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Ligand-gated ion channels are a large category of essential ion channels, modulating their state by binding to specific ligands to allow ions to pass through the cell membrane. Purinergic ligand-gated ion channel receptors (P2XRs) and acid-sensitive ion channels (ASICs) are representative members of trimeric ligand-gated ion channel. Recent studies have shown that structural differences in the intracellular domain of P2XRs may determine the desensitization process. The lateral fenestrations of P2XRs potentially serve as a pathway for ion conductance and play a decisive role in ion selectivity. Phosphorylation of numerous amino acid residues in the P2XRs are involved in regulating the activity of ion channels. Additionally, the P2XRs interact with other ligand-gated ion channels including N-methyl-D-aspartate receptors, γ-aminobutyric acid receptors, 5-hydroxytryptamin receptors and nicotinic acetylcholine receptors, mediating physiological processes such as synaptic plasticity. Conformational changes in the intracellular domain of the ASICs expose binding sites of intracellular signal partners, facilitating metabolic signal transduction. Amino acids such as Val16, Ser17, Ile18, Gln19 and Ala20 in the ASICs participate in channel opening and membrane expression. ASICs can also bind to intracellular proteins, such as CIPP and p11, to regulate channel function. Many phosphorylation sites at the C-terminus and N-terminus of ASICs are involved in the regulation of receptors. Furthermore, ASICs are involved in various physiological and pathophysiological processes, which include pain, ischemic stroke, psychiatric disorders, and neurodegenerative disease. In this article, we review the roles of the intracellular domains of these trimeric ligand-gated ion channels in channel gating as well as their physiological and pathological functions, in order to provide new insights into the discovery of related drugs.

Electroencephalogram pattern predicting neurological outcomes of children with seizures secondary to abusive head trauma.

BACKGROUND: The clinical presentations of abusive head trauma can abruptly worsen, so the occurrence of seizures and changes of EEG can be variable according to patients' conditions. Since the changes of EEG background waves reflect the cortical function of children, we aimed to find out whether the timing of EEG background, epileptiform discharges and seizure patterns were associated with the outcomes of patients with AHT. MATERIAL AND METHODS: Using seizure type and acute stage electroencephalographic (EEG) characteristics to assess adverse neurological outcomes in children with seizures secondary to abusive head trauma (AHT). Children who were hospitalized with AHT at a tertiary referral hospital from October 2000 to April 2010 were evaluated retrospectively. A total of 50 children below 6 years of age admitted due to AHT were included. KOSCHI outcome scale was used to evaluate the primary outcome and neurological impairment was used as secondary outcome after 6 months discharge. RESULTS: Children with apnea, cardiac arrest, reverse blood flow and skull fracture in clinic had a higher mortality rate even in the no-seizure group (3/5 [60%] vs. 3/45 [6.7%], odds ratio [OR] = 11; 95% CI = 2.3-52; p = 0.025). Seizure occurrence reduced mostly at the second day after admission in seizure groups; but children with persistent seizures for 1 week showed poor neurological outcomes. The occurrence of initial seizure was frequency associated with younger age; focal seizure, diffuse cortical dysfunction in acute-stage EEG, and low Glasgow Coma Scale (GCS) score were significantly related to poor outcomes after 6 months. Diffuse cortical dysfunction was also associated with motor, speech, and cognitive dysfunction. CONCLUSIONS: Diffuse cortical dysfunction in acute-stage EEG combined with low GCS score and focal seizure may related to poor outcomes and neurological dysfunctions in children with AHT.

LDHA-regulated tumor-macrophage symbiosis promotes glioblastoma progression.

Abundant macrophage infiltration and altered tumor metabolism are two key hallmarks of glioblastoma. By screening a cluster of metabolic small-molecule compounds, we show that inhibiting glioblastoma cell glycolysis impairs macrophage migration and lactate dehydrogenase (LDH) inhibitor stiripentol (an FDA-approved anti-seizure drug for Dravet Syndrome) emerges as the top hit. Combined profiling and functional studies demonstrate that LDHA-directed ERK pathway activates YAP1/STAT3 transcriptional co-activators in glioblastoma cells to upregulate CCL2 and CCL7, which recruit macrophages into the tumor microenvironment. Reciprocally, infiltrating macrophages produce LDHA-containing extracellular vesicles to promote glioblastoma cell glycolysis, proliferation, and survival. Genetic and pharmacological inhibition of LDHA-mediated tumor-macrophage symbiosis markedly suppresses tumor progression and macrophage infiltration in glioblastoma mouse models. Analysis of tumor and plasma samples of glioblastoma patients confirms that LDHA and its downstream signals are potential biomarkers correlating positively with macrophage density. Thus, LDHA-mediated tumor-macrophage symbiosis provides therapeutic targets for glioblastoma.

Chronic cough relief by allosteric modulation of P2X3 without taste disturbance.

P2X receptors are cation channels that sense extracellular ATP. Many therapeutic candidates targeting P2X receptors have begun clinical trials or acquired approval for the treatment of refractory chronic cough (RCC) and other disorders. However, the present negative allosteric modulation of P2X receptors is primarily limited to the central pocket or the site below the left flipper domain. Here, we uncover a mechanism of allosteric regulation of P2X3 in the inner pocket of the head domain (IP-HD), and show that the antitussive effects of quercetin and PSFL2915 (our nM-affinity P2X3 inhibitor optimized based on quercetin) on male mice and guinea pigs were achieved by preventing allosteric changes of IP-HD in P2X3. While being therapeutically comparable to the newly licensed P2X3 RCC drug gefapixant, quercetin and PSFL2915 do not have an adverse effect on taste as gefapixant does. Thus, allosteric modulation of P2X3 via IP-HD may be a druggable strategy to alleviate RCC.

Comparison of active versus passive robotic-endoscope-holder-assisted unisurgeon uniportal thoracoscopic surgery in terms of surgical efficacy and patient safety.

Background: Few studies have compared robotic-arm-assisted unisurgeon uniportal surgeries with conventional human-assisted uniportal video-assisted thoracoscopic surgeries (VATSs) in terms of surgical efficacy and patient safety. In the present study, we compared the aforementioned surgeries. Methods: We explored two robotic endoscope holders-a passive robotic platform (ENDOFIXexo, EA group) and a pedal-controlled active robotic platform (MTG-100, MA group)-for unisurgeon uniportal surgeries and compared the surgical outcomes with those of human-assisted uniportal surgeries (HA group) in 228 patients with a lung lesion (size, <5 cm). The primary parameters for this comparison were surgical efficacy, patient safety, and short-term patient outcomes. Results: No significant differences were observed among the EA, MA, and HA groups. The success rate of robotic-arm-assisted unisurgeon uniportal wedge resection was 100%, regardless of the group. No major differences were noted in preparation time between the EA and MA groups. Segmentectomy was more favorable in the EA group than in the MA group. The rates of surgical conversion were 5% and 60% in the EA and MA groups, respectively. The EA and MA groups did not differ considerably from the HA group in terms of postoperative complications. Conclusions: Unisurgeon uniportal wedge resection may be effectively performed using a robotic endoscope holder, without the need for any human assistants with an expert hand. However, the rate of surgical conversion increases with the complexity of uniportal anatomic resections. The passive platform appears to be more suitable for unisurgeon uniportal surgery than the active pedal-controlled platform given the equipment in contemporary operating rooms.

Computational discovery, structural optimization and biological evaluation of novel inhibitors targeting transient receptor potential vanilloid type 3 (TRPV3).

Transient receptor potential vanilloid type 3 (TRPV3) is a Ca2+ permeable nonselective cation channel and expressed abundantly in skin keratinocytes. TRPV3 emerges as an attractive target for treatment of pruritic, inflammatory, pain and skin-related diseases. However, only a few reports of TRPV3 inhibitors exist at present besides some patents. Therefore, TRPV3 research has always been fraught with challenges. Through a combination of virtual screening and biological evaluation, compound P1 (10 µM) was identified as a top hit with 34.5% inhibitory effect on 2-APB (1 mM)-evoked currents of mTRPV3-WT. Further structural optimization provided the inhibitor PC5 with the best activity (IC50 = 2.63 ± 0.28 µM), and point mutation assays indicated that amino acids V629 and F633 are crucial for the binding of PC5 and TRPV3. In summary, these newly discovered inhibitors could serve as promising lead compounds for the development of TRPV3 inhibitors in the future.

Effect of Le Fort I Maxillary Repositioning on Three-Dimensional Nasal Tip Rotation: A Comparative Study with Implication for the Asian Nose.

BACKGROUND: Le Fort I maxillary repositioning influences nasal morphology. In Asian cultures, upward nasal tip rotation with increased nostril exposure is considered aesthetically unpleasant and can have psychosocial consequences. This three-dimensional imaging-based study evaluated the effect of different Le Fort I maxillary movements on nasal tip rotation. METHODS: Consecutive patients who underwent two-jaw orthognathic surgery (n = 107) were enrolled. To achieve a standard head orientation, preoperative and 1-week and 12-month postoperative cone-beam computed tomography-derived three-dimensional craniofacial models were superimposed. Tip rotation angle was calculated according to the Frankfort horizontal plane for all three-dimensional digital models. The final tip rotation angle change was defined as 12-month postoperative value minus preoperative value. Translational maxillary movement types (advancement versus setback and intrusion versus extrusion), postoperative maxillary segment locations (anterosuperior, anteroinferior, posterosuperior, or posteroinferior), and actual linear maxillary changes were noted. RESULTS: Advancement (1.79 ± 5.20 degrees) and intrusion (2.23 ± 4.96 degrees) movements demonstrated significantly larger final tip rotation angle changes than setback (-0.88 ± 5.15 degrees) and extrusion (0.09 ± 5.44 degrees) movements (all p < 0.05). Postoperative anterosuperior location (2.95 ± 4.52 degrees) of the maxillary segment demonstrated a significantly larger final tip rotation angle change than anteroinferior (0.48 ± 5.65 degrees), posterosuperior (-1.08 ± 4.77 degrees), and posteroinferior (-0.64 ± 5.80 degrees) locations (all p < 0.05). Translational maxillary movement and actual linear maxillary change were not correlated with final tip rotation angle change. CONCLUSION: Effects of Le Fort I maxillary repositioning on nasal tip rotation depend on movement types and maxillary segment location. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Impact of the Different Types of Le Fort I Maxillary Surgical Movement on Nasal Width Changes: A Photogrammetric Analysis.

BACKGROUND: Le Fort I maxillary movements affect nasal width, but nasal width changes with specific movement types have not been formally addressed to date. OBJECTIVES: The purpose of this study was to analyze and compare the changes in nasal width with different maxillary movements. METHODS: A retrospective study was performed among consecutive patients who underwent bimaxillary orthognathic surgery (n = 138) and who were grouped based on the type of maxillary movement (ie, maxillary advancement with intrusion [MAI], maxillary advancement with extrusion [MAE], and maxillary setback with intrusion [MSI]). Preoperative and 12-month postoperative nasal widths were analyzed photogrammetrically by 2 blinded evaluators. RESULTS: Maxillary advancement with intrusion and MAE presented a significantly (P < 0.05) higher alar base widening than MSI did, with no significant (P > 0.05) differences between MAI and MAE. Maxillary advancement movements (MAI and MAE) showed significantly (P < 0.05) higher alar base widening than maxillary setback movement (MSI). However, no significant (P > 0.05) difference was observed between maxillary intrusion (MAI and MSI) and maxillary extrusion (MAE) movements. CONCLUSIONS: This study shows that the nasal width varies distinctly depending on the type of Le Fort I maxillary surgical movement.

Type of maxillary segment mobilization affects three-dimensional nasal morphology.

BACKGROUND: Surgical mobilization of the maxillary segment affects nasal morphology. This study assessed the impact of the type of maxillary mobilization on the three-dimensional (3D) nasal morphometry. METHODS: Pre- and postsurgery cone beam computed tomography-derived facial image datasets of consecutive patients who underwent two-jaw orthognathic surgery were reviewed. Using preoperative 3D facial models as the positional reference of the skeletal framework, 12-month postoperative 3D facial models were classified into four types of maxillary mobilizations (advancement [n = 83], setback [n = 24], intrusion [n = 55], and extrusion [n = 52]) and four types of final maxillary positions (anterosuperior [n = 44], anteroinferior [n = 39], posterosuperior [n = 11], and posteroinferior [n = 13]). Six 3D soft tissue nasal morphometric parameters were measured, with excellent intra- and interexaminer reliability scores (ICC>0.897) for all the measurements. The 3D nasal change for each nasal parameter was computed as the difference between postoperative and preoperative measurement values. RESULTS: The intrusion maxillary mobilization resulted in a significantly (all p<0.05) larger 3D nasal change in terms of alar width, alar base width, and nostril angle parameters, and a smaller change in terms of the nasal tip height parameter than the extrusion maxillary mobilization; however, no significant (all p>0.05) difference was observed between advancement and setback maxillary mobilizations. The anterosuperior and posterosuperior maxillary positions had a significantly (all p<0.05) larger 3D nasal change in terms of the alar base width and nostril angle than the anteroinferior and posteroinferior maxillary positions. CONCLUSION: The type of maxillary mobilization affects the 3D nasal morphometry.

Skeletal Muscle Is an Antigen Reservoir in Integrase-Defective Lentiviral Vector-Induced Long-Term Immunity.

We previously developed integrase-defective lentiviral vectors (IDLVs) as an antigen delivery system for inducing strong and prolonged immunity in animal models. Here, we examined the association between persistence of antigen expression and durability of immune response. Following a single intramuscular (i.m.) or subcutaneous (s.c.) injection of IDLV delivering GFP in mice, we evaluated antigen expression and inflammation at the site of injection and persistence of antigen-specific T cells at early and late time points. Durable antigen expression was detected up to 90 days only after i.m. immunization. Mononuclear inflammation was evident soon after IDLV injection in both i.m. and s.c. immunized mice, but remained detectable up to 30 days postinjection only in i.m. immunized mice. Similarly, GFP-specific T cells were more persistent in the i.m. immunized mice. Interestingly, GFP+ muscle fibers were co-expressing major histocompatibility complex (MHC) class I, suggesting that muscle cells are competent for presenting antigens to T cells in vivo. In in vitro experiments, we demonstrated that although both primary myoblasts and myocytes present the antigen to GFP-specific T cells through MHC class I, myoblasts are more resistant to Fas-dependent cytotoxic T lymphocyte (CTL) killing activity. Overall, these data indicate that muscle cells may serve as an antigen reservoir that contributes to the long-term immunity induced by IDLV vaccination.

Hydroxymethyl-Functionalized PEDOT-MeOH:PSS for Perovskite Solar Cells.

Poly(hydroxymethylated-3,4-ethylenedioxythiophene):polystyrene sulfonate (PEDOT-MeOH:PSS) conducting polymers are synthesized and incorporated in inverted structured perovskite solar cells (PVSCs) as hole transport materials. The highest occupied molecular orbital of PEDOT-MeOH is lowered by adding a hydroxymethyl (-MeOH) functional group to ethylenedioxythiophene (EDOT), and thus, the work function of PEDOT-MeOH:PSS is increased. Additionally, hydrogen bonding can be formed among EDOT-MeOH monomers and between EDOT-MeOH monomers and sulfate groups on PSS, which promotes PEDOT-MeOH chain growth and enhances PSS doping. The electronic, microstructural, and surface morphological properties of PEDOT-MeOH:PSS are modified by changing the amounts of PSS and the ferric oxidizing agent used in the polymerization and by adding ethylene glycol in the postsynthesis treatment. The PVSCs based on ethylene-glycol-treated PEDOT-MeOH:PSS overperform the PVSCs based on commercial PEDOT:PSS because of the better energetic alignment and the enhancement of PEDOT-MeOH:PSS electrical conductivity. This work opens the way to develop new hole transport materials for highly efficient inverted PVSCs.

A Multi-Scale U-Shaped Convolution Auto-Encoder Based on Pyramid Pooling Module for Object Recognition in Synthetic Aperture Radar Images.

Although unsupervised representation learning (RL) can tackle the performance deterioration caused by limited labeled data in synthetic aperture radar (SAR) object classification, the neglected discriminative detailed information and the ignored distinctive characteristics of SAR images can lead to performance degradation. In this paper, an unsupervised multi-scale convolution auto-encoder (MSCAE) was proposed which can simultaneously obtain the global features and local characteristics of targets with its U-shaped architecture and pyramid pooling modules (PPMs). The compact depth-wise separable convolution and the deconvolution counterpart were devised to decrease the trainable parameters. The PPM and the multi-scale feature learning scheme were designed to learn multi-scale features. Prior knowledge of SAR speckle was also embedded in the model. The reconstruction loss of the MSCAE was measured by the structural similarity index metric (SSIM) of the reconstructed data and the images filtered by the improved Lee sigma filter. A speckle suppression restriction was also added in the objective function to guarantee that the speckle suppression procedure would take place in the feature learning stage. Experimental results with the MSTAR dataset under the standard operating condition and several extended operating conditions demonstrated the effectiveness of the proposed model in SAR object classification tasks.

Formulation and evaluation of multilamellar vesicles ropivacaine in pain management.

PURPOSE: The improvement of postoperative pain control plays an important role in recovery outcomes and patient satisfaction. Multilamellar vesicles ropivacaine, MVR, is being developed to sustain the release of ropivacaine in situ while maintaining the local concentration of ropivacaine within the therapeutic window. METHODS: These studies summarized the processes of MVR formulation development and the evaluation of its releasing profile in vitro and the pharmacokinetics and anesthetic effect in vivo. RESULTS: The MVR demonstrates a sustained-release profile in an in vitro serum environment model after 24 hrs of incubation which translates in the in vivo rat pharmacokinetic profile of ropivacaine as a prolonged half-life that is 10-fold longer in duration than plain ropivacaine solution. The anesthetic effect of single-dose MVR is apparent by providing a prolonged analgesia effect compared to plain ropivacaine solution in an in vivo guinea pig pin-prick wheal model after a single intracutaneous injection. From a safety evaluation, MVR is well tolerated after a subcutaneously injection at a dose level of 20 mg/kg in rats, with no observable changes in clinical observation, body weight, organ weight, hematology and serum chemistry analysis. CONCLUSION: These results suggest that single administration of MVR is a promising candidate in postoperative pain management.

Narrowband Ultraviolet Photodetectors Based on Nanocomposite Thin Films with High Gain and Low Driving Voltage.

Narrowband ultraviolet (UV) photodetectors are highly desired in multiple areas. Photodetectors based on organic-inorganic nanocomposites offer high sensitivity, widely adjustable response range, light weight, and low-temperature solution processibility. However, the broad absorption range of organic and inorganic semiconductor materials makes it difficult to achieve a narrowband detection feature for nanocomposite photodetectors. In this work, nanocomposite thin films containing the wide band gap conjugated polymer poly[(9,9-dioctylfluorenyl-2,7-diyl)- alt- co-(bithiophene)] (F8T2) blended with wide band gap ZnO nanoparticles (NPs) serve as the active layers of the photodetectors. Narrowband UV photodetectors with high gain and low driving voltage are demonstrated by adopting a symmetric device structure, controlling the active layer composition and microstructure, and manipulating the light penetration depth in the active layer. The fabricated photodetector exhibits a high external quantum efficiency of 782% at 358 nm under a low forward bias of 3 V with the full-width at half-maximum of 16 nm. Combined with a low dark current, a high specific detectivity of 8.45 × 1012 Jones is achieved. The impacts of the F8T2:ZnO NPs weight ratio and the device structure on the UV-selectivity and the device performance are investigated and discussed. Our method offers a pathway to design and fabricate narrowband UV photodetectors.

An Improved Phase-Robust Configuration for Vibration Amplitude-Phase Extraction for Capacitive MEMS Gyroscopes.

This paper presents for the first time an improved algorithm for vibration amplitude-phase information extraction of capacitive microelectromechanical systems (MEMS) gyroscopes. Amplitude and phase information resulting from the improved algorithm is insensitive to the phase variation of an interface capacitance-voltage (CV) circuit, thus both long time drift of the gyroscope and bias instability have been improved. Experimental results show that both the phase and amplitude information extracted using this improved algorithm is insensitive to phase variation of CV circuit which is in accordance with theory. Bias instability using this improved configuration is 0.64°/h, which is improved two times more than the configuration using traditional double-side-band (DSB) demodulation configuration, and 4.3 times more than the configuration using single-side-band (SSB) demodulation, respectively. Allan deviation analysis shows that the slow varying drift term using D&S configuration is effectively reduced due to its robustness to CV phase variation compared to test results using DSB or SSB configuration.

[Improving the Storage Integrity of Electroencephalography (EEG) Recordings in the Pediatric Ward].

BACKGROUND & PROBLEMS: A total of 20 cases of children with epilepsy implemented electroencephalography (EEG) recording examinations in our ward between January 1st and March 10th, 2016. Fifteen (75%) of the recordings were incompletely stored, indicating that the EEG recordings storage integrity in our unit was 25%. Incomplete storage of these recordings results in prolonged hospital stays and negatively affects the ability of doctors to provide accurate diagnoses. PURPOSE: This project was developed to increase the EEG recording storage integrity for epileptic children to 100%. RESOLUTIONS: Improvement plans included reinforcing related promotions, formulating a standard flowchart for EEG recording education, making "warm bear signs", designing simple cartoon health-education flashcards, and providing in-service education. RESULTS: The EEG recording storage integrity for epileptic children in our ward rose to 100% after implementation of the resolution measures, which achieved our purpose. CONCLUSIONS: We want to share this experience to improve the storage integrity of EEG recordings at other hospitals and clinics. The greatest benefit of this project was that the family members of children with epilepsy perceived more strongly the effort and care of the nursing staffs during examinations, which reduces the costs of healthcare.

KH-type splicing regulatory protein is a new component of chromatoid body.

The chromatoid body (CB) is a specific cloud-like structure in the cytoplasm of haploid spermatids. Recent findings indicate that CB is identified as a male germ cell-specific RNA storage and processing center, but its function has remained elusive for decades. In somatic cells, KH-type splicing regulatory protein (KSRP) is involved in regulating gene expression and maturation of select microRNAs (miRNAs). However, the function of KSRP in spermatogenesis remains unclear. In this study, we showed that KSRP partly localizes in CB, as a component of CB. KSRP interacts with proteins (mouse VASA homolog (MVH), polyadenylate-binding protein 1 (PABP1) and polyadenylate-binding protein 2 (PABP2)), mRNAs (Tnp2 and Odf1) and microRNAs (microRNA-182) in mouse CB. Moreover, KSRP may regulate the integrity of CB via DDX5-miRNA-182 pathway. In addition, we found abnormal expressions of CB component in testes of Ksrp-knockout mice and of patients with hypospermatogenesis. Thus, our results provide mechanistic insight into the role of KSRP in spermatogenesis.

Identifying genetic hypomethylation and upregulation of Toll-like receptors in Kawasaki disease.

Kawasaki disease (KD) is an acute febrile systemic vasculitis that occurs in children and is characterized by elevated levels of proinflammatory cytokines. Toll-like receptors (TLRs) serve as the sensor arm of the innate immune system and induce proinflammatory cytokine expressions.We recruited a total of 18 paired KD patients, before intravenous immunoglobulin (IVIG) and at least 3 weeks after IVIG treatment, 18 healthy controls, and 18 febrile controls. For TLR genes and their cytosine-phosphate-guanine (CpG) markers, we used Affymetrix GeneChip® Human Transcriptome Array 2.0 and Illumina HumanMethylation450 BeadChip to evaluate gene expression levels and methylation patterns, respectively.KD patients demonstrated a significantly differential expression of TLR mRNA levels compared to both the healthy and febrile controls, with only TLR 3 and 7 not differing between the KD patients and the controls. After patients underwent IVIG treatment, the TLR mRNA levels, except for TLR3, decreased significantly in KD patients. In contrast, the methylation status of the CpG sites of TLR1, 2, 4, 6, 8, and 9 demonstrated an opposite tendency between the two stages of both the KD samples and the controls.TLRs, particularly TLR1, 2, 4, 6, 8, and 9, may stimulate the immunopathogenesis of KD. These results are among the first to use TLRs to prove that a bacterial inflammatory response may trigger KD.

[The Effect of Taking an Affectionate Approach to Discharge Education in the Pediatric Ward].

BACKGROUND & PROBLEMS: From January to March 2013, only 36.7% of pediatric patients in our hospital were given health education by nurses and only 47.1% of patient families indicated feeling "good" about the health education that they had received. After analyzing the situation, we identified the following key issues: (1) Lack of an SOP; (2) Inconsistent nursing guidelines; (3) Difficulties in comprehending health education tools; and (4) Poor caregiver adoption of TPN skills. PURPOSE: Our aim was to apply "impressive service" at our pediatric department to improve the effect of post-discharge health education in order to enhance the quality of care received by patients and their families. RESOLUTIONS: A variety of measures were implemented to improve the satisfaction rate of post-discharge health education. These measures included: reinforcing advocacy during hospitalization, developing an SOP on health education and an auditing system, manufacturing an "Impressive Service Card" and a "Pamphlet for hospitalized children", and employing a health education method and leaflets that were beneficial to the caregiver. RESULTS: The result of our practice increased the rate of health education to 100% and a rate of satisfaction of 99.4%. These significant improvements indicate that the "Impressive Service" program may be an effective strategy to improve the quality and effectiveness of post-discharge health education. CONCLUSIONS: This program was implemented as part of standard discharge procedures as a strategy to improve the attitudes of nursing staff, to enhance the satisfaction of pediatric patients and their family members, and the enhance the image of our hospital and nursing personnel.

KSRP is critical in governing hepatic lipid metabolism through controlling Per2 expression.

Hepatic lipid metabolism is controlled by integrated metabolic pathways. Excess accumulation of hepatic TG is a hallmark of nonalcoholic fatty liver disease, which is associated with obesity and insulin resistance. Here, we show that KH-type splicing regulatory protein (KSRP) ablation reduces hepatic TG levels and diet-induced hepatosteatosis. Expression of period 2 (Per2) is increased during the dark period, and circadian oscillations of several core clock genes are altered with a delayed phase in Ksrp(-/-) livers. Diurnal expression of some lipid metabolism genes is also disturbed with reduced expression of genes involved in de novo lipogenesis. Using primary hepatocytes, we demonstrate that KSRP promotes decay of Per2 mRNA through an RNA-protein interaction and show that increased Per2 expression is responsible for the phase delay in cycling of several clock genes in the absence of KSRP. Similar to Ksrp(-/-) livers, both expression of lipogenic genes and intracellular TG levels are also reduced in Ksrp(-/-) hepatocytes due to increased Per2 expression. Using heterologous mRNA reporters, we show that the AU-rich element-containing 3' untranslated region of Per2 is responsible for KSRP-dependent mRNA decay. These findings implicate that KSRP is an important regulator of circadian expression of lipid metabolism genes in the liver likely through controlling Per2 mRNA stability.