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This study explores the versatile binding properties of a tetrapodal ligand framework with nickel, demonstrating significant ligand fluxionality through the interconversions of several complexes. Kinetic studies using UV-vis and NMR techniques underscore the pivotal role of solvent coordination in initiating these dynamic processes. A unique reverse-dative Ni → Ag interaction provides another approach in modifying nickel's geometry.

Purpose: To assess safety and immune biomarkers after preoperative radiation therapy (RT) and anti-PD1 therapy in breast cancer., Materials and Methods: A phase I/IIb trial of pembrolizumab with RT was conducted in patients with triple-negative breast cancer (TNBC) and hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer. All received pembrolizumab followed by a second cycle + RT (anti-PD1/RT) of 24 Gy/three daily fractions delivered to the breast tumor and then neoadjuvant chemotherapy (NAC). Blood and tumor biopsies were obtained at baseline, after anti-PD1, and after anti-PD-RT. Coprimary end points were safety and change in tumor-infiltrating lymphocytes (TILs). Secondary end points were pathologic complete response (pCR), residual cancer burden (RCB) rates, and event-free survival (EFS)., Results: Sixty-six patients with stage I-III breast cancer (54 TNBC, 12 HR+/HER2-) were enrolled. The median follow-up was 32 months. Safety end point was met. Incidence of grade ≥3 toxicities was 41%. The pCR rate was 59.2%, 33.3%, and 54.5% for the TNBC, HR+/HER2-, and entire cohort, respectively. A total of 77.8% of TNBC and 41.6% of HR+/HER2- had a near pCR (RCB 0-1). The 3-year EFS was 80%. In the entire cohort, PD-L1 expression increased after anti-PD1 (median Combined Positive Score [CPS], 7.49-23.20; 95% CI, -41.88 to -6.30; P = .044) and anti-PD1/RT (median CPS, 7.49-23.41; 95% CI, -41.88 to -6.30; P = .009), compared with baseline. In TNBC, adding RT to anti-PD1 significantly decreased TILs (28.9%-17.1%; 95% CI, 2.46 to 21.09; P = .014). Baseline TILs correlated with PD-L1 expression and TNF-a., Conclusion: Preoperative RT with pembrolizumab is safe and results in high pCR rates and 3-year EFS, despite the lack of pembrolizumab during NAC. PD-L1 and TILs may be predictive biomarkers for preoperative anti-PD1/RT response. Reduction in TILs after adding RT to anti-PD1 highlights the importance of treatment sequencing.

Aims: For women with breast cancer, seminal studies have shown that adjuvant hypofractionated external beam radiation therapy (hEBRT) maintains similar outcomes and may reduce overall costs compared with conventionally fractionated external beam radiation therapy (cEBRT). However, it is unclear whether hEBRT may be associated with differential risk of development of radiation-induced second malignancies compared with cEBRT. Because the occurrence of second malignancies is small, large databases may improve our understanding of the relative risk of second malignancies between hEBRT and cEBRT., Materials and Methods: Using the National Cancer Database, we carried out a retrospective cohort analysis of women diagnosed with non-metastatic, stage 0-III breast cancer from 2004 to 2017. All patients had a lumpectomy or mastectomy and a follow-up time of at least 60 months after diagnosis. The probability of second malignancies in women receiving adjuvant cEBRT or hEBRT was compared using multivariable logistic regression adjusting for sociodemographic, geographical, clinical and treatment factors, allowing for relative (but not absolute) comparison of second malignancy risk. Temporal sensitivity analyses stratified by year of diagnosis and length of follow-up time were also conducted., Results: Of the 125 228 women in our study, 115 576 (92.3%) received cEBRT and 9652 (7.71%) received hEBRT. The median age of the cohort was 60 (interquartile range 51-68) years at diagnosis and the median follow-up time was 99.61 (interquartile range 77.5-128.49) months. Upon adjusting for sociodemographic and clinical factors, patients who received hEBRT had no difference in relative risk than patients who received cEBRT (odds ratio 0.937, 95% confidence interval 0.869-1.010, P = 0.091). In analyses stratified by year of diagnosis, and stratified by length of follow-up, there was no difference in second malignancy probability between patients who completed hEBRT and patients who completed cEBRT., Conclusions: In this analysis of over 120 000 women with non-metastatic breast cancer, hEBRT was not associated with different odds of developing second malignancies compared with cEBRT. Our findings may inform patient counselling in the choice of radiation regimens for breast cancer and further support the safety of hypofractionated regimens for breast cancer., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Little is known about communication between patients, families, and healthcare providers regarding ethical concerns that patients and families experience in the course of illness and medical care. To address this gap in the literature, we surveyed patients and family members to learn about their ethical concerns and the extent to which they discussed them with their healthcare providers., Methods: We surveyed adult, English-speaking patients and family members receiving inpatient care in five hospitals in the Washington DC-Baltimore metropolitan area from July 2017 to March 2020. Descriptive statistics were used to determine the frequency, comfortableness, and helpfulness of discussions regarding ethical concerns experienced when sick or receiving medical care. Univariable and multivariable stepwise logistic regression models were used to identify associations between healthcare provider and respondent characteristics and attitudes and (1) the likelihood of speaking to a healthcare provider about their ethical concern and (2) their level of comfort during these discussions., Results: Of 468 respondents who experienced ethical issues, 299 (64%) reported discussing the situation with a member of their healthcare team; 74% (197/265) of respondents who had such a discussion found the discussion comfortable, and 77% (176/230) of respondents found the discussion helpful. To make discussions more comfortable and helpful, respondents proposed suggestions in open-ended responses involving (1) content and quality of communication; (2) positive healthcare provider qualities such as empathy, open-mindedness, knowledge, honesty, and trustworthiness; and (3) other contextual factors including having adequate time and available resources., Conclusions: Patients and families often have ethical concerns that they discuss with clinicians, and they want clinicians to be routinely receptive and attentive to such discussions., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

The hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-gonadal (HPG) axes have reciprocal relationships with steroidogenesis regulation. However, the relationship between testicular steroids and defective glucocorticoid production under chronic stress remains unclear. Metabolic changes of testicular steroids in bilateral adrenalectomized (bADX) 8-week-old C57BL/6 male mice were measured using gas chromatography-mass spectrometry. Twelve weeks after surgery, testis samples were obtained from the model mice, which were divided into tap-water (n = 12) and 1 % saline (n = 24) supplementation groups, and their testicular steroid levels were compared with those of sham controls (n = 11). An increased survival rate with lower testicular levels of tetrahydro-11-deoxycorticosterone was observed in the 1 % saline group compared to both the tap-water (p = 0.029) and sham (p = 0.062) groups. Testicular corticosterone levels were significantly decreased in both tap-water (4.22 ± 2.73 ng/g, p = 0.015) and 1 % saline (3.70 ± 1.69, p = 0.002) groups compared to those in sham controls (7.41 ± 7.39). Testicular testosterone levels tended to increase in both bADX groups compared to those in the sham controls. In addition, increased metabolic ratios of testosterone to androstenedione in tap-water (2.24 ± 0.44, p < 0.05) and 1 % saline (2.18 ± 0.60, p < 0.05) mice compared to sham controls (1.87 ± 0.55) suggested increased production of testicular testosterone. No significant differences in serum steroid levels were observed. Defective adrenal corticosterone secretion and increased testicular production in bADX models revealed an interactive mechanism underlying chronic stress. The present experimental evidence suggests the crosstalk between the HPA and HPG axes in homeostatic steroidogenesis., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest. The funding agencies had no role in the study design, data collection, analysis, or interpretation., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Boron neutron capture therapy (BNCT) is a promising cancer treatment that eliminates tumor cells by triggering high-energy radiation within cancer cells. Aim: In vivo evaluation of poly(vinyl alcohol)/boric acid crosslinked nanoparticles (PVA/BA NPs) for BNCT. Materials & methods: PVA/BA NPs were synthesized and intravenously injected into tumor-bearing mice for BNCT. Results: The in vitro boron uptake of PVA/BA NPs in tumor cells was 70-fold higher than the required boron uptake for successful BNCT. In an in vivo study, PVA/BA NPs showed a 44.29% reduction in tumor size compared with clinically used boronophenylalanine for oral cancer in a murine model. Conclusion: PVA/BA NPs exhibited effective therapeutic results for oral cancer treatments in BNCT.

Purpose: Oligometastatic disease (OMD) refers to a limited state of metastatic cancer, which potentially derives benefit from local treatments. Given the relative novelty of this paradigm, oncologist perspectives on OMD are not well established. We thus explored oncologist views on curability of and treatment recommendations for patients with OMD., Methods and Materials: We developed a survey focused on oncologist views of 3 subtypes of OMD: synchronous, oligorecurrent, and oligoprogressive. Eligible participants included medical and radiation oncologists at 2 large cancer centers invited to participate between May and June 2022. Participants were presented with 3 hypothetical patient scenarios and asked about treatment recommendations, rationale, and demographic information., Results: Of 44 respondents, over half (61.4%) agreed that synchronous OMD is curable. A smaller proportion (46.2% and 13.5%) agreed for oligorecurrence and oligoprogression, respectively. When asked whether they use the word "cure" or "curative" in discussing prognosis, 31.8% and 33.3% agreed for synchronous and oligorecurrent OMD, respectively, while 78.4% disagreed for oligoprogression. Views on curability did not significantly affect treatment recommendations. More medical oncologists recommended systemic treatment only compared with radiation oncologists for the synchronous OMD (50.0% vs 5.3%; P < .01) and oligoprogression cases (43.8% vs 10.5%; P  = .02), not the oligorecurrent case. There were no significant differences in confidence in treatment recommendations by specialty., Conclusions: In this exploratory study, we found notable divergence in oncologists' views about curability of OMD as well as variability in treatment recommendations, suggesting need for more robust research on outcomes of patients with OMD., (© 2023 The Authors.)

Patients and family members ( N  = 671) were surveyed in five Mid-Atlantic U.S. hospitals to ascertain the number and kinds of ethical concerns they are presently experiencing or have previously experienced while being sick or receiving medical care. Seventy percent of participants had at least one (range 0-14) type of ethical concern or question. The most commonly experienced concerns pertained to being unsure how to plan ahead or complete an advance directive (29.4%), being unsure whether someone in the family was able to make their own decisions (29.2%), deciding about limiting life-sustaining treatments (28.6%), wondering about disclosing personal medical information to others in the family (26.4%) and not being sure whether to undergo treatment because of cost (26.2%). Most were interested to some degree in getting help from ethics consultants in the future (76.6%). Given this prevalence, common concerns might usefully be addressed systematically, rather than exclusively on a case-by-case basis.

Nuclear receptor subfamily 5 group A member 1 (NR5A1) is expressed in the pituitary gonadotrope and regulates their differentiation. Although several regulatory regions were implicated in Nr5a1 gene expression in the pituitary gland, none of these regions have been verified using mouse models. Furthermore, the molecular functions of NR5A1 in the pituitary gonadotrope have not been fully elucidated. In the present study, we generated mice lacking the pituitary enhancer located in the 6th intron of the Nr5a1 gene. These mice showed pituitary gland-specific disappearance of NR5A1, confirming the functional importance of the enhancer. Enhancer-deleted male mice demonstrated no defects at fetal stages. Meanwhile, androgen production decreased markedly in adult, and postnatal development of reproductive organs, such as the seminal vesicle, prostate, and penis was severely impaired. We further performed transcriptomic analyses of the whole pituitary gland of the enhancer-deleted mice and controls, as well as gonadotropes isolated from Ad4BP-BAC-EGFP mice. These analyses identified several genes showing gonadotrope-specific, NR5A1-dependent expressions, such as Spp1 , Tgfbr3l , Grem1 , and Nr0b2 . These factors are thought to function downstream of NR5A1 and play important roles in reproductive organ development through regulation of pituitary gonadotrope functions.

Background: Whole pelvic radiation therapy (WPRT) may improve outcomes compared with prostate only radiation therapy (PORT) in some subsets of men with prostate cancer, as in the POP-RT trial. However, there is concern about increased risk of adverse effects with WPRT, including the development of radiation-induced second malignancies (SM). Given the rarity of SM, little is known about relative rates of SM between WPRT and PORT., Methods: A retrospective cohort analysis was performed of men with nonmetastatic, node-negative prostate cancer with at least 60 months of follow-up using a national database. SM probabilities were compared in men receiving either WPRT or PORT using multivariable logistic models adjusting for clinical and sociodemographic factors. Temporal sensitivity analyses stratified by year of diagnosis and length of follow-up were also conducted., Results: Of 50,237 patients in the study, 39,338 (78.4%) received PORT, and 10,899 (21.7%) received WPRT. Median follow-up was 106.2 months (interquartile range 82.32-132.25). Crude probabilities of SM were 9.16% for WPRT and 8.88% for PORT. The adjusted odds ratio (AOR) for development of SM with PORT versus WPRT was 1.046 (95% confidence interval 0.968-1.130). Temporal sensitivity analyses by stratifying by year of diagnosis and follow-up length also did not demonstrate any significant difference in rates of SM between WPRT and PORT using AORs with WPRT as the referent., Conclusions: Retrospective analysis of over 50,000 patients did not demonstrate an association between WPRT and an increased probability of SM compared to PORT. Given the findings of POP-RT, the use of WPRT may become widespread for certain subsets of men. Thus, our findings could help guide how we counsel patients deciding between WPRT and PORT and suggest the need for prospective assessment of SM risk with WPRT and PORT., (© 2022 Wiley Periodicals LLC.)

We report the insertion of Pd(II) into an originally achiral rotaxane producing two chiral metallorotaxanes: one is planar-chiral, with its two interlocked components both chelating nonequivalently to the metal center; the other is C 2 -symmetrical-chiral, with the dynamically exchangeable stereogenic units stabilized by the interlocked structure. Chiral additives confirmed the existence of chirality, with the enantiomers of the C 2 -symmetrical N-heterocyclic carbene complex being resolved using chiral TRISPHAT counteranions.

We aimed to develop an artificial neural network (ANN) model to estimate the maximal oxygen uptake (VO 2 max) based on a multistage 10 m shuttle run test (SRT) in healthy adults. For ANN-based VO 2 max estimation, 118 healthy Korean adults (59 men and 59 women) in their twenties and fifties (38.3 ± 11.8 years, men aged 37.8 ± 12.1 years, and women aged 38.8 ± 11.6 years) participated in this study; data included age, sex, blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP)), waist circumference, hip circumference, waist-to-hip ratio (WHR), body composition (weight, height, body mass index (BMI), percent skeletal muscle, and percent body), 10 m SRT parameters (number of round trips and final speed), and VO 2 max by graded exercise test (GXT) using a treadmill. The best estimation results (R 2 = 0.8206, adjusted R 2 = 0.7010, root mean square error; RMSE = 3.1301) were obtained in case 3 (using age, sex, height, weight, BMI, waist circumference, hip circumference, WHR, SBP, DBP, number of round trips in 10 m SRT, and final speed in 10 m SRT), while the worst results (R 2 = 0.7765, adjusted R 2 = 0.7206, RMSE = 3.494) were obtained for case 1 (using age, sex, height, weight, BMI, number of round trips in 10 m SRT, and final speed in 10 m SRT). The estimation results of case 2 (using age, sex, height, weight, BMI, waist circumference, hip circumference, WHR, number of round trips in 10 m SRT, and final speed in 10 m SRT) were lower (R 2 = 0.7909, adjusted R 2 = 0.7072, RMSE = 3.3798) than those of case 3 and higher than those of case 1. However, all cases showed high performance (R 2 ) in the estimation results. This brief report developed an ANN-based estimation model to predict the VO 2 max of healthy adults, and the model's performance was confirmed to be excellent.

Background: Due to the noninvasive nature of boron neutron capture therapy (BNCT), it is considered a promising cancer treatment method. Aim: To investigate whether polyvinyl alcohol/boric acid crosslinked nanoparticles (PVA/BA NPs) are an efficient delivery system for BNCT. Materials & methods: PVA/BA NPs were synthesized and cocultured with brain and oral cancers cells for BNCT. Results: PVA/BA NPs had a boron-loading capacity of 7.83 ± 1.75 w/w%. They accumulated in brain and oral cancers cells at least threefold more than in fibroblasts and macrophages. The IC 50  values of the brain and oral cancers cells were at least ninefold and sixfold lower than those of fibroblasts and macrophages, respectively. Conclusion: Theoretically, PVA/BA NPs target brain and oral cancers cells and could offer improved therapeutic outcomes of BNCT.

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals. We conducted a content analysis of their responses to open-ended questions about their most memorable experience with an ethical concern for them or their family member. Participants ( N  = 196) described 219 unique ethical experiences that spanned many of the prevailing themes of bioethics, including the patient-physician relationship, end-of-life care, decision-making capacity, healthcare costs, and genetic testing. Participants focused on relational issues in the course of experiencing illness and receiving medical care and concerns regarding the patient-physician encounters. Many concerns arose outside of a healthcare setting. These data indicate areas for improvement for healthcare providers but some concerns may be better addressed outside of the traditional healthcare setting.

Potentially curative but high-risk trials of gene therapy or stem cell transplantation (PBSCT) for sickle cell disease (SCD) pose new opportunities for adults with SCD, many of whom experience significant disease burden and complications with few treatment options, as well as stigma and disparities in care. We explored motivations and decision-making processes of enrollees and decliners of such trials. Semistructured interviews were conducted with a purposive sample of 20 enrollees and 6 decliners. Interviews explored participants' SCD experiences, motivations, and decision-making about trial participation, understanding of research-related information, and retrospective reflections. Interviews were analyzed with content analysis. Most identified the purpose of research, risks, and uncertainties of participation. Both enrollees and decliners described deliberative weighing of study risks and potential benefits (especially the prospect of a cure), with heavy factoring of their SCD status, experiences, and desire for a better life. Despite the influence of spirituality/religion and support of family and friends, all described the decision about participation as their own. In some patients, the primary outcome status defined by the trial did not match the patients' perceived outcomes. Patients with negative experiences expressed a desire for greater emphasis on risks and possible outcomes during informed consent. This cohort of adults with SCD were thoughtfully deliberative in their decisions about gene therapy or PBSCT trials. Future participants' decision-making may be enhanced by emphasizing that "successful" scientific outcomes can still involve complications or symptoms and be facilitated by referrals to former research participants and anticipatory discussions., (Published by Elsevier Inc.)

Background: Researchers worry that patients in early-phase research experience unrealistic optimism about benefits and risks of participation. The standard measure of unrealistic optimism is the Comparative Risk/Benefit Assessment (CRBA) questionnaire, which asks people to estimate their chances of an outcome relative to others in similar situations. Such a comparative framework may not be a natural way for research participants to think about their chances., Objective: To examine how people interpret questions measuring unrealistic optimism and how their interpretations are associated with their responses., Methods: Using an early-phase cancer trial vignette, we administered the CRBA to 297 adults from the general public. They estimated their comparative chances of risk and benefit (7-point scale: -3 less likely to +3 more likely), then provided rationales for their estimates., Results: For both CRBA benefit and risk questions, about 50% of respondents chose 0 (the 'correct' response of 'average likelihood'), and 50% chose a non-0 response. Respondents' rationales for their estimates showed that overall only about 40%-44% gave comparative rationales, indicating that they interpreted the CRBA as intended. 68.7% of respondents who gave the 'correct' 0 rating gave comparative rationales, whereas only 11.6% of respondents who gave non-0 ratings did so. A similar trend was seen for chances of risk (p<0.001 for both)., Conclusion: Research participants may not understand comparative benefit and risk questions as intended; attributions of unrealistic optimism may require additional evidence that the respondents' estimates are intended to be comparative., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

A composite solid propellant which generates high propulsive force in a short time is typically composed of an oxidizer, a metal fuel powder and a binder. Among these, the binder is an important component. The binder maintains the mechanical properties of propellant grains and endures several thermal and mechanical stresses in the engine. Several studies have been reported for the development of energetic propellant binders for increasing the propellant's propulsive force. While several materials have been studied for the synthesis of energetic prepolymers, a nitramine-group-containing prepolymer is a suitable candidate because these types of prepolymers are less toxic and more cost-effective when compared to the traditional glycidyl azide polymers (GAP) and triazole-based prepolymers. Considering the lack of studies for the binder using a nitramine-group-containing prepolymers, we synthesized a nitramine-group-containing monomer and polymerized a nitramine-group-containing prepolymer. The prepolymer was then used for the preparation of the binder and its thermal and mechanical properties, as well as the effect of the plasticizer, were studied. The binder that was prepared using the prepolymer containing a nitramine-group showed very high elongation, tensile strength. Nitrate-ester (NE)-type plasticizer could reduce the glassy transition temperature (T g )of the binder successfully. Also, high-energy is released due to the decomposition of the nitramine-group at around 245 °C, thus exhibiting the efficiency of the nitramine-group-containing prepolymer as an excellent energetic binder material., Competing Interests: The authors declare no conflict of interest

Three central themes in the study of the phenomenon of resistive switching are the nature of the conducting phase, why it forms, and how it forms. In this study, the answers to all three questions are provided by performing switching experiments in situ in a transmission electron microscope on thin films of the model system polycrystalline SrTiO 3 . On the basis of high-resolution transmission electron microscopy, electron-energy-loss spectroscopy and in situ current-voltage measurements, the conducting phase is identified to be SrTi 11 O 20 . This phase is only observed at specific grain boundaries, and a Ruddlesden-Popper phase, Sr 3 Ti 2 O 7 , is typically observed adjacent to the conducting phase. These results allow not only the proposal that filament formation in this system has a thermodynamic origin-it is driven by electrochemical polarization and the local oxygen activity in the film decreasing below a critical value-but also the deduction of a phase diagram for strongly reduced SrTiO 3 . Furthermore, why many conducting filaments are nucleated at one electrode but only one filament wins the race to the opposite electrode is also explained. The work thus provides detailed insights into the origin and mechanisms of filament generation and rupture., (© 2019 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: Injection of intra-articular corticosteroids is effective for improving the recovery of range of motion (ROM) and pain in various conditions of the shoulder but its use is limited after rotator cuff repair owing to concern over the possible harmful effects of steroids on the repaired tendon., Purpose: To evaluate the effect of intra-articular corticosteroid injections on the clinical outcomes and cuff integrity of patients after rotator cuff repair., Study Design: Randomized controlled trial; Level of evidence, 1., Methods: Between March 2011 and April 2014, 80 patients with a small- to medium-sized rotator cuff tear were enrolled in this study and underwent arthroscopic rotator cuff repair. Forty patients received an injection of triamcinolone (40 mg) and lidocaine (1.5 mL) into the glenohumeral joint 8 weeks after surgery (group 1), while the remaining 40 patients received normal saline injection (group 2). Outcome measures-including ROM, American Shoulder and Elbow Surgeons (ASES) score, Constant score, pain visual analog scale, and Simple Shoulder Test score-were evaluated at 3, 6, and 12 months after surgery and at the last follow-up. The integrity of the repaired tendon was evaluated by magnetic resonance imaging (MRI) and classified per Sugaya classification at 8 weeks (before injection) and 12 months after surgery., Results: The mean follow-up period was 25.7 months. At 3 months postoperatively, patients in group 1 had a significantly higher ROM with respect to forward flexion ( P = .05), external rotation at the side ( P = .05), and external rotation at abduction ( P = .04) as compared with group 2, whereas no significant difference was noted between the groups for internal rotation behind the back ( P = .65). Patients in group 1 had significantly lower visual analog scale pain scores ( P = .02) and higher ASES scores (group 1, 68.90; group 2, 60.28; P = .02) at 3-month follow-up. However, there was no significant difference after 6 months with respect to ROM and ASES scores (group 1, 77.80; group 2, 75.88; P = .33). Retears (Sugaya classification IV and V) were determined by MRI at 12 months and observed in a total of 7 patients (8.8%): 3 from group 1 (7.5%) and 4 from group 2 (10%). No retears were observed on MRI in the remaining 73 patients (91.2%): 37 patients from group 1 and 36 patients from group 2. There was no statistically significant difference in rate of retears between groups ( P = .69)., Conclusion: Intra-articular injection of corticosteroids after rotator cuff repair does not increase the risk of retears and is thus an effective and safe treatment method for increasing ROM (forward flexion, external rotation) and improving clinical score (ASES) during the early postoperative period of patients undergoing rotator cuff repair.

Study Design: This study was a technical case report., Objectives: To introduce a new transforaminal percutaneous endoscopic lumbar discectomy (PELD) technique for the treatment of upper lumbar disc herniation using an extradiscal epiduroscopic approach., Summary of Background Data: Although upper lumbar disc herniation accounts for only 1%-2% of all cases of lumbar disc herniation, the treatment is difficult and shows relatively poor outcomes compared with lower lumbar disc herniation. The anatomic characteristics of the upper lumbar spine are somewhat different from those of the lower lumbar spine. Thus, conventional transforaminal PELD may fail to remove the herniated disc., Methods: In the setting of extradiscal epiduroscopic PELD for upper lumbar disc herniation, the approach angle on the axial plane is ~30 degrees, which is less than that of the conventional transforaminal endoscopic discectomy and the working cannula is directly targeted to the herniated disc. Four patients who presented with back and/or leg pain due to disc herniation at L1-L2 or L2-L3 disc space were treated with extradiscal epiduroscopic PELD., Results: The patients experienced relief from symptoms and were discharged the next day., Conclusions: Extradiscal epiduroscopic PELD is a promising treatment strategy for upper lumbar disc herniation, which may otherwise lead to a poor outcome.

Background/aims Sparse literature exists on the challenges and ethical considerations of including people with limited access to healthcare, such as the uninsured and low-income, in clinical research in high-income countries. However, many ethical issues should be considered with respect to working with uninsured and low-income participants in clinical research, including enrollment and retention, ancillary care, and post-trial responsibilities. Attention to the uninsured and low-income is particularly salient in the United States due to the high rates of uninsurance and underinsurance. Thus, we conducted a scoping review on the ethical considerations of biomedical clinical research with uninsured and low-income participants in high-income countries in order to describe what is known and to pinpoint areas of needed research on this issue. Methods MEDLINE/PubMed, Embase, and Scopus databases were searched using terms that described main concepts of interest (e.g., uninsured, underinsured, access to healthcare, poverty, ethics, compensation, clinical research). Articles were included if they met four inclusion criteria: (1) English, (2) high-income countries context, (3) about research participants who are uninsured or low-income, which limits their access to healthcare, and in biomedical clinical research that either had a prospect of direct medical benefit or was offered to them on the basis of their ill health, and (4) recognizes and/or addresses challenges or ethical considerations of uninsured or low-income participants in biomedical clinical research. Results The searches generated a total of 974 results. Ultimately, 23 papers were included in the scoping review. Of 23 articles, the majority (n = 19) discussed enrollment and retention of uninsured or low-income participants. Several barriers to enrolling uninsured and low-income groups were identified, including limited access to primary or preventive care; lack of access to institutions conducting trials or physicians with enough time or knowledge about trials; overall lack of trust in the government, research, or medical system; and logistical issues. Considerably fewer articles discussed treatment of these participants during the course of research (n = 5) or post-trial responsibilities owed to them (n = 4). Thus, we propose a research agenda that builds upon the existing literature by addressing three broad questions: (1) What is the current status of uninsured research participants in biomedical clinical research in high-income countries? (2) How should uninsured research participants be treated during and after clinical research? (3) How, if at all, should additional protections for uninsured research participants affect their enrollment? Conclusions This review reveals significant gaps in both data and thoughtful analysis on how to ethically involve uninsured research participants. To address these gaps, we propose a research agenda to gather needed data and theoretical analysis that addresses three broad research questions.

With increasingly strict regulations regarding patient exposure, research on digital radiography technology has recently focused on indirect methods that can produce high-quality images for a low radiation dose. In particular, medical imaging systems based on indirect methods universally use rare-earth metal phosphors, because of their high atomic number and excellent luminescence efficiency. Thus, various studies aiming to improve the luminescence efficiency of phosphors have been conducted. Despite this research, however, the current luminescence efficiencies are insufficient. Here, we report a basic study aiming to develop a phosphor screen containing a three-quarter-wave optical-thickness layer to improve the light transmission efficiency. Specifically, the fabrication and measurement of a Gd2O2S:Tb phosphor screen containing a single three-quarter-wave optical-thickness layer is presented. The screen is fabricated via a screen-printing and spin-coating method. Based on histograms of the degree of luminescence and the pixel values, we demonstrate that the light transmission efficiency is improved by the three-quarter-wave optical-thickness layer. Note that analysis of the full width at half maximum of the pixel value distribution reveals the possibility of resolution loss when obtaining medical images. Overall, the results of this study confirm that the light transmission efficiency can be improved through use of a single-layer anti-reflection coating. However, because the emission spectrum of the Gd2O2S:Tb screen is in the 480-600-nm band, it is necessary to expand the areas exhibiting the lowest reflectance to the wavelengths at the edge of this band. Thus, further study should be conducted to optimize the optical thickness.

The transcription factor NFAT1 plays a pivotal role in the homeostasis of T lymphocytes. However, its functional importance in non-CD4 + T cells, especially in systemic immune disorders, is largely unknown. In this study, we report that NFAT1 regulates dendritic cell (DC) tolerance and suppresses systemic autoimmunity using the experimental autoimmune myasthenia gravis (EAMG) as a model. Myasthenia gravis and EAMG are T cell-dependent, Ab-mediated autoimmune disorders in which the acetylcholine receptor is the major autoantigen. NFAT1-knockout mice showed higher susceptibility to EAMG development with enhanced Th1/Th17 cell responses. NFAT1 deficiency led to a phenotypic alteration of DCs that show hyperactivation of NF-κB-mediated signaling pathways and enhanced binding of NF-κB (p50) to the promoters of IL-6 and IL-12. As a result, NFAT1-knockout DCs produced much higher levels of proinflammatory cytokines such as IL-1β, IL-6, IL-12, and TNF-α, which preferentially induce Th1/Th17 cell differentiation. Our data suggest that NFAT1 may limit the hyperactivation of the NF-κB-mediated proinflammatory response in DCs and suppress autoimmunity by serving as a key regulator of DC tolerance., (Copyright © 2017 by The American Association of Immunologists, Inc.)

Objective: The purpose of this study is to compare the characteristics of those ertapenem-treated adult patients with and without development of seizures, and identify the associated factors for the development of seizures., Methods: This retrospective study was conducted at Chia-Yi Christian Hospital from January 2012 to December 2014. Patients developing seizures during their ertapenem treatment course were identified as case patients. Those without seizures who had received ertapenem for at least five days were considered as the pool of control patients. For each case patient, four matched patients from the control pool were randomly selected as the final control group, based on age, gender, and the date of ertapenem prescription., Results: A total of 1706 ertapenem-treated patients were identified, 33 (1.9%) individuals developed seizures with the enrollment of 132 matched control patients. Among these 33 patients, the average age was 79.3 ± 7.5 years, and 20 (60.6%) were male. The mean Charlson co-morbidity score was 4.5 ± 2.4, and the first episode of seizure happened 3.3 ± 2.6 days after receiving ertapenem. In multivariate logistic regression analysis, the independent predictors associated with the development of ertapenem-associated seizures were old stroke (OR, 14.36; 95% CI, 4.38-47.02; p < 0.0001), undergoing brain images within one year prior to the admission (OR, 5.73; 95% CI, 1.78-18.43; p = 0.0034), low hemoglobin level (OR, 3.88; 95% CI, 1.28-12.75; p = 0.0165) and low platelet count (OR, 4,94; 95% CI, 1.56-15.68; p = 0.0067) at presentations, and protective factors against the development of seizures were heart failure (OR, 0.04; 95% CI, 0.00-0.63; p = 0.0222), concomitant use of steroids (OR, 0.19; 95% CI, 0.05-0.77; p = 0.0201), or antiplatelet agents (OR, 0.12; 95% CI, 0.02-0.63, p = 0.0123) with ertapenem., Conclusions: The development of ertapenem-associated seizures may occur more frequently and much earlier due to its widespread use in treating drug-resistant pathogens, especially when these pathogens emerged worldwide.Our study would help physician to estimate the risk of developing seizure among patients receiving ertapenem.

The purpose of this study was to evaluate the self-determined motivation predictors of exercise behaviour following pulmonary rehabilitation in COPD recipients. This cross-sectional study was conducted with 135 COPD patients. A demographic questionnaire, clinical factors, behavioural regulations in exercise questionnaire, and leisure time exercise questionnaire were used to collect data. A logistic regression model was used to identify the predictors associated with demographics and self-determined motivation types regarding physical activity. Education level, episodes of acute exacerbation within 2 years, and identified regulation were significant predictors of executing physical activities with high metabolic equivalents. The results of this study imply that healthcare providers need to be aware of the importance of exercise motivation among COPD patients., (© 2017 John Wiley & Sons Australia, Ltd.)

Background: The majority of Salmonella arizonae human infections have been reported in southwestern United States, where rattlesnake-based products are commonly used to treat illness; however, little is known in non-endemic areas. We reviewed and analyzed the clinical manifestations and treatment outcomes in adult patients with S. arizonae infection at our institution., Method: A retrospective study was conducted at a regional teaching hospital in southern Taiwan from July 2007 to June 2014. All adult patients diagnosed with S. arizonae infections and treated for at least three days at Chia-Yi Christian Hospital were included. Patients were followed till discharge., Results: A total of 18 patients with S. arizonae infections (median age: 63.5 years) were enrolled for analysis, of whom two thirds were male. The three leading underlying diseases were diabetes mellitus, peptic ulcer disease and malignancy. Ten patients had bacteraemia and the most common infection focus was the lower respiratory tract. Most of the patients (72.2%) received third-generation cephalosporins as definitive therapy. In contrast, ampicillin-based regimens (accounting for 45.2%) were the major treatment modalities in previous reports. The crude in-hospital mortality was 5.6%, which was much lower than what was previously reported (22.7%)., Conclusions: Though uncommon, there were cases of S. arizonae infections in Taiwan. Patients receiving third-generation cephalosporins treatment had better prognosis compared with those treated with ampicillin-based regimen.

The surface wettability and anti-protein adsorption of a silicone-based hydrogel that was synthesized by a block copolymer of polydimethylsiloxane (PDMS) and poly (ethylene glycol) methacrylate (PEGMA) was improved via polyelectrolyte multilayer (PEM) immobilization. Polysaccharide PEMs of chitosan (CS, as a positive-charged agent) and hyaluronic acid (HA, as a negative-charged and anti-adhesive agent) were successfully assembled on the PDMS-PU-PEGMA silicone hydrogel in a layer-by-layer (LBL) self-assembly manner. Atomic force microscopy (AFM) and dyeing data verified the progressive buildup of the PEM silicone hydrogel. The results showed that the contact angle of the silicone hydrogel decreased with an increase in the number of PEM grafting layers. Furthermore, after immobilizing five layers of CS/HA, the protein adsorption decreased from 78 ± 11 to 26 ± 4 μg/cm(2) for HSA and from 55 ± 10 to 20 ± 4 μg/cm(2) for lysozymes. This indicates that CS/HA PEM-immobilized silicone hydrogels can resist protein adsorption. Furthermore, these hydrogels were non-cytotoxic according to an in vitro L929 fibroblast assay. Overall, the results demonstrated that the modified silicone hydrogels exhibited hydrophilicity and anti-protein adsorption, as well as relatively high oxygen permeability and optical transparency. Therefore, they would be applicable as a contact lens material., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Purpose: This study was aimed to explore and report the short term results of primary cementless hip arthroplasty in treatment of unstable intertrochanteric femur fracture in elderlys., Materials and Methods: Between March 2009 and Feburary 2012, 35 arthroplasty cases performed by single surgeon and followed up for more than one year were evaluated. They were 21 females and 14 males with mean age of 78 years (range, 71-92 years). Preoperative evaluation was performed by American Society of Anesthesia score. Retrospective evaluation was performed by operative time, transfusion amount, time to operation days, hospital stay and time to full weight bearing. Clinically, ambulatory ability was checked by Parker and Palmer (P&P) score and function of hip was appraised by Harris hip score (HSS). Radiologically, bone healing of fractured trochanteric fragment and presence of subsidence, stress shielding or osteolysis were checked., Results: Fracture type was 11 cases of A2.2, 18 cases of A2.3 and 6 cases of A3.3. Femoral stems used were 8 cases of rectangular tapered wedge type and 27 cases of fluted modular distal fixation type. P&P score improved from mean preinjury score of 7.1 to mean postoperative last follow-up score of 6.5. Median HHS at last follow-up was 75. Mean time to full weight bearing was 47 days (24-79 days). Postoperative complications were one case of linear periprosthetic femoral fracture and one case of postoperative dislocation., Conclusion: Cementless hip replacement arthroplasty could be a good option for unstable intertrochanteric femoral fracture in elderlys.

Purpose: To report clinical results and demonstrate posterior femoral translation (PFT) in medial pivot total knee arthroplasty (TKA) of posterior cruciate ligament (PCL) retaining type., Materials and Methods: A prospective study was performed upon thirty consecutive subjects who were operated on with medial pivot TKA of PCL retaining type between March 2009 and March 2010 and had been followed up for at least 2 years. Clinically, the knee society knee score and function score were used. In full extension and active flexion lateral radiograph, anteroposterior (AP) condylar position and magnitude of PFT was determined., Results: At last follow-up, the mean knee society knee score and function score improved significantly compared to preoperative scores. The AP condylar positions were consistently posterior to midline throughout the entire range of flexion. The PFTs averaged 0.31 (±0.12) of half length of tibial base plate and were greater in higher flexion cases (r = 0.56, p = 0.0012). There were no cases having either component migration or radiolucent line wider than 2 mm except for one case showing instability related to trauma., Conclusions: In medial pivot TKA of PCL retaining type, clinical outcomes were satisfactory and posterior femoral translations were consistently observed during progressive flexions of knees at two- to three-year follow-up.

Purpose: Pathologic stage is the most accurate prognostic factor of renal cell carcinoma. We evaluated whether perirenal fat infiltration is a significant factor in tumors 7 cm or less in size., Materials and Methods: We retrospectively reviewed the record of 164 cases of tumors 7 cm or less in size. We divided the patients into two groups according to the presence of perirenal fat infiltration (group A, pT1; group B, pT3a). We evaluated relationships, recurrence-free survival and disease-specific survival according to clinicopathologic parameters. Statistical differences were calculated by log-rank test., Results: A total 131 patients were included in group A, with a mean age of 55.8 years, average tumor size was 4.2 cm, and a mean follow-up period of 43 months. Group B included 33 patients, with a mean age of 55.9 years, an average tumor size of 4.1 cm, and a mean follow-up period of 38 months. There was no significant difference in disease-specific survival; however, recurrence-free survival showed significantly different between two groups (group A: 95.5%, group B: 84.4%)., Conclusion: In this study, perirenal fat infiltration proved to be an independent prognostic factor for predicting disease-free survival in patients with tumors of 7 cm or less in size. Therefore, as this study showed, the presence of perirenal fat infiltration requires stricter follow-up planning, even in small renal cell carcinoma.

A butterfly vertebra is a rare congenital anomaly that is usually asymptomatic. The authors, however, describe a novel case involving a butterfly vertebra overlapping with disc herniation that presented as radiculopathy. A butterfly vertebra is characterized by a symmetrical fusion defect resulting in a sagittal cleft vertebra. Only a few cases of butterfly vertebrae have been reported as incidental findings. This spinal anomaly may be associated with other congenital conditions such as Pfeiffer, Crouzon, Jarcho-Levin, and Alagille syndromes. Moreover, there is no previous report of a case associated with symptomatic disc herniation from the sagittal cleft. The authors excised the herniated disc fragment. They performed intraoperative discography after exposure of the corresponding intervertebral space via a conventional interlaminar approach. Histological examination of a tissue specimen showed scattered chondrocytes in the myxohyaline stroma, which indicated the nucleus pulposus.

Background: To evaluate the utility of additional fixation methods and to suggest a method of reduction in the treatment of unstable pertrochanteric femur fractures with a sliding hip screw (SHS)., Methods: A retrospective study was performed on thirty patients with unstable pertrochanteric femur fractures, who were operated on with a SHS between September 2004 and September 2009 and were followed up for at least 6 months. The additional fixation devices were as follows; antirotation screw (21 cases), fixation of displaced fractures of the posteromedial bone fragment (cerclage wiring, 21 cases and screw, 2 cases) and trochanter stabilizing plate (27 cases). Clinically, the Palmer's mobility score and Jensen's social function group were used. Radiologically, alignment and displacement were observed. The tip-apex distance (TAD) and sliding of the lag screw were measured, and the position of the lag screw within the femoral head was also examined., Results: The mean age at the time of surgery was 76 years (range, 56 to 89 years) and the average follow-up period was 25 months (range, 6 to 48 months). At the last follow-up, the average mobility and social function score was 6.2 (± 3.5) and 2.3 (± 1.5). Postoperatively, the alignment and displacement indices were adequate in almost all the cases. The mean amount of lag screw sliding and the mean TAD was 5.1 mm (range, 2 to 16 mm) and 6 mm (range, 3 to 11 mm) respectively. The lag screws were located in the center-center zone in 21 cases. The average period to union was 18.7 weeks without any cases of nonunion or malunion. Mechanical failure was noted in one case with breakage of the lag screw and clinical failure was noted in another case with persistent hip pain related to excessive sliding (16 mm)., Conclusions: With additional fixations, the unstable pertrochanteric femur fractures could be well stabilized by SHS until bone union.

Avulsion fractures of the posterior horn of the medial meniscus are uncommon and must be differentiated from a loose body. The authors present a displaced avulsion fracture of the medial meniscus posterior horn through the intercondylar notch into the anteromedial compartment of the knee, which was treated by arthroscopic reduction and internal fixation using pull-out suture technique.

Two patients presented with sciatica-like pain caused by thoracic disk herniation. Sciatica-like pain was the initial and major symptom in both patients, but careful neurological examination showed vague signs of upper motor neuron disturbance, and thoracic magnetic resonance (MR) imaging revealed disk herniations at the mid-thoracic level. After video-assisted thoracoscopic discectomy, the pain was completely improved. Thorough neurological examination and MR imagery of the thoracic spine, and if needed, even the cervical spine, are required if lumbar image findings do not correlate with the symptoms or physical examination.

Purpose: The aim of this study is to assess the influence exerted by the observer's dental specialization and compare patients' opinion with observers' opinion of the esthetics of maxillary single-tooth implants in the esthetic zone., Methods: Forty-one adult patients, who were treated with a single implant in the esthetic zone, were enrolled in this study. Eight observers (2 periodontists, 2 prosthodontists, 2 orthodontists and 2 senior dental students) applied the pink esthetic score (PES)/white esthetic score (WES) to 41 implant-supported single restorations twice with an interval of 4 weeks. We used a visual analog scale (VAS) to assess the patient's satisfaction with the treatment outcome from an esthetic point of view., Results: In the PES/WES, very good and moderate intraobserver agreements were noted between the first and second rating. The mean total PES/WES was 11.19 ± 3.59. The mean PES was 5.17 ± 2.29 and mean WES was 6.02 ± 1.96. In the total PES/WES, the difference between the groups was not significant. However, in the WES, the difference between the groups was significant and prosthodontists were found to have assigned poorer ratings than the other groups. Periodontists gave higher ratings than prosthodontists and senior dental students. Orthodontists were clearly more critical than the other observers. The statistical analysis revealed statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth. However, the correlation between the total PES/WES and the VAS score for the first premolar was not statistically significant., Conclusions: The PES/WES is an objective tool in rating the esthetics of implant supported single crowns and adjacent soft tissues. Orthodontists were the most critical observers, while periodontists were more generous than other observers. The statistical analysis revealed a statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth.

Background: To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations., Methods: From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion., Results: VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions., Conclusions: In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.

Leptin is known to play an important role in the pathophysiology of osteoarthritis (OA). This study investigated whether synovial fluid (SF) leptin level is related to the radiographic severity of OA and its role as a quantitative marker for the detection of OA. SF was obtained from 42 OA patients who underwent knee surgery and 10 who had no abnormality of articular cartilage during arthroscopic examination. The progression of OA was classified by Kellgren-Lawrence grading scale. The concentrations of leptin were measured with commercial enzyme-linked-immunosorbent serologic assay kits. Median leptin concentrations in SF were significantly higher in OA patients (median 4.40 ng/ml; range 0.5-15.8) compared to controls (median 2.05 ng/ml; range 1.0-4.6; P = 0.006). SF leptin levels showed significant difference according to the severity of OA (P = 0.0125). Median SF leptin level was highest in stage IV patients (11.1 ng/ml), which was significantly higher compared to all other groups including controls (P < 0.05). Age showed a significant positive correlation with leptin concentrations in OA patients (P < 0.05), but not in controls. These results demonstrate that SF leptin concentrations were closely related to the radiographic severity of OA, suggesting that SF leptin levels could be used as an effective marker for quantitative detection of OA.

Arthroscopic repair of peripheral dorso-ulnar triangular fibrocartilage complex (TFCC) lesions is now a preferred method. Both outside-in and inside-out techniques are commonly performed for repairing Palmer type 1B TFCC tear. But these techniques have disadvantages of making an additional skin incision to tie knots subcutaneously over the capsule. We performed an arthroscopic all-inside repair technique of Palmer type 1B TFCC tears, which is a modified method of the outside-in technique using a spinal needle. This all-inside technique is as simple as previously described arthroscopic techniques and also has advantages of vertical mattress suture and no additional incision. We recommend this technique as a useful alternative to the others for repairing Palmer type 1B TFCC tear.

Although the conventional outside-in technique is especially useful for repairing tears in the anterior portion of the meniscus, it has a disadvantage of making an additional 1-2 cm sized skin incision and tying knots subcutaneously over the capsule. Therefore we devised two all-inside repair techniques of lateral meniscus anterior horn tear according to the site of meniscal tear, meniscosynovial junction or red-red zone. Because these techniques are modified methods of the outside-in meniscal repair using a spinal needle, they are as simple as conventional outside-in technique. In addition they have advantages of vertical mattress suture, which is an important characteristic of the all-inside repair, and no additional incision. We recommend these techniques as an alternative method for repairing an anterior horn tear of the lateral meniscus.

Scutellaria barbata D. Don (Lamiaceae; SB) inhibited the growth of uterine leiomyomal (LM) cells with unknown actions. The expression patterns of beta-adrenergic receptors (beta-ARs) in human uterine LM cells and functional coupling to gene expression have also been investigated. Northern blot analysis showed that beta-AR subtypes are expressed at different levels in the uterine LM cells and myometrial smooth muscle cells (SMCs). beta1-AR expression was to be found approximately at the same level in the two cell types. beta2-ARs were expressed at higher levels in uterine LM cells than that in myometrial SMCs. beta3-AR expression was not found in both the cells. c-fos gene expression was induced by SB in uterine LM cells via increases in adenosine-3',5', cyclic monophosphate (cAMP), which in turn activated the cAMP/protein kinase A (PKA) pathway. The PKA inhibitor, H89, inhibited c-fos gene expression induced by SB. It seems that the mechanism of proto-oncogenes c-fos different leiomyoma from other myometrial cancer. Further studies are necessary to elucidate whether c-fos induction by SB in uterine LM cells influences a regression of leiomyoma or induces other differentiation.

Background/aims: Gastric cancer is still the most frequently diagnosed malignancy in Korea. It has been reported that COX-2 and PPAR are involved in multi-step gastric carcinogenesis. The aim of the present study was to examine the expression of COX-2 and PPAR in gastric cancer., Methods: A total of 75 subjects including 45 patients with gastric cancer and 30 controls were enrolled. All subjects underwent upper gastrointestinal endoscopic examination with tissue collection. mRNA extraction from the tissues and real-time PCR for COX-2, PPAR-delta, and PPAR-gamma were performed. Gastric mucosal concentration of PGE2, which is a final product of COX-2, and 15d-PGJ2, which is a ligand of PPAR-gamma, were measured by the enzyme immunoassay method., Results: COX-2 mRNA expression was significantly higher in both early gastric cancer tissues (EGC, 8.32 +/- 4.84 micro gram/micro L, p<0.005) and advanced gastric cancer tissues (AGC, 8.16 +/- 2.67 micro gram/micro L, p<0.001) than in non-cancerous tissues of controls (3.46 +/- 1.72 micro gram/micro L). There was no significant difference of PPAR-delta and PPAR-gamma mRNA expression between gastric cancer tissues and controls. Mucosal PGE2 concentration was significantly higher in both EGC tissues (5.31 +/- 0.49 micro gram/mg protein, p<0.001) and AGC tissues (5.46 +/- 0.54 micro gram/mg protein, p<0.001) than in non-cancerous tissues of controls (4.22 +/- 0.8 micro gram/mg protein). There was no significant difference of 15d-PGJ2 concentration between gastric cancer tissues and controls., Conclusions: COX-2 overexpression and increased PGE2 concentration in gastric tissues may play an important role in gastric carcinogenesis. However, the role of PPAR (delta and gamma) and 15d-PGJ2 in gastric carcinogenesis is uncertain. Further studies are needed.

The original screening test and one-point population analysis (OPPA) were compared for the detection of hetero-vancomycin-resistant Staphylococcus aureus, and the influence of osmolarity on those tests was evaluated. The positivity rates and the reproducibilities were similar for both tests. The addition of NaCl increased the MIC as well as the positivity rates for both tests and the reproducibility of OPPA.