Abnormal Sleep Duration Is Associated with a Higher Risk of Accidental Injury.
Develop normative data for adult sleep duration and determine if nonstandard sleep time relates to the likelihood of accidental injury. Cross-sectional analysis. National health information database. The National Health Interview Survey, 2004-2013, was examined for adult sleep time and accidental injury within the past 3 months. The mean hours slept per night was determined. The relationship between sleep time and incidence of accidental injury was determined for any injury, injury while driving, and injury while working, adjusting for demographic variables. Among 221.4 million adults (raw sample, N = 282,692), the mean sleep time was 7.17 hours (95% confidence interval [95% CI], 7.16-7.18 hours). Men and women slept very similar times (7.14 vs 7.17 hours, respectively), and sleep time decreased until the fifth decade (minimum, 6.99 hours), increasing each decade thereafter; 2.81% of adults reported being accidentally injured in the preceding 3 months. Too little sleep and excessive sleep times were both associated with higher rates of accidental injury (odds ratio per hour of deviation from mean, 1.16 [95% CI, 1.12-1.19]), adjusting for age, sex, marital status, and education level. Similar increased odds ratios were noted for injury while driving (1.11 [95% CI, 1.01-1.22]) and injury while at work (1.12 [95% CI, 1.04-1.20]) with sleep time deviation. Most adults sleep between 7 and 8 hours nightly. Adults with sleep time outside this range, with either less or more sleep, have increased rates of accidental injury. These data highlight the need for sufficient quantity and quality of sleep in preventing accidental injury.


Induction of neuron-specific glycosylation by Tollo/Toll-8, a Drosophila Toll-like receptor expressed in non-neural cells.
Specific glycan expression is an essential characteristic of developing tissues. Our molecular characterization of a mutation that abolishes neural-specific glycosylation in the Drosophila embryo demonstrates that cellular interactions influence glycan expression. The HRP epitope is an N-linked oligosaccharide expressed on a subset of neuronal glycoproteins. Embryos homozygous for the TM3 balancer chromosome lack neural HRP-epitope expression. Genetic and molecular mapping of the relevant locus reveals that Tollo/Toll-8, a member of the Toll-like receptor family, is altered on the TM3 chromosome. In wild-type embryos, Tollo/Toll-8 is expressed by ectodermal cells that surround differentiating neurons and precedes HRP-epitope appearance. Re-introduction of Tollo/Toll-8 into null embryos rescues neural-specific glycan expression. Thus, loss of an ectodermal cell surface protein alters glycosylation in juxtaposed differentiating neurons. The portfolio of expressed oligosaccharides in a cell reflects its identity and also influences its interactions with other cells and with pathogens. Therefore, the ability to induce specific glycan expression complements the previously identified developmental and innate immune functions of Toll-like receptors.


Alcohol and coronary heart disease: the roles of HDL-cholesterol and smoking.
To study the role of HDL-cholesterol (HDLc) in the causal pathway mediating the effect of alcohol on coronary heart disease (CHD). Cox proportional hazard models were used to compare the relative CHD risks in various HDLc-smoking categories. A prospective, multicentre, placebo-controlled, double-blind CHD primary prevention trial with gemfibrozil in primary (occupational) health care units, the Helsinki Heart Study. Dyslipidaemic middle-aged men with available alcohol consumption data (1924 of 2035) in the placebo arm of the 5-year study. Seventy-seven (of 84) cases of nonfatal myocardial infarction or cardiac death. A U-shaped association was detected between alcohol consumption and CHD. The protection was found both in subjects with low (mean 0.94 mmol L-1) and normal (mean 1.25 mmol L-1) HDLc with corresponding reductions of 23% and 36% in relative risks. In contrast to previous data, alcohol offered virtually no protection against CHD in non-smokers. In subjects consuming more than 800 g pure ethanol annually, the CHD incidence was 6/1000 in subjects with more than three weekly drinking occasions, compared to 11/1000 in 'weekend' drinkers. Our results confirm the protective effect of alcohol against CHD. However, in contrast to previous data the effect in our population is restricted to smokers and the role of HDLc in mediating the effect is less central than suggested previously.


Fibrin sealant in experimental tubal microsurgery.
This study compares the results of microsurgical tubal anastomosis performed using a fibrin sealant, 9-0 monofilament polyglycolic acid (PGA) suture, or fibrin sealant in combination with 9-0 PGA suture. Sixty rabbits were divided into three groups of 20 rabbits each. The pregnancy rate of the rabbits was 95%, 95%, and 85%, respectively; without any intervention, the fertility rate was 95% in 20 nonexperimental rabbits (control group). We conclude that fibrin adhesive employed for reanastomosing of the fallopian tube in rabbits, compared with synthetic microsutures, results in identical pregnancy rate and identical conditions of passage through the tubes. Fibrin sealant is absorbed more rapidly than absorbable microsutures, results in fewer adhesions, and shorter operating time. Thus, fibrin adhesive possibly provides an alternative to the traditional employment of sutures in gynecological microsurgery.


Fully kinetic particle-in-cell simulations of a deuterium gas puff z pinch.
We present the first fully kinetic, collisional, and electromagnetic simulations of the complete time evolution of a deuterium gas puff z pinch. Recent experiments with 15-MA current pinches have suggested that the dominant neutron-production mechanism is thermonuclear. We observe distinct differences between the kinetic and magnetohydrodynamic simulations in the pinch evolution with the kinetic simulations producing both thermonuclear and beam-target neutrons. The kinetic approach demonstrated in this Letter represents a viable alternative for performing future plasma physics calculations.


Oral mucous membrane pemphigoid: A clinical study of 100 low-risk cases.
To analyze the severity of the oral lesions in low-risk oral mucous membrane pemphigoid (OMMP) measured according to the size of the bullous areas and the number of simultaneously affected oral locations. A total of 100 cases of low-risk OMMP were studied. The symptoms and location of OMMP in the oral cavity were analyzed. The bullous areas were measured, establishing three grades according to the greatest bullous lesion size (grade 1: < 3 cm in size; grade 2: 3-6 cm; and grade 3: > 6 cm). The mean age of the patients was 66.07 ± 13.55 years, with a clear predominance of females (84%). Desquamative gingivitis was the most common presentation (97%). A single oral location was found in 67% of the cases, two in 18% and three in 15%. The most common presentation corresponded to grade 1 (the greatest bullous lesion size < 3 cm; 51.6% of the cases). Most cases of low-risk OMMP are restricted to a single site in the oral cavity, the gingiva being the most common location-the predominant grade corresponding to the greatest bullous lesion size < 3 cm.


A selective history of the study of visual motion aftereffects.
The visual motion aftereffect (MAE) was initially described after observation of movements in the natural environment, like those seen in rivers and waterfalls: stationary objects appeared to move briefly in the opposite direction. In the second half of the nineteenth century the MAE was displaced into the laboratory for experimental enquiry with the aid of Plateau's spiral. Such was the interest in the phenomenon that a major review of empirical and theoretical research was written in 1911. In the latter half of the present century novel stimuli (like drifting gratings, isoluminance patterns, spatial and luminance ramps, random-dot kinematograms, and first-order and second-order motions), introduced to study space and motion perception generally, have been applied to examine MAEs. Developing theories of cortical visual processing have drawn upon MAEs to provide a link between psychophysics and physiology; this has been most pronounced in the context of monocular and binocular channels in the visual system, the combination of colour and contour information, and in the cortical sites most associated with motion processing. The relatively unchanging characteristic of the study of MAEs has been the mode of measurement: duration continues to be used as an index of its strength, although measures of threshold elevation and nulling with computer-generated motions are becoming more prevalent. The MAE is a part of the armoury of motion phenomena employed to uncover the mysteries of vision. Over the last 150 years it has proved itself immensely adaptable to the shifts of fashion in visual science, and it is likely to continue in this vein.


Characteristics of Single-Loop Macroreentrant Biatrial Tachycardia Diagnosed by Ultrahigh-Resolution Mapping System.
Biatrial tachycardia (BiAT) is a rare form of atrial macroreentrant tachycardia, in which both atria form a critical part of the circuit. We aimed to identify the characteristics and precise circuits of single-loop macroreentrant BiATs. We identified 8 patients (median age, 59.5 years old) with 9 BiATs in a cohort of 336 consecutive patients from 2 institutions who had undergone AT catheter ablation using an automatic ultrahigh-resolution mapping system. Seven of the 8 patients had a history of persistent AF ablation, including septal or anterior left atrium ablation before developing BiAT. One of the 8 patients had a history of an atrial septal patch closure with a massively enlarged right atrium. Nine ATs (median cycle length, 334 ms; median 12 561 points in the left atrium; 8814 points in the right atrium) were diagnosed as single-loop macroreentrant BiATs. We observed 3 types of BiAT (1) BiAT with a perimitral and peritricuspid reentrant circuit (n=3), (2) BiAT using the right atrium septum and a perimitral circuit (n=3), and (3) BiAT using only the left atrium and right atrium septum (n=3). Catheter ablation successfully terminated 8 of the 9 BiATs. All patients who developed BiAT had an electric obstacle on the anteroseptal left atrium, primarily from prior ablation lesions. In this situation, mapping of both atria should be considered during AT. Because 3 types of single-loop BiAT were observed, ablation strategies should be adjusted to the type of BiAT circuit.


[Vascular placental pathology in high-risk groups: definition and synopsis].
The vascular placental pathology (VPP) is associated with many etiologies. Some are the consequence of a maternal genetic or acquired predisposition. Others are associated with a chronic maternal disease (hypertension, lupus, obesity, diabetes, ...). Finally, some others are associated with placental implantation leading to fetal ischemia (multiple pregnancy, chorioangioma, primiparity, feto-placental hydrops) or to environmental (altitude) or nutritional factors (famine and specific alimentary depressions). We classify these factors into three categories according to the risk level (moderate, significant and elevated). While any of these factors can increase the risk of VPP, no one is sufficiently sensitive or specific in predict inevitable onset of VPP. In most cases VPP results from a combination of two (or more) risk factors. The risk factors of VPP classified as moderate include age (> or = 35 years), increased blood pressure during the second trimester of pregnancy, a new paternity, dietetic factors or environmental factors, smoking and controlled diabetes (class B, C), or inactive systemic diseases. Risk is significantly elevated among obese (BMI > or = 25), primiparous women, women with a past familial history (first degree) of preeclampsia or eclampsia, cocaine use or association of tobacco and caffeine use, increased placental mass (associated with twin pregnancy, fetal hydrops or molar pregnancy), uncontrolled diabetes, lupus, active scleroderma. Risk is considered to be high among patients with chronic hypertension, women with a past history of preeclampsia, diabetes (class D, F, R), patients with active systemic disease or with antiphospholipid antibodies or women with lupus or renal lesions and/or proteinuria as well as chronic kidney disease resulting in proteinuria, hypertension and renal insufficiency. Finally, the risk of VPP is considered to be increased in the presence of acquired thrombophilia. It remains moderate in the presence of isolated genetic thrombophilia, except in forms presenting with multiple genetic mutations or associated with an hyperhomocysteinemia. A "high-risk group" is defined among women with past history of deep venous thromboembolic events outside pregnancy, or with a past history of placental vascular pathology (intra-uterine death, placental abruptio, severe and precocious placental, intra-uterine growth retardation, early and repetitive fetal loss) and who, in addition, present with acquired thrombophilia (antiphospholipid antibodies, thrombocytemia), unique homozygous genetic thrombophilia, amultiple genetic thrombophilia or unique heterozygous genetic thrombophilia associated with hyperhomocysteinemia. Prophylactic treatment of acquired thrombophilia and of the multiple genetic forms or associated with hypercysteinemia is a logical rationale, particularly among women with a past history of placental vascular pathology, or with a past history of venous thromboembolic events. On the contrary, prophylaxis using low-molecular-weight heparin in the event of asymptomatic genetic thrombophilic mutations and for women without a past history of deep venous thromboembolism or vascular placental pathology remains controversial.


[The 'railway spine': alleged spinal injury caused by railway concussions as a basis for financial claims in 19th century England].
The diagnosis 'railway spine' was a predominantly 19th century British phenomenon, with faint echos in the Netherlands. The diagnosis was controversial. Train accidents gave rise to litigation in compensation cases in which posttraumatic symptoms with no apparent lesions were related to molecular spinal damage. Medical opinion differed about the physical or psychic nature of the symptoms. The diagnosis was strongly associated with fraudulent claims for compensation and became obsolete after 1900, when the symptoms were generally diagnosed as a functional neurosis. The railway spine controversy was a precursor of the modern discussion concerning the validation of posttraumatic symptoms.


Environmental Life Cycle Assessment of marine sediment decontamination by citric acid enhanced-microwave heating.
The potential ability of microwave heating (MWH) for the remediation of marine sediments affected by severe hydrocarbon (HC) contamination was investigated. Decontamination effectiveness and environmental sustainability through a comparative Life Cycle Assessment (LCA) were addressed. Main results revealed that the application of a 650-W MWH treatment resulted in a rapid (15min) HC removal. A citric acid (CA) dose of 0.1M led to enhanced-HC removals of 76.9, 96.5 and 99.7% after 5, 10 and 15min of MW irradiation, respectively. The increase in CA dose to 0.2M resulted in a shorter successful remediation time of 10min. The exponential kinetic model adopted showed a good correlation with the experimental data with R2 values in the 0.913-0.987 range. The nature of the MW treatment was shown to differently influence the HC fraction concentration after the irradiation process. Achieved HC removals in such a short remediation time are hardly possible by other clean-up techniques, making the studied treatment a potential excellent choice. Removal mechanisms, which allowed the enhanced-MWH to operate as a highly effective multi-step technique (pure thermal desorption+chemical washing), undoubtedly represent a key factor in the whole remediation process. The LCA highlighted that the MW technology is the most environmentally sustainable alternative for sediment decontamination applications, with a total damage, which was 75.74% lower than that associated with the EK (0.0503pt).


Emergent properties of proteostasis-COPII coupled systems in human health and disease.
In eukaryotic membrane trafficking, emergent protein folding pathways dictated by the proteostasis network (the 'PN') in each cell type are linked to the coat protein complex II (COPII) system that initiates transport through the exocytic pathway. These coupled pathways direct the transit of protein cargo from the endoplasmic reticulum (ER) to diverse subcellular and extracellular destinations. Understanding how the COPII system selectively manages the trafficking of distinct folded states of nascent cargo (comprising one-third of the proteins synthesized by the eukaryotic genome) in close cooperation with the PN remains a formidable challenge to the field. Whereas the PN may contain a thousand component, the minimal COPII coat components that drive all vesicle budding from the ER include Sar1 (a GTPase), Sec12 (a guanine nucleotide exchange factor), Sec23-Sec24 complexes (protein cargo selectors) and the Sec13-Sec31 complex (that functions as a protein cargo collector and as a polymeric lattice generator to promote vesicle budding). A wealth of data suggests a hierarchical role of the PN and COPII components in coupling protein folding with recruitment and assembly of vesicle coats on the ER. In this minireview, we focus on insights recently gained from the study of inherited human disease states of the COPII machinery. We explore the relevance of the COPII system to human biology in the context of its inherent link with the remarkably flexible folding capacity of the PN in each cell type and in response to the environment. The pharmacological manipulation of this coupled system has important therapeutic implications for restoration of function in human disease.


Identification of a genomic island of Actinobacillus actinomycetemcomitans.
Horizontal gene transfer (HGT) is a process by which bacteria acquire genes from organisms of distant taxa. HGT is now recognized as a major driving force in the evolution of bacterial pathogens. Through this process, bacteria may accumulate blocks of DNA such as genomic islands (GEIs) that encode fitness or virulence factors. The periodontal pathogen A. actinomycetemcomitans has been known to exhibit variable virulence potential. It is postulated that GEIs may play a role in modifying the virulence potential of A. actinomycetemcomitans. This study was initiated to identify and determine the distribution of GEIs in A. actinomycetemcomitans. Forty-seven A. actinomycetemcomitans strains of serotypes a through f were examined. Strain-specific variant DNA in the genomes of A. actinomycetemcomitans was identified by polymerase chain reaction (PCR) genomic mapping and sequenced to identify GEIs. The distribution of the GEIs among test strains of A. actinomycetemcomitans was determined by PCR analysis and Southern hybridization assays. An approximately 22 kb GEI of A. actinomycetemcomitans, designated AAI-1, was identified in five serotype b strains. The AAI-1 exhibits low %G+C and encodes proteins of phage, restriction modification systems, mobile elements, and other hypothetical proteins of unknown functions. The insertion of AAI-1 was found to cause truncation of A. actinomycetemcomitans genes at the insertion site. Some A. actinomycetemcomitans strains may harbor GEIs, which were acquired via HGT by the bacteria. The GEIs may increase the gene repertoire of A. actinomycetemcomitans. However, the insertion of the GEIs in A. actinomycetemcomitans may also cause truncation and inactivation of resident genes at the insertion sites. The virulence significance of such gain and loss of genes in A. actinomycetemcomitans remains to be determined.


Discontinuation of hormone replacement therapy in young GH-treated hypopituitary women increases liver enzymes.
Hypopituitarism, often characterized by hypogonadism, is associated with central obesity, increased cardiovascular and endocrine morbidity and mortality. In Turner syndrome, which is also characterized by hypogonadism liver enzymes are often elevated, but readily suppressed by a short course of hormone replacement therapy (HRT). We investigated the effect of HRT on liver enzymes, lipid levels and measures of insulin sensitivity 26 in hypopituitary women. We studied 26 hypopituitary women (age 38.8+/-11.0 (mean+/-SD years), BMI 27.4+/-5.1kg/m(2)) during HRT and 28days off therapy. We measured liver enzymes, fasting levels of lipids, insulin and glucose as well as adiponectin and leptin levels. Body composition was assessed by means of anthropometry and bioimpedance. Alanine transaminase (ALT) and aspartate transaminase (AST) increased after discontinuation of HRT (ALT; treated: 22.3+/-11.5 vs. untreated: 27.1+/-11.1 (U/L) (P<0.02); AST; treated: 20.4+/-6.1 vs. untreated: 24.6+/-8.9 (U/L) (P<0.002)), whereas other liver function tests remained unchanged. Measures of insulin sensitivity and fasting lipids were also unaffected by HRT, whereas leptin levels decreased with cessation of HRT (leptin; treated: 23 (8-71) vs. untreated: 20 (8-64) (mug/L) (P<0.0005)). Short time discontinuation of HRT in young hypopituitary women increased liver enzymes, whereas measures of insulin sensitivity and lipid levels remained unchanged. We speculate that the estrogen component of HRT has beneficial effects on hepatic metabolism through various pathways. Further studies including liver imaging and with a time-dependent design are needed to clarify the role of HRT on liver enzyme levels, metabolic variables and liver fat content.


Temperature response of litter and soil organic matter decomposition is determined by chemical composition of organic material.
The global soil carbon pool is approximately three times larger than the contemporary atmospheric pool, therefore even minor changes to its integrity may have major implications for atmospheric CO2 concentrations. While theory predicts that the chemical composition of organic matter should constitute a master control on the temperature response of its decomposition, this relationship has not yet been fully demonstrated. We used laboratory incubations of forest soil organic matter (SOM) and fresh litter material together with NMR spectroscopy to make this connection between organic chemical composition and temperature sensitivity of decomposition. Temperature response of decomposition in both fresh litter and SOM was directly related to the chemical composition of the constituent organic matter, explaining 90% and 70% of the variance in Q10 in litter and SOM, respectively. The Q10 of litter decreased with increasing proportions of aromatic and O-aromatic compounds, and increased with increased contents of alkyl- and O-alkyl carbons. In contrast, in SOM, decomposition was affected only by carbonyl compounds. To reveal why a certain group of organic chemical compounds affected the temperature sensitivity of organic matter decomposition in litter and SOM, a more detailed characterization of the (13) C aromatic region using Heteronuclear Single Quantum Coherence (HSQC) was conducted. The results revealed considerable differences in the aromatic region between litter and SOM. This suggests that the correlation between chemical composition of organic matter and the temperature response of decomposition differed between litter and SOM. The temperature response of soil decomposition processes can thus be described by the chemical composition of its constituent organic matter, this paves the way for improved ecosystem modeling of biosphere feedbacks under a changing climate.


Prognostic value of high sensitivity troponin T after ST-segment elevation myocardial infarction in the era of cardiac magnetic resonance imaging.
To determine if high sensitivity troponin T (hs-TnT) measurements performed during the 'plateau phase' of troponin release (≥48 h) following ST-segment elevation myocardial infarction (STEMI) can predict major adverse cardiovascular endpoints (MACE), and to evaluate its prognostic value compared with cardiac magnetic resonance imaging (CMRI) parameters. We prospectively recruited 201 first presentation STEMI patients. Serial hs-TnT levels were measured at admission, peak (highest), 24, 48 and 72 h. CMRI and transthoracic echocardiography were performed (4 days median) post-STEMI, evaluating infarct scar characteristics and left ventricular ejection fraction (LVEF). Associations were determined between hs-TnT levels and CMRI parameters early after STEMI with MACE (comprising mortality, re-infarction, new or worsening of heart failure, cerebrovascular accident, and sustained ventricular arrhythmias) at medium-term follow-up. After 602 days (median), 33 (17%) patients had MACE. Upper tertile hs-TnT levels at 48 and 72 h were associated with MACE (Kaplan-Meier P = 0.002 and P = 0.012, respectively). Multivariate Cox analyses, incorporating diabetes, CMRI scar size, LVEF and hs-TnT levels (applied at a single hs-TnT time point) showed that 48 and 72 h hs-TnT levels were independent predictors for MACE (HR = 1.20, P = 0.002, and HR = 1.21, P = 0.035 respectively). Measurement of hs-TnT in the plateau phase after STEMI is an inexpensive method of prognostic risk assessment.


Ankle-joint salvage following a tibial pilon fracture. A case report.
This article presents a case of a tibial pilon fracture following a motor-vehicle accident. It discusses the main classification system and mechanism of injury for such fractures and emphasizes an alternative form of treatment of the usually suggested ankle fusion: an arthrectomy, which allows motion, thereby salvaging the ankle joint.


Progressive impairment of constructional abilities: a visuospatial sketchpad deficit?
The case of a patient, PC, with an impairment of constructional abilities due to a progressive degenerative disease is described. Ideomotor apraxia was also present. PC showed difficulties in all tasks requiring a "manipulation" of a visual model or requiring a visual model to address a specific movement or a choice among alternatives. The spatial component of mental imagery was also severely impaired. The conclusion was that the patient presented a deficit of the rehearsal component of the visuospatial sketchpad (VSSP). This produced an impairment of spatial learning, but spatial retrograde memory was preserved, as well as object recognition. The most prominent sites of atrophy were located in the parietal lobe bilaterally. A 3-year follow-up is reported, showing a progressive impairment of verbal abilities.


Wireless Optogenetic Nanonetworks for Brain Stimulation: Device Model and Charging Protocols.
In recent years, numerous research efforts have been dedicated toward developing efficient implantable devices for brain stimulation. However, there are limitations and challenges with the current technologies. They include neuron population stimulation instead of single neuron level, the size, the biocompatibility, and the device lifetime reliability in the patient's brain. We have recently proposed the concept of wireless optogenetic nanonetworking devices (WiOptND) that could address the problem of long term deployment, and at the same time target single neuron stimulation utilizing ultrasonic as a mode for energy harvesting. In addition, a number of charging protocols are also proposed, in order to minimize the quantity of energy required for charging, while ensuring minimum number of neural spike misfirings. These protocols include the simple charge and fire, which requires the full knowledge of the raster plots of neuron firing patterns, and the predictive sliding detection window, and its variant Markov-chain based time-delay patterns, which minimizes the need for full knowledge of neural spiking patterns as well as number of ultrasound charging frequencies. Simulation results exhibit a drop for the stimulation ratio of ~ 25% and more stable trend in its efficiency ratio (standard deviation of ~0.5%) for the Markov-chain based time-delay patterns protocol compared with the baseline change and fire. The results show the feasibility of utilizing WiOptND for long-term implants in the brain, and a new direction toward precise stimulation of neurons in the cortical microcolumn of the brain cortex.


Determination of the protein components of native thin filaments isolated from natural actomyosin: nebulin and alpha-actinin are associated with actin filaments.
A new method was developed for extracting natural actomyosin with full length connectin (titin) and nebulin from rabbit skeletal muscle. To determine the protein components of native thin filaments, thin filaments were isolated from natural actomyosin by sedimentation in a H2O/D2O/sucrose density gradient. Both alpha-actinin and nebulin were cosedimented with actin filaments, while connectin was not. This shows that the native thin filaments contained alpha-actinin and nebulin. This indicates that the native thin filaments were more complicated than synthetic filaments reconstituted from actin, tropomyosin, and troponin. It is known that synthetic filaments are less Ca2+ sensitive than native thin filaments. This difference in Ca2+ sensitivity may be due to the differences in components and/or the different structures of native and synthetic filaments. The newly developed methods described here for extracting natural actomyosin and for isolating native thin filaments are useful for addressing these important problems related to the structure and function of native thin filaments.


What patients say about living with psychogenic nonepileptic seizures: A systematic synthesis of qualitative studies.
This is a narrative systematic synthesis of qualitative research investigating patients' accounts of living with psychogenic nonepileptic seizures (PNES). Qualitative methodologies allow patients to share lived experiences in their own words. The examination of patients' own accounts is likely to offer revealing insights into a poorly understood, heterogeneous disorder. We identified 21 separate studies about PNES published after 1996 and based on analyses of patients' own words. Papers were synthesised inductively and deductively using an iterative approach. Five key themes emerged from the synthesis of studies capturing accounts from over 220 patients, reflecting experiences of seizure events, diagnosis, treatment and management, emotional events, and impact on daily life. Patients with PNES discussed the phenomenology of their seizures differently from those with epilepsy. PNES were experientially heterogeneous. Many patients shared a sense of uncertainty surrounding PNES, often resisting psychological explanations. Negative experiences with healthcare professionals were common. Patients seeking validation of their experiences often reported feeling ignored or doubted. Many reported past or current stressful events. Some demonstrated insight into their methods of emotional processing. PNES were described as a significant burden associated with financial and psychosocial losses. Qualitative studies have produced helpful insights into patients' experiences of living with PNES, but many patient groups (men, young people, elderly, non-Western patients) are underrepresented in studies carried out to date. Research capturing these patient groups and using new methods of data collection and qualitative analysis could help to deepen our understanding of this disorder.


A rapid scan vacuum FTIR method for determining diffusion coefficients in viscous and glassy aerosol particles.
We report a new method to investigate water transport kinetics in aerosol particles by using rapid scan FTIR spectroscopy combined with a custom-built pulse relative humidity (RH) control system. From real time in situ measurements of RH and composition using high time resolution infrared spectroscopy (0.12 s for one spectrum), and through achieving a high rate of RH change (as fast as 60% per second), we are able to investigate the competition between the gas and condensed phase diffusive transport limits of water for particles with mean diameter ∼3 μm and varying phase and viscosity. The characteristic time (τ) for equilibration in particle composition following a step change in RH is measured to quantify dissolution timescales for crystalline particles and to probe the kinetics of water evaporation and condensation in amorphous particles. We show that the dissolution kinetics are prompt for crystalline inorganic salt particles following an increase in RH from below to above the deliquescence RH, occurring on a timescale comparable to the timescale of the RH change (<1 s). For aqueous sucrose particles, we show that the timescales for both the drying and condensation processes can be delayed by many orders of magnitude, depending on the viscosity of the particles in the range 101 to 109 Pa s considered here. For amorphous particles, these kinetics are shown to be consistent with previous measurements of mass transfer rates in larger single particles. More specifically, the consistency suggests that fully understanding and modelling the complex microphysical processes and heterogeneities that form in viscous particles may not be necessary for estimating timescales for particle equilibration. A comparison of the kinetics for crystalline and amorphous particles illustrates the interplay of the rates of gas and condensed phase diffusion in determining the mass transport rates of water in aerosols.


Boundaries between chromosomal domains of X inactivation and escape bind CTCF and lack CpG methylation during early development.
Escape from X inactivation results in expression of genes embedded within inactive chromatin, suggesting the existence of boundary elements between domains. We report that the 5' end of Jarid1c, a mouse escape gene adjacent to an inactivated gene, binds CTCF, displays high levels of histone H3 acetylation, and functions as a CTCF-dependent chromatin insulator. CpG island methylation at Jarid1c was very low during development and virtually absent at the CTCF sites, signifying that CTCF may influence DNA methylation and chromatin modifications. CTCF binding sites were also present at the 5' end of two other escape genes, mouse Eif2s3x and human EIF2S3, each adjacent to an inactivated gene, but not at genes embedded within large escape domains. Thus, CTCF was specifically bound to transition regions, suggesting a role in maintaining both X inactivation and escape domains. Furthermore, the evolution of X chromosome domains appears to be associated with repositioning of chromatin boundary elements.


Process dissociation using a guided procedure.
A method for achieving process dissociation is described that places less emphasis on participants' understanding and remembering interpretations of test cues than does the standard procedure. The proposed method, called the guided procedure, tests memory with a sequence of two prompts, one requesting word-stem recognition, followed by another for word-stem completion. Inclusion and exclusion conditions are produced by requesting completion of recognized stems to form previously presented or new words, respectively. Estimates of automatic and conscious memory produced by the standard and the guided procedures are compared in studies modeled after Toth, Reingold, and Jacoby (1994). Although not significantly different in many aspects, the outcomes differ in ways that may reflect less reliance on a generate-recognize strategy of participants tested with the guided procedure. Additional measures of memory available only with the guided procedure are presented.


Enhanced directionality of bio-hybrid mobile microrobots using non-spherical body geometries.
Mobile microrobots are envisioned to be employed for several applications including drug delivery, diagnostic imaging and environmental monitoring. In the bio-hybrid microrobot that is presented here, microparticles are used as the body of the microrobot and bacterial cells are utilized to realize on-board actuation. In this work, the importance of body shape on the dynamics of bacteria-propelled swimming microrobots (BacteriaBots) is investigated. We have shown that, with the use of non-spherical microparticles, average directionality of the BacteriaBots is enhanced compared with the spherical BacteriaBots.


ACTN4 gene mutations and single nucleotide polymorphisms in idiopathic focal segmental glomerulosclerosis.
To investigate the association between mutations or single nucleotide polymorphisms (SNPs) of the gene ACTN4 in Chinese patients with idiopathic focal segmental glomerulosclerosis (FSGS). Genomic DNA of 82 Chinese idiopathic FSGS patients and 70 healthy people were used to analyze ACTN4 gene mutations by polymerase chain reaction, direct sequencing and GenBank matching. Hair follicle DNA of novel mutated patients' parents were sequenced and alpha-actinin-4 expression in patients' kidney was examined by immunofluorescence. For SNPs, after the Hardy-Weinberg equilibrium test, allele association and the frequencies of genotypes were analyzed, followed by association analysis between genotypes and clinical diagnosis. We found a heterozygous candidate mutation 184T>A (S62T) in 1 patient and a 5' UTR candidate mutation 1-34C>T in another patient. Both patients had non-nephrotic syndrome FSGS with reduced kidney alpha-actinin-4 expression. Promoter activity analysis suggests that the 1-34C>T candidate mutation may affect the transcriptional regulation of ACTN4 gene. Additionally, 6 novel silent variants and 2 novel SNPs were also found in this study. Novel SNP 484 + 87C>G had a significant association with the level of urine protein excretion in these idiopathic FSGS patients. Our data suggest that mutations and SNP of ACTN4 gene may contribute to be associated with Chinese idiopathic FSGS.


Pleomorphic xanthoastrocytoma: report of a case diagnosed by intraoperative cytopathological examination.
The authors present an unusual case of a 13-yr-old boy with a 3-mo history of seizures. A CT scan showed a contrast-enhancing mass located in the left temporal lobe. The patient underwent a stereotatic-guided craniotomy; intraoperative cytological diagnosis was performed by the smear technique, showing a pleomorphic xanthoastrocytoma. The tumor was totally resected. Definitive diagnosis was established by examination of paraffin-embedded material. Six months after the surgical intervention, the patient is doing well, with no radiological evidence of recurrence. The cytological differential diagnosis of giant cell lesions of the central nervous system is emphasized.


Childhood cancer and hypercalcemia: report of a case treated with pamidronate.
Hypercalcemia in a 4-year-old boy with non-Hodgkin lymphoma treated with pamidronate is presented. The child had relapsed disease with bone metastasis. Hypercalcemia is rare in children, and bisphosphonates are relatively new agents for the treatment of hypercalcemia. Information concerning their use in the treatment of hypercalcemia in childhood is limited. We found that pamidronate is effective and has no significant side effects in a child.


Transcriptional analysis reveals the relativity of acid tolerance and antimicrobial peptide resistance of Salmonella.
The objective of this study was to comprehensively identify the target genes induced by acid stimulation in Salmonella, and to clarify the relativity of acid tolerance and antimicrobial peptide resistance. A clinical S. Typhimurium strain, S6, was selected and performed a transcriptome analysis under the acid tolerance response. In total, we found 1461 genes to be differentially expressed, including 721 up-regulated and 740 down-regulated genes. Functional annotation revealed differentially expressed genes to be associated with regulation, metabolism, transport, virulence, and motility. Interestingly, KEGG pathway analysis demonstrated that the induced genes by acid were enriched in cationic antimicrobial peptide resistance, sulfur relay system, ABC transporters, and two-component system pathway. Therein, PhoQ belonging to the two-component system PhoP-PhoQ that promotes virulence by detecting the macrophage phagosome and controls the transcript levels of many genes associated with the resistance to AMPs; MarA, a multiple antibiotic resistance factor; SapA, one of the encoding gene of sapABCDF operon that confers resistance to small cationic peptides of Salmonella; YejB, one of the encoding gene of yejABEF operon that confers resistance to antimicrobial peptides and contributes to the virulence of Salmonella, were all induced by acid stimulation, and could potentially explain that there is a correlation between acid tolerance and AMPs resistance, and finally affects the virulence of intracellular pathogenic bacteria.


Cardiac disease in the adult: MR evaluation.
Cardiac MR imaging to date has provided detailed information regarding cardiac structure and anatomy. Recent developments in imaging speed have broadened the applications of cardiac MR from the research laboratory to a wide variety of clinical applications involving assessment of both cardiac function and perfusion. In this review, we present methods used for MR evaluation of acquired cardiac disease in the adult. Applications to ischemic heart disease, cardiomyopathy, coronary imaging, myocardial perfusion, and pericardial disease are discussed.


Regulation of renal transport processes and hemodynamics by macrophages and lymphocytes.
Inflammatory diseases of the renal glomerulus and interstitium are characterized by numerous alterations in renal glomerular hemodynamics and tubule transport processes. The cellular mechanisms underlying these changes have been theoretically attributed to nephron toxicity and destruction. However, recent studies suggest that many of the alterations in renal physiology may be mediated by specific immune cell-derived factors. Macrophages release a variety of cytokines on activation. One of these monokines, interleukin 1, induces a natriuresis by direct inhibition of collecting duct sodium reabsorption. Glomerular macrophages release highly vasoconstrictive compounds, including leukotriene D4 and thromboxane A2. Macrophages have now been demonstrated to migrate into the renal interstitium in diseases not previously considered to have an immunological component. Acute ureteral obstruction is characterized by a rapid infiltration of macrophages and lymphocytes into the kidney. Removal of the immune cell infiltrate in ureteral obstruction by irradiation markedly improves glomerular filtration rate and renal blood flow and partially corrects sodium and water excretion. Such immune modulation of renal function is likely to occur in a wide variety of diseases of the kidney, many of which do not involve a primary immunological insult. We propose that the abnormalities in renal hemodynamics and in the transport of fluid and electrolytes observed in states characterized by coexistence of immune cells among renal parenchymal cells may reflect a complex immune modulation of renal cell physiology.


Transposition of great arteries with aortopulmonary window: our surgical experience.
Transposition of the great arteries with aortopulmonary window is a rare congenital cardiac anomaly. An arterial switch operation with repair of the aortopulmonary window is the preferred operation in this subset. As the tissue between the great arteries is missing, it is considered to be a complex operation. The purpose of this study is to present our experience of a simple yet highly effective surgical technique for the management of this rare complex cardiac defect. We detail our experience of the surgery of this complex defect in 4 patients. Standard technique of an arterial switch operation with minor modification in excision of branch pulmonary arteries is all that is needed in approaching this complex subset. The moiety of tissue resulting from the absence of an aortopulmonary window was naturally covered by the proximal and distal neo-aortic flap tissue. The operative technique used in the 4 cases and their presentations are detailed in the text. Four patients of ages 28 days, 35 days, 40 days, and 6 months were successfully operated. One patient expired on postoperative day 21. In this case, advanced age of presentation, severe pulmonary artery hypertension, and sepsis possibly caused the death. The remaining 3 patients are off medication now and are being regularly followed up. In our experience early diagnosis and an arterial switch operation have been crucial in getting a favorable outcome in planning of this complex congenital heart disease.


Interpretive Reliability of Six Computer-Based Test Interpretation Programs for the Minnesota Multiphasic Personality Inventory-2.
The reliability of six Minnesota Multiphasic Personality Inventory-Second edition (MMPI-2) computer-based test interpretation (CBTI) programs was evaluated across a set of 20 commonly appearing MMPI-2 profile codetypes in clinical settings. Evaluation of CBTI reliability comprised examination of (a) interrater reliability, the degree to which raters arrive at similar inferences based on the same CBTI profile and (b) interprogram reliability, the level of agreement across different CBTI systems. Profile inferences drawn by four raters were operationalized using q-sort methodology. Results revealed no significant differences overall with regard to interrater and interprogram reliability. Some specific CBTI/profile combinations (e.g., the CBTI by Automated Assessment Associates on a within normal limits profile) and specific profiles (e.g., the 4/9 profile displayed greater interprogram reliability than the 2/4 profile) were interpreted with variable consensus (α range = .21-.95). In practice, users should consider that certain MMPI-2 profiles are interpreted more or less consensually and that some CBTIs show variable reliability depending on the profile.


Modern perspectives on the health benefits of kefir in next generation sequencing era: Improvement of the host gut microbiota.
Kefir is a natural complex fermented milk product containing more than 50 species of probiotic bacteria and yeast, and has been demonstrated to have multiple properties conferring health benefits, including antiobesity, anti-hepatic steatosis, antioxidative, antiallergenic, antitumor, anti-inflammatory, cholesterol-lowering, constipation-alleviating, and antimicrobial properties. To better understand the underlying mechanisms of these benefits, we here review research on the effect of kefir (and kefir microorganisms) consumption to modulate the host gut microbiota. Owing to its excellent gastrointestinal resistance and colonization ability and wide ranges of microbial interaction, kefir has shown significant and wide-spectrum modulatory effects on the host gut microbiota. In particular, as a bacteria- and yeast-containing food, kefir can modulate both the gut microbiota and mycobiota. Since the association of this modulation with health benefit has only been addressed in a small number of recent studies thus far, further studies are needed to determine the precise mechanisms of the beneficial effects of kefir in relation to the modulation of the gut microbiota and mycobiota. Gaining this insight will surely help to take full advantage of this unique probiotic food.


[Autoradiographic investigation into the influence of factor XIII on wound healing in the animal experiment (author's transl)].
1. In Wistar rats pretreated with factor XIII, placebo (human albumin solution), or physiological saline, a muscle wound was produced. For pre- and postlabelling purposes the animals received 3H-thymidine. 2. Autoradiographic and histological examinations revealed wound healing promoting activity of factor XIII from 72 h post operationem onwards. 3. 7 days after surgery, in contrast to the controls, the animals pretreated with factor XIII displayed sturdy, directed connective tissue in the wound bed with ample vascularization. 4. The method with pre- and postlabelling with 3H-thymidine elucidates that wound healing through factor XIII prevailingly occurs by faster fibroblast formation.


Amaurosis fugax caused by hereditary thrombophilia due to mutation of gene.
We are presenting a 59-year-old woman and 37-year-old man with amaurosis fugax. They underwent a comprehensive ophthalmological and neurological examination. Standard diagnostic examination revealed no possible cause of this temporary condition, therefore additional genetic analysis for possible hereditary thrombophilia was performed. Examination established hereditary thrombophilia: the heterozygotic type gene for MTHFR (C677), deletion/insertion polymorphism for PAI-1 (4G/5G) in women and deletion/insertion polymorphism 4G/5G for PAI-1 and heterozygotic genotype DD (190 bp) for angiotensin converting enzyme (ACE) in man. In our patients, amaurosis fugax is probably caused by hereditary thrombophilia (Ref. 16). Full Text (Free, PDF) www.bmj.sk.


Osteolysis circumscripta evanescans.
A circumscribed radiolucent skull abnormality was detected on plain radiographs obtained to evaluate minor cranial trauma in a young boy. The lesion disappeared on follow-up X-rays performed later in the day. Analysis of the case revealed that the lesion was an artifact resulting from a superimposed hole in a wooden backboard on which the patient was X-rayed initially. Radiographs shot through a protective backboard may be misleading, and not all abnormalities identified belong to the patient.


Nicotine decreases beta-amyloid through regulating BACE1 transcription in SH-EP1-α4β2 nAChR-APP695 cells.
Alzheimer's disease (AD) is a neurodegenerative disorder that affects the elderly population. Deposition of beta-amyloid (Aβ) in the brain is a hallmark of AD pathology. In our previous study, we have constructed a cell line expressing human APP695 (hAPP695) in SH-EP1 cells stably transfected with human nicotinic receptor (nAChR) α4 subunit and β2 subunit gene. In present study, we found that activation of α4β2 nAChR by nicotine and epibatidine decreased secreted Aβ level in the cell line and hippocampal neurons, but had no effects on full-length APP695 and sAPP-α. Nicotine also decreases BACE1 and PSEN1 expression, as well as ERK1 and NFκB P65 subunit expression in the cell line. Furthermore, BACE1 promoter activity is, but PSEN1 not, decreased by nicotine in the cell line. All the results suggest that activation of α4β2 nAChR decreases Aβ through regulating BACE1 transcription by ERK1-NFκB pathway. Additionally, analysis of BACE1 promoter activity by dual-luciferase reporter assay may be useful for drug screening as a high throughput method.


A conceptually novel construction of the 6a-hydroxypterocarpan skeleton - Synthesis of (±)-variabilin.
A new access to the 6a-hydroxypterocarpan variabilin was established. Key step of this concise total synthesis is a challenging cyclization of a haloketone via halogen-metal exchange and subsequent intramolecular addition to the carbonyl function.


Facilitation of spinal cord stimulator implantation with epidural analgesia.
Spinal cord stimulator insertion can sometimes be impossible to achieve because of pain during attempted electrode advancement. Heavy sedation and general anaesthesia are contraindicated and epidural analgesia would appear to be a logical, but overlooked solution. A case is described where dilute lignocaine abolished prohibitive pain but left the appreciation of stimulation paraesthesias unaffected. The advantages of such an approach are discussed.


Free energy landscape for glucose condensation and dehydration reactions in dimethyl sulfoxide and the effects of solvent.
The mechanisms and free energy surfaces (FES) for the initial critical steps during proton-catalyzed glucose condensation and dehydration reactions were elucidated in dimethyl sulfoxide (DMSO) using Car-Parrinello molecular dynamics (CPMD) coupled with metadynamics (MTD) simulations. Glucose condensation reaction is initiated by protonation of C1--OH whereas dehydration reaction is initiated by protonation of C2--OH. The mechanisms in DMSO are similar to those in aqueous solution. The DMSO molecules closest to the C1--OH or C2--OH on glucose are directly involved in the reactions and act as proton acceptors during the process. However, the energy barriers are strongly solvent dependent. Moreover, polarization from the long-range electrostatic interaction affects the mechanisms and energetics of glucose reactions. Experimental measurements conducted in various DMSO/Water mixtures also show that energy barriers are solvent dependent in agreement with our theoretical results.


[Update on the Mali Pharmacy Code: legislative section].
Due to colonization (1895-1960) Mali has been submitted, on the legislative and regulation plan to a corpus of numerous and scattered texts relative to pharmacy. It is essentially the Law AN XI of 21 Germinal or the 11 April 1803 Law; the content of Book V of the Public Health Code relative to pharmacy practice, of which some disposals have been extended to Overseas Territories, Togo and Cameroon in 1953; the 1955 Ministerial Order about the dispatching of the Retail Pharmacy in AOF; the 1960 Law creating the Board of Pharmacists in the Federation of Mali etc. After independence, the new Malian State while renewing the pharmacy legislation issued by the old tutor State which was not opposed to the new fundamental Law, has also set up, according to the political orientations of the moment, some new texts. In the framework of this work, we have collected all the legislative and regulation texts that have been allowed in Mali in the pharmacy area and in that of Studies in Pharmacy. We have examined those texts and proceeded to codify the legislative part. The present Code consists of 189 articles divided in 5 titles layed out in chapters and sections.


The economic impact of minimally invasive total hip arthroplasty.
We compared hospital length of stay (LOS) and costs between (1) minimally invasive total hip surgery (MIS) combined with an active hip pathway (AHP) and (2) long incision total hip surgery (LIS) with a passive hip pathway (PHP). A prospective consecutive cohort of 214 MIS/AHP patients was compared to a concurrent cohort of 265 LIS/PHP patients. The MIS/AHP cohort had significantly decreased LOS (1.5 days vs. 3.8 days, P < .001) and hospital costs ($12.8 thousand vs. $16.7 thousand, P < .001). The complication rates were similar for MIS/AHP and LIS/PHP. We conclude that, compared to LIS/PHP, MIS/AHP significantly shortened LOS by an average of 2.3 days, and significantly reduced hospital costs by an average of $3.9 thousand per patient.


Seamless prevention of adverse events from tattooing: integrated strategy emphasising the customer-tattooist interaction.
The boom in tattooing has been paralleled by more frequent adverse events, which may be localised in the skin or systemic and manifested clinically or latent. Infections, allergic reactions from red-coloured tattoos and papulo-nodular reactions from black tattoos dominate. Mild complaints are very common, with 1/5 of all tattooed individuals having acquired sensitivity to sunlight in the tattooed skin. The potential risk of cancer due to potential carcinogens in some tattoo inks has hitherto not manifested in clinical reports, despite the millions of people who have been tattooed over many decades. A risk of death from tattooing remains associated with severe infection, i.e. sepsis. Preventive strategies may rely on focused preventions, and sterility and preservation of ink is essential, rational and knowledge-based. The chemical and particle contents of ink nanoparticles cannot be unrestricted; however, focused control of ink is facing many uncertainties, including analytical problems, lack of identification of allergens in ink and discrepancies between the content of potential carcinogens and manifestation of cancer in the clinic. The concept of seamless prevention is introduced as a pragmatic strategy that emphasises the customer-tattooist interaction, which is the 'engine' of tattoo safety. This strategy amalgamates the range of narrow-scope preventive instruments and shall ensure that any relevant instrument is used actively and without deficiency or drop out, thus resulting in a complete orchestration of a multi-targeted strategy. High-priority elements of this strategy shall facilitate a qualified 'go' or 'no go' decision by the customer before the tattoo is made and should involve informed consent, qualification of the tattooist and the parlour, including supplies of inks etc., and attention to hygienic security. Records and documentation of tattoo cases with complications and the culprit inks as well as the establishment of national or European-based surveillance systems that are properly equipped to deliver efficient clarification and handling of adverse events and hazards of tattooing and inks, which needs attention and timely action to prevent additional cases and epidemic outbreaks, are part of this seamless strategy, along with optimised medical therapy and research.


Interferon alpha-2B and ribavirin in combination for patients with chronic hepatitis C who failed to respond to, or relapsed after, interferon alpha therapy: a randomized trial.
To assess the efficacy of interferon alpha-2b and ribavirin in combination in the treatment of patients with chronic hepatitis C who had either failed to respond to therapy with interferon alpha (nonresponders), or who had relapsed after interferon therapy (relapsers). Four hundred patients with chronic hepatitis C (200 nonresponders and 200 relapsers) were randomly assigned in equal numbers to receive either subcutaneous administration of recombinant interferon alpha-2b (3 million units three times per week) and ribavirin (1,000 to 1,200 mg/daily orally) or interferon alpha-2b alone (6 million units three times per week). Both ribavirin and interferon alpha-2b were given for 24 weeks. The patients were then followed for an additional 24 weeks. At the end of the treatment period, normalization of serum alanine aminotransferase levels and absence of hepatitis C virus RNA were seen in 21% of nonresponders and in 39% of relapsers who were treated with interferon alpha-2b and ribavirin, compared with 5% of nonresponders (P = 0.001) and 9% of relapsers treated with interferon alpha-2b alone (P <0.001). At the end of follow-up, 14% of nonresponders and 30% of relapsers treated with the combination therapy had a sustained response, compared with 1% of nonresponders (P = 0.001) and 5% of relapsers treated with interferon alpha alone (P <0.001). A 24-week course of treatment with interferon alpha-2b and ribavirin offers a chance of sustained response, whereas retreatment with interferon alpha-2b alone does not give satisfactory results. The role of long-term therapy in inducing prolonged remission remains to be explored.


Clinical evidence of subcutaneous CO2 insufflations: a systematic review.
To evaluate the evidence of clinical effectiveness of subcutaneous CO2 insufflations (SCIs). STUDY LOCATION: The entire databases of MEDLINE, EMBASE Excerpta Medica (Field: Rehabilitation and Physical Medicine) and the Cochrane Library were screened for data up to August 1999. In addition, other potentially relevant journals were handsearched and references were checked. Uncontrolled observational trials (UCOTs) with sample sizes of at least n = 100, and controlled clinical trials (CCTs) and randomized controlled trials (RCTs) were included. Outcomes had to be patient-centered. English-, Czechoslovakian-, and German-language papers were considered. For all study types, a criteria-based analysis was performed. For controlled trials only, quality was quantitatively assessed with the Jadad and Maastricht Scales. Thirteen studies (5 RCTs, 2 CCTs, and 6 UCOTs) were included. Mean scores on the Jadad and Maastricht Scales were 2 (Maximum 5) and 37 (Maximum 100), respectively. SCIs were found to be effective in addition to standard physical therapy in "peripheral arterial occlusive disease" (2 RCTs) and "stable angina pectoris" (1 RCT) and superior to sham needling for migraine headaches (1 RCT). There were no differences among SCIs and CO2 gas baths (1 RCT) or combined interventions, including SCIs (2 CCTs). All 6 UCOTs showed marked longitudinal effects. The low number and quality of the available studies precludes firm conclusions on the clinical effectiveness of SCIs.


Carotid intima-media thickness in young survivors of childhood cancer.
Radiotherapy (RT) and some chemotherapy regimens are known risk factors predisposing to the development of premature arterial disease. Vascular ultrasound measurement of carotid intima-media thickness (IMT) is a non-invasive technique, useful to detect early subclinical symptoms of atherosclerosis that can appear in the paediatric population. We analysed the influence of chemotherapy and moderate doses of head or neck irradiation in childhood cancer survivors on the possibility of premature carotid artery disease. Ultrasound measurements of the intima-media thickness (IMT) in the common carotid artery (CCA), bulb and internal carotid artery (ICA) were performed in 74 young cancer survivors and in 48 age- and sex-matched controls. In the whole study group, we observed higher IMT in all positions as compared with the control, except for comparable thickness in the CCA (bilaterally). We failed to find any differences in IMT between irradiated and non-irradiated females. In irradiated males, all IMT measurements on the right side were higher than in non-irradiated patients. There was no effect of body mass index, blood pressure, serum cholesterol, triglycerides, fibrinogen and thyroid hormones on IMT. In the irradiated group, a positive correlation was observed between IMT in the right bulb and the post-radiation time. Anticancer treatment during childhood, especially including irradiation to the mediastinum, head or neck, affects the IMT, particularly in males. This suggests a possible role of irradiation in the premature development of carotid artery disease.


Molecular detection of Enterococcus species in root canals of therapy-resistant endodontic infections.
The objectives were to identify Enterococcus spp in nonhealing endodontic cases using PCR amplification and molecular sequencing, and to determine if the prevalence of enterococci is increased in diabetic patients. Specimens from 40 cases undergoing retreatment were incubated in prereduced thioglycollate broth at 37 degrees C. Extracted DNA had PCR amplification using primers that target the tuf gene of 14 Enterococcus spp. PCR products were directly sequenced and identified phylogenetically. Three cases were eliminated because the patients were on antibiotics or the tooth did not have a periradicular radiolucency. The remaining 37 specimens included 6 from diabetic patients. Eight specimens were positive for Enterococcus spp. Of these, 6 (19%) were from nondiabetic and 2 (33%) from diabetic patients (odds ratio = 2.1; chi squared, P = .45). Phylogenetically, all sequences from positive specimens matched E faecalis V583 (AE016947). Conclusion E faecalis was the only enterococcal species detected, with an overall prevalence of 22%.


[Pathophysiology of biliary lithiasis].
Gallstones affect about 15% of adults in Europe. Cholesterol gallstone is the common form of the disease. Pigment stones, resulting from bilirubin precipitation feature particular clinical settings such as chronic hemolysis, intestinal malabsorption and various biliary tract diseases. Supersaturation of bile with cholesterol, increased formation of deoxycholic acid and gallbladder hypomotility are the main factors involved in gallstones pathogenesis.


Repair of erosions in rheumatoid arthritis does occur. Results from 2 studies by the OMERACT Subcommittee on Healing of Erosions.
The committee was charged with determining whether healing of erosions in rheumatoid arthritis (RA) occurs. Two exercises were performed: The first asked the committee members, as a panel of experts, to express agreement or disagreement with the presence of improvement and features of bone reaction to injury in images submitted by members as examples of healing. The second presented panel members with 28 pairs of serial images, 14 chosen to illustrate progression and 14 chosen to illustrate repair. Agreement was tested on 8 items: global judgment on which image in the pair was better, relative size of the erosion in the 2 images, judgment on which image was first, presence and extent of sclerosis, cortication, filling-in, remodeling, and reconstituting normal structure. Our results showed good agreement, among the 15 respondents, on global assessment of which image was better and which image showed the smaller erosion. Correct assignment of sequence was only slightly better than expected by chance (in 65% of the cases). Agreement was poor regarding the presence of morphologic features of bone repair. A majority of a panel of experts agreed on which 2nd images in a set of paired, serial images represented improvement and which showed progression based on global assessment of which was better and on size of erosion. Features of bone repair were not distinctive and did not enable the panel to deduce the correct sequence of the serial images. This study provides evidence that repair of bone damage in RA does occur, resulting in some degree of improvement, which was recognized by a majority of a panel of experts.


Cost of Surgery for Symptomatic Spinal Metastases in the United Kingdom.
Spinal metastases represent a significant health and economic burden. The average cost of surgical management varies between institutions and countries, partially a result of differences in health care system billing. This study assessed hospital costs from a single institute in the United Kingdom National Healthcare Service and identified patient factors associated with these costs. This prospective study recruited patients with confirmed symptomatic spinal metastases who presented for surgical treatment. The primary outcome was cost of inpatient treatment collected using the Patient Level Costing and Information System; preoperative details collected included patient demographics, primary tumor type, Tomita and Tokuhashi scores, pain level, EuroQol 5 dimension score, Frankel, Karnofsky, and American Society of Anesthesiologists' physical status classification system scores, and operative details. Costs were analyzed for 74 patients. The mean cost of treatment (standard deviation, SD) per patient was £ 16,885 (£ 10,687); which was mainly comprised of operating theater (25% of the total) and ward costs (27%). Better health status at presentation significantly increased total and ward costs (Frankel score P = 0.006, and EuroQol 5 dimension index P = 0.014 respectively); male sex also increased total and ward costs (P < 0.01 and P = 0.06). Operation cost showed a trend to increased costs with less impairment on American Society of Anesthesiologists' physical status classification system scores. The cost of surgical management of spinal metastases is associated with several factors but is greater in patients presenting with better health status, probably because of their suitability for larger operations, whereas those with poor health status undergo smaller, palliative operations, resulting in shorter inpatient postoperative recovery.


Chronic effects of imipramine and lithium on postsynaptic 5-HT1A and 5-HT1B sites and on presynaptic 5-HT3 sites in rat brain.
The effects of chronic treatment with imipramine, a tricyclic antidepressant, or lithium, an antimanic-depressive illness drug, on postsynaptic serotonin-1A (5-HT1A) and 5-HT1B sites and on presynaptic 5-HT3 sites in the frontal cortex and hippocampus from rat brains were studied. Chronic i.p. administration (21 days) of imipramine reduced the maximum number of binding sites (Bmax) for postsynaptic 5-HT1A as monitored by the radioligands 3H-5-HT or 3H-8-hydroxy-2-(di-n-propylamino)tetralin (3H-8-OH-DPAT), but did not change the Bmax for postsynaptic 5-HT1B and presynaptic 5-HT3 in either the frontal cortex or the hippocampus. Chronic i.p. administration (21 days) of lithium reduced the Bmax for postsynaptic 5-HT1A sites in the hippocampus, but not in the frontal cortex. There was a specific difference between imipramine and lithium regarding the inhibitory effect on postsynaptic 5-HT1A sites in the frontal cortex. In addition, lithium decreased the affinity of presynaptic 5-HT3 sites in the hippocampus. These findings may be also consistent with the inhibitory effect of lithium on presynaptic autoreceptors, which results in an increase of 5-HT release. It is concluded that enhanced 5-HT neurotransmission which develops during chronic treatment with imipramine or lithium seems tob e related to the down-regulation of postsynaptic 5-HT1A receptors in addition to postsynaptic 5-HT2 receptors, which may also have an important role in the antidepressant effects of these drugs.


CD40 stimulation induces Pax5/BSAP and EBF activation through a APE/Ref-1-dependent redox mechanism.
CD40 is a member of the growing tumor necrosis factor receptor family that has been shown to play important roles in T cell-mediated B lymphocyte activation. Ligation of B cell CD40 by CD154, mainly expressed on activated T cells, stimulates B cell proliferation, differentiation, isotype switching, up-regulation of surface molecules contributing to antigen presentation, development of the germinal center, and the humoral memory response. In this study we demonstrate that the redox factor APE/Ref-1 acts as a key signaling intermediate in response to CD40-mediated B cell activation. The transcription factors Pax5a or BSAP (B cell lineage-specific activator protein) and EBF (early B cell factor) are constitutively expressed in spleen B cells and CD40 cross-linking induces increases in Pax5a and EBF binding activity compared with nonstimulated B cells. We show that upon CD40 antibody-mediated cross-linking, APE/Ref-1 translocates from the cytoplasm to the nucleus of activated B cells, where it modulates the DNA binding activity of both Pax5a and EBF. Moreover, we show that the repression of APE/Ref-1 protein production is able to block CD40-mediated Pax5a activation. We also provide evidence that APE/Ref-1 can modulate the cooperative activation of the blk promoter operated by Pax5a and EBF and that APE/Ref-1 might directly regulate EBF functional activity. Finally, we show that the interaction between Pax5a and EBF enhances EBF binding activity to its consensus sequence, suggesting that Pax5a can physically interact with EBF and modulate its DNA binding activity.


Differences in the biotransformation of 2,4,6-trinitrotoluene (TNT) between wild and axenically grown isolates of Myriophyllum aquaticum.
The aim of this study was to demonstrate the potential for aquatic plants and their associated microbes to bioremediate wetland sites contaminated with 2,4,6-trinitrotoluene (TNT). The transformation of TNT was studied using both wild and axenically grown isolates of Myriophyllum aquaticum (parrot feather). Differences in TNT transformation rates and nitroaromatic metabolites were observed between different plants. The wild isolates, containing a consortium of associated microorganisms, transformed TNT into 2-amino-4,6-dinitrotoluene (2-A-DNT) and 4-amino-2,6-dinitrotoluene (4-A-DNT) via 2- and 4-hydroxylamino-dinitrotoluene, which were detected as intermediates. The wild M. aquaticum also converted the metabolites, 2-A-DNT and 4-A-DNT, into low levels of 2,4-diaminotoluene (2,4-DAT). The axenically grown plants, containing no cultureable microorganisms, also transformed TNT into 2-A-DNT and 4-A-DNT, but at a much lower rate than that observed for the wild isolates. Unlike the wild plants, axenically grown M. aquaticum could not transform either 2-A-DNT or 4-A-DNT into 2,4-DAT over the incubation period. The differences in the performance between these plants could indicate that plant-associated microorganisms assisted in the overall transformation of TNT. For each plant, unidentifiable metabolites were observed and the soluble monoamino-derivatives present in the wild and axenic medium accounted for 14 and 7% of the initial TNT concentration, respectively. Thus, the majority of nitroaromatic derivatives remained associated with the plant tissues. Furthermore, only 7 and 3% of the initial TNT concentration were extracted as monoamino-derivatives from the tissues of the wild and axenically grown plants, respectively.


A Bayesian spatial multimarker genetic random-effect model for fine-scale mapping.
Multiple markers in linkage disequilibrium (LD) are usually used to localize the disease gene location. These markers may contribute to the disease etiology simultaneously. In contrast to the single-locus tests, we propose a genetic random effects model that accounts for the dependence between loci via their spatial structures. In this model, the locus-specific random effects measure not only the genetic disease risk, but also the correlations between markers. In other words, the model incorporates this relation in both mean and covariance structures, and the variance components play important roles. We consider two different settings for the spatial relations. The first is our proposal, relative distance function (RDF), which is intuitive in the sense that markers nearby are likely to correlate with each other. The second setting is a common exponential decay function (EDF). Under each setting, the inference of the genetic parameters is fully Bayesian with Markov chain Monte Carlo (MCMC) sampling. We demonstrate the validity and the utility of the proposed approach with two real datasets and simulation studies. The analyses show that the proposed model with either one of two spatial correlations performs better as compared with the single locus analysis. In addition, under the RDF model, a more precise estimate for the disease locus can be obtained even when the candidate markers are fairly dense. In all simulations, the inference under the true model provides unbiased estimates of the genetic parameters, and the model with the spatial correlation structure does lead to greater confidence interval coverage probabilities.


Assessment of the yeast species composition of cocoa bean fermentations in different cocoa-producing regions using denaturing gradient gel electrophoresis.
The yeast species composition of 12 cocoa bean fermentations carried out in Brazil, Ecuador, Ivory Coast and Malaysia was investigated culture-independently. Denaturing gradient gel electrophoresis of 26S rRNA gene fragments, obtained through polymerase chain reaction with universal eukaryotic primers, was carried out with two different commercial apparatus (the DCode and CBS systems). In general, this molecular method allowed a rapid monitoring of the yeast species prevailing during fermentation. Under similar and optimal denaturing gradient gel electrophoresis conditions, the CBS system allowed a better separated band pattern than the DCode system and an unambiguous detection of the prevailing species present in the fermentation samples. The most frequent yeast species were Hanseniaspora sp., followed by Pichia kudriavzevii and Saccharomyces cerevisiae, independent of the origin of the cocoa. This indicates a restricted yeast species composition of the cocoa bean fermentation process. Exceptionally, the Ivorian cocoa bean box fermentation samples showed a wider yeast species composition, with Hyphopichia burtonii and Meyerozyma caribbica among the main representatives. Yeasts were not detected in the samples when the temperature inside the fermenting cocoa pulp-bean mass reached values higher than 45 °C or under early acetic acid production conditions.


Antibacterial, partially acetylated oligorhamnosides from Cleistopholis patens.
Three new (1-3) and five known (4-8) partially acetylated oligorhamnoside derivatives were obtained from Cleistopholis patens via high-throughput natural products chemistry procedures. The rapid structure elucidation and dereplication were performed primarily utilizing a capillary-scale NMR probe and LR-/HRESIMS spectroscopic methods. Compounds 1, 2, and 6 were found to possess significant in vitro antibacterial activity against the Gram-positive bacteria methicillin-resistant Staphylococcus aureus ATCC 33591 and S. aureus 78-13607A with MICs of < or =16 microg/mL. Furthermore, 2 and 6 were found to show significant in vitro antibacterial activity against an expanded panel of Gram-positive pathogens including either ATCC strains or well-characterized clinical isolates from the global SENTRY Antimicrobial Surveillance Program.


Outcomes in prevention and management of miscarriage trials: a systematic review.
There is a substantial body of research evaluating ways to prevent and manage miscarriage, but all studies do not report on the same outcomes. To review systematically, outcomes reported in existing miscarriage trials. MEDLINE, Embase, CINAHL, and Cochrane were searched from inception until January 2017. Randomised controlled trials (RCTs) reporting prevention or management of miscarriage. Miscarriage was defined as a pregnancy loss in the first trimester. Data about the study characteristics, primary, and secondary outcomes were extracted. We retrieved 1553 titles and abstracts, from which 208 RCTs were included. For prevention of miscarriage, the most commonly reported primary outcome was live birth and the top four reported outcomes were pregnancy loss/stillbirth (n = 112), gestation of birth (n = 68), birth dimensions (n = 65), and live birth (n = 49). For these four outcomes, 58 specific measures were used for evaluation. For management of miscarriage, the most commonly reported primary outcome was efficacy of treatment. The top four reported outcomes were bleeding (n = 186), efficacy of miscarriage treatment (n = 105), infection (n = 97), and quality of life (n = 90). For these outcomes, 130 specific measures were used for evaluation. Our review found considerable variation in the reporting of primary and secondary outcomes along with the measures used to assess them. There is a need for standardised patient-centred clinical outcomes through the development of a core outcome set; the work from this systematic review will form the foundation of the core outcome set for miscarriage. There is disparity in the reporting of outcomes and the measures used to assess them in miscarriage trials.


Public funding of contraceptive, sterilization and abortion services, fiscal year 1990.
In FY 1990, the federal and state governments spent $504 million to provide contraceptive services and supplies, according to results of a survey of state health, social services and Medicaid agencies conducted by The Alan Guttmacher Institute. Medicaid accounted for 38 percent of all public funds spent on contraceptive services, Title X provided 22 percent, and two federal block-grant programs--Social Services and Maternal and Child Health--together were responsible for 12 percent of public expenditures. State governments accounted for the remaining 28 percent of public funding. Although public expenditures for contraceptive services have risen by $154 million over the past decade, when inflation is taken into account, expenditures have actually fallen by one-third. Since 1980, the proportion of public contraceptive expenditures contributed by Title X has been cut virtually in half, while the proportion contributed by state governments has nearly doubled. When inflation is taken into account, Title X expenditures for contraceptive services have fallen by almost two-thirds since 1980. The federal and state governments together spent $95 million to subsidize sterilization services in 1990, and $65 million to provide abortion services. The federal government was the major source of funding for sterilization services but provided less than one percent of the cost of abortion services. Because of changes over time in survey methodology and the difficulties some states had in separating out expenditures by type of care, these data are approximations.


[Evaluation of the new detectable method of the specimen mix-up in a microbiological examination].
To date, it has been difficult to detect a mix-up of specimens for microbiological examinations. We developed and evaluated a computer program that detects specimen mix-up during the examinations. Once some bacterial species such as Pseudomonas aeruginosa and MRSA are detected in an examination, it is not easy for these bacteria to disappear on subsequent examinations. It is possible to speculate that there has been a specimen mix-up when there are differences in the existence of bacterial species between the results of the past and current examinations. In this study, 1379 false mix-up specimens were created and evaluated for the detection of specimen mix-ups using this method and 417 of the 1379 specimens were detected as mix-ups (sensitivity; 30.2%). Furthermore, when 1486 real specimens were evaluated for the detection of mix-ups, 114 samples were judged to have been mixed-up. Three of these samples were mixed up during the examinations (specificity; 92.5%). These findings suggest that this method is useful for the detection of specimen mix-up during microbiological examinations.


The urea cycle: a two-compartment system.
Channelling and enzyme localization remain controversial; they have been proposed for a number of metabolic pathways, especially glycolysis and the tricarboxylic acid cycle. One aspect that is often overlooked in discussions of channelling is that very tight channelling is readily accepted in pathways which occur in enzyme complexes, for example fatty acid synthetase, the 2-oxoacid dehydrogenase complexes and the protein synthesis/ribosome complex. As a metabolon the urea cycle is presently unique since it covers two conventional compartments. For the urea cycle, channelling appears to be almost complete with varying degrees of tightness at each step. Since a considerable portion of the nitrogen for urea synthesis is derived within the hepatocyte from amino acids, does this means that numerous enzyme-enzyme associations are required for this metabolon? Another important, as yet unaddressed, question is what are the consequences of channelling to theories of metabolic regulation? The answers will no doubt be forthcoming in the next few years as the concept of metabolons gains or loses acceptance.


Performance Comparison Between 18F-FDG PET/CT Plus Brain MRI and Conventional Staging Plus Brain MRI in Staging of Small Cell Lung Carcinoma.
The purpose of this study was to prospectively compare the capabilities of integrated FDG PET/CT and conventional staging for identification of TNM factors, evaluation of the TNM and Veterans Administration Lung Study Group (VALSG) stages, and selection of patients with stage I small cell lung carcinoma (SCLC). Fifty-nine patients (mean age, 69.6 ± 7.8 [SD] years; range, 40-84 years) with pathologically diagnosed SCLC underwent integrated 18F-FDG PET/CT and conventional staging with enhanced brain MRI. TNM and VALSG stages were evaluated by two different reader groups. Kappa statistics and chi-square test result were determined for evaluations of interobserver agreement of all factors and for each clinical stage for both methods. Diagnostic accuracy of identification of each factor and clinical stage was statistically compared by McNemar test. Interobserver agreements for all factors and each clinical stage were assessed as almost perfect for PET/CT (0.83 ≤ κ ≤ 0.93; p < 0.001) and substantial and almost perfect (0.63 ≤ κ ≤ 0.96; p < 0.001) for conventional staging plus enhanced brain MRI. The diagnostic accuracy of PET/CT for N factor and TNM stage (N, 89.8% [53/59]; TNM stage, 88.1% [52/59]) was significantly higher than that of conventional staging plus enhanced brain MRI (N, 67.8% [40/59], p = 0.0002; TNM stage, 72.9% [43/59], p = 0.004). Integrated FDG PET/CT with contrast-enhanced brain MRI is potentially equal to or more effective than conventional staging plus enhanced brain MRI for T, N, and M assessment and TNM and VALSG staging of SCLC.


Tantalum isocyanide complexes: TaI(CNDipp)6 (Dipp is 2,6-diisopropylphenyl) and ionic [Ta(CNDipp)7][Ta(CNDipp)6], a formal disproportionation product of the 17-electron Ta0 metalloradical Ta(CNDipp)6.
Treatment of tetraethylammonium hexacarbonyltantalate, [Et4N][Ta(CO)6], with 1.1 equivalents of molecular iodine (I2) in tetrahydrofuran (THF) at 200 K, followed by the addition of 6.0 equivalents of 2,6-diisopropylphenyl isocyanide (CNDipp) and slow warming to 293 K over a 24 h period gave the tantalum(I) iodide derivative hexakis(2,6-diisopropylphenyl isocyanide-κC)iodidotantalum(I), [TaI(C13H17N)6] or TaI(CNDipp)6, 1. Recrystallization of this substance from pentane provided deep-red nearly black parallelepipeds of the product, which was characterized by single-crystal X-ray diffraction. Addition of 1 in THF at 200 K to a suspension of an excess (5.8 equivalents) of caesium graphite (CsC8), followed by warming, filtration, and solvent removal, afforded a dark-green oily solid of unknown composition, from which several red-brown rhombohedral plates of the ditantalum salt heptakis(2,6-diisopropylphenyl isocyanide-κC)tantalum hexakis(2,6-diisopropylphenyl isocyanide-κC)tantalate, [Ta(C13H17N)7][Ta(C13H17N)6] or [Ta(CNDipp)7][Ta(CNDipp)6], 2, were harvested. Salt 2 is a unique substance, as it is the only known example of a salt containing a homoleptic cation, [MLx]+, and a homoleptic anion, [MLy]-, with the same transition metal and π-acceptor ligand L. In solution, 2 undergoes full comproportionation to afford the recently reported 17-electron paramagnetic zerovalent tantalum complex Ta(CNDipp)6, the only known isolable TaL6 complex of Ta0.


Therapeutic effect of nicotine in a mouse model of intracerebral hemorrhage.
Intracerebral hemorrhage (ICH) resulting from the leakage of blood into the brain parenchyma triggers severe tissue damage involving neurodegeneration and inflammation. Increasing lines of evidence indicate that the stimulation of central nicotinic acetylcholine receptors affords neuroprotection against various insults and also suppresses the proinflammatory activation of microglia. Therefore, the present study aimed to determine whether the administration of nicotine modifies the pathological consequences of ICH, using a mouse model of ICH induced by intrastriatal injection of collagenase. Daily intraperitoneal administration of nicotine (2 mg/kg), starting from 3 h after the induction of ICH, inhibited apoptosis and decreased the number of remaining striatal neurons at 3 days after the insult. We also found that nicotine administration increased the relative expression level of the antiapoptotic protein B cell lymphoma-2 versus that of the proapoptotic protein Bax in the brain. In addition, nicotine administration attenuated the activation of microglia/macrophages, infiltration of neutrophils, and increases in oxidative stress associated with ICH, without affecting hematoma expansion and brain edema. It is noteworthy that mice treated with nicotine exhibited improved sensorimotor performance and a marked increase in survival rate after ICH. These results indicate that nicotinic acetylcholine receptors may serve as a novel target for emergency therapy for ICH.


Propofol in patients with cardiac disease.
Propofol is an intravenous anaesthetic which is chemically unrelated to other iv anaesthetics. Most anaesthetists are now becoming familiar with propofol's pharmacokinetic and pharmacodynamic properties. It has proved to be a reliable drug that can be used safely for induction and maintenance of anaesthesia for most surgical procedures and unlike other anaesthetic agents, it can especially be extended into the postoperative setting or intensive care unit for sedation. Propofol's greatest attributes are its pharmacokinetic properties which result in a rapid, clear emergence and lack of cumulative effects even after prolonged administration. Compared with other iv anaesthetics, the induction dose of propofol has a relatively higher incidence of respiratory depression, short-lived apnoea and blood pressure reduction that may occasionally be marked. Possible mechanisms for the hypotension may relate to (1) its action on peripheral vasculature (vasodilatation), (2) decreased myocardial contractility, (3) resetting of the baroreflex activity and (4) inhibition of the sympathetic nervous system outflow. In vitro studies indicate that propofol depresses the immunological reaction to bacterial challenge as well as the chemotactic activity. Clinical studies, in cardiac surgery, have demonstrated that propofol, in association with an opioid, is a logical anaesthetic choice. Propofol is about to receive approval for continuous iv sedation. Comparative studies of propofol and midazolam have clearly demonstrated the superiority of propofol in terms of rapid recovery and precise control of the level of sedation.


Combined laparoscopic cholecystectomy and drainage of pancreatic pseudocyst: a case report and review of current management.
Pancreatic pseudocyst is a well recognized complication of acute or chronic pancreatitis. Active treatment (surgical or endoscopic) has been recommended if the pseudocyst persists for more than 6 weeks after the diagnosis. Open trans-abdominal drainage was initially the mainstay treatment for it. However, over the past decade, laparoscopic techniques have been developed to provide patient with minimal access alternative. We report a case of a large symptomatic pseudocyst which developed following attack of severe gallstone pancreatitis. Laparoscopic cholecystectomy and cysto-gastrostomy were done at the same sitting. The operative technique is briefly explained.


Dirofilaria presenting as orbital mass.
Dirofilaria is a common roundworm infection of dogs, cats, raccoons, and other animals that is commonly referred to as "heartworm." The genus Dirofilaria includes D. immitis, which is a common cause of animal disease in the western hemisphere and primarily manifests as pulmonary lesions in humans, and D. repens, which is the more common causative agent of animal disease in Eurasia and primarily results in subcutaneous and ocular lesions in humans. Humans are accidental end hosts, with infection resulting from bites by mosquitoes of the Culicidae family in which ingested microfilaria have matured to infectious larvae.


A randomized clinical trial comparing ranitidine and antacids in critically ill patients.
In a randomized trial of gastric pH control for stress ulcer prophylaxis, 200 mg/day ranitidine iv was compared to antacids in 86 patients admitted to an ICU. Six (15%) patients receiving ranitidine and six (13%) given antacids failed to maintain greater than 50% of the hourly gastric pH measurements at or above 4. Increasing the ranitidine dosage to 300 mg/day did not provide additional control. One patient in the antacid group developed an overt upper GI bleed secondary to endoscopically proven erosive disease. We conclude that iv ranitidine in a dosage of 200 mg/day is as effective as antacids in reducing gastric acidity and preventing stress ulcer disease in critically ill patients.


U.S. health care policy and the rising uninsured: an alternative solution.
The lack of adequate health insurance affects one's ability to access care, which directly affects one's health. In the 21st century, there are 44 million people in the United States without health care insurance. The majority of people without health care insurance are working people under age 65, because most people over age 65 are retired and have health insurance through the federal Medicare program. Maintaining a healthy population makes good business sense because healthy people are more able to work, buy goods, and pay taxes that contribute to a healthy economy and strong government. We must understand, through provider "cost shifting," the American public is already "footing the bill" for the uninsured. However, the actual amount is hidden and passed on to consumers in payments to insurance companies through raised premiums, deductibles, co-payments, exclusions from coverage, and direct out-of-pocket payments to providers (e.g., physicians, hospitals). Ironically, the very working poor who are uninsured and underinsured help fund the health insurance of select federally protected groups through taxation. A huge gap exists in the current United States system of health care wherein there is no cogent benefit, only a vicious cycle as the insured continue to pay more for their care to help compensate provider losses due to the uninsured. This in turn causes a growing rank of uninsured individuals that lack access to adequate health care. The purpose of this article is to assert an alternative to the current U.S. health care insurance system. It takes advantage of structures already in place to promote a "win-win" American health system premised on a workable tiered universal health care system in which there is a benefit to the major populace. As an emanation of a diverse society, the proposed system does not advocate a one-payer universal system that is not amenable to the U.S. health care, social, or political environment.


The plaque cytogram assay. II. Correlation between morphology and density of linear bovine serum albumin buoyant density gradient-separated immunocompetent cells.
The plaque cytogram assay has been combined with pH 6.8, linear bovine serum albumin (BSA) gradients to demonstrate the correlation between the morphology and buoyant density of immunocompetent cells. Ten types of plaque-forming cells (PFC) and four types of plaques have been identified and enriched in the density gradients. Reproducible density profiles of mouse erythrocytes, lymphoid cells, and PFC have been obtained with BSA gradients. The density peak for mouse erythrocytes was about 1.080 g/ml, while the lymphoid cell density profile had several peaks with a maximum concentration at 1.064 g/ml. Three distinct peaks or shoulders were found in the density profile of hemolytic PFC. Most of the density distributions of the individual morphologic classes of PFC were considerably narrower than that of the entire PFC distribution and were discrete from each other. The combined result that the PFC could be subdivided by morphology and density, and that the two phenomena were correlated establishes that the PFC are truly a heterogeneous population. Whether this heterogeneity is due to different stages in development or due to the existence of differing classes of cells will have to await future experimentation.


[Morpho-functional changes in the heart of sympathectomized animals during acute myocardial ischemia].
Experiments on 142 Wistar male rats were made to study the effect of chemical desympathization on functional and structural changes in the heart during acute myocardial ischemia produced by ligation of the anterior descending branch of the left coronary artery. In the desympathized rats with acute myocardial ischemia, arrhythmias occurred in a less number of cases and were less severe. One day after the artery occlusion the decrease in myocardial contractility was less considerable than in the control animals. More rapid localization of the ischemic focus was found to occur in the desympathized myocardium. The pattern of changes in lipid metabolism in the desympathized and in normally innervated heart was different: in the desympathized heart accumulation of neutral fat was observed while in the normal one acid lipids. It is concluded that different pattern of functional and structural changes in the myocardium of the normal and desympathized animal is determined by the status of the heart sympathetic nervous system, namely by a decrease or elimination of the pathogenic action on the myocardium of noradrenaline which is released in high concentrations because of sharp stimulation of the sympathoadrenal system.


Monoclonal antibodies to human vitamin K-dependent protein S.
Monoclonal antibodies to human protein S have been prepared using established hybridoma technology. One antibody was isolated that binds protein S only when Ca2+ is present; others bind antigen equally well in the presence or absence of EDTA. Other antibodies display a diminished affinity for protein S in the presence of EDTA. Purified immunoglobulins from cell lines displaying Ca2+ dependence were immobilized and used to purify protein S from fractions obtained by barium precipitation of citrated plasma, ammonium sulfate fractionation, and chromatography on diethylaminoethanol (DEAE)-Sephadex and dextran sulfate agarose. Essentially homogeneous protein S was isolated from the barium-citrate-adsorbed, 35% ammonium-sulfate-soluble proteins using a totally Ca2+-dependent antibody and EDTA elution. Protein S and several substances of higher mol wt were bound directly from plasma by a partially Ca2+-dependent antibody and were eluted partially with EDTA and NaCl and finally with NaSCN. The largest and most abundant of the high mol wt materials is likely protein S-complement C4b-binding protein complex. The immunoaffinity-isolated protein S was found to be indistinguishable from conventionally isolated protein S in terms of activity, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) mobility, and by high-performance liquid chromatography (HPLC). These studies establish reagents that can probe the structure of protein S and isolate protein S in its free and complexed forms.


Chloramine-T in radiolabeling techniques. III. Radioiodination of biomolecules containing thioether groups.
A previously reported method for iodination of the tyrosine moiety of oxidation-sensitive biomolecules was found to cause unacceptable damage to biomolecules containing thiols and thioether groups. This was due to the oxidation of the sulfur-containing residues by molecular iodine (I(2)). To selectively iodinate the tyrosine moiety with minimum oxidation to the sulfur functionality, studies of the kinetics of the reactions between I-(3) and various amino acids and small peptides at various pH values in phosphate buffer were undertaken. Within the pH range studied (5.5-8.2), the results showed that the iodination reaction is strongly catalyzed by hydroxide ions, whereas the oxidation of the sulfur group was insensitive to pH. The results also showed that both reactions are strongly catalyzed by HPO-(4) ion. In a complex molecule, such as methionine-enkephalin, oxidation of the methionine residue (undesirable reaction) proceeds in parallel with iodination of the tyrosine residue (desirable reaction). If such a molecule was iodinated in 0.01 M phosphate buffer at pH values above 7.5, the iodination reaction would proceed much more rapidly than the oxidation reaction, resulting in a high yield of iodinated substrate with little oxidative damage.