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Patients with severe coronavirus disease 2019 (COVID‐19) can develop a systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction. The current treatment guideline recommends the use of corticosteroids in patients who require supplemental oxygen or are mechanically ventilated. This study reports a patient with severe COVID‐19 pneumonia. Initially, the patient was treated with dexamethasone for 10 days and remdesivir for 5 days. There was clinical improvement following the treatments. However, on day 15, the patient experienced rebound pneumonia and clinical deterioration. His clinical condition improved until dexamethasone was re‐administered. This case demonstrates the rebound phenomenon after the steroid was discontinued. The duration and timing of steroids are crucial to reduce the risk of prolonged systemic inflammation and rebound pneumonia., We report a patient with coronavirus disease 2019 (COVID‐19) who was recovering following steroid treatment but experienced rebound pneumonia after the steroid was discontinued. The duration and timing of steroids are crucial to reduce the risk of prolonged systemic inflammation and rebound pneumonia.

Microglia-mediated neuroinflammation is recognized to mainly contribute to the progression of neurodegenerative diseases. Epigallocatechin-3-gallate (EGCG), known as a natural antioxidant in green tea, can inhibit microglia-mediated inflammation and protect neurons but has disadvantages such as high instability and low bioavailability. We developed an EGCG liposomal formulation to improve its bioavailability and evaluated the neuroprotective activity in in vitro and in vivo neuroinflammation models. EGCG-loaded liposomes have been prepared from phosphatidylcholine (PC) or phosphatidylserine (PS) coated with or without vitamin E (VE) by hydration and membrane extrusion method. The anti-inflammatory effect has been evaluated against lipopolysaccharide (LPS)-induced BV-2 microglial cells activation and the inflammation in the substantia nigra of Sprague Dawley rats. In the cellular inflammation model, murine BV-2 microglial cells changed their morphology from normal spheroid to activated spindle shape after 24 h of induction of LPS. In the in vitro free radical 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, EGCG scavenged 80% of DPPH within 3 min. EGCG-loaded liposomes could be phagocytized by BV-2 cells after 1 h of cell culture from cell uptake experiments. EGCG-loaded liposomes improved the production of BV-2 microglia-derived nitric oxide and TNF-α following LPS. In the in vivo Parkinsonian syndrome rat model, simultaneous intra-nigral injection of EGCG-loaded liposomes attenuated LPS-induced pro-inflammatory cytokines and restored motor impairment. We demonstrated that EGCG-loaded liposomes exert a neuroprotective effect by modulating microglia activation. EGCG extracted from green tea and loaded liposomes could be a valuable candidate for disease-modifying therapy for Parkinson’s disease (PD).

Spinal tuberculosis (STB) is a common manifestation of extrapulmonary tuberculosis (TB). STB accounts for around 2% of all cases of TB and around 15% of extrapulmonary TB cases. The World Health Organization has proposed a global strategy and targets for TB prevention, care, and control after 2015. Under this strategy, patients will receive standard care according to the recommendations and guidelines after confirmation of STB diagnosis. However, current recommendations and guidelines focus on disease and medication therapy management, and recommendations for early detection or decision-making algorithms regarding STB are lacking. In this review, we identified five key components for early diagnosis: (1) risk factors for STB; (2) common symptoms/signs of STB; (3) significant neuroradiological findings of STB; (4) significant laboratory findings of STB, including positive interferon-γ release assays and nonpyogenic evidence in initial laboratory data; and (5) significant clinical findings of STB. Individualized consideration for each patient with STB is essential, and we hope that the algorithm established in this review will provide a valuable tool for physicians who encounter cases of STB.

Although epigallocatechin-3-gallate (EG) is well-known as a potent antioxidant and free radical scavenger for neurodegenerative diseases, it still has disadvantages that reduce its treatment effectiveness due to low bioavailability, slow absorption, and water solubility. Therefore, the aim of this study is to improve the bioavailability of EG and increase the effectiveness of anti-inflammatory properties to microglial cells by using Poly(Lactide-co-Glycolide) (PLGA) microspheres as carriers. In this study, we used UV–Vis spectroscopy to show the formation of the complex of β-cyclodextrin (β-CD) and EG (CD-EG). The loading efficiency of EG in PLGA microspheres was optimized by the addition of β-CD. The highest loading efficiency of 16.34% was found among other formulations. The results of Fourier transform infrared spectroscopy indicated the loading of CD-EG in PLGA microspheres. The scanning electron microscopic images demonstrated the spherical PLGA particles with controlled particles size ranging from 1–14 µm. Moreover, the in vitro release of EG was conducted to explore the sustained release property of the PLGA formulations. In the in vitro model of mouse microglial cells (BV-2 cells) stimulated by lipopolysaccharide, the cytotoxicity test showed that for up to 1 mg/mL of PLGA microspheres no toxicity to BV-2 cells was found. PLGA microspheres can significantly suppress the nitric oxide production from BV-2 cells, indicating EG loaded in PLGA microspheres can suppress the inflammation of activated microglial cells. Furthermore, the intracellular iNOS in BV-2 cells was also found to be down regulated. In summary, we have successfully shown that the use of β-CD can increase the loading efficiency of EG in PLGA microspheres and provide neuroprotective effect on the activated microglial cells.

Hydrocortisone is a growth hormone frequently used in the treatment of low back pain. Hydrocortisone treatment has an anti-inflammation effect, which also inactivates glucose transporter type 4 (GLUT4) by p38 mitogen-activated protein kinase (MAPK) inhibition. Translocation of GLUT4 regulates body glucose homeostasis and muscle repair and is induced by insulin. In this study, 56 SD rats were divided into seven groups, and were treated with insulin or hydrocortisone in sedentary or exercise training groups. The muscle proteins and biochemical blood parameters were analyzed after 7 days of treatments. The results showed that the serum glucose increased in hydrocortisone treatment accompanied by GLUT4 inactivation in both the sedentary and exercise training rats. In the exercise training groups, GLUT4 was redistributed on the plasma membrane on co-treatment with insulin and hydrocortisone through Akt phosphorylation. Insulin treatment exerted a compensatory feedback effect on the GLUT4 translocation on hydrocortisone co-treatment, which was the cause of GLUT4 inactivation.

HeA new machine will not fail easily in the early stage of its useful life. This phenomenon is consistent with the fact that the optimal sequential preventive maintenance (PM) policy which has longer PM intervals in its earlier stage of lifetime. In this paper, we propose a failure-rate-reduction periodic PM model with delayed initial time in a finite time span. Then, the optimal periodic PM policy is developed by minimizing the expected total maintenance cost, which can have smaller expected total maintenance cost than the optimal policy of the original failure-rate-reduction periodic PM model. The algorithm of finding the optimal PM policy for the proposed PM model is developed. Finally, examples are illustrated to verify the optimal policies of the proposed new PM model.

Hepatic cancer remains a challenging disease and there is a need to identify new treatments. Sann-Joong-Kuey-Jian-Tang (SJKJT), a traditional medicinal prescription, has been used to treat lymphadenopathy and exhibits cytotoxic activity in many types of human cancer cells. Our previous studies revealed that SJKJT is capable of inhibiting colon cancer colo 205 cells by inducing autophagy and apoptosis. However, the effects and molecular mechanisms of SJKJT in human hepatocellular carcinoma have not been clearly elucidated. In the present study we evaluated the effects of SJKJT in human hepatic cellular carcinoma Hep-G2 cells. The cytotoxicity of SJKJT in Hep-G2 cells was measured by MTT assay. The cell cycles were analyzed by fluorescence‑activated cell sorting (FACS). The protein expression of translationally controlled tumor protein (TCTP), Mcl-1, Fas, TNF-α, Caspase-8, Caspase-3 and Bax in Hep-G2 cells treated with SJKJT was evaluated by western blotting. The protein expression of Caspase-3 was also detected by immunofluorescence staining. The results showed that SJKJT inhibits Hep-G2 cells in a time- and dose‑dependent manner. During SJKJT treatment for 48 and 72 h, the half-maximum inhibitory concentration (IC50) was 1.48 and 0.94 mg/ml, respectively. The FACS results revealed that increased doses of SJKJT were capable of increasing the percentage of cells in the sub-G1 phase. Immunofluorescence staining showed that Hep-G2 treated with SJKJT had increased expression of Caspase-3. The western blot results showed that the protein expression of Fas, TNF-α, Caspase-8, Caspase- 3 and Bax was upregulated, but that of TCTP and Mcl-1 was downregulated in Hep-G2 cells treated with SJKJT. In conclusion, these findings indicated that SJKJT inhibits Hep-G2 cells. One of the molecular mechanisms responsible for this may be the increased Fas, TNF-α, Caspase-8, Caspase- 3 and Bax expression; another mechanism may be via decreasing TCTP and Mcl-1 expression in order to induce apoptosis.

Supplemental Digital Content is available in the text, Postcraniotomy meningitis (PCM) is a major challenge in neurosurgery, and changing patterns of infectious agents in PCM have been noted. The limited epidemiological data and urgent clinical needs motivated this research. We conducted this study to determine a risk assessment for PCM and the current pattern of infectious agents. We performed a retrospective case-control study of significant cases of postcraniotomy meningitis in the Changhua Christian Hospital System between January 1, 2008, and December 31, 2012. Postcraniotomy meningitis was diagnosed in 22 out of 4392 surgical patients; this data was reviewed for risk assessment. This study assessed the risk factors for postcraniotomy meningitis and found that it was more frequently seen in patients who were elderly (OR = 1.57, 95% CI = 1.32–2.98, P = 0.013), underwent emergency procedures (OR = 4.82, 95% CI = 1.50–14.53, P = 0.008), had leak of cerebrospinal fluid (OR = 4.62, 95% CI = 2.03–10.50, P = 0.012), had external ventricular drainage (OR = 4.68, 95% CI = 2.46–8.87, P = 0.006), were admitted to the intensive care unit (OR = 2.41, 95% CI = 1.53–8.08, P = 0.012), had used drain placement >72 hours (OR = 2.66, 95% CI = 1.04–4.29, P = 0.007), had surgery >4.5 hours (OR = 2.38, 95% CI = 1.39–4.05, P = 0.005), had repeat operations (OR = 2.74, 95% CI = 1.31–5.73, P = 0.018), endured trauma (OR = 5.97, 95% CI = 1.57–17.61, P = 0.007), or had 30-days mortality (OR = 5.07, 95% CI = 2.20–11.48, P = 0.001). The predominant pathogens isolated from cerebrospinal fluid were Staphylococcus aureus in 8 patients (36.7%) and Acinetobacter baumannii in 7 patients (31.8%). In our study, the mortality rate was 5.1% among all postcraniotomy patients. Accurate risk assessment, early diagnosis, and choice of appropriate antibiotics in accordance with epidemiologic information are the cornerstones of reducing mortality and morbidity in PCM. The changing pattern of infectious agents in PCM over time suggests the necessity of further studies to provide the most up-to-date insight to physicians.

The ability of tanshinone IIA (Tan-IIA) to inhibit the proliferation of human breast cancer cell lines in vitro and in vivo is well documented. However, the molecular mechanisms have not been fully elucidated. In the present study, MDA-MB-231 cells were treated with different concentrations of Tan-IIA for 48 h, followed by protein extraction for western blotting. For an in vivo study, MDA-MB-231 cells were implanted directly into female SCID mice which were divided randomly into three groups to be treated with vehicle, Tan-IIA (20 mg/kg) and Tan-IIA (60 mg/kg) every other day orally, with treatment starting 4 weeks after inoculation with the MDA-MB-231 cells. The results showed that Tan-IIA inhibited the proliferation of MDA-MB-231 cells and decreased the protein expression of LC3-II and Erb-B2 in vitro. Treatment with Tan-IIA (20 or 60 mg/kg) for 90 days resulted in a reduction in tumor size and weight compared to the control group. The protein expression of NF-κBp65 was reduced, while caspase-3 was up-regulated compared to the control group. These findings indicate that Tan-IIA inhibits tumor growth in a MDA-MB-231 xenograft animal model. One of the molecular mechanisms may be through a decrease in NF-κBp65 and an increase in caspase-3 expression.

From the literature, it is known that preventive maintenance (PM) can reduce the deterioration of system or equipment to a younger level. Researchers usually develop optimal PM policies based on the assumption that the PM can reduce system's age or failure rate. However, the PM actions, such as cleaning, adjustment, alignment, and lubrication work, may not always reduce system's age or failure rate. Instead, it may only reduce the degradation rate of the system to a certain level. In addition, most of the existing optimal PM policies are developed by minimizing the expected cost rate only. Yet, as demonstrated in this paper, the system will have very low reliability at the time of preventive replacement if the reliability limit is not considered. Hence, this paper is to develop an optimal periodic PM model by minimizing the expected cost rate per unit time with the consideration of reliability limit for repairable systems with degradation rate reduction after each PM. The improvement factor method is used to measure the reduction effect of the degradation rate. The algorithm for searching the optimal solutions for this PM model is developed. Examples are also presented with discussions of parameter sensitivity and special cases.

In this research, a flow shop scheduling problem in which setup, processing and removal times are separated, with the objective of minimizing makespan, is considered. A tabu search based heuristic is presented for solving the addressed problem. The proposed heuristic begins with the construction of artificial processing times for each operation; then a modified NEH algorithm is used to generate an initial solution, followed by a designed tabu search procedure applied for further improvement of the solution. The proposed heuristic, as well as the existing one, is evaluated in a large number of randomly generated problems. The results of the experimental investigations of the proposed heuristic algorithm and the existing heuristic in meeting the objective of makespan are also reported. It is found that the solution quality of the proposed tabu search heuristic is better than that of the existing heuristic, but for large size problems more computational efforts are needed; however, the CPU time is still acceptable.

This paper examines the problem of scheduling two-machine no-wait open shops to minimize makespan. The problem is known to be strongly NP-hard. An exact algorithm, based on a branch-and-bound scheme, is developed to optimally solve medium-size problems. A number of dominance rules are proposed to improve the search efficiency of the branch-and-bound algorithm. An efficient two-phase heuristic algorithm is presented for solving large-size problems. Computational results show that the branch-and-bound algorithm can solve problems with up to 100 jobs within a reasonable amount of time. For large-size problems, the solution obtained by the heuristic algorithm has an average percentage deviation of 0.24% from a lower bound value.

This paper addresses the open shop scheduling problem to minimize the total completion time, provided that one of the machines has to process the jobs in a given sequence. The problem is NP-hard in the strong sense even for the two-machine case. A lower bound is derived based on the optimal solution of a relaxed problem in which the operations on every machine may overlap except for the machine with a given sequence of jobs. This relaxed problem is NP-hard in the ordinary sense, however it can be quickly solved via a decomposition into subset-sum problems. Both heuristic and branch-and-bound algorithm are proposed. Experimental results show that the heuristic is efficient for solving large-scaled problems, and the branch-and-bound algorithm performs well on small-scaled problems.

High expression levels of cyclooxygenase-2 (COX-2) contribute a strong proliferative ability to human lung cancer cells, and this function is link to the epidermal growth factor receptor (EGFR) pathway, which was mediated by extracellular-signal-regulated kinase (ERK) and nuclear factor kappa B (NFκB). In this study, scutellarein, a flavonoid compound, was screened for proliferation inhibition at different concentrations (0, 5, 25 and 50 μM) at 24 h or 48 h in human lung cancer cell line A549. Results showed that A549 cell proliferation was inhibited by 50 μM scutellarein treatment in 24 h and 48 h of treatment. The expression levels of phosphorylated EGFR, phosphorylated ERK, phosphorylated NFκB and COX-2 were reduced in a dose-dependent manner after 24 h scutellarein treatments at different concentrations. Further, ERK inhibitor U0126 and NFκB inhibitor MG132 also inhibited A549 cell proliferation similar to 50 μM scutellarein treatment from 24 h to 48 h. The experimental results showed that scutellarein could inhibit proliferation of the human lung cancer cell line A549 through ERK and NFκB mediated by the EGFR pathway.

Background Closure of the dura defect may be easy to perform in open lumbar surgery but could be difficult in minimally invasive transforaminal lumbar interbody fusions (MIS-TLIF) since MIS-TLIF was done through a small tube, which limited the use of standard dural repair instruments. We used nonpenetrating titanium clips that were originally designed for the vascular anastomoses to repair the dura defect, which is never described in the literature. Methods We presented a case of spinal stenosis with incidental durotomy while performing MIS-TLIF. We closed the dura laceration with three medium-sized nonpenetrating titanium clips (AnastoClip Vessel Closure System, LeMaitre Vascular, Inc., Burlington, MA). Results Nonpenetrating titanium clips have the benefits of being technically easy to use, reduced durotomy repair time, decreased bed rest due to related medical complications, superior postoperation with immediate hydrostatic strength, and better reapproximation if it fails to clip successfully. As for the postoperation follow up, clips are tiny and reveal no obvious artifact, especially in cases where the pedicle screws are already causing much artifact. Conclusion Primary dural closure during MIS-TLIF with clips is an effective way in cases that involve limited tubular space.

Tanshinone IIA (Tan-IIA) decreases the viability of human hepatocellular carcinoma (HCC) cells through the induction of apoptosis in vitro. However, there are no reports that Tan-IIA is capable of inhibiting J5 HCC cell growth in vivo. In this study, J5 cells were implanted directly into nude SCID mice which were divided randomly into four groups to be treated with vehicle, Tan-IIA (30 mg/-kg of body weight, Q.week days 3 and 5), 5-FU (30 mg/-kg of body weight, Q.week day 1) or Tan-IIA (30 mg/-kg of body weight, Q.week days 3 and 5) plus 5-FU (30 mg/-kg of body weight, Q.week day 1). Each agent was injected intraperitoneally, with treatment starting 4 weeks after inoculation with J5 cells. Treatment with Tan-IIA 30 mg/-kg or with 30 mg/-kg of 5‑FU resulted in a reduction in tumor size and weight compared with the control group. The protein expression of Bax and caspase-3 in the J5 xenograft tumors treated with Tan-IIA 30 mg/-kg or with 30 mg/kg of 5-FU was upregulated, whereas that of CD31 was downregulated compared with the control group. These findings indicate that Tan-IIA may inhibit tumor growth in a J5 xenograft animal model by increasing Bax and caspase 3 and decreasing CD31 expression in vivo.

Sann-Joong-Kuey-Jian-Tang (SJKJT), a traditional Chinese medicine, has been prescribed as complementary medication for colon cancer in Taiwan. However, its molecular mechanisms are not yet understood. In the present study, we investigated the effects of SJKJT on human colon cancer colo 205 cells in vitro. The cytotoxicity of SJKJT in colo 205 cells was evaluated using the MTT assay, and the protein expression of microtubule-associated protein II light chain 3 (MAP-LC3-II) was measured using Western blot analysis. The results showed that SJKJT inhibited the survival rates of colo 205 cells in a time- and dose-dependent manner, with an IC50 concentration at 24 h of 590.34 µg/ml. In addition, SJKJT up-regulated the protein expression of MAP-LC3-II in colo 205 cells. These findings indicate that one of the molecular mechanisms by which SJKJT inhibits the proliferation of colo 205 cells in?vitro may be through the induction of the autophagic pathway. SJKJT may therefore have therapeutic potential for the treatment of human colon cancer.

Sann-Joong-Kuey-Jian-Tang (SJKJT), a traditional Chinese medicine prescription, has been used to treat lymph node diseases and tumors. However, the molecular mechanisms of SJKJT in human colon cancer in vivo and in vitro have not been clearly elucidated. In the present study, we investigated the molecular mechanisms of SJKJT in human colon cancer colo 205 cells in vitro and in vivo. In the in vitro study, colo 205 cells were treated with various concentrations (0.5, 1 and 2 mg/ml) of SJKJT. The protein expression of TNF-α, Caspase-8 and Caspase-3 in colo 205 cells was measured by Western blotting. The results demonstrate that SJKJT up-regulated Fas, TNF-α, Caspase-8 and Caspase-3 protein expression. In the in vivo study, human colon cancer colo 205 cells (3x106/0.2 ml) were injected subcutaneously into the flank area of nude SCID mice (n=32) randomly divided into four groups. SJKJT was dissolved in saline and then administered orally to the mice at concentrations of 0.01, 0.1 and 0.3 g/kg/day for 30 days. The control group was treated with an equal volume of saline. SCID mice were sacrified by CO2 inhalation and the xenograft tumors were dissected. Subsequently, the protein expression of Fas, TNF-α, Caspase-8 and Caspase-3 in the tumors was measured by Western blotting. The results demonstrate that SJKJT up-regulated Fas, TNF-α, Caspase-8 and Caspase-3 protein expression, both in vitro and in vivo. These observations suggest that SJKJT has therapeutic potential in colon cancer.

Curcumin (diferuloylmethane), which is obtained from turmeric, the rhizome of Curcuma longa (L.), inhibits many human cancer cells. However, the molecular mechanisms responsible for curcumin-induced endoplasmic reticulum stress in human hepatic cellular carcinoma J5 cells, are not yet clearly understood. J5 cells were treated with various concentrations of curcumin for different durations. The cell viability was detected by MTT assay. The protein expressions of caspase-12, ATF6, GADD153, Calnexin, Calreticulin, PDI and Ero1-Lα, which are associated with endoplasmic reticulum stress and the unfolding protein response pathway, were examined by Western blot analysis. The cell cycle was analyzed by flow cytometry. The protein expressions of TCTP, Mcl-1, Bcl-2 and Bax, which are related to mitochondrial dysfunction, were detected by Western blot analysis. We also detected the ATF6 protein location by immunocytochemistry. The results showed that curcumin inhibits the proliferation of J5 cells in a time- and dose-dependent manner. Curcumin induced the unfolding protein response by down-regulating the protein expressions of Calnexin, PDI and Ero1-Lα and up-regulating the Calreticulin expression. Curcumin induces the GADD153 expression by cleaving caspase-12 and ATF6, and then by translocating ATF6 to the nucleus. Curcumin also down-regulates the protein expressions of TCTP, Mcl-1 and Bcl-2, in order to induce mitochondrial dysfunction. Curcumin induced cell cycle arrest at the G2/M phase by decreasing the Cdc2 expression. In conclusion, the present study showed that curcumin inhibits the proliferation of J5 cells by inducing endoplasmic reticulum stress and mitochondrial dysfunction.

Tanshinone IIA (Tan-IIA) is extracted from Danshen, Salviae miltiorrhizae Radix, which has been widely adopted in traditional herbal medicine to treat cardiovascular and hepatic diseases. Tan-IIA induces apoptosis and inhibits proliferation in human hepatocellular carcinoma (HCC) cells. However, the molecular mechanisms of Tan-IIA on human HCC cells are not understood clearly. In the present study, the cytotoxicity of Tan-IIA as well as its molecular mechanisms in human HCC J5 cells was investigated. The cytotoxicity was assayed by MTT. The protein expression of p53, p21, Bax, Bcl-2, Cdc25c, Cdc2, calreticulin, caspase 12, GADD153, caspase 3 and beta-actin in J5 cells were determined by Western blotting. The cell cycles were analyzed by FACS. The protein expression of caspase 12, GADD1533 and caspase 3 were detected by immunocytochemical staining. The results showed that Tan-IIA inhibited J5 cells in a dose- and time-dependent manner. The protein expression of p53, p21, Bax, calreticulin, caspase 12, caspase 3 and GADD153 were increased, but Bcl-2, Cdc25c and Cdc2 were decreased in J5 cells. In addition, the results also showed that Tan-IIA arrested J5 cells in the G2/M phase. Immunocytochemistry staining showed that J5 cells treated with Tan-IIA up-regulated the protein expression of caspase 12, 3 and GADD153. Taken together, the findings suggest that Tan-IIA inhibits and induces apoptosis in J5 cells through novel molecular targets, calreticulin, caspase 12 and GADD153.

Some systems work for a job with random working and processing times, and are checked at periodic and random times. When a failure occurs, we execute the backup operation to the latest checking time. First, the expected costs with periodic and random backups are formulated, and comparisons between periodic and random policies are made. Next, we focus on the backup policies when the system is checked at the Nth interval of working times, two total expected costs are obtained and optimal numbers N* which minimize them are derived analytically. Finally, one modified backup model in which failures are detected only at checking times is proposed and two expected costs are obtained.

Spontaneous spinal epidural hematoma (SSEH) is a neurosurgical emergency that requires prompt diagnosis and treatment. We report a 24-year-old woman who presented with acute onset of paralysis in both lower limbs and sensory disturbance below the fourth-thoracic dermatome. Spinal magnetic resonance image (MRI) revealed an intraspinal, extradural mass is extending from the fifth to the seventh thoracic vertebrae with compression of the spinal cord. Laminectomy of the T5 to T7 vertebrae was performed 12 h after onset. During the procedure, an epidural hematoma with hypervascularization and an abnormal vascular network were observed grossly on the dorsal dural surface. Postoperative angiography and MRI revealed complete resolution of the hematoma and no evidence of residual vascular lesion in the intra- or extra-dural region. At 6-month follow-up, the patient had regained full muscle power and sensation in the lower limbs. There was no evidence of urinary or stool incontinence. The patient had a history of remaining seated for prolonged periods of time, which may have elevated the spinal venous return pressure, resulting in spontaneous hemorrhage due to rupture of the spinal epidural arteriovenous fistula. This case report shows that patients with SSEH can have excellent neurologic outcomes if the condition is treated early with decompressive laminectomy.

Background: Osteoporosis is predominantly a condition of the elderly. In this study, we evaluated the effects of teriparatide on lung function and pain relief in elderly women with multiple osteoporotic vertebral compression fractures. Methods: A total of 37 patients who received teriparatide treatment during the period January 2010 to December 2011 were enrolled. Dual-energy X-ray absorptiometry scans were used to measure bone mineral density (BMD) and lung function was measured using a MasterScreen Body Jaeger spirometer. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) values were recorded. The Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for pain were used to evaluate physical health and pain intensity, respectively, at baseline and after 6 months of teriparatide treatment. Results: Mean BMD at the lumbar spine increased from 0.716 g/cm2 at baseline to 0.829 g/cm2 after 6 months of treatment. In addition, both mean FVC and FEV1 values after 6 months of treatment were significantly higher than baseline values (99.01% and 100.06% vs. 87.62% and 90.62%, respectively). Teriparatide treatment also resulted in a significant reduction in self-reported pain intensity and a significant improvement in physical health as measured by VAS and ODI scores, respectively. Conclusions: In addition to increasing BMD, teriparatide treatment improves the lung function and results in diminished pain intensity in women with multiple osteoporotic vertebral compression fractures.

Background: High-grade primary glioma have poor prognosis and predictive biomarkers is very important. Midkine (MDK), a heparin-binding growth factor, is important in regulating carcinogenesis, cell proliferation, mitogenesis, and angiogenesis. This study aimed to identify over-expression of MDK in gliomas and correlate this with clinical outcomes. The authors put forward their hypothesis correlating proliferation and poor survival with over-expression of this novel protein. Methods: Two datasets from Gene Expression Omnibus (GEO) included human data of 100 and 180 patients, respectively. The MDK expression, World Health Organization (WHO) pathological grade, sex, age, and survival time were identified for statistical analysis. Results: A search of the GEO profile revealed that MDK expression level was statistically greater in the WHO grade IV compared with grade II (P = 0.002), in grades III and IV compared with nontumor control (P = 0.044 and P < 0.001, respectively) after adjustments using the Bonferroni method. By the Kaplan-Meier survival curve, the high MDK expression group had poorer survival outcome (2.38-fold hazard, 95% confidence interval: 1.22-4.63) than the low MDK expression group after adjustments for WHO grade and age. Conclusions: Taken together, there is a positive correlation between MDK expression and WHO grading of human gliomas. Moreover, MDK over-expression is significant correlated to poor survival outcome in high-grade, suggesting that MDK may be an important therapeutic target.

Background: Spinal manipulation is widely used for low back pain treatments. Complications associated with spinal manipulation are seen. Lumbar epidural hematoma (EDH) is one of the complications reported in the literature. If lumbar chronic EDH symptoms are present, which are similar to those of a herniated nucleus pulposus, surgery may be considered if medical treatment fails. Percutaneous endoscopic discectomy utilizing an interlaminar approach can be successfully applied to those with herniated nucleus pulposus. We use the same technique to remove the lumbar chronic EDH, which is the first documented report in the related literature. Methods: We present a case with chronic lumbar EDH associated with spinal manipulation. Neurologic deficits were noted on physical examination. We arranged for a full-endoscopic interlaminar approach to remove the hematoma for the patient with the rigid endoscopy (Vertebris system; Richard Wolf, Knittlingen, Germany). Results: After surgery, the patient's radiculopathy immediately began to disappear. Magnetic resonance imaging (MRI) follow-up 10 days after the surgery revealed no residual hematoma. No complications were noted during the outpatient department follow up. Conclusions: Lumbar EDH is a possible complication of spinal manipulation. Patient experiencing rapidly progressive neurologic deficit require early surgical evacuation, while conservative treatment may only be applied to those with mild symptoms. A percutaneous full-endoscopic interlaminar approach may be a viable alternative for the treatment of those with chronic EDH with progressive neurologic deficits.

This paper presents an all-digital delay locked loop (ADDLL) that uses asynchronous-deskewing technology and achieves low power/voltage, small jitter, fast locking, and high process, voltage, and temperature (PVT)-variation tolerance. The measurement results show that the maximum frequency is 100 MHz at 0.35 V with 19 μW power dissipation, 62 ps peak-to-peak jitter, and 3 locking cycles. When operated at 0.5 V, the measured maximal operating clock frequency is 450 MHz with 12 ps peak-to-peak jitter, 6 locking cycles and 119 μW power dissipation. The ADDLL is fabricated with 55 nm CMOS technology, and the active area is only 0.019 mm2.