In-plane scattering patterns from a complex dielectric grating at the normal and oblique incidence.

The in-plane scattering patterns from a complex dielectric grating were both numerically and experimentally studied in contrast to those from well-known metallic gratings. The incidence was the transverse electric or transverse magnetic wave of wavelength λ=660 nm. The grating profile was complex with a period Λ=7.0 µm, while the material was lightly doped crystalline silicon. Patterns of the electric field, magnetic field, and spatial intensity distribution were demonstrated at the normal (θ(i)=0°) and oblique (θ(i)=+30°) incidence. Electric and magnetic fields were presented in the near field as well as the far field. The measured power ratio within -90°≤θ(r)≤+90° was plotted. Their major peaks and the numerically obtained diffraction efficiency of 21 orders (-10≤m≤+10 or -15≤m≤+5) of diffracted waves occurred at the same θ(r). Other peaks and stair-like shoulders of major peaks also exhibited in spectra.

Effect of eritoran, an antagonist of MD2-TLR4, on mortality in patients with severe sepsis: the ACCESS randomized trial.

IMPORTANCE: Eritoran is a synthetic lipid A antagonist that blocks lipopolysaccharide (LPS) from binding at the cell surface MD2-TLR4 receptor. LPS is a major component of the outer membrane of gram-negative bacteria and is a potent activator of the acute inflammatory response. OBJECTIVE: To determine if eritoran, a TLR4 antagonist, would significantly reduce sepsis-induced mortality. DESIGN, SETTING, AND PARTICIPANTS: We performed a randomized, double-blind, placebo-controlled, multinational phase 3 trial in 197 intensive care units. Patients were enrolled from June 2006 to September 2010 and final follow-up was completed in September 2011. INTERVENTIONS: Patients with severe sepsis (n = 1961) were randomized and treated within 12 hours of onset of first organ dysfunction in a 2:1 ratio with a 6-day course of either eritoran tetrasodium (105 mg total) or placebo, with n = 1304 and n = 657 patients, respectively. MAIN OUTCOME MEASURES: The primary end point was 28-day all-cause mortality. The secondary end points were all-cause mortality at 3, 6, and 12 months after beginning treatment. RESULTS: Baseline characteristics of the 2 study groups were similar. In the modified intent-to-treat analysis (randomized patients who received at least 1 dose) there was no significant difference in the primary end point of 28-day all-cause mortality with 28.1% (366/1304) in the eritoran group vs 26.9% (177/657) in the placebo group (P = .59; hazard ratio, 1.05; 95% CI, 0.88-1.26; difference in mortality rate, -1.1; 95% CI, -5.3 to 3.1) or in the key secondary end point of 1-year all-cause mortality with 44.1% (290/657) in the eritoran group vs 43.3% (565/1304) in the placebo group, Kaplan-Meier analysis of time to death by 1 year, P = .79 (hazard ratio, 0.98; 0.85-1.13). No significant differences were observed in any of the prespecified subgroups. Adverse events, including secondary infection rates, did not differ between study groups. CONCLUSIONS AND RELEVANCE: Among patients with severe sepsis, the use of eritoran, compared with placebo, did not result in reduced 28-day mortality. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00334828.

Role of kisspeptin on cell proliferation and steroidogenesis in luteal cells in vitro and in vivo.

BACKGROUND: Kisspeptin (KISS1) and kisspeptin receptor (KISS1R) are essential gatekeepers of the reproductive system. The functions of KISS1 and KISS1R in corpus luteal cells remain ambiguous. The objective was to observe normal physiologic functions of corpus luteal cells in vivo and clarify the functions of KISS1 in vitro. METHODS: We conducted an in vivo observation of cellular patterns as well as the levels of steroidogenic enzymes and KISS1/KISS1R in corpus luteal cells obtained from female crossbred Taiwan native goats in the estrous cycle; the observation was performed using hematoxylin and eosin and immunohistochemistry staining. Subsequently, we used kisspeptin-10 (Kp-10) to stimulate temperature sensitive-caprine luteal cell line (ts-CLC-D) cells to investigate the progesterone (P4) levels, steroidogenic messenger RNA (mRNA)/protein levels, cell survival rate, intracellular Ca2+ concentration, and cell proliferation-related mRNA/protein levels in the mitogen-activated protein kinase pathway in vitro by applying immunofluorescence staining, Western blotting, 2,3-bis (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide assay, and real-time polymerase chain reaction. RESULTS: We observed the presence of proteins and mRNAs for STAR, CYP11A1, HSD3B, KISS1, and KISS1R in the corpus luteal cells from goats in vivo. In vitro, the addition of Kp-10 reduced the P4 levels (p < 0.01) and increased cell proliferation (p < 0.05) of the ts-CLC-D cells. Furthermore, we found that the levels of proteins and mRNA for STAR, CYP11A1, and HSD3B decreased significantly when Kp-10 was added (p < 0.05). However, adding Kp-10 did not affect the mRNA levels for PLCG2, DAG1, PRKCA, KRAS, RAF1, MAP2K1, MAP2K2, MAPK3, MAPK1, and MAPK14. CONCLUSION: We determined that KISS1 could affect the P4 levels, steroidogenesis, and cell proliferation in luteal cells. However, further research is required to clarify how KISS1 regulates proliferation and steroid production in luteal cells.

Prevalence of mycotoxins in feed and feed ingredients between 2015 and 2017 in Taiwan.

Contamination of feed by mycotoxins is a global epidemic that has a sizeable impact on animal health and causes economic losses. Mycotoxins, including aflatoxins (AFs), zearalenone (ZEN), fumonisins (FUMs), deoxynivalenol (DON), and ochratoxin A (OTA), lead to acute and chronic adverse effects in pigs. Animal feed and feed ingredients are commonly contaminated by one or more mycotoxins worldwide; however, the prevalence of mycotoxin contamination in feed and feed ingredients in Taiwan remains unclear. A total of 820 cornmeal and corn-based swine feed (pregnancy and nursery diets) samples provided by feed and animal producers were analyzed using the enzyme-linked immunosorbent assay method between January 2015 and December 2017 to determine the presence of mycotoxins. The results revealed that the most prevalent mycotoxin in Taiwan was DON, with 91.4% of positive samples between 2015 and 2017, followed by ZEN, AFs, and FUMs, with 70.2%, 58.0%, and 50.4% of positive samples, respectively. A similar prevalence of mycotoxins was observed in cornmeal and corn-based swine feed. Furthermore, 7.7% of the analyzed feed samples contained one mycotoxin, and 91.3% contained multiple mycotoxins. DON was the most prevalent mycotoxin in cornmeal and corn-based swine feed in Taiwan. Moreover, a high incidence of contamination by multiple mycotoxins was observed in swine feed. Awareness of mycotoxin presence in feed and development of mycotoxin detoxification strategies are unmet needs.

The photothermal effect of silica-carbon hollow sphere-concanavalin A on liver cancer cells.

Hepatocellular carcinoma (HCC) is one of the most common cancers and causes of death by cancer. Concanavalin A (ConA) lectin can specifically bind to the glycoprotein receptors of HCC, which are produced by the aberrant overexpression of liver cancer cells. ConA was used in the current study to conjugate on silica-carbon hollow spheres (SCHSs) and applied in the thermal ablation therapy of liver cancer cell lines under near-infrared (NIR) laser irradiation. We found that the amount of ConA-SCHS complex binding to hepatoma cells was significantly higher than that seen with normal hepatocytes, based on flow cytometric analysis and confocal imaging. Hepatoma cells incubated with ConA-SCHSs were thus more easily killed by the subsequent irradiation with a NIR laser. The results show that the ConA-SCHS complex may enhance the interaction with highly expressed ConA receptors on hepatoma cells, and thus serve as an effective photothermal therapy agent for liver cancer treatment.

A 'membrane in syringe' technique that allows identification of the epidural space with saline while avoids injection of air into the epidural space.

BACKGROUND: The 'MEMBRANE IN SYRINGE' technique is, in principle, a modification of the loss of resistance technique for identifying the epidural space in epidural anaesthesia. A plastic membrane is placed halfway inside a syringe dividing the syringe into two compartments. The saline compartment encompasses the nozzle of the syringe (the distal compartment). The plunger is installed in the opposite half of the hallow cylinder. Air is trapped in the space between the membrane and the rubber plunger (air compartment). METHODS: There were altogether 20 epidural procedures to put to the test for this technique. The time spent in the undertaking of the procedure, the amount of normal saline injected, whether there was a feel of loss of resistance with wrinkling of the membrane in the syringe, inadvertent puncture of the dura, the level of epidural block and the insertion depth of epidural needle were recorded. RESULTS: The procedure took less than 4 minutes to complete in most of the cases. There was no inadvertent dural puncture. The average amount of normal saline injected was less than 1 ml. In 3 cases, despite the absence of the feel of loss of resistance the epidural space was still successfully identified by visible wrinkling of the membrane in the syringe. All catheters were inserted smoothly through the epidural needle and appropriate level of anesthesia was achieved in all the cases. CONCLUSIONS: The advantage of this technique is twofold. Firstly when the syringe is filled with both normal saline and air, it can prevent injection of the air into the epidural space during identification while at the same time it does not molest the feel of compressibility. Secondly, with the membrane separating the normal saline and air, correct placement of the needle tip can also be ascertained with loss of resistance while, as will be seen, the plastic membrane will wrinkle when saline is released into the epidural space.

Intravenous mannitol does not increase blood-brain barrier permeability to inert dyes in the adult rat forebrain.

Intravenous mannitol (IV-M) is widely administered in the clinic to lower intracranial pressure in patients with brain trauma and stroke. However, intracarotid arterial mannitol (ICA-M) is known to potently open the blood-brain barrier (BBB) to serum protein tracers such as the Evans blue dye (EBD). In this study, we aimed to determine the potential effect of IV-M on BBB permeability to EBD and a small molecular tracer sodium fluorescein dye (NaF). Rats received intravenous EBD/NaF injections, and after a 30-min equilibration time, they received mannitol (20%, 0.5 g/kg) through either route of administration. At 90 min after the mannitol injection, the rats were perfused to rid their circulations of the tracers, and the tracers extravasated into the brain parenchyma were measured by photospectrometry. As expected, ICA-M considerably increased EBD extravasation into the rat forebrain regions, including the motor cortex (P=0.0069), the striatum (P=0.0097), and the hippocampus (P=0.0281; student's t-test). In marked contrast, IV-M exerted no effect on EBD extravasation into these forebrain regions. To increase the power of the IV-M study, we repeated the experiments in two independent trials of experiments (n=6-9/group/trial) and found the same result. Finally, consistent with no effect on EBD extravasation, IV-M had no effect on NaF extravasation into the rat forebrain. In conclusion, we report direct evidence that IV-M, at a dose used clinically, in contrast to the same dose of ICA-M, exerted no effect on BBB permeability to protein and small molecular tracers.

Increase in Evans blue dye extravasation into the brain in the late developmental stage.

The development of the blood-brain barrier (BBB) against permeability to inert tracers, such as Evans blue dye (EBD), occurs quite early on at embryonic stages (before E13-E15), and the BBB remains resistant to EBD between E15 and early adulthood (P20-P30). Here, we aimed to examine the changes in EBD permeability at a later stage in development, specifically comparing young rats (P20) with adult rats (P86). We found markedly higher EBD extravasation into the forebrains of adult rats compared with those of the young rats (P=0.0132; Student's t-test). In contrast, there was no difference in EBD extravasation to the liver, suggesting no change in vascular permeability in peripheral tissues. Furthermore, EBD extravasation into the cerebellum was less prominent than that into the forebrain, suggesting that the disruption of the BBB was brain-region specific. In conclusion, we found a specific increase in EBD extravasation in the mature forebrain, and the protocol that we used may be a good template for studying developmental disruption of the BBB.

Improvement in otitis media with effusion in patients undergoing tracheostomy after prolonged endotracheal intubation.

OBJECTIVES: Otitis media with effusion (OME) has a higher incidence in adult intensive care unit (ICU) patients. This observational study sought to examine the effect of tracheostomy on OME in critically ill patients and explore the predisposing factors. MATERIALS AND METHODS: Twenty-seven ICU patients who had undergone prolonged intubation (more than 14 days) received traditional tracheostomies. Otoscopic examination, tympanometry, and spectral gradient acoustic reflectometry were performed both at the time of the tracheostomy and 7 days later. We collected data on the patients' demographics (age and gender), underlying diseases, duration of intubation prior to the tracheostomy, history of gastroesophageal reflux disease, length of antibiotic use, level of consciousness, and presence of nasogastric tubes. RESULTS: At the time of the tracheostomy, 25 (46%) ears from 14 (52%) patients were classified as cases of OME, 17 (31%) ears and 7 (26%) patients as normal cases, and 12 (11%) ears from 6 (11%) patients as cases of negative pressure in the tympanic cavity. Seven days after the tracheostomy, OME was resolved in 17 (68%) ears and persisted in 6 (24%) ears, whereas negative pressure developed in 2 (8%) ears. Our data showed that the incidence of OME reduced from 46% to 22% after tracheostomy was performed on the patients. CONCLUSION: The incidence of OME in adult ICU patients who were intubated for more than 14 days was found to reduce after tracheostomy. Notably, the rate of improvement in the conscious patients was significantly higher than that in the unconscious patients.

Syndrome of inappropriate antidiuretic hormone secretion and diabetes insipidus in an infant following surgery.

Syndrome of inappropriate secretion of antidiuretic hormone and diabetes insipidus occurring in very short order in the same patient is rare. We report a 9 month-old male infant suffering form holoprosencephaly developed syndrome of inappropriate secretion of antidiuretic hormone followed by diabetes insipidus within a relative short time postoperatively after his third operation. Inability to suppress as well as to stimulate arginine vasopressin secretion and anesthetic and surgical stresses, were thought to be the possible causes of this event.

Middle ear effusion in intensive care unit patients with prolonged endotracheal intubation.

OBJECTIVES: The purpose of this study is to explore the factors related to the occurrence of middle ear effusion (MEE) in prolonged endotracheal intubation patients in the intensive care unit (ICU). METHODS: Information about the age, sex, duration of endotracheal intubation, level of consciousness, and placement of nasogastric tube was retrospectively collected from medical charts of 20 prolonged endotracheal intubation (>7 days) patients in the ICU. All patients received otoscopic examination, tympanometry studies, and spectral gradient acoustic reflectometry for evidence of MEE. RESULTS: Among the 40 ears examined in this study, 20 ears had MEE (50%), 14 ears were normal (35%), and 6 ears had negative pressure in the middle ear (15%). In addition, patients with conscious disturbance and those who had been intubated for 14 days had a significantly higher incidence of MEE. Nasogastric tube was not implicated in MEE in this study. No episodes of acute otitis media or systemic infection were encountered in this study. CONCLUSIONS: Prolonged endotracheal intubation (>7 days) in adult ICU patients contributed to the high incidence of MEE (50%). Moreover, conscious disturbance and endotracheal intubation for 14 days were also significant contributing factors of MEE.

Management of postdural puncture headache by epidural saline delivered with a patient-controlled pump--a case report.

Unintentional dural puncture is the most frequent cause of postdural puncture headache (PDPH) in epidural anesthesia and analgesia. Conservative treatments of PDPH include bed rest, oral analgesics, and hydration. When conservative measures fail, epidural blood patch is an effective substitute. However, epidural blood patch carries some risks, such as subdural hematoma, pneumocephalus, exacerbation of PDPH and new dural puncture. Many patients may refuse the procedure due to the risks involved. We describe a female patient who had her PDPH successfully treated with epidural saline delivered by a patient-controlled analgesia device (Abbott Pain Management-APM) without molestation of her daily activities.

Anesthetic approach to the Dyke-Davidoff-Masson syndrome--a case report.

The so-called Dyke-Davidoff-Masson syndrome (DDMS) is a rare disorder of cerebral hemiatrophy. The clinical presentation may consist of facial asymmetry, contralateral atrophy (including the trunk, and the extremities) and hemiparesis, speech difficulties, mental retardation, and epilepsy. Because it involves multiple systems, especially problem of the airway, occult myopathy, and seizure disorder, anesthesia for such a patient is a challenge to any anesthesiologist. However, there are no clinical reports which concern the anesthetic management of such patients in the literature. We herein report a 5-year-old girl, a sufferer of DDMS, scheduled for burr trephination. The successful anesthetic management is brought forward with highlights of inference from the experience.