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Summary: Background: Endovascular therapy (EVT) was demonstrated effective in acute large vessel occlusion (LVO) with large infarction. Revealing subgroups of patients who would or would not benefit from EVT will further inform patient selection for EVT. Methods: This post-hoc analysis of the ANGEL-ASPECT trial, a randomised controlled trial of 456 adult patients with acute anterior-circulation LVO and large infarction, defined by ASPECTS 3–5 or infarct core volume 70–100 mL, enrolled from 46 centres across China, between October 2, 2020 and May 18, 2022. Patients were randomly assigned (1:1) to receiving EVT and medical management or medical management alone. One patient withdrew consent, 455 patients were included in this post-hoc analysis and categorised into 4 subgroups by lower or higher NIHSS (< or ≥16) and smaller or larger infarct core (< or ≥70 mL). Those with lower NIHSS & smaller core, and higher NIHSS & larger core were considered clinical-radiological matched subgroups; otherwise clinical-radiological mismatched subgroups. Primary outcome was 90-day modified Rankin Scale (mRS). ANGEL-ASPECT is registered with ClinicalTrials.gov, NCT04551664. Findings: Overall, 139 (30.5%) patients had lower NIHSS & smaller core, 106 (23.3%) higher NIHSS & larger core, 130 (28.6%) higher NIHSS & smaller core, and 80 (17.6%) lower NIHSS & larger core. There was significant ordinal shift in the 90-day mRS toward a better outcome with EVT in clinical-radiological matched subgroups: lower NIHSS & smaller core (generalised OR, 1.76; 95% CI, 1.18–2.62; p = 0.01) and higher NIHSS & larger core (1.64; 1.06–2.54; 0.01); but not in the two clinical-radiological mismatched subgroups. Interpretation: Our findings suggested that in patients with anterior-circulation LVO and large infarction, EVT was associated with improved 90-day functional outcomes in those with matched clinical and radiological severities, but not in those with mismatched clinical and radiological severities. Simultaneous consideration of stroke severity and infarct core volume may inform patient selection for EVT. Funding: Unrestricted grants from industry [Covidien Healthcare International Trading (Shanghai), Johnson & Johnson MedTech, Genesis MedTech (Shanghai), and Shanghai HeartCare Medical Technology].

Concrete-filled steel tube (CFST) columns, incorporating various types of concrete, are increasingly prevalent in engineering applications. This study develops a finite element (FE) model and a design methodology for rectangular dune sand-concrete-filled steel tube (DS-CFST) columns. Investigating the composite behavior of rectangular DS-CFST columns and the effects of different DS replacement ratios, the results indicate a reduction in the ultimate bearing capacity compared to traditional CFST columns, attributed to diminished confinement effects, particularly at higher DS replacement ratios. Analysis of different design factors, including concrete and steel strengths, steel ratio, and aspect ratio, assesses their impacts on axial load-bearing capacity and composite behavior. This analysis leads to the establishment of a design formula, validated through experiments and FE analysis. The formula's efficacy and conciseness are evaluated against current design codes, with a reliability study assessing sensitivity to fluctuations. The proposed formula demonstrates accurate predictions of the ultimate load-bearing capacity.

In this work, we have investigated the Cabibbo-suppressed process Λc→π0ηp, by taking into account the intermediate scalar state a0(980), which could be dynamically generated from the S-wave pseudoscalar-pseudoscalar interaction within the chiral unitary approach. We have calculated the π0η invariant mass distribution, and found that there is a significant structure associated to the a0(980). We have also roughly estimated the branching fraction B(Λc→π0ηp)∼10−4. We encourage our experimental colleagues to measure the process Λc→π0ηp for searching for the state a0(980) in this reaction.

In this paper, a total of 44 rectangular CFST column finite element models are established and verified. The effect of loading path, the working mechanism and the constraint interaction of rectangular CFST column under compression-torsion loading are discussed. The obtained results show that the ultimate axial bearing capacity of CFST column is decreased when the torsional moment is applied first, and the ultimate torsional capacity is increased when the compression force is applied first. The working mechanism of the compression-torsion CFST column can be simplified as unity of “pulling/compressive torsion” of the steel tube and “compressive torsion” of the core concrete. Finally, the torque-axial force correlative formula of rectangular CFST column is proposed, and is verified well with the test results and finite element results with higher accuracy and less dispersion.

Inspired by the recent discovery of a doubly charmed tetraquark state Tcc+ by the LHCb Collaboration, we employ the effective Lagrangian approach to investigate the decay width of Tcc+→D+D0π0/D0D0π+ and Tcc+→D0D+γ with the assumption that Tcc+ is an isoscalar DD⁎ molecule. We show that both the Tcc→DDπ and Tcc→DDγ modes contribute to the decay width of Tcc, with the former being dominant. The resulting total decay width of about Γ=63 keV is smaller than the experimental decay width obtained from the Breit-Wigner fit of the LHCb data, Γ=410±165±43−38+18 keV, while close to the number obtained from the alternative unitary analysis, Γ=48±2−14+0 keV, which supports the molecular nature of Tcc.

In this work, we have investigated the process Ds+→K+K−π+, taking into account the contributions from the S-wave pseudoscalar-pseudoscalar interaction within the chiral unitary approach, and also the intermediate ϕ resonance. By analyzing the BESIII and BABAR measurements, we conclude that the f0(980) state, dynamically generated from the S-wave pseudoscalar-pseudoscalar interaction, gives the dominant contribution close to the K+K− threshold in the K+K− invariant mass distribution of the decay Ds+→K+K−π+ in S-wave. On the other hand, our results imply that the lineshape adopted by BESIII and BABAR for the resonances a0(980) and f0(980) is not advisable in the fit to the data close to the K+K− threshold.

We present the theoretical study of the process χc0(1P)→Σ¯Σπ decay, by taking into account the πΣ and πΣ¯ final state interactions of the final meson-baryon pair based on the chiral unitary approach. We show that the process filters the isospin I=1 in the πΣ channel and offers a reaction to test the existence of an I=1 state with strangeness S=−1 and spin-parity Jp=1/2− around the K¯N threshold predicted by some theories and supported by some experiments.

The MiniBooNE experiment has reported results from the analysis of νe and ν¯e appearance searches, which show an excess of signal-like events at low reconstructed neutrino energies, with respect to the expected background. A significant component of this background comes from photon emission induced by (anti)neutrino neutral current interactions with nucleons and nuclei. With an improved microscopic model for these reactions, we predict the number and distributions of photon events at the MiniBooNE detector. Our results are compared to the MiniBooNE in situ estimate and to other theoretical approaches. We find that, according to our model, neutral current photon emission from single-nucleon currents is insufficient to explain the events excess observed by MiniBooNE in both neutrino and antineutrino modes.

Preclinical models serve as indispensable tools in translational medicine. Specifically, patient-derived models such as patient-derived xenografts (PDX), induced pluripotent stem cells (iPSC), organoids, and recently developed technique of conditional reprogramming (CR) have been employed to reflect the host characteristics of diseases. CR technology involves co-culturing epithelial cells with irradiated Swiss-3T3-J2 mouse fibroblasts (feeder cells) in the presence of a Rho kinase (ROCK) inhibitor, Y-27632. CR technique facilitates the rapid conversion of both normal and malignant cells into a “reprogrammed stem-like” state, marked by robust in vitro proliferation. This is achieved without reliance on exogenous gene expression or viral transfection, while maintaining the genetic profile of the parental cells. So far, CR technology has been used to study biology of diseases, targeted therapies (precision medicine), regenerative medicine, and noninvasive diagnosis and surveillance. Respiratory diseases, ranking as the third leading cause of global mortality, pose a significant burden to healthcare systems worldwide. Given the substantial mortality and morbidity rates of respiratory diseases, efficient and rapid preclinical models are imperative to accurately recapitulate the diverse spectrum of respiratory conditions. In this article, we discuss the applications and future potential of CR technology in modeling various respiratory tract diseases, including lung cancer, respiratory viral infections (such as influenza and Covid-19 and etc.), asthma, cystic fibrosis, respiratory papillomatosis, and upper aerodigestive track tumors. Furthermore, we discuss the potential utility of CR in personalized medicine, regenerative medicine, and clinical translation.

Summary: C3N4 is widely applied in the synthesis of single-atom catalysts. However, understanding on the active site and the reaction mechanism is not fully in consensus. Especially, bare studies have considered the coordination environment of the single-atomic dopant and the effect of nitrogen vacancy on C3N4. In this study, we found that the presence of nitrogen vacancies promotes the activation of water and reduces the activation energy barrier for hydrogen generation. The results show that a synergistic effect between single-atom Pt and nitrogen vacancies enables the catalyst to achieve a superior hydrogen production rate of 3,890 μmol/g/h, which is 16.8 times higher than that of pristine C3N4. Moreover, the catalyst is also applicable for photocatalytic hydrogen production from seawater without significantly decreased hydrogen production rate. This study paves the way for the rational design and optimization of next-generation photocatalysts for sustainable energy applications, particularly in solar-driven hydrogen production.

With increasing age, peak alpha frequency (PAF) is slowed, and alpha power is reduced during resting-states with eyes closed. These age-related changes are evident across the whole scalp but remained unclear at the source level. The purpose of this study was to determine whether age impacts the power and frequency of the dominant alpha rhythm equally across source generators or whether the impact of age varies across sources. A total of 28 young adults and 26 elderly adults were recruited. High-density EEG was recorded for 10 mins with eyes closed. Single dipoles for each independent component were localized and clustered based on their anatomical label, resulting in 36 clusters. Meta-analyses were then conducted to assess effect sizes for PAF and power at PAF for all 36 clusters. Subgroup analyses were then implemented for frontal, sensorimotor, parietal, temporal, and occipital regions. The results of the meta-analyses showed that the elderly group exhibited slower PAF and less power at PAF compared to the young group. Subgroup analyses revealed age effects on PAF in parietal (g = 0.38), temporal (g = 0.65), and occipital regions (g = 1.04), with the largest effects observed in occipital regions. For power at PAF, age effects were observed in sensorimotor (g = 0.84) and parietal regions (g = 0.80), with the sensorimotor region showing the largest effect. Our findings show that age-related slowing and attenuation of the alpha rhythm manifests differentially across cortical regions, with sensorimotor and occipital regions most susceptible to age effects.

Background/Purpose: Controversies over the use of alpha-fetoprotein (AFP) for detection of hepatocellular carcinoma (HCC) existed from guidelines. Using large-scale database and hospital-based information, we aimed to reappraise the role of AFP in HCC surveillance, including proportion of AFP elevation by stage of HCC, additional benefit of AFP in combination of ultrasonography (US) in the detection of early HCC, and survival in early HCC with high AFP levels. Methods: This retrospective study enrolled 43,437 patients from database of the Taiwan Cancer Registry (TCR) and 4250 patients from Kaohsiung Chang Gung Memorial Hospital (KCGMH) between January 2011 and December 2017. Results: The HCC cases in KCGMH accounted for 9.8% of the total cases in the TCR. Among both nationwide database and hospital-based information, the proportion of early HCC patients with an AFP level of ≥20 ng/mL was approximately 40%. In KCGMH, the proportion of patients with an AFP level of ≥20 ng/mL and a virus-related (hepatitis B and C) etiology was around 41.7%; furthermore, among patients with early HCC, those with an AFP level of ≥20 ng/mL had 4.7 years of median survival and 48.3% of the 5-year overall survival rate. By hospital electronic medical records review of early HCC cohort in KCGMH, approximately 10.9% of patients with AFP levels ≥20 ng/mL had US-undetectable early HCC. Conclusion: This study suggested that AFP in combination with US would add an additional benefit as being a prompted role for detection of early HCC in patients with US-undetectable HCC.

Background and purpose: Cerebral small vessel disease biomarkers including white matter hyperintensities (WMH), lacunes, and enlarged perivascular spaces (ePVS) are under investigation to identify those specific to cerebral amyloid angiopathy (CAA). In subjects with Alzheimer’s disease (AD), we assessed characteristic features and amounts of WMH, lacunes, and ePVS in four CAA categories (no, mild, moderate and severe CAA) and correlated these with Clinical Dementia Rating sum of boxes (CDRsb) score, ApoE genotype, and neuropathological changes at autopsy. Methods: The study included patients with a clinical diagnosis of dementia due to AD and neuropathological confirmation of AD and CAA in the National Alzheimer’s Coordinating Center (NACC) database. The WMH, lacunes, and ePVS were evaluated using semi-quantitative scales. Statistical analyses compared the WMH, lacunes, and ePVS values in the four CAA groups with vascular risk factors and AD severity treated as covariates, and to correlate the imaging features with CDRsb score, ApoE genotype, and neuropathological findings. Results: The study consisted of 232 patients, of which 222 patients had FLAIR data available and 105 patients had T2-MRI. Occipital predominant WMH were significantly associated with the presence of CAA (p = 0.007). Among the CAA groups, occipital predominant WMH was associated with severe CAA (β = 1.22, p = 0.0001) compared with no CAA. Occipital predominant WMH were not associated with the CDRsb score performed at baseline (p = 0.68) or at follow-up 2–4 years after the MRI (p = 0.92). There was no significant difference in high grade ePVS in the basal ganglia (p = 0.63) and centrum semiovale (p = 0.95) among the four CAA groups. The WMH and ePVS on imaging did not correlate with the number of ApoE ε4 alleles but the WMH (periventricular and deep) correlated with the presence of infarcts, lacunes and microinfarcts on neuropathology. Conclusion: Among patients with AD, occipital predominant WMH is more likely to be found in patients with severe CAA than in those without CAA. The high-grade ePVS in centrum semiovale were common in all AD patients regardless of CAA severity.

In-plane (MoSi2N4)5-n/(MoSiGeN4)n heterostructures have been delicately designed and systematically studied using first-principles density functional theory calculations. Such heterostructures exhibit dynamical stability as verified by calculated phonon dispersion spectra. The calculated band gap values increase with the MoSi2N4 area increase, as 1.385(1.860) eV for (MoSi2N4)0/(MoSiGeN4)5 and 1.925(2.385) eV for (MoSi2N4)5/(MoSiGeN4)0 using PBE (HSE06). By density of states analysis, the Ge 4p state made an excellent contribution to moving up the conduction band position and altering the band gap value. Also, the work function values can be modulated by the n numbers of (MoSi2N4)5-n/(MoSiGeN4)n. Based on optical and redox potential calculations, the calculated results suggest that the (MoSi2N4)5-n/(MoSiGeN4)n heterostructures have the potentials to be applied as ideal photocatalysts for photocatalytic CO2 reduction. Notably, different photocatalytic reduction reaction products can be formed using such (MoSi2N4)5-n/(MoSiGeN4)n in-plane heterostructures with different n values, indicating that selective catalytic reduction reactions can be realized on the in-plane heterostructures. Our findings suggest that (MoSi2N4)5-n/(MoSiGeN4)n monolayer in-plane heterostructures can serve as a new class of 2D materials for photovoltaic and photocatalysis applications, providing insightful guidance for the development of optoelectronic devices.

Background: As common progenitor cells of osteoblasts and adipocytes, bone marrow mesenchymal (stromal) stem cells (BMSCs) play key roles in bone homeostasis, tissue regeneration, and global energy homeostasis; however, the intrinsic mechanism of BMSC differentiation is not well understood. Plasticity in energy metabolism allows BMSCs to match the divergent demands of osteo-adipogenic differentiation. Targeting BMSC metabolic pathways may provide a novel therapeutic perspective for BMSC differentiation unbalance related diseases. Scope of review: This review covers the recent studies of glucose, fatty acids, and amino acids metabolism fuel the BMSC differentiation. We also discuss recent findings about energy metabolism in BMSC differentiation. Major conclusions: Glucose, fatty acids, and amino acids metabolism provide energy to fuel BMSC differentiation. Moreover, some well-known regulators including environmental stress, hormone drugs, and biological and pathological factors may also influence BMSC differentiation by altering metabolism. This offers insight to the significance of metabolism on BMSC fate determination and provides the possibility of treating diseases related to BMSC differentiation, such as obesity and osteoporosis, from a metabolic perspective.

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality in Taiwan. To help clinical physicians to manage patients with HCC, the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan produced the management consensus guideline for HCC. Methods: The recommendations focus on nine important issues on management of HCC, including surveillance, diagnosis, staging, surgery, local ablation, transarterial chemoembolization/transarterial radioembolization/hepatic arterial infusion chemotherapy, systemic therapy, radiotherapy, and prevention. Results: The consensus statements were discussed, debated and got consensus in each expert team. And then the statements were sent to all of the experts for further discussion and refinement. Finally, all of the experts were invited to vote for the statements, including the level of evidence and recommendation. Conclusion: With the development of the management consensus guideline, HCC patients could benefit from the optimal therapeutic modality. Keywords: Diagnosis, Hepatocellular carcinoma, Staging, Surveillance, Treatment

Oxidative DNA damage in bone marrow cells is the main side effect of chemotherapy drugs including cyclophosphamide (CTX). However, not all antioxidants are effective in inhibiting oxidative DNA damage. In this study, we report the beneficial effect of carnosine (β-alanyl-l-histidine), a special antioxidant with acrolein-sequestering ability, on CTX-induced bone marrow cell suppression. Our results show that carnosine treatment (100 and 200 mg/kg, i.p.) significantly inhibited the generation of reactive oxygen species (ROS) and 8-hydroxy-2â²-deoxyguanosine (8-oxo-dG), and decreased chromosomal abnormalities in the bone marrow cells of mice treated with CTX (20 mg/kg, i.v., 24 h). Furthermore, carnosine evidently mitigated CTX-induced G2/M arrest in murine bone marrow cells, accompanied by reduced ratios of p-Chk1/Chk1 and p-p53/p53 as well as decreased p21 expression. In addition, cell apoptosis caused by CTX was also suppressed by carnosine treatment, as assessed by decreased TUNEL-positive cell counts, down-regulated expressions of Bax and Cyt c, and reduced ratios of cleaved Caspase-3/Caspase-3. These results together suggest that carnosine can protect murine bone marrow cells from CTX-induced DNA damage via its antioxidant activity. Keywords: Carnosine, Cyclophosphamide, Oxidative DNA damage, Sister chromatid exchange, Apoptosis, Cell cycle arrest

Pain perception is associated with priming of the motor system and the orienting of attention in healthy adults. These processes correspond with decreases in alpha and beta power in the sensorimotor and parietal cortices. The goal of the present study was to determine whether these findings extend to individuals with chronic pain. Individuals with chronic jaw pain and pain-free controls anticipated and experienced a low pain or a moderate pain-eliciting heat stimulus. Although stimuli were calibrated for each subject, stimulus temperature was not different between groups. High-density EEG data were collected during the anticipation and heat stimulation periods and were analyzed using independent component analyses, EEG source localization, and measure projection analyses. Direct directed transfer function was also estimated to identify frequency specific effective connectivity between regions. Between group differences were most evident during the heat stimulation period. We report three novel findings. First, the chronic jaw pain group had a relative increase in alpha and beta power and a relative decrease in theta and gamma power in sensorimotor cortex. Second, the chronic jaw pain group had a relative increase in power in the alpha and beta bands in parietal cortex. Third, the chronic jaw pain group had less connectivity strength in the beta and gamma bands between sensorimotor cortex and parietal cortex. Our findings show that the effect of chronic pain attenuates rather than magnifies neural responses to heat stimuli. We interpret these findings in the context of system-level changes in intrinsic sensorimotor and attentional circuits in chronic pain.

Alcohol use may have negative impacts on hepatitis C virus (HCV) treatment due to low adherence, and racial differences can influence HCV sustained virological response (SVR) rate between East Asian and European ancestry. The objective of this study is to confirm the influence of alcohol consumption and racial differences on HCV treatment outcome in aboriginal and nonaboriginal people of southeastern Taiwan. Methods: In this retrospective cohort study, a total of 195 patients were treated with peginterferon-alpha once weekly plus ribavirin for 24 weeks. The efficacy analysis was performed based on the SVR rate for patients who received at least one dose of the study medication or who completed treatment. The endpoints were denoted by virological response rate including the influences of alcohol use, HCV genotype, serum level of HCV virological load, and racial differences. Results: No differences were observed in the baseline clinical characteristics between drinkers and nondrinkers, but a significant difference was noted in the body mass index between aboriginal and nonaboriginal populations (28.3 vs. 25.8; p

Background and aim. The treatment efficacy of peginterferon plus ribavirin for patients with HCV genotype 1 is inferior to that in patients with HCV genotype 2, but the efficacy among patients with mixed HCV genotype 1 + 2 is less clear. We compared the treatment outcome of peginterferon alpha-2b plus ribavirin among naïve chronic hepatitis C patients in Taiwan with HCV genotype 1 and 2, and mixed genotype 1 + 2.Material and methods. In this retrospective cohort study, 150 patients were treated with peginterferon alpha-2b once weekly, plus ribavirin, for 24 weeks. The endpoint was sustained virological response after receiving at least one dose of the study medication.Results. There were no differences in clinical characteristics among the 3 groups. There were significant differences in rapid virological response rate between patients with genotype 1 and genotype 2 (64.7 vs. 85.5%, respectively; p < 0.05) and a sustained virological response rate (55.9 vs. 83.6%, respectively; p = 0.001). The rapid virological response rate differed between the genotype 1 and mixed genotype 1 + 2 groups (64.7 vs. 85.2%, respectively; p < 0.05), but the sustained virological response rate was similar (55.9 vs. 74.1%; p = 0.101). Conclusions. Using peginterferon alpha-2b plus ribavirin for 24 weeks to treat patients with HCV genotype 1 + 2 achieved a 74.1% sustained virological response rate; the treatment efficacy was not inferior to patients with HCV genotype 1, but the percentage of liver cirrhosis in mixed genotype 1 + 2 group was higher to 22%, it is worth to be appropriately valued and studied.

Capsule endoscopy is a highly sensitive method for the detection of small bowel lesions. False-positive findings are important confounding factors. This study reports on a scoring system for evaluating the role of capsule endoscopy in small bowel tumors. Methods: Ten men and two women (age, 23–79 years) with suspected small bowel tumors were included from 120 patients referred for capsule endoscopy between March 2004 and March 2008. The indications were gastrointestinal bleeding (n = 9), melanoma workup (n = 1), physical checkup (n = 1), and iron deficiency anemia (n = 1). The proposed tumor score was composed of five components: bleeding, mucosal disruption, an irregular surface, color, and white villi. These can be scored for probability of mass lesions seen at capsule endoscopy. Small bowel mass lesions were probably present in those with a score of ≥ 4, and a score of ≤ 2 indicated a low probability of a small bowel mass lesion. Results: Capsule endoscopy showed probable small bowel mass lesions in six patients, and a low lesion probability in the other six. Capsule endoscopy showed that new lesions were not detected by esophagogastroduodenoscopy or colonoscopy. All six patients with probable small bowel tumors were found to have pathological findings upon capsule endoscopy: two with lymphangioma, and one each with ileal ectopic pancreas, with melanoma metastasis, gastrointestinal lymphoma, and gastrointestinal stromal tumor. Conclusion: Capsule endoscopy may detect small bowel tumors more reliably by using the scoring system outlined. It should be considered in suspected cases of small bowel tumor.

For patients undergoing gastric surgery because of complications of peptic ulcers, such as bleeding or perforation in the pre-Helicobacter pylori eradication era, their infection status was not surveyed or it was neglected altogether. Previous reports have shown spontaneous clearance of H. pylori in these patients but the determining factors remain ill-defined. Methods: Seventy-six patients with previous partial gastrectomy for complicated peptic ulcers were enrolled prospectively. Patients with peptic ulcers but without gastrectomy were selected as a control group. Gastric biopsy specimens were obtained from each patient for histological H. pylori staining and rapid urease test on endoscopic evaluation. Spontaneous clearance of H. pylori colonization was defined when patients who were positive for H. pylori prior to operation became negative, without eradication treatment. Results: The prevalence of H. pylori colonization was significantly lower in patients with partial gastrectomy (22.4%, 17/76 vs. 67.1%, 51/76, p < 0.001). There was a trend towards decreasing prevalence of H. pylori colonization as time after operation increased: 1–15 years, 29.5% (13/44); 16–30 years, 13.6% (3/22); and > 31 years, 10% (1/10). The spontaneous clearance rate of H. pylori after partial gastrectomy was 43% (13/30). The time after operation in the spontaneous clearance group was longer than that in those without (20.8 ±11.7 vs. 12.1 ± 11.0 years, p = 0.048). Billroth-II procedure had a higher bile reflux rate and a lower H. pylori infection prevalence than the Billroth-I procedure. Conclusion: Spontaneous clearance of H. pylori develops in a certain number of patients who undergo distal gastrectomy. The clearance rate is related to operative procedures and time after operation.

Bile, blood or pus may rupture into or extend to the hepatic subcapsular space, but most descriptions in the literature are from isolated case reports. When fluid collections are limited by the size of the subcapsular space, they rarely present with abrupt symptoms and signs. We reviewed our experience with hepatic subcapsular fluid collections, including diagnostic studies and outcome. Methods: Two radiologists independently assessed imaging database from computed tomography (CT) with the letter strings “subcapsule”, “subcapsular”, “liver” or “hepatic”. Subcapsular fluid collection was defined as fluid deep in the liver capsule and superficial to the liver parenchyma without rupture into the peritoneum. The demographic data, clinical presentation, laboratory and imaging results, length of hospital stay, final diagnosis, and outcome were reviewed and recorded. Results: From January 2002 to December 2004, 60 patients (33 males, 27 females; age range, 4–92 years) were diagnosed by CT to have a subcapsular fluid accumulation in liver. Etiologies included traumatic hematoma in 10, tumor-related hematoma in 18, ruptured liver abscess in 20, biloma in 8, and 4 miscellaneous causes. CT typically showed a lenticular-shaped fluid collection compressing the liver parenchyma. The fluid accumulation was connected in over half the cases to an intrahepatic lesion with a visible tract. Conservative management was adequate in 32 patients, while 9 had surgery and 19 underwent either percutaneous drainage (by CT or ultrasound guidance) or transarterial therapy. Of the 60 patients, 49 (82%) survived the episode, including all 10 with traumatic hematoma. The shortest mean length of hospital stay was 7.8 ± 6.7 days in the tumor-related hematoma group, and the longest was 50.7 ± 41.7 days in the abscess group. The international normalized ratio for coagulation for those who died and those who survived was 1.8 ± 1.4 and 1.4 ± 0.2 respectively (p = 0.027). Conclusion: If these fluid collections are limited in the subcapsular space, they are rarely associated with abrupt hemodynamic instability and usually not lethal. The only characteristic that differed significantly between those who died and those who survived was the international normalized ratio, meaning that good liver function and normal coagulation has the ability to recover from this dismal episode.

Insulinoma in a patient with pre-existing diabetes is extremely rare. A 74-year-old woman with type 2 diabetes mellitus who had been treated with a sulfonylurea for 6 years began experiencing frequent episodes of hypoglycemia. Endogenous hyperinsulinism was found 9 months after the sulfonylurea was discontinued, and transabdominal ultrasonography and magnetic resonance imaging identified a pancreatic tumor. Pathology examination of the resected tumor demonstrated an insulinoma. Postoperatively, the patient had no further episodes of hypoglycemia. Thereafter, she required insulin to control her hyperglycemia. Although hypoglycemic agents are the commonest cause of hypoglycemia in type 2 diabetes, insulinomas may occur in these patients. This possibility should be considered if the hypoglycemia persists despite dose adjustment or cessation of the drugs.

Modular and compact adsorption heat pumps (AHPs) promise an energy-efficient alternative to conventional vapor compression based heating, ventilation and air conditioning systems. A key element in the advancement of AHPs is the development of adsorbents with high uptake capacity, fast intracrystalline diffusivity and durable hydrothermal stability. Herein, the ion exchange of NaY zeolites with ingoing Mg 2+ ions is systematically studied to maximize the ion exchange degree (IED) for improved sorption performance. It is found that beyond an ion exchange threshold of 64.1%, deeper ion exchange does not benefit water uptake capacity or characteristic adsorption energy, but does enhance the vapor diffusivity. In addition to using water as an adsorbate, the uptake properties of Mg,Na-Y zeolites were investigated using 20 wt.% MeOH aqueous solution as a novel anti-freeze adsorbate, revealing that the MeOH additive has an insignificant influence on the overall sorption performance. We also demonstrated that the labscale synthetic scalability is robust, and that the tailored zeolites scarcely suffer from hydrothermal stability even after successive 108-fold adsorption/desorption cycles. The samples were analyzed using N 2 sorption, 27 Al/ 29 Si MAS NMR spectroscopy, ICP-AES, dynamic vapor sorption, SEM, Fick's 2 nd law and D-R equation regressions. Among these, close examination of sorption isotherms for H 2 O and N 2 adsorbates allows us to decouple and extract some insightful information underlying the complex water uptake phenomena. This work shows the promising performance of our modified zeolites that can be integrated into various AHP designs for buildings, electronics, and transportation applications.

Lithium (LiCl) and carbamazepine (CBZ), the common mood stabilizers, are thought to be effective treatments for bipolar disorder. The aim of the present study was to investigate whether LiCl as well as CBZ has similar effects on the bipolar disorder-associated cognitive dysfunctions in rats, particularly the spatial learning and depressive responses. Adult male Wistar rats were administered intracerebroventricularly with 5μl of 10(-3)M ouabain on session 1, and then received an intraperitoneal injection of LiCl or CBZ for 4 sessions (1 session/2days). For the behavioral tests, all rats were subjected to the water maze 15min for spatial learning and the forced swimming test 5min for depression on each session. The present results showed that ouabain resulted in increased latency and longer distance traveled to reach the hidden platform in the water maze, indicating that ouabain impaired the spatial learning. However, ouabain did not affect swimming velocity in the water maze and depressive responses in the forced swimming test. LiCl treatment decreased the ouabain-enhanced latency and the total distance, but not the velocity, swam to reach the hidden platform in the water maze task. Additionally, LiCl did not result in changes of any depressive indices, such as struggling behavior, swimming behavior, and floating behavior. Likewise, CBZ did not affect any behavioral indices of spatial learning and depression. A linear regression analysis suggested that LiCl, but not CBZ, could predict the decreased latency and total distance traveled except the velocity of swimming in the water maze and depressive behaviors. In summary, the present results suggested that lithium provided a better therapeutic effect than CBZ for ouabain-caused dysfunctions of spatial learning in a rat model of bipolar disorder., (Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.)