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Compared to their non-Chinese peers in Australia, Chinese international students have very low rates of effective contraceptive use and this combined with other factors impacts unintended pregnancy rates. There is limited research exploring Chinese international students in Australia's decision-making with respect to contraceptive choices. In early 2020, 26 individual semi-structured interviews were conducted with 18-25-year-old Chinese international students to explore factors influencing their contraceptive choices. Using both deductive and inductive analysis, seven primary themes were identified. Of note was the identification of the strongly expressed cultural value of (

The demand for higher education has increased student mobility across the world. Studying abroad provides an opportunity for young adults to engage in sexual behaviours, some of which may be risky. Yet, little is known about international students’ current sexual health knowledge or practices. The aim of this review was to identify their sexual health knowledge, behaviours, and attitudes. A search of five databases yielded 21 studies that met inclusion criteria. These studies used quantitative (n = 13), qualitative (n = 7) and mixed methods (n = 1) and included a total of 4666 international and exchange students from diverse cultural backgrounds. Findings were grouped into three themes: sexual health knowledge, sexual behaviours, and sexual health attitudes. Asian international students had poorer levels of knowledge, suggesting a need for culturally appropriate sex education. They were less sexually experienced and were older than domestic students at first age of sex. Fewer engaged in risky sexual behaviours when compared to domestic students. They also reported fewer sexual partners and higher condom usage. However, culture influenced the sexual behaviours and attitudes of international students; in particular, Asian female international students, who tested risk-taking behaviours, such as casual sex, in more liberal Western countries. Appropriate intervention and further education are needed to decrease international students’ sexual health risks.

Milroy disease, known as primary congenital lymphedema, is characterized by chronic tissue swelling due to impaired lymphatic drainage and is inherited in an autosomal dominant manner. This study reports a rare case of Milroy disease affecting siblings from unaffected parents. A one-month-old female infant presented with swelling of the bilateral calf and the dorsum of the feet which had been present since birth. Her 14-month-old brother had a similar presentation since birth with swelling of the bilateral calf and the dorsum of the feet. Milroy disease was diagnosed based on the clinical findings of bilateral lower limb swelling and confirmed by molecular genetic testing. The patient and her family, including her brother, parents, and maternal grandfather, were genetically tested, and two novel missense mutations (NM_182925.4: c.2534TC; p.Leu845Pro, c.4006GA; p.Glu1336Lys) were found in the Fms-related tyrosine kinase (FLT4) gene. Mutations segregated by the parents who carried each mutation in the heterozygous state were identified in the patient and her brother. The present case report in which Milroy disease developed in all offspring of parents with a normal phenotype suggests the possibility of a compound heterozygous mutation or non-penetrance during the process of inheritance of Milroy disease.

PurposePrecision oncology, such as next generation sequencing (NGS) molecular analysis and bioinformatics are used to guide targeted therapies. The laboratory turnaround time (TAT) is a key performance indicator of laboratory performance. This study aims to formally apply statistical process control (SPC) methods such as CUSUM and EWMA to a precision medicine programme to analyze the learning curves of NGS and bioinformatics processes.Patients and MethodsTrends in NGS and bioinformatics TAT were analyzed using simple regression models with TAT as the dependent variable and chronologically-ordered case number as the independent variable. The M-estimator “robust” regression and negative binomial regression were chosen to serve as sensitivity analyses to each other. Next, two popular statistical process control (SPC) approaches which are CUSUM and EWMA were utilized and the CUSUM log-likelihood ratio (LLR) charts were also generated. All statistical analyses were done in Stata version 16.0 (StataCorp), and nominal P < 0.05 was considered to be statistically significant.ResultsA total of 365 patients underwent successful molecular profiling. Both the robust linear model and negative binomial model showed statistically significant reductions in TAT with accumulating experience. The EWMA and CUSUM charts of overall TAT largely corresponded except that the EWMA chart consistently decreased while the CUSUM analyses indicated improvement only after a nadir at the 82nd case. CUSUM analysis found that the bioinformatics team took a lower number of cases (54 cases) to overcome the learning curve compared to the NGS team (85 cases).ConclusionAs NGS and bioinformatics lead precision oncology into the forefront of cancer management, characterizing the TAT of NGS and bioinformatics processes improves the timeliness of data output by potentially spotlighting problems early for rectification, thereby improving care delivery.

Data are limited on the ability of dipyridamole to additionally inhibit platelet function/reactivity in ischaemic cerebrovascular disease (CVD) patients on aspirin.To assess inhibition of platelet function/reactivity and platelet activation with dipyridamole in CVD.This prospective, observational study assessed TIA/ischaemic stroke patients before (baseline; N = 60), at 14 ±7 days (14d, N = 39) and ≥ 90 days (90d, N = 31) after adding dipyridamole to aspirin. Platelet function/reactivity at high shear stress (PFA-100® C-ADP) and low shear stress (VerifyNow® P2Y12 and Multiplate® ADP assays), and platelet activation status (% expression of CD62P, CD63 and leucocyte-platelet complexes on whole blood flow cytometry) were quantified. 'Dipyridamole-high on-treatment platelet reactivity (HTPR)' was defined as failure to inhibit ADP-induced platelet aggregation +/- adhesion compared with the patient's baseline on aspirin monotherapy by more than twice the coefficient-of-variation of the assay after adding dipyridamole to aspirin.Dipyridamole-HTPR was identified in 71.4-75% of patients on PFA-100 C-ADP, 83.9-86.8% of patients on VerifyNow P2Y12, and 81.5-83.3% of patients on Multiplate ADP assays. There were no changes in CD62P/CD63 expression (P ≥ 0.18), or consistent changes in leucocyte-platelet complexes in CVD patients overall at 14d or 90d vs. baseline after commencing dipyridamole. Monocyte-platelet complexes increased in the patient subgroup with dipyridamole-HTPR at 14d and 90d on PFA-100, and at 14d on VerifyNow (P ≤ 0.04), but not in those without dipyridamole-HTPR.Additional antiplatelet effects of dipyridamole are detectable under high and low shear stress conditions with user-friendly platelet function/reactivity tests ex vivo. Increasing circulating monocyte-platelet complexes over time are associated with dipyridamole-HTPR.

Limited data are available on the incidence of primary ophthalmic cancers worldwide. We describe the incidence and trends of primary ophthalmic cancers in Singapore.Data on ophthalmic cancers diagnosed in Singapore from 1996 to 2016 were retrieved from the Singapore Cancer Registry for analysis. All were histologically proven primary ophthalmic cancers. Calculations of incidence and age-specific frequency of ophthalmic malignancy were made.A total of 297 cases were included, with males constituting 59.9%. The race distribution was 78.5% Chinese, 16.5% Malay, 3.7% Indians and 1.3% others. There was an overall increase in ophthalmic malignancies. The mean age of onset was 47.4 years. The most common cancers were retinoblastoma (93.3%) in patients younger than 15 years, and lymphoma (71.3%) in patients aged 15 years and older. There has been an increase in lymphomas from 16.7% in 1968-1995 to 71.3% in 1996-2016 in those aged 15 years and older. The most common types of ophthalmic cancer according to location are lymphoma of the orbit, conjunctiva, cornea and lacrimal gland; retinoblastoma of the retina; and malignant melanoma of the choroid and ciliary body.Our study reported the incidence and trends of ophthalmic cancer in the Singapore population and showed an overall increase in ophthalmic malignancies in Singapore from 1996-2016. A substantial increase in lymphomas over the last 2 decades was noted. The data could aid clinicians, epidemiologists and policymakers in implementing strategies to address trends in ophthalmic cancers and spur aetiological research to improve quality of life in patients with such cancers.

Introduction With the global aging population, elderly patients are increasingly undergoing colorectal surgery. This study aims to evaluate postoperative outcomes in open (OS) and laparoscopic surgery (LS) for right hemicolectomy in elderly patients. Method We retrospectively reviewed patients aged 70 and above undergoing right hemicolectomy for malignancies at our institution. Additionally, Embase and Medline databases were reviewed, and comparative meta-analysis was conducted. Results 84 patients were included in our cohort (OS = 34; LS = 50). No significant difference in anastomotic leak (AL) (OS = 4; LS = 2; p = 0.176), surgical site infection (SSI) (OS = 4; LS = 2; p = 0.216), and ileus (OS = 10; LS = 16; p = 0.801) was observed. LS was associated with decreased postoperative stay (p = 0.001). Additionally, LS had faster return of bowel function (ROBF) (p = 0.068) and resumption of diet (p = 0.147), albeit without significance. Overall survival (p = 0.062), and disease-free survival (p = 0.067) did not significantly differ between LS and OS. Pooled analysis of 463 patients yielded no significant difference in AL (OR:1.15; 95%CI: 0.17-8.01; p = 0.89), SSI (OR:0.88; 95%CI: 0.44-1.76; p = 0.71), and ileus (OR:1.42; 95%CI: 0.69 – 2.92; p = 0.35). Postoperative stay (WMD:1.90 days; 95%CI: -1.81–5.61 days; p = 0.31), and ROBF (WMD:14.49 hours; 95%CI: -4.07–33.05 hours; p = 0.13) were shortened in LS, although without significance. Conclusions LS is associated with improved functional outcomes without an increased risk of postoperative morbidity or mortality.

The demand for higher education has increased student mobility across the world. Studying abroad provides an opportunity for young adults to engage in sexual behaviours, some of which may be risky. Yet, little is known about international students' current sexual health knowledge or practices. The aim of this review was to identify their sexual health knowledge, behaviours, and attitudes. A search of five databases yielded 21 studies that met inclusion criteria. These studies used quantitative (n =13), qualitative (n =7) and mixed methods (n =1) and included a total of 4666 international and exchange students from diverse cultural backgrounds. Findings were grouped into three themes: sexual health knowledge, sexual behaviours, and sexual health attitudes. Asian international students had poorer levels of knowledge, suggesting a need for culturally appropriate sex education. They were less sexually experienced and were older than domestic students at first age of sex. Fewer engaged in risky sexual behaviours when compared to domestic students. They also reported fewer sexual partners and higher condom usage. However, culture influenced the sexual behaviours and attitudes of international students; in particular, Asian female international students, who tested risk-taking behaviours, such as casual sex, in more liberal Western countries. Appropriate intervention and further education are needed to decrease international students' sexual health risks.

PURPOSE/OBJECTIVE(S) Nasopharyngeal carcinoma (NPC) is a distinct head and neck cancer that is associated with Epstein-Barr virus (EBV). Its histomorphology is characterized by epithelial carcinoma that is admixed with immune cells. This cellular pattern concurs with whole exome sequencing (WES) profiles of NPC that reveal several recurrent mutations involving NFKs and MHC-class genes, which are linked to poor outcomes. There is little information on the transcriptomic landscape of NPC. Here, we performed whole transcriptome sequencing (RNAseq) of a prospectively recruited cohort of NPC patients who were treated at a single institution. MATERIALS/METHODS Patients with biopsy-proven NPC, staged using the UICC/AJCC 8th ed, were prospectively recruited under an institutional approved protocol. All formalin-fixed paraffin-embedded specimens were centrally reviewed. Specimens with tumor cellularity of > 70% were macrodissected and Ranse (Illumina Trusses, CA) was performed. All patients underwent radiotherapy (RT); concurrent (CRT) and/or induction (IC) or adjuvant chemotherapy (AC) was performed for patients with advanced NPC. Primary clinical endpoint was disease-free survival (DFS). RESULTS Of 1,040 patients recruited, 145 patients had specimens that were successfully profiled by Ranse. Median age of this sub-cohort was 54.2 (IQR: 45.2-61.1) y; median follow-up was 4.8 (IQR: 3.3-8.1) y. Stage distribution was as such: 10 (6.9%) for Stage 1, 36 (24.8%) for Stage 2, 47 (32.4%) for Stage 3 and 41 (28.3%) for Stage 4A; 7 (4.8%) for Stage 4B; 4 (2.8%) were unclassified. 77 (53.1%) and 55 (37.9%) had EBV DNA titers of < 4,000 copies/ml and ≥4,000 copies/ml, respectively (13 [9.0%] missing). In terms of treatment received, 42 (29.0%) underwent RT alone; 50 (34.5%) and 41 (28.3%) received CRT and IC/AC+CRT; 12 (8.3%) had other treatment combinations. Unsupervised hierarchical clustering using expression of the top 1,000 most variable genes across the cohort revealed three distinct clusters that were characterized by differential expression of immune-related genes; incidentally, the cluster of patients with low immune score were enriched for recurrences, while the intermediate/high immune score groups had comparable prognoses. Subsequently, we performed gene-selection based on the low and intermediate/high immune score clusters and identified 511 genes that were significantly differentially expressed between them. We further clustered these genes to obtain a representative 5-gene GC that was prognostic for DFS (HR 3.28 [95% CI: 1.36-7.9]) on multivariable analyses, adjusted for T- and N-status and EBV DNA. Our GC was also prognostic for DFS in a validation dataset (N = 88, Zhang et al., 2017); HR 2.1 (95% CI: 0.73-6). CONCLUSION Herein, we developed and validated an immune-based prognostic GC for NPC. Our findings underscore the importance of the immune landscape in EBV-positive NPC.

SETTING: Multicentre retrospective study in South Korea.OBJECTIVE: To longitudinally evaluate changes in lung volume and diffusing capacity for carbon monoxide (DLCO) with forced expiratory volume in 1 sec (FEV1).DESIGN: A total of 155 patients with chronic obstructive pulmonary disease (COPD), whose pulmonary function parameters were measured annually for 5 years, were selected from a prospective cohort in South Korea. A random coefficients model was used to estimate mean annual FEV1, lung volume parameter and DLCO change rates.RESULTS: Patients were classified into four groups based on baseline DLCO and residual volume/total lung capacity (RV/TLC) measurements. The annual FEV1 decline rate was greater in patients with low DLCO than in those with normal DLCO, with the greatest decline occurring in patients with low DLCO and normal RV/TLC. RV and RV/TLC declined in patients with high RV/TLC, whereas these increased in patients with normal RV/TLC. DLCO decreased longitudinally in all four groups, with the greatest decline occurring in patients with normal DLCO and normal RV/TLC.CONCLUSIONS: Different subgroups of patients with COPD exhibited distinctive pulmonary function change patterns. Baseline DLCO and RV/TLC may be used as physiological markers to predict long-term changes in pulmonary function.

Pseudo aneurysm of the ankle is a rare presentation and the management is complex due to the complex anatomy. The aim of this review is to examine the epidemiology, etiology, diagnostic modalities used and management. This is the first systematic review of this topic in literature.We performed a systematic review in multiple databases (including PubMed, MEDLINE, EMBASE, and Scopus) from 1966 to May 18, 2019, to identify all case reports and case series describing patients with ankle pseudo aneurysm. This systematic review was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA). Our inclusion criteria included patients with ankle pseudo aneurysm of any age. We excluded reports in which the individual level data is not available. Patients demographic (gender, age), clinical characteristics (precipitating event, duration), diagnostic modality and treatment were recorded.There were in total 23 case reports identified on ankle pseudo aneurysm from 1966 until 2018. Among these twenty-three reports, 16 (70%) were male and seven (30%) patients were female. Age distribution showed higher number of reports among young adults, 15 patients (65%). Based on our systematic review trauma (48%), arthroscope (48%) and arthrodesis (4%) were the etiologies described in all these case reports. Ultrasound duplex and CT Angiogram has been used as a single modality in three reports each. In fifteen patients (65%) combination of imaging has been used for diagnosis. Anterior tibial artery is the most commonly injured vessel among the reported cases, comprised of 14 (61%) patients. Among these arthroscopes were the highest reported precipitating events, 9 (64%), followed by trauma in four patients (29%) and arthrodesis in one patient (7%). Treatment modalities described in all previous reports were excision and ligation, 10 (42%); excision of sac and primary repair, 4 (17%); excision of sac followed by reversed saphenous venous graft repair, 2 (8%); US guided compression, 2 (8%); US guided thrombin injection, 4 (17%); stenting, 1 (4%) and coiling, 1 (4%).Ankle pseudoaneurysm is mostly preventable by detailed initial assessment following trauma or careful approach during arthroscope. Evolving diagnostic modality and treatment has shed some light into noninvasive management of pseudo aneurysm of ankle.

Intensive aeration for nitrification is a major energy consumer in sewage treatment plants (STPs). Low-dissolved-oxygen (low-DO) nitrification has the potential to lower the aeration demand. However, the applicability of low-DO nitrification in the tropical climate is not well-understood. In this study, the potential of low-DO nitrification in tropical setting was first examined using batch kinetic experiments. Subsequently, the performance of low-DO nitrification was investigated in a laboratory-scale sequential batch reactor (SBR) for 42 days using real tropical sewage. The batch kinetic experiments showed that the seed sludge has a relatively high oxygen affinity. Thus, the rate of nitrification was not significantly reduced at low DO concentrations (0.5 mg/L). During the operation of the low-DO nitrification SBR, 90% of NH4-N was removed. The active low-DO nitrification was mainly attributed to the limited biodegradable organics in the sewage. Fluorescence in-situ hybridisation and 16S rRNA amplicon sequencing revealed the nitrifiers were related to Nitrospira genus and Nitrosomonadaceae family. Phylogenetic analysis suggests 47% of the operational taxonomic units in Nitrospira genus are closely related to a comammox bacteria. This study has demonstrated active low-DO nitrification in tropical setting, which is a more sustainable process that could significantly reduce the energy footprint of STPs.

SUMMARY This study evaluated the biocompatibility of contemporary bulk-fill resin-based composites (RBCs) including PRG (pre-reacted glass ionomer) materials based on the International Organization for Standardization 10993. In addition, the effect of composite thickness on cytotoxicity was also assessed. Two standard composites, two bulk-fill PRG RBCs, and three bulk-fill non-PRG RBCs were investigated. Block-shaped specimens of 2-mm and 4-mm thickness were cured with an irradiance of 700 mW/cm2 for 20 seconds with a light-emitting diode curing light and eluted with culture medium at 37°C for 24 hours. L929 mouse fibroblasts were exposed to extracts at varying dilutions (1:1, 1:2, and 1:10) for 24 hours. Analyses were performed to assess cytotoxicity, phase contrast microscopy, and quantitative cell viability. Among the bulk-fill RBCs, extracts of PRG materials resulted in the lowest cell viability. At 4-mm thickness, undiluted extracts of bulk-fill non-PRG RBCs had significantly higher cell viability than the standard composites. Chemical composition, specimen thickness, and testing concentrations of extracts had significant effects on cell viability and morphology. Cytotoxic effects of composites on cell viability were parallel with cell morphologic changes. Not all bulk-fill RBCs demonstrated high cell viability (>70%) at 4-mm thickness despite manufacturers' recommendations of bulk placement and curing.

Lead-free Ta-modified (Na0.53+xK0.47+x)(Nb0.55Ta0.45)O3 ceramics (NKNT, x = −0.01, −0.005, 0, 0.005 and 0.01) were prepared by conventional solid-state reaction. The structural and electrical properties were systematically investigated for Na/K ions non-stoichiometry. The coexistence of the orthorhombic and the tetragonal phases was confirmed near room temperature. An A-site Na/K excess improved the dielectric, piezoelectric and ferroelectric properties; in particular, the ceramic with x = 0.005 showed the highest piezoelectric constant of d33 = 340 pC/N among all the compositions studied.

Supplemental material for Systemic lupus erythematosus is a risk factor for cardiovascular disease: a nationwide, population-based study in Korea by S Y Lim, E H Bae, K-D Han, J-H Jung, H S Choi, HY Kim, C S Kim, S K Ma and S W Kim in Lupus

UNLABELLED We conducted a comprehensive humidifier disinfectant exposure characterization for 374 subjects with lung disease who presumed their disease was related to humidifier disinfectant use (patient group) and for 303 of their family members (family group) for an ongoing epidemiological study. We visited the homes of the registered patients to investigate disinfectant use characteristics. Probability of exposure to disinfectants was determined from the questionnaire and supporting evidence from photographs demonstrating the use of humidifier disinfectant, disinfectant purchase receipts, any residual disinfectant, and the consistency of their statements. Exposure duration was estimated as cumulative disinfectant use hours from the questionnaire. Airborne disinfectant exposure intensity (μg/m(3)) was estimated based on the disinfectant volume (ml) and frequency added to the humidifier per day, disinfectant bulk level (μg/ml), the volume of the room (m(3)) with humidifier disinfectant, and the degree of ventilation. Overall, the distribution patterns of the intensity, duration, and cumulative exposure to humidifier disinfectants for the patient group were higher than those of the family group, especially for pregnant women and patients ≤6 years old. Further study is underway to evaluate the association between the disinfectant exposures estimated here with clinically diagnosed lung disease. PRACTICAL IMPLICATIONS Retrospective exposure to household humidifier disinfectant as estimated here can be used to evaluate associations with clinically diagnosed lung disease due to the use of humidifier disinfectant in Korea. The framework, with modifications to account for dispersion and use patterns, can also be potentially adapted to assessment of other household chemical exposures.

Enzymatic Membrane Reactor (EMR) was applied to overcome drawback from batch cellulose hydrolysis such as inability of reusing the enzyme and product inhibition which leads to low product yield. However, the major problem of EMR is membrane fouling. Therefore, the membrane fouling mechanisms in EMR was investigated using Hermia’s pore blocking model. In this study, fed batch cellulose hydrolysis in EMR was carried out for 72 hours. The hydrolysate was filtered using polyethersulfone (PES) membrane at 24 hours interval and the flux of permeate was recorded. The cellulose hydrolysis has successfully converted more than 80% of the substrate into reducing sugar in EMR, which is approximately 20% more in batch hydrolysis. The product inhibition was minimized when there was glucose removal in EMR. The flux was analysed and the result showed that the membrane fouling was controlled by cake filtration mechanism. The larger size of substrate and enzyme than the membrane pore size blocked the membrane pore and eventually cause the development of cake layer.

P53 is critically important in preventing oncogenesis but its role in inflammation in general and in the function of inflammatory macrophages in particular is not clear. Here, we show that bone marrow-derived macrophages exhibit endogenous p53 activity, which is increased when macrophages are polarized to the M2 (alternatively activated macrophage) subtype. This leads to reduced expression of M2 genes. Nutlin-3a, which destabilizes the p53/MDM2 (mouse double minute 2 homolog) complex, promotes p53 activation and further downregulates M2 gene expression. In contrast, increased expression of M2 genes was apparent in M2-polarized macrophages from p53-deficient and p53 mutant mice. Furthermore, we show, in mice, that p53 also regulates M2 polarization in peritoneal macrophages from interleukin-4-challenged animals and that nutlin-3a retards the development of tolerance to Escherichia coli lipopolysaccharide. P53 acts via transcriptional repression of expression of c-Myc (v-myc avian myelocytomatosis viral oncogene homolog) gene by directly associating with its promoter. These data establish a role for the p53/MDM2/c-MYC axis as a physiological ‘brake' to the M2 polarization process. This work reveals a hitherto unknown role for p53 in macrophages, provides further insight into the complexities of macrophage plasticity and raises the possibility that p53-activating drugs, many of which are currently being trialled clinically, may have unforeseen effects on macrophage function.

Development requires new findings and innovative science to support. This research aims to study the simulation of soft ground improvement by comparing the soil strength after mixing with pozzolanic and fibrous additive such as Palm Oil Fuel Ash (POFA) and Palm Oil Fibre (POF) were chosen due to its redundancy found as industrial waste material. The soft soil sample collected was added with 0%, 5%, 10%, 15% and 20% percentage of additives by weight respectively. The soil sample used was from the soil that passed through sieve size of 0.425 mm. The data and analysis show that POF treated soil has a higher optimum moisture content and greater shear strength than the POFA treated soil.

The study presents application of an in-house software program to calculate image quality parameters of kV cone-beam CT (CBCT) system in radiotherapy. The parameters include uniformity, noise, contrast-to-noise ratio, CT number linearity, spatial resolution and geometric distortion as recommended in AAPM TG142 and TG179 quality assurance (QA) programme for image quality performance of kV CBCT. The computer algorithm packaged in the software program is developed using MATLAB (MathWorks, Natick, MA). The algorithm was optimised for two CT image quality phantoms, Catphan 600 (The Phantom Laboratory, Salem, NY) and CIRS 062QA (CIRS, Norfolk, VA). The phantoms were scanned with XVI CBCT system (Elekta AB, Stockholm, Sweden) using an optimised CT imaging protocol. The algorithm measures the image quality metrices from the corresponding image quality test patterns in the reconstructed CT images. The algorithm provides image quality parameters from both phantoms quantitatively. The software program allows the results to be exported and recorded in MS Excel for monitoring the performance trend of the image quality parameters. The software reduces measurement uncertainties from qualitative human observation of the test patterns.

Accessory breast is a frequently seen developmental breast abnormality, commoner among Asians than Caucasians. This ectopic breast tissue shares many similarities as the normal breast tissue, and although subjected to the same pathological processes, accessory breast carcinoma is rare. As locations of the accessory breast may be variable, detection of pathological lesions through clinical examinations and standard diagnostic tools (i.e., mammogram) can be difficult. Staging and management should be tailored-made according to the location of the accessory breast as well as its known pattern of lymphatic drainage. We report a case of an intra-ductal carcinoma occurring in an axillary accessory breast.

Introduction: Weight loss amongst women with polycystic ovary syndrome (PCOS) is crucial to reduce the risk of endocrine, reproductive and metabolic complications including hirsutism, menstrual disturbances and cardiovascular disease. With approximately 50% of women with PCOS being overweight or obese, effective dietary management of weight in PCOS is essential. However, there is inconsistent evidence as to whether specifically modified diets (e.g. reduced carbohydrate diets) are more effective at achieving weight loss amongst women with PCOS than are conventional healthy hypocaloric diets. Material and Methods: A systematic review and meta-analysis of randomized controlled trials that had compared weight and BMI between women with PCOS who had undergone either a specifically modified diet or a conventional healthy hypocaloric diet were performed. Six electronic databases were searched, a manual search of the reference lists of the included studies was carried out and authors were contacted for additional information. Nine studies with a total of 395 participants (all with a body mass index [BMI] ≥30) were included in the meta-analysis. The effect size used was the mean difference in post-intervention weight and BMI between participants who had undergone a specifically modified diet and participants who had undergone a conventional healthy hypocaloric diet. Results: There were no differences between groups in post-intervention weight (mean difference 1.26, 95% confidence interval (CI) -0.92 to 3.43, p = .26; heterogeneity I2 = 50%, p = .04) or BMI (mean difference 0.15, 95% CI -0.93 to 1.23, p = 0.79; heterogeneity I2 = 44%, p = 0.10). Subgroup analyses according to the presence of a dietary run-in period (a period at the start of the study during which all participants are placed on an identical diet in order to equalize them on variables influenced by diet), intervention duration and type of diet and a sensitivity analysis according to study quality were not significant. Conclusions: Whilst the results should be interpreted in light of the moderate heterogeneity observed, they suggest that specifically modified diets offer no added benefit for weight loss in women with PCOS over conventional healthy hypocaloric diets. The findings of this meta-analysis may promote the unification of guidelines for the dietary management of PCOS and allow clinicians to be confident in prescribing conventional healthy hypocaloric diets for weight loss amongst their PCOS patients.

An electrical resistivity evaluation method for a pillar-shaped solid material, especially a brittle thermoelectric Bi2Te3, is presented with short compensation based on a probing apparatus with four-spring pins. The method eliminates the process of modelling a complex contact resistance, resulting in a simple but reproducible characterisation without any contamination on the surface in comparison to either a conventional paste or welding contact. Furthermore, it enables a small electrical or thermoelectric material

BACKGROUND: Chronic obstructive pulmonary disease (COPD) can lead to pulmonary hypertension and cor pulmonale, which are predictors of mortality. OBJECTIVE: To identify predictors of increased pulmonary artery pressure (PAP) in COPD patients without resting hypoxaemia, and to characterise COPD patients with increased PAP. DESIGN: A study of 117 COPD patients from the Korean Obstructive Lung Disease (KOLD) cohort who had measurable tricuspid regurgitant flow under transthoracic Doppler echocardiography and no resting hypoxaemia. RESULTS: The mean patient age was 67 years. Mean forced expiratory volume in 1 second (FEV 1 ) was 47% predicted, mean haemoglobin (Hb) concentration was 145 g/l and mean systolic PAP (sPAP) was 33 mmHg. Multiple linear regression analysis showed that Hb was the only factor independently associated with sPAP (beta = ―1.752, P = 0.005). Cluster analysis using FEV 1 % predicted, sPAP and Hb concentration as variables indicated three patient clusters: Cluster 1 (n = 36; mean FEV 1 44% predicted, mean sPAP 39 mmHg, mean Hb 132 g/l), Cluster 2 (n = 45; FEV 1 35% predicted, sPAP 31 mmHg, Hb 154 g/l), and Cluster 3 (n = 36; FEV 1 65% predicted, sPAP 29 mmHg, Hb 148 g/l). CONCLUSION: Elevated PAP was linked to low haemoglobin levels in COPD without resting hypoxaemia.

The purpose of this study was to examine flavor binding of high hydrostatic pressure (HHP)-treated whey protein concentrate (WPC) in a real food system. Fresh Washington State University (WSU, Pullman) WPC, produced by ultrafiltration of separated Cheddar cheese whey, was treated at 300 MPa for 15 min. Commercial WPC 35 powder was reconstituted to equivalent total solids as WSU WPC (8.23%). Six batches of low-fat ice cream were produced: A) HHP-treated WSU WPC without diacetyl; B) and E) WSU WPC with 2 mg/L of diacetyl added before HHP; C) WSU WPC with 2 mg/L of diacetyl added after HHP; D) untreated WSU WPC with 2 mg/L of diacetyl; and F) untreated commercial WPC 35 with 2 mg/L of diacetyl. The solution of WSU WPC or commercial WPC 35 contributed 10% to the mix formulation. Ice creams were produced by using standard ice cream ingredients and processes. Low-fat ice creams containing HHP-treated WSU WPC and untreated WSU WPC were analyzed using headspace-solid phase microextraction-gas chromatography. Sensory evaluation by balanced reference duo-trio test was carried out using 50 untrained panelists in 2 sessions on 2 different days. The headspace-solid phase microextraction-gas chromatography analysis revealed that ice cream containing HHP-treated WSU WPC had almost 3 times the concentration of diacetyl compared with ice cream containing untreated WSU WPC at d 1 of storage. However, diacetyl was not detected in ice creams after 14 d of storage. Eighty percent of panelists were able to distinguish between low-fat ice creams containing untreated WSU WPC with and without diacetyl, confirming panelists' ability to detect diacetyl. However, panelists were not able to distinguish between low-fat ice creams containing untreated and HHP-treated WSU WPC with diacetyl. These results show that WPC diacetyl-binding properties were not enhanced by 300-MPa HHP treatment for 15 min, indicating that HHP may not be suitable for such applications.

A new method for geometrical error compensation of precision motion systems using support vector machines (SVMs) will be developed in this paper. The compensation is carried out with respect to an overall geometrical error model which is constructed from measurements made with respect to each axis of the machine. These error components are modeled using support vector regression method, thus dispensing with the conventional look-up table. The adequacy and clear benefits of the proposed approach are illustrated from an application to a two-axial precision motion platform.

Previous research demonstrated that application of high hydrostatic pressure (HHP), particularly at 300 MPa for 15 min, can enhance foaming properties of whey protein concentrate (WPC). The purpose of this research was to determine the practical impact of HHP-treated WPC on the body and texture of lowfat ice cream. Washington State University (WSU)-WPC was produced by ultrafiltration of fresh separated whey received from the WSU creamery. Commercial whey protein concentrate 35 (WPC 35) powder was reconstituted to equivalent total solids as WSU-WPC (8.23%). Three batches of lowfat ice cream mix were produced to contain WSU-WPC without HHP, WSU-WPC with HHP (300 MPa for 15 min), and WPC 35 without HHP. All lowfat ice cream mixes contained 10% WSU-WPC or WPC 35. Overrun and foam stability of ice cream mixes were determined after whipping for 15 min. Ice creams were produced using standard ice cream ingredients and processing. The hardness of ice creams was determined with a TA-XT2 texture analyzer. Sensory evaluation by balanced reference duo-trio test was carried out using 52 volunteers. The ice cream mix containing HHP-treated WSU-WPC exhibited the greatest overrun and foam stability, confirming the effect of HHP on foaming properties of whey proteins in a complex system. Ice cream containing HHP-treated WSU-WPC exhibited significantly greater hardness than ice cream produced with untreated WSU-WPC or WPC 35. Panelists were able to distinguish between ice cream containing HHP-treated WSU-WPC and ice cream containing untreated WPC 35. Improvements of overrun and foam stability were observed when HHP-treated whey protein was used at a concentration as low as 10% (wt/wt) in ice cream mix. The impact of HHP on the functional properties of whey proteins was more pronounced than the impact on sensory properties.

Whey protein concentrate (WPC) has many applications in the food industry. Previous research demonstrated that treatment of whey proteins with high hydrostatic pressure (HHP) can enhance solubility and foaming properties of whey proteins. The objective of this study was to use HHP to improve functional properties of fresh WPC, compared with functional properties of reconstituted commercial whey protein concentrate 35 (WPC 35) powder. Fluid whey was ultrafiltered to concentrate proteins and reconstituted to equivalent total solids (8.23%) as reconstituted commercial WPC 35 powder. Solutions of WPC were treated with 300 and 400 MPa (0- and 15-min holding time) and 600 MPa (0-min holding time) pressure. After HHP, the solubility of the WPC was determined at both pH 4.6 and 7.0 using UDY and BioRad protein assay methods. Overrun and foam stability were determined after protein dispersions were whipped for 15 min. The protein solubility was greater at pH 7.0 than at pH 4.6, but there were no significant differences at different HHP treatment conditions. The maintenance of protein solubility after HHP indicates that HHP-treated WPC might be appropriate for applications to food systems. Untreated WPC exhibited the smallest overrun percentage, whereas the largest percentage for overrun and foam stability was obtained for WPC treated at 300 MPa for 15 min. Additionally, HHP-WPC treated at 300 MPa for 15 min acquired larger overrun than commercial WPC 35. The HHP treatment of 300 MPa for 0 min did not improve foam stability of WPC. However, WPC treated at 300 or 400 MPa for 15 min and 600 MPa for 0 min exhibited significantly greater foam stability than commercial WPC 35. The HHP treatment was beneficial to enhance overrun and foam stability of WPC, showing promise for ice cream and whipping cream applications.

Experiments have been carried out to measure the profile of the depth of a bed of sand flowing at steady state through an inclined, rotating cylinder fitted with a dam. Results are given for cylindrical and conical dams fitted at the end of the cylinder, and for cylindrical and conical internal dams, fitted halfway along the cylinder. The results are compared to the model of Saeman and of Kramers and Croockewit; the agreement is good, showing that the model is a useful predictor for flow over dams as well as for flow through cylinders without dams. The results are relevant to industrial kilns, which often contain conical brickwork dams at the discharge end and part way along the kiln.

Hypertrophic chondrocytes play a critical role in endochondral bone formation as well as the progress of osteoarthritis (OA). An in vitro cartilage hypertrophy model can be used as a platform to study complex molecular mechanisms involved in these processes and screen new drugs for OA. To develop an in vitro cartilage hypertrophy model, we treated a tissue-engineered cartilage template, living hyaline cartilaginous graft (LhCG), with osteogenic medium for hypertrophic induction. In addition, endothelial progenitor cells (EPCs) were seeded onto LhCG constructs to mimic vascular invasion. The results showed that osteogenic treatment significantly inhibited the synthesis of endostatin in LhCG constructs and enhanced expression of hypertrophic marker-collagen type X (Col X) and osteogenic markers, as well as calcium deposition in vitro. Upon subcutaneous implantation, osteogenic medium-treated LhCG constructs all stained positive for Col X and showed significant calcium deposition and blood vessel invasion. Col X staining and calcium deposition were most obvious in osteogenic medium-treated only group, while there was no difference between EPC-seeded and non-seeded group. These results demonstrated that osteogenic treatment was of the primary factor to induce hypertrophic transition of LhCG constructs and this model may contribute to the establishment of an in vitro cartilage hypertrophy model.

Myeloid cells promote the development of distant metastases, but little is known about the molecular mechanisms underlying this process. Here we have begun to uncover the effects of myeloid cells on cancer cells in a mouse model of liver metastasis. Monocytes/macrophages, but not granulocytes, isolated from experimental liver metastases stimulated migration and invasion of MC38 colon and Lewis lung carcinoma cells. In response to conditioned media from tumor-infiltrating monocytes/macrophages, cancer cells upregulated S100a8 and S100a9 messenger RNA expression through an extracellular signal-related kinase-dependent mechanism. Suppression of S100A8 and S100A9 in cancer cells using short hairpin RNA significantly diminished migration and invasion in culture. Downregulation of S100A8 and S100A9 had no effect on subcutaneous tumor growth. However, colony size was greatly reduced in liver metastases with decreased invasion into adjacent tissue. In tissue culture and in the liver colonies derived from cancer cells with knockdown of S100A8 and S100A9, MMP2 and MMP9 expression was decreased, consistent with the reduction in migration and invasion. Our findings demonstrate that monocytes/macrophages in the metastatic liver microenvironment induce S100A8 and S100A9 in cancer cells, and that these proteins are essential for tumor cell migration and invasion. S100A8 and S100A9, however, are not responsible for stimulation of proliferation. This study implicates S100A8 and S100A9 as important mediators of tumor cell aggressiveness, and highlights the therapeutic potential of S100A8 and S100A9 for interference of metastasis.

A detailed analysis of the motion af a single particle in a slowly rotating horizontal cylinder in the avalanching mode has been carried out using the positron emission particle–tracking technique to follow the motion of a tagged particle. Cylinders of diameters 240, 390, and 488 mm, and sand of mean diameter 500 μm were used; the tracer was an irradiated sand particle. It was found that a tracer particle rotates with the bed in rigid body motion and then traverses the active surface region in a series of discrete avalanches before being absorbed once again into the rigid body rotation. The mean number of avalanches required to traverse the active region decreased from 3.5 to 4 at low rotational speed to 1 at higher rotational speed at the transition to the rolling mode.

The objective of this study is to quantitatively evaluate the image quality of a kV cone-beam CT-based IGRT system (Elekta, XVI) using two commercial CT image quality phantoms, Catphan-600 and CIRS-062QA. Both phantoms consist of similar image quality test modules (uniformity, CT linearity and spatial resolution) but each phantom has different diameter and test pattern design. Each test module was imaged separately using an optimised cone-beam CT imaging parameter. The quality metrics of the reconstructed images were analysed using algorithms developed with MatLab. The image uniformity and the spatial resolution measured with Catphan were of 4% and 40% greater respectively, compared to those measured with CIRS phantom. The differences were due to the beam scattering and hardening originated from the CIRS phantom holder. The contrast-to-noise ratio (CNR) values measured with CIRS phantom were at least 2% higher than that of Catphan. The diameter of CIRS phantom is smaller and resulted in lower beam attenuation. The quantitative image quality assessment algorithms developed for both phantoms provided a phantom-specific set of reference values for a cone-beam CT imaging system as recommended by AAPM TG-142. Further investigation will be performed to resolve beam hardening issue arising from the CIRS phantom holder.

This paper presents an analytical method for the computation of boundary shear stress distributions acting on the flow perimeter of prismatic open channels. The approach is based on the premise that the surplus energy of any arbitrary unit volume of fluid in a three-dimensional flow channel will be transported towards and dissipated at a unit area on the wetted perimeter. This leads to a concept which states that the direction of energy transportation will define a minimum relative distance, Φ, between the source of energy in the flow field and the boundary. Based on this concept, a novel method is developed for the partitioning of the flow cross-sectional area into various parts corresponding to the channel shape and roughness composition on the wetted perimeter. The method enables the distribution of the boundary shear over the wetted perimeter to be assessed within each sub-flow area. This paper illustrates the application of the principle to steady and uniform flow in smooth rectangular open channels. Analytical equations governing the boundary shear stress distributions have been derived and are valid for all channel aspect ratios. The formulae have been verified using experimental shear data from published sources.

This study investigates the mechanism and the characteristic parameters affecting local scour around a vertical pile caused by turbulent circular wall jets. There are two basic scouring mechanisms; the pile obstruction and the jet diffusion mechanisms. The former is dominated by a horseshoe vortex system while the latter is controlled by the bed shear stress as the jet diffuses into the flow. Four types of equilibrium scour hole profiles were identified. The criteria for each type of profile are classified in terms of the densimetric Froude number \IF\do\N and the relative impingement distance \IX\N\Di\N/d\Do\N. Semiempirical equations were developed to delineate the boundary limits for the different profiles. The results show that the maximum equilibrium scour depth \Id\N\Ds\N\De\N and the scour depth at the pile \Id\N\Dpe\N are highly dependent on \IF\N\Do\N; and generally for large \IF\N\Do\N, \IdN\Dse\N = \Id\N\Dpe\N. The scour depths are insensitive to the relative size of the pile to jet diameter \ID\N/d\D0\N. However, \IX\N/di/d\Do\N does not appear to affect \Id\N\Dse\N/d\Do\N but it has a profound influence on \Id\N\Dpe\N/d/Do\N.

A variant (rs3129882) in the genome-wide association study (GWAS)-linked variant [in the human leukocyte antigen (HLA) gene region] has been reported to associate with an increased risk of Parkinson's disease (PD) in Caucasian population. Studies among Chinese are limited. To address this, we analysed rs3129882 in a total of 1312 subjects of Chinese ethnicity from independent Asian centers comprising of 675 controls and 637 PD cases. The rs3129882 variant was associated with a decreased risk in our ethnic Chinese PD patients. Logistic regression analysis taking into consideration variables of age, gender and race showed that allele A reduced the risk of PD via a dominant model [odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.62, 0.96, p = 0.018]. As HLA is a highly polymorphic region, it is possible that ethnic-specific effect or environmental agents may modulate the effect of this GWAS-linked locus in influencing the risk of PD.