[Chemical constituents of diterpenoids from Boswellia carterii].

This paper explored the chemical constituents of Boswellia carterii by column chromatography on silica gel, Sephadex LH-20, ODS column chromatography, and semi-preparative HPLC. The structures of the compounds were identified by physicochemical properties and spectroscopic data such as infrared radiation(IR), ultra violet(UV), mass spectrometry(MS), and nuclear magnetic resonance(NMR). Seven diterpenoids were isolated and purified from n-hexane of B. carterii. The isolates were identified as(1S,3E,7E,11R,12R)-11-hydroxy-1-isopropyl-4,8,12-trimethyl-15-oxabicyclo[10.2.1]pentadeca-3,7-dien-5-one(1),(1R,3S,4R,7E,11E)-4,8,12,15,15-pentamethyl-14-oxabicyclo[11.2.1]hexadeca-7,11-dien-4-ol(2), incensole(3),(-)-(R)-nephthenol(4), euphraticanoid F(5), dilospirane B(6), and dictyotin C(7). Among them, compounds 1 and 2 were new and their absolute configurations were determined by comparison of the calculated and experimental electronic circular dichroisms(ECDs). Compounds 6 and 7 were obtained from B. carterii for the first time.

Modified distributed Bragg reflector for protecting organic light-emitting diode displays against ultraviolet light.

Sunlight/UV (ultraviolet)-induced degradation is still a critical issue for outdoor applications of organic light-emitting diode (OLED) displays. Therefore, effective UV-blocking structures that can prevent OLED displays from sunlight/UV degradation and still keep the OLED panels' display performance is necessary. In this report, modified distributed Bragg reflector (DBR) structures having UV-absorbing dielectric materials and adjusted layer/pair thicknesses were developed to realize effective UV blocking properties (nearly 0% transmittance below 400 nm), constantly high transmittance like glass in the visible range (∼92%) required for display applications, and sharp transition in transmission between the UV and the visible ranges. Furthermore, under the rigorous IEC 60068-2-5 solar test condition, it was verified that the developed modified, UV-blocking DBR can effectively enhance the OLED panel's resistance against UV/solar-induced degradation, effectively reducing voltage shifts of OLED devices after repeated solar test cycles.

Oncological and functional outcomes in patients over 70 years of age treated with robotic radical prostatectomy: a propensity-matched analysis.

PURPOSE: The aim of this study was to report on the safety (complications) and efficacy (oncological and functional outcomes) of robot-assisted radical prostatectomy (RARP), performed at our institution, in patients aged over 70. PATIENTS AND METHODS: Review of our prospectively collected database [Cancer Information Systems (CAISIS)] identified two hundred and fifteen (215) patients, aged > 70, who underwent RARP for localized prostate cancer between July 2003 and August 2017. A propensity score-matched analysis, with multiple covariates, was performed to stratify the patients into Age ≤ 70 and Age > 70 comparison groups. RESULTS: Apart from Age (mean ± SD years: 73.5 ± 2.1 vs 59.5 ± 5.9, p < 0.0001) and nerve-sparing status, the two groups were evenly matched for all covariates (p values > 0.05). Median follow-up was 10.6 years. There were no 90-day mortalities in either group. Minor complications (Clavien ≤ 2) were more common in the Age > 70 group (p = 0.0002). Operating room time (p = 0.83), length of hospital stay (p = 0.06) and catheterization duration (p = 0.13) were similar. On final pathology, a higher pT stage (p < 0.0001) and pN1 (p = 0.003) were observed in the Age > 70 group. However, this did not translate adversely into higher rates of positive surgical margin (p = 0.41) or biochemical relapse (p = 0.72). Allowing for the follow-up duration (median 10.6 years), cancer-specific survival was marginally significant (p = 0.05) with an observed lower rate in the Age > 70 group. In terms of functional outcomes, post-operative erectile dysfunction and pad-free continence were significantly better in the younger cohort (p < 0.0001). CONCLUSIONS: Robot-assisted radical prostatectomy should not be denied to those over 70 years solely on the basis of age. Older men need to be counseled about the likelihood of encountering higher-risk features on final pathology and that their functional outcomes may be worse compared to a younger person.

Accelerated Skills Acquisition Protocol (ASAP) in optimizing robotic surgical simulation training: a prospective randomized study.

PURPOSE: To assess the efficacy of an accelerated proficiency-based training protocol in robotic simulation practice in delivering durable proficiency compared to conventional training methods. METHODS: Novice medical students (n = 16) were randomized into either the accelerated skills acquisition protocol (ASAP) or conventional training protocol (CTP). Subjects were trained to proficiency on the da Vinci Skills Simulator (dVSS) by an expert trainer. Differences in the repetitions required to achieve proficiency in two simple and two complex virtual reality (VR) training tasks were assessed as the primary outcome measure. Transfer of the acquired skills to two other non-practiced tasks was assessed immediately and prospectively followed through to 3, 6 and 12 months in the two groups. Retention of the practiced tasks was assessed along the same timeframe. RESULTS: Subjects in the ASAP group acquired proficiency significantly faster in three of the four training tasks: camera control (p = 0.0002), suture sponge (p < 0.0001), ring walk3 (p < 0.0001), and peg board (p = 0.6936). When assessing transfer of skills, there were no significant differences between the two groups: Ring rail 3 (p = 0.6807) and Tubes (p = 0.2240). When assessing retention of skills at 3, 6 and 12 months, for all 6 tasks, no significant differences were seen between the ASAP and CTP groups. CONCLUSION: ASAP is proven to be an efficient approach for delivering proficiency in robotic VR simulation training. The results are durable when compared to conventional simulation training methods. The findings may have significant implications in the design of robotic VR simulation curricula.

The relations among three popular indices of risks.

The relative risk, risk difference, and odds ratio are three major indices of differences in risks of diseases between different groups. Although widely used in research and practice in biomedical and epidemiologic research, misconceptions are not uncommon about their relationships. Many publications offer contradicting advices in how to use them in studies. Some biomedical researchers believe that these indices are related in a monotone fashion, and, thus, changes in one direction in one of the indices can be interpreted as same directional changes in the other two. Misconceptions about these three indices such as the monotone relationship are so prevalent in the biomedical and epidemiologic research that clarifications of such popular beliefs are warranted. In this paper, we take a systematic approach to characterize the relationships among the indices. We develop key results to elucidate the intricate relationships between the indices. Our findings speak to the need for investigators to carefully consider the different indices before using them in their studies, since they are not interchangeable and results based on one index are generally not translatable into any of the others.

Multi-institutional nomogram predicting benign prostate pathology on magnetic resonance/ultrasound fusion biopsy in men with a prior negative 12-core systematic biopsy.

BACKGROUND: Prostate multiparametric magnetic resonance imaging (mpMRI) may be recommended for patients with a prior negative systematic biopsy (SB). However, a proportion of these patients will continue to have no prostate cancer (PCa) identified on magnetic resonance/ultrasound fusion biopsy (FB) despite abnormal mpMRI findings. METHODS: In this multi-institutional, retrospective study, clinical and mpMRI parameters were assessed for 285 consecutive patients with at least 1 prior negative biopsy who underwent FB for a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 to 5 at the University of Rochester Medical Center from December 2014 to December 2016, or at the University of Alabama at Birmingham from February 2014 to February 2017. Nomograms were generated for predicting benign prostate pathology on both the targeted biopsy and the concurrent SB. RESULTS: Benign pathology was found in 132 of 285 patients (46.3%). In a multivariate analysis, the predictors of benign prostate pathology on FB were age, prostate-specific antigen, prostate volume, and PI-RADS score. The predicted probabilities were plotted on a receiver operating characteristic curve, and the area under the curve was 0.825. The nomogram demonstrated excellent calibration and a high net benefit in a decision curve analysis. With a theoretical cutoff probability of ≥0.7 used to recommend deferment of FB, 61 of 285 patients (21.4%) would have avoided an unnecessary biopsy, and only 4 of 285 patients (1.4%) with PCa with a Gleason score ≥ 3 + 4 would have been missed. CONCLUSIONS: False-positive mpMRI examinations may occur in up to 46.3% of patients with a prior negative biopsy. Thus, a multi-institutional nomogram has been developed and validated for predicting benign pathology after FB in patients with a prior negative biopsy, and this may help to reduce the number of unnecessary biopsies in the setting of abnormal mpMRI findings. Cancer 2018;124:278-85. © 2017 American Cancer Society.

Comprehensive assessment of T-cell repertoire following autologous hematopoietic stem cell transplantation for treatment of type 1 diabetes using high-throughput sequencing.

OBJECTIVE: We aimed to investigate T-cell receptor (TCR) repertoires in type 1 diabetes (T1D) patients receiving autologous hematopoietic stem cell transplantation (AHSCT) treatment. METHODS: High-throughput deep TCR beta (TCRB) chain sequencing was performed to assess millions of individual TCRs in five T1D patients receiving AHSCT treatment and another five patients receiving insulin treatment during 12 months of follow-up. RESULTS: No significant changes in TCRB sequence reads, complementarity-determining region 3 (CDR3) sequences, or the usage of TCRB VJ gene-segments were observed at 12 months after AHSCT. Compared with the baseline, the usage of TCRB VJ gene-segments at 12 months decreased in the insulin treatment group (1836.4 ± 437.7 vs 2763.6 ± 390.6, P = 0.015), and the change rates were larger than those undergoing AHSCT (-0.62 ± 0.16 vs 0.06 ± 0.45, P = 0.002). Changes in the TCR repertoire were smaller after AHSCT than those with insulin treatment (P = 2.2*10-32 ). TCRBV 7-7/TCRBJ 2-5 was depleted after AHSCT while expanded with insulin treatment. TCRBV 12-4, TCRBV 10-3, TCRBV 12-3/TCRBJ 1-2 were expanded after AHSCT while ablated with insulin treatment. CONCLUSIONS: We found that AHSCT is safe without reduction in the diversity of TCR repertoires and TCR repertoires tend to be more stable after AHSCT. Furthermore, these four candidate TCRBV/TCRBJ gene usages on CDR3 regions may act as therapeutic targets and biomarkers.

Analyzing polymeric matrix for fabrication of a biodegradable microneedle array to enhance transdermal delivery.

Traditional drug delivery systems, using invasive, transdermal, and oral routes, are limited by various factors, such as the digestive system environment, skin protection, and sensory nerve stimulation. To improve the drug delivery system, we fabricated a polysaccharide-based, dissolvable microneedle-based array, which combines the advantages of both invasive and transdermal delivery systems, and promises to be an innovative solution for minimally invasive drug delivery. In this study, we designed a reusable aluminum mold that greatly improved the efficiency and convenience of microneedle fabrication. Physical characterization of the polysaccharides, individual or mixed at different ratios, was performed to identify a suitable molecule to fabricate the dissolvable microneedle. We used a vacuum deposition-based micro-molding method at low temperature to fabricate the model. Using a series of checkpoints from material into product, a systematic feedback mechanism was built into the "all-in-one" fabrication step, which helped to improve production yields. The physical properties of the fabricated microneedle were assessed. The cytotoxicity analysis and animal testing of the microneedle demonstrated the safety and compatibility of the microneedle, and the successful penetration and effective release of a model protein.

Application of in vivo brain imaging technology in the basic research of acupuncture-moxibustion for encephalopathy. / æ´»ä½“è„‘æˆåƒæŠ€æœ¯åœ¨é’ˆç¸è„‘ç— åŸºç¡€ç ”ç©¶ä¸­çš„åº”ç”¨.

Acupuncture-moxibustion is remarkably effective on encephalopathy, but its mechanism is unclear. With the continuous development of imaging technology, the in vivo brain imaging technology has been used increasingly in life science research and it also becomes a more effective tool for the basic research of acupuncture-moxibustion in treatment of encephalopathy. The paper summarizes the application of its technology in the basic research of acupuncture-moxibustion for encephalopathy and the characteristics of imaging, as well as the advantages and shortcomings. It is anticipated that the references may be provided for the basic research of acupuncture-moxibustion in treatment of encephalopathy and be conductive to the modernization of acupuncture-moxibustion.

Inconsistency between overall and subgroup analyses.

Suppose we have a sample of subjects in two treatment groups. To study the difference of the treatment effects, we can analyse the data using all subjects (overall analysis). We may also divide the subjects into several subgroups based on some covariates of interest (eg, gender), and study the treatment effects within each subgroup. The results of these two analyses may be different or even in opposite directions. In this paper, we give a general sufficient condition of consistency between the overall and subgroup analyses.

Detrimental health relationship between blood lead and cadmium and the red blood cell folate level.

Increasing studies have demonstrated the association between heavy metal pollution and micronutrients, especially folate. However, the relationship between cadmium and folate remains rarely discussed. In this study, we aim to explore the potential correlation between cadmium and folate in human population and highlight the possible mechanism of cadmium impacting human health. We utilized the National Health and Nutrition Examination Survey (NHANES) 2017-2018 data with 5690 participants in this study. Multivariable linear regression models were adopted to investigate the serum lead and cadmium levels and RBC folate concentration. A significant reverse relationship was found between serum lead and cadmium and RBC folate. A negative relationship between serum lead and cadmium levels and the levels of RBC folate in the U.S. adult population was found in this study. Nevertheless, due to the general limitations of the NHANES data, as a cross-sectional study, a further prospective investigation is needed to discover the causality of lead and cadmium in folate status and to determine whether the folate supplement has a beneficial influence against heavy metal toxicities.

Relations among sensitivity, specificity and predictive values of medical tests based on biomarkers.

Diagnostic tests are usually based on some quantitative biomarkers. Two key parameters used to characterise the quality of a test are test sensitivity and specificity. Predictive values of the disease status based on test results are also of interest in medical research and public health management. In this paper, we study the relations among sensitivity, specificity and predictive values of the test. The core concept is risk function, which is assumed to be an increasing function of the biomarker. Our results show that test sensitivity and specificity change in opposite directions. The positive predictive value and the sensitivity also change in opposite directions. Likewise, the negative predictive value and the specificity change in opposite directions.

Graphitic carbon nitride embedded with graphene materials towards photocatalysis of bisphenol A: The role of graphene and mediation of superoxide and singlet oxygen.

Composite photocatalysts comprising graphitic carbon nitride (g-C3N4) and graphene materials were synthesized and evaluated in the photocatalysis of bisphenol A (BPA) with a focus on elucidating the reaction mechanism. Embedding reduced graphene oxide (rGO) to g-C3N4 significantly accelerated the photocatalysis rate of BPA by three folds under visible light irradiation at neutral pH. We showed that rGO synthesized in intimate contact with g-C3N4 increased the surface areas and electrical conductivity of the g-C3N4 composites and promoted the electron-hole pair separation. The BPA photodegradation mechanism involved selective oxidants as superoxide (O2•-) and singlet oxygen (1O2) that were formed through one-electron reduction of O2 and the unique oxidation of O2•- by photogenerated hole (h+), respectively. The synthesized photocatalyst exhibited superior visible light photoreactivity to that of N-doped P25 TiO2, good photo-stability and reuse potential, and was operative in complex wastewater. rGO embedded g-C3N4 achieved good photomineralization of BPA at 80% in 4 h compared to 40% of bare g-C3N4. This study sheds light on the photocatalysis mechanism of BPA with a metal-free, promising rGO/g-C3N4 photocatalyst.

Machine learning methods in psychiatry: a brief introduction.

Machine learning (ML) techniques have been widely used to address mental health questions. We discuss two main aspects of ML in psychiatry in this paper, that is, supervised learning and unsupervised learning. Examples are used to illustrate how ML has been implemented in recent mental health research.

The association between gingival recession and buccal bone at maxillary anterior teeth.

BACKGROUND: Gingival recession and a thin or absent buccal plate occur frequently at maxillary anterior teeth and necessitate careful treatment planning to prevent future complications. However, the association between these two conditions is unclear and the ability of gingival recession to predict underlying buccal bone deficiencies is unknown. Therefore, the aim of this study is to use clinical and radiographic data to test this association and determine the influence of demographic and clinical parameters on both conditions. METHODS: This investigation comprised a single-center, retrospective study. Data were derived from periodontal examinations performed on 66 adult subjects. Corresponding cone-beam computed tomography images were used to measure the width of buccal bone at two points along the root surface and the distance between the bone crest and cemento-enamel junction (CEJ). Results were then analyzed to determine the association between the presence of gingival recession and the condition of radiographic buccal bone, as well as the relative contribution of demographic parameters and other clinical findings to gingival recession and buccal bone conditions. RESULTS: Gingival recession was present at 32.9% of maxillary anterior teeth and was most common at canines, followed by lateral incisors and central incisors. Mean buccal bone widths were significantly less, and the distance between the CEJ and bone crest was significantly greater for teeth with recession. Accordingly, gingival recession was a significant predictor for buccal bone thickness <1 mm at the level of 4 mm apical to the CEJ (odds ratio 2.733, 95% confidence interval 1.644 to 4.543, P < 0.0001). Probing depths were related to the presence or absence of gingival recession, while patient sex, age, and the apico-coronal height of the gingiva were related to buccal bone thickness. CONCLUSION: Within the limitations of this study, maxillary anterior teeth with pre-existing gingival recession were more likely to have thin (<1 mm) buccal bone.

Advanced machine learning methods in psychiatry: an introduction.

Mental health questions can be tackled through machine learning (ML) techniques. Apart from the two ML methods we introduced in our previous paper, we discuss two more advanced ML approaches in this paper: support vector machines and artificial neural networks. To illustrate how these ML methods have been employed in mental health, recent research applications in psychiatry were reported.

The p-value and model specification in statistics.

The p value has been widely used as a way to summarise the significance in data analysis. However, misuse and misinterpretation of the p value is common in practice. Our result shows that if the model specification is wrong, the distribution of the p value may be inappropriate, which makes the decision based on the p value invalid.

Non-inferiority trial of a pedal controlled injection device: a step toward enhancing patient safety and operator independence during neural blockade.

BACKGROUND AND OBJECTIVES: Limitations in manpower in health care facilities, both in civilian and military settings, can severely affect patient safety as well as overall outcomes. Regional anesthesia via neural blockade is an effective means of managing uncontrolled acute pain, which has been associated with cardiopulmonary, endocrine, immunologic, and hematologic derangement in addition to the development of potentially life-threatening coagulopathy. We have designed a remote-controlled injection device that may expedite the performance of regional nerve blocks in these situations. METHODS: This work examines how the device affects the ability of the operator to act independently with respect to various block component times by statistically comparing device-assisted blockade with usual or clinically relevant techniques. The classic or two-person technique was compared with the foot-controlled technique. RESULTS: The results validated the hypothesis that the novel mechanism of performing a nerve block is not inferior to the classic technique with regard to the specified endpoints within our experimental design. CONCLUSION: This confirmation indicates that the use of this device may be feasible when the use of another technique could be cumbersome, or otherwise untenable.

Multi-institutional Clinical Tool for Predicting High-risk Lesions on 3Tesla Multiparametric Prostate Magnetic Resonance Imaging.

BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) for prostate cancer detection without careful patient selection may lead to excessive resource utilization and costs. OBJECTIVE: To develop and validate a clinical tool for predicting the presence of high-risk lesions on mpMRI. DESIGN, SETTING, AND PARTICIPANTS: Four tertiary care centers were included in this retrospective and prospective study (BiRCH Study Collaborative). Statistical models were generated using 1269 biopsy-naive, prior negative biopsy, and active surveillance patients who underwent mpMRI. Using age, prostate-specific antigen, and prostate volume, a support vector machine model was developed for predicting the probability of harboring Prostate Imaging Reporting and Data System 4 or 5 lesions. The accuracy of future predictions was then prospectively assessed in 214 consecutive patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Receiver operating characteristic, calibration, and decision curves were generated to assess model performance. RESULTS AND LIMITATIONS: For biopsy-naïve and prior negative biopsy patients (n=811), the area under the curve (AUC) was 0.730 on internal validation. Excellent calibration and high net clinical benefit were observed. On prospective external validation at two separate institutions (n=88 and n=126), the machine learning model discriminated with AUCs of 0.740 and 0.744, respectively. The final model was developed on the Microsoft Azure Machine Learning platform (birch.azurewebsites.net). This model requires a prostate volume measurement as input. CONCLUSIONS: In patients who are naïve to biopsy or those with a prior negative biopsy, BiRCH models can be used to select patients for mpMRI. PATIENT SUMMARY: In this multicenter study, we developed and prospectively validated a calculator that can be used to predict prostate magnetic resonance imaging (MRI) results using patient age, prostate-specific antigen, and prostate volume as input. This tool can aid health care professionals and patients to make an informed decision regarding whether to get an MRI.

Tests for paired count outcomes.

For moderate to large sample sizes, all tests yielded pvalues close to the nominal, except when models were misspecified. The signed-rank test generally had the lowest power. Within the current context of count outcomes, the signed-rank test shows subpar power when compared with tests that are contrasted based on full data, such as the GEE. Parametric models for count outcomes such as the GLMM with a Poisson for marginal count outcomes are quite sensitive to departures from assumed parametric models. There is some small bias for all the asymptotic tests, that is, the signed-ranktest, GLMM and GEE, especially for small sample sizes. Resampling methods such as permutation can help alleviate this.