Search

Objective/hypothesis: Studies have suggested preterm birth, defined as gestational age (GA) <37 weeks, is a risk factor for obstructive sleep apnea (OSA) in later childhood. However, little is known about the characteristics, severity, and degree of intervention of childhood OSA in former preterm infants compared to term infants. This study compares polysomnographic characteristics and surgical interventions in former preterm and term infants presenting with sleep disordered breathing., Study Design: Retrospective cohort study from 2015 to 2019 at a single tertiary referral center., Methods: Electronic Medical Records of pediatric patients ages 0 to 18 presenting with sleep disordered breathing were reviewed for gestational age, polysomnographic findings, clinical characteristics, and OSA surgical interventions. Association between gestational age, polysomnographic characteristics, and surgical interventions for OSA were reported., Results: A total of 615 patient records were analyzed. Adjusting for covariates, prematurity was associated with a 2.97× higher likelihood of development of severe OSA (aOR (95%CI): 2.97 (1.40-6.32)), increased apneic-hypoxic index (AHI) (mean (SD): 6.5 (9.8) vs. 4.6 (6.4), P < .05), increased end tidal CO 2 (50.5 (5.11) vs. 48.5 (5.8), P < .05), decreased REM latency (116 (64.7) vs. 132.4 (69.9), P < .05), and increased number of surgeries for OSA (0.65 (.95) vs. 0.45 (0.69), P < .05) compared to children born at term. Children born with GA < 32 weeks presented at a significantly later age with sleep disordered breathing (7.04 (.80) vs. 5.1 (0.15), P < .05) than children born at term., Conclusions: Prematurity was associated with increased likelihood of severe OSA, increased AHI, as well as increased number of surgical interventions for OSA compared to children born at term. These results suggest an association with preterm birth and increased severity of childhood OSA., Level of Evidence: 3 Laryngoscope, 131:1909-1914, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

We prepared a poly(pyrrole : biphenyldisulfonic acid : pyrrole (Py:BPDSA:Py)) nanocomposite of molybdenum disulfide (MoS 2 ), P(Py:BPDSA:Py)-MoS 2 , with high crystallinity. The composite is synthesized by oxidative polymerization of Py:BPDSA:Py as a two-monomer-connected precursor (TMCP) linked by ionic bonding on a molybdenum disulfide (MoS 2 ) monolayer. The chemical, structural and morphological characterization of this composite is confirmed by Raman spectroscopy, FT-IR, X-ray photoelectron spectroscopy (XPS), electron energy loss spectroscopy (EELS), and scanning electron microscopy (SEM). The crystal structure is analysed by X-ray diffraction (XRD) and high-voltage electron microscopy (HVEM), which shows a face-centered cubic (FCC) crystal structure for the composite. Nitrogen adsorption-desorption isotherms show an improved specific surface area (91.3 m 2 g -1 ). The electrochemical properties of the composite with a unique crystal structure and a large specific surface area are analysed through cyclic voltammetry (CV), which shows a specific capacitance of 681 F g -1 demonstrating that the composite can be used as an efficient electrode active material for electrochemical energy storage systems.

Background: Medication-related problems (MRPs) are a major healthcare burden. The rate of MRPs in those ≥65 years old is ∼50 events per 1000 person-years, and contributes to a four-fold higher hospitalization rate when compared to younger patients. Medication therapy management (MTM) can identify MRPs in high-risk patients. However, in 2015, only 12.9% of Medicare patients qualified for MTM services through their Part D plan., Objective: To examine the type and frequency of MRPs in community-dwelling Medicare beneficiaries and which patient factors are associated with having ≥1 MRP., Methods: Fourteen health clinics targeting Medicare beneficiaries were held in 10 Northern/Central California cities during Fall 2017. Trained student pharmacists, supervised by licensed pharmacists, conducted comprehensive medication reviews. Sociodemographic, chronic condition, medication, and MRP data were collected via standardized surveys., Results: MTM services were provided to 910 patients, of which 633 (69.6%) had at least 1 MRP. The most common MRPs were severe drug-drug interaction [n = 297(33.4%)] and untreated condition [n = 134 (14.7%). Individuals with MRPs took significantly more prescription and over-the-counter medications. Additionally, those with MRPs were more likely to be subsidy recipients and in a Medicare Advantage Prescription Drug Plan. A total of 120 (13%) individuals were found to have had an MRP severe enough to warrant prescriber follow-up., Conclusions: Although only a fraction of Medicare beneficiaries qualify for MTM services through their Part D plan, many can benefit from such services. Understanding the type, frequency, and factors contributing to MRPs is imperative to identify and avoid negative sequelae. Reduction of MRPs can potentially improve patient clinical outcomes, increase quality-of-life, and decrease overall cost of care., (Copyright © 2019 Elsevier Inc. All rights reserved.)

We investigate the effect of bacteriophage infection and antibiotic treatment on the coordination of swarming, a collective form of flagellum- and pilus-mediated motility in bacteria. We show that phage infection of the opportunistic bacterial pathogen Pseudomonas aeruginosa abolishes swarming motility in the infected subpopulation and induces the release of the Pseudomonas quinolone signaling molecule PQS, which repulses uninfected subpopulations from approaching the infected area. These mechanisms have the overall effect of limiting the infection to a subpopulation, which promotes the survival of the overall population. Antibiotic treatment of P. aeruginosa elicits the same response, abolishing swarming motility and repulsing approaching swarms away from the antibiotic-treated area through a PQS-dependent mechanism. Swarms are entirely repelled from the zone of antibiotic-treated P. aeruginosa , consistent with a form of antibiotic evasion, and are not repelled by antibiotics alone. PQS has multiple functions, including serving as a quorum-sensing molecule, activating an oxidative stress response, and regulating the release of virulence and host-modifying factors. We show that PQS serves additionally as a stress warning signal that causes the greater population to physically avoid cell stress. The stress response at the collective level observed here in P. aeruginosa is consistent with a mechanism that promotes the survival of bacterial populations. IMPORTANCE We uncover a phage- and antibiotic-induced stress response in the clinically important opportunistic pathogen Pseudomonas aeruginosa Phage-infected P. aeruginosa subpopulations are isolated from uninfected subpopulations by the production of a stress-induced signal. Activation of the stress response by antibiotics causes P. aeruginosa to physically be repelled from the area containing antibiotics altogether, consistent with a mechanism of antibiotic evasion. The stress response observed here could increase P. aeruginosa resilience against antibiotic treatment and phage therapy in health care settings, as well as provide a simple evolutionary strategy to avoid areas containing stress., (Copyright © 2019 American Society for Microbiology.)

There is a high demand for the development of reliable chronic toxicity tests using tropical marine species for subsequent use in tropical risk assessment. However, many chronic test endpoints can be laborious and time-consuming to assess, particularly if the endpoints require measurements of individuals (e.g. growth, size) or advanced taxonomic expertise (e.g. differentiating between larval development stages). In this study, we used scanning and image recognition (SIR) technology to develop and validate a chronic toxicity test with larvae of the tropical euryhaline copepod, Acartia sinjiensis. Optimisation steps are described, and included egg age, and effect of algal food type and salinity on toxicity. Comparisons were made between traditional endpoints measured using microscopy and those measured using SIR. Traditional endpoints of larval development ratio (LDR) and survival achieved using microscope examination and SIR were almost identical (R 2  = 0.96-0.97). Additional endpoints made possible by SIR included larval development index (LDI; based on the number of animals at different stages of development), and a range of size measurements (e.g. surface area, perimeter and length) for individual animals and for total populations (i.e. a proxy for biomass). The SIR-derived endpoints were based on measurements that had concentration-dependant responses to tested toxicants (copper, nickel, ammonia), and were a sub-set of the full range of metrics provided by the software. Toxicity values based on SIR-measurements were similar to or more sensitive than the traditional LDR endpoint. SIR technology provides a major opportunity to improve and modernise larval development tests for a range for species, but comes at a cost of increased data size and complexity. Therefore, as a research tool, SIR has significant advantages over traditional microscope methods, but for routine toxicity testing, SIR incorporation into invertebrate toxicity testing will benefit from further improvements to the associated software and data management systems., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Low open-circuit voltages significantly limit the power conversion efficiency of organic photovoltaic devices. Typical strategies to enhance the open-circuit voltage involve tuning the HOMO and LUMO positions of the donor (D) and acceptor (A), respectively, to increase the interfacial energy gap or to tailor the donor or acceptor structure at the D/A interface. Here, we present an alternative approach to improve the open-circuit voltage through the use of a zinc chlorodipyrrin, ZCl [bis(dodecachloro-5-mesityldipyrrinato)zinc], as an acceptor, which undergoes symmetry-breaking charge transfer (CT) at the donor/acceptor interface. DBP/ZCl cells exhibit open-circuit voltages of 1.33 V compared to 0.88 V for analogous tetraphenyldibenzoperyflanthrene (DBP)/C60-based devices. Charge transfer state energies measured by Fourier-transform photocurrent spectroscopy and electroluminescence show that C60 forms a CT state of 1.45 ± 0.05 eV in a DBP/C60-based organic photovoltaic device, while ZCl as acceptor gives a CT state energy of 1.70 ± 0.05 eV in the corresponding device structure. In the ZCl device this results in an energetic loss between E(CT) and qV(OC) of 0.37 eV, substantially less than the 0.6 eV typically observed for organic systems and equal to the recombination losses seen in high-efficiency Si and GaAs devices. The substantial increase in open-circuit voltage and reduction in recombination losses for devices utilizing ZCl demonstrate the great promise of symmetry-breaking charge transfer in organic photovoltaic devices.

Zinc dipyrrin complexes with two identical dipyrrin ligands absorb strongly at 450-550 nm and exhibit high fluorescence quantum yields in nonpolar solvents (e.g., 0.16-0.66 in cyclohexane) and weak to nonexistent emission in polar solvents (i.e., <10 -3 , in acetonitrile). The low quantum efficiencies in polar solvents are attributed to the formation of a nonemissive symmetry-breaking charge transfer (SBCT) state, which is not formed in nonpolar solvents. Analysis using ultrafast spectroscopy shows that in polar solvents the singlet excited state relaxes to the SBCT state in 1.0-5.5 ps and then decays via recombination to the triplet or ground states in 0.9-3.3 ns. In the weakly polar solvent toluene, the equilibrium between a localized excited state and the charge transfer state is established in 11-22 ps.

Background: The patient pathway to cataract surgery in Australia generally begins with optometric services; however, little is known about the cataract surgery referral criteria used by optometrists in Australia., Methods: Members of Optometrists Association Australia were invited to complete an online survey in April 2013. The survey elicited information on practice demographics, professional characteristics of optometrists and cataract surgery referral considerations., Results: We received responses from 533 of 4272 (13 per cent) practising optometrists. Over three-quarters (407 of 528, 77 per cent) indicated a visual acuity (VA) cataract referral benchmark of 6/9 to 6/12. Almost all respondents (499 out of 532, 94 per cent) stated they included glare sensitivity as part of their referral criteria, whereas a considerably lower proportion (40 of 528, eight per cent) used contrast sensitivity testing. Patient-centred factors such as hobbies (94 per cent) and driving (73 per cent) featured in the decision to refer patients sooner, while a patient not wanting surgery (79 per cent) was the most frequent reason cited for delaying referral. Respondents practising in more advantaged socioeconomic areas were 2.4 times more likely to refer privately (95% CI 1.6-3.6) and less likely to consider surgical costs as an important consideration (p < 0.001). Almost all respondents (97 per cent) who referred publicly discussed public hospital waiting times with their patients (median minimum wait estimate of 12 to 18 months), compared to the smaller proportion (64 per cent) of respondents discussing private waiting times (median minimum wait estimate of one to two months)., Conclusion: While modest reductions in VA were sufficient to prompt referral for cataract surgery by Australian optometrists, patient-reported visual disability guided the optometrist's overall referral decision. Socioeconomic status of practice location influenced the choice to refer publicly versus privately and surgical costs were also considered., (© 2014 The Authors. Clinical and Experimental Optometry © 2014 Optometrists Association Australia.)

Background: The Src homology-2 domain protein B (Shb) is an adapter protein operating downstream of several tyrosine kinase receptors and consequently Shb regulates various cellular responses. Absence of Shb was recently shown to reduce hematopoietic stem cell proliferation through activation of focal adhesion kinase (FAK) and thus we sought to investigate Shb's role in the progression of leukemia., Methods: Wild type and Shb knockout bone marrow cells were transformed with a retroviral BCR-ABL construct and subsequently transplanted to wild type or Shb knockout recipients. Disease latency, bone marrow and peripheral blood cell characteristics, cytokine expression, signaling characteristics and colony formation were determined by flow cytometry, qPCR, western blotting and methylcellulose colony forming assays., Results: It was observed that Shb knockout BCR-ABL-transformed bone marrow cells produced a disease with death occurring at earlier time points compared with corresponding wild type controls due to elevated proliferation of transformed bone marrow cells. Moreover, significantly elevated interleukin-6 and granulocyte colony-stimulation factor mRNA levels were observed in Shb knockout c-Kit + leukemic bone marrow cells providing a plausible explanation for the concurrent peripheral blood neutrophilia. Shb knockout leukemic bone marrow cells also showed increased ability to form colonies in methylcellulose devoid of cytokines that was dependent on the concomitantly observed increased activity of FAK. Transplanting BCR-ABL-transformed Shb knockout bone marrow cells to Shb knockout recipients revealed decreased disease latency without neutrophilia, thus implicating the importance of niche-derived cues for the increase of blood granulocytes., Conclusions: Absence of Shb accelerates disease progression by exerting dual roles in BCR-ABL-induced leukemia: increased cell expansion due to elevated FAK activity and neutrophilia in peripheral blood, the latter dependent on the genetic background of the leukemic niche.

Previous studies have shown that cannabinoid CB1/2 and vanilloid TRPV1 agonists (delta-9-tetrahydrocannabinol (Δ(9)-THC) and resiniferatoxin (RTX), respectively) can attenuate the emetic effects of chemotherapeutic agents such as cisplatin. In this study we used the least shrew to demonstrate whether combinations of varying doses of Δ(9)-THC with resiniferatoxin can produce additive antiemetic efficacy against cisplatin-induced vomiting. RTX by itself caused vomiting in a bell-shaped dose-dependent manner with maximal vomiting at 18 μg/kg when administered subcutaneously (s.c.) but not intraperitoneally (i.p.). Δ(9)-THC up to 10 mg/kg provides only 80% protection of least shrews from cisplatin-induced emesis with an ID50 of 0.3-1.8 mg/kg. Combinations of 1 or 5 μg/kg RTX with varying doses of Δ(9)-THC completely suppressed both the frequency and the percentage of shrews vomiting with ID50 dose values 5-50 times lower than Δ(9)-THC doses tested alone against cisplatin. A less potent TRPV1 agonist, capsaicin, by itself did not cause emesis (i.p. or s.c.), but it did significantly reduce vomiting induced by cisplatin given after 30 min but not at 2 h. The TRPV1-receptor antagonist, ruthenium red, attenuated cisplatin-induced emesis at 5mg/kg; however, another TRPV1-receptor antagonist, capsazepine, did not. In summary, we present evidence that combination of CB1/2 and TRPV1 agonists have the capacity to completely abolish cisplatin-induced emesis at doses that are ineffective when used individually., (© 2013 Published by Elsevier B.V.)

Fullerenes are currently the most popular electron-acceptor material used in organic photovoltaics (OPVs) due to their superior properties, such as good electron conductivity and efficient charge separation at the donor/acceptor interface. However, low absorptivity in the visible spectral region is a significant drawback of fullerenes. In this study, we have designed a zinc chlorodipyrrin derivative (ZCl) that absorbs strongly in the visible region (450-600 nm) with an optical density 7-fold higher than a C60 film. ZCl efficiently transfers absorbed photoenergy to C60 in mixed films. Application of ZCl as an energy sensitizer in OPV devices leads to an increase in the photocurrent from the acceptor layer, without changing the other device characteristics, i.e., open circuit voltage and fill factor. For example, C60-based OPVs with and without the sensitizer give 4.03 and 3.05 mA/cm(2), respectively, while both have V(OC) = 0.88 V and FF = 0.44. Our ZCl sensitization approach improves the absorbance of the electron-acceptor layer while still utilizing the beneficial characteristics of C60 in OPVs.

We demonstrate the concentration dependence of C60 absorption in solid solutions of C60 and bathocuprione (BCP), revealing a nonlinear decrease of the C60 charge transfer (CT) state absorption. These blends are utilized to study the photocurrent contribution of the CT in bilayer organic photovoltaics (OPVs); 1:1 blends produce 40% less photocurrent. As exciton blocking electron transporting layers, the blends achieve power conversion efficiencies of 5.3%, an increase of 10% compared to conventional buffers.

Background: Kawasaki disease is an acute, self-limited vasculitis of childhood that can result in structural damage to the coronary arteries. Previous studies have implicated the TGF-β pathway in disease pathogenesis and generation of myofibroblasts in the arterial wall. microRNAs are small non-coding RNAs that modulate gene expression at the post-transcriptional level and can be transported between cells in extracellular vesicles. To understand the role that microRNAs play in modifying gene expression in Kawasaki disease, we studied microRNAs from whole blood during the acute and convalescent stages of the illness., Methodology/principal Findings: RNA isolated from the matched whole blood of 12 patients with acute and convalescent Kawasaki disease were analyzed by sequencing of small RNA. This analysis revealed six microRNAs (miRs-143, -199b-5p, -618, -223, -145 and -145* (complementary strand)) whose levels were significantly elevated during the acute phase of Kawasaki disease. The result was validated using targeted qRT-PCR using an independent cohort (n = 16). miR-145, which plays a critical role in the differentiation of neutrophils and vascular smooth muscle cells, was expressed at high levels in blood samples from acute Kawasaki disease but not adenovirus-infected control patients (p = 0.005). miR-145 was also detected in small extracellular vesicles isolated from acute Kawasaki disease plasma samples. Pathway analysis of the predicted targets of the 6 differentially expressed microRNAs identified the TGF-β pathway as the top pathway regulated by microRNAs in Kawasaki disease., Conclusion: Sequencing of small RNA species allowed discovery of microRNAs that may participate in Kawasaki disease pathogenesis. miR-145 may participate, along with other differentially expressed microRNAs, in regulating expression of genes in the TGF-β pathway during the acute illness. If the predicted target genes are confirmed, our findings suggest a model of Kawasaki disease pathogenesis whereby miR-145 modulates TGF-β signaling in the arterial wall.

We report here on a 25-year follow-up of cranio-meta-diaphyseal dysplasia in a 31-year-old Caucasian male, who was reported in the literature at the age of 8 years [Langer et al. (1991); Skeletal Radiol 20:37-41]. He has hyperostotic craniofacial features with protruding lower jaw and midface hypoplasia. He has the typical radiographic features of wide long tubular bones without normal metaphyseal flaring and wide short tubular bones without normal diaphyseal constriction. We describe here his clinical and radiological findings and compare his case with those published in the literature. He is the oldest reported patient with this disorder giving some insight into the natural history of this rare skeletal dysplasia.

Smoke, smoke-water and aerosols have a stimulatory effect on seed germination and growth vigour of many seedlings, making them potentially useful for different purposes, provided they do not pose a health risk. Therefore, the genotoxicity of two kinds of smoke-water and 3,7-dimethyl-2H-furo[2,3-c]pyran-2-one, a variant of the most active smoke compound (3-methyl-2H-furo[2,3-c]pyran-2-one) was evaluated using the Vitotox assay. Smoke-water extracts were obtained from burning leaves: Themeda triandra (smoke-water Tt) and a mix of Themeda triandra and Passerina vulgaris (smoke-water Kb). No genotoxic effect was observed for any of the three samples. However, the three samples are toxic at the highest concentrations (3,7-dimethyl-2H-furo[2,3-c]pyran-2-one, 2 ppm; smoke-water Tt, dilutions 1 : 1, 1 : 2, 1 : 4; smoke-water Kb, dilution 1 : 1) without addition of S9 mix. Both the butenolide 3,7-dimethyl-2H-furo[2,3-c]pyran-2-one and smoke-water Tt are also toxic at high doses in the presence of S9 (2 ppm and dilutions 1 : 1 and 1 : 2, respectively), but not smoke-water Kb. Thus, from these results, no genotoxicity of these three samples can be assumed, which is accordance with the previous tests performed with 3-methyl-2H-furo[2,3-c]pyran-2-one and a smoke-water., ((c) 2010 John Wiley & Sons, Ltd.)

Context: The siblings of teenage parents are known to be at very high risk of teenage pregnancy, but little is known about how an older sister's childbearing affects a younger sibling's risk. Understanding these influences could help address the very high rates of pregnancy and childbearing among Latino adolescents., Methods: From 2005 through 2007, a sample of 41 Mexican American 12-18-year-olds from southern California completed in-depth interviews about how an older sister's teenage childbearing had affected them. Themes that emerged were categorized as risk factors (circumstances that increased youths' likelihood of becoming involved in a teenage pregnancy) or protective factors (conditions that reduced this likelihood) on the basis of well-established findings in the literature., Results: Interview data reflected six risk factors and 11 protective factors. The most commonly reported risk factors (discussed by more than a quarter of participants) were that youths did not perceive early parenting as a hardship, had increased difficulties in school and wanted to have a baby too. The most commonly cited protective factors (mentioned by more than half) were an increased motivation to avoid early parenting, an increased appreciation of the difficulties of parenting, mothers' explicitly discouraging early parenting and youths' feeling of greater closeness with their mother., Conclusions: Interventions that build on the protective factors that result when a youth's older sibling has a teenage birth, while reducing the risk factors, might help families prevent younger children from becoming involved in a teenage pregnancy.

The structures and stability of monomeric and oligomeric compounds resulting from the elimination of 2 mol of HBr from the AlBr(3)en complex have been studied theoretically at the B3LYP/LANL2DZ(d,p) level of theory. Two series of the ring and cage oligomer compounds were considered: imino [AlBrNCH(2)CH(2)NH(2)](n), n = 1-4, 6 (I(n)), and isomeric amido [AlBrNHCH(2)CH(2)NH](n), n = 1-3 (A'(n)), species. In all cases the amido isomers are 95-295 kJ mol(-1) more stable compared to their imino counterpairs. Intramolecular donor-acceptor interactions play an important role in the stabilization of the structure. Possible pathways of the polymerization have also been explored. Although the generation of the oligomers via HBr elimination in the gas phase is predicted to be thermodynamically unfavorable, operation of such reactions in the condensed phase is feasible. Substitution of bromine by hydrogen makes H(2) elimination reactions thermodynamically favorable. This opens a perspective for the synthesis of novel ladder-type oligomers with a continuous (AlN)(n) core supported by C(2)H(4) balustrade and imino cages with C(2)H(4) handles.

Diarrhea in the elderly population is one disease that needs special attention in treatment and management, especially in acute- and long-term care residents, because of their multiple comorbidities, immunosenescence, frailty, and poor nutritional status. Close follow-up to ensure adequate hydration and electrolyte replacement and infection control measures to contain outbreaks should be emphasized to caregivers and nursing staff in acute- and long-term care facilities. Although C difficile colitis causes significant morbidity and mortality in this population, judicious use of antibiotics is important to decrease the incidence and recurrence of the disease. When the diarrhea is chronic and all stool testings and serologies have been performed, the patient may benefit from endoscopy and colonoscopy for biopsy. Attentive and vigilant nursing staff is crucial in the timely diagnosis and treatment of diarrheal diseases to improve quality of life and reduce mortality.

Context: Underlying mechanisms explaining the effects of osteopathic manipulative treatment (OMT) are poorly defined. The authors evaluate various nociceptive (pain) biomarkers that have been suggested as important mediators in this process., Objective: To determine if OMT influences levels of circulatory pain biomarkers., Methods: In a prospective, blinded assessment, blood was collected from 20 subjects (10 with chronic low back pain [LBP], 10 controls without chronic LBP) for 5 consecutive days. On day 4, OMT was administered to subjects 1 hour before blood collection. Blood was analyzed for levels of beta-endorphin (betaE), serotonin (5-hydroxytryptamine [5-HT]), 5-hydroxyindoleacetic acid (5-HIAA), anandamide (arachidonoylethanolamide [AEA]), and N-palmitoylethanolamide (PEA). A daily questionnaire was used to monitor confounding factors, including pain and stress levels, sleep patterns, and substance use., Results: Increases from baseline in betaE and PEA levels and a decrease in AEA levels occurred immediately posttreatment. At 24 hours posttreatment, similar biomarker changes from baseline were observed. A decrease in stress occurred from baseline to day 5. The change in PEA from baseline to 24 hours posttreatment correlated with the corresponding changes in stress. Subgroup analysis showed that subjects with chronic LBP had significantly reduced 5-HIAA levels at 30 minutes posttreatment (P=.05) and 5-HT levels at 24 hours posttreatment (P=.02) when compared with baseline concentrations. The increase in PEA in subjects with chronic LBP at 30 minutes posttreatment was two times greater than the increase in control subjects., Conclusion: Concentrations of several circulatory pain biomarkers were altered after OMT. The degree and duration of these changes were greater in subjects with chronic LBP than in control subjects without the disorder.

The structural and thermodynamic properties of the donor-acceptor (DA) complexes of Group 13 metal halides (MX3) with ethylenediamine and their decomposition products have been studied theoretically at the B3LYP/LANL2DZ(d,p) level of theory. Gas-phase dissociation into various components and HX elimination reactions are considered. Both processes are endothermic but favored by entropy. Complexes of 2:1 composition are predicted to be stable in the gas phase up to 640-1000 K. It is found that complexation with the second acceptor molecule lowers the HX elimination enthalpy; in turn, HX elimination increases DA bonding with a second MX3 molecule. Exceptionally high values of the dissociation enthalpies (310-390 kJ mol(-1)) and HX elimination reactions (360-420 kJ mol(-1)) of the amido compounds MX2NHC2H4NH2 and MX2NHC2H4NHMX2 make them important intermediates in the decomposition processes. Dissociation reactions of the complexes are more favorable than HX elimination reactions; however, the subsequent oligomerization and cyclization processes of coordinationally unsaturated amido and imido compounds may facilitate HX elimination. Since HI elimination reactions are predicted to be the least endothermic, and aluminum-containing compounds have the strongest M-N dissociation enthalpies, it is expected that compounds based on aluminum iodide are promising objects for experimental studies.

Background: Although aortography has been the long-held "gold standard" for diagnosis of traumatic blunt aortic injury, advances in imaging technology offer less-invasive, more-rapid, and potentially more cost-effective evaluation. The purpose of this study was to review this hospital's experience with the screening and diagnosis of blunt aortic injury with emphasis on the critical evaluation of computed tomography (CT) scans for defining descending thoracic aortic injury., Methods: A retrospective single-center analysis of all patients undergoing aortography to evaluate for blunt aortic injury between January 1, 1997, and August 31, 2004, was performed. A policy of relying on CT scans to definitively diagnose blunt aortic injury was not in force, and all patients with positive, equivocal, and negative screening CT scans with significant injury mechanism underwent subsequent aortography; this contributed to an unbiased analysis. A subgroup of patients imaged with the latest generation multislice CT scanners (July 1, 2003, to August 31, 2004) was separately analyzed with rapid three-dimensional reconstruction., Results: Of 856 aortograms, 206 (24.1%) were preceded by chest CT scan. Of 31 patients with confirmed aortic injury, 20 had undergone CT scan with 16 positive for definite injury, 3 positive for possible injury, and 1 false-negative study. Of the 206 patients scanned, 114 (55.3%) showed possible injury, 76 (36.9%) were negative, and 16 (7.8%) were positive. Only 3 of the 114 with possible injury (2.6%) were true positives whereas 1 of the 76 negative scans (1.3%) was a false negative and all 16 positive scans were true positives. These data for CT scan imaging result in a sensitivity of 95%, a specificity of 40%, a positive predictive value of 15%, and a negative predictive value of 99%., Conclusions: Chest CT is an acceptable screening tool based on prerequisite high sensitivity and ease of performance in the trauma patient suspected of having a descending thoracic aortic injury. Although the excellent negative predictive value resulted in an algorithm change at this institution, there were a significant number of equivocal scans that required subsequent aortography. Three-dimensional software reconstruction of the aorta can aid in diagnosing blunt aortic injury when findings are equivocal, but there will continue to be artifacts and limitations that require aortography for clarification.

The authors report a patient who presented 4 times a systemic urticaria with arthralgias and fever treated by corticosteroids with efficacy. Wild hop (Humulus lupulus) was finally proved to be the causal factor. H.L. belongs to the cannabinaceas family. Hop dermatitis in hop workers population is the main widely described clinical manifestation. Rhinitis, conjunctivitis, asthma are rare as soon as contact urticaria. IgE-anti Hop induced allergies are described in the literature. However, in some cases of reactions to hop the mechanisms are uncertain: toxicity--possible role of lupuline--or immunoallergic processus with immunocomplexes (IC) (with increased IC in serum) and systemic urticaria such as in our observation.

The authors present a case of a Latin American patient with systemic lupus erythematosus who was referred for a mesenteric arteriogram because of acute lower gastrointestinal bleeding. Multiple segments of dilation alternating with stenosis or spasm were noted in the superior mesenteric artery/inferior mesenteric artery distributions. At the time, these irregularities were thought to be representative of lupus vasculitis. Despite appropriate treatment for vasculitis, the patient continued to have bleeding episodes and ultimately died of multiple organ failure. Autopsy demonstrated no evidence of vasculitis, but did demonstrate the unexpected finding of Strongyloides stercoralis hyperinfection with vessel invasion.

Objectives: Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care., Methods: A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist., Results: Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%). Those more likely to report oral health problems than other participants had annual household incomes of less than $9000 (36%), were unemployed (34%), and lacked health insurance (34%). The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%)., Conclusions: There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism.

We report a new homozygous CTG-->CCG (Leu-->Pro) mutation at codon 354 in the factor XIIIA gene of a patient suffering from FXIII deficiency. Leu354 lies in a pocket within the core domain of the FXIIIA molecule, with its side chain pointing into the structure of the barrel 1 domain. Replacement of leucine with a proline residue gives rise to steric hindrance between the proline ring and the surrounding residues, and rearrangement of these residues would be necessary for proline to be accommodated at this position. Using PCR-RFLP, we have demonstrated the absence of this mutation from 220 normal alleles. Together, these data suggest that Leu354Pro is likely to be the disease-causing mutation in this factor XIII deficient family.

Background: The concentration of steroid glucuronides in serial samples of early morning urine (EMU) can be used to predict the fertile period in the female menstrual cycle. The monoclonal antibody 4155 has been used as a convenient means of measuring the concentration of steroid glucuronides in EMU, as it specifically recognises the steroid hormone estrone beta-D-glucuronide (E3G), with very high affinity, and the closely related hormone estriol 3-(beta-d-glucuronide) (EI3G), with reduced affinity. Although 4115 binds these hormones with different affinities, EI3G differs from E3G only in the addition of a hydroxyl group and reduction of an adjacent carbonyl. To investigate the structural basis of this fine binding specificity, we have determined the crystal structures of the variable fragment (Fv) of 4155 in complex with each of these hormones., Results: Two crystal forms of the Fv4155-EI3G complex, at resolutions of 2.1 A and 2.5 A, and one form of the Fv4155-E3G complex, at 2.1 A resolution were solved and refined. The crystal structures show the E3G or EI3G antigen lying in an extended cleft, running form the centre of the antibody combining site down one side of the variable domain interface, and formed almost entirely from residues in the heavy chain. The binding cleft lies primarily between the heavy chain complementarity determining regions (CDRs), rather than in the interface between the heavy and light chains. In both complexes the binding of the glucuronic sugar, and rings A and B of the steroid, is specified by the shape of the narrow cleft. Analysis of the Fv structure reveals that five of the six CDR regions can be assigned to one of the predefined canonical structural classes., Conclusions: The difference in the binding affinity of Fv4155 for the two steroid hormones is accounted for by a subtle combination of a less favoured hydrogen-bond geometry, and a minor rearrangement of the water molecule network around the binding site. The rearrangement of water molecules results from the burial of the additional hydroxyl group of the EI3G in a hydrophobic environment.