Medicine

Recent data suggest that specialty intensive care units (ICUs) have outcomes better than those of mixed ICUs. The cause for this apparent discrepancy has not been well established. We hypothesized that trauma patients admitted to a dedicated trauma ICU (TICU) would have a lower complication rate as well as death after complication (failure to rescue [FTR]). This was a retrospective review of the ICUs of two Level I trauma centers covered by one group of surgical intensivists. One center has a dedicated TICU, while the other has a mixed ICU. Demographic and clinical characteristics were stratified into TICU and ICU groups. The primary outcomes were postinjury complications and FTR. Multivariate regression was used to derive factors associated with complications and FTR. During the 5-year study period, 3,833 patients were analyzed. TICU patients were older (57.8 vs. 47.0 years, p G 0.0001), had higher Charlson score (2 vs. 1, p = 0.001), had more severe head injuries (Head Abbreviated Injury Scale [AIS] score Q 3, 50.0% vs. 37.5%, p G 0.0001), and had greater injury burden (Injury Severity Score [ISS] 9 16, 49.6% vs. 38.6%, p G 0.0001) than those admitted to the mixed ICU. Need for immediate operative intervention was similar (18.0% vs. 17.6%, p = 0.788). Overall complications were significantly higher in trauma patients admitted to the mixed ICU (27.5% vs. 17.0%, p G 0.0001), as well as FTR (3.7% vs. 1.8%, p G 0.0001). Trauma patients admitted to a dedicated TICU had significantly lower chance of developing a postinjury complication (adjusted odds ratio [AOR], 0.5; p G 0.0001), FTR (AOR, 0.3; p G 0.0001), and overall mortality (AOR, 0.4; p G 0.0001). Admission of critically ill trauma patients to a TICU staffed by a surgical intensivist is associated with a lower complication rate and FTR. Factors such as trauma nursing experience, education, and unit management structure should be further explored to elucidate the observed improved outcomes. (

Background: In an expanding elderly population, traumatic brain injury (TBI) remains a significant cause of death and disability. Guidelines for management of TBI, according to the Brain Trauma Foundation (BTF), include intracranial pressure (ICP) monitoring. Whether ICP monitoring contributes to outcomes in the elderly patients with TBI has not been explored. Methods: This is a retrospective study extracted from the National Trauma Database 2007e2008 research datasets. Patients were included if aged >55 y and they met BTF indications for ICP monitoring. Patients that had nonsurvivable injuries (any body region, abbreviated injury score ¼ 6), were dead on arrival, had withdrawal of care, or length of stay <48 h were excluded. Outcomes were then stratified based on ICP monitoring. The primary outcomes were inhospital mortality and favorable discharge. Logistic regression was used to analyze the effect of ICP monitoring on outcomes. Results: A total of 4437 patients were included with 11.2% having an ICP monitor placed. Patients requiring an ICP monitor were younger overall, more likely to present hypertensive, had higher injury severity, and more likely to require operative intervention. Median initial Glasgow coma scale (3) was similar between groups. Of those patients with ICP monitoring, overall mortality was significantly higher, and they were less likely to have favorable discharge status. Craniotomy itself was not associated with increased mortality (P ¼ 0.450). Conclusions: Our findings suggest that the use of ICP monitoring according to BTF guidelines in elderly TBI patients does not provide outcomes superior to treatment without monitoring. The ideal group to benefit from ICP monitor placement remains to be elucidated.

A previous study postulated that acetate metabolism was a metabolic sensory mechanism that related information about E. coli&#39;s environment to the formation of biofilms (Prüβ et al., Arch. Microbiol. 2010). Considering that mutants in pta ackA (no acetyl phosphate) and ackA (high acetyl phosphate) exhibited similarly increased biofilm amounts and three dimensional structures, the hypothesis for this study was that acetyl Co-A was a more likely mediator of the acetate effect than acetyl phosphate. The effect of acetate metabolism on biofilm amounts was detailed by using single carbon sources rather than the previously used mixed amino acid medium, as well as mutations in additional genes that contribute to acetate metabolism (ldhA, pflA, pflB). In summary, the mutations in ackA, pta ackA, and ldhA increased biofilm amounts in the presence of maltose, D-trehalose, D-mannose, and L-rhamnose, all of which get converted to acetyl-CoA. The ackA mutant also exhibited increased biofilm a...

Introduction: Giardia lamblia is an important cause of diarrheal disease followed by malabsorption in children throughout the world and is the most frequent pathogenic intestinal protozoan infection. Children having diarrhoea with duration of more than seven days with abdominal pain comprises of Giardia infection . Around 80% of children were affected with Giardia infection as they belong from lower socioeconomical class. Giardia intestinalis causes Giardiasis which is one of the major causes of diarrheal diseases throughout the world. Infection occurred by Giardia may be either asymptomatic or may cause diarrheal illness that can be acute or chronic. In areas of poor sanitation it affects 33% of the people in the developing world. Study aimed to isolate Giardia cyst in paediatric patient under five in Kanpur Region. The study was carried in the Department of Microbiology, GSVM Medical College, Kanpur, Uttar Pradesh. A total of 197 stool sample were collected and screened for Giardia through microscopy (Iodine and saline mount. Result: Among 197 samples screened. The 18 samples were positive through direct microscopy for Giardia cyst. Maximum amount of parasitic infection was found in age group 3.5-5 years. Stool microscopy is (gold standard); however, its sensitivity is low due to intermittent faecal shedding for Giardiasis which is a common gastrointestinal parasitic infection in tropics. Parasitic infection caused by Giardia lamblia is a major worldwide public health problem. Infection is also associated with complications in early childhood if not treated. For better management of the patients early diagnosis and treatment is required. Drinking water standards, hand hygiene, health education, safe sanitation are factors and should be given priority to minimize such infections.

The patient presented to the acute care hospital with seizure activity, requiring intensive care unit management. He was previously healthy, but complaining of headache and abdominal pain the day before admission. Initial evaluation included cerebral spinal fluid (CSF) analysis concerning for aseptic meningoencephalitis. Antiviral therapy was empirically started. Initial head computed tomography (CT) reportedly unremarkable. Further CSF and serum tests were negative for infectious etiology. Repeated imaging of the brain revealed diffuse cerebral swelling and hypoattenuation in the left frontal lobe, which was later biopsied demonstrating nonspecific inflammation. Subsequently, rheumatology was consulted to evaluate for an autoimmune source and a CSF sample was sent for analysis. Antibodies against N-methyl-D-aspartate receptors (NMDAR) were detected. No oncologic process was detected. The patient underwent immunotherapy with high dose steroids, plasmapheresis, and intravenous immunoglobulin. Setting: Tertiary care pediatric hospital. Results: After immunotherapy, the patient demonstrated neurologic improvement over the course of his hospital stay. He continued to display oral-facial dyskinesias and upper extremity purposeless choreiform activity, however, these were less intense and less frequent. No further seizures. He was dependent for all functional activities and later transferred to an acute inpatient rehabilitation facility to address his severe cognitive deficits and functional impairments. Discussion: Anti-NMDA receptor encephalitis is a recently described clinical entity that is typically seen in young females. It is considered paraneoplastic and has a close association with ovarian teratomas, however, approximately 40% of patients have no detectable tumor. Conclusions: Autoimmune encephalitis should be considered in the differential diagnosis in patients that present with a prodromal viral syndrome, psychiatric or memory impairments, autonomic dysfunction, seizure activity, dyskinesias, and hypoventilation. Tumor removal and immunotherapy followed by rehabilitation likely produce the best outcome.

The patient presented to the acute care hospital with seizure activity, requiring intensive care unit management. He was previously healthy, but complaining of headache and abdominal pain the day before admission. Initial evaluation included cerebral spinal fluid (CSF) analysis concerning for aseptic meningoencephalitis. Antiviral therapy was empirically started. Initial head computed tomography (CT) reportedly unremarkable. Further CSF and serum tests were negative for infectious etiology. Repeated imaging of the brain revealed diffuse cerebral swelling and hypoattenuation in the left frontal lobe, which was later biopsied demonstrating nonspecific inflammation. Subsequently, rheumatology was consulted to evaluate for an autoimmune source and a CSF sample was sent for analysis. Antibodies against N-methyl-D-aspartate receptors (NMDAR) were detected. No oncologic process was detected. The patient underwent immunotherapy with high dose steroids, plasmapheresis, and intravenous immunoglobulin. Setting: Tertiary care pediatric hospital. Results: After immunotherapy, the patient demonstrated neurologic improvement over the course of his hospital stay. He continued to display oral-facial dyskinesias and upper extremity purposeless choreiform activity, however, these were less intense and less frequent. No further seizures. He was dependent for all functional activities and later transferred to an acute inpatient rehabilitation facility to address his severe cognitive deficits and functional impairments. Discussion: Anti-NMDA receptor encephalitis is a recently described clinical entity that is typically seen in young females. It is considered paraneoplastic and has a close association with ovarian teratomas, however, approximately 40% of patients have no detectable tumor. Conclusions: Autoimmune encephalitis should be considered in the differential diagnosis in patients that present with a prodromal viral syndrome, psychiatric or memory impairments, autonomic dysfunction, seizure activity, dyskinesias, and hypoventilation. Tumor removal and immunotherapy followed by rehabilitation likely produce the best outcome.

Five children (three males, two females; four right‐, one left‐handed; age range 6 to 14 years) who developed aphasia after gross‐total excision of left predominantly thalamic tumors are reported. Three patients had Broca aphasia, one had mixed transcortical aphasia, and one patient had conduction aphasia. In the months after surgery, three children improved while receiving radiation and/or chemotherapy, although none recovered completely. Two patients with malignant tumors developed worsening aphasia when the tumor recurred, and later died. Two of three patients tested had visuospatial difficulties in addition to language deficits. Attention and executive functioning were affected in three of three patients tested. Memory, verbal and/or visual functioning, were affected in four of four patients tested. Both patients who were tested showed transient right hemineglect. Two of two patients tested were probably apraxic. The wide range of deficits in these children highlights the import...

In 2013, the World Health Organization (WHO) issued guidelines for cervical pre-cancer screening. It recommended screening women aged 30-49, and younger women once they tested HIV-positive. Subsequent WHO guidelines recommended screening women living with HIV (WLHIV) starting at age 25. However, the impact of 2013 guidelines and age to start screening on screening has not been studied. We used a regression discontinuity design (RDD) analysis of population-based data to assess the impact of the 2013 WHO guidelines on the screening rates for women according to HIV status and age group in Ethiopia, Malawi, Rwanda, Tanzania, Zambia, and Zimbabwe. The outcome was self-reported ever having been screened for cervical pre-cancer between 2008 and 2018. We compared the screening rates according to HIV status and age group, before and after age 25 years. And before and after 2014, the year countries adopted the 2013 guidelines. We then used a data-driven optimal bandwidth selection procedure to estimate the guidelines' average treatment effect (ATE), with a local polynomial regression discontinuity and robust bias-corrected confidence intervals. We validated the RDD methodology overall and for women with a significant ATE at the country-level analysis. We included 73179 women: 6680 (9.1%) living with HIV, 4328 (5.9%) with unknown HIV status, and 62171 (85.0) with a negative HIV status. 5726 (7.9%) reported having ever been screened; 4022 (6.5%) with unknown HIV status, 525 (12.1%) with a negative HIV status and 1179 (17.7%) living with HIV. Adolescent girls and young women living with HIV (AGYWLHIV) aged 15-24 reported screening less often (917 (13.7%)) than their peers with unknown (1677 (38.8%)) or positive HIV status (27278 (43.9%)) (P<0.001), or older women. The ATE of screening was 0 for women with unknown or positive HIV status, for whom the RDD was valid. We found no evidence the 2013 WHO guidelines increased or reduced women's cervical precancer screening. However, AGYWLHIV reported screening less often. Policy makers should lower the age to start screening WLHIV from 25 to 15 to screen more AGYWLHIV. Studies are required to examine the impact of the guidelines on cervical pre-cancer screening in more countries. This study did not require ethical review because the personal details in the data are deidentified, and the data is publicly available. It can be accessed with a request at data.icap.columbia.edu Bibliography 1. World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer

Ph o my examiner Puan Hajj8h Rusinah Joned and Zainai Ahmad for their patience. Sllpport and reinforcenlent. Their encouregernent has been invaiuable. § also vvish to acknovvledge the assistance given by my graduate coUegues especIally w1d. Nor Abdul Rahman and my office-mate Puan Ramiah Hj fvluda and Abdul Jahl Saad \,tvho aSisted me Hi data analySiS fv1y thanks also go to rny Head of Departrnent. Dr t�ik Abdullah Hj. �Ll,. vyang \A/ho supported my study. am also indebted to other c.oncerned staff of I also ';,-,fISh to express my grat!tude to ail those ';,I.JhO fiHed out the questionnaires and to the trainers. a special thank yOu for sharing ideas and experienc� and also in distributing the questionnaires to the participants. FinaUy� my greatest appreciation and love to my ,=vife and Children, Tee: support throughout rily study \lVithout their love and tolerance. this research \;vouid not have been possible. Last but not least my special gratitude and appreciation to aU the University Putra fvlaiaysia lecturers especially those invloved Hi the Human Resource Developrnent prograrn

Ph o my examiner Puan Hajj8h Rusinah Joned and Zainai Ahmad for their patience. Sllpport and reinforcenlent. Their encouregernent has been invaiuable. § also vvish to acknovvledge the assistance given by my graduate coUegues especIally w1d. Nor Abdul Rahman and my office-mate Puan Ramiah Hj fvluda and Abdul Jahl Saad \,tvho aSisted me Hi data analySiS fv1y thanks also go to rny Head of Departrnent. Dr t�ik Abdullah Hj. �Ll,. vyang \A/ho supported my study. am also indebted to other c.oncerned staff of I also ';,-,fISh to express my grat!tude to ail those ';,I.JhO fiHed out the questionnaires and to the trainers. a special thank yOu for sharing ideas and experienc� and also in distributing the questionnaires to the participants. FinaUy� my greatest appreciation and love to my ,=vife and Children, Tee: support throughout rily study \lVithout their love and tolerance. this research \;vouid not have been possible. Last but not least my special gratitude and appreciation to aU the University Putra fvlaiaysia lecturers especially those invloved Hi the Human Resource Developrnent prograrn

Rationale: To report a case of familial exudative vitreoretinopathy (FEVR) complicated with full-thickness macular hole (FTMH). Patient concerns: A 39-year-old male presented after becoming aware of metamorphopsia in his left eye. Diagnoses: Fundus examination showed a retinal avascular area, retinal vascular abnormality, and yellow exudation at the peripheral retina in both eyes. Optical coherence tomography findings revealed impending MH (IMH) due to posterior vitreous detachment (PVD) in his left eye. Despite of the occurrence of spontaneous complete PVD, an FTMH developed at 4 months after the onset of IMH. Interventions: To treat the FTMH, vitreous surgery was performed. Intraoperative findings revealed that the thick posterior vitreous membrane (PVM) had no adhesions with the edge of the FTMH. However, a thin epiretinal membrane (ERM) was observed around the MH. Outcomes: Postoperatively, the FTMH was closed, and the patient's corrected visual acuity improved from (0.4) to (0.8). Lessons: In this present case, an IMH developed via traction by a thick PVM, characteristic of FEVR, with FTMH then developing via traction by a thin ERM. Our findings reveal that it is vital to fully understand these anatomical features before performing vitreous surgery for FTMH complicated with FEVR. Abbreviations: ERM = epiretinal membrane, FEVR = familial exudative vitreoretinopathy, FTMH = full-thickness MH, ILM = inner limiting membrane, IMH = impending MH, MH = macular hole, OCT = optical coherence tomography, OD = oculus dexter, OS = oculus sinister, PVD = posterior vitreous detachment, PVM = posterior vitreous membrane, RD = retinal detachment, ROP = retinopathy of prematurity, VTMS = vitreo-macular traction syndrome.

Background Patients having hip fracture surgery are at high risk for postoperative delirium. Red blood cell (RBC) transfusion may increase postoperative delirium risk by causing neuroinflammation. We hypothesized that RBC transfusion would be associated with postoperative delirium in patients having hip fracture surgery. Methods An observational cohort study was performed using the United States National Surgical Quality Improvement Program (NSQIP) participant use files for hip fracture from 2016 to 2018. Propensity score analysis and inverse probability of treatment weighting (IPTW) were used to reduce bias from confounding. An IPTW adjusted odds ratio for developing postoperative delirium was calculated for patients who received RBC transfusion during surgery or in the 72 hours after. Results There were 20,838 patients who had eligible current procedural terminology (CPT) codes for primary hip fracture surgery and complete study data. After employing strict exclusions to balance c...

Epilepsy is a chronic neurological disorder characterized by spontaneous recurrent seizures (SRS) and comorbidities. Kindling through repetitive brief stimulation of a limbic structure is a commonly used model of temporal lobe epilepsy. Particularly, extended kindling over a period up to a few months can induce SRS, which may simulate slowly evolving epileptogenesis of temporal lobe epilepsy. Currently, electroencephalographic (EEG) features of SRS in rodent models of extended kindling remain to be detailed. We explored this using a mouse model of extended hippocampal kindling. Intracranial EEG recordings were made from the kindled hippocampus and unstimulated hippocampal, neocortical, piriform, entorhinal, or thalamic area in individual mice. Spontaneous EEG discharges with concurrent low-voltage fast onsets were observed from the two corresponding areas in nearly all SRS detected, irrespective of associated motor seizures. Examined in brain slices, epileptiform discharges were ind...

BACKGROUNDSurgical patients receive platelet concentrates (PCs) for a variety of indications. However, there is limited evidence for efficacy or dosing of PCs.STUDY DESIGN AND METHODSWe performed a retrospective cohort study of surgical patients receiving isolated PC transfusion at a single academic tertiary medical center during 1 year. The primary outcome was reoperation for a bleeding complication. Bleeding complication rates were compared in patients transfused for different indications, and multivariable logistic regression was performed to determine variables associated with bleeding complications.RESULTSApproximately 1% of surgical patients (n = 205), including 7% of cardiac surgery patients, received an isolated PC transfusion. Cardiac surgery patients accounted for 47% of isolated PC transfusions, followed by neurosurgery (19%) and gastrointestinal surgery (13%). Most patients (81%) received a single apheresis unit of PC. Common indications were antiplatelet drugs (50%), th...

Temporal lobe epilepsy is the most common and often drug-resistant type of epilepsy in the adult and aging populations and has great diversity in etiology, electro-clinical manifestations, and comorbidities. Kindling through repeated brief stimulation of limbic structures is a commonly used model of temporal lobe epilepsy. Particularly, extended kindling can induce spontaneous recurrent seizures in several animal species. However, kindling studies in middle-aged, aging, or aged animals remain scarce, and currently, little is known about kindling-induced behavioral changes in middle-aged/aging animals. We therefore attempted to provide more information in this area using a mouse model of extended hippocampal kindling. We conducted experiments in middle-aged mice (C57BL/6, male, 12-14 months of age) to model new-onset epilepsy in adult/aging populations. Mice experienced twice daily hippocampal stimulations or handling manipulations for 60-70 days and then underwent continuous electroencephalogram (EEG)-video monitoring to detect spontaneous recurrent seizures. Extended kindled mice consistently exhibited spontaneous recurrent seizures with mean incidences of 6-7 events per day, and these seizures featured EEG discharges and corresponding convulsions. The handling control mice showed neither seizure nor aberrant EEG activity. The two groups of mice underwent the Morris water maze test of spatial learning and memory 1-2 weeks after termination of the kindling stimulation or handling manipulation. During visible platform trials, the kindled mice took a longer distance and required more time than the control mice to find the platform. During hidden platform trials, the kindled mice showed no improvement over 5-day trials in finding the platform whereas the control mice improved significantly. During probe tests in which the hidden platform was removed, the kindled mice spent less time than the controls searching in the correct platform location. There were no significant differences between the kindled and control mice with respect to swim speed or total locomotor activity in an open-field test. Together, these observations indicate that the extended kindled mice with spontaneous recurrent seizures are impaired in spatial learning and memory as assessed by the Morris water maze test. We postulate that

BACKGROUND: There is a paucity of data on the underlying procoagulant–anticoagulant balance during extracorporeal membrane oxygenation (ECMO). We hypothesized that adult ECMO patients would have an imbalance between procoagulant and anticoagulant factors, leading to an abnormal underlying thrombin generation (TG) pattern. METHODS: Twenty adult venoarterial (VA) ECMO patients had procoagulant and anticoagulant factor levels measured temporally on ECMO day 1 or 2, day 3, and day 5. In heparin-neutralized plasma, underlying TG patterns, and sensitivity to activated protein C were assessed using calibrated automated thrombogram. TG parameters including lag time, peak TG, and endogenous thrombin potential (ETP) were compared against 5 normal plasma controls (3 males and 2 females) obtained from a commercial supplier. Thrombomodulin (TM) was added to some samples to evaluate for activated protein C resistance. RESULTS: Procoagulant factors (factor [F] II, FV, and FX) were mostly in normal...

Epilepsy is a common neurological disorder characterized by naturally-occurring spontaneous recurrent seizures and comorbidities. Kindling has long been used to model epileptogenic mechanisms and to assess antiepileptic drugs. In particular, extended kindling can induce spontaneous recurrent seizures without gross brain lesions, as seen clinically. To date, the development of spontaneous recurrent seizures following extended kindling, and the effect of the antiepileptic drugs on these seizures are not well understood. In the present study we aim to develop a mouse model of extended hippocampal kindling for the first time. Once established, we plan to evaluate the effect of three different antiepileptic drugs on the development of the extended-hippocampal-kindled-induced spontaneous recurrent seizures. Male C57 black mice were used for chronic hippocampal stimulations or handling manipulations (twice daily for up to 70 days). Subsequently, animals underwent continuous video/EEG monit...

Asymptomatic infections often proceed undetected, yet can still prime the host to be sensitive to secondary environmental stress. While the mechanisms underlying disease caused by asymptomatic infections are unknown, it is believed that productive pathogen replication is required. We report that the environmental stress of carbon dioxide (CO2) anesthesia converts an asymptomatic rhabdovirus infection in Drosophila to one that is lethal. This lethality results from a pool of infectious virus in glial cells and is regulated by the antiviral RNAi pathway of the host. CO2 sensitivity is caused by the fusogenic activity of the viral glycoprotein, which results in fusion of neurons and glia. Expression of the viral glycoprotein, but not a fusion defective mutant, is sufficient to cause CO2 sensitivity, which can occur even in the absence of productive viral replication. These findings highlight how viral proteins, independent of pathogen replication, may predispose hosts to life-threateni...

The increased deposition of iron in gastric mucosa is known as gastric siderosis. It is believed that the only regulated step of the iron metabolism cycle occurs during absorption in the small intestine. Once this system becomes overwhelmed due to either local or widespread iron levels, then iron can be absorbed very quickly by a passive concentration-dependent mechanism. This excess iron is initially stored in the liver but later can be found in the pancreas, heart and joints. Excess iron is not expected to deposit in the gastric mucosa. This gastric deposition has been found in association with hemochromatosis, oral iron medications, alcohol abuse, blood transfusions, hepatic cirrhosis and spontaneous portacaval shunt with esophageal varices. The precise mechanism of this iron deposition in gastric epithelial and stromal cells is still not well understood; thus, identification of iron in gastric mucosa raises many questions. On histology, the pattern of deposition is variable, and...

To prevent the spread of infection, an invading pathogen must first be recognized by the innate immune system. Host pattern recognition receptors detect distinct pathogen-associated molecules and induce the transcription and release of interferon and inflammatory molecules to resolve infection. Unlike infections with pathogens that replicate autonomously from the host, viral infections blur the boundaries of self and non-self. Differentiation of host from virus is achieved by restricting localization of host nucleic acids and by placing pattern recognition receptors in specific subcellular compartments. Within this review, we discuss how several families of pattern recognition receptors act to provide a comprehensive surveillance network that has the potential to induce interferon expression in response to any viral infection.

Metastatic adenocarcinoma to the breast from an extramammary site is extremely rare. In the literature, the most current estimate is that extramammary metastases account for only 0.43% of all breast malignancies and that, of these extramammary sites, colon cancer metastases form a very small subset. Most commonly seen metastasis in breast is from a contralateral breast carcinoma, followed by metastasis from hematopoietic neoplasms, malignant melanoma, sarcoma, lung, prostate, and ovary and gastric neoplasms. Here we present two rare cases, in which colonic adenocarcinomas were found to metastasize to the breast. In both cases, core biopsies were obtained from the suspicious areas identified on mammogram. Histopathology revealed neoplastic proliferation of atypical glandular components within benign breast parenchyma which were morphologically consistent with metastatic adenocarcinoma. By immunohistochemical staining, it was confirmed that the neoplastic components were immunoreactiv...

Eight undescribed neolignans and an undescribed propanoid dimer were isolated from the leaves of Miliusa sessilis, together with two known compounds, dehydrodieugenol A and dehydrodieugenol B. All structures were elucidated by extensive spectroscopic data analysis and the structure of (7S,8R)-5′-hydroxy-3,4-dimethoxy-4′,7epoxy-8,3′-neolign-8′-en-9-acetate (miliusin A) was further confirmed by X-ray crystallographic analysis. The absolute configurations were determined using circular dichroism (CD) data analysis and the modified Mosher's method. All isolated compounds were evaluated for their cytotoxic activities against four human cancer cell lines (HeLa, HN22, HepG2, and HCT116), including one normal-type cell line (HaCaT) using MTT assay. (7S,8R)-5′hydroxy-3,4-dimethoxy-4′,7-epoxy-8,3′-neolign-8′-en-9-ol (miliusin B) was found to exhibit the most promising cytotoxic effect against Hela cells with the lowest IC 50 value of 0.04 μM and the highest selective index of 187.8, highlighting miliusin B as an attractive candidate for cervical cancer drug development.

Bioassay-guided fractionation of the hexane extract of the branches of Mitrephora alba led to the isolation of five diterpenoids: ent-8b-hydroxypimar-15-en-18-oic acid, ent-15,16-dihydroxypimar-8( )-en-18oic acid, ent-3b-hydroxytrachyloban-18-oic acid, ent-3b-hydroxytrachyloban-18-al and methyl ent-3bhydroxytrachyloban-18-oate, together with five related known diterpenoids. The structures were elucidated by spectroscopic analysis and comparison with literature data. All isolated compounds were evaluated for their cytotoxic activities against three human cancer cell lines. The results showed that three ent-trachylobane diterpenes had moderate cytotoxicity against NCI-H187 cancer cells.

New Synthesis of Benzothiazines and Benzoisothiazoles Containing a Sulfoximine Functional Group. -A successful initial exploration via the reaction of sulfoxime (I) with a variety of the terminal alkynes is presented. The reaction affords predominantly thiazines with alkylalkynes, while thiazoles are favored in the cases of arylalkynes.

A new phenolic compound, 1-(3-hydroxy-4-methoxyphenyl)-3-(2,4-dihydroxy-5-methoxyphenyl)propan-1-ol, named as millettinol (1), along with six known compounds, medicarpin (2), 4hydroxy-3-methoxy-8,9-methylenedioxypterocarpan (3), 5,4'-dihydroxy-7,8-dimethoxyisoflavone (4), physcion ( ), (R)-(-)-mellein (6) and isoliquiritigenin (7), were isolated from the wood of Millettia leucantha. The structures of the compounds were determined by an analysis of their spectroscopic data. Some of the isolates were tested for anticancer activity. Compound 1 exhibited strong cytotoxicity against the BCA-1 tumor cell lines with an IC 50 = 3.44 µg/mL.

Protein mobility affects most cellular processes, such as the rates of enzymatic reactions, signal transduction, and assembly of macromolecular complexes. Despite such importance, little systematic information is available about protein diffusion inside bacterial cells. Here we combined fluorescence recovery after photobleaching with numerical modeling to analyze mobility of a set of fluorescent protein fusions in the bacterial cytoplasm, the plasma membrane, and in the nucleoid. Estimated diffusion coefficients of cytoplasmic and membrane proteins show steep dependence on the size and on the number of transmembrane helices, respectively. Protein diffusion in both compartments is thus apparently obstructed by a network of obstacles, creating the so-called molecular sieving effect. These obstructing networks themselves, however, appear to be dynamic and allow a slow and nearly size-independent movement of large proteins and complexes. The obtained dependencies of protein mobility on the molecular mass and the number of transmembrane helices can be used as a reference to predict diffusion rates of proteins in Escherichia coli. Mobility of DNA-binding proteins apparently mainly depends on their binding specificity, with FRAP recovery kinetics being slower for the highly specific TetR repressor than for the relatively nonspecific H-NS regulator.

Responses to questionnaire interviews of 73 men who had undergone vasectomies are discussed, and summary tables presented. The questions cover personal characteristics, the operation itself, motivational factors, and outcome of the operation. Analysis of the outcome includes pre-and postoperative physical health; sexual behavior; psychosocial adjustment factors-including marital, job, and community relationships and concern over children; satisfaction with the operation; and social behavior with regard to the operation. On most of these questions the respondent was also asked to evaluate his wife's condition, behavior, or attitude. Medical aspects of the vasectomy and postoperative sperm tests are also discussed. V-ZVER THE PAST few years, the performance of vasectomy has increased in importance as a means of fertility control in the United States and elsewhere. Information obtained in a nationwide survey 1 indicates that about 45,000 such operations are performed annually in the United States. The basic assumption of the present study is that, aside from eliminating the ability to deliver sperm, vasectomy can yield consequences that constitute the psychosocial sequelae of having decided to sterilize oneself. We sought to focus on several questions: 1. How many men and their wives

Interrelationships between nuclear architecture and gene expression were examined by comparing the representation of nuclear matrix proteins in ROS 17/2.8 rat and MG-63 human osteosarcoma cells with those in normal diploid osteoblasts. The tumor-derived cells coexpress genes which are expressed in a sequential and mutually exclusive manner during the progressive stages of osteoblast differentiation. In osteosarcoma cells two-dimensional electrophoretic analysis indicates a composite representation of nuclear matrix proteins characteristic of both the proliferative and postproliferative periods of osteoblast phenotype development. In addition, nuclear matrix proteins unique to the tumor cells and the absence of nuclear matrix proteins found only in normal diploid osteoblasts are observed. Tumor-specific nuclear matrix proteins include those expressed in a proliferation-dependent and independent manner. There is a parallel relationship between nuclear matrix proteins and the expressio...

Background:Central diabetes insipidus (CDI) is a heterogeneous disease caused by arginine vasopressin deficiency; its management implies a profound understanding of the pathophysiology and the clinical spectrum. The aim of the study was to describe the clinical characteristics that indicate organicity in children and adolescents with central diabetes insipidus treated at the Department of Endocrinology from The Child Health’s Institute during 2001 to 2013.Methods:Cross-sectional, retrospective study. 79 cases of patients diagnosed with CDI (51 males and 28 females) from 1 month to 16 years of age were reviewed. For the descriptive analysis, measures of central tendency and dispersion were used; groups of organic and idiopathic CDI were compared using χResults:The average age of patients was 8.1±4.2 years. Organic causes were intracranial tumors, 44 (55.7%), Langerhans cell histiocytosis (LCH), 11 (13.9%) and cerebral malformations in 7 (8.9%) patients, while the idiopathic group was...

We sincerely appreciate the editorial by Drs. Huang and Tseng, 1 commenting on our recent study published in Clinical and Molecular Hepatology 2 regarding the role of time-varying hepatitis B core-related antigen (HBcrAg) in predicting clinical relapse (CR) for chronic hepatitis B (CHB) patients who discontinued tenofovir or entecavir. We agree that nucleos(t) ide analogue (NA) cessation is generally safe with hepatitis B surface antigen (HBsAg) seroclearance, 3 which is the only treatment endpoint widely acceptable across guidelines. Unfortunately, it rarely occurs during long-term NA therapy. Treatment discontinuation without first achieving HBsAg seroclearance invariably leads to recurrence of viremia and could precipitate hepatitis flare and even life-threatening acute on chronic liver failure. The strategy of finite NA therapy, therefore, cannot be practiced without thorough consideration of the conceivable benefits and potential risks for an

Increased serum uric acid (UA) has been shown to directly promote oxidative stress. Recent studies point toward a role for oxidative stress in the pathogenesis of ascending aortic aneurysms (AscAAs). This study was designed to examine the relationship between serum UA concentrations, total antioxidant reductive capacity, and AscAAs. The serum UA concentrations, total antioxidant reductive capacity were compared in 60 patients with ascending aortic dilatation (ectasia group (3.8-4.3 cm), 34 patients; aneurysmal group (≥4.4 cm), 26 patients) vs. 30 control subjects. The patients were evaluated by a complete transthoracic echocardiographic examination including measurement of the aortic dimensions. The serum UA concentration and total antioxidant reductive capacity were significantly higher in patients with AscAAs. In multiple linear regression analysis, hypertension and serum UA concentration were significantly associated with aortic dilatation (β = 0.3, P = 0.03; β = 0.15, P &lt; 0.0...

Matrix metalloproteinases (MMP) have been associated with neonatal lung morbidity and MMP dysregulation contributes to the pathology of chronic and acute lung disorders. Most of the previous studies were performed in the 1 st weeks of life of the preterm newborns. There are no data on the serum levels of MMP-2, MMP-9 or tissue inhibitors of matrix metalloproteinases (TIMP-1) from preterm infants recovering from lung morbidities. We aimed to compare MMP-2, MMP-9 and TIMP-1 levels in preterm and term infants hospitalized with their first episode of wheezing. We prospectively evaluated 18 preterm infants with a history of chronic lung disease, respiratory distress syndrome or oxygen therapy and 14 age-and sex-matched term infants who were admitted for a first episode of wheezing. We quantified total serum concentrations of MMP-2, MMP-9 and TIMP-1 to assess whether these serum markers levels were associated with the first episode of wheezing in infants with a history of oxygen therapy during the neonatal period. Upon hospitalization, MMP-2 and TIMP-1 levels were higher in preterm infants than in term infants. In contrast, there was no significant relationship between MMP-9 levels or the MMP-9/TIMP-1 ratio between preterm and term infants. The area under the receiver operating characteristic curve for MMP-2 was 0.70 (95% confidence interval [CI] 0.51-0.89). The area under the curve for TIMP-1 was 0.78 (95% CI 0.61-0.94). MMP-9, MMP-2 and TIMP-1 levels did not correlate with gestational age, gender or severity of wheezing. The negative proportion of MMP-9 to TIMP-1 that we detected in term infants was not present in preterm infants. The balance of MMP-9 to TIMP-1 may have been disrupted by lung damage in the premature infants. Overproduction of MMP-2 and TIMP-1 in the serum may be associated with the pathogenesis of wheezing in preterm infants.

PURPOSE: To investigate whether chitosan application over colonic anastomosis line, provide reinforcement, and subsequently improve anastomotic healing. METHODS: Forty eight Wistar albino female rats were used and were randomly divided into four groups, 12 rats in each: The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received chitosan application over the colonic anastomosis. After sacrifying rats at the end of the experiment (either on day three or on day seven, depending on the group), colonic bursting pressure, a hihydroxyproline level and histopathologic characteristics of the perianastomotic tissue were examined. RESULTS: At three days, chitosan and control groups had similar values for histopathologically. On day seven, chitosan group had significantly higher mean score of collagenization (p=0.007) and a significantly higher bursting pressure (p=0.038). CONCLUSION: Our study emphasizes the positive effect of chitosan in the process...

ABSTRACTThis study aimed at investigating the effects of weaning kids abruptly at an average of 55 ± 13 days of age on intake, behavioral and serum parameters and, lasted for a total of six weeks; two weeks pre‐weaning and four weeks post‐weaning. Sixteen single kids with equal gender were used. Kids were only allowed to stay with their mothers for suckling (45 min/period) both in the morning and in the evening period during pre‐weaning. Grower concentrate and hay were offered ad libitum. The duration of the study was divided into three periods for the sampling of behavioral and serum parameters; (i) pre‐weaning period lasting for two weeks (P‐BW) (ii) early post‐weaning period lasting for one week (P‐AW1) and (iii) late post‐weaning period lasting for three weeks (P‐AW2). Daily weight gain of kids gradually decreased as the observation period progressed (P = 0.001). However concentrate feed intake increased from 0.154 kg/day in P‐BW to 0.479 kg/day in P‐AW1 and 0.499 kg/day in P‐AW...

Hormonal contraceptives (HC) are widely used among women in reproductive ages. In this review, the effects of HCs on 91 routine chemistry tests, metabolic tests, and tests for liver function, hemostatic system, renal function, hormones, vitamins and minerals were evaluated. Test parameters were differently affected by the dosage, duration, composition of HCs and route of administration. Most studies concerned the effects of combined oral contraceptives (COC) on the metabolic, hemostatic and (sex) steroids test results. Although the majority of the effects were minor, a major increase was seen in angiotensinogen levels (90-375 %) and the concentrations of the binding proteins (SHBG [∼200 %], CBG [∼100 %], TBG [∼90 %], VDBP [∼30 %], and IGFBPs [∼40 %]). Also, there were significant changes in levels of their bound molecules (testosterone, T3, T4, cortisol, vitamin D, IGF1 and GH). Data about the effects of all kinds of HCs on all test results are limited and sometimes inconclusive due to the large variety in HC, administration routes and dosages. Still, it can be concluded that HC use in women mainly stimulates the liver production of binding proteins. All biochemical test results of women using HC should be assessed carefully and unexpected test results should be further evaluated for both methodological and pre-analytical reasons. As HCs change over time, future studies are needed to learn more about the effects of other types, routes and combinations of HCs on clinical chemistry tests.

Background: Bipolar disorder (BD) is a serious psychiatric disorder that is associated with a high suicide rate, and for which no clinical biomarker has yet been identified. To address this issue, we investigated the use of magnetoencephalography (MEG) as a new prospective tool. MEG has been used to evaluate frequency-specific connectivity between brain regions; however, no previous study has investigated the frequencyspecific resting-state connectome in patients with BD. This resting-state MEG study explored the oscillatory representations of clinical symptoms of BD via graph analysis. Methods: In this prospective case-control study, 17 patients with BD and 22 healthy controls (HCs) underwent resting-state MEG and evaluations for depressive and manic symptoms. After estimating the source current distribution, orthogonalized envelope correlations between multiple brain regions were evaluated for each frequency band. We separated regions-of-interest into seven left and right network modules, including the frontoparietal network (FPN), limbic network (LM), salience network (SAL), and default mode network (DMN), to compare the intra-and inter-community edges between the two groups. Results: In the BD group, we found significantly increased inter-community edges of the right LM-right DMN at the gamma band, and decreased inter-community edges of the right SAL-right FPN at the delta band and the left SAL-right SAL at the theta band. Intracommunity edges in the left LM at the high beta band were significantly higher in the BD group than in the HC group. The number of connections in the left LM at the high beta band showed positive correlations with the subjective and objective depressive symptoms in the BD group. We introduced graph theory into resting-state MEG studies to investigate the functional connectivity in patients with BD. To the best of our knowledge, this is a novel approach that may be beneficial in the diagnosis of BD. This study describes the

Iron deficiency anemia in toddlers can be prevented by introducing complementary foods alongside breastfeeding. Fish, rich in protein and iron, offers a valuable nutritional source for young children, but proper processing is crucial. This research investigated the impact of fish-based complementary food processing practices (known as MP-ASI in Indonesia) on the nutritional intake and hemoglobin levels of children under five in Tiro District, Pidie Regency. Using a quasi-experimental design, this study involved 40 toddlers from the stunting-prone area of Tiro District, Pidie Regency, along with their mothers as respondents. The toddlers, aged 12-36 months without severe illnesses, were included in the study. The intervention comprised educating and practicing complementary food processing. Beforeand-after intervention comparisons showed significant improvements in energy, carbohydrate, protein, zinc, and iron intake levels. Additionally, there was a notable increase in the average hemoglobin (Hb) level, rising by 1.06 g/dl after one month of fish-based complementary food processing intervention. In summary, this intervention effectively enhanced the nutritional quality of children's intake and increased their hemoglobin levels, contributing to the prevention of iron deficiency anemia in toddlers.

Using exergaming for exercise training was found to improve physical fitness. Yet, few studies have used the "Xbox Kinect" to examine its effects on physical fitness in healthy middle-aged and older adults. The purpose of this study was to investigate the effect of 10-weeks of Xbox Kinect training on physical fitness in healthy middle-aged and older adults. Forty participants (average 64.00 ± 4.44 years old, eight males and 32 females) were randomized to either intervention (n = 20) or control group (n = 20). The intervention group played Xbox Kinect three times per week, for an average of 50 min per session for 10 weeks. The control group was instructed to maintain their levels of physical activity. All the participants completed assessments of body composition, muscle strength, flexibility, balance and cardiopulmonary endurance at baseline and after 10-week intervention. After 10 weeks of training, the intervention group showed significant improvements in cardiopulmonary endurance and leg muscle strength. Moreover, there were significant differences between the intervention and control group in changes in aerobic fitness and leg muscle strength. The exergame program effectively improved cardiopulmonary endurance and leg muscle strength in healthy middle-aged and older adults. It could be an alternative to conventional exercise.

The aim of this study was to investigate the P300 in electroencephalography (EEG) and the reaction time in children with attention deficit hyperactivity disorder (ADHD) during an auditory oddball task when sitting on a classroom chair or therapy ball. [Subjects] Fifteen ADHD children with a mean age of 8.6 ± 2.1 years and 14 healthy children with a mean age of 8.7 ± 2.0 years were used as subjects in this study. [Methods] All subjects were asked to sit on a chair or therapy ball and perform simultaneously the auditory oddball task. A portable 40-channel EEG system and a sound operating system were employed to record and analyze the EEG and button reaction time signals. [Results] When seated on the chair, the ADHD group had a significantly longer reaction time than the control group. ADHD children seated on a therapy ball showed a significant improvement in reaction time compared with when seated on the chair. In the parietal lobe, the ADHD group had a significantly delayed P300 latency during chair seating compared with the control group. The ADHD group showed a significantly shorter P300 latency time when seated on a therapy ball. [Conclusion] The therapy ball has a significant advantage for enhancing the attentional ability in children with ADHD.

Objectives: The purpose of the study was to investigate the effects of a 12-week yoga program on heart rate variability (HRV) and depressive symptoms in depressed women. Methods: This was a randomized controlled trial. Twenty-six sedentary women scoring ‡14 on the Beck Depression Inventory-II were randomized to either the yoga or the control group. The yoga group completed a 12week yoga program, which took place twice a week for 60 min per session and consisted of breathing exercises, yoga pose practice, and supine meditation/relaxation. The control group was instructed not to engage in any yoga practice and to maintain their usual level of physical activity during the course of the study. Participants' HRV, depressive symptoms, and perceived stress were assessed at baseline and post-test. Results: The yoga group had a significant increase in high-frequency HRV and decreases in low-frequency HRV and low frequency/high frequency ratio after the intervention. The yoga group also reported significantly reduced depressive symptoms and perceived stress. No change was found in the control group. Conclusions: A 12-week yoga program was effective in increasing parasympathetic tone and reducing depressive symptoms and perceived stress in women with elevated depressive symptoms. Regular yoga practice may be recommended for women to cope with their depressive symptoms and stress and to improve their HRV.

Standing yoga poses strengthen a person’s legs and helps to achieve the goal of musculoskeletal rehabilitation, but inadequate exercise planning can cause injuries. This study investigated changes in the electromyogram and joint moments of force (JMOFs) of lower extremities during common standing yoga poses in order to explore the feasibility and possible injury risk in dealing with musculoskeletal problems. Eleven yoga instructors were recruited to execute five yoga poses (Chair, Tree, Warrior 1, 2, and 3). The results revealed significant differences in hip, knee, and ankle JMOFs and varying degrees of muscle activation among the poses. Among these poses, rectus femoris muscle activation during the Chair pose was the highest, Warrior 2 produced the highest muscle activation in the vastus lateralis of the front limb, while Warrior 1 had the highest muscle activation in the vastus medialis of the back limb. Therefore, all three poses can possibly be suggested as a therapeutic interv...