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In the experiments of neutron interaction with research samples, the incident neutron energy spectrum, distribution inside the irradiating sample volume, is affected by the unexpected neutron self-shielding effects. The nature of these effects is due to the formation and thickness of the irradiating sample, which significantly causes neutron self-absorption and multiple scattering inside the sample volume. The datasets presented in this article showed the thermal (Gth) and epithermal (Gepi) neutron self-shielding correction factors for the 186W(n,γ)187W neutron capture reaction rate in irradiating tungsten (W) foil samples with different thicknesses. The simulations were performed for three models of surface neutron source's geometries and relative orientations of the irradiating foil samples of isotropic cylinder surface neutron source with foil sample along to the center line, isotropic cylinder neutron source with foil sample flat to the center line, and isotropic spherical neutron source with foil sample placed at the center point. The range of sample thicknesses was from 10 µm to 2.5 mm. The uncertainties for each data point are also reported in the data table, making it more convenient for reuse in related experiments or evaluations.

Background: Guidelines recommend left ventricular ejection fraction (LVEF) assessments every 3 months for cardiotoxicity monitoring during human epidermal growth factor receptor 2 (HER2) targeted therapy. Evidence in support of this practice is lacking. Objectives: This study examines the association between adherence to cardiotoxicity surveillance guidelines and heart failure (HF) in HER2-positive breast cancer patients. Methods: A case-control study was performed in 53 patients who developed cardiotoxicity during HER2 targeted therapy, and 159 controls matched by age, anthracycline exposure, and year of treatment. Cardiotoxicity was defined as HF (New York Heart Association functional class III or IV) or cardiac death. Adherence to cardiotoxicity surveillance guidelines was ascertained from the beginning of HER2 targeted therapy to the diagnosis date of HF for cases or the corresponding timepoint for matched controls. Conditional logistic regression was used for case-control comparisons. Results: Eighty-one percent of cases and controls were previously treated with an anthracycline. Adherence to cardiotoxicity surveillance guidelines during the entire observation period or during the first 6 months of treatment was not associated with lower risk of HF. An LVEF

The study aimed to compare an innovative method, namely liquid CO2 extraction without high-pressure pump (LCE-WHP), with hydro-distillation (HD), microwave-assisted hydro-distillation (MA-HD) and steam distillation (SD) on yield, physical and biological properties of essential oils (EOs) from fruit peels of three green and one yellow orange cultivars. LCE-WHP oils retained the fragrance of the original fruit peels with yellow color and low content of waxes. For green cultivars, oil yields of LCE-WHP (4.8–5.9%) were significantly higher than those of SD (3.6–5.2%), but lower than those of HD (10.5–12.4%) and MA-HD (11–11.9%). Green cultivars had higher oil yield than yellow cultivar regardless of extraction method. Volatile components of EOs were similar for all methods and cultivars. Limonene was main volatile compound of all EOs with concentrations of 95.3–96.9%. Total polyphenol and carotenoid content of LCE-WHP oils were 2.3–19.1 and 5.9–113.6 folds higher than those of oils extracted by other methods, respectively. EOs extracted by LCE-WHP showed the strongest activities against Bacillus cereus, Staphylococcus aureus, Pseudomonas aeruginosa, S. enteritidis, Escherichia coli and Candida albicans as compared to EOs extracted by other methods. Similarly, the antioxidant activities of LCE-WHP oils determined by DPPH and ABTS assay were also the strongest. This is the first report on using LCE-WHP for extracting orange EOs with high quality and biological activities. LCE-WHP has lower capital cost and safer operation than conventional CO2 extraction methods. Such findings promote the application of LCE-WHP for commercial extraction of orange EOs.

Coffee with different regions and species tends to have different chemical compositions and, therefore, gains variable commercial values. This means that the authenticity of green coffee beans, the raw material for coffee beverages, is necessary for coffee supply chains. This paper focused on the application of ultraviolet–visible (UV–VIS) spectroscopy combined with the Partial Least Squares with Discriminant Analysis (PLS–DA) model to authenticate Vietnamese green coffee beans. Spectra of 147 samples were used to build prediction models. PLS–DA model combined with the Standard Normal Variate (SNV) and second order of derivative performed excellently in predicting coffee species with a percentage of cross–validation accuracy at 100.00%. With the treatment of SNV and the first order of derivative, percentages of cross–validation accuracy for the PLS–DA model authenticating the origin of samples from all provinces varied from 88.23% to 95.80%. The results showed a high potential of the UV–VIS spectroscopy techniques in the authenticity of green coffee beans.

Summary: Background: Anti-androgens and combined oral contraceptive pills (COCPs) may mitigate hyperandrogenism-related symptoms of polycystic ovary syndrome (PCOS). However, their efficacy and safety in PCOS remain unclear as previous reviews have focused on non-PCOS populations. To inform the 2023 International Evidence-based Guideline in PCOS, we conducted the first systematic review and meta-analysis investigating the efficacy and safety of anti-androgens in the management of hormonal and clinical features of PCOS. Methods: We systematically searched MEDLINE, Embase, PsycInfo, All EBM reviews, and CINAHL up to 28th June 2023 for randomised controlled trials (RCTs) examining oral anti-androgen use, alone or in combination with metformin, COCPs, lifestyle, or other interventions, in women of any age, with PCOS diagnosed by Rotterdam, National Institutes of Health or Androgen Excess & PCOS Society criteria, and using a form of contraception. Non-English studies and studies of less than 6 months duration or which used the same anti-androgen regimen in both/all groups were excluded in order to establish efficacy for the clinical outcomes of interest. Three authors screened articles against selection criteria and assessed risk of bias and quality using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Critical outcomes (prioritised during guideline development for GRADE purposes) included weight, body mass index (BMI), irregular cycles, hirsutism, liver function, and quality of life. Random effects meta-analyses were conducted where appropriate. This study is registered with PROSPERO, CRD42022345640. Findings: From 1660 studies identified in the search, 27 articles comprising 20 unique studies were included. Of these, 13 studies (n = 961) were pooled in meta-analysis. Seven studies had a high risk of bias, nine moderate and four low. Anti-androgens included finasteride, flutamide, spironolactone, or bicalutamide. In meta-analysis, anti-androgens + lifestyle were superior to metformin + lifestyle for hirsutism (weighted mean difference [WMD] [95% CI]: −1.59 [−3.06, −0.12], p = 0.03; I2 = 74%), SHBG (7.70 nmol/l [0.75, 14.66], p = 0.03; I2 = 0%), fasting insulin and fasting insulin: glucose ratio (−2.11 μU/ml [−3.97, −0.26], p = 0.03; I2 = 0% and −1.12 [−1.44, −0.79], p

Summary: Background: Polycystic ovary syndrome (PCOS) is a common endocrine condition in women of reproductive age that often presents with reproductive, metabolic, and psychological symptoms. While exercise is part of the management of PCOS, it is unclear which form of exercise may be most effective and for which outcomes. Aim: In order to inform the updated 2023 International evidence-based guideline for the assessment and management of polycystic ovary syndrome, this systematic review aimed to determine the exercise modality that provides the greatest improvement in anthropometric, metabolic, hormonal/reproductive, and psychological outcomes in adult women with PCOS. Methods: Five databases were searched from inception to July 2022. Studies eligible for inclusion consisted of those in a PCOS population, that compared two exercise modalities, and reported at least one anthropometric, metabolic, hormonal/reproductive, and/or psychological outcome. Screening, data extraction, and methodological quality assessments were conducted by two independent reviewers. Methodological quality assessment was performed using the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines were used to determine the certainty of evidence. Meta-analysis was performed utilising Comprehensive Meta-Analysis software, Version 3. Results: Of the 4739 records identified, five unique studies were eligible for inclusion in the systematic review and meta-analysis, comprising a total of 216 individuals. Meta-analyses comparing high-intensity interval training (HIIT) to moderate-intensity continuous training (MICT) on anthropometric, metabolic, and hormonal/reproductive parameters found no statistically significant differences in outcomes between groups, and the certainty of evidence was graded as low or very low. Results from single studies showed that HIIT was more effective than MICT for menstrual regularity (odds ratio [95% confidence interval] ​= ​7.875 [1.105, 56.125], p ​= ​0.039, very low certainty). HIIT vs resistance training, and diet ​+ ​MICT vs diet ​+ ​MICT ​+ ​resistance training were examined by a single study each, and no statistically significant differences were found for any outcome, with the certainty of evidence ranked as very low. Conclusion: To date, there are insufficient RCTs comparing exercise modalities in individuals with PCOS to establish with certainty whether one form of exercise is superior to another for the management of PCOS.

The calcium sensitivity hypothesis helps explain the development of different forms of cardiomyopathy: increased sensitivity to calcium in cardiac sarcomeres leads to hypertrophic cardiomyopathy (HCM) and decreased sensitivity results in dilated cardiomyopathy (DCM). This hypothesis has driven the development of next generation drugs targeting sarcomere proteins to correct the amount of force generated as a result of changes in calcium sensitivity (e.g. mavacamten decreases cardiac myosin activity to treat HCM). Characterization of variants of cardiac actin (ACTC) found in patients with HCM or DCM has generally supported the calcium sensitivity hypothesis. Of interest are two different substitution mutations at R312 on ACTC: R312H leads to DCM, while R312C was found in patients with HCM. To determine how changes in the same codon on the same gene lead to different disease phenotypes, we characterized recombinant R312H- and R312C-ACTC variant proteins. Both variants exhibited the same change in calcium sensitivity, suggesting that a factor other than calcium sensitivity is responsible for disease differentiation. We observed a gradient of increased residual myosin activity with R312-ACTC variant proteins under relaxing conditions which may trigger different disease development. Our findings suggest that factors other than calcium sensitivity may contribute to cardiomyopathy development and should be considered when planning treatments.

The aim of this study was to determine the effects of Pro-A (a mixture of Bacillus subtilis, B. licheniformis, B. pumilus) on the growth performance, feed utilization, immune responses, and intestinal microbiota of whiteleg shrimp (Litopenaeus vannamei). The experiment was conducted with four iso-nitrogenous (45.4% crude protein) and iso-caloric (19.9 KJ g−1) diets supplemented with different levels (0%, 0.05%, 0.1%, and 0.2%) of Pro-A. Whiteleg shrimp (n = 1400, average body weight: 0.45 g) were randomly assigned to 500-L composite tanks (filled with 400 L of brackish water) at a stocking rate of 70 shrimp tank−1 for 10 weeks. There were five replicates per dietary treatment. The results showed that the diet containing 0.1% Pro-A significantly increased the growth, protein efficiency ratio, feed conversion ratio, and survival rate compared to the control. Diets containing 0.05% and 0.1% Pro-A significantly increased the digestive enzymes compared to the control. Furthermore, diet containing 0.1% Pro-A significantly improved hematological and immune profiles. The total vibrio count was lowest in the diet supplemented with 0.1% of Pro-A, accordingly, the bacterial clearance efficiency was higher in this diet. The whiteleg shrimp fed the Pro-A diets (at 0.05%, 0.1%, and 0.2%) had lower cumulative mortality than the control after being challenged with Vibrio parahaemolyticus. Our results suggest that dietary supplementation with 0.1% Pro-A is the most effective in improving the performance and immunity of whiteleg shrimp; however, this should be confirmed in a further study under full-scale commercial trials.

Agricultural systems in Southeast Asia are rapidly transitioning from subsistence-oriented to market-oriented agriculture. Driven by the highly complex and variable decision processes of individual farm households, these transitions have produced a diverse landscape mosaic across the region. Elucidation and characterization of underlying decision-making processes, and the factors that influence land use choices, are thus essential for sustainable land use planning. To enable a study that seeks to understand these linkages, data on plot-level 10-year land use history, management and farm performance indicators were collected from 163 households in the Northern Lao uplands and in the Central Highlands of Vietnam, areas chosen to represent two extremes of the transition gradient. The objectives of the study were (i) to describe plot-level sequence patterns of seasonal variation of land use over several years, (ii) to apply a sequence dissimilarity metric, the complexity index (CI), to measure land use transition in an agricultural system, and (iii) to identify the key drivers of land use change and their linkages with farm performance indicators and plot level characteristics through multi-dimensional analysis. CI allowed compressing historical land use data and quantifying land use complexity in a simple and efficient manner. Land use dynamics varied strongly between the two sites, with 66% of the land use types in the Laos site being completely replaced by others during the recall periods, compared to only 15% in the Vietnam site. Associated key drivers of land use change also differed significantly: while end use of agricultural products was the main driver behind land use changes in the Vietnam site, a more complex relationship between topography and management vs. land use change was evident in the Laos site. Likewise, land use complexity does not exhibit the same relationship with farm performance in the two sites: in the Central Highlands, households with higher food availability are half as likely to transition, while in the Lao uplands, land use complexity was significantly correlated with the Progress out of Poverty index. Multidisciplinary studies remain necessary to assess the impact of innovative sustainable intensification options on system performance and environmental sustainability, before policies are enacted to support their dissemination in Southeast Asian smallholder agricultural systems. Context-specific CI thresholds associated with system quality indicators could support this by informing decision-makers on the pace of agricultural transformation and its environmental impacts.

Prior reviews describing approach, methodological quality and effectiveness of dietary policies and programs may be limited in use for practitioners seeking to introduce innovative programming, or academic researchers hoping to understand and address gaps in the current literature. This review is novel, assessing the “where, who, and in whom” of dietary policies and programs research in the United States over the past decade – with results intended to serve as a practical guide and foundation for innovation. This study was conducted from October 2018 to March 2019. Papers were selected through a tailored search strategy on PubMed as well as citation searches, to identify grey literature. A total of 489 papers were relevant to our research objective. The largest proportion of papers described school-based strategies (31%) or included economic incentives (19%). In papers that specified demographics, the study populations most often included children, adults and adolescents (54%, 46%, and 42% respectively); and White, Black and Hispanic populations (77%, 76% and 70%, respectively). Results highlight opportunities for future research within workplace and faith-based settings, among racial/ethnic minorities, and older adults.

Behavioral interventions utilizing community health workers (CHWs) have demonstrated effectiveness in improving hypertension disparities in ethnic minority populations in the United States, but few have focused on Asian Americans. We assessed the efficacy of a CHW intervention to improve hypertension management among Filipino Americans with uncontrolled blood pressure (BP) in New York City (NYC) from 2011 to 2013. A total of 240 Filipino American individuals (112 in the treatment group and 128 in the control group) with uncontrolled hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg) were recruited from community-based settings in NYC. Using a community-based participatory research approach, treatment participants received 4 educational workshops and 4 one-on-one visits with CHWs over a 4-month period, while control group participants received 1 educational workshop. Main outcome measures included BP control, changes in SBP and DBP, and changes in appointment keeping at 8-months. At 8-months, BP was controlled among a significantly greater percentage of treatment group participants (83.3%) compared to the control group (42.7%). The adjusted odds of controlled BP for the treatment group was 3.2 times the odds of the control group (P

Asian Americans have lower levels of physical activity (PA) compared to other racial/ethnic groups; however, there is little understanding of the social and cultural determinants of PA in this population. Few analyses describe specific PA domains (occupation-, transportation-, recreation-related), focus on one Asian subgroup, or use validated scales. The study objective was to assess the association between acculturation and activity behaviors (meeting 2008 PA guidelines, activity minutes by PA domain, sitting time) in a cross-sectional sample of urban-dwelling, Chinese American immigrants. Data were from the Chinese American Cardiovascular Health Assessment (CHA CHA) 2010–11 among participants with valid reports of PA minutes, assessed by the WHO Global Physical Activity Questionnaire (n = 1772). Acculturation was assessed using the Stephenson Multigroup Acculturation Scale, a 32-item instrument which characterizes two acculturative dimensions: ethnic society (Chinese) immersion and dominant society (American) immersion (maximum possible scores = 4). Multivariable models regressing activity behaviors on acculturation were run, adjusting for age, sex, household income, education, and age at immigration. Ethnic society immersion was high (mean = 3.64) while dominant society immersion was moderate (mean = 2.23). Higher ethnic society immersion was associated with less recreation-related PA (−40.7 min/week); higher dominant society immersion was associated with a higher odds of meeting PA guidelines (OR: 1.66 (1.25, 2.20), p

At the two latest FIRMS (The Forensic Isotope Ratio Mass Spectrometry Network Ltd) conferences, presentations were made describing the status of IRMS based evidence in criminal proceedings [S. Doyle, T. Chau and J. Howa, IRMS based evidence passes the 'test' (aided by FIRMS) - an important milestone, in: 8th FIRMS Conference, 2022; J. Ehleringer, J. Howa and T. Chau, Stable isotope evidence in the U.S. courts, in: 7th FIRMS Conference, 2019]. One of those cases was of particular significance in that it established the admissibility of IRMS (isotope ratio mass spectrometry) based expert testimony having satisfied the US Federal Rule of Evidence (FRE)702 'Testimony by Expert Witnesses' in the State of Colorado. While specific to the State of Colorado and the particulars of the case, the admissibility of IRMS based evidence in other cases might be supported by such a ruling. This paper provides the detail of the process by which IRMS based evidence was found to be admissible and in so doing also provides practical guidance on how to satisfy FRE 702 and meet a Daubert challenge. It also highlights the role of approval by the FIRMS Network of both practitioners and their methods in support of admissibility [The FIRMS Network Ltd., FIRMS Approved Practitioners, [Online]. Available: https://www.forensic-isotopes.org/fafp.html [Accessed 11 May 2023].]., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Context: Abnormal serum calcium concentrations affect the heart and may alter the electrocardiogram (ECG), but the detection of hypocalcemia and hypercalcemia (collectively dyscalcemia) relies on blood laboratory tests requiring turnaround time., Objective: The study aimed to develop a bloodless artificial intelligence (AI)-enabled (ECG) method to rapidly detect dyscalcemia and analyze its possible utility for outcome prediction., Methods: This study collected 86,731 development, 15,611 tuning, 11,105 internal validation, and 8401 external validation ECGs from electronic medical records with at least 1 ECG associated with an albumin-adjusted calcium (aCa) value within 4 h. The main outcomes were to assess the accuracy of AI-ECG to predict aCa and follow up these patients for all-cause mortality, new-onset acute myocardial infraction (AMI), and new-onset heart failure (HF) to validate the ability of AI-ECG-aCa for previvor identification., Results: ECG-aCa had mean absolute errors (MAE) of 0.78/0.98 mg/dL and achieved an area under receiver operating characteristic curves (AUCs) 0.9219/0.8447 and 0.8948/0.7723 to detect severe hypercalcemia and hypocalcemia in the internal/external validation sets, respectively. Although < 20 % variance of ECG-aCa could be explained by traditional ECG features, the ECG-aCa was found to be associated with more complications. Patients with ECG-hypercalcemia but initially normal aCa were found to have a higher risk of subsequent all-cause mortality [hazard ratio (HR): 2.05, 95 % conference interval (CI): 1.55-2.70], new-onset AMI (HR: 2.88, 95 % CI: 1.72-4.83), and new-onset HF (HR: 2.02, 95 % CI: 1.38-2.97) in the internal validation set, which were also seen in external validation., Conclusion: The AI-ECG-aCa may help detecting severe dyscalcemia for early diagnosis and ECG-hypercalcemia also has prognostic value for clinical outcomes (all-cause mortality and new-onset AMI and HF)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: To investigate the effects of short-term orthokeratology (OK) on accommodation and binocular visual function in young adults., Methods: Twenty-four myopes (18 to 38 years) were fitted with OK lenses in both eyes. Best corrected distance visual acuity (VA), subjective and objective refractions, corneal topography and a series of binocular vision tests were measured at baseline (BL) before lens wear and then repeated after 28 nights of OK. Data from 15 subjects who demonstrated successful OK lens fit are reported., Results: Corneal flattening and hyperopic shifts in spherical equivalent refractive error (all p < 0.001) after 28 nights of OK indicated myopic correction. Improvement in best corrected distance VA was measured after OK (right eye p = 0.021; left eye p = 0.014). Although there was no significant change in mean distance and near phorias and stereoacuity scores after OK compared to BL, there was a significant reduction in standard deviation (SD) and range of data (distance p = 0.01; near p = 0.02; stereoacuity p < 0.001). While there appeared to be an improvement in distance accommodative facility after OK, this failed to reach statistical significance (p = 0.053). Furthermore, there was no change in AC/A gradients with ±1 D and ±2 D lenses after OK compared to BL., Conclusions: Binocular vision remained unchanged after OK, although variability of phoria and stereoacuity measures reduced. This suggests that OK improves or maintains accommodative and binocular vision function in young adult myopes who achieve good vision with OK. Myopes with phorias outside normal ranges and/or poor distance accommodative facility may benefit most with OK, in binocular and accommodative function., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Although previous studies have highlighted both similarities and differences between the timing of electromyography (EMG) and mechanomyography (MMG) activities of muscles, there is no method to systematically quantify the temporal alignment between corresponding EMG and MMG signals. We proposed a novel method to determine the level of coincident activity in quasi-periodic MMG and EMG signals. The method optimizes 3 muscle-specific parameters: amplitude threshold, window size and minimum percent of EMG and MMG overlap using a particle swarm optimization algorithm to maximize the agreement (balanced accuracy) between electrical and mechanical muscle activity. The method was applied to bilaterally recorded EMG and MMG signals from 4 lower limb muscles per side of 25 pediatric participants during self-paced gait. Mean balanced accuracy exceeded 75% for all muscles except the lateral gastrocnemius, where EMG and MMG misalignment was notable (56% balanced accuracy). The proposed method can be applied to the criterion-driven comparison of simultaneously recorded myographic signals from two different measurement modalities during a motor task., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: Brain-computer interfaces (BCIs) allow users to operate a device or application by means of cognitive activity. This technology will ultimately be used in real-world environments which include the presence of distractors. The purpose of the study was to determine the effect of visual distractors on BCI performance., Methods: Sixteen able-bodied participants underwent neurofeedback training to achieve motor imagery-guided BCI control in an online paradigm using electroencephalography (EEG) to measure neural signals. Participants then completed two sessions of the motor imagery EEG-BCI protocol in the presence of infrequent, small visual distractors. BCI performance was determined based on classification accuracy., Results: The presence of distractors was found to affect motor imagery-specific patterns in mu and beta power. However, the distractors did not significantly affect the BCI classification accuracy; across participants, the mean classification accuracy was 81.5 ± 14% for non-distractor trials, and 78.3 ± 17% for distractor trials., Conclusion: This minimal consequence suggests that the BCI was robust to distractor effects, despite motor imagery-related brain activity being attenuated amid distractors., Significance: A BCI system that mitigates distraction-related effects may improve the ease of its use and ultimately facilitate the effective translation of the technology from the lab to the home., (Copyright © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Electromyography (EMG) is the standard modality for measuring muscle activity. However, the convenience and availability of low-cost accelerometer-based wearables makes mechanomyography (MMG) an increasingly attractive alternative modality for clinical applications. Literature to date has demonstrated a strong association between EMG and MMG temporal alignment in isometric and isokinetic contractions. However, the EMG-MMG relationship has not been studied in gait. In this study, the concurrence of EMG- and MMG-detected contractions in the tibialis anterior, lateral gastrocnemius, vastus lateralis, and biceps femoris muscles were investigated in children during self-paced gait. Furthermore, the distribution of signal power over the gait cycle was statistically compared between EMG-MMG modalities. With EMG as the reference, muscular contractions were detected based on MMG with balanced accuracies between 88 and 94% for all muscles except the gastrocnemius. MMG signal power differed from that of EMG during certain phases of the gait cycle in all muscles except the biceps femoris. These timing and power distribution differences between the two modalities may in part be related to muscle fascicle length changes that are unique to muscle motion during gait. Our findings suggest that the relationship between EMG and MMG appears to be more complex during gait than in isometric and isokinetic contractions., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Brain computer interfaces (BCI) can provide communication opportunities for individuals with severe motor disabilities. Transcranial Doppler ultrasound (TCD) measures cerebral blood flow velocities and can be used to develop a BCI. A previously implemented TCD BCI system used verbal and spatial tasks as control signals; however, the spatial task involved a visual cue that awkwardly diverted the user's attention away from the communication interface. Therefore, vision-independent right-lateralized tasks were investigated. Using a bilateral TCD BCI, ten participants controlled online, an on-screen keyboard using a left-lateralized task (verbal fluency), a right-lateralized task (fist motor imagery or 3D-shape tracing), and unconstrained rest. 3D-shape tracing was generally more discernible from other tasks than was fist motor imagery. Verbal fluency, 3D-shape tracing and unconstrained rest were distinguished from each other using a linear discriminant classifier, achieving a mean agreement of κ=0.43±0.17. These rates are comparable to the best offline three-class TCD BCI accuracies reported thus far. The online communication system achieved a mean information transfer rate (ITR) of 1.08±0.69bits/min with values reaching up to 2.46bits/min, thereby exceeding the ITR of previous online TCD BCIs. These findings demonstrate the potential of a three-class online TCD BCI that does not require visual task cues., (Copyright © 2016 Elsevier Ireland Ltd and Japan Neuroscience Society. All rights reserved.)

With the increasing use of enzymes in environmental applications, there is a need for analytical methods adapted to large factorial experiments. Existing reference methods are chemical and labor intensive and unsuitable to analyze in parallel a large number of samples. Based on an extensive literature review and on experimental results, this work compares reference and microplate adapted methods to define the most adequate filter paper, carboxymethylcellulase, β-glucosidase and xylanase activity tests. In the adapted methods, the total reaction volume was reduced from 2.2-24.5 mL to 0.21-0.24 mL. Statistical analysis of the activities measured on enzyme mixtures by applying the 96-well plate reduced methods showed that they were not significantly different to the activities obtained with reference tests., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Dual anti-HER2 therapy is effective for HER2-amplified breast cancer. Weekly paclitaxel, trastuzumab, and full-dose lapatinib (PTL) is not feasible because of grade 3 diarrhea. We conducted a phase II feasibility study of dose-dense (DD; every other week) PTL (ClinicalTrials.gov identifier, NCT01827163)., Patients and Methods: Eligible patients had HER2-positive breast cancer, tumor size ≤ 3 cm, and negative nodes. Treatment included paclitaxel (175 mg/m(2) × 4, every 2 weeks with pegfilgrastim), trastuzumab (4 mg/kg load and then 2 mg/kg weekly), and lapatinib (1000 mg daily). After paclitaxel × 4, trastuzumab (6 mg/kg every 3 weeks) plus lapatinib were continued for 1 year. The primary endpoint was feasibility, defined as (1) > 80% of patients completing PTL without a dose delay or reduction, (2) grade 3 diarrhea rate < 20%, and (3) cardiac event rate < 4%., Results: From May 2013 to November 2013, we enrolled 20 of 55 planned patients. The median age was 49 years (range, 34-74 years). One patient had immediate paclitaxel hypersensitivity and was deemed inevaluable. Only 13 of 19 evaluable patients (68%) completed PTL without a dose delay or reduction or unacceptable toxicities. Only 3 of 19 (16%) had grade 3 diarrhea. Rash was frequent, with all grades in 18 of 19 (95%) and grade 3 in 2 of 19 (11%). The study was stopped early because of excess toxicity., Conclusion: The discontinuation rate during DD PTL was high, owing, in part, to an unexpectedly high incidence of rash. The trial was halted, because the initial discontinuation rate from overall toxicity made it unlikely that full accrual would demonstrate feasibility., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Response surface methodology (RSM) was used to optimize the removal of five endocrine disrupting compounds (EDCs) by the enzyme versatile peroxidase (VP): bisphenol A (BPA), triclosan (TCS), estrone (E1), 17β-estradiol (E2) and 17α-ethinylestradiol (EE2). The optimal variables of enzyme activity (90-100 U L(-1)), sodium malonate (29-43 mM) and MnSO4 (0.8-1 mM) led to very high removal rates of the five pollutants (2.5-5.0 mg L(-1) min(-1)). The structural elucidation of transformation products arising from the enzymatic catalysis of the EDCs was investigated by Gas Chromatography coupled to Mass Spectrometry (GC-MS) and Liquid Chromatography Electrospray Time-of-Flight Mass Spectrometry (LC-ESI-TOF-MS). The presence of dimers and trimers, indicative of oxidative coupling, was demonstrated., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Evidence suggests that the cerebral blood flow patterns accompanying cognitive activity are retained in many locked-in patients. These patterns can be monitored using transcranial Doppler ultrasound (TCD), a medical imaging technique that measures bilateral cerebral blood flow velocities. Recently, TCD has been proposed as an alternative imaging modality for brain-computer interfaces (BCIs). However, most previous TCD-BCI studies have performed offline analyses with impractically lengthy tasks. In this study, we designed a BCI that automatically differentiates between counting and verbal fluency tasks using sequential hypothesis testing to make decisions as quickly as possible. Ten able-bodied participants silently alternated between counting and verbal fluency tasks within the paradigm of a simulated on-screen keyboard. During this experiment, blood flow velocities were recorded within the left and right middle cerebral arteries using bilateral TCD. Twelve features were used to characterize TCD signals. In a simulated online analysis, sequential hypothesis testing was used to update estimates of class probability every 250 ms as TCD data were processed. Classification was terminated once a threshold level of certainty was reached. Mean classification accuracy across all participants was 72% after an average of 23s, compared to an offline analysis which obtained a classification accuracy of 80% after 45 s. This represents a substantial gain in data transmission rate, while maintaining classification accuracies exceeding 70%. Furthermore, a range of decision times between 19 and 28s was observed, suggesting that the ability of sequential hypothesis testing to adapt the task duration for each individual participant is critical to achieving consistent performance across participants. These results indicate that sequential hypothesis testing is a promising alternative for online TCD-BCIs., (Copyright © 2015 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.)

Nur77, encoded by Nr4a1 (alias Nur77), plays roles in cell death, survival, and inflammation. To study the role of Nur77 in liver regeneration, wild-type (WT) and Nur77 knockout (KO) mice were subjected to standard two-thirds partial hepatectomy (PH). Nur77 mRNA and protein levels were markedly induced at 1 hour after PH in WT livers, coinciding with ERK1/2 activation. Surprisingly, Nur77 KO mice exhibited a higher liver-to-body weight ratio than WT mice at 24, 48, and 72 hours after PH. Nur77 KO livers exhibited increase in Ki-67-positive hepatocytes at 24 hours, with early induction of cell-cycle genes. Despite accelerated regeneration, Nur77 KO livers paradoxically incurred necrosis, hepatocyte apoptosis, elevated serum alanine aminotransferase activity, and Kupffer cell accumulation. Microarray analysis revealed up-regulation of genes modulating inflammation, cell proliferation, and apoptosis but down-regulation (due to Nur77 deficiency) of glucose and lipid homeostasis genes. Levels of proinflammatory cytokines IL-6, IL-12, IL-23, and CCL2 were increased and levels of anti-inflammatory IL-10 were decreased, compared with WT. Activated NF-κB and STAT3 and mRNA levels of target genes Myc and Bcl2l1 were elevated in Nur77 KO livers. Overall, Nur77 appears essential for regulating early signaling of liver regeneration by modulating cytokine-mediated inflammatory, apoptotic, and energy mobilization processes. The accelerated liver regeneration observed in Nur77 KO mice is likely due to a compensatory effect caused by injury., (Copyright © 2014 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.)

The elements of human hair record specific information about an individual's health, diet, and surrounding environment. Strontium isotope ratios of human hair have attracted interest as they potentially record an individual's environment. Yet, separating the external environmental signals from the internal dietary indicators has remained a challenge. Here, we examined the effects of five different hair-cleaning methodologies to determine the extent that internal and external strontium signals can be isolated from human hair. In the first study of its kind, we employed an in-line strontium purification methodology and a multi-collector inductively coupled plasma mass spectrometer to obtain high-precision strontium isotope ratio of human hair and of leachates of the different washing treatments. We found that the different applications of an individual treatment removed a consistent amount of strontium from hair and that replicate analyses showed each treatment altered the strontium isotope ratios of hair consistently. A mass-balance approach was applied to demonstrate that strontium was quantitatively removed and was accounted for in either the treated hair or the leachate. We observed that strontium isotope ratio varied as a function of treatment aggressiveness so as to suggest that there was a fine-scale structuring of strontium within hair (transverse cross-sectional variations); these variations existed as differences in strontium concentrations and isotope ratios. As a result, the Sr isotope ratio of hair and hair leachates treated with the most aggressive cleaning methods reflected the isotope ratios of the interior and total exterior strontium signatures, respectively. The results of this study indicate that external environmental strontium signals can be distinguished from the internal signals and therefore permit the application of strontium isotope ratios of modern human hair for geospatial applications., (Copyright © 2013 Elsevier B.V. All rights reserved.)

This paper presents a two-part study with walking conditions involving music and television (TV) to investigate their effects on human gait. In the first part, we observed seventeen able-bodied adults as they participated in three 15-minute walking trials: (1) without music, (2) with music and (3) without music again. In the second part, we observed fifteen able-bodied adults as they walked on a treadmill for 15 min while watching (1) TV with sound (2) TV without sound and (3) TV with subtitles but no sound. Gait timing was recorded via bilateral heel sensors and center-of-mass accelerations were measured by tri-axial accelerometers. Measures of statistical persistence, dynamic stability and gait variability were calculated. Our results showed that none of the considered gait measures were statistically different when comparing music with no-music trials. Therefore, walking to music did not appear to affect intrinsic walking dynamics in the able-bodied adult population. However, stride interval variability and stride interval dynamics were significantly greater in the TV with sound walking condition when compared to the TV with subtitles condition. Treadmill walking while watching TV with subtitles alters intrinsic gait dynamics but potentially offers greater gait stability., (© 2013 Published by Elsevier Ltd. All rights reserved.)

Mechanomyography (MMG) is an important kinesiological tool and potential communication pathway for individuals with disabilities. However, MMG is highly susceptible to contamination by motion artifact due to limb movement. A better understanding of the nature of this contamination and its effects on different sensing methods is required to inform robust MMG sensor design. Therefore, in this study, we recorded MMG from the extensor carpi ulnaris of six able-bodied participants using three different co-located condenser microphone and accelerometer pairings. Contractions at 30% MVC were recorded with and without a shaker-induced single-frequency forearm motion artifact delivered via a custom test rig. Using a signal-to-signal-plus-noise-ratio and the adaptive Neyman curve-based statistic, we found that microphone-derived MMG spectra were significantly less influenced by motion artifact than corresponding accelerometer-derived spectra (p⩽0.05). However, non-vanishing motion artifact harmonics were present in both spectra, suggesting that simple bandpass filtering may not remove artifact influences permeating into typical MMG bands of interest. Our results suggest that condenser microphones are preferred for MMG recordings when the mitigation of motion artifact effects is important., (Copyright © 2011. Published by Elsevier Ltd.)

Swallowing accelerometry is a biomechanical approach for the assessment of difficulties during deglutition. However, the effects of various swallowing tasks and different anthropometric/demographic variables on the statistical behavior of these accelerometric signals are unknown. In particular, to understand the statistical persistence of these signals, we used detrended fluctuation analysis (DFA) to analyze accelerometric data collected from 408 healthy participants during dry, wet and wet chin tuck swallowing tasks. The results of DFA were then examined for potential influences of age, gender or body mass index. Several important conclusions were reached. First, the strongest persistence was observed for the wet chin tuck swallows. Second, the vibrations in the superior-inferior (S-I) direction generally have stronger temporal dependencies than those in the anterior-posterior (A-P) direction. Both of these phenomena can be attributed to the dominating influence of head movements on the amplitude of vibrations in the S-I direction. Third, gender, age and body mass index of the participants did not impact the observed persistence for dry and wet chin tuck swallows, while a gender effect was identified for wet swallows. In particular, male participants experienced more Brownian-like statistical dependencies in their swallowing signals. Future developments in the field should attempt to remove signal components associated with strong statistical persistence, as they tend to be associated with non-swallowing phenomena., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

A coordinated activation of distal forearm muscles allows the hand and fingers to be shaped during movement and grasp. However, little is known about how the muscle activation patterns are reflected in multi-channel mechanomyogram (MMG) signals. The purpose of this study is to determine if multi-site MMG signals exhibit distinctive patterns of forearm muscle activity. MMG signals were recorded from forearm muscle sites of nine able-bodied participants during hand movement. By using 14 features selected by a genetic algorithm and classified by a linear discriminant analysis classifier (LDA), we show that MMG patterns are specific and consistent enough to identify 7+/-1 hand movements with an accuracy of 90+/-4%. MMG-based movement recognition required a minimum of three recording sites. Further, by classifying five classes of contraction patterns with 98+/-3% accuracy from MMG signals recorded from the residual limb of an amputee participant, we demonstrate that MMG shows pattern-specificity even in the absence of typical musculature. Multi-site monitoring of the RMS of MMG signals is suggested as a method of estimating the relative contributions of muscles to motor tasks. The patterns in MMG facilitate our understanding of the mechanical activity of muscles during movement., (Copyright (c) 2009 Elsevier Ltd. All rights reserved.)

Contact angle and the wetting behaviour of solid particles are influenced by many physical and chemical factors such as surface roughness and heterogeneity as well as particle shape and size. A significant amount of effort has been invested in order to probe the correlation between these factors and surface wettability. Some of the key investigations reported in the literature are reviewed here. It is clear from the papers reviewed that, depending on many experimental conditions such as the size of the surface heterogeneities and asperities, surface cleanliness, and the resolution of measuring equipment and data interpretation, obtaining meaningful contact angle values is extremely difficult and such values are reliant on careful experimental control. Surface wetting behaviour depends on not only surface texture (roughness and particle shape), and surface chemistry (heterogeneity) but also on hydrodynamic conditions in the preparation route. The inability to distinguish the effects of each factor may be due to the interplay and/or overlap of two or more factors in each system. From this review, it was concluded that: Surface geometry (and surface roughness of different scales) can be used to tune the contact angle; with increasing surface roughness the apparent contact angle decreases for hydrophilic materials and increases for hydrophobic materials. For non-ideal surfaces, such as mineral surfaces in the flotation process, kinetics plays a more important role than thermodynamics in dictating wettability. Particle size encountered in flotation (10-200 microm) showed no significant effect on contact angle but has a strong effect on flotation rate constant. There is a lack of a rigid quantitative correlation between factors affecting wetting, wetting behaviour and contact angle on minerals; and hence their implication for flotation process. Specifically, universal correlation of contact angle to flotation recovery is still difficult to predict from first principles. Other advanced techniques and measures complementary to contact angle will be essential to establish the link between research and practice in flotation.

Rationale: A clinically limiting feature of currently-available nicotine gum is its slow rate of nicotine delivery and consequently slow onset of therapeutic effects. Previous research suggested that a nicotine hydrogen tartrate gum (NHTG1) that delivered nicotine more rapidly provided more effective craving relief. A subsequent gum formulation (NTHG2) was developed to further increase speed of delivery., Objective: Compare the plasma nicotine absorption and clinical tolerability of NHTG2 to NHTG1 and Nicorette FreshMint., Methods: A single-dose, randomized, crossover study evaluated the early kinetics of nicotine absorption and tolerability of 4 mg NHTG2 compared to NHTG1 and Nicorette., Results: NHTG2 gum reached higher Cmax (p=0.059 versus Nicorette; p=0.006 versus NHTG1) and delivered significantly more nicotine than Nicorette or NHTG1 within the first 10-30 min of chewing (AUCs0-10, 0-30) and overall (AUC0-180). NHT gums and Nicorette were well tolerated, with little difference in their AE profiles., Conclusions: Study results indicate that NHTG2 gum provided more rapid uptake of nicotine in blood without notable decreases in tolerability. To the extent that rate of delivery and onset of therapeutic effects are related, these gums would be expected to provide more rapid therapeutic effects.

This study investigates the stationarity of steady state mechanomyogram signals for the purpose of determining appropriate features for signal classification. Mechanomyography is the superficial recording of low frequency vibrations detected over contracting muscles. Steady state mechanomyogram signals, recorded at the belly of the extensor digitorum, flexor digitorum superficialis and flexor pollicis longus muscles during functional grasps were tested for weak stationarity. Twenty percent of the contractions were found to be non-stationary, indicating that time frequency methods may be appropriate for automatic pattern recognition of functional grasp from the mechanomyogram. The distribution of the stationary test statistic was dependent on the type of muscle contractions, suggesting that the test statistic itself might be a discriminating feature for mechanomyogram pattern recognition in applications such as multifunction prosthetic control. Since the major known source of non-stationarity was decreasing variance, it is suggested that shifts in the distribution of the test statistic may indicate the time course of relative muscle contributions to functional grasp.

There are no predictive factors for peritoneal dialysis-associated peritonitis; however, its resolution correlates with a cell-mediated Th1 immune response. We tested the hypothesis that induction of receptor-interacting protein 2 (RIP2), an assumed kinase linked with Th1 responses, is a useful marker in this clinical setting. Basal RIP2 expression was measured in human immune cells and during dialysis-associated peritonitis. RIP2 increased with bacterial toxin cell activation and the temporal profile for this differed depending on immune cell involvement in the innate or adaptive phases of the response. Importantly, RIP2 expression increased in peritoneal immune cells during dialysis-associated peritonitis and this upregulation correlated with clinical outcome. An early induction in peritoneal CD14(+) cells correlated with rapid resolution, whereas minimal induction correlated with protracted infection and with catheter loss in 36% of patients. These latter patients had higher levels of MCP-1 consistent with a delayed transition from innate to adaptive immunity. Our study shows that upregulation of RIP2 is a useful marker to monitor dialysis-associated peritonitis and in predicting the clinical outcome of these infections.

Hyponatremia can be classified as acute or chronic depending on its duration, and treatment options are tailored to this classification. However, it is sometimes difficult to differentiate acute from chronic hyponatremia in the Emergency Department (ED). The objective of this study was to identify characteristics to help diagnose and manage acute hyponatremia in the ED. Patients with acute hyponatremia in the ED were enrolled from a retrospective 2-year chart review. Eleven patients (0.8%) were identified with acute hyponatremia out of a total of 1321 hyponatremic patients. There were nine women and two men. The mean age was 48.9 years. The mean sodium (Na(+)) level was 115+/-4 mmol/L. Accompanying biochemical abnormalities included hypouricemia and hypouremia with increased fractional excretions of uric acid (UA) and urea. The estimated amount of water intake ranged from 2.5 to 10 liters (mean, 5.1+/-2.3 liters) during the day before ED presentation. All patients were treated with hypertonic saline and furosemide at a correction rate of 1.6+/-0.5 mmol/L/h. No patients had neurological sequelae after treatment. The causes of acute hyponatremia included induction of abortion with oxytocin (n=1), primary polydipsia on neuroleptic agents (n=2), polyethylene glycol (PEG) preparation for colonoscopy (n=1), diuretic therapy for hypertension (n=4), ecstasy use (n=1), and weight-reducing herbal teas (n=2). We conclude that in the right clinical setting, high free water intake and low serum urea and UA favor acute hyponatremia. A detailed drug history may be helpful in the differential diagnosis of acute hyponatremia.

Although acute nonoliguric renal failure is a well-known nephrotoxic effect of aminoglycoside antibiotics, less recognized is acquired Bartter-like syndrome. Herein, we describe four female patients who presented with marked paresthesia, muscle weakness, and tetany following gentamicin therapy with total dose ranging from 1.2 g to 2.6 g. All were normotensive. Biochemical abnormalities included hypokalemia (K+ 1.8-2.3 mmol/L), metabolic alkalosis (HCO(3-) 31.9-34.2 mmol/L), hypomagnesemia (Mg2+ 0.9-1.2 mg/dL), hypermagnesiuria (fractional excretion of Mg 3-6%), hypocalcemia (free Ca2+ 2.0-4.1 mg/dL), and hypercalciuria (molar ratio of Ca2+/creatinine 0.23-0.53), all consistent with Bartter-like syndrome. Serum immunoreactive parathyroid hormone concentration was low despite the hypocalcemia. The Bartter-like syndrome lasted for 2 to 6 weeks after cessation of gentamicin, coupled with supplementation of K+, Ca2+, and Mg2+. These biochemical abnormalities resembled those seen in patients with gain-of-function mutations in the calcium-sensing receptor. We hypothesize that gentamicin, a polyvalent cationic molecule, induces the action of calcium-sensing receptor on the thick ascending loop of Henle and distal convoluted tubule to cause renal wasting of Na+, K+, Cl-, Ca2+, and Mg2+.

Acute hypercapnic respiratory failure is a potentially life-threatening complication of profound hypokalemia usually seen in patients with large total-body potassium (K+) deficits. It has rarely been reported in thyrotoxic periodic paralysis (TPP), which is due to intra-cellular shifts of K+. The authors report on a 29-year-old man who presented with sudden onset of muscle paralysis in all extremities and acute progressive respiratory insufficiency requiring artificial respiratory support. He was treated with intravenous KCl. After six hours, muscular strength had returned to normal, with plasma K+ concentration of 3.0 mmol/L. At the eighth hour, rebound hyperkalemia (6.6 mmol/L) developed with high-tented T waves, even after the KCl was discontinued. Ventilatory support was uneventfully weaned at 14 hours. Elevated free thyroxine and undetectable thyroid-stimulating hormone confirmed the diagnosis of TPP. TPP should be kept in mind as a cause of acute respiratory failure in association with acute muscle weakness to avoid delayed diagnosis and improper management.

Background: Thyrotoxic periodic paralysis (TPP) commonly precedes the overt symptoms and signs of hyperthyroidism and may be misdiagnosed as other causes of paralysis (non-TPP). Because the cardiovascular system is very sensitive to elevation of thyroid hormone, we hypothesize that electrocardiographic manifestations may aid in early diagnosis of TPP., Methods: We retrospectively identified 54 patients who presented to the emergency department (ED) with hypokalemic paralysis during a 3.5-year period. Thirty-one patients had TPP and 23 patients had non-TPP, including sporadic periodic paralysis, distal renal tubular acidosis, diuretic use, licorice intoxication, primary hyperaldosteronism, and Bartter-like syndrome. Electrocardiograms during attacks were analyzed for rate, rhythm, conduction, PR interval, QRS voltage, ST segment, QT interval, U waves, and T waves., Results: There were no significant differences in age, sex distribution, and plasma K+ concentration between the TPP and non-TPP groups. Plasma phosphate was significantly lower in TPP than non-TPP. Heart rate, PR interval, and QRS voltage were significantly higher in TPP than non-TPP. Forty-five percent of TPP patients had first-degree atrioventricular block compared with 13% in the non-TPP group. There were no significant differences in QT shortening, ST depression, U wave appearance, or T wave flattening between the 2 groups., Conclusion: Relatively rapid heart rate, high QRS voltage, and first-degree AV block are important clues suggesting TPP in patients who present with hypokalemia and paralysis.

Long-term licorice ingestion is a well-known cause of secondary hypertension and hypokalemia. Nevertheless, its initial presentation with a very severe degree of hypokalemia and paralysis is exceedingly rare. We report an elderly Asian man who presented to the emergency department with marked muscle weakness that progressed to paralysis. His blood pressure was 160/96 mm Hg. The major biochemical abnormalities were hypokalemia (plasma K+ concentration, 1.8 mmol/L) and metabolic alkalosis (HCO - 3 , 36 mmol/L). His renal potassium excretion was higher (transtubular potassium gradient of 9). Plasma renin activity and aldosterone concentration were suppressed and cortisol concentration was normal. A detailed history revealed that he had ingested tea flavored with 100 g of natural licorice root containing 2.3% glycyrrhizic acid daily for 3 years. Note that renal potassium wasting and hypertension persisted for 2 weeks after discontinuing licorice consumption along with KCl supplement and spironolactone. Long-term licorice ingestion should be kept in mind as a cause of paralysis with an extreme degree of hypokalemia to avoid missing this recognizable and curable medical disorder.

Thyrotropin (TSH)-secreting pituitary adenoma presenting with hypokalemic periodic paralysis is extraordinarily rare and may be misdiagnosed. We describe a 44-year-old man who suffered from acute muscle weakness and inability to ambulate upon awakening in the morning. Physical examination showed hypertension, tachycardia, and symmetrical flaccid paralysis of all extremities. The major biochemical abnormality was hypokalemia (K+, 2.0 mmol/L) with low urine K+ excretion. A thyroid function study revealed elevated thyroid hormone levels and inappropriately high TSH concentrations (2.10 microU/mL). Brain magnetic resonance imaging delineated a pituitary tumor with suprasellar extension. After trans-sphenoidal removal of tumor, he became clinically and biochemically euthyroid without any further attack of paralysis. Pathological findings confirmed a TSH-secreting adenoma with exclusive TSH immunostaining. TSH-secreting pituitary adenoma must be kept in the differential diagnosis in any thyrotoxic periodic paralysis patients with detectable TSH levels to avoid delaying diagnosis and management.

Background: Although quality indicators for the care of acute myocardial infarction (AMI) patients have been described for other countries, there are none specifically designed for the Canadian health care system. The authors' goal was to develop a set of Canadian quality indicators for AMI care., Methods: A literature review identified existing quality indicators for AMI care. A list of potential indicators was assessed by a nine-member panel of clinicians from a variety of disciplines using a modified-Delphi panel process. After an initial round of rating the potential indicators, a series of indicators was identified for a second round of discussion at a national meeting. Further refinement of indicators occurred following a teleconference and review by external reviewers., Results: To identify an AMI cohort, case definition criteria were developed, using a hospital discharge diagnosis for AMI of International Classification of Diseases-Ninth revision (ICD-9) code 410.x. Thirty-seven indicators for AMI care were established. Pharmacological process of care indicators included administration of acetylsalicylic acid, beta-blockers, angiotensin-converting enzyme inhibitors, thrombolytics and statins. Mortality and readmissions for AMI, unstable angina and congestive heart failure were recommended as outcome indicators. Nonpharmacological indicators included median length of stay in the emergency department, and median waiting times for cardiac catheterization, percutaneous coronary intervention and/or coronary artery bypass graft surgery., Interpretation: A set of Canadian quality indicators for the care of AMI patients has been established. It is anticipated that these indicators will be useful to clinicians and researchers who want to measure and improve the quality of AMI patient care in Canada.

Background: The diagnosis of tuberculous meningitis is difficult. Discrimination of cases from those of bacterial meningitis by clinical features alone is often impossible, and current laboratory methods remain inadequate or inaccessible in developing countries. We aimed to create a simple diagnostic aid for tuberculous meningitis in adults on the basis of clinical and basic laboratory features., Methods: We compared the clinical and laboratory features on admission of 251 adults at an infectious disease hospital in Vietnam who satisfied diagnostic criteria for tuberculous (n=143) or bacterial (n=108) meningitis. Features independently predictive of tuberculous meningitis were modelled by multivariate logistic regression to create a diagnostic rule, and by a classification-tree method. The performance of both diagnostic aids was assessed by resubstitution and prospective test data methods., Findings: Five features were predictive of a diagnosis of tuberculous meningitis: age, length of history, white-blood-cell count, total cerebrospinal fluid white-cell count, and cerebrospinal fluid neutrophil proportion. A diagnostic rule developed from these features was 97% sensitive and 91% specific by resubstitution, and 86% sensitive and 79% specific when applied prospectively to a further 42 adults with tuberculous meningitis, and 33 with bacterial meningitis. The corresponding values for the classification tree were 99% and 93% by resubstitution, and 88% and 70% with prospective test data., Interpretation: This study suggests that simple clinical and laboratory data can help in the diagnosis of adults with tuberculous meningitis. Although the usefulness of the diagnostic rule will vary depending on the prevalence of tuberculosis and HIV-1 infection, we suggest it be applied to adults with meningitis and a low cerebrospinal fluid glucose, particularly in settings with limited microbiological resources.

Rapid correction of severe chronic hyponatremia with hypertonic saline has been known to cause osmotic demyelination syndrome (ODS). Less recognized are the dangers of rapid correction with normal saline. A 60-year-old woman on thiazide diuretics for hypertension presented with profound hyponatremia (94 mmol/L) and hypokalemia (1.9 mmol/L) associated with volume depletion. Normal saline (2 L/day) and (KCl 40 mmol/day) were given for 5 days. Serum Na+ concentration rose to 106 mmol/L within 18 hours. With improvement of her hyponatremia, she became more alert although the hypokalemia persisted. However, she developed progressive obtundation, quadriplegia, and respiratory failure 6 days later. Magnetic resonance imaging of the brain clearly showed typical features of pontine and extrapontine myelinolysis. We suggest that the aggressive KCl supplement would have been the first-line therapy for this patient presenting with chronic hyponatremia and hypokalemia associated with volume depletion.

This study was conducted to assess whether the genotypic frequency of Smephenytoin 4'-hydroxylase CYP2C19 gene differs in Japanese cirrhotic patients who developed hepatocellular carcinoma. Thirty-eight patients with cirrhosis were studied. The wild-type allele CYP2C19*1 and the two mutated alleles, CYP2C19*2 and CYP2C19*3, were identified by PCR-RFLP method. Individuals with homozygous CYP2C19*2 or CYP2C19*3 mutation and those with CYP2C19*2 and CYP2C19*3 heterozygous mutation were predicted to be the poor metabolizer (PM) phenotype. The overall frequency of PM predicted from the genotyping analysis was 29% (11 of the 38 patients), consisting of 5 patients homozygous for CYP2C19*2, two homozygous for CYP2C19*3 and four heterozygous for the two defects. Among 24 HCV-seropositive patients with cirrhosis and hepatocellular carcinoma, the frequency of PM was 41.7% and significantly higher than that observed in 186 healthy controls. We postulate that the PM phenotype caused by the mutation of CYP2C19 gene in cirrhotic patients with HCV infection is associated with a high risk for developing hepatocellular carcinoma.