Rapid access chest pain clinics in Australia and New Zealand

Chest pain is the second most common reason for adult emergency department presentations. Most patients have low or intermediate risk chest pain, which historically has led to inpatient admission for further evaluation. Rapid access chest pain clinics represent an innovative outpatient pathway for these low and intermediate risk patients, and have been shown to be safe and reduce hospital costs. Despite variations in rapid access chest pain clinic models, there are limited data to determine the most effective approach. Developing a national framework could be beneficial to provide sites with evidence, possible models, and business cases. Multicentre data analysis could enhance understanding and monitoring of the service.

Intermediate valence state in YbB4revealed by resonant x-ray emission spectroscopy

We report the temperature dependence of the Yb valence in the geometrically frustrated compoundYbB4from 12 to 300 K using resonant x-ray emission spectroscopy at the YbLα1transition. We find that the Yb valence,v, is hybridized between thev = 2 andv = 3 valence states, increasing fromv=2.61±0.01at 12 K tov=2.67±0.01at 300 K, confirming thatYbB4is a Kondo system in the intermediate valence regime. This result indicates that the Kondo interaction inYbB4is substantial, and is likely to be the reason whyYbB4does not order magnetically at low temperature, rather than this being an effect of geometric frustration. Furthermore, the zero-point valence of the system is extracted from our data and compared with other Kondo lattice systems. The zero-point valence seems to be weakly dependent on the Kondo temperature scale, but not on the valence change temperature scaleT_v.

Metastatic acral melanoma treatment outcomes: a systematic review and meta-analysis

Acral melanomas are a unique subset of melanomas occurring on the palms, soles, and nails. There is poor prognosis with surgery alone and no specific guidelines for the treatment of metastatic acral melanoma. This meta-analysis explored the systemic therapy outcomes for metastatic acral melanoma. Medline, Pubmed, EMBASE, and the grey literature were searched from 2010 to August 2020 for studies specifying the treatment outcome of metastatic acral melanoma. Studies were assessed by two investigators. A random-effects meta-analysis was performed and pooled Kaplan-Meier curves for progression-free survival and overall survival were created. Critical appraisal was performed using the Newcastle-Ottawa Scale. Nineteen nonrandomized studies were included, comprising 646 patients with acral melanomas and 1609 patients with nonacral melanomas treated with systemic therapy including chemotherapy, KIT-targeted drugs, as well as anti-CTLA-4 and anti-PD-1 checkpoint inhibitor therapy. Thirteen studies included Kaplan-Meier curves for progression-free survival or overall survival and 11 studies reported treatment responses. Patients with acral melanomas had worse prognosis than nonacral cutaneous melanoma (acral overall survival: median 15 months, 95% CI, 13.7-16.3 months; nonacral cutaneous: median 24 months, 95% CI, 22.6-25.4 months, P < 0.001). Acral melanoma patients treated with anti-PD-1 monotherapy had higher overall survival at 12 months (53%) compared with anti-CTLA-4 monotherapy (34%; P < 0.001). This study provides estimates of treatment response for metastatic acral melanoma, demonstrating low activity across a breadth of approved drug therapies, including anti-PD-1, the most active therapy in melanoma to date. Further research into treatments for metastatic acral melanoma is needed.

Modeling and optimization of process parameters of biofilm reactor for wastewater treatment

The efficiency of heavy metal in biofilm reactors depends on absorption process parameters, and those relationships are complicated. This study explores artificial neural networks (ANNs) feasibility to correlate the biofilm reactor process parameters with absorption efficiency. The heavy metal removal and turbidity were modeled as a function of five process parameters, namely pH, temperature(°C), feed flux(ml/min), substrate flow(ml/min), and hydraulic retention time(h). We developed a standalone ANN software for predicting and analyzing the absorption process in handling industrial wastewater. The model was tested extensively to confirm that the predictions are reasonable in the context of the absorption kinetics principles. The model predictions showed that the temperature and pH values are the most influential parameters affecting absorption efficiency and turbidity.

Artificial neural networks modeling for lead removal from aqueous solutions using iron oxide nanocomposites from bio-waste mass

Heavy metal ions in aqueous solutions are taken into account as one of the most harmful environmental issues that ominously affect human health. Pb(II) is a common pollutant among heavy metals found in industrial wastewater, and various methods were developed to remove the Pb(II). The adsorption method was more efficient, cheap, and eco-friendly to remove the Pb(II) from aqueous solutions. The removal efficiency depends on the process parameters (initial concentration, the adsorbent dosage of T-Fe3O4 nanocomposites, residence time, and adsorbent pH). The relationship between the process parameters and output is non-linear and complex. The purpose of the present study is to develop an artificial neural networks (ANN) model to estimate and analyze the relationship between Pb(II) removal and adsorption process parameters. The model was trained with the backpropagation algorithm. The model was validated with the unseen datasets. The correlation coefficient adj.R² values for total datasets is 0.991. The relationship between the parameters and Pb(II) removal was analyzed by sensitivity analysis and creating a virtual adsorption process. The study determined that the ANN modeling was a reliable tool for predicting and optimizing adsorption process parameters for maximum lead removal from aqueous solutions.

Persistent pathology of the patent foramen ovale: a review of the literature

A patent foramen ovale (PFO) is an interatrial shunt, with a prevalence of 20-34% in the general population. While most people do not have secondary manifestations of a PFO, some reported sequelae include ischaemic stroke, migraine, platypnoea-orthodeoxia syndrome and decompression illness. Furthermore, in some cases, PFO closure should be considered for patients before neurosurgery and for patients with concomitant carcinoid syndrome. Recent trials support PFO closure for ischaemic stroke patients with high risk PFOs and absence of other identified stroke mechanisms. While PFOs can be associated with migraine with auras, with some patients reporting symptomatic improvement after closure, the evidence from randomised controlled trials is less clear in supporting the use of PFO closure for migraine treatment. PFO closure for other indications such as platypnoea-orthodeoxia syndrome, decompression illness and paradoxical embolism are based largely on case series with good clinical outcomes. PFO closure can be performed as a day surgical intervention with high procedural success and low risk of complications.

The self-regulated learning of medical students in the clinical environment - a scoping review

BACKGROUND

Self-regulated learning is the individual's ability to effectively use various strategies to reach their learning goals. We conducted this scoping review to explore what has been found regarding self-regulated learning in the clinical environment and how this was measured.

METHODS

Using Arksey and O'Malley's five-stage framework, we searched three medical and educational databases as well as Google Scholar for literature on the self-regulated learning of medical students in the clinical environment published between 1966 and February 2017. After results were screened and relevant studies were identified, the data was summarised and discursively reported.

RESULTS

The search resulted in 911 articles, with 14 articles included in the scoping review after the inclusion criteria was applied. Self-regulated learning was explored in these studies in various ways including qualitative, quantitative and mixed methods. Three major findings were found: 1) levels of self-regulated learning change in the clinical environment, 2) self-regulated learning is associated with academic achievement, success in clinical skills and mental health and 3) various factors can support self-regulated learning levels in medical students.

CONCLUSIONS

Most of articles exploring the self-regulated learning of medical students during the clinical years have been published in the last 5 years, suggesting a growing interest in the area. Future research could explore the self-regulated learning levels of medical students during the clinical years using a longitudinal approach or through the use of novel qualitative approaches.

Increased propionate concentration in Lactobacillus mucosae-fermented wet brewers grains and during in vitro rumen fermentation

AIMS

This study was conducted to isolate and identify propionate-producing bacteria that can be used as an inoculum in improving wet brewers grains and rumen fermentation via increasing propionate concentration.

METHODS AND RESULTS

A strain of Lactobacillus that exhibits high levels of propionate production was identified and characterized as Lactobacillus mucosae 521129 by 16S rRNA gene sequencing and phylogenetic analyses. Wet brewers grains were fermented through L. mucosae inoculation and resulted in an increase in propionate concentration. Fermented wet brewers grains were used in in vitro rumen fermentation and revealed that L. mucosae-fermented wet brewers grains produced more gas and had higher accumulations propionate and total volatile fatty acid (VFA) than the control. The fewest methanogen DNA copies were detected in L. mucosae-fermented wet brewers grains.

CONCLUSION

Identified L. mucosae improved the fermentation of wet brewers grains and the in vitro rumen fermentation via increasing propionate and total VFA concentrations.

SIGNIFICANCE AND IMPACT OF THE STUDY

The presented research provided the identification of L. mucosae 521129 as a propionate producer and was metabolically profiled. Furthermore, data present the putative application of this organism in improving the fermentation of wet brewers grains and in vitro rumen fermentation.

Medical student changes in self-regulated learning during the transition to the clinical environment

BACKGROUND

Self-regulated learning (SRL), which is learners' ability to proactively select and use different strategies to reach learning goals, is associated with academic and clinical success and life-long learning. SRL does not develop automatically in the clinical environment and its development during the preclinical to clinical learning transition has not been quantitatively studied. Our study aims to fill this gap by measuring SRL in medical students during the transitional period and examining its contributing factors.

METHODS

Medical students were invited to complete a questionnaire at the commencement of their first clinical year (T0), and 10 weeks later (T1). The questionnaire included the Motivated Strategies for Learning Questionnaire (MSLQ) and asked about previous clinical experience. Information about the student's background, demographic characteristics and first clinical rotation were also gathered.

RESULTS

Of 118 students invited to participate, complete paired responses were obtained from 72 medical students (response rate 61%). At T1, extrinsic goal orientation increased and was associated with gender (males were more likely to increase extrinsic goal orientation) and type of first attachment (critical care and community based attachments, compared to hospital ward based attachments). Metacognitive self-regulation decreased at T1 and was negatively associated with previous clinical experience.

CONCLUSIONS

Measurable changes in self-regulated learning occur during the transition from preclinical learning to clinical immersion, particularly in the domains of extrinsic goal orientation and metacognitive self-regulation. Self-determination theory offers possible explanations for this finding which have practical implications and point the way to future research. In addition, interventions to promote metacognition before the clinical immersion may assist in preserving SRL during the transition and thus promote life-long learning skills in preparation for real-world practice.

Effects of β-Glucan on the Release of Nitric Oxide by Macrophages Stimulated with Lipopolysaccharide

This research analyzed the effect of β-glucan that is expected to alleviate the production of the inflammatory mediator in macrophagocytes, which are processed by the lipopolysaccharide (LPS) of Escherichia. The incubated layer was used for a nitric oxide (NO) analysis. The DNA-binding activation of the small unit of nuclear factor-κB was measured using the enzyme-linked immunosorbent assay-based kit. In the RAW264.7 cells that were vitalized by Escherichia coli (E. coli) LPS, the β-glucan inhibited both the combatant and rendering phases of the inducible NO synthase (iNOS)-derived NO. β-Glucan increased the expression of the heme oxygenase-1 (HO-1) in the cells that were stimulated by E. coli LPS, and the HO-1 activation was inhibited by the tin protoporphyrin IX (SnPP). This shows that the NO production induced by LPS is related to the inhibition effect of β-glucan. The phosphorylation of c-Jun N-terminal kinases (JNK) and the p38 induced by the LPS were not influenced by the β-glucan, and the inhibitory κB-α (IκB-α) decomposition was not influenced either. Instead, β-glucan remarkably inhibited the phosphorylation of the signal transducer and activator of transcription-1 (STAT1) that was induced by the E. coli LPS. Overall, the β-glucan inhibited the production of NO in macrophagocytes that was vitalized by the E .coli LPS through the HO-1 induction and the STAT1 pathways inhibition in this research. As the host immune response control by β-glucan weakens the progress of the inflammatory disease, β-glucan can be used as an effective immunomodulator.

Disruption of effective connectivity from the dorsolateral prefrontal cortex to the orbitofrontal cortex by negative emotional distraction in obsessive-compulsive disorder

BACKGROUND

Obsessive-compulsive disorder (OCD) has been associated with abnormal cognitive and emotional functions and these dysfunctions may be dependent on the disruption of dynamic interactions within neuronal circuits associated with emotion regulation. Although several studies have shown the aberrant cognitive-affective processing in OCD patients, little is known about how to characterize effective connectivity of the disrupted neural interactions. In the present study, we applied effective connectivity analysis using dynamic causal modeling to explore the disturbed neural interactions in OCD patients.

METHOD

A total of 20 patients and 21 matched healthy controls performed a delayed-response working memory task under emotional or non-emotional distraction while undergoing functional magnetic resonance imaging.

RESULTS

During the delay interval under negative emotional distraction, both groups showed similar patterns of activations in the amygdala. However, under negative emotional distraction, the dorsolateral prefrontal cortex (DLPFC) and the orbitofrontal cortex (OFC) exhibited significant differences between groups. Bayesian model averaging indicated that the connection from the DLPFC to the OFC was negatively modulated by negative emotional distraction in patients, when compared with healthy controls (p < 0.05, Bonferroni-corrected).

CONCLUSIONS

Exaggerated recruitment of the DLPFC may induce the reduction of top-down prefrontal control input over the OFC, leading to abnormal cortico-cortical interaction. This disrupted cortico-cortical interaction under negative emotional distraction may be responsible for dysfunctions of cognitive and emotional processing in OCD patients and may be a component of the pathophysiology associated with OCD.

Molecular cloning and expression of a novel family A endoglucanase gene from Fibrobacter succinogenes S85 in Escherichia coli

A Fibrobacter succinogenes S85 gene that encodes endoglucanase hydrolysing CMC and xylan was cloned and expressed in Escherichia coli DH5 by using pUC19 vector. Recombinant plasmid DNA from a positive clone hydrolysing CMC and xylan was designated as pCMX1, harboring 2,043 bp insert. The entire nucleotide sequence was determined, and an open-reading frame (ORF) was deduced. The nucleotide sequence accession number of the cloned gene sequence in Genbank is U94826. The endoglucanase gene cloned in this study does not have amino sequence homology to the other endoglucanase genes from F. succinogenes S85, but does show sequence homology to family 5 (family A) of glycosyl hydrolases from several species. The ORF encodes a polypeptide of 654 amino acids with a measured molecular weight of 81.3 kDa on SDS-PAGE. Putative signal sequences, Shine-Dalgarno-type ribosomal binding site and promoter sequences (-10) related to the consensus promoter sequences were deduced. The recombinant endoglucanase by E. coli harboring pCMX1 was partially purified and characterized. N-terminal sequences of endoglucanase were Ala-Gln-Pro-Ala-Ala, matched with deduced amino sequences. The temperature range and pH for optimal activity of the purified enzyme were 55 approximately 65 degrees C and 5.5, respectively. The enzyme was most stable at pH 6 but unstable under pH 4 with a K(m) value of 0.49% CMC and a V(max) value of 152 U/mg.

Cellular distribution of isozymes of protein kinase C in septal olfactory epithelium of mice

To determine the presence of protein kinase C (PKC) isozymes in the septal olfactory epithelium of mice (mSOE), western blotting and immunohistochemistry were performed using antibodies against PKC isozymes. With the exception of PKC-betaI, all of the PKC isozymes were detected in the whole lysate of septal tissue layer and apparent molecular weights for each isoform were found. PKC-alpha, PKC-gamma and PKC-epsilon were detected in the olfactory glandular cells of the lamina propria, and PKC-betaI and PKC-betaII were located in the microvillar cells. Neither novel PKC nor atypical PKC was detected in olfactory glandular cells or microvillar cells, except for PKC-epsilon. PKC-lambda was localized in the mucous layer of the mSOE. Meanwhile, PKC-delta and PKC-xi were distributed in the receptor cells in the mSOE. These data demonstrate the isoform-specific expression of PKC in mSOE and suggest a role for the novel and atypical types of PKC in olfactory transduction.

Potentials and limitations of adenovirus-p53 gene therapy for brain tumors

We investigated the antineoplastic potentials of recombinant adenovirus containing wild-type p53 cDNA (Ad5CMV-p53) for malignant gliomas. In four human glioma cell lines (U-251 and LG expressing endogenous mutant p53, and U-87 and EFC-2 expressing wild-type p53) and two rat glioma cell lines (9L and C6, each expressing mutant and wild-type p53), gene transfer efficiency determined by X-gal staining and Western blotting was varied (10-99% at 10-500 multiplicity of infection, MOI). Growth inhibitory effect was drastic (>90% at 100 MOI) in U-251 cells and only moderate or minimal in other cell lines harboring wild-type p53 or low gene transfer efficiency. Ex vivo transduction of U-251 cells with Ad5CMV-p53 suppressed the in vivo tumorigenicity of the cells. Histopathologic examination for Ad5CMV-p53 toxicity to rat brains showed inflammatory reactions in half of the tested brains at 10(8) MOI. U-251 cells were inoculated intracerebrally in nude mice and injected Ad5CMV-p53 into the tumor, in which neither the tumor suppression nor the survival benefit was observed. In conclusion, heterogeneity of the cellular subpopulations of malignant glioma in p53 status, variable and insufficient gene delivery to tumor, and adenoviral toxicity to brain at higher doses may be limiting factors to be solved in developing adenovirus-p53 gene therapy for malignant gliomas.

Rapid degradation of PrxI and PrxII induced by silica in Rat2 cells

Peroxidases of the peroxiredoxin (Prx) family catalyze the reduction of H(2)O(2) and lipid peroxides. The effects of H(2)O(2), 12-O-tetradecanoylphorbol 13-acetate (TPA), and silica on the abundance of two cytosolic isoforms of Prx (PrxI and PrxII) were examined in Rat2 cells. TPA induces the production of reactive oxygen species (ROS) in various mammalian cell types, and silica induces the production of ROS in Rat2 cells. Whereas H(2)O(2) and TPA did not affect the concentration of PrxI or Prx II, silica triggered a rapid degradation of both Prx enzymes. Silica also induced degradation of the NF-kappaB inhibitor IkappaB-alpha. N-Acetylcysteine and diphenyleneiodonium, both of which inhibit the accumulation of intracellular ROS, each blocked silica-induced degradation of IkappaB-alpha but had no effect on that of the Prx enzymes, suggesting that ROS do not contribute to Prx proteolysis. The silica-induced degradation of Prx enzymes was also insensitive to the proteasome inhibitors MG132 and lactacystin, whereas IkappaB-alpha proteolysis was completely blocked by these inhibitors. Experiments with the Ca(2+) ionophore A23187 indicated that a Ca(2+)-dependent protease such as calpain might contribute substantially to silica-induced degradation of PrxII, but only moderately to that of PrxI. These results indicate that silica increases cellular oxidative stress not only by inducing ROS production, but also by triggering the degradation of Prx enzymes that are responsible for elimination of cellular ROS. Such aggravated oxidative stress might be important in the initial pathogenesis of silica-associated pulmonary diseases.

The role of protein kinase Calpha in U-87 glioma invasion

To investigate the hypothesis that protein kinase Calpha (PKCalpha) is functional glial tumor cell invasion, stable PKCalpha sense and antisense transfected U-87 cell lines were established and PKCalpha expression characterized by Western blot and PKC activity assays. Invasion assays including barrier migration (Koochekpour et al., Extracellular matrix proteins inhibit proliferation, upregulate migration and induce morphological changes in human glioma lines. Eur. J. Cancer, 1995, 31, 375-380; Merzak et al., CD44 mediates human glioma cell adhesion and invasion in vitro. Cancer Res., 1994, 54, 3988-3992; Merzak et al., Cell surface gangliosides are involved in the control of human glioma cell invasion in vitro. Neurosci. Lett., 1994, 177, 11-16), and spheroid confrontation were used to study the relationship between PKCalpha expression and invasiveness. PKCalpha overexpressing clones show increased barrier migration (1.5x) relative to the control transfected clones. PKCalpha inhibited clones exhibited reduced invasiveness, to < 50%. In coculture with PKCalpha overexpressing clones, the remaining normal fetal rat brain aggregate volume was significantly decreased (up to 200%) but 90% of the initial brain volume was left in PKCalpha inhibited clone in the rat brain aggregate tumor spheroid confrontation. This effect was not associated with significant growth inhibition. We conclude that expression of PKCalpha in glioma-derived cell lines appears to be central to glioma invasion in vitro.

Simple bone cyst of the axis

A 12-year-old girl presented with a 1-month history of posterior neck pain and a large cyst in the second cervical vertebra. She underwent complete curettage of the cyst wall without any kind of bone graft, and the surgical result was good. Microscopic findings in the cyst wall were consistent with simple bone cyst, which is very rare in the spine.

Subepidermal capillary basement membrane thickness of the skin obtained by punch biopsy in patients with non insulin dependent diabetes mellitus

Thickening and proliferation of the capillary basement membrane is a generalized phenomenon in diabetes mellitus and has been described in many organs including the heart, kidney, pancreas, retina etc. While such changes are specific, it is difficult to obtain specimens from those organs. Tissue samples were obtained from the medial surface of the thigh of 33 diabetics and 4 healthy controls by means of punch biopsy. Measurements carried out by normogram obtained from electron microscopic pictures. HbA1c values were also determined at time of muscle biopsy. 1. The HbA1c values are higher in diabetics than in the control group (p<0.01). 2. The subepidermal capillary basement membrane thickness of the diabetics: 30% of the 5’th decade population, 53.9% of the 6’th decade population and 83.3% of the 7’th decade population was greater than 3,000 A°. Whereas that of the controls was less than 3,000 A°. 3. The subepidermal capillary basement membrane thickness was not significantly increased with the duration of the disease. 4. In cases of greater subepidermal capillary besement membrane thickness, HbA1c showed a significant increase. (p<0.01).

Serum and erythrocyte lipoperoxides and supproxide dismutase levels in normal persons and hypertensive patients

To assess the role and responses of lipoperoxide and superoxide dismutase in hypertensive disease, the serum and erythrocyte lipid peroxide and erythrocyte superoxide dismutase levels were measured in 65 normal persons and hypertensive patients.

The results are summerized as follows: In normal persons, serum and erythrocyte lipoperoxide values showed an increase according to age, but the elevation was not statistically significant. In normal persons, the erythrocyte superoxide dismutase value did not change according to age. In hypertensive patients, the serum and erythrocyte lipoperoxide values showed increases of 10.8% and 26% respectively compared to those of the controls. In hypertensive patients, the erythrocyte superoxide dismutase value showed a decrease of 29.9% compared to that of the controls.

A clinical study of adult Japanese encephalitis in the Chonnam District, Korea, during summer of 1982--a difference between improved and expired cases

In the summer of 1982, we experienced a great number of patients with Japanese encephalitis compared with the previous years. We have studied 85 adult cases of Japanese encephalitis which were diagnosed clinically and/or serologically. A difference between improved and expired cases was also investigated. We found that deteriorated mental state, elevated SGOT (AST) level, lower hemagglutination-inhibition(H-I) titer, and a more acute onset of the illness were associated with higher mortality. The mortality rate in our cases was 35.3 percent.