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The 1997/1998 El Niño event caused mass coral bleaching and mortality in many tropical and subtropical regions, including corals on Green Island, Taiwan, in the northwestern Pacific Ocean. This study analyzed coral carbon isotope ratios (δ 13 C), oxygen isotope ratios (δ 18 O), and Sr/Ca ratios for 29 years, including the 1997/1998 El Niño period, to examine how high water temperature events are recorded in coral geochemical indicators. Sr/Ca ratios in coral skeletons from Green Island show the lowest peak, means the highest temperature during the 1997/1998 El Niño period. However, we couldn't observe high-temperature events on δ 18 O. Furthermore, a negative δ 13 C shift was observed after El Niño events. The regime shift of δ 13 C might have been caused by temporal bleaching and/or a decrease in symbiotic algae due to high water temperature stress under the continuous decrease in δ 13 C in DIC due to the Suess effect., (© 2024. The Author(s).)

Sea level rise and climate change are shaping present societies, particularly those on oceanic islands. Few historical examples could serve as references for these changes. One such potential model is the Saudeleur Dynasty with its capital Nan Madol on the Pacific Island of Pohnpei. However, the timing of its construction, as well as the dynasty's fluctuations and potential environmental influences, has remained unresolved. Through the analyses of 230 Th ages on 171 dates on corals fragments used as building materials and charcoal 14 C ages from excavations, 2 major construction phases spanning from the 10th to the 15th century CE can be discerned. The results show that the first phase of the site's construction, spanning the 10th-12th century, marked the dynasty's rise. The second period, spanning from the late 12th to the early 15th century, provides the most substantial evidence for the demise of the island-scale chiefdom and a significant societal reorganization. The phases are centuries earlier than previously believed. With this new evidence, we propose the hypothesis that variations in the El Niño-Southern Oscillation and subsidence-related sea level rise presented major challenges for building and maintaining Nan Madol, and thus, influenced the course of the island's history. This case serves as a compelling example of how adverse climatic conditions can spur investments-in this case, in seawater defense under high sea levels-yet ultimately may contribute to abandonment. It offers lessons for island nations, showcasing coastal resilience in the face of worsening catastrophic events that unfolded over generations., (© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences.)

A cross-sectional study was conducted on the 12th month of using the voice nursing and health education system. Work sampling method was used to observe for 120 hours, and 39 satisfaction questionnaires were collected. The results showed that the usage rate of voice health education system accounted for 14.3% of nursing guidance tools. Pearson analysis showed that user satisfaction and usage efficiency had the greatest impact (p < .001). When the system's ease of operation and stability meet expectations, the care guidance process can be improved.

Competing Interests: Competing interests statement:The authors declare no competing interest.

Abstract: During interventional procedures of endovascular abdominal aortic aneurysm repair (EVAR), the dosimeter was conventionally placed on chest facing toward the surgical table, instead of the main source of scatter radiation. Purpose of this study is to evaluate the underestimation of occupational radiation exposure. Phantom experiments were performed in a hybrid operating room equipped with an interventional angiography system. Electric personal dosimeters were placed at the level of eyes, chest, abdomen, and gonad of three positions, representing the principal operator (PO), assistant operator (AO), and sterile nurse (SN). Personal dose equivalent was measured with two different orientations of radiation detection, facing the table and facing the phantom, respectively. In addition to fluoroscopy, the dose produced by digital subtraction angiography was also measured to estimate the radiation exposure of routine EVAR. In this study, staff doses of 26 EVAR cases were also collected in our hospital to correlate the estimated dose. Our results show that the facing-phantom dose normalized by dose area product of patient is significantly higher than the facing-table dose when the latter is regularly seen in clinical practice. This underestimation could be even worse at a more distant position (e.g., AO and SN) as the incident angle of scatter radiation is larger. Besides, the estimated dose is highly correlated with the on-site measured dose (R 2 ~ 0.8) at chest and gonad of the PO., (Copyright © 2023 Health Physics Society.)

The intertropical convergence zone (ITCZ) plays a key role in regulating tropical hydroclimate and global water cycle through changes in its convection strength, latitudinal position, and width. The long-term variability of the ITCZ, along with the corresponding driving mechanisms, however, remains obscure, mainly because it is difficult to separate different ITCZ variables in paleoclimate proxy records. Here, we report a speleothem oxygen isotope (δ 18 O) record from southwestern Sulawesi, Indonesia, and compile it with other speleothem records from the Maritime Continent. Using the spatial gradient of speleothem δ 18 O along a transect across the ITCZ, we constrain ITCZ variabilities over the Maritime Continent during the past 30,000 y. We find that ITCZ convection strength overall intensified from the last glacial period to the Holocene, following changes in climate boundary conditions. The mean position of the regional ITCZ has moved latitudinally no more than 3° in the past 30,000 y, consistent with the deduction from the atmospheric energy framework. However, different from modern observations and model simulations for future warming, the ITCZ appeared narrower during both the late Holocene and most part of the last glacial period, and its expansion occurred during Heinrich stadials and the early-to-mid Holocene. We also find that during the last glacial and deglacial period, prominent millennial-scale ITCZ changes were closely tied to the variability of the Atlantic meridional overturning circulation (AMOC), whereas during the Holocene, they were predominantly modulated by the long-term variability of the Walker circulation.

The Mekong River Delta (MRD) is an essential agricultural area for the worldwide rice supply. Floods and droughts triggered by El Niño southern oscillation (ENSO) have been threatening sustenance in the MRD. Sustainable food supplies require understanding the response of the MRD hydrology to the changing ENSO behaviour in recent decades. Here, we reconstructed the annual rainfall maxima in the MRD using the oceanic paleoclimate proxy from coral skeletons and compared them with ENSO indexes. Annual minima of coral-based seawater oxygen isotope (δ 18 O sw ) correlated with annual rainfall maxima, which allowed to extend rainfall data from 1924 to the recent. The annual rainfall maxima based on δ 18 O sw negatively correlated with the central Pacific El Niño index. This suggested that La Niña and central Pacific El Niño events lead to heavy and light rainy seasons. The heavy rainy season had more serious impacts in recent decades, which likely increases the flood risk. In contrast, the frequency and rainfall amount of the light rainy season has not changed significantly, although a catastrophic drought has hit the MRD. Our finding concludes that the impact of the ENSO event on MRD hydrology is inconsistent in the past century., (© 2022. The Author(s).)

In humans, excessive bleeding during civilian accidents, and surgery account for 40% of the mortality worldwide. Hence, the development of biocompatible hemostatic materials useful for rapid hemorrhage control has become a fundamental research problem in the biomedicine community. In this study, we prepared biocompatible gelatin-tannic acid-κ-carrageenan (GTC) microparticles using a facile Tween 80 stabilized water-in-oil (W/O) emulsion method for rapid hemostasis. The formation of GTC microparticles occurs via polyelectrolyte interactions between gelatin and k-carrageenan as well as hydrogen bonding from tannic acid. In addition, the GTC microparticles formulated in our study showed high water adsorption ability with a low volume-swelling ratio for a particle size of 46 μm. In addition, the GTC microparticles displayed >80% biocompatibility in NIH 3T3 cells and <5% hemocompatibility in hemolysis ratio tests. Notably, the GTC microparticles induced rapid blood clotting in 50 s and blood loss of approximately 46 mg in the femoral artery of BALB/c female mice with a 100% survival rate that was significantly better than the control group (blood clot time:250 s; blood loss: 259 mg). Thus, the findings from our study collectively suggest that GTC microparticles may play a promising clinical role in medical applications to tackle hemorrhage control., (Copyright © 2021 Elsevier B.V. All rights reserved.)

A new analytical method has been developed to determine atomic 236 U/ 238 U ratios in samples with only femtograms of 236 U using a secondary electron multiplier (SEM) on a multicollector high-resolution inductively coupled plasma mass spectrometer (MC-ICPMS). The abundance sensitivity of the 238 U tail at 236 atomic mass unit is reduced from 10 -6 to 10 -10 with the deployment of a retarding potential quadrupole lens. This method features the reduction of polyatomic interferences from hydride, nitride, lead, and plutonium and the evaluation of nonlinear SEM behavior. The instrument sensitivity is 1-2%, and the estimated methodological detection limit of the 236 U/ 238 U atomic ratio is as low as 2 × 10 -10 . Measurements on reference materials with 236 U/ 238 U ratios of 10 -7 -10 -9 , including the IRMM-075 series and the ETH Zurich in-house standard ZUTRI, demonstrate the accuracy of our MC-ICPMS technique. The analytical precisions (2σ) are ±4% for 5 fg of 236 U at a 236 U/ 238 U of 1 × 10 -8 and ±8% for 2 fg of 236 U at a 236 U/ 238 U of 4 × 10 -9 level. Compared to state-of-the-art accelerator mass spectrometry techniques and triple quadrupole-based ICPMS, our detection limit is not as low, but the required sample size is 3-40 times lower, and the throughput is as high as 3-4 samples per hour. The new MC-ICPMS-SEM technique is sensitive enough for determining 236 U/ 238 U in various small natural samples, such as marine carbonates and seawater.

Comprehensive comparison of paleoclimate change based on records constrained by precise chronology and high-resolution is essential to explore the correlation and interaction within earth climate systems. Here, we propose a new stalagmite-based multidecadal resolved Asian summer monsoon (ASM) record spanning the past thirty-seven thousand years (ka BP, before AD 1950) from Furong Cave, southwestern China. This record is consistent with the published Chinese stalagmite sequences and shows that the dominant controls of the ASM dynamics include not only insolation and solar activity but also suborbital-scale hydroclimate events in the high latitudes of the northern hemisphere, such as the Heinrich events, Bølling-Allerød (BA), and Younger Dryas (YD). Benefit from the unprecedented accurate chronology, the timings of these events are precisely dated, with uncertainties of, at most, 40 years (2σ). The onset of the weak ASM during the YD began at 12.92 ka BP and lasted for 430 years. The occurrence of the 200-yr Older Dryas during the BA period was dated from 13.87 to 14.06 ka BP. The durations of the three Heinrich (H) events, H1, H2, and H3, are 14.33-18.29, 23.77-24.48, and 28.98-30.46 ka BP, respectively. Furong record shows surprisingly variable onset transitions of 980, 210, and 40 years for the corresponding weak ASM events. These discrepancies suggest different influences of the H events on ASM dynamics. During the periods of H 1-3, the obvious difference between our Furong record and NGRIP δ 18 O record indicated the decoupling correlation between the mid-low latitudes and high latitudes. On the other hand, synchronous climate change in high and low latitudes suggests another possibility which different to the dominant role of Northern high latitudes in triggering global climate change. Our high quality records also indicate a plausible different correlation between the high and mid-low latitudes under glacial and inter-glacial background, especially for the ASM regimes.

Background: The purpose of this work was to evaluate orthopedic surgeons' exposure to occupational radiation doses from scattering using a mobile flat panel C-arm X-ray machine at different standing positions during an intraoperative pedicle screw implantation., Objective: Evaluate the radiation dose received by medical staff, by applying flat X-ray machine in surgical room during an intraoperative pedicle screw implantation., Methods: A mobile flat-panel C-arm X-ray machine at a dedicated orthopedic operating room was used to image an anthropomorphic female phantom which was set in a prone position on the operating table. The X-ray was projected horizontally, and 1 minute continuous fluoroscopy was used for lumbar spine and thoracolumbar spine during pedicle screw implantation. Scattering radiation doses to orthopedic surgeons were measured at different standing positions and body heights (50, 100, 150 cm above the ground) with and without limited collimations., Results: The dose area product (DAP) in this experiment is normalized as 343 μGy⋅m2. In the four areas, the lowest scattered radiation measured by DF is 11.2 vs. 0.7 μSv, outside and inside the lead suit, respectively, with or without restricted field, 150 cm above the ground, and the lowest scattered radiation dose inside the lead suit. It is 1.3 vs. 0.5 μSv. Comparing the highest dose of the TF at with the lowest dose of the DF, the average result is 73.7 vs. 11.1 μSv, P< 0.05., Conclusions: Using a mobile flat-panel C-arm X-ray machine during a pedicle screw implantation, the minimum scattering radiation to surgeons was found to be at the terminal DF area based on the analysis of the scattering doses orthopedic surgeons were exposed to.

Purpose: To evaluate the effective doses received by donors and recipients, identify effective dose contributions, and make risk assessments., Materials and Methods: It was a retrospective study. 100 Donors and 100 recipients were enrolled with an operative day from March 2016 to August 2017. The dose was analyzed for all radiation-related examinations over a period of 2 years, 1 year before and 1 year after the LDLT procedure. The effective doses of plain X-rays, CT, fluoroscopy, and nuclear medicine per patient were simulated by a Monte Carlo software, evaluated by the dose-length product conversion factors, evaluated by the dose-area product conversion factors, and evaluated by the activity conversion factors, respectively. The risks of radiation-induced cancer were assessed on the basis of the ICRP risk model., Results: The median effective doses were 71 (range: 30-186) mSv for donors and 147 (32-423) mSv for recipients. The radiation examinations were mainly performed in the last three months of preoperative period to first month of postoperative period for recipients and donors. The HCC recipients received a higher effective dose, 195 (64-423) mSv, than those with other indications. The median radiation-induced cancer risk was 0.38 % in male and 0.48 % in female donors and was 0.50 % in male and 0.58 % in female recipients., Conclusion: Donors and recipients received a large effective dose, mainly from the CT scans. To reduce effective doses should be included in future challenges in some living donor liver transplants centers that often use CT examinations., Competing Interests: Declaration of Competing Interest This study was supported by a grant from Nuclear Technology Cooperative Research, Ministry of Science and Technology (MOST), Taiwan (MOST106−2623-E-040−001-NU). Hsien-Wen Chiang and Tou-Rong Chen report receipt of a grant from Nuclear Technology Cooperative Research, Ministry of Science and Technology, Taiwan. No other disclosures were reported. The MOST had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication., (Copyright © 2020 Elsevier B.V. All rights reserved.)

While Asian monsoon (AM) changes have been clearly captured in Chinese speleothem oxygen isotope (δ 18 O) records, the lack of glacial-interglacial variability in the records remains puzzling. Here, we report speleothem δ 18 O records from three locations along the trajectory of the Indian summer monsoon (ISM), a major branch of the AM, and characterize AM rainfall over the past 180,000 years. We have found that the records close to the monsoon moisture source show large glacial-interglacial variability, which then decreases landward. These changes likely reflect a stronger oxygen isotope fractionation associated with progressive rainout of AM moisture during glacial periods, possibly due to a larger temperature gradient and suppressed plant transpiration. We term this effect, which counteracts the forcing of glacial boundary conditions, the moisture transport pathway effect., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).)

Background: The air kerma radiation doses have gained much attention since the operating room interventional radiology is a place where medical staff are exposed to a fluoroscopy environment and gain a cumulative dose during the uterine artery embolization procedure., Objective: We aimed to evaluate the radiation dose received by medical staff by applying a flat X-ray machine in the surgical room during uterine artery embolization., Methods: An ATOM humanoid model was laid on the operating table and simulated a patient. The scattered radiation dose received by the radiologist, anesthetist and radiologic technologist was evaluated. The scintillation detector was adopted. The measurement points were 50 cm, 100 cm and 150 cm above the floor, representing the limbs, abdomen and thyroid level, respectively. We compared the X-rays under different tube voltages of 70, 80, and 90, respectively and frames per second (FPS) of 30, 15, and 7.5, respectively. We configured the dose level per pulse of 40 nGy with a fixed detector., Results: In Section 1, when the tube voltage was 70 kVp and 7.5 FPS, the average radiation doses of limbs, abdomen and thyroid level was 0.48, 1.3 and 1.9 μSv/min respectively. When the tube voltage was 80 kVp and the fluoroscopy decreases from 30 FPS to 7.5 FPS, 58% of the radiation dose was reduced. When the tube voltage was 90 kVp, the radiation dose in the lead garment increased 31-177% in comparison to when the tube voltage was 80 kVp. Sections 2 and 3 were far away from the central ray, so the highest radiation dose 100 cm above the floor were 0.05 and 0.02 μSv/min., Conclusions: Lead garment can effectively reduce medical staff from occupational doses with an average attenuation rate of 90%. 80 kVp was most commonly used. Fluoroscopy 7.5 FPS was used 100 cm above the floor in A section and the lowest radiation dose was 1.33 μSv/min. The operator should decrease the duration of X-rays or adopt suspended lead shielding to decrease the radiation dose received by the operator. When kVp increases, the penetration increases. Decreasing FPS cannot decrease occupational doses of medical staff.

Background: Aromatherapy is a treatment method that applies fragrant extracts from herbal plants, existed long ago in medical history as a major treatment approach and now used as an auxiliary treatment and sometimes a major treatment for pain and stress management, including those that occur in labour., Aim: We aimed to conduct a meta-analysis of randomised controlled trials of the effectiveness of aromatherapy on labour pain and duration reduction., Methods: We searched the Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar and Clinicaltrials.gov for randomised controlled trials investigating the effectiveness of aromatherapy on labour pain and duration., Results: A total of 17 trials with low-risk labouring women were included for meta-analysis using the Review Manager 5.3. Meta-analyses showed that aromatherapy reduced labour pain in the transition phase and the duration of active phase and third stage labour; a trend toward shortened duration was observed in the second stage. Also, aromatherapy had no influences on emergency caesarean section, membrane rupture, and spontaneous labour onset., Conclusion: Our findings suggest that aromatherapy is effective in reducing labour pain and duration, and generally safe to the mothers. However, due to the heterogeneity across trials in some of the outcomes, further trials with device-based pain measurements, larger sample size, and more stringent design, should be conducted before strong recommendation., (Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the effectiveness of an automatic, personalized exposure prescription method designed to reduce radiation dose during radiography examinations., Methods: Using standard imaging parameters of average-sized patients, the authors measured individual body-part thicknesses or imaging regions of 116 patients (69 men, 47 women) and calculated each patient's exposure amount according to the thickness of the part or region. The data were used to develop each patient's personalized exposure prescription. Using the personalized exposure prescriptions, authors acquired chest images of the patients on a Carestream DRX-Revolution mobile digital radiography system., Results: All images acquired using the personalized exposure prescription method were satisfactory for diagnosis; exposure indexes were above 1300, a figure deemed acceptable for diagnosis by the manufacturer. The personalized exposure method reduced the amount of radiation each patient received., Discussion: Variation of tube voltage alone can control patients' exposure levels; however, using the personalized exposure prescription method eliminates the need to use automatic exposure controls., Conclusion: The personalized exposure prescription method is an effective tool for reducing radiation to patients during radiography as well as for eliminating dose creep., (©2018 American Society of Radiologic Technologists.)

Reconstructing the history of tropical hydroclimates has been difficult, particularly for the Amazon basin-one of Earth's major centres of deep atmospheric convection. For example, whether the Amazon basin was substantially drier or remained wet during glacial times has been controversial, largely because most study sites have been located on the periphery of the basin, and because interpretations can be complicated by sediment preservation, uncertainties in chronology, and topographical setting. Here we show that rainfall in the basin responds closely to changes in glacial boundary conditions in terms of temperature and atmospheric concentrations of carbon dioxide. Our results are based on a decadally resolved, uranium/thorium-dated, oxygen isotopic record for much of the past 45,000 years, obtained using speleothems from Paraíso Cave in eastern Amazonia; we interpret the record as being broadly related to precipitation. Relative to modern levels, precipitation in the region was about 58% during the Last Glacial Maximum (around 21,000 years ago) and 142% during the mid-Holocene epoch (about 6,000 years ago). We find that, as compared with cave records from the western edge of the lowlands, the Amazon was widely drier during the last glacial period, with much less recycling of water and probably reduced plant transpiration, although the rainforest persisted throughout this time.

Objective: The purpose of this study is to evaluate the accuracy rate of the one breath-hold single voxel hydrogen-1 magnetic resonance spectroscopy (MRS) in comparison with intraoperative biopsy for liver fat quantification in living-donor liver transplantation., Materials and Methods: A total of 80 living liver donors participated in this study. Each patient underwent both MRS and intraoperative biopsy for evaluation of liver fatty content. MRS was performed using 1.5-T magnetic resonance imaging and placed in segments 2-4, 5-8, and left lateral segment for each donor. Accuracy was assessed through receiver operating characteristic curve analysis. Sensitivity and specificity of MRS fat fractions were also calculated., Results: Eighty living-donor liver transplantation donors were enrolled in this study. There was no fatty liver in 59 subjects (73.8%), 5% to 10% fatty liver in 17 subjects, 11% to 15% fatty liver in 3 subjects, and >16% fatty liver in 1 subject. MRS fat fraction showed excellent parameters to predict between normal liver and fatty liver groups (1.85% ± 0.98, 8.13% ± 3.52, respectively; P < .0001). Linear regression between MRS fat fraction and pathology grading showed high correlation (R(2) = 0.7092). Pearson correlation revealed high correlation between MRS and pathology results (r = 0.936), poor correlation between body mass index and pathology results (r = 0.390). The sensitivity and specificity for detection of liver steatosis in MRS fat fraction were 95.2% and 98.3%, respectively., Conclusion: (1)H MRS fat fraction is a highly precise and accurate method in quantification of hepatic steatosis for the living donor and can be finished in a single breath-hold., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Neuroendocrine tumors are composed by a heterogeneous group of tumors with a wide range of morphologic, functional, and behavioral characteristics. These tumors are generally slow growing and behave in an indolent fashion. However, they have the potential to spread, especially for poorly differentiated neuroendocrine carcinomas, and when they do, they can be very aggressive, with high propensity for distant metastases, and difficult to treat with current modalities. As poorly differentiated neuroendocrine carcinomas rarely occur in extrapulmonary sites, to the best of our knowledge, this is the first case report of a poorly differentiated duodenal neuroendocrine carcinoma with diffuse liver and bone metastases as the primary manifestation. Despite receiving a trial of chemotherapeutic regimen, the patient had progressive intrahepatic cholestasis and died of subacute hepatic failure.

Unlabelled: This work aimed to investigate the spatial distribution of scattered radiation doses induced by exposure to the portable X-ray, the C-arm machine, and to simulate the radiologist without a shield of lead clothing, radiation doses absorbed by medical staff at 2 m from the central exposure point., Material and Method: With the adoption of the Rando Phantom, several frequently X-rayed body parts were exposed to X-ray radiation, and the scattered radiation doses were measured by ionization chamber dosimeters at various angles from the patient. Assuming that the central point of the X-ray was located at the belly button, five detection points were distributed in the operation room at 1 m above the ground and 1-2 m from the central point horizontally., Results: The radiation dose measured at point B was the lowest, and the scattered radiation dose absorbed by the prosthesis from the X-ray's vertical projection was 0.07 ±0.03 μGy, which was less than the background radiation levels. The Fluke biomedical model 660-5DE (400 cc) and 660-3DE (4 cc) ion chambers were used to detect air dose at a distance of approximately two meters from the central point. The AP projection radiation doses at point B was the lowest (0.07±0.03 μGy) and the radiation doses at point D was the highest (0.26±0.08 μGy) .Only taking the vertical projection into account, the radiation doses at point B was the lowest (0.52 μGy), and the radiation doses at point E was the highest (4 μGy).The PA projection radiation at point B was the lowest (0.36 μGy) and the radiation doses at point E was the highest(2.77 μGy), occupying 10-32% of the maximum doses. The maximum dose in five directions was nine times to the minimum dose. When the PX and the C-arm machine were used, the radiation doses at a distance of 2 m were attenuated to the background radiation level. The radiologist without a lead shield should stand at point B of patient's feet. Accordingly, teaching materials on radiation safety for radiological interns and clinical technicians were formulated.

Objective: Hepatic steatosis can cause substantial problems for both donors and recipients in living donor liver transplantation (LDLT). The aim of this study is to evaluate the accuracy of the magnetic resonance IDEAL (iterative decomposition of water and fat with echo asymmetry and least squares estimation) sequence in quantifying the liver fat during LDLT., Materials and Methods: A total of 63 liver donors (29 men and 34 women ranging from 18 to 47 years old with a mean age of 30) who received both magnetic resonance imaging (MRI) and intraoperative liver biopsy were enrolled in this study. MR IDEAL IQ sequences were performed by 1.5-T MRI (Discovery 450; GE Healthcare, Milwaukee, Wis, United States) to estimate the liver fatty content. Accuracy was assessed through linear regression between fat fraction image and pathology grading. Sensitivity and specificity of MR IDEAL IQ fat fractions were also calculated., Results: A total of 63 LDLTs were performed and with pathology grading. No fatty content was found in 48 donors (76.2%; group 1), 5% to 10% fatty liver in 11 donors (17.4%; group 2), 11% to 15% fatty liver in 2 donors (3.2%; group 3), and >16% fatty change in 2 donors (3.2%; group 4). MR IDEAL fat fraction results were excellent in prediction of the normal and fatty content and with good correlation with the pathology grading (2.9 ± 0.9, 8.3 ± 4.2, P < .0001). Linear regression between IDEAL image and pathology grading indicated a high accuracy rate (R(2) = 0.813, R(2) = 0.9286) for all 4 groups. The sensitivity and specificity for detection of liver steatosis in MRI fat fraction image were 100% and 77.1% (P < .0001, 95% confidence interval 0.000-1.000)., Conclusion: MR IDEAL IQ sequencing is a highly precise and accurate method in quantifying hepatic steatosis for the living donor., (Copyright © 2014 Elsevier Inc. All rights reserved.)

A series of ionic zinc-salicylideneimine compounds, [HNEt3][Zn(L)Cl2] (L = sal(H)-4-CN, 1; sal(Cl)-4-CN, 2; sal(Br)-4-CN, 3; sal(OMe)-4-CN, 4) and [NEt4][Zn(sal(H)-4-CN)Cl2] (5), have been synthesized and structurally characterized. Compounds 1-5 all display an intense fluorescence band in both solution (methanol, MeOH; acetonitrile, ACN; dimethylsulfoxide, DMSO; dichloromethane, DCM) and solid phases, with a maximum in the region of 515-560 nm and 529-573 nm, respectively. Detailed (1)H NMR and optical spectroscopic studies indicate the occurrence of ligand dissociation and recoordination in 1-4 in solution, leading to an equilibrium between the zinc-salicylideneimine complex species, [Zn(L)Cl2](-), and the salicylideneimine free ligand, HL. The tendency of ligand dissociation is related to the solvent, the concentration, and the substitution of the salicylidene ring. The greatest degree of ligand dissociation is observed for 1-4 when dissolved in noncoordinating, less polar DCM solvent, followed by coordinating, high polar DMSO solvent. The least degree of ligand dissociation occurs in solutions of coordinating, moderately polar MeOH and ACN solvents for 1-3 and 4, respectively. Dilute solutions are likely characterized by the high degree of ligand dissociation, whereas the equilibrium shifts in favor of the complex [Zn(L)Cl2](-) form at higher concentration. Furthermore, the electron-donating methoxy substitution in the salicylidene ring promotes a high tendency for ligand dissociation, while electron-withdrawing chloro and bromo groups cause the reverse tendency. The (1)H NMR spectrum of 5 shows only one set of proton resonances in the aromatic region corresponding to the complex [Zn(sal(H)-4-CN)Cl2](-) species, indicating that the lack of ammonium proton would protect the complex form from ligand dissociation.

Objective: The purpose of this study was to evaluate the image quality and diagnostic accuracy of postgadolinium complex of diethylenetriaminepentaacetic acid (GD-DTPA)-enhanced magnetic resonance cholangiography (MRC) in donor selection., Materials and Methods: Donors (n=228) with both preoperative MRC and intraoperative cholangiography (IOC) were enrolled in this study. MRC pre- and post-GD-DTPA enhancement were performed using 1.5-T magnetic resonance imaging. The signal-to-noise ratio (SNR) of liver parenchyma and contrast-to-noise ratio of bile duct, as well as the contrast between bile duct and liver parenchyma, were calculated. The biliary anatomy correlation with the IOC during hepatectomy and patient prognosis were also evaluated., Results: Quantitative results of the SNR of the liver parenchyma post-GD-DTPA were statistically significantly lower than preenhanced MRC (2.69 times reduced from the preenhanced MRC). The contrast of the bile duct and liver parenchyma in post-GD-DTPA were significantly higher than the preenhancement MRC. The anatomic diagnostic accuracy rate of post-GD-DTPA MRC was 92.9%. The sensitivity and specificity of GD-PTPA MRC were 85% and 96%, respectively. GD-DTPA-enhanced MRC has higher accuracy than the preenhanced MRC (92.9% vs 75%). The concurrence between GD-DTPA-enhanced MRC and IOC were commendable (kappa=0.9). The posttransplant biliary complication rate was 5.5%, and the 3-year survival rate was 91.2% in the recipients., Conclusion: GD-DTPA, a paramagnetic metal, can shorten the T1 and T2 relaxation values of surrounding protons. This decreases the signal of the liver parenchyma and brightens the biliary anatomy. It can improve the image quality of MRC and increase the diagnostic accuracy of the biliary tract classification. It is mandatory in the "donor and recipient surgery during the LDLT"., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This study evaluated the correlations between spiritual beliefs and health-related quality of life (HRQOL) of hemodialysis (HD) patients in Taiwan. Participants had to complete two questionnaires: the 36-item Short Form Health Survey Questionnaire and the Royal Free Interview for Spiritual and Religious Beliefs. They were then divided into three groups according to their strength of spiritual beliefs-having no, weak, or strong beliefs. Demographic, clinical, and laboratory data among groups were compared. Correlations between spiritual beliefs and HRQOL were then determined by the analysis of covariance and the post hoc Scheffe tests. Six hundred thirty-three patients completed the study. There were more women in the group of patients with strong beliefs (P = 0.005) and more less-educated patients in the group of patients with weak beliefs (P = 0.005). Patients with no or with strong spiritual beliefs had higher role physical (P = 0.01) and social functioning (SF) (P = 0.001) scores than patients with weak beliefs. After adjustment for gender, age, marital status, education, comorbidities, and time on dialysis, patients with no or with strong spiritual beliefs were found to have higher SF scores (P = 0.02) than patients with weak beliefs. HD patients with no or strong spiritual beliefs had higher SF HRQOL than those with weak spiritual beliefs.

Aims and Objectives: The purpose of this study was to assess the effectiveness of a pain management education programme in improving the nurses' knowledge about, attitude towards and application of relaxation therapy., Background: Pain of surgical patients has long been an existing problem of health care. Nursing staff need to be educated continuously to develop the professional ability of pain management., Methods: A quasi-study design with pre- and posttest and post- and posttest was used. Subjects were chosen from a medical centre in Taipei by convenience sampling. The total sample size of 81 was segregated into a study group of 42 and control group of 39 participants. The study group attended a seven-session pain management programme totalling 15 hours. The control group received no pain management training. Scaled measurements were taken on pain management knowledge and attitude and relaxation therapy practice., Results: (1) Scores for pain management knowledge differed significantly between the two groups (F = 40.636, p = 0.001). (2) Attitudes towards pain management differed between the two groups (F = 8.328, p = 0.005) and remained stable over time (F = 1.603, p = 0.205). (3) Relaxation therapy practice differed significantly between the two groups, with the study group better than the control group (F = 4.006, p = 0.049). (4) Relaxation therapy was applied to nearly all (97.5%) of the patients cared for by study group nurses. All of the instructed patients performed this technique one to three times per day postsurgery., Conclusions: Continuing education can improve nurses' knowledge about, attitude towards and behaviour of pain management., Relevance to Clinical Practice: Results of this study could be used to guide the development and implementation of continuing education programmes for nursing staff to enhance patients' care knowledge and skills.

Background: Adiponectin, a cytokine with anti-inflammatory properties that is secreted from adipose tissue, is associated with insulin resistance. Adiponectin has been shown to be a predictor of cardiovascular events in both the general population and patients undergoing hemodialysis (HD); however, its role in peritoneal dialysis (PD) analogues remains unclear., Methods: Serum adiponectin levels, measured by means of enzyme-linked immunosorbent assay in subjects with normal renal function and patients undergoing HD or PD (28 subjects in each group), were analyzed to establish the relationship between adiponectin and lipid levels, as well as insulin resistance. In the second study, 104 PD patients were recruited to analyze the relationships between serum adiponectin level and residual renal and peritoneal function and C-reactive protein (CRP) level. Independent factors for serum adiponectin level were determined from multiple linear regression., Results: No significant difference was shown comparing serum adiponectin levels of PD and HD patients; however, both were significantly greater than those of control subjects (P < 0.01). Negative associations were shown between adiponectin and triglyceride (TG; P < 0.01) and insulin levels (P < 0.05) and homeostatic model assessment of insulin resistance (P < 0.01) for the former 2 groups; however, a positive association was shown for high-density lipoprotein (HDL) level (P < 0.05). Neither HD nor PD removed adiponectin significantly, with levels for the PD group negatively associated with residual renal function (P < 0.01) and CRP level (P < 0.001). PD patients administered glucose-lowering agents had lower adiponectin levels; however, lipid-lowering agents and renin-angiotensin blockades did not appear to affect them. Independent determinants for serum adiponectin level in PD patients were TG, HDL, and CRP levels and body mass index, after adjustment for age, sex, PD therapy duration, and diabetes. Adiponectin levels were not associated with left ventricular mass or ejection fraction. As for HD patients, PD patients had high adiponectin levels; adiponectin was not removed effectively using either of the studied dialysis modalities. In addition to a significant relationship with the components of insulin resistance, adiponectin level was associated with CRP level in these patients., Conclusion: These results indicate that adiponectin level in PD patients may be a good indicator of cardiovascular disease risk.

Acute renal failure (ARF) occasionally occurs after intravenous injection of contrast medium, but complications are rare after retrograde pyelography. After reviewing the reports in the English-language literature, the authors found very few on those complications after retrograde pyelography. The authors present a patient who had ARF after the technique. The patient had a history of hypopharyngeal cancer with underlying serum creatinine level at the high end of the normal limits. Bilateral flank pain and decreased urine amount were noted soon after the procedure of retrograde pyelography. Subsequently, blood urea nitrogen and creatinine levels both elevated, and hemodialysis was needed. Several days later, diuretic phase took place. Thereafter, the symptoms subsided gradually. Pyelorenal extravasation of contrast medium was remarkable during the procedure. There was no evidence of hydronephrosis during the course of ARF. Early awareness and management may prevent the complications of ARF such as acute lung edema and hyperkalemia. Therefore, clinical physicians should be aware of the occurrence of ARF and its clinical presentation after performing retrograde pyelography.

Idiopathic multicentric osteolysis is a rare syndrome that manifests with progressive loss of carpal and tarsal bones in childhood. Affected children have arthritic-like episodes, followed by progressive deformities, radiographic osteolytic changes, and variable degrees of disability. A rare form of this disease (type III, sporadic) is associated with serious nephropathy. We present the first reported case of type III idiopathic multicentric osteolysis in a Chinese woman. The patient, a 34-year-old woman with normal mental development and no family history of bone or kidney disease, presented with a 4-day history of nausea and vomiting. She had shortening and swelling of the hands, which had occurred in childhood and persisted at the time of admission. X-ray studies showed disappearance of the carpal bones, and multiple osseous erosions of the tarsal bones. Hypertension, severe azotemia, and metabolic acidosis were also noted. Advanced renal disease was documented after a series of investigations, including renal biopsy. She is now dialysis-dependent. This case illustrates the importance of early diagnosis and management of idiopathic multicentric osteolysis with nephropathy.