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This study aimed to investigate the value of multidisciplinary team (MDT) management in minimally invasive treatment of complex intrahepatic bile duct stones (IHDs) by laparoscopy, choledochoscopy and percutaneous choledochoscopy. The characteristics, perioperative index, complication rate and minimally invasive rate of patients in MDT group (n = 75) and non-MDT group (n = 70) were compared. The members of MDT include doctors in ultrasound, imaging, hepatobiliary and pancreatic surgery, anaesthesia and intensive care medicine. The results showed that minimally invasive surgery reduced the incidence of postoperative residual stones, OR (95% CI) = 0.365 (0.141-0.940) (p = 0.037). MDT reduced the operation time, OR (95% CI) = 0.406 (0.207-0.796) (p = 0.009). Minimally invasive surgery significantly reduced intraoperative bleeding, OR (95% CI) = 0.267 (0.133-0.534) (p < 0.001). Minimally invasive surgery also reduced hospitalization time, OR (95% CI) = 0.295 (0.142-0.611) (p = 0.001). The stone clearance rates of MDT group and non-MDT group were 81.33% and 81.43% respectively. In the MDT group, the operative time was less than that in the non-MDT group (p = 0.010); the intraoperative bleeding volume was significantly less than that in the non-MDT group (p < 0.001); the hospitalization time was less than that in the non-MDT group (p = 0.001). Minimally invasive operation rate:48 cases (64.00%) in MDT group were significantly higher than 17 cases (24.29%) in non-MDT group (p < 0.001). In conclusion, minimally invasive procedures can be selected more through MDT. MDT can shorten the operation time, and minimally invasive surgery can reduce the incidence of residual stones, reduce intraoperative bleeding, and may shorten hospital stay. Therefore, MDT management model can provide personalized and minimally invasive surgical protocol for patients with complex IHD, which has high application value.

Hepatocellular carcinoma (HCC) is one of the most commonly cancers with poor prognosis and drug response. Identifying accurate therapeutic targets would facilitate precision treatment and prolong survival for HCC. In this study, we analyzed liver hepatocellular carcinoma (LIHC) RNA sequencing (RNA-seq) data from The Cancer Genome Atlas (TCGA), and identified PARD3 as one of the most significantly differentially expressed genes (DEGs). Then, we investigated the relationship between PARD3 and outcomes of HCC, and assessed predictive capacity. Moreover, we performed functional enrichment and immune infiltration analysis to evaluate functional networks related to PARD3 in HCC and explore its role in tumor immunity. PARD3 expression levels in 371 HCC tissues were dramatically higher than those in 50 paired adjacent liver tissues (p p = 0.002), vascular invasion (p = 0.012) and TP53 mutation (p = 0.009). Elevated PARD3 expression also correlated with lower overall survival (OS, HR = 2.08, 95% CI = 1.45–2.98, p p = 0.003). 242 up-regulated and 71 down-regulated genes showed significant association with PARD3 expression, which were involved in genomic instability, response to metal ions, and metabolisms. PARD3 is involved in diverse immune infiltration levels in HCC, especially negatively related to dendritic cells (DCs), cytotoxic cells, and plasmacytoid dendritic cells (pDCs). Altogether, PARD3 could be a potential prognostic biomarker and therapeutic target of HCC.

While thermal proteome profiling (TPP) shines in the field of drug target screening by analyzing the soluble fraction of the proteome samples treated at high temperature, the counterpart, the insoluble precipitate, has been overlooked for a long time. The analysis of the precipitate is hampered by the inefficient sample processing procedure. Herein, we propose a novel method, termed microparticle-assisted precipitation screening (MAPS), for drug target identification. The MAPS method exploits the principle that drug-bound proteins will be more resistant to thermal unfolding similar to the classic TPP method, but the process of protein precipitation is assisted by microparticles. Upon heating, proteins unfold and aggregate on the surface of the microparticles. The introduction of a microparticle simplifies the whole sample preparation workflow. The proteins that precipitate on the microparticles are subjected to washing, alkylation, and digestion. The whole sample preparation is processed conveniently on the surface of the microparticles without any transfer. With the assistance of microparticles, sample loss is minimized. The MAPS method is compatible with minute amounts of initial proteins. MAPS was applied to screen the targets of several well-studied drugs and the known target proteins were successfully identified with high confidence and specificity. To investigate the specificity of the method, MAPS was applied to screen the targets of the pan-kinase inhibitor, staurosporine, and 32 protein kinases (specificity of 80%) were identified using only 20 μg of initial proteins of each sample. MAPS is an unbiased robust method for drug target screening, filling the vacancy of stability-based target screening using a precipitate.

Background Systemic chemotherapy is often the last resort of advanced cutaneous T-cell lymphoma (CTCL). Tumor recurrence and adverse effects of systemic chemotherapy are the main limitations. Objective We aim to investigate the metabolic alterations in tumor cells after CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) chemotherapy. Methods and results In advanced CTCL, CHOP chemotherapy has no survival benefit and the duration of response is significantly inferior to other canonical treatments. HIF-1α is significantly elevated in lesions of advanced MF patients as well as tumor cell line Hut78 and tumor xenograft mice model. CHOP therapy also increased glycolytic activities in a HIF-1α-dependent manner. In CTCL xenograft tumor mice model, lesional cells showed a significant increase in IL-17F after chemotherapy, shifting toward a Th17 phenotype, which process is also regulated by HIF-1α. Echinomycin, HIF-1α inhibitor, was co-administered in xenograft tumor mouse models with CHOP and showed a significant reduction in tumor growth. Conclusion CHOP chemotherapy promotes glycolysis and IL-17 pathways in a HIF-1α-dependent fashion. Furthermore, HIF-1α blockade is promising as an accompanying agent in systemic chemotherapy for patients with advanced CTCL.

CTRP7 is a cytokine that is known to be associated with obesity. However, its relationship with insulin resistance (IR) and metabolic diseases remains unknown. The aim of this study is to investigate the relationship between CTRP7 and IR underCTRP7 expression in mice and hepatocytes was determined using RT-qPCR and western blotting. Circulating CTRP7 concentrations were measured with an ELISA kit. EHC, OGTT, lipid-infusion, physical activity, and cold-stimulation experiments were performed in humans and mice. SOD, GSH, and MDA were measured by commercial kits. ROS levels were detected using dichlorofluorescein diacetate.The expression levels of CTRP7 protein in the liver and fat of ob/ob and db/db mice were higher than that of WT mice. Individuals with IGT, T2DM, and obesity had higher circulating CTRP7 levels. CTRP7 levels were associated with HOMA-IR, obesity, and other metabolic parameters. During OGTT, serum CTRP7 levels gradually decreased, while CTRP7 levels significantly increased during EHC in response to hyperinsulinemia in healthy individuals without IR. In addition, lipid infusion-induced IR further increased serum CTRP7 levels in healthy adults. Physical activity increased serum CTRP7 levels in healthy individuals and CTRP7 protein expression in iWAT and skeletal muscle in mice. UnderOur evidence shows that CTRP7 could be a useful biomarker and potential treatment target in IR and metabolic disorders.

Nitidine chloride (NC) has displayed anti-tumor effects in various types of cancer. However, the role of NC in human melanoma is largely unknown. This study aimed to investigate the effects of NC on melanoma cancer cells A375 and WM35 by MTT assay. Apoptosis was measured by detecting caspase-3 protein expression level and its activity. Autophagy was measured by TEM image, immunostaining and immunoblotting assays. MTT assays showed that NC significantly blocks melanoma cells proliferation. Immunoblotting and caspase-3 activity assays showed that NC inhibited melanoma cells proliferation by inducing cell apoptosis. TEM, immunostaining and immunoblotting assays showed that NC also triggers melanoma cells autophagy and activation of the AMPK-mTOR pathway, which plays an important role in autophagy initiation. Finally, we found that blocking autophagy by 3-MA or AMPK pathway inhibitor greatly enhanced NC-induced apoptosis and cell death, indicating that NC-induced autophagy may have a cytoprotective effect in melanoma cells. Together, these results suggested that NC has strong anti-tumor effects on melanoma cells.

Cutaneous T cell lymphoma (CTCL) can have clinical and histological features resembling benign inflammatory dermatosis and can be difficult to diagnose. Very limited biomarkers are available for CTCL prognosis. We aimed to identify microRNA (miR) signatures to facilitate diagnostic and prognostic evaluations of CTCL. A cross-platform miR microarray identified 10 miRs that were differentially expressed between CTCL and benign inflammatory dermatosis patients. Subsequent reverse transcription polymerase chain reaction validation was used to generate a 5-miR-based diagnosing classifier, which showed high diagnostic accuracy in CTCL (area under the curve = 0.985 and 0.956 for training and testing set, respectively). Association between miR expressions and patient prognosis was studied. miR-155 and miR-200b were significantly associated with overall survival in CTCL patients, outperformed Ki-67. miR expressions were combined with Ki-67 to create a classifier for 5-year overall survival in CTCL patients. Our work provided miR signatures to facilitate CTCL diagnosis and prognosis with satisfying accuracy.

Cutaneous T-cell lymphoma (CTCL) is a heterogeneous group of skin-homing T-cell neoplasms. Clinical management is stage based but diagnosis and prognosis could be extremely challenging. The presented study aims to explore the metabolic profiling of CTCL by an accelerated untargeted metabolomics data analysis tool "Mummichog" to facilitate the discoveries of potential biomarkers for clinical early stage diagnosis, prognosis, and treatments in CTCL. Ultra high-performance liquid chromatography-quadrupole time-of-flight-based untargeted metabolomics were conducted on the skin and plasma of CTCL mice. It showed that the metabolism of skin changed greatly versus control samples in the development of CTCL. Increased l-glutamate and decreased adenosine monophosphate were the most essential metabolic features of CTCL tumor and tumor adjacent skins. Unique metabolism changes in tumor adjacent non-involved skin tissues (ANIT) occurred in the progress of carcinogenesis, including upregulated cytidine-5'-triphosphate, aberrant biosynthesis of prostaglandins, pyrimidine, mevalonate pathway, and tryptophan degradation. Sharply elevated 5-phospho-α-d-ribose 1-diphosphate (PRPP) marked the final state of tumor in CTCL. In the plasma, systematic shifts in corticosterone, sphingolipid, and ceramide metabolism were found. These uncovered aberrant metabolites and metabolic pathways suggested that the metabolic reprogramming of PRPP in tumor tissues may cause the disturbance of cytidine and uridine metabolic homeostasis in ANIT. Accumulative cytidine-5'-triphosphate in ANIT may exert positive feedback on the PRPP level and leads to CTCL further development. In addition, the accelerated data analysis tool "Mummichog" showed good practicability and can be widely used in high-resolution liquid chromatography mass spectrometry-based untargeted metabolomics.

Context Myonectin has been identified as a myokine, expressed predominantly in skeletal muscle. However, its clinical implications are largely unknown. Objective The aim of this study is to investigate the relationship between myonectin (C1q tumor necrosis factor-α-related protein isoform 15) and type 2 diabetes mellitus (T2DM) in cross-sectional and interventional studies. Design In a separate study, oral glucose tolerance tests, a 45-minute bout of exercise, lipid infusions, and euglycemic-hyperinsulinemic clamps (EHCs) were performed to investigate the association of myonectin with homeostasis model assessment of insulin resistance (HOMA-IR) and T2DM. Circulating myonectin was measured by enzyme-linked immunosorbent assay. Patients One hundred four newly diagnosed T2DM (nT2DM), 109 impaired glucose tolerance (IGT), and 128 healthy individuals were recruited for this study. Results nT2DM and IGT subjects had higher circulating myonectin concentrations than normal subjects (82.3 ± 47.6 and 68.9 ± 46.6 vs. 45.2 ± 23.5 µg/L, P < 0.05 or P < 0.01). It was also found that in nT2DM individuals, circulating myonectin was higher than in IGT subjects. Plasma myonectin correlated positively with waist/hip ratio, percentage of body fat, triglyceride, fasting blood glucose, 2-hour blood glucose after glucose overload, fasting insulin, hemoglobin A1c, and HOMA-IR and negatively with the insulin sensitivity index in all of the study population. Multivariate logistic regression analysis revealed that circulating myonectin levels were significantly correlated with IGT and T2DM. A 45-minute bout of exercise did not change circulating myonectin levels in healthy, young individuals. Circulating myonectin levels were not significantly altered in response to an oral glucose challenge or EHC. In addition, acute elevated free fatty acid levels induced by lipid infusion had no effects on circulating myonectin. Conclusions These data suggest that myonectin may be a useful marker in predicting the development of prediabetes and diabetes.

Background. Previous studies have suggested that Fetuin-B seems to be a secreted adipokine related to metabolic diseases. However, the results have been inconsistent. Here, our objective is to investigate the changes in circulating Fetuin-B levels in women with polycystic ovary syndrome (PCOS) and analyze the association of Fetuin-B and insulin resistance (IR). Methods. The current study is comprised of a cross-sectional study and a series of interventional studies. Oral glucose tolerance test (OGTT) and euglycemic-hyperinsulinemic clamp (EHC) were engaged to assess glucose tolerance and insulin sensitivity. Serum Fetuin-B levels were determined by ELISA. Results. Serum Fetuin-B and TNF-α levels were markedly increased in women with PCOS compared to healthy women. Circulating Fetuin-B was positively associated with body mass index, waist-to-hip ratio, the percentage of body fat (FAT%), systolic blood pressure, triglyceride, low-density lipoprotein cholesterol, fasting blood glucose, 2 h blood glucose after glucose overload, fasting insulin, 2 h insulin after glucose overload, HOMA-insulin resistance index (HOMA-IR), the area under the curve for insulin (AUCi), AUCg, and TNF-α, while negatively associated with M value and follicular stimulating hormone (FSH). During the EHC, Fetuin-B levels were found to be significantly increased in PCOS women. After a glucose challenge, serum Fetuin-B levels in healthy women were significantly increased. Lipid infusion reduced serum Fetuin-B levels in 30 healthy subjects. After six months of glucagon-like peptide-1 receptor agonist (GLP-1RA) intervention, serum Fetuin-B concentrations in PCOS women markedly decreased following ameliorated IR. Conclusion. Our results indicate that Fetuin-B may be a biomarker of IR in individuals with PCOS. This trial is registered with ChiCTR-IIR-16007901.

Background Nanosecond pulsed electric fields (nsPEFs) can produce more significant biological effects than traditional electric fields and have thus attracted rising attention in developing medical applications based on short pulse duration and high field strength, such as effective cancer therapy. However, little is known about their effects on the differentiation of stem cells. Furthermore, mechanisms of electric fields on chondrogenic differentiation of mesenchymal stem cells (MSCs) remain elusive, and effects of electric fields on cartilage regeneration need to be verified in vivo. Here, we aimed to study the effects of nsPEFs on chondrogenic differentiation of MSCs in vitro and in vivo and further to explore the mechanisms behind the phenomenon. Methods The effects of nsPEF-preconditioning on chondrogenic differentiation of mesenchymal stem cells (MSCs) in vitro were evaluated using cell viability, gene expression, glycosaminoglycan (sGAG) content, and histological staining, as well as in vivo cartilage regeneration in osteochondral defects of rats. Signaling pathways were investigated with protein expression and gene expression, respectively. Results nsPEF-preconditioning with proper parameters (10 ns at 20 kV/cm, 100 ns at 10 kV/cm) significantly potentiated chondrogenic differentiation capacity of MSCs with upregulated cartilaginous gene expression and increased matrix deposition through activation of C-Jun NH2-terminal kinase (JNK) and cAMP-response element binding protein (CREB), followed by activation of downstream signal transducer and activator of transcription (STAT3). Implantation of nsPEF-preconditioned MSCs significantly enhanced cartilage regeneration in vivo, compared with implantation of non-nsPEF-preconditioned MSCs. Conclusion This study demonstrates a unique approach of nsPEF treatment to potentiate the chondrogenic ability of MSCs through activation of JNK/CREB-STAT3 that could have translational potential for MSC-based cartilage regeneration. Electronic supplementary material The online version of this article (10.1186/s13287-019-1133-0) contains supplementary material, which is available to authorized users.

Bone morphogenetic protein (BMP)-9 has been associated with insulin resistance and type 2 diabetes mellitus. However, methods for delivering exogenous BMP-9 genes in vivo are lacking. In this study, we developed a gene delivery system using polyethyleneimine (PEI)-based core-shell nanoparticles (PCNs) as gene delivery carriers, and investigated the effectiveness and safety for delivery of the shBMP-9 gene. PCNs possessed a well-defined core-shell nanostructure with hydrophobic polymer cores and dense PEI shells of uniform particle size and highly positively charged surfaces. In vitro evaluation suggested that PCNs had high loading capacity for exogenous genes and low cytotoxicity toward hepatocytes. The transfection efficiency of PCNs/pENTR-shBMP9 complexes was higher than that of commercial lipofectamine 2000/shBMP9. In vivo studies showed that PCNs/pENTR-shBMP9 transfection led to a significant decrease in hepatic BMP9 expression compared with pENTR-shBMP9 transfection. Under high fat diet (HFD) feeding, PCNs/pENTR-shBMP9 mice exhibited aggravated glucose and insulin tolerance. At a molecular level, PCNs/pENTR-shBMP9 mice displayed elevated PEPCK protein levels and lower levels of InsR and Akt phosphorylation than pENTR-shBMP9 mice. These results suggest that the biological effects of PCNs/pENTR-shBMP9 in vivo are much more effective than those of pENTR-shBMP9. Therefore, the polyethyleneimine (PEI)-based core-shell nanoparticle can be applied as promising nanocarriers for effective and safe gene delivery.

Cutaneous T-cell lymphoma (CTCL) is a class of non-Hodgkin lymphoma with a difficult early diagnosis. The overall annual age-adjusted incidence of CTCL had consistently increased to around 10.2 cases per million persons. However, our knowledge regarding its mechanism of disease origin and progression remains unclear. In this study, serum samples from 31 CTCL patients and 31 matched healthy volunteers were analyzed in depth to screen metabolites capable of differentiating CTCL from controls. To obtain a higher coverage of metabolome with various hydrophilicity, a multiplatform approach with GC-MS and UHPLC-QTOF-MS has been employed. Data were analyzed by multivariate statistical analysis and CTCL group was separated from control group successfully using supervised OPLS-DA model. A total of 51 CTCL-regulated metabolites were identified, among which 15 differential metabolites have an AUC > 0.9 in receiver operating characteristic (ROC) curve analysis. Glycerophospholipid metabolism, tryptophan metabolism and purine metabolism were highlighted as 3 major altered pathways in CTCL serum. These alterations revealed impacts to membrane stability and weakened immune as well as ATP depletion associated with CTCL. Overall, these results aid in improving understanding of the mechanism related to CTCL, and demonstrate this multiplatform approach is suitable for serum metabolomics researches.

Objectives: The identification of cutaneous T cell lymphoma (CTCL) biomarkers may serve as a predictor of disease progression and treatment response. The aim of this study was to map potential biomarkers in CTCL plasma. Design and Methods: Plasma metabolic perturbations between CTCL cases and healthy individuals were investigated using metabolomics and ultrahigh performance liquid chromatography–quadrupole time-of-flight mass spectrometry (UHPLC-QTOF/MS). Results: Principal component analysis (PCA) of the spectra showed clear metabolic changes between the two groups. Thirty six potential biomarkers associated with CTCL were found. Conclusions: Based on PCA, several biomarkers were determined and further identified by LC/MS/MS analysis. All of these could be potential early markers of CTCL. In addition, we established that heparin as anticoagulant has better pre-treatment results than EDTA with the UHPLC-QTOF/MS appraoch.

Wearable and everyday-carry medical devices can improve quality of life for individuals that need frequent health monitoring. Such tools can supplement ubiquitous home care environments populated with medical sensors, extending the reach of these environments and increasing the freedom of their occupants. This paper presents the concept design for an everyday-carry medical device called a 'GumPack': a small cuboid-shaped device that offers wireless connectivity and plug-and-play surface components, where a component can be a biomedical sensor or a wireless network coordinator that manages a body area network. This geometrical layout optimizes access to surface-based medical hardware mounted on a small form factor. The device offers substantive computing power, supports local component reconfigurability, and promotes interoperability with medical device coordination environments. The GumPack is envisioned to be a personal health assistant carried in a pocket or handbag that can operate alone or interface to, e.g., a cell phone.

Pulse oximeters are central to the move toward wearable health monitoring devices and medical electronics either hosted by, e.g., smart phones or physically embedded in their design. This paper presents a small, low-cost pulse oximeter design appropriate for wearable and surface-based applications that also produces quality, unfiltered photo-plethysmograms (PPGs) ideal for emerging diagnostic algorithms. The design's "filter-free" embodiment, which employs only digital baseline subtraction as a signal compensation mechanism, distinguishes it from conventional pulse oximeters that incorporate filters for signal extraction and noise reduction. This results in high-fidelity PPGs with thousands of peak-to-peak digitization levels that are sampled at 240 Hz to avoid noise aliasing. Electronic feedback controls make these PPGs more resilient in the face of environmental changes (e.g., the device can operate in full room light), and data stream in real time across either a ZigBee wireless link or a wired USB connection to a host. On-board flash memory is available for store-and-forward applications. This sensor has demonstrated an ability to gather high-integrity data at fingertip, wrist, earlobe, palm, and temple locations from a group of 48 subjects (20 to 64 years old).

Onboard assessment of photoplethysmogram (PPG) quality could reduce unnecessary data transmission on battery-powered wireless pulse oximeters and improve the viability of the electronic patient records to which these data are stored. These algorithms show promise to increase the intelligence level of former "dumb" medical devices: devices that acquire and forward data but leave data interpretation to the clinician or host system. To this end, the authors have developed a unique onboard feature detection algorithm to assess the quality of PPGs acquired with a custom reflectance mode, wireless pulse oximeter. The algorithm uses a Bayesian hypothesis testing method to analyze four features extracted from raw and decimated PPG data in order to determine whether the original data comprise valid PPG waveforms or whether they are corrupted by motion or other environmental influences. Based on these results, the algorithm further calculates heart rate and blood oxygen saturation from a "compact representation" structure. PPG data were collected from 47 subjects to train the feature detection algorithm and to gauge their performance. A MATLAB interface was also developed to visualize the features extracted, the algorithm flow, and the decision results, where all algorithm-related parameters and decisions were ascertained on the wireless unit prior to transmission. For the data sets acquired here, the algorithm was 99% effective in identifying clean, usable PPGs versus nonsaturated data that did not demonstrate meaningful pulsatile waveshapes, PPGs corrupted by motion artifact, and data affected by signal saturation.

HA and bone morphogenetic protein-2 (BMP-2) possess superior osteoinductive and osteoconductive activities in the repair of bone defects. In this study, a BMP-2 mimicking oligopeptide (serine–serine–valine–proline–threonine, SSVPT) was introduced to the surface of nano-sized HA as the reinforcement phase of a poly(methyl methacrylate) (PMMA) cement, and the synergistic action of HA and oligopeptide on the bioactivity of HA/PMMA bone cement was investigated. Incorporated with 3-trimethoxysilyl propyl methacrylate (MPS)-modified HA, the compressive strength, flexural strength, and flexural modulus of HA/PMMA complied with the international standardization organization 5833 standard. Adherence measurement demonstrated that the introduction of HA and SSVPT could promote the adhesion and proliferation of human fetal osteoblast (hFOB) on the surface of HA/PMMA cement. The increased alkaline phosphatase (ALP) activity indicated that HA/PMMA could promote osteogenic differentiation of hFOB. All of the results illuminated that the HA/PMMA cement could be used as a bioactive material for regeneration and reconstruction of load-bearing bone.

Accidental slips and falls due to decreased strength and stability are a concern for the elderly. A method to detect and ideally predict these falls can reduce their occurrence and allow these individuals to regain a degree of independence. This paper presents the design and assessment of a wireless, wearable device that continuously samples accelerometer and gyroscope data with a goal to detect and predict falls. Lyapunov-based analyses of these time series data indicate that wearer instability can be detected and predicted in real time, implying the ability to predict impending incidents.

Wireless body area networks (WBANs) will take on more diverse forms in terms of their sensor combinations and communication protocols as their presence is extended to a greater number of monitoring scenarios. This paper presents an application layer protocol that solves issues caused by sensor nodes that must compete for high speed, real-time communication with the receiver. Such applications emphasize the delivery of large amounts of raw data from different sensor nodes in a time-synchronized manner, rather than channels that experience intermittent operation. An example of tracking pulse wave velocity (PWV) is introduced in this paper, where high-precision PWVs are estimated with the help of timeline recovery and feature extraction processes in MATLAB.

Pulse wave velocity (PWV) has garnered attention as a means to estimate vessel elasticity. This paper presents an approach to measure PWV using two synchronized, wireless pulse oximeters placed on the wrist and fingertip of the same hand. A MATLAB interface acquires and time-aligns these incoming photoplethysmograms (PPGs), and then it calculates PWVs using time differences at three waveform features: the foot, inflection point, and peak of the rising slope in each PPG. Consistent with expectations, PWV values for inflection points are larger than those calculated at waveform feet, since PWV is known to increase with increased intra-arterial pressure. However, the presence of pulse wave reflections complicates the interpretation of PWVs calculated from the PPG peaks since the reflected components impose a varying time delay on the related peaks.

Summary Interleukin-23 (IL-23) and CD4 + T helper 17 (Th17) cells are thought to be critical in psoriasis pathogenesis. Here, we report that IL-23 predominantly stimulated dermal γδ T cells to produce IL-17 that led to disease progression. Dermal γδ T cells constitutively expressed the IL-23 receptor (IL-23R) and transcriptional factor RORγt. IL-17 production from dermal γδ T cells was independent of αβ T cells. The epidermal hyperplasia and inflammation induced by IL-23 were significantly decreased in T cell receptor δ-deficient ( Tcrd −/− ) and IL-17 receptor-deficient ( Il17ra −/− ) mice but occurred normally in Tcra −/− mice. Imiquimod-induced skin pathology was also significantly decreased in Tcrd −/− mice. Perhaps further promoting disease progression, IL-23 stimulated dermal γδ T cell expansion. In psoriasis patients, γδ T cells were greatly increased in affected skin and produced large amounts of IL-17. Thus, IL-23-responsive dermal γδ T cells are the major IL-17 producers in the skin and may represent a novel target for the treatment of psoriasis.

Most pulse oximeters determine blood oxygen saturation (SpO(2)) after calculating a coefficient, R, that represents the normalized ratiometric contributions of the pulsatile red and near-infrared photoplethysmograms (PPGs) acquired by the sensor. This paper presents a new approach that uses principle component analysis (PCA) to separate the signal and noise components of unfiltered PPGs and provide the determination of R. Also, rather than use peak-to-valley time intervals to obtain R, this technique uses eigenvalue and eigenvector data obtained during PCA to optimize these time intervals and improve the R calculation. Early analyses on unfiltered PPGs from 16 subjects indicate that these R values compare to those obtained from FFT-based methods and yield SpO(2) values consistent with those reported by a commercial unit. All signal data are considered during the PCA process, so this technique shows promise to precisely segment clean versus noise-corrupted PPGs.

Psoriasis is a multifactorial cutaneous disorder that in many aspects is influenced by both genetic and environmental elements. IL-20, a member of IL-10 family, is found to be involved in the development of psoriasis. In our previous study, a single-nucleotide polymorphism (SNP) of IL-20-1723C→G (rs1713239) was found to be associated with psoriasis progression, especially in those induced by upper respiratory tract infection. To further explore the underlying mechanism, we investigated the function of this specific variant and its cooperative effect with bacterial-like DNA or IL-1β on regulating IL-20 expression. We found that in HaCat cells, both IL-1β and CpG-A triggered a stronger IL-20 promoter activity with the risk-associated G allele in comparison with the nonrisk C allele of rs1713239. Furthermore, on stimulation with IL-1β or CpG-A, an increased level of IL-20 expression was also observed in psoriatic lesions of patients carrying the risk-associated G allele. This study demonstrates that rs1713239 and infection may have potential synergetic effect on modulating the transcriptional activity of IL-20.