title stringlengths 0 1.13k | abstract stringlengths 1 15.7k | PMID int64 22 36.5M |
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Targets for hydrogen-peroxide-induced damage to suspension and biofilm cells of Streptococcus mutans. | Hydrogen peroxide (H2O2) is considered a major endogenous source of oxidative stress to oral bacteria and also is widely used in oral care products. Our study objectives were to identify specific targets for H2O2-induced damage to cells of Streptococcus mutans in suspensions and monospecies biofilms and to differentiate bacteriostatic and bactericidal actions of the peroxide. Streptococcus mutans was grown in suspension cultures and fed-batch biofilms for assessing relative sensitivities of viability, glycolysis, and protein synthesis to H2O2 damage. Biofilm cells were found to have essentially the same peroxide sensitivity as cells in suspensions. H2O2 at low concentrations of about 16.3 mmol/L was highly inhibitory for glycolysis and mainly bacteriostatic. The most sensitive target detected for glycolytic inhibition was glyceraldehyde-3-phosphate dehydrogenase with IC50 (50% inhibitory concentration) values of ca. 2.2 mmol/L for suspension cells and 2.3 mmol/L for biofilms with 15 min treatments. The phosphoenolpyruvate:glucose phosphotransferase pathway was less sensitive with an IC50 of ca. 10 mmol/L. Aldolase was not inhibited at bacteriostatic concentrations of the peroxide. For suspensions and biofilms, acidification somewhat diminished peroxide sensitivity, while increased temperature enhanced sensitivity. At concentrations above about 30 mmol/L, H2O2 became mainly bactericidal but not mutagenic for S. mutans. A major target for bactericidal damage was protein synthesis, thus rendering cells incapable of repairing or replacing oxidatively damaged proteins. | 18,923,556 |
Transposon Tn5281 is the main distributor of the aminoglycoside modifying enzyme gene among isolates of Enterococcus faecalis in Tehran hospitals. | Infections with high levels of gentamicin-resistant (HLGR) isolates of Enterococcus faecalis are common in Tehran hospitals. Genes encoding such resistance are transmissible by conjugation at high frequency. The purpose of this study was to determine the existence of Tn5281 and its flanking aminoglycoside modifying enzyme gene aac(6')-aph(2") among 102 HLGR isolates of E. faecalis cultured from patients at three hospitals in Tehran, Iran. These isolates were detected by disks containing 120 microg of gentamicin and made 65% of all E. faecalis during the study period. DNA was extracted from HLGR isolates and subjected to PCR assays targeting aac(6')-aph(2") and conjugative transposon Tn5281. The amplified aac(6')-aph(2") gene was labeled with digoxigenin and probed with Tn5281 amplicons in dot blot hybridization assays. The aac(6')-aph(2") gene was detected in 91%-92% (n = 93) of the HLGR isolates. All isolates containing aac(6')-aph(2") were positive in long-PCR targeting Tn5281 and the probe hybridized with Tn5281 amplicons. The number of HLGR isolates of E. faecalis has increased considerably in Tehran hospitals. Tn5281 is the main cause of transmission of aac(6')-aph(2") to different isolates of E. faecalis in the hospitals studied. | 18,923,558 |
PGC-1alpha-mediated regulation of gene expression and metabolism: implications for nutrition and exercise prescriptions. | The discovery 10 years ago of PGC-1alpha represented a major milestone towards understanding of the molecular processes regulating energy metabolism in many tissues, including skeletal muscle. PGC-1alpha orchestrates a metabolic program regulating oxidative lipid metabolism and insulin sensitivity. This is essentially the same metabolic program that is activated by exercise and down-regulated by sedentary lifestyles and high-fat diets, as well as in cases of obesity and type 2 diabetes. The present review examines the evidence in support of the key role for PGC-1alpha regulation of substrate metabolism and mitochondrial biogenesis in skeletal muscle. Surprisingly, studies with PGC-1alpha null and transgenic mice have revealed unexpected pathologies when PGC-1alpha is completely repressed (KO animals) or is massively overexpressed. In contrast, PGC-1alpha overexpression within normal physiological limits results in marked improvements in fatty acid oxidation and insulin-stimulated glucose transport. Exercise, sedentary lifestyles, and nutritional factors can regulate PGC-1alpha expression. We speculate that optimal targeting of PGC-1alpha upregulation, whether by diet, exercise, or a combination of both, could represent effective prophylactic or therapeutic means to improve insulin sensitivity. Indeed, using modern molecular tools, it may indeed be possible to prescribe optimally individualized nutrition and exercise programs. | 18,923,559 |
Heat shock proteins and exercise: a primer. | Heat shock proteins (HSPs) are, in general, prosurvival molecules within the cellular environment, and the overexpression of even just 1 family of HSPs can lead to protection against and improvements after a variety of stressors. Not surprisingly, a fertile area of study has grown out of efforts to exploit the innate biologic behaviour of HSPs. Exercise, because of the inherent physiologic stresses associated with it, is but 1 stimulus that can result in a robust increase in various HSPs in several tissues, not the least of which happen to be the heart and skeletal muscle. The purpose of this review is to introduce the reader to the major HSP families, the control of their expression, and some of their biologic functions, specifically with respect to the influence of exercise. Moreover, as the first in a series of reviews from a common symposium, we will briefly introduce the concepts presented by the other authors, which include the effects of different exercise paradigms on skeletal muscle HSPs in the adult and aged systems, HSPs as regulators of inflammation, and the ion channel stabilizing effects of HSPs. | 18,923,583 |
Serum lipid profile in malnourished Nigerian children in Zaria. | There is paucity of data on the pattern of serum lipids in malnourished children in Zaria. Most of the reported studies were carried out in southern part of Nigeria. The overall objective of this study was therefore to measure serum lipids in children with PEM in Zaria with the view to recommending its use in them. Serum lipids were measured in 115 children presenting with PEM and 115 age- and sex-matched well nourished controls aged 6-36 months .The malnourished children consisted of 25, 30, 30 and 30 children with kwashiorkor, marasmic-kwashiorkor, marasmus and underweight respectively. There were 60 males and 55 females. Serum total cholesterol(TC),high density lipoprotein cholesterol (HDL-C) and triglyceride(TG) were measured by enzymatic colorimetric methods of serum low density lipoprotein cholesterol(LDL-C) and very low density lipoprotein cholesterol(VLDL-C) were estimated using Friedewald formula. Serum TC, LDL-C and HDL-C levels were significantly lower (p<0.01, p<0.05 and p<0.001 respectively), while the ratio TC/HDL-C was significantly higher (p<0.001) in children with PEM than in their well-nourished counterparts. Concentrations of serum TG and VLDL-C were apparently but not significantly lower in children with PEM than in well-fed children (p>0.05).Serum levels of TC, LDL-C and HDL-C were significantly higher (p<0.001, p<0.001 and p<0.01 respectively) in oedematous PEM patients than in their non-oedematous counterparts. Serum TG and VLDL-C values were apparently but not significantly higher in oedematous PEM patients than in non-oedematous ones. There was a significant reduction in serum lipid concentrations in children with PEM. The study therefore suggests that measurement of serum lipids could be of importance in the assessment of childhood malnutrition. | 18,923,595 |
Cross-polarized wave generation in the UV region. | We demonstrate experimentally the generation of cross-polarized femtosecond pulses in BaF2 crystal in the UV region. We show that unsaturated cross-polarized wave generation in the UV is six times more efficient than in the visible region, and we deduce the corresponding wavelength dispersion of the third-order nonlinearity. | 18,923,602 |
Dark-spot formation by vector beams. | Dark-spot formation is demonstrated by calculating electric-field distribution near the focus produced by focusing higher-order transverse-mode vector beams with radial and azimuthal polarizations in addition to Laguerre-Gaussian beams with linear and circular polarizations. The size of the dark spot in the radial direction varies from one beam to another, but the size in the axial direction is almost the same. The radially polarized TM02-mode beam is predicted to form a dark spot solely by an axial electric field. | 18,923,611 |
Coherence transfer between atomic ground states by the technique of stimulated Raman adiabatic passage. | We experimentally and theoretically demonstrate that the atomic coherence can be completely transferred or arbitrarily contributed among the different levels in a four-level atomic (tripod) scheme by a group of coupled pulse sequences. This technique can be applied to the information conversion in slow-light storage, quantum logical gates, and so on, which is based on the atomic coherence effect. | 18,923,629 |
Enhanced Luminescence from Emissive Defects in Aggregated Conjugated Polymers. | Degradation experiments and model studies suggested that the longer lived green fluorescence from an aggregated poly(p-phenylene ethynylene) (PPE) was due to the presence of highly emissive, low-energy, anthryl defect sites rather than the emissive conjugated polymer excimers proposed in a previous report. After elucidating the origin of the green fluorescence, additional anthryl units were purposely incorporated into the polymer to enhance the blue-to-green fluorescence color change that accompanied polymer aggregation. The improved color contrast from this anthryl-doped conjugated polymer led to the development of crude solution-state and solid-state sensors, which, upon exposure to water, exhibited a visually noticeable blue-to-green fluorescence color change. | 18,923,651 |
Long-range enhancer associated with chromatin looping allows AP-1 regulation of the peptidylarginine deiminase 3 gene in differentiated keratinocyte. | Transcription control at a distance is a critical mechanism, particularly for contiguous genes. The peptidylarginine deiminases (PADs) catalyse the conversion of protein-bound arginine into citrulline (deimination), a critical reaction in the pathophysiology of multiple sclerosis, Alzheimer's disease and rheumatoid arthritis, and in the metabolism of the major epidermal barrier protein filaggrin, a strong predisposing factor for atopic dermatitis. PADs are encoded by 5 clustered PADI genes (1p35-6). Unclear are the mechanisms controlling the expression of the gene PADI3 encoding the PAD3 isoform, a strong candidate for the deimination of filaggrin in the terminally differentiating epidermal keratinocyte. We describe the first PAD Intergenic Enhancer (PIE), an evolutionary conserved non coding segment located 86-kb from the PADI3 promoter. PIE is a strong enhancer of the PADI3 promoter in Ca2+-differentiated epidermal keratinocytes, and requires bound AP-1 factors, namely c-Jun and c-Fos. As compared to proliferative keratinocytes, calcium stimulation specifically associates with increased local DNase I hypersensitivity around PIE, and increased physical proximity of PIE and PADI3 as assessed by Chromosome Conformation Capture. The specific AP-1 inhibitor nordihydroguaiaretic acid suppresses the calcium-induced increase of PADI3 mRNA levels in keratinocytes. Our findings pave the way to the exploration of deimination control during tumorigenesis and wound healing, two conditions for which AP-1 factors are critical, and disclose that long-range transcription control has a role in the regulation of the gene PADI3. Since invalidation of distant regulators causes a variety of human diseases, PIE results to be a plausible candidate in association studies on deimination-related disorders or atopic disease. | 18,923,650 |
Stroke and conditions that mimic it: a protocol secures a safe early recognition. | Certain disorders may be falsely diagnosed as stroke. We examined the efficacy of the diagnostic protocol that is followed in our stroke unit and was designed in order to early differentiate more efficiently between stroke and conditions that mimic it. METHODS-PATIENTS: Three hundred sixty-two elderly patients (196 male, 166 female with average age 74.56 years), who were hospitalized at our stroke center between January of 2005 and June of 2007 and diagnosed at admission as stroke patients, were retrospectively studied in order to investigate if the final diagnosis agreed with the initial diagnosis of stroke on admission.Our diagnostic protocol included medical history of the patient, assessment of state of consciousness, blood pressure, electrocardiogram, complete blood cell count (hematocrit/hemoglobin, leukocytes, platelets), clotting mechanism (prothrombin time, activated partial thromboplastin time), glucose, electrolytes (Na, K, Ca), renal (blood urea nitrogen, creatinine) and liver function (SGOT, SGPT), as well as imaging methods like chest X-Ray and brain CT scan. In 95% of patients, the final diagnosis agreed with the initial diagnosis of stroke at admission. According to final diagnosis, 344 (95%) of them had stroke -either hemorrhagic or ischemic-, while from the rest 18 (5%), 12 (66.7%) were found to have metastatic neoplasm of brain, 3 (18.7%) had primal tumour of brain, whereas 3 (18.7%) suffered from other diseases (respiratory infection, meningoencephalitis, thyrotoxicosis). The principal symptoms of the conditions that mimicked a stroke were: aphasic disturbances (27.3%), dizziness/fainting (27.3%), headache/diplopia (11.1%), dysarthria (11.1%), hiccup and/or swallow disturbances (5.6%). Our diagnostic protocol seems to ensure a high degree of differential diagnosis between stroke and conditions that mimic it. | 18,923,652 |
Toxoplasmosis during pregnancy: a case report and review of the literature. | Although toxoplasmosis is considered harmless for a non-pregnant woman, it is potentially harmful during pregnancy, especially at first trimester. The aim of this study is to increase our alertness and monitoring in case of toxoplasmosis during pregnancy, given that when diagnosed it can be effectively treated.We present a case of a healthy 26 years old adult woman, found with toxoplasmosis during the 13th week of pregnancy. The role of frequent maternal and fetus immunological tests, PCR-tests of the amniotic fluid and ultrasound screening of the fetus throughout pregnancy was of great value. The patient was treated with spiramycin (1 grx3) from the 16th week of pregnancy. The patient was subjected to cesarean delivery at the 36th week of pregnancy due to preterm contractions and history of previous cesarean delivery. The newborn was a healthy girl with a birth weight of 2880 gr. A two-year follow up of the baby revealed no medical condition. Maternal infections are a serious medical condition during pregnancy. Toxoplasmosis when diagnosed on time and treated properly can lead to healthy offspring. | 18,923,664 |
The effect of recombinant human erythropoietin treatment on insulin resistance and inflammatory markers in non-diabetic patients on maintenance hemodialysis. | Iron overload and inflammation might participate in the pathogenesis of insulin resistance in community. The improvement of insulin resistance in hemodialysis (HD) patients is frequently seen after correction of anemia. The aim of this study was to investigate the influence of recobinant humam erythropoietin (Epo) treatment on insulin resistance in non-diabetic HD patients. We investigated the effects of 6 months-duration treatment with Epo on insulin resistance and inflammatory parameters in 16 (6 male/10 female) patients on maintenance HD with renal anemia (hemoglobin concentration </=105 g/l). The control group consisted of 15 patients on HD with renal anemia, without Epo treatment. Further clinical and laboratory variables were observed: fasting blood glucose (FBG), insulin, albumin, iron, total iron binding capacity (TIBC), transferrin saturation (TSAT), ferritin, TNF-alpha, and IL-6. Independent predictors for changes of calculated insulin resistance index by homeostasis model assessment (HOMA-IR) were identified by multivariate linear regression analysis. A significant reduction of insulin levels and therefore significant lowering of HOMA-IR was registered in Epo treated group. It was observed improvement of anemia [Hb 93.90+/-17.34 g/L vs. 116.40+/-21.03 g/L, p: 0.01; Hct 0.28 (0.24-0.31) vs. 0.33% (0.31-0.37), p: 0.01] as well as a trend toward iron stores decrease [ferritin 466.45 (174.40-886.90) vs. 279 microg/L (137.00-648.50), p: 0.06]. A significant decrease of TNF-alpha [2.30 pg/ml (1.48-2.95) vs. 1.65 pg/ml (0.11-1.96), p: 0.01] and IL6 levels [8.32 pg/ml (2.31-9.83) vs. 2.60 pg/ml (2.00-3.05), p: 0.01] was presented. After adjustment for confounding variables (age, sex, and Kt/v), a model consisting of BMI, ferittin, and TNF alpha accounted for 96% of the variance in HOMA-IR in Epo treated patients. The present study demonstrated that Epo treatment could participate in reducing insulin resistance through iron stores reduction and improvement of chronic inflammation in patients on maintenance HD. | 18,923,665 |
Quality of life of children and adolescents with diabetes of Northern Greek origin. | To culturally adapt the diabetes- specific quality of life (QOL) instrument PedsQL 3.0 Diabetes Module (DM) and the generic QOL instrument PedsQL 4.0 Generic Core Scales (GCS) to the population of Greek diabetic children. Also, to evaluate QOL in youths with type 1 diabetes, compare it with that of healthy youths, and identify relationships between QOL and metabolic control and intensity of treatment. Eighty nine (89) children and adolescents with type I diabetes and 89 without diabetes, all with their parents (2-18 years of age, diabetes duration>6 months) completed the Greek GCS. Those with diabetes also completed the Greek DM. Cronbach alpha coefficient of child and parent report of both instruments, in general approached 0.70, indicating their internal consistency reliability. Both instruments demonstrated positive intercorrelations with their total scores and subscales of DM demonstrated positive intercorrelations with total score of the generic instrument, supporting the validity of both instruments for the evaluation of QOL of Greek diabetic children. No statistically important differences were found among patient and parent report of diabetes and control group in both instruments. Exception was "Social functioning" in which children with diabetes reported better QOL. Growing age, female gender, large BMI, poor metabolic control and intensity of treatment did not influence QOL of children with diabetes. Greek PedsQL GCS and DM have sufficient acceptability, reliability and validity so as to be used for the purposes of a comparative study. Youth with diabetes reported similar QOL with non-diabetic youth of the same age and socioeconomic status. | 18,923,667 |
Genetic disruption of both tryptophan hydroxylase genes dramatically reduces serotonin and affects behavior in models sensitive to antidepressants. | The neurotransmitter serotonin (5-HT) plays an important role in both the peripheral and central nervous systems. The biosynthesis of serotonin is regulated by two rate-limiting enzymes, tryptophan hydroxylase-1 and -2 (TPH1 and TPH2). We used a gene-targeting approach to generate mice with selective and complete elimination of the two known TPH isoforms. This resulted in dramatically reduced central 5-HT levels in Tph2 knockout (TPH2KO) and Tph1/Tph2 double knockout (DKO) mice; and substantially reduced peripheral 5-HT levels in DKO, but not TPH2KO mice. Therefore, differential expression of the two isoforms of TPH was reflected in corresponding depletion of 5-HT content in the brain and periphery. Surprisingly, despite the prominent and evolutionarily ancient role that 5-HT plays in both vertebrate and invertebrate physiology, none of these mutations resulted in an overt phenotype. TPH2KO and DKO mice were viable and normal in appearance. Behavioral alterations in assays with predictive validity for antidepressants were among the very few phenotypes uncovered. These behavioral changes were subtle in the TPH2KO mice; they were enhanced in the DKO mice. Herein, we confirm findings from prior descriptions of TPH1 knockout mice and present the first reported phenotypic evaluations of Tph2 and Tph1/Tph2 knockout mice. The behavioral effects observed in the TPH2 KO and DKO mice strongly confirm the role of 5-HT and its synthetic enzymes in the etiology and treatment of affective disorders. | 18,923,670 |
Evolutionarily conserved transcriptional co-expression guiding embryonic stem cell differentiation. | Understanding the molecular mechanisms controlling pluripotency in embryonic stem cells (ESCs) is of central importance towards realizing their potentials in medicine and science. Cross-species examination of transcriptional co-expression allows elucidation of fundamental and species-specific mechanisms regulating ESC self-renewal or differentiation. We examined transcriptional co-expression of ESCs from pathways to global networks under the framework of human-mouse comparisons. Using generalized singular value decomposition and comparative partition around medoids algorithms, evolutionarily conserved and divergent transcriptional co-expression regulating pluripotency were identified from ESC-critical pathways including ACTIVIN/NODAL, ATK/PTEN, BMP, CELL CYCLE, JAK/STAT, PI3K, TGFbeta and WNT. A set of transcription factors, including FOX, GATA, MYB, NANOG, OCT, PAX, SOX and STAT, and the FGF response element were identified that represent key regulators underlying the transcriptional co-expression. By transcriptional intervention conducted in silico, dynamic behavior of pathways was examined, which demonstrate how much and in which specific ways each gene or gene combination effects the behavior transition of a pathway in response to ESC differentiation or pluripotency induction. The global co-expression networks of ESCs were dominated by highly connected hub genes such as IGF2, JARID2, LCK, MYCN, NASP, OCT4, ORC1L, PHC1 and RUVBL1, which are possibly critical in determining the fate of ESCs. Through these studies, evolutionary conservation at genomic, transcriptomic, and network levels is shown to be an effective predictor of molecular factors and mechanisms controlling ESC development. Various hypotheses regarding mechanisms controlling ESC development were generated, which could be further validated by in vitro experiments. Our findings shed light on the systems-level understanding of how ESC differentiation or pluripotency arises from the connectivity or networks of genes, and provide a "road-map" for further experimental investigation. | 18,923,680 |
"It is me who endures but my family that suffers": social isolation as a consequence of the household cost burden of Buruli ulcer free of charge hospital treatment. | Despite free of charge biomedical treatment, the cost burden of Buruli ulcer disease (Bu) hospitalisation in Central Cameroon accounts for 25% of households' yearly earnings, surpassing the threshold of 10%, which is generally considered catastrophic for the household economy, and calling into question the sustainability of current Bu programmes. The high non-medical costs and productivity loss for Bu patients and their households make household involvement in the healing process unsustainable. 63% of households cease providing social and financial support for patients as a coping strategy, resulting in the patient's isolation at the hospital. Social isolation itself was cited by in-patients as the principal cause for abandonment of biomedical treatment. These findings demonstrate that further research and investment in Bu are urgently needed to evaluate new intervention strategies that are socially acceptable and appropriate in the local context. | 18,923,711 |
ESBL genotypes in fluoroquinolone-resistant and fluoroquinolone-susceptible ESBL-producing Escherichia coli urinary isolates in Manitoba. | Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli are increasingly common in nosocomial and community settings. Furthermore, fluoroquinolone (FQ) and even multidrug resistance (MDR) appear to be associated with certain ESBL genotypes. The purpose of the present study was to determine which ESBL genotypes are associated with FQ and MDR in E coli urinary isolates in Manitoba. The authors determined the antimicrobial susceptibility, genetic similarity and ESBL genotype of 27 FQ-resistant and seven FQ-susceptible, ESBL-producing urinary isolates submitted to the clinical microbiology laboratories of two teaching hospitals between October 2000 and April 2005. Susceptibilities to beta-lactams, FQs, trimethoprim-sulfamethoxazole (SXT), doxycycline (DOX), gentamicin (GM) and tigecycline were determined by microbroth dilution; pulsed-field gel electrophoresis (PFGE) was used to determine genetic relatedness, and ESBL genotype was determined by polymerase chain reaction and sequencing. Of 34 ESBL-producing organisms, 27 (79.4%) were found to be ciprofloxacin (CIP) resistant, 27 (79.4%) were SXT resistant, eight (23.5%) were GM resistant and 29 (85.3%) were DOX resistant. Twenty-three (67.6%) had MDR, with concomitant resistance to CIP and SXT; 16 had concomitant resistance to CIP, SXT and DOX; and seven (20.6%) had MDR, with concomitant resistance to CIP, SXT, DOX and GM. All isolates were susceptible to tigecycline. Of 27 FQ-resistant ESBL-producing organisms, seven (25.9%) were genotype CTX-M-14, 19 (70.4%) were genotype CTX-M-15 and one (3.7%) was genotype CTX-M-24. Among the seven FQ-susceptible strains, three (42.8%) expressed SHV-type enzymes, three (42.8%) expressed TEM-type enzymes and one (14.3%) expressed CTX-M-9. CTX-M-15 was the most common MDR-associated genotype. Of a total of 19 strains, 18 (94.7%) were resistant to FQs and SXT; 15 (78.9%) were resistant to FQs, SXT and DOX; and five (26.3%) were resistant to FQs, SXT, DOX and GM. PFGE analysis revealed genetic similarity within CTX-M-15-producing isolates only. CTX-M-15 in E coli is strongly associated with an MDR phenotype compared with other genotypes. CTX-M-14 is associated with FQ resistance only. PFGE suggests clonality of CTX-M-15-producing isolates within and among hospitals. | 18,923,714 |
Antibiotic availability and the prevalence of pediatric pneumonia during a physicians' strike. | Antibiotics are widely believed to be overpre-scribed for pediatric respiratory infections, yet there are few data available on the effect of a sudden decrease in antibiotic availability on pediatric infectious disease. To determine whether the prevalence of radiographically diagnosed pneumonia changed over a period of decreased physician access and decreased antibiotic availability. A retrospective study was performed which reviewed the number of pediatric respiratory antibiotic prescriptions over a period which included a physicians' strike. The study examined whether antibiotic availability had been affected by the strike. Pediatric chest radiograph reports were reviewed for the same period to determine whether changes in antibiotic availability had affected the prevalence of radiographically diagnosable pneumonias among children presenting to a pediatric emergency room. While prescriptions for antibiotics fell by a minimum estimate of 28% during the strike, there was no change in the frequency of radiographic diagnoses of pneumonia. Respiratory antibiotics appear to be available in the community in excess of the amount required to control pneumonia. A 28% decrease in antibiotic availability did not result in a significant increase in respiratory disease. | 18,923,715 |
A prospective two years study of first trimester screening for Down syndrome. | Nowadays maternal age of pregnant women has increased in most developed countries. The rate of women above 35 years old constitutes about 15% of pregnancies. The aim of our study is to prove that by first trimester screening, the number of women who have indication for invasive prenatal diagnostic procedure is significantly reduced. This prospective study lasted two years from 02/2005 to 02/2007. The participants to our study were 531 pregnant women with a mean maternal age of 30 years (19-42). We used the first trimester screening test for Down's syndrome. The biochemical blood test of free b-hCG (beta human chorionic gonadotropin) and PAPP-A (pregnancy associated plasma protein A) and the measurement of nuchal translucency were performed between 11-13 weeks +6 days (mean gestational age 12 weeks +2 days). In our study group, 69 women (12%) were 35 years old or more. The risk estimate for Down syndrome was 1 in 300 or more in 14 (2%) cases. In all these 14 cases we offered CVS (chorionic villus sampling) or amniocentesis. It is a fact that although the risk of any individual 36 years old is higher, most abnormalities (approximately 70%) occur in the low risk population. With the first trimester screening the sensitivity of detecting DOWN syndrome reaches 90%. Our study confirms that by first trimester screening, the number of women who have indication for invasive prenatal diagnostic procedure is significantly reduced. As a result the cost for prenatal diagnosis of the population and also the risk of iatrogenic missed miscarriages is also reduced. Finally, this screening method gives the advantage of early diagnosis. | 18,923,756 |
Revascularization treatment in patients with coronary artery disease. | The choice of optimal revascularization strategy in patients with coronary artery disease (CAD) is becoming more challenging lately, due to recent advances in percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG). On one hand, drug-eluting stents (DES) have emerged as a solution to the problem of restenosis after balloon angioplasty or bare-metal stent implantation, which was responsible for a higher rate of events (mainly repeat revascularization) in relation to CABG. On the other hand, off-pump bypass techniques and minimally invasive grafting of the left anterior descending artery appear to be safe and efficacious alternatives to traditional, on-pump CABG. Available literature includes studies outdated by current technologies, leaving the dilemma of best revascularization strategy unanswered in the general CAD population, but also in high-risk groups, such as diabetics and patients with chronic kidney disease. A number of ongoing trials, especially designed for this purpose, are set to end the debate, providing headto- head comparisons between DES-assisted PCI and contemporary bypass surgery. | 18,923,757 |
Isolated double gastric rupture caused by blunt abdominal trauma in an eighteen months old child: a case report. | We report a case of an isolated double gastric rupture, resulted from blunt abdominal trauma, that we successfully repaired by primary closure. A 18-month-old girl injured in a motor vehicle accident was admitted to our hospital where the plain X-ray and the CT findings revealed the presence of free abdominal air. An immediate performed exploratory laparotomy disclosed two full-thickness ruptures of the stomach (on the greater curvature and the posterior wall). The ruptures were closed primarily by a two-layer closure. Twenty-four hours post-operatively the patient developed delayed shock as a result of chemical peritonitis. On the 8th postoperative day the girl developed septic shock and gastrorrhagia. She underwent a gastroscopy which revealed stress-ulcer, and was treated conservatively in the children intensive care unit of our hospital. She was discharged home on 20th postoperative day. At 3-month follow up, she was doing well with normal growth and eating a regular regimen about her age. Gastric rupture following blunt abdominal trauma is rare, with a reported incidence of 0.02-1.7%. The morbidity and mortality are directly related to the number of associated injuries, the delay in diagnosis and the development of intraabdominal sepsis. In this paper we emphasise the need for early diagnosis and the aggressive surgical treatment as a key to decreasing the mortality and morbidity from this relatively rare injury, especially in this age group of children. | 18,923,758 |
Methicillin-resistant Staphylococcus aureus in a Canadian intensive care unit: Delays in initiating effective therapy due to the low prevalence of infection. | Methicillin-resistant Staphylococcus aureus (MRSA) infection in intensive care units (ICUs) has increased dramatically in prevalence in recent years, and is associated with increased morbidity, mortality and cost of care. The aim of the present study was to describe the epidemiology and outcomes of MRSA infection in the general systems ICU at the University of Alberta Hospital in Edmonton, Alberta. A retrospective cohort analysis of patients infected with MRSA in a general systems ICU was conducted from January 1, 1997, to August 15, 2005. Forty-six cases of MRSA were identified, of which 36 (78.3%) were infected. The most common admitting diagnoses included respiratory failure (41.7%) and sepsis or septic shock (36.1%). Infection was hospital acquired in 58.3% of cases (10 cases ICU acquired), with a median time to infection of 11 days. The most common sites of infection were the respiratory tract, skin and blood. Median lengths of stay were 13 days in the unit and 27 days in-hospital. Crude mortality was 55.6%. Time to appropriate antimicrobial treatment was delayed in 80.5% of patients. Four prototypical Canadian MRSA (CMRSA) strains were identified by pulsed-field gel electrophoresis. Hospital-acquired strains were predominantly CMRSA-2 (59%), indicating that this clone circulates at the University of Alberta Hospital. MRSA infection remains uncommon at the University of Alberta Hospital, resulting in delays in instituting appropriate antimicrobial therapy. To date, only a few community-acquired strains have been noted. ICU acquisition of MRSA remains rare, with only 10 cases over the past nine years. The majority of hospital-acquired strains were CMRSA-2. | 18,923,765 |
Biliary atresia: we still operate too late. | To analyze the age at surgery for children with biliary atresia and their survival periods without need for liver transplantation. The study was performed at Hospital de Clínicas de Porto Alegre, in Porto Alegre, state of Rio Grande do Sul, Brazil. The medical records of patients operated between 1982 and 2007 who were residents of the state of Rio Grande do Sul were reviewed. Of the 112 cases of children with biliary atresia studied, 38 (33.9%) occurred between 1982 and 1989, 46 (41.1%) between 1990 and 1999 and 28 (25.0%) after 2000. Portoenterostomy was not performed for 12 cases (10.7%). Age at surgery ranged from 25 to 297 days (median: 80.5; IQR25-75: 61.3-109.0 days); for 20.5% of cases, the age was below 60 days. There was no age difference at diagnosis for the three decades in the study. Patients from the countryside (median: 87.0; IQR25-75: 69.0-115.0 days) were referred significantly later (p = 0.007) than those living in Porto Alegre and the metropolitan area (median: 68.0; IQR25-75: 55.5-98.0 days). The ratio of patients younger than 60 days was significantly lower (p = 0.013) for those from the countryside. Survival periods with native liver for all patients was 46.2% in 2 years, falling continuously until reaching 15.3% in 20 years. Patients operated before reaching 60 days of age had longer survival periods with native livers (log rank < 0.0001). Late performance of portoenterostomy was a constant in the past 25 years, and this delay led to shorter survival periods with native livers for biliary atresia patients. | 18,923,787 |
High-throughput self-interaction chromatography: applications in protein formulation prediction. | Demonstrate the ability of an artificial neural network (ANN), trained on a formulation screen of measured second virial coefficients to predict protein self-interactions for untested formulation conditions. Protein self-interactions, quantified by the second virial coefficient, B22, were measured by self-interaction chromatography (SIC). The B22 values of lysozyme were measured for an incomplete factorial distribution of 81 formulation conditions of the screen components. The influence of screen parameters (pH, salt and additives) on B22 value was modeled by training an ANN using B22 value measurements. After training, the ANN was asked to predict the B22 value for the complete factorial of parameters screened (12,636 conditions). Twenty of these predicted values (distributed throughout the range of predictions) were experimentally measured for comparison. The ANN was able to predict lysozyme B22 values with a significance of p<0.0001 and RMSE of 2.6x10(-4) mol ml/g2. The results indicate that an ANN trained on measured B22 values for a small set of formulation conditions can accurately predict B22 values for untested formulation conditions. As a measure of protein-protein interactions correlated with solubility, B22 value predictions based on a small screen may enable rapid determination of high solubility formulations. | 18,923,812 |
Visante anterior segment OCT in a patient with gas bubbles in the anterior chamber after femtosecond laser corneal flap formation. | A patient with anterior chamber gas bubbles after LASIK flap formation with femtosecond laser is presented. A 33-year-old male patient had LASIK for myopia with corneal flap formation with IntraLase FS30 femtosecond laser. In the right eye, air bubbles were observed in anterior chamber after successful flap formation. Laser correction was completed successfully, by Wavelight Allegretto Wave Eye-Q excimer laser, without eye-tracker. Visante anterior segment optical coherence tomography imaging displayed that the pocket extended to limbal area, with stromal bed thickness of >600 microm at that area. We propose as possible causes of the air bubbles scattering of femtosecond laser beam producing direct photodissociation of aqueous humor, or direct cavitation effect in aqueous humor due to rapid pressure changes in corneal lamellar interface during the femtosecond laser procedure. Other causes such as migration of intrastromal bubbles through peripheral corneal stroma and trabecular meshwork, or through posterior stroma and endothelium, seem to be unlikely. | 18,923,814 |
Comparative biomechanical study of the Ligament Plate and other fixation devices in ACL reconstruction. | The objective of this study was to evaluate and compare the biomechanical properties of the Ligament Plate with other femoral fixation devices. The Ligament Plate and three different femoral fixation devices were used in fixation of 60 porcine femora and harvested porcine tendons. For each fixation device, a porcine graft-tendon complex was used for the simple load-to-failure test and the load-to-failure test after a cyclic loading test, and the maximal failure load was measured. The amount of graft elongation and failure pattern after the cyclic loading test and load-to-failure test were evaluated. In the BioScrew group, the mean maximal failure load in the load-to-failure test and load-to-failure test after a cyclic loading test was significantly lower and significant graft elongation was noted. There were no significant differences between the other groups. The Ligament Plate provided adequate initial fixation power suitable for early rehabilitation. | 18,923,833 |
Mutations in the paralogous human alpha-globin genes yielding identical hemoglobin variants. | The human alpha-globin genes are paralogues, sharing a high degree of DNA sequence similarity and producing an identical alpha-globin chain. Over half of the alpha-globin structural variants reported to date are only characterized at the amino acid level. It is likely that a fraction of these variants, with phenotypes differing from one observation to another, may be due to the same mutation but on a different alpha-globin gene. There have been very few previous examples of hemoglobin variants that can be found at both HBA1 and HBA2 genes. Here, we report the results of a systematic multicenter study in a large multiethnic population to identify such variants and to analyze their differences from a functional and evolutionary perspective. We identified 14 different Hb variants resulting from identical mutations on either one of the two human alpha-globin paralogue genes. We also showed that the average percentage of hemoglobin variants due to a HBA2 gene mutation (alpha2) is higher than the percentage of hemoglobin variants due to the same HBA1 gene mutation (alpha1) and that the alpha2/alpha1 ratio varied between variants. These alpha-globin chain variants have most likely occurred via recurrent mutations, gene conversion events, or both. Based on these data, we propose a nomenclature for hemoglobin variants that fall into this category. | 18,923,834 |
Sporadic amyotrophic lateral sclerosis of long duration is associated with relatively mild TDP-43 pathology. | Recently, sporadic amyotrophic lateral sclerosis (SALS), a fatal neurological disease, has been shown to be a multisystem proteinopathy of TDP-43 in which both neurons and glial cells in the central nervous system are widely affected. In general, the natural history of SALS is short (<5 years). However, it is also known that a few patients may survive for 10 years or more, even without artificial respiratory support (ARS). In the present study using TDP-43 immunohistochemistry, we examined various regions of the nervous system in six patients with SALS of long duration (10-20 years) without ARS, in whom lower motor-predominant disease with Bunina bodies and ubiquitinated inclusions (UIs) in the affected lower motor neurons was confirmed. One case also showed UIs in the hippocampal dentate granule cells (UDG). In all cases, except one with UDG, the occurrence of TDP-43-immunoreactive (ir) neuronal cytoplasmic inclusions (NCIs) was confined to a few regions in the spinal cord and brainstem, including the anterior horns. In one case with UDG, TDP-43-ir NCIs were also detected in the substantia nigra, and some regions of the cerebrum, including the hippocampal dentate gyrus (granule cells). The number of neurons displaying NCIs in each region was very small (1-3 per region, except the dentate gyrus). On the other hand, the occurrence of TDP-43-ir glial cytoplasmic inclusions (GCIs) was more widespread in the central nervous system, including the cerebral white matter. Again, however, the number of glial cells displaying GCIs in each region was very small (1-3 per region). In conclusion, compared to the usual form of SALS, TDP-43 pathology shown in SALS of long duration was apparently mild in degree and limited in distribution, corresponding to the relatively benign clinical courses observed. It is now apparent that SALS of long duration is actually part of a TDP-43 proteinopathy spectrum. | 18,923,836 |
Brain and mind operational architectonics and man-made "machine" consciousness. | To build a true conscious robot requires that a robot's "brain" be capable of supporting the phenomenal consciousness as human's brain enjoys. Operational Architectonics framework through exploration of the temporal structure of information flow and inter-area interactions within the network of functional neuronal populations [by examining topographic sharp transition processes in the scalp electroencephalogram (EEG) on the millisecond scale] reveals and describes the EEG architecture which is analogous to the architecture of the phenomenal world. This suggests that the task of creating the "machine" consciousness would require a machine implementation that can support the kind of hierarchical architecture found in EEG. | 18,923,856 |
Interventional radiology in the diagnosis, management, and follow-up of pseudoaneurysms. | Arterial wall disruption, as a consequence of inflammation/infection, trauma (penetrating or blunt), or iatrogenic causes, may result in pseudoaneurysm formation. Currently, iatrogenic causes are increasing as a result of the growth of endovascular intervention. The frequency of other causes also seems to be increasing, but this may simply be the result of increased diagnosis by better imaging techniques, such as multidetector contrast-enhanced computed tomography. Clinically, pseudoaneurysms may be silent, may present with local or systemic signs, or can rupture with catastrophic consequences. Open surgical repair, previously the mainstay of treatment, has largely been replaced by image-guided occlusion methods. On the basis of an experience of over 100 pseudoaneurysms, treatments at various anatomical sites, imaging modalities used for accurate diagnosis, current changing therapeutic options for pseudoaneurysm management, approved embolization agents, and clinical follow-up requirements to ensure adequate treatment will be discussed. Image-guided direct percutaneous and endovascular embolization of pseudoaneurysms are established treatment options with favorable success rates and minimal morbidity. The pendulum has now swung from invasive surgical repair of pseudoaneurysms to that of image-guided interventional radiology. | 18,923,864 |
Relationship between duration of teriparatide therapy and clinical outcomes in postmenopausal women with osteoporosis. | The extent to which fracture protection and safety varies with increasing time on teriparatide [rhPTH(1-34)] therapy is a clinically relevant unanswered question. In postmenopausal women with osteoporosis, increased duration of teriparatide versus placebo treatment was associated with a progressive decrease in the rates of nonvertebral fragility fractures and back pain. The impact of duration of teriparatide [rhPTH(1-34)] therapy on patient outcomes is a relevant unanswered question. Postmenopausal women with osteoporosis were randomized to once-daily subcutaneous injection with placebo (N = 544), teriparatide 20 microg (TPTD20; N = 541), or teriparatide 40 microg (TPTD40; N = 552) plus calcium and vitamin D supplementation. The time to first nonvertebral fragility fracture and new or worsening back pain following treatment initiation was analyzed using Cox partial likelihood regression treating time on therapy as a linear, time-dependent covariate. Compared with placebo, the relative hazard for nonvertebral fragility fractures decreased by 7.3% for each additional month of TPTD20 [hazard ratio = 0.927, 95% CI (0.876 to 0.982), p = 0.009] and by 7.6% for each additional month of TPTD40 [hazard ratio = 0.924, 95% CI (0.871 to 0.981), p = 0.009]. Clinical vertebral fractures appeared to increase over time in the placebo group and occurred primarily in the first time interval in the teriparatide treatment groups. Compared with placebo, the relative hazard of back pain was decreased by 8.3% for each additional month of TPTD20 [hazard ratio = 0.920, 95% CI (0.902 to 0.939), p < 0.001] and 8.7% for each additional month of TPTD40 [hazard ratio = 0.917, 95% CI (0.898 to 0.935), p < 0.001]. These findings suggest increased nonvertebral fracture protection, reduced back pain, and reduced occurrence of side effects with longer duration of teriparatide therapy. | 18,923,884 |
Acculturation of host individuals: immigrants and personal networks. | There has been a vast amount of research on the changes experienced by immigrants, but little is known about the changes experienced by host individuals. This article focuses on the role of host individuals in the networks of relations between immigrant populations and the communities from the dominant culture, as well as the changes experienced by host individuals because of their continuous contact with immigrants. This research applied a network approach to the study of the acculturation of host individuals. Two independent studies were carried out: a systematic analysis of the personal networks of Argentinean (n = 67), Ecuadorian (n = 59), Italian (n = 37) and German (n = 37) residents in Seville and Cadiz (Spain) (Study 1); and an ethnographic study with human service workers for Latin American immigrants in Boston (USA) (Study 2). With two different strategies, the role of host individuals in personal networks of foreigners in the United States and Spain was analyzed. The results show that host individuals tend to have less centrality than compatriots, showing an overall secondary role in the personal networks of immigrants. The lowest average centrality was observed in recent and temporal migrants, whereas the highest corresponded to the individuals with more time of residence in Spain. The personal networks of human service providers in the United States vary in ethnic composition and in their structural properties, and therefore shape different types of integrative bridges for immigrants. | 18,923,893 |
Migrant well-being is a multilevel, dynamic, value dependent phenomenon. | Research demonstrates that the well-being of migrants is a multilevel, dynamic, and value dependent phenomenon. It is multilevel because risk and protective factors are present at various ecological planes, from the individual to the social sphere. It is dynamic because objective and subjective risk and protective factors interact across ecological levels, creating favorable or unfavorable conditions for migrants to adjust to the new surroundings. Finally, it is value dependent because access to resources is conditioned by norms of justice prevalent in the host society. Findings from this special section on acculturation are combined with previous literature to support the three claims advanced in this article. | 18,923,898 |
Absorption, excretion and retention of 51Cr from labelled Cr-(III)-picolinate in rats. | The bioavailability of chromium from Cr-picolinate (CrPic(3)) and Cr-chloride (CrCl(3)) was studied in rats using (51)Cr-labelled compounds and whole-body-counting. The intestinal absorption of Cr was twice as high from CrPic(3) (1.16% vs 0.55%) than from CrCl(3), however most of the absorbed (51)Cr from CrPic(3) was excreted into the urine within 24 h. After i.v. or i.p. injection, the whole-body retention curves fitted well to a multiexponential function, demonstrating that plasma chromium is in equilibrium with three pools. For CrPic(3), a large pool exists with a very rapid exchange (T (1/2) = <0.5 days), suggesting that CrPic(3) is absorbed as intact molecule, from which the main part is directly excreted by the kidney before degradation of the chromium complex in the liver can occur. CrCl(3) is less well absorbed but the rapid exchange pool is much smaller, resulting in even higher Cr concentrations in tissue such as muscle and fat. However, 1-3 days after application, the relative distribution of (51)Cr from both compounds was similar in all tissues studied, indicating that both compounds contribute to the same storage pool. In summary, the bioavailability of CrPic(3) in rats is not superior compared to CrCl(3). | 18,923,913 |
Increased spontaneous osteoclastogenesis from peripheral blood mononuclear cells in phenylketonuria. | Phenylketonuria (PKU) is commonly complicated by a progressive bone impairment of uncertain aetiology. The therapeutic phenylalanine (Phe)-restricted diet and the possible noxious effects of high plasma Phe concentrations on bone have previously been suggested as possible determinant factors. Since osteoclasts are involved in bone reabsorption, they could play a role in determining bone damage in PKU. The reported increased excretion of bone resorption markers in PKU patients is consistent with this hypothesis. Although different diseases characterized by bone loss have been related to increased spontaneous osteoclastogenesis from peripheral blood mononuclear cells (PBMCs), to date there is no evidence of increased osteoclast formation in PKU. In this study, we compared the spontaneous osteoclastogenesis from PBMCs in 20 patients affected by PKU with that observed in age- and sex-matched healthy subjects. Phenylketonuric patients showed the number of osteoclasts to be almost double that observed in controls (159.9 ± 79.5 and 87.8 ± 44.7, respectively; p = 0.001). Moreover, a strict direct correlation between the spontaneous osteoclastogenesis in PKU patients and the mean blood Phe concentrations in the preceding year was observed (r = 0.576; p = 0.010). An imbalance between bone formation and bone resorption might explain, at least in part, the pathogenesis of bone loss in this disease. These findings could provide new insights into the biological mechanisms underlying bone damage in PKU. | 18,923,919 |
Influence of gender on ventilatory efficiency during exercise in young children. | In this study, we assessed the ventilatory response in 84 children (46 males: age 8.1 +/- 1.0 years, body mass 34.2 +/- 7.9 kg, height 1.32 +/- 0.16 m; 38 females: age 8.0 +/- 0.8 years, body mass 31.7 +/- 8.7 kg, height 1.31 +/- 0.08 m) during a cycle ergometer test to determine if there was an influence of gender on ventilatory efficiency. The test commenced at 25 W and increased by 10 W every minute. Expired air was collected through a face mask and analysed breath by breath. The ventilatory anaerobic threshold was determined according to gas exchange methods and we focused our attention on the analysis of carbon dioxide production (VCO(2)), ventilation (V(E)), the ratio V(E)/VCO(2) and its slope. Differences between the sexes at maximal power output were strongly significant for V(E) and VCO(2) (P = 0.0001 and P = 0.0004 respectively) and moderately significant for the V(E)/VCO(2) ratio (P = 0.05). The slope of V(E) versus VCO(2) was 30.8 +/- 4.2 for males and 29.4 +/- 3.2 for females, with no difference between the sexes (P = 0.1). In conclusion, although the peak values of V(E) and VCO(2) were significantly different between the sexes, there were no such differences in ventilatory efficiency during a maximal incremental test expressed as the slope of V(E)/VCO(2), at least in young children. | 18,923,953 |
A comparison of lactate indices during ramp exercise using modelling techniques and conventional methods. | The aim of this study was to compare the lactate indices provided by single- and double-breakpoint models with lactate thresholds obtained with conventional methods. Arterial samples for the determination of lactate concentrations were drawn from eight participants at rest and every minute during a ramp test (15 W x min(-1)) on a cycle ergometer. Lactate thresholds were determined from a blood lactate concentration equal to 4 mM (LT(4)), from an increase of 1 mM above the resting level (Delta1 mM), and from indirect methods using ventilatory parameters. Other indices were computed from the modelling of the lactate curve using an exponential function (LSI), a polynomial function (Dmax), a semi-log model (SLog), a parabola plus delay model (Mod P), and a two-breakpoint model (Mod M). Mod P and Mod M showed poor agreement with the other methods. LT(4), Dmax, LSI, and respiratory exchange ratio equal to 1 were correlated with each other (0.81 <or= R <or= 0.92) and their mean differences ranged from 2.8 to 15 W, with limits of agreement within the range +/- 24.6 to +/- 42.4 W. These results question the interest in breakpoints models to detect lactate thresholds, knowing that LT(4), LSI, Dmax, and respiratory exchange ratio equal to 1 provide indices that occur at similar power outputs. | 18,923,955 |
Development of a partial Balint's syndrome in a congenitally deaf patient presenting as pseudo-aphasia. | We present a 56 year-old, right-handed, congenitally deaf female who exhibited a partial Balint's syndrome accompanied by positive visual phenomena restricted to her lower right visual quadrant (e.g., color band, transient unformed visual hallucinations). Balint's syndrome is characterized by a triad of visuo-ocular symptoms that typically occur following bilateral parieto-occipital lobe lesions. These symptoms include the inability to perceive simultaneous events in one's visual field (simultanagnosia), an inability to fixate and follow an object with one's eyes (optic apraxia), and an impairment of target pointing under visual guidance (optic ataxia). Our patient exhibited simultanagnosia, optic ataxia, left visual field neglect, and impairment of all complex visual-spatial tasks, yet demonstrated normal visual acuity, intact visual fields, and an otherwise normal neurocognitive profile. The patient's visuo-ocular symptoms were noticed while she was participating in rehabilitation for a small right pontine stroke. White matter changes involving both occipital lobes had been incidentally noted on the CT scan revealing the pontine infarction. As the patient relied on sign language and reading ability for communication, these visuo-perceptual limitations hindered her ability to interact with others and gave the appearance of aphasia. We discuss the technical challenges of assessing a patient with significant barriers to communication (e.g., the need for a non-standardized approach, a lack of normative data for such special populations), while pointing out the substantial contributions that can be made by going beyond the standard neuropsychological test batteries. | 18,923,965 |
Serous otitis media in the 20th and 21st centuries: evolving views and treatments. | The historical study of serous otitis media (SOM) demonstrates steps in recognition of the disease, shifts in prevalence, and relationships between the disease's affect and evolving economic bases of society. SOM, although noted in early Roman and Arabic medicine, was only identified as a distinct and significant pathology in the last half of the 20th century. This paper examines the development of understanding of SOM, and ways in which it has been cared for during the 20th and 21st centuries. The medical literature from antiquity to the present was reviewed for mention of otological conditions that related to SOM. For this report, the primary source of each notation was examined. The first part of the 20th century saw little change from earlier times in the recognition or treatment of SOM. Our current 21st century conceptualization and concern for SOM has come about from five advances: antibiotics, the rediscovery of the tympanostomy tube, the clinical use of middle ear impedance, the association of a history of otitis with linguistic deficiency, and recognition of the significance of transformation to a communication-based economy. | 18,923,967 |
Induction and exacerbation of psoriasis with TNF-blockade therapy: a review and analysis of 127 cases. | There are reports of rare adverse effects of tumor necrosis factor (TNF) inhibitors, including infections, malignancies, and induction of autoimmune conditions. Intriguing, are cases of induction or exacerbation of psoriasis in conjunction with TNF inhibitor therapy, given that they are approved for treatment of the same condition. Published cases of psoriasis occurring during anti-TNF therapy were analyzed, including overviews of proposed etiologies and treatment recommendations. A literature search using Ovid MEDLINE and PubMed was performed for articles published between January 1990 and September 2007 to collect reported cases of psoriasis in patients receiving therapy with TNF blocking agents. A total of 127 cases were identified: 70 in patients on infliximab (55.1%), 35 with etanercept (27.6%), and 22 with adalimumab (17.3%). Females comprised 58% of cases; mean age of reported patients was 45.8 years, and the time from initiation of treatment to onset of lesions averaged 10.5 months. These patients suffered from a number of primary conditions, with rheumatoid arthritis, ankylosing spondylitis, and Crohn's disease accounting for the vast majority. Palmoplantar pustular psoriasis was observed in 40.5% of the cases, with plaque-type psoriasis in 33.1%, and other types comprising the remainder. Topical corticosteroids were the most commonly employed treatment modality but led to resolution in only 26.8% of cases in which they were employed solely. Switching to a different anti-TNF agent led to resolution in 15.4% of cases. Cessation of anti-TNF therapy with systemic therapy led to resolution in 64.3% of cases. More information and cases are needed. Biopsies of TNF-blockade-induced lesions may reveal what cytokines and cell types drive the development of these lesions. Additionally, there is a need to develop an algorithm to treat this paradoxical side effect of therapy with TNF-blockers. | 18,923,992 |
Time-response effects of testicular gene expression profiles in Sprague-Dawley male rats treated with di(n-butyl) phthalate. | Phthalate esters were reported to damage fetal and postnatal testes of experimental animals, but the molecular mechanisms underlying these effects remain unknown. The time-response effects of di(n-butyl) phthalate (DBP) on the expression patterns of the testicular genes in male Sprague-Dawley rats were examined for different periods of exposure (1, 7, 14, or 28 d). The steroidogenic- or spermatogenic-related gene expression patterns were measured using reverse-transcription polymerase chain reaction (RT-PCR). After 28 d of exposure, the serum concentrations of DBP and monobutyl phthalate (MBP) increased in a dose-dependent manner, and were significantly higher in the DBP-treated rats than in the control rats. Liver weight was increased markedly at 28 d after DBP exposure at 750 mg/kg/d. Testicular weight was reduced significantly after 14 and 28 d of exposure. DBP (750 mg/kg/d) produced a significant increase in scavenger receptor class B1 (SR-B1) and steroidogenic acute regulatory (StAR) mRNA after 14 and 28 d of exposure. The level of cytochrome P-450 (P450) side-chain cleavage (P450scc) mRNA decreased in the group treated with DBP at 750 mg/kg/d at 7 d. After 14 and 28 d of exposure, there was an apparent increase in P450scc mRNA. High doses of DBP significantly increased the Cyp17 mRNA level after 28 d of exposure. At 7 d, a significant decrease in Cyp19 mRNA was observed only in the group exposed to 750 mg/kg/d DBP. In addition, DBP significantly decreased the levels of a spermatid-specific gene (Spag4) and lactate dehydrogenase A (LDHA) mRNA after 7 d of exposure. The levels of androgen receptor (AR), estrogen receptor-alpha (ER-alpha), and retinoid X receptor-gamma (RXR-r) expression decreased significantly in a time- or dose-dependent manner. DBP significantly increased the peroxisome proliferator-activated receptor-gamma (PPAR-r) and phosphorylated extracellular-signal-regulated kinase (p-ERK1/2) levels in the testis. These results suggest that the acute and chronic effects of DBP on the steroidogenic pathways in the testes show mechanistically distinct patterns. Data thus provide some insights into the molecular mechanisms underlying DBP-induced testicular dysgenesis. | 18,923,996 |
Does arsenic exposure increase the risk for prostate cancer? | Arsenic has been well documented as the major risk factor for blackfoot disease (BFD), a unique peripheral vascular disease that was endemic to the southwestern coast of Taiwan, where residents consumed artesian well water containing high levels of arsenic for more than 50 yr. Chronic arsenic exposure was also reported to be associated with mortality attributed to prostate cancer in a dose-response relationship. A tap-water supply system was implemented in the early 1960s in the BFD-endemic areas in Taiwan. Artesian well water was no longer used for drinking and cooking after the mid-1970s. The objective of this study was to determine whether prostate cancer mortality decreased after the improvement of drinking-water supply system through elimination of arsenic ingestion from artesian well water. Standardized mortality ratios (SMRs) for prostate cancer were calculated for the BFD-endemic area for the years 1971-2006. Results showed that mortality attributed to prostate cancer declined gradually after the improvement of drinking-water supply system. Based on the reversibility criterion, the association between arsenic exposure and development of prostate cancer is likely to be causal. | 18,923,998 |
Arrhythmogenic right ventricular cardiomyopathy--time for Nordic cooperation! | This editorial discusses arrhythmogenic right ventricular cardiomyopathy (ARVC) with respect to diagnosis and organisation of patient care. Two papers in the current issue are commented upon. Aneq and coworkers present a long-term echocardiographic study on ARVC patients. Baseline changes were seldom diagnostic, but over years, changes in right ventricular structure and function occurred; the most consistent being increasing diameter of the right ventricular outflow tract. Haapalaita and coworkers used body surface ECG, comparing right and left ventricular types of ECG. The duration of electrical systole (QT-end) and the dispersion of the action potentials (QT peak-end) was longer in the right-sided compared to the left-sided leads in ARVC, at variance from in healthy controls, and the shortening effect of autonomic manoeuvres that activate sympathetic tone, was much more marked on the right side, compatible with the tendency of arrhythmias to occur under stress. An initiative to create a Nordic registry on ARVC has come from Denmark. This is highly welcomed; our individual institutions are too small to gain the experience needed for optimal patient care. | 18,924,017 |
Efficacy of intra-operative radiofrequency ablation in patients with permanent atrial fibrillation undergoing concomitant mitral valve replacement. | Permanent atrial fibrillation (AF) is present before operation and persists after surgery in 30-40% of patients undergoing mitral valve surgery. Using the maze procedure, 75-82% of patients can be cured of AF, but the procedure is difficult and long lasting. Percutaneous radiofrequency (RF) ablation has emerged as an effective therapy for AF in recent years. To assess the efficacy of intra-operative RF ablation of AF in patients undergoing mitral valve surgery. 100 adults with permanent AF underwent mitral valve replacement. Patients were divided into two groups: the RF group--50 patients qualified for mitral valve replacement and RF ablation; and the control group--50 patients selected for mitral valve replacement without ablation. Odds ratio and 95% confidence interval were examined to assess the influence of several factors on the outcome (free from AF during one-year follow-up based on symptoms and serial Holter ECG recordings). Baseline clinical, demographic and echocardiographic characteristics were similar in both groups. Electrical cardioversion following surgery was required in 76% of patients from the RF group compared with 94% from the control group (p<0.002). In those who underwent cardioversion, sinus rhythm was restored more frequently in RF than control patients (32 vs. 16%, p<0.002). Sinus rhythm at hospital discharge was present in 56% of RF patients compared with 22% of controls (p=0.0001), and after one-year follow-up in 54 vs. 16% (p<0.001), respectively. The use of amiodarone was significantly lower in RF patients compared with controls (32 vs. 70%, p<0.05). NYHA class III (OR 8.5, CI 1.0-394) or IV (OR 36, CI 1.2-1958) and left atrial diameter >6 cm (OR 9.3, CI 0.5-5230) were identified as predictors of AF. Intra-operative RF ablation performed in the left atrium in patients with chronic AF undergoing mitral valve replacement significantly improves sinus rhythm restoration rate. Advanced heart failure (NYHA class IV) and left atrial diameter >6 cm are negative prognostic factors for sinus rhythm maintenance. | 18,924,020 |
Prevention of pediatric drug calculation errors by prehospital care providers. | Calculating weight-based drug doses for pediatric patients is difficult, with significant error potential. In the prehospital setting, few safeguards currently avert pediatric drug administration errors. We sought to determine whether use of a protocol-specific pediatric code card enables prehospital care providers to calculate more consistently accurate weight-based drug doses, volumes of administration, and age-appropriate endotracheal tube sizes. Questionnaires requiring calculations of medication doses, volumes, and endotracheal tube sizes were administered to prehospital care providers between June and November 2006 in fire department continuing education classes in the State of Maryland and the District of Columbia. Half of the participants performed the calculations with the pediatric code card as an aid, and half without. Calculations done by the two groups were compared for rate and extent of errors. We evaluated the error frequency in calculations of pediatric medication doses and endotracheal tube sizes. Of the 523 advanced life support prehospital care providers questioned, 246 answered questions using the pediatric code card, and 277 answered questions without using the card. The mean individual percentages of correct responses were 94% for the group aided by the code card and 65% for the group unaided by the card (percentage difference, 29%; 95% confidence interval [CI], 25-31%; p < 0.001). Ninety-eight percent of the aided group and 23% of the unaided group calculated the correct endotracheal tube size (percentage difference, 75%; 95% CI, 70-81%; p < 0.001). The use of the pediatric code card enabled prehospital care providers to determine weight-based drug doses, volumes of administration, and endotracheal tube sizes more accurately than peers without access to the code card. | 18,924,013 |
Pay for performance improves rural EMS quality: investment in prehospital care. | To evaluate the effect of a system of financial reward for emergency medical technicians (EMTs) who meet selected quality marker goals. This project was reviewed by an institutional review board (IRB) and was found to be exempt from IRB review. Two operational and four clinical markers were targeted for improvement. Baseline performance measurements were retrospectively measured for the preceding year, and challenging but achievable goals for improvement were established. Operational markers included completing run reports within three hours after completion of the run and call-to-en route ("out-of-chute") times of less than 90 seconds for emergency calls on our first-line ambulance. Clinical markers included the use of aspirin in adults with nontraumatic chest pain, electrocardiogram (ECG) performance in adults with nontraumatic chest pain, documentation of pain assessment and intervention in patients with traumatic hip pain, and documentation of the time of onset of symptoms in stroke calls. Each full-time EMT could earn up to $1,000 in addition to baseline pay, with part-time EMTs eligible for prorated amounts. Postincentive run reports were completed within three hours 99.7% of the time, with 21 of 24 providers meeting the goal 100% of the time. Before the incentive, reports were completed within three hours 64% of the time, with only two of 23 providers meeting the goal 100% of the time. The out-of-chute goal of less than 90 seconds was met 98.7% of the time, compared with 90.1% before the incentive. Aspirin use in adult nontraumatic chest pain improved from 68% to 96.3%, and ECG performance in this group improved from 43% to 87.8%. Documentation of the time of onset of symptoms in stroke patients improved from 97% to 100%, and the assessment of and intervention for pain in traumatic hip pain patients improved from 56% to 100%. Financial motivation improved targeted quality measures in this rural emergency medical service. It appears to be a useful adjuvant to traditional quality improvement mechanisms. | 18,924,014 |
[Myopericarditis complicated with cardiogenic shock mimicking acute coronary syndrome with ST elevation in a patient with hyperthyroidism and diabetes mellitus]. | We describe a case of a 56 year old man with myopericarditis complicated with cardiogenic shock within first 3 days, mimicking on admission acute myocardial infarction with ST elevation in inferior ECG leads. Additionally, patient presented hyperthyroidism and totally decompensated diabetes mellitus. He required during the first 3 days intravenous infusion of inotropic agents. Cardiac enzymes levels were elevated. Akinesia in mid-inferior and mid-posterior regions in ECHO was observed. On the 10th day ST segment elevation in I, II, V3-V6 and ST depression in aVR was observed in ECG. After stabilisation patient underwent coronarography which showed normal coronary arteries. The final diagnosis was acute myopericarditis complicated with acute heart failure and cardiogenic shock. | 18,924,029 |
[Liberalisation of preoperative fasting guidelines: effects on patient comfort and clinical practicability during elective laparoscopic surgery of the lower abdomen]. | In this study, the recently liberalised national guidelines for preoperative fasting were evaluated from the view point of the patients and according to their clinical usability. Patients undergoing elective laparoscopic gynaecological surgery were randomised into two groups. Patients in the long-time NPO-group (LTNPO-group) had nothing per mouth after midnight whereas patients in the short-time NPO-group (STNPO-group) did not receive any oral nutrition after midnight but were allowed an unlimited intake of Pfrimmer Nutricia preOP up to 2 hours before scheduled surgery. Patients were asked to assess the incidence of 12 symptoms of perioperative discomfort prior to and 4-6 hours after surgery using a standardised questionnaire. Gastric fluid volume, vital signs during the induction period of anaesthesia and the actual duration of fasting were registered and compared. 42 patients were included into the study (LTNPO-group: n = 23, STNPO-group: n = 19). The actual duration of fasting for solid nutritition was 11.3 h in the LTNPO-group and 10.9 h in the STNPO-group, respectively. The time of fasting for fluids was in the STNPO-group significantly shorter (4.5 h) compared to the LTNPO-group (11.3 h). The patients of the STNPO-group reported preoperatively a significant lower incidence of "feeling cold" and pre- and postoperatively of "thirst / having a dry mouth". No significant differences were reported between the groups with respect to heart rate, blood pressure, gastric volume, need of vasopressors and infusion requirements. The liberation of the national guidelines for preoperative fluid administration with unlimited intake of a carbohydrate drink offers the benefit of a significantly lower incidence of the preoperative item "feeling cold" and of the pre- and postoperative item "thirst / having a dry mouth". However, in daily clinical practice the length of fasting for fluids was conspicuously longer than that postulated by the new recommendations. | 18,924,048 |
[Suspicion of a newly appearing hypertrophic obstructive cardiomyopathy in a patient treated for hepatocellular carcinoma]. | A 42-year-old women presented with shortness of breath, tachycardia and weakness to our department. Five years ago she had been diagnosed with hepatocellular carcinoma for which an extended hemihepatectomy had been performed. The clinical examination revealed a systolic murmur over the artic region. Echocardiography showed an hypertrophed interventricular septum with signs like those in hypertrophic obstructive cardiomyopathy. Ultrasound demonstrated a cystic mass in the pelvis highly suspicious of a metastasis of a hepatocellular carcinoma. Fine needle biopsy confirmed the diagnosis of a metastatic lesion of hepatocellular carcinoma. Computed tomography demonstrated metastase in the lung and a space-occupying in the interventricular septum. The patients underwent resection of the lung and pelvic metastasis and died a few weeks later. This case demonstrates the rare occurence of a metastasis to the heart, imitating obstructive cardiac myopathy, in a patient with hepatocellular carcinoma. | 18,924,054 |
Splenogonadal fusion. | We report a case of an 11-year-old boy who presented with a painless left scrotal mass of one year's duration. Clinical examination and diagnostic modalities indicated a solid left testicular mass. Exploration was done and a complete splenogonadal fusion was found. The ectopic splenic tissue was completely removed with preservation of the testis. Splenogonadal fusion is a rare and infrequently reported entity in the paediatric surgical literature. This was our first encounter with this condition. A review of the literature is briefly presented here. | 18,924,073 |
Pseudoaneurysm of a branch of the profunda femoris artery following distal locking of an intramedullary hip nail: an unusual anatomical location. | Vascular complications following internal fixation of trochanteric femoral fractures are extremely rare. Iatrogenic injury to the profunda femoris artery or one of its branches and resultant pseudoaneurysm formation has been documented, most commonly following sliding hip screw fixation and typically arises on the posteromedial aspect of the femur. We report an unusual variation, following proximal femoral nailing of an intertrochanteric femoral neck fracture, where the pseudoaneurysm presented four weeks following surgery on the posterolateral aspect of the femur. The mechanism of injury, clinical presentation and potential preventative measures are discussed. | 18,924,081 |
Prevention of infections associated with vascular catheters. | The expanding use of vascular catheters has increased the need to prevent hazardous infectious complications. Since bloodstream infection is the most common serious complication of indwelling vascular catheters, the proof that a potentially preventive approach is truly protective against clinical infection requires a significant reduction in the incidence of this infectious complication.Although catheter colonization is a prelude to infection, most colonized catheters do not result in catheter-related infection and, therefore, a mere reduction in catheter colonization does not, in and by itself, confirm protection against clinical infection. Adherence to optimal infection control guidelines is the primary measure for preventing infection, but in most instances the level of adherence to guidelines drops subsequent to the initial surge that follows the institutional adoption of educational programs. This explains the need to assess the potential clinical protection afforded by anti-infective technologies. In addition to improving patient care, a clinically protective anti-infective approach can also bring tremendous cost savings. | 18,924,093 |
NO-sulindac inhibits the hypoxia response of PC-3 prostate cancer cells via the Akt signalling pathway. | Nitric oxide-donating non-steroidal anti-inflammatory drugs are safer than traditional NSAIDs and inhibit the growth of prostate cancer cells with greater potency than NSAIDs. In vivo, prostate cancer deposits are found in a hypoxic environment which induces resistance to chemotherapy. The aim of this study was to assess the effects and mechanism of action of a NO-NSAID called NO-sulindac on the PC-3 prostate cancer cell line under hypoxic conditions. NO-sulindac was found to have pro-apoptotic, cytotoxic, and anti-invasive effect on PC-3 cells under normoxia and hypoxia. NO-sulindac was significantly more cytotoxic than sulindac at all oxygen levels. The sulindac/linker and NO-releasing subunits both contributed to the cytotoxic effects of NO-sulindac. Resistance of PC-3 cells to NO-sulindac was induced as the oxygen concentration declined. Hypoxia-induced chemoresistance was reversed by knocking-down hypoxia-inducible factor-1alpha (HIF-1alpha) mRNA using RNAi. Nuclear HIF-1alpha levels were upregulated at 0.2% oxygen but reduced by treatment with NO-sulindac, as was Akt phosphorylation. NO-sulindac treatment of hypoxic PC-3 cells transfected with a reporter construct, downregulated activation of the hypoxia response element (HRE) promoter. Co-transfection of PC-3 cells with the HRE promoter reporter construct and myr-Akt (constitutively active Akt) plasmids reversed the NO-sulindac induced reduction in HRE activation. Real-time polymerase chain reaction analysis of hypoxic, NO-sulindac treated PC-3 cells showed downregulation of lysyl oxidase and carbonic anhydrase IX mRNA expression. Collectively, these novel findings demonstrate that NO-sulindac directly inhibits the hypoxia response of PC-3 prostate cancer cells by inhibiting HIF-1alpha translation via the Akt signalling pathway. The ability of NO-sulindac to inhibit tumour adaption to hypoxia has considerable relevance to the future management of prostate cancer with the same cellular properties as PC-3. | 18,924,134 |
Cervical prephrenic interneurons in the normal and lesioned spinal cord of the adult rat. | Although monosynaptic bulbospinal projections to phrenic motoneurons have been extensively described, little is known about the organization of phrenic premotor neurons in the adult rat spinal cord. Because interneurons may play an important role in normal breathing and recovery following spinal cord injury, the present study has used anterograde and transneuronal retrograde tracing to study their distribution and synaptic relations. Exclusive unilateral, first-order labeling of the phrenic motoneuron pool with pseudorabies virus demonstrated a substantial number of second-order, bilaterally distributed cervical interneurons predominantly in the dorsal horn and around the central canal. Combined transneuronal and anterograde tracing revealed ventral respiratory column projections to prephrenic interneurons, suggesting that some propriospinal relays exist between medullary neurons and the phrenic nucleus. Dual-labeling studies with pseudorabies virus recombinants also showed prephrenic interneurons integrated with either contralateral phrenic or intercostal motoneuron pools. The stability of interneuronal pseudorabies virus labeling patterns following lateral cervical hemisection was then addressed. Except for fewer infected contralateral interneurons at the level of the central canal, the number and distribution of phrenic-associated interneurons was not significantly altered 2 weeks posthemisection (i.e., the point at which the earliest postinjury recovery of phrenic activity has been reported). These results demonstrate a heterogeneous population of phrenic-related interneurons. Their connectivity and relative stability after cervical hemisection raise speculation for potentially diverse roles in modulating phrenic function normally and postinjury. | 18,924,146 |
Neurodevelopmental outcomes of children with low-grade gliomas. | As a group, children with low-grade gliomas (LGGs) enjoy a high rate of long-term survival and do not require the intensity of neurotoxic treatments used with higher risk pediatric brain tumors. Because they are generally considered to have favorable neurobehavioral outcomes, they have not been studied as thoroughly as higher-grade brain tumors by late-effects researchers. In this article, we review the literature on the neurobehavioral effects associated with low-grade gliomas and conclude that, (1) this is a large, understudied group of survivors of pediatric brain tumors; (2) recent small- and large-scale studies document increased risk in multiple cognitive-behavioral domains after treatment for LGGs compared with healthy peers; (3) such risk is not uniform but varies with tumor location and treatments; and (4) a life span development perspective is essential to a complete understanding of the risks faced by these children. More research on the most efficacious biopsychosocial treatment models for improving the outcomes of survivors of low-grade glioma is recommended, informed by a better understanding of theireducational needs. Investigations of genetic influences on outcome as well as prospective studies of these patients as they age are also recommended. | 18,924,158 |
Inherited disorders as a risk factor and predictor of neurodevelopmental outcome in pediatric cancer. | Each year in the United States, an average of one to two children per 10,000 develop cancer. The etiology of most childhood cancer remains largely unknown but is likely attributable to random or induced genetic aberrations in somatic tissue. However, a subset of children develops cancer in the setting of an underlying inheritable condition involving a germline genetic mutation or chromosomal aberration. Despite overall improved survival rates for children with cancer over recent decades, many patients experience neurological and neurocognitive complications during the course of their illness and/or as late effects of treatment. Improvements in therapy, longer survival times, and improved imaging techniques have all increased both the time that patients are at risk and the ability to detect such complications. How an underlying inherited disorder influences the incidence, timing, etiology, and treatment of such sequelae has not been extensively documented, but evidence exists for an increased risk for secondary malignancies and in some cases life-threatening sensitivity/toxicity to conventionally dosed cancer treatments, thus emphasizing the need for the early recognition of such syndromes. This review outlines the major tumor- and treatment-related neurodevelopmental sequelae in pediatric cancer patients, with particular attention to children with an underlying inheritable disorder. | 18,924,162 |
Valence-state analysis through spectroelectrochemistry in a series of quinonoid-bridged diruthenium complexes [(acac)(2)Ru(mu-L)Ru(acac)(2)](n) (n=+2, +1, 0, -1, -2). | The quinonoid ligand-bridged diruthenium compounds [(acac)(2)Ru(mu-L(2-))Ru(acac)(2)] (acac(-)=acetylacetonato=2,4-pentanedionato; L(2-)=2,5-dioxido-1,4-benzoquinone, 1; 3,6-dichloro-2,5-dioxido-1,4-benzoquinone, 2; 5,8-dioxido-1,4-naphthoquinone, 3; 2,3-dichloro-5,8-dioxido-1,4-naphthoquinone, 4; 1,5-dioxido-9,10-anthraquinone, 5; and 1,5-diimido-9,10-anthraquinone, 6) were prepared and characterized analytically. The crystal structure analysis of 5 in the rac configuration reveals two tris(2,4-pentanedionato)ruthenium moieties with an extended anthracenedione-derived bis(ketoenolate) pi-conjugated bridging ligand. The weakly antiferromagnetically coupled {Ru(III)(mu-L(2-))Ru(III)} configuration in 1-6 exhibits complicated overall magnetic and EPR responses. The simultaneous presence of highly redox-active quinonoid-bridging ligands and of two ruthenium centers capable of adopting the oxidation states +2, +3, and +4 creates a large variety of possible oxidation state combinations. Accordingly, the complexes 1-6 exhibit two reversible one-electron oxidation steps and at least two reversible reduction processes. Shifts to positive potentials were observed on introduction of Cl substituents (1-->2, 3-->4) or through replacement of NH by O (6-->5). The ligand-to-metal charge transfer (LMCT) absorptions in the visible region of the neutral molecules become more intense and shifted to lower energies on stepwise reduction with two electrons. On oxidation, the para-substituted systems 1-4 exhibit monocation intermediates with intervalence charge transfer (IVCT) transitions of Ru(III)Ru(IV) mixed-valent species. In contrast, the differently substituted systems 5 and 6 show no such near infrared (NIR) absorption. While the first reduction steps are thus assigned to largely ligand-centered processes, the oxidation appears to involve metal-ligand delocalized molecular orbitals with variable degrees of mixing. | 18,924,186 |
Effect of osmolytes on pressure-induced unfolding of proteins: a high-pressure SAXS study. | Herein, we explore the effect of different types of osmolytes on the high-pressure stability and tertiary structure of a well-characterized monomeric protein, staphylococcal nuclease (SNase). Changes in the denaturation pressure and the radius of gyration are obtained in the presence of different concentrations of trimethylamine N-oxide (TMAO), glycerol and urea. To reveal structural changes in the protein upon compression at various osmolyte conditions, small-angle X-ray scattering (SAXS) experiments were carried out. To this end, a new high-pressure cell suitable for high-precision SAXS studies at synchrotron sources was built, which allows one to carry out scattering experiments up to maximum pressures of about 7 kbar. Our data clearly indicate that the osmolytes that stabilize proteins against temperature-induced unfolding drastically increase their pressure stability and that the elliptically shaped curve of the pressure-temperature-stability diagram of proteins is shifted to higher temperatures and pressures with increasing osmolyte concentration. A drastic stabilization is observed for the osmolyte TMAO, which exhibits not only a significant stabilization against temperature-induced unfolding, but also a particularly strong stabilization of the protein against pressure. In fact, such findings are in accordance with in vivo studies (for example P. J. Yancey, J. Exp. Biol. 2005, 208, 2819-2830), where unusually high TMAO concentrations in some deep-sea animals were found. Conversely, chaotropic agents such as urea have a strong destabilizing effect on both the temperature and pressure stability of the protein. Our data also indicate that sufficiently high TMAO concentrations might be able to largely offset the destabilizing effect of urea. The different scenarios observed are discussed in the context of recent experimental and theoretical studies. | 18,924,198 |
CXCL12 is essential for migration of activated Langerhans cells from epidermis to dermis. | The initial step in Langerhans cell (LC) migration from the epidermis to the lymph node involves migration of maturing LC into the dermis. Here, we investigated the migration of LC out of the epidermis after exposure of the skin to contact allergens. Ex vivo intact human skin, epidermal sheets, and LC derived from the MUTZ-3 cell line (MUTZ-LC) were used to determine whether dermal fibroblasts play a role in mediating LC migration towards the dermis. Exposure of epidermal sheets or MUTZ-LC to allergens (nickel sulphate, 2,4-dinitrochlorobenzene, and cinnamaldehyde) or a cytokine maturation cocktail resulted in LC migration towards dermal fibroblasts. This was due to upregulation of CXCR4 on maturing LC and secretion of CXCL12/stromal derived factor-1 chemokine by fibroblasts. Neutralizing antibodies to either CXCL12 or CXCR4 completely blocked migration. Injection of CXCL12 neutralizing antibodies into intact human skin totally inhibited LC migration into the dermis. In contrast, neutralizing antibodies to CCL19/CCL21 did not inhibit migration into the dermis. We describe a novel and essential role of dermis-derived CXCL12 in initiating migration of maturing human LC to the dermis thus permitting their further journey to the draining lymph nodes. | 18,924,211 |
Tr1 and naturally occurring regulatory T cells induce IgG4 in B cells through GITR/GITR-L interaction, IL-10 and TGF-beta. | Regulatory T cells exert their function through the modulation of both T and B cell responses. Our previous studies demonstrated that IL-10-producing Treg (Tr1) can induce B cells to secrete IgG4 in a cell-contact-dependent manner. The benefit of such non-inflammatory B-cell responses is apparent in the hyporesponsive state of patients with helminth infections such as Onchocerciasis. Here, we investigated the mechanisms involved to induce IgG4, within B:Tr-cell co-cultures, using IL-10-producing tetanus-toxoid-specific regulatory T cell lines and clones (Tr-TCC) from human PBMC. During the generation process, we found that increasing Foxp3 levels in regulatory T cell lines correlated with their ability to induce IgG4 in B cells. Using Tr-TCC, we found that blocking glucocorticoid-induced tumour necrosis factor receptor-related protein (GITR) molecules selectively prevented IgG4 production as did neutralizing Ab to glucocorticoid-induced tumour necrosis factor receptor-related protein ligand (GITR-L), IL-10 and TGF-beta. Furthermore, the prevention of IgG4 induction by anti-GITR Ab was reversed by excess rIL-10 but not rTGF-beta. In contrast, anti-ICOS and anti-CTLA-4 Abs had no effect. When compared with Tr-TCC, freshly isolated CD4+CD25+ T cells, but not effector T cell populations, induced low levels of IgG4, which were also blocked by anti-GITR and anti-GITR-L Ab. Thus, the mechanism of IgG4 induction by regulatory cells involves GITR-GITR-L interactions, IL-10 and TGF-beta. | 18,924,213 |
Expression of AP-2delta in the developing chick retina. | AP-2 is a family of transcription factors that play important roles during embryonic development. Two AP-2 genes, AP-2alpha and AP-2beta, have previously been characterized in chick retina. Here, we demonstrate that a third member of the chicken AP-2 family, AP-2delta, is primarily expressed in the retina and brain, with highest levels at embryonic days 7 to 11. By in situ hybridization and immunohistochemical analysis, we show that AP-2delta RNA and protein are found in a subset of ganglion cells in embryonic chick retina. Co-immunostaining with anti-Brn3a and anti-AP-2delta antibodies indicates that approximately one-third of Brn3a-positive ganglion cells express AP-2delta. AP-2delta RNA but not AP-2delta protein is also found in cells located in the outer half of the inner nuclear layer. The spatial and temporal distribution of AP-2delta protein in the retina suggests a transient role in a subset of late-born ganglion cells likely involving axonal trafficking or pathfinding. | 18,924,234 |
BMP4 is required in the anterior heart field and its derivatives for endocardial cushion remodeling, outflow tract septation, and semilunar valve development. | The endocardial cushions play a critical role in septation of the four-chambered mammalian heart and in the formation of the valve leaflets that control blood flow through the heart. Within the outflow tract (OFT), both cardiac neural crest and endocardial-derived mesenchymal cells contribute to the endocardial cushions. Bone morphogenetic protein 4 (BMP4) is required for endocardial cushion development and for normal septation of the OFT. In the present study, we show that anterior heart field (AHF)-derived myocardium is an essential source of BMP4 required for normal endocardial cushion expansion and remodeling. Loss of BMP4 from the AHF in mice results in an insufficient number of cells in the developing OFT endocardial cushions, defective cushion remodeling, ventricular septal defects, persistent truncus arteriosus, and abnormal semilunar valve formation. | 18,924,235 |
Is there a need for autopsies in the management of fungal disease? | The autopsy rates in Germany became low like in other European, American and Asian countries. Main reasons for this development are the lack of acceptance of autopsy in the society as well as in the medical profession, the introduction of a requirement for consent, unclear legal position, the public health system, pressure of costs and a change in the field of activity in pathology with much more diagnostics of surgical and biopsy material. The autopsy is missing with respect to the reliability of causes of death and morbidity statistics and other epidemiological studies. Published data indicate that up to 20-30% of patients who die in hospitals have important diseases/lesions that remain undetected before death but that are found at autopsy. For infectious diseases, the data are similar. Therefore, a higher incidence of invasive fungal infections was found. Some rare fungal disorders are diagnosed by autopsy. Only exact death statistics makes specific health care possible and is cost saving in a public health system in the long term. Autopsy remains an important tool for quality control in medical diagnostic and therapeutic activity. It is also essential for fundamental medical education and further training. | 18,924,260 |
The continuing process of parental grief. | The death of a child is an incomprehensible and devastating loss. Grief for parents is lifelong, becoming the connection between parent and child. To extend and deepen current understanding of parental grief, a new survey instrument was developed, combining quantitative and qualitative measures. The qualitative findings from this combined methodological study are presented. Parental grief themes are derived from the respondents' descriptions of their grief resulting in a reformulation of parental grief. | 18,924,293 |
[Burnout in volunteer health workers]. | While diverse studies carried out in nursing and medical personnel have demonstrated that health workers can be subject to burnout, little effort has been focused on investigating burnout in volunteer hospital workers. The aim of the present study was to verify if burnout exists with volunteer auxiliary personnel and investigate what organizational conditions may favour it. The study was carried out on 80 volunteer workers of the Red Cross of Mortara (PV), subdivided into two categories: those performing emergency interventions and those performing routine services. For the evaluation of burnout, the Italian version of the Maslach Burnout Inventory was used, together with a qualitative type of methodology. A 5-factor multivariate analysis (sex x shift x team x seniority x role), having as dependent variables the three scales of the MBI, showed that the highest values of depersonalization and fulfillment are found in the emergency team, and that subjects with least seniority are those who are least satisfied or fulfilled. The category of team-leader resulted as that with the highest values of emotional burnout, while sex- and shift-based differences were restricted to routine service workers. Despite these differences, findings showed that subjects are minimally affected by problems linked to burnout, although some relational and organizational difficulties emerged with the medical staff that underlie a certain degree of professional dissatisfaction. | 18,924,296 |
Reliability of verbal descriptors of dyspnea and their relationship with perceived intensity and unpleasantness. | Verbal descriptors of dyspnea have been suggested as being useful in providing information on the underlying pathophysiology. However, little is known about the reliability of these descriptors. The present study examined the reliability of a German language list of respiratory symptom descriptors and studied the association of these descriptors with the intensity and unpleasantness of perceived dyspnea. Fourteen healthy volunteers performed cycle-ergometer exercise and voluntary breath-holding during which they rated the perceived intensity (VAS-I) and unpleasantness (VAS-U) of dyspnea on visual analog scales. Following this, they judged their sensations of dyspnea using the list of symptom descriptors. Both conditions were repeated in reverse order on a subsequent occasion 10 days apart. Ventilatory measures, heart rate, blood lactate, VAS-I and VAS-U during cycle-exercise as well as breath-holding time, VAS-I and VAS-U during breath-holding showed no differences between both occasions. Separate hierarchical cluster analyses identified four clusters of verbal descriptors of dyspnea which were widely comparable between both occasions: effort, speed, obstruction and suffocation. Separate multidimensional scaling analyses (MDS) confirmed these four clusters for each occasion. On both days, perceived unpleasantness of dyspnea was correlated with all four clusters during cycle-exercise, while perceived intensity showed only correlations with effort or speed, respectively. No such correlations were obtained for breath-holding. The results suggest that separable clusters of German language descriptors of dyspnea are reliably used by healthy volunteers. The obtained clusters are widely comparable to previously described clusters in other languages and are differently related to the intensity and unpleasantness of perceived dyspnea. | 18,924,297 |
Exposure to occupational carcinogens and lung cancer risk. Evolution of epidemiological estimates of attributable fraction. | Lung cancer is the leading cause of cancer death world-wide. Among the possible causes, occupational risk factors play a major role and are potentially preventable. We reviewed the scientific evidence about lung cancer burden due to occupation. We reviewed the literature and selected population case-control and cohort studies which provided estimates of the proportion of lung cancers attributable to occupational carcinogens (population attributable fraction, PAF). Different methods were used to evaluate occupational exposure to suspected/known lung carcinogens: lists of high-risk occupations, job-exposure matrix (JEM), expert assessment. Only studies which adjusted for tobacco smoking were included. The PAFs reported by the 32 selected Italian and international studies among men vary greatly in time and space: they ranged between 0 to 40% according to different geographical prevalence of hazardous industries (e.g., basic metal industries, shipbuilding and railroad equipment manufacturing). The PAFs estimated using JEM and expert assessment were on average higher. Data for women were usually few and insufficient to calculate stable estimates. A significant proportion of lung cancers is attributable to occupational carcinogens. The estimates are extremely variable in time and place and mainly depend on the industrial setting of the area under study; caution is therefore required in generalizing these results to the whole country. Alternative approaches to evaluate occupational lung cancer burden among women are necessary. | 18,924,308 |
[Helicobacter pylori infection: what to do after first intent treatment failure?]. | First intent therapy of H. pylori infection is triple therapy combining PPI, amoxicillin and clarithromycin for 7 to 10 days. Due to the increasing rate of primary resistance to clarithromycin, expected eradication rates are below 70%. Consequently, treatment effect has to be systematically assessed by urea breath test: in case of failure, a second line triple therapy combining PPI, amoxicillin and metronidazole instead of clarithromycin for 14 days should be prescribed. Using this strategy, the global eradication rate after two lines of treatment is 90%. Rescue triple therapies combine PPI and amoxicillin with either levoloxacin or rifabutin for 10 days. Levofloxacin should be used first in order to prevent development of rifabutin resistance among mycobacteria. The increasing rate of quinolone resistance led to the proposal to perform culture with susceptibility testing prior to third line therapy. | 18,924,328 |
[Budd-Chiari syndrome--hematologists' part in the multidisciplinary approach]. | Budd-Chiari syndrome presents a serious disease with a complex etiology and clinical manifestations, which is associated with high morbidity and mortality. An early diagnosis and therapy is mandatory due to the severity of disease and therapy contains the treatment of underlying disorder, anticoagulation therapy and therapy of liver impairment. We discuss hematologists' contribution to the diagnostic approach and therapy of this syndrome. | 18,924,345 |
[Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis]. | Acute mesentery artery embolization is a rare complication of invasive catheterizations. The incidence is unknown. In case of late diagnosis the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Plain X-Rays of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the artery with embolus. We report a case of a man who was admitted with an acute myocardial infarction who underwent primary angioplasty with implantation ofa bare-metal stent. After the procedure he developed severe and progressive abdominal pain as a result of acute superior mesentery artery embolization. In this patient we performed a local thrombolysis with rt-PA (alteplase) with a great technical success and immediate pain relief, with no need of surgical revision. Our approach was concordant to recommendations cited in this article. | 18,924,349 |
Comparison of body mass index and waist circumference as predictors of all-cause mortality in a male insured lives population. | Obesity assessed by body mass index (BMI) is associated with increased mortality risk, but there is uncertainty about whether BMI is the best way to measure obesity. Waist circumference (WC) has been proposed as a better measure. The Swiss Re BMI/WC Study was conducted to determine whether BMI or WC is a better predictor of future all-cause mortality in a large male insurance population. Using Cox proportional hazard models, risk ratios for increasing BMI and WC were 1.033 (P < .001) and 1.027 (P < .001), respectively. Risk ratios for obesity defined by BMI > or = 30 kg/m2 and WC > or = 40 inches were 1.33 (P < .001) and 1.20 (P = .002), respectively. In this study, BMI and WC are essentially equivalent in their ability to predict mortality risk in a male insurance population. Obesity, measured by either BMI or WC, has important underwriting and pricing implications. | 18,924,364 |
"Complicated" right bundle branch block. | Isolated right bundle branch block is generally regarded as a benign finding in the absence of underlying structural heart disease. The presence of "electrocardiographically-complicated" right bundle branch block should alert the medical director to occult heart disease, which might impact on long-term survival. | 18,924,370 |
Vibrio tapetis-like strain isolated from introduced Manila clams Ruditapes philippinarum showing symptoms of brown ring disease in Norway. | The Manila clam Ruditapes philippinarum was introduced to Norway in 1987 and was produced in 2 hatcheries until 1991. Clam seed was planted at 6 sites. Two sites were on the Island of Tysnes, south of Bergen. Surviving adult Manila clams were recovered in 1995 and 1996. In the present study, Manila clams from the original seeding that displayed morphological signs of brown ring disease (BRD) were recovered in June 2003 (n=7) and in June 2004 (n=17). Samples from extrapallial fluid, tissues and haemolymph were inoculated on marine agar. Replicate subcultures on selective media were used to select potential Vibrio tapetis strains, and in total, 190 bacterial strains were isolated. One of these strains clustered within the V tapetis clade and was named NRP 45. DNA:DNA hybridisation with the type strain CECT4600 showed 52.7 and 57.3% DNA:DNA similarity. Hybridisation of NRP 45 and the V tapetis LP2 strain, isolated from corkwing wrasse Symphodus melops, produced 46.6 and 44.4% re-association. Partial gene segments encoding 16S rRNA, gyrase B protein (GyrB) and chaperonin 60 protein (Cpn60) were characterised and compared to CECT 4600. NRP 45 showed 5 differences in the 1416 nucleotides (nt) of the 16S rRNA encoding gene (99.6% similarity), while the GyrB encoding gene had 62 substitutions of 1181 nt compared (94.8% similarity) and the Cpn60 encoding gene had 22 substitutions out of 548 nt compared (96% similarity). This is the first finding of BRD and the first isolation of a V. tapetis-like bacterial strain from a bivalve in Norway. | 18,924,380 |
Grandparent caregivers. | Although grandparent caregiving is not a new phenomenon in the United States, there has been a dramatic increase in grandparent-headed households in the last two decades. Many of these care providers are older and feel somewhat unprepared to raise a new generation of children. As a result, grandparent caregivers are at risk for multiple physical, mental, and emotional problems due to the stresses and strains of care provision. This article summarizes characteristics of grandparent caregivers in our society, the challenges that they face, and how organizations are attempting to assist these older adults with their care provision responsibilities. Recommendations for future research and intervention design will also be discussed. | 18,924,399 |
[Genetic aspects of the interrelation between alkaloids and chemical elements in Atropa belladonna L. and Glaucium flavum Grantz. plants]. | The variability of the contents of tropane and isoquinoline alkaloids, ashes, Na, K, Ca, Mg, Fe, Mn, Cu, Zn, Co, Mo, Cr, Al, Ba, V, Ni, Sr, Cd, Pb, J, and Ag was studied in individual plants of the industrial population of belladonna (Atropa belladonna L.) and yellow horned poppy (Glaucium flavum Crantz.). Numerous linear and nonlinear correlations of isoquinoline and tropane alkaloids with ashes and mineral elements were revealed by means of correlation and regression analyses. Alkaline earth elements (especially Sr and Ba) were shown to have a major role in the regulation of tropane alkaloid accumulation in belladonna leaves. K and Ni were of particular importance in the aerial part of yellow horned poppy. These elements at the suboptimal concentrations were most favorable for isoquinoline alkaloid accumulation in yellow horned poppy. Analytical mathematical models were derived for the regulation of alkaloid metabolism in test plants by some mineral elements (Ba, Mg, Al, Sr, Ni, Mn, and K). Our results indicate that the interrelation between alkaloids and elements in these plants is genetically determined. | 18,924,415 |
[Antioxidant properties of essential oils from lemon, grapefruit, coriander, clove, and their mixtures]. | Antioxidant properties of individual essential oils from lemon (Citrus limon L.), pink grapefruit (Citrus paradise L.), coriander (Coriandrum sativum L.), and clove (Caryophyllus aromaticus L.) buds and their mixtures were studied by capillary gas-liquid chromatography. Antioxidant activity was assessed by oxidation of the aliphatic aldehyde hexanal to the carboxylic acid. The lowest and highest antioxidant activities were exhibited by grapefruit and clove bud essential oils, respectively. Mixtures containing clove bud essential oil also strongly inhibited oxidation of hexanal. Changes in the composition of essential oils and their mixtures in the course of long-term storage in the light were studied. The stability of components of lemon and coriander essential oils in mixtures increased compared to individual essential oils. | 18,924,419 |
5-HT system in the gut: roles in the regulation of visceral sensitivity and motor functions. | 5-Hydroxytryptamine (5-HT) is a major transmitter molecule within the gastrointestinal tract. It is contained in enterochromaffin (EC) cells, which form part of the epithelial lining of the gut and in enteric neurones in the submucosal and myenteric plexuses. 5-HT is present in murine mucosal mast cells in the lamina propria and some studies have suggested that human mast cells may also contain 5-HT especially in conditions associated with mastocytosis. The strategic positioning of the enteric and extrinsic sensory innervation in close proximity to these sources of 5-HT, in conjunction with their demonstrated sensitivity to this mediator, suggests the involvement of 5-HT in the transduction of visceral stimuli and reflex responses affecting motor and secretory function. Under physiological conditions, the release of 5-HT from these storage sites may result in the orchestration of reflexes responsible for transit of material along the bowel at a rate that is appropriate for digestion and absorption of nutrients. However, in the pathophysiological state, 5-HT acting together with other inflammatory mediators may cause inappropriate intestinal secretomotor activity and/or initiate sensations such as nausea or discomfort/pain. Current evidence suggests that the bioavailability of 5-HT within the gut wall is altered in a number of post-inflammatory models of gut dysfunction with increased numbers of EC cells and mast cells with increased 5-HT content in proximity to sensory nerve endings, and decreased serotonin reuptake mechanisms. Changes may also occur in the sensory innervation or pathways within the central nervous system. These processes may contribute to pain mechanisms in the irritable bowel syndrome, in which visceral hypersensitivity is a predominant feature and may also contribute to motor dysfunction leading to altered bowel habit. | 18,924,445 |
Cannabinoids and gastrointestinal motility: animal and human studies. | The plant Cannabis has been known for centuries to be beneficial in a variety of gastrointestinal diseases, including emesis, diarrhea, inflammatory bowel disease and intestinal pain. delta9-tetrahydrocannabinol, the main psychotropic component of Cannabis, acts via at least two types of cannabinoid receptors, named CB1 and CB2 receptors. CB1 receptors are located primarily on central and peripheral neurons (including the enteric nervous system) where they modulate neurotransmitter release, whereas CB2 receptors are concerned with immune function, inflammation and pain. The discovery of endogenous ligands [i.e. anandamide and 2-arachidonoyl glycerol (2-AG)] for these receptors indicates the presence of a functional endogenous cannabinoid system in the gastrointestinal tract. Anatomical and functional evidence suggests the presence of CB1 receptors in the myenteric plexus, which are associated with cholinergic neurons in a variety of species, including in humans. Activation of prejunctional CB1 receptors reduces excitatory enteric transmission (mainly cholinergic transmission) in different regions of the gastrointestinal tract. Consistently, in vivo studies have shown that cannabinoids reduce gastrointestinal transit in rodents through activation of CB1, but not CB2, receptors. However, in pathophysiological states, both CB1 and CB2 receptors could reduce the increase of intestinal motility induced by inflammatory stimuli. Cannabinoids also reduce gastrointestinal motility in randomized clinical trials. Overall, modulation of the gut endogenous cannabinoid system may provide a useful therapeutic target for disorders of gastrointestinal motility. | 18,924,447 |
New insights into the pathophysiology of IBS: intestinal microflora, gas production and gut motility. | Irritable bowel syndrome (IBS) is a complex disorder clinically characterized by abdominal pain and altered bowel habit. Its pathogenetic mechanisms are still incompletely known; genes, psychosocial factors, changes in gastrointestinal motility and visceral hypersensitivity are traditionally thought to play a crucial role in symptom generation. Recent studies have identified new additional factors that can interact with the established mechanisms. Dysregulation of brain-gut axis, gastrointestinal infection, low-grade infiltration and activation of mast cells in the intestinal mucosa with consequent release of bioactive substances, and altered serotonin metabolism are the emerging factors of IBS pathogenesis. Finally, modification of small bowel and colonic microflora and altered gas balance may be of relevance in at least some subgroups of IBS patients. New therapies can be developed only on the basis of a better understanding of the heterogeneous picture of the pathophysiology of IBS. | 18,924,450 |
[Assessment of implication of transcranial ultrasonography in the diagnostics of acute disturbances of cerebral blood circulation in adults]. | Implication of transcranial ultrasonography (TUS) in diagnostics of acute disturbances of cerebral blood circulation (ADCBC) was studied in 324 subjects, aged from 20 to 83 years, including group I (208 subjects without neurological disturbances), group II (56 subjects without the structural intracranial changes which, along with TUS, underwent MRT), group III (60 patients with diagnosis of ADCBC which underwent TUS and then CT of the brain). The brain areas where intracranial hemorrhages (ICH) were most often localized in hemorrhage stroke (HS) were found in 166 subjects (80%) of group I. The second and third cerebral ventricles were seen in 187 (90%) people. The third ventricular was seen in 19 patients (the effectiveness was corresponded to Echo-EG). The comparison of US-, CT- and MRT-images did not reveal significant differences as in the total assessment of the intracranial structural state of the brain as well in the most relevant measurements. TUS revealed no significant changes in 40 patients from group III but the diagnosis of infarction was confirmed by CT. The specific US signs of ICH were found in HS. In 19 patients the CT revealed and verified the ICH of supratentorial localization. In conclusion, TUS with using portative US equipment provides the possibility of screening-diagnostics and monitoring of ICH in strokes. | 18,924,473 |
[The biomechanics of dental implants and dentures]. | Osseointegrated implants are actually replacements for natural teeth, and, like natural teeth, they are exposed to various forces. Rejection and bad osseointegration of implants rarely occur today because oral implants are made from biocompatible materials. Most complications are a consequence of badly planned implant loading. The aim of this work was the optimization of the process of planning and inserting oral implants and dentures based on the analysis of the biomechanical problems in implantology. In order to determine the influence of the number of cantilevered superstructures, the number of implants and implant microdesign on tensions within the implant and in the peri-implant tissue, a calculation of tensions and deformations was made in a virtual model (control model) using the finite elements analysis. The obtained values served as reference values in the analysis of the results from three experimental models. In the control model, as well as in the experimental models, the first implant bears the heaviest load with dominant contraction tensions, the second one carries significantly weaker straining tensions, the third one carries weak contraction tensions and the fourth one the weakest straining tensions. The values of tensions and deformations have the same sign (-/+), but the absolute values depend on the number of cantilevered superstructures, implant microdesign and the number of inserted implants. Knowing the biomechanics of oral implants and the dentures on them allows for proper indication, a good choice of implants and good superstructure design. The prevention measures for bone resorption caused by biomechanical factors are: insertion of symmetrical screw implants and root-shaped cylindrical implants as long and as wide as possible, insertion of implants with the total supporting area expanded, choosing materials that are rigid enough, the right direction of implants, narrowing of the denture occlusal surfaces and location of the contact point at the centre. | 18,924,477 |
[Endoscopic augmentation of neurogenic bladder with botulinum-A toxin in children]. | To present our experience with endoscopic intradetrusor injections of botulinum-A toxin. Endoscopic treatment was proposed for children in which no improvement or side effects were observed. Botulinum-A toxin was injected in 25 children 3 to 7 years old. All children were evaluated with voiding-charts, in all of them urodynamic investigations were also performed in the pre and post-procedure period. Increased bladder volume was found in 18 patients, in 5 children bladder volume decreased. No major side effects were noted post BTX injections. Botulinum-A toxin in useful in children with neurogenic bladder overactivity. | 18,924,493 |
[Usefulness of Pak's test in Stapleton's modification in diagnosis of hypercalciuria in children]. | Recognition of the type of hypercalciuria in children in Pak's test in Stapleton's modification was performed. 26 children with hypercalciuria was enrolled to the study. 15/26 had positive family history. In all Pak's test in Stapleton's modification was done, blond tests of renal function (urea, creatinine), calcium-phosphate balance (Ca, P, ALP, PTH, Vit D3 metabolites) and in 24 hr urine collection: promoters and inhibitors of crystallization, 24 hr urine pH measurement was performed. In 18 children--absorptive hipercalciuria: type II, in 1--type I, renal in 4; complex mechanism in 3, hypocitraturia was recognized in 4. Normalization of calciuria was obtained in 16 out of 26. In 3 others new formation of kidney stones was observed. Performation of Pak's test in Stapleton's modification allows to establish a type of hypercalciuria in children and recognize a pathomechanism of disease. | 18,924,500 |
[Urinary tract infections--pediatric urologist point of view]. | Urinary tract infections (UTI) could present with different clinical forms dependent on intensity and localization of infection and child's age. The symptoms could be non specific in children. Condition that provoke to urinary stasis, especially voiding dysfunction is the favourable factor for UTI appearance. Gram-negative enteric bacteria is the most common pathogen. Urine culture is the basic investigation that allow to identify pathogen and its drug sensitiveness but simultaneous urinalysis is necessary to recognize the inflammation of urinary organs. In addition, the number of leukocytes gives an idea about inflammation intensity. Ultrasonographic (USG) scan is necessary to examine urostasis. DMSA study performed during febrile UTI allow to identify children with acute pyelonephritis and when repeated 6 months later - those with renal scars. A normal USG and DMSA scan during infection makes voiding cystourethrography (VCU) unnecessary in the primary examination. The presence of vesicoureteric reflux (VUR) not always predispose children to renal lesions. Early and appropriate treatment of UTI, especially during the first 24 hours, diminishes the likelihood of renal involvement during the acute phase of infection but does not prevent scar formation. The proper hygiene of the urethral meatus, voiding and drinking habits and preventing of constipation are crucial in UTI prophylaxis. | 18,924,514 |
[Reflux and obstructive nephropathy as a cause of renal failure in chronic dialysis children]. | We carried out a retrospective analysis of medical files to evaluate causes of chronic renal failure in 80 children (M--49, F--31), age 1 month to 20 years) who started renal replacement therapy in the Department of Nephrology and Dialysis of the Polish Mothers Memorial Hospital in the years 1990-2007. In 28 children (35%) reflux and obstructive nephropathy was a cause of renal failure. In 5 children the disease was secondary to the neurogenic bladder. The incidence of these nephropathies in our population was constant in the analyzed years. In our group there were 2 neonates and 7 adolescent who were diagnosed with nephropathy as late as in the endstage phase. Boys with posterior urethral valve required renal replacement therapy earlier (146 +/- 55 months). We conclude that obstructive and reflux nephropathy are still the essential cause of end stage renal disease in children. | 18,924,517 |
[Program of early diagnosis of chronic renal disease in children--SopKard 15 nephrological project]. | The Sopot Program of Cardiac Infarct and Stroke Prevention--SopKard 1999-2009 was established for health promotion to decrease cardio-vascular diseases mortality. To serve these purposes a new project SopKard 15 for adolescents was created. The main aim of SopKard 15 is evaluation of health status with particular attention to risk factors of civilization diseases, with chronic kidney disease (CKD) among them. In population of 14-year-old students a complex nephrological examination including medical history, blood pressure measurements, ultrasound examination, and laboratory tests with e.g. albuminuria, urinalysis, and serum creatinine and cystatin C levels was performed. Nephrology part of Program SopKard 15 aspired to early detection of CKD and verifies normal value for this age group. | 18,924,519 |
[Kidney transplantation into a neurogenic bladder in myelomeningocele patient (MMC)]. | We report a 24-year-old patient with neurogenic bladder due to myelomeningocele (MMC) who received a kidney transplant without prior bladder reconstruction. Following transplantation recurrent episodes of febrile pyelonephritis were observed with elevations of creatinine. A year after Tx a bladder augmentation was performed with appendicostomy to enable intermittent catheterization. Following surgery only sporadic episodes of UTI have been observed and his renal function is stable. bladder reconstruction surgery in patients with neurogenic bladder is feasible post transplantation though the optimal timing is prior to a kidney Tx. | 18,924,522 |
Breastfeeding, body mass index, asthma and atopy in children. | The objective of this study was to determine the relationship between breastfeeding, asthma and atopy, and any influence of child body mass index (BMI). Prospective birth cohort data were used to model the association between breastfeeding duration, BMI, asthma and atopy in children at six years. After adjustment for BMI and associated covariates, breastfeeding (per additional month of feeding) was marginally associated with decreased BMI (p=0.083). BMI was significantly associated with current asthma (p=<0.0005) and atopy (p=0.055). Exclusive breastfeeding for less than four months was a risk for current asthma (p=0.033) and atopy (p=0.005). The early introduction of formula leads to an increase in child BMI and early asthma and atopy. Increased BMI is a risk factor for childhood asthma and atopy. These findings suggest that public health interventions to optimise breastfeeding duration and reduce overweight in children may help attenuate the community burden of wheezing illness early in life. | 18,924,535 |
Ethnic differences in the BMI-%BF relationships between young Japanese and Australian-Caucasian males living in Australia using dual-energy X-ray absorptiometry. | The Body Mass Index (BMI) has been used worldwide as an indicator of fatness. However, the universal cut-off points by the World Health Organisation (WHO) classification may not be appropriate for every ethnic group when consider the relationship with their actual total body fatness (%BF). The application of population-specific classifications to assess BMI may be more relevant to public health. Ethnic differences in the BMI-%BF relationship between 45 Japanese and 42 Australian-Caucasian males were assessed using whole body dual-energy X-ray absorptiometry (DXA) scan and anthropometry using a standard protocol. Japanese males had significantly (p<0.05) greater %BF at given BMI values than Australian males. When this is taken into account the newly proposed Asia-Pacific BMI classification of BMI >23 as overweight and >25 as obese may better assess the level of obesity that is associated increased health risks for this population. To clarify the current findings, further studies that compare the relationships across other Japanese populations are recommended. | 18,924,538 |
Clinical presentation and diagnosis of acne: patient-centric considerations. | Acne is a common dermatologic condition that primarily affects adolescents and young adults. Advances in research have led to more in-depth understanding of the pathophysiology of this condition and the development of new therapeutic interventions. Acne is now recognized as a multifactorial disease requiring a multifaceted approach to therapy. Acne can affect individuals of either gender, any ethnicity, and any age group. Nuances in the underlying pathophysiology, distribution, clinical presentation, and differential diagnosis are important to appreciate, as they may substantially contribute to the choice of therapy. | 18,924,542 |
Genetic opportunities for psychiatric epidemiology: on life stress and depression. | Genetics can offer new resources to epidemiology. This review will consider recent findings regarding the link between stress and depression as an example to illustrate the added value of employing genetics in epidemiological studies. Systematic review of medical and psychological databases. Genetic and environmental factors may correlate. This suggests the potential for genetic mediation of the exposure to the environment. Gene-environment correlations can help epidemiologists to better understand causal pathways and suggest effective therapeutic strategies. Genetic and environmental factors may also interact. This suggests the potential for genetic modification of environmental effects on disease risk. Gene-environment interactions can help epidemiologists to identify vulnerable individuals and strata-specific environmental effects. New models of disease based on the interplay between genes and environments are providing epidemiology with a new set of testable hypotheses that will advance our understanding of mental health and illness. | 18,924,559 |
The metabolic implications of long term cannabis use in patients with psychosis. | The aim of this paper is to summarise the effects of cannabis use on appetite and energy balance, and to subsequently investigate the possible implications this may have in patients with psychosis, in whom a high prevalence of cannabis use has been reported. A narrative review based on the recent literature regarding cannabis use in the general population and patients with psychosis. The short-term abilities of cannabis to increase appetite and body weight, through actions on the endogenous endocannabinoid system, have been well characterised throughout the literature. The long term effects of cannabis use are however unclear and only a minority of studies have been conducted in the general population with overall conflicting results. In terms of the effects of cannabis in patients with psychosis, there has only been one study to date that has investigated this and interestingly found cannabis use to be associated with increased body weight and blood glucose levels, thus providing evidence that cannabis use may be an important contributing factor to the reduced life expectancy, as is currently observed in this vulnerable patient group. It is clear from the literature that patients with psychosis are at a high risk of metabolic and cardiovascular disease in comparison to the general population. However the contribution of cannabis use to this risk is as of yet undetermined and further long term studies are need to confirm current findings and evaluate hypothesised mechanisms. | 18,924,561 |
Longitudinal differences and trends in body fat and running endurance in Hungarian primary schoolboys. | Long-range repeated-measure sample differences in body dimensions, body composition and physical performance are considered accurately describing the changes in a population's life standards and lifestyle. The aim of our study was to analyse such changes in longitudinal studies repeated after a 15-year interval. Two six-monthly repeated data collections (1987-1991 and 2002-2006, respectively; n = 136 and n = 147, respectively) were carried out in non-athletic boys aged between 6.51 and 11.00 decimal years in the same schools of the city of Gyor, Hungary. The means of height, body mass, body mass index (BMI), body fat percentage and running distance in the Cooper-Test were compared as well as the slopes of the changes. The children of the second series of studies were significantly taller and heavier, had more depot fat and showed poorer cardio-respiratory endurance than their peers 15 years before. The increases with age in weight, BMI and depot fat were steeper in the second series. The significant differences that developed in body weight, fat content and physical performance between the two samples during these 15 years are regarded as an indirect evidence for how severely the average physical condition had declined, respectively how the health risks of the schoolchildren of the respective middle socio-economic strata had increased. Recent adverse changes in lifestyle are too strong, so that the presently obligatory physical education classes at school (four times in 10 days, 45 minutes per class) cannot be expected to provide any solution. Daily 90 minutes blocks of exercise only may promise some improvement. | 18,924,569 |
[High Frequency Jet Ventilation and laryngeal surgery, clinical practice]. | High Frequency Jet Ventilation is one in a group of alternative ventilatory techniques characterized by the application of small tidal volumes delivered at higher than physiological rates, followed by the passive expiration. There are two groups of indications: first, High Frequency Jet ventilation was used as a special ventilation mode during diagnostic or surgical procedures in patients with airway pathology; and second, High Frequency Jet Ventilation was employed as a respiratory support technique to improve gas exchange during severe pulmonary failure in infants, children and adults. Diagnostic or surgery laryngoscopy requires a method that can give good exposure of the larynx, continuing control of the airway patency and immobility of the vocal cords. High frequency Jet Ventilation overcomes the disadventage of an anaesthetic technique using a tracheal tube which can hide the posterior part of the glottis and which carries the risk of the fire in the airway. Small plastic cannulae have been introduced by the nasotracheal, orotracheal or transtracheal route for supraglottic or subglottic application of jet streams, employing tubeless HFJV. Jet ventilation via a catheter placed through the cricothyroid membrane, is an easy and safe way to ventilate patients with an abnormality of the upper airway, such as in cases of head and neck cancer. Inappropriate airway pressure monitoring and/or an insufficient expiratory airflow enhances the risk of pulmonary barotrauma. Despite a large body of published evidence describing its benefits as an alternative ventilatory approach in anaesthesia and intensive care medicine, its application has not gained widespread acceptance and is restricted to specialized centres only. | 18,924,593 |
ABCG1 and HDL protect against endothelial dysfunction in mice fed a high-cholesterol diet. | Plasma HDL levels are inversely related to the incidence of atherosclerotic disease. Some of the atheroprotective effects of HDL are likely mediated via preservation of EC function. Whether the beneficial effects of HDL on ECs depend on its involvement in cholesterol efflux via the ATP-binding cassette transporters ABCA1 and ABCG1, which promote efflux of cholesterol and oxysterols from macrophages, has not been investigated. To address this, we assessed endothelial function in Abca1(-/-), Abcg1(-/-), and Abca1(-/-)Abcg1(-/-) mice fed either a high-cholesterol diet (HCD) or a Western diet (WTD). Non-atherosclerotic arteries from WTD-fed Abcg1(-/-) and Abca1(-/-)Abcg1(-/-) mice exhibited a marked decrease in endothelium-dependent vasorelaxation, while Abca1(-/-) mice had a milder defect. In addition, eNOS activity was reduced in aortic homogenates generated from Abcg1(-/-) mice fed either a HCD or a WTD, and this correlated with decreased levels of the active dimeric form of eNOS. More detailed analysis indicated that ABCG1 was expressed primarily in ECs, and that these cells accumulated the oxysterol 7-ketocholesterol (7-KC) when Abcg1(-/-) mice were fed a WTD. Consistent with these data, ABCG1 had a major role in promoting efflux of cholesterol and 7-KC in cultured human aortic ECs (HAECs). Furthermore, HDL treatment of HAECs prevented 7-KC-induced ROS production and active eNOS dimer disruption in an ABCG1-dependent manner. Our data suggest that ABCG1 and HDL maintain EC function in HCD-fed mice by promoting efflux of cholesterol and 7-oxysterols and preserving active eNOS dimer levels. | 18,924,609 |
My continuing adventure with 21 CFR Part 11--the evolution of Zymark's compliance. | A renewed focus has been given to the 3-year-old regulation 21 CFR Part 11, Electronic Records and Electronic Signatures. This paper gives a chronology of the process of an equipment vendor, Zymark Corporation, validating laboratory automation equipment for compliance to the regulation 21 CFR Part 11. Zymark's Tablet Processing Workstation II (TPW) and Prelude are the instruments chronicled. The first instrument, the TPW, was developed before Zymark defined its strategy on how to meet its customer's need for 21 CFR Part 11 compliant equipment. The TPW has been available for several years, and in the summer of 1999 it received a major software upgrade to improve its security. The second instrument, the Prelude, is a new product. It had a design requirement to meet the regulation. Zymark's Part 11 strategy was already in place and used for this development project. This chronology will include all aspects of the exercise, including familiarization with the standard, development of the protocols, review of the protocols by industry experts, review of the protocols by pharmaceutical users, execution of the tests, preparation of the exception reports, and the release of any necessary product revisions. | 18,924,710 |
New Developments in the Field of Reaction Technology: The Multiparallel Reactor HPMR 50-96. | Catalytic high-pressure reactions play an important role in classic bulk chemistry. The optimization of common reactions, the search for new and more effective catalysts, and the increasing use of catalytic pressure reactions in the field of drug development call for high-parallel reaction systems. A crucial task of current developments, apart from the parameters of pressure, temperature, and number of reaction chambers, is, in this respect, the systems' integration into complex laboratory automation environments. | 18,924,722 |
Evaluation of the Dimension XL clinical chemistry system. | The analytical performance of the Dimension XL clinical chemical system was evaluated. The XL is the latest addition to the Dimension family of instruments; it is a random access analyser with a throughput up to 740 tests/hour. Regression analysis of method comparison studies with Dimension AR yielded slopes of 0.93 to 1.03 and correlation coefficients >/=0.96 for 28 assays. Excellent precision performance was also observed. New instrument features of the XL are discussed. | 18,924,790 |
An automatic system for determining the effects of temperature on the hysteresis curves of ion-selective electrodes. | This paper describes an automatic system which measures the effect of temperature variations on the response of ion-selective electrodes (hysteresis curves). The system is managed by a computer program which plots hysteresis curves following a pre-established temperature cycle, from setting and controlling the temperature of the water-bath, to acquiring the response potentials of up to five electrodes after temperature stabilization. | 18,924,793 |
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