New diagnosis of conversion disorder following anterior lumbar interbody fusion: a case report.

Neurologic deficit after lumbar spine surgery is a rare and serious complication that must be promptly diagnosed and treated to avoid long-term neurologic disability. Anterior lumbar interbody fusion (ALIF) is an effective technique for the treatment of recurrent disc herniation and lumbar disc degeneration. This case report describes a 20-year-old female with L5-S1 recurrent disc herniation and lumbar degeneration. She underwent an L5-S1 ALIF complicated by post-operative lower left extremity paralysis. Revision surgery with downsizing of the ALIF cage was performed with normal neuromonitoring throughout the procedure. The patient displayed persistent post-operative neurologic deficits despite no evidence of central or foraminal compression. Patient was later diagnosed with conversion disorder by neurology during her hospitalization. This case report presents the initial diagnosis of conversion disorder after a routine ALIF procedure, which led to surgical re-exploration and prolonged inpatient hospital stay. Psychiatric diagnoses must be considered when neurologic deficits are present with no apparent organic cause.

InGaP electron spectrometer for high temperature environments.

In this work, a 200 µm diameter InGaP (GaInP) p+-i-n+ mesa photodiode was studied across the temperature range 100 °C to 20 °C for the development of a temperature-tolerant electron spectrometer. The depletion layer thickness of the InGaP device was 5 µm. The performance of the InGaP detector was analysed under dark conditions and then under the illumination of a 183 MBq 63Ni radioisotope beta particle source. The InGaP photodiode was connected to a custom-made low-noise charge-sensitive preamplifier to realise a particle counting electron spectrometer. Beta spectra were collected at temperatures up to 100 °C with the InGaP device reverse biased at 5 V. The spectrum accumulated at 20 °C was compared with the spectrum predicted using Monte Carlo simulations; good agreement was found between the predicted and experimental spectra. The work is of importance for the development of electron spectrometers that can be used for planetary and space science missions to environments of high temperature or extreme radiation (e.g. Mercury, Jupiter's moon Europa, near-Sun comets), as well as terrestrial applications.

Note: Elastic wave velocity measurement using ultrasonic system with two-reflectors.

We report an experiment protocol for ultrasonic velocity measurements carried out in a synchrotron-based multi-anvil high-pressure apparatus. By adding a second reflector in the cell assembly, ultrasonic signals are significantly stabilized for experiments where samples experience structural changes such as phase transition or partial melting. Features of the elastic wave can be calculated from acoustic impedance allowing us to evaluate the possible interference between the sample reflection and other internal multiple reflections. This new protocol allows various forms of samples including cold-pressed powder samples, for which grain size and porosity can be monitored and controlled in situ during the annealing process.

Bioavailability of Oral Hydrocortisone Corrected for Binding Proteins and Measured by LC-MS/MS Using Serum Cortisol and Salivary Cortisone.

CONTEXT: The assessment absolute bioavailability of oral hydrocortisone is complicated by its saturable binding to cortisol binding globulin (CBG). Previous assessment of bioavailability used a cortisol radioimmunoassay which has cross reactivity with other steroids. Salivary cortisone is a measure of free cortisol and LC-MS/MS is the gold standard method for measuring steroids. We here report the absolute bioavailability of hydrocortisone calculated using serum cortisol and salivary cortisone measured by LC-MS/MS. METHODS: 14 healthy male dexamethasone suppressed volunteers were administered 20 mg hydrocortisone either intravenously or orally by tablet. Samples of serum and saliva were taken and measured for cortisol and cortisone by LC-MS/MS. Serum cortisol was corrected for saturable binding using published data and pharmacokinetic parameters derived using the program WinNonlin. RESULTS: The mean (95% CI) bioavailability of oral hydrocortisone calculated from serum cortisol, unbound serum cortisol and salivary cortisone was 1.00 (0.89-1.14); 0.88 (0.75-1.05); and 0.93 (0.83-1.05), respectively. CONCLUSION: The data confirm that, after oral administration, hydrocortisone is completely absorbed. The data derived from serum cortisol corrected for protein binding, and that from salivary cortisone, are similar supporting the concept that salivary cortisone reflects serum free cortisol levels and that salivary cortisone can be used as a non-invasive method for measuring the pharmacokinetics of hydrocortisone.

Preoperative sentinel lymph node identification, biopsy and localisation using contrast enhanced ultrasound (CEUS) in patients with breast cancer: a systematic review and meta-analysis.

AIM: To evaluate whether contrast-enhanced ultrasound (CEUS)-guided core biopsy of the sentinel lymph node (SLN) could identify metastatic nodes preoperatively and reduce the number of surgical SLN biopsies in patients with breast cancer and normal axillary B-mode ultrasound; and to establish whether CEUS SLN identification and localisation is a viable alternative to standard lymphatic mapping using isotope and blue dye. MATERIALS AND METHODS: A search of several electronic databases was performed and identified studies were assessed using QUADAS-2 for methodological quality. Pooled estimates of sensitivity and specificity for identification of nodal metastases were calculated. RESULTS: Eleven prospective studies and one retrospective study with 1,520 participants were included. The SLN identification and localisation rate for CEUS-guided skin marking was 70-100%, CEUS guided-wire localisation was 89-97%, and CEUS-guided iodine-125 (125I) seed localisation was 60%. Across the four studies that evaluated preoperative CEUS-guided SLN biopsy, pooled sensitivity for identification of nodal metastases was 54% (95% confidence interval [CI]: 47-61) and pooled specificity 100% (95% CI: 99-100). CONCLUSION: CEUS is a promising technique for preoperative staging of the axilla. CEUS-guided core biopsy has the potential to identify nodal metastases in over half (54%) of patients with normal axillary B-mode ultrasound. CEUS-guided identification and localisation of the SLN may offer a viable alternative to standard lymphatic mapping using isotope and blue dye; however, further prospective studies with larger samples are warranted.

Temperature effects on an InGaP (GaInP) 55Fe X-ray photovoltaic cell.

This paper investigates the effects of temperature on an InGaP (GaInP) 55Fe X-ray photovoltaic cell prototype for a radioisotope microbattery (also called a nuclear microbattery). An In0.5Ga0.5P p-i-n (5 µm i-layer) mesa photodiode was illuminated by a standard 206 MBq 55Fe radioisotope X-ray source and characterised over the temperature range -20 °C to 100 °C. The electrical power output of the device reached its maximum value of 1.5 pW at a temperature of -20 °C. An open circuit voltage and a short circuit current of 0.82 V and 2.5 pA, respectively, were obtained at -20 °C. While the electrical power output and the open circuit voltage decreased with increasing temperature, an almost flat trend was found for the short circuit current. The cell conversion efficiency decreased from 2.1% at -20 °C to 0.7% at 100 °C.

Role of Defects and Surface States in the Carrier Transport and Nonlinearity of the Diode Characteristics in PbS/ZnO Quantum Dot Solar Cells.

The roles of bulk surface states and interfacial defects are probed experimentally using a combination of current-voltage, capacitance-voltage, and impedance measurements. The critical importance of the quality of both the film and interfaces is evident in current-voltage measurements where shunting and interface states result in large dark currents and the subsequent loss of Jsc. These properties are shown to be critically related to the nature and role of the PbS QD interface with the (nominally) ohmic gold contact. Specifically, the nonideality of this interface results in the formation of an electric field and therefore a Schottky barrier that opposes the transport of carriers across the conventional ZnO-PbS CQD system. Nonidealities in the structure and absorber layer are also reflected in nonmonotonic behavior and dispersion in C-V measurements with trapping processes on the CQD surfaces, and the ZnO/PbS and PbS/Au interfaces also affecting the carrier dynamics, which is reflected in the response time of these systems under different biases.

Functional Outcomes of Thoracolumbar Junction Spine Fractures.

INTRODUCTION: Few studies have evaluated the functional outcomes of traumatic thoracic and lumbar vertebral body fractures. This study evaluated the functional and clinical outcomes of patients, who sustained a fracture to the thoracolumbar area of the spine (T10 to L2 region), with ≥ 25° kyphosis versus those with less kyphotic curvature. METHODS: The trauma registry records of two level 1 trauma centers using ICD-9 codes for fracture to the thoracolumbar juncture (T10 to L2 region) were reviewed. Kyphosis angle was measured on the standing lateral thoracolumbar (T1 - L5) radiograph at initial trauma and at clinical follow-up. Functional outcome questionnaires, including the Oswestry Disability Questionnaire (ODQ), the Roland Morris Disability Questionnaire (RMDQ), and the Nottingham Health Profile (NHP), were evaluated at clinical follow-up. Work status and medication used after trauma also were recorded. RESULTS: A total of 38 patients met the inclusive criteria. Seventeen patients (45%) had ≥ 25° kyphosis and 21 patients (55%) had < 25° kyphosis at follow-up. These two groups were similar based on sex and age. Based on the ODQ Score, the RMDQ Score, and the NHP, no statistically significant differences were detected between the two groups in regards to energy, pain, mobility, emotional reaction, social isolation, and sleep. CONCLUSIONS: Patients who sustained a fracture to the thoracolumbar area of the spine with ≥ 25° kyphosis do not report worse clinical outcomes. When using the kyphosis angle as an indication for surgery, it should be used with caution and not exclusively.

AlGaAs 55Fe X-ray radioisotope microbattery.

This paper describes the performance of a fabricated prototype Al0.2Ga0.8As 55Fe radioisotope microbattery photovoltaic cells over the temperature range -20 °C to 50 °C. Two 400 µm diameter p+-i-n+ (3 µm i-layer) Al0.2Ga0.8As mesa photodiodes were used as conversion devices in a novel X-ray microbattery prototype. The changes of the key microbattery parameters were analysed in response to temperature: the open circuit voltage, the maximum output power and the internal conversion efficiency decreased when the temperature was increased. At -20 °C, an open circuit voltage and a maximum output power of 0.2 V and 0.04 pW, respectively, were measured per photodiode. The best internal conversion efficiency achieved for the fabricated prototype was only 0.95% at -20 °C.

Pathogenic Helicobacter pylori strains translocate DNA and activate TLR9 via the cancer-associated cag type IV secretion system.

Helicobacter pylori (H. pylori) is the strongest identified risk factor for gastric cancer, the third most common cause of cancer-related death worldwide. An H. pylori constituent that augments cancer risk is the strain-specific cag pathogenicity island, which encodes a type IV secretion system (T4SS) that translocates a pro-inflammatory and oncogenic protein, CagA, into epithelial cells. However, the majority of persons colonized with CagA+ H. pylori strains do not develop cancer, suggesting that other microbial effectors also have a role in carcinogenesis. Toll-like receptor 9 (TLR9) is an endosome bound, innate immune receptor that detects and responds to hypo-methylated CpG DNA motifs that are most commonly found in microbial genomes. High-expression tlr9 polymorphisms have been linked to the development of premalignant lesions in the stomach. We now demonstrate that levels of H. pylori-mediated TLR9 activation and expression are directly related to gastric cancer risk in human populations. Mechanistically, we show for the first time that the H. pylori cancer-associated cag T4SS is required for TLR9 activation and that H. pylori DNA is actively translocated by the cag T4SS to engage this host receptor. Activation of TLR9 occurs through a contact-dependent mechanism between pathogen and host, and involves transfer of microbial DNA that is both protected as well as exposed during transport. These results indicate that TLR9 activation via the cag island may modify the risk for malignancy within the context of H. pylori infection and provide an important framework for future studies investigating the microbial-epithelial interface in gastric carcinogenesis.

PEGylated Biodegradable Polyesters for PGSS Microparticles Formulation: Processability, Physical and Release Properties.

BACKGROUND: Particles from Gas Saturated Solution (PGSS) is an emergent method that employs supercritical carbon dioxide (scCO2) to produce microparticles. It is suitable for encapsulating biologically active compounds including therapeutic peptides and proteins. Poly(lactide acid) (PLA) and/or poly(lactic-coglycolic acid) (PLGA) are the most commonly used materials in PGSS, due to their good processability in scCO2. Previous studies demonstrated that the properties of the microparticles can be modulated by adding polyethylene glycol (PEG) or tri-block PEGylated copolymers. OBJECTIVE: In the present work, the effect of the addition of biodegradable PEGylated di-block copolymers on the physical properties and drug release performance of microparticles prepared by PGSS technique was evaluated. METHOD: mPEG5kDa-P(L)LA and mPEG5kDa-P(L)LGA with similar molecular weights were synthesized and their behaviour, when exposed to supercritical CO2, was investigated. Different microparticle formulations, composed of a high (81%) or low (9%) percentage of the synthesized copolymers were prepared and compared in terms of particle size distribution, morphology, yield and protein release. Drug release studies were performed using bovine serum albumin (BSA) as a model protein. RESULTS: PEGylated copolymers showed good processability in PGSS without significant changes to the physical properties of the microparticles. However, the addition of PEG exerted a modulating effect on the microparticle drug dissolution behaviour, increasing the rate of BSA release as a function of its content in the formulation. CONCLUSION: This study demonstrated the feasibility of producing microparticles by using PEGylated di-block copolymers through a PGSS technique at mild operating conditions (low operating pressure and temperature).

Community Context and Men's Control-Seeking in Intimate Relationships.

This study explores social-ecological influences on men's control-seeking in intimate relationships with women. Desire for control is central to the battered women's movement and is incorporated into intimate partner violence (IPV) prevention work. Recent IPV scholarship re-focuses on control, but the role of community contexts is underdeveloped. Community contexts have been associated with men's risk for IPV and evidence supports that social ecology facilitates IPV against women. Given the importance of the social ecology to control in IPV, this study examines community contexts that influence men's control-seeking of women partners. The sample comprised 2,342 in-state, male undergraduate students who completed a cross-sectional survey at a public university. Hypotheses were tested using hierarchical linear modeling. Results support a connection between county contexts and men's control-seeking toward women partners. Implications for IPV research and practice are discussed.

Successful private-public funding of paediatric medicines research: lessons from the EU programme to fund research into off-patent medicines.

UNLABELLED: The European Paediatric Regulation mandated the European Commission to fund research on off-patent medicines with demonstrated therapeutic interest for children. Responding to this mandate, five FP7 project calls were launched and 20 projects were granted. This paper aims to detail the funded projects and their preliminary results. Publicly available sources have been consulted and a descriptive analysis has been performed. Twenty Research Consortia including 246 partners in 29 European and non-European countries were created (involving 129 universities or public-funded research organisations, 51 private companies with 40 SMEs, 7 patient associations). The funded projects investigate 24 medicines, covering 10 therapeutic areas in all paediatric age groups. In response to the Paediatric Regulation and to apply for a Paediatric Use Marketing Authorisation, 15 Paediatric Investigation Plans have been granted by the EMA-Paediatric Committee, including 71 studies of whom 29 paediatric clinical trials, leading to a total of 7,300 children to be recruited in more than 380 investigational centres. CONCLUSION: Notwithstanding the EU contribution for each study is lower than similar publicly funded projects, and also considering the complexity of paediatric research, these projects are performing high-quality research and are progressing towards the increase of new paediatric medicines on the market. Private-public partnerships have been effectively implemented, providing a good example for future collaborative actions. Since these projects cover a limited number of off-patent drugs and many unmet therapeutic needs in paediatrics remain, it is crucial foreseeing new similar initiatives in forthcoming European funding programmes.

Linking community protective factors to intimate partner violence perpetration.

This study explores how community factors moderate men's individual risk for physical and psychological intimate partner violence (IPV) perpetration. The sample of 604 male first-semester undergraduate students supports a connection between county-level protective and risk factors, an individual risk factor, and IPV perpetration. For each unit increase in the proportion of women in powerful positions within a county, there was a 71% decrease in the risk that control-seeking respondents would perpetrate physical IPV, controlling for other factors including population density and violent crime. This article presents a multilevel analysis using hierarchical generalized linear modeling and discusses practice and research implications.

Stand-alone anterior lumbar interbody fusion for degenerative disc disease of the lumbar spine: results with a 2-year follow-up.

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To report outcomes of a consecutive series of patients diagnosed with degenerative disc disease (DDD) between L4 and S1, treated with stand-alone anterior lumbar interbody fusion (ALIF, either 1 or 2 levels) and use of recombinant human bone morphogenetic protein 2 for bony fusion with instrumented fixation. SUMMARY OF BACKGROUND DATA: Degeneration of the lumbar spine is described as lumbar spondylosis, or DDD. To treat DDD, surgical interventions include: ALIF, circumferential fusion (360° fusion), posterior spinal fusion, and total disc replacement. Currently, there has been paucity in the literature on the evaluation of ALIFs. METHODS: Researchers reviewed a consecutive series of patients with DDD who had undergone a 1-level or 2-level ALIF between 2005 and 2010, with the use of recombinant human bone morphogenetic protein 2. Patients' clinical and functional outcomes were documented. Radiographs were analyzed for disc height, mean optical density, and integrated optical density. Operative time, length of hospital stay, and estimated blood loss were also reported. RESULTS: Patients' 2-year Oswestry Disability Index and visual analogue scale presurgery scores significantly improved (P ≤ 0.0001). Patients' 2-year postoperative disc height was significantly greater than the preoperative disc height at the fused level (P ≤ 0.0001); there was no significant difference at the level adjacent to fusion. Majority of patients (107 of 115, 93.0%) satisfied fusion criteria based on mean optical density. Intraoperative time, estimated blood loss, and hospital stay was significantly fewer with 1-level and 2-level ALIFs than 360° fusions and total disc replacement. CONCLUSION: Stand-alone ALIF used to treat DDD can produce comparative clinical and functional outcomes. ALIFs showed significant decreases in blood loss, operative time, and hospital stay. Furthermore, at 2 years' time, mean optical density suggests high rate of bony fusion, and no significant loss of disc height was noted at the adjacent level. LEVEL OF EVIDENCE: 4.

Evaluation of P(L)LA-PEG-P(L)LA as processing aid for biodegradable particles from gas saturated solutions (PGSS) process.

A series of biodegradable P(L)LA-PEG1.5 kDa-P(L)LA copolymers have been synthesized and compared as processing aid versus Poloxamer 407 (PEO-PPO-PEO), in the formulation of protein encapsulated microparticles, using supercritical carbon dioxide (scCO2). Bovine serum albumin (BSA) loaded microcarriers were prepared applying the particles from the gas saturated solutions (PGSS) technique using scCO2 and thus, avoiding the standard practice of organic solvent encapsulation. Four triblock copolymers were synthesized and characterized, particularly in terms of thermal properties and behaviour when exposed to scCO2. The effects of the inclusion of these copolymers in the formulation of poly(α-hydroxy acids) based microparticles - e.g. poly(D,L-lactic-co-glycolic acid) (PLGA) and poly(D,L-lactide) (PLA) - were analysed in terms of yield, particle size, morphology and drug release. The use of P(L)LA-PEG1.5 kDa-P(L)LA triblock copolymers were found to increase the yield of the PGSS-based process and to decrease the size of the microparticles produced, in comparison with the formulation containing the Poloxamer 407. Moreover the microparticles formulated with the triblock copolymers possessing the higher hydrophobic character were able to maintain a controlled drug release profile.

Motivational attributions about intimate partner violence among male and female perpetrators.

Given the widely acknowledged negative impact and pervasiveness of intimate partner violence (IPV), many have sought to discover why people perpetrate IPV. To this end, IPV risk factors have been extensively studied and attributions have recently received more attention. Evidence suggests males and females have similar attributions and both engage in IPV. Yet, IPV tactics and attribution rates appear to differ by perpetrator sex. This study explores whether males and females tend to attribute different reasons to their IPV, and whether these attributions help to distinguish among physical and psychological IPV tactics. The study tests three hypotheses: that IPV tactics and attributions will differ between females and males, that females and males will have similar latent constructs associated with types of attributions made about IPV, and that males and females will have different relationships among attribution factors and IPV tactics. This study is based on a cross-sectional survey of 5,035 18- to 25-year-old undergraduate university students in the Southeastern United States. Analyses used SPSS 20 to conduct basic and bivariate analyses, multiway frequency analysis, reliability analysis, and logistic regression, and MPlus 6.12 to conduct exploratory and confirmatory factor analysis. Overall, the results provide support for the three study hypotheses, although there was inconsistency in findings for the second hypothesis. The results suggest important practice and research implications, which are discussed. The study fills a gap in the limited literature on IPV perpetrator motivational attributions by presenting a nuanced analysis of an early measure of IPV attributions.

Centrality of control-seeking in men's intimate partner violence perpetration.

Two million women and one million men experience rape, stalking, or physical assault by a current or former romantic partner each year in the U.S. Not only do women report twice the incidents, but intimate partner violence (IPV) that women experience is typically more severe. Explanations for IPV gender asymmetry include male dominance attitudes, hostile sexism, and men's control-seeking. There are gaps in our knowledge of how attitudes and control-seeking co-relate to influence IPV. This study demonstrates a mediation analysis to investigate these relationships. Data were from a cross-sectional online survey of male undergraduate students from a public Southeastern university. The survey measured attitudes of male dominance and hostile sexism, desire for control, and IPV perpetration. After including age and academic level in the model, male dominance remained a significant predictor of likelihood of physical IPV (OR = 1.16, p = .004) but not psychological IPV. The addition of control-seeking (physical OR = 1.65, p < .001) mediated the influence of male dominance on the likelihood of physical IPV perpetration (OR = 1.018, p = .753). Hostile sexism was a significant predictor of psychological and physical IPV (psychological IPV OR = 1.31, p < .001; physical IPV OR = 1.54, p < .001), over and above age and academic level. The addition of control-seeking (psychological IPV OR = 1.27, p < .001; physical OR = 1.53, p < .001) partially mediated the influence of hostile sexism on IPV (psychological IPV OR = 1.21, p = .001; physical OR = 1.34, p < .001). Results suggest control-seeking mediates the relationship between male dominance and physical IPV and partially mediates the relationship between hostile sexism and IPV. Practical implications for IPV prevention programs and theoretical implications are discussed.

Magnetic interaction in ferrous antimonite, FeSb2O4, and some derivatives.

Ferrous antimonite, FeSb(2)O(4), which is isostructural with Pb(3)O(4), and some lead- and cobalt-doped variants of composition FeSb(1.5)Pb(0.5)O(4) and Co(0.5)Fe(0.5)Sb(1.5)Pb(0.5)O(4) have been examined by (57)Fe and (121)Sb Mössbauer spectroscopy. Antimony is present as Sb(3+). The presence of Pb(2+) on the antimony site induces partial oxidation of Fe(2+) to Fe(3+). There is no Verwey-type transition in which electrons are shared between iron in different oxidation states. The quasi-one-dimensional magnetic structure gives rise to situations in which weakly coupled Fe(2+) ions can coexist in a non-magnetic state alongside Fe(3+) ions in a magnetically ordered state.