Search

Parry-Romberg syndrome (PRS) is a rare disorder resulting in disfiguring facial asymmetry. Ocular manifestations can result in complex strabismus. There were limited reports on the treatment of PRS with coexisting strabismus. We present a multistaged surgical approach to manage the facial asymmetry and strabismus.

Phthalates as a large group of environmental pollutants are used primarily as plasticizers and solvents, which have become a growing problem worldwide. Epidemiological results show that severity of heart disease is related to degree of environmental contamination. As the most usually used phthalate, di(2-ethylhexyl) phthalate (DEHP) has toxic effects on organism health and is also a major cause of heart damage. Ingestion of food, liquid, or dust contaminated with DEHP are major routes of exposure. The purpose of the present research was to determine the mechanism of cardiotoxicity in mice after exposure to DEHP. Here, male mice were treated by gavage with three different doses of (50, 200 and 500 mg/kg b.w.) DEHP for 28 days. Our research showed that DEHP brought about histopathological changes involving cardiomyocyte lysis and rupture, and ultrastructural damage such as dissolution and loss of mitochondrial cristae. Furthermore, DEHP induced oxidative stress and a significant decline in the antioxidant function, which activates nuclear factor E2-related factor 2 (Nrf2)/heme-oxygense-1 (HO-1) signaling pathways. Interestingly, DEHP resulted in lipid peroxidation and increased ferrous ion content, suggesting that ferroptosis occurred in mouse hearts. Therefore, our findings demonstrated that DEHP could induce cardiac ferroptosis via upregulation of HO-1. The present study provides novel evidence of HO-1 as a target for DEHP-induced cardiotoxicity.

Adipose tissue-derived mesenchymal stem cells (ADSC) exert neuroprotective and anti-inflammatory effects. ADSCs are considered potential therapeutics for rheumatoid arthritis (RA), an inflammatory, multisystemic autoimmune disease. Epigallocatechin-3-gallate (EGCG), the major polyphenolic compound in green tea, has strong anti-inflammatory and antioxidant properties. This study aimed to investigate whether EGCG has a synergistic effect on the neuroprotective effects of ADSCs to protect the RA-damaged brain. Wistar rats were classified into four groups: sham, RA, RA + ADSCs (1 × 10

Male infertility is a multifactorial pathological condition and may be a harbinger of future health. Phthalates are ubiquitous environmental contaminants that have been implicated in the global decline in male fertility. Among them, di-(2-ethylhexyl) phthalate (DEHP) is the most prevalently used. Lycopene (LYC) is a possible preventive and therapeutic agent for male infertility owing to its antioxidant properties. The blood-testis barrier (BTB) is formed between Sertoli cells where it creates a unique microenvironment for spermatogenesis.We hypothesize that phthalate caused male infertility and LYC plays an important role in phthalate-induced male fertility disorders.Hematoxylin-eosin (HE) staining, ultrastructure observation, and fluorescence microscopy were used to examine the morphological changes. RNA-Seq, and western blotting were conducted to detect gene and protein levels. Routine testing for sperm morphology and sperm-egg binding assay were conducted to examine the morphological structure and function of sperm. Cell scratch assay and transepithelial electrical resistance (TER) were used to detect cell migration capacity and barrier integrity.In vivo experiments, we showed that LYC prevented DEHP-induced impairment of BTB integrity, which provided a guarantee for the smooth progress of spermatogenesis. LYC improved DEHP-induced change in sperm parameters and fertilization ability. Subsequent in vitro experiments, LYC alleviated MEHP-induced disruption of intercellular junctions in mouse Spermatogonia cells (GC-1 cells) and mouse Sertoli cells (TM4 cells). In MEHP-induced BTB impairment models of Sertoli cells, treatment with LYC or overexpressing connexin-43 (Cx43) promoted cell migration capacity and normalized BTB integrity. Cx43 knockdown inhibited cell migration capacity and perturbed BTB reassembly in LYC preventing DEHP-induced BTB impairment.Our study provides evidence for the role of LYC in phthalates-induced spermatogenic disorders and points to Cx43 as a potential target for male fertility.

Background Reports of synchronous bilateral giant (>10 cm) phyllodes tumors of the breast are scant in the literature. Reconstruction of the two large defects created after bilateral mastectomies is a challenge. Our patient, a 45-year-old woman, had a borderline phyllodes tumor measuring 15.5×15×7.3 cm in the right breast and a malignant phyllodes tumor measuring 16×10×9.8 cm in the left breast. After bilateral mastectomy, the following two huge defects remained: a 15×15 cm defect in the right breast and a 18×15-cm defect in the left breast. Methods We used one donor site with two separated deep inferior epigastric perforator flaps for postmastectomy breast reconstruction. This is the first case of bilateral giant phyllodes tumor in which mastectomy was followed immediately by autologous tissue reconstruction. Results Large flap reconstruction conferred adequate leverage for wide excision of giant phyllodes tumors, and no local recurrence or distal metastatic lesions were observed over a follow-up period of 4 years. Conclusions This method caused less donor site morbidity than did methods involving other types of flaps, and good functional and cosmetic results were achieved.

Multiple cranial nerve palsies often lead to complex clinical presentations. We report 2 cases in which a combination of multiple palsies resulted in paralytic esotropia with the medial rectus being the sole functioning rectus muscle. Both cases were treated with temporal transposition of split medial rectus.

Soybean oil (SO)-, SO medium-chain triglyceride (MCT)-, olive oil (OO)-, and fish oil (FO)-based lipid emulsions are generally applied in clinical practice via intravenous injection for patients with nutritional requirements. The function of lipid emulsions on immune modulation remains inconsistent, and their effects on macrophages are limited. In the present study, we used a model of S. aureus-infected mouse RAW264.7 macrophages to determine the influence of three different compositions of lipid emulsions (Lipofundin, ClinOleic, and Omegaven) on reactive oxygen species (ROS) production, phagocytosis, and bacterial survival. The three individual lipid emulsions similarly enhanced bacterial survival but reduced S. aureus-stimulated ROS, phagocytosis of S. aureus bioparticles conjugate, polymerization of F-actin, and phosphorylation of AKT, JNK, and ERK. Compared with the JNK and ERK inhibitors, the PI3K inhibitor markedly suppressed the phagocytosis of S. aureus bioparticles conjugate and the polymerization of F-actin, whereas it significantly increased the bacterial survival. These results suggest that the three lipid emulsions diminished ROS production and phagocytosis, resulting in increased bacterial survival. PI3K predominantly mediated the inhibitory effects of the lipid emulsions on the phagocytosis of mouse RAW264.7 macrophages.

The coding region for the sortase A (SrtA) of Staphylococcus aureus was fused at the N-terminus of LfcinB. The SrtA-LfcinB fusion protein in E. coli C43(DE3) was expressed with the expected sizes of 21 kDa and 38 kDa by pET21b-SrtA-LfcinB and pET32-1SrtA-LfcinB constructs, respectively. Increased levels of the TrxA-His-SrtA-SrtA-LfcinB fusion protein were detected by the pET32-3SrtA-LfcinB construct having three expression cassettes. LfcinB is released from the expressed SrtA-LfcinB protein by SrtA self-cleavage which is induced in the presence of Ca2+. The antibacterial activity was detected after SrtA-mediated cleavage of LfcinB. Furthermore, to reduce the antimicrobial peptide toxicity to the E. coli host, the human interferon-γ (hIFN-γ) sequences were mutated into a negatively charged mIFc2 protein (7 kDa), which was co-expressed with LfcinB in an insoluble form. The yield of LfcinB was elevated while changing the gene order of LfcinB and mIFc2 (pET21b-fLfcinB-bmIFc2). Furthermore, increased levels of LfcinB were detected using the pET21b-(fLfcinB-bmIFc2)2 construct. To increase the dissolution rate of inclusion bodies, inclusion bodies treated with different temperatures and pH and resuspended in different volumes of 50 mM Tris-HCl were assayed. Our results reveal that heat-treated LfcinB/mIFc2 inclusion bodies at 90 °C, pH 10, and 16X resuspended volumes have the best resolubilization rate. This work suggests that the mIFc2 co-expression system shows higher efficiency for LfcinB production than the SrtA fusion system. The expressed LfcinB from the mIFc2 co-expression system exhibits excellent broad-spectrum antibacterial activities against thirteen Gram-negative and ten Gram-positive bacteria species with a range of minimum inhibitory concentrations (MIC) between 37–150 ug/mL.

Chong-Bin Tsai,1,2 Chien-Liang Fang,3,4 Ming-Shan Chen,5,6 Min-Yueh Yen,1 Chi-Yen Yeh,7 Zhi-Ming Lai,7 Mei-Ling Hsu,7 Shan-Tair Wang8 1Department of Ophthalmology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan; 2Department of Optometry, College of Medical and Health Science, Asia University, Taichung, Taiwan; 3Division of Plastic and Reconstruction Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; 4Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung City, Taiwan; 5Department of Anesthesiology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan; 6Department of Biotechnology, Asia University, Taichung City, Taiwan; 7Department of Information Technology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan; 8Department of Medical Research, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, TaiwanCorrespondence: Chong-Bin Tsai,Department of Ophthalmology, Ditmanson Medical Foundation Chiayi Christian Hospital, No. 539 Zhongxiao Road, East District, Chiayi City, 60002, Taiwan, Tel +886-5-2765041 ext 8503, Fax +886-5-2774511, Email cbtsai@gmail.comPurpose: Modern cataract surgeries aim to treat impaired vision and also improve quality of life. An appropriate pre-operative selection of the intraocular lens is important to post-operative quality of life. Patients often have difficulty in choosing the best fit for individual needs. Patient decision aids (PDAs) are useful tools to assist patients in such decision-making process. However, most PDAs are paper-based and lack user interaction. This study is aimed to develop and evaluate an interactive computerized patient decision aid (cPDA) to help patients in the selection of an appropriate intraocular lens model before cataract surgery.Materials and Methods: Patients and their families who were making the decision regarding intraocular lens selection before cataract surgeries were eligible to participate in this study. A cPDA was built on an interactive robot, to help the patients in the decision-making process. The usefulness of the cPDA was measured with the Decision Self-Efficacy (DSE) scale and Preparation for Decision Making (PrepDM) scale.Results: A total of 50 participants (18 men and 32 women) were enrolled in the pilot test. The mean pre-cPDA DSE score was 46.5 ± 13.6, and the post-cPDA DSE score was 72.6 ± 12.8. The average gain score on DSE was 26.1, and the standard deviation was 8.0. The gain score on DSE was statistically significant, and the effect size was bigger than 3. The patients with junior or senior high degrees had the highest gain score on DSE, and the ones with college or above degrees had the lowest. The patients with college or above degrees had the highest PrepDM score, and the ones with elementary school or below had the lowest. Age and sex were not significant correlates of PrepDM. The patients with college or above degrees had the highest preparedness, but the lowest gain on DSE.Conclusion: Education levels are associated with the usefulness of cPDA, both for the preparedness and decision efficacy of patients. The results provide insight into the feasibility of cPDA for the decision-making of pre-operative intraocular lens selection.Keywords: decision making, preparedness, decision self-efficacy, education level

Neutrophil extracellular traps (NETs) consist of chromatin DNA networks that are studded with cytosolic and granular antimicrobial proteins to trap or kill an infected microorganism. A lipid emulsion, the solvent of pure propofol for intravenous application, is given to clinical patients who require intravenous feeding of fatty acids and fat for energy. Intravenous propofol is widely used to sedate critically ill patients. Both intravenous propofol and its lipid emulsion have immunomodulatory activity. However, the role of lipid emulsion of intravenous propofol on NET induction remains unclear.In this study, neutrophils were stimulated with phorbol myristate acetate (PMA) or Escherichia coli (E. coli) in the absence or presence of intravenous propofol (Propofol-Lipuro®), its solvent lipid emulsion (Lipofundin) or pure propofol, and NETs were stained with SYTOX Green for visualization and quantification. Total HOCl was determined by measuring the taurine-chloramine complex, and intracellular HOCl was evaluated with BioTracker™ TP-HOCl 1 dye.PMA-induced NETs were not efficiently inhibited when Propofol-Lipuro® was added after PMA stimulation. Clinically relevant concentrations of Lipofundin exerted a significant reduction in PMA-induced NETs and total reactive oxidative species (ROS), which was comparable to that observed for Propofol-Lipuro®. Lipofundin transiently reduced intracellular HOCl production and the phosphorylation level of extracellular regulated kinase (p-ERK) but did not scavenge HOCl. Moreover, Lipofundin decreased E. coli-induced NETs in a ROS-independent pathway, similar to Propofol-Lipuro®.All data agree that Lipofundin, the major component of Propofol-Lipuro®, inhibits intracellular HOCl and p-ERK to suppress PMA-induced NET formation but reduces E.coli-induced NETs in a ROS-independent pathway.

Among the different types of oral cancer, >90% of cases are oral squamous cell carcinoma (OSCC). 5‑fluorouracil (5‑FU) is a commonly used treatment for OSCC, but cells typically display resistance to the drug. Propofol, an intravenous anesthetic agent, exhibits certain anticancer effects, including the inhibition of cancer cell proliferation, migration and invasion. Secreted proteins, such as growth factors and cytokines are involved in cancer development and progression, but the effect of propofol on secreted proteins in OSCC is not completely understood. An MTT assay, flow cytometry and western blotting were performed to determine the anticancer effects of propofol. The secretion profile of OSCC was determined using an antibody array, and clinical importance was assessed using the Gene Expression Profiling Interactive Analysis database. The results were verified by performing reverse transcription‑quantitative PCR (RT‑qPCR) and western blotting. 5‑FU‑resistant cells were established to determine the role of the gene of interest in drug resistance. The results demonstrated that propofol decreased cell viability and promoted cell apoptosis. The antibody array results showed that propofol attenuated the secretion of multiple growth factors. The bioinformatics results indicated that amphiregulin (AREG) was expressed at significantly higher levels in cancer tissues, which was also related to poor prognosis. The results of RT‑qPCR and western blotting revealed that propofol decreased AREG expression. Pretreatment with exogenous recombinant AREG increased EGFR activation and conferred propofol resistance. Moreover, the results indicated that the expression and activation of AREG was also related to 5‑FU resistance, but propofol ameliorated 5‑FU drug resistance. Therefore, the present study suggested that propofol combination therapy may serve as an effective treatment strategy for OSCC.

BACKGROUND This study is a retrospective review to compare combining progressive tension sutures, closed drain, and fibrin sealant effects on seroma formation, postoperative drainage volume, and hospital stay for abdominoplasty after deep inferior epigastric artery perforator (DIEP) flap. We ever published a 0% seroma rate in abdominoplasty after DIEP flap using progressive tension sutures and closed drain. Massive abdominal wound drainage caused delayed drain removal and increased hospital stay and medical costs. METHODS We retrospectively evaluated 54 abdominoplasty patients between December 2013 and September 2017; 43 patients used fibrin glue and 11 used progressive tension sutures and closed drain. RESULTS Abdominal drainage for the first 3 postoperative days was 84.65 ± 52.95 mL in the fibrin group, with total drainage of 127.70 ± 125.50 mL and 214.45 ± 104.35 mL in the no fibrin group, with total drainage of 350.45 ± 213.58 mL. Drains were removed on postoperative day 6.21 ± 1.44 in the fibrin group and day 9.64 ± 1.96 in the no fibrin group. The association of the first 3 days and total drainage volumes with the drain removal day significantly differed in the fibrin and no fibrin groups. Hospital stay was 9.88 ± 3.55 and 12.45 ± 5.22 days in the fibrin and no fibrin group, respectively, with borderline significant differences. CONCLUSIONS Donor site abdominoplasty after DIEP flap combining progressive tension sutures, closed drainage, and fibrin glue can prevent seroma occurrence, reduce postoperative abdominal drainage and need for blood transfusion, and achieve early removal of the abdominal drain, shorter hospital stay, and lower medical cost.

Lipofundin is the solvent for propofol in the intravenous injection of Propofol-Lipuro® and is used in patients who need intravenous feeding to provide fatty acids and fat for energy. In addition to propofol, Lipofundin also affects the immune modulation of phagocytes. In a previous study, we reported that intravenous propofol effectively decreased Staphylococcus aureus-stimulated reactive oxygen species (ROS) levels, IL-1β secretion, and phagocytosis in RAW264.7 macrophages. It is important to separately assess the effects of pure propofol, Lipofundin, and Propofol-Lipuro. By using an S. aureus-infected RAW264.7 macrophage model, the levels of secreted IL-1β in cell supernatants were determined by ELISA. IL-1β mRNA in cell pellets was further analyzed by quantitative polymerase chain reaction (qPCR), and Western blotting was performed to detect pro-IL-1β synthesis. Total ROS levels were determined by a luminol chemiluminescence assay. Compared with pure propofol, treatment with clinically relevant concentrations of Propofol-Lipuro and Lipofundin obviously reduced IL-1β secretion (>85% inhibition), S. aureus-stimulated ROS production (50% inhibition), and phagocytosis (>60% inhibition) to similar levels. Treatment with pure propofol alone significantly decreased IL-1β mRNA levels and pro-IL-1β protein synthesis, and slightly inhibited phagocytosis. In contrast, treatment with Propofol-Lipuro did not influence IL-1β mRNA or pro-IL-1β protein expression, even though treatment with Lipofundin increased the levels of both IL-1β mRNA and its precursor protein. In conclusion, IL-1β secretion is regulated at the posttranslational level. Lipofundin mediated the major effect of Propofol-Lipuro on the inhibition of IL-1β secretion, ROS production, and phagocytosis in S. aureus-infected RAW264.7 cells.

Autologous breast reconstructions using deep inferior epigastric perforator (DIEP) flaps create a large incision, presenting an opportunity for surgical site complications. In this pilot study, we aimed to examine outcomes in DIEP donor site incisions managed with standard dressings (control; n = 5) or closed incision negative pressure therapy (ciNPT; n = 5). We observed no significant differences between group age, body mass index, and past medical history. Both treatment groups had a similar duration of hospital stay, the number of blood transfusions, and pain scores on postoperative day 2 (P > .05). There was a trend of higher drainage (P = .251) and shorter time to incision healing (P = .067) in the ciNPT group than the control though the difference was not statistically significant. We did observe a significant improvement in scar pigmentation, vascularity, and pliability at 3, 6, and 12 months post‐surgery in the ciNPT group compared with control (P

Male infertility is an attracting growing concern owing to decline in sperm quality of men worldwide. Phthalates, in particular to di (2-ethylhexyl) phthalate (DEHP) or its main metabolite mono-2-ethylhexyl phthalate (MEHP), affect male reproductive development and function, which mainly accounts for reduction in male fertility. Lycopene (LYC) is a natural antioxidant agent that has been recognized as a possible therapeutic option for treating male infertility. Testosterone (T)/androgen receptor (AR) signaling pathway is involved in maintaining spermatogenesis and male fertility. How DEHP causes spermatogenesis disturbance and whether LYC could prevent DEHP-induced male reproductive toxicity have remained unclear. Using in vivo and vitro approaches, we demonstrated that DEHP caused T biosynthesis reduction in Leydig cell and secretory function disorder in Sertoli cell, and thereby resulted in spermatogenic impairment. Results also showed that MEHP caused mitochondrial damage and oxidative damage, which imposes a serious threat to the progress of spermatogenesis. However, LYC supplement reversed these changes. Mechanistically, DEHP contributed to male infertility via perturbing T/AR signaling pathway during spermatogenesis. Overall, our study reveals critical role for T/AR signal transduction in male fertility and provides promising insights into the protective role of LYC in phthalate-induced male reproductive disorders.

Objectives: To prevent aesthetic and functional deformities, precisely closed reduction is crucial in the management of nasal fractures. Plain film radiography (PF), ultrasonography (USG), and computed tomography can help confirm the diagnosis and classification of fractures and assist in performing closed reduction. However, no study in the literature reports on precisely closed reduction assisted with PF measurements under the picture archiving and communication system (PACS). Methods: We retrospectively evaluated 153 patients with nasal bone fracture between January 2013 and December 2017. Surgeons conducted precisely closed reduction assisted with PF measurement of the distance between the fracture site and nasal tip under PACS on 34 patients (group A). Another group on 119 patients were reduced under surgeon’s experience (group B). Results: No significant differences in age, gender, Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification, and reduction outcome were observed between group A and group B ( P > .05). The operative time of the group A was significantly lower (12.50 ± 4.64 minutes) compared to group B (23.78 ± 11.20 minutes; P < .001). After adjusted age, gender, and AO classification, patients in group A scored 10.46 minutes less on the operative time than those in group B ( P < .001). In addition, the severity of nasal bone fracture (AO classification, β = 3.37, P = .002) was positive associated with the operative time. Conclusions: In this study, closed reduction in nasal bone fracture assisted with PF measurements under PACS was performed precisely, thereby effectively decreasing operative time and the occurrence of complications. This procedure requires neither the use of new instruments or C-arm nor USG or navigation experience. Moreover, reduction can be easily performed using this method, and it requires short operative time, helps achieve great reduction, less radiation exposures, and is cost-effective.

BACKGROUND Suction-curettage using an arthroscopic shaver is the most effective surgical treatment for bromhidrosis; however, information regarding the procedure is limited. This study investigated the factors that affect the efficacy of suction-curettage. PATIENTS AND METHODS We retrospectively evaluated data for 215 patients (430 axillae) with bromhidrosis treated with suction-curettage using an arthroscopic shaver between 2011 and 2019. RESULTS Excellent or good efficacy with improved malodor was achieved in 418 axillae (97.21%). Secondary suction-curettage was performed for 11 (2.56%), with excellent results. Efficacy and need for secondary suction-curettage were not associated with age, sex, shaving time, and tumescent infiltration use. Complications were observed in 52 (12.09%) axillae, including hematoma or seroma, epidermis decortication, skin necrosis, and infections; 10 (2.33%) required local debridement for wounds. Complications showed a significant difference with respect to age (p < .001). Pain scores on postoperative Day 2 were significantly lower for patients treated using tumescent infiltration than those for the others (1.65 ± 0.84 vs 4.57 ± 1.16; p < .001). CONCLUSION The results suggest that 7 to 15 minutes of suction curettage using an arthroscopic shaver is sufficient to achieve good efficacy for bromhidrosis with few complications. Older age was a risk factor for complications, and tumescent infiltration use achieved good postoperative pain control. LEVELS OF EVIDENCE II.

We report the case of a 38-year-old man with abducens palsy following a traumatic skull injury who failed multiple strabismus surgeries. A suture-armed 5 mm micro bone screw was placed on the anterior face of the lateral orbital rim and used to tether and abduct the globe. The patient remained orthotropic in primary position 12 months postoperatively.

Anesthetics have immunomodulatory effects, but the use of different assay systems has contributed to inconsistent results in the literature. IL-1β and reactive oxygen species (ROS) secreted by phagocytes are important factors that protect against Staphylococcus aureus infection. In this study, the effects of four intravenous anesthetics (propofol, thiamylal sodium, midazolam, and ketamine) on IL-1β secretion, ROS, and bacterial survival in S. aureus-infected RAW264.7 cells were evaluated. S. aureus-infected RAW264.7 cells with or without intravenous anesthetic treatment were established as the experimental model. Cell supernatants were subjected to ELISAs to measure secreted IL-1β. Cell pellets were subjected to qPCR and western blot analyses to analyze IL-1β mRNA and protein levels. Luminol chemiluminescence assays were used to detect ROS, and bacterial survival was determined by counting the colony forming units at the beginning and end of the infection. Compared with the levels after treatment with the other intravenous anesthetics, secreted IL-1β levels were lowest in the supernatant of S. aureus-infected RAW264.7 cell cultures after propofol treatment, but propofol did not decrease IL-1β mRNA or protein expression. However, thiamylal sodium and midazolam decreased IL-1β mRNA and protein expression in a dose-dependent manner. Additionally, propofol substantially decreased S. aureus-stimulated ROS and phagocytosis. Bacterial survival was strongly increased by propofol treatment. Of the four intravenous anesthetics, propofol was the most potent inhibitor of IL-1β secretion and ROS level in S. aureus-infected RAW264.7 cells; moreover, propofol resulted in an increase in bacterial survival by inhibiting ROS and phagocytosis.

Autophagy is a potential target for the treatment of triple negative breast cancer (TNBC). Because of a lack of targeted therapies for TNBC, it is vital to find optimal agents that avoid chemoresistance and metastasis. Flavopereirine has anti-proliferation ability in cancer cells, but whether it regulates autophagy in breast cancer cells remains unclear. A Premo&trade, Tandem Autophagy Sensor Kit was used to image the stage at which flavopereirine affects autophagy by confocal microscopy. A plasmid that constitutively expresses p-AKT and siRNA targeting p38 mitogen-activated protein kinase (MAPK) was used to confirm the related signaling pathways by Western blot. We found that flavopereirine induced microtubule-associated protein 1 light chain 3 (LC3)-II accumulation in a dose- and time-dependent manner in MDA-MB-231 cells. Confocal florescent images showed that flavopereirine blocked autophagosome fusion with lysosomes. Western blotting showed that flavopereirine directly suppressed p-AKT levels and mammalian target of rapamycin (mTOR) translation. Recovery of AKT phosphorylation decreased the level of p-p38 MAPK and LC3-II, but not mTOR. Moreover, flavopereirine-induced LC3-II accumulation was partially reduced in MDA-MB-231 cells that were transfected with p38 MAPK siRNA. Overall, flavopereirine blocked autophagy via LC3-II accumulation in autophagosomes, which was mediated by the AKT/p38 MAPK signaling pathway.

Neutrophil extracellular traps (NETs) are net-like chromatin fibers that can trap and kill microorganisms. Although several anti-inflammatory effects of intravenous anesthetics have been reported, it has not been investigated whether intravenous anesthetics influence NET formation. Aims To compare the effects of four intravenous anesthetics (propofol, thiamylal sodium, midazolam, and ketamine) on phorbol myristate acetate (PMA)-induced NET formation and analyze the associated signaling pathways. Materials and methods PMA-stimulated NETs formed in the absence or presence of intravenous anesthetics were stained with SYTOX Green and then quantified. Inhibitors were applied to investigate the related mechanism, which was confirmed by western blotting, and ROS were detected. Key findings The neutrophils incubated with propofol showed the lowest degree of NET formation compared with those incubated with the other intravenous anesthetics. Propofol significantly reduced the level of myeloperoxidase (MPO)-derived HOCl but not that of superoxide. Aminopyrine, an MPO inhibitor, markedly decreased the number of PMA-induced NETs, indicating the involvement of HOCl in the inhibitory effect of propofol on NET formation. According to western blotting results, the level of p-ERK was reduced by propofol during PMA-induced NET formation. The ERK inhibitor PD98059 decreased NET formation but did not inhibit PMA-induced HOCl generation, and aminopyrine did not reduce ERK phosphorylation. Significance Through this study, we define a new anti-inflammatory effect of intravenous anesthetics. Of the four intravenous anesthetics tested, propofol was the most potent inhibitor of NET formation. Moreover, propofol resulted in a decrease in PMA-induced NET formation by two independent mechanisms: inhibition of HOCl and p-ERK.

Breast cancer, which is the most frequently diagnosed cancer, is quite heterogeneous. For breast cancer subtypes lacking targeted therapies, it is vitally essential to find novel agents that prevent chemoresistance and metastatic relapse. Flavopereirine is a β-carboline alkaloid that has antiplasmodial activity, and its antiproliferative effect in different cancers remains unclear. The effect of flavopereirine on cell cycle arrest and apoptosis signaling in breast cancer cells was analyzed by flow cytometry. An inhibitor and siRNA were used to confirm the related signaling pathways by Western blot analysis. We found that flavopereirine caused G0/G1 phase arrest in MCF-7 cells and S phase arrest in MDA-MB-231 cells. MDA-MB-231 cells were more sensitive to flavopereirine-induced apoptosis. Furthermore, we found that flavopereirine-induced apoptosis was partially reduced in MDA-MB-231 cells treated with an extracellular regulated kinase (ERK) inhibitor and p38 mitogen-activated protein kinase (MAPK) siRNA. Moreover, p38 siRNA treatment simultaneously reduced phosphorylated ERK expression levels. Conversely, the recovered phosphorylation of AKT decreased the levels of p-ERK and p-p38 MAPK. Overall, flavopereirine induces cell cycle arrest and the AKT/p38 MAPK/ERK signaling pathway, which contribute to flavopereirine-induced apoptosis in MDA-MB-231 cells.

Due to the development of drug resistance, the outcome for the majority of patients with acute myeloid leukemia (acute myelogenous leukemia; AML) remains poor. To prevent drug resistance and increase the therapeutic efficacy of treating AML, the development of new combinatory drug therapies is necessary. Sonic hedgehog (Shh) is expressed in AML biopsies and is essential for the drug resistance of cancer stem cells of AML. AML patients are frequently infected by bacteria and exposed to lipopolysaccharide (LPS). LPS itself, its derivatives, and its downstream effectors, such as tumor necrosis factor-α (TNF-α) and interferons (IFNs), have been shown to provoke anti-tumor effects. The application of a Shh inhibitor against AML cells in the presence of LPS/TNF-α/IFNs has not been investigated. We found that the Shh inhibitor cyclopamine in combination with LPS treatment synergistically induced massive cell apoptosis in THP-1 and U937 cells. The cytotoxic effects of this combined drug treatment were confirmed in 5 additional AML cell lines, in primary AML cells, and in an AML mouse model. Replacing cyclopamine with another Shh inhibitor, Sant-1, had the same effect. LPS could be substituted by TNF-α or IFNs to induce AML cell death in combination with cyclopamine. Our results suggest a potential strategy for the development of new therapies employing Shh antagonists in the presence of LPS/TNF-α/IFNs for the treatment of AML patients.

A manual guided vehicle (MGV) is used to handle heavy materials in thin film transistor-liquid crystal display (TFT-LCD) manufacturing clean rooms. This study focuses on evaluating the force exertions and muscle activities in MGV operations. The independent variables include gender, force direction, handle height, load handled and wheel diameter of the MGV. The results show the force direction, handle height and load handling effects are significant in most measures except for F(ending) (the peak force required to stop the MGV) and the EMG of the anterior deltoid. The wheel diameter had a significant effect on F(initial) (the peak force required to move the MGV) and F(ending) responses. Gender did not significantly effect any measures. Moreover, the pushing and pulling force is less at 115cm handle height than at 101.5cm and 88cm handle heights. Using 15.3cm (6 inch) diameter wheels requires less force than 20.3cm (8 inch) diameter wheels because the two front wheels are fixed and the two rear wheels are rotatable. The design implications are discussed.

Pulmonary alveolar proteinosis (PAP) is rarely seen in Taiwan. According to the literature the incidence is one in two million with a male to female ratio of 3 to 1. The pathohistology of PAP is associated with the filling of the alveoli by a proteinaceous material. PAP can be divided into primary and secondary forms. PAP was once diagnosed by open lung biopsy, but since the introduction of bronchoalveolar lavage, open lung biopsy is less common now for the diagnosis of PAP. The most definite and effective therapy for PAP is whole lung lavage (WLL). Therapeutic WLL is performed under one-lung general anesthesia with a double lumen tube (DLT). This procedure is associated with three problems: 1. hypoxia. 2. circulatory disturbance. 3. difficulty in positioning the DLT. We present a case undergoing WLL in our hospital who had contracted pulmonary TB was diagnosed as a case of PAP by open lung biopsy. She was convinced to receive WLL because of intolerance of daily activity. The result of the left lung lavage was excellent, but the attempt on the other lung at a later time was cancelled because of difficulty in positioning the DLT due to tracheal stenosis. Here we would like to give an account of our management and discuss about PAP and WLL after literature review.

The stress corrosion cracking (SCC) behavior of 2205 duplex stainless steel (DSS) in 26 wt% NaCl solution at 90°C was investigated. Slow strain rate testing was performed at a strain rate of 4.1 × 10−6 s−1. The susceptibility of 2205 DSS to SCC at open circuit potential and at various anodic potentials was evaluated. The experimental results showed that 2205 DSS was immune to SCC in the solution at potentials less than −160 mV (SCE). At potentials greater than −160 mV (SCE), a dramatic reduction in ductility was observed, indicating the susceptibility to SCC. The critical potential for the occurrence of SCC of 2205 DSS was coincident with its pitting potential in the above environment. Fractographical examination revealed that pitting corrosion assisted the initiation and selective dissolution was involved in the propagation of SCC of 2205 DSS in concentrated NaCl solution at 90°C.

Neuromuscular blocking agents (NMBAs) are widely used during the induction and maintenance of anesthesia. Postoperative residual curarization (PORC) following the use of NMBAs still occurs even though intermediate-acting NMBAs were used. Train-of-four (TOF) stimulation is used to quantify the degree of neuromuscular blockade. The TOF ratio of 0.7 in the adductor pollicis muscle was associated with normal respiratory function. Pharyngeal function returned to normal while the TOF ratio reached 0.9. The aim of this study was to survey the PORC in the post-anesthesia care unit (PACU).In this observational study, 308 patients who received general anesthesia with NMBAs were enrolled. Residual curarization was evaluated using the TOF-Watch acceleromyograph upon arrival in the PACU. Three consecutive TOF stimulations were applied and recorded at 15-second intervals. Two thresholds of TOF ratios (0.9 and 0.7) were used to assess the presence of residual curarization.TOF ratios less than 0.7 and 0.9 were observed in 15 (5%), and 97 (31%) patients, respectively. The differences of the TOF ratios between the male and female patients were significant (p = 0.014). In terms of weight, the differences between the patients with ratios0.9 andor = 0.9 were significant (p = 0.013). There were 67, 49, 15, and three patients who received reversal medication in the0.9 group,or = 0.9 and0.7 group, andor = 0.7 group, respectively. The differences of the TOF ratios between the patients who received and those who did not receive reversal medication were not significant (p = 0.91).PORC is still a clinical problem in the modern PACU. Objective neuromuscular monitoring needs to be performed to ensure patient safety.

Postoperative nausea and vomiting (PONV) is still a common and major complication for surgical patients, which may delay post-anesthetic care unit discharge, prolong hospital stay and thus increase the cost of hospitalization. It is understood that PONV is a multi-factorial outcome and occurs more often with general anesthesia than with other anesthetic methods. Prophylactic administration of antihistamines, antidopaminergics, anticholinergics, phenothiazines, serotonin antagonist, steroids and even acupuncture has been shown to be effective. However, expenses and side effects of these agents have also been a concern for clinical doctors. The aim for this prospective study was to find an agent that is cost effective and side effect free (or at least with a low incidence of side effects) for the prevention of PONV.A total of 700 adult surgical patients who planned to have surgery under general anesthesia were enrolled in this double-blinded, randomized and placebo-controlled study. Group P received the placebo (0.9% normal saline 2 ml) and Group D received 10 mg dexamethasone intravenously right before the induction of anesthesia.We found that during the postoperative period of 1-8 h, patients in Group D reported a lower incidence of PONV (24%) than those in Group P (39%, p0.001). Patients in Group D also requested less rescue anti-emetic (17%) than those in Group P (30%, p0.05). The same phenomenon was also noted in the 8-to-24-hour interval (PONV 4% vs. 12%, p0.05 and rescue anti-emetic 3% vs. 9%, p0.05 in Group D vs. Group P, respectively.)We conclude that the prophylactic intravenous administration of 10 mg dexamethasone immediately before the induction of anesthesia is effective in preventing PONV in the general surgical adult patient population.

Metallic wire expandable stents are increasingly used to alleviate tracheal obstruction due to malignancies. Patients usually tolerate these stents well and benefit from good to excellent palliation of their symptoms. Nevertheless, some miserable complications have also come to our notice. We report here an unfortunate case in whom severe bilateral main bronchial obstruction occurred immediately after the insertion of a Wall-stent over the tracheal stenosis.

Pulmonary alveolar proteinosis (PAP) is rarely seen in Taiwan. According to the literature the incidence is one in two million with a male to female ratio of 3 to 1. The pathohistology of PAP is associated with the filling of the alveoli by a proteinaceous material. PAP can be divided into primary and secondary forms. PAP was once diagnosed by open lung biopsy, but since the introduction of bronchoalveolar lavage, open lung biopsy is less common now for the diagnosis of PAP. The most definite and effective therapy for PAP is whole lung lavage (WLL). Therapeutic WLL is performed under one-lung general anesthesia with a double lumen tube (DLT). This procedure is associated with three problems: 1. hypoxia. 2. circulatory disturbance. 3. difficulty in positioning the DLT. We present a case undergoing WLL in our hospital who had contracted pulmonary TB was diagnosed as a case of PAP by open lung biopsy. She was convinced to receive WLL because of intolerance of daily activity. The result of the left lung lavage was excellent, but the attempt on the other lung at a later time was cancelled because of difficulty in positioning the DLT due to tracheal stenosis. Here we would like to give an account of our management and discuss about PAP and WLL after literature review.

Primary liver cancer (PLC) is one of the most frequently seen tumors in China. Thirty years ago, patients with PLC were often detected at relatively late stage, with a palpable mass or marked clinical symptoms and poor prognosis. In the past 30 years, the diagnosis and treatment of PLC have been greatly improved with better prognosis.In order to study the changes of PLC during the 30 years, the clinical data of 3250 patients with PLC from 10 medical institutions of China were collected, analyzed, and compared with those of 3254 PLC patients before the 30 years.In the 3250 patients aged 1-80 years, with an average age of 49.1 years, the male to female ratio (2.3:1) was lower than that before the 30 years. 73.5% of the 3250 patients sought medical advice within 3 months after the onset of the disease in contrast to 63.8% before the 30 years. Compared with those patients before the 30 years the symptoms and signs were alleviated generally. The HBsAg positive rate was 81.0%, but the HCV-Ab positive rate was 13.2%. The AFP level in 75% of patients was elevated, but in the remaining 25% was normal. 1912 patients (58.8%) were confirmed pathologically. Among them 1755 patients (91.8%) had hepatocellular carcinoma. The overall resection rate was 46.3%. Those who had early, middle, late stage carcinoma accounted for 29.9%, 51.5%, and 18.6% respectively in contrast to 0.4%, 47.0%, and 52.6% reported before the 30 years. The 1-, 3-, 5-year survival rates of the patients were 66.1%, 39.7%, and 32.5% respectively, whereas 93.5%, 70.1%, and 59.1% for the early stage patients, and 65.3%, 30.5%, and 23.5% for the middle stage patients. The half and 1-year survival rates of the late stage patients were 52.5%, and 14.7%, respectively.Comparison with the clinical data before and after the 30 years show that PLC can be diagnosed early. More PLC patients tend to undergo resection while receiving a better conservative treatment, which ensures a prognosis.

Inferior vena cava tear is a rare but potentially lethal event associated with spinal surgery. Early recognition and repair are mandatory to minimize morbidity and mortality. Here we report a case of inferior vena cava tear which occurred during posterior spinal fusion surgery. Without marked bleeding from the surgical field, the patient was suddenly seized with a profound shock. Abdominal distension was found after resumption of the supine position from prone. Emergent exploratory laparotomy disclosed inferior vena cava tear. After repairing of the torn vessel, the patient was transferred to ICU. Unfortunately, patient expired two weeks later due to multiple-organ failure.