Are physiological oscillations physiological?

Despite widespread and striking examples of physiological oscillations, their functional role is often unclear. Even glycolysis, the paradigm example of oscillatory biochemistry, has seen questions about its oscillatory function. Here, we take a systems approach to argue that oscillations play critical physiological roles, such as enabling systems to avoid desensitization, to avoid chronically high and therefore toxic levels of chemicals, and to become more resistant to noise. Oscillation also enables complex physiological systems to reconcile incompatible conditions such as oxidation and reduction, by cycling between them, and to synchronize the oscillations of many small units into one large effect. In pancreatic ß-cells, glycolytic oscillations synchronize with calcium and mitochondrial oscillations to drive pulsatile insulin release, critical for liver regulation of glucose. In addition, oscillation can keep biological time, essential for embryonic development in promoting cell diversity and pattern formation. The functional importance of oscillatory processes requires a re-thinking of the traditional doctrine of homeostasis, holding that physiological quantities are maintained at constant equilibrium values, a view that has largely failed in the clinic. A more dynamic approach will initiate a paradigm shift in our view of health and disease. A deeper look into the mechanisms that create, sustain and abolish oscillatory processes requires the language of nonlinear dynamics, well beyond the linearization techniques of equilibrium control theory. Nonlinear dynamics enables us to identify oscillatory ('pacemaking') mechanisms at the cellular, tissue and system levels.

Intraoperative Heparin Bolus and Postoperative Anticoagulation with Low Molecular Weight Heparin Increase Reliability of Microsurgical Free Flaps for Upper Extremity Reconstruction.

BACKGROUND: Microsurgery is an indispensable tool of upper extremity reconstruction addressing defect coverage and the restoration of function. Perioperative anticoagulation and antiplatelet therapy are controversially discussed with impact on microsurgical outcome, but without clear evidence. This study aims to evaluate the impact of perioperative anticoagulation and antiplatelet therapy in microsurgical upper extremity reconstruction. METHODS: All eligible patients treated with microsurgical upper extremity reconstruction between January 2000 and July 2014 were included in a comparative analysis to define a superior anticoagulation and antiplatelet regime in a retrospective study. Endpoints were all major complications (e.g., total flap loss, arterial and venous thrombosis) as well as minor complication. RESULTS: A total of 183 eligible free flaps to the upper extremity were transferred in 169 patients. Altogether, 11 arterial (6.0%) and 9 venous (4.9%) thromboses, 11 total flap losses (6.0%), and 16 cases with hematoma (8.7%) were detected. In the subgroup analysis, patients who did not receive any heparin intraoperatively (n = 21; 11.5%) had a higher rate of major complications (p = 0.001), with total flap loss being the most frequent event (p = 0.004). A trend was shown for intraoperative bolus administration of 501 to 1,000 units unfractionated heparin (UFH) intravenously to have the lowest rate of major complications (p = 0.058). Intraoperative administration of acetylsalicylic acid (n = 13; 8.1%) did not have any influence on the rate of major complications. Postoperative anticoagulation with continuous UFH intravenously (n = 68; 37.2%) resulted in more frequent complications (p = 0.012), for example, an increased rate of total flap loss (p = 0.02) and arterial thrombosis (p = 0.02). CONCLUSION: The results of the present study favor administration of 501 to 1,000 units UFH intravenously as an intraoperative bolus (e.g., 750 units UFH intravenously). Postoperative low molecular weight heparin subcutaneous application in a prophylactic dose given once or twice a day was associated with less complications compared with continuous infusion of UFH, although continuously applied UFH may reflect an increased risk profile.

Heritable genetic variants in key cancer genes link cancer risk with anthropometric traits.

BACKGROUND: Height and other anthropometric measures are consistently found to associate with differential cancer risk. However, both genetic and mechanistic insights into these epidemiological associations are notably lacking. Conversely, inherited genetic variants in tumour suppressors and oncogenes increase cancer risk, but little is known about their influence on anthropometric traits. METHODS: By integrating inherited and somatic cancer genetic data from the Genome-Wide Association Study Catalog, expression Quantitative Trait Loci databases and the Cancer Gene Census, we identify SNPs that associate with different cancer types and differential gene expression in at least one tissue type, and explore the potential pleiotropic associations of these SNPs with anthropometric traits through SNP-wise association in a cohort of 500,000 individuals. RESULTS: We identify three regulatory SNPs for three important cancer genes, FANCA, MAP3K1 and TP53 that associate with both anthropometric traits and cancer risk. Of particular interest, we identify a previously unrecognised strong association between the rs78378222[C] SNP in the 3' untranslated region (3'-UTR) of TP53 and both increased risk for developing non-melanomatous skin cancer (OR=1.36 (95% 1.31 to 1.41), adjusted p=7.62E-63), brain malignancy (OR=3.12 (2.22 to 4.37), adjusted p=1.43E-12) and increased standing height (adjusted p=2.18E-24, beta=0.073±0.007), lean body mass (adjusted p=8.34E-37, beta=0.073±0.005) and basal metabolic rate (adjusted p=1.13E-31, beta=0.076±0.006), thus offering a novel genetic link between these anthropometric traits and cancer risk. CONCLUSION: Our results clearly demonstrate that heritable variants in key cancer genes can associate with both differential cancer risk and anthropometric traits in the general population, thereby lending support for a genetic basis for linking these human phenotypes.

Vein Grafting in Microsurgical Lower Extremity Reconstruction: Outcome Analysis of Primary versus Secondary Salvage Procedures.

BACKGROUND: Many microsurgeons fear high complication rates and free flap loss when vein grafting is necessary to restore blood flow at the recipient site. The aims of this study were to comparatively analyze surgical outcomes of interposition vein grafts (VG) in microsurgical primary lower extremity reconstruction and secondary salvage procedures. METHODS: A retrospective study was conducted on 58 patients undergoing free flap transfers with vein grafting for primary lower extremity reconstruction (cohort 1) and secondary salvage procedures (cohort 2) between 2002 and 2016. A matched-pair analysis of both cohorts and 58 non-VG flaps was performed. Patient data, preoperative conditions, flap and vein graft characteristics, postoperative outcomes such as flap failure, thrombosis, and wound complications were analyzed. RESULTS: A total of 726 free flap transfers were performed. In total, 36 primary reconstructions (5%) utilized 41 interposition VG (cohort 1). Postoperative vascular compromise was observed in 65 free flaps (9%). In total, 22 out of 65 secondary salvage procedures (33.8%) utilized 26 interposition VG (cohort 2). Two total flap losses occurred in each cohort (5.6 vs. 9.1%; p = 0.63). Postoperative complications were observed in 38.9% of free flaps in cohort 1 and 72.7% in cohort 2 (p = 0.01). Takeback for microvascular compromise was comparable in both cohorts (19.4 vs. 22.7%; p = 0.75). Microvascular complications occurred more often in cohort 2 (22.7%) than in cohort 1 (8.3%; p = 0.28). Lower extremity salvage rates were high among both cohorts (94.4 vs. 90.9%; p = 0.63). Matched-pair analysis did not show any relevant differences on takebacks and flap loss (p = 0.32 and p = 1.0). CONCLUSION: In complex lower extremity reconstructions, VG can be performed with acceptable complication rates and outcomes in primary and especially in salvage cases. With careful planning and a consistent surgical protocol, VG can provide reliable success rates in limb salvage.

A Structured, Microsurgical Training Curriculum Improves the Outcome in Lower Extremity Reconstruction Free Flap Residency Training: The Ludwigshafen Concept.

BACKGROUND: Risk stratification, economic pressure, and a flat learning curve make the realization and development of proper microsurgical skills and competences a challenging task in the daily clinical practice. In previous studies, we were able to show that microsurgical procedures, e.g., free flaps and replantations, are safe training procedures and teachable in daily clinical practice in view of certain issues of risk stratification. The present study aims to evaluate further improvements in terms of safety and complication rates for free flaps as a training procedure after introduction and continuous implementation of a structured in-house training curriculum for microsurgical skills and competences and a 24-hour free accessible microsurgical training facility for the plastic surgery resident. METHODS: This retrospective comparative cohort study was conducted to review whether microsurgical skills for free flaps to the lower extremity can further be improved after implementation of the curriculum and a 24-hour accessible training facility. Therefore, we compared cohort A before (2009-2012) and B after (2014-2017) implementation. Patient demographics, procedural characteristics, and outcome parameters for free tissue transfer of the lower extremity were evaluated. RESULTS: The comparison of both cohorts showed a significantly reduced postoperative complication rate for cohort B (p <0.05). Furthermore, operation time was shorter, and the hospital stay could be significantly decreased (p <0.01). Workhorse flaps for plastic surgical training were the anterior lateral thigh (ALT) flap or the musculus latissimus dorsi (LD) flap. However, even more complex procedures with arteriovenous loops could be safely performed by plastic surgery residents under the supervision of the senior surgeon in exceptional cases. CONCLUSION: The implementation of a regularly held, microsurgical in-house training curriculum with 24-hour accessible training facility improves procedural and outcome parameters for free flaps to the lower extremity for surgical residents and is an elementary part of skills and competency training. However, risk stratification, repeated surgical exposure, expertise, and institutional infrastructures are essential and must be taken into consideration.

Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases.

BACKGROUND: In elderly patients, complex soft tissue defects are increasingly observed due to the prolonged life expectancy and accompanying comorbidities. The aim of this study is to evaluate whether free tissue transfer is safe in very old patients without additional risk and complications. METHODS: All patients older than 65 years undergoing free tissue transfer between November 2007 and September 2016 were reviewed in a retrospective study. Two cohorts were compared regarding perioperative morbidity and postoperative outcome (cohort 1 [old patients, ages 65-79]; cohort 2 [very old patients, ages ≥ 80]). RESULTS: In total, 256 patients were included in the study (cohort 1 [n = 217]; cohort 2 [n = 39]). Overall, 262 free flaps were performed due to a second microsurgical reconstruction in six cases. No statistically significant differences between cohorts were observed regarding surgical complications, total flap losses, and mortality. Detailed evaluation of cohort 2 revealed a significant learning curve during the observation period regarding the perioperative management and procedure of soft tissue reconstruction: operation length as well as postoperative intensive care unit stay decreased significantly over time (p < 0.05) and also surgical complications showed a positive trend (p = 0.07). We ascertained a shift toward a "more reliable" flap selection from predominantly anterolateral thigh flap) to axial flaps such as rectus abdominis and latissimus dorsi flaps. CONCLUSION: Our study showed that age is not associated with an increased risk of postoperative complications. Reliable muscle free flaps, two-stage procedures, and safe vascular supply are important strategic aspects to achieve microvascular tissue transfer with high success rates in geriatric patients.

Periauricular Purse-String Reinforced with SMAS plication and Malaria Fat Pad Elevation for Mid-and Lower Facial Rejuvenation: FACE-Q Report.

BACKGROUND: Facial aging is a complex process influencing every layer of the facial structure. Most accepted surgical techniques for facial rejuvenation involve certain manipulation of the superficial musculoaponeurotic system (SMAS). Out of these SMAS-based techniques, SMAS plication or suspension provides excellent outcomes with shorter convalescence and fewer potential complications. Herein, we would like to present our own technique combining SMAS plication, periauricular purse-string, and malar fat pad elevation technique for mid and lower facelift. METHODS: Through a classical periauricular and temporal incision, a periauricular permanent purse-string suture was woven into the SMAS to suspend sagging soft tissue of the mid and lower face after superficial undermining, then plication of inner and outer SMAS of the purse-string loop was performed to further secure suspension, and at last the malar fat pad was elevated for midface rejuvenation. The shape of the loop varies with patients' age; for younger patients, the loop is more vertical, and for older patients, the loop is more horizontal. Patient-reported outcomes were described using the FACE-Q questionnaire. RESULTS: From January 2010 to June 2015, a total of 138 patients were treated with this technique by a same surgeon. Follow-up duration ranged from 1 to 6 years. Preoperative and postoperative photographs were recorded and analyzed. The complications rates were low, and satisfaction rates were high. Patients felt that they appeared 7.3 years younger than their actual age on average and were most satisfied with the appearance of their lower face and jawline. CONCLUSIONS: Periauricular purse-string reinforced with SMAS plication and malar fat pad elevation technique produces esthetically pleasing outcomes, besides being simple, safe, and personalized.

Multiphase Multi-Detector Row Computed Tomography Imaging Characteristics of Large (>5 cm) Focal Hepatocellular Carcinoma.

OBJECTIVE: The aim of this study was to describe the multiphase multi-detector row computed tomography (MDCT) imaging findings of large (>5 cm) focal hepatocellular carcinoma (HCC). METHODS: Following review of the medical records of 321 patients with newly diagnosed HCC who underwent MDCT within the radiology database from January 2007 to November 2014, 27 patients (20 men and 7 women; mean age, 69 [SD, 10.1] years [range, 49-87 years]) with histologically confirmed HCC greater than 5 cm were included in this institutional review board-approved study. Multiphase, dedicated liver MDCT images of these cases were retrospectively reviewed by 2 radiologists in consensus to describe the enhancement characteristics of these lesions. RESULTS: Mean tumor diameter was 8.4 (SD, 2.4) cm (range, 5.2-13.5 cm). Cirrhosis was present in 16 (59%) of 27 patients. Seventeen (85%) of 20 patients with available laboratory data presented with elevated alpha-fetoprotein (median, 97 ng/mL). Twenty-three (85%) of 27 demonstrated either heterogeneous enhancement with gradual fill-in (14/27 [52%]) or peripheral enhancement with centripetal fill-in (9/27 [33%]). Twenty-two (81%) of 27 lacked washout on delayed phase images, and 21 (78%) of 27 demonstrated a pseudocapsule. Twenty-seven of 27 lesions were well defined, 8 (30%) of 27 were exophytic, 15 (56%) of 27 were unifocal, 5 (25%) of 20 cases demonstrated vascular invasion, and 7 (26%) of 27 cases presented with extrahepatic metastases. CONCLUSIONS: Large (>5 cm) focal HCC may present as a dominant mass with a pseudocapsule and initial heterogeneous or peripheral enhancement with gradual or centripetal fill-in without washout on multiphase MDCT. Awareness of this variant is important to allow distinction from other benign (eg, hemangioma) and malignant (eg, cholangiocarcinoma) focal liver lesions.

Free flaps for reconstruction of soft tissue defects in lower extremity: A meta-analysis on microsurgical outcome and safety.

BACKGROUND: Microsurgical free flaps for reconstruction of soft tissue defects in lower extremity have evolved into a reliable procedure over last decades; however, there lacked high level of evidence. METHODS: A systematic literature research was performed including studies between 2000 and 2014 in English, German, and Chinese (PubMed, EMBASE). Publications were selected applying inclusion/exclusion criteria. Postoperative complications were statistically analyzed with metaprop command of R GUI 3.0.1. RESULTS: Alltogether 30 articles overlooking 1,397 free flaps were included. The rate of total flap loss was 6.0% (95% confidence interval [CI] = 4.0%-8.0%, PQ (P values of Q statistics) = 0.03); the thrombosis rate was 6.0% (95% CI = 4.0%-9.0%, PQ = 0.01); the hematoma rate was 4.0% (95% CI = 3.0%-5.0%, PQ = 0.79); the partial necrosis rate was 6.0% (95% CI = 4.0%-10.0%, PQ < 0.01); the early infection rate was 4.0% (95% CI = 2.0%-6.0%, PQ = 0.03), and the dehiscence rate was 3.0% (95% CI = 2.0%-5.0%, PQ = 0.12). Reconstruction for diabetic foot may be not associated with a significant increase of procedural risk (Total flap loss rate = 6%, 95% CI = 3.0%-9.0%, PQ = 0.44). CONCLUSIONS: Microsurgical reconstruction of soft tissue defects in the lower extremity reconstruction could be regarded safe and reliable. A standardization of report of perioperative parameters and clinical outcomes is needed. © 2016 Wiley Periodicals, Inc. Microsurgery 36:511-524, 2016.

In vitro expression of cytokeratin 18, 19 and tube formation of adipose-derived stem cells induced by the breast epithelial cell line HBL-100.

Fat transplantation is increasingly used in breast augmentation; and recently, the issue of safety concerns from a cellular and molecular point of view has been raised. In this study, attentions were paid to the interaction between adipose-derived stem cells (ADSC) and mammary epithelial cells: human breast cancer cell line - 100 (HBL - 100) cells were used to simulate the normal microenvironment in breast tissue, ADSCs were harvest from human and co-cultured with HBL-100 cells. It was found that ADSCs formed tube-like structures in the co-culture with HBL-100 cells in contrast to the normal morphology of ADSCs in the control group. In addition, the immunofluorescence imaging showed that cytokeratin 18 and 19 (CK18 and 19) were significantly expressed in ADSCs after the co-culture with HBL-100 cells. The ultrastructure of those ADSCs also showed epithelial changes. In conclusion, ADSCs are not biological stable when co-cultured with HBL-100 cells. They differentiate into epithelial-like cells with the expression of epithelial surface marks (CK 18, 19) and form tube-like structures. This may offer an important evidence for the further study of clinical application of transplanting ADSCs rich adipose tissue into the breast in the future.

Influence of repeated aspiration on viability of fat grafts: a comparative study.

BACKGROUND: Fat grafting has been increasingly widely used in cosmetic and reconstructive surgery. However, the long-term retention of fat grafts is still unpredictable. Many critical variables have been found to significantly affect the viability of fat grafts; still, some of the ordinary impact factors are overlooked. OBJECTIVES: We performed this study to find out whether repeated aspiration had an impact on fat grafts through an in vitro analysis and a nude mouse model. METHODS: A 15 cm by 10 cm rectangle was marked at the lower abdomen. The cannula was gently advanced and retracted through the same incision in a fan fashion within the superficial layer to collect fat samples. Based on the sequence of harvesting, the collected adipose tissue was divided into five groups and labeled as syringes 1, 2, 3, 4, and 5. Part of the sample was dissociated and analyzed using cell staining, Cell Counting Kit-8 assay, and flow cytometry. The other part was injected in vivo and analyzed for weight and histology at varying time intervals. RESULTS: Fat grafts from the former syringes were presented with a greater number of viable adipocytes and a higher level of cellular function compared to the latter syringes. Additionally, fat grafts from former syringes had higher graft retention, better vascularity, and less cystic necrosis. Neither the viability of stromal vascular fractions (SVFs) nor the ratio of CD34 + CD45- cells within the SVFs were different among the five groups. CONCLUSIONS: Repeated aspiration had a negative impact on the adipocytes, but not on the SVFs. With an increasing time of aspiration, the viability of the adipocytes and long-term retention of fat grafts decreased gradually. Harvested fat grafts from the first few syringes may be more suitable for fat grafting.

Oxidative stress-mediated cytotoxicity and metabolism of T-2 toxin and deoxynivalenol in animals and humans: an update.

Trichothecenes are a large family of structurally related toxins mainly produced by Fusarium genus. Among the trichothecenes, T-2 toxin and deoxynivalenol (DON) cause the most concern due to their wide distribution and highly toxic nature. Trichothecenes are known for their inhibitory effect on eukaryotic protein synthesis, and oxidative stress is one of their most important underlying toxic mechanisms. They are able to generate free radicals, including reactive oxygen species, which induce lipid peroxidation leading to changes in membrane integrity, cellular redox signaling, and in the antioxidant status of the cells. The mitogen-activated protein kinases signaling pathway is induced by oxidative stress, which also induces caspase-mediated cellular apoptosis pathways. Several new metabolites and novel metabolic pathways of T-2 toxin have been discovered very recently. In human cell lines, HT-2 and neosolaniol (NEO) are the major metabolites of T-2 toxin. Hydroxylation on C-7 and C-9 are two novel metabolic pathways of T-2 toxin in rats. The metabolizing enzymes CYP3A22, CYP3A29, and CYP3A46 in pigs, as well as the enzymes CYP1A5 and CYP3A37 in chickens, are able to catalyze T-2 toxin and HT-2 toxin to form the C-3'-OH metabolites. Similarly to carboxylesterase, CYP3A29 possesses the hydrolytic ability in pigs to convert T-2 toxin to NEO. T-2 toxin is able to down- or upregulate cytochrome P-450 enzymes in different species. The metabolism of DON in humans is region-dependent. Free DON and DON-glucuronide are considered to be the biomarkers for humans. The masked mycotoxin DON-3-ß-D-glucoside can be hydrolyzed to free DON in the body. This review will provide useful information on the progress of oxidative stress as well as on the metabolism and the metabolizing enzymes of T-2 toxin and DON. Moreover, the literature will throw light on the blind spots of metabolism and toxicological studies in trichothecenes that have to be explored in the future.

Short monolithic dual-wavelength single-longitudinal-mode DBR phosphate fiber laser.

We propose and demonstrate a 5-cm-long monolithic dual-wavelength single-longitudinal mode distributed Bragg reflector (DBR) all-phosphate fiber laser. Strong UV-induced fiber Bragg gratings are directly written in highly Er/Yb codoped phosphate fiber. The separation between gratings is selected as 1 cm to only excite two longitudinal modes in the DBR cavity. By exploiting the spatial hole burning effect and the polarization hole burning effect, stable narrow-linewidth dual-wavelength lasing emission with 38 pm wavelength spacing and a total emitted power of 2.8 mW is obtained from this DBR fiber laser. A microwave signal at 4.58 GHz is generated by the heterodyne detection of the dual-wavelength laser.

The 1,2-intercompartmental supraretinacular artery vascularized bone graft for scaphoid nonunion: management and clinical outcome.

PURPOSE: To evaluate the clinical outcome of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone graft for scaphoid nonunion (SN). METHODS: A retrospective study was performed to evaluate patients with SN and treated with 1,2-intercompartmental supraretinacular artery pedicled vascularized bone graft between 1997 and 2010. Functional measures, quality of life by Short Form SF-36 questionnaire, and analysis of risk factors were included. RESULTS: Out of 39 patients who were eligible for the study, 11 were lost to follow-up. Out of the remaining 28 patients, union was achieved in 21 (75%). The mean length of follow-up was 63 ± 45 months. In hands with scaphoid union, the grip strength and the radioulnar active range of motion were less than the contralateral side but greater compared with patients with nonunion. Active extension-flexion was less compared with the noninjured hand but similar to patients with nonunion. Disabilities of the Arm, Shoulder and Hand (DASH) score decreased from 58 to 23 in dominant hands and from 46 to 13 in nondominant hands. Smoking was found to be a risk factor for nonunion. Patients with scaphoid union tended to higher scores in 8 domains of SF-36-Item Health Survey quality of life without significant difference. CONCLUSIONS: Surgical treatment of SN with 1,2-intercompartmental supraretinacular artery pedicled vascularized bone graft provided a union rate comparable with other vascularized bone graft techniques. Previous scaphoid reconstruction with standard iliac crest bone graft was not associated with higher risk for secondary nonunion. There was an upward tendency seen in DASH score and quality of life after scaphoid union. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Adipose-derived stem cells from the breast.

BACKGROUND: The adipose tissue is deemed as an ideal source of adipose-derived stem cells (ADSCs). Previous studies have reported that ADSCs can be isolated from several organs and locations; however, slight attention has been paid to the breast. We would like to report our experiences in isolating breast ADSCs (bADSCs). MATERIALS AND METHODS: Adipose tissues were harvested from the breasts of seven hypertrophic breast patients. Collagenase I was used to isolate the primary ADSCs. Surface markers were analyzed by flow cytometry. Cellular morphologies were observed. Proliferations of different passages were compared. Viabilities after the cryopreservation were evaluated. Adipogenic and osteogenic differentiation was induced. RESULTS: Primary cultured cells showed morphologies similar to fibroblasts, and expressed surface markers including CD13, CD44, CD90, and CD105. There was no statistical difference of proliferation between different passages (P > 0.05) and between with and without cryopreservation (P > 0.05). Additionally, isolated cells were differentiated into adipocytes and osteoblasts. CONCLUSION: bADSCs may represent an alternative candidate for tissue engineering. Further studies are needed to obtain more comprehensive understanding on bADSCs.

Sex differences in renal transporters: assessment and functional consequences.

Mammalian kidneys are specialized to maintain fluid and electrolyte homeostasis. The epithelial transport processes along the renal tubule that match output to input have long been the subject of experimental and theoretical study. However, emerging data have identified a new dimension of investigation: sex. Like most tissues, the structure and function of the kidney is regulated by sex hormones and chromosomes. Available data demonstrate sex differences in the abundance of kidney solute and electrolyte transporters, establishing that renal tubular organization and operation are distinctly different in females and males. Newer studies have provided insights into the physiological consequences of these sex differences. Computational simulations predict that sex differences in transporter abundance are likely driven to optimize reproduction, enabling adaptive responses to the nutritional requirements of serial pregnancies and lactation - normal life-cycle changes that challenge the ability of renal transporters to maintain fluid and electrolyte homeostasis. Later in life, females may also undergo menopause, which is associated with changes in disease risk. Although numerous knowledge gaps remain, ongoing studies will provide further insights into the sex-specific mechanisms of sodium, potassium, acid-base and volume physiology throughout the life cycle, which may lead to therapeutic opportunities.

Effect of destability time on microstructure and properties of hypoeutectic high chromium cast iron.

The present work investigated the effect of destabilization time on the mechanical properties and microstructure evolution of high chromium cast iron, and scanning electron microscopy and electron probe microanalysis techniques were employed. The results show that the hardness of hypoeutectic high chromium cast iron is related to the size and volume fraction of secondary carbides precipitated from the matrix. The hardness of the alloy continues to rise due to the continuous increase of the volume fraction of the secondary carbide at the initial stage of destabilization. The alloy reaches its peak hardness value at 950 °C and 1000 °C for 1 hour holding time. The solid solubility of carbon and alloying elements in the matrix increases as the holding time extends, resulting in a large number of carbides redissolved into the matrix, making the hardness of the alloy decrease; the hardness of the alloy at 14 h is less than that at 10 min. Under 1050 °C, the size and density of the secondary carbide increase significantly; extending the holding time will lead to the continuous reduction of the carbide rod that provides strength, thus, the hardness curve shows a downward trend.

Deep UV-induced near-infrared photodarkening of Er/Yb-doped and undoped phosphate fibers.

Photodarkening (PD) of Er/Yb-doped and undoped phosphate fibers caused by pulsed 193 nm irradiation from an ArF excimer laser to form Bragg grating mirrors is investigated. Doped and undoped phosphate fibers exhibit the same level of significant UV-induced PD loss, which is associated with the formation of a color center band at 467 nm. The UV-induced absorption extends into the NIR and creates a loss on the order of 1 dB/cm across the C-band. Photo-bleaching by a high-power supercontinuum source, and thermal-bleaching processes are performed on photodarkened samples. Both bleaching processes are found effective to fully erase the UV-induced PD loss.

Treatment of xanthelasma palpebrarum by upper eyelid skin flap incorporating blepharoplasty.

BACKGROUND: Wound repair after xanthelasma palpebrarum excision in the upper eyelid is a challenge for the plastic surgeon due to the difficulty obtaining tissue of the appropriate color and texture. The authors present their treatment of xanthelasma palpebrarum by an upper eyelid skin flap incorporating blepharoplasty with satisfactory results for 16 patients. METHODS: From September 2004 to August 2012, 32 xanthelasma lesions in the upper eyelids of 16 patients were surgically excised, after which an orbicularis oculi muscle myocutaneous flap was formed in blepharoplasty. The flap was used to repair the defect resulting from excision of the lesion. The xanthelasma palpebrarum treatment and blepharoplasty were performed simultaneously. RESULTS: No flap necrosis complications occurred after the operation. During a 3- to 12-months follow-up period, no lesion recurrence, lagophthalmos, hypertrophic scar, or bulky appearance was noted in any of the 16 patients. Aesthetic results in the upper eyelid were obtained for all the patients. CONCLUSION: By the reported method, the "waste" skin in blepharoplasty can become "treasure" material for covering the defect resulting from lesion excision. No new donor area is required. The dual effects are excision of the xanthelasma lesion and a satisfactory cosmetic result in the upper eyelid. This procedure could be the preferred option for xanthelasma palpebrarum in the upper eyelid.

F-Doped Carbon Nanoparticles-Based Nucleation Assistance for Fast and Uniform Three-Dimensional Zn Deposition.

Aqueous Zn metal-based batteries have considerable potential as energy storage system; however, their application is extremely limited by dendrite development and poor reversibility. In this study, to overcome both challenges, F-doped carbon nanoparticles (FCNPs) are uniformly constructed on substrates (Ti, Zn, Cu, and steel) by a plasma-assisted surface modification, which endows reversible and uniform deposition of Zn metal. FCNPs with high surface charge density act as nucleation assistors and form numerous homogenous Zn nucleation sites toward Zn 3D growth, which improves Zn plating kinetic and results in uniform Zn deposition. Furthermore, the ZnF2  solid electrolyte interface generated during cycling contributes to rapid mass transfer and enhances Zn reversibility, but also suppresses the side reaction. Accordingly, the half-cell of P-Ti coupled with Zn exhibits an average Coulombic efficiency of 99.47% with 500 cycles. The symmetric cell of the P-Zn anode presents a lifespan of over 1500 h at the current density of 5 mA cm-2 . Notably, the cell works for 100 h at 50 mA cm-2 . It is believed that this ingenious surface modification broadens revolutionary methods for uniform metallic deposition, as well as the dendrite-free rechargeable batteries system.