Design and quantitative evaluation of 'Aerosol Bio-Containment Device (ABCD)' for reducing aerosol exposure during infectious aerosol-generating events.

The Coronavirus Disease 2019 (COVID-19) pandemic renewed interest in infectious aerosols and reducing risk of airborne respiratory pathogen transmission, prompting development of devices to protect healthcare workers during airway procedures. However, there are no standard methods for assessing the efficacy of particle containment with these protective devices. We designed and built an aerosol bio-containment device (ABCD) to contain and remove aerosol via an external suction system and tested the aerosol containment of the device in an environmental chamber using a novel, quantitative assessment method. The ABCD exhibited a strong ability to control aerosol exposure in experimental and computational fluid dynamic (CFD) simulated scenarios with appropriate suction use and maintenance of device seals. Using a log-risk-reduction framework, we assessed device containment efficacy and showed that, when combined with other protective equipment, the ABCD can significantly reduce airborne clinical exposure. We propose this type of quantitative analysis serves as a basis for rating efficacy of aerosol protective enclosures.

Visual-auditory interactions on explicit and implicit information processing.

Interactions among sensory information are important for generating a coherent percept of the external world. Facilitation and inhibition effects in cross-modal perception have been widely studied for decades. The present study tried to confirm the interaction effects between sensory information in a bimodal context and explore these influences when part of the sensory information was presented without participants' subjective awareness. A total of 40 undergraduate participants were recruited in this mixed design study. Participants were required to count the flashing of the black circle (visual task) or the presentation frequency of the beep sound (auditory task) with the presence of either congruent or incongruent sensory signals in the background. Participants in the explicit group generally performed more accurately and also faster with the congruent stimuli than with the incongruent stimuli. Performance accuracy in the visual task in the implicit group was affected by the non-target sound signals which were presented beneath participants' subjective awareness. The better performance yielded in the auditory task than in the visual task was explained by the appropriateness of the auditory stimulation to the task nature. In addition, the supportive findings regarding processing without awareness should be interpreted with caution.

Outcome of surgical-orthodontic treatment in hemifacial microsomia with and without early mandibular distraction osteogenesis.

The aim of this study was to compare the outcomes of surgical-orthodontic treatment between hemifacial microsomia (HFM) patients who had and had not undergone early mandibular distraction osteogenesis (DO). Twenty adult unilateral HFM patients were included, seven who had undergone early mandibular DO (DO group) and 13 who had not (NDO group). All patients were type IIB, except for one type IIA patient in the NDO group. Mean age at definitive surgery was 20.72±2.96 years. Linear, cross-sectional, and volumetric measurements were obtained from serial cone beam computed tomography scans. Data were obtained pre-surgery (T0), 1 week after surgery (T1), and at treatment completion (T2) to determine surgical movement, post-surgical stability, and net gain movement. Surgical and ultimate outcomes did not differ significantly between the groups. The overall surgical movement among all patients was as follows (mean values): maxillomandibular complex (MMC) symmetry was achieved by Le Fort I differential roll movement (3.78mm extrusion on the affected side, 4.28mm impaction on the non-affected side), a combination of medial movement and yaw rotation of MMC, and genioplasty. Upper and lower dental midlines and deviated menton were shifted by 5.73mm, 5.08mm, and 12.38mm, respectively. Anterior impaction and advancement with counterclockwise rotation of MMC were also performed. Menton was advanced by 6.14mm and lower facial height was increased by 3.55mm. Neither group exhibited a significant difference in stability. Relapse at the maxilla was <1mm and relapse at the mandible was <1.5mm. The results suggest that early DO had limited beneficial effects on the definitive correction outcome. HFM patients achieved acceptable symmetry and a stable surgical outcome, regardless of early DO, following surgical-orthodontic correction at skeletal maturity with three-dimensional surgical simulation.

Review of indoor aerosol generation, transport, and control in the context of COVID-19.

The coronavirus disease-2019 (COVID-19) pandemic has heightened the awareness of aerosol generation by human expiratory events and their potential role in viral respiratory disease transmission. Concerns over high severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) viral burden of mucosal surfaces has raised questions about the aerosol-generating potential and dangers of many otorhinolaryngologic procedures. However, the risks of aerosol generation and associated viral transmission by droplet or airborne routes for many otorhinolaryngology procedures are largely unknown. Indoor aerosol and droplet viral respiratory transmission risk is influenced by 4 factors: (1) aerosol or droplet properties; (2) indoor airflow; (3) virus-specific factors; and (4) host-specific factors. Herein we elaborate on known aerosol vs droplet properties, indoor airflow, and aerosol-generating events to provide context for risks of aerosol infectious transmission. We also provide simple but typically effective measures for mitigating the spread and inhalation of viral aerosols in indoor settings. Understanding principles of infectious transmission, aerosol and droplet generation, as well as concepts of indoor airflow, will assist in the integration of new data on SARS-CoV-2 transmission and activities that can generate aerosol to best inform on the need for escalation or de-escalation from current societal and institutional guidelines for protection during aerosol-generating procedures.

Branded versus generic drug use in chronic disease management in Hong Kong-perspectives of health care professionals and the general public.

INTRODUCTION: The aim of the present study was to evaluate the understanding of generic substitution among health care professionals and members of the general public ("general public") in Hong Kong. METHODS: This cross-sectional descriptive study was performed by using a self-completed anonymous questionnaire from March 2015 to May 2017. The questionnaire included demographic data, knowledge of generic drugs, experiences of generic substitution, and views on policy. RESULTS: A total of 2106 general public, 73 doctors, 22 nurses, and 50 pharmacists responded the questionnaire. In all, 41.2% of the general public was aware that generic drugs have the same active ingredients. Although a majority of the health care professionals knew that generic drugs have the same active ingredients (doctors: 79.5%; nurses: 86.4%; pharmacists: 98.0%), many were unaware of bioequivalence (doctors: 37.0%; nurses: 18.2%; pharmacists: 50.0%). "Efficacy" was ranked as the primary concern among all groups; a substantial portion of respondents reported experiencing adverse drug reactions upon generic substitution (general public: 26.6%; doctors: 23.3%; nurses: 9.1%; pharmacists: 42.0%). At least half of the general public, nurses, and pharmacists considered that patients should be given a choice for generic substitution. However, fewer than one-fifth of doctors and nurses and approximately one-third of pharmacists considered that patient consent was needed prior to generic substitution, compared with approximately two-thirds of the general public. CONCLUSION: The knowledge and perception of generic substitution remains low, both in the general public and among health care professionals. This knowledge deficit could potentially lead to different perspectives among stakeholders regarding generic substitution.

Running in fear: an investigation into the dimensional account of emotion in discriminating emotional expressions.

Emotion can be conceptualized by the dimensional account of emotion with the dimensions of valence and arousal. There is little discussion of the difference in discriminability across the dimensions. The present study hypothesized that any pair of emotional expressions differing in the polarity of both valence and arousal dimensions would be easier to distinguish than a pair differing in only one dimension. The results indicate that the difference in the dimensions did not affect participants' reaction time. Most pairs of emotional expressions, except those involving fear, were similarly discriminative. Reaction times to pairs with a fearful expression were faster than to those without. The fast reaction time to fearful facial expressions underscores the survival value of emotions.

The genetic diversity and population structures of indigenous pig breeds in Zhejiang Province revealed by GGRS sequencing.

Chinese indigenous pigs in Zhejiang Province are well known for their high fecundity. In order to verify breed subdivision at the genomic level, we investigated genetic diversity and population structure of seven breeds and made comparisons with three Western pig breeds using next-generation sequencing data. Parameters obtained from allelic richness and proportion of polymorphic markers indicated that the genetic diversity of the Chinese indigenous pigs was higher than that of the Western pigs, with the highest and lowest values found in the Chaluand and the Landrace pigs respectively. Both neighbor-joining tree and principal components analysis could distinguish breeds from one another and structure analysis showed less differentiation among Western pigs than among the Chinese pigs. The average linkage disequilibrium decay over distance was significantly less in the Chinese pigs compared with the Western pigs, ranging from 188.2 to 280.6 kb for the Chinese pigs and 680.3 to 752.8 kb for the Western breeds and showing an average r2 threshold value of 0.3. Results obtained from high-density SNP comparison over the whole genome on genetic diversity and population structure were in agreement with the current breed classification of the pigs in Zhejiang Province. More importantly, the results presented here advances our current understanding of the genomic biology of Chinese indigenous pigs in Zhejiang Province and allows for implementation of conservation strategies in additional breeds.

Note: Rapid measurement of fluorescence lifetimes using SiPM detection and waveform sampling.

In fluorescence spectroscopy and imaging, fluorescence lifetime measurement-assessing the average time fluorophores spend in their excited state before returning to their ground state-offers a number of advantages over quantifying fluorescence intensities that include resistance to photo-bleaching and independence from fluorophore concentration, excitation intensity, and measurement methodology. Despite growing interest, fluorescence lifetime techniques frequently mandate relatively complex instrumentation, slow data acquisition rates, and significant data analyses. In this work, we demonstrate the feasibility of measuring fluorescence lifetimes using off-the-shelf analog silicon photomultipliers and switched-capacitor array waveform sampling techniques, with precision matching that of much larger and more elaborate commercial instruments.

Comparison of the adult three-dimensional craniofacial features of patients with unilateral craniofacial microsomia with and without early mandible distraction.

This study was conducted to analyze the long-term facial growth of patients with craniofacial microsomia (CFM) after early mandible distraction osteogenesis (DO), and compared adult three-dimensional (3D) craniofacial features of patients with and without early mandibular DO for Pruzansky grade II deformities. The study included 20 patients: 9 with early mandible DO (the DO group) and 11 without previous treatment (the NDO group). Longitudinal radiographs were measured for growth changes after DO. The 3D craniofacial images were constructed to compare the craniofacial forms between the two groups. The patients with early DO presented 8 to 9mm forward and downward maxillary growth and 4.6mm limited forward and 17.3mm substantial downward mandibular growth. The ramus length ratio (affected/nonaffected) was 90.8% at DO completion and decreased to 69.5% at growth completion during 13 years of follow-up. Both groups showed obvious craniofacial asymmetry, as indicated by occlusal plane canting, chin deviation, transverse and vertical condyle positions, and mandibular contours. Although all the bilateral differences were higher in the NDO group than in the DO group, no statistical differences were found. Early mandible distraction could not alter the inherent facial growth pattern in patients with grade II CFM. Limited changes are derived for definitive facial correction with early DO.

A quick eye to anger: An investigation of a differential effect of facial features in detecting angry and happy expressions.

Detection of angry and happy faces is generally found to be easier and faster than that of faces expressing emotions other than anger or happiness. This can be explained by the threatening account and the feature account. Few empirical studies have explored the interaction between these two accounts which are seemingly, but not necessarily, mutually exclusive. The present studies hypothesised that prominent facial features are important in facilitating the detection process of both angry and happy expressions; yet the detection of happy faces was more facilitated by the prominent features than angry faces. Results confirmed the hypotheses and indicated that participants reacted faster to the emotional expressions with prominent features (in Study 1) and the detection of happy faces was more facilitated by the prominent feature than angry faces (in Study 2). The findings are compatible with evolutionary speculation which suggests that the angry expression is an alarming signal of potential threats to survival. Compared to the angry faces, the happy faces need more salient physical features to obtain a similar level of processing efficiency.

Angry Versus Furious: A Comparison Between Valence and Arousal in Dimensional Models of Emotions.

The present study compared the roles of valence and arousal, proposed by the dimensional models of emotions, in recognizing emotional expressions. It was hypothesized that the dimension of valence, due to its functional significance, would be more salient in the recognition of emotional expressions than the dimension of arousal would be. The results of the current study supported this hypothesis. The participants in all age groups were more accurate and quicker in recognizing an emotion when the expression was paired up with another emotional expression that was different in the polarity of the valence dimension than with this similar polarity difference in the arousal dimension. The insignificant difference in recognizing the positive and negative emotional expressions in the group of elders also rejected the Socio-Emotional Selectivity Theory.

Topically applied connective tissue growth factor/CCN2 improves diabetic preclinical cutaneous wound healing: potential role for CTGF in human diabetic foot ulcer healing.

AIMS/HYPOTHESIS: Topical application of CTGF/CCN2 to rodent diabetic and control wounds was examined. In parallel research, correlation of CTGF wound fluid levels with healing rate in human diabetic foot ulcers was undertaken. METHODS: Full thickness cutaneous wounds in diabetic and nondiabetic control rats were treated topically with 1 µg rhCTGF or vehicle alone, on 2 consecutive days. Wound healing rate was observed on day 14 and wound sites were examined for breaking strength and granulation tissue. In the human study across 32 subjects, serial CTGF regulation was analyzed longitudinally in postdebridement diabetic wound fluid. RESULTS: CTGF treated diabetic wounds had an accelerated closure rate compared with vehicle treated diabetic wounds. Healed skin withstood more strain before breaking in CTGF treated rat wounds. Granulation tissue from CTGF treatment in diabetic wounds showed collagen IV accumulation compared with nondiabetic animals. Wound α-smooth muscle actin was increased in CTGF treated diabetic wounds compared with untreated diabetic wounds, as was macrophage infiltration. Endogenous wound fluid CTGF protein rate of increase in human diabetic foot ulcers correlated positively with foot ulcer healing rate (r = 0.406; P < 0.001). CONCLUSIONS/INTERPRETATION: These data collectively increasingly substantiate a functional role for CTGF in human diabetic foot ulcers.

Pharmacokinetics and safety of plasma-derived factor XIII concentrate (human) in patients with congenital factor XIII deficiency.

UNLABELLED: Congenital factor XIII (FXIII) deficiency is a rare condition with substantial risk for life-threatening bleeding. Replacement of deficient FXIII with plasma-derived FXIII concentrate is a treatment option. The current 12-week study evaluated the steady-state pharmacokinetic (PK) and safety profile of prophylactic infusions of FXIII concentrate (human) in patients with congenital FXIII deficiency. Patients received FXIII concentrate (human) 40 IU kg(-1) on Days 0, 28, and 56. FXIII levels were assessed before and after each infusion; steady-state PK parameters were assessed up to 28 days after the infusion on Day 56. Treatment effectiveness in maintaining trough FXIII activity levels ≥ 5% over 28 days and safety parameters were also assessed. Fourteen patients received FXIII concentrate (human) and 13 completed the study. Post-infusion, FXIII activity levels increased to within the range found in patients without congenital FXIII deficiency without reaching supra-therapeutic levels. Non-baseline-adjusted trough FXIII activity levels were maintained at or above 10% at all post-baseline visits in all patients. Steady-state PK parameters were baseline-adjusted; maximum FXIII activity was 87.7% at 1.72 h post-infusion, subsequently declining to a minimum of 5.0%. The half-life was 6.6 days. FXIII concentrate (human) was generally well tolerated. Two patients had possibly treatment-related adverse events. There were no reports of thromboembolism, viral transmission, bleeding events or treatment-related hypersensitivity. These findings support use of FXIII concentrate (human) 40 IU kg(-1) every 28 days as an appropriate regimen for routine, long-term prophylaxis in children and adults with congenital FXIII deficiency. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov/ct2/show/NCT00883090.

Immunologic assessment and KMT2D mutation detection in Kabuki syndrome.

Kabuki or Niikawa-Kuroki syndrome (KS) is a rare disorder with multiple malformations and recurrent infections, especially otitis media. This study aimed to investigate the genetic defects in Kabuki syndrome and determine if immune status is related to recurrent otitis media. Fourteen patients from 12 unrelated families were enrolled in the 9-year study period (2005-2013). All had Kabuki faces, cleft palate, developmental delay, mental retardation, and the short fifth finger. Recurrent otitis media (12/14) and hearing impairment (8/14) were also more common features. Immunologic analysis revealed lower memory CD19+ cells (11/13), lower memory CD4+ cells (8/13), undetectable anti-HBs antibodies (7/13), and antibody deficiency (7/13), including lower IgA (4), IgG (2), and IgG2 (1). Naïve emigrant lymphocytes, lymphocyte proliferation function, complement activity, and superoxide production in polymorphonuclear cells were all normal. All the patients had KMT2D mutations and 10 novel mutations of R1252X, R1757X,Y1998C, P2550R fs2604X, Q4013X, G5379X, E5425K, R5432X, R5432W, and R5500W. Resembling the phenotype of common variable immunodeficiency, KS patients with antibody deficiency, decreased memory cells, and poor vaccine response increased susceptibility to recurrent otitis media. Large-scale prospective studies are warranted to determine if regular immunoglobulin supplementation decreases the frequency of otitis media and severity of hearing impairment.

Effects of seat structural dynamics on current ride comfort criteria.

The ISO 2631-1 ( 1997 ) provides methodologies for assessment of the seated human body comfort in response to vibrations. The standard covers various conditions such as frequency content, direction and location of the transmission of the vibration to the human body. However, the effects of seat structural dynamics mode shapes and corresponding resonances have not been discussed. This study provides important knowledge about the effects of vehicle seat structural vibration modes on discomfort assessment. The occupied seat resonant frequencies and corresponding vibration modes were measured and comfort test was carried out based on the paired comparison test method. The results show that the ISO 2631-1 ( 1997 ) method significantly underestimates the vibration discomfort level around the occupied seat twisting resonant frequencies. This underestimation is mainly due to the ISO suggested location of the accelerometer pad on the seatback. The centre of the seatback is a nodal point at the seat twisting mode. Therefore, it underestimates the total vibration transferred to the occupant body from the seatback. PRACTITIONER SUMMARY: The effects of the vehicle seat structural dynamics have not been discussed in the human body vibration ISO . The results of this research show that the current measurement method suggested by ISO 2631-1 (1997) can significantly underestimate the vibration discomfort level at around the seat structural vibration mode.

Polymorphisms in the promoter region of myostatin gene are associated with carcass traits in pigs.

Higher average daily gain, more lean meat yield and less fat yield of porcine carcass increase selling profits for animal producers. Myostatin (MSTN), previously called GDF8, is a member of transforming growth factor-ß (TGF-ß) superfamily. It is a negative regulator for both embryonic development and adult homeostasis of skeletal muscle. In this study, the genotypes of the previously described SNPs MSTN g.435G>A and g.447A>G SNPs in 66 Duroc pigs, 33 Landrace pigs, 180 Duroc × Landrace (DL) pigs and 155 Duroc × Yorkshire × Landrace (DYL) pigs were determined by Taqman SNP Genotyping Assays. For Duroc and Landrace pigs, MSTN g.435GG/g.447AA individual had greater backfat thickness (p < 0.05) than g.435AA/g.447GG individual, whereas MSTN g.435AA/g.447GG had greater meat (p < 0.05) and meat percentage (p < 0.05) than g.435GA/g.447AG individual. For DL and DYL pigs, the MSTN g.435GG/g.447AA animals were greater in backfat at ultrasound 10th rib (p < 0.05) and carcass 10th rib (p < 0.01) than g.435AA/g.447GG individual. The MSTN g.435AA/g.447GG individual also had higher values than g.435GG/g.447AA for anterior-end meat (p < 0.05), posterior-end meat (p < 0.01), total meat weight (p < 0.01) and meat percentage (p < 0.01). This study confirmed evidence that MSTN g.435G>A and g.447A>G affected carcass traits in pigs. The effects of the mutated alleles were additive with the maximal effects resulting from two copies of the mutated allele. Selection for MSTN g.435A/g.447G allele is expected to increase muscle of limb and total meat production and decrease backfat thickness.

Long-term follow-up of arrhythmia characteristics and clinical outcomes in heart transplant patients.

INTRODUCTION: Arrhythmias occur frequently after heart transplantation (HT), but knowledge of their impact on long-term outcomes is limited. This study sought to investigate the characteristics of the arrhythmias among biatrial orthotopic HT patients during long-term follow-up. METHODS: This study included 217 patients who received biatrial orthotopic HT. Patients were classified into 5 groups according to the arrhythmia episodes that occurred >1 month after HT: no arrhythmias (group 1; n = 149); atrial tachyarrhythmias only (group 2; n = 34); ventricular tachyarrhythmias only (group 3; n = 9); bradyarrhythmias only (group 4; n = 7); or double/triple arrhythmias (group 5; n = 18). We analyzed their long-term outcomes respectively. RESULTS: During 83 ± 51 months of follow-up, all-cause mortality rates were higher in groups 3 (88.9%) and 5 (72.2%) compared with the other groups (groups 1, 2, and 4: 21.5%, 41.2%, and 57.1%, respectively; P < .001). Cardiovascular mortality rates were higher in groups 4 (42.9%) and 5 (61.1%) compared with the other groups (groups 1, 2, and 3: 8.1%, 20.6%, and 0% respectively; P < .001). Noncardiovascular mortality rate was greater in group 3 (88.9%) compared with the other groups (groups 1, 2, 4, and 5: 13.4%, 20.6%, 14.3%, and 11.1%, respectively; P < .001). Sudden death rates were higher in groups 4 (42.9%) and 5 (44.4%) compared with the other groups (groups 1, 2, and 3: 7.4%, 8.8%, and 0%, respectively; P < .001). CONCLUSION: Patients with posttransplantation arrhythmias experienced significantly worse clinical outcomes.

Tissue factor expression in the metaplasia-adenoma-carcinoma sequence of gastric cancer in a European population.

BACKGROUND: Tissue factor (TF), which has a role in normal tissue haemostasis, was reported to be aberrantly expressed, associated with higher microvascular density and a poor prognosis in intestinal-type gastric adenocarcinoma in the Japanese population. This is the first study to look at the relationship of TF and the metaplasia-adenoma-carcinoma sequence (MACS) of gastric cancer in a European population. METHODS: The expression of TF was examined immunohistochemically in 191 gastric tissue samples: (13: normal; 18: intestinal metaplasia; 160: gastric adenocarcinoma) from the European population. RESULTS: TF was not expressed in normal gastric mucosal cells. A strong intensity of staining was found in intestinal metaplasia cells but in 2 of 18 samples. TF expression increased with advancing stage of gastric cancer (P<0.0001, Jonckheere's test for ordered medians). Stage 3-4 gastric cancers preferentially expressed TF (34%, P=0.04). In comparison with the Japanese study, TF was not expressed at a higher level in intestinal vs diffuse-type gastric cancers and expression had 'no prognostic' significance. CONCLUSION: TF may be involved in tumour progression along the MACS of gastric cancer in the European population and is shown to start in precancerous lesions. However, clinical features may differ due to differences in biological features in the two populations, as reflected by differences in TF expression profile.

Myeloperoxidase in the plasma and placenta of normal pregnant women and women with pregnancies complicated by preeclampsia and intrauterine growth restriction.

Myeloperoxidase (MPO) is a heme protein produced and released by activated neutrophils and monocytes, and increased MPO is considered important in the pathophysiology of cardiovascular diseases (CVD). Accumulating evidence suggests that preeclampsia (PE), idiopathic intrauterine growth restriction (IUGR), and CVD share many similar metabolic disturbances, including an enhanced systemic inflammatory response and endothelial dysfunction. We hypothesized that MPO plays an important role in the development of PE and IUGR. Plasma samples were collected mid-gestation and at delivery from women with normal pregnancies (n = 40) and those who subsequently developed PE (n = 20), IUGR (n = 11) or both (PE + IUGR, n = 8). Placental samples were obtained immediately after delivery from 22 women with normal pregnancies, 19 women with PE, 14 women with IUGR, and 14 women with PE + IUGR. The MPO concentrations were measured using ELISA. Women with PE + IUGR had significantly higher plasma MPO before delivery than normal pregnant women. There was no difference in plasma levels at mid-gestation or the placental concentrations between women with normal pregnancies and those who developed PE, IUGR, or PE + IUGR. Using explants prepared from the placentas of 8 women with normal pregnancies and 8 women with PE, we found no difference in the levels of MPO in the tissue homogenates and culture media between these two groups of women. Together, these results indicate that increased maternal circulating MPO in women with PE + IUGR is likely a result of enhanced systemic inflammation caused by the established disease rather than a primary pathophysiological factor.