Application of intraoperative lung-protective ventilation varies in accordance with the knowledge of anaesthesiologists: a single-Centre questionnaire study and a retrospective observational study.

BACKGROUND: The benefits of lung-protective ventilation (LPV) with a low tidal volume (6 mL/kg of ideal body weight [IBW]), limited plateau pressure (< 28-30 cm H2O), and appropriate positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome have become apparent and it is now widely adopted in intensive care units. Recently evidence for LPV in general anaesthesia has been accumulated, but it is not yet generally applied by anaesthesiologists in the operating room. METHODS: This study investigated the perception about intraoperative LPV among 82 anaesthesiologists through a questionnaire survey and identified the differences in ventilator settings according to recognition of lung-protective ventilation. Furthermore, we investigated the changes in the trend for using this form of ventilation during general anaesthesia in the past 10 years. RESULTS: Anaesthesiologists who had received training in LPV were more knowledgeable about this approach. Anaesthesiologists with knowledge of the concept behind LPV strategies applied a lower tidal volume (median (IQR [range]), 8.2 (8.0-9.2 [7.1-10.3]) vs. 9.2 (9.1-10.1 [7.6-10.1]) mL/kg; p = 0.033) and used PEEP more frequently (69/72 [95.8%] vs. 5/8 [62.5%]; p = 0.012; odds ratio, 13.8 [2.19-86.9]) for laparoscopic surgery than did those without such knowledge. Anaesthesiologists who were able to answer a question related to LPV correctly (respondents who chose 'height' to a multiple choice question asking what variables should be considered most important in the initial setting of tidal volume) applied a lower tidal volume in cases of laparoscopic surgery and obese patients. There was an increase in the number of patients receiving LPV (VT < 10 mL/kgIBW and PEEP ≥5 cm H2O) between 2004 and 2014 (0/818 [0.0%] vs. 280/818 [34.2%]; p <  0.001). CONCLUSIONS: Our study suggests that the knowledge of LPV is directly related to its implementation, and can explain the increase in LPV use in general anaesthesia. Further studies should assess the impact of using intraoperative LPV on clinical outcomes and should determine the efficacy of education on intraoperative LPV implementation.

Whole Exome Sequencing Identifies a Novel Hedgehog-Interacting Protein G516R Mutation in Locally Advanced Papillary Thyroid Cancer.

Locally advanced thyroid cancer exhibits aggressive clinical features requiring extensive neck dissection. Therefore, it is important to identify changes in the tumor biology before local progression. Here, whole exome sequencing (WES) using tissues from locally advanced papillary thyroid cancer (PTC) presented a large number of single nucleotide variants (SNVs) in the metastatic lymph node (MLN), but not in normal tissues and primary tumors. Among those MLN-specific SNVs, a novel HHIP G516R (G1546A) mutation was also observed. Interestingly, in-depth analysis for exome sequencing data from the primary tumor presented altered nucleotide 'A' at a very low frequency indicating intra-tumor heterogeneity between the primary tumor and MLN. Computational prediction models such as PROVEAN and Polyphen suggested that HHIP G516R might affect protein function and stability. In vitro, HHIP G516R increased cell proliferation and promoted cell migration in thyroid cancer cells. HHIP G516R, a missense mutation, could be a representative example for the intra-tumor heterogeneity of locally advanced thyroid cancer, which can be a potential future therapeutic target for this disease.

High Resolution Full-Aperture ISAR Processing through Modified Doppler History Based Motion Compensation.

A high resolution inverse synthetic aperture radar (ISAR) technique is presented using modified Doppler history based motion compensation. To this purpose, a novel wideband ISAR system is developed that accommodates parametric processing over extended aperture length. The proposed method is derived from an ISAR-to-SAR approach that makes use of high resolution spotlight SAR and sub-aperture recombination. It is dedicated to wide aperture ISAR imaging and exhibits robust performance against unstable targets having non-linear motions. We demonstrate that the Doppler histories of the full aperture ISAR echoes from disturbed targets are efficiently retrieved with good fitting models. Experiments have been conducted on real aircraft targets and the feasibility of the full aperture ISAR processing is verified through the acquisition of high resolution ISAR imagery.

Shadow Detection Based on Regions of Light Sources for Object Extraction in Nighttime Video.

Intelligent video surveillance systems detect pre-configured surveillance events through background modeling, foreground and object extraction, object tracking, and event detection. Shadow regions inside video frames sometimes appear as foreground objects, interfere with ensuing processes, and finally degrade the event detection performance of the systems. Conventional studies have mostly used intensity, color, texture, and geometric information to perform shadow detection in daytime video, but these methods lack the capability of removing shadows in nighttime video. In this paper, a novel shadow detection algorithm for nighttime video is proposed; this algorithm partitions each foreground object based on the object's vertical histogram and screens out shadow objects by validating their orientations heading toward regions of light sources. From the experimental results, it can be seen that the proposed algorithm shows more than 93.8% shadow removal and 89.9% object extraction rates for nighttime video sequences, and the algorithm outperforms conventional shadow removal algorithms designed for daytime videos.

Transfer of Chemically Modified Graphene with Retention of Functionality for Surface Engineering.

Single-layer graphene chemically reduced by the Birch process delaminates from a Si/SiOx substrate when exposed to an ethanol/water mixture, enabling transfer of chemically functionalized graphene to arbitrary substrates such as metals, dielectrics, and polymers. Unlike in previous reports, the graphene retains hydrogen, methyl, and aryl functional groups during the transfer process. This enables one to functionalize the receiving substrate with the properties of the chemically modified graphene (CMG). For instance, magnetic force microscopy shows that the previously reported magnetic properties of partially hydrogenated graphene remain after transfer. We also transfer hydrogenated graphene from its copper growth substrate to a Si/SiOx wafer and thermally dehydrogenate it to demonstrate a polymer- and etchant-free graphene transfer for potential use in transmission electron microscopy. Finally, we show that the Birch reduction facilitates delamination of CMG by weakening van der Waals forces between graphene and its substrate.

The importance of correcting for variable probe-sample interactions in AFM-IR spectroscopy: AFM-IR of dried bacteria on a polyurethane film.

AFM-IR is a combined atomic force microscopy-infrared spectroscopy method that shows promise for nanoscale chemical characterization of biological-materials interactions. In an effort to apply this method to quantitatively probe mechanisms of microbiologically induced polyurethane degradation, we have investigated monolayer clusters of ∼200 nm thick Pseudomonas protegens Pf-5 bacteria (Pf) on a 300 nm thick polyether-polyurethane (PU) film. Here, the impact of the different biological and polymer mechanical properties on the thermomechanical AFM-IR detection mechanism was first assessed without the additional complication of polymer degradation. AFM-IR spectra of Pf and PU were compared with FTIR and showed good agreement. Local AFM-IR spectra of Pf on PU (Pf-PU) exhibited bands from both constituents, showing that AFM-IR is sensitive to chemical composition both at and below the surface. One distinct difference in local AFM-IR spectra on Pf-PU was an anomalous ∼4× increase in IR peak intensities for the probe in contact with Pf versus PU. This was attributed to differences in probe-sample interactions. In particular, significantly higher cantilever damping was observed for probe contact with PU, with a ∼10× smaller Q factor. AFM-IR chemical mapping at single wavelengths was also affected. We demonstrate ratioing of mapping data for chemical analysis as a simple method to cancel the extreme effects of the variable probe-sample interactions.

Metformin Restores Parkin-Mediated Mitophagy, Suppressed by Cytosolic p53.

Metformin is known to alleviate hepatosteatosis by inducing 5' adenosine monophosphate (AMP)-kinase-independent, sirtuin 1 (SIRT1)-mediated autophagy. Dysfunctional mitophagy in response to glucolipotoxicities might play an important role in hepatosteatosis. Here, we investigated the mechanism by which metformin induces mitophagy through restoration of the suppressed Parkin-mediated mitophagy. To this end, our ob/ob mice were divided into three groups: (1) ad libitum feeding of a standard chow diet; (2) intraperitoneal injections of metformin 300 mg/kg; and (3) 3 g/day caloric restriction (CR). HepG2 cells were treated with palmitate (PA) plus high glucose in the absence or presence of metformin. We detected enhanced mitophagy in ob/ob mice treated with metformin or CR, whereas mitochondrial spheroids were observed in mice fed ad libitum. Metabolically stressed ob/ob mice and PA-treated HepG2 cells showed an increase in expression of endoplasmic reticulum (ER) stress markers and cytosolic p53. Cytosolic p53 inhibited mitophagy by disturbing the mitochondrial translocation of Parkin, as demonstrated by immunoprecipitation. However, metformin decreased ER stress and p53 expression, resulting in induction of Parkin-mediated mitophagy. Furthermore, pifithrin-α, a specific inhibitor of p53, increased mitochondrial incorporation into autophagosomes. Taken together, these results indicate that metformin treatment facilitates Parkin-mediated mitophagy rather than mitochondrial spheroid formation by decreasing the inhibitory interaction with cytosolic p53 and increasing degradation of mitofusins.

Chemical stability of graphene fluoride produced by exposure to XeF2.

Fluorination can alter the electronic properties of graphene and activate sites for subsequent chemistry. Here, we show that graphene fluorination depends on several variables, including XeF2 exposure and the choice of substrate. After fluorination, fluorine content declines by 50-80% over several days before stabilizing. While highly fluorinated samples remain insulating, mildly fluorinated samples regain some conductivity over this period. Finally, this loss does not reduce reactivity with alkylamines, suggesting that only nonvolatile fluorine participates in these reactions.

Visible light photocatalytic activity of N-ion implanted TiO2 thin films prepared by oblique incident electron-beam evaporation method.

TiO2 thin films were prepared using electron-beam evaporation method with various oblique angles of 0 degrees, 30 degrees, 60 degrees and 75 degrees. All samples were annealed at 600 degrees C for 1 hour in air and their visible light photocatalytic properties were characterized after nitrogen implantation. The photocatalytic activity of the thin films was evaluated by the photodecomposition of methylene blue. The photocatalytic activity of N-ion implanted TiO2 film deposited with the oblique angle of 60 degrees was considerably enhanced due to high visible light absorption and low charge carrier recombination by sufficient N-ion implantation.

High-density amine-terminated monolayers formed on fluorinated CVD-grown graphene.

There has been considerable interest in chemically functionalizing graphene films to control their electronic properties, to enhance their binding to other molecules for sensing, and to strengthen their interfaces with matrices in a composite material. Most reports to date have largely focused on noncovalent methods or the use of graphene oxide. Here, we present a method to activate CVD-grown graphene sheets using fluorination followed by reaction with ethylenediamine (EDA) to form covalent bonds. Reacted graphene was characterized via X-ray photoelectron spectroscopy (XPS), attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), and Raman spectroscopy as well as measurements of electrical properties. The functionalization results in stable, densely packed layers, and the unbound amine of EDA was shown to be active toward subsequent chemical reactions.

Ramosetron, dexamethasone, and their combination for the prevention of postoperative nausea and vomiting in women undergoing laparoscopic cholecystectomy.

BACKGROUND: In this randomized and controlled study, we evaluated the antiemetic efficacy of ramosetron combined with dexamethasone for postoperative nausea and vomiting (PONV) compared with that of dexamethasone or ramosetron alone in women who underwent laparoscopic cholecystectomy. METHODS: One hundred twenty female patients were randomly assigned to one of three groups to receive antiemetics as follows: ramosetron 0.3 mg (group R), dexamethasone 8 mg (group D), or ramosetron 0.3 mg combined with dexamethasone 8 mg (group RD). PONV, postoperative pain intensity, rescue antiemetics requirement, and side effects were assessed at 0-6, 6-12, and 12-24 h after surgery. RESULTS: The ratio of complete response (no PONV and no rescue antiemetic) was higher at 6-12 h in groups R and RD than in group D (p < 0.05) and at 12-24 h in group RD than in group D (p < 0.05). The incidence of nausea was lower at 6-12 h in groups R (p = 0.043) and RD (p = 0.003) compared to group D and at 12-24 h in group RD (p = 0.01) compared to group D. The severity of nausea was also significantly reduced at 6-12 h in groups R and RD compared to group D (p < 0.05). There were no clinically serious adverse events related to the studied drugs. CONCLUSION: Antiemetic efficacy of the combination of ramosetron 0.3 mg and dexamethasone 8 mg for PONV was most superior, with 93% of the patients showing complete response at 12-24 h after surgery followed by ramosetron alone and dexamethasone alone.

Chemically isolated graphene nanoribbons reversibly formed in fluorographene using polymer nanowire masks.

We demonstrated the fabrication of graphene nanoribbons (GNRs) as narrow as 35 nm created using scanning probe lithography to deposit a polymer mask(1-3) and then fluorinating the sample to isolate the masked graphene from the surrounding wide band gap fluorographene. The polymer protected the GNR from atmospheric adsorbates while the adjacent fluorographene stably p-doped the GNRs which had electron mobilities of ∼2700 cm2/(V·s). Chemical isolation of the GNR enabled resetting the device to nearly pristine graphene.

Regulation of cancer stem cell activity by thyroid hormone receptor ß.

Increasing numbers of cancer stem cell markers have been recently identified. It is not known, however, whether a member of the nuclear receptor superfamily, thyroid hormone receptor ß (TRß), can function to regulate cancer stem cell (CSC) activity. Using anaplastic thyroid cancer cells (ATC) as a model, we highlight the role of TRß in CSC activity. ATC is one of the most aggressive solid cancers in humans and is resistant to currently available therapeutics. Recent studies provide evidence that CSC activity underlies aggressiveness and therapeutic resistance of ATC. Here we show that TRß inhibits CSC activity by suppressing tumor-sphere formation of human ATC cells and their tumor-initiating capacity. TRß suppresses the expression of CSC regulators, including ALDH, KLF2, SOX2, b-catenin, and ABCG2, in ATC cell-induced xenograft tumors. Single-cell transcriptomic analysis shows that TRß reduces CSC population in ATC-induced xenograft tumors. Analysis of The Cancer Genome Atlas (TCGA) database demonstrates that the inhibition of CSC capacity by TRß contributes to favorable clinical outcomes in human cancer. Our studies show that TRß is a newly identified transcription regulator that acts to suppress CSC activity and that TRß could be considered as a molecular target for therapeutic intervention of ATC.

Cell non-autonomous effect of hepatic growth differentiation factor 15 on the thyroid gland.

The thyroid gland plays an essential role in the regulation of body energy expenditure to maintain metabolic homeostasis. However, to date, there are no studies investigating the morphological and functional changes of the thyroid gland due to mitochondrial stress in metabolic organs such as the liver. We used data from the Genotype-Tissue Expression portal to investigate RNA expression patterns of the thyroid gland according to the expression of growth differentiation factor 15 (GDF15) such as the muscles and liver. To verify the effect of hepatic GDF15 on the thyroid gland, we compared the morphological findings of the thyroid gland from liver-specific GDF15 transgenic mice to that of wild type mice. High GDF15 expression in the muscles and liver was associated with the upregulation of genes related to hypoxia, inflammation (TGF-α via NFκB), apoptosis, and p53 pathway in thyroid glands. In addition, high hepatic GDF15 was related to epithelial mesenchymal transition and mTORC1 signaling. Electron microscopy for liver-specific GDF15 transgenic mice revealed short mitochondrial cristae length and small mitochondrial area, indicating reduced mitochondrial function. However, serum thyroid stimulating hormone (TSH) level was not significantly different. In our human cohort, those with a high serum GDF15 level showed high fasting glucose, alanine transaminase, and alkaline phosphatase but no difference in TSH, similar to the data from our mice model. Additionally, high serum GDF15 increased the risk of lymph node metastasis to lateral neck. The hepatic GDF15 affected thyroid morphogenesis via a TSH-independent mechanism, affecting aggressive features of thyroid cancers.

Maskless nanoscale writing of nanoparticle-polymer composites and nanoparticle assemblies using thermal nanoprobes.

Nanoparticle polymer composites containing metal, semiconductor, magnetic, and optically active nanoparticles were deposited onto multiple substrates from a heatable atomic force microscope tip. The nanoparticle nanostructures were functional as deposited or could be etched with an oxygen plasma, revealing single nanoparticle lithographic resolution. Many types of nanoparticles can be patterned with the same technique, without the need to tailor the substrate chemistry and without solution processing.

D-(+)-galactose-conjugated single-walled carbon nanotubes as new chemical probes for electrochemical biosensors for the cancer marker galectin-3.

D-(+)-Galactose-conjugated single-walled carbon nanotubes (SWCNTs) were synthesized for use as biosensors to detect the cancer marker galectin-3. To investigate the binding of galectin-3 to the d-(+)-galactose-conjugated SWCNTs, an electrochemical biosensor was fabricated by using molybdenum electrodes. The binding affinities of the conjugated SWCNTs to galectin-3 were quantified using electrochemical sensitivity measurements based on the differences in resistance together with typical I-V characterization. The electrochemical sensitivity measurements of the d-(+)-galactose-conjugated SWCNTs differed significantly between the samples with and without galectin-3. This indicates that d-(+)-galactose-conjugated SWCNTs are potentially useful electrochemical biosensors for the detection of cancer marker galectin-3.

Targeting transcriptional regulators for treatment of anaplastic thyroid cancer.

Dysregulation of genes perpetuates cancer progression. During carcinogenesis, cancer cells acquire dependency of aberrant transcriptional programs (known as "transcription addiction") to meet the high demands for uncontrolled proliferation. The needs for particular transcription programs for cancer growth could be cancer-type-selective. The dependencies of certain transcription regulators could be exploited for therapeutic benefits. Anaplastic thyroid cancer (ATC) is an extremely aggressive human cancer for which new treatment modalities are urgently needed. Its resistance to conventional treatments and the lack of therapeutic options for improving survival might have been attributed to extensive genetic heterogeneity due to subsequent evolving genetic alterations and clonal selections during carcinogenesis. Despite this genetic complexity, mounting evidence has revealed a characteristic transcriptional addiction of ATC cells resulting in evolving diverse oncogenic signaling for cancer cell survival. The transcriptional addiction has presented a huge challenge for effective targeting as shown by the failure of previous targeted therapies. However, an emerging notion is that many different oncogenic signaling pathways activated by multiple upstream driver mutations might ultimately converge on the transcriptional responses, which would provide an opportunity to target transcriptional regulators for treatment of ATC. Here, we review the current understanding of how genetic alterations in cancer distorted the transcription program, leading to acquisition of transcriptional addiction. We also highlight recent findings from studies aiming to exploit the opportunity for targeting transcription regulators as potential therapeutics for ATC.

Traumatic Iridodialysis Associated With Hyphema Secondary to Injury From a Bungee Cord.

We present a case of an iris sphincter tear with iridodialysis, mydriasis, and hyphema secondary to a traumatic injury from a bungee cord. The correlation between the mechanism of injury and physical exam findings as well as the emergency department evaluation and management are discussed.

Flash Burn of the Eyes Caused by High-Voltage Electrical Spark.

We present a rare case of corneal abrasion with mild eyelid epitheliopathy caused by a high-voltage electrical spark. The case includes emergency department evaluation and subsequent management at the burn center with ophthalmology. The prognosis, in this case, is good, however, the potential severity of high-voltage electrical injuries can be much worse. Prevention strategies for occupational electrical injuries are discussed with an emphasis on proper personal protective equipment (PPE).

SHMT2 expression as a diagnostic and prognostic marker for thyroid cancer.

BACKGROUND: Catabolism of serine via serine hydroxymethyltransferase2 (SHMT2) through the mitochondrial one-carbon unit pathway is important in tumorigenesis. Therefore, SHMT2 may play a role in thyroid cancer. METHODS: Thyroid tissue samples and The Cancer Genome Atlas (TCGA) database were used to evaluate SHMT2 expression in thyroid tissues and the association with clinical outcomes. RESULTS: SHMT2 protein expression was evaluated in thyroid tissues consisting of 52 benign nodules, 129 papillary thyroid carcinomas (PTC) and matched normal samples, and 20 anaplastic thyroid carcinomas (ATC). ATCs presented the highest (95.0%) positivity of SMHT2 protein expression. PTCs showed the second highest (73.6%) positivity of SHMT2 expression, which was significantly higher than that of benign nodules (19.2%, P = 0.016) and normal thyroid tissues (0%, P < 0.001). Analysis of TCGA data showed that SHMT2 messenger RNA (mRNA) expression was significantly higher in tumors than in normal tissues (P < 0.001). When we classified thyroid cancer into high and low groups according to SHMT2 mRNA expression levels, the thyroid differentiation score for the high SHMT2 group was significantly lower than that of the low SHMT2 group (P < 0.001). There was also a significant correlation between SHMT2 mRNA expression and the stemness index (r = 0.41, P < 0.001). The high SHMT2 group had more advanced TNM stages and shorter progression-free survival rates than the low SHMT2 group (P < 0.01 and P = 0.007, respectively). CONCLUSION: SHMT2 expression is higher in thyroid cancers than normal or benign tissues and is associated with de-differentiation and poor clinical outcomes. Thus, SHMT2 might be useful as a diagnostic and prognostic marker for thyroid cancer.