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Chih-Wei Chiang,1,2,* Chih-Hwa Chen,3– 6,* Yankuba B Manga,4 Shao-Chan Huang,4 Kun-Mao Chao,1,7 Pei-Ru Jheng,4 Pei-Chun Wong,4 Batzaya Nyambat,4 Mantosh Kumar Satapathy,4 Er-Yuan Chuang4,8 1Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, 10617, Taiwan; 2Department of Orthopedics, Taipei Medical University Hospital, Taipei, 11031, Taiwan; 3Department of Orthopedics, Taipei Medical University–Shuang Ho Hospital, New Taipei City, 23561, Taiwan; 4Graduate Institute of Biomedical Materials and Tissue Engineering, International PhD Program in Biomedical Engineering, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan; 5School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan; 6Research Center of Biomedical Device, Taipei Medical University, Taipei, 11031, Taiwan; 7Department of Computer Science and Information Engineering, National Taiwan University, Taipei, 10617, Taiwan; 8Cell Physiology and Molecular Image Research Center, Taipei Medical University–Wan Fang Hospital, Taipei, 116, Taiwan*These authors contributed equally to this workCorrespondence: Er-Yuan Chuang Email eychuang@tmu.edu.twBackground and Purpose: Strontium ranelate (SrR) is an oral pharmaceutical agent for osteoporosis. In recent years, numerous unwanted side effects of oral SrR have been revealed. Therefore, its clinical administration and applications are limited. Hereby, this study aims to develop, formulate, and characterize an effective SrR carrier system for spinal bone regeneration.Methods: Herein, glycol chitosan with hyaluronic acid (HA)-based nanoformulation was used to encapsulate SrR nanoparticles (SrRNPs) through electrostatic interaction. Afterward, the poly(ethylene glycol) diacrylate (PEGDA)-based hydrogels were used to encapsulate pre-synthesized SrRNPs (SrRNPs-H). The scanning electron microscope (SEM), TEM, rheometer, Fourier-transform infrared spectroscopy (FTIR), and dynamic light scattering (DLS) were used to characterize prepared formulations. The rabbit osteoblast and a rat spinal decortication models were used to evaluate and assess the developed formulation biocompatibility and therapeutic efficacy.Results: In vitro and in vivo studies for cytotoxicity and bone regeneration were conducted. The cell viability test showed that SrRNPs exerted no cytotoxic effects in osteoblast in vitro. Furthermore, in vivo analysis for new bone regeneration mechanism was carried out on rat decortication models. Radiographical and histological analysis suggested a higher level of bone regeneration in the SrRNPs-H-implanted groups than in the other experimental groups.Conclusion: Local administration of the newly developed formulated SrR could be a promising alternative therapy to enhance bone regeneration in bone-defect sites in future clinical applications.Keywords: strontium ranelate, drug formulation, nanoparticles, hyaluronic acid, glycol chitosan

Carl PC Chen,1 Chih-Chin Hsu,2 Chih-Hsiu Cheng,3 Shu-Chun Huang,1 Jean-Lon Chen,1 Shin-Yi Lin1 1Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan; 2Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Keelung and College of Medicine, Chang Gung University, Taoyuan City, Taiwan; 3School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan City, TaiwanCorrespondence: Carl PC ChenDepartment of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, 5, Fu-Hsin Street, Guishan, Taoyuan 333, TaiwanTel +886-909396196Fax +886-3-3281320Email carlchendr@gmail.comBackground: To investigate whether body mass index (BMI) and changes in body positioning have any correlation with the distance from the pleura to the inferior trunk of the supraclavicular brachial plexus.Patients and Methods: Twenty stroke patients with upper limb spasticity and complex regional pain syndrome were recruited for this study. Distance from the pleura to the inferior trunk was measured in the supine position, body turned sideways at 45 °, and in the lateral decubitus position. Correlations between BMI and measured distances in these body positions were evaluated. A linear musculoskeletal ultrasound transducer was used to conduct these distance measurements.Results: The distance from the pleura to the inferior trunk in the supine position was calculated to have an average of 0.42 ± 0.06 cm (D1), 0.44 ± 0.05 (D2) when lying sideways at 45 °, and 0.87 ± 0.08 cm (D3) in the lateral decubitus position. The Kruskal–Wallis test revealed significant differences when comparing D3 with D1, and D3 with D2 (p < 0.001). Positive correlations were observed between BMI and D1 (Spearman’s rho = 0.62, p = 0.004, two-tailed), and between BMI and D2 (Spearman’s rho = 0.61, p = 0.005, two-tailed). The strongest positive correlation was observed between BMI and D3 (Spearman’s rho = 0.78, p < 0.001, two-tailed).Discussion: In the lateral decubitus body position, the distance from the pleura to the inferior trunk increased significantly by 2-fold and was positively correlated with BMI. The increased distance may improve the safety of the nerve block procedure. As a result, it is recommended that patients be placed in the lateral decubitus body position when performing ultrasound-guided supraclavicular brachial plexus nerve block of the inferior trunk.Keywords: body mass index, ultrasound-guided, brachial plexus, nerve block, inferior trunk, lateral decubitus, corner pocket, complex regional pain syndrome

Kun-Chun Chiang,1 Sheng-Teng Huang,2 Ren-Chin Wu,3 Shih-Chiang Huang,3 Ta-Sen Yeh,4 Ming-Huang Chen,5 Jun-Te Hsu,4 Li-Wei Chen,6 Sheng-Fong Kuo,7 Ho-Yen Chueh,8 Horng-Heng Juang,9 Shuen-Iu Hung,10 Chun-Nan Yeh,4 Jong-Hwei S Pang11,12 1General Surgery Department, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan, ROC; 2Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan, ROC; 3Department of Anatomic Pathology, Chang Gung Memorial Hospital, Kwei-Shan, Chang Gung University, Taoyuan, Taiwan, ROC; 4General Surgery Department, Chang Gung Memorial Hospital, Kwei-Shan, Chang Gung University, Taoyuan, Taiwan, ROC; 5Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; 6Department of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan, ROC; 7Department of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan, ROC; 8Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC; 9Department of Anatomy, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 333, Taiwan, ROC; 10Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; 11Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan, ROC; 12Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkow, Taoyuan City, Taiwan, ROC Objective: Cholangiocarcinoma (CCA) is a devastating disease. Interferon α-inducible protein 27 (IFI27), originally known to involve in innate immunity, is later found to intervene in cell proliferation, leading to inventive studies regarding the role of IFI27 in cancer treatment. We aimed to investigate the role of IFI27 in CCA.Materials and methods: Cell proliferation, migration, and invasion assays, Western blot, gene transfection and knockdown, immunofluorescent and immunohistochemical stains, and xenograft animal model were applied.Results: IFI27 knockdown in CCA cells induced cell cycle arrest in S phase, resulting in lower cell proliferative rate in vitro and in vivo. IFI27 knockdown attenuated CCA cell migration and invasion through inhibition of epithelial–mesenchymal transition, which was supported by increased E-cadherin and decreased N-cadherin and fibronectin. Filamentous actin level was also reduced. IFI27 knockdown further repressed expression and secretion of vascular endothelial growth factor (VEGF-A), a strong stimulator of angiogenesis, through downregulation of c-jun and c-fos, which was supported in vitro by the finding that human vascular endothelial cells grew more slowly in conditioned medium of IFI27 knockdown on CCA cells and in vivo by the lower erythropoietin concentration found in the xenografted tumors derived from IFI27 knockdown on CCA cells. In addition, anti-VEGF-A antibody treatment was able to repress CCA cell growth. To the contrary, IFI27 overexpression could increase CCA cell proliferation, migration, and invasion. Clinically, higher IFI27 expression was linked to inferior overall survival of CCA patients.Conclusion: Our data strongly suggest that IFI27 could be deemed as a potential target for CCA treatment. Keywords: IFI27, cholangiocarcinoma, oncogene, angiogenesis, VEGF-A, metastasis, tumor growth, cell cycle

Edward J Filippone,1 Shirley J Dopson,2 Denise M Rivers,3 Rebeca D Monk,4 Suneel M Udani,5 Golriz Jafari,6 Solomon C Huang,6 Arafat Melhem,7 Bassim Assioun,7 Paul G Schmitz7 1Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, 2Division of Medicine, Washington Health System, Southwestern Nephrology, Inc, Washington, PA, 3Department of Medicine, University Nephrology, University of Tennessee, Knoxville, TN, 4Department of Medicine, Division of Nephrology, University of Rochester Medical Center, Rochester, NY, 5Department of Medicine, Section of Nephrology, University of Chicago, Chicago, IL, 6Division of Nephrology and Hypertension, Olive View–University of California, Los Angeles Medical Center, Sylmar, CA, 7Department of Internal Medicine, Division of Nephrology, Saint Louis University, St Louis, MO, USABackground: Adrenocorticotropic hormone is being increasingly studied for treatment of various glomerulopathies, most notably membranous nephropathy. Less data are available regarding its use in idiopathic nephrotic syndrome (INS) secondary to minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS). We report here our experience with H.P. Acthar® Gel (repository corticotropin injection) as first-line or subsequent therapy in patients with INS.Methods: Data were taken from three patients with MCD and ten patients with FSGS from around the US, who were treated with Acthar Gel as initial or subsequent therapy. Treatment was solely at the discretion of the primary nephrologist without a specific protocol. A complete response (CR) was defined as final urine protein-to-creatinine ratio

Chi-Tung Cheng,1,* Yin-Yi Chu,2,* Chun-Nan Yeh,1 Shih-Chiang Huang,3 Ming Huang Chen,4 Shang-Yu Wang,1 Chun-Yi Tsai,1 Kun-Chun Chiang,5 Yen-Yang Chen,6,7 Ming-Chun Ma,6,7 Chien-Ting Liu,6,7 Tsung-Wen Chen,1 Ta-Sen Yeh11Department of Surgery, 2Department of Gastroenterology and Hepatology, 3Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; 4Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 5Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan; 6Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 7Chang Gung University, Taoyuan, Taiwan*These authors contributed equally to this workBackground and objectives: Cholangiocarcinoma (CCA) affects thousands worldwide with increasing incidence. SPARC (secreted protein acidic and rich in cysteine) plays an important role in cellular matrix interactions, wound repair, and cellular migration, and has been reported to prevent malignancy from growth. SPARC undergoes epigenetic silencing in pancreatic malignancy, but is frequently expressed by stromal fibroblasts adjacent to infiltrating pancreatic adenocarcinomas. CCA is also a desmoplastic tumor, similar to pancreatic adenocarcinoma. SPARC’s clinical influence on clinicopathological characteristics of mass-forming (MF)-CCA still remains unclear. In this study, we evaluate the expression of SPARC in tumor and stromal tissue to clarity its relation with prognosis.Methods: Seventy-eight MF-CCA patients who underwent hepatectomy with curative intent were enrolled for an immunohistochemical study of SPARC. The expression of immunostaining of SPARC was characterized for both tumor and stromal tissues. We conducted survival analysis with 16 clinicopathological variables. The overall survival (OS) was analyzed by Kaplan–Meier analysis and Cox proportional hazards regression modeling.Results: Thirty-three men and 45 women with MF-CCA were studied. Within total 78 subjects, 12 (15.4%) were classified as tumor negative/stroma negative, 37 (47.4%) as tumor positive/stroma negative, four (5.1%) as tumor negative/stroma positive, and 25 (32.1%) as tumor positive/stroma positive. With a median follow-up of 13.6 months, the 5-year OS was 14.9%. Cox proportional hazard analysis revealed that SPARC tumor positive and stromal negative immunostaining and curative hepatectomy predicted favorable OS in patients with MF-CCA after hepatectomy.Conclusion: MF-CCA patients with SPARC tumor positive and stromal negative expression may have favorable OS rates after curative hepatectomy.Keywords: SPARC, mass-forming cholangiocarcinoma, prognosis, predicting factors

Using our recently reported whole body PET imaging technique, we performed whole body PET studies of the skeletal system with [18F]fluoride ion in 19 patients with a range of malignant and benign skeletal conditions and in 19 normal male volunteers. The technique produces two-dimensional projection images of the entire skeletal system ("a PET bone scan"), in addition to coronal, sagittal, and axial tomographic images of the skeletal system. The tomographic images had a 13% higher lesion detection sensitivity than the projection images. Whole body PET skeletal imaging with [18F]fluoride ion is technically feasible, provides images of excellent quality, and may be coupled with more quantitatively precise kinetic PET [18F]fluoride ion studies (over limited regions of the body) when numerical estimates of skeletal [18F]fluoride ion uptake are desired. The method is potentially useful in clinical applications where the high resolution and numerical precision of PET are of particular value (e.g., in accurately defining the anatomic location and extent of lesions and in assessing changes in bone metabolism on serial studies).

Introduction: Implantation of TheraCyte 4 × 10(6) live parathyroid cells can increase the bone marrow density of the spine of ovariectomized rats. There has been no published study examining the effect of such implantation on spinal fusion outcomes. The purpose of this study was to examine the effect of TheraCyte-encapsulated parathyroid cells on posterolateral lumbar fusions in a rat model.Materials and Methods: Forty Sprague-Dawley rats underwent single-level, intertransverse process spinal fusions using iliac crest autograft. The rats were randomly assigned to two groups: Group 1 rats received sham operations on their necks (control; N = 20); Group 2 rats were implanted with TheraCyte-encapsulated 4 × 10(6) live parathyroid cells into the subcutis of their necks (TheraCyte; N = 20). Six weeks after surgery the rats were killed. Fusion was assessed by inspection, manual palpation, radiography, and histology. Blood was drawn to measure the serum levels of calcium, phosphorus, and intact parathyroid hormone (iPTH).Results: Based on manual palpation, the control group had a fusion rate of 33 % (6/18) and the TheraCyte group had a fusion rate of 72 % (13/18) (P = 0.044). Histology confirmed the manual palpation results. Serum iPTH levels were significantly higher in the TheraCyte group compared with the control group (P < 0.05); neither serum calcium nor phosphorus levels were significantly different between the two groups.Discussion: This pilot animal study revealed that there were more fusions in rats that received TheraCyte-encapsulated 4 × 10(6) live parathyroid cells than in control rats without significant change in serum calcium or phosphorus concentrations. As with any animal study, the results may not extrapolate to a higher species. Further studies are needed to determine if these effects are clinically significant. [ABSTRACT FROM AUTHOR]

Contents The survival and development of pre-implantation embryos are determinant factors affecting the outcome of animal reproduction. It is essential to transfer the expression of the genetic material from maternal sources, that is the ovum to the zygote before implantation to ensure successful development. Differentiation and transformation of blastomeres initiated during the morula and blastocyst stages is an important step of the embryonic development prior to implantation. We collected morula and early blastocyst samples from pure-bred Landrace pigs in vivo to study the differential gene expression patterns at these two stages. Total RNA was extracted from individual embryos and two rounds of amplification were employed. Two micrograms of antisense RNA, targets, were prepared and hybridized with each of four custom made oligo microarrays representing 24 000 porcine genes. The analyses of replicate hybridizations showed that among the 24 000 genes, 162 genes were expressed fivefold or greater in the morula compared to early blastocysts and 2126 genes were expressed fivefold or greater in early blastocysts compared to the morula. Of these differentially expressed genes, 1429 genes were functionally annotated with related human Gene Ontology terms. In addition to basic metabolic processes, genes related to signal transduction, transportation and cell differentiation were found in both stages and were up-regulated as embryo development proceeded. Real time polymerase chain reaction was utilized to quantify 12 genes differentially expressed in the 2 embryonic stages and validated the reliability of major evidences shown in microarrays. In conclusion, we have obtained a preliminary landscape of genes differentially expressed during the transition from morula to early blastocysts in pigs and showed a generally increased transcriptional activity, perhaps in preparation for implantation. Our results provide an opportunity to study the functions of these genes in relation to the development and survival of pre-implantation porcine embryos. [ABSTRACT FROM AUTHOR]

Background: The favorable results of Pemberton acetabuloplasty in children with developmental dysplasia of the hip have been well reported. We reviewed our long-term results related to osteonecrosis of the femoral head after this surgery, especially with regard to the effect of excessive inferior displacement of the femoral head.Methods: From 1993 to 1997, we performed 167 Pemberton acetabuloplasties in patients with developmental dysplasia of the hip who were eighteen months of age or older. Patients who had had prior treatment or developmental dysplasia of the hip due to neuromuscular disease were excluded. We selected patients who had unilateral developmental dysplasia of the hip, had undergone simultaneous open reduction and Pemberton acetabuloplasty between the ages of eighteen and thirty-six months, and had been followed for a minimum of ten years. Forty-nine patients met these criteria. The patients were divided into osteonecrosis-absent and osteonecrosis-present groups according to the criteria described by Kalamchi and MacEwen. Preoperative, interim follow-up and final radiographs were available for evaluation, as were the results of clinical examination. We used the femoral head inferior displacement percentage, measured on the radiographs, to quantify the amount of excessive correction postoperatively. Outcomes were measured with use of the McKay criteria and the Severin criteria.Results: The mean age at the time of surgery was 20.8 months, and the mean duration of follow-up was 134.6 months. Twenty-four patients (49%) were classified as not having osteonecrosis (the osteonecrosis-absent group) and twenty-five patients (51%), as having osteonecrosis (the osteonecrosis-present group). There were no significant differences between the two groups in terms of sex, age, laterality, Tönnis grade, or preoperative acetabular index. Seven of the cases of osteonecrosis were type I, thirteen were type II, one was type III, and four were type IV. The inferior displacement percentage revealed significant differences between the two groups (p < 0.0001). In the osteonecrosis-absent group, 96% of the patients had a radiographically satisfactory result (Severin class I or II); however, only 76% of the patients in the osteonecrosis-present group had a radiographically satisfactory result (p < 0.0001). According to the McKay criteria, there were significant clinical differences between the groups (p < 0.0001).Conclusions: Our results showed significant correlation between excessive reduction of the femoral head and the development of osteonecrosis. In light of the high prevalence of type-II osteonecrosis, we postulated that the lateral epiphyseal branch of the medial circumflex artery was vulnerable to compression with increased inferior displacement of the femoral head. The latest radiographic and functional results corresponded to the severity of the osteonecrosis. [ABSTRACT FROM AUTHOR]

Objectives: Amyloid senile plaques and tau neurofibrillary tangles are neuropathologic hallmarks of Alzheimer disease, which may be associated with mild cognitive impairment (MCI) or mood and anxiety symptoms years before the dementia diagnosis. To address this issue, the authors obtained positron emission tomography (PET) scans after intravenous injections of 2-(1-{6-[(2-[fluorine-18]fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene)malononitrile (FDDNP), a molecule that binds to amyloid plaques and neurofibrillary tangles, to determine whether symptoms of depression and anxiety in nondemented subjects were associated with increased FDDNP-PET binding values.Methods: Forty-three middle-aged and elderly volunteers received clinical and FDDNP-PET assessments. Subjects were nondemented--23 of them were diagnosed with MCI and 20 were cognitively normal. Subjects with a diagnosis of major depression or an anxiety disorder were excluded. Correlations between standardized measures of depressive and anxiety symptoms and regional FDDNP binding values were calculated.Results: The MCI and comparison subjects did not differ by the depression and anxiety scores. In the MCI group, depression scores correlated with lateral temporal and trait anxiety scores correlated with posterior cingulate FDDNP binding. In the comparison group, depression scores correlated with medial temporal, and trait anxiety scores correlated with medial temporal and frontal FDDNP binding.Discussion: This is the first report to demonstrate a relationship between the severity of depression and anxiety symptoms and FDDNP binding values in nondemented middle age and older individuals. The results suggest a relationship between relatively mild mood symptoms and biomarkers of cerebral amyloid and tau deposition and vary according to degree of cognitive impairment. The presence of MCI may signify different pathophysiological mechanisms underlying mood and anxiety symptoms. [ABSTRACT FROM AUTHOR]

In this study, we evaluated the analgesic effect of methanol extract from Desmodium triflorum DC (MDT) by using animal models of acetic acid-induced writhing response and formalin test. The anti-inflammatory effect of MDT was investigated by lambda-carrageenan-induced paw edema in mice. In order to study the anti-inflammatory mechanism of MDT, we detected the activities of glutathione peroxidase (GPx) and glutathione reductase (GRd) in the liver, the levels of interleukin-1beta (IL-1beta), tumor necrosis factor (TNF-alpha), malondialdehyde (MDA) and nitric oxide (NO) in the edema paw tissue. In the analgesic test, MDT (0.5 and 1.0 g/kg) decreased the acetic acid-induced writhing response and the licking time on the late phase in the formalin test. In the anti-inflammatory test, MDT (0.5 and 1.0 g/kg) decreased the paw edema at the 3rd, 4th, 5th and 6th hour after lambda-carrageenan administration. On the other hand, MDT increased the activities of SOD and GRd in liver tissues and decreased the MDA level in the edema paw at the 3rd hour after lambda-carrageenan-induced inflammation. MDT also affected the levels of interleukin-1beta, tumor necrosis factor-alpha, NO and MDA which were induced by lambda-carrageenan. The results suggested that MDT possessed analgesic and anti-inflammatory effects. The anti-inflammatory mechanism of MDT might be related to the decreases in the level of MDA in the edema paw via increasing the activities of SOD and GRd in the liver, and the NO level via regulating the IL-1beta production and the level of TNF-alpha in the inflamed tissues. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe survival and neurologic outcome and identify the factors associated with survival among pediatric patients following extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest. DESIGN: Retrospective study. SETTING: A university-affiliated tertiary care hospital. PATIENTS: Eligible patients were < or = 18 yrs of age and received extracorporeal membrane oxygenation during active cardiopulmonary resuscitation for in-hospital cardiac arrest. INTERVENTIONS: Extracorporeal membrane oxygenation (ECMO) during active cardiopulmonary resuscitation. MEASUREMENTS AND MAIN RESULTS: The primary outcome was survival to hospital discharge. The secondary outcome was neurologic status after ECPR at hospital discharge and late follow-up. Good neurologic outcome was defined as Pediatric Cerebral Performance Categories 1, 2, and 3. Continuous variables were expressed as medians (interquartile range). We prospectively defined the early cohort (January 1999 to December 2001) and late cohort (January 2002 to January 2006) and compared the survival rates. We identified 27 ECPR events. The survival rate to hospital discharge was 41% (11 of 27). The nonsurvivors had higher pre-cardiopulmonary resuscitation serum lactate levels (14 [10.2-19.6] mmol/L vs. 8.5 [4.4-12.6] mmol/L, p < .01), longer durations of cardiopulmonary resuscitation (60 [37-81] mins vs. 45 [25-50] mins, p < .05) with longer activating time for ECMO (12.5 [7.5-33.8] mins vs. 5 [0-10] mins, p < .01), and more renal failure after ECPR (68% [11 of 16] vs. 9% [1 of 11], p < .01). The survival rate of the late cohort was better than that of the early cohort (58% [11 of 19] vs. 0% [0 of 8], p < .05). By exact multiple logistic regression analysis, the early cohort and renal failure after ECPR were two independent risk factors for mortality. Among the 11 survivors, ten had good neurologic outcomes. CONCLUSIONS: ECPR successfully rescued some pediatric patients who failed rescue with conventional in-hospital CPR. Good neurologic outcomes were achieved in the majority of the survivors. Early cohort and post-ECPR renal failure were associated with mortality. [ABSTRACT FROM AUTHOR]

Background: Spontaneous rupture of solid pseudopapillary neoplasm of the pancreas is an unusual complication during pregnancy.Case: At 19 weeks of gestation, a 29-year-old woman presented with a pancreatic mass and upper abdominal pain radiating to the back. On the third day of admission, shock and peritoneal signs developed. Exploratory laparotomy and subsequent subtotal pancreatectomy were performed for a bleeding tumor. Solid pseudopapillary neoplasm was confirmed by pathological examination. The patient delivered a healthy full-term girl vaginally. Eight months postoperatively, the clinical courses of both mother and infant have been uneventful.Conclusion: Ruptured solid pseudopapillary neoplasms can cause an acute abdomen during pregnancy. The expression of progesterone receptors in solid pseudopapillary neoplasm is a possible cause of this potentially devastating event. [ABSTRACT FROM AUTHOR]

This paper deals with finding the maximum number of security policies without conflicts. By doing so we can remove security loophole that causes security violation. We present the problem of maximum compatible security policy and its relationship to the problem of maximum acyclic subgraph, which is proved to be NP-hard. Then we present a polynomial-time approximation algorithm and show that our result has approximation ratio for any integer with complexity .