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Inappropriate prescription of antibiotics contributes to antibiotic resistance. Therefore, the objective of this study was to determine the awareness, attitudes, and intention to practice of dentists prescribing antibiotics in Colombia in order to design a virtual learning environment on this subject.In a descriptive study across seven cities, 700 dentists from different Colombian cities were requested to complete a validated questionnaire containing five sections: general information, awareness on antibiotic effectiveness and antibiotic resistance, attitudes regarding prescription decision, intention to practice concerning clinical cases, and complementary information. The level of awareness, attitudes, and intention to practice was determined and Chi-square test was used to determine the existence of significant differences among cities.The majority of dentists showed a medium level regarding the number of correct answers on awareness (62.4 percent) and attitudes (88.7 percent) and a high level on intention to practice (91.7 percent). Common errors within the awareness section included the meaning of the term "antibiotic resistance" (35 percent) and most dentists were not convinced that such resistance could be derived from prescription of antibiotics (51.2 percent). In the attitudes section, only 45 percent declared that they prescribe antibiotics based mainly on symptoms, and the intention to practice section showed a significant percentage of unnecessary prescription (51 percent for pacemaker users) or absence of prescription (53.9 percent for ventricular septal defect) in antibiotic prophylaxis for infectious endocarditis (IE).The dentists interviewed should be trained and made aware of antibiotic resistance, microbiological and clinical foundations, and current antibiotic prophylaxis guidelines.

Bleeding is the most concerning complication associated with anticoagulant therapy but poorly characterized and important for risk/benefit assessment. We developed a risk stratification score to predict vitamin K antagonist (VKA)-associated bleeding in venous thromboembolism (VTE) using the UK Clinical Practice Research Datalink. Significant bleeding events in outpatients consisted of major bleeding and clinically relevant non-major bleeding requiring hospitalisation (CRNMB-H) within 90 days of VKA initiation. A scoring scheme for predicting bleeding was developed from subhazard ratios, validated using cross-validation and expressed by the C-statistic. The study cohort consisted of 10,010 patients with first VTE receiving initial VKA treatment, mean age 62·2 years. Between 2008 and 2016, 167 significant bleeding events were recorded (1·7%), i.e. incidence rate was 7·4/100 person-years. Independent predictors for community-acquired significant bleeding included active cancer, trauma/surgical procedure, male gender, dementia, liver disease, anaemia, history of bleeding, cerebrovascular, renal and chronic pulmonary disease, VTE presenting as pulmonary embolism and age over 75. The overall C-statistic was 0·68 (95% CI, 0·60-0·76), 0·75 (0·60-0·88) for major bleeding and 0·65 (0·55-0·75) for CRNMB-H, and higher than in other risk schemes applied to our study population. The developed risk score may identify patients having a significant bleeding risk, in particular major bleeding events, in outpatients.

We conducted a prospective evaluation of drug-induced severe hyponatremia (adverse drug reaction (ADR)) through the Prospective Pharmacovigilance Program from Laboratory Signals at Hospital over a period of 10 years. Cases of serum sodium (Na(s))

The role of waves in the propagation, scattering and energization of electrons in the solar wind has long been a topic of interest. Conversely, understanding the excitation of waves by energetic el...

A one-year-old neutered male Chihuahua was referred for further investigations of spontaneous pneumothorax. Before referral, thoracocentesis and chest drain placement was performed. On presentation, the dog was dull and dyspnoeic displaying a restrictive respiratory pattern. Thoracic radiography and CT findings performed at the referral centre were consistent with right lung agenesis and pneumothorax. Retrospective review of the radiographs obtained at the referring practice identified right-sided mediastinal shift, separation of the cardiac silhouette from the sternum and overinflated left lung lobes. Neither free intrathoracic gas nor subcutaneous emphysema was identified. The initial images were suboptimally displayed resulting in artefactual ‘blackening’ of the lung parenchyma, necessitating digital manipulation to identify lung markings. The combination of mediastinal shift and separation of the cardiac silhouette from the sternum as a result of the right lung agenesis could potentially lead to a false impression of pneumothorax.

Summary This note considers the problem of deriving sufficient delay-range-dependent stability (DRDS) condition for a general class of uncertain (or nonlinear) retarded system. The stability result is developed by proposing appropriate Lyapunov–Krasovskii functional to effectively utilize the merit of recently proposed affine Wirtinger inequality. The delay upper bound results obtained by the developed condition are found to be less conservative compared with recent results for both nominal and uncertain systems. Copyright © 2016 John Wiley & Sons, Ltd.

Background Hypertrophic cardiomyopathy (HCM) is characterized by inappropriate hypertrophy, myocyte disarray and increased interstitial fibrosis. The tumour necrosis factor-like weak inducer of apoptosis (TWEAK) is a cell surface cytokine with biological activities including stimulation of cell growth, induction of inflammatory cytokines and stimulation of apoptosis. There are controversial data about the potential role of TWEAK in different cardiovascular pathologies. NT-proBNP is an established biomarker of myocardial wall stress, associated with poor functional class in HCM. We hypothesized that effort capacity in patients with HCM could be related to serum levels of these biomarkers. Materials and methods We included 40 haemodynamic stable HCM patients and 53 healthy controls with similar sex and age. We studied exercise capacity by maximal oxygen consumption in a limited treadmill exercise test. TWEAK and NT-proBNP were assayed by ELISA method and automated Elecsys® platform, respectively. We obtained 46 samples of myocardial tissues by septal myectomy in patients with HCM and evaluated myocardial fibrosis, immunoreaction with TWEAK antibody and apoptosis with TUNEL assay. Results We found raised TWEAK and NT-proBNP serum levels in patients when compared with control levels (both P

We report here the first results on magnetic nanoparticles fabricated from basalt fragments of the eruption that took place in Lanzarote (Canary Islands) between 1730 and 1736, to be used in technologies of biomedicine. This approach was inspired by the strong and extremely stable remanent magnetization of slowly cooled rocks from basaltic lavas containing finely members of the hematite–ilmenite (Fe2O3–FeTiO3) series. Besides, the presence of titanium may promote good biocompatibility and an adequate corrosion resistance, as it does in prosthesis. The green, simple, fast, and cost-effective synthesis of magnetic nanoparticles was attempted using solar vapor-phase condensation. This technique allows the preparation of large volumes of nanoparticles presenting a narrow particle size distribution without purification steps. Alternatively, high-energy ball-milling of rock powder in the presence of organic surfactants was also studied as a potential method to produce, in a one-step approach, large quantities of nanostructured particles for biomedical applications. As a proof of concept, we explore these materials as candidates to be used in hyperthermia therapy, which promotes selective necrosis of cancer cells by raising the temperature of the tissue slightly above 43 oC. Results are correlated to their chemical and structural properties and compared to initial igneous rock characteristics. (© 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Summary A solution to the stabilization problem of a compact set by means of the Interconnection and Damping Assignment Passivity-Based Control methodology, for an affine nonlinear system, was introduced. To this end, we expressed the closed-loop system as a Port Hamiltonian system, having the property of almost all their trajectories asymptotically converge to a convenient limit set, except for a set of measure zero. It was carried out by solving a partial differential equation (PDE) or single matching condition, which allows the desired energy level or limit set E to be shaped explicitly. The control strategy was tested using the magnetic beam balance system and the pendulum actuated by a direct current motor (DC-motor), having obtained satisfactory results. Copyright © 2014 John Wiley & Sons, Ltd.

Summary In this paper, we study the exponential stability of linear discrete time-delay systems with slowly varying coefficients and nonlinear perturbations. We establish the robustness of the exponential stability in Hilbert spaces, in the sense that the exponential stability for a given linear equation persists under sufficiently small perturbations. As an application of the main results, we discuss the exponential stability of a general nonlinear system. The main novelty of this work is that we always consider the exponential behavior of solutions with respect to an specific ball. Copyright © 2013 John Wiley & Sons, Ltd.

The Fe-MgO core-shell morphology is proposed within the single-domain nanoparticle regime as an enhanced magnetically driven hyperthermia carrier. The combinatory use of metallic iron as a core material together with the increased particle size (37–65 nm) triggers the tuning of dipolar interactions between particles and allows for further enhancement of their collective heating effi ciency via concentration control. A theoretical universal estimation of hysteresis losses reveals the role of dipolar interactions on heating effi ciency and outlines the strong infl uence of coupling effects on hyperthermia opening a novel roadmap towards multifunctional heat-triggered theranostics particles.

Background: In patients with Parkinson's disease (PD), asymmetric motor signs provide an interesting model to evaluate whether asymmetric nigrostriatal degeneration can affect neuropsychological function and other nonmotor symptoms (NMS). This study was designed to evaluate the predominant laterality of motor symptoms and its relationship with cognition and other NMS in idiopathic PD. Methods: Nationwide, longitudinal, and multicenter study (ELEP Registry) using outpatients with PD. Left PD (LPD) and right PD (RPD) was defined based on the motor signs on the SCOPA-motor scale. To include the clinical spectrum of asymmetric PD patients, we considered two groups of patients with mild-moderate and extreme asymmetry. Predominant LPD or RPD with mild-moderate versus extreme asymmetry were compared using the following scales: cognition, psychosis (Parkinson Psychosis Rating Scale), anxiety/depression, sleep (and autonomic dysfunction at baseline and 1 year later. Nonparametric tests were used for comparison. Results: One hundred forty-nine PD patients (74 RPD and 75 LPD) with mild-moderate asymmetry and 90 (47 RPD and 43 LPD) with extreme asymmetry and a mean age of 64.5 (10.4) years were included. Extreme RPD had higher Parkinson Psychosis Rating Scale scores over time (P = 0.005) compared with LPD, but no significant differences were observed between LPD and RPD in terms of other NMS. Conclusions: These findings suggest that damage to left-hemisphere plays a disproportionately greater role in PD-related psychosis over time. In contrast, motor laterality does not consistently affect other NMS, suggesting that NMS are related to a more widespread brain disorder. © 2009 Movement Disorder Society

We studied 19 patients with pericardial disease using two-dimensional and three-dimensional transthorathic echocardiography (2DTTE and 3DTTE, respectively) in order to determine whether 3DTTE provides incremental value on top of 2DTTE in the evaluation of these patients. With 3DTTE a more comprehensive assessment of pericardial effusion can be made and both the parietal and visceral layers of the pericardium can be visualized en face and examined for pathologies and fibrin deposits. In our series of patients, 3DTTE was superior to 2DTTE in uncovering mass lesions involving the pericardium such as tuberculous granulomas and metastatic disease. Furthermore, it provided a better assessment of the nature of pericardial lesions, such as pericardial and mediastinal hematomas, pericardial cysts, and metastatic disease to the pericardium by sequential cropping of the 3D data sets and visualizing the interior of the lesions in a manner not possible with 2DTTE. It was also valuable in determining the extent of pericardial calcification in pericardial constriction and in measuring the size of pericardial masses. These preliminary results suggest the superiority of 3DTTE over 2DTTE in the evaluation of pericardial diseases and that it provides incremental knowledge to the echocardiographer. (ECHOCARDIOGRAPHY, Volume 26, November 2009) constrictive pericarditis, live/real time three-dimensional transthoracic echocardiography, pericardial cyst, pericardial disease, pericardial disorders, pericardial effusion, three-dimensional echocardiography

AIMS: Delta-like ligand 4 (DLL4) is one of five known Notch ligands in mammals and interacts predominantly with Notch 1. DLL4 is induced by vascular endothelial growth factor (VEGF) and acts downstream of VEGF as a 'brake' on VEGF-induced vessel growth, forming an autoregulatory negative feedback loop inactivating VEGF. This action was believed to occur only in vascular development, raising hopes that DLL4 could be a specific drug target for controlling vessel growth in tumours and other pathological conditions. Our aim was to pursue this by raising a monoclonal antibody to the internal domain of DLL4 and assess its distribution in normal and malignant tissues in comparison with antibodies against the external domain of DLL4. METHODS AND RESULTS: The anti-DLL4 monoclonal antibody was raised using conventional mouse hybridoma techniques. The antibody has been fully characterized by Western blotting and transfectant immunostaining. It has also been comprehensively compared with other antibodies against both the internal and external domains of DLL4. The antigen is widely expressed on human tissues not only on endothelium but also on epithelium and stromal cells. Indeed, in our comprehensive survey only pulmonary alveoli failed to express DLL4. Of a wide range of malignancies, most also expressed DLL4 on tumour cells with a predominantly cytoplasmic pattern, although a number also displayed nuclear positivity. CONCLUSIONS: Contrary to previous beliefs, DLL4 is widely distributed in tissues other than vessels including many malignancies. Furthermore, the molecule is internalized on binding its receptor and often transported to the nucleus. These findings raise many interesting possibilities for further study of DLL4 and its potential as a therapeutic target.

The hospital anxiety and depression scale (HADS) is commonly used to assess mood in Parkinson's disease (PD) patients. Very few studies analyze the scale from the standpoint of item response theory. This article sought to analyze how the HADS fits the Rasch model in PD. The HADS was administered to 387 PD patients. Three sets of Rasch analyses were performed for the HADS total score, and anxiety and depression subscales (HADS-T, -A, and -D, respectively). Although the HADS-T and HADS-A displayed a good fit, with little threshold disordering and no differential item functioning, the HADS-D failed to fit the model. The person separation index, a reliability measure, was 0.87 (HADS-T) and 0.80 (HADS-A). Both HADS-T and HADS-A showed unidimensionality. Our results supported the use of HADS-T as a measure of psychological distress in PD patients. Moreover, the HADS-A was also an adequate anxiety measure. Further research is required to address the use of HADS-D in PD.

BACKGROUND. The authors analyzed the retinoblastoma (Rb) tumor-suppressor pathway in meningeal hemangiopericytomas (MHPCs). METHODS. Immunohistochemical detection of the Rb pathway proteins (Rb; E2F transcription factor 1 [E2F1]; cyclins D1, D3, and E; cyclin-dependent kinase 4 [CDK4]; and the CDK4 inhibitor p16/INKa) was followed by double immunofluorescence (DIF) staining and laser-scanning confocal microscopy (LSCM) in 11 MHPC specimens and from 4 specimens of recurrent disease from 1, 2, and 4 recurrences (total, 18 specimens). RESULTS. All specimens displayed Rb pathway alterations, including low or negative Rb protein expression (17 specimens), high Rb protein expression (1 specimen), and loss of p16/INK4a expression (17 specimens). High levels of positive cell-cycle regulators were observed for E2F1 (10 specimens), cyclin E (7 specimens), CDK4 (5 specimens), cyclin D3 (1 specimen), and cyclin D1 (1 specimen). DIF and LSCM revealed no or very weak Rb and E2F1 colocalization, indicating that Rb does not act as a growth suppressor. High levels of human mouse double-minute 2 (HDM2) expression were observed in a previous study of these tumors, and they displayed colocalization with E2F1 and Rb in the current study, which supports the argument that HDM2 activates E2F1 and inactivates Rb. CONCLUSIONS. The current findings demonstrated that loss of Rb and p16/INKa expression and high E2F1 expression indicate impairment of the Rb suppressor pathway. HDM2 colocalization with E2F1 and Rb also indicates that Rb suppressor pathway inactivation and transactivation of DNA synthesis genes may play pathogenic roles in MHPCs. High expression levels of cyclin E, cyclin D1, cyclin D3, and CDK4 were associated with Rb suppressor pathway neutralization. Cancer 2008. © 2008 American Cancer Society.

The increased susceptibility during pregnancy to certain pathogens that cause abortions may be related to changes in the distribution and phenotype of lymphocyte subpopulations in the uterus. Histological, electron microscopic and immunocytochemical techniques were used in this study to examine whether such variations occur in different stages of the reproductive cycle of goats. The study of non-pregnant goats showed that most uterine lymphocytes were T cells and displayed both an intraepithelial and stromal distribution. CD8 + T lymphocytes were more numerous than CD4 + T lymphocytes. In the endometrial epithelium two lymphocyte subpopulations were observed: non-granulated CD2 + CD8 + T lymphocytes and granulated CD2 + CD8 ) T lymphocytes. During gestation, no lymphocytes were observed in the placentomal area, while a decreased number of T lymphocyte subpopulations were found in the inter-placentomal area. In the inter-caruncular epithelium, non-granulated CD2 + CD8 + T lymphocytes disappeared, whereas the granulated CD2 + CD8 ) T lymphocyte subpopulations increased their number and changed their morphology.

MAX phases are promising materials for protective coatings on steel due to their unique combination of properties like corrosion and oxidation resistance, good electrical conductivity, low friction coefficient, damage tolerance, and high temperature stability. Here the deposition of large area MAX phase coatings on steel was investigated by magnetron sputtering of a Ti 2 AlC compound target. It was found that the chemical composition of the produced films was different from the composition of the target. The deposited films contained about half as much Ti as the target. Consequently the dependence of the film composition on temperature and pressure was investigated. The film composition prooved to be independent of pressure but the lack of Ti increased with increasing temperature. The stoichiometry of the films was then adjusted by adding Ti to the growing coating from a separate plasma source. This method provides a pathway to stoichiometric Ti 2 AlC coatings with an equilibrium volume that is in excellent agreement with our ab initio calculations.

Objective To investigate the impact of a diagnosis of fibromyalgia (FM) in clinical practice on health care resource use in the UK. Methods Rates of visits, prescriptions, referral, and diagnostic testing were estimated in patients who had been diagnosed as having FM between 1998 and March 2003 in UK primary care and compared with those in matched controls. Rates were calculated in 6-month intervals from 10 years before until 4 years after the FM diagnosis. Results Patients (2260) were newly diagnosed as having FM; 81.3% were women. Their mean age was 49 years. FM patients had considerably higher rates of visits, prescriptions, and testing from at least 10 years prior to diagnosis compared with controls. By the time of diagnosis, FM patients had 25 visits and 11 prescriptions per year compared with 12 visits and 4.5 prescriptions per year in controls. Visit rates were highest for depression, followed by fatigue, chest pain, headache, and sleep disturbance. Following diagnosis, visits for most symptoms and health care use markers declined, but within 2–3 years, most visits rose to levels at or higher than those at diagnosis. Conclusion Primary care patients who had been diagnosed as having FM reported higher rates of illness and health care resource use for at least 10 years prior to their diagnosis, which suggests that illness behavior may play a role. Being diagnosed as having FM may help patients cope with some symptoms, but the diagnosis has a limited impact on health care resource use in the longer term, possibly because there is little effective treatment.

Multiple-sequence alignment of glycoside hydrolase (GH) families 32, 43, 62, and 68 revealed three conserved blocks, each containing an acidic residue at an equivalent position in all the enzymes. A detailed analysis of the site-directed mutations so far performed on invertases (GH32), arabinanases (GH43), and bacterial fructosyltransferases (GH68) indicated a direct implication of the conserved residues Asp/Glu (block I), Asp (block II), and Glu (block III) in substrate binding and hydrolysis. These residues are close in space in the 5-bladed β-propeller fold determined for Cellvibrio japonicus α-L-arabinanase Arb43A [Nurizzo et al., Nat Struct Biol 2002;9:665–668] and Bacillus subtilis endo-1,5-α-L-arabinanase. A sequence–structure compatibility search using 3D-PSSM, mGenTHREADER, INBGU, and SAM-T02 programs predicted indistinctly the 5-bladed β-propeller fold of Arb43A and the 6-bladed β-propeller fold of sialidase/neuraminidase (GH33, GH34, and GH83) as the most reliable topologies for GH families 32, 62, and 68. We conclude that the identified acidic residues are located at the active site of a β-propeller architecture in GH32, GH43, GH62, and GH68, operating with a canonical reaction mechanism of either inversion (GH43 and likely GH62) or retention (GH32 and GH68) of the anomeric configuration. Also, we propose that the β-propeller architecture accommodates distinct binding sites for the acceptor saccharide in glycosyl transfer reaction. Proteins 2004. © 2003 Wiley-Liss, Inc.

The effects of argon r.f. plasma etching processes on steel samples at discharge voltages substantially lower than 300 V were studied. The removal of not only the hydrocarbon contamination of the surface but also of the native oxidic scale was investigated by means of x-ray photoelectron spectroscopy (XPS). Special attention was paid to the remaining structure of the surface after etching, using reflection high-energy electron diffraction (RHEED) to determine the influence of plasma etching on the crystallographic structure. The removal of hydrocarbons was already effective at a power of 20 W. At a power of 60 W it was possible to remove the native oxidic scale in only a few minutes. In contrast to the amorphization observed after etching at high Ar+ energies, the crystalline structure of the outermost layers was not significantly influenced by the low-energy ion etching. Copyright © 2002 John Wiley & Sons, Ltd.

Background: Injuries to tendons are among the most common injuries to the body. To determine whether a proposed animal tendon injury model is appropriate, some conditions must be met. First, the correct anatomic structure must be modeled and the desired pathologic condition must be simulated. Purpose: To describe an experimental model to study Achilles tendon healing. Methods: Forty male Rattus norvegicus albinus, Wistar lineage adult male weighing 250 to 300 g were used for this experiment and thirty were surgically submitted to bilateral partial transverse section of the Achilles tendon. The right tendon was treated with RF whereas the left tendon served as control. On the third postoperative day, the rats were divided into four experimental groups consisting of ten rats each which were treated with monopolar RF (Tonederm™) adjusted to 650 kHz and 2w, for two minutes twice a week and a group of normal animals without any intervention, until they were sacrificed on the 7th, 14th and 28th days, respective...

The oxidation behaviour of low alloyed steels, Fe-0.6%Mn and Fe-1.5%Mn, under different annealing conditions was studied. Due to the crucial importance of the surface state of the sample, the experiments were performed in an in-situ device to avoid any contact with air after the annealings. The annealing experiments were carried out under different conditions: high vacuum (∼10 -6 mbar), N 2 /H 2 protective atmospheres with traces of water (dew point -30 °C) and temperatures ranging from 873 to 1073 K. Under this variety of heat treatments, the reconstruction of the Fe surface and the formation of different oxides was observed and characterised, paying special attention to the selective oxidation of manganese. The surface structure and composition was investigated by means of the combined use of reflection high-energy electron diffraction (RHEED) and X-ray photoelectron spectroscopy (XPS). The analyses show that the use of RHEED is a good alternative for determining the crystallographic structure of the outermost layers of the surface. With this technique the structures of iron and manganese oxides can be distinguished despite the similar structures and lattice parameters. It is also possible to identify the crystallographic textures present on the oxidation products and to give qualitative information about the surface reconstruction of the grains.

We report a young patient with post traumatic acquired thoracic aortic coarctation in whom three-dimensional transthoracic echocardiography (3DTTE) demonstrated incremental value over two-dimensional transthoracic echocardiography (2DTTE). 3DTTE showed (1) en face views of the obstruction site that showed a markedly narrowed, roughly circular orifice measuring 0.33 cm(2) in area, (2) echogenic tissue encroaching on the graft lumen consistent with fibrosis/thrombus, and (3) no graft protrusion into the aortic lumen, only hypermobility of the medial portion of the graft. These important findings were not detected by 2DTTE.

We describe the value of live/real time three-dimensional transthoracic echocardiography (3DTTE) over two-dimensional transthoracic echocardiography (2DTTE) in the assessment of inferior vena cava (IVC) and hepatic vein (HV) obstruction in a patient with sickle cell disease. 3DTTE provided additional information when compared to 2DTTE by (1) identifying the obstructing lesion as a likely thrombus, (2) by providing assessment of anatomical severity of IVC lumen obstruction since the thrombus could be visualized en face also, and (3) identifying an area of increased mobility of a portion of the thrombus suggesting greater risk of embolization. (Echocardiography 2010;27:594-596).