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Hypoplasia of the mitral leaflets is rarely reported in adults. We reported a 45-year-old man presented to us with palpitation, dyspnea, and severe mitral regurgitation. In echocardiographic examination, an immobile hypoplastic posterior mitral leaflet (PML) was detected. A review of clinical and echocardiographic findings of all reported cases revealed that mitral regurgitation was the most common finding associated with PML hypoplasia/uni-leaflet mitral valve. PML hypoplasia is rare and often an incidental diagnosis during echocardiography, which could be relatively well tolerated since adulthood and carries a good prognosis...

A biological system is more than the sum of its parts - it accomplishes many functions via synergy. Deconstructing the system down to the molecular mechanism level necessitates the complement of reconstructing functions on all levels, i.e., in our conceptualization of biology and its perturbations, our experimental models and computer modelling. Toxicology contains the somewhat arbitrary subclass "systemic toxicities"; however, there is no relevant toxic insult or general disease that is not systemic...

National-level summaries of crop production and nutrient use efficiency, important for international comparisons, only partially elucidate agricultural dynamics within a country. Agricultural production and associated environmental impacts in large countries vary significantly because of regional differences in crops, climate, resource use and production practices. Here, we review patterns of regional crop production, nitrogen use efficiency (NUE), and major inputs of nitrogen to US crops over 1987-2012, based on the Farm Resource Regions developed by the Economic Research Service (USDA-ERS)...

Bridged-organosilica nanotubes with a variety of bridging groups (methylene, ethylene, ethenylene, phenylene and p-xylylene) were synthesized using swollen mixtures of Pluronic triblock copolymer surfactants as micellar templates. The mixtures consisted of Pluronic F127 surfactant (EO106 PO70 EO106 ) with long poly(ethylene oxide), PEO, blocks, which help prevent the formation of consolidated structures, and another Pluronic with shorter PEO blocks and higher poly(propylene oxide) content, which promote swelling and the cylindrical micelle morphology...

BACKGROUND: Studies have shown similar efficacy of different antidepressants in the treatment of depression. METHOD: Data of phase-2 and -3 clinical-trials for 16 antidepressants (levomilnacipran, desvenlafaxine, duloxetine, venlafaxine, paroxetine, escitalopram, vortioxetine, mirtazapine, venlafaxine XR, sertraline, fluoxetine, citalopram, paroxetine CR, nefazodone, bupropion, vilazodone), approved by the FDA for the treatment of depression between 1987 and 2016, were extracted from the FDA reviews that were used to evaluate efficacy prior to marketing approval, which are less liable to reporting biases...

BACKGROUND: In low and middle income countries where mental health resources are limited, community based depression intervention models, which can be implemented through the existing health system, are extremely relevant. OBJECTIVE: To test the effectiveness of Community based Depression Intervention Programme (ComDIP), newly developed by us, to reduce severity of depression in women, compared to the treatment as usual (TAU). METHODS: An RCT (Trial registration Number: CTRI/2011/08/001978, Clinical Trials Registry -India) was conducted in a primary care setting in Trivandrum, Kerala, South India...

The major histocompatibility complex (MHC) is a large genetic region with many genes, including the highly polymorphic classical class I and II genes that play crucial roles in adaptive as well as innate immune responses. The organization of the MHC varies enormously among jawed vertebrates, but class I and II genes have not been found in other animals. How did the MHC arise, and are there underlying principles that can help us to understand the evolution of the MHC? This review considers what it means to be an MHC and the potential importance of genome-wide duplication, gene linkage, and gene coevolution for the emergence and evolution of an adaptive immune system...

OBJECTIVES: We aim to explore the association between blood heavy metal concentrations of cadmium, lead, and mercury with ever-report of eczema in the US population. METHODS: We used NHANES cross-sectional data from 2005-2006. Eczema was measured among 4509 adults and 3898 non-adults. The association between eczema and tertiles of concentrations of cadmium, lead, mercury was estimated using multivariate logistic regression models adjusted for different confounding variables...

Abnormal early visual development can result in a constellation of neural and visual deficits collectively known as amblyopia. Among the many deficits, a common finding is that both saccadic and manual reaction times to targets presented to the amblyopic eye are substantially delayed when compared to the fellow eye or to normal eyes. Given the well-known deficits in contrast sensitivity in the amblyopic eye, a natural question is whether the prolonged reaction times are simply a consequence of reduced stimulus visibility...

Continuous flash suppression (CFS) is a popular technique whereby a dynamic sequence of Mondrian patterns is presented to one eye in order to suppress a static target presented to the other eye. Although the effectiveness of CFS is generally assumed to increase with the flicker rate of the Mondrian masker, a recent study has shown that suppression is optimal at very low masker rates for sustained targets, but higher rates may be necessary for transient targets. Here we vary the modulation rates of the masker and target using temporally filtered dynamic noise, which allowed us to examine the relationship between target and masker frequency and its effect on suppression strength...

Importance: Because of the aging population, osteoporotic fractures are an increasingly important cause of morbidity and mortality in the United States. Approximately 2 million osteoporotic fractures occurred in the United States in 2005, and annual incidence is projected to increase to more than 3 million fractures by 2025. Within 1 year of experiencing a hip fracture, many patients are unable to walk independently, more than half require assistance with activities of daily living, and 20% to 30% of patients will die...

Importance: Osteoporotic fractures result in significant morbidity and mortality. Objective: To update the evidence for benefits and harms of vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults to inform the US Preventive Services Task Force. Data Sources: PubMed, EMBASE, Cochrane Library, and trial registries through March 21, 2017; references; and experts. Surveillance continued through February 28, 2018...

Importance: Uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF) are commonly performed pelvic organ prolapse procedures despite a lack of long-term efficacy data. Objective: To compare outcomes in women randomized to (1) ULS or SSLF and (2) usual care or perioperative behavioral therapy and pelvic floor muscle training (BPMT) for vaginal apical prolapse. Design, Setting, and Participants: This 2 × 2 factorial randomized clinical trial was conducted at 9 US medical centers...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

OBJECTIVE: We derive a novel model-based metric for effective adherence to medication, and validate it using data from the INhaler Compliance Assessment device (INCATM). This technique employs dose timing data to estimate the threshold drug concentration needed to maintain optimal health. METHODS: The parameters of the model are optimised against patient outcome data using maximum likelihood methods. The model is fitted and validated by secondary analysis of two independent datasets from two remote-monitoring studies of adherence, conducted through clinical research centres of 5 Irish hospitals...

Lipids, commonly including phospholipids, sphingolipids, fatty acids, sterols, and triacylglycerols (TAGs), are important biomolecules for the viability of all cells. Phospholipids, sphingolipids, and sterols are important constituents of biological membranes. Many lipids play important roles in the regulation of cell metabolism by acting as signaling molecules. Neutral lipids, including TAGs and sterol esters (STEs), are important storage lipids in cells. In view of the importance of lipid molecules, this review briefly summarizes the metabolic pathways for sterols, phospholipids, sphingolipids, fatty acids, and neutral lipids in fungi and illustrates the differences between fungal and human (or other mammalian) cells, especially in relation to lipid biosynthetic pathways...

Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work...

BACKGROUND: Data on liver transplant (LT) outcomes using deceased donors with heavy drinking (HD) (>2 drinks/day) are scanty. METHODS: Using the United Network for Organ Sharing database (2002-2014), we examined outcomes after LT in adults comparing deceased HD donors with not heavy drinking (ND) donors. RESULTS: Of 56 182 first LTs performed in the US for 10 common indications using deceased donors, 47 882 with available information on alcohol use were analyzed...

BACKGROUND: The switch from International Classification of Diseases, Ninth Revision, Clinical Modification to International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for coding of inpatient procedures in the United States increased the number of procedural codes more than 19-fold, in large part due to the addition of laterality. We examined ICD-10-PCS codes for pairs of mirror-image procedures that are surgically equivalent. METHODS: We developed an algorithm in structured query language (SQL) to identify ICD-10-PCS codes differing only by laterality...