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Background: Prolonged field care is a military adaptation of tactical combat casualty care providing extended prehospital management during delayed extrication. Effects of addition of valproic acid (VPA) to fresh-frozen plasma (FFP) in a prolonged field care model of hemorrhagic shock and traumatic brain injury are not known. We hypothesized that VPA is associated with decreased neurological impairment, and its protective changes are detected at the transcriptomic level., Study Design: Swine underwent traumatic brain injury and 40% blood volume hemorrhage. After 2 hours of shock, they were randomized to (1) normal saline (NS), (2) NS + 250 mL FFP (NS + FFP), or (3) NS + FFP + 150 mg/kg VPA (NS + FFP + VPA). At 72 hours, they were transfused packed RBCs before being euthanized. Intraoperative variables and neurological outcomes were compared. Brain lesion size was measured, and gene expression profiles were analyzed using RNA sequencing. Pathway and network analyses were performed on differentially expressed genes. Real-time polymerase chain reaction was performed to validate key genes., Results: NS + FFP and NS + FFP + VPA required significantly less crystalloid resuscitation (974 mL: NS + FFP; 1,461 mL: NS + FFP + VPA vs 4,540 mL: NS, p < 0.001), had smaller brain lesion size (2,477 mm 3 : NS + FFP; 3,018.0 mm 3 : NS + FFP + VPA vs 4,517.0 mm 3 : NS, p < 0.01), and required less functional neurologic impairment compared with NS. Per pathway analysis of differentially expressed genes, VPA was associated with enrichment of numerous metabolic changes in injured brains, which were not observed with FFP. Network analysis showed enrichment of various gene networks. Mitochondrially encoded ATP synthase membrane subunit 8 gene was downregulated in VPA-treated animals., Conclusions: The addition of FFP to the resuscitation protocol resulted in a significant reduction in crystalloid requirements. Both the NS + FFP and NS + FFP + VPA groups showed improved neurological recovery compared with NS alone and had distinctive transcriptomic profiles in injured brains at 72 hours. The mitochondrially encoded ATP synthase membrane subunit 8 gene, involved in worsening ischemia following brain injury, was downregulated in VPA-treated animals., (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Organizations that perform Health Policy and Systems Research (HPSR) need robust capacities, but it remains unclear what these organizations should look like in practice. We sought to define 'HPSRIs' (pronounced as 'hip-srees', i.e. 'Health Policy and Systems Research Institutions') as organizational models and developed a conceptual framework for assessing their capacities based on a set of attributes. We implemented a multi-method study in the Philippines that comprised: a qualitative analysis of perspectives from 33 stakeholders in the HPSR ecosystem on the functions, strengths and challenges of HPSRIs; a workshop with 17 multi-sectoral representatives who collectively developed a conceptual framework for assessing organizational capacities for HPSRIs based on organizational attributes; and a survey instrument development process that determined indicators for assessing these attributes. We defined HPSRIs to be formally constituted organizations (or institutions) with the minimum essential function of research. Beyond the research function, our framework outlined eight organizational attributes of well-performing HPSRIs that were grouped into four domains, namely: 'research expertise' (1) excellent research, (2) capacity-building driven; 'leadership and management' (3) efficient administration, (4) financially sustainable; 'policy translation' (5) policy orientation, (6) effective communication; and 'networking' (7) participatory approach, (8) convening influence. We developed a self-assessment instrument around these attributes that HPSRIs could use to inform their respective organizational development and collectively discuss their shared challenges. In addition to developing the framework, the workshop also analysed the positionality of HPSRIs and their interactions with other institutional actors in the HPSR ecosystem, and recommends the importance of enhancing these interactions and assigning responsibility to a national/regional authority that will foster the community of HPSRIs. When tailored to their context, HPSRIs that function at the nexus of research, management, policy and networks help achieve the main purpose of HPSR, which is to 'achieve collective health goals and contribute to policy outcomes'., (© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Introduction: Plants undergo various natural changes that dramatically modify their genomes. One is polyploidization and the second is hybridization. Both are regarded as key factors in plant evolution and result in phenotypic differences in different plant organs. In Silene , we can find both examples in nature, and this genus has a seed shape diversity that has long been recognized as a valuable source of information for infrageneric classification., Methods: Morphometric analysis is a statistical study of shape and size and their covariations with other variables. Traditionally, seed shape description was limited to an approximate comparison with geometric figures (rounded, globular, reniform, or heart-shaped). Seed shape quantification has been based on direct measurements, such as area, perimeter, length, and width, narrowing statistical analysis. We used seed images and processed them to obtain silhouettes. We performed geometric morphometric analyses, such as similarity to geometric models and elliptic Fourier analysis, to study the hybrid offspring of S. latifolia and S. dioica ., Results: We generated synthetic tetraploids of Silene latifolia and performed controlled crosses between diploid S. latifolia and Silene dioica to analyze seed morphology. After imaging capture and post-processing, statistical analysis revealed differences in seed size, but not in shape, between S. latifolia diploids and tetraploids, as well as some differences in shape among the parentals and hybrids. A detailed inspection using fluorescence microscopy allowed for the identification of shape differences in the cells of the seed coat. In the case of hybrids, differences were found in circularity and solidity. Overal seed shape is maternally regulated for both species, whereas cell shape cannot be associated with any of the sexes., Discussion: Our results provide additional tools useful for the combination of morphology with genetics, ecology or taxonomy. Seed shape is a robust indicator that can be used as a complementary tool for the genetic and phylogenetic analyses of Silene hybrid populations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Marcel, Javier, Emilio, Roman and Jose Luis.)

SARS-CoV-2 is spread through exhaled breath of infected individuals. A fundamental question in understanding transmission of SARS-CoV-2 is how much virus an individual is exhaling into the environment while they breathe, over the course of their infection. Research on viral load dynamics during COVID-19 infection has focused on internal swab specimens, which provide a measure of viral loads inside the respiratory tract, but not on breath. Therefore, the dynamics of viral shedding on exhaled breath over the course of infection are poorly understood. Here, we collected exhaled breath specimens from COVID-19 patients and used RTq-PCR to show that numbers of exhaled SARS-CoV-2 RNA copies during COVID-19 infection do not decrease significantly until day 8 from symptom-onset. COVID-19-positive participants exhaled an average of 80 SARS-CoV-2 viral RNA copies per minute during the first 8 days of infection, with significant variability both between and within individuals, including spikes over 800 copies a minute in some patients. After day 8, there was a steep drop to levels nearing the limit of detection, persisting for up to 20 days. We further found that levels of exhaled viral RNA increased with self-rated symptom-severity, though individual variation was high. Levels of exhaled viral RNA did not differ across age, sex, time of day, vaccination status or viral variant. Our data provide a fine-grained, direct measure of the number of SARS-CoV-2 viral copies exhaled per minute during natural breathing-including 312 breath specimens collected multiple times daily over the course of infection-in order to fill an important gap in our understanding of the time course of exhaled viral loads in COVID-19.

Objectives: This study aimed to estimate the financial and economic impact of sacubitril/valsartan compared with enalapril for the treatment and prevention of hospitalization/rehospitalization because of heart failure with reduced ejection fraction (HFrEF)., Methods: The budget impact analysis was guided by the Philippine Reference Case and ISPOR's Principles of Good Practice for Budget Impact Analysis. A government-funded healthcare payer perspective and a societal perspective were considered. Data collection was guided by the pathways of disease progression and care. Collection of costing data followed a bottom-up approach. The model was based on a Markov model used in a study in Thailand., Results: Over the next 5 years, there will be 17 625 less hospitalizations (∼5.1% less than enalapril arm) and 7968 less cardiovascular-related deaths (∼7.0% less than enalapril arm). In 5 years, the total cost of treating patients with HFrEF with sacubitril/valsartan at current market coverage and annual growth conditions is ₱15.430 billion, which is ₱11.077 billion higher than fully treating with enalapril only. The total required additional investment with treatment of sacubitril/valsartan compared with the full enalapril arm are ₱407 million (at 30-day coverage), ₱800 million (at 60-day coverage), and ₱1.181 billion (at 90-day coverage). If hospitalizations costs alone are considered, only the 30-day coverage is cost-saving. If a societal perspective is considered, all options are cost-saving where at least ₱4.003 billion is saved by the economy., Conclusion: The initial investment required to treat patients with HFrEF with sacubitril/valsartan is high; nevertheless, the year-on-year cost deficit shrinks in favor of investing in sacubitril/valsartan treatment., (Copyright © 2023 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Background: The way patients perceive nurses' caring behaviors can potentially impact patient outcomes and satisfaction. Studies have revealed incongruence between nurses' and patients' perceptions with regard to which behaviors are considered caring., Objective: This study aimed to conduct a cross-cultural validation and evaluation of the psychometric properties of the Caring Behaviors Inventory (CBI-16), a self-report questionnaire, from English to Filipino., Methods: A descriptive cross-sectional design involving forward and back-translation with bilingual translators, expert validation, and a survey in a sample of patients and nurses was used. The psychometric evaluation used a sample of 142 staff nurses and 180 hospitalized patients. Exploratory factor analysis, internal consistency reliability, and inferential statistics were used for data analysis., Results: The Filipino version of the CBI-16 (CBI-16-FIL) had excellent internal consistency (Cronbach's alpha of 0.95) and a unidimensional factor structure (accounted for 85% of total variance). The CBI-16-FIL was found to be a valid, reliable, and unidimensional tool to measure the perceptions of nurse caring behaviors in the Philippines., Conclusion: The CBI-16-FIL can be used to measure perceptions of nurse caring behaviors. There is a need for further studies involving other cultures, dyadic samples of nurses and patients, and larger sample sizes., Competing Interests: The authors declare that they do not have conflicts of interest in this study., (© The Author(s) 2022.)

Background: Non-invasive ventilation (NIV) has been increasingly used in COVID-19 patients. The limited physiological monitoring and the unavailability of respiratory mechanic measures, usually obtainable during invasive ventilation, is a limitation of NIV for ARDS and COVID-19 patients management., Objectives: This pilot study was aimed to evaluate the feasibility of non-invasively monitoring respiratory mechanics by oscillometry in COVID-19 patients with moderate-severe acute respiratory distress syndrome (ARDS) receiving NIV., Method: 15 COVID-19 patients affected by moderate-severe ARDS at the RICU (Respiratory Intensive Care Unit) of the University hospital of Cattinara, Trieste, Italy were recruited. Patients underwent oscillometry tests during short periods of spontaneous breathing between NIV sessions., Results: Oscillometry proved to be feasible, reproducible and well-tolerated by patients. At admission, 8 of the 15 patients showed oscillometry parameters within the normal range which further slightly improved before discharge. At discharge, four patients had still abnormal respiratory mechanics, not exclusively linked to pre-existing respiratory comorbidities. Lung mechanics parameters were not correlated with oxygenation., Conclusions: Our results suggest that lung mechanics provide complementary information for improving patients phenotyping and personalisation of treatments during NIV in COVID 19 patients, especially in the presence of respiratory comorbidities where deterioration of lung mechanics may be less coupled with changes in oxygenation and more difficult to identify. Oscillometry may provide a valuable tool for monitoring lung mechanics in COVID 19 patients receiving NIV., Competing Interests: Dr Dellaca’ reports grants and other from Restech, personal fees from Philips Healthcare, outside the submitted work. In addition, Dr Dellaca’ has a patent on the detection of EFL by FOT with royalties paid to Philips Respironics and Restech Srl, a patent on monitoring lung volume recruitment by FOT with royalties paid to Vyaire, and a patent on early detection of exacerbations by home monitoring of FOT with royalties paid to Restech and is co-founder and shareholder of Restech Srl, a spin-off company of the Politecnico di Milano University producing medical devices for lung function testing based on FOT. In details: System and methods for the automatic detection of expiratory flow limitation. Application number PCT/EP03/06119. International filing date 10/06/2003. Apparatus for respiratory support and non-invasive detection of alveolar derecruitment for patients suffering from respiratory failure. Application Number: PCT/EP2007/059534, publication date 20/03/2008. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Huntington's disease is caused by a pathologically long (>35) CAG repeat located in the first exon of the Huntingtin gene (HTT). While pathologically expanded CAG repeats are the focus of extensive investigations, non-pathogenic CAG tracts in protein-coding genes are less well characterized. Here, we investigated the function and evolution of the physiological CAG tract in the HTT gene. We show that the poly-glutamine (polyQ) tract encoded by CAGs in the huntingtin protein (HTT) is under purifying selection and subjected to stronger selective pressures than CAG-encoded polyQ tracts in other proteins. For natural selection to operate, the polyQ must perform a function. By combining genome-edited mouse embryonic stem cells and cell assays, we show that small variations in HTT polyQ lengths significantly correlate with cells' neurogenic potential and with changes in the gene transcription network governing neuronal function. We conclude that during evolution natural selection promotes the conservation and purity of the CAG-encoded polyQ tract and that small increases in its physiological length influence neural functions of HTT. We propose that these changes in HTT polyQ length contribute to evolutionary fitness including potentially to the development of a more complex nervous system., (© 2021. The Author(s).)

SARS-CoV-2 is a respiratory borne pathogenic beta coronavirus that is the source of a worldwide pandemic and the cause of multiple pathologies in man. The rhesus macaque model of COVID-19 was utilized to test the added benefit of combinatory parenteral administration of two high-affinity anti-SARS-CoV-2 monoclonal antibodies (mAbs; C144-LS and C135-LS) expressly developed to neutralize the virus and modified to extend their pharmacokinetics. After completion of kinetics study of mAbs in the primate, combination treatment was administered prophylactically to mucosal viral challenge. Results showed near complete virus neutralization evidenced by no measurable titer in mucosal tissue swabs, muting of cytokine/chemokine response, and lack of any discernable pathologic sequalae. Blocking infection was a dose-related effect, cohorts receiving lower doses (6, 2 mg/kg) resulted in low grade viral infection in various mucosal sites compared to that of a fully protective dose (20 mg/kg). A subset of animals within this cohort whose infectious challenge was delayed 75 days later after mAb administration were still protected from disease. Results indicate this combination mAb effectively blocks development of COVID-19 in the rhesus disease model and accelerates the prospect of clinical studies with this effective antibody combination., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Beddingfield, Maness, Fears, Rappaport, Aye, Russell-Lodrigue, Doyle-Meyers, Blair, Carias, Madden, Redondo, Gao, Montefiori, Hope and Roy.)

Objectives: To investigate, in infants born preterm with or without bronchopulmonary dysplasia (BPD), the trajectory of tidal breathing flow-volume (TBFV) parameters in the first 2 years of life; the association between TBFV parameters and perinatal risk factors; and the predictive value of TBFV parameters for rehospitalizations due to respiratory infections and wheeze., Study Design: We retrospectively analyzed TBFV measurements performed at 0-6, 6-12, and 12-24 months of corrected age in 97 infants <32 weeks of gestation and <1500 g. We assessed the association between TBFV parameters and perinatal risk-factors using linear regressions and the predictive capacity for subsequent respiratory morbidity using logistic regressions. We used the area under the curve and likelihood ratio test (LRT) to compare nested models., Results: Time to peak tidal expiratory flow/expiratory time ratio (tPTEF/tE) was lower than normal for the first 2 years of corrected age. Longer duration of oxygen supplementation, intubation, and respiratory support were associated with reduced tPTEF/tE at all time points. For each z-score increase in tPTEF/tE, the OR for rehospitalizations decreased by 0.70. tPTEF/tE added significantly to BPD classifications alone in predicting rehospitalizations (area under the receiver operating characteristic curve = 0.81 vs 0.76, P value for LRT = .0012), and wheeze (area under the receiver operating characteristic curve = 0.76 vs 0.71, P value for LRT <.001)., Conclusions: Infants born preterm, with and without BPD, display persistent airway obstruction during the first 2 years of life. tPTEF/tE may identify infants at greater risk of severe respiratory morbidity., (Copyright © 2020 Elsevier Inc. All rights reserved.)

A study was conducted at the Escuela Superior Politècnica de Chimborazo, Ecuador, to evaluate the influence of litter size of guinea pigs ( Cavia porcellus ) on their development and to establish the economic profitability of the production system. Forty-eight animals were used, distributed into litters of two, three, and four rodents per litter, with a balanced diet and green fresh alfalfa for the weaning, growth, and fattening stage, the rodents and litters were randomly selected, applying the statistical model completely randomly and evaluating different variables across 120 days. The litters of three guinea pigs obtained the best productive responses and economic profitability. With respect to sex, the males presented better productive behavior, greater economic increase, and less cost, evidencing that mixed feeding influences the number of guinea pigs per birth in terms of growth and development. The results serve to improve guinea pig meat production for the rural population.

This work explores the ability of the Spanish Geochemical Database to identify the existence of polluted stream sediments due to the presence of abandoned mine wastes. The mining district of Sierra de Cartagena-La Unión has been used as test area. A total of 18 abandoned tailings facilities were selected and samples were taken for analysis of the content in potential toxic elements. The results were contrasted with geochemical background values in order to identify which geochemical elements could entail anomalies potentially reflected in the Spanish Geochemical Database. For the study area, As, Cd, Pb, and Zn have been identified as potential toxic elements which can be used as geochemical indicators of sediment pollution processes originated in abandoned mine wastes. Furthermore, the correlation between Cd and Zn allows them to be considered as the best indicators of potential sediment contamination. The study of anomaly thresholds, through the analysis of accumulated frequencies of the contents of these elements in the sediments of the Spanish Geochemical Database, allows identifying sediments that may have been contaminated. A Mann-Whitney test contrasting the data of tailings, polluted sediments, and non-polluted sediments has been performed in order to verify differences among these types of samples. In addition, a geospatial analysis has demonstrated a very close relationship between contaminated sediments and the presence of mining wastes upstream. This methodology can be applied to any other mining region, to recognize the possible influence of pollution processes derived from the presence of abandoned mine wastes taking advantage of existing geochemical databases.

In this work, fast sequential determination and chemical speciation analysis of inorganic arsenic and antimony in airborne particulate matter collected in outdoor and indoor environments using slurry sampling and detection by hydride generation atomic absorption spectrometry (HG-AAS) is proposed. A Doehlert design was applied to optimise the hydride generation conditions of As and Sb for fast sequential determination in the same aliquot of particulate matter samples after preparation of the slurry. The limits of quantification (LoQ) obtained for As and Sb were 0.3 and 0.9 ng m -3 , respectively. The accuracy of the analytical method was confirmed by analysis of the certified reference material of urban particulate matter (SRM NIST 1648a), presenting concordance with certified values of 92.7±7.7% for As and 91.2±9.5% for Sb. Precision was expressed as relative standard deviation (% RSD, n=3), with our results presenting values better than 3.4% and 4.2% for total inorganic As and Sb, respectively. For all analysed samples, total As concentrations and its inorganic species were below the LoQ of the analytical method (<0.3 ng m -3 ). However, the averages of total inorganic Sb concentrations in airborne particulate matter, collected as total suspended outdoor particles (TSP outdoor ), inhalable particulate matter (PM 10 ), and total suspended indoor particles (TSP indoor ), were 3.1±0.5, 2.4±0.6, and 2.6±0.4 ng m -3 , respectively. Trivalent Sb (Sb 3+ ) was the predominant inorganic species in all samples investigated, with mean percentages of 76%, 72%, and 73% in TSP outdoor , PM 10 , and TSP indoor , respectively. The presence of Sb and its predominant inorganic form (Sb 3+ ) can be attributed to vehicular traffic close to the sampled urban areas. Therefore, fast sequential determination of As and Sb and their inorganic species in particulate matter samples prepared as slurry by FS-HG-AAS is an efficient, accurate, and precise method and can be successfully applied to routine analysis.

[This corrects the article DOI: 10.18632/oncotarget.23919.].

The clinical outcome of T-cell non-Hodgkin lymphoma (NHL) is poor and innovative treatments are needed. Tenascin-C is a large extracellular glycoprotein not expressed under physiological conditions, but overexpressed in cancer. Aim of the study was to evaluate tenascin-C expression within pathologic tissue of T-cell NHL and determine its clinical significance. We used an immunohistochemistry approach using the anti-tenascin-C monoclonal antibody Tenatumomab in 75 systemic T-cell NHL (including 72 mature and 3 precursor T-cell NHL), and 25 primary cutaneous T-cell NHL. Data were analyzed in terms of staining intensity, proportion of involved areas and histologic pattern, and results were correlated with clinical characteristics and outcome. Ninety-three percent of the cases were tenascin-C positive and 59% of systemic diseases were characterized by a predominant involvement (>50%). Stromal expression was detected in all the cases while vascular and vascular plus cytoplasmic expression was present in 49% and 23%. The constant overexpression of the tenascin-C gene was observed in two independent publicly available T-cell NHL gene expression datasets. In conclusions, tenascin-C represents an attractive target that sets the rationale to investigate the therapeutic activity of radiolabeled Tenatumomab in T-cell NHL., Competing Interests: CONFLICTS OF INTEREST R.D.S. and F.P. are employee of Sigma-Tau S.p.A., A.Ra. and L.G.S received honoraria form Sigma Tau.

MeCP2 is associated with several neurological disorders; of which, Rett syndrome undoubtedly represents the most frequent. Its molecular roles, however, are still unclear, and data from animal models often describe adult, symptomatic stages, while MeCP2 functions during embryonic development remain elusive. We describe the pattern and timing of Mecp2 expression in the embryonic neocortex highlighting its low but consistent expression in virtually all cells and show the unexpected occurrence of transcriptional defects in the Mecp2 null samples at a stage largely preceding the onset of overt symptoms. Through the deregulated expression of ionic channels and glutamatergic receptors, the lack of Mecp2 during early neuronal maturation leads to the reduction in the neuronal responsiveness to stimuli. We suggest that such features concur to morphological alterations that begin affecting Mecp2 null neurons around the perinatal age and become evident later in adulthood. We indicate MeCP2 as a key modulator of the transcriptional mechanisms regulating cerebral cortex development. Neurological phenotypes of MECP2 patients could thus be the cumulative result of different adverse events that are already present at stages when no obvious signs of the pathology are evident and are worsened by later impairments affecting the central nervous system during maturation and maintenance of its functionality., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Background: Autoimmune hepatitis (AIH) is a chronic liver disease of unknown aetiology and characterized by continuing hepatocellular inflammation and necrosis. Autoantibodies represent accessible markers to measure the adaptive immune responses in the clinical investigation. Protein microarrays have become an important tool to discriminate the disease state from control groups, even though there is no agreed-upon standard to analyze the results., Results: In the present study 15 sera of patients with AIH and 78 healthy donors (HD) have been tested against 1626 proteins by an in house-developed array. Using a Partial Least Squares Discriminant Analysis (PLS-DA) the resulting data interpretation led to the identification of both new and previously identified proteins. Two new proteins AHPA9419 and Chondroadherin precursor (UNQ9419 and CHAD, respectively), and previously identified candidates as well, have been confirmed in a validation phase by DELFIA assay using a new cohort of AIH patients. A receiver operating characteristic analysis was used for the evaluation of biomarker candidates. The sensitivity of each autoantigen in AIH ranged from 65 to 88%; moreover, when the combination of the two new autoantigens was analyzed, the sensitivity increased to 95%., Conclusions: Our findings demonstrate that the detection of autoantibodies against the two autoantigens could improve the performance in discriminating AIH patients from control classes and in combination with previously identified autoantigens and they could be used in diagnostic/prognostic markers.

Knowledge of both the common and atypical presentations of human immunodeficiency virus (HIV)-associated dermatoses may be helpful in arousing suspicion of HIV, especially in patients with no reported risk factors. Herein, we report the case of an otherwise healthy, nonpromiscuous 29-year-old man who presented to our institution with an eight-week history of plaques with oyster shell-like scales on the trunk, extremities and genital area. The plaques were associated with fever, and intermittent knee pain and swelling. Initial diagnostic tests were suggestive of drug hypersensitivity syndrome, and the patient's condition improved with treatment using oral prednisone. However, the lesions recurred when the dose of prednisone was tapered, even after the culprit drug had long been discontinued. Repeat skin punch biopsy and arthrocentesis revealed a diagnosis of psoriasis vulgaris with psoriatic arthritis. Due to the atypical presentation of psoriasis, the patient was counselled to undergo HIV testing, which came back positive. Clinicians should be attuned to the skin signs heralding HIV/acquired immunodeficiency syndrome, in order to facilitate early diagnosis and treatment.

Professional football players may experience negative health consequences when they retire such as chronic pain, cognitive problems as well as other consequences of sports-related injuries. The purpose of this pilot study is to determine the effects of dietary supplementation with multiple nutrients on the quality of life of retired football players. Fifteen retired players received daily supplementation of fish oil with cholecalciferol, antioxidants, natural vitamins and minerals, polysaccharides and phytosterol-amino acid complex for 6 months. Using an open-labeled repeated measures design, volunteers completed self-report assessment measures at baseline, 1, 3 and 6 months. Outcome measures were CDC HRQOL-4, WHOQOL-BREF, POMS, MFQ and pain self-assessment. General health rating improvement on CDC HRQOL-4 from month 1 was sustained to month 6 (p&lt;0.0001). Mental health days improved at 6 months (p&lt;0.05). WHOQOL-BREF showed increased health satisfaction at all measurement points (p&lt;0.05) and the Physical and Psychological Domain Scores at 6 months (p&lt;0.05). MFQ General Rating of Memory improved at 3 and 6 months (p&lt;0.05). Vigor scale in POMS was significant at 3 months (p&lt;0.05). Decreased pain was noted only for the elbow at month 1 and the knee at month 3 (p&lt;0.05). No adverse events were reported. Results of this study offer preliminary insight into using dietary supplements to support and optimize quality of life in retired football players. Further research using a placebo-controlled design is needed to characterize the potential benefit to physical and psychological well-being of multiple dietary supplementations for this cohort.

Graft-versus-host disease (GVHD) is the major cause of morbidity and mortality among patients undergoing allogeneic hematopoietic stem cell transplantation. Although animal models have been clearly established for the study of skin, liver, and gut, currently there is no equivalent experiemental model for analyzing ocular involvement, which is rather common, especially among patients diagnosed with chronic GVHD. In the current study we have developed a murine model of ocular GVHD and, for the first time, we describe the histopathologic features involving cornea and limbus, which could play a role in the physiopathology of the disease at the ocular level. Our results represent a major finding that allows us to define a model for evaluating new therapeutic strategies for treating ocular GVHD prior to their use in clinical setting., (Copyright © 2011 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)

The first multi-tissue bank was founded at Havana in 1958. At that time, freeze-drying was used at the bank as a method of preserving, as well as Cobalt 60 irradiation to sterilise bone tissue, heart valves and others. The impact of the IAEA program in tissue banking activities in Cuba can be summarised as follows: (a) Increase in the production of sterilised tissues using ionising radiation (bone, pig skin and amnion) for medical treatment in the tissue bank of the Hospital Frank Pais; (b) increase of the quality of the productions of bone tissues, pig skin and amnion; (c) reduction in the import of tissues by increasing the local production of tissues; (d) sustainability in the number of donors through the implementation of a public and professional awareness campaign; (e) training of six persons in the Regional Training Centre of Buenos Aires; (f) qualification of one person in the administration of a tissue bank and in the implementation of a Quality System. The amount of tissues produced and sterilised using the ionising radiation techniques in the established banks was 25,510 units. The amount of patients treated with sterilised tissues produced by the established banks was 2,448.

Background: Various reports support the use of cervical spine (c-spine) CT over conventional radiography in screening of c-spine injury. Interest now exists in diagnostic radiation-induced morbidity., Objective: To estimate excess relative risk for developing cancer from c-spine high-resolution CT radiation exposure., Materials and Methods: We conducted a retrospective review of children evaluated for c-spine injury using CT. The study population was divided into three age groups, 0-4 years (group 1), 5-8 years (group 2), and older than 8 years (group 3). Anthropomorphic 1-year-old and 5-year-old phantoms were used to measure radiation at the thyroid during radiography and CT. Excess relative risk for thyroid cancer was estimated using these measurements., Results: A total of 557 patients were evaluated with CT. The radiographic method most commonly used was head CT/c-spine CT in 363 (65%). Only 179 children (32%) had any type of prior radiography. The use of c-spine CT exposes the thyroid to 90-200 times more radiation than multiple conventional radiographs. The mean excess relative risk for thyroid cancer after CT was 2.0 for group 1 and 0.6 for group 2. There were no comparison data for group 3., Conclusion: C-spine CT is associated with a significant exposure to ionizing radiation and increases excess relative risk for thyroid cancer in young children.

Background: Gastrointestinal stromal tumors (GIST) are a unique subset of intestinal mesenchymal tumors that behave in an aggressive fashion. They have been commonly described in adults but have been rarely observed in children., Methods: The authors review the presentation, diagnostic workup, operative records, pathologic specimens, and outcomes of 3 children with GISTs that originated from the stomach., Results: All 3 children presented after upper gastrointestinal bleeding from the gastric tumor. The first was a 10-year-old girl who underwent partial gastrectomy but had recurrence 8 years later requiring a second resection. She subsequently had a hepatic metastasis 8 years later requiring a third resection. The second patient was a 9-year-old girl who had an antrectomy with a Bilroth I reconstruction and was noted to have a synchronous liver metastasis that was also resected. Despite Imatinib Mesylate, she had further hepatic metastases. The third child was a 4-year-old boy who recently underwent a partial gastrectomy and has no signs of metastatic disease at this time., Conclusions: GISTs are unusual tumors that have been rarely described in children. When they arise in the stomach, they often present after upper gastrointestinal bleeding. Diagnosis can be made by endoscopy and biopsy. GISTs require resection and close observation for hepatic metastases. Current studies are ongoing for the potential role of Imatinib Mesylate for GISTs in children.

Objectives: Papillary renal cell carcinoma is a malignant neoplasia which represents 5-10% of all renal cell carcinomas. We perform a bibliographic review, and detail the clinical, diagnostic and therapeutic aspects of the case, as well as its postoperative outcome., Methods: 55-year-old patient who was admitted in the urology department from the emergency room. On physical examination we detected a mass in the left flank and left upper abdominal quadrant, painful on flank percussion, and gross hematuria also. It was a patient who debuted with left lumbar-abdominal pain and hematuria with clots after a physical effort. Blood tests, ultrasound, x-rays and surgical treatment were performed., Results and Conclusions: On evaluation of the ultrasound and x-ray films it was concluded that it was a significant renal tumor. Left radical nephrectomy was performed and pathology reported papillary renal cell carcinoma. Postoperative outcome was satisfactory after three months.

Development, migration and survival of infective larvae (L3) were studied in the Western Pampeana Region. Faeces of naturally nematode infected cattle were deposited as artificial pats on plots during mid-spring-summer of 1994/1995 and 1995/1996. Since the start and during 1995, the study coincided with a severe drought, rainfalls being 29% below the 45-year means. The predominant genera recovered were Cooperia, Ostertagia and Haemonchus. Initial and peak recovery of L3 from pats occurred 8-15 and 15-21 days later respectively. A low percentage of L3 survived from November (0.3% L3) and January (0.06% L3) to the following autumn and winter. The mean persistence of larvae detected in pats or herbage was around 200 days from deposition. The migration of L3 from faecal pats to herbage started 15 to 30 days after deposition according to rainfall occurrence. Maximum herbage recoveries of L3 from pats deposited in late summer occur during autumn rainfalls. Only, few L3 were occasionally recovered from soil. Summer conditions were associated with rapid development and translation of L3 to herbage, but also with low L3 detection after initial recoveries. Faecal pats deposited from mid-summer were the main source of autumn herbage contamination.

Purpose: To study the clinical and imaging features of splenic lymphangiomatosis., Materials and Methods: The clinical and abdominal imaging data of 10 children with splenic lymphangiomatosis were retrospectively reviewed. The modalities used in the study included computed tomography (CT) (10 patients), sonography (five patients), and magnetic resonance (MR) imaging (two patients). Pathologic confirmation of lymphangiomatosis was obtained in nine patients., Results: Splenic lymphangiomatosis was discovered incidentally in all cases and was a key finding in enabling the correct diagnosis in six children with extrasplenic disease as well. Only two children had clinical splenomegaly. Sonograms and MR images showed multiple, wEll-defined cysts. Multiple, low-attenuation lesions that did not enhance with intravenous administration of contrast material (n = 8) or a mottled spleen (n = 2) were seen at CT. One of the mottled spleens had target lesions on an early (arterial) image obtained after administration of a bolus of contrast material. One child underwent a splenectomy; one child underwent therapeutic embolization. Eight patients remained asymptomatic with respect to the spleen 1-20 years later., Conclusion: Splenic lymphangiomatosis is often an incidental imaging finding that frequently has a characteristic imaging appearance. The recognition of this appearance helps in diagnosis of this disease and may prevent the need for further invasive procedures. Splenic changes can be isolated or can coexist with bone or soft-tissue lymphangiomas.

The differential diagnosis of cervical cysts in children includes common entities such as branchial cleft cysts, thyroglossal duct cysts, and cystic hygromas. Congenital thymic cysts are uncommon and often misdiagnosed as either branchial cleft cysts or cystic hygromas. However, they may have an appearance on CT that can be characteristic. The course of the descent of embryologic thymic tissue in the neck to the mediastinum indicates the potential site of deposition of an ectopic cervical thymic cyst. In a child, a cystic lesion that has an intimate relationship to the carotid sheath is likely to be a thymic cyst. Of the approximately 100 cases of vestigial cervical thymus or thymic cysts that have been reported in children, only 5 cases of a persistent thymopharyngeal duct cyst have been described [1-5]. In two of these five, the persistent thymopharyngeal duct cyst was demonstrated by CT [1,2]. We report one additional case of a cervical thymic cyst and one case of a persistent thymopharyngeal duct cyst both depicted by CT.

A 16 year old male with a four year history of recurrent pheochromocytoma develops multiple osseous lytic lesions in the skull, clavicle, ribs, and fibula all of an expansile, ill-defined appearance. These are biopsy proven metastatic sites. To our knowledge this is the first reported proven case of malignant extra-adrenal or adrenal pheochromocytoma with multiple bone metastases in a child.

A simple technique used to catheterize boys for voiding cystourethrography, using a feeding catheter while the urethra is distended by a saline solution is described.

Three children aged 17 months to 17 years developed right-sided peripheral lung abscesses. Clinical signs were fever and cough. Laboratory cultures were negative, and the patients did not respond to appropriate antibiotic coverage. Under fluoroscopic guidance, purulent material was removed from the abscesses by needle aspiration. The patients became afebrile within 24 hours; none suffered complications of bleeding or pneumothorax. Cultures of the aspirate were positive for microorganisms sensitive to the prescribed treatments. A simple aspiration technique is described and proposed as useful for selected patients when surgical drainage is recommended. There was no morbidity in our cases, and recovery from a typically prolonged course was shortened by the procedure.

A large posterior pneumomediastinum that compromised the respiratory status and reaccumulated promptly after needle aspiration, aroused the suspicion of airway laceration. Tracheogram was consistent with laceration of the right bronchus. Evacuation of air with chest tube resulted in complete resolution of pneumomediastinum and healing of bronchial tear with no recurrence following removal of chest tube after seven days.

Since 1969 we have treated 10 pediatric cases of posterior urethral valves. Of these patients 5 underwent early upper tract diversion and 5 underwent valve resection and observation. There were no deaths and no patients with permanent urinary diversion. All patients in whom blood pressure was recorded were hypertensive preoperatively and normotensive postoperatively. Creatinine clearances stabilized or improved in all but 1 case, although the urogram findings did not correlate well with improved clearance. Dilatation of the upper tracts resolved slowly in all cases. The current treatment should include early valve resection or fulguration followed by observation with emphasis on renal function, blood pressure and infection as opposed to the urographic appearance of the collecting system.

Cystic neuroblastoma is a rare form of neuroblastoma. Three cases of cystic neuroblastoma in the infant are reported with emphasis on the sonographic findings. In two cases, the tumor was demonstrated in the fetus. The pathologic features of the tumors are described. Development of cysts may be related to a prominent microcystic arrangement of tumor nests.

Positive contrast peritoneography allows the preoperative demonstration of the exact diaphragmatic contour in suspected eventration or paralysis. Anatomical appearances of bilateral elevation or infracardiac involvement will indicate the need for abdominal rather than transthoracic approach for repair. The use of peritoneography should permit rapid evaluation of newborns with respiratory distress and allow repair before long-standing respirator support has produced pulmonary parenchymal damage.

Prone frontal and cross-table lateral views of the abdomen are recommended as most helpful in radiographic evaluation of infants and children suspected of having obstructive of nonobstructive ileus. A series of films in multiple projections is recommended to evaluate the gas in the large bowel, particularly the rectum. When studies must be limited, prone and left lateral decubitus views are recommended. In obstructive ileus, the collapsed rectum contains little or no air. Utilization of the prone view will often obviate the use of fluoroscopic contrast studies. The level of obstruction, as well as the cause, can often be determined by this plain film approach. Six cases are presented to illustrate these points.

Vertebral body aplasia or hypoplasia leads to rapidly progressive spinal deformity and neurologic defects when unrecognized in infancy. Four patients with this unusual defect are described.