Production and properties of a bioemulsifier obtained from a lactic acid bacterium.

In the present work, the production of bioemulsifier (BE) by a lactic acid bacterium (LAB) grown at 25 °C in lactic whey-based media for 24 h was evaluated. Maximum production was detected in a medium containing yeast extract, peptone and lactic whey (LAPLW medium), with a yield of 270 mg L-1. The BE proved to be more innocuous for Caco-2 cells, used as a toxicological indicator, than the non-ionic surfactant Triton X-100. In addition, the microbial product presented higher stability to changes in temperature (37 °C to 100 °C), pH (2-10), and salt concentration (5% and 20%, w/v) than the synthetic surfactant. Regarding emulsifying capacity tested against different hydrophobic substrates (kerosene, motor oil, diesel, sunflower oil, and grape oil), the BE displayed E24 values similar to or even better than those of Triton X-100. Finally, Triton X-100 caused irreversible modifications on the giant unilamellar vesicles (used as model membrane system), promoting the solubilization of the lipid bilayers. Nevertheless, BE induced temporary modifications of the membrane, which is associated with incorporation of the bioproduct in the outer layer. These results demonstrate the role of BE in biological processes, including reversible changes in microbial membranes to enhance the access to hydrophobic substrates.

Divergence in mating signals correlates with genetic distance and behavioural responses to playback.

Animals use acoustic signals to defend resources against rivals and attract breeding partners. As with many biological traits, acoustic signals may reflect ancestry; closely related species often produce more similar signals than do distantly related species. Whether this similarity in acoustic signals is biologically relevant to animals is poorly understood. We conducted a playback experiment to measure the physical and vocal responses of male songbirds to the songs of both conspecific and allopatric-congeneric animals that varied in their acoustic and genetic similarity. Our subjects were territorial males of four species of neotropical Troglodytes wrens: Brown-throated Wrens (Troglodytes brunneicollis), Cozumel Wrens (T. beani), Clarion Wrens (T. tanneri) and Socorro Wrens (T. sissonii). Our results indicate that birds respond to playback of both conspecific and allopatric-congeneric animals; that acoustic differences increase with genetic distance; and that genetic divergence predicts the strength of behavioural responses to playback, after removing the effects of acoustic similarity between subjects' songs and playback stimuli. Collectively, these results demonstrate that the most distantly related species have the most divergent songs; that male wrens perceive divergence in fine structural characteristics of songs; and that perceptual differences between species reflect evolutionary history. This study offers novel insight into the importance of acoustic divergence of learned signals and receiver responses in species recognition.

Adjuvant chemotherapy for elderly patients with stage I non-small-cell lung cancer ≥4 cm in size: an SEER-Medicare analysis.

BACKGROUND: The role of adjuvant chemotherapy for non-small-cell lung cancer (NSCLC) stage I patients with tumors size ≥4 cm is not well established in the elderly. PATIENTS AND METHODS: We identified 3289 patients with stage I NSCLC (T2N0M0 and tumor size ≥4 cm) who underwent lobectomy from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database diagnosed from 1992 to 2009. Overall survival and rates of serious adverse events (defined as those requiring admission to hospital) were compared between patients treated with resection alone, platinum-based adjuvant chemotherapy, or postoperative radiation (PORT) with or without adjuvant chemotherapy. Propensity scores for receiving each treatment were calculated and survival analyses were conducted using inverse probability weights based on the propensity score. RESULTS: Overall, 84% patients were treated with resection alone, 9% received platinum-based adjuvant chemotherapy, and 7% underwent PORT with or without adjuvant chemotherapy. Adjusted analysis showed that adjuvant chemotherapy [hazard ratio (HR), 0.82; 95% confidence interval (CI) 0.68-0.98] was associated with improved survival compared with resection alone. Conversely, the use of PORT with or without adjuvant chemotherapy (HR 1.91; 95% CI 1.64-2.23) was associated with worse outcomes. Patients receiving adjuvant chemotherapy had more serious adverse events compared with those treated with resection alone, with neutropenia (odds ratio, 21.2; 95% CI 5.8-76.6) being most significant. No significant difference was observed in rates of fever, cytopenias, nausea, and renal dysfunction. CONCLUSIONS: Platinum-based adjuvant chemotherapy is associated with reduced mortality and increased serious adverse events in elderly patients with stage I NSCLC and tumor size ≥4 cm.

Competency frameworks for advanced practice nursing: a literature review.

AIM: This paper describes a literature review that identified common traits in advanced practice nursing that are specific to competency development worldwide. BACKGROUND: There is a lack of international agreement on the definition of advanced practice nursing and its core competencies. Despite the lack of consensus, there is an ongoing process worldwide to establish and outline the standards and competencies for advanced practice nursing roles. INTRODUCTION: International agencies, such as the International Council of Nurses, have provided general definitions for advanced practice nursing. Additionally, a set of competency standards for this aim has been developed. METHODS: A literature review and a directed search of institutional websites were performed to identify specific developments in advanced practice nursing competencies and standards of practice. To determine a competency map specific to international advanced practice nursing, key documents were analysed using a qualitative approach based on content analysis to identify common traits among documents and countries. RESULTS: The review process identified 119 relevant journal articles related to advanced practice nursing competencies. Additionally, 97 documents from grey literature that were related to advanced practice nursing competency mapping were identified. From the text analysis, 17 worldwide transversal competency domains emerged. CONCLUSIONS: Despite the variety of patterns in international advanced practice nursing development, essential competency domains can be found in most national frameworks for the role development of international advanced practice nursing. These 17 core competencies can be used to further develop instruments that assess the perceived competency of advanced practice nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The results of this review can help policy developers and researchers develop instruments to compare advanced practice nursing services in various contexts and to examine their association with related outcomes.

Brain metastases from prostate adenocarcinoma.

Brain metastases of prostate adenocarcinoma are rare. We report a case of brain metastases from prostate adenocarcinoma 15 months after the diagnosis of the primary tumour. The patient had headache and one solitary metastasis upon magnetic resonance imaging (MRI). The biopsy performed showed metastatic prostate adenocarcinoma. He was treated with surgery and cranial irradiation.

Concurrent chemoradiation for locally advanced stage III non-small cell lung cancer with cisplatin, vinorelbine, and thoracic radiotherapy: a phase II study from the Galician Lung Cancer Group.

PURPOSE: The aim of this phase II study was to evaluate the activity and safety of the combination of cisplatin and vinorelbine with thoracic radiotherapy in unresectable locally advanced stage III non-small cell lung cancer (NSCLC). The primary endpoint was the objective response rate (ORR). Secondary objectives included toxicity profile, progression-free survival (PFS), and overall survival (OS). MATERIALS AND METHODS: A total of 48 NSCLC patients were enrolled (median age 60 years, 52% stage IIIA and 48% stage IIIB, 52% adenocarcinoma). Patients received three cycles of chemotherapy every 21 days [intravenous cisplatin 80 mg/m2 and intravenous vinorelbine 25 mg/m2 on day 1 and oral vinorelbine on day 8 (60 mg/m2)] concurrent with radiotherapy (66 Gy, administered at 1.8 Gy per day, five consecutive days per week). RESULTS: ORR was 79.2% (72.9% showing partial response and 6.3% showing complete response). With a median follow-up of 20.7 months, median PFS was 12 months and median OS was 36 months. Grade 3/4 toxicities were: neutropenia (14.5%), anaemia (6.2%), vomiting (2%), and oesophagitis (4.2%). No toxic deaths were reported. CONCLUSION: This combined regimen shows efficacy and a manageable safety profile. PFS and OS outcomes are encouraging and warrant further research.

The effect of calcium ion on the urea denaturation of immobilized bovine trypsin.

The effect of calcium ion on the urea denaturation of trypsin has been investigated. By using trypsin immobilized on glass beads, all possibilities of autolysis occurring during the denaturation process are eliminated. It was found that in 8 M urea calcium ion markedly decreases the denaturation rate of the immobilized trypsin. Conversely, the presence of calcium ion markedly accelerates the rate of renaturation of denatured immobilized trypsin. Calcium may exert its stabilizing effect on the tertiary structure of the protein by coordination to the side chains of Asp 194, Ser 190 and the carbonyl group of Ser 139 (using the chymotryptic numbering system).

Social and psychological characteristics of Kuwaiti children and adolescents with type 1 diabetes.

Type 1 diabetes mellitus is a chronic disease that may have an impact on children's psychosocial adjustment. This study aimed to investigate the psychosocial characteristics of Kuwaiti children with type 1 diabetes as compared to healthy children without diabetes, and assess the impact of glycaemic control on psychosocial variables. A total of 349 school children aged 6-18 years with type 1 diabetes, and 409 children without diabetes having comparable age, gender, and social class were included in the study. Data were obtained by interviewing children and parents using a questionnaire. Psychological distress was measured by the Hopkins symptoms checklist-25 scale including anxiety and depression. Glycaemic control was assessed by glycosylated haemoglobin, HbA(IC) level. Glycaemic control was considered 'good to excellent' at HbA(IC)<8.0%, 'fair' at HbA(IC) 8.1 to 10.0%, and 'poor' at HbA(IC)>10.0%. Median scores of anxiety, depression, and total distress were significantly higher in children with diabetes indicating worse psychological adjustment. There was also significant difference between children with diabetes and those without diabetes in social aspects and school absence days. There was significant positive correlation between HbA(IC) concentration and scores of the psychological functioning indices. Children with poor glycaemic control had worse psychological adjustment. After controlling the variance accounted by gender and age, stepwise multiple regression analysis showed that girls, older children, children in need of emotional support, and those with higher HbA(IC) were at higher risk for psychological maladjustment. These variables explained 47.9% of the variation in total distress. In conclusion, the study supported our hypotheses. Children with diabetes had worse psychological adjustment, and distress was related to glycaemic control. Since psychological distress increases the risk for future complications due to its relation with glycaemic control, longitudinal studies are recommended to identify children with diabetes having distress at an early stage when preventive interventions are effective.

Factors associated with type 1 diabetes in Kuwaiti children.

Type 1 diabetes is a common chronic disease in childhood, and the outcome of environmental, genetic and immunologic interactions. The aim was to study the social and metabolic characteristics (lipids, lipoproteins, apolipoproteins, lipoprotein a (Lpa) and total sialic acid) and predisposing factors in 6-18-year-old Kuwaiti children with type 1 diabetes. This pair-matched case-control study included 348 type 1 diabetic children (131 males, 217 females) matched by age and gender to 348 non-diabetic controls. Diabetic children were identified, according to the WHO and the American Diabetes Association criteria, at 182 randomly selected schools. Social and metabolic characteristics were adversely affected in diabetic children compared to their controls. The logistic regression analysis showed that the predisposing factors: family history of type 1 and type 2 diabetes and thyroid disease, were significant associated factors with type 1 diabetes after adjusting for demographic and social variables. The significant correlations of Lpa and total sialic acid with glycated haemoglobin, lipoproteins and apolipoproteins partially explain reporting them as possible markers for coronary heart disease. There are adverse metabolic changes in children with type 1 diabetes. As these changes are associated with early onset atherogenesis, metabolic markers need to be measured and possibly corrected at an early stage in children with diabetes.

Color selection with a hygromycin-resistance-based Escherichia coli-mycobacterial shuttle vector.

Hygromycin-resistance (HyR)-based Escherichia coli-mycobacterial shuttle plasmids have high efficiencies of transformation and a broad mycobacterial host range. We have introduced a lacZ alpha (encoding the alpha-polypeptide fragment of beta-galactosidase (beta Gal))-multiple cloning site cassette into a HyR-based shuttle vector to generate a plasmid with nine unique cloning sites and the added feature of beta Gal color selection in appropriate E. coli host strains.

Current use of adequate preparticipation history forms for heart disease screening of high school athletes.

OBJECTIVE: To determine the proportion of US high schools using sports preparticipation evaluation (PPE) forms containing the 3 elements of the medical history currently recommended for screening young athletes for heart disease, including questions about exercise-related symptoms, previous diagnosis of heart murmur or high blood pressure, and family history of early myocardial infarction or sudden death. DESIGN: A random, population-based mail survey was conducted of 500 US high schools. The survey was mailed to the athletic trainer at each school. Each trainer was asked to complete and return a brief survey along with a copy of the PPE form used at that school. PARTICIPANTS: High schools employing an athletic trainer who is a member of the National Athletic Trainers Association. MAIN OUTCOME MEASURE: The proportion of PPE forms containing all 3 components of the recommended cardiac screening history, RESULTS: Of the 500 high schools surveyed, 254 (50.8%) responded. Of the PPE forms received, 47 (25.3%) included questions about exercise-related symptoms, 97 (52.2%) included questions about a previous diagnosis of heart murmur or high blood pressure, and 57 (30.7%) had questions about a family history of early myocardial infarction or sudden death. Only 32 (17.2%) of the PPE forms received contained all 3 components of the recommended cardiac screening history. CONCLUSIONS: Only 17.2% of high schools in this nationwide survey use PPE forms that contain all the elements of the cardiac history recommended by the American Academy of Pediatrics for identifying young athletes at risk for sudden death.

Temporal profile of the directional tuning of the discharge of dorsal premotor cortical cells.

This study examined the directional modulation of dorsal premotor (PMd) cells as a function of time in an instructed delay, reaching task that systematically varied direction and accuracy constraints. In two monkeys, the activity of 150 PMd cells was recorded and the preferred direction (PD) of the firing as a function of time, the PD trajectory, was calculated. Forty-one cells had nearly continuous significant directional tuning of at least 1 s duration (mean duration 1694 +/- 754 ms) that began in the instructed delay period and continued into the movement period. The PD gradually changed in time (mean change of 47.7 +/- 40.8 degrees), a change best described as a rotation. The change in the directional tuning as a function of time is consistent with the hypothesis that the PMd plays a role in the non-standard mapping of sensory stimuli into motor commands.

Bilateral anterior inferior iliac spine avulsion fractures.

A case of bilateral groin pain of sudden onset in a 14-yr-old boy is presented. The patient reported sudden onset of pain in both inguinal regions during a 100-m dash. He presented a week later to the clinic where physical examination revealed a shuffling gait, bilateral hip flexion contractures, limited active and passive hip extension, and bilateral weakness of hip flexion and knee extension. Plain radiographs of the pelvis revealed avulsion fragments minimally displaced from both anterior inferior iliac spines (AIIS). Pain relief in the acute phase was achieved by limiting ambulation until weight bearing was painless. The patient was treated conservatively and returned to full speed running in 10 wk. Only one case of bilateral AIIS avulsion fractures has previously been reported. AIIS avulsion fractures that are not widely displaced may be treated conservatively. Following a careful program of rehabilitation, full functional recovery following AIIS avulsion fractures may be achieved in 4-6 wk.

Low spinal and pelvic bone mineral density among individuals with Down syndrome.

The bone mineral density of 15 adults with Down syndrome was compared to 25 control subjects without Down syndrome. Bone mineral density was measured by dual x-ray absorptiometry with a Lunar DPX scanner. Arm, leg, pelvic, and spine bone mineral density was tested. Analysis of covariance was conducted for each variable; Down syndrome was the independent variable, and the covariates were height, lean body mass, fat mass, age, and gender. No significant group differences were found for arm or leg bone mineral density. Individuals with Down syndrome had significantly lower pelvic and spinal bone mineral density. Before adjustment for covariates, percentage difference between group means for spine was 14.5% and for pelvis, 11.6%. Adjusted percentage was 11.1% and 13.9%, respectively. Suggestions for further research were made.

Comparisons of the oscillatory shear viscoelasticity and composition of pathological synovial fluids.

Rheological and compositional properties of pathological synovial fluids were measured and compared in order to reveal differences between disease states. The cases include degenerative joint disease, rheumatoid arthritis, mixed connective tissue disease, and pseudogout. Using an oscillatory flow capillary instrument, measurements were made of both the frequency and shear rate dependence of the complex viscoelasticity. The fluid types differ most in their elasticity, with the degenerative joint disease fluids having the greatest average viscosity, elasticity and intrinsic viscosity, followed by the rheumatoid arthritis fluids, and the fluids from cases of mixed connective tissue disease. Differences in the hyaluronate and protein concentrations are not as great as those between rheological variables. The viscoelasticity of synovial fluid appears more strongly dependent on the degree of polymerization of hyaluronate than on its concentration. These synovial fluids conform well to a model of relaxation process truncation. Distinct types of elastic stress-strain behavior reveal the nature of the dynamic fluid structure.

Primary motor cortex neuronal discharge during reach-to-grasp: controlling the hand as a unit.

This study has begun to test the hypothesis that aspects of hand/object shape are represented in the discharge of primary motor cortex (M1) neurons. Two monkeys were trained in a visually cued reach-to-grasp task, in which object properties and grasp forces were systematically varied. Behavioral analyses show that the reach and grasp force production were constant across the objects. The discharge of M1 neurons was highly modulated during the reach and grasp. Multiple linear regressions models revealed that the M1 discharge was highly dependent on the object grasped, with object class, volume, orientation and grasp force as significant predictors. These findings are interpreted as evidence that the CNS controls the hand as a unit.

Ability of middle-school soccer players to localize overuse leg pain correctly using a graphic self-report form.

This study was conducted to assess the probability of success with which middle-school-age soccer players could correctly localize lower leg pain to sites of common overuse injuries, using a graphic self-report instrument. Subjects included 98 middle-school soccer players, ages 12 to 15 years. Players' self-reports of leg pain were compared with the results of a blind physical examination. Players reporting pain of more than two weeks' duration successfully localized a statistically significant number of their sites of pain using the graphic form, providing evidence of concurrent validity. Further development is needed before the measure can be used in surveillance of overuse injuries in youth sports.

Insuficiencia suprarrenal secundaria: una causa subestimada de hiponatremia euvolemica

RESUMEN Introducción: La hiponatremia por insuficiencia suprarenal secundaria es subestimada tratamiento inapropiados. Objetivos: Describir las características clínicas y bioquímicas de pacientes con hiponatremia por insuficiencia suprarrenal secundaria y sus causas. Materiales y Metodos: Revisión retrospectiva de historias clínicas de pacientes consultantes a un hospital de tercer nivel entre Enero 2015 a Septiembre 2017 con hiponatremia y bioquímica de insuficiencia suprarenal secundaria. Los hallazgos fueron comparados con los reportados por estudios previamente publicados. Resultados: Todos los pacientes con insuficiencia suprarrenal secundaria se presentaron con hiponatremia euvolemica hipotónica. 54.5% eran mujeres, la edad promedio fue 57 años. Solo 1 paciente tuvo hiponatremia leve. La mediana de la concentración de cortisol fue 2.8 mcg/dL (RIQ 1.75-3.25 mcg/dL) y la de ACTH fue de 7.7 pg/nL (RIQ 4.5-9.5 pg/nL). Todos los pacientes tuvieron densidad urinaria alta indistinguible del SSIDH. El hipogonadismo hipogonadotrópico y el hipotiroidismo central fueron las alteraciones de ejes hipofisarios mas comúnmente asociados. La presencia de hipoglicemia, hipotensión e hipercaliemia fue baja. La causa más frecuente fue silla turca vacía. Conclusiones: La hiponatremia hipotonica euvolémica es una presentación común de insuficiencia suprarrenal secundaria y no suele acompañarse de otras manifestaciones de deficiencia de glucocorticoides. Es clínica y bioquímicamente indistinguible del SSIDH. Un bajo umbral de sospecha y la medición de cortisol serico matutino es esencial en estos pacientes para evitar un diagnostico y manejo inapropiados.

ABSTRACT Introduction: Hyponatremia due to secondary adrenal insufficiency is frequently underestimated and underdiagnosed. This paper underscores the importance of an adequate evaluation of euvolemic hyponatremia to avoid an inappropriate treatment and diagnosis. Objectives: To describe the clinical and biochemical characteristics of patients with hyponatremia due to secondary adrenal insufficiency and its causes. Materials and Methods: A retrospective review of the clinical records of patients presenting to a third level hospital between January 2015 to September 2017 with hyponatremia and a biochemical profile of secondary adrenal insufficiency. Findings were compared with previously published reports. Results: All patients with secondary adrenal insufficiency presented with hypotonic euvolemic hyponatremia. 54.5% of patients were females, median age was 57 years. Only 1 patient had mild hyponatremia. Cortisol median concentration was 2.8 mcg/dL (IQR 1.75-3.25 mcg/dL) and median ACTH concentration was 7.7 pg/nL (IQR 4.5-9.5 pg/nL). All the patients had high urinary density and features indistinguishable from SIADH. Hypogonadotropic hypogonadism and central hypothyroidism were the most commonly accompanying hypophyseal axis. Hypoglycemia, hypotension, and hyperkalemia were infrequent findings in these patients. The most frequent etiology identified was empty sella syndrome. Conclusions: Euvolemic hypotonic hyponatremia is a common presentation of secondary adrenal insufficiency and is often not accompanied with other manifestations of glucocorticoid deficiency. This disease is clinical and biochemical indistinguishable from SIADH. A low threshold for suspicion and a serum morning cortisol measurement in these patients is essential to avoid an inappropriate diagnosis and management.

[Preiser's disease. A case study]. / Enfermedad de Preiser. A propósito de un caso.

The idiopathic avascular necrosis of the scaphoid or Preiser's disease is condition about which few cases have been described. In the majority of cases, it is debatable whether it is actually a spontaneous osteonecrosis, or a pathological process secondary to a systematic disease, or a result of chemotherapy treatment, or associated with taking steroids. We present the case of a 20-year old woman, with no previous trauma, with pain in her right wrist, which progressed over a period of four years. It was wrongly diagnosed as a tendinitis, and was treated conservatively without any improvement. A simple X-ray was requested that showed an abnormality of the proximal pole of the scaphoid that was beginning to fragment; a fact which was confirmed later by performing a CT scan. This was followed by nuclear magnetic resonance spectroscopy (NMR), which showed signs of ischaemia, mainly in the proximal pole. There were signs of viability in the distal fragment in the NMR using paramagnetic contrast. After the imaging tests, idiopathic avascular necrosis of the scaphoid was diagnosed. The surgical treatment consisted of the removal of necrotic fragments of the proximal pole and removal of the posterior interosseous-nerve. Two years after the intervention, the patient is asymptomatic and with a complete range of movement in the operated wrist.

whmD is an essential mycobacterial gene required for proper septation and cell division.

A study of potential mycobacterial regulatory genes led to the isolation of the Mycobacterium smegmatis whmD gene, which encodes a homologue of WhiB, a Streptomyces coelicolor protein required for sporulation. Unlike its Streptomyces homologue, WhmD is essential in M. smegmatis. The whmD gene could be disrupted only in the presence of a plasmid supplying whmD in trans. A plasmid that allowed chemically regulated expression of the WhmD protein was used to generate a conditional whmD mutant. On withdrawal of the inducer, the conditional whmD mutant exhibited irreversible, filamentous, branched growth with diminished septum formation and aberrant septal placement, whereas WhmD overexpression resulted in growth retardation and hyperseptation. Nucleic acid synthesis and levels of the essential cell division protein FtsZ were unaltered by WhmD deficiency. Together, these phenotypes indicate a role for WhmD in mycobacterial septum formation and cell division.