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Pylephlebitis, which is a type of septic thrombophlebitis of the portal vein, is a rare and life-threatening complication that commonly occurs following appendicitis. However, nonspecific abdominal complaints and fever can impede the diagnosis of pylephlebitis. Timely use of appropriate antibiotics and anticoagulants is paramount for treating this condition. We present a case of pylephlebitis and septic shock caused by acute nonperforated appendicitis. A 32-year-old man presented with migratory right lower abdominal pain. Blood cultures showed the presence of Escherichia coli . Blood test results showed increased bilirubin concentrations and coagulation factor abnormalities. A computed tomographic abdominal scan showed that the portal vein had a widened intrinsic diameter. After intensive care treatment with antibiotics, antishock therapy, anticoagulants, and other supportive treatments, the infection was monitored, the abdominal pain disappeared, and the jaundice subsided. Laparoscopic appendectomy was performed. Histopathology showed acute suppurative appendicitis, and no abnormalities were observed during the follow-up period after discharge. A multidisciplinary approach is mandatory for the decision-making process in the presence of pylephlebitis caused by appendicitis to obtain a correct diagnosis and prompt treatment. Similarly, the timing of appendectomy is important for minimizing intra- and postoperative complications., Competing Interests: Declaration of conflicting interestThe authors declare that there is no conflict of interest.

Importance: Insurance coverage expansion has been proposed as a solution to improving health disparities, but insurance expansion alone may be insufficient to alleviate care access barriers., Objective: To assess the association of Area Deprivation Index (ADI) with postsurgical textbook outcomes (TO) and presentation acuity for individuals with private insurance or Medicare., Design, Setting, and Participants: This cohort study used data from the National Surgical Quality Improvement Program (2013-2019) merged with electronic health record data from 3 academic health care systems. Data were analyzed from June 2022 to August 2023., Exposure: Living in a neighborhood with an ADI greater than 85., Main Outcomes and Measures: TO, defined as absence of unplanned reoperations, Clavien-Dindo grade 4 complications, mortality, emergency department visits/observation stays, and readmissions, and presentation acuity, defined as having preoperative acute serious conditions (PASC) and urgent or emergent cases., Results: Among a cohort of 29 924 patients, the mean (SD) age was 60.6 (15.6) years; 16 424 (54.9%) were female, and 13 500 (45.1) were male. A total of 14 306 patients had private insurance and 15 618 had Medicare. Patients in highly deprived neighborhoods (5536 patients [18.5%]), with an ADI greater than 85, had lower/worse odds of TO in both the private insurance group (adjusted odds ratio [aOR], 0.87; 95% CI, 0.76-0.99; P = .04) and Medicare group (aOR, 0.90; 95% CI, 0.82-1.00; P = .04) and higher odds of PASC and urgent or emergent cases. The association of ADIs greater than 85 with TO lost significance after adjusting for PASC and urgent/emergent cases. Differences in the probability of TO between the lowest-risk (ADI ≤85, no PASC, and elective surgery) and highest-risk (ADI >85, PASC, and urgent/emergent surgery) scenarios stratified by frailty were highest for very frail patients (Risk Analysis Index ≥40) with differences of 40.2% and 43.1% for those with private insurance and Medicare, respectively., Conclusions and Relevance: This study found that patients living in highly deprived neighborhoods had lower/worse odds of TO and higher presentation acuity despite having private insurance or Medicare. These findings suggest that insurance coverage expansion alone is insufficient to overcome health care disparities, possibly due to persistent barriers to preventive care and other complex causes of health inequities.

Objective: Develop an ordinal Desirability of Outcome Ranking (DOOR) for surgical outcomes to examine complex associations of Social Determinants of Health., Background: Studies focused on single or binary composite outcomes may not detect health disparities., Methods: Three health care system cohort study using NSQIP (2013-2019) linked with EHR and risk-adjusted for frailty, preoperative acute serious conditions (PASC), case status and operative stress assessing associations of multilevel Social Determinants of Health of race/ethnicity, insurance type (Private 13,957; Medicare 15,198; Medicaid 2835; Uninsured 2963) and Area Deprivation Index (ADI) on DOOR and the binary Textbook Outcomes (TO)., Results: Patients living in highly deprived neighborhoods (ADI>85) had higher odds of PASC [adjusted odds ratio (aOR)=1.13, CI=1.02-1.25, P <0.001] and urgent/emergent cases (aOR=1.23, CI=1.16-1.31, P <0.001). Increased odds of higher/less desirable DOOR scores were associated with patients identifying as Black versus White and on Medicare, Medicaid or Uninsured versus Private insurance. Patients with ADI>85 had lower odds of TO (aOR=0.91, CI=0.85-0.97, P =0.006) until adjusting for insurance. In contrast, patients with ADI>85 had increased odds of higher DOOR (aOR=1.07, CI=1.01-1.14, P <0.021) after adjusting for insurance but similar odds after adjusting for PASC and urgent/emergent cases., Conclusions: DOOR revealed complex interactions between race/ethnicity, insurance type and neighborhood deprivation. ADI>85 was associated with higher odds of worse DOOR outcomes while TO failed to capture the effect of ADI. Our results suggest that presentation acuity is a critical determinant of worse outcomes in patients in highly deprived neighborhoods and without insurance. Including risk adjustment for living in deprived neighborhoods and urgent/emergent surgeries could improve the accuracy of quality metrics., Competing Interests: Dr D.E.H. reported receiving grants from the National Institutes of Health and Veterans administration during the conduct of this study; he also reported a consulting relationship with FutureAssure, LLC. Dr K.B.S. reported receiving grant funding from the National Institutes of Health. Dr. L.S.K. reported receiving royalties from Springer, Wolters-Klower, and McGraw-Hill. Dr P.K.S. reported receiving grants from the National Institutes of Health and Veterans Health Administration and salary support from Texas A&M School of Medicine, South Texas Veterans Health Care System and the University of Texas Health San Antonio during the conduct of the study. Dr S.S. reports receiving grants from the National Institutes of Health and Veterans Health Administration. The remaining authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Assess associations of Social Determinants of Health (SDoH) using Area Deprivation Index (ADI), race/ethnicity and insurance type with Textbook Outcomes (TO)., Summary Background Data: Individual- and contextual-level SDoH affect health outcomes, but only one SDoH level is usually included., Methods: Three healthcare system cohort study using National Surgical Quality Improvement Program (2013-2019) linked with ADI risk-adjusted for frailty, case status and operative stress examining TO/TO components (unplanned reoperations, complications, mortality, Emergency Department/Observation Stays and readmissions)., Results: Cohort (34,251 cases) mean age 58.3 [SD=16.0], 54.8% females, 14.1% Hispanics, 11.6% Non-Hispanic Blacks, 21.6% with ADI>85, and 81.8% TO. Racial and ethnic minorities, non-Private insurance, and ADI>85 patients had increased odds of urgent/emergent surgeries (aORs range: 1.17-2.83, all P<.001). Non-Hispanic Black patients, ADI>85 and non-Private insurances had lower TO odds (aORs range: 0.55-0.93, all P<.04), but ADI>85 lost significance after including case status. Urgent/emergent versus elective had lower TO odds (aOR=0.51, P<.001). ADI>85 patients had higher complication and mortality odds. Estimated reduction in TO probability was 9.9% (CI=7.2%-12.6%) for urgent/emergent cases, 7.0% (CI=4.6%-9.3%) for Medicaid, and 1.6% (CI=0.2%-3.0%) for non-Hispanic Black patients. TO probability difference for lowest-risk (White-Private-ADI≤85-elective) to highest-risk (Black-Medicaid-ADI>85-urgent/emergent) was 29.8% for very frail patients., Conclusion: Multi-level SDoH had independent effects on TO, predominately affecting outcomes through increased rates/odds of urgent/emergent surgeries driving complications and worse outcomes. Lowest-risk versus highest-risk scenarios demonstrated the magnitude of intersecting SDoH variables. Combination of insurance type and ADI should be used to identify high-risk patients to redesign care pathways to improve outcomes. Risk adjustment including contextual neighborhood deprivation and patient-level SDoH could reduce unintended consequences of value-based programs., Competing Interests: Dr. Hall reported receiving grants from the National Institutes of Health and Veterans administration during the conduct of this study; he also reported a consulting relationship with FutureAssure, LLC. Dr. Stitzenberg reported receiving grant funding from the National Institutes of Health. Dr. Kao reported receiving royalties from Springer, Wolters-Klower, and McGraw-Hill. Dr. Shireman reported receiving grants from the National Institutes of Health and Veterans Health Administration and salary support from Texas A&M School of Medicine, South Texas Veterans Health Care System and the University of Texas Health San Antonio during the conduct of the study. Dr. Schmidt reports receiving grants from the National Institutes of Health and Veterans Health Administration. No other disclosures were reported.

Based on a phosphine oxide ligand, HMPA (hexamethylphosphoric triamide), two mononuclear Ho III -pentagonal bipyramidal complexes were synthesized with the formulas [Ho(HMPA) 2 (H 2 O) 5 ] 2 Cl 6 ·2HMPA·2H 2 O (1) and [Ho(HMPA) 2 (H 2 O) 5 ]Br 3 ·2HMPA (2). Single-crystal X-ray diffraction results show that all Ho III ions in both the two complexes are hepta-coordinated and are located in pentagonal bipyramidal {HoO7} coordination polyhedrons constructed by two axial HMPA ligands and five equatorial water molecules. However, due to the employment of different halide ions as counterions, the second coordination sphere surrounding each [Ho(HMPA) 2 (H 2 O) 5 ] 3+ moiety is different in the two complexes: in 1, three Cl - ions, one water molecule and one HMPA ligand; in 2, three Br - ions and two HMPA ligands. Ac magnetic susceptibilities under zero dc field show that both the two complexes are single-ion magnets with effective energy barriers of 290 K and 320 K for 1 and 2, respectively. Compared with 1, the enhancement in the energy barrier of 2 is believed to be induced mainly by the change in the second coordination sphere rather than the minor differences in the {HoO7} polyhedrons.

Based on the HMPA ligand, a new air- and moisture-stable pentagonal-bipyramidal DyIII single-ion magnet [Dy(HMPA)2(H2O)5]2·Br6·2HMPA·2H2O (1) was prepared and characterized. Single-crystal X-ray tests showed the two crystallographically independent DyIII ions located in a pentagonal-bipyramidal coordination sphere with strong axial HMPA ligands and weak equatorial water molecules relating to strong unaxial anisotropy. Direct-current and alternating-current magnetic susceptibilities were measured and showed that 1 exhibited slow relaxation of magnetization up to 36 K (1000 Hz) with an energy barrier of 556 K and blocking temperature of 7 K (defined by the peak temperature of zero-field cooling data). The application of a dc field and magnetic dilution were also carried out to explore the existing quantum tunelling of the magnetization process.

Barium-strontium titanate (BST) powder was prepared by using oxalate coprecipitate method, and the surface of barium-strontium titanate (BST) powder was modified by coating with dithizone, gaining a new sort of sorbent. FTIR analysis was used for characterizing the surface modification. By means of determination with flame atomic absorption spectrometry (FAAS), the adsorption capability of cadmium on the coating BST powder was investigated, and the condition of elution was observed; studies of coating and adsorption mechanism were also performed. The results showed that dithizone coated on the BST powder throngh hydrogen bonding between the hydroxyl groups and oxygen atoms on surface of the BST and dithizone. The cadmium ion in water could be adsorbed quantitively on dithizone coated BST when the pH was 6.0. At room temperature, the adsorption equilibrium could be obtained in 20 min. 5% EDTA was sufficient for complete elution. A new method for the determination of trace cadmium based on dithizone coated BST separation/ preconcentration and FAAS determination was proposed. The detection limit of this method for cadmium ion was 0.2 microg x L(-1), and the RSD was 2.9%. The method has been applied to the determination of trace cadmium ion in water samples with satisfactory results.

Nanosized barium-stroutium titanate (BST) powder, a double salt sorbent, was prepared from BaCl2, SrCl2 and TiCl4 by using oxalate co-precipitate method, and characterized by using transmission electron microscope (TEM), X-ray diffraction (XRD) and Fourier transform infrared spectrophotometer (FTIR). By means of determination with flame atomic absorption spectrometry (FAAS), the adsorption characteristic of lead on the BST powder w as investigated. The results showed that theforms of the BST powders are clubbed, highly pure perovskite, and the average particle diameter is 36 nm. Lead can be adsorbed strongly on nanosized BST. The adsorption capacity of BST nanoparticle towards lead was found to be 13 mg x g(-1) when the pH is 6.0, and 0.5 mol x L(-1) HNO3 is sufficient for complete elution. A new method for the determination of trace lead based on BST nanoparticle separation/preconcentration and FAAS determination was proposed. The detection limit of this method for lead ion is 11 microg x L(-1), and the relative standard deviation is 2.6%. The method has been applied to the determination of trace lead in water samples with satisfactory results.

The National Retail Data Monitor (NRDM) has monitored over-the-counter (OTC) medication sales in the United States since December 2002. The NRDM collects data from over 18,600 retail stores and processes over 0.6 million sales records per day. This paper describes key architectural features that we have found necessary for a data utility component in a national biosurveillance system. These elements include event-driven architecture to provide analyses of data in near real time, multiple levels of caching to improve query response time, high availability through the use of clustered servers, scalable data storage through the use of storage area networks and a web-service function for interoperation with affiliated systems. The methods and architectural principles are relevant to the design of any production data utility for public health surveillance-systems that collect data from multiple sources in near real time for use by analytic programs and user interfaces that have substantial requirements for time-series data aggregated in multiple dimensions.

The goal of the Real-time Outbreak and Disease Surveillance (RODS) Open Source Project is to accelerate deployment of computer-based syndromic surveillance. To this end, the project has released the RODS software under the GNU General Public License and created an organizational structure to catalyze its development. This paper describes the design of the software, requested extensions, and the structure of the development effort.

Organotin compounds were found to obviously inhibit the activity of phospholipid/Ca(2+)-dependent protein kinase (PKC) in rat brain tissue and the proliferation of tumor cell lines in vitro. The results showed that a correlation exists between the effects on PKC and anti-proliferative and antitumor activities. The structure-activity relationship was shown to be as follows: (1) R, the organic group determines the biological activity; (2) electronegativity of the halogen can affect the activity. The organotin compounds inhibit tumor cells by its [SnR2]2+, and inhibit G1-->S phases of HL-60 cell cycle. The IC50 of [SnPh2F2], [SnPh2(CysOS)].H2O and [SnPh2Cl2.phen(CH3)2] are respectively 25, 15 and 20 mumol.L-1 on PKC, 0.5, 4.0 and 0.3 mumol.L-1 on HL-60 cells, 2.7, 9 and 1.5 mumol.L-1 on BEL-7402 cells, 2.2, 15 and 5.0 mumol.L-1 on KB cells. But no induction of differentiation of leukemic cell lines HL-60 and K562 was observed.

Synthetic peptide analogs of the bovine myelin basic protein (MBP) corresponding to residues 104-118 were found to specifically inhibit phospholipid/ Ca2+-dependent protein kinase (protein kinase C). The peptides [Ala107]MBP (104-118) and [Ala113]MBP (104-118) inhibited protein phosphorylation of intact MBP, histone H1 and peptide phosphorylation with MBP(104-123), MBP(104-118) or [Ala105]MBP (104-118) as substrates. The inhibitor peptides [Ala107]MBP(104-118) and [Ala113]MBP (104-118), containing alanine in place of the arginine recognition sites, apparently inhibited the enzyme noncompetitively with respect to substrates, with IC50 values ranging from 46-145 and 28-62 microM, respectively. These peptide analogs did not inhibit cyclic AMP-dependent protein kinase or myosin light chain kinase but inhibited phospholipid/Ca2+-dependent phosphorylation of endogenous proteins in the total, solubilized fraction of rat brain.

Selenium compounds (selenium dioxide, selenious acid, and selenic acid) were found to inhibit phospholipid/Ca2+-dependent protein kinase (protein kinase C) and the phorbol ester-stimulated phosphorylation of endogenous substrate proteins from HL60 cells. Kinetic analysis indicated that selenium dioxide (SeO2) inhibited the enzyme noncompetitively with respect to phosphatidylserine (apparent Ki, 60 microM) and Ca2+ (apparent Ki, 68 microM). The inhibitory effect of SeO2 on protein kinase C was additive to that of another inhibitor of the enzyme (alkyl-lysophospholipid) when present together. SeO2 was also equally inhibitory to myosin light chain kinase, a calmodulin/Ca2+-dependent class of protein kinase. It, however, affected only very slightly cyclic adenosine 3':5'-monophosphate-dependent protein kinase. It is suggested that inhibition of Ca2+-dependent reactions might be related to the anticarcinogenic property of selenium.

The substrate specificity determinants of protein kinase C are probed using synthetic peptides encompassing the major phosphorylation site serine 115 in bovine MBP. The results indicate that basic residues arginine 107 and 113 N-terminal to the phosphorylation site are essential for the substrate activity of the peptides. Substitutions of these basic residues by alanine cause a marked decrease in their substrate activity and the resulting peptide analogs become specific and rather potent inhibitors of protein kinase C. Leukemic cells are particularly abundant in protein kinase C and its substrate proteins, and the enzyme system has been shown to play a key role in cell growth. The agents that stimulate protein kinase C include tumor promoting phorbol esters (such as TPA) and mezerein, and the putative second messenger diacylglycerol. Many antineoplastic agents, on the other hand, inhibit the enzyme which include adriamycin, tamoxifen, alkyl-lysophospholipid, selenium, retinal and lipoidal amine CP-46, 665-1. Immunocytochemical studies of protein kinase C in leukemic cells indicate that it is localized in the plasma membrane, cytoplasm, nucleus and Golgi apparatus, and the subcellular distribution of the enzyme might be related to the phases of the cell cycle. TPA induces translocation of the enzyme to plasma membrane, suggesting an additional mode of action for the tumor promotor.

Antiestrogens (tamoxifen, clomiphene and nafoxidine) were found to inhibit phospholipid/Ca2+-dependent protein kinase (PL/Ca-PK, or protein kinase C), whereas estrogens (estradiol and diethylstilbesterol) and the weakly estrogenic chlorotrianisene were inactive. Kinetic analysis indicated that the antiestrogens inhibited PL/Ca-PK competitively with respect to phosphatidylserine (Ki = 16-27 microM), but non-competitively with Ca2+ (Ki = 14-30 microM). Tamoxifen, but not diethylstilbesterol, also inhibited the phospholipid/Ca2+-dependent phosphorylation of various endogenous proteins from the total, solubilized fraction of the rat brain and ovary. Myosin light chain kinase, a calmodulin/Ca2+-dependent class of protein kinase, was similarly inhibited by tamoxifen; the drug, however, was without effect on cyclic AMP-dependent and cyclic GMP-dependent protein kinases. It is suggested that PL/Ca-PK, by virtue of the hydrophobic interactions required for the enzyme activation, may represent a potential site of action for the lipophilic antiestrogens, in addition to the commonly recognized intracellular estrogen receptors.

The substrate specificity of phospholipid/Ca2+-dependent protein kinase (protein kinase C) was studied using synthetic peptides, in particular those corresponding to the amino acid sequence around serine 115 in bovine myelin basic protein (MBP). It was found that MBP (104-118) and MBP (104-123) were substrates for the enzyme, with apparent Km values of 14 and 10 microM, respectively. Neither MBP (111-118) nor MBP (111-123) were phosphorylated, indicating that an additional segment of sequence extending toward the N terminus, but not toward the C terminus, was essential for the substrate activity of the peptides. Of the alanine-substituted analogs examined, [Ala 105] MBP (104-118) was comparable to the parent peptide, whereas [Ala 107] MBP (104-118) and [Ala 113] MBP-(104-118) were much poorer substrates. These findings indicated that lysine 105 was not essential, but both arginine 107 and arginine 113 were important specificity determinants. Initial studies revealed that [Ala 113] MBP (104-118) inhibited phosphorylation by the enzyme of the parent peptide and, to a lesser extent, the intact MBP(1-170). Serine 115 was the only site phosphorylated in the analog peptides [Ala 105] MBP (104-118) and [Ala 107]MBP (104-118). In the parent peptide, serine 115 was the initial site of phosphorylation but after prolonged phosphorylation other sites became phosphorylated (serine 110 and/or serine 112), further supporting the concept that arginine residues act as essential substrate specificity determinants for phospholipid/Ca2+-dependent protein kinase.