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This paper provides a solution to the problem of the deformation of 3D printed cookie products during post-processing such as baking. The influence of the incorporation of hydrocolloids on the dimensional stability of the cookie dough during temperature variations was investigated. Methylcellulose and xanthan gum were blended in mass fractions of 0.5, 1, 2, and 3 g/100 g dough basis. In dynamic viscoelasticity experiments, during the temperature sweep, the cookie doughs with methylcellulose showed losses in storage modulus (G′) and loss modulus (G″) that were comparable to those of the control samples. Although the incorporated xanthan gum exhibited high structural retention owing to its high shear modulus, its low extrudability resulted in a high extrusion hardness and poor 3D printing performance. In the post-processing, sufficient dimensional stability was observed even with a xanthan gum incorporation of 0.5 g/100 g. Moreover, the heat-resistant 3D printable cookie samples with 0.5 g/100 g xanthan gum exhibited a texture profile having a hardness and fracturability similar to those of the control cookies.

This paper proposes a novel approach to implement a plant cell-laden hydrogel model that could extend the application range of plant-based food production to unique food texture. Callus based food-inks were prepared by blending a callus dispersion with 4% alginate at ratios of 1:2, 1:1, and 2:1 (w/w). During the 3D food printing process, all samples were cured using Ca2+ ions to form a rigid gel. While the 1:2 and 1:1 samples showed proper shape fidelity, excessive cell concentrations (i.e. the 2:1 sample) resulted in lower resolution and deviation from the intended dimensions. Plant cell-laden scaffolds with various callus content showed high viability and prolonged cell growth over a 35-day culture period, quantified by optical density and imaged by confocal microscopy. The cells implanted in the hydrogel developed into clusters during incubation and exhibited unique texture of artificial plant tissues. Through this approach, the possibility of applying 3D food printing to plant cell culture was verified. The concept of callus-based food-ink provides the promising potential for artificial plant tissue simulation and improves textural properties of 3D printed food similar to real food textures by developing a plant cell-laden hydrogel model.

We performed a systematic review of the published evidence regarding nonpharmacologic antishivering interventions in various clinical settings.Studies through November 2014 were identified using predefined search terms in electronic databases, including PubMed, the Cochrane Library, EMBASE: Excerpta Medica (Ovid), and Web of Science.All identified articles were critically analyzed by applying prespecified criteria. We included experimental trials with comparable baseline data investigating the antishivering efficacy of nonpharmacological interventions in subjects without underlying thermoregulatory dysfunction.Sixty-five publications (3,361 subjects) were analyzed by the type of clinical setting, intervention, comparison, and study design. In addition, each study underwent a standardized study quality assessment.Nonpharmacological interventions consisted of active cutaneous warming (forced-air warming, electric heating pad/blanket, radiant heating, and water-circulating mattress), body core warming (fluid or gas warming system), passive cutaneous warming (space blankets or towels), and electroacupuncture. Identified clinical settings included perioperative settings without induced hypothermia (60 of 77 comparisons), perioperative settings with induced hypothermia (8 of 77), and induced hypothermia without anesthesia (9 of 77). Active cutaneous warming was the most commonly studied intervention, and it was associated with the highest prevalence of positive results when compared with controls in all three clinical settings. In contrast, passive cutaneous warming and body core warming showed conflicting efficacy. Comparison evaluations among different antishivering interventions were limited due to the paucity and heterogeneity of studies directly comparing different interventions against one another.This systematic review of the effectiveness of nonpharmacological antishivering methods delineates active cutaneous warming as the most effective nonpharmacologic antishivering intervention in the perioperative and induced hypothermia settings.

Background and Purpose Variant alleles of CYP2C9 and VKORC1 account for differences in anticoagulation response. We sought to establish a warfarin dosing formula for individualized target International Normalization Ratio of Prothrombin Times (INRs) using data from single nucleotide polymorphisms (SNPs) in VKORC1 and CYP2C9 in Korean patients. Methods Ischemic stroke patients displaying stable target INR for at least 3 months before enrollment were analyzed. Warfarin and vitamin K levels were measured to adjust for confounders. Phenotypes were defined using the 'warfarin response index' (WRI) defined as INR divided by the daily maintenance warfarin dose. We tested SNPs in CYP2C9 (3 sites: 430C>T (rs1799853), 1075A>C (rs1057910), 1076T>C) and VKORC1 (14 sites: 381C>T, 861C>A (rs17880887), 2653G>C, 3673A>G, 5496G>T, 5808T>G (r17882154), 6009C>T, 6484T>C (rs9934438), 6853C>T (rs17886369), 7566T>C, 8767G>C, 8814T>C, 9041G>A (rs17880624), and 9071G>T) using a standard sequencing method. Multivariate linear regression analysis was applied to establish the formula for warfarin dosage. Results All 204 patients had excellent drug compliance. The mean INR was 2.22 (+0.56) and mean daily maintenance dose of warfarin was 3.92 mg (+1.54). Patients with low WRI were younger (PC, PC, 3673G>A, 6484T>C, 6853C>G. 7566C>T, 9041G>A) (r2=1). Based on these data, a warfarin dosing formula was established. Conclusions WRI is influenced by age, body mass index and SNPs in VKORC1 and CYP2C9 in Korean stroke patients. The obtained warfarin dosing formula may be clinically applicable.

Shivering after anesthesia or in the critical care setting is frequent, can be prolonged, and has the potential for serious adverse events and worsening outcomes. Furthermore, there are conflicting published data and clinical protocols on how to best treat shivering. In this study, we aimed to critically analyze the published evidence of antishivering medications.We systematically reviewed, categorized, and analyzed all literature on antishivering medications published in English. Target key words and study types were determined and major scientific databases (PubMed, EMBASE, the Cochrane Controlled Trials Register, Ovid-Medline, and JAMA Evidence) and individual target journals were systematically searched up to August 1, 2011.Publications were categorized by the pharmacological intervention used, regardless of whether the subjects were ventilated, underwent surgery, received anesthesia, or received additional medications. Randomized, double-blinded, placebo-controlled trials investigating antishivering treatment were extracted and evaluated for clinical and statistical homogeneity and, if suitable, included in a subsequent meta-analysis using linear comparisons calculating shivering risk-reduction ratios.A total of 41 individual and eight combination antishivering medications were tested in 124 publications containing 208 substudies and recruiting a total of 9,668 subjects. Among those, 80 publications containing 119 substudies were identified as randomized, double-blinded, placebo-controlled of which 94 substudies were subjected to linear comparison analysis.Study drug frequencies, calculated pooled risk benefits, and pooled numbers needed to treat of the five most frequently studied and efficacious medications were clonidine (22 studies; risk ratio: 1.6, numbers needed to treat: 4), meperidine (16; 2.2, 2), tramadol (8; 2.2, 2), nefopam (7; 2.1, 2), and ketamine (7; 1.8, 3).There is significant heterogeneity in the literature with respect to study methods and efficacy testing of antishivering treatments. Clonidine, meperidine, tramadol, nefopam, and ketamine were the most frequently reported pharmacological interventions and showed a variable degree of efficacy in randomized, double-blinded, placebo-controlled trials.

Introduction/Hypothesis: We were interested in studying patient outcomes with acute cerebrovascular disease (ACVD) who had concomitant acute or chronic renal insufficiency (RI). Methods: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (1998-2009) and identified 1,760,415 adult ACVD patients among 92,848,710 patients enrolled. Using SAS 6.4 and applying SPSS 22 the outcome variables mortality, length of hospital stay (LOS), HC (HC) >$20,000, and disposition (home or any care facility) were selected. Logistic regression analyses were performed adjusting for the covariates hypertension (HTN), diabetes mellitus (DM), age, race, sex, number of comorbidities, and care complexity (numbers of inpatient procedures) among all ACVD with and without RI. Results: Mean age was 71 years (SD 15) with 76% >65 years old; 54% female gender; 55% Whites, 11% Blacks, 6% Hispanics. Among all ACVD, 66% had HTN, 28% DM, RI 9%, LOS 7.6 days (SD 9.8), in-patient mortality 12%; disposition home 42% and facility 44%, and mean HC $36,010 (SD $63,331). After covariate adjustment, the mortality rate of ACVD patients with RI was 24% vs 11% (P Conclusions: Acute or chronic RI was present in 9% of patients with ACVD. RI was associated with significantly greater risks of in-patient mortality, LOS, and discharge to a facility. In subgroup analyses, the overall HC were greater in patients with acute RI. Patients undergoing HD experienced a similar negative impact on all outcome parameters except for disposition status. The negative impact of RI on vital outcome parameters in ACVD patients should be considered, i.e., when indicating the administration of contrast for imaging.

Introduction/Hypothesis: We examined the prevalence and outcomes of patients admitted with acute cerebrovascular disease (ACVD) and concomitant acute myocardial infarction (AMI). Methods: We utilized the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (1998-2009) and identified 1,760,415 adult ACVD patients among 92,848,710 patients enrolled. Using SAS 6.4 and applying SPSS 22 the outcome variables mortality, length of hospital stay (LOS), hospital costs >$20,000, and disposition (home or any care facility) were selected and logistic regression analyses was performed adjusting for the covariates hypertension, diabetes mellitus, age, race, sex, number of comorbidities, and care complexity (numbers of inpatient procedures) among all ACVD with and without AMI. Results: Mean age was 71 years (SD 15) with 76% >65 years old; 54% female gender; 55% Whites, 11% Blacks, and 6% Hispanics. Among all ACVD, 66% had HTN, 28% DM, AMI 4.1%, LOS was 7.6 days (SD 9.8), in-patient mortality 12%; disposition home 42% and facility 44%, and mean hospital costs $36,010 (SD $63,331). After covariate adjustment, ACVD patients with AMI compared to those without AMI had a mortality of 30% vs 12% (P Conclusions: Acute myocardial infarction occurred in 4.1% of patients with acute cerebrovascular disease. It was associated with significantly increased risks of in-patient mortality, length of hospital stay, facility disposition and hospital costs. Considering the poor outcomes of ACVD patients with AMI may indicate more aggressive strategies for early recognition and reduction of myocardial injury.

Case Report A 28-year-old right-handed man with an 11-year history of intractable seizures underwent a comprehensive presurgical evaluation. His past history was unremarkable for febrile convulsion, head trauma, meningoencephalitis, or other primary neurologic diseases, and there was no family history of epilepsy. He first experienced a sudden loss of consciousness at age 17. Thereafter, a similar event occurred several times per month. He always felt the same indescribable unpleasant sensation, and could not recall any event. His family members noted that he looked blank, did not respond, fumbled with something using both hands, repetitively spat at the ground, and drooled. An antiepileptic drug (valproic acid 1,200 mg/ day) was prescribed after a diagnosis of epilepsy. However, despite the administrations of multiple drugs (valproic acid 1,200 mg/day, carbamazepine 800 mg/ day, lamotrigine 100 mg/day), his seizures continued at a frequency of one or two per month. A cranial MRI revealed left hippocampal atrophy on the T 1 -weighted image with increased signal intensity on the T 2 -weighted image, which was consistent with hippocampal sclerosis ( fig. 1 a), and 18 FDG-PET showed mild hypometabolism in the left medial temporal cortex ( fig. 1 b). Dear Sir, Automatisms are traditionally defined as stereotyped nonpurposeful automatic behaviors during a complex partial seizure, and the automatisms known to have a lateralizing value in temporal lobe epilepsy (TLE), spitting automatisms, though rarely reported, have been predominantly associated with nondominant temporal lobe lateralization. Although the pathophysiological mechanism of spitting automatism has not been fully defined, it has been hypothesized that the right hemispheric dominance of spitting automatism is due to the functional asymmetry of the central autonomic network [1] , such as ictal vomiting or ictal urinary urge [2, 3] . There have been rare reports of ictal spitting in dominant hemispheric seizures, but in such cases it has not been well explained whether the symptomatogenic ictal spitting area originates from the dominant hemisphere. Here, we present the case of a righthanded TLE patient with ictal spitting, whose seizures originated from the left temporal lobe. An intracarotid amobarbital procedure (IAP) demonstrated left hemispheric language dominance. In the described case, the epileptogenic area proved to be in the left temporal lobe and the symptomatogenic area of ictal spitting was located to the right hemisphere, most likely the temporal lobe. Received: March 29, 2006 Accepted: August 16, 2006 Published online: November 14, 2006

Background and Purpose— The aim of this study was to investigate differences in risk factors and stroke mechanisms between intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS) and between anterior and posterior circulation atherosclerosis. Methods— A multicenter, prospective, Web-based registry was performed on atherosclerotic strokes using diffusionweighted magnetic resonance imaging and magnetic resonance angiography. Stroke mechanisms were categorized as artery-to-artery embolism, in situ thrombo-occlusion, local branch occlusion, or hemodynamic impairment. Results— Onethousand patients were enrolled from 9 university hospitals. Age (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.018–1.049), male gender (OR, 3.399; 95% CI, 2.335–4.949), and hyperlipidemia (OR, 1.502; 95% CI, 1.117–2.018) were factors favoring ECAS (vs ICAS), whereas hypertension (OR, 1.826; 95% CI, 1.274–2.618; P =0.001) and diabetes mellitus (OR, 1.490; 95% CI, 1.105–2.010; P =0.009) were related to posterior (vs anterior) circulation diseases. Metabolic syndrome was a factor related to ICAS (vs ECAS) only in posterior circulation strokes (OR, 2.433; 95% CI, 1.005–5.890; P =0.007). Stroke mechanisms included arterytoartery embolism (59.7%), local branch occlusion (14.9%), in situ thrombo-occlusion (13.7%), hemodynamic impairment (0.9%), and mixed (10.8%). Anterior ICAS was more often associated with artery-to-artery embolism (51.8% vs 34.0%) and less often associated with local branch occlusion (12.3% vs 40.4%) than posterior ICAS ( P Conclusions— The prevalence of risk factors and stroke mechanisms differ between ICAS and ECAS, and between anterior and posterior circulation atherosclerosis. Posterior ICAS seems to be closely associated with metabolic derangement and local branch occlusion. Prevention and management strategies may have to consider these differences.