Nature's marvels endowed in gaseous molecules I: Carbon monoxide and its physiological and therapeutic roles

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Adaptation of the frailty index for brazilian portuguese in adult spine deformity surgery / Adaptação para o português do Brasil do índice de fragilidade em cirurgia de deformidade da coluna vertebral do adulto / Adaptación para portugués de Brasil del índice de fragilidad en cirugía de deformidad de la columna vertebral del adulto

ABSTRACT Objectives To adapt the adult spinal deformity frailty index (ASD-FI), which was presented as an instrument for stratification of risk of surgical complications, for application in the Brazilian population. Methods This is a consensus-building study, following the Delphi method, in which a team of six Brazilian spine surgery specialists worked alongside the International Spine Study Group (ISSG), the group responsible for preparing the original version of the ASD-FI, in order to adapt the index for the Brazilian population. The variables to be included in the new version, as well as the translation of the terminology into Portuguese, were evaluated and a consensus was considered to have been reached when all (100%) of the Brazilian experts were in agreement. Results A version of the ASD-FI was created, composed of 42 variables, with the inclusion of two new variables that were not included in the original version. The new version was then back translated into English and approved by the ISSG members, resulting in the adapted version of the ASD-FI for the Brazilian population. Conclusion This study presents an adapted version of the adult spinal deformity frailty index for the Brazilian population, for the purpose of risk stratification in the surgical treatment of these complex deformities. Level of evidence II; Study of adaptation of a valid score.

RESUMO Objetivos Adaptar o Índice de Fragilidade para Deformidade da Coluna Vertebral do Adulto (IF-DCVA), apresentado como instrumento para estratificação de risco para complicações cirúrgicas, para aplicação na população brasileira. Métodos Trata-se de um estudo de criação de consenso, seguindo o método Delphi, em que uma equipe de seis especialistas brasileiros em cirurgia da coluna trabalhou em conjunto com o International Spine Study Group (ISSG), grupo responsável pelo desenvolvimento da versão original do IF-DCVA, a fim de adaptar o índice para a população brasileira. As variáveis a serem incluídas na nova versão, assim como a tradução da terminologia para o português foram avaliadas e foi considerado consenso quando todos (100%) os especialistas brasileiros chegaram a um acordo. Resultados Uma versão do IF-DCVA foi criada, composta por 42 variáveis, com a inclusão de duas novas variáveis que não faziam parte da versão original. A nova versão foi, então, retrotraduzida para o inglês e aprovada pelos membros do ISSG, resultando na versão adaptada do IF-DCVA para a população brasileira. Conclusões O presente estudo apresenta uma versão adaptada do Índice de Fragilidade para Deformidade da Coluna Vertebral do Adulto para a população brasileira com o objetivo de avaliar a estratificação de risco no tratamento cirúrgico dessas deformidades complexas. Nível de evidência II; Estudo de adaptação de um escore válido.

RESUMEN Objetivos Adaptar el Índice de Fragilidad para Deformidad de la Columna Vertebral del Adulto (IF-DCVA), presentado como instrumento para estratificación de riesgo para complicaciones quirúrgicas, para aplicación en la población brasileña. Métodos Se trata de un estudio de creación de consenso, siguiendo el método Delphi, en el que un equipo de seis especialistas brasileños en cirugía de columna trabajó junto con el International Spine Study Group (ISSG), grupo responsable por el desarrollo de la versión original de IF-DCVA, a fin de adaptar el índice para la población brasileña. Las variables a ser incluidas en la nueva versión, así como la traducción de la terminología para el portugués de Brasil fueron evaluadas y se consideró consenso cuando todos (100%) los especialistas brasileños llegaron a un acuerdo. Resultados Fue creada una versión del IF-DCVA, compuesta por 42 variables, con la inclusión de dos nuevas variables que no formaban parte de la versión original. La nueva versión fue entonces retrotraducida al inglés y aprobada por los miembros del ISSG, lo que resultó en la versión adaptada del IF-DCVA para la población brasileña. Conclusiones El presente estudio presenta una versión adaptada para la población brasileña del Índice de Fragilidad para la Deformidad de la Columna Vertebral del Adulto, con el objetivo de evaluar la estratificación de riesgo en el tratamiento quirúrgico de esas deformidades complejas. Nivel de evidencia II; Estudio de adaptación de una escala válida.

The Evolution of Flow-Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction

In spite of the developing endovascular era, large (15–25 mm) and giant (>25 mm) wide-neck cerebral aneurysms remained technically challenging. Intracranial flow-diverting stents (FDS) were developed to address these challenges by targeting aneurysm hemodynamics to promote aneurysm occlusion. In 2011, the first FDS approved for use in the United States market. Shortly thereafter, the Pipeline of Uncoilable or Failed Aneurysms (PUFS) study was published demonstrating high efficacy and a similar complication profile to other intracranial stents. The initial FDA instructions for use (IFU) limited its use to patients 22 years old or older with wide-necked large or giant aneurysms of the internal carotid artery (ICA) from the petrous segment to superior hypophyseal artery/ophthalmic segment. Expanded IFU was tested in the Prospective Study on Embolization of Intracranial Aneurysms with PipelineTM Embolization Device (PREMIER) trial. With further post-approval clinical data, the United States FDA expanded the IFU to include patients with small or medium, wide-necked saccular or fusiform aneurysms from the petrous ICA to the ICA terminus. However, IFU is more restrictive in South Korea than in United States. Several systematic reviews and meta-analyses have sought to evaluate the overall efficacy of FDS for the treatment of cerebral aneurysms and consistently identify FDS as an effective technique for the treatment of aneurysms broadly with complication rates similar to other traditional techniques. A growing body of literature has demonstrated high efficacy of FDS for small aneurysms; distal artery aneurysms; non-saccular aneurysms posterior circulation aneurysms and complication rates similar to traditional techniques. In the short interval since the Pipeline Embolization Device was first introduced, FDS has been firmly entrenched as a powerful tool in the endovascular armamentarium. As new FDS are developed, established FDS are refined, and delivery systems are improved the uses for FDS will only expand further. Researchers continue to work to optimize the mechanical characteristics of the FDS themselves, aiming to optimize deploy ability and efficacy. With expanded use for small to medium aneurysms and posterior circulation aneurysms, FDS technology is firmly entrenched as a powerful tool to treat challenging aneurysms, both primarily and as an adjunct to coil embolization. With the aforementioned advances, the ease of FDS deployment will improve and complication rates will be further minimized. This will only further establish FDS deployment as a key strategy in the treatment of cerebral aneurysms.

Identifying challenges to quality in preconception health care among women of reproductive age in Lipa City, Batangas

Background@#Preconception care is a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management. These interventions emphasize factors that must be addressed before conception or early in pregnancy in order to have maximal impact. Preconception health care is a key intervention in improving maternal and neonatal health care. Identification of specific needs of population-at-risk remains crucial in developing quality preconception health care programs in the Philippines. @*Objectives@#This paper: 1) described the preconception health status of women of reproductive age in selected communities in Lipa City Batangas; 2) identified the perceived preconception needs of women of reproductive age in selected communities; 3) determined the significant challenges to the provision of appropriate preconception health care; and 4) provided recommendations to address the gaps and challenges. @*Methods@#A total of 4,357 women of reproductive age were interviewed using a preconception checklist tool previously developed by researchers from Peking University (China), American University of Beirut (Lebanon), and University of the Philippines Manila (Philippines). Eleven Focus Group Discussions (FGDs) on various aspects of preconception health care were conducted among women of reproductive age from communities and workplaces (industries/factories, government offices, schools, entertainment centers, health centers). Thematic analyses of the data from the FGDs were performed. Recommendations for overcoming identified challenges to quality services were presented. @*Results@#There are salient gaps in preconception health care, particularly in micronutrient intake, immunization status, family planning and infectious diseases screening in both urban and rural communities. The study also showed major gaps in medical and educational services, particularly for adolescents. @*Conclusion@#Health and social challenges in the preconception health care delivery system for women of reproductive age in Lipa City Batangas were identified, including the prioritization of at-risk groups and development of strategies to address preconception health care gaps in both urban and rural settings. The alarming increasing rate of teenage pregnancy must be given highest priority with integration of safe and healthy pregnancy in the curriculum. The development of programs for men and women recognizes that parenthood is a partnership. To guarantee a successful program on preconception health care services, government must utilize an inter-sectoral and interdisciplinary approach with the participation of various stakeholders and sectors, both government and private. The engagement of women of reproductive age in planning provides a dynamic feedback for the relevance of the planned programs.

A Pilot study on the prevalence of Post-Traumatic Stress Disorder (PTSD) among Veterans Memorial Medical Center (VMMC) Department Of Psychiatry Patients with combat experience from January 2013 - January 2015

Objectives@#The objectives of this pilot study was to establish the preliminary data on the prevalence of Post-Traumatic Stress Disorder (PTSD) among VMMC Department of Psychiatry In-Patients and Out-Patients with combat experience.@*Methodology@#It is a cross sectional study conducted by reviewing patients' charts. Case definition was based on the standardized ClinicianAdministered PTSD Scale (CAPS) - Filipino Version. In -patients were recruited directly while new and old OPD patients were recruited through chart review and invitations. Adequate combat exposure was measured with the United States Veterans Affairs Combat Exposure Scale (USVACES). Data was presented as lifetime and current prevalence among the exposed population.@*Results@#The study showed that 17.85% of the subjects (n=28) of this pilot study had a lifetime diagnosis of PTSD. None of the subjects reached the symptom threshold for a current diagnosis of PTSD. Three out of 19 subjects (15.78%) diagnosed with Schizophrenia had a lifetime diagnosis of PTSD while two out of five subjects (40%) with Bipolar I Disorder had comorbid lifetime diagnosis of PTSD. The number of subjects needed to power the study using Daniel's (1999) formula was N= 225.@*Conclusion@#The pilot study showed that the lifetime prevalence rate of PTSD among VMMC Psychiatry patients (17.85%) was comparable to worldwide trends. The study did not report any new occurrences of PTSD.

Volunteer youth leaders for Health - Philippines: Providing a mechanism for youth empowerment towards advocacy for birth defects prevention and care

@#<p style="text-align: justify;">The Volunteer Youth Leaders for Health-Philippine(VYLH- Philippines) is a national youth network established in 2009 as an model on how to organized young women and men into a national force that promotes self-learnings, independence,personal growth and sustained public health change from the grassroots level to up.Formed under the aegis of the University of the Philippines Manila and the department of health,the VYLH- Philippines has focused its activities in the past eight years on helping reduce mortality and disability from congenital disorder through awareness program and support for policy development.This paper describes in details the organization and extraordinary accomplishment of the VYLH- Philippines to date.</p>

Estrogen receptor-α, progesterone receptor, and c-erbB/HER-family receptor mRNA detection and phenotype analysis in spontaneous canine models of breast cancer

Well characterized, stable, p16-defective canine mammary cancer (CMT) cell lines and normal canine mammary epithelial cells were used to investigate expression of the major breast cancer-specific hormone receptors estrogen receptor alpha (ER1) and progesterone receptor (PR) as well as luminal epithelial-specific proto-oncogenes encoding c-erbB-1 (epidermal growth factor receptor/EGFr), c-erbB-2/HER2, c-erbB-3, and c-erbB-4 receptors. The investigation developed and validated quantitative reverse transcriptase polymerase chain reaction assays for each transcript to provide rapid assessment of breast cancer phenotypes for canine cancers, based on ER1, PR, and c-erbB-2/HER2 expressions, similar to those in human disease. Roles for relatively underexplored c-erbB-3 and c-erbB-4 receptor expressions in each of these breast cancer phenotypes were also evaluated. Each quantitative assay was validated by assessment of amplicon size and DNA sequencing following amplification. Differential expression of ER1, PR, and c-erbB-2 in CMT cell lines clearly defined distinct human-like breast cancer phenotypes for a selection of CMT-derived cell lines. Expression profiles for EGFr family genes c-erbB-3 and c-erbB-4 in CMT models also provided an enriched classification of canine breast cancer identifying new extended phenotypes beyond the conventional luminal-basal characterization used in human breast cancer.

Intracardiac tumor causing left-ventricular outflow-tract obstruction in a newborn

The following report describes the case of newborn girl with an asymptomatic systolic murmur, which on imaging revealed a nearly obstructive mass in the left-ventricular outflow tract. The mass was resected and found to be consistent with a rhabdomyoma. Here, we describe the pathologic and clinical characteristics of this tumor

Sensitizing undergraduate medical students to consultation skills: A pilot study.

Background. Good consultation skills help physicians to diagnose the problems of the patient more accurately, and foster a therapeutic relationship. We describe a pilot study that used role-play with peers as a method to sensitize first clinical year medical students to consultation skills. Methods. Students were divided into groups of three where one acted as a doctor, the second as a patient and the third as an observer. Students were asked to perform a role-play of a prepared clinical scenario where the patient had a hidden fear of malignancy. Observations were recorded in a simplified Calgary– Cambridge consultation checklist. Students’ feedback and their emotions written after the role-play were analysed and discussed. Assessment of their learning was done with an objective structured clinical examination. Results. Students’ feedback revealed that they were sensitized to the importance of starting the consultation with an open question, listening to the opening statement, non-verbal

Bioreductive prodrugs as cancer therapeutics: targeting tumor hypoxia / 癌症

Hypoxia, a state of low oxygen, is a common feature of solid tumors and is associated with disease progression as well as resistance to radiotherapy and certain chemotherapeutic drugs. Hypoxic regions in tumors, therefore, represent attractive targets for cancer therapy. To date, five distinct classes of bioreactive prodrugs have been developed to target hypoxic cells in solid tumors. These hypoxia-activated prodrugs, including nitro compounds, N-oxides, quinones, and metal complexes, generally share a common mechanism of activation whereby they are reduced by intracellular oxidoreductases in an oxygen-sensitive manner to form cytotoxins. Several examples including PR-104, TH-302, and EO9 are currently undergoing phase II and phase III clinical evaluation. In this review, we discuss the nature of tumor hypoxia as a therapeutic target, focusing on the development of bioreductive prodrugs. We also describe the current knowledge of how each prodrug class is activated and detail the clinical progress of leading examples.

Direct and mediated associations between religious coping, spirituality, and youth violence in El Salvador / Asociaciones directas y mediadas entre el afrontamiento religioso, la espiritualidad y la violencia juvenil en El Salvador

OBJECTIVE: To examine the direct and mediated relationships between religious coping, spirituality, social developmental factors, and violence among high-risk and gang-involved youth in a high-crime, Latin American country. METHODS: Using a community sample of 290 high-risk and gang-involved youth in San Salvador, El Salvador, structural equation modeling was employed to examine the relationships between religious coping, spirituality, social developmental factors (e.g., antisocial bond and antisocial beliefs), and violence. RESULTS: Religious coping (β = - 0.14, P < 0.05) and spirituality (β = - 0.20, P < 0.01) were both significantly associated with antisocial bond. Antisocial bond, in turn, was directly associated with violence (β = 0.70, P < 0.001) and was associated with antisocial beliefs (β = 0.54, P < 0.001); however, the path from antisocial beliefs to violence was not statistically significant. No direct paths were identified from religiosity and spirituality to violence. The goodness-of-fit statistics (root mean square error of approximation, 0.034; comparative fit index, 0.974; and Tucker-Lewis index, 0.966) suggest that the final model had acceptable fit. CONCLUSIONS: This study is among the first to shed light on the relationship between religiosity, spirituality, and youth violence in the Latin American context. Elevated levels of religious coping and spirituality are associated with less antisocial bonding, which, in turn, is associated with lower levels of violent behavior among high-risk and gang-involved Salvadoran youth. Study findings suggest that religious coping and spirituality are indirectly protective for youth violence among this high-risk population.

OBJETIVO: Analizar las relaciones directas y mediadas entre el afrontamiento religioso, la espiritualidad, los factores de desarrollo social, y la violencia en jóvenes de alto riesgo y pertenecientes a pandillas de un país latinoamericano con una alta incidencia de criminalidad. MÉTODOS: Se seleccionó una muestra de la comunidad de 290 jóvenes de alto riesgo y pertenecientes a pandillas de San Salvador (El Salvador). Mediante el modelado de ecuaciones estructurales se analizaron las relaciones entre el afrontamiento religioso, la espiritualidad, los factores de desarrollo social (por ejemplo, el vínculo antisocial y las creencias antisociales), y la violencia. RESULTADOS: El afrontamiento religioso (β = - 0,14, P < 0,05) y la espiritualidad (β = - 0,20, P < 0,01) se asociaron ambos significativamente con el vínculo antisocial. El vínculo antisocial, a su vez, se asoció directamente con la violencia (β = 0,70, P < 0,001) y también se asoció con las creencias antisociales (β = 0,54, P < 0,001); sin embargo, la vía de las creencias antisociales a la violencia no fue estadísticamente significativa. No se identificaron vías directas de la religiosidad y la espiritualidad a la violencia. La prueba estadística de bondad de ajuste (error de aproximación cuadrático medio, 0,034; índice de ajuste comparativo, 0,974; índice de Tucker-Lewis, 0,966) indica que el modelo final mostraba un ajuste aceptable. CONCLUSIONES: Este estudio es uno de los primeros en clarificar la relación entre la religiosidad, la espiritualidad y la violencia juvenil en el entorno latinoamericano. Los niveles elevados de afrontamiento religioso y espiritualidad se asocian con vínculos menos antisociales que, a su vez, se asocian con menores niveles de comportamiento violento entre los jóvenes salvadoreños de alto riesgo y pertenecientes a pandillas. Los resultados de este estudio indican que el afrontamiento religioso y la espiritualidad son protectores indirectos de la violencia juvenil en esta población de alto riesgo.

short to medium-term risks of intracameral phenylephrine

To compare outcomes and complications of patients undergoing phacoemulsification with and without the administration of intracameral phenylephrine. In this retrospective study, a chart review was performed. Two groups with an equal number of patients who did or did not receive intracameral phenylephrine during phacoemulsification were compared for differences in outcomes, risk factors and complications. The Chi-square test was used for comparison between groups. P<0.05 was statistically significant. The two groups were well matched with regard to preoperative ophthalmic and systemic risk factors for complications and had very similar phacoemulsification power and time profiles. No differences in outcome were detected [P>0.05, all comparisons]. This retrospective study suggests that intracameral phenylephrine normalizes the intraoperative risk of small pupil cataract surgery and is not associated with an increased risk of systemic or postoperative ophthalmic complications

Expression of the tyrosine kinase receptor EphA5 and its ligand ephrin-A5 during mouse spinal cord development / 神经科学通报·英文版

<p><b>OBJECTIVES</b>To study the expression patterns of two Eph family molecules, the receptor EphA5, and the ligand ephrin-A5, during spinal cord development.</p><p><b>METHODS</b>The receptor expression was analyzed using beta-galactosidase knockin mice, and affinity ligand probe binding. The ligand expression was assessed using two different affinity probes, and knockout mouse tissues as controls.</p><p><b>RESULTS</b>EphA5 was expressed in the ventral spinal cord, while ephrin-A5 was located in the dorsolateral regions of the spinal cord throughout development.</p><p><b>CONCLUSIONS</b>These results show that EphA5 and ephrin-A5 are expressed over broad developmental stages and may play important roles in establishing the dorsoventral organization of the spinal cord.</p>

Immunomodulatory activities of Centella asiatica and Rhinacanthus nasutus extracts.

Centella asiatica (CA) and Rhinacanthus nasutus (RN )have been used for treatment of various illnesses, but the mechanisms of action remain largely unknown. This study focused on the influence of CA and RN extracts on cell-mediated and humoral immune responses. In human peripheral blood mononuclear cells (PBMCs), CA (water extract) and RN (water and ethanol extracts) significantly increased proliferation and the production of IL-2 and TNF-alpha. In contrast, an ethanol extract of CA inhibited human PBMC mitogenesis and the production of IL-2 and TNF-alpha. BALB/c mice treated with CA extracts (100 mg/kg bw) showed higher responses to both primary and secondary antibodies against BSA when compared with non-treated group. Only the secondary antibody response was increased in RN extract-treated mice. The present study revealed immunomodulating activity of CA and RN extracts with regard to both non-specific cellular and humoral immune responses. The data available to date suggest that they may have chemopreventive or anticancer potential.

Attitudes towards mental illness in the Commonwealth of Dominica

Little is known about the perception of mental illness in the English-speaking Caribbean. This study was conducted in 1995 to determine the attitudes, knowledge, and help-seeking practices for emotional disorders in the Commonwealth of Dominica. Two groups in Dominica were surveyed: 67 community leaders, consisting of nurses, teachers, and police officers; and 135 community members grouped into five socioeconomic strata that were collapsed to three for the analysis. All the respondents were asked to identify and suggest management of individuals with psychosis, alcoholism, depression, and childhood hyperactivity, as depicted in case vignettes. The person in the psychosis vignette was diagnosed as suffering from mental illness by 84.0 per cent of the leaders and by 71, 2 per cent of the community members. However, in each of the three other vignettes, fewer than 30 per cent of the respondents thought that mental illness was present. The person with alcoholism was viewed as having a serious problem by only slightly more than half of the respondents. Fewer than half of the respondents thought that the individuals with depression or hyperactivity had serious problems. The community leaders did somewhat worse in redcognizing mental illness than did the community members. Respondents were most likely to refer a family member with emotional problems to a medical practitioner. In conclusion, education about mental health problems is needed in Dominica. Especially disconcerting was the lack of knowledge on mental illness among nurses, teachers, and police officers, that is, professionals directly involved in the pathway to care