BACKGROUND & AIMS: :Mice lacking T cell receptor alpha chain (TCRalpha(-/-)) develop inflammation of the colon. We have examined the effect of this inflammation on the colonic epithelium by studying markers of epithelial cuff, enteroendocrine, and immune cell differentiation. Using immunohistochemical techniques, colons were compared in normal C57/BL6 and murine TCR alpha(-/-) mice aged 2 and 3 weeks and 3-11 months. TCR alpha(-/-) mice aged 3-11 months had histologic evidence of inflammation with increased expression of CD45, CD4+, CD8+, and B220+ cells and a decrease in expression of IgA+ cells. There was a decrease in the number of cholecystokinin, serotonin, and neurotensin enteroendocrine expressing cells in the colon of TCR alpha(-/-) mice. These changes were not present in 2-3-week-old suckling/weaning mice. In contrast, peptide tyrosine tyrosine (PYY), glucagon-like peptide-1, and gastrin expression did not change and small intestinal enteroendocrine cells remained unaltered. The change in colonic enteroendocrine cell expression appears to be a specific response, since only a subset of these cells was altered, and the epithelium was intact by histologic analysis. The absence of functional T cells in TCR alpha(-/-) colon has a marked effect on differentiation of a specific subpopulation of enteroendocrine cells, prior to loss of integrity of the epithelium.

背景与目标： ：缺乏T细胞受体α链（TCRalpha（-/-））的小鼠发展成结肠的炎症。我们已经通过研究上皮袖带，肠内分泌和免疫细胞分化的标志物检查了这种炎症对结肠上皮的影响。使用免疫组织化学技术，比较了2周，3周和3-11个月大的正常C57 / BL6和鼠TCR alpha（-/-）小鼠的结肠。 3-11个月大的TCR alpha（-/-）小鼠具有炎症的组织学证据，CD45，CD4，CD8和B220细胞表达增加，而IgA细胞表达减少。在TCR alpha（-/-）小鼠结肠中，胆囊收缩素，血清素和神经降压素肠内分泌表达细胞的数量有所减少。这些变化在2至3周大的哺乳/断奶小鼠中不存在。相反，肽酪氨酸酪氨酸（PYY），胰高血糖素样肽-1和胃泌素的表达没有改变，小肠肠内分泌细胞保持不变。结肠肠内分泌细胞表达的变化似乎是一种特异性反应，因为这些细胞中只有一部分被改变，并且通过组织学分析完整上皮。在失去上皮的完整性之前，TCR alpha（-/-）结肠中功能性T细胞的缺失对肠内分泌细胞特定亚群的分化具有明显的影响。

BACKGROUND & AIMS: :Chromosome breaks, often with damaged or missing DNA flanking the break site, are an important threat to genome stability. They are repaired in vertebrates primarily by nonhomologous end joining (NHEJ). NHEJ is unique among the major DNA repair pathways in that a continuous template cannot be used by DNA polymerases to instruct replacement of damaged or lost DNA. Nevertheless, at least 3 out of the 17 mammalian DNA polymerases are specifically employed by NHEJ. Biochemical and structural studies are further revealing how each of the polymerases employed by NHEJ possesses distinct and sophisticated means to overcome the barriers this pathway presents to polymerase activity. Still unclear, though, is how the resulting network of overlapping and nonoverlapping polymerase activities contributes to repair in cells.

背景与目标： ：染色体断裂，通常是断裂位点两侧的DNA受损或缺失，是对基因组稳定性的重要威胁。它们主要通过非同源末端连接（NHEJ）在脊椎动物中修复。 NHEJ在主要的DNA修复途径中是独一无二的，因为DNA聚合酶不能使用连续的模板来指示替换受损或丢失的DNA。尽管如此，NHEJ专门采用了17种哺乳动物DNA聚合酶中的至少3种。生化和结构研究进一步揭示了NHEJ所采用的每种聚合酶如何具有独特而复杂的方法来克服该途径对聚合酶活性造成的障碍。不过，仍然不清楚的是，重叠和不重叠的聚合酶活性所形成的网络如何促进细胞修复。

BACKGROUND & AIMS: BACKGROUND:Out-of-hospital cardiac arrest (OHCA) is a common reason for calls for intervention by emergency medical teams (EMTs) in Poland. Regardless of the mechanism, OHCA is a state in which the chance of survival is dependent on rapid action from bystanders and responding health professionals in emergency medical services (EMS). We aimed to identify factors associated with return of spontaneous circulation (ROSC). METHODS:The medical records of 2137 EMS responses to OHCA in the city of Wroclaw, Poland between July 2017 and June 2018 were analyzed. RESULTS:The OHCA incidence rate for the year studied was 102 cases per 100,000 inhabitants. EMS were called to 2317 OHCA events of which 1167 (50.4%) did not have resuscitation attempted on EMS arrival. The difference between the number of successful and failed cardiopulmonary resuscitations (CPRs) was statistically significant (p < 0.001). Of 1150 patients in whom resuscitation was attempted, ROSC was achieved in 250 (27.8%). Rate of ROSC was significantly higher when CPR was initiated by bystanders (p < 0.001). Patients presenting with asystole or pulseless electrical activity (PEA) had a higher risk of CPR failure (86%) than those with ventricular fibrillation/ventricular tachycardia (VF/VT). Patients with VF/VT had a higher chance of ROSC (OR 2.68, 1.86-3.85) than those with asystole (p < 0.001). The chance of ROSC was 1.78 times higher when the event occurred in a public place (p < 0.001). CONCLUSIONS:The factors associated with ROSC were occurrence in a public place, CPR initiation by witnesses, and presence of a shockable rhythm. Gender, age, and the type of EMT did not influence ROSC. Low bystander CPR rates reinforce the need for further efforts to train the public in CPR.

背景与目标： 背景：院外心脏骤停（OHCA）是波兰紧急医疗小组（EMT）呼吁进行干预的常见原因。无论采用哪种机制，OHCA的生存机会都取决于旁观者和应急医疗服务（EMS）中响应卫生专业人员的迅速行动。我们旨在确定与自然循环恢复（ROSC）相关的因素。
方法：分析了2017年7月至2018年6月在波兰弗罗茨瓦夫市发生的2137例OHCA对EMS的EMS病历。
结果：本研究年度的OHCA发病率为每100,000居民102例。 EMS被召集到2317 OHCA事件中，其中1167（50.4％）没有在EMS到达时进行复苏尝试。心肺复苏成功次数与失败次数之间的差异具有统计学意义（p <0.001）。在尝试进行复苏的1150例患者中，有250例达到了ROSC（27.8％）。由旁观者发起心肺复苏术时，ROSC率显着更高（p <0.001）。表现为无搏动或无脉搏电活动（PEA）的患者发生CPR失败的风险（86％）高于发生室颤/室性心动过速（VF / VT）的患者。 VF / VT患者的ROSC发生机率（OR 2.68，1.86-3.85）高于无搏动的患者（p <0.001）。当事件发生在公共场所时，ROSC的机会要高1.78倍（p <0.001）。
结论：与ROSC相关的因素包括在公共场所发生，证人进行心肺复苏术以及出现令人震惊的心律。性别，年龄和EMT类型不会影响ROSC。旁观者的心肺复苏术率低，这表明需要进一步努力对公众进行心肺复苏术培训。

BACKGROUND & AIMS: BACKGROUND:The routine application of whole-body CT after extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA) has not been extensively investigated. We aimed to evaluate the benefit of CT in this context. METHODS:We retrospectively analyzed all OHCA patients who had received ECPR between January 2006 to May 2019. Electronic records were reviewed to filter out patients who had a whole-body CT as their first clinical evaluation after ECPR. CT findings and major hospital outcomes were evaluated. RESULTS:From January 2006 to May 2019, 700 patients had received ECPR in our institution. We identified 93 OHCA patients who received whole-body CT as the first clinical evaluation after ECPR. 22.6% of those had no acute findings detected on CT requiring immediate treatment. In the remaining 77.4%, CT had findings that might lead to alterations in clinical course. Most important findings were myocardial infarction (57.0%), hypoxic brain injury (29.0%), sternal/rib fractures (16.1%), aortic dissection (7.5%), pulmonary embolism (5.4%), and cardiac tamponade (5.4%). There were no significant differences in ICU/hospitalization days, time on ECMO support, survival and neurological outcomes between those with and without immediate CT. In our OHCA cohort, there were 27 patients with CT evidence of hypoxic brain injury, of whom 22.2% (n = 2) managed to wean from ECMO support, 14.8% (n = 4) survived to discharge, but only 3.7% (n = 1) survived with good neurological outcome. Hypoxic brain injury on CT has a 95% specificity in predicting poor neurological outcome, with a false positive rate of only 3.7%. Logistic regression suggested a potential correlation between CT findings of hypoxic brain injury and poor neurological outcome [Odds ratio (OR) = 12.53 (1.55 to 10.1), p = 0.02)]. CONCLUSIONS:Routine whole-body CT after ECPR in OHCA patients appears to have a limited role, as the majority is caused by ACS. However, it may be a useful tool when CPR-related injury or non-ACS causes of OHCA are suspected, as well as in cases where the cause of OHCA is unknown. On the contrary, routine brain CT may be a valuable tool in guiding anticoagulant therapy during ECMO and in aiding outcome prediction.

背景与目标： 背景：体外循环心脏复苏（ECPR）在院外心脏骤停（OHCA）中全身CT的常规应用尚未得到广泛研究。我们旨在评估在这种情况下CT的好处。
方法：我们回顾性分析了2006年1月至2019年5月间所有接受ECPR的OHCA患者。审查了电子记录以筛选出全身CT作为ECPR后的首次临床评估的患者。评估CT表现和主要医院结局。
结果：从2006年1月到2019年5月，我们机构有700名患者接受了ECPR。我们确定了93例接受全身CT的OHCA患者，这是ECPR后的首次临床评估。 22.6％的患者未在CT上发现急性症状，需要立即治疗。在其余的77.4％中，CT的发现可能会导致临床过程的改变。最重要的发现是心肌梗塞（57.0％），低氧性脑损伤（29.0％），胸骨/肋骨骨折（16.1％），主动脉夹层（7.5％），肺栓塞（5.4％）和心脏压塞（5.4％）。有和没有立即CT的患者之间的ICU /住院天数，ECMO支持时间，生存率和神经系统结局无显着差异。在我们的OHCA队列中，有27例具有缺氧性脑损伤的CT证据，其中22.2％（n = 2）设法从ECMO支持中撤离，14.8％（n = 4）幸存了下来，但只有3.7％（n = 1）存活，神经功能良好。 CT缺氧性脑损伤在预测不良神经功能方面具有95％的特异性，假阳性率仅为3.7％。 Logistic回归表明，缺氧性脑损伤的CT表现与不良的神经系统预后之间存在潜在的相关性[几率（OR）= 12.53（1.55至10.1），p = 0.02）]。
结论：OHCA患者ECPR后常规的全身CT检查似乎作用有限，因为多数是ACS引起的。但是，当怀疑与CPR相关的损伤或OHCA的非ACS原因以及未知的OHCA原因时，它可能是有用的工具。相反，常规脑部CT可能是指导ECMO期间抗凝治疗以及帮助预测结果的有价值的工具。

BACKGROUND & AIMS: :We examine the impact of the accessibility of an older individual's house on her use of nursing home care. We link administrative data on the accessibility of all houses in the Netherlands to data on long-term care use of all older persons from 2011 to 2014. We find that older people living in more accessible houses are less likely to use nursing home care. The effects increase with age and are largest for individuals aged 90 or older. The effects are stronger for people with physical limitations than for persons with cognitive problems. We also provide suggestive evidence that older people living in more accessible houses substitute nursing home care by home care.

背景与目标： ：我们研究了老年人的住房对他们使用养老院护理的影响。我们将有关荷兰所有房屋的可及性的行政数据与2011年至2014年所有老年人的长期护理使用数据相关联。我们发现，居住在更容易接近的房屋中的老年人不太可能使用养老院护理。效果会随着年龄的增长而增加，并且对于90岁或90岁以上的个体影响最大。对于身体有局限性的人，其影响要强于对认知有障碍的人。我们还提供了暗示性的证据，表明居住在更容易接近的房屋中的老年人用家庭护理代替了家庭护理。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :Hearing or visual impairments may negatively affect child's development and participation. Yet the literature about participation of children with hearing or visual impairments is insufficient. The present study aimed to compare participation patterns of children with visual impairments to those of children with hearing impairments and to typical peers and to examine the correlations between participation and socio-demographic parameters in each group. Participants were 70 children between the ages of 6-11: 25 with hearing impairments, 20 with visual impairments and 25 typical peers. All children filled the Children's Assessment of Participation and Enjoyment (CAPE). This self-report refers to participation in daily out of school activities. Children with hearing or visual impairments showed significant limited participation compared to typical peers, expressed in lower number of activities, lower participation intensity; more activities performed at home and with someone else. The limited participation was more emphasized among children with visual impairments. Socio-demographic variables (age, mother's education and socio-economic level) correlated with participation dimensions in both study groups. In conclusion, children with hearing or visual impairments may have restricted participation in out of school activities. Socio-demographic parameters may play a role in encouraging child's participation. Participation among these populations should be further studied in order to assist service providers to create intervention programs together with the child, for enhancing his/her inclusion in the community.

背景与目标： ：听力或视力障碍可能会对孩子的发育和参与产生负面影响。然而，有关听力或视力障碍儿童参与的文献不足。本研究旨在比较视力障碍儿童，听力障碍儿童和典型同龄人的参与模式，并检验每组中参与度和社会人口统计学参数之间的相关性。参加者为70名6至11岁的儿童：25名听力障碍儿童，20名视力障碍儿童和25名典型同伴。所有儿童都填写了儿童参与和娱乐评估（CAPE）。此自我报告是指参加每天的校外活动。与典型的同龄人相比，有听力或视觉障碍的儿童表现出明显的受限参与，表现为较少的活动，较低的参与强度；在家里以及与其他人一起进行的更多活动。视力障碍儿童更加强调了有限的参与。社会人口统计学变量（年龄，母亲的受教育程度和社会经济水平）与两个研究组的参与程度相关。总之，听力或视力障碍的儿童可能会限制参加校外活动。社会人口统计学参数可能在鼓励儿童参与方面发挥作用。应进一步研究这些人群的参与情况，以帮助服务提供者与儿童一起制定干预计划，以增强他/她在社区中的包容性。

BACKGROUND & AIMS: :T-box transcription factor genes are widely conserved in metazoan development and widely involved in developmental processes. With the phase of T-box gene discovery winding down, the phase of transcriptional target discovery for T-box transcription factors is finally taking off and yielding rich rewards. Mutant phenotypes in mouse and zebrafish as well as morpholino studies in zebrafish have helped to link the T-box genes to a variety of signaling pathways through diverse target genes and feedback loops. Particularly in early mesoderm development, it is emerging that a network of T-box genes interacts with Wnt/beta-catenin and Notch/Delta signaling pathways, among others, to control the important processes of mesoderm specification, somite segmentation, and left/right body axis determination.

背景与目标： ：T-box转录因子基因在后生动物的发育中广泛保守，并广泛参与发育过程。随着T-box基因发现阶段的结束，T-box转录因子的转录靶点发现阶段终于开始，并产生了丰厚的回报。小鼠和斑马鱼中的突变表型以及斑马鱼中的吗啉代研究已帮助通过不同的靶基因和反馈环将T-box基因与多种信号通路联系起来。特别是在中胚层的早期发展中，正在出现T-box基因网络与Wnt /β-catenin和Notch / Delta信号通路相互作用等，以控制中胚层规格，体节分割和左/右的重要过程。体轴确定。

BACKGROUND & AIMS: BACKGROUND:Despite the availability of free tuberculosis (TB) diagnosis and treatment, TB care still generates substantial costs that push people into poverty. We investigated out-of-pocket (OOP) payments for TB care and assessed the resulting economic burden and economic consequences for those with varying levels of household income in eastern China. METHODS:A cross-sectional study was conducted among TB patients in the national TB programme networks in eastern China. TB-related direct OOP costs, time loss, and coping strategies were investigated across households in different economic strata. Analysis of Variance was used to examine the differences in various costs, and Kruskal-Wallis tests were used to compare the difference in total costs as a percentage of annual household income. RESULTS:Among 435 patients, the mean OOP total costs of TB care were USD 2389.5. In the lower-income quartile, OOP payments were lower, but costs as a percentage of reported annual household income were higher. Medical costs and costs prior to treatment accounted for 66.4 and 48.9% of the total costs, respectively. The lower the household income was, the higher the proportion of medical costs to total costs before TB treatment, but the lower the proportion of medical costs patients spent in the intensive phase. TB care caused 25.8% of TB-affected households to fall below the poverty line and caused the poverty gap (PG) to increase by United States Dollar (USD) 145.6. Patients in the poorest households had the highest poverty headcount ratio (70.2%) and PG (USD 236.1), but those in moderately poor households had the largest increase in the poverty headcount ratio (36.2%) and PG (USD 177.8) due to TB care. Patients from poor households were more likely to borrow money to cope with the costs of TB care; however, there were fewer social consequences, except for food insecurity, in poor households. CONCLUSIONS:Medical and pretreatment costs lead to high costs of TB care, especially among patients from the poorest households. It is necessary to train health system staff in general hospitals to promptly identify and refer TB patients. Pro-poor programmes are also needed to protect TB patients from the medical poverty trap.

背景与目标： 背景：尽管有免费的结核病（TB）诊断和治疗方法，但结核病护理仍然产生大量的费用，使人们陷入贫困。我们调查了结核病护理的自付费用，并评估了中国东部家庭收入水平各异的人群所承受的经济负担和经济后果。
方法：在中国东部国家结核病规划网络中对结核病患者进行了横断面研究。在不同经济阶层的家庭中调查了与结核相关的直接OOP成本，时间损失和应对策略。方差分析用于检验各种成本之间的差异，而Kruskal-Wallis检验用于比较总成本在家庭年收入中所占百分比的差异。
结果：在435名患者中，结核病护理的平均OOP总费用为2389.5美元。在收入较低的四分位数中，OOP支付额较低，但成本占报告的家庭年收入的百分比较高。医疗费用和治疗前费用分别占总费用的66.4％和48.9％。家庭收入越低，结核病治疗前医疗费用在总费用中所占的比例越高，但在强化治疗阶段花费在患者身上的医疗费用所占比例越低。结核病护理使25.8％的受结核病影响的家庭降至贫困线以下，并使贫富差距（PG）增加了145.6美元。最贫困家庭的患者的贫困率最高（70.2％）和PG（236.1美元），而中度贫困家庭的患者由于结核病，贫困率最高（36.2％）和PG（177.8美元）关心。来自贫困家庭的患者更有可能借钱来应付结核病护理费用；但是，除了粮食不安全之外，贫困家庭的社会后果较少。
结论：医疗和预处理费用导致结核病护理的高昂费用，尤其是在最贫困家庭的患者中。有必要对综合医院的卫生系统人员进行培训，以迅速发现并转诊结核病患者。还需要扶贫计划，以保护结核病患者免受医疗贫困陷阱的困扰。

BACKGROUND & AIMS: :The immune system is increasingly recognized to play an integral role in regulating stress responses. In a recent article in Cell, Fan et al. demonstrate a novel mechanism through which stress drives mitochondrial fragmentation-induced xanthine accumulation in mouse CD4+ T cells, subsequently acting on oligodendrocytes to induce anxiety-like behaviors.

背景与目标： 免疫系统在调节压力反应中起着不可或缺的作用。 Fan等人在Cell的最新文章中。证明了一种新的机制，应力可通过该机制驱动小鼠CD4 T细胞中的线粒体片段化诱导的黄嘌呤积累，随后作用于少突胶质细胞以诱导焦虑样行为。

BACKGROUND & AIMS: RATIONALE:Despite increasing number of left ventricular assist device (LVAD) implantation, standardized cardiopulmonary resuscitation (CPR) protocol for patients with LVAD, especially in out-of-hospital settings are not well known. PATIENT CONCERNS:A 41-year-old LVAD implanted man became cardiac arrest in an out-of-hospital setting. Bystander CPR was started and the patient was brought to our hospital without noticing LVAD. Upon arrival, the medical staff noted the LVAD and that the battery of the LVAD was exhausted. DIAGNOSIS:Cardiac arrest on LVAD. INTERVENTIONS:It took 50 minutes to change the battery, then the patient has become ventricular fibrillation; hence, we introduced extracorporeal membranous oxygenation and defibrillated the patient. After the sinus rhythm was restored, the LVAD started working uneventfully. OUTCOMES:The patient became brain dead. LESSONS:There are several difficulties in treating these patients. First, hemodynamic collapse is difficult to diagnose. Second, chest compression for LVAD implanted patients remains controversial. Third, education to first responders who are not familiar with LVAD are not enough. Appropriate education for those issues is needed.

背景与目标： 理由：尽管左心室辅助装置（LVAD）植入的数量不断增加，但对于LVAD患者（尤其是在院外环境中），标准化的心肺复苏（CPR）方案尚不清楚。
患者担忧：一名41岁的LVAD植入患者在院外环境中心脏骤停。开始进行旁观者心肺复苏术，并且患者没有被告知LVAD就被送往我们的医院。到达后，医务人员注意到LVAD，并且LVAD的电池电量已耗尽。
诊断：LVAD心脏骤停。
干预：更换电池花了50分钟，然后患者才出现心室颤动。因此，我们引入了体外膜性充氧，并对患者进行了除颤。窦性心律恢复后，LVAD开始平稳地工作。
结果：患者脑死亡。
教训：治疗这些患者有几个困难。首先，血液动力学崩溃难以诊断。其次，LVAD植入患者的胸部按压仍然存在争议。第三，对不熟悉LVAD的急救人员的教育还不够。需要对这些问题进行适当的教育。

BACKGROUND & AIMS: :Progressive-ratio (PR) schedules of reinforcement have provided valuable information regarding the reinforcing strength of cocaine and the underlying neurobiological mechanisms. Parametric manipulations, such as altering time-out (TO) values, can affect the shape of the cocaine dose-response curve. Earlier studies have used PR schedules with widely varying parameters, thus complicating comparisons across experiments. This study evaluated the reinforcing strength of cocaine (0.005-0.9 mg/kg) as a function of post-reinforcement TO duration (5, 10, 30, or 60 min) under a PR schedule in rhesus monkeys. Daily sessions ended when 2 h elapsed without an injection; the breakpoint value was defined as the total number of injections. When the TO was 10 min, the relationship between cocaine dose and the number of injections received (i.e. BP) was characterized by an inverted U-shaped curve in all monkeys. Increasing the TO to 30 min resulted in a rightward shift of the ascending limb of the dose-response curve, but did not affect self-administration of higher doses. The number of injections received of a low cocaine dose was not further increased when the TO was shortened to 5 min, nor did increasing the TO to 60 min alter self-administration of the highest tested dose. These results suggest that drug accumulation plays a role in determining the reinforcing strength of low and intermediate cocaine doses under PR schedules. However, the reinforcing strength of higher cocaine doses was unaffected by manipulating TO, suggesting that the BP value is a useful measure of reinforcing strength.

背景与目标： ：增强的渐进比率（PR）计划提供了有关可卡因增强强度和潜在神经生物学机制的有价值的信息。参数操作（例如更改超时（TO）值）可能会影响可卡因剂量反应曲线的形状。较早的研究使用的PR计划参数各不相同，因此使整个实验的比较变得复杂。这项研究评估了在猕猴的PR计划下，可卡因的增强强度（0.005-0.9 mg / kg）与增强后TO持续时间（5、10、30或60分钟）的关系。每天的会议在没有注射2小时后结束；断点值定义为进样总数。当TO为10分钟时，可卡因剂量与所接受的注射次数（即BP）之间的关系以所有猴子的倒U形曲线为特征。将TO增加到30分钟会导致剂量反应曲线的上升肢向右移动，但不会影响大剂量的自我给药。当TO缩短至5分钟时，低可卡因剂量的注射次数没有进一步增加，TO升高至60分钟也没有改变最高试验剂量的自我给药。这些结果表明，在PR计划下，药物蓄积在确定中低剂量可卡因的增强强度中起着作用。但是，可卡因剂量的增强强度不受操作TO的影响，表明BP值是增强强度的有用指标。

BACKGROUND & AIMS: AIM:To report prospectively the outcome from prehospital cardiac arrest according to the Utstein template in the city of Tampere, Finland, with special reference to those patients in whom resuscitation was not attempted. MATERIALS AND METHODS:In Tampere (population 203,000), a two-tiered emergency medical service (EMS) system provides first response and basic life support (BLS), supported by advanced life support (ALS) units staffed with nurse-paramedics. We analysed all out-of-hospital cardiac arrests considered for resuscitation during a 12-month period. RESULTS:Of 191 patients with prehospital cardiac arrest, resuscitation was not attempted in 98 patients (51%). Reasons to withhold from resuscitation were estimated futility (97 cases) and a do-not-attempt-resuscitation order (1). Sixty percent of the patients with no resuscitation had secondary signs of death, 97% had asystole as the initial cardiac rhythm and 98% had suffered an unwitnessed cardiac arrest. Resuscitation was successful in 45 of the remaining 93 patients with attempted resuscitation. Twelve patients were discharged (overall survival rate 13%), nine of them with a CPC score of 1 or 2. Fifteen patients were treated with therapeutic hypothermia. Of the bystander-witnessed cardiac arrests with VF as initial rhythm, 29% survived. CONCLUSIONS:The Tampere EMS system initiated resuscitation less frequently than reported from other EMS systems, but the reasons to withhold resuscitation seemed justified. The overall and Utstein's 'golden standard' survival rates were comparable with previous reports.

背景与目标： 目的：根据芬兰坦佩雷市的Utstein模板前瞻性报告院前心脏骤停的结果，并特别提及未尝试进行复苏的患者。
材料和方法：在坦佩雷（人口203,000）中，两级紧急医疗服务（EMS）系统提供第一响应和基本生命支持（BLS），并由配备了护士护理人员的高级生命支持（ALS）单位提供支持。我们分析了在12个月内考虑进行复苏的所有院外心脏骤停。
结果：在191例院前心脏骤停的患者中，有98例（51％）未尝试进行复苏。拒绝复苏的原因是估计无效（97例）和不尝试复苏的命令（1）。没有复苏的患者中有60％具有继发性死亡迹象，最初的心律下有97％的患者处于心搏停止状态，无心音骤停的患者有98％。其余93例尝试复苏的患者中，有45例复苏成功。 12例患者出院（总生存率13％），其中9例CPC得分为1或2。15例患者接受了治疗性低温治疗。以旁观者见证的以VF作为初始节律的心脏骤停幸存者中，有29％存活。
结论：坦佩雷EMS系统启动复苏的频率低于其他EMS系统报告的频率，但停止复苏的原因似乎是合理的。总体生存率和Utstein的“黄金标准”生存率与以前的报告相当。

BACKGROUND & AIMS: :The integrin family of cell adhesion receptors mediates bi-directional signaling: 'inside-out' signaling activates the ligand binding function of integrins and 'outside-in' signaling mediates cellular responses induced by ligand binding to integrins leading to cell spreading, retraction, migration, and proliferation. Integrin signaling requires both heterotrimeric G proteins and monomeric small G proteins. This review focuses on recent development in the roles of G proteins in integrin outside-in signaling. The finding of direct interaction between the heterotrimeric G protein subunit Gα13 and integrin β subunits reveals a new mechanism for integrin signaling, and also uncovers a crosstalk between the signaling pathways initiated by G protein-coupled receptors (GPCRs) and integrins. This crosstalk, which may be referred to as 'inside-outside-in' signaling, dynamically regulates contractility and greatly promotes integrin outside-in signaling.

背景与目标： ：整联蛋白家族的细胞粘附受体家族介导双向信号传导：“由内而外”的信号传导激活整联蛋白的配体结合功能，“由外而内”的信号介导配体与整联蛋白结合所诱导的细胞应答，从而导致细胞扩散，收缩，迁移和扩散。整联蛋白信号传导既需要异源三聚体G蛋白，又需要单体小G蛋白。这篇综述着重于G蛋白在整联蛋白由外而内的信号传导中的作用的最新进展。异源三聚体G蛋白亚基Gα13与整合素β亚基之间直接相互作用的发现揭示了整合素信号传导的新机制，并且还揭示了由G蛋白偶联受体（GPCR）和整合素引发的信号传导途径之间的串扰。这种串扰，可以称为“内-外-外-内”信号传输，动态调节收缩力，并大大促进整联蛋白外-内-信号传输。

BACKGROUND & AIMS: Background and Aims:The breadfruit genus ( Artocarpus , Moraceae) includes valuable underutilized fruit tree crops with a centre of diversity in Southeast Asia. It belongs to the monophyletic tribe Artocarpeae, whose only other members include two small neotropical genera. This study aimed to reconstruct the phylogeny, estimate divergence dates and infer ancestral ranges of Artocarpeae, especially Artocarpus , to better understand spatial and temporal evolutionary relationships and dispersal patterns in a geologically complex region. Methods:To investigate the phylogeny and biogeography of Artocarpeae, this study used Bayesian and maximum likelihood approaches to analyze DNA sequences from six plastid and two nuclear regions from 75% of Artocarpus species, both neotropical Artocarpeae genera, and members of all other Moraceae tribes. Six fossil-based calibrations within the Moraceae family were used to infer divergence times. Ancestral areas and estimated dispersal events were also inferred. Key Results:Artocarpeae, Artocarpus and four monophyletic Artocarpus subgenera were well supported. A late Cretaceous origin of the Artocarpeae tribe in the Americas is inferred, followed by Eocene radiation of Artocarpus in Asia, with the greatest diversification occurring during the Miocene. Borneo is reconstructed as the ancestral range of Artocarpus , with dozens of independent in situ diversification events inferred there, as well as dispersal events to other regions of Southeast Asia. Dispersal pathways of Artocarpus and its ancestors are proposed. Conclusions:Borneo was central in the diversification of the genus Artocarpus and probably served as the centre from which species dispersed and diversified in several directions. The greatest amount of diversification is inferred to have occurred during the Miocene, when sea levels fluctuated and land connections frequently existed between Borneo, mainland Asia, Sumatra and Java. Many species found in these areas have extant overlapping ranges, suggesting that sympatric speciation may have occurred. By contrast, Artocarpus diversity east of Borneo (where many of the islands have no historical connections to the landmasses of the Sunda and Sahul shelves) is unique and probably the product of over water long-distance dispersal events and subsequent diversification in allopatry. This work represents the most comprehensive Artocarpus phylogeny and biogeography study to date and supports Borneo as an evolutionary biodiversity hotspot.

背景与目标： 背景和目的：面包果属（面包果，桑科）包括有价值的未充分利用的果树作物，其在东南亚具有多样性的中心。它属于单亲部落Artocarpeae，其唯一的其他成员包括两个小的新热带属。这项研究旨在重建系统的系统发育，估计面包果，尤其是面包果的发散日期和推断祖先范围，以更好地了解地质复杂区域中的时空演化关系和扩散模式。
方法：为了研究面包car的系统发育和生物地理学，本研究使用贝叶斯和最大似然方法分析了7％的面包果物种的6个质体和2个核区域的DNA序列，这两个都是新热带的腕足动物属以及所有其他桑科部落的成员。桑科中的六种基于化石的标定用于推断发散时间。还推断出祖先区域和估计的传播事件。
关键结果：面包果，面包果和四个单生的面包果亚属得到了良好的支持。据推测，美洲白垩纪部落起源于白垩纪晚期，其次是亚洲的面包果始新世辐射，在中新世发生的变化最大。婆罗洲被重建为面包果的祖传范围，在那里推断出数十个独立的原位多样化事件，以及向东南亚其他地区的传播事件。提出了面包果及其祖先的传播途径。
结论：婆罗洲（Borneo）在面包果（Artocarpus）种类的多样化中处于中心地位，并且可能是物种在多个方向上分散和多样化的中心。推测最大程度的多样化发生在中新世时期，当时海平面波动，婆罗洲，亚洲大陆，苏门答腊和爪哇岛之间经常存在陆地联系。在这些地区发现的许多物种都存在广泛的重叠范围，这表明可能发生了同族物种形成。相比之下，婆罗洲以东（许多岛屿与Sun他河和萨胡尔大陆架的陆架之间没有历史联系）的面包果树多样性是独特的，可能是水上远距离扩散事件和随后的异相生物多样性的产物。这项工作代表了迄今为止最全面的面包果树系统发育和生物地理学研究，并支持婆罗洲成为进化性生物多样性热点。