QRDRs in gyrA identified amino acid codon mutations Ser83Leu and Asp87Asn and, Ser80Ile in parC. Docking analysis implied that marbofloxacin could not form strong complexes with mutated DNA-gyrase. A high prevalnce of PMQR genes, especially qnrS, was observed along with overexpression of AcrAB-TolC efflux pump. CONCLUSIONS The study highlighted high prevalence of transferable mechanisms of quinolone resistance and over-expression of efflux pumps in marbofloxacin-resistantE. coli isolates apart from classic QRDR mutations. The present study recommends to consider the period of dominance of resistant commensals, being excreted by animals during the antimicrobial treatments, while formulating the withdrawal period for drugs especially, in food producing animals. OBJECT Preoperative thalamic targeting methods have historically relied on indirect targeting techniques that do not fully account for variances in anatomy or for thalamic atrophy in epilepsy. This study aims to address the variability noted between traditional indirect targeting and direct targetint methods for the anterior nucleus of the thalamus (ANT). METHODS Fifteen consecutive patients undergoing ANT deep brain stimulator (DBS) placement were evaluated (30 thalamic nuclei). Direct ANT targeting was performed utilizing a fast gray matter acquisition T1 inversion recovery sequence and compared with standard stereotactic coordinates. Thalamic volumes were also calculated for each patient and degree of thalamic volume loss was assessed compared to matched controls. Vertex analysis was also performed to assess shape changes in the thalamus compared to an age and gender matched cohort. RESULTS There was significant variation between the direct and indirect targets in the y-axis and z-axis on both sides. On the left, the direct target was located at y = 2 ± 1.3 mm and z = 9.3 ± 1.8 mm (both p=0.02). On the right, the direct target was located at y = 2.9 ± 1.8 and z = 9.2 ± 2 mm (both p=0.5). Additionally, there was a correlation between thalamic volume and difference between direct and indirect targets in both the y- and z-axis. CONCLUSIONS We have shown a significant difference in direct and indirect targeting in the y- and z-axes when targeting the ANT for DBS for epilepsy. This difference is also correlated to thalamic volume, with a larger difference noted in patients with thalamic atrophy. OBJECTIVE To explore the influencing factors of postoperative delirium (POD)in Parkinson's disease (PD)patients over 50 years old after deep brain electrical stimulation(DBS), and to construct an nomogram model to predict the risk of POD. METHODS A prospective cohort study was conducted on 229 PD patients over 50 years old hospitalized from January 2015 to August 2019.  https://www.selleckchem.com/products/GW501516.html  All subjects received deep brain stimulation during hospitalization.The incidence of POD of patients and clinical data such as gender, age, educational level and duration of disease were collected, the influencing factors of POD of Parkinson patients were analyzed, and an nomogram model for predicting the risk of POD was established. RESULTS POD occurred in 47 of 229 patients with PD, with an incidence rate of 20.52%. Gender, age, PDSS, preoperative cerebral ischemia, preoperative pulmonary inflammation and preoperative length of stay are the influencing factors of POD in Parkinson patients over 50 years old (P less then 0.05).After deviation correction, the area under receiver operating characteristic (ROC)curve of nomogram model for predicting POD risk is 0.755, the sensitivity is 74.47%, and the specificity is 73.08%. Meanwhile, The mean absolute error between the prediction of POD risk by nomogram model and actual delirium risk is 0.024, suggesting that nomogram model has good prediction efficiency. CONCLUSION Based on the influencing factors of delirium after DBS for PD patients over 50 years old, the nomogram model for predicting the risk of POD has been established in this study. The prediction efficiency is good, which can provide reference for early clinical identification of high-risk patients and formulate intervention countermeasures as soon as possible. BACKGROUND Cranial base chordomas are complex lesions centered on the clivus and surgically can be approached both from a midline or lateral corridor. OBJECTIVE To compare the surgical outcomes from midline versus lateral approaches by conducting meta-analysis of the literature. METHODS Studies were identified between the years 2000-2018. The primary outcome was gross total resection rate (GTR). The secondary outcomes were recurrence rate, rates of cerebrospinal fluid (CSF) leak and new cranial nerve palsy. Odds Ratios (ORs) were calculated with Random-effect-model using studies describing both approaches. An indirect (proportion) meta-analysis was performed pooling studies describing either of the approaches. Individual patient data (IPD) was analyzed for differences in GTR or recurrence rate with different tumor extensions. RESULTS Thirty-three and 10 studies were found suitable for indirect and direct meta-analysis respectively. The overall odd of GTR with midline as compared to lateral approach was 0.83 (95%CI-0.43, 1.62). The ORs for recurrence, CSF leak and new cranial nerve palsy were 0.82 (95%CI 0.26-2.56), 1.49 (95%CI 0.14-15.5) and 0.14 (95%CI 0.04-0.56). With IPD analysis, no statistical significant difference was observed in GTR or recurrence rates between the two approaches with different tumor extensions. CONCLUSION The meta-analysis did not show any significant difference in GTR or recurrence rates between the midline vs lateral approaches. Tumor extension to different compartments did not affect the GTR or recurrence rates with either approach. In terms of complications, CSF leak rate was higher in midline approaches and cranial nerve palsy was higher in lateral approaches. Obesity and type 2 diabetes increase hepatocellular carcinoma (HCC) incidence in humans, and accelerate diethylnitrosamine (DEN)-induced hepatocarcinogenesis in mice. We investigated whether exercise reduces HCC development in obese/diabetic Alms1 mutant (foz/foz) mice, and studied protective mechanisms METHODS We measured HCC development in DEN-injected male foz/foz and wildtype (Wt) littermates housed with or without exercise wheel from 4 until 12 or 24wks, and in foz/foz mice pair-fed to Wt littermates. We also studied HCC development in DEN-injected Jnk1-/-.foz/foz mice generated by cross breeding, as well as their genetic controls. Dysplastic hepatocytes were identified by GST-pi immunohistochemistry (IHC), liver nodules counted, and HCC analysed by histopathology RESULTS Exercising foz/foz mice maintained similar weight as Wt to 10wks, but then gained weight and were obese by 24wks; a similar body weight profile was obtained by pair-feeding foz/foz mice to Wt. At 12wks, livers of exercising foz/foz mice exhibited fewer GST-pi positive hepatocytes than sedentary counterparts; by 24wks, fewer exercising foz/foz mice developed HCC (15% vs 64%, P less then 0.