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Background: The mortality rate of afebrile bacteremia has been reported to be as high as 45%. This investigation focused on the risk factors and predictive performance of scoring systems for the clinical outcomes of afebrile patients with monomicrobial gram-negative bacteria (GNB) in the emergency department (ED). Methods: We conducted a retrospective analysis of afebrile adult ED patients with monomicrobial GNB bacteremia from January 2012 to December 2021. We dissected the demographics, clinical pictures, and laboratory investigations. We applied five scoring systems and three revised systems to predict the clinical outcomes. Results: There were 600 patients included (358 males and 242 females), with a mean age of 69.6 ± 15.4 years. The overall mortality rate was 50.17%, reaching 68.52% (74/108) in cirrhotic patients. Escherichia coli was the leading pathogen (42.83%). The non-survivors had higher scores of the original MEDS (p < 0.001), NEWS (p < 0.001), MEWS (p < 0.001), qSOFA (p < 0.001), and REMS (p = 0.030). In univariate logistic regression analyses, several risk factors had a higher odds ratio (OR) for mortality, including liver cirrhosis (OR 2.541, p < 0.001), malignancy (OR 2.259, p < 0.001), septic shock (OR 2.077, p = 0.002), and male gender (OR 0.535, p < 0.001). The MEDS demonstrated that the best predictive power with the maximum area under the curve (AUC) was measured at 0.773 at the cut-off point of 11. The AUCs of the original NEWS, MEWS, qSOFA, and REMS were 0.663, 0.584, 0.572, and 0.553, respectively. We revised the original MEDS, NEWS, and qSOFA by adding red cell distribution width, albumin, and lactate scores and found a better predictive power of the AUC of 0.797, 0.719, and 0.694 on the revised MEDS ≥11, revised qSOFA ≥ 3, and revised NEWS ≥ 6, respectively. Conclusions: The original MEDS, revised MEDS, revised qSOFA, and revised NEWS were valuable tools for predicting the mortality risk in afebrile patients with monomicrobial GNB bacteremia. We suggested that clinicians should explore patients with the risk factors mentioned above for possible severe infection, even in the absence of fever and initiate hemodynamic support and early adequate antibiotic therapy in patients with higher scores of the original MEDS (≥11), revised MEDS (≥11), revised NEWS (≥6), and revised qSOFA (≥3). [ABSTRACT FROM AUTHOR]

Background: Vibrio is a genus of Gram-negative bacteria found in various aquatic environments, including saltwater and freshwater. Vibrio bacteremia can lead to sepsis, a potentially life-threatening condition in which the immune system enters overdrive in response to the disease, causing widespread inflammation and damage to tissues and organs. V. vulnificus had the highest case fatality rate (39%) of all reported foodborne infections in the United States and a high mortality rate in Asia, including Taiwan. Numerous scoring systems have been created to estimate the mortality risk in the emergency department (ED). However, there are no specific scoring systems to predict the mortality risk of Vibrio bacteremia. Therefore, this study modified the existing scoring systems to better predict the mortality risk of Vibrio bacteremia. Methods: Cases of Vibrio bacteremia were diagnosed based on the results from at least one blood culture in the ED. Patient data were extracted from the electronic clinical database, covering January 2012 to December 2021. The primary outcome was in-hospital mortality.This study used univariate and multivariate analyses to evaluate the mortality risk. Results: This study enrolled 36 patients diagnosed with Vibrio bacteremia, including 23 males (63.9%) and 13 females (36.1%), with a mean age of 65.1 ± 15.7 years. The in-hospital mortality rate amounted to 25% (9/36), with 31.5% in V. vulnificus (6/19) and 17.6% in V. non-vulnificus (3/17). The non-survivors demonstrated higher MEDS (10.3 ± 2.4) than the survivors (6.2 ± 4.1) (p = 0.002). Concerning the qSOFA, the survivors scored 0.3 ± 0.5, and the non-survivors displayed a score of 0.6 ± 0.7 (p = 0.387). The AUC of the ROC for the MEDS and qSOFA was 0.833 and 0.599, respectively. This study modified the scoring systems with other predictive factors, including BUN and pH. The AUC of the ROC for the modified MEDS and qSOFA reached up to 0.852 and 0.802, respectively. Conclusion: The MEDS could serve as reliable indicators for forecasting the mortality rate of patients grappling with Vibrio bacteremia. This study modified the MEDS and qSOFA to strengthen the predictive performance of mortality risk for Vibrio bacteremia. We advocate the prompt initiation of targeted therapeutic interventions and judicious antibiotic treatments to curb fatality rates. [ABSTRACT FROM AUTHOR]

Background: Aeromonas species, Gram-negative, non-sporulating, facultative, and anaerobic bacilli, widely distributed in aquatic environments, derive various infections, including bacteremia. Most of these infections were opportunistic and found in patients with predisposing conditions. Among the infections, bacteremia remains with notable mortality, reported from 15% to 45%. However, predicting systems for assessing the mortality risk of this disease have yet to be investigated. We aimed to validate the performance of specific predictive scoring systems to assess the clinical outcomes of Aeromonas bacteremia and applied the revised systems to predict mortality risk. Methods: A retrospective observational study reviewed patients with bacteremia caused by Aeromonas spp. based on at least one positive blood culture sample collected in the emergency department from January 2012 to December 2020. The outcome was in-hospital mortality. We used seven predictive scoring systems to predict the clinical outcome. According to the effectiveness in predicting mortality, we revised three of the seven predictive scoring systems by specific characteristics to refine their risk-predicting performances. Results: We enrolled 165 patients with bacteremia caused by Aeromonas spp., including 121 males (73.3%) and 44 females (26.7%), with a mean age of 66.1 ± 14.9 years and an average length of hospital stay of 12.4 ± 10.9 days. The overall mortality rate was 32.7% (54/165). The non-survivors had significantly higher scores in MEDS (6.7 ± 4.2 vs. 12.2 ± 3.3, p < 0.001), NEWS (4.0 ± 2.8 vs. 5.3 ± 3.0, p = 0.008), and qSOFA (0.3 ± 0.6 vs. 0.6 ± 0.7, p = 0.007). Regarding mortality risk prediction, the MEDS demonstrated the best predictive power with AUC of ROC measured up to 0.834, followed by NEWS (0.626) and qSOFA (0.608). We revised the MEDS, NEWS, and qSOFA by hemoglobin and lactate. We found that the revised scores had better powerful performance, including 0.859, 0.767, and 0.691 of the AUC of ROC, if the revised MEDS ≥10, revised NEWS ≥8, and revised qSOFA ≥2, respectively. Conclusions: MEDS, NEWS, and qSOFA were good tools for predicting outcomes in patients with Aeromonas spp. bacteremia. The revised MEDS, NEWS, and qSOFA demonstrated more powerful predicting performance than the original scoring systems. We suggested that patients with higher scores in revised MEDS (≥10), revised NEWS (≥8), and revised qSOFA (≥2) received early goal-directed therapy and appropriate broad-spectrum antibiotic treatment as early as possible to reduce mortality. [ABSTRACT FROM AUTHOR]

Background: The in-hospital mortality of cardiogenic shock (CS) remains high (28% to 45%). As a result, several studies developed prediction models to assess the mortality risk and provide guidance on treatment, including CardShock and IABP-SHOCK II scores, which performed modestly in external validation studies, reflecting the heterogeneity of the CS populations. Few articles established predictive scores of CS based on Asian people with a higher burden of comorbidities than Caucasians. We aimed to describe the clinical characteristics of a contemporary Asian population with CS, identify risk factors, and develop a predictive scoring model. Methods: A retrospective observational study was conducted between 2014 and 2019 to collect the patients who presented with all-cause CS in the emergency department of a single medical center in Taiwan. We divided patients into subgroups of CS related to acute myocardial infarction (AMI-CS) or heart failure (HF-CS). The outcome was all-cause 30-day mortality. We built the prediction model based on the hazard ratio of significant variables, and the cutoff point of each predictor was determined using the Youden index. We also assessed the discrimination ability of the risk score using the area under a receiver operating characteristic curve. Results: We enrolled 225 patients with CS. One hundred and seven patients (47.6%) were due to AMI-CS, and ninety-eight patients among them received reperfusion therapy. Forty-nine patients (21.8%) eventually died within 30 days. Fifty-three patients (23.55%) presented with platelet counts < 155 × 103/μL, which were negatively associated with a 30-day mortality of CS in the restrictive cubic spline plot, even within the normal range of platelet counts. We identified four predictors: platelet counts < 200 × 103/μL (HR 2.574, 95% CI 1.379–4.805, p = 0.003), left ventricular ejection fraction (LVEF) < 40% (HR 2.613, 95% CI 1.020–6.692, p = 0.045), age > 71 years (HR 2.452, 95% CI 1.327–4.531, p = 0.004), and lactate > 2.7 mmol/L (HR 1.967, 95% CI 1.069–3.620, p = 0.030). The risk score ended with a maximum of 5 points and showed an AUC (95% CI) of 0.774 (0.705–0.843) for all patients, 0.781 (0.678–0.883), and 0.759 (0.662–0.855) for AMI-CS and HF-CS sub-groups, respectively, all p < 0.001. Conclusions: Based on four parameters, platelet counts, LVEF, age, and lactate (PEAL), this model showed a good predictive performance for all-cause mortality at 30 days in the all patients, AMI-CS, and HF-CS subgroups. The restrictive cubic spline plot showed a significantly negative correlation between initial platelet counts and 30-day mortality risk in the AMI-CS and HF-CS subgroups. [ABSTRACT FROM AUTHOR]

Cryptococcal infection is usually diagnosed in immunocompromised individuals and those with meningeal involvement, accounting for most cryptococcosis. Cryptococcemia indicates a poor prognosis and prolongs the course of treatment. We use the scoring systems to predict the mortality risk of cryptococcal fungemia. This was a single hospital-based retrospective study on patients diagnosed with cryptococcal fungemia confirmed by at least one blood culture collected from the emergency department covering January 2012 and December 2020 from electronic medical records in the Taichung Veterans General Hospital. We enrolled 42 patients, including 28 (66.7%) males and 14 (33.3%) females with a mean age of 63.0 ± 19.7 years. The hospital stay ranged from 1 to 170 days (a mean stay of 44.4 days), and the overall mortality rate was 64.3% (27/42). In univariate analysis, the AUC of ROC for MEWS, RAPS, qSOFA, MEWS plus GCS, REMS, NEWS, and MEDS showed 0.833, 0.842, 0.848, 0.846, 0.846, 0.878, and 0.905. In the multivariate Cox regression analysis, all scoring systems, older age, lactate, MAP, and DBP, indicated significant differences between survivor and non-survivor groups. Our results show that all scoring systems could apply in predicting the outcome of patients with cryptococcal fungemia, and the MEDS displays the best performance. We recommend a further large-scale prospective study for patients with cryptococcal fungemia. [ABSTRACT FROM AUTHOR]

Background: Emphysematous cystitis (EC) is a complicated urinary tract infection (UTI) characterized by gas formation within the bladder wall and lumen. Immunocompetent people are less likely to suffer from complicated UTIs, but EC usually occurs in women with poorly controlled diabetes mellitus (DM). Other risk factors of EC include recurrent UTI, neurogenic bladder disorder, blood supply disorders, and prolonged catheterization, but DM is still the most important of all aspects. Our study investigated clinical scores in predicting clinical outcomes of patients with EC. Our analysis is unique in predicting EC clinical outcomes by using scoring system performance. Materials and Methods: We retrospectively collected EC patient data from the electronic clinical database of Taichung Veterans General Hospital between January 2007 and December 2020. Urinary cultures and computerized tomography confirmed EC. In addition, we investigated the demographics, clinical characteristics, and laboratory data for analysis. Finally, we used a variety of clinical scoring systems as a predictor of clinical outcomes. Results: A total of 35 patients had confirmed EC, including 11 males (31.4%) and 24 females (68.6%), with a mean age of 69.1 ± 11.4 years. Their hospital stay averaged 19.9 ± 15.5 days. The in-hospital mortality rate was 22.9%. The Mortality in Emergency Department Sepsis (MEDS) score was 5.4 ± 4.7 for survivors and 11.8 ± 5.3 for non-survivors (p = 0.005). For mortality risk prediction, the AUC of ROC was 0.819 for MEDS and 0.685 for Rapid Emergency Medicine Score (REMS). The hazard ratio of univariate and multivariate logistic regression analyses of REMS for EC patients was1.457 (p = 0.011) and 1.374 (p = 0.025), respectively. Conclusion: Physicians must pay attention to high-risk patients according to clinical clues and arrange imaging studies as soon as possible to confirm the diagnosis of EC. MEDS and REMS are helpful for clinical staff in predicting the clinical outcome of EC patients. If EC patients feature higher scores of MEDS (≥12) and REMS (≥10), they will have higher mortality. [ABSTRACT FROM AUTHOR]

Background: Emphysematous pyelonephritis (EPN) is a rare but severe necrotizing infection causing there to be gas in the pelvicalyceal system, renal parenchyma, and perirenal or pararenal space. Physicians should attend to EPN because of its life-threatening septic complications. The overall mortality rate has been reported to be as high as 20–40%. In addition, most patients had diabetes mellitus (DM) and obstructive uropathy. The most common isolated microorganism is Escherichia coli. This study aims to analyze the risk factors and performance of scoring systems in predicting the clinical outcomes of patients with EPN. Materials and Methods: We collected the data of patients with EPN in this single hospital-based retrospective study from the electronic medical records of Taichung Veterans General Hospital between January 2007 and December 2020. Radiological investigations of abdominal computed tomography (CT) confirmed the diagnosis of EPN. In addition, we analyzed demographics, clinical characteristics, and laboratory data. Finally, we used various scoring systems to predict clinical outcomes. Results: A total of fifty patients with EPN, whose diagnoses were confirmed through CT, were enrolled in the study. There were 18 males (36%) and 32 females (64%), with a mean age of 64.3 ± 11.3 years. The in-hospital mortality rate was 16%. A DM of 34 (68%) patients was the most common comorbidity. Fever was the most common symptom, found in 25 (50%) patients. The Mortality in Emergency Department Sepsis (MEDS) score was 4.64 ± 3.67 for survivors and 14.25 ± 5.34 for non-survivors (p < 0.001). The National Early Warning Score (NEWS) was 3.64 ± 2.33 for survivors and 7.13 ± 4.85 for non-survivors (p = 0.046). The Rapid Emergency Medicine Score (REMS) was 5.81 ± 1.97 for survivors and 9.13 ± 3.87 for non-survivors (p = 0.024). Regarding performance of mortality risk prediction, the AUC of ROC was 0.932 for MEDS, 0.747 for REMS, and 0.72 for NEWS. Conclusions: MEDS, REMS, and NEWS could be prognostic tools for the prediction of the clinical outcomes of patients with EPN. MEDS showed the best sound performance. In those with higher scores in MEDS (≥12), REMS (≥10), and NEWS (≥8), we recommended aggressive management and appropriate antimicrobial therapy as soon as possible to reduce mortality. Further large-scale studies are required to gain a deep understanding of this disease and to ensure patient safety. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Currently, the impact of hospital‐wide glycemic control interventions on length of hospital stay (LOS) and readmission rates are largely unknown. We investigated the impact of a 4‐year hospital‐wide remote glycemic management program on LOS and 30‐day readmission rates among hospitalized adults who received glucose monitoring. Materials and Methods: In this retrospective study, hospitalized patients who received glucose monitoring were classified into groups 1 (high glucose variability), 2 (hypoglycemia), 3 (hyperglycemia) and 4 (relatively stable). The monthly percentage changes, and average monthly percentage changes of hyperglycemia, hypoglycemia and treat to target were determined using joinpoint regression analysis. Results: A total of 106,528 hospitalized patients (mean age 60.9 ± 18.5 years, 57% men) were enrolled. We observed a significant reduction in the percentage of inpatients in poor glycemic control groups (groups 1, 2 and 3, all P < 0.001), and a reciprocal increase in the relatively stable group (group 4) from 2016 to 2019. We found a significant reduction in LOS by 11.4% (10.5–9.3 days, P = 0.002, after adjustment for age, sex, and admission department). The 30‐day readmission rate decreased from 29.9% to 29.3%, mainly among those in group 4 in 2019 (P < 0.001 after adjustment of sex, age, admission department and LOS). Conclusions: Improved glycemic control through a hospital‐wide electronic remote glycemic management system reduced LOS and 30‐day readmission rates. Findings observed in this study might be associated with the reduction in cost of avoidable hospitalizations. [ABSTRACT FROM AUTHOR]

Long-chain fatty acids activate the free fatty acid receptor 1 (FFA1) and FFA4. In the gastrointestinal system, FFA1 and FFA4 have been found in the pancreas and intestine. Fatty food and decreased lower esophageal sphincter (LES) motility are associated with gastroesophageal reflux disease. The effect of long-chain fatty acids on the esophageal motility is unknown. The purpose of this study is to investigate the effects of long-chain fatty acids on the porcine LES motility ex vivo using isometric transducers. In endothelin 1-precontracted porcine LES strips, the FFA1 selective agonists, fasiglifam, TUG424, and GW9508, caused marked relaxations in a concentration-dependent manner. The relative efficacies to elicit relaxation were GW9508 > TUG424 > fasiglifam in both clasp and sling strips. In contrast, the FFA4 specific agonists, TUG891 and GSK137647, produced mild relaxations. In addition, the endogenous FFA1 agonist DHA caused a mild relaxation whereas GW1100, an FFA1 antagonist, inhibited GW9508 induced relaxation of the porcine LES clasp and sling muscle. Both real-time PCR and immunohistochemistry revealed that FFA1 and FFA4 were expressed in the porcine LES. Real-time PCR analysis showed that the FFA4 expression was much lower than FFA1. Taken together, long-chain fatty acid receptor agonists elicit relaxation of the porcine LES. FFA1 might influence LES motility. [ABSTRACT FROM AUTHOR]

Background: Endothelin‐converting enzyme‐1 (ECE‐1) primarily converts big endothelins (ETs) into active endothelin‐1 (ET‐1). However, the expression pattern and prognostication status of ECE‐1 in head and neck cancer (HNC) are enigmatic. In this study, we investigated ECE‐1 expression and assessed the roles of ECE‐1 as a predictor for HNC differentiation and prognosis. Materials and Methods: ECE‐1 expressions were evaluated by immunohistochemical analysis using a tissue microarray (TMA) composed of 100 cases of head and neck squamous cell carcinoma. The correlation of ECE‐1 expression with clinicopathologic variables and patient outcomes was analyzed. Results: ECE‐1 may be overexpressed in HNC carcinoma cells. Higher ECE‐1 level was detected more frequently in moderately to poorly differentiated tumors and showed a lower differentiation category compared to the G1 cases (p = 0.015); this finding was further confirmed by an adjusted odds ratio (OR) of 4.071 (p = 0.042). Moreover, Kaplan–Meier survival analyses showed that a higher ECE‐1 expression was associated with a poorer survival in patients with HNC (p < 0.0001). On multivariate Cox proportional hazards models analysis, ECE‐1 of high expression proved to be an independent prognostic factor with a hazard ratio (HR) of 3.985 (p < 0.001). Conclusion: Our data provide the first evidence that overexpression of ECE‐1 in HNC is a predictor of poor tumor differentiation and prognosis. [ABSTRACT FROM AUTHOR]

Background: Resveratrol is a polyphenolic compound that can be isolated from plants and also is a constituent of red wine. Resveratrol induces relaxation of vascular smooth muscle and may prevent cardiovascular diseases.Purpose: Impaired gastric accommodation plays an important role in functional dyspepsia and fundic relaxation and is a therapeutic target of functional dyspepsia. Although drugs for fundic relaxation have been developed, these types of drugs are still rare. The purpose of this study was to investigate the relaxant effects of resveratrol in the guinea pig fundus.Study Design: We studied the relaxant effects of resveratrol in the guinea pig fundus. In addition, we investigated the mechanism of resveratrol-induced relaxation on the guinea pig fundus by using tetraethylammonium (a non-selective potassium channel blocker), apamine (a selective inhibitor of the small conductance calcium-activated potassium channel), iberiotoxin (an inhibitor of large conductance calcium-activated potassium channels), glibenclamide (an ATP-sensitive potassium channel blocker), KT 5720 (a cAMP-dependent protein kinase A inhibitor), KT 5823 (a cGMP-dependent protein kinase G inhibitor), NG-nitro-L-arginine (a competitive inhibitor of nitric oxide synthase), tetrodotoxin (a selective neuronal Na+ channel blocker), ω-conotoxin GVIA (a selective neuronal Ca2+ channel blocker) and G-15 (a G-protein coupled estrogen receptor antagonist).Results: The results of this study showed that resveratrol has potent and dose-dependent relaxant effects on the guinea pig fundic muscle. In addition, the results showed that resveratrol-induced relaxation of the guinea pig fundus occurs through nitric oxide and ATP-sensitive potassium channels.Conclusion: This study provides the first evidence concerning the relaxant effects of resveratrol in the guinea pig fundic muscle strips. Furthermore, resveratrol may be a potential drug to relieve gastrointestinal dyspepsia. [ABSTRACT FROM AUTHOR]

Delonix regia (Boj. Ex. Hook) is a flowering plant in the pea family found in tropical areas and its leaves are used informally to treat diseases in folk medicine. However, the cardioprotective effects in this plant are still unclear. In this study, we found that the Delonix regia leaf extract (DRLE) (400 mg/kg/d) can reduce the mortality rate in an isoproterenol (ISO)-induced heart injury and hypertrophy mouse model. Decreased serum levels of creatine phosphokinase, LDH, GOT, TNF-alpha and increased nitric oxide levels were found in DRLE-treated ISO-injured mice. In the in vitro study, the porcine coronary artery exhibited vasodilation effect induced by DRLE in a dose-dependent manner. In the DRLE toxic test, overdose of DRLE showed the high safety in normal mice and may have the ability to remove the metabolic wastes in blood. In conclusion, we demonstrated for the first time that DRLE has the cardioprotective effects by activating the vasodilation through NO pathway and preventing the myocyte injury via inhibition of TNF-alpha pathway. We suggest that DRLE may act as a promising novel herbal medicine for cardioprotection. [ABSTRACT FROM AUTHOR]

Objective Estrogen interacts with a membrane receptor, G protein-coupled estrogen receptor (GPER). It was reported that 17β-estradiol was able to inhibit contraction of the human colon and cause relaxation of the guinea pig gallbladder, however, the involvement of GPER was not clarified. The aim of the present study was to investigate the effect of estrogen on human gallbladder motility and the possible role of GPER. Materials and Methods Relaxation of human gallbladder strips were measured using isometric transducers. Expression of GPER was evaluated by reverse transcription polymerase chain reaction (PCR), real-time PCR, and immunohistochemistry. Results In human gallbladder strips, 17β-estradiol and G-1 elicited marked and rapid relaxation, whereas tamoxifen produced mild concentration-dependent relaxation. The relative efficacies to cause relaxation were as follows: 17β-estradiol = G-1 > tamoxifen. The relaxant response of 17β-estradiol was not attenuated by tetrodotoxin or conotoxin GVIA. This implies that nerve stimulation was not involved in the 17β-estradiol-induced gallbladder relaxation. Analysis by reverse transcription PCR and real-time PCR showed that GPER was expressed in the human gallbladder. Further analysis by immunohistochemistry revealed that GPER was expressed in the gallbladder muscle. This suggests that 17β-estradiol relaxes the human gallbladder via GPER. Conclusion These results demonstrate for the first time that 17β-estradiol and GPER agonist G-1 cause relaxation of the human gallbladder, probably through GPER. Estrogen might play an important role in the control of human gallbladder motility. [ABSTRACT FROM AUTHOR]

Distribution system states have become more dynamic due to the integration of intermittent distributed generation/load and bi-directional power flows. The availability of close to real-time distribution system models will help the controls and customer participations in the active distribution networks. A framework using on-line and off-line computing power and data in existing distribution management system to work together and build distribution feeder models for operation purposes is proposed. Simulations and evaluation results of the synergy of big heterogeneous topological and measurement data from systems that have different data formats, polling cycles, and accuracy to establish immediate past and future feeder models are presented. Archived customer meter interval and supervisory control and data acquisition (SCADA) data with the same time stamp are used to build quasi dynamic models off-line, and to forecast the states and measurements at the feeder buses. The results are then used in the on-line quasi dynamic state estimations (DySEs). The state tracking capability of two DySE techniques in conjunction with a static state estimator under various data accuracy assumptions is evaluated. Numerical results demonstrate the benefit of data synergy in the improvement of system operation models and network efficiency. [ABSTRACT FROM PUBLISHER]

Objectives The internal anal sphincter (IAS) plays an important role in maintaining continence. Atrial natriuretic peptide (ANP) could relax the IAS. The purpose of the present study was to investigate the roles of natriuretic peptide receptors (NPRs) in the IAS. Materials and methods Relaxation of isolated rat IAS strips caused by natriuretic peptides was measured using isometric transducers. Expression of NPRs was evaluated by reverse transcription–polymerase chain reaction (PCR), immunohistochemistry and real-time PCR. Results In the rat IAS, C-type natriuretic peptide (CNP) produced a marked and concentration-dependent relaxation while ANP caused a mild relaxation. By contrast, brain natriuretic peptide, dendroaspis natriuretic peptide, and des[Gln18, Ser19, Gly20, Leu21, Gly22]ANP(4–23) amide did not generate relaxation. CNP was much more effective than ANP and brain natriuretic peptide in stimulating the relaxation, indicating that NPR-B mediates IAS relaxation. The CNP-induced relaxation was inhibited by the protein kinase G inhibitor Rp-8CPT-cGMPS and potassium channel blocker charybdotoxin but not by protein kinase A inhibitor Rp-cAMPS. This suggests the involvement of cGMP and calcium-activated potassium channels in the CNP-induced IAS relaxation. Reverse transcription PCR and immunohistochemistry revealed the existence of NPR-B in the rat IAS. Furthermore, real-time PCR identified abundant expression of CNP and NPR-B in the rat IAS. Conclusion CNP causes relaxation of the IAS via NPR-B, cGMP, and potassium channel pathways in rats. CNP might regulate IAS motility. NPR-B is a potential therapeutic target in anorectal motility disorders. [ABSTRACT FROM AUTHOR]

The role of nerve growth factor (NGF) in liver injury induced by bile duct ligation (BDL) remains elusive. This study aimed to investigate the relationship between inflammation and hepatic NGF expression, to explore the possible upstream molecules up-regulating NGF, and to determine whether NGF could protect hepatocytes from oxidative liver injury. Biochemical and molecular detection showed that NGF was up-regulated in cholestatic livers and plasma, and well correlated with systemic and hepatic inflammation. Conversely, systemic immunosuppression reduced serum NGF levels and resulted in higher mortality in BDL-treated mice. Immunohistochemistry showed that the up-regulated NGF was mainly localized in parenchymal hepatocytes. In vitro mechanistic study further demonstrated that TGF-β1 up-regulated NGF expression in clone-9 and primary rat hepatocytes. Exogenous NGF supplementation and endogenous NGF overexpression effectively protected hepatocytes against TGF-β1- and oxidative stress-induced cell death in vitro, along with reduced formation of oxidative adducted proteins modified by 4-HNE and 8-OHdG. TUNEL staining confirmed the involvement of anti-apoptosis in the NGF-exhibited hepatoprotection. Moreover, NGF potently induced Akt phosphorylation and increased Bcl-2 to Bax ratios, whereas these molecular alterations by NGF were only seen in the H2O2-, but not TGF-β1-treated hepatocytes. In conclusion, NGF exhibits anti-oxidative and hepatoprotective effects and is suggested to be therapeutically applicable in treating cholestatic liver diseases. [ABSTRACT FROM AUTHOR]

Distribution network designers use a transformer load-management system to estimate and examine the historical and current loads occurring on transformers and test proposed load situations. Due to a lack of measurements at the feeders and distribution transformers, the confidence on the transformer load-management reports was low in the past. Intelligent equipment and advanced information and communication technology are now being integrated into distribution networks at an unprecedented speed. The technology advancement provides an opportunity to enhance transformer load modeling and management. In this paper, a framework using synchronized measurements obtained from different information systems via a utility's enterprise service bus is proposed to calculate the actual load profiles of distribution transformers and reflect changing system conditions. Network analyses resulting from using improved system models based on distribution state estimation allow the system operators and designers to make informed decisions concerning where new loads can be added and when new transformer capacity must be included. [ABSTRACT FROM PUBLISHER]

Abstract: Activation of proteinase-activated receptor-1 (PAR1) and PAR2 stimulates contraction of the rat but relaxation of the guinea pig colon. The aim of the present study was to investigate PAR effects on internal anal sphincter (IAS) motility. We measured relaxation of isolated muscle strips from the guinea pig IAS caused by PAR agonists using isometric transducers. Reverse transcription polymerase chain reaction (RT-PCR) was performed to determine the existence of PAR. In the IAS, thrombin and PAR1 peptide agonists TFLLR-NH2 and SFLLRN-NH2 evoked moderate to marked relaxation in a concentration-dependent manner. In addition, trypsin and PAR2 peptide agonists 2-furoyl-LIGRLO-NH2, SLIGRL-NH2 and SLIGKV-NH2 produced relaxation. In contrast, both PAR1 and PAR2 inactive control peptides did not elicit relaxation. Furthermore, the selective PAR1 antagonist vorapaxar and PAR2 antagonist GB 83 specifically inhibited thrombin and trypsin-induced relaxations, respectively. RT-PCR revealed the presence of PAR1 and PAR2 in the IAS. This indicates that PAR1 and PAR2 mediate the IAS relaxation. The relaxant responses of TFLLR-NH2 and trypsin were attenuated by N(omega)-Nitro-L-arginine (L-NNA), indicating involvement of NO. These responses were not affected by tetrodotoxin, implying that the PAR effects are not neurally mediated. On the other hand, PAR4 agonists GYPGKF-NH2, GYPGQV-NH2 and AYPGKF-NH2 did not cause relaxation or contraction, suggesting that PAR4 is not involved in the sphincter motility. Taken together, these results demonstrate that both PAR1 and PAR2 mediate relaxation of the guinea pig IAS through the NO pathway. PAR1 and PAR2 may regulate IAS tone and might be potential therapeutic targets for anal motility disorders. [Copyright &y& Elsevier]

Illegal use of electric energy is a widespread practice in many parts of the world. Smart metering enables the improvement of customer load model, theft and stressed asset detections. In this paper, a state estimation based approach for distribution transformer load estimation is exploited to detect meter malfunction/tampering and provide quantitative evidences of non-technical loss (NTL). A measure of overall fit of the estimated values to the pseudo feeder bus injection measurements based on customer metering data aggregated at the distribution transformers is used to localize the electricity usage irregularity. Following the state estimation results, an analysis of variance (ANOVA) is used to create a suspect list of customers with metering problems and estimate the actual usage. Typical Taiwan Power Company (TPC) distribution feeder data are used in the tests. Results of NTL detection under meter defect and energy theft scenarios are presented. Experiences indicate that the proposed scheme can give a good trace of the actual usage at feeder buses and supplement the current meter data validation estimation and editing (VEE) process to improve meter data quality. [ABSTRACT FROM PUBLISHER]

Abstract: Objectives: Bile acids inhibit contraction of the gallbladder and intestine through the G-protein-coupled bile acid receptor (GPBAR). Perfusion of the esophagus with bile and acid (HCl) decreases lower esophageal sphincter (LES) pressure. The effects of bile acids on LES motility are not clear. The purpose of the present study was to investigate the effects of bile acids on LES motility in vitro. Materials and Methods: We measured the relaxation of muscle strips isolated from guinea pig and rat LES caused by bile acids or the selective GPBAR agonist RG-239. Reverse transcription polymerase chain reaction (RT-PCR) was performed to determine GPBAR expression in rat LES. Results: In carbachol-contracted guinea pig LES strips, lithocholic acid (LCA), deoxycholic acid (DCA), chenodeoxycholic acid (CDCA), and cholic acid (CA) produced relaxation in a concentration-dependent manner. The relative potency was LCA ≥ DCA > CDCA > CA. RG-239 also induced concentration-dependent relaxation. This suggests that GPBAR mediates relaxation in guinea pig LES. DCA-induced LES relaxation was attenuated by the protein kinase A inhibitor KT 5720 but not by the protein kinase G inhibitor KT 5823 or the NO synthase inhibitor L-NNA. This suggests the involvement of cAMP. Separately, in endothelin-1-contracted rat LES strips, bile acids induced relaxation. The relative potency was LCA = DCA > CDCA > CA. RT-PCR revealed GPBAR expression in rat LES. Conclusion: These results demonstrate that bile acids cause relaxation of guinea pig and rat LES through GPBAR. [Copyright &y& Elsevier]

Objective. Muscarinic receptors mediate contraction of the human gallbladder through unclear receptor subtypes. The aim of the present study was to characterize muscarinic acetylcholine receptors mediating contraction of the human gallbladder. Materials and methods. Contraction of human gallbladder muscle strips caused by agonists carbachol and muscarine was measured and the inhibition of carbachol-induced contraction by muscarinic receptor antagonists was evaluated. Reverse transcription polymerase chain reaction was performed to determine the existence of muscarinic receptor subtypes. Results. Carbachol and muscarine caused concentration-dependent contraction of gallbladder strips. Four receptor antagonists, including atropine, 4-diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP), methoctramine, and pirenzepine, inhibited the carbachol-induced contraction. The relative inhibitory potency of these receptor antagonists was atropine > 4-DAMP > methoctramine > pirenzepine. The antagonist affinity estimates (pA2 values) correlated with the known affinities at M3, M4, and M5 muscarinic receptors. In addition, the M4-selective antagonist muscarinic toxin 3 did not inhibit and the M5-selective positive allosteric modulator VU0238429 did not potentiate carbachol-induced gallbladder contraction. This suggests that M3 muscarinic receptors mediate the muscarinic response predominantly. The contractile response of carbachol was attenuated by the voltage-gated Ca2+ channel inhibitor nifedipine and Rho-kinase inhibitor H-1152, but not affected by protein kinase C inhibitor chelerythrine. This implies the involvement of voltage-gated Ca2+ channel and Rho kinase but not protein kinase C. Conclusions. These results suggest a major role of M3 muscarinic receptors mediating the human gallbladder contraction through voltage-gated Ca2+ channels and Rho kinase. M3-selective muscarinic receptor antagonists could be of therapeutic importance in the treatment of biliary motility disorders. [ABSTRACT FROM AUTHOR]

Abstract: Trypsin and thrombin activate proteinase-activated receptors (PARs), which modulate gastrointestinal motility. The common bile duct is exposed to many proteinases that can activate PARs, especially during infection and stone obstruction. We investigated PAR effects on common bile duct motility in vitro. Contraction and relaxation of isolated guinea pig common bile duct strips caused by PAR1, PAR2 and PAR4 agonists were measured using isometric transducers. Reverse transcription polymerase chain reaction (RT-PCR) was performed to determine the expression of PAR1 and PAR2. Thrombin and two PAR1 peptide agonists, TFLLR-NH2 and SFLLRN-NH2, evoked moderate relaxation of the carbachol-contracted common bile duct in a concentration-dependent manner. Trypsin and three PAR2 peptide agonists, 2-furoyl-LIGRLO-NH2, SLIGKV-NH2 and SLIGRL-NH2, generated moderate to marked relaxation as well. The existence of PAR1 and PAR2 mRNA in the common bile duct was identified by RT-PCR. Moreover, two PAR4-selective agonists, AYPGKF-NH2 and GYPGQV-NH2, produced relaxation of the common bile duct. In contrast, all PAR1, PAR2 and PAR4 inactive control peptides did not elicit relaxation. This indicates that PAR1, PAR2 and PAR4 mediate common bile duct relaxation. The thrombin, TFLLR-NH2, trypsin, and AYPGKF-NH2-induced responses were not affected by tetrodotoxin, implying that the PAR effects are not neurally mediated. Our findings provide the first evidence that PAR1 and PAR2 mediate whereas agonists of PAR4 elicit relaxation of the guinea pig common bile duct. Trypsin and thrombin relax the common bile duct. PARs may play an important role in the control of common bile duct motility. [Copyright &y& Elsevier]

Abstract: Ethnopharmacological relevance: Danshen, root of Salvia miltiorrhiza (SM), has been traditionally used in Chinese medicine for the treatment of heart, abdomen, gurgling in the intestines, and relieving fullness. However, the effects of SM on intestine have rarely been done to date. Aim of the study: To investigate the contraction effect of SM on isolated rat ileum and its mechanisms involved. Materials and methods: The isometric contractions of ileum segments were investigated in organ baths for spontaneous activity and response to ethanolic extracts of SM. To determine the contraction mechanism caused by SM extracts, atropine (a muscarinic receptor antagonist), tetrodotoxin (TTX, a sodium channel blocker), nifedipine (a calcium channel blocker), Ca2+ free Krebs solution with EGTA, or trifluoperazine (TFP, a calmodulin blocker) was administered and its response to cumulative dosages of SM extracts were examined. The effect of SM extracts on Ca2+ signaling in the intestinal epithelial cell-6 (IEC-6) was examined using fura-2 as a Ca2+ indicator. Results: SM extracts caused dose-dependent tonic contraction on rat ileum in ex vivo organ bath studies. The contraction induced by SM extracts was not inhibited by atropine, TTX, nifedipine, or in Ca2+ free solution. However, the ileal contractions induced by SM extracts were significantly inhibited by TFP in a dose-dependent manner. In IEC-6 cells, the SM extracts induced extracellular Ca2+ entry and massive intracellular Ca2+ release in Ca2+-contained medium, and induced intracellular Ca2+ release in Ca2+-free medium. Conclusion: These results demonstrate that SM extracts cause ileal contraction through the Ca2+-calmodulin pathway. [Copyright &y& Elsevier]