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Saturated carbon nanothreads are one of the most attractive new materials produced under high pressure in the last years. Nanothreads can be considered as a monodimensional diamond; in fact, they preserve some of the mechanical properties of the diamond itself, like stiffness, but their intrinsic flexibility makes them excellent nanowires. Since their discovery, many advancements have been made, and nowadays, they can be obtained from the compression of several aromatic molecular crystals. However, it is often not clear why certain starting crystals give high-quality nanothreads while others do not or which are the best conditions for the synthesis in terms of pressure, temperature, compression rate, and reaction time. In other words, the mechanisms that allow their formation with respect to other byproducts are often unclear. This is an important piece of information that can be used for the design of a synthetic strategy for the production of functional materials with targeted characteristics, like conductivity and electro-optical properties, while preserving the mechanical ones. Here, we report an X-ray diffraction study in which we followed the transformation induced by the pressure of trans-azobenzene using polycrystalline samples compressed with and without a pressure-transmitting medium. With this approach, we were able to highlight the structural relations along the reactive path leading to double-core saturated carbon nanothreads. The features that we discovered could be common to all pseudo-stilbene crystals, a class of compounds isostructural to azobenzene and characterized by two phenyl rings connected by a variety of different linkers, thus representing excellent starting materials for the synthesis of functional nanothreads.

Objective: The aims of the study were to compare mobility in multiple sclerosis, Parkinson disease, and stroke, and to quantify the relationship between mobility and participation restrictions. Design: This is a multicenter cross-sectional study. Included were compliant subjects with Parkinson disease, multiple sclerosis, and stroke seen for rehabilitation, with no comorbidities interfering with mobility. Functional scales were applied to each subject to investigate gait speed (10-meter walking test), balance while maintaining body position (Berg Balance Scale), dynamic balance and mobility (Timed Up and Go and Dynamic Gait Index), and participation (Community Integration Questionnaire). Results: Two hundred ninety-nine patients (111 multiple sclerosis, 94 Parkinson disease, and 94 stroke)were enrolled. Stroke had the slowest gait speed (mean gait speed = 0.9 m/sec) compared with Parkinson disease (1.1 m/sec), and multiple sclerosis (1.2 m/sec) (P < 0.001). Multiple sclerosis was more limited than Parkinson disease and stroke in dynamic balance both in the Timed Up and Go Test (multiple sclerosis = 16.7 secs, Parkinson disease = 11.4 secs, stroke = 14.0 secs; P < 0.001) and Dynamic Gait Index (multiple sclerosis = 11.6 points, Parkinson disease = 12.9 points, stroke = 13.6 points; P = 0.03); ability to maintain balance and body position (Berg Balance Scale) was more affected in stroke and Parkinson disease than multiple sclerosis (multiple sclerosis = 42.6 points, Parkinson disease = 39.4 points, stroke = 39.7 points; P = 0.03). Balance disorders were associated with participation restrictions but not gait speed. Conclusions: Neurological conditions have differing impacts on gait and balance, leading to different levels of participation restriction.

BACKGROUND The recurrent laryngeal nerve is one of the constant branches of vagus nerve. In this study, our aim is to find out the variations of recurrent laryngeal nerve by dissecting the neck of 25 cadavers. Aim of the study was to- 1. Find out the recurrent laryngeal nerve which is located in the Tracheo-oesphageal groove or outside the groove on right and left side. 2. Study the branching pattern of the recurrent laryngeal nerve on both sides. 3. Study the relationship of the recurrent laryngeal nerve with the inferior thyroid artery and to the thyroid gland on both sides. MATERIALS AND METHODS The present study was conducted by dissecting the neck of 25 cadavers in the department of Anatomy, Government T D Medical College, Alappuzha, Kerala. RESULTS The recurrent laryngeal nerve in 88% of cases is seen in the tracheo-oesophageal groove and in 12% of cases, the nerve is seen on lateral surface of trachea. In all the cases, the recurrent laryngeal nerve originated from the vagus. The recurrent laryngeal nerve was in the trachea-oesophageal groove of left side in 22 and outside it in 3 cases. CONCLUSION To avoid injury to the recurrent laryngeal nerve in thyroid surgery, a thorough knowledge of position of the nerve and its relationship with the inferior thyroid artery is of great importance.

BACKGROUND Normally, the arch of aorta gives three branches- brachiocephalic trunk, left common carotid and left subclavian arteries. The variations in the branching pattern of aortic arch are numerous due to the altered development of the fourth aortic arch during the embryonic period of gestation. These variations maybe of great surgical importance. Many variations occur in the number and position of vessels arising from the aortic arch. Variations in the branching pattern of aorta are due to the altered development of the fourth aortic arch during the embryonic period of gestation. Aortic arch in human is produced by the persistence and development of the left fourth arch. Usually, the arch of aorta gives three branches, i.e. brachiocephalic trunk, left common carotid and left subclavian arteries. The variations of branching patterns of aortic arch are numerous. Although, many of these variations cause no disturbance in the functions of the body, they may be of great importance to the surgeon. MATERIALS AND METHODS 50 human cadaveric hearts with intact arch of aortae from the Department of Anatomy, Government T.D. Medical College, Alappuzha, Kerala, were used to study its branching patterns. RESULTS The usual branching pattern of aorta into three branches, i.e. brachiocephalic trunk, left common carotid and left subclavian arteries was found in 78%. In 14%, the aortic arch gave rise to two branches, a common trunk (for left common carotid and brachiocephalic trunk) and a left subclavian artery. In 8%, the aortic arch gave rise to four branches, namely brachiocephalic trunk, left common carotid, left vertebral and left subclavian arteries. CONCLUSION The arch of aorta maybe of different branching patterns due to developmental variations. A knowledge about the variations of branching patterns of arch of aorta will help the surgeon during cardiothoracic surgeries.

Background Systemic treatments for gingivitis frequently are inadequate for controlling specific sites of severe gingival inflammation. The authors conducted a study to test site-specific therapy using a transmucosal herbal periodontal patch (THPP) that was impregnated with plant extracts reported to reduce inflammatory response. Methods The study was a single-center, randomized, placebo-controlled, double-masked, longitudinal phase II trial involving participants with clinically diagnosed gingivitis. Participants who were enrolled in the study received either THPPs or placebo patches (PP) for three days. The authors evaluated gingival inflammation visually using the gingival index (GI) and by measuring gingival crevicular fluid β-glucuronidase (BG) enzymatic activity at baseline (day one) and on days two, four, eight and 15. Results The authors randomly assigned 53 participants to receive the THPP or the PP. Participants who received the THPPs had a greater reduction in mean GI scores than did those who received the PPs. This finding was significant on days four and 15. The percentage of participants whose GI scores decreased by one or more was higher among those receiving the THPP than among those receiving the PP, as assessed on days four and 15. The average decrease in BG levels (fluorescence units) for participants receiving the THPP was significantly greater on days four and eight than they were for those receiving the PP. No serious adverse events were associated with the use of the THPP. Conclusions Topical treatment by means of the THPP may be effective and safe in reducing topical gingival inflammation. Further studies are needed to confirm these findings and determine the best method for administering the THPP and the appropriate dosing. Clinical Implications Site-specific treatment of gingival inflammation is feasible and could be used as an adjunct for systemic therapeutic interventions.

To present two cases of severe hyperglycemia in patients without diabetes who received gatifloxacin therapy.We describe the histories, clinical findings, and hospital courses of two women in whom severe hyperglycemia developed after gatifloxacin therapy was initiated. Interacting factors that may result in severe hyperglycemia in patients without diabetes and the literature explaining the mechanism by which gatifloxacin can alter glucose metabolism are reviewed.Our first patient, a 46-year-old woman with end-stage renal disease, presented with a 3-day history of fever, abdominal pain, and hypotension. Admission laboratory data included a fasting plasma glucose level of 72 mg/dL and a glycosylated hemoglobin of 5.3%. She was treated with gatifloxacin for an infected ovarian cyst found on laparotomy. Her subsequent glucose values ranged from 400 to 500 mg/dL and remained high during gatifloxacin therapy. Antibiotic treatment was changed to ciprofloxacin. On outpatient follow-up, the patient's fasting plasma glucose levels had decreased to a range of 87 to 108 mg/dL. Our second patient, a 77-year-old woman with a history of chronic renal failure and congestive heart failure, was hospitalized because of dyspnea and hypotension. She was given gatifloxacin for a urinary tract infection. Her daily fasting plasma glucose value gradually increased from 100 mg/dL on admission to 694 mg/dL on the 6th hospital day. The patient required insulin therapy throughout her hospitalization, and she died on the 12th hospital day.Gatifloxacin therapy may precipitate severe hyperglycemia in patients without diabetes, especially in the elderly population, those with renal insufficiency, and those receiving multiple drugs known to alter glucose metabolism. Discontinuation of gatifloxacin treatment may result in improved glucose homeostasis.

We present the histories, clinical findings, and hospital course of three patients who developed hypoglycemia after receiving gatifloxacin. Possible mechanisms for the hypoglycemia are outlined. Case 1 A 89-year-old diabetic male receiving glyburide was given a single dose of gatifloxacin for bronchitis. Thirteen hours later, he was found to be unresponsive with a blood glucose level of 34 mg/dL. The hypoglycemia resolved within 24 hours of stopping gatifloxacin. Case 2 A 80-year-old nondiabetic woman with end-stage renal disease and recent surgery was treated with gatifloxacin, cefepime, and metronidazole for pneumonia. Sixteen hours later, her serum glucose level was 61 mg/dL, and over the next 24 hours was as low as 39 mg/dL. The hypoglycemia resolved within 40 hours of stopping gatifloxacin. Case 3 A 58-year-old diabetic man receiving glyburide was admitted for myocardial infarction and renal failure. Twelve hours after receiving gatifloxacin for pneumonia, his blood glucose level was 60 mg/dL and was as low as 42 mg/dL between 2 and 22.5 hours of a second dose of gatifloxacin. The hypoglycemia resolved within 24 hours of stopping gatifloxacin. Conclusions Gatifloxacin use may precipitate hypoglycemia in diabetic patients receiving oral hypoglycemic agents and in nondiabetic patients with chronic renal failure. Discontinuation of gatifloxacin results in improvement in glucose homeostasis.

Background: Patients with diabetes have increased incidence and severity of periodontal disease not accounted for by differences in the subgingival microbial infection. Poor glycemic control has been consistently associated with periodontal disease severity. Also, recent evidence suggests that hyperglycemia may induce inflammatory cytokine production. Few studies, however, have examined local biochemical measures of periodontal inflammation in patients with type 2 diabetes. The aim of this study was to determine whether glycemic control was related to gingival crevicular fluid (GCF) levels of interleukin-1β (IL-1β). Methods: GCF samples were collected from 45 patients with type 2 diabetes and untreated chronic periodontitis. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and attachment level (AL) were recorded at six sites per tooth. IL-1β levels were determined from individual GCF samples by enzyme-linked immunoabsorbent assay (ELISA). Individual site and mean patient values were calculated. Glycated hemoglobin (HbA 1c ) levels were measured from anticoagulated whole blood using an automated affinity chromatography system. Serum glucose was also determined. Results: Clinical periodontal measures (PD, AL, BOP) and measures of glycemic control (HbA1c, random glucose) were significantly correlated with GCF IL-1β. Patients with greater than 8% HbA1c had significantly higher mean GCF IL-1β levels than patients with less than 8% HbA1c. In a multivariate model adjusting for age, gender, PD, AL, BOP, and PI, HbA1c and random glucose were independent predictors of high GCF IL-1β. Conclusions: Poor glycemic control is associated with elevated GCF IL-1β. These data are consistent with the hypothesis that hyperglycemia contributes to an heightened inflammatory response, and suggests a mechanism to account for the association between poor glycemic control and periodontal destruction. J Periodontol 2004;75:1203-1208.

Objective To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design. Design Multicenter prospective cohort study. Setting Institutions for physical therapy and rehabilitation. Participants Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation. Interventions Not applicable. Main Outcome Measures Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used. Results Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD). Conclusions PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level.

Background: Falls, mobility impairments and lack of social support lead to participation restrictions in people with neurological conditions. The aim of this multicenter, single blinded randomized controlled trial was to test whether an educational program focusing on fall prevention and safe mobility reduces falls and increases social participation among people with neurological conditions. Methods: Ninety people with Stroke (n = 25), multiple sclerosis (n = 33) and Parkinson disease (n = 32), median age 63 (31-89), were randomized. A permuted block algorithm stratified by field center was used to allocate participants to an education group (EG, n = 42) consisting of an educational program focused on fall prevention and tailored balance exercises and a control group (CG, n = 48) receiving usual treatments. After baseline assessment, each participants was followed for 6 months with telephone contacts by blinded interviewers. Being fallers (>1 fall) and time to become a faller were used as primary outcomes. Community Integration Questionnaire (CIQ) and Instrumental Activities of Daily Living (IADL) scales assessed treatment effects on social integration and daily living activities. Results: Over a median (Interquartile Range) follow-up of 189 (182-205) days, [EG = 188 (182-202), CG = 189 (182-209)] fallers were 10 in the CG and 11 in the EG (hazard ratio 0.95, 95% confidence interval (CI) 0.45 to 2.5; P = 0.94). At follow-up the EG scored significantly better than CG on the CIQ (+1.7 points, CI: 0.1 to 3.3) and IADL (+2.2 points, CI: 0.4 to 4.0). Conclusions: This educational program did not reduce the risk of falls but it improved the ability to carry out activities of daily living and decreased participation restrictions in people with neurological conditions. ispartof: FRONTIERS IN NEUROLOGY vol:10 ispartof: location:Switzerland status: published

Summary Background Current treatment for metastatic pancreatic ductal adenocarcinoma includes combination chemotherapy, such as FOLFIRINOX or nab-paclitaxel plus gemcitabine. We investigated the activity of a novel four-drug regimen, consisting of cisplatin, nab-paclitaxel, capecitabine, and gemcitabine, compared with nab-paclitaxel plus gemcitabine, in the PACT-19 trial. Methods This single-centre, randomised, open-label, phase 2 trial was done in San Raffaele Hospital in Italy. We enrolled patients aged 18–75 years with pathologically confirmed stage IV pancreatic ductal adenocarcinoma who had received no previous chemotherapy and had Karnofsky performance status of at least 70. Patients were randomly assigned (1:1) by computer-generated permutated block randomisation (block size of four) stratified by baseline concentration of carbohydrate antigen 19-9 to PAXG (cisplatin 30 mg/m 2 , nab-paclitaxel 150 mg/m 2 , and gemcitabine 800 mg/m 2 on days 1 and 15 and oral capecitabine 1250 mg/m 2 on days 1–28 every 4 weeks), or nab-paclitaxel and gemcitabine alone (nab-paclitaxel 125 mg/m 2 and gemcitabine 1000 mg/m 2 on days 1, 8, and 15 every 4 weeks). The primary endpoint was the proportion of patients who were progression-free at 6 months, analysed in the intention-to-treat population. Data cutoff was on March 31, 2018. The safety population included all patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov, number NCT01730222, and is now closed. Findings Between April 22, 2014, and May 30, 2016, we randomly assigned 83 patients to treatment: 42 patients to PAXG and 41 patients to nab-paclitaxel plus gemcitabine. At 6 months, 31 (74%, 95% CI 58–86) of 42 patients in the PAXG group were alive and free from disease progression compared with 19 (46%, 31–63) of 41 patients in the nab-paclitaxel plus gemcitabine group. The most frequent grade 3 adverse events were neutropenia (12 [29%] of 42 in the PAXG group vs 14 [34%] of 41 in the nab-paclitaxel plus gemcitabine group), anaemia (nine [21%] vs nine [22%]), and fatigue (seven [17%] vs seven [17%]). The most common grade 4 adverse event was neutropenia (five [12%] in the PAXG group vs two [5%] in the nab-paclitaxel plus gemcitabine group). Two (5%) treatment-related deaths occurred in the nab-paclitaxel plus gemcitabine group compared with none in the PAXG group. Interpretation Despite the small sample size, our findings suggest that the PAXG regimen warrants further investigation in a phase 3 trial in patients with metastatic pancreatic ductal adenocarcinoma. Funding Celgene.