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Objective: To evaluate the feasibility and clinical value of suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) in nephroureterectomy using method of transvaginal natural orifice specimen extraction (NOSE) (SA-LESS+TV-NOSE NU). Methods: Four patients (three cases of renal pelvic carcinoma and one case of ureteral carcinoma) undergoing SA-LESS+TV-NOSE NU were enrolled between April 2015 and January 2016. After general anesthesia, the patients were placed in the lithotomy position with the affected side elevated by 60°. Two trocars were inserted at the medial margin of umbilicus, and the third one was inserted into abdominal cavity at the superior margin of pubic symphysis. The operation was performed under a direct vision with a 5.4 mm 0° flexible-tip laparoscope. Firstly, the distal ureter was isolated completely and blocked by a Hem-O-lok clip. Then, the laparoscopic nephrectomy was performed according to the standard method. Finally, the bladder cuff excision was executed and the incision was sutured. The intact specimen was placed inside a homemade bag and removed through the incision at posterior vaginal fornix. Results: All the procedures were successfully performed. The median operative time was 150 (range: 120 to 210) minutes, and the median estimated blood loss was 180 (range: 80 to 350) ml. No major perioperative complications occurred. The mean visual analogue score (VAS) of 24 hours and 48 hours after operation were 3.25 (range: 2 to 5) and 2.25 (range: 2 to 3). All the patients resumed ambulation on postoperative day 1. Pelvic drainage tube was removed on postoperative day 2-4. On postoperative day 7, urethral catheter was removed. The patients were discharged on postoperative day 7-9. During the follow-up of 20-29 months, the patient recovered well with no case of incisional hernia and pelvic, abdominal infections. The vaginal fornix incision healed well, and the umbilical and suprapubic puncture scars were not obvious. All the patients completed the patient-assessed acromegaly symptom questionnaire PASQ. The average PSAQ score of 3 months after surgery was 34.5. Three of them restarted their sex lives, with an average female sexual function index score of 16.0, which was not significantly different with that of preoperation (15.6). There was no tumor recurrence, metastasis and implantation in all cases. Conclusion: SA-LESS+TV-NOSE NU is safe and feasible for upper tract urothelial carcinoma with faster postoperative recovery, less pain, shorter hospitalization time, better cosmetic results, and does not cause negative effect on the female sexual function.
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Neoplasias Renales , Laparoscopía , Femenino , Humanos , Neoplasias Renales/cirugía , Recurrencia Local de Neoplasia , Nefrectomía , Nefroureterectomía , OmbligoRESUMEN
Cantharidin is a biomolecule with a role in host defense that can also be used as an anticancer drug. The in vivo biosynthetic pathway for cantharidin has been the subject of debate for several decades and the mechanism is not yet completely understood. To study the biosynthetic pathway of cantharidin in blister beetles, Mylabris cichori, a full-length MenA (McMenA) cDNA was cloned based on the partial sequence of the MenA gene from a suppression subtractive hybridization (SSH) library of male and female adult M. cichorii. The cDNA was 1264 base pairs (bp) with an open reading frame of 1026 bp nucleotides encoding a 341 amino acid protein. Analysis of the McMenA amino acid sequence showed that the aspartate rich motif N/DDxxD represented binding sites for prenyl diphosphate via a Mg(2+) ion. Phylogenetic analysis showed that McMenA was most closely related to MenA of Tribolium castaneum, and the amino acid sequence similarity was 86%. The expression pattern of McMenA in adults was analyzed using RT-qPCR, and we found that the highest expression of McMenA occurred during 22-25 days in the sex-separate breeding males, while the lowest expression occurred in females at the same time. Injection with a specific double-strand RNA (dsRNA) of McMenA led to a significant reduction of McMenA mRNA levels after 24 h. Cantharidin and ATP concentrations dropped around the same time. Together, our data showed that the McMenA gene might be involved in cantharidin biosynthesis.
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Transferasas Alquil y Aril/metabolismo , Cantaridina/metabolismo , Escarabajos/enzimología , Proteínas de Insectos/metabolismo , Transferasas Alquil y Aril/genética , Animales , Escarabajos/genética , Femenino , Expresión Génica , Proteínas de Insectos/genética , Masculino , FilogeniaRESUMEN
The electronic structure of IrO2 has been investigated using hard x-ray photoelectron spectroscopy and density-functional theory. Excellent agreement is observed between theory and experiment. We show that the electronic structure of IrO2 involves crystal field splitting of the iridium 5d orbitals in a distorted octahedral field. The behavior of IrO2 closely follows the theoretical predictions of Goodenough for conductive rutile-structured oxides [J. B. Goodenough, J. Solid State Chem. 3, 490 (1971).
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Citrate fermentation by Escherichia coli requires the function of the citrate/succinate antiporter CitT (citT gene) and of citrate lyase (citCDEFXG genes). Earlier experiments suggested that the two-component system CitA/CitB, consisting of the membrane-bound sensor kinase CitA and the response regulator CitB, stimulates the expression of the genes in the presence of citrate, similarly to CitA/CitB of Klebsiella pneumoniae. In this study, the expression of a chromosomal citC-lacZ gene fusion was shown to depend on CitA/CitB and citrate. CitA/CitB is related to the DcuS/DcuR two-component system which induces the expression of genes for fumarate respiration in response to C(4)-dicarboxylates and citrate. Unlike DcuS, CitA required none of the cognate transporters (CitT, DcuB, or DcuC) for function, and the deletion of the corresponding genes showed no effect on the expression of citC-lacZ. The citAB operon is preceded by a DcuR binding site. Phosphorylated DcuR bound specifically to the promoter region, and the deletion of dcuS or dcuR reduced the expression of citC. The data indicate the presence of a regulatory cascade consisting of DcuS/DcuR modulating citAB expression (and CitA/CitB levels) and CitA/CitB controlling the expression of the citCDEFXGT gene cluster in response to citrate. In vivo fluorescence resonance energy transfer (FRET) and the bacterial two-hybrid system (BACTH) showed interaction between the DcuS and CitA proteins. However, BACTH and expression studies demonstrated the lack of interaction and cross-regulation between CitA and DcuR or DcuS and CitB. Therefore, there is only linear phosphoryl transfer (DcuSâDcuR and CitAâCitB) without cross-regulation between DcuS/DcuR and CitA/CitB.
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Ácido Cítrico/metabolismo , Proteínas de Unión al ADN/metabolismo , Proteínas de Escherichia coli/metabolismo , Escherichia coli/metabolismo , Regulación Bacteriana de la Expresión Génica , Proteínas Quinasas/metabolismo , Factores de Transcripción/metabolismo , Proteínas de Unión al ADN/genética , Escherichia coli/genética , Proteínas de Escherichia coli/genética , Fermentación , Regiones Promotoras Genéticas , Unión Proteica , Proteínas Quinasas/genética , Factores de Transcripción/genéticaRESUMEN
We have successfully determined the hitherto unknown sign of the B(4)(4) Stevens crystal-field parameter of the tetragonal heavy-fermion compound CeCu(2)Si(2) using vector q-dependent nonresonant inelastic x-ray scattering experiments at the cerium N(4,5) edge. The observed difference between the two different directions, qâ¥[100] and qâ¥[110], is due to the anisotropy of the crystal-field ground state in the (001) plane and is observable only because of the utilization of higher than dipole transitions possible in nonresonant inelastic x-ray scattering. This approach allows us to go beyond the specific limitations of dc magnetic susceptibility, inelastic neutron scattering, and soft x-ray spectroscopy, and provides us with a reliable information about the orbital state of the 4f electrons relevant for the quantitative modeling of the quasiparticles and their interactions in heavy-fermion systems.
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AIM: Monocyte chemoattractant protein-1 (MCP-1) is a potent chemokine and plays an important role in atherosclerosis of Type 2 diabetes. The aim of this study was to investigate the methylation status of CpG sites in the MCP-1 promoter in Type 2 diabetic patients and its correlation to serum MCP- 1 level, and blood glucose level. METHODS: The 32 patients with Type 2 diabetes and 15 healthy controls were enrolled into the study. Bodymass index, blood pressure, blood lipid, blood glucose, glycosylated hemoglobin (HbA1c), and serum MCP-1 were measured. Genomic DNA was isolated fromthe peripheral blood mononuclear cells (PBMC). Methylation status of CpG sites in theMCP-1 promoter was determined using methylation specific polymerase chain reaction. RESULTS: The promoter region (2890-3050 bp) was predominantly methylated in PBMC from controls.Methylation of CpGmotifs were less methylated in the patients than in the controls (25% vs 80%; p<0.001), while the level of MCP-1 in serum was higher in patients with Type 2 diabetes (193.95±74.96 vs 88.46±55.10; p<0.001). MCP-1 promoter methylation was significantly correlated to serum MCP-1, HbA1c, fasting blood glucose, and triglyceride. CONCLUSION: These data suggest that hypomethylation of CpG sites in the MCP-1 promoter region may be affected by blood glucose and TG, which then increase the serum MCP-1 level and may play a role in the vascular complications of Type 2 diabetes.
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Aterosclerosis/etiología , Quimiocina CCL2/sangre , Quimiocina CCL2/genética , Islas de CpG/genética , Metilación de ADN , Diabetes Mellitus Tipo 2/sangre , Regiones Promotoras Genéticas/genética , Adulto , Anciano , Aterosclerosis/patología , Glucemia/metabolismo , Índice de Masa Corporal , Estudios de Casos y Controles , Complicaciones de la Diabetes/etiología , Complicaciones de la Diabetes/patología , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Leucocitos Mononucleares/metabolismo , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Triglicéridos/metabolismoRESUMEN
OBJECTIVES: To determine independent predictors of root resorption for surgical-orthodontic treatment of impacted maxillary central incisors. SETTING AND SAMPLE POPULATION: The Department of Dentistry at Show Chwan Hospital, Changhua, Taiwan. Eighty patients with unilateral osseous-impacted maxillary central incisors receiving a surgical-orthodontic treatment. MATERIAL AND METHODS: This is a retrospective observational study. Root resorption and its predictors were abstracted from patients' charts, pre-treatment cephalometric radiographs, and post-treatment periapical radiographs. Predictors included demographics, treatment duration, crown angle, crown height, crown depth, and root dilacerations. RESULTS: The patients' mean age was 9.2 ± 2.3 years (6.4-20.6 years), and 60% were females. Impacted maxillary central incisors had greater root resorption than naturally erupted contralateral incisors (Δ = -2.8 mm, p < 0.001). Independent predictors of root resorption for impacted maxillary central incisors were shown by linear regression analysis to be crown height (ß = -0.2, p < 0.01), crown depth (ß = -0.3, p = 0.001), treatment duration (ß = 0.2, p < 0.01), and root dilacerations (ß = 3.1, p = 0.001). CONCLUSIONS: Impacted maxillary central incisors had greater root resorption during surgical-orthodontic treatment than their naturally erupted contralateral incisors. Predictors of a greater root resorption were highly and deeply impacted incisors, longer treatment, and root dilacerations. These predictors may help to inform patient and family counseling before treatment.
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Incisivo/diagnóstico por imagen , Resorción Radicular/etiología , Técnicas de Movimiento Dental/métodos , Diente Impactado/diagnóstico por imagen , Adolescente , Cefalometría/métodos , Niño , Femenino , Estudios de Seguimiento , Predicción , Humanos , Masculino , Modelos Dentales , Odontometría/métodos , Hueso Paladar/diagnóstico por imagen , Radiografía de Mordida Lateral , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Corona del Diente/diagnóstico por imagen , Erupción Dental/fisiología , Raíz del Diente/anomalías , Diente Impactado/clasificación , Diente Impactado/cirugía , Adulto JovenRESUMEN
OBJECTIVES: To determine independent predictors of duration of surgical-orthodontic treatment of impacted maxillary central incisors. SETTING AND SAMPLE POPULATION: The Department of Dentistry at Show Chwan Hospital, Changhua, Taiwan. Eighty patients with unilateral osseous impacted maxillary central incisors receiving a surgical-orthodontic treatment. MATERIAL AND METHODS: This is a retrospective observational study. Treatment duration and its predictors were abstracted from the patients' charts and pre-treatment cephalometric radiographs. Predictors included demographics, crown angle, crown height, crown depth, and root dilacerations. RESULTS: The mean age of the cohort was 9.2±2.3 years (6.4-20.6 years), and 60% were women. The mean orthodontic traction time was 8.0±4.5 months (2.0-24.1 months). Using multiple linear regression analysis, the independent predictors of treatment duration for an impacted maxillary central incisor were age (ß=0.9, p<0.001), crown height (ß=-0.2, p<0.05), and root dilacerations (ß=3.8, p<0.001). CONCLUSIONS: Duration of surgical-orthodontic treatment of an impacted maxillary central incisor varied widely. Predictors of longer treatment time were older age, high impacted tooth, and dilacerated incisors.
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Incisivo/patología , Maxilar/patología , Extrusión Ortodóncica/métodos , Diente Impactado/terapia , Adolescente , Factores de Edad , Cefalometría , Niño , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Predicción , Humanos , Incisivo/cirugía , Masculino , Maxilar/cirugía , Estudios Retrospectivos , Factores de Tiempo , Corona del Diente/patología , Raíz del Diente/anomalías , Raíz del Diente/patología , Diente Impactado/cirugía , Adulto JovenRESUMEN
Orthognathic surgery using a surgery-first approach (SFA) has been shown to result in better quality of life (QoL) throughout the treatment duration; however, the effects of gender, age and type of dentofacial deformity on SFA-related QoL remain unknown. In total, 228 consecutive patients underwent SFA for correction of dentofacial deformities (skeletal class III, bimaxillary protrusion and facial asymmetry). We assessed their QoL before surgery and at 1, 6 and 12 months after surgery using the Orthognathic Quality of Life Questionnaire (OQLQ). The results indicated a significant decrease in the total OQLQ, facial aesthetics and social aspect domain scores 1, 6 and 12 months after surgery. Among all domains, the greatest improvement was noted in the facial aesthetics domain. The oral function scores declined significantly immediately after surgery, but improved significantly 6 and 12 months after surgery; however, the awareness scores remained relatively stable. At each time point, women and the bimaxillary protrusion group exhibited a significantly higher total and specific domain scores. Patients aged 18-22 years exhibited lower total and four specific domain scores than older patients. Thus, QoL improves in all aspects, except awareness domain, by 12 months after SFA, but gender, age, and type of dentofacial deformity affect this improvement.
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Deformidades Dentofaciales , Maloclusión , Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Femenino , Humanos , Calidad de Vida , Encuestas y CuestionariosRESUMEN
BACKGROUND AND AIMS: Macrophages and Toll-like receptor 4 (TLR4) are involved in the inflammatory process of adipogenesis. This study aimed to characterize macrophage infiltrates and the associated TLR4 expression in different locations of white adipose tissues (WAT) of male Chinese and determine their correlations to adipocyte hypertrophy and hyperplasia. METHODS AND RESULTS: A total of 30 men, who were lean, overweight or with type 2 diabetes (T2D), were recruited. Their abdominal omental WAT (oWAT) and subcutaneous WAT (scWAT) were obtained. The contents of macrophages in oWAT and scWAT were quantified using anti-CD68 staining. The levels of TLR4 expression were analyzed by western blot assays and the adipocyte size was quantified, followed by linear regression analysis. Significantly higher numbers of macrophages (24.4+/-3.2 vs 6.1+/-2.9, p<0.001), associated with higher levels of TLR4 expression (0.59+/-0.19 vs 0.20+/-0.03, p<0.001), were observed in oWAT, as compared with that in scWAT. Furthermore, the levels of macrophage infiltrates and TLR4 expression in oWAT of subjects who were overweight or/and have T2D were significantly higher than that in the lean group. The average adipocyte diameters and cross-sectional areas in oWAT of subjects who were overweight were significantly greater than those in the lean group (p=0.003 and p=0.04, respectively). Importantly, the numbers of macrophage infiltrates were positively correlated to the levels of TLR4 expression, the sizes of adipocytes, the levels of body mass index and C-reactive protein, respectively. CONCLUSION: Our data suggest that macrophage-related TLR4 expression and inflammation contribute to the development of adipocyte hypertrophy in male Chinese.
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Grasa Intraabdominal/patología , Macrófagos/fisiología , Grasa Subcutánea Abdominal/patología , Receptor Toll-Like 4/metabolismo , Adulto , Antígenos CD/metabolismo , Antígenos de Diferenciación Mielomonocítica/metabolismo , Índice de Masa Corporal , Proteína C-Reactiva/análisis , Tamaño de la Célula , Diabetes Mellitus Tipo 2/sangre , Humanos , Hiperplasia/patología , Hipertrofia/patología , Grasa Intraabdominal/metabolismo , Macrófagos/inmunología , Macrófagos/metabolismo , Masculino , Persona de Mediana Edad , Sobrepeso/sangre , Grasa Subcutánea Abdominal/metabolismo , Delgadez/sangreRESUMEN
BACKGROUND: The receptor for advanced glycation end products (RAGE) plays an important role in the pathogenesis of diabetic complications. The aim of this study is to investigate the association of the 1704 G/T and G82S polymorphisms in the RAGE gene with diabetic retinopathy (DR). METHODS: The 1704G/T and G82S polymorphisms were genotyped in 340 Type 2 diabetes (T2DM) without DR subjects (DR- group); 166 T2DM with DR subjects (DR+ group), and 182 normal glucose tolerant subjects (NGT group). The genotypes were detected by the methods of ligase detection reaction coupled PCR. RESULTS: There was no evident difference in the 1704G/T and G82S genotypic and allelic frequencies distribution between NGT and T2DM subjects. However, the frequences of G/A+AA genotypes (60.6%) and A allele (36.4%) of G82S were significantly higher in DR+ group than those (38.4%; 20.9%, respectively) in DR- group (p=0.01and p=0.007, respectively). Furthermore, haplotype analysis revealed that the frequency of G-A haplotype containing 1704G and 82S allele in DR+ group was significantly higher than that in DR- group (33.5% vs 19.6%, p=0.01). The multiple logistic regression analysis indicated that the G82S polymorphism [odds ratio (OR): 2.964, 95% confidence interval (CI): 1.013-5.46, p=0.029] and diabetes duration (OR: 1.013, 95% CI: 1.007-1.02, p<0.001) were independent risk factors for DR. CONCLUSIONS: G82S polymorphism in the RAGE gene is associated with DR and G-A haplotype containing 1704G and 82S allele might be a genetic marker of DR in Chinese T2DM patients.
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Retinopatía Diabética/genética , Polimorfismo de Nucleótido Simple , Receptores Inmunológicos/genética , Adulto , Anciano , Sustitución de Aminoácidos/genética , Estudios de Casos y Controles , China , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/genética , Femenino , Frecuencia de los Genes , Genética de Población , Genotipo , Glicina/genética , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple/fisiología , Receptor para Productos Finales de Glicación Avanzada , Serina/genéticaRESUMEN
A stable occlusion at the time of surgery is considered important for post-surgical stability after orthognathic surgery. The aim of this study was to determine whether skeletal stability after bimaxillary surgery using a surgery-first approach for skeletal class III deformity is related to the surgical occlusal contact or surgical change. Forty-two adult patients with a skeletal class III deformity corrected by Le Fort I osteotomy and bilateral sagittal split osteotomy with a surgery-first approach were studied. Dental models were set and used to measure the surgical occlusal contact, including contact distribution, contact number, and contact area. Cone beam computed tomography was used to measure the surgical change (amount and rotation) and post-surgical skeletal stability. The relationship between skeletal stability and surgical occlusal contact or surgical change was evaluated. No relationship was found between maxillary or mandibular stability and surgical occlusal contact. However, a significant relationship was found between maxillary and mandibular stability and the amount and rotation of surgical change. The results suggest that in the surgical-orthodontic correction of skeletal class III deformity with a surgery-first approach, the post-surgical skeletal stability is not related to the surgical occlusal contact but is related to the surgical change.
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Maloclusión de Angle Clase III , Procedimientos Quirúrgicos Ortognáticos , Adulto , Cefalometría , Estudios de Seguimiento , Humanos , Mandíbula , Maxilar , Osteotomía Le Fort , Osteotomía Sagital de Rama MandibularRESUMEN
PURPOSE: The aim of this study was to investigate the association between the +33371 A/G polymorphism of adiponectin receptor 2 gene and the risk of Type 2 diabetes (T2DM) in the Chinese population. METHODS: A case-control study was performed among 594 unrelated Chinese people. All of them underwent a standardized assessment on phenotypic characterization including anthropometry, 75-g oral glucose tolerance test with insulin levels, fasting serum total cholesterol, and fasting serum triglyceride. The +33371 A/G polymorphism was detected by PCR-restriction fragment length polymorphism. RESULTS: The PCR products after digestion displayed 3 genotypes, including AA, AG, and GG. The frequencies of AA, AG, and GG genotypes in T2DM group (no.=261) and control group (no.=353) were 0.379, 0.414, 0.207 and 0.162, 0.541, 0.297, respectively. There was a significant difference in both genotypic and allelic frequencies distribution of +33371 A/G polymorphism between T2DM and control subjects (p<0.001). Subjects with AA+AG genotypes showed higher levels of fasting plasma glucose (p=0.024), fasting serum triglycerides (p=0.036), and body mass index (BMI) (p=0.013) than those with GG genotype in the T2DM group but not in the control group. Compared with GG genotype, AA (p<0.001) and AA+AG (p=0.002) genotype group had a significantly higher risk of T2DM, with odds ratio (OR) for 2.290 [95% confidence interval: 1.482-3.359] and 1.963 (1.183-2.997). Compared with AG+GG genotype group, the risk of T2DM in AA genotype increased slightly (p=0.007), with OR for 1.478 (1.025-2.036). CONCLUSION: The present findings suggest that +33371 A/G polymorphism is associated with increased risk of T2DM and multiple insulin resistance-related phenotypes (including fasting plasma glucose, fasting serum triglycerides, and BMI) in the Chinese population.
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Pueblo Asiatico/genética , Diabetes Mellitus Tipo 2/etnología , Diabetes Mellitus Tipo 2/genética , Polimorfismo de Longitud del Fragmento de Restricción , Receptores de Adiponectina/genética , Adulto , Estudios de Casos y Controles , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad/etnología , Genotipo , Humanos , Resistencia a la Insulina/genética , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Fenotipo , Factores de RiesgoRESUMEN
Catabolism of alpha-linked mannose residues on eukaryotic glycoproteins is accomplished by a broad specificity lysosomal alpha-mannosidase (EC 3.2.1.24). Based on regions of protein sequence conservation between the lysosomal alpha-mannosidase from Dictyostelium discoideum and the murine Golgi glycoprotein processing alpha 1,3/1,6-mannosidase, alpha-mannosidase II, we have cloned a cDNA encoding the murine lysosomal alpha-mannosidase. The longest of the clones was 3.1 kb in length and encoded a polypeptide of 992 amino acids containing a putative NH2-terminal signal sequence and 11 potential N-glycosylation sites. The deduced amino acid sequence was 76.5% identical to the human lysosomal alpha-mannosidase and 38.1% identical to the lysosomal alpha-mannosidase from D. discoideum. Expression of the cDNA in Pichia pastoris resulted in the secretion of an alpha-mannosidase activity into the culture medium. This recombinant expression product was purified and was shown to have enzymatic characteristics highly similar to the enzyme purified from mammalian sources and to the human lysosomal alpha-mannosidase cDNA expressed in Pichia. These characteristics include a similar pH optimum, Km, Vmax, inhibition by swainsonine, and activity toward natural substrates. Northern blots identified a major 3.5 kb RNA transcript in all murine tissues tested. A minor transcript of 5.4 kb was also detected in some murine tissues similar to the alternatively spliced transcripts that have been previously identified in human tissues.
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Lisosomas/enzimología , Manosidasas/genética , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Clonación Molecular , ADN Complementario/aislamiento & purificación , Glicoproteínas/metabolismo , Manosidasas/aislamiento & purificación , Manosidasas/metabolismo , Ratones , Datos de Secuencia Molecular , Peso Molecular , Pichia/genética , Proteínas Recombinantes/aislamiento & purificación , alfa-ManosidasaRESUMEN
Excluding tracheostomy, maxillomandibular advancement (MMA) is the most effective surgical treatment for obstructive sleep apnoea (OSA). However, the anticipated facial changes may prevent acceptance of this procedure by patients with bimaxillary protrusion, a common feature of Asian faces. We therefore developed a modified MMA technique for such cases, consisting of anterior segmental osteotomies together with standard Le Fort I and bilateral sagittal split osteotomies. A prospective study of 20 consecutive Taiwanese adults with moderate-to-severe OSA who underwent modified MMA and postsurgical orthodontics was undertaken to evaluate the efficacy with regard to OSA and the postoperative facial appearance and dental occlusion. After modified MMA, the mean apnoea-hypopnoea index decreased from 41.6±19.2 n/h to 5.3±4.0 n/h (P<0.001). All patients had a successful outcome. No patient was dissatisfied with their postoperative facial appearance. The mean Peer Assessment Rating score decreased from 21.9±14.3 to 1.7±1.6 (P=0.001). The data suggest that the modified MMA is effective in treating patients with moderate-to-severe OSA without negatively affecting facial appearance or dental occlusion. To achieve a better outcome, surgical-orthodontic integration is warranted. The surgery-first approach can achieve early improvement.
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Pueblo Asiatico , Avance Mandibular/métodos , Maxilar/cirugía , Apnea Obstructiva del Sueño/cirugía , Adulto , Cefalometría , Oclusión Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ortodoncia Correctiva , Osteotomía/métodos , Polisomnografía , Estudios Prospectivos , Taiwán , Resultado del TratamientoRESUMEN
We report measurements of the physical properties and electronic structure of the hexagonal compounds Yb2Ni12Pn7 (Pn = P, As) by measuring the electrical resistivity, magnetization, specific heat and partial fluorescence yield x-ray absorption spectroscopy (PFY-XAS). These demonstrate a crossover upon reducing the unit cell volume, from an intermediate valence state in Yb2Ni12As7 to a heavy-fermion paramagnetic state in Yb2Ni12P7, where the Yb is nearly trivalent. Application of pressure to Yb2Ni12P7 suppresses TFL, the temperature below which Fermi liquid behavior is recovered, suggesting the presence of a quantum critical point (QCP) under pressure. However, while there is little change in the Yb valence of Yb2Ni12P7 up to 30 GPa, there is a strong increase for Yb2Ni12As7 under pressure, before a near constant value is reached. These results indicate that any magnetic QCP in this system is well separated from strong valence fluctuations. The pressure dependence of the valence and lattice parameters of Yb2Ni12As7 are compared and at 1 GPa, there is an anomaly in the unit cell volume as well as a change in the slope of the Yb valence, indicating a correlation between structural and electronic changes.
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A new modular recurrent neural network (MRNN)- based speech-recognition method that can recognize the entire vocabulary of 1280 highly confusable Mandarin syllables is proposed in this paper. The basic idea is to first split the complicated task, in both feature and temporal domains, into several much simpler subtasks involving subsyllable and tone discrimination, and then to use two weighting RNN's to generate several dynamic weighting functions to integrate the subsolutions into a complete solution. The novelty of the proposed method lies mainly in the use of appropriate a priori linguistic knowledge of simple initial-final structures of Mandarin syllables in the architecture design of the MRNN. The resulting MRNN is therefore effective and efficient in discriminating among highly confusable Mandarin syllables. Thus both the time-alignment and scaling problems of the ANN-based approach for large-vocabulary speech-recognition can be addressed. Experimental results show that the proposed method and its extensions, the reverse-time MRNN (Rev-MRNN) and bidirection MRNN (Bi-MRNN), all outperform an advanced HMM method trained with the MCE/GPD algorithm in both recognition-rate and system complexity.
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This study developed a novel type of normalization procedure for modulation reflectance spectroscopy experiments to obtain the relative change in the reflectance spectrum, ΔR/R. This technique uses a polymer-dispersed liquid crystal to ensure that the dc component of the signal from the detector remained constant by varying the intensity of the light striking the sample. This method is particularly useful for photoreflectance measurement, which may encounter background problems because of scattered pump light and/or photoluminescence. It does not require a change in the gain of the detector or the use of a variable neutral density filter mounted on a servo-motor.
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Median facial dysplasia affects a subset of patients with cleft lip and palate exhibiting certain characteristics of median facial structure deficiencies without definable gross abnormalities of the brain. The aim of this study was to describe the craniofacial and dental morphology of almost skeletally mature patients with median facial dysplasia. Patients were selected for this retrospective study if they were diagnosed with median facial dysplasia and ≥15 years old. The craniofacial and dental morphology was evaluated by analysing cephalometric and panoramic radiographs. This sample of median facial dysplasia patients (9 males and 11 females; 6 unilateral and 14 bilateral clefts) had a mean age of 16.7 ± 1.9 years. Controls were age-, sex-, cleft type-matched, and nonsyndromic patients. The results showed that in patients with median facial dysplasia, the anterior cranial base and midface were shorter than in controls. The median facial dysplasia inter-orbital distance was shorter and the nasal bone was more retrusive than in controls. All patients with median facial dysplasia had several missing permanent teeth. These features require extensive surgical, orthodontic, and dental rehabilitation procedures.
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Labio Leporino/complicaciones , Fisura del Paladar/complicaciones , Huesos Faciales/anomalías , Anomalías Dentarias/patología , Adolescente , Puntos Anatómicos de Referencia/patología , Anodoncia/patología , Estudios de Casos y Controles , Cefalometría/métodos , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Femenino , Estudios de Seguimiento , Humanos , Incisivo/anomalías , Estudios Longitudinales , Masculino , Mandíbula/patología , Maxilar/patología , Hueso Nasal/anomalías , Hueso Nasal/patología , Órbita/anomalías , Órbita/patología , Radiografía Panorámica , Estudios Retrospectivos , Base del Cráneo/anomalías , Base del Cráneo/patología , Erupción Ectópica de Dientes/patología , Diente Impactado/patología , Adulto JovenRESUMEN
The purpose of this review was to evaluate the effect of 1-stage versus 2-stage palate repair with delayed hard palate closure on facial growth in patients with cleft lip and palate. A literature survey from the PubMed database from January 1966 to December 2007 used the medical subject headings terms 'facial growth', 'cleft lip and palate', 'cephalometry', and '1-stage palate repair' in combination with '2-stage palate repair' or 'delayed hard palate closure'. The Cleft Palate-Craniofacial Journal from 1964 to November 2007 was hand searched. Controlled studies written in English were selected. Two reviewers selected and extracted the data independently and assessed the quality of the studies. On the basis of this search only nine studies were included in this review. All studies were retrospective and non-randomized. Six studies were cross-sectional, and three were longitudinal. Heterogeneity and methodological deficiencies in the studies prevented conclusions regarding stage of palate repair and facial growth. Further well-designed controlled studies and long-term studies are needed, and researchers should focus on the variation in hard palate repair timing before 3 years of age and consider patient speech.