Crystal Structural Characteristics and Electrical Properties of (Ba0.7Sr0.3-xCax)(Ti0.9Zr0.1)O3 Ceramics Prepared Using the Citrate Gelation Method.

The electrical properties of (Ba0.7Sr0.3-xCax)(Ti0.9Zr0.1)O3 (0 ≤ x ≤ 0.2) (BSCTZ) ceramics prepared using citrate gelation (CG) method were investigated by substituting Ca2+ ions for the Sr2+ sites based on the structural characteristics of the ceramics. BSCTZ was sintered for 3 h at 1300 °C, lower than the temperature (1550 °C) at which the specimens prepared using the solid-state reaction (SSR) method were sintered, which lasted for 6 h. As the amount of substituted Ca2+ ions increased, the unit cell volume of the BSCTZ decreased because of the smaller ionic radius of the Ca2+ ions compared to the Sr2+ ions. The dielectric constant of BaTiO3-based ceramics is imparted by factors such as the tetragonality and B-site bond valence of the ceramics. Although the ceramic tetragonality increased with Ca2+ ion substitution, the x = 0.05 specimens exhibited the highest dielectric constant. The decrease in the dielectric constant of the sintered x > 0.05 specimens was attributed to the increase in the B-site bond valence of the ABO3 perovskite structure. Owing to the large number of grain boundaries, the breakdown voltage (6.6839 kV/mm) of the BSCTZ prepared using the CG method was significantly improved in relation to that (2.0043 kV/mm) of the specimen prepared using the SSR method.

Tobacco Smoking Could Accentuate Epithelial-Mesenchymal Transition and Th2-Type Response in Patients With Chronic Rhinosinusitis With Nasal Polyps.

Tobacco smoking (TS) has been known as one of the most potent risk factors for airway inflammatory diseases. However, there has been a paucity of information regarding the immunologic alteration mediated by TS in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). To identify the effect of TS, we harvested human tissue samples (never smoker: n=41, current smoker: n=22, quitter: n=23) and analyzed the expression of epithelial-derived cytokines (EDCs) such as IL-25, IL-33, and thymic stromal lymphopoietin. The expressions of Th2 cytokines and total serum IgE showed a type-2 inflammatory alteration by TS. In addition, the epithelial marker E-cadherin and epithelial-mesenchymal transition (EMT)-associated markers (N-cadherin, α-SMA, and vimentin) were evaluated. Histological analysis showed that EDC expressions were upregulated in the current smoker group and downregulated in the quitter group. These expression patterns were consistent with mRNA and protein expression levels. We also found that the local Th2 cytokine expression and IgE class switching, as well as serum IgE levels, were elevated in the current smoker group and showed normal levels in the quitter group. Furthermore, the expressions of E-cadherin decreased while those of N-cadherin, α-SMA, and vimentin increased in the current smoker group compared those in the never smoker group. Taken together, these results indicate that TS contributes to the deterioration of pathogenesis by releasing local EDCs and Th2 cytokines, resulting in EMT in patients with CRSwNP. We verified that alterations of immunological response by TS in sinonasal epithelium can play a vital role in leading to CRSwNP.

Ultra-Widefield Fluorescein Angiography Findings in Patients with Macular Edema Following Cataract Surgery.

Purpose: To evaluate the ultra-widefield fluorescein angiography (UWFA) findings in patients with macular edema (ME) following cataract surgery.Methods: Thirty-three eyes from patients who showed greater than a 30% increase in the central subfield thickness following cataract surgery were included. UWFA scored according to a system suggested by the Angiography Scoring for Uveitis Working Group (ASUWG). Factors associated with a high ASUWG score were evaluated.Results: Thirty-three (100.0%) of the 33 eyes showed abnormal UWFA findings, including optic disc staining (81.8%), capillary leakage (100.0%), pinpoint leakage (84.8%), peripheral retinal vascular leakage (24.2%) and retinal staining (6.1%). Multiple regression analysis reveals that following adjustment for other factors, younger age was independently associated with a higher ASUWG score (R2 = 0.476, p = .001).Conclusions: Patients with ME following cataract surgery show generalized inner and outer blood-retinal barrier breakage. Particular attention is required during cataract surgery in young patients.

Effects of Food Art Therapy on the Self-Esteem, Self-Expression, and Social Skills of Persons with Mental Illness in Community Rehabilitation Facilities.

Persons with mental illness often have low self-esteem, a lack of self-expression, and poor social skills. This study used a quasi-experimental two-group pre-test-post-test design to investigate the effects of food art therapy on the self-esteem, self-expression, and social skills of persons with mental illness attending community rehabilitation facilities. The authors recruited persons with mental illness aged 18 years or older attending three community rehabilitation facilities. Participants in two rehabilitation facilities participated in food art therapy (experimental groups 1 and 2; n = 15 for each group), and participants in the third rehabilitation facility participated in regular programs of the facility (control group, n = 30). Participants in the experimental groups attended a total of eight sessions of food art therapy twice per week for four weeks. The Korean versions of the Rosenberg self-esteem scale, self-expression scale, and social skill rating system were administered at pre- and post-test in both the experimental and control groups. The self-esteem, self-expression, and social skills of the experimental group improved significantly compared to the control group. The findings suggested that food art therapy would be an excellent psychosocial intervention to help persons with mental illness to rehabilitate in the community.

Chronic and Low Dose Exposure to Nonlyphenol or Di(2-Ethylhexyl) Phthalate Alters Cell Proliferation and the Localization of Steroid Hormone Receptors in Uterine Endometria in Mice.

Based on our preliminary results, we examined the possible role of low-dose and chronic-exposing of the chemicals those are known as endocrine disrupting chemical (EDC), on the proliferation of uterine endometrium and the localization of steroid receptors. Immunohistochemical or immunofluorochemical methodology were employed to evaluate the localization of antigen identified by monoclonal antibody Ki 67 protein (MKI67), estrogen receptor 1 (ESR1), estrogen receptor 2 (ESR2), and progesterone receptor (PGR). In 133 µg/L and 1,330 µg/L di(2-ethylhexyl) phthalate (DEHP) and 50 µg/L nonylphenol (NP) groups, the ratio of MKI67 positive stromal cells was significantly increased but not in 500 µg/L NP group. The ratios of MKI67 positive glandular and luminal epithelial cells were also changed by the chronic administration of NP and DEHP in tissue with dose specific manner. ESR1 signals were localized in nucleus in glandular and luminal epithelia of control group but its localization was mainly in cytoplasm in DEHP and NP administered groups. On the other hand, it was decreased at nucleus of stromal cells in 1,330 µg/L DEHP group. The colocalization patterns of these nuclear receptors were also modified by the administration of these chemicals. Such a tissue specific and dose specific localization of ESR2 and PGR were detected as ESR1 in all the uterine endometrial tissues. These results show that the chronic lows-dose exposing of NP or DEHP modify the localization and colocalization of ESRs and PGR, and of the proliferation patterns of the endometrial tissues.

Chronic Low-Dose Nonylphenol or Di-(2-ethylhexyl) Phthalate has a Different Estrogen-like Response in Mouse Uterus.

Through the development of organic synthetic skill, chemicals that mimic signaling mediators such as steroid hormones have been exposed to the environment. Recently, it has become apparent that this circumstance should be further studied in the field of physiology. Estrogenic action of chronic low-dose nonylphenol (NP) and di-(2-ethylhexyl) phthalate (DEHP) in mouse uterus was assessed in this study. Ten to twelve-week-old female mice (CD-1) were fed drinking water containing NP (50 or 500 µg/L) or DEHP (133 or 1,330 µg/L) for 10 weeks. Uterine diameter, the thickness of myometrium and endometrium, and the height of luminal epithelial cells were measured and the number of glands were counted. The expression levels of the known 17ß-estradiol (E2)-regulated genes were evaluated with real-time RT-PCR methodology. The ration of uterine weight to body weight increased in 133 µg/L DEHP. Endometrial and myometrial thickness increased in 133 and 1,330 µg/L DEHP treated groups, and in 50, 500 µg/L NP and 133 µg/L DEHP, respectively. The height of luminal epithelial cell decreased in NP groups. The numbers of luminal epithelial gland were decreased in NP groups but increased in 50 µg/L DEHP group. The histological characters of glands were not different between groups. The mRNA expression profiles of the known 17ß-estradiol (E2) downstream genes, Esr1, Esr2, Pgr, Lox, and Muc1, were also different between NP and DEHP groups. The expression levels dramatically increased in some genes by the NP or DEHP. Based on these results, it is suggested that the chronic low-dose NP or DEHP works as estrogen-like messengers in uterus with their own specific gene expression-regulation patterns.

Correction: Whole genome expression profiling associates activation of unfolded protein response with impaired production and release of epinephrine after recurrent hypoglycemia.

[This corrects the article DOI: 10.1371/journal.pone.0172789.].

Whole genome expression profiling associates activation of unfolded protein response with impaired production and release of epinephrine after recurrent hypoglycemia.

Recurrent hypoglycemia can occur as a major complication of insulin replacement therapy, limiting the long-term health benefits of intense glycemic control in type 1 and advanced type 2 diabetic patients. It impairs the normal counter-regulatory hormonal and behavioral responses to glucose deprivation, a phenomenon known as hypoglycemia associated autonomic failure (HAAF). The molecular mechanisms leading to defective counter-regulation are not completely understood. We hypothesized that both neuronal (excessive cholinergic signaling between the splanchnic nerve fibers and the adrenal medulla) and humoral factors contribute to the impaired epinephrine production and release in HAAF. To gain further insight into the molecular mechanism(s) mediating the blunted epinephrine responses following recurrent hypoglycemia, we utilized a global gene expression profiling approach. We characterized the transcriptomes during recurrent (defective counter-regulation model) and acute hypoglycemia (normal counter-regulation group) in the adrenal medulla of normal Sprague-Dawley rats. Based on comparison analysis of differentially expressed genes, a set of unique genes that are activated only at specific time points after recurrent hypoglycemia were revealed. A complementary bioinformatics analysis of the functional category, pathway, and integrated network indicated activation of the unfolded protein response. Furthermore, at least three additional pathways/interaction networks altered in the adrenal medulla following recurrent hypoglycemia were identified, which may contribute to the impaired epinephrine secretion in HAAF: greatly increased neuropeptide signaling (proenkephalin, neuropeptide Y, galanin); altered ion homeostasis (Na+, K+, Ca2+) and downregulation of genes involved in Ca2+-dependent exocytosis of secretory vesicles. Given the pleiotropic effects of the unfolded protein response in different organs, involved in maintaining glucose homeostasis, these findings uncover broader general mechanisms that arise following recurrent hypoglycemia which may afford clinicians an opportunity to modulate the magnitude of HAAF syndrome.

Posttranscriptional regulation of adrenal TH gene expression contributes to the maladaptive responses triggered by insulin-induced recurrent hypoglycemia.

Acute metabolic stress such as insulin-induced hypoglycemia triggers a counterregulatory response during which the release of catecholamines (epinephrine), the activation of tyrosine hydroxylase (TH) enzyme and subsequent compensatory catecholamine biosynthesis occur in the adrenal medulla. However, recurrent exposure to hypoglycemia (RH), a consequence of tight glycemic control in individuals with type 1 and type 2 diabetes compromises this physiological response. The molecular mechanisms underlying the maladaptive response to repeated glucose deprivation are incompletely understood. We hypothesize that impaired epinephrine release following RH reflects altered regulation of adrenal catecholamine biosynthesis. To test this hypothesis, we compared the effect of single daily (RH) and twice-daily episodes of insulin-induced hypoglycemia (2RH) on adrenal epinephrine release and production in normal rats. Control animals received saline injections under similar conditions (RS and 2RS, respectively). Following 3 days of treatment, we assessed the counterregulatory hormonal responses during a hypoglycemic clamp. Changes in adrenal TH gene expression were also analyzed. The counterregulatory responses, relative TH transcription and TH mRNA levels and Ser40-TH phosphorylation (marker for enzyme activation) were induced to a similar extent in RS, 2RS, and RH groups. In contrast, epinephrine and glucagon responses were attenuated in the 2RH group and this was associated with a limited elevation of adrenal TH mRNA, rapid inactivation of TH enzyme and no significant changes in TH protein. Our results suggest that novel posttranscriptional mechanisms controlling TH mRNA and activated TH enzyme turnover contribute to the impaired epinephrine responses and may provide new therapeutic targets to prevent HAAF.

A comprehensive model of factors affecting adoption of clinical practice guidelines in Korea.

This study aims to investigate the factors related to the adoption of clinical practice guidelines in clinical settings in Korea; it also aims to determine how these factors differ depending on the specific situation of health care system and professional climate. The research sample comprised physicians who are board members of academic societies with experiences in development of clinical practice guidelines using a convenient sampling. We analyzed 324 physicians with pooling two-year sample of 2007 and 2008. From all the respondents, 48.8% stated that they followed Clinical Practice Guidelines, and 93.4% agreed with the content in the Clinical Practice Guidelines. With regard to the item on the self-efficacy of practicing guidelines, 90.3% of the respondents selected 'low level'. In the regression analysis, the factors associated with implementation were level of recognition, agreement and self-efficacy and positive attitude towards practice guidelines. Although the health care system in Korea differs from those in Western countries, our results revealed that the factors related to the adoption of practice guidelines were similar to the research results of Western countries. These results suggest that professionals' attitudes towards clinical practice guidelines are universal, and implementation strategies should be developed globally.

[A study of factors related to Korean physicians' trust in the government: on the target for board members of physicians' associations].

OBJECTIVES: This study aims to investigate the factors related to Korean physicians' trust in the government. METHODS: We used structured questionnaires that were composed of multidimensional scales for each of the various categories. RESULTS: The recognition levels of trust of the government by Korean physicians were not high, and they ranged from 3.6 to 4.8 for ten scales. The factors related to trust in the government were categorized into seven factors on the basis of a factor analysis. On the regression analysis, a positive relationship was found between "the individual propensity to trust" and trust in the government, while a negative relationship was found between "the recognition level regarding the government as an authoritarian power" and trust in the government. "Confidence about participation in the policy process" as internal efficacy and "belief in governmental ability and motivation toward public demand" as external efficacy also showed a strong positive relationship with trust in the government. CONCLUSIONS: From these results, we can draw the conclusion that making efforts to improve the recognition level of trust in the government among physicians is an important policy task. To increase the trust level, participation of physicians in the policy process in various ways and open communication between the physicians'associations and the government should be facilitated.

Stroma-free mass production of clinical-grade red blood cells (RBCs) by using poloxamer 188 as an RBC survival enhancer.

BACKGROUND: In vitro generation of red blood cells (RBCs) is an important alternative to donor RBCs. It was impossible, however, to generate a large quantity of RBCs due to necessity of supporting stromal cells or xenogeneic or human serum for in vitro culture, which had restrictions in safety, supplies, and expenses. In addition, the low viability of erythroblasts during terminal maturation in vitro required highly efficient production protocols. Here, we present a protocol for mass production of clinical-grade RBCs from cord blood (CB) CD34+ cells in stroma-free culture by using poloxamer 188 (P188), a polymer known to be cytoprotective against hydrodynamic stress. STUDY DESIGN AND METHODS: Umbilical CB CD34+ cells were cultured for 21 days in medium containing several cytokines, and roughly fibrin-eliminated CB derived plasma was added from Day 13. To enhance the final RBC production, P188 was added from Day 13 and the cell count and viability were compared with controls lacking P188. RESULTS: Erythroid expansion between Day 17 and Day 21 was significantly higher in cultures treated with P188, with a mean of 1.5 times and maximum of 3.6 times higher expansion than in controls lacking P188. The enhanced survival resulted from increased stability of the RBC membrane and decreased fragility. The erythroid cells were enucleated up to 95% and demonstrated hematologic variables similar to those of reticulocytes. CONCLUSION: This RBC production protocol is a simple stroma- and serum-free culture method ensuring enhanced viability of terminally mature erythroid cells and can be easily applicable to mass production of clinical-grade RBCs as well as erythropoiesis research.

Comparative Analysis of the Role of Beliefs in the Causes of Illness and Attitudes toward Medical Services in University Students from Disparate Specialties.

PURPOSE: This study aims to compare and investigate the differences in beliefs with regard to the cause of illnesses, medial skepticism, and attitudes toward medical care between medical, Oriental medical, and nonmedical students. METHODS: To this end, we used a structured questionnaire and collected self-reported data from a sample of 667 respondents. RESULTS: First, their beliefs on the causes of illness were markedly different, depending on their specialty. Compared with students from other specialties, Oriental medical students ranked host factors, environmental factors, and natural factors as the highest causes of illness. -the former group regarded supernatural factors as a more influential cause of illnesses compared with the latter. Among Oriental medical students and nonmedical students-who were also subdivided into the aforementioned groups-the upper-grade group regarded host factors as a higher cause of illness than the lower-grade group. Second, Medical skepticism also differed depending on specialty. Compared with the medical students, Oriental medical students were more likely to have high confidence in "overcoming illnesses", "home remedies", "self-decision in treatments", and "understanding their own health". In subdividing medical and Oriental medical students according to grade we observed that the senior group had more confidence in home remedies than the junior group. Third, In an analysis of the students attitudes toward medical care, we found that nonmedical students had the highest score in the "care-oriented" and "cure-oriented" attitude categories. In the overall results, the care-oriented category ranked highest for the nonmedical students, followed by Oriental medical students and medical students; the cure-oriented category ranked highest for nonmedical students, followed by medical students and then Oriental medical students. CONCLUSION: Based on our results, we conclude that these differences between specialties should be reflected in medical curricula to bridge the gap between patients and doctors in medical education with regard to the causes of illness and attitudes toward medical care.

[How are consumers, service and market factors related to customer loyalty in medical service? Targeting the medical consumer in a city].

OBJECTIVES: This study was performed to explore customer loyalty and the related factors. METHODS: 900 households (a 1% sample) were randomly selected from the total population of K city located in Kangwon province. An interview survey was performed with using a structured questionnaire for the subjects (923 persons) who had used medical service during the year before the survey, and the survey was done September, 2002. RESULTS: When comparing the relating factors related with customer loyalty according to the sociodemographic characteristics, the older group showed a significantly higher level of recognition for service quality, service reputation, internal customers.attitudes and switching cost. The lower income group showed a higher level of recognition for service quality, service image and switching cost. The lower educated group showed a higher level of recognition for service reputation, service image and internal customers.attitudes. The higher educated group showed a higher level of recognition for perceived risk, and seeking variety. In addition, the expert group or the service and manufacturing workers group showed a higher level of recognition for service involvement. On multiple regression analysis, internal customers' attitudes, service image, service reputation, service quality, switching cost, and substitutability showed significant relations with customer loyalty. CONCLUSIONS: This study showed that customer loyalty was significantly influenced by service factors like internal customers' attitudes, service image, service reputation, and service quality, and by market factors like switching cost, and substitutability. The results of this study can be used as a baseline for developing strategies to create and keep customers with high loyalty.