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A histologic hallmark of primary SS (pSS) is lymphocytic infiltration of the salivary and lacrimal glands, in particular by CD4+ T and B cells. In the early stages of the disease, infiltrates are dominated by CD4+ T cells, while B cell accumulation occurs at later stages. Activated T cells contribute to pathogenesis by producing pro-inflammatory cytokines and by inducing B cell activation, which results in the establishment of a positive feedback loop. In the inflamed glandular tissues, many different CD4+ effector subsets are present, including IFN-γ-producing Th1 cells, IL-17-producing Th17 cells and IL-21-producing T follicular helper cells. In blood from pSS patients, frequently observed abnormalities of the T cell compartment are CD4+ T cell lymphopenia and enrichment of circulating follicular helper T (Tfh) cells. Tfh cells are critical mediators of T cell–dependent B cell hyperactivity and these cells can be targeted by immunotherapy. Inhibition of T cell activation, preferably early in the disease process, can mitigate B cell activity and may be a promising treatment approach in this disease.

Wastewater treatment is a process used in several countries, particularly in Algeria. A study on Earth for one month was carried out at the sewage plant of the Sebdou textile complex, Tlemcen, north-west of Algeria. Regular samples gave average values at the outlet such that the water temperature is 22 ° C, the ph 7.43, the biochemical oxygen demand BOD5 is 36.5 mg / l, the chemical oxygen demand COD vary between 100 and 200 mg / l at the exit of the WWTP mg / l and finally suspended solids SS is of the order of 36.2 mg / l. All these values conform with the standards and therefore the treatment plant operates within Algerian standards.

Song Wen, Wenjing Jiang, Ligang Zhou Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of ChinaCorrespondence: Ligang ZhouDepartment of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of ChinaTel +8613611927616Email zhouligang@yahoo.comAbstract: The glutamic acid decarboxylase 65 antibody (GAD65-Ab) is an autoimmune marker in some diseases such as diabetes or autoimmune disorders of the central nervous system such as stiff-man syndrome. It can appear with other pancreatic autoantibodies, such as insulin autoantibodies (IAA), presenting as early signs of pancreatic islet β-cells impairing, and play roles in the pathogenesis of type1 diabetes (T1D) and latent autoimmune diabetes in adults (LADA). Positive GAD65-Ab is rarely observed in insulin-dependent diabetic patients with other acquired autoimmune diseases, such as Sjogren’s syndrome (SS). Besides, LADA revealed by islet autoantibodies such as GAD65-Ab can also be complicated with Hashimoto’s thyroiditis (HT), another autoimmune thyroid disease. To date, whether GAD65-Ab positive in patients with autoimmune diseases predicts the onset or progression to T1D or LADA remains unknown. Herein, two unique cases of middle-aged Chinese Han women free from diabetes for three years are described despite their blood tests persistently testing positive for GAD65-Ab or IAA. Both patients suffered from HT and SS. Follow-up OGTTs (oral glucose tolerance test) for three years revealed that the patients had a well-controlled glycemic level and normal pancreatic function. However, one of the patients had a temporary increase of postprandial glucose after a short-term loss of diet control. The presence of auto-immune antibodies in these patients had little impact on glucose tolerance or insulin secretion in 3 years. The study postulate that both the primary immune injury caused by serum GAD65-Ab positive, an autoimmune marker, and increased body weight contribute to the progression of LADA.Keywords: latent onset autoimmune diabetes in adults, LADA, Hashimoto’s thyroiditis, HT, Sjogren’s syndrome, SS, autoimmune diseases, glutamic acid decarboxylase 65 antibody, GAD65-Ab, insulin autoantibody, IAA-Ab

Objectives To assess non-invasive imaging for detection and quantification of gland structure, inflammation and function in patients with primary Sjogren's syndrome (pSS) using PET-CT with 11C-Methionine (11C-MET; radiolabelled amino acid), and 18F-fluorodeoxyglucose (18F-FDG; glucose uptake marker), to assess protein synthesis and inflammation, respectively; multiparametric MRI evaluated salivary gland structural and physiological changes. Methods In this imaging/clinical/histology comparative study (GSK study 203818; NCT02899377) patients with pSS and age- and sex-matched healthy volunteers underwent MRI of the salivary glands and 11C-MET PET-CT. Patients also underwent 18F-FDG PET-CT and labial salivary gland biopsies. Clinical and biomarker assessments were performed. Primary endpoints were semi-quantitative parameters of 11C-MET and 18F-FDG uptake in submandibular and parotid salivary glands and quantitative MRI measures of structure and inflammation. Clinical and minor salivary gland histological parameter correlations were explored. Results Twelve patients with pSS and 13 healthy volunteers were included. Lower 11C-MET uptake in parotid, submandibular and lacrimal glands, lower submandibular gland volume, higher MRI fat fraction, and lower pure diffusion in parotid and submandibular glands were observed in patients vs healthy volunteer, consistent with reduced synthetic function. Disease duration correlated positively with fat fraction and negatively with 11C-MET and 18F-FDG uptake, consistent with impaired function, inflammation and fatty replacement over time. Lacrimal gland 11C-MET uptake positively correlated with tear flow in patients, and parotid gland 18F-FDG uptake positively correlated with salivary gland CD20+ B-cell infiltration. Conclusion Molecular imaging and MRI may be useful tools to non-invasively assess loss of glandular function, increased glandular inflammation and fat accumulation in pSS.

FinFET devices with and without LDD implantation has been studied for dimensions compatible with leading 14nm technology node. Devices without LDD have better electrostatic characteristics with SS = 65mV/dec and DIBL = 33mV. The nFET transistors with no LDD have device Vtsat mismatch reduction by 20%, together with retained device reliability of HCI as compared to devices with LDD. A full range of device Vtsat flavors is enabled in this experiment, presenting excellent device performances at different operating voltages of 0.55V, 0.8V and 1.2V. All results indicates that devices with no LDD and one less mask in FinFET architecture achieve lower cost, compelling performance and area scaling compared to devices with LDD, for high performance and low power applications.

Purpose To introduce a novel technique of encircling laser prophylaxis (ora secunda cerclage Stickler syndrome, OSC/SS) to prevent rhegmatogenous retinal detachment (RRD) in Stickler syndrome eyes. Patients and Methods After first eye RRD at age 50 and at age 18, respectively, a 53-year-old father and his 22-year-old son with type 2 SS (STL2) gave informed consent and underwent OSC/SS prophylaxis, performed in each fellow eye. A 26-year-old STL2 daughter then suffered first eye retinal detachment and similarly chose fellow eye OSC/SS prophylaxis. A second son, 28 years of age with STL2, chose OSC/SS prophylaxis in both eyes. Results The three OSC/SS treated fellow eyes have gone 12 years, 11 years, and 8 years without RRD. STL1 and less common STL2 eyes are known to have a similar rate of RRD, and 80% of STL1 fellow eyes develop RRD at a median of 4 years in the absence of prophylaxis. Moreover, five of six (83%) known STL2 family members suffered RRD, only the STL2 son with bilateral OSC/SS remaining bilaterally attached. All five OSC/SS treated eyes (average 8.7 years post-prophylaxis) retained preoperative visual acuity of 20/20 to 20/30, with an average, asymptomatic reduction of meridional field in each eye to 50 degrees. In contrast, in the three eyes having suffered RRD prior to presentation, visual acuity ranged from 20/125 to 8/200 and average meridional field was 29 degrees. Conclusion Encircling grid laser (OSC) modified in Stickler eyes to encompass the ora serrata and extend posteriorly to and between the vortex vein ampullae (OSC/SS) is a reasonable RRD prophylaxis option to offer STL1 and STL2 patients as an alternative to no treatment or less effective prophylaxis. Because of rarity and severity, the ultimate proof of safety and efficacy will likely come not from randomized trials, but from a non-randomized, prospective, cohort comparison study of such individual efforts., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/AzHz4xYUV_w

The research aims to determine priority economic sector to develop at Sukoharjo Regency. Based method used in research is descriptive with using time series data for 1998 to 2002 about economic sector on GRDP (Gross of Regional Domestic Product) of Sukoharjo Regency. Analysis method use combination Location Quotient (LQ) and Shift share (SS) Model. Its result, the first sector to develop are Contruction, and the second sector are Mining and quaning, Electricity, Gas and Water supply sector, Trade, hotel and restaurant sector, Transport and communication sector, Agriculture sector and Services sector. Finally sector to develop are manufacturing industry and financial, ownership and business service sector.

Currently, non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, and more functional foods are needed for NAFLD prevention and treatment. Kaempferol can be obtained from tea, broccoli, propolis, grapefruit and other green plants. However, relatively systematic studies concerning the preventative effects of kaempferol against NAFLD are lacking. In this study, using network pharmacological methods, we found that kaempferol could prevent the development of NAFLD by targeting multiple targets; for instance, kaempferol suppressed inflammation, improved insulin resistance and reduced oxidative stress. Furthermore, we confirmed that kaempferol could suppress inflammatory responses and prevent the development of NAFLD in vitro and in vivo by inhibiting the nuclear transcriptional activity of NF-κB. Our study supports the use of kaempferol as a functional food or dietary supplement for NAFLD prevention and treatment. In addition, this study could be beneficial for understanding the anti-NAFLD mechanism of many other flavonoids.

Low Power Wide Area Network (LPWAN) is imperative for the expansion and development of IoT networks and their connectivity infrastructure. This far-reaching connectivity of low power devices that are placed virtually anywhere is evolving a new things-based business model. This things-based business model has certain requirements such as long range, extended battery life and very low end point cost. LPWAN technologies have successfully addressed these IoT requirements and are receiving wider acceptance in the IoT industry. In most LPWAN technologies, two main alternative communication techniques, Ultra Narrow Band (UNB) and Spread Spectrum (SS) are used at the physical layer. However, the greatest dilemma is the selection of the most suitable technique from UNB and SS for LPWAN. This paper addresses this selection dilemma of UNB and SS by examining some of the most critical factors responsible for the performance of LPWAN technologies such as interference, capacity, link budget and coexistence. Furthermore, it evaluates the most popular UNB-based LPWAN technologies Sigfox and Telensa, and SS-based LPWAN technologies LoRa and RPMA investigating their strengths and limitations for IoT applications.

Purpose The purpose of this paper is to examine the implications of work-life-balance (WLB) challenges for Nigerian female medical doctors. This study focusses on Nigeria, which its peculiar socio-cultural, institutional and professional realities constitute WLB as well as social sustainability (SS) challenge for female medical doctors. Design/methodology/approach Relying on qualitative, interpretivist approach and informed by institutional theory, this study explores how Nigeria’s institutional environment and workplace realities engender WLB challenges, which consequently impact SS for female doctors. In total, 43 semi-structured interviews and focus group session involving eight participants were utilised for empirical analysis. Findings The study reveals that factors such as work pressure, cultural expectations, unsupportive relationships, challenging work environment, gender role challenges, lack of voice/participation, and high stress level moderate the ability of female medical doctors to manage WLB and SS. It also identifies that socio-cultural and institutional demands on women show that these challenges, while common to female physicians in other countries, are different and more intense in Nigeria because of their unique professional, socio-cultural and institutional frameworks. Research limitations/implications The implications of the WLB and SS requires scholarship to deepen as well as extend knowledge on contextual disparities in understanding these concepts from developing countries perspective, which is understudied. Originality/value This study offers fresh insights into the WLB and SS concepts from the non-western context, such as Nigeria, highlighting the previously understudied challenges of WLB and SS and their implications for female doctors.

Storytelling about places is recognized as a tool to enhance the reputation of regions as they compete for tourism and economic development spending in the digital age. Through digital media, people can be encouraged to tell their tourism stories and share their experiences. Our design approach integrates Service Science, Management, Engineering, plus Design, Arts and Public Policy (SSME + DAPP, so just SS) and Viable Systems Approach (VSA) perspectives. Storytelling can be managed in a local service system to enhance brand competitiveness. The way local governments and cultural organizations understand and encourage storytelling about places (“place storytelling”) can have a significant impact on the success of a region competing for tourism and development spending. Place storytelling enables local stakeholders to tell their personal stories about their beloved places. Our analysis and cases demonstrate that place storytelling enables strategic communication that supports sustainable competitive advantage. By means of an analysis of “Umbria on the Blog”, which is an innovative project which joins place and web 2.0, and “Il Mangiastorie”, which promotes wine and food and tourism of some Campania internal area, we highlight the relevance of managing place storytelling as a strategic communication involving stakeholders in the place-identity-building process. This paper presents a model of place storytelling that local governments and cultural organizations can use to encourage and manage stakeholder engagement in a multilevel process for improving regional service system marketing and communications in the digital age.

Corrosion of steel rebars is known to cause deterioration of concrete structures that can lead to catastrophic failures. To mitigate this problem, steel rebars can be replaced with Glass Fiber-Reinforced Polymer (GFRP) rebars. However, the lack of ductility of GFRP-reinforced elements has prevented their use in many structural applications, especially in seismic areas. Stainless Steel (SS) rebars are corrosion resistant and have adequate energy absorption and ductility. However, they are much more expensive than steel rebars. This paper proposes the combined use of SS and GFRP rebars to achieve ductile and corrosion-free elements. The first challenge for such a proposal relates to designing SS-GFRP reinforced concrete frame with adequate lateral performance in terms of initial stiffness, ductility, and strength. Design equations, which are based on a comprehensive parametric study, are developed to allow designing such a frame. A six-storey concrete frame is then designed using the proposed equations and its lateral performance is examined using pushover analysis.

Rationale: As increasing frequency of serotonergic drug use, SS (serotonin syndrome) occurred more than ever. But clinicians have not enough knowledge and experience about SS as a potentially life-threatening condition. SS is usually caused by the increased serotonin activity in the central nervous system which may due to a serotonergic agent overdose or the concomitant use of 2 or more serotonergic antidepressants. We report a case of SS due to a normal dose of selective serotonin inhibitors (SSRIs) thus to remind clinicians to pay attention to such patients and make an early diagnosis and initiation of therapy in the clinical practice. Patient concerns: We report here a 49-year-old man presented with lethargic, less communicative, and insomnia for 20 days while a diagnosis of depression was considered and he was treated with SSRIs. Diagnosis: The patient in our case fulfilled the 3 criteria existed now for diagnosing SS, including the Sternbach criteria, Radomski revised diagnostic criteria, and the Hunter serotonin toxicity criteria. Interventions: All the antidepressants were stopped and cyproheptadine with an initial dose of 12 mg a day was started along with supportive care. The patient was also admitted to emergency intensive care unit for further treatment. He was sedated and paralyzed by intravenous Midazolam and Clonazepam along with physical cooling and supportive care. Outcomes: All of the patient's symptoms abated gradually and he soon could get off the bed and be communicative. Finally, the patient made a full recovery and he was discharged from the hospital. Lessons: Our case suggests an atypical clinical course while the medicine the patient takes was not in so much dose. We assumed that there may have been some variation in metabolism of these agents, resulting in increased possibility that led to the subsequent syndrome. Thus, it is essential for clinicians to keep in mind when patients taking serotonergic agents who demonstrate acute change in their mental status. Besides, clinicians should be aware of such patients who seem to be sensitive to SSRIs, who may require a genetic testing before the initiation of SSRI therapy.

session 4: Steep slope devices; International audience; We report the fabrication and the characterization of Tunnel FETs fabricated on SiGe-On-Insulator with a High K Metal Gate (HKMG) CMOS process. The beneficial impact of low band gap SiGe channel on ID(VG) characteristics is presented and analyzed: compressive Si0.75Ge0.25 enables to increase by a factor of 20 the saturation currents, even at small gate length (LG=50nm). This large gain is due to the threshold voltage shift and to enhanced intrinsic band-to-band tunneling injection (both related to the narrow band gap of SiGe channels).