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Transcription regulation in multicellular species is mediated by modular transcription factor (TF) binding site combinations termed cis-regulatory modules (CRMs). Such CRM-mediated transcription regulation determines the gene expression patterns during development. Biologists frequently investigate CRM transcription regulation on gene expressions. However, the knowledge of the target genes and regulatory TFs participating in the CRMs under study is mostly fragmentary throughout the literature. Researchers need to afford tremendous human resources to fully surf through the articles deposited in biomedical literature databases in order to obtain the information. Although several novel text-mining systems are now available for literature triaging, these tools do not specifically focus on CRM-related literature prescreening, failing to correctly extract the information of the CRM target genes and regulatory TFs from the literature. For this reason, we constructed a supportive auto-literature prescreener called Drosophila Modular transcription-regulation Literature Screener (DMLS) that achieves the following: (i) prescreens articles describing experiments on modular transcription regulation, (ii) identifies the described target genes and TFs of the CRMs under study for each modular transcription-regulation-describing article and (iii) features an automated and extendable pipeline to perform the task. We demonstrated that the final performance of DMLS in extracting the described target gene and regulatory TF lists of CRMs under study for given articles achieved test macro area under the ROC curve (auROC) = 89.7% and area under the precision-recall curve (auPRC) = 77.6%, outperforming the intuitive gene name-occurrence-counting method by at least 19.9% in auROC and 30.5% in auPRC. The web service and the command line versions of DMLS are available at https://cobis.bme.ncku.edu.tw/DMLS/ and https://github.com/cobisLab/DMLS/, respectively. Database Tool URL: https://cobis.bme.ncku.edu.tw/DMLS/.
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Minería de Datos , Factores de Transcripción , Animales , Factores de Transcripción/genética , Factores de Transcripción/metabolismo , Minería de Datos/métodos , Drosophila/genética , Drosophila melanogaster/genética , Bases de Datos Genéticas , Regulación de la Expresión Génica , Proteínas de Drosophila/genética , Proteínas de Drosophila/metabolismoRESUMEN
miRNAs (microRNAs) target specific mRNA (messenger RNA) sites to regulate their translation expression. Although miRNA targeting can rely on seed region base pairing, animal miRNAs, including human miRNAs, typically cooperate with several cofactors, leading to various noncanonical pairing rules. Therefore, identifying the binding sites of animal miRNAs remains challenging. Because experiments for mapping miRNA targets are costly, computational methods are preferred for extracting potential miRNA-mRNA fragment binding pairs first. However, existing prediction tools can have significant false positives due to the prevalent noncanonical miRNA binding behaviors and the information-biased training negative sets that were used while constructing these tools. To overcome these obstacles, we first prepared an information-balanced miRNA binding pair ground-truth data set. A miRNA-mRNA interaction-aware model was then designed to help identify miRNA binding events. On the test set, our model (auROC = 94.4%) outperformed existing models by at least 2.8% in auROC. Furthermore, we showed that this model can suggest potential binding patterns for miRNA-mRNA sequence interacting pairs. Finally, we made the prepared data sets and the designed model available at http://cosbi2.ee.ncku.edu.tw/mirna_binding/download.
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MicroARNs , Animales , Humanos , MicroARNs/metabolismo , ARN Mensajero/genética , ARN Mensajero/metabolismo , Algoritmos , Biología Computacional/métodosRESUMEN
This study aims to improve the solubility and bioavailability of daidzein by preparing the ß-cyclodextrin-daidzein/PEG_(20000)/Carbomer_(940) nanocrystals. Specifically, the nanocrystals were prepared with daidzein as a model drug, PEG_(20000), Carbomer_(940), and NaOH as a plasticizer, a gelling agent, and a crosslinking agent, respectively. A two-step method was employed to prepare the ß-cyclodextrin-daidzein/PEG_(20000)/Carbomer_(940) nanocystals. First, the insoluble drug daidzein was embedded in ß-cyclodextrin to form inclusion complexes, which were then encapsulated in the PEG_(20000)/Carbomer_(940) nanocrystals. The optimal mass fraction of NaOH was determined as 0.8% by the drug release rate, redispersability, SEM morphology, encapsulation rate, and drug loading. The inclusion status of daidzein nanocrystals was determined by Fourier transform infrared spectroscopy(FTIR), thermogravimetric analysis(TGA), and X-ray diffraction(XRD) analysis to verify the feasibility of the preparation. The prepared nanocrystals showed the average Zeta potential of(-30.77±0.15)mV and(-37.47±0.64)mV and the particle sizes of(333.60±3.81)nm and(544.60±7.66)nm before and after daidzein loading, respectively. The irregular distribution of nanocrystals before and after daidzein loading was observed under SEM. The redispersability experiment showed high dispersion efficiency of the nanocrystals. The in vitro dissolution rate of nanocrystals in intestinal fluid was significantly faster than that of daidzein, and followed the first-order drug release kinetic model. XRD, FTIR, and TGA were employed to determine the polycrystalline properties, drug loading, and thermal stability of the nanocrystals before and after drug loading. The nanocrystals loaded with daidzein demonstrated obvious antibacterial effect. The nanocrystals had more significant inhibitory effects on Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa than daidzein because of the improved solubility of daidzein. The prepared nanocrystals can significantly increase the dissolution rate and oral bioavailability of the insoluble drug daidzein.
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Resinas Acrílicas , Nanopartículas , Hidróxido de Sodio , Escherichia coliRESUMEN
Layered transition metal oxide cathodes have been one of the dominant cathodes for lithium-ion batteries with efficient Li+ intercalation chemistry. However, limited by the weak layered interaction and unstable surface, mechanical and chemical failure plagues their electrochemical performance, especially for Ni-rich cathodes. Here, adopting a simultaneous elemental-structural atomic arrangement control based on the intrinsic Ni-Co-Mn system, the surface role is intensively investigated. Within the invariant oxygen sublattice of the crystal, a robust surface with the synergistic concentration gradient and layered-spinel intertwined structure is constructed on the model single-crystalline Ni-rich cathode. With mechanical strain dissipation and chemical erosion suppression, the cathode exhibits an impressive capacity retention of 82 % even at the harsh 60 °C after 150â cycles at 1â C. This work highlights the coupling effect of structure and composition on the chemical-mechanical properties, and the concept will spur more researches on the cathodes that share the same sublattice.
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KEY MESSAGE: Analysis of the flower color formation mechanism of 'Rhapsody in Blue' by BF and WF transcriptomes reveals that RhF3'H and RhGT74F2 play a key role in flower color formation. Rosa hybrida has colorful flowers and a high ornamental value. Although rose flowers have a wide range of colors, no blue roses exist in nature, and the reason for this is unclear. In this study, the blue-purple petals (BF) of the rose variety 'Rhapsody in Blue' and the white petals (WF) of its natural mutant were subjected to transcriptome analysis to find genes related to the formation of the blue-purple color. The results showed that the anthocyanin content was significantly higher in BF than in WF. A total of 1077 differentially expressed genes (DEGs) were detected by RNA-Seq analysis, of which 555 were up-regulated and 522 were down-regulated in the WF vs. BF petals. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses of the DEGs revealed that a single gene up-regulated in BF was related to multiple metabolic pathways including metabolic process, cellular process, protein-containing complex, etc. Additionally, the transcript levels of most of the structural genes related to anthocyanin synthesis were significantly higher in BF than in WF. Selected genes were analyzed by qRT-PCR and the results were highly consistent with the RNA-Seq results. The functions of RhF3'H and RhGT74F2 were verified by transient overexpression analyses, and the results confirmed that both affect the accumulation of anthocyanins in 'Rhapsody in Blue'. We have obtained comprehensive transcriptome data for the rose variety 'Rhapsody in Blue'. Our results provide new insights into the mechanisms underlying rose color formation and even blue rose formation.
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Rosa , Transcriptoma , Antocianinas/metabolismo , Rosa/genética , Fitomejoramiento , Perfilación de la Expresión Génica/métodosRESUMEN
A single-crystalline Ni-rich (SCNR) cathode with a large particle size can achieve higher energy density, and is safer, than polycrystalline counterparts. However, synthesizing large SCNR cathodes (>5 µm) without compromising electrochemical performance is very challenging due to the incompatibility between Ni-rich cathodes and high temperature calcination. Herein, we introduce Vegard's Slope as a guide for rationally selecting sintering aids, and we successfully synthesize size-controlled SCNR cathodes, the largest of which can be up to 10 µm. Comprehensive theoretical calculation and experimental characterization show that sintering aids continuously migrate to the particle surface, suppress sublattice oxygen release and reduce the surface energy of the typically exposed facets, which promotes grain boundary migration and elevates calcination critical temperature. The dense SCNR cathodes, fabricated by packing of different-sized SCNR cathode particles, achieve a highest electrode press density of 3.9 g cm-3 and a highest volumetric energy density of 3000 Wh L-1. The pouch cell demonstrates a high energy density of 303 Wh kg-1, 730 Wh L-1 and 76% capacity retention after 1200 cycles. SCNR cathodes with an optimized particle size distribution can meet the requirements for both electric vehicles and portable devices. Furthermore, the principle for controlling the growth of SCNR particles can be widely applied when synthesizing other materials for Li-ion, Na-ion and K-ion batteries.
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BACKGROUND: Our aim was to evaluate the cutoff values of RHE and MRV as markers to diagnose IDA in healthy Han ethnic adults of Chengdu. METHODS: A total of 263 Han adults who needed bone marrow aspiration for diagnosis were enrolled according to the inclusive and exclusive criteria. The cutoff values of RHE and MRV were determined by receiver operating curves. RESULTS: According to statistical analysis, the cutoff values of RHE and MRV in male and female groups were 26.75 pg, 89.60 fL and 26.65 pg, 88.55 fL respectively. The areas under the curve (AUC) of RHE and MRV were 0.941, 0.939 and 0.925, 0.909 in male and female groups, respectively. CONCLUSIONS: In our study, we explored the cutoff values of RHE and MRV to diagnose IDA in the Han ethnic population in Chengdu for the first time.
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Anemia Ferropénica , Adulto , Femenino , Humanos , Masculino , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/epidemiología , Área Bajo la Curva , Pueblos del Este de Asia , Índices de EritrocitosRESUMEN
Metazoa gene expression is controlled by modular DNA segments called cis-regulatory modules (CRMs). CRMs can convey promoter/enhancer/insulator roles, generating additional regulation layers in transcription. Experiments for understanding CRM roles are low-throughput and costly. Large-scale CRM function investigation still depends on computational methods. However, existing in silico tools only recognize enhancers or promoters exclusively, thus accumulating errors when considering CRM promoter/enhancer/insulator roles altogether. Currently, no algorithm can concurrently consider these CRM roles. In this research, we developed the CRM Function Annotator (CFA) model. CFA provides complete CRM transcriptional role labeling based on epigenetic profiling interpretation. We demonstrated that CFA achieves high performance (test macro auROC/auPRC = 94.1%/90.3%) and outperforms existing tools in promoter/enhancer/insulator identification. CFA is also inspected to recognize explainable epigenetic codes consistent with previous findings when labeling CRM roles. By considering the higher-order combinations of the epigenetic codes, CFA significantly reduces false-positive rates in CRM transcriptional role annotation. CFA is available at https://github.com/cobisLab/CFA/.
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Aprendizaje Profundo , Regiones Promotoras Genéticas/genética , Epigénesis Genética/genéticaRESUMEN
Single-crystalline Ni-rich cathodes with high capacity have drawn much attention for mitigating cycling and safety crisis of their polycrystalline analogues. However, planar gliding and intragranular cracking tend to occur in single crystals with cycling, which undermine cathode integrity and therefore cause capacity degradation. Herein, we intensively investigate the origin and evolution of the gliding phenomenon in single-crystalline Ni-rich cathodes. Discrete or continuous gliding forms are revealed with new surface exposure including the gliding plane (003) and reconstructed (-108) under surface energy drive. It is also demonstrated that the gliding process is the in-plane migration of transition metal ions, and reducing oxygen vacancies will increase the migration energy barrier by which gliding and microcracking can be restrained. The designed cathode with less oxygen deficiency exhibits outstanding cycling performance with an 80.8% capacity retention after 1000 cycles in pouch cells. Our findings provide an insight into the relationship between defect control and chemomechanical properties of single-crystalline Ni-rich cathodes.
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High-nickel (Ni ≥ 90%) cathodes with high specific capacity hold great potential for next-generation lithium-ion batteries (LIBs). However, their practical application is restricted by the high interfacial reactivity under continuous air erosion and electrolyte assault. Herein, a stable high-nickel cathode is rationally designed via in situ induction of a dense amorphous Li2 CO3 on the particle surface by a preemptive atmosphere control. Among the residual lithium compounds, Li2 CO3 is the most thermodynamically stable one, so a dense Li2 CO3 coating layer can serve as a physical protection layer to isolate the cathode from contact with moist air. Furthermore, amorphous Li2 CO3 can be transformed into a robust F-rich cathode electrolyte interphase (CEI) during cycling, which reinforces the cathode's interfacial stability and improves the electrochemical performance. The assembled coin cell with this modified cathode delivers a high discharge capacity of 232.4 mAh g-1 with a superior initial Coulombic efficiency (CE) of 95.1%, and considerable capacity retention of 90.4% after 100 cycles. Furthermore, no slurry gelation occurs during the large-scale electrode fabrication process. This work opens a valuable perspective on the evolution of amorphous Li2 CO3 in LIBs and provides guidance on protecting unstable high-capacity cathodes for energy-storage devices.
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Single-crystalline Ni-rich cathodes are promising candidates for the next-generation high-energy Li-ion batteries. However, they still suffer from poor rate capability and low specific capacity due to the severe kinetic hindrance at the nondilute state during Li+ intercalation. Herein, combining experiments with density functional theory (DFT) calculations, we demonstrate that this obstacle can be tackled by regulating the oxidation state of nickel via injecting high-valence foreign Ta5+ . The as-obtained single-crystalline LiNi0.8 Co0.1 Mn0.1 O2 delivers a high specific capacity (211.2â mAh g-1 at 0.1 C), high initial Coulombic efficiency (93.8 %), excellent rate capability (157â mAh g-1 at 4 C), and good durability (90.4 % after 100 cycles under 0.5 C). This work provides a strategy to mitigate the Li+ kinetic hindrance of the appealing single-crystalline Ni-rich cathodes and will inspire peers to conduct an intensive study.
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Droplet-based transport driven by surface tension has been explored as an automated pumping source for several biomedical applications. This paper presented a simple and fast superhydrophobic modify and patterning approach to fabricate various open-surface platforms to manipulate droplets to achieve transport, mixing, concentration, and rebounding control. Several commercial reagents were tested in our approach, and the Glaco reagent was selected to create a superhydrophobic layer; laser cutters are utilized to scan on these superhydrophobic surface to create gradient hydrophilic micro-patterns. Implementing back-and-forth vibrations on the predetermined parallel patterns, droplets can be transported and mixed successfully. Colorimetry of horseradish peroxidase (HRP) mixing with substrates also reduced the reaction time by more than 5-times with the help of superhydrophobic patterned chips. Besides, patterned superhydrophobic chips can significantly improve the sensitivity of colorimetric glucose-sensing by more than 10 times. Moreover, all bioassays were distributed homogeneously within the region of hydrophilic micropatterns without the coffee-ring effect. In addition, to discuss further applications of the surface wettability, the way of controlling the droplet impacting and rebounding phenomenon was also demonstrated. This work reports a rapid approach to modify and patterning superhydrophobic films to perform droplet-based manipulations with a lower technical barrier, higher efficiency, and easier operation. It holds the potential to broaden the applications of open microfluidics in the future.
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Li+-conductive ceramic oxide electrolytes, such as garnet-structured Li7La3Zr2O12, have been considered as promising candidates for realizing the next-generation solid-state Li-metal batteries with high energy density. Practically, the ceramic pellets sintered at elevated temperatures are often provided with high stiffness yet low fracture toughness, making them too brittle for the manufacture of thin-film electrolytes and strain-involved operation of solid-state batteries. The ceramic powder, though provided with ductility, does not yield satisfactorily high Li+ conductivity due to poor ion conduction at the boundaries of ceramic particles. Here we show, with solid-state nuclear magnetic resonance, that a uniform conjugated polymer nanocoating formed on the surface of ceramic oxide particles builds pathways for Li+ conduction between adjacent particles in the unsintered ceramics. A tape-casted thin-film electrolyte (thickness: <10 µm), prepared from the polymer-coated ceramic particles, exhibits sufficient ionic conductivity, a high Li+ transference number, and a broad electrochemical window to enable stable cycling of symmetric Li/Li cells and all-solid-state rechargeable Li-metal cells.
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BACKGROUND: The goals of this study are to determine the RIs of RHE, MRV, and reticulocyte count percentage (RET) in healthy Han ethnic adults of Chengdu. METHODS: A total of 691 Han adults without iron deficiency, aged 20 to 90 years were included in the study. The RIs were defined as mean ± 1.96 SD. RESULTS: After statistical analysis the RIs were 29.95 - 35.12 pg (RHE), 99.76 - 115.97 fL (MRV) in males and 29.77 - 34.52 pg (RHE), 98.72 - 113.83 fL (MRV) in females. RET reference interval was 0.485 - 1.504%. CONCLUSIONS: In our study, we established RHE, MRV, and RET RIs of the Han ethnic population in Chengdu for the first time.
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Anemia Ferropénica , Reticulocitos , Adulto , Etnicidad , Femenino , Hemoglobinas/análisis , Humanos , Masculino , Valores de Referencia , Recuento de Reticulocitos , Reticulocitos/químicaRESUMEN
BACKGROUND: In order to establish suitable reference intervals (RIs) of serum cytokeratin-19 fragment (Cyfra211) and neuron specific enolase (NSE) for the healthy Chinese population in Chengdu, China, an indirect method was developed using the data from the people presented for routine health check-up. METHODS: All results for 4,988 healthy persons serum cytokeratin-19 fragment and 3,293 healthy persons neuron specific enolase were collected in our laboratory information system between January 2016 and December 2018. Outliers were identified and excluded using the stem-and-leaf and box plot methods. Mann-Whitney U test was used to observe the difference between sexes. Spearman's rank correlation analysis was used to evaluate the correlation between serum results and age. The RIs were defined by nonparametric 95th percentile interval. RESULTS: After statistical analysis the indirect RIs were 0.0 - 3.70 ng/mL (Cyfra211) and 0 - 17.26 ng/mL (NSE) in males and 0.0 - 3.35 ng/mL (Cyfra211) and 0.0 - 16.29 ng/mL (NSE) in females. Cyfra211 and NSE levels in males and females had no correlation with age. Therefore, there was no need to establish RIs according to age group. RIs of Cyfra211 and NSE were verified and passed the verification in the end. CONCLUSIONS: Using health check-up persons' laboratory data values is a relatively easy and cheap method of establishing laboratory specific references. This method deserves to be promoted and applied by other clinical laboratories.
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Antígenos de Neoplasias/sangre , Técnicas de Laboratorio Clínico/métodos , Estado de Salud , Queratina-19/sangre , Fosfopiruvato Hidratasa/sangre , Vigilancia de la Población/métodos , Adulto , Anciano , Anciano de 80 o más Años , Pueblo Asiatico , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Adulto JovenRESUMEN
Catalytic efficiency is a crucial index for electrodes in flow batteries, and tremendous efforts have been devoted to exploring catalysts with as many reaction zones as possible. Nevertheless, the space between the reaction sites, especially for interstitial space utilization, is usually ignored and challengeable to exploit owing to the balance between the catalytic efficiency and structural stability. Herein, a three-dimensional conducting network was constructed via a nitrogen-rich carbon film-bridged graphite felt framework (GF@N-C) to maximize its electrocatalytic effectiveness toward redox species. As the electrode, GF@N-C exhibits a superior rate constant and catalytic efficiency at 370 mA cm-2 and enables the vanadium redox flow battery to operate steadily at 200 mA cm-2 with an energy efficiency of 74.3% and a discharge specific capacity of 23 A h L-1. It is anticipated that the conducting network with optimized space utilization and catalysis will provide guidance for the design of high-efficiency electrodes and advance their development in flow batteries.
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The development of a three-dimensionally flexible, large-surface area, high-conductivity electrode is important to improve the low conductivity and utilization of active materials and restrict the shuttle of long-chain polysulfides in Li-polysulfide batteries. Herein, we constructed an integrated three-dimensional carbon nanotube forest/carbon cloth electrode with heteroatom doping and high electrical conductivity. The as-constructed electrode provides strong trapping on the polysulfide species and fast charge transfer. Therefore, the Li-polysulfide batteries with as-constructed electrodes achieved high specific capacities of â¼1200 and â¼800 mA h g-1 at 0.1 and 1 C, respectively. After 300 cycles at 0.5 C, a specific capacity of 623 mA h g-1 was retained.
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In the present work we undertook the complete mitochondrial genome sequencing of an important hepatocellular carcinoma model inbred Sprague-Dawley strain for the first time. The total length of the mitogenome was 16,308 bp. It harbored 13 protein-coding genes, two ribosomal RNA genes, 22 transfer RNA genes and one non-coding control region (D-loop region). The mutation events were also reported.
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Carcinoma Hepatocelular , Modelos Animales de Enfermedad , Genoma Mitocondrial/genética , Neoplasias Hepáticas , Ratas Sprague-Dawley/genética , Animales , ADN Mitocondrial/química , ADN Mitocondrial/genética , Femenino , Humanos , Mitocondrias/genética , Proteínas Mitocondriales/genética , Mutación , ARN Ribosómico/genética , ARN de Transferencia/genética , Ratas , Análisis de Secuencia de ADNRESUMEN
OBJECTIVE: The role of Ommaya reservoir implantation in children with tuberculous meningitis hydrocephalus (TBMH) has been seldomly reported. Therefore, we performed this study to determine the role of the Ommaya reservoir in the treatment of children with TBMH. METHODS: We retrospectively analyzed the effects of Ommaya reservoir implantation in 12 children with TBMH. Intracapsular puncture of the reservoir was performed for draining the cerebrospinal fluid and the TBM was treated by intraventricular injection of isoniazid. RESULTS: The ideal treatment outcome was observed in nine (75 %) of the 12 children; two (16.7 %) children developed serious disabilities and one of them (8.3 %) eventually died. The treatment method was effective for all six (100 %) children with Palur grade II TBM but showed no effect in three (50 %) children with grade III and IV TBM. The number of leukocytes in the cerebrospinal fluid decreased to 20 × 10(6)/L (75 %) within 2 weeks after implantation of the reservoirs. Finally, the Ommaya reservoirs in eight children were removed but were retained in four children. Four children had to undergo ventriculoperitoneal shunt. CONCLUSION: Ommaya reservoir implantation has been shown to be effective in treating children with TBMH. This method may be largely suitable for children with early grade II TBM or partly in children with grade III TBM who have mild or moderate hydrocephalus that can alleviate after short-term treatment. Thus, a good proportion of children who undergo Ommaya reservoir implantation can avoid ventriculoperitoneal shunt surgery.
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Antituberculosos/administración & dosificación , Derivaciones del Líquido Cefalorraquídeo/instrumentación , Sistemas de Liberación de Medicamentos , Hidrocefalia/cirugía , Tuberculosis Meníngea/terapia , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Hidrocefalia/etiología , Lactante , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Tuberculosis Meníngea/complicacionesRESUMEN
OBJECTIVE: Ventriculoperitoneal shunting is the current mainstay of treatment for children with tuberculous meningitis with hydrocephalus. However, ventriculoperitoneal shunting is highly associated with complications, and more importantly, long-term, indwelling shunt devices may adversely affect children's spirits and psychological health. Therefore, there is clearly a need to explore methods of CSF diversion to avoid ventriculoperitoneal shunting. METHODS: We studied 6 cases of children with tuberculous meningitis with hydrocephalus in whom external drainage from the ventricle to the subcutaneous abdomen was adopted. Outcomes were assessed over a 6- to 9-month follow-up period based on improvements in radiological features, such as ventricular morphology, as well as the need for ventriculoperitoneal shunting and any complications. RESULTS: The drainage tubes were removed in 4 cases 4-6 months after the modified external ventricular drainage surgery, and 2 patients went on to receive a ventriculoperitoneal shunt. All patients' CSF protein and cell counts returned to normal, and imaging showed improved ventricular morphology and no intracranial secondary infection. CONCLUSION: In our preliminary study, the modified ventricular drainage device can produce satisfactory outcomes and relatively safe effects and may help some patients to avoid ventriculoperitoneal shunt placement.