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Men with diabetic erectile dysfunction (ED) respond poorly to the currently available oral phosphodiesterase-5 inhibitors. Therefore, functional therapies for diabetic ED are needed. Stromal vascular fraction (SVF) and the adenovirus-mediated cartilage oligomeric matrix angiopoietin-1 (Ad-COMP-Ang1) gene are known to play critical roles in penile erection. We previously reported that SVF and Ad-COMP-Ang1 have only a short-term effect in restoring erectile function. Further improvements to ED therapy are needed for long-lasting effects. In the present study, we aimed to test if the combination of SVF and Ad-COMP-Ang1 could extend the erection effect in diabetic ED. We found that the combination therapy showed a long-term effect in restoring erectile function through enhanced penile endothelial and neural cell regeneration. Combination therapy with SVF and Ad-COMP-Ang1 notably restored cavernous endothelial cell numbers, pericyte numbers, endothelial cell-cell junctions, decreased cavernous endothelial cell permeability, and promoted neural regeneration for at least 4 weeks in diabetic mice. In summary, this is an initial description of the long-term effect of combination therapy with SVF and Ad-COMP-Ang1 in restoring erectile function through a dual effect on endothelial and neural cell regeneration. Such combination therapy may have therapeutic potential for the treatment of diabetic ED.

Transversus abdominis plane (TAP) block reduces opiate requirements and pain scores in abdominal surgery, but the effect has not been evaluated in hernia surgery. The aim of this study was to evaluate the efficacy of TAP block in hernia surgery.A meta-analysis of randomized clinical trials (RCTs) evaluating the effect of TAP block in adults undergoing hernia surgery was performed. The primary outcomes were morphine requirements 24 hours after surgery and the number of rescue analgesia patients. Secondary outcomes were pain scores on rest and on movement at 24 hours after surgery, postoperative nausea and vomiting and general postoperative complications.The search strategy yielded 231 articles after duplicates have been removed, and finally 8 RCTs with a total of 791 patients were included. In patients who received a TAP block, the cumulative morphine utilization was significantly reduced at 24 hours (weighted mean difference [WMD] -11.40 mg, -22.41 to -0.39; P=0.04). The number of patients needing a rescue analgesia (relative risk: 0.35, 0.22 to 0.55; P0.001), the pain scores on rest 24 hours after surgery (WMD: -0.29, -0.55 to -0.04; P=0.02) and the pain scores on movement or coughing 24 hours after surgery (WMD: -0.70, -1.33 to -0.06; P=0.03) were all lower in patients who received a TAP block. There was also significant reduction in the postoperative nausea and vomiting, and the general postoperative complications in TAP block group.Within a heterogeneous group of RCTs, TAP block reduces postoperative morphine requirements and the severity of pain after hernia surgery.

Acetylcholine (Ach) is the key anti-inflammatory transmitter in the cholinergic anti-inflammatory pathway. In this study, critically ill patients treated with early enteral nutrition (EEN) were observed to explore whether EEN affected Ach levels and inflammation.One hundred thirteen patients were included in this prospective observational study. All patients were provided the early enteral nutrition protocol 24-48 h after admission to the intensive care unit (ICU). Blood samples were collected, and the plasma levels of Ach, cholecystokinin (CCK), and inflammatory markers (tumour necrosis factor alpha (TNF-α), interleukin 1beta (IL1-β), and IL6) were measured on Days 0, 1, 3, 5, and 7. Nutritional intervention data were recorded within one week, including the number of patients receiving nutrition, the number of days nutrition was provided, the caloric intake and protein intake, feeding intolerance and prokinetic drug administration. Other collected data included the sequential organ failure assessment score (SOFA score), the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the use of mechanical ventilation (the number of patients and the duration), use of vasoactive drugs and the number of renal replacement treatments (RRT) received by each patient during their ICU stay. The primary outcome was 28-day mortality. Additionally, we analysed the correlation between plasma Ach levels and inflammation, as well as the correlation between plasma Ach and CCK levels. Moreover, a multivariate regression analysis was performed to examine the independent effects of different variables on 28-day mortality and Ach levels.The overall 28-day mortality was 28.3% (32/113). Eighty-two patients tolerated enteral nutrition. Compared with Day 0 15.6 (2.8) nmol/l, the plasma Ach level was significantly increased on Day 3 18.6 (6.7) nmol/l, Day 5 19.3 (6.2) nmol/l and Day 7 19.7 (4.3) nmol/l (p .001). Compared with Day 0176.2 (50.4) pg/ml, the plasma TNF-α level was significantly decreased on Day 3144.0 (77.4) pg/ml, Day 5127.3 (51.8) pg/ml and Day 7111.4 (42.5) pg/ml (p .05). Compared with Day 0, the plasma IL1-β level was significantly decreased on Day 7 (p .05). The plasma IL6 level was significantly decreased on Day 5 and Day 7 (p .05) compared with Day 0. Compared with Day 0, the plasma CCK level was significantly increased on Day 3, 5 and 7 (p .001). The correlation analysis revealed negative correlations between Ach levels and inflammation (p .001), and a positive correlation between CCK and Ach levels (r = 0.775, p .001). A comparison of patients who did or did not tolerate EEN revealed significant differences in the plasma levels of Ach, TNF-α, IL6 and CCK (p .05). Significant differences in plasma levels of Ach, TNF-α, IL1-β, IL6 and CCK were observed between 28-day survivors and non-survivors (p .05). The multivariate logistic regression analysis identified vasopressor support, RRT, the administration of EEN, SOFA score, APACHE II score at ICU admission and plasma Ach levels as independent determinants of 28-day mortality. Additionally, the multivariate linear regression analysis identified EEN, plasma lactate, mechanical ventilation, the SOFA score and plasma CCK levels as independent determinants of plasma Ach levels.The administration of EEN to critically ill patients contributed to the increased plasma Ach levels and decreased inflammatory markers. The effect of EEN on Ach levels is partially attributed to the increase in CCK levels. Elevated plasma Ach levels indicate a better prognosis. Clinical trials identifier: NCT03612206.

Background Acute gastrointestinal injury is associated with significantly increased mortality in critically ill patients. However, markers for measuring acute gastrointestinal injury are neither sensitive nor specific. Objective To determine whether enzymes in digestive fluid are predictive of the severity of acute gastrointestinal injury. Methods A prospective observational study was conducted between June 2015 and December 2015 in a surgical intensive care unit. Enrolled patients were classified by acute gastrointestinal injury grade according to the 2012 European Society of Intensive Care Medicine system. Digestive fluid was collected through nasointestinal tubes and analyzed 24 hours after the diagnosis of acute gastrointestinal injury. Intestinal markers of injury (pH, interleukin 6, interleukin 10, tumor necrosis factor α, and secretory immunoglobulin A) were measured in digestive fluid. Results Of the 76 patients included, acute gastrointestinal injury was grade I in 41, grade II in 20, grade III in 8, and grade IV in 7. Secretory immunoglobulin A was an independent predictor of grade III acute gastrointestinal injury. When data from patients with grades I and II injury and patients with grades III and IV injury were grouped together, analysis revealed that pH, interleukin 10, and secretory immunoglobulin A were independent predictors of acute gastrointestinal failure. Conclusions Secretory immunoglobulin A was predictive of grade III acute gastrointestinal injury. Digestive fluid markers of injury (pH, interleukin 10, and secretory immunoglobulin A) were predictors of acute gastrointestinal failure. Further study is required to determine if other markers are specific or sensitive for acute gastrointestinal injury.

The frequency modulation continuous wave (FMCW) radar algorithms are proposed for the software-defined-radio (SDR) platform to verify the range and speed estimation of the target. The measurement platform can provide the RF imperfection and the multipath channel effects to test the FMCW algorithms. Based on the measurement results via SDR instruments and RF components, it is confirmed that the FMCW algorithm can provide the reliable performance over the RF and channel effect environments.

Vehicular Ad Hoc Networks (VANETs) have attracted a lot of attention during the last decade. VANETs can not only improve driving safety, but also convenience, and support most future Intelligent Transportation System (ITS). Due to the highly dynamic network topology of VANETs, many geographic routing protocols have been proposed and use real-time traffic information as an important metric to select a reliable forwarding path. However, most of the existing works do not describe how to gather real-time traffic. They either assume this information is already available, or can query an existing traffic center. Few studies have noticed this issue but the proposed solutions only consider a small region. In this paper, we propose a Comprehensive Real-Time Traffic Map (CRT Map) to collect wide-ranging real-time traffic information with low overhead. In the design of a CRT Map, the concept of Crowdsensing is adopted. Vehicles cooperatively gather traffic information and share it with each other to construct an overview of the whole road network traffic. In addition, we design a CRT Map Based Routing (CBR), which takes into account the connectivity of consecutive roads in routing decisions. Simulation results show that the CBR can achieve a lower end-to-end delay and a higher packet delivery ratio.

Overall scheme for large-aircraft Intelligence Virtual Maintenance Training System (IVMTS) information model which integrates the Standard for the Exchange of Product model data (STEP) standard geometric model with agent model is presented in this paper. Firstly, the system multi-agent model architecture are constructed. Secondly, Integrated STEP standard geometric model with agent model and maintenance applying information, the maintenance object agent IP(intelligence part) ,IB(intelligence body) and IT(intelligence tool) are constructed utilizing the EPRESS-G language. Thirdly, the communication method between components and system level agents is presented based on Blackboard model each other. Finally, how to realize the model under catia-caa secondary development method is described, and the intelligence maintenance process simulation, maintenance of the elements of the intelligent interaction, intelligence collision detection and maintenance sequence optimization simulation can be realized in this method in IVMTS.

Background: It has been known for thousands of years that humans have meridian lines. Objective: To understand the effects of induction of Qi by acupuncture in the meridians. Design, Setting, and Patients: The study was performed in 56 healthy volunteers who were randomly selected from the university population at Chia-Nan University of Pharmacy and Science, Taiwan. Blood flow at the acupoints of Lieque (LU 7) and Chize (LU 5) of the right hand, or a nonacupuncture point chosen freely near LU 5, was recorded. Intervention: Acupuncture stimulation of a human LU 7 point for about 15 seconds, until the De Qi sensation was achieved. Main Outcome Measure: Skin blood flow detected using a laser Doppler flowmeter. Results: When LU 7 was stimulated by acupuncture, the blood flow was increased after the De Qi sensation; as long as the participant was getting the emergence of a strong De Qi feeling or feeling a flow of numbness to reach LU 5, there was a visible peak of upward LU 5 blood flow. Conclusions:...

The purpose of this study was to explore whether passive watching of a stroke videotape in the Emergency Department waiting room could be an effective method for patient education. The setting was an urban, inner city teaching hospital. After providing informed consent, subjects were randomized into two arms: those watching a 12-min educational video on stroke developed by the American Stroke Association (video group) and those not undergoing an intervention (control group). Both groups were administered a 13-question quiz covering different stroke-related issues, but only the video group received this same test again after the completion of the educational program. Those enrolled were contacted after 1 month to determine knowledge retention via the same test. Immediately after watching the educational program, participants demonstrated improved knowledge of stroke-related questions, with an increase of test scores from 6.7 +/- 2.5 to 9.5 +/- 2.6 (p0.01). Even at the 1-month follow-up, the video group had significantly higher test scores than the control group. A stroke educational videotape improves the knowledge of this dangerous disease and may be a valuable and relatively low-cost tool for focused patient education in the Emergency Department waiting room.

An InAs-GaAs quantum ring infrared photodetector has been fabricated successfully. The photodetector demonstrates a cutoff wavelength at 175 mum (1.7 THz) and the detectivity of 1.3times107 cm Hz1/2/W at 80 K. The precise control of the In(Ga)As ring height by capping GaAs layer thickness is responsible for extension of the detector response to terahertz range.

The main objective of developing an image watermarking technique is to satisfy both imperceptibility and robustness requirements. To achieve this objective, a hybrid image watermarking scheme based on discrete wavelet transform and singular value decomposition is proposed in this paper. In our approach, the edge information of an image is used to embed the watermark. In addition, we apply the particle swarm optimization algorithm to search the proper value of scaling factor which is used to determine the watermark strength. Experimental results are provided to illustrate the proposed approach is able to withstand a variety of image processing attacks.

High density interconnection is a key technology to realize the miniaturization trend in Integrated Circuit (IC) industry, and to reduce power consumption for next generation mobile devices. In advanced three-dimensional (3D) package, fine pitch pillar bump is deployed not only to fulfill ever-growing I/O density requirement, but also provides better electrical performance than that of traditionally solder bump [1]. Meanwhile, to maximize die area utilization, die sizes of top and bottom die are generally kept as close as possible, leaving stringent spacing for underfilling, and makes fillet width control and dispense space two great challenges for capillary underfill (CUF). In this paper, test vehicle of fine pitch micro-bump interconnection was achieved by thermal compression bonding (TCB) with Non-Conductive Paste (NCP). This paper addresses development of TCB process with NCP material by different TCB condition and NCP properties to show the correlation between TCB process parameter and NCP material. In order to achieve spherical bump shape, NCP gel time was studied in different bump melting time. Fillet width was studied to control the exceeding area around chip. Void was also studied for TCB parameter adjusting. Finally, reliability test was tested for NCP properties discussion.

Advances in stroke care will have the greatest effect on stroke outcome if care is delivered within a regional stroke system designed to improve both efficiency and effectiveness. The ultimate goal of stroke care is to minimize ongoing injury, emergently recanalize acute vascular occlusions, and begin secondary measures to maximize functional recovery. These efforts will provide stroke patients with the greatest opportunity for a return to previous quality of life and decrease the overall societal burden of stroke.

In order to uniformly expose Cu via, TSV wafer thinning becomes much critical contrary to conventional process. The complete wafer thinning process is expected composed of not only grinding, but also handling. This study develops advance wafer thinning process from temporary carrier bonding to carrier de-bonding that also includes grinding and backside processes. In this case, the bonded wafer thinning target is 100um for backside process. Void-free carrier bonding and bump after backside processes could be addressed. The carrier de-bonding process performs no wafer crack and residue. Moreover, whole wafer thinning process never suffers from Cu scratching. In this study, Under Bump Metallization (UBM) and bump were laid on the backside of Through Silicon Via (TSV) wafer. The wafers composed of various surface structures were carried out to bond glass carrier. The structure difference above came from various designs on UBM and bump. These designs may be backside UBM only, Redistribution Layer (RDL) + UBM, and even bumps on UBM. All the wafers were prepared through passivation patterning, sputtering, solder printing, plating and reflow. Among these processes, the wafer preparation also requires necessary passivation curing, sputtering for Cu seed deposition, and electroplating to form solder bump.

Study objective The Institute of Medicine Committee on the Future of Emergency Care in the United States Health System (2003) identified a need to enhance the research base for emergency care. As a result, a National Institutes of Health (NIH) Task Force on Research in Emergency Medicine was formed to enhance NIH support for emergency care research. Members of the NIH Task Force and academic leaders in emergency care participated in 3 Roundtable discussions to prioritize current opportunities for enhancing and conducting emergency care research. We identify key research questions essential to advancing the science of emergency care and discuss the barriers and strategies to advance research by exploring the collaboration between NIH and the emergency care community. Methods Experts from emergency medicine, neurology, psychiatry, and public health assembled to review critical areas in need of investigation, current gaps in knowledge, barriers, and opportunities. Neurologic emergencies included cerebral resuscitation, pain, stroke, syncope, traumatic brain injury, and pregnancy. Mental health topics included suicide, agitation and delirium, substances, posttraumatic stress, violence, and bereavement. Results Presentations and group discussion firmly established the need for translational research to bring basic science concepts into the clinical arena. A coordinated continuum of the health care system that ensures rapid identification and stabilization and extends through discharge is necessary to maximize overall patient outcomes. There is a paucity of well-designed, focused research on diagnostic testing, clinical decisionmaking, and treatments in the emergency setting. Barriers include the limited number of experienced researchers in emergency medicine, limited dedicated research funding, and difficulties of conducting research in chaotic emergency environments stressed by crowding and limited resources. Several themes emerged during the course of the roundtable discussion, including the need for development of (1) a research infrastructure for the rapid identification, consent, and tracking of research subjects that incorporates innovative informatics technologies, essential for future research; (2) diagnostic strategies and tools necessary to understand key populations and the process of medical decisionmaking, including the investigation of the pathobiology of symptoms and symptom-oriented therapies; (3) collaborative research networks to provide unique opportunities to form partnerships, leverage patient cohorts and clinical and financial resources, and share data; (4) formal research training programs integral for creating new knowledge and advancing the science and practice of emergency medicine; and (5) recognition that emergency care is part of an integrated system from emergency medical services dispatch to discharge. The NIH Roundtable "Opportunities to Advance Research on Neurological and Psychiatric Emergencies" created a framework to guide future emergency medicine–based research initiatives. Conclusion Emergency departments provide the portal of access to the health care system for most patients with acute neurologic and psychiatric illness. Emergency physicians and colleagues are primed to investigate neurologic and psychiatric emergencies that will directly improve the delivery of care and patient outcomes.

In this paper, frequency selective surface with random distributed resistance patches (RRDFSS) has been proposed and the effects of occupancy factor, distribution and surface resistance have been studied numerically with HFSS. The results show that occupancy factor, distribution and aggregative quantities have notable effects on absorbing properties of the proposed RRDFSS and absorbing performances could be improved greatly in wide band while using suitable surface resistance. RRDFSS can be used in composite absorbing material and be easily realized.

Emergency physicians are routinely confronted with problems associated with language barriers. It is important for emergency health care providers and the health system to strive for cultural competency when communicating with members of an increasingly diverse society. Possible solutions that can be implemented include appropriate staffing, use of new technology, and efforts to develop new kinds of ties to the community served. Linguistically specific solutions include professional interpretation, telephone interpretation, the use of multilingual staff members, the use of ad hoc interpreters, and, more recently, the use of mobile computer technology at the bedside. Each of these methods carries a specific set of advantages and disadvantages. Although professionally trained medical interpreters offer improved communication, improved patient satisfaction, and overall cost savings, they are often underutilized due to their perceived inefficiency and the inconclusive results of their effect on patient care outcomes. Ultimately, the best solution for each emergency department will vary depending on the population served and available resources. Access to the multiple interpretation options outlined above and solid support and commitment from hospital institutions are necessary to provide proper and culturally competent care for patients. Appropriate communications inclusive of interpreter services are essential for culturally and linguistically competent provider/health systems and overall improved patient care and satisfaction.

AIM: To detect multiple H pylori antibodies in serum samples of individuals who carryH pylori by protein array. METHODS: Recombinant H pylori antigens, urease B subunit (UreB), vacuolating toxin A (VacA) and cytotoxin associated gene A protein (CagA), were prepared and immobilized in matrixes on nitrocellulose membrane by robotics to bind the specific immunoglobulin G (IgG) antibodies in serum. Staphylococcus protein A (SPA) labeled by colloid gold was used to integrate the immuno-complex and gave red color signal. The scanner based on charge-coupled device (CCD) could collect the image signal and convert it into digital signal. RESULTS: When human IgG was printed on the membrane in increasing concentrations and incubated with immunogold, a linear dose response curve was obtained and the detection limit for IgG was about 0.025 ng. The cutoff values, which were defined as the mean grey level plus 3 times of standard deviation, were 27.183, 28.546 and 27.402, for anti-UreB IgG, anti-CagA IgG and anti-VacA IgG, respectively, as 400 human serum samples with negative H pylori antibodies were detected by the protein array. When 180 serum samples from patients in hospital were employed for detection of IgG against UreB, CagA and VacA, the sensitivity of the protein array was 93.4%, 95.4%, 96.0%, and the specificity was 94.8%, 94.4% and 97.5%, respectively, as compared with the results obtained by ELISA. The assay also showed high reproducibility, uniformity and stability, and the results were available within 30 min. CONCLUSION: The protein array is a very practical method for rapid detection of multiple antibodies in serum samples. It is especially useful for large scale epidemiological investigation of the infection of H pylori.

The aim of this study was to investigate the effects of a human urine preparation on the differentiation of tumor cells.The pheochromocytoma PC12 cells were used to examine the effects of a human urine preparation, CDA-2 on the induction of differentiation markers, neurofilaments, and compared with that induced by nerve growth factor (NGF). The MAPK/ERK kinase (MEK) inhibitor U0126 was used to examine the involvement of mitogen-activated protein kinase (MAPK) signaling pathway in this differentiation inducing effect.We find that CDA-2 could induce differentiation of pheochromocytoma PC12 cells, as evidenced by the markedly increased expression of neurofilaments to a level comparable to those induced by NGF. This phenomenon was accompanied by the phosphorylation of extracellular-signal-regulated kinase (ERK) and could be inhibited by the MEK inhibitor, U0126.Our results demonstrate the presence of active components in the human urine extract that can induce differentiation of PC12 cells and may involve the ERK signaling pathway. This may provide new insights for seeking novel differentiation agents and offer hope for cancer patients.

Nationally, only 2-3% of patients with acute ischemic stroke (AIS) currently receive tissue plasminogen activator (TPA). To better understand the reasons, we investigated the practice patterns, level of familiarity and acceptance of TPA for AIS among emergency physicians in New York City (NYC). Fifty-seven 911-receiving hospital emergency department directors were surveyed regarding TPA use. Of those responding, 37% had never used TPA to treat AIS. Lack of neurological support was reported by 33%. Departments with formal protocols were more likely to use TPA for AIS. In conclusion, there is considerable variation in the practice, knowledge, and attitudes regarding the use of TPA for AIS in NYC emergency departments. Improved educational efforts and institutional support may be necessary to ensure the appropriate use of TPA by emergency physicians.

Hepatitis C is a world-wide epidemic disease stemming from the hepatitis C virus (HCV). HCV is not only the pathogenic factor of hepatitis C but also plays an important role in the process of triggering and development of cirrhosis and liver cancer. There are two indicators for detecting HCV infection: one is HCV RNA which is the gene of the virus itself and the other is anti-HCV which is the antibody produced when the HCV antigen stimulates the body. The HCV antibody detection includes the detection of HCV IgG and HCV-IgM antibody. At present, EIA and the recombinant immunoblot assay (RIBA) are mainly used for detecting anti-HCV-IgG. By using the colloidal gold labeling technique to fix the structural and the non-structural domains of HCV recombinant antigen on the millipore membrane, a dot immunogold filtration assay for detecting anti-HCV-IgG was successfully established.

The enhanced optical transmission through the annular aluminum metal with different number of concentric rings arranged in a long-range periodic structure on the silicon substrate is investigated. The measured transmission spectra demonstrate that the surface plasmon modes depend sensitively on the structural parameters of the metallic rings. The degenerate (1,0), (1,1), and (2,1) Al∕Si surface plasmon modes are determined by the long periodicity of the structure. The localized modes in cavities with different length can be observed in this structure as well. These phenomena suggest that both surface plasmons and localized cavity modes are excited within super unit cell.

This paper reports the optical properties of Al∕Si structure and trilayer Ag∕SiO2∕Ag plasmonic thermal emitter with different concentric metal rings on top metal film. It is found that when the metal width is smaller than 40% of the period (=gap+metal width), the (1,0) Al∕Si surface plasmon leads to a maximum in the transmission spectra; otherwise, the opposite is observed. The dispersion relations and emission spectra of the plasmonic thermal emitters were investigated. The emission peaks are independent of the gap width and redshift as annular metal width increases. This phenomenon suggests the excitation of Fabry-Perot type resonance within cavity of Ag∕SiO2∕Ag structure. No (1,0) Ag∕SiO2 surface plasmon was observed.

(2004). THE EFFECT OF WEATHER AND AIR POLLUTION ON EMS CALLS FOR BREATHING-RELATED COMPLAINTS IN AN URBAN CITY. Prehospital Emergency Care: Vol. 8, No. 1, pp. 107-107.