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Necrotizing fasciitis following venomous snakebites in a tertiary hospital of southwest Taiwan. Necrotizing fasciitis following venomous snakebites is uncommon. The purpose of this study was to describe the initial clinical features of necrotizing fasciitis after snakebites, and to identify the risk factors for patients with cellulitis who later developed necrotizing fasciitis. Sixteen patients with surgically confirmed necrotizing fasciitis and 25 patients diagnosed with cellulitis following snakebites were retrospectively reviewed over a 6-year period. Differences in patient characteristics, clinical presentations, snake species and laboratory data were compared between the necrotizing fasciitis and the cellulitis groups. None of the 41 patients died after being bitten by a snake. Twenty-nine patients (70.7%) were bitten by a cobra. Enterococcus species and Morganella morganii were the most common pathogens identified in wound cultures. Relative to the cellulitis group, the necrotizing fasciitis group had significantly higher rates of hemorrhagic bullae (p=0.000), patients with underlying chronic disease (p=0.019), white blood cell counts (p=0.035), segmented white cell counts (p=0.02), and days of hospitalization (p=0.001). Victims of venomous snakebites should be admitted for close monitoring of secondary wound infections. The risk factors of developing necrotizing fasciitis from cellulitis following snakebites were associated with chronic underlying diseases and leukocytosis (total white blood-cell counts ≥10000cells/mm3 and ≥80% of segmented leukocyte forms). Physicians should be alert to a worsening wound condition after a snakebite, and surgical interventions should be performed for established necrotizing fasciitis with the empirical use of third-generation cephalosporins plus other regimens.

Midsole thickness affects running patterns in habitual rearfoot strikers during a sustained run. The purpose of this study was to: (1) investigate how kinematic patterns are adjusted while running in footwear with THIN, MEDIUM, and THICK midsole thicknesses and (2) determine if these patterns are adjusted over time during a sustained run in footwear of different thicknesses. Ten male heel-toe runners performed treadmill runs in specially constructed footwear (THIN, MEDIUM, and THICK midsoles) on separate days. Standard lower extremity kinematics and acceleration at the tibia and head were captured. Time epochs were created using data from every 5 minutes of the run. Repeated-measures ANOVA was used (P < .05) to determine differences across footwear and time. At touchdown, kinematics were similar for the THIN and MEDIUM conditions distal to the knee, whereas only the THIN condition was isolated above the knee. No runners displayed midfoot or forefoot strike patterns in any condition. Peak accelerations were slightly increased with THIN and MEDIUM footwear as was eversion, as well as tibial and thigh internal rotation. It appears that participants may have been anticipating, very early in their run, a suitable kinematic pattern based on both the length of the run and the footwear condition.

The development of immunological relationship between mother and fetus under physiological and pathological conditions. On the basis of results of our research and review of literature, the complex of immuno logical influences, operating during the development of the human fetus, were evaluated. It is obvious that during the early stages of pregnancy the conceptus is protected by non-specific mechanisms, i.e. hormonally (HCG, progesterone) and by certain properties of the trophoblast (barrier function, immunologically inert surface). Specific immunological tolerance is formed by gradual penetration of trophoblast particles and later by penetration of fetal blood cells into maternal circulation. Thus a specific suppression of maternal T lymphocytes against fetal antigens develops, other immunological functions being intact. - Following a strong antigenic stimulus (e.g. Rh-D), isoimmunization of the mother and serious risk for the fetus occur. Immunological causes of abortion could not be unequivocally proved in recurrent abortions. The explanation of the origin of EPH-gestosis on the basis of toxic action of immunocomplexes is highly probable, however the laboratory and experimental proof is still lacking.

Association between Cognitive Status before Surgery and Outcomes in Elderly Patients with Hip Fracture in a Dedicated Orthogeriatric Care Pathway. Dementia is associated with a worse prognosis of hip fracture, but the impact of a dedicated geriatric care pathway on the prognosis of these patients has not been evaluated. According to the cognitive status before surgery, our main objective was to compare mortality rate at 6 months; secondary outcomes were to compare in-hospital complications, the risk of new institutionalization, and the ability to walk at 6 months. Between 2009 and 2015, all patients (>70 years) admitted after hip fracture surgery into a dedicated unit of peri-operative geriatric care were included: patients with dementia (DP), without dementia (NDP), and with cognitive status not determined (CSND). Data are expressed as hazard ratio (HR) for multivariate cox analysis or odds ratio (OR) for multivariate logistic regression analysis and their 95% confidence interval (CI). We included 650 patients (86±6 years): 168 DP, 400 NDP, and 82 CSND. After adjustment for age, sex, comorbidities, polypharmacy, pre-fracture autonomy, time-to-surgery, and delirium, there were no significant differences for 6-month mortality (DP versus NDP: HR = 0.7[0.4-1.2], DP versus CSND: HR = 0.6[0.3-1.4], CSND versus NDP: HR = 0.8[0.4-1.7]); but DP and CSND were more likely to be newly institutionalized after 6 months compared to NDP (OR DP = 2.6[1.4-4.9], p = 0.003, OR CSND = 2.9[1.4-6.1], p = 0.004). 92% of population was walking after 6 months (63% with assistance): no difference was found between the three groups. In a dedicated geriatric care pathway, DP and CSND undergoing hip surgery have the same 6-month mortality and walking ability as NDP.

Pathway length and evolutionary constraint in amino acid biosynthesis. The evolutionary properties of a metabolic network may be determined by the topology of the network. One attribute of pathways that make up the network is the number of enzymatic steps between initial substrates and final products. To determine the effect of pathway length on evolutionary lability of pathway structure, we examined amino acid biosynthetic pathways across 48 sequenced organisms. We demonstrate that longer pathways exhibit lower rates of change in pathway structure than shorter pathways. This finding suggests that increasing complexity may increase constraint on evolutionary change.

Mycoplasmal pneumonia in pigs in Croatia: first evaluation of a vaccine in fattening pigs. The immunoprophylaxis of mycoplasmal pneumonia of swine (MPS) caused by Mycoplasma hypopneumoniae was investigated for the first time in fattening pigs in Croatia. The incidence of MPS was monitored in pigs weighing on average 27.5 kg (12 weeks old) after immunization with a M. hyopneumoniae vaccine. Of 350 pigs in each group, in the nonvaccinated group 55 animals (15.7%) were affected by pneumonia and 11 (3.1%) died of consequences of pneumonia, whereas in the vaccinated group 20 pigs (5.7%) were affected by pneumonia without any death due to the infection. In the nonvaccinated group 44% more pigs were individually treated with antibiotic, and these animals received in-feed therapy for more than 1/4 of the fattening period. Vaccinated pigs gained weight faster, at the rate of 0.745 kg/day (or 82 g/day more) than control animals. The mean score of lung lesions due to M. hyopneumoniae was 10.51 in the control pigs and only 0.54 in the vaccinated animals. The total tissue alterations on lungs due to M. hyopneumoniae, Pasteurella multocida and/or Actinobacillus pleuropneumoniae expressed as the mean-score were 13.21 in the control group and 2.98 in the vaccinated group. According to the results of evaluation of the M. hyopneumoniae vaccine in the field, the vaccine appeared to provide an adequate immunity in fattening pigs but was less effective when administered to younger pigs at 1-3 weeks of age.

Current topics in neuropathology. Cushing's disease. The application of modern investigative techniques, particularly electron microscopy and immunohistochemistry, to the pituitary gland in Cushing's disease have confirmed that in the majority of cases (up to 90% in some series) the disease is due to a corticotroph microadenoma. It has also been shown that the tumours may produce not only ACTH, but also other peptides derived from the same precursor molecule, pro-opiomelanocortin and, in a small minority of cases, other pituitary hormones (e.g. prolactin). Since these peptides are known to have physiological actions they may account for some of the varied symptoms and signs of Cushing's disease. Because of the high incidence of single tumours the treatment of choice in many centres has become selective adenomectomy by the transsphenoidal route. However, a minority of cases appear to be the result of primary hypothalamic or central abnormalities and this may account for the identification of a normal pituitary gland or of corticotroph hyperplasia (with or without tumour formation). It is not possible at the present to identify these groups of patients on the basis of biochemical testing. It is hoped that detailed prospective studies correlating hormone secretion, responses to biochemical testing and detailed investigation of pathological tissue will provide further insight into the pathogenesis of particular variants of the disease.

A survey of anesthesiologist and anesthetist attitudes toward single-use vials in an academic medical center. To evaluate whether proper implementation of safety measures was uniform at 5 hospitals, and to elucidate motivating factors that lead to nonadherence. Electronic anonymous survey instrument. Academic medical center. Of the 319 surveys sent to anesthesia providers across 5 hospitals, 89 responses were obtained. Questions addressed compliance with Centers of Disease Control (CDC) safety standards and the rationale for anesthesia providers' decisions to comply or not comply with these standards. 59.6% of respondents reported that they had reused vials between cases, while 40.4% had never done so. Of the 89 respondents, 63 (44%) felt that cost was the primary factor that prevented them from using entirely new medications on each case. Thirty-two (23%) reported convenience/efficiency as the reason; 11 (8%) responded that time prevented them from using entirely new medications on each case; 14 (10%) reported that the environment was a driving factor; and 3 individuals (2%) responded apathy. Eighteen (13%) responded "other" and, when asked to amplify a response, most of these individuals reported that they do use entirely new medications on each case. Safe anesthetic practices were not uniform among respondents, and one of the main reasons given for noncompliance with safe standards was cost.

The 'Distress Barometer': validation of method of combining the Distress Thermometer with a rated complaint scale. Screening instruments may enhance the clinician's ability to detect elevated levels of distress in cancer patients, but these are often neither suitable nor effective for the routine of daily care for cancer patients. The newly developed Distress Barometer (DB) was intended to provide medical doctors with a convenient tool to interpret 'at single glance' the nature and the intensity of distress in ambulatory cancer patients. The DB, i.e. a combination of the Distress Thermometer (DT) and a new tool, the Colored Complaint Scale was developed to improve the specificity of distress screening without decreasing the sensitivity of the Distress Thermometer. Distress was screened in a sample of 538 out-patients, using the Hospital Anxiety and Depression Scale (HADS) and the new Distress Barometer (DB). The results confirm the validity of the Dutch version of the DT against the HADS as standard measure. In addition, it was found that the overall accuracy of the new DB was higher, with a sensitivity of 0.79 and a specificity of 0.81. These results indicate that the Distress Barometer, which is convenient for both patients and doctors, can be used as an acceptable, brief and sufficiently accurate method for detecting distress in cancer patients.

Synthetic polycation: polynucleotide interactions determined using liquid chromatography with short monolithic columns. LC on short monolithic columns (Convective Interaction Medium Disks) was applied to investigate several specially synthesized water soluble polycations of different charge type (primary, tertiary, quaternary amine), as well as a copolymer of neutral saccharide and cationic monomers, regarding their ability to form reversible complexes with DNA. For this purpose, two separation modes were used, namely, pseudo-affinity and cation-exchange chromatography. Synthetic polynucleotides, namely, polyriboadenylic acid (poly(rA)) and polyribocytidylic acid (poly(rC)), were used as approximate structural analogues of DNA. In first case, the hypothetical specific binding between dissolved polymers and polynucleotide (poly(rA) or poly(rC)), covalently attached to epoxy-bearing monolithic sorbent, has been studied and compared to the results obtained using cation exchange chromatography. Quantitative parameters of interactions between macromolecules were established using frontal elution method.

Percutaneous testicular sperm aspiration and intracytoplasmic sperm injection in obstructive and non-obstructive azoospermia: an easy alternative to TESE and MESA. To evaluate the recovery rate of sperm from the testis using percutaneous testicular aspiration with a 22-gauge hypodermic needle followed by evaluation of the fertilization rate and pregnancy rate after intracytoplasmic sperm injection. This is a prospective observational study performed in a private in vitro fertilization setting in Kuwait. Fifteen patients with obstructive and non-obstructive azoospermia were included in the study. Thirteen of them had previous microepididymal sperm aspiration, percutaneous epididymal sperm aspiration or testicular sperm extraction. The sperm were retrieved using percutaneous testicular aspiration under local analgesia. This was followed by intracytoplasmic sperm injection. A total of 146 eggs were collected and 112 were injected. Normal fertilization occurred in 91 oocytes (87.5%) and the total number of embryos cleaved was 83 (91%). Embryo transfer was performed in 13 with pregnancy rate of 33.3 per treatment cycle and 38.5 per embryo transfer. Failure to retrieve sperm was encountered in 2 cases both in the hypospermatogenesis group. Percutaneous testicular sperm aspiration using hypodermic needles under local analgesic is an easy and cheap method with high patient acceptability, minimal complications and no need of special training. In this small group, it seems to have an acceptable success rate in terms of sperm retrieval and pregnancy in the obstructive type as well as hypospermatogenesis, but to lesser extent.

Dysregulation of cellular signaling in gastric cancer. The pathogenesis of gastric cancer is complex and related to multiple factors. Dysregulation of intracellular signaling pathways represents a common pathogenic mechanism and may be amenable to drug targeting. Multiple well-established oncogenic pathways, such as those mediated by cell cycle regulators, nuclear factor-kappaB, cyclooxygenase-2 and epidermal growth factor receptor are implicated in gastric carcinogenesis. Emerging evidence also underscores the importance of signaling pathways involved in the developmental process, including transforming growth factor-beta/bone morphogenetic protein signaling, Wnt/beta-catenin signaling, Hedgehog signaling and Notch signaling. Understanding their biological significance will provide a rational basis for drug development. Their relative importance and cross-talk in gastric carcinogenesis, however, are still not completely understood and warrant further investigation.

[Stabilization double osteotomy of the knee]. Stabilization osteotomy of the knee is a single or double 1-stage osteotomy done to correct ligamentous deficiency of the knee. The concept of stabilization osteotomy depends on the residual ligamentous and capsular tissues which envelope the circumference of the joint. The technique relies on open wedge osteotomy to restore alignment of the joint. Satisfactory results in 6 patients who underwent stabilization osteotomy as a salvage procedure during the past 5 years encouraged us to publish the principles of this concept.

An alternative parameterization of the general linear mixture model for longitudinal data with non-ignorable drop-outs. This paper considers the mixture model methodology for handling non-ignorable drop-outs in longitudinal studies with continuous outcomes. Recently, Hogan and Laird have developed a mixture model for non-ignorable drop-outs which is a standard linear mixed effects model except that the parameters which characterize change over time depend also upon time of drop-out. That is, the mean response is linear in time, other covariates and drop-out time, and their interactions. One of the key attractions of the mixture modelling approach to drop-outs is that it is relatively easy to explore the sensitivity of results to model specification. However, the main drawback of mixture models is that the parameters that are ordinarily of interest are not immediately available, but require marginalization of the distribution of outcome over drop-out times. Furthermore, although a linear model is assumed for the conditional mean of the outcome vector given time of drop out, after marginalization, the unconditional mean of the outcome vector is not, in general, linear in the regression parameters. As a result, it is not possible to parsimoniously describe the effects of covariates on the marginal distribution of the outcome in terms of regression coefficients. The need to explicitly average over the distribution of the drop-out times and the absence of regression coefficients that describe the effects of covariates on the outcome are two unappealing features of the mixture modelling approach. In this paper we describe a particular parameterization of the general linear mixture model that circumvents both of these problems.

Mycophenolate mofetil and daclizumab targeting T lymphocytes in bleomycin-induced experimental scleroderma. T lymphocytes induce the transformation of fibroblasts into myofibroblasts, the main mediators of fibrogenesis. The inosine 5'-monophosphate dehydrogenase inhibitor mycophenolate mofetil (MMF) and the anti-CD25 monoclonal antibody daclizumab (DCZ) have been reported to suppress the proliferation of T lymphocytes. To evaluate the preventive effects of MMF and DCZ in early stages of bleomycin (BLM)-induced scleroderma. This study involved five groups of Balb/c mice (n = 10 per group). Mice in four of the groups were injected subcutaneously (SC) with BLM [100 μg/day in 100 μL phosphate-buffered saline (PBS)] for 4 weeks; the remaining (control) group received only 100 μL PBS. Three of the BLM-treated groups also received either intraperitoneal MMF 50 or 150 mg/kg/day, or SC DCZ 100 μg/week. At the end of the fourth week, all mice were killed, and blood and tissue samples were obtained for further analysis. In the BLM-treated group, increases were seen in inflammatory-cell infiltration, α-smooth muscle actin-positive (α-SMA+) fibroblastic cell count, tissue hydroxyproline content, and dermal thickness. Dermal fibrosis was histopathologically prominent. In BLM-treated mice also given MMF or DCZ, inflammatory-cell infiltration, tissue hydroxyproline content and dermal thickness were decreased. In the MMF groups, decreases were also noted in α-SMA+ fibroblastic cell count. In this BLM-induced dermal fibrosis model, MMF and DCZ treatments prevented the development of dermal fibrosis. Further studies are needed to evaluate whether targeting T lymphocytes is effective in resolving pre-existing fibrosis in human scleroderma.

Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of distant metastasis and survival. This retrospective study was conducted to identify the prognostic factors for distant metastasis and survival in a population of 378 patients with nasopharyngeal carcinomas treated by radiation therapy alone. All patients were treated at the University of Texas M.D. Anderson Cancer Center between 1954 and 1992, following a consistent dose and volume prescription policy. There were 286 males and 92 females. The median age was 52 years (range: 16-86 years). The majority of the patients were white Caucasians (282 patients,75%). Tumors were classified as squamous cell carcinomas (193; 51%), lymphoepitheliomas (154; 41%), or unclassified carcinomas (31, 8%). Three fourths of the patients presented with AJCC Stage IV disease (T4, N0-3, 118 patients; T1-3, N2-3 164 patients). The treatment techniques included opposed lateral fields with or without an anteroposterior or an anterior oblique pairs for dose supplementation to the primary site. Average total doses per T-stage ranged between 60.2 and 72.0 Gy. Median follow-up time was 10 years (range 0.3 to 28.6 years). A total of 103 patients (27%) developed distant metastases at a median time of 8 months (range: 1-90 months). Actuarial rates for distant metastasis were 30%, 32%, 32% at 5, 10, and 20 years, respectively. Actuarial rates for disease specific survival at the same time points were 53%, 45%, and 39% with 184 patients (49%) dying of their nasopharyngeal cancer. Advanced T-stage, N-stage, and non-lymphoepithelioma histology were independent adverse prognostic factors for disease specific survival. Advanced N-stage and low neck disease were independent adverse prognostic factors for distant metastasis with a very high rate of distant metastases for those patients who presented with both adverse factors (relative risk 7.86). On average, patients with distant metastasis lived 5 months after they were diagnosed with metastatic disease (range: 0-172 months), although four patients (4%) survived more than 5 years after diagnosis. This study demonstrates good long term survival rates after definitive radiotherapy for patients with nasopharyngeal carcinomas. Patients with advanced and lower neck disease have the highest risk of developing distant failures. Such patients can be considered the reference risk group to test the value of adjunctive chemotherapy.

A laparoscopic complication? A medical legal case analysis. Part I. This article describes a case of a laparoscopic injury and the ensuing litigation. Data from the hospital report and the testimony of witnesses are presented. In the next issue of this Journal, the results of the jury finding will be presented as Part II.

Multisegment nanowire/nanoparticle hybrid arrays as electrochemical biosensors for simultaneous detection of antibiotics. Antibiotics such as penicillin and tetracycline drugs are widely used in food animals to treat, control, and prevent diseases, and penicillin is approved for use to improve growth rates in pigs and poultry. However, due to the overuse of antibiotics in food and medical industry, the antimicrobial resistance is starting to show up in some developing countries. The antibiotic abuse may cause allergic reactions, resistance in microorganisms and general lowering of immunity in consumers of meat and dairy products. It is important and necessary to develop an easy, inexpensive, and quantitative sensing method to monitor and analyze the antibiotics concentration in real samples such as milk or meat. In this research, an electrochemical biosensor based on hybrid nanowire/nanoparticle array with various bio-molecular receptors was fabricated for the simultaneous detection of penicillin and tetracycline. The vertically aligned Pt-Au nanowire array has been prepared by an electrodeposition method within anodic aluminum oxide (AAO) membranes; L-cysteine was used to form a monolayer on the Au segment as the bio-receptor for tetracycline detection; electroless plating of Au nanoparticles was applied on the Pt nanowire segments, and then the penicillinase was immobilized on the Au nanoparticles using EDC/NHS cross-linker. The prepared Au(L-cysteine)-Pt(penicillinase) nanowire array electrode showed simultaneous detection ability and remarkably high sensitivity of penicillin and tetracycline, which are 41.2 μA μM-1 cm-2 for penicillin detection and 26.4 μA μM-1 cm-2 for tetracycline detection. The sensitivities of each analytes with different segment length were also investigated. Real sample tests with chicken and beef extract were conducted, which showed good recovery performance. Due to the advantages of the hybrid nanowire/nanoparticle array structure, this new sensor can serve as an enhanced platform for simultaneous detection of various bioanalytes.

Is it possible to make a reliable prognosis within the first hour of life for very low birth weight infants delivered after preterm premature rupture of membranes? One third of all preterm births are due to preterm premature rupture of membranes (pPROM). An accurate prognostic evaluation after admission to the neonatal intensive care unit is necessary. The aim of this study was to identify prognostic factors within the first hour of life for mortality, short-term pulmonary morbidity, chronic lung disease (CLD) and severe cerebral morbidity in very low birth weight (VLBW) infants after pPROM. This retrospective study included 300 infants with pPROM who fit the study criteria and were derived from a cohort of 1,435 VLBW infants. A total of 17 obstetric and neonatal factors were evaluated by univariate and multivariate analysis. Gestational age at birth and 5-min Apgar score correlated significantly with all 4 outcomes. The results of the first blood gas analysis correlated with 3 outcomes and the first mean arterial pressure with 2 outcomes. Anhydramnios and a lower number of courses of antenatal steroids correlated with higher mortality, and preterm labor correlated with CLD. The multivariate analysis revealed gestational age, 5-min Apgar score, the results of the first blood gas analysis, the first mean arterial pressure and anhydramnios to be significant predictors. The positive predictive value ranged from 20 to 81%, and the negative predictive value ranged from 79 to 92%. Gestational age at birth and parameters reflecting postnatal adaptation were the most precise factors for assessment of the prognosis of VLBW infants after pPROM within the first hour of life. Apart from anhydramnios, obstetric factors did not predict neonatal outcome. At 1 h of age, our models of perinatal risk factors were more effective in predicting a favorable outcome than an adverse outcome.

The rise and fall of the Old World savannah fauna and the origins of the African savannah biome. Despite much interest in the ecology and origins of the extensive grassland ecosystems of the modern world, the biogeographic relationships of savannah palaeobiomes of Africa, India and mainland Eurasia have remained unclear. Here we assemble the most recent data from the Neogene mammal fossil record in order to map the biogeographic development of Old World mammalian faunas in relation to palaeoenvironmental conditions. Using genus-level faunal similarity and mean ordinated hypsodonty in combination with palaeoclimate modelling, we show that savannah faunas developed as a spatially and temporally connected entity that we term the Old World savannah palaeobiome. The Old World savannah palaeobiome flourished under the influence of middle and late Miocene global cooling and aridification, which resulted in the spread of open habitats across vast continental areas. This extensive biome fragmented into Eurasian and African branches due to increased aridification in North Africa and Arabia during the late Miocene. Its Eurasian branches had mostly disappeared by the end of the Miocene, but the African branch survived and eventually contributed to the development of Plio-Pleistocene African savannah faunas, including their early hominins. The modern African savannah fauna is thus a continuation of the extensive Old World savannah palaeobiome.

Experience with developmental facial paralysis: part II. Outcomes of reconstruction. The purpose of this study was to document the 30-year experience of the authors' center in the management of developmental facial paralysis and to analyze the outcomes of microsurgical reconstruction. Forty-two cases of developmental facial paralysis were identified in a retrospective clinical review (1980 to 2010); 34 (80.95 percent) were children (age, 8 ± 6 years) and eight (19.05 percent) were adults (age, 27 ± 12 years). Comparisons between preoperative and postoperative results were performed with electrophysiologic studies and video evaluations by three independent observers. Mean follow-up was 8 ± 6.3 years (range, 1 to 23 years). Overall, outcome scores improved in all of the patients, as was evident from the observers' mean scores (preoperatively, 2.44; 2 years postoperatively, 3.66; final, 4.11; p < 0.001, Kruskal-Wallis test) and the electrophysiologic data (p < 0.0001). The improvement in eye closure, smile, and depressor function was greater in children as compared with adults (p < 0.005, Mann-Whitney test). Early targeted screening and diagnosis, with prompt specialized treatment, improves the physical and emotional development of children with developmental facial paralysis and reduces the prevalence of aesthetic and functional sequelae of the condition, thus facilitating reintegration among their peers. The experience of this center should serve as a framework for the establishment of accurate and reliable guidelines that will facilitate early diagnosis and management of developmental facial paralysis and provide support and counseling to the family.

Analysis, fate studies and monitoring of the antifungal agent clotrimazole in the aquatic environment. The analysis and presence of clotrimazole, an antifungal agent with logK(OW) > 4, was thoroughly studied in the aquatic environment. For that reason analytical methods based on gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry were developed and validated to quantify clotrimazole with limits of quantification down to 5 and 1 ng/L, respectively. Both methods were compared in an intercalibration exercise. The complete mass-spectrometric fragmentation pattern could be elucidated with the aid of quadrupole time of flight mass spectrometry. Since clotrimazole tends to adsorb to laboratory glassware, studies on its adsorption behaviour were made to ensure the appropriate handling of water samples, e.g. pH, storage time, pretreatment of sampling vessels or material of the vials used for final extracts. The phenomena of adsorption to suspended matter were investigated while analysing different waste-water samples. Application of the methods in various investigated wastewater and surface water samples demonstrated that clotrimazole could only be detected in the low nanogram per litre range of anthropogenic influenced unfiltered water samples after acidification to pH 2.

Taking the next step: combining incrementally valid indicators to improve recidivism prediction. The possibility of combining indicators to improve recidivism prediction was evaluated in a sample of released federal prisoners randomly divided into a derivation subsample (n = 550) and a cross-validation subsample (n = 551). Five incrementally valid indicators were selected from five domains: demographic (age), historical (prior convictions), adjustment (prior incident reports), rating scale (Violation scale of the Lifestyle Criminality Screening Form), and self-report (General Criminal Thinking score from the Psychological Inventory of Criminal Thinking Styles). After converting scores on the five indicators to a common scale (z score), two combined scores were calculated: a simple summed score (unweighted summed score) and a score computed using beta weights from a Cox survival analysis of the derivation subsample (weighted summed score). Correlational and receiver operating characteristic analyses revealed that the unweighted and weighted summed scores produced equivalent results and that both improved significantly on the results of the five contributing indicators.

Hepatitis B virus-associated liver disease after renal transplantation. A retrospective analysis of the first 200 recipients of renal transplants at the Johannesburg Hospital showed that 23 (11,5%) were chronic carriers of the hepatitis B virus (HBV) and a further 10 (5%) had previously been exposed to the virus as evidenced by detectable concentrations of antibody to the hepatitis B surface antigen in their serum. In no patient did graft function appear to suffer as a result of chronic HBV infection. However, 7 of the patients with hepatitis B surface antigenaemia had biochemical evidence of liver dysfunction. In 3 of these patients liver tissue was examined histologically; 2 had a macronodular cirrhosis and 1 chronic persistent hepatitis. One further patient developed acute fulminant B virus hepatitis and was the only one who died of liver failure in either group. Chronic infection with HBV may cause liver disease in renal transplant recipients, and strict techniques to limit the spread of the virus in renal transplant and dialysis units should continue to be enforced.

Orthostatic intolerance in survivors of childhood cancer. To compare the prevalence and severity of orthostatic intolerance in survivors of childhood cancer and in healthy controls, and to correlate results of self-reported measures of health status with orthostatic testing in survivors of childhood cancer. Thirty-nine survivors of childhood cancer and 56 controls were recruited for this study. Each cancer survivor completed standardised self-report measures and all participants underwent a standing test (5 min supine, 10 min of motionless standing leaning against a wall, followed by another 2 min supine). The main outcomes of the standing test were orthostatic tachycardia (OT), defined as a heart rate increase of at least 30 beats per minute (bpm) during standing, and neurally mediated hypotension (NMH), defined as a drop in systolic blood pressure of at least 25 mmHg. OT developed in 22/39 (56%) cancer survivors versus 17/56 (30%) controls (P=.01). Cancer survivors had a higher baseline and maximum standing heart rate (both P<.001) and a more rapid onset of significant OT (P=.005). No significant difference in scores on self-report measures was found between cancer survivors with or without OT. This study provides preliminary evidence of a higher rate of orthostatic intolerance in childhood cancer survivors. Further study is warranted to better define whether this is a modifiable risk factor for fatigue in this population, and how orthostatic intolerance interacts with other known risk factors for lowered quality of life.

Evaluation of IL17A expression and of IL17A, IL17F and IL23R gene polymorphisms in Brazilian individuals with periodontitis. The IL23/Th17 axis plays an important role in the pathogenesis of cell-mediated tissue damage caused either by autoimmunity or immune responses against bacterial infection. Single nucleotide polymorphisms in the IL17A, IL17F and IL23R genes have been associated with several inflammatory diseases. However, these polymorphisms have not yet been studied in periodontitis. The aim of present study was to evaluate the expression of IL17A and occurrence of the IL17A (rs2275913), IL17F (rs763780) and IL23R (rs11209026) gene polymorphisms in different clinical forms or severity of periodontitis in a sample of Brazilian individuals. Peripheral blood was obtained from 30 non-smoker individuals and analyzed by flow cytometry to determine IL-17 expression. Genomic DNA was obtained from oral swabs in 180 individuals and analyzed by Real-time PCR. The study group was composed by individuals without periodontitis (control), with aggressive periodontitis (AP) and with chronic periodontitis (CP). Higher frequency of IL17A+CD4+ T cells was observed in control group. The A+ genotype from IL17A (rs2275913) was associated with lack of disease. No association was found considering the IL17F and IL23R polymorphisms. Our data suggest that IL17A and the presence of IL17A (rs2275913) A allele are associated with the absence of periodontal disease.

Traumatic lesions of the salivary glands. Injuries to the region of the major salivary glands, especially the parotid, may have important sequelae and require insight and persistence to manage. This is an area in which microsurgery comes into its own, especially for repair of the duct or nerve. In cases of severe injury or complications, the removal of the involved gland is always an option.

Do you believe in magic? The impact of "Magic" Johnson on adolescents' AIDS knowledge and attitudes. A group of young people ages 10 to 18, interviewed after basketball star Earvin "Magic" Johnson announced that he had tested positive for the human immunodeficiency virus (HIV), were asked for their reactions to the news. Their knowledge of and attitudes regarding AIDS were also compared to those of similar young people interviewed before the announcement. Reactions to the announcement were varied and were accompanied by only isolated changes in knowledge and attitudes, suggesting that news of this celebrity's HIV infection served primarily to reinforce or make temporarily more salient knowledge and attitudes that predated the announcement.

Prevalence of overweight and hypertension in Tanzania: special emphasis on resting energy expenditure and leptin. 1. In the present study we investigated the difference in the distribution of selected cardiovascular disease risk factors among three middle-aged Tanzanian populations with different lifestyles. 2. The prevalence of hypertension and overweight was higher in urban areas than in rural areas. Plasma leptin concentration was also highest in urban areas. Based on these results, we speculated that overweight in the urban population may be partly due to adiposity. 3. Resting energy expenditure was lower in urban areas than in other areas for both genders. These findings suggest that the high prevalence of overweight in the urban population may be partly due to low physical activity levels.

Midregional pro-atrial natriuretic peptide: a novel marker of myocardial fibrosis in patients with hypertrophic cardiomyopathy. We aimed to determine the diagnostic performance of biomarkers in predicting myocardial fibrosis assessed by late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) in patients with hypertrophic cardiomyopathy (HCM). LGE CMR was performed in 40 consecutive patients with HCM. Left and right ventricular parameters, as well as the extent of LGE were determined and correlated to the plasma levels of midregional pro-atrial natriuretic peptide (MR-proANP), midregional pro-adrenomedullin (MR-proADM), carboxy-terminal pro-endothelin-1 (CT-proET-1), carboxy-terminal pro-vasopressin (CT-proAVP), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1) and interleukin-8 (IL-8). Myocardial fibrosis was assumed positive, if CMR indicated LGE. LGE was present in 26 of 40 patients with HCM (65%) with variable extent (mean: 14%, range: 1.3-42%). The extent of LGE was positively associated with MR-proANP (r = 0.4; P = 0.01). No correlations were found between LGE and MR-proADM (r = 0.1; P = 0.5), CT-proET-1 (r = 0.07; P = 0.66), CT-proAVP (r = 0.16; P = 0.3), MMP-9 (r = 0.01; P = 0.9), TIMP-1 (r = 0.02; P = 0.85), and IL-8 (r = 0.02; P = 0.89). After adjustment for confounding factors, MR-proANP was the only independent predictor associated with the presence of LGE (P = 0.007) in multivariate analysis. The area under the ROC curve (AUC) indicated good predictive performance (AUC = 0.882) of MR-proANP with respect to LGE. The odds ratio was 1.268 (95% confidence interval 1.066-1.508). The sensitivity of MR-proANP at a cut-off value of 207 pmol/L was 69%, the specificity 94%, the positive predictive value 90% and the negative predictive value 80%. The results imply that MR-proANP serves as a novel marker of myocardial fibrosis assessed by LGE CMR in patients with HCM.

The use of membrane vesicles to study the NaCl/KCl cotransporter involved in active transepithelial chloride transport. Properties of the NaCl/KCl cotransport system were investigated in isolated membranes by flux measurements and binding studies. Chloride competes with "furosemide-like loop diuretics" for its two binding sites at the cotransporter as evidenced by the decrease in piretanide sensitivity of sodium flux and inhibition of high affinity N-methylfurosemide binding by chloride in rectal gland plasma membranes. In the rectal gland lithium inhibits sodium flux but is not translocated whereas in the renal thick ascending limb (TALH) it is also transported. Ammonium is a substrate for the sodium and potassium site in the rectal gland but only for the potassium site in the TALH. The latter finding raises the possibility that part of the ammonium reabsorption in the TALH is mediated by the cotransport system as NaCl/NH4Cl cotransport.

Common presentations of elder abuse in health care settings. Health care professionals encounter elder abuse in the community and in medical offices, emergency rooms, hospitals, and long-term care facilities. Keen awareness of risk factors for elder abuse and the variety of presentations in different health settings helps promote detection, treatment, and prevention of elder abuse.

Effect of an accelerated finishing program on performance, carcass characteristics, and circulating insulin-like growth factor I concentration of early-weaned bulls and steers. Sixty-three Angus x Simmental calves were allotted to a bull or a steer group based on sire, birth date, and birth weight to determine effects of castration status on performance, carcass characteristics, and circulating insulin-like growth factor I (IGF-I) concentrations in early-weaned cattle. At 75 d of age, calves in the steer group were castrated. Calves were not creep-fed prior to weaning. All calves were weaned and weighed at an average age of 115 d and transported by truck to the OARDC feedlot in Wooster, OH. Performance and carcass characteristics were measured in three phases. Phase 1 was from 115 to 200 d of age, phase 2 was from 201 to 277 d of age, and phase 3 was from 278 d of age to slaughter. Before implantation, four bulls and four steers were selected for serial slaughter and carcass evaluation. Steers were implanted with Synovex-C at 130 d of age and with Revalor-S at 200 and 277 d of age. Serum samples were collected from all calves on the day of implantation, 28 and 42 d after implantation, and at slaughter and analyzed for circulating IGF-I concentration. Bulls gained 9.7% faster (1.75 vs 1.60 kg/d; P < 0.01), consumed 25 kg more DM (521 vs 496 kg; P = 0.11), and were 3.3% more efficient (282 vs 273 g/kg, P < 0.10) than steers in phase 1. However, steers gained 10.5% faster (1.62 vs 1.46 kg/d; P < 0.02), consumed similar amounts of DM, and were 6.5% more efficient than bulls (214 vs 201 g/kg; P < 0.06) in phase 2. Overall gains and efficiency were similar between bulls and steers; however, bulls consumed 140 kg more DM (P < 0.05), were 27 kg heavier (P < 0.05), and had to stay in the feedlot 18 more days (P < 0.05) than steers to achieve a similar amount of fat thickness. Implanted steers had greater concentrations of circulating IGF-I than bulls (P < 0.01), and the pattern of IGF-I concentration over time was affected by castration status (castration status x time interaction; P < 0.01). Synovex-C had a lower impact on circulating IGF-I concentration (implant effect, P < 0.01) than either Revalor-S implant. Eighty-five percent of both bulls and steers had marbling scores sufficient to grade low Choice or better. Bulls achieved their target fat thickness later, increased muscle growth, and deposited fat more favorably than steers, possibly due to a gradual increase in IGF-I concentration as the testicles grew rather than the large fluctuations in IGF-I concentration observed in steers following implantation.

Speech and language intervention for language impairment in patients in the FTD-ALS spectrum. Amyotrophic lateral sclerosis (ALS) is the most common neurodegenerative disease that belongs to the group of motor neuron diseases. Motor deficits like reduce in tongue strength, may coexist with cognitive deficits compatible with frontotemporal dementia (FTD), also known as frontotemporal lobar degeneration (FTLD). FTD is a neurodegenerative syndrome with two main clinical variants: behavioral (bvFTD) and language or Primary Progressive Aphasia (PPA). ALS and FTD have significant clinical and neuropathological overlapping so that for some researchers they are "the ends of the same disease spectrum". A key intervention in this patient population is the speech language therapy (SLT), a specific form of cognitive intervention, which evaluates communication skills and designs a personalized intervention plan to improve communication abilities. It has been used in patients with aphasia of different etiologies and has been shown to be effective. There is limited research in SLT interventions in patients in FTD-ALS spectrum, and the initial findings indicate success to some extent. Due to progressive neurodegeneration in FTD-ALS spectrum, the main goal of the intervention is not the complete rehabilitation of linguistic deficits but the reduction and, if possible, the delay of language decline in order to improve patient's communication and the quality of his/her life. In this paper, we critically review the reported approaches of speech language therapy (SLT) for monitoring language impairments and the impact of interventions in patients with FTD-ALS spectrum. Initial findings are supporting more systematic treatment of speech and language impairment in patients in the FTD-ALS spectrum.

Better Parenting through Biomedical Modification: A Case for Pluralism, Deference, and Charity. In this paper, I will argue that the moral assessment of the prenatal selection and postnatal modification biotechnologies requires a nuanced approach, which pays close attention to the variety of sometimes conflicting parental roles and reasons involved in decisions for and against their use. I will focus on several related but distinct reasons that parents have, or give, for modifying existing children or selecting future children. Many of these reasons are expressed in terms of more effective parenting. Because there is a plurality of legitimate parental goals, I will conclude that assessing parental interventions requires us to adjudicate conflicts or tradeoffs among those goals.

Daily variation of brain-derived neurotrophic factor and cortisol in women with normal menstrual cycles, undergoing oral contraception and in postmenopause. Plasma brain-derived neurotrophic factor (BDNF) levels are associated with the hormonal status of women. Moreover, the suprachiasmatic nucleus appears to be implicated in the modulation of BDNF central levels. We aimed to investigate whether BDNF circadian rhythms exist in women and if there is a relationship with cortisol circadian rhythmicity. Moreover, we aimed to establish whether the hormonal status influences BDNF diurnal variations. A total of 30 women were studied: 10 fertile ovulatory women, 10 women undergoing oral contraceptive (OC) therapy and 10 post-menopausal women. Basal BDNF and estradiol levels were assayed in blood samples collected after overnight fasting at regular intervals (08:00, 12:00, 16:00, 20:00, 24:00). BDNF and cortisol levels were measured in samples collected during the follicular and luteal phases in ovulatory women and once a month in OC and post-menopausal women. Luteal BDNF levels were significantly higher than follicular levels in fertile women (P < 0.001). In OC women, BDNF levels were similar to the follicular BDNF levels, whereas in post-menopausal women, they were significantly lower (P < 0.001). BDNF showed a diurnal rhythm in the follicular phase and in women undergoing OC, although the diurnal rhythm was blunted in the luteal phase. In post-menopausal women, BDNF and cortisol levels significantly decreased during the day. BDNF has a diurnal variation in women that is somewhat analogous to cortisol variation; however, the amplitude of the variation in BDNF levels appears to be influenced by ovarian function. Interactions between BDNF, the hypothalamus-pituitary-adrenal axis and sex steroids might play a critical role in the human homeostasis and adaptation.

Should liver transplantation be performed for patients with hepatitis B? Because of the almost universal recurrence of hepatitis B surface antigenemia (HBsAg) after liver transplantation, some centers have questioned whether these patients are appropriate allograft candidates. Since January 1984, 51 patients with hepatitis B (HBV) underwent OLT at our center. No therapy was given to prevent reinfection. Three patients underwent retransplantation. The indications for transplant included fulminant HBV (13 patients), chronic HBV (33 patients), and hepatocellular carcinoma (HCCA) in addition to HBV (5 patients). Incidental HCCA was found in 2 of the 33 patients thought to have only chronic HBV. Actuarial survival for the entire group was 57% at 1 year and 54% at 3 years. Of the 23 patients who died, only 4 deaths were attributable to recurrent HBV liver disease. Four patients survived less than 4 days due to primary graft nonfunction. Ten patients died in the first 3 months from sepsis. Although all patients who died beyond 30 days had recurrent HBsAg, only 4 deaths were attributable to recurrent HBV. The remaining 5 deaths were caused by portal vein thrombosis, bile leak, lymphoma, pancreatitis, and sepsis occurring at 15 months. Excluding the 4 patients who died from primary graft nonfunction, actuarial survival was 63% at 1 year and 60% at 3 years. Of the 28 survivors, 24 are HBsAg positive; however, only 5 have recurrent HBV liver disease. Multiple factors were evaluated to determine their influence on survival; i.e., HBV serology, United Network for Organ Sharing status, fulminant versus chronic HBV, incidence of rejection, immunosuppression, transfusion requirements, and presence of HCCA. Of these, only the presence of HCCA adversely affected outcome. Of the 7 patients with HCCA and HBV, 6 patients died within the first 6 months and 1 patient has recurrent HBV liver disease at 25 months. Actuarial survival excluding those patients with HCCA was 64% at 1 year and 61% at 3 years. Based on our results, patients with HBV and associated HCCA have a poorer prognosis and should probably be excluded from transplantation. Although the survival for patients with HBV undergoing liver transplantation is inferior to that expected in patients with some other diagnoses, long-term survival can be achieved in a majority of these patients despite recurrence of HBsAg. We believe that appropriately selected patients with a diagnosis of HBV alone should continue to be candidates for liver allografts.

A variant of a descriptive epidemiological study of cancer with the aid of a minicomputer. The presented method of descriptive epidemiological study with the aid of a computer was designed using the model of an average district with a data file of carcinoma incidence from the period 1975-1983. The method is based on processing the statistical characteristics of a data file and on their evaluation. Plotting the coordinates of the communities and of the boundaries of the district constitutes the frame for the construction of maps. The population is divided into age groups of 5 years, incidence is standardized with respect to the age standard of the district. The selection of boundaries (isolines) of zones in the maps is based on the evaluation of the distribution of incidences and on the relative number of inhabitants in communities classified according to the standardized values. The application of the study to the work of centers for clinical oncology is discussed.

The role of miR156 in developmental transitions in Nicotiana tabacum. Plants undergo a series of developmental transitions during their life cycle. After seed germination, plants pass through two distinct phases: the vegetative phase in which leaves are produced and the reproductive phase in which flowering occurs. Based on the reproductive competence and morphological changes, the vegetative phase can be further divided into juvenile and adult phases. Here, we demonstrate that the difference between juvenile and adult phase of Nicotiana tabacum is characterized by the changes in leaf size, leaf shape as well as the number of leaf epidermal hairs (trichomes). We further show that miR156, an age-regulated microRNA, regulates juvenile-to-adult phase transition in N. tabacum. Overexpression of miR156 results in delayed juvenile-to-adult transition and flowering. Together, our results support an evolutionarily conserved role of miR156 in plant developmental transitions.

Fibrinogen: a comparison of an immunoturbidimetric method with four conventional methods. A rapid and simple immunochemical method for fibrinogen determination is described. The method is based on measuring the turbidity caused by antigen-antibody complexes with an enzyme analyser using diluted antiserum as a starting reagent. This immunoturbidimetric method correlates well with the immunodiffusion method and with two of the thrombin methods. Its correlation with the precipitation method according to Low was a little weaker.

Portal venous gas and thrombosis complicating superior mesenteric artery syndrome (Wilkie's syndrome) in a child. We report a case of a 10-year-old girl presenting with portal venous gas and thrombosis associated with superior mesenteric artery syndrome. To our knowledge, this is the first reported case of superior mesenteric artery syndrome complicated by gastric wall pneumatosis, portal venous gas, and thrombosis in childhood. Although these complications usually lead to bowel resection in adults and result in a high mortality rate, our pediatric patient was successfully treated nonoperatively with intensive care management and jejunal tube feedings. Presence of portal venous gas may occur in superior mesenteric artery syndrome in children and does not necessarily lead to bowel injury, allowing conservative medical management as a first-line treatment.

Leg ulcers in patients with myeloproliferative disorders: disease- or treatment-related? Leg ulcers are a relatively frequent problem in patients with myeloproliferative disorders under treatment with hydroxyurea (HU). The pathogenesis is currently unknown and may be multifactorial. Concomitant arterial or venous disease may play a contributing role in the development of these wounds. Vasculitis, cryoglobulinemia and pyoderma gangrenosum should be considered if typical clinical signs are present. We report on 3 patients with myeloproliferative disorders who developed HU-induced leg ulcers and review the literature. HU-induced leg ulcers share clinical features which can help to differentiate them from leg ulcers of other etiologies: occurrence under long-term treatment with HU at a dose of at least 1 g/day, localization in the malleolar region and spontaneous healing when HU is discontinued. We conclude that differentiation between disease-related and treatment-induced leg ulcers can be difficult and may not always be possible. In HU-induced leg ulcers, cessation of the drug typically leads to wound healing.

Efficacy evaluation of two new teat dip formulations under experimental challenge. Two new teat dip formulations were evaluated against Streptococcus agalactiae and Staphylococcus aureus in half-udder, experimental challenge studies. The first product contained a combination of 1.9% linear dodecyl benzene sulfonic acid - .55% iodophor. Incidence of infection was reduced 52.7 and 70.7% for Streptococcus agalactiae and Staphylococcus aureus in dipped quarters compared to undipped controls. The second formulation was a barrier-type product consisting of milk protein solubilized with lauryl sulfate, a surface active detergent and 4.8% glycerin. Rates of infection were reduced 60.3 and 67.9% for Streptococcus agalactiae and Staphylococcus aureus.

Use of human-milk fucosyltransferase in the chemoenzymic synthesis of analogues of the sialyl Lewis(a) and sialyl Lewis(x) tetrasaccharides modified at the C-2 position of the reducing unit. Two series of trisaccharides, having the formulas alpha-Neu5Ac-(2-->3)-beta-D-Gal-(1-->4)-beta-D-GlcZ-OR and alpha-Neu5Ac-(2-->3)-beta-D-Gal-(1-->3)-beta-D-GlcZ-OR [R = (CH2)8CO2CH3] respectively, in which the 2-deoxy substituent Z is azido, amino, propionamido, or acetamido, were prepared by chemical synthesis. Both types of modified trisaccharides are acceptors for a fucosyltransferase preparation obtained from human milk. Preparative fucosylations using this enzyme provided analogues of the sialyl Lewis(x) and sialyl Lewis(a) tetrasaccharide structures, which have been proposed to be ligands for cell-adhesion molecules. These syntheses further demonstrate the utility of glycosyltransferases in the preparation of oligosaccharide analogues.

Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis. Despite proven effectiveness, participation in traditional supervised exercise-based cardiac rehabilitation (exCR) remains low. Telehealth interventions that use information and communication technologies to enable remote exCR programme delivery can overcome common access barriers while preserving clinical supervision and individualised exercise prescription. This meta-analysis aimed to determine the benefits of telehealth exCR on exercise capacity and other modifiable cardiovascular risk factors compared with traditional exCR and usual care, among patients with coronary heart disease (CHD). CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed and PsycINFO were searched from inception through 31 May 2015 for randomised controlled trials comparing telehealth exCR with centre-based exCR or usual care among patients with CHD. Outcomes included maximal aerobic exercise capacity, modifiable cardiovascular risk factors and exercise adherence. 11 trials (n=1189) met eligibility criteria and were included in the review. Physical activity level was higher following telehealth exCR than after usual care. Compared with centre-based exCR, telehealth exCR was more effective for enhancing physical activity level, exercise adherence, diastolic blood pressure and low-density lipoprotein cholesterol. Telehealth and centre-based exCR were comparably effective for improving maximal aerobic exercise capacity and other modifiable cardiovascular risk factors. Telehealth exCR appears to be at least as effective as centre-based exCR for improving modifiable cardiovascular risk factors and functional capacity, and could enhance exCR utilisation by providing additional options for patients who cannot attend centre-based exCR. Telehealth exCR must now capitalise on technological advances to provide more comprehensive, responsive and interactive interventions.

Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. The authors propose a new laparoscopic technique for correction of rectal prolapse. The unique feature of this technique is that it avoids any posterolateral dissection of the rectum. The mesh is sutured to the anterior aspect of the rectum to inhibit intussusception. The technique was applied in 109 consecutive patients to correct total rectal prolapse. Conversion was needed for four patients. No postoperative mortality or major morbidity occurred. Minor morbidity was noted for 7% of the patients, and a recurrence rate of 3.66% was observed. Because this technique limited the dissection and the subsequent risk of autonomic nerve damage, a cure comparable with that resulting from classical mesh rectopexy can be anticipated.

Pruritic papular eruption of the acquired immunodeficiency syndrome. We report a case of acquired immunodeficiency syndrome with pruritic papular eruption. The patient, a hemophiliac, presented with generalized pruritic, skin-colored papules and nodules. The chronic lesions were excoriated and hyper-pigmented. The eosinophil count was elevated, but IgE was normal. The lesions and pruritus responded only to ultraviolet B phototherapy. While the mechanism is not known, ultraviolet B phototherapy may provide relief of AIDS-related pruritus.

[Mental health and solitude in old age]. Mental health and solitude in old age. Elderly people experience solitude as isolation, even more so when the person is ill. However, in the same circumstances, some people see solitude as an experience of maturity. Is it simply a question of inner strength?

Measurement of serum total glycerides and free glycerol by high-performance liquid chromatography. Serum levels of total glycerides and free glycerol are important indices of lipid metabolism and cardiovascular disease risk. Convenient enzymatic methods of measurement have been available, but they are susceptible to interference. Situations exist in both research and clinical laboratories in which more specific and precise methods are needed. We developed HPLC methods for the measurement of serum total glycerides and free glycerol. For total glycerides, serum was mixed with an internal standard (1,2,4-butanetriol) and treated with alcoholic sodium hydroxide to hydrolyze glycerides to glycerol. After deproteinization with tungstic acid, the glycerol was benzoylated with an optimized Schotten-Baumann reaction and analyzed by HPLC. For free glycerol, serum was equilibrated with the internal standard and deproteinized with tungstic acid to remove the glycerides. The glycerol was benzoylated and analyzed as for total glycerol. Various factors were investigated, and no significant sources of interference were detected. The total coefficients of variation ranged from 0.7% to 2.0% for total glycerides and from 1.7% to 3.2% for free glycerol. The analytical recoveries ranged from 98.5% to 101.6%. In conclusion, simple and reliable HPLC methods for serum total glycerides and free glycerol have been developed. The methods may also be used for the analyses of glycerol or glycerides in other biological samples.

Health and citizenship: the characteristics of 21st century health. Health is at the core of modernity and its governance has been characterised by two expansions: an expansion of the territory of health into an increasing array of personal and political spaces; and an expansion of the do-ability of health. Health is an exemplary area to study the 'consequences of modernity' in all its dimensions and it is inextricably linked to the concept of modern citizenship.

Issues in Internet survey research among cancer patients. Considering the increasing number of cancer patients who are online, it is clear that the Internet will provide an important research medium and/or setting for oncology nurses in the near future. Despite increasing Internet usage in nursing research and practice, issues in using the Internet among cancer patients as a research tool have rarely been explored and discussed. The purpose of the article is to propose future directions for Internet research among cancer patients based on discussions of practical issues raised in an Internet survey study among 40 online cancer patients. The issues raised through the research process include (a) ethical issues, (b) recruitment issues, (c) issues in Web site development and maintenance, and (d) data entry and analysis issues. On the basis of the discussions of these issues, some future directions for Internet survey studies are proposed, including dealing with ethical issues, getting computer expertise, using motivational strategies, and using national and international approaches.

A Perioperative Medicine Model for Population Health: An Integrated Approach for an Evolving Clinical Science. Health care delivery in the United States continues to balance on the tight rope that connects its transition from volume to value. Value in economic terms can be defined as the amount something exceeds its commodity price and is determined by extraordinary reputation, quality, and/or service, whereas its destruction can be a consequence of poor management, unfavorable policy, decreased demand, and/or increased competition. Going forward, payment for health care delivery will increasingly be based on services that contribute to improvements in individual and/or population health value, and funds to pay for health care delivery will become increasingly vulnerable to competitive market forces. Therefore, a sustainable population health strategy needs to be comprehensive and thus include perioperative medicine as an essential component of the complete cycle of patient-centered care. We describe a multidisciplinary integrated program to support perioperative medicine services that are integral to a comprehensive population health strategy.

Gene Editing in Sorghum Through Agrobacterium. The application of CRISPR/Cas to introduce targeted genomic edits is powering research and discovery across the genetic frontier. Applying CRISPR/Cas in sorghum can facilitate the study of gene function and unlock our understanding of this robust crop that serves as a staple for some of the most food insecure regions on the planet. When paired with recent advances in sorghum tissue culture and Agrobacteria technology, CRISPR/Cas can be used to introduce desirable changes and natural genetic variations directly into agriculturally relevant sorghum lines facilitating product development. This chapter describes CRISPR/Cas gene editing and provides high-level strategies and expectations for applying this technology using Agrobacterium in sorghum.

Transfusion requirements in 811 patients during and after cardiac surgery: a prospective observational study. To identify patients at risk for intra- and postoperative blood product transfusion in a mixed adult cardiac surgical patient population. A prospective, observational study. A single-center university hospital. Patients (n = 811) undergoing cardiac surgery from January 1, 2008, to November 30, 2008. The outcome in terms of transfusion of red blood cells (RBCs), fresh frozen plasma (FFP), and/or pooled platelets within the first 24 hours after surgery was studied. Pre- and perioperative risk factors for bleeding and transfusion of blood products were studied. The majority of RBCs and FFP (>70%) were given to a minority of patients (<12%). The type of surgical procedure, previous cardiac surgery, and emergency operations were all significantly associated with the transfusion of RBCs, FFP, and platelets. Antithrombotic therapy was not significantly associated with the transfusion requirement in the mixed group of cardiac patients. However, in the low-risk procedures such as coronary artery bypass graft surgery, ongoing antithrombotic therapy at the time of the operation significantly increased the risk of transfusion in this otherwise low-risk category of surgery. The identification of high-risk patients is necessary to optimize the perioperative management of bleeding complications. Because of the high variability in transfusion requirements, a specifically tailored patient intervention based on the individual's risk profile appears more likely to improve patient outcome compared with general interventions given to the entire patient group.

Supramolecular control over the structural organization of a second-order NLO-active organogelator. A study of the structural parameters which govern the supramolecular organization of an organogelator built from the Disperse Red moiety is proposed. In particular, the key balance between intermolecular H-bonding and/or π-π interactions is addressed by comparing the effect of a secondary amide vs. an ester linker within the molecular structure. Solution 1H-NMR studies show the superiority of the former interaction in promoting the nanostructuring process, allowing it to reach a gel state in toluene. The nanostructures obtained from both the amide and the ester derivatives were also studied in the solid state. In particular, the use of second-harmonic generation microscopy demonstrates that an anisotropic organization of the material can even be observed in the case of the ester derivative, which demonstrates the efficiency of the tris(alkoxy)benzene unit in directing the self-assembly process, independently of additional H-bond interactions.

Formation of imine oligomers on Au under ambient conditions investigated by scanning tunneling microscopy. Scanning tunneling microscopy has been used to investigate the nucleophilic substitution reaction between melamine (1,3,5-triazine-2,4,6-triamine) and terephthalaldehyde on Au/mica following deposition from solution in ambient conditions. The reaction is observed to proceed at room temperature over a time scale of days with the formation of imine oligomers intermixed with melamine islands on the Au surface. The oligomers ultimately self-assemble into a porous arrangement. The mechanism and extent of the surface confined reactions are discussed.

[Multifactor analysis of the immunomodulating properties of aclarubicin]. The effect of different doses of aclarubicin, an anthracycline antitumor antibiotic and different regimens of its use on the cellular and humoral immune response in mice with semisyngeneic carcinoma 755 was studied with using multifactor experiments. The resulting quantitative data were computer processed and 2nd order polynomial equations reflecting regressive relationships between the indices being studied and expressed graphically were developed. The analysis indicated that it was possible to use multifactor experiments for studying relationships between various factors defining this or that effect and in particular for determining optimal interaction between therapeutic and immunological activity of antitumor drugs.

The α₂ adrenergic antagonist fipamezole improves quality of levodopa action in Parkinsonian primates. Reduction in the antiparkinsonian benefit of levodopa is a major complication of long-term levodopa treatment in advanced Parkinson's disease (PD). Such loss of benefit arises because of reduced duration of action and appearance of disabling dyskinesia. We assess the potential of the α(2) adrenergic antagonist fipamezole to reduce motor complications in parkinsonian macaques. MPTP-lesioned macaques were treated acutely with fipamezole (10 mg/kg) alone and in combination with two doses of levodopa. Fipamezole extended both duration and quality of antiparkinsonian action of levodopa. Duration of antiparkinsonian action, on time, was increased by up to 75% while "good-quality" on time, i.e., that not associated with disabling dyskinesia, was increased by up to 98%. Combination of fipamezole with the lower dose of levodopa provided antiparkinsonian benefit at least equivalent to that provided by the higher dose levodopa alone. However, with the combination, antiparkinsonian benefit was of much better quality. The proportion of on time without disabling dyskinesia (79%) was significantly greater than that with high dose levodopa alone (45%). Increased duration and quality of levodopa action may represent therapeutically valuable actions of α(2) adrenergic antagonists.

[Effect of strychnine on evoked potentials and postsynaptic responses of sensomotor cortex neurons in the cat]. In acute experiments on cats under light nembutal anaesthesia, immobilized by myorelaxants, superficial application of strychnine was shown to suppress the slow negative potentials (arising during direct and primary cortical responses) and IPSPs of the pyramidal neurons corresponding to the slow negative potentials. Iontophoretic application of strychnine blocks predominantly the early component of IPSP during which the input resistance is significantly less than that of the late component indicating their different genesis. It is concluded that individual components of evoked potentials have a common genesis, the slow negative potential is the reflection of the IPSP of pyramidal neurons whose early component seems to be generated by axo-somatic synapses while the late one by axo-dendritic inhibitory synapses. Neurotransmitters in these inhibitory synapses may be different.

Surgical Principles for Disc Resection of Deep Bowel Endometriosis. Colorectal involvement represents 90% of bowel endometriosis. The best surgical approach must consider the patient's clinical symptoms, preoperative imaging, and correlation with surgical findings. For patients with severe pain who either have failed medical treatment or contraindications to hormonal treatment and have a single bowel lesion <3 cm that involves the inner muscularis, disc resection is the preferred approach to treat bowel endometriosis [1,2]. Therefore, here we describe the surgical principles for disc resection for deep bowel endometriosis. Step-by-step video illustration of our surgical technique with clarification of surgical principles. Tertiary care center. A mechanical bowel preparation is given before surgery. A 10-mm port is placed in the umbilicus, and 3 other 5-mm auxiliary ports are placed in the right and left iliac fossa and in the suprapubic region. Dissection starts with development of both medial pararectal spaces. The retrocervical region is approached, and the bowel lesion is isolated. A suture is placed into the endometriosis bowel lesion to facilitate invagination into the stapler. A circular stapler is inserted into the rectum, and the anvil is opened at the level of the endometriosis lesion. Each end of the suture held by 2 graspers are pushed dorsally, whereas the stapling device is gently pushed ventrally, imbricating the delineated area. The stapler is closed, including the endometriosis area. After reassuring that the posterior part of the mesentery is free, the device is fired, excising only the anterior wall of the rectum. Disc resection is the technique of choice to treat a focal bowel endometriosis lesion <3 cm.

SDBS-assisted preparation of novel polyaniline planar-structure: morphology, mechanism and hydrophobicity. Leaf-like hierarchical polyaniline (PANI) structure with interlaced nanofibers on the surface was prepared by chemical oxidation polymerization of aniline assisted by sodium dodecyl benzene sulfonate (SDBS). The chemical structure and the composition of the leaf-like PANI obtained were characterized by FTIR, UV-vis, XRD and XPS. In order to investigate the formation mechanism of such micro/nanostructures, some micro/nanostructures of PANI polymerized at different polymerization times were synthesized and observed for comparison. The results show that the PANI micro/nanostructures originate from PANI microleaves due to SDBS as soft template, which then covered with interlaced nanofibers on the surface. The leaf-like PANI micro/nanostructures exhibit good hydrophobic property with a water contact angle of 134.3° resulted from the hydrophobic long dodecyl groups of SDBS dopant.

Non-invasive tension time index in relation to severity of disease in children with cystic fibrosis. The non-invasive tension-time index of the inspiratory muscles at rest (TTMUS) can be used for assessing respiratory muscle function in children with cystic fibrosis (CF). This study aimed to investigate how TTMUS becomes altered with increasing pulmonary impairment, and which factors determine TTMUS changes in CF. We assessed TTMUS in 47 patients with stable CF ranging in age from 9 to 26 years and in 47 controls of same age and gender. Pulmonary impairment was assessed by the pulmonary function score (PFS) according to Cropp (PFS 0-2 = no, 3-7 = mild, 8-12 = moderate, and 13-18 = severe dysfunction). Median TTMUS was significantly higher in the entire CF-group than in controls ((0.112 (0.079-0.174) vs. 0.07 (0.052-0.094), P < 0.001)). It was nearly identical in CF-patients without (0.079 (0.056-0.114)) and mild (0.080 (0.059-0.128)) pulmonary dysfunction. It was non-significantly higher in subjects with moderate (0.118 (0.103-0.173)) and grossly elevated in individuals with severe (0.232 (0.211-0.31), P < 0.001)) respiratory impairment when compared to the other PFS-groups. TTMUS was significantly related to percent predicted airway resistance (Raw%pred) (r = 0.60, P < 0.001), percent predicted Forced Expiratory Volume in 1 sec (r = -0.49, P < 0.001), percent predicted Vital Capacity (-0.57, P < 0.001), Functional Residual Capacity in percent Total Lung Capacity (r = 0.42, P = 0.003), and transcutaneous oxygen saturation (r = -0.49, P < 0.001). By contrast, Raw%pred was the only variable that had a significant effect on TTMUS (P = 0.01), when a multivariate logistic regression was applied, using the median of the entire CF-cohort to dichotomise TTMUS. These findings suggest that subjects with stable CF and severe pulmonary dysfunction are prone to respiratory muscle fatigue, and that airway obstruction is an important factor contributing to the increase of TTMUS in CF. Regular determination of TTMUS may be clinically useful during course of disease, and may aid the decision to institute therapies like respiratory muscle training or non-invasive intermittent ventilation.

Localization of a pernicious anaemia autoantibody epitope on the alpha-subunit of human H,K-adenosine triphosphatase. Four cDNA fragments encoding different portions of the alpha-subunit of human H,K-adenosine triphosphatase (ATPase) were amplified by means of the polymerase chain reaction technique, ligated into the plasmid pGEX-2T, and expressed as glutathione S-transferase fusion proteins in Escherichia coli. The fragments A (residues 163-313), Ba (residues 360-797), Bb (residues 526-797), and C (residues 822-1031) together encompass 77% of the alpha-subunit and cover most of its cytosolic part. The reactivities of autoantibodies in the sera from patients with pernicious anaemia with the recombinant fusion proteins were analysed by immunoblotting. One autoantigenic epitope was found in the NH2-terminal part of the Ba fragment--that is, between residues 360 and 525. No epitope was detected in the other fragments. The Ba fragment was cleaved off from the glutathione S-transferase fusion protein by the action of thrombin and was then further purified. By means of enzyme-linked immunosorbent assay, 28 of 42 sera (67%) from patients with pernicious anaemia were positive against the purified Ba fragment. The present results provide a final proof that the human H,K-ATPase alpha-subunit is a major autoantigen in the parietal cell and that the major epitope is located between residues 360 to 525 on the cytosolic side of the secretory membrane.

Does intra-operative flexible endoscopy reduce anastomotic complications following left-sided colonic resections? A systematic review and meta-analysis. Postoperative anastomotic leakage (AL) or bleeding (AB) significantly impacts on patient outcome following colorectal resection. To minimize such complications, surgeons can utilize different techniques perioperatively to assess anastomotic integrity. We aim to assess published anastomotic complication rates following left-sided colonic resection, comparing the use of intra-operative flexible endoscopy (FE) against conventional tests used to assess anastomotic integrity. PubMed/MEDLINE and Embase online databases were searched for non-randomized and randomized case-control studies that investigated postoperative AL and/or AB rates in left-sided colonic resections, comparing intra-operative FE against conventional tests. Data from eligible studies were pooled, and a meta-analysis using Review Manager 5.3 software was performed to assess for differences in AL and AB rates. Data from six studies were analysed to assess the impact of FE on postoperative AL and AB rates (1084 and 751 patients respectively). Use of FE was associated with reduced postoperative AL and AB rates, from 6.9% to 3.5% and 5.8% to 2.4% respectively. Odds ratios favoured intra-operative FE: 0.37 (95% CI 0.21-0.68, P = 0.001) for AL and 0.35 (95% CI 0.15-0.82, P = 0.02) for AB. This meta-analysis showed that the use of intra-operative FE is associated with a reduced rate of postoperative AL and AB, compared to conventional anastomotic testing methods.

Probability, personality, age, and risk taking. Male and female college (n=22) and high school (n=18) students were presented information concerning probability and were also measured on the personality variables of independence of judgment, response set, Machiavellianism, and open-mindedness. An investigation of the risky shift phenomenon revealed that an understanding of probability did not vitiate the shift toward greater risk. Age was shown to be functionally related to risk taking, the teen years showing greater proclivity for risk than later years. Independence of judgment emerged as a powerful predictor of initial risk; Machiavelianism bore no relationship to risk taking. Both of these findings concerning personality variables were at odds with earlier work. An interpretation of contextual interaction was advanced as a possible explanation.

Working hours: an employer's duty. Recent EC negotiations on the Working Time Directive have shown UK thinking to be at odds with the rest of Europe. Susan Hayes examines the implications for employee health.

Can laparoscopic cholecystectomy be performed with a positive margin at medicaid reimbursement rates? The Affordable Care Act provides health care coverage to an increasing segment of the population at Medicaid reimbursement rates. Health care systems currently offset lower Medicaid reimbursement through higher payers. The ability to "cost shift" will be diminished as the Medicaid population increases. A financial cost and revenue analysis of outpatient laparoscopic cholecystectomy at our institution was performed. Cost was defined as actual expense to the health care institution. Fixed and variable costs were identified to calculate a break-even point. Time spent from check in to dismissal was based on historic averages. When actual costs could not be pinpointed, estimates from industry experts were used. Reimbursement included surgeon and anesthesia professional fees and facility fees. A total of 501 laparoscopic cholecystectomies were performed at the main operating room facility in 2012. Annual fixed costs were $252,637. Variable costs were $1,860/case. Personnel and single-use equipment made the largest contribution to variable costs. Reimbursement for professional and facility fees totaled $2,444/case. The break-even point occurred at 454 cases. Based on historic volume, the break-even point for the calendar year would occur on November 27. Our analysis demonstrates that laparoscopic cholecystectomy can be performed with a positive margin at Medicaid reimbursement rates with sufficient volume. The minimal margin, however, could substantially limit the ability of lower-volume hospitals to provide these services and negatively impact access to care in this patient population.

Synthesis and in vitro antibacterial activity of some 1-(difluoromethoxyphenyl)quinolone-3-carboxylic acids. We report on the synthesis of N-1-phenylquinolones in which the difluoromethoxy moiety is utilized as a halogen replacement. The antibacterial activity is discussed with reference to N-1-halophenylquinolones.

Is there a role for TPN in terminally ill patients with bowel obstruction? There is controversy regarding the use of total parenteral nutrition (TPN) in individuals with metastatic malignancies. The objective of this study was to determine whether a subgroup of patients with intestinal obstruction would benefit from support with TPN. A retrospective review of patients considered for home TPN by a regionalized home TPN program was conducted Over a 6-y period, nine patients with primary gastrointestinal malignancy and metastatic intestinal obstruction were identified. There was a variable survival rate of 27 to 433 d. Survival rate longer than 60 d was noted in six of nine patients. Most patients had no direct TPN-related complications, but one patient had significant morbidity related to venous thrombosis and line sepsis. There were no nutritional predictors of prolonged survival rate with TPN. TPN was continued until death in six of nine patients. Patients with small bowel obstruction and metastatic malignancy may benefit from TPN as demonstrated by prolonged survival rate longer than 60 d. There are no clear predictors of who will benefit from TPN, and each case should be considered individually, with the potential risks and benefits discussed with the family and primary caregivers. Future studies should address the effect of TPN on quality of life of the patient and their caregivers.

Stereocontrolled access to isoprostanes via a bicyclo[3.3.0]octene framework. We report a simple and highly stereocontrolled strategy toward the total synthesis of isoprostanes based on a bicyclic alpha,beta-epoxy ketone intermediate 6. Bicyclo[3.3.0]octene scaffold permitted stereodirection of reagents allowing stereoselective epoxidation, diastereoselective ketone reduction, and regioselective epoxide opening otherwise not accessible with a simple cyclopentene framework.

In vivo imaging of human labial glands using advanced optical coherence tomography. Optical coherence tomography (OCT) has emerged as a high-resolution noninvasive clinical imaging application. The purpose of this study was to show OCT images of human labial glands obtained using a swept-source (SS) OCT system. Labial gland OCT imaging was carried out using our new SS-OCT system for 5 healthy volunteers using a hand-held in vivo OCT scanning probe. The labial tissue was scanned in a superior to inferior direction in 2 and 3 dimensions. The resulting 2- and 3-dimensional ultrahigh-resolution images of in vivo OCT human labial minor salivary glands revealed the epithelium, connective tissue, lobes, and duct. OCT was capable of providing simultaneous and noninvasive structural information with high resolution. This clinical imaging modality promises to have clinical impact in the diagnosis of such conditions as Sjögren syndrome and xerostomia.

[A 50-year study on the epidemiology of hypertension in Heilongjiang Province of China]. To assess the epidemiological characteristics of hypertension and its attributing factors in Heilongjiang province and establish a comprehensive basis for the prevention and control of hypertension in this region. Using the stratified chunk method, a survey lasting 50 years was conducted on a sample of 299 677 (including 158 782 males and 140 895 females) patients, aged 15 and above, residing in both rural and urban areas of Heilongjiang province from 1958 to 2007. Both blood pressure measurement and analysis on attributing factors of hypertension were carried out in 1958, 1979, 1991, 1999 and 2007. The prevalence of hypertension was significantly higher in Heilongjiang than in other provinces. It elevated annually, reaching a 3-fold increase in 50 years with an accelerating pace (17.06% to 25.69%) in the recent 8 years. Among the people examined, the prevalence of hypertension increased with aging. Furthermore, the prevalence of hypertension varied among different professions. Office workers had the highest prevalence (41.67%). Compared with; female population, male participants had a much higher prevalence before the age of 55 (P<0.0001). Body mass index, gender, hypertriglyceridemia, age, low-high density lipoprotein cholesterol and family history were identified as major risk factors for the development of hypertension in Heilongjiang province. However, the awareness (48.90%), treatment (25.33%) and control (4.32%) rates of hypertension in this region were relatively low. The results of the present study identified Heilongjiang province as a high-risk region for hypertension. It also suggests the necessity to plan and implement actions for the effective prevention and treatment of hypertension in this region.

Microbial interactions in the anaerobic oxidation of methane: model simulations constrained by process rates and activity patterns. Proposed syntrophic interactions between the archaeal and bacterial cells mediating anaerobic oxidation of methane coupled with sulfate reduction include electron transfer through (1) the exchange of H2 or small organic molecules between methane-oxidizing archaea and sulfate-reducing bacteria, (2) the delivery of disulfide from methane-oxidizing archaea to bacteria for disproportionation and (3) direct interspecies electron transfer. Each of these mechanisms was implemented in a reactive transport model. The simulated activities across different arrangements of archaeal and bacterial cells and aggregate sizes were compared to empirical data for AOM rates and intra-aggregate spatial patterns of cell-specific anabolic activity determined by FISH-nanoSIMS. Simulation results showed that rates for chemical diffusion by mechanism (1) were limited by the build-up of metabolites, while mechanisms (2) and (3) yielded cell specific rates and archaeal activity distributions that were consistent with observations from single cell resolved FISH-nanoSIMS analyses. The novel integration of both intra-aggregate and environmental data provided powerful constraints on the model results, but the similarities in model outcomes for mechanisms (2) and (3) highlight the need for additional observational data (e.g. genomic or physiological) on electron transfer and metabolic functioning of these globally important methanotrophic consortia.

Generation time statistics of Escherichia coli B measured by synchronous culture techniques. Synchronous cultures of Escherichia coli B were produced under various environmental conditions. Analysis of the cell number data permitted the characterization of the generation time distribution for these organisms and the estimation of the mother-daughter generation time correlation coefficients. For all growth conditions, the distribution of generation times was found to be symmetrical with a coefficienoefficient was significantly negative at doubling times between 40 and 64 min. However, the results for a culture growing in succinate medium at 37 degrees C, which had a significantly greater generation time, yielded a correlation coefficient close to zero. Within the range of temperatures studied (26 to 37 degrees C), no significant effect on the correlation coefficient was observed.

Cyclic AMP regulates transcription of the genes encoding human chorionic gonadotropin with different kinetics. Choriocarcinoma cell lines characteristically synthesize and secrete the alpha- and beta-subunits of human chorionic gonadotropin (hCG), as well as the intact heterodimer. Treatment of one such cell line, BeWo, with 8-bromo-adenosine 3':5'-cyclic monophosphate (8-Br-cAMP) causes at least a 10-fold increase in the concentration of the mRNA encoding each subunit. Changes in mRNA concentrations are associated with similar changes in transcription rates of both the CG alpha and CG beta genes, although the kinetics of their transcriptional responses are different. Transcription of the alpha-subunit gene increases rapidly and becomes maximal within 1 hr after addition of 8-Br-cAMP. By contrast, transcription of the CG beta gene increases slowly and progressively for at least 8 hr after treatment with 8-Br-cAMP. The slow transcriptional response of the CG beta gene(s) appears to be unique compared to that of other cAMP-responsive genes, and suggests that the cyclic nucleotide may regulate transcription of the CG genes by different mechanisms.

[Determination of trace microcystins in water by ultra performance liquid chromatography/tandem mass spectrometry]. An analytical method for the analysis of trace microcystins (MCYST) in water was developed using solid phase extraction (SPE) for enrichment and ultra performance liquid chromatography/tandem mass spectrometry (UPLC/MS/MS) for detection. One litre of water was passed through SPE columns, the extracted sample was rinsed off by 10 mL methanol, then evaporated to 1.0 mL before being analyzed with UPLC/MS/MS. The effect of formic acid concentration in the mobile phase on the sensitivity was studied and the results showed that 0.1% was the optimum concentration. Four microcystins, MCYST-LR, RR, LW, LF, can be separated and detected in 5 min, which is much shorter than that by the conventional liquid chromatography. The detection limits were 1.3 - 6.0 ng/L, and the recoveries were 91.1% - 111%. The calibration curves showed good linearity in the range of 1.0 microg/L - 1.0 mg/L with correlation coefficients larger than 0.99. The method was also applied to determine MCYST in real water samples from three reservoirs in Zhejiang Province, and the results showed that the concentrations of LR and RR were 0.044 7 - 2.73 microg/L and 0.020 8 - 1.36 microg/L respectively, and LW and LF were not detected.

Complexity and dynamics of switched human balance control during quiet standing. In this paper, we use a combination of numerical simulations, time series analysis, and complexity measures to investigate the dynamics of switched systems with noise, which are often used as models of human balance control during quiet standing. We link the results with complexity measures found in experimental data of human sway motion during quiet standing. The control model ensuring balance, which we use, is based on an act-and-wait control concept, that is, a human controller is switched on when a certain sway angle is reached. Otherwise, there is no active control present. Given a time series data, we determine how does it look a typical pattern of control strategy in our model system. We detect the switched nonlinearity in the system using a frequency analysis method in the absence of noise. We also analyse the effect of time delay on the existence of limit cycles in the system in the absence of noise. We perform the entropy and detrended fluctuation analyses in view of linking the switchings (and the dead zone) with the occurrences of complexity in the model system in the presence of noise. Finally, we perform the entropy and detrended fluctuation analyses on experimental data and link the results with numerical findings in our model example.

[Necrotizing fasciitis--a frequently mistaken disease (author's transl)]. A case of Fasciitis necroticans on the leg is reported in a female patient, age 28. The disease began with symptoms of an erysipelas, but it was resistant to penicillin. Within a few days necrotic decay of circumscribed skin areas occurred and the adjacent skin was widely undermined by the necrotizing process. Beta-hemolytic streptococci and Staphylococcus aureus haemolyticus were isolated. However, the disease could not be managed by adequate antibiotic therapy. Finally, the process was brought under control by extended incisions and removal of the necrotic masses. Defects were covered by plastic surgery.

Ecological investigation on intestinal bacterial flora of patients nursed in protected environmental units. The present results of investigations performed on fresh fecal samples from a healthy adult and subjects with acute leukemia cultured bacteriologically using both aerobic and anaerobic techniques have led to the following conclusions. 1) In studies on the intestinal bacterial flora of the subjects examined, obligate anaerobic bacteria rather than facultative anaerobes accounted for more than 99% of the microorganisms. 2) Although some qualitative differences seem to exist between fecal bacterial flora components of the normal individual and leukemia patients examined, further investigations considering various factors controlling and influencing the composition of intestinal bacterial flora are needed to evaluate the results obtained. 3) The results obtained herein indicate that changes in intestinal bacterial flora induced by non-absorbable antibiotics are associated with the host defense mechanisms. 4) The relative predominance of aerobic versus anaerobic bacterial flora in the intestine may reflect the degree of severity of clinical manifestation in leukemia patients. In the data obtained from the present investigations, the predominating fecal anaerobic bacteria may serve as a base line for the evaluation and interpretation of the host defense system by patterns of the components of bowel flora brought about by internal or external environmental changes.

Corepressor binding to progesterone and glucocorticoid receptors involves the activation function-1 domain and is inhibited by molybdate. Corepressors are known to interact via their receptor interaction domains (RIDs) with the ligand binding domain in the carboxyl terminal half of steroid/nuclear receptors. We now report that a portion of the activation function-1 domain of glucocorticoid receptors (GRs) and progesterone receptors (PRs), which is the major transactivation sequence, is necessary but not sufficient for corepressor [nuclear receptor corepressor (NCoR) and silencing mediator of retinoid and thyroid hormone receptor (SMRT)] RID binding to GRs and PRs in both mammalian two-hybrid and coimmunoprecipitation assays. Importantly, these two receptor sequences are functionally interchangeable in the context of GR for transactivation, corepressor binding, and corepressor modulatory activity assays. This suggests that corepressors may act in part by physically blocking portions of receptor activation function-1 domains. However, differences exist in corepressor binding to GRs and PRs. The C-terminal domain of PRs has a higher affinity for corepressor than that of GRs. The ability of some segments of the coactivator TIF2 to competitively inhibit corepressor binding to receptors is different for GRs and PRs. With each receptor, the cell-free binding of corepressors to ligand-free receptor is prevented by sodium molybdate, which is a well-known inhibitor of receptor activation to the DNA-binding state. This suggests that receptor activation precedes binding to corepressors. Collectively, these results indicate that corepressor binding to GRs and PRs involve both N- and C-terminal sequences of activated receptors but differ in ways that may contribute to the unique biological responses of each receptor in intact cells.

Intranasal application of dopamine reduces activity and improves attention in Naples High Excitability rats that feature the mesocortical variant of ADHD. Based on findings of a profound action of intranasally applied dopamine (DA) on dopamine release in the striatum, we examined the possibility that intranasal application of DA would influence indices of attention and activity in juvenile male rats of the Naples High Excitability line. This rat model features the main aspects of Attention Deficit/Hyperactivity Disorder (ADHD). Juvenile NHE rats received an intranasal application of either DA (0.075 mg/kg, 0.15 mg/kg and 0.3 mg/kg) or vehicle into both nostrils daily for 15 days. On day 14, 1 h after treatment, they were tested in the Làt maze, and one day later, in the eight arm radial maze. Activity in the Làt maze: The highest dose of DA (0.3 mg/kg) decreased horizontal (HA) and vertical (VA) activity during the first 10 min of the test. No effect was found for rearing duration (RD), which indexes non-selective attention (NSA). Activity in the radial maze: No treatment effects were found for HA and VA components, and for RD. Attention indices: The intermediate dose of DA (0.15 mg/kg) significantly improved the number of arms visited before the first repetitive arm entry in the radial maze, an index of selective spatial attention (SSA). In conclusion, intranasal application of DA reduced hyperactivity at the highest dose used, whereas the intermediate dose improved attention in an animal model of ADHD. These results suggest the potential of employing intranasal DA for therapeutic purposes.

Evaluation of gastrointestinal involvement of Behçet's disease by nuclear medical techniques. To evaluate the value of nuclear medicine procedures in the diagnosis of gastrointestinal involvement of Behcet's disease in asymptomatic patients, Tc-99m human immunoglobulin (HIG) and Tc-99m leucocyte (LC) whole body scintigraphies were performed on 30 patients with major symptoms of the disease. Comparison of the results with other diagnostic techniques showed that Tc-99m HIG whole body scanning can be a useful diagnostic aid before the disease becomes clinically active in the gastrointestinal system.

Relationship between pictorial interpretation and comprehension of three spatial relations in school-age children. Effects on spatial term comprehension as the result of transformations in the stimulus dimensions of six pictures containing the same three figures were explored using Piaget's concept of spatial perspective. A Modified Test of Pictorial Space (MTPS), adapted from Hudson's (1960) studies on non-Western pictorial perception strategies, was administered to 200 children, aged 6 yrs 5 mos to 11 yrs 3 mos. The purpose of the investigation was to gather data on (1) pictorial interpretation as a function of variations in perceptual depth cue complexity and transformations in conceptual perspective and (2) order of acquisition in the comprehension of two sets of spatial terms referring to perceptual object knowledge and more advanced conceptual knowledge of object relations. Significant age and IQ, but not sex, interactions were found for MTPS performance. Data analyses also supported predicted orders of acquisition and indicated that transformation of conceptual perspective better differentiated among the age span than did either perceptual depth cue complexity or comprehension of spatial terms. Findings are discussed in terms of their methodological and substantive implications for constructing and interpreting pictorially-based language comprehension tasks.

Augmentation of catecholamine-stimulated [3H]GDP release in adipocyte membranes from exercise-trained rats. The effects of exercise training on the catecholamine-stimulated [3H]GDP release in rat adipocyte membranes prelabeled with [3H]GTP and the adenylate cyclase activity were investigated. Exercise training significantly increased the release of [3H]GDP in response to (-)isoproterenol. The adenylate cyclase activity induced by a nonhydrolyzable guanine nucleotide analogue, Gpp(NH)p, was significantly greater in exercise-trained rats.

The toxic effect of fluoride on MG-63 osteoblast cells is also dependent on the production of nitric oxide. Some soda-lime-phospho-silicate glasses, such as Hench's Bioglass(®) 45S5, form bone-like apatite on their surface when bound to living bone. To improve their osteointegration for clinical purposes, the fluoride insertion in their structure has been proposed, but we recently showed that fluoride causes oxidative damage in human MG-63 osteoblasts, via inhibition of pentose phosphate oxidative pathway (PPP) and its key enzyme glucose 6-phosphate dehydrogenase (G6PD). In the same cells we have now investigated the role of nitric oxide (NO) in these effects. Fluoride-containing bioactive glasses and NaF caused, as expected, release of lactate dehydrogenase in the extracellular medium, accumulation of intracellular malonyldialdehyde, inhibition of PPP and G6PD: we have now observed that these effects were significantly reverted not only by superoxide dismutase (SOD) plus catalase (scavengers of reactive oxygen species), but also by N-monomethyl l-arginine (l-NMMA, a NOS inhibitor) and 2-phenyl-4,4,5,5,-tetramethylimidazoline-1oxyl 3-oxide (PTIO, a NO scavenger). Moreover the two highest concentrations of both fluoride-containing bioglasses and NaF caused increase of nitrite (a stable derivative of NO) levels in the culture supernatant, which was inhibited by l-NMMA, erythrocytes, PTIO and SOD/catalase, and increase of intracellular NO synthase (NOS) activity. The incubation with bioglasses or NaF increased also the phosphorylation of Ser(1177) in the endothelial NOS isoform. Furthermore, the NO donor spermine NONOate was able to inhibit G6PD activity in vitro, and this effect was partly reverted by PTIO. Therefore our results suggest that most cytotoxic effects of fluoride are mediated by the production of NO: reactive oxygen species are important, causing NOS phosphorylation. We also observed, for the first time, that Tempol, but not SOD/catalase, besides inhibiting the oxidative stress induced by fluoride, also scavenges fluoride ions. For this reason it is not a selective inhibitor of the oxidative effects of fluoride.

Prevalence and management of central sleep apnea in heart failure patients. There is increasing awareness of sleep-disordered breathing, which may manifest as obstructive sleep apnea, central sleep apnea (CSA), or a mixture of the two. Obstructive sleep apnea and CSA are strongly associated with heart failure (HF) and risk factors for developing HF. CSA may be considered a manifestation of the pathophysiology of HF; hence, approaches to optimize pharmacologic and nonpharmacologic treatment of HF should help to ameliorate CSA. However, if CSA also contributes to HF progression, CSA may represent a potential therapeutic target. There was hope that CSA prevalence would decline with better HF therapies. However, contemporary studies of HF patients on optimal medical therapy have shown that CSA prevalence remains 30% to 40%. Treating CSA poses significant challenges. Presently, the role of routine continuous positive airway pressure remains unclear, although newer ventilatory strategies may prove effective. Currently, CSA treatment involves standard optimal HF therapies, although growing evidence indicates that newer ventilation modes and cardiac resynchronization therapy may prove to be useful.

Tailoring and modifications of a ZnO nanostructure surface by the layer-by-layer deposition technique. Different ZnO nanostructures have been modified using the layer-by-layer polyelectrolyte deposition process. The polymer multilayers were deposited on free standing ZnO tetrapods, ZnO tetrapods on a substrate and ZnO nanorod arrays. In addition, attachment of metallic (Au) nanoparticles to the ZnO nanostructure surface using layer-by-layer deposition was demonstrated. The properties of the ZnO nanostructures with modified surfaces were investigated by electron microscopy, absorption and photoluminescence measurements. A linear increase in polymer thickness with the number of polymer multilayers was confirmed by absorption and transmission electron microscopy. The technique can be readily extended to different nanoparticles and different morphologies of ZnO.

The chlorine contents and chain lengths influence the neurobehavioral effects of commercial chlorinated paraffins on zebrafish larvae. Increasing concern has arisen regarding ubiquitous environmental distribution and potential ecological and health risks of chlorinated paraffins (CPs), especially short chain congeners. Four commercial CP products with different carbon chain lengths and chlorine contents were employed to investigate and compare the possible neurotoxic effects on zebrafish larvae at 5 days post fertilization using behavioral tests, including locomotion, path angle, and two-fish social interaction. The high-chlorinated short-chain CP-70 product resulted in the strongest effects in all three tests, while the low-chlorinated long-chain CP-42 product was on the other end of the spectrum. The consequences of the chain length of two CP-52 products could be clearly distinguished by the tests. Although exposure to the two products both caused inhibition in the locomotion test, they resulted in different kinds of effects in the path angle and interaction tests. Our results suggested, as evidenced by the sensitivity and resolution of the behavioral tests, that the influence of the chain length and chlorine content of CPs could be well characterized and that chlorine content consistently showed a more significant impact than chain length. The health threats of long-chain CPs could also not be overlooked when they contained relatively high chlorine contents.

Phytoplankton bloom produced by a receding ice edge in the ross sea: spatial coherence with the density field. Measurements of chlorophyll, particulate carbon, and biogenic silica concentrations near a receding ice edge off the coast of Victoria Land, Antarctica, indicated the presence of a dense phytoplankton bloom. The bloom extended 250 kilometers from the ice edge and was restricted to waters where the melting of ice had resulted in reduced salinity. The region involved was one of enhanced vertical stability, which may have favored phytoplankton growth, accumulation, or both. Epontic algae released from melting ice may have served as an inoculum for the bloom. Ratios of organic carbon to chlorophyll and biogenic silica to carbon were unusually high, resulting in high biogenic silica concentrations despite only moderately high chlorophyll levels.

Peer review: a simplified approach. One hundred and thirteen grant applications were initially reviewed with only a brief outline of the applicant and the proposal and were later reviewed in more detail with the reports of outside experts. The detailed discussion and referees' reports had little impact on the original ratings.

Face and facial expression memory in temporal lobe epilepsy patients: preliminary results. Right temporal lobe structures are involved in face and facial expression processing and in mnestic functions. Face and facial expression memory was investigated in 15 patients with left (LTLE) and 18 patients with right (RTLE) temporal lobe epilepsy as well as 13 healthy controls. Pairs of pictures combining four faces and four emotions had to be matched according to face identity or facial expression. In the memory tasks, the two pictures of a pair were divided by a memory interval of 2000 milliseconds, whereas in the perception tasks (control condition) both pictures were presented simultaneously. RTLE patients had significantly lower scores than healthy controls in face memory. LTLE patients had significantly lower scores than healthy controls in face and facial expression memory. The data confirm impaired face memory in RTLE patients and show that LTLE patients display deficits in face as well as in facial expression memory. Results are discussed according to functional reorganization, memory strategies, perception performance, naming problems, and group characteristics.

Redox-Regulated, Targeted Affinity Isolation of NADH-Dependent Protein Interactions with the Branched Chain Aminotransferase Proteins. Isolation and identification of protein targets for redox-active proteins is challenging. The human branched chain aminotransferase (hBCAT) proteins are redox active transaminases that can be regulated through oxidation, S-nitrosation and S-glutathionylation. This metabolic protein was shown to associate with the E1 decarboxylase component of the branched-chain α-keto acid dehydrogenase complex in a NADH-dependent manner, where mutation of the CXXC center was shown to prevent complex formation. To determine if the redox state of the CXXC motif can influence other NADH-dependent protein-protein interactions, proteins were extracted from neuronal cells treated under reduced and oxidized conditions and then isolated using targeted affinity chromatography, resolved using 2D electrophoresis. Select proteins spots were excised and identified using a quadrupole time of flight mass spectrometer (Thermo) with a precursor tolerance of 10 ppm and subsequently analyzed using Proteome Discoverer 2.1 with Swiss-Prot human DB. Mass tolerances for precursor/product were set to 10 ppm/0.6 Da and data were filtered by peptide confidence with PD2.1. It was determined that the protein profile considerably altered in both number and abundance dependent on the redox state of the cell and also on the availability of the redox active thiol groups. The biological relevance of the newly identified partners was determined using DAVID, the bioinformatics database, which indicated that proteins important to cytoskeletal function, protein transport, protein synthesis, chaperone activity, and cell signaling.

Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes. The impact of off-pump median sternotomy coronary artery bypass grafting procedures on risk-adjusted mortality and morbidity was evaluated versus on-pump procedures. Using the Department of Veterans Affairs Continuous Improvement in Cardiac Surgery Program records from October 1997 through March 1999, nine centers were designated as having experience (with at least 8% coronary artery bypass grafting procedures performed off-pump). Using all other 34 Veterans Affairs cardiac surgery programs, baseline logistic regression models were built to predict risk of 30-day operative mortality and morbidity. These models were then used to predict outcomes for patients at the nine study centers. A final model evaluated the impact of the off-pump approach within these nine centers adjusting for preoperative risk. Patients treated off-pump (n = 680) versus on-pump (n = 1,733) had lower complication rates (8.8% versus 14.0%) and lower mortality (2.7% versus 4.0%). Risk-adjusted morbidity and mortality were also improved for these patients (0.52 and 0.56 multivariable odds ratios for off-pump versus on-pump, respectively, p < 0.05). An off-pump approach for coronary artery bypass grafting procedures is associated with lower risk-adjusted morbidity and mortality.

Bronchiolitis obliterans in workers exposed to flavoring chemicals. Medical and environmental surveys at microwave popcorn plants and flavoring production plants have revealed a risk for bronchiolitis obliterans in workers exposed to flavoring chemicals. Workers in other food industries may also be at risk. This review summarizes the available information on disease characteristics and natural history and provides information on workplace characteristics associated with disease development. Investigations carried out in flavoring plants in California have identified severely affected current and former workers in four plants. Affected former workers have also been identified at a plant in the Netherlands that manufactured diacetyl, a predominant chemical in butter flavorings which has been implicated as a causal agent for lung disease in microwave popcorn workers. Workers who manufacture or use flavorings can be subjected to repeated intense exposures to flavoring chemicals. Affected workers can progress to severe fixed airways obstruction in as little as 7 months. Since medical treatment is generally ineffective, early identification of affected workers and removal from further exposure, along with control of exposures to protect coworkers, are essential to minimize this hazard.

Monitoring Cyp2b10 mRNA expression at cessation of 2-year carcinogenesis bioassay in mouse liver provides evidence for a carcinogenic mechanism devoid of human relevance: the dalcetrapib experience. Dalcetrapib is a cholesteryl ester transfer protein (CETP) modulator in clinical assessment for cardiovascular outcome benefits. In compliance with regulatory requirements, dalcetrapib was evaluated in rodent 2-year carcinogenesis bioassays. In the mouse bioassay, male mice demonstrated increased liver weight and statistically increased incidences of hepatocellular adenoma/carcinoma. Hepatic cytochrome p450 (Cyp) 2b10 mRNA induction and increased Cyp2b10 enzyme activity signify activation of hepatic nuclear receptor constitutive androstane receptor (CAR), a widely established promoter of rodent-specific hepatic tumors. We therefore monitored hepatic Cyp2b10 mRNA and its enzyme activity in a subset of dalcetrapib-treated male mice from the bioassay. Liver samples were obtained from ~1/3 of male mice from each dose group including vehicle-controls (mean and earliest study day of death 678 and 459 respectively). Quantitative real time PCR (qRT-PCR) was performed to determine Cyp2b10 mRNA expression and Cyp1a-, Cyp2b10- and Cyp3a-selective activities were monitored. Cyp2b10 mRNA was strongly induced by dalcetrapib with an expected wide inter-individual variation (5-1421-fold). Group average fold-induction versus vehicle-controls showed a dose-related increase from 48-fold (250mg/kg/day) to 160-fold (750mg/kg/day), which declined slightly at 2000mg/kg/day (97-fold). Cyp enzyme activities showed approximate doubling of total Cyp P450 content per milligram protein and a 9-fold increase in Cyp2b10-selective pentoxyresorufin O-dealkylase activity (750mg/kg/day). These data from hepatic Cyp2b10 monitoring are strongly suggestive of CAR activation by dalcetrapib, a mechanism devoid of relevance towards hepatocarcinogenesis in humans; results show feasibility of Cyp2b10 as a surrogate marker for this mechanism at cessation of a carcinogenesis bioassay.

Fluoroscopic versus laparoscopic implantation of peritoneal dialysis catheters: a retrospective cohort study. A previous clinical trial showed that radiologic insertion of first peritoneal dialysis (PD) catheters by modified Seldinger technique is noninferior to laparoscopic surgery in patients at low risk in a clinical trial setting. The present cohort study was performed to confirm clinical effectiveness of radiologic insertion in everyday practice, including insertion in patients with expanded eligibility criteria and by fellows in training. Between 2004 and 2009, 286 PD catheters were inserted in 249 patients, 133 with fluoroscopic guidance in the radiology department and 153 by laparoscopic surgery. Survival analyses were performed with the primary outcome of complication-free catheter survival and secondary outcomes of overall catheter survival and patient survival. Outcomes were assessed at last follow-up, as long as 365 days after PD catheter insertion. In the radiologic group, unadjusted 365-day complication-free catheter, overall catheter, and patient survival rates were 22.6%, 81.2%, and 82.7%, respectively, compared with 22.9% (P = .52), 76.5% (P = .4), and 92.8% (P = .01), respectively, in the laparoscopic group. Frequencies of individual complications were similar between groups. Adjusting for patient age, comorbidity, and previous PD catheter, the hazard ratio (HR) for catheter complications by radiologic versus laparoscopic insertion is 0.90 (95% confidence interval [CI], 0.62-1.31); the HR for overall catheter survival is 1.25 (95% CI, 0.59-2.65); and that for death is 2.47 (95% CI, 0.84-7.3). Radiologic PD catheter insertion is a clinically effective alternative to laparoscopic surgery, although there was poorer long-term survival with radiologic catheter placement, possibly because of preferential selection of radiologic insertion for more frail patients.

[Excitation-contraction coupling in skeletal muscle: questions remaining after 50 years of research]. The excitation-contraction coupling mechanism was defined as the entire sequence of reactions linking excitation of plasma membrane to activation of contraction in skeletal muscle. By using different techniques, their regulation and interactions have been studied during the last 50 years, defining until now the importance and origin of the calcium ion as a contractile activator and the main proteins involved in the whole mechanism. Furthermore, the study of the ultrastructural basis and pharmacological regulation of the excitation-contraction coupling phenomenon has begun. The excitation-contraction coupling is thought to be altered in situations as ageing, muscle fatigue and some muscle diseases. However, many questions remain to be answered. For example, (1) How excitation-contraction coupling develops and ages? (2) What role does it play in muscle fatigue and other diseases? (3) What is the nature of the interaction between the proteins believed to be involved? The present review describes excitation-contraction coupling in skeletal muscle and techniques used to better understand it as an introduction for discussing unanswered questions regarding excitation-contraction coupling.

Learning and personality types are related in cavies (Cavia aperea). The evolution and maintenance of consistent individual differences, so called animal personalities, have attracted much research interest over the past decades. Variation along common personality traits, such as boldness or exploration, is often associated with risk-reward trade-offs. Individuals that are bolder and hence take more risks may be more successful in acquiring resources over the short term. Cautious individuals taking fewer risks may, on the other hand, live longer, but may also gather fewer resources over the short term. According to recent theory, individual differences in personality may be functionally related to individual differences in cognitive performance (i.e., the way in which individuals acquire or use information). Individual differences in the acquisition speed of cognitively challenging tasks are often associated with a speed-accuracy trade-off. Accuracy can be improved by investing more time in the decision-making process or, conversely, decisions can be made more quickly at the cost of making more mistakes. Hence, the speed-accuracy trade-off often involves a risk-reward trade-off. We tested whether 3 personality traits, boldness, activity, and aggressiveness, are correlated with individual learning, associative learning speed, and behavioral flexibility as assessed by reversal learning in wild cavies (Cavia aperea). We found strong positive relationships between all personality traits and learning speed, whereas flexibility was negatively associated with aggressiveness. Our results support the hypothesis that performance reflects individual differences in personality in a predictable way.

Divisions and diversity: the complexities of medical refuge in Britain, 1933-1948. The experiences of medical refugees who came to the United Kingdom from Nazi Germany and occupied Europe in the 1930s and 1940s reflect the general characteristics of the British response to the refugee crisis. This article analyzes the role of the British medical establishment and its interplay with the government and refugee aid organizations. Processes of decision making and changes of policy are revealed, drawing on the files of the "Aliens Committee" at the archive of the British Medical Association, on the private collection of Yvonne Kapp, former administrative head of the Medical Department of the Central Office for Refugees, and on the medical subseries of the archive of the Society for the Protection of Science and Learning. "Divisions" refer to differing interests and attitudes of the institutions, organizations and individuals involved; "diversity" reflects the response to the various nationalities of medical refugees, mainly German, Austrian, Czech, and Polish.

[Effect of processing on chemical composition and medical activity of rhizoma Anemarrhenae]. A comparative study was conducted on the chemical composition and medical activity of different kinds of processed drug of Rhizoma Anemarrhenae. It was found that the content of effective components of zhimu was affected obviously by processing: the rhizome should not be barked when used as drug. It was also observed that different kind of processed drug should be used in line with different particular circumstance.