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In the present work, nanostructured hydroxyapatite (HA)-containing coating was prepared on a Ti surface by ultrasonic mechanical coating and armoring (UMCA). A Ti plate was pre-coated with HA slurry, followed by UMCA, which was achieved by high-frequency ZrO2 ball bombardment. The UMCA process comprised several cycles of pre-coating and ball bombardment, providing high amounts of HA and good coating adhesion. The coating mainly consisted of nano-HA particles (less than 10 nm) and a small amount of Ti. Furthermore, the deformation structures of the Ti surface region were characterized in a nanocrystalline layer with a grain size of 50–200 nm. Additionally, the coating exhibited improved bioactivity and corrosion resistance in Hanks’ balanced salt solution than the Ti surface. Furthermore, the in vitro cytotoxicity test assessed that the HA-containing coating was non-cytotoxic.

Thermoprotective carrier agents increase bacterial viability during the drying process. We investigated the ability of various carriers, including skim milk powder, casein, and whey protein, to improve the survival rate of Lactobacillus brevis RK03 under gastrointestinal tract conditions. Employing optimized top fluid bed drying (TFBD) conditions (40 min at 50 °C), the highest bacterial survival rate (95 %) was achieved using casein and whey protein as carriers for RK03. Additionally, whey protein-microencapsulated RK03 displayed the highest survival rates in gastric juice at pH 3.0 (96 %) and 2.0 (75 %). Further, whey protein-microencapsulated RK03 exhibited better dispersibility and solubility than RK03 microencapsulated with other carriers, displayed a slower degradation rate at 50 °C and 60 °C, and had the lowest activation energy (30.27 J/mol). These results indicate that the use of whey protein as a carrier during TFBD is suitable for the production of RK03 probiotic powder.

Purpose This large-scale nationwide population-based study aimed to determine the recurrence rate and risk factors for recurrence after video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP). Methods This retrospective study used data from the Taiwan National Health Insurance Database to identify individuals who underwent VATS for PSP from 2007 to 2014. All patients were followed up until December 31, 2017. Study variables included demographic characteristics, intensive care unit admission, lung resection status, use of non-steroidal anti-inflammatory drugs (NSAIDs), and hospital level. The primary outcome was 1-year recurrence, and the secondary outcomes were the 1-year rate of reintervention for recurrence and overall recurrence rate. Results During the study period, 6654 patients underwent VATS for PSP (average age: 23.2 years, 89.1% male), including 910 patients (13.7%) who experienced recurrence within 1 year and 531 patients (8.0%) who required reintervention within 1 year. The overall recurrence rate was 24.8%, with an average follow-up time of 6.7 years. Age ≤18 years and the use of NSAIDs, especially ketorolac, were significant risk factors for 1-year recurrence and overall recurrence. Younger age was a risk factor for 1-year reintervention. In subgroup analysis, NSAID use was a significant risk factor for 1-year recurrence, 1-year reintervention, and overall recurrence in pediatric patients but not in adult patients. Conclusions In Taiwan, the 1-year recurrence rate was 13.7% after VATS for PSP. Younger age and the use of NSAIDs, especially ketorolac, were significant risk factors for short- and long-term recurrence after VATS for PSP.

AJCC TNM stage and WHO grade (G) are two widely used staging systems to guide clinical management for pancreatic neuroendocrine neoplasms (panNENs), based on clinical staging and pathological grading information, respectively. We proposed to integrate TNM stage and G grade into one staging system (TNMG) and to evaluate its clinical application as a prognostic indicator for panNENs. Accordingly, 5254 patients diagnosed with panNENs were used to evaluate and to validate the applicability of TNMG to panNENs. The predictive accuracy of TNMG system was compared with that of each separate staging/grading system. We found that TNM stage and G grade were independent risk factors for survival in both the Surveillance, Epidemiology, and End Result (SEER) and multicenter series. The interaction effect between TNM stage and G grade was significant. Twelve subgroups combining the TNM stage and G grade were proposed in the TNMG stage, which were classified into five stages TNMG. According to the TNMG staging classification in the SEER series, the estimated median survival for stages I, II, III, IV, and V were 203, 174, 112, 61, and 8 months, respectively. The predictive accuracy of TNMG stage was higher than that of TNM stage and G grade used independently. The TNMG stage classification was more accurate in predicting panNEN patient's prognosis than either the TNM stage or G grade.

Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare with low-grade malignancy and unclarified clinicopathological features. This study aimed to examine their characteristics and re-evaluate current treatments.Databases from three sources were screened for patients with SPNs. We compared the perioperative variables, clinical data, overall survival (OS), and prognostic factors for recurrence among the three corresponding cohorts.We identified 286 patients diagnosed with SPNs between 1988 and 2020. Patients were mostly women (81%; median age: 38 years), and peak incidence was observed in women of 20-29 years of age. SPNs had a peak incidence in Asian men at 50-59 years of age (p = 0.002) and a delayed peak incidence in Asian women at 30-39 years of age (p 0.001). Treatment strategies differed significantly across the institutions and included variations in the number of harvested lymph nodes and rates of vascular resection. Lymph node positivity was the only predictor of postoperative recurrence (odds ratio, 2.2; 95% confidence interval, 1.38-2.99; p = 0.007). Higher rates of lymphovascular invasion (p = 0.02), perineural invasion (p 0.001), and R1 margin involvement (p 0.001), as seen in one institution, did not result in poorer long-term survival in terms of the overall (p = 0.43), SPN-specific (p = 0.69), and recurrence-free survivals (p = 0.067).In contrast to previous findings that SPNs are prevalent in young women, a racial predilection for middle-aged Asian men and a delayed female peak incidence were noted. Parenchyma-preserving pancreatectomy may be an acceptable treatment. Non-radical surgery may be appropriate in patients with multiple comorbidities.

To analyze the effect of preoperative body composition on survival in patients with pancreatic cancer following pancreaticoduodenectomy (PD). Between October 2005 and August 2018, 116 patients (68 men, 48 women, mean age 66.2 ± 11.9 years) diagnosed with pancreatic adenocarcinoma following PD were retrospectively enrolled. The preoperative CT on vertebral level L3 was assessed for total abdominal muscle area (TAMA), visceral adipose tissue area (VAT), subcutaneous adipose tissue area (SAT), and mean skeletal muscle attenuation (SMD). The clinical data and pathological findings of tumors were collected. The impact of these factors on disease-free survival (DFS) and overall survival (OS) was evaluated by the Kaplan–Meier method and by univariable and multivariable Cox proportional hazards models. The 3-year DFS and OS rates were 8% and 25%, respectively. Of 116 patients, 20 (17.2%), 3 (2.6%), and 46 (39.7%) patients were classified as having sarcopenia, sarcopenic obesity, and myosteatosis, respectively. The VAT–TAMA ratio (1.2 ± 0.7 vs 0.9 ± 0.5, p = 0.01) and the visceral to subcutaneous adipose tissue area ratio (1.3 ± 0.7 vs 0.9 ± 0.5, p = 0.04) were higher in sarcopenic patients than in the nonsarcopenic group. Preoperative sarcopenia and sarcopenic obesity were associated with shorter OS (p = 0.012 and p = 0.041, respectively), but not shorter DFS. Myosteatosis was neither associated with DFS nor OS. On multivariable analysis, sarcopenia was the only significant prognostic factor for OS (p = 0.039). Preoperative sarcopenia assessed by CT is a poor prognostic factor for OS in pancreatic cancer patients after PD. • Sarcopenia and sarcopenic obesity can be evaluated by abdominal CT on L3 level. • Patients with diabetes mellitus (DM) had lower sex-standardized subcutaneous adipose tissue area index and skeletal muscle density and higher visceral to subcutaneous adipose tissue area ratio than did those without DM. • Preoperative sarcopenia, sarcopenic obesity, and new-onset diabetes mellitus may predict poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy.

Background The centralization of pancreatoduodenectomy (PD) has been shown to improve patient outcomes. The scheduling of two PDs in one day is one option to shorten the waiting time for patients referred to high volume centers. The effect on the surgical team or patient outcomes of such an approach have not previously been explored. This study aimed to investigate the effect of scheduling two PDs in one day on the surgeon's workload and patient outcomes. Methods A retrospective review of patients undergoing PD by a single surgeon between 2007 and 2018 was performed. Patients were allocated into: first PD (FIRSTPD group) or second PD (SECONDPD group) according to the position on the surgical operating list. The intraoperative, postoperative outcomes, and workload (the Surgery Task Load Index; SURG-TLX) were assessed between two groups. Results A total of 967 (91%) and 101 (9%) patients were included in the FIRSTPD and SECONDPD group, respectively. There were no differences in the duration of surgery (coefficient = −9.65; 95% confidence interval: −29.26 to 9.94; P = 0.334), incidence of major complications (odds ratio = 1.08; 95% confidence interval: 0.67–1.73; P = 0.739), or 90-day mortality (odds ratio = 1.03; 95% confidence interval: 0.12–8.53; P = 0.978) for those patients in the SECONDPD group as compared to the FIRSTPD group. The mean scores of two (physical and temporal demand) of the six SURG-TLX subscales of surgical workload were recorded as significantly higher by surgeons following two PD's as compared to one PD. Conclusions Although scheduling a second PD in one day shows no association with adverse patient outcomes, there is an increase in the physical and temporal subscales of surgical workload and consideration should be given to how this could be minimized.

In this work, a new family of fully biobased thermoplastic polyurethanes (TPUs) with thermo-induced shape memory is developed. First, a series of TPUs were successfully synthesized by the one-shot solvent-free bulk polymerization of bio-poly(1,3-propylene succinate) glycol (PPS) with various molecular weights (Mn = 1000, 2000, 3000, and 4000), 1,4-butanediol (BDO), and 4,4′-methylene diphenyl diisocyanate (MDI). These polyurethanes (PUs) are denoted as PPS-x-TPUs (x = 1000, 2000, 3000, and 4000), where x represents the Mn of PPS in the polymers. To determine the effect of the molecular weight of the soft segment of PU, all PPS–TPUs were formed with the same hard segment content (32.5 wt %). The soft segment with high molecular weight in PPS-4000-TPU caused a high degree of soft segment entanglement and formed many secondary bonds. PPS-4000-TPU exhibited better mechanical (tensile strength: 64.13 MPa and hardness: 90A) and thermomechanical properties (maximum loading: 2.95 MPa and maximum strain: 144%) than PPS-1000-TPU. At an appropriate shape memory programming temperature, all synthesized PPS-x-TPUs exhibited excellent shape memory behaviors with a fixed shape rate of >99% and a shape recovery rate of >86% in the first round and 95% in the following rounds. Therefore, these bio-TPUs with shape memory have potential for use in smart fabrics.

Present study focused on optimizing bioprocess condition for microalgal lutein production. From previous baseline yields of biomass (3.46 g/L) and lutein (13.7 mg/g), this study examined few key parameters. The 3X:3X ratio macro- and micronutrients was the most affecting parameter with highest biomass and lutein yields of 4.61 g/L and 14.3 mg/g. Temperature 30 °C enhanced the lutein up to 17.3 mg/g but reduced the biomass to 3 g/L. The light effects study showed 10k lux was most effective for lutein up to 14 mg/g, and effect of increasing salinity (25-75%) was detrimental. All the above parameters' optimization resulted in a lipid content of 22.5-26.5%. A maximum lutein productivity and yield of 0.451 mg/L/d and 65.74 mg/L with a 3X:3X macro- and micronutrient ratio was achieved. The Chlorella sorokiniana Kh12 strain exhibited one of the highest yields among recent reports; hence it could be a source for commercial lutein production.

In this study, a Ti nitride/Ni metal-based composite was fabricated by the carbothermal reduction reaction during the sintering process. After cold isostatic pressing, green compacts consisting of 50 wt% Ti and 50 wt% Ni were soaked in a water-based hot forging lubricant followed by sintering in air at 850, 950, and 1050 °C. The effects of the sintering temperature on the wear resistance and the compressive strength of the composites were investigated. During sintering, Ti particles were transformed to Ti nitride as TiN0.3 at 850 °C, and then gradually transformed to TiN0.3 and TiN at 950 °C accompanied by TiO2 formation. The Ti oxide layer surrounding the outer surface of the Ti nitride particles has a hardness of 327.5 HV, which is lower than that of the Ti nitride particles (1224.0 HV) and higher than that of the Ni matrix (77.2 HV). The oxide layer is regarded as a buffer layer which can improve the adhesion of the Ti nitride particles and the Ni matrix. The compact sintered at 950 °C had the highest wear resistance and compressive strength among all the compacts due to its low porosity and thick oxide layer. The compact sintered at 850 °C had the lowest wear resistance, and the main fracture mechanism realizes due to the detachment of the Ti nitride particles from the Ni matrix. The wear fracture mechanism of the compact sintered at 1050 °C explained by the enlargement of the pores in the Ti nitride particle by abrasion.

Although the hypoglycemic potential of brewer’s yeast extract has been reported, there is limited information pertaining to the hypoglycemic ingredients of Saccharomyces pastorianus extract and their mechanisms of action available. This study aimed to investigate the in vivo and in vitro hypoglycemic effect of S. pastorianus extract and to elucidate its molecular mechanisms. S. pastorianus extract was mainly composed of proteins followed by carbohydrates. In diabetic rats, oral administration of S. pastorianus extract significantly reduced the levels of plasma glucose and enhanced the activity of hepatic glucose-6-phosphatase dehydrogenase. Treatment with S. pastorianus extract increased the localization of type 4 glucose transporter (GLUT4), PTP, and insulin receptor at 3T3-L1 cell membranes and raised the levels of P38 MAPK, PI3K, and AKT in the cytosol. In agreement with these results, pretreatment of 3T3-L1 cells with inhibitors of PTP, PI3K, Akt/PKB, and p38 MAPK inhibited glucose uptake induced by application of S. pastorianus extract. Most importantly, a 54 kDa protein with hypoglycemic activity was identified and suggested as the major ingredient contributing to the hypoglycemic activity of S. pastorianus extract. In summary, these results clearly confirm the hypoglycemic activity of S. pastorianus extract and provide critical insights into the underlying molecular mechanisms.

Purpose Pancreatic cancer is one of the most malignant cancers with poor survival. The latest edition of the American Joint Committee on Cancer (AJCC) staging system classifies the majority of operable pancreatic cancer patients as stage-III, while dramatic heterogeneity is observed among these patients. Therefore, subgrouping is required to accurately predict their prognosis and define a treatment plan. This study conducts a cohort study to provide a more precise classification system for stage-III pancreatic cancer patients by utilizing clinical variables. Methods We analyzed survival using log-rank tests, univariate Cox-regression models, and Kaplan-Meier survival curves for stage-III pancreatic ductal adenocarcinoma (PDAC) patients from the Taiwan Cancer Registry (TCR). Patients were further divided into subgroups using classification and regression tree (CART) algorithm. All results were validated using the SEER database. Results Among stage-III PDAC patients, lymph node and tumor grade showed significant association with survival. Patients with N2 stage had higher mortality risks (hazard ratio [HR] = 2.30, 95% confidence interval [CI] 1.71–3.08, p p p Conclusions Lymph node involvement and tumor grade are predictive factors for survival in stage-III PDAC patients. This new precise classification system can be used to guide treatment planning in advanced-stage pancreatic cancer.

Background:There is no widely-accepted staging system for pancreatic neuroendocrine tumors (pNETs). The aim of this study was to validate the American Joint Committee on Cancer (AJCC) 8th edition staging system for well-differentiated (G1/G2) pNETs.Methods:A multicenter dataset (n=1086) was used to evaluate the application of the AJCC 7th and 8th, the European Neuroendocrine Tumor Society (ENETS), and the modified ENETS (mENETS) staging systems for well-differentiated pNETs.Results:The proportion of patients with stage III tumors was extremely low (1.1%) according to the AJCC 7th staging system. For the ENETS staging system, patients with stage IIIA disease had worse estimated mean survival than patients with stage IIIB disease (78.9 vs. 107.3 months). When comparing with patients in stage I, the AJCC 7th, ENETS, and mENETS staging systems showed good performance in discriminating between stages; however, there was no significant difference in some stages when the reference was defined as the earlier stage. When the reference was defined as stage I or the earlier stage, there was a significant inter-stage difference in the AJCC 8th staging system.Conclusions:The AJCC 8th staging system is more suitable for pNETs than other TNM staging systems and may be adopted in clinical practice.

A biocomposite coating comprising chitosan and ZnO deposited on a porous Ti oxide is developed to avoid orthopedic and dental implant-related infections. The coating comprised of an inner layer of nanoporous TiO2 and the outer layer of the chitosan matrix with ZnO nanoparticles. Microbiological tests show that chitosan coating is effective against Escherichia coli (E. coli), however, its ability to inhibit bacterial adhesion is very limited. A 1.2-fold increase in the antibacterial activity of chitosan/ZnO coating against E. coli was detected as compared to the chitosan coating alone, and the chitosan/ZnO efficiently inhibited biofilm formation. In addition, the chitosan/ZnO coating exhibited improved bioactivity compared to the chitosan coating. The improvement in antibacterial properties and bioactivity of the chitosan/ZnO coating is attributed to the release of Zn2+ ions. The critical force of scratching the chitosan/ZnO coating was approximately twice that of the chitosan coating. The potentiodynamic polarization results confirmed that the corrosion resistance of the implant with ZnO/chitosan/Ti structure was improved. In addition, cytocompatibility evaluation indicated that the chitosan/ZnO coating has good cytocompatibility in MG-63 cells as compared to pure Ti.

Patients with periampullary cancer frequently suffer obstructive jaundice and commonly require preoperative biliary drainage (PBD) for relief and to avoid related complications. Although research has established a correlation between PBD and surgical wound infection, the impact of PBD on major infectious complications (intra-abdominal abscess [IAA]) and overall mortality remains debatable. We hypothesized that PBD could lead to IAA and mortality, and evaluated their correlation in patients undergoing pancreaticoduodenectomy (PD). We enrolled patients undergoing PD at an Asian academic medical center between 2007 and 2016. The types of PBD included endoscopic retrograde biliary drainage (ERBD) and percutaneous transhepatic cholangiography and drainage (PTCD). The primary outcome was IAA, defined as the presence of pus or infected fluid inside the abdominal cavity and with documented infectious pathogens. There was one (0.1%) 30-day mortality and eight (0.9%) 90-day mortalities among 899 consecutive patients examined. More than one-quarter of patients had PBD (n = 237, 26.4%; 165 ERBD, 72 PTCD). In the ERBD, PTCD, and non-PBD groups, the IAA rates were 37.0%, 16.7%, and 10.6%, respectively. On multivariate analysis, ERBD (odds ratio 3.67; 95% confidence interval 2.22–6.06; p

The effect of a harmonic scalpel on postoperative pancreatic fistula (POPF) has not been addressed. This study assessed the effect of pancreatic neck transection using a harmonic scalpel on rate and severity of POPF after pancreaticoduodenectomy (PD).This retrospective analysis included patients who underwent PD at National Taiwan University Hospital between July 2015 and March 2019. We compared rate and severity of POPF between patients who underwent pancreatic neck transection using a harmonic scalpel versus electrosurgical unit.Of 422 consecutive PDs, the pancreatic neck was transected using a harmonic scalpel or electrosurgical unit in 144 and 278 patients, respectively. Use of a harmonic scalpel significantly increased risk of biochemical leak (25.7% versus [vs] 10.8%; P 0.05) but not clinically relevant POPF (CR-POPF; 30.2% vs 26.4%; P = 0.41). Harmonic transection was an independent predictor of biochemical leak (odds ratio [OR] = 2.93; P 0.05) but not CR-POPF (OR = 0.83; P = 0.41) or other major complications (OR = 0.72; P = 0.27). There was no significant intergroup difference in postoperative hospital stay.Pancreatic neck transection using a harmonic scalpel increased risk of biochemical leak but not CR-POPF or other major complications.

Chitosan is produced by thermochemical alkaline deacetylation of chitin, but the process is usually environmentally problematic. In the present study, Illex argentinus squid pen chitin, after de-proteinization and demineralization, was pretreated with a compressional-puffing (CP) process under various puffing pressures. The CP process facilitated the increase of the crystalline index and degree of deacetylation of chitins. The CP-treated chitins were subjected to further extraction of chitosan, and four chitosan isolates (CI1-CI4) were obtained. The CP process was found to have beneficial effects in terms of increased extraction yield and increased antibacterial activity of the extracted chitosans. Moreover, the antibacterial property of the extracted chitosans seemed to be negatively related to their molecular weight (MW). Our findings showed that CI4 exhibited the highest extraction yield and the greatest antibacterial activity, and thus we recommend it as a safe and potent antibacterial agent for food, biomedicine, and other industrial usages.

Background The rate of preoperative biliary drainage for pancreaticoduodenectomy has been increasing despite most recent evidence that favors avoiding it. Only a few studies have focused on late surgical complications - biliary stricture after pancreaticoduodenectomy and have produced only inconclusive results. We evaluate the role of preoperative biliary drainage in the formation of biliary stricture after pancreaticoduodenectomy. Methods The Taiwan National Health Insurance Program is a mandatory health care plan that covers nearly the entire population of 23 million in this country. A retrospective study was conducted to analyze the database compiled by the Taiwan National Health Insurance between January 2000 and December 2011. We included only patients with at least 2 years of follow-up. A cohort of 2,087 patients with preoperative diagnosis of biliary obstruction that underwent pancreaticoduodenectomy was evaluated. Results A total of 212 (10.1%) of the 2,087 studied patients needed intervention for biliary stricture after pancreaticoduodenectomy. The median time to biliary stricture formation was 15.2 months (range: 1.2-89.7 months). The cumulative biliary stricture rate was 6.9% (1 year), 15.8% (5 years), and 18.5% (10 year). Multivariate analysis showed preoperative biliary drainage (hazard ratio 1.78, 95% CI 1.27-2.50, P = 0.001) associated with biliary stricture after pancreaticoduodenectomy. Conclusions Preoperative biliary drainage increases biliary stricture rate after pancreaticoduodenectomy.

During the processing of mango, a huge amount of peel is generated, which is environmentally problematic. In the present study, a compressional-puffing process was adopted to pretreat the peels of various mango cultivars, and then the bioactive compounds of mango peels were extracted by water or ethanol. The phenolic compound compositions as well as the free radical-scavenging, anti-inflammatory, and antibacterial activities of water extract (WE) and ethanol extract (EE) from nonpuffed (NP) and compressional-puffed (CP) mango peels were further evaluated. It was found that compressional-puffing could increase the yield of extracts obtained from most mango varieties and could augment the polyphenol content of extracts from Jinhwang and Tainoung number 1 (TN1) cultivars. The WE and EE from TN1 exhibited the highest polyphenol content and the greatest free radical-scavenging activities among the mango cultivars tested. Seven phenolic compounds (gallic acid, pyrogallol, chlorogenic acid, p-hydroxybenzoic acid, p-coumaric acid, ECG, and CG) were detected in CPWE (compressional-puffed water extract) and CPEE (compressional-puffed ethanol extract) from TN1, and antioxidant stability of both CPWE and CPEE was higher than that of vitamin C. Further biological experiments revealed that CPEE from TN1 possessed the strongest anti-inflammatory and antibacterial activities, and thus it is recommended as a multibioactive agent, which may have applications in the food, cosmetic, and nutraceutical industries.

Chitosan/drug (cefazolin) coatings were synthesized on alkali-treated Ti surfaces via electrophoretic deposition to improve the antibacterial activities and corrosion resistances of the surfaces. The coatings exhibited desirable adhesion to the alkali-treated Ti due to the penetration of chitosan and drug into the pores of the substrates. The chitosan were cationic molecules which carried drug and both of them migrated toward the cathode during electrophoretic deposition. At a low potential, the drug dissolved in the chitosan film, whereas at a high potential, the drug aggregated into sheets on the surface of chitosan. The high potential provided the coating with high drug loading and releasing capacity. The total drug release of chitosan/drug coatings with 4.3 and 6.9 μm thickness in Hank's balanced salt solution (HBSS) was about 3 and more than 14 days, respectively. The coatings exhibited increased corrosion resistance than the Ti in HBSS evaluated via potentiostat. Additionally, the coating with high drug loading demonstrated approximate 100% antibacterial activities against Escherichia coli; thus, the proposed coatings can be used as promising Ti coatings to limit bacterial adhesion and proliferation.

Waste biomass of Lactobacillus brevis obtained from in vivo γ-aminobutyric acid (GABA) production was used for value-addition. This study aims to extract glutamate decarboxylase (GAD) and characterize it for in vitro GABA production. Extracted GAD showed an excellent activity for in vitro GABA production. 52 W ultrasonic output was best in crude GAD extraction which was purified by Q HP anion-exchange column followed by Superdex-200 colloid separation column. The molecular weight of the purified GAD was determined to be ~53 kDa, and the Km value for L-glutamic acid was calculated ~7.65 mM. Pyridoxal 5′-phosphate (PLP) acted as the best cofactor for GAD. Optimum temperature and PLP dosing were deferring for crude and purified enzyme forms which respectively exhibited at 45°C, 55°C, 200 µmol and 20 µmol whereas optimum pH was the same at 4.5. GAD finds applications in food industries hence its detailed characterization would be promising for commercial exploitations.

This paper proposes a revised Glosten-Jagnnathan-Runkle (GJR) model for estimating hedge ratios. The model can take into account three important characteristics in the return behavior, i.e., fat-tailed distribution, leverage effect, and spot-futures spread. Hedge performance in terms of the White's (2000) reality check is conducted. Our results demonstrate that the generalized autoregressive conditional heteroskedasticity (GARCH) model that considers both fat-tailed distribution and asymmetric effects of the spread provides the best hedging effectiveness for longer horizons.

We evaluated γ-aminobutyric acid (GABA) production by Lactobacillus brevis RK03 immobilized fermentation using three types of porous ceramic materials, All Clean (AC), Ocean Free (OF), and Power Material (PM). Almost same surface areas of the three porous ceramic materials were used to perform batch cultures with a modified GM broth and 500 mM monosodium glutamate (MSG). PM produced the highest GABA production after 96 h with an MSG conversion rate of 96.5% at pH 4.5 and 10% bacterial inoculum growing in a 500 mL flask. We then developed a semi-continuous GABA fermentation system by culturing 10% cells in the 500 mL flask comprising AC, OF, and PM carriers with similar surface areas and 500 mM MSG, for 288 h and five cycles at 30 °C. PM produced the highest GABA yield with a 86% conversion rate after five cycles. Semi-continuous fermentation was performed in a 10 L fermenter; MSG conversion rates still reached 97.3% or more following 25 consecutive fermentations, resulting in a maximum GABA yield, which was high for five cycles. Therefore, PM was the best carrier for continuous fermentation of GABA after 25 cycles and 1200 h. PM can be applied to industrial mass production of GABA.

Implant-associated infections may be prevented by coating silver on a titanium implant; however, the excessive release of Ag+ can induce cytotoxicity. This study fabricated a silver/collagen coating on a porous titanium oxide surface to improve the antibacterial ability of titanium implants without compromising cytocompatibility. Micro-arc oxidation was first applied on titanium to form a porous surface, which was then coated with silver through electrochemical deposition. Collagen was then used to modulate the amount and shape of the silver applied. It was found that high potential induced silver aggregations grow anisotropically into coarse dendritic structures non-uniformly distributed on the surface. The co-deposition of collagen and silver reduces the silver-aggregation size and allows the silver to grow into a spherical shape. The silver/collagen coating can effectively prevent adhesion and proliferation of Escherichia coli. In addition, the silver/collagen coating significantly improves the hydrophilicity (water contact angle of 39.8°) of the porous titanium oxide (109.5°). Based on MTT assay tests, the mean optical densities for the silver/collagen coated surfaces after 72 h of MG63 osteoblast cell adhesion were greater than those obtained from the silver coated surfaces. Therefore, the silver/collagen coating is expected to be useful for the development of new antibacterial dental and orthopedic implants.

Nitinol is an unusual material for hard-tissue replacements because of their unique superelasticity, biocompatibility, and low elastic modulus. Nitinol surface was modified by plasma electrolytic oxidation with an aim to produce oxide film on the surfaces for inhibiting Ni ion release. In addition, various Ag structures were constructed on the oxide templates on nitinol using electrodeposition in an AgC2H3O2-based solution for improving the antibacterial ability. Control of the electrolyte by collagen concentration caused a change in Ag shape and aggregation. Preferred growth along Ag (1 1 1) by orientated attachment of the Ag led to the formation of Ag dendrites in the AgC2H3O2 solution. Spherical Ag nanostructures, which were well dispersed on the templates, were obtained by electrodeposition in an AgC2H3O2-collagen solution on templates. Increasing the concentration of collagen caused aggregated Ag to form coarse spherical structures with a non-uniform distribution.

Background The pancreatoenteric anastomotic stricture (PEAS) is a common long-term complication after pancreaticoduodenectomy (PD), some of which present as acute pancreatitis requiring emergency care. This important topic has never been reported. In this study, we focus on the incidence, radiological features, clinical outcome, and risk factors of late-occurring acute pancreatitis (LAP) after PD. Methods We retrospectively reviewed a prospectively collected database of 539 patients who underwent PD at a single tertiary referral center between June 2005 and December 2014. Only patients with at least 3 years of follow-up and available pre- and post-operative images were included. Results Of the 539 patients, 23 (15 [65%] with and eight [35%] without PEAS) were diagnosed with LAP after PD. The cumulative incidence of LAP was 3.6% (1-year), 4.4% (2-year), and 5.1% (5-year). The median time to the first LAP episode was 22 months (range 8-38 months) after PD. All the first and recurrent LAP events were mild in severity and resolved after conservative treatment. Multivariate analysis showed that a history of acute pancreatitis before PD (P = 0.001, HR 5.24, 95% CI 1.95-14.10) and PEAS (P = 0.047, HR 2.75, 95% CI 1.01-7.49) were two significant risk factors. Conclusions We propose using a more conservative treatment for patients who experience LAP after PD.

The aim of this study was to investigate whether oral administration in BALB/c mice with chitosan hydrolytic products including chitosan hydrolysate, LMWC and a chitooligosaccharide mixture (oligomixture), modulates mitogen-induced and antigen-specific immune responses. A water-soluble chitosan hydrolysate was obtained via cellulase degradation of chitosan, and a LMWC and the oligomixture were separated from this hydrolysate. In non-immunized mice, both the chitosan hydrolysate and oligomixture significantly increased the phagocytic activity of peritoneal macrophages. Three chitosan hydrolytic products significantly increased the mitogen-induced proliferation of splenocytes and Peyer's patch (PP) lymphocytes. LMWC and oligomixture up-regulated IFN-γ secretion, and induced predominantly Th1 cytokine secretion in splenocytes. In antigen-specific immunity, similar effects of the chitosan hydrolytic products were observed on augmenting ovalbumin (OVA)-, as well as mitogen-, induced proliferation of splenocytes harvested from OVA-immunized mice. Interestingly, oligomixture was the most potent chitosan hydrolytic product to elicit OVA-specific IgM, IgG, and IgA production, while LMWC was the most potent one to elevate splenic IFN-γ production and IFN-γ/IL-4 (Th1/Th2) ratio. These results provide the distinct immunomodulatory properties of chitosan hydrolytic products in response to mitogens and specific antigen, paving the way for further development and application of dietary chitosan hydrolytic products against immune disorders and infection.

BackgroundWhether continued oral feeding may have a negative impact on healing of postoperative pancreatic fistula (POPF) is unclear. The aim was to test the hypothesis that oral feeding is non-inferior to enteral feeding in closure of POPF after pancreatoduodenectomy, and to clarify the effects of oral feeding on the duration and grade of POPF.MethodsThis multicentre, non-inferiority randomized trial of oral or enteral feeding of patients with POPF after pancreatoduodenectomy recruited patients between August 2013 and September 2016. The primary efficacy outcome was the 30-day fistula closure rate. The prespecified non-inferiority margin was 15 per cent. Other efficacy outcomes included grade of fistula, and hospital stay and costs.ResultsA total of 114 patients were included, and received oral (57) or enteral (57) feeding. The two groups were balanced in baseline characteristics and no patient was lost to follow-up. In intention-to-treat analysis, oral feeding was non-inferior to enteral feeding in terms of 30-day fistula closure rate (88 versus 89 per cent respectively; difference –1·8 per cent, lower limit of 95 per cent c.i. –14·4 per cent; P = 0·020 for non-inferiority). Compared with enteral feeding, oral feeding significantly reduced hospital costs and duration of stay. No significant differences were noted in the number of patients whose POPF evolved into grade B/C, or other outcomes.ConclusionOral feeding in patients with POPF after pancreatoduodenectomy did not increase the duration or grade of POPF, and was associated with reduced duration of stay and hospital costs. Registration number: NCT01755260 (http://www.clinicaltrials.gov).

An incident of food-borne poisoning causing illness in 37 victims due to ingestion of fried fish sticks occurred in September 2014, in Tainan city, southern Taiwan. Leftovers of the victims' fried fish sticks and 16 other raw fish stick samples from retail stores were collected and tested to determine the occurrence of histamine and histamine-forming bacteria. Two suspected fried fish samples contained 86.6 mg/100 g and 235.0 mg/100 g histamine; levels that are greater than the potential hazard action level (50 mg/100 g) in most illness cases. Given the allergy-like symptoms of the victims and the high histamine content in the suspected fried fish samples, this food-borne poisoning was strongly suspected to be caused by histamine intoxication. Moreover, the fish species of suspected samples was identified as milkfish ( Chanos chanos ), using polymerase chain reaction direct sequence analysis. In addition, four of the 16 commercial raw milkfish stick samples (25%) had histamine levels greater than the US Food & Drug Administration guideline of 5.0 mg/100 g for scombroid fish and/or products. Ten histamine-producing bacterial strains, capable of producing 373–1261 ppm of histamine in trypticase soy broth supplemented with 1.0% L-histidine, were identified as Enterobacter aerogenes (4 strains), Enterobacter cloacae (1 strain), Morganella morganii (2 strains), Serratia marcescens (1 strain), Hafnia alvei (1 strain), and Raoultella orithinolytica (1 strain), by 16S ribosomal DNA sequencing with polymerase chain reaction amplification.

Cell immobilization is a way to isolate or localize intact cells in a certain space and maintain their catalytic activity. Immobilized cells can effectively reduce the negative effects of inhibitors and the processing cost of inoculum preparation for continuous or fed-batch fermentation of microorganisms. In this study, a novel yeast immobilization technique using renewable poly- l -lactic acid (PLLA) microtube array membrane (MTAM) was thoroughly evaluated for bioethanol fermentation. PLLA-MTAM was shown to be stable in 15% (v/v) ethanol solution during shaking cultivation. A yeast encapsulation efficiency of 67–70% was obtained, and the yeasts in MTAMs with greater porosity showed greater bioethanol productivity. The MTAM-immobilized Kluyveromyces marxianus , prepared using in situ and siphon methods, were evaluated using 5% (w/v) glucose fermentation. Improved glucose consumption and bioethanol production were observed in batch bioethanol fermentation. In 7 cycles during repeated-batch fermentation, the immobilized yeasts prepared using the in situ method showed a maximum C EtOH of 24.23 g/L, maximum Y P/S of 0.48 g/g, and r P EtOH of 2.69 g/L h. Our data indicated that the PLLA-MTAM immobilized yeasts significantly enhanced bioethanol productivity and was a novel, promising technology for bioethanol fermentation.

One-step sulfuric acid saccharification of the red alga Pterocladiella capillacea was optimized, and various detoxification methods (neutralization, overliming, and electrodialysis) of the acid hydrolysate were evaluated for fermentation with the thermotolerant yeast Kluyveromyces marxianus. A proximate composition analysis indicated that P. capillacea was rich in carbohydrates. A significant galactose recovery of 81.1 ± 5% was also achieved under the conditions of a 12% (w/v) biomass load, 5% (v/v) sulfuric acid, 121°C, and hydrolysis for 30 min. Among the various detoxification methods, electrodialysis was identified as the most suitable for fermentable sugar recovery and organic acid removal (100% reduction of formic and levulinic acids), even though it failed to reduce the amount of the inhibitor 5-HMF. As a result, K. marxianus fermentation with the electrodialyzed acid hydrolysate of P. capillacea resulted in the best ethanol levels and fermentation efficiency.

A yeast strain of Saccharomyces pastorianus no. 54 with hypoglycemic activity was isolated from soils of a winery. The aims of this study were first to investigate the effects of the cultivation conditions on proliferation and hypoglycemic activity of this yeast using the assay model of the differentiated 3T3-L1 adipocytes, and then, to confirm in vivo the hypoglycemic activity of cultured yeast by oral administration in streptozotocin (STZ)-induced diabetic mice. Among 7 diluted fruit juice samples the diluted strawberry juice (1.74 g/L reducing sugar content) was chosen as the basal medium. After investigation of the effects of addition of various substances, including 1% of 5 different sugars and glycerol, 0.1% of 6 nitrogen-containing substances, and 1 ppm of 7 growth factors, the diluted strawberry juice added with 1% glucose, 0.1% yeast extract and 1 ppm aspartic acid was optimized at 20 °C with initial pH value of 6.0 for cultivating S. pastorianus no. 54 in flask. The scale-up system of a 5-L fermentor was further established by using the same medium with initial pH 6.0 and being incubated at 20 °C with an aeration rate of 1.2 vvm for 96 h. The hypoglycemic activity of yeast cells cultivated in fermentor was 3.11 times of that in flask. Oral administration of the cultured yeast at a dosage of 130 mg/kg body weight/day for 6 days could significantly reduce the plasma glucose content in STZ-induced diabetic mice and keep their body weights in the normal range.

Patients with systemic lupus erythematosus (SLE) are known to have lower heart rate variability and impaired vagal modulation, and right lateral position has been shown to lead to a higher vagal modulation than supine position in healthy subjects and patients with cardiovascular diseases. This study evaluated the effect of disease activity and different recumbent positions on cardiac autonomic nervous modulation by heart rate variability analysis in patients with SLE. Thirty-five female patients with SLE and 33 female controls were enrolled in this study. Electrocardiogram was recorded during supine, left lateral, and right lateral positions for 15 min. Both time and frequency domains heart rate variability measures were calculated. The normalized high-frequency power was used as the index of vagal activity, and the low-/high-frequency power ratio as the index of sympathovagal balance. We found that patients with SLE had lower indices of time domain heart rate variability measures and lower low-frequency power, high-frequency power, and normalized high-frequency power than control subjects. SLE patients with lower serum albumin had lower normalized high-frequency power and higher low-/high-frequency power ratio. In patients with SLE, right lateral position could lead to higher high-frequency power, normalized high-frequency power, and lower low-/high-frequency power ratio than supine position. In addition, the lower the normalized high-frequency power in supine position the patient had, the greater the increase in normalized high-frequency power when the position of the patient was changed from supine to right lateral. Thus, serum albumin level might be used as a potential disease severity index of SLE, and right lateral position can lead to higher vagal modulation and lower sympathetic modulation, renin-angiotensin-aldosterone modulation, and vagal withdrawal than supine position in patients with SLE. Right lateral position can be used as an efficient and physiological vagal enhancer in SLE patients with depressed vagal modulation.

Systemic lupus erythematosus (SLE) patients may have psychiatric manifestations during the illness course. Psychotropic agents are indicated in treating these symptoms. Second-generation antipsychotics, such as risperidone, olanzapine and quetiapine, have been thought to be safer than clozapine with regard to the side effect of neutropenia or agranulocytosis. We report a case of SLE who developed agranulocytosis during the treatment with olanzapine for the SLE-related psychiatric symptoms.

MafB is a transcription factor that induces myelomonocytic differentiation. However, the precise role of MafB in the pathogenic function of macrophages has never been clarified. Here we demonstrate that MafB promotes hyperlipidemic atherosclerosis by suppressing foam-cell apoptosis. Our data show that MafB is predominantly expressed in foam cells found within atherosclerotic lesions, where MafB mediates the oxidized LDL-activated LXR/RXR-induced expression of apoptosis inhibitor of macrophages (AIM). In the absence of MafB, activated LXR/RXR fails to induce the expression of AIM, a protein that is normally responsible for protecting macrophages from apoptosis; thus, Mafb-deficient macrophages are prone to apoptosis. Haematopoietic reconstitution with Mafb-deficient fetal liver cells in recipient LDL receptor-deficient hyperlipidemic mice revealed accelerated foam-cell apoptosis, which subsequently led to the attenuation of the early atherogenic lesion. These findings represent the first evidence that the macrophage-affiliated MafB transcription factor participates in the acceleration of atherogenesis.

Item does not contain fulltext Lesch-Nyhan disease is a neurogenetic disorder caused by deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase. The classic form of the disease is described by a characteristic syndrome that includes overproduction of uric acid, severe generalized dystonia, cognitive disability and self-injurious behaviour. In addition to the classic disease, variant forms of the disease occur wherein some clinical features are absent or unusually mild. The current studies provide the results of a prospective and multi-centre international study focusing on neurological manifestations of the largest cohort of Lesch-Nyhan disease variants evaluated to date, with 46 patients from 3 to 65 years of age coming from 34 families. All had evidence for overproduction of uric acid. Motor abnormalities were evident in 42 (91%), ranging from subtle clumsiness to severely disabling generalized dystonia. Cognitive function was affected in 31 (67%) but it was never severe. Though none exhibited self-injurious behaviours, many exhibited behaviours that were maladaptive. Only three patients had no evidence of neurological dysfunction. Our results were compared with a comprehensive review of 78 prior reports describing a total of 127 Lesch-Nyhan disease variants. Together these results define the spectrum of clinical features associated with hypoxanthine-guanine phosphoribosyltransferase deficiency. At one end of the spectrum are patients with classic Lesch-Nyhan disease and the full clinical phenotype. At the other end of the spectrum are patients with overproduction of uric acid but no apparent neurological or behavioural deficits. Inbetween are patients with varying degrees of motor, cognitive, or behavioural abnormalities. Recognition of this spectrum is valuable for understanding the pathogenesis and diagnosis of all forms of hypoxanthine-guanine phosphoribosyltransferase deficiency. 01 maart 2010

The frequency of hypoxanthine-guanine phosphoribosyltransferase (HPRT) deficiency within the gout-affected population in Taiwan was unclear. We evaluated its frequency and sought to identify a new genetic variation in a case with HPRT deficiency.From 2004 to 2005, a total of 983 patients with gout were followed among outpatients attending the Department of Rheumatology. Among these, 12 cases were suspected to have HPRT deficiency, and HPRT activity was examined by HPLC. In the index case found to have HPRT deficiency, genetic variation was analyzed by RT-PCR, direct sequencing, and SSCP.Only a single case proved to have partial HPRT deficiency among 12 suspicious cases. Both cDNA and genomic DNA analysis identified a new mutation on exon 2 with T to G transition at cDNA base 93, resulting in a change from aspartic acid to glutamic acid at position 31. It was designated as HPRTChia-Yi, from our case's residence at Chia-Yi Hsein, Taiwan.According to this hospital-based survey, HPRT deficiency is a rare trait in the Taiwanese gouty population. However, our index case with HPRT deficiency provided the first proven HPRT mutation in non-aboriginal Taiwanese patients with gout, which was different from a mutation previously found in aboriginal Taiwanese. Hence, in non-aboriginal Taiwanese gouty patients with HPRT deficiency, exon 2, rather than just exon 3, should be analyzed.

There are many treatment methods for lupus nephritis, including high-dose steroids, pulse methylprednisolone, and cyclophosphamide therapy. In cyclophosphamide therapy, there can be some side effects such as nausea, vomiting, and infection. We report on a case receiving a combination of high dose steroid and intravenous cyclophosphamide. Following this, she developed a fever and a protruding right eye, and septic cavernous sinus thrombosis was diagnosed. This complication had never been reported in a patient with systemic lupus erythematosus, and related literature is reviewed.