Comparison between graph theory connectivity indices and landscape connectivity metrics for modeling river water quality in the southern Caspian sea basin

The maintenance of connectivity is critical to the proper functioning of an ecosystem. The present study was conducted with the aim of comparing graph theory connectivity indices and landscape connectivity metrics for the purpose of modeling river water quality. To conduct this study, a forest layer was extracted from land cover map and 25 large watersheds were selected. River water quality was then assessed from the perspective of 8 landscape connectivity metrics and 12 graph theory indices. We developed predictive models using stepwise linear regression, power, exponential, and logarithmic models to locate the best model form for each water quality parameter (dependent variable) we examined. The results indicated that models developed using graph theory connectivity indices resulted in higher coefficients of determination (R²) than models developed using landscape metrics. Only 5 independent variables from a potential set of 13 were significant in explaining the variation in water quality parameters. Also, the models with the highest R² attempted to explain variations in CO₃ (0.818), water discharge (0.733), and Ca levels (0.702). Therefore, the results of this study showed that graph theory connectivity indices had more significant correlation with water quality parameters compared to landscape connectivity metrics. This work also indicates that there exist nonlinear relationships among connectivity indices and water quality parameters.

Size-dependent molecular interaction of nontraditional 2D antibiotics withStaphylococcus aureus

The application of nanomaterials for their antibacterial properties is the subject of many studies due to antibiotic resistance of pathogen bacteria and the necessity of omitting them from food and water resources. Graphene oxide (GO) is one of the most popular candidates for antibacterial application. However, the optimum condition for such an effect is not yet clear for practical purposes. To shed light on how GO and bacteria interaction depends on size, a wide range of GO flake sizes from hundreds of µm²going down to nano-scale as low as 10 N m²was produced. In anin-vitrosystematic study to inhibitStaphylococcus aureusgrowth, the correlation between GO flake size, thickness, functional group density, and antibacterial activity was investigated. The GO suspension with the average size of 0.05 µm², in the order of the size of the bacteria itself, had the best bacteriostatic effect onS. aureuswith the minimum inhibitory concentration value of 8 μg ml^-1, well within the acceptable range for practical use. The bacteriostatic effect was measured to be a 76.2% reduction of the colony count over 2 h of incubation and the mechanism of action was the wrapping and isolation of cells from the growth environment. Furthermore,in-vivoanimal studies revealed that 16 μg ml^-1of the optimum GO has efficient antibacterial performance against the methicillin-resistant strains of the bacteria with an enhanced wound healing rate and tensiometrial parameters which is important for realized targets.

Seismic Damage Identification Method for Curved Beam Bridges Based on Wavelet Packet Norm Entropy

Curved beam bridges, whose line type is flexible and beautiful, are an indispensable bridge type in modern traffic engineering. Nevertheless, compared with linear bridges, curved beam bridges have more complex internal forces and deformation due to the curvature; therefore, this type of bridge is more likely to suffer damage in strong earthquakes. The occurrence of damage reduces the safety of bridges, and can even cause casualties and property loss. For this reason, it is of great significance to study the identification of seismic damage in curved beam bridges. However, there is currently little research on curved beam bridges. For this reason, this paper proposes a damage identification method based on wavelet packet norm entropy (WPNE) under seismic excitation. In this method, wavelet packet transform is adopted to highlight the damage singularity information, the Lp norm entropy of wavelet coefficient is taken as a damage characteristic factor, and then the occurrence of damage is characterized by changes in the damage index. To verify the feasibility and effectiveness of this method, a finite element model of Curved Continuous Rigid-Frame Bridges (CCRFB) is established for the purposes of numerical simulation. The results show that the damage index based on WPNE can accurately identify the damage location and characterize the severity of damage; moreover, WPNE is more capable of performing damage location and providing early warning than the method based on wavelet packet energy. In addition, noise resistance analysis shows that WPNE is immune to noise interference to a certain extent. As long as a series of frequency bands with larger correlation coefficients are selected for WPNE calculation, independent noise reduction can be achieved.

A New Amphotericin B-loaded Trimethyl Chitosan Nanoparticles as a Drug Delivery System and Antifungal Activity on Candida albicans Biofilm

Amphotericin B (AmB) is an effective antifungal agent; however, the application of AmB is associated with a number of drawbacks. Application of nanoparticles (NPs) is known to improve the efficiency of drug delivery to the target tissues, compared to the traditional methods. In this study, a novel method of NPs preparation was developed. The trimethyl chitosan (TMC) was synthesized using low molecular weight chitosan and was used for the preparation of TMC-NPs through ionic gelation method. Afterward, AmB-loaded TMC-NPs (TMC-NPs/AmB) were prepared and their drug delivery potential was testes. The TMC-NPs and TMC-NPs/AmB were characterized for their structure, particle size, Zeta potential, polydispersity index, morphology, loading efficiency, loading capacity, in vitro release profile, release kinetic, and entrapped AmB potency. The cytotoxicity and antifungal activity of TMC-NPs/AmB against Candida albicans biofilm were evaluated. The quaternization of TMC was estimated to be 36.4%. The mean particle size of TMC-NPs and TMC NPs/AmB were 210±15 and 365±10 nm, respectively, with a PDI of 0.30 and 0.4, ZP of +34±0.5 and +28±0.5 mV, respectively. Electron microscopy analysis indicated uniform spherical shapes with smooth surfaces. The TMC-NPs/AmB indicated LE of 76% and LC of 74.04 % with a potency of 110%. The release profile of TMC-NPs/AmB was best explained by the Higuchi model. The initial release after 10 h was obtained at 38%, and the rates of release after 36 and 84 h were determined at 67% and 76% respectively, which was significantly different (P<0.05) from previous time points. The minimum inhibitory concentration (MIC) (50%) of NPs/AmB and AmB were 0.65 and 1.75 μg/mL, and the MIC 80% were determined at 1.95 and 7.75 μg/mL, respectively, demonstrating a significant improvement in antifungal activity. The half-maximal inhibitory concentration for TMC-NPs/AmB and AmB were estimated at 86 and 105 μg/mL, respectively, indicating a significant reduction in cytotoxicity and the adverse effect. This study could successfully introduce a practical method to synthesize TMC-NPs. The encapsulation process was efficient and significantly improved the antifungal activity of AmB. The developed method can be applied to improve the feasibility of oral delivery while reducing the adverse effects associated with traditional methods.

Subtilisin Gene Activity in Dermatophytes: A study on the Presence of the Subtilisin Gene in Trichophyton verrucosum and Microsporum gypseum in Clinical and Nonclinical Samples in Tehran, Iran

The keratinolytic activities of dermatophyte species are accompanied by the secretion of enzymes, such as serine proteases, which are coded by the Subtilisin (SUB) genes. This study aimed to determine the presence of the SUB genes in the clinical and nonclinical samples of Trichophyton verrucosum and Microsporum gypseum. Isolation was carried out by direct and laboratory examination. Following that, for the determination of the presence of the SUB gene, polymerase chain reaction with specific primers was conducted. The frequencies of the SUB gene were observed in almost 66% of the isolates. Statistical analysis showed a significant relationship between the presence of the SUB gene and the samples collected from human, animals, and soil (p ˂0.005). The current investigation has been the first study of the presence/absence of the SUB gene in the clinical and nonclinical isolates of T. verrucosum and M. gypseum in Iran which may be a new step to perform further studies.

Identification of Dairy Fungal Contamination and Reduction of Aflatoxin M1 Amount by Three Acid and Bile Resistant Probiotic Bacteria

Aflatoxins (AFs) released by fungi are observed in the cow’s milk even after pasteurization. Aflatoxin M1 (AFM1) has particularly an incredible clinical significance, as a critical carcinogenic agent for humans. Several strategies have been implemented for lowering the AFM1 amount, such as the employment of probiotics, particularly lactobacilli or lactic acid bacteria (LAB). However, this strategy has not been applied routinely until today. This study aimed to evaluate the effect of three LABs on the reduction of AFM1 in traditional milk and cheese samples. In total, 85 milk (n=45) and cheese (n=40) samples were obtained from the open markets of Shiraz, Iran, from February to June 2018. Additionally, the AFM1 levels were evaluated, compared to those of the National Iranian Standard. The data were then analyzed in SPSS software (version 20) through the Chi-square test. Statistical analysis was performed at a 95% confidence level (p-value of <0.00001). Out of 50 purchased LABs, the efficient antifungal property and resistance to bile salts were observed in five strains. The mean value of these five strains was calculated after adding 5 ppm AFM1, compared to natamycin. The strains with a reduction in AFM1 level were sequenced and registered in the NCBI database.In total, 15 samples with contamination higher than the allowed limit included Penicillium spp, Aspergillus niger, Saccharomyces cerevisia, Saccharomyces paradoxus, and Yarrowia lipolytica.The results also showed reduced AFM1 levels in three LAB-treated strains. Lactobacillus fermentum CECT562 (T), Lactobacillus brevis ATCC14869 (T), and Enterococcus faecium LMG 11423 (T) had this capability to 0.05, 0.03, and 0.03 respectively. The National Iranian Standard should be implemented to have control over traditional dairy products with more care. The three LABs selected in the current study revealed a significant effect on reducing AFM1 levels in traditional milk and cheese.

Structural damage detection using finite element model updating with evolutionary algorithms: a survey

Structural damage identification based on finite element (FE) model updating has been a research direction of increasing interest over the last decade in the mechanical, civil, aerospace, etc., engineering fields. Various studies have addressed direct, sensitivity-based, probabilistic, statistical, and iterative methods for updating FE models for structural damage identification. In contrast, evolutionary algorithms (EAs) are a type of modern method for FE model updating. Structural damage identification using FE model updating by evolutionary algorithms is an active research focus in progress but lacking a comprehensive survey. In this situation, this study aims to present a review of critical aspects of structural damage identification using evolutionary algorithm-based FE model updating. First, a theoretical background including the structural damage detection problem and the various types of FE model updating approaches is illustrated. Second, the various residuals between dynamic characteristics from FE model and the corresponding physical model, used for constructing the objective function for tracking damage, are summarized. Third, concerns regarding the selection of parameters for FE model updating are investigated. Fourth, the use of evolutionary algorithms to update FE models for damage detection is examined. Fifth, a case study comparing the applications of two single-objective EAs and one multi-objective EA for FE model updating-based damage detection is presented. Finally, possible research directions for utilizing evolutionary algorithm-based FE model updating to solve damage detection problems are recommended. This study should help researchers find crucial points for further exploring theories, methods, and technologies of evolutionary algorithm-based FE model updating for structural damage detection.

The Effect of Locally Administered Pamidronate on Autogenous Bone Graft in Maxillofacial Reconstruction: A Randomized Clinical Trial

BACKGROUND

Although bone grafts are commonly used in reconstructive surgeries, they are sensitive to local perfusion and are thus prone to severe resorption. Biphosphonates can inactivate osteoclasts and can be used to control the undesirable bone resorption.

OBJECTIVE

To assess the effect of administration of biphosphonates on bone resorption.

METHODS

20 patients with bony defects who were candidates for free autogenous grafts were randomized into "pamidronate" and "control" groups. Bone segments were soaked in either pamidronate solution or normal saline and were inserted into the area of the surgery. Bone densities were measured post-surgery and in 6-month follow-up. Data were obtained via Digora software and analyzed.

RESULTS

The mean±SD bone density in pamidronate group changed from 93.4±14.6 to 93.6±17.5 (p<0.05); in the control group the density decreased from 89.7±13.2 to 78.9±11.4 (p<0.05). The mean difference of bone density in anterior areas of the jaws showed higher DXA in comparison to posterior regions (p=0.002).

CONCLUSION

Locally administered pamidronate affects reduction in bone resorption.

Note. Physicochemical Composition of Ten Pomegranate Cultivars (Punica granatum L.) Grown in Iran

Ten pomegranate varieties were analysed for their percent of skin, juice, seed, lipid content and moisture, and sugars, minerals, vitamin C, protein, pH, titrable acidity (TA) and soluble solid content (SSC) of juices. Predominant sugars were fructose (3.50 to 5.96g/100g) and glucose (3.40 to 6.40g/100g). Saccharose and maltose were not practically detected in any variety. K, Na, Ca, Mg, Mn, Cu, Fe, Zn, Pb and Cd were determined by ICP atomic spectroscopy. Contents of K, Na, Ca and Mg were the highest among minerals in fruit juices. The average concentration of vitamin C, protein, TA, SSC and pH were 0.09-0.40mg/100g, 0.29-1.93%, 4.0-24.5g/L, 10.0-16.5°Brix and 2.90-4.21, respectively.

The cytokinesis-blocked micronucleus assay: dose-response calibration curve, background frequency in the population and dose estimation

An in vitro study of the dose responses of human peripheral blood lymphocytes was conducted with the aim of creating calibrated dose-response curves for biodosimetry measuring up to 4 Gy (0.25-4 Gy) of gamma radiation. The cytokinesis-blocked micronucleus (CBMN) assay was employed to obtain the frequencies of micronuclei (MN) per binucleated cell in blood samples from 16 healthy donors (eight males and eight females) in two age ranges of 20-34 and 35-50 years. The data were used to construct the calibration curves for men and women in two age groups, separately. An increase in micronuclei yield with the dose in a linear-quadratic way was observed in all groups. To verify the applicability of the constructed calibration curve, MN yields were measured in peripheral blood lymphocytes of two real overexposed subjects and three irradiated samples with unknown dose, and the results were compared with dose values obtained from measuring dicentric chromosomes. The comparison of the results obtained by the two techniques indicated a good agreement between dose estimates. The average baseline frequency of MN for the 130 healthy non-exposed donors (77 men and 55 women, 20-60 years old divided into four age groups) ranged from 6 to 21 micronuclei per 1000 binucleated cells. Baseline MN frequencies were higher for women and for the older age group. The results presented in this study point out that the CBMN assay is a reliable, easier and valuable alternative method for biological dosimetry.

Identification of Mucorales isolates from soil using morphological and molecular methods

Background and Purpose:

Soil is the main habitat of saprophytic and pathogenic fungi. Mucoromycotina constitutes a large group of soil fungi, with certain opportunistic members causing systemic infections in immunocompromised hosts. The majority of human and animal infections are caused by the members of the genera Rhizopus, Mucor, Rhizomucor, Lichtheimia (Absidia), Cunninghamella, and Mortierella. Accordingly, in the present study, we aimed to isolate and identify the main genera of the order Mucorales, using molecular assays and morphological features.

Materials and Methods:

In total, 340 soil samples were collected from seven public parks throughout the city and sidewalk gardens in 14 municipal districts in Isfahan, Iran. All the samples were cultured on the appropriate media, incubated at 27°C for 2- 4 days, and examined daily for visible fungal growth. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was applied and macroscopic, microscopic, and physiological characteristics were assessed to identify fungal colonies.

Results:

400 pure colonies, belonging to the orders Mucorales and Mortierellales, including the genera Lichtheimia, Rhizopus, Rhizomucor, Mucor, Cunninghamella, and Mortierella, were identified. The genus Rhizopus (35.5%) was the most frequent isolate, followed by Mucor (32.25%) and Rhizomucor (27.5%).

Conclusion:

The results emphasize the importance of opportunistic fungi in public areas and indicate the risk of exposure for immunocompromised individuals.

New Pd(ii) complexes of sulfur ylides; synthesis, X-ray characterization, a theoretical study and catalytic activity toward the Mizoroki–Heck reaction

The reaction of sulfur ylides SMe₂C(H)C(O)R (R = 4-nitrophenyl, phenyl, and 3-nitrophenyl) with [PdCl₂(cod)] gives the new Pd(ii) complexes of type cis- and trans-[PdCl₂(SMe₂C(H)C(O)R)₂] (R = phenyl (1), 3-nitrophenyl (2), and 4-nitrophenyl (3)).

Landscape variation in tree species richness in northern Iran forests

Mapping landscape variation in tree species richness (SR) is essential to the long term management and conservation of forest ecosystems. The current study examines the prospect of mapping field assessments of SR in a high-elevation, deciduous forest in northern Iran as a function of 16 biophysical variables representative of the area's unique physiography, including topography and coastal placement, biophysical environment, and forests. Basic to this study is the development of moderate-resolution biophysical surfaces and associated plot-estimates for 202 permanent sampling plots. The biophysical variables include: (i) three topographic variables generated directly from the area's digital terrain model; (ii) four ecophysiologically-relevant variables derived from process models or from first principles; and (iii) seven variables of Landsat-8-acquired surface reflectance and two, of surface radiance. With symbolic regression, it was shown that only four of the 16 variables were needed to explain 85% of observed plot-level variation in SR (i.e., wind velocity, surface reflectance of blue light, and topographic wetness indices representative of soil water content), yielding mean-absolute and root-mean-squared error of 0.50 and 0.78, respectively. Overall, localised calculations of wind velocity and surface reflectance of blue light explained about 63% of observed variation in SR, with wind velocity accounting for 51% of that variation. The remaining 22% was explained by linear combinations of soil-water-related topographic indices and associated thresholds. In general, SR and diversity tended to be greatest for plots dominated by Carpinus betulus (involving ≥ 33% of all trees in a plot), than by Fagus orientalis (median difference of one species). This study provides a significant step towards describing landscape variation in SR as a function of modelled and satellite-based information and symbolic regression. Methods in this study are sufficiently general to be applicable to the characterisation of SR in other forested regions of the world, providing plot-scale data are available for model generation.

Bone Reconstruction following Application of Bone Matrix Gelatin to Alveolar Defects: A Randomized Clinical Trial

BACKGROUND

Conventional dentoalveolar osseous reconstruction often involves the use of graft materials with or without barrier membranes.

OBJECTIVE

To evaluate the efficacy of bone induction by bone matrix gelatin (BMG), delivered on an absorbable collagen sponge (ACS), compared to a placebo (ACS alone) in human alveolar socket defects.

METHODS

20 alveolar sockets from 10 healthy adults were studied. In all cases, both the mandibular premolar area and the contralateral premolar area (as the control site) were involved. In each of the 10 patients, the extraction sites were filled randomly with BMG and ACS. The repair response was examined on day 90. Qualitative histological and quantitative histometric analysis, including the percentage of new-formed bone fill and density were done.

RESULTS

Assessment of the alveolar bone indicated that patients treated with BMG had significantly (p<0.05) better bone quality and quantity compared to the controls. In addition, bone density and histology revealed no differences between the newly induced and native bone.

CONCLUSION

The data from this single-blind clinical trial demonstrated that the novel combination of BMG had a striking effect on de novo osseous formation for the bone regeneration.

Spreader graft placement: a simplified technique for young surgeons

The spreader graft is a longitudinal graft placed between the dorsal septum and the upper lateral cartilage in a submucoperichondrial pocket. This graft has functional and aesthetic indications. Although placement and suturing of the spreader graft to the septum is an easy part of rhinoplasty for the experienced surgeon, it can be difficult and time-consuming for young surgeons. Here we suggest a very simple technique for easier placement and suturing of spreader grafts.

Finite element analysis on longitudinal and radial functionally graded femoral prosthesis

This study focused on developing a 3D finite element model of functionally graded femoral prostheses to decrease stress shielding and to improve total hip replacement performance. The mechanical properties of the modeled functionally graded femoral prostheses were adjusted in the sagittal and transverse planes by changing the volume fraction gradient exponent. Prostheses with material changes in the sagittal and transverse planes were considered longitudinal and radial prostheses, respectively. The effects of cemented and noncemented implantation methods were also considered in this study. Strain energy and von Mises stresses were determined at the femoral proximal metaphysis and interfaces of the implanted femur components, respectively. Results demonstrated that the strain energy increased proportionally with increasing volume fraction gradient exponent, whereas the interface stresses decreased on the prostheses surfaces. A limited increase was also observed at the surfaces of the bone and cement. The periprosthetic femur with a noncemented prosthesis exhibited higher strain energy than with a cemented prosthesis. Radial prostheses implantation displayed more strain energy than longitudinal prostheses implantation in the femoral proximal part. Functionally graded materials also increased strain energy and exhibited promising potentials as substitutes of conventional materials to decrease stress shielding and to enhance total hip replacement lifespan.

Blood pressure, height, weight and body mass index of primary school students in a low socio-economic district in Turkey

AIM

This study was conducted to evaluate the growth and blood pressure measurements of the students.

BACKGROUND

School health services are important to evaluate, protect and to improve the health status of the students. This study was conducted to evaluate the growth and blood pressure measurements of the students who were registered in a primary school with low socio-economic level in Kayseri Province in Türkiye between 1 April 2004 and 30 May 2004. The data were collected using questionnaire and health-screening forms.

FINDINGS

It was determined that the average age was 9.77 +/- 2.41 in girls and 10.16 +/- 14.70 in boys. It was observed that the average height was 137.95 +/- 14.70 cm, and the average weight was 33.07 +/- 10.08 kg for all students. The girls between 10 years and 12 years old had a better average body mass index (kg/m(2)) (BMI) compared with boys. Boys between 6 years and 9 years old had a better BMI than the girls. The difference between the groups was considered statistically important (P = 0.006 and P = 0.002, respectively). Furthermore, 4.9% of the students were underweight and 2.2% of the students were obese. It was thought that there was a positive correlation among height, weight, BMI, age and the blood pressure values; and as BMI and age increased, so did the blood pressure value.

CONCLUSION

Cooperation and dialogue need to be established among the school directorate, the families and the students to promote and encourage proper growth development and nutrition of the students within the school health services.

Evidence of resilience in families of children with autism

BACKGROUND

Family resilience is a growing field of inquiry, investigating factors that contribute to a family's becoming stronger in spite of dealing with adversity. Despite the growing interest in studying family resilience, the topic has not been explored in families with children who have disabilities. This report, a part of a larger study--using both quantitative and qualitative methodologies--is an examination of factors of family resilience in the families of children with autism. Evidence of family resilience such as family connectedness and closeness, positive meaning-making of the disability, and spiritual and personal growth were identified and examined in this part of the study.

METHOD

The study uses a survey methodology, analysing responses to several rating scales and written responses to three open-ended questions. Survey respondents consisted of 175 parents and other primary caregivers of a child with autism--ages between 2 and 18 years.

RESULTS

Results suggest identification of specific resilience processes, such as: making positive meaning of disability, mobilization of resources, and becoming united and closer as a family; finding greater appreciation of life in general, and other people in specific; and gaining spiritual strength.

CONCLUSIONS

This study presents evidence that a considerable number of families of children with autism display factors of resilience--reporting having become stronger as a result of disability in the family.

[Inguinal arteriovenous fistula after hernia surgery]

A 57-year-old man who 16 years earlier had been operated on for right-sided inguinal hernia and since had undergone reoperation four times for recurrent symptoms from the region, presented with an arteriovenous fistula originating from the right inguinal area, with varicose veins spreading towards the umbilicus. Angiography confirmed the diagnosis and the fistula was resected, after which the symptoms completely disappeared.

Effect of moderate exercise on blood flow in the gastrointestinal tract in trained conscious miniature swine

AIM

To examine how moderate exercise affects the blood flow in the gastrointestinal tract.

MATERIALS AND METHODS

Twelve miniature swine weighing 38-43 kg were used. All animals were trained on a cardiac exercise treadmill. Blood flow measurements were done on conscious animals using labeled microspheres with a diameter of 16.5 +/- 0.1 (SD) microm. The first flow was measured while the animal was awake and resting, the second flow after 15 min of exercise, the third flow after 30 min of rest.

RESULTS

Flow in the oesophagus at rest was 19.5 +/- 1.3 (SEM) ml/min/100 g. During exercise the flow decreased to 13.3 +/- 1.2 (SEM) ml/min/100 g (ns). After 30 min of rest the flow was 9.9 +/- 1.2 (SEM) ml/min/100 g (p < 0.05 when comparing the flow before and after exercise). Flow in the cardia at rest was 23.1 +/- 1.3 (SEM) ml/min/100 g. During exercise the flow decreased to 14.0 +/- 1.2 (SEM) ml/min/100 g (p < 0.05). After 30 min of rest the flow was 15.0 +/- 1.2 (SEM) ml/min/100 g. Flow in the pylorus at rest was 38.9 +/- 1.1 (SEM) ml/min/100 g. During exercise the flow decreased to 24.6 +/- 1.1 (SEM) ml/min/100 g (p < 0.01). After 30 min of rest the flow was 26.9 +/- 1.2 (SEM) ml/min/100 g. Blood flow in the small and large intestine was mainly unaffected by moderate exercise.

CONCLUSION

Under moderate exercise, blood flow in the upper part of the gastrointestinal tract declines while it is mainly unaffected in the duodenum, small and large intestine.

Generalized tetanus in a patient with a diabetic foot infection

Tetanus is a preventable disease that continues to affect people in the United States due to poor immunization practices in our health care system. A 57-year-old man with type 2 diabetes mellitus, hypertension, and end-stage renal disease with many hospital admissions came to the hospital emergency department because of a blackened great toe. He denied pain in the toe or knowledge of foot injury. The patient also complained of temporomandibular tenderness accompanied by inability to open his mouth completely. The man's problems progressed to generalized tetanus and required a long hospitalization. Clostridium tetani can flourish in the anaerobic environment of a diabetic foot infection. Practitioners should be aware of tetanus as a rare but potentially serious complication of diabetic foot infections.

Direct and quantitative vitamin B12 absorption measurement in patients with disorders in the distal part of the bowel. Comparison of stool spot test [SST] with whole body counting in patients with ileal pelvic reservoir, ileostomy or Crohn's disease

Direct and quantitative vitamin B12 absorption studies were performed in 25 patients with disorders in the distal small intestine using whole body counting as the gold standard. Simultaneously, vitamin B12 absorption was also determined by the more simple stool spot test (SST) which incorporates 51CrCl3 as a nonabsorbable marker. The SST provided a reliable direct and quantitative measure of vitamin B12 absorption in patients with previous ileal resections due to Crohn's disease (CD) (n = 7) as compared with whole body counting. In ulcerative colitis (UC) patients with either an ileal pelvic reservoir (n = 10) or a conventional ileostomy (n = 8), markedly shorter bowel transit times and absence of colon may have hindered sufficient mixture of the tracer and marker isotopes which could explain the false absorption values according to the SST in single patients. Therefore, an intact colon and a near-normal bowel transit time seem to be essential for performance of the SST. Whole body counting showed, as expected, that all CD patients except one had decreased vitamin B12 absorption (median 23%; range 3-39%) (normally > 35%). In UC patients with ileostomy, only one had a markedly decreased vitamin B12 absorption, two borderline normal values, while the rest had normal values (median 54%, range 15-76%). All UC patients with ileal pelvic reservoir had normal vitamin B12 absorption values (median 40.5%, range 36-87%). We conclude that vitamin B12 substitution therapy is probably required in patients with CD with ileal resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Autotransplantation of splenic tissue in an isolated segment of small intestine

The ability of splenic tissue to regenerate when implanted in an isolated segment of small intestine with intact circulation was studied in six pigs. After total splenectomy, 10 per cent of the weight of the spleen was implanted in a 10-15-cm long isolated segment of small intestine with an intact vascular supply. Bowel continuity was established by end-to-end anastomosis. Before implantation, the mucosal layer was completely removed from the isolated segment of the small intestine. The animals were killed 6 months later and the isolated segment of small bowel containing the splenic tissue identified. Most of the implanted splenic tissue was recovered in the isolated segment of small intestine; the weight ranged from 43 to 120 (mean 80) per cent of that of the implanted tissue. An isolated segment of small intestine with an intact circulation produces a higher index of regeneration than other previously reported sites.