Effect of high-flow vs. low-flow nasal plus mouthguard oxygen therapy on hypoxaemia during sedation: a multicentre randomised controlled trial.

Whether high-flow vs. low-flow nasal oxygen reduces hypoxaemia for sedation during endoscopic retrograde cholangiopancreatography is currently unknown. In this multicentre trial, 132 patients ASA physical status 3 or higher, BMI > 30 kg.m-2 or with known or suspected obstructive sleep apnoea were randomly allocated to high-flow nasal oxygen up to 60 l.min-1 at 100% FI O2 or low-flow nasal oxygen at 4 l.min-1 . The low-flow nasal oxygen group also received oxygen at 4 l.min-1 through an oxygenating mouthguard, totalling 8 l.min-1 . Primary outcome was hypoxaemia, defined as Sp O2 < 90% regardless of duration. Hypoxaemia occurred in 7.7% (5/65) of patients with high-flow and 9.1% (6/66) with low-flow nasal oxygen (percentage point difference -1.4%, 95%CI -10.9 to 8.0; p = 0.77). Between the groups, there were no significant differences in frequency of hypoxaemic episodes; lowest Sp O2 ; peak transcutaneous carbon dioxide; hypercarbia (transcutaneous carbon dioxide > 2.66 kPa from baseline); requirement of chin lift/jaw thrust; nasopharyngeal airway insertion; bag-mask ventilation; or tracheal intubation. Following adjustment for duration of the procedure, the primary outcome remained non-significant. In high-risk patients undergoing endoscopic retrograde cholangiopancreatography, oxygen therapy with high-flow nasal oxygen did not reduce the rate of hypoxaemia, hypercarbia or the need for airway interventions, compared with combined oral and nasal low-flow oxygen.

LmCDA1 organizes the cuticle by chitin deacetylation in Locusta migratoria.

Cells produce an extracellular matrix (ECM) with a stereotypic organization that is important for tissue function. The insect cuticle is a layered ECM that mainly consists of the polysaccharide chitin and associated proteins adopting a quasi-crystalline structure. Our understanding of the molecular mechanisms deployed during construction of the highly ordered protein-chitin ECM so far is limited. In this study, we report on the role of the chitin deacetylase 1 (LmCDA1) in the organization of the protein-chitin ECM in the migratory locust Locusta migratoria, and LmCDA1 localizes predominantly to the apical tier of the protein-chitin ECM, but it is also found in lower regions. Reduction of LmCDA1 function correlates with lower amounts of chitin and impedes conversion of chitin to chitosan by deacetylation. Establishment of the quasi-crystalline architecture of the protein-chitin ECM is, however, independent of LmCDA1 activity, but it is dependent on another chitin deacetylase, LmCDA2, which has no detectable effects on chitin deacetylation and, as shown previously, no influence on chitin content. Our data reveal that LmCDA1 and LmCDA2 act in parallel and independently from each other in defining the dimensions of the cuticle. Both enzymes are non-uniformly distributed within the protein-chitin matrix, suggesting a site-autonomous function.

The effect of sevoflurane on the transmural dispersion of repolarisation in patients with type 2 diabetes mellitus: a prospective observational study.

The 'torsadogenic' property of a drug is linked to its ability to increase the transmural dispersion of repolarisation, represented by the interval between the peak of, and the end of, the T-wave (Tp-e interval) in an electrocardiogram. Reports have consistently shown that sevoflurane does not increase the Tp-e interval. Type 2 diabetes is a risk factor for increased QTc (rate-corrected QT interval), QTcd (rate-corrected QTc dispersion: difference between the maximum and the minimum QTc interval), and Tp-e, as well as the rate-corrected Tp-e (Tp-e/QTc ratio). The study aimed to ascertain whether sevoflurane increased the Tp-e interval and Tp-e/QTc ratio in patients with diabetes, thereby increasing their risk of torsades. We enrolled 35 female patients; 17 with type 2 diabetes and 18 controls undergoing non-laparoscopic surgery under sevoflurane anaesthesia. The Tp-e interval, Tp-e/QTc ratio, QTc and QTcd were recorded after intubation, 5, 10, 30 and 60 minutes into the anaesthetic, and were compared between the groups. No significant increase in the Tp-e interval or Tp-e/QTc was observed between or within the groups (a 13 ms increase was considered significant). In the control group, the QTc was significantly increased from baseline immediately after intubation (449 versus 414 ms, P <0.001); at 5 minutes (434 versus 414 ms, P=0.01); at 10 minutes (444 versus 414 ms, P=0.002); at 30 minutes (439 versus 414 ms, P=0.001) and at 60 minutes (442 versus 414 ms; P <0.001) (a 20 ms increase was considered significant). No significant increase in QTc was observed in the diabetic group. There were no between or within group differences observed for QTcd. Our findings suggest that sevoflurane does not have a significant predictable pro-arrhythmic effect in type 2 diabetic patients in the absence of other factors affecting ventricular repolarisation.

Quantification of fat infiltration in the sacroiliac joints with ankylosing spondylitis using IDEAL sequence.

AIM: To quantitatively assess fat infiltration in the sacroiliac joints (SIJs) of patients with ankylosing spondylitis (AS) by measuring the fat/water signal ratios of periarticular bone marrow with iterative decomposition of water and fat with echo asymmetry and least square estimation (IDEAL). MATERIALS AND METHODS: Routine SIJ magnetic resonance imaging (MRI) and IDEAL were performed on 40 patients with AS and 30 healthy subjects. The fat infiltration regions (FIRs) and normal-appearing regions (NARs) of patients were measured based on the fat/water signal intensity on IDEAL. RESULTS: AS patients had higher fat/water signal ratios on FIRs and NARs (65.4-85.4%, p<0.05, and 44.1-70.7%, p<0.05, respectively) compared to healthy controls (38.3-43.3%). After treatment, the fat/water signal ratios of FIRs and NARs decreased (42.1-53.7% and 41.5-50.3%, respectively), but they remained higher than in the healthy controls (p<0.05). The fat infiltration was detected more effectively with a fat fraction map of the IDEAL sequence (95%) than other sequences, including the T1-weighted sequence (65%), and the fat/water signal ratios of the sacrum and ilium between the left and right sides of SIJs were approximately the same. CONCLUSION: The findings of this study suggest that IDEAL may be useful as a quantitative and objective method for evaluating the fat infiltration in the periarticular bone marrow of SIJs with AS; additionally, the sensitivity of IDEAL is better than that of routine sequences in detecting micro-fat infiltration of SIJs, and IDEAL can be used to quantitatively measure the adipose content and monitor patient follow-up after AS treatment.

Ground states of a Bose-Einstein Condensate in a one-dimensional laser-assisted optical lattice.

We study the ground-state behavior of a Bose-Einstein Condensate (BEC) in a Raman-laser-assisted one-dimensional (1D) optical lattice potential forming a multilayer system. We find that, such system can be described by an effective model with spin-orbit coupling (SOC) of pseudospin (N-1)/2, where N is the number of layers. Due to the intricate interplay between atomic interactions, SOC and laser-assisted tunnelings, the ground-state phase diagrams generally consist of three phases-a stripe, a plane wave and a normal phase with zero-momentum, touching at a quantum tricritical point. More important, even though the single-particle states only minimize at zero-momentum for odd N, the many-body ground states may still develop finite momenta. The underlying mechanisms are elucidated. Our results provide an alternative way to realize an effective spin-orbit coupling of Bose gas with the Raman-laser-assisted optical lattice, and would also be beneficial to the studies on SOC effects in spinor Bose systems with large spin.

Anosognosia, neglect and quality of life of right hemisphere stroke survivors.

BACKGROUND AND PURPOSE: Anosognosia and neglect may coexist in stroke patients. Neglect patients often report poor quality of life (QOL), whereas patients suffering from other cognition disorders with poor insight report better QOL. This study investigates the relationship between anosognosia, neglect and QOL amongst stroke survivors. METHODS: Stroke survivors who met the criteria were used as a sampling pool. Sixty stroke patients were observed in this study, amongst whom 20 patients with anosognosia and neglect (A+N+), 20 patients with neglect but not anosognosia (A-N+) and 20 patients with neither anosognosia nor neglect (A-N-) were selected from the sampling pool based on demographic characteristics matched with the A+N+ group. A questionnaire (SS-QOL) was used to collect the QOL perceived by the stroke survivors. RESULTS: The perceived QOL of the A+N+ group was significantly better than those of the other groups, including the subscales of self-care, mobility, work/productivity, upper extremity, mood, family role and social role. However, the A+N+ group had poor balance level and more fall incidents were reported. CONCLUSION: The A+N+ group perceived better QOL but had more falls and poorer balance than the other groups. Health providers should work with caregivers aggressively in preventing accidents.

Comprehensive gene expression profiling and immunohistochemical studies support application of immunophenotypic algorithm for molecular subtype classification in diffuse large B-cell lymphoma: a report from the International DLBCL Rituximab-CHOP Consortium Program Study.

Gene expression profiling (GEP) has stratified diffuse large B-cell lymphoma (DLBCL) into molecular subgroups that correspond to different stages of lymphocyte development-namely germinal center B-cell like and activated B-cell like. This classification has prognostic significance, but GEP is expensive and not readily applicable into daily practice, which has lead to immunohistochemical algorithms proposed as a surrogate for GEP analysis. We assembled tissue microarrays from 475 de novo DLBCL patients who were treated with rituximab-CHOP chemotherapy. All cases were successfully profiled by GEP on formalin-fixed, paraffin-embedded tissue samples. Sections were stained with antibodies reactive with CD10, GCET1, FOXP1, MUM1 and BCL6 and cases were classified following a rationale of sequential steps of differentiation of B cells. Cutoffs for each marker were obtained using receiver-operating characteristic curves, obviating the need for any arbitrary method. An algorithm based on the expression of CD10, FOXP1 and BCL6 was developed that had a simpler structure than other recently proposed algorithms and 92.6% concordance with GEP. In multivariate analysis, both the International Prognostic Index and our proposed algorithm were significant independent predictors of progression-free and overall survival. In conclusion, this algorithm effectively predicts prognosis of DLBCL patients matching GEP subgroups in the era of rituximab therapy.

Prediction of optimal lithium doses for Taiwanese psychiatric patients.

BACKGROUND: Standard dosing regimens with lithium usually require significant time before the optimal serum concentration is achieved. METHOD: The present study compares a new method (Method 1) with two existing ones (Methods 2 and 3) for dosing of individual patients with lithium, to more rapidly achieve optimum concentrations. Thirty patients, who were on lithium therapy and who met the inclusion criteria, were evaluated. RESULTS: The correlation coefficient between true and expected concentrations were 0.518 (P < 0.01), 0.555 (P < 0.01) and 0.424 (P = 0.019) respectively. The mean +/- standard deviation of the difference from the expected concentrations of three methods were 0.02 +/- 0.20 mEq/L, 0.31 +/- 0.22 and -0.27 +/- 0.25 respectively. CONCLUSION: Method 1 was the least biased and most accurate among three methods for predicting the optimal therapeutic lithium dose in Taiwanese psychiatric patients.

Soliton solution of continuum magnetization equation in a conducting ferromagnet with a spin-polarized current.

Exact soliton solutions of a modified Landau-Lifshitz equation for the magnetization of conducting ferromagnet in the presence of a spin-polarized current are obtained by means of inverse scattering transformation. From the analytical solution the effects of spin current on the frequency, wave number, and dispersion law of spin wave are investigated. The one-soliton solution indicates obviously current-driven precession and periodic shape variation as well. The inelastic collision of solitons, by which we mean the shape change before and after collision, appears due to the spin current. We, moreover, show that complete inelastic collisions can be achieved by adjusting spectrum and current parameters. This may lead to an potential technique for shape control of spin wave.

Analysis of high density expression microarrays with signed-rank call algorithms.

MOTIVATION: We consider the detection of expressed genes and the comparison of them in different experiments with the high-density oligonucleotide microarrays. The results are summarized as the detection calls and comparison calls, and they should be robust against data outliers over a wide target concentration range. It is also helpful to provide parameters that can be adjusted by the user to balance specificity and sensitivity under various experimental conditions. RESULTS: We present rank-based algorithms for making detection and comparison calls on expression microarrays. The detection call algorithm utilizes the discrimination scores. The comparison call algorithm utilizes intensity differences. Both algorithms are based on Wilcoxon's signed-rank test. Several parameters in the algorithms can be adjusted by the user to alter levels of specificity and sensitivity. The algorithms were developed and analyzed using spiked-in genes arrayed in a Latin square format. In the call process, p-values are calculated to give a confidence level for the pertinent hypotheses. For comparison calls made between two arrays, two primary normalization factors are defined. To overcome the difficulty that constant normalization factors do not fit all probe sets, we perturb these primary normalization factors and make increasing or decreasing calls only if all resulting p-values fall within a defined critical region. Our algorithms also automatically handle scanner saturation.

Placenta accreta diagnosed at 9 weeks' gestation.

The majority of cases of placenta accreta are unanticipated and initially identified intraoperatively. Although color Doppler ultrasound is adequate for the evaluation of placenta accreta in the third trimester, ultrasound diagnosis in the first trimester has never been reported. To our knowledge, this is the first case of placenta accreta detected at 9 weeks' gestation by ultrasound. Placenta accreta with intraplacental lacunae can be identified together with a loss of the hypoechogenic retroplacental myometrial zone. Based on this case, we found that early diagnosis of placenta accreta in the first trimester by ultrasound is possible.

Nonlinear effects in interference of bose-einstein condensates

Nonlinear effects in the interference of Bose-Einstein condensates are studied using exact solutions of the one-dimensional nonlinear Schrodinger equation, which is applicable when the lateral motion is confined or negligible. With the inverse scattering method, the interference pattern is studied as a scattering problem with the linear Schrodinger equation, whose potential is profiled by the initial density distribution of the condensates. Our theory not only provides an analytical framework for quantitative predictions for the one-dimensional case, it also gives an intuitive understanding of some mysterious features of the interference patterns observed in experiments and numerical simulations.

One Hundred Twenty-four Laparoscopic-Assisted Vaginal Hysterectomies

Laparoscopic-assisted vaginal hysterectomy (LAVH) is not yet widely practiced in Taiwan, but interest in this operation is increasing as our knowledge of operative laparoscopy expands. From October 1994 to December 1995, 124 LAVHs were performed. The endoscopic stapler divides tissues and achieves hemostasis quite easily, but its cost is a disadvantage. Kleppinger bipolar forceps for hemostasis and scissors for division are less expensive for the average hospital. Ureteral injury is a crucial issue in LAVH, and is linked to various stages of the operation. Identifying the ureter before the operation and dissecting it after division of the infundibulopelvic ligament are essential to avoid ureteral injury.