Comparison of morbidity, 30-day mortality, and long-term survival after pneumonectomy and sleeve lobectomy for non-small cell lung carcinoma.
The advantage of sleeve lobectomy as an alternative to pneumonectomy for preserving lung function is obvious and among other arguments allows operating on patients with lung cancer who would not tolerate pneumonectomy. The purpose of this retrospective, nonrandomized study is to compare the early (30-day mortality) and late (5-year survival) outcomes of both procedures. The charts of 310 patients who underwent either pneumonectomy or sleeve lobectomy for lung cancer stages I to IIIA from 1987 to 1997 were reviewed. One hundred ninety-four patients underwent pneumonectomy, and 116 patients underwent sleeve lobectomy. Specific operative complications, i.e., anastomotic leakage versus stump dehiscence, perioperative complications, 30-day or in-hospital mortality, and 5-year survival were registered for comparison of the immediate risk of the respective procedures. In the bronchial sleeve lobectomy group, the incidence of anastomotic leakage was 6.9% (8 of 116 patients) and the operative mortality was 4.3%. The incidence of bronchial stump fistulas after pneumonectomy was 3.6% (7 of 194 patients), and early mortality was 4.6%. All but 6 patients (98%) had a complete resection. Overall 5-year survival after sleeve lobectomy was 39% and after pneumonectomy, 27%. The distribution of 5-year survival stage by stage in either group is presented. Sleeve lobectomy, age younger than 65 years, pN0, and stage I are positive prognostic factors for long-term survival. In the multivariate analysis, pneumonectomy is a negative prognostic factor. The indication for pneumonectomy versus sleeve lobectomy depends on the localization of the primary tumor on the one hand, and on cardiorespiratory function, which might be more often distinctly impaired in the sleeve group, on the other hand. This could explain why the mortality in the sleeve lobectomy group was identical with that in the pneumonectomy group. However, both techniques are appropriate treatment modalities of advanced lung cancer or patients with critical functional reserve. Therefore, whenever possible, sleeve lobectomy should be performed.


[The clustering of cardiovascular risk factors in the urban population of Porto].
The aim of the study was to assess the total prevalence of obesity, non-insulin-dependent diabetes mellitus (NIDDM), hypertension, hypertriglyceridemia, hypercholesterolemia and central fat distribution, in a population-based survey. Two-hundred and ten individuals from the community were selected by random digit dialing. Obesity was defined as a body mass index > or = 25 kg/m2, central distribution of fat if the waist-to-hip ratio > 0.80 in women and 1.0 in men, diabetes was diagnosed if fasting plasma glucose levels > or = 140 mg/dl and/or currently under treatment, hypertension was defined as a systolic blood pressure > or = 140 mm Hg and/or diastolic blood pressure > 90 mm Hg and/or currently taking antihypertensive medications, hypertriglyceridemia was defined as a fasting serum triglyceride concentration > or = 200 mg/kg and hypercholesterolemia as a fasting serum cholesterol level > or = 200 mg/dl and/or currently taking specific medication. Prevalence rates of obesity, NIDDM, hypertension, hypertriglyceridemia, hypercholesterolemia and central fat distribution were 54.3%, 8.0%, 60.0%, 13.9%, 67.0% and 46.7% respectively. The prevalence of each of these conditions in its isolated form was 2.8% for obesity, 0.0% for diabetes, 3.8% for hypertension, 0.5% for hypertriglyceridaemia, 12.0% for hypercholesterolemia and 0.1% for the central fat distribution pattern. The large differences in prevalence between isolated and combined forms in the six disorders analyzed indicate a great overlap between these cardiovascular risk factors, and give epidemiologic support to a proposed metabolic syndrome.


Constructing Periodic Phase Space Orbits from ab Initio Molecular Dynamics Trajectories to Analyze Vibrational Spectra: Case Study of the Zundel (H5O2(+)) Cation.
A method of analysis is introduced to probe the spectral features obtained from ab initio molecular dynamics simulations. Here, the instantaneous mass-weighted velocities are projected onto irreducible representations constructed from discrete time translation groups comprising operations that invoke the time-domain symmetries (or periodic phase space orbits) reflected in the spectra. The projected velocities are decomposed using singular value decomposition (SVD) to construct a set of "modes" pertaining to a given frequency domain. These modes now include all anharmonicities, as sampled during the dynamics simulations. In this approach, the underlying motions are probed in a manner invariant with respect to coordinate transformations, operations being performed along the time axis rather than coordinate axes, making the analysis independent of choice of reference frame. The method is used to probe the underlying motions responsible for the doublet at ∼1000 cm(-1) in the vibrational spectrum of the H5O2(+), Zundel cation. The associated analysis results are confirmed by projecting the Fourier transformed velocities onto the harmonic normal mode coordinates and a set of mass-weighted, symmetrized Jacobi coordinates. It is found that the two peaks of the doublet are described and differentiated by their respective contributions from the proton transfer, water-water stretch, and water wag coordinates, as these are defined. Temperature dependent effects are also briefly noted.


The supply chain and clinical quality.
Improving quality of care has become a major consideration when it comes to buying supplies. Here's how leading-edge hospitals are changing the process, including adding clinicians to their buying staffs and standardizing how they choose and use products.


[The isolation amd study of lipopolysaccharide from Klebsiella pneumoniae vaccinal strain 204].
K. pneumoniae lipopolysaccharide (LPS) was isolated from biomass grown under the conditions of controlled multicycle and continuous cultivation. A considerable yield of LPS containing the minimal amount of protein and nucleic acid admixtures was obtained from biomass grown by continuous cultivation with the concentration of glucose in the medium equal to 20 g/l and the content of dissolved oxygen at a level of 0% of complete saturation. Erythrocyte diagnosticum prepared on the basis of this LPS was found to have a sensitizing dose of 100 micrograms per ml of solid erythrocytic precipitate and high specificity, studied in the passive hemagglutination test with the use of rabbit sera.


Inflammation in Diabetic Kidney Disease.
Diabetes is a growing public health problem. Diabetic kidney disease (DKD) is the most prevalent chronic renal disease and the major cause of end-stage renal failure worldwide, predominantly due to the increase of Type 2 diabetes associated with obesity. The intimate mechanisms leading to the development and progression of renal injury in DKD are not well understood, but current knowledge indicates that its pathogenesis is multifactorial, where the immune response and inflammation appear to be relevant factors. This review summarizes the role of relevant inflammatory molecules and pathways that participate in the development of DKD. Likewise, we focused on the new therapeutic approaches based on anti-inflammatory effects of different drugs. Key Messages: This new pathogenic perspective of DKD as an inflammatory condition leads to novel horizons, such as the potential role of inflammatory signaling pathways and their downstream products as emerging biomarkers and promising therapeutic targets.


A clinicopathologic study of oral leukoplakia and erythroplakia in a Thai population.
To determine the prevalence of oral leukoplakia and erythroplakia in a group of Thai patients and to study the clinical and pathologic features of these 2 lesions. Cases having provisional diagnoses of leukoplakia and erythroplakia between 1973 and 2004 were retrieved from the files of the Department of Oral Pathology, Faculty of Dentistry, Mahidol University. Clinical and pathologic features were reviewed and analyzed. Of 7,177 biopsy specimens, 123 cases (1.7%) of leukoplakia and 9 cases (0.13%) of erythroplakia were found. There was no significant gender predilection in leukoplakia (male:female = 1.2:1). The peak of age-frequency distribution of leukoplakia was in the fourth decade among men and fifth decade among women. The most common site of leukoplakia was buccal mucosa (28.5%), followed by alveolar mucosa (18.7%) and tongue (16.3%). Microscopic study of leukoplakia revealed hyperkeratosis with or without acanthosis in 60.9% of cases, epithelial dysplasia in 10.6%, and squamous cell carcinoma in 4.9%. Erythroplakia was found in 6 men and 3 women. It was most frequently seen during the seventh decade of life. The palate was the most common site. Epithelial dysplasia and squamous cell carcinoma were found in 6 patients with erythroplakia (66.7%). Leukoplakia occurred 13 times more frequently than erythroplakia. However, squamous cell carcinoma was more frequently found in erythroplakia cases. Both lesions were found most frequently in elderly individuals and affected men more than women.


Three cases of cervicocephalic artery dissection in an amusement park.
About 20 cases of cerebrovascular accidents in amusement parks have been documented. However, only a few cases of amusement park stroke (APS) after roller coaster rides have been reported. Here, we present triggers of stroke, clinical characteristics, and the angiographic appearance of 3 consecutive patients of APS. Their clinical characteristics included young age, absence of atherosclerotic risk factors, and severe injuries. Serial changes in angiographic appearance led to the diagnosis of cervicocephalic artery dissection (CAD). Patients A and B were diagnosed with isolated middle cerebral artery (MCA) dissection, and patient C was diagnosed with internal carotid artery dissection involving MCA dissection. Running excitedly toward an attraction in patient A, a go-kart ride in patient B, and riding in an enhanced motion vehicle in patient C were considered as the likely triggers for APS. We had specific cases with APS associated with CAD, which can occur under diverse contexts other than roller coaster rides at amusement parks. Our findings suggest that the variable directions of the high gravitational forces induced by vehicle riding or running excitedly might injure the MCA or internal carotid artery, and thereby cause CAD in the amusement park.


Late-stage mediators of the inflammatory response: identification of interleukin-1 and a casein-degrading enzyme in equine acute inflammatory exudates.
Interleukin-1 and a casein-degrading enzyme have been identified in an experimental system for studying acute inflammation in the horse. The levels of both the cytokine and the proteinase increased over the first 24 hours following initiation of the inflammatory response, and remained at high levels through to the last sample collected at 48 hours. This is in marked contrast to prostaglandin E2 concentrations which were low initially, peaked at four to eight hours and had returned to low levels by 12 to 24 hours. It is likely that interleukin-1 and various proteinases are involved in the later stages of the inflammatory response, such as the tissue remodelling associated with wound repair, and control of this cytokine may be important in the progression from acute to chronic inflammation.


Studies on the Ni-content of the centriole.
Nickel-containing organelles or subcellular structures have not yet been described in the literature; only some Ni-containing enzymes or "factors" acting at the cellular level have been studied. In the present study the nickel-content of centrioles and basal bodies were detected by using a new histochemical method. The centrioles and basal bodies are able to take up nickel. Evidence has also been presented that low concentrations of Ni (10(-5) M) enhance the growth rate of Tetrahymena.


45,X karyotype: may the diagnosis be suspected on ultrasonic examination in the second trimester of pregnancy?
We report three cases of Turner's syndrome with cystic hygromata, which were diagnosed by routine ultrasound scanning before amniocentesis in the second trimester of pregnancy. Maternal and amniotic level of alpha-fetoprotein were normal. Karyotyping carried out afterwards showed a 45,X karyotype. Our data indicate, that cystic hygromata in Turner's syndrome may coexist with a normal amniotic fluid AFP, thus questioning the theory of leakage from the hygroma. It remains to be investigated if all cases of Turner's syndrome present a cystic hygroma in utero.


Toll-like receptor 4 polymorphisms and atherogenesis.
The ability to mount a prominent inflammatory response to bacterial pathogens confers an advantage in innate immune defense but may signal an increased risk of atherosclerosis. We determined whether recently discovered genetic variants of toll-like receptor 4 (TLR4) that confer differences in the inflammatory response elicited by bacterial lipopolysaccharide are related to the development of atherosclerosis. As part of the five-year follow-up in the Bruneck (Italy) Study, we screened 810 persons in the study cohort for the TLR4 polymorphisms Asp299Gly and Thr399Ile. The extent and progression of carotid atherosclerosis were assessed by high-resolution duplex ultrasonography. As compared with subjects with wild-type TLR4, the 55 subjects with the Asp299Gly TLR4 allele had lower levels of certain proinflammatory cytokines, acute-phase reactants, and soluble adhesion molecules, such as interleukin-6 and fibrinogen. Although these subjects were found to be more susceptible to severe bacterial infections, they had a lower risk of carotid atherosclerosis (odds ratio, 0.54; 95 percent confidence interval, 0.32 to 0.98; P=0.05) and a smaller intima-media thickness in the common carotid artery (regression coefficient, -0.07; 95 percent confidence interval, -0.12 to -0.02; P=0.01). The Asp299Gly TLR4 polymorphism, which attenuates receptor signaling and diminishes the inflammatory response to gram-negative pathogens, is associated with a decreased risk of atherosclerosis. This finding is consistent with the hypothesis that innate immunity may play a part in atherogenesis.


Parents' perceptions, attitudes and behaviours towards child safety: a study in 14 European countries.
Injury is the leading cause of death for children 0- 19 years of age in Europe, accounting for 3.1 deaths per 10 000 children per year. The youngest children of the ages 0-4 years require the most protection in this age group, with 2.5 injury-related deaths per 10 000 children in Europe annually. As parents are the primary caregivers of children, it is necessary to learn more about parents' perceptions, attitudes and behaviours towards child safety. This study presents the findings of a 14-country study in Europe on this theme. A quantitative survey of parents of children aged 5 years or under was performed in 14 EU member states in order to enable better targeting of prevention efforts aimed at educating parents. The total sample size was 2088. The results show that 95% of parents reported that they personally take measures to avoid accidental injury to their children. Their top concern with regard to safety of their children was children being hit by a car. The most common response, when asked why some parents find it difficult to protect their children from accidental injury, was not being able to watch their children constantly. Lack of awareness or knowledge about the causes of accidents was the second response. Two-thirds of parents would like to see more help from the government to prevent childhood injuries. Three-quarters of parents agreed that child injuries can be avoided. It was concluded that parents want to be better informed about the causes of child accidents and about actions they and society can take to reduce injury-related risks to children.


[The place of anatomo-pathological study in the diagnosis of enterocolitis complicated by Yersinia pseudo-tuberculosis].
Over a period of 3 months, 3 patients were operated on for subacute enterocolitis. The first case was a 3 years old boy with a transverse colonic perforation near the right angle and gross lymphadenopathy. The second case was a 21 years old man who had subacute terminal ileitis. Histopathological study showed specific lesions in those two cases: ovoïd or starry abscesses with preepithelioïd cells, rare giant Langhans cells, rare altered polynuclear cells in necrosis, massive lymphoïd hyperplasia. The third case was a 27 years woman with mild appendicitis showing masses of bacteria in the wall of appendix, surrounded by lymphocytes without polynuclear. Serological study showed anti YPST agglutinins significantly modified in all 3 cases. In the absence of bacteriological study, the role of pathological findings is discussed.


Nasal CPAP treatment for obstructive sleep apnea: developing a new perspective on dosing strategies and compliance.
Nasal continuous positive airway pressure (CPAP) is presently considered as the "treatment of choice" for obstructive sleep apnea (OSA). Though some OSA patients adhere to treatment recommendations and ultimately respond quite well to CPAP therapy, there is a substantial subgroup for which compliance is a particularly difficult issue. Despite receiving recommendations to the contrary and for reasons that are incompletely understood, the majority of OSA patients settle for a partial compliance pattern. Whether a partial compliance schedule is beneficial or harmful is virtually unexamined: Unlike other medical treatments, there are few data concerning the "dose-response relationship" of CPAP to its desired effects. We argue that CPAP "dose" is a function not only of CPAP pressure but of time-on-CPAP as well. Critical questions that remain unanswered are what "dose" of CPAP is needed to effect an appropriate treatment outcome and which treatment outcomes should form the basis of our recommendations. Recent placebo-controlled studies comparing CPAP to suboptimal CPAP pressures may be informative in this regard. Directions for future research are suggested.


Plastic deformation in pediatric fractures: mechanism and treatment.
The plastic deformation often observed in children's long bone fractures is due largely to the complex nature of the molecular and histologic aspects of pediatric bone. Pediatric cortical bone has a lower mineral content than adult bone, accounting in part for its different material properties. Although plasticity allows children's long bones to absorb more energy prior to fracture, a significant deformity may persist after injury. An algorithm and technique for treatment of plastic deformation of the radius and ulna, the two most commonly involved bones in plastic deformation, are reviewed.


N-acetylcysteine in acute hepatic failure (non-paracetamol-induced).
Acute liver failure is a serious condition associated with poor prognosis. It may be associated with changes in systemic hemodynamics, i.e., tissue hypoxia, which contributes to multiple-organ failure. Recent studies have shown that N-acetylcysteine administered to patients with fulminant hepatic failure (paracetamol-induced) increases oxygen delivery and improves survival. The aim of this pilot study was to evaluate N-acetylcysteine administration to patients with non-paracetamol-induced acute liver failure and assess its effect on the clinical course and outcome. N-acetylcysteine was administered at presentation to 7 patients with non-paracetamol-induced acute liver failure. Patients were followed for changes in clinical parameters (grade of encephalopathy), coagulation factors, biochemical parameters and outcome. Clinically, 3 patients who initially had grade O/II encephalopathy, did not progress, and have fully recovered. The mean peak prothrombin time, serum factor V, aspartate aminotransferase and alanine aminotransferase levels, all significantly improved. Four patients (57%) have recovered fully (1 patient, although fully recovered, died later from an unrelated cause). Two patients required orthotopic liver transplantation and 1 patient died. N-acetylcysteine administration may have prevented progression to grade III/IV encephalopathy and improved serum coagulation factors. This may account for its beneficial effect on survival in patients who had poor prognostic criteria at base-line. No side effects of the drug were noted. This study suggests that N-acetylcysteine administration should be considered in all patients with acute liver failure.


Intraoperative core temperature monitoring: accuracy and precision of zero-heat flux heated controlled servo sensor compared with esophageal temperature during major surgery; the ESOSPOT study.
Monitoring of intraoperative core temperature is strongly recommended to reduce the risk of perioperative thermic imbalance and related complications. The zero-heat-flux sensor (3M Bair Hugger Temperature monitoring system, ZHF), measures core temperature in a non-invasive manner. This study was aimed at comparing accuracy and precision of the ZHF sensor compared to the esophageal thermometer. Patients scheduled for major elective abdominal or urologic surgery were considered eligible for enrollment. Core body temperature was measured using both an esophageal probe (TESO) and a ZHF sensor (TZHF) every 15 min from induction until the end of general anaesthesia. A Bland-Altman plot for repeated measures was performed. The proportion of measurements within ± 0.5 °C was estimated; from a clinical point of view, a proportion greater than 90% was considered sufficiently accurate. Lin's concordance correlation coefficient (CCC) for repeated measures were calculated. To evaluate association between the two methods, a generalized estimating equation (GEE) simple linear regression model, was elaborated. A GEE multiple regression model was also performed in order to adjust the estimate of the association between measurements from surgical and patient's features. Ninety-nine patients were enrolled. Bland-Altman plot bias was 0.005 °C with upper and lower limits of agreement for repeated measures of 0.50 °C and - 0.49 °C. The percentage of measurements within 0.5 °C of the reference value was 97.98% (95% confidence interval 92.89-99.75%), indicating a clinically sufficient agreement between the two methods. This was also confirmed by a CCC for repeated measures of 0.89 (95% CI 0.80 to 0.94). The GEE simple regression model (slope value of 0.77) was not significantly influenced by any patient or surgical variables. According to GEE multiple regression model results, the explored patient- and surgery-related variables did not influence the association between methods. ZHF sensor has shown a clinically acceptable accuracy and precision for body core temperature monitoring during elective major surgery. CLINICAL TRIALS: Clinical trial number: NCT03820232.


CT imaging of colitis.
Computed tomography (CT) is widely used to assess patients with nonspecific abdominal pain or who are suspected of having colitis. The authors recommend multidetector CT with oral, rectal, and intravenous contrast material and thin sections, which can accurately demonstrate inflammatory changes in the colonic wall and help assess the extent of disease. In most cases, the final diagnosis of the type of colitis is based on clinical and laboratory data and colonoscopic and biopsy findings, but specific CT features help narrow the differential diagnosis. Ulcerative colitis is distinguished from granulomatous colitis (Crohn disease) in terms of location of involvement, extent and appearance of colonic wall thickening, and type of complications. Ulcerative colitis and Crohn disease (granulomatous colitis) are rarely associated with ascites, which is often seen in infectious, ischemic, and pseudomembranous colitis. Pseudomembranous colitis also demonstrates marked wall thickening and, occasionally, skip areas but is associated with broad-spectrum antibiotic treatment or chemotherapy. Neutropenic colitis is characterized by right-sided colonic and ileal involvement, whereas ischemic colitis is characterized by vascular distribution pattern and history. Diverticulitis is a focal asymmetric process with fascial thickening and inflamed diverticula. Dilatation of a thick-walled appendix with increased enhancement and adjacent stranding suggests appendicitis, but inflammatory changes may extend to the cecum and terminal ileum. Epiploic appendagitis is a focal rim-enhancing area next to the colon, usually without any substantial colonic wall thickening.


[Noncardiac risk factors in heart surgery--the blood coagulation system].
Diagnostics and therapy in coagulation disorders are presented. A special emphasis is given to alterations of blood coagulation in cardiac surgery. No major rule can be defined for this particular field. All disturbances of blood coagulation may become clinically overt in highly variable combinations, thus representing no or high risk to patients conditions. This implies that the actual risk has to be estimated individually for every patient and that the risk of the cardiac disorder has to be considered in view of the risk of the operation plus potential disturbances in coagulation. The latter in order to be assessed appropriately, clearly requires a laboratory specialised in diagnostics of coagulation, as well as a highly experienced coagulation physiologist for decision making. Following this policy, we have not been forced to disagree about extracorporeal circulation for cardiac surgery in most instances. Problems have been confined to patients suffering from various hepatic disorders or from impaired platelet functions.


Reaction time measures of spelling: testing a two-strategy model of skilled spelling.
Two strategies have been suggested to be important in skilled English spelling: a lexical strategy, which relies on word-specific graphemic information, and a rule strategy, which relies on phoneme-to-grapheme correspondences. Limitations in the usefulness of spelling accuracy as a dependent variable make it difficult to test claims about how the strategies might work together. Two experimental paradigms that measure both spelling accuracy and time are suggested to be useful. Results produced with the paradigms were consistent with the claims that skilled spellers make use of both strategies and that the lexical strategy is more useful than the rule strategy. Working memory may be important in combining products of both strategies. Results were inconsistent with the claim that the rule strategy is invoked only when the lexical strategy fails to produce a complete spelling.


[Ogilvie syndrome with cecal perforation. A rare complication after isolated thoracic trauma. Case report and current literature review].
In reviewing 750 cases of acute colonic pseudo-obstruction from the literature, the most commonly associated disorders are listed and the therapeutical management is critically discussed. The authors describe an additional case of a 77-year-old male with ogilvie's syndrome following isolated thoracic trauma. Ogilvie's syndrome has been used synonymously with acute colonic pseudo-obstruction (ACPO) of the colon, first defined by Sir Heneage Ogilvie in 1948. If inappropriately managed, the massive colonic dilatation may lead to caecal ischaemia and perforation with a high mortality rate. Aetiology and pathogenesis of the syndrome are still unknown, but mostly ACPO is associated with a wide variety of medical conditions. Often it appears to be a complication after abdominal or pelvic surgery or trauma. In few cases the pseudo-obstruction is isolated and therefore truly idiopathic. Conservative treatment is indicated if the caecum is less than 12 cm in diameter. If there is a progressive increase in diameter or no improvement is seen, the colon should be decompressed without further delay. The indications for surgery are failure of conservative treatment and colonoscopy, signs for ceacal ischaemia or perforation. The choice of procedure, coecostomy or resection, is dictated by the state of the caecum. Due to a high mortality rate (up to 50%) if the caecum is perforated, an aggressive therapeutical management should be applied.


Determination of 5-(p-hydroxyphenyl)-5-phenylhydantoin and studies relating to the disposition of phenytoin in man.
A gas chromatographic on-column methylation technique was developed for the routine laboratory determination of 5-(p-hydroxyphenyl)-5-phenylhydantoin (p-HPPH), the principal urinary product of phenytoin )PHT) metabolism in man. 5-(p-Hydroxyphenyl)-5-(p-tolyl)hydantoin (HMPPH), a new internal standard, was synthesized and evaluated against 5-phenyl--5-(p-tolyl)hydantoin (MPPH), the compound normally used as the internal standard in p-HPPH assays. HMPPH withstood the challenges of intralaboratory quality control checks and tests of precision of p-HPPH values at times when MPPH provided erratic and unreliable values. Both an enzyme and acid treatment of urine were studied for the purpose of hydrolysis of p-HPPH-glucuronide, the form in which p-HPPH is excreted in urine. The use of both treatments in studies of three different patient urines pointed to the conclusion that acid-catalyzed decomposition of PHT dihydrodiol, a minor urinary metabolite of PHT in man, was unimportant from the analytical point of view, contributing little if anything to total urinary p-HPPH content. Some aspects of PHT disposition, as evidenced by studies of PHT plasma levels and p-HPPH urinary outputs in individual patients, are discussed.


Study of novel d1 alleles, defective mutants of the alpha subunit of heterotrimeric G-protein in rice.
It has been shown that the disruption of the alpha-subunit gene of heterotorimeric G-proteins (Galpha) results in dwarf traits, the erection of leaves and the setting of small seeds in rice. These mutants are called d1. We have studied the expression profiles of the transcripts and translation products of rice Galpha in ten alleles of d1 including five additional alleles newly identified. By RT-PCR, the transcripts of the Galpha gene were detected in the all d1 alleles. By western blot, the Galpha proteins were not detected in the plasma membrane fractions of the d1 alleles with the exception of d1-4. In d1-4, one amino acid change in the GTP-binding box A of the Galpha protein was occurred and even in this case the Galpha protein was only just detectable in the plasma membrane fraction. Given that the Galpha protein did not accumulate in the plasma membrane fraction in d1-8 which has a deletion of just a single amino acid in the Galpha protein, it is likely that a proper conformation of the Galpha is necessary for accumulation of Galpha protein in the plasma membrane. Nine alleles of d1 showed a severer phenotype whilst d1-4 exhibited a mild phenotype with respect to seed size and elongation pattern of internodes. As brassinosteroid signaling was known to be partially impaired in d1s, the sensitivity to 24-epibrassinolide (24-epiBL) was compared among d1 alleles in a T65 genetic background. Only d1-4 showed responses similar to wild type rice. The results show that the d1-4 mutant is a mild allele in terms of the phenotype and mild hyposensitivity to the exogenously applied 24-epiBL.


Determination of the the H3 factor in hydrogen isotope ratio monitoring mass spectrometry.
The H3 factor, K, is a parameter required in high-precision, mass spectrometric analyses of hydrogen isotopic abundances. When H2 is used as the sample gas, R* = R - Ki2, where R* is the true HD/H2 ratio, R is the observed (mass 3)/(mass 2) ion-current ratio, and i2 is the ion current at mass 2. Four different methods for the determination of K were defined and tested under conditions characteristic of isotope ratio monitoring systems. Three of these were peak-based. The fourth employed steady flows of H2 from a conventional inlet system. Results obtained using the latter method were more precise (standard deviation of K = 0.1 versus approximately 0.6 ppm mV(-1) for the peak-based methods). However, use of the resulting values of K for correction of isotope ratio monitoring GC/MS results led to systematic errors as large as 9 per thousand, whereas use of the peak-based values led to no systematic errors. Values of K were only weakly dependent on the pressure of He, declining approximately 5% for each 10-fold increase in P(He). Small variations in partial pressures of H2O and CH4, potential contaminants under isotope ratio monitoring conditions, had no significant effect on values of K.


The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures.
Forty-eight patients with 50 severe fractures of the proximal tibia were followed prospectively for 2-4 years (mean 2.7 years) to evaluate the use of limited internal fixation combined with external fixation in the treatment of these injuries. There were 27 men and 21 women ranging in age from 20 to 74 years. Fractures were classified according to the A0 system (Mast J, Ganz R, Jacob R: Planning and reduction technique in fracture surgery. Berlin, Springer-Verlag, 1989), which included 5 A3, 6 C1, 16 C2, and 23 C3 fractures. All patients in this series healed; 48 fractures healed in an average of 12 weeks without subsequent surgery. There were two (4%) nonunions requiring bone graft. The average hospital special surgery knee score was 90 (68-100). Grading criteria for anatomical outcome revealed there were 17 (34%) excellent results, 24 (48%) good results, 6 (12%) fair results, and 3 (6%) poor results. In conclusion, this treatment method is associated with a high percentage of good and excellent results. Combined internal and external fixation combines the advantages of anatomic, stable fixation with less soft-tissue dissection and eliminates the need for large implants.


Monitoring membrane properties and apoptosis using membrane probes of the 3-hydroxyflavone family.
Environment-sensitive fluorescent membrane probes are attractive tools for investigating the membrane properties and their changes under perturbing conditions. Membrane probes of the 3-hydroxyflavone family are of particular interest due to their excited-state intramolecular proton transfer (ESIPT) reaction, which confers a dual emission highly sensitive to the polarity and hydration of the environment. In the present work, we will describe the protocols used with these probes in order to monitor the physicochemical properties of lipid membrane models and cell plasma membranes and to detect apoptosis.


Microbial source tracking by DNA sequence analysis of the Escherichia coli malate dehydrogenase gene.
Criteria for sub-typing of microbial organisms by DNA sequencing proposed by Olive and Bean were applied to several genes in Escherichia coli to identify targets for the development of microbial source tracking assays. Based on the aforementioned criteria, the icd (isocitrate dehydrogenase), and putP (proline permease) genes were excluded as potential targets due to their high rates of horizontal gene transfer; the rrs (16S rRNA) gene was excluded as a target due to the presence of multiple gene copies, with different sequences in a single genome. Based on the above criteria, the mdh (malate dehydrogenase) gene was selected as a target for development of a microbial source tracking assay. The mdh assay was optimized to analyze a 150 bp fragment corresponding to residues G191 to R240 (helices H10 and H11) of the Mdh catalytic domain. 295 fecal isolates (52 horse, 50 deer, 72 dog, 52 seagull and 69 human isolates) were sequenced and analyzed. Target DNA sequences for isolates from horse, dog plus deer, and seagull formed identifiable groupings. Sequences from human isolates, aside from a low level (ca. 15%) human specific sequence, did not group; nevertheless, other hosts could be distinguished from human. Positive and negative predictive values for two- and three-way host comparisons ranged from 60% to 90% depending on the focus host. False positive rates were below 10%. Multiple E. coli isolates from individual fecal samples exhibited high levels of sequence homogeneity, i.e. typically only one to two mdh sequences were observed per up to five E. coli isolates from a single fecal sample. Among all isolates sequenced from fecal samples from each host, sequence homogeneity decreased in the following order: horse>dog>deer>human and gull. For in-library isolates, blind analysis of fecal isolates (n=12) from four hosts known to contain host specific target sequences was 100% accurate and 100% reproducible for both DNA sequence and host identification. For blind analysis of non-library isolates, 18/19 isolates (94.7%) matched one or more library sequences for the corresponding host. Ten of eleven geographical outlier fecal isolates from Florida had mdh sequences that were identical to in-library sequences for the corresponding host from California. The mdh assay was successfully applied to environmental isolates from an underground telephone vault in California, with 4 of 5 isolates matching sequences in the mdh library. 146 sequences of the 645bp mdh fragment from five host sources were translated into protein sequence and aligned. Seven unique Mdh protein sequences, which contained eight polymorphic sites, were identified. Six of the polymorphic sites were in the NAD+ binding domain and two were in the catalytic domain. All of the polymorphic sites were located in surface exposed regions of the protein. None of the non-silent mutations of the Mdh protein were in the 150bp mdh target. The advantages and disadvantages of the assay compared to established source tracking methods are discussed.


Iron overload: detection using a micromethod for iron-binding capacity.
Depending upon the transferrin saturation value, 214 serum samples were divided into three groups--iron overloaded (46 cases), iron deficient (61 cases) and normal (107 cases)--and tested with a micromethod based upon detection of unsaturated iron binding capacity. All the samples with iron overload could be distinguished from the other two groups, the results of the normal and iron deficient groups showing wide scatter and overlap. The high prevalence of iron deficiency anaemia and thalassaemia (iron overload) syndromes in India and other developing countries emphasises the need to differentiate these disorders at the earliest opportunity. The micromethod can be of immense help as it is a simple, rapid and inexpensive.


Clinical and biochemical parameters related to cardiovascular disease after Helicobacter pylori eradication.
Since the major established risk factors explain the pathogenesis of ischemic heart disease (IHD) in a proportion of cases, it is crucial to search for other causal mechanisms. The possible link between IHD and Helicobacter pylori (H.pylori) infection has been reported. However, the precise mechanism of this potential relationship, by a proinflammatory activity or metabolic disorder, is unclear. In order to investigate this issue, the authors assessed changes in clinical and biochemical parameters related to IHD after bacterial eradication. A total of 496 patients (281 males; mean age 59.7+/-2.3) with H.pylori-positive dyspepsia and/or peptic ulcer were studied after cure of the bacterium. H.pylori status was determined by histology or 13C-urea breath testing. Examinations for body mass index, diastolic blood pressure and blood testing (C-reactive protein, fibrinogen, triglycerides, total cholesterol, high-density and low-density lipoprotein cholesterol, fasting glucose) were performed before eradication and annually for up to five years thereafter. For statistical analyses, the Student's t test was performed. HDL-C increased (P=0.02) while C-reactive protein and fibrinogen levels diminished (P<0.0001) significantly. BMI and diastolic blood pressure increased in a significant (P=0.032 and P=0.039 respectively) manner compared to baseline. H.pylori eradication is associated with modification of some clinical and biochemical parameters related to IHD during a follow-up of five years. There is a need for large interventional randomized studies in order to prove a causal association.


A case of right atrial mobile thrombus complicating multiple pulmonary emboli.
Right atrial thrombi are usually immobile. However, a mobile type mimicking a cardiac tumor, especially myxoma, has been described on rare occasions. We report here a case of atrial thrombus which was mobile in the cardiac chambers. A 29-year-old male was admitted because of exertional dyspnea. On admission, his echocardiogram showed an abnormal mass in the right atrium with a stalk attached to the interatrial septum. It decreased in size on the next day. On the fourth day of admission, it moved to the right ventricle. Multiple pulmonary emboli were revealed by the lung perfusion scintigram. Two days after the administration of intravenous urokinase, the abnormal mass in the cardiac chambers was no longer seen on the echocardiogram. This was a rare case of mobile atrial thrombus associated with multiple pulmonary emboli. Thrombolytic therapy appeared to be effective in this case.


Generation of an erythromycin-sensitive derivative of Clostridium difficile strain 630 (630Deltaerm) and demonstration that the conjugative transposon Tn916DeltaE enters the genome of this strain at multiple sites.
Erythromycin resistance in Clostridium difficile strain 630 is conferred by a genetic element termed Tn5398 which contains two erm(B) genes: erm1(B) and erm2(B). An erythromycin-sensitive derivative of strain 630 (designated 630Deltaerm) was generated by spontaneous mutation after continuous subculture for 30 days. This strain had lost the erm2(B) gene from within Tn5398 but retained erm1(B). However, the strain could revert to erythromycin resistance at a frequency of 2.79 x 10(-8), although it still contained the deletion of erm2(B). The availability of C. difficile 630Deltaerm allowed the behaviour of Tn916DeltaE to be investigated in this strain. This element entered the genome at multiple sites indicating that it could be useful as an insertional mutagen.


Mitochondrial function in Babesia microti and Babesia rodhaini.
The role of mitochondria in the energy metabolism of Babesia microti and Babesia rodhaini was investigated. A variety of mitochondrial inhibitors showed greater sensitivity to B. microti than to B. rodhaini. Additionally, alpha-glycerophosphate- and succinate-cytochrome c reductase activities in the crude mitochondrial fraction from B. microti were substantially higher than those from B. rodhaini. Our results suggest that the mitochondria of these parasites possess a series of "classical" apparati for energy production and their relative functional role may be quantitatively greater in B. microti when compared with B. rodhaini.


[Harpoons--toy, tool, weapon?].
The case of a 13-year-old boy injured by a Spanish souvenir harpoon is reported. Shooting experiments with the harpoon showed that serious injuries can be caused. The results are discussed and compared with the rare literature.


Solvation of dimethyl succinate in a sodium hydroxide aqueous solution. A computational study.
Molecular dynamics simulations were carried out to study dimethyl succinate/water/NaOH solutions. The potential of mean force method was used to determine the transport mechanism of a dimethyl succinate (a diester) molecule across the aqueous/vapor interface. The computed number density profiles show a strong propensity for the diester molecules to congregate at the interface, with the solubility of the diester increasing with increasing NaOH concentration. It is observed that the major contribution to the interfacial solvation free-energy minimum is from electrostatic interactions. Even at higher NaOH concentrations, the increasing electrostatic interaction between the diester and ions is not large enough to favor the solvation of diester in bulk solutions. The calculated solvation free energies are found to be -2.6 to -3.5 kcal/mol in variant concentrations of NaOH aqueous solutions. These values are in qualitative agreement with the corresponding experimental measurements. The computed surface potential indicates that the contribution of diester molecules to the total surface potential is about 25%, with the major contribution from interfacial water molecules.


Basement membrane in human endometrium: possible role of proteolytic enzymes in developing hyperplasia and carcinoma.
Basement membranes (BM) are elements of the extracellular matrix that are essential for growth and differentiation of tissues. Several collagenolytic enzymes of tumor cells are involved in degradation of the extracellular matrix; growth and inhibitor factors [e.g. Epidermal Growth Factor (EGF), Transforming Growth Factors alpha and beta (TGF-alpha, beta)] seem to be involved in the extracellular matrix formation and degradation. To establish a possible association between the presence of collagenase (C), urokinase-type plasminogen activator (uPA) and the neoplastic growth of the endometrium, 44 endometrial specimens (14 proliferative, 11 secretive, 7 adenomatous hyperplasia, 12 adenocarcinoma) were studied using immunohistochemistry with antisera for C, uPA, EGF receptors and TGF-alpha. Immunostaining for collagenase revealed a positive reaction in moderately differentiated adeno-carcinoma without staining the normal and hyperplastic endometrium. A progressive increase in uPA immunostaining was observed in proliferative and neoplastic endometrium. TGF-alpha and its receptor (EGFr) were stained in proliferative and more clearly in hyperplastic and carcinomatous endometrium. In conclusion, BM play an important role in proliferation and differentiation of human endometrium; their degradation influences estrogen transportation from blood to the stroma. Endometrial BM degradation is associated with the presence of collagenolytic enzymes and growth factors.


Oxidized fish oil injury stress in Megalobrama amblycephala: Evaluated by growth, intestinal physiology, and transcriptome-based PI3K-Akt/NF-κB/TCR inflammatory signaling.
Lipids are essential nutrients for animal. Oxidized lipid might induce injury stress for fish. Here we conducted a 12-week rearing experiment with diets containing 0, 2, 4, and 6% oxidized fish oil (6F, 4F2OF, 2F4OF, and 6OF) to describe the oxidative impairment mechanism on teleost fish blunt snout bream, Megalobrama amblycephala. Results were evaluated by growth performance, intestinal physiology, and transcriptome-based PI3K-Akt/NF-κB/TCR inflammatory signaling. From the results, 6OF reduced growth performance with increased FCR and reduced FBW, WGR and SGR compare with 6 F. Meanwhile, oxidized fish oil treatments also increased antioxidant enzyme activity, suggesting an impaired physiological condition. The plasmatic antioxidant enzyme activity of T-SOD, GSH-Px, ASAFR, concentration of MDA and cortisol were significantly increased in 6OF, while GSH concentration was decreased. Histological ultrastructure revealed the integrity of mid-intestinal cells and villus were destroyed in 6OF. Moreover, transcriptomic analysis revealed PI3K-Akt/NF-κB/TCR inflammatory signaling were active to oxidized fish oil stress. We verified the expression of twelve key genes related to this signaling by RT-PCR, which revealed TLR2, PI3K, Akt, NF-κB, MHCII-β, TCR-α, TGF-β, TNF-α, IL-6, IL-1β, GPx1 and GSTm were all activated under 6OF stimulation. We found that oxidized fish oil may induce oxidative stress, destroy intestinal integrity, produce free radical, dysregulate lipid metabolism and oxidative balance, reversely affect the physiological adaptation, and eventually lead to growth inhibition. This study revealed the mechanism of PI3K-Akt/NF-κB/TCR inflammatory signaling in M. amblycephala under oxidized fish oil stress, which may help to understand the complex regulation involved in lipid oxidative stress resistance.


Dosimetry models for radioimmunotherapy.
Tumor therapy using radiolabeled antibodies presents a challenging problem in absorbed dose determination. The purpose of this study is to evaluate the effect of tumor size on the absorbed dose distribution from beta-emitters when the radiolabeled antibody is not uniformly distributed throughout the tumor. Two theoretical dosimetry models are constructed, one for nonvascularized micrometastases and the other for vascularized tumors. All calculations assume no penetration of radionuclide into the tumor. These are compared to an even distribution of radionuclide throughout the tumor. In micrometastases of 1-mm diameter or less, emitters of low energy such as 131I give higher dose rates than emitters of higher energy because less energy is lost outside the target volume. However, even with 131I, a significant proportion of the energy is not absorbed in the tumor and, as a result, the concentration of radionuclide necessary for a therapeutic radiation dose becomes higher as the tumor diameter gets smaller. Because it may be impossible to achieve these concentrations in very small tumors (less than 0.5-mm diameter), alpha-emitters may be useful in combination with beta-emitters for therapy of micrometastatic disease. In vascularized tumors, higher energy emitters such as 90Y yield higher doses because of overlapping dose distributions from multiple vascular sources. This also produces a more even dose distribution across a tumor, even when there is poor penetration of the radiolabeled antibody. Thus tumor size, antibody penetration, and tumor vascularity all influence the choice of radionuclide and, depending on the circumstances, alpha-emitters, low-energy beta-emitters, high-energy beta-emitters, or some combination of the three may be most efficacious.


Establishing minimally important differences for the American Shoulder and Elbow Surgeons score and the Western Ontario Rotator Cuff Index in patients with full-thickness rotator cuff tears.
The American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Rotator Cuff Index (WORC) are frequently used measures in clinical research for patients with rotator cuff tears (RCTs). The minimally important differences (MIDs) for these measures have not been established in patients with RCTs. The purpose of this study was to establish the MIDs for patients with known RCTs treated both surgically or nonsurgically. We included 222 subjects with full-thickness RCTs. The WORC and ASES were collected at baseline and at 4, 8, 16, 32, 48, and 64 weeks, as was an end of study form with questions about change in the condition after treatment. We calculated anchor-based and distribution-based MIDs. We used regression modeling to determine change in MIDs as predicted by several variables. For the anchor-based method, we found an MID of 21.9 for the ASES and -282.6 for the WORC. When using the distribution-based method of ½ and ⅓ the standard deviation, we arrived at an MID of 26.9 and 17.9 points for the ASES and -588.7 and -392.5 points for the WORC. No variables predicted MID changes. This is the first study to report MIDs for the ASES and WORC in a population of patients with only full-thickness RCTs. This information will directly improve our ability to determine when patients with RCTs are changing in a meaningful manner and accurately power clinical studies using these outcome measures.


ApoE and CYP2D6 polymorphism with and without parkinsonism-dementia complex in the people of Chamorro, guam.
Parkinsonism-dementia complex (PDC), a neurodegenerative disorder in the Chamorro, Guam population, has been epidemiologically ascribed to the ingestion of the neurotoxin cycasin. This disease is characterized neuropathologically by the presence of abundant neurofibrillary tangles (NFTs). We analyzed a genetic risk factor of Alzheimer's disease (AD), apolipoprotein E, hypothesized to be linked to NFT formation, and a genetic risk factor of Parkinson's disease (PD), CYP2D6 mutation, linked to slower metabolism of exogenous toxins, in Chamorro, Guam individuals with and without PDC. The representation of the G-to-C mutation in exon 9 of the CYP2D6 gene was higher in Chamorro and Filipino than in Caucasian individuals, but this mutant allele had similar high frequencies in both PDC patients and healthy Chamorro individuals. We found no alleles of these genes associated with AD or PD to be overrepresented among those with PDC.


Universal screening with automated essay scoring: Evaluating classification accuracy in grades 3 and 4.
The adoption of the Common Core State Standards and its associated assessments has placed increased focus on writing performance. Consequently, weak writers may be at risk of failing Common Core English language arts (ELA) assessments. Thus, the current study sampled a diverse group of third and fourth grade students (n=100 and 130, respectively) who were administered Fall and Spring writing screeners using the procedures of a Direct Assessment of Writing (DAW). Results were used to predict whether students did or did not attain grade-level standards as evaluated by the summative Smarter Balanced ELA assessment. Writing screeners were scored using the Project Essay Grade (PEG) automated essay scoring system. ROC curve analysis and logistic regression were used to evaluate screening models. Area under the ROC curve (AUC) values for grade 3 were in the acceptable range (Fall=0.74, Spring=0.75). AUCs approached or fell within the excellent range for grade 4 (Fall=0.79, Spring=0.83). Sensitivity-based and d-based cutpoints were selected and measures of diagnostic accuracy, including sensitivity and specificity, are reported. Results indicate that automatically-scored DAW has promise for universal screening for writing risk.


Reprint of Bioneutronics: Thermal scattering in organics tissues and its impact on BNCT dosimetry.
Neutron transport calculation is a key factor in BNCT numerical dosimetry assessments where thermal neutron flux is intimately related to the neutron dose, specially, the therapeutic boron dose. In this work, numerical calculations in phantoms were performed to determine the importance of utilizing the appropriate thermal scattering treatment for different organic tissues. Two thermal treatments for the neutron scattering were included in the simulations: hydrogen bounded in bulk water and hydrogen bounded in a lipid like carbon chain (polyethylene). The results showed difference between both thermal treatments that can reach several percent points depending on the type of source and irradiated geometry.


High-repetition-rate combustion thermometry with two-line atomic fluorescence excited by diode lasers.
We report on kilohertz-repetition-rate flame temperature measurements performed using blue diode lasers. Two-line atomic fluorescence was performed by using diode lasers emitting at around 410 and 451 nm to probe seeded atomic indium. At a repetition rate of 3.5 kHz our technique offers a precision of 1.5% at 2000 K in laminar methane/air flames. The spatial resolution is better than 150 microm, while the setup is compact and easy to operate, at much lower cost than alternative techniques. By modeling the spectral overlap between the locked laser and the probed indium lines we avoid the need for any calibration of the measurements. We demonstrate the capability of the technique for time-resolved measurements in an acoustically perturbed flame. The technique is applicable in flames with a wide range of compositions including sooting flames.


Supporting Blind and Visually Impaired Persons in Managing Their Medication.
Various reasons lead to non-adherence to drug therapy, such as forgotten reordering of medications or wrong intake behavior. Blind and visually impaired persons face additional challenges, such as recognizing the medication package or reading the package insert which additionally impacts on patient safety. To address these challenges, we developed a concept for supporting medication management. In the center of the concept is the mobile application MyPills. It reminds on drug intake and reordering. These functionalities are made available to blind and visually impaired persons using screen reader functionalities. The current medication is entered into MyPills using the eMediplan, a Swiss national exchange format for eMedication. Beyond, package inserts are made accessible through voice output. MyPills supports in scanning the global trade item number (GTIN) for medication package identification. A usability tests carried out with six participants including two blind persons showed that users get along well with the app and the functionalities are helpful. In future studies with patients, it should be checked whether the MyPills app can improve compliance with drug therapy and impacts on intake behavior.


Accuracy of Doppler sonography in the evaluation of acute conditions of the scrotum in children.
During a 12-month period, 65 boys (newborn to 18 years of age) with acute scrotal pain or swelling underwent Doppler sonography of both testes, followed by scintigraphy (15) and/or surgery (34) and close clinical follow-up for at least 4 months (23). Pulsed Doppler was performed with an ATL UM8 or Quantum II apparatus, using 7.5- or 10-MHz transducers. In 25 patients, color Doppler was also used. The testicular artery was deemed patent if Doppler shifts from branches within the parenchyma could be found. (Doppler signals from scrotal or marginal arteries were considered nondiagnostic). Through surgery, 19 testicular torsions were noted. Seventeen were diagnosed as such with Doppler. Two boys with torsion were deemed normal at the time of both Doppler and scintigraphy evaluation. One boy had a second Doppler examination 13 hours later, which showed no flow. The testicle was necrotic at the time of surgery. The second boy had had 8 hours of symptoms and had a viable testis at the time of surgery. This probably represented intermittent torsion. In six of the 65 cases, no signals could be found on either side, and they were deemed technical failures of the test. Doppler sonography was technically successful in 59 of the 65 patients (91%) and yielded a sensitivity of 89% and specificity of 100%. Comparing the normal and painful side helped to define technical failures. Pulsed Doppler with mechanical sector scanners was more sensitive than color Doppler. Intermittent torsion was missed with both Doppler sonography and scintigraphy. Although ultrasonography cannot replace clinical judgement, it may be very helpful in unclear cases.


Headache complaints in relation to nocturnal oxygen saturation among patients with sleep apnea syndrome.
Morning headaches are often ascribed to patients with sleep apnea syndrome (SAS) but the etiology of headaches in SAS is unclear. Given the relationship between oxygen and other headache syndromes, nocturnal hypoxia might be one factor contributing to headaches in SAS. All subjects 18-80 years of age who were determined to have SAS and who underwent a continuous positive airway pressure trial in our sleep laboratory between March 1, 1997 and March 18, 1998 were considered for inclusion. Subjects were grouped according to whether they endorsed that waking with headaches is a problem for them. Polysomnography and standardized questionnaires were used to test the main hypothesis that patients with SAS and headaches would spend more time at lower oxyhemoglobin levels than those SAS patients without headache. Headache and non-headache patients did not differ in the percentage of time spent with an oxygen saturation less than 90%, either in total sleep time or in rapid eye movement sleep (REM). The headache patients were more likely to be female and spend a lower percentage of time in REM sleep. The REM sleep difference was not accounted for by the use of REM suppressing medications or by depression (as measured by the Zung scale). These data do not support the hypothesis that the duration of nocturnal hypoxemia relates to headache complaints in patients with SAS. The lower REM sleep percentage and higher variability in REM apnea index among the headache patients warrants further investigation.


Chemotherapy for prostate cancer.
The development of chemotherapy for prostate cancer has been limited by the toxicity of treatment in an elderly population. The evaluation of newer agents in the 1990's has allowed chemotherapy to be given which has fewer side effects, and has improved life quality. The investigation of adjuvant treatment may be warranted in an attempt to improve the outlook of this condition.


The Geographic Origin of an Intercepted Biosecurity Pest Beetle Assigned Using Hydrogen Stable Isotopes.
Arhopalus ferus (Mulsant) (Coleoptera: Cerambycidae) is a forest pest that does not occur in Australia. In February 2010, the container ship Tatiana Schulte, en route from New Zealand, was refused permission to enter Australia following the discovery of numerous A. ferus aboard. The place where the infestation occurred was unknown, representing an uncontrolled biosecurity-risk pathway. Hydrogen isotope analysis of the beetles' wings showed that the infestation most likely originated from Auckland, New Zealand.


Identification and Visualization of a Distinct Microbiome in Ocular Surface Conjunctival Tissue.
Knowledge of whether microorganisms reside in protected niches of the conjunctiva is potentially significant in terms of minimizing risks of contact lens inflammation/infection and endophthalmitis. We define if and how microbial communities from limbal and forniceal conjunctival tissue differ from those on the conjunctival surface. Human limbal and forniceal conjunctival tissue was obtained from 23 patients undergoing pterygium surgery and analyzed with data from a recent study of conjunctival surface swabs (n = 45). Microbial communities were analyzed by extracting total DNA from tissue samples and surface swabs and sequencing the 16S rRNA gene using the Illumina MiSeq platform. Sequences were quality filtered, clustered into operational taxonomic units (OTUs) at 97% similarity. OTUs associated with blank extraction and sampling negative controls were removed before analysis. Fluorescent in situ hybridization (FISH) was performed on cyrosections of limbal and forniceal conjunctival tissue. There was a significant difference in bacterial community structure between the conjunctival surface and fornix (P = 0.001) and limbus (P = 0.001) tissue. No difference was found in bacterial communities between the limbus and fornix (P = 0.764). Fornix and limbal samples were dominated by OTUs classified to the genus Pseudomonas (relative abundance 79.9%), which were found only in low relative abundances on conjunctival surfaces (6.3%). Application of FISH showed the presence of Pseudomonas in the forniceal tissue sample. There is a discrete tissue-associated microbiome in freshly-collected human limbal and fornix tissue, which is different from the microbial community structure and composition of the ocular surface microbiome.


[Precarity, vulnerability, anticipating end-of-life care at home].
Many patients want to end their life at home. Care teams adapt to these wishes and organise a form of treatment which blends safety of care and the respect of the expectations of the patients and family members. When factors of precarity increase the vulnerability inherent to the end of life, caregivers anticipate and support as best as they can the difficulties encountered as testified by a hospital at home team in Dax.


Targeted gene editing restores regulated CD40L function in X-linked hyper-IgM syndrome.
Loss of CD40 ligand (CD40L) expression or function results in X-linked hyper-immunoglobulin (Ig)M syndrome (X-HIGM), characterized by recurrent infections due to impaired immunoglobulin class-switching and somatic hypermutation. Previous attempts using retroviral gene transfer to correct murine CD40L expression restored immune function; however, treated mice developed lymphoproliferative disease, likely due to viral-promoter-dependent constitutive CD40L expression. These observations highlight the importance of preserving endogenous gene regulation in order to safely correct this disorder. Here, we report efficient, on-target, homology-directed repair (HDR) editing of the CD40LG locus in primary human T cells using a combination of a transcription activator-like effector nuclease-induced double-strand break and a donor template delivered by recombinant adeno-associated virus. HDR-mediated insertion of a coding sequence (green fluorescent protein or CD40L) upstream of the translation start site within exon 1 allowed transgene expression to be regulated by endogenous CD40LG promoter/enhancer elements. Additionally, inclusion of the CD40LG 3'-untranslated region in the transgene preserved posttranscriptional regulation. Expression kinetics of the transgene paralleled that of endogenous CD40L in unedited T cells, both at rest and in response to T-cell stimulation. The use of this method to edit X-HIGM patient T cells restored normal expression of CD40L and CD40-murine IgG Fc fusion protein (CD40-muIg) binding, and rescued IgG class switching of naive B cells in vitro. These results demonstrate the feasibility of engineered nuclease-directed gene repair to restore endogenously regulated CD40L, and the potential for its use in T-cell therapy for X-HIGM syndrome.


[Effect of low-intensity laser radiation on the brain cholinesterase activity of rats].
In studying the activity of cholinesterase in subcellular fractions of rat brain affected by laser radiation of low intensity (9 mW) symbasic changes were noted which were more pronounced in vitro than in vivo.


Ultrasound image fusion - clinical implementation and potential benefits for monitoring of renal transplants.
To evaluate the feasibility of US image fusion in the clinical routine and to discuss potential benefits for follow-up after renal transplantation. 15 patients with a renal transplant were prospectively included in the study. For all of them, a previously performed CT- or MRI-scan covering the renal transplant was available. Each patient was investigated using ultrasound image fusion. Time needed for sucessful implementation of image fusion was registered. Subsequently, quality of image fusion was assessed by two experienced radiologists (10 and 5 years of experience) in consensus using a subjective 5 point rank scale (1 = best). Image fusion was successfully performed in all patients. Time needed for setup of image fusion varied from 45-120 sec (85 ± 5 sec). The score for quality of US image fusion was 1.9 ± 0.7. Assessment of renal transplants using US image fusion is feasible and provides several potential benefits for the follow-up of renal transplants.


Musculoskeletal disease and injury, now and in the future. Part 2: Tendon and ligament injuries.
Tendon and ligament injuries continue to be one of the most frequent causes of orthopaedic injury and early retirement in the Thoroughbred racehorse. In the UK, the Horserace Betting Levy Board has invested considerable research funding in the last decade in order to investigate aspects of tendon epidemiology, biology and therapy, in order to decrease both the welfare and economic consequence of such injuries. This review summarises key aspects of this research effort and identifies specific research directions for the future.


The painful arm.
The painful arm often presents a diagnostic challenge. The cause is often obvious, especially with regional pain syndromes including the carpal tunnel and the tennis elbows. However, pain reference syndromes can be confusing and it is advisable to first examine the cervical spine because it is a common and often overlooked cause of arm pain or paraesthesia. It is common for arm pain to cause sleep disturbances and in such cases it is worth considering cervical causes, carpal tunnel syndrome and the thoracic outlet syndromes. The working rule is: patients with thoracic outlet syndrome cannot fall asleep; a carpal tunnel lesion wakes the patient in the middle of the night; and cervical spondylosis wakes the patient with pain and stiffness that persists well into the day.


[Analysis of CSF flow through L-P shunt during changes in posture].
Two methods for percutaneous study of lumboperitoneal shunt patency are described. The first is an LP shuntography in which patency of the shunt can be assessed by the intraperitoneal spread of contrast medium injected intrathecally via the lumbar route. This method was performed in 27 hydrocephalic patients. The other is a thermosensitive determination technique, in which patency of the shunt can be assessed by definite temperature changes. In a patient with an LP shunt, flow of CSF, and hence patency of the shunt, are indicated by a downward deflection of the recording trace. Twenty-three trials of the thermosensitive determination of CSF shunt patency in LP shunts of 19 hydrocephalic cases were performed. We got five different types of recording traces by the thermosensitive method. A flat-line recording (two recordings) and an upward deflection (two recordings) showed complete occlusion. Operative findings and LP shuntography showed that four cases with a nearly flat line recording had a partial occlusion of the shunt. Patency of the shunt was confirmed by LP shuntography in all cases (12 recordings) with a gradual downward deflection. A steep downward deflection showed an acute excessive CSF drainage. An experimental study was carried out to perform a quantitative analysis of CSF flow in an LP shunt. Derived data suggested that the flow velocity was 10 ml/hr in a case with a nearly flat-line recording, 30 ml/hr in a case with a gradual downward deflection and 60 ml/hr in a case with a steep downward deflection.(ABSTRACT TRUNCATED AT 250 WORDS)


Binocular enhancement of color discrimination in a deutan.
A 31-year-old white male deutan produced reliably different profiles when examined binocularly and monocularly with a Farnsworth-Munsell 100-hue test. Discrimination in the long wavelengths improved under the binocular conditions. Intensive testing yielded no information to account for the phenomenon.


The use of preexisting and novel coping strategies in adapting to age-related vision loss.
Research has proposed that when faced with a stressor, individuals test novel coping strategies when preexisting strategies fail to reduce perceived threat. However, the utilization of novel coping strategies has received scant empirical attention. This study presents data in the form of spontaneous comments or responses to open-ended questions from three previous quantitative studies of adaptation to age-related vision loss (N = 155, 95, and 343 participants). Self-reported coping strategies were identified using a "Grounded Theory" approach, and then examined for evidence of whether the strategy was recently utilized (novel) or whether it had been used prior to vision loss (preexisting). Results supported the utilization of novel coping strategies in the process of adaptation to a chronic impairment among older adults. Overall, the use of novel coping strategies was found to be associated with better adaptational outcomes, emphasizing the importance of novel coping in response to stressful life circumstances.


Efficacy and safety of covered self-expandable metal stents for management of distal malignant biliary obstruction due to lymph node metastases.
Distal malignant biliary obstruction (MBO) due to lymph node metastases (LNM) is a common problem in advanced malignant disease. However, the role of covered self-expandable metal stents (SEMS) in treating MBO has not been studied. The aim of this study was to evaluate the efficacy and safety of covered SEMS for the treatment of distal MBO due to LNM. Between November 1994 and December 2009, a total of 65 patients with distal MBO due to LNM underwent covered (n = 44) and uncovered (n = 21) SEMS placement. Successful drainage was achieved in all patients. There was no significant difference in patient survival. The cumulative stent patency of covered SEMS was significantly higher than that of uncovered SEMS (P = 0.0020). Stent occlusion occurred in 5 patients (11%) with covered SEMS and in 8 (38%) with uncovered SEMS. There was no tumor ingrowth in covered SEMS, but seven in the uncovered SEMS group showed some ingrowth. Cholecystitis was not observed, but mild pancreatitis was observed in 6 (14%) of those with covered SEMS. No stent-insertion-related deaths occurred. Covered SEMS are safe and effective for treatment of distal malignant biliary obstruction due to LNM.


Intracaval extension of pheochromocytoma ultrasonographic demonstration.
Pheochromocytoma is a relatively rare neoplasm, one which may also be found in association with other neoplasms. Preoperative demonstration of malignant pheochromocytoma into the inferior vena cava is uncommon. This is the first confirmed report of the ultrasonographic demonstration of inferior vena cava extension of a malignant pheochromocytoma. The coexistance of a primary bronchio-alveolar adenocarcinoma with this lesion has also not been previously reported.


[Heat-shock proteins and arthritis].
Heat-shock proteins are a category of proteins which are synthesized under stressful conditions (such as increased temperatures) both by prokaryotic and eukaryotic cells. Heat-shock proteins are a major target of the immune response and thus can be considered dominant antigens. Under physiological circumstances the response to heat-shock proteins is considered to play a role in overall defence against bacterial infections. An aberrant immune response against heat-shock proteins may lead to autoimmunity; adjuvant arthritis in Lewis rats. Current evidence also points towards a role of T cell immunity against heat-shock proteins in the etiology and pathogenesis of human autoimmune diseases such as juvenile chronic arthritis.


Innovative Approaches to Improve Anti-Infective Vaccine Efficacy.
Safe and efficacious vaccines are arguably the most successful medical interventions of all time. Yet the ongoing discovery of new pathogens, along with emergence of antibiotic-resistant pathogens and a burgeoning population at risk of such infections, imposes unprecedented public health challenges. To meet these challenges, innovative strategies to discover and develop new or improved anti-infective vaccines are necessary. These approaches must intersect the most meaningful insights into protective immunity and advanced technologies with capabilities to deliver immunogens for optimal immune protection. This goal is considered through several recent advances in host-pathogen relationships, conceptual strides in vaccinology, and emerging technologies. Given a clear and growing risk of pandemic disease should the threat of infection go unmet, developing vaccines that optimize protective immunity against high-priority and antibiotic-resistant pathogens represents an urgent and unifying imperative.


[Effects of moxibustion on cell proliferative factors in gastric mucosa in rats with precancerous lesions of chronic atrophic gastritis].
To explore the molecular mechanism of moxibustion at stomach meridian acupoints for precancerous lesions of chronic atrophic gastritis (CAG). Fifty male SD rats were randomly divided into a normal group, a model group, a stomach meridian group, a control point group and a vitacoenzyme group, 10 rats in each group. The CAG precancerous lesion model was made in all the groups except the normal group. The rats in the normal group and model group were bundled for 30 min per day; the rats in the stomach meridian group and control point group were bundled and treated with moxibustion at stomach meridian acupoints or control points for 30 min per day; the rats in the vitacoenzyme group were treated with intragastric administration of vitacoenzyme, once per day. All the treatment was given for 20 weeks. The pathological morphological change of gastric mucosa was observed under optical microscope; the expression of epidermal growth factor (EGF), transforming growth factor alpha (TGF-alpha), vascular endothelial growth factor (VEGF), gastric mucosal proliferatig cell nuclear antigen (PCNA), argyrophilic protein of nucleolar organizer regions (Ag-NORs) in gastric mucosal cells were detected by enzyme linked immuno sorbent assay (ELISA). Compared with the normal group, in the model group the gastric mucosal cells showed dysplasia and the expression of EGF, TGF-alpha, PCNA, VEGF, Ag-NORs in gastric mucosa cells in the model group was increased significantly (all P < 0.05). Compared with the model group, the gastric mucosa lesion gradually recovered and the expression of EGF, TGF-alpha, PCNA, VEGF, Ag-NORs in gastric mucosal cells was gradually decreased in the stomach meridian group, control point group and vitacoenzyme group, in which the stomach meridian group had the most significant effects (all P < 0.05). Moxibustion at stomach meridian acupoints can obviously decrease the expression of cell proliferative factors in gastric mucosa in rats with CAG precancerous lesions, inhibit the gastric mucosal cell dysplasia, and promote the recovery of gastric mucosa.


Accurate prediction of the optical rotation and NMR properties for highly flexible chiral natural products.
Despite advances in electronic structure theory the theoretical prediction of spectroscopic properties remains a computational challenge. This is especially true for natural products that exhibit very large conformational freedom and hence need to be sampled over many different accessible conformations. We report a strategy, which is able to predict NMR chemical shifts and more elusive properties like the optical rotation with great precision, through step-wise incremental increases of the conformational degrees of freedom. The application of this method is demonstrated for 3-epi-xestoaminol C, a chiral natural compound with a long, linear alkyl chain of 14 carbon atoms. Experimental NMR and [α]D values are reported to validate the results of the density functional theory calculations.


Sex Differences in the Prognostic Power of Brain Natriuretic Peptide and N-Terminal Pro-Brain Natriuretic Peptide for Cardiovascular Events - The Japan Morning Surge-Home Blood Pressure Study.
Brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are prognostic biomarkers. Although these 2 peptides differ with regard to biological characteristics, there are few reports on the differences between BNP and NT-proBNP with regard to cardiovascular events or according to sex.Methods and Results:Between 2005 and 2012, this study analyzed 3,610 of 4,310 Japanese outpatients (mean age, 65 years; men, n=1,664; women, n=1,947) with a history of at least one cardiovascular event who were recruited to the Japan Morning Surge-Home Blood Pressure Study. During an average 4-year follow-up, there were 129 cardiovascular events. Both median BNP (21.1 pg/mL; IQR, 10.9-40.6 pg/mL vs. 16.2 pg/mL, IQR, 7.2-36.2 pg/mL, P<0.001) and median NT-proBNP (54.7 pg/mL; IQR, 30.2-102.6 pg/mL vs. 44.9 pg/mL, IQR, 20.7-92.6 pg/mL, P<0.001) were significantly higher in women than in men. A 1-SD increment in log-transformed BNP (hazard ratio [HR], 2.18; 95% CI: 1.53-3.10) and NT-proBNP (HR, 2.39; 95% CI: 1.73-3.31) was associated with a significant increase in cardiovascular events in women; in men, only NT-proBNP showed this association. There was an interaction between log-transformed BNP (P=0.007) or NT-proBNP (P=0.001) and cardiovascular events according to sex. Both BNP and NT-proBNP predicted cardiovascular outcomes in a large Japanese clinical population. BNP and NT-proBNP were significantly stronger predictors in women than in men.


Brown adipose and central nervous system glucose uptake is lower during cold exposure in older compared to young men: a preliminary PET study.
The purpose of this study was to determine the activity of brown adipose tissue (BAT) and the central nervous system (CNS) during cold exposure in young and older men. Two young, 24 and 21 years, and two older, 76 and 74 years, men participated in the study. Positron emission tomography images showed cold-induced BAT activity was absent in older men but clearly present in the clavicular region of the young men (Standardized Uptake Value: SUVmean: 3.12 and 3.71). Statistical parametric mapping revealed cortical brain activity was lower in the older men within areas of the frontal, parietal, temporal, and occipital lobes, and the thalamus (peak-level p uncorr < 0.036). Cervical spinal cord SUVmean values tended to be lower for older (SUVmean: 1.64 and 1.61) compared to young men (SUVmean: 1.91 and 1.71). These preliminary findings suggest lower BAT activity in older men may in part be due to lower CNS activity.


Increased transcription of RPL40A and RPL40B is important for the improvement of RNA production in Saccharomyces cerevisiae.
Yeast (Saccharomyces cerevisiae) RNA is an important source of 5'-ribonucleotides that is used in both the food and pharmaceutical industries. Efficient transcription of rDNA is very important to construct yeast strains with high RNA content. The gene RRN10, which encodes, a component of the upstream activation factor, is essential to promote high-level transcription of rDNA. In our previous study, we isolated SupE strain as a dominant suppressor, which showed the ability to restore the severe growth defects and reduced RNA content caused by disruption of the RRN10 gene. SupE strain has multiple mutations which we designated collectively as SUPE. Further analysis on SUPE mutation indicated that RPL40A was responsible for suppression of defect caused by rrn10 disruption. However, there were no base changes in this gene as compared with the parental Δrrn10 strain, thus suggesting that an additional copy of RPL40A suppress the defects caused by Δrrn10 disruption, and that, in SupE strain, these defects are suppressed by increased transcription of RPL40A whose copy is doubled. When multiple copies of RPL40A were combined with SUPE mutation on an RRN10⁺ background, the resultant SupE strain had significantly higher RNA content than wild-type strain. In addition, increased transcription of RPL40B also showed significant effect to restore the growth defect and reduced RNA content caused by Δrrn10 disruption. We propose a model to explain how SUPE mutation increases the transcription of ribosomal protein genes such as RPL40A and RPL40B in SupE strain, resulting in an increase in RNA content.


Radiopacity Evaluation of Gutta-Percha Points in Thinner Samples than the ANSI/ADA Recommendation.
The aim of this study was to evaluate the radiopacity of different gutta-percha points (Endo Points®, Dentsply®, Tanari®, Meta®, Roeko® and Odous®) in samples of 1 mm thick as established by ANSI/ADA Specification #57 and ISO 6876/2001, in comparison with thinner samples. Twelve test specimens for each material, four for each thickness (0.3, 0.6, and 1 mm and diameter of 8 mm), were laminated and compressed between two polished glass plates until the desirable thickness. Digital radiographs were obtained along with a graduated aluminum stepwedge varying from 1 to 10 mm in thickness. The X-ray unit was set at 70 kVp, 10 mA and 0.4 s exposure time, at a focal distance of 36 cm. One calibrated observer quantified the average values of pixels with Adobe Photoshop® software. Data were analyzed using ANOVA and Tukey tests, at 5% significance level. At 0.6 and 1 mm thickness, all the tested materials showed radiopacity higher than 3 mm of aluminum (reference value). At 0.3 mm thickness, Odous and Tanari presented significantly less radiopacity than the reference, and the other materials showed similar radiopacity to the reference. The study concluded that the materials demonstrated different radiopacities and all had values above the minimum recommended by ANSI/ADA specification #57, being Odous and Tanari less radiopaque than the reference value in thinner samples (0.3mm).


Disparities in the allocation of treatment in advanced ovarian cancer: are there certain patient characteristics associated with nonstandard therapy?
To explore data from the National Cancer Database to identify pretreatment patient characteristics associated with receipt of nonstandard treatment for advanced ovarian cancer. Between 2003 and 2006, there were 47,390 patients with ovarian cancer registered with the National Cancer Database. Variables included demographics, insurance, Charlson comorbidity score, zip income, and facility characteristics. Multivariable log binomial regression analyses were performed to assess factors associated with nonstandard care. Among the 47,390 patients, 27,045 (81%) were stage IIIC or IV. After excluding patients with missing treatment information (n=1,129 [2.38%]), 13,789 (53.21%) had received standard treatment. In multivariable analyses, uninsured and Medicaid-insured patients were less likely to receive standard treatment as compared with privately insured patients (relative risk 0.88, 95% confidence interval [CI] 0.83-0.93 and relative risk 0.91, 95% CI 0.86-0.95, respectively). African Americans and Hispanics were also less likely to receive standard treatment (relative risk 0.87, 95% CI 0.83-0.92 and relative risk 0.89, 95% CI 0.84-0.94, respectively). Patients with a Charlson comorbidity score of 2+ were less likely to receive standard care (relative risk 0.74, 95% CI 0.68-0.80). Treatment at a community cancer hospital compared with a teaching hospital was also less likely to be associated with standard treatment (relative risk 0.83, 95% CI 0.80-0.87). In this large multi-institutional cohort, approximately 47% of patients with stage IIIC and IV ovarian cancer did not receive standard treatment. Pretreatment patient characteristics such as race, insurance status, age, Charlson comorbidity score, and facility type were associated with nonstandard treatment.


Mechanisms of stereoscopic vision: the disparity energy model.
The past year has seen significant advances in our understanding of the role played by the primary visual cortex (V1) in stereoscopic vision. Recently, the mechanism by which complex cells in V1 respond to random-dot stereograms has been characterized; it appears that their response properties greatly reduce the complexity of one of the critical links for stereopsis, the correspondence problem.


Intrinsic and extrinsic motives for originally following a sport team and team identification.
Research indicates that both highly and lowly identified fans are more likely to be intrinsically than extrinsically motivated and that highly identified fans have a particularly strong inclination for intrinsic motivation. The current investigation was designed to extend this work by examining the relationship between level of identification and one's intrinsic and extrinsic motives for originally following a sport team. Preference for intrinsic motives for originally following a team should be highest among those high on team identification. 88 participants completed questionnaires containing the Sport Spectator Identification Scale and items assessing their intrinsic and extrinsic motives for originally identifying with a team. Analyses provided clear support for the hypotheses.


Lack of association of glutathione-S-transferase omega 1(A140D) and omega 2 (N142D) gene polymorphisms with urinary arsenic profile and oxidative stress status in arsenic-exposed population.
Individual variability in arsenic metabolism is suggested to be associated with the effects of chronic arsenic exposure on health. Glutathione-S-transferase omega (GSTO) 1 and 2 are known to have the activity of monomethyl arsenate [MMA(V)] reductase, which is the rate-limiting enzyme for the biotransformation of inorganic arsenic. This study was conducted to investigate the relationship between polymorphisms in the GSTO1 and GSTO2 genes and arsenic metabolism and oxidative stress status in Chinese populations chronically exposed to different levels of arsenic in drinking water. Two polymorphisms (GSTO1*A140D and GSTO2*N142D) with relatively higher mutation frequencies in the Chinese population were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The allele frequencies of 140D and 142D in the entire study population were 0.17 and 0.25, respectively. There were no significant differences in the urinary arsenic profile, the blood reduced glutathione (GSH) levels, the blood superoxide dismutase (SOD) activity, or the urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels between the study subjects with different genotypes of GSTO1*A140D or GSTO2*N142D. Multivariate analysis revealed that there was no association between the urinary profile or oxidative stress status and the polymorphism of GSTO1*A140D or GSTO2*N142D. Collectively, polymorphisms in GSTO1 or GSTO2 do not appear to contribute to the large individual variability in arsenic metabolism or susceptibility to arsenicosis.


Effects of nicardipine, nitroglycerin, and nitroprusside on left ventricular diastolic function during enflurane anesthesia.
The purpose of this study was to evaluate the effects of nicardipine (NCR), nitroglycerin (NTG), or nitroprusside (SNP) on left ventricular diastolic function during enflurane anesthesia in acutely instrumented dogs. Using echocardiography, time constants for the decline in isovolumic left ventricular pressure (T), stiffness constant (K), diastolic time intervals, and left ventricular filling rates were measured in 21 mongrel dogs during the following conditions: (1) 0% enflurane (control), (2) 3.3% enflurane, (3) intravenous infusion of NCR, 1 microgram/kg/min, NTG, 2 micrograms/kg/min, or SNP, 2 micrograms/kg/min, during 3.3% enflurane, and (4) intravenous infusion of NCR, 2 micrograms/kg/min, NTG, 4 micrograms/kg/min, or SNP, 4 micrograms/kg/min, during 3.3% enflurane. During 3.3% enflurane anesthesia, T and K increased significantly, and left ventricular filling rates decreased. The administration of NCR, NTG, or SNP returned T and K to control levels. Left ventricular rapid filling rate returned toward the control level only with NCR (P < 0.05, NCR v NTG, SNP). It is concluded that the depression of diastolic function during enflurane anesthesia was improved by NCR or other vasodilators. The extent and mechanism of action of these vasodilators might differ, however.


Non-canonical Bases in the Genome: The Regulatory Information Layer in DNA.
Multicellular organisms developed the concept of specialized cells that perform specific functions. Examples are neurons and fibroblast to name just two out of more than 200. These cellular differences are established based on the same sequence information stored in the cell nucleus of all cells of an organism. The sequence information needs consequently different interpretations by the different cell types. During cellular development this interpretation of the genetic code has to be tightly regulated in space and time. Interpretation of the sequence information involves the controlled activation and silencing of specific genes so that certain proteins are made in one cell type but not in others. This involves an additional regulatory information layer beyond the pure base sequence. One aspect of this regulatory information layer relies on functional groups that are attached to the C(5) position of the canonical base dC. Currently four regulatory, non-canonical bases with a methyl (CH3 )-, a hydroxymethyl (CH2 OH)-, a formyl (CHO)- and a carboxyl (COOH)- group are known. While 5-methyl-cytidine is long recognised to be a regulatory base in the genome, the other three bases and the enzymes responsible for generating them, were just recently discovered.


Nutritional implications and physiologic response to pediatric diarrhea.
As depicted in Figure 1 acute diarrhea causes the host to undergo a sequence of hormonal, metabolic and immunologic responses, all of which have a nutritional cost. The impact will be more significant in the debilitated or marginally nourished child. From a nutritional point of view this process of nutrient loss and redistribution has the potential for being exploited to the benefit of the host. Two treatment techniques could be used to improve the host response to infection. Nutrients which are essential for optimal immune function and which are rapidly being metabolized may be selectively replaced, while nutrients that the offending organism needs may be withdrawn or temporarily withheld. A better understanding of the physiologic response and nutritional consequences of diarrhea should permit us to further improve the outcome of this and other infectious diseases.


Is routine hospital visit after day case inguinal hernia surgery in children necessary?
To observe the prospects of day case inguinal hernia surgery in children without routine postoperative hospital visits. The aim was to access the advantages, acceptability and safety of this change in practice in low resource country like Nepal. This was a cross-sectional study in a tertiary care general teaching hospital. Thirty children aged 6 months to 14 years who had elective day case Inguinal Hernia surgery from May 2011 to Oct 2011 were prospectively observed. Children with obstructed hernia, un-descended testis were excluded. Parents were counseled for omission of routine hospital visit after surgery. Main outcome measures were to observe unplanned hospital visit, reasons for visit, post-operative pain, wound infection and overall satisfaction of parents interviewed by telephone. Study was approved by institutional review committee. There were 28 boys and two girls. Average age was five years. Right Inguinal Hernia patients were 19 in number while 11 patients had left sided hernia. None of the children visited health facility for pain or wound problem. Two children were brought to outpatient because they were mistakenly given appointment slip. Mother noticed recurrence and brought one child to surgical outpatient. All 30 parents responded to telephone enquiry and were satisfied. Routine follow up visit after day care Inguinal Hernia surgery in children is not necessary. This practice is safe, economic and well accepted by children and parents.


[Preliminary estimation of results of high-dose intravenous immunoglobulin in severe steroid-dependent adult asthma].
The aim of this study was to estimate efficacy and safety the high-dose intravenous immunoglobulin's (IVIG) in severe steroid-dependent adult asthma. The study group consisted of 10 asthmatic patients aged 18-74 (in an average 53 +/- 15) who received 6 months infusions therapy (7 doses). Each IVIG dose was 2 g/kg/month of body mass. In treatment monitoring the following parameters were used: asthma score, drugs (systemic and inhaled corticosteroids, beta 2-mimetic) use, daily PEF and monthly FEV1. Preliminary estimation of the obtained results shows the reduction of systemic corticosteroids doses and simultaneous improvement of asthma score and FEV1 as well as the decrease of asthma aggravation and emergency need among examined patients. Basing on this experience in high-dose IVIG treatment of patients with severe steroid-dependent asthma one could conclude about the safety and effectiveness of this method, particularly about its influence on the reduction of corticosteroids doses necessary for asthma control. The short time of observation does not allow to estimate the persistence of therapeutic effect after finish of this therapy. However, in some patients the recovery persisted for 6 months after the ending of IVIG infusions.


[Arachnoid cyst with hematoma in the cyst wall].
It is well known that arachnoid cysts can be associated with chronic subdural hematoma. We report a case of an arachnoid cyst in which the hematoma was located in the cyst wall. A 23-year-old male was found by chance to have an arachnoid cyst in the left middle fossa. We followed him up, because he had no symptoms. Two years after the initial examination, he began to complain of severe headache. MR image showed a hematoma located in the anterolateral space of the cyst. On operation, we found that arachnoid membranes had covered the hematoma. We removed the hematoma and tore the inner wall of the cyst so that cerebrospinal fluid in the cyst could flow easily into the basal cistern. Pathological examination revealed arachnoid-like tissues outside the hematoma capsules. Since the hematoma was wrapped all over by arachnoid tissues, it was considered that the hematoma was located in the outer wall of the cyst. About the mechanism of hematoma formation in this case, we suppose that some force could have split the outer wall of the cyst, and bloody fluid seeping through the wall membranes may have collected in the wall itself.


A novel paradigm for engineering education: virtual internships with individualized mentoring and assessment of engineering thinking.
Engineering virtual internships are a novel paradigm for providing authentic engineering experiences in the first-year curriculum. They are both individualized and accommodate large numbers of students. As we describe in this report, this approach can (a) enable students to solve complex engineering problems in a mentored, collaborative environment; (b) allow educators to assess engineering thinking; and (c) provide an introductory experience that students enjoy and find valuable. Furthermore, engineering virtual internships have been shown to increase students'-and especially women's-interest in and motivation to pursue engineering degrees. When implemented in first-year engineering curricula more broadly, the potential impact of engineering virtual internships on the size and diversity of the engineering workforce could be dramatic.


Treatment of pilonidal sinus disease with the Z-plasty procedure (modified).
This article points out the significance of the internatal cleft for the formation of pilonidal sinus. Elimination of the internatal cleft by means of Z-plasty carries the smallest recurrence rate. The author, in an attempt to eliminate this small recurrence rate, applied a modified Z-plasty which is described in the present communication, and which was successfully applied in a series of cases of pilonidal sinus.