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IntroductionCritical care in low-income and low-middle income countries (LLMICs) is an underdeveloped component of the healthcare system. Given the increasing growth in demand for critical care services in LLMICs, understanding the current capacity to provide critical care is imperative to inform policy on service expansion. Thus, our aim is to describe the provision of critical care in LLMICs with respect to patients, providers, location of care and services and interventions delivered.Methods and analysisWe will search PubMed/MEDLINE, Web of Science and EMBASE for full-text original research articles available in English describing critical care services that specify the location of service delivery and describe patients and interventions. We will restrict our review to populations from LLMICs (using 2016 World Bank classifications) and published from 1 January 2008 to 1 January 2020. Two-reviewer agreement will be required for both title/abstract and full text review stages, and rate of agreement will be calculated for each stage. We will extract data regarding the location of critical care service delivery, the training of the healthcare professionals providing services, and the illnesses treated according to classification by the WHO Universal Health Coverage Compendium.Ethics and disseminationReviewed and exempted by the Stanford University Office for Human Subjects Research and IRB on 20 May 2020. The results of this review will be disseminated through scholarly publication and presentation at regional and international conferences. This review is designed to inform broader WHO, International Federation for Emergency Medicine and partner efforts to strengthen critical care globally.PROSPERO registration numberCRD42019146802.

A CO2/NaAlO2/H2O absorption-reaction system was adopted to prepare nano aluminum trihydate (ATH) particles for cables use in a rotating packed-bed (RPB) reactor (Phase I). The Taguchi experimental design was used to give an orthogonal array, L9(34). The parameters were the speed of rotation (A), gas-liquid flow rate ratio (B), aging temperature (C) and aging time (D), each having three levels. According to the signal/noise (S/N) ratio analysis, the larger-the-better for the BET area (Sw) was found to be A3B3C1D1, while the parameter significance was DABC. Empirical formula for Sw was also obtained and discussed. Subsequently, the optimum size (10.7 nm) of ATH powders were used to blend with the matrix including plastics and additives (Phase II) for characterization further. The examination of composite materials showed that the limiting oxygen index (LOI) was higher than 28, indicating an excellent fire-retarding property. The Taguchi method was used to look for optimum conditions for preparing nano-ATH. The particle size, grain size, powder morphology and thermal analysis were analyzed. The results also showed that the LOI for nano ATH is higher than that bought from the market, while the fire-retarding grade examination (UL-94 test) for both ATHs was found to be of a V-0 grade. In addition, the mechanical properties for nano ATH were measured prior to using the ATH from the market. Finally, the process creates an opportunity to capture CO2 for some industries.

OBJECTIVE: To investigate the risk factors for acute myocardial injury in coronavirus disease 2019 (COVID-19) patients. METHODS: This is a retrospective analysis of a COVID-19 cohort, in which 149 confirmed COVID-19 patients enrolled were divided into the group of myocardial injury (19 cases) and the group of non-myocardial injury (130 cases). Myocardial injury was defined according to Fourth universal definition of myocardial infarction released by European Society of Cardiology (ESC) in 2018, that cardiac troponin (cTn) was above 99th percentile of the reference level. Clinical information and results of laboratory tests of the eligible patients were collected. Factors associated with myocardial injury in COVID-19 patients were evaluated. RESULTS: Compared with the group of non-injury, the patients in the group of injury were older and had a larger proportion of severe or critical cases (P < 0.05), higher respiratory rate and lower percutaneous oxygen saturation (SpO(2)) without oxygen therapy on admission (P < 0.05). All inflammatory indexes except for tumor necrosis factor α (TNF-α) showed significant elevation in the patients of the group of injury (P < 0.05). Analyzed by Spearman correlation test, we showed that the levels of circulatory cTnI were in positive correlation with the levels of high-sensitivity C-reactive protein (hs-CRP), ferritin, receptor of interleukin-2 (IL-2R), interleukin-6 (IL-6) and interleukin-8 (IL-8) (ρ > 0, P < 0.05). Lower SpO(2) without oxygen therapy on admission (OR: 0.860, 95%CI: 0.779-0.949, P=0.003) and higher plasma IL-6 levels (OR: 1.068, 95%CI: 1.019-1.120, P=0.006) were independent risk factors for acute myocardial injury in the patients with COVID-19 by multivariate Logistic regression analyses. CONCLUSION: Hypoxic state and inflammation may play a key role in the pathogenesis of acute myocardial injury in COVID-19 patients.

OBJECTIVE: The pathogenesis of myocardial injury upon corona virus disease 2019 (COVID-19) infection remain unknown,evidence of impact on outcome is insufficient, therefore, we aim to investigate the risk factors for death among COVID-19 patients combined with hypertension, coronary heart disease or diabetes in this study. METHODS: This was a single-centered, retrospective, observational study. Patients of Sino-French Eco-City section of Tongji Hospital, Wuhan, China attended by Peking University Supporting Medical Team and admitted from Jan. 29, 2020 to Mar. 20, 2020 were included. The positive nucleic acid of COVID-19 virus and combination with hypertension, coronary heart disease or diabetes were in the standard. We collected the clinical data and laboratory examination results of the eligible patients to evaluate the related factors of death. RESULTS: In the study, 94 COVID-19 patients enrolled were divided into the group of death (13 cases) and the group of survivors (81 cases), the average age was 66.7 years. Compared with the survival group, the death group had faster basal heart rate(103.2 beats/min vs. 88.4 beats /min, P=0.004), shortness of breath(29.0 beats /min vs. 20.0 beats /min, P9.1 ng/L, OR=101.93, 95%CI=4.74-2190.71, P=0.003)were independent risk factors for COVID-19 patients combined with hypertension, coronary heart disease or diabetes. CONCLUSION: In COVID-19 patients combined with hypertension, coronary heart disease or diabetes, the risk factors for death were old age, low non oxygen saturation, low lymphocyte count, myocardial injury, and abnormal increase of IL-2R, IL-6, and IL-10. Old age, low non oxygen saturation and abnormal increase of IL-10 were independent risk factors.

Objectives: Chronic pulmonary aspergillosis (CPA) is an emerging global disease with tuberculosis (TB) being the most important risk factor. Epidemiologic data on the seroprevalence of Aspergillus IgG and prevalence of CPA in different areas, especially in country with intermediate burden of TB, are lacking. Methods: We prospectively recruited healthy volunteers, TB close contacts, active TB patients and participants with old pulmonary TB in Taiwan during 2012–2019. We measured serum Aspergillus fumigatus and niger-specific IgG levels and assessed if the participants were having CPA. Results: A total of 1242 participants (including 200 healthy volunteers, 326 TB close contacts, 524 active TB patients and 192 old TB cases) were recruited. Using 27 mgA/L (milligrams of antigen-specific antibodies per liter) as cut-off level, the seropositive rate of A. fumigatus-specific IgG was 33.0% (66/200), 37.7% (123/326), 26.5% (139/524) and 43.2% (83/192) among the four groups, respectively. In multivariate logistic regression, pulmonary cavitation (OR 1.73; 95% CI 1.07–2.80), female sex (OR 1.49; 95% CI 1.14–1.95), old TB (OR 1.59; 1.05–2.42) were independent risk factors for Aspergillus IgG positivity. One (0.2%) active TB patient and four (2.1%) old TB patients developed CPA. Correlation between A. fumigatus and A. niger-specific IgG was high (Spearman correlation coefficient: 0.942). Discussion: Geographic variation in Aspergillus IgG seroprevalence and CPA prevalence exists. A universal cut-off value for Aspergillus IgG may not exist. In areas and populations in which background Aspergillus IgG level is unknown, Aspergillus IgG may be better used as a test of exclusion for CPA using prespecified cut-off level. © 2019 The Author(s)

该文报道了2例肥厚型心肌病合并心尖部室壁瘤患者的病例资料。病例1，患者以室性心动过速起病，复律后心电图提示下壁及V(4)~V(6)导联ST段持续抬高，排除冠心病后完善心脏磁共振成像（CMR）确诊。病例2，患者以心力衰竭起病，心电图同样可见下壁导联及V(4)~V(6)导联ST段持续抬高，除外冠心病后通过超声心动图及CMR确诊。对于心电图存在下壁及V(4)~V(6)导联ST段持续抬高的肥厚型心肌病患者，除外冠心病后，应积极完善CMR检查以明确是否合并心尖部室壁瘤。.

The objective of the study was to investigate the differences in eggshell quality, bone quality and serum bone biochemistry markers associated with changes in age and dietary soybean oil levels in laying hens. A total of 54, 19-week-old Hy-Line Brown laying hens were housed in 18 battery cages (3 birds/cage) and randomly divided into three diet treatments for 90 d: control-fat (CF, 1.9% soybean oil), moderate-fat (MF, 7% soybean oil) and high-fat (HF, 10% soybean oil). The hens' body weights (BW), egg production, egg weights, eggshell thickness and femoral diameter were higher at d 90 than at d 60 or d 30. Meanwhile, feed intake, relative bone weights, all bone strength parameters and serum Ca were lower at d 90 or 60 than at d 30. Compared to the CF hens, the feed intake, BW, abdominal fat pad weights and serum alkaline phosphatase activity were elevated in MF or HF hens. The eggshell thickness, relative femoral and tibial weight, femoral stiffness, femoral modulus, tibial mixed force and serum calcium and phosphorus levels were lower in MF or HF hens than CF hens. These findings suggest that bone loss in caged hens starts from an early stage of the laying period, and dietary oil (particularly with diets over 10% soybean oil) has harmful effects on eggshell quality, bone strength and bone mineralisation from an early stage of the laying period.

Recent progress in studies of several types of core-shell structured electrode materials, including TiO2/C, Si/C, Si/SiOx, LiCoO2/C, and LiFePO4/C nanocomposites, including details of their preparation and their electrochemical performance is briefly reviewed. Results clearly show that the coating shell can effectively prevent the aggregation of the nanosized cores, which are the electrochemically active materials. In addition, the diffusion coefficients of lithium ions can be increased, and the reversibility of lithium intercalation and deintercalation is improved. As a result, the cycling behavior is greatly improved. The reviewed results suggest that core-shell nanocomposites are a good starting point for further development of new promising electrode materials.

The regeneration of the periodontal attachment apparatus remains clinically challenging because of the involvement of three tissue types and the complexity of their relationship. Human recombinant bone morphogenic protein-2 (rhBMP-2) can accelerate the regeneration of bone and cementum and the insertion of periodontal ligament fibers but may lead to a deranged periodontal relationship, ankylosis and root resorption.This study evaluated a novel approach to regeneration of the periodontal attachment apparatus using a combination of ex vivo autologous bone marrow mesenchymal stem cells (MSCs) engineered by replication-defective adenovirus to express the BMP-2 gene and Pluronic F127 (PF127). Twenty-four periodontal defects were surgically created in 12 New Zealand white rabbits and randomly assigned to three experimental groups with MSCs: the advBMP-2 group; the advbetagal group; the MSC group and one control group: PF127 only. The regenerated periodontal attachment apparatus was assessed histologically and the total regenerated bone volume was calculated from three-dimensional computed tomography analysis.This approach regenerated not only cementum with Sharpey's fiber insertion, but also statistically significant quantities of bone, re-establishing a more normal relationship among the components of the regenerated periodontal attachment apparatus, which is beneficial for the maintenance of periodontal health.Ex vivo gene transfer using stem cells as vectors may provide an advantage of slower BMP-2 release, increasing cementogenesis. There is regeneration of the periodontal attachment apparatus, whereas direct usage of the protein (rhBMP-2) yields unhinged periodontal relationship. Thus, this approach may represent an alternative means for periodontal alveolar bone graft in clinical settings.

TaxNi1−x (x=0.65 and 0.50) thin films were prepared on p-type (1 0 0) Si substrate by magnetron dc sputtering as a barrier film with a high crystallization temperature and a low resistivity for Cu metallization. The failure properties of the studied films were elucidated using a four-point probe, X-ray diffractometry, scanning electron microscopy and transmission electron microscopy. The results indicate that as-deposited thin films had a glassy structure. The resistivity and failure temperature of TaxNi1−x (x=0.65 and 0.50) thin films were about 240.4 μΩ cm and 700 °C and 170.3 μΩ cm and 700 °C, respectively. The experimental findings revealed that the failure mechanism of the studied films involved the initial dissociation of the barrier layer annealed at a specific elevated temperature, and further silicidation with the underlying Si substrate.

We examined two targets containing Co40Fe40B20and Co60Fe20B20. We deposited Co40Fe40B20and Co60Fe20B20monolayer thin films of various thicknesses on glass substrates through DC magnetron sputtering; the thicknesses ranged from 25 to 200 Å. The thermal properties of the Co40Fe40B20and Co60Fe20B20thin films were determined using a differential scanning calorimeter (DSC). The thermal properties included the glass transition temperature (Tg), onset crystallization temperature (Tx), and glass-forming ability, which were determined according to these values. Using the Kissinger formula revealed that the activation energy of the Co60Fe20B20with a thickness of 75 Å is the highest, implying that crystallization was the lowest and the Co60Fe20B20film showed anticrystallization properties. However, the energy of 75 Å Co40Fe40B20thin films was the lowest, which is opposite to that of Co60Fe20B20. This observation can be reasonably explained based on the concentration of Co or Fe. Therefore, a thickness of 75 Å is critical.

Epitaxial Cu-poor CuInSe2 films have been synthesized on GaAs(1 1 1)B [As-terminated], (1 1 1)A[Ga-terminated] and (0 0 1) substrates by co-sputtering Cu/In and evaporating Se method. Scanning electron micrograph results show that surface morphologies of the epitaxial Cu-poor CuInSe2(1 1 2)B[Se-terminated], (1 1 2)A[metal-terminated] and (0 0 1)-oriented films are substantially different. The surface morphology results clarify that the (1 1 2)B facets are the lowest energy, being the only surfaces which are stable against roughening. The characteristic stacking fault, twin, dislocation and anti-phase domain boundary structures in the epitaxial films, and the faceted second phase and Kirkendall void structures in the GaAs substrates have been observed by the cross-sectional transmission electron microscope and secondary ion mass spectrometry examinations. The resistivities of the grain boundary-free epitaxial Cu-poor films are two orders lower than those of the compositionally corresponding polycrystalline films. It implies that there exists a resistive Cu-poor point-defect and/or ordered vacancy compound in the grain boundaries of the polycrystalline Cu-poor films.

In the recent design and testing of the upgraded detonator used in the Titan IVB explosive bolt for jettison of expended strap-on solid rocket motors, it was determined that the 25-kV, 500 pF, pin-to-case electrostatic discharge test without the traditional 5-kΩ series resistor is a destructive test. After this test, pin-to-case insulation resistance in the detonator measured under the traditional 500 V could fail the 2-MΩ minimum requirement. An extensive investigation established a relationship between three phenomena: the electrostatic discharge, the insulation resistance, and the pin-to-case breakdown voltage. Several screening techniques were developed and verified. Parameters and designs for eliminating or reducing the failure were identified for future design of electroexplosive devices.

A new composite anode material of Ag and polymeric carbon was prepared by heat-treating the mixture of polyacrylonitrile and AgNO3. They were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), electrochemical impedance spectroscopy (EIS) and electrochemical measurements. It was found that the addition of Ag was favorable for the improvement of electrochemical performance of the composite in comparison with the virginal polymeric carbon. These improvements were due to an increase of electronic conductivity, alloying of lithium with Ag and smaller particle size of the composites. The optimal amount of Ag addition is 5% based on the molar ratio of the monomer unit. Copyright © 2006 John Wiley & Sons, Ltd.

Background Livedoid vasculopathy, also known as atrophie blanche, is a recurrent painful vasculopathy appearing mostly on the lower limbs. Treatment is challenging and relapses are frequent. Objectives To analyse the long-term effect and safety of hyperbaric oxygen (HBO) therapy in treating livedoid vasculopathy. Methods Twelve patients with active livedoid vasculopathy were included in this study. All patients underwent HBO therapy five times a week. Each week photographs were taken and the total dose of analgesics was recorded. Side-effects were documented and assessed. Recurrence was defined as the presence of skin ulceration. Results Of the eight patients who completed the treatment, resumption of ambulation and reduction of analgesics were achieved at an average of 4.9 HBO therapy sessions. Leg ulcers in all eight patients healed completely at a mean of 3.4 weeks (range 2-5 weeks). Six patients suffered relapses of ulceration and responded to additional HBO therapy. No significant side-effects were found. Conclusions HBO is a relatively safe, fast and effective method to treat patients with livedoid vasculopathy.

N-methyl-D-aspartate (NMDA) receptor activation, at the level of the spinal cord, has been shown to play an important role in the facilitation of nociception in several animal models. However, the use of NMDA antagonists as analgesics is limited by serious side effects due to nonselective effects among the NMDA receptor subtypes. Recent discoveries revealed that the transfection of small interfering RNAs (siRNAs) into animal cells resulted in the potent, long-lasting, post-transcriptional silencing of specific genes. Thus, we investigated the effect of intrathecal (i.t.) injection of siRNAs targeting NMDA-R2B receptor subunit protein (NR2B) receptors, a subunit of NMDA receptor, for the modulation of pain. The results indicate that the use of siRNA targeting the NR2B subunit not only decreased the expression of NR2B mRNA and its associated protein, as demonstrated by real-time PCR and Western blotting, but also abolished formalin-induced pain behaviors in rat model. The peak effect occurred on day 3 for mRNA and day 7 for its protein, following i.t. injection of 5 microg of siRNA-NR2B. These data prove the feasibility of i.t. siRNAs in the investigation of functional gene expression in the context of whole animal behavior for the management of chronic pain.

The objective of this study was to determine the cytocompatibility of three different extracts of gingival retraction cords and to compare the cytotoxic effect of these materials on human gingival fibroblasts. Gingival retraction cords impregnated with aluminium sulphate (Gingi-Aid), dl-adrenaline HCl (Gingi-Pak) and non-drug-impregnated cord (Gingi-Plain) were eluted with culture medium for 10 min and 24 h. Cytotoxicity was judged using a tetrazolium bromide reduction assay. Our data demonstrated that gingival retraction cords applied alone almost completely inhibited cell viability (P0.05). In addition, the results also showed that the eluates from aluminium sulphate-impregnated cord, dl-adrenaline HCl-impregnated cord and non-drug-impregnated cord were cytotoxic to primary human gingival fibroblast cultures (P0.05). The cell viability of incubation of gingival fibroblasts containing 10-min eluates of aluminium sulphate, dl-adrenaline HCl and non-drug-impregnated cord was 61, 21 and 70%, respectively. The cell viability of incubation of gingival fibroblasts containing 24 h eluates of aluminium sulphate, dl-adrenaline HCl and non-drug-impregnated cord was 68, 58 and 72%, respectively. It was found that dl-adrenaline HCl-impregnated gingival retraction cord was the most toxic gingival retraction cord among the materials tested in all cultures (P0.05). The cytotoxicity decreased in an order of dl-adrenaline HCl-impregnated cordaluminium sulphate-impregnated cordnon-drug-impregnated cord. The extent or degree of the cytotoxicity depended on the materials tested. Gingival retraction cords have significant potential for gingival toxicity. Careful management of gingiva retraction cords would lower the risk of potential gingival tissue damage during clinical application procedure and thus increase the success of prosthodontic procedures.

Ordnance subsystems and components are critical elements in intercontinental ballistic missile systems. Ord- nance is required for stage ignition, stage separation, thrust vector control system actuation, �uid isolation valve actuation, battery actuation, thrust termination, and release of reentry vehicles. In addition, an ordnance destruct subsystem is mandatory for eachight test. The similarity between missile systems enabled the development and evolution of ordnance designs; for example, the isolation valves, linear-shaped charges for destruct subsystems, linear explosives for stage separation rings, and conned detonating cords for explosive train interconnections were used on allve missile systems developed by the U.S. Air Force since the early 1960s. The approach did not prevent the adoption of new technologies to improve performance. High-temperature resistant hexanitrostilbene explosive was adopted and the through-bulkhead initiator and exploding bridgewire initiator replaced the hot bridgewire-based squibs and detonators. A laser/�ber-optics-based ordnancering system was developed for a mobile missile system. Hermetic seal technologies were adopted for achieving a longer service life for explosive devices. Better methods were adopted for ordnance testing, for example, the thermal transient pulse test and the builtin reectometry. These approaches dramatically improved reliability, safety, weight efciency, service life, and cost effectiveness.

Injury to the peripheral nervous system can lead to spontaneous pain, hyperalgesia and allodynia. Previous studies have shown sprouting of Abeta-fibres into lamina II of the spinal cord dorsal horn after nerve injury and the formation of new synapses by these sprouts. Synaptophysin is a presynaptic vesicle protein, useful in the identification of synaptogenesis. Here we investigated whether synaptogenesis as measured by the expression of synaptophysin protein correlates with symptoms of neuropathic pain in rats with a chronic constriction injury (CCI) of the sciatic nerve. We used immunohistochemistry, Western immunoblotting and densitometry to study the distribution of synaptophysin and to quantify relative protein. Synaptophysin was increased in the ipsilateral dorsal horn with a peak level on day 14 and returned to baseline on day 21 post-CCI. Synaptophysin levels temporally correlated with thermal hyperalgesia but not with tactile allodynia. Our results indicate that thermal hyperalgesia in CCI significantly correlates with synaptogenesis within the superficial layers of the dorsal horn.

Background: Pain on injection is still a major problem with propofol. We performed this study to compare different doses of intravenous (i.v.) ketorolac with and without venous occlusion and its effect on the incidence and the severity of the pain after propofol injection. Methods: We conducted a prospective, randomized and double-blind study of 180 patients (20–60 years of age.) scheduled to undergo elective surgery. Six groups of patients were generated: group A received normal saline (NS) 2 ml i.v.; groups B, C, D received ketorolac 10 mg in 2 ml NS with venous occlusion (VO) and a subsequent propofol injection at either 30, 60 or 120 s; groups E and F received ketorolac 15 mg and 30 mg in 2 ml NS and propofol was injected after 60 s. The pain perception was assessed during injection of propofol in all patients. Result: The incidence of propofol-associated injection pain was for A: 46.7%; B: 43.4%; C: 23.3%; D:16.7%; E: 20%, and F: 10%. The incidence of pain following propofol injection was reduced by i.v. ketorolac 10 mg with venous occlusion for 120 s. Furthermore, i.v. ketorolac 15 mg and 30 mg but not 10 mg following propofol injection after 60 s without venous occlusion revealed significant pain reduction when compared to saline group. There was no difference in venous sequelae at 7 days postoperatively between the groups. Conclusion: Our results suggested that pretreatment with i.v. 15 and 30 mg ketorolac reduces pain following propofol injection. Moreover, pretreatment with i.v. ketorolac 10 mg with venous occlusion for 120 s achieves the same pain relief effect.

Intrathecal (IT) lamotrigine, a sodium channel blocker which suppresses neuronal release of glutamate, has been shown to produce a long-lasting antihyperalgesic effect in the neuropathic pain models. In the present study, we examined the anti-hyperalgesic effects of pre- versus post-treatment of IT lamotrigine in an animal inflammatory pain model, the inflamed knee joint model of the rat. Thermal and mechanical antinociception was assessed in rats using a modified Hargreaves box and von Frey hairs. Induction of tonic persistent inflammatory pain was induced by intra-articular injection (i.a.) of a carrageenan-kaolin mixture (CK) into the right knee-joint. Rats were randomly assigned to the groups receiving IT lamotrigine in distinct doses of 5, 50 or 100 ug either pre- (10 min before CK injection) or post-inflammation induction (4 h or 23 h). We observed that CK injection resulted in a significant thermal and mechanical hyperalgesia throughout a 24-h observation period. Pre-treatment with IT lamotrigine revealed a time and dose-dependent suppression of thermal and mechanical hyperalgesia, whereas the post-treatment with IT lamotrigine only showed an effect for mechanical nociception. Conclusion: IT Lamotrigine is antihyperalgesic at a dose larger than 50 ug in the early phase of inflammatory pain model. It reverses tactile allodynia but not thermal hyperalgesia when given after the inflammation induction.

Background: Deep vein thrombosis (DVT) remains a leading cause of postoperative morbidity and mortality in patients who undergo total knee arthroplasty (TKA). Although patients with previous thrombotic episodes are inherently at a higher risk for subsequent episodes of DVT, it remains difficult to predict such an occurrence and to make a diagnosis in early stages. One potentially useful assay that can be used in the determination of changes of coagulation among patients who undergo arthroplasty is platelet activation. The goal of this study was to establish a predictive value for DVT with measurement of P-selectin levels that could help in planning appropriate perioperative management strategies for patients at high risk for DVT. Methods: A total of 52 patients who underwent TKA with general anesthesia underwent contrast venography on the 5th postoperative day. Platelet activation before and after operation was measured with platelet surface expression of P-selectin with flow cytometry in these two groups of patients for TKA. None of the patients underwent any anticoagulation therapy. Results: Nineteen of the 52 patients for TKA showed radiologic evidence of DVT, whereas 33 patients for TKA had no radiologic signs of DVT. There was no difference in platelet activation at baseline, which was 1 hour before induction of anesthesia, between the two groups (P >.05) as measured with P-selectin assays. Differences were noted between the two groups on the 5th day after operation, wherein P-selectin was expressed in only 2.72% ± 0.9% (mean ± standard deviation) of platelets in patients for TKA with healthy venogram results. This differed significantly from platelets in patients for TKA with DVT, who had P-selectin expression of 6.56% ± 3.1% (mean ± standard deviation; P

UNLABELLED The release of excitatory amino acids (EAAs), nitric oxide, and prostaglandins plays a critical role in the development of peripheral tactile and thermal hypersensitivity after the induction of knee joint inflammation. In this study, we used a model of chronic spinal microdialysis to examine the effect of complete Freund's adjuvant (CFA)-induced inflammation on the spinal release of EAAs and also assessed the antinociceptive effect of a new alpha(2)-adrenergic agonist, apraclonidine, by using this model. Male Sprague-Dawley rats were implanted with microdialysis catheters. CFA was injected into the plantar surface of the left hindpaw to induce inflammation. Concentrations of amino acids in dialysate and thermal and tactile withdrawal latency were evaluated for 1 wk. Intraplantar injection of CFA evoked a significant release of glutamate, aspartate, and citrulline for 6 days. Three milligrams of intraperitoneal apraclonidine significantly suppressed the release of EAAs and citrulline. Apraclonidine was given intraperitoneally 2--3 days after CFA injection. Prominent thermal and tactile allodynia was observed for 6 days. Our results show that the significant modulatory effect of the alpha(2)-adrenergic agonist apraclonidine on the release of EAAs may account for its antinociceptive properties in adjuvant-induced inflammation. IMPLICATIONS This study showed a novel finding that the hypersensitivity state seems to be dependent on increased release of spinal excitatory amino acids (EAAs), and the significant modulatory effect of the alpha(2)-adrenergic agonist apraclonidine on the release of spinal EAAs accounts for its analgesic properties in adjuvant-induced inflammation.

A long-lasting antihyperalgesic effect has been demonstrated for intrathecal (IT) clonidine, an alpha2-adrenergic agonist. In the present study, the mechanism and antihyperalgesic effects of IT clonidine were examined post-treatment in a rat model of Complete Freund's Adjuvant (CFA)-induced inflammatory hyperalgesia. Using a chronic model of spinal cord dialysis, we examined the effect of the adjuvant-induced inflammation on spinal release of nitric oxide (NO) and the development of chronic pain and assessed the antinociceptive effects and mechanisms of the alpha2-adrenergic agonist, clonidine (IT). Chronic, persistent inflammatory pain was induced by left hind paw injection of 0.3 ml CFA prepared in a mixture with Mycobacterium butyricum. Rats were randomly assigned to groups receiving IT clonidine in discrete doses of 1, 10 or 50 μg, 3 or 24 hr post-inflammation. Measurement of total NO x (NO + $${\text{NO}}_{2 - } + {\text{NO}}_{3 - } $$ ) was used to determine NO release into the cerebrospinal fluid. Rat thermal antinociception was assessed using a radiant heat thermal hyperalgesia model. CFA injection resulted in significant thermal hyperalgesia throughout the four days of observation. A dose-dependent suppression of thermal hyperalgesia and spinal NO release was observed after IT clonidine treatment. Evidence from this CFA-induced inflammatory pain model suggests that clonidine's spinal antihyperalgesic mechanisms act through inhibition of spinal NO release.

Neurotoxicity is the dose-limiting side-effect of vincristine in cancer therapy. Using the nerve growth factor (NGF)-dependent neurite outgrowth and cell proliferation of the PC12 pheochromocytoma cell line as an in vitro assay, the protective effect of different intravenous anesthetics was assessed. Vincristine (1 nmol/L) significantly decreased the percentage of neurite-forming cells from 68% +/- 9% to 27% +/- 7% within a 3-day incubation period. The longer neurites (> 2 x cell body) in particular proved to be extremely sensitive to vincristine (from 17% +/- 4% to 0% of total neurite-expressing cells). Flow cytometry results revealed an S-phase percentage of 15.85% +/- 3.25% after NGF induction, with vincristine reducing this percentage to 0.68% +/- 0.38%. Reversal of the inhibitory effect of vincristine was noted in the cells treated with thiopental or propofol but not etomidate. Bicuculline partially antagonized the protective effect of thiopental and propofol in both studies. We conclude that thiopental and propofol, but not etomidate, have a protective effect in vincristine-induced neurotoxicity. The protective effect produced by thiopental and propofol is probably secondary to activation of GABAA receptors.

This study evaluates 40-nm-thick amorphous Ta2N (a-Ta2N) thin films with various compositions and metallurgical designs as diffusion barriers for copper metallization. Results based on sheet resistance measurements, x-ray diffraction analyses, and transmission and scanning electron microscopies consistently follow a sequence of coarsening copper grains, transforming a-Ta2N into a crystalline phase, and finally forming {111}-faceted pyramid Cu3Si precipitates and TaSi2. The degradation of the single-layered stoichiometric Ta2N (a-Ta67N33) barriers is primarily triggered by a premature crystallization of the amorphous barrier layers at temperatures as low as 450 °C. However, as adequately designed double-layered (20 nm Ta67N33/20 nm Ta62N38) amorphous barriers can be subjected to high-temperature annealing without crystallization, the effectiveness of the double-layered barriers can be significantly improved, elevating the degradation temperature by approximately 100 °C.

We utilize the Zn-diffusion technique to fabricate a single-mode high-speed 850-nm vertical-cavity surface-emitting laser. With this technique, we are able to minimize the thermal effect without greatly scaling down the diameter of the oxide-confined aperture. The demonstrated device has a 9-mum active diameter with which we can attain a bandwidth of 8 GHz, a small differential resistance (~47 Omega), and a maximum output power of 3 mW. The single-mode characteristics can be sustained under dynamic operation for the whole bias current range. The dynamic measurement results indicate that with this single-mode device the damping-limited bandwidth of our multimode control can be eliminated without a Zn-diffusion aperture. A larger intrinsic bandwidth (32 versus 21 GHz) is also obtained due to the minimization of damping. The narrower divergence angle (8deg versus 20deg) means that the device exhibits a larger alignment tolerance and much lower coupling loss (9 dB) when used with the standard multimode fiber than those of the control sample.

Preclinical studies suggest that systemic lidocaine acts at the level of the spinal dorsal horn to inhibit hyperalgesia resulting from nerve injury, yet no clinical data are available to support this view.Therefore, we sought to characterize the time course of lidocaine in the plasma and cerebrospinal fluid (CSF) after an IV bolus injection of lidocaine 2 mg/kg in patients scheduled for surgery involving spinal anesthesia. Sixty-five patients were randomly allocated to one of five study groups (n = 13 per group) receiving IV lidocaine before CSF/plasma sampling at 5, 10, 15, 30, or 60 min. Gas chromatographic analysis of these samples revealed a fast but transient peak (5-15 min) in lidocaine plasma levels (1.7 +/- 0.16 [micro sign]g/mL), which declined rapidly thereafter. Only small concentrations of IV lidocaine were found in the CSF (6%-8% of plasma concentration), but this fraction remained stable from 15 min until termination of the experiment. No statistical correlation was observed between plasma and CSF lidocaine levels. These data suggest that because of the prolonged availability of lidocaine at the spinal dorsal horn level, systemic administration of lidocaine suppresses central sensitization within the spinal cord after nerve injury in humans. Implications: Cerebrospinal fluid concentrations of lidocaine after its systemic bolus delivery in humans indicate that the spinal cord may be the major site of antinociceptive action by this route of drug administration. (Anesth Analg 1998;87:601-4)

This prospective study was undertaken to evaluate the prognostic value of uterine perfusion on the day of human chorionic gonadotropin administration in patients who were undergoing intrauterine insemination. Uterine perfusion was evaluated by measuring the pulsatility index of the ascending branch of the uterine arteries on the day of administration of human chorionic gonadotropin. No pregnancy occurred when the pulsatility index of the ascending branch of the uterine arteries was more than 3. The fecundity rate was 18% when the pulsatility index was less than 2 and was 19.8% when the pulsatility index was between 2 and 3 (not significant). The continuing pregnancy rate was 18% when the pulsatility index was less than 2, compared with 12.1% when the pulsatility index was between 2 and 3 (P < 0.05). Our data suggest that the measurement of uterine perfusion on the day of human chorionic gonadotropin administration may have predictive value regarding fecundity and the continuation of pregnancy in intrauterine insemination.

The evolution of microstructure in Mo-Cu thin films during annealing has been investigated by {ital in} {ital situ} sheet resistance measurements, {ital ex} {ital situ} x-ray diffraction, and {ital in} {ital situ} hot-stage as well as conventional transmission electron microscopy. Mo-Cu thin films, deposited on various glass substrates by magnetron sputtering at {similar_to}30 {degree}C, were supersaturated solid solutions of Cu in Mo with a nanocrystalline microstructure. The as-deposited films had large compressive residual stresses owing to the low homologous deposition temperature and low Ar pressure during deposition. Annealing results showed two distinct sets of microstructural changes occurring in the temperature ranges between {similar_to}300 and 500 {degree}C, and {similar_to}525 and 810 {degree}C. In the lower-temperature range, anisotropic growth of nanocrystallites was accompanied by stress relaxation without any observable phase separation. At temperatures greater than {similar_to}525 {degree}C, the metastable solid solution collapsed and Cu precipitated at the grain boundaries. Increasing temperature resulted in the coarsening of Cu precipitates and simultaneous growth of Mo grains. At temperatures greater than {similar_to}700 {degree}C, phase separation and grain growth approached completion. {copyright} {ital 1995} {ital American} {ital Institute} {ital of} {ital Physics}.

The neural and nonneural factors contributing to maintain the hemodynamic status in 14 to 16 weeks old stroke prone spontaneously hypertensive rats (SHRSP) and spontaneously hypertensive rats (SHR) were compared with those of the age matched normotensive Wistar Kyoto (WKY) rats under chloralose-urethane anesthesia. The ascending aortic blood flow, arterial blood pressure and heart rate were measured under resting condition, ganglionic blockade by hexamethonium, 5 mg/kg i.v. and maximum vasodilation by hexamethonium and 0.07 mg/kg nitroprusside. The neural component (hexamethonium blockable component) was the major factor in the maintenance of resting blood pressure and total peripheral resistance index (TPRI) in the above three strains of rats. In contrast, the residual component after hexamethonium and nitroprusside administrations was the most important controlling factor for cardiac index (CI). In SHRSPs, the neural component of TPRI and residual component of CI were both significantly higher than those of WKYs by 75% and 47%, respectively. In SHRs, the residual component of CI was 52% higher than that of WKYs. These results suggest that both the increased neural component of TPRI and nonneural component of CI are important contributing factors for the blood pressure increase in the early stage of established hypertension in SHRSPs. On the other hand, in the age matched SHRs, the most important contributing factor for hypertension is the increased nonneural component of CI. Considering the differences between these two strains of hypertensive rats, the neural component of TPRI is the major factor responsible for the different levels of hypertension in SHRSPs and SHRs.

Protein arginine methyltransferase 1 (PRMT1) catalyzes the majority of arginine methylation in cells and plays important roles in the differentiation and development of neurons. It is also implicated in the regulation of nitric oxide synthetase (NOS). Hirschsprung disease (HSCR) is characterized by the absence of intramural ganglion cells in the nerve plexuses of the distal gut.Western blot analyses revealed reduced PRMT1 protein levels in the aganglionosis segments of HSCR patients. Immunohistochemistry detected PRMT1 expression in the colonic mucosa, the enteric nervous system (ENS) and endothelial cells. Specific and strong PRMT1 expression in neuron cell bodies of the plexus was demonstrated by immunofluorescent double-labeling with neuron-specific marker HuC/D.In the mucosa, PRMT1 was detected at all crypt cells. Intensive PRMT1 staining was detected in the submucosal and the myenteric plexuses in normal or oligoganglionosis segments. Aganglionosis segments from HSCR patients contain no plexuses, and thus not labeled with PRMT1. The phenomenon is specific to the megacolon of HSCR as strong PRMT1 staining was observed in plexuses of the rectal ectasia segments (dilated rectum and distal sigmoid not related with aganglionosis) from anorectal malformation patients. Furthermore, PRMT1 was also present in the same neuronal cells expressing neuronal NOS in the plexuses.We suggest that PRMT1 can be a useful marker for HSCR. This study is the first illustration of PRMT1 protein expression in human tissues from non-cancerous disease and set up the base for further investigations of PRMT1 function in ENS development and intestinal motility.

Background Obesity has been found to be associated with an increased risk of psoriasis in general population. However, studies addressing the relationship between obesity and clinical severity of psoriasis are still scarce, especially in Asian people. Objectives In this study, we investigated the relationship between levels of obesity and the clinical severity of psoriasis in Taiwanese psoriasis patients. Methods This was a hospital-based cross-sectional study. A total of 399 patients with chronic plaque psoriasis were recruited. Their body mass index (BMI) was calculated as weight in kilograms divided by height in metres squared and was categorized into four groups (BMI

Gas-phase host-guest chemistry of two hemicarcerands and one carcerand, having masses of approximately 2000 Da and with successively more restricted access to their interior phases (because they possess two, three, and four bridging -O-CH 2 -O- groups, respectively), are studied by laser desorption Fourier transform mass spectrometry (LD-FTMS). Gas-phase reactions of the hemicarcerands with dimethylacetamide and of a triply-bridged hemicarcerand with α-pyrone are reported, and it is shown that the laser desorption behaviour and gas-phase reactivities are in qualitative agreement with the expected effects of steric requirements of the guests

N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-methylisoxazolone-4-propionic acid (AMPA), and kainate (KA) receptors are members of the ionotropic glutamate receptor (iGluR) family and are increased in inflamed rat skin. These receptors contribute to inflammatory pain. In this study, we have examined whether there is a similar increase in iGluRs in inflamed human skin in the presence of inflammatory pain.Normal and inflamed-skin biopsies were obtained from eight patients undergoing elective wound-debridement surgery. Real-time-polymerase chain reaction (PCR) and western blot analysis were used for quantitation of iGluR mRNA and protein in normal and inflamed human skin.A significant increase in mRNA and protein for NMDA, AMPA, and KA receptor subunits was detected in inflamed compared with normal skin. The amounts of NMDA (NR1 subunit), AMPA (GluR2 subunit), and KA (GluR6 subunit) mRNA in inflamed skin were mean 6 (SD 1.6-fold), 2.5 (0.6-fold), and 3.8 (0.9-fold) (P0.05), respectively, greater than that measured in normal skin. The ratio of NR1, GluR2, and GluR6 protein in inflamed compared with normal skin was 5.7 (1.2), 2.4 (0.5), and 3.6 (0.9) (P0.05), respectively.These results, in human tissue, demonstrate that iGluR mRNA and protein expression are increased during persistent inflammation and that this increased activity may be involved in mediating clinical inflammatory pain in human skin.