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Study Design: Biomechanical experiment using an in situ porcine model., Objective: To find the effect of traction treatment on annulus microstructure, molecular convection, and cell viability of degraded discs., Summary of Background Data: Spinal traction is a conservative treatment for disc disorders. The recognized biomechanical benefits include disc height recovery, foramen enlargement, and intradiscal pressure reduction. However, the influence of traction treatment on annulus microstructure, molecular transportation, and cell viability of degraded discs has not been fully investigated., Methods: A total of 48 thoracic discs were dissected from 8 porcine spines (140 kg, 6-month old) within 4 hours after killing them and then divided into 3 groups: intact, degraded without traction, and degraded with traction. Each disc was incubated in a whole-organ culture system and subjected to diurnal loadings for 7 days. Except for the intact group, discs were degraded with 0.5 mL of trypsin on day 1 and a 5-hour fatigue loading on day 2. From day 4 to day 6, half of the degraded discs received a 30-minute traction treatment per day (traction force: 20 kg; loading: unloading = 30 s: 10 s). By the end of the incubation, the discs were inspected for disc height loss, annulus microstructure, molecular (fluorescein sodium) intensity, and cell viability., Results: Collagen fibers were crimped and delaminated, whereas the pores were occluded in the annulus fibrosus of the degraded discs. Molecular transportation and cell viability of the discs decreased after matrix degradation. With traction treatment, straightened collagen fibers increased within the degraded annulus fibrosus, and the annulus pores were less occluded. Both molecular transportation and cell viability increased, but not to the intact level., Conclusion: Traction treatment is effective in enhancing nutrition supply and promoting disc cell proliferation of the degraded discs., Level of Evidence: N/A.

Intracranial hemorrhage is the third most common cause of cerebrovascular disease. Some polymorphisms that affect clotting factors increase the risk of thrombosis. However, few reports have analyzed the effect of polymorphisms on the hemostatic state in bleeding disorders. The low-density lipoprotein receptor (LDLR) has been shown to contribute to factor VIII (FVIII) homeostasis, which represents a link between LDLR and hemostasis. FVIII plays a pivotal role in the coagulation cascade. Patients with high levels of FVIII are at an increased risk of arterial and venous thrombosis. On the other hand, patients with insufficient FVIII tend to bleed excessively, such as in hemophilia A. In a previous study, analysis of the genetic LDLR variant rs688 provided evidence suggesting that genetic polymorphisms of rs688 are associated with thrombotic cardiovascular diseases. The current study aimed to investigate the potential role of rs688 in primary intracerebral hemorrhage (PICH). This genetic association study was conducted within an isolated Taiwanese population (447 PICH patients and 430 controls). Genotypes C/C and C/T were used as the reference genotypes, and the genotype T/T was found to be associated with a 73% decreased risk of PICH. The preliminary evidence suggests that genetic polymorphisms of LDLR are associated with PICH.

Background: In the antibiotic era, tuberculosis (TB) still causes a substantial number of mortalities. We aimed to identify the causes and risks of death among TB patients., Methods: Medical records of mortality cases of culture-proven TB diagnosed during 2003-2007 were reviewed. All TB deaths were classified into 2 groups (TB-related and non-TB-related), based on the underlying cause of death., Results: During the study period, 2016 cases (male: 71.1%) of culture-proven TB were identified. The mean age was 59.3 (range: 0.3-96) years. The overall mortality rate was 12.3% (249 cases) and the mean age at death was 74 years; 17.3% (43 cases) of all TB deaths were TB-related. Most of the TB-related deaths occurred early (median survival: 20 days), and the patient died of septic shock. Malignancy, liver cirrhosis, renal failure, and miliary and pneumonic radiographic patterns were all independent predictors for all TB deaths. Cavitary, miliary and pneumonic radiographic patterns were all significant predictive factors for TB-related death. Extrapulmonary involvement and liver cirrhosis were also factors contributing to TB-related death., Conclusions: The majority of TB deaths were ascribed to non-TB-related causes. Managing TB as well as underlying comorbidities in a multidisciplinary approach is essential to improve the outcome of patients in an aging population. However, the clinical manifestations of patients with TB-related death vary; many progressed to fulminant septic shock requiring timely recognition with prompt treatment to prevent early death.

Study Design: An in situ study using whole-organ culture system., Objective: To study the effect of disc degeneration at different stages on its rheological and dynamic properties and to investigate the efficacy of exogenous cross-linking therapy., Summary of Background Data: Disc degeneration can involve protein denaturation or microdefects to the disc's collagen fiber network. A disc degeneration model using whole-organ culture technique can be effectively used for the screening of treatments of degenerated discs. Exogenous cross-linking therapy has been shown to enhance the mechanical properties of the disc by cross-linking collagen. However, the efficacy of this therapy on the degenerated disc is unclear., Methods: A total of 40 porcine thoracic discs were assigned to 5 groups: intact discs, moderately degenerated discs, moderately degenerated discs with cross-linker augmentation, severely degenerated discs, and severely degenerated discs with cross-linker augmentation. The disc degeneration was simulated by trypsin digestion and mechanical fatigue loading. Rheological properties, dynamic properties, water content, and histological analysis were conducted after a 7-day incubation., Results: The mechanical properties of moderate degenerated discs significantly decrease both in rheological and dynamic properties, and laminate structure disorganization was observed. Mechanical defects of severely degenerated discs resulted in disc height loss, an increase in the aggregate modulus and stiffness modulus, and a decrease in the damping coefficient, hydraulic permeability, and water content. Cross-linker augmentation significantly recovered mechanical properties of moderately degenerated discs and restored the water content compared with the intact disc. However, the augmentation did not fully repair the severely degenerated discs., Conclusion: Trypsin-induced extracellular matrix damage resulted in a change of the disc's biomechanics. Cross-linker augmentation recovers the rheological and dynamic properties of moderately degenerated discs but not of the severely degenerated discs. The genipin cross-linker may be able to improve the proteoglycan depletion effect in the nucleus pulposus but may not be effective to restore the structural damage in the collagen molecule of the anulus fibrosus.

Background: Halitosis affects people of all ages. Among hospitalized patients, oral care includes toothbrushing and mouth rinses. Tongue cleaning is not included in most guidelines or nursing education curricula., Objectives: The aim of this study was to compare the effectiveness of two types of oral care, toothbrushing alone and toothbrushing plus tongue cleaning, on halitosis and tongue coating (TC)., Methods: A systematic review and meta-analysis of randomized controlled trials were conducted to compare toothbrushing and toothbrushing plus tongue cleaning during oral care to reduce halitosis and TC. The databases included PubMed, ProQuest, CINAHL, the Cochrane Central Register of Controlled Trials, experts, and bibliographic review. A quality assessment of study reports and methodology was conducted using the CONSORT checklist and the Jadad Scale. The measurement of volatile sulfide compounds (VSCs) evaluated halitosis, whereas TC was measured with assessment indexes., Results: Seven experimental data sets were obtained from five randomized clinical trials. There were 188 male and 63 female subjects within an age range of 17-80 years. All intervention groups indicate a large effect size of toothbrushing plus tongue cleaning decreases volatile sulfur compounds and TC by 0.745 and 0.922, respectively, compared with toothbrushing only., Discussion: The use of toothbrushing plus tongue cleaning compared with toothbrushing alone significantly reduced the indicators of halitosis and TC. However, there is insufficient evidence to recommend frequency, duration, or delivery method of tongue cleaning. Further research is needed to articulate a comprehensive clinical guideline. Oral care is an important nursing intervention. Tongue cleaning should be incorporated into current nursing procedures.

Background and Objective: Correct and early risk stratification for critically ill pneumonia patients remains an unmet medical need. This study aimed to test whether N-terminal pro B-type natriuretic peptide (NT-proBNP) can serve as a prognostic marker in this setting., Methods: This prospective study enrolled 216 pneumonia patients admitted to intensive care unit. Plasma NT-proBNP samples were obtained upon admission and primary outcome was all-cause mortality at 30 days. Meanwhile, Acute Physiology and Chronic Health Evaluation (APACHE) II and Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) 2007 minor criteria were assessed., Results: Overall 30-day mortality was 30%. NT-proBNP levels were significantly higher in nonsurvivors than survivors (11 938 ± 13 121 vs 5658 ± 9240 pg/mL, P = 0.001). Area under receiver operating characteristic curves of NT-proBNP, APACHE II and IDSA/ATS 2007 minor criteria were not significantly different regarding prediction of mortality (0.715, 0.754 vs 0.654, P = 0.085). Adding NT-proBNP to APACHE II significantly increased the area under receiver operating characteristic curve from 0.754 to 0.794 (P = 0.048). Receiver operating characteristic analysis revealed optimal NT-proBNP and APACHE II cut-offs of 2177.5 pg/mL and 25.5, respectively. In multivariate analysis, both NT-proBNP and APACHE II values above cut-offs had a significantly higher probability of death than those below cut-offs. A categorical approach combining NT-proBNP and APACHE II cut-offs provides additional risk stratification over a single marker approach., Conclusions: For pneumonia patients admitted to intensive care unit, NT-proBNP strongly and independently predicts mortality, and its prognostic accuracy is comparable with APACHE II and IDSA/ATS 2007 minor criteria., (© 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.)

We compared direct laryngoscopy with a Macintosh blade vs indirect bronchoscopy with a Trachway® stylet, for endobronchial intubation with a left-sided double-lumen tube. We allocated participants scheduled for thoracic surgery and who had normal predicted laryngoscopy, 30 to each group. The mean (SD) intubation times with laryngoscope and Trachway were 48 (11) s vs 28 (4) s, respectively, p < 0.001. The rates of hoarseness on the first postoperative day, categorised as none/mild/moderate/severe, were 10/12/7/1 and 22/6/2/0, respectively, p = 0.008, without differences on subsequent days. Left endobronchial intubation with a double-lumen tube is slower using direct laryngoscopy and causes more hoarseness than indirect bronchoscopy with a Trachway stylet., (© 2013 The Association of Anaesthetists of Great Britain and Ireland.)

A wing-type imbedded electrodes was introduced into the lateral light emitting diode configuration (WTIE-LEDs) to reduce the effect of light shading of electrode in conventional sapphire-based LEDs (CSB-LEDs). The WTIE-LEDs with double-side roughened surface structures not only can eliminate the light shading of electrode and bonding wire, but also increase the light extraction and light output power. Contrast to CSB-LEDs, a 79% enhancement of output intensity in the WTIE-LED was obtained at 100 mA injection current. Similarly, the output power of packaged WTIE-LEDs was enhanced 59% higher compared with the packaged CSB-LEDs at the same injection condition. Therefore, using the imbedded contact to reduce light shading would be a promising prospective for LEDs to achieve high output power.

Previous studies have shown that spontaneous breathing trials (SBT) with a T-tube or low-level pressure support are comparable. However, low-level pressure support may overestimate the ability of a patient to sustain spontaneous breathing, resulting in premature extubation. Understanding factors contributing to different responses by patients to the two SBT methods aids in clarifying the limitation of using low-level pressure support for SBT. We performed a prospective observational study in 80 consecutive adult patients with mechanical ventilation to identify the factors contributing to different responses of a patient to the two SBT methods. The 80 patients underwent both a T-tube trial and pressure support ventilation of 6 cmH2O (PS-6) on the day of extubation. Stratified analysis was used to evaluate the effects of age, respiratory compliance and resistance, PaO2/FiO2 ratio and underlying disease on post-SBT responses. Comparing the responses to a T-tube trial and PS-6, the patients with old age, poor pulmonary compliance (≤40 ml/cmH2O) and chronic obstructive pulmonary disease had a higher heart rate (difference [95% CI]: 4 [0,8], 5 [2,9], 5 [0,10] beats/minute, respectively) and systolic blood pressure (10 [4,16], 11 [5,16], 7 [0,13] mmHg, respectively) after the T-tube trial. In conclusion, this research shows that old age and impaired respiratory mechanics contribute to different responses to spontaneous breathing trials with a T-tube and low-level pressure support. Further studies are needed to compare the effectiveness of the two SBT methods in predicting successful extubation in such patient groups.

Background: Tuberculous pleurisy is traditionally indicated by extreme lymphocytosis in pleural fluid and low yield of effusion culture. However, there is considerable inconsistency among previous study results. In addition, these data should be updated due to early effusion studies and advances in culture methods., Methods: From January 2004 to June 2009, patients with tuberculous pleurisy were retrospectively identified from the mycobacteriology laboratories and the pathology and tuberculosis registration databases of two hospitals in Taiwan where tuberculosis is endemic. Pleural fluid characteristics and yields of mycobacterial cultures using liquid media were evaluated., Results: A total of 382 patients with tuberculous pleurisy were identified. The median lymphocyte percentage of total cells in pleural fluids was 84% (IQR 64-95%) and 17% of cases had a lymphocyte percentage of <50%. The lymphocyte percentage was negatively associated with the probability of a positive effusion culture (OR 0.97; 95% CI 0.96 to 0.99). The diagnostic yields were 63% for effusion culture, 48% for sputum culture, 79% for the combination of effusion and sputum cultures, and 74% for histological examination of pleural biopsy specimens., Conclusion: The degree of lymphocyte predominance in tuberculous pleurisy was lower than was previously thought. The lymphocyte percentage in pleural fluid was negatively associated with the probability of a positive effusion culture. With the implementation of a liquid culture method, the sensitivity of effusion culture was much higher than has been previously reported, and the combination of effusion and sputum cultures provided a good diagnostic yield.

The low-density lipoprotein receptor (LDLR) gene has been reported to be associated with cerebral infarction. This study aimed to explore 2 genetic LDLR variants, rs688 and rs5925, for their potential roles in cerebral infarction. This genetic association study was conducted within an isolated Taiwanese population; 815 ischemic stroke patients (431 with atherothrombotic stroke and 384 with lacunar infarction) and 430 normal controls were enrolled. There was no significant difference in the genetic frequency of rs688 and rs5925 between the control group and overall ischemic stroke, atherothrombotic stroke, or lacunar infarct groups. However, when analyzing the association between the haplotypes related to rs688 and rs5925 and cerebral ischemic stroke, the most common haplotype allele CT was used as the reference allele, and the haplotype TC associated with a 65% increased risk of overall ischemic stroke, 72% increased risk of atherothrombotic stroke, and 70% increased risk of lacunar infarction; this indicated a synergistic effect between these 2 single-nucleotide polymorphisms. The LDLR analysis based on the haplotypes rs688 and rs5925 was conducted in a Taiwanese population and provided preliminary evidence suggesting that genetic polymorphisms of LDLR are associated with cerebral infarction.

Subcutaneous (s.c.) D-galactose (DG) treatment has been shown to facilitate the development of biomarkers for Alzheimer's disease in C57BL/6J mice. The aim of the present study was to determine whether this treatment in young BALB/cJ mice, another mouse strain, enhanced oxidative stress to similar extents shown in older mice, and to further determine the effects of fructo-oligosaccharide (FO), a prebiotic fibre and vitamin E (antioxidant control) on the DG-induced oxidative damage of lipids, proteins and mitochondrial DNA, and erythrocyte antioxidant enzyme activities. Mice (12 weeks of age, n 40) were divided into four groups: vehicle (s.c. saline)+control (modified rodent chow); DG (s.c. 1·2 g/kg body weight)+control; DG+FO (5 %, w/w); DG+vitamin E (α-tocopherol, 0·2 %). Then, the animals were killed after 52 d of treatment. Another natural ageing (NA) group without any injection was killed at 47 weeks of age, which served as an aged control. The results indicated that the DG treatment enhanced malonaldehyde dimethyl acetal (MDA) levels in the plasma, liver and cerebral cortex, and protein carbonyl levels in the liver and hippocampus to similar levels shown in the NA group. FO, similar to α-tocopherol, systemically normalised DG-induced elevations in the levels of MDA in the plasma, liver and cerebral cortex, protein carbonyls in the liver and hippocampus, hepatic mitochondrial 8-oxo-deoxyguanosine and erythrocyte superoxide dismutase activity. In conclusion, the s.c. DG treatment in younger BALB/cJ mice resembled the oxidative status in older mice. FO supplementation systemically prevented DG-induced oxidative stress, probably through its fermentation products and prebiotic effect.

Percutaneous vertebroplasty (VP) is a minimally invasive procedure that is used to treat osteoporosis-induced vertebral compression fractures (OVCFs). Frequently observed complications are fractures of adjacent and augmented vertebrae. In the present work, mechanisms for these fractures are presented. Fresh 4-level osteoporotic thoracic motion segments were tested. Both ends of the specimen were mounted. The lower level of the free vertebra was compressively fractured and followed by an injection of a 3.5 mL of a PMMA bone cement. Three steps of fatigue loading (5 Hz for 5 h) were incrementally and vertically applied on the specimens from 650 N to 950 N to 1150 N. Specimens of intact, compressively fractured, cement augmented and post-fatigued loading were radiographed for the measurement of deformations of the vertebra, the canal, and the foramen. At the end of fatigue loading, the vertebrae were sliced for micro morphologic analysis. The largest height loss after fatigue loading was at the posterior region of the augmented vertebra. In the augmented vertebra, fissures were found along the bone-cement interface. These fissures split the cement and the trabeculae and propagated into the vertebrae and the endplates. The compactness ratio of the trabeculae region of the adjacent cranial vertebra was higher than that for intact and adjacent caudal ones. We attribute the fracture of the augmented vertebra, following simulated VP, to the initiation of fissures along the cement-bone interface, which, in turn, may be due to uneven deformation of the vertebra. Fracture of the adjacent cranial vertebra is attributed to collapse of its trabeculae., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Intubation with a double-lumen tube is important for achieving one-lung ventilation and facilitating thoracic surgery. The GlideScope(®) videolaryngoscope (Verathon Inc., Bothell, WA, USA) is designed to assist tracheal intubation for patients with a difficult airway. We wished to compare the GlideScope and direct laryngoscopy for double-lumen tube intubation. Sixty adult patients requiring a double-lumen tube for thoracic surgery and predicted uncomplicated laryngoscopy were randomly assigned to a direct Macintosh laryngoscopy group (n = 30) or a GlideScope group (n = 30). The mean (SD) duration of intubation was longer in the Macintosh group (62.5 (29.7) s) than in the GlideScope group (45.6 (10.7) s; p = 0.007). There was no difference in the success of the first attempt at intubation (26/30 (87%) and 30/30 (100%) for Macintosh and GlideScope groups, respectively; p = 0.112). The incidence of sore throat and hoarseness was higher in the Macintosh group (18 (60%) and 14 (47%), respectively) than in the GlideScope group (6 (20%) and 4 (13%), respectively; p = 0.003 and 0.004). We conclude that double-lumen tube intubation in patients with predicted normal laryngoscopy is easier using the GlideScope videolaryngoscope than the Macintosh laryngoscope., (Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.)

We report a periodically patterned organization of hierarchical ZnO twin-crystals on a planar substrate in a biomimetic solution process. The deposition of the porous complex ZnO structure on specific sites of the substrate is achieved by introduction of the substrate surface modification and gelatin in a hydrothermal crystallization of ZnO., (This journal is © The Royal Society of Chemistry 2012)

Background/purpose: This two-part study aimed to investigate compliance with the sepsis resuscitation bundle (SRB) and the barriers to its implementation for patients developing septic shock in the general medical wards., Methods: In the first part, medical records of patients who were admitted to the intensive care unit from the general medical wards due to septic shock were reviewed. Compliance rates with the six SRB components were assessed. In the second part, responsible junior physicians (first-year and second-year residents) in the general wards and senior physicians (third-year residents and fellows) were randomly invited for questionnaire-based interviews., Results: In the first part, during the 6-month study period, 40 patients were included. Overall compliance with the SRB within 6 h was only 2.5%, mainly due to femoral catheterization (42.5%) and the lack of measuring central venous oxygen saturation (ScvO₂). Delayed completion of SRB components contributed little to the low compliance rate. In the second part, based on the questionnaire results of 71 junior physicians and 64 senior physicians, the junior physicians were less familiar with the SRB guidelines, particularly regarding the meaning of ScvO₂ (p = 0.01) and management of low ScvO₂ (p = 0.04). Junior physicians were also more reluctant to measure the central venous pressure (CVP; p = 0.04) and the ScvO₂ (p = 0.01), and were also less confident with internal jugular vein or subclavian vein catheterization (p < 0.001)., Conclusion: Compliance with the SRB for patients developing septic shock in the general medical wards is very low. Besides providing educational programs to improve awareness and acceptance of the SRB, measures to help in central venous catheterization and completion of SRB may be considered., (Copyright © 2012. Published by Elsevier B.V.)

Background: The risk of endobronchial ultrasound-guided transbronchial biopsy-related pneumothorax is a major concern and warrants further studies. The aim of our study was to estimate the risk of pneumothorax after this procedure and identify its risk factors., Methods: From 2007 to 2011, 399 patients who underwent endobronchial ultrasound-guided transbronchial biopsy for peripheral lung lesions were included in this study. The variables analyzed included patient factors, lesion factors and procedure factors. Multivariate logistic regression analysis was used to identify independent risk factors for pneumothorax., Results: The incidence of pneumothorax was 3.3% (13/399). Chest tube placement was required for 31% (4/13) of pneumothoraces. Independent risk factors for pneumothorax included pulmonary emphysema (OR, 55.09; 95% CI, 9.37-324.03; p<0.001) and probe position adjacent to the lesion (OR, 17.01; 95% CI, 2.85-101.64; p = 0.002). The number of biopsy specimens, age, sex, history of prior lung surgery and lesion size, location and character did not influence the risk of pneumothorax in our analyses., Conclusions: The risk of pneumothorax after endobronchial ultrasound-guided transbronchial biopsy is low. To further reduce the risk of pneumothorax, every effort should be made to advance the endobronchial ultrasound probe into the bronchus where it is imaged within the target lesion before embarking on transbronchial biopsy.

Objectives: To investigate the clinical impact of different genospecies of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ACB complex; A. baumannii, Acinetobacter gen. sp. 13TU and Acinetobacter gen. sp. 3) on the severity of bacteraemia., Methods: We retrospectively compared the clinical features and outcomes of patients with bacteraemia caused by A. baumannii, Acinetobacter gen. sp. 13TU or Acinetobacter gen. sp. 3. The genospecies were identified using oligonucleotide array sequence analysis (interspacer sequence), and the clonality of Acinetobacter gen. sp. 13TU and 3 isolates was determined by PFGE analysis., Results: A total of 215 patients with bacteraemia due to ACB complex were evaluated. Among them, 117 (54.4%) had A. baumannii bacteraemia, 77 (35.8%) had Acinetobacter gen. sp. 13TU bacteraemia and 21 (9.8%) had Acinetobacter gen. sp. 3 bacteraemia. A. baumannii bacteraemia was associated with a higher 14 day mortality rate (P < 0.001), a higher 30 day mortality rate (P < 0.001) and a higher in-hospital mortality rate than bacteraemia due to Acinetobacter gen. sp. 13TU or Acinetobacter gen. sp. 3. Independent prognostic factors for the 30 day mortality included the Charlson co-morbidity index (P < 0.001) and Pitt bacteraemia score (P < 0.001). Bloodstream infection caused by a multidrug-resistant A. baumannii isolate appeared to be associated with a poor outcome (P = 0.069). There was no clonal spread of Acinetobacter gen. sp. 13TU or Acinetobacter gen. sp. 3 during the study period., Conclusions: Bacteraemia due to multidrug-resistant strains but not A. baumannii per se appears to be associated with poor outcome.

Objectives: The main purpose of this study was to determine the long-term (8 wk) effects of isomalto-oligosaccharide (IO) supplementation on fecal microflora, bowel function, and biochemical indicators of nutritional status in constipated elderly subjects. We also assessed whether the effect of IO was sustained after its withdrawal., Methods: Thirteen (five male) constipated subjects (age 82.5 ± 1.9 y) participated in this diet-controlled study that consisted of a 4-wk placebo period, two 4-wk IO (10 g/d) -supplementation periods (IO1 and IO2), and a 4-wk post period. Fasting blood was collected on the last day of each period. Stools were collected during the last week of each period. The bowel function was monitored throughout the study., Results: The fecal bifidobacteria, lactobacilli, and bacteroides counts (log counts/g wet feces) significantly increased and clostridia count decreased at the end of the IO1 period. The effects were more pronounced in the IO2 period and then returned to the levels of the IO1 period at the end of the post period. Daily fecal excretion of acetate and propionate increased along with IO supplementation. The frequency of spontaneous defecation increased in the IO2 period, and wet fecal mass increased by 24% in both the IO1 and the IO2 periods. The effects of IO on bowel function diminished in the post period. Plasma total and low-density lipoprotein cholesterol levels were lower with 4- or 8-wk IO supplementation as compared with the placebo and post period, respectively., Conclusions: IO supplementation into a low-fiber diet improved colonic microflora profile and bowel movement in a time-dependent fashion in constipated elderly subjects. These beneficial effects decreased after discontinuation of the supplements., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: This study assessed effects of fructo-oligosaccharides (FOS) supplementation on fecal bifidobacteria, lipid peroxidation index, indices of nutritional status, and whether effects of FOS were sustained after its withdrawal in constipated nursing-home residents. The associations of fecal bifidobacteria and blood measurements were also examined., Methods: Six men and four women participated in a double-blind, diet-controlled study that consisted of a 4-wk placebo (3 mL of fructose syrup) period, a 4-wk FOS (10 g/d) period, and a 4-wk post-FOS period. Stools were collected during the last week of each period to determine the microflora and fecal weight. Fasting blood was collected at the end of each period and analyzed for thiobarbituric acid-reactive substances (TBARS) and biochemical indices., Results: Fecal counts (log counts/gram of dry feces) and daily fecal output of bifidobacteria significantly increased with FOS compared with placebo. The effect on bifidobacteria output was sustained in the post-FOS period. Plasma TBARS concentration was reduced by 16% and 21% in the FOS and post-FOS periods, respectively, compared with that in the placebo period. The plasma cholesterol level was significantly lowered by 7% in the FOS and post-FOS periods compared with that in the placebo period. The increases in fecal bifidobacteria output during the FOS period (log colony-forming units per day) were associated with decreases in plasma TBARS and plasma cholesterol, respectively., Conclusion: Supplementation of FOS increases the daily output of bifidobacteria and decreases plasma TBARS and cholesterol concentrations in constipated nursing-home elderly residents and these effects remained at the end the post-FOS period., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Chronic subcutaneous (s.c.) administration of d-galactose (DG) to BL/6J mice has been shown to induce oxidative stress and is considered a model to mimic accelerated ageing. Fructo-oligosaccharide (FO) is a well-defined prebiotic and its fermentation by lactic acid bacteria has been shown to exert antioxidative capacity. The present study was aimed to determine whether FO attenuated DG-induced oxidative stress and hepatopathy in Balb/cJ mice. Mice (12 weeks of age, n 40) were divided into control (s.c. saline), DG (s.c. 1·2 g/kg body weight), DG+FO (5%, w/w) and DG+vitamin E (0·2%, w/w) groups and were killed after 52 d of treatment. Results indicated that DG significantly decreased the hepatic superoxide dismutase and glutathione peroxidase activities. These alterations were ameliorated both by FO and vitamin E. DG increased the hepatic TAG content approximately by 7·2% compared with the vehicle control, which was in agreement with the histological alteration. FO, similar to vitamin E, almost normalised the hepatic TAG content and ameliorated the histological characteristics of fatty liver. Similarly, the increased plasma alanine aminotransferase activity induced by DG was normalised by FO and vitamin E, respectively. Faecal bifidobacteria counts were greater in the DG+FO and DG+vitamin E groups compared with the DG group, respectively. In conclusion, the present study indicated that FO diminished the altered hepatic antioxidative enzyme activities and morphology caused by chronic DG administration in Balb/cJ mice, partially associated with its prebiotic role in the colon.

Vascular endothelial damage has been found to be associated with thrombus formation, which is considered to be a risk factor for cardiovascular disease. A diet of natto leads to a low prevalence of cardiovascular disease. The aim of the present study was to investigate the effects of natto extract on vascular endothelia damage with exposure to laser irradiation. Endothelial damage both in vitro and in vivo was induced by irradiation of rose bengal using a DPSS green laser. Cell viability was determined by MTS assay, and the intimal thickening was verified by a histological approach. The antioxidant content of natto extract was determined for the free radical scavenging activity. Endothelial cells were injured in the presence of rose bengal irradiated in a dose-dependent manner. Natto extract exhibits high levels of antioxidant activity compared with purified natto kinase. Apoptosis of laser-injured endothelial cells was significantly reduced in the presence of natto extract. Both the natto extract and natto kinase suppressed intimal thickening in rats with endothelial injury. The present findings suggest that natto extract suppresses vessel thickening as a synergic effect attributed to its antioxidant and anti-apoptosis properties.

Neuromuscular blocking agents (NMBAs) might diminish the electromyography signal of the vocalis muscles during intraoperative neuromonitoring of the recurrent laryngeal nerve. The aim of this study was to compare differential sensitivity of different muscles to succinylcholine in a swine model, and to realize the influence of NMBAs on neuromonitoring. Six male Duroc-Landrace piglets were anesthetized with thiamylal and underwent tracheal intubation without the use of an NMBA. The left recurrent laryngeal nerve, the spinal accessory nerve, the right phrenic nerve and the brachial plexus were stimulated. Evoked potentials (electromyography signal) of four muscle groups were elicited from needle electrodes before and after intravenous succinylcholine bolus (1.0 mg/kg). Recorded muscles included the vocalis muscles, trapezius muscle, diaphragm and triceps brachii muscles. The onset time and 80% recovery of control response were recorded and analyzed. The testing was repeated after 30 minutes. The onset time of neuromuscular blocking for the vocalis muscles, trapezius muscle, diaphragm and triceps brachii muscle was 36.3 ± 6.3 seconds, 38.8 ± 14.9 seconds, 52.5 ± 9.7 seconds and 45.0 ± 8.2 seconds during the first test; and 49.3 ± 10.8 seconds, 40.0 ± 12.2 seconds, 47.5 ± 11.9 seconds and 41.3 ± 10.1 seconds during the second test. The 80% recovery of the control response for each muscle was 18.3 ± 2.7 minutes, 16.5±6.9 minutes, 8.1±2.5 minutes and 14.8±2.9 minutes during the first test; and 21.5±3.8 minutes, 12.5 ± 4.3 minutes, 10.5 ± 3.1 minutes and 16.4 ± 4.2 minutes during the second test. The sensitivity of the muscles to succinylcholine, ranked in order, was: the vocalis muscles, the triceps brachii muscle, the trapezius muscle and the diaphragm. We demonstrated a useful and reliable animal model to investigate the effects of NMBAs on intraoperative neuromonitoring. Extrapolation of these data to humans should be done with caution., (Copyright © 2010 Elsevier. Published by Elsevier B.V. All rights reserved.)

Nasogastric tube (NGT) intubations occur frequently in clinical practice and can be a painful procedure for patients. A systematic review of current knowledge concerning the use of nebulized lidocaine to reduce the pain of NGT insertion was conducted in order to develop evidence-based guidelines. In addition, a meta-analysis of appropriate randomized controlled trials (RCTs) was performed. The databases included PubMed (1996-2009), ProQuest (1982-2009), CINAHL (1982-2009), and the Cochrane Central Register of Controlled Trials (2009), and reference lists of articles. Experts in this field also were contacted. Two investigators selected the research based on inclusion criteria and reviewed each study's quality according to the Jadad scale. Five RCTs with 212 subjects were identified. A total of 113 (58%) subjects were women. The mean age of treatment and control groups was 59.6 and 55 years, respectively. The countries of studies were the United States, United Kingdom, Australia, Canada, and Thailand. In the treatment groups, the use of lidocaine concentration was 4% and 10%. The pooled effect size was 0.423 (95% confidence interval: 0.204-0.880; Z=-2.301; P=0.021), indicating that the use of nebulized lidocaine before NGT insertion can decrease pain by 57.7%. There is insufficient evidence to recommend the dosage, concentration, or delivery method. Further research is needed to articulate a comprehensive clinical guideline., (Copyright © 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)

Study Design: An ex vivo biomechanical study on the rheological properties of healthy porcine and degenerated human intervertebral disc., Objective: To quantify the effect of loading history, loading magnitude, fatigue loading, and degeneration on disc rheology., Summary of Background Data: Disc rheological parameters, i.e., the aggregate modulus (HA) and hydraulic permeability (k) regulate the mechanical and biologic function of disc. The knowledge of effects of loading condition and degeneration on disc rheology can be beneficial for the design of new disc/nucleus implants or therapy., Methods: The following 4 phases of experiments were conducted to find the changes of disc rheological properties: (1) Effect of loading history during 1-hour creep (640 N) and relaxation (20% strain) test. (2) Effect of loading magnitude (420 N vs. 640 N) during the creep test. (3) Effect of fatigue loading (420 N, 5 Hz for 0.5, 1, and 2 hours) on the creep loading behavior. (4) Difference of healthy porcine and degenerated human discs during creep loading. The experimental data were fitted with linear biphasic model., Results: The aggregate modulus increased but hydraulic permeability decreased during creep loading. The aggregate modulus decreased but the hydraulic permeability did not change significantly during relaxation loading. The higher creep loading increased the aggregate modulus but decreased the hydraulic permeability. The fatigue loading did not change the aggregate modulus significantly, but decreased hydraulic permeability. Comparing the degenerated human disc to the healthy porcine disc, the aggregate modulus was higher but the hydraulic permeability was lower., Conclusion: The external loading and degeneration induce disc structural changes, e.g., the disc water content and interstitial matrix porosity, hence affect the disc rheological properties. The increase of aggregate modulus may be due to the reduction of disc hydration level, whereas the decrease of hydraulic permeability may be because of the shrinkage of disc matrix pores.

Tomatoes in Guatemala have been affected by a new disease, locally known as "mancha de chocolate" (chocolate spot). The disease is characterized by distinct necrotic spots on leaves, stems and petioles that eventually expand and cause a dieback of apical tissues. Samples from symptomatic plants tested negative for infection by tomato spotted wilt virus, tobacco streak virus, tobacco etch virus and other known tomato-infecting viruses. A virus-like agent was sap-transmitted from diseased tissue to Nicotiana benthamiana and, when graft-transmitted to tomato, this agent induced chocolate spot symptoms. This virus-like agent also was sap-transmitted to Datura stramonium and Nicotiana glutinosa, but not to a range of non-solanaceous indicator plants. Icosahedral virions approximately 28-30 nm in diameter were purified from symptomatic N. benthamiana plants. When rub-inoculated onto leaves of N. benthamiana plants, these virions induced symptoms indistinguishable from those in N. benthamiana plants infected with the sap-transmissible virus associated with chocolate spot disease. Tomatoes inoculated with sap or grafted with shoots from N. benthamiana plants infected with purified virions developed typical chocolate spot symptoms, consistent with this virus being the causal agent of the disease. Analysis of nucleic acids associated with purified virions of the chocolate-spot-associated virus, revealed a genome composed of two single-stranded RNAs of approximately 7.5 and approximately 5.1 kb. Sequence analysis of these RNAs revealed a genome organization similar to recently described torradoviruses, a new group of picorna-like viruses causing necrosis-associated diseases of tomatoes in Europe [tomato torrado virus (ToTV)] and Mexico [tomato apex necrosis virus (ToANV) and tomato marchitez virus (ToMarV)]. Thus, the approximately 7.5 kb and approximately 5.1 kb RNAs of the chocolate-spot-associated virus corresponded to the torradovirus RNA1 and RNA2, respectively; however, sequence comparisons revealed 64-83% identities with RNA1 and RNA2 sequences of ToTV, ToANV and ToMarV. Together, these results indicate that the chocolate-spot-associated virus is a member of a distinct torradovirus species and, thus, another member of the recently established genus Torradovirus in the family Secoviridae. The name tomato chocolate spot virus is proposed.

One-lung ventilation (OLV) is essential in some surgical situations. The use of double- lumen tubes (DLTs) can achieve OLV more quickly and more easily than bronchial blockers. The management of a difficult airway is a challenge for anesthesiologists when, at the same time, OLV is needed for a surgical procedure. This report describes the successful application of DLTs in two patients with difficult airways, and who were scheduled for pulmonary decortication. Case 1 already had a permanent tracheostomy, while Case 2 had oral cancer with an extremely limited mouth opening and needed elective tracheostomy for anesthesia. Nasal intubation of Case 2 was done with fiberoptic-guided intubation with the patient awake. OLV was achieved uneventfully after inserting the DLT directly through the tracheostomy in both cases. We also describe the appropriate use of airway devices for OLV, focusing on patients with an anticipated difficult airway., (2010 Taiwan Society of Anesthesiologists. Published by Elsevier B.V. All rights reserved.)

Here we report the clinical features and treatment outcomes of three patients with Candida haemulonii infection. Candida haemulonii was confirmed by sequence analysis of the internal transcribed spacer (ITS) regions of the rRNA genes and the 18S rRNA genes. Two of the three isolates were associated with fungaemia and reduced susceptibility to fluconazole [minimum inhibitory concentrations (MICs) of 16 mg/L] and amphotericin B (MICs of 2 mg/L). However, one of these two patients responded to fluconazole therapy. Echinocandins, voriconazole and posaconazole demonstrated excellent in vitro potency against the isolates.

Two important issues after a complete right forearm amputation are replantation and ongoing pain management. There are no reports of successful forearm replantation as a consequence of a crocodile bite. Here, we discuss our pain management in a case of complete forearm amputation after a bite from a saltwater crocodile (Crocodylus porosus), which necessitated six further operations to achieve successful replantation. Continuous infraclavicular brachial plexus block was effective for acute pain control in this case. We strongly recommend performing the block with an indwelling catheter under ultrasound guidance for higher accuracy and safety.

During the 2008 early-summer growing season, virus-like necrosis symptoms, most similar to those induced by Tobacco streak virus (TSV), were observed in leaves, stems, and petioles of processing tomato plants in the Central Valley of California. Symptoms were observed in numerous fields in Merced, San Joaquin, and Yolo counties, though the incidence of the disease in most fields was not high (not more than 5% but over 20% in some areas). Antibody-based tests of representative samples of the disease for infection with Tomato spotted wilt virus, TSV, and Tomato apex necrosis virus, which cause similar symptoms, were negative. A putative virus-like agent was sap- and graft-transmitted to tomato plants and induced necrotic spots in leaves and stem and petiole necrosis symptoms that were similar to those observed in the field. Eventually, these plants recovered from these symptoms. In sap-transmission experiments, the virus-like agent induced systemic symptoms in Chenopodium quinoa and C. amaranticolor (stunted growth and leaf curl and necrosis), Nicotiana benthamiana (necrotic leaf and stem lesions), N. tabacum cvs. Havana and Turkish (stunted growth and necrotic etching and ringspots followed by recovery for cv. Havana but not for cv. Turkish), and Datura stramonium (mild mottle and ringspots in newly emerged leaves followed by recovery); no symptoms were observed in inoculated common bean (cv. Topcrop), pumpkin (cv. Small Sugar), pepper, and N. glutinosa plants. Virus minipurification was performed with leaves from noninfected and infected D. stramonium plants, and polyacrylamide gel electrophoresis analyses revealed a protein band of ~29 kDa in infected but not noninfected plants. This protein was purified and subjected to liquid chromatography-mass/mass spectrometry analysis. Four peptides, obtained from the trypsin-digested protein, each had the highest match (score of 118) with the capsid protein (CP) of Parietaria mottle virus (PMoV), an ilarvirus that induces leaf and stem necrosis in tomatoes in Europe (1). Using sequences of PMoV and other ilarviruses, a single primer was designed from the 3' nontranslated region and paired with primers designed from conserved regions of ilarvirus RNAs 1, 2, and 3. In reverse transcription-PCR analyses, these primer pairs directed the amplification of the expected-sized fragments for ilarvirus RNAs 1, 2, and 3 from RNA extracts prepared from leaves with the unusual necrosis symptoms. Sequence analyses confirmed these were ilarvirus fragments. Partial RNA 1, 2, and 3 sequences were 81, 84, and 82% identical, respectively, with those of PMoV and 80, 77, and 69% identical, respectively, with those of TSV. The amino acid sequence of the CP gene (GenBank Accession No. FJ236810) was 86 and 61% identical to those of PMoV and TSV, respectively. Together, these results indicate the necrosis disease of tomato is caused by a new ilarvirus species, tentatively named Tomato necrotic spot virus, although further studies are needed to confirm this. The mode of transmission of this new ilarvirus to tomatoes in the field is unknown, but it may involve thrips feeding on infected pollen, a known method of transmission for TSV (2). References: (1) L. Galipienso et al. Plant Pathol. 54:29, 2005. (2) R. Sdoodee and D. S. Teakle. Plant Pathol. 36:377, 1987.

Impatiens necrotic spot virus (INSV; family Bunyaviridae, genus Tospovirus) is an important pathogen of ornamental plants in North America and Europe, particularly in the greenhouse industry (2,3). However, INSV is now emerging as a pathogen of vegetable crops. During the 2006 and 2007 growing seasons, lettuce (Lactuca sativa) in Monterey County, CA showed necrotic spotting, leaf chlorosis, and plant stunting typical of symptoms induced by Tomato spotted wilt virus (TSWV). Significant and damaging outbreaks of these disease symptoms were found in numerous romaine, greenleaf, redleaf, butterhead, and iceberg lettuce fields in Monterey and San Benito counties. Samples from symptomatic plants from 21 of 27 fields in Monterey County were negative when tested with TSWV immunostrips (Agdia, Elkhart, IN); however, tests of the TSWV-negative samples with INSV immunostrips were positive. In most fields where INSV was detected, disease development was limited to the edges of fields and disease incidence was <5%; however, some fields had incidences >50% and crop loss was experienced. The virus causing the tospovirus symptoms in the TSWV-negative lettuce was sap transmitted to Nicotiana benthamiana and lettuce, where it induced chlorosis and necrosis. Symptoms in N. benthamiana were consistent with INSV infection, and those in lettuce were similar to symptoms observed in the field. Immunostrip tests confirmed that symptomatic N. benthamiana and lettuce plants were infected with INSV. To further confirm the identity of this virus, reverse transcription (RT)-PCR analysis was conducted with an INSV primer pair that directs the amplification of a ~1.3-kb fragment from the small RNA of INSV (4). The 1.3-kb fragment was amplified from RNA from symptomatic lettuce plants that were INSV positive with immunostrips, and not from asymptomatic lettuce. A total of 38 of 54 samples showing tospovirus-like symptoms were confirmed to be infected with INSV by RT-PCR. Sequences of two representative 1.3-kb DNA fragments were 98 to 99% identical with sequences of INSV isolates from Japan, Italy, and The Netherlands (GenBank Accession Nos. AB109100, DQ425096, and X66972). Taken together with the previous identification of the INSV vector, the western flower thrips (Frankliniella occidentalis), in central California lettuce (1), these results confirm that INSV induced tospovirus symptoms in lettuce fields in Monterey County in 2007. To our knowledge, this is the first report of the occurrence of INSV infecting lettuce in California. References: (1) W. E. Chaney. Annu. Rep. California Lettuce Res. Board. 2006. (2) M. Daughtrey et al. Plant Dis. 81:1220, 1997. (3) M. D. Law and J. W. Moyer. J. Gen. Virol. 71:933, 1990. (4) R. A. Naidu et al. Online publication. doi: 10.1094/PHP-2005-0727-01-HN. Plant Health Progress, 2005.

Background: The most common causes of morbidity and mortality in uremic patients are cardiovascular disease and central nervous system dysfunction. However, the exact causes of dementia in uremic patients remain unclear. This study attempted to determine which risk factors are associated with dementia in hemodialysis patients., Methods: In total, 147 chronic uremic patients receiving regular hemodialysis treatment were recruited. Data for risk factors regarding cardiovascular disease and dementia, such as hypertension, diabetes mellitus, smoking, age, illiteracy, serum levels of albumin, cholesterol, triglycerides, and homocysteine, and liver function, were recorded. The Mini-Mental Status examination was used to assess mental function, and the Hachinski ischemic scale was applied to differentiate among dementia types. The diagnosis of dementia was based on criteria from the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition., Results: Twenty-six patients were diagnosed as manifesting dementia. Of all patients with dementia, 21 had a Hachinski score of 0 to 4, and 5 had a score of 7 to 10. In a multiple logistic regression analysis, low serum albumin and illiteracy were significantly associated with dementia. However, no difference existed between the two groups in terms of homocysteine levels., Conclusions: This study demonstrated that uremic patients were prone to nonvascular dementia. We conclude that hypoalbuminemia and not hyperhomocysteinemia is a risk factor for dementia in hemodialysis patients.

Marital violence or intimate partner violence is a serious and recurring public health issue. In the clinical setting, battered women often seek medical advice, because of the health problems that result from marital violence. Thus, nursing staff are the first persons to come into contact with the battered women. Can nurses execute their notify responsibility to prevent continued injury before obtained the woman's agreement? Will this action violate the principle of autonomy or not? Nurses would face an ethical dilemma when they care for battered women. The purpose of this article is to use Aroskar's ethical decision making model to analyze and clarify the ethical dilemmas involved in managing marital violence, including: under the value systems of the person, the profession, and time to illustrate the basic information, decision theory dimensions, and ethical theories or positions. It is hoped that this article provides an ethical decision making model for the ethical dilemmas facing nurses who manage marital violence in the clinical setting.

Femoral nerve block (FNB) is by far the most useful lower extremity regional anesthetic technique for the anesthesiologist, and high-resolution ultrasonography is a useful tool with which to guide the performance of FNB. However, the relationships between the femoral nerve and the femoral artery in different lower extremity positions have rarely been discussed. The purpose of this study was to evaluate the relative positions of the femoral nerve and artery at different lateral rotational angles of the lower extremities using ultrasonographic imaging. We enrolled 41 healthy volunteers in this study. Two-dimensional ultrasonographic images of the femoral nerve were obtained using an ultrasound unit, in the inguinal crease, for four positions of the bilateral lower extremities: 0 degrees , 15 degrees , 30 degrees and 45 degrees lateral rotation of each extremity. The following assessments were made in each position: minimal skin-to-nerve distance (SN) and deviation of nerve-to-landmark (femoral artery pulsation) horizontal distance (NF). A trend towards lateral rotation of both lower extremities was identified. The Pearson correlation values between rotational degree to SN and rotational degree to NF were -0.216 and 0.430, with p values of 0.001 and less than 0.001, respectively. Body mass index had a good correlation ( r = 0.76-0.78) with SN. The results of our ultrasound study revealed that the more lateral the rotation of both lower extremities, the closer the femoral nerve was to the skin and the farther away it was from the femoral artery. In order to increase the success rate and decrease the rate of complications, a suggested lateral 45 rotation of both lower extremities is strongly recommended when performing FNB using the peripheral nerve stimulator technique or the field block technique. In any situation, individual ultrasound guidance is recommended for FNB whenever possible.

The aim of this study was to evaluate the efficiency of lightwand-guided endotracheal intubation (LWEI) performed using either the right (dominant) or left (nondominant) hand. Two hundred and forty patients aged 21-64 years, with a Mallampati airway classification grade of I-II and undergoing endotracheal intubation under general anesthesia, were enrolled in this randomized and controlled study. Induction of anesthesia was initiated by intravenous administration of fentanyl (2 microg/kg) and thiopentone (5 mg/kg), and tracheal intubation was facilitated by intravenous atracurium (0.5 mg/kg). In the direct-vision laryngoscope group (group D; n = 80), the intubator held the laryngoscope in the left hand and inserted the endotracheal tube (ETT) into the glottic opening with the right hand. In the group in which LWEI was performed with the right hand (group R; n = 80), the intubator lifted the patients' jaws with the left hand and inserted the ETT-LW unit into the glottic openings with the right hand. On the contrary, in the group in which LWEI was performed with the left hand (group L; n = 80), the intubator lifted the jaws with the right hand and inserted the ETT-LW unit with the left hand. Data including total intubation time, the number of intubation attempts, hemodynamic changes during intubation, and side effects following intubation, were collected. Regardless of whether lightwand manipulation was performed with the left hand (group L; 11.4 +/- 9.3 s) or the right-hand (group R; 12.4 +/- 9.2 s), less time was consumed in the LWEI groups than in the laryngoscope group (group D; 17.9 +/- 9.9 s) (p < 0.001). All three groups obtained success rates greater than 95% on their first intubation attempts. The changes in mean arterial blood pressure and heart rate were similar among the three groups. A higher incidence of intubation-related oral injury and ventricular premature contractions (VPC) was found in group D compared with groups L and R (oral injury: group D 8.5%, group L 1.3%, group R 0%, p = 0.005; VPC: group D 16.3%, group L 5%, group R 7.5%, p = 0.04). We concluded that LWEI performed by either dominant or nondominant hands resulted in similar efficiency, and could be a suitable alternative to traditional laryngoscopy. It is both feasible and logical for an experienced anesthesiologist to use the nondominant hand to perform LWEI.

Background: The coracoid infraclavicular block first introduced by Whiffler provides a safer and easily approach than classic infraclavicular block. In this technique, the anatomy-based puncture site is 2 cm medial and 2 cm caudal from the coracoid process. This prospective study was purposed to evaluate the feasibility of surface landmark-based coracoid block by ultrasonography., Methods: High-frequency ultrasonographic examination was performed in 80 volunteers along the vertical line 2 cm medial to the coracoid process. The C point (C) is defined as landmark-based puncture site. The U point (U) is defined as the ultrasonographically modified optimal puncture site. After identifying the neurovascular bundle, the extent of precision based on landmark was examined and ultrasonographic measurements were also done. Demographic data was applied to correlate with the deviation between C and U., Results: The landmark-based puncture site for coracoid infraclavicular block was found to have a fair precision rate of 74.4%, although not high enough to provide a reliable puncture in daily practice. There was a significant trend toward a more superior puncture site of 2.95 mm (95% CI, 1.2-4.7). In female subjects, U was 5.12 mm (95% CI, 2.91-7.33) superior to C which was statistically significantly (P < 0.001). In male subjects, U was not significantly superior to C., Conclusions: Ultrasonographic guidance is suggested whenever anatomical precision is inadequate or meeting with great individual bodily variance which renders landmark-based technique difficult. However, if this facility is not available, the gender discrepancy in measurement should be seriously considered when coracoid process is used as the landmark.

In August and September of 2006, melon plants (Cucumis melo L.) near Niland in California's Imperial Valley and near Yuma, AZ began exhibiting interveinal chlorosis and leaf mottling and spotting, symptoms resembling those resulting from infection by viruses of the genus Crinivirus, family Closteroviridae (4). Some plants also exhibited leaf crumpling and curling, symptoms characteristic of begomovirus (genus Begomovirus, family Geminiviridae) infection. Leaves of plants had large populations of silverleaf whitefly (Bemisia tabaci biotype B), a known vector of begomoviruses and some criniviruses. Leaf samples were collected from four plants from California and 13 plants from three separate fields in Arizona. Total RNA was extracted using RNeasy kits (Qiagen, Valencia, CA) and subjected to reverse transcription (RT)-PCR using degenerate primers specific to the conserved polymerase region of a diverse group of criniviruses (3). The expected 500-bp RT-PCR product was amplified from RNA obtained from all the symptomatic melons, whereas no fragment was obtained from RNA extracted from leaves of healthy controls. The 500-bp fragment from four plants from California and five plants from Arizona was sequenced and found to be identical for all nine isolates (GenBank Accession No. EF121768). The sequenced region of the California and Arizona Cucurbit yellow stunting disorder virus (CYSDV) isolates was identical to that from a CYSDV isolate from Texas (GenBank Accession No. AY242077) and shared 99% identity with a CYSDV isolate from Spain (GenBank Accession No. AJ537493). Subsequent RT-PCR analysis of RNA from these nine plants, with primers specific to the capsid protein (CYScp1F 5' GCACGGTGACCAAAAGAAG 3' and CYScp1R 5' GAA-CATTCCAAAACTGCGG 3') and HSP70h (CYShspF 5' TGATGTATG-ACTTCGGAGGAGGAAC 3' and CYShspR 5' TCAGCGGACAAA-CCACCTTTC 3') genes of CYSDV, was used to further confirm virus identity. The expected fragments, 202 and 175 bp, respectively, were amplified from all nine samples, but not from healthy controls. DNA extracts also were prepared from these nine melon samples from California and Arizona, and PCR assays were conducted for the begomoviruses Cucurbit leaf crumple virus (CuLCrV) and Squash leaf curl virus (SLCV) (2). The four plants from California showed crumpling, curling, and yellowing symptoms; all were infected with SLCV and one with CuLCrV. The five plants from Arizona showed mostly yellowing symptoms; five were infected with SLCV and two with CuLCrV. These results demonstrate begomovirus and crinivirus co-infection. The economic impact of mixed infections with CYSDV and begomoviruses remains to be determined. Incidence of CYSDV in melon was directly correlated with incidence of its vector, B. tabaci. Host range information has demonstrated that the primary hosts of CYSDV are members of the Cucurbitaceae (1). A number of experimental hosts have been documented; however, the extensive vegetable production in the southwestern United States warrants further study on the potential for the establishment of local reservoirs in both crop and weed species in the area. The virus causes economic losses worldwide for curcurbit production. References: (1) A. Celix et al. Phytopathology 86:1370, 1996. (2) R. Gilbertson. Ann. Rep. CA Melon Res. Board, 2001. (3) R. Martin et al. Acta Hortic. 656:137, 2004. (4) G. Wisler et al. Plant Dis. 82:270. 1998.

ABSTRACT The NSs protein of Watermelon silver mottle virus (WSMoV) was expressed by a Zucchini yellow mosaic virus (ZYMV) vector in squash. The expressed NSs protein with a histidine tag and an additional NIa protease cleavage sequence was isolated by Ni(2+)-NTA resins as a free-form protein and further eluted after sodium dodecyl sulfate-polyacrylamide gel electrophoresis for production of rabbit antiserum and mouse monoclonal antibodies (MAbs). The rabbit antiserum strongly reacted with the NSs crude antigen of WSMoV and weakly reacted with that of a high-temperature-recovered gloxinia isolate (HT-1) of Capsicum chlorosis virus (CaCV), but not with that of Calla lily chlorotic spot virus (CCSV). In contrast, the MAbs reacted strongly with all crude NSs antigens of WSMoV, CaCV, and CCSV. Various deletions of the NSs open reading frame were constructed and expressed by ZYMV vector. Results indicate that all three MAbs target the 89- to 125-amino-acid (aa) region of WSMoV NSs protein. Two indispensable residues of cysteine and lysine were essential for MAbs recognition. Sequence comparison of the deduced MAbs-recognized region with the reported tospoviral NSs proteins revealed the presence of a consensus sequence VRKPGVKNTGCKFTMHNQIFNPN (denoted WNSscon), at the 98- to 120-aa position of NSs proteins, sharing 86 to 100% identities among those of WSMoV, CaCV, CCSV, and Peanut bud necrosis virus. A synthetic WNSscon peptide reacted with the MAbs and verified that the epitopes are present in the 98- to 120-aa region of WSMoV NSs protein. The WSMoV sero-group-specific NSs MAbs provide a means for reliable identification of tospoviruses in this large serogroup.

Over the past decade, self-efficacy has become one of the most measured variables in studies on health behaviors and patient education. The concept was originally proposed in 1977 by Bandura, who initially promoted its use in social science research, especially psychology. It is now considered one of the most important determinants of health-related behaviors. Using Walker and Avant's concept analysis methods, the authors clarify the attributes and characteristics of self-efficacy. Refinement of this concept is proposed as a prerequisite for application to nursing research and practice.