Modulation instability induced by intermodal cross-phase modulation in step-index multimode fiber.
Based on linear stability analysis, we theoretically investigate the onset condition and gain spectrum of intermodal cross-phase modulation-induced noise-seeded modulation instability taking place in the normal dispersion regime of step-index multimode fiber, specially designed to support four modes (LP01, LP11, LP21, LP02) at 1064 nm. For the case of total power being distributed equally in certain bimodal combinations, the peak sideband frequency scales as the square root of total power, and peak gain increases linearly with total power. For the case of total power being distributed unequally, there exists an optimal power ratio to obtain peak gain, which does not depend on total power significantly. When the mode group velocity mismatch is considered, the range and peak values of gain spectra are notably increased.


Evaluate of the effect of low tube voltage on the radiation dosage using 640-slice coronary CT angiography.
640-slice coronary CT angiography is becoming an accurate and reliable method of diagnosing coronary heart disease. However, how to reduce the radiation dosage while ensuring the clinically acceptable image quality remains a quite challenging issue. To evaluate the effect of low tube voltage on radiation dosage under 640-slice coronary CT angiography (CCTA). Four hundred patients (236 males, 164 females) with coronary heart disease and underwent CCTA using DCVT were classified into A1 (tube voltage: 120 kV; exposure phase window: 30-80%), B1 (120 kV; 70-80%), A2 (100 kV; 30-80%) and B2 group (100 kV; 70-80%), respectively. Image qualities and effective dose (ED) were assessed and compared. No significant differences were observed among the groups in terms of age, height, weight and body mass index (BMI) (P > 0.05). ED were significantly lower in 100 kV group (P < 0.05). CT values of coronary artery in 100 kV groups were 13.5% and 17.3% higher than 120 kV group. ED in B1 group were 64.5% and 67.0% lower than A1 group. ED in B2 group were 65.4% and 65.2% lower than A2 group. When using a 640-slice CCTA prospective ECG-gating scanning mode, it is preferable to use a 100 kV tube voltage setting because compared to 120 kV tube voltage protocol, it seems to significantly decrease the mean effective radiation dose, without significantly lowering both the subjective and objective image quality.


Clinical evaluation of allogeneic cultured dermal substitutes for intractable skin ulcers after tumor resection.
Clinical research on allogeneic cultured dermal substitute (CDS), which was newly developed at the R&D Center for Artificial Skin of Kitasato University, has been carried out in medical centers across Japan with the support of the Millennium Project of the Ministry of Health, Labor and Welfare of Japan. Allogeneic CDS was prepared by cultivation of fibroblasts on a two-layered spongy matrix of hyaluronic acid and atelo-collagen. This paper reports the clinical results of application of allogeneic CDS in 12 patients with full-thickness skin defects after surgical resection of skin tumors. In 9 of 10 patients, healthy granulation tissue developed immediately, allowing us to perform split-thickness skin grafts at an early stage. In two cases, allogeneic CDS was used to cover an expanded mesh skin graft that had been applied to treat a large ulcer, and rapid epithelization was observed. No patient developed local infection nor local tumor recurrence after treatment with CDS. The spongy matrix itself as well as the vascular endothelial growth factor (VEGF) released by the allogeneic CDS seemed to be beneficial for the treatment of intractable skin ulcers. Allogeneic CDS functions as an excellent biological dressing, and could dramatically change the treatment of intractable skin ulcers.


Are collision athletes at a higher risk of re-dislocation after an open Bristow-Latarjet procedure? A systematic review and meta-analysis.
The primary aim of the present study was to review, summarize and compare the redislocation risk for collision athletes and noncollision athletes after an open Bristow-Latarjet procedure. Our secondary aim was to summarize return to sport, satisfaction, pain and complications. We conducted a systematic review in PubMed and EMBASE of articles until 1 July 2016. We included all studies describing Bristow-Latarjet like procedures as a result of glenohumeral instability, mentioning redislocation rates in collision athletes with >2 years of follow-up. We pooled the data using random-effects meta-analysis for redislocation risk-differences (RD) between collision and noncollision athletes, and assessed heterogeneity with I2 and Tau2 tests. From 475 titles and abstracts, 11 studies were included and eight studies were meta-analyzed. The pooled RD to develop a postoperative redislocation between collision athletes and noncollision athletes was -0.00 (95% confidence interval: -0.03 to 0.03, p = 0.370). Return to sports rates were high (67-100%), and patients reported high satisfaction scores (93-100% satisfied) and low pain scores (mean visual analogue scale score of 1.6); however, postoperative complication rates varied from 0.8% to 19.2%. Collision athletes are not more at risk for redislocation rates after an open Bristow-Latarjet procedure compared to noncollision athletes. Overall postoperative outcomes were good, although numerous complications occurred.


Preparation and evaluation of C18-bonded 1-microm silica particles for pressurized capillary electrochromatography.
Nonporous silica spheres (1 microm) were synthesized and bonded with octadecylsilane functionality. These stationary phase particles were packed electrokinetically into fused-silica capillaries with 100 microm id for a length of 20 cm, which was evaluated by using pressurized CEC (pCEC). The efficiency of the C18 RP column was characterized through the theoretical plates of thiourea, benzyl alcohol, toluene, styrene, and naphthalene. The effects of experimental parameters such as the applied voltage, sample size, pump flow rate, pH value and the concentration of the buffer solution, and the content of methanol in the mobile phase, on-column efficiency were evaluated. Column efficiency as high as 200 000 theoretical plates per meter for naphthalene was obtained with the optimal condition of 70% v/v methanol and 30% v/v of 10 mmol/L phosphate buffer (pH 7.8) at an applied voltage of 10 kV and a supplementary pressure of 500 psi.


Insulin and fiber type in the offspring of T2DM subjects with resistance training and detraining.
Effects of resistance training and detraining on glucose and insulin responses to an oral glucose load, muscle fiber type, and muscular performance in the offspring of those with type 2 diabetes (familial insulin resistant (FIR)) were investigated. Six FIR participants and 10 controls (C) completed 9 wk of resistance training and 9 wk of detraining. Measures of strength and power, an oral glucose tolerance test, and a muscle biopsy to determine myosin heavy chain (MHC) fiber composition were taken at baseline (T1), after training (T2), and after detraining (T3). Three-repetition maximum increased (P ≤ 0.001) similarly in both groups in all strength measures, e.g., leg press (FIR T1, T2: 121 ± 34 kg, 186 ± 50 kg; C T1, T2: 137 ± 42 kg, 206 ± 64 kg, respectively (means ± SD)). Wingate peak power increased (FIR T1, T2: 505 ± 137 W, 523 ± 143 W; C T1, T2: 636 ± 211 W, 672 ± 223 W, respectively; P ≤ 0.005 (means ± SD)). Training reduced insulin area under the curve more (P = 0.050) in FIR (T1, T2: 1219 ± 734 pmol·L, 837 ± 284 pmol·L, respectively (means ± SD)) than that in C (T1, T2: 647 ± 268 pmol·L, 635 ± 258 pmol·L, respectively (means ± SD)). MHC distribution did not change with training. Strength (three-repetition maximum measures) decreased with detraining (P ≤ 0.001) although Wingate power did not. Detraining increased insulin area under the curve (P = 0.018) in FIR (T2, T3: 837 ± 285 pmol·L, 1040 ± 194 pmol·L, respectively (means ± SD)) but not in C (T2, T3: 635 ± 258 pmol·L, 625 ± 213 pmol·L, respectively (means ± SD)). MHC IIX fibers increased with detraining (P = 0.026). FIR appears to have exaggerated responses to resistance training and detraining, with a greater reduction in insulin release with glucose ingestion after training and increase when training ceases. Resistance training has a significant effect on insulin responses and may reduce future risk of type 2 diabetes mellitus among FIR.


Studies related to antibody fragment (Fab) production in Escherichia coli W3110 fed-batch fermentation processes using multiparameter flow cytometry.
Microbiology is important to industry therefore rapid and statistically representative measurements of cell physiological state, proliferation, and viability are essential if informed decisions about fermentation bioprocess optimization or control are to be made, because process performance will depend largely on the number of metabolically active viable cells. Samples of recombinant Escherichia coli W3110, containing the gene for the D1.3 anti-lysozyme Fab fragment under the control of the lac-based expression system, were taken at various stages from fed-batch fermentation processes and stained with a mixture of bis-(1,3-dibutylbarbituric acid) trimethine oxonol and propidium iodide (PI/BOX). Where appropriate, measurements of dissolved oxygen tension (DOT), OD600nm and Fab concentration were made. Depending on time of induction the maximum amount of Fab accumulating in the supernatant varied quite markedly from 1 to 4 microg ml(-1) as did subsequent cell physiological state with respect to PI/BOX staining with a concomitant drop in maximum biomass concentration. Depending on point of induction a fourfold increase in Fab production could be achieved accompanied by a approximately 50% drop in maximum biomass concentration but with a higher proportion of viable cells as measured by multiparameter flow cytometry.


Surgical indications for gastrectomy combined with distal or partial pancreatectomy in patients with gastric cancer.
The purpose of this study was to clarify the surgical indications for gastrectomy combined with distal or partial pancreatectomy (GP) in patients with gastric cancer. From January 1994 to December 2009, 29 patients with primary gastric cancer surgically invading the pancreas without distant organ metastasis underwent GP for R0 resection. The patients' characteristics, surgical data, and clinicopathological features were used for the analysis of survival and prognostic factors. The median disease-free survival and median survival time (MST) of all patients were 15 and 30 months, respectively. Only pN3 status (characterized by 7 or more pathologically metastatic lymph nodes) according to the Japanese Classification of Gastric Carcinoma, 14th edition, was shown to be a prognostic factor in a multivariate analysis. The MST of the patients with pN3 and the other patients were 12 and 51 months, respectively (p < 0.001). We suggest that pancreas invasion should not be considered a contraindication for gastrectomy and that patients with a small number of lymph node metastases (six or fewer) might be candidates for GP in the case of gastric cancer that requires pancreatectomy for R0 resection.


Overview of gynaecological and colorectal reconstruction.
Plastic surgeons are often required to reconstruct defects following radical pelvic surgery for advanced or recurrent anorectal and gynaecological malignancies. This article describes the most commonly used flaps for reconstruction following radical pelvic surgery and provides a treatment algorithm to facilitate decision making.


CNS monoamines and their metabolites in canine narcolepsy: a replication study.
In two separate studies a significantly greater concentration of DA (dopamine) and its metabolite, DOPAC (3,4-dihydroxyphenylacetic acid), was observed in the amygdala of narcoleptic canines. DOPAC was also significantly elevated in the reticularis parvicellularis, whereas NE (norepinephrine) was significantly elevated in the reticularis oralis, but depressed in the preoptic hypothalamus. No changes were observed in concentrations of serotonin or its metabolite, 5-HIAA (5-hydroxyindoleauric acid) in any region in the narcoleptic canine brain. Results of the two studies were similar, except that previously observed differences between narcoleptic and control canines in DOPAC levels in the caudate and reticularis oralis failed to replicate. Thus, steady state measures of neurotransmitter/metabolite tissue concentrations suggest region-specific alterations in DA and NE metabolism, rather than a global deficit in catecholamine neurotransmission in canine narcolepsy.


Heart retransplantation: a 23-year single-center clinical experience.
The main causes of allograft failure after cardiac transplantation are primary graft dysfunction, intractable acute rejection, and coronary graft disease. Despite the important progress in the last several years in graft preservation, surgical techniques, immunosuppression, and treatment of coronary graft disease, retransplantation in selected cases is the only way to achieve long-term recipient survival. We compare here in a case-control study 24 retransplantations with 47 first transplants in patients matched for date of transplantation. Between 1973 and 1996, 1,063 patients underwent cardiac transplantation in our institution. In this cohort, 22 patients had a total of 24 retransplantations (2 second-time retransplantations). The causes of retransplantations were primary graft failure (n=4), acute rejection (n=7), coronary graft disease (n=11), and miscellaneous (n=2). Survival at 1 and 5 years of patients with retransplantations is 45.5% and 31.2%, and survival of control patients is 59.4% and 38.8% (p=0.07). An interval between first transplantation and retransplantation shorter (n=11) or longer (n=13) than 1 year is associated with a 1-year survival of 27.3% and 61.5% and a 4-year survival of 27.3% and 46%, respectively (not significant). Intervals shorter than 1 year between first transplantation and retransplantation were exclusively secondary to primary graft failure or intractable acute rejection. In the face of lack of donor grafts, these and other data indicate that retransplantation should be considered cautiously, especially when the interval between the first transplantation and retransplantation is short.


Reduction of myocardial myoglobin in bovine dilated cardiomyopathy.
Myoglobin levels are decreased in various animal models of heart failure, a change that has been associated with compromised energy supply. The underlying mechanisms by which myoglobin content decreases in failing myocardium are unknown. Bovine hereditary cardiomyopathy (bCMP) displays several characteristics of human dilated cardiomyopathy with a marked desensitization of the beta-adrenoceptor signal cascade. The aim of the present study was to investigate whether a similar reduction of myoglobin can be seen in this animal model, and to elucidate the possible mechanism of this reduction. Myoglobin protein concentration was decreased by 46-47% (P < 0.05) in left and right ventricular myocardium of failing hearts (n = 9) compared to control hearts (n = 11). No difference was found between atria of diseased and control animals. Immunohistochemistry with a polyclonal antibody against myoglobin revealed a strong and uniform labeling in cardiomyocytes of non-failing hearts. Using microscopic densitometry, immunosignals were significantly decreased in ventricular myocytes of bCMP hearts (168 +/- 5.3 v 118 +/- 8.6 arbitrary units, P < 0.05). Moreover, myoglobin was heterogeneously distributed in bCMP hearts, with single myocytes showing no staining. Slot blot analysis of total RNA demonstrated a 40-50% reduction (P < 0.05) of myoglobin mRNA levels in ventricular but not in atrial myocardium of bCMP hearts. The results support the view that a decrease of myocardial myoglobin is a general phenomenon in end-stage heart failure. It appears to be primarily due to reduced gene expression but may be aggravated by leaking from single myocytes. The decrease of myoglobin may contribute to the imbalance between energy production and energy expenditure in heart failure.


Beta 2-adrenergic receptor polymorphisms and haplotypes are associated with airways hyperresponsiveness among nonsmoking men.
To investigate the relationship of common single nucleotide polymorphisms (SNPs) of the beta(2)-adrenergic receptor (AR) gene at codons 16 and 27, and the intermediate phenotype of airways hyperresponsiveness. A case-control study in 543 white men (152 case patients and 391 control subjects), who were nested in an ongoing longitudinal cohort. Subjects were selected from the Normative Aging Study, an ongoing longitudinal cohort of healthy aging. Case patients were defined as those having a positive response to methacholine challenge testing. Control subjects were selected among those who did not have a diagnosis of asthma and who had no response to methacholine. There was a trend for an association of the Arg16 SNP genotype with airways hyperresponsiveness (odds ratio, 1.25; 95% confidence interval, 0.96 to 1.64 [in an additive model]). In stratified analyses, the effect of the Arg16 variant was seen mainly among nonsmokers. Smokers had increased risks for airway hyperresponsiveness regardless of genotype at either SNP. Using a program to estimate haplotype frequencies, three common haplotypes were identified. Adjusting for age, baseline FEV(1), serum IgE level, and smoking status, the Gly16/Gln27 haplotype was negatively associated with airways hyperresponsiveness in the full complement of case patients and control subjects (score statistic, - 2.43; p = 0.02). The effect of the beta(2)-AR haplotypes was much stronger among lifelong nonsmokers, among whom the Gly16/Gln27 haplotype remained negatively associated with airways hyperresponsiveness (score statistic, - 3.114; p = 0.002), whereas the Arg16/Gln27 haplotype was positively associated with airways hyperresponsiveness (score statistic, 3.142; p = 0.002). No effects were seen among ever-smokers. In this cohort of middle-aged to older white men, beta(2)-AR polymorphisms were associated with airways hyperresponsiveness, particularly among lifelong nonsmokers. Our results illustrate an instance in which greater power is obtained by performing haplotype analyses as opposed to single SNP analysis.


Family functioning, psychosocial stress, and goal attainment in brain injury rehabilitation.
The study investigated the impact of family functioning (as measured by the Family Assessment Device) on goal attainment (as measured by a Goal Attainment Scale) and psychosocial distress (as measured by the Brief Symptom Inventory-18) among survivors of acquired brain injury in a community re-entry rehabilitation setting. The bivariate analysis suggests that participants had significantly greater goal attainment scores if they were members of families with stronger general functioning (r = .27, p < .05), stronger defined family roles (r = .28, p < .05), a greater capacity to respond emotionally to each other (r = .29, p < .05), and proactively solved family problems (r = .28, p < .05).


Reading outcomes of children and adolescents with attention-deficit/hyperactivity disorder and dyslexia following atomoxetine treatment.
Abstract Objective: This study assessed the efficacy of atomoxetine on attention-deficit/hyperactivity disorder (ADHD) symptoms in children and adolescents having ADHD with comorbid dyslexia (ADHD+D) and the effects of the treatment on reading measures. The analyses in this report used data from a study designed to examine the effects of a nonstimulant pharmacological agent, atomoxetine, on reading in children with ADHD+D. Patients ages 10-16 years with ADHD or ADHD+D received open-label atomoxetine for 16 weeks. The ADHD Rating Scale (ADHD-RS) and reading subtests of the Kaufman Test of Educational Achievement (K-TEA) were assessed. Changes in ADHD symptoms and reading scores were also analyzed by ADHD subtype. Treatment effect sizes and correlations between changes in ADHDRS and K-TEA scores were calculated. After atomoxetine treatment, both ADHD and ADHD+D patient groups showed significant reduction in ADHD symptom and improvements in K-TEA reading scores. The range of treatment effect sizes on K-TEA scores was 0.35-0.53 for the ADHD group and 0.50-0.62 for the ADHD+D group. Pearson's correlation coefficients revealed only a few weak correlations between changes in ADHD symptoms and reading scores, regardless of diagnostic group. ADHD symptoms and K-TEA reading scores improved for both the ADHD and ADHD+D groups following atomoxetine treatment. Correlation analyses indicate that improvements in reading outcomes cannot be explained by a reduction of ADHD symptoms alone. These findings support further exploration of the potential effects of atomoxetine on reading in children with ADHD and dyslexia or dyslexia alone.


Social relationship quality buffers negative affective correlates of everyday solitude in an adult lifespan and an older adult sample.
Aging takes place in a social context but older adults also spend a significant amount of their time alone. Solitude (the objective state of being alone and without social interaction) has been associated with negative experiences but also with specific benefits. We examine the importance of social relationships for time-varying associations between affective experiences and solitude. Using repeated daily life assessments from an adult life span sample (Study 1, N = 183, age: 20-81 years) and an older adult sample (Study 2, N = 97, age: 50-85 years), we examined the moderating role of social relationship quality on within-person solitude-affect associations. Data were analyzed using multilevel models controlling for gender, age, overall amount of time in solitude, retirement status, marital status, education, and current work activity. Higher relationship quality was associated with higher average affective well-being. Compared to being with others, participants reported lower levels of high-arousal positive affect (PA) during solitude in both studies. In Study 1, solitude was also associated with higher levels of low-arousal negative affect (NA) and higher levels of low-arousal PA compared to when with others. Across both studies, individuals with higher quality relationships reported lesser increases in low-arousal NA when in solitude, as compared to individuals with lower quality relationships. Findings highlight that solitude is experienced less negatively for individuals embedded in a context of higher quality social relationships. Thus, preservation and promotion of social resources in older adulthood may be important to ward off potential negative ramifications of spending a significant amount of time alone. (PsycINFO Database Record


Secondhand Smoke Exposure and Preclinical Markers of Cardiovascular Risk in Toddlers.
To investigate relationships between secondhand smoke exposure in young children and several preclinical markers of cardiovascular risk that have been established as relevant to adult populations. There were 139 children, 2-5 years of age, enrolled in a cross-sectional study. Secondhand smoke exposure was objectively determined by hair nicotine level; a comprehensive panel of clinical markers (morning blood pressure, fasting glucose and insulin, lipid profiles, inflammation) and research markers (markers of oxidation, endothelial stress, and endothelial repair) of cardiovascular risk status were assessed. Univariate and multivariate linear regression were used to evaluate relationships between secondhand smoke exposure and cardiovascular risk markers. Hair nicotine levels were correlated directly with blood pressure and serum C-reactive protein, and inversely correlated with serum high-density lipoprotein cholesterol and endothelial cell progenitor cell prevalence. In multivariate analyses, these relationships remained when controlled for age, sex, body mass index z-score, maternal education, and method of payment. Additionally, in multivariate analyses, hair nicotine level was significantly negatively correlated with total antioxidant capacity. These results support the view that secondhand smoke exposure in the very young has a detectable relationship with several markers of cardiovascular risk, long before the emergence of clinical disease. Further studies to define mechanisms and strategies to prevent and mitigate these risks early in life are warranted.


Efficacy and Safety of Low-Dose Protamine in Reducing Bleeding Complications during TAVI: A Propensity-Matched Comparison.
We aimed to evaluate the efficacy and safety of low-dose protamine in reducing access site-related complications during Transcatheter Aortic Valve Implantation (TAVI) as compared to full-dose protamine. Access site-related complications represent an independent predictor of poor outcomes of TAVI. Data regarding heparin reversal with protamine and the dosage needed to prevent bleeding complications are scarce among patients undergoing TAVI. A total of 897 patients were retrospectively included in the study. Patients who underwent percutaneous coronary intervention within 4 weeks before or concomitantly with TAVI (n = 191) were given 0.5 mg protamine for each 100 units of unfractionated heparin. All other patients (n = 706) were considered as a control group and 1 mg protamine for each 100 units of heparin was administered. The combined intra-hospital endpoint of death, life-threatening major bleeding, and major vascular complications were significantly more frequent in patients receiving low-dose protamine [29 (15.2%) vs. 50 (7.1%), p < 0.001]. After propensity matching (n = 130 for each group) for relevant clinical characteristics including anti-platelet therapy [19 (14.6%) vs. 6 (4.6%), p = 0.006], low-dose protamine predicted the combined endpoint (OR 3.54, 95%-CI 1.36-9.17, p = 0.009), and even in multivariable analysis, low-dose protamine continued to be a predictor of the combined endpoint in the matched model (OR 3.07, 95%-CI 1.17-8.08, p = 0.023) alongside baseline hemoglobin. In this propensity-matched retrospective analysis, a low-dose protamine regime is associated with a higher rate of major adverse events compared to a full-dose protamine regime following transfemoral TAVI.


The development of clinical nurse specialists (CNSs) in intellectual disability nursing in Ireland.
Since the commencement of intellectual disability nurse training in 1959, both education and service provision philosophies have changed over time in Ireland. These changes have occurred in response to national and international reports and attitudes. Coinciding with the changes in education and philosophy have been the development and advancement of the intellectual disability nursing profession. Currently undergraduate intellectual disability nurse education is unique to Ireland and the United Kingdom and, similar to the developments across other disciplines of nursing, advance practice has become a focus of development. This article traces the development of intellectual disability clinical nurse specialists (CNSs) in Ireland and identifies possible challenges and implications for future practice.


Signal enhancement of electrochemical biosensors via direct electrochemical oxidation of silver nanoparticle labels coated with zwitterionic polymers.
A new electrochemical label has been developed, which is made up of silver nanoparticles (AgNPs) coated with a mixture of zwitterionic and biotinylated zwitterionic polymers. These polymers improve colloidal stability in physiological medium and ensure biorecognition while direct electrochemical oxidation of silver nanoparticles strongly enhances the detection signal. The resulting hybrid nanomaterials are used as labels in the electrochemical sensing of avidin using sandwich assays elaborated using the biotin-avidin biorecognition system.


Sequential metabolic expressions of the lethal process in human serum-treated Escherichia coli: role of lysozyme.
Several metabolic parameters indicative of Escherichia coli function and integrity were kinetically examined in response to treatment with normal human serum in the presence and absence of functional human lysozyme. Specific inhibition of this enzyme in bacteriolytic and bactericidal reactions was accomplished by using purified rabbit anti-human lysozyme immunoglobulin G. Initiation of the complement-mediated alterations of cytoplasmic membrane integrity, as judged by the leakage of 86Rb from prelabeled cells or the hydrolysis of o-nitrophenyl-beta-D-galactopyranoside by a cryptic strain, was found to be independent of lysozyme action. Furthermore, inhibition of macromolecular synthesis by E. coli in response to serum treatment occurred at the same time regardless of the functional state of lysozyme. Although the rate and extent of bacteriolysis were reduced in the absence of lysozyme, the bactericidal kinetics was unaffected. These results demonstrate that the lethal events associated with the action of antibody and complement on gram-negative bacteria are independent of lysozyme, suggesting an accessory role for this enzyme in immune reactions. A possible temporal sequence of complement-induced effects occurring at the cell surface is presented.


Characterization and evaluation of avermectin solid nanodispersion prepared by microprecipitation and lyophilisation techniques.
Poorly water-soluble and photosensitive pesticide compounds are difficult to formulate as solvent-free nanoformulations with high efficacy. A avermectin solid nanodispersion with a mean particle size of 188 nm was developed by microprecipitation and lyophilisation techniques. The suspensibility and wetting time of the solid nanodispersion in water were 99.8% and 13 s, respectively, superior to those of conventional water dispersible granules and wettable powders. The anti-photolysis performance of the nanoformulation was twice that of the technical material, and the biological activity against diamondback moths was more than 1.5 times that of the conventional solid formulations while taking LC 50 as the evaluation index. Moreover, the formulation composition substantially decreased the surfactant content and avoided organic solvents. Microprecipitation combined with lyophilisation is an easy and promising method to construct solid nanoformulations for pesticides with poor water solubility and environmental sensitivity. The application of the highly effective solid nanodispersion in crop production will have a great potential in reducing chemical residues and environmental pollution.


Intracellular pathways of native iron in the maternal part of the porcine placenta.
In the diffuse epitheliochorial porcine placenta iron is secreted as uteroferrin by the maternal epithelium of the areola-gland subunit of the placenta. To elucidate the intracellular pathways of physiological iron in uterine gland epithelium material from 10 sows at 15 to 111 days of gestation was processed for electron microscopy by different routine methods with or without postfixation in osmium tetroxide. Ferritin particles were identified by their size and shape and the content of iron was confirmed by X-ray energy dispersive microanalysis of accumulated ferritin particles. Distinct ferritin particles were not observed in the extracellular space either basal to or luminal to the epithelial cells. Intracellular ferritin was observed apparently free in the cytoplasm, but in variable amounts. Transfer tubules and dense bodies were located basally in the secretory cells. Both of these organelles contained ferritin particles, showed reaction sites for acid phosphatase and were stained by periodic acid-thiocarbohydrazide-silver proteinate. The ciliated cells differed by having apically located dense bodies containing numerous ferritin particles. Our finding of native ferritin in cells with hormonally regulated iron transport supports the concept that transfer tubules as part of the lysosomal complex are part of the endocytic pathway in secretory cells and indicate that ferritin here is an intracellular transport or storage intermediate.


Habitual physical activity and health-related physical fitness in fourth-grade children.
To examine the relationship between habitual physical activity and components of health-related physical fitness in children. Cross-sectional survey with correlational analysis. Seven public elementary schools in a suburban southern California city. Five hundred twenty-eight healthy fourth-grade children (274 boys and 254 girls), 85% of whom were non-Hispanic whites. Ninety-eight percent of eligible students participated. None. Results of six measures of physical activity in children (monitoring by accelerometer, parent report, and child self-reports of weekday activity, weekend activity, and summer involvement in activity classes and youth sports) were combined in a physical activity index. This index of habitual physical activity was examined in relation to measures of five components of health-related fitness: the mile run, skin-fold tests, pull-ups, sit-ups, and the sit-and-reach test. The physical activity index was significantly associated with all five fitness components. The canonical correlation was .29. Active children appear to engage in a sufficient variety of activities to enhance multiple components of health-related fitness.


The initiation of smooth pursuit eye movements and saccades in normal subjects and in "express-saccade makers".
A vast knowledge exists about saccadic reaction times (RT) and their bi- or multimodal distributions with very fast (express) and regular RT. Recently, there has been some evidence that the smooth pursuit system may show a similar RT behavior. Since moving targets usually evoke a combined pursuit/saccade response, we asked which processes influence the initiation of pursuit and saccadic eye movements. Furthermore, we investigated whether and how the pursuit and saccadic system interact during the initiation of eye movements to moving targets. We measured the RT of the initial smooth pursuit (iSP) response and of the first corrective saccade and compared the RT behavior of both. Furthermore we compared the behavior of the corrective saccades to moving targets to that of saccades to stationary targets, known from the literature. The stimulus consisted of a target that moved suddenly at constant velocity (ramp). In addition, prior to the movement, a temporal gap, a position step or a combination of both could occur (gap-ramp, step-ramp, gap-step-ramp, respectively). Differently from most previous studies, we chose step and ramp with the same direction to provoke competition between the pursuit and saccade system. For the first time we investigated pursuit initiation in "express-saccade makers" (ES makers), a subject group known to produce an abnormally high percentage of short-latency saccades in saccade tasks. We compared their results with subject groups who were either naive or trained with respect to saccade tasks. The iSP started at approximately 100 ms, which corresponds to express saccade latencies. These short iSP-RT occurred reflex-like and almost independent of the experimental task. A bimodal frequency distribution of RT with a second peak of longer iSP-RT occurred exclusively in the ramp paradigm. The RT of the first corrective saccades in a pursuit task were comparable with that in a saccade task and depended on the stimulus. The ability of ES makers to produce a high number of express saccades was transferred to corrective saccades in the pursuit task, but not to pursuit initiation. In summary, short-latency pursuit responses differ from express saccades with respect to their independence of experiment and subject group. Therefore, a simple analogy to express saccades cannot be drawn, although some mechanisms seem to act similarly on both the pursuit and the saccade system (such as disengagement of attention with the gap effect). Furthermore, we found evidence that the initial pursuit response and the first corrective saccade are processed independently of each other. The first corrective saccades to moving targets behave like saccades to stationary targets. Normal pursuit but abnormal saccade RT of ES makers can be explained by recent theories of superior colliculus (SC) function in terms of retinal error handling.


Effects of Cold Temperature and Ethanol Content on VOC Emissions from Light-Duty Gasoline Vehicles.
Emissions of speciated volatile organic compounds (VOCs), including mobile source air toxics (MSATs), were measured in vehicle exhaust from three light-duty spark ignition vehicles operating on summer and winter grade gasoline (E0) and ethanol blended (E10 and E85) fuels. Vehicle testing was conducted using a three-phase LA92 driving cycle in a temperature-controlled chassis dynamometer at two ambient temperatures (-7 and 24 °C). The cold start driving phase and cold ambient temperature increased VOC and MSAT emissions up to several orders of magnitude compared to emissions during other vehicle operation phases and warm ambient temperature testing, respectively. As a result, calculated ozone formation potentials (OFPs) were 7 to 21 times greater for the cold starts during cold temperature tests than comparable warm temperature tests. The use of E85 fuel generally led to substantial reductions in hydrocarbons and increases in oxygenates such as ethanol and acetaldehyde compared to E0 and E10 fuels. However, at the same ambient temperature, the VOC emissions from the E0 and E10 fuels and OFPs from all fuels were not significantly different. Cold temperature effects on cold start MSAT emissions varied by individual MSAT compound, but were consistent over a range of modern spark ignition vehicles.


[The prevalence of diseases among persons drafted to military service].
The article considers dynamics of indices of suitability to military service of individuals drafted to military service in the Novosibirskaia oblast in 1997-2014. The level of suitability without limitations because of health conditions made up to in 37.7% in average. and with fluctuations according years - 31.6-43.6%. The negligible limitations of suitability included 23.4% of examined, restrictedly suitable - 33.9% and provisionally non-suitable - 1.6% of conscripts. The main classes and nosologic groups of diseases limiting suitability were determined. It is established that 86.3% of limitation of suitability resulted from morbidity of conscripts with diseases of musculoskeletal system and connective tissue, endocrine system, disorders of nutrition and metabolism, aftermaths of trauma of head and spinal cord with disorders of central nervous system, flat-footedness and foot deformation, disorders of refraction and accommodation of eyes, mental deficiency, ulcer diseases, diseases of skin, organic psychic disorders, asthma, pathology of liver and pancreas, hypertension disease, diseases of oral cavity and throat rheumatoid affections of heart. This situation predetermines implementation of corresponding curative health promoting measures with purpose of avoiding loss of servicemen during time military service and returning of this contingent because of diseases inconsistent with implementation of military duty.


Cardiovascular risk factors in elderly Koreans in Australia and Korea.
Koreans are a recent but relatively small ethnic minority group in Australia. This descriptive cross-sectional, comparative intercountry study examines the effect of Australian acculturation among elderly Koreans on cardiovascular disease (CVD) risk factors, compared with their counterparts in Korea. Fifty-one (72.4 ± 8.7 years) Australian Koreans (AK) and 48 (75.7 ± 6.9 years) Koreans (K) living in Seoul participated in the study. Diabetes was reported by 10.2% of AK and 17.4% of K and hypertension by 38.8 and 29.8% of AK and K, respectively. Significantly, more AK (85.7%) than K (53.2%) reported undertaking physical activity (P = 0.0005) and fewer AK were current smokers (6% vs 26.1%; P = 0.0077). After controlling for age, body mass index and waist-to-hip ratio no differences were found in lipid profiles between AK and K men or women. The effect of acculturation may be reflected among Australian Koreans by increased physical activity and reduced smoking levels and increased levels of abdominal obesity.


An internet-based method to elicit experts' beliefs for Bayesian priors: a case study in intracranial stent evaluation.
Bayesian methods provide an interesting approach to assessing an implantable medical device (IMD) that has evolved through successive versions because they allow for explicit incorporation of prior knowledge into the analysis. However, the literature is sparse on the feasibility and reliability of elicitation in cases where expert beliefs are used to form priors. To develop an Internet-based method for eliciting experts' beliefs about the success rate of an intracranial stenting procedure and to assess their impact on the estimated benefit of the latest version. The elicitation questionnaire was administered to a group of nineteen experts. Elicited experts' beliefs were used to inform the prior distributions of a Bayesian hierarchical meta-analysis model, allowing for the estimation of the success rate of each version. Experts believed that the success rate of the latest version was slightly higher than that of the previous one (median: 80.8 percent versus 75.9 percent). When using noninformative priors in the model, the latest version was found to have a lower success rate (median: 83.1 percent versus 86.0 percent), while no difference between the two versions was detected with informative priors (median: 85.3 percent versus 85.6 percent). We proposed a practical method to elicit experts' beliefs on the success rates of successive IMD versions and to explicitly combine all available evidence in the evaluation of the latest one. Our results suggest that the experts were overoptimistic about this last version. Nevertheless, the proposed method should be simplified and assessed in larger, representative samples.


Bevacizumab in combination with metronomic chemotherapy in patients with anthracycline- and taxane-refractory breast cancer.
A vascular endothelial growth factor (VEGF) inhibitor might enhance metronomic chemotherapy in previously treated metastatic breast cancer (MBC) patients. Anthracycline and taxane refractory MBC patients were given cyclophosphamide 50 mg p.o. daily, methotrexate 1 mg/kg i.v. every 14 days, and bevacizumab 10 mg/kg i.v. every 14 days. Trastuzumab was added in HER2-overexpressing tumors. 24 patients were enrolled and 22 were evaluable. All tumors had histologic grade II-III and most patients had > or =2 metastatic sites. After a median follow-up of 7.7 months the response rates were: complete response (CR) 0%, partial response (PR) 31.8% (95% CI 13.9- 54.9%), stable disease for >or =24 weeks (SD) 31.8% (95% CI 13.9-54.9%). Clinical benefit (CB= CR + PR + SD>24w) 63.6% (95% CI 40.7-82.8%). Median progression-free survival (PFS) was 7.5 months; overall survival (OS) was 13.6 months. HER2-overexpressing or high proliferative-index tumors had better 6-month PFS (75% vs. 34% in HER-negative tumors, P = 0.043; 67% vs. 0% in Ki-67 > or =20% tumors, P = 0.015). Adverse effects were mild. The combination of bevacizumab and a metronomic-based chemotherapy was effective, well tolerated and provided clinical benefit in heavilytreated MBC patients.


Use of subsidies to low-income people for coverage through small employers.
If tax credits or other public subsidies are made available only for health insurance that is not employment-based, serious erosion of employer coverage could result. To prevent this, public subsidies targeted to low-income workers and families could be applied in ways that broaden employer coverage for low-income workers and their families by encouraging small employers with largely low-wage workforces to offer and partially fund health coverage for their workers. To accomplish this, such employers--very few of which now provide health coverage--must be allowed to contribute much less than normally required in the commercial market.


[Macrophage phagocytic function].
Described a century ago by Metschnikoff , phagocytosis plays an essential role in the defence of organisms faced with bacterial infection. Phagocytosis is ensured essentially by neutrophils and macrophages. In cases of inflammatory response, chemotactic factors induce an afflux of neutrophils which predominate at the site of infection for the first few hours. Then macrophages intervene to try and eliminate the infectious agent. If the latter can be rapidly ingested and degraded, the inflammatory response will gradually dwindle . On the other hand, if the infection persists (bacteria resistant to phagocytosis, or to bactericidal agents), the inflammatory response will become chronic. Macrophage anti-bacterial activity is therefore essential and can be broken down into several stages: first chemotaxis, which initiates macrophage migration towards the inflammatory focus. Then adherence to bacteria, via opsonins and membrane receptors. This binding releases an intra-cytoplasmic signal which governs the following stages, i.e. actual ingestion (phagocytosis), then enzymatic destruction within phagolysosomes " bactericidosis ". The phase of recognition and membrane binding to bacteria thus occupies an important place in the physiological role of macrophages. Two receptors are especially involved: the Fc receptor and the C3b receptor. The ingestion phase appears to be initiated by the redistribution of these membrane receptors, which first reform in "micro-clusters" (reversible small aggregates), then in "clusters" (irreversible larger aggregates), which finally become "patches" and "caps". " Bactericidosis " then ensures in most cases the disintegration of the infectious agent, by systems that can be either dependent or independent of oxygen. The main techniques for the study of macrophage phagocytosis are briefly reviewed.


Study of the Direct Red 81 Dye/Copper(II)-Phenanthroline System.
Recovered papers contain several chromophores, such as wood lignin and dyes. These have to be eliminated during paper recycling in order to produce white paper. Hydrogen peroxide under alkaline conditions is generally used to decolorize lignin, but its effect on dyes is limited. Copper(II)-phenanthroline (Cu-Phen) complexes can activate the oxidation of lignin by hydrogen peroxide. Hydrogen peroxide may also be activated during recycled fiber bleaching, thus enhancing its color-stripping efficiency towards unoxidizable azo dyes. The purpose of this paper was to determine the effect of Cu-Phen complexes on a model azo dye, Direct Red 81 (DR81), in aqueous solution. Different Cu-Phen solutions (with different initial Cu:Phen molar ratios) were prepared and mixed with the dye at different pHs. The geochemical computer program PHREEQC allowed precise calculation of the theoretical distribution between different possible coordinates (CuPhenOH⁺, Cu(Phen)₂2+, CuPhen(OH)₂, Cu(Phen)₃2+, etc.) depending on pH and initial concentrations. UV-vis spectroscopic measurements were correlated with the major species theoretically present in each condition. The UV absorbance of the system was mainly attributed to the Cu-Phen complex and the visible absorbance was only due to the dye. Cu-Phen appeared to reduce the color intensity of the DR81 dye aqueous solution under specific conditions (more effective at pH 10.7 with Cu:Phen = 1:1), probably owing to the occurrence of a coordination phenomenon between DR81 and Cu-Phen. Hence, the ligand competition between phenanthroline and hydroxide ions would be disturbed by a third competitor, which is the dye molecule. Further investigation proved that the DR81 dye is able to form a complex with copper-phenanthroline, leading to partial color-stripping. This new "color-stripping effect" may be a new opportunity in paper and textile industries for wastewater treatment.


The potentiating effect of propionyl carnitine on prostacycline prevention of thrombosis induced by endothelin (ET-1) and K-carrageenin.
The aim of the present experiments was to ascertain whether prostacycline could exercise a protective effect against the formation of thrombosis in the rat tail induced by endothelin and K-carrageenin and to compare the effect of prostacycline with that of carnitine and propionyl carnitine. Both prostacycline and propionyl carnitine exhibited a similar protective effect on this experimental model. A combined protective effect of prostacycline administered with carnitine was also observed and a possible interaction between these two substances is proposed.


Responsibility therapy in community psychiatry.
The author describes a day treatment program using responsibility therapy, a form of behaviorism based on the principles of Alcoholics Anonymous. Mental illness is conceptualized as an addiction or bad habit to be corrected through definition of the client's problems, values, and therapeutic objectives. The program, which is operated by the county, requires high client motivation and the involvement of significant others. About 100 clients enter the program each year; more than half are referrals from the county probation department. A recent study showed that the program is serving the most disabled group of clients as least as effectively as the other county services.


Characterization and evaluation of a recombinant multiepitope peptide antigen MAG in the serological diagnosis of Toxoplasma gondii infection in pigs.
Toxoplasmosis caused by Toxoplasma gondii is a serious disease threatening human and animal health. People can be infected with T. gondii by ingesting raw pork contaminated with cysts or oocysts. Serological test is a sensitive and specific method usually used for large-scale diagnosis of T. gondii infection in humans and animals (such as pigs). Commercial pig Toxoplasma antibody ELISA diagnostic kits are expensive, which limits their use; moreover, the wide antigen composition used in these diagnostic kits is still unclear and difficult to standardize. The multiepitope peptide antigen is a novel diagnostic marker, and it has potential to be developed into more accurate and inexpensive diagnostic kits. The synthetic multiepitope antigen (MAG) cDNA encoding a protein with epitopes from five T. gondii-dominant antigens (SAG1, GRA1, ROP2, GRA4, and MIC3) was designed, synthesized, and expressed in Escherichia coli BL21 (DE3) strain. The recombinant protein was detected through western blot with pig anti-T. gondii-positive and -negative serum, and then IgG enzyme-linked immunosorbent assay (ELISA) named MAG-ELISA was designed. The MAG-ELISA was evaluated in terms of specificity, sensitivity, and stability. The MAG-ELISA was also compared with a commercial PrioCHECK® Toxoplasma Ab porcine ELISA (PrioCHECK ELISA). Finally, the trend of pig anti-T. gondii IgG levels after artificial infection with RH tachyzoites was evaluated using MAG-ELISA and two other ELISA methods (rMIC3-ELISA and PrioCHECK ELISA). MAG antigen could be specifically recognized by pig anti-T. gondii-positive but not -negative serum. MAG-ELISA showed high diagnostic performance in terms of specificity (88.6%) and sensitivity (79.1%). MAG-ELISA could be used for detecting anti-T. gondii IgG in the early stage of T. gondii infection in pigs (at least 7 days after artificial infection). Our results suggest that MAG antigen can be applied to specifically recognize anti-T. gondii IgG in pig, and MAG-ELISA has the potential for large-scale screening tests of T. gondii infection in pig farms and intensive industries.


Risk of gestational diabetes recurrence and the development of type 2 diabetes among women with a history of gestational diabetes and risk factors: a study among 18 clinical centers in China.
Gestational diabetes mellitus (GDM) brings health issues for both mothers and offspring, and GDM prevention is as important as GDM management. It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence. The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China. We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China. A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers. All participants were enrolled from January 2018 to October 2018, where they delivered the second baby during this period. A total of 6204 women were enrolled in this study, and 1002 women with a history of GDM were analyzed further. All participants enrolled in the study had an oral glucose tolerance test (OGTT) result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value (when any one of the following values is met or exceeded to the 75-g OGTT: 0 h [fasting], ≥5.10 mmol/L; 1 h, ≥10.00 mmol/L; and 2 h, ≥8.50 mmol/L). The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated, and its related risk factors were analyzed. In 6204 participants, there are 1002 women (1002/6204,16.15%) with a history of GDM and 5202 women (5202/6204, 83.85%) without a history of GDM. There are significant differences in age (32.43 ± 4.03 years vs. 33.00 ± 3.34 years vs. 32.19 ± 3.37 years, P < 0.001), pregnancy interval (4.06 ± 1.44 years vs. 3.52 ± 1.43 years vs. 3.38 ± 1.35 years, P = 0.004), prepregnancy body mass index (BMI) (27.40 ± 4.62 kg/m2vs. 23.50 ± 3.52 kg/m2vs. 22.55 ± 3.47 kg/m2, P < 0.001), history of delivered macrosomia (22.7% vs. 11.0% vs. 6.2%, P < 0.001) among the development of diabetes mellitus (DM), recurrence of GDM, and normal women. Moreover, it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM. There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value (18.31 ± 1.90 mmol/L vs. 16.27 ± 1.93 mmol/L vs. 15.55 ± 1.92 mmol/L, P < 0.001), OGTT fasting value (5.43 ± 0.48 mmol/L vs. 5.16 ± 0.49 mmol/L vs. 5.02 ± 0.47 mmol/L, P < 0.001), OGTT 1-hour value (10.93 ± 1.34 mmol/L vs. 9.69 ± 1.53 mmol/L vs. 9.15 ± 1.58 mmol/L, P < 0.001), OGTT 2-hour value (9.30 ± 1.66 mmol/L vs. 8.01 ± 1.32 mmol/L vs. 7.79 ± 1.38 mmol/L, P < 0.001), incidence of impaired fasting glucose (IFG) (fasting plasma glucose ≥5.6 mmol/L) (31.3% vs. 14.6% vs. 8.8%, P < 0.001), and incidence of two or more abnormal OGTT values (68.8% vs. 39.7% vs. 23.9%, P < 0.001) among the three groups. Using multivariate analysis, the factors, such as age (1.07 [1.02-1.12], P = 0.006), prepregnancy BMI (1.07 [1.02, 1.12], P = 0.003), and area under the curve of OGTT in the first pregnancy (1.14 [1.02, 1.26], P = 0.02), have an effect on maternal GDM recurrence; the factors, such as age (1.28 [1.01-1.61], P = 0.04), pre-pregnancy BMI (1.26 [1.04, 1.53], P = 0.02), and area under the curve of OGTT in the first pregnancy (1.65 [1.04, 2.62], P = 0.03), have an effect on maternal DM developed further. The history of GDM was significantly associated with a higher maternal risk for GDM recurrence during follow-up after the first pregnancy. The associated risk factors for GDM recurrence or development of DM include age, high pre-pregnancy BMI, history of delivered macrosomia, the OGTT level in the first pregnancy, such as the high area under the curve of OGTT, IFG, and two or more abnormal OGTT values. To prevent GDM recurrence, women with a history of GDM should do the preconception counseling before preparing next pregnancy.


Clinicopathological and prognostic features of hepatitis B virus-associated diffuse large B-cell lymphoma: a single-center retrospective study in China.
While the epidemiologic association between hepatitis B virus (HBV) infection and diffuse large B-cell lymphoma (DLBCL) is established, little is known about the pathological characteristics and outcome of DLBCL arising in patients with HBV infection. We retrospectively studied a cohort of 420 patients with DLBCL for the incidence of HBV infection, and the clinicopathologic features and prognostic factors in HBsAg-positive DLBCL patients in China, a hepatitis B endemic area. In our study, 127 (30.2%) patients were HBsAg-positive. HBsAg-positive DLBCL displayed a younger median onset age (50 vs. 54 years, P = 0.002), more frequent involvement of the spleen (19.7% vs. 6.1%, P < 0.001), less frequent involvement of the small and large intestine (2.3% vs. 11.2%, P = 0.003), more advanced disease (stage III/IV: 56.7% vs. 45.1%, P = 0.028), and lower expression rate of MYC (49.1% vs. 66.7%, P = 0.026). The median follow-up time was 61.9 months. Univariate analysis showed that there was no significant difference in overall survival (OS) between HBsAg-negative and -positive DLBCL (P = 0.577). In the HBsAg-positive DLBCL subgroup, age older than 60 years, advanced disease, elevated lactate dehydrogenase (LDH), spleen involvement, B symptoms (fever, night sweats, weight loss), and double expressers of MYC and BCL2 had a significantly worse outcome, and patients treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) had a better prognosis. Multivariate analysis further confirmed that spleen involvement and rituximab use were independent prognostic factors in HBsAg-positive DLBCL patients. Our study indicates that HBsAg-positive DLBCL has unique clinicopathological features and independent prognostic factors. Moreover, under antiviral prophylaxis, the survival of DLBCL patients with HBV infections was comparable to that of HBV-negative patients, and the use of rituximab significantly improved OS in HBsAg-positive DLBCL patients.


The needs and experiences of family members of adult patients in an intensive care unit: a review of the literature.
Insight into the needs and experiences of family members is an initial but necessary step in providing appropriate care for both family members and the patient. This literature review aims to structure the available scientific knowledge on needs and experiences of family members of intensive care unit patients with particular extension to coma patients. Qualitative as well as quantitative studies are discussed. Literature review. Needs are divided into four categories: cognitive, emotional, social and practical needs. The need for accurate and comprehensible information that leaves room for hope is universal. Family members want to speak to a doctor every day about the condition of and the prognosis for the patient, and want a nurse to explain to them about the care, the unit, the equipment and what they can do for the patient during visiting hours. Family members place great importance on being called at home if the condition of the patient changes. Emotional needs as hope, reassurance and being able to remain in the vicinity of the patient are crucial. Family members always give priority to the welfare of their relative. In their confused state, they often do not get around to paying attention to themselves. Caregivers underestimate all of the needs of family members and do not do enough to meet these needs. Priority needs should be central in the nurses' approach of family members. The initiative for meeting the needs must be with the caregivers. Future, focused and well-designed qualitative research over a longer period of time could clarify the process that family members go through and explain the results of quantitative studies.


Health beliefs and practices among Arab women.
The purpose of this article is to describe the healthcare beliefs and practices of Arab American women, specifically those regarding menstruation, pregnancy, childbirth, and family planning. The information in this paper is derived from the author's experience as a researcher, as an Arab healthcare provider, and from the literature. Guidelines for nurses who provide care to Arab American women are also presented.


Implant-prosthetic treatment in patients with oral lichen planus: A systematic review.
This review is aiming on identifying the ideal implant-prosthetic treatment design in patients with OLP. A systematic review was conducted using four electronic databases; Medline (PubMed), Cochrane library, DOAJ and SCOPUS, following the PRISMA statement recommendations to answer the PICO question: "which implant-prosthetic treatment design is most useful to ensure implant survival in OLP patients?". The study was pre-registered in PROSPERO (CRD 42020220102). Included articles quality was assessed using the "Newcastle-Ottawa scale" and the JBI critical appraisal tool for case series. No article was found specifically designed to analyze the prosthetic influence on implant survival in OLP patients. Despite, information about implant-prostheses in studies designed with other goals was compiled. Eight articles that involved 141 patients and 341 implants were finally selected. The weighted mean follow-up was 38 months and the weighted mean survival of the implants 98.9%. No statistical differences were observed between cemented or screw retained prostheses and the materials employed or the technology to manufacture the prostheses. The influence of prosthetic design on implant survival in OLP patients is still poorly understood, but important clinical recommendations can be drawn. The strength of evidence was grade 3b (CEBM) or low (GRADE).


Epigenetic programming by stress and glucocorticoids along the human lifespan.
Psychosocial stress triggers a set of behavioral, neural, hormonal, and molecular responses that can be a driving force for survival when adaptive and time-limited, but may also contribute to a host of disease states if dysregulated or chronic. The beneficial or detrimental effects of stress are largely mediated by the hypothalamic-pituitary axis, a highly conserved neurohormonal cascade that culminates in systemic secretion of glucocorticoids. Glucocorticoids activate the glucocorticoid receptor, a ubiquitous nuclear receptor that not only causes widespread changes in transcriptional programs, but also induces lasting epigenetic modifications in many target tissues. While the epigenome remains sensitive to stressors throughout life, we propose two key principles that may govern the epigenetics of stress and glucocorticoids along the lifespan: first, the presence of distinct life periods, during which the epigenome shows heightened plasticity to stress exposure, such as in early development and at advanced age; and, second, the potential of stress-induced epigenetic changes to accumulate throughout life both in select chromatin regions and at the genome-wide level. These principles have important clinical and translational implications, and they show striking parallels with the existence of sensitive developmental periods and the cumulative impact of stressful experiences on the development of stress-related phenotypes. We hope that this conceptual mechanistic framework will stimulate fruitful research that aims at unraveling the molecular pathways through which our life stories sculpt genomic function to contribute to complex behavioral and somatic phenotypes.


EzrA: a spectrin-like scaffold in the bacterial cell division machinery.
Much progress has been made in identifying the components of the divisome, the assembly of proteins that undertakes the vital process of cell division in bacteria. However, how the highly interdependent processes on either side of the membrane are coordinated during division is a major unresolved question. How is the degradation and synthesis of the cell wall on the outside of the cell coordinated with cytokinesis and membrane fission, which are driven from the inside of the cell by the tubulin homologue FtsZ? A possible key mediator of such coordination is the membrane protein EzrA, as it interacts both with FtsZ and the penicillin binding proteins (PBPs) that synthesize peptidoglycan. Cleverley et al. [Nature Communications (2014) 5, 5421] have recently solved the crystal structure of the cytoplasmic domain of B. subtilis EzrA, which points to an important scaffolding role for EzrA in the divisome. The structure resembles the eukaryotic, cytoskeletal spectrin proteins, which link actin filaments in the cytoskeleton and also connect the actin cytoskeleton to membrane-bound integrin proteins.


Prenatal education for congenital toxoplasmosis.
Congenital toxoplasmosis is considered a rare but potentially severe infection. Prenatal education about congenital toxoplasmosis could be the most efficient and least harmful intervention, yet its effectiveness is uncertain. To assess the effects of prenatal education for preventing congenital toxoplasmosis. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 January 2012), PubMed (1966 to 15 January 2012), EMBASE (1980 to 15 January 2012), CINAHL (1982 to 15 January 2012), LILACS (1982 to 15 January 2012), IMEMR (1984 to 15 January 2012), and reference lists of relevant papers, reviews and websites. Randomized and quasi-randomized controlled trials (RCTs) of all types of prenatal education on toxoplasmosis infection during pregnancy. Cluster-randomized trials were included. Two review authors independently assessed trials for inclusion and study quality. Two review authors extracted data. Data were checked for accuracy. Two cluster-randomized controlled trials (involving a total of 5455 women) met the inclusion criteria. The two included trials measured the effectiveness of the intervention in different ways which meant that meta-analysis of the results was not possible One trial (432 women enrolled) conducted in Canada was judged of low methodological quality. The authors did not report measure of association but only provided P values (P less than 0.05) for all outcomes. Moreover, losses to follow-up were high (34%, 147 out of 432 women initially enrolled). The authors concluded that prenatal education can effectively change pregnant women's behavior as it increased pet, personal and food hygiene. The second trial conducted in France was also judged of low methodological quality. Losses to follow-up were high (44.5%, 2233 out of 5023 women initially enrolled) and differential (40% in the intervention group and 52% in the control group). The authors concluded that prenatal education for congenital toxoplasmoses has a significant effect on improving women's knowledge whereas it has no effect on changing women's behavior. In this trial 17/3949 pregnant women seroconverted for toxoplasmosis: 13/2591 (0.5%) in the intervention group and 4/1358 (0.3%) in the control group. The number of events was too small to reach conclusions about the effect of prenatal education on seroconversion rate during pregnancy.No other randomized trials on the effect of prenatal education on congenital toxoplasmosis rate, or toxoplasmosis seroconversion rate during pregnancy were detected. Even though primary prevention of congenital toxoplasmosis is considered a desirable intervention, given the lack of related risks compared to secondary and tertiary prevention, its effectiveness has not been adequately evaluated. There is very little evidence from RCTs that prenatal education is effective in reducing congenital toxoplasmosis even though evidence from observational studies suggests it is. Given the lack of good evidence supporting prenatal education for congenital toxoplasmosis prevention, further RCTs are needed to confirm any potential benefits and to further quantify the impact of different sets of educational intervention.


Li13Mn(SeO3)8: Lithium-Rich Transition Metal Selenite Containing Jahn-Teller Distortive Cations.
A novel lithium-rich transition metal selenite, Li13Mn(SeO3)8, that is composed of a Jahn-Teller distortive cation, Mn3+, in the high spin d4 state, and a second-order Jahn-Teller (SOJT) distortive lone pair cation, Se4+, has been synthesized via hydrothermal and high temperature solid state reactions. The selenite is classified as a molecular compound consisting of MnO6 octahedra, SeO3 trigonal pyramids, and Li+ cations. Considering the Li-O interactions, the structure of Li13Mn(SeO3)8 may be described as a pseudo-three-dimensional framework as well. The title compound is thermally stable up to 500 °C and starts decomposing above the temperature attributable to the volatilization of SeO2. While the MnO6 octahedra in Li13Mn(SeO3)8 exhibit six identical Mn-O bond distances at room temperature due to the dynamic Jahn-Teller effect, a clear elongation of two Mn-O bonds along a specific direction is observed at 100 K. A series of isostructural selenites with different transition metals, i.e., Li13M(SeO3)8 (M = Sc, Cr, and Fe), have been also successfully obtained in phase pure forms using similar synthetic methods. Magnetic properties, spectroscopic characterizations, and local dipole moments calculations for all the synthesized selenites are presented.


Mechanism of attenuation of morphine antinociception by chronic treatment with L-arginine.
The effects of twice-daily injections of L-arginine or D-arginine (200 mg/kg i.p.) for 4 days on morphine-induced antinociception, brain nitric oxide synthase activity and brain and serum distribution of morphine and brain mu-opioid receptors labeled with [3H][D-Ala2,MePhe4,Gly5-ol]enkephalin were determined in male Swiss-Webster mice. Chronic treatment with L-arginine, but not D-arginine, decreased the antinociceptive response to morphine in mice, increased the activity of nitric oxide synthase in the midbrain and decreased brain levels of morphine, compared with vehicle-injected controls. Significant decreases in morphine levels were observed in midbrain, pons and medulla, hippocampus, striatum and spinal cord of L-arginine-treated mice, in comparison with vehicle-injected mice. However, the levels of morphine in cortex, amygdala and hypothalamus of L-arginine- or D-arginine-treated mice did not differ from those of vehicle-injected controls. Acute treatment with L-arginine (200 mg/kg i.p.) or D-arginine (200 mg/kg i.p.) did not modify either morphine antinociception or morphine distribution in brain regions or the spinal cord. Chronic administration of L-arginine or D-arginine did not alter the Bmax or Kd values of [3H][D-Ala2,MePhe4,Gly5-ol]enkephalin binding to the mouse brain membranes. These results suggest that chronic treatment with L-arginine reduces the antinociceptive effect of morphine by increasing brain nitric oxide synthase activity and by decreasing the concentration of morphine in certain brain regions and spinal cord.


Lower gastrointestinal bleeding diagnosed by red blood cell scintigraphy in a patient with a left ventricular assist device.
A patient with ischemic congestive heart failure, managed with a left ventricular assist device (LVAD) as a bridge to cardiac transplantation, developed hematochezia. This article illustrates the utility of Tc-99m-labeled red blood cell scintigraphy for identification of the lower gastrointestinal bleeding site in a patient with LVAD. The study initially showed a normal biodistribution of radiotracer, with expected activity in the sac of the LVAD and its cannulae, and later identified the bleeding from the sigmoid, permitting selective angiography and therapeutic embolization. There is a prior limited illustration of red blood cell scintigraphy in the presence of LVAD.


New hydrazonoindolin-2-ones: Synthesis, exploration of the possible anti-proliferative mechanism of action and encapsulation into PLGA microspheres.
The synthesis and molecular characterization of new isatin-based hydrazonoindolin-2-ones 4a-o and 7a-e are reported. The in vitro anti-proliferative potential of the synthesized compounds 4a-o and 7a-e was examined against HT-29 (colon), ZR-75 (breast) and A549 (lung) human cancer cell lines. Compounds 7b, 7d and 7e were the most active congeners against the tested human cancer cell lines with average IC50 values of 4.77, 3.39 and 2.37 μM, respectively, as compared with the reference isatin-based drug, sunitinib, which exhibited an average IC50 value of 8.11 μM. Compound 7e was selected for further pharmacological evaluation in order to gain insight into its possible mechanism of action. It increased caspase 3/7 activity by 2.4- and 1.85-fold between 4 and 8 h of treatment, respectively, at 10 μM and it caused a decrease in the percentage of cells in the G1 phase of the cell cycle with a corresponding increase in the S-phase. In addition, compound 7e increased phosphorylated tyrosine (p-Tyr) levels nearly two-fold with an apparent IC50 value of 3.8 μM. The 7e-loaded PLGA microspheres were prepared using a modified emulsion-solvent diffusion method. The average encapsulation efficiency of the 7e-loaded PLGA microspheres was 85% ± 1.3. While, the in vitro release profile of the 7e-loaded microspheres was characterized by slow and continuous release of compound 7e during 21 days and the release curve was fitted to zero order kinetics. Incorporation of 7e into PLGA microspheres improved its in vitro anti-proliferative activity toward the human cancer cell line A549 after 120 h incubation period with an IC50 value less than 0.8 μM.


[Benign cerebral angiopathies and phenylpropanolamine].
Heroin, cocaine, amphetamines, sympathomimetic drugs can cause cerebral angiopathy. We report 2 patients with cerebrovascular disorders after ingestion of a nasal vasoconstrictor containing phenylpropanolamine (P.P.A.). The first patient had two acute repetitive attacks of severe headache and vomiting, occurring after a daily treatment with 180 mg of P.P.A. during 6 weeks. The second patient had an intracerebral hemorrhage, occurring some hours after taking for the first time 120 mg of P.P.A. In both cases, cerebral angiography, performed in the next week, demonstrated segmental narrowing and dilatations of medium-size intracranial arteries. None of the usual causes of cerebral vasculitis were present. The outcome was favorable and follow-up angiograms showed the disappearance of the beading pattern. P.P.A. is widely used over the counter in diet pills and stimulants. Cerebral vascular complications have been rarely reported, always hemorrhagic and often associated with cerebral vasculitis. They are unrelated to duration or dosage of treatment. The mechanism is unclear but could result from several factors: chronic or paroxystic high blood pressure, immuno-allergic vasculitis, arterial spasm, direct "toxic" effect of the P.P.A. on the arterial wall may be increased by other drugs and caffeine.


Producing Tailocins from Phages Using Osmotic Shock and Benzalkonium Chloride.
In the light of the worldwide antimicrobial resistance crisis, new substitutes to antibiotics are urgently needed. Tailocins or phage tail-like bacteriocin particles, produced by bacteria for environmental competition, are a potential antimicrobial alternative to antibiotic treatment. Yet, the availability of characterized Tailocins is limited. We explored the possibility to produce new Tailocins from phage particles, using osmotic shock or chemical treatment by the ammonium quaternary compound benzalkonium chloride on Ackermannviridae phage S117 and using Straboviridae phage T4 as control. We report that phage S117 was resistant to such treatment, while successful production of Tailocins by osmotic shock was achieved for phage T4. Finally, chemical treatment with benzalkonium chloride was inefficient on phage S117 but successfully inactivated phage T4 without production of Tailocins. Further studies are needed to implement such treatments of phages for producing Tailocins with killing activity.


[Substantiation of the concept of "freshness" with fodder rye and wheat as examples].
In moderately or severely damaged fodder rye and wheat, the catalase test and the acidity determination are suited for corroborating the results of the organoleptic examination; But it must be emphasized that organoleptic tests cannot be replaced by the determination of chemical parameters. The present studies indicate that the substantiation of freshness by means of chemical parameters is limited in case of light or moderate deterioration.


The Impact of Bioactive Compounds Derived from Marine Fish on Cancer.
Cancer persists as the world's leading cause of mortality, thereby making it a compelling condition to research and potentially develop prevention options. Anticancer therapies such as chemotherapy, surgery and radiation therapy are becoming highly futile and tend to have achieved a clinical deficit due to massive side effects, toxicities, and limited specificity. Anticancer agents from natural sources, such as aquatic fishes, terrestrial mammals, animal venoms, and amphibians, have mainly been focused on in recent researches. Edible marine fishes contain high contents of fatty acids, vitamins, and proteins, also having bioactive compounds. Fish derivatives naturally have the potential to target cancer cells while being less hazardous to normal tissues, making them a better choice for cancer prevention and therapy. In this review, we mainly focused on the bioactive compounds identified in marine fishes which have significant biological properties including anticancer effects, also discuss the mechanism of action.


Effects of hormones on sleep.
Administration of hormones to humans and animals results in specific effects on the sleep electroencephalogram (EEG) and nocturnal hormone secretion. Studies with pulsatile administration of various neuropeptides in young and old normal controls and in patients with depression suggest they play a key role in sleep-endocrine regulation. Growth hormone (GH)-releasing hormone (GHRH) stimulates GH and slow wave sleep (SWS) and inhibits cortisol, whereas corticotropin-releasing hormone (CRH) exerts opposite effects. Changes in the GHRH:CRH ratio contribute to sleep-endocrine aberrations during normal ageing and acute depression. In addition, galanin and neuropeptide Y promote sleep, whereas, in the elderly, somatostatin impairs sleep. The rapid eye movement (REM)-nonREM cycle is modulated by vasoactive intestinal polypeptide. Cortisol stimulates SWS and GH, probably by feedback inhibition of CRH. Neuroactive steroids exert specific effects on the sleep EEG, which can be explained by gamma-aminobutyric acid(A) receptor modulation.


Risk factors of erythrocytosis post renal transplantation.
Post-transplant erythrocytosis (PTE) is characterized by persistently elevated hematocrit level >or= 51%. This complication is reported to develop in 10-20% of renal allografts recipients, mostly 2 years after kidney transplantation. PTE is self-limited in 25% of the patients; however it may persist in patients with an increased susceptibility for thrombosis and potential fatal outcome. To evaluate the prevalence and risk factors of PTE in our center, we reviewed the records of 235 patients who received renal allografts from 1999 to 2004. Polycythemia was found in 45 (19%) patients. There was no significant correlation of polycythemia and age, history of hypertension, diabetes, pre-transplant hematocrit level, pre-transplant history of transfusion, graft's function, and source of kidney. A significantly higher proportion of PTE patients were males, patients with history of polycystic kidney disease, and patients with glomerulonephritis. We conclude that PTE is an important complication of kidney transplantation. There are several risk factors that should be addressed to prevent this complication.


Prognostic factors of the postoperative vomiting in case of hypertrophic pyloric stenosis.
From January 1986 to February 1994, 198 children were operated on for hypertrophic pyloric stenosis (HPS). Postoperative follow-up have been carried out in 194 cases. The children were divided into two groups: group A (n = 134; 69.1%): without any postoperative diet troubles (n = 52) or simple regurgitations (n = 82), and group B (n = 60; 30.9%) presenting more significant vomiting requiring medical treatment (n = 52) or a prolongation of parental nutrition (n = 8). A retrospective study of the different factors which can possibly explain this postoperative vomiting was carried out. The criteria having an influence are: the age (44.5 days in group A; 35.7 days in group B; (p < 0.001) the weight at the time of the operation (3921) g in group A; 3647 in group B; p = 0.01) the thickness of the pylorus at the pre-operative ultrasound scan (5.2 mm in group A; 47 in group B; p < 0.015). The other studied criteria (prematurity, birth weight, delay in diagnosis, weight loss, hydroelectrolytic abnormalities, surgical approach way-subcostal or umbilical-, surgical difficulties and operation duration) are not statistically significant. The young age (and therefore the low weight) at the time of the pyloromyotomy can easily explain the post-operative vomiting through the physiological immaturity of the lower sphincter of the esophagus. It is more paradoxical to note that these difficulties are all the more frequent because the pyloric tumor is less thick at the ultrasound scan. But this criterion is also directly related to the child's age (average thickness of 4.5 mm before the age of one month and 5.8 mm after the age of two months; p < 0.0001). These data suggest the importance of systematic medical treatment to prevent postoperative vomiting in high-risk children, in order to decrease hospital stay (4.14 days in group A; 5.20 days in group B; p < 0.0001).


[Management of gastrinoma].
Gastrinoma is a very rare tumor leading to gastrin hypersecretion and characterised by Zollinger-Ellisson syndrome (ZES) i.e. severe gastric and duodenal ulceration and profuse diarrhea. This disease can be sporadic or familial within a multiple endocrine neoplasia type 1 (MEN-1) syndrome. Diagnosis is based on hypergastrinemia/hypercholrhydria. Tumors are usually located in the duodeno-pancreas. Preoperative tumor location by CT, echoendoscopy and fibroscopy is not always possible because of the small size of the lesion that are frequently multiple. The aim of gastrinoma treatment is 1/to control the hormonal hypersecretion 2/to remove the neoplasm when it is possible. Surgery is the only chance to cure. Gastrinoma is a slow-growing tumor, and overall survival is good with a median survival above 10years and a 5-year survival above 80 % in surgically resected patients. Recurrence is frequent, a biochemical recurrence is observed in 65 % of cases and morphological recurrence in 40 % of patients at 2years. Metastases are associated with a dismal prognosis.


[Depressive symptoms and serum levels of polyunsaturated fatty acids omega-3 and omega-6 among college students from Northern Mexico].
Previous studies suggest that low consumption as well as low serum levels of polyunsaturated fatty acids (PUFA) omega-3 and a high omega-6/omega-3 ratio may be implicated in the etiology of depressive disorders, however, epidemiologic evidence is inconclusive. To assess the relationship of serum levels of omega-3 fatty acids (docosahexaenoic [DHA], eicosapentaenoic [EPA], alpha-linolenic fatty acid [ALA]) and the omega-6 (arachidonic acid [AA])/EPA ratio with depressive symptoms among Mexican college students. A cross-sectional study that included 60 male and female participants (ages 18 to 24 years) with serum levels of EPA, DHA, ALA and AA. Depressive symptoms were ascertained with the Center for Epidemiologic Studies Depression (CES-D) scale validated for Mexican students. Linear regression was used to assess the relationship between depressive symptoms and serum PUFA omega-3 and omega-6. Serum levels of EPA, DHA and EPA/DHA ratio were not related to depressive symptoms, high serum ALA was related with lower depressive symptoms before and after covariate adjustment; however, these results were not statistically significant. Among women, 1% increase in EPA resulted in 5.5. (p = 0.57) increase in the depressive scale scores while 1% increase in ALA resulted in 6.7 decrease (p = 0.39) in the scores. Our results did not confirm the relationship of serum levels of PUFA omega-3 and omega-6/omega-3 ratio with depressive symptoms; the negative correlation of serum ALA with depressive symptoms remains to be confirmed in prospective studies.


Thermopriming reprograms metabolic homeostasis to confer heat tolerance.
Heat stress threatens agriculture worldwide. Plants acquire heat stress tolerance through priming, which establishes stress memory during mild or severe transient heat stress. Such induced thermotolerance restructures metabolic networks and helps maintain metabolic homeostasis under heat stress. Here, we used an electrospray ionization mass spectrometry-based platform to explore the composition and dynamics of the metabolome of Arabidopsis thaliana under heat stress and identify metabolites involved in thermopriming. Primed plants performed better than non-primed plants under severe heat stress due to altered energy pathways and increased production of branched-chain amino acids, raffinose family oligosaccharides (RFOs), lipolysis products, and tocopherols. These metabolites serve as osmolytes, antioxidants and growth precursors to help plants recover from heat stress, while lipid metabolites help protect membranes against heat stress. The carbohydrate (e.g., sucrose and RFOs) and lipid superpathway metabolites showed the most significant increases. Under heat stress, there appears to be crosstalk between carbohydrate metabolism (i.e., the thermomemory metabolites stachyose, galactinol, and raffinose) and tyrosine metabolism towards the production of the thermomemory metabolite salidroside, a phenylethanoid glycoside. Crosstalk occurs between two glycerophospholipid pathways (the biosynthetic pathways of the thermomemory metabolite S-adenosyl-L-homocysteine and the terpenoid backbone) and the δ-tocopherol (chloroplast lipid) pathway, which favors the production of glycine betaine and other essential tocopherols, respectively, compounds which are essential for abiotic stress tolerance in plants. Therefore, metabolomic analysis can provide comprehensive insights into the metabolites involved in stress responses, which could facilitate plant breeding to maximize crop yields under adverse conditions.


Preparation, characterization and gas permeation investigation of resorcinol-formaldehyde polymer or carbon xerogels/tubular ceramic composites.
New very stable composites prepared by deposition of resorcinol-formaldehyde polymer (RF-) or carbon (C-) xerogels into walls of commercial porous tubular ceramics (TiO2-ZrO2 and alphaAl2O3-gammaAl203) were obtained by a sol-gel process followed by a drying and a pyrolytic (only for C-xerogel/ceramic composites) step. They were characterized by nitrogen adsorption-desorption, SEM and XRD, and tested for gas (H2, CH4, CO2 and CO) separation applications. Additional morpho-structural information about the open-interconnected ultramicropore structure of composites was found by gas permeation investigation. Interesting results for H2 permeance was obtained especially for RF-polymer/ceramic composites respecting Knudsen diffusion mechanism of gas permeance: H2 > CH4 > CO > CO2. The coexistence of Knudsen and surface diffusion mechanisms were confirmed.


[Clinical outcome of therapeutic cervical cerclage in short cervix syndrome].
Objective: To investigate the clinical effect of therapeutic cervical cerclage on short cervix syndrome for anti-premature birth in the second trimester. Methods: Totally 44 singleton pregnant patients were diagnosed as short cervix syndrome, which was cervical length ≤2.5 cm without cervical dilatation, and received treatment from January 2008 and July 2015 in Peking University Third Hospital were collected. Among them, 30 patients who received therapeutic cervical cerclage were defined as cerclage group and another 14 cases who received conservative treatment were defined as un-cerclage group. The days of conservative treatment, delivery rate of different gestational weeks, birth weight of newborns, neonatal survival rate within 7 days of birth were analyzed between the two groups. Results: There were no significant differences between the two groups in days of pregnancy conservative treatment [103 (84-141) vs 105 (85-114) days], delivery weeks [38.0 (35.5-39.4) vs 38.5 (37.3-39.5) weeks], birth weight of newborns [3 120 (2 750-3 400) vs 3 130 (2 760-3 545) g], and survival rate of newborns [100% (30/30) vs 13/14]. The fetuses of both groups were all delivered after 28 weeks. There was no significant difference in accumulated delivery rate between the two groups after 32 weeks, 34 weeks, and 37 weeks, respectively (all P>0.05) . Conclusions: The treatment of cervical cerclage is not superior to conservative means in single pregnancy of cervical length ≤2.5 cm without cervical dilatation. For such patients with short cervix syndrome, the treatment of cervical cerclage may not be necessary, but dynamic monitoring and search for the causing factors and prompt treatment are more important.


Familial dysalbuminemic hyperthyroxinemia: a syndrome that can be confused with thyrotoxicosis.
We investigated 15 euthyroid patients from eight families with a recently recognized syndrome, familial dysalbuminemic hyperthyroxinemia (FDH), that could be mistaken for thyrotoxicosis. The syndrome is characterized by elevations in serum thyroxine and the free-thyroxine index (FT4l), which are due to an abnormal serum albumin that preferentially binds thyroxine. This albumin has an abnormal binding site with a much greater affinity for thyroxine (relative to its affinity for triiodothyronine) than that of the hormone-binding site on thyroxine-binding globulin. Results of thyrotropin-releasing hormone and thyroid-suppression tests, as well as direct measurements of the free-thyroxine concentration by equilibrium dialysis, are normal in these patients, although the serum triiodothyronine concentration may be slightly elevated. Although its prevalence is uncertain, FDH may be more common than suspected; we have seen 26 cases within the past year.


Quality of care in Crohn's disease.
Crohn's disease (CD) is a chronic and progressive inflammatory disease of the intestine. Overall, healthcare delivery for patients with CD is not optimal at the present time and therefore needs improvement. There are evidences which suggest that there is a variation in the care provided to patients with CD by the inflammatory bowel disease (IBD) experts and community care providers. The delivery of healthcare for patients with CD is often complex and requires coordination between gastroenterologists/IBD specialist, gastrointestinal surgeon, radiologists and IBD nurses. In order to improve the quality of health care for patients with CD, there is need that we focus on large-scale, system-wide changes including creation of IBD comprehensive care units, provision to provide continuous care, efforts to standardize care, and education of the community practitioners.


Silk peptide intake increases fat oxidation at rest in exercised mice.
Silk peptides (SP) have been reported to decrease body weight and accumulate fat. We investigated the effects of SP administration by using an open circuit calorimetry system on resting energy expenditure and substrate utilization in resting mice for the duration of 24 h. Seven-week-old male ICR-mice were orally administered SP (800 mg/kg) for 2 wk and were subjected to endurance training. The results indicated that not only was oxygen uptake higher in the SP group than in the CON group (*p<0.05), but also the respiratory exchange rate was lower than that in the CON group for the duration of 24 h (**p<0.01). Moreover, fat oxidation was increased in the SP group. Body weight of the SP group was significantly decreased compared to that of the CON group (*p<0.05). These results suggest that intake of silk peptides increases fat oxidation during rest in exercised mice. Intake of silk peptides is considered to be a favorable supplement for athletes in training. In particular, it would be an effective supplement for athletes who require weight loss along with an increase in muscle mass.


The use of implantable bone stimulators in nonunion treatment.
Delayed or failure of bone healing in fracture, osteotomy, and arthrodesis patients continues to be a clinical dilemma. Electromagnetic stimulation is 1 modality demonstrated in many studies to aid bone healing; however, relatively few studies depict the use and complications associated with direct current implantable bone stimulators. Over a 9-year period, we studied a consecutive series of 120 adult patients who underwent implantation of a direct current bone stimulator. The goals of this study were to determine the time until healing, the presence of infection, and the need for additional nonunion surgery or salvage procedure following internal bone stimulator placement for nonunion treatment. Of the factors affecting the time until healing, tobacco smoking was a significant factor associated with increased time until healing. Tobacco smoking and duration of nonunion prior to implantable bone stimulator placement were both significant factors in the need for revision nonunion surgery or salvage procedure after implantable bone stimulator placement. Deep soft tissue infection or osteomyelitis was a significant factor predicting prolonged time to healing, subsequent infection following implantable bone stimulator placement, and the need for revision or salvage surgery. With the relative lack of complications directly attributable to electromagnetic implantable bone stimulators, their use may be an effective adjuvant to stable internal fixation and autogenous bone grafting in healing nonunions. However, the use of implantable bone stimulators in patients with nonunion prior to deep soft tissue infection or osteomyelitis exhibited an increased rate of postoperative infection in this study.


Mosquito species collected from a marsh in western Kenya during the long rains.
A total of 475,431 mosquitoes representing 8 genera and 43 species were collected from a marsh in the western Kenya highlands to determine species composition and succession in relation to the epidemiology of Rift Valley fever virus. Culex pipiens was the most common species, totalling 92.3% of the collection, followed by Cx. zombaensis (2.2%), Anopheles coustani (1.1%), An. squamosus (0.8%), Mansonia uniformis (0.6%), Coquillettidia microannulatus (0.5%), Uranotaenia mashonaensis (0.5%), Ma. africana (0.4%) and Cq. aurites (0.4%). Aedes quasiunivittatus was the first floodwater species to emerge from newly flooded areas and was the most abundant Aedes collected, representing 88% of all Aedes specimens. Culex guiarti and Cx. zombaensis colonized newly flooded areas soon after the areas became flooded.


Rivastigmine in the treatment of delirium in older people: a pilot study.
Delirium is common in the elderly and is associated with high mortality and negative health outcomes. Reduced activity in the cholinergic system has been implicated in the pathogenesis of delirium. Cholinesterase inhibitors, which increase cholinergic activity, may therefore be beneficial in the treatment of delirium. This is a double-blind, placebo-controlled randomized pilot study of the treatment of delirium with a cholinesterase inhibitor of patients admitted to hospital medical wards. Patients over the age of 65 years were identified as having delirium by the Confusion Assessment Method (CAM). Patients with delirium were randomized to receive rivastigmine 1.5 mg once a day increasing to 1.5 mg twice a day after seven days or an identical placebo (two tablets after seven days). Fifteen patients entered the trial; eight received rivastigmine and seven received placebo. All of the rivastigmine group, but only three of the placebo group, were negative for delirium on the CAM when they left the study and eventually discharged home. There was no significant difference in the duration of delirium between the two groups (rivastigmine group 6.3 days versus placebo group 9.9 days, p = 0.5, 95% confidence interval -15.6-8.4). The numbers of patients who screened positive for delirium was very small and as a result the sample size was too small to make any meaningful inferences about treatment of delirium. Despite the small numbers included in the study, there are some indicators that rivastigmine may be safe and effective in treating delirium.


Hypofractionation vs conventional radiation therapy for newly diagnosed diffuse intrinsic pontine glioma: a matched-cohort analysis.
Despite conventional radiation therapy, 54 Gy in single doses of 1.8 Gy (54/1.8 Gy) over 6 weeks, most children with diffuse intrinsic pontine glioma (DIPG) will die within 1 year after diagnosis. To reduce patient burden, we investigated the role of hypofractionation radiation therapy given over 3 to 4 weeks. A 1:1 matched-cohort analysis with conventional radiation therapy was performed to assess response and survival. Twenty-seven children, aged 3 to 14, were treated according to 1 of 2 hypofractionation regimens over 3 to 4 weeks (39/3 Gy, n=16 or 44.8/2.8 Gy, n=11). All patients had symptoms for ≤3 months, ≥2 signs of the neurologic triad (cranial nerve deficit, ataxia, long tract signs), and characteristic features of DIPG on magnetic resonance imaging. Twenty-seven patients fulfilling the same diagnostic criteria and receiving at least 50/1.8 to 2.0 Gy were eligible for the matched-cohort analysis. With hypofractionation radiation therapy, the overall survival at 6, 9, and 12 months was 74%, 44%, and 22%, respectively. Progression-free survival at 3, 6, and 9 months was 77%, 43%, and 12%, respectively. Temporary discontinuation of steroids was observed in 21 of 27 (78%) patients. No significant difference in median overall survival (9.0 vs 9.4 months; P=.84) and time to progression (5.0 vs 7.6 months; P=.24) was observed between hypofractionation vs conventional radiation therapy, respectively. For patients with newly diagnosed DIPG, a hypofractionation regimen, given over 3 to 4 weeks, offers equal overall survival with less treatment burden compared with a conventional regimen of 6 weeks.