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To investigate the reference range and influeing factors of the nuclear division index (NDI) of peripheral blood lymphocyte in Chinese general population in Anhui province.We selected 281 subjects from the general poulation in Anhui province, without occupational exposure to genetic toxicants and no chronic disease history. We used questionnaires to collect occupational history, age, gender, region, body mass index, smoking, and alcohol drinking status etc. NDI was measured by cytokinesis block micronucleus assay in peripheral blood lymphocytes, and the related factors were also analyzed. And NDI was used as the dependent variable, age, gender and other factors as independent variables to conduct stepwise multiple linear regression.We found the data of NDI according with normal distribution, and the nuclear division index was 1.71±0.22, the minimum value was 1.10 while the maximum was 2.36. The results showed that NDI value of the males (1.67±0.20) were lower than that of the females (1.76±0.24), the difference was statistically significant (t=-3.65, P0.001); current smokers NDI (1.66±0.18) lower than non-smokers (1.73±0.24) differences were statistically significant (t=3.06, P=0.002); the NDI of drinking groups (1.66±0.20) was lower than that of non-drinking population (1.74±0.23), the differences was statistically significant (t=3.15, P=0.002); Using multiple stepwise linear regression calibration factors and found that gender was an independent factor of NDI (β=0.098, Sx=0.027, t=3.66, P0.001).We set the reference value on the nuclear division index among general population of survey areas in this study, it could provide a reference for similar studies and will provide reference for better evaluation of the effects of hazards on the body.

To study the surface radial dose distribution of different length radioactive biliary stents in different activity of (125)I seeds by treatment planning system.After a radioactive biliary stent was positioned in measurement phantom, which were made of solid paraffin and polymethyl methacrylate, a CT scan was performed to get the stent images. The images were then transferred to the treatment planning system for planning. The maximum dose level slice nearest to the center of the stent was selected to calculate the surface radial dose distribution.The length of the stents (F=3 189.160, P0.01) and the activity of the (125)I seeds (F= 811.509, P0.01) can both significantly affect the cumulative radial dose distribution of the radioactive stent. Radial cumulative dose dose (Gy), stent length (cm), (125)I seeds activity (mCi) and distance from the stent surface (cm) meet the regression equation: ln dose =2.565+ 0.208 length+ 1.502 activity-0.738 distance (F=4 929.279, P0.05).The choice of suitable activity of radioactive (125)I should be based on treatment purpose in combination with the length and diameter of lesion and also with reference to the dose table. The measurement results are with smaller uncertainty, which can provide reference for the clinical application of dosimetry.

Cognitive-behavioral therapy (CBT) is the treatment of choice for panic disorder (PD); however, the effectiveness of the treatment is often thought to be diminished in the presence of comorbid conditions. PD and posttraumatic stress disorder (PTSD) commonly co-occur in veteran populations, potentially complicating the effective treatment of each disorder. The individual presented in this case is a female veteran in her mid-50s who received treatment for PD and presented with significant comorbidities (PTSD, histrionic personality traits, major depressive disorder, and chronic suicidality). She participated in an intensive weekend treatment for PD that involved psychoeducation, cognitive restructuring, and interoceptive exposure. This case illustrates the challenges in implementing a manualized treatment for panic with a diagnostically complex veteran and the improvement in panic symptoms despite comorbid presentation.

Background Tuberculosis (TB) has been reported to increase morbidity after kidney transplantation and pose a therapeutic challenge. However, population-based research, specifically focused on the association between kidney transplantation and subsequent pulmonary or extrapulmonary TB, is lacking. Methods A nationwide population-based study was conducted using Taiwan's National Health Insurance Research Database, which provided claims data belonging to kidney transplant recipients during 1997–2006. Multivariate analysis was used to identify independent risk factors for TB after kidney transplantation. Kaplan-Meier survival analysis was used to assess the outcome of patients with TB. Results Among 4554 kidney transplant recipients over the 10-year period, 109 (2.4%) patients with newly diagnosed TB were identified: 75 patients with only pulmonary involvement, and 34 with extrapulmonary spread. The incidence of kidney transplant recipients developing TB was 638 per 100,000 person-years. The independent risk factors for post-transplant TB included cyclosporine-based immunosuppressant agents during the first year after kidney transplantation (odds ratio [OR]: 1.98, P = 0.001), hepatitis C infection (OR: 1.79, P = 0.024), and chronic obstructive pulmonary disease (OR: 1.50, P = 0.041). Kidney transplant recipients who developed TB had a lower 5-year survival rate than those who did not (78.6% vs. 93.4%, P = 0.001). Conclusions Kidney transplant recipients in Taiwan did have a high risk of TB infection, with high proportion of extrapulmonary spread. Physicians need to be vigilant in surveying for TB in kidney transplantation, especially in high-risk patients.

Group-based exposure therapy (GBET) is an intensive group treatment that targets posttraumatic stress disorder (PTSD) symptoms through repeated imaginal and in vivo exposure. The purpose of the present study was to assess the feasibility and acceptability of a modified 12-week course of GBET (modified from the standard 16 weeks) and to examine its effectiveness in reducing veterans' PTSD symptoms. Participants were 10 male Operation Iraqi Freedom and Vietnam-era veterans recruited from a PTSD specialty clinic at a large Veterans Affairs Medical Center. All participants were retained and demonstrated clinically significant reductions in PTSD symptoms (η(2) = .84-.87) comparable to the standard protocol. The findings from this small sample indicate that the abbreviated 12-week GBET protocol is a potentially effective treatment for PTSD.

In China's largest city, Shanghai, dry deposition fluxes of Cd, Pb, As and Hg were 137, 19 354, 2897 and 9.4 μg m−2 a−1, respectively in an urban area, intermediate in a suburban area, and 51.7, 5311, 1703 and 7.3 μg m−2 a−1, respectively in a rural area. Enrichment factors were Cd>Pb>As>Hg. Seasonal variations of metals differed: Pb and As were dominated by fossil fuel combustion, Cd was related to industrial pollution, and natural source controlled Hg levels.

Background and purpose: The relationship between myasthenia gravis (MG) and extrathymic malignancies has not been determined. This study aimed to explore the risk of extrathymic malignancy in patients with MG based on a nationwide population-based dataset. Methods: We identified 2614 patients with MG from the Taiwan National Health Insurance database between 1997 and 2005 and compared the incidence rates of extrathymic malignancies with 15 684 randomly selected age-, sex-, and comorbidity-matched subjects without MG. Both cohorts were followed until the end of 2009. Cox proportional hazard model was used to evaluate the predictors of extrathymic malignancy in the MG cohort, including age, sex, comorbidities, and prescription drugs. Results: After an average follow-up of 8 years, the MG cohort had a higher risk of extrathymic cancers with an incidence rate ratio (IRR) of 1.38 (95% CI 1.12–1.68, P = 0.002) than the control cohort. Although breast cancer was the most common cancer found, no statistically significant relationship between MG and any specific malignancy was observed. Cox multivariate proportional hazards analysis showed that only age (HR = 1.05, 95% CI 1.04–1.06, P

Objective: Relatively little attention has focused on the impact of psychiatric conditions on human subjects' comprehension of consent information. The purpose of this randomized study was to determine whether depression affects comprehension and recall of informed consent information among persons with Parkinson's disease and their caregivers and to evaluate the effects of support on comprehension and recall during the consent process. Method: Comprehension and recall of information were assessed using a modified version of the Modified Quality of Informed Consent Questionnaire, taken 1 week and 1 month later, and scored using a consensus-based algorithm. Participants also completed the Center for Epidemiologic Studies Depression Scale. Data analyses were conducted on 129 patients and caregivers ( t-tests, Fisher's exact tests, and ANCOVAs). Results: T-tests showed no significant differences in comprehension and recall between depressed and nondepressed participants at 1 week and 1 month. However, ANCOVA showed patients with a support person present had significantly higher comprehension and recall at 1 week but not at 1 month compared with controls. Caregivers present with a patient had lower comprehension/recall than those without a patient present ( p = 0.02). Conclusions: Having a support person present during the informed consent process helps depressed PD patients better retain information in the short term, but effects diminish over the long term. Implications for interventions will be discussed.

In vitro studies dealing with amyloid formation by mesangial cells have been reported in the literature in the last decade. Crucial steps in the cascade of events that result in the forma...

This study details results of an open trial of a group psychological treatment for Veterans with posttraumatic stress disorder (PTSD) and chronic posttraumatic nightmares called “Imagery Rescripting and Exposure Therapy” (IRET). IRET is a variant of a successful imagery rescripting treatment for civilian trauma-related nightmares that was modified to address the needs of the Veteran population. Thirtyseven male U.S. Veterans with PTSD and nightmares attended 6 multicomponent group sessions. Findings indicated that the intervention significantly reduced frequency of nightmares and PTSD severity, as well as increased hours of sleep. Unlike the few open trials examining treatment of nightmares in Veterans, effect sizes in this study were similar to those that have been found in the civilian randomized controlled trial. These preliminary findings suggest that a nightmares treatment can be adapted to successfully reduce distress associated with combat Veterans’ chronic nightmares. Clinical and research implications are discussed. © 2011 Elsevier Ltd. All rights reserved.

By combining low-cost printed circuit board technology and focused ion beam techniques, a simple method has been developed to produce thermal microsensors in a robust package with straightforward electrical connectivity. Two devices have been developed to demonstrate the principle. The first was fabricated using a single step process comprised of FIB deposited platinum. The second device utilised a multistep process using FIB milled thermally evaporated Au on a PCB platform with through-plated vias. The performance of these devices was tested by measuring their thermo-electrical characteristics.

With the forthcoming laser intensities (I ≥ 1023 W/cm2), synchrotron radiation in a laser-plasma interaction has attracted particular interest because it can lead to an extremely bright source of γ-rays. Here, a scheme to generate a bright γ-ray pulse with high efficiency is proposed and numerically demonstrated. Using a circularly polarized (CP) laser pulse impinged on a thin foil, a relativistic flying plasma layer is formed. With another counterpropagating CP pulse colliding with the flying layer, it is found that the electrons are efficiently accelerated in the longitudinal direction by the space-charge field. The energetic electrons interact with the counterpropagating CP pulse, producing ultra-brilliant (∼1024 photons/s/mm2/mrad2/0.1%BW) highly dense (∼270nc) femtosecond (∼5 fs) γ-ray pulses. At a moderate laser intensity of 4 × 1022 W/cm2, the fraction of laser energy transferred into the γ-ray pulse is as high as 10%, which is comparable to that previously predicted for an order of magnitude higher in laser intensity. The enhanced γ-photon emission might pave the way for its potential applications in the near future.

Please cite this paper as: Shi Z, Ma L, Yang Y, Wang H, Schreiber A, Li X, Tai S, Zhao X, Teng J, Zhang L, Lu W, An Y, Alla N, Cui T. Adhesion formation after previous caesarean section—a meta-analysis and systematic review. BJOG 2011;118:410–422. Background The optimal technique for performing caesarean section with respect to minimising postoperative adhesions has not been determined. Objectives To evaluate adhesion formation for three common caesarean section techniques in women undergoing repeat caesarean section surgeries. Search strategy A database was constructed from Medline, EMBASE, Cochrane Library, National Science Digital Library, China Biological Medicine Database and through contact with experts in this field from January 1990 to May 2010. Selection criteria Studies were included if they examined adhesion formation in repeat caesarean sections as a primary objective, delineated a clear study design, specified an adhesion scoring system, and had sufficient patient exclusion criteria. Data collection and analysis We abstracted data regarding adhesion formation. The Mantel–Haenszel random-effects model was employed for all analyses using odds ratio or inverse variance, along with 95% CI. Main results Thirty-three qualified studies including 4423 women were analysed. There were 406 adhesions among 571 women and 238 adhesions among 596 women in the Stark’s caesarean section (also known as Misgav–Ladach method) group and modified Stark’s caesarean section group, respectively, with pooled OR 4.69 (95% CI 3.32–6.62; P

Background The number of applications to Canadian cardiac surgery programs has declined recently. Perception of a difficult job market for new graduates may contribute to this decline. The objective of this survey was to document the experience of recent graduates of Canadian cardiac surgery training programs. Methods A 45-question, web-based survey was distributed to all graduates of Canadian cardiac surgery training programs who completed their training between 2002 and 2008. Results Of the 62 estimated recent graduates, 50 completed the survey (81%). Mean age was 36 ± 3 years and 90% were male. The mean number of years of training after medical school was 9.4 ± 1.6 years; 78% completed a graduate degree; and 27% extended their training because of a lack of jobs. When asked about employment, 74% mostly or definitely got the job they wanted, although 34% considered themselves underemployed. Most respondents (98%) considered finding employment for a new graduate in cardiac surgery today difficult or extremely difficult, and 64% believed that there is currently an excess of cardiac surgeons in Canada. Only 54% of participants would strongly recommend cardiac surgery to potential trainees. Conclusions The majority of recent graduates from Canadian cardiac surgery training programs were successful in finding secure employment. A substantial proportion, however, extended their training because of a lack of jobs and reported feeling underemployed. Survey respondents agreed that a new graduate might have difficulty finding a job in cardiac surgery today. These concerns may contribute to the challenges of recruiting to the specialty.

Research indicates that psychiatric comorbidity can limit the effectiveness of evidence-based psychotherapy interventions. Panic disorder (PD) can be effectively treated with panic control treatment. However, the effectiveness of this intervention with comorbid posttraumatic stress disorder (PTSD) is not well established. This case is about a 57-year-old Vietnam Veteran diagnosed with PD with agoraphobia and comorbid PTSD and depression. The veteran participates in 10 sessions of panic control treatment after limited success with pharmacotherapy. He completed a structured clinical interview and self-report measures at pretreatment, 1-week posttreatment and 3-month follow-up. The veteran’s panic attacks were eliminated prior to completing the protocol. He remained panic free at posttreatment and follow-up but continued to meet criteria for PTSD and depression. These findings indicate that comorbid PTSD and depression do not limit the success of panic control treatment for PD. However, treatment effects do not generalize across anxiety disorders. Implications and recommendations are presented.

Obsessive-compulsive (OC)-spectrum conditions consist of neurological-motoric conditions, impulse-control disorders, and disorders associated with bodily preoccupation. This article is a review of some understudied OC-spectrum conditions, with particular focus on phenomenology and overlap with obsessive-compulsive disorder, etiology, treatment outcome, treatment refractory issues, and new developments in treatment research. The focus will be on representative disorders from each related area, namely, Tourette's syndrome, trichotillomania, skin-picking, and body dysmorphic disorder. Similarities among the disorders and areas in need of more research are discussed.

BACKGROUND To observe the efficacy of the combination therapy of mycophenolate mofetil (MMF) and glucocorticoids on steroid-resistant idiopathic membranoproliferative glomerulonephritis (IMPGN) with moderate to heavy proteinuria. METHODS 13 cases were diagnosed as IMPGN by renal biopsy after excluding secondary etiology. 9 patients had heavy proteinuria and another 4 with moderate proteinuria, 9 with hypertension and 11 with decreased renal function. Before MMF therapy, all of them were resistant to treatment of glucocorticoid (prednisone 1 mg/kg/d) for 8 weeks or more. The initial dose of MMF was 1.5 g/d. Patients were followed up every month, including blood pressure, urine protein excretion, liver and kidney function, complete blood count, and adverse events recorded. RESULTS At the initiation, the 24-h urine protein excretion was 4.1 +/- 1.4 g, serum creatinine (Scr) 131.0 +/- 44.9 mmol/l, and estimated glomerular filtration rate (eGFR) 63.3 +/- 26.8 ml/min/1.73 m(2). After prednisone therapy for at least 2 months, the 24-h urine protein excretion and eGFR did not change significantly (p > 0.05). After 3 months of the addition of MMF, 24-h urine protein excretion decreased slightly to 3.8 +/- 1.2 g (p < 0.05),Scr decreased to 127.3 +/- 43.7 micromol/l and eGFR elevated to 65.7 +/- 26.8 ml/min/1.73 m(2), (p < 0.05); after 6 months, 24-h urine protein excretion decreased more significantly (2.5 +/- 0.9 g, p < 0.01), with improved kidney function (Scr 97.2 +/- 27.3 mmol/l and eGFR 81.3 +/- 24.2 ml/min/1.73 m(2), p < 0.01); compared with that before MMF treatment. After 12 months, 24-h urine protein excretion decreased further (1.5 +/- 0.6g, p < 0.01) with kidney function remained stable (Scr 95.9 +/- 22.5 micromol/l and eGFR 81.2 +/- 23.8 ml/min/1.73 m(2)). CONCLUSION MMF combined with glucosteroids could effectively decrease proteinuria and improve renal function on steroid-resistant IMPGN. Further study with a large sample is needed to evaluate the efficacy and safety of MMF in the treatment of IMPGN.

Psychiatric inpatients who demonstrate persistent aggressive behavior present unique treatment planning and placement challenges. This article presents the case of a severely Veteran who demonstrated high levels of aggressive behavior as well as persistent adaptive behavior deficits. A comprehensive Treatment Recovery and Rehabilitation Plan (TRRP) based on Social-Learning Program procedures resulted in rapid improvements in recovery-related outcomes and discharge within 31 days of TRRP initiation. This intervention significantly reduced maladaptive behavior and increased treatment participation.These improvements were unrelated to pharmacotherapy changes during the hospitalization. Following discharge, a re-emergence of problematic behaviors in a community placement resulted in a more restrictive rehospitalization. The absence of TRRP implementation at this placement likely contributed to the re-emergence of problem behavior. This case illustrates the importance of implementing evidence-based psychosocial interventions in acute settings, engaging in recovery-oriented treatment planning, and maintaining continuity of care across settings.

The transition from cellular to dendritic microstructure in directional solidification is investigated in succinonitrile (SCN)–camphor alloys. This transition is found not to be sharp, but occurs locally over a range of velocities or thermal gradients, and the diffuseness of the transition is related to the existence of a range of primary spacing. Within the transition zone, critical cell spacing λ cd is present where a cell just develops sidewise perturbations. An expression for the critical spacing for the onset of sidewise perturbation is obtained, and it is used to establish the conditions for the start and end of the transition. The results of the present study are then synthesized with those in the SCN–acetone system to incorporate the effect of system parameters on the onset of sidewise instability.

Post hoc test comparison. Table S2. On multivariate Cox regression, the daily cumulative fluid was a predictor of mortality for only the Overall population and AKI patients. After adjusted analysis N-AKI patients were not independently associated with a higher risk of death, even with a higher mean cumulative fluid overload. Table S3. FO (%) on ICU discharge for Alive and Death patients. FO (%) for All patients, N-AKI, AKI and AKI-RRT for survivors and non-survivors. (DOCX 19Â kb)

Scores displayed as a pie chart. Figure S2. Fluid balance chart. The red dot represents the diuretics while the area under the curve is the cumulative fluid. The green and blue lines are respectively the total intake and the urine output. (DOCX 250Â kb)

An explosion in a borehole or an accidental explosion in a tunnel will generate a two-dimensional (2-D) compressive wave that travels through the surrounding rock mass. For the problem of 2-D compressive wave propagation in a rock mass with parallel joints in the radial direction normal to the joints, parametric studies on the transmission ratio and the maximum rebound ratio are performed in universal distinct element code. The variation of the transmission ratio with the ratio of joint spacing to wavelength is generalized into a characteristic curve, which can be used as a prediction model for estimating the transmission ratio. The relationship between the maximum rebound ratio and the influence factors is obtained in charts. The charts can be used as a prediction model for estimating the maximum rebound ratio. The proposed prediction models for estimating the transmission ratio and the maximum rebound ratio are applied to a field explosion test, Mandai test in Singapore. The minimum possible values of peak particle velocity (PPV) at the monitoring points are estimated by using the proposed prediction model for estimating the transmission ratio along the radial direction normal to the joints. On the other hand, the maximum possible values of PPV are estimated by using the proposed prediction model for estimating the maximum rebound ratio along the same radial direction. The comparison shows a good agreement between the field-recorded PPVs and the estimated range of PPVs given by the minimum possible PPVs and the maximum possible PPVs at the monitoring points in Mandai test. The good agreement between the estimated and field-recorded values validates the proposed prediction models for estimating peak particle velocity in a rock mass with a set of joints due to application of a compressive wave at the boundary of a tunnel or a borehole.

The concentration of radon in an underground research facility (URF) was measured by setting up 12 sampling points in the URF and with 3 different measurement methods. All the methods were calibrated in the radon laboratory of the No. 6 Institute of Nuclear Industry. The accumulation of radon in the URF was observed before a ventilation system was applied. The reduction of radon concentration in the URF by 1-hour ventilation was also observed. Experimental result indicates that the concentration of radon in the URF increased from 15 to 50 Bq·m−3 in 5 days without ventilation, and decreased to less than 10 Bq·m−3 with 1-hour ventilation. Applying the average working time of 4 hours per day of the workers in the URF, the additional effective dose is 0.75 msv·y−1 when 1 hour ventilation is applied before entering the URF and 13 mSv·y−1 without ventilation. These figures strongly suggest that for the health of the workers, ventilation in such underground research facilities is needed.

The microstructure and damping capacity of Fe–18·39Mn alloy after equal channel angular pressing (ECAP) and annealing treatment were studied. The damping capacity was measured using reversal torsion pendulum. The microstructure was observed using SEM and TEM. The phase structures were determined using XRD. The results indicated that the damping capacity of Fe–18·39Mn alloy all vanished after ECAP and annealing at 600°C, increased rapidly at 700°C, reached the maximum at 900°C and then decreased at 1000°C. All these were ascribed to the change of the size of ϵ martensite plates.

We report scM&T-seq, a method for parallel single-cell genome-wide methylome and transcriptome sequencing that allows for the discovery of associations between transcriptional and epigenetic variation. Profiling of 61 mouse embryonic stem cells confirmed known links between DNA methylation and transcription. Notably, the method revealed previously unrecognized associations between heterogeneously methylated distal regulatory elements and transcription of key pluripotency genes.

Prenatal thalassemia studies from Taiwan show that one-third of fetuses with genetic abnormalities have β-thalassemia major (β-TM). However, the phenotypes and genotypes of adult thalassemia warrant further investigation. From September 2006 to April 2014, 741 male candidates drafted for military service with mean corpuscular volume (MCV)80 fL and serum ferritin20 µg/L were analyzed. The results showed that the detection rates of α- and β-thalassemia (α- an β-thal) were 50.20% (372/741) and 49.12% (364/741), respectively. Only five patients (0.67%) were diagnosed with both α- and β-thal. The - -(SEA)/αα mutation was found in 76.88% (286/372) of α-thal patients. Heterozygous mutations in IVS-II-654 (C T) and codons 41/42 (-TCTT) accounted for 55.77% (203/364) of β-thal cases. The leukocyte counts for α- and β-thal were 6241.74 ± 1552.99 and 6622.87 ± 1814.41 × 10(9)/L, respectively (p = 0.007). The α-thal patients had lower red blood cell (RBC) mass (5.85 ± 0.44 × 10(12)/L vs. 6.09 ± 0.45 × 10(12)/L; p 0.001) and higher hemoglobin (Hb) (12.82 ± 0.72 vs. 12.35 ± 0.71 g/dL; p 0.001) than β-thal patients. Mean serum ferritin values were 169.67 and 241.36 µg/L, respectively, in α- and β-thal patients (p 0.001), indicating more profound ineffective erythropoiesis in β-thal. Only four of the 741 patients underwent further hematological follow-up. Our study suggests that iron overload might be a potential problem in β-thal patients; therefore, regular follow-up is highly recommended.

The recent rise of mobile applications such as Internet of Things (IoT), wearable electronics, and context aware computing has renewed the search for a universal embedded memory technology [1]. Such a technology should combine fast read/write, low voltage operation, low power consumption, non-volatility, infinite endurance, with CMOS process compatibility. Magnetic Random Access Memory based on Spin Transfer Torque phenomena (STT-MRAM) has been recognized as a promising candidate. The technology is innately non-volatile, and it has been shown that STT-MRAM based on perpendicularly magnetized Magnetic Tunnel Junctions (MTJs) can be written at high speed with low power. However, two major challenges remain. The first is to design multilayered MTJs that can withstand temperatures used in CMOS backend processing without any degradation of their magnetic properties. The second challenge is that fast read/write must be achieved not only at the single device level, but on entire memory arrays which requires controlling defects and distributions of magnetic properties.

BACKGROUND AND PURPOSE: White matter abnormalities have been demonstrated to play an important role in minimal hepatic encephalopathy. In this study, we aimed to evaluate whether WM diffusion tensor imaging can be used to identify minimal hepatic encephalopathy among patients with cirrhosis. MATERIALS AND METHODS: Our study included 65 patients with cirrhosis with covert hepatic encephalopathy (29 with minimal hepatic encephalopathy and 36 without hepatic encephalopathy). Participants underwent DTI, from which we generated mean diffusivity and fractional anisotropy maps. We used a Bayesian machine-learning technique, called Graphical-Model-based Multivariate Analysis, to determine WM regions that characterize group differences. To further test the clinical significance of these potential biomarkers, we performed Cox regression analysis to assess the potential of these WM regions in predicting survival. RESULTS: In mean diffusivity or fractional anisotropy maps, 2 spatially distributed WM regions (predominantly located in the bilateral frontal lobes, corpus callosum, and parietal lobes) were consistently identified as differentiating minimal hepatic encephalopathy from no hepatic encephalopathy and yielded 75.4%–81.5% and 83.1%–92.3% classification accuracy, respectively. We were able to follow 55 of 65 patients (median = 18 months), and 15 of these patients eventually died of liver-related causes. Survival analysis indicated that mean diffusivity and fractional anisotropy values in WM regions were predictive of survival, in addition to the Child-Pugh score. CONCLUSIONS: Our findings indicate that WM DTI can provide useful biomarkers differentiating minimal hepatic encephalopathy from no hepatic encephalopathy, which would be helpful for minimal hepatic encephalopathy detection and subsequent treatment.

We read with interest ‘Efficacy and safety of long-term treatment with lenalidomide and dexamethasone in patients with relapsed/refractory multiple myeloma'.1 Dimopoulos et al. reported a retrospective post-hoc pooled analysis by using the data from two randomized trials, MM-009 and MM-010, which showed improved outcomes in patients with relapsed/refractory multiple myeloma treated with lenalidomide and dexamethasone. An important finding in Dimopoulos's report is the association between humoral improvement (uninvolved immunoglobulin A) and the long-term benefit of therapy. It shows humoral responders had better progression-free survival and overall survival compared with humoral nonresponders, in Figure 2. However, humoral response could occur at anytime from cycle one to ten. If the data was analyzed by using a log-rank test or time-independent Cox regression model, it is likely that an ‘immortal time bias' could interfere with this result.2, 3, 4, 5 ‘Immortal time' refers to a time interval during the follow-up period in which the outcome could never occur because of exposure definition. For example, death cannot occur in the first 5 months of follow-up, in patients who had humoral response after at least six cycles (of each 28-day cycle). In conventional survival analysis, the immortal time bias can confer a spurious survival advantage to the responder group if the response is measured in the middle of the follow-up period but not at the beginning of the trial. Humoral improvement might predict the outcomes of the patients with multiple myeloma. Nevertheless, the result should be analyzed using time-dependent analysis,2, 5 such as Cox regression with response status as a time-dependent covariate. We look forward to see such reanalysis of the original data.

The self-anchored suspension bridge provides a competitive solution for bridges with short or moderate spans. This paper introduces some key techniques used in three concrete, self-anchored suspension bridges in China: GoldenBay Bridge, LanQi Bridge and WanXin Bridge. GoldenBay Bridge was the first concrete self-anchored suspension bridge in China. WanXin Bridge has a main span of 160 m. The appropriate structural forms were designed to take account of their different geographic positions, surrounding environments and functions. In the WanXin Bridge, two sliding saddles and one fixed saddle are set at each end of the main girder. The cables are made of a continuous galvanised steel rope passing over all saddles, and the two main cables form a closed loop. It was the first time that the practice of using a looped main cable had been utilised in China. Currently, the WanXin Bridge has the longest span of all concrete, self-anchored suspension bridges in the world. The final part of the paper describes the model investigation, developed to understand the basic structural behaviour of the WanXin Bridge.

Focused ion beam (FIB) technology was used to fabricate thermally actuated cantilever arrays using silicon nitride membrane chips for microelectromechanical systems (MEMS) applications. Sequential modification and test is made possible by the dualbeam FIB/SEM. A fabrication route based largely on the use of FIB etch and deposition steps applied to a silicon nitride membrane chip resulted in the formation of readily released bimorph structures with lengths

Octakis(3,3,3-trifluoropropyldimethylsiloxy)cyclotetrasiloxane ( I ), octakis[tridecafluoro-2,2,5,5-tetramethyl-2,5-disilatridecanoxy]cyclotetrasiloxane ( II ), and octakis(7-pentafluorophenyl-2,2,5,5-tetramethyl-2,5-disilaheptanoxy)cyclotetrasiloxane ( III ) have been prepared and characterized. Reaction of octakis[chloro calcium oxy]cyclotetrasiloxane (Ca 8 Si 4 O 12 Cl 8 ) with 3,3,3-trifluoroproyldimethylchlorosilane yields I , II , and III , on the other hand, have been prepared by platinum catalyzed hydrosilylation reactions of octakis(vinyldimethylsiloxy)cyclotetrasiloxane with tridecafluoro-1H,1H,2H,2H-octyldimethylsilane and 2-pentafluorophenyl-1H,1H,2H,2H-ethyldimethylsilane, respectively.

Physicians and possibly psychologists are likely to be at the center of clinical care for persons with Tourette's Syndrome (TS). To date, it is unclear (a) how much basic knowledge these health care providers possess about the disorder, (b) how much incorrect or untested information is believed about the disorder, (c) what the perceived role of a psychologist is in the treatment process, and (d) if physicians and psychologists are familiar with, or desire more information about, habit reversal, an effective nonpharmacological procedure used to reduce tics. To study these topics, a survey was sent to 443 physicians and psychologists. Of the 67 surveys returned, results showed that the health care professionals responded correctly to 77% of the general knowledge items about TS. No differences in TS-related knowledge were found between physicians and psychologists, but there was a trend toward those with experience treating TS being more knowledgeable than those without experience. Regarding beliefs about incorrect or empirically untested information about TS, few professionals believed that allergies or diets affected tics, but considerably more believed that persons with TS had the ability to suppress tics, and that doing so produced a “rebound” in tic occurrence. A large portion of the sample also believed that discussing tics with a person who had TS made the tics worse. There was some disagreement among professionals as to the role psychologists could play in the clinical management of TS. Psychologists, more so than physicians, believed the psychologist's role could involve treating tics, educating the patient about the disorder, and treating ADHD, depression, and family difficulties. A small percentage of both groups had heard of habit reversal, but up to 63% wanted to learn more. Implications of the findings and limitations to the study are discussed.

This paper reports on 2 studies designed to examine the contribution of affective variables on the expression of body-focused repetitive behaviors (BFRBs; e.g., skin picking, nail biting). The first study revealed that persons engaging in a BFRB experienced significantly higher levels of anxiety and depression than those without BFRBs. The second study was conducted to determine if repetitive behaviors were differentially affected across various emotional states and across those persons with and without BFRBs. Participants were randomly exposed to anxiety, depression, boredom, and control conditions. Results showed no differential effects on the occurrence of repetitive behaviors within the no-BFRB group; however, the BFRB group engaged in more repetitive behaviors in the Bored condition than in the Control condition. This study offers the first experimental evidence that emotional variables can have a differential impact on the expression of BFRBs.

Triflic acid and P4-t-Bu superbase both catalyze the ring-opening polymerization (ROP) of 2,2,4,4,6,6-hexamethyl-8,8-diphenylcyclotetrasiloxane (I) to yield a mixture of linear copoly(dimethylsiloxane/diphenylsiloxane) (3:1 mole ratio), low molecular weight oligomer and cyclic siloxanes. The molecular weight distribution, microstructure and thermal properties of the copolymers have been determined. The composition of the low molecular weight fractions have been analyzed. Triflic acid catalyzed ROP of I yields a copolymer whose microstructure can be accounted for by chemoselective ring opening of a single silyloxonium ion intermediate. In addition, 40% of I is recovered. On the other hand, P4-t-Bu superbase catalyzed ROP of I yields a copolymer whose microstructure is random. The low molecular weight fraction, in this case, is made up of oligomer and a number of cyclotetra-, cyclopenta- and cyclohexasiloxanes.

Ring-opening polymerization (ROP) of 2,2,4,4,6,6-hexamethyl-8,8-divinylcyclotetrasiloxane (I) initiated by both 1-tert-butyl-4,4,4-tris(dimethylamino)-2,2-bis[tris(dimethylamino)phosphoranylidenamino]-2λ5,4λ5-catenadi(phosphazene) (C22H63N13P4, P4-t-Bu superbase) and trifluoromethanesulfonic acid (CF3SO3H, triflic acid) has been studied. Both reactions lead to mixtures of linear copolymer, low molecular weight co-oligomers and monomeric cyclosiloxanes. The composition, molecular weight distribution, microstructure, and thermal properties of the copolymers have been determined. The copolymer microstructure has been determined by 29Si NMR spectroscopy. Monomeric cyclosiloxanes have been identified by GC/MS. Both copolymer microstructure and cyclosiloxanes formed depend on the particular catalyst system utilized. P4-t-Bu superbase-initiated anionic ROP of I leads to a copolymer with a random microstructure and to a series of monomeric cyclotetra-, cyclopenta-, and cyclohexasiloxanes formed by random combinat...

The purpose of our study was to determine long-term survival, shunt patency, and quality of life in patients after creation of a transjugular intrahepatic portosystemic shunt (TIPS).We followed up 103 patients who underwent TIPS for a mean of 20.10 +/- 25.58 months (range, 1 day-92 months). Various statistical methods were used to analyze long-term survival, shunt patency, and correlation with Child-Pugh classification and indications for TIPS. The Rand 36-Item Health Survey 1.0 was used to assess quality of life over time.The cumulative survival rate was 68%, 60%, 50%, 41%, and 41% at years 1-5, respectively. The cumulative survival rate was significantly higher for patients classified as Child-Pugh class A or B versus those classified as class C (p0.01), as well as for patients with the original indication of variceal bleeding versus refractory ascites or hydrothorax (p0.01). No significant difference in survival rates was found between patients with Child-Pugh A and those with Child-Pugh B. The cumulative primary patency rate was 50%, 34%, 21%, 13%, and 13% at years 1-5, respectively, with assisted patency rate of 80%, 61%, 46%, 42%, and 36%. Cumulative secondary patency rate was 85%, 64%, 55%, 55%, and 55% at years 1-5. Mean follow-up time in 33 patients who completed quality-of-life questionnaires with one follow-up was 17.46 months. Scores after TIPS in all nine of the health categories were higher than those preprocedure with statistically significant improvement in four categories. The second follow-up was completed by 21 patients at a mean of 30.58 months after TIPS creation. Both scores after TIPS were higher than those before TIPS, and scores in five categories were further improved at the second surveillance (p0.0, only for health change), whereas in four categories, the scores were slightly worse.TIPS has positive efficacy both for controlling bleeding or ascites and for improving the quality of life. The precise impact of TIPS on long-term survival, however, requires further clarification.

To economically enhance the performance of active/passive control devices for seismic response reduction of tall buildings, this paper investigates the optimal placement and optimal parameter of control devices using the linear quadratic performance index as an objective function. The linear relation between the increment of performance index and the change of the position matrix of control devices is first established based on the assumption that the control gain remains unchanged. The optimal placement of control devices is then determined in terms of the sequence of the calculated performance index increments and the number of control devices to be used. With the control devices at their optimal places, the seismic response of the building is finally computed using the suboptimal control gain derived using the minimum error principle, from which the equivalent optimal parameters of passive devices can be also determined. The applicability of the proposed approach and its limitation are carefully examined through numerical examples. The results from the numerical examples show that the suggested approach is quite accurate and effective in determining the optimal placement and optimal parameter of control devices if the number of removed control devices is limited to a certain range. Copyright © 2002 John Wiley & Sons, Ltd.