Progressive nodule-like lesions on bilateral lower limbs.

Pancreatic panniculitis is a rare disease characterized by subcutaneous fat necrosis. It could be the result of an associated pancreatic tumor. Herein, we reported a 63-year-old man who presented with progressive bilateral lower limb edema accompanied with nodule-like lesions for 1 month. His serum lipase was 3,927 U/L (normal, 0-160 U/L). Histopathology of the skin specimen revealed lobular panniculitis, favoring a diagnosis of pancreatic panniculitis. Abdominal computed tomography (CT) scan with contrast showed a huge mass in his left upper quadrant. Endoscopic ultrasound showed a mixed echoic tumor, measuring 11.9 × 7.8 cm in dimensions, originating from the pancreatic tail. Biopsy performed via an endoscopic ultrasound showed a poorly differentiated acinar cell carcinoma. Because of the unresectable status of the tumor, the patient underwent chemotherapy with paclitaxel and gemcitabine. After chemotherapy, his skin lesions improved progressively. It is important to treat pancreatic panniculitis with its underlying pancreatic disease.

Mental Health Youth Ambassador Programme for Anti-Stigma Among Secondary Students in Hong Kong: a Pilot Study.

OBJECTIVES: To evaluate the Mental Health Youth Ambassador Programme between 2016 and 2019 in terms of participants' improvement in attitudes towards individuals with depression or psychosis. METHODS: This anti-stigma programme was provided to secondary students (form 3 and above) and comprised three levels. Level 1 involved attending lectures about mental health; level 2 and level 3 involved social contact with persons-in-recovery. Students' attitudes towards those with depression and those with psychosis were assessed at baseline and after completion of each level of programme using the Chinese version of the Social Distance Scale. RESULTS: Only 25 students who were assessed at all four time points were included in analysis. The mean Social Distance Scale scores for attitudes towards depression and psychosis improved significantly across all time points. Specifically, significant improvement occurred after completion of level 2 and level 2 but not after completion of level 1. CONCLUSION: Social contact with people with mental illness (rather than attending lectures about mental health) contributed significantly to the improvement in students' attitude towards depression and psychosis. With the positive preliminary results, the Mental Health Youth Ambassador Programme should be extended to more students.

Repeating fast radio burst 20201124A originates from a magnetar/Be star binary.

Fast radio bursts (FRBs) are cosmic sources emitting millisecond-duration radio bursts. Although several hundreds FRBs have been discovered, their physical nature and central engine remain unclear. The variations of Faraday rotation measure and dispersion measure, due to local environment, are crucial clues to understanding their physical nature. The recent observations on the rotation measure of FRB 20201124A show a significant variation on a day time scale. Intriguingly, the oscillation of rotation measure supports that the local contribution can change sign, which indicates the magnetic field reversal along the line of sight. Here we present a physical model that explains observed characteristics of FRB 20201124A and proposes that repeating signal comes from a binary system containing a magnetar and a Be star with a decretion disk. When the magnetar approaches the periastron, the propagation of radio waves through the disk of the Be star naturally leads to the observed varying rotation measure, depolarization, large scattering timescale, and Faraday conversion. This study will prompt to search for FRB signals from Be/X-ray binaries.

A rapid cosmic-ray increase in BC 3372-3371 from ancient buried tree rings in China.

Cosmic rays interact with the Earth's atmosphere to produce 14C, which can be absorbed by trees. Therefore, rapid increases of 14C in tree rings can be used to probe previous cosmic-ray events. By this method, three 14C rapidly increasing events have been found. Plausible causes of these events include large solar proton events, supernovae, or short gamma-ray bursts. However, due to the lack of measurements of 14C by year, the occurrence frequency of such 14C rapidly increasing events is poorly known. In addition, rapid increases may be hidden in the IntCal13 data with five-year resolution. Here we report the result of 14C measurements using an ancient buried tree during the period between BC 3388 and 3358. We found a rapid increase of about 9‰ in the 14C content from BC 3372 to BC 3371. We suggest that this event could originate from a large solar proton event.

Psychiatric Morbidity in Chinese Adults with Type 1 Diabetes in Hong Kong.

OBJECTIVES: To determine the prevalence of psychiatric morbidity and identify the correlates, as well as to evaluate the effectiveness of the Hospital Anxiety and Depression Scale and the 12-item General Health Questionnaire to screen for psychiatric morbidity in Chinese adults with type 1 diabetes. METHODS: Subjects were recruited from a local public diabetes specialist outpatient clinic from August 2013 to January 2014. Demographic and clinical factors were recorded. Psychiatric diagnosis was established using the Chinese-bilingual version of the Structured Clinical Interview for the DSM-IV Axis I disorders. Scores for the Hospital Anxiety and Depression Scale and the 12-item General Health Questionnaire were compared with the psychiatric diagnosis. RESULTS: Of the 136 patients, the point prevalence of overall psychiatric, depressive, and anxiety disorders was 39.7%, 23.5%, and 25.7%, respectively. Family history of mental illness, smoking status, history of mental illness, presence of social problems, perceived absence of confidant, presence of neuropathy and hyperlipidaemia, as well as higher level of glycosylated haemoglobin were found to be the associated factors. CONCLUSION: Psychiatric disorders were common in Chinese adults with type 1 diabetes. Finding out associated factors and using the Hospital Anxiety and Depression Scale and the 12-item General Health Questionnaire as a screening tool helped to identify patients in a diabetes clinic with psychiatric disorders.

Clarification of recombinant proteins from high cell density mammalian cell culture systems using new improved depth filters.

Increasingly high cell density, high product titer cell cultures containing mammalian cells are being used for the production of recombinant proteins. These high productivity cultures are placing a larger burden on traditional downstream clarification and purification operations due to higher product and impurity levels. Controlled flocculation and precipitation of mammalian cell culture suspensions by acidification or using polymeric flocculants have been employed to enhance clarification throughput and downstream filtration operations. While flocculation is quite effective in agglomerating cell debris and process related impurities such as (host cell) proteins and DNA, the resulting suspension is generally not easily separable solely using conventional depth filtration techniques. As a result, centrifugation is often used for clarification of cells and cell debris before filtration, which can limit process configurations and flexibility due to the investment and fixed nature of a centrifuge. To address this challenge, novel depth filter designs were designed which results in improved primary and secondary direct depth filtration of flocculated high cell density mammalian cell cultures systems feeds, thereby providing single-use clarification solution. A framework is presented here for optimizing the particle size distribution of the mammalian cell culture systems with the pore size distribution of the gradient depth filter using various pre-treatment conditions resulting in increased depth filter media utilization and improved clarification capacity. Feed conditions were optimized either by acidification or by polymer flocculation which resulted in the increased average feed particle-size and improvements in throughput with improved depth filters for several mammalian systems.

High-redshift gamma-ray bursts: observational signatures of superconducting cosmic strings?

The high-redshift gamma-ray bursts (GRBs), GRBs 080913 and 090423, challenge the conventional GRB progenitor models by their short durations, typical for short GRBs, and their high energy releases, typical for long GRBs. Meanwhile, the GRB rate inferred from high-redshift GRBs also remarkably exceeds the prediction of the collapsar model, with an ordinary star formation history. We show that all these contradictions could be eliminated naturally, if we ascribe some high-redshift GRBs to electromagnetic bursts of superconducting cosmic strings. High-redshift GRBs could become a reasonable way to test the superconducting cosmic string model because the event rate of cosmic string bursts increases rapidly with increasing redshifts, whereas the collapsar rate decreases.

Increased programmed death-ligand-1 expression in human gastric epithelial cells in Helicobacter pylori infection.

B7-H1 [programmed death-ligand-1 (PD-L1)] is a B7-family member that binds to programmed death-1 (PD-1). Recently, deficiency of PD-L1 has been demonstrated to result in accelerated gastric epithelial cell damage in gastritis, and PD-L1 is suggested to play a critical role in regulating T cell homeostasis. Here, we aimed to gain more insight into gastric PD-L1 expression, regulation and function during Helicobacter pylori infection. PD-L1 expression in human gastric epithelial cells was analysed using Western blotting, quantitative polymerase chain reaction and fluorescence activated cell sorter analysis. Furthermore, co-culture experiments of human gastric epithelial cells with primary human T cells or Jurkat T cells were conducted. PD-L1 expression in primary human gastric epithelial cells was strongly enhanced by H. pylori infection and activated T cells, and augmented markedly by further stimulation with interferon-γ or tumour necrosis factor-α. Moreover, PD-L1 expression in gastric epithelial cells significantly induced apoptosis of T cells. Our results indicate that a novel bidirectional interaction between human gastric epithelial cells and lymphocytes modulates PD-L1 expression in human gastric epithelial cells, contributing to the unique immunological properties of the stomach.

Closed-form solution for the thermal dose delivered during single pulse thermal therapies.

This study provides a closed form, analytical expression for the thermal dose delivered by a single heating pulse. The solution is derived using the effective cooling method and the non-linear Sapareto-Dewey equation to determine the thermal dose delivered by the time-temperature history of a treatment. The analytical solutions are used to determine the optimal treatment conditions, i.e. those that exactly deliver the desired thermal dose at a specified time. For purposes of illustration, this study focuses on a 'conservative' clinical approach in which the desired thermal dose is delivered at the end of the 'cool down' period. The analytical results show that, after a clinical strategy has been chosen (e.g. conservative, aggressive or intermediate), the user can only specify two free variables for such an optimal treatment. Results are presented which suggest that a practical approach would be to specify both (1) the desired thermal dose to be delivered to the target (the clinically relevant outcome) and (2) the peak temperature to be reached (a measurable, clinically useful, patient dependent response variable that can be employed in feedback control systems); and then determine the associated, optimal heating magnitude and duration that need to be used to reach that dose and temperature. The results also reveal that, with a given patient condition and power deposition distribution (together specifying an effective cooling time constant for the treatment) and a specified thermal dose, there is a maximum allowable peak temperature that, if exceeded, will result in 'over-dosing' the heated tissue. The results also show that avoiding such non-optimal 'over-dosing' will be difficult in most high temperature therapies since, when high temperatures are produced in tissues, the temperature decay must be very fast in order to avoid over-dosing during the cooling period. Such rapid cooling can only occur if short effective cooling time constants are present-either as a result of large tissue blood flows in the patient or due to large conduction effects induced by the use of highly localized power deposition sources.

Ruptured 'fem-pop' vein graft presenting as deep venous thrombosis.

The public is becoming increasingly aware of the symptoms of deep vein thrombosis (DVT) due to the so-called 'economy class' syndrome. However, arterial rupture can mimic these symptoms. We report of a misdiagnosis of a ruptured 'fem-pop' vein graft (previously unreported) presenting identically as a DVT. The patient received conventional anticoagulation treatment which could have resulted in disastrous consequences.

Optimal power deposition patterns for ideal high temperature therapy/hyperthermia treatments.

If it were possible to achieve, an ideal high temperature therapy or hyperthermia treatment would involve a single heating session and yield a desired thermal dose distribution in the tumour that would be attained in the shortest possible treatment time without heating critical normal tissues excessively. Simultaneously achieving all of these goals is impossible in practice, thus requiring trade-offs that allow clinicians to approach more closely some of these ideal goals at the expense of others. To study the basic nature of a subset of these trade-offs, the present simulation study looked at a simple, ideal case in which the tumour is heated by a single, optimized (with respect to space) power pulse, with no power deposition in the normal tissue. Results were obtained for two different clinical strategies (i.e. trade-off approaches), including: (1) an 'aggressive' approach, wherein the desired, uniform thermal dose is completely delivered to the tumour during the power-on period. This approach gives the clinician the satisfaction of knowing that the tumour was treated completely while power was being delivered, and yields the shortest attainable tumour dose delivery time. However, that benefit is attained at the cost of both 'overdosing' the tumour during the subsequent cool down period and, paradoxically, requiring a longer, overall treatment time. Here, the treatment time is considered as that time interval from the initiation of the heating pulse to the time at which the entire tumour has decayed to a specified 'safe' temperature--below 43 degrees C for our calculations. And, (2) a 'conservative' approach is considered, wherein the desired uniform dose is attained at the post-heating time at which the complete tumour cools back down to 'basal' conditions, taken as 4 h in this study. This conservative approach requires less applied power and energy and avoids the 'overdosing' problem, but at the cost of having a tumour dose delivery time that can be significantly longer than the heating pulse duration. This approach can require that clinicians wait a significant time after the power has been turned off before being able to confirm that the desired tumour thermal dose was reached. The present findings show that: (1) for both clinical strategies, an optimal power deposition shape (with respect to position in the tumour) can always be found that provides the desired uniform thermal dose in the tumour, regardless of the heating pulse duration chosen or the tumour perfusion pattern; and (2) shorter heating pulses are preferable to longer ones in that they require less total energy, take less total time to treat the patients, and have optimal power deposition patterns less influenced by perfusion. On the other hand, shorter pulses always require higher temperatures, and for the 'aggressive' clinical approach, they give significantly larger excess thermal doses in the tumour. The aggressive approach always requires longer treatment times than comparable conservative treatments. The optimal power patterns for both strategies involve a high-power density at the tumour boundary, which frequently creates a 'thermal wave' that contributes significantly to the final thermal dose distribution attained.

Carotid and femoral arterial wall mechanics in scleroderma.

OBJECTIVE: Large-vessel arterial disease is increasingly recognized as a major cause of morbidity in autoimmune rheumatic disorders. Recent evidence suggests that scleroderma (systemic sclerosis, SSc) may be linked to altered fibrillin-1 metabolism associated with a defect in chromosome 15q. If this is the case, we may expect to see changes in the arterial wall mechanics of large vessels not clinically involved in the disease process. We undertook a study to determine whether the biomechanical properties and intima-media thickness (IMT) of the elastic carotid artery and the muscular femoral artery are altered in subjects with limited (lcSSc) and diffuse (dcSSc) cutaneous SSc. METHODS: Measurements of carotid and femoral wall mechanics were made in 33 patients with lcSSc, 19 patients with dcSSc and 21 control subjects, using a duplex scanner coupled to a Wall Track system. Their age, gender, body mass index, heart rate, systolic and diastolic blood pressures, presumed cardiovascular load, and plasma creatinine, fasting cholesterol, triglyceride and glucose concentrations were also measured. RESULTS: There was a progressive and significant reduction (P < 0.001) in the elastic properties of the carotid artery from the control group (compliance, 16.24 +/- 4.39 %mmHg(-1) x 10(-2)) to the lcSSc group (10.89 +/- 2.43 %mmHg(-1) x 10(-2)) to the dcSSc group (7.65 +/- 2.08 %mmHg(-1) x 10(-2)), even after adjustment for the systemic physiological and biochemical variables studied, which are known to influence the mechanics of arterial walls. There was no apparent difference between the groups in the mean elastic indices of the femoral artery and the IMT of the carotid and femoral arteries. CONCLUSION: The elastic properties of the carotid artery are significantly altered in SSc, and the two major subsets of SSc may be distinguished by their carotid artery biomechanics. This suggests that connective tissue abnormality occurs at sites not previously assessed.

Improving the patency of vascular bypass grafts: the role of suture materials and surgical techniques on reducing anastomotic compliance mismatch.

BACKGROUND: compliance mismatch is an important factor in the development of myointimal hyperplasia in both coronary and vascular anastomoses. This mismatch may be reduced by the use of newer suture materials and techniques. This review discusses the current techniques and materials used to date in generating anastomoses in both coronary and vascular applications and to correlate these with the degree of inherent compliance achieved. METHODS: PubMed, ISIS, CAS and PAS database searches were performed. Other articles were cross-referenced. RESULTS AND CONCLUSION: continuous suture is still the most used technique in both cardiac and vascular surgery for the generation of anastomoses due to the reduced time and improved haemostasis. However, continuous suture results in a greater compliance mismatch than the interrupted technique. Vein cuffs and patches improve compliance and transmission of pulsatile blood flow and offer improvement of graft patency. Alternative to sutures are biological glue, clips and laser generated solders all of which have shown promising results, but further work is required before they become applicable for routine use.

Differentiation of primary and secondary Raynaud's disease by carotid arterial stiffness.

INTRODUCTION: primary Raynaud's disease may be difficult to differentiate clinically from the secondary form with an underlying connective tissue, haematological, neurovascular or drug-induced disorder. We undertook a study to determine the elastic carotid and muscular femoral arterial biomechanical properties and intima-media thickness (IMT) in subjects with primary and secondary Raynaud's disease, to assess whether these parameters could differentiate the two conditions. METHODS: twenty patients with primary Raynaud's disease and 53 subjects with secondary Raynaud's associated with scleroderma (systemic sclerosis, SSc) had measurements of their carotid and femoral wall mechanics with a duplex scanner coupled to a Wall Track system. Their age, gender, body mass index, heart rate, systolic and diastolic blood pressures, presumed cardiovascular load, plasma creatinine, fasting cholesterol, triglyceride and glucose concentrations were also measured. RESULTS: the carotid elastic properties [mean (SD): elastic modulus: 560 (180) vs 1204 (558) mmHg,p <0.001 and stiffness index: 5.69 (1.35) vs 11.92 (6.4), p<0.001 for primary and secondary Raynaud's respectively] were significantly impaired in patients with secondary Raynaud's disease even after adjustment for potentially influencing physiological and biochemical variables. There were no statistical differences in the femoral elastic properties or the carotid and femoral IMTs between the two groups. CONCLUSION: Duplex determination of the carotid elasticity or stiffness is different in primary Raynaud's phenomenon compared with secondary Raynaud's associated with SSc. This may be a useful non-invasive tool, in addition to autoantibody markers and nail-fold capillaroscopy, to differentiate between the two forms of Raynaud's phenomenon.