Effects of Early Initiation of Polymyxin B Hemoperfusion Therapy in Patients with Cancer with Refractory Septic Shock.

Background: We aimed to analyze the correlation between in-hospital mortality and hemodynamic changes, using polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) initiation time in patients with cancer with refractory septic shock. Methods: Forty-six patients with cancer who received PMX-DHP for refractory septic shock were retrospectively analyzed and classified into early (≤3 h between refractory septic shock and PMX-DHP; n = 17) and late (>3 h; n = 29) initiation groups. The vasopressor inotropic score (VIS), sequential organ failure assessment (SOFA) score, and lactate clearance before and 24 h post-PMX-DHP were compared. Results: Overall, 52.17% died from multiple organ dysfunction, with a lower mortality rate in the early initiation group. The VIS and SOFA score decreased in both groups, but the magnitude of decrease was not significant. Lactate clearance improved in both groups, with greater improvement in the early initiation group. Univariable analysis identified associations of in-hospital mortality with early initiation, ΔC-reactive protein, lactate clearance, ΔSOFA score, and ΔVIS. Multivariable analysis demonstrated associations of in-hospital mortality risk with ΔSOFA score and early PMX-DHP initiation. Overall survival was higher in the early initiation group. Early initiation of PMX-DHP in patients with cancer with refractory septic shock reduced in-hospital mortality and improved lactate clearance.

The hazardous interactions of copper-dyed patient gowns with MRI: Two cases of superficial abdominal burns.

Magnetic resonance imaging is a commonly used imaging modality in medical procedures. Despite its prevalent use, unexpected adverse events such as burns can occur during an MRI procedure. The majority of the transmitted Radio Frequency power can be converted into heat within the patient's tissue due to resistive losses, leading to such incidents. In this study, we present an intriguing case of a patient who experienced an MRI-induced burn, presumably caused by the copper dye in the patient's gown. Notably, we observed frequent distortion of the MR image due to the patient's gown. The awareness and understanding of such potential adverse events are critical for clinicians and technicians to prevent future occurrences. Through this study, we aim to contribute to this critical area of patient safety during MRI procedures.

Methylprednisolone and 60 Days in Hospital Survival in Coronavirus Disease 2019 Pneumonia.

OBJECTIVES: To determine methylprednisolone's dose, duration, and administration from onset of symptoms and association with 60 days in hospital survival of coronavirus disease 2019 pneumonia. DESIGN: Cohort study. SETTING: Thirteen hospitals in New Jersey, United States during March to June 2020. PATIENTS: Seven-hundred fifty-nine hospitalized coronavirus disease 2019 patients. INTERVENTIONS: We performed a propensity matched cohort study between patients who received methylprednisolone and no methylprednisolone. Patients in the methylprednisolone group were further differentiated into dose (high dose and low dose), duration, and administration from onset of symptoms. MEASUREMENTS AND MAIN RESULTS: In the propensity matched sample, 99 out of 380 (26%) in no methylprednisolone, 69 out of 215 (31.9%) in low-dose methylprednisolone, and 74 out of 164 (55.2%) high-dose methylprednisolone expired. Overall median survival for no methylprednisolone (25.0 d), low-dose methylprednisolone (39.0 d), high-dose methylprednisolone (20.0 d), less than or equal to 7 days duration (19.0 d), 7-14 days duration (30.0 d), greater than 14 days duration (44.0 d), onset of symptoms less than or equal to 7 days (20.0 d), and onset of symptoms 7-14 days (27.0 d) were statistically significant (log-rank p ≤ 0.001). Multivariate Cox regression showed nursing home residents, coronary artery disease, and invasive mechanical ventilation were independently associated with mortality. Methylprednisolone was associated with reduced mortality compared with no methylprednisolone (hazard ratio, 0.40; 95% CI, 0.27-0.59; p < 0.001) but no added benefit with high dose. Low-dose methylprednisolone for 7-14 days was associated with reduced mortality compared with less than or equal to 7 days (hazard ratio, 0.45; 95% CI, 0.22-0.91; p = 0.0273), and no additional benefit if greater than 14 days (hazard ratio, 1.27; 95% CI, 0.60-2.69; p = 0.5434). Combination therapy with tocilizumab was associated with reduced mortality over monotherapy (p < 0.0116). CONCLUSIONS: Low-dose methylprednisolone was associated with reduced mortality if given greater than 7 days from onset of symptoms, and no additional benefit greater than 14 days. High dose was associated with higher mortality.

Effects of Propylene Oxide End Capping on Amination of Polyalkylene Glycols.

Polyalkylene glycols with two different end-capping groups of ethylene oxide (EO) and propylene oxide (PO) were used for amination to produce polyetheramine (PEA) on cobalt-based catalysts. Although it is known that the amination of secondary alcohol is more difficult than that of primary alcohol, PO end-capped block copolymers showed remarkably enhanced activity toward PEA and selectivity toward the primary amine compared to EO end-capped block copolymers.

Nitride-Based Microlight-Emitting Diodes Using AlN Thin-Film Electrodes with Nanoscale Indium/Tin Conducting Filaments.

Microlight-emitting diodes (µLEDs) are emerging solutions for both high-quality displays and lighting technologies. However, the overall light output power density of these devices is low, as the emission area is shielded by the p-electrodes required for current injection. In this study, instead of the more conventionally used indium tin oxide (ITO), an AlN thin film with nanoscale conducing filaments (CFs) is used, referred to as CF-AlN, as a transparent conducting electrode (TCE), to enhance the output power density from the same emission area. As a result of this modification, the electroluminescence intensity is enhanced by 10% at an injection current of 10 mA, and the current density is improved by 13% at a forward voltage of 4.9 V, in comparison to the parameters observed with ITO-based µLEDs. This improvement is attributed to the higher transmittance of CF-AlN TCEs, together with efficient hole injection from the p-electrode into the light-emitting layer, through the CFs formed in the AlN layer. In addition, using transmission electron microscopy analyses, the origin of the CFs is directly identified as the diffusion of In and Sn ions, which provides critical insight into the conduction mechanism of AlN-based TCEs.

Exploring oxygen-affinity-controlled TaN electrodes for thermally advanced TaOx bipolar resistive switching.

Recent advances in oxide-based resistive switching devices have made these devices very promising candidates for future nonvolatile memory applications. However, several key issues remain that affect resistive switching. One is the need for generic alternative electrodes with thermally robust resistive switching characteristics in as-grown and high-temperature annealed states. Here, we studied the electrical characteristics of Ta2O5-x oxide-based bipolar resistive frames for various TaNx bottoms. Control of the nitrogen content of the TaNx electrode is a key factor that governs variations in its oxygen affinity and structural phase. We analyzed the composition and chemical bonding states of as-grown and annealed Ta2O5-x and TaNx layers and characterized the TaNx electrode-dependent switching behavior in terms of the electrode's oxygen affinity. Our experimental findings can aid the development of advanced resistive switching devices with thermal stability up to 400 °C.

Dietary Pea Fiber Supplementation Improves Glycemia and Induces Changes in the Composition of Gut Microbiota, Serum Short Chain Fatty Acid Profile and Expression of Mucins in Glucose Intolerant Rats.

Several studies have demonstrated the beneficial impact of dried peas and their components on glucose tolerance; however, the role of gut microbiota as a potential mediator is not fully examined. In this study, we investigated the effect of dietary supplementation with raw and cooked pea seed coats (PSC) on glucose tolerance, microbial composition of the gut, select markers of intestinal barrier function, and short chain fatty acid profile in glucose intolerant rats. Male Sprague Dawley rats were fed high fat diet (HFD) for six weeks to induce glucose intolerance, followed by four weeks of feeding PSC-supplemented diets. Cooked PSC improved glucose tolerance by approximately 30% (p < 0.05), and raw and cooked PSC diets reduced insulin response by 53% and 56% respectively (p < 0.05 and p < 0.01), compared to HFD (containing cellulose as the source of dietary fiber). 16S rRNA gene sequencing on fecal samples showed a significant shift in the overall microbial composition of PSC groups when compared to HFD and low fat diet (LFD) controls. At the family level, PSC increased the abundance of Lachnospiraceae and Prevotellaceae (p < 0.001), and decreased Porphyromonadaceae (p < 0.01) compared with HFD. This was accompanied by increased mRNA expression of mucin genes Muc1, Muc2, and Muc4 in ileal epithelium (p < 0.05). Serum levels of acetate and propionate increased with raw PSC diet (p < 0.01). These results indicate that supplementation of HFD with PSC fractions can improve glycemia and may have a protective role against HFD-induced alterations in gut microbiota and mucus layer.

Shoulder muscle atrophy and its relation to strength loss in obstetrical brachial plexus palsy.

BACKGROUND: Treatment/prevention of shoulder muscle strength imbalances are major therapeutic goals for children with obstetrical brachial plexus palsy. The study aims were to characterize muscle atrophy in children/adolescents with unilateral obstetrical brachial plexus palsy, to quantify the agonist-antagonist muscle volume balance and the association between muscle volume and strength. METHODS: Eight boys and four girls (age=12.1, standard deviation=3.3) participated in this case-control study. Three-dimensional magnetic resonance images of both shoulders were acquired. The unimpaired shoulder served as a reference. Volumes of deltoid, pectoralis major, supraspinatus, infraspinatus, teres major, subscapularis were calculated based on 3D models, derived through image segmentation. Maximal isometric torques were collected in six directions. FINDINGS: All the major muscles studied were significantly atrophied. The teres major demonstrated the biggest difference in atrophy between groups (51 percentage points), the pectoralis major was the least atrophied (23 percentage points). The muscle volume distribution was significantly different between shoulders. Muscle volume could predict maximal voluntary isometric torques, but the regression coefficients were weaker on the impaired side (72% to 91% of the strength could be predicted in the uninvolved side and 24% to 90% in the involved side and external rotation strength could not be predicted). INTERPRETATION: This study demonstrates muscle atrophy varied across all the main shoulder muscles of the glenohumeral joint, leading to significant muscle volume imbalances. The weaker coefficients of determination on the impaired side suggest that other variables may contribute to the loss of strength in addition to atrophy.

Local Atrial/Ventricular Ratio as an Adjuvant Marker for Catheter Ablation of Atrioventricular Accessory Pathways.

BACKGROUND AND OBJECTIVES: The earliest atrial (A)/ventricular (V) activation potential, or accessory pathway (AP) potential are commonly used as ablation targets for atrioventricular (AV) APs. However, these targets are sometimes ambiguous. SUBJECTS AND METHODS: We reviewed 119 catheter ablation cases in 112 patients diagnosed with orthodromic atrioventricular reentrant tachycardia (AVRT) or Wolff-Parkinson-White (WPW) syndrome. Local A/V amplitude potentials with the earliest activation or AP potential were measured shortly before achieving antegrade AP conduction block, ventriculoatrial block during right ventricle (RV) pacing, or AVRT termination with no AP conduction. RESULTS: APs were located in the left lateral (55.5%), left posterior (17.6%), left posteroseptal (10.1%), midseptal (1.7%), right posteroseptal (7.6%), right posterior (1.7%), and right lateral (5.9%) regions. The mean earliest activation time was 16.7±15.5 ms, mean A/V potential was 1.1±0.9/1.0±0.9 mV, and mean A/V ratio was 1.7±2.0. There was no statistically significant difference between the activation methods (antegrade vs. RV pacing vs. orthodromic AVRT) or AP locations (left vs. right atrium). However, when the local A/V ratio was divided into 3 groups (≤0.6, 1.0±0.3, and ≥1.4), the antegrade approach resulted in an A/V ratio greater than 1.0±0.3 (86.7%, p=0.007), and the orthodromic AVRT state resulted in a ratio of less than 1.0±0.3 (87.5%, p<0.001). CONCLUSION: The mean local A/V potential and ratio did not differ by activation method or AP location. However, a different A/V ratio based on activation method (≥1.0±0.3, antegrade approach; and ≤1.0±0.3, orthodromic AVRT state) could be a good adjuvant marker for targeting AV APs.

Effect of pertussis toxin pretreated centrally on blood glucose level induced by stress.

In the present study, we examined the effect of pertussis toxin (PTX) administered centrally in a variety of stress-induced blood glucose level. Mice were exposed to stress after the pretreatment of PTX (0.05 or 0.1 µg) i.c.v. or i.t. once for 6 days. Blood glucose level was measured at 0, 30, 60 and 120 min after stress stimulation. The blood glucose level was increased in all stress groups. The blood glucose level reached at maximum level after 30 min of stress stimulation and returned to a normal level after 2 h of stress stimulation in restraint stress, physical, and emotional stress groups. The blood glucose level induced by cold-water swimming stress was gradually increased up to 1 h and returned to the normal level. The intracerebroventricular (i.c.v.) or intrathecal (i.t.) pretreatment with PTX, a Gi inhibitor, alone produced a hypoglycemia and almost abolished the elevation of the blood level induced by stress stimulation. The central pretreatment with PTX caused a reduction of plasma insulin level, whereas plasma corticosterone level was further up-regulated in all stress models. Our results suggest that the hyperglycemia produced by physical stress, emotional stress, restraint stress, and the cold-water swimming stress appear to be mediated by activation of centrally located PTX-sensitive G proteins. The reduction of blood glucose level by PTX appears to due to the reduction of plasma insulin level. The reduction of blood glucose level by PTX was accompanied by the reduction of plasma insulin level. Plasma corticosterone level up-regulation by PTX in stress models may be due to a blood glucose homeostatic mechanism.

Memory window engineering of Ta2O5-x oxide-based resistive switches via incorporation of various insulating frames.

Three-dimensional (3D) stackable memory frames, including nano-scaled crossbar arrays, are one of the most reliable building blocks to meet the demand of high-density non-volatile memory electronics. However, their utilization has the disadvantage of introducing issues related to sneak paths, which can negatively impact device performance. We address the enhancement of complementary resistive switching (CRS) features via the incorporation of insulating frames as a generic approach to extend their use; here, a Pt/Ta2O5-x/Ta/Ta2O5-x/Pt frame is chosen as the basic CRS cell. The incorporation of Ta/Ta2O5-x/Ta or Pt/amorphous TaN/Pt insulting frames into the basic CRS cell ensures the appreciably advanced memory features of CRS cells including higher on/off ratios, improved read margins, and increased selectivity without reliability degradation. Experimental observations identified that a suitable insulating frame is crucial for adjusting the abrupt reset events of the switching element, thereby facilitating the enhanced electrical characteristics of CRS cells that are suitable for practical applications.

The Association between Stress Level in Daily Life and Age at Natural Menopause in Korean Women: Outcomes of the Korean National Health and Nutrition Examination Survey in 2010-2012.

BACKGROUND: Although several risk factors associated with reduced age at natural menopause (ANM) have been investigated, the results are inconsistent. Excessive stress, which leads to elevation of stress hormones, can also negatively affect reproductive ability, including by accelerating menopause. However, a direct association between stress level and ANM has not yet been demonstrated. Therefore, the object of this study was to investigate the association between stress level and ANM in Korean women. METHODS: Study participants were Korean women between 40 and 70 years old who were in natural menopause during the 5th Korean National Health and Nutrition Examination Survey (n=3,176). The level of stress in daily life was estimated based on data from the mental health topics of the survey. We used the t-test and one-way analysis of variance to analyze the correlation between stress level and ANM. Regression (ß) coefficients calculated by multiple regression analysis were used to estimate various factors affecting ANM. RESULTS: Women who experienced a high level of stress in daily life had a lower mean ANM than women with a low stress level (50.17±3.7 and 50.58±3.5 years, respectively), with a statistically significant correlation (P<0.05). This correlation was still observed after adjusting for age, body mass index, menstrual regularity, and personal income (P<0.05 for variables). CONCLUSION: In Korean women between 40 and 70 years of age who are in natural menopause, there is a statistically significant correlation between stress level and ANM. In particular, women who experience a high level of stress in daily life have reduced ANM.

The effective quadriceps and patellar tendon moment arms relative to the tibiofemoral finite helical axis.

The moment arm is a crucial parameter for understanding musculoskeletal dynamics as it defines how linear muscle force is transformed into a moment. Yet, for the quadriceps tendon this parameter cannot be directly calculated, as the patella creates a dynamic fulcrum. Thus, the effective quadriceps moment arm (EQma) was developed to define the quadriceps force to tibial moment relationship. In vivo data in regards to the EQma are lacking and the critical question of how patellofemoral kinematics may influence the EQma remains unresolved. Therefore, the purpose of this study was to quantify the in vivo EQma during a knee extension exercise in asymptomatic controls and to correlate the EQma with sagittal plane patellofemoral kinematics. While subjects (30F/10M, 26.5±5.6 years, 167.5±10.2 cm, 62.6±10.7 kg) cyclically flexed-extended their knees within the MR scanner, dynamic cine-phase contrast and cine MR images were acquired. From these data, patellofemoral kinematics, the ratio of the patellar tendon to quadriceps force, the patellar tendon moment arm, and the EQma were quantified. The EQma trended upwards (32.9-45.5 mm (females) and 31.5-47.1 mm (males)) as the knee angle decreased (50-10°). The quadriceps had a mechanical advantage (ratio of patellar to quadriceps tendon forces >1.0) for knee angles ≤20°. The EQma did not correlate with sagittal plane patellofemoral kinematics. As this is the first study to characterize the EQma in vivo during dynamic volitional activity, in a large group of asymptomatic controls, it can serve as a foundation for future knee joint models and to explore how pathological conditions affect the EQma.

In vivo pediatric shoulder muscle volumes and their relationship to 3D strength.

In the pediatric shoulder, injury and pathology can disrupt the muscle force balance, resulting in severe functional losses. As little data exists pertaining to in vivo pediatric shoulder muscle function, musculoskeletal data are crucially needed to advance the treatment of pediatric shoulder pathology/injury. Therefore, the purpose of this study was to develop a pediatric database of in vivo volumes for the major shoulder muscles and correlate these volumes with maximum isometric flexion/extension, internal/external rotation, and abduction/adduction joint moments. A methodology was developed to derive 3D shoulder muscle volumes and to divide the deltoid into sub-units with unique torque producing capabilities, based on segmentation of three-dimensional magnetic resonance images. Eleven typically developing children/adolescents (4F/7M, 12.0 ± 3.2 years, 150.8 ± 16.7 cm, 49.2 ± 16.4 kg) participated. Correlation and regression analyses were used to evaluate the relationship between volume and maximum, voluntary, isometric joint torques. The deltoid demonstrated the largest (30.4 ± 1.2%) and the supraspinatus the smallest (4.8 ± 0.5%) percent of the total summed volume of all six muscles evaluated. The anterior and posterior deltoid sections were 43.4 ± 3.9% and 56.6 ± 3.9% of the total deltoid volume. The percent volumes were highly consistent across subjects. Individual muscle volumes demonstrated moderate-high correlations with torque values (0.70-0.94, p<0.001). This study presents a comprehensive database documenting normative pediatric shoulder muscle volume. Using these data a clear relationship between shoulder volume and the torques they produce was established in all three rotational degrees-of-freedom. This study furthers the understanding of shoulder muscle function and serves as a foundation for evaluating shoulder injury/pathology in the pediatric/adolescent population.

Complete mitochondrial genome of the whiter-spotted flower chafer, Protaetia brevitarsis (Coleoptera: Scarabaeidae).

Abstract The complete nucleotide sequences of the mitochondrial genome from the whiter-spotted flower chafer, Protaetia brevitarsis (Coleoptera: Scarabaeidae), was determined. The 20,319-bp long circular genome is the longest among completely sequenced Coleoptera. As is typical in animals, the P. brevitarsis genome consisted of two ribosomal RNAs, 22 transfer RNAs, 13 protein-coding genes and one A + T-rich region. Although the size of the coding genes was typical, the non-coding A + T-rich region was 5654 bp, which is the longest in insects. The extraordinary length of this region was composed of 28,117-bp tandem repeats and 782-bp tandem repeats. These repeat sequences were encompassed by three non-repeat sequences constituting 1804 bp.

Reliability and Validity of the Korean World Health Organization Quality of Life (WHOQOL)-BREF in People With Physical Impairments.

OBJECTIVE: To identify the validity and reliability of the Korean version World Health Organization Quality of Life Assessment (WHOQOL)-BREF among people with physical impairments living in a community. METHODS: Participants listed in the community-based rehabilitation project were recruited from 45 public health centers. People with brain lesions or physical disabilities were selected. Respondents (n=750) filled out the Korean WHOQOL-BREF questionnaire. Obtained data were analyzed statistically to assess the internal consistency as well as the construct and discriminant validity. An exploratory factor analysis was also performed. RESULTS: Cronbach's α for the total score was 0.839. The value for each domain ranged from 0.746 to 0.849. Pearson correlation coefficient between each domain ranged from 0.539 to 0.717. The highest correlation was between the psychological and physical domain. The item-domain correlation indicated a significant correlation with their original domains. A multiple regression analysis of each domain with two overall questions was performed. The psychological domain made the strongest contribution with the overall quality of life (unstandardized coefficient B=0.065, r(2)=0.437). When general health satisfaction was considered as a dependent variable, the physical domain most strongly contributed to the variable (unstandardized coefficient B=0.081, r(2)=0.462). Exploratory factor analysis yielded four factors in the WHOQOL-BREF, accounting for 55.29% of the variability. To assess the discriminant validity, a comparison of each domain with Modified Barthel Index (MBI) was conducted. There were highly significant changes across the MBI scores with the WHOQOL-BREF domains (p<0.001). CONCLUSION: Korean WHOQOL-BREF is a valid and reliable tool to measure the quality of life for people with physical impairments. It has good internal consistency, construct validity and discriminant validity for the population. Further study with a stratified sample is needed.

Reaction-based dual signaling of fluoride ions by resorufin sulfonates.

We developed new reaction-based probes for the dual signaling of fluoride ions. Selective fluoride-assisted deprotection of resorufin nosylate to generate resorufin fluorochrome was used for signaling. Resorufin nosylate exhibited selective colorimetric and fluorogenic signaling of fluoride ions in acetonitrile. The response from sulfide ions was effectively masked by using the TPEN-Cu(2+) complex as a source of Cu(2+) ions for masking sulfide. Selective optical signaling of fluoride was possible in the presence of commonly encountered anions with a detection limit of 1.9 × 10(-6) M.

Synthesis and antifungal activity of 1-thia-4b-aza-cyclopenta[b]fluorene-4,10-diones.

1-Thia-4b-aza-cyclopenta[b]fluorene-4,10-diones were synthesized and tested for in vitro antifungal activity against two pathogenic strains of fungi. Among them tested, many compounds showed good antifungal activity. The results suggest that 1-thia-4b-aza-cyclopenta[b]fluorene-4,10-diones would be antifungal agents.