Effects of an intraoperative intravenous Bolus Dose of Dexmedetomidine on postoperative catheter-related bladder discomfort in male patients undergoing transurethral resection of bladder tumors: a randomized, double-blind, controlled trial.

PURPOSE: To investigate whether the effect of intravenous bolus doses of dexmedetomidine on postoperative catheter-related bladder discomfort (CRBD) was dose-dependent in male patients undergoing transurethral resection of bladder tumors (TURBT). METHODS: The study protocol was registered at the Chinese Clinical Trial Registry (ChiCTR 2,000,034,657, date of registration: July 14, 2020). Adult male patients were randomized to one of four groups: placebo (Group C); dexmedetomidine 0.2 µg/kg (Group D 0.2); dexmedetomidine 0.5 µg/kg (Group D 0.5); or dexmedetomidine 1 µg/kg (Group D 1). The primary outcome was the incidence of moderate-to-severe CRBD at 0, 1, 6, 24, and 48 h postoperatively. RESULTS: The incidence of moderate-to-severe CRBD was significantly lower in Group D 0.5 and Group D 1 than in Group C at 0 h (13% vs. 40%, P = 0.006; 8% vs. 40%, P = 0.001), 1 h (15% vs. 53%, P < 0.001; 13% vs. 53%, P < 0.001), and 6 h (10% vs. 32%, P = 0.025; 8% vs. 32%, P = 0.009) postoperatively. Compared with baseline, both the MAP and HR were significantly lower in Group D 1 at 1 min ([94 ± 15] vs. [104 ± 13] mm Hg, P = 0.003; [64 ± 13] vs. [73 ± 13] bpm, P = 0.001) and 30 min ([93 ± 10] vs. [104 ± 13] mm Hg, P < 0.001; [58 ± 9] vs. [73 ± 13] bpm, P < 0.001) postextubation. CONCLUSION: The effect of intravenous bolus doses of dexmedetomidine on postoperative CRBD was dose-independent, whereas intravenous administration of 0.5 µg/kg dexmedetomidine reduced the early postoperative incidence of CRBD with minimal side effects. TRIAL REGISTRATION: Clinical trial number and registry URL: ChiCTR 2,000,034,657, http://www.chictr.org.cn , date of registration: July 14, 2020.

CCL2 regulated by the CTBP1-AS2/miR-335-5p axis promotes hemangioma progression and angiogenesis.

CONTEXT: Hemangioma (HA) is a benign vascular neoplasm that can lead to permanent scarring. C-C motif chemokine ligand 2 (CCL2) plays a crucial role in facilitating growth and angiogenesis during HA progression. However, the mechanism regulating CCL2 in HA remains poorly elucidated. OBJECTIVE: To elucidate the mechanism regulating CCL2 in HA. METHODS: Quantitative real-time polymerase chain reaction (RT-qPCR) was employed to determine the expression levels of CCL2, long noncoding RNA (lncRNA) CTBP1 divergent transcript (CTBP1-AS2), and microRNAs (miRNAs). Proliferation, migration, invasion, and angiogenic abilities of human HA endothelial cells (HemECs) were assessed using cell counting kit-8 (CCK-8), colony formation, flow cytometry, transwell, and tube formation assays. Bioinformatics analysis, RNA pull-down, and luciferase reporter assays were conducted to investigate whether CCL2 targets miR-335-5p. Additionally, rescue experiments were performed in this study. RESULTS: CCL2 expression was markedly upregulated in HemECs. CCL2 promoted HA cell proliferation, migration, invasion, and angiogenesis while inhibiting apoptosis. CCL2 was directly targeted by miR-335-5p. Additionally, we found that CTBP1-AS2 could function as a competing endogenous RNA (ceRNA) to sponge miR-335-5p, thereby upregulating CCL2. CONCLUSION: Our findings suggest that targeting the CTBP1-AS2/miR-335-5p/CCL2 axis may hold promise as a therapeutic strategy for HA.

Effects of Etco2 on the Minimum Alveolar Concentration of Sevoflurane that Blunts the Adrenergic Response to Surgical Incision: A Prospective, Randomized, Double-Blinded Trial.

BACKGROUND: CO2 has anesthetic potency and effectively influences the circulatory system. We investigated the effects of Etco2 on the minimum alveolar concentration of sevoflurane that blunts the adrenergic response to surgical incision (MAC-BAR) in patients undergoing radical surgery for gastric carcinoma. METHODS: Ninety patients undergoing radical gastric-carcinoma surgery under general anesthesia were enrolled and randomly assigned into 3 groups. After intubation, the Etco2 in group L (n = 30), group N (n = 30), and group H (n = 30) was adjusted to 25 mm Hg ≤ Etco2 <30 mm Hg, 30 mm Hg ≤ Etco2 < 40 mm Hg, and 40 mm Hg ≤ Etco2 < 45 mm Hg, respectively, by changes in controlled ventilation. Hemodynamics and depth of anesthesia were observed before and after skin incision. The MAC-BAR of sevoflurane for each group was determined using an up-and-down sequential-allocation technique. RESULTS: To obtain 7 crossovers, 25, 26, and 26 patients were used in group L, group N, and group H, respectively. The MAC-BAR of sevoflurane using the up-and-down method for group H was significantly lower than that for group L (2.3% [95% confidence interval {CI}, 2.2-2.4] vs 2.9% [95% CI, 2.7-3.0]; difference, -0.6% [95% CI, -0.7 to -0.4], P < .001) and group N (2.3% [95% CI, 2.2-2.4] vs 2.8% [95% CI, 2.8-2.9]; difference, -0.5% [95% CI, -0.7 to -0.4], P < .001), while no significant difference was found between group L and group N (P = 1.000). CONCLUSIONS: Higher Etco2 levels (Etco2 values equal to 40 mm Hg or higher) can effectively decrease the MAC-BAR of sevoflurane in patients undergoing radical surgery for gastric carcinoma.

Peroxiredoxin 6 mediates the protective function of curcumin pretreatment in acute lung injury induced by serum from patients undergoing one-lung ventilation in vitro.

BACKGROUND: Curcumin has attracted much attention due to its wide range of therapeutic effects. In this study, we used serum collected from patients undergoing one-lung ventilation (OLV) to establish an in vitro acute lung injury (ALI) model to explore the potential protective mechanism of curcumin on ALI. Our study provides a new reference for the prevention and treatment of ALI induced by OLV. METHODS: A549 cells were treated with 20% serum from patients undergoing OLV to establish an in vitro ALI model. Curcumin, at a dose of 40 µg/ml, was administered two hours prior to this model. The levels of inflammation and oxidative stress markers were observed by Western blot, qRT-PCR, ELISA and reactive oxygen species assay. Additionally, the expression of peroxiredoxin 6 (Prdx6) and proteins involved in the NF-κB signaling pathway was evaluated. RESULTS: Twenty percent of serum collected from patients undergoing OLV downregulated the expression of Prdx6, leading to the activation of the NF-κB signaling pathway, which was associated with the subsequent overproduction of inflammatory cytokines and reactive oxygen species. Pretreatment with curcumin restored Prdx6 downregulation and inhibited NF-κB pathway activation by suppressing the nuclear translocation of P65, eventually reducing inflammation and oxidative stress damage in A549 cells. CONCLUSIONS: Prdx6 mediated the protective function of curcumin by inhibiting the activation of the NF-κB pathway in ALI in vitro.

Effects of an Intraoperative Intravenous Bolus Dose of Dexmedetomidine on Remifentanil-Induced Postinfusion Hyperalgesia in Patients Undergoing Thyroidectomy: A Double-Blind Randomized Controlled Trial.

BACKGROUND: Consecutive exposure to high-dose remifentanil during anesthesia may induce remifentanil-induced postinfusion hyperalgesia (RPH). Dexmedetomidine, a highly selective α2-adrenergic receptor agonist, may have synergistic effects with opioids and aid in perioperative pain management. In this study, we hypothesized that an intraoperative bolus dose of intravenous dexmedetomidine could alleviate RPH in patients undergoing thyroidectomy under general anesthesia. METHODS: Ninety patients undergoing thyroidectomy were randomly assigned to 1 of 3 groups: placebo, normal saline (group P); low-dose dexmedetomidine 0.2 µg·kg-1 (group LD); or high-dose dexmedetomidine 0.5 µg·kg-1 (group HD). Remifentanil was infused at a rate of 0.30 µg·kg-1·minute-1. Mechanical pain thresholds were measured using an Electronic von Frey device preoperatively and at 30 minutes, 6 hours, 24 hours, and 48 hours after surgery and were analyzed with 2-way repeated-measures analysis of variance (ANOVA) followed by Bonferroni post hoc comparison. We also recorded postoperative pain scores, the incidence of receiving rescue analgesics, and side effects up to 48 hours after surgery. RESULTS: The mechanical pain thresholds around the skin incision were significantly higher in group LD compared to group P 30 minutes and 6 hours after surgery (mean ± standard deviation: [65.0 ± 25.2] vs [49.6 ± 24.4] g, mean difference [95% confidence interval]: 15.4 [0.3-30.5] g, P = .045 at 30 minutes; [65.9 ± 24.5] vs [49.3 ± 26.1] g, 16.6 [1.1-32.1] g, P = .032 at 6 hours). The pain thresholds around the skin incision were significantly higher in group HD compared to group P 30 minutes and 6 hours after surgery ([67.8 ± 21.7] vs [49.6 ± 24.4] g, 18.2 [3.1-33.3] g, P = .013 at 30 minutes; [68.3 ± 22.5] vs [49.3 ± 26.1] g, 19.0 [3.5-34.5] g, P = .011 at 6 hours). The incidence of hyperalgesia around the skin incision was lower in group HD than in group P 30 minutes and 6 hours after surgery (4 [13%] vs 14 [48%], P = .012 at 30 minutes, 4 [13%] vs 12 [41%], P = .045 at 6 hours), although no significant difference was observed between group LD and group P. Postoperative pain scores, the incidence of rescue analgesic demand, and postoperative side effects were not significantly different between the groups. CONCLUSIONS: An intraoperative intravenous bolus dose of dexmedetomidine 0.5 µg·kg-1 alleviates remifentanil-induced hyperalgesia in patients undergoing thyroidectomy without a significant difference in side effects.

Hydrogen Spillover to Oxygen Vacancy of TiO2-xHy/Fe: Breaking the Scaling Relationship of Ammonia Synthesis.

Optimizing kinetic barriers of ammonia synthesis to reduce the energy intensity has recently attracted significant research interest. The motivation for the research is to discover means by which activation barriers of N2 dissociation and NHz (z = 1-2, surface intermediates) destabilization can be reduced simultaneously, that is, breaking the "scaling relationship". However, by far only a single success has been reported in 2016 based on the discovery of a strong-weak N-bonding pair: transition metals (nitrides)-LiH. Described herein is a second example that is counterintuitively founded upon a strong-strong N-bonding pair unveiled in a bifunctional nanoscale catalyst TiO2-xHy/Fe (where 0.02 ≤ x ≤ 0.03 and 0 < y < 0.03), in which hydrogen spillover (H) from Fe to cascade oxygen vacancies (OV-OV) results in the trapped form of OV-H on the TiO2-xHy component. The Fe component thus enables facile activation of N2, while the OV-H in TiO2-xHy hydrogenates the N or NHz to NH3 easily.

Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear-Negative Drug-Resistant Tuberculosis, China.

The increase in drug-resistant tuberculosis in China calls for scaling up rapid diagnosis. We evaluated introduction of rapid resistance testing by line-probe assay for all patients with a diagnosis of pulmonary tuberculosis in 2 prefectures in middle and eastern China. We analyzed sputum samples for smear-positive patients and cultures for smear-negative patients. We used a before-after comparison of baseline and intervention periods (12 months each) and analyzed data for 5,222 baseline period patients and 4,364 intervention period patients. The number of patients with rifampin resistance increased from 30 in the baseline period to 97 in the intervention period for smear-positive patients and from 0 to 13 for smear-negative patients, reflecting a low proportion of positive cultures (410/2,844, 14.4%). Expanding rapid testing for drug resistance for smear-positive patients resulted in a 3-fold increase in patients with diagnoses of rifampin-resistant tuberculosis. However, testing smear-negative patients had limited added value because of a low culture-positive rate.

Chinese health literacy scale for tuberculosis patients: a study on development and psychometric testing.

BACKGROUND: The role of health literacy on tuberculosis patients has not been evaluated in China, in part because few special health literacy measurements exist. METHODS: A three-step design process was used: (1) Scale construction: Based on the model of revised Bloom's taxonomy, the item-pool was drafted from a literature review, focus group discussion, and in-depth interviews. In addition, a Delphi survey was used in order to select items for inclusion in the scales; (2) Pilot study: Acceptability and clarity were tested with 60 tuberculosis patients; and (3) Psychometric testing: Validity analysis includes content validity, construct validity, and discriminative validity. The Cronbach's alpha coefficient, split-half reliability, and test-retest method were used to assess reliability. Finally, a receiver operating characteristic analysis was conducted to generate a cut-off point. RESULTS: The final scale had 29 items with four domains. The item level Content Validity Index ranged from 0.70 to 1.0, and the scale level Content Validity Index was 0.95. The mean score among the lowest 27% group was significantly lower than that those of the highest 27% group (p < 0.01), which supports adequate discriminant validity. Explanatory factor analysis produced a clear four-factor construct, explaining 47.254% of the total variance. Factor 1 and Factor 2 were consistent with read and memorize TB-related words; Factor 3 was associated with understand the meaning of the health education leaflets and examine if TB patients can apply the correct approach to correct context; Factor 4 was related to the ability of TB patient to calculate and identify what unspecified assumptions are included in known conditions. The confirmatory factory analysis results confirmed that a four-factor model was an acceptable fit to the data, with a goodness-of-fit index = 0.930, adjusted goodness of fit index = 0.970, root mean square error of approximation = 0.069, and χ2/df = 2.153. The scale had good internal consistency and test-retest reliability. Additionally, the receiver operating characteristic analysis indicated that the cut-off point for the instrument was set at 45 and 35. CONCLUSIONS: The Chinese Health Literacy scale for Tuberculosis has good reliability and validity, and it could be used for measuring the health literacy of Chinese patients with tuberculosis.

Effect of Remote Ischemic Preconditioning in Patients Undergoing Hepatectomy With Portal Triad Clamping: A Randomized Controlled Trial.

BACKGROUND: Remote ischemic preconditioning (RIPC) is reported to reduce liver injury in patients undergoing hepatectomy for colorectal liver metastasis, but its role is unclear in hepatocellular carcinoma patients with portal triad clamping during hepatectomy. METHODS: In this prospective, randomized trial, 140 patients with hepatocellular carcinoma undergoing liver resection requiring portal triad clamping were randomized to a RIPC group or a control group. Patients in the RIPC group received RIPC (3 cycles of 5-minute ischemia and 5-minute reperfusion in right upper limb with cuff pressure at 30 kPa [225 mm Hg]) approximately 10 minutes after induction of anesthesia. In the control group, patients received sham RIPC (the cuff was not inflated). The primary outcome was the postoperative peak level of total bilirubin (TBIL) and was analyzed with the independent t test. Secondary outcomes were liver function test at postoperative days 1, 3, and 5; postoperative morbidity and mortality during the first month; and the length of postoperative hospital stay. RESULTS: Data from 136 patients (69 in the RIPC group and 67 in the control group) were analyzed. The RIPC group had on average a 5.9 µmol lower peak level of TBIL than the control group; the mean difference is -5.9, and the 95% confidence interval (CI) reverses to -17.9 to 6.1. There were no significant differences between the 2 groups in liver function test at postoperative days 1, 3, and 5; postoperative morbidity and mortality during the first month; and the length of postoperative hospital stay. CONCLUSIONS: We found no evidence that RIPC can reduce postoperative liver injury after hepatectomy.

A Systematic Study of Vascular Distribution Characteristics and Axis Design of Various Flap Types.

BACKGROUND The aim of this study was to define blood flow characteristics of multiple types of flaps and the theoretical basis of flap axis design. MATERIAL AND METHODS Sixty Sprague-Dawley (SD) rats were randomly divided into 6 groups: a normal skin group, and 5 groups with different types of flap: abdominal flap group, dorsal flap group, single-perforator flap group, double-perforators flap group, and delayed cutaneous nerve flap group. The vascular distribution characteristics of normal skin and various flap types were observed by gross morphology of specimens and X-ray after perfusion. RESULTS There were distinct differences in vascular anastomosis and density in dorsal and ventral SD rats. The area of flap survival in the dorsal flap group was superior to that in the abdominal flap group, but the flap axis of the 2 groups passed straight through the middle of the pedicle. The flap surviving area in the double-perforators flap group was remarkably larger than in the single-perforator flap group, while the flap axis in the single-perforator flap group passed straight through the perforators, and in the double-perforators flap group there was a linking vessel between the 2 perforators. There were linking and reticulate vessels, in addition, linking vessels and cutaneous nerves were concomitant in the delayed cutaneous nerve flap group. The flap axis was the travel route of the cutaneous nerve. CONCLUSIONS Variations in flap blood supply patterns and axes with alterations based on flap types have implications for flap survival. Understanding blood flow characteristics within each flap type and accurately designing the flap axis is essential for flap survival.

Interaction between adipocytes and high-density lipoprotein:new insights into the mechanism of obesity-induced dyslipidemia and atherosclerosis.

Obesity is the most common nutritional disorder worldwide and is associated with dyslipidemia and atherosclerotic cardiovascular disease. The hallmark of dyslipidemia in obesity is low high density lipoprotein (HDL) cholesterol (HDL-C) levels. Moreover, the quality of HDL is also changed in the obese setting. However, there are still some disputes on the explanations for this phenomenon. There is increasing evidence that adipose tissue, as an energy storage tissue, participates in several metabolism activities, such as hormone secretion and cholesterol efflux. It can influence overall reverse cholesterol transport and plasma HDL-C level. In obesity individuals, the changes in morphology and function of adipose tissue affect plasma HDL-C levels and HDL function, thus, adipose tissue should be the main target for the treatment of HDL metabolism in obesity. In this review, we will summarize the cross-talk between adipocytes and HDL related to cardiovascular disease and focus on the new insights of the potential mechanism underlying obesity and HDL dysfunction.

Development and psychometric testing of the Knowledge, Attitudes and Practices (KAP) questionnaire among student Tuberculosis (TB) Patients (STBP-KAPQ) in China.

BACKGROUND: TB outbreaking in schools is extremely complex, and presents a major challenge for public health. Understanding the knowledge, attitudes and practices among student TB patients in such settings is fundamental when it comes to decreasing future TB cases. The objective of this study was to develop a Knowledge, Attitudes and Practices Questionnaire among Student Tuberculosis Patients (STBP-KAPQ), and evaluate its psychometric properties. METHODS: This study was conducted in three stages: item construction, pilot testing in 10 student TB patients and psychometric testing, including reliability and validity. The item pool for the questionnaire was compiled from literature review and early individual interviews. The questionnaire items were evaluated by the Delphi method based on 12 experts. Reliability and validity were assessed using student TB patients (n = 416) and healthy students (n = 208). Reliability was examined with internal consistency reliability and test-retest reliability. Content validity was calculated by content validity index (CVI); Construct validity was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA); The Public Tuberculosis Knowledge, Attitudes and Practices Questionnaire (PTB-KAPQ) was applied to evaluate criterion validity; As concerning discriminant validity, T-test was performed. RESULTS: The final STBP-KAPQ consisted of three dimensions and 25 items. Cronbach's α coefficient and intraclass correlation coefficient (ICC) was 0.817 and 0.765, respectively. Content validity index (CVI) was 0.962. Seven common factors were extracted by principal factor analysis and varimax rotation, with a cumulative contribution of 66.253%. The resulting CFA model of the STBP-KAPQ exhibited an appropriate model fit (χ2/df = 1.74, RMSEA = 0.082, CFI = 0.923, NNFI = 0.962). STBP-KAPQ and PTB-KAPQ had a strong correlation in the knowledge part, and the correlation coefficient was 0.606 (p < 0.05). Discriminant validity was supported through a significant difference between student TB patients and healthy students across all domains (p < 0.05). CONCLUSIONS: An instrument, "Knowledge, Attitudes and Practices Questionnaire among Student Tuberculosis Patients (STBP-KAPQ)" was developed. Psychometric testing indicated that it had adequate validity and reliability for use in KAP researches with student TB patients in China. The new tool might help public health researchers evaluate the level of KAP in student TB patients, and it could also be used to examine the effects of TB health education.

Interperforator Flow Pattern and Clinical Application of Distal Extended Peroneal Artery Perforator Flaps.

INTRODUCTION: Peroneal artery perforator flaps are the most widely used pedicled flaps for soft tissue defects of the distal lower extremity. Most research regarding peroneal artery flaps focuses on the location, diameter, and number of peroneal artery perforators. However, there is little literature regarding interperforator flow patterns within the peroneal artery perforator flaps. The aims of the present study were to describe interperforator flow patterns of the distally based extended peroneal artery perforator flaps through digital subtraction angiography and review their clinical application. METHODS: Twelve consecutive patients underwent digital subtraction angiography of the lower-limb arteries. The number and classification of peroneal artery perforators and the interperforator flow patterns were observed. Based on these observations, distally based extended peroneal artery perforator flaps were designed to repair nonhealing wounds located on the ankles and feet of 14 patients. RESULTS: The peroneal artery gives out grades I to IV perforators in the lateral leg. There were 2 to 7 grade I perforators and true anastomoses between adjacent grade II perforators, which generate directly linked vessels in the middle leg. The grade III or IV perforators form a reticular vascular network through a large number of chock and potential anastomoses. All flaps survived and had excellent appearance and texture. CONCLUSIONS: Distally based extended peroneal artery perforator flaps appear reliable for repairing wounds located on or around the ankle and front foot. However, whether the middle perforator or peroneal artery should be used depends on the condition of the anastomosis between direct linking vessels and the distal perforator.

Two successive calcium-dependent transitions mediate membrane binding and oligomerization of daptomycin and the related antibiotic A54145.

Daptomycin and A54145 are homologous lipopeptide antibiotics that permeabilize the cell membranes of Gram-positive bacteria. Membrane permeabilization depends on the presence of both phosphatidylglycerol (PG) and calcium, and it involves the formation of oligomeric transmembrane pores that consist of approximately 6-8 subunits. We here show that each lipopeptide molecule binds two calcium ions in separable, successive steps. The first calcium ion causes the lipopeptide molecule to bind to the target membrane, and likely to form a loosely associated oligomer. Higher calcium concentrations induce binding of a second ion, which produces the more tightly associated and more deeply membrane-inserted final, functional form of the oligomer. Both calcium-dependent steps are accompanied by fluorescence signals that indicate transition of specific amino acid residues into less polar environments, suggestive of insertion into the target membrane. Our findings agree with the earlier observation that two of the four acidic amino acid residues in the daptomycin molecule are essential for antibacterial activity.

Development and validation of college students' tuberculosis knowledge, attitudes and practices questionnaire (CS-TBKAPQ).

BACKGROUND: China faces many challenges in controlling tuberculosis (TB). One significant challenge is the control of college students' TB. In particular, cross-sectional studies of college students' knowledge, attitudes and practices (KAP) in regard to TB have attracted substantial attention. However, few measurement tools have been developed to aid processes related to expert consultation, pre-testing, reliability and validity testing. Our study developed the College Students' TB Knowledge Attitudes and Practices Questionnaire (CS-TBKAPQ) following the scale development steps. METHODS: The construction of the CS-TBKAPQ was based on the Theory of Knowledge, Attitude, Belief, and Practice (KABP or KAP). The item pool was compiled from literature reviews and individual interviews. The reliability validation was assessed by calculating Cronbach's α coefficient, the split-half reliability coefficient, and the test-retest reliability coefficient. Construct validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The diagnostic accuracy was evaluated using the World Health Organization Advocacy, Communication and Social Mobilization KAP Survey Questionnaire (WHO-TBKAPQ) as the reference standard. RESULTS: A total of 31 questionnaire items were proposed. Cronbach's α coefficient, the split-half reliability coefficient and the test-retest reliability coefficient were 0.86, 0.78 and 0.91. Four factors that explained 62.52% of the total variance were also identified in EFA and confirmed in CFA. The CFA model fit indices were x 2 /df = 1.82 (p < 0.001), GFI = 0.925, AGFI = 0.900, RMR = 0.068, and RMSEA = 0.049. The CS-TBKAPQ was significantly correlated with the WHO-TBKAPQ and the Chinese Public TB KAP Questionnaire (CDC-TBKAPQ) developed by the Chinese Center for Disease Control and Prevention (r = 0.59, 0.60, p < 0.001). The receiver operating characteristics curve (ROC) analysis suggested a cut-off point of 47.5, with which the CS-TBKAPQ showed a sensitivity of 73.63% and a specificity of 80.51% in identifying students with low-level KAP. The positive and negative predictive values were 83.23% and 69.91%. CONCLUSIONS: The findings of this study demonstrate that the CS-TBKAPQ is a reliable and valid tool for measuring the KAP towards TB in college students.

Membrane Binding and Oligomerization of the Lipopeptide A54145 Studied by Pyrene Fluorescence.

A54145 is a lipopeptide antibiotic related to daptomycin that permeabilizes bacterial cell membranes. Its action requires both calcium and phosphatidylglycerol in the target membrane, and it is accompanied by the formation of membrane-associated oligomers. We here probed the interaction of A54145 with model membranes composed of dimyristoylphosphatidylcholine and dimyristoylphosphatidylglycerol, using the steady-state and time-resolved fluorescence of a pyrene-labeled derivative (Py-A54145). In solution, the labeled peptide was found to exist as a monomer. Its membrane interaction occurred in two stages that could be clearly distinguished by varying the calcium concentration. In the first stage, which was observed between 0.15 and 1 mM calcium, Py-A54145 bound to the membrane, as indicated by a strong increase in pyrene monomer emission. At the same calcium concentration, excimer emission increased also, suggesting that Py-A54145 had oligomerized. A global analysis of the time-resolved pyrene monomer and excimer fluorescence confirmed that Py-A54145 forms oligomers quantitatively and concomitantly with membrane binding. When calcium was raised beyond 1 mM, a distinct second transition was observed that may correspond to a doubling of the number of oligomer subunits. The collective findings confirm and extend our understanding of the action mode of A54145 and daptomycin.

The experiences of high school students with pulmonary tuberculosis in China: a qualitative study.

BACKGROUND: Clustered tuberculosis (TB) still occurred nationally in Chinese schools every year, where high school students patients accounts for the highest proportion. These young TB patients are in a critical period of physical and psychological growth. Research on their illness experience and analysis of underlying causes remains blank. The purpose of this study is to explore the overall illness experience of Chinese high school TB patients and to investigate the individual and social causes of such experience. METHODS: Twenty-two high school TB patients in a certain county of Shaanxi province were interviewed in-depth twice when initial diagnosed and during intermediate treatment periods. Interview data were analyzed by framework approach. RESULTS: The high school TB patients worried about interruption of studies rather than the disease. They generally showed a lack of awareness of tuberculosis, were highly dependent on parents, and received assistance from teachers and students during the treatment. Most of them did not show obvious stigma. CONCLUSION: The unique education system and sociocultural factors in China are the root of special illness experience of high school TB patients. Huge pressure in college entrance examination leads sick students to worry about interruption of studies more than the disease itself. Their serious lack of awareness of TB, caused by the ignorance of school, parents and the students, becomes the biggest obstacle to timely diagnosis and treatment. Whether high dependence on parents is conducive to disease recovery varies with each individual. Meanwhile, patients' weak stigma could play a positive role in disease recovery. Educational and medical institutions should develop more effective TB control strategies based on these factors.

Planar scanning method for detecting refraction characteristics of two-dimensional photonic quasi-crystal wedge-shaped prisms.

In this study, a planar scanning method is proposed. This novel method adapts two monitors moving along double planar tracks that can be used to detect refraction characteristics of two-dimensional (2D) photonic quasi-crystal (PQC) wedge-shaped prisms. Refraction of a decagonal Penrose-type PQC prism is analyzed for a given incident beam and two polarization modes at different incident positions in the prism using this method. Refraction from the prism is irregular, indicating that nonuniformity in the arrangement of scatterers in the prism causes Bragg-like scattering irregularities. Numerical results show that this method can be used for guiding the design of a 2D PQC prism and for the analysis of its refraction characteristics.

Thoracic Endovascular Aortic Repair Combined with Assistant Techniques and Devices for the Treatment of Acute Complicated Stanford Type B Aortic Dissections Involving Aortic Arch.

BACKGROUND: The present study retrospectively reviewed and evaluated the effectiveness of thoracic endovascular aortic repair (TEVAR) combined with assistant techniques and devices for the treatment of acute complicated Stanford type B aortic dissections involving aortic arch. METHODS: Fifty-six patients with acute complicated Stanford type B aortic dissection involving aortic arch were treated with TEVAR combined with hybrid procedure, chimney-graft technique, and branched stent grafts from January 2009 to March 2014. RESULTS: Seventeen patients undergone TEVAR combined with hybrid technique. Technical success was achieved in 94.1% with 5.8% of early mortality. Strokes occurred in a patient developing paraplegia, who completely recovered after lumbar drainage. Cardiocirculatory and pulmonary complications, bypass dysfunction or severe endoleak was not observed. Thirty patients undergone TEVAR combined with chimney technique with 100% technical success rate. Chimney-stent compression was observed in 1 patient, and another bare stent was deployed inside the first one. Three patients (10%) died during the study period. Immediate postoperative type I endoleak was detected in 4 cases (13.3%). TEVAR assisted by Castor branched aortic stent grafts in 9 patients was successful. Mortality during perioperative period and 30 days after TEVAR was null. No serious complications such as strokes, acute myocardial infarction, and ischemia of arms occurred. CONCLUSIONS: The results indicate that TEVAR combined with hybrid technique, chimney technique, and branched stent grafts is proven to be a technically feasible and effective treatment for acute complicated Stanford type B aortic dissection involving aortic arch in small cohort.

Cardiolipin prevents membrane translocation and permeabilization by daptomycin.

Daptomycin is an acidic lipopeptide antibiotic that, in the presence of calcium, forms oligomeric pores on membranes containing phosphatidylglycerol. It is clinically used against various Gram-positive bacteria such as Staphylococcus aureus and Enterococcus species. Genetic studies have indicated that an increased content of cardiolipin in the bacterial membrane may contribute to bacterial resistance against the drug. Here, we used a liposome model to demonstrate that cardiolipin directly inhibits membrane permeabilization by daptomycin. When cardiolipin is added at molar fractions of 10 or 20% to membranes containing phosphatidylglycerol, daptomycin no longer forms pores or translocates to the inner membrane leaflet. Under the same conditions, daptomycin continues to form oligomers; however, these oligomers contain only close to four subunits, which is approximately half as many as observed on membranes without cardiolipin. The collective findings lead us to propose that a daptomycin pore consists of two aligned tetramers in opposite leaflets and that cardiolipin prevents the translocation of tetramers to the inner leaflet, thereby forestalling the formation of complete, octameric pores. Our findings suggest a possible mechanism by which cardiolipin may mediate resistance to daptomycin, and they provide new insights into the action mode of this important antibiotic.