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We present and compare the design and performance of two 850 GHz radial probe fed superconductor-insulator-superconductor mixers, where the antenna is aligned perpendicular to the E-Plane of the input full-height rectangular waveguide connected to a multiple flare-angles smooth-walled horn. Both designs are comprised of 0.5 µm2 hybrid niobium/aluminium-nitride/niobium-nitride tunnel junction, fabricated on top of a niobium titanium nitride ground plane with an Al wiring layer. The entire superconducting circuit is supported with a 40 µm thick quartz substrate. The major difference between the two designs is the method used to cancel out the parasitic junction capacitance for broadband performance. The first design utilises two identical junctions connected in parallel with a short transmission line to convert the capacitance of one junction into the equivalent inductance of the other junction, commonly known as the twin-junction tuning scheme; whilst the second design employs an end-loaded scheme with only one tunnel junction. We found that both methods offer similar radio frequency performances, with close to 2× the double sideband quantum noise temperature, but the twin-junction design is more resilient to fabrication tolerances. However, the end-loaded design offers a much better intermediate frequency (IF) bandwidth performance, made possible by the sub-micron and high current density tunnel junction technology. The improved IF performance is important for many millimetre (mm) and sub-mm observatories, such as future upgrades of Atacama Large Millimetre/sub-mm Array receivers, as well as forthcoming space-borne far-infrared missions. Therefore, we conclude that the single-junction mixer design is the preferred option for THz applications, as long as the fabrication error can be minimised within a certain limit.

Background Despite similar survival rates, breast-conserving therapy (BCT) remains a distant second choice after simple mastectomy for patients with early-stage breast cancer in Singapore. Uptake of reconstruction after mastectomy is also low (18 per cent). The aim of this study was to explore the factors influencing a patient's choice for mastectomy when eligible for BCT, and why patients decline reconstruction after mastectomy. Methods Patients from the National Cancer Centre Singapore, who were eligible for BCT but chose mastectomy without reconstruction, between December 2014 and December 2015 were included. An interviewer-administered questionnaire focusing on patients' reasons for choosing mastectomy over BCT and not opting for immediate breast reconstruction after mastectomy was used. Tumour characteristics were retrieved from medical records. Spearman's rank correlation coefficient, Mann-Whitney U and Kruskal-Wallis tests were used to analyse the correlation between the patient's self-rated influential factors and variables. Statistical significance was taken as P

Introduction Several studies highlighted an increased risk of cardiovascular disease (CVD) in HIV-HCV co-infected patients without clearly identifying specific virologic factors associated with atherosclerotic CVD (ASCVD) events. Purpose Hence, we analyzed data collection from the French nationwide ANRS CO13 HEPAVIH cohort to determine the incidence of ASCVD events in HIV-HCV co-infected patients and the predictive factors associated with its occurrence. Methods The French multicenter nationwide ANRS CO13 HEPAVIH clinic-based cohort collected prospective clinical and biological data from HIV-HCV co-infected patients followed-up in 28 different university hospitals between December 2005 to November 2016. Participants with at least one year of follow-up were included. Primary outcome was the occurrence of major ASCVD events (cardiovascular death, acute coronary syndrome, coronary revascularization and stroke). Secondary outcomes were total ASCVD events including major ASCVD events and minor ASCVD events (peripheral arterial disease [PAD]). Incidence rates were estimated using Aalen-Johansen method and factors associated with ASCVD identified with Cox proportional hazards models. Results A total of 1213 patients were included: median age 45.4 years [42.1–49.0], 70.3% men, current smoking 70.2%, overweight 19.5%, liver cirrhosis 18.9%, chronic alcohol consumption 7.8%, diabetes mellitus (5.9%), personal history of CVD 2.7%, and statins use 4.1%. After a median follow-up of 5.1 years [3.9–7.0], 44 participants experienced at least one ASCVD event (26 major ASCVD event, and 20 a minor event). Incidences for total, major and minor ASCVD events were of 6.98 [5.19; 9.38], 4.01 [2.78; 6.00], and 3.17 [2.05; 4.92] per 1000 person-years, respectively. Personal history of CVD (Hazard Ratio (HR)=13.94 [4.25–45.66]), high total cholesterol (HR=1.63 [1.24–2.15]), low HDL cholesterol (HR=0.08 [0.02–0.34]) and undetectable HIV viral load (HR=0.41 [0.18–0.96]) were identified as independent factors associated with major ASCVD events while cirrhosis status, liver fibrosis and HCV sustained viral response were not. Cumulative incidence of CV events Conclusion HIV-HCV co-infected patients experience a high incidence of ASCVD events both coronary and peripheral artery diseases. Traditional CV risk factors are the main determinants of ASCVD whereas undetectable HIV viral load seems to be protective. Management of cholesterol abnormalities and controlling viral load are essential to modify this high cardiovascular risk. Acknowledgement/Funding Agence Natoinale de Recherche sur le SIDA et les Hépatites virales

Summary Background Coronary heart disease is rapidly increasing in developing countries, but access to cardiac rehabilitation and secondary prevention remains low. In this study, we aimed to assess the effectiveness of a smartphone-based cardiac rehabilitation and secondary prevention programme delivered via the social media platform WeChat (SMART-CR/SP). Methods In this parallel-group, single-blind, randomised controlled trial, we recruited patients aged 18 years or older with coronary heart disease who had received percutaneous coronary interventions from a large tertiary hospital in Shanghai, China. Participants were randomly assigned (1:1) by block randomisation to either a 2-month intensive programme followed by a 4-month step-down phase of SMART-CR/SP or to usual care. In the SMART-CR/SP group, participants received comprehensive cardiac rehabilitation and secondary prevention via WeChat. The usual care group received standard outpatient cardiology follow-up but without formal cardiac rehabilitation and secondary prevention. Assessments were done at baseline, 2 months, 6 months, and 12 months. The primary outcome was change in functional capacity from baseline, measured by 6-min walk distance, at 2 months and 6 months. Analysis was by intention to treat. Research personnel involved in assessments were blinded to group allocation. Adverse-event analysis was based on percentage of patients who discontinued the study owing to adverse events. SMART-CR/SP programme-related safety issues were also recorded. This study was registered with the Chinese Clinical Trial Registry, number ChiCTR-INR-16009598. Findings Between Nov 17, 2016, and March 18, 2017, 312 patients (mean age 60·5 years [SD 9·2]), of whom 58 (19%) were female and 254 (81%) were male, were recruited and subsequently randomly assigned to SMART-CR/SP (n=156) or usual care (n=156). The improvement in 6-min walk distance at 2 months was significantly greater in the SMART-CR/SP group (from 489·2 m [99·4] at baseline to 539·1 m [68·0]) than in the control group (from 485·0 m [93·5] at baseline to 517·8 m [74.6]), with an adjusted mean difference of 20·64 m (95% CI 7·50–33·77; p=0·034). This improvement was maintained at 6 months (mean 6-min walk distance 543·4 m [67·5] in the SMART-CR/SP group vs 523·5 m [60·2] in the control group), with a mean between-group difference of 22·29 m (8·19–36·38; p=0·027). No adverse events or SMART-CR/SP programme-related safety issues were reported by participants during the study. Interpretation SMART-CR/SP was found to be a cardiac rehabilitation and secondary prevention service model with high efficacy and accessibility and to be easy to use. These results justify the implementation of similar models of care on a broader scale. Funding Curtin University.

Background: Coronary heart disease (CHD) is rapidly increasing in developing countries, but access to cardiac rehabilitation and secondary prevention (CR/SP) remains low. We assessed the effectiveness of SMARTphone and WeChat-based CR/SP (SMART-CR/SP) in the first randomised controlled trial (RCT) of a dedicated social media-based CR/SP program for patients with CHD. Methods: In this parallel-group, single-blind, RCT, CHD patients from a large tertiary hospital in Shanghai, China were randomised (1:1) to an eight-week 'intensive', followed by a 16-week 'step down' program of SMART-CR/SP, or usual care. Assessments were conducted at baseline, eight and 24 weeks. The primary outcome was functional capacity measured by six-minute walk test distance (6MWTD). Secondary outcomes included CHD knowledge, and risk factor control. Analysis was by intention-to-treat. Findings: Between November 17, 2016 and March 18, 2017, 312 patients (mean age, 60.5 [SD 9.2] years, 81.4% male) were randomised to SMART-CR/SP (n=156) or usual care (n=156). The mean increase in 6MWTD was greater at both eight (46.5 vs. 20.9 m; 95% CI 9.6 to 41.5; p=0.002) and 24 weeks (54.2 vs. 26.2 m; 95% CI 10.9 to 44.9; p=0.001) in the SMART-CR/SP group versus controls. The SMART-CR/SP group had a better knowledge of CHD score at eight (17.9 vs. 13.8; 95% CI 2.84 to 5.44; p

Introduction The burden of cardiovascular disease (CVD) is rapidly increasing in developing countries, however access to cardiac rehabilitation and secondary prevention (CR/SP) in these countries is limited. Alternative delivery models that are low-cost and easy to access are urgently needed to address this service gap. The objective of this study is to investigate whether a smartphone and social media-based (WeChat) home CR/SP programme can facilitate risk factor monitoring and modification to improve disease self-management and health outcomes in patients with coronary heart disease (CHD), after percutaneous coronary intervention (PCI) therapy. Methods and analysis We propose a single-blind, randomised controlled trial of 300 patients post-PCI with follow-up over 12 months. The intervention group will receive a smartphone-based and WeChat-based CR/SP programme providing education and support for risk factor monitoring and modification. SMART-CR/SP incorporates core components of modern CR/SP: physical activity tracking with interactive feedback and goal setting; education modules addressing CHD understanding and self-management; remote blood pressure monitoring and strategies to improve medication adherence. Furthermore, a dedicated data portal and a CR/SP coach will facilitate individualised supervision and counselling. The control group will receive usual care but no formal CR/SP programme. The primary outcome is change in exercise capacity measured by 6 minute walk test distance. Secondary outcomes include knowledge and awareness of CHD, risk factor status, medication adherence, psychological well-being and quality of life, major cardiovascular events, re-hospitalisations and all-cause mortality. To assess the feasibility and patients’ acceptance of the intervention, a process evaluation will be performed at the conclusion of the study. Ethics and dissemination Ethics approval was granted by both the Human Research Ethics Committee of Fudan University Zhongshan Hospital (HREC B2016-058) and Curtin University Human Research Ethics Office (HRE2016-0120). Results will be disseminated via peer-reviewed publications and presentations at conferences. Clinical trial registration number ChiCTR-INR-16009598; Pre-results.

The most commonly utilized class of chemotherapeutic agents administered as a first-line therapy are antimitotic drugs; however, their clinical success is often impeded by chemoresistance and disease relapse. Hence, a better understanding of the cellular pathways underlying escape from cell death is critical. Mitotic slippage describes the cellular process where cells exit antimitotic drug-enforced mitotic arrest and “slip” into interphase without proper chromosome segregation and cytokinesis. The current report explores the cell fate consequence following mitotic slippage and assesses a major outcome following treatment with many chemotherapies, therapy-induced senescence. It was found that cells postslippage entered senescence and could impart the senescence-associated secretory phenotype (SASP). SASP factor production elicited paracrine protumorigenic effects, such as migration, invasion, and vascularization. Both senescence and SASP factor development were found to be dependent on autophagy. Autophagy induction during mitotic slippage involved the autophagy activator AMPK and endoplasmic reticulum stress response protein PERK. Pharmacologic inhibition of autophagy or silencing of autophagy-related ATG5 led to a bypass of G1 arrest senescence, reduced SASP-associated paracrine tumorigenic effects, and increased DNA damage after S-phase entry with a concomitant increase in apoptosis. Consistent with this, the autophagy inhibitor chloroquine and microtubule-stabilizing drug paclitaxel synergistically inhibited tumor growth in mice. Sensitivity to this combinatorial treatment was dependent on p53 status, an important factor to consider before treatment. Implications: Clinical regimens targeting senescence and SASP could provide a potential effective combinatorial strategy with antimitotic drugs. Mol Cancer Res; 16(11); 1625–40. ©2018 AACR.

Lafarge Infrastructure Team had constructed Malaysia's first hybrid concrete pavement using Jointed Plain Concrete Pavement (JPCP) and Roller Compacted Concrete (RCC) at Lafarge's Kanthan Cement Plant, Ipoh, Malaysia. The main purpose of the project is to showcase and study construction challenges in combining JPCP and RCC hybrid product for road solutions. The progress and pavement performance were monitored recorded and detailed through tests and site observation reports. JPCP pavement was constructed using two (2) type of construction methods; slip form and fixed form, while RCC pavement was laid and constructed using an asphalt paver set. The Quality Assurance & Control (QA/QC) monitored comprises of concrete design mix, concrete slump, concrete delivery, joints insertion, concrete curing, compaction, profile levels, saw cut and sequence of construction activities. Throughout the study, we have managed to table out the "Challenges and Best Practices" on the construction methods which mainly involves labours, machinery and material. All the information has been taken into consideration, to prepare a comprehensive report for the project. The study will enhance the knowledge and understanding for road owners, concrete suppliers, consultants and contractors in understanding the right application of JPCP and RCC in the future. We able to share and propose few best practices based on the challenges that we had face.

Sao Paulo State Univ UNESP, Ctr Human Reprod Prof Franco Jr, Paulista Ctr Diag Res & Training, Dept Gynecol & Obstet,Botucatu Med Sch, Ribeirao Preto, Brazil

This article outlines the process of developing a quantitative instrument and livelihood asset index. The intent of the index was to assess household perspectives of the impact of the removal of explosive remnants of war on livelihoods. Conducted in the Lao People’s Democratic Republic, the study used a sequential mixed methods design. It began with a qualitative component, which informed instrument development. The article discusses the instrument development process and some of the challenges faced. These included developing a reliable livelihood asset index and finding the limitations of quantitative indexes in this setting. Another challenge was reconciling tensions in mixing methods informed by different worldviews.

The healthcare cost of managing osteoporotic fractures is projected to rise because of the change in population demographics. To reduce the fracture epidemic, strategies are needed to identify those at risk early to allow preventative intervention to be implemented. The aim of this study was to investigate if low-cost community-based assessments, such as calcaneal ultrasound and falls risk assessments, can discriminate a group of elderly women at risk of osteoporotic fracture from those at lower risk. Over the period of 2002-2003, 104 community-dwelling women (mean age 71.3, standard deviation 5.8) were recruited via various modes including advertisements in community newspaper and community centres. These women underwent dual-energy X-ray absorptiometry bone mineral density (BMD) and calcaneal quantitative ultrasound (QUS) measurements; spinal radiography; and performance-based assessment of strength, mobility and balance. The women were classified into a 'high risk' (osteoporotic) group, based on low BMD (T-score of

Following the publication on the principle and theory of a newly proposed non-imaging focusing heliostat, this paper presents a report on the design, optical alignment and application of the first prototype heliostat. In the architecture of the first prototype, 25 mirrors, each with a dimension of 40×40 cm, are arranged into five rows and five columns to form a total reflective area of 4 m2. The design of the essential part of the first prototype heliostat will be discussed in this paper, which consists of two primary elements; a rotation–elevation system for tracking a mirror support frame which carries 25 mirror facets, and a separate two-axis tracking system for compensating (each second) off-axis aberrations of 24 slave facets relative to the central mirror, which is fixed in the mirror frame. The rotation–elevation system consists of a pedestal supporting a rotational tracking mechanism carrying a U-shaped arm and a second tracking system for tracking a moving frame in elevation. The moving frame carries a central stationary (relative to the frame) mirror, called a master mirror. Slave mirrors are arrayed in five rows and five columns, and eight stepper motors drive the outer four rows and columns relative to the master mirror via a computer programme implementing newly proposed formulas to eliminate the first-order aberration. With a second stage concentrator comprising a small aperture size parabolic mirror (diameter of 60 cm), a cost-effective high temperature solar furnace was constructed. In our experiment, the highest furnace temperature of 3400°C has been recorded through the melting of pure tungsten wires.

In this study, column tests were used to determine the retention capability of three types of estuarine alluvia collected adjacent to landfill sites in South Wales. Selective sequential extraction (SSE) was used to study the retention mechanisms of heavy metals in the soil columns obtained from leaching experiments. Acid digestion was later used to check the validity of the SSE results. Breakthrough curves show good retention of heavy metal ions (Pb, Cu, and Zn) by all soils, where almost 99% of heavy metals were retained with the Ce/Co values in the order of 10−3. The retention strength of these soils was observed to be constant up to five pore volumes (PV). This corresponds with the pH of the effluents and pore water of soil slices, which also show good buffering capacity against very acidic leachate up to 5PV. The heavy metal extraction profiles from SSE show very similar trends with the retention profiles from the leaching experiments, where heavy metals were retained mainly at the top part where the leachate entered the column. SSE indicates qualitatively that heavy metals precipitated with carbonates and amorphous materials (oxides/hydroxides) are higher than heavy metal retention via exchangeable mechanisms. The mass balance calculation gives range of deviation of 1–16% of the total soil extraction. The distribution of the heavy metals with various soil constituents are ranked in the following order: Carbonates>Amorphous oxides hydroxides>Organic matter>Exchangeable phases.

The ‘internet-driven information age’ is a term in common usage, implying that everyone can access all the information they need, when they need it. The purpose of this brief paper is to outline some web sources that highlight the possibilities and potential for accessing web-based knowledge. From this the clinician will be encouraged to follow leads along the labyrinth of links to a greater appreciation of how this resource can be used to shape their practice. Examples of web links are provided for: search engines; library-based sources, including medical databases and electronic journals; evidence-based practice databases, mail-groups; electronic conferences; research centres; and general health sources. Importantly, this review does not aspire to be all-inclusive, for the web changes, chameleon-like, to the seasons. The web is here to stay. It will provide the framework for much education and will guide clients to a greater appreciation of their disease or disability than ever before. It may ultimately be the tool through which health fund agents will promote best practice, including self-help to clients, and therefore direct discriminating individuals to select health practitioners who have been endorsed by professional and fund agencies as providing a contemporary service which conforms to evidence-based practice.

The lower trapezius island myocutaneous flap is a useful flap in head and neck reconstruction. It is thin and pliable and can reach defects in most areas of the head and neck. Its usefulness in head and neck reconstruction has often been limited or discouraged by reports of significant failure rates. In this study, the vascular anatomy and clinical use of the extended lower trapezius myocutaneous flap based solely on the dorsal scapular artery system are elucidated, and experience gained performing 20 flaps over the past 5 years by using the extended lower trapezius myocutaneous flap is reported. The vascular anatomy of the dorsal scapular artery system is reviewed in 13 fresh cadaveric dissections by using methylene blue, latex injection studies, and radiologic examination.

This study focuses on the basic test and evaluation requirements necessary for a successful competency assessment of the contaminant attenuation capability of clay soils. Two clay soils from South Wales were chosen for study. Of particular interest is the problem of specification of ‘ necessary and sufficient tests ’ for proper assessments of competency. The tests and evaluation protocols leading towards confident competency assessment of the candidate clay soils are developed. Soil column leaching studies, together with results from analyses of the physicochemical and mineralogical characteristics of the soils, are used to determine clay soil contaminant attenuation capability. The results demonstrate that reliance on a limited amount of information can lead to some inappropriate premature interpretations that can prove to be harmful. In a situation where attenuation of dissolved metals is important, only one of the soils tested is considered to be an adequate clay soil for a clay engineered barrier.

Physical and chemical properties were used to determine the capability of several types of soil as a natural barrier system. Six types of soils were collected adjacent to a landfill in Selangor. The results indicate that marine clay from Sg. Besar in Kuala Selangor (SBMC) and metasediment soil from Kg. Rang Tuah in Batang Berjuntai (RMS) have good potential as natural liner materials compared to weathered quartzite from Ayer Ritam, Puchong (PMS), river alluvium from Sg. Sedu, Rulu Langat (SRA), river alluvium from Ampar Tenang, Sepang (ARA), and metasediment from Sg. Kembong, Rulu Langat (KMS). The capability of soils can be ranked as follows: SBMC > RMS > PMS > SRA > ARA> KMS. PENDAHULUAN

Cryosurgery for tumoural ablation traditionally involves instilling liquid nitrogen into a tumoural bed. The inability to control precise delivery can result in potentially disastrous consequences of skin necrosis and nitrogen gas embolism. In this study, we evaluated a probe-based closed cryosurgical system, which eliminates these risks.We performed a prospective evaluation of 36 cases of bone tumours treated with a probe-based cryosurgical system at the National University Hospital, Singapore. Cases consisted of patients with benign aggressive tumours (42%), primary malignant bone tumours (25%) and bone metastases (33%). In primary bone tumours, the aim of therapy was cure. In bone metastasis, the aim of therapy was palliation defined as the relief of symptoms for the patients' remaining lifetime.In the primary bone tumour group, no recurrences were reported. In the metastases group, where the intention was palliation, there were 3 cases of radiological relapses (P = 0.02) and 2 clinical relapses. Kaplan-Meier evaluation showed a statistically significant tendency for radiological relapse in metastatic disease versus primary disease (P = 0.02). Median time for relapse free survival in the metastatic group was 17 months (P = 0.01). There were 4 deaths in the metastatic group due to progression of disease unrelated to the index region of cryosurgical treatment. There were no deaths in the primary bone tumor group. We had 2 complications from this therapy involving fractures through the cryoablated segments. One case healed spontaneously and the other was most expediently managed with a shoulder hemiarthoplasty. There were no skin burns or embolic complications.Good clinical efficacy with probe delivered cryotherapy has been shown in this group of 32 patients with cure in all primary disease. Relapse occurred in only a small proportion of patients with bone metastasis.

Metformin is a widely used and extensively studied insulin sensitising drug for the treatment of women with polycystic ovary syndrome (PCOS), with various actions in tissues responding to insulin that include the liver, skeletal muscle, adipose tissue, the endothelium of blood vessels, and the ovaries. Treatment of PCOS women with metformin has been shown to reduce fasting glucose levels, blood pressure, and serum androgens; further effects of metformin in women with PCOS may include direct effects on the central nervous system; and indirect effects via the modification of gut hormone and adipokine synthesis and/or secretion. A number of "novel" adipokines and metabolic factors have been recently identified which may play a role both in the pathogenesis and the treatment of women with PCOS. We here discuss recent advances in the area, with a focus on neuroendocrine and endocrine dysfunctions in women with PCOS and the potential role of metformin in this context.

The prevalence of chronic diseases and their risk factors in different general populations are well documented, but little is known about disabled populations in China.The purpose of this study is to report available data on the medical profile of disabled persons living in Zhabei District, Shanghai, Mainland China. It also aimed to explore the association between any medical conditions, types and severity of disabilities and socio-demographic factors.Nine hundred and sixty-one disabled persons underwent physical medical examination to identify predisposing conditions for chronic diseases (hypertension and elevated glucose, lipids and triglyceride levels) and to diagnose two common chronic diseases - heart disease and diabetes. Logistic regression was used to assess the influence of age, gender, disability type, disability severity, education level, employment status, socio-economic status or marital status on chronic diseases and predisposing factors.The mean age of the participants was 53 (±12.5) years. The most prevalent types of disability were physical disability (44.9%), visual impairment (28.8%) and intellectual disability (12.5%). Hyperlipidemia was most prevalent (17.1%), followed by hypertension (15.3%), heart disease (7.2%) and diabetes (6.0%). These conditions were not associated with the type or the severity of disability in this sample. Males were more likely to have hypertension (OR=1.75; 95% CI: 1.05, 2.93) and elevated triglycerides (OR=1.84; 95% CI: 1.05, 3.20). The unemployed (OR=4.80, 95% CI: 1.45, 15.76) and older participants (OR=1.04, 95% CI: 1.02, 1.07) were more likely to have elevated blood glucose levels. Divorced individuals were more likely to be diagnosed with heart disease (OR=3.72; 95% CI: 1.37, 10.09) and those with better socio-economic backgrounds (OR=3.09; 95% CI: 1.05, 9.15) and the older disabled (OR=1.08, 95% CI: 1.04, 1.12) were more likely to have diabetes.This preliminary study found that abnormal clinical findings were not related to the type or the severity of disability. Most abnormal findings were, however, related to increasing age, consistent with previous findings in the general Chinese population.

Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by local inflammation of the upper airways and sinuses and is frequently divided into polypoid CRS (CRSwNP) and nonpolypoid CRS (CRSsNP). However, the mechanism of inflammation in CRS has still not been fully elucidated. The aim of the study was to investigate the role of interleukin-32 (IL-32), a recently discovered proinflammatory cytokine, in CRS. We collected nasal epithelial cells and nasal tissue from patients with CRS and control subjects. We assayed mRNA for IL-32 by real-time PCR and measured IL-32 protein using ELISA, Western blot, and immunohistochemistry. The expression of mRNA for IL-32 was elevated in epithelial cells from uncinate tissue from patients with CRSsNP compared with patients with CRSwNP (P 0.05), control subjects (P=0.06), and epithelial cells from nasal polyp (NP) tissue (P 0.05). Production of IL-32 was induced by IFN-γ, TNF, and dsRNA in primary airway epithelial cells. In whole-tissue extracts, the expression of IL-32 protein was significantly elevated in patients with CRSwNP compared with patients with CRSsNP and control subjects. Immunohistochemistry data showed that IL-32 was detected in mucosal epithelial cells and inflammatory cells in the lamina propria. Levels of IL-32 were correlated with the levels of CD3 and macrophage mannose receptor in NP tissue. Immunofluorescence data showed IL-32 co-localization with CD3-positive T cells and CD68-positive macrophages in NPs. Overproduction of IL-32 may be involved in the pathogenesis of CRS, although the role of IL-32 in the inflammation in CRSsNP and CRSwNP may be different.

STUDY DESIGN Observational cross-sectional study. OBJECTIVE To perform a psychometric evaluation of Simplified Chinese versions of back pain beliefs questionnaires for use in health care professionals living in mainland China. SUMMARY OF BACKGROUND DATA Back pain beliefs are of importance in the development of chronic low back pain (LBP) and disability. Different types of beliefs exist with regard to LBP and these include inevitable consequences of LBP and fear-avoidance beliefs. LBP beliefs held by health care providers are also known to influence their patients' pain beliefs and can contribute to the development of chronic LBP and disability. At present, validated questionnaires such as the Back Beliefs Questionnaire, Health Care Providers' Pain and Impairment Relationship Scale, and Fear-Avoidance Beliefs Questionnaire are commonly used to investigate back pain beliefs held by health care professionals working in western countries. There are no published nor validated Simplified Chinese versions to allow investigation of back pain beliefs in health care professionals living in mainland China. METHODS The English versions of the earlier mentioned questionnaires were translated and culturally adapted into Simplified Chinese using the double-back-translation method. A psychometric evaluation of the translated questionnaires was conducted on 65 health care professionals (rehabilitation medicine specialists, osteopaths, and nurses), with and without LBP, practicing in Shanghai, China. The questionnaires were completed twice within 7- to 10-day period. RESULTS The Back Beliefs Questionnaire, Health Care Providers' Pain and Impairment Relationship Scale, and Fear-Avoidance Beliefs Questionnaire (work and physical subscales) had acceptable internal consistency (Cronbach α range: 0.70-0.87) and construct validity (r = 0.40-0.49, P < 0.05), good reproducibility (Intraclass correlation coefficients, ICC(2,1) range: 0.85-0.93) and an absence of any floor or ceiling effects. CONCLUSION This study showed that the Simplified Chinese versions of back pain beliefs questionnaires are valid and reliable. Therefore, these questionnaires can be used in research involving Chinese health care professionals living in mainland China.

Rehabilitation service providers in Cambodia are increasingly adopting family-centred practices when working with children with cerebral palsy and their families. This study examined the perceptions of parents living in rural Cambodia regarding family-centred rehabilitation practices.This qualitative study used in-depth semi-structured individual and small group interviews with a convenience sample of 24 parents of children with cerebral palsy from three rural provinces. Participants were drawn from Cambodia Trust's client database and had been involved in a rehabilitation planning process which incorporated family-centred practices.Twenty-four parents and carers of children with cerebral palsy aged 3-12 years were interviewed. Almost all parents valued family-centred practices in rehabilitation, with many of the needs and preferences of parents living in rural Cambodia similar to those of parents in Western contexts.Family-centred approaches to paediatric rehabilitation were found to be valued in and appropriate for a rural Cambodian context. Social and cultural mechanisms to be considered when adapting a Western, family-centred model of rehabilitation planning to the rural Cambodian context include the hierarchical nature of Cambodian culture, the emphasis on group relational patterns rather than individual needs and the context of chronic poverty.

The Global Financial Crisis (GFC) of 2008/2009 was the largest economic slowdown since the Great Depression. It undermined the growth and development prospects of developing countries. Several recent studies estimate the impact of economic shocks on the poor and vulnerable, especially women and children. Infant and child mortality rates are still likely to continue to decline, but at lower rates than would have been the case in the absence of the GFC. Asia faces special challenges. Despite having been the fastest growing region in the world for decades, and even before the current crisis, this region accounted for nearly 34% of global deaths of children under 5, more than 40% of maternal deaths and 60% of newborn deaths. Global development goals cannot be achieved without much faster and deeper progress in Asia. Current health financing systems in much of Asia are not well placed to respond to the needs of women and their children, or the recent global financial and economic slowdown. Public expenditure is often already too low, and high levels of out-of-pocket health expenditure are an independent cause of inequity and impoverishment for women and their children. The GFC highlights the need for reforms that will improve health outcomes for the poor, protect the vulnerable from financial distress, improve public expenditure patterns and resource allocation decisions, and so strengthen health systems. This paper aims to highlight the most recent assessments of how economic shocks, including the GFC, affect the poor in developing countries, especially vulnerable women and children in Asia. It concludes that conditional cash transfers, increasing taxation on tobacco and increasing the level, and quality, of public expenditure through well-designed investment programmes are particularly relevant in the context of an economic shock. That is because these initiatives simultaneously improve health outcomes for the poor and vulnerable, protect them from further financial distress, improve public financing and/or provide a much-needed counter-cyclical stimulus at times of economic slowdown.

Debris flow is a natural geohazard in mountainous terrains showered with high annual rainfalls. This paper presents three case studies of debris flow in Peninsular Malaysia based on published literature/reports and personal involvement in one of the case studies by the principal author (Ting). The special features of debris flow, in contrast to other naturally occurring geohazards, are highlighted.

The scorch property of accelerated sulfur vulcanization of three grades of expoxidized natural rubber (viz. ENR 10, ENR 25, and ENR 50) was studied by using Mooney Shearing Disk Viscometer in the temperature range of 100–180°C. Effects of accelerator types, concentration of accelerator, and carbon black on ENR 10 were also determined. Results obtained indicate a similar scorch behavior as that reported earlier for SMR L. However, some differences in the magnitude of scorch times in the temperature and concentration studies are observed between ENR and SMR L. These differences are attributed to the activation of a double bond by the adjacent epoxide group in ENR, the effect being more significant for a higher degree of epoxidation of natural rubber. In the case of ENR 50, differential scanning calorimetry measurement suggests that additional crosslink occurs via a ring-opening reaction at about 155°C. Based on first-order reaction kinetics, the apparent activation energy of vulcanization for the rubbers studied is estimated and discussed.

The healthcare cost of managing osteoporotic fractures is projected to rise because of the change in population demographics. To reduce the fracture epidemic, strategies are needed to identify those at risk early to allow preventative intervention to be implemented. The aim of this study was to investigate if low-cost community-based assessments, such as calcaneal ultrasound and falls risk assessments, can discriminate a group of elderly women at risk of osteoporotic fracture from those at lower risk. Over the period of 2002-2003, 104 community-dwelling women (mean age 71.3, standard deviation 5.8) were recruited via various modes including advertisements in community newspaper and community centres. These women underwent dual-energy X-ray absorptiometry bone mineral density (BMD) and calcaneal quantitative ultrasound (QUS) measurements; spinal radiography; and performance-based assessment of strength, mobility and balance. The women were classified into a 'high risk' (osteoporotic) group, based on low BMD (T-score of/= -2.5) and/or a history of a fragility fracture, or a 'low risk' (non-osteoporotic) group. Multiple stepwise logistic regression identified decreased speed of sound (SOS), a QUS variable, and poor mobility [slower performance in the timed 'up and go' (TUG) task], as significant discriminators, adjusted for age [SOS: adjusted odds ratio (OR) = 2.96, 95% confidence interval (CI) = 1.64-5.12, P0.001; TUG: adjusted OR = 1.69, 95% CI = 1.04-2.73, P = 0.031]. This result suggests that there may be a potential role for primary healthcare practitioners to use calcaneal QUS and functional mobility assessment (TUG) to screen for post-menopausal women at risk of osteoporotic fracture in community settings.

Individuals with existing vertebral fractures may not be aware that they are at high risk of subsequent fractures. We investigated if calcaneal quantitative ultrasonometry (QUS) and assessment of thoracic kyphosis could discriminate a group of older women with prevalent vertebral fracture from those without.One hundred four women (mean age 71.3 +/- 5.8 yrs) underwent dual-energy x-ray absorptiometry (DEXA) bone mineral density (BMD; lumbar spine and hip), calcaneal QUS, and video rasterstereographic thoracic kyphosis measurements. They were dichotomized into a group with prevalent vertebral fracture (VF, n = 24) or without vertebral fracture (NVF, n = 80).Univariate variables associated with the VF group included broadband ultrasound attenuation (BUA; age-adjusted OR 1.96, 95% CI 1.12-3.42, p = 0.018); speed of sound (SOS; age-adjusted OR 2.01, 95% CI 1.09-3.70, p = 0.026); and thoracic kyphosis (age-adjusted OR 1.72, 95% CI 1.01-2.92, p = 0.049). A composite model (BUA and thoracic kyphosis) had higher area under the receiver-operating characteristic curve (AUC = 0.75) compared to lumbar spine DEXA BMD (AUC = 0.50, p = 0.0004) and total hip DEXA BMD (AUC = 0.60, p = 0.057).Reduced calcaneal QUS values and greater thoracic kyphosis were found to be significantly associated with the group of women with prevalent vertebral fractures. A composite risk score (BUA and thoracic kyphosis) had better discriminatory power than the individual risk factor of (low) DEXA BMD.

We report the case of an 82-year-old woman treated with biliary stents for an ampulloma of Vater's papilla, with recurrent stenosis of the common bile duct. She was hospitalized with a cholestasis. An endoscopic retrograde cholangiopancreatography (ERCP) was scheduled to change the biliary stent for a metallic one, under general anaesthesia, with oral intubation. The ERCP was performed initially without any complication, but as the metallic biliary stent was placed, an air embolism occurred and a cardiac arrest happened immediately. The etiologic diagnosis was quickly confirmed by an injected multislice body-scan, which showed liver, right heart and brain gas embolism. Cardiopulmonary resuscitation allowed a complete haemodynamic recovery but a poor neurological recovery. The patient was transferred in intensive care unit, were she died 12 days after, despite hyperbaric oxygen therapy and the disappearance of the air embolism on the following computed tomography scan. This case may be useful to recall the utility of a body-scan for the diagnosis, treatment and follow-up of an air embolism during ERCP.

The leaching column test is a very useful and versatile tool that can be used to study the interactions between soils and various contaminants. This paper presents the results of leaching column tests conducted to examine the interactions of arsenic with soils. The migration of arsenic through compacted soil columns are monitored for both the sorption and desorption phases of the leaching column tests to study the arsenic-soil interactions during these phases. The effects of varying amounts of organics in the soil on the sorption and desorption of arsenic are also investigated. While low contents of organics appear not to have too much effect on the sorption/desorption characteristics of the admixed soils, higher organics contents significantly affect these characteristics. Understanding the fundamental arsenic-soil interactions is a pre-requisite to solving the soil contamination and arsenic mobility problems and for any proposed cleanup or remediation measures.

Flap prefabrication is one of the most exciting areas in Plastic Surgery because of its bridging role between conventional reconstructive surgery and tissue engineering. Using this technique,tissues such as bone, cartilage, skin and muscle can be preassembled to form precise composites that will fit any defect. In pre-lamination, for example, an ear may be created by burying cartilage underneath forearm skin and later harvested as a skin-cartilage composite free flap to replace the missing part. Vascular induction is yet another means of customising flaps where new blood supply is introduced to create transplantable tissue. For example, bone chips wrapped in avascular carrier such as muscle can become vascularised grafts. Our experiment describes jejunal prefabrication in a rat model using the same technique. Intestinal segments wrapped in muscle flaps become independent of their mesenteric blood supply by "parasitising" on the muscle's blood supply. This idea arose from our initial observations that intestinal segments transferred to the neck to reconstruct the oesophagus could survive accidental disruption of the pedicle if sufficient time had elapsed. Clearly, the bowel had picked up new blood supply from its bed. Subsequently, jejunal prefabrication was used to reconstruct the oesophagus in a patient in whom there were no recipient vessels for free jejunal transfer. The pedicled latissimus dorsi muscle flap was used as a carrier for the jejunum. Another application of this idea could be in the area of allogeneic trachea or pancreatic transplantation, since present-day techniques have yet to overcome problems such as insufficient vascularity and unpredictable transplant survival. Future applications incorporating biomaterials and cultured cells will usher in the era of tissue-engineered flaps.

(2000). Asynchronous ovarian torsion in a patient with McCune-Albright syndrome. Journal of Obstetrics and Gynaecology: Vol. 20, No. 2, pp. 204-204.

Rectal carcinoma presenting during pregnancy is rare with a reported incidence of 0.002%. Management of such an emotionally charged condition can be difficult, especially when the twin goals of curing the disease and preserving the pregnancy are divergent. Four cases of rectal carcinoma presenting during pregnancy are reported. In the first or second trimester of pregnancy, it is possible to resect the tumour with preservation of pregnancy, and in the third trimester, it is best to bring the pregnancy to term before removing the tumour. Unfortunately, the prognosis for such rectal cancer is poor.

In this study, we compared three scaffold/cell constructs with different physical and chemical properties, in their potential for tissue engineering elastic cartilage. Group I consisted of PCL scaffolds Group II custom-made non-woven made of PGA fibers in combination with agarose beads; collagen sponges were used in-group III. Chondrocytes were isolated via enzyme digestion from an ear cartilage biopsy of 2 year old male piglets. 250,000 cells in 30 μl were seeded into three different scaffold types. The specimens were then cultured for 1 week. The scaffold/cell constructs and controls were placed subcutaneously on the paravertebral fascia for 4 1/2 month. Explanted scaffolds were cut in cubical blocks and mechanically tested in phosphate buffered saline solution at 37°C in accordance with ASTM F451-99a Standard Specification for Acrylic Bone Cement. After explantation the non-seeded PCL specimens (control) had compressive stiffness and 1 % offset yield strength in plane of 5.6 ± 0.4 MPa and out of plane 4.9 ± 0.5 MPa, respectively. In comparison, the scaffolds with a seeded specimens had compressive stiffness of 4.9 ± 0.5 MPa and 3.9± 0.3 MPa, respectively. The polymer molecular weight distribution was determined by gel permeation chromatography to study the in vivo degradation of the polymer matrix. Sections of expiants were prepared using standard cryohistochemical techniques and stained with anti-type II III, DC collagen antibodies, Factin and anti-integrin beta, and I. There was considerably more organized extracellular matrix formation in group I, whereas group II and III exhibiting a loosely scattered patterns. Results of the toluidine blue, trichrome Goldner’s staining and collagen II expression showed cartilage-like tissue formation in the PCL scaffolds whereas all the other matrices showed fibrous tissue in combination with calcification.

Introduction – objectifs Le risque et le spectre des evenements cardiovasculaires (ECV) restent mal connus au cours de la co-infection VIH-VHC. Materiels et methodes Au sein de la cohorte prospective multicentrique HEPAVIH-ANRS CO13, nous avons releve les ECV majeurs (syndrome coronarien aigu (SCA), revascularisation coronaire (RC), mort subite (MS), accident vasculaire cerebral ischemique (AVC)) et mineurs (maladie thromboembolique (MTE), maladie vasculaire peripherique (MVP), insuffisance cardiaque congestive), mesure leur incidence et recherche des facteurs predictifs d’ECV. Les tests de Chi 2 et de Wilcoxon ont ete utilises pour depister des facteurs predictifs d’ECV. Le modele de Cox a ete utilise apres ajustement des parametres selectionnes en analyse univariee. Resultats Parmi les 1 175 patients co-infectes VIH-VHC inclus de 2006 a 2008 (70,4 % d’hommes, âge moyen de 45,0 ans) et suivis jusqu’en septembre 2013 (mediane de suivi de 57,6 mois), nous avons observes un total de 42 ECV pour 28 patients. L’incidence des ECV est de 8,3 pour 1 000 personne-annees (IC95 = 5,0-11,6). Les ECV majeurs comprenaient 4 MS, 10 SCA, 1 RC, 2 AVC. Les ECV mineurs comprenaient 10 MVP et 3 MTE. Les patients avec ECV etaient plus souvent de sexe masculin (p = 0,0092), avait plus souvent une lipoatrophie (p = 0,0399), un niveau plus eleve de cholesterol total (p = 0,0165), de LDL-cholesterol (p = 0,0132) et de triglycerides (p = 0,0002) que les patients sans evenement. Ni l’eradication du VHC par antiretroviraux ni le tabac (p = 0,6414) n’influencait la survenue d’ECV (p = 0,1730). En analyse multivariee, le niveau de LDL-cholesterol (RR = 6,202 IC95 = 1,580-24,352 ; p = 0,0089) et de triglycerides (RR = 2,010, IC95 = 1,207-3,347 ; p = 0,0076) etaient des facteurs predictifs independants d’ECV. Conclusion Chez les patients co-infectes VIH-VHC, les ECV sont domines par les SCA et les MVP. Les niveaux de LDL-cholesterol et de triglycerides etaient des facteurs predictifs independants d’ECV.

The demonstration of beneficial effects of salvia miltiorrhiza (DanShen) on ischemic diseases has revolutionized the management of angina pectoris, myocardial infarction (MI) or stroke in Chinese society. Experimental studies have shown that DanShen dilated coronary arteries, increased coronary blood flow, and scavenged free radicals in ischemic diseases, so that it reduced the cellular damage from ischemia and improved heart functions. Clinical trials also indicated that DanShen was an effective medicine for angina pectoris, MI, and stroke. This review will focus on DanShen's effects in angina pectoris, MI and stroke.

To reduce ischemic time and yet achieve a high-quality repair, the replantation team should be well organized. The team should be conversant with microvascular techniques and employ efficient methods of tendon repair and bone fixation. Developments in instrumentation and technique in recent years have improved success rates and consequently enlarged the indications for replantation surgery. Nevertheless, the economics of care and long-term functional outcome should not be overlooked, and these issues remain unresolved in the replantation versus terminalization question. The authors address topics relevant to replantation, including techniques and complications of digital replantation, ring avulsion injuries, and distal replantation.

The aim was to demonstrate the effects of the leaves of Gynura procumbens (Lour.) Merr. on blood sugar and lipid levels in experimental animals.We obtained an ethanolic extract of the leaves of G. procumbens and monitored the effects of an oral administration of (i) different single doses of the extract on oral glucose tolerance in streptozotocin-induced diabetic and normal rats and (ii) fourteen doses over 7 days on serum cholesterol and triglyceride levels in streptozotocin-induced diabetic rats. Metformin and glibenclamide were used as positive control drugs.The extract, at single doses of 50, 150 and 300 mg/kg orally, significantly suppressed the elevated serum glucose levels in diabetic rats; 150 mg/kg was found to be the optimum hypoglycaemic dose. The extract however did not significantly suppress the elevated serum glucose levels in normal rats, unlike glibenclamide. Metformin, but not glibenclamide, improved glucose tolerance in the diabetic rats. When the optimum dose was given to diabetic rats for 7 days, the extract significantly reduced serum cholesterol and triglyceride levels in these rats.These results indicate that the leaves of G. procumbens may have biguanide-like activity.

This report is a retrospective review of 74 cases of mandibular fractures managed in a craniomaxillofacial trauma centre between January 1994 and May 1998. Demographic data revealed that 85% of the patient population were male, with a mean age of 27.5 years. The commonest causes of injury were motor vehicle accidents (48.6%), followed by assault (16.2%) and accidental falls (17.6%). In 25 patients (33.8%) the fractures were single. Of these, fractures of the condylar region were the most common (8 patients). The remaining patients sustained fractures in two or more anatomic sites. There were other associated facial fractures in 45.9% of patients. Trauma to other systems was present in 37.8%, with orthopaedic and neurosurgical injuries being the most common. Surgical management in the form of open reduction and internal fixation was carried out in 61 patients (82.4%). Maxillo-mandibular fixation was used as an adjunct to maintain occlusion and bony reduction in unstable and comminuted fractures (15 patients, 20.3%), and as the primary mode of treatment in patients with stable, undisplaced fractures, particularly condylar fractures, in which the pretraumatic occlusal relationship was not disrupted (9 patients, 12.2%). A successful outcome was defined as a stable and healed fracture, with restoration of functional occlusion, facial symmetry and facial aesthetics. Complications observed included temporomandibular joint dysfunction (10.8%), malocclusion (9.5%), infection (8.1%), implant exposure (5.4%), and non-union or delayed union (4.1%).