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Roux-en-Y gastric bypass surgery (RYGB) is among the most effective therapies for obesity and type 2 diabetes, and intestinal adaptation is a proposed mechanism for these effects. It was hypothesized that intestinal adaptation precedes and relates to metabolic improvement in humans after RYGB.This was a prospective, longitudinal, first-in-human study of gene expression (GE) in the "Roux limb" (RL) collected surgically/endoscopically from 19 patients with and without diabetes. GE was determined by microarray across six postoperative months, including at an early postoperative (1 month ± 15 days) time point.RL GE demonstrated tissue remodeling and metabolic reprogramming, including increased glucose and amino acid use. RL GE signatures were established early, before maximal clinical response, and persisted. Distinct GE fingerprints predicted concurrent and future improvements in HbA1c and in weight. Human RL exhibited GE changes characterized by anabolic growth and shift in metabolic substrate use. Paradoxically, anabolic growth in RL appeared to contribute to the catabolic state elicited by RYGB.These data support a role for a direct effect of intestinal energy metabolism to contribute to the beneficial clinical effects of RYGB, suggesting that related pathways might be potential targets of therapeutic interest for patients with obesity with or without type 2 diabetes.

BACKGROUND Mesothelin is a cell surface glycoprotein overexpressed in 28%-58% of colorectal cancer (CRC). We hypothesized that CRC mesothelin expression contributes to peritoneal spread and that it is selectively overexpressed in those with peritoneal metastasis versus distant metastasis. METHODS This case-controlled study involved mesothelin immunohistochemistry staining of tumor specimens from patients with metastatic CRC/appendiceal cancers between 2017 and 2019. Staining reactivity was graded from trace to 4+ (low ≤1+; high >1+). Staining patterns were characterized on global (focal/patchy/diffuse) and cellular (apical/cytoplasmic) levels. Immunostaining of normal mesothelial cells served as internal control. RESULTS Thirty-one patients were identified: 11 peritoneal (study) and 20 distant metastasis (control). The control group did not include appendiceal cancers. The study group had greater proportion of high staining reactivity (55% vs. 5%; odds ratio [OR] = 20.4, 95% confidence interval [CI] 1.96-211.8). The study group had more diffuse (36% vs. 0%; OR = 22.2, 95% CI 1.1-465.3) and cytoplasmic staining patterns (73% vs. 28%; OR = 6.9, 95% CI 1.3-37.2). CONCLUSION Mesothelin expression is higher in CRC/appendiceal cancers with peritoneal metastasis than those with distant metastasis. Immunohistochemistry staining patterns suggestive of propensity towards peritoneal metastasis include diffuse and cytoplasmic staining. Mesothelin may be a potential target for novel treatments of CRC/appendiceal carcinoma with peritoneal involvement.

PURPOSE To determine the relationship among flow index (FI), uroflowmetry curve shape, and electromyography (EMG) lag time in children. MATERIALS AND METHODS A total of 294 children with lower urinary tract symptoms were included. The overall relationship between lag time and FI was investigated with curve estimation regression. Normal and primary bladder neck dysfunction was defined according to the previous classification, while patients with a lag time less than 2 seconds were grouped based on 2-second intervals. We also categorized cases into four groups (tower shaped, bell shaped, plateau shaped, and fractionated void) by FI and compared lag time. RESULTS The overall distribution chart demonstrated that FI was the highest at lag time 0 second and decreased with the change in lag time both ways. The best fitting model for maximum FI and lag time was a cubic model (R2 = .282; P 6 seconds) or delayed lag time (

BACKGROUND Data relating to the association between inflammatory bowel disease (IBD) and pregnancy outcomes are lacking in Korea. AIMS To determine the incidence rates of pregnancy outcomes in women with IBD. METHODS A nationwide population study was performed using the Korean National Health Insurance claims database. A total of 2058 women with IBD consisting of ulcerative colitis (UC, n = 1469) and Crohn's disease (CD, n = 589) were pregnant between 2007 and 2016. We compared their incidence of pregnancy outcomes with 20 580 age-matched controls without IBD. We also stratified the patients into those with quiescent to mild and moderate to severe IBD and compared the outcomes between them. RESULTS The pregnancy rate of women with IBD was lower than that of women without (25.7% vs 32.3%, P

A trivalent rare-earth ion (Sm3+ )-doped LiNa3 P2 O7 (LNPO) phosphor was synthesized using a conventional high-temperature solid-state reaction route. A predominant orthorhombic phase of LNPO was observed in all X-ray diffraction patterns. The surface states of the LNPO:Sm phosphor were confirmed by X-ray photoelectron spectroscopy. Under 401 nm excitation, the Sm-doped LNPO phosphors showed sharp emission peaks at 563, 600 and 647 nm that are related to the f-f transition of Sm3+ ions. The optimum concentration of Sm3+ (9 mol%) produced Commission Internationale de l'Eclairage chromaticity coordinates, color rendering index and correlated color temperature of (0.564, 0.434), 42 and 1843 K, respectively.

A customer journey map CJM is a widely used tool to represent user experience with a service. Although numerous companies have used this tool to improve existing services or to develop new services, the maps are neither consistent nor mutually compatible because no clear design process for a CJM has been presented. This study aimed to develop a design process and rule sets for a CJM based on a human factors approach. The 10-step process and the rule sets were built on case studies of 25 categories of mobile services. Large-scale case studies were conducted with mobile service providers and combined with the result of a user diary method that collected users' daily activities and the difficulties that the user perceived when performing a task. We suggested various methods for using the CJM to generate new service opportunities. The proposed design process and the way for opportunity discovery can help service designers to develop unified CJMs and to identify innovative service ideas.

Aim The natural history and appropriate management of anastomotic sinus has not been clearly defined. The aim of this study was to evaluate the incidence, management and outcomes of anastomotic sinus. Method The medical records of all patients who underwent a low anterior resection (LAR) or an ileal pouch– anal anastomosis (IPAA) with a diverting loop ileostomy (LI) and with contrast enema performed before planned stoma closure between 2001 and 2011 were retrospectively reviewed. The radiological features of the sinus tract, treatment and outcome of anastomotic sinus were studied. Results Twenty patients (8.2%) were found to have anastomotic sinuses out of the total of 244 patients who had undergone LAR (n = 146) or IPAA (n = 98) with LI. Of these, 13 (65%) had prior symptomatic leaks, while seven did not. Twelve patients (60%) were found to have simple sinus tracts, while eight had complex sinuses (associated with either pelvic cavities or severe strictures). Five patients with simple tracts were treated with observation alone. Fifteen patients underwent surgical interventions. Overall, with a median follow-up of 28 (6–73) months, 16 patients (80%) had resolution of their sinuses. All of 12 patients (100%) with simple sinus tracts and four of eight patients (50%) with complex sinuses underwent successful stoma reversals after 8 (3.5–24) months following the initial surgery (P = 0.01). Conclusion Patients with simple tracts are significantly more likely to have complete resolution of sinuses than patients with complex sinuses. Persistent sinus associated with either a pelvic cavity or severe stricture despite surgical intervention is likely to lead to a permanent

Objectives/Hypothesis To quantify the threshold for human perception of asymmetry for eyebrow elevation, eye closure, and smile, and to ascertain whether asymmetry detection thresholds and perceived severity of asymmetry differ in distinct facial zones. Study Design Online survey. Methods Photographs of a female volunteer performing eyebrow elevation, eye closure, and smile were digitally manipulated to introduce left-to-right asymmetry in 1-mm increments from 0 mm to 6 mm. One hundred and forty-five participants viewed these photographs using an online survey, measuring accuracy of asymmetry detection and perceived expression unnaturalness (on a scale of 1–5). Results Photographs of facial asymmetries were correctly judged as asymmetrical over 90% of the time for 2 mm or more of asymmetry in eyelid closure, and 3 mm or more of asymmetry during smiling. Identification of eyebrow elevation asymmetry gradually rose from 23% correct to 97% correct across the range of 1 mm to 6 mm of asymmetry. Greater degrees of asymmetry were ranked as significantly more unnatural across all expressions (3 tests; X2 (6, N = 145) = 405.52 to 656.27, all P

A polyimide substrate based microfluidic chip with thousands of comb-shaped microelectrodes has been designed, fabricated, and tested for sterilization of bacteria by using pulsed electric field. The performance of bacteria sterilization as functions of the electric field strength, pulse number and width, treatment buffer, bacteria growth status, and bacteria enrichment by positive dielectrophoresis has been experimentally investigated on the microfluidic chip. Experimental results show that only 100 V are sufficient to obtain good sterilization of Escherichia coli. Higher electric field strength, bacteria enrichment by positive dielectrophoresis, longer pulse time, buffer with fewer components and nutritions, and suitable bacteria growth status also improve the sterilization of bacteria. In addition, configuration of the microelectrode array affects bacteria sterilization. This microfluidic device allows one to preconcentrate bacteria to a region with high electric field strength by using positive dielectrophoresis, and subsequently kill the enriched bacteria by applying a pulsed electric field through the same microelectrode array.

In the next-generation nanopore-based DNA sequencing technique, the DNA nanoparticles are electrophoretically driven through a nanopore by an external electric field, and the ionic current through the nanopore is simultaneously altered and recorded during the DNA translocation process. The change in the ionic current through the nanopore as the DNA molecule passes through the nanopore represents a direct reading of the DNA sequence. Due to the large mismatch of the cross-sectional areas of the nanopore and the microfluidic reservoirs, the electric field inside the nanopore is significantly higher than that in the fluid reservoirs. This results in high-speed DNA translocation through the nanopore and consequently low read-out accuracy on the DNA sequences. Slowing down DNA translocation through the nanopore thus is one of the challenges in the nanopore-based DNA sequencing technique. Slowing down DNA translocation by lowering the fluid temperature is theoretically investigated for the first time using a continuum model, composed of the coupled Poisson-Nernst-Planck equations for the ionic mass transport and the Navier-Stokes equations for the hydrodynamic field. The results qualitatively agree with the existing experimental results. Lowering the fluid temperature from 25 to 0°C reduces the translocation speed by a magnitude of about 6.21 to 2.50 mm/sK (i.e. 49.82 to 49.71%) for the salt concentration at 200 and 2000 mM, respectively, improving the read-out accuracy considerably. As the fluid temperature decreases, the magnitude of the ionic current signal decreases (increases) when the salt concentration is high (sufficiently low).

A novel cell electrofusion microfluidic chip using discrete coplanar vertical sidewall electrodes has been designed, fabricated, and tested. The device contains a serpentine-shaped microchannel with 22 500 pairs of vertical sidewall microelectrodes patterned on two opposing vertical sidewalls of the microchannel. The adjacent microelectrodes on each sidewall are separated by coplanar SiO(2) -Polysilicon-SiO(2) /silicon. This design of coplanar discrete vertical sidewall electrodes eliminates the "dead area" present in previous designs using continuous three-dimensional (3D) protruding sidewall electrodes, and generates uniform electric field along the height of the microchannel, leading to a lower voltage required for cell fusion compared to designs using 2D thin-film electrodes. This device is tested to fuse NIH3T3 cells under a low voltage (∼9 V). Almost 100% cells are aligned to the edge of the discrete microelectrodes, and cell-cell pairing efficiency reaches 70%. The electrofusion efficiency is above 40% of the total cells loaded into the device, which is much higher than traditional fusion methods and existing microfluidic devices using continuous 3D protruding sidewall microelectrodes.

As many new cosmetic products are introduced into the market, attention must be given to contact dermatitis, which is commonly caused by cosmetics. We investigate the prevalence of preservative allergy in 584 patients with suspected cosmetic contact dermatitis at 11 different hospitals. From January 2010 to March 2011, 584 patients at 11 hospital dermatology departments presented with cosmetic contact dermatitis symptoms. These patients were patch-tested for preservative allergens. An irritancy patch test performed on 30 control subjects using allergens of various concentrations showed high irritancy rates. Preservative hypersensitivity was detected in 41.1% of patients. Allergens with the highest positive test rates were benzalkonium chloride (12.1%), thimerosal (9.9%) and methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) (5.5%). Benzalkonium chloride and chlorphenesin had the highest irritancy rate based on an irritancy patch test performed using various concentrations. Seven of 30 normal subjects had a positive irritant patch reading with 0.1% benzalkonium chloride and eight of 30 normal subjects had a positive irritant patch reading at 4 days with 0.5% chlorphenesin in petrolatum. Although benzalkonium chloride was highly positive for skin reactions in our study, most reactions were probably irritation. MCI/MI and thimerosal showed highly positive allergy reactions in our study. The optimum concentration of chlorphenesin to avoid skin reactions is less than 0.5%.

We consider the stability of a thin liquid film with a free charged surface resting on a solid charged substrate by performing a general Orr-Sommerfeld (O-S) analysis complemented by a long-wave (LW) analysis. An externally applied field generates an electroosmotic flow (EOF) near the solid substrate and an electrophoretic flow (EPF) at the free surface. The EPF retards the EOF when both the surfaces have the same sign of the potential and can even lead to the flow reversal in a part of the film. In conjunction with the hydrodynamic stress, the Maxwell stress is also considered in the problem formulation. The electrokinetic potential at the liquid-air and solid-liquid interfaces is modelled by the Poisson-Boltzmann equation with the Debye-Hückel approximation. The O-S analysis shows a finite-wavenumber shear mode of instability when the inertial forces are strong and an LW interfacial mode of instability in the regime where the viscous force dominates. Interestingly, both the modes are found to form beyond a critical flow rate. The shear (interfacial) mode is found to be dominant when the film is thick (thin), the electric field applied is strong (weak), and the zeta-potentials on the liquid-air and solid-liquid interfaces are high (small). The LW analysis predicts the presence of the interfacial mode, but fails to capture the shear mode. The change in the propagation direction of the interfacial mode with the zeta-potential is predicted by both O-S and LW analyses. The parametric range in which the LW analysis is valid is thus demonstrated.

Aim: There has been limited data on capecitabine monotherapy in metastatic colorectal cancer (CRC) patients who were previously treated with both oxaliplatin/5-fluorouracil(FU)/leucovorin (FOLFOX) and irinotecan/5-FU/leucovorin (FOLFIRI). Methods: We analyzed 20 patients between August 2002 and March 2008 with metastatic CRC who had been treated with capecitabine monotherapy after the failure of FOLFOX and FOLFIRI. Results: Overall, one partial response was observed (overall response rate, 5%) and stable disease was observed in 11 patients (55.0%). The disease control rate was 60.0%. The median progression-free survival (PFS) was 2.3 months (95% CI 1.9–2.7) and the median overall survival (OS) was 5.3 months (95% CI 4.6–6.0). Patients without ascites had longer PFS than those with ascites (P = 0.02). Patients with more than three metastatic sites had poorer OS than those with less than two (P = 0.01). Grade 3 or 4 non-hematological toxicities included hand–foot syndrome in one patient. There were no grade 3 or 4 hematological toxicities or treatment-related deaths. Conclusion: The capecitabine monotherapy had a moderate disease control rate and a tolerable toxicity profile as third-line or fourth-line treatment for metastatic CRC patients who were refractory to standard chemotherapy with no further treatment options.

The translation of a charged, elongated cylindrical nanoparticle along the axis of a nanopore driven by an imposed axial salt concentration gradient is investigated using a continuum theory, which consists of the ionic mass conservation equations for the ionic concentrations, the Poisson equation for the electric potential in the solution, and the modified Stokes equations for the hydrodynamic field. The diffusiophoretic motion is driven by the induced electrophoresis and chemiphoresis. The former is driven by the generated overall electric field arising from the difference in the ionic diffusivities and the double layer polarization, while the latter is generated by the induced osmotic pressure gradient around the charged particle. The induced diffusiophoretic motion is investigated as functions of the imposed salt concentration gradient, the ratio of the particle's radius to the double layer thickness, the cylinder's aspect ratio (length/radius), the ratio of the nanopore size to the particle size, the surface charge densities of the nanoparticle and the nanopore, and the type of the salt used. The induced diffusiophoretic motion of a nanorod in an uncharged nanopore is mainly governed by the induced electrophoresis, driven by the induced electric field arising from the double layer polarization. The induced particle motion is driven by the induced electroosmotic flow, if the charges of the nanorod and nanopore wall have the same sign.

Objective There are a limited number of studies describing the role of minimally invasive colectomy for urgent or emergent conditions of the large bowel. We hypothesize that laparoscopic colectomy in urgent and emergent setting can be performed safely in select settings. Method A cohort of patients treated at a single institution from 2001 to 2006 was identified from a prospective database. Patients who underwent open or minimally invasive surgery (MIS), including laparoscopic (LAP) or hand-assisted laparoscopic surgery (HALS) colectomy for urgent and emergent conditions were included. Results A total of 68 [open 32, MIS 36 [HALS 22, LAP 14)] patients underwent urgent or emergent colectomy on our colorectal service during the 5-year time period. Patients with toxic colitis were more often selected for MIS. Patients with colon perforation or large bowel obstruction were more often selected for open surgery. The MIS group had a lower body mass index (BMI), lower American Society of Anesthesiologists fitness grade and was more likely to have been immunosuppressed. There was no difference in patient morbidity between the open and MIS groups. The MIS group had a longer median operative time and fewer cases of prolonged hospitalization. Conclusion We conclude that minimally invasive colectomy by experienced surgeons appears to be safe and effective for appropriately selected patients with emergent and urgent conditions of the large bowel.

Introduction: We compared outcomes of elderly patients (>70 years) who underwent the Altemeier procedure versus laparoscopic rectopexy for full-thickness rectal prolapse. Materials and Methods: We reviewed our data from a prospective database and the medical records of patients treated at a single institution from 2002 to 2008. Patients who underwent surgery for full-thickness rectal prolapse were evaluated. Results: Sixteen patients underwent laparoscopic rectopexy (median age 82 years; ASA 2.6), and 16 patients underwent the Altemeier procedure (median age 85 years; ASA 2.8). The Altemeier procedure patients had a significantly higher recurrence rate when compared to laparoscopic rectopexy patients (P

Mounting evidence indicates that deregulation of microRNAs (miRNAs) are involved in development of many human diseases, including cancers. Regulation of miRNA is a complicated process and some components in the regulation are known to be altered in human cancers. Among the miRNA regulation-related genes, we found that AGO1, AGO2, TNRC6A, TNRC6C, TARBP2 and EXPORTIN5 genes have mononucleotide repeats in their coding sequences. To see whether these genes are mutated in cancers with microsatellite instability (MSI), we analysed the mononucleotide repeats in 27 gastric cancers (GCs) with high MSI (MSI-H), 18 GC with low MSI (MSI-L), 45 GC with stable MSI (MSS), 41 colorectal cancers (CRCs) with MSI-H, 14 CRCs with MSI-L and 45 CRCs with stable MSI (MSS) by single-strand conformation polymorphism (SSCP) analysis and DNA sequencing. We found AGO2, TNRC6A, TARBP2, TNRC6C and EXPORTIN5 mutations in 10, six, one, one and one cancer(s), respectively. They were detected in MSI-H but not in MSI-L or MSS cancers. The GCs and CRCs with MSI-H harboured one or more mutations of the genes in 22% and 27%, respectively. We also analysed Ago2 and TNRC6A protein expressions in GCs and CRCs with MSI-H. In cancers with MSI-H, loss of Ago2 expression was observed in 40% of GCs and 35% of CRCs, while loss of TNRC6A was observed in 52% of the GCs and 54% of the CRCs. Our data indicate that frameshift mutations in AGO2 and TNRC6A and their losses of expression are common in GCs and CRCs with MSI-H, and suggest that these alterations may contribute to the cancer development by deregulating miRNA regulation. Copyright © 2010 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

An effective stacked memory concept utilizing all-oxide-based device components for future high-density nonvolatile stacked structure data storage is developed. GaInZnO (GIZO) thin-film transistors, grown at room temperature, are integrated with one-diode (CuO/InZnO)–one-resistor (NiO) (1D–1R) structure oxide storage node elements, fabricated at room temperature. The low growth temperatures and fabrication methods introduced in this paper allow the demonstration of a stackable memory array as well as integrated device characteristics. Benefits provided by low-temperature processes are demonstrated by fabrication of working devices over glass substrates. Here, the device characteristics of each individual component as well as the characteristics of a combined select transistor with a 1D–1R cell are reported. X-ray photoelectron spectroscopy analysis of a NiO resistance layer deposited by sputter and atomic layer deposition confirms the importance of metallic Ni content in NiO for bi-stable resistance switching. The GIZO transistor shows a field-effect mobility of 30 cm2 V−1 s−1, a Vth of +1.2 V, and a drain current on/off ratio of up to 108, while the CuO/InZnO heterojunction oxide diode has forward current densities of 2 × 104 A cm−2. Both of these materials show the performance of state-of-the-art oxide devices.

Lysophosphatidylcholine induces expression of adhesion molecules; however, the underlying molecular mechanisms of this are not well elucidated. In this study, the intracellular signaling by which lysophosphatidylcholine upregulates vascular cell adhesion molecule-1 and P-selectin was delineated using YPEN-1 and HEK293T cells. The results showed that lysophosphatidylcholine dose-dependently induced expression of vascular cell adhesion molecule-1 and P-selectin, accompanied by the activation of transcription factor nuclear factor kappaB. However, the nuclear factor kappaB inhibitor caffeic acid phenethyl ester (CAPE) and the antioxidant N-acetylcysteine only partially blocked lysophosphatidylcholine-induced adhesion molecules. Subsequently, we found that the lysophosphatidylcholine receptor G protein-coupled receptor 4 (GPK4) was expressed in YPEN-1 cells and triggered the cAMP/protein kinase A/cAMP response element-binding protein pathway, resulting in upregulation of adhesion molecules. Further evidence showed that overexpression of human GPK4 enhanced lysophosphatidylcholine-induced expression of adhesion molecules in YPEN-1 cells, and enabled HEK293T cells to express adhesion molecules in response to lysophosphatidylcholine. In conclusion, the current study suggested two pathways by which lysophosphatidylcholine regulates the expression of adhesion molecules, the lysophosphatidylcholine/nuclear factor-kappaB/adhesion molecule and lysophosphatidylcholine/GPK4/cAMP/protein kinase A/cAMP response element-binding protein/adhesion molecule pathways, emphasizing the importance of the lysophosphatidylcholine receptor in regulating endothelial cell function.

OBJECTIVES: To evaluate the clinical and biochemical characteristics of middle ear effusion (MEE) that affect distortion product otoacoustic emissions (DPOAE) responsiveness and to investigate the possible role of DPOAE as a tool to know the characteristics of MEE preoperatively.STUDY DESIGN AND SETTING: Prospective analysis of children with MEE effusion in a tertiary referral center. DPOAE results were compared with other audiologic tests, the character, amount of MEE, the amount of total protein, and TNF-α in the effusion.RESULTS: The negative DPOAE with MEE group had much more thick mucous fluid in their middle ears than that of positive DPOAE with MEE group. The levels of total protein and TNF-α in MEE were significantly higher in the negative DPOAE group than those of the positive DPOAE group (P < 0.01).CONCLUSIONS AND SIGNIFICANCE: The measurement of DPOAE in the children with MEE may predict the amount and the characteristics of MEE, which may help to decide the treatment methods.© 2007 American Ac...