Ileus caused by small bowel, ileocaecal and rectal endometriosis misdiagnosed as Crohn's disease and managed by synchronous ileocaecal and rectal resection.

The reported incidence of intestinal endometriosis varies between 22% and 37%, with bowel obstruction in only 2.3% of cases, but few series report acute obstruction. We report a rare case of acute bowel obstruction due to multiple bilateral deep intestinal endometriosis lesions localised in the ileum, ileocaecal valve and upper rectum, requiring synchronous resection in an emergency setting. A 42-year-old woman was referred to our clinic with a diagnosis of obstructing Crohn's disease based on abdominal computed tomography with oral contrast showing a thickened terminal ileum with stenosis, compression of the caecum and proximally dilated small bowel loops. Simultaneous ileocaecal resection and segmental resection of the upper rectum with handsewn end-to-end anastomosis between the sigmoid colon and rectum was performed. Owing to the advanced bowel obstruction and significant weight loss, a double barrelled ileoascendostomy was created. The patient had an uneventful recovery. Histological examination revealed transmural endometriosis with involvement of the pericolic fat in both specimens. Although intestinal endometriosis causing acute bowel obstruction is rare, it should be included among the differential diagnoses in young women with recurrent abdominal pain, intermittent diarrhoea and constipation without a family history for inflammatory bowel disease or cancer. Bleeding synchronous with menstruation is not typical for intestinal endometriosis. Right-sided intestinal endometriosis more frequently causes acute bowel obstruction, in most cases due to intussusception.

Tau and amyloid-related pathologies in the entorhinal cortex have divergent effects in the hippocampal circuit.

The entorhinal cortex (EC) is affected early in Alzheimer's disease, an illness defined by a co-occurrence of tau and amyloid-related pathologies. How the co-occurrence of these pathologies in the EC affects the hippocampal circuit remains unknown. Here we address this question by performing electrophysiological analyses of the EC circuit in mice that express mutant human amyloid precursor protein (hAPP) or tau (hTau), or both in the EC. We show that the alterations in the hippocampal circuit are divergent, with hAPP increasing but hTau decreasing neuronal/circuit excitability. Most importantly, mice co-expressing hAPP and hTau show that hTau has a dominant effect, dampening the excitatory effects of hAPP. Additionally, compensatory synaptic downscaling, in response to increased excitability in EC was observed in subicular neurons of hAPP mice. Based on simulations, we propose that EC interneuron pruning can account for both EC hyperexcitability and subicular synaptic downscaling found in mice expressing hAPP.

Laryngospasm, central and obstructive apnea during seizures: Defining pathophysiology for sudden death in a rat model.

Seizure spread into the autonomic nervous system can result in life-threatening cardiovascular and respiratory dysfunction. Here we report on a less-studied consequence of such autonomic derangements-the possibility of laryngospasm and upper-airway occlusion. We used parenteral kainic acid to induce recurring seizures in urethane-anesthetized Sprague Dawley rats. EEG recordings and combinations of cardiopulmonary monitoring, including video laryngoscopy, were performed during multi-unit recordings of recurrent laryngeal nerve (RLN) activity or head-out plethysmography with or without endotracheal intubation. Controlled occlusions of a tracheal tube were used to study the kinetics of cardiac and respiratory changes after sudden obstruction. Seizure activity caused significant firing increases in the RLN that were associated with abnormal, high-frequency movements of the vocal folds. Partial airway obstruction from laryngospasm was evident in plethysmograms and was prevented by intubation. Complete glottic closure (confirmed by laryngoscopy) occurred in a subset of non-intubated animals in association with the largest increases in RLN activity, and cessation of airflow was followed in all obstructed animals within tens of seconds by ST-segment elevation, bradycardia, and death. Periods of central apnea occurred in both intubated and non-intubated rats during seizures for periods up to 33s and were associated with modestly increased RLN activity, minimal cardiac derangements, and an open airway on laryngoscopy. In controlled complete airway occlusions, respiratory effort to inspire progressively increased, then ceased, usually in less than 1min. Respiratory arrest was associated with left ventricular dilatation and eventual asystole, an elevation of systemic blood pressure, and complete glottic closure. Severe laryngospasm contributed to the seizure- and hypoxemia-induced conditions that resulted in sudden death in our rat model, and we suggest that this mechanism could contribute to sudden death in epilepsy.

Mortality on the Kidney Waiting List and After Transplantation in Patients With Peripheral Arterial Disease: An Analysis of the United States Renal Data System.

BACKGROUND: Reports from the United States Renal Data System (USRDS) indicated that kidney transplantation, whether from a living donor (LD) or deceased donor (DD), offers survival advantage over being on the waiting list. Whether this is true for patients with peripheral arterial disease (PAD) is unknown given that patients with PAD have significant comorbidities. METHODS: We used a cohort of USRDS incident dialysis patients from 2001 to 2007, with follow-up through 2008. Patients with PAD younger than the age of 70 were included and divided into 3 groups; PAD waitlisted, PAD patients who received a first transplant from a DD, or PAD patients who received a first transplant from a LD. Time-dependent Cox regression models were used to compare differences in mortality. RESULTS: In this study, 23,699 incident dialysis patients met inclusion criteria; only 16.7% (n = 3964) were waitlisted, of which 8.9 % (n = 2121) underwent transplantation. Patient survival in the LD group at any time point was significantly better than being on the waiting list (P < .001). For DD, mortality was higher in the first year compared with waitlisted patients (P < .001), however, after 1 year survival did not differ as compared with remaining on the waiting list. After adjusting for confounders, the relative risk (RR) of dying was significantly higher for patients with history of severe vascular disease requiring amputation (RR, 1.45; 95% confidence interval [CI], 1.15-1.84) in the DD group. CONCLUSIONS: Kidney transplantation from a DD did not offer survival advantage over being on the waiting list, in part due to a higher rate of severe vascular disease. Careful patient selection may improve outcomes in the DD group.

Adaptive changes in photosynthetic performance and secondary metabolites during white dead nettle micropropagation.

The white dead nettle, Lamium album L., is an herb that has been successfully cultivated under in vitro conditions. The L. album micropropagation system offers a combination of factors (light intensity, temperature, carbon dioxide (CO2) level, humidity) that are limiting for plant growth and bioactive capacity. To get a better understanding of the mechanism of plant acclimation towards environmental changes, we performed a comparative investigation on primary and secondary metabolism in fully expanded L. album leaves during the consecutive growth in in situ, in vitro, and ex vitro conditions. Although the genetic identity was not affected, structural and physiological deviations were observed, and the level of bioactive compounds was modified. During in vitro cultivation, the L. album leaves became thinner with unaffected overall leaf organization, but with a reduced number of palisade mesophyll layers. Structural deviation of the thylakoid membrane system was detected. In addition, the photosystem 2 (PS2) electron transport was retarded, and the plants were more vulnerable to light damage as indicated by the decreased photoprotection ability estimated by fluorescence parameters. The related CO2 assimilation and transpiration rates were subsequently reduced, as were the content of essential oils and phenolics. Transfer of the plants ex vitro did not increase the number of palisade numbers, but the chloroplast structure and PS2 functionality were recovered. Strikingly, the rates of CO2 assimilation and transpiration were increased compared to in situ control plants. While the phenolics content reached normal levels during ex vitro growth, the essential oils remained low. Overall, our study broadens the understanding about the nature of plant responses towards environmental conditions.

Real-time estimation of tongue movement based on suprahyoid muscle activity.

In this study, we introduce a real-time method for tongue movement estimation based on the analysis of the surface electromyography (EMG) signals from the suprahyoid muscles, which usual function is to open the mouth and to control the position of the hyoid, the base of the tongue. Nine surface electrodes were affixed to the underside of the jaw and their signals were processed via multi-channel EMG system. The features of the EMG signals were extracted by using a root mean square (RMS) method. The dimension of the variables was reduced additionally from 108 to 10 by applying the Principal Component Analysis (PCA). The feature quantities of the reduced dimension set were associated with the tongue movements by using an artificial neural network. Results showed that the proposed method allows precise estimation of the tongue movements. For the test data set, the identification rate was greater than 97 % and the response time was less than 0.7 s. The proposed method could be implemented to facilitate novel approaches for alternative communication and control of assistive technology for supporting the independent living of people with severe quadriplegia.

Robot-aided motion planning for knee joint rehabilitation with two robot-manipulators.

In this paper, we propose a simultaneous design method of motion and external force trajectories for knee joint rehabilitation based on the biomechanical analysis of the lower limb. In this method we assume to use two robots manipulators which provide forces and moments at shank and thigh. We developed a 7 degree of freedom musculoskeletal model of lower limb with 19 muscles. The valuation function of rehabilitation efficiency e has been maximized by Genetic Algorithm (GA) that refers to the musculoskeletal model and tunes motion trajectory of the robots and forces acting on the shank and thigh.

Robot-aided rehabilitation task design for inner shoulder muscles.

In this paper, we propose a simultaneous design method of motion and external force trajectories for shoulder inner muscles in the robot-aided rehabilitation system, based on a biomechanical analysis of patient's body. The rehabilitation efficiency evaluation function was maximized by Genetic Algorithm (GA), where the structure of spline curves parameters are pre-defined, and the structural parameters are explored to design smooth rehabilitation motion and external force trajectories.

Cortical control of voluntary saccades in Parkinson's disease and pre-emptive perception.

Gamma range EEG has been associated with cognition. Bodis-Wollner et al. [Ann NY Acad Sci 2002;956:464-7] and Forgacs et al. [Perception 2008;37:419-32] described posterior perisaccadic gamma (35-45 Hz) modulation associated with voluntary saccades. Voluntary impairment is a hallmark of Parkinson's disease (PD). We have done correlational analysis of frontally and posteriorly (posterior-parietal) recorded intrasaccadic gamma (ISG) powers, to understand cortical control of voluntary saccades in PD and healthy controls. Fifteen PD patients (55-71 years, 4 females) and 17 healthy controls (54-72 years, 9 females) participated in the study. The EEG was recorded over frontal and posterior-parietal scalp sites. Saccades were recorded with electro-oculogram and infra-red ISCAN camera. Subjects executed horizontal voluntary saccades to a mark; 15 degree distance rightwards or leftwards (centrifugal CF) from the central fixation, then back to the center (centripetal CP) and so on, for 2 minutes. Perisaccadic EEG segments were wavelet transformed followed by Hilbert transform to obtain ISG (35-45 Hz) powers. ISG power was trial-averaged, separately for the 4 possible saccade types; CP and CF, rightwards and leftwards. The perisaccadic EEG revealed disorganization in the intrasaccadic period. The correlations between frontal and posterior ISG power are high in PD (correlation coefficient >0.6) while low in controls (correlation coefficient <0.02). We interpret these results as lack of modulatory coupling between frontal and posterior intrasaccadic mechanisms in PD. Impaired volition in PD may be due to impaired circuitry of preemptive perception (PEP). Interareal phase coupling analysis will help in investigating the cortical voluntary saccade control with greater temporal precision.

[Genetic bases of diversity of the repertoire of immunoglobulins in application to diagnostics of clonality of B-cell lymphoid populations].

Molecular mechanisms underlying the formation of B-cell lymphomas in connection with processes associated with the maturation of B lymphocytes are reviewed. The currently used diagnostic methods do not always distinguish lymphomas from reactive changes of the lymphoid tissue. The principle of the molecular genetic method ofclonality detection in lymphocyte populations, technical problems, and the strategy of its application in clinical diagnostics of lymphomas are described in detail.

Trapping as an alternative method of eradicating classical swine fever in a wild boar population in Bulgaria.

Between August and November 2009, eight cases of classical swine fever (CSF) occurred in young wild boar in a 25-km2 oak forest3 km south of the river Danube in the north-eastern part of Bulgaria. The wild boar population within the affected area was estimated to be 156 animals, or approximately six boar per km2. To control and eradicate the disease, and in addition to vaccination and hunting, trapping was used to reduce the boar population to below two animals per km2. In total, 124 wild boar were removed from the infected area within three months. Of these, 119 were trapped. In this paper, the authors present trapping as a successful tool to eradicate CSF from an area where hunting and vaccination alone might not be sufficient. Up to seven wild boar could be trapped in a single trap. Furthermore, the spread of CSF virus to the local domestic pig population and to wild boar in neighbouring areas was prevented. By decreasing the wild boar population to fewer than two animals per km2, it was assumed that the virus would no longer circulate and the disease would fade out. In fact, no further CSF cases were diagnosed afterwards. Under Bulgarian and similar conditions, trapping seems to be a more reliable method than hunting for reducing a wild boar population within a short period of time. Furthermore, trapping may be used alone or in combination with hunting, depending on the situation.

Trajectory planning of a robot for lower limb rehabilitation.

We introduce a method for lower-limb physical rehabilitation by means of a robot that applies preliminary defined forces to a patient's foot while moving it on a preliminary defined trajectory. We developed a special musculoskeletal model that takes into consideration the generated muscle forces of 27 musculotendon actuators and joint stiffness of the leg and allows the calculation of the motion trajectory of the robot and the forces that the robot needs to apply to the foot in each moment of the therapeutic exercise. Robotic treatment programs are customized for the individual patient by using a genetic algorithm (GA) that refers to the musculoskeletal model and calculates the parameters of the spline curves of the motion trajectory of the robot and forces acting on the foot.

A pea mutant (costata) expressing higher activity in thylakoid membrane-bound carbonic anhydrase alters PSII downregulation mechanisms.

The interaction between photosynthetic electron transport and the activities of the thylakoid associated carbonic anhydrase (tCA), estimated as combined tCA activity in pea plants (Pisum sativum L. Borek cv., WT) and mutant form (costata 2/125) that differ in chlorophyll content have been compared. Chlorophyll a fluorescence changes after the inhibition of tCA by ethoxyzolamide (EZ), estimating possible role of tCA in PSII downregulation were investigated. Costata expresses higher tCA activity and higher O2 evolution in comparison to WT. Inhibition of tCA by EZ decreased effective PSII photochemistry that coincided with an enhancement in thermal dissipation, while maximal PSII quantum yield (F(v)/F(m)) did not significantly change. Ethoxyzolamide induced changes in fluorescence parameters that were more strongly expressed in costata 2/125. The results show that tCA is involved in the regulation of the proton gradient across thylakoid membranes and thus limits PSII downregulation.

Characterization of juvenile and adult leaves of Eucalyptus globulus showing distinct heteroblastic development: photosynthesis and volatile isoprenoids.

Heteroblastic Eucalyptus (Eucalyptus globulus L.) leaves were characterized for their functional diversity examining photosynthesis and photosynthesis limitations, transpiration, and the emission of isoprene and monoterpenes. In vivo and combined analyses of gas-exchange, chlorophyll fluorescence, and light absorbance at 830 nm were made on the adaxial and abaxial sides of juvenile and adult leaves. When adult leaves were reversed to illuminate the abaxial side, photosynthesis and isoprene emission were significantly lower than when the adaxial side was illuminated. Monoterpene emission, however, was independent on the side illuminated and similarly partitioned between the two leaf sides. The abaxial side of adult leaves showed less diffusive resistance to CO(2) acquisition by chloroplasts, but also lower ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) activity, than the adaxial leaf side. In juvenile leaves, photosynthesis, isoprene, and monoterpene emissions were similar when the adaxial or abaxial side was directly illuminated. In the abaxial side of juvenile leaves, photosynthesis did not match the rates attained by the other leaf types when exposed to elevated CO(2), which suggests the occurrence of a limitation of photosynthesis by ribulose bisphosphate (RuBP) regeneration. Accordingly, a reduced efficiency of both photosystems and a high non-radiative dissipation of energy was observed in the abaxial side of juvenile leaves. During light induction, the adaxial side of juvenile leaves also showed a reduced efficiency of photosystem II and a large non-radiative energy dissipation. Our report reveals distinct functional properties in Eucalyptus leaves. Juvenile leaves invest more carbon in isoprene, but not in monoterpenes, and have a lower water use efficiency than adult leaves. Under steady-state conditions, in adult leaves the isobilateral anatomy does not correspond to an equal functionality of the two sides, while in juvenile leaves the dorsiventral anatomy does not result in functional differences in primary or secondary metabolism in the two sides. However, photochemical limitations may reduce the efficiency of carbon fixation in the light, especially in the abaxial side of juvenile leaves.

Effects of the whole extract and the chromatographic fractions of the pig placenta on lymphocyte proliferation and humoral immune response.

The immunoregulatory properties of pig fetal placenta extracts (PE) from 1 st, 2nd and 3rd month of pregnancy and five fractions (F1 to F5), isolated on Sephadex G-200 and additionally characterized by fast performance liquid chromatography, FPLC (Superose 12 HR) were studied in order to clarify the local immune regulation in diffuse epitheliochorial placentation. The obtained substances were added at 6.25 to 100 microg in cultures of Concanavalin A-stimulated mouse splenocytes and Phytohemagglutinin-stimulated pig and human PBL to monitor their influence on [(3)H]Thimidine uptake in proliferating lymphocytes. Their effects on the number of plaque-forming cells in spleen cell suspensions from mice treated ip simultaneously with sheep red blood cells and with 100 microg protein of PE, respectively, of each fraction were also investigated: PE and F1 had no effect while F4 and F5 suppressed the mitogen-induced lymphocyte proliferation in all studied species. F2 and F3 stimulated mouse and pig lymphocyte proliferation. The effects were dose-dependent and the suppression was not due to cytotoxic effects. The FPLC data allowed the suggestion that 110 kD protein(s) were involved in stimulation and 7 kD substance(s) - in suppression of cell proliferation. The PE from the 3 studied periods as well as the 5 fractions increased significantly the primary humoral immune response against T-dependent antigen. The results revealed that trophoblast of epitheliochorial placenta produces simultaneously immuno-stimulatory and -suppressive factors acting across the species barrier. Their presence at the feto-maternal interface may contribute to the regulation of local immune reactions and survival of the allogenic fetuses despite the morphological specificities of this type of placentation.

[Isolation and receptor activity of mammalian lymphocytes]. / Izolirane i retseptorna aktivnost na limfotsitite pri niakoi bozainitsi.

The possibilities of lymphocytes from the blood of pigs, cows, sheep and rabbits, using Lymphoprep, Polysep, and Histopaque were investigated. The conditions given by the producer firms were strictly observed when dealing with the separation media, and in cases when the results were unsatisfactory modifications were made with regard to the velocity and duration of centrifugation in carrying out the separation. The functional state of membrane receptors of lymphocytes was checked by rosette tests with erythrocytes for the detection of T-lymphocytes. It was demonstrated that lymphocytes from pig's blood are successfully isolated with all three separating media, when observing the conditions of manipulation as indicated by producer firms. With ruminants the best results were obtained with Lymphoprep. Polysep is not suitable medium for lymphocyte isolation from cow's blood; Histopaque can be used if the separation is carried out at 1880 r. p. m. for 40 minutes. Good results are obtained with Polysep with sheep's blood when the separation is performed at 1880 r. p. m. for 40 minutes. All three media can be used in isolation of lymphocytes from rabbit's blood. The isolation of lymphocytes with Histopaque must be performed by centrifugation at 1520 r. p. m. for the duration of 40 minutes. The separation media investigated do not harm the membrane receptors of lymphocytes.