Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis.
Urinary incontinence (UI) is any involuntary loss of urine. In female athletes, physical exercise may be a risk factor for UI because of increased intra-abdominal pressure generated during high-impact exercises, which overloads the pelvic organs, predisposing them to UI. This is a systematic review of the prevalence of UI in female athletes in different sports. A search for articles was carried out in the PEDro, Scopus, Cinahl, PubMed, LILACS, SciELO, Science Direct, Web of Science, Embase, and Cochrane databases as well as a manual search of the references of studies already published on the subject with the keywords "athlete," "urinary incontinence," and "women" in Portuguese and English. Only articles published from 2000 to 2016 were included. Observational studies assessing the prevalence of UI in female athletes were selected. Methodological quality was assessed using the Downs and Black scale, and the data collected from the studies were analyzed through meta-analysis. Eight studies met the eligibility criteria. Meta-analysis showed a 36% prevalence of UI in female athletes in different sports, and compared with sedentary women, the athletes had a 177% higher risk of presenting with UI. There is a higher prevalence of UI in female athletes compared with sedentary women. There have been reports of UI in different sports.


How medical students learn from residents in the workplace: a qualitative study.
To explore what third-year medical students learn from residents and which teaching strategies are used by excellent resident teachers in their interactions with students in the clinical workplace environment. In this multi-institutional qualitative study between January and March 2012, the authors conducted focus groups with medical students who were midway through their third year. Qualitative analysis was used to identify themes. Thirty-seven students participated. Students contributed 228 comments related to teaching methods used by residents. The authors categorized these into 20 themes within seven domains: role-modeling, focusing on teaching, creating a safe learning environment, providing experiential learning opportunities, giving feedback, setting expectations, and stimulating learning. Role-modeling, the most frequently classified method of teaching in this study, was not included in three popular "Resident-as-Teacher" (RAT) models. Strategies including offering opportunities for safe practice, involving students in the team, and providing experiential learning opportunities were not emphasized in these models either. Almost 200 comments representing the knowledge and skills students learned from residents were categorized into 33 themes within nine domains: patient care, communication, navigating the system, adaptability, functioning as a student/resident, lifelong learning, general comments, career/professional development, and medical content. Most of these areas are not emphasized in popular RAT models. Residents serve as critically important teachers of students in the clinical workplace. Current RAT models are based largely on the teaching behaviors of faculty. The content and teaching strategies identified by students in this study should serve as the foundation for future RAT program development.


A ballooning heart-giant left ventricular apical pseudoaneurysm presenting as congestive heart failure.
Left ventricular (LV) pseudo aneurysm is a contained rupture of ventricular wall by adherent pericardium or scar tissue. We present a case of a 70 year-old male presented with exertional dyspnea for 2 months and found to have giant LV pseudo aneurysm on transthoracic echocardiogram, cardiac MRI and angiogram. To our knowledge such a large pseudo aneurysm involving LV apex and presenting as congestive heart failure is the first case in literature.


Epstein-Barr virus myocarditis as the first symptom of infectious mononucleosis.
This case report describes a 20-year-old immunocompetent man with an episode of chest pain radiating into both arms, an increase in the level of myocardial enzymes, electrocardiogram abnormalities (widespread ST-segment elevation and q waves in leads V(4)-V(6)) and serological evidence for acute Epstein-Barr Virus infection preceding typical signs and symptoms of infectious mononucleosis.


Kidney and testicle injuries in team and individual sports: data from the national pediatric trauma registry.
We define the risk of kidney or testicle injury in children who play contact sports. National Pediatric Trauma Registry data from 50 United States pediatric trauma centers for 1990 to 1999 were analyzed. The data were from age groups 5 to 11, 12 to 14 and 15 to 18 years. Major abdominal injuries, injuries due to team and individual contact sports, and the site of injury were examined. Of the 81,923 cases 5,439 were sports related. Abdominal injuries occurred in 459 patients (0.56%), and were due to contact sports in 191. Team sports were involved in 184 cases, including football in 44%, hockey in 19%, baseball in 15%, soccer in 12% and basketball in 6%. Abdominal injury rate by age was 16% for 5 to 11-year olds, 42% for 12 to 14-year-olds and 42% for 15 to 18-year-olds. Most common was splenic injury at 50% of cases, kidney injuries occurred in 22% and no testicle injuries were reported. Football accounted for the most kidney injuries (62%). Kidney injuries were more common among older teenagers. No injuries led to nephrectomy. Abdominal injuries are rare in children who play team and individual contact sports. No testicular injuries were reported. Kidneys are most at risk in football. Splenic injuries are most common overall, although the risk to kidney and spleen is equal in basketball. No kidneys were reported as lost. These data should help families and schools when assessing risk to genitourinary organs during these activities.


Pneumopyopericardium.
Pneumopyopericardium is a rare disease, the etiology of which can be traumatic or non-traumatic. Today the most common cause of non-traumatic disease seems to be ulceration or carcinoma in the lower esophagus or upper stomach. The present cases were caused by ulcerations in two patients and a postoperative penetrating abscess in the third. All had connections with surgery in the region. Chest radiography disclosing fluid and gas in the expanded pericardium was the main diagnostic method. The prognosis is poor and all three patients died.


Human mesenchymal stromal cells express CD14 cross-reactive epitopes.
Mesenchymal stromal cells (MSCs) do not express a unique definite epitope or marker gene. As such, minimal criteria were recently established for defining multipotent MSC. These criteria include expression of CD73, CD90, CD105, and a lack of hematopoietic marker expression. However, we detected binding of a CD14 antibody on bone marrow- and placenta-derived MSC and investigated the staining of CD14 antibodies on these MSC in more detail. The MSC were isolated from human bone marrow and placenta tissue, expanded, characterized by quantitative RT-PCR, flow cytometry, and immunocytochemistry and differentiated to generate osteoblasts, chondrocytes, and adipocytes. The CD14-cross-reactive MSCs were enriched by cell sorting. Human peripheral blood mononuclear cells, fibroblasts, and hematopoietic cell lines served as controls. Utilizing four different clones of CD14 monoclonal antibodies, we found that three CD14 reagents stained the MSC. Two CD14 antibodies (HCD14 and M5E2) clearly marked the CD90(+) MSC population with distinct intensities, clone 134 620 generated a shift in flow cytometry histograms, but clone MΦP9 did not stain MSC. Transcripts encoding CD14 or the CD14 protein were not detected in MSC. We confirm that bone marrow- and placenta-derived MSC do not express CD14 and that the CD14 antibody MΦP9 discriminates between monocytes and MSC more efficiently than the other antibodies employed here. This investigation does not contradict previous work but provides a more accurate characterization of MSC.


Enzyme catalysis of 1,2-amino shifts: the cooperative action of B6, B12, and aminomutases.
Ab initio molecular orbital theory is used to investigate 1,2-amino shifts catalyzed by aminomutases, coenzyme B12, and vitamin B6 (in the form of pyridoxal 5'-phosphate or PLP). Our calculations suggest essential catalytic roles for each of B12, B6, and the enzyme in aminomutase-catalyzed reactions. In the first place, coenzyme B12 provides a source of abstracting radicals, allowing the rearrangement reaction to take place on the radical surface. The involvement of radicals is supported by comparison of experimental and theoretical electron paramagnetic resonance parameters. Next, B6 allows the enzyme to lower the barrier height by introducing a double bond (allowing a low-energy intramolecular rearrangement pathway) and by providing a suitable site for partial protonation (preventing overstabilization of the reaction intermediate which could lead to enzyme inactivation). The PLP hydroxyl group is also identified as an important participant in these reactions. Finally, the enzyme holds the various reaction components in place and is the source of acidic functional groups that can provide partial protonation.


Subcutaneous glycerol injection fails to reduce food intake in rats fed a high protein diet.
To test whether glycerol utilization might contribute to glycerol-induced hypophagia, cumulative food intake was measured following subcutaneous glycerol injection in rats fed a high carbohydrate (HC), a high fat (HF) or a high protein (HP) diet, because food composition is known to influence the activity of several glycerol metabolizing enzymes. In additional experiments, the effect of glycerol injection on plasma glycerol, blood glucose, and liver glycogen levels was also investigated in HC-, HF-, and HP-rats. Subcutaneous glycerol injection (6.3 mmoles/kg b.w.) significantly reduced food intake in HC- and HF-rats, but failed to decrease feeding in HP-rats. Five hours after glycerol injection, plasma glycerol levels were significantly elevated in HP-rats, but did not differ from the glycerol levels of controls in HC- and HF-rats. Subcutaneous glycerol injection did not affect blood glucose concentration or liver glycogen content 5 hours after injection in any feeding group. The results suggest that oxidation of the injected glycerol might contribute to the glycerol-induced hypophagia in HC- and in HF-rats.


Influence of genetic drift on patterns of genetic variation: The footprint of aquaculture practices in Sparus aurata (Teleostei: Sparidae).
Aquaculture finfish production based on floating cage technology has raised increasing concerns regarding the genetic integrity of natural populations. Accidental mass escapes can induce the loss of genetic diversity in wild populations by increasing genetic drift and inbreeding. Farm escapes probably represent an important issue in the gilthead sea bream (Sparus aurata), which accounted for 76.4% of total escapees recorded in Europe during a 3-year survey. Here, we investigated patterns of genetic variation in farmed and wild populations of gilthead sea bream from the Western Mediterranean, a region of long gilthead sea bream farming. We focused on the role that genetic drift may play in shaping these patterns. Results based on microsatellite markers matched those observed in previous studies. Farmed populations showed lower levels of genetic diversity than wild populations and were genetically divergent from their wild counterparts. Overall, farmed populations showed the smallest effective population size and increased levels of relatedness compared to wild populations. The small broodstock size coupled with breeding practices that may favour the variance in individual reproductive success probably boosted genetic drift. This factor appeared to be a major driver of the genetic patterns observed in the gilthead sea bream populations analysed in the present study. These results further stress the importance of recommendations aimed at maintaining broodstock sizes as large as possible and equal sex-ratios among breeders, as well as avoiding unequal contributions among parents.


A machine-learning approach for predicting B-cell epitopes.
The immune activity of an antibody is directed against a specific region on its target antigen known as the epitope. Numerous immunodetection and immunotheraputics applications are based on the ability of antibodies to recognize epitopes. The detection of immunogenic regions is often an essential step in these applications. The experimental approaches used for detecting immunogenic regions are often laborious and resource-intensive. Thus, computational methods for the prediction of immunogenic regions alleviate this drawback by guiding the experimental procedures. In this work we developed a computational method for the prediction of immunogenic regions from either the protein three-dimensional structure or sequence when the structure is unavailable. The method implements a machine-learning algorithm that was trained to recognize immunogenic patterns based on a large benchmark dataset of validated epitopes derived from antigen structures and sequences. We compare our method to other available tools that perform the same task and show that it outperforms them.


Pseudo-guillain-barre syndrome due to "whippet"-induced myeloneuropathy.
Guillain-Barre syndrome (GBS) is the rubric encompassing highly variable phenotypic subgroups of acute, postinfectious, immune-mediated peripheral neuropathy. The hallmark of GBS phenomenology is a rapidly progressive ascending lower extremity weakness. GBS taxonomy includes a motor and sensory axonal neuropathy (AMSAN). Nitrous oxide (NO) abuse may create a pattern of neurological dysfunction almost identical to subacute combined degeneration. We report an adult with myeloneuropathy due to NO abuse that mimicked the presenting features of the GBS-subtype AMSAN.


[Influence of cooling temperatures on aflatoxin formation in milk products (author's transl)].
In the literature several contradictionary results have been published on the aflatoxin formation at temperatures below 10 degrees C. Therefore experiments with pastes made from milk and cheese powder artificially contaminated with Aspergillus parasiticus, were performed at temperatures of 1 degree C, 5 degrees C, and 10 degrees C for 28 days at a relative humidity of 90--95%. Even at 1 degree C, the aflatoxins B1, B2, G1, G2, and M1 could be determined quantitatively. The lactose content did not have a significant influence on the aflatoxin values. Even storage of cheese (camembert and cottage cheese) in a 10% salt solution did not inhibit aflatoxin formation at 20 degrees C.


Malaria in refugee camps in eastern Sudan: a sero-epidemiological approach.
A study of the endemicity of malaria was carried out in two refugee camps in Sudan, and the advantages and disadvantages of treating either all febrile cases or only confirmed cases of malaria were considered. Based on the information obtained during the survey, guidelines for the treatment of malaria in such refugee camps are proposed.


Ataxia-telangiectasia in Iran: clinical and laboratory features of 104 patients.
Ataxia-telangiectasia is a multisystem disorder characterized by progressive neurologic impairment, variable immunodeficiency, impaired organ maturation, x-ray hypersensitivity, oculocutaneous telangiectasia, and a predisposition to malignancy. To evaluate clinical and immunologic features of Iranian patients with ataxia-telangiectasia, the records of 104 patients with ataxia-telangiectasia (54 male, 50 female) with the age range of 1.6-23.5 years were reviewed. The Iranian Primary Immunodeficiency Registry was used as the data source. Progressive ataxia was seen in all the patients. Other symptoms were eye movement disorders (n = 84), slurred speech (n = 70), mental retardation (n = 10), and ocular (n = 87) and cutaneous (n = 73) telangiectasia. Three patients developed leukemia and lymphoma, and 17 patients had family history of malignancy. Positive correlation was seen between clinical immunologic symptoms and immunoglobulin deficiencies (P = 0.004). The predominant infections were sinopulmonary and acute and recurrent infections (78 cases). Infections included pneumonia (56 patients), otitis media (34 patients), and sinusitis (50 patients). Average serum alpha-fetoprotein level was 149 +/- 137 ng/dL. The incidence of ataxia-telangiectasia in Iran is high, possibly due to familial marriages. Treatment should be focused on supportive management to prolong survival.


The effect of vaccination against Mycoplasma hypopneumoniae in pig herds with a continuous production system.
An inactivated Mycoplasma hyopneumoniae vaccine was evaluated in five pig herds clinically infected with enzootic pneumonia and practising a continuous production system in the growing/finishing unit. In each herd, a vaccinated and control group of approximately 47 pigs each were individually monitored from birth until slaughter. Vaccinated pigs received the first dose at about 1 week of age and the second approximately 3 weeks later. During all production stages, an equal number of vaccinated and control pigs was present in the same pen. Both groups were compared with respect to zootechnical parameters (major variables) and by means of serological, pathological, and bacteriological parameters (ancillary variables). Daily weight gain was improved by 14 gr/day during the period from 8 days of age until slaughter (P = 0.0486) and by 25 gr/day during the growing/finishing period (P = 0.0067). Mortality rate, and the costs for curative medication were not significantly improved by vaccination. The results of the ancillary variables are presented and discussed.


Usefulness of 16-slice multislice spiral computed tomography for follow-up study of coronary stent implantation.
Although multislice spiral computed tomography (MSCT) is a promising technique for non-invasive coronary angiography, its usefulness in patients with stent implantation remains unclear. The aim of the present study was to compare the usefulness of MSCT with that of invasive coronary angiography for evaluating coronary stent patency. Thirty-one patients were enrolled after coronary stent implantation. Sixteen-slice MSCT scans were performed (39.0+/-21.8 days) before follow-up coronary angiography. After assigning an image score based on luminal visibility (1= poor, 2= fair, 3= good), factors determing image quality were analyzed. Among 42 implanted stents, 33 (78%) were assigned an image score of 3, 2 (5%) a score of 2, and 7 (17%) a score of 1. Image scores among stents with diameters >or=3.5 mm were significantly (p<0.05) higher than among smaller stents (<or=3.0 mm). Stent strut thickness did not affect image quality, but coronary calcification significantly (p<0.01) hampered the image quality. After excluding 7 stents with image scores of 1, the sensitivity, specificity, positive and negative predictive values of MSCT to identify patent stents were 83%, 90%, 63% and 96%, respectively. MSCT can provide useful and valuable clinical information for assessing stent patency during the follow-up period when patients are treated with relatively large diameter coronary stents.


Effect of topical tretinoin under occlusion on atypical naevi.
Atypical naevi are potential precursors of melanoma and markers of increased melanoma risk. To examine the possibility of chemoprevention of melanoma by retinoids, we studied the effect of topical tretinoin 0.1% (all-transretinoic acid; vitamin A acid) and tretinoin 0.1% with hydrocortisone on atypical naevi. Thirty patients with atypical naevi were enrolled in a prospective randomized double blind study. For each patient three comparable naevi were selected and randomized to receive tretinoin 0.1% (T), tretinoin 0.1% with hydrocortisone 1% (C) or a placebo cream (P) once a week under Actiderm occlusion for 4 months. Baseline views of the naevi, taken with a videomicroscope (magnification 20 x), were assessed for morphological changes compared with views taken 2 months after the beginning of treatment, 1 week after completion of treatment and 6 months later. After completion of the study all naevi in the T and C groups and six naevi in the P group were removed and evaluated histologically for the presence of atypia. The number of naevi that had changed in colour or size was significantly higher in the T and C groups compared with the placebo group. A size reduction took place in 42.9% (T) and 40.0% (C) of the naevi and the colour changed in 75.0% (T) and 66.7% (C). The effect of treatment, in general subtle, did not differ significantly between groups T and C, but naevi treated with C became significantly less irritated. Histologically, 75.0% of the naevi treated with T and 69.6% of the naevi treated with C were atypical. Therefore, no major change was seen in the clinical aspect of atypical naevi after treatment with tretinoin 0.1% or tretinoin with hydrocortisone 1%, and most of the treated naevi still met the histological criteria for atypia after the treatment period. The current management of follow-up of atypical naevi and excision when change to melanoma is suspected is therefore still recommended. Nevertheless, some response was seen, which may justify a further exploration of tretinoin and hydrocortisone 1% therapy for a longer treatment period in combination with research to clarify its mechanism.


Does your facility have a 'patient-safe' climate?
Although it's difficult to measure an institution's culture, it is possible to measure the factors that affect patient safety, says quality consultant Patrice Spath, RHIT. Areas to evaluate include management systems, safety systems, and individual attitudes and perceptions about patient safety improvement. In this month's Quality-Co$t Connection, Spath examines the elements that contribute to a patient-safe climate.


Study of the representativity of uranium and thorium assays in soil and sediment samples by alpha spectrometry.
The activity concentrations of soil and sediment samples are determined by alpha spectrometry with a sample size usually < 1 g. Hence, a systematic and careful procedure must be followed in the sampling and pre-treatment of the sample in order to ensure that the aliquot analysed represents the activity concentration of the entire sample. Statistical analyses of the activity concentrations of uranium and thorium isotopes in soil and sediment samples were performed to study the activity variation due to the lack of the representativity of the sample. These studies showed that, although some uncertainty in the determination of the sample activity concentration may be due to the lack of representativity (about 10%), the procedure followed for the pre-treatment of the sample can be considered adequate, providing an acceptable level of representativity.


Mycoplasma pneumoniae intrathecal antibody responses in Bickerstaff brain stem encephalitis.
The pathogenesis of Mycoplasma pneumoniae encephalitis is not established. We report, for the first time, the case of a patient with severe Bickerstaff brain stem encephalitis in whom we detected intrathecal production of M. pneumoniae-specific antibodies, contrasting the findings in another patient with less severe encephalitis in whom we detected intrathecal M. pneumoniae DNA but no specific antibodies. Our observations suggest that intrathecal M. pneumoniae-specific antibody responses may contribute to a more severe course of M. pneumoniae encephalitis.


Selection and characterization of HIV-1 variants resistant to the (+) and (-) enantiomers of 2'-deoxy-3'-oxa-4'-thiocytidine (dOTC).
Human immunodeficiency virus type 1 (HIV-1) variants were selected for resistance against the (+) and (-) enantiomers of a novel nucleoside analogue, 2'-deoxy-3'-oxa-4'-thiocytidine (dOTC), using the infectious molecular clone HXB2D grown in the MT-4 line of human T cells. The variants selected with (+) dOTC were approximately 6-7-fold less sensitive than wild-type virus to this drug. Cloning and sequencing of the complete reverse transcriptase (RT) coding region of these variants identified the M1841 mutation and further selection with virus containing the M1841 substitution led to the appearance of an M184V mutation. In contrast, selection experiments performed with (-) dOTC yielded variants capable of growing in drug concentrations as high as 100 microM, but phenotypic analysis of these viruses revealed near wild-type 50% inhibitory concentration (IC50) values for this compound. Site-directed mutagenesis experiments in which the M1841 and M184V mutations were introduced into HXB2D confirmed the importance of these mutations when viruses were grown in MT4 cells. However, wild-type IC50 values in regard to both (-) and (+) dOTC were obtained when these recombinant viruses were grown in cord blood mononuclear cells (CBMC). Clinical isolates of HIV-1 resistant to lamivudine and containing the M184V substitution also displayed low-level resistance to both (-) and (+) dOTC when grown in CBMC. Finally, cell-free RT assays were performed in the presence of either (-) dOTC triphosphate, (+) dOTC triphosphate, or the triphosphate of a racemic mixture of (+) and (-) dOTC with wild-type and mutated M184V-containing recombinant RT. The data demonstrate chain termination effects of these compounds with regard to both wild-type and mutated enzyme and that the latter was approximately twofold less sensitive than the former to these drugs.


Surface forces, supramolecular polymers, and inversion symmetry.
The effects of supramolecular equilibrium polymers on surface forces are studied by both a phenomenological Landau type analysis and a molecular model based on a Bethe-Guggenheim approximation. We point out that surface forces brought about by equilibrium polymers may be completely different from what can be found with "ordinary" polymers. The new feature is the role of inversion (a)symmetry or "directionality" of the associating unit molecules ("monomers"). Symmetric B-B monomers (where B denotes a self-complementary binding group) give rise to nondirectional chains and lead to attractive forces between similar surfaces. Asymmetric A-D monomers (where A and D denote complementary acceptor and donor groups, respectively) produce directional chains and can cause strong repulsion. The range of the attractive force has a maximum at intermediate concentration, while the range of the repulsive force increases over the whole concentration range.


A randomised cross-over trial of antiemetic therapy for platinum-based chemotherapy. Improved control with an intensive multiagent regimen.
In a partially blinded randomised cross-over trial, 78 patients receiving cisplatinum based chemotherapy were assigned to receive two forms of antiemetic therapy: SAD, a regimen composed of serenace (haloperidol), ativan (lorazepam), and dexamethasone followed by low dose maxolon (metoclopramide) and STADMAX, a regimen composed of scopolamine (hyoscine), tavegyl (clemastine), ativan, dexamethasone and high dose maxolon. Each antiemetic regimen was given in random order, with the first and second cycles of cytotoxic chemotherapy. 66 (85%) patients completed both cycles of antiemetic therapy and were available for the cross-over comparison. Significantly less acute vomiting, as assessed by nurse observer (P < 0.0001), and less delayed vomiting, as assessed by patient diary (P = 0.03), were seen with STADMAX. In the first 18 h, complete control of vomiting (no episodes) was achieved in 30 (45%) patients with STADMAX compared with 10 (15%) receiving SAD. Overall, major control of emesis (< or = 2 episodes) was achieved in 56 (85%) patients with STADMAX compared with 35 (53%) receiving SAD. Vomiting was also better controlled on STADMAX in the week after this initial 18 hour period based on the 7 day patient diary with no vomiting episodes in 18/65 (28%) on STADMAX vs. 13/65 (20%) on SAD. However, no significant differences in appetite, nausea or vomiting were found when based on linear analogue self assessment (LASA) scales recorded by patients. Significant differences in side effects of the two antiemetic regimens were noted on LASA scales with more dry mouth (P = 0.01), blurred vision (P = 0.03) and diarrhoea (P = 0.04) associated with STADMAX and more restlessness (P = 0.002) associated with SAD. Significantly, no episodes of dystonic reactions were seen among patients on either regimen. In the 68 patients who completed both cycles and were in a position to express a preference, 46 (68%) preferred STADMAX compared with only 20 (29%) who preferred SAD (P = 0.001), while 2 patients expressed no preference. It is concluded that STADMAX is the preferred regimen to SAD for the control of cisplatinum-related emesis. It has a role, both where specific serotonin 3 antagonists are not available and as a model for building more effective combinations where these agents are available.


Equilibrium selection in evolutionary games with random matching of players.
We discuss stochastic dynamics of populations of individuals playing games. Our models possess two evolutionarily stable strategies: an efficient one, where a population is in a state with the maximal payoff (fitness) and a risk-dominant one, where players are averse to risks. We assume that individuals play with randomly chosen opponents (they do not play against average strategies as in the standard replicator dynamics). We show that the long-run behavior of a population depends on its size and the mutation level.


Generalization of the Cole-Davidson and Kohlrausch functions to describe the primary response of glass-forming systems.
We introduce a three-parameter step-response function which is based on a generalization of the Cole-Davidson (CD) and Kohlrausch (K) functions, and which provides a highly flexible susceptibility description for viscous liquids. A second parameter α characterizing the overall width, in addition to a parameter β determining the high-frequency behavior of the susceptibility, allows for a continuous change of the spectral shape from the CD-type to the K-type. We prove that the function fulfills mathematical conditions required for a step-response function. When applying the function to interpolate dielectric spectra of neat (pure) glass formers, it is possible to keep the high-frequency parameter β temperature-independent while varying the parameter α to account for the change of the overall width. This analysis might suggest that the failure of frequency-temperature superposition in glass formers is reflected by a broadening in the low-frequency region instead of in the high-frequency one.


Diaphragmatic movement studied with ultrasound during spontaneous breathing and mechanical ventilation with intermittent positive pressure ventilation (IPPV) and airway pressure release ventilation (APRV) in man.
Earlier knowledge about diaphragmatic movement during mechanical ventilation is based on radiological information. Since real-time bed-side monitoring is now possible the movement of the right hemidiaphragm was studied using ultrasound (US), both during spontaneous and mechanical ventilation. Nine healthy non-medicated volunteers lying supine were exposed to the following ventilation modes in random order: 1. breathing air at ambient pressure, or 2. at 7.6 mmHg of CPAP or 3. mechanical ventilation with airway pressure release ventilation (APRV), or 4. with IPPV, by mask. The movement of the diaphragm was recorded with a US sector transducer, imaging the ventral, dome and dorsal parts. The maximal movement was detected in the dome in four volunteers during spontaneous breathing with both ambient pressure and CPAP, but in the ventral part in seven and six volunteers, respectively, during APRV and IPPV. Diaphragmatic movement can be studied with US and the findings support the earlier study, with the diaphragm shifting towards the non-dependent regions of the lungs during mechanical ventilation. In this respect APRV is similar to IPPV.


Effect of tacrolimus on the excitatory synaptic transmission between the parallel fibers and pyramidal cells in the rat dorsal cochlear nucleus.
The immunosuppressive drug tacrolimus has several effects on the central nervous system. Besides its protective effect in hearing deficiencies, it is also considered to be able to cause tinnitus. In the present work, we attempted to describe its effects on a characteristic synapse of the auditory system that may be involved in the pathogenesis of tinnitus. Slices of the dorsal cochlear nucleus (200 microm thick) were prepared from 9- to 14-day-old Wistar rats. In response to stimulation targeting the superficial layer of the nucleus, we recorded excitatory postsynaptic currents (EPSCs) developing in the cell bodies of the pyramidal neurons using whole-cell voltage clamps. Inhibitory synaptic activity was inhibited by the application of bicuculline and strychnine. Short-term plasticity was investigated using high-frequency stimulation (50 Hz). Unambiguous identification of the investigated neurons was ensured by employing biocytin in the pipette solution, which allowed the confocal reconstruction of the cells after the functional measurements. A concentration of 1 micromol/L tacrolimus was applied extracellularly. Tacrolimus effectively and reversibly inhibited glutamatergic neurotransmission in the investigated synapse from -145 +/- 26 pA to -55 +/- 15 pA (n = 7; P = .00928). In contrast, EPSC amplitudes without failures were not significantly reduced (from -153 +/- 26 pA to -131 +/- 23 pA) in the presence of tacrolimus, but there were increased failure numbers of synaptic transmission. These data suggested that application of tacrolimus produced a combined pre- and postsynaptic inhibition. Tacrolimus affected short-term synaptic plasticity in the rat dorsal cochlear nucleus. It was also capable of inhibiting the glutamatergic neurotransmission. These effects suggested that tacrolimus may have neuroprotective effects in this structure.


Differences in Upper and Lower Body Adipose Tissue Oxygen Tension Contribute to the Adipose Tissue Phenotype in Humans.
Upper and lower body adipose tissue (AT) exhibits opposing associations with obesity-related cardiometabolic diseases. Recent studies have suggested that altered AT oxygen tension (pO2) may contribute to AT dysfunction. Here, we compared in vivo abdominal (ABD) and femoral (FEM) subcutaneous AT pO2 in women who are overweight and have obesity, and investigated the effects of physiological AT pO2 on human adipocyte function. ABD and FEM subcutaneous AT pO2 and AT blood flow (ATBF) were assessed in eight [BMI (body mass index) 34.4 ± 1.6 kg/m2] postmenopausal women who were overweight with obesity and impaired glucose metabolism. ABD and FEM AT biopsy specimens were collected to determine adipocyte morphology and AT gene expression. Moreover, the effects of prolonged exposure (14 days) to physiological AT pO2 on adipokine expression/secretion, mitochondrial respiration, and glucose uptake were investigated in differentiated human multipotent adipose-derived stem cells. AT pO2 was higher in ABD than FEM AT (62.7 ± 6.6 vs 50.0 ± 4.5 mm Hg, P = 0.013), whereas ATBF was comparable between depots. Maximal uncoupled oxygen consumption rates were substantially lower in ABD than FEM adipocytes for all pO2 conditions. Low physiological pO2 (5% O2) decreased proinflammatory gene expression, increased basal glucose uptake, and altered adipokine secretion in ABD and FEM adipocytes. We demonstrated for the first time, to our knowledge, that AT pO2 is higher in ABD than FEM subcutaneous AT in women who are overweight/with obesity, partly due to a lower oxygen consumption rate in ABD adipocytes. Moreover, low physiological pO2 decreased proinflammatory gene expression and improved the metabolic phenotype in differentiated human adipocytes, whereas more heterogeneous effects on adipokine secretion were found.


[Papillon-Lefèvre syndrome. Presentation of a case].
The authors report a case of hyperkeratosis palmoplantaris with periodontosis (Papillon-Lefèvre syndrome) in a five year old male patient. This patient showed hyperkeratosis over palms, soles, knees and premature periodontoclasia. No other abnormalities were detected on physical examination and the personal and familial antecedents were negative. There is no history of consanguinity of his parents. Roentgenographic examination of his skull did not reveal ectopic calcification of the falk cerebri or tentorium. The skin biopsy of the lesions exhibit marked hyperkeratosis, acantosis and a moderate perivascular infiltrate composed mainly of mononuclears, localized in the upper dermis. The corium showed a mild atrophy. We assumed that this case resulted from homozygosity for autosomal recessive genes. Considering this is the first case detected in Panama with a population near two millions habitant, it supports the low frequency of the disorder, estimated roughly at one to four per million persons in the general population, according Gorlin et al.


Circular RNA-100219 promotes breast cancer progression by binding to microRNA-485-3p.
To investigate whether circ-100219 could promote the proliferation and migration of breast cancer cells by upregulating NTRK3 after binding to microRNA-485-3p, thus participating in the development of breast cancer. Breast cancer cell lines MCF-7, MDA-MB-231, MDA-MB-549 and human mammary epithelial cells were cultured. The expression levels of circ-100219, microRNA-485-3p and NTRK3 in breast cancer and paracancer tissues were determined using real-time quantitative polymerase chain reaction (RT-qPCR). The regulatory effects of circ-100219, microRNA-485-3p and NTRK3 on the proliferative and migratory capacities of breast cancer cells were assessed using cell counting kit-8 (CCK-8) and Transwell assay, respectively. Dual-luciferase reporter gene assay was conducted to determine the binding condition among circ-100219, microRNA-485-3p and NTRK3. Rescue experiments were performed in co-transfected breast cancer cells. RT-qPCR data showed that circ-100219 and NTRK3 were highly expressed, whereas microRNA-485-3p was lowly expressed in breast cancer tissues than those of paracancer tissues. Knockdown of circ-100219 in MCF-7 and MDA-MB-231 cells inhibited their proliferative and migratory capacities. On the contrary, microRNA-485-3p knockdown improved the proliferative and migratory capacities. Dual-luciferase reporter gene assay revealed that circ-100219 could bind to microRNA-485-3p and NTRK3 was the target gene of microRNA-485-3p. Western blot results elucidated that circ-100219 stabilized NTRK3 expression, whereas microRNA-485-3p degraded NTRK3 expression. Rescue experiments demonstrated that overexpression of NTRK3 could partially reverse the inhibited proliferative and migratory capacities induced by circ-100219 knockdown in MCF-7 and MDA-MB-231 cells. Overexpression of circ-10021 promotes the proliferative and migratory capacities of breast cancer cells by sponging microRNA-485-3p to upregulate the NTRK3 expression.


Risk-adapted induction and consolidation therapy in adults with de novo AML aged </= 60 years: results of a prospective multicenter trial.
We treated 305 de novo acute myeloid leukemia (AML) patients aged </=60 years with risk-adapted therapy. Patients with CBF leukemias or normal karyotype and good response to induction I [</=5% bone marrow (BM) blasts on day 15] were considered standard risk (SR), all others as high risk (HR). Patients with t(15;17) were excluded. Chemotherapy comprised double induction followed by early consolidation. As late consolidation, SR patients received high-dose cytarabine/daunorubicin (AraC/DNR). SR patients with normal karyotype were allotransplanted from HLA-matched siblings. HR patients were allotransplanted or if no sibling donor was available autotransplanted with peripheral blood progenitor cells (PBSC) harvested after early consolidation. 89% of the SR and 60% of the HR patients achieved CR. The continuous complete remission (CCR) rate at 80 months (median follow-up: 48 months) was 48% for SR and 32% for HR. The CCR rate was 54% for t(8;21), 47% for normal karyotype, and 33% for inv(16) patients. In the HR group, the CCR rate did not differ significantly for patients with bad response to IVA-I, unfavorable karyotype, or both. Forty-five HR patients were autotransplanted (n=20) or allotransplanted (n=25). The probability of CCR was 44% for autotransplantation vs 33% for allotransplantation. In conclusion, our risk-adapted strategy produced encouraging results in SR patients. Early response to therapy is a strong prognostic factor that predicts the probability of CR and long-term outcome.


Resolving conflict and building cooperation in the National Estuary program.
Since its beginning in 1987, researchers and policymakers have touted the US Environmental Protection Agency National Estuary program (NEP) as one of the leading examples of collaborative institutions designed to resolve conflict and build cooperation at the watershed level. Using the NEP as an example, I summarize the advantages and disadvantages of collaborative institutions. Using data gathered from focused surveys of policy elites in 22 estuaries, I estimate statistical models that show the NEP does a better job of resolving conflict and building project-level cooperation than similar estuaries without the NEP. I also describe the activities of the NEP mentioned by respondents as contributing to this outcome.


Blood pool contrast-enhanced MRA: improved arterial visualization in the steady state.
Blood pool agents (BPAs) for contrast-enhanced magnetic resonance angiography (CE-MRA) allow prolonged imaging during the steady state when the agent is distributed through the complete vascular system. This increases both the spatial resolution and the contrast resolution. However, simultaneous venous and arterial enhancement hampers interpretation. For the pelvic region of the vasculature, it is shown that arterial visualization in this equilibrium phase can be improved if the central arterial axis (CAA) is known. However, manually obtaining this axis is not feasible in clinical practice. Therefore, a method is presented that utilizes images acquired during the first pass of the contrast agent to find the CAA in the steady-state data with minimum user initialization. The accuracy of the resulting CAA is compared with tracings of three observers in six patient datasets. It was found that the mean difference between the semiautomatic method and the manual delineation is 1.32 mm in the steady-state data, and that the resulting CAA was always within the arterial lumen, which is an important prerequisite for both improved visualization and segmentation.


Temporal trends in incidence of childhood cancer in Switzerland, 1985-2014.
Incidence of childhood cancer increased in most countries worldwide, but reasons are unclear. This study investigates trends of childhood cancer incidence in Switzerland from 1985 to 2014. We extracted data on all childhood cancer cases diagnosed at ages 0-14 years in Switzerland from the Swiss Childhood Cancer Registry. We included ICCC-3 main groups I-XII and calculated age-standardised, cumulative, and age-specific incidence for different diagnostic groups. We analysed trends of annual age-standardised incidence using JoinPoint regression models. Over the study period from 1985 to 2014, 5104 of 5486 cancer diagnoses (93%) were microscopically verified. The proportion of children treated in paediatric cancer centres increased from 84% during 1985-1994 to 93% in 1995-2004 and 98% in 2005-2014 (p < 0.001). Using the World standard population, age-standardised incidence was 143 in 1985-1994, 154 in 1995-2004, and 162 per million in 2005-2014. Incidence increased by 0.7% (95% confidence interval (CI) 0.5; 1.0) per year for all cancers from 1985 to 2014, 0.8% (95% CI 0.2%-1.4%) for leukaemias over the same period, 3.0% (95% CI 0.2%-1.4%) for CNS tumours during 1985-2002, and 3.8% (95% CI 1.7%-6.0%) for epithelial neoplasms and melanomas over the period 1985-2014. Trends in incidence were driven mostly by increases among leukaemias and CNS tumours. For CNS tumours, observed trends may be explained at least partially by diagnostic changes and improved registration. For leukaemias, rising incidence may be real and due to risk factors that experience similar increases in trends.


Comparison of biologically effective spectra for erythema and pre-vitamin D3 synthesis.
The short wavelength cut-off (lambdac), the wavelength of the maximum spectral UV (lambdaMax) of spectral pre-vitamin D3 effective solar UV irradiance (UVD3), and the spectral erythemal UV (UVEry) were compared at 5-min intervals over a 6-month period at solar zenith angles (SZA) ranging from 4.7 degrees to 80 degrees. Averaged over the entire period, lambdac for UVD3 is higher by 1.05 nm than that for UVEry. The lambdaMax is higher for UVD3 compared to UVEry for SZA<approximately 50 degrees. For higher SZA (>55 degrees), the ratio of lambdaMax for UVD3 to that for UVEry is less than 1. As the erythemal action spectrum extends into the UVA, the ratio of UVD3 to UVEry irradiances decreases with increasing SZA, along with a decrease in the ratio of lambdaMax for UVD3 compared to UVEry. The changes in lambdac and lambdaMax influence both personal UVD3 and UVEry exposure and, to take this into account, a dual calibration technique for polysulphone dosimeters has been developed to simultaneously provide measurements of both types of exposure.


[Development and application of a web-based expert system using artificial intelligence for management of mental health by Korean emigrants].
The purpose of this project was to develop an international web-based expert system using principals of artificial intelligence and user-centered design for management of mental health by Korean emigrants. Using this system, anyone can access the system via computer access to the web. Our design process utilized principles of user-centered design with 4 phases: needs assessment, analysis, design/development/testing, and application release. A survey was done with 3,235 Korean emigrants. Focus group interviews were also conducted. Survey and analysis results guided the design of the web-based expert system. With this system, anyone can check their mental health status by themselves using a personal computer. The system analyzes facts based on answers to automated questions, and suggests solutions accordingly. A history tracking mechanism enables monitoring and future analysis. In addition, this system will include intervention programs to promote mental health status. This system is interactive and accessible to anyone in the world. It is expected that this management system will contribute to Korean emigrants' mental health promotion and allow researchers and professionals to share information on mental health.


Severe pneumococcal pneumonia: new strategies for management.
Streptococcus pneumoniae is the leading cause of community-acquired pneumonia worldwide and is the most likely causative pathogen in patients with community-acquired pneumonia admitted to the intensive care unit. Bacteremic pneumococcal pneumonia is an advanced stage of severe pneumococcal pneumonia. Improvement in the management of bacteremic pneumococcal pneumonia has the potential for improving the survival for severe pneumococcal pneumonia. Non-culture methods, especially the Binax urinary antigen test, can increase the diagnostic yield for pneumococcal pneumonia, allowing targeted antimicrobial therapy (specifically penicillin). In-vitro resistance to penicillin has increased over the past decade; however, it has not led to clinical failure when used for pneumococcal pneumonia. Hospitalized patients with community-acquired pneumonia should have blood cultures obtained to confirm the possibility of bacteremic pneumococcal pneumonia. Based on pharmacodynamic properties, parenteral penicillin remains the drug of choice to treat pneumococcal pneumonia regardless of in-vitro resistance. Combination antimicrobial therapy will likely improve survival of patients with bacteremic pneumococcal pneumonia among the subset of critically ill patients.


Full recovery from Baylisascaris procyonis eosinophilic meningitis.
Infection by Baylisascaris procyonis is an uncommon but devastating cause of eosinophilic meningitis. We report the first case-patient, to our knowledge, who recovered from B. procyonis eosinophilic meningitis without any recognizable neurologic deficits. The spectrum of illness for this organism may be wider than previously recognized.


A combined regimen of controlled motion following flexor tendon repair in "no man's land".
A program of controlled motion following repair of flexor tendons in the hand is presented. This regimen incorporates the features of active extension against rubber band passive flexion, as well as those of controlled passive extension and passive flexion. In this prospective study, 44 digits with complete lacerations of the flexor digitorum profundus and flexor digitorum superficialis in zone 2 were treated. Using the Strickland formula of total active motion of the interphalangeal joints, 36 fingers (82 percent) were rated "excellent"; 7 fingers (16 percent) were rated "good"; 1 finger (2 percent) was rated "fair"; none was rated "poor". There was no statistical difference between the results of delayed primary repair and immediate primary repair.


Peak Systolic Velocity Measured by Continuous-Wave Doppler Ultrasonography without Angle Correction in Patients with Internal Carotid Artery Stenosis.
Peak systolic velocity (PSV) is measured with pulse-wave (PW) Doppler with angle correction in patients with internal carotid artery stenosis (ICAS). However, the correlation between conventional angiography and PSV shows considerable scattering. We hypothesized that measuring PSV without angle correction would lead to better inter-rater reliability. This hypothesis was tested using a sector probe and continuous-wave (CW) Doppler without angle correction. Consecutive patients with more than 50% ICAS were enrolled from a prospective database. PSV was measured with PW Doppler with angle correction (PW PSV) and CW Doppler without angle correction (CW PSV) by 2 examiners. The inter-rater reliabilities of PW PSV and CW PSV were analyzed by Spearman's rank correlation test. A total of 37 ICAS sites (median 67 [interquartile range 57-78] % stenosis) were enrolled. Measuring PSV using a sector probe insonating nearly parallel to the flow was feasible in all cases. Inter-rater reproducibility of CW PSV (Spearman's ρ = .810) was similar to that of PW PSV (Spearman's ρ = .796). When limited to patients with a PSV greater than 200 cm/s with both PW Doppler examinations (25 ICAS sites), inter-rater reliability was relatively higher for CW PSV (Spearman's ρ = .674) than for PW PSV (Spearman's ρ = .423). Measuring PSV with CW Doppler using a sector probe was feasible. Inter-rater reliability was similar between PW Doppler with angle correction and CW Doppler without angle correction in evaluating PSV in patients with ICAS. CW Doppler appears to have better inter-rater reproducibility than PW Doppler in assessing high PSV.


Fast and slow thermal processes in harmonic scalar lattices.
An approach for analytical description of thermal processes in harmonic lattices is presented. We cover longitudinal and transverse vibrations of chains and out-of-plane vibrations of two-dimensional lattices with interactions of an arbitrary number of neighbors. The motion of each particle is governed by a single scalar equation and therefore the notion 'scalar lattice' is used. The evolution of initial temperature field in an infinite lattice is investigated. An exact equation describing the evolution is derived. Continualization of this equation with respect to spatial coordinates is carried out. The resulting continuum equation is solved analytically. The solution shows that the kinetic temperature is represented as the sum of two terms, one describing short time behavior, the other large time behavior. At short times, the temperature performs high-frequency oscillations caused by redistribution of energy among kinetic and potential forms (fast process). Characteristic time of this process is of the order of ten periods of atomic vibrations. At large times, changes of the temperature are caused by ballistic heat transfer (slow process). The temperature field is represented as a superposition of waves having the shape of initial temperature distribution and propagating with group velocities dependent on the wave vector. Expressions describing fast and slow processes are invariant with respect to substitution t by [Formula: see text]. However, examples considered in the paper demonstrate that these processes are irreversible. Numerical simulations show that presented theory describes the evolution of temperature field at short and large time scales with high accuracy.


High prevalence of pulmonary hypertension in patients with hereditary hemorrhagic telangiectasia.
Hereditary hemorrhagic telangiectasia (HHT) is a vascular disorder causing mucocutaneous telangiectases and visceral arteriovenous malformations (AVMs). Pulmonary hypertension (PH) is considered an uncommon complication of HHT whose impact on the survival of these patients is currently unknown. From January 1995 to December 2008, 29 hospitalized patients with definite HHT were included and followed until January 2011. Data on demographics, clinical symptoms and survival were recorded. PH was classified according to echocardiographic probability. A CT angiogram was performed in 24 of the 29 patients with HHT and AVMs were detected in 16 of them (67%): hepatic in 58%, pulmonary in 33% and spinal in 3%; 37% had both pulmonary and hepatic AVMs. Transthoracic Doppler echocardiography (TTE) was performed in 21 patients. PH was considered possible in 4 (14%) and probable in 9 (31%). The mean age at diagnosis was lower in patients with PH than in patients without PH (54±16.5 years vs 73±8.8 years, p=0.002). PH was more prevalent in patients with AVMs (56 vs. 23%, p=0.036). The mean follow-up of the entire cohort was 6±4.4 years (range: 2 months-17 years), during this time 18 patients died (62%; mean age 73±8.1 years). Patients with PH died at a younger age (68±8.4 vs. 79±2.7 years, p=0.015) than those without PH. PH is a severe condition that significantly reduces survival on HHT patients. PH should be suspected in all HHT patients with dyspnea and hepatic AVMs.


Effects of ischemic preconditioning in human heart.
The aim of this study is to investigate the effects of ischemic preconditioning (IP) on myocardium and the level of nitric oxide (NO) in patients undergoing aorta-coronary bypass surgery. Twenty consecutive patients with coronary artery disease were subjected into two equal groups; the IP group and the control group. Following the onset of cardiopulmonary bypass in the study group, hearts were preconditioned with two 3-minute periods of cross-clamping separated by 2 minutes of reperfusion. In the control group, cardiopulmonary bypass was continued for 10 minutes without using cross-clamp. Arterial and coronary sinus blood samples were used to determine serum NO, malondialdehyde (MDA), creatine phosphokinase-MB (CKMB), and lactate dehydrogenase (LDH) levels. Need for defibrillation after cross-clamp removal, ECG changes, postoperative arrhythmias, ejection fraction, and fractional shortening rates were recorded as hemodynamic data. Serum NO level was higher in the study group 5 minutes after aortic clamp removal (199.3 +/- 92.7 vs. 112.2 +/- 35.8 micromol; p = 001). Serum MDA (2.55 +/- 0.4 vs. 4.06 +/- 0.5; etamol/ml; 5 minutes after the aortic clamp removal; p = 0.0002); CK-MB (22.8 +/- 2.5 vs. 37.4 +/- 4.1; U/L 12 hours after the operation, p < 0.0001), and LDH (501.8 +/- 46.7 vs. 611.4 +/- 128.3; IU/L 48 hours after the operation, p = 0.02) levels were significantly lower in the preconditioned group when compared with the control group. Also, need for electrical defibrillation was significantly lower in the study group; Ejection fraction (64.3 +/- 6.3 vs. 57.6 +/- 7.6; p = 0.04) and fractional shortening (31.7 +/- 3.9 vs. 26.2 +/- 4.0; p = 0.04) rates were better in the study group postoperatively. These data may suggest that cardioprotection by ischemic preconditioning offers higher NO production, a lower myocardial ischemia, and better functional recovery of the hearts in coronary artery surgery patients.


Widowhood in elderly women: exploring its relationship to community integration, hassles, stress, social support, and social support seeking.
This study examined the degree to which widows were integrated in their community, the daily hassles and stress they may have experienced, and their social networks and support-seeking behavior. A sample of 160 women, sixty years of age or older, eighty widows and eighty non-widows were interviewed. Half the sample participated in senior centers in Kansas City, Missouri, while the other half belonged to other organizations or were obtained through a truncated snowball technique. The findings indicated that widowhood in and of itself does not appear to be a predictor either of community integration or the lack of it or the experience of stress and hassles. Those who experienced hassles were not the same persons as those who experienced stress. It was surprising to find that those who sought social support did not seem most in need of it. Age and education, along with community integration, were better predictors of the variables studied than was widowhood.


Case study: factors in defining the nurse informatics specialist role.
Healthcare organizations, consultant groups, vendor companies, and academic institutions feel the challenge to enhance user experiences with information systems. To meet this challenge, organizations and companies are looking to better understand and utilize a variety of informatics roles to further marketing, business, or healthcare goals. Nursing is one practice area that can support the successful integration of information systems development, implementation, support, and user experience. However, the definition and development of such a role or position has met with mixed success. This article explores some of the issues and influences related to the role's development. The issues, impacts, and influences have been identified based on healthcare business assessment, job description analysis, employment and project evaluations, and professional standards set by the American Nurses Association.


Quantitative MRI of Diffuse Liver Disease: Current Applications and Future Directions.
As radiologic technology advances, quantitative imaging is becoming more prevalent in clinical practice. This article reviews quantitative hepatic MRI, specifically involving fat and iron deposition, by demonstrating how they were iteratively improved. These iterative improvements involved incorporating more knowledge about the physiology of liver disease and MRI physics to reduce the adverse effects caused by confounding factors. The relevant foundations of MRI physics and liver pathophysiology are briefly reviewed, followed by the various improvements made by expanding on this foundational knowledge. Results from the literature are then discussed within this context, validating the improvement of these resultant methods into clinically robust and useful techniques. Fibrosis quantification, which has been more difficult to robustly perform in clinical practice, is similarly reviewed in an online appendix, with proposals for future multiparametric directions to improve performance on the basis of the insights gained from fat and iron quantification in the liver.


Retrospective comparison of magnetic resonance imaging features and histopathology in Crohn's disease patients.
To retrospectively compare histopathological findings of surgically resected bowel segments with magnetic resonance imaging (MRI) findings on Crohn's disease activity. Patients who underwent a MR enterography or enteroclysis before surgery were included after informed consent. MRI features (T1-enhancement, T1 and T2 stratification, T2 signal intensity, bowel wall thickness, presence of ulcerations, comb sign, creeping fat, and disease activity) were assessed by three experienced abdominal radiologists. An acute inflammatory score based on histopathology (parameters: mucosal ulceration, edema, depth and degree of neutrophils) was calculated. Interobserver variability for subjective MRI features was also assessed. Thirty-nine segments in 25 patients (mean age 38 years) were included. Of the MRI features, disease activity per segment and bowel wall thickness had a positive association with the acute inflammatory score (p<0.05). T1-enhancement had a positive correlation with disease chronicity. All other MRI features did not have an association with the acute inflammatory score. Interobserver agreement between the three observers was weak to moderate. MR features bowel wall thickness and disease activity per-segment reflect disease activity in Crohn's disease patients.


Optical delay of a signal through a dispersive invisibility cloak.
We present a full-wave analysis method on the transmission of a Gaussian light pulse through a spherical invisibility cloak with causal dispersions. The spatial energy distribution of the Gaussian light pulse is distorted after the transmission. A volcano-shaped spatial time-delay distribution of the transmitted light pulse is demonstrated as a concrete example in our physical model. Both the time-delay and the energy transport depend on the polarization of light waves. This study helps to provide a complete picture of energy propagation through an invisibility cloak.


Screening for diabetic retinopathy by general practitioners.
To assess the quality of screening for diabetic retinopathy by 19 general practitioners (GPs) using ophthalmoscopy, the GPs' performance was compared with the performance of ophthalmologists. The GPs had received special training in retinal examination. Direct ophthalmoscopy was performed after mydriasis of both eyes. Later, one of the ophthalmologists at the local hospital performed ophthalmoscopy in the same way as the GP. The ophthalmologist's diagnosis was used as the criterion for retinopathy. 252 NIDDM patients were analysed. The ophthalmologists found 23 cases of retinopathy, of which one patient was referred immediately for photocoagulation. The GPs diagnosed 12 and missed 11 of these 23 cases (false negatives): sensitivity 52%. In 37 of the 229 negative cases the GPs reported a retinopathy: specificity 84%. Of the 11 missed cases, 7 had stage I retinopathy and four showed more serious abnormalities (hard and soft exudates, macular oedema) Further training of GPs in the art of ophthalmoscopy is recommended.


[Oxidative stress in porphyria and carriers].
We sought to establish a causal relationship between oxidative stress and porphyria in patients and carriers. We reported changes in urinary porphyrin concentrations related to 8-hydroxy-2'-deoxyguanosine. We measured urinary 8-hydroxy-2'-deoxyguanosine concentration in porphyria patients and carriers with multifactorial inheritance as a possible marker of attack. The porphyria types included 10 patients with porphyria cutanea tarda, 5 with variegate porphyria, 8 with hereditary coproporphyria, 7 with congenital erythropoietic porphyria, 5 with erythropoietic protoporphyria, 5 with acute intermittent porphyria, 7 erythropoietic protoporphyria carriers, and 7 acute intermittent porphyria carriers. Urinary porphyrin concentrations in these patients were significantly higher than those in healthy subjects (p<0.001). Urinary 8-hydroxy-2'-deoxyguanosine concentrations were significantly high in dermatopathy porphyria types namely porphyria cutanea tarda (p<0.001), variegate porphyria (p<0.05), hereditary coproporphyria (p<0.05), congenital erythropoietic phyria (p<0.05), and erythropoietic protoporphyria (p<0.001). These results reveal that urinary 8-hydroxy-2'-deoxyguanosine concentration in cutis porphyria types is a good predictor of attack and abatement.


Ultrastructural localization and gradient of activity of alkaline phosphatase activity during rodent odontogenesis.
The ultrastructural localization and gradient of activity of alkaline phosphatase were studied with respect to cell differentiation, matrix synthesis, and matrix mineralization in the incisor and molar teeth of 4-day-old Sprague-Dawley rats. The animals were perfused intracardially at room temperature with 2.5% glutaraldehyde in 0.1M sodium cacodylate (pH 7.4) with 3-4% sucrose. The jaws were dissected, immersion-fixed for 24 h, and the incisor and molar tooth germs removed. These were determined in 10% EDTA in NaOH (pH 7.4) with 7% sucrose. After reactivation of the enzyme with 0.1M MgCl in Tris-maleate buffer (pH 7.4) at 4 degrees C, the medium consisting of 6 ml 3% sodium beta-glycerophosphate, 4 ml 0.2M Tris-HCl buffer (pH 9.2), 3 ml 1.6% MgSO4, 12 ml 0.5% lead citrate (pH congruent to 12), and 2.1 g sucrose. The pH was adjusted to 9.2 with 0.2M HCl, the volume made up to 30 ml, and the solution centrifuged for 10 min at 5000 rpm. Control teeth were incubated in medium minus the substrate. Finally, the specimens were routinely post-fixed and embedded for sectioning and examination with a Philips 300 electron microscopy. A gradient of alkaline phosphatase activity was mapped along the developing teeth in the cells of the stratum intermedium, the proximal borders of the ameloblasts, the early dentine matrix, the predentine-dentine border, matrix vesicles, and the plasma membranes of odontoblasts and subodontoblast cells. The gradient of alkaline phosphatase activity was evident in the forming tooth from the cervical loop to the crown apex and was related to the cellular events, matrix synthesis, and matrix mineralization occurring during odontogenesis.


Bax is not the heterodimerization partner necessary for sustained anti-photoreceptor-cell-death activity of Bcl-2.
Ectopic expression of Bcl-2 in photoreceptors of certain mouse models of retinitis pigmentosa (RP) temporarily slows disease progression. The temporary effect produced by Bcl-2 may result from insufficient levels of functional complexes between Bcl-2 and additional proteins necessary for maintaining the anti-apoptotic activity of Bcl-2. Although the overexpression of Bax generally induces apoptosis, Bax exerts anti-apoptotic properties when complexed with Bcl-2 in certain cell culture systems. These studies were designed to determine whether coexpression of Bcl-2 and Bax would improve the neuroprotective effect provided by Bcl-2 alone in photoreceptors of mice with autosomal dominant RP (adRP). Transgenic mice were produced that overexpressed Bax and Bcl-2 specifically in photoreceptor cells, using the murine opsin promoter to drive transgene expression. These mice were crossed with an adRP mouse model to assess the effect of coexpression of Bax and Bcl-2 on retinal degeneration. Morphologic analysis was performed on retinas isolated at various developmental times to monitor disease progression. Ectopic expression of Bax in photoreceptors resulted in extensive rod cell death dependent on the level of Bax transgene expression. Although Bcl-2 was able to inhibit Bax-induced photoreceptor cell death, the coexpression of Bcl-2 and Bax in photoreceptors of mice with adRP did not enhance the protective effect against photoreceptor cell death exerted by Bcl-2 alone. Coexpression of Bax and Bcl-2, at the levels produced in the transgenic lines, does not extend the temporary neuroprotective effect produced by Bcl-2 in photoreceptors of mice with adRP.


The cement apparatus of larval and adult Pomphorhynchus laevis (Acanthocephala: Palaeacanthocephala).
Light and electron microscopy were used to study the ultrastructure of the cement apparatus, namely cement glands and cement ducts of mature specimens of the acanthocephalan parasite Pomphorhynchus laevis Müller, 1776, recovered from the digestive tracts of fish Leuciscus cephalus Risso, 1826. In addition, the cement glands of immature P. laevis found within the body cavity of the fish Alburnus alburnus alborella De Filippi, 1844 were examined. In a mature male of P. laevis the 6 cement glands are rounded to oval in shape and each of them has an outer cytoplasmic layer containing nuclei and surrounding a space for storage of the cement material within the gland. The nuclei have an irregular outline and the cytoplasm of the cells contains round, membrane-bound secretory granules approximately 1 micron in diameter. Nuclei surrounded by secretory granules were present inside the gland lumen. Within the gland ducts of mature males, granules were present within the wall thickness and, inside the luminal area, mitochondria were encountered. In contrast, within the cement glands of immature P. laevis there were no secretory granules and the chromatin of the nuclei appeared condensed. The nature of the secretory product of the cement glands was investigated with histological and electrophoretic methods. A protein with molecular weight of 23 kDa was recorded as a major component of cement.


[Malaria in hominids].
Malaria parasites (Plasmodium spp) that infect great apes are very poorly documented Malaria was first described in gorillas, chimpanzees and orangutans in the early 20th century, but most studies were confined to a handful of chimpanzees in the 1930-1950s and a few orangutans in the 1970s. The three Plasmodium species described in African great apes were very similar to those infecting humans. The most extensively studied was P reichenowi, because of its close phylogenetic relation to P. falciparum, the predominant parasite in Africa and the most dangerous for humans. In the last three years, independent molecular studies of various chimpanzee and gorilla populations have revealed an unexpected diversity in the Plasmodium species they harbor, which are also phylogenetically close to P falciparum. In addition, cases of non human primate infection by human malaria parasites have been observed. These observations shed fresh light on the origin and evolutionary history of P. falciparum and provide a unique opportunity to probe the biological specificities of this major human parasite.


Increased proportion of CD4(+)CD25(+)Foxp3(+) regulatory T cells during early-stage sepsis in ICU patients.
We investigated whether CD4(+)CD25(+)Foxp3(+) regulatory T cells (Tregs) are induced in patients suffering from early-stage septic shock and distinguish them from noninfectious patients with systemic inflammatory response. The study included 37 patients with early-stage septic shock, 15 patients with noninfectious systemic inflammatory response syndrome (SIRS), and 24 heath controls. We prospectively assayed the fraction of Tregs expressing high levels of CD25 and forkhead box P3 (Foxp3) as well as the plasma levels of interferon-γ (IFN-γ), interleukin-4 (IL-4), and soluble CD25 in all the subjects studied. Compared with the control groups, the plasma levels of IFN-γ [66.10 (45.23-85.08) pg/mL vs. 20.97 (17.58-26.21) pg/mL, p < 0.001] and IL-4 [100.69 (77.41-127.68) pg/mL vs. 70.40 (64.14-80.15) pg/mL, p < 0.001] as well as the IFN-γ/IL-4 ratio [0.66 (0.62-0.67) vs. 0.30 (0.27-0.33), p < 0.001] were significantly elevated in the patients with early-stage septic shock, but there was no difference between patients with sepsis and patients with SIRS. We found that the proportion of CD4(+)CD25(+)Foxp3(+) T cells was significantly increased in the patients with early-stage septic shock [(66.82 ± 21.79%) vs. (51.79 ± 21.79%) vs. (56.45 ± 10.68%), p = 0.003] in comparison with the SIRS and control groups, which could be differentiated from the patients with SIRS. The plasma levels of soluble CD25 were also increased, and positively correlated with the proportion of Tregs in patients with early-stage septic shock (Spearman correlation coefficient = 0.390, p = 0.003). Our findings indicate that the proportion of CD4(+)CD25(+)Foxp3(+) T cells could be an indicator for the early diagnosis of sepsis. This proportion can also facilitate the evaluation of the patient's immune status and guide suitable immunoregulatory therapy.


Compliant behaviour: relationship to attitudes and control in diabetic patients.
A study was conducted to examine patient performance of certain safety measures in relation to 'attitude' and glycaemic control. One hundred and thirty consecutive routinely attending insulin-dependent diabetic patients (IDDM) were asked to show a source of sugar and diabetes identification (ID). An attitude scale, developed and psychometrically evaluated with intent to examine 'general attitude to diabetes', was used to study attitudes. Fifty-eight per cent of the IDDM patient sample carried both sugar and ID. The mean HbA1c of these patients (8.4%) was 2% lower (p less than 0.01) compared with patients carrying either ID only (24% of sample: mean HbA1c 10.4%), sugar only (6% of sample: mean HbA1c 10.3%) or neither item (12% of sample: mean HbA1c 10.7%). The general attitude score in these patients was significantly higher if sugar was carried (p less than 0.02) but there was no relationship with HbA1c (p greater than 0.1). A seven-item subcluster representing attitudes to diabetic management was more strongly related to sugar carriage (p less than 0.001) and was inversely correlated with HBA1c (r = 0.252: p less than 0.02). These findings indicate that attitudes to diabetes management may influence specific behavioural elements (i.e. compliance with advice always to carry sugar and ID). However, there was also a significant trend to higher carriage rates for sugar with a higher frequency of perceived hypoglycaemia (p less than 0.05) but no relationship between perceived hypoglycaemia and HbA1c. Absence of sugar of ID appears to represent a useful indicator of poor diabetic control and may assist in the definition of relevant attitudinal differences.


Adenylate degradation in Escherichia coli. The role of AMP nucleosidase and properties of the purified enzyme.
Extracts of Escherichia coli K12 degrade AMP to hypoxanthine, adenine, adenosine, and inosine. Degradation experiments with mutants which lack purine nucleoside phosphorylase or both purine nucleoside phosphorylase and adenosine deaminase demonstrate that hypoxanthine formation is dependent on purine nucleoside phosphorylase. These findings are consistent with an absence of adenine deaminase activity in E. coli. Adenine is formed from AMP in extracts of the E. coli mutants as well as the wild type cells. This activity is due to AMP nucleosidase. Purified, homogeneous AMP nucleosidase gives a subunit Mr = 52,000 on denaturing gel electrophoresis and an oligomer molecular weight of approximately 280,000 by comparative gel filtration. Kinetic studies with this enzyme give cooperative initial rate curves with AMP as substrate, with MgATP2- as an activator, and with Pi as an inhibitor. Phosphate inhibition is competitive with McATP2- (Ki = 0.2 mM) and reverses the activation by MgATP2-. In the absence of MgATP2-, the apparent S0.5 for AMP is 15 mM and decreases to 90 microM at saturating MgATP2-. The maximum rate of AMP hydrolysis is not affected by MgATP2-. Kinetics of MgATP2- activation give a constant for half-maximum activation varying from 120 microM in the presence of low AMP to approximately 2 microM when AMP is present at near saturation. Formycin 5'-PO4 is a powerful competitive inhibitor with respect to AMP, giving a Kis of 72 nM and a Km/Kis ratio of 1,200. Adenylate degradation experiments indicate that AMP nucleosidase is the major enzyme of AMP catabolism in E. coli. The kinetic properties of the purified enzyme indicate that regulation occurs by the intracellular MgATP2- /Pi ratio and the concentration of AMP.


Some aspects of rat femorotibial joint microanatomy as demonstrated by high-resolution magnetic resonance imaging.
High-resolution magnetic resonance images (MRI) of the right femorotibial joint of normal Han:Wistar rats were acquired using a 4.7 Tesla magnet and a single-turn solenoid radio frequency coil (built in-house). Some anatomical findings of the rat femorotibial joint, which have not been reported previously using MRI, are described. The separation of patellar ligament and crural fascia was feasible on MRI. This separation would not be seen on images of lower resolution and its presence on high-resolution images could be mistaken for artefact due to the magic angle effect. Band-like fibrous structures exist in the infra-patellar fat pad, which might be mistaken as ligaments within the femorotibial joint. On sagittal MRI a vessel was seen inserted on the central part of the caudal surface of the patellar ligament. Subcutaneous fascia/cutaneous muscles (panniculus carnosus) could also be demonstrated with MRI in the femorotibial joint area.


Measuring the Contribution of Agricultural Conservation Practices to Observed Trends and Recent Condition in Water Quality Indicators in Ohio, USA.
Over the last three decades, significant investments made to upgrade wastewater infrastructure and manage pollution from diffuse sources have resulted in measurably improved water quality and biological conditions in Ohio's rivers and streams. Conservation measures to reduce soil loss appear to have contributed significantly to the improvement witnessed over the last two decades and should therefore be continued. Within the most recent timeframe examined, little difference was found in either total phosphorus or suspended sediment concentration in relation to conservation measures, indicating that the environmental benefits of measures targeting soil loss may be approaching an asymptote. Conservation measures targeting livestock and forage management, however, appear to have reduced nitrogen concentrations within the recent time frame. An examination of the interrelationships between habitat quality, conservation measures, and land use indicated that water quality was generally mediated by interactions with stream habitat quality. However, the positive effect of habitat quality was reduced in catchments draining fine-textured soils. The implication of these latter two findings suggest that proscriptively adding natural function to the large network of ditched and maintained conveyances draining agricultural lands would substantially improve water quality, but management at the field level is necessary to minimize phosphorus losses.


18F-fluorodexyglucose Position Emission Tomography identifies altered brain metabolism in patients with Cri du Chat syndrome.
Cri-Du-Chat Syndrome (CdCs) is a rare genetic disease caused by a deletion in the short arm of chromosome 5 (5p) with a variable clinical spectrum. To date no study in literature has ever investigated the alterations of brain glucose metabolism in these subjects by means of [18F]fluoro-2-deoxy-d-glucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT). The aims of this study were to detect difference in brain FDG metabolism in patients affected by CdCs with different clinical presentations and identify possible "brain metabolic phenotypes" of this syndrome. Methods: 6 patients (age: 5 M and 1 F, age range: 10-27) with CdCs were assessed for presence of cognitive and behavioral symptoms with a battery of neuropsychological tests and then classified as patient with a severe or mild phenotype. Then, patients underwent a brain 18F-FDG PET/CT scan. PET/CT findings were compared to a control group, matched for age and sex, by using statistical parametric mapping (SPM). Association of different clinical phenotypes and 18F-FDG PET/CT findings was investigated. Results: Four patients presented a severe phenotype, whereas 2 patients demonstrated mild phenotype. SPM single subject and group analysis compared to the control cohort revealed a significant hypometabolism in the left temporal lobe (BAs 20, 36 and 38), in the right frontal subcallosal gyrus (BA 34) and caudate body, and in the cerebellar tonsils (p<0.001). Hypermetabolism (P = 0.001) was revealed in the right superior and precentral frontal gyrus (BA 6) in patient group compared to the control cohort. In SPM single subject analysis the hypermetabolic areas were detected only in patients with a severe phenotype. Conclusion: This study revealed different patterns of brain glucose metabolism in patients with severe and mild phenotype compared to control subjects. In particular, the hypermetabolic abnormalities in the brain, evaluated by18F-FDG PET/CT, seem to correlate with the severe phenotype in patients with CdCs.


Protein-poly(amino acid) complex precipitation for high-concentration protein formulation.
A method for concentration of protein solutions is required for high-dosage protein formulation. Here, we present a precipitation-redissolution method by poly(amino acid) for proteins, including therapeutic enzymes, antibodies, and hormones. The proteins were fully precipitated by the addition of poly-L-lysine or poly-L-glutamic acid at low ionic strength, after which precipitate was dissolved at physiological ionic strength. The activities and secondary structures of redissolved proteins, especially antibodies, were almost identical to the native state. The precipitation-redissolution method is a simple and rapid technique for concentration of protein formulations.


Controlled growth of SnO₂@Fe₂O₃ double-sided nanocombs as anodes for lithium-ion batteries.
A novel heterostructure is developed by grafting 1D SnO(2) nanorods onto both sides of pre-grown 2D Fe(2)O(3) nanoflakes, forming a comb-like rather than tree-like branched nanostructure. The SnO(2) nanorod branches are determined to grow along the [001] direction on the (±001) planes of Fe(2)O(3) nanoflakes. The resulting SnO(2)@Fe(2)O(3) nanocombs show stabilized cycling performance and improved volumetric energy density compared to pristine Fe(2)O(3) nanoflakes presumably due to the integration of SnO(2) branches as well as the 3D hierarchical structural features.


Molecular, biochemical, and clinical analyses of five patients with carbamoyl phosphate synthetase 1 deficiency.
Carbamoyl phosphate synthetase 1 deficiency (CPS1D) is a rare urea cycle disorder. The aim of this study was to present the clinical findings, management, biochemical data, molecular genetic analysis, and short-term prognosis of five children with CPS1D. The information of five CPS1D patients was retrospectively studied. We used targeted next-generation sequencing to identify carbamoyl phosphate synthetase 1 (CPS1) variants in patients suspected to have CPS1D. Candidate mutations were validated by Sanger sequencing. In silico and structure analyses were processed for the pathogenicity predictions of the identified mutations. The patients had typically clinical manifestations and biochemical data of CPS1D. Genetic analysis revealed nine mutations in the CPS1 gene, including recurrence of c.1145C > T, five of which were firstly reported. Seven mutations were missense changes, while the remaining two were predicted to create premature stop codons. In silico and structure analyses showed that these genetic lesions were predicted to affect the function or stability of the enzyme. We reported five cases of CPS1D. Five novel mutations of CPS1 gene were found. Mutations of CPS1 have private nature, and most of them are missense compound heterozygous. The mutation affecting residue predicted to interfere the catalytic sites, the internal tunnel, or the regulatory domain results in severe phenotype.


Increased expression of leucocyte adherence-related glycoproteins by polymorphonuclear leucocytes during phagocytosis of staphylococci on an endothelial surface.
Phagocytosis of Staphylococcus aureus by human polymorphonuclear leucocytes (PMN) on the surface of endothelial cells is accompanied by adherence of the PMN to the endothelial surface and detachment of the endothelial cells from the culture monolayer. We studied the role of the leucocyte adherence-related glycoproteins (Leu-CAM: Mo1/LFA-1/150,95 or CD11a-c-CD18 complex) in these processes. Phagocytosis of S. aureus induced increased expression of the common beta chain (CD18) of Leu-CAM as demonstrated by flow cytometric analysis of PMN treated with a monoclonal antibody (MoAb) (CLB-LFA-1/1) directed against CD18 and fluorescein isothiocyanate (FITC)-conjugated anti-MoAb. This same MoAb also inhibited the increased adherence of the PMN to the endothelial cells which occurs during phagocytosis. Blocking of adherence during phagocytosis with MoAb CLT-LFA-1/1 had no effect on the detaching activity of the PMN on the endothelial cells. We conclude that adherence of PMN to endothelial cells during phagocytosis of S. aureus is mediated by the Leu-CAM complex. Adherence through the Leu-CAM, however, is not necessary for endothelial damage by the phagocytosing PMN.


[Depression and apathy in Parkinson disease].
Although Parkinson disease (PD) is primarily a condition of motor symptoms, an increasing amount of research has indicated that non-motor symptoms including cognitive and emotional deficits are observed even in the earliest stage of the disease. Individuals with PD may display various psychiatric and/or behavioural problems, among which depression and apathy are the most prominent symptoms. Prevalence of comorbid depression in PD has reportedly been estimated to be 7-76%. Such marked differences in the prevalence is partially attributable to different diagnostic criteria. It is useful to make a diagnosis according to standardized semi-structured diagnostic interview following DSM-IV or ICD-10. Based on such diagnostic criteria, prevalence of depression may approximate 20-40%. A half of such individuals fulfill the criteria of major depressive disorder while remaining half may be diagnosed as having dysthymia, minor depression or apathy. The second reason contributing to diversity of prevalence of depression in PD is a sampling procedure. Prevalence of depression in PD is much lower in the community-based surveys than those examined recruited patients. The third reason which makes the diagnosis of depression in PD difficult is an approach how to treat ambiguous symptoms. Caution should be paid whether the researcher is taking an inclusive or exclusive approach while they diagnose depression in PD. Concerning apathy in PD, one should be aware that typical apathy syndrome is quite different from depressive mood state. Rather, apathy syndrome is on the opposite side of depression in the sense that the former lacks serious self reproach or feeling of guilty. Neural substrate of apathy is known to include the dorsolateral, medial and orbital frontal cortices, and subcortical structures such as the basal ganglia, thalamus and internal capsule. Future researches are warranted that discriminate neural correlates and/or chemical neurotransmitters between depression and apathy.


A flexible current tracking control of sensorless induction motors via adaptive observer.
In this article, an interconnected adaptive observer-based backstepping control method is proposed to achieve sensorless current control without persistent excitation condition. Based on the stability theories of mathematics, an effective observer utilized to estimate the fluxes and external load is given. It has a good foundation for breaking the limitation caused by the coupling between the control process and the parameter estimation course. The characteristic of the uncoupling can make the control range for currents more wider. Due to the effective online tracking and the good adaptability of the designed observers, the control effect shows good robustness to the parameters. Finally, numerical simulations are provided to intuitively illustrate the effectiveness and the superiority of the theoretical results.


Neurosurgical management of low- and intermediate-grade gliomas.
Surgery remains an effective treatment for most histologic types of low- and intermediate-grade gliomas and is an important part of their initial management. Controversies nonetheless abound regarding the timing and goals of surgery for these gliomas. This article reviews surgical therapy of low- and intermediate-grade gliomas, paying special attention to new surgical techniques.


Relativistic Effects Break Periodicity in Group 6 Diatomic Molecules.
The finding of the periodic law is a milestone in chemical science. The periodicity of light elements in the Periodic Table is fully accounted for by quantum mechanics. Here we report that relativistic effects change the bond multiplicity of the group 6 diatomic molecules M2 (M = Cr, Mo, W, Sg) from hextuple bonds for Cr2, Mo2, W2 to quadruple bonds for Sg2, thus breaking the periodicity in the nonrelativistic domain. The same trend is also found for other superheavy-element diatomics Rf2, Db2, Bh2, and Hs2.


De novo malignancies after kidney and liver transplantations: experience on 582 consecutive cases.
De novo malignancies after transplantation are a growing problem of solid organ transplant recipients, due to longer survival follow-up under chronic immunosuppression. The aim of this study was to analyze a population of 582 consecutive kidney (n = 382) and liver (n = 202) transplant recipients, who survived at least 12 months after transplantation, at a single transplant center for the development of de novo cancers. The incidence of de novo malignancies was 7% after both renal and liver transplantation. The median elapsed time from transplant to the diagnosis of de novo malignancy was 45 months (range 3 to 220) months for kidney and 37 months (range 12 to 101 months) for liver transplants. Skin cancers were the most common within renal recipients, while gastroenteric cancers were more frequently encountered in liver transplants. Oropharyngeal and upper digestive tract tumors were always associated with a history of chronic alcohol consumption in liver recipients. Liver transplant recipients treated for acute rejection had a worse cancer prognosis than patients without rejection 1- and 2-year survivals 83% and 63% versus 36% and 17% (P = .026). The estimated 1- and 2-year survival rates for all types of de novo malignancies were 79% and 66%, including 64% and 51% for solid organ tumors versus 89% and 89% for skin cancers and posttransplant lymphoproliferative disorder (PTLD) (P = .17) in renal transplants and 70% and 42%, including 57% and 28% for solid organ tumors versus 85% and 64% for skin cancers and PTLD (P = .43) in liver transplants respectively.


Eletefine, a stephaoxocane alkaloid from cissampelos glaberrima
A novel isoquinoline alkaloid bearing an oxocane ring (stephaoxocane type (Kashiwaba, N.; Morooka, S.; Kimura, M.; Ono, M.; Toda, J.; Suzuki, H.; Sano, T. J. Nat. Prod. 1996, 59, 803)), has been isolated from the roots of Cissampelos glaberrima. This compound was given the trivial name eletefine (1) and its structure assigned on the basis of spectroscopic data and conversion to the corresponding ketone (2).


Subchronic metabolic effects and toxicity of a simulated pulp mill effluent on juvenile lake trout, Salmo trutta m. lacustris.
Juvenile lake trout (Salmo trutta m. lacustris) were exposed for 7 weeks to 0.05X and 0.2X 96-hr LC50 concentrations of simulated bleached kraft pulp mill effluent (KME - Sa + CP). A sulfate soap preparation, composed mainly of resin and fatty acids, with added chlorophenols (CP, tri-, tetra-, and penta-CP) was used as the toxicant mixture. Concentrations of free CP in plasma and free and conjugated CP in bile were proportional to their concentrations in the water. The greatest total gradient between bile and water CP was 5.2 X 10(4) for pentachlorophenol. The activity of a liver polysubstrate monooxygenase (PSMO) system, assayed with three model substrates, increased 40 to 67% due to KME - Sa + CP. However, the increase was not directly dependent on the exposure concentration. In contrast to PSMO, activities of conjugating enzymes (p-nitrophenol UDP-glucuronosyl and glutathione transferases) were decreased in the liver. Increased concentration of glutathione was noted in the liver and kidney. In addition, a small (9%) but significant decrease in blood hemoglobin concentration was observed at the higher exposure concentration. Although growth rate of lake trout was markedly decreased due to KME - Sa + CP, hydromineral balance and carbohydrate metabolism in fish were unaffected, indicating possible physiological compensation. On the other hand, lethality tests with lake trout preexposed to KME - Sa + CP at 0.2 X LC50 revealed decreased tolerance, whereas at the lower exposure concentration it was unchanged. We therefore conclude that various physiological adjustments in trout during subchronic exposures were not adaptive in terms of short-term tolerance.


Mummification and folie à deux.
Mummification is the preservation of the effects and/or corpse of a loved one. Psychiatric literature regarding this condition is reviewed and a case is presented in which a mother's paranoid psychosis is discovered following her apparent mummification of her son's corpse. In retrospect, it appears that a diagnosis of folie à deux pertained to this pair. The authors contend that mummification may represent the outcome of a shared delusional system and that failure to establish psychiatric diagnoses in those who practice mummification has been the result of inherent difficulties in diagnosing paranoid disorders.


Challenges in Facing the Lung Cancer Epidemic and Treating Advanced Disease in Latin America.
Lung cancer, the deadliest cancer worldwide, is of particular concern in Latin America. The rising incidence poses a myriad of challenges for the region, which struggles with limited resources to meet the health care needs of its low- and middle-income populations. In this environment, we are concerned that governments are relatively unaware of the pressing need to implement effective strategies for screening, diagnosis, and treatment of lung cancer. The region has also been slow in adopting molecularly-based therapies in the treatment of advanced disease: testing for epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangements are not routine, and access to targeted agents such as monoclonal antibodies and tyrosine kinase inhibitors is problematic. In this paper, we review the current situation in the management of lung cancer in Latin America, hoping that this initiative will help physicians, patient associations, industry, governments, and other stakeholders better face this epidemic in the near future.


An ossifying fibroma presenting as Stafne's idiopathic bone cavity.
The purpose of this paper is to present a case of a fibro-osseous lesion which was diagnosed as an ossifying fibroma rather than a cemento-ossifying fibroma because of its location away from the tooth bearing parts of the jaw and the absence of cemental tissue in the excised specimen. Its location and features on a panoramic radiographic made Stafne's idiopathic bone cavity a possible diagnosis.


Retrograde recanalisation of popliteal artery occlusion.
The increasing prevalence of critical lower limb ischemia is frequently associated with complex tibioperoneal obstructive disease and a high rate of amputation. In this article, we report our recent experience in order to highlight this valuable and underutilised technique, which proved successful in a complicated case where a conventional approach failed.


Preoperative localization of suspicious parathyroid adenomas by assay of parathyroid hormone in needle aspirates.
To determine the usefulness of parathyroid hormone (PTH) measurement in needle aspirates of a suspicious neck mass to confirm its parathyroid nature in patients with primary hyperparathyroidism. Thirty-three patients with surgically proved primary hyperparathyroidism were submitted to neck ultrasound (US), parathyroid scintigraphy, and assay of PTH in the aspirate (PTHa) of the suspicious cervical mass. Based on the results of neck US and parathyroid scintigraphy, patients were divided into two groups. Group 1: 16 patients (seven with nodular goiter) with concordant positive US and scintigraphic results. In all but one patient, PTHa was detectable and often markedly elevated (> 1000 pg in 12 patients, between 292 pg and 803 pg in three patients and 53 pg in one patient). The patient with undetectable PTHa had a small lower left parathyroid adenoma (8x8x10 mm). Group 2: 17 patients (12 with nodular goiter) with discordant US and scintigraphic results. PTHa established the parathyroid nature of the mass in 13 cases (> 1000 pg in 8 patients, between 501 pg and 953 pg in three patients and 90 and 79 pg in two patients): 11 of these had a suspected lesion by US examination but the scintigraphy results were negative; two had a mass that gave positive scintigraphy results but was of uncertain origin according to US: in both cases an intrathyroidal parathyroid adenoma was found. PTHa was undetectable in four cases (three with nodular goiter): all of these had equivocal US results, and three had positive scans and one a negative scan. Assay of PTHa is a simple method and should be useful for confirming the parathyroid nature of a cervical mass in patients with discordant or non-diagnostic US and scintigraphic results.