MicroRNA Expression Profile in Acute Ischemic Stroke.

Introduction: Acute ischemic stroke with large vessel occlusion (LVO) continues to present a considerable challenge to global health, marked by substantial morbidity and mortality rates. Although definitive diagnostic markers exist in the form of neuroimaging, their expense, limited availability, and potential for diagnostic delay can often result in missed opportunities for life-saving interventions. Despite several past attempts, research efforts to date have been fraught with challenges likely due to multiple factors such as inclusion of diverse stroke types, variable onset intervals, differing pathobiologies, and a range of infarct sizes, all contributing to inconsistent circulating biomarker levels. In this context, microRNAs (miRNAs) have emerged as a promising biomarker, demonstrating potential as biomarkers across various diseases, including cancer, cardiovascular conditions, and neurological disorders. These circulating miRNAs embody a wide spectrum of pathophysiological processes, encompassing cell death, inflammation, angiogenesis, neuroprotection, brain plasticity, and blood-brain barrier integrity. This pilot study explores the utility of circulating exosome-enriched extracellular vesicle (EV) miRNAs as potential biomarkers for anterior circulation LVO (acLVO) stroke. Methods: In our longitudinal prospective cohort study, we collected data from acute large vessel occlusion (acLVO) stroke patients at four critical time intervals post-symptom onset: 0-6 hours, 6-12 hours, 12-24 hours, and 5-7 days. For comparative analysis, healthy individuals were included as control subjects. In this study, extracellular vesicles (EVs) were isolated from the plasma of participants, and the miRNAs within these EVs were profiled utilizing the NanoString nCounter system. Complementing this, a scoping review was conducted to examine the roles of specific miRNAs such as miR-140-5p, miR-210-3p, and miR-7-5p in acute ischemic stroke (AIS). This review involved a targeted PubMed search to assess their influence on crucial pathophysiological pathways in AIS, and their potential applications in diagnosis, treatment, and prognosis. The review also included an assessment of additional miRNAs linked to stroke. Results: Within the first 6 hours of symptom onset, three specific miRNAs (miR-7-5p, miR-140-5p, and miR-210-3p) exhibited significant differential expression compared to other time points and healthy controls. These miRNAs have previously been associated with neuroprotection, cellular stress responses, and tissue damage, suggesting their potential as early markers of acute ischemic stroke. Conclusion: This study highlights the potential of circulating miRNAs as blood-based biomarkers for hyperacute acLVO ischemic stroke. However, further validation in a larger, risk-matched cohort is required. Additionally, investigations are needed to assess the prognostic relevance of these miRNAs by linking their expression profiles with radiological and functional outcomes.

Antimicrobial prescribing in a secondary care setting during the COVID-19 pandemic.

Background: Increased antimicrobial resistance patterns lead to limited options for antimicrobial agents, affecting patient health and increasing hospital costs. Objectives: To investigate the antimicrobial prescribing patterns at two district hospitals in Northern Ireland before and during the COVID-19 pandemic. Methods: A mixed prospective-retrospective study was designed to compare pre- and during pandemic antimicrobial prescribing data in both hospitals using a Global Point Prevalence Survey. Results: Of the 591 patients surveyed in both hospitals, 43.8% were treated with 402 antimicrobials. A total of 82.8% of antimicrobial prescriptions were for empirical treatment. No significant difference existed in numbers of patients treated or antimicrobials used before and during the pandemic. There was a slight decrease of 3.3% in the compliance rate with hospital antimicrobial guidelines during the pandemic when compared with the pre-pandemic year of 2019, when it was 69.5%. Treatment based on patients' biomarker data also slightly decreased from 83.5% pre-pandemic (2019) to 81.5% during the pandemic (2021). Conclusions: There was no overall significant impact of the pandemic on the antimicrobial prescribing patterns in either hospital when compared with the pre-pandemic findings. The antimicrobial stewardship programmes would appear to have played an important role in controlling antimicrobial consumption during the pandemic.

An Exploratory Assessment of Self-Reported Satisfaction with Infrastructure and Out-of-Home Activities for People with Vision Impairments.

PURPOSE: The purpose of this study is to assess the satisfaction levels of people with VI with regard to infrastructure and outdoor activities. Furthermore, this study aims to develop an assessment model for the levels of difficulty in using public transport. METHODS: Participants in a standardized survey questionnaire included 74 participants with VI. Three assessment-ordered probit models were estimated based on self-reported responses. RESULTS: Estimation results revealed that the use of public transport is extremely difficult for 83.47% of older participants. In addition, 84.2% of people with albinism have extreme difficulty using public transport. Furthermore, 53.98% of people with restricted horizontal and vertical fields face extreme difficulty using public transport. There was dissatisfaction with outdoor activities among 97.40% of people with macular disease. The results show that 51.70% of people with normal or near-normal horizontal visual fields and restricted vertical planes are satisfied with their level of outdoor activity while 72.65% of people with retinal diseases expressed dissatisfaction with the existing infrastructure. CONCLUSION: This study revealed that the experiences of people with VI are heterogeneous and depend on their eye condition, access to assistive technology, and socioeconomic characteristics. Results clearly show evidence of heterogeneity among individuals with VI. The combination of horizontal and vertical restrictions yields random parameters, underscoring the heterogeneous experiences of people with VI, influenced by their eye condition and access to assistive devices. Our results have important implications for developing targeted interventions to enhance the mobility of people with VI.

Imaging biomarkers of cerebral edema automatically extracted from routine CT scans of large vessel occlusion strokes.

BACKGROUND AND PURPOSE: Volumetric and densitometric biomarkers have been proposed to better quantify cerebral edema after stroke, but their relative performance has not been rigorously evaluated. METHODS: Patients with large vessel occlusion stroke from three institutions were analyzed. An automated pipeline extracted brain, cerebrospinal fluid (CSF), and infarct volumes from serial CTs. Several biomarkers were measured: change in global CSF volume from baseline (ΔCSF); ratio of CSF volumes between hemispheres (CSF ratio); and relative density of infarct region compared with mirrored contralateral region (net water uptake [NWU]). These were compared to radiographic standards, midline shift and relative hemispheric volume (RHV) and malignant edema, defined as deterioration resulting in need for osmotic therapy, decompressive surgery, or death. RESULTS: We analyzed 255 patients with 210 baseline CTs, 255 24-hour CTs, and 81 72-hour CTs. Of these, 35 (14%) developed malignant edema and 63 (27%) midline shift. CSF metrics could be calculated for 310 (92%), while NWU could only be obtained from 193 (57%). Peak midline shift was correlated with baseline CSF ratio (ρ = -.22) and with CSF ratio and ΔCSF at 24 hours (ρ = -.55/.63) and 72 hours (ρ = -.66/.69), but not with NWU (ρ = .15/.25). Similarly, CSF ratio was correlated with RHV (ρ = -.69/-.78), while NWU was not. Adjusting for age, National Institutes of Health Stroke Scale, tissue plasminogen activator treatment, and Alberta Stroke Program Early CT Score, CSF ratio (odds ratio [OR]: 1.95 per 0.1, 95% confidence interval [CI]: 1.52-2.59) and ΔCSF at 24 hours (OR: 1.87 per 10%, 95% CI: 1.47-2.49) were associated with malignant edema. CONCLUSION: CSF volumetric biomarkers can be automatically measured from almost all routine CTs and correlate better with standard edema endpoints than net water uptake.

Reflective teaching and academic optimism as correlates of work engagement among university instructors.

As teaching is a complex and demanding activity especially in university and higher education contexts, exploring the correlates of work engagement in university contexts seems to be a promising research area. As an attempt to further clarify this research area, this study sought to examine the significance of reflective teaching and academic optimism as correlates of work engagement among university instructors in Iran. Having been selected via convenience sampling, a sample of 289 Iranian English as a foreign language (EFL) university instructors participated in this survey. The electronic versions of the scales of teacher academic optimism, reflective teaching, and work engagement were administered to the participants. Initially, the construct validity of the scales was verified for the university contexts via performing confirmatory factor analysis. Then the hypothesized structural relationships among the constructs were tested using structural equation modelling (SEM). The results demonstrated that both reflective teaching and academic optimism significantly predicted work engagement among English university instructors. Some notable implications are finally discussed based on these findings.

Cardiovascular Predictors of Intracerebral Hematoma Expansion.

BACKGROUND: There is limited evidence on the effect and relevance of cardiovascular parameters on the cerebrovascular system when an intracerebral hemorrhage (ICH) occurs. While recent studies evaluating this relationship are conflicting, one evaluating the effect of systolic cardiac function on clinical outcomes in ICH patients, found low cardiac ejection fractions to be associated with poor clinical outcomes. Our primary objective was to study such correlations and identify various cardiovascular disease states that may be associated with hematoma expansion. METHODS: This is an IRB-approved single-center retrospective study utilizing our institutional "Get with the Guidelines"-Stroke registry between 2013 and 2017. Patients included were older than 18 years of age, admitted with an acute ICH, and had an echocardiogram during their hospitalization. Univariate and multivariate logistical regression analyses were used to identify cardiovascular predictors of hematoma expansion. RESULTS: Two-hundred forty-nine patients were identified from our GWTG-S registry that met initial inclusion criteria. Of these patients, a history of peripheral arterial disease (PAD) (p = 0.015), presence of aortic stenosis (AS) on the echocardiogram (p = 0.025), and a positive spot sign on the CT-angiogram (CTA) of the head (p < 0.001) were found to be independently associated with ICH expansion. Both a history of hypertension and elevated blood pressure on presentation were not significant predictors. Additionally, patients with a history of congestive heart failure had decreased odds of hematoma expansion (p = 0.027). CONCLUSION: This exploratory study highlights potential novel cardiac predictors of hematoma expansion, including PAD and AS, which warrant further study. Larger prospective studies are needed to further investigate such associations to ultimately optimize cardio-cerebral health.

Phase field model for cell spreading dynamics.

We suggest a 3D phase field model to describe 3D cell spreading on a flat substrate. The model is a simplified version of a minimal model that was developed in Winkler (Commun Phys 2:82, 2019). Our model couples the order parameter u with 3D polarization (orientation) vector field [Formula: see text] of the actin network. We derive a closed integro-differential equation governing the 3D cell spreading dynamics on a flat substrate, which includes the normal velocity of the membrane, curvature, volume relaxation rate, a function determined by the molecular effects of the subcell level, and the adhesion effect. This equation is easily solved numerically. The results are in agreement with the early fast phase observed experimentally in Dobereiner (Phys Rev Lett 93:108105, 2004). Also we find agreement with the universal power law (Cuvelier in Curr Biol 17:694-699, 2007) which suggest that cell adhesion or contact area versus time behave as [Formula: see text] in the early stage of cell spreading dynamics, and slow down at the next stages.

Investigation of the Possible Correlation between Idiopathic Parkinson's Disease and Diabetes Mellitus in Egyptian Patients: A Pilot Study.

OBJECTIVES: To study the diabetes-Parkinson's disease (PD) linkage. METHODS: The investigators recorded the rapid eye movement sleep behavior disorder screening questionnaire (RBDSQ) score for 60 diabetic patients: 30 patients were treated with metformin-inclusive sulfonylurea and 30 patients were treated with sulphonylurea(s) monotherapy and matched with 30 controls. We evaluated blood glucose kinetics during a 75 g oral glucose tolerance test for (22) nondiabetic parkinsonian patients and (10) controls. The motor complications scores were recorded for all parkinsonian patients using the relevant parts of the Unified Parkinson's Disease Rating Scale (UPDRS) part IV. RESULTS: Diabetics recorded higher scores of RBDSQ than controls (p < 0.001), with no differences related to antidiabetic therapy. In nondiabetic PD patients, after oral glucose, blood glucose was significantly higher at T1 (p < 0.001) than controls. Moreover, the total area under the time curve for blood glucose levels was significantly higher in PD compared to controls (281.22 ± 52.25 vs. 245.65 ± 48.63 mg.hr./dL; p=0.013). Higher blood glucose levels were associated with motor abnormalities. Diabetic PD patients recorded higher scores of UPDRS (p < 0.001). CONCLUSION: Diabetes mellitus and Parkinson's disease are linked, which raises concerns about either of them, probably increasing the risk of the other. This trial is registered with NCT03685357.

Design and experimental evaluation of block-pulse functions and Legendre polynomials observer for attitude-heading reference system.

The main purpose of this paper is design and implementation of a new linear observer for an attitude and heading reference system (AHRS), which includes three-axis accelerometers, gyroscopes, and magnetometers in the presence of sensors and modeling uncertainties. Since the increase of errors over time is the main difficulty of low-cost micro electro mechanical systems (MEMS) sensors producing instable on-off bias, scale factor (SF), nonlinearity and random walk errors, development of a high-precision observer to improve the accuracy of MEMS-based navigation systems is considered. First, the duality between controller and estimator in a linear system is presented as the base of design method. Next, Legendre polynomials together with block-pulse functions are applied for the solution of a common linear time-varying control problem. Through the duality theory, the obtained control solution results in the block-pulse functions and Legendre polynomials observer (BPLPO). According to product properties of the hybrid functions in addition to the operational matrices of integration, the optimal control problem is simplified to some algebraic equations which particularly fit with low-cost implementations. The improved performance of the MEMS AHRS owing to implementation of BPLPO has been assessed through vehicle field tests in urban area compared with the extended Kalman filter (EKF).

Lorazepam timing for acute convulsive seizure control (LoTASC).

INTRODUCTION: Guidelines specify early administration of benzodiazepines (BZD) for the management of convulsive status epilepticus. The distinction between acute convulsive seizure and status epilepticus can be misconstrued resulting in BZD administration prior to a patient meeting criteria of status epilepticus. Early BZD administration may theoretically lead to systemic vital instability. Our study aims to assess if administering lorazepam, for convulsive seizures <5 min, causes vital instability. METHODS: This is a retrospective study analyzing patients who presented with a seizure lasting <5 min between 2011 and 2016. Continuous variables of lorazepam receivers versus non- receivers were analyzed using t-test for parametric and Mann-Whitney U test for nonparametric data. Categorical variables were analyzed using Chi-Square Test. Subsequently, subjects were analyzed through univariate and multivariate regression models to determine predictors of vital instability. RESULTS: Out of 1052 subjects initially screened, 165 were included. Of these, 91 (55 %) received lorazepam, and 74 (45 %) did not. Through univariate and multivariate analyses, there was a significantly higher incidence of vital instability (defined as receipt of a vasopressor or intubation) in patients who received lorazepam (OR = 6.76, 95 % CI = 1.48, 30.95) (p = 0.014). This was dose-dependent (p < 0.0001). It was responsible for 22.5 % of the vital instability. Lorazepam administration significantly prolonged the intensive care unit (ICU) length of stay (0 days [IQR 0 - 0] vs [IQR 0-2.3]; p = 0.038). CONCLUSION: Our study suggests that lorazepam administration for acute convulsive seizures not meeting convulsive status epilepticus criteria may lead to iatrogenic vital instability and need for ICU admission.

Links between donor macrosteatosis, interleukin-33 and complement after liver transplantation.

BACKGROUND: As prevalence of nonalcoholic fatty liver disease increases in the population, livers with steatosis will continue to infiltrate the donor pool. Safe utilization of these extended criteria grafts is paramount given the increased risk associated with their use in transplantation. Prognostic factors that can predict liver dysfunction immediately after transplantation with macrosteatotic grafts are lacking. AIM: To understand the relationship between interleukin-33 (IL-33) and complement in recipients immediately following liver reperfusion as a marker of liver dysfunction. METHODS: Cohort consisted of patients who received a liver transplant from September 2016-September 2019 at our institution. Clinical variables were retrospectively extracted from the electronic medical record. Back-table donor biopsies were obtained with donor steatosis percentage retrospectively determined by a board-certified pathologist. Blood samples were available immediately following liver transplantation. Quantification of plasma IL-33 and complement proteins, C3a and C5a, were determined by enzyme-linked immunosorbent assay. For mRNA expression, RNA was extracted from donor biopsies and used against a 780 gene panel. RESULTS: Cohort consisted of 99 donor and recipients. Donor median age was 45 years and 55% male. Recipients had a median age of 59 years with 62% male. The main etiologies were alcoholic hepatitis, nonalcoholic steatohepatitis, and hepatocellular carcinoma. Median MELD-Na at transplant was 21. Donors were grouped based on moderate macrosteatosis (≥ 30%). Recipients implanted with moderate macrosteatotic grafts had significantly higher peak alanine aminotransferase/aspartate aminotransferase (P < 0.001 and P < 0.004), and increased incidence of early allograft dysfunction (60% compared to 18%). Circulating IL-33 levels were significantly elevated in recipients of ≥ 30% macrosteatotic grafts (P < 0.05). Recipients with detectable levels of circulating IL-33 immediately following reperfusion had significantly higher alanine aminotransferase/aspartate aminotransferase (P < 0.05 and P < 0.01). Activated complement (C3a and C5a) were elevated in recipients implanted with moderate macrosteatotic grafts. RNA expression analysis of donor biopsies revealed moderate steatotic grafts upregulated genes inflammatory processes while downregulated hepatocyte-produced complement factors. CONCLUSION: Circulating IL-33 and activated complement levels immediately following liver reperfusion in recipients of moderate macrosteatotic grafts may identify which patients are at risk of early allograft dysfunction.

Role of Non-Perfusion Factors in Mildly Symptomatic Large Vessel Occlusion Stroke.

INTRODUCTION: Uncertainty regarding reperfusion of mildly-symptomatic (minor) large vessel occlusion (LVO)-strokes exists. Recently, benefits from reperfusion were suggested. However, there is still no strong data to support this. Furthermore, a proportion of those patients don't improve even after non-hemorrhagic reperfusion. Our study evaluated whether or not non-perfusion factors account for such persistent deconditioning. METHODS: Patients with identified minor LVO-strokes (NIHSS ≤ 8) from our stroke alert registry between January-2016 and May-2018 were included. Variables/ predictors of outcome were tested using univariate/multivariate logistic and linear regression analyses. Three month-modified ranking scale (mRS) was used to differentiate between favorable (mRS = 0-2) and unfavorable outcomes (mRS = 3-6). RESULTS: Eighty-one patients were included. Significant differences between the two outcome groups regarding admission-NIHSS and discharge-NIHSS existed (OR = 0.47, 0.49 / p = 0.0005, <0.0001 respectively).The two groups had matching perfusion measures. In the poor outcome group, discharge-NIHSS was unchanged from the admission-NIHSS while in the good outcome group, discharge-NIHSS significantly improved. CONCLUSION: Admission and discharge NIHSS are independent predictors of outcome in patients with minor-LVO strokes. Unchanged discharge-NIHSS predicts worse outcomes while improved discharge-NIHSS predicts good outcomes. Unchanged NIHSS in the poor outcome group was independent of the perfusion parameters. In literature, complement activation and pro-inflammatory responses to ischemia might account for the progression of stroke symptoms in major-strokes. Our study concludes similar phenomena might be present in minor-strokes. Therefore, discharge-NIHSS may be useful as a clinical marker for future therapies.

Effectiveness of mechanical debridement with and without adjunct antimicrobial photodynamic for treating peri-implant mucositis among prediabetic cigarette-smokers and non-smokers.

AIM: The aim of the present study was to compare the effectiveness of mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) for treating peri-implant mucositis among prediabetic cigarette-smokers and non-smokers. METHODS: Prediabetic and non-diabetic smokers and non-smokers with peri-implant mucositis were included. Patients with peri-implant mucositis were divided into 4 groups as follows: Group-1: Prediabetic smokers with peri-implant mucositis; Group-2: Prediabetic non-smokers with peri-implant mucositis; Group-3: Systemically-healthy smokers with peri-implant mucositis; and Group-4: Systemically-healthy non-smokers with peri-implant mucositis. Hemoglobin A1c levels were measured in all groups prior to MD with adjunct aPDT. Peri-implant plaque index (PI), bleeding on probing (BOP) and probing depth (PD) were assessed at baseline and at 4- and 12-weeks of follow-up. Sample-size estimation was done and data normality was assessed. Group-comparisons were performed. and P < 0.01 was selected as an indicator of statistical significance. RESULTS: Fifteen, 15, 15 and 15 individuals were included in groups 1, 2, 3 and 4, respectively. At baseline, peri-implant PI, BOP and PD were comparable in all groups. In prediabetic smokers and non-smokers, there was no significant difference in peri-implant PI, BOP and PD at 4- and 12-weeks' follow-up. Among non-diabetic smokers and non-smokes MD with adjunct PDT significant reduced PI (P < 0.01) and PD (P < 0.01) at 4- and 12-weeks' follow-up. CONCLUSION: The outcomes of MD with adjunct aPDT for the treatment of peri-implant mucositis are compromised in smokers and non-smokers with prediabetes. In non-diabetic smokers and non-smokers, MD with aPDT is effective for treating peri-implant mucositis.

The Significance of Contrast Density of the Computed Tomography-Angiographic Spot Sign and its Correlation with Hematoma Expansion.

BACKGROUND AND PURPOSE: The computed tomography angiographic (CTA) spot sign has been shown to predict hematoma expansion in patients with intracranial hemorrhage (ICH), but the significance of the spot sign density (SSD) and the spot sign ratio (SSR) has not yet been explored. METHODS: Using the institutional Neurocritical care and Stroke registry, we retrospectively reviewed patients with ICH from January-2013 to June-2017. We selected patients who had baseline CT-head (CTH), CTA with positive-spot sign within 6 hours of last known well and at least one follow-up CTH within 24 hours. Baseline demographics and variables known to affect hematoma-volume were collected. Hematoma-volumes and SSR were calculated using computer-assisted 3D-volumetric measurement and the average of the surrounding hematoma density divided by the SSD, respectively. The 2-sample t test and the area-under-the-curve (receiver operating characteristic) were used to detect the association between hematoma expansion and outcome at discharge. RESULTS: A total of 320 patients were reviewed; 22 met the inclusion criteria. Significant hematoma expansion (volume expansion ≥12.5 cc or ≥33% compared to baseline) was noted in 14 (64%) subjects. SSD was significantly higher in subjects with hematoma expansion (216 ± 66) than those without (155 ± 52, P = .036). With a cut-off SSD of ≥150 HU, we had sensitivity of 86% and specificity of 75%. For SSR, lower ratios suggested a trend toward hematoma expansion, although it was not statistically significant (P = .12). There was no significant correlation between SSD or SSR and modified ranking scale at discharge and after 3-6 months. CONCLUSION: SSD might be a good predictor of hematoma growth. Although SSR showed a trend toward expansion, results were not statistically significant.

The intraventricular-spot sign: prevalence, significance, and relation to hematoma expansion and outcomes.

BACKGROUND: The presence of the spot sign on computed tomography angiogram (CTA) is considered a sign of active bleeding, and studies have shown it can predict hematoma expansion in intraparenchymal hemorrhage (IPH). The spot sign in intraventricular hemorrhage (IVH) has not been explored yet. The purpose of this study is to estimate the prevalence of the intraventricular-spot sign, and its prediction of hematoma expansion and clinical outcomes. METHODS: We retrieved data of hemorrhagic stroke patients seen at our medical center from January 2013 to January 2018. A total of 321 subjects were filtered for the prevalence analysis (PA). We further excluded 114 subjects without a follow-up CT-head for the hematoma expansion analysis (HEA). Patients were grouped based on the location of hemorrhage into three groups: isolated IPH with the spot sign always in IPH (i-IPH), isolated IVH with the spot sign always in IVH (i-IVH), and combined IPH and IVH which would be further sub-grouped according to the location of the spot sign: in IPH only (IPH+/IVH) and in IVH only (IPH/IVH+). The prevalence, demographics, and incidence of hematoma expansion were compared between the groups using Pearson's chi-square test and Student's t test. RESULTS: The prevalence of the spot sign was 8, 20, 17, 5% in (i-IPH), (i-IVH), (IPH+/IVH), and (IPH/IVH+) groups, respectively. The rate of hematoma expansion were (42 vs. 13%), (33 vs. 31%), (80 vs. 22%), and (25 vs. 22%) in spot sign positive vs. negative subjects in each group, respectively (p values = 0.023, = 1, <0.001, and = 1). CONCLUSION: We studied the prediction of spot sign on hematoma expansion and clinical outcomes in the different subtypes of ICH. Our study showed that spot sign is a good predictor in IPH but not IVH. Despite the rarity of IVH; the prevalence of spot sign was higher in IVH than IPH. This might be due to anatomical and physiological variations.

Carbonic anhydrase II deficiency: report of a novel mutation.

Carbonic anhydrase II (CAII) deficiency is an autosomal recessive disorder characterized by renal tubular acidosis, osteopetrosis, recurrent bone fractures, renal stones, growth failure, and mental retardation. Several cases have been reported in Saudi Arabia with homozygous mutations in CA2 consistent with a high degree of consanguinity. We report a case of carbonic anhydrase II deficiency with short stature, mixed renal tubular acidosis, recurrent bone fractures due to trivial trauma, recurrent renal stones and cerebral calcification. This patient was compound heterozygous for a novel CA2 mutation and a previously reported mutation in Arabs.

Stability of a directional solidification front in subdiffusive media.

The efficiency of crystal growth in alloys is limited by the morphological instability, which is caused by a positive feedback between the interface deformation and the diffusive flux of solute at the front of the phase transition. Usually this phenomenon is described in the framework of the normal diffusion equation, which stems from the linear relation between time and the mean squared displacement of molecules 〈x2(t)〉∼K1t (K1 is the classical diffusion coefficient) that is characteristic of Brownian motion. However, in some media (e.g., in gels and porous media) the random walk of molecules is hindered by obstacles, which leads to another power law, 〈x2(t)〉∼Kαtα, where 0<α≤1. As a result, the diffusion is anomalous, and it is governed by an integro-differential equation including a fractional derivative in time variable, i.e., a memory. In the present work, we investigate the stability of a directional solidification front in the case of an anomalous diffusion. Linear stability of a moving planar directional solidification front is studied, and a generalization of the Mullins-Sekerka stability criterion is obtained. Also, an asymptotic nonlinear long-wave evolution equation of Sivashinsky's type, which governs the cellular structures at the interface, is derived.

Chronic obstructive pulmonary disease in the older patient.

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases in the world. It is a major cause of morbidity, mortality, and health care use, particularly in older adults. In the following sections, the authors review the diagnosis and management of COPD with a focus on special issues in older adults.

Transplant-related bronchiolitis obliterans (BOS) demonstrates unique cytokine profiles compared to toxicant-induced BOS.

Bronchiolitis obliterans (BOS - bronchiolitis obliterans syndrome - clinical diagnosis; CBO-histopathologic diagnosis), is a chronic disease process of fibrosis and cellular deposition in airways, complicating long term survival following lung transplantation. BOS is also the result of sporadic toxicant exposure, with airway signs, symptoms, and histology indistinguishable from allograft rejection. This study establishes a transplant BOS model in MHC-mismatched rats and compares their cytokine profiles and histopathology to that of our established toxicant-induced BOS model. Both models result in lung histopathology similar to human disease. Cytokines and inflammation markers that are elevated in human transplant BOS (TGFbeta, iNOS, IFNgamma) were also elevated significantly in both models. Anti-nuclear antibody was absent from all sera in transplant or toxicant models exhibiting advanced airway pathology. The cytokine osteopontin was highly elevated in BAL early in toxicant-induced BOS, but increased late in the transplant-induced BOS model. The data show that BOS is a disease of a pathologic endpoint that is induced by different triggers and processes. The highly elevated BAL osteopontin early in the toxicant-induced BOS model suggests a need for evaluation in the diagnostic setting.

Separation and preconcentration in a batch mode of Cd(II), Cr(III, VI), Cu(II), Mn(II, VII) and Pb(II) by solid-phase extraction by using of silica modified with N-propylsalicylaldimine.

The complexes formed between IE11 and Cd(II), Cr(III), Cu(II), Mn(II) and Pb(II) were identified and confirmed by IR, UV and pH-metric titration. The uptake behavior of porous silica modified with N-propylsalicylaldimine (IE11) and these metal ions were studied. Log k(d) was found to be within the range 2.19-5.16 depending on pH and time of stirring. IE11 was used in the separation and preconcentration of Cd(II), Cr(III, VI), Cu(II), Mn(II, VII) and Pb(II) from some natural water samples. Data were compared with those obtained by the solvent extraction method APDC/MIBK. The proposed methodology allows to verify an improvement in the water quality of Nile River probably attributed to high to moderate floods in the last few years. The method was found to be accurate and not subject to random error, i.e. precise.