Sunlight exposure is just one of the factors which influence vitamin D status.

Studies on the determinants of vitamin D status have tended to concentrate on input - exposure to ultraviolet B radiation and the limited sources in food. Yet, vitamin D status, determined by circulating concentrations of 25-hydroxyvitamin D (25(OH)D), can vary quite markedly in groups of people with apparently similar inputs of vitamin D. There are small effects of polymorphisms in the genes for key proteins involved in vitamin D production and metabolism, including 7-dehydrocholesterol reductase, which converts 7-dehydrocholesterol, the precursor of vitamin D, to cholesterol, CYP2R1, the main 25-hydroxylase of vitamin D, GC, coding for the vitamin D binding protein which transports 25(OH)D and other metabolites in blood and CYP24A1, which 24-hydroxylates both 25(OH)D and the hormone, 1,25-dihydroxyvitamin D. 25(OH)D has a highly variable half-life in blood. There is evidence that the half-life of 25(OH)D is affected by calcium intake and some therapeutic agents. Fat tissue seems to serve as a sink for the parent vitamin D, which is released mainly when there are reductions in adiposity. Some evidence is presented to support the proposal that skeletal muscle provides a substantial site of sequestration of 25(OH)D, protecting this metabolite from degradation by the liver, which may help to explain why exercise, not just outdoors, is usually associated with better vitamin D status.

Effect of stage-based education provided by dedicated dietitians on hyperphosphataemic haemodialysis patients: results from the Nutrition Education for Management of Osteodystrophy randomised controlled trial.

BACKGROUND: The Nutrition Education for Management of Osteodystrophy trial showed that stage-based nutrition education by dedicated dietitians surpasses existing practices in Lebanon with respect to lowering serum phosphorus among general haemodialysis patients. The present study explores the effect of nutrition education specifically on hyperphosphataemic patients from this trial. METHODS: Hyperphosphataemic haemodialysis patients were allocated to a dedicated dietitian (DD), a trained hospital dietitian (THD) and existing practice (EP) protocols. From time-point (t)-0 until t-1 (6 months), the DD group (n = 47) received 15 min of biweekly nutrition education by dedicated dietitians trained on renal nutrition; the THD group (n = 89) received the usual care from trained hospital dietitians; and the EP group (n = 42) received the usual care from untrained hospital dietitians. Patients were followed-up from t-1 until t-2 (6 months). Analyses used two-way repeated measures analysis of variance and Cohen's effect sizes (d). RESULTS: At t-1, phosphataemia significantly decreased in all groups (DD:-0.27 mmol L-1 ; EP:-0.15 mmol L-1 ; THD:-0.12 mmol L-1 ; P < 0.05); the DD protocol had the greatest effect relative to EP (d = -0.35) and THD (d = -0.50). Only the DD group showed more readiness to adhere to a low phosphorus diet at t-1; although, at t-2, this regressed to baseline levels. The malnutrition inflammation score remained stable only in the DD group, whereas the EP and THD groups exhibited a significant increase (DD: 6.74, 6.97 and 7.91; EP: 5.82, 8.69 and 8.13; THD: 5.33, 7.92 and 9.42, at t-0, t-1 and t-2, respectively). CONCLUSIONS: The results of the present study suggest that the DD protocol decreases serum phosphorus compared to EP and THD, at the same time as maintaining the nutritional status of hyperphosphataemic haemodialysis patients. Assessing the cost-effectiveness of the DD protocol is recommended.

Influence of non-ventilating intervals during early incubation stage on egg hatching process.

Background and Aim: The exchange of oxygen and carbon dioxide (CO2) in the incubator plays a key role in embryonic development and hatching. This study aimed to study the effect of non-ventilated (NV) intervals during the early stage of embryonic development on the hatching process. Materials and Methods: Hatching eggs (n = 7200) were equally divided into four treatment groups and incubated in four incubators. The first group was incubated in normal ventilated condition (V) during the setting phase of incubation. Ventilation holes of the three remaining incubators were closed for the first 3, 6, and 9 days and termed as NV groups (NV1, NV2, and NV3, respectively). A gradual increase in CO2 was allowed for NV groups, followed by opening the incubator holes to permit ventilation throughout the rest of the incubation periods. Results: Obtained results demonstrated that CO2 concentration gradually increased up to 0.19% for the NV1 group, 0.41% for the NV2 group, and 0.90% for the NV3 group, while CO2 concentration remained at 0.08% during the first 9 days of incubation in the V group. Albumen pH was lowered for all NV groups. The highest hatchability percentage was recorded for NV3 followed by NV2 and NV1 groups. All NV groups represented earlier and narrower spread of hatch and higher hatched chick weight. Embryos and hatched chicks in the NV groups had higher hormonal levels of thyroxin and corticosterone. Conclusion: All non-ventilation periods had positive effects on narrowing the spread of hatch, increasing hatched chick weight and hatchability percentage compared to the normal V condition. Furthermore, the non-ventilation throughout the first 9 days of incubation yielded the best hatching results.

Effect of incubation humidity and flock age on hatchability traits and posthatch growth in Pekin ducks.

This study was conducted to determine the effect of incubation relative humidity (RH) from 14 to 24 d of incubation during 3 parental ages on hatchability and posthatching growth of Pekin ducklings. Egg production was divided into 3 age groups (25-35, 36-55, and 56-65 wk). A total of 21,600 hatching eggs was subjected to 55, 60, 65, and 70% RH from 14 to 24 d, whereas standard conditions were used from 0 to 14 d and 24 to 28 d of incubation. All eggs were individually weighed before setting in the incubator and again at 14 and 24 d of incubation to determine egg weight loss. A sample of 20 eggs from unhatched and hatched eggs from each group were randomly taken on the hatching day and used to determine eggshell thickness and pore number. Duckling weight at hatching was recorded and BW gain, feed consumption, feed conversion, and viability were then recorded to 21 d of age. Egg weight increased with hen age but did not differ by incubation treatment. Increasing RH from 55% to 60, 65, and 70% decreased percentage egg weight loss in a stepwise manner irrespective of parental age. Shell thickness was less for hatched eggs compared with nonhatched eggs within each parental age. Shell thickness decreased while pore density increased with increased parental age for both nonhatched and hatched eggs. The lowest embryonic mortality among the incubation periods (14-24 and 0-24 d) and best hatchability of fertile eggs was recorded with 60% RH during the first parental age (25-35 wk), 65% RH during 36-55 wk of age, and 70% RH during 56-65 wk of age. The best incubation results were directly associated with the greatest duckling BW at hatching and at 21 d of age, BW gain, feed conversion, and viability during each parental age period. It was concluded that duck eggs produced within a specific parental age period require a specific incubation RH to attain the best hatchability and posthatching duckling performance.

Towards population inversion of electrically pumped Er ions sensitized by Si nanoclusters.

This study reports the estimation of the inverted Er fraction in a system of Er doped silicon oxide sensitized by Si nanoclusters, made by magnetron sputtering. Electroluminescence was obtained from the sensitized erbium, with a power efficiency of 10(-2)%. By estimating the density of Er ions that are in the first excited state, we find that up to 20% of the total Er concentration is inverted in the best device, which is one order of magnitude higher than that achieved by optical pumping of similar materials.

Histocompatibility antigens in Egyptians with cutaneous leishmaniasis: a preliminary study.

The frequency of human leucocytic antigens (HLA) were studied in 27 patients with cutaneous leishmaniasis to evaluate the role of HLA antigens as genetic markers in the pathogenesis of this protozoal skin infection. A significant statistical association was observed between HLA-A11, -B5 and -B7 antigens and diffuse cutaneous leishmaniasis. In conclusion, study of immune response genes could be of value to understand the pathogenic mechanisms responsible for cutaneous leishmaniasis.

Relationship between shell porosity, shell thickness, egg weight loss, and embryonic development in Japanese quail eggs.

Japanese quail eggs that hatched (H) or pipped (PIP) exhibited less weight loss through 15 d of incubation than did eggs that died late (LD), whereas eggs containing early dead (ED) embryos exhibited the greatest weight loss. The pore concentration at the large end of each egg was greatest in H eggs when compared with all other types. The pore concentration at the equator was greatest in H eggs and least in the eggs of the ED embryos. All other egg types lay statistically between these two types with regard to equator porosity. The small end pore concentration was similar in H, INF, and LD eggs and in the LD, PIP, and ED eggs. The least number was exhibited by the ED eggs and most by the H eggs. The thinnest shells at the small end were exhibited by H eggs, whereas thicker small end shells were exhibited by ED, LD, and PIP egg types. No differences were observed at the large end or equator. The data suggest that ED eggs exhibit excessive weight loss even though shell porosity was lower and shell thickness was similar to other egg types. This suggests that some functional component of the egg such as the shell membrane or albumen may contribute to this excessive weight loss. A similar statement can be made for LD eggs, which experienced greater weight loss through 15 d than did PIP or H eggs.

[Osteoid osteoma of the intramedullary diaphyse in children]. / Ostéome ostéoïde du canal médullaire diaphysaire chez l'enfant.

We report 2 cases of uncommon osteoid osteoma in 2 children; they occurred at an exceptional age: 18 months and 2.5 years. They have also original location at the intramedullary diaphyseal tibial shaft. Osteoid osteoma is divided into cortical, medullary and subperiosteal location. Cortical osteoid osteoma is accompanied by intense reactive bone sclerosis, but medullary and subperiosteal types are associated with mild or non reactive bone sclerosis. In our cases, osteoid osteoma were associated with intense reactive bone sclerosis as noted in the cortical form.

Quantum conductance in silicon oxide resistive memory devices.

Resistive switching offers a promising route to universal electronic memory, potentially replacing current technologies that are approaching their fundamental limits. In many cases switching originates from the reversible formation and dissolution of nanometre-scale conductive filaments, which constrain the motion of electrons, leading to the quantisation of device conductance into multiples of the fundamental unit of conductance, G0. Such quantum effects appear when the constriction diameter approaches the Fermi wavelength of the electron in the medium - typically several nanometres. Here we find that the conductance of silicon-rich silica (SiOx) resistive switches is quantised in half-integer multiples of G0. In contrast to other resistive switching systems this quantisation is intrinsic to SiOx, and is not due to drift of metallic ions. Half-integer quantisation is explained in terms of the filament structure and formation mechanism, which allows us to distinguish between systems that exhibit integer and half-integer quantisation.

Drug-induced hypertriglyceridemia with and without pancreatitis.

We describe two cases of drug-induced hypertriglyceridemia, one associated with interferon alfa-2b and the other with asparaginase, each of which is mediated through a different mechanism. Hypertriglyceridemia caused by these medications is not listed as an adverse reaction in the Physicians' Desk Reference, one of the most popular pharmacologic reference sources used in the United States. We emphasize the importance of early recognition of this metabolic effect and the potential life-threatening complication, acute pancreatitis.

Endoscopic hemorrhoidal ligation: preliminary clinical experience.

BACKGROUND: Endoscopic hemorrhoidal ligation may provide an alternative to surgical treatment of internal hemorrhoids. This study assessed the safety and efficacy of endoscopic elastic band ligation for bleeding internal hemorrhoids. METHODS: Endoscopic hemorrhoid ligation was performed in 20 adult patients who had chronic rectal bleeding attributed to internal hemorrhoids. Elastic band ligation was accomplished using a ligating device attached to the end of a video endoscope. Repeat endoscopy was done 3 weeks after the initial procedure. RESULTS: Seventy band ligations were performed during 23 separate sessions. Post-therapy endoscopy showed reduction of hemorrhoidal size by at least one grade in 19 of 20 patients (95%). Bleeding resolved in 19 of 20 patients (95%) in 5.4 months (mean) of follow-up; 18 of 20 (90%) required only one banding session. No major complications (perforation, secondary bleeding, deep ulceration) occurred in this small group. CONCLUSIONS: Preliminary data indicates that endoscopic hemorrhoidal ligation is a safe and effective technique for treating internal hemorrhoids. It holds promise as an important technique for successfully treating and possibly eradicating symptomatic internal hemorrhoids.

Hyperbilirubinemia and cholestatic liver injury in hepatitis C-infected liver transplant recipients.

OBJECTIVE: A cholestatic pattern of liver injury has been observed in liver transplant recipients with rapidly progressive hepatitis C. We assessed the frequency and causes of cholestasis in hepatitis C-infected liver transplant patients, and evaluated the clinical and pathological course of those with cholestatic hepatitis C. METHODS: Sixty-nine sequential liver transplant recipients who had detectable hepatitis C viremia were studied retrospectively. Records and diagnostic tests were examined from patients who developed hyperbilirubinemia. RESULTS: Hyperbilirubinemia occurred in 33 of 69 (48%) hepatitis C-infected liver transplant patients. A thorough evaluation including review of clinical and laboratory data, ultrasound with Doppler, cholangiogram, and liver biopsy identified causes of hyperbilirubinemia other than hepatitis C in 26 of 33 patients. Seven patients developed cholestatic hepatitis C characterized by histological features of recurrent hepatitis C and cholestatic liver injury with ballooning of centrilobular hepatocytes, bile ductular proliferation, and canalicular cholestasis, in the absence of other causes of cholestasis. Five progressed rapidly to bridging fibrosis and two died of complications related to liver failure. Four patients with cholestatic hepatitis C showed extended survival after the onset of hyperbilirubinemia. CONCLUSIONS: 1) Hepatitis C is a relatively infrequent cause of cholestasis in liver transplant recipients. 2) The diagnosis of cholestatic hepatitis C requires a multimodality approach to exclude other causes of cholestasis. 3) Cholestatic hepatitis C ranges in severity and is not always associated with rapid development of graft failure, although significant histological abnormalities are frequent.

Endoscopic management of biliary strictures in liver transplant recipients: effect on patient and graft survival.

BACKGROUND: Biliary strictures in liver transplant recipients cause significant morbidity and can lead to reduced patient and graft survival. METHODS: Of 251 liver transplant recipients, 22 patients with biliary strictures were categorized into two groups: donor hepatic duct (n = 12) or anastomotic (n = 10). Strictures were dilated and stented. Endoscopic therapy was considered successful if a patient did not require repeat stenting or dilation for 1 year. RESULTS: Patient and graft survival did not differ significantly in the 22 patients compared with patients without strictures (relative risk of death and graft survival 1.8 and 1.3). Donor hepatic duct strictures required significantly longer therapy than anastomotic strictures (median days 185 versus 67, p = 0.02). Twenty-two months after the first endoscopic treatment, 73% of the donor hepatic duct stricture group were stent free compared with 90% of the anastomotic group (p = 0.02). The former group had significantly more (p < 0.05) hepatic artery thrombosis (58.3% versus 10%), cholangitis (58.3% versus 30%), choledocholithiasis (91% versus 10%), and endoscopic interventions. No patient undergoing endoscopic treatment required retransplantation or biliary reconstruction during a median follow-up of 35.7 months. CONCLUSION: Endoscopic therapy of biliary strictures after liver transplantation is effective and is not accompanied by reduced patient or graft survival.

A double-blind, randomized comparison of the efficacy and safety of intramuscular injections of olanzapine, lorazepam, or placebo in treating acutely agitated patients diagnosed with bipolar mania.

There are no rapid-acting intramuscular formulations of atypical antipsychotics available for quickly calming an agitated patient with bipolar disorder. In this study, 201 agitated patients with bipolar mania were randomly assigned to receive one to three injections of the atypical antipsychotic olanzapine (10 mg, first two injections; 5 mg, third injection), the benzodiazepine lorazepam (2 mg, first two injections; 1 mg, third injection), or placebo (placebo, first two injections; olanzapine, 10 mg, third injection) within a 24-hour period. Agitation was measured at baseline, every 30 minutes for the first 2 hours, and at 24 hours after the first injection using the Positive and Negative Syndrome Scale-Excited Component subscale and two additional agitation scales. At 2 hours after the first injection, patients treated with olanzapine showed a significantly greater reduction in scores on all agitation scales compared with patients treated with either placebo or lorazepam. At 24 hours after the first injection, olanzapine remained statistically superior to placebo in reducing agitation in patients with acute mania, whereas patients treated with lorazepam were not significantly different from those treated with placebo or olanzapine. Furthermore, no significant differences among the three treatment groups were observed in safety measures, including treatment-emergent extrapyramidal symptoms, the incidence of acute dystonia, or QTc interval changes. These findings suggest that intramuscular olanzapine is a safe and effective treatment for reducing acute agitation in patients with bipolar mania.