The application of individual virtual nostalgic game design to the evaluation of cognitive function

The aim of this study was to develop a task set based on personalized material for nostalgic experience, which could detect cognitive ability via a virtual experience system combined with Kinect somatosensory interactive operation applications without the user wearing any accessory input device. Fifty-nine subjects participated in the experiment. The receiver operating characteristic curve of the game system was statistically analyzed for determining the best cutoff-point in the cognitive function assessment. Correlation analysis and regression analysis were used to explore the correlations between the results and the clinical cognitive assessment scales. According to the MoCA scores, the results showed that the accuracy of the system was 86.4% in evaluating mild cognitive impairment. The system seems feasible and was strongly correlated with clinical cognitive assessment scales. We anticipate that daily use of our system could keep track of changes of cognitive function of the elderly in home life.

EMG synchrony to assess impaired corticomotor control of locomotion after stroke

Adapting one's gait pattern requires a contribution from cortical motor commands. Evidence suggests that frequency-based analysis of electromyography (EMG) can be used to detect this cortical contribution. Specifically, increased EMG synchrony between synergistic muscles in the Piper frequency band has been linked to heightened corticomotor contribution to EMG. Stroke-related damage to cerebral motor pathways would be expected to diminish EMG Piper synchrony. The objective of this study is therefore to test the hypothesis that EMG Piper synchrony is diminished in the paretic leg relative to nonparetic and control legs, particularly during a long-step task of walking adaptability. Twenty adults with post-stroke hemiparesis and seventeen healthy controls participated in this study. EMG Piper synchrony increased more for the control legs compare to the paretic legs when taking a non-paretic long step (5.02±3.22% versus 0.86±2.62%), p<0.01) and when taking a paretic long step (2.04±1.98% versus 0.70±2.34%, p<0.05). A similar but non-significant trend was evident when comparing non-paretic and paretic legs. No statistically significant differences in EMG Piper synchrony were found between legs for typical walking. EMG Piper synchrony was positively associated with walking speed and step length within the stroke group. These findings support the assertion that EMG Piper synchrony indicates corticomotor contribution to walking.

Heart Rate Variability: A Novel Modality for Diagnosing Neuropathic Pain after Spinal Cord Injury

Background: Heart rate variability (HRV), the physiological variance in the heart's R-R interval length, can be analyzed to produce various parameters reflective of one's autonomic balance. HRV analysis may be used to capture those autonomic aberrations associated with chronic neuropathic pain (NP) in spinal cord injury (SCI). This study assesses the capacity of HRV parameters to diagnose NP in an SCI cohort.

Methods: An electrocardiogram (ECG) was collected at rest from able bodied participants (AB, n = 15), participants with SCI only (SCI-NP, n = 11), and those with SCI and NP (SCI+NP, n = 20). HRV parameters were analyzed using conventional time and frequency analysis.

Results: At rest, there were no heart rate differences amongst groups. However, SCI+NP participants demonstrated lower overall HRV, as determined by the SDNN time domain parameter, compared to either AB (p < 0.01) or SCI-NP (p < 0.05) groups. Moreover, AB and SCI-NP participants were statistically comparable for all HRV time and frequency domain parameters. Additional analyses demonstrated no differences in HRV parameters between T4, above vs. T5, below SCI groups (for all parameters: p > 0.15) or between C8, above vs. T1, below SCI groups (p > 0.30).

Conclusions: Participants with SCI and NP exhibit a lower overall HRV, which can be determined by HRV time domain parameter SDNN. HRV analysis is an innovative modality with the capacity for objective quantification of chronic NP in participants with SCI.

[Surgical treatment and prognosis of pancreatic neuroendocrine carcinoma]

Objective: Pancreatic neuroendocrine carcinoma (pNEC) is a highly malignant tumor.This study aimed to evaluate the role of surgery and the prognosis for patients with pancreatic neuroendocrine carcinoma (pNEC). Methods: We collected and reviewed all clinical data of patients who underwent radical surgery for pNEC from Jan 2000 through Jan 2016 in our hospital. Cox-regression analysis wasused to evaluate the factors potentially influencing survival. Results: Twenty patients including 11 males and 9 females (median age, 62.5 years) were included in this study. All patients underwent radical surgery and 17 cases received postoperative platinum-based chemotherapy.The median follow-up time was 41 months (range, 1 to 127 months). The 1-, 3-, and 5-year survival rates of the patients were 66.7%, 51.5% and 28.1%, with a median survival time of 75.3 months.The multivariate analysis indicated that tumor size and Ki-67 index were of prognostic significance. Conclusions: Pancreatic neuroendocrine carcinomas are rare but increasing in incidence. Patients with localized nonmetastatic primary tumors seem to benefit from surgery. Early diagnosis and multimodality therapy are key points of an improved survival.

Nanometre-scale 3D defects in Cr2AlC thin films

MAX-phase Cr₂AlC containing thin films were synthesized by magnetron sputtering in an industrial system. Nanometre-scale 3D defects are observed near the boundary between regions of Cr₂AlC and of the disordered solid solution (CrAl)_xC_y. Shrinkage of the Cr-Cr interplanar distance and elongation of the Cr-Al distance in the vicinity of the defects are detected using transmission electron microscopy. The here observed deformation surrounding the defects was described using density functional theory by comparing the DOS of bulk Cr₂AlC with the DOS of a strained and unstrained Cr₂AlC(0001) surface. From the partial density of states analysis, it can be learned that Cr-C bonds are stronger than Cr-Al bonds in bulk Cr₂AlC. Upon Cr₂AlC(0001) surface formation, both bonds are weakened. While the Cr-C bonds recover their bulk strength as Cr₂AlC(0001) is strained, the Cr-Al bonds experience only a partial recovery, still being weaker than their bulk counterparts. Hence, the strain induced bond strengthening in Cr₂AlC(0001) is larger for Cr d – C p bonds than for Cr d – Al p bonds. The here observed changes in bonding due to the formation of a strained surface are consistent with the experimentally observed elongation of the Cr-Al distance in the vicinity of nm-scale 3D defects in Cr₂AlC thin films.

Motor plan differs for young and older adults during similar movements

Older adults exhibit altered activation of the agonist and antagonist muscles during goal-directed movements compared with young adults. However, it remains unclear whether the differential activation of the antagonistic muscles in older adults results from an impaired motor plan or an altered ability of the muscle to contract. The purpose of this study, therefore, was to determine whether the motor plan differs for young and older adults. Ten young (26.1 ± 4.3 yr, 4 women) and 16 older adults (71.9 ± 6.9 yr, 9 women) participated in the study. Participants performed 100 trials of fast goal directed movements with ankle dorsiflexion while we recorded the electromyographic activity of the primary agonist (tibialis anterior; TA) and antagonist (soleus; SOL) muscles. From those 100 trials we selected 5 trials in each of 3 movement end-point categories (fast, accurate, and slow). We investigated age-associated differences in the motor plan by quantifying the individual activity and coordination of the agonist and antagonist muscles. During similar movement end points, older adults exhibited similar activation of the agonist (TA) and antagonist (SOL) muscles compared with young adults. In addition, the coordination of the agonist and antagonist muscles (TA and SOL) was different between the two age groups. Specifically, older adults exhibited lower TA-SOL overlap (F_1,23 = 41.2, P < 0.001) and greater TA-SOL peak EMG delay (F_1,25 = 35.5, P < 0.001). This finding suggests that although subjects in both age groups displayed similar movement end points, they exhibited a different motor plan, as demonstrated by altered coordination between the agonist and antagonist muscles.NEW & NOTEWORTHY We aimed to determine whether the altered activation of muscles in older adults compared with young adults during fast goal-directed movements is related to an altered motor plan. For matched movements, there were differences in the coordination of antagonistic muscles but no differences in the individual activation of muscles. We provide novel evidence that the differential activation of muscles in older adults is related to an altered motor plan.

[Surgical treatment and curative effect observation of vascular malformations in the adult floor of the mouth and pharyngeal space]

Objective:To investigate the effect of surgical treatment of vascular malformation in the adult floor of the mouth and pharyngeal space. Method:Collect 12 cases of vascular malformation from the floor of the mouth and pharyngeal space.All of them were checked out of the different degrees of tongue elevation and dysphagia and to carry out the excision of vascular malformation with lingual nerve and hypoglossal nerve preservation. Result:The lesion reduction degree of 10 cases of patients were Ⅳ class(excellent), theoher 2 cases were Ⅲ class(good). Hematoma at the bottom of the mouth after operation were not happened. Follow-up 0.5-3 years,tongue deviation appeared in 1 cases of postoperation. After 6 months of follow-up, the tongue is in the middle when it put out, functional recovery,no tongue muscle atrophy,no tongue movement disorder in the rest of the patients,no obvious recurrence of vascular malformations, no swallowing disorder in all patients. Conclusion:It would be obtained ideal therapeutic effect with surgical treatment in the adult vascular malformations of the floor of the mouth and pharyngeal space.It would be the key to the success of surgery with protecting the lingual nerve and hypoglossal nerve and controlling bleeding.

Blue fluorescent protein derived from the mutated purple chromoprotein isolated from the sea anemone Stichodactyla haddoni

Chromoproteins, especially far-red fluorescent proteins with long stokes shift, are good sources for engineering biological research tools. However, chromoproteins have not been used for developing fluorescent proteins with short emission wavelength. Therefore, we herein report the development of a blue fluorescent protein, termed shBFP, which is derived from a purple chromoprotein isolated from the sea anemone Stichodacyla haddoni (shCP) after shCP was simultaneously mutated on E63L and Y64L. The shBFP chromophore is composed of Leu-Leu-Gly, which introduced a maximum excitation and emission wavelength at 401 nm and 458 nm, respectively, and a quantum yield of 0.79. Interestingly, the N158S and L173I double mutations of shBFP conducted in the chromophore environment further shifted the maximum excitation to 375 nm, and elevated the quantum yield to 0.84. Thus, shBFP, which is based on the Leu-Leu-Gly chromophore composition, results in higher quantum yields and short wavelength emission. Additionally, we found that the cDNA of shBFP is stably expressed in zebrafish embryos with fidelity, indicating the application of shBFP as a biomarker or selective marker.

Serum Spot 14 concentration is negatively associated with thyroid-stimulating hormone level

Spot 14 (S14) is a protein involved in fatty acid synthesis and was shown to be induced by thyroid hormone in rat liver. However, the presence of S14 in human serum and its relations with thyroid function status have not been investigated.The objectives of this study were to compare serum S14 concentrations in patients with hyperthyroidism or euthyroidism and to evaluate the associations between serum S14 and free thyroxine (fT4) or thyroid-stimulating hormone (TSH) levels.We set up an immunoassay for human serum S14 concentrations and compared its levels between hyperthyroid and euthyroid subjects. Twenty-six hyperthyroid patients and 29 euthyroid individuals were recruited. Data of all patients were pooled for the analysis of the associations between the levels of S14 and fT4, TSH, or quartile of TSH.The hyperthyroid patients had significantly higher serum S14 levels than the euthyroid subjects (median [Q1, Q3]: 975 [669, 1612] ng/mL vs 436 [347, 638] ng/mL, P < 0.001). In univariate linear regression, the log-transformed S14 level (logS14) was positively associated with fT4 but negatively associated with creatinine (Cre), total cholesterol (T-C), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and TSH. The positive associations between logS14 and fT4 and the negative associations between logS14 and Cre, TG, T-C, or TSH remained significant after adjustment with sex and age. These associations were prominent in females but not in males. The logS14 levels were negatively associated with the TSH levels grouped by quartile (ß = -0.3020, P < 0.001). The association between logS14 and TSH quartile persisted after adjustment with sex and age (ß = -0.2828, P = 0.001). In stepwise multivariate regression analysis, only TSH grouped by quartile remained significantly associated with logS14 level.We developed an ELISA to measure serum S14 levels in human. Female patients with hyperthyroidism had higher serum S14 levels than the female subjects with euthyroidism. The serum logS14 concentrations were negatively associated with TSH levels. Changes of serum S14 level in the whole thyroid function spectrum deserve further investigation.

Aerosol synthesis of phase-controlled iron-graphene nanohybrids through FeOOH nanorod intermediates

Iron-based nanoparticles form the basis for a host of sustainable alternative technologies based on this earth-abundant, low-toxicity element that can adopt a variety of oxidation states, crystal phases, and functions. Control of size, shape, and phase stability is a challenge for many nano-iron-based technologies, especially those involving Fe0 that is susceptible to oxidation under ambient conditions. This article presents a continuous method for hybridizing Fe-based nanoparticles with carbon in the form of graphene-encapsulated Fe-based particles with core-shell symmetry that allows flexible control of iron particle size, shape, and phase stability. The method uses FeOOH nanorods and graphene oxide as precursors, and subjects them to an aerosol-phase microdroplet drying and annealing process to yield a range of Fe/C nanohybrids whose structure can be controlled through adjustment of aerosol process temperature and post-synthesis thermal treatment conditions. We demonstrate that FeOOH nanorods can be successfully encapsulated in graphene, and transform during annealing into encapsulated Fe3O4 or Fe0 nanoparticles by reductive fragmentation, where the graphene nanosack acts as a carbothermic reductant. The hybrids are characterized by vibrating sample magnetometry and Cr(VI) reduction rates in aqueous media. The Fe0-graphene hybrids show high activity, good stability, and good recyclability in aqueous Cr(VI) removal due to the effect of graphene encapsulation. The present work suggests this rapid and continuous synthesis method can produce stable Fe-based materials, and can be extended to other metal systems, where graphene encapsulation can induce in situ reduction of metal oxide precursors into zero-valent metal-graphene hybrids.

Different Effects of Startling Acoustic Stimuli (SAS) on TMS-Induced Responses at Rest and during Sustained Voluntary Contraction

Previous studies have shown that a habituated startling acoustic stimulus (SAS) can cause a transient suppression of motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS) during light muscle contraction. However, it is still unknown whether this phenomenon persists when at rest or during a sustained voluntary contraction task. Therefore, the purpose of this study was to determine whether a conditioning SAS has different effects. TMS was delivered to the hot spot for the left biceps on 11 subjects at rest both with and without a conditioning SAS. Of the 11subjects, 9 also had TMS delivered during isometric flexion of the left elbow, also with and without a conditioning SAS. TMS-induced MEPs, TMS-induced force, and silent periods were used to determine the effect of conditioning SAS. Consistent with previous findings, TMS-induced MEPs were smaller with a conditioning SAS (0.49 ± 0.37 mV) as compared without the SAS (0.69 ± 0.52 mV) at rest. However, a conditioning SAS during the voluntary contraction tasks resulted in a significant shortening of the MEP silent period (187.22 ± 22.99 ms with SAS vs. 200.56 ± 29.71 ms without SAS) without any changes in the amplitude of the MEP (1.37 ± 0.9 mV with SAS V.S. 1.32 ± 0.92 mV without SAS) or the TMS-induced force (3.11 ± 2.03 N-m with SAS V.S. 3.62 ± 1.33 N-m without SAS). Our results provide novel evidence that a conditioning SAS has different effects on the excitability of the motor cortex when at rest or during sustained voluntary contractions.

Comparative cost-effectiveness of metformin-based dual therapies associated with risk of cardiovascular diseases among Chinese patients with type 2 diabetes: Evidence from a population-based national cohort in Taiwan

OBJECTIVE

To assess the cost-effectiveness of metformin-based dual therapies associated with cardiovascular disease (CVD) risk in a Chinese population with type 2 diabetes.

METHODS

We utilized Taiwan's National Health Insurance Research Database (NHIRD) 1997-2011, which is derived from the claims of National Health Insurance, a mandatory-enrollment single-payer system that covers over 99% of Taiwan's population. Four metformin-based dual therapy cohorts were used, namely a reference group of metformin plus sulfonylureas (Metformin-SU) and metformin plus acarbose, metformin plus thiazolidinediones (Metformin-TZD), and metformin plus glinides (Metformin-glinides). Using propensity scores, each subject in a comparison cohort was 1:1 matched to a referent. The effectiveness outcome was CVD risk. Only direct medical costs were included. The Markov chain model was applied to project lifetime outcomes, discounted at 3% per annum. The bootstrapping technique was performed to assess uncertainty in analysis.

RESULTS

Metformin-glinides was most cost-effective in the base-case analysis; Metformin-glinides saved $194 USD for one percentage point of reduction in CVD risk, as compared to Metformin-SU. However, for the elderly or those with severe diabetic complications, Metformin-TZD, especially pioglitazone, was more suitable; as compared to Metformin-SU, Metformin-TZD saved $840.1 USD per percentage point of reduction in CVD risk. Among TZDs, Metformin-pioglitazone saved $1831.5 USD per percentage point of associated CVD risk reduction, as compared to Metformin-rosiglitazone.

CONCLUSIONS

When CVD is considered an important clinical outcome, Metformin-pioglitazone is cost-effective, in particular for the elderly and those with severe diabetic complications.

Resistive switching characteristics and mechanisms in silicon oxide memory devices

Intrinsic unipolar SiOx-based resistance random access memories (ReRAM) characterization, switching mechanisms, and applications have been investigated. Device structures, material compositions, and electrical characteristics are identified that enable ReRAM cells with high ON/OFF ratio, low static power consumption, low switching power, and high readout-margin using complementary metal-oxide semiconductor transistor (CMOS)–compatible SiOx-based materials. These ideas are combined with the use of horizontal and vertical device structure designs, composition optimization, electrical control, and external factors to help understand resistive switching (RS) mechanisms. Measured temperature effects, pulse response, and carrier transport behaviors lead to compact models of RS mechanisms and energy band diagrams in order to aid the development of computer-aided design for ultralarge-v scale integration. This chapter presents a comprehensive investigation of SiOx-based RS characteristics and mechanisms for the post-CMOS device era.

Development and Psychometric Properties of the Taiwan Odd-Even Number Sequencing Test: A Nonalphabetic Measure of Working Memory

Alphabetic working memory (WM) tests, such as the Wechsler Adult Intelligence Scale-III and IV Letter Number Sequencing, are not appropriate for nonalphabetic cultures. This study examined the psychometric properties of the Taiwan Odd-Even Number Sequencing Test (TOENST) and identified representative norms. The TOENST and other mental screening tasks were administered to 300 randomly selected healthy participants, 32 purposive sampling patients with schizophrenia, and 32 quota sampling controls. To investigate reliability and validity, a subset of the 300 healthy participants was randomly selected to receive a second TOENST ( n = 30) or conventional WM tests ( n = 42). The split-half reliability of the TOENST ranged from 0.69 to 0.95, and its test-retest reliability was 0.75. Criterion validity was demonstrated by significant correlations with conventional WM measures (all p < .05, except semantic verbal fluency), and construct validity was demonstrated by significant correlations with aging (main effect, F_10,259 = 10.99, p < .001). Normative data were established, and performance was significantly associated with age and education. TOENST scores of patients with schizophrenia were significantly lower and correlated with frontal lobe tests, but not demographical or clinical characteristics. The TOENST has adequate psychometric properties and clinical utility and is as a viable alternative WM task for nonalphabetic cultures.

Flame-induced atmospheric pressure chemical ionization mass spectrometry

RATIONALE

Charged species such as formylium (CHO(+) ), hydronium (H3 O(+) ), and water clusters [H3 O(+) (H2 O)n ] are commonly found in flames. These highly reactive species can react with analytes via ion-molecule reactions (IMRs) to form analyte ions. A new mass spectrometric technique, named flame-induced atmospheric pressure chemical ionization mass spectrometry (FAPCI-MS), was developed to characterize organic compounds via these mechanisms.

METHODS

A commercial corona-discharge atmospheric pressure chemical ionization (APCI) source was modified by replacing the corona needle with a flame to make a FAPCI source. Liquid samples were vaporized in a heated tube and delivered to the IMRs region by nitrogen to react with the charged species generated by a flame. Analytes on surfaces were directly desorbed and ionized by a flame using the technique called desorption-FAPCI-MS (DFAPCI-MS).

RESULTS

Intact molecular ions of various chemical and biological compounds were successfully characterized by FAPCI-MS. The FAPCI mass spectra are nearly identical to those obtained by traditional APCI-MS. The limit of detection (LOD) of reserpine by FAPCI-MS was 50 μg L(-1) with a linear calibration curve (R(2) = 0.9947) from 100 μg L(-1) to 10 mg L(-1) . The LOD for ketamine by DFAPCI-MS was estimated to be less than 0.1 ng.

CONCLUSIONS

In FAPCI, analytes are not incinerated but vaporized and introduced into the ion source to react with the reactive charged species generated by a flame. The features of the FAPCI source include: configuration is very simple, operation is easy, high voltage or inert gas is unnecessary, and the source is maintenance free. Various combustible gases, solvents and solids are useful flame fuels for FAPCI. Copyright © 2016 John Wiley & Sons, Ltd.

Atrial Fibrillation Increases the Risk of Peripheral Arterial Disease With Relative Complications and Mortality: A Population-Based Cohort Study

Atrial fibrillation (AF), an increasing prevalent cardiac arrhythmia due to aging general population, has many common risk factors with peripheral arterial disease (PAD). However, it is unclear whether AF is associated with a risk of PAD. We investigated the prevalence of AF and PAD in the general population and the risk of PAD among the AF population. This longitudinal, nationwide, population-based cohort study was conducted using data from the Taiwan National Health Insurance Research Database recorded during 2000 to 2011. In total, 3814 and 15,364 patients were included in the AF and non-AF cohorts, respectively. Univariate and multivariate Cox proportional hazard regression models were used for examining the effects of AF on the risk of outcomes. The average follow-up periods of PAD were 4.96 ± 3.28 and 5.29 ± 3.35 years for the AF and non-AF cohorts, respectively. Overall, the risk of PAD showed a significantly higher risk in the AF cohort (adjusted HR=1.31, 95% CI=1.19-1.45) compared with the non-AF cohort. Similar results were observed for heart failure and stroke, where the AF cohort had a 1.83-fold and 2.53-fold higher risk of developing heart failure and stroke. The AF cohort also had a significant increased risk for mortality (adjusted HR=1.66, 95% CI=1.49-1.84). The present study indicated that the incidence of PAD, heart failure, stroke, and overall mortality is higher in patients with AF than in those without it.

Abstract WP126: Impaired Dynamic Cerebral Autoregulation Predicts Cerebral Hyperperfusion Syndrome After Carotid Angioplasty and Stenting

Introduction: Cerebral hyperperfusion syndrome (CHS) is a devastating complication after carotid revascularization procedure such as carotid angioplasty and stenting (CAS). Although there is no reliable predictor of CHS after CAS, it is believed CHS is caused by impaired cerebral autoregulation (CA). However, there is no study using CA assessment as a predictor of the occurrence of CHS after CAS.

Hypothesis: Impaired preoperative CA index is associated with occurrence of CHS after CAS.

Methods: 17 patients with 70-95% stenosis of internal carotid artery who were scheduled to have CAS were enrolled. All patients had dynamic CA assessment 1 day before CAS by analyzing the relationship between the blood pressure of peripheral artery and the flow of stenotic internal carotid artery. Two dynamic CA indexes were measured: time domain analysis (mean pressure-flow correlation coefficient index, Mx) and frequency domain analysis (phase difference at 0.05-0.15Hz measured by a nonlinear analytic method based on Hilbert-Huang transform). In addition, magnetic resonance perfusion image with arterial spin labeling (MR-ASL) was done at 1 day before CAS as baseline, and was followed at 1 and 3 days after CAS to assess the temporal change of cerebral blood flow (CBF). The definition of hyperperfusion is 100% increase of CBF in MR-ASL compared to baseline.

Results: 1 patient developed CHS after CAS, whose Mx is 0.68; and 1 patient was found to have asymptomatic hyperperfusion after CAS, whose Mx is 0.58. The other 15 patients have no hyperperfusion after CAS, and their CBF after CAS did not change significantly compared to baseline (P=0.312 and 0.286 on day 1 and day 3 after CAS, respectively) The average Mx between patients with and without hyperperfusion are significant different (0.16±0.24 vs. 0.63±0.07, p=0.025). The average phase difference between patients with and without hyperperfusion are not different (32.5±11.1 vs. 28.2±19.8, p=0.307).

Conclusions: Impaired preoperative dynamic CA using time domain analysis (Mx) is associated with cerebral hyperperfusion status after CAS. Therefore, preoperative dynamic CA is a potential screening tool to improve the safety of CAS.

Serum Levels of Follistatin Are Positively Associated With Serum-Free Thyroxine Levels in Patients With Hyperthyroidism or Euthyroidism

Follistatin is a glycoprotein with various biologic functions that plays a role in adipocyte differentiation, muscle stimulation, anti-inflammation, and energy homeostasis. Thyroid hormones influence energy expenditure, glucose, and lipid metabolism. The association between serum follistatin level and thyroid function statuses has seldom been evaluated.The objectives of this study were to compare serum follistatin concentrations in different thyroid function statuses and to evaluate the associations between serum follistatin and free thyroxine (fT4) levels.In this study, 30 patients with hyperthyroidism (HY group) and 30 euthyroid individuals (EU group) were recruited. The patients of HY group were treated with antithyroid regimens as clinically indicated, whereas no medication was given to EU group. The demographic and anthropometric characteristics, biochemical data, serum levels of follistatin, and thyroid function of both groups at baseline and at the 6th month were compared. Data of all patients were pooled for the analysis of the associations between the levels of follistatin and fT4.At baseline, the HY group had significantly higher serum follistatin levels than the EU group (median [Q1, Q3]: 1.81 [1.33, 2.78] vs 1.13 [0.39, 1.45] ng/mL, P < 0.001). When treated with antithyroid regimens, the follistatin serum levels in HY group decreased to 1.54 [1.00, 1.88] ng/mL at the 6th month. In all patients, the serum levels of follistatin were positively associated with fT4 levels at baseline (β = 0.54, P = 0.005) and at the 6th month (β = 0.59, P < 0.001). The association between follistatin and fT4 levels remained significant in the stepwise multivariate regression analysis, both initially and at the 6th month.In comparison to the EU group, patients with hyperthyroidism had higher serum follistatin levels, which decreased after receiving antithyroid treatment. In addition, the serum follistatin concentrations were positively associated with serum fT4 levels in patients with hyperthyroidism or euthyroidism.

Association Between Serum Levels of Adipocyte Fatty Acid-binding Protein and Free Thyroxine

Adipocyte fatty acid-binding protein (AFABP) has been shown to be a biomarker of body weight change and atherosclerosis. Changes in thyroid function are associated with changes in body weight and risks of cardiovascular diseases. The association between AFABP and thyroid function status has been seldom evaluated.The aim of this study was to compare the serum AFABP concentrations in hyperthyroid patients and those in euthyroid individuals, and to evaluate the associations between serum AFABP and free thyroxine (fT4) levels.For this study, 30 hyperthyroid patients and 30 euthyroid individuals at a referral medical center were recruited. The patients with hyperthyroidism were treated with antithyroid regimens as clinically indicated. No medication was given to the euthyroid individuals. The body weight, body mass index, thyroid function, serum levels of AFABP, and biochemical data of both groups at baseline and at the 6th month were compared. Associations between AFABP and fT4 levels were also analyzed.At the baseline, the hyperthyroid patients had significantly higher serum AFABP levels than the euthyroid individuals (median [Q1, Q3]: 22.8 [19.4, 30.6] ng/mL vs 18.6 [15.3, 23.2] ng/mL; P = 0.038). With the antithyroid regimens, the AFABP serum levels of the hyperthyroid patients decreased to 16.6 (15.0, 23.9) ng/mL at the 6th month. No difference in the AFABP level was found between the hyperthyroid and the euthyroid groups at the 6th month. At baseline, sex (female vs male, ß = 7.65, P = 0.022) and fT4 level (ß = 2.51, P = 0.018) were significantly associated with AFABP levels in the univariate regression analysis. At the 6th month, sex and fT4 level (ß = 8.09, P < 0.001 and ß = 3.61, P = 0.005, respectively) were also significantly associated with AFABP levels. The associations between sex and fT4 level with AFABP levels remained significant in the stepwise multivariate regression analysis, both at baseline and at the 6th month.The patients with hyperthyroidism had higher serum AFABP levels than the individuals with euthyroidism. In the patients with hyperthyroidism, the serum AFABP concentrations decreased after the antithyroid treatment. In this study, the serum AFABP concentrations were positively associated with female sex and the serum fT4 level.

Serum level of endothelial cell-specific molecule-1 and prognosis of colorectal cancer

We evaluated the clinical significance and explored the prognostic value of serum endothelial cell-specific molecule-1 (ESM-1) expression in colorectal cancer (CRC) in a Chinese population. Serum samples were obtained from 89 CRC patients undergoing surgical treatment and 90 healthy volunteers (control group). ESM-1 levels in serum samples from CRC patients and controls were measured using a sandwich enzyme-linked immunosorbent assay. Overall survival was analyzed by the log-rank test, and survival curves were plotted according to the Kaplan-Meier method. Univariate Cox regression was performed on each clinical covariate to examine its influence on patient survival. Final multivariate models were based on step-wise addition. Serum ESM-1 expression levels were significantly higher in patients with CRC (66.81 ± 22.97 pg/mL) than in healthy volunteers (31.50 ± 16.81 pg/mL, P = 0.012). Expression levels of ESM-1 in CRC patients were significantly correlated with histological differentiation (P = 0.004), TNM stage (P = 0.007), depth of tumor invasion (P = 0.02), and lymph node metastasis (P = 0.001). Kaplan-Meier survival curves revealed that the overall survival was significantly lower in patients with high ESM-1 levels than in those with low levels (29.43 vs 61.20%, P = 0.0166). Multivariate analysis confirmed that the hazard risk of death was significantly higher in patients with high serum ESM-1 expression compared with low expression (hazard risk = 4.09, 95% confidence interval: 2.27-10.88, P < 0.001). Detection of ESM-1 levels in the serum may serve as a tumor biomarker for assessing prognosis in CRC.

Ministry of Health Clinical Practice Guidelines: Diabetes Mellitus

The Ministry of Health (MOH) have updated the clinical practice guidelines on Diabetes Mellitus to provide doctors and patients in Singapore with evidence-based treatment for diabetes mellitus. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Diabetes Mellitus, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Force dysmetria in spinocerebellar ataxia 6 correlates with functional capacity

Spinocerebellar ataxia type 6 (SCA6) is a genetic disease that causes pure cerebellar degeneration affecting walking, balance, and coordination. One of the main symptoms of SCA6 is dysmetria. The magnitude of dysmetria and its relation to functional capacity in SCA6 has not been studied. Our purpose was to quantify dysmetria and determine the relation between dysmetria and functional capacity in SCA6. Ten individuals diagnosed and genetically confirmed with SCA6 (63.7 ± 7.02 years) and nine age-matched healthy controls (65.9 ± 8.5 years) performed goal-directed isometric contractions with the ankle joint. Dysmetria was quantified as the force and time error during goal-directed contractions. SCA6 functional capacity was determined by ICARS and SARA clinical assessments. We found that SCA6 participants exhibited greater force dysmetria than healthy controls (P < 0.05), and reduced time dysmetria than healthy controls (P < 0.05). Only force dysmetria was significantly related to SCA6 functional capacity, as measured with ICARS kinetic score (R² = 0.63), ICARS total score (R² = 0.43), and SARA total score (R² = 0.46). Our findings demonstrate that SCA6 exhibit force dysmetria and that force dysmetria is associated to SCA6 functional capacity. Quantifying force and time dysmetria in individuals with SCA6 could provide a more objective evaluation of the functional capacity and disease state in SCA6.

Objective palliative prognostic score among patients with advanced cancer

CONTEXT

The accurate prediction of survival is one of the key factors in the decision-making process for patients with advanced illnesses.

OBJECTIVES

This study aimed to develop a short-term prognostic prediction method that included such objective factors as medical history, vital signs, and blood tests for use with patients with advanced cancer.

METHODS

Medical records gathered at the admission of patients with advanced cancer to the hospice palliative care unit at a tertiary hospital in Taiwan were reviewed retrospectively. The records included demographics, history of cancer treatments, performance status, vital signs, and biological parameters, Multivariate logistic regression analyses and receiver operating characteristic curves were used for model development.

RESULTS

The Objective Palliative Prognostic Score was determined by using six objective predictors identified by multivariate logistic regression analysis. The predictors include heart rate >120/min, white blood cells >11,000/mm(3), platelets <130,000/mm(3), serum creatinine level >1.3 mg/dL, serum potassium level >5 mg/dL, and no history of chemotherapy. The area under the receiver operating characteristic curve used to predict seven-day survival was 82.0% (95% confidence interval 75.2%-88.8%). If any three predictors of the six were reached, death within seven days was predicted with 68.8% sensitivity, 86.0% specificity, 55.9% positive predictive value, and 91.4% negative predictive value.

CONCLUSION

The Objective Palliative Prognostic Score consists of six objective predictors for the estimation of seven-day survival among patients with advanced cancer and showed a relatively high accuracy, specificity, and negative predictive value. Objective signs, such as vital signs and blood test results, may help clinicians make decisions at the end of life.

Clinical manifestations of non-O1 Vibrio cholerae infections

BACKGROUND

Infections caused by non-O1 Vibrio cholera are uncommon. The aim of our study was to investigate the clinical and microbiological characteristics of patients with non-O1 V. cholera infections.

METHODS

The clinical charts of all patients with non-O1 V. cholera infections and who were treated in two hospitals in Taiwan were retrospectively reviewed.

RESULTS

From July 2009 to June 2014, a total of 83 patients with non-O1 V. cholera infections were identified based on the databank of the bacteriology laboratories of two hospitals. The overall mean age was 53.3 years, and men comprised 53 (63.9%) of the patients. Liver cirrhosis and diabetes mellitus were the two most common underlying diseases, followed by malignancy. The most common type of infection was acute gastroenteritis (n = 45, 54.2%), followed by biliary tract infection (n = 12, 14.5%) and primary bacteremia (n = 11, 13.3%). Other types of infection, such as peritonitis (n = 5, 6.0%), skin and soft tissue infection (SSTI) (n = 5, 6.0%), urinary tract infection (n = 3, 3.6%) and pneumonia (2, 2.4%), were rare. July and June were the most common months of occurrence of V. cholera infections. The overall in-hospital mortality of 83 patients with V. cholera infections was 7.2%, but it was significantly higher for patients with primary bacteremia, hemorrhage bullae, acute kidney injury, acute respiratory failure, or admission to an ICU. Furthermore, multivariate analysis showed that in-hospital mortality was significantly associated with acute respiratory failure (odds ratio, 60.47; 95% CI, 4.79-763.90, P = 0.002).

CONCLUSIONS

Non-O1 V. cholera infections can cause protean disease, especially in patients with risk factors and during warm-weather months. The overall mortality of 83 patients with non-O1 V. cholera infections was only 7.2%; however, this value varied among different types of infection.

Electroforming and resistive switching in silicon dioxide resistive memory devices

Electroforming and resistive switching data are presented and models are given addressing the unusual operating features of SiO₂ resistive memory.

Excitons and biexcitons in InGaN quantum dot like localization centers

Indium segregation in a narrow InGaN single quantum well creates quantum dot (QD) like exciton localization centers. Cross-section transmission electron microscopy reveals varying shapes and lateral sizes in the range ∼1-5 nm of the QD-like features, while scanning near field optical microscopy demonstrates a highly inhomogeneous spatial distribution of optically active individual localization centers. Microphotoluminescence spectroscopy confirms the spectrally inhomogeneous distribution of localization centers, in which the exciton and the biexciton related emissions from single centers of varying geometry could be identified by means of excitation power dependencies. Interestingly, the biexciton binding energy (E(b)xx) was found to vary from center to center, between 3 to -22 meV, in correlation with the exciton emission energy. Negative binding energies are only justified by a three-dimensional quantum confinement, which confirms QD-like properties of the localization centers. The observed energy correlation is proposed to be understood as variations of the lateral extension of the confinement potential, which would yield smaller values of E(b)xx for reduced lateral extension and higher exciton emission energy. The proposed relation between lateral extension and E(b)xx is further supported by the exciton and the biexciton recombination lifetimes of a single QD, which suggest a lateral extension of merely ∼3 nm for a QD with strongly negative E(b)xx = -15.5 meV.

Coupled states in dinitrofluorene: relationships between ground state and excited state mixed valence

The electronic absorption spectrum of 9,9-dimethyl-2,7-dinitrofluorene radical anion in HMPA displays both a NIR intervalence charge transfer and a visible excited state mixed valence transition. These transitions contain a similar vibronic progression resulting from molecular orbitals that are common to both transitions. Vibrational frequency and intensity data are acquired from the resonance Raman spectrum and used to calculate a best fit for the absorption spectrum. The normal coordinate distortions are analyzed in terms of the electronic changes for both transitions to explain their similarity. The Raman scattering intensity decreases at lower excitation wavelength as a result of Raman de-enhancement caused by interference between neighboring excited states.

Characterization of a fungicidal substance produced by Eupenicillium brefeldianum isolated from soil for plant disease control and its significance in nature

BACKGROUND

A fungus identified as Eupenicillium brefeldianum was isolated from soil amended with vegetable tissues.

RESULT

When grown in liquid medium prepared from the same vegetable tissues, E. brefeldianum produced a substance capable of preventing disease development of leaf spots of mustard cabbage caused by Alternaria brassicicola and inhibiting the germination of A. brassicicola conidia. The inhibitory substance was fungicidal and was very stable under high temperature and extreme pH. It was soluble in polar solvents but not soluble in non-polar solvents, and did not have charges on its molecule. This is the first discovery of the production of a fungicidal substance by this fungus.

CONCLUSION

Results from this study suggest the possession of a strong competitive saprophytic ability by E. brefeldianum, which in turn may explain the widespread occurrence of this fungus in soils.

A Case Report of Japanese Encephalitis Focusing on MR Findings

meningitis or encephalitis with or without neurological deficits. JEV typically attacks the thalamus, corpus striatum, brainstem and spinal cord. The laboratory diagnosis of JEV infection involves the detection of anti-JEV antibody IgMs using an enzyme-linked immunosorbent assay (ELISA), which has high sensitivity and specificity. Because of the lack of a specific antiviral therapy, JE is usually managed by symptomatic treatment and supportive care. We report a case of JE in a 34-year-old man. With a clinical presentation similar to herpes simplex virus encephalitis, the patient was finally diagnosed as having JE. The distinction of different viral encephalitides in MR findings is briefly reviewed.

Compact bis-adduct fullerenes and additive-assisted morphological optimization for efficient organic photovoltaics

Bis-adduct fullerenes surrounded by two insulating addends sterically attenuate intermolecular interaction and cause inferior electron transportation. In this research, we have designed and synthesized a new class of bis-adduct fullerene materials, methylphenylmethano-C60 bis-adduct (MPC60BA), methylthienylmethano-C60 bis-adduct (MTC60BA), methylphenylmethano-C70 bis-adduct (MPC70BA), and methylthienylmethano-C70 bis-adduct (MTC70BA), functionalized with two compact phenylmethylmethano and thienylmethylmethano addends via cyclopropyl linkages. These materials with much higher-lying lowest unoccupied molecular orbital (LUMO) energy levels successfully enhanced the Voc values of the P3HT-based solar cell devices. The compact phenylmethylmethano and thienylmethylmethano addends to promote fullerene intermolecular interactions result in aggregation-induced phase separation as observed by the atomic force microscopy (AFM) and transmission electron microscopy (TEM) images of the poly(3-hexylthiophene-2,5-diyl) (P3HT)/bis-adduct fullerene thin films. The device based on the P3HT/MTC60BA blend yielded a Voc of 0.72 V, a Jsc of 5.87 mA/cm(2), and a fill factor (FF) of 65.3%, resulting in a power conversion efficiency (PCE) of 2.76%. The unfavorable morphologies can be optimized by introducing a solvent additive to fine-tune the intermolecular interactions. 1-Chloronaphthalene (CN) having better ability to dissolve the bis-adduct fullerenes can homogeneously disperse the fullerene materials into the P3HT matrix. Consequently, the aggregated fullerene domains can be alleviated to reach a favorable morphology. With the assistance of CN additive, the P3HT/MTC60BA-based device exhibited enhanced characteristics (a Voc of 0.78 V, a Jsc of 9.04 mA/cm(2), and an FF of 69.8%), yielding a much higher PCE of 4.92%. More importantly, the additive-assisted morphological optimization is consistently effective to all four compact bis-adduct fullerenes regardless of the methylphenylmethano or methylthienylmethano scaffolds as well as C60 or C70 core structures. Through the extrinsic additive treatment, these bis-adduct fullerene materials with compact architectures show promise for high-performance polymer solar cells.

Polygonum cuspidatum extracts as bioactive antioxidaion, anti-tyrosinase, immune stimulation and anticancer agents

In our study, it was applied for the technology of supercritical fluid carbon dioxide extraction to achieve biological constitutes from a Taiwan native plant, Polygonum cuspidatum. We developed bioactive effects of P. cuspidatum extracts via multiple examinations that established bio-purposes at a range of dosage ranges. The research of P. cuspidatum extracts indicated that they possessed anti-oxidative properties on radical-scavenging abilities, reducing activities and metal chelating powers in dose-dependant manners. The extracts also had minor in vitro mushroom tyrosinase suppression and decreased cellular tyrosinase activities and melanin production in B16-F10 cells. Immunologically, P. cuspidatum extracts enhanced the release of tumor necrosis factor α (TNF-α) induced by THP-1 macrophage cell line. In addition, the cell proliferation showed anti-proliferation in dose-dependent manner on human skin melanoma cells, A375 and A375.S2, of the extracts suggesting biological constitutes employed the anti-cancer possessions. This is the first statement presenting bioactivities on P. cuspidatum extracts including anti-oxidation, immune stimulation, anti-tyrosinase and anti-melanoma as far as we know.

Right and left amygdalae activation in patients with major depression receiving antidepressant treatment, as revealed by fMRI

Background

A differential contribution of the right and left amygdalae to affective information processing has been proposed. However, the direction of this lateralization has not been confirmed. In this study, we used a pre- and post-treatment (escitalopram) design to analyze the relative differences between neural activity in the right and left amygdalae during exposure to emotional stimuli in currently depressed patients. To the best of our knowledge, this study is to compare neural activity between the left and right amygdalae in people with depression. Our findings could lead to the development of parameters or biomarkers for depressive symptoms and treatment response.

Methods

We used a pre–post-test design without a control group. Twenty currently depressed participants underwent an emotion processing task during fMRI. These participants were then treated with an antidepressant for 6 weeks. We used amygdala region-of-interest analysis to evaluate the hemodynamic response during exposure to colored emotional pictures.

Results

In total, thirteen of the 20 participants were placed into a separate group based on degree of response to antidepressants. The partial response group had an averaged HDRS score of 10.75 ± 2.25 and an averaged DBOLD_LR signal of 189.18 ± 140.23 (m₁ = 8), and the remitted group had an averaged HDRS score of 4.80 ± 1.64 and an averaged DBOLD_LR signal of 421.26 ± 109.19 (m₂ = 5). Each individual had lateralized amygdala activity, and the direction of asymmetry persisted following treatment. Amygdala responses to four types of emotional stimuli did not significantly change (p > 0.05) with treatment in either the right or the left amygdala. However, the difference in neural activity between the right and left amygdalae was greater after treatment, and the variation in neural activity was larger in the left amygdala.

Conclusions

We found that the response between the right and left amygdala did not differ in terms of time series, although activity increased after pharmaceutical treatment for each emotion tested. In the future, changes in BOLD signals as revealed by fMRI might be useful in evaluating the clinical manifestation of major depression.

Resonance Raman spectroscopic study of solvent-dependent coexistence of localized and delocalized dinitroaromatic radical anions

Optical absorption spectra of three dinitroaromatic radical anions, 2,7-dinitro-9,9-dimethylfluorene (1•−), 4,4′-dinitrobiphenyl (2•−), and 4,4′-dinitrotolane (3•−) in solvents THF, HMPA, and MeCN show both an unresolved broad band characteristic of charge-localized mixed valence species (Robin-Day classification Class II), and a vibronically structured band of the delocalized species (Class III). With decreasing solvent reorganization energy, a greater portion of the compounds become charge-delocalized. In particular, 1•− with the greatest coupling, is almost entirely composed of the delocalized species in all solvents. An intense Raman mode is used to identify the charge-bearing unit as the nitrobenzene moiety. Resonance Raman profiles are utilized to gain detailed information of vibrational modes. The out-of-phase ring lengthening stretch mode is observed to be enhanced at higher excitation energies, corresponding to the absorption band of the Class II species, while the in-phase ring lengthening stretch mode, a totally symmetric vibration, is most strongly enhanced in the absorption region of the Class III species. Resonance Raman profiles support the solvent-dependent coexistence of Class II and Class III molecules of the same chemical composition.

Conduction control at ferroic domain walls via external stimuli

Intriguing functionalities at nano-sized domain walls have recently spawned a new paradigm for developing novel nanoelectronics due to versatile characteristics. In this study, we explore a new scenario to modulate the local conduction of ferroic domain walls. Three controlling parameters, i.e., external electrical field, magnetic field and light, are introduced to the 90° domain walls (90° DWs) of BiFeO₃. Electrical modulation is realized by electrical transport, where the mobility of 90° DWs can be altered by gating voltage. We further use the ferromagnetic/antiferromagnetic coupling to reveal the inherent magnetism at the DWs. With an established magnetic nature, magnetotransport has been conducted to introduce magnetic controlling parameter, where a giant positive magnetoresistance change can be observed up to 200%. In addition, light modulated conduction, a core factor for multifunctional applications, is successfully demonstrated (current enhancement by a factor of 2 with 11 W white lamp). These results offer new insights to discover the tunability of domain wall nanoelectronics.

Genetic diversity of central and peripheral populations of Toona ciliata var. pubescens, an endangered tree species endemic to China

Our objective was to examine the genetic diversity of central and peripheral populations of Toona ciliata var. pubescens, to elucidate whether the central-peripheral hypothesis applies to these populations. We analyzed 392 individuals from nine natural populations using eight pairs of polymorphic SSR primers. The results showed that the mean numbers of observed and expected alleles in peripheral populations were higher than in central populations. Common widespread and rare local (RL) alleles were observed in all populations. However, common local alleles were found in five populations and rare widespread alleles were only found in three. The total numbers of the four types of alleles were higher in peripheral than in central populations, and the quantity of the RL allele was obviously higher in the peripheral populations than in the central populations. Both the observed and expected heterozygosities were higher in peripheral populations compared with the central populations. The coefficient of gene differentiation of the peripheral populations was 0.3045, which was significantly higher than that of the central populations. The gene flow between central populations was greater than one, but less than one between peripheral populations. This indicates that frequent gene flow exists between central populations, while terrain and habitat fragmentation prevent gene flow between peripheral populations. A Mantel test indicated that there was no relationship between genetic and geographical distance of T. ciliata var. pubescens.

Antagonizing STAT3 dimerization with a rhodium(III) complex

Kinetically inert metal complexes have arisen as promising alternatives to existing platinum and ruthenium chemotherapeutics. Reported herein, to our knowledge, is the first example of a substitutionally inert, Group 9 organometallic compound as a direct inhibitor of signal transducer and activator of transcription 3 (STAT3) dimerization. From a series of cyclometalated rhodium(III) and iridium(III) complexes, a rhodium(III) complex emerged as a potent inhibitor of STAT3 that targeted the SH2 domain and inhibited STAT3 phosphorylation and dimerization. Significantly, the complex exhibited potent anti-tumor activities in an in vivo mouse xenograft model of melanoma. This study demonstrates that rhodium complexes may be developed as effective STAT3 inhibitors with potent anti-tumor activity.