The effect of the electronic platform of menopausal health screen system and counseling intervention on the empowerment of menopausal women: a quasi-experimental study.

This article explores the efficacy of the electronic platform of menopausal health screen system (EPMHSS) and counseling intervention on the empowerment of menopausal women, seventy four participants were randomly assigned to this study. The intervention group significantly relieved menopausal disturbance, reduced uncertainty, increased health behaviors, and decreased waist circumference after the fourth and eighth week compared with the control group. Our results proved that EPMHSS and counseling would help menopausal women to become more aware of their health, as a result, effectively empowered themselves to take actions for improving their health.

Comprehensive analysis on the assembly of a dielectric-filled crossed compound parabolic concentrator and a concentrator photovoltaic module.

A comprehensive analysis on assembly of dielectric-filled 3D crossed compound parabolic concentrator (CCPC) and concentrator photovoltaic (CPV) module is presented by embracing the consideration of spectral irradiance, incident angles, and breakdown optical losses. The theoretical modeling is supported by experimental validation to evaluate the optical efficiency of the CCPC-CPV module. From our analysis, Fresnel reflection loss of 11.27%, absorption loss of 11.59%, and other losses of 4.79% are obtained to reach the total loss of 27.65% or equivalent solar concentration ratio (SCR) of 4.65 suns out of a geometrical concentration ratio (GCR) of 5.998 suns. Then, indoor and outdoor measurements prove the actual SCR of 4.57 and 4.48 suns, respectively.

Differing Requirements for MALT1 Function in Peripheral B Cell Survival and Differentiation.

During a T cell-dependent immune response, formation of the germinal center (GC) is essential for the generation of high-affinity plasma cells and memory B cells. The canonical NF-κB pathway has been implicated in the initiation of GC reaction, and defects in this pathway have been linked to immune deficiencies. The paracaspase MALT1 plays an important role in regulating NF-κB activation upon triggering of Ag receptors. Although previous studies have reported that MALT1 deficiency abrogates the GC response, the relative contribution of B cells and T cells to the defective phenotype remains unclear. We used chimeric mouse models to demonstrate that MALT1 function is required in B cells for GC formation. This role is restricted to BCR signaling where MALT1 is critical for B cell proliferation and survival. Moreover, the proapoptotic signal transmitted in the absence of MALT1 is dominant to the prosurvival effects of T cell-derived stimuli. In addition to GC B cell differentiation, MALT1 is required for plasma cell differentiation, but not mitogenic responses. Lastly, we show that ectopic expression of Bcl-2 can partially rescue the GC phenotype in MALT1-deficient animals by prolonging the lifespan of BCR-activated B cells, but plasma cell differentiation and Ab production remain defective. Thus, our data uncover previously unappreciated aspects of MALT1 function in B cells and highlight its importance in humoral immunity.

Novel Neovaginoplasty Using Rudimentary Uterine Horn Serosa and Pelvic Peritoneum as a Graft in Müllerian Anomalies with Vaginal Agenesis.

STUDY OBJECTIVE: To study the outcome of a novel method of laparoscopic neovaginal reconstruction using rudimentary uterine horn serosa and the pelvic peritoneum as a graft. DESIGN: Canadian Task Force classification II-1. SETTING: A university hospital. PATIENTS: A retrospective study of 14 patients from 2000 to 2014 of patients with vaginal agenesis who underwent laparoscopic neovagina reconstruction using rudimentary uterine horn serosa and the pelvic peritoneum as a graft. INTERVENTION: Patients with vaginal agenesis associated with müllerian agenesis who requested surgery. Tertiary referral center and laparoscopic unit. The creation of a neovagina using rudimentary uterine horn serosa and the pelvic peritoneum as a graft via a combined laparoscopic and vaginal route. MEASUREMENTS AND MAIN RESULTS: Data were collected retrospectively including postoperative vaginal length and width, complications, stenosis or reoperations, dyspareunia, and sexual satisfaction. There were no major complications from the surgery with no rectal perforation or bladder or ureteric injury. The postoperative mean (±SD) vaginal length was 6.0±0.7 cm and a width of 2 fingerbreadths. The mean operation time was 142.7±45.9 min. Median blood loss was 100 ml (range: 10 to 300 mL). The mean duration of the hospital stay was 6.6±1.6 days. The follow-up period ranged from 3 to 84 months with a median follow-up of 11 months. CONCLUSION: Lee's method of neovaginoplasty using rudimentary uterine horn serosa and the pelvic peritoneum as a graft is a good method for neovagina creation with minimal morbidity, fast recovery, and minimal complications. This method results in good anatomic and functional outcome and can be a method that is widely used.

Severe infections in patients with lupus nephritis treated with immunosuppressants: A retrospective cohort study.

AIM: Lupus nephritis (LN) is associated with significant morbidity and mortality and hence usually treated aggressively with immunosuppressants. This predisposes LN patients to increased infections, yet few studies have evaluated LN patients for infective complications. We aimed to describe the epidemiology and identify risk factors for infections requiring hospitalization among patients with biopsy-proven LN. METHODS: This was a single-centre retrospective cohort study of patients with biopsy-proven LN between 1 January 2000 and 31 May 2009. Patients were excluded if they were <16 years old at time of biopsy, had previous kidney transplant or if pharmacotherapy data were incomplete. Hospitalizations for infections, bacteraemia and polymicrobial infections were recorded until patients' last visit or when they received immunosuppression for non-glomerulonephritis indications, such as solid organ transplant or chemotherapy. RESULTS: We studied 189 patients who had biopsy-proven lupus nephritis. Median age at diagnosis was 36.9 (IQR: 27.4, 47.5) years and 82% were female. Most patients received at least one immunosuppressant after LN diagnosis, including glucocorticosteroids in 94.2%. One hundred and four patients (60.3%) had at least one hospitalization for infection at 11 (1, 53) months from diagnosis. Bacteraemia occurred in 26 patients (13.8%) and 32 patients (16.9%) had polymicrobial infections. On multivariate analysis, LN relapse was associated with hospitalization for infection (OR 2.33 (1.18, 4.60), P = 0.01) and bacteraemia (OR 3.47 (1.05, 11.45), P = 0.04). Infection-related mortality occurred in 10 patients (5.3%). CONCLUSION: Serious infections are common among patients with LN and are associated with mortality.

[Developing and Verifying the Validity and Reliability of the Electronic Menopausal Health Screen System].

BACKGROUND: Menopausal women are in a transitional phase between health and sickness. Although the highest standards of menopausal care include clinical assessment and patient education on menopausal symptoms, current practices lack integrated care that aim to prevent chronic diseases for which menopause is a predisposing factor. PURPOSE: To integrate menopausal disturbances; to evaluate the risk factors for osteoporosis, cardiovascular disease, and diabetes; and to create a reliable and effective electronic menopausal health screen system (EMHSS). METHODS: The research was conducted in the four stages of assessment and analysis, design, development, and pretest stage in order to explore the effectiveness of the developed EMHSS. RESULTS: The EMHSS has a high degree of reliability and validity. Analysis found an expert validity of .97~.99, content validity of .99, and test-retest reliabilities of .80~.96 (Pearson's correlation) and .79~.96 (intra-class correlation). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The EPMHSS was developed using cross-disciplinary collaboration among nursing staff, medical practitioners, and information engineers in order to screen menopausal women. The EPMHSS provides tailored health education content for patients in a timely manner and compiles historical assessment data that may be referenced by nursing staff when providing health consultations and by physicians when delivering diagnoses and treatment.

First Report of bla(IMP-8) in Raoultella planticola.

Two carbapenem-resistant Raoultella planticola clinical isolates were isolated from patients with pneumonia and Port-A catheter-related bacteremia, respectively, in Taiwan. These isolates remained susceptible to fluoroquinolone, aminoglycoside, and colistin. Though the two isolates had the same antibiogram, plasmidic carbapenemase blaIMP-8, class 1 integron cassette (dfrA12-orfF-aadA2), and qnrB2, they had different pulsed-field gel electrophoresis patterns, plasmid sizes, and outer membrane protein loss profiles. To our knowledge, this is the first report of blaIMP-8 found in R. planticola. Interestingly, blaIMP-8 is the most common carbapenemase found in Klebsiella pneumoniae in Taiwan. In the literature, carbapenemase genes in R. planticola in each country were also found in carbapenem-resistant Enterobacteriaceae in the same country.

pH-controlled multiple chiral inversion that induces molecular dimerization in a gold(I)-cobalt(III) coordination system with L-cysteinate.

Herein, a unique coordination system that exhibits multiple chiral inversions and molecular dimerization in response to a subtle pH change is reported. Treatment of (Δ)2-H3[Au3Co2(L-cys)6] (H3[1 a]) with [Co3(aet)6](NO3)3 (aet=2-aminoethanethiolate) in water at pH 7 gave a 1:1 complex salt of [Co3(aet)6](3+) and [1 a](3-), retaining the Au(I)3Co(III)2 structure and chiral configurations of [1 a](3-). Similar treatment at pH 9 led to not only the inversion of all of the chiral Co(III) and S centers but also the dimerization of [1 a](3-), giving a 2:1 complex salt of [Co3(aet)6](3+) and (Λ)4(R)12-[Au6Co4(L-cys)12](6-) ([2](6-)). When dissociated from [Co3(aet)6](3+) in solution, [2](6-) was converted to (Λ)2(R)6-[Au3Co2(L-cys)6](3-) ([1 b](3-)) with retention of the chiral configurations.

Life experiences among obstructive sleep apnoea patients receiving continuous positive airway pressure therapy.

AIMS AND OBJECTIVES: To generate a descriptive theoretical framework for experiences among obstructive sleep apnoea (OSA) patients undergoing continuous positive airway pressure (CPAP) therapy. BACKGROUND: Insufficient information is available about subjective experiences among OSA patients undergoing CPAP therapy. This study aims to address that lack of insight into patients' feelings. DESIGN: A qualitative study using the grounded theory method to establish a descriptive theory. METHODS: Twenty-two Taiwanese OSA patients undergoing CPAP therapy participated in comprehensive interviews. RESULTS: The patients, aged 37-68 years, participated in wide-ranging interviews. 'Living with CPAP' was the core theme describing the life experiences of OSA patients undergoing CPAP. Health warnings were identified as the antecedent condition, with subcategories including the following: severe snoring, choking and feelings of a terrible death during sleep, day and night sleepiness, easy tiredness, decreased memory, poor sleep, dry mouth, dry throat, headache, high blood pressure, poor blood sugar level control and falling asleep while driving. Analyses indicated seven subcategories of OSA patients with CPAP: (1) seeking medical information, (2) difficulties with CPAP, (3) trial and error for the 'right' CPAP, (4) long scheduled waiting times, (5) wondering, (6) high expectations, and (7) getting back good health. CONCLUSIONS: The results will assist healthcare providers with references for OSA health care based on patients' subjective perspectives. RELEVANCE TO CLINICAL PRACTICE: After interpreting and analysing results, suggestions include the following: (1) provide medical resource education for outpatients and inpatients to access self-care knowledge regarding OSA; (2) institute professional personnel for providing OSA health education in sleep clinics or sleep centres; (3) develop hospital standards for sleep examination processes to shorten waiting times; (4) establish case management for pursuing OSA patients receiving CPAP; (5) arrange regular forums for patients to share their experiences; and (6) provide community health education to promote awareness of snoring issues.

Relieving my discomforts safely: the experiences of discontinuing HRT among menopausal women.

AIM AND OBJECTIVES: To generate a descriptive theoretical framework about the experiences of women who discontinued hormone replacement therapy. BACKGROUND: Some menopausal women would depend on hormone replacement therapy for relieving their menopausal symptoms. However, most of them feared of hormone replacement therapy's side effects and tried to discontinue hormone replacement therapy immediately. How did these women self-manage their discomforts without using dependent medicine--hormone replacement therapy? There are few studies conducted on this issue. DESIGN: A grounded theory research was applied. METHODS: Nineteen Taiwanese women discontinuing hormone replacement therapy for three months, aged 45 to 67 years, participated in face-to-face audio-taped interviews. Data collection, and coding of interviews, and data analysis occurred simultaneously. All conversations were audio-recorded and then transcribed as verbatim text. The constant comparative method was used to analyse the interview data. RESULTS: 'Relieving my discomforts safely' was the core theme for describing and guiding the process of discontinuing hormone replacement therapy. 'Immediately discontinuing hormone replacement therapy--it would hurt my body' was identified as the antecedent condition. Analyses showed five dimensions to the women's relieving my discomforts safely: (1) symptoms bothered me again, (2) negative emotions, (3) learning to let it go, (4) trying to use nonhormone replacement therapy or products and (5) choosing safely therapies as first priority. Finally, some women would choose their suitable nonhormone replacement therapy way, and some women would reuse hormone replacement therapy cautiously. CONCLUSIONS: 'Relieving my discomforts safely' was the first-priority consideration for the menopausal women discontinuing hormone replacement therapy. It is the challenge to establish the health programme or management for helping these women felt safety and security to relieve their menopausal symptoms by using hormone replacement therapy or nonhormone replacement therapy. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers need to empower women the rights of decision-making of using hormone replacement therapy and assist them in monitoring their health status to reduce their fear and uncertainty.

Effectiveness of telephone-based counseling for improving the quality of life among middle-aged women.

Perimenopausal women may encounter multidimensional changes that influence their quality of life. Our purpose in this study was to evaluate the long-term effects of telephone counseling as a method of intervention for menopausal women. A parallel group controlled trial was designed. The intervention group showed a significant increase in self-health management at the four- and eight-month follow-up evaluations. The quality of life in the intervention group was significantly improved when measured during the eighth and twelfth months. Results of this study can be used as a basis for practical implementation of the telephone counseling service in middle-aged women elsewhere.

Chromosome X-encoded Cancer/Testis antigens are less frequently expressed in non-seminomatous germ cell tumors than in seminomas.

Cancer/Testis (CT) antigens are normally only expressed in germ cells and yet are aberrantly activated in a wide variety of human cancers. Most chromosome X-encoded CT antigens (CT-X) show restricted expression in pre-meiotic germ cells in adult testis, except for the expression of SPANX in post-meiotic germ cells. In the present study, the expression of eight CT-X antigens (MAGE-A, NY-ESO-1, GAGE, MAGE-C1/CT7, MAGE-C2/CT10, CT45, SAGE1, and SPANX) in non-seminomatous germ cell tumors was evaluated immunohistochemically, including 24 embryonal carcinomas, 20 yolk sac tumors, 9 teratomas, and 3 choriocarcinomas, and the results were compared to our previous study of 77 classic seminomas and 2 spermatocytic seminomas. SPANX was not detected in any germ cell tumors tested. Spermatocytic seminoma showed strong expression of all CT-X antigens tested (except SPANX), reflecting their origin from adult CT-Xpositive pre-meiotic germ cells. Classic seminomas, originating from prenatal gonocytes, showed widely variable frequency of CT-X antigen expression, ranging from > 80% (CT7, CT10, CT45, and GAGE), 63% (MAGE-A), 18% (NY-ESO-1) to only 4% (SAGE1). In comparison, non-seminomatous germ cell tumors expressed CT-X antigens much less frequently and usually only in small subsets of tumor cells. Intratubular germ cell neoplasia (ITGCN) were mostly CT-X-negative, even in CT-X positive classic seminomas. These findings indicate that CT-X antigens are not expressed in the fetal precursor cells for germ cell tumors, and their expression likely reflects germ cell differentiation of the neoplastic cells (in seminomas) or aberrant gene activation as cancer antigens (in non-seminomatous tumors).

Mediating effects of aryl-hydrocarbon receptor and RhoA in altering brain vascular integrity: the therapeutic potential of statins.

We have demonstrated previously that focal adhesion kinase (FAK)/RhoA alteration by the aryl-hydrocarbon receptor (AhR) agonist 3-methylcholanthrene (3MC) is involved in the antimigratory effects of 3MC in human umbilical vascular endothelial cells. Here, we identified that signaling properties and molecular mechanisms of RhoA/ß-catenin were both implicated in alterations to blood-brain barrier integrity. The mechanisms of action were the down-regulation of integrin, the extracellular matrix, and adherens junction stability. PTEN phosphorylation by 3MC-mediated AhR/RhoA activation increased the proteasomal degradation of ß-catenin through PKCδ/pGSK3ß-mediated ß-catenin phosphorylation; the crucial roles of AhR/RhoA in this process were verified by using gain- or loss-of-function experiments. The decrease in ß-catenin led to decreased expression of fibronectin and α5ß1 integrin. Additionally, protein interactions among FAK, VE-cadherin, vinculin, and ß-actin were simultaneously decreased, resulting in adherens junction instability. Novel functional TCF/LEF1 binding sites in the promoter regions of fibronectin and α5/ß1 integrin were identified by electrophoretic mobility shift and chromatin immunoprecipitation assays. The results indicate that the binding activities of ß-catenin decreased in mouse cerebrovascular endothelial cells treated with 3MC. In addition, simvastatin and pravastatin treatment reversed 3MC-mediated alterations in mouse cerebrovascular endothelial cells by RhoA inactivation, and the in vitro findings were substantiated by an in vivo blood-brain barrier assay. Thus, endothelial barrier dysfunction due to 3MC occurs through AhR/RhoA-mediated ß-catenin down-regulation, which is reversed by simvastatin treatment in vivo.

Analysis of bacterial diversity during the fermentation of inyu, a high-temperature fermented soy sauce, using nested PCR-denaturing gradient gel electrophoresis and the plate count method.

The diversity of bacteria associated with the fermentation of inyu, also known as black soy sauce, was studied through the nested PCR-denaturing gradient gel electrophoresis (DGGE) of samples collected from the fermentation stages of the inyu production process. The DGGE profiles targeted the bacterial 16S rDNA and revealed the presence of Citrobacter farmeri, Enterobacter cloacae, Enterobacter hormaechei, Enterococcus faecium, Klebsiella pneumoniae, Pantoea agglomerans, Salmonella enterica, Serratia marcescens, Staphylococcus sciuri and Weissella confusa. The bacterial compositions of 4 fermented samples were further elucidated using the plate count method. The bacteria isolated from the koji-making stage exhibited the highest diversity; Brachybacterium rhamnosum, E. hormaechei, K. pneumoniae, Kurthia gibsonii, Pantoea dispersa, Staphylococcus gallinarum, Staphylococcus kloosii and S. sciuri were identified. Koji collected during the preincubation stage presented the largest cell counts, and E. hormaechei, K. pneumoniae, E. cloacae and Enterobacter pulveris were identified. In brine samples aged for 7 and 31 days, the majority of the bacteria isolated belonged to 4 Bacillus species, but 4 Staphylococcus species and Delftia tsuruhatensis were also detected. This study demonstrates the benefits of using a combined approach to obtain a more complete picture of microbial populations and provides useful information for the control or development of bacterial flora during inyu fermentation.

Expression of cancer testis antigen CT45 in classical Hodgkin lymphoma and other B-cell lymphomas.

We have shown previously that cancer/testis (CT) antigen, CT45, is expressed in various epithelial cancers at a frequency of <5% to approximately 35%. In this study, the protein expression of CT45 was examined in non-Hodgkin B-cell lymphomas and classical Hodgkin lymphoma by immunohistochemical analysis. Serological response to CT45 was also evaluated by ELISA using CT45 recombinant protein and sera from patients with Hodgkin lymphoma. None of the 80 low-grade B-cell lymphomas, including chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, and mantle cell lymphoma, expressed CT45. In comparison, CT45 was expressed in 28 of 126 (22%) diffuse large B-cell lymphomas (DLBCL). A remarkably high percentage (42/72, 58%) of classical Hodgkin lymphoma contained CT45-positive Reed-Sternberg cells. Nodular sclerosis and mixed-cellularity subtypes had similar frequency of CT45 expression, but most EBV-positive cases were CT45 negative. Gray-zone lymphoma (cases with features of both DLBCL and classical Hodgkin lymphoma) also showed frequent (64%) CT45 expression. Evaluation of reactive lymphoid tissues showed scattered CT45-positive lymphocytes in a single case of florid follicular hyperplasia, raising the possibility that this case was an evolving malignancy. Despite frequent CT45 expression, only 1 of 67 Hodgkin lymphoma patients had detectable anti-CT45 antibodies in the serum, suggesting that the immune response to CT45 may be suppressed. In conclusion, classical Hodgkin lymphoma has the highest frequency of CT45 expression among all malignancies tested to date, the frequency of CT45 expression in DLBCL is similar to that seen in epithelial cancers, and low-grade non-Hodgkin B-cell lymphomas do not express CT45.

Biochemical characterization of a phospholipase A2 from Photobacterium damselae subsp. piscicida.

Photobacterium damselae subsp. piscicida (Phdp) is the causative agent of fish photobacteriosis (pasteurellosis) in cultured cobia (Rachycentron canadum) in Taiwan. A component was purified from the extracellular products (ECP) of the bacterium strain 9205 by fast protein liquid chromatography (FPLC) and identified as a phospholipase. An N-terminal sequence of 10 amino acid residues, QDQPNLDPGK, was determined by mass spectroscopy (MS) and found to be identical with that of another Phdp phospholipase (GenBank accession no. BAB85814) at positions 21 to 30. The corresponding gene sequence of the phospholipase (GenBank accession no. AB071137) was employed to design primers for amplification of the sequence by the polymerase chain reaction (PCR). The PCR products were transformed into Escherichia coli, and a recombinant protein product was obtained which was purified as a His-tag fusion protein by Ni-metal affinity chromatography. A single 43-kDa band was determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Phosphatidylcholine was degraded by this protein to lysophosphatidylcholine and a fatty acid. These products were characterized by thin-layer (TLC) and gas chromatography (GC), respectively, allowing the identification of the protein as a phospholipase A2. The recombinant protein had maximum enzymatic activity between pH 4 and 7, and at 40 degrees C. The activity was inhibited by Zn(2+) and Cu(2+), activated by Ca(2+) and Mg(2+), and completely inactivated by dexamethasone and p-bromophenacyl bromide. A rabbit antiserum against the recombinant protein neutralized the phospholipase A2 activity in the ECP of Phdp strain 9205 and the recombinant protein itself. The recombinant protein was toxic to cobia of about 5 g weight with an LD50 value between 2 and 4 microg protein/g fish. The results revealed phospholipase A2 as a fish toxin in the ECP of Phdp strain 9205.

What you need to know about: imaging in patients with renal failure.

Contrast-enhanced medical imaging is commonly requested in clinical practice. Contrast media provide better differentiation of tissue enhancement, improves the soft tissue contrast resolution, and enhances the ability to study the physiology and function of the organs and/or systems. However, contrast media may cause complications, especially in patients with renal failure. This article discusses the use of contrast media in common imaging modalities and the relationship between contrast media and renal function. Administration of iodinated contrast media in computed tomography may cause contrast-associated acute kidney injury; the risk factors and preventive strategies for this are elaborated in this article. Administration of gadolinium-based contrast media in magnetic resonance imaging may lead to nephrogenic systemic fibrosis. Therefore, precautions should be taken when planning for medical imaging for patients with pre-existing acute kidney injury or end-stage chronic kidney disease, for whom contrast media administration in computed tomography or magnetic resonance imaging may be relatively contraindicated. Alternatively, ultrasound contrast agents can be safely used in patients with acute kidney injury or chronic kidney disease. Clinical teams should discuss these patients with radiologists, taking into account the risk-benefits of contrast media, to determine the optimal imaging protocol or modality to answer the clinical query.

A neonatal case of vascular ring with Alagille syndrome.

A female infant, born at 37 week 5 days to a mother via induced vaginal delivery for preeclampsia, was prenatally diagnosed with a right aortic arch with vascular ring. On the third day of life, the infant exhibited a bronze-gray coloration, and a direct bilirubin of 1.7 mg/dL was detected. The abdominal ultrasound did not visualize the gallbladder. Clinically, the infant displayed features consistent with Alagille syndrome, including unusual facial appearance, butterfly vertebrae, cardiovascular defects, and cholestasis. The geneticist noted that the mother of the patient also exhibited similar features. Both the infant and the mother were diagnosed with Alagille syndrome, both having the same heterozygous JAG1 gene (NM_000214.2) variant (c.1890_1893del, p.Ile630Metfs*112). We believe that the vascular ring observed in our patient is the first reported instance of a vascular ring associated with Alagille syndrome.

Cation-Induced Assembly of Conductive MXene Fibers for Wearable Heater, Wireless Communication, and Stem Cell Differentiation.

Emerging wearable electronics, wireless communication, and tissue engineering require the development of conductive fiber-shaped electrodes and biointerfaces. Ti3C2Tx MXene nanosheets serve as promising building block units for the construction of highly conductive fibers with integrated functionalities, yet a facile and scalable fabrication scheme is highly required. Herein, a cation-induced assembly process is developed for the scalable fabrication of conductive fibers with MXene sheaths and alginate cores (abbreviated as MXene@A). The fabrication scheme of MXene@A fibers includes the fast extrusion of alginate fibers followed by electrostatic assembly of MXene nanosheets, enabling high-speed fiber production. When multiple fabrication parameters are optimized, the MXene@A fibers exhibit a superior electrical conductivity of 1083 S cm-1, which can be integrated as Joule heaters into textiles for wearable thermal management. By triggering reversible de/hydration of alginate cores upon heating, the MXene@A fibers can be repeatedly contracted and generate large contraction stress that is >40 times higher than the ones of mammalian skeletal muscle. Furthermore, the MXene@A springs demonstrate large contraction strains up to 65.5% and are then fabricated into a reconfigurable dipole antenna to wirelessly monitor the surrounding heat sources. In the end, with the biocompatibility of MXene nanosheets, the MXene@A fibers enable the guidance of neural stem/progenitor cells differentiation and the promotion of neurite outgrowth. With a cation-induced assembly process, our multifunctional MXene@A fibers exhibit high scalability for future manufacturing and hold the prospect to inspire other applications.

Vaginal natural orifice transvaginal endoscopic surgery (vNOTES) surgical staging for endometrial carcinoma: The feasibility of an innovative approach.

OBJECTIVE: This study aims to describe the feasibility of treating early-stage endometrial cancer with hysterectomy, bilateral salpingo-oophorectomy, sentinel lymph node biopsy, and bilateral pelvic lymphadenectomy by vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES). MATERIALS AND METHODS: A longitudinal study of prospectively registered patients was conducted at an academic tertiary care center. 15 patients who underwent vNOTES surgical staging of early endometrial carcinoma between January 2014 and December 2020 were included in the study. RESULTS: 15 patients between 20 and 80yrs of age with histologically proven Stage1 Gr1-2 endometrial cancer underwent vNOTES surgical staging. The mean age of the study population was 52.8 years (Standard Deviation [SD] 6.8) and the mean BMI was 27.8 kg/m2 (SD 6.4). The average operative time was 231.4 min (SD 41.0) with the mean estimated blood loss of 122.0 mL (SD 104.4). A total of 12 (80%) patients underwent SNL biopsy with ICG guided system, whereas 3 (20%) had pelvic lymph node dissection. There was one case with the surgical complication of bladder injury requiring conversion to conventional laparoscopy. CONCLUSION: With this study, we studied the feasibility of vNOTES surgery for early-stage endometrial cancer with minimal complications and the best long-term surgical outcome. The surgeries were performed by a single skilled endoscopist surgeon with previous experience with vNOTES surgery for adnexal tumors and hysterectomy. Our results showed the practicality of vNOTES in staging surgery for early-stage endometrial cancer. However, application to a larger cohort is required for more extensive surgical outcome studies.