Toxoplasma gondii in the etiopathogenesis of schizophrenia is supported by epidemiological studies and animal models of infection. However, recent studies attempting to link Toxoplasma to schizophrenia have yielded mixed results. We performed a nested case-control study measured serological evidence of exposure to Toxoplasma gondii in a cohort of 2052 individuals. Within this cohort, a total of 1481 individuals had a psychiatric disorder and 571 of were controls without a psychiatric disorder. We found an increased odds of Toxoplasma exposure in individuals with a recent onset of psychosis . On the other hand, an increased odds of Toxoplasma exposure was not found in individuals with schizophrenia or other psychiatric disorder who did not have a recent onset of psychosis. By identifying the timing of evaluation as a variable, these findings resolve discrepancies in previous studies and suggest a temporal relationship between Toxoplasma exposure and disease onset.A possible role for  Toxoplasma gondii has been previously associated with an increased risk of serious psychiatric disorders such as schizophrenia. However, this association has been found in some studies and not others. We examined whether the differences among previous studies might be explained by the timing of patient evaluation and testing. We found that individuals who were evaluated soon after the onset of psychosis had increased odds of exposure to Toxoplasma gondii as evidenced by the measurement of antibodies in their blood. However. we did not find an increased rate of exposure to Toxoplasma gondii in individuals who had a diagnosis of schizophrenia or bipolar disorder but who did not have recent onset psychosis. Our findings are consistent with Toxoplasma exposure occurring around the time of onset of psychiatric symptoms in individuals with schizophrenia. Our findings might lead to the evaluation of new methods for the early treatment of schizophrenia in some individuals.The protozoan parasite  Toxoplasma gondii is an apicomplexan protozoan with a worldwide distribution. Felines serve as definitive hosts for Toxoplasma and can support the complete life cycle of the organism including sexual reproduction and the shedding of oocysts in the feces. Most other species of warm-blooded animals support the replication of portions of the Toxoplasma life cycle including asexual reproduction and the development of tissue cysts in multiple organs including the brain. Humans can become infected with Toxoplasma through the ingestion of oocysts shed from cats into the environment or by the consumption of tissue cysts in the meat of infected food animals such as pigs, sheep, and cows. Human fetuses can also become infected through vertical transmission from the mothers, although this mode of transmission is relatively rare compared to the other modes of transmission.As in the case of other intermediate hosts, initial exposure to Toxoplasma in humans can lead to the formation of tissue cysts in multiple organs including the brain. Exposure also leads to a vigorous immune response evident from the presence of specific antibodies directed at Toxoplasma proteins. Previously, tissue cysts were not thought to cause symptoms in immune competent hosts. However recently studies have documented that tissue cysts are engaged in active metabolism and interaction with the host . AccordiToxoplasma gondii. An association between Toxoplasma and schizophrenia was first made in 1953 [Schizophrenia is the psychiatric condition that has been most extensively studied in terms of association with  in 1953 However recently a number of studies have also been reported which did not find a significant association between serological evidence of Toxoplasma and risk of schizophrenia –13.A metWe postulated that, in areas of low Toxoplasma prevalence, individuals with the recent onset of the symptoms of schizophrenia would be more likely to have evidence of exposure to Toxoplasma than individuals with established schizophrenia who are receiving antipsychotic therapy.The study population consisted or 2052 individuals with recent onset psychosis, schizophrenia, bipolar disorder, major depressive disorder, or non-psychiatric controls who were enrolled during the period January 1999 through May 2017 in the Stanley Research Program at Sheppard Pratt, Baltimore, Maryland, USA. This cohort, which is ongoing, has been recruited for the study of the association between infection, immunity, and psychiatric disorders. Detailed descriptions of the methods employed for the recruitment and analysis of the cohort have been as previously described [The inclusion criterion for recent onset psychosis was the onset of psychotic symptoms for the first time within the past 24 months defined as the presence of a positive psychotic symptom of at least moderate severity that lasted through the day for several days or occurred several times a week and was not limited to a few brief moments and which was not substance-induced. Participants meeting the criteria for a recent onset of psychosis could have a DSM-IV diagnosis from amoThe inclusion criterion for individuals with schizophrenia was a diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder. The inclusion criterion for individuals with bipolar disorder included a diagnosis of bipolar I disorder, bipolar II disorder, or bipolar disorder not otherwise specified. Those with major depressive disorder had either a single episode or recurrent episodes. Participants who met the criteria for recent onset of psychosis and another diagnosis were assigned to the recent onset group.The psychiatric participants were recruited from inpatient and day hospital programs of Sheppard Pratt and from affiliated psychiatric rehabilitation programs. The diagnosis of each psychiatric participant was established by the research team including a board-certified psychiatrist and based on the Structured Clinical Interview for DSM-IV Axis 1 Disorders  and avaiThe inclusion criterion for the non-psychiatric control individuals was the absence of a current or past psychiatric disorder as determined by screening with the DSM-IV Axis I Disorders, Non-patient Edition The contrParticipants in all groups met the following additional criteria: age 18–65 (except the control participants who were aged 20–60); proficient in English; absence of any history of intravenous substance abuse; absence of intellectual disability by history; absence of HIV infection; absence of serious medical disorder that would affect cognitive functioning; absence of a primary diagnosis of alcohol or substance use disorder per DSM-IV criteria. The occurrence of psychosis not of recent onset was not an exclusion criterion for individuals in the bipolar disorder or major depression diagnostic groups.All participants were individually administered a brief cognitive battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Form A at the study visit. This battery measures a range of domains and yields a scaled Total Score with a nominal population mean of 100., ParticiToxoplasma gondii using solid phase enzyme immunoassay as previously described. Assay reagents were obtained from IBL America, Minneapolis Minn. A standard sample with a known amount of antibody was also analyzed in each assay run. For each antibody measurement, a sample was considered to be reactive if it generated a signal which was at least 0.8 times the value generated by the standard as previously described[Each participant had a blood sample obtained, generally at study enrollment. For 1875 (91.4%) if the study individuals the sample was obtained within 90 days of intial screening. Plasma was separated from the blood sample by centrifugation and stored at -70 until testing. At the time of testing, the sample was thawed and test for IgG class antibodies to Univariate analyses were performed by means of analysis of variance for continuous variables and Pearson’s chi square for categorical variables. The odds ratios associated with seropositivity and clinical diagnosis was calculated by the use of logistic regression models employing age, gender, race, maternal education (as a marker of socioeconomic status), and place of birth (United States or Canada vs other countries). These covariates were selected since they have been previously shown to be associated with the prevalence of antibodies to Toxoplasma and other infectious agents. Missing data were added by imputation. All analyses were performed by STATA Version 12, College Station, Texas.This research was approved by the Institutional Review Boards of the Sheppard Pratt Health System and the Johns Hopkins School of Medicine. All participants were at least 18 years of age and provided written informed consent.There were a total number of 2052 individuals in the study population. These included 221 individuals with the recent onset of psychosis, 752 individuals with established schizophrenia, 444 individuals with bipolar disorder without a recent onset of psychosis, 64 individuals with major depressive disorder without a recent onset of psychosis, and 571 control individuals without a psychiatric disorder. Of the 221 individuals with recent onset psychosis, 206 (93.2%) were hospitalized at the time of study recruitment, either in the inpatient service or day hospital. Of the 752 individuals with schizophrenia without a recent onset of psychosis, 141 (18.8%) were hospitalized at the time of recruitment, Of the 444 individuals with bipolar disorder without the recent onset of psychosis, 281 (63.3%) were hospitalized at the time of recruitment. A total of 59 (92.2%) of the 64 individuals with major depressive disorder without the recent onset of psychosis were hospitalized at the time of recruitment. The demographic and clinical characteristics of the population are depicted in 2 = 11.8, p < .017). This difference was further explored by means of logistic regression models employing age, gender, race, maternal education (as a measure of socioeconomic status) and birth outside of the United States or Canada. As depicted in As noted in Toxoplasma gondii as determined by antibody measurement. This increase was independent of demographic factors associated with Toxoplasma exposure such as age, place of birth and socioeconomic status. The odds ratio associated with Toxoplasma exposure in our population with recent onset psychosis was, 2.44 . This odds ratio is similar to that reported in some recent meta-analyses examining the association between Toxoplasma and recent onset psychosis and schizophrenia [We found that individuals with recent onset psychosis had a significantly increased rate of exposure to ophrenia , 23. It On the other hand, the level of Toxoplasma exposure in our population of individuals with established schizophrenia or bipolar disorder, while somewhat elevated, did not differ significantly from that of the control population. It is of note that the individuals with these disorders were derived from the same geographic area and tested by the same methods as those employed for the analysis of individuals with recent onset psychosis, suggesting that these differences are not related to socio-demographic factors.The reasons for finding an increased rate of Toxoplasma exposure in individuals with recent onset psychosis but not established schizophrenia is not known with certainty but may be related to changes in antibody levels over time. It had previously been thought that Toxoplasma seropositivity was lifelong. However this concept has been called into question on the basis of longitudinal and population based analyses , 25 leadOur finding that individuals with established schizophrenia or bipolar disorder did not have increased odds of having Toxoplasma exposure is consistent with several other studies performed in low prevalence populations where individuals were receiving medications for extended periods of time. Our findings thus serve to resolve some of the discrepancies in past studies based on differences in regard to the timing of illness onset and assessment for Toxoplasma exposure as well as the receipt of medications. Prospective longitudinal studies relating to the timing of exposure to Toxoplasma and the onset of psychiatric disorders are necessary to directly address the issue of the temporal relationship between Toxoplasma exposure and subsequent risk of psychiatric disorders. These studies should include measurements of additional class-specific and subclass specific measures of antibodies, such as measurements of IgM and IgA class antibodies and measurements of IgG subclasses, which were not available from all members of this study population.It is of note that the prevalence of Toxoplasma is decreasing in many areas of the world. In the case of our study population, the prevalence of exposure to Toxoplasma in the control population was 6.1%, a level consistent with recent studies of young adults living in the United States. The reasThe effect of this decrease in Toxoplasma exposure on human diseases relating to Toxoplasma is unclear. On the one hand, the rate of these diseases may decrease due to a lower level of organisms in the environment. On the other hand, a lower level of exposure in childhood may result in a larger number of individuals who are susceptible to primary infection in later life, resulting in an increased incidence of adult onset disorders. The long-term effects of these epidemiological changes on the role of Toxoplasma on human health and human disease are thus worthy of close examination.Unlike Toxoplasma infection in immune deficient individuals which is associated with the rapid replication of the tachyzoite form of the organism, Toxoplasma infection in immune competent hosts is associated with slowly replicating tissue cysts which are relatively resistant to currently available anti-Toxoplasma medications . Recentl


Within the last years, and since the inclusion of the biofilm concept in Endodontics, our understanding of root canal infections and the periapical tissues have developed tremendously. Development of new technology and inclusion of novel clinical antimicrobial protocols nowadays rely in the fact that microbial biofilms are formed inside the root canal of teeth and thus these are main targets for elimination. However, main concepts underlying important biological aspects of biofilm formation in root canals remain unclear. In this presentation, a hypothesis is presented where the endodontic biofilm is considered as an extension of dental plaque. By means of this hypothesis, a basis for clarifying important aspects of formation, maturation and resistance of root canal biofilms are proposed.


Saccharomyces cerevisiae as factors crucial for the mother-bud separation, septin genes were later identified in almost all eukaryotes except higher plants. Initial studies on septins were limited to their functions in yeast, with a major focus on cell division. However, much information has been gathered about mammalian septins in the present century and septins are gaining importance as a distinct fourth component of the mammalian cytoskeleton. The presence of multiple septin genes with possibly redundant roles and the lack of potent and specific septin inhibitors have hindered functional characterization of the septin cytoskeleton. These difficulties have been effectively tackled by the widespread use of RNAi technologies and at least 10 out of the 13 mouse septin genes have been successfully knocked out, aiding in the identification of several general and isoform-specific physiological functions of septins. This Frontiers Research topic on the emerging functions of septins compiles contributions from the diverse field of septin research dealing with complex issues from yeast cell division to human cancer, from cellular morphogenesis to protein stability and from plant pathogens to human infections.Septins are a family of conserved cytoskeletal GTPases with unique heteropolymerization properties and diverse physiological functions . While an siRNA screen identified SEPT2 family members as mediators of calcium signaling in HeLa cells (Sharma et al., Our understanding on the canonical functions of septins in cell division is constantly being revisited. In addition, the foot print is spreading far and wide as more and more physiologically relevant functions emerge for the septin family proteins. Collectively, the articles in this research topic including original research, perspectives and reviews on diverse aspects of septin research comprehensively summarizes the advances in the field. The contributions also provide ideas of promising directions for future investigations.Both authors equally contributed to the drafting and revision of the editorial and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The objective of this study was to differentiate the attention patterns associated with attention deficit disorder with or without hyperactivity using continuous performance test (CPT). The diagnoses were based on the DSM-III, III-R, and IV criteria and of the 39 children who participated in the study, 14 had attention deficit disorder with hyperactivity (ADDH) and 11 had attention deficit disorder without hyperactivity (ADDWO), while 14 normal children served as a control group. Attention patterns were examined according to the performance of subjects on the CPT and parental scores on the ADHD Rating Scale, the Child Attention Profile, and the Conners Rating Scale. CPT performances were assessed before and after administration of 10 mg methylphenidate. We found as hypothesized that the CPT differentiated between the ADDH and ADDWO groups. However, contrary to our expectations, the ADDH children made more omission errors than the ADDWO children; they also showed more hyperactivity and impulsivity. The performance of both groups improved to an equal degree after the administration of methylphenidate. It is conluded that different subtypes of the attention deficit disorders are characterized by different attention profiles and that methylphenidate improves scores on test of continuous performance.


There is an error in the final sentence of the Results. The correct sentence is: Fig 3B shows that the heritability of education increases with increasing deprivation (ie decreasing SES).There are errors in the final two sentences of the fifth paragraph of the Discussion. The correct sentences are: On the other hand, the heritability of education showed significant interactions with SES, with increasing heritability at lower SES levels. Prior evidence has suggested that education has substantial genetic correlation with IQ and may be a suitable proxy phenotype for genetic analyses of cognitive performance [35]; thus our results may indirectly support earlier studies of the SES moderation of IQ heritability, though in the opposite direction of that reported in twin study data.


Complex facial injuries with soft tissue degloving and bony avulsion are very devastating to the patient. Partial degloving injuries are described but hemifacial degloving with zygoma avulsion are rare. The author presents a case of post-traumatic degloving of the left upper lip, nose, part of forehead, upper and lower eyelids and cheek with avulsion of the left zygoma. The management included immediate resuscitation and early surgery to reposition the skeletal as well as soft tissue avulsion. The wound was thoroughly washed and primary repositioning and fixation were done. Early one stage surgery with meticulous debridement and alignment of the anatomical landmarks results in very good aesthetic and functional outcome. The face is a very important part of the human body giving identity and sense of confidence to a person. Any post traumatic facial deformity not only causes functional problems but also psychosocial dysfunction. This article reports a case of post-traumatic degloving of majority of left side of the face with avulsion of the zygomatic bone. There are various reports suggesting better outcomes with early primary reconstruction with less risk of infectionA 56 years old female presented with history of road traffic accident with resultant avulsion of her left side of face. There was degloving and avulsion of the left hemi-face including the upper lip nose, forehead skin and eyebrow, upper and lower eyelids and the entire left cheek. The zygomatic bone was also avulsed and displaced laterally. The globe was displaced inferiorly towards the maxillary sinus .The patient was immediately resuscitated airway management, control of bleeding and maintainence of circulation. Other injuries were quickly ruled out and CT scan with 3D CT of the face was done. CT scan showed avulsion of the zygoma with lateral blowout fracture of the orbit. There was no brain injury. The vision was tested for finger counting which was present at 2 to 3 feet. Decision was taken for an immediate single stage reconstruction of the bony as well as soft tissue avulsion.The patient was taken for surgery and under anesthesia the wound was thoroughly washed with normal saline and diluted betadine solution. All contaminants and foreign bodies were removed. Careful debridement was done and crushed nonviable tissues were excised. The orbital cavity was then reconstructed. The globe was seen to be displaced towards the maxillary sinus. The avulsed zygoma still had soft tissue attachments. There was a piece of lateral orbital rim with the soft tissue flap which was repositioned and the lateral orbital wall was reformed. The fractures were fixed with titanium miniplates. The eyeball was thus repositioned to its original position and the volume of the orbital cavity was restored  and 3.th postoperative day. All wounds healed well without any flap necrosis (Once the bony fixation was done the soft tissue reconstruction was started. The degloved flap was repositioned. Tacking sutures were taken to the periosteum wherever possible to keep the flap in place. The upper lip was repaired in layers after marking the anatomical landmarks. The mucosa and muscle were repaired with absorbable sutures and skin with nylon. The nose was reconstructed with repair of the mucosal lining followed by repair of the cartilage framework. The nasal ala was repositioned and the skin was repaired. The eyelids and forehead were repaired in layers . The posnecrosis . The pat6-8 Meticulous matching of the anatomical landmarks and repair in anatomical layers gives very good final results. Immediate soft tissue reconstruction results in less scarring and infection. Delayed repair results in oedema developing which obscures the anatomical landmarks and give inferior aesthetic results. There is higher risk of infection too in case of delayed repair. The complete avulsion with lateral displacement of the zygoma is a rare occurrence and it causes displacement of the globe inferiorly and outwards. Early repositioning of the bony fragments and rigid orbit reconstruction repositions the globe and helps maintain visual acuity.9-11Complex hemifacial avulsion injuries are challenging and difficult to treat. The most common causes are high velocity trauma and assault. There is not only a soft tissue degloving but also a bony avulsion in such cases. The problem is compounded by the presence of foreign bodies and contaminations including dirt and stone particles. Early single stage reconstruction provides excellent functional and aesthetic outcomes. Thorough washing and removal of foreign bodies and precise debridement help to prevent infection and flap loss.Surgical management of unusual complex problems is highly challenging as they do not follow any set protocols. Sticking to the basic tenets of reconstruction with matching of the anatomical landmarks and reconstructing in layers gives very satisfying outcomes even in the most ghastly injuries. Immediate single stage procedure with meticulous reconstruction is the key to excellent functional and aesthetic results.The authors declare no conflict of interest.


Their test battery was comprised of a series of, “tasks based on established measures of avian cognitive performance: a motor task, color and shape discrimination, reversal learning, spatial memory and inhibitory control.”  rather than as a primary factor with secondary specific intelligences. A psychometric approach that has been employed to analyse human cognition (and many other forms of behavior and experience) is that of facet theory  and crystalized (gc) general intelligence  to reveal the structure of avian intelligence in the form of a mapping sentence. By using a mapping sentence to design research and non-parametric statistical analyses this allows the investigation of the structure of avian intelligence in a way that does not make unsubstantiated assumptions of the psychometric qualities of the data. Furthermore, facet theory based research produces cumulative and directly comparable results across studies employing a faceted design. Thus, the use of facet theory could potentially develop greater understanding of avian cognitive processes.The author confirms being the sole contributor of this work and approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Avulsion fractures of the inferior pole of the patella and proximal tibial apophysis are independently rare injuries. They occur in children due to the relative weakness of the apophyseal cartilage compared to the ligaments and tendons. The combination of these two fractures, is exceedingly rare, with only a few previously described cases in the literature. Due to the infrequent presentation of this injury, careful examination and consideration of advanced imaging is important for diagnosis and preoperative planning. Here we present two cases of combined sleeve fractures of the inferior pole of the patella and tibial apophysis, with discussion of the pathophysiology, classification, identification and management of the injury. An intense muscle contraction may result in the rupture of a muscle or tendon, or an avulsion fracture. In contrast to adults, children are more likely to suffer from avulsion fractures due to the relative weakness of their apohyseal cartilage compared to connective tissues such as ligaments and tendons.Fractures of the lower pole of the patella are relatively rare. As these are often predominantly cartilaginous avulsions, they are often difficult to distinguish on plain radiographs.Avulsion of the proximal tibial apophysis is also a rare injury  patellar dislocation developed pain and inability to bear weight in his right lower extremity following an awkward landing after jumping over a hurdle. On physical exam he was noted to have swelling and effusion of the affected knee with tenderness to palpation over the patella and tibial tubercle. Radiographs obtained in the emergency center demonstrated patella alta and a very small patella sleeve avulsion fracture . He was Intraoperative examination revealed an apophyseal avulsion of the medial 2/3 of the patella tendon from the tibial tubercle and avulsion of the lateral 1/3 of the tendon from the patella . Repair Postoperatively, the patient was placed in a knee immobilizer and with touch down weight bearing precautions and crutches for the initial four weeks following surgery. Follow-up six weeks after surgery demonstrated radiographic healing. Full range of motion had been achieved at his 3 months follow up.A 12-year-old male athlete with history of Osgood-Schlatter disease developed acute pain in his left knee while jumping during a basketball game. He was unable to ambulate following the injury and was originally seen at an outside hospital, where he was treated for a presumptive patellar dislocation. Two attempts at reduction under sedation were unsuccessful, and the patient was transferred to the authors’ institution for further management. Examination at this time revealed patella alta and diffuse swelling. No neurovascular deficits were noted.Radiographs showed a likely inferior patellar sleeve fracture with a possible concomitant tibial tubercle fracture. MRI confirmed avulsion fractures of both the patellar and tibial insertions of the patellar tendon, as well as a quadriceps strain at the patellar insertion and tears of the medial and lateral patellar retinaculum –7. OperaIntraoperative findings revealed a 75% avulsion of the tendon from its attachment at the medial tibial tubercle with the remaining lateral quarter of the tendon intact distally but detached from the inferior pole of the patella. Additionally, the fat pad and anterior capsule had also avulsed from the inferior aspect of the patella. The injury extended into the medial and lateral retinaculum at the level of the inferior patella. Repair of the patellar tendon at the distal avulsion site was performed with screw and ligament staple through the apophysis, and reinforced with Krackow sutures tied over a bone bridge in the anterior tibia. The proximal avulsion fracture was repaired with #2 non-absorbable sutures running from the tendon through patellar bone tunnels, and tied over the bone bridge at the superior patella. The retinaculum was repaired with absorbable suture.Postoperatively the patient was placed in a locked straight leg brace for one week  and 9. FThe occurrence of bifocal patellar tendon avulsion injuries in the absence of definitive radiographic signs was an especially important feature of these two cases. In Case 1, the diagnosis was not suspected from radiographs, and instead discovered intraoperatively. In Case 2, the diagnosis was suspected and then confirmed by MRI.Tibial tubercle fractures in adolescent patients are typically avulsion-type injuries, given the relative weakness of the open physis compared to the superior strength of the patellar tendon at that stage of development. The classification of these injuries was originally proposed by Watson-Jones in 1955 and described three types of fractures spanning the tubercle, physis and knee joint. Type I involved an avulsion of the tubercle distal to the physis, while Type II involved the physis but spared the knee joint, and Type III extended into the knee joint itself. This classification system was later expanded on by Ogden and colleagues in 1980 to further characterize the fracture patterns associated with each injury, and propose specific treatment approaches. With his case report of tubercle fractures associated with associated patellar ligament avulsions, Frankl et al. suggested a Type C classification to the modified Ogden system . Mosier Two traction apophysitis diseases postulated to be associated with avulsion-style fractures are Osgood-Schlatter Syndrome (OSS), at the tibial tubercle, and Sinding-Larsen Johansson (SLJ) Syndrome, at the inferior pole of the patella, respectively. Of the two, OSS is the more common and is due to repetitive traction on the secondary ossification center of the tibial tuberosity. It is most commonly seen in male athletes between 10 and 15 years of age, concurrent with the rapid growth seen in adolescents during this time. SLJ Syndrome is a rare but similar disease to OSS where the inferior pole of the patella at the site of the proximal attachment of the patellar tendon is affected. This condition is frequently seen in a younger cohort than the Osgood-Schlatter patients, most commonly at ages 10–12. Preceding pain is common for this kind of patients. Nevertheless, despite the fact of remote history of OSS in Case 1, neither of our patients had immediately preceding anterior knee pain before the described trauma.We report two cases of combined sleeve fractures of the inferior pole of the patella and tibial apophysis. In first case, preoperative images were confusing and the full complexity of this trauma were verified only during surgery. In the second case we used MRI examination preoperatively, which allowed us to fully characterize the origin of trauma pattern and to prepare proper option for its operative treatment. In our conviction patients of this age and with this type of trauma need extra attention during examination and preoperative planning, we suggest MRI study as clarifying imaging modality when radiographs are not conclusive.The authors declare that they have no conflict of interest.


Nutrients for any inconvenience caused.The integrity of several Western blot bands in Figures 3 and 4  has beenNutrients is a member of the committee on publication ethics (COPE) and takes the integrity of publications very seriously. In the interests of correcting the research literature, [erature,  will be


The field of plastic and reconstructive surgery has historically been the cradle for the conception and development of tissue fabrication strategies. The compelling need of tissue for challenging reconstructions has also been a fertile soil for the first practical implementation of tissue engineering paradigms , which iEBioMedicine describes the use of autologous engineered cartilage grafts for ear reconstruction in one fully documented clinical case and reports treatment of additional four patients with shorter follow-up times. Despite the nature of a preliminary, proof-of-principle study, the work represents an important milestone and offers the opportunity to some general considerations. The authors correctly embed their work in the stream of developments within the major areas required to engineer cartilage grafts, namely cells, signals and scaffolds  and openly reports the need to adapt the complex surgical procedure to the specific patient conditions, to the extent that three different methods were applied for the five patients treated. In line with similar developments for nasal cartilage restoration , the autEBioMedicine opens several questions which require a bed-to-bench approach. For example, what is the relative contribution of the implanted vs resident cells in the formation of de novo cartilage over time? Could the use of cells be bypassed by delivery of suitable factors recruiting and activating endogenous progenitors? Which signals are required to maintain stability of the formed tissue? Last but not least, the work prompts addressing the fundamental issue of whether the engineered cartilage tissue could grow with the patients, especially since these are young children. Ultimately, in order to guarantee fully coordinated integration, how can an engineered graft be designed to not only replace a body part, but rather activate its development and growth? And towards this goal, should developmental processes be merely recapitulated or somewhat re-engineered, considering that boundary conditions are not the same of an embryo (Emphasis on surgical procedures does not mean neglecting the importance of underlying biological processes. Control of vascularization, management of inflammation, guided tissue regeneration as well as prevention of surrounding soft tissue contraction are some of the concepts exemplifying the critical influence of a surgical procedure on the associated healing events. These need to be more comprehensively understood in order to be more effectively regulated. In this perspective, the bench-to-bed study published in n embryo ? In thisThe authors declared no conflicts of interest.


Upon publication of the original article , it was As such, please see below the modified text of this paragraph, which provides a brief description of the procedures used:in silico analyses performed in this study were carried out using the microbiome data of the Tyrolean Iceman previously sequenced and released by Maixner et al., [21]. For details to the DNA extraction procedures, library preparation and sequencing please refer to the Supplementary Material of this previous study [21]. In brief, DNA extraction using 250 mg of biological samples have been performed with all the stringent laboratory procedures needed for investigations of ancient DNA in the ancient DNA laboratory of the EURAC - Institute for Mummies and the Iceman, Bolzano, Italy [26-27]. Library preparation and Illumina sequencing were performed at the Institute of Clinical Molecular Biology, Kiel University .The


The obturator artery is a branch of the internal iliac artery, although there are reports documenting variations, with origin from neighboring vessels such as the common iliac and external iliac arteries or from any branch of the internal iliac artery. It normally runs anteroinferiorly along the lateral wall of the pelvis to the upper part of the obturator foramen where it exits the pelvis by passing through said foramen. Along its course, the artery is accompanied by the obturator nerve and one obturator vein. It supplies the muscles of the medial compartment of the thigh and anastomoses with branches of the femoral artery on the hip joint. We report a rare arterial variation in a Brazilian cadaver in which the obturator artery arose from the external iliac artery, passing beyond the external iliac vein toward the obturator foramen, and was accompanied by two obturator veins with distinct paths. We also discuss its clinical significance. The obturator artery (OA) is usually a branch of the anterior division of the internal iliac artery (IIA), running medially to the lateral wall of the pelvis to reach the obturator canal. This artery emits iliac branches (to the iliac fossa), a vesicle branch (to the urinary bladder), and a pubic branch, which anastomoses with the inferior epigastric artery (IEA) and the contralateral pubic branch. As it exits the pelvis, the OA divides into anterior and posterior branches.,The OV is formed in the proximal portion of the adductor region, and runs to the pelvis through the obturator foramen (OBF) in the obturator canal before running posteriorly and superiorly on the lateral wall of the pelvis, inferior to the OA, and crossing the ureter and the IIA to join the internal iliac vein (IIV).,,-These vessels are often involved in anatomic variations affecting their origins and paths and so careful studies are needed to ensure success before vascular and orthopedic procedures. It is also crucial to study these vessels in view of the many reports in the literature describing pelvic fractures associated with hemorrhage and iatrogenic lesions, with special regard to the “corona mortis” arterial variation.The aim of this study is to present a case of arterial variation in which the OA arose from the external iliac artery (EIA), passing beyond the external iliac vein toward the OBF, and was accompanied by two OVs with distinct paths.During dissection of the right pelvic region of a male cadaver fixed with a 10% formalin solution, we observed that the OA originated from the EIA and passed laterally to the EIV, before crossing the pelvic brim and descending anteriorly into the OBF . MediallThe origins of the IEA and the deep circumflex iliac artery were as normal. The ON entered the OBF below the artery . There w,,,During embryonic life some arterial channels appear (or enlarge) and disappear (or retract) and the result of this process will dictate the vascular territory of each artery.,,According to the literature, the OA can arise from the common iliac artery, EIA, IEA, inferior gluteal artery, internal pudendal artery (or a common trunk between both arteries), iliolumbar artery, or even from the superior gluteal artery.Sañudo et al.The OV can sometimes connect with the inferior epigastric vein or the femoral veinThe variable origins of the OA can also influence its relationship with the ON and OV. For instance, when it arises from the EIA, the artery would be placed superiorly in relation to such structures, which would affect the surgeon during delicate procedures.-,The corona mortis variation is a vascular connection between the obturator and the inferior epigastric vessels (or directly to the EIA) in which either the artery or vein (and sometimes both) forms an anastomosis near the superior pubic ramus. It is also a connection between the EIA and the OA.Obturator bypass is a procedure that was initially described with the premise of treating mycotic aneurysms, but has since become popular and has been widely used to treat any form of injury to the femoral and iliac systems.The OA variant reported here is very important surgically because it could cause dangerous complications during femoral ring procedures or laparoscopic interventions, due to its unusual trajectory and the presence of a supernumerary OV.


Extremely low frequency electromagnetic fields (ELF EMF) are commonly present in daily life all over the world. Moreover, EMF are used in the physiotherapy of many diseases because of their beneficial effects. There is widespread public concern that EMF may have potential consequences for human health. Although experimental animal studies indicate that EMF may influence secretion of some hormones, the data on the effects of EMF on human endocrine system are scarce. Most of the results concentrate on influence of EMF on secretion of melatonin. In this review, the data on the influence of EMF on human endocrine system are briefly presented and discussed.


The unique qualities of women can make them bearers of solutions towards achieving sustainability and dealing with the dangers attributed to climate change. The attitudinal study utilized a questionnaire instrument to obtain perception of female construction professionals. By using a well-structured questionnaire, data was obtained on women participating in green jobs in the construction Industry. Descriptive statistics is performed on the collected data and presented in tables and mean scores (MS). In addition, inferential statistics of categorical regression was performed on the data to determine the level of influence (beta factor) the identified barriers had on the level of participation in green jobs. Barriers and the socio-economic benefits which can guide policies and actions on attracting, retaining and exploring the capabilities of women in green jobs can be obtained from the survey data when analyzed. Specifications tableValue of the data•The questionnaire instrument is compact and can be adapted or modified for studies in other climes, thereby comparing the results from under-developed, developing and developed countries.•The data provided the descriptive statistics for the selected sample for measuring the level of participation of women compared to men in green jobs in the construction industry.•The data when completely analyzed can provide insight into the obstacles hindering the career advancement of women in green jobs in the construction industry, while the socio-economic benefits of engaging women in green jobs if well harness can help the environment and the construction industry.•An understanding of the barriers and socio-economic benefits can guide policy makers and construction industry stakeholders on ways to tackle the shortage of women participation in the construction industry.•The data can increase the awareness of women and the girl child on the distinct features of green jobs in contrast to other jobs available in the construction industry in general.1The data instrument of a well-structured questionnaire was administered to one hundred and twenty (120) women construction professionals in Lagos State, Nigeria. The demographic characteristics of the female construction professionals is shown in 2The data collected was built on previous research conducted on women participation in the construction industry and the areas of green jobs that appear in the construction industry. Details on other researched works on the subject can be found in


In the original publication  the lastIncorrect version:The implications of this work are important for SSA because of the small number of RCTs performed in this part of the world [38], and the shortage of research resources. For this reason, waste must be addressed. In accordance previous works , our results highlight that waste in RCTs in SSA could be avoided with simple and inexpensive methodological adjustments as well as a better reporting of interventions. Investigators should be informed of the feasibility of these adjustments and reporting guidelines when planning their trials and drafting their reports to limit the number of flaws in trial methods and poor descriptions of interventions at an early stage . The Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network is an international initiative created to improve the reliability and value of published health research literature by promoting transparent and accurate reporting and wider use of robust reporting guidelines (http://www.equator-network.org/). In our study, articles journals recommending reporting guidelines in their instructions to authors have a better description of interventions than those that did not recommend any reporting guidelines.Correct version:The implications of this work are important for SSA because of the small number of RCTs performed in this part of the world [38], and the shortage of research resources. For this reason, waste must be addressed. In accordance previous works , our results highlight that waste in RCTs in SSA could be avoided with simple and inexpensive methodological adjustments as well as a better reporting of interventions. Investigators should be informed of the feasibility of these adjustments and reporting guidelines when planning their trials and drafting their reports to limit the number of flaws in trial methods and poor descriptions of interventions at an early stage . The Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network is an international initiative created to improve the reliability and value of published health research literature by promoting transparent and accurate reporting and wider use of robust reporting guidelines (http://www.equator-network.org/).


In the search for new neuroprotective compounds, interest has turned to marijuana derivatives, since in several 2-mediated control of neuroinflammation that could liberate cannabinoids from the slavery of their central side effects.Despite the emerging evidence regarding pharmacological activities of cannabinoids, their effective introduction into clinical therapy still remains controversial and strongly limited by their unavoidable psychotropicity. Since the psychotropic effect of cannabinoids is generally linked to the activation of the CB1 receptor on neurons, the aim of our review is to clarify the function of the two cannabinoid receptors on glial cells and the differential role played by them, highlighting the emerging evidence of a CB


Most patients with Tourette syndrome report characteristic sensory experiences (premonitory urges) associated with the expression of tic symptoms. Despite the central role of these experiences to the clinical phenomenology of Tourette syndrome, little is known about their underlying brain processes. In the present article we present the results of a systematic literature review of the published studies addressing the pathophysiological mechanisms of premonitory urges. We identified some preliminary evidence for specific alterations in sensorimotor processing at both cortical and subcortical levels. A better insight into the brain correlates of premonitory urges could lead to the identification of new targets to treat the sensory initiators of tics in patients with Tourette syndrome.


Lofa County has one of the highest cumulative incidences of Ebola virus disease (Ebola) in Liberia. Recent situation reports from the Liberian Ministry of Health and Social Welfare (MoHSW) have indicated a decrease in new cases of Ebola in Lofa County . In OctoLiberia is in the midst of the largest outbreak of Ebola to date, with approximately 6,500 reported cases as of October 31, 2014  aggregate data for newly reported suspected, probable, and confirmed cases of Ebola; 2) case-based data for persons admitted to the Foya ETU operated by MSF; and 3) test results for oral swab specimens collected from persons who died in the community and whose deaths were investigated for possible Ebola.Aggregate data for newly reported cases were obtained from the county health office and publicly available national situation reports published by Liberian MoHSW. These data include new cases reported daily by local health offices in the six districts of Lofa County. The weekly number of new cases increased from 12 in the week ending June 14 to 153 in the week ending August 16, and then decreased, reaching four new reported cases in the week ending November 1 .MSF provided deidentified case-based data of persons admitted to the Foya ETU. Final epidemiologic classification of cases was consistent with case definitions described by the World Health Organization . LaboratCase-based data for persons admitted to the Foya ETU describe a trend  similar Oral swab specimens were collected by outreach teams from MSF and district health offices from persons who died in communities with symptoms suggestive of Ebola. Specimens were analyzed by the EMLab field laboratories using RT-PCR, which has similar performance on oral swab specimens and blood specimens . Test reThe trends in numbers of newly reported cases, persons admitted to the Foya ETU, and positivity rate among community decedents evaluated for Ebola virus during June 8–November 1, 2014, are consistent with a substantial decrease in transmission of Ebola virus in Lofa County beginning as early as August 17, 2014. The aggregate data from the Lofa County Health Office and case-based data from the Foya ETU describe a peak of reported cases and new admissions respectively in the week ending August 16 followed by a decline in subsequent weeks. The high percentage of positive specimens collected from community decedents during June 8–August 16 suggests that Ebola was causing deaths in communities, whereas the lower percentage during August 24–November 1 suggests that other endemic diseases, such as malaria or typhoid, had become the main causes of mortality as transmission of Ebola virus decreased. The findings from this analysis might indicate the first example in Liberia of a successful strategy to reduce the transmission of Ebola virus in a county with high cumulative incidence.Transparency in activities and engagement with the community were central to the response strategy in Lofa County. For example, the Foya ETU was designed without high, opaque walls to minimize fear of the facility. Family members were permitted to visit their loved ones in the ETU, either by talking with them across a fence or inside the ward while wearing full personal protective equipment. Decedents in the ETU were buried in the presence of family members at designated burial sites in graves with clear identification. In communities, rapid transport of ill persons to the ETU and safe burial of persons suspected of dying from Ebola demonstrated to the local population that partners could quickly respond to requests for help. During safe burials of community decedents, family members were invited to hold grieving ceremonies according to local customs in memory of the deceased. Engagement with the local population might have built confidence in response activities and contributed to the success of the strategy.Data on final classifications of patients admitted to the Foya ETU and test results from community decedents indicate ongoing engagement from the community. The high percentage of non-Ebola cases among persons admitted to the ETU during the peak of admissions suggests that the community and health workers were aware that persons with symptoms suggestive of Ebola should be evaluated at the ETU. The high percentage of non-Ebola cases among new admissions in recent weeks and the increasing number of weekly specimens collected from community decedents suggests that trust in response activities remains strong in the local population despite the recent decrease in cases.Although transmission in Lofa County might have decreased, situation reports from MSF, EMLab, and the World Health Organization have indicated an increase in cases during September and October in Macenta ,9, a heaRecent reports indicate that transmission of Ebola virus in Liberia is ongoing . The finWhat is already known on this topic?Lofa County in Liberia has one of the highest numbers of reported cases of Ebola virus disease (Ebola) in West Africa. Government health offices, nongovernmental organizations, and technical agencies coordinated response activities to reduce transmission of Ebola in Lofa County. The intensity and thoroughness of activities increased in response to the resurgence of Ebola in early June.What is added by this report?Trends in new reported cases, admissions to the dedicated Ebola treatment unit in the town of Foya, and test results of community decedents evaluated for Ebola virus suggest transmission of Ebola virus decreased in Lofa County as early as August 17, 2014, following rapid scale-up of response activities after a resurgence of Ebola in early June.What are the implications for public health practice?A comprehensive Ebola response strategy developed with participation from the local community and rapidly scaled up following resurgence of Ebola might have reduced the spread of Ebola virus in Lofa County. The strategy implemented in Lofa County might serve as a model for reducing transmission of Ebola virus in other affected areas.


The ANTARES radiation hydrodynamics code is capable of simulating the solar granulation in detail unequaled by direct observation. We introduce a state-of-the-art numerical tool to the solar physics community and demonstrate its applicability to model the solar granulation. The code is based on the weighted essentially non-oscillatory finite volume method and by its implementation of local mesh refinement is also capable of simulating turbulent fluids. While the ANTARES code already provides promising insights into small-scale dynamical processes occurring in the quiet-Sun photosphere, it will soon be capable of modeling the latter in the scope of radiation magnetohydrodynamics. In this first preliminary study we focus on the vertical photospheric stratification by examining a 3-D model photosphere with an evolution time much larger than the dynamical timescales of the solar granulation and of particular large horizontal extent corresponding to  The structure and dynamics of the solar photosphere is crucially determined by the mass and energy transport processes taking place across the solar surface. For the study of the solar convection and its phenomenological manifestation on the visible surface of the Sun, the solar granulation, numerical simulations not only complement observational data but also serve as a means of their own by providing complete and almost continuous information in 3-D of the physical state and the dynamics which otherwise often has to be drawn indirectly from observations. The physics of the layers surrounding the solar surface is rather involved; below the surface the opacity is sufficiently large so that the local adiabatic gradient is exceeded by the temperature gradient needed for radiative-diffusive energy transport, turning the fluid convectively unstable. This process is primarily described by mixing length theory  code ANTARES , applied to the study of the near surface convection and the photosphere of the Sun. In spite of the broad range of applicability, ranging from the modeling of photospheric turbulence  finite volume schemes. The code is based on a high-resolution finite-volume method that can treat turbulence by adopting local mesh refinement. Essentially, finite volume schemes are based on interpolation of discrete data using polynomials; fixed stencil interpolations work well for sufficiently smooth problems but introduce oscillations near discontinuities, whose amplitudes do not decay in the course of mesh refinement. Whereas traditional remedies such as the introduction of an artificial viscosity or the application of limiters to discard such oscillations have obvious drawbacks, ENO  two-point correlations for which one quantity is fixed at the solar surface while the second one is varied with height.The one-point correlation between the vertical velocity- and temperature fluctuations A high correlation of temperature fluctuations at the solar surface with temperature fluctuations at varying heights, The gas pressure is higher in granular upflows throughout subphotospheric and photospheric regions resulting in an entirely positive correlation From the images of the vertical velocity in Fig. Finally, we discuss the two-point correlation of the intensity fluctuations at the surface with the mean opacity fluctuations at varying heights, mentclasspt{minimamentclasspt{minimaAltogether these data provide the necessary information for outlining the overall vertical structure of the photosphere (see also Table n et al. , we can d Nelson  or the 2d Nelson , we findWe introduce the radiation hydrodynamics code ANTARES that we applied to the study of the solar granulation and that has not yet received much attention in the Solar Physics community. We used correlation analysis to examine the vertical stratification of the photosphere and determined height levels subdividing the photosphere in layers that exhibit characteristic dynamics of their own: The subphotospheric layers up to a height of The WENO scheme implemented in ANTARES avoiding oscillatory solutions at discontinuities which otherwise occur due to the interpolation of discrete data in finite volume methods is particularly useful for the ongoing study of shocks which are observed in the intergranulum of our model photospheres and for the study of acoustic oscillations in the scope of RHD. We intend to further investigate photospheric wave excitation and propagation by the application of wavelet and wavepacket analysis and to quantify the associated energy transfer through the photosphere.As this RHD-code is currently heavily under development with an imminent RMHD upgrade to be released, we intend to soon present further model results and focus on photospheric, small-scale, intergranular rotating plasma jets that have been detected and studied in our RHD simulations (Lemmerer et al.


The Back to Sleep Campaign was initiated in 1994 to implement the American Academy of Pediatrics' (AAP) recommendation that infants be placed in the nonprone sleeping position to reduce the risk of the Sudden Infant Death Syndrome (SIDS). This paper offers a challenge to the Back to Sleep Campaign (BTSC) from two perspectives: (1) the questionable validity of SIDS mortality and risk statistics, and (2) the BTSC as human experimentation rather than as confirmed preventive therapy.The principal argument that initiated the BTSC and that continues to justify its existence is the observed parallel declines in the number of infants placed in the prone sleeping position and the number of reported SIDS deaths. We are compelled to challenge both the implied causal relationship between these observations and the SIDS mortality statistics themselves.


There are errors in the Results and Conclusions sections of the Abstract.The last sentence of the Results section of the Abstract should read: In nerves, the median time until demonstrable histological changes was 24 hours.The last sentence of the Conclusions section of the Abstract should read: Whereas pancreas and liver showed the first damages after 1–2 hours, this took 24 hours in nerves and 7 days in blood vessels.


Cognitive impairment in multiple sclerosis is an increasingly recognized entity. This article reviews the cognitive impairment of multiple sclerosis, its prevalence, its relationship to different types of multiple sclerosis, and its contribution to long-term functional prognosis. The discussion also focuses on the key elements of cognitive dysfunction in multiple sclerosis which distinguish it from other forms of cognitive impairment. Therapeutic interventions potentially effective for the cognitive impairment of multiple sclerosis are reviewed including the effects of disease modifying therapies and the use of physical and cognitive interventions.


Equus hemionus) in order to assess the suitability of several skeletal elements to reconstruct the life history strategy of the species. Bone tissue types, vascular canal orientation and BGMs have been analyzed in 35 cross-sections of femur, tibia and metapodial bones of 9 individuals of different sexes, ages and habitats. Our results show that the number of BGMs recorded by the different limb bones varies within the same specimen. Our study supports that the femur is the most reliable bone for skeletochronology, as already suggested. Our findings also challenge traditional beliefs with regard to the meaning of deposition of the external fundamental system (EFS). In the Asiatic wild ass, this bone tissue is deposited some time after skeletal maturity and, in the case of the femora, coinciding with the reproductive maturity of the species. The results obtained from this research are not only relevant for future studies in fossil Equus, but could also contribute to improve the conservation strategies of threatened equid species.The study of bone growth marks (BGMs) and other histological traits of bone tissue provides insights into the life history of present and past organisms. Important life history traits like longevity or age at maturity, which could be inferred from the analysis of these features, form the basis for estimations of demographic parameters that are essential in ecological and evolutionary studies of vertebrates. Here, we study the intraskeletal histological variability in an ontogenetic series of Asiatic wild ass ( The study of bone growth marks (BGMs) is nowadays the focus of many investigations due to its potential to reconstruct many aspects of the life history of present and past vertebrates . These hFrom dinosaurs to mammals, the annual periodicity of the CGMs is the basis for inferences of life history strategies in many groups of fossil organisms e.g., . The numThe histological analysis of bones for this kind of research in mammals is still little explored in comparison with other vertebrate groups . HoweverEquus hemionus Pallas, 1775). With this study, we aim to find out what life history information can be inferred from the histological study of equids and to try to determine which is the best skeletal element to develop skeletochronological studies in this mammal. The kulan or Asiatic wild ass, a mammal endemic to the Gobi desert, is one of the eight extant species of the family Equidae  between different limb bones of the same individual in the Asiatic wild ass  to estimate its bone perimeter at the time of death. The perimeter of adult individuals was not determined and only the length of the BGMs identified within the EFS is shown. Because it is generally considered that the presence of EFS indicates the cessation of radial growth in long bones  has also been noted in some of the limb bones studied, regardless of the orientation of the cutting plane .All bones of The histology of kulan’s femora was previously described in Tibial cortices consist of laminar bone  and remoBone tissue and vascular arrangement is very similar in metatarsi and metacarpi. In both skeletal elements, the bone cortex is mainly composed of a FLC with primary osteons (POs) oriented in circular rows . The vasE. hemionus) in mammals  present a variable number of LAGs. As it is shown in Two BGMs are identified in the tibia and the metatarsus of the juvenile individual (IPS83155) while the femur and the metacarpus present only one , Fig. 5.Wild adult individuals (IPS83876 and IPS83877) also present differences in the number of BGMs between limb bones , Fig. 6.Based on the ontogenetic time schedule obtained from the study of the BGMs, we represented the growth curve for the different bones of each specimen –7D. In tIn adult individuals, the growth curves, as well as the plots of growth rate estimations, indicate a change in the pace of growth during ontogeny. Equus hemionus for the first time. Previous studies have addressed this issue in isolated bones of fossil vertebrate species . Our results show that these bones record a similar total number of BGMs as the femur  than to skeletal maturity. Skeletal maturity, however, is recorded in growth curves as a significant drop in periosteal growth rate.


Alterations in consciousness are central to epileptic manifestations, and involve changes in both the level of awareness and subjective content of consciousness. Generalised seizures are characterised by minimal responsiveness and subjective experience whereas simple and complex partial seizures demonstrate more selective disturbances. Despite variations in ictal origin, behaviour and electrophysiology, the individual seizure types share common neuroanatomical foundations generating impaired consciousness. This article provides a description of the phenomenology of ictal consciousness and reviews the underlying shared neural network, dubbed the 'consciousness system', which overlaps with the 'default mode' network. In addition, clinical and experimental models for the study of the brain correlates of ictal alterations of consciousness are discussed. It is argued that further investigation into both human and animal models will permit greater understanding of brain mechanisms and associated behavioural consequences, possibly leading to the development of new targeted treatments.


For data analysis, the systematic text condensation method was used. Results: The study participants described two opposing positions regarding the development of community pharmacies in the future. Reform supporters emphasized increased professional independence and more healthcare-oriented operation of community pharmacies. Reform opponents argued against these ideas as community pharmacists do not have sufficient practical experience and finances to ensure sustainable development of the community pharmacy sector in Estonia. Conclusion: Based on the current perception of all respondents, the future operation of the community pharmacy sector in Estonia is unclear and there is urgent need for implementation criteria for the new regulations.Objectives: From 2020, the ownership of community pharmacies in Estonia will be limited to the pharmacy profession, and the vertical integration of wholesale companies and community pharmacies will not be allowed. The aim of this study was to evaluate the perception of different stakeholders in primary healthcare toward the new regulations of the community pharmacy sector in Estonia. Methods: A qualitative electronic survey was distributed to the main stakeholders in primary healthcare and higher education institutions providing pharmacy education ( Due to the relevant role that pharmacists play in the delivery of healthcare, community pharmacies in the majority of cases are highly regulated in most European countries . The folThere are several examples of countries in Europe  where the ownership of community pharmacies is limited to the pharmacy profession ,4. On thEstonia has been a country with a liberal pharmaceutical policy for more than 20 years . The phaPrivatization of the community pharmacy sector in Estonia began immediately after the regaining of independence in 1991. The opening, operation and management of community pharmacies are strictly regulated by the Medicinal Products Act. Since 1996, however, the ownership of community pharmacies has no longer been limited to the pharmacy profession. The reasoning behind liberalization was mostly connected to economical needs and less connected to improved patient care.Vertical and horizontal integration of community pharmacies started to emerge in the second half of the 1990s. The liberal system has led to a rapid growth in the number of community pharmacies, from about 250 in 1993 to 476  in 2015. Currently, approximately 90% of community pharmacies (the majority operating in larger towns) are joined through ownership or partner status to chains what are mostly connected to wholesale companies. This is one of the reasons why the vast majority of pharmacies buy most medicinal products from certain wholesalers. In the current situation, competition in the pharmaceutical wholesale and retail market is limited and new competitors find it difficult to enter the market .Demographic and geographic restrictions to the opening of new entities existed between 2006–2013, but did not fulfill their purpose about a more even distribution of pharmacies in rural areas. Even contrary, since 2006, the number of community pharmacies has decreased by 5% in towns, and by 12% in the countryside. In December 2013, the State Court repealed the establishment criteria for community pharmacies . TemporaThe aim of this qualitative electronic survey was to evaluate the perceptions towards the new regulations of the community pharmacy sector among different stakeholders in and connected to the primary healthcare of Estonia.A qualitative electronic survey using the web platform Google Sheets was used for data collection. The survey was conducted in May 2015 and forwarded to 40 different parties of primary healthcare in Estonia: governmental institutions, professional and patient organizations, representatives of community (owners-pharmacists and owners-chains) pharmacies and wholesale companies of medicinal products; and universities providing pharmacy education at the Bachelor and Master’s level . The surPresent research conforms to the legal and ethical standards of Estonia. Separate approval from the ethics committee was not required for this type of study.Publicly available information about  discussions and positions of different stakeholders before and after changes in pharmaceutical legislation was used for the development of the survey instrument. The survey was planned and the questions were self-designed by the panel of representatives from the University of Tartu, the Estonian State Agency of Medicines, and the Estonian Pharmacy Association.(1)How could the transition of pharmacy ownership be organized to satisfy all parties involved? Should the government provide financial support to pharmacists who want to open or buy a pharmacy?(2)What impact could the prohibition of vertical integration have on the pharmacy sector?(3)Will the new regulation increase or decrease competition in the community pharmacy sector? Will new companies enter the pharmaceutical wholesale market after the prohibition of vertical integration?(4)Will the new regulation increase or decrease the number of community pharmacies? How will the situation change for community pharmacies in rural areas?(5)Will the new regulation change the quality of community pharmacy services? Should community pharmacy services be classified as healthcare services?(6)Will the pricing of medicines and wages for community pharmacy professional staff change with the new regulation?(7)Will the professional roles and responsibilities of a pharmacist and an assistant pharmacist change with the new regulation?(8)Should pharmacy education be updated according to the new regulation?The survey instrument consisted of the following open-ended questions and respondents were asked to justify their responses:n = 5) of representatives from a governmental institution, a professional organization, a wholesale company, and practicing pharmacists.For content and face validity, the survey instrument was evaluated by a small sample total impression—researcher reads the entire description or all results to get a general understanding about the topic;(2)identifying and sorting meaning units—the researcher identifies and organizes the data by meaning units that are related to the study question;(3)condensation—the researcher examines meaning units one by one to get a detailed understanding of the content of every unit; the data is decontextualized;(4)synthesizing—the researcher condenses information received from meaning units into a consistent statement/results, and the data is put back into context .The method includes four steps:Described structure was used to analyze all questions and each question was analyzed separately. If applicable, meaning units were divided and condensed by positive/negative/neutral perceptions of the respondents.n = 5), community pharmacies owned by pharmacists (n = 4) and chains (n = 6), and from a wholesale company of medicines (n = 1)  .All respondents agreed on the need to classify community pharmacy services as healthcare services in the future: “Community pharmacy services could reduce or divide the work load of family physicians and nurses, and should therefore clearly be a part of the primary care services in the future.”Respondents emphasized the strong need to increase collaboration between physicians and pharmacists. Community pharmacies should be re-designed to ensure more private and patient-centered communication, and the government should be involved in the development of extended services at community pharmacy. “There should be a list of traditional and extended community pharmacy services. This document could serve as a basis for future negotiations with the Estonian Health Insurance Fund about the remuneration of extended community pharmacy services.”All respondents agreed that there is an urgent need for information about the transition conditions of community pharmacy ownership from pharmacy chains to pharmacists. They described the increased role of the government in specifying the structure of the community pharmacy sector , and in making it easier for community pharmacists to receive bank loans. In addition, a longer and more gradual transition period (between 7–10 years) was suggested as it would be impossible to complete the planned reforms in less than five years. The impact of the new regulations on the community pharmacy sector in Estonia was mostly described by positive or negative scenarios. All respondents agreed that the number of community pharmacies could decrease in towns and in rural areas—pharmacists do not have the finances and interest to buy and operate non-profitable entities. While the smaller number of pharmacies in towns could lead to the opening of larger pharmacies and encourage the development of extended services, it could cause problems with access to medicines in rural areas. Despite the possible emergence of large pharmacies in towns, the system for the provision and development of community pharmacy services and continuing professional education of community pharmacists remains unclear.The restriction of vertical integration “will increase professional independence of community pharmacists and decrease commercial influence on operation of community pharmacies.” According to another opinion, “The new regulation would jeopardize the retail sale of medicines, the maintenance and development of the current community pharmacy system needs financial support from the wholesale sector.”Changes in the pricing of medicines were directly connected with restrictions of vertical integration. “Opening the pharmaceutical market will enable new wholesale companies to enter the pharmaceutical market in Estonia and increased competition would result in the decrease of medicine price,” future owners concluded. Current owners gave a completely opposing description: “The new regulation will end the collaboration between the wholesale and retail sector that currently provides efficient discounts on medicine prices”.There is no common pattern for the pharmaceutical retail and wholesale sector in Europe. Based on the trends of the last decade, community pharmacy chains have become more prevalent and vertical integration between wholesalers and retailers has also been on the rise in EU. Some form of a pharmacy chain is allowed in 19 EU countries, and vertical integration is implemented in 10 EU countries . AlthougNew regulations of the community pharmacy sector in Estonia aim to reduce the degree of liberalism in pharmaceutical policy. Over the last 20 years, community pharmacies in Estonia have become modern healthcare institutions offering better access to a large selection of medicines and patient-centered services. On the other hand, privatization and the deregulation of pharmacy ownership have resulted in an increased number of new pharmacies, especially in larger towns. This has created a shortage of pharmacists and assistant pharmacists, which could be seen as a limiting or delaying factor in the introduction of novel, extended and patient-centered services at community pharmacies. Decreasing profit margins may threaten the viability of small community pharmacies in rural areas, potentially limiting consumer access to community pharmacy services in the future .In this study, the future operation of a newly regulated community pharmacy sector was unclear for all participants. Reform proponents based their descriptions of future developments mostly on theoretical considerations about management of community pharmacies and emphasized professional ethics and the independence of pharmacists. Without support from the government, however, these ideas would be too declarative and lack actual solutions for practical implementation. Opponents of the reforms combined economical and professional thinking linked to existing practical experience on operation of community pharmacies in their descriptions. However, the ideas described were mostly based on the defense and approval of the current situation and not really open to possible new developments or collaboration with new owners.New regulations of the community pharmacy sector have brought to light several unresolved problems within the pharmacy sector in Estonia. This could be connected to not having an actual national pharmaceutical policy . One posThis study highlighted several other unsolved problems in the community pharmacy sector of Estonia. For example, changed ownership will not resolve the uneven geographical distribution of community pharmacies or the future role of pharmacies in the healthcare system. Lately, encouraging initiatives have been launched in developing professional standards, including the specification of professional roles for pharmacists and assistant pharmacists, and the development and harmonization of the community pharmacy services . It seemWhile the sector is being reformed it would be wise first to identify the common ideas of all stakeholders, find ways for collaboration and not confront the main players of the community pharmacy sector. Otherwise, it could easily happen that main stakeholders dealing with a jumble of questions related to the new regulations forget the main purpose of healthcare for pharmacists, which is to provide quality pharmaceutical care to patients.Important stakeholders in primary healthcare as governmental institutions, representatives of general practitioners and patients as well as representatives of the academia did not participate in the study and the results could therefore be biased. As such, the results may not be generalizable to the entire community pharmacy sector in Estonia. Many of the institutions and organizations explained their non-participation in the study with not having an official position regarding the restrictions of pharmacy ownership and vertical integration, or their lack of need for a study on this topic.For data analysis, the text condensation method was used. This method helped to identify core information from open-ended replies. However, the condensation of meaning units was only possible using the positive/negative/neutral perceptions of the respondents as some of the questions received contrasting replies. However, this type of grouping could underline the impression of the stakeholders of the Estonian community pharmacy sector more as opponents than collaborators.Pharmacy ownership and vertical integration restrictions have raised many questions and unclear expectations among different stakeholders in the pharmacy sector of Estonia. The study revealed two opposing positions regarding the future development of community pharmacies. Future owners underlined the need for increased professional independence and more healthcare-oriented operation of community pharmacies. Opponents of the reform argued against these ideas as community pharmacists do not have sufficient practical experience and finances to ensure the sustainable development of the community pharmacy sector. There is an urgent need for official government standpoints regarding the implementation of new regulations to assure the continuous provision of community pharmacy services and patient care in Estonia.


In this paper, we introduce a biased median filtering image segmentation algorithm for intestinal cell glands consisting of goblet cells. While segmentation of individual cells are generally based on the dissimilarities in intensities, textures, and shapes between cell regions and background, the proposed segmentation algorithm of intestine cell glands is based on the differences in cell distributions. The intestine cell glands consist of goblet cells that are distributed in the chain-organized patterns in contrast to the more randomly distributed nongoblet cells scattered in the bright background. Four biased median filters with long rectangular windows of identical dimension, but different orientations, are designed based on the shapes and distributions of cells. Each biased median filter identifies a part of gland segments in a particular direction. The complete gland regions are the combined responses of the four biased median filters. A postprocessing procedure is designed to reduce the defects that may occur when glands are located very close together and to narrow the gapping areas because of the thin distribution of goblet cells. Segmentation results of real intestinal cell gland images are provided to show the effectiveness of the proposed algorithm.


The superior alveolar nerves course lateral to the maxillary sinus and the greater palatine nerve travels through the hard palate. This difficult three-dimensional anatomy has led some dentists and oral surgeons to a critical misunderstanding in developing the anterior and middle superior alveolar (AMSA) nerve block and the palatal approach anterior superior alveolar (P-ASA) nerve block. In this review, the anatomy of the posterior, middle and anterior superior alveolar nerves, greater palatine nerve, and nasopalatine nerve are revisited in order to clarify the anatomy of these blocks so that the perpetuated anatomical misunderstanding is rectified. We conclude that the AMSA and P-ASA nerve blockades, as currently described, are not based on accurate anatomy. Anesthetic blockade of the posterior superior alveolar (PSA) branch of the maxillary nerve has played an important role in the endodontic treatment of irreversible acute pulpitis of the upper molar teeth except for the mesiobuccal root of the first molar tooth , 2. ThisThe infraorbital nerve gives rise to middle superior alveolar (MSA) and anterior superior alveolar (ASA) branches. However, blockade of the greater palatine nerve (GPN) has been used, especially for periodontal treatment, to anesthetize the palatal mucosa, including the posterior part of the hard palate and its overlying soft tissues, anteriorly as far as the first premolar and medially to the midline, and palatal gingiva.The superior alveolar nerves course lateral to the maxillary sinus and the GPN travels through the hard palate , 2. HoweWith such a clinically significant error being propagated in the dental literature, we aimed to review this anatomy and investigate the origin of the anatomical misunderstanding. With an improved understanding of the anatomy of the innervation of the maxillary teeth, unnecessary anesthetic blockade will be avoided with resultant improved patient outcomes.Anatomy of the superior alveolar nerves The upper teeth are supplied by three superior alveolar nerves that arise from the maxillary nerve in the pterygopalatine fossa or infraorbital canal. The PSA branch leaves the maxillary nerve in the pterygopalatine fossa and runs anteroinferiorly to enter the posterior alveolar foramen on the infratemporal surface of the maxilla . It then descends under the mucosa of the maxillary sinus . Finally, this nerve divides into small branches that unite as the molar part of the superior dental plexus, which supplies the ipsilateral molar teeth, gingivae and the adjoining part of the cheek . As it rAnatomy of the greater palatine and nasopalatine nervesThe GPN is one of the branches of the maxillary nerve that enters the greater palatine foramen to travel within the oral cavity along the roof of the mouth. It travels downward and forward giving rise to numerous branches to the ipsilateral palatal mucosa, gingiva, and glands of the hard palate as it approaches the incisor teeth. The GPN communicates with the terminal branch of the nasopalatine nerve.The nasopalatine nerve leaves the pterygopalatine fossa through the sphenopalatine foramen to enter the nasal cavity. It passes across the cavity to the back of the nasal septum, runs downward and forward through the nasal septum in a groove in the vomer and then turns down through the incisive canal to traverse the incisive foramen at the anterior part of the hard palate. It supplies the lower part of the nasal septum and the anterior part of the hard palate where it communicates with the GPN.Propagated misunderstanding of the AMSA nerve blockThe technique of AMSA nerve block was first developed by Friedman and Hochman based on the description in the old literature that pulpal anesthesia can be accomplished from a palatal injection as documented by Fischer  in 1911 Friedman and Hochman  illustraIn their drawing, the infraorbital nerve or maxillary nerve is shown as giving rise to branches to all of the maxillary teeth through the hard palate as if they traveled in a similar course as the GPN. Furthermore, in their drawing, the main trunk of the infraorbital nerve becomes the ASA as if it were the terminal branch of the infraorbital nerve. The course of the ASA in this figure might be confused with the pathway of the nasopalatine nerve toward the incisive foramen through the nasal septum. Therefore, this publication has added to the confusion of the course of the superior alveolar branches, GPN and nasopalatine nerve, and has probably resulted in patients undergoing unnecessary nerve blockade.Concept of the P-ASA nerve block and misunderstandingThe P-ASA nerve block was proposed by Friedman and Hochman in 1999  as a priAccording to Friedman and Hochman , the useApplication to periodontal treatmentSeveral studies have reported the effectiveness of AMSA nerve block in periodontal surgery and scaling and root planing (SRP) , 15-17. CriticismsCorbett, et al.  reportedBurns, et al.  reportedTiny branches could exist between the GPN and AMSA branches and between the nasopalatine nerve and the ASA branch. However, if we revisit the anatomy of the maxilla, palate and nasal septum, it is easy to understand how many reports in the literature have made critical mistakes regarding AMSA and P-ASA nerve blockade.The AMSA and P-ASA nerve blockades are not based on accurate anatomy. The term “AMSA” nerve blockade is infiltration anesthesia to the root of the anterior, canine and premolar teeth, and blockade of the branch of the GPN. This anesthesia might provide numbness to some extent, but this comes most likely from “infiltration anesthesia.” The term “P-ASA” nerve block is similar to the nasopalatine nerve block. The innervation of the maxillary teeth should be revisited in order to provide the best local anesthesia to patients without unnecessary injections and the potential for associated complications.


Spodoptera frugiperda, J.E. Smith) is a noctuid moth that is a major and ubiquitous agricultural pest in the Western Hemisphere. Infestations have recently been identified in several locations in Africa, indicating its establishment in the Eastern Hemisphere where it poses an immediate and significant economic threat. Genetic methods were used to characterize noctuid specimens infesting multiple cornfields in the African nation of Togo that were tentatively identified as fall armyworm by morphological criteria. Species identification was confirmed by DNA barcoding and the specimens were found to be primarily of the subgroup that preferentially infests corn and sorghum in the Western Hemisphere. The mitochondrial haplotype configuration was most similar to that found in the Caribbean region and the eastern coast of the United States, identifying these populations as the likely originating source of the Togo infestations. A genetic marker linked with resistance to the Cry1Fa toxin from Bacillus thuringiensis (Bt) expressed in transgenic corn and common in Puerto Rico fall armyworm populations was not found in the Togo collections. These observations demonstrate the usefulness of genetic surveys to characterize fall armyworm populations from Africa.The fall armyworm ( Spodoptera frugiperda (J.E. Smith), is the primary pest of corn production in South America and in portions of the southeastern United States ).) allele .The sudden discovery of fall armyworm in Africa presents a major concern to a continent that is already periodically troubled by insufficient and unstable food supplies. The invasion of this pest presents two general problems. The first is that the introduction of a new species into an area where its normal natural enemies are not present could allow an initial period of rapid population growth and dispersion with consequent substantial impacts on agriculture. This may be the case with fall armyworm where the economic damage of infesting populations has been identified in widely dispersed regions over a short time period . The secCO1 and Tpi markers both separately and in combination indicate that both strains are present in Togo, with the corn-strain predominant in the tested collection. The proportions of the two strains differed depending on the marker used, with Tpi giving a substantially higher corn-strain percentage than CO1  found among the 17 collected at locations north of site 21. These numbers are small and only from a single year, so they at best describe a preliminary indication of possible differences in the geographical distribution of genetically defined subpopulations of fall armyworm. A more comprehensive and systematic survey that includes plant hosts preferred by the rice-strain is needed to determine the consistency of this observation.The specimens obtained from Togo were collected from multiple regions over a six-month period in 2016. The than CO1 . These rplotypes , 23, 26.he coast . Of the CO1 barcode region used to identify the species and host strain of the Togo collection identified only a single rice-strain and corn-strain haplotype, both of which were the most common forms present in North American populations [CO11164-1287 analysis that identified only one of the four possible corn-strain haplotypes was present in Togo. This haplotype, h4, predominates in the FL-type subpopulation, suggesting that the Western Hemisphere source of the Togo infestation is most likely the region that extends northward from the Lesser Antilles to Puerto Rico, through Florida and includes much of the eastern coast of the United States (in review) was not present in Togo suggests that Puerto Rico may not be the source of the Togo infestation.The ulations . This lod States . HoweverIn conclusion, genetic markers provide an important resource for the investigation of fall armyworm infesting agricultural areas of Africa. Genetic analysis can confirm species identification based on morphology, is the only reliable means of identifying host strains, can provide an indication of where in the Western Hemisphere the population invading Africa might have originated, and can detect a Bt-resistance trait that could compromise the effectiveness of Bt pesticides and Bt crops as control options. The Togo population may not be representative of fall armyworm in other parts of Africa and may be susceptible to future invasive introductions, indicating the need for continued and more comprehensive genetic characterizations of African fall armyworm populations to monitor and forecast the spread of this invasive pest.


Elastic properties of model crystalline systems, in which the particles interact via the hard potential (infinite when any particles overlap and zero otherwise) and the hard-core repulsive Yukawa interaction, were determined by Monte Carlo simulations. The influence of structural modifications, in the form of periodic nanolayers being perpendicular to the crystallographic axis [111], on auxetic properties of the crystal was investigated. It has been shown that the hard sphere nanolayers introduced into Yukawa crystals allow one to control the elastic properties of the system. It has been also found that the introduction of the Yukawa monolayers to the hard sphere crystal induces auxeticity in the  Comprehensive Monte Carlo simulations revealed that the structural modification of the Yukawa system in the form of nanolayers in the (111) crystallographic plane can lead both to strengthening as well as weakening the auxetic properties of the system. Reduction of auxetic properties is achieved by increasing the concentration of nanolayer particles in multilayer Yukawa systems, whereas monolayered Yukawa systems exhibit the enhancement of auxetic properties. The latter is the appearance of a new auxetic direction  way of controlling the elastic properties of materials and show the consequences of introducing the nanolayers in the (111) crystallographic plane of given crystal. This information may be useful for the construction of nanocomposites, and may indicate directions for further research on materials with desired elastic properties.


Collection of insects at the scene is one of the most important aspects of forensic entomology and proper collection is one of the biggest challenges for any investigator. Adult flies are highly mobile and ubiquitous at scenes, yet their link to the body and the time of colonization (TOC) and post-mortem interval (PMI) estimates is not well established. Collection of adults is widely recommended for casework but has yet to be rigorously evaluated during medicolegal death investigations for its value to the investigation. In this study, sticky card traps and immature collections were compared for 22 cases investigated by the Harris County Institute of Forensic Sciences, Houston, TX, USA. Cases included all manner of death classifications and a range of decomposition stages from indoor and outdoor scenes. Overall, the two methods successfully collected at least one species in common only 65% of the time, with at least one species unique to one of the methods 95% of the time. These results suggest that rearing of immature specimens collected from the body should be emphasized during training to ensure specimens directly associated with the colonization of the body can be identified using adult stages if necessary. Insects can provide useful data in death investigations. While they have the potential to provide many types of information, the most widespread application of forensic entomology data in death investigations is the estimation of the time of colonization (TOC) by insects . The estUsing accumulated degree days (ADD) or accumulated degree hours (ADH) is one method employed by forensic entomologists to estimate the TOC . This meAn ADH method–based case uses a targeted approach to sampling focused on obtaining the oldest species and the most developed life stages present on and around the body as they presumably represent the primary colonizers, which in turn provide the most accurate indicators of PMI. Succession-based PMI estimation, a widely researched ecologically based technique for PMI estimation , is moreIndoor scenes comprise approximately two-thirds of the forensic entomology cases, represented by all manners of death, analyzed by the Harris County Institute of Forensic Sciences (HCIFS) . Scene iThere are two widely adopted methods for collecting adult flies on the scene including: active sampling with a sweep net and passive sampling with a sticky trap ,11. The Cases—The cases included in this analysis consist of 22 scene deaths investigated by the Harris County Institute of Forensic Sciences (HCIFS) where the forensic entomologist attended the scene and collected larval flies from the decedent’s body and adult flies from the scene with the use of a passive sticky trap. All of the samples from these cases were used to calculate an estimated TOC using the ADH method [H method  as part In addition to the comparison of species composition on trapping method, the presence of male and female blow flies collected on the sticky trap was recorded for comparison to data collected by Mohr and Tomberlin . HoweverCollection Methods—Larval fly specimens were collected from the body according to HCIFS standard operating procedures which are based on several sources [ sources ,3,4,12.  sources  and the  sources ,20,21,22A single sticky trap  was placed within approximately 30 cm of the body at each scene following the method of Haskell and Williams  in a “puThe 22 cases reviewed in this study revealed a lack of congruence between the fly specimens collected via the passive sticky trap and those collected as immatures from the body during death scene investigations. Only 65% of the cases had at least one species that was the same using both methods. The cases included both indoor and outdoor scenes; however, a majority were indoor scenes. The manner of death for the cases included several different manners ; howeverSpecies collected differed for both indoor and outdoor scenes, for the observed stages of decomposition, and months and manners of death. There is one exception in these data, however: all three of the cases with the official manner of death of accident were accidental overdoses related to acute cocaine toxicity (one coupled with chronic ethanol abuse). In these three cases, both of these collection methods yielded the same species. Two of these accidental cases were located indoors and one was located outdoors and all three were moderately decomposed . CocaineOverall more female flies (115) were collected than males (33). This would appear to be consistent with changes at the scene either allowing additional opportunities for colonization or in changing the attractive nature of the scene to additional flies. However, there did not appear to be a trend associated with the variables recorded in this limited study.An often-overlooked aspect of scene investigation is the impact of the investigation itself on insect access. Insects can gain access to the scene once the scene is entered by first responders and there can be hours between the arrival of first responders and the forensic entomologist or medicolegal death investigator who may collect specimens . This co