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Background: The aspect of sexual differentiation and the mechanism controlling the position of genitalia, which represents one of the most substantial differences between the sexes, is still poorly understood. Minor cases and some variants of penoscrotal transposition (PST) are unreported, and obvious cases were classified broadly and confused with other unrelated anomalies. Methodology: Relevant literature published till 2022 were reviewed then organized, recapitulated, and presented in comparison with the findings and data of 65 child diagnosed with PST. So, an integrated comprehensive approach to this uncommon condition enabled a new classification including few unreported variant cases, which were complemented. Results: PST is classified herein into a cephalic or caudal scrotal migration, the cephalic type subdivided into major and minor subtypes the latter type subdivided into bilateral, unilateral or central subtypes. Cases of caudal scrotal regression is an unreported anomaly in which the scrotum located caudally, as constant association with epispadias/exstrophy anomalies leaving a wide distance between the fixed penis and the scrotal sacs. Conclusion: PST is not rare as it was believed, it occurs in two directions; cephalic and caudal directions. Scrotal caudal regression anomaly was not described before, as well the PST presented as an inguinal hernia. [ABSTRACT FROM AUTHOR]

Twenty‐first‐century climate change projections are uncertain, especially on regional scales. An important source of uncertainty is that climate models exhibit biases, which limits their ability to predict climate. One of the largest biases is the too warm sea surface temperature (SST) in the eastern tropical Atlantic (TA), reflecting deficient atmospheric and oceanic circulation. Here, we show that CO2‐forced TA‐sector climate changes simulated by state‐of‐the‐art climate models exhibit a strong mean‐state dependence. In particular, models simulating largest SST warming in the eastern TA, consistent with the warming observed since the mid‐20th century, typically exhibit a more realistic mean state than models simulating largest warming in the western TA. The former models exhibit a larger climate sensitivity, and predict stronger and in part qualitatively different climate changes over the TA sector, for example in precipitation. These findings may help to reducing uncertainty in TA‐climate change projections. Plain Language Summary: Twenty‐first‐century climate change projections are uncertain, especially on regional scales. An important source of uncertainty is that climate models exhibit biases, which limits their ability to predict climate. One of the largest biases is the too warm sea surface temperature in the eastern tropical Atlantic (TA), reflecting deficient atmospheric and oceanic circulation. Here, we show that CO2‐forced TA‐sector climate changes simulated by state‐of‐the‐art climate models exhibit a strong relationship to the quality of simulating the mean state. These findings may help to reducing uncertainty in climate change projections over the TA sector. Key Points: Climate projections for the tropical Atlantic sector depend on the quality of simulating present‐day conditionsLess biased climate models provide more reliable projectionsSpread in CO2‐forced climate changes over the Tropical Atlantic region [ABSTRACT FROM AUTHOR]

Long‐term predictability of the North Atlantic sea surface temperature (SST) is commonly attributed to buoyancy‐forced changes of the Atlantic Meridional Overturning Circulation. Here we investigate the role of surface wind stress forcing in decadal hindcasts as another source of extratropical North Atlantic SST predictability. For this purpose, a global climate model is forced by reanalysis (ERA‐interim) wind stress anomalies over the period 1979–2017. The simulated climate states serve as initial conditions for decadal hindcasts. Significant skill in predicting detrended observed annual SST anomalies is observed over the extratropical central North Atlantic with anomaly correlation coefficients exceeding 0.6 at lead times of 4 to 7 yrs. The skill is insensitive to the calendar month of initialization and primarily linked to upper ocean heat content anomalies that lead anomalous SSTs by several years. Plain Language Summary: Certain aspects of the climate can be predicted several years in advance. This is primarily due to the slow components of the climate system, especially the ocean, which can influence the atmosphere on time scales of years to decades. It is thus essential to start long‐term climate forecasts from a realistic ocean state. However, ocean observations, especially subsurface data, are limited. Hence, predictions are often only based on surface observations. Here we demonstrate that the use of observed surface wind stress yields skillful predictions of the sea surface temperature (SST) over the extratropical North Atlantic at lead times of up to about 7 yrs. This is because the ocean circulation responds to the wind stress changes, which generate subsurface temperature anomalies that affect the surface with a time delay. These results may not only be of scientific but also of public and economic interest, because extratropical North Atlantic SST is thought to influence mean climate and extreme weather events over the adjacent continents. Key Points: Wind stress initialization yields skillful multiyear hindcasts of annual extratropical North Atlantic sea surface temperature anomaliesThe skill is essentially insensitive to the initialization calendar monthThe skill is linked to an upper ocean heat content anomaly that leads anomalous sea surface temperatures by several years [ABSTRACT FROM AUTHOR]

Characteristics of the seasonal and interannual sea surface temperature variability in the eastern equatorial Pacific (EEP) over last two interglacials, the Holocene and Eemian, are analyzed using transient climate simulations with the Kiel Climate Model. There is a tendency toward a strengthening of the seasonal as well as the El Niño/Southern Oscillation (ENSO)‐related variability from the early to the late interglacials. The weaker EEP sea surface temperature annual cycle during the early interglacials is mainly a result of insolation‐forced cooling during its warm phase and dynamically induced warming during its cold phase. Enhanced convection over northern South America weakens northeasterlies in the EEP leading to weaker equatorial upwelling, deeper thermocline and subsequent warming in this region. We show that a negative ENSO modulation of the annual cycle operates only on short timescales and does not affect their evolutions on orbital time scales where both ENSO and annual cycle show similar tendencies to increase. Plain Language Summary: Although the Sun crosses the equator twice a year, the sea surface temperature (SST) in the eastern equatorial Pacific (EEP) exhibits a distinct annual cycle. Therefore, in addition to the direct solar forcing, coupled ocean‐atmosphere processes must also be taken into consideration to explain the observed annual cycle of the EEP SST. The annual cycle is also an important factor for the seasonal phase locking of the El Niño/Southern Oscillation. The aim of this study is to identify dominant factors affecting the annual cycle and interannual variability in the EEP on geological time scales. For this purpose we analyze transient climate simulations of the last two interglacials, the Holocene (9,500–0 BP) and the Eemian (126,000–115,000 BP). We find that both El Niño/Southern Oscillation variability and the annual cycle of SST in the EEP tend to increase from the early to late interglacials. We will show that local radiative forcing and reorganized atmospheric circulation are dominant factors to modify the annual cycle. However, a relative contribution of these factors may vary within the year. Our research demonstrates that the mechanism of the present‐day annual cycle should be updated when considering long‐term variations of climate states on orbital time scales. Key Points: Both ENSO variability and the annual cycle of SST in the eastern tropical Pacific tend to increase from the early to late interglacialsDirect radiation forcing and dynamical processes are underlying factors to intensify annual cycle of the EEP SST through the interglacialsStrengthening of the annual cycle of the EEP SST is in agreement with reconstructed seasonal range of the eastern tropical Pacific SST [ABSTRACT FROM AUTHOR]

ABSTRACT: Understanding the effects of climate change and global warming on the South Asian summer monsoon rainfall trend is critically important for millions of inhabitants of this region. This study investigates seasonal (June–September) rainfall trend over the Indo‐Pakistan subcontinent by using 36 climate model outputs from the World Climate Research Programme's Coupled Model Inter‐comparison Project Phase 5. The historical (1951–2005) and future (2006–2100) simulations under two representative concentration pathways (RCPs), RCP4.5 and RCP8.5, are analysed for this purpose. Model reproducibility is evaluated based on spatial correlation of seasonal rainfall and vertically integrated meridional moisture transport between simulated and observed fields. It is found that the majority of models shows reasonable skill in capturing the observed pattern of rainfall climatology and trend over the subcontinent. Our results showed that the models are more skilful in simulating seasonal mean moisture transport than trend over the Arabian Sea and Bay of Bengal. Of the 36 models analysed, only two models HadGEM2‐AO and CNRM‐CM5 closely approximate both the climatology and trend based on statistical performance metrics. Our results suggest that the strengthening of northwards moisture transport over the Arabian Sea and Bay of Bengal is a likely reason for the increasing rainfall trend over Indo‐Pakistan subcontinent in a warmer climate. The RCP8.5 indicates marked increase in both rainfall and moisture transport trends compared to RCP4.5 forcing scenario. [ABSTRACT FROM AUTHOR]

Abstract: Climate models depict large diversity in the strength of the El Niño/Southern Oscillation (ENSO) (ENSO amplitude). Here we investigate ENSO‐amplitude diversity in the Coupled Model Intercomparison Project Phase 5 (CMIP5) by means of the linear recharge oscillator model, which reduces ENSO dynamics to a two‐dimensional problem in terms of eastern equatorial Pacific sea surface temperature anomalies (T) and equatorial Pacific upper ocean heat content anomalies (h). We find that a large contribution to ENSO‐amplitude diversity originates from stochastic forcing. Further, significant interactions exist between the stochastic forcing and the growth rates of T and h with competing effects on ENSO amplitude. The joint consideration of stochastic forcing and growth rates explains more than 80% of the ENSO‐amplitude variance within CMIP5. Our results can readily explain the lack of correlation between the Bjerknes Stability index, a measure of the growth rate of T, and ENSO amplitude in a multimodel ensemble. [ABSTRACT FROM AUTHOR]

Hymenolepis nana is the most commonly known intestinal cestode infecting mainly human. This study aimed to investigate the potential effect of chitosan particles ( CSP) to enhance the immune system against H. nana infection. Determination of worm burden, egg output, histopathological changes, oxidative stress markers (lipid peroxidation and reduced glutathione), goblet ( GCs) and mucosal mast cells ( MMCs) counts in intestinal ileum was performed. In addition, levels of intestinal mRNA expression of interleukin ( IL)-4, IL-9, stem cell factor ( SCF), type I and II interferons ( IFN)- α/ γ, tumour necrosis factor ( TNF)- α, mucin 2 ( MUC2) and inducible nitric oxide synthase ( iNOs) were investigated using real-time PCR. The results indicated induced reductions in adult worm and egg counts in infected mice after CSP treatment. This was associated with improvement in tissue morphometric measurements and oxidative stress which were altered after infection. Expression levels of iNOs, IFN- α, IFN- γ, TNF- α and IL-9 were decreased by CSP. Conversely, expression levels of MUC2, IL-4 and SCF increased compared to infected untreated group. In addition, GCs and MMCs counts were normalized by CSP. In conclusion, this study could indicate the immunoprotective effect of CSP against H. nana infection. This was characterized with Th2 anti-inflammatory responses. [ABSTRACT FROM AUTHOR]

Developing fragrant rice through marker-assisted/aided selection ( MAS) is an economical and profitable approach worldwide for the enrichment of an elite genetic background with a pleasant aroma. The PCR-based DNA markers that distinguish the alleles of major fragrance genes in rice have been synthesised to develop rice scent biofortification through MAS. Thus, the present study examined the aroma biofortification potential of these co-dominant markers in a germplasm panel of 189 F2 progeny developed from crosses between a non-aromatic variety ( MR84) and a highly aromatic but low-yielding variety ( MRQ74) to determine the most influential diagnostic markers for fragrance biofortification. The SSRs and functional DNA markers RM5633 (on chromosome 4), RM515, RM223, L06, NKSbad2, FMbadh2-E7, BADEX7-5, Aro7 and SCU015 RM (on chromosome 8) were highly associated with the 2 AP (2-acetyl-1-pyrroline) content across the population. The alleles traced via these markers were also in high linkage disequilibrium (R2 > 0.70) and explained approximately 12.1, 27.05, 27.05, 27.05, 25.42, 25.42, 20.53, 20.43 and 20.18% of the total phenotypic variation observed for these biomarkers, respectively. F2 plants harbouring the favourable alleles of these effective markers produced higher levels of fragrance. Hence, these rice plants can be used as donor parents to increase the development of fragrance-biofortified tropical rice varieties adapted to growing conditions and consumer preferences, thus contributing to the global rice market. [ABSTRACT FROM AUTHOR]

Aims To investigate the regulation of cannabinoid receptors CB1 and CB2 on immune cells by pro-inflammatory cytokines and its potential relevance to the inflammatory neurological disease, multiple sclerosis ( MS). CB1 and CB2 signalling may be anti-inflammatory and neuroprotective in neuroinflammatory diseases. Cannabinoids can suppress inflammatory cytokines but the effects of these cytokines on CB1 and CB2 expression and function are unknown. Methods Immune cells from peripheral blood were obtained from healthy volunteers and patients with MS. Expression of CB1 and CB2 mRNA in whole blood cells, peripheral blood mononuclear cells ( PBMC) and T cells was determined by quantitative real-time polymerase chain reaction ( qRT- PCR). Expression of CB1 and CB2 protein was determined by flow cytometry. CB1 and CB2 signalling in PBMC was determined by Western blotting for Erk1/2. Results Pro-inflammatory cytokines IL-1 β, IL-6 and TNF- α (the latter likely NF- κB dependently) can upregulate CB1 and CB2 on human whole blood and peripheral blood mononuclear cells ( PBMC). We also demonstrate upregulation of CB1 and CB2 and increased IL-1 β, IL-6 and TNF- α mRNA in blood of patients with MS compared with controls. Conclusion The levels of CB1 and CB2 can be upregulated by inflammatory cytokines, which can explain their increase in inflammatory conditions including MS. [ABSTRACT FROM AUTHOR]

Objectives: Minimally invasive, transnasal endoscopic approaches to the larynx have been utilized but are limited by the precision and accuracy afforded to the surgeon. The objective of this study is to analyze the feasibility of a rapidly deployable telerobotic system for enabling transnasal microsurgery of the larynx and upper airways, specifically injection laryngoplasty.Study Design: This is a feasibility study.Setting: This study was conducted at a laboratory in the Department of Mechanical Engineering at Vanderbilt University.Subjects and Methods: A feasibility study was conducted in which a telerobotic system was transnasally inserted in both a human intubation trainer mannequin and a cadaver. A flexible needle was passed through an instrumentation port and targeted specific areas of the vocal folds of our models to simulate injection laryngoplasty. The experiments were recorded with both still and video photography. Average forces exerted on surrounding tissue and times of deployment were measured.Results: Our robot was able to expeditiously gain access to the glottis with an average manual insertion time of 5.87 seconds while exerting minimal forces on the surrounding tissues with an average force of 4.45 Newtons. The onboard fiberoptic endoscope conveyed images of adequate quality for the completion of a simulated injection medialization laryngoplasty. The experiment was successfully completed in both mannequin and cadaveric models.Conclusion: This telerobotic system proved to be capable of being rapidly deployed to the upper airways while exerting minimal forces to the surrounding structures and successfully simulated injection medialization laryngoplasty. [ABSTRACT FROM AUTHOR]

Background and Purpose: The P2Y₁₄ receptor is the newest member of the P2Y receptor family; it is G(i/o) protein-coupled and is activated by UDP and selectively by UDP-glucose and MRS2690 (2-thiouridine-5'-diphosphoglucose) (7-10-fold more potent than UDP-glucose). This study investigated whether P2Y₁₄ receptors were functionally expressed in porcine isolated pancreatic arteries.Experimental Approach: Pancreatic arteries were prepared for isometric tension recording and UDP-glucose, UDP and MRS2690 were applied cumulatively after preconstriction with U46619, a TxA₂ mimetic. Levels of phosphorylated myosin light chain 2 (MLC2) were assessed with Western blotting. cAMP concentrations were assessed using a competitive enzyme immunoassay kit.Key Results: Concentration-dependent contractions with a rank order of potency of MRS2690 (10-fold) > UDP-glucose ≥ UDP were recorded. These contractions were reduced by PPTN {4-[4-(piperidin-4-yl)phenyl]-7-[4-(trifluoromethyl)phenyl]-2-naphthoic acid}, a selective antagonist of P2Y₁₄ receptors, which did not affect responses to UTP. Contraction to UDP-glucose was not affected by MRS2578, a P2Y₆ receptor selective antagonist. Raising cAMP levels and forskolin, in the presence of U46619, enhanced contractions to UDP-glucose. In addition, UDP-glucose and MRS2690 inhibited forskolin-stimulated cAMP levels. Removal of the endothelium and inhibition of endothelium-derived contractile agents (TxA₂, PGF(2α) and endothelin-1) inhibited contractions to UDP glucose. Y-27632, nifedipine and thapsigargin also reduced contractions to the agonists. UDP-glucose and MRS2690 increased MLC2 phosphorylation, which was blocked by PPTN.Conclusions and Implications: P2Y₁₄ receptors play a novel vasocontractile role in porcine pancreatic arteries, mediating contraction via cAMP-dependent mechanisms, elevation of intracellular Ca²⁺ levels, activation of RhoA/ROCK signalling and MLC2, along with release of TxA₂, PGF(2α) and endothelin-1. [ABSTRACT FROM AUTHOR]

BACKGROUND AND PURPOSE The P2Y14 receptor is the newest member of the P2Y receptor family; it is Gi/o protein-coupled and is activated by UDP and selectively by UDP-glucose and MRS2690 (2-thiouridine-5'-diphosphoglucose) (7-10-fold more potent than UDP-glucose). This study investigated whether P2Y14 receptors were functionally expressed in porcine isolated pancreatic arteries. EXPERIMENTAL APPROACH Pancreatic arteries were prepared for isometric tension recording and UDP-glucose, UDP and MRS2690 were applied cumulatively after preconstriction with U46619, a TxA2 mimetic. Levels of phosphorylated myosin light chain 2 (MLC2) were assessed with Western blotting. cAMP concentrations were assessed using a competitive enzyme immunoassay kit. KEY RESULTS Concentration-dependent contractions with a rank order of potency of MRS2690 (10-fold) ≥ UDP-glucose = UDP were recorded. These contractions were reduced by PPTN {4-[4-(piperidin-4-yl)phenyl]-7-[4-(trifluoromethyl)phenyl]-2-naphthoic acid}, a selective antagonist of P2Y14 receptors, which did not affect responses to UTP. Contraction to UDP-glucose was not affected by MRS2578, a P2Y6 receptor selective antagonist. Raising cAMP levels and forskolin, in the presence of U46619, enhanced contractions to UDP-glucose. In addition, UDP-glucose and MRS2690 inhibited forskolin-stimulated cAMP levels. Removal of the endothelium and inhibition of endothelium-derived contractile agents (TxA2, PGF2α and endothelin-1) inhibited contractions to UDP glucose. Y-27632, nifedipine and thapsigargin also reduced contractions to the agonists. UDP-glucose and MRS2690 increased MLC2 phosphorylation, which was blocked by PPTN. CONCLUSIONS AND IMPLICATIONS P2Y14 receptors play a novel vasocontractile role in porcine pancreatic arteries, mediating contraction via cAMP-dependent mechanisms, elevation of intracellular Ca2+ levels, activation of RhoA/ROCK signalling and MLC2, along with release of TxA2, PGF2α and endothelin-1. [ABSTRACT FROM AUTHOR]

We explore the amplification of magnetic fields in the high-redshift Universe. For this purpose, we perform high-resolution cosmological simulations following the formation of primordial halos with ∼ ⊙ 107 M, revealing the presence of turbulent structures and complex morphologies at resolutions of at least 32 cells per Jeans length. Employing a turbulence subgrid-scale model, we quantify the amount of unresolved turbulence and show that the resulting turbulent viscosity has a significant impact on the gas morphology, suppressing the formation of low-mass clumps. We further demonstrate that such turbulence implies the efficient amplification of magnetic fields via the small-scale dynamo. We discuss the properties of the dynamo in the kinematic and non-linear regime, and explore the resulting magnetic field amplification during primordial star formation. We show that field strengths of ∼ 10-5 G can be expected at number densities of ∼ 5 cm-3. (© 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [ABSTRACT FROM AUTHOR]

This article analyses the influence of acrylic fibers shape on the flexural behavior of cement composite. The fibers differ in their cross-sectional shapes due to the spinning process (wet-spun and dry-spun). The fibers were characterized by optical microscopy, and the shape factors were calculated on the basis of their geometric characteristics. Results showed that both types of acrylic fiber remarkably improved the flexural performance of the composites. Wet-spun acrylic fibers lead to high flexural strength and toughness. It was found that by increasing the fibers' shape factor by a factor of 10%, flexural strength and toughness increase to 26% and 23%, respectively. © 2012 Wiley Periodicals, Inc. J Appl Polym Sci, 2012 [ABSTRACT FROM AUTHOR]

Two sympatric populations of brown planthopper (BPH), one from rice and the other from Leersia hexandra were collected from each of five locations in Malaysia. All the tested malathion-resistant individuals of the rice BPH population and F generation (cross between malathion-resistant [usually caught on rice] and malathion-susceptible [usually caught on Leersia]) showed high esterase activity, while all malathion-susceptible individuals on L. hexandra showed low esterase activity. In the F generation, all the individuals tested against malathion were approximately 75% resistant and 25% susceptible and the inheritance pattern of esterase activity (high and low esterase activity) segregated in the same manner to a 3: 1 ratio. This confirms that resistance to malathion is mono-factorial and inheritance pattern of esterase activity is also linked to malathion resistance. Carboxylesterase or total esterase activity in BPH is inherited in a simple Mendelian fashion that is encoded by a single dominant gene. For the total esterase assay, average esterase activity levels in the rice-infesting population ranged from 17.64 to 19.37 nmoles 1-napthol/mg protein while that in the Leersia-infesting population ranged from 5.29 to 6.11 nmoles 1-napthol/mg protein. In terms of esterase activity, the two sympatric Nilaparvata lugens populations separated into two distinct groups. Results based on the tube color intensity test showed 96% and 98% resistant and susceptible individuals were present in the rice- and Leersia-infesting populations, respectively. In a filter paper test, the rice-infesting population had 94% with high esterase activity while the Leersia-infesting population had 96% with low esterase activity. [ABSTRACT FROM AUTHOR]

We have conducted a systematic inversion of striated fault planes throughout northern Pakistan in order to better depict the temporal and spatial variations in stress patterns. Two domains are evidenced at a regional scale, separated by the active Raikhot fault, the western boundary of the Nanga Parbat spur. West of this fault, a wrench-type stress field with σ1 axis oriented around N-S predominates in the Karakorum and in Kohistan. It predates Pliocene-Quaternary exhumation of Nanga Parbat and corresponds to the Miocene or earlier regional stress field related to Indian-Asian convergence. East of the Raikhot fault, compression parallel to the belt accounts for initiation of the Nanga Parbat anticlinorium after 5 Ma. It is followed by predominant post-2 Ma extension, both parallel to the belt and NNE-SSW oriented. Thus, in the N-W Himalayan syntaxis, multidirectional extension is juxtaposed on short timescales to shortening either parallel or perpendicular to the belt. Such juxtaposition could be characteristic of strain and stress partitioning during oblique convergence. [ABSTRACT FROM AUTHOR]

Background and purpose:The uracil nucleotides UDP and UTP have been reported to activate P2Y2, P2Y4 and P2Y6 receptors to cause vasoconstriction. We have performed a comparative analysis of these receptors in endothelium-denuded smooth muscle from porcine isolated coronary and ear arteries, using pharmacological and molecular tools.Experimental approach:Tissue segments were used to construct non-cumulative concentration response curves for UTP and UDP, in the absence and presence of the P2 receptor antagonists PPADS or suramin. RT-PCR and immunoblot analyses were employed to define gene expression and immunoreactivity for P2Y2, P2Y4 and P2Y6 receptors.Key results:In the coronary artery, UTP-evoked contractile responses were reduced in the presence of suramin, but not PPADS, while the smaller responses to UDP were unaffected by either antagonist. In the ear artery, contractile responses to UDP were much smaller than those to UTP; responses to UTP were inhibited by both PPADS and suramin. RT-PCR suggested predominant expression of P2Y2 receptors in the coronary artery, while P2Y4 and P2Y6 receptor gene expression appeared equivalent in both tissues. Immunoblot analyses provided evidence for P2Y6 receptors in both tissues, with equivocal evidence of P2Y2 and P2Y4 receptor immunoreactivities.Conclusions and implications:We conclude that UTP-evoked contraction of porcine coronary artery smooth muscle appears to be predominantly P2Y2-mediated, while the ear artery appears to express a uracil nucleotide-sensitive P2 receptor(s) which fails to fit readily into the current classification.British Journal of Pharmacology (2007) 150, 604–612. doi:10.1038/sj.bjp.0707120; published online 29 January 2007 [ABSTRACT FROM AUTHOR]

: The frequency and determinants of receipt of antiviral therapy once a diagnosis of a mood disorder is established in hepatitis C virus (HCV)-infected patients remains unknown.: To examine the incidence and determinants of receiving antiviral therapy in HCV-infected veterans with abnormal scores of Zung Self-Rating Depression Scale (SDS).: We systematically evaluated the presence of psychiatric disorders among HCV-infected patients with initial referral between September 2000 and May 2002. We reviewed medical records, obtained history, and administered Zung SDS to evaluate for depressive symptoms. Patients with psychiatric disorders were referred for psychiatric evaluation. The primary outcome was the receipt of antiviral therapy during and after the initial evaluation up to December 1, 2003. The association between SDS scores and receipt of antiviral therapy was examined in a multivariate Cox proportional hazards regression.: A total of 424 patients completed a Zung SDS. The scores were normal in only 43% of all patients, and were impaired mildly in 25%, moderately in 23%, and severely in 9%. Zung SDS scores were significantly higher in patients who served during the Vietnam War era, participated in combat, or had lower albumin levels. At the end of the first visit, 180 (42%) had psychiatric disorders. An abnormal Zung score (>55) was the only reason for referral to psychiatry in 83 of 180 patients; and in those 78 (94%) a formal psychiatric evaluation confirmed depressive disorder. Psychiatric disorders were the sole contraindication to therapy in 145 (34%) patients in whom eligibility for antiviral therapy was achieved in 42 (29%) during a mean follow-up duration of 27 months.: Approximately one-quarter of patients with psychiatric disorders may become eligible for antiviral therapy following subsequent management of these disorders. The Zung self-screening test is an easy, valid method for detecting mood disorders in HCV-infected veterans. [ABSTRACT FROM AUTHOR]

Treatment for childhood acute myeloid leukaemia (AML) consists of remission induction chemotherapy followed by postremission chemotherapy with or without bone marrow transplantation. The AML Berlin–Frankfurt–Munster (BFM)-83 protocol with induction–consolidation–maintenance chemotherapy for 2 years has been reported to result in a 6-year event-free survival (EFS) and event-free interval (EFI) of 49% and 61% respectively. A total of 174 Malaysian children were treated with this protocol between 1985 and 1999. The 5-year EFS and EFI was 30.7% and 48.0% respectively. The overall mortality from sepsis was 24%, which needs urgent address. The 5-year EFS for patients treated before 1993 and after 1993 was 18.6% and 41.3%, respectively (P = 0.04), while the EFI was 32% and 60.6% respectively (P = 0.034). The improvement seen after 1993 was related to a reduction in induction deaths for that period and probably reflected increased capability and familiarity to cope with the demands of the AML-BFM-83 protocol and accompanying complications in the treatment of AML. [ABSTRACT FROM AUTHOR]

Authors from Mansoura evaluated the outcome of patients with continent urinary diversion who had a single functioning kidney. They recommend a regular follow-up of renal function in such patients. They found that rectal diversion was associated with a higher renal functional loss than orthotopic or cutaneous reservoirs. In the second article, the authors from Cairo describe the value of dynamic three-dimensional spiral CT cysto-urethrography in evaluating post-traumatic posterior urethral defects. To evaluate the outcome of patients with continent urinary diversions who had a solitary functioning kidney at the time of surgery. In all, 62 patients with continent urinary reservoirs and a solitary functioning kidney were reviewed (51 men and 11 women). The indications for surgery were bladder cancer in 54 and a contracted bladder in eight. The surgical procedures included an orthotopic ileal neobladder in 36 patients, a continent cutaneous ileal reservoir in 13 and rectal diversion in 13. Kidneys were evaluated using serum creatinine level, ultrasonography, intravenous urography and other radiological studies. The follow-up was 6–173 months; 44 renal units (71%) remained stable during this period. Serum creatinine was increased in four patients with an orthotopic neobladder, with no evidence of obstruction or reflux, in one with preoperative renal impairment and one with voiding dysfunction, reflux and bacteriuria. Six renal units deteriorated because of uretero-intestinal strictures; of these patients, two were treated endoscopically, two with open ureteric reimplantation, one with conversion from a rectal reservoir to an ileal loop conduit, and one was maintained on JJ stenting. Six patients with a rectal diversion had renal deterioration because of chronic pyelonephritis. A regular follow-up of renal function is mandatory in patients with a continent urinary diversion. Rectal diversion is associated with a higher risk of renal deterioration (54%) than are orthotopic (28%) and cutaneous reservoirs (8%). [ABSTRACT FROM AUTHOR]

Unlabelled: Respiratory syncytial virus (RSV) chest infection is a common cause of hospitalization in the very young child. The aim of this study was to determine the direct cost of resource utilization in the treatment of children hospitalized with RSV chest infection and the potential cost-savings with passive immunization for high-risk infants. An audit of the hospital resource consumption and its costs was performed for 216 children aged < 24 mo admitted with RSV chest infection between 1995 and 1997. The cost-saving potential of passive immunization using monoclonal RSV antibodies during the RSV season was determined by assuming an 0.55 efficacy in hospitalization reduction when administered to "high-risk" infants according to the guidelines outlined by the American Academy of Pediatrics (AAP). The hospital treatment cost of 1064 bed-days amounted to USD 64 277.70. Each child occupied a median of 4.0 bed-days at a median cost of USD 169.99 (IQ1 128.08, IQ3 248.47). Children, who were ex-premature or with an underlying illness were more likely to have a longer hospital stay, higher treatment costs and need for intensive care. Ten (42%) of 24 ex-premature infants fulfilled the recommended criteria for passive immunization. Its use resulted in an incremental cost of USD 31.39 to a potential cost saving of USD 0.91 per infant for each hospital day saved.Conclusion: Ex-prematurity and the presence of an underlying illness results in escalation of the direct treatment cost of RSV chest infection. Current guidelines for use of passive RSV immunization do not appear to be cost-effective if adopted for Malaysian infants. [ABSTRACT FROM AUTHOR]

Oesophageal Doppler monitoring allows non-invasive estimation of stroke volume and cardiac output. We studied the impact of Doppler guided fluid optimisation on haemodynamic parameters, peri-operative morbidity and hospital stay in patients undergoing major bowel surgery. Fifty-seven patients were randomly assigned to Doppler (D) or control (C) groups. All patients received intra-operative fluid therapy at the discretion of the non-investigating anaesthetist. In addition, Group D were given fluid challenges (3 ml x kg(-1)) guided by oesophageal Doppler. Group D received significantly more intra-operative colloid than Group C (mean 28 (SD 16) vs. 19.4 (SD 14.7) ml x kg(-1), p = 0.02). Cardiac output increased significantly for Group D whilst that of controls remained unchanged. The mean difference between the groups in final cardiac output was 0.87 l x min(-1) (95% confidence interval 0.31-1.43 l x min(-1), p = 0.003). Five control patients required postoperative critical care admission. Fluid titration using oesophageal Doppler during bowel surgery can improve haemodynamic parameters and may reduce critical care admissions postoperatively. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Healthcare systems contribute 5%–10% of the global carbon footprint. Given the detrimental impact of climate change on population health, health systems must seek to address this environmental responsibility. This is especially relevant in the modern era of minimally invasive procedures (MIP) where single‐use instruments are increasingly popular. We compared the environmental footprint of single‐use versus multi‐use instruments in MIP.We conducted a systematic review across five databases to identify relevant original studies, following the PRISMA guidelines. We extracted environmental impact data and performed a quality assessment of included studies.We included 13 studies published between 2005 and 2024. Eight employed Life Cycle Analysis (LCAs), which is the gold standard methodology for studies evaluating environmental impact. The instruments studied included laparoscopy systems, endoscopes, cystoscopes, bronchoscopes, duodenoscopes, and ureteroscopes. Six studies, including three high quality LCAs and one fair quality LCA, showed that single‐use instruments have a significantly higher environmental footprint than their multi‐use counterparts. Six studies suggested a lower environmental footprint for single‐use instruments, and one study presented comparable results. However, these studies were of poor/fair quality.Although our systematic review yielded mixed results, all high quality LCAs suggested multi‐use instruments may be more environmentally friendly than their single‐use counterparts. Our findings are limited by inter‐study heterogeneity and methodological quality. There is an urgent need for additional research employing gold standard methodologies to explore the interplay between environmental impact and operational factors such as workflow efficiency and cost‐benefit ratio to allow health systems to make more informed decisions. [ABSTRACT FROM AUTHOR]

Two hexaploid somatic hybrids [SH; L. esculentum (+) L. peruvianum] accessions 6 and 18 were backcrossed with two diploid L. esculentum cultivars 'Moneymaker' (MM) and 'Pusa Ruby' (PR). Twenty-two plants of the BC2 generation were produced by backcrossing 7 BC1 plants (MM ) × SH, 6, 18) with five tomato cultivars. Fourteen of the BC2 plants were self-fertile, five produced anther cones with anthocyanin pigmentation not present in the parents. A BC3 generation was developed by crossing the four cultivars as female parent with three BC2 generation plants. The BC3 progeny derived from one pollen parent plant were produced without the need to culture immature seeds. They segregated with respect to pigmented anther cones and were self-fertile. The anther cone pigmentation of the pollen parent plant was associated with increased seed set, greater fruit size and an orange-red fruit colour. These features were transmitted to the fertile BC3 generation. Conversely, BC3 offspring involving the other two parent plants were only recovered by culture of immature seeds. The recovery of diploid plants in BC1 and self-fertility in BC2 resulted in almost total recovery of the tomato cultivar characteristics (fruit size, colour and number of seeds) by BC3. [ABSTRACT FROM AUTHOR]