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Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast numbers of cataract surgeries performed daily, complications occur often enough that every ophthalmologist should be equipped with techniques to manage aphakia. Medical management of aphakia used to be commonplace but these techniques have their disadvantages including thick bulky lenses, poor cosmesis, and aniseikonia. Surgical management of aphakia overcomes these disadvantages and offers patients the possibility of a spectacle and contact lens-free lifestyle. This article reviews the various options of surgical management of aphakia and their advantages and disadvantages. Comparison of outcomes between techniques and a protocol for deciding between techniques is presented.

To explore the use of a thermoreversible copolymer gel coating to prevent donor tissue scrolling in Descemet's membrane endothelial keratoplasty (DMEK).PLGA-PEG-PLGA triblock copolymer was synthesised via ring opening polymerisation. Two formulations were fabricated and gelation properties characterised using rheological analyses. Endothelial cytotoxicity of the copolymer was assessed using a Trypan Blue exclusion assay. Thickness of the copolymer gel coating on the endothelial surface was analysed using anterior segment optical coherence tomography (OCT) (RTVue-100, Optovue Inc.). Gold nanoparticles were added to the copolymer to aid visualisation using OCT. Prevention of Descemet membrane donor scrolling was represented via a novel, in vitro, immersion of copolymer coated donor graft material.Two different formulations of PLGA-PEG-PLGA copolymer were successfully fabricated and the desired peak gelling temperature of 24°C was achieved by polymer blending. Application of 20%, 30% and 40% (wt/vol) polymer concentrations resulted in a statistically significant increase in polymer thickness on the endothelium (p 0.001). There was no detectable endothelial cytotoxicity. The polymer was easy to apply to the endothelium and prevented scrolling of the DMEK graft.This PLGA-PEG-PLGA thermoreversible copolymer gel could be exploited as a therapeutic aid for preventing DMEK graft scrolling.

Understanding of antibody kinetics against SARS-CoV-2 and its vaccines is rapidly evolving. This study aims to (1) determine post-vaccination seroprevalence; (2) compare antibody levels between vaccine types and various clinical/demographic determinants; and (3) determine post-vaccination antibody concentrations against time. This is a retrospective cross-sectional study involving 148 healthcare employees all over Malaysia. IgG Spike (RBD), IgM Spike and IgG Nucleocapsid concentration medians were compared using Mann-Whitney U or Kruskal-Wallis tests. Chi Square and Spearman correlation coefficient tests were performed to identify variables associated with antibody titers. A scatter plot of IgG Spike (RBD) against time from last vaccine dose was also plotted. At 1-month post-vaccination, all employees successfully seroconverted regardless of vaccine type, health status and COVID- 19 history. Comirnaty, convalescent, female or Malay vaccinees had significantly higher IgG Spike (RBD) titers compared to their respective counterparts. No correlation was found between age and IgG Spike (RBD) levels. Concentration of all three antibodies waned with time post-vaccination, with IgM Spike and IgG Nucleocapsid waning faster than IgG Spike (RBD).

The disc damage likelihood scale (DDLS) is a tool for classifying glaucomatous structural changes to the optic disc based on the radial width of the neuroretinal rim at its thinnest location, or if no rim is present, the extent of absence of the rim. Unlike cup disc ratio (CDR), the DDLS also considers disc size. Twenty years after its first description, the aim of this review was to critically appraise evidence for the DDLS and evaluate its role in current practice. A literature search by two independent authors identified 33 relevant articles for inclusion. Five studies evaluated reproducibility, 5 diagnostic performance, and 2 studies examined ability to detect progression. Eleven studies evaluated correlation between DDLS and other markers of glaucoma. Despite the widespread availability of imaging devices such as optical coherence tomography (OCT), clinical examination of the optic disc remains an essential component of glaucoma diagnosis and monitoring. The DDLS provides a reliable method for semi-quantitative clinical grading of the optic disc in glaucoma, with higher reproducibility than methods such as CDR.

Poor adherence to medical therapy is a major challenge to the effective treatment of chronic diseases including glaucoma. Potential factors influencing adherence include treatment complexity and patient understanding of disease and health beliefs. An increasing number of patients are seen in virtual clinics, where there is no face-to-face consultation, potentially reducing opportunities for patient education and reinforcement of the importance of treatment. The aim of this study was to examine adherence among patients attending a virtual glaucoma clinic.100 consecutive patients attending the virtual clinic were surveyed, with 78 using topical medications included in the analysis. All patients completed a validated adherence questionnaire with a score of2 defined as poor adherence. The relationship between adherence and age, sex, duration since diagnosis, and disease severity was examined.The mean age was 73.1 ± 13.4 years, with an average mean deviation of -5.9 ± 5.5 dB and duration since first diagnosis of 9.0 ± 5.7 years. 93.6% reported self-instilling eye drops. Seventy-one patients (91.0 %) had good self-reported adherence. Multivariate logistic regression revealed those instilling eye drops independently had higher odds of good adherence.The level of medication adherence in the virtual glaucoma clinic was higher than adherence in previous studies examining patients attending face-to-face clinics. Virtual clinics should incorporate methods to ensure effective two-way communication with patients and strategies for patient education.

The aim of this study was to investigate the relationship between glaucoma severity and perifoveal vessel density (pfVD), branching complexity, and foveal avascular zone (FAZ) size in normal tension glaucoma (NTG). 31 patients with NTG washed out of glaucoma medications were subjected to tests including; intraocular pressure measurement; standard automated perimetry; optical coherence tomography (OCT) measurement of macular ganglion cell complex (mGCC), inner macular thickness (IMT) and circumpapillary retinal nerve fibre layer (cpRNFL); and OCT angiography measurement of pfVD, FAZ perimeter and multispectral fractal dimensions (MSFD). Eyes with more severe glaucoma had significantly thinner mGCC and cpRNFL and lower pfVD. MD decreased by 0.4 dB (95% CI 0.1 to 0.6 dB, P = 0.007) for every 1% decrease in pfVD. Lower MSFD was observed in eyes with lower pfVD and in patients with systemic hypertension. Multivariable analysis, accounting for age and OCTA quality, found lower pfVD remained significantly associated with thinner IMT, thinner mGCC and worse MD but not with MSFD. pfVD was reduced in NTG and was diminished in eyes with worse MD. Macular vessel branching complexity was not related to severity of visual field loss but was lower in patients with systemic hypertension.

Gene editing is a powerful tool for genome and cell engineering. Exemplified by CRISPR–Cas, gene editing could cause DNA damage and trigger DNA repair processes that are often error-prone. Such unwanted mutations and safety concerns can be exacerbated when altering long sequences. Here we couple microbial single-strand annealing proteins (SSAPs) with catalytically inactive dCas9 for gene editing. This cleavage-free gene editor, dCas9–SSAP, promotes the knock-in of long sequences in mammalian cells. The dCas9–SSAP editor has low on-target errors and minimal off-target effects, showing higher accuracy than canonical Cas9 methods. It is effective for inserting kilobase-scale sequences, with an efficiency of up to approximately 20% and robust performance across donor designs and cell types, including human stem cells. We show that dCas9–SSAP is less sensitive to inhibition of DNA repair enzymes than Cas9 references. We further performed truncation and aptamer engineering to minimize its size to fit into a single adeno-associated-virus vector for future application. Together, this tool opens opportunities towards safer long-sequence genome engineering.

BACKGROUND Socioeconomic deprivation is known to increase the risk of late presentation of many diseases. This is the largest study in United Kingdom investigating the relationship between socioeconomic deprivation and acute primary angle closure (APAC). METHODS A retrospective review of case notes was conducted of 718 consecutive patients who underwent laser peripheral iridotomy (LPI) in Edinburgh (Princess Alexandra Eye Pavilion) and Fife (Queen Margaret Hospital) between 2015 and 2019. Baseline demographics including sex, age, ethnicity, pre-existing diabetes, use of anti-depressants, and family history of glaucoma were collected. Deprivation was scored using the Scottish Index of Multiple Deprivation (SIMD) Index 2020v2. A lower rank and decile indicate higher degrees of deprivation. We investigated differences in characteristics between patients who were referred routinely versus patients who referred as APAC. RESULTS The SIMD rank and deciles were consistently lower in patients who were referred urgently with APAC in both centres (P =

Although the negative association between discrimination and recovery has been established, only a few studies have attempted to investigate the underlying mechanism of how perceived discrimination dampens both clinical and personal recovery among people with psychiatric disorders. This study aimed to examine the mediating roles of self-stigma and mental health service engagement in the relationship between perceived discrimination and recovery.A total of 374 people (half men and half women; mean±SD age=43.47±12.76) living in Hong Kong and in recovery with a primary diagnosis of a psychotic disorder, mood disorder, or substance use disorder responded to a cross-sectional questionnaire on discrimination, self-stigma, mental health service adherence, recovery orientation of services, clinical recovery, and personal recovery. Multisample structural equation modeling was conducted to examine whether the hypothesized model for perceived discrimination and recovery produced results that could be generalized across people with various psychiatric diagnoses.Findings indicated that respondents perceived discrimination from the general public and from health care professionals, which was positively associated with self-stigmatization and service disengagement and was negatively associated with clinical and personal recovery across three different types of psychiatric disorder.This study showed that the influence of perceived discrimination on recovery was universal and could be generalized across people with different psychiatric diagnoses. Multipronged stigma reduction interventions targeting the general public, health care professionals, and people in recovery, along with policies that avert discrimination and uphold human rights in health care settings and beyond, should be implemented.

Background Blood loss during liver surgery is found to be correlated with central venous pressure (CVP). The aim of the current retrospective study is to find out the cutoff value of CVP and stroke volume variation (SVV), which may increase the risk of having intraoperative blood loss of more than 100 mL during living liver donor hepatectomies. Method and Patients Twenty-seven adult living liver donors were divided into 2 groups according to whether they had intraoperative blood loss of less (G1) or more than 100 mL (G2). The mean values of the patients' CVP and SVV at the beginning of the transaction of the liver parenchyma was used as the cutoff point. Its correlation to intraoperative blood loss was evaluated using the χ2 test; P Results The cutoff points of CVP and SVV were 8 mm Hg and 13% respectively. The odds ratio of having blood loss exceeding 100 mL was 91.25 (P Conclusion CVP less than 5 mm Hg, as suggested by most authors, is not always clinical achievable. Our results show that a value of less than 8 mm Hg or SVV 13% is able to achieve a minimal blood loss of 100 mL during parenchyma transaction during a living donor hepatectomy. Measurements used to lower the CVP or increased SVV in our serial were intravenous fluids restriction and the use of a diuretic.

Background Opsite (Smith & Nephew, Hull, UK) is widely used in wound care but its use in eye protection against corneal abrasion during major surgery is rarely reported. The purpose of the current study is to compare the effectiveness of using Opsite in eye protection with either wet gauze alone or with wet gauze following application of eye ointment in patients undergoing living donor liver transplantation (LDLT). Methods This is a prospective, double-blinded, randomized controlled trial. Forty-one patients undergoing liver transplantation were enrolled. One eye of each patient was protected with sterile gauze soaked with normal saline solution and covered with Opsite. Duratears (ALCON, Fort Worth, Tex, United States) ointment was applied to the other eye before covering it with sterile wet gauze and Opsite (ointment group). The corneal examination was carried out after fluorescein staining before and at the end of surgery by the same doctor. A Student t-test and a χ2 test were used for the statistical analyses. Results Forty-one patients with 82 eyes were observed in this study. No corneal epithelial defects were found in either the normal saline group or the ointment group. Conclusion Opsite combined with wet gauze with or without additional eye ointment provided 100% protection against corneal abrasion in patients undergoing LDLT.

Objectives The aims of this study were to compare the core temperature changes between pediatric patients lying on regular operating room linen drapes and a water-repellent sheepskin rug during living donor liver transplantation (LDLT) and to evaluate the effectiveness of using a water-repellent sheepskin rug in preventing profound hypothermia due to fluid overflow from the abdominal cavity during LDLT. Patients and Methods The operative records of pediatric patients who underwent LDLT from June 1994-September 2003 were reviewed retrospectively. The nasopharyngeal temperature (NT) changes during the LDLT procedure between patients lying on regular operating room drapes (GI) and water-repellent sheepskin rug (GII) were compared and analyzed using the Mann-Whitney U test. A P value Results Thirty-two patients were included in GI and 56 in GII. Profound hypothermia was not observed in any recipients lying on a water-repellent sheepskin rug (GII). The NT after induction and the following 4 hours into the LT procedure were significantly higher in GII than GI. Conclusion Pediatric patients lying on water-repellent sheepskin preserved their core temperature better in comparison to patients lying on linen drapes. The use of a water-repellent sheepskin rug seems to be effective in preventing profound hypothermia related to physical contact with abdominal fluid overflow during the LDLT.

Several existing technologies enable short genomic alterations including generating indels and short nucleotide variants, however, engineering more significant genomic changes is more challenging due to reduced efficiency and precision. Here, we developed RecT Editor via Designer-Cas9-Initiated Targeting (REDIT), which leverages phage single-stranded DNA-annealing proteins (SSAP) RecT for mammalian genome engineering. Relative to Cas9-mediated homology-directed repair (HDR), REDIT yielded up to a 5-fold increase of efficiency to insert kilobase-scale exogenous sequences at defined genomic regions. We validated our REDIT approach using different formats and lengths of knock-in templates. We further demonstrated that REDIT tools using Cas9 nickase have efficient gene-editing activities and reduced off-target errors, measured using a combination of targeted sequencing, genome-wide indel, and insertion mapping assays. Our experiments inhibiting repair enzyme activities suggested that REDIT has the potential to overcome limitations of endogenous DNA repair steps. Finally, our REDIT method is applicable across cell types including human stem cells, and is generalizable to different Cas9 enzymes.

Objective Right lobe living donor hepatectomy poses a greater risk for the donor in relation to blood loss. The aims of this study were to compare anesthetic and intraoperative fluid management in right and left lateral segment living donor hepatectomy. Patients and Methods The anesthesia records of living donor hepatectomy patients were retrospectively reviewed. Donor age and weight, anesthesia time, central venous pressure, blood loss, blood product transfusion, intravenous fluids used, doses of furosemide, and urine output were compared and analyzed between groups using the Mann Whitney U test. Results Forty-six patients underwent living donor left lateral segment hepatectomy (Group I); while 31 patients underwent right lobe hepatectomy (Group II). The mean blood loss in Group II was significantly higher compared to Group I (118 ± 81 mL vs 68 ± 64 mL), but clinically such amount of blood loss was not high enough to affect the hemodynamics. The fluid management was therefore not meaningfully different between the two groups. No blood transfusions or colloid infusions were required for either group. Urine output, hemoglobin changes, blood urea nitrogen, and serum creatinine pre- and postoperatively were not significantly different between groups. Conclusions As long as blood loss is minimal, we found no difference in the anesthetic management and fluid replacements between right and left lateral segment living donor hepatectomy.

Background To evaluate the effect of dextrose contained in banked blood products on the changes of blood glucose levels in adult living donor liver transplantation patients retrospectively. Methods Four hundred seventy-seven patients were divided into a non–blood transfusion (BT) group (G1) and a BT group (G2). The changes in blood glucose levels during the operation were compared using a Mann-Whitney U test, and a P value less than .05 was regarded as significant. Results No significant changes were detected in blood glucose levels after anesthesia, during dissection phase, in the anhepatic phase, or after reperfusion between the groups. Estimated blood loss for G1 (n = 89) and G2 (n = 388) were 718 ± 514 and 5804 ± 877 mL respectively, G1 had no blood transfusion but G2 had received 4350 ± 6230 mL leukocyte-poor red blood cell transfusion, the pre- and end operation hemoglobin for G1 and G2 were 13.2 ± 2.0, 10.2 ± 1.9 and 10.1 ± 1.6, 10.2 ± 1.9 mg/dL respectively, indicating that they were not under or over transfused. Conclusion When banked blood products are used to replace ongoing blood loss, the dextrose contained in citrate-phosphate-dextrose-adenine seems to have no effect on the changes in the blood glucose levels of the recipients.

Badiranji Buya Keli (BBK) is a traditional Uyghur medicine derived from Dracocephalum Moldavica Herba (DMH, the aerial part of Dracocephalum moldavica L.). BBK has been widely used in treating cardiovascular and cerebrovascular diseases. Here, the quality control of BBK was established by using HPLC analysis of rosmarinic acid and tilianin. After chemical standardization, the biological effects of BBK was tested. First, BBK inhibited platelet aggregation of rabbit plasma. Second, BBK induced vasodilation in rat aortic ring, and this effect was partially mediated by nitric oxide (NO) production in endothelial cells. Third, BBK induced NO production in cultured human umbilical vein endothelial cells (HUVECs). In HUVECs, the phosphorylation of endothelial NO synthase (eNOS) was markedly increased after application of BBK. Pre-treatment with the eNOS blocker N(ω) -nitro-l-arginine methyl ester hydrochloride could abolish BBK-induced NO production and eNOS phosphorylation. Taken together, these results suggest that BBK could exert beneficial effects in cardiovascular system, which may provide parts of molecular explanation to account for its traditional usage in Uyghur medicine.

ATP is co-stored and co-released with acetylcholine (ACh) at the pre-synaptic vesicles in vertebrate neuromuscular junction (nmj). Several lines of studies demonstrated that binding of ATP to its corresponding P2Y1 and P2Y2 receptors in the muscle regulated post-synaptic gene expressions. To further support the notion that P2Y receptors are playing indispensable role in formation of post-synaptic specifications at the nmj, the knock-out mice of P2Y1 receptor (P2Y1R (-/-)) were employed here for analyses. In P2Y1R (-/-) mice, the expression of P2Y2 receptor in muscle was reduced by over 50 %, as compared to P2Y1R (+/+) mice. In parallel, the expression of acetylcholinesterase (AChE) in muscle was markedly decreased. In the analysis of the expression of anchoring subunits of AChE in P2Y1R (-/-) mice, the proline-rich membrane anchor (PRiMA) subunit was reduced by 60 %; while the collagen tail (ColQ) subunit was reduced by 50 %. AChE molecular forms in the muscle were not changed, except the amount of enzyme was reduced. Immuno-staining of P2Y1R (-/-) mice nmj, both AChE and AChR were still co-localized at the nmj, and the staining was diminished. Taken together our data demonstrated that P2Y1 receptor regulated the nmj gene expression.

Edible bird’s nest (EBN; Yan Wo), or cubilose, is originated from the salivary secretion of Aerodramus fuciphagus. In Asia, EBN is famous for its unproven skin lightening function. Here, we aim to reveal the active ingredients of EBN responsible for skin lightening function. Three major fractions were isolated from EBN water extract by chromatography using LC-MS/MS, bioactivities of these isolated fractions were analyzed by assays of tyrosinase, melanocytes and 3D human skin model, from which, N-acetylneuraminic acid (NANA), the second isolated fraction showed an inhibition effect on tyrosinase activity in a dose-dependent manner. The IC50 of tyrosinase originated from mushroom and human was 16.93 mM and 0.10 mM respectively. Furthermore, only EBN with higher content of NANA (e.g. White and Red EBN), but not EBN with less NANA (e.g. Grass EBN), showed promising skin lightening function. This is the first report to reveal NANA being an active ingredient of EBN on skin lightening function.

Hyperkalemia, defined as a serum potassium level higher than 5 mEq/L, is common in the liver transplantation setting. Severe hyperkalemia may induce fatal cardiac arrhythmias; therefore, it should be monitored and treated accordingly. The aim of the current retrospective study is to evaluate and indentify the predictive risk factors of hyperkalemia during living-donor liver transplantation (LDLT).Four hundred eighty-seven adult LDLT patients were included in the study. Intraoperative serum potassium levels were monitored at least five times during LDLT; patients with a potassium level higher than 5 mEq/L were included in group 1, and the others with normokalemia in group 2. Patients' categorical characteristics and intraoperative numeric variables with a P value .1 were selected into a multiple binary logistic regression model. In multivariate analysis, a P value of .05 is regarded as a risk factor in the development of hyperkalemia.Fifty-one of 487 (10.4%) patients had hyperkalemia with a serum potassium level higher than 5.0 mEq/L during LDLT. Predictive factors with P .1 in univariate analysis (Table 1), such as anesthesia time, preoperative albumin level, Model for End-stage Liver Disease score, preoperative bilirubin level, amount of blood loss, red blood cell (RBC) and fresh frozen plasma transfused, 5% albumin administered, hemoglobin at the end of surgery, and the amount of furosemide used, were further analyzed by multivariate binary regression. Results show that the anesthesia time, preoperative serum albumin level, and RBC count are determinant risk factors in the development of the hyperkalemia in our LDLT serials.Prolonged anesthesia time, preoperative serum albumin level, and intraoperative RBC transfusion are three determinant factors in the development of intraoperative hyperkalemia, and close monitoring of serum potassium levels in patients with abovementioned risk factors are recommended.

Background The aim of this study is to determine whether preoperative portal vein flow velocity or size has any correlative effect on hemodynamic changes during clamping of the inferior vena cava in liver transplantation. Patients and Methods A total of 42 anesthesia charts of adult patients who underwent living donor liver transplantation (LDLT) were analyzed and compared retrospectively. Preoperative portal vein (PV) flow velocity and sizes were obtained using Doppler ultrasound. All changes in the hemodynamic data before and after clamping of the portal vein (PV) and inferior vena cava (IVC) were recorded and analyzed by linear regression. A P value of Results Heart rate (HR), mean arterial blood pressure (MAP), central venous pressure (CVP), cardiac output (CO), cardiac index (CI), and stroke volume (SV) before and after clamping of the PV and IVC were significantly different for as long as the PV and IVC were clamped. Linear regression analysis indicated that R2 of HR, MAP, CVP, CO, and CI in correlation with the PV velocity were 0.002, 0.035, 0.024, and 0.001; R2 of the PV diameter for HR, MAP, CVP, CO, and CI were 0.028, 0.01, 0.034, and 0.004. The changes in the percentages of cardiac output at 1- and 5-minute intervals after IVC clamping were not correlated significantly with either the preoperative flow velocity or the size of the PV. Conclusion Preoperative PV flow velocity and size are not correlated or associated with hemodynamic changes during IVC clamping in liver transplantation.

Background Whether the history of esophageal variceal bleeding (EVB) can be used clinically to predict the tolerability or hemodynamic instability during clamping of the inferior vena cava (IVC) and portal vein in liver transplantation is unknown and, therefore, needs to be elucidated. Patients and Methods A total of 50 anesthesia charts of patients who underwent living donor liver transplantation were reviewed, analyzed and compared retrospectively. Patients without a history of EVB were classified as group 1 and patients with a history of EVB were classified as group 2. The numbers of patients with a decrease in cardiac index (CI) of ≥20%, ≥30%, or ≥40% from their preclamping values after IVC clamping were compared with a χ 2 , and a P value of .05 was regarded as statistically significant. Results The measured hemodynamic parameters before and 5 minutes after clamping of the IVC and portal vein were all significantly different in comparison with the patient's preclamping values. The incidence of a decrease in CI of ≥20%, ≥30%, or ≥40% 5 minutes after clamping of the IVC and portal vein were not significantly different between groups. Conclusions Clamping of the portal vein and IVC without performing veno-venous bypass in living donor liver transplantation had a significant negative impact on CI in both groups due to the drastic reduction in the venous return. Statistical analysis revealed that a history of EVB affects hemodynamics in a manner similar to that in patients without history of EVB during IVC clamping.

HHV-6 reactivation in immunocompromised patients is common and may be associated with serious morbidity and mortality; therefore, early detection and initiation of therapy might be of benefit. Real-time PCR assays allow for early identification of HHV-6 reactivation to assist in providing a timely response. Thus, we compared the performance of an in-house developed HHV-6 quantitative PCR assay with a commercially available kit, the RealStarThe analytical sensitivity, analytical specificity, linearity, precision and accuracy of the in-house developed HHV-6 qPCR assay were evaluated. The diagnostic performance of the in-house HHV-6 qPCR assay was compared with the RealStarLinear regression analysis of the quantitative results showed a dynamic range from 2 to 10 logThe in-house developed HHV-6 qPCR method is a sensitive and reliable assay with lower cost for the detection and quantification of HHV-6 DNA when compared to the RealStar

BACKGROUND The aim of this retrospective observational study is to evaluate the effectiveness and impact on glycemia of the administration of 10 gram glucose and 10 units insulin in treating hyperkalemia during living donor liver transplantation (LDLT). METHODS In LDLT, patients whose serum potassium exceeded 5.4 mEq/L and were treated with 10 gram glucose and 10 U regular insulin were included in this study. The descriptive statistics summarize the demographic data, baseline laboratory values, and intra-operative parameters of the treated patients. The changes of the serum potassium and serum glucose levels after treatment were analyzed by the paired Student's t-test. All the data were given as means ± SD. A P value < 0.05 was regarded as statistically significant. RESULTS After administration of 10 gram glucose and 10 units regular insulin bolus intravenously, a drastic and significant decreased of serum potassium from 5.73 ± 0.44 to 4.48 ± 0.06 mEq/L was noted. The serum glucose level was slightly higher after the treatment (166.6 ± 32.1 and 196.8 ± 44.3 mg/dl respectively, p = 0.05). CONCLUSIONS An intravenous bolus of 10 units regular insulin with 10 gram glucose was able to decrease the serum -potassium level effectively and additionally increase serum glucose in LDLT patients.

This paper covers work carried out on the electrical design for a 245kV Vacuum Circuit Breaker, specifically the design of the Vacuum Interrupters. The design is based on a “T” style transmission breaker, with two Vacuum Interrupters in series. The VCB uses a single permanent magnetic actuator with a toggle mechanism to provide the opening and closing forces required and the synchronization of the two Vacuum Interrupters. Vacuum Interrupters are not presently used at these high voltages, but the continuing search for a replacement for the present SF6 based technology for environmental reasons leads us to consider the use of Vacuum Interrupters at ever increasing system voltages. At present single interrupter VCB are in service up to 145kV, and have been for many years. This logically leads to the simple concept of a two break VCB for 245kV Multiple break circuit breakers using both SF 6 and Vacuum technology have been used for many years, and are well proven in service. Rather than taking existing 145kV Vacuum Interrupters and designing a VCB around them, we have taken the approach of designing special interrupters which are intended to work in pairs. Using Vacuum Interrupters in pairs gives significant advantages over single Vacuum Interrupters for these high voltages and this allows us to optimize the vacuum interrupter design for this application. The paper discusses the problems of achieving these high ratings and the methods of optimizing the performance, size, and cost to achieve these requirements. As part of the design process we have modelled the single Vacuum Interrupters and the pair of Vacuum Interrupters using 2D and 3D electrostatic finite element modelling to optimize the voltage design of the Vacuum Interrupters as well as modelling the arc control using 3D electromagnetic finite element modelling to give the required interruption performance. The electrostatic design of the Vacuum Interrupters is discussed in this paper, as well as the design of the VCB. The electromagnetic modelling will be discussed in a future paper.

Background: Adverse drug events (ADE) have been studied widely in hospitalised and emergency department (ED) patients. Less is known about the ED visits of drug-related injury in Taiwan. This study seeks to determine the incidence, risk and patient outcomes of ADE in an ED population. Methods: We conducted a prospective observational cohort study of patients 18 years and older presenting to the ED of an urban, tertiary medical centre. ED visits between 1 March 2009 and 28 February 2010 identified by investigators for suspected ADE were further assessed by using the Naranjo Adverse Drug Reaction probability scale. Outcomes (ED disposition, injury severity and preventability) and associated variables (triage, gender, drug category, number of drugs, Charlson comorbidity index score and ADE mechanism) were measured. Results: Of 58 569 ED visits, 452 patients (0.77%) had physician-documented ADE. 24% of patients with ADE were hospitalised with life-threatening conditions, with a mortality rate of 10.0%. The majority of ADE were considered preventable (73.4%), and the unintentional overdose was the most common cause. Cardiovascular agents accounted for the most ADE (25.8%) and consisted of 65.3% of ADE in patients aged 65 years and older. Risk factors for ADE-related hospitalisation were elderly age (odds ratio (OR) 1.9, 95% confidence interval (CI) 1.1–3.4), severity of ADE (OR 6.9, 95% CI 3.3–14.5) and higher Charlson comorbidity index scores (OR 3.4, 95% CI 2.0–5.7). Conclusion: ADE-related ED visits are not uncommon in Taiwan and many cases are preventable. ED-based surveillance may provide useful information for monitoring outpatient ADE.

This paper presents the fabrication, design and electrical performance of magnetic thin-film inductors for monolithic integration with CMOS for DC-DC power conversion. Magnetic core inductors were fabricated using conventional CMOS processes to achieve peak inductance density of 290nH/mm2, quality factor 15 at 150MHz, current density exceeding 11 A/mm2 and coupling coefficient of 0.89 for coupled inductors.

Background and purpose : Few studies have addressed factors that contribute to functional recovery in people with hemorrhagic stroke. We assessed the value of using pre-training functional level and cognitive abilities measured at a dmission in order to predict functional gain in a sample of stroke patients. Methods: The Functional Independence Measure (FIM) was administered to 85 hemorrhagic stroke patients. Three multiple regression models were constructed using total gain in FIM scores, gain in scores in the cognitive domain of FIM, and gain in scores in the motor domain of FIM as outcome variables. Predictor variables were age; scores on the Digit Span Forward Test (DSF), Digit Span Backward Test (DSB), and Chinese Auditory Verbal Learning Test (CAVLT); and the FIM scores measured at admission. Results: All regression models were significant, P s < 0.001, and each explained over 73% of the variance in the FIM gains. Age and admission FIM scores were both significant predictors in each of the three models. The DSB span score was a significant predictor of the total FIM and the cognitive FIM gains. The CAVLT recognition score was also a significant predictor of the cognitive FIM gain. Conclusions: Functional improvement in patients with hemorrhagic stroke after in-patient rehabilitation was predicted by age, pre-training functional level, and cognitive abilities me asured at admission.

Background There is a lack of evidence on the effectiveness of postnatal depression (PND) screening programmes in reducing morbidity. The aim of this study was to evaluate the effectiveness of a PND screening programme using Edinburgh Postnatal Depression Scale (EPDS) in improving maternal mental health. Methods The randomized controlled trial design was used. Participants were 462 Chinese mothers with 2-month-old babies visiting Maternal and Child Health Centres in Hong Kong. Participants in the intervention group were screened for PND using the EPDS, whereas those in the control group were screened by clinical assessment. In both groups, participants identified with PND were offered follow-up management according to protocol. Results Participants in the intervention group had better maternal mental health outcome as assessed by EPDS at 6 months (risk ratio: 0.59; 95% confidence interval: 0.39‐0.89). The number needed to screen was 25. Conclusions A PND screening programme comprising the use of EPDS as the screening tool and the provision of follow-up care had resulted in an improvement in maternal mental health at 6 months. Trial Registration: ClinicalTrials.gov (US NIH) (NCT00251342).

Periodic Ag line arrays with different line pitches from 500 nm to 950 nm on ITO coated glass substrates have been fabricated by using electron-beam lithography (EBL) technique for studying the color light guide in a display system. The patterned Ag line array is used as a light outcoupling and color-selection component due to the emission wavelength changed by the Ag line arrays with different periodic distances that could achieve color variation. We have demonstrated that the ITO coated glass substrates containing periodic Ag line arrays with varied line pitches can be used as a color filter in a display device. This means that with a proper metallic nanostructure layer, the red, green, and blue colors in a display system can be obtained without a traditional color filter for modern multi-applications of optoelectronic display devices.

Analysis of the electrostatic characteristics and the gate capacitance of typical nanostructured carbon nanotube field effect transistors (CNTFETs) were performed numerically. A previously developed parallelized electrostatic Poisson's equation solver (PPES) is employed, coupled with a parallel adaptive mesh refinement (PAMR) to improve the numerical accuracy near the region where variation of potentials are significant. CNTFETs with four typical configurations of the gate electrode, the bottom gate (BG), the double gate (DG), the top gate (TG), and the surrounding gate (SG) were simulated. Effects of the nanotube arrangement and the gate length on the gate capacitance are presented and discussed. The simulation results show that SG-CNTFET possesses the largest gate capacitance among various structures. However, TG-CNTFET is recommended for practical applications by taking into account both the device performance and the difficulty of fabrication. According to the simulated gate capacitance, estimation of the on-state current of CNTFETs is possible.

Background In this study, as our center transitions from using patient-controlled analgesia (PCA) morphine with intravenous (IV) ketorolac to PCA morphine with IV parecoxib, the two regimens are compared in terms of quality of pain control. Methods Post-operative pain management sheets were collected retrospectively among the living donors of liver transplantation during this transitional period. Group parecoxib was given plain PCA morphine. A single dose of IV parecoxib 40 mg was given 30 minutes before the end of surgery. Group ketorolac was given PCA morphine pre-mixed ketorolac with a concentration of 1.87 mg/mL. Daily and total morphine consumption, Visual Analog Score (VAS), and number of rescue attempts made up to 3 post-operative days, together with satisfaction score and incidence of side effects of PCA usage, were analyzed and compared by means of the Mann-Whitney U test; a value of P Results Fifty patients were analyzed; group 1 comprised 21 patients and group 2 comprised 29 patients. There was no difference between group 1 and group 2 in terms of daily VAS. PCA morphine requirements were significantly lower at day 2 and day 3 in group 1. However, the total overall morphine usage and satisfactory score was not statistically different ( P = .863, P = .052). Conclusions A single dose of IV parecoxib 40 mg can provide satisfactory pain control when paired with PCA morphine for donors undergoing living donor liver transplantation. The use of parecoxib in the multimodal analgesia regimen has similar efficacy, with possibly less morphine consumption, when compared with ketorolac.

The aim of this retrospective observational study is to evaluate the effectiveness and impact on glycemia of the administration of 10 gram glucose and 10 units insulin in treating hyperkalemia during living donor liver transplantation (LDLT).In LDLT, patients whose serum potassium exceeded 5.4 mEq/L and were treated with 10 gram glucose and 10 U regular insulin were included in this study. The descriptive statistics summarize the demographic data, baseline laboratory values, and intra-operative parameters of the treated patients. The changes of the serum potassium and serum glucose levels after treatment were analyzed by the paired Student's t-test. All the data were given as means ± SD. A P value0.05 was regarded as statistically significant.After administration of 10 gram glucose and 10 units regular insulin bolus intravenously, a drastic and significant decreased of serum potassium from 5.73 ± 0.44 to 4.48 ± 0.06 mEq/L was noted. The serum glucose level was slightly higher after the treatment (166.6 ± 32.1 and 196.8 ± 44.3 mg/dl respectively, p = 0.05).An intravenous bolus of 10 units regular insulin with 10 gram glucose was able to decrease the serum -potassium level effectively and additionally increase serum glucose in LDLT patients.

Badiranji Buya Keli (BBK) is a traditional Uyghur medicine derived from Dracocephalum Moldavica Herba (DMH, the aerial part of Dracocephalum moldavica L.). BBK has been widely used in treating cardiovascular and cerebrovascular diseases. Here, the quality control of BBK was established by using HPLC analysis of rosmarinic acid and tilianin. After chemical standardization, the biological effects of BBK was tested. First, BBK inhibited platelet aggregation of rabbit plasma. Second, BBK induced vasodilation in rat aortic ring, and this effect was partially mediated by nitric oxide (NO) production in endothelial cells. Third, BBK induced NO production in cultured human umbilical vein endothelial cells (HUVECs). In HUVECs, the phosphorylation of endothelial NO synthase (eNOS) was markedly increased after application of BBK. Pre-treatment with the eNOS blocker N(ω) -nitro-l-arginine methyl ester hydrochloride could abolish BBK-induced NO production and eNOS phosphorylation. Taken together, these results suggest that BBK could exert beneficial effects in cardiovascular system, which may provide parts of molecular explanation to account for its traditional usage in Uyghur medicine.

Being infected with Severe Acute Respiratory Syndrome (SARS) can be a traumatic experience. Recent findings indicate that SARS survivors tend to report prominent distress after short-term recovery. This study aimed to examine the roles of appraisal and post-traumatic growth in explaining adjustment outcomes in SARS survivors. Fifty-seven Hong Kong Chinese SARS survivors completed self-administered questionnaires that assessed anxiety and depression symptoms, perceived health, appraisal, and post-traumatic growth. Results of regression analyses showed that factors of appraisal (‘perceived impact’ and ‘coping efficacy’) and of post-traumatic growth (‘personal growth’ and ‘relationship growth’) respectively accounted for a significant portion of variance in all of the outcome measures, after the effects of demographic and clinical features were controlled. Path analyses revealed that ‘perceived impact’ and ‘coping efficacy’ had direct and indirect effects on all outcome variables, whereas ‘personal growth’ o...

This article proposes a novel closed-loop rotor flux observer to estimate the rotor flux and velocity of induction motors. With the proposed algorithm, the accuracy of the estimated flux is guaranteed when the estimated stator current converges to its actual one. With the help of the estimated rotor flux magnitude and angle information, the direct rotor field orientation vector control can be implemented, and the rotor speed can be derived. Compared with the traditional Luenberger observer, the salient advantage of the proposed observer-based flux estimation is that the flux estimation is independent of either the estimated speed error or rotor time constant deviation. The validity of the proposed method is verified by intensive digital simulation results.

This study aimed to examine the short-term adjustment outcomes including distress, self-esteem, and quality of life among Chinese patients after 1-month recovery from severe acute respiratory syndrome (SARS) in Hong Kong and to investigate the predictive abilities of a set of selected variables on the outcomes. At 1-month recovery, 100 SARS survivors (mean age = 37; 66 women) and 184 community subjects completed self-administered questionnaires. In the General Health Questionnaire-28, 61% of the SARS survivors were identified as distressed cases under a conservative cutoff score of 6. Compared with the community sample, SARS survivors had significantly more distress and poor quality of life. Being a healthcare worker, severity of SARS symptoms, steroid dosage, and social support accounted for a portion of variances of different measures. Early psychiatric screening and intervention may be beneficial for the adjustment of SARS survivors after short-term recovery. Future research on the long-term impact of SARS is recommended.

In 2003, severe acute respiratory syndrome (SARS) severely hit Hong Kong. We conducted a series of five studies examining the psychological impacts of SARS on the sufferers. Results showed that (1) various psychiatric complications emerged in the acute treatment phase; (2) certain types of behavioral and verbal responses of health‐care workers (HCWs) were able to ameliorate the psychological distress of the sufferers in the acute phase; (3) the short‐term adjustment outcomes of the sufferers were unsatisfactory; (4) ‘being an HCW’ and ‘having a family member killed by SARS’ were risk factors predisposing individuals to the development of high distress after discharge; and (5) after controlling for the effects of demographic and risk factors psychosocial factors such as social support, negative appraisal (or perceived impact), positive appraisal (or post‐traumatic growth) and self‐efficacy could account for substantial variances of differential outcomes including symptoms of anxiety and depression, quality of life and perceived health of the sufferers. This practitioner report aims to summarize the key findings, which have significant clinical implications in the provision of psychological intervention to the sufferers of SARS or other comparable infectious diseases. Copyright © 2004 John Wiley & Sons, Ltd.

Background. Severe acute respiratory syndrome (SARS) is a novel disease. The authors have limited knowledge of its impact on mental health. The present study aimed to examine the level and extent of psychological distress of SARS survivors following 1-month recovery, to explore patients' negative appraisals of the impact of SARS, and to evaluate the associations between psychological distress and negative appraisals.Method. The Beck Anxiety Inventory, the Beck Depression Inventory, and a newly developed measure, the SARS Impact Scale (SIS), were mailed to 453 Hong Kong Chinese SARS survivors discharged from hospital for 4 weeks or more.Results. A total of 425 patients received the questionnaires and 180 (mean age 36·9 years; 120 women) gave valid replies. The response rate was 42·4%. The participants also represented 13·6% of all adult survivors in Hong Kong. About 35% of respondents reported ‘moderate to severe’ or ‘severe’ ranges of anxiety and/or depressive symptoms. It was found that those working as healthcare workers or having family members killed by SARS were more prone to develop subsequent high levels of distress. Factor analyses extracted three meaningful factors of the SIS, namely ‘survival threat’, ‘physical impact’, and ‘social impact’. Negative appraisals at the acute phase and 1-month recovery significantly accounted for substantial portions of variances for anxiety and depressive symptoms, after the effects of other psychosocial variables were controlled.Conclusions. Psychological distress of SARS survivors at 1-month recovery is real and significant. Negative appraisals may play a pivotal role in the development of psychological distress for SARS survivors, at least in the short term.

The properties of organic/inorganic poly(3-hexylthiophene) (P3HT):TiO2 nanocomposite films and nanocomposite based solar cells as a function of TiO2 concentration and the solvent used for the film fabrication were studied. For low nanoparticle concentration (20?30%) the device performance was worse compared to pure P3HT, while for nanoparticle concentration of 50% and 60% significant improvements were obtained. P3HT photoluminescence quenching in 600?800?nm spectral region changes by a factor of two for the increase in TiO2 concentration from 20% to 60%, while the AM1 power conversion efficiency increases times. Photoluminescence quenching and solar cell efficiency were found to be strongly dependent not only on nanoparticle concentration but also on the solvent used for spin-coating. The changes in the film and device properties were explained by the change in the film morphology. For optimal fabrication conditions, external quantum efficiency up to 15% and AM1 power conversion efficiency of 0.42% were obtained.