Evaluation of overexposure risk when there is a space between the subject and the couch in computed tomography: a phantom study.

The purpose of this study was to investigate the risk of overexposure associated with automatic tube current modulation (ATCM) and automatic couch height positioning compensation mechanism (AHC) in computed tomography (CT) systems, particularly in scenarios involving a gap between the subject and the couch. Results revealed that when AHC was enabled, CT dose index volume (CTDIvol) increased by approximately 10% at 2.5 cm, 20% at 5.0 cm, and 40% at 10.0 cm gaps compared to close contact conditions. While the AHC function ensures consistent exposure doses and image quality regardless of subject positioning relative to the CT gantry isocenter, the study highlights a potential risk of overexposure when a gap exists between the subject and the couch. These findings offer valuable insights for optimizing CT imaging protocols and underscore the importance of carefully considering subject positioning in clinical practice.

Printability of Nixtamalized Corn Dough during Screw-Based Three-Dimensional Food Printing.

This study aimed to analyze the printability of corn-based dough during screw-based three-dimensional (3D) food printing (3DFP) by relating its rheological and mechanical properties to its screw-based 3DFP performance, with the objective of providing insights into the utilization of corn-based dough to produce 3D-printed foods. Screw-based 3DFP was performed using seven corn-based doughs with different nixtamalized corn flour (NCF) and water contents. Afterward, their rheological and mechanical properties were analyzed and associated with their screw-based 3DFP performance. The results showed that stable printability was obtained within a specific range of NCF content in the dough (30-32.5 wt%). Below this range, the 3D-printed foods flattened, while above it, the extrudability of the dough was affected. The printability of the dough was influenced by different rheological and mechanical properties, depending on the stage of the screw-based 3DFP process. During the extrusion stage, the loss tangent at nozzle strain, yield stress, apparent viscosity, and adhesiveness mainly affected the extrudability of the dough. In contrast, the loss tangent at minimum strain, elastic modulus, Young's modulus, and hardness influenced the self-supporting stage. Therefore, it is important to find a balance between all of these properties, where stable extrudability and self-supporting of the 3D structure are achieved.

Economic Evaluation of Wastewater Surveillance Combined with Clinical COVID-19 Screening Tests, Japan.

The COVID-19 pandemic has imposed substantial burdens on the global society. To find an optimal combination of wastewater surveillance and clinical testing for tracking COVID-19, we evaluated the economic efficiency of hypothetical screening options at a single facility in Japan. To conduct cost-benefit analyses, we developed standard decision models in which we assumed model parameters from literature and primary data, such as screening policies used at the Tokyo Olympic and Paralympic Village in 2021. We compared hypothetical 2-step screening options that used clinical PCR to diagnose COVID-19 after a positive result from primary screening using antigen tests (option 1) or wastewater surveillance (option 2). Our simulation results indicated that option 2 likely would be economically more justifiable than option 1, particularly at lower incidence levels. Our findings could help justify and promote the use of wastewater surveillance as a primary screening at a facility level for COVID-19 and other infectious diseases.

Endogenous interleukin-22 prevents cardiac rupture after myocardial infarction in mice.

Myocardial infarction (MI) can result in fatal myocardial rupture or heart failure due to adverse remodeling and dysfunction of the left ventricle. Although recent studies have shown that exogenous interleukin (IL)-22 shows cardioprotective effect after MI, the pathophysiological significance of endogenous IL-22 is unknown. In this study, we investigated the role of endogenous IL-22 in a mouse model of MI. We produced MI model by permanent ligation of the left coronary artery in wild-type (WT) and IL-22 knock-out (KO) mice. The post-MI survival rate was significantly worse in IL-22KO mice than in WT mice due to a higher rate of cardiac rupture. Although IL-22KO mice exhibited a significantly greater infarct size than WT mice, there was no significant difference in left ventricular geometry or function between WT and IL-22KO mice. IL-22KO mice showed increase in infiltrating macrophages and myofibroblasts, and altered expression pattern of inflammation- and extracellular matrix (ECM)-related genes after MI. While IL-22KO mice showed no obvious changes in cardiac morphology or function before MI, expressions of matrix metalloproteinase (MMP)-2 and MMP-9 were increased, whereas that of tissue inhibitor of MMPs (TIMP)-3 was decreased in cardiac tissue. Protein expression of IL-22 receptor complex, IL-22 receptor alpha 1 (IL-22R1) and IL-10 receptor beta (IL-10RB), were increased in cardiac tissue 3 days after MI, regardless of the genotype. We propose that endogenous IL-22 plays an important role in preventing cardiac rupture after MI, possibly by regulating inflammation and ECM metabolism.

Endovascular Retrieval of a Fractured Tunneled Hemodialysis Central Venous Catheter Using the Loop Snare Technique.

The tunneled cuffed hemodialysis catheter is a valuable vascular access option for patients with end-stage renal disease (ESRD). Healthcare providers have become more familiar with the insertion of medical devices, including central venous catheters, in their daily practice. The occurrence of foreign body fragmentation is rare with these catheters. This article presents a case in which a fracture of the distal portion of the hemodialysis catheter was inadvertently identified during a coronary angiography. Percutaneous removal of the fractured venous catheter was performed successfully using a loop snare catheter, which prevented the patient from experiencing further complications.

Economic Evaluation of Telemedicine Consultations to Reduce Unnecessary Neonatal Care Transfers.

OBJECTIVES: To perform an economic evaluation to estimate the return on investment (ROI) of making available telemedicine consultations from a healthcare payer perspective, and to estimate the economic impacts of telemedicine under a hypothetical scenario in which all rural hospitals providing level I neonatal care in California had access to telemedicine consultations from neonatologists at level III and level IV neonatal intensive care units (NICUs). STUDY DESIGN: We developed standard decision models with assumptions derived from primary data and the literature. Telemedicine costs included equipment installation and operation costs. Probabilistic analysis with Monte Carlo simulation was performed to address model uncertainties and to estimate 95% probabilistic confidence intervals (PCIs). All costs were adjusted to 2017 US dollars using the Consumer Price Index. RESULTS: Our probabilistic analysis estimated the ROI to have a mean value of 2.23 (95% PCI, -0.7 to 6.0). That is, a $1 investment in this telemedicine model would yield a net medical expenditure saving of $1.23. "Cost saving" was observed for 75% of the hypothetical 1000 Monte Carlo simulations. For the state of California, the estimated mean annual net savings was $661 000. CONCLUSIONS: Providing telemedicine and making available consultations to rural hospitals providing level I neonatal care are likely to reduce medical expenditures by reducing potentially avoidable transfers of newborns to level III and IV NICUs, offsetting all telemedicine-related costs.

"Nata Puree," a Novel Food Material for Upgrading Vegetable Powders, Made by Bacterial Cellulose Gel Disintegration in the Presence of (1,3)(1,4)-ß-Glucan.

Pulverization is a potentially powerful solution for the resource management of surplus- and non-standard agricultural products, maintaining their nutritional values for long and ensuring their homogeneity, whereas their original textures could disappear to narrow the application ranges. Therefore, new technologies should be developed for reconstructing the powders to provide them with new physical characteristics. Herein, we developed a novel food material, nata puree (NP), by nata de coco (bacterial cellulose gel) disintegration with a water-soluble polysaccharide using a household blender. The process worked well with (1,3)(1,4)-ß-glucan (BGL) as the polysaccharide, which could be substituted with barley extract. Lichenase treatment of the NP dramatically modified its physical properties, suggesting the importance of the BGL polymeric forms. NP exhibited distinct potato powder and starch binding activities, which would be attributed to its interactions with the cell wall components and a physical capture of powders by the NP network, respectively. NP supplementation into the potato paste improved its firmness and enabled its printable range shift for 3D food printing to a lower powder-concentration. NP also promoted the dispersion of powders in its suspension, and designed gelation could also be successfully performed by the laser irradiation of an NP suspension containing dispersed curdlan and turmeric powders. Therefore, NP could be applied as a powder modifier to a wide range of products in both conventional cooking, food manufacturing, and next generation processes such as 3D food printing.

SOCS3 deficiency in cardiomyocytes elevates sensitivity of ischemic preconditioning that synergistically ameliorates myocardial ischemia reperfusion injury.

Ischemic preconditioning (IPC) is the most powerful endogenous cardioprotective form of cellular adaptation. However, the inhibitory or augmenting mechanism underlying cardioprotection via IPC remains largely unknown. Suppressor of cytokine signaling-3 (SOCS3) is a cytokine-inducible potent negative feedback regulator of the signal transducer and activator of transcription-3 (STAT3) signaling pathway. Here, we aimed to determine whether cardiac SOCS3 deficiency and IPC would synergistically reduce infarct size after myocardial ischemia reperfusion injury. We evaluated STAT3 activation and SOCS3 induction after ischemic conditioning (IC) using western blot analysis and real-time PCR, and found that myocardial IC alone transiently activated myocardial STAT3 and correspondingly induced SOCS3 expression in wild-type mice. Compared with wild-type mice, cardiac-specific SOCS3 knockout (SOCS3-CKO) mice showed significantly greater and more sustained IC-induced STAT3 activation. Following ischemia reperfusion, IPC substantially reduced myocardial infarct size and significantly enhanced STAT3 phosphorylation in SOCS3-CKO mice compared to in wild-type mice. Real-time PCR array analysis revealed that SOCS3-CKO mice after IC exhibited significantly increased expressions of several anti-apoptotic genes and SAFE pathway-related genes. Moreover, real-time PCR analysis revealed that myocardial IC alone rapidly induced expression of the STAT3-activating cytokine erythropoietin in the kidney at 1 h post-IC. We also found that the circulating erythropoietin level was promptly increased at 1 h after myocardial IC. Myocardial SOCS3 deficiency and IPC exert synergistic effects in the prevention of myocardial injury after ischemia reperfusion. Our present results suggest that myocardial SOCS3 is a potent inhibitor of IPC-induced cardioprotection, and that myocardial SOCS3 inhibition augment IPC-mediated cardioprotection during ischemia reperfusion injury.

Multiacquisition Variable-Resonance Image Combination Selective Can Improve Image Quality and Reproducibility for Metallic Implants in the Lumbar Spine.

The aim of this study is to evaluate how metallic artifacts in the lumbar spine can affect images obtained from magnetic resonance (MR) sequences. We performed a phantom experiment by scanning an agar containing an orthopedic metallic implant using 64-channel multidetector row computed tomography (CT) and a 3-tesla MR unit. We compared the reproducibility in each measurement, enlargement or reduction ratio of the CT and MR measurements, and signal deviation in each voxel from the control. The reproducibility on CT and multiacquisition variable-resonance image combination selective (MAVRIC SL) was good, but that on the other MR sequences showed either fixed bias or proportional bias. The reduction ratios of the distance between the nails were significantly smaller in MAVRIC SL than in the other MR sequences after CT measurements (p<0.001, respectively). MAVRIC SL was able to reduce the metallic artifact, permitting observation of the tissue surrounding the metal with good reproducibility.

Interleukin-22 Directly Activates Myocardial STAT3 (Signal Transducer and Activator of Transcription-3) Signaling Pathway and Prevents Myocardial Ischemia Reperfusion Injury.

BACKGROUND Interleukin (IL)-22, a member of the IL-10 cytokine family, is the only known cytokine that is secreted by immune cells but does not target immune cells; it mainly targets epithelial cells. In this study, we aimed to determine whether IL-22 administration could activate the myocardial STAT3 (signal transducer and activator of transcription-3) signaling pathway, and thus prevent myocardial injury, in a mouse model of ischemia reperfusion injury. METHODS AND RESULTS We evaluated the STAT3 activation after IL-22 injection by Western blot analysis and immunostaining for phosphorylated STAT3 in the heart and found that STAT3 activation in heart tissue rapidly peaked after IL-22 injection. Coimmunostaining of phosphorylated STAT3 and α-actinin revealed that STAT3 activation occurred in cardiomyocytes after IL-22 administration. In heart tissue from intact mice, real-time PCR demonstrated significant expression of IL-22 receptor subunit 1, and coimmunostaining of IL-22 receptor subunit 1 and α-actinin showed IL-22 receptor subunit 1 expression in cardiomyocytes. In cultured cardiomyocytes, IL-22 activated STAT3, and we detected IL-22 receptor subunit 1 expression. Overall, these results indicated that IL-22 directly activated the myocardial IL-22-receptor subunit 1-STAT3 signaling pathway. Following ischemia reperfusion, compared with PBS-treated mice, IL-22-treated mice exhibited a significantly reduced infarct size, significantly reduced myocardial apoptosis, and significantly enhanced phosphorylated STAT3 expression. Moreover, heart tissue from IL-22-treated mice exhibited a significantly reduced expression ratio of phosphorylated p53 to p53. CONCLUSIONS Our present findings suggest that IL-22 directly activated the myocardial STAT3 signaling pathway and acted as a cardioprotective cytokine to ameliorate acute myocardial infarction after ischemia reperfusion.

Influence of anionic, neutral, and cationic polysaccharides on the in vitro digestibility of raw and gelatinized potato starch.

BACKGROUND: Polysaccharides have been expected to have a suppressive effect on starch digestibility by blending. The objective of this study was to investigate the effects of anionic (xanthan gum), neutral (guar gum), and cationic (chitosan) polysaccharides on the in vitro digestibility of raw and gelatinized starch using six potato cultivars differing in phosphorus content. RESULTS: By comparing the starch digestibility between potato cultivars, a significant difference was observed for the raw starches, and 'Benimaru', which is a potato cultivar containing a higher proportion of short-chain amylopectin and the lowest phosphorus content in starch, showed a distinctly faster rate of starch hydrolysis. The added polysaccharides decreased the extent of digestion of both raw and gelatinized starches. No significant correlation between phosphorus content and the extent of starch digestion was observed in mixed systems, whereas significant correlations were noted between the extent of starch digestion and Rapid Visco Analyser parameters. The extent of raw and gelatinized starch digestion negatively correlated with pasting temperature, initial viscosity before heating, and peak viscosity (P < 0.01). CONCLUSION: The added polysaccharides were observed to decrease the starch digestibility, and their suppressive effects were mainly dependent on the increase of viscosity rather than chemical interactions. A combination of potato cultivar and type of polysaccharide was proved to be important for nutritional value of potato starch. © 2020 Society of Chemical Industry.

Comparison of textural properties and structure of gels prepared from cooked rice grain under different conditions.

The objective of this study was to investigate the effects of rice variety, water content, and preparation temperature on the textural properties of gels processed from cooked rice grains via high-speed shear homogenization. Rice gels were prepared from seven high-amylose rice varieties. The results demonstrated the significant differences in rice gel hardness and hardening rates during storage based on the rice variety used. The proportion of short chains of amylopectin was negatively correlated with the hardness of the rice gel. The sample temperature before shear treatment also influenced the rice gel hardness. Rice gels prepared from cooked rice maintained at 75°C prior to homogenization showed a higher breaking force than those from cooked rice at 25°C. Observation using scanning electron microscopy demonstrated the tendency of the cooked rice sample maintained at 75°C to form a finer gel network after homogenization than those at 25°C from the same rice variety.

Purification of Branched Dextrin from Nägeli Amylodextrin by Ethanol Precipitation and Characterization of Its Aggregation Property in Methanol-Water.

Ethanol precipitation process for purification of branched dextrin (BD) in Nägeli amylodextrin from waxy rice starch was developed. Temperature and ethanol concentration for precipitation were main parameters affecting the recovery and purity of BD, and the purification condition at 4 °C and 10 % (v/v) ethanol in water was adopted. After four-time precipitation, the BD recovery was 34.6 %, whereas the purity improved from 78.5 % at the initial to 94.5 % at the four-time purified BD (BD4). BD4 mainly showed a chain length distribution between 18 to 35 with a mode length of 25, which shifted after enzymatic debranching with isoamylase to that between 9 and 20 with a mode length of 14. Each purified BD was solubilized in water, and each solution was mixed with methanol-water at 25 °C to a final methanol concentration of 16 M. The flakes of BD precipitated with 16 M methanol exhibited an A-type crystal structure by an X-ray diffraction analysis, and the speed generation of white flakes in 16 M methanol dramatically increased as the purification time increased. The effect of addition of highly branched cyclic dextrin (HBCD) or sodium tetraborate on BD aggregation in 16 M methanol was also investigated, where the former retarded aggregation but the latter had no effect on the velocity. Thus, the purified BD enables rapid characterization of aggregation of double helix structures of A-type crystal structure, and screening of compounds which could affect the phenomena for prediction of potentials in starch modification as well.

One Pot Cooking of Rice Grains for Preparation of Rice-Gel Samples Using a Small-Scale Viscosity Analyzer: Small-scale Rice-gel Preparation from Grains.

Rice-gel prepared by the following three steps: rice grain cooking, shearing of the cooked rice, and cooling for gel formation, is expected as a novel food ingredient for modification of various food products such as bread and noodles. To meet the demand for high-throughput systems for research and developments on the new rice gels, herein we established a mini-cooking system for preparation of rice gel samples from grains using a small-scale viscosity analyzer (Rapid Visco Analyzer; RVA). Polished rice grains (4 g) were cooked with 22 mL of water in a canister, and the paddle equipped in the canister was rotated at 2,000 rpm for 30 min (80 °C was used as a representative) to shear the cooked rice. The sheared paste was cooled to 10 °C at 160 rpm, and the initial gelation property was evaluated by viscosity analysis within the RVA. Alternatively, the sheared paste was transferred to an acrylic mold and kept at 4 °C for 0, 1, 3, and 5 days for determination of the hardness with a compression test. Compressive forces required to penetrate 20 % thickness for three tested rice cultivars were measured, and the trend of the value shifts during preservation is similar to the corresponding trend obtained in 300-g grain scale laboratory tests, whereas the individual values were halved in the former. This small cooking method could offer a useful assay system for a rapid evaluation in the breeding programs and in the high-throughput screening of additives for the modification of properties.

Urinary IgG4 and Smad1 Are Specific Biomarkers for Renal Structural and Functional Changes in Early Stages of Diabetic Nephropathy.

Diabetic nephropathy (DN) is the major cause of end-stage kidney disease, but early biomarkers of DN risk are limited. Herein we examine urinary IgG4 and Smad1 as additional early DN biomarkers. We recruited 815 patients with type 2 diabetes; 554 patients fulfilled the criteria of an estimated glomerular filtration rate (eGFR) >60 mL/min and no macroalbuminuria at baseline, with follow-up for 5 years. Patients without macroalbuminuria were also recruited for renal biopsies. Urinary IgG4 and Smad1 were determined by enzyme-linked immunoassays using specific antibodies. The specificity, sensitivity, and reproducibility were confirmed for each assay. Increased urinary IgG4 was significantly associated with lower eGFR. The level of urinary IgG4 also significantly correlated with surface density of peripheral glomerular basement membrane (Sv PGBM/Glom), whereas Smad1 was associated with the degree of mesangial expansion-both classic pathological findings in DN. Baseline eGFR did not differ between any groups; however, increases in both urinary IgG4 and Smad1 levels at baseline significantly predicted later development of eGFR decline in patients without macroalbuminuria. These data suggest that urinary IgG4 and Smad1 at relatively early stages of DN reflect underlying DN lesions and are relevant to later clinical outcomes.

Suppressive effect of ethanol extract from mango (Mangifera indica L.) peel on IgE production in vitro and in vivo.

Immunoglobulin E (IgE) is involved in the onset of allergic reaction, and the suppression of IgE production leads to alleviation of allergic symptoms. We found that mango peel ethanol extract (MPE) significantly suppresses IgE production by human myeloma cell line U266 cells, suggesting that MPE has an anti-allergic effect by inhibiting the production of IgE. Although mangiferin is contained in mango, which suppresses IgE production by U266 cells, it was not contained in MPE. We investigated the suppressive effect of MPE in 2,4-dinitrofluorobenzene (DNFB)-induced allergic contact dermatitis model mice. The elevation of serum IgE level was significantly suppressed by oral administration of MPE. Intake of MPE also suppressed the expression level of IL-4 in the DNFB-challenged ears, suggesting that MPE suppresses the IL-4-mediated maturation into IgE-producing cells. Our findings indicate that MPE has a potential to alleviate the increase in serum IgE level that is feature of type I allergy.

Selected Use of Telemedicine in Intensive Care Units Based on Severity of Illness Improves Cost-Effectiveness.

BACKGROUND: Telemedicine in the intensive care unit (tele-ICU) is expected to address geographic health disparities through more efficient resource allocation. Our previous economic evaluation demonstrated tele-ICU to be cost-effective in most cases and cost saving in some cases, compared to conventional intensive care unit (ICU) care without adequate intensivist coverage. INTRODUCTION: This study's objective is to examine how to optimize the cost-effectiveness of tele-ICU use by selecting highest risk (i.e., both highest mortality and highest cost) subpopulations. We also explore potential cost savings. MATERIALS AND METHODS: We conducted simulation analyses among a hypothetical adult ICU patient cohort defined by the literature, distinguishing four types of hospitals: urban tertiary (primary analysis), urban community, rural tertiary, and rural community. The selected tele-ICU use was assumed to affect per-patient ICU cost and hospital mortality among highest risk subpopulations (10-100% of all ICU patients), defined by an established illness-severity measure. RESULTS: We found a U-shaped relationship between the economic efficiency and selected tele-ICU use among all 4 hospital types. Optimal cost-effectiveness was achieved when tele-ICU was applied to the 30-40% highest risk patients among all ICU patients (incremental cost-effectiveness ratio = $25,392 [2014 U.S. dollars] per extending a quality-adjusted life year) in urban tertiary hospitals (primary analysis). Our break-even analyses indicated that cost saving seems more feasible when reducing ICU medical care cost, rather than lowering the cost to operate telemedicine alone. DISCUSSION AND CONCLUSIONS: A selected use of tele-ICU based on severity of illness is likely to improve tele-ICU cost-effectiveness. To achieve cost saving, tele-ICU must reduce more than just telemedicine-related cost.

A comparison of the effects of heat moisture treatment (HMT) on rheological properties and amylopectin structure in sago (Metroxylon sago) and arenga (Arenga pinnata) starches.

The objective of this study was to study and compare the impact of HMT on rheology and textural properties observed between sago and arenga starces, and then related to structural change of amylopectin. The HMT were conducted using the autoclaving method at 20% moisture content and heated to 120 C for 60 min for sago and 90 min for arenga starch as optimum condition. The HMT shifted gelatinization temperature higher and reduced the enthalpy of both starches. The HMT sago starch paste exhibited an exceptionally strong shear thinning behavior as shown by a rapid decrease of viscosity and an increase of shear rate. The HMT clearly made the texture of starch gels more fragile compared to their native form and reduced their breaking point to a lower strain. The HMT effect on the rheological properties and texture of the sago starch was greater than the changes observed with the arenga starch. Major changes in rheological properties after HMT was not followed by changes in amylopectin structure. The HMT process did not significantly affect the amylopectin chain-length distribution in Arenga starch. In the sago starch, HMT affect to long chain amylopectin with DP ≥ 37. The HMT effect on rheology and textural properties was higher in sago starch than arenga starch. This study demonstrated that long chain amylopectin with DP ≥ 37 plays an important role in contributing to the rheological change caused by the HMT.