[The centennial history of perioperative management].

Stress reaction is a systemic adaptive response of individual in face of changes in their environment. In 1859, Darwin elaborated on the influence of external circumstances on life.In 1878, Bernard hold that a stable internal environment is the primary condition for the independent existence of life.In 1914, Cannon proposed the concept of "stress reaction".In 1932, Casbertson confirmed that surgical stress can have a huge impact on patients.In 2001, Klerter introduced the concept of Enhanced Recovery Surgery (ERAS), which reduces surgical trauma and stress and accelerates postoperative recovery through a series of perioperative optimization measures based on evidence-based medical evidence. Subsequently, the concept of ERAS was quickly accepted and became one of the most important development directions leading the progress of modern surgical technology in the 21st century.

Merkel cell carcinoma in Taiwan: A rare tumour with a better prognosis in those harbouring Merkel cell polyomavirus.

Merkel cell carcinoma (MCC) is a rare malignant cutaneous neuroendocrine tumour affecting mainly elderly patients and is more common in the West than in Asia. It is associated with Merkel cell polyomavirus (MCPyV), immunosuppression, and ultraviolet light. In this study, we retrospectively investigated the first series of MCC from Taiwan and identified 19 cases from three tertiary centres. All patients were males with a median age of 67.5. Twelve (63%) cases occurred in the extremities, with one unique case presenting initially as nodal metastasis of unknown primary. Immunohistochemically, the great majority of tumours expressed CK20 (89%), synaptophysin (89%), and INSM1 (84%), with none positive for TTF1. Eleven (58%) cases were positive for MCPyV by immunohistochemistry (clone CM2B4). All patients were treated with excision, including four with additional radiotherapy and one with radiotherapy and chemotherapy. Nodal status and treatment modalities significantly affected survival. The median survival time of MCPyV-positive cases was much longer than the negative cases (median 40 vs. 10 months). In summary, we presented the first report on the clinicopathological features of MCC in Taiwan, with 58% cases associated with MCPyV. The prognosis of patients with MCPyV-positive tumours was better than those negative for MCPyV.

A novel technique to identify the nerve of origin in head and neck schwannomas.

OBJECTIVE: Identifying the nerve of origin in head and neck schwannomas is a diagnostic challenge. Surgical management leads to a risk of permanent deficit. Accurate identification of the nerve would improve operative planning and patient counselling. METHODS: Three patients with head and neck schwannomas underwent a diagnostic procedure hypothesised to identify the nerve of origin. The masses were infiltrated with 1 per cent lidocaine solution, and the patients were observed for neurological deficits. RESULTS: All three patients experienced temporary loss of nerve function after lidocaine injection. Facial nerve palsy, voice changes with documented unilateral same-side vocal fold paralysis, and numbness in the distribution of the maxillary nerve (V2), respectively, led to a likely identification of the nerve of origin. CONCLUSION: Injection of lidocaine into a schwannoma is a safe, in-office procedure that produces a temporary nerve deficit, which may enable accurate identification of the nerve of origin of a schwannoma. Identifying the nerve of origin enhances operative planning and patient counselling.

Clinical efficacies of coracoclavicular ligament reconstruction using suture anchor versus hook plate in the treatment of distal clavicle fracture.

INTRODUCTION: Comparison of clinical efficacies between coracoclavicular ligament reconstruction using autologous gracilis tendon with suture anchor and clavicular hook plate for the treatment of acute Neer type II distal clavicle fracture. HYPOTHESIS: Both coracoclavicular reconstruction with autologous gracilis tendon and clavicular hook plate could achieve satisfactory results for treating acute Neer type II distal clavicle fracture. METHODS: Acute Neer type II distal clavicle fracture patients enrolled in this prospective randomized study were divided into the coracoclavicular ligament reconstruction group (using autologous gracilis tendon and suture anchor) and the hook plate group. Clinical outcomes were evaluated by shoulder X-ray, forward flexion, abduction and external rotation angle, Constant-Murley shoulder score and pain Visual Analogue Scale (VAS) at each follow-up for up to 24 months. RESULTS: The current study enrolled a total of 42 acute Neer type II distal clavicle fracture patients attended our hospital from March 2010 to December 2013. All patients had achieved complete healing and followed up for an average of 26 months (range, 24-38 months). At 3-month and 6-month follow-ups, Constant-Murley score in the ligament reconstruction group was significantly higher (93.8±2.6 vs. 88.7±8.7; 95.9±2.7 vs. 93.0±7.0, P<0.05), while VAS score was poorer than those in the hook plate group (1.6±0.8 vs. 2.5±1.9; 1.1±1.0 vs. 1.6±1.7, P<0.05). DISCUSSION: Reconstruction with autologous gracilis tendon improved VAS pain score in early postoperation follow-up; while Constant-Murley score and VAS score were significantly improved in the hook plate group after the implant was removed. These suggested that both coracoclavicular reconstruction with autologous gracilis tendon and clavicular hook plate could achieve satisfactory results. LEVEL OF EVIDENCE: Level II, low-powered prospective randomized trial.

Evaluation of nephrotoxic effects of aristolochic acid on zebrafish (Danio rerio) larvae.

To analyze the toxic effects of aristolochic acid (AA) on developed kidneys in zebrafish larvae, zebrafish at 3 days postfertilization were treated with various concentrations of AA for 24 h before the status of kidney injury was investigated from several points of view. It was found that 21% of the larvae treated with 10 µmoL/L AA exhibited evident periocular edema. When the concentrations of AA were increased to 20 and 40 µmoL/L, defect in the cardiovascular system characterized by slow heart beat and blood flow was seen coupled with periocular edema. Creatinine in the whole larval tissue determined by liquid chromatography-mass spectrometry/mass spectrometry exhibited dramatic increase in the treated groups in a dose-dependent manner within a certain range of doses. Several evident protein bands were detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis in supernatant of the treated larvae, indicating leakage of glomerular filtration barrier. Results of quantitative polymerase chain reaction show that the messenger RNA expression of nephrin in the 20 and 40 µmoL/L AA-treated groups decreased to 0.58 ± 0.062 and 0.37 ± 0.075-folds of the control, respectively. Kidney damage was further confirmed by the histological changes in paraffin sections of treated larvae, for example, cystic glomeruli and disorganized epithelia cells of pronephric tubules. Our results revealed that AA exerted toxic effects on developed kidney of zebrafish larvae in a dose-dependent manner and podocyte dysfunction may be involved in the kidney injury and proteinuria.

PPAR-γ agonist pioglitazone affects rat gouty arthritis by regulating cytokines.

The objective was to study peroxisome proliferator-activated receptor gamma (PPARγ) agonist pioglitazone regulation effect and its mechanism of expression of cytokines on acute gouty arthritis synovial in rats. Rats with unilateral ankle were injected with artificial monosodium urate (MSU) crystals to make the acute gouty arthritis model. Taking the synovium 48 h after the injection of MSU and using RT-PCR, we assessed the effect of pioglitazone (20 mg·kg(-1)·day(-1), oral administration) on synovial expression, by detecting tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), and interferon-γ (IFN-γ). The pioglitazone treatment group showed synovial expression of TNF-α, and IFN-γ was significantly lower than in the control group; the inhibition rates were 78.5 and 60.4%. The IL-1 expression difference was not statistically significant between the two groups. Pioglitazone has anti-inflammatory effects on acute gouty arthritis by inhibiting the expression of TNF-α and IFN-γ.

Control of Fusarium wilt in banana with Chinese leek.

The inhibitory effects of Chinese leek(Allium tuberosum) on Fusarium oxysporum f. sp. cubense (Foc) and on Fusarium wilt incidence were studied in order to identify a potential efficient way to control the disease. Adopting the rotation system of Chinese leek-banana reduced the Fusarium wilt incidence and disease severity index by 88 %-97 % and 91 %-96 %, respectively, improved the crop value by 36 %-86 %, in an area heavily infested by Foc between 2007 and 2009. As a result of inoculation in the greenhouse, Chinese leek treatment reduced disease incidence and the disease severity index by 58 % and 62 %, respectively in the variety Baxi (AAA) and by 79 % and 81 %, respectively in the variety Guangfen NO.1 (ABB). Crude extracts of Chinese leek completely inhibited the growth of Foc race 4 on Petri dishes, suppressed the proliferation of the spores by 91 % and caused 87 % spore mortality. The findings of this study suggest that Chinese leek has the potential to inhibit Foc growth and Fusarium wilt incidence. This potential may be developed into an environmentally friendly treatment to control Fusarium wilt of banana.

Malignancy-associated chylothorax: a 20-year study of 18 patients from a single institution.

Malignancy-associated chylothorax is a rare manifestation with uncertain characteristics and clinical significance. We segregated 18 patients into malignant lymphoma (n= 11) and solid malignancy (n= 7) groups to analyse the characteristics, treatment response and prognostic value of malignancy-associated chylothorax. Diagnosis of chylothorax was confirmed by a triglyceride concentration of >110 mg/dL or by the presence of chylomicrons in the pleural effusion. Concentrations of glucose, protein and lactate dehydrogenase did not differ significantly between the malignant lymphoma and solid malignancy groups. Although not statistically significant (P= 0.25), 90.9% malignant lymphoma patients and 57.1% solid malignancy patients had exudates. The cytology diagnostic rate in the malignant lymphoma and solid malignancy groups was 20.0% and 33.3% respectively (P > 0.99). After chemotherapy, six malignant lymphoma patients achieved complete remission, with simultaneous chylothorax disappearance. The overall survival rate at 12 and 24 months in the malignant lymphoma group was 54.5% and 36.4% respectively, while that in the solid malignancy group was 35.7% and 0% respectively. Malignant lymphoma was the chief cause of chylothorax in our cohort. Effective lymphoma treatment, lacking supplementary interventions, is essential for treating chylothorax in malignant lymphoma patients. Chylothorax indicates extremely limited life expectancy for solid malignancy patients.

Resistance to Tan Spot and Stagonospora nodorum Blotch in Wheat-Alien Species Derivatives.

Tan spot (caused by Pyrenophora tritici-repentis) and Stagonospora nodorum blotch (SNB) (caused by Stagonospora nodorum) are destructive fungal diseases of wheat (Triticum aestivum) throughout the world. Host plant resistance is thought to be an efficient and economical method of control. The objective of the present study was to identify novel sources of tan spot and SNB resistance in wheat genotypes derived from the crosses between wheat and alien species. Evaluations were conducted at the seedling stage in a growth chamber with 100% relative humidity. For each genotype, three replications were used for each disease. Among the 199 wheat-alien species derivatives evaluated, 65 exhibited resistance to tan spot and 30 showed resistance to SNB similar to BR34, a Brazilian wheat line used as the resistant control. Eleven derivatives were resistant to both diseases. Reactions of the derivatives and their respective wheat parents to tan spot and SNB suggest that resistance genes in the derivatives are derived from alien species. These derivatives can serve as desirable bridges for introgression of resistance genes from alien species to cultivated wheat, and could contribute novel and effective tan spot and SNB resistance to wheat breeding.

Effects of diets supplemented with organic acids and nucleotides on growth, immune responses and digestive tract development in weaned pigs.

Sixty-eight (Experiment 1, 46 days feeding) and sixteen (Experiment 2, 21 days feeding) 21-days-old weaned pigs were allotted to four dietary treatments including control, 0.6% organic acids (OA), 0.1% nucleotides (NA) and 0.6% OA plus 0.1% NA for determining the dietary effects. In Experiment 1, OA enhanced peripheral blood mononuclear cells proliferation on day 28 and 46. The plasma immunoglobulin (Ig) A level was elevated by OA (p < 0.06) and NA (p < 0.07), respectively. In Experiment 2, NA increased plasma IgM level, and had an interactive effect with OA on ileal Peyer's patches and mesenteric lymph node lymphocyte proliferation, bile and plasma IgA levels, and jejunal crypt depth. NA elevated gastric pepsin and jejunal alkaline phosphatase activities, however, decreased ileal aminopeptidase N, sucrase or maltase activity. These results suggest that OA and NA have synergistically enhanced the gut-associated lymphocyte responses and NA modulates the digestive tract development of weaned pigs.

Microbial population structure changes in a suspended carrier biofilm reactor.

The changes of microbial population structure in biofilm caused by variations of COD/NHNH4(+)-N ratio in influent were investigated in a suspended carrier biofilm reactor (SCBR). When COD/NHNH4(+)-N was 10, the highest COD removal reached was about 73.8 per cent, whereas the highest NH4(+)-N removal, about 55.9 per cent, was reached when COD/NH4(+)-N was 5. By using fluorescence in situ hybridization (FISH) and confocal laser scanning microscopy (CLSM) observation, it was found that the thickness of the biofilm formed on the carrier was about 80 to 120 microm, and ammonia-oxidizing bacteria (AOB) and nitrifying bacteria existed mainly in the upper layer about 20 to 30 microm. The results of the quinone profile analysis showed that when the COD/NH4(+)-N increased, the microbial diversity (DQ) increased, while the proportions of AOB and nitrifying bacteria in the biofilm communities decreased.

Microglial stability and repopulation in the retina.

BACKGROUND/AIMS: Parenchymal central nervous system microglia are repopulated by bone marrow derived monocytes more slowly than any other reticuloendothelial cells. The contribution of bone marrow derived monocytes to the uninflammed retina has not been studied. The present study sought to determine repopulation of retinal microglia in uniflammed retina by bone marrow derived monocytes in bone marrow chimeric rats. METHODS: Chimeric (Y-->X) Lewis rats were constructed by transplanting 5 x 10(7) male bone marrow cells into lethally irradiated female recipient rats. The chimeras were sacrificed 8, 10, 12, 30, and 52 weeks after bone marrow transplant, and retina, brain, lung, and spleen samples were collected. DNA was extracted and quantified. Y positive infiltrating cells in the collected samples were detected by polymerase chain reaction amplification of a Y chromosome specific 104 bp fragment. RESULTS: There was a rapid repopulation of haematopoietic tissues in the spleen (at 8 weeks), confirming the establishment of chimerism, and to a lesser extent, of lung (at 30 weeks). This repopulation was absent in the brain parenchyma and retina until 52 weeks after transplantation. CONCLUSIONS: These data indicate that resident microglia in the retina, much like those in the brain, are stable in number in the retinal compartment (up to 1 year), and repopulation by bone marrow derived cells may be delayed for a year.

EMG signal classification for myoelectric teleoperating a dexterous robot hand.

This paper details a strategy of discriminating finger motions using surface electromyography (EMG) signals, which could be applied to teleoperating a dexterous robot hand or controlling the advanced multi-fingered myoelectric prosthesis for hand amputees. Finger motions discrimination is the key problem in this study. Thus the emphasis is put on myoelectric signal processing approaches in this paper. The EMG signal classification system was established based on the surface EMG signals from the subject's forearm. Four pairs of electrodes were attached on the subjects to acquire the signals during six types of finger motions, i.e. thumb extension, thumb flexion, index finger extension, index finger flexion, middle finger extension, and middle finger flexion. In order to distinguish these finger motions. A combination of autoregressive (AR) model and an Artificial Neural Network (ANN) was used in the system. The discrimination procedure consists of two steps. Firstly, the AR model is used to preprocess the surface EMG signals to reduce the scale of the data. These data will be imported into the myoelectric pattern classifier. Secondly the coefficients of AR model are imported into the ANN to identify the finger motions. The experimental results show that the discrimination system works with satisfaction.

Juvenile xanthogranuloma masquerading as pediatric chronic uveitis: a clinicopathologic study.

Juvenile xanthogranuloma (JXG) is a rare, pediatric histiocytic skin disorder that may affect the eye. It can present with protean ocular manifestations, including masquerade uveitis, heterochromia, hyphema, or glaucoma. It very rarely involves the retina and posterior segment; indeed, posterior involvement has been documented histopathologically in only one case. We present the case of a 2-year-old child with ocular JXG presenting as chronic, refractive uveitis, without skin or systemic findings. The blind, painful eye was enucleated and found to harbor a diffuse histiocytic process that involved both the anterior and posterior segments, including the retina and subretinal space. Histological, immunohistochemical, and electron microscopic studies confirmed the diagnosis of JXG. The pathologic classification and differential diagnosis of systemic histiocytic disorders are discussed. Since JXG can present as masquerade pediatric uveitis, this entity should be considered in children with atypical uveitis. In rare instances, JXG may involve the posterior segment and the retina, leading to retinal detachment and blindness.

Identification and characterization of wheat-wheatgrass translocation lines and localization of barley yellow dwarf virus resistance.

Stable introgression of agronomically important traits into crop plants through wide crossing often requires the generation and identification of translocation lines. However, the low efficiency of identifying lines containing translocations is a significant limitation in utilizing valuable alien chromatin-derived traits. Selection of putative wheatgrass-wheat translocation lines based on segregation ratios of progeny from gamma-irradiated seed using a standard phenotypic analysis resulted in a low 4% success rate of identifying barley yellow dwarf virus (BYDV) resistant and susceptible translocation lines. However, 58% of the susceptible progeny of this irradiated seed contained a Thinopyrum intermedium chromosome-specific repetitive sequence, which indicated that gamma-irradiation-induced translocations occurred at high rate. Restriction fragment length polymorphism (RFLP) analysis of susceptible lines containing alien chromatin, their resistant sister lines and other resistant lines showed that more than one third of the progeny of gamma-irradiated double monosomic seeds contained wheatgrass-wheat translocations. Genomic in situ hybridization (GISH) analysis of selected lines confirmed that these were wheatgrass-wheat translocation lines. This approach of initially identifying BYDV susceptible deletion lines using an alien chromosome-specific repetitive sequence followed by RFLP analysis of their resistant sister lines efficiently identified resistant translocation lines and localized the BYDV resistance to the distal end of the introgressed Th. intermedium chromosome.

Visual loss and central venous catheterization: cortical blindness and hemianopsia after inadvertent subclavian artery entry.

A case of presumed embolic transient ischemic episodes and multifocal infarcts to the occipital and parietal cortices and the cerebellum of a young woman with ulcerative colitis is reported. These episodes were manifested by multifocal neurologic deficits including cortical blindness, visual hallucinations, and homonymous hemianopsia. They correlated with parenteral nutrition via a central line, presumed venous, but found to be in the subclavian artery. The complications of central venous lines are reviewed. The need for attention to neighborhood structures and unexpected symptoms, in view of the less well-recognized arterial embolic complications is emphasized.

Reduction of adenosine-5'-phosphosulfate instead of 3'-phosphoadenosine-5'-phosphosulfate in cysteine biosynthesis by Rhizobium meliloti and other members of the family Rhizobiaceae.

We have cloned and sequenced three genes from Rhizobium meliloti (Sinorhizobium meliloti) that are involved in sulfate activation for cysteine biosynthesis. Two of the genes display homology to the Escherichia coli cysDN genes, which code for an ATP sulfurylase (EC 2.7.7.4). The third gene has homology to the E. coli cysH gene, a 3'-phosphoadenosine-5'-phosphosulfate (PAPS) reductase (EC 1.8.99.4), but has greater homology to a set of genes found in Arabidopsis thaliana that encode an adenosine-5'-phosphosulfate (APS) reductase. In order to determine the specificity of the R. meliloti reductase, the R. meliloti cysH homolog was histidine tagged and purified, and its specificity was assayed in vitro. Like the A. thaliana reductases, the histidine-tagged R. meliloti cysH gene product appears to favor APS over PAPS as a substrate, with a Km for APS of 3 to 4 microM but a Km for PAPS of >100 microM. In order to determine whether this preference for APS is unique to R. meliloti among members of the family Rhizobiaceae or is more widespread, cell extracts from R. leguminosarum, Rhizobium sp. strain NGR234, Rhizobium fredii (Sinorhizobium fredii), and Agrobacterium tumefaciens were assayed for APS or PAPS reductase activity. Cell extracts from all four species also preferentially reduce APS over PAPS.

Strap muscle neurovascular supply.

OBJECTIVES/HYPOTHESIS: Knowledge and preservation of the neurovascular supply to strap muscles, such as the sternohyoid (SH) muscle, used in laryngotracheal reconstruction are important in preventing loss of tissue and bulk from ischemia and/or denervation. STUDY DESIGN: Arteriovenous and neural supply variations to the strap muscles were examined in cadaver specimens. METHODS: Strap muscle neurovascular supply was studied in 16 cadavers, including one transparent corrosion cast specimen with injected vessels. RESULTS: For the upper SH and upper belly of the omohyoid (OMO), the arterial supply consistently arose from a branch of the superior thyroid artery (STA) most commonly terminating at the cricothyroid membrane. The inferior SH was supplied by the inferior thyroid artery. The ansa cervicalis innervated the SH inferiorly with a branch below the loop. Each arterial branch to the muscles had an accompanying venous tributary. The corrosion cast specimen demonstrated that the arterial lumen diameters were almost threefold larger in branches entering the upper SH, compared with the lower SH or OMO. Small intramuscular arteries without axial supply were found within the middle third of the upper SH, the lower SH, and the upper OMO. CONCLUSIONS: It is possible to preserve neurovascular integrity in an inferiorly based SH flap. The superior and medial borders are released, with dissection of vascular supply laterally and deep to the muscle, and preservation of the inferior terminal ansa branch.

Three-dimensional analysis of cricoarytenoid joint motion.

The normal motion of the cricoarytenoid joint was characterized and analyzed in this study using seven fresh cadaver larynges mounted rigidly in an external fixator apparatus after radiopaque markers were attached to laryngeal landmarks. Fluoroscopic imaging and recording was performed of top, front, and side views while the arytenoid cartilages of each larynx were manipulated through the full range of motion from adduction to abduction. Computer video capture was performed of the recordings and editing of still frames accomplished to generate three-dimensional plots of cricoarytenoid joint motion, which are shown in the manuscript. Selective and varying sequential disconnection of muscular and ligamentous structures to the arytenoid cartilage was achieved to determine their contributions to cricoarytenoid joint motion limitations and stability. The vocalis ligament, cricoarytenoid ligament, and conus elasticus are most important in controlling abduction, whereas the posterior cricoarytenoid muscle and conus elasticus are crucial in limiting adduction. The vocalis ligament prevents posterior displacement of the vocal process, while the cricoarytenoid ligament and a newly described ligament, the posterior capsular ligament, restricts anterior vocal process migration. Another ligament, the anterior capsular ligament, is described, which limits backward arytenoid cartilage tilting and lateral movement of the arytenoid cartilage on the cricoid cartilage facet. Section of the vocalis ligament with underlying conus elasticus produced reducible lateral arytenoid cartilage subluxation. Confirmation of cricoarytenoid joint facet relationships in full adduction and abduction was accomplished by fixation of the cricoarytenoid joints of one larynx in the two positions with adhesive, and subsequent exposure of the joint surfaces. Review of literature detailing human laryngeal embryological development shows that the glottis and arytenoid cartilages are formed in adduction, which explains how cricoarytenoid joint ligaments collaborate to achieve accurate vocal process approximation in adduction despite side-to-side asymmetries of the cricoarytenoid joint structures in the same larynges.