An evaluation of routine early pregnancy ultrasonography.
A review of 1 000 pregnancies in which routine early pregnancy scanning was performed is reported. Ultrasound predicted accurately (to within +/- 14 days) the date of confinement in more than 90% of women who were unsure of their dates. Clinical estimation of gestation age compared well with ultrasound report in 90% of singleton pregnancies. Scanning diagnosed 3 out of 4 lethal congenital abnormalities in early pregnancy. The diagnosis of multiple pregnancy and placenta praevia have no immediate clinical implication in early pregnancy. Early pregnancy scan is recommended for women who are uncertain of their last menstrual period and for those with identified early pregnancy risks. Routine use of ultrasonography in early pregnancy should be related to the identified need of the population served and should be employed with caution. Where the policy of routine scanning is adopted, optional information is obtained when the procedure is carried out between the 14th and 18th week of gestation. Clinical pelvic examination in early pregnancy remains a valuable practice for the estimation of gestational age.


[Management of fetuses in the late pregnancy by serial determinations of serum human placental lactogen levels].
Serum human placental lactogen levels (HPL) were measured serially during the last three weeks before full term deliveries of 69 normal and 60 high risk pregnant women with the method of latex agglutination (Gestefollow 'Eiken'). Except pregnancies complicated with diabetes mellitus, no fetal distress were observed when deliveries were made while HPL levels were increasing. The incidence of fetal distress was only 3.7 per cent when the range of variation of HPL levels was within 20 per cent for 3 weeks before delivery. On the contrary, the incidence of fetal distress increased to 29.4 per cent when infants were delivered after decreasing of HPL levels to less than 80 per cent of the highest HPL levels. It was also demonstrated that single determinations of HPL levels were not clinically useful in predicting fetal distress or fetal growth retardation.


Cranberry juice for prophylaxis of urinary tract infections--conclusions from clinical experience and research.
Cranberry juice (Vaccinium macrocarpon) is a widely used and recommended North-American folk remedy for prophylaxis of urinary tract infections (UTI). Clinical trials have documented its efficacy in women with recurrent UTI, but so far not in other groups of patients. The composition of effective cranberry products and its dosage in UTI prophylaxis have not been defined. Intriguing experimental research has identified an anti-adhesive mechanism of cranberry juice that prevents docking of bacteria on host tissues. This efficacy mechanism can be traced in patients' urine following oral intake of cranberry products and appears to be due to proanthocyanidins with an A-type linkage of flavanols. The application of this anti-adhesion mechanism of cranberry-proanthocyandins is currently also investigated in other common diseases of bacterial pathogenesis, for example Helicobacter pylori-associated gastritis and dental caries/periodontal disease. The use of cranberry products appears to be safe and provide additional benefits by anti-oxidant and cholesterol-lowering activity.


Mesofaunal biodiversity and its importance in Thar desert.
Soil animals are considered as important contributors to soil fertility However, there is paucity of such information for harsh climatic conditions. Therefore, the below ground faunal density and frequency have been studied in relation to physicochemical properties of soil in Thar desert. The selected soil systems were Vigna radiata--Cuminum cyminum, grassland, flower garden and Zizyphus mauritiana. Acari and other soil arthropods exhibited seasonal variation in their populations. There were two population peaks, one in February/March and other in August/September. The highest population was in flower garden, whereas lowest was in Z. mauritiana field. It clearly indicates that the soil fauna population develops in different degrees. The relative density showed that the acarines were more prevalent in comparison to other soil arthropods. The prostigmatids exhibited maximum relative density in comparison to cryptostigmatids and mesostigmatids in all fields. Pauropus showed higher relative density among all other soil arthropods. Acari had higher frequency of occurrence, while the other soil arthropods indicated lower frequency of occurrence in all systems. The highest frequency of occurrence was recorded in July/August and the lowest in May/June. The soil temperature, moisture, organic carbon, total nitrogen and carbon/nitrogen ratio varied significantly throughout the year The fluctuations in physicochemical characteristics of soil greatly influenced below ground faunal density in different fields. A highly significant and positive correlation was obtained among different soil fauna groups. Faunal population showed a significant positive correlation with soil moisture, organic carbon and total nitrogen. The abiotic factors such as temperature, pH and C/N ratio showed negative correlation with moisture, organic carbon and total nitrogen. However, moisture, organic carbon and total nitrogen had positive correlation among themselves. The present study suggests that the plantation may be done for improvement of physicochemical and biological health of soil on a sustainable basis in desert.


Performance improvement: how to get employee buy-in.
The radiology department at Northern Michigan Hospital in Petoskey, Mich. operated with little change under the same leadership for nearly 20 years. Its equipment was archaic and its operations production focused. Staff morale and both physician and patient satisfaction were low. Given a directive to measurably improve the service and quality offered by the department, the new director let her staff know she needed their support. She then set out to weave in performance expectations for both the organization and the department. Her goal was to create a relationship to both individual and organizational performance improvement, and in turn, to add value to the success of each individual, the department and the organization. Defining work processes was important for the definition of a common vision and core behaviour. The result was the F.A.S.T. concept (friendly, accurate, safe and timely) that put each general work process in a flowchart showing its steps. The next phase involved identifying the measurement for each critical point in the process and determining how to measure it. At each step, questions were defined, answered and translated into individual job descriptions and performance plans. Now, employees know how they and their departments are doing through quarterly reviews. Results are presented monthly at staff meetings, where report cards are posted to provide timely feedback. In some cases, individual report cards within a modality are shared. Successes are celebrated, both in staff meetings and on annual Quality Day, where departments present story boards showing how they have improved service or quality.


A potential influence of rhizobium activity on the availability of nitrogen to legume herbivores.
Evidence is presented which supports the hypothesis that allantoin, a ureide that is a major storage form of nitrogen (N) in legumes whose N is derived from N-fixation, is not utilizable by at least some insect herbivores. We suggest that the nutritive quality of soybean foliage for Mexican bean beetles is influenced by soil nitrogen level through its impact on rhizobial activity which indirectly alters the proportion of ureide-nitrogen to amino acid-nitrogen without affecting total Kjeldahl-nitrogen. This may provide a basic mechanism for protecting the nitrogen stores of legumes from herbivory while avoiding the metabolic burden of secondary compound production.


Oscillapeptin J, a new grazer toxin of the freshwater cyanobacterium Planktothrix rubescens.
Oscillapeptin J (1), a new and highly potent crustacean grazer toxin, was isolated from the axenic cyanobacterium Planktothrix rubescens, which frequently forms blooms in freshwater lakes. Chemical and spectroscopic analyses, including high resolving MS and two-dimensional NMR, were used to elucidate the compound's structure as a depsiheptapeptide of the oscillapeptin type. Strict application of a bioassay-guided isolation procedure proved this compound to be one of the major causative agents (besides [d-Asp(3),(E)-Dhb(7)]microcystin-RR) of the acute grazer toxicity of P. rubescens from Lake Zürich. The LC(50) value of oscillapeptin J as determined for the freshwater crustacean Thamnocephalus platyurus was 15.6 microM.


Vocal shimmer in sustained phonation of normal and pathologic voice.
Vocal shimmer during sustained phonation was measured in normal subjects and patients with laryngeal polyps, using the mean amplitude difference between consecutive cycles expressed in dB. A small laboratory computer was then used for measuring each discrete amplitude and for data processing. The results showed some overlap between the values for two groups studied, but nevertheless it appears that the measured value may be a useful index in screening for laryngeal disorders and for definitive diagnosis of such disorders.


[Antihypertensive therapy and drug-drug interactions].
Adverse drug reactions (ADR) have increasing clinical implications and are a permanent challenge for general practitioners. Data suggest that ADR cause 3 to 18% of all hospital admissions with potentially serious consequences. Polymedication, female sex, multiple pathologies with age-related changes are predisposing factors. Antihypertensive drugs with a low bioavailability, a high protein binding capacity and specific elimination pathways are particularly prone to pharmacokinetic interactions. ACE-inhibitors, atenolol, moxonidine and diuretics have few pharmacokinetic interactions. Calcium channel blockers and beta-blockers are associated with an increased risk of pharmacokinetic drug-drug interactions. Diltiazem and verapamil are particularly prone to interactions, as they strongly inhibit the elimination of drugs undergoing the CYP3A4 and P-glycoprotein pathways.


Optimization of attenuation correction for positron emission tomography studies of thorax and pelvis using count-based transmission scans.
The quality of thorax and pelvis transmission scans and therefore of attenuation correction in PET depends on patient thickness and transmission rod source strength. The purpose of the present study was to assess the feasibility of using count-based transmission scans, thereby guaranteeing more consistent image quality and more precise quantification than with fixed transmission scan duration. First, the relation between noise equivalent counts (NEC) of 10 min calibration transmission scans and rod source activity was determined over a period of 1.5 years. Second, the relation between transmission scan counts and uniform phantom diameter was studied numerically, determining the relative contribution of counts from lines of response passing through the phantom as compared with the total number of counts. Finally, the relation between patient weight and transmission scan duration was determined for 35 patients, who were scanned at the level of thorax or pelvis. After installation of new rod sources, the NEC of transmission scans first increased slightly (5%) with decreasing rod source activity and after 3 months decreased with a rate of 2-3% per month. The numerical simulation showed that the number of transmission scan counts from lines of response passing through the phantom increased with phantom diameter up to 7 cm. For phantoms larger than 7 cm, the number of these counts decreased at approximately the same rate as the total number of transmission scan counts. Patient data confirmed that the total number of transmission scan counts decreased with increasing patient weight with about 0.5% kg(-1). It can be concluded that count-based transmission scans compensate for radioactive decay of the rod sources. With count-based transmission scans, rod sources can be used for up to 1.5 years at the cost of a 50% increased transmission scan duration. For phantoms with diameters of more than 7 cm and for patients scanned at the level of thorax or pelvis, use of count-based transmission scans is feasible and results in statistically more consistent transmission scans as compared with fixed transmission scan duration.


Glioma Surgery: Technological Advances to Achieve a Maximal Safe Resection.
Glioblastoma multiforme (GBM) is the most frequent primary central nervous system (CNS) tumor. Despite the best treatment and advances in therapy, prognosis remains poor. One of the mainstays of therapy in GBM is surgical excision. Several studies have confirmed that the extent of resection (EOR) positively influences overall survival (OS) in patients with high-grade gliomas (HGGs). A literature search was performed using PubMed to assess the useful neurosurgical tools to achieve the best neurosurgical performance. In order to achieve the major extent of resection, preserving neurological function, many tools are now available, especially neuronavigation, intraoperative fluorescence, intraoperative ultrasound, and neuromonitoring. In addition to the maximal excision of tumor, the neurosurgeon can use photodynamic therapy (PTD) and local drug delivery (LDD) to improve the local control and bridge conventional radio and chemotherapy. EOR improves OS in patients with HGGs. There are technological possibilities for achieving a complete resection preserving neurological function, and it is not acceptable to perform only biopsy of these lesions.


Follistatin allows efficient retroviral-mediated gene transfer into rat liver.
Retroviral vectors are widely used tools for gene therapy. However, in vivo gene transfer is only effective in dividing cells, which, in liver, requires a regenerative stimulus. Follistatin is effective in promoting liver regeneration after 90% and 70% hepatectomy in rats. We studied its efficacy on liver regeneration and retroviral-mediated gene delivery in 50% hepatectomized rats. When human recombinant follistatin was infused into the portal vein immediately after 50% hepatectomy, hepatocyte proliferation was significantly higher than in control 50% hepatectomized rats. A single injection of virus particles administered 23 h after follistatin infusion resulted in more than 20% gene transduction efficiency in hepatocytes compared to 3% in control rats. It is concluded that a single injection of follistatin induces onset of proliferation in 50% hepatectomized rats and allows efficient retroviral-mediated gene transfer to the liver.


Comparability of the 6-min walk test using different test configurations.
The 6-min walk test (6MWT) is a common component of fitness assessments of older adults; however, differing course configurations might affect 6MWT performance. It is unclear how comparable 2 different configurations are. To determine the comparability of 2 courses, 35 adults >65 years of age completed two 6MWT, once walking around a 20- by 5-yd outdoor rectangle and once on an indoor oval track (circumference 144.3 yd). Scores for the 2 tests were internally consistent (intraclass correlation coefficient = .95). The participants walked farther on the oval track than around the rectangle (639 +/- 19 vs. 582 +/- 16 yd; p < .0001), but responses to the rectangular configuration could be readily estimated using the equation 66.7 yd + 0.807 x (oval walking distance), R2 = .85. Thus, within-participant responses are similar across both 6MWT, but the course configuration affects the distance walked.


Sequence analysis of cymbidium ringspot virus satellite and defective interfering RNAs.
The nucleotide sequences of cloned cDNA copies of satellite and defective interfering (DI) RNAs of cymbidium ringspot virus were determined. DI RNA is 499 nucleotides long and is composed of six stretches of sequence derived from CyRSV genomic RNA. Four of these stretches share common 5' sequences and the 5' and 3' ends are identical to those of genome RNA. Satellite RNA is 621 nucleotides long. In some regions the sequence is very similar (60% to 100% identical) to genomic RNA. A consensus sequence is proposed to be involved in the replication of genomic, DI and satellite RNAs.


Electrostatic Interactions and Stability of Poly-l -lysine Covered Polystyrene Latex Particles Investigated by Dynamic Light Scattering
Adsorption isotherms of the pH dependent positively charged polyelectrolyte poly-l -lysine (PLL) on negatively and positively charged polystyrene latices are determined. With photon correlation spectrometry (PCS) the influence of the fluctuating PLL domaines in solution on the diffusion coefficient is observed at low salt concentrations c NaBr < 10(-3) M with lambda = c PE /c NaBr < 0.1 (c PE = concentration of the polyelectrolyte units). Screening of the charged layer by increasing electrolyte concentration results in large adsorbed amounts and layer thicknesses. At low molar mass of PLL the suspensions become unstable and the state and kinetic of flocculation is followed by the decreasing diffusion coefficient. PLL of higher molar mass (M w >/= 100 000) stabilizes the particles sterically and the adsorbed layer thicknesses can be determined. The conclusions drawn from PCS features are confirmed directly by raster electron micrographs of the filtered particles.


Pathways for the non-CO-involved oxidation of methanol on Pt(111).
The non-CO-involved oxidation of methanol (NCOIOM) on a Pt(111) surface is investigated by using density functional theory. Relative energy diagrams for the NCOIOM are established in which the reaction mechanisms for a catalytic cycle-including the associated barriers, the reactive energies, the intermediates, and the transient states-are shown. The results indicate that the reaction proceeds via the kinetically favored pathways: A) HCOH-->HC(OH)(2)-->HCOOH-->HCOO- [-COOH]-->CO(2) and B) CHO-->HCOOH-->HCOO- [-COOH]-->CO(2), with OH playing a key role in the entire process. The vibrational frequencies of the intermediate states derived from the calculations are in agreement with the experimental measurements.


Acute sectorial choroidal ischemia.
Four eyes (of three patients) with sectorial choroidal ischemia by temporal arteritis or carotid obstruction underwent fluorescein angiography during and after the acute phase. In all cases hypoperfusion affected the whole temporal choroid; however, disturbance of retinal pigment epithelium was much less extensive. In two cases the retinal pigment epithelium became necrotic and scarred within a limited area that was typically triangular in shape; in the third case scarring was limited to some pigmented streaks, and in the fourth case, retinal pigment epithelium remained normal. The triangular scar that appeared after episodes of choroidal hypoperfusion did not seem to be a true reflection of the extent of the choroidal artery obstruction in the acute phase. Our observations suggest that the deficient choroidal perfusion involved more than the choroidal artery supplying the triangular area of pigment epithelium disturbance. Several mechanisms (for example, retrograde venous filling, restoration of perfusion) reduce the deleterious effects of ischemia. Thus the necrosis of the retinal pigment epithelium would appear in only those sectors where ischemia was particularly severe or prolonged.


Monoclonal antibodies against isotypic and isoallotypic determinants of human IgA1 and IgA2: fine specificities and binding properties.
We have analysed and compared the fine specificity and behavior in various immunoassays of 10 mouse monoclonal antibodies, from three independent laboratories, directed against IgA1, IgA2 or non-IgA2m(2). The following observations were made. (1) Although all of the monoclonal antibodies were specific for a particular IgA subclass or isoallotype in a radioimmunoassay, three of them were not specific when tested in indirect immunofluorescence on plasma cells derived from pokeweed-activated peripheral blood lymphocytes. In this highly sensitive system, contrary to direct immunofluorescence previously performed using formalin-fixed lymphoid tissue, the anti-IgA1 69.114 reacted with some of the IgA2 plasma cells, the anti-IgA2 DLDB7 reacted with some of the IgA1 plasma cells and the anti-IgA2 16.512 dimly reacted with all IgM plasma cells. (2) Among the eight anti-IgA subclass antibodies, seven were directed against the CH2 domain of IgA whereas the anti-IgA1 1-155-1 recognised an epitope destroyed by Streptococcus sanguis IgA1 protease and localised in the hinge region of IgA1. The two anti-isoallotype antibodies were directed against epitope(s) probably localised in the 65 C-terminal amino acid residues of the alpha-CH3 domain. All of the 10 antibodies were able to react with endogeneously produced surface IgA on B-cells. (3) Using monoclonal anti-IgA subclass antibodies in radioimmunoassay may be hazardous in the absence of knowledge of their affinity constants and of careful control experiments: some of the antibodies were not sensitive in radioimmunoassays designed to measure the serum titer of specific IgA1 and IgA2 antibodies. Moreover, major differences were observed between the different monoclonal reagents with respect to the influence of the size of IgA on a solid-phase sandwich radioimmunoassay. While three of the anti-IgA1 underestimated dimeric IgA relative to monomeric IgA, the fourth anti-IgA1 and all the anti-IgA2 overestimated dimeric IgA relative to monomeric IgA, by a factor sometimes close to 7.


Polymer scaffolds with no skin-effect for tissue engineering applications fabricated by thermally induced phase separation.
Thermally induced phase separation (TIPS) based methods are widely used for the fabrication of porous scaffolds for tissue engineering and related applications. However, formation of a less-/non-porous layer at the scaffold's outer surface at the air-liquid interface, often known as the skin-effect, restricts the cell infiltration inside the scaffold and therefore limits its efficacy. To this end, we demonstrate a TIPS-based process involving the exposure of the just quenched poly(lactide-co-caprolactone):dioxane phases to the pure dioxane for a short time while still being under the quenching strength, herein after termed as the second quenching (2Q). Scanning electron microscopy, mercury intrusion porosimetry and contact angle analysis revealed a direct correlation between the time of 2Q and the gradual disappearance of the skin, followed by the widening of the outer pores and the formation of the fibrous filaments over the surface, with no effect on the internal pore architecture and the overall porosity of scaffolds. The experiments at various quenching temperatures and polymer concentrations revealed the versatility of 2Q in removing the skin. In addition, the in vitro cell culture studies with the human primary fibroblasts showed that the scaffolds prepared by the TIPS based 2Q process, with the optimal exposure time, resulted in a higher cell seeding and viability in contrast to the scaffolds prepared by the regular TIPS. Thus, TIPS including the 2Q step is a facile, versatile and innovative approach to fabricate the polymer scaffolds with a skin-free and fully open porous surface morphology for achieving a better cell response in tissue engineering and related applications.


[Amyloidosis of the kidneys in Crohn disease].
At the instance of the variegated anamnesis of a patient with Crohn's disease the unusually rapid development of a secondary amyloidosis of the kidneys is described. Crohn's disease became manifest at the 17th year of age. The severe course of the disease of the last four years with relapsing intraabdominal abscesses and multiple formations of fistulae might be significant for the pathogenesis of the amyloidosis. If the local complications of Crohn's disease are controlled then the amyloidosis still threatens the patient's life. In case the inflammatory process could be cured the consequence would as expected be the alleviation of the amyloidosis. An additional colchicine therapy may then accelerate the process of healing. However, the nature of Crohn's disease is uncertain.


[The heart and weaning].
The initiation of and weaning from mechanical ventilation with extubation cause significant changes in intrathoracic pressures and have profound consequences for the cardiovascular function. However, in spite of the known pathophysiological relationships, frequently little attention is paid to the cardiovascular situation during the weaning period. The currently available guidelines concerning weaning and extubation/reintubation are based on only limited evidence and are thus rather general. Moreover, recommendations for the cardiovascular management during weaning reflect mainly the pathophysiological rationale. In patients with known cardiac disease, studies have demonstrated the necessity for a prolonged weaning process. On the contrary, many intensive care patients have subclinical or undiagnosed cardiac disease, and cardiovascular compensation mechanisms are frequently hampered by the underlying critical illness. Therefore, in a significant proportion of patients, weaning and extubation attempts fail due to the patient's limited cardiovascular reserves. This review summarises the relevant information for a successful weaning and extubation with special respect to the cardiovascular function.


Surgical anatomy of the human middle ear: an insight into cochlear implant surgery.
This research was designed to aid practical otologic studies of the human middle ear. The topographic anatomy access of the middle ear was described with special focus to the cochlear implant procedure. It was conducted in an attempt to elucidate factors that would ultimately determine the ease of insertion of an electrode array. Fifteen right and 12 left temporal bones were dissected under the surgical microscope. After performing appropriate incisions, the distances between the stapedius muscle tendon, incus long crus and the cochleostomy were measured with the help of a digital microscope (Dino-Lite plus(®)). After performing statistical analysis, we found that strong relationship exists in the distances between the measured anatomical landmarks. Microscopic anatomical studies of the temporal bone are essential to safely perform surgical intervention within the middle ear. The results shows that morphometric data concerning different anatomical structures inside the middle ear, particularly distances, is an important contribution towards the planning of safe surgical procedures.


Hiatal hernia repair by restoration and stabilization of normal anatomy. An evaluation in four dogs and one cat.
Clinical signs of esophageal hiatal hernia in four dogs and one cat included regurgitation, vomiting, hematemesis, hypersalivation, dysphagia, and dyspnea. Thoracic radiographs, esophagram, and fluoroscopy were used to demonstrate cranial displacement of the esophagogastric junction and part of the stomach through the esophageal hiatus. Other findings included megaesophagus, esophageal hypomotility, gastroesophageal reflux, and pneumonia. Medical therapy failed to resolve the clinical signs. Reduction in size of the esophageal hiatus, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and a left fundic gastropexy were performed. Surgical results were considered good to excellent.


Cancer risk following polymyositis and dermatomyositis: a nationwide cohort study in Denmark.
Polymyositis and dermatomyositis (PM/DM) have been associated with cancer, although the long-term risks are poorly understood. To evaluate the risk of cancer by time periods subsequent to PM/DM diagnosis, a cohort of 539 patients hospitalized with PM/DM in Denmark between 1977 and 1989 was identified from the Danish Central Hospital Discharge Register. Cancer incidence among cohort members was ascertained by linkage to the Danish Cancer Registry using a unique personal-identification number. The overall cancer risk was elevated significantly among patients with DM (standardized incidence ratio [SIR] = 3.8, 95 percent confidence interval [CI] = 2.6-5.4) and to a lesser extent PM (SIR = 1.7, CI = 1.1-2.4). Significant excesses were observed for cancers of lung, ovary, and lymphatic and hematopoietic system. However, the excess cancer incidence declined steadily with increasing years since initial diagnosis of PM/DM. The cancer risk was increased about sixfold (SIR = 5.9, CI = 3.8-8.7) during the first year, but was lower during the second year (SIR = 2.5, CI = 1.1-4.8), with no significant excesses in subsequent years of follow-up. These findings confirm that PM/DM may occur as a paraneoplastic syndrome that calls for steps aimed at early cancer detection and treatment. Among long-term survivors of PM/DM, however, there is little evidence to warrant extensive preventive and screening measures beyond those recommended for the general population.


Effect of heat stress on cutaneous vascular responses to the initiation of exercise.
To explore further the competition between vasoconstrictor and vasodilator reflexes in the regulation of skin blood flow, responses in forearm blood flow (FBF) to the initiation of supine leg exercise were measured by plethysmography against a background of rising internal temperature. In 17 studies involving six men, skin temperature (Tsk) was controlled with water-perfused suits first at normothermic levels, followed by a 40- to 50-min period during which Tsk was held at 38-38.5 degrees C. Supine leg exercise at a moderate intensity (100-150 W) was performed for 5-6 min of each 15 min throughout, yielding one period of exercise performed during normothermic conditions and three periods of exercise performed during the period of elevated Tsk. On the average, FBF fell significantly with the beginning of each period of exercise (P less than 0.05). Furthermore, the amount by which FBF fell tended to increase with increasing levels of preexercise FBF. Thus the average fall in FBF associated with the onset of the last period of exercise, 2.45 ml X 100 ml-1 X min-1, significantly exceeded the 1.12 ml X 100 ml-1 X min-1 fall in FBF seen with onset of work in normothermic conditions. These responses were not due to changes in internal temperature as reflected by esophageal temperatures. However, individual studies occasionally revealed a reduction or abolition of the vasoconstrictor response with the last period of exercise. These findings are in agreement with earlier studies showing a cutaneous participation in the vasoconstrictor responses to exercise but also indicate that sufficient hyperthermia can attenuate or even abolish this response.


Papillary hidradenoma of the eyelid margin: clinical and immunohistochemical observations further supporting an apocrine rather than an eccrine origin.
A 46-year-old woman was evaluated for a "recurring papilloma" of the left medial upper eyelid margin. Beneath the papillary lesion medial to the punctum was a 5-mm diameter cutaneous mass thought to be cystic. After excisional biopsy, histopathologic analysis documented the presence of an epidermal keratinizing squamous papilloma surmounting a circumscribed dermal papillary hidradenoma composed of deeply eosinophilic columnar cells. Additionally, there was intraductal proliferation of tumor extending toward a subclinical poral opening through the epidermis. Immunohistochemistry proved the apocrine nature of the benign, non-cystic lesion by virtue of its nuclear androgen receptor and cytoplasmic gross-cystic disease fluid protein-15 positivity, along with its smooth muscle actin-positive myoepithelial layer. This and prior cases establish that apocrine tumors, both benign and malignant, are strictly localized at or near the eyelid margin where only apocrine glands are found. These tumors are more often papillary than solid adenomas, and most exceptionally can be malignant. We review the differential diagnosis of simulating eccrine eyelid tumors. We recommend wide local excision for benign lesions, in view of possible intraductal extension that can be eccentric to the main tumor and the miniscule potential for malignant transformation.


Acute toxicity of methyl isocyanate, administered subcutaneously in rabbits: changes in physiological, clinico-chemical and histological parameters.
Subcutaneous administration of methyl isocyanate (MIC) in 0.5 LD50 and 1 LD50 doses in female rabbits resulted in significant changes in physiological, clinico-chemical and histological parameters. There was a fall in arterial blood pressure and cardioacceleration in both the 0.5 LD50 and 1 LD50 groups, while the respiration showed a differential response in these groups with the former showing hyperpnoea and the latter showing respiratory inhibition. A significant increase in the arterial blood lactic acid, lactate/pyruvate ratio and 2,3-diphosphoglycerate levels, and the significant changes in acid-base status of both arterial and venous blood indicated tissue hypoxia of a stagnant type. Histopathological observations revealed a mild to moderate degree of congestion, focal lymphocytic infiltrations and necrosis in all visceral organs examined. These findings suggest that acute toxicity of MIC in vivo may be mediated by its effects on vascular beds.


Some factors modifying the insulinotropic and cardiovascular effects of isoprenaline in the rat.
The effects of L-isoprenaline on plasma immunoreactive insulin (IRI) and glucose concentrations were examined in pentobarbitone anaesthetized rats. When given by bolus injection hyperinsulinaemia was produced only by very large doses of isoprenaline (100-200 micrograms/kg). Infusion of isoprenaline allowed the demonstration of hyperinsulinaemia at low dose rates (0.07-0.7 microgram kg-1 min-1). Pretreatment with phentolamine or production of a functional sympathectomy by bilateral adrenal demedullation and chronic guanethidine treatment augmented the hyperinsulinaemic effect of isoprenaline. Isoprenaline-induced hyperglycaemia was attenuated by sympathectomy and by phentolamine pretreatment, this attenuation being attributed to the augmented hyperinsulinaemic effect of isoprenaline under these conditions. The increase in heart rate and reduction in blood pressure produced by isoprenaline were also augmented in sympathectomized rats.


Development of pumping emulsification device with glass membrane to form ideal lipiodol emulsion in transarterial chemoembolization.
To evaluate a pumping emulsification device that can improve the physiochemical properties and stability of lipiodol emulsion for conventional transarterial chemoembolization. A pumping emulsification device constructed of a glass membrane with a hydrophobic surface with pore size of 50 μm in diameter was placed between two syringe adaptors. Epirubicin solutions were mixed with lipiodol with pumping exchanges using the emulsification device or a three-way cock. The ratios of epirubicin solution to lipiodol were 1:2 or 1:1. A total of 120 emulsions were created. The emulsification device showed significantly higher percentages of water-in-oil when compared with the three-way cock (97.9 % vs. 68.9 % in 1:2 ratio, and 82.1 % vs. 17.8 % in 1:1 ratio, p < .001). Droplet sizes in the emulsification device were more homogenous. Mean droplet sizes and viscosities in the emulsification device did not show any significant changes for 30 min after pumping, whereas in the three-way cock, the droplet sizes significantly enlarged and viscosities significantly decreased (p=.023 and p=.002). The emulsification device can form a high percentage of water-in-oil emulsion with stable droplets sizes and viscosities. This developed device is promising to increase therapeutic effects in conventional transarterial chemoembolization. • We developed new device for transarterial chemoembolization for liver cancer. • The device can improve the physiochemical properties of lipiodol emulsion. • The device can increase the therapeutic effects in conventional transarterial chemoembolization.


[Study of the reference values and nyctohemeral cycle of serum iron].
Marked variations in the same individual of serum iron levels may be due to a circadian rhythm. We determined the reference values of serum iron in a population of blood donors who had no blood disease. The very wide reference interval found (0.47 to 1.75 mg/l in man and 0.36 to 1.66 mg/l in women) was due to physiological variations rather than analytical variations. We also demonstrated in individuals with a normal life rhythm, a circadian rhythm for iron with maximal levels in the morning (8 to 12) and minimal levels in the evening (8 p.m. to midnight) the ratio of these levels is usually between 1.5 and 2, but may reach much higher figures. On the other hand, the total fixation capacity varies little over 24 hours. In night workers, one may note a displacement of the cycle with a maximum towards 8 p.m. a minimum at 8 a.m. In diabetics, the circadian rhythm exists but with a lower amplitued than in healthy subjects. In a few cases a hemochromatosis, one may note disappearance of the cycle.


Laparoscopic cholecystectomy and gallbladder cancer.
This study was designed to assess the treatment of patients in whom gallbladder cancer was diagnosed in the course of histological examination of their gallbladders, which were removed during laparoscopic cholecystectomy. Six (0.29%) cancers were found among 2,017 patients who underwent laparoscopic cholecystectomy. Four of these cancers (0.22%) were in 1,831 gallbladders with normal walls, two (1.0%) were in 186 with thicker walls, and two (1.8%) were in 109 patients in whom conversion was necessary because of extensive inflammation and thickening of gallbladder wall. In two cases, the cancer did not cross the muscular layer. In one of them, no further treatment was undertaken. In the second case, liver resection and lymphadenectomy was performed. In the other four cases, dissemination was diagnosed during laparotomy, precluding radical treatment. Thickened and infiltrated gallbladder walls in patients without preoperative symptoms of cholecystitis should raise a suspicion of cancer. The surgeon should be prepared to perform a conversion, an intraoperative histological examination, and an appropriate radical operation, if necessary.


GPs have key role in managing motor neurone disease.
Motor neurone disease (MND) is a rapidly progressive neurodegenerative condition. It affects people of all ages, but is more common with increasing age (especially over 50 years) and men are affected twice as often as women. The causes remain unknown, although around 5% of cases have a genetic basis. Survival is usually only three to five years from diagnosis. MND affects both upper and lower motor neurones, with variable contributions. The nerve involvement in MND usually has a focal onset, is asymmetrical, but tends to spread to adjacent regions of the body. If the affected region is in the legs, a common presenting feature is tripping, falls or foot drop. If it is in the arms there may be difficulty with fine tasks such as fastening buttons, or raising an arm, and if the cranial nerves are affected there may be slurring of speech, or difficulty swallowing. Key to the diagnosis is evidence of progression, and this may lead to some delay in considering and also confirming the diagnosis. When examining the patient, evidence of more widespread neuromuscular involvement should be looked for. In a patient with foot drop, and fasciculation of the tongue, MND would be a likely diagnosis. Upper motor neurone involvement may be readily determined by examining the reflexes. Brisk reflexes, in the arms, legs or jaw, in the context of features of lower motor neurone denervation are highly suggestive of MND. Suspicion of MND should lead to referral for a neurology opinion. The most useful investigation is likely to be EMG with nerve conduction studies, and probably MRI scan of relevant areas. Blood tests are arranged to screen for any other causative condition. Riluzole is a disease modifying drug licensed to extend the life of patients with MND. There is no treatment that will reverse, or halt, progression of the disease.


Structure clustering features on the Sfold Web server.
The energy landscape of RNA secondary structures is often complex, and the Boltzmann-weighted ensemble usually contains distinct clusters. Furthermore, the minimum free energy structure often lies outside of the cluster containing the structure determined by comparative sequence analysis. We have developed procedures to characterize and visualize the Boltzmann-weighted ensemble, and have made them available on the Sfold Web server. The new features on the Web server include clustering statistics, ensemble and cluster centroids, multi-dimensional scaling display and energy landscape representation of the Boltzmann-weighted ensemble. http://sfold.wadsworth.org; http://www.bioinfo.rpi.edu/applications/sfold chanc@wadsworth.org.


Interprofessional Intervention to Improve Geriatric Consultation Timing on an Acute Medical Service.
To determine whether an interprofessional intervention would improve the use and timing of a geriatric consultation on a hospitalist service. Difference-in-differences (DID), which measures the difference in improvement over time between intervention and control team patients attributable to the intervention. 1,000-bed U.S. academic medical center. Individuals aged 60 and older admitted to a general medicine hospitalist service (N=7,038; n = 718 on intervention teams, n = 686 historical controls, n = 5,634 on control teams (concurrent and historic). On 2 of 11 hospitalist teams, a geriatrician attended multidisciplinary discharge rounds twice weekly and advised on the benefits of a geriatric consultation for individuals aged 60 and older. Primary outcome was percentage of hospitalizations resulting in a geriatric consultation. Secondary outcome was days to geriatric consultation. Both outcomes were controlled for age, sex, comorbidity, mean daily intensity of inpatient care utilization, and admission in the prior 30 days. In the primary analysis, length of stay was controlled. Intervention participants were more likely to have a geriatric consultation (DID = 2.35% absolute percentage points, 95% confidence interval (CI) = 0.59-4.39%) and to have a consultation sooner (DID = 3.61 fewer days, 95% CI = -1 to -7). An interprofessional intervention that focused on hospitalist ordering practices increased use of appropriate geriatric consultation and decreased time to consultation. This model of interprofessional effort is effective. Future adaptations are needed to target scarce geriatric resources without increasing overall use. J Am Geriatr Soc 66:2372-2376, 2018.


Negative scintigraphy with positive magnetic resonance imaging in bone metastases.
We report three patients with known primary tumor in whom radionuclide skeletal imaging for metastatic disease was normal with or without clinical symptomatology referable to this area. Magnetic resonance imaging (MRI) of the spine demonstrated focal areas of abnormal signal intensity in the vertebral bodies of these patients. In all three patients, biopsy confirmed metastatic disease. All the patients received radiation or chemotherapy depending upon the etiology. These preliminary data suggest that MR imaging may be useful in evaluating patients with known primary tumor in whom clinical suspicion persists despite a negative radionuclide bone scan.


Sites of carbonic anhydrase in avian gastric mucosa identified by electron microscope autoradiography.
Carbonic anhydrase was localized at the ultrastructural level by autoradiography of [3H]acetazolamide in quail gastric mucosa. Grains were associated predominantly with mucin granules at the apical end of surface mucosal cells. Secreted mucin was also labeled. Oxynticopeptic cells of the multilobular glands were not labeled. The pH of fluid secreted by was 7.0-7.4 compared with a pH of 1.3-1.8 of freshly secreted fluid in the gastric lumen. The results of this study suggest that surface mucosal cells, which are strikingly similar in birds, amphibians, and mammals, are the site of acid secretion in the vertebrate stomach.


Value of computerized tomography and ultrasonography in the preoperative diagnosis of renal cell carcinoma extending into the inferior vena cava.
During a 15-year period, 34 patients with renal cell carcinoma extending into the inferior vena cava were submitted to radical ablative surgery at our institution. 8 patients had caval tumor thrombus (TT) extension at the level of the renal veins, 17 had infrahepatic, 8 retrohepatic and 1 atrial TT extension. Cavography, computerized tomography (CT) and ultrasonography (US) were performed preoperatively on 34, 24 and 16 of these 34 patients, respectively. The sensitivity of the techniques used in diagnosing caval involvement was 100, 97 and 87.5% for US, cavography and CT, respectively. The upper limits of TT were clearly detected by US, CT and cavography in 100, 95 and 76% of diagnosed cases, respectively. From this study it appears that US and CT have a sensitivity comparable to cavography in the detection of caval TT. However, US and CT allow a more precise delineation of the upper limits of TT if compared to cavography. This implies that the role of cavography in diagnosing caval TT and its upper limits must be reappraised in light of the progress of noninvasive outpatient procedures.


[Probabilistic assessment of dietary exposure to both deoxynivalenol and zearalenone from cereal-based products in Chinese populations].
To elucidate the dietary exposure to deoxynivalenol (DON) and zearalenone (ZEN) from cereal-based products in Chinese populations using the probabilistic assessment approach. A total of 292 wheat flours and 347 corn-based products were collected from sampling sites of 107 supermarkets or farmers markets, which were randomly selected from 44 cities of 13 provinces in 2009 by the stratified cluster random sampling method. Then, DON and ZEN contamination levels in these samples above analyzed by UPLC-MS/MS in combination with the food consumption data of 68 959 respondents, who were divided into group 1 aged 3 to 13 years old, and group 2 aged 14 and over 14 years old (≥14 years old), obtained by China National Nutrition and Health Survey in 2002 were investigated. A probabilistic assessment model using Monte Carlo simulation was applied to derive the intake distribution of P(1)-P(99) percentile of dietary exposure to DON and ZEN. Meanwhile, all parameters related to dietary exposure to both toxins were compared with either the provisional maximum tolerable daily intake (PMTDI) of 1 µg·kg(-1)·d(-1) for DON, or the tolerable daily intake (TDI) of 0.25 µg·kg(-1)·d(-1) for ZEN in order to evaluate the risk of dietary intake of two toxins and find the minimum percentile of dietary exposure to these two toxins. The statistical differences of dietary exposure to these two toxins between two groups were achieved by t test. The detection frequencies of DON in wheat flours and corn-based products were 100% (292/292) and 97.4% (338/347), respectively. A total of 21 out of 639 samples (wheat flours: 5/292, corn-based products: 16/347) were positive for DON at the levels exceeding the Chinese regulatory limit of 1 000 µg/kg for DON. And the detection frequencies of ZEN in wheat flours and corn-based products were 53.4% (156/292) and 87.6% (304/347), respectively.54 out of 347 corn-based products and no wheat flours were positive for ZEN at the levels exceeding the Chinese regulatory limit of 60 µg/kg for ZEN. Meanwhile, the mean values (95% CI) of the P(50), P(75), P(90), P(95), P(97.5) and P(99) percentile of dietary exposure to DON in populations of 3 to 13 years old were 0.170 (0.170-0.171), 0.762 (0.759-0.765), 2.066 (2.038-2.069), 3.515 (3.501-3.530), 5.342 (5.314-5.372), and 9.220 (9.155-9.279) µg · kg(-1)·d(-1), which were higher than those in populations of ≥14 years old (0.131 (0.130-0.131), 0.500 (0.498-0.501), 1.280 (1.276-1.285), 2.138 (2.128-2.14), 3.510 (3.494-3.527), and 5.512 (5.474-5.546) µg·kg(-1)·d(-1)), with t values of 87.19, 163.87, 164.66, 157.78, 105.47 and 96.31, and all P values less than 0.001. And the mean values (95% CI) of the P(50), P(75), P(90), P(95), P(97.5) and P(99) percentile of dietary exposure to ZEN in populations of 3 to 13 years old were 0.001 (0.001-0.001), 0.006 (0.006-0.006), 0.039 (0.038-0.039), 0.101 (0.100-0.101), 0.195 (0.194-0.197) and 0.378 (0.374-0.381) µg · kg(-1)·d(-1), which were also higher than those in populations of ≥14 years old (0.001 (0.001-0.001), 0.004 (0.004-0.004), 0.026 (0.026-0.026), 0.061 (0.060-0.061), 0.115 (0.115-0.116) and 0.232 (0.231-0.235) µg·kg(-1)·d(-1)) with T-values of 151.11, 73.80, 96.81, 100.81, 91.93 and 76.13, and all P values less than 0.001. Besides, the minimum percentile of dietary exposure to DON in populations of 3 to 13 years old and ≥14 years old exceeded the corresponding PMTDI of 1 µg·kg(-1)·d(-1) was found in the probability distribution of P(76) (99% percentile = 1.03 µg·kg(-1)·d(-1)) and P(84) (95% percentile = 1.01 µg·kg(-1)·d(-1)) percentile, respectively. And the minimum percentile of dietary exposure to ZEN in populations of 3 to 13 years old and ≥14 years old exceeded the corresponding TDI of 0.25 µg·kg(-1)·d(-1) was found in the probability distribution of P(97) (95% percentile = 0.25 µg·kg(-1)·d(-1)) and P(98) (90% percentile = 0.26 µg·kg(-1)·d(-1)) percentile, respectively. The contamination levels of DON and ZEN in wheat flours and corn-based products and the risk of dietary exposure to both DON and ZEN in populations in Chinese populations were at relatively low levels. The dietary exposure to both DON and ZEN in populations of 3 to 13 years old was higher than those in populations of ≥14 years old . Populations of 3 to 13 years old were the populations at the high risk of dietary exposure to both mycotoxins.


[Catecholamine-induced myocarditis in pheochromocytoma].
Pheochromocytoma is a rare tumor, usually benign, potentially lethal in case of crisis with acute release of catecholamines. The heart is a target and the clinical presentation can mimic various cardiac conditions, thus rendering diagnosis elusive. Cardiac magnetic resonance is a valuable non-invasive diagnostic tool for the evaluation of cardiomyopathies; it allows the identification of catecholamine-induced myocarditis pattern and, in some cases, it can detect the primary tumor. The definitive treatment of pheochromocytoma is surgical, while the acute crisis may require mechanical support to circulation. We here report a case of pheochromocytoma in a 25-year-old man complicated by catecholamine-induced myocarditis and heart failure.


[Determination of immune complexes in renal diseases (author's transl)].
The concentration of circulating immune complexes were determined by Clq solid phase assay in 30 patients with systemic lupus erythematosus (n = 15), glomerulonephritis (n = 5), and after kidney transplantation (n = 10). Elevated immune complex concentrations were found in glomerulonephritis and systemic lupus erythematosus correlating with disease activity. In the posttransplant period the level of immune complexes was increased after antilymphocyte globulin therapy. The function of the transplanted kidney or rejection crises showed no effect on immune complex formation. The presence of circulating immune complexes indicates a high activity of disease in cases of glomerulonephritis and systemic lupus erythematosus.


Evidence of familial nature of male homosexuality.
We recruited 51 predominantly homosexual and 50 predominantly heterosexual men as index subjects for a family study of sexual orientation. The sexual orientation of siblings (115 sisters and 123 brothers) was ascertained in two ways: via interview with the index subjects and via interview of and/or mailed questionnaire to the siblings themselves. Index subjects' knowledge of the sexual orientation of their siblings was, for the most part, quite accurate. Moreover, heterosexual index men had about as many homosexual brothers as would be predicted given national prevalence figures for homosexuality, but homosexual index men had about four times as many homosexual brothers, although in both cases most brothers were heterosexual. There was no significant difference between the index groups in number of homosexual sisters. We conclude that there is a significant familial component to male homosexuality.


Chenodeoxycholic acid stimulated fibroblast growth factor 19 response - a potential biochemical test for bile acid diarrhoea.
Bile acid diarrhoea is underdiagnosed and better diagnostic tests are needed. Fasting serum fibroblast growth factor-19 (FGF19) has insufficient diagnostic value, but this may be improved by stimulation. To explore if an impaired FGF19 response identifies primary bile acid diarrhoea. Eight patients with primary bile acid diarrhoea and eight healthy volunteers ingested (i) a meal plus 1250 mg chenodeoxycholic acid (CDCA), (ii) 1250 mg CDCA or (iii) the meal. Blood was sampled at fasting and repeatedly after stimulation. We analysed FGF19 by enzyme-linked immunosorbent assay and bile acids including 7α-hydroxy-4-cholesten-3-one by liquid chromatography-tandem mass spectrometry. Stimulation with the meal plus CDCA increased median FGF19 in healthy volunteers from fasting 62 pg/mL [interquartile range (IQR): 41-138] to 99 pg/mL (IQR: 67-147; P = 0.012) after 90 min and peaked after 150 min at 313 pg/mL (IQR: 54-512). This response was impaired in primary bile acid diarrhoea patients [fasting 56 pg/mL (IQR: 42-79); 90 min: 48 pg/mL [IQR: 37-63); 150 min: 57 pg/mL (48-198)]. Receiver operating characteristics (ROCAUC ) for fasting FGF19 was 0.55 (P = 0.75) and at 90 min 0.84 (P = 0.02). The difference in FGF19 from fasting to 90 min after the meal plus CDCA separated the groups (ROCAUC 1.0; P = 0.001). 7α-hydroxy-4-cholesten-3-one was elevated in primary bile acid diarrhoea (P = 0.038) and not significantly affected by stimulation. The FGF19 response following chenodeoxycholic acid plus meal is impaired in primary bile acid diarrhoea. This may provide a biochemical diagnostic test.


Meniscal sizing based on gender, height, and weight.
Successful meniscus transplantation may depend on accurate sizing. Meniscal sizing is currently determined by measuring a combination of bony landmarks and soft-tissue insertion points through images obtained radiographically or by magnetic resonance imaging (MRI). The literature widely reports inaccuracy in sizing resulting from radiographic errors in magnification, erroneous identification of bony landmarks, and difficulty in differentiating between the soft-tissue and bone interface. In our meniscus transplantations we have observed that when the height and weight of the recipient matched those of the donor, the meniscal size appeared to be a match at surgical implantation; we designed this study to confirm this observation. The MRI-based meniscal sizing of 111 patients (63 male and 38 female patients; mean age, 44 years [range, 15 to 76 years]), totaling 147 menisci (87 lateral and 60 medial), was compared with the height, weight, gender, and body mass index (BMI) of each patient. MRI scans were obtained with a 1.0-Tesla MRI system (ONI Medical Systems, Wilmington, MA). Sizing was performed by an independent musculoskeletal MRI radiologist as established by the literature. Statistical methods include nonparametric Pearson correlation (r) between MRI-based lateral meniscal width, lateral meniscal length, medial meniscal width, medial meniscal length, total tibial plateau width, and patient height, weight, gender, and BMI. Significance at the P = .05 level was used. Height was found to have a linear relationship to total tibial plateau, which has a good predictive correlation with meniscal dimensions of r > 0.7. Female patients generally present with smaller dimensions than male patients. High-BMI groups present with significantly larger meniscal dimensions than low-BMI groups at any given height. Height, weight, and gender are easily obtained variables and are proportional to meniscal tissue dimensions. These exploratory statistics establish correlations between height, weight, gender, total tibial plateau width, and meniscal size. Height, weight, and gender should be considered by both tissue banks and surgeons as fast and cost-effective variables by which to predict meniscal dimensions.


Current issues in billing and coding in interventional pain medicine.
Interventional pain management is a dynamic field with changes occurring on a daily basis, not only with technology but also with regulations that have a substantial financial impact on practices. Regulations are imposed not only by the federal government and other regulatory agencies, and also by a multitude of other payors, state governments and medical boards. Documentation of medical necessity with coding that correlates with multiple components of the patient's medical record, operative report, and billing statement is extremely important. Numerous changes which have occurred in the practice of interventional pain management in the new millennium continue to impact the financial viability of interventional pain practices along with patient access to these services. Thus, while complying with regulations of billing, coding and proper, effective, and ethical practice of pain management, it is also essential for physicians to understand financial aspects and the impact of various practice patterns. This article provides guidelines which are meant to provide practical considerations for billing and coding of interventional techniques in the management of chronic pain based on the current state of the art and science of interventional pain management. Hence, these guidelines do not constitute inflexible treatment, coding, billing or documentation recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis taking into account an individual patient's medical condition, personal needs, and preferences, along with physician's experience and in a similar manner, billing and coding practices will be developed. Based on an individual patient's needs, treatment, billing and coding, different from what is outlined here is not only warranted but essential.


A general purpose computer analysis system for chromatographic data.
A manual integration system for the analysis of chromatographic data is described. The analog output produced by an HPLC absorbance monitor is passed to a non-inverting signal amplifier. This amplified signal is sent to an IBM PC where an analog to digital converter is used to digitize the data. A set of six computer programs which collect, store and analyze these data are presented. This system was used to analyze the nucleotide content of the anaerobic organism Clostridium acetobutylicum by strong anion-exchange HPLC.


[Effect of ionol on the stomach lesion in rats during immobilization stress].
Intragastric administration of the antioxidant ionol (50 mg/kg/a day) for 7 days did not prevent the formation of ulcers or massive hemorrhages to the gastric mucosa in immobilized animals, increased the number of petechiae and lowered that of erosions. In this case the parietal pH increased in the stomach and dropped in the remaining divisions of the alimentary tract. The combined action of stress and ionol brought about marked hypocoagulation. Ionol exerted a protective action on the stress-induced activation of lipid peroxidation in the stomach but did not produce any such effect on the liver.


The first global deep-sea stable isotope assessment reveals the unique trophic ecology of Vampire Squid Vampyroteuthis infernalis (Cephalopoda).
Vampyroteuthis infernalis Chun, 1903, is a widely distributed deepwater cephalopod with unique morphology and phylogenetic position. We assessed its habitat and trophic ecology on a global scale via stable isotope analyses of a unique collection of beaks from 104 specimens from the Atlantic, Pacific and Indian Oceans. Cephalopods typically are active predators occupying a high trophic level (TL) and exhibit an ontogenetic increase in δ15N and TL. Our results, presenting the first global comparison for a deep-sea invertebrate, demonstrate that V. infernalis has an ontogenetic decrease in δ15N and TL, coupled with niche broadening. Juveniles are mobile zooplanktivores, while larger Vampyroteuthis are slow-swimming opportunistic consumers and ingest particulate organic matter. Vampyroteuthis infernalis occupies the same TL (3.0-4.3) over its global range and has a unique niche in deep-sea ecosystems. These traits have enabled the success and abundance of this relict species inhabiting the largest ecological realm on the planet.


Treatment of Barrett's esophagus: update on new endoscopic surgical modalities.
Barrett's esophagus represents a premalignant condition, which is strongly associated with the incidence of esophageal adenocarcinoma. Currently, there are no validated markers to extract exactly that certain patient that will proceed to neoplastic progression. Therefore, therapeutic options have to include a larger population to provide prophylaxis for affected patients. Recently developed endoscopic therapeutic approaches offer treatment options for prevention or even treatment of limited esophageal adenocarcinoma. At present, high eradication rates of intestinal metaplasia as well as dysplasia are observed, whereas low complication rates offer a convenient safety profile. These striking new methods symbolize a changing paradigm in a field, where minimal-invasive tissue ablating methods and tissue preserving techniques have led to modified regimens. This review will focus on current standards and newly emerging methods to treat Barrett's esophagus and its progression to cancer and will highlight their evolution, potential benefits and their limitations.


Nanostructured biomaterials with antimicrobial properties.
The present review is intended to bring together the main advances in the field of nanostructured biomaterials with antimicrobial properties. It is generally accepted that the discovery of antibiotics was of great importance but, nowadays new antimicrobial agents are needed and/or their better administration routes. The limitation of the use of antibiotics is essential because of the following reasons: the excessive use of antibiotics leads to the development of antibiotic resistant microorganisms; there are some alternatives for many types of infections, many of these alternatives being less toxic and do not lead to antibiotic similar resistance. In compliance with the above presented, the use of antibiotic is recommended to be eliminated (when alternatives are available) or to be reduced by using combined therapy when possible or to administrate these drugs through targeted or loco-regional drug delivery systems.


Effects of Image Gently and the North American guidelines: administered activities in children at 13 North American pediatric hospitals.
The goal of this investigation was to assess the impact of the publication of the 2010 North American guidelines on the practice of nuclear medicine in children at 13 dedicated pediatric institutions within the United States and Canada by comparing results of similar surveys from 2007 and 2013. In 2013, a follow-up survey was performed of the original 13 dedicated pediatric institutions initially surveyed in 2007. Both surveys inquired about the administered activities for 16 nuclear medicine procedures commonly performed on children. The administered activity per body mass, the maximum activity, and the minimum activity for patients for each procedure were requested from each site. For each parameter the minimum and maximum reported values, as well as the median and the mean, were tabulated. The mean difference in the mean between 2007 and 2013 was calculated, as well as the 95% confidence intervals for the mean administered activity per body mass for both years. The factor of variation used with the previous survey for each parameter was calculated by taking the ratio of the maximum and minimum reported values. For the 8 procedures addressed in the 2010 North American guidelines, the percentage of institutions that were compliant (defined as within 20%) for each parameter were noted for both surveys. Institutions were asked whether they were familiar with "Image Gently," the North American guidelines, and the "Go with the Guidelines" campaign and whether they adjusted their administered activities on the basis of these guidelines. In general, the 13 pediatric institutions have reduced their administered activities in children, particularly for those procedures addressed by the 2010 North American guidelines. The average variability in the activity per body mass and the minimum activity as measured by the factor of variation were substantially reduced by 9.7% (from 3.1 to 2.8) and 24% (from 10.0 to 7.6). The average variability of the maximum activity was increased by 6.1% (from 3.3 to 3.5), but the increase was mostly due to some sites reducing their limits while others maintained their previous values. For the 8 procedures addressed by the guidelines, half or more of the institutions were compliant (within 20%) with the associated parameters in 66% of the cases. Ten of the 13 institutions reported that they adjusted their administered activities according to the North American guidelines. The publication of these guidelines and the associated public relations program appear to have had a positive effect with regard to both dose optimization and procedure standardization in pediatric nuclear medicine.


Nonmelanoma skin cancer treatment training varies across different medical specialists.
Physicians from various specialties treat patients with nonmelanoma skin cancer (NMSC). The isolation of specialties from each other may result in different approaches to skin cancer training. Our purpose was to determine the type and amount of NMSC surgical training that is received during dermatology, general surgery, internal medicine, otolaryngology, and plastic surgery residencies. E-mail contact information for residency program directors of all accredited programs in each specialty was compiled through the American Medical Association's online residency database. A total of 920 residency program directors were emailed surveys concerning the training of residents in the treatment of NMSC. Forty-two of 920 surveys were returned. All surveyed specialty groups, except internal medicine, had training in NMSC treatment including simple excision, split thickness skin grafts, and tissue rearrangement. A majority of the dermatology and plastic surgery programs instruct their residents in Mohs micrographic surgery and full thickness skin grafts. Electrodessication and curettage was most often instructed in dermatology, general surgery, and plastic surgery programs. Greater consistency in NMSC treatment training may be beneficial. Because different approaches may be best suited to particular clinical situations, NMSC treatment training should include adequate exposure to all NMSC treatment techniques.


Enhanced Size Selection in Two-Photon Excitation for CsPbBr3 Perovskite Nanocrystals.
Cesium lead bromide (CsPbBr3) perovskite nanocrystals (NCs), with large two-photon absorption (TPA) cross-section and bright photoluminescence (PL), have been demonstrated as stable two-photon-pumped lasing medium. With two-photon excitation, red-shifted PL spectrum and increased PL lifetime is observed compared with one-photon excitation. We have investigated the origin of such difference using time-resolved laser spectroscopies. We ascribe the difference to the enhanced size selection of NCs by two-photon excitation. Because of inherent nonlinearity, the size dependence of absorption cross-section under TPA is stronger. Consequently, larger size NCs are preferably excited, leading to longer excited-state lifetime and red-shifted PL emission. In a broad view, the enhanced size selection in two-photon excitation of CsPbBr3 NCs is likely a general feature of the perovskite NCs and can be tuned via NC size distribution to influence their performance within NC-based nonlinear optical materials and devices.


¿Qué es racismo?: awareness of racism and discrimination in Ecuador.
In the national consciousness, Ecuador is a mestizo nation. However, it is also an ethnically diverse nation with sizable minorities of indigenous and Afrodescended peoples. In national surveys, there is also a considerable minority who self-identify as blanco (white). Although there is strong evidence of continuing discrimination and prejudice toward both indigenous and Afro-descended peoples, there is little public discussion or political action addressing such issues. The emergence of a powerful and resilient indigenous movement in the late 1980s gained international interest and acclaim in the 1990s, in part because of the peaceful mobilization efforts and effective bargaining tactics of the movement. However, indigenous leaders usually have not engaged in a discourse of racismo and/or discriminación. There has been much less social movement solidarity and activism among Afro-Ecuadorians, but their leaders commonly employ a discourse of racismo and discriminación. In August and September 2004, a survey of more than eight thousand adult Ecuadorians was conducted in regard to racism and related topics. In this research, we use several measures from this survey that focus on awareness of and sensitivity to issues of racism, prejudice, and discrimination. Self-identification of respondents enables us to contrast the responses of whites, mestizos, Indians, and Afro-Ecuadorians to the measures. Other independent variables of interest are level of education, the region in which the respondent resides, and whether the respondent lives in an urban or rural area. Regression results show differences among the ethnic groups in levels of awareness of racism, but more powerful predictors are level of education and rural residence.


A new benzenediamine derivative modulates Toll-like receptors-induced myeloid dendritic cells activation and ameliorates lupus-like syndrome in MRLlpr/lpr mice.
Modulators of the over-activation of myeloid dendritic cells (mDCs) by Toll-like receptors (TLRs) have an advantage in the treatment of systemic lupus erythematosus (SLE). This study was designed to evaluate the effects of FC-99, a novel benzenediamine derivative, on TLR-induced activation of mDCs, and to assess the efficacy of FC-99 in a murine model of SLE. In vitro, FC-99 inhibited the phenotypic (CD40 and MHC-II) and functional activation (IL-12 and CXCL10) of mDCs induced by TLR ligands. In vivo, MRLlpr/lpr mice displayed renal diseases associated with increased levels of proteinuria and immunoglobulin, which were ameliorated by FC-99. Enhanced accumulation and activation of mDCs in lymphoid organs was also impaired by FC-99. Additionally, FC-99 inhibited the activation of IκB-α and upregulated the expression of TNFα-induced protein 3 (TNFAIP3) in vitro and in vivo. These results indicate that FC-99 modulates TLR-induced activation of mDCs and ameliorates lupus-like syndrome in MRLlpr/lpr mice. This effect is closely associated with the inhibition of IκB-α and upregulation of TNFAIP3.


Suicide by overdoses of medicines among the aged.
The current literature on suicide by medicinal overdose among the elderly population of the United States and Britain is discussed. The older white male is a high risk in this regard. Physical and mental illnesses contribute to the problem of suicide among the aged, and some of the drugs prescribed for treatment (e.g., barbiturates and psychotherapeutic agents) are often accessible to the older person for misuse in suicide. The responsibilities of the prescribing physician and the practices of the dispensing pharmacist are considered in relation to the exposure of the elderly patient to potentially lethal drugs. Prediction of suicidal attitudes in the elderly is complicated by the fact that any attempt at suicide usually is serious and rarely preceded by gestures. Depression, based on social factors, is common among older people. Some of them face problems of declining income and prestige, as well as a loss of physical and mental powers. A change in the attitude of society towards the elderly may help to alleviate the depressive state which so often contributes to the suicidal potential.


[The report of organophosphorus pesticides cause delayed nervous system diseases (143 cases)].
This article reports delayed dysneuria 143 cases, 54 cases in male and 89 cases in female, age 8-59 years old. They are treated by atropine. After the cholinesterase inhibited symptoms had vanished or had improved and after the other factors had been eliminated the delayed dysneurias occur after poisoning 5.42 days. They are the peripheral neuritis, the amyotrophic lateral sclerosis, the myasthenic crisis, the peptic neuritis, the encephalitis, the mixed aphasia and the symptoms like Guillain-Barre's syndrome. Their death rates are higher in two months to the types of the myasthenic crisis, the encephalitis and the amyotrophic lateral sclerosis and to the other types of disease and the cases. Poisoned two months later, their prognosis are better and the mechanism are not very clear now.


The Ohmeda Universal PAC drawover apparatus. A technical and clinical evaluation.
The Ohmeda Universal PAC drawover apparatus, a modification of an earlier series of vapour-specific vaporizers, was assessed with regard to its output under varying gas flows and temperatures and its clinical usage with isoflurane and enflurane. The device tended to over-deliver vapour, particularly at low flows and at high temperatures. Its clinical performance during spontaneous and positive pressure ventilation was satisfactory, although adequate concentrations were not achieved using enflurane in the spontaneous ventilation mode. The device was not assessed with ether or halothane. The robust construction, relatively large capacity and thermocompensation make it suitable for field or military anaesthesia.


Differentiation Between Crohn Disease and Intestinal Tuberculosis in Children.
The aim of the study was to evaluate clinical, endoscopic, radiologic, and histopathological features helpful in differentiating Crohn disease (CD) from intestinal tuberculosis (ITB) in children. Patients diagnosed to have CD or ITB based on standard recommended criteria were enrolled. Children with inflammatory bowel disease unclassified or suspected ITB or CD with incomplete work-up or lost to follow-up were excluded. The clinical and laboratory (radiology, endoscopy, and histology) details of children were analyzed. Twenty cases of ITB (14 [3-17] years) and 23 of CD (11 [1-17] years) were enrolled. Presentation with chronic diarrhea (82% vs 40%; P = 0.006) and blood in stool (74% vs 10%; P = 0.001) favored CD, whereas subacute intestinal obstruction (20% vs 0%; P = 0.04) and ascites (30% vs 0%; P = 0.005) favored ITB. Presence of deep ulcers (61% vs 30%; P = 0.04), longitudinal ulcers (48% vs 15%; P = 0.02), involvement of multiple colonic segments (70% vs 35%; P = 0.02), left-sided colon (87% vs 40%; P = 0.003), extraintestinal manifestations (21.7% vs 0%; P = 0.02), and higher platelet count (3.9 vs 2.6 × 10/mm; P = 0.02) favored CD. Isolated ileocecal involvement (40% vs 8.7%; P = 0.03) was a feature of ITB. TB bacilli were demonstrated in 40% ITB cases (colon-6, ascites-1, abdominal lymph node-1). On multivariate analysis, presence of blood in stool (odds ratio: 37.5 [confidence interval: 3.85-365.72], P = 0.002) and left-sided colonic involvement (odds ratio: 16.2 [confidence interval: 1.63-161.98], P = 0.02) were independent predictors of CD. Microbiologic confirmation of tuberculosis is possible in 40% ITB cases. Presence of blood in stool and left-sided colonic involvement are the most important features favoring CD.


[Efficiency of fixed partial dentures].
A proposal for restorative treatment is based on the expected efficiency of the treatment. Efficiency is determined by measuring the investment, such as the monetary and biological cost, against what is gained, such as functional restoration and durability. If one's goal is to save tooth tissue in the restorative process, it is interesting to compare the conventional fixed partial denture with the adhesive fixed partial denture. The mean survival rate of conventional fixed partial dentures clearly exceeds the mean survival rate of adhesive fixed partial dentures but there are biological risks. Loss of vitality of the abutment teeth and the occurrence of caries are more prominent with conventional fixed partial dentures than with adhesive fixed partial dentures. Consequently, the possibility of replacing a conventional fixed partial denture with a new conventional fixed partial denture is limited. Because this and other clinical aspects can not easily be expressed numerically, the patient should be informed qualitatively about the advantages, disadvantages and uncertainties of the various types of fixed partial dentures.


MLH1 promoter hypermethylation: are you absolutely sure about the absence of MLH1 germline mutation? About a new case.
Lynch syndrome accounts for 3-5% of colorectal cancers and is due to a germline mutation in one of the mismatch repair genes MLH1, MSH2, MSH6, and PMS2. Somatic hypermethylation of the MLH1 promoter is commonly associated to sporadic cases. Strategies have been developed to identify patients with Lynch Syndrome based on clinical findings, tumoral phenotype, family history and immunohistochemistry analysis. However, there still are some pitfalls in this strategy, possibly responsible for an underdiagnosis of Lynch syndrome. Here we report the case of a 37 years-old man presenting with two concomitant tumors located in the rectosigmoid and in the ileocecal angle. Both tumors were microsatellites instability-high (MSI-H) and showed a loss of MLH1 and PMS2 protein expression, but only one had MLH1 promoter hypermethylation. Constitutional analysis of mismatch repair genes could not be performed from a blood sample, because of the early death of the patient. However, tumoral tissue analyses revealed in both tumors a pathogenic variant in the MLH1 gene. Further analysis of the surrounding tumor-free tissue also showed the presence of this alteration of the MHL1 gene. Finally, the same pathogenic variant was present constitutionally in one of the siblings of the patient, confirming its hereditary nature. This new case of concomitant presence of MLH1 promoter hypermethylation and MLH1 germline mutation demonstrates that the presence of MLH1 promoter hypermethylation should not rule out the diagnosis of Lynch Syndrome.


Isolation and Purification of Fungal Luciferase from Neonothopanus nimbi.
This is the first study to obtain a high-purity luciferase from the fungus Neonothopanus nambi biomass that is suitable for subsequent sequencing.


A developmentally keyed scheme for the placement of gay men into psychotherapy groups.
Patients can meet their needs for intimacy and individuation within the context of long-term psychotherapy groups. This is especially true for gay male patients as they work toward the development of a positive gay identity. Coming out is a social phenomenon, which is why groups are especially suited to the tasks involved. Historically, mixed groups of gay and nongay men and women have not been a safe or neutral treatment atmosphere for gay men due to therapists' prejudicial assumptions and a lack of understanding of gay male development. A developmental scheme will be presented which is keyed to the particular needs of gay men depending on their developmental stage of functioning. This scheme should serve as a more rational and appropriate guide for the diagnosis, treatment planning, and assigning of gay men to long-term psychotherapy groups.


Elongated oligomers assemble into mammalian PrP amyloid fibrils.
In prion diseases, the mammalian prion protein PrP is converted from a monomeric, mainly alpha-helical state into beta-rich amyloid fibrils. To examine the structure of the misfolded state, amyloid fibrils were grown from a beta form of recombinant mouse PrP (residues 91-231). The beta-PrP precursors assembled slowly into amyloid fibrils with an overall helical twist. The fibrils exhibit immunological reactivity similar to that of ex vivo PrP Sc. Using electron microscopy and image processing, we obtained three-dimensional density maps of two forms of PrP fibrils with slightly different twists. They reveal two intertwined protofilaments with a subunit repeat of approximately 60 A. The repeating unit along each protofilament can be accounted for by elongated oligomers of PrP, suggesting a hierarchical assembly mechanism for the fibrils. The structure reveals flexible crossbridges between the two protofilaments, and subunit contacts along the protofilaments that are likely to reflect specific features of the PrP sequence, in addition to the generic, cross-beta amyloid fold.


Multishell microspheres with integrated chromatographic and detection layers for use in array sensors.
The development of miniaturized chromatographic systems localized within individual polymer microspheres and their incorporation into a bead-based cross-reactive sensor array platform is reported. The integrated chromatographic and detection concept is based on the creation of distinct functional layers within the microspheres. In this first example of the new methodology, complexing ligands have been selectively immobilized to create "separation" layers harboring an affinity for various metal cations. Additionally, a broadly responsive compleximetric dye is used to yield the "detection" layers that exhibit optical responses in the presence of a wide range of metal cations. Information concerning the identities and concentrations of solution-dissolved metal cations can be drawn from the temporal properties of the beads' optical responses. Varying the nature of the ligand in the separation shell yields a collection of cross-reactive sensing elements well-suited for use in array-based micrototal analysis systems. Accordingly, such beads have been incorporated into the "Electronic Taste Chip" platform and used for discriminating among aqueous metal cation solutions.


Deliberations and evaluations of the approaches, endpoints and paradigms for dietary recommendations about copper.
Important aspects of copper nutrition were collected from all 10 editions of the Recommended Dietary Allowance along with the history of the paradigm concept according to Thomas Kuhn. Important anomalies in copper nutrition, such as the easy accessibility to diets containing considerably less copper than the estimated safe and adequate daily dietary intake are reviewed. Important experiments with animals are compared with copper depletion experiments with humans. Data support the belief that people respond to diets low in copper similarly to animals and that measurement of copper in blood plasma generally is useless in assessing nutritional status. If common diets low in copper are consumed regularly during pregnancy, maternal stores of copper will be depleted. Although there is some evidence of lower copper in heart and major blood vessels in elderly people, it is premature to suggest different intakes for adults of different ages. Although consideration of cardiovascular data in establishing an RDA for copper may seem to be a new paradigm, considerations of general health and well being have long contributed to establishing RDAs. Dietary copper can be increased by adhering to the advice symbolized by the food pyramid.


Community clinicians' views about patient adherence to osteoporosis medication.
Anecdotal and research evidence suggests that poor adherence and persistence with oral bisphosphonates can result in patients being at increased risk of osteoporotic fractures. Several interventions have been researched for their effectiveness with adherence and persistence, but the most effective method of supporting patients with oral bisphosphonate medications is clinician reviews, generally identified as doctors and nurses. This service evaluation aimed to explore the knowledge and views of multidisciplinary community-based clinicians about adherence and persistence with oral bisphosphonates. The results indicated a positive attitude to a multidisciplinary approach supporting patients to take their medication as prescribed, with recommendations for future research.


Investigation of the properties of organically modified ordered mesoporous silica films.
Organically modified, ordered mesoporous silica films, which can provide hydrophobicity and low polarizability to the framework, were prepared using Brij-76 block copolymer as a template. Due to a fast condensation reaction of the silica precursor, mesostructured silica films were not properly synthesized. To circumvent this problem, a synthesis procedure was modified to provide an enhancement of pore periodicity through the incorporation of methyl ligands on the framework. The micropore volume was reduced, and the pore size was enlarged, as the concentration of the methyl ligands on the framework was increased. A mesophase transition from a two-dimensional hexagonal structure to a body-centered cubic (BCC) structure was observed according to the concentration of incorporated methyl ligands. The mechanical properties of the fabricated films were investigated according to the pore ordering and film density. The mechanical properties of the films with random pore geometry show a positive correlation between film density and elastic modulus. Meanwhile, the mechanical behavior of organically modified mesoporous silica films with periodic pore distribution represents a negative correlation within a certain density range, which is advantageous to the low-k materials. Especially, film with a low micropore volume fraction and BCC pore ordering is more applicable to a low-k material due to low dielectric constant and high mechanical strength.


Degrees of saturation with respect to apatites in fruit juices and acidic drinks.
Some fruit juices and carbonated acidic drinks, recognized as agents causing dental erosions, were analyzed for calcium, phosphate, fluoride and pH. Ionic activity/concentration products for hydroxyapatite and fluorapatite were calculated. It was found that all liquids analyzed were unsaturated with respect to both apatites, which explains their erosive effect.


[Role of heparin in neoplastic angiogenesis].
Angiogenesis, the growth of new capillary blood vessels, is a multistep process required for tumor growth and metastasis. The significant correlation between density of microvessels and occurrence of metastasis was shown in cutaneous melanoma, cancers of breast, lung (non-small-cell), and bladder. It has been shown that heparin play a crucial role in angiogenesis. In this review the mechanism of this regulation was summarized, and it was compared to action of specific antagonists of heparin in angiogenesis. It is known that heparin can promote this process, but some fractions may not. Knowing the complex action of heparin in the angiogenesis, the exact role of heparin in tumor growth and metastasis is unknown. Therefore, we suggest that it is needed to confirm if an use of heparin for treating patients with cancer can prolong their survival.


[Quantitative evaluation of the focus range of juvenile onset recurrent respiratory papillomatosis].
To investigate the clinical application of quantitative evaluation of the focus range of juvenile onset recurrent respiratory papillomatosis (JO-RRP). Disease severity was scored as the sum of ratings of 1 (minimal), 2 (moderate), or 3 (severe) for involvement of 22 areas of the respiratory tract and digestive tract. Sixty-eight cases with JO-RRP patients underwent 238 procedures were removed papillomas. A Storz laryngoscope was used to exposed and suspend the larynx, and an endoscope video system was used to display the pathological changes. The score of these cases range from 2 to 20, most of them range from 7 to 14. Papillomas were found in the larynx in each case, vocal cords and false vocal cords were the most common places involved. Nose, pharynx, hard palate, lung or esophagus involved was seldom found. The score declined as the patients underwent more procedures. It is in accord with the clinical characteristic of JO-RRP. We concluded that our means of JO-RRP focus range quantitative evaluation could evaluate the severity and clinical curative effect objectively. It was a scientific and convenient way, and worth to be generalized.


Why did heterospory evolve?
The primitive land plant life cycle featured the production of spores of unimodal size, a condition called homospory. The evolution of bimodal size distributions with small male spores and large female spores, known as heterospory, was an innovation that occurred repeatedly in the history of land plants. The importance of desiccation-resistant spores for colonization of the land is well known, but the adaptive value of heterospory has never been well established. It was an addition to a sexual life cycle that already involved male and female gametes. Its role as a precursor to the evolution of seeds has received much attention, but this is an evolutionary consequence of heterospory that cannot explain the transition from homospory to heterospory (and the lack of evolutionary reversal from heterospory to homospory). Enforced outcrossing of gametophytes has often been mentioned in connection to heterospory, but we review the shortcomings of this argument as an explanation of the selective advantage of heterospory. Few alternative arguments concerning the selective forces favouring heterospory have been proposed, a paucity of attention that is surprising given the importance of this innovation in land plant evolution. In this review we highlight two ideas that may lead us to a better understanding of why heterospory evolved. First, models of optimal resource allocation - an approach that has been used for decades in evolutionary ecology to help understand parental investment and other life-history patterns - suggest that an evolutionary increase in spore size could reach a threshold at which small spores yielding small, sperm-producing gametophytes would return greater fitness per unit of resource investment than would large spores and bisexual gametophytes. With the advent of such microspores, megaspores would evolve under frequency-dependent selection. This argument can account for the appearance of heterospory in the Devonian, when increasingly tall and complex vegetative communities presented competitive conditions that made large spore size advantageous. Second, heterospory is analogous in many ways to anisogamy. Indeed, heterospory is a kind of re-invention of anisogamy within the context of a sporophyte-dominant land plant life cycle. The evolution of anisogamy has been the subject of important theoretical and empirical investigation. Recent work in this area suggests that mate-encounter dynamics set up selective forces that can drive the evolution of anisogamy. We suggest that similar dispersal and mating dynamics could have underlain spore size differentiation. The two approaches offer predictions that are consistent with currently available data but could be tested far more thoroughly. We hope to re-establish attention on this neglected aspect of plant evolutionary biology and suggest some paths for empirical investigation.


[Pneumatic intracorporeal lithotripsy of salivary calculi. In vitro and animal experiment studies].
The effort to use minimally invasive strategies in the treatment of human sialolithiasis in principle seems to allow the clinical application of pneumatic lithotripsy because of the small diameters of the probes involved. While this kind of therapy is already used successfully in urology, we investigated the method during in vitro and animal experiments. The treatment of stones and tissue utilized the pneumatic lithotripter "Lithoclast". This system works with ballistic energy and is similar to a biologic "pneumatic hammer". Thirty salivary calculi were treated with pneumatic lithotripsy. Four submandibular salivary glands and their ducts were removed intraoperatively and were exposed to the pneumatic probes. Moreover, in two cases a salivary concretion was also implanted prior to pneumatic lithotripsy. In two rabbits the ducts of the parotid glands were ligated for 2 weeks. On the basis of the in vitro experiments, concretions were placed in two of the four salivary ducts. Following this, the pneumatic probes were inserted along the ducts and lithotripsy was completed. All of the 30 salivary calculi were reduced to sizes smaller than 1.5 mm in diameter. No macroscopic or microscopic damage was detectable while the probe was in a duct. However, in both cases with implanted calculi retropulsion of fragments occurred consequent perforation of the ducts. After application of ballistic pulses along the duct, small periductal hematoma without any perforation were detected macroscopically. Microscopically, only small bleeding was observed along the submucosa and partial loss of epithelium was found. In contrast, the pulse application to the implanted concretions lead to destruction of the calculi with perforation of the ducts as well as hemorrhage in the surrounding tissue. The method of pneumatic lithotripsy used in the present study resulted in sufficient destruction of salivary calculi. In vitro and in vivo lithotripsy of duct implanted calculi led to perforation of the salivary duct in all cases. Because of these results, the clinical use of this technique to treat human sialolithiasis appears to be not justified.


Cystic fibrosis. A dilemma in the metabolic pathogenesis of genetic disease.
The fundamental pathological observations in cystic fibrosis (CF) were made over three decades ago. More recently, physiological findings have directed investigation toward a plethora of humoral substances and their possible role in disturbances of the secretory processes in CF. The application of the techniques of molecular biology and of tissue culture is beginning to increase our knowledge about the so-called CF factors and their diverse effects on epithelial and ciliated surfaces. Emphasis in current research is on the chemical characterization of the CF factors, the metabolism of cells cultured from patients with CF, and the biochemical events controlling the processes of secretion. Some current theories as to the metabolic pathogenesis of CF are considered in the context of existing findings.


ProICET: a cost-sensitive system for prostate cancer data.
Cancer is the second most threatening disease in the world today, not only because of its mortality rate, but also due to the brutal changes it imposes on the patient's life, and the fact that its exact causes of progression remain to be discovered. Recent evolution in computer technology has resulted in the emergence of a combined approach to the diagnosis and prognosis process, with a data driven analytical approach complementing biomedical and clinical methods. Cost-sensitive learning is one such data mining method, particularly well suited for medical problems. This paper investigates the performance of a new system based on a hybrid cost-sensitive algorithm (ProICET) on a prostate cancer medical dataset, while trying to produce new medical knowledge. The target of such a system is to reduce the total cost while keeping a high classification accuracy.


Electrophysiological correlates of verbal and tonal working memory.
The present study's basic research question concerns differences in the processing of verbal and tonal stimuli in working memory. Participants had to rehearse sequences containing tonal and verbal information and to decide whether a subsequently presented probe stimulus belonged to the previously presented sequence. Electrophysiological measures were taken and analysed with regard to local (event-related potentials, ERP) and global (microstates) aspects. A larger N400 amplitude occurred for new compared to old items in the verbal, but not the tonal condition. The microstate analysis revealed differences in the specificity of several microstates for old compared to new items in the tonal and the verbal working memory condition. Corroborating previous results, the present study reveals differences in the efficiency of working memory processes for tonal compared to verbal stimuli with processes being more capable for the verbal compared to the tonal condition.


Effects of mucosal metallothionein in small intestine on tissue distribution of cadmium after oral administration of cadmium compounds.
The effect of mucosal metallothionein (MT) preinduced by zinc (Zn) on tissue distribution of cadmium (Cd) after administration of Cd with several chelating agents was studied in rats. After Cd-cysteine (Cd-Cys) was incubated with intestinal Zn-MT in vitro, all the Cd dissociated from Cys and exchanged the Zn bound to MT. However, dissociation of Cd bound to EDTA (Cd-EDTA) was not observed in the incubation mixture containing intestinal Zn-MT. The concentration of Cd in intestinal mucosa reached a maximum 16 hr after oral administration of Cd-Cys. The Cd level in the intestine was higher than that in the liver and kidney and was similar to that occurring after oral administration of CdCl2. The amount of Cd distributed to the liver and kidney after Cd-EDTA administration was about 30% of the level after CdCl2 administration. Even at 15 mg Cd/kg Cd-EDTA, the Cd level in the intestinal mucosa reached a plateau after 2-4 hr, as it did in the liver and kidney. When Cd-Cys was administered po to control or to Zn-pretreated rats, it was found that Zn pretreatment increased the concentration of Cd in the kidney, as was the case after oral administration of CdCl2. This effect of Zn pretreatment was not observed after oral administration of Cd-EDTA. When Cd-MT was injected into the duodenum, the intestinal absorption of Cd was 60% of that after CdCl2 administration. After the duodenal administration of Cd-MT, at all doses, the concentration of Cd in the kidney was higher than that in the liver. These results suggest that mucosal MT in the small intestine might trap Cd absorbed from the intestinal lumen and transport it to the kidney.