was present in each of the 32 litters (n = 32 per treatment). During castration, vocalizations were recorded continuously. Blood samples were collected 15 min before and 20 min after castration for determination of plasma levels of total cortisol, glucose, lactate and creatine kinase (CK). Mortality was registered and piglets were weighed several times to calculate growth. Several aspects of vocalizations during castration showed consistent and significantly different levels in CAST compared with LIDO, L + M and SHAM. CAST piglets squealed longer, louder and higher. Vocalizations of MELO piglets most resembled those of CAST. An increase in cortisol was seen in all treatments. However, in SHAM piglets this increase was significantly lower than in the other treatments. LIDO piglets showed a significantly smaller increase in plasma cortisol levels compared with CAST and MELO. L + M piglets differed significantly only from the SHAM group. Lactate levels differed significantly between LIDO and MELO, the level in LIDO being decreased after castration. In the other treatments an increase was measured. No treatment effects were found in plasma glucose and CK levels, nor in growth and mortality of the piglets. In conclusion, on the basis of vocalizations and plasma cortisol, local anaesthesia with lidocaine reduces pain responses in piglets during castration. A positive effect of meloxicam on technical performance was not found.


CD 200 - A useful marker in chronic B lymphoprolipherative disorders.
Background: The diagnosis and management of the patients with chronic lymphoproliferative diseases have become dependent on immunological criteria. Flow cytometry immunophenotyping is used for rapid and specific diagnosis but there are cases when we are not facing a typical immunophenotype, so there is a constant need to find new markers and new combinations of markers that would allow the improvement and the development of our diagnosis. Aim: Our aim was to evaluate CD 200 expression in different B-cell chronic lymphoproliferative disorders. CD200 is a membrane glycoprotein belonging to the immunoglobulin superfamily and the over-expression of CD200 has been reported in a number of malignancies, including CLL, as well as on cancer stem cells. Methods: We analyzed the CD200 expression in 122 patients diagnosed with chronic lymphoproliferative disorders (100 patients with CLL, 10 patients with splenic marginal zone lymphoma (SMZL), 10 patients with MCL and 2 patients with hairy cell leukemia), in the Department of Hematology of the University Emergency Hospital, Bucharest. We performed immunophenotypical analysis of peripheral blood and bone marrow aspiration on BD FACS Calibur flowcytometer. Results: CD200 was brightly expressed in all 100 CLL patients (100%). In SMZL patients, CD200 was dim positive (40%-60%), in patients with HCL. CD200 was also bright positive (96% and 97%) and in patients with MCL CD200 was negative (1-10%); CD 200 was significantly higher in CLL patients compared with other B-cell chronic lymphoproliferative disorders. We found 14 patients with CD19, CD5 positive population and CD23- , but with high expression of CD 200. Cyclin D1 was negative on bone marrow biopsy in 13/14 of these patients. (1/14 patients were without bone marrow involvement); Conclusions: CD200 has a great impact in diagnosing B- chronic lymphoproliferative disorders, especially when we want to determine the origin of a CD19, CD5 positive population and distinguish between CLL and MCL. CD 23 is a reliable marker in those cases, but, as we showed, CD23 might have a lower specificity than CD200 for CLL. We added CD200 in our panels in order to diagnose chronic lymphoproliferative disorders, not to replace CD 23, but to improve and save time in our diagnostic process. The high expression of CD200 in CLL and HCL could open the option for new- targeted therapy (anti-CD200).


Cell cycle regulating mechanisms in oral lichen planus: molecular bases in epithelium predisposed to malignant transformation.
Expression of p53, p21, ki-67, Bcl-2 and caspase-3 proteins in oral lichen planus (OLP) was studied to investigate cell cycle regulation mechanisms in this disease. Oral biopsies were obtained from 51 patients with OLP and 26 controls for immunohistochemical analysis (peroxidase antiperoxidase) to quantify expression of the proteins under study (-: 0%, +: <10%, ++: 10-25%, +++: 26-50%, ++++: >50% positive cells). Basal expression of caspase-3 was negative in 22 cases (46.8%) and positive in <10% of basal cells in 22 cases (46.8%); caspase-3 expression in inflammatory infiltrate was negative in 22 cases (46.8%) and positive in <10% of lymphocytes in 20 cases (42.5%). Basal expression of Bcl-2 was negative in 35 cases (74.5%); Bcl-2 was expressed in inflammatory infiltrate in 34 cases (72.3%) and was positive in <25% of lymphocytes in 14 of these (29.7%). Basal expression of p53 and p21 was positive in 32 (67.9%) and 23 (48.8%) cases, respectively. Basal expression of ki-67 was positive in 45 cases (95.7%), of which 20 (42.5%) showed positivity in >25% of cells; ki-67 was expressed in inflammatory infiltrate in 23 cases (48.9%). Significant associations were found between basal expressions of p53 and ki-67 (p<0.001) and between Bcl-2 expression in infiltrate and basal expression of ki-67 (p<0.001). No association was observed between basal expressions of p53 and caspase-3 (p=0.08). Bcl-2 expression in infiltrate and basal expression of ki-67 were independently associated with presence of OLP. Epithelial cells in OLP do not preferentially develop apoptosis but rather cycle arrest or an increased proliferation rate, which may create a suitable substrate for malignant transformation.


Deep learning and SURF for automated classification and detection of calcaneus fractures in CT images.
The calcaneus is the most fracture-prone tarsal bone and injuries to the surrounding tissue are some of the most difficult to treat. Currently there is a lack of consensus on treatment or interpretation of computed tomography (CT) images for calcaneus fractures. This study proposes a novel computer-assisted method for automated classification and detection of fracture locations in calcaneus CT images using a deep learning algorithm. Two types of Convolutional Neural Network (CNN) architectures with different network depths, a Residual network (ResNet) and a Visual geometry group (VGG), were evaluated and compared for the classification performance of CT scans into fracture and non-fracture categories based on coronal, sagittal, and transverse views. The bone fracture detection algorithm incorporated fracture area matching using the speeded-up robust features (SURF) method, Canny edge detection, and contour tracing. Results showed that ResNet was comparable in accuracy (98%) to the VGG network for bone fracture classification but achieved better performance for involving a deeper neural network architecture. ResNet classification results were used as the input for detecting the location and type of bone fracture using SURF algorithm. Results from real patient fracture data sets demonstrate the feasibility using deep CNN and SURF for computer-aided classification and detection of the location of calcaneus fractures in CT images.


Enantioselective synthesis of vicinal halohydrins via dynamic kinetic resolution.
[reaction: see text] Expanding the scope of enantioselective catalysis via DKR, transfer hydrogenation of a variety of cyclic alpha-halo ketones was accomplished using the Noyori/Ikariya (R,R)- or (S,S)-I catalysts and either HCO(2)H/Et(3)N or HCO(2)Na/n-Bu(4)NBr in H(2)O/CH(2)Cl(2) as the hydrogen sources. Good yields of vicinal bromo-, chloro-, and fluorohydrins with excellent de and ee levels were achieved in most cases after a simple tuning of reaction conditions.


[The role of transvaginal ultrasonography in the screening of ovarian tumors].
From January 1992 to March 1996, 1987 women underwent vaginal sonography screening, at the Department of Obstetrics and Gynaecology of the II Faculty of Medicine and Surgery "Federico II" in Naples. This mass screening aimed at early diagnosis of ovarian cancer. Patients included in this investigations were all asymptomatic and had no pelvic abnormalities. Each ovary was measured in three planes and ovarian volume was calculated using the prolate ellipsoid formula. In premenopausal women, ovaries were normal if their volume was of > or = 18 cm3 and if they were hypoechogenic or anechogenic. In postmenopausal women a normal ovary was defined as having a volume of > or = 8 cm3 and a uniformly hypogenic internal structure. In thirty-five premenopausal women was detected an abnormal volume of the ovaries. Forty-six postmenopausal women had abnormal vaginal sonograms. In this investigations vaginal sonography has permitted the detection of about 4.88% ovarian tumors in asymptomatic women, so that, it can be considered a more accurate and direment screening method for ovarian cancer than abdominal sonography.


[Orthostatic hypotension : diagnosis and therapy].
Syncope is a frequent clinical event in the general population and occurs in up to every second patient during their lifetime. Reflex syncope is the most prevalent mechanism and is often triggered by orthostatic stress. Orthostatic hypotension (OH) represents a rare cause in young patients but is an important differential diagnosis in the aged. The Framingham study revealed an increase in the incidence of OH-triggered syncope from 5.7 events/1000 person-years at the age of 60-69 to 11.1 in men who are 70-79 years of age. OH often constitutes a chronic, debilitating illness with significant reduction in the quality of life. Important causes are volume loss, side effects of different vasoactive drugs, and neurodegenerative or secondary autonomic diseases following long-standing diabetes or amyloid disease. OH is difficult to treat. The therapeutic goal is to improve postural symptoms, standing time, and prevention of syncopal events. Drug therapy alone is never adequate. Because orthostatic stress varies during the day, a patient-tailored approach that emphasizes education and several general actions is recommended together with physical therapy and isometric exercise maneuvers. Moderate and severe cases require additional drug treatment to increase peripheral vascular resistance.


Microvascular reconstruction of composite cranial defects.
Microvascular reconstruction of composite cranium defects is challenging, and operative planning differs in various anatomic regions of the cranium. The aim of this article is to detail surgical strategies for microvascular reconstruction in different areas of the cranium. Fifty-eight free tissue transfers were performed in 54 patients with composite cranial defects between 1995 and 2009. The cranium was divided into six zones to classify the defects. Data on patient demographics, location and cause of the defects, technical details of surgical management, and complications were analyzed. Defects were secondary to ablative procedures in 45 patients. Eight patients had posttraumatic defects, and one patient had congenital defect. Nine different flap types were used in the series. Choice of recipient vessels and the use of interpositional vein grafts varied according to the site of the cranial defects. Microsurgical reconstruction of cranial defects can be performed safely with predictable outcome by methodic assessment of the problem and by careful attention to the details of the reconstructive plan. In this article, valid conclusions on the planning of microvascular reconstruction in different areas of the cranium have been determined.


Oral cholecystography in the early phase of acute alcoholic pancreatitis. A prospective, randomized comparison of Telepaque and Bilopaque.
Biliary tract disease is a major cause of acute pancreatitis. However, with traditionally employed Telepaque, radiographic visualization of the gallbladder during acute pancreatitis remains unreliable, even in patients with apparently normal gallbladders. Therefore, oral cholecystography has customarily been deferred for such patients for several weeks. Recently, successful oral cholecystography has been described during the acute episode of pancreatitis, using Bilopaque, a more water-soluble cholecystopaque. The relative intestinal absorption of Telepaque and Bilopaque and the ability of these agents to produce diagnostic oral cholecystograms of fasting patients with acute alcoholic pancreatitis were compared. Forty-five hospitalized patients were studied within 96 hours of admission. Mean peak plasma contrast concentrations for Bilopaque exceeded those for Telepaque. Thirty-one percent of the Bilopaque group achieved diagnostic single-dose oral cholecystograms, compared with to 11% of the Telepaque group (P less than 0.05).


Hominoid lineage specific amplification of low-copy repeats on 22q11.2 (LCR22s) associated with velo-cardio-facial/digeorge syndrome.
Segmental duplications or low-copy repeats (LCRs) constitute approximately 5% of the sequenced portion of the human genome and are associated with many human congenital anomaly disorders. The low-copy repeats on chromosome 22q11.2 (LCR22s) mediate chromosomal rearrangements resulting in deletions, duplications and translocations. The evolutionary mechanisms leading to LCR22 formation is unknown. Four genes, USP18, BCR, GGTLA and GGT, map adjacent to the LCR22s and pseudogene copies are located within them. It has been hypothesized that gene duplication occurred during primate evolution, followed by recombination events, forming pseudogene copies. We investigated whether gene duplication could be detected in non-human hominoid species. FISH mapping was performed using probes to the four functional gene loci. There was evidence for a single copy in humans but additional copies in hominoid species. We then compared LCR22 copy number using LCR22 FISH probes. Lineage specific LCR22 variation was detected in the hominoid species supporting the hypothesis. To independently validate initial findings, real time PCR, and screening of gorilla BAC library filters were performed. This was compared to array comparative genome hybridization data available. The most striking finding was a dramatic amplification of LCR22s in the gorilla. The LCR22s localized to the telomeric or subtelomeric bands of gorilla chromosomes. The most parsimonious explanation is that the LCR22s became amplified by inter-chromosomal recombination between telomeric bands. In summary, our results are consistent with a lineage specific coupling between gene and LCR22 duplication events. The LCR22s thus serve as an important model for evolution of genome variation.


Internal fixation of proximal humerus fractures using the Polarus intramedullary nail.
It has been stated that proximal humeral fractures are the last unsolved fractures in orthopedics. In this study, we evaluate the results of the Polarus nail, in order to constitute to the controversial problem of the treatment of proximal humerus fractures. Between 2003 and 2005, 27 patients with severely displaced proximal humeral fractures were treated with the Polarus intramedullary system. The fractures were classified according to the Neer classification system. There were 16 2-part fractures and 11 3-part fractures. At the 12-months follow up we graded the clinical outcome of the patients according to the Neer scoring system. The duration from time of injury to operation ranged from 1 to 6 days. The mean operative time was 55 min and no need of blood transfusion was recorded. Bony union was obtained in 27 patients. There were no cases of nonunion and the period from operation to the appearance of sufficient bridging callus on radiographs was 5-11 weeks (mean 6 weeks). In one patient, a backed-out proximal screw was recorded. Stiffness of the shoulder was seen in one patient and avascular necrosis of the head of humerus in another. Related to the clinical outcome, six patients had an excellent result, 15 patients had a satisfactory result, four patients had an unsatisfactory result, and two patients had a poor result. The 77.78% of the patients had an excellent or satisfactory clinical outcome. There was significant difference in the functional outcome between patients younger than 65 years (91.55) and those older than 65 years (80.22) (P < 0.05). No significant difference was recorded in the Neer score between the patients with a 2-part fracture and the patients with a 3-part fracture (80.18) (P > 0.05). The Polarus nail is designed to provide stable fixation with a straightforward insertion and targeting procedure. The fact that 77.78% of the patients had an excellent or satisfactory clinical outcome, suggest that Polarus humeral rod system can be a worthy alternative to traditional operative methods for displaced proximal fractures of the humerus.


Neuronal organization and cell interactions of the cat stellate ganglion.
The functional structure of the cat stellate ganglion (SG) and, in particular, its extra- and intraganglionic connections and neuronal organization, were investigated using histochemical, immunohistochemical, morphological and histological methods. Retrograde axonal transport of horseradish peroxidase was used to determine most of the extraganglionic interactions. Of the targets tested, the most extensive efferent connections of the SG were with the stemocleidomastoid muscle, trachea, esophagus and heart. Neurons of the SG also send a small number of postganglionic efferents to the thyroid and stomach. Furthermore, ganglion cells send axons to the spinal ganglia. Several afferent connections of the SG were determined. Sympathetic preganglionic neurons of segments C8-T10 of the spinal cord, sensory neurons of C8-T9 spinal ganglia, intramural ganglia of the thoracic viscera and the reticular formation of the medulla oblongata send their axons to the SG. Intraganglionic interactions of intemeurons with principal ganglionic cells were assumed to occur, based on the presence of interneurons immunoreactive to GABA and substance P. GABA- and substance P-immunoreactive fibers located around a small number of postganglionic neurons were also identified. Morphological study revealed asymmetry between the left and right ganglia: the right ganglion is larger than the left and contains more cells. This asymmetry was also reflected in basic structural parameters of neurons, such as average neuronal area and average diameter of cell somata. The present data has been used to develop a scheme for the basic inter- and intraneuronal connections of the cat SG. This ganglion is a true nervous center, with postganglionic neurons, some of which might be performing sensory functions, and interneurons. The ganglion is connected not only with the spinal cord and spinal ganglia, but also with neurons of the intramural ganglia and, by direct links, with efferent neurons of the medulla oblongata. Thus, the SG may play an essential role in viscera-visceral reflexes.


Comparison of NMOSFET and PMOSFET devices that combine CESL stressor and SiGe channel.
Strained-Si technology could enhance the carrier mobility and improve the device performance. Contact-etch-stop-layer (CESL) structure with different stress and SiGe channel was fabricated with 90-nm technology. The electrical properties of N and PMOSFET devices combining CESL and SiGe channel were investigated. The short channel effects (SCE), such as drain-induced barrier lowering (DIBL), were also studied. Moreover, the stress contour in the SiGe channel has been simulated with TCAD to understand the relationship between stress distribution and device performance for different CESL structures. It is observed that the stress in the channel region was independent of the type of N or PMOSFET devices, but it was dependent on the CESL type and channel length. Based on the experimental and simulation results, it is confirmed that the device performance is associated with the stress in the channel, and the approach of CESL stressor and SiGe channel is shown to effectively improve the mobility of NMOSFETs and PMOSFETs.


Analysis of stereochemistry and biosynthesis of epicatechin in tea plants by chiral phase high performance liquid chromatography.
Tea (Camellia sinensis) is rich in flavan-3-ols (catechins), especially epicatechin (EC), which is the predominant extension unit of polymeric proanthocyanidins (PAs). However, studies assessing EC's stereochemistry are scarce. Here, a high performance liquid chromatography column using amylose tris-(3, 5-dimethylphenylcarbamate) immobilized on silica-gel as chiral stationary phases (CSPs) was applied to explore its stereochemistry and biosynthetic pathway in tea plants. The results revealed (-)-epicatechin [(-)-EC] was the predominant di-hyroxy-non-galloylated-catechins, while (+)-epicatechin [(+)-EC] was not detected. Interestingly, (-)-EC was the only product obtained from cyanidin using the partially purified native C. sinensis anthocyanidin reductase (CsANR) in the presence of reduction nicotinamide adenine dinucleotide phosphate (NADPH); meanwhile, (+)-EC was the main product using recombinant CsANR in the same conditions. In addition, (-)-EC could be obtained from (+)-catechin [(+)-C] using recombinant CsANR, which displayed C3-epimerase activity in the presence of oxidation nicotinamide adenine dinucleotide phosphate (NADP(+)). But the partially purified native CsANR did not possess this function. Finally, (-)-EC could result from the de-gallate acid reaction of epicatechin gallate (ECG) catalyzed by a novel partially purified native galloylated catechins hydrolase (GCH) from tea leaves. In summary, (-)-EC is likely the product of native protein from the tea plants, and (+)-EC is only produced in a reaction catalyzed by recombinant CsANR in vitro.


Differing alpha-tocopherol oxidative lability and ascorbic acid sparing effects in buoyant and dense LDL.
The enhanced oxidizability of smaller, more dense LDL is explained in part by a lower content of antioxidants, including ubiquinol-10 and alpha-tocopherol. In the present studies, we also observed greater rates of depletion of alpha-tocopherol (mole per mole LDL per minute) in dense (d = 1,040 to 1,054 g/mL) compared with buoyant (d = 1,026 to 1,032 g/mL) LDL in the presence of either Cu2+ or the radical-generating agent 2-2'-azobis (2-amidinopropane)dihydrochloride. Differences were particularly pronounced at the lowest Cu2+ concentration tested (0.25 mumol/L), with a fivefold greater rate in dense LDL. At higher concentrations (1.0 and 2.5 mumol/L Cu2+), there was a greater dependence of depletion rate on initial amount of alpha-tocopherol, which was reduced in dense LDL, thus resulting in smaller subfraction-dependent differences in depletion rates. Inclusion of ascorbic acid (15 mumol/L), an aqueous antioxidant capable of recycling alpha-tocopherol by hydrogen donation, was found to extend the course of Cu(2+)-induced alpha-tocopherol depletion in both buoyant and dense LDL, but this effect was more pronounced in dense LDL (time to half-maximal alpha-tocopherol depletion was extended 15.6-fold and 21.2-fold in buoyant and dense LDL, respectively, at 2.5 mumol/L Cu2+; P< .05). Thus, dense LDL exhibits more rapid alpha-tocopherol depletion and conjugated diene formation than buoyant LDL when oxidation is performed in the absence of ascorbic acid, but these differences are reversed in the presence of ascorbic acid.(ABSTRACT TRUNCATED AT 250 WORDS)


Comparison of patient survival between hemodialysis and peritoneal dialysis in a single Chinese center.
No study in China has so far investigated the difference in patient survival rates between hemodialysis (HD) and peritoneal dialysis (PD). Therefore, the aim of the present single-center follow-up study was to determine and compare the survival rates associated with HD and PD at a Chinese hospital. Clinical data were analyzed for all adult patients (age >18 years) with chronic renal failure who dialysis between 2006 and 2010. The study included 216 patients, 140 of whom underwent PD and 76 of whom underwent HD. Compared to patients in the HD group, patients in the PD group were older (61 ± 14 vs. 55 ± 14 years, P = 0.004) and had higher baseline blood uric acid levels (452 ± 136 vs. 388 ± 150 μmol/L, P = 0.002) and lower baseline iPTH (224 ± 260 vs. 305 ± 267 pg/ml, P = 0.036). Moreover, a higher number of PD patients had diabetes (40 vs. 27.6 %, P = 0.056). The average follow-up time was 25 months in the PD group and 36 months in the HD group. The 1-, 2- and 3-year survival rates were 98.7, 93.2, and 85.5 %, respectively, in the HD group and 90.9, 81.5, and 73.8 %, respectively, in the PD group. In the first 3 years, HD was associated with better survival compared to the PD group. However, when adjusted for age, diabetes and BMI, there was no significant difference between the PD and HD group. The mode of dialysis itself has no effect on the survival rate of ESRD patients on dialysis.


Replacement therapy with imiglucerase for type 1 Gaucher's disease.
Gaucher's disease, the most common sphingolipidosis, is caused by deficiency of the lysosomal enzyme glucocerebrosidase. Therapy with alglucerase (the placental enzyme) is safe and effective at various dosing regimens. We report the use of low-dose imiglucerase (the recombinant enzyme) at two dosing schedules: 15 u/kg once fortnightly or 2.5 u/kg thrice weekly. Mean reductions in spleen and liver volumes achieved (in all ten patients) by imiglucerase at 12 months were 36.4% and 14.5%, respectively; mean increase in haemoglobin and platelet counts were 13.4% and 25.7%. There were no serious side-effects. No significant differences were observed between the two schedules. Low-dose low-frequency imiglucerase may be an alternative cost-effective approach with satisfactory clinical response and uncompromised quality of life.


Initial staging for squamous cell carcinoma of the mouth, larynx and pharynx (except nasopharynx). Part 3: general assessment. 2012 SFORL recommendations.
The French Society of Otorhinolaryngology (SFORL) set up a work group to draw up guidelines for initial staging of head and neck squamous cell carcinoma. Locoregional and remote extension assessment are dealt with in two separate reports. The present part 3 deals with the assessment of frequent associated symptoms and pathologies, requiring early treatment and the collection of data on a certain number of clinical and paraclinical parameters for therapeutic decision-making in the multidisciplinary team meeting. A multidisciplinary critical analysis of the literature was conducted. General assessment here covers screening, assessment and initial management of the following: usual risk factors (smoking, alcohol, HPV), the most frequent medical comorbidities, nutritional status, social and psychological status, dental status, pain and possible anemia. As oncologic management frequently associates surgery, radiation therapy and chemotherapy, the underlying examinations should be early, as part of initial staging. The levels of evidence for the examinations were estimated so as to grade guidelines, failing which expert consensuses were established. The high rates of pain, malnutrition and anemia call for systematic screening and early management, especially as rapidly effective treatments exist. Assessing comorbidity and social and psychological status enables general health status to be assessed, along with possible contraindications to the usual treatments. Tracheal intubation problems may require intubation under flexible endoscopy or jet-ventilation by inter-cricothyroid catheterization from the diagnostic endoscopy stage. Assessment and adapted dental care should be conducted if radiation therapy is likely or certain. Early management of symptoms and comorbidity and anticipation of subsequent treatment are intended to shorten initial staging time and to collate the data needed for therapeutic decision-making. This assessment should be performed at the same time as the locoregional and remote extension assessment, and is obviously to be adapted according to tumoral extension stage and the possible treatment options.


Keratin antibody localization in head and neck tissues and neoplasms.
Immunohistochemical staining for keratin proteins may be useful as a diagnostic parameter in head and neck neoplasms. Our study evaluates the keratin antibody staining properties of normal tissues as well as neoplastic and non-neoplastic head and neck lesions from surgical procedures performed on 100 patients. The results indicate that the anti-keratin antibody technique can be helpful in several areas of head and neck pathology.


Phenylthiourea disrupts thyroid function in developing zebrafish.
Thyroid hormone (T4) can be detected in thyroid follicles in wild-type zebrafish larvae from 3 days of development, when the thyroid has differentiated. In contrast, embryos or larvae treated with goitrogens (substances such as methimazole, potassium percholorate, and 6-n-propyl-2-thiouracil) are devoid of thyroid hormone immunoreactivity. Phenythiourea (PTurea; also commonly known as PTU) is widely used in zebrafish research to suppress pigmentation in developing embryos/fry. PTurea contains a thiocarbamide group that is responsible for goitrogenic activity in methimazole and 6-n-propyl-2-thiouracil. In the present study, we show that commonly used doses of 0.003% PTurea abolish T4 immunoreactivity of the thyroid follicles of zebrafish larvae. As development of the thyroid gland is not affected, these data suggest that PTurea blocks thyroid hormone production. Like other goitrogens, PTurea causes delayed hatching, retardation and malformation of embryos or larvae with increasing doses. At doses of 0.003% PTurea, however, toxic side effects seem to be at a minimum, and the maternal contribution of the hormone might compensate for compromised thyroid function during the first days of development.


Autonomic nerve function in rheumatoid arthritis of varying severity.
Autonomic nerve function was evaluated by deep breathing and tilt table tests in 17 patients with rheumatoid arthritis (RA) and in 24 healthy control subjects. The results showed that all RA patients had increased heart rates at rest, irrespective of the severity of the disease. Patients with severe RA had increased systolic and diastolic blood pressures before and after tilting. Pronounced abnormalities in the immediate heart rate reaction to tilting indicating autonomic neuropathy (AN) were also demonstrated in patients with severe RA. The abnormal immediate reaction to tilting was mainly the result of vagal neuropathy. From the present study it is evident that severe RA may be accompanied by AN and the consequences need to be elucidated.


Selective detection of carbon-13, nitrogen-15, and deuterium labeled metabolites by capillary gas chromatography-chemical reaction interface/mass spectrometry.
We have applied a new chemical reaction interface/mass spectrometer technique (CRIMS) to the selective detection of 13C-, 15N-, and 2H-labeled phenytoin and its metabolites in urine following separation by capillary gas chromatography. The microwave-powered chemical reaction interface converts materials from their original forms into small molecules whose mass spectra serve to identify and quantify the nuclides that make up each analyte. The presence of each element is followed by monitoring the isotopic variants of CO2, NO, or H2 that are produced by the chemical reaction interface. Chromatograms showing only enriched 13C and 15N were produced by subtracting the abundance of naturally occurring isotopes from the observed M + 1 signal. A selective chromatogram of 2H (D) was obtained by measuring HD at m/z 3.0219 with a resolution of 2000. Metabolites representing less than 1.5% of the total labeled compounds could be identified in the chromatogram. Detection limits from urine of 380 pg/mL of a 15N-labeled metabolite, 7 ng/mL of a 13C-labeled metabolite, and 16 ng/mL of a deuterium labeled metabolite were determined at a signal to noise ratio of 2. Depending on the isotope examined, a linear dynamic range of 250-1000 was observed using CRIMS. To identify many of these labeled peaks (metabolites), the chromatographic analysis was repeated with the chemical reaction interface turned off and mass spectra obtained at the retention times found in the CRIMS experiment. CRIMS is a new analytical method that appears to be particularly useful for metabolism studies.


Objective and subjective memory impairment in elderly adults: a revised version of the Everyday Memory Questionnaire.
Growing interest in understanding the relationship between subjective memory complaints (SMCs) and objective measures of memory abilities emphasizes the importance of SMC assessment for diagnostic purposes. The present study investigated the relationship between SMCs and objective memory deficits in elderly adults by analysis of the factor structure of the Everyday Memory Questionnaire (EMQ). Objective and subjective assessment of memory function was carried out in 112 elderly adults. Principal component analysis was then performed to study the factor structure of the EMQ in relation to the assessment. Objective memory impairment was evident in 8.9% of elderly adults. The factor analysis showed that the most interpretable solution to detect objective changes with the EMQ comprised only 20 out of 28 items of the original list, with three factors explaining 48% of total variance. This version was more sensitive for detecting SMCs in elderly adults, since one out of the three factors was able to differentiate subjects with objective memory deficits from those without. Taken together, these results illustrate that this 20-item version of the revised EMQ may serve as an easy-to-use instrument during clinical screening, to evaluate objective memory impairment in individuals who report SMC.


In vitro elevation of red blood cell 2,3-diphosphoglycerate with fructose, phosphate, and methylene blue.
2,3-Diphosphoglycerate (2,3-DPG) is an important regulator of hemoglobin oxygen affinity and thus can theoretically affect tissue oxygenation. Marked stimulation of DPG with substances that would likely be well tolerated by humans has not been reported previously. In order to achieve such stimulation, we investigated (n = 102) the effect of various combinations of fructose (2.8-11.1 mM) and sodium phosphate (1.0-130.0 mM) on 2,3-DPG production by perfusing fresh human blood in dialysis tubing, 37 degrees C, pH 7.15-7.70, with the appropriate solutions and with compressed air or 100% O2 for up to 6 hours. The DPG increased significantly with fructose/phosphate incubations for 6 hours. At pH greater than 7.35 the average increase was 25%; at pH less than 7.35, 12%; PO4 greater than 6 mM + pH greater than 7.35 yielded the highest changes, 28%. Methylene blue 2.5-7.5 microM + PO4 greater than 2.5 mM + pH greater than 7.35 yielded similar results. Glucose + PO4 showed no effect on DPG. Results were comparable at all fructose levels either with compressed air or 100% O2. Significant elevations in 2,3-DPG were also noted at 4 hours but were of lesser magnitude. In conclusion, significant elevations in 2,3-DPG can be achieved by incubating whole blood with fructose/phosphate solutions or with methylene blue and phosphate for 4-6 hours. It should be possible to adapt these solutions for human use to raise 2,3-DPG. The potential physiologic value of rightward shifts in hemoglobin oxygen affinity can then be tested under appropriate conditions.


Attention-related activity during episodic memory retrieval: a cross-function fMRI study.
In functional neuroimaging studies of episodic retrieval (ER), activations in prefrontal, parietal, anterior cingulate, and thalamic regions are typically attributed to episodic retrieval processes. However, these activations are also frequent during visual attention (VA) tasks, suggesting that their role in ER may reflect attentional rather than mnemonic processes. To investigate this possibility, we directly compared brain activity during ER and VA tasks using event-related fMRI. The ER task was a word recognition test with a retrieval mode component, and the VA task was a target detection task with a sustained attention component. The study yielded three main findings. First, a common fronto-parietal-cingulate-thalamic network was found for ER and VA, suggesting that the involvement of these regions during ER reflects general attentional processes. This idea is compatible with some of the interpretations proposed in the ER literature (e.g. postretrieval monitoring), which may be rephrased in terms of attentional processes. Second, several subregions were differentially involved in ER versus VA. For example, the frontopolar cortex and the precuneus were more activated for ER than for VA, possibly reflecting retrieval mode and processing of internally generated stimuli, respectively. Finally, the study yielded an unexpected finding: some medial temporal lobe regions were similarly activated for ER and VA. This finding suggests that the medial temporal lobes may be involved in indexing representations within the focus of consciousness, regardless of whether they are mnemonic or perceptual. Overall, the present results suggest that many of the activations attributed to specific cognitive processes, such as episodic memory, may actually reflect more general cognitive operations.


Influence of time of injection of recombinant porcine somatotropin (rpST) relative to time of feeding on growth performance, hormone and metabolite status, and muscle RNA, DNA, and protein in pigs.
Thirty-six barrows were used in a 2 X 3 factorial treatment array to determine the effects of time of injection (0800 [AM] or 1800 [PM]) of recombinant porcine somatotropin (rpST) (0, 50, or 100 micrograms.kg BW.d-1 adjusted weekly) relative to time of feeding on growth performance, carcass composition, serum hormones and metabolites, and muscle RNA, DNA, and protein. Pigs were fed at 85% of ad libitum and allowed access to feed between 0800 and 1200. Treatments were initiated at 38 kg and continued until each pig consumed an average of 7.5 Mcal of DE/d. There was no significant effect of injection time for any measure of growth performance or composition of gain even though rpST treatment improved most criteria evaluated. Treatment with rpST increased ADG by 30%, improved feed:gain by 23%, reduced lipid accretion by 46%, increased protein accretion by 69%, and increased loin eye area (LEA) by 26%. Time of injection also had no effect on serum hormones or metabolites, except for nonesterified fatty acids (NEFA), which were 20% higher in the AM-injected animals. Treatment with rpST increased (P less than .05) RNA concentration (21%) and RNA/DNA (17%) in longissimus dorsi (LD) muscle. In semimembranosus (SM) muscle, however, rpST administration resulted in an increased (P less than .05) DNA concentration (10%) and a decreased DM content (4%). These results suggest that rpST influences growth differently in these two muscles. We conclude that time of rpST administration (AM vs PM) has no effect on its metabolic properties and, therefore, no effect on growth performance in the pig.


Fiber-optic device for endoscopic polarization imaging.
Polarization images were obtained using a flexible optical fiber device. The endoscopic technique is based on the real-time compensation of the birefringence of the standard fiber by means of a miniaturized Faraday rotator. Based on a Jones formalism analysis, specific signal processing allows one to extract both the phase retardation and the degree of polarization of the light backscattered by a remote target.


Heme iron from diet as a risk factor for coronary heart disease in women with type 2 diabetes.
Diabetes-related metabolic abnormality may aggravate the adverse effects of iron overload on cardiovascular health. However, little is known about whether iron consumption affects coronary heart disease (CHD) risk in diabetes. We prospectively assessed the associations of long-term intakes of dietary iron and red meat with CHD risk among 6,161 women who reported a diagnosis of type 2 diabetes. During 54,455 person-years of follow-up from 1980 through 2000, we documented 550 incident cases of CHD. After adjustment for age and BMI, high intakes of both heme iron and red meat were associated with a significantly increased risk of fatal CHD (P for trend = 0.003 and 0.018), coronary revascularization (P for trend = 0.02 and 0.06), and total CHD (P for trend = 0.0009 and 0.007). Women with the highest intake of heme iron had 50% (6-94%) increased risk of total CHD compared with those with the lowest intake. Further adjustment for other lifestyle and dietary factors did not appreciably change the associations. The positive association between heme iron and red meat intakes and CHD was more evident among postmenopausal women compared with premenopausal women. Our data indicate that higher consumption of heme iron and red meat may increase CHD risk among women with type 2 diabetes.


Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation.
Orthotopic liver transplantation (OLT) can be a definitive treatment for patients with hepatocellular carcinoma (HCC). Prolonged waiting times for cadaveric livers, however, may lead to dropout from the waiting list or worsened post-OLT prognosis as a result of interval tumor progression. Percutaneous radiofrequency ablation (RFA) is widely used for local control of small unresectable HCC, but its pretransplant role remains unclear. We studied the outcome of 52 consecutive patients accepted for OLT bearing 87 HCC nodules and treated with percutaneous RFA. On initial staging, the tumor burden exceeded the Milan criteria in 10 patients. Complete tumor coagulation was observed in 74 of 87 (85.1%) nodules based on postablation imaging. After a mean of 12.7 months (range: 0.3-43.5) on the waiting list, 3 of 52 patients (5.8%) had dropped out due to tumor progression. Forty-one patients had undergone transplantation, with 1- and 3-year post-OLT survival rates of 85% and 76%, respectively. No patient developed HCC recurrence. There were three major complications in 76 RFA procedures (hepatic arterial hemorrhage, small bowel perforation, and liver decompensation salvaged by OLT), without resultant death or dropout. In conclusion, percutaneous RFA is an effective bridge to OLT for patients with compensated liver function and safely accessible tumors. Tumor-related dropout rate and post-OLT outcome compared favorably with published controls of patients with early-stage disease. This can be attributed to the efficacy of RFA in producing local cure or curbing tumor progression during the waiting period.


Estimating the correlation of bivariate failure times under censoring.
The analysis of correlations within pairs of survival times is of interest to many research topics in medicine, such as the correlation of survival-type endpoints of twins, the correlation of times till failure in paired organs, or the correlation of survival time with a surrogate endpoint. The dependence of such times is assumed monotonic and thus quantification by rank correlation coefficients appropriate. The typical censoring of such times requires more involved methods of estimation and inference as have been developed in recent years. The paper focuses on semiparametric approaches, and in particular on the normal copula-based estimation of Spearman correlation coefficients. The copula approach, often presented for a mathematically inclined readership, is reviewed from the viewpoint of an applied statistician. As an alternative to the maximum likelihood methodology for the normal copula approach (NCE) we introduce an iterative multiple imputation (IMI) method which requires only about 0.05% of the computing time of NCE, without sacrificing statistical performance. For IMI, survival probabilities at death or censoring times are first transformed to normal deviates. Then, those deviates that relate to censored times are iteratively augmented, by using conditional multiple imputation, until convergence is obtained for the normal scores rank correlation, which is similar to Spearman's rank correlation. Statistical properties of NCE and IMI are compared by means of a Monte Carlo study and by means of three real data sets, which also give an impression of the typical range of applications, and of their problems.


Primary mucinous adenocarcinoma of the vagina.
Primary mucinous adenocarcinoma of the vagina is a rare disease which is characterized by aggressiveness and poor prognosis because of its rapid growth and recurrence, its frequent distant metastases, and its relative resistance to conventional treatment modalities including surgery, radiotherapy, and chemotherapy. We report a case of advanced stage primary mucinous adenocarcinoma of the vagina that showed a highly aggressive course and resistance to combination chemotherapy with paclitaxel and carboplatin. A 46-year-old multigravid Japanese woman was admitted to our hospital to be treated for Stage IVb primary mucinous adenocarcinoma of the vagina. She had no history of in utero exposure to diethylstilbestrol. She was treated by two courses of neoadjuvant chemotherapy with tri-weekly paclitaxel and carboplatin, which were not effective. Subsequently, total pelvic exenteration with pelvic lymphadenectomy was performed. However, the disease progressed rapidly and the patient died five months after the initial treatment. Because of its rarity, little is known about the behavior of primary mucinous adenocarcinoma of the vagina. Additional data about patients with this rare tumor should be collected and analyzed in an attempt to elucidate its prognostic factors, characteristics, optimal treatment, and outcome.


Interactions between photoautotrophic and heterotrophic metabolism in photoheterotrophic cultures of Euglena gracilis.
Interactions between photoautotrophic and heterotrophic metabolism in photoheterotrophic culture of Euglena gracilis were studied. Under a low light supply coefficient, these two metabolic activities seem to proceed independently. The cell growth rate in photoheterotrophic culture was about the sum of the growth rates in pure photoautotrophic and heterotrophic cultures. However under a high light supply coefficient, both photoautotrophic and heterotrophic (glucose assimilation) metabolic activities were inhibited, resulting in a low photoheterotrophic growth rate. The photoheterotrophic culture was more sensitive to photoinhibition compared to the pure photoautotrophic culture. Inhibition of glucose assimilation in the photoheterotrophic culture was due to both direct and indirect (through photosynthesis) effects of high light intensity. Cell growth, glucose assimilation and alpha-tocopherol content of the cells were higher when ambient air was used for aeration than when a mixture of carbon dioxide and air was used. Even when photosynthesis was inhibited by addition of 3-(3,4-dichlorophenyl)- 1,1-dimethylurea to photoheterotrophic culture, light stimulated alpha-tocopherol synthesis by E. gracilis.


10-Year follow-up of 621 patients treated using high-dose rate brachytherapy as ambulatory boost technique in conservative breast cancer treatment.
Breast conserving treatment, consisting of lumpectomy followed by whole-breast irradiation, is considered the standard of care in early-stage breast cancer. Randomized studies have reported that delivering boost doses to tumor bed improves local control rates, particularly in young women. This study sought to evaluate local control and cosmetic results of delivering boost doses using a high-dose-rate (HDR) brachytherapy (HDRBT) in breast cancer conservative treatment. We included 621 T1-T2, N0-N1 breast cancer patients who underwent lumpectomy, external irradiation (44Gy over 5weeks), and a boost dose of two fractions of 5Gy to the tumor bed by means of HDR iridium brachytherapy. Implantation was performed during the lumpectomy or 2-3weeks after external irradiation. Population characteristics were as follows: pTis=11.6%; pT1=63.4%; pT2=25.0%; median tumor size=1.5cm; histology: ductal carcinoma in situ (DCIS): 72 (11.6%); infiltrative ductal carcinoma (IDC): 471 (75.8%); other: 78 (12.6%). For IDCs, the surgical margins were positive in 38cases (6.2%) and an extensive intraductal component was present in 254 cases. With a median follow-up of 10.3years, 47 local relapses were observed (10-year local relapse rate: 7.4%). Small-volume implantation (V100<45cc) and ductal carcinoma in situ histology both significantly correlated with local relapse. The 10-year overall survival was 91%. Cosmetic results were evaluated in 264patients, proving excellent in 58 (22%), good in 153 (58%), fair in 40 (15%), and poor in 13 (5%). Small implant volume and ductal carcinoma in situ histology significantly correlated with local relapse following HDR brachytherapy dose boost in breast cancer conservative treatment. Modern image-guided breast brachytherapy techniques using surgical clips as a guide may decrease potential treatment targeting errors, consequently improving local control without increasing toxicity.


Technosphere insulin (Afrezza): a new, inhaled prandial insulin.
To review the pharmacology, pharmacokinetics, safety, and efficacy of Technosphere insulin (TI), a new inhaled insulin product. Searches were conducted in PubMed/MEDLINE, Scientific Citation Index, and abstracts from both the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) meetings from 2005 to August 2014, utilizing the search terms Afrezza, Technosphere, Afresa, and inhaled insulin. References were reviewed to identify additional sources. Studies with adequate sample sizes, evaluating clinically relevant end points were included. TI is approved by the Food and Drug Administration as a bolus insulin to treat patients with type 1 and type 2 diabetes. Its glucose-lowering properties are less than that of rapid-acting insulins, but it does demonstrate less hypoglycemia. TI's kinetics make it the fastest absorbed of any insulin available, although its overall onset of action appears similar to insulin lispro. It represents an alternative to bolus injections but would likely be used concomitantly with injected basal insulin. Major adverse effects are respiratory in nature, with cough being the most prominent. There is a small decrease in the forced expiratory volume in 1 s (FEV1) with TI; this appears to be consistent, nonprogressive, and reversible. Patients using TI must receive pulmonary function tests periodically throughout therapy. TI is contraindicated in patients with chronic lung disease and should be used with caution in patients who smoke. TI is a novel inhaled insulin that provides prandial coverage to patients with diabetes, representing an alternative to bolus insulin injections.


The cannulation of the caudal caval vein through the femoral vein in the pig for endocrine research.
The present study was designed to examine the usefulness of cannulation of the caudal caval vein through the femoral vein for the measurement of hormone concentrations in the reproductive tract in the pig. The experiment was performed on sexually pubertal gilts (Polish Large White x Polish Landrace) of a similar age (7-8 months) and body mass (100-110 kg) after two controlled subsequent estrous cycles. Six gilts in the luteal phase (10th day) of the estrous cycle were used in this experiment. The animals were subjected to a surgical procedure which included:--premedication (Combelen, i.m. 1 ml/10 kg of body mass) and than after 20-30 min general anaesthesia (Vetbutal, i.v., dose 30-40 ml) according to body mass and the symptoms observed,--insertion of cannulas (o.d. 2.2 and i.d. 1.8 mm)--one into the jugular vein and the other into the caudal caval vein through the femoral vein. In several gilts the cannulas were inserted into the caudal caval vein to a depth of 14, 18, 20, 23, 25 and 30 cm from the femoral ring. The concentrations of progesterone (P4) and testosterone (T) were analysed in samples of blood plasma from the jugular and caudal caval veins by radioimmunoassay (RIA). The largest differences in hormone concentrations between the jugular and caudal caval veins were ascertained when a cannula was inserted into the caudal caval vein to a depth of 20 cm from the femoral ring. In other cases the differences were less prominent, or no differences were observed (e.g. 14 cm for progesterone and testosterone or 18 cm for testosterone).


Genetic variants of GSK3B are associated with biomarkers for Alzheimer's disease and cognitive function.
Glycogen synthase kinase 3 beta (GSK3B) is the major kinase phosphorylating tau protein. Hyperphosphorylated tau is one of the hallmarks of Alzheimer's disease (AD). Despite extensive research, the role of GSK3B in AD pathogenesis is not fully understood. To evaluate possible associations between gene variants of GSK3B and risk of AD. Twelve GSK3B tag single-nucleotide polymorphisms (SNPs), together with the previously AD-associated rs334558, were analyzed in 583 AD patients and 673 controls. Analyses on single marker and haplotype levels were done to relate to risk of AD, Mini-Mental State Examination (MMSE) scores, and cerebrospinal fluid (CSF) biomarker levels of total tau (T-tau), hyperphosphorylated tau (P-tau181), and amyloid-β (Aβ42). After correction for multiple testing, we found a number of associations of gene variants with CSF biomarker levels and cognitive function in the AD patients. Firstly, rs334558 was associated with elevated T-tau levels (pc = 0.04). Next, rs1154597 showed association with reduced Aβ42 levels (pc = 0.007). Lastly, rs3107669 was associated with lower MMSE scores (pc = 0.03). In addition, one more SNP was nominally significantly associated with reduced Aβ42 levels and another was associated with reduced MMSE. We found GSK3B gene variants associated with cognitive function and CSF biomarkers T-tau and Aβ42. To our knowledge, this is the first time GSK3B has been associated with cognitive function or CSF biomarkers reflecting neuronal degeneration (T-tau) and brain amyloid load (Aβ42). The regulation of GSK3B needs to be investigated further, to fully understand how these GSK3B gene variants are involved in AD pathogenesis.


The establishment of an introduced community of fluorescent pseudomonads in the soil and in the rhizosphere is affected by the soil type.
Indigenous populations of fluorescent pseudomonads were previously shown to vary in two different soils (Châteaurenard and Dijon) and in the rhizosphere of a plant species (Linum usitatissimum L.) cultivated in these two soils. These differences could be related to the soil type and to their crop history. In the present study, the influence of the soil type on the diversity of fluorescent pseudomonads in bulk and rhizospheric soils was evaluated. The soils of Châteaurenard and Dijon were sterilized before being inoculated with the same community of fluorescent pseudomonads. Bacterial isolates from bulk and rhizospheric soils were characterized on the basis of their repetitive extragenic palindromic-PCR patterns allowing the comparison of the distributions of the introduced populations. The influence of the soil type on the establishment of the introduced bacterial community was recorded in the two bulk soils. Indeed, the density and the structure of the community differed significantly between the two soils. The rhizosphere effect was also affected by the soil type. This effect was expressed in the Châteaurenard soil but not in the Dijon soil. Hence, the structure of the bacterial community associated with the roots of the same plant species cultivated in the two soils differed significantly.


Reducing activity level of alliin.
Alliin has been reported to have antioxidative activity. We tried to reexamine the antioxidative activity of alliin with a purified alliin preparation, and found that it has no antioxidative activity in a linoleic acid oxidation system. The reducing activity of alliin tested by the ECD method was also weak in showing antioxidative activity.


Geographic migration of black and white families over four generations.
This article analyzes patterns of geographic migration of black and white American families over four consecutive generations. The analysis is based on a unique set of questions in the Panel Study of Income Dynamics (PSID) asking respondents about the counties and states in which their parents and grandparents were raised. Using this information along with the extensive geographic information available in the PSID survey, the article tracks the geographic locations of four generations of family members and considers the ways in which families and places are linked together over the course of a family's history. The patterns documented in the article are consistent with much of the demographic literature on the Great Migration of black Americans out of the South, but they reveal new insights into patterns of black migration after the Great Migration. In the most recent generation, black Americans have remained in place to a degree that is unique relative to the previous generation and relative to whites of the same generation. This new geographic immobility is the most pronounced change in black Americans' migration patterns after the Great Migration, and it is a pattern that has implications for the demography of black migration as well as the literature on racial inequality.


Enantio- and diastereoselective synthesis of duocarmycine-based prodrugs for a selective treatment of cancer by epoxide opening.
For the enantio- und diastereoselective synthesis of the prodrug 2, the N-tert-butyloxycarbonyl-protected amine 7 was alkylated with the enantiopure epoxide 14 to give the amide 10. A regio- and facial-selective metal-mediated cyclisation by using a cuprate led to 17 with an inversion of configuration at C10. Subsequent transformation of the hydroxy group in 17 by using the Appel procedure afforded (1S,10R)-9 with an unusual double inversion owing to neighbouring-group participation of the N-tert-butoxycarbonyl group. (1S,10R)-9 is the key intermediate in the synthesis of the prodrug 2, which has been developed for a selective treatment of cancer based on the antibody-directed enzyme prodrug therapy as an analogue of the natural antibiotic duocarmycine SA (1).


Claiming our core: appraising qualitative evidence for nursing questions about human response and meaning.
The growing acceptance of evidence-based practice (EBP) principles in nursing raises the possibility that only question domains central to medical practice--therapy, harm, prognosis, and medical diagnosis--and "best evidence" appropriate to those domains will be valued. We propose incorporation of 2 additional question domains--human response and meaning--as particularly important for nursing practice, and we argue that the strongest evidence for these questions arises from qualitative research traditions. We discuss the evaluation and application of qualitative evidence for practice and identify unresolved issues for further discussion within the discipline.


Possible involvement of PI3K-dependent pathways in the increased VEGF120 release from osteoblastic cells preloaded with palmitate in vitro.
It have been reported that abnormal bone metabolism often occurs in patients with type 2 diabetes, but the underlying mechanisms remain to be elucidated. In recent years dyslipidemia (hyperlipidemia) has been presumed to have an influence on bone metabolism. In addition, the involvements of VEGF and MCP-1 derived from osteoblasts in bone abnormal metabolism were also observed. Thus, we investigated the pathogenic mechanism of this abnormal bone metabolism, which is included in the regulation of VEGF and MCP-1 secretions from osteoblasts, by using UMR-106 osteosarcoma cells as an osteoblast cell model and treating them with palmitate in order to mimic a state of hyperlipidemia. Palmitate-preloaded cells showed the significant increase of VEGF120 release (1.8-fold vs. control cells, p<0.01). Moreover, the treatment with palmitate significantly increased VEGF-A mRNA with the maximal 2.5-fold upregulation at 12h after the treatment (p<0.01). However, MCP-1 release was not affected by palmitate. Moreover, the amplified VEGF120 secretion with palmitate was significantly decreased by the treatment with TLR4 antagonist or PI3K pathway inhibitors, LY294002 and wortmannin (p<0.01, respectively). On the other hand, the stimulation with TNF-α, which osteoclasts were able to release, significantly enhanced MCP-1 secretion (p<0.01), but had no effect on VEGF120. On the contrary IL-1β amplified VEGF120 release (p<0.01), but not MCP-1. These results suggest that palmitate can increase VEGF120 release from UMR-106 osteosarcoma cells, which is accelerated at the transcriptional level, and this increase of VEGF120 release may be mediated though, at least partly, TLR4 and the PI3K pathways. In addition, we also verified that TNF-α and IL-1β, which are considered to be derived from osteoclasts, amplified the secretions of MCP-1 and VEGF120 from UMR-106 cells, respectively.


Familial aggregation of urinary system tumors in a region with endemic nephropathy.
In hyperendemic villages in the Vratza district of Bulgaria, 193 patients with urinary system tumors (UST) were diagnosed during 1965 to 1976. A tendency towards familial aggregation was revealed when the patients were compared with two groups of controls, namely, patients with tumors other than UST and healthy persons. Each control group consisted of 193 persons matched by sex, age, and place of birth. This tendency was observed in all relatives who lived together as well as in those related by blood. The probability of having relatives with UST was 2.5 times higher than could be expected as chance occurrence among UST patients than among the controls. The UST cases also had significantly more relatives with endemic nephropathy than did the controls. The familial clustering of both UST and nephropathy in the endemic region is considered another clue to their common etiology.


Excitation of self-transparency Bragg solitons in quadratic media.
We show that self-transparent or gap solitons with leading-order components at fundamental frequency can be generated in a singly resonant Bragg grating by second-harmonic generation. We discuss the conditions required for exciting these localized waves.


Efficacy of porcine versus bovine surfactants for preterm newborns with respiratory distress syndrome: systematic review and meta-analysis.
To compare the efficacy of a porcine surfactant (poractant alfa) versus bovine surfactants (beractant and calfactant) with respect to clinical outcomes among preterm infants with respiratory distress syndrome. A search of major electronic databases, including Medline (1980-2010) and the Cochrane Central Register of Controlled Trials, for randomized controlled trials that compared poractant alfa versus beractant and/or calfactant among preterm infants with respiratory distress syndrome who required intubation and surfactant treatment was performed. The primary outcome was oxygen requirement at a postmenstrual age of 36 weeks. Five randomized controlled trials involving 529 infants compared poractant alfa versus beractant for rescue treatment. No trials studied surfactant prophylaxis, and none compared poractant alfa versus calfactant. The incidences of oxygen dependence at a postmenstrual age of 36 weeks were similar for poractant alfa and beractant. Infants treated with poractant alfa at 100 mg/kg (low dose) or 200 mg/kg (high dose) exhibited statistically significant reductions in deaths (relative risk: 0.51 [95% confidence interval: 0.30-0.89]), the need for redosing (relative risk: 0.71 [95% confidence interval: 0.57-0.88]), oxygen requirements, duration of oxygen treatment, and duration of mechanical ventilation. The test of heterogeneity yielded positive results for the latter 2 outcomes. The difference remained statistically significant for deaths and the need for redosing with high-dose poractant alfa but not for low dose poractant alfa. There were significant reductions in deaths and the need for redosing with high-dose poractant alfa but not low-dose poractant alfa, compared with beractant.


Economic evaluation of a nursing-led inpatient unit: the impact of findings on management decisions of service utility and sustainability.
The nursing-led inpatient unit is designed to substitute for a period of care in acute hospital wards and to improve patient outcome prior to discharge to the community. This paper aims to evaluate the cost, from the UK National Health Service perspective, of transfer to a nursing-led inpatient unit for intermediate care and to discuss the impact of these findings to the future development and sustainability of the nursing-led inpatient unit. Recent economic analyses have showed that nursing-led inpatient units are associated with increased costs of care with length of stay as the main driver of inpatient costs. The cost-effectiveness analysis was part of a randomized-controlled trial with a sample size of 175, of which 89 were in the nursing-led inpatient unit arm and 86 in the control arm. Resource use data included length of stay, investigations performed, multiprofessional input and nursing input. Clinical outcome was measured using Barthel Index, a functional status measure. Cost per day was lower on the nursing-led inpatient unit although cost per hospital stay was higher due to significantly increased length of stay. Postdischarge community care costs were lower. The incremental cost-effectiveness ratio of the treatment was 1044 pounds sterling per point improvement of the Barthel Index. The nursing-led inpatient unit was associated with higher costs however, the question of whether the nursing-led inpatient unit is cost-effective has not been clearly answered because of the limited follow-up period of the study. The increased cost of care on the nursing-led inpatient unit was not a major factor in local management decisions about the future of the unit. The changes in the context of service provision within which the nursing-led inpatient unit operated as a result of substantial investment in intermediate care did have a major impact.


Determination of sex: interest of frontal sinus 3D reconstructions.
Frontal sinuses (FSs) have been studied in radiology, anthropology, and forensic anthropology. This study aimed to determine whether it was possible to predict the age and sex of an individual using FS volume. Sixty-nine anonymized CT scans were imported to MIMICS 10.01(®) software (Materialise N.V.), and each FS volume was calculated in mm(3) . There was an absence of significant difference between right and left FS volume (p = 0.173) and an absence of correlation between age and FS volume (Pearson's test; p = 0.705). Sexual dimorphism was significantly different (p = 0.001). However, the most discriminant datum for determining sex was found to be the total FS volume (sum of an individual's right and left FS volumes) with linear discriminant Fisher's function coefficients of -2.759 for the male group and -1.275 for the female group. With this model, 72.5% of our sample was correctly classified according to sex.


Fv-clasp: An Artificially Designed Small Antibody Fragment with Improved Production Compatibility, Stability, and Crystallizability.
Antibody fragments are frequently used as a "crystallization chaperone" to aid structural analysis of complex macromolecules that are otherwise crystallization resistant, but conventional fragment formats have not been designed for this particular application. By fusing an anti-parallel coiled-coil structure derived from the SARAH domain of human Mst1 kinase to the variable region of an antibody, we succeeded in creating a novel chimeric antibody fragment of ∼37 kDa, termed "Fv-clasp," which exhibits excellent crystallization compatibility while maintaining the binding ability of the original IgG molecule. The "clasp" and the engineered disulfide bond at the bottom of the Fv suppressed the internal mobility of the fragment and shielded hydrophobic residues, likely contributing to the high heat stability and the crystallizability of the Fv-clasp. Finally, Fv-clasp antibodies showed superior "chaperoning" activity over conventional Fab fragments, and facilitated the structure determination of an ectodomain fragment of integrin α6β1.


A rhodium IBiox[(-)-menthyl] complex as a highly selective catalyst for the asymmetric hydroarylation of azabicyles: an alternative route to epibatidine.
The synthesis and characterization of a new chiral rhodium N-heterocyclic carbene complex, Rh(IBiox[(-)-menthyl](CO)(2)Cl, is reported. In addition, the very high enantioselectivity exhibited by this complex, as a catalyst for the asymmetric hydroarylation of azabicycles, is demonstrated and applied to the synthesis of epibatidine.


Stochastic modelling suggests that an elevated superoxide anion - hydrogen peroxide ratio can drive extravascular phagocyte transmigration by lamellipodium formation.
Chemotaxis, integrates diverse intra- and inter-cellular molecular processes into a purposeful patho-physiological response; the operatic rules of which, remain speculative. Here, I surmise, that superoxide anion induced directional motility, in a responding cell, results from a quasi pathway between the stimulus, surrounding interstitium, and its biochemical repertoire. The epochal event in the mounting of an inflammatory response, is the extravascular transmigration of a phagocyte competent cell towards the site of injury, secondary to the development of a lamellipodium. This stochastic-to-markovian process conversion, is initiated by the cytosolic-ROS of the damaged cell, but is maintained by the inverse association of a de novo generated pool of self-sustaining superoxide anions and sub-critical hydrogen peroxide levels. Whilst, the exponential rise of O2(.-) is secondary to the focal accumulation of higher order lipid raft-Rac1/2-actin oligomers; O2(.-) mediated inactivation and redistribution of ECSOD, accounts for the minimal concentration of H2O2 that the phagocyte experiences. The net result of this reciprocal association between ROS/ RNS members, is the prolonged perturbation and remodeling of the cytoskeleton and plasma membrane, a prelude to chemotactic migration. The manuscript also describes the significance of stochastic modeling, in the testing of plausible molecular hypotheses of observable phenomena in complex biological systems.


Suprasellar non-Langerhans cell histiocytosis (Erdheim-Chester disease)--a case report.
Erdheim-Chester disease (ECD) is an uncommon non-Langerhans cell histiocytosis that affects multiple body systems and can present clinically in a myriad of ways. An adult onset is most common with bony involvement and constitutional symptoms. We report the case of a 52-year-old female presenting with diabetes insipidus and a suprasellar mass on imaging, with no evidence of extracerebral involvement. Histopathology was consistent with ECD.


Comparing mortality outcomes of major burns and toxic epidermal necrolysis in a tertiary burns centre.
Our aim was to provide descriptive information to burn clinicians, who have extensive experience treating major burns and determining prognosis, as to whether significant differences in mortality exist between major burns injuries and the comparatively less common toxic epidermal necrolysis for a given age and total body surface area percentage. Retrospective data was analyzed of all deceased patients admitted to the Victorian Adult Burns Service in Melbourne, Australia over a period of 10 years with greater than 30% total body surface area burned or greater than 30% total body surface area epidermal detachment in the case of toxic epidermal necrolysis. Retrospective data was also collected on all patients, survivors and deceased, with toxic epidermal necrolysis and these patients were matched with burns patients by age and % total body surface area burned. Comparisons in outcomes were performed with mortality being the primary variable of interest. Toxic epidermal necrolysis patients that died were older (median: 68.5 vs 57 yrs; P=0.04), had a longer length of hospital stay (36.5 vs 0.8 days; P=0.001) and significantly longer periods of mechanical ventilation (1404 vs 14.5h; P=0.011) than major burns patients that died. When toxic epidermal necrolysis patients were matched to major burns patients by age and total body surface area burned, there were no significant differences between the two groups with respect to mortality. Palliative care approaches are more frequently administered at the time of presentation for major burns patients in comparison to toxic epidermal necrolysis patients. This may be due to a perception that if toxic epidermal necrolysis patients can survive their initial systemic injury, they are likely to survive, as opposed to major burns patients who often undergo extensive surgery and for whom other factors should be taken into account in the context of end-of-life decision making.


Effects of (56)Fe radiation on hippocampal function in mice deficient in chemokine receptor 2 (CCR2).
(56)Fe irradiation affects hippocampus-dependent cognition. The underlying mechanisms may involve alterations in neurogenesis, expression of the plasticity-related immediate early gene Arc, and inflammation. Chemokine receptor-2 (CCR2), which mediates the recruitment of infiltrating and resident microglia to sites of CNS inflammation, is upregulated by (56)Fe irradiation. CCR2 KO and wild-type mice were used to compare effects of (56)Fe radiation (600MeV, 0.25Gy) on hippocampal function using contextual fear conditioning involving tone shock pairing during training (+/+) and exposure to the same environment without tone shock pairings (-/-). In the -/- condition, irradiation enhanced habituation in WT mice, but not CCR2 KO mice, suggesting that a lack of CCR2 was associated with reduced cognitive performance. In the +/+ condition, irradiation reduced freezing but there was no genotype differences. There were no significant correlations between the number of Arc-positive cells in the dentate gyrus and freezing in either genotype. While measures of neurogenesis and gliogenesis appeared to be modulated by CCR2, there were no effects of genotype on the total numbers of newly born activated microglia before or after irradiation, indicating that other mechanisms are involved in the genotype-dependent radiation response.


[Caffeine inactivation of mammalian cells in the S phase of the mitotic cycle due to anomalous replicon initiation during the inhibition of the elongation of replicating DNA].
Chinese hamster cells were treated with an inhibitor of DNA synthesis (hydroxyurea or arabinoside-cytesine) in non-toxic concentrations for 20 hours in the presence or absence of caffeine (2 mM). Under these conditions caffeine considerably inactivates the cells. If cells are synchronized by hydroxyurea (0.25 mM) in the S-phase of mitotic cycle, the addition of caffeine kills all the S-phase cells, while gamma-irradiation or novobiocine treatment markedly decreases the sensibilizing effect of caffeine. These findings permit us to conclude that cell inactivation is due to anomalous reinitiation of DNA synthesis stimulated by caffeine in the presence of drugs which inhibit the DNA chain elongation.