Decidual mesenchymal stem/stromal cells from preeclamptic patients secrete endoglin, which at high levels inhibits endothelial cell attachment invitro.

INTRODUCTION: In preeclampsia (PE), inadequate remodelling of spiral arterioles in the decidua basalis causes oxidative stress and subsequent increased release of antiangiogenic soluble endoglin (sENG) into the maternal circulation. Decidual mesenchymal stem/stromal cells (DMSCs) reside adjacent to endothelial cells in this vascular niche. Surprisingly, DMSCs express membrane-bound ENG (CD105). PE-affected DMSCs (PE-DMSCs) are abnormal and due to reduced extravillous invasion, more of them are present, but the significance of this is not known. METHODS: DMSCs were isolated and characterised from normotensive control and severe-PE placentae. Extracellular vesicle (EV) types, shed microvesicles (sMV) and exosomes, were isolated from DMSC conditioned media (DMSCCM), respectively. Secretion of ENG by DMSCs was assessed by ELISA of DMSCCM, with and without EV depletion. The effects of reducing ENG concentration, by blocking antibody, on human umbilical vein endothelial cell (HUVEC) attachment were assessed by xCELLigence real-time functional assays. RESULTS: ENG was detected in DMSCCM and these levels significantly decreased when depleted of exosomes and sMV. There was no significant difference in the amount of ENG secreted by control DMSCs and PE-DMSCs. Blocking ENG in concentrated DMSCCM, used to treat HUVECs, improved endothelial cell attachment. DISCUSSION: In normotensive pregnancies, DMSC secretion of ENG likely has a beneficial effect on endothelial cells. However, in PE pregnancies, shallow invasion of the spiral arterioles exposes more PE-DMSC derived sources of ENG (soluble and EV). The presence of these PE-DMSCs in the vascular niche contributes to endothelial cell dysfunction.

Animacy-Based Accessibility and Competition in Relative Clause Production in Hindi and Malayalam.

Two studies investigated interaction of animacy-based accessibility and competition processes with language specific constraints in shaping production preferences. Relative clause elicitation tasks (Gennari et al. in Cogn Psychol 65:141-176, 2012) were performed by two groups with 40 participants in each. Significantly more passives were produced with animate question/focus and assigned subject function to them in Malayalam, while the difference was insignificant in Hindi with animacy not equating with grammatical function assignment. Both languages produced active objects with OSV order significantly more with animate question/focus. This indicates animacy effect on word order. Animacy also influenced the expression of the agent phase in both languages as a tendency was found to omit the agent by-phase or to delay its appearance, when the two animate nouns entering into the structure are highly similar. The results point to language specific constraints in relative clause production and variability in the role of animacy-based retrieval order across languages.

Three-Dimensional Anorectal Manometry Findings in Primigravida.

BACKGROUND: Vaginal delivery is an identified risk factor for anal sphincter injury. Therefore, to identify postpartum injury, an antepartum value or a normal range is required. However, at present, the normal values of 3D manometry are not available for primigravida or pregnant mothers. AIMS: Our study aims at describing normal values of 3D manometry in primigravida. METHODS: We analyzed 3DARM data of 101 consecutive primigravid mothers in the third trimester. 3DARM was performed using the Given Imaging(®) ManoScan system. RESULTS: The mean age was 24.7 (SD 5.1) years. All patients had a normal Cleveland Clinic Incontinence Score. The mean resting pressure (RP) was 87.02 (SD 18.43) mmHg and the maximum squeeze pressure (SP) was 179.21 (SD 52.96) mmHg. The mean length of the high-pressure zone (HPZ) was 3.67 (SD 0.52) cm. Mean volumes for initial rectal sensation, urge, and discomfort were 50.36 (± 25.57), 76.70 (± 35.17), and 143.40 (± 66.26) ml, respectively. The pressure asymmetry was highest in the lower anal sphincter and lowest in the mid-sphincter. There was a statistically significant relationship between the HPZ and RP (Pearson ρ -0.23, p = 0.01), height (Pearson ρ 0.22, p = 0.028), and weight (Pearson ρ 0.25, p = 0.012). There were no statistically significant correlations between age, height, or weight with RP, SP, or balloon fill volumes. The characteristic appearance of the normal RP and SP was clearly visualized in all patients. CONCLUSIONS: Normal 3DARM values for Sri Lankan primigravid mothers have been established. These may be used as reference values by other investigators.

Excitation of bound plasmons along nanoscale stripe waveguides: a comparison of end and grating coupling techniques.

In this paper we excite bound long range stripe plasmon modes with a highly focused laser beam. We demonstrate highly confined plasmons propagating along a 50 µm long silver stripe 750 nm wide and 30 nm thick. Two excitation techniques were studied: focusing the laser spot onto the waveguide end and focusing the laser spot onto a silver grating. By comparing the intensity of the out-coupling photons at the end of the stripe for both grating and end excitation we are able to show that gratings provide an increase of a factor of two in the output intensity and thus out-coupling of plasmons excited by this technique are easier to detect. Authors expect that the outcome of this paper will prove beneficial for the development of passive nano-optical devices based on stripe waveguides, by providing insight into the different excitation techniques available and the advantages of each technique.

The Eye Phone Study: reliability and accuracy of assessing Snellen visual acuity using smartphone technology.

PURPOSE: Smartphone-based Snellen visual acuity charts has become popularized; however, their accuracy has not been established. This study aimed to evaluate the equivalence of a smartphone-based visual acuity chart with a standard 6-m Snellen visual acuity (6SVA) chart. METHODS: First, a review of available Snellen chart applications on iPhone was performed to determine the most accurate application based on optotype size. Subsequently, a prospective comparative study was performed by measuring conventional 6SVA and then iPhone visual acuity using the 'Snellen' application on an Apple iPhone 4. RESULTS: Eleven applications were identified, with accuracy of optotype size ranging from 4.4-39.9%. Eighty-eight patients from general medical and surgical wards in a tertiary hospital took part in the second part of the study. The mean difference in logMAR visual acuity between the two charts was 0.02 logMAR (95% limit of agreement -0.332, 0.372 logMAR). The largest mean difference in logMAR acuity was noted in the subgroup of patients with 6SVA worse than 6/18 (n=5), who had a mean difference of two Snellen visual acuity lines between the charts (0.276 logMAR). CONCLUSION: We did not identify a Snellen visual acuity app at the time of study, which could predict a patients standard Snellen visual acuity within one line. There was considerable variability in the optotype accuracy of apps. Further validation is required for assessment of acuity in patients with severe vision impairment.

An SYBR Green-based real-time RT-PCR assay for the detection of H5 hemagglutinin subtype avian influenza virus.

Increasing diversity among H5 hemagglutinin (HA) subtype avian influenza (AI) viruses has resulted in the need of novel sensitive and specific molecular assays. In this study, an SYBR Green-based real-time reverse transcription-PCR (RRT-PCR) assay was developed for the detection of H5 subtype AI virus. Sequence analysis of the Mexican lineage H5N2 isolates (subgroup B) revealed several mismatches in the primer/hydrolysis probe set reported in the commonly used RRT-PCR assay for the detection of H5 North American lineage. The present assay was designed to circumvent the challenge that these viruses represent for the specific detection of H5 subtype AI viruses. This RRT-PCR assay successfully detected a range of different H5 subtype AI strains from both Eurasian and North American lineages representing different avian H5 HA clades from diverse geographical locations. The sensitivity of the present method was determined by using in vitro-transcribed RNA and 10-fold serial dilutions of titrated AI viruses. High sensitivity levels were obtained, with limits of detection of 10(0) 50% egg infectious dose (EID50)/mL and 4.2 gene copies/µl. The linear ranges of the assay span within 10(6)-10(0) EID50/mL and 10(6)-10(0) gene copies/µl. The results obtained from this method were directly compared with those of the H5 RRT-PCR assay recommended by the OIE. The comparison was performed with 110 tracheal and cloacal swabs from various bird species collected during field and laboratory investigations in Eurasia and Africa in 2006 and 2008 and showed 100% agreement. This assay is recommended as an alternative method, also allowing a 'double check' approach detection, to be use mainly in outbreak scenarios with higher risk of poultry infections by Central American/Caribbean H5 AI viruses.

Clinical presentation, risk factors and treatment outcomes of first allograft rejection after penetrating keratoplasty in early and late postoperative period.

PURPOSE: Corneal graft rejection is the most common reason for the failure of an allograft corneal transplant. We undertook this study to identify and compare risk factors and treatment outcomes for early and late corneal graft rejections after optical penetrating keratoplasty. METHODS: A retrospective case file analysis of 880 primary penetrating keratoplasties was performed at a tertiary ophthalmic care centre. Patients were divided into early rejectors (rejection episode within 6 months postoperatively) and late rejectors (rejection episode after 6 months postoperatively). Main parameters evaluated were demographics, preoperative diagnosis and clinical signs, donor tissue details, surgical technique, details of rejection episode, treatment, and outcome information. RESULTS: A total of 156 patients with rejection episodes were identified. Of these, 42 (26.9%) patients experienced early rejection episodes and 114 (73.1%) patients experienced late rejection episodes. Preoperative donor and recipient characteristics, surgical technique, and clinical presentation of graft rejection were found to be similar between both groups after a Bonferroni correction was applied (P>0.005). Treatment outcomes of graft rejections were not significantly different (P=0.46) between early and late rejectors, with 83% of patients responding to rejection treatment (80% early rejectors; 85% late rejectors). CONCLUSION: Patients with early and late graft rejection have similar characteristics and both groups respond to treatment equally.

Resistant starch in Micronesian banana cultivars offers health benefits.

Resistant Starch (RS) is a type of starch that is resistant to starch hydrolyzing enzymes in the stomach and thus behaves more like dietary fibre. RS has been shown to have beneficial effects in disease prevention including modulation of glycaemic index diabetes, cholesterol lowering capability and weight management, which are critically important for many people in the Federated States of Micronesia. Green bananas are known to contain substantial concentrations of RS and are a common part of the Micronesian diet. Therefore the aim of this study was to determine the RS content in banana cultivars from Pohnpei, Micronesia: Daiwang, Inahsio, Karat, Utin Kerenis and Utin Ruk, for which no such information was available. Utin Kerenis, Inahsio and Utin Ruk were found to contain the highest amounts of RS. The fate of RS after incorporation into a food product (i.e., pancakes) was also studied and a significant reduction in the RS content was found for each cultivar after cooking. Microscopy of the banana samples indicated that the overall morphology of the cultivars was similar. In conclusion, green banana, including these varieties, should be promoted in Micronesia and other places for their rich RS content and related health benefits including diabetes control. Further research is needed to more clearly determine the effects of cooking and food processing on RS.

Ectopic gastric and pancreatic tissue: a rare cause of umbilical discharge.

Persistent umbilical drainage may be due to vestigial remnants of the omphalomesenteric duct. Rarely, it may be owing to the presence of ectopic pancreatic tissue within these remnants. An 18-month-old boy underwent surgical exploration for umbilical discharge. An umbilical nodule containing both ectopic gastric and pancreatic tissue was found. This is the first instance where both tissue types have been implicated as a cause.

Attention deficit hyperactivity disorder in adults.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a disorder that begins in childhood, characterised by hyperactivity, inattentiveness and impulsivity. The disorder persists into adulthood but with some differences in the way it presents. METHODS: This case series included 29 adult patients from a metropolitan, office-based, private psychiatric consultant practice over a period of four years. RESULTS AND DISCUSSION: 72% were males and 28% were females, with a mean age of 28 years. Management involved biological, psychological and educational approaches. Stimulants, including dexamphetamine and methylphenidate, were mainstay in biological treatment and non-stimulant medications, such as, atomoxetine was used infrequently. Comorbidities such as substance abuse and mood disorders were common among the study group. CONCLUSION: ADHD is an illness, the symptoms of which may persist into adulthood. With diagnosis of the disease and the use of stimulants, adjunctive medications as appropriate, and behavioural interventions.

Management of dead bodies as a component of psychosocial interventions after the tsunami: a view from Sri Lanka.

Even if predicted, disasters may not be completely averted due to reasons beyond human control. There is always likely to be a degree of loss, human as well as material. Therefore, the correct strategy is to limit the damage and minimize the harm. Such damage control exercises should be mindful about the psychological costs of the disaster. Identification of dead bodies and the missing, as well as providing a dignified burial, is a crucial part of the overall management of a disaster. It will alleviate the long-term psychological as well as legal consequences. Hence, a comprehensive forensic service including modern genetic capabilities is a must for disaster response. Development of a comprehensive and efficient psychosocial intervention at community level after a disaster should recognise the importance of dead body management as an integral part of it. The guiding principles of psychosocial interventions are: to be multi-sectoral and multi-level; to include immediate, mid-term and long-term interventions; to be socially and culturally sensitive; to recognize the functionality of existing social and healthcare systems; to adopt a public mental health approach; and to be informed by evidence-based planning and implementation proven to be locally effective.

Climate change and reliability of urban water supply.

This paper describes a probability-based method for assessing the potential impact of climate change on urban water supply systems. Specifically, the assessment method uses probability distributions to place a confidence level on the plausible values of response variables. The Benalla water supply system has been used to demonstrate applicability of the proposed assessment method. For the application, impact of the 2030 climate change scenarios on streamflows and system yield has been examined. The preliminary results have demonstrated that the proposed assessment method can provide valuable insights into the impact of climate change on water supply systems, allowing it to be incorporated into planning decisions.

Evaluation of the use of the Flexiblade.

The Flexiblade is a laryngoscope which has a 'flexible' blade. The 'front' half of the blade can be moved in an anterior direction during laryngoscopy, enhancing the view of the glottis. The degree of movement can be controlled with the lever. We studied 200 ASA 1 and 2 adult patients requiring tracheal intubation and the patients acted as their own controls. The view of the larynx was improved in 93% of the cases when the vocal cords were not completely visible at laryngoscopy with the lever in the neutral position. Ninety-seven per cent of patients with a Cormack and Lehane grading of 2 at normal laryngoscopy were transformed to grade 1 when the lever of the Flexiblade was depressed and 84% of cases with a grading of 3 were transformed to grade 2 or 1. In four patients, there was deterioration in the view of the cords: three patients with grade 1 were transformed to grade 2 and one with grade 2 to grade 3. There was no improvement in one case with grade 2 and three with grade 3.

Spread of Neisseria meningitidis group A clone III-I meningitis epidemic into Zambia.

The epidemic of Neisseria meningitidis group A clone III-I strain began with the 1987 outbreak in Mecca, Saudi Arabia. Intense epidemics in African countries occurred the following year. Clone III-I was first isolated from Africa in 1988 in Chad, followed by epidemics in Ethiopia (1989), Kenya and Tanzania (1989), and The Central African Republic (1992). We report an epidemic of Neisseria meningitidis group A clone III-I afflicting Zambia during a 2-year period (April 1992-May 1994). This extension of the 'meningitis belt' southwards into Central Africa is cause for concern. Active surveillance for this disease should be carried out by all African countries, even those outside the well described sub-Saharan 'meningitis belt'.