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There has been significant increase in the use of molecular tools for the diagnosis of invasive aspergillosis (IA) and mucormycosis. However, their range of detection may be too limited as species diversity and coinfections are increasing. Here, we aimed to evaluate a molecular workflow based on a new multiplex PCR assay detecting the whole Aspergillus genus and the Mucorales order followed by a species-specific PCR or a DNA-sequencing approach for IA and/or mucormycosis diagnosis and species identification on serum. Performances of the MycoGENIE Aspergillus spp./Mucorales spp. duplex PCR kit were analyzed on a broad range of fungal strains and on sera from high-risk patients prospectively over a 12-month period. The kit allowed the detection of nine Aspergillus species and 10 Mucorales (eight genera) strains assessed. No cross-reactions between the two targets were observed. Sera from 744 patients were prospectively analyzed, including 35 IA, 16 mucormycosis, and four coinfections. Sensitivity varies from 85.7% (18/21) in probable/proven IA to 28.6% (4/14) in COVID-19-associated pulmonary aspergillosis. PCR-positive samples corresponded to 21 A. fumigatus, one A. flavus, and one A. nidulans infections. All the disseminated mucormycosis were positive in serum (14/14), including the four Aspergillus coinfections, but sensitivity fell to 33.3% (2/6) in localized forms. DNA sequencing allowed Mucorales identification in serum in 15 patients. Remarkably, the most frequent species identified was Rhizomucor pusillus (eight cases), whereas it is barely found in fungal culture. This molecular workflow is a promising approach to improve IA and mucormycosis diagnosis and epidemiology.

Background Laparoscopic totally extraperitoneal (TEP) surgery with a single large mesh is currently the technique of choice for repair of bilateral inguinal hernias in our institution. Most surgeons use two meshes for the TEP repair. We present our experience with a single mesh repair. Material & Methods Records of all patients who had bilateral inguinal hernia and underwent bilateral laparoscopic TEP repair at our institution, 2010–2016, were retrospectively reviewed. We excluded patients who had a conversion to transabdominal intraperitoneal or open approach. Results A total of 470 patients were identified. The median age of patients was 56 (IQR 1–3; 41–66) years and median BMI was 25.9 (IQR 1–3; 23.1–28.1). 18.7% of the cohort (88 patients) had previous abdominal surgery and 39 patients (8.41%) had a recurrent inguinal hernia. Median length of operation was 63 (IQR1–3; 48–89) minutes. Operative complication were bleeding (0.4%) and bladder injury (0.2%). Post operative complications occurred in 32 patients; among the complications were seroma (2.6%), hematoma (2.1%), surgical site infection (0.4%) urinary retention (1.5%) and intestinal obstruction (0.2%). Median length of hospitalization was 1 day (IQR1–3; 1–2). After a median follow up of 102 months, 36 patients had a recurrence. 20 patients (4.3%) had a re-operation for recurrent inguinal hernia. Post-operative groin pain was present in 48 patients. Conclusion The use of a large single mesh is an effective and safe technique for TEP repair of bilateral inguinal hernias. The recurrence rate and prevalence of post-operative pain is consistent with the results reported by others.

Aims: This study aimed to compare the prevalence of P. falciparum gametocyte carriage in two sympatric ethnic groups living in seasonal malaria transmission setting in Burkina Faso. Study Design: A cross-sectional survey was conducted from September to November 2017 in children aged from 2 to 12 years and living in Barkoundouba, avillage located at the Northeast part of Ouagadougou, capital city of Burkina Faso. The study participants were subject to clinical examination including axillary temperature. Blood samples were collected from finger pricks to performed RDT and blood smears for malaria diagnosis and on filter paper for molecular detection of the parasite. Any case of fever (temperature ≥ 37.5°C) with RDT positive was treated according to national guideline. Methodology: We included 461 patients in this study. P. falciparum presence and densities were determined by microscopy using Giemsa-stained thick blood smears. The nested PCR was used to confirm the presence of the asexual parasites assessed by the microscopy. Results: P. falciparum prevalence assessed by microscopy was 83 (32.55%) and 103 (50%) for Fulani and Mossi respectively, whereas the prevalence by nested PCR was 88 (39.11%) for Fulani and 121 (68.75%) for Mossi. The gametocyte carriage in the two ethnic groups was: 3.53% for Fulani and 11.65% for Mossi. The prevalence ratio for P. falciparum asymptomatic and gametocyte carriers was 1.5 and 3 in favor of Mossi group respectively. Conclusion: This study showed that the Fulani have a lower prevalence of P. falciparum compared to the Mossi group despite the decrease of parasitemia and prevalence in both groups compared to previous studies.

Infants who are exclusively breastfed in the first six months of age receive adequate nutrients, achieving optimal immune protection and growth. In addition to the known nutritional components of human breast milk (HBM), i.e., water, carbohydrates, fats and proteins, it is also a rich source of microRNAs, which impact epigenetic mechanisms. This comprehensive work presents an up-to-date overview of the immunomodulatory constituents of HBM, highlighting its content of circulating microRNAs. The epigenetic effects of HBM are discussed, especially those regulated by miRNAs. HBM contains more than 1400 microRNAs. The majority of these microRNAs originate from the lactating gland and are based on the remodeling of cells in the gland during breastfeeding. These miRNAs can affect epigenetic patterns by several mechanisms, including DNA methylation, histone modifications and RNA regulation, which could ultimately result in alterations in gene expressions. Therefore, the unique microRNA profile of HBM, including exosomal microRNAs, is implicated in the regulation of the genes responsible for a variety of immunological and physiological functions, such as FTO, INS, IGF1, NRF2, GLUT1 and FOXP3 genes. Hence, studying the HBM miRNA composition is important for improving the nutritional approaches for pregnancy and infant’s early life and preventing diseases that could occur in the future. Interestingly, the composition of miRNAs in HBM is affected by multiple factors, including diet, environmental and genetic factors.

Introduction Le traitement du cancer a ete profondement modifie ces dernieres annees avec l’introduction des inhibiteurs du checkpoint immunologiques (ICI). Le pronostic de certains cancers, tels le melanome ou le cancer pulmonaire non a petites cellules s’en est trouve largement ameliore [1] , [2] . Ces traitements sont cependant a l’origine d’effets secondaires appeles effets indesirables lies a l’immunotherapie (EILI), dont les atteintes les plus frequentes (digestives, cutanees, endocriniennes) sont maintenant bien decrites, et relativement simples a diagnostiquer et traiter [3] . A contrario, certaines atteintes plus rares comme la myocardite sont peu decrites, alors que le taux de mortalite est eleve (jusqu’a 40 %) et de prise en charge plus delicate. Patients et methodes Nous avons conduit une etude transversale retrospective multicentrique sur une periode allant de juillet 2019 a novembre 2020. Les criteres d’inclusion etaient : traitement par un inhibiteur du checkpoint immunologique, survenue d’une suspicion de myocardite en s’appuyant sur les criteres de la societe europeenne de cardiologie, donnees de suivi disponibles pour chaque patient. Les myocardites etaient classees en possible/probable/definies selon des criteres internationaux, la severite a ete cotee en utilisant la classification CTCAE v5.0. Resultats Vingt-neuf patients ont ete inclus, de 6 centres differents, avec un âge median de 69 (32-83) ans. Les cancers traites etaient majoritairement pulmonaires (10 patients), des melanomes (8 patients), ou urotheliaux (4 patients). La myocardite survenait dans un delai median de 39 (2-181) jours, principalement avec des anti-PD1 (16 patients, 55 %). La plupart des patients (83 %) etaient symptomatiques, la dyspnee etant le symptome le plus frequent (17 patients, 59 %). Tous avaient une troponine HS elevee, avec une mediane de 5,35 fois la normale superieure, l’ECG montrait des anomalies chez 19 patients (68 %), alors que l’ETT etait disponible chez 27 patients et montrait une FEVG alteree chez 10 d’entre eux (37 %). Une IRM cardiaque a ete realisee chez 24 patients, montrant une prise de contraste tardive chez 9 d’entre eux (37 %). Quatorze patients (48 %) ont subi une coronarographie, et 6 ont beneficie d’une biopsie endomyocardique. Ces dernieres montraient chez 5 patients une infiltration lymphocytaire, majoritairement CD8+. Parmi les toxicites associees, la myosite etait la plus frequente (13 patients, 45 %), suivie du syndrome sec (11 patients, 38 %). Les patients les plus severes (CTCAE grade 4 et 5, n = 11) avaient un taux plus important de maladies auto-immunes systemiques preexistantes (5 patients contre 1, p = 0,018), une frequence cardiaque plus elevee a l’admission (113 contre 79,5, p = 0,001), une troponinemie d’entree plus elevee (42 fois la norme superieure contre 3,55, p = 0,001), et presentaient plus souvent des anticorps anti-recepteur de l’acetylcholine (5 contre 0, p = 0,001). L’analyse en courbe ROC nous a permis de selectionner une valeur seuil de troponinemie a 4,89 fois la norme superieur (sensibilite = 90,9 %, specificite 66,7 %) pour predire l’evolution vers une forme grave. Concernant le traitement, la plupart des patients (28) ont recu des corticoides, le plus souvent apres des bolus initiaux (19 patients, 68 %). Les autres modalites de traitement concernaient les plasmaphereses (10 patients), les immunoglobulines polyvalentes (8 patients), et d’autres immunosuppresseurs (5 patients). 7 patients (24 %) sont morts lors de la prise en charge initiale. Nous disposions d’une evaluation de la reponse carcinologique chez 21 patients, dont seulement 1 presentait une progression de la maladie. Au cours du suivi (d’une mediane de 4 mois), 7 patients supplementaires sont decedes. 6 patients ont recu a nouveau un traitement par ICI, seulement 1 ayant presente une rechute de myocardite. Conclusion Certains facteurs de mauvais pronostic ont ete mis en evidence, comme un taux eleve de troponine a l’admission, ce qui pourrait aider a la decision therapeutique. La mortalite est moindre dans notre serie, possiblement par le depistage de formes subintrantes en dosant la troponine de facon systematique. Cependant, la contre-indication definitive de l’immunotherapie sera peut etre a rediscuter selon la balance benefice/risque.

Objectives: The study aimed at assessing the stressors among hemodialysis (HD) patients and finding out whether there is any relation between these stressors and patients' characteristics in the North of the West Bank. Methods: A quantitative, cross-sectional, descriptive–analytical study was carried out. Data collection took place at three governmental hospitals and one private hospital where 120 HD patients responded to the HD stress scale. Results: Hemodialysis patients were mildly to moderately stressed, the greatest perceived sources of stress appeared to be “physiological stressors” (mean = 2.655), but the item with the highest percentage was 'limitation on time and place for vacation' (84.2%) which belong to psychosocial stress subscale, and the item stress with the least percentage was “dependency on nurses and technicians”(45%). Conclusions: There was significant difference between the psychosocial stressors and duration of treatment. The study concluded that HD patients are in need for continuous support, and it is recommended different contributions to improve the quality of their life.

Summary With the rapid increase of use of Distributed Acoustic Sensing (DAS) technology for seismic acquisition, it is important to have a good understanding of the nature of DAS measurements. It is little known that the measurement characteristics of a DAS interrogator can be significantly altered by the design principles used to measure optical phase. In this study we demonstrate that directional sensitivity of incident seismic wave can be influenced by DAS interrogator design. In this work we compare amplitudes of VSP direct wave acquired in dedicated research well using borehole geophones and two DAS systems: deformation rate based Terra15-Treble and strain rate based Fotech-Helios. Data analysis shows that the amplitude of the direct wave recorded with Terra15 DAS system is proportional to particle velocity amplitudes recorded by geophones. Meanwhile, the amplitude relationship between Fotech system and Terra15 system is proportional to cosine function of the incidence angle. It means that the directivity pattern of the deformation rate DAS system is similar to geophones.

Summerfield, Douglas T., Kirsten E. Coffman, Bryan J. Taylor, Amine N. Issa, and Bruce D. Johnson. Exhaled nitric oxide changes during acclimatization to high altitude: a descriptive study. High Alt Med Biol. 19:215-220, 2018.This study describes differences in the partial pressures of exhaled nitric oxide (PeNO) between subjects fully acclimatized (ACC) to 5300 m and those who have just arrived to high altitude.PeNO was determined in eight subjects newly exposed and nonacclimatized (non-ACC) to high altitude and compared with that in nine subjects who had ACC to high altitude for 1 month. In addition, systolic pulmonary artery pressure (sPAP) and arterial oxygen saturation (SaOPeNO levels on day 1 were significantly higher in the non-ACC versus ACC cohort (8.7 ± 3.5 vs. 3.9 ± 2.2 nmHg, p = 0.004). As the non-ACC group remained at altitude, PeNO levels fell and were not different when compared with those of the ACC group by day 9 (5.9 ± 2.4 vs. 3.9 ± 2.2 nmHg, p = 0.095). Higher sPAP was correlated with lower PeNO levels in all participants (R = -0.50, p = 0.043). PeNO levels were not correlated with SaOAs individuals acclimatized to high altitude, PeNO levels decreased. Even after acclimatization, PeNO levels continued to play a role in pulmonary vascular tone.

Phytotoxic effects of some vegetable crops including bean, cabbage, cauliflower, eggplant, pepper, potato, radish and tomato were investigated against Amaranthus retroflexus, Chenopodium murale, Eruca sativa, Malva sylvestris, Portulaca oleracea and Solanum nigrum weed species under laboratory and glasshouse conditions. Shoot extracts, foliage leachates and volatile materials of different crops significantly reduced seed germination and seedlings growth of different weed species in Petri-dishes. Leachates of cauliflower, pepper and potato were highly toxic to weeds. Extracts effects were concentration-dependent and roots were more inhibited than shoots. The effects of crops soil-incorporated dried shoot residues were varied on weeds and ranged from highly toxic to stimulatory. Residues of cabbage, cauliflower and bean were most toxic, while A. retroflexus, C. murale and P. oleracea were most sensitive weeds. Decayed residues of tomato, cabbage, bean and eggplant in the soil were most toxic to the tested weeds. Soil-applied extracts significantly reduced germination and growth of certain weeds. Growing weeds in the same soil after crops severely reduced shoot dry weight of most weed species with radish, cauliflower and bean were most toxic to A. retroflexus, C. murale and S. nigrum. Among weeds, M. sylvestris was most tolerant.

Introduction La pneumopathie a Pneumocystis jirovecii (PcP) est associee a un recours frequent aux soins intensifs (USI), a la ventilation mecanique et a un pronostic pejoratif. L’initiation precoce d’une corticotherapie adjuvante dans les formes severes de PcP permet une reduction significative de la mortalite chez les patients infectes par le virus de l’immunodeficience humaine (VIH), mais son benefice reste controverse chez les patients non infectes par le VIH (NVIH). Chez les patients hospitalises en USI, l’immunodepression et le recours a la corticotherapie au cours d’infection respiratoire severe comme la grippe est associee au risque de co-infections respiratoires ainsi qu’a la mortalite. L’objectif de cette etude etait d’evaluer l’epidemiologie et l’impact pronostique des co-infections respiratoires lors du diagnostic de PcP. Materiels et methodes Nous avons conduit une etude observationnelle retrospective, bicentrique, entre janvier 2011 et avril 2019, incluant tous les patients pour lesquels le diagnostic de PcP a ete etabli apres confirmation mycologique (examen direct positif et/ou qPCR positive) sur des prelevements respiratoires profonds (liquide d’aspiration tracheo-bronchique, lavage broncho-alveolaire (LBA)). La co-infection respiratoire etait definie par la detection d’un autre micro-organisme pathogene sur le meme prelevement que celui ayant conduit au diagnostic de PcP. Les analyses ont ete realisees sur la population globale puis sur les sous-groupes VIH et NVIH. Resultats A partir des 7 882 prelevements respiratoires analyses durant la periode de l’etude, 328 patients ont ete inclus. La moyenne d’âge etait de 56,7 ± 14,9 ans, 193 (58,8 %) etaient des hommes, 74 (22,6 %) etaient infectes par le VIH, le score SOFA moyen a l’admission etait de 3,5 ± 3,3, 168 (51,2 %) patients ont recu une corticotherapie adjuvante et la mortalite a J-90 etait de 25,3 %. Une co-infection respiratoire a ete mise en evidence chez 180 patients (54,9 %): 125 (38,1 %) co-infections virales dont 79 (24,1 %) a cytomegalovirus (CMV), 76 (23,2 %) co-infections bacteriennes et 36 (11 %) co-infections parasitaires ou fongiques. En analyse multivariee, la presence d’une co-infection respiratoire par le CMV (OR 3,44; 1,24-2,90; p = 0,02), de tumeur solide en cours de prise en charge (OR 11,8; 1,90-78; p = 0,008) et un score SOFA eleve a l’admission (OR 1,62; 1,34-2,05; p Conclusion La co-infection respiratoire par le CMV au diagnostic de PcP est independamment associee au risque de mortalite a J-90, en particulier chez les patients NVIH avec une corticotherapie adjuvante. Ces resultats suggerent que la recherche de co-infection respiratoire a CMV devrait etre systematiquement realisee au diagnostic de PcP dans le LBA, notamment avant d’envisager une corticotherapie adjuvante chez les patients NVIH. Des etudes interventionnelles prospectives prenant en compte la presence du CMV au diagnostic de PcP afin d’evaluer l’interet de la corticotherapie adjuvante et/ou du traitement anti-CMV sur le pronostic des patients NVIH semblent donc justifiees.

We aimed to assess lung fluid balance before and after gradual ascent to 5150m. Lung diffusion capacity for carbon monoxide (DLCO), alveolar-capillary membrane conductance (DmCO) and ultrasound lung comets (ULCs) were assessed in 12 healthy lowlanders at sea-level, and on Day 1, Day 5 and Day 9 after arrival at Mount Everest Base Camp (EBC). EBC was reached following an 8-day hike at progressively increasing altitudes starting at 2860m. DLCO was unchanged from sea-level to Day 1 at EBC, but increased on Day 5 (11±10%) and Day 9 (10±9%) vs. sea-level (P≤0.047). DmCO increased from sea-level to Day 1 (9±6%), Day 5 (12±8%), and Day 9 (17±11%) (all P≤0.001) at EBC. There was no change in ULCs from sea-level to Day 1, Day 5 and Day 9 at EBC. These data provide evidence that interstitial lung fluid remains stable or may even decrease relative to at sea-level following 8days of gradual exposure to high-altitude in healthy humans.

High-altitude ascent induces left (LV) and right (RV) ventricular adaptations secondary to hypoxia-related hemodynamic and myocardial alterations. Since cardiopulmonary decrements observed with aging (e.g., decreased LV compliance and increased pulmonary vascular resistance) may limit cardiac plasticity, this study examined myocardial adaptability throughout an 11 day sojourn to 5893 m in young and older-aged trekkers.Echocardiography was performed on 14 young (8 men; 32 ± 5 years) and 13 older-aged (8 men; 59 ± 5 years) subjects on non-trekking days (Day 0: 880 m; Day 3: 3100 m; Day 8: 4800 m; Day 12/post-climb: 880 m). RV systolic pressure (mmHg) was systematically higher in older-aged subjects (p 0.01) with similar progressive increases observed during ascent for young and older subjects, respectively (Day 0: 18 ± 1 vs 20 ± 2; Day 3: 25 ± 2 vs 29 ± 3; Day 8: 30 ± 2 vs 35 ± 2). Estimates of LV filling pressure (E/E') were systematically higher in older subjects (p 0.01) with similar progressive decreases observed during ascent for young and older-aged subjects, respectively (Day 0: 5.6 ± 0.3 vs 6.7 ± 0.5; Day 3: 5.1 ± 0.2 vs 6.1 ± 0.3; Day 8: 4.7 ± 0.3 vs 5.4 ± 0.3). Overall, RV end-diastolic and end-systolic area increased at altitude (p 0.01), while LV end-diastolic and end-systolic volume decreased (p 0.01). However, all RV and LV morphological measures were similar on Day 3 and Day 8 (p 0.05), and returned to baseline post-climb (p 0.05). Excluding mild LV dilatation in some older-aged trekkers on Day 8/Day 12 (p 0.01), altitude-induced morphological and functional adaptations were similar for all trekkers (p 0.05).Altitude-induced myocardial adaptations are chamber specific, secondary to RV and LV hemodynamic alterations. Despite progressive hemodynamic alterations during ascent, morphological and functional cardiac perturbations plateaued, suggesting rapid myocardial adaptation which was mostly comparable in young and older-aged individuals.

Background and Objectives: This study aimed to investigate the possible association between exclusive breastfeeding duration during early infancy and susceptibility to allergy and influenza in adulthood. Furthermore, we also investigated the association of breastfeeding duration with DNA methylation at two sites in the promoter of the toll-like receptor-1 (TLR1) gene, as well as the association between DNA methylation of the toll-like receptor-1 (TLR1) gene and susceptibility to different diseases. Materials and Methods: Blood samples were collected from 100 adults and classified into two groups according to breastfeeding duration (

Objective It is well documented that cognitive performance may be altered with ascent to altitude, but the association of various cognitive performance tests with symptoms of acute mountain sickness (AMS) is not well understood. Our objective was to assess and compare cognitive performance during a high-altitude expedition using several tests and to report the association of each test with AMS, headache, and quality of sleep. Methods During an expedition to Mount Everest, 3 cognitive tests (Stroop, Trail Making, and the real-time cognitive assessment tool, an in-house developed motor accuracy test) were used along with a questionnaire to assess health and AMS. Eight team members were assessed pre-expedition, postexpedition, and at several time points during the expedition. Results There were no significant differences (P >.05) found among scores taken at 3 time points at base camp and the postexpedition scores for all 3 tests. Changes in the Stroop test scores were significantly associated with the odds of AMS (P

Lean manufacturing is concerned with the implementation of several tools and methodologies that aim for the continuous elimination of wastes throughout manufacturing process flow in the production system. Lean manufacturing also focuses on company's goals of improving quality, reducing inventory and becoming more competitive. This research addresses the implementation of lean principles and tools in a small-medium size plastic industry, and focuses on a company producing "Fused" plastic bags products. In this production operation, the major types of waste to eliminate include material waiting, processing-time and setup wastes. The primary goal is to identify and implement selected lean strategies to eliminate waste in the plastic bags manufacturing operation under study. A systematic approach was used for the implementation of lean principles and techniques, through the application of Value Stream Mapping analysis. The current state value stream map was constructed to improve the plastic bags manufacturing process through identifying opportunities to eliminate waste and its sources. Also, the future-state value stream map was developed describing improvements in the overall manufacturing process resulting from eliminating wastes. The implementation of VSM, 5S, Visual Control, Kaizen, and Reduced lot size methods have provided significant benefits and results. Productivity has increased to 95.5%, Manufacturing Lead Time reduced by 10.4% and the cycle time for the "Cutting/Packaging" process was reduced by 35% to about 30 minutes.

Background: Bronchopulmonary dysplasia (BPD), a common adverse outcome of extreme preterm birth, can be caused by oxygen-related lung injury and is characterized by arrested alveolar development. Mesenchymal stromal cells (MSCs) have lung protective effects. Conversely, BPD is associated with increased MSCs in tracheal aspirates. This apparent discrepancy is unexplored. We hypothesized that endogenous lung (L-)MSCs are perturbed in an oxygen-induced rat model mimicking BPD. Methods: Rat pups were exposed to 21% or 95% O2 from postnatal day 0 to 10. On day 12, CD146+ L-MSCs were isolated and characterized. Epithelial and vascular repair potential were tested by scratch assay and endothelial network formation respectively, immune function by mixed lymphocyte reaction assay. Microarray analysis was performed using GSEA software. Results: L-MSCs isolated from hyperoxia rat pups had decreased CD73 expression and inhibited lung endothelial network formation. L-MSCs indiscriminately promoted epithelial wound healing and limited T-cell proliferation. Expression of anti-angiogenic genes of the axonal guidance cue pathway was increased after in vivo hyperoxia, whereas genes of the anti-inflammatory JAK/STAT and lung/vascular growth promoting FGF pathways were decreased. Conclusions: In vivo hyperoxia exposure alters the pro-angiogenic effects and FGF expression of L-MSCs. Additionally, decreased CD73 and JAK/STAT expression suggest decreased immune function. L-MSC function may be perturbed and contribute to BPD pathogenesis. These findings may lead to improvements in manufacturing exogenous MSCs with superior repair capabilities.

Aim The purpose of this study was to evaluate whether the open apex measurements of the lower teeth can be used for prediction of the pubertal growth spurt. Materials and methods The study group consisted of 150 males and 142 females ranging in age from 10 to 16 years. A total of 292 panoramic and 292 hand-wrist radiographs were obtained and analyzed. The skeletal maturity was determined according to the skeletal maturity indicators (SMIs) developed by Fishman. The open apices measurements of the left lower teeth were made according to the method described by Cameriere. Results The Spearman rank order correlation coefficient revealed a relationship between the skeletal maturity stages and the open apex measurements. These correlations ranged from 0.577 for the lower second premolar to 0.830 for the lower canine. The measurement of the left lower canine showed the highest correlation, so its relationship with the SMIs was further investigated. The measurements of 6.07 (or greater) indicated to SMI4, and 2.485 (or lesser) indicated to SMI7. Conclusion The skeletal maturity well related to the measurements of the open apices of the lower teeth. Lower canine open apex measurements could be used as an indicator of the SMI4 and SMI7. Clinical significance The measurements of the open apices of the left lower canines from panoramic radiographs may be clinically useful as an indicator of the beginning and the ending of the pubertal growth period. How to cite this article Issa YN, Burhan AS, Nawaya FR, Massouh LG. Assessment of the Pubertal Growth Period using the Open Apices of the Lower Teeth. J Contemp Dent Pract 2017;18(1):16-22.

Local control for Ewing sarcoma (ES) has improved in modern studies. However, it is unclear if these gains have also been achieved for pelvis tumors. The purpose of this study is to evaluate local control and survival in pelvis ES patients treated in the modern era.All pelvis ES patients diagnosed from 1990 to 2012 and seen at Mayo Clinic were identified. Factors relevant to survival and local control were analyzed.The cohort consisted of 48 patients. Fifty-two percent had metastatic disease at diagnosis. The 5-year overall survival and event-free survival was 73% and 65%, respectively, for localized disease. The 5-year cumulative incidence of local recurrence was 19%, with a 26% incidence for radiation, 13% for surgery, and 0% for surgery + radiation (P = 0.54). All local failures occurred in-field. Sacral involvement by tumor trended toward a higher incidence of local recurrence (hazard ratio 3.06, P = 0.09). Patients treated with definitive radiation doses ≥5,600 cGy had a lower incidence of local recurrence (17% vs. 28%, P = 0.61).Our study demonstrates excellent survival for localized tumors in the modern era. Anatomical localization within the pelvis likely correlates with outcomes. Local control remains problematic, especially for patients treated with definitive radiation. Though statistically not significant, surgery + radiation and definitive radiation dose ≥5,600 cGy were associated with the lowest incidence of local failure, suggesting treatment intensification may improve local control for pelvis ES.

Background and Objectives: This study aimed to investigate the possible association between exclusive breastfeeding duration during early infancy and susceptibility to allergy and influenza in adulthood. Furthermore, we also investigated the association of breastfeeding duration with DNA methylation at two sites in the promoter of the toll-like receptor-1 (TLR1) gene, as well as the association between DNA methylation of the toll-like receptor-1 (TLR1) gene and susceptibility to different diseases. Materials and Methods: Blood samples were collected from 100 adults and classified into two groups according to breastfeeding duration (&lt, 6 months and &ge, 6 months) during infancy. Subjects were asked to complete a questionnaire on their susceptibilities to different diseases and sign a consent form separately. Fifty-three samples underwent DNA extraction, and the DNA samples were divided into two aliquots, one of which was treated with bisulfite reagent. The promoter region of the TLR1 gene was then amplified by polymerase chain reaction (PCR) and sequenced. Results: We found a significant association between increased breastfeeding duration and a reduction in susceptibility to influenza and allergy, as well asa significant reduction in DNA methylation within the promoter of the TLR1 gene. No association was found between DNA methylation and susceptibility to different diseases. Conclusions: The findings demonstrate the significance of increased breastfeeding duration for improved health outcomes at the gene level.

Aims: Typing and characterization of 100 P. aeruginosa clinical isolates by pulse field gel electrophoresis (PFGE) to detect changes in the clonal composition of local strains and to correlate banding patterns with site of infection, drug resistance and Type III secretion system effectors. Methodology: A total of 100 P. aeruginosa isolates obtained from clinical specimens were used to study resistance profiles, PFGE banding patterns and virulence determinants. Results: Results from antimicrobial susceptibility testing yielded showed that 77 of the strains were multi drug resistant (MDR). Grouping isolates as non-susceptible when tested intermediate and resistant accordingly showed that resistance was 25% each for imipenem and piperacillin-tazobactam, while it was 29% for ceftazidime these drugs are among the ones most commonly used in treating infections caused by P. aeruginosa. Studying effectors released by the type III secretion system including exoU and exoS revealed that 48% of the isolates harbored exoS toxin gene and 46% the exoU, with 3% having both and 8% having none. When the different pulsotypes were compared on a dendogram, 45 Short Communication British Microbiology Research Journal, 2(4): 243-250, 2012 244 groups emerged showing vast differences among the isolates. Conclusion: This study showed the emergence of drug resistance in P. aeruginosa against the antimicrobial agents being routinely used for treatment and revealed the likely presence of co-selected traits that result in highly virulent and resistant strains. Further clinical investigations are warranted to combat infections caused by this important human pathogen in Lebanon.

The neuregulin (NRG) family of trophic factors is present in the central and peripheral nervous systems and participates in the survival, proliferation, and differentiation of many different cell types, including motoneurons. NRG1 was first characterized by its role in the formation of the neuromuscular junction, and recently it was shown to play a crucial role in modulating glutamatergic and cholinergic transmission in the central nervous system of adult rats. However, little is known about NRG1's role in adult motor systems. Motoneurons receive dense glutamatergic and cholinergic input. We hypothesized that NRG1 is present at synapses on phrenic motoneurons. Confocal microscopy and 3D reconstruction techniques were used to determine the distribution of NRG1 and its colocalization with these different neurotransmitter systems. We found that NRG1 puncta are present around retrogradely labeled motoneurons and are distributed predominantly at motoneuron somata and primary dendrites. NRG1 is present exclusively at synaptic sites (identified using the presynaptic marker synaptophysin), making up ∼30% of all synapses at phrenic motoneurons. Overall, NRG1 immunoreactivity is found predominantly at cholinergic synapses (75% ± 14% colocalize with the vesicular acetylcholine transporter; VAChT). Nearly all (99% ± 1%) VAChT-immunoreactive synapses expressed NRG1. NRG1 also is present at a subset of glutamatergic synapses expressing the vesicular glutamate transporter (VGLUT) type 2 (∼6%) but not those expressing VGLUT type 1. Overall, 26% ± 6% of NRG1 synapses are VGLUT2 immunoreactive. These findings provide the first evidence suggesting that NRG1 may modulate synaptic activity in adult motor systems.

Ligation under vision (LUV) is a simple method for the surgical treatment of haemorrhoids. In this study, we evaluated the results of our initial experience with the procedure in terms of postoperative pain, patients' final satisfaction and complications. We reviewed a group of patients who had undergone suture ligation of symptomatic haemorrhoids of grade II and III. This was performed with the haemorrhoids under direct vision and without the use of any ancillary instrumentation such as a Doppler sensor. All interventions were performed in the day-care surgical unit using general or regional anaesthesia. Surgical outcome and degree of postoperative pain were determined from outpatient clinic follow-up and individual phone interviews. A total of 32 patients (19 men and 13 women) with a mean age of 59 years had undergone LUV. There were 23 patients (72%) with grade II and 9 patients (28%) with grade III haemorrhoids. The indication for the surgery was bleeding in 19 patients (59%), prolapse in 6 (19%) and both in 7 (22%). A previous rubber band ligation had been carried out in 17 patients (53%). On average, the surgery took 22 min. All patients were discharged on the same day. Four %patients (12%) suffered only mild postoperative pain, 14 (44%) suffered from moderate pain and another 14 (44%) had severe pain. At follow-up (median 21 months, range 9-33 months), 28 %patients (87.5%) were completely asymptomatic at the time of the phone interview. The final result was assessed as excellent by 19 patients (60%), successful by 10 (31%), and unsuccessful by 3 (9%). All patients had complete functional recovery and there were no major surgical complications. Our data show that LUV of symptomatic haemorrhoids is a simple and safe procedure. It can be performed as effective isolated surgery for symptomatic haemorrhoids and as an additional procedure in the treatment of complex perianal pathology.

Purpose We determined whether well-acclimatized humans have a reserve to recruit pulmonary capillaries in response to exercise at high altitude. Methods At sea level, lung diffusing capacity for carbon monoxide (DLCO), alveolar-capillary membrane conductance (DmCO), and pulmonary capillary blood volume (Vc) were measured at rest before maximal oxygen consumption (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{V}{\text{O}}_{2\hbox{max} }$$\end{document}V˙O2max) was determined in seven adults. Then, DLCO, DmCO and Vc were measured pre- and post-exhaustive incremental exercise at 5150 m after ~40 days of acclimatization. Results Immediately after exercise at high altitude, there was an increase in group mean DmCO (14 ± 10 %, P = 0.040) with no pre- to post-exercise change in group mean DLCO (46.9 ± 5.8 vs. 50.6 ± 9.6 ml/min/mmHg, P = 0.213) or Vc (151 ± 28 vs. 158 ± 37 ml, P = 0.693). There was, however, a ~20 % increase in DLCO from pre- to post-exercise at high altitude (51.2 ± 0.2 vs. 61.1 ± 0.2 ml/min/mmHg) with a concomitant increase in DmCO (123 ± 2 vs. 156 ± 4 ml/min/mmHg) and Vc (157 ± 3 vs. 180 ± 8 ml) in 2 of the 7 participants. There was a significant positive relationship between the decrease in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{V}{\text{O}}_{2\hbox{max} }$$\end{document}V˙O2max from sea level to high altitude and the change in DLCO and lung diffusing capacity for nitric oxide (DLNO) from rest to end-exercise at high altitude. Conclusion These data suggest that recruitment of the pulmonary capillaries in response to exercise at high altitude is limited in most well-acclimatized humans but that any such a reserve may be associated with better exercise capacity.

INTRODUCTION Recent physiological incidents involving pilots of high performance fighter aircraft have raised the question of whether inadvertent, short bursts of significantly reduced oxygen could negatively impact real-time performance. This study evaluated normobaric, real-time performance in the setting of transient near-anoxia to inform future countermeasure development. METHODS The study was performed on 12 healthy subjects without significant medical history. Following collection of baseline data, real-time performance changes were evaluated during sequentially increasing periods of near-anoxic gas exposure (F(I)0(2) = 1%) using a computer-based performance assessment tool. Both room air and 100% oxygen were used as the prebreathe/recovery gases. Statistical analysis was performed on the results. RESULTS Under normobaric conditions, subjects inspiring up to five near-anoxic breaths showed no significant performance decrement in either accuracy or effective actions per minute. Mean accuracy up to five near-anoxic breaths was 0.67 (SD = 0.01) as compared to a baseline mean of 0.68 (SD = 0.02). Hyperoxia had a protective effect on subject physiological response to near anoxia. DISCUSSION These normobaric findings offer an assessment of real-time performance changes in the setting of transient, near-anoxic gas exposure. Overall, the results help inform the design of increasingly complex aircraft oxygen delivery systems in terms of how tightly such systems must match the sea-level gas equivalent with increasing altitude. This is particularly relevant as such systems are being called upon to ensure safe aircrew operations across an expanding operational flight envelope.