The present study analyzed multiple morphological attributes of the adductor mandibulae in representatives of 53 of the 55 extant teleostean orders, as well as significant information from the literature in order to elucidate the homologies of the main subdivisions of this muscle. The traditional alphanumeric terminology applied to the four main divisions of the adductor mandibulae – A1, A2, A3, and Aω – patently fails to reflect homologous components of that muscle across the expanse of the Teleostei. Some features traditionally used as landmarks for identification of some divisions of the adductor mandibulae proved highly variable across the Teleostei; notably the insertion on the maxilla and the position of muscle components relative to the path of the ramus mandibularis trigeminus nerve. The evolutionary model of gain and loss of sections of the adductor mandibulae most commonly adopted under the alphanumeric system additionally proved ontogenetically incongruent and less parsimonious than a model of subdivision and coalescence of facial muscle sections. Results of the analysis demonstrate the impossibility of adapting the alphanumeric terminology so as to reflect homologous entities across the spectrum of teleosts. A new nomenclatural scheme is proposed in order to achieve congruence between homology and nomenclature of the adductor mandibulae components across the entire Teleostei.The infraclass Teleostei is a highly diversified group of bony fishes that encompasses 96% of all species of living fishes and almost half of extant vertebrates. Evolution of various morphological complexes in teleosts, particularly those involving soft anatomy, remains poorly understood. Notable among these problematic complexes is the  The infraclass Teleostei adductor mandibulae usually is by far the most striking cranial muscle of teleosts adductor mandibulae is composed of a massive facial segment positioned lateral to the suspensorium and usually connected anteriorly via tendinous tissue to a smaller mandibular segment of the muscle attached to be the medial surface of the lower jaw adductor mandibulae ranges from a simple, undivided muscle mass to an intricate architecture encompassing up to ten discrete subdivisions adductor mandibulae given its position on the lateral surface of the head and its pronounced plasticity across the spectrum of teleostean taxa resulted in this muscle being the focus of multiple studies. These analyses range across comparative morphology The adductor mandibulae complex, the terminology advanced by Vetter in 1878 adductor mandibulae) was combined with Arabic numbers and Greek letters. In combination these yielded a unique identifier for each of the subunits of the adductor mandibulae which Vetter encountered in the four teleosts he examined – the cypriniforms Barbus and Cyprinus, the esocoid Esox and the perciform Perca. The entire mandibular segment of the adductor mandibulae positioned medial to the lower jaw in these fishes was termed the Aω, whereas the main subdivisions of the facial segment located lateral to the suspensorium were designated as the A1, A2 and A3 sections. Under this identification system, the A1 section was a superficial muscle division inserting onto the maxilla, the A2 an external division attaching to the dorsal portion of the lower jaw and the A3 a more medially positioned component of the muscle inserting onto the inner aspects of the lower jaw proximate to the posterior terminus of Meckel's cartilage. Additional subdivisions of these main facial components were designated by the incorporation of a Greek letter as a suffix of the primary indicator for a particular section of the adductor mandibulae .Although Owen adductor mandibulae post Vetter adductor mandibulae (the A1 and A2 sections of his terminology) in the four teleosts examined in his study were derived from the more medially positioned A3. Subsequent studies based on broader surveys across teleosts alternatively proposed that A3 was derivative of A2 and eventually also lost in some taxa 1 or a subdivision of that muscle 1 was a superficial portion of the adductor mandibulae with an insertion on the maxilla. Use of point of insertion on the maxilla as the overarching basis for homology hypotheses thereby resulted in the untenable assumption that positionally dramatically different muscles sections within the the adductor mandibulae  were, nonetheless, homologous.Myological surveys involving the e.g., A3′ and A3″ e.g., Aw for Aω ramus mandibularis trigeminus nerve as a landmark useful for the purposes of identifying the facial divisions of the muscle Other minor alterations of the original terminology proposed by Vetter e.g., adductor mandibulae across the expanse of the Teleostei or for that matter often between many closely related orders within that infraclass. Inadequacy of the Vetter terminology for broad homology statements at higher phylogenetic scales has been long recognized by various researchers . As a consequence, even the most detailed and comprehensive synonymy of the teleostean skeletal muscles ever produced, that by Winterbottom adductor mandibulae. That author instead retained the alphanumeric terminology for descriptive purposes rather than as indicative of homology.In retrospect, the traditional alphanumeric terminology proposed by Vetter adductor mandibulae in the Teleostei and identifying the homologies of its main components across that infraclass. In order to address these questions, we undertook a comparative analysis of the adductor mandibulae and its associated soft and hard anatomical structures in representatives of 53 of the 55 currently recognized orders of the Teleostei  adductor mandibulae and prior hypotheses of evolution of the muscle across the infraclass.The present study centers on elucidating the morphological diversification of the adductor mandibulae across the Teleostei due to multiple factors discussed below. An alternative nomenclature that reflects these homologies across the entire Teleostei is proposed to facilitate this discussion along with future myologically based analyses in the infraclass.The evidence demonstrates that the present alphanumeric nomenclature fails to identify homologous components of the i.e., hyopalatine arch plus opercular series) follows Grande and Bemis The classification of the Teleostei proposed by Wiley and Johnson Specimens that served for the analysis of the musculature were double-stained for cartilage and bone prior to dissection following the procedure outlined by Datovo and Bockmann Anatomical drawings were based on photographs and direct stereomicroscopic observations of specimens in order to capture fine anatomical details. Drawings are bidimensional and were all produced with a Wacom Intuos4 pen tablet . Outlines were generated in Adobe Illustrator CS5 and the shading and coloring in Adobe Photoshop CS5 .adductor mandibulae and related structures across a morphologically dramatically diverse group such as the Teleostei is difficult. The general features presented herein are intended to serve as guidelines to facilitate the recognition of the primary components of the muscle and associated soft tissues occurring in most teleosts and apparently reflect the myological patterns generalized for most teleostean orders. It is crucial to appreciate that these basic configurations are often altered among highly derived teleosts characterized by greatly restructured jaws with associated significantly modified musculature.An enumeration of the invariant features that characterize the adductor mandibulae that apply to all species of the morphologically and taxonomically diverse infraclass Teleostei are an unachievable goal. As is the case for virtually all morphological traits, an elucidation of the homologies of the components of the highly modified adductor mandibulae muscle can in many lineages be only achieved via comparisons with less derived but comparatively closely related taxa  a rostrolateral component termed the buccopalatal membrane adductor mandibulae; and (2) a medially positioned posteroventral component termed the buccopharyngeal membrane occasionally associated with the intramandibular segment of the adductor mandibulae.Most teleosts have the The first of these major components of the buccal membrane, the buccopalatal membrane, forms the anterodorsolateral boundary of the buccal cavity. Ventrally, the buccopalatal membrane is limited by the lower jaw, anteriorly and anterodorsally by the premaxilla and maxilla and posteromedially by the anterodorsal margin of the suspensorium . The bucThe superior labial lamina extends between the posterior and posterodorsal margins of the premaxilla and the anterior and anteroventral margins of the maxilla . As wouljugum, an adjectival form meaning structures connected or yoked or pertaining to the cheek], is nearly invariably delimited posteriorly by the paramaxillar and preangular ligaments and ventrally by the coronomaxillar ligament (see below). In the closed mouth, the projugal lamina folds on itself and lies mostly internal to the retrojugal lamina  and jugal  laminas. Gosline The portion of the buccopalatal membrane situated immediately posterodorsal to the maxilla similarly undergoes significant retraction and expansion in the course of the operation of the mouth. This portion, termed the projugal lamina , [8]adductor mandibulae associate with the buccal ligaments, which are thereby coopted to act as tendons of this muscle. Under the traditional definitions, a ligament interconnects two or more osseous structures, whereas a tendon joins a muscle to a bone, another muscle, or any other anchoring structure. The application of these standard definitions to the buccal ligaments would lead to the recognition of homologous structures via alternative qualifiers (ligament vs. tendon) in different taxa depending on the presence versus absence of a muscular association. As discussed by Johnson and Patterson In several teleosts, portions of the cf.Nine discrete primary ligaments within the buccopalatal membrane were identified among examined teleosts . By way adductor mandibulae muscle.Three ligaments may be associated with the dorsal portion of the maxilla which typically is situated proximate to the mesethmoid . The paradductor mandibulae muscle. The endomaxillar ligament attaches to the medial surface of the dorsalmost portion of the maxilla. From that attachment area, this ligament proceeds posteriorly and becomes associated with the adductor mandibulae muscle , thus, forming a compound labial ligament that surrounds most of the gape of the mouth. The name labial ligament was previously applied by some authors to these combined ligaments The supralabial ligament extends from the posteroventral region of the premaxilla to the distal portion of the maxilla and forms the anteroventral border of the superior labial lamina. This ligament is often absent or poorly differentiated in examined taxa; a condition especially prevalent among basal teleosts. Terminology previously applied to this ligament includes the maxillary-premaxillary The coronomaxillar, infralabial and on occasion the supralabial ligaments are sometimes very stout and fibrocartilaginous Stauroglanis gouldingi . This ligament is herein named the faucal ligament .The posteroventral portion of the buccal membrane is the buccopharyngeal membrane which is situated internal to the suspensorium and lower jaw. This membrane lines most of the buccopharyngeal cavity and connects the lower jaw and often the mandibular segment of the adductor mandibulae in the Teleostei is into facial and mandibular muscle segments. These segments, termed the segmentum facialis and segmentum mandibularis, respectively, interconnect via a strong tendinous complex, the intersegmental aponeurosis segmentum mandibularis and the anteroventral component – the meckelian tendon – directly attaches anteriorly to the lower jaw  have the segmentum mandibularis expanded posteriorly and directly contacting the anterior portion of the segmentum facialis. In such cases a raphe marks the limits between the segmenta mandibularis and facialis. This raphe, herein termed the mandibular raphe, is always continuous medially with the mandibular tendon  or attach to several of the components of the lower jaw including the medial portion of the coronomeckelian bone , the ventral region of the dentary . Based on this configuration, Datovo and Castro e.g., polymixiforms) or even arise independent of both the meckelian and mandibular tendons , may also be present. The facial tendon is a posteroventral division of the intersegmental aponeurosis that parallels the ventral border of the segmentum facialis and attaches to the ventrolateral surface of the suspensorium, usually onto the quadrate. The facial tendon is known only in some aulopiforms, characiforms Posteriorly the intersegmental aponeurosis may be expanded and subdivided in a mode comparable to the anterior portion of that connective tissue band, albeit with these subdivisions less common and less significant for the purposes of our discussion. A posterodorsal branch of the intersegmental aponeurosis, the subocular tendon, runs along the dorsal rim of the stegalis (see next section).It is worthy of note that the aforementioned tendons derived from the intersegmental aponeurosis may associate with different muscle sections in different teleostean groups. Some associations are conversely highly conserved in various cases as exemplified by the invariable association of the meckelian tendon with the segmentum facialis of the adductor mandibulae is situated on the cheek and originates primarily from the lateral surface of various elements of the suspensorium  and are named rictalis, malaris and stegalis. Therefore, the terms section or pars of a muscle refers to any identifiable muscular subunit whose homology and evolutionary history can be traced and studied across the examined taxa regardless of the degree of separation/differentiation between that and other sections.The d; Elops  and the ower jaw  or onto ower jaw , 6A. Thrrictalis, malaris and stegalis sections although a differentiation between these sections is readily apparent. For example, the osteoglossomorph Hiodon has all the facial sections fully continuous with one another but the stegalis is unambiguously differentiable from the remaining sections of the segmentum facialis by its more anterior area of origin  may be total  or partial (restricted to a portion of the muscle). Often, some facial sections are continuous with each other at their origin but gradually differentiated .It is critical to appreciate that the muscle sections detailed below are subdivisions of the segmentum facialis is composed of two primary sections; a ventral component termed the pars rictalis and a dorsal element named the pars malaris  of the preopercle . Many ostariophysans, smegmamorpharians, anabantiforms, gobiesociforms and a few perciforms have the rictalis, or a part of that section, inserting onto the maxilla , the rictalis is differentiated into an external subsection, herein termed the ectorictalis, and an internal subsection, named the endorictalis  of the preopercle , smegmamorpharians, anabantiforms and a few perciforms, the malaris inserts primarily or exclusively on the lower jaw via the intersegmental aponeurosis  also inserts on the posterodorsal region of the retrojugal lamina. This condition is found, for example, in the elopomorphs Elops .The  eyeball , 4A, 6A.eopercle , 6B. As neurosis , 6A. In hs Elops  and Megaligament , 6A. In ower jaw , 6A. Thimalaris over the retrojugal lamina is yet more pronounced in some neoteleosts in which the muscle nearly directly reaches the maxilla  but can be continuous and, thus, form a compound section at the other extremity  completely lack the segmentum mandibularis  distinguishable posteriorly and non-differentiable anteriorly .This section, which is named in reference to its proximity to the coronoid process of the lower jaw, usually originates from the dorsal part of the mandibular tendon , 9. In sfacialis . The cormentalis whose name is derived from the Latin mentum, meaning chin, in reference to its relative position, may extend ventrally beyond Meckel's cartilage and rarely continues caudally beyond the posterior limits of the lower jaw . In this configuration these muscle sections form a compound corono-prementalis.The ramus mandibularis trigeminus nerve is a branch of the truncus infraorbitalis of the trigemino-facialis nerve complex adductor mandibulae across the Teleostei. Our analysis, in contrast, demonstrates that the course of the nerve towards the inner portion of the lower jaw takes many alternative paths (see Discussion). These include different passages of the ramus mandibularis trigeminus lateral, medial or through different sections of the segmentum facialis , occupies almost the same portion of the cheek, and invariably inserts on the lower jaw in members of all teleostean orders  a ventrolateral set of fibers originating from the quadrate and the ventral portion of the preopercle and inserting onto the ventral part of the mandibular tendon; (2) a dorsolateral set of fibers arising from the posteroventral region of the hyomandibula and the dorsal portion of the preopercle and inserting onto the dorsal part of the mandibular tendon and the retrojugal lamina and, thus, indirectly connecting to the maxilla; and (3) a medial set of fibers originating from the metapterygoid and the anterior region of the hyomandibula and inserting on the meckelian tendon .Friel and Wainwright segmentum facialis to the maxilla are another frequently occurring modification of the adductor mandibulae of teleosts. In many lower teleosts (non-Neoteleostei), the entire segmentum mandibularis inserts solely on the intersegmental aponeurosis and via that connective tissue sheet onto the lower jaw  with the posterodorsal region of the retrojugal lamina  pass lateral to the ramus mandibularis trigeminus and insert on the posterolateral portion of the retrojugal lamina, primarily on the preangulo-paramaxillar ligament  have been considered to be derived from a superficial A1 section ramus mandibularis trigeminus. Some authors adductor mandibulae in the Teleostei. This premise is a likely an extrapolation from the classical study of Luther ramus maxillaris trigeminus and ramus mandibularis trigeminus.Some authors have operated under the assumption of the primacy of certain morphological attributes for the identification of the homologies among sections of the adductor mandibulae morphology across the Teleostei revealed that dependence on a single morphological attribute as the sole or primary indicator of the homologies of any muscle section could lead to arbitrary and unjustifiable homology proposals. Hypotheses of homology of any morphological character, as in this case the sections of the adductor mandibulae, should take into account as many attributes as possible. An informative example involves the attachment described above of facial sections to the maxilla: regardless of their insertions, the rictalis, malaris, and epistegalis exhibit nearly identical respective sites of origin, positions, and relationships with most surrounding structures across all examined teleosts uriforms , siluriframus mandibularis trigeminus. An assumption of invariance of the course of the nerve through the adductor mandibulae across the Teleostei necessitates highly non-parsimonious hypotheses of homology for some muscle complexes. In one of the more extreme situations, the entire segmentum facialis in the blenniiform Scartella, which lies fully external to the ramus mandibularis trigeminus, would be considered non-homologous with any part of the segmentum facialis of many other teleosts, including Albula (Albuliformes), Denticeps (Clupeiformes), Diaphus (Myctophiformes), Elops (Elopiformes), Maurolicus (Stomiatiformes), Neoscopelus (Myctophiformes), Oncorhynchus , Osmerus , Pellona (Clupeiformes) and Xenodermichthys (Argentiniformes) in which the entire segmentum facialis is situated fully internal to the same nerve  in Chanos and in the middle of the endorictalis versus between the endoricto-malaris and the stegalis  of muscle sections. Gain or loss of specific facial or mandibular sections was not detected in any teleost, but the entire segmentum mandibularis is absent in several lineages .Examined teleosts, as well as virtually all reliable data available in the literature, demonstrate that the known alterations in the adductor mandibulae may be a non-issue or prove merely inconvenient for myological and/or phylogenetic investigations centered on smaller subgroups of the Teleostei. Such imprecise terminology conversely poses serious problems when it comes to homology statements in phylogenetic reconstructions of more inclusive groupings. Our analysis amply demonstrated that the coding of phylogenetically informative characters derived from the sections of the adductor mandibulae via the present alphanumeric terminology is virtually impossible across the expanse of teleosts. Progressive modification of the terminology first implemented by Vetter adductor mandibulae across the Teleostei. A notable example is the A1 which was traditionally defined by its insertion on the maxilla; a form of attachment which has in retrospect proved to have arisen independently in various lineages within the infraclass. The consequence of this attachment-centered definition was the designation of non-homologous sections of the adductor mandibulae as an A1 (see discussion above). Due to the resultant confusion the name A1 has been applied to at least the following facial muscle sections:Nomenclatural schemes that fail to reflect the primary homologies of the components of the rictalis of characiforms the ectorictalis of cypriniforms the endorictalis of anabantiforms the malaris of osteoglossiforms the promalaris of carangiforms the retromalaris of carangiforms the 1 to multiple sections within the adductor mandibulae across diverse teleostean groups, it should follow that the term A2 was comparably applied inappropriately to the same, or nearly the same, number of non-homologous structures. In actuality, application of the term A2 proved to be even more ambiguous than was the case with A1 due to an additional complication. The A3 section, which in most cases corresponds to the stegalis herein, is often poorly differentiated or indistinguishable from the adjoining lateral section of the adductor mandibulae which inserts on the lower jaw . In such morphologies some authors applied composite identifiers such as A2A3 in an attempt to reflect the compound nature of the sections inserted on the lower jaw 3 was absent. Thus, the term A2 was applied to both simple and compound facial sections  in the literature since the above detailed misapplications of the terms A1 and A2 amply document the magnitude of the problems involved with the present alphanumeric terminology. It is noteworthy that these nomenclatural ambiguities derive not only from different authors who published across the spectrum of groups in the Teleostei, but on occasion involve different taxa within a single analysis . Alternatively, in ostariophysans a ventrolateral portion of the same segment would initially acquire an attachment to the posterolateral region of the lower jaw and, in a more derived evolutionary stage, an attachment to the maxilla. Thus, according to Gosline adductor mandibulae for the Neoteleostei, but introduced the terms “internal division” and “external division” for the main sections resultant from the ostariophysan pathway of subdivision in order to emphasize the incompatibilities between the ostariophysan and neoteleostean arrangements. Under Gosline's rictalis and malaris in Ostariophysi . The problems associated with these erroneous assumptions were exhaustively detailed above and are not repeated herein. Furthermore, a broader analysis across teleosts demonstrated that the alternative muscle patterns described by Gosline Although we agree with Gosline segmentum facialis of the basalmost teleosts should be termed A2, whereas the muscle divisions of neoteleosts should retain the traditional alphanumeric terminology. Alternatively, the two main sections yielded by the supposedly unique subdivision pattern in the Ostariophysi were designated by Diogo and Chardon 2  and non-comparable (A1-OST and A0) to those generated via the subdivision in neoteleosts. These shortcomings in conjunction with other erroneous factors such as the definition of muscle sections based on variable attributes (insertion on the maxilla and the path of the ramus mandibularis trigeminus) and the adoption of an equivocal evolutionary model assuming the gain and loss of muscle sections, resulted in a totally unsatisfactory terminology. Not to belabor the point, but as an example, reference to only two of the nearly 30 studies dealing with the teleostean adductor mandibulae authored by Diogo 2 was explicitly used to refer to at least five different portions of the adductor mandibulae . These are:The nomenclatural scheme of Diogo and Chardon the entire segmentum mandibularis of Alepocephalus, Clupea, Denticeps, Elops, Hiodon and Salvelinus;the stego-malaris of Chanos, Cromeria, Danio, Hepsetus and Salminus;the ricto-stegalis of Aulopus;the malaris of Brycon and Diplomystes;the rictalis of Perca.endorictalis of cypriniforms and the rictalis of characiforms and siluriforms. Moreover, in Diogo and Chardon , the characiform Distichodus  and the gymnotiform Sternopygus , whereas the A0 section is inexplicably considered to be “exclusively found” solely in cypriniforms   : p. 261.adductor mandibulae which failed to reflect homologous components – the core critical aim of any naming convention. Symptomatic of the irreparable state of this nomenclatural system was the fact that the rictalis in the order Siluriformes has received at minimum 11 different designations despite having the same basic position, origin, and insertion in almost all members of the order. Curiously these identifiers span all the three available terms of the alphanumeric terminology for the facial sections:The sum of the above discussed problems perpetuated across more than a century resulted in a progressively complex alphanumeric terminology for the sections of the 1 or “lateral fibers of muscle b” in loricariids AA1-OST in auchenipterids, callichthyids and diplomystids A1-OST+A2A3′β in trichomycterids A2′ in trichomycterids A2α in bagrids 2A3′β in clariids AA2ventral in loricariids 1 in bagrids Adadductor mandibulae superficialis in sisorids external division in diplomystids partie latérale or “muscle a” in silurids e.g., A1βb″mα adductor mandibulae among teleosts. Since most of the problems associated with the alphanumeric terminology are inherent to mistaken underlying original premises, an adaptation of this nomenclature to reflect the homologies of the adductor mandibulae is impossible. Retention of the terms A1, A2, and A3 would only increase nomenclatural confusion, more so post the publications of Diogo and Chardon Authors were frequently forced to coin inordinately complex terms  reflective of the basic position of each muscle component, a definite advantage over the uninformative vague alphanumeric codes in the present naming convention. In this, the new nomenclature parallels the naming conventions applied to most other anatomical systems. Short names were selected for primary muscle components to facilitate combinations into relatively brief composite terms designating compound sections  and to allow easy aggregation of prefixes and adjectives to indicate subdivisions .We found this nomenclature could be successfully employed without complications in all examined teleosts ranging from the simple architecture of the adductor mandibulae in some basal teleosts lacking any trace of differentiation in the segmentum facialis .Confronted with the quandary resultant from the inherent problems with the alphanumeric terminology, it is preferable to create a new terminology for the facialis  to the hfacialis  and tetrTable S1Material examined.(PDF)Click here for additional data file.


Prediction of the location of culprit lesions responsible for ST-segment elevation myocardial infarctions may allow for prevention of these events. A retrospective analysis of coronary artery motion (CAM) was performed on coronary angiograms of 20 patients who subsequently had ST-segment elevation myocardial infarction treated by primary or rescue angioplasty and an equal number of age and sex matched controls with normal angiograms.There was no statistically significant difference between the frequency of CAM types of the ST-segment elevation acute myocardial infarction and control patients (p = 0.97). The compression type of CAM is more frequent in the proximal and mid segments of all three coronary arteries. No statistically significant difference was found when the frequency of the compression type of CAM was compared between the ST-segment elevation acute myocardial infarction and control patients for the individual coronary artery segments (p = 0.59).The proportion of the compression type of coronary artery motion for individual artery segments is not different between patients who have subsequent ST-segment elevation myocardial infarctions and normal controls. The three-dimensional motion of the heart is characterized by rotation (around the centre of gravity), radial displacement (towards or away from the center of gravity), and translational motion . The totMotion of individual segments of coronary arteries reflects the motion of the underlying myocardium. The classification system for different patterns of coronary artery motion (CAM) used in this study is derived from a system where CAM was classified into 10 patterns, which were grouped into 3 types: (1) compression type: the length of the arterial segment is shortened without vertical deviation of the artery; (2) displacement type: the location of the coronary artery shifts without change of the length or shape of the arterial segment; and (3) bend type: the coronary artery flexes into a curve[The compression type of CAM for individual artery segments is associated with stenosis and is aThe hypothesis to be tested in this study is that the compression type of CAM is more likely to be present in patients who have subsequent STEMI than in age and sex matched control patients with normal coronary angiograms.Twenty patients were identified who had coronary angiography after March 1998 and subsequently re-presented with a STEMI. STEMI was defined as ischemic chest pain with ST segment elevation of 1 mm in 2 contiguous limb leads or 2 mm in 2 contiguous chest leads. Patients were excluded if they had previous coronary artery bypass surgery or had stent thrombosis as the cause of STEMI. Twenty age and sex matched control patients were identified with normal coronary angiograms.The CAM patterns of coronary segments were assessed retrospectively in both the STEMI and control patients. For the STEMI patients, the coronary angiography performed before the STEMI was used. The assessment was made blinded to the location of the future culprit segment. The CAM classification of Konta and Bett was usedAssessment of CAM was made in up to fourteen segments of the coronary arterial tree. The segments were given a numerical label as shown in Figure Clinical risk factors  of all patients were obtained from the medical records.Chi-squared tests were used for comparison of frequencies between groups. All statistical analyses were performed using Stata .The Royal Prince Alfred Hospital Ethics Review Committee approved the research protocol (reference X10-0159). The research protocol did not include obtaining patient consent.The demographics for the STEMI and control patients are shown in Table The proportion of the compression type of CAM for individual artery segments for both patient groups is shown in Figure This study shows that the proportion of the compression type of coronary artery motion for individual artery segments is not statistically significantly different between patients who have subsequent STEMIs and age and sex matched controls.The main limitations of this study are its small sample size and the potential observer bias in the qualitative assessment of CAM. The technique relies on a visual assessment. Knowledge of the asymmetrical frequency distribution of culprit lesions in patients with STEMIs and the Although the exact pattern of CAM varies amongst individual patients, there are consistent themes of motion differences between the different coronary arteries,8 and alPreviously published work has shown that the compression type of CAM is a predictor of the location of stenosis and the The authors declare that they have no competing interests.AO and PK conceived the study. AO undertook the ethics application, data collection, data analysis, and manuscript preparation. KB recommended the statistical methods and supervised data analysis. JF, DR, AH and RD prepared the ethics application, performed manuscript revision and supervised the activities of AO. All authors except KB read and approved the final manuscript.


To the Editor:Mycobacterium ulcerans disease, commonly called Buruli ulcer, is an emerging infectious disease in West Africa  used water directly from the Couffo River. Other villages employed protected water sources for domestic purposes . These results are similar to Barker's findings in Uganda, which showed that families who used unprotected sources of water for domestic purposes had higher prevalence rates of Buruli ulcer than those who used boreholes . ConsequDetermining the complex relationship between distance from the Couffo River and the numbers of cases and level of protection of water supply is difficult. Our findings argue for the need to perform additional epidemiologic studies to understand more completely the key factors that determine the distribution of the disease in the entire commune of Lalo.


Neuromuscular electrical stimulation (NMES) for treating dysphagia is a relatively new therapeutic method. There is a paucity of evidence about the use of NMES in patients with dysphagia caused by stroke. The present review aimed to introduce and discuss studies that have evaluated the efficacy of this method amongst dysphagic patients following stroke with emphasis on the intensity of stimulation (sensory or motor level) and the method of electrode placement on the neck. The majority of the reviewed studies describe some positive effects of the NMES on the neck musculature in the swallowing performance of poststroke dysphagic patients, especially when the intensity of the stimulus is adjusted at the sensory level or when the motor electrical stimulation is applied on the infrahyoid muscles during swallowing. Diverse paramedical treatments for swallowing disorders usually carried out by speech and language pathologists (SLPs) are introduced in the literature. It is expected that these treatment methods help to recover the swallowing functions, improve nutritional status, and prevent from developing the dysphagia consequences . But, whNeuromuscular electrical stimulation (NMES) of the swallowing muscles is a relatively new therapeutic modality that is of great interest to the SLPs recently , 4. SeveThe present review aimed to introduce and discuss studies that have evaluated the efficacy of this method amongst dysphagic patients following stroke with emphasis on the intensity of stimulation (sensory or motor level) and the method of electrode placement on the neck. These two parameters can have important effects on the outcomes, but they had not been considered specifically by the previous published reviews , 5–7. MoThe external electrical stimulation on the swallowing muscles is applied with two general purposes: to cause muscle contractions and to stimulate the sensory pathways . In the In the sensory approach, the sensory threshold is usually identified as the lowest current level at which the patient feels a tingling sensation on his/her neck skin . ConsideElectrode placement always is a major challenge in surface electrotherapy especially on the small and overlapping swallowing muscles. Suprahyoid muscles including the anterior belly of the digastric, the mylohyoid, and the geniohyoid pull the hyoid upward and toward the mandible. Most of the infrahyoid muscles such as sternohyoid, omohyoid, and sternothyroid muscles lower the hyolaryngeal complex toward the sternum. Therefore, when the electrodes are placed on and around the thyroid cartilage, the motor electrical stimulation will pull the larynx downward . If the Freed et al.  introducn = 25), there were no statistically significant differences in the outcomes between groups  of patients who suffered from other musculature disorders respond appropriately to the inactive electrotherapy devices , 34. TheThe majority of the reviewed studies describe some positive effects of the NMES on the neck musculature in the swallowing performance of poststroke dysphagic patients, especially when the intensity of the stimulus is adjusted at the sensory level or when the motor electrical stimulation is applied on the infrahyoid muscles during swallowing. However, we still need to know more about the physiologic and neurologic effects of these therapeutic methods on the stroke patients' swallowing function. The identification of stimulation effects on the underlying pathophysiology of the swallowing disorders and on the central nervous system organization will help to design specific and individual treatment protocols.


P.falciparum resistance gene markers have been investigated during the malaria transmission October 2011 to February 2012. More than 1500 children and 700 pregnant women were recruited. The prevalence of malaria was comprised between 9% and 30% depending of the localization of the health center. It was found that acceptability of technicians to use rapid diagnostic tests was low and microscopy is still considered as the reference. A comparison between health centers and reference lab technicians showed similar level of in malaria diagnosis performance. The P.falciparum genetic diversity  and multiplicity of infection (1.7) do not show any reduction but parasite densities were lower than reported in studies conducted before the introduction of ACTs. As a conclusion: in order to improve quality of care and the acceptability of RDT, there is a need to provide a targeted training to heath workers.Since the introduction of artemisin-based combination therapies in the Republic of Congo, limited number of investigations have been conducted to evaluate the burden of the disease at the district level. The main goal of this study was to document laboratory-confirmed cases using rapid diagnostic tests of malaria in children and pregnant women attending health facilities located in Northern districts of Brazzaville and Pointe Noire which is the second main city of the Republic of Congo. As objective2, the malaria diagnostic performance of each health facility has been assessed and as objective3, genetic diversity, multiplicity of infection and the prevalence of


We consider the problem of sensorimotor delays in the optimal control of (smooth) eye movements under uncertainty. Specifically, we consider delays in the visuo-oculomotor loop and their implications for active inference. Active inference uses a generalisation of Kalman filtering to provide Bayes optimal estimates of hidden states and action in generalised coordinates of motion. Representing hidden states in generalised coordinates provides a simple way of compensating for both sensory and oculomotor delays. The efficacy of this scheme is illustrated using neuronal simulations of pursuit initiation responses, with and without compensation. We then consider an extension of the generative model to simulate smooth pursuit eye movements - in which the system believes both the target and its centre of gaze are attracted to a (fictive) point moving in the visual field. Finally, the generative model is equipped with a hierarchical structure, so that it can recognise and remember unseen (occluded) trajectories and emit anticipatory responses. These simulations speak to a straightforward and neurobiologically plausible solution to the generic problem of integrating information from different sources with different temporal delays and the particular difficulties encountered when a system - like the oculomotor system - tries to control its environment with delayed signals.


Management of diabetic foot problems presents a series of complex challenges for patients and for health care professionals. Appropriate guidance on best practice is essential to delivering high-quality care. The NHMRC guidelines for the management of diabetic foot problems in primary care have just been updated to address this issue. The guidelines have been developed using systematic reviews of the literature, and broad consultation of organisations representing the relevant health care professionals and patients. The development of the guidelines, the evidence considered and the recommendations developed will be reviewed.


Clarias gariepinus fish were also collected from the experimental Asa River and from the control Asa Dam water and were analysed for comparative histological investigations and bacterial density in the liver and intestine in order to evaluate the impact of pollution on the aquatic biota. The water pH was found to range from 6.32 to 6.43 with a mean temperature range of 24.3 to 25.8 °C. Other physicochemical parameters monitored including total suspended solids, total dissolved solids, biochemical oxygen demand and chemical oxygen demand values exceeded the recommended level for surface water quality. Results of bacteriological analyses including total heterotrophic count, total coliform and thermotolerant coliform counts revealed a high level of faecal pollution of the river. Histological investigations revealed no significant alterations in tissue structure, but a notable comparative distinction of higher bacterial density in the intestine and liver tissues of Clarias gariepinus from Asa River than in those collected from the control. It was inferred that the downstream Asa River is polluted and its aquatic biota is bacteriologically contaminated and unsafe for human and animal consumption.Water is a valued natural resource for the existence of all living organisms. Management of the quality of this precious resource is, therefore, of special importance. In this study river water samples were collected and analysed for physicochemical and bacteriological evaluation of pollution in the Unity Road stream segment of Asa River in Ilorin, Nigeria. Juvenile samples of  Water is vital to the existence of all living organisms, but this valued resource is increasingly being threatened as human populations grow and demand more water of high quality for domestic purposes and economic activities . The quavia the food chain p < 0.05)athogens ,39.Clarias gariepinus collected from experimental Asa River section depicted no significant alterations or pathological effects in the livers and intestines when compared with those collected from the control Asa Dam water. This result does not corroborate with similar studies on fish species of Tilapia zillii and Solea vulgaris from Lake Qarun in Egypt which observed histological alterations in the muscles including vacuolar degeneration and aggregation of necrosis in gills and inflammatory cells in hepatocytes of liver tissues [The histological findings on the tissue structures of the four different parts of  tissues .The observed histological alterations in the fishes studied in Lake Qarun was possible simply because the lake is a closed system which acts as a reservoir for agricultural and sewage drainage water and whose components are found to be polluted with heavy metals ,41. Howein situ river pollution impact of non-point source pollution, though it has been for chronic exposure studies on specific metal concentrations [Previous toxicological evaluation studies on the Amilegbe segment of Asa River by haematological and enzyme studies of rats fed the polluted river water revealed marked haematological changes and effects on enzymes of the rat after a period of eight weeks . This watrations –46.Nevertheless, the high microbial load observed on the gram-stained histological slides of the fish liver and intestine  and 8 isThe comparative study done between the catfish of the Asa Dam reservoir water (control) and the polluted Asa River segment revealed, by bacterial examination in the fish tissues observed through special staining, a comparatively significant alteration of the normal microbial flora of the catfish from the polluted river.4 of faecal coliforms (Escherichia coli) and that high concentrations of pathogenic microorganisms might occur in the digestive tract and intraperitoneal fluid of the fish even at low numbers of indicatory bacteria [In his work, Strauss reported that invasion of fish flesh by pathogenic bacteria was very likely if the fish were reared in water containing over 10bacteria . The valThis pollution impact study has proven that the downstream Asa River segment is indeed polluted. The study has been able to track the type of pollution to be more of faecal contamination by the evaluation of the bacteriological quality of the river water samples. Non-point sources of pollution which include the agricultural activities (pesticides and crop wastes) and domestic activities by the poorly planned settlers nearby the river as well as the point source discharge of industrial effluents along the industrial estate have been implicated to be causative to the poor quality of the river and its aquatic life.Clarias gariepinus caught from the polluted Asa River and the control Asa Dam water. However, this does not imply good quality of the aquatic life of the river as further investigation of the bacteria present in the fish tissues portrayed very high bacterial density in the tissues of Clarias gariepinus collected from the Asa River segment when compared to the tissues of Clarias gariepinus caught from the Asa Dam water. The implications of these findings may be that people dependent on this river water for domestic use including cooking, bathing, washing and even drinking or for agricultural uses like fishing and farming may be exposed to public health risks. Proper treatment is imperative for the river to be appropriate for potable, domestic and industrial purposes.This study has also shown that there were no significant tissue alterations observed during the comparative histological studies carried out on juvenile live samples of It is therefore recommended to coordinate different efforts at the level of the community dwellers and the government to rescue the downstream Asa River segment and its aquatic life from the current hazard-posing environmental problems.


We study the ever more integrated and ever more unbalanced trade relationships between European countries. To better capture the complexity of economic networks, we propose two global measures that assess the trade integration and the trade imbalances of the European countries. These measures are the network (or indirect) counterparts to traditional (or direct) measures such as the trade-to-GDP (Gross Domestic Product) and trade deficit-to-GDP ratios. Our indirect tools account for the European inter-country trade structure and follow (i) a decomposition of the global trade flow into elementary flows that highlight the long-range dependencies between exporting and importing economies and (ii) the commute-time distance for trade integration, which measures the impact of a perturbation in the economy of a country on another country, possibly through intermediate partners by domino effect. Our application addresses the impact of the launch of the Euro. We find that the indirect imbalance measures better identify the countries ultimately bearing deficits and surpluses, by neutralizing the impact of trade transit countries, such as the Netherlands. Among others, we find that ultimate surpluses of Germany are quite concentrated in only three partners. We also show that for some countries, the direct and indirect measures of trade integration diverge, thereby revealing that these countries  trade to a smaller extent with countries considered as central in the European Union network. The structure of European trade has undergone deep transformations last two decades, such as the integration of former socialist economies and the introduction of the Euro. Across the years, under these events and the evolution of the world trade, the structure of European trade has been modified thoroughly, generally speaking in the sense of higher mutual trade but also in terms of acuter trade imbalance.Among the indicators that can quantify the structure of trade, one finds direct measures of bilateral trade such as the trade-to-GDP ratio (where trade is defined as the sum of imports and exports of goods and services) and the deficit-to-GDP ratio (where trade deficit is defined as the difference between imports and exports). The first one is a measure of the trade integration of a country within its environment. The second one is a measure of trade imbalance between a country and its partners. These measures are direct in the sense that they only take into account the interaction of one country with its trade partners, neglecting the remainder of the network.In this paper, we propose two complementary methods for analysing the global structure of a trade network. These methods take part in the development of complex networks theory for economics . Such a flow may for instance exhibit a four -way cycle where country The relevance of considering the indirect flows can be illustrated with the example of the Netherlands. This country plays the role of a hub in the trade network, with imports from the rest of the world transiting through the Netherlands to the other European countries. The direct measure would only note that the Netherlands have a trade surplus with all European countries, neglecting that most of the trade only transits through the Netherlands from an initial exporter to a final importer. The indirect measure cleans these network-related effects to reveal the ultimate trade debtors and creditors. The indirect measure is thus also a relevant tool to assess the competitiveness of a country. This example illustrates the case of a chain of production with goods transiting through the Netherlands, but the relevance of the indirect measure is more general, and not confined to chains of production. The case of a country A exporting wheels to country B, which will then export cars (and the wheels herewith) to a country C is not fundamentally different from the case of a country A exporting beer to country B, letting him devote more resources (the ones previously affected to beer production) to wheel production and cars export to country C. At the end, country A is the ultimate creditor and country C the ultimate debtor, given the resources the former used for the final consumption of the latter.This Flow Decomposition Method and the associated notion of indirect trade deficit are the main conceptual innovations of this paper. These tools bear some superficial resemblance with the cycle, middleman, in and out statistics developed in In the second method, we make a thought experiment in which we follow the random tribulations of a dollar travelling randomly through the trade network. At stationarity, the fraction of time spent by the random dollar, called the PageRank Trade integration between two countries is commonly apprehended through bilateral trade-to-GDP ratio. The larger the ratio the more integrated the country with its partners. This traditional measure is direct in the sense that this statistics does not take into account the position, or centrality, of the trade partners in the network. Let us consider a mostly autarkic country As a case study, we show how these indirect measures complement their direct counterparts in the context of the European trade. We especially study the role of the Euro in the development of trade within Europe. The benefit of sharing a common currency (by decreasing the cost of cross-border transactions) depends on the degree of trade integration. The higher the trade integration, the larger the benefits. It is therefore crucial to dispose of fine measures of trade integration. We show how our methods can better capture the complexity of the trade network as complement to the usual direct measures.We study the network of trade flows between 24 countries of the European Union, using data provided by the International Monetary Fund (IMF) and the World Bank (WB). The two datasets provide different information about the network: the IMF dataset contains the total exports between each pair of countries of the European Union in current US Dollar value, while the WB dataset provides the gross domestic product (GDP) of each country and the consumer price index. By combining those two datasets, we build a network of trade flows between European countries. Since each export from a country The data ranges from 1993 to 2007. By starting in 1993, we avoid the potential structural break related to the removal of EU internal customs (which had an impact on the recording of trade flows). By ending in 2007, we avoid the specific impact of the financial crisis. We therefore have a time period of 15 years. Our dataset originally contains the data of the 27 members of the European Union. However, Malta and Cyprus have been removed from the dataset since large parts of their data were missing. Also, Belgium and Luxembourg are recorded together for the so-called Belgium-Luxembourg Economic Union  to (6) take the form of linear or convex quadratic programs that can be solved efficiently with usual methods. An example of such a decomposition is given on The trade integration of a country with another country or group of countries is usually measured by the bilateral trade-to-GDP ratio. The larger the ratio the more integrated the country with its partners. This measure is direct in the sense that this statistics does not take into account the position, or centrality, of the trade partners in the network. We propose to use commute times of a random walking dollar in the trade network as a measure of integration of countries with respect to one another taking into account their direct and indirect ties. A small commute time between two countries implies a small trade distance between those countries, i.e. a high mutual integration.The commute-time distance, defined in the general context of random walks over graphs or Markov chains We imagine that all the money in circulation in the world is materialised in one-dollar notes. We identify one particular note and we track it as it switches from hand to hand. We suppose that every dollar paid out by an individual is randomly uniformly chosen among all the dollars in her possession. For the moment we suppose also time invariance: every two individual who have economic contacts, have regular economic contacts whose frequency and intensity (measured for instance by the number of dollars exchanged in a year) is constant in time, thus resulting in a constant expected fortune (number of dollars possessed) of individuals through time. The probability of presence of a random walker in a given node of a network is sometimes called the PageRank of the node, in analogy with a well known search tool on the World Wide Web In our case, nodes represent individual countries, and we assume that the random dollar is exchanged at regular discrete-time steps, rather than in continuous time. We can choose a restricted network  and perform a random walk on restricted network, which corresponds to the random walk in the global network conditional to the fact that the random dollar stays in the restricted network. In this paper, we study the random dollar walk conditional to the fact that it corresponds to a trade of goods and services produced in the year within Europe. This excludes the non-European countries but also the trade of second-hand goods already accounted for in previous years.In this network, the PageRank is a truly global quantity which gives a useful indication of the centrality of a country in the network of exchanges, as exemplified in Let The Euclidean commute-time distances embeds the national economies as points in a geometric space, where proximity of two countries indicates that a large fraction of the GDP of both countries participes to trade between them, either directly or through a chain of intermediate partners. Assuming that Commute times can be further interpreted in terms of the propagation of a small perturbation of one country's activity to another country, as the following simplistic thought experiment suggests. Imagine indeed that a new activity is created in country So far we have presented commute-time distance as a pairwise relationship indicating mutual integration of two countries. However we are often more interested in assessing how a country is integrated in the regional or global economy, rather than with a specific partner. Clearly, a regional economy is tightly integrated as a whole, if all the national economies are close to each other in terms of commute-time distances, which translates into a quick propagation of shocks across the network through direct or domino effects. This can be assessed by the variance of the countries in their Euclidean space representation, which is the average square commute-time distance to the centre of mass of the region. The square distance of one particular country to the centre of mass indicates how integrated this country is with the regional network as a whole, rather than with a specific country.We now explain how to compute the commute-time distances. Let In order to facilitate the visualisation or analysis of data, one can perform a principal component analysis of the We now illustrate how the tools derived from the flow decomposition approach can help to better understand the European trade network. The symmetric, cyclic and acyclic components of the inter-country trade structures represent three types of economic interactions. The symmetric part reflects the pairwise exchanges where both countries have neither trade deficit nor surplus. The cyclic part reflects the same kind of interaction, but circulating over a larger number of actors. Symmetric interactions can be seen as cycles of length 2. Finally, the third part contains the transfers of money that flow from countries that accumulate deficits to surplus-making countries. The study of those three components provides insights on the evolution of the European trade network.Firstly, the largest fraction of the European trade is made of symmetric exchanges , which rThis acyclic component provides a new way to consider the trade imbalances in a network of countries. Contrarily to the traditional approach focusing on the trade deficit-to-GDP between two countries, a direct measure, the tool we propose goes farther by considering the indirect exposures to get at the end a finer understanding of the ultimate debtors and creditors of trade flows. The example of the Netherlands, see The relevance of the indirect measure of the trade deficit is double. First, it reveals ultimate deficits/surpluses, cleaned from transit node effects. As such, the indirect measure is an analytic complementary tool to the direct trade deficit-to-GDP measure. To the extent that a direct trade deficit-to-GDP can reveal both a relative competitiveness problem and a specific role in the world trade network , its interpretation might be delicate. The indirect measure by neutralizing the network component of the deficit can thus be considered as a more precise measure of competitiveness. It better captures specific competitiveness problems since it controls for country specializations in the trade network. Secondly, it reduces the size of the information matrix. The indirect measures reduce the bilateral trade surpluses/deficits matrix to a relatively small subset of ultimate bilateral trade deficits/surpluses. Countries who measure the evolution of their competitiveness can thus focus on the sole countries with which indirect trade deficits prevail. For example, More generally, the rising complexity and imbalances of the trade network, where some countries record large surpluses  and others large deficits  awake the debate on the need of a global coordinated adjustment plan involving all countries  is one of the main benefits derived from the common currency. We here illustrate how the network tools provided by the commute-time distance approach help to deepen the understanding of the European trade network, the degree of integration of the countries in the network and their integration dynamics.These distances, built upon the information available in the whole European network, are global, or indirect, measures of the country trade integration, as opposed to the direct trade integration computed as bilateral trade-to-GDP ratio.We first present in In the same figure, we also represent individual trajectories through their square distance to the centre of mass of the European Union, in order to show the variety of situations aggregated into the variance. For example, the United Kingdom, albeit outside the Euro zone, is actually better integrated to Euro zone than some Euro zone countries such as Spain. Nevertheless from the years 2000 it tends to split away from the centre of mass. Interestingly, this tendency is also observed for some Euro zone countries as we observe in another visualization hereafter. The comparison reveals that the average inter-country trade distances, as measured by their variance, is much smaller for Euro zone countries than for European countries (in or out of the Euro zone), revealing a larger integration among Euro countries. We also note that the variance decreases, mostly at the beginning of the period, with no specific break in 1999 for the introduction of the Euro. Some preliminary studies estimated the effect of the launch of the Euro on the volume of trade within the Euro zone countries to be in the range of 8% to 16%  or deficits (−) of Austria toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S2Evolution of the direct and indirect measures of trade imbalances for Belgium and Luxembourg. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Belgium and Luxembourg toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S3Evolution of the direct and indirect measures of trade imbalances for Bulgaria. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Bulgaria toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S4Evolution of the direct and indirect measures of trade imbalances for Czech Republic. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Czech Republic toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S5Evolution of the direct and indirect measures of trade imbalances for Demnark. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Demnark toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S6Evolution of the direct and indirect measures of trade imbalances for Spain. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Spain toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S7Evolution of the direct and indirect measures of trade imbalances for Estonia. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Estonia toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S8Evolution of the direct and indirect measures of trade imbalances for Finland. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Finland toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S9Evolution of the direct and indirect measures of trade imbalances for France. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of France toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S10Evolution of the direct and indirect measures of trade imbalances for Germany. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Germany toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S11Evolution of the direct and indirect measures of trade imbalances for Greece. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Greece toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S12Evolution of the direct and indirect measures of trade imbalances for Hungary. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Hungary toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S13Evolution of the direct and indirect measures of trade imbalances for Ireland. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Ireland toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S14Evolution of the direct and indirect measures of trade imbalances for Italy. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Italy toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S15Evolution of the direct and indirect measures of trade imbalances for Latvia. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Latvia toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S16Evolution of the direct and indirect measures of trade imbalances for Lituania. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Lituania toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S17Evolution of the direct and indirect measures of trade imbalances for the Netherlands. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of the Netherlands toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S18Evolution of the direct and indirect measures of trade imbalances for Poland. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Poland toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S19Evolution of the direct and indirect measures of trade imbalances for Portugal. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Portugal toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S20Evolution of the direct and indirect measures of trade imbalances for Romania. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Romania toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S21Evolution of the direct and indirect measures of trade imbalances for Slovakia. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Slovakia toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S22Evolution of the direct and indirect measures of trade imbalances for Slovenia. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Slovenia toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S23Evolution of the direct and indirect measures of trade imbalances for Sweden. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of Sweden toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.Figure S24Evolution of the direct and indirect measures of trade imbalances for UK. The figures in each cell correspond to direct trade surpluses (+) or deficits (−) of UK toward countries listed on the rows. The colors correspond to the indirect measures of trade imbalances, as computed by the Flow Decomposition Method, with ultimate surpluses in green and ultimate deficits in red.(TIFF)Click here for additional data file.


Retrograde ureteropyelography plays a vital role in imaging of the upper tract, particularly in aiding the diagnosis of upper tract urothelial cancers.Under radiological imaging, a retrograde ureteric catheter is placed in the upper ureter/renal pelvis. The urethral catheter is placed into the urinary bladder, the balloon inflated and gently pulled down, taking care not to displace the ureteric catheter. The tips of the small artery forceps are used to puncture a hole into the distal end of the urethral catheter . The disThis technique allows the ureteric catheter to be secured firmly until the formal retrograde studies are performed in the radiology department. Furthermore, the closed system minimises the risks of introducing infection into the urinary tract.


Recent findings illustrate how changes in consciousness accommodated by neural correlates and plasticity of the brain advance a model of perceptual change as a function of meditative practice. During the mind-body response neural correlates of changing awareness illustrate how the autonomic nervous system shifts from a sympathetic dominant to a parasympathetic dominant state. Expansion of awareness during the practice of meditation techniques can be linked to the Default Mode Network (DMN), a network of brain regions that is active when the one is not focused on the outside world and the brain is restful yet awake  has been shown to decrease activation of the DMN as compared to DMN activation in techniques requiring no effort. The TM technique utilizes automatic self-transcending to allow the mind to settle to a state of quiescence (Alexander et al., Activation of the DMN has been found to be increased during periods of low cognitive load and decreased under greater executive control. Findings reflect differences in specific meditation practices employed, which may also be attributed to methodological differences in measurement of fluctuating cognitive states (Hasenkamp et al., Recent research illustrates how the neural correlates and plasticity of the brain accommodate changes in consciousness. Neural correlates of expanding awareness during the mind-body response illustrate how the autonomic nervous system shifts from a sympathetic dominant to a parasympathetic dominant state. We have attempted to synthesize the literature in order to advance a model illustrating meditation's dynamic mind-body response, and associations are made with the cardiac and respiratory center, the thalamus and amygdala, the DMN and cortical function connectivity.Synchronization of the hemodynamic response during meditation was shown to lead to inhibition of the limbic system, and deactivation of DMN leads to an increase in cortical functional connectivity. This article provides evidence to support the mechanism of neurophysiological changes during meditation at the cellular level based on neurovascular coupling, and at the global brain activity level from the autonomic response generated by cardiorespiratory synchronization. Future research will benefit from use of a standardized set of psychophysiological variables and imaging protocols, for comparison of studies different kinds of meditation, that would foster clearer understanding of the relationship between the DMN and experiences during meditation (Travis et al.,


Standard methods including pharmacotherapy, radioiodine and surgery cannot always be applied in treatment of thyroid diseases. The limitations of these methods are: drug intolerance and their side effects, too low radioiodine uptake, high risk of surgery. The obliteration of thyroid arteries seems to be an alternative method which could be used in the stiuation of ineffective standard treatment. It is based on shut down of blood flow in chosen thyroid arteries by injection of embolizative material  into the vessels. The consequence of acute ischemia is a septic necrosis of the glandular tissue in a field being supplied by this particular artery. Further repair processes and fibrosis lead to the reduction of an active thyroid hormone synthesis and decrease of thyroid volume. Effects of the embolization on apoptosis induction and modulation of autoimmune reactions are also observed. Preoperative selective embolization of a huge goiter or thyroid cancer improves surgery outcomes, reduces the risk of haemorrhage and damage to surrounding tissue. Palliative use of embolization in advanced stages of thyroid cancer reduces symptoms and improves quality of life. Little invasive nature of this procedure in comparison to surgery, the lack of serious undesirable coincidence makes the embolization of thyroid arteries an attractive form of therapy, which may become a therapeutic option in many difficult clinical situations and may improve the effectiveness of treatment of thyroid disease. The authors present the experiences gained in their institution with conclusions as follows:1. As a result of using embolization of thyroid arteries in the treatment of selected thyroid diseases the following observations have been made: a significant reduction in goiter volume with resolution of compression symptoms of adjacent organs, reduction of the concentration of thyroid antibodies characteristic for patients with Graves' disease (TRAb), cure of hyperthyroidism in 71% of patients with thyrotoxicosis. Embolization procedure was not associated with the occurrence of undesirable side effects, such as the clinical symptoms associated with increased concentration of free thyroid hormones, and induction or exacerbation of pre-existing autoimmune thyroid disease.2. Thyroid artery embolization had no significant influence on activity of the parathyroid glands, regardless of the number and quality of closed vessels.3. Thyroid artery embolization is an effective and safe treatment of selected thyroid diseases as an alternative to conventional forms of therapy.


Diflavin reductases are essential proteins capable of splitting the two-electron flux from reduced pyridine nucleotides to a variety of one electron acceptors. The primary sequence of diflavin reductases shows a conserved domain organization harboring two catalytic domains bound to the FAD and FMN flavins sandwiched by one or several non-catalytic domains. The catalytic domains are analogous to existing globular proteins: the FMN domain is analogous to flavodoxins while the FAD domain resembles ferredoxin reductases. The first structural determination of one member of the diflavin reductases family raised some questions about the architecture of the enzyme during catalysis: both FMN and FAD were in perfect position for interflavin transfers but the steric hindrance of the FAD domain rapidly prompted more complex hypotheses on the possible mechanisms for the electron transfer from FMN to external acceptors. Hypotheses of domain reorganization during catalysis in the context of the different members of this family were given by many groups during the past twenty years. This review will address the recent advances in various structural approaches that have highlighted specific dynamic features of diflavin reductases. Flavoproteins represent 1%–3% of all proteins present in prokaryotic and eukaryotic genomes  and abouThis diflavin reductases family includes the NADPH-cytochrome P450 reductase , the flavoprotein subunits of bacterial sulfite reductase  and of the mammalian methionine synthase reductase , the reductase part of the nitric oxide synthase  and of cytochrome P450-BM3  and the novel reductase 1 cytoplasmic protein (NR1).c (cyt c) reductase . A. A130]. ntal CPR .More recently, the analysis of chimeric CPR combining domains from yeast and human CPR highlighted the role of interdomain interface and recognition in diflavin reductase activity and conformation . The eleInterestingly, the two opposite chimeras exhibit kinetic behaviors analogous to those of the rat nNOS mutants in which the modification of a single residue, Arg1229, located on the interface between the flavinic domains, destabilized the interdomain recognition by disrupting one specific electrostatic interaction . Like chThese chimeras combining the three NOS isoforms, different CPR or the NOS and the CPR clearly demonstrate the capacity of distant diflavin reductases to exchange individual domains while totally or partially preserving their catalytic activities. CPR and NOS, and probably other diflavin reductases, are not only sharing high structural homologies. The presence of acceptable ET capacities in these different chimeras prove that, despite the architectural complexity of the regulatory elements present in NOS but absent in the other members of the family, the ET mechanisms of all diflavin reductases may involve the same structural reorganization steps. It seems then reasonable to propose that the dynamical events hypothesized from the various biochemical analyses of NOS and CPR may as well exist in all other diflavin reductases.The above-mentioned results did not constitute a solid proof of the dynamical behavior of diflavin reductases, but they eventually cast a strong support of the existence of domains movements. In addition, the parameters controlling those movements, if partially understood in the case of the NOS, remained totally unknown for the other members of the diflavin reductase family ,92. Someet al.[236TGEE239, PDB ID: 3ES9), crystallized with three molecules in the crystallographic cell. As illustrated in c reductase activity, most probably due to the incapacity of the catalytic domains to come to a position competent for interflavin ET. Consequently, the detection of this new conformation on an incompetent form of the enzyme raises the question about its existence in the course of the catalytic cycle.In 2009, two groups published novel crystallographic structures of mutant or chimeric CPR demonstrating the existence of alternate conformations different than the hitherto unique closed conformation ,137. Thec), but nevertheless remained capable of reducing other artificial and natural acceptors such as ferricyanide and P450-3A4 with a complete conservation of the electron pathway. Interestingly, the backbone of YH is almost completely conserved (RMSD 0.9 Å and 0.46 Å for the FAD and FMN domains respectively) except for the linker domain for which only a limited number (3) of residues have their Psi and Phi angles completely changed. An analysis of the interdomain interface of YH CPR [On the other hand, our group published the structure of one of the abovementioned yeast-human chimeric CPR (YH)  values and predicted RDC values using the closed structure. This NMR study unambiguously proved that the CPR adopts the same conformation in solution and in the crystal environment. Interestingly, we also showed the high flexibility of the linker region between the FMN and connecting domain in the nanosecond timescale. The CPR can thus be described as two beads (FAD and FMN domains) forming a stable interface bridged by a flexible string. Our results are in sharp contrast with the previous SAXS/NMR analysis. This might be explained by slightly different (but yet unidentified) experimental conditions. Since the CPR enzyme used for the NMR study is fully active, we postulated that the opening of the structure required in the course of the reaction must be provoked by some (yet unknown) molecular trigger such as substrate binding or flavin reduction.Lastly, our groups revisited the solution properties of CPR by NMR . This la+) binding while open states are favored in the absence of the bound coenzyme. However, ELDOR spectroscopy describes conformational distributions exhibited by the proteins just before their internal motions are quenched by rapid freezing at 80 K. Therefore, the observed distance distribution may not represent distances between points on heavy atoms, but rather a weighted mean of the unpaired electron spin density distribution over the flavosemiquinones in absence of domain mobility. Nonetheless, the distance variations observed upon NADP+ binding and salt effects were in agreement with the SAXS experiments [Analysis of CPR dynamics using electron-electron double resonance (ELDOR) allowed a fine description of the conformational sampling of human CPR in the di-semiquinone state (one electron reduced FMN and one electron reduced FAD) . The auteriments .+-bound CPR are in good agreement with the observed distances in the available closed crystal structures  and wit. The la that converge towards the existence of a wide conformational space that the human CPR may sample in solution. Furthermore, the energy landscape appears to be largely influenced by substrate binding or flavin reduction, which may reveal the complex domain rearrangement during the catalytic reaction. However, despite the huge recent progress, a thorough characterization of the CPR is still lacking that may include a better understanding of the structure and dynamics of the extended conformation and its interactions with partners and a more precise description of the time-dependent conformational change during the catalytic cycle. Similarly, the concepts developed for the CPR will have to be tested for the other related proteins.kInt and that the deshielded state is the only one competent for external ET (rate constant kExt). Using such a simple kinetic model linking for the first time conformational sampling and electron transfer they have been able to reproduce some experimental data on NOS. For example, this model explains how the slow conformational equilibrium, and hence the supposed conformational motion of the FMN domain, directly controls the intensity of the slow and fast phase of FAD reduction and the electron flux to cyt c[versus the fraction of (de)shielded state which nicely fits experimental data obtained on various nNOS forms [+ release steps are all integrated in a single step (kInt). In addition, there are experimental evidences for significant effects of flavin reduction and cofactor binding on the conformational equilibrium, which are not taken into account in the model. It seems then possible to improve the kinetic model at the expense of additional data collection for validating the increased number of elementary steps. There is no doubt that future investigations on the coupling between conformations sampling and kinetic properties of diflavin reductase will provide invaluable clues on the microscopic behavior of the enzyme at work.Different models have been proposed in the past to describe the successive electrons transfers ,144, how to cyt c. In addiOS forms . HoweverStarting from the first published CPR structure, in 1997, the scientific community has tracked avidly alternate architectures of diflavin reductases that would be compatible with ET to external acceptors. We have now plenty of evidences that, at least for CPR and NOS, reorientation of the FMN and FAD domains occurs at some stage during the electronic cycles. The alternative model described with the yeast CPR and involving the rotation of the FMN cofactor instead of the FMN domain seems not to fit with the very recent evidences of domain movements in human and rat CPR. As of today, the model involving conformational changes is really favored. The fact that several structural organizations were characterized by different methods seems to indicate that diflavin reductases may exist as a mixture of some discrete or continuous conformations in equilibrium. This equilibrium appears to be easily disturbed by mild change in working conditions, at least for the oxidized form of the CPR, suggesting that great care should be taken when comparing structural studies carried out in different laboratories. As a result the published crystallographic structures probably represent the most populated conformations depending on the enzyme considered (wild-type or mutant). Even if these crystallographic structures do not correspond to highly populated conformers in solution, they still demonstrate that reorientation of the catalytic domains occur with almost no change within the backbone of the domains themselves. This is also true for the connecting domain of CPR for which no specific role has yet been assigned. This connecting domain, as well as the various regulatory domains of NOS or MSR having more complex catalytic regulation, probably plays a very important role in the sensing mechanisms and in the control of the domains structural reorganization. The surfaces of these regulatory domains, being in direct contact with both catalytic domains, are probably the place where this information exchange takes place.That being said, we still lack information on the possible sensing mechanisms and how they are transmitted within the enzyme prior any structural reorganization. The involvement of cofactors and redox potential were described. Whether these factors are involved in changing existing conformational equilibria (by selectively binding to and lowering the energy of extended conformations) or directly impact structural points that could trigger domain reorganization is still under debate and will probably be the subject of intense and ardent research in the next years. Another open question concerns the role of the physiological acceptors in the control of these movements. From the simpler model of CPR to the more evolved NOS, the regulation of ET in diflavin reductases is of crucial importance for the enzyme and most probably to avoid electron leakage to oxygen and the consequent production of toxic ROS. It is likely that the presence or absence of these acceptors drive the equilibrium between the various conformations and therefore may also constitute some of the necessary triggers. Such propositions will probably constitute future research directions in the field of diflavin reductase mechanisms.