Bilateral hyperkeratosis of the nipples and areolae with linear nevus and acanthosis nigricans: A rare case report.

Hyperkeratosis of the nipples and areolae (HNA) is an uncommon skin disorder with no definite aetiology. We report a case of a 16-year-old boy, who presented with bilateral pigmentation and thickening of the nipples and areolae, accompanied with linear brown protrusions on the anterior neck and a velvet like appearance with pigmentation on the axillary bilaterlly. Based on clinical and histopathological, and dermatoscopic findings, the diagnosis of bilateral HNA accompanied by linear nevus and acanthosis nigricans was made. The skin lesions were improved by treatment with topical calcipotriol gel.

[Determination of 13 chemical components of Epimedii Folium in pharmacopoeia by UPLC method combined with quantitative analysis of multicomponents by single-marker].

The quantitative analysis of multicomponents by single-marker(QAMS) was established for 13 chemical components of Epimedii Folium, including neoglycolic acid, chlorogenic acid, cryo-chlorogenic acid, magnolidine, hypericin, epimedin A, epimedin B, epimedin C, icariin, baohuoside Ⅱ, sagittatoside A, icariin subside Ⅰ, and baohuoside Ⅰ, so as to investigate the feasibility and accuracy of this method in evaluating the quality of Epimedii Folium materials from different origins and different varieties. Through the scientific and accurate investigation of the experimental method, the external standard method was used to determine the content of 13 chemical components in epimedium brevieornu. At the same time, icariin was used as the internal standard, and the relative correction factors of icariin with neoglycolic acid, chlorogenic acid, cryo-chlorogenic acid, magnolidine, hypericin, epimedin A, epimedin B, epimedin C, icariin, baohuoside Ⅱ, sagittatoside A, icariin subside Ⅰ, and baohuoside Ⅰ were established, respectively. The contens of neoglycolic acid, chlorogenic acid, cryo-chlorogenic acid, magnolidine, hypericin, epimedin A, epimedin B, epimedin C, icariin, baohuoside Ⅱ, sagittatoside A, icariin subside Ⅰ, and baohuosideⅠ in Epimedii Folium were calculated by QAMS. Finally, the difference between the measured value and the calculated value was compared to verify the accuracy and scientific nature of QAMS in the determination. The relative correction factor of each component had better repeatability, and there was no significant difference between the results of the external standard method and those of QAMS. With icariin as the internal standard, QAMS simultaneously determining neoglycolic acid, chlorogenic acid, cryo-chlorogenic acid, magnolidine, hypericin, epimedin A, epimedin B, epimedin C, icariin, baohuoside Ⅱ, sagittatoside A, icariin subside Ⅰ, and baohuoside Ⅰ can be used for quantitative analysis of Epimedii Folium.

Developing a prototype system of computer-aided appointment scheduling: A radiology department case study.

BACKGROUND: Scheduling patient appointments in hospitals is complicated due to various types of patient examinations, different departments and physicians accessed, and different body parts affected. OBJECTIVE: This study focuses on the radiology scheduling problem, which involves multiple radiological technologists in multiple examination rooms, and then proposes a prototype system of computer-aided appointment scheduling based on information such as the examining radiological technologists, examination departments, the patient's body parts being examined, the patient's gender, and the patient's age. METHODS: The system incorporated a stepwise multiple regression analysis (SMRA) model to predict the number of examination images and then used the K-Means clustering with a decision tree classification model to classify the patient's examination time within an appropriate time interval. RESULTS: The constructed prototype creates a feasible patient appointment schedule by classifying patient examination times into different categories for different patients according to the four types of body parts, eight hospital departments, and 10 radiological technologists. CONCLUSION: The proposed patient appointment scheduling system can schedule appointment times for different types of patients according to the type of visit, thereby addressing the challenges associated with diversity and uncertainty in radiological examination services. It can also improve the quality of medical treatment.

Patient Unpunctuality's Effect on Appointment Scheduling: A Scenario-Based Analysis.

This study examined patient unpunctuality's effect on patient appointment scheduling in the ultrasound department of a hospital. The study created a simulation system incorporating the formulated F3 distribution to describe patient unpunctuality. After the simulation model passed verification and validation processes, what-if scenarios were conducted under two policies: The preempt policy and the wait policy. A comparison of the total cost of each policy showed that the preempt policy performed better than the wait policy in the presence of unpunctuality. The study used sensitivity analyses to identify the different effects of patient unpunctuality on the system. The weights of the cost coefficient of both radiological technician's idle time and patient waiting time must be equal in order to achieve a lower cost. The patient's inter-arrival time must be close to the average total time in the system to achieve lower costs. Moreover, utilization decreases as the patient's inter-arrival increases. Therefore, the patient's inter-arrival time should be higher than, but close to, the service time to ensure less radiological technician's idle time and patient waiting time.

Tannic acid-aminopropyltriethoxysilane co-deposition modified polymer membrane for α-glucosidase immobilization.

Mussel-inspired catechol-amine co-deposition is an effective modification strategy for various materials. In this work, polyvinylidene fluoride (PVDF) membrane was employed as the carrier for α-glucosidase immobilization. By virtue of the co-polymerization of tannic acid (TA) and 3-aminopropyltriethoxysilane (APTES) and the hydrolysis of APTES, a hierarchical layer-colloidal nanospheres coating was decorated on the surface of PVDF membrane. Subsequently, α-glucosidase was covalently bound to the modified PVDF membrane through Schiff base reaction and Michael addition reaction between the residual quinine groups in the coating and the amino groups in enzyme molecules. Several parameters affecting the immobilization procedure were investigated thoroughly. The morphology and functional groups of the prepared composite were characterized by scanning electron microscopy (SEM), Fourier transform infrared-Attenuated total reflectance spectroscopy (FTIR-ATR), and X-ray photoelectron spectroscopy (XPS). Combined with capillary electrophoresis (CE) analysis, the performance, enzyme reaction kinetics and inhibition kinetics of PVDF-immobilized α-glucosidase were studied. The immobilized enzyme exhibited the enhanced tolerance to temperature and pH value. In addition, it possessed good reusability maintaining 77.1% of initial relative activity after 11 recycles, and batch-to-batch reproducibility with RSD of 4.3% (n = 10). The Michaelis-Menten constant (Km) of immobilized enzyme was calculated to be 4.16 mM, and IC50 value of acarbose was 0.10 µM. Finally, the PVDF-immobilized α-glucosidase was applied to screening potential inhibitors from 13 kinds of traditional Chinese medicines (TCMs), among which Sanguisorba Radix exhibited the strongest inhibitory activity. The positive results suggested that TA/APTES co-deposition was a simple and mild functionalization method for chemically inert polymer membrane and the proposed screening method was a reliable approach for discovering enzyme inhibitors from TCMs.

Applying the task-technology fit model to construct the prototype of a medical staff scheduling system.

BACKGROUND: Medical staff scheduling problems are complex and involve numerous constraints. OBJECTIVE: This research uses the task-technology fit (TTF) model to measure the technology characteristics of information technology (IT) systems as a reference for constructing a prototype for a medical staff scheduling system to identify function requirements and design human interfaces. METHOD: After the evaluation of the proposed scheduling system, this research excludes compatibility from the 13 technology characteristics and adds two technology characteristics for consideration: customization and scalability. RESULTS: Based on the revised technology characteristics of the TTF model, this research develops flexible scheduling functions to satisfy daily manpower requirements and allow predetermined schedules and day-off reservations for a hospital's radiological technologists. Characterized by flexibility, customization, and scalability, the system can accommodate several algorithms to generate a better schedule that satisfies hard and soft constraints. Furthermore, the scheduler can choose the required hard and soft constraints from all constraints. The prototype of the scheduling system will be easily extended to add or modify constraints in the case of requirement or regulation changes. CONCLUSION: The results of this study provide a prototype for system developers to design a customized staff scheduling system for each medical unit.

Applying Simulation Optimization to Minimize Drug Inventory Costs: A Study of a Case Outpatient Pharmacy.

Drug inventory management is an important part of hospital management. The large amounts of drug data in hospitals bring challenges to optimizing the setting values for the safety stock and the maximum inventory of each drug. This study combined a two-stage clustering method with an inventory policy (s, S) and established a simulation optimization model for the case hospital's outpatient pharmacy. This research used the simulation optimization software Arena OptQuest, developed by Rockwell Automation Inc (Rockwell Automation, Coraopolis, PA, USA), in order to determine the minimum and maximum values (s, S) of the best stock amounts for each drug under the considerations of cost and related inventory constraints. The research results showed that the minimum and maximum inventory settings for each drug in the simulation model were better than those set by the case outpatient pharmacy system. The average inventory cost was reduced by 55%, while the average inventory volume was reduced by 68%. The proposed method can improve management efficiency and inventory costs of hospital pharmacies without affecting patient services and increasing the inventory turnover rate of the drugs.

Using Simulation Optimization to Solve Patient Appointment Scheduling and Examination Room Assignment Problems for Patients Undergoing Ultrasound Examination.

This study investigates patient appointment scheduling and examination room assignment problems involving patients who undergo ultrasound examination with considerations of multiple examination rooms, multiple types of patients, multiple body parts to be examined, and special restrictions. Following are the recommended time intervals based on the findings of three scenarios in this study: In Scenario 1, the time interval recommended for patients' arrival at the radiology department on the day of the examination is 18 min. In Scenario 2, it is best to assign patients to examination rooms based on weighted cumulative examination points. In Scenario 3, we recommend that three outpatients come to the radiology department every 18 min to undergo ultrasound examinations; the number of inpatients and emergency patients arriving for ultrasound examination is consistent with the original time interval distribution. Simulation optimization may provide solutions to the problems of appointment scheduling and examination room assignment problems to balance the workload of radiological technologists, maintain high equipment utilization rates, and reduce waiting times for patients undergoing ultrasound examination.

Developing three-phase modified bat algorithms to solve medical staff scheduling problems while considering minimal violations of preferences and mean workload.

BACKGROUND: This research studies a medical staff scheduling problem, which includes government regulations and hospital regulations (hard constraints) and the medical staff's preferences (soft constraints). OBJECTIVE: The objective function is to minimize the violations (or dissatisfaction) of medical staff's preferences. METHODS: This study develops three variants of the three-phase modified bat algorithms (BAs), named BA1, BA2, and BA3, in order to satisfy the hard constraints, minimize the dissatisfaction of the medical staff and balance the workload of the medical staff. To ensure workload balance, this study balances the workload among medical staff without increasing the objective function values. RESULTS: Based on the numerical results, the BA3 outperforms the BA1, BA2, and particle swarm optimization (PSO). The robustness of the BA1, BA2, and BA3 is verified. Finally, conclusions are drawn, and directions for future research are highlighted. CONCLUSIONS: The framework of this research can be used as a reference for other hospitals seeking to determine their future medical staff schedule.

Solving patient referral problems by using bat algorithm.

BACKGROUND: A two-hospital patient referral problem intends to calculate an optimal value of referral patients between two hospitals and to evaluate whether or not the current number of referral patients is too low. OBJECTIVE: The goal of this study is to develop a simulation-based optimization algorithm to find the optimal referral between two hospitals with the unfixed daily patient referral policy. METHODS: This study applied system simulation and a bat algorithm (BA) to build a simulation model in accordance with the status of the two hospitals case and to calculate an optimal value of daily referral patients. RESULTS: Based on the 20 test instances, we verified the stability of this algorithm. The results show that the average magnetic resonance imaging (MRI) patient wait time reduced from 16 days to eight days. The hospital should increase the average total monthly MRI referral patients to 370 under the limitation of the daily referral patients to 25. CONCLUSIONS: This research investigated the two-hospital patient referral problems. We conducted and analyzed a simulation model and improved the case hospital's conditions, enhancing the quality of its medical care. The findings of this study can extend to other departments or hospitals.

Dynamic configuration scheduling problem for stochastic medical resources.

Scheduling approaches for conventional surgery operating rooms in a hospital treat surgeons as bottleneck resources directly, but do not deal with stochastic medical resources, leading to an uneven human resource distribution in optimizing medical resource scheduling. Thus, this research focuses on the dynamic configuration scheduling problem for stochastic medical resources. In this paper, the surgical operating room is limited, and the arriving calls (i.e., number of patients) are dynamic. When a patient arrives, the nurse anesthetist and anesthesiologist are limited, but the medical service duration per patient is random. We introduce the drum-buffer-rope (DBR) scheduling approach to analyze which types of medical resources become bottleneck resources for optimizing operating room scheduling. After verifying the effectiveness of the DBR method in uncertain situations, the Monte Carlo simulation is demonstrated.

Development of simulation optimization methods for solving patient referral problems in the hospital-collaboration environment.

This research studied a patient referral problem among multiple cooperative hospitals for sharing imaging services' referrals. The proposed problem consisted of many types of patients and the uncertainty associated with the number of patients of each type, patients' arrival time, and patients' medical operation time, leading to a difficulty in finding solutions due to the uncertain environment. This research used system simulation to construct a model and develop a simulation optimization method, combining the heuristic algorithm (patient referral mechanism) with the particle swarm optimization (PSO) method, to determine a better way to refer patients from one hospital (referring hospital) to another (recipient hospital) to receive certain imaging services. After the simulated model was verified and validated, three patient referral mechanisms to dispatch referring patients to the appropriate recipient hospitals were proposed. Based on the numerical results, the findings showed that Mechanism 2, transferring patients to the hospital with the shortest waiting time, had good performance in both scenarios: allowing patient referrals among all hospitals and limiting the patients' waiting time. Finally, this study presents the conclusions and some directions for future research.

Veronicastrum axillare Alleviates Lipopolysaccharide-Induced Acute Lung Injury via Suppression of Proinflammatory Mediators and Downregulation of the NF-κB Signaling Pathway.

Veronicastrum axillare is a traditional medical plant in China which is widely used in folk medicine due to its versatile biological activities, especially for its anti-inflammatory effects. However, the detailed mechanism underlying this action is not clear. Here, we studied the protective effects of V. axillare against acute lung injury (ALI), and we further explored the pharmacological mechanisms of this action. We found that pretreatment with V. axillare suppressed the release of proinflammatory cytokines in the serum of ALI mice. Histological analysis of lung tissue demonstrated that V. axillare inhibited LPS-induced lung injury, improved lung morphology, and reduced the activation of nuclear factor-κB (NF-κB) in the lungs. Furthermore, the anti-inflammatory actions of V. axillare were investigated in vitro. We observed that V. axillare suppressed the mRNA expression of interleukin-1ß (IL-1ß), IL-6, monocyte chemotactic protein-1 (MCP-1), cyclooxygenase-2 (COX-2), and tumor necrosis factor-α (TNF-α) in RAW264.7 cells challenged with LPS. Furthermore, pretreatment of V. axillare in vitro reduced the phosphorylation of p65 and IκB-α which is activated by LPS. In conclusion, our data firstly demonstrated that the anti-inflammatory effects of V. axillare against ALI were achieved through downregulation of the NF-κB signaling pathway, thereby reducing the production of inflammatory mediators.

Scheduling Patients' Appointments: Allocation of Healthcare Service Using Simulation Optimization.

In the service industry, scheduling medical procedures causes difficulties for both patients and management. Factors such as fluctuations in customer demand and service time affect the appointment scheduling systems' performance in terms of, for example, patients' waiting time, idle time of resources, and total cost/profits. This research implements four appointment scheduling policies, i.e., constant arrival, mixed patient arrival, three-section pattern arrival, and irregular arrival, in an ultrasound department of a hospital in Taiwan. By simulating the four implemented policies' optimization procedures, optimal or near-optimal solutions can be obtained for patients per arrival, patients' inter-arrival time, and the number of the time slots for arrived patients. Furthermore, three objective functions are tested, and the results are discussed. The managerial implications and discussions are summarized to demonstrate how outcomes can be useful for hospital managers seeking to allocate their healthcare service capacities.

Applying Task-Technology Fit Model to the Healthcare Sector: a Case Study of Hospitals' Computed Tomography Patient-Referral Mechanism.

With the growth in the number of elderly and people with chronic diseases, the number of hospital services will need to increase in the near future. With myriad of information technologies utilized daily and crucial information-sharing tasks performed at hospitals, understanding the relationship between task performance and information system has become a critical topic. This research explored the resource pooling of hospital management and considered a computed tomography (CT) patient-referral mechanism between two hospitals using the information system theory framework of Task-Technology Fit (TTF) model. The TTF model could be used to assess the 'match' between the task and technology characteristics. The patient-referral process involved an integrated information framework consisting of a hospital information system (HIS), radiology information system (RIS), and picture archiving and communication system (PACS). A formal interview was conducted with the director of the case image center on the applicable characteristics of TTF model. Next, the Icam DEFinition (IDEF0) method was utilized to depict the As-Is and To-Be models for CT patient-referral medical operational processes. Further, the study used the 'leagility' concept to remove non-value-added activities and increase the agility of hospitals. The results indicated that hospital information systems could support the CT patient-referral mechanism, increase hospital performance, reduce patient wait time, and enhance the quality of care for patients.

Comparisons of ethanol extracts of chinese propolis (poplar type) and poplar gums based on the antioxidant activities and molecular mechanism.

The biological activities of propolis are varied from plant sources and the prominent antioxidant effects of Chinese propolis (poplar type) have been extensively reported. Oxidative stress is associated with inflammation and induces many diseases. In the study, to evaluate antioxidant capacities and clarify the underlying molecular mechanisms of ethanol extracts of Chinese propolis (EECP) and ethanol extracts of poplar gums (EEPG), we analyzed their compositions by HPLC, evaluating their free radical scavenging activities and reducing power by chemical analysis methods. Moreover, we studied the roles of EECP and EEPG on the elimination of ROS and expressions of antioxidant genes (HO-1, TrxR1, GCLM, and GCLC) in RAW264.7 cells. We further investigated the effects of MAPKs on the antioxidant genes expression by specific inhibitors. The nucleus translocation effects of Nrf2 were also measured by confocal microscopy analysis. The results indicated that EECP had higher TPC and FDC values but regarding TFC values were not significant. EECP also possessed more contents of 11 compounds than EEPG. Both phytochemical analysis and cell experiment reflected that EECP exerted stronger antioxidant activities than EEPG. EECP and EEPG enhanced endogenous antioxidant defenses by eliminating reactive oxygen species directly and activating Erk-Nrf2-HO1, GCLM, and TrxR1 signal pathways.

Anti-inflammatory effects of ethanol extracts of Chinese propolis and buds from poplar (Populus×canadensis).

ETHNOPHARMACOLOGICAL RELEVANCE: Propolis is used widely in a number of cultures as a folk medicine and is gaining wider recognition for its potential therapeutic use, due to its wide range of biological properties and pharmacological activities, especially its anti-inflammatory effects. Despite an increasing number of studies focused on the biological activities of propolis together with its botanical sources, studies on Chinese propolis are insufficient. This study was designed to investigate the anti-inflammatory properties of ethanol extracts from Chinese propolis (EECP) and poplar buds (EEPB) from Populus×canadensis Moench (Salicaceae family). MATERIALS AND METHODS: Phytochemical analysis of EECP and EEPB was performed via total phenolic and flavonoid content measurements followed by high-performance liquid chromatography (HPLC) analysis. DPPH and ABTS free-radical scavenging methods were used to evaluate their anti-oxidant properties. The anti-inflammatory effects of EECP and EEPB were investigated in vitro by evaluating their modulating effects on the key inflammatory cytokines and mediators in LPS/IFN-γ co-stimulated RAW 264.7 cells and by measuring nuclear factor (NF)-κB activation in TNF-α or IL-1ß stimulation HEK 293 cells using reporter gene assays. Their effects on acute inflammatory symptoms (LPS-induced endotoxemia and acute pulmonary damage) were also examined in mice. RESULTS: EECP and EEPB exhibited strong free-radical scavenging activity and significant in vitro anti-inflammatory effects by modulating key inflammatory mediators of mRNA transcription, inhibiting the production of specific inflammatory cytokines, and blocking the activation of nuclear factor (NF)-κB. The administration of EECP and EEPB (25 and 100 mg/kg) provided significant protective effects by attenuating lung histopathological changes and suppressing the secretion of LPS-stimulated inflammatory cytokines, such as interleukin-6 (IL-6), IL-10, MCP-1, TNF-α and IL-12p70 production in endotoxemic mice. CONCLUSIONS: The results presented here reveal the potent anti-inflammatory properties of Chinese propolis and poplar buds, and provide biological information for developing suitable substitute(s) for propolis in the prevention and treatment of inflammatory diseases.

Molecular mechanisms underlying the in vitro anti-inflammatory effects of a flavonoid-rich ethanol extract from chinese propolis (poplar type).

China produces the greatest amount of propolis but there is still lack of basic studies on its pharmacological mechanisms. Our previous study found that ethanol extract from Chinese propolis (EECP) exerted excellent anti-inflammatory effects in vivo but mechanisms of action were elusive. To further clarify the possible mechanisms underlying the anti-inflammatory effects of Chinese propolis (poplar type), we utilized EECP to analyze its chemical composition and evaluated its potential anti-inflammatory effects in vitro. High-performance liquid chromatography (HPLC) profile indicated that EECP contained abundant flavonoids, including rutin, myricetin, quercetin, kaempferol, apigenin, pinocembrin, chrysin, and galangin. Next we found that EECP could significantly inhibit the production of NO, IL-1ß, and IL-6 in lipopolysaccharide- (LPS-) stimulated RAW 264.7 cells and suppress mRNA expression of iNOS, IL-1ß, and IL-6 in a time- and dose-dependent manner. Furthermore, we found that EECP could suppress the phosphorylation of IκBα and AP-1 but did not affect IκBα's degradation. In addition, using a reporter assay, we found that EECP could block the activation of NF-κB in TNF-α-stimulated HEK 293T cells. Our findings give new insights for understanding the mechanisms involved in the anti-inflammatory effects by Chinese propolis and provide additional references for using propolis in alternative and complementary therapies.

[Research on relevance between macroscopic feature individual differences and quality of Gansu cultivated Angelica sinensis].

OBJECTIVE: To analyze the appearance differences of Gansu cultivated Angelica sinensis, and explore the relevance between the appearance differences and quality. METHODS: The macroscopic feature of 22 batches of Angelica sinensis from different habitats was measured as index. The content of ferulic acid, volatile oil and extract were determined by the method recorded in the Chinese Pharmacopoeia. The data were analyzed by SPSS 15.0 software. RESULTS: The habitat was positively correlated with the index. Indexes of nine groups had direct correlation with each other. The habitat was significantly correlated with other indexes except the length of the head. The extract and ferulic acid were positively correlated with habitat and index. Extract had significant correlation with macroscopic feature. Ferulic acid only had significant correlation with head length. The volatile oil only had significant correlation with habitat and no significant correlation with index. Root weight and number of lateral roots had obvious difference in different habitat which coefficient of variation was 44.1% and 28.6%, respectively. CONCLUSION: There are significant individual differences in Angelica sinensis. The chemical composition has a certain correlation with macroscopic feature. Angelica sinensis cultivation needs to consider the choice of habitat.

Effects of shape, porosity, and operating parameters on carbon dioxide recovery in polytetrafluoroethylene membranes.

In this study, the recovery of carbon dioxide using an absorbent composed of 2-amino-2-methyl-l-propanol (AMP)+monoethanolamine (MEA)+piperazine (PZ) in polytetrafluoroethylene (PTFE) membrane contactors was investigated. Experiments were conducted using various gas flow rates, liquid flow rates, absorbent blends, and pore size membranes. CO(2) recovery increased with increasing liquid flow rates. The blended amine absorbent had a synergistic effect on CO(2) recovery. CO(2) recovery increased as the pore size of the PTFE membrane decreased. An asymmetric membrane had a better CO(2) recovery than that of symmetric membrane. Besides, membrane mass transfer coefficient and operational stability of asymmetric membrane were enhanced. For an asymmetric membrane, the smaller pore-size side of the membrane surface contacting the liquid phase can reduce the level of wetting of the membrane.