Search

Due to the advancement in network technology, consumer behavior has changed gradually. In face of continually developing technology and the upsurge of environmental awareness, the negative environmental impacts generated from the production process and logistics are gradually being valued. In this research, a mathematical model has been built in consideration for a manufacturer with green investments, an online sales platform with blockchain technology, and consumers with environmental awareness in correlation to a supply chain. From the manufacturer’s perspective, decisions on distribution channels, green investment, and pricing will be explored with illustrations of the influence made on the supply chain.

Acute type A aortic dissection (ATAAD) is a severe, rapidly progressing disease which typically requires patients to undergo emergency surgical intervention. Despite advancements in surgical procedures, still, ATAAD remains a surgical emergency associated with high mortality. The aim of this systematic review and meta-analysis was to compare whether either ascending aorta replacement (AR) or total aortic arch replacement (TR) leads to improved short- and long-term clinical outcomes.A search of PubMed, Embase, Science Direct, Web of Science, SciELO, BIOSIS, and China National Knowledge Infrastructure (CNKI) databases were supplemented by searching through bibliographies of key articles. Thereafter, data on early and late prognostic factors were extracted. A systematic review and meta-analysis of 15 studies were performed to compare whether either AR or TR leads to a reduction in the risk of in-hospital and short-term mortality, postoperative complications, re-operation rate, and long-term mortality.A total of 15 cohort studies (n = 2822 patients with ATAAD; AR with HA, partial arch = 1911, TR = 911) were deemed eligible and included in the meta-analysis. Compared with TR, AR led to a significantly lower risk of in-hospital mortality (RR = 0.77; 95% CI: 0.61-0.96), shorter cardiopulmonary bypass time (CPB, mean difference = -53.09; 95% CI: -56.68--49.50), circulatory arrest time (CA, mean difference = -8.09; 95% CI: -9.04-7.15), and antegrade cerebral perfusion (ACP, mean difference = -28.62; 95% CI: -30.23--27.00). Differences in the incidence rates of neurological dysfunctions and renal dialysis were not significant. The pooled rate of aortic re-operation was lower in TR group (AR 7.6% vs. TR 5.3%), albeit not significantly (risk ratio = 1.39; 95% CI: 0.94-2.07; p = 0.10).These findings demonstrate that AR is associated with a lower early mortality rate and shorter operative times overall. Nevertheless, the incidence of postoperative complications in patients undergoing AR is comparable to that of patients undergoing TR. Further prospective follow-up data needs to be collected and analyzed to discern whether there are statistically significant differences in the risks of re-operation and long-term mortality between AR and TR procedures.

Background Congenital megalourethra is a rare prenatal finding while prenatal diagnosis of imperforate anus poses high challenge. This is the first prenatally ultrasound diagnosed case which had congenital megalourethra and imperforate anus. This case demonstrated the possibility of using the prenatal imaging findings to evaluate the postnatal prognostic outcomes in multi-organ anomalies. Case We present a case of congenital megalourethra, diagnosed prenatally at 22 weeks’ gestation, in which the penis appeared severe dilated with complete absence of the corpora spongiosa and cavernosa. This case also revealed absence of perianal muscle which was in associated with imperforate anus. Detailed prenatal ultrasonographic findings predicted the high possibility of poor outcome of the fetus in the pulmonary, renal, and sexual functions. Conclusion This case serves to identify not only the marked bilateral hydronephrosis features but also the striking lower urethral malformation with obstruction flow effect of the penis. Indeed we believe this is the first case report of a rare case of fetal megalourethra associated with imperforate anus at early second trimester on ultrasonography imaging.

Background: The risk of breast cancer is at least doubled in young women with a family history of breast cancer. Pregnancy has a dual effect on breast cancer risk; a short-term increase followed by a long-term protection. It has been hypothesized that women with a genetic predisposition for breast cancer are particularly susceptible to physiological changes during childbearing that may influence short term risk. Materials & methods: We followed a cohort of women aged 15 to 44 years between 1963 and 2009 identified in Swedish registers. Family history was defined as having a mother or sister with breast cancer. In a case-cohort analysis, we estimated incidence rate ratios of breast cancer during pregnancy and time intervals up to 10 years post-delivery. Results: In 3,452,506 women, there were 15,548 cases of breast cancer (1,208 were pregnancy-associated (PABC), defined as breast cancer during or within 2 years of pregnancy). Compared to nulliparous women, the risk of breast cancer was decreased during pregnancy, similar during 1st year and increased during 2nd year post-delivery. The pattern was similar in women with or without family history of breast cancer. A peak in risk was observed 5-6 years following the first birth regardless of family history. After a second birth, this peak was only present in women with a family history. Conclusions: Our results indicate that women with a family history of breast cancer do not have a different breast cancer risk during and within 10 years following pregnancy compared to women without a family history. Citation Format: Lambe M, Johansson ALV, Andersson TM, Hsieh C-C, Cnattingius S, Dickman PW. Family history and risk of pregnancy-associated breast cancer (PABC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-07.

Objectives To investigate placental autophagic activity in cases of twin-twin transfusion syndrome (TTTS) after successful laser therapy and to evaluate the effect of intertwin anastomoses on discordant placenta autophagic activity in monochorionic twins with one twin exhibiting selective intrauterine growth restriction. Materials and methods Placenta samples were prospectively obtained from 11 cases of successful TTTS post-laser therapy with two living babies. Among these infants, five infants had selective intrauterine growth restriction (sIUGR), based on the definition of a birth weight below the 10 th percentile. After protein extraction, western blot tests were used to determine the amount of placenta microtubule-associated protein 1A/1B-light chain 3 (LC3)-II protein in the two individual placenta territories of the twin pair. The LC3-II protein fold change ratio (FCR) in a twin pair was defined as the LC3-II protein fold value over β-actin of the smaller twin divided by the LC3-II protein fold value over β-actin of the larger twin. Results The LC3-II FCRs were not significantly different between TTTS with sIUGR and TTTS without sIUGR, after successful laser therapy. Conclusion The discordance of placenta autophagic activity in the monochorionic twin with sIUGR was reduced after laser coagulation of the intertwin anastomoses, which may result from the effect of correction of the discordant intertwin placenta perfusion.

The bulk nanocrystalline Nd–Fe–B magnets in cylindrical form with various diameters were prepared by injection casting of the molten alloy into copper moulds. The effects of the diameter size and the application of magnetic field during the solidification process on the magnetic properties and microstructure of Nd9·5Fe71·5Ti2·5Zr0·5Cr1B14·5C0·5 alloy have been studied. The smaller the diameter is, the better magnetic properties can be obtained. The intrinsic coercivity of bulk magnet is more sensitive to the diameter size than the remanence. Applying a 3·0 kOe magnetic field during the casting process is helpful to refine the grain size, thus improving the magnetic properties of bulk magnets, especially the intrinsic coercivity. The increase in the intrinsic coercivity induced by the applied magnetic field is much obvious for the samples with larger size.

Subject This study investigates the placental autophagic activity in growth-restricted fetuses in the monochorionic (MC) twin model. Patients and methods Forty MC twins were prospectively enrolled in this study, including 21 with and 19 without selective intrauterine growth restriction (sIUGR), defined as birth weight below the tenth percentile. The sIUGR group was subdivided on the basis of present versus absent or reversed umbilical artery end-diastolic flow at Doppler. Placenta samples were taken after delivery from each twin placenta territories. After protein extraction, Western blot was used to determine light chain 3 (LC3)-II placental protein expression in sIUGR and appropriately grown (appropriate-for-gestational age, AGA) twins. Results The LC3-II was significantly higher in the sIUGR twin placental territory than in their AGA counterparts. In the sIUGR group, LC3-II fold change was significantly increased compared with that in the AGA cotwins (2.28 vs 1.04, p

This study was designed to evaluate the degree of placenta share discordance in relation to the betamethasone-induced return of positive end-diastolic flow in monochorionic twin pregnancies with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler. Monochorionic twins with sIUGR was defined as one twin having an estimated fetal weight below the 10th percentile combined with an estimated fetal weight discordance >25%. The umbilical artery Doppler directly prior to (D0) and 24 hours (D1) and 48 hours (D2) after the first dose of betamethasone administration was recorded. The estimated individual placental weight in monochorionic twins was obtained by cutting the placenta along the vascular equator into two territories; the placenta share discordance was calculated as [(estimated individual placental weight of appropriated for gestational age twin- estimated individual placental weight of growth restricted twin)/estimated individual placental weight of appropriated for gestational age twin] × 100%. Six (23.1%) of the 26 included cases achieved betamethasone-induced return of positive umbilical artery end-diastolic flow. The difference of placenta share discordance and birth weight discordance were not significantly different between twins with and without betamethasone-induced return of positive umbilical artery end-diastolic flow. Thus, according to our study results, it was proposed that although the placenta share discordance correlated with the abnormal umbilical artery Doppler in the IUGR fetus in monochorionic twin, the betamethasone-induced return of positive umbilical artery end-diastolic flow, however, did not reveal the similar relationship with the severity of placenta share discordance.

Objective To evaluate the incidence and predictive factors of poor neurological outcome in survivors of twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser photocoagulation (FLP). Methods Brain magnetic resonance imaging (MRI) and neurodevelopmental assessment were performed at a corrected age of 1 year in survivors of TTTS treated by FLP. Severe neurological abnormality was defined as either the presence of severe clinical neurodevelopmental disability or severe anomalies, visualized on MRI of the brain. Result In a consecutive series of 46 cases treated by FLP, the total survival rate was 66.3%; survival of at least one was 80.4%. Severe neurodevelopment disability was 6.7 % (4/59) and the presence of a severe anomaly on brain imaging was 8.8% (5/57), which combined to a clinical or MRI abnormality rate of 10.5% (6/57). Univariate analysis revealed that early gestational age at delivery was the most significant predictor. However, the multiple logistic regression model did not identify any significant variables. Conclusion In this small series, we determined a rate of clinical neurologic impairment rate at the age of 1 year of 6.7%, which compares to what has been published. © 2012 John Wiley & Sons, Ltd.

Background: The incidence of pregnancy-associated breast cancer (PABC), i.e. breast cancer diagnosed during pregnancy or within two years after delivery, is increasing in Sweden. Results from epidemiological studies suggest that women with PABC have worse prognosis than women of same age and no recent birth. We studied the mortality in women with PABC, compared to women with a diagnosis of breast cancer not close to pregnancy, and in relation to when the PABC diagnosis occurred (during pregnancy, different postpartum periods). We also studied whether mortality varied over time since diagnosis. Materials and Methods: We used data from the Swedish National Cancer Register to identify all women diagnosed with breast cancer between ages 15–44 years during 1963–2002 (n=15,729). The study cohort was linked to the Multi-Generation Register to obtain information on childbirths and when they occurred. We estimated mortality rates among women with and without PABC, and subdivided by time of detection among PABC patients (PABC during pregnancy, or during months 1–3, 4–6, 7–12, 13–18, 19–24 after delivery). Hazard ratios (HR) with 95% confidence intervals (CI) were estimated using the novel method of flexible parametric survival models. These models use splines to model the baseline hazard rate, and are able to pick up more subtle time-dependent effects than the more commonly used piecewise splitting of the timescale (for example in Poisson regression). Results: Women with PABC had higher mortality than women diagnosed at the same age and calendar period and with no recent birth. In women with PABC (n=1,110), 46% died during follow-up, compared to 34% of the non-PABC patients (n=14,611). The mortality in both groups peaked at around two years after diagnosis, with the highest peak occurring in women diagnosed 4–6 months after delivery (HR=3.8, 95% CI 2.4−5.9). Also, among women diagnosed during pregnancy the mortality was higher compared to women diagnosed further away from delivery. An increased mortality among women with PABC remained up to 10 years after diagnosis. Discussion: Women with PABC had a poorer prognosis compared to women with breast cancer and no recent birth. The worse prognosis may be due to diagnostic delays or tumour promoting hormonal boosts or changes in the tumour micro-environment post-partum. Taken together, our findings indicate that women with PABC represent a high-risk group of young breast cancer patients that may require special management. Also, by applying novel statistical methods we were able to detect time dependent effects in that the elevated mortality associated with PABC varied by timing of diagnosis and time since diagnosis. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-09.

Aim: To evaluate fetal hemodynamic changes following maternal betamethasone administration in monochorionic twin pregnancies featuring one twin with selective intrauterine growth restriction (sIUGR) and absence of end-diastolic velocity in umbilical artery (UA) Doppler. Material and Methods: sIUGR was defined as fetal weight below the 10th percentile in one twin and inter-twin birth weight discordance >25%. The results of Doppler examinations including UA, middle cerebral artery (MCA) and ductus venosus directly prior to (D0), at 24 h (D1) and 48 h (D2) after administration of the first dose of betamethasone were recorded. Cerebral-placenta ratio was defined as MCA pulsatility index (PI) divided by UA-PI. Results: In four (20%) of the 20 cases, the UA Doppler of the growth-restricted twin returned to positive end-diastolic velocity after betamethasone administration. The UA-PI and MCA-PI of the sIUGR twin changed significantly after betamethasone administration: UA-PI was decreased at D1, the MCA-PI was reduced at both D1 and D2, and the cerebral-placenta ratio was not altered after betamethasone administration in the sIUGR twin. Conclusion: The hemodynamic changes after betamethasone administration were different between the two monochorionic twin fetuses where one presented with sIUGR and absence of UA end-diastolic velocity. The etiology of a low rate of return of end-diastolic velocity in the sIUGR twin needs further evaluation.

Background: Breast cancer is less common in China than in the United States and perinatal characteristics predict breast cancer risk in the offspring. We determined levels of pregnancy hormones in Boston and Shanghai to identify those possibly involved in the intrauterine origin of breast cancer. Participants and methods: We compared maternal and cord blood levels of estradiol, estriol, testosterone, progesterone, prolactin, insulin-like growth factors (IGF) 1 and 2, insulin-like growth factor-binding protein 3, adiponectin and sex hormone-binding globulin (SHBG) in 241 Caucasian and 295 Chinese women. Results: In both centers, hormone levels at the 16th were predictive of those at the 27th gestational week, but there was little correlation between maternal and cord blood levels. In cord blood, we found significantly (P < 0.01) higher levels of estradiol (44.2%), testosterone (54.5%), IGF-2 (22.7%) and strikingly SHBG (104.6%) in Shanghai women, whereas the opposite was true for IGF-1 (236.8%). Conclusions: Taking into account the current understanding of the plausible biological role of the examined endocrine factors, those likely to be involved in the intrauterine origin of breast cancer are SHBG and IGF-2, with higher cord blood levels among Chinese, and IGF-1, with higher cord blood levels among Caucasian women.

Reactive oxygen species (ROS) and elevated levels of p38 MAPK activity accelerate physiological aging. This emphasizes the importance of understanding the molecular mechanism(s) that link ROS production to activation of the p38 mediated promotion of aging, longevity, and resistance to oxidative stress. We examinedKlotho(-/-) (elevated ROS) and Klotho overexpressing mice (low ROS and resistance to ROS) to determine whether the ROS-sensitive apoptosis signal-regulating kinase (ASK1)-signalosome → p38 MAPK pathway plays a role in the accelerated aging of Klotho(-/-), and resistance to oxidative stress and extended lifespan in the Klotho overexpressing models. Our results suggest that increased endogenous ROS generated by Klotho(-/-) and resistance to oxidative stress in Klotho overexpression are linked to the regulation of ASK1-signalosome → p38 activity. We propose that (a) the ASK1-signalosome → p38 MAPK pathway is activated by oxidative stress due to ablation of the Klotho gene; (b) increased longevity by Klotho overexpression is linked to to suppression of the ASK1-signalosome-p38 MAPK activity; (c) the ROS-responsive ASK1-signalosome regulates physiological aging via its regulation of p38 MAPK, through a mechanism that balances the levels of inhibitory vs. activating ASK1-signalosomes. We conclude that the Klotho suppressor-of-aging activity is linked to the ASK1-signalsome, a physiological ROS-sensitive signaling center.

Extensive reports on postoperative urodynamic evaluation of female patients with GSI have been published in the current literature. However, urodynamic data from immediate postoperative evaluation has not yet been presented. Urodynamic study was made in 33 out of 41 patients from 9th–12th postoperative day. Our results indicated that preoperative and postoperative FUL in erect and supine position were 2.90±0.71; 3.72±0.98; P

SUMMARY. It is proposed that epithelial changes induced by gastroesophageal reflux disease are related to the pH environment of the esophageal lumen. We hypothesized that the various types of esophageal epithelium are associated with specific pH environments that induce their formation. The aim of this study was to compare the luminal pH environment to the histology of the distal esophageal epithelium in patients with gastroesophageal reflux disease. A total of 197 symptomatic patients with increased esophageal acid exposure on 24-hour pH monitoring were grouped according to the histology based on biopsies from the distal esophagus: 17 with squamous epithelium, 126 with cardiac epithelium (CE), and 54 with Barrett’s epithelium (BE). All were free of Helicobacter pylori infection and monitored off acid suppression therapy. Acid exposure was expressed as the percent of time the luminal pH was at intervals of 0‐1, 1‐2, 2‐3, 3‐4, 4‐5, 5‐6, and 6‐7 over a 24-hour period. Patients with BE spent significantly more time at pH intervals 2‐3, 3‐4, and 4‐5 than those with CE. This pattern switched at pH interval 5‐6, where patients with cardiac mucosa spent more time than those with BE. Patients with squamous and CE had similar pH exposure at all intervals. Patients with BE have significantly longer exposure time at the pH interval of 2 to 5 compared to those with cardiac and squamous epithelium. This suggests that the exposure of stem cells to a luminal pH between 2 and 5 may trigger the differentiation of CE into intestinalized CE.

Objective To evaluate the clinical outcome and placental territory ratio in monochorionic diamniotic (MCDA) twin pregnancies and selective intrauterine growth restrictions (sIUGR) with different types of umbilical artery (UA) Doppler. Study Design An MCDA twin pregnancy with sIUGR was defined as a fetal weight below the 10th percentile in one twin. MCDA twins were divided into three groups: without IUGR (group I); with sIUGR, and a normal UA Doppler (group II); or an abnormal UA Doppler (persistent absence or reverse of end-diastolic velocity) (group III). Placental territory was calculated as the estimated individual placental mass/total placenta weight. Results Altogether, 27 cases of group I, 11 cases of group II and 13 cases of group III MCDA twins were included. The placenta territory of the IUGR twin in group III MCDA twin was the smallest among the three groups of MCDA twins (ANOVA test, p < 0.001). There was incidence of neonatal death in six (6/26) of group III MCDA fetuses, while none in groups I and II MCDA twins did. Conclusions In MCDA twins with sIUGR, abnormal UA Doppler in the IUGR twin may reflect a more severe unequal placenta share and poorer neonatal outcomes. The prognosis of group II MCDA twins, even with sIUGR found in early gestation, is, by contrast, better. Copyright © 2009 John Wiley & Sons, Ltd.

Birth size of a woman has been positively associated with her breast cancer risk, particularly before menopause, but no study has investigated neonatal growth in relation to this risk. We conducted a case–control study nested within a population-based cohort of women, born in Sweden between 1901 and 1961, covering all 405 breast cancer patients and 1081 age- and hospital-matched controls, who were born after newborn charts became available. Compared to neonates who lost

SummaryCervical length in high-risk women for preterm birth has to be identified before early second trimester. Sequential evaluations lead to high predictive significance. The mean cervical length at 24 weeks is about 35 mm when measured by transvaginal ultrasound. A short cervix is defined as a cervix that is less than 25 mm and funneling, i.e. ballooning of the membranes into a dilated internal os, but with a closed external os. Factors such as short cervical length, uterine anomaly, previous cervical surgery, multiple gestation and positive fetal fibronectin results are associated with preterm delivery. Serial transvaginal ultrasound examinations during the early second trimester would provide longitudinal changes in the cervical length. The use of 17α-hydroxyprogesterone caproate and cerclage has shown to be beneficial in preventing preterm delivery. When combined with other predictors such as occiput position, parity, maternal age and body mass index, cervical length is a useful parameter for predicting the feasibility of labor induction and successful delivery.

Brian MacMahon was born in Sheffield, UK in 1923. He served as chair of the Department of Epidemiology at Harvard School of Public Health for more than 30 years. He was admired as a noble and generous man and respected for his shining intellect, scientific integrity, and broad culture. He set the pace for modern epidemiology and led the way for a whole school of epidemiologists who are now spread around the nation and the world. He made major scientific contributions, received several distinguished prizes and awards, and continued to publish insightful papers until the very end. Brian MacMahon was the first editor-in-chief of Cancer Causes and Control.

Good service design can increase organization revenue and consumer satisfaction while reducing labor and time costs. The problems facing consumers in the original serve model for eyewear and optical industry includes the following issues: 1. Insufficient information on eyewear products 2. Passively dependent on recommendations, insufficient selection 3. Incomplete records on progression of vision conditions 4. Lack of complete customer records. This study investigates the case of Kobayashi Optical, applying the Theory of Inventive Problem Solving (TRIZ) to develop innovative solutions for eyewear and optical industry. Analysis results raise the following conclusions and management implications: In order to provide customers with improved professional information and recommendations, Kobayashi Optical is suggested to establish customer purchasing records. Overall service efficiency can be enhanced by applying data mining techniques to analyze past consumer preferences and purchase histories. Furthermore, Kobayashi Optical should continue to develop a 3D virtual trial service which can allow customers for easy browsing of different frame styles and colors. This 3D virtual trial service will save customer waiting times in during peak service times at stores., {"references":["S. K. Feiner, Augmented Reality: A New Way of Seeing, Scientific American Magazine, vol. 286, no. 4, pp. 34–41, 2002.","P. Milgram, H. Takemura, A. Utsumi and F. Kishino, \"Augmented Reality: A class of displays on the reality-virtuality continuum\" SPIE, 2351, pp. 282-292.","\"10 Examples of Augmented Reality in Retail,\" Creative guerrilla marketing, 2014. http://www.creativeguerrillamarketing.com/ augmented-reality/10-examples-augmented-reality-retail/.","Total Immersion, \"TryLive: Virtual Try-On and Product Visualization Solutions\", 2015. http://www.timmersion.com/trylive/trylive%E2%84% A2-augmented-reality-fashion.","G. Altshuller, The Innovation Algorithm: TRIZ, Systematic Innovation and Technical Creativity. Technical Innovation Center, 2000.","E. Domb, J. Terninko, J. Miller, and E. MacGran, \"The Seventy-Six Standard Solutions: How They Relate to the 40 Principles of Inventive Problem Solving\", The TRIZ Journal, 1999.","H. I. Peng, Integrated TRIZ and DFMA in Patent Design around Process, 2008.","TRIZ Matrix. http://www.triz40.com/aff_Matrix_TRIZ.php.","H. H. Chang, P. W. Lu. P.W., Using a TRIZ-based Method to Design Innovative Service Quality - A Case Study on Insurance Industry. Journal of Quality, 16(3): 179-193, 2009.\n[10]\tC. H. Lee, Y. H. Wang, and A. J. C Trappey, \" Service design for intelligent parking based on theory of inventive problem solving and service blueprint\" Advanced Engineering Informatics, in press, 2014."]}

We have previously demonstrated that solution-cast films of conjugated polymers with grafted alkyl side chains comprise clearly identifiable domains ca. 10 nm in size upon solvent evaporation. Here we show that these nanodomains indeed serve as basic units for morphological development in poly(9,9-di-n-octyl-2,7-fluorene) (PFO) films during cold crystallization. Results of our microscopic and diffraction observations indicate that the cold crystallization process involves intradomain nucleation and growth, followed by nanodomain alignment and coalescence into fibrils in the sub-micrometer length scale via thermally activated adjustment of nanodomain orientation. An analogy with oriented aggregation (or oriented attachment−coalescence) behavior of nanocrystals of metal oxides is drawn; the relevance to recently proposed models of polymer crystallization via primary nucleation induced at the growth front is addressed.

Careful scrutiny of pH recordings and symptom diaries in patients having 24-hour pH-metry reveals that most reflux episodes are asymptomatic. Although this observation is well known and long recognized, the explanation for why one reflux episode leads to symptoms and others do not is incompletely understood. Forty-four patients with chronic typical gastroesophageal reflux disease (GERD) symptoms referred for ambulatory pH testing were studied. Antisecretory medication was stopped 2 weeks prior to the study. Two meals were taken during the study; one standardized (hamburger, fries, milk-shake) and one at the patient's discretion. A system onset marker noted the type, beginning and end of symptoms (heartburn, regurgitation, chest pain). Age, sex, upright/supine position, nadir pH, time pH4, and relationship to meals were compared for symptomatic/asymptomatic reflux episodes. An acid reflux event was defined as a drop in pH4 lasting5 seconds. The pH catheter detected 1464 reflux episodes. Only 93 (6.3%) were symptomatic. Forty-six of the 93 (49.4%) were associated with heartburn, 38 (40.9%) with regurgitation, and nine (9.7%) with chest pain. Nadir pH was significantly lower in symptomatic episodes. Nearly 50% of symptomatic reflux episodes occurred after meals, especially after non-standardized compared to standardized meal. Symptomatic episodes tended to be longer in duration and to occur in the supine position, while age/sex made no difference. Six percent of the reflux episodes were temporally associated with typical GERD symptoms. This association seems to be influenced by the acidity of the refluxate. Nearly half of the symptomatic reflux episodes occurred after eating.

Previous work has considered the effect of exposure misclassification on the bias of population attributable risk (AR) estimates, but little is known about the corresponding effects on their precision or mean squared error (MSE). This paper considers AR estimation in typical scenarios for case–control and cohort studies. The analogous index used when exposure reduces the risk—the prevented fraction (PF)—is also investigated. It is shown, through both theoretical and simulation results, that even with quite modest levels of exposure misclassification, the MSE can increase substantially, relative to the variance of AR estimated without measurement error. When exposure assessment is perfectly sensitive, there is no bias in AR but lack of measurement specificity can still cause a substantial loss of precision. In a few cases, the AR or PF with misclassified exposure can actually have smaller MSE; these exceptional cases arise when sensitivity is poor and the bias in AR or PF is relatively large. We conclude that while bias can be reduced by defining exposure on a highly sensitive basis, one must also consider the deleterious effect on precision by doing so. Loss of precision in the AR and PF estimates can be safely ignored only when the exposure measure is very accurate. Copyright © 2007 John Wiley & Sons, Ltd.

OBJECTIVE The objective was to determine whether tumor volume, calculated by multiplying 3-dimensional diameters recorded from surgical specimens, could represent tumor size more precisely than the currently used greatest tumor diameter (T status) as a prognostic factor in early-stage non-small cell lung cancer (NSCLC). METHODS From 1991 to 2001, a total of 236 stage Ia NSCLC patients underwent curative resection in our institution. Their clinicopathological factors were retrospectively reviewed. The cases were grouped according to stereographic tumor size. Group 1 included tumor volumes less than 0.5236 (1(3) x pi/6) cm3, Group 2 included tumor volumes between 0.5236 - 4.1888 (2(3) x pi/6) cm3, while Group 3 included tumor volumes between 4.188 - 14.1372 (3(3) x pi/6) cm3. Overall survival and disease-free interval analyses were performed with the Kaplan-Meier method and multivariable Cox's proportional hazard model. Tumor volume and other clinico-pathological factors were included for analysis. RESULTS Median follow-up was 55.5 months. The overall 5- and 10-year survival rates were 78 % and 71 %, and the 5- and 10-year disease-free intervals were 68 % and 64 %, respectively. The overall survival ( P = 0.0075) and disease-free interval ( P = 0.0025) showed significant differences between tumor volume groups. Smoking history, presence of symptoms and the number of resected lymph nodes were also significantly related to overall survival and disease-free interval. CONCLUSION The products of 3-D diameters (tumor volume) more precisely evaluated tumor size as well as survival of patients with stage Ia NSCLC.

Chorioamnionitis increases the risk of preterm labour and is associated with adverse neonatal outcomes including cerebral palsy. Tumour necrosis factor-alpha (TNF-alpha) derived from the gestational tissues (placenta, fetal membranes and maternal decidua) is thought to play a pivotal role in the induction of cytokine response in chorioamnionitis. Tumour necrosis factor-alpha converting enzyme (TACE) is essential for the release of TNF-alpha. Our aim was to determine whether the expression of TACE is increased in human gestational tissues from pregnancies complicated by chorioamnionitis, and whether lipopolysaccharide (LPS) causes increased expression of TACE in the human gestational tissues in vitro. The immunostaining of TACE was generally more intense, in particular in the syncytiotrophoblast and stromal cells, in villous samples from pregnancies complicated by chorioamnionitis than those from normal pregnancies. Increased immunoreactivity of TACE was also noted in the amnion and choriodecidua. In parallel, there was an increased infiltration of monocytes/macrophages within the villous stroma and choriodecidua. As a complement to our in vivo findings, LPS significantly increased the levels of mRNA and protein of TACE in a dose-dependent response in villous and fetal membrane explant cultures. Together, our results imply a potential role of TACE in the pathogenesis of chorioamnionitis.

This paper describes a high-power density, silicon-based micro-scale direct methanol fuel cell (DMFC), under development at Carnegie Mellon. Major issues in the DMFC design include the water management and energy-efficient micro fluidic sub-systems. The air flow and the methanol circulation are both at a natural draft, while a passive liquid‐gas separator removes CO2 from the methanol chamber. An effective approach for maximizing the DMFC energy density, pumping the excess water back to the anode, is illustrated. The proposed DMFC contains several unique features: a silicon wafer with arrays of etched holes selectively coated with a nonwetting agent for collecting water at the cathode; a silicon membrane micro pump for pumping the collected water back to the anode; and a passive liquid‐gas separator for CO2 removal. All of these silicon-based components are fabricated using microelectro-mechanical systems (MEMS)-based processes on the same silicon wafer, so that interconnections are eliminated, and integration efforts as well as post-fabrication costs are both minimized. The resulting fuel cell has an overall size of one cubic inch, produces a net output of 10 mW, and has an energy density three to five times higher than that of current lithium-ion batteries.

The Bravo catheter-free pH monitoring system uses a capsule attached to the esophageal mucosa to detect acid exposure. Placement of the Bravo capsule is associated with intermittent chest pain in 50% of normal volunteers. The authors hypothesized that chest pain in this setting may be attributable to hypertensive esophageal contractions induced by the Bravo capsule. The study population consisted of 40 consecutive patients with reflux symptoms who had stationary esophageal manometry within 1 h after Bravo capsule placement. The control group consisted of 40 patients with symptomatic gastroesophageal reflux disease (GERD) from a population of patients with foregut symptoms who were computer matched to the study group for age, sex, lower esophageal sphincter (LES) pressure, LES length, and 24-h pH composite score. The patients in the control group had manometry before Bravo capsule placement. The occurrence of chest pain was assessed before and during the monitoring period by interview and review of the patient’s diary. Mean contraction amplitudes in the distal third of the esophagus after 10 wet swallows were averaged. The prevalence of patients with esophageal contraction amplitudes in the distal third that exceeded the 95th percentile of normal (180 mmHg) and the mean amplitude of distal third esophageal contractions in the study and control populations were compared. In the study group, the incidence of chest pain among the patients with hypercontractility of the esophagus was compared with the incidence among those without hypercontractility. The mean contraction amplitude was higher in the study group (144.7 vs 105.5 mmHg; p = 0.002). The number of patients with a mean distal esophageal contraction amplitude exceeding the 95th percentile of normal also was significantly higher in the study group (13/40 vs 5/40; p = 0.03). A total of 10 patients experienced new onset of chest pain with the Bravo capsule in place, and 6 patients experienced hypertensive esophageal contractions. The intraesophageal Bravo capsule can cause hypertensive esophageal contractions, which may lead to chest pain.

The presentation and management of esophageal cancer are changing, as more patients are diagnosed at an earlier stage of the disease in which endoscopic treatment methods may be contemplated. Therefore, we conducted a study to determine whether symptomatic and endoscopic findings can accurately identify node-negative early-stage adenocarcinoma. A total of 213 consecutive patients (171 men and 42 women) with resectable esophageal adenocarcinoma seen from 1992 to 2002 were evaluated. None of these patients received neoadjuvant chemotherapy or radiation therapy. Using a multivariable model, model-based probabilities of early-stage disease (T1 im/sm N0) were calculated for each combination of the following three features: no dysphagia as main symptom at presentation, tumor length ≤2 cm, and noncircumferential lesion. Eighty-two percent of the patients with all three characteristics presented with early-stage disease. Even in the setting of small, visible, noncircumferential tumors/nodules in patients without dysphagia, 14% of the patients harbored node metastasis. Simple clinical and endoscopic findings predicted early-stage disease in 82% of cases, whereas a small but significant percentage had node metastasis. Because node metastasis predisposes to local failure in nonresectional treatment options such as endoscopic mucosal resection and photodynamic therapy, such findings should have a significant bearing on treatment decisions.

It is generally accepted that MgO additions enhance the sintering of alumina. The distribution of the low concentration required is, however, difficult to attain and critical to the final properties and microstructures. To improve the MgO distributions in ceramic injection-molded (CIM) alumina, Mg-containing precursors, Mg-stearate and Mg-acetate, were added during the kneading step of the CIM process, and the results were compared with those from adding MgO particles. Of the three additives, the Mg-stearate showed the highest sintered density and bending strength. This was attributed to its high molecular weight and it being able to mix with other binder components homogeneously in the liquid state, which leads to a better distribution of the MgO. In contrast, the MgO powder was kneaded in the solid particle form, and its distribution was not uniform. The Mg-acetate also imparted poorer MgO distribution because the liquid Mg-acetate dehydrated in the early stage of the kneading and formed solid lumps before it was well mixed into the binder system. The resulting sintered densities and bending strength using these two additives were, therefore, inferior to those for specimens in which Mg-stearate was used.

This paper describes the development of embedded droplet impingement for integrated cooling of electronics (EDIFICE), which seeks to develop an integrated droplet impingement cooling device for removing chip heat fluxes over 100W/cm2, employing latent heat of vaporization of dielectric fluids. Micromanufacturing and microelectromechanical systems are used as enabling technologies for developing innovative cooling schemes. Microspray nozzles are fabricated to produce 50–100 μm droplets coupled with surface texturing on the backside of the chip to promote droplet spreading and effective evaporation. This paper examines jet impingement cooling of EDIFICE with a dielectric coolant and the influence of fluid properties, microspray characteristics, and surface evaporation. The development of micronozzles and microstructured surface texturing is discussed. Results of a prototype testing of swiss-roll swirl nozzles with dielectric fluid HFE-7200 on a notebook PC are presented. This paper also outlines the challenges to practical implementation and future research needs.

Proton pump inhibitors are the mainstay of medical management in gastroesophageal reflux disease. Although they provide relief from most symptoms, reflux may persist. We hypothesize that omeprazole does not reduce the total amount of gastroesophageal reflux but simply alters its pH characteristics. Six asymptomatic volunteers had combined 24-hour impedance pH monitoring before and after 7 days of omeprazole (20 mg BID). Multichannel intraluminal impedance was used to identify reflux episodes, which were classified as acid (pH 4 but decrease > 1 pH unit) and nonacid (pH > 4 and decrease < 1 pH unit) by pH measurements 5 cm above the lower esophageal sphincter (LES). A gastric pH sensor located 10 cm below the LES was used to verify the action of omeprazole. Impedance detected a total of 116 reflux episodes before and 96 episodes after omeprazole treatment. The median number of reflux episodes (18 versus 16, P = 0.4), median duration of reflux episodes (4.7 versus 3.6 minutes, P = 0.5), and total duration of reflux episodes (27.2 versus 42.4 minutes, P = 0.5) per subject were similar before and after omeprazole. Acid reflux episodes were reduced from 63% before to 2.1% after omeprazole (P < 0.0001), whereas nonacid reflux episodes increased (15% to 76%, P < 0.0001). Weak acid reflux episodes did not change (22.4% to 21.8%, P = 1.0). The proportion of reflux episodes greater than pH 4 increased from 37% to 98% (P < 0.0001). In normal subjects, omeprazole treatment does not affect the number of reflux episodes or their duration; rather it converts acid reflux to less acid reflux, thus exposing esophagus to altered gastric juice. These observations may explain the persistence of symptoms and emergence of mucosal injury white on proton pump inhibitor therapy.

Single-phase electron-doped manganite thin films with nominal composition of La0.7Ce0.3MnO3(LCeMO) have been prepared on SrTiO3(100) substrates by pulsed laser deposition. The conditions for obtaining purely single-phase LCeMO films lie within a very narrow window of substrate temperature (Ts∼720°C) and laser energy density (ED∼2J∕cm2) during deposition. In situ postdeposition annealing, mainly to relax the possible epitaxial in-plane tensile strain between the film and the substrate, leads to an increasing c-axis lattice constant accompanied by the formation of secondary CeO2 phase and higher metal-insulator transition temperature. This is indicative of a strong coupling between the electron and lattice degree of freedom.

Asthma is a chronic inflammatory disease of the airway. Both genetic and environmental factors are thought to be involved in the onset of the disease. We aimed to investigate if the interleukin-1β (IL-1β)-511 promoter and IL-1 receptor antagonist (IL-1Ra) gene polymorphisms could be used as markers of susceptibility to bronchial asthma in children. Children were divided into two groups: (1) bronchial asthma (n = 202) and (2) healthy control (n = 144). Polymorphisms for the IL-1β-511 promoter and IL-1Ra were detected by polymerase chain reaction. Genotypes and allelic frequencies for these polymorphisms in both groups were compared. The difference in the proportions of different IL-1β-511 promoter and IL-1Ra polymorphisms in both groups were not significant. Proportions of C homozygote/heterozygote/T homozygote for IL-1β-511 promoter were (1) 34.2/46.0/19.8% in the asthma group and (2) 33.3/48.6/18.1% in the control group. Alleles I/II/III/IV for IL-1Ra were (1) 91.8/7.7/0.5/0% in the asthma group and (2) ...

Objective: Maternal weight gain has been consistently linked to birth weight but, beyond maternal energy intake, no macronutrient has been associated with either of them. We have examined whether maternal energy-adjusted intake of macronutrients is associated with either maternal weight gain or birth-size parameters. Design: Cohort study. Setting: University hospital in Boston, USA. Subjects: A total of 224 pregnant women coming for their first routine prenatal visit. The women were followed through delivery. Interventions: None. Pregnant women's dietary intake during the second trimester was ascertained at the 27th week of pregnancy through a food frequency questionnaire. Results: Intake of neither energy nor any of the energy-generating nutrients was significantly associated with birth size. In contrast, maternal weight gain by the end of the second trimester of pregnancy was significantly associated with energy intake (+0.9 kg/s.d. of intake; P∼0.006) as well as energy-adjusted intake of protein (+3.1 kg/s.d. of intake; P

Klotho transgenic mice exhibit resistance to oxidative stress as measured by their urinal levels of 8-hydroxy-2-deoxyguanosine, albeit this anti-oxidant defense mechanism has not been locally investigated in the brain. Here, we tested the hypothesis that the reactive oxygen species (ROS)-sensitive apoptosis signal-regulating kinase 1 (ASK1)/p38 MAPK pathway regulates stress levels in the brain of these mice and showed that: 1) the ratio of free ASK1 to thioredoxin (Trx)-bound ASK1 is relatively lower in the transgenic brain whereas the reverse is true for the Klotho knockout mice; 2) the reduced p38 activation level in the transgene corresponds to higher level of ASK1-bound Trx, while the KO mice showed elevated p38 activation and lower level of-bound Trx; and 3) that 14-3-3ζ is hyper phosphorylated (Ser-58) in the transgene which correlated with increased monomer forms. In addition, we evaluated the in vivo robustness of the protection by challenging the brains of Klotho transgenic mice with a neurotoxin, MPTP and analyzed for residual neuron numbers and integrity in the substantia nigra pars compacta. Our results show that Klotho overexpression significantly protects dopaminergic neurons against oxidative damage, partly by modulating p38 MAPK activation level. Our data highlight the importance of ASK1/p38 MAPK pathway in the brain and identify Klotho as a possible anti-oxidant effector.

The stability of styrene-divinyl benzene copolymer (SDB)-supported Pt (Pt/SDB) catalysts for destruction of volatile-organic-compound (VOC) in wastewater was examined. The test reaction was wet oxidation of water-containing aliphatic alcohol and formaldehyde at 140 degrees C and 90 psig for 40 h. The catalytic performance tests indicated that activity of the Pt/SDB catalysts could be maintained for VOC concentration of 3 wt.%, whereas the catalysts deactivated rapidly for 10 wt.% VOC containing wastewater. In order to investigate the nature of catalyst deactivation, extended X-ray absorption fine structure (EXAFS) and X-ray absorption near edge (XANES) spectroscopy were used to characterize the fresh and used catalysts. After the reaction, there is no oxidation of Pt clusters observed in EXAFS and XANES spectroscopy suggesting that the oxidation reaction takes places via the adsorbed oxygen. The spectroscopy results further indicated that deactivation of the catalysts were mainly caused by the increase of Pd particle size. After the reaction, the Pt-Pt coordination number has no significant change for the 3 wt.% wastewater whereas increase from 5.6 to 6.2 for 10 wt.% wastewater. Combined with the fact that the catalysts fractured during the reactions, we suggested that Pt agglomeration was mainly caused by thermal migration of the metal clusters.

Epidemiological findings indicate that hormonal influences may play a role in the etiology of renal cell cancer (RCC). The possible effect of childbearing remains enigmatic; while some investigators have reported a positive association between number of births and renal cell cancer risk, others have not. A case–control study, nested within a nation-wide Fertility Register covering Swedish women born 1925 and later, was undertaken to explore possible associations between parity and age at first birth and the risk of renal cell cancer. Among these women a total of 1465 cases of RCC were identified in the Swedish Cancer Register between 1958 and 1992 and information on the number of live childbirths and age at each birth was obtained by linkage to the Fertility Database. For each case, five age-matched controls were randomly selected from the same register. Compared to nulliparous women, ever-parous women were at a 40% increased risk of RCC (Odds Ratio [OR]=1.42; 95% CI 1.19-1.69). The corresponding OR for women of high parity (five or more live births) was 1.91 (95% CI 1.40–2.62). After controlling for age at first birth among parous women, each additional birth was associated with a 15% increase in risk (OR=1.15; 95% CI 1.08–1.22). The observed positive association between parity and renal cell cancer risk is unlikely to be fully explained by uncontrolled confounding, but warrants further evaluation in large studies, with allowance for body mass index. British Journal of Cancer (2002) 86, 1425–1429. DOI: 10.1038/sj/bjc/6600263 www.bjcancer.com © 2002 Cancer Research UK

Background: Xiao-qing-long-tang (XQLT sho-seiru-to), a traditional Chinese medicine, has been used to treat patients with bronchial asthma in Oriental countries for several centuries. However, the therapeutic mechanisms of this Chinese medicine remain a matter of considerable debate. Therefore, a series of experiments using ovalbumin-sensitized guinea pigs was performed to elucidate the possible antiasthmatic effect of XQLT. Methods: The effect of XQLT on ovalbumin-induced airway inflammation in a guinea pig model of allergic asthma was examined, and early and late asthmatic responses were measured in terms of airway resistance and extent of eosinophil infiltration. Furthermore, the bronchorelaxing effect of XQLT was measured in isolated guinea pig trachea. Results: XQLT significantly inhibited the antigen-induced immediate asthmatic response (IAR) and late asthmatic response (LAR) in actively sensitized guinea pigs. Cumulative administration of XQLT caused concentration-dependent relaxation of the carbachol-precontracted guinea pig trachea. The bronchorelaxing effect of XQLT was reversed by ICI-118551, a selective β2-adrenoceptor antagonist. Furthermore, examination of bronchoalveolar lavage fluid (BALF) revealed that XQLT significantly suppressed the increase in eosinophils (24 h after antigen challenge) in the airway. In addition, XQLT significantly attenuated the increase in eosinophils at 1, 6, 24, 48, and 72 h after antigen challenge when it was administered once daily from the day of sensitization to the day of challenge. Histopathologic examination results showed that XQLT suppressed eosinophil infiltration into lung tissue. Conclusions: These results demonstrate that the antiasthmatic effects of XQLT appear to be partly mediated by stimulation of β2-adrenoceptors, leading to bronchorelaxation, and that XQLT inhibits the infiltration of eosinophils into the airway. Thus, XQLT may be useful for the prevention or treatment of asthma.

Obesity has been associated with an increased risk of renal cell cancer among women, while the evidence for men is considered weaker. We conducted a quantitative summary analysis to evaluate the existing evidence that obesity increases the risk of renal cell cancer both among men and women. We identified all studies examining body weight in relation to kidney cancer, available in MEDLINE from 1966 to 1998. The quantitative summary analysis was limited to studies assessing obesity as body mass index (BMI, kg m−2), or equivalent. The risk estimates and the confidence intervals were extracted from the individual studies, and a mixed effect weighted regression model was used. We identified 22 unique studies on each sex, and the quantitative analysis included 14 studies on men and women, respectively. The summary relative risk estimate was 1.07 (95% CI 1.05–1.09) per unit of increase in BMI (corresponding to 3 kg body weight increase for a subject of average height). We found no evidence of effect modification by sex. Our quantitative summary shows that increased BMI is equally strongly associated with an increased risk of renal cell cancer among men and women. © 2001 Cancer Research Campaignhttp://www.bjcancer.com

To explore possible associations between the reproductive history amongst women and the risk of parathyroid adenoma (PA).Two nationwide Swedish registries. The Fertility Register included data on more than 3.4 million livebirths between 1943 and 1992 amongst Swedish females born 1925-72. The Cancer Register encompasses more than 1800 women with a diagnosis of PA 1960 until 1992.All women resident in Sweden 1960-92.Cases were all 1800 women born 1925-72 reported to the Swedish Cancer Registry with a histopathological diagnosis of PA. Five controls were selected at random for each case by matching for the month and year of birth. Conditional logistic regression was used to estimate relative risks of PA.Parathyroid adenoma.High parity (four or more live births) was associated with an increased risk of PA. Amongst women with a diagnosis of PA before menopause (i.e. the age of 50 years) there was an increased risk of PA with younger age at first childbirth. Nulliparous women were at increased risk for PA before menopause, and at decreased risk after menopause.There is an association between childbearing and the risk of PA, which has not previously been demonstrated, but the underlying biological mechanisms remain to be determined.

Temperature distribution in a two-dimensional electrical heated system was determined both by computer simulation and experimental measurement. A commercial software program package was used for simulation. The experiment was conducted in a system where the vertical dimension was minimal to minimize natural convection during ohmic heating. In a rectangular static system containing a rectangular particle, computer simulation showed a trend verified by similar experimental results. Heat loss to the environment and physical property values used in simulation were major factors affecting differences between experimental and simulation results. There was no evidence for the presence of any coldest spot other than at the center of particles.