Novel Electronic Health Records-Based Consultation Workflow Improves Time to Operating Room for Vascular Surgery Patients in an Acute Setting

BACKGROUND

Inefficient clinical workflows can have downstream effects of increased costs, poor resource utilization, and worse patient outcomes. The surgical consultation process can be complex with unclear communication, potentially delaying care for patients requiring time-sensitive intervention in an acute setting. A novel electronic health records (EHR)-based workflow was implemented to improve the consultation process. After implementation, we assessed the impact of this initiative in patients requiring vascular surgery consultation.

METHODS

An EHR-driven consultation workflow was implemented at a single institution, standardizing the process across all consulting services. This order-initiated workflow automated notification to clinicians of consult requests, communication of patient data, patient addition to consultants' lists, and tracking consult completion. Preimplementation (1/1/2020-1/31/2022) and postimplementation (2/1/2022-12/4/2022) vascular surgery consultation cohorts were compared to evaluate the impact of this initiative on timeliness of care.

RESULTS

There were 554 inpatient vascular surgery consultations (255 preimplementation and 299 postimplementation); 45 and 76 consults required surgery before and after implementation, respectively. The novel workflow resulted in placement of a consult note 32 min faster than preimplementation (preimplementation: 462 min, postimplementation: 430 min, P = 0.001) for all vascular surgery consults. Furthermore, vascular surgery patients with ASA class III or IV status requiring an urgent or emergent operation were transported to the operating room 63.3% faster after implementation of the workflow (preimplementation: 284 min, postimplementation: 180 min, P = 0.02). There were no differences in procedure duration, postoperative disposition, or intraoperative complication rates.

CONCLUSIONS

We implemented a novel workflow utilizing the EHR to standardize and automate the consultation process in the acute inpatient setting. This institutional initiative significantly improved timeliness of care for vascular surgery patients, including decreased time to operation. Innovations such as this can be further disseminated across shared EHR platforms across institutions, representing a powerful tool to increase the value of care in vascular surgery and healthcare overall.

Intuitionistic Fuzzy Weighted Least Squares Twin SVMs

Fuzzy membership is an effective approach used in twin support vector machines (SVMs) to reduce the effect of noise and outliers in classification problems. Fuzzy twin SVMs (TWSVMs) assign membership weights to reduce the effect of outliers, however, it ignores the positioning of the input data samples and hence fails to distinguish between support vectors and noise. To overcome this issue, intuitionistic fuzzy TWSVM combined the concept of intuitionistic fuzzy number with TWSVMs to reduce the effect of outliers and distinguish support vectors from noise. Despite these benefits, TWSVMs and intuitionistic fuzzy TWSVMs still suffer from some drawbacks as: 1) the local neighborhood information is ignored among the data points and 2) they solve quadratic programming problems (QPPs), which is computationally inefficient. To overcome these issues, we propose a novel intuitionistic fuzzy weighted least squares TWSVMs for classification problems. The proposed approach uses local neighborhood information among the data points and also uses both membership and nonmembership weights to reduce the effect of noise and outliers. The proposed approach solves a system of linear equations instead of solving the QPPs which makes the model more efficient. We evaluated the proposed intuitionistic fuzzy weighted least squares TWSVMs on several benchmark datasets to show the efficiency of the proposed model. Statistical analysis is done to quantify the results statistically. As an application, we used the proposed model for the diagnosis of Schizophrenia disease.

Impact of acute stress on cortical electrical activity and cardiac autonomic coupling

Assessment of heart rate variability (reflective of the cardiac autonomic nervous system) has shown some predictive power for stress. Further, the predictive power of the distinct patterns of cortical brain activity and - cardiac autonomic interactions are yet to be explored in the context of acute stress, as assessed by an electrocardiogram and electroencephalogram. The present study identified distinct patterns of neural-cardiac autonomic coupling during both resting and acute stress states. In particular, during the stress task, frontal delta waves activity was positively associated with low-frequency heart rate variability and negatively associated with high-frequency heart rate variability. Low high-frequency power is associated with stress and anxiety and reduced vagal control. A positive association between resting high-frequency heart rate variability and frontocentral gamma activity was found, with a direct inverse relationship of low-frequency heart rate variability and gamma wave coupling at rest. During the stress task, low-frequency heart rate variability was positively associated with frontal delta activity. That is, the parasympathetic nervous system is reduced during a stress task, whereas frontal delta wave activity is increased. Our findings suggest an association between cardiac parasympathetic nervous system activity and frontocentral gamma and delta activity at rest and during acute stress. This suggests that parasympathetic activity is decreased during acute stress, and this is coupled with neuronal cortical prefrontal activity. The distinct patterns of neural-cardiac coupling identified in this study provide a unique insight into the dynamic associations between brain and heart function during both resting and acute stress states.

Ten-year fracture risk by FRAX and osteoporotic fractures in patients with systemic autoimmune diseases

The Fracture Risk Assessment Tool (FRAX) has been used universally for the purpose of fracture risk assessment. However, the predictive capacity of FRAX for autoimmune diseases remains inconclusive. This study aimed to compare the applicability of FRAX for autoimmune disease patients. This retrospective study recruited rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and primary Sjögren syndrome (pSS) patients with bone mineral density (BMD) tests. Patients with any osteoporotic fractures were identified. Taiwan-specific FRAX with and without BMD were then calculated. In total, 802 patients (451 RA, 233 SLE and 118 pSS) were enrolled in this study. The cumulative incidences of osteoporotic fractures in the RA, SLE and pSS patients were 43.0%, 29.2% and 33.1%, respectively. For those with a previous osteoporotic fracture, T-scores were classified as low bone mass. Overall, the patients' 10-year probability of major fracture risk by FRAX without BMD was 15.8%, which then increased to 20.3% after incorporation of BMD measurement. When analyzed by disease group, the fracture risk in RA patients was accurately predicted by FRAX. In contrast, current FRAX, either with or without BMD measurement, underestimated the fracture risk both in SLE and pSS patients, even after stratification by age and glucocorticoid treatment. For pSS patients with major osteoporotic fractures, FRAX risks imputed by RA were comparable to major osteoporotic fracture risks of RA patients. Current FRAX accurately predicted fracture probability in RA patients, but not in SLE and pSS patients. RA-imputed FRAX risk scores could be used as a temporary substitute for SLE and pSS patients.

Combination immunosuppressant therapy and lupus nephritis outcome: a hospital-based study

Lupus nephritis (LN) is the leading cause of mortality in lupus patients. This study aimed to investigate the treatment outcome and renal histological risk factors of LN in a tertiary referral center. Between 2006 and 2017, a retrospective observational study enrolled 148 biopsy-proven LN patients. After propensity score matching, 75 cases were included for further analysis. The classification and scoring of LN were assessed according to the International Society of Nephrology/Renal Pathology Society. Treatment response was evaluated by daily urine protein and urinalysis at two years after commencing induction treatment and the development of end-stage renal disease (ESRD). In total, 50.7% patients achieved complete remission (CR) or partial remission (PR), while 49.3% patients were categorized as nonresponders. Therapeutic responses in terms of CR/PR rates were associated with Systemic Lupus Erythematosus Disease Activity Index scores (odds ratio (OR): 1.34, 95% confidence interval (CI): 1.12-1.60, p = 0.001). Moreover, higher baseline creatinine levels (hazard ratio (HR): 2.10, 95% CI: 1.29-3.40, p = 0.003), higher renal activity index (HR: 1.30, 95% CI: 1.07-1.58, p = 0.008) and chronicity index (HR: 1.40, 95% CI: 1.06-1.85, p = 0.017) predicted ESRD. Among pathological scores, cellular crescents (HR: 4.42, 95% CI: 1.01-19.38, p = 0.049) and fibrous crescents (HR: 5.93, 95% CI: 1.41-24.92, p = 0.015) were independent risk factors for ESRD. In conclusion, higher lupus activity was a good prognostic marker for renal remission. Renal histology was predictive of ESRD. Large-scale prospective studies are required to verify the efficacy of mycophenolate in combination with azathioprine or cyclosporine in LN patients.

Evidence for weak collective pinning and δl pinning in topological superconductor Cu x Bi2Se3

We investigated the vortex pinning behavior in the single crystal topological superconductor Cu_0.10Bi₂Se₃ with a pronounced anisotropic peak effect. A weak collective pinning regime is clarified from the power-law behavior in [Formula: see text] and the small critical current density ratio of [Formula: see text] ~ 10^-5 ([Formula: see text] is the critical current density, [Formula: see text] is the depairing current density). The spatial variation of the charge-carrier mean free path induced pinning is evidenced and probably results from the well-defined atomic defects. Within the framework of collective pinning theory, we computed the values of the correlated length and volume at 1.8 K, which start declining prior to the onset field of the peak effect [Formula: see text], demonstrating the vortex lattices already suffered a preferential collapse ahead of the peak effect turns up. Thus, the peak effect can be understood by elastic moduli softening near the upper critical field [Formula: see text]. We suggest Cu _x Bi₂Se₃ is a prototype topological material for investigating the vortex pinning dynamics associated with the peak effect phenomenon.

Use of 0.4-Tesla static magnetic field to promote reparative dentine formation of dental pulp stem cells through activation of p38 MAPK signalling pathway

AIM

To investigate whether static magnetic fields (SMFs) have a positive effect on the migration and dentinogenesis of dental pulp stem cells (DPSCs) to promote reparative dentine formation.

METHODOLOGY

In vitro scratch assays and a traumatic pulp exposure model were performed to evaluate the effect of 0.4-Tesla (T) SMF on DPSC migration. The cytoskeletons of the DPSCs were identified by fluorescence immunostaining and compared with those of a sham-exposed group. Dentinogenic evaluation was performed by analysing the expressions of DMP-1 and DSPP marker genes using a quantitative real-time polymerase chain reaction (qRT-PCR) process. Furthermore, the formation of calcified deposits was examined by staining the dentinogenic DPSCs with Alizarin Red S dye. Finally, the role played by the p38 MAPK signalling pathway in the migration and dentinogenesis of DPSCs under 0.4-T SMF was investigated by incorporating p38 inhibitor (SB203580) into the in vitro DPSC experiments. The Student's t-test and the Kruskal-Wallis test followed by Dunn's post hoc test with a significance level of P < 0.05 were used for statistical analysis.

RESULTS

The scratch assay results revealed that the application of 0.4-T SMF enhanced DPSCs migration towards the scratch wound (P < 0.05). The cytoskeletons of the SMF-treated DPSCs were found to be aligned perpendicular to the scratch wound. After 20 days of culture, the SMF-treated group had a greater number of out-grown cells than the sham-exposed group (nonmagnetized control). For the SMF-treated group, the DMP-1 (P < 0.05) and DSPP genes (P < 0.05), analysed by qRT-PCR, exhibited a higher expression. The distribution of calcified nodules was also found to be denser in the SMF-treated group when stained with Alizarin Red S dye (P < 0.05). Given the incorporation of p38 inhibitor SB203580 into the DPSCs, cell migration and dentinogenesis were suppressed. No difference was found between the SMF-treated and sham-exposed cells (P > 0.05).

CONCLUSION

0.4-T SMF enhanced DPSC migration and dentinogenesis through the activation of the p38 MAPK-related pathway.

Magnetotransport study of topological superconductor Cu0.10Bi2Se3 single crystal

We report a magnetotransport study of vortex-pinning in Cu_0.10Bi₂Se₃ single crystal. The sample is demonstrated to be in clean limit and absent of Pauli spin-limiting effect. Interestingly, the resistivity versus magnetic field shows an anomalously pronounced increase when approaching the superconducting-normal state boundary for both [Formula: see text] and [Formula: see text] configurations. We have investigated the flux-flowing behavior under various magnetic fields and temperatures, enabling us to establish its anisotropic vortex phase diagram. Our results suggest the Cu_0.10Bi₂Se₃ can be served as one unique material for exploring exotic surface vortex states in topological superconductors.

Charge-density-wave order takes over antiferromagnetism in Bi2Sr2-x La x CuO6 superconductors

Superconductivity appears in the cuprates when a spin order is destroyed, while the role of charge is less known. Recently, charge density wave (CDW) was found below the superconducting dome in YBa₂Cu₃O_y when a high magnetic field is applied perpendicular to the CuO₂ plane, which was suggested to arise from incipient CDW in the vortex cores that becomes overlapped. Here by ⁶³Cu-nuclear magnetic resonance, we report the discovery of CDW induced by an in-plane field, setting in above the dome in single-layered Bi₂Sr_2−xLa_xCuO₆. The onset temperature T_CDW takes over the antiferromagnetic order temperature T_N beyond a critical doping level at which superconductivity starts to emerge, and scales with the pseudogap temperature T*. These results provide important insights into the relationship between spin order, CDW and the pseudogap, and their connections to high-temperature superconductivity.

Whilst superconductivity usually appears when magnetic order is suppressed, the role of charge is less known. Here, Kawasaki et al. report a charge density wave (CDW) above the superconducting transition induced by an in-plane magnetic field in Bi₂Sr_2-xLa_xCuO₆, with the CDW onset temperature scaling with the pseudogap temperature.

Observation of the weak electronic correlations in KFeCoAs2 (3d 6): an isoelectronic to the parent compounds of 122 series of iron pnictides BaFe2As2

Using the angle-resolved photoemission spectroscopy and band structure calculations we study the electronic structure of KFeCoAs₂, which is isoelectronic to the parent material of 122 series of iron-based superconductors BaFe₂As₂. Although band structure calculations predict nearly identical dispersions of the electronic states in both compounds, experiment reveals drastic differences in both the global renormalization and Fermi surfaces. On the basis of the comparison of electronic structures of these two isoelectronic compounds, we demonstrate local magnetic correlations as a vital role for the peculiar low-energy electron dynamics of iron-based superconductors.

Direct Visualization of Helicase Dynamics Using Fluorescence Localization and Optical Trapping

Helicases control the accessibility of single-stranded (ss) nucleic acid (NA) generated as a transient intermediate during almost every step in cells related to nucleic acid metabolisms. For subsequent processing, however, helicases need to adjust the pace of unwinding adequately to avoid ssNA exposure to nucleases. Therefore, understanding how the unwinding process of helicases is regulated is crucial to address genome integrity and repair mechanisms. Using single-molecule fluorescence-force spectroscopy with fluorescence localization, we recently observed the stoichiometry of UvrD helicase, which determines the functions of UvrD: translocation and unwinding. For the first time, we provide direct evidence that a UvrD dimer is required to initiate the unwinding pathway. Moreover, with subpixel precision of fluorescence localization, the dynamic parameters of helicases can be obtained directly. Here, we present detailed single-molecule assays for observing the biochemical activities of helicases in real time and revealing how mechanical forces are involved in protein-nucleic acid interactions. These single-molecule approaches are generally applicable to many other protein-nucleic acid systems.

Structure and superconductivity of (Li1-x Fe x )OHFeSe single crystals grown using A x Fe2-y Se2 (A = K, Rb, and Cs) as precursors

We present results on the hydrothermal growth of ([Formula: see text])OHFeSe single crystals using floating-zone-grown [Formula: see text] (A  =  K, Rb, and Cs) as precursors. The growth proceeds by the hydrothermal ion exchange of Li/Fe-O-H for K, Rb, and Cs, resulting in a stacking layer of ([Formula: see text])OH sandwiched between the FeSe layers. Optimal growth parameters are achieved using high quality A 0.80Fe1.81Se2 single crystals added to the mixtures of LiOH, H2O, Fe and C(NH2)2Se in an autoclave and subsequently heated to 120 °C for 2 d, to obtain highest quality single crystals. The obtained crystals have lateral dimensions up to centimeters, with the final size related to that of the precursor crystal used. All ([Formula: see text])OHFeSe single crystals show a superconducting transition temperature T c  >  42 K, regardless of the phase of the precursor such as superconducting K0.80Fe1.81Se2 (T c  =  29.31 K) or non-superconducting Rb0.80Fe1.81Se2 or poor-superconducting Cs0.80Fe1.81Se2 (T c  =  28.67 K). The T c and transition width ΔT vary in the obtained single crystals, due to the inhomogeneity of the ionic exchange. X-ray diffraction analysis demonstrates that the 245 insulating phase is absent in the ion-exchanged single crystals, while it is observed in the [Formula: see text] precursors. Comparative studies of the structure, magnetization, and superconductivity on the parent A 0.80Fe1.81Se2 and the ion-exchanged ([Formula: see text])OHFeSe crystals are discussed. A phase diagram including antiferromagnetic spin density wave and superconducting phases is also proposed.

TP53 mutations in de novo acute myeloid leukemia patients: longitudinal follow-ups show the mutation is stable during disease evolution

The TP53 mutation is frequently detected in acute myeloid leukemia (AML) patients with complex karyotype (CK), but the stability of this mutation during the clinical course remains unclear. In this study, TP53 mutations were identified in 7% of 500 patients with de novo AML and 58.8% of patients with CK. TP53 mutations were closely associated with older age, lower white blood cell (WBC) and platelet counts, FAB M6 subtype, unfavorable-risk cytogenetics and CK, but negatively associated with NPM1 mutation, FLT3/ITD and DNMT3A mutation. Multivariate analysis demonstrated that TP53 mutation was an independent poor prognostic factor for overall survival and disease-free survival among the total cohort and the subgroup of patients with CK. A scoring system incorporating TP53 mutation and nine other prognostic factors, including age, WBC counts, cytogenetics and gene mutations, into survival analysis proved to be very useful to stratify AML patients. Sequential study of 420 samples showed that TP53 mutations were stable during AML evolution, whereas the mutation was acquired only in 1 of the 126 TP53 wild-type patients when therapy-related AML originated from different clone emerged. In conclusion, TP53 mutations are associated with distinct clinic-biological features and poor prognosis in de novo AML patients and are rather stable during disease progression.

EEG correlates of spatial orientation in the human retrosplenial complex

Studies on spatial navigation reliably demonstrate that the retrosplenial complex (RSC) plays a pivotal role for allocentric spatial information processing by transforming egocentric and allocentric spatial information into the respective other spatial reference frame (SRF). While more and more imaging studies investigate the role of the RSC in spatial tasks, high temporal resolution measures such as electroencephalography (EEG) are missing. To investigate the function of the RSC in spatial navigation with high temporal resolution we used EEG to analyze spectral perturbations during navigation based on allocentric and egocentric SRF. Participants performed a path integration task in a clearly structured virtual environment providing allothetic information. Continuous EEG recordings were decomposed by independent component analysis (ICA) with subsequent source reconstruction of independent time source series using equivalent dipole modeling. Time-frequency transformation was used to investigate reference frame-specific orientation processes during navigation as compared to a control condition with identical visual input but no orientation task. Our results demonstrate that navigation based on an egocentric reference frame recruited a network including the parietal, motor, and occipital cortices with dominant perturbations in the alpha band and theta modulation in frontal cortex. Allocentric navigation was accompanied by performance-related desynchronization of the 8-13 Hz frequency band and synchronization in the 12-14 Hz band in the RSC. The results support the claim that the retrosplenial complex is central to translating egocentric spatial information into allocentric reference frames. Modulations in different frequencies with different time courses in the RSC further provide first evidence of two distinct neural processes reflecting translation of spatial information based on distinct reference frames and the computation of heading changes.

Effects of low amplitude pulsed radiofrequency stimulation with different waveform in rats for neuropathic pain

Pulsed-radiofrequency (PRF) electrical stimulation has been widely used for chronic pain treatment. It has been demonstrated with advantages of low temperature over traditional continuous radiofrequency (CRF) lesions with higher amplitude and mono polar electrode to treat pain in clinics (frequency 500 KHz, Pulse duration 20 msec, Amplitude 45 V, Treatment 2 min). We compare the effects of different pulse waveforms and PRF parameters (Pulse duration 25 ms, Treatment duration 5 min, low amplitude of 2.5/1.25 V) with a miniature bi-polar electrode on Dorsal root ganglion (DRG). The pain relief effect due to PRF is evaluated by using Von Frey method for the pain threshold index based on behavior response to mechanical stimulus of various strengths. Experimental results of Von Frey Score show that the sinusoidal group has higher responses than the square wave one. Both fast and secondary expressed proteins of c-fos and pp38 are measured from spinal cord tissue sectioning slides to characterize the pain associated inflammatory responses and their responses due to PRF stimulation.

Postradiation dermatofibrosarcoma protuberans : case report and literature review

Radiotherapy has long been known to induce soft tissue sarcomas. However, there are only six cases of postradiation dermatofibrosarcoma protuberans (DFSP) reported in the literature, and no case in Asians has been reported so far. Herein, we report a case of DFSP, confirmed by immunohistochemistry, which developed on the old scar at the irradiated right chest wall of an Asian woman. We performed a radical surgical excision of the lesion and covered the defect with latissimus dorsi island myocutaneous flap followed the surgical treatment. 12 months postoperatively, the patient leads a good result without signs of recurrence.

Inhibitory effect of Lactobacillus salivarius on Streptococcus mutans biofilm formation

Dental caries arises from an imbalance of metabolic activities in dental biofilms developed primarily by Streptococcus mutans. This study was conducted to isolate potential oral probiotics with antagonistic activities against S. mutans biofilm formation from Lactobacillus salivarius, frequently found in human saliva. We analysed 64 L. salivarius strains and found that two, K35 and K43, significantly inhibited S. mutans biofilm formation with inhibitory activities more pronounced than those of Lactobacillus rhamnosus GG (LGG), a prototypical probiotic that shows anti-caries activity. Scanning electron microscopy showed that co-culture of S. mutans with K35 or K43 resulted in significantly reduced amounts of attached bacteria and network-like structures, typically comprising exopolysaccharides. Spot assay for S. mutans indicated that K35 and K43 strains possessed a stronger bactericidal activity against S. mutans than LGG. Moreover, quantitative real-time polymerase chain reaction showed that the expression of genes encoding glucosyltransferases, gtfB, gtfC, and gtfD was reduced when S. mutans were co-cultured with K35 or K43. However, LGG activated the expression of gtfB and gtfC, but did not influence the expression of gtfD in the co-culture. A transwell-based biofilm assay indicated that these lactobacilli inhibited S. mutans biofilm formation in a contact-independent manner. In conclusion, we identified two L. salivarius strains with inhibitory activities on the growth and expression of S. mutans virulence genes to reduce its biofilm formation. This is not a general characteristic of the species, so presents a potential strategy for in vivo alteration of plaque biofilm and caries.

Exciton photoluminescence in resonant quasi-periodic Thue-Morse quantum wells

This Letter investigates exciton photoluminescence (PL) in resonant quasi-periodic Thue-Morse quantum wells (QWs). The results show that the PL properties of quasi-periodic Thue-Morse QWs are quite different from those of resonant Fibonacci QWs. The maximum and minimum PL intensities occur under the anti-Bragg and Bragg conditions, respectively. The maxima of the PL intensity gradually decline when the filling factor increases from 0.25 to 0.5. Accordingly, the squared electric field at the QWs decreases as the Thue-Morse QW deviates from the anti-Bragg condition.

A CMOS wireless biomolecular sensing system-on-chip based on polysilicon nanowire technology

As developments of modern societies, an on-field and personalized diagnosis has become important for disease prevention and proper treatment. To address this need, in this work, a polysilicon nanowire (poly-Si NW) based biosensor system-on-chip (bio-SSoC) is designed and fabricated by a 0.35 μm 2-Poly-4-Metal (2P4M) complementary metal-oxide-semiconductor (CMOS) process provided by a commercialized semiconductor foundry. Because of the advantages of CMOS system-on-chip (SoC) technologies, the poly-Si NW biosensor is integrated with a chopper differential-difference amplifier (DDA) based analog-front-end (AFE), a successive approximation analog-to-digital converter (SAR ADC), and a microcontroller to have better sensing capabilities than a traditional Si NW discrete measuring system. In addition, an on-off key (OOK) wireless transceiver is also integrated to form a wireless bio-SSoC technology. This is pioneering work to harness the momentum of CMOS integrated technology into emerging bio-diagnosis technologies. This integrated technology is experimentally examined to have a label-free and low-concentration biomolecular detection for both Hepatitis B Virus DNA (10 fM) and cardiac troponin I protein (3.2 pM). Based on this work, the implemented wireless bio-SSoC has demonstrated a good biomolecular sensing characteristic and a potential for low-cost and mobile applications. As a consequence, this developed technology can be a promising candidate for on-field and personalized applications in biomedical diagnosis.

Doping-dependent photon scattering resonance in the model high-temperature superconductor HgBa2CuO4+δ revealed by Raman scattering and optical ellipsometry

We study the model high-temperature superconductor HgBa(2)CuO(4+δ) with electronic Raman scattering and optical ellipsometry over a wide doping range. The dependence of the resonant Raman cross section on the incident photon energy changes drastically as a function of doping, in a manner that corresponds to a rearrangement of the interband optical transitions seen with ellipsometry. This doping-dependent Raman resonance allows us to reconcile the apparent discrepancy between Raman and x-ray detection of magnetic fluctuations in superconducting cuprates. Intriguingly, the strongest variation occurs across the doping level where the antinodal superconducting gap appears to reach its maximum.

Enhancement of phase separation and superconductivity in Mn-doped K0.8Fe2-yMnySe2 crystals

Single crystals of K0.8Fe2-yMnySe2 with slight Mn doping have been grown by a self-flux method. X-ray diffraction measurements show enhanced phase separation with increasing Mn doping in the compounds. The superconducting transition temperature increases to Tc,onset ∼ 46.1 K for the sample with y ∼ 0.03, as observed by electrical transport measurements. Our results demonstrate that the doping of Mn does not suppress the superconductivity, and on the contrary increases the superconducting shield fraction and transition temperature, an effect which may originate from the Mn dopant's high preference to fill into iron vacancies in the Mn-doped samples. It suggests that the Mn dopant can induce a local lattice strain or distortion that profitably modifies the microstructure of the superconducting/metallic phase, leading to superconductivity of the compound.

A dithiol glutaredoxin cDNA from sweet potato (Ipomoea batatas [L.] Lam): enzyme properties and kinetic studies

Glutaredoxins (Grx) play an important role in reduction of protein glutathione mixed disulphides. An IbGrx cDNA (561 bp, EF362614) encoding a putative dithiol Grx was cloned from sweet potato (Ipomoea batatas [L.] Lam). The deduced amino acid sequence is conserved among the reported dithiol Grx, having a CGYC dithiol motif at the active site. A 3-D structural model was created based on the known crystal structure of a poplar Grx (GrxC1). To characterise the IbGrx protein, the coding region was subcloned into an expression vector and transformed into Escherichia coli. The recombinant His(6) -tagged IbGrx was expressed and purified by metal affinity chromatography. The purified enzyme showed a monomeric band, as demonstrated with 15% SDS-PAGE. The Michaelis constant (K(M) ) for ß-hydroxyethyl disulphide (HED) was 0.50 ± 0.08 Mm. The enzyme retained 60% activity at 80 °C for 16 min. The enzyme was active over a broad pH range from 6.0 to 11.0, and in the presence of imidazole up to 0.4 M. The enzyme was susceptible to protease.

Highly anisotropic anomaly in the dispersion of the copper-oxygen bond-bending phonon in superconducting YBa2Cu3O7 from inelastic neutron scattering

Motivated by predictions of a substantial contribution of the "buckling" vibration of the CuO(2) layers to d-wave superconductivity in the cuprates, we have performed an inelastic neutron scattering study of this phonon in an array of untwinned crystals of YBa(2)Cu(3)O(7). The data reveal a pronounced softening of the phonon at the in-plane wave vector q=(0,0.3) upon cooling below ~105 K, but no corresponding anomaly at q=(0.3,0). Based on the observed in-plane anisotropy, we argue that the electron-phonon interaction responsible for this anomaly supports an electronic instability associated with a uniaxial charge-density modulation and does not mediate d-wave superconductivity.

Direct observation of local potassium variation and its correlation to electronic inhomogeneity in (Ba(1-x)K(x))Fe2As2 pnictide

Local fluctuations in the distribution of dopant atoms are thought to cause the nanoscale electronic disorder or phase separation in pnictide superconductors. Atom probe tomography has enabled the first direct observations of dopant species clustering in a K-doped 122-phase pnictide. First-principles calculations suggest the coexistence of static magnetism and superconductivity on a lattice parameter length scale over a wide range of dopant concentrations. Our results provide evidence for a mixed scenario of phase coexistence and phase separation, depending on local dopant atom distributions.

Magnetic phase diagram of multiferroic MnWO4 probed by ultrasound

The magnetic phase diagram of multiferroic MnWO(4) is studied in magnetic fields up to 60 T using sound velocity and sound attenuation measurements. Anomalies are observed at temperatures T(N1) = 7.6 K, T(N2) = 12.6 K and T(N3) = 13.6 K that separate commensurate antiferromagnetic (AF1) to helical AF2 and commensurate AF3 to paramagnetic phases, respectively. The anomalies are significantly different and shed light on the spin-phonon coupling and evolution of the various order parameters in this multiferroic material. For temperatures below T(N2) pronounced field hysteresis effects are also observed in the sound velocity, indicating field-induced transformations. In the temperature dependence of the attenuation we observe anomalies distinctively different from the usual maxima related to relaxation effects. They are attributed to the combination of dispersion effects due to domain walls and the discontinuously changing sound velocity. In total, six different magnetic phases, at various temperatures and fields including a novel high-field phase, are revealed and analyzed.

Successful treatment of mucormycosis infection after liver transplantation: report of a case and review of the literature

Mucormycosis (zygomycosis) is a rare opportunistic fungal infection mainly affecting patients with diabetes mellitus, immunodeficiency, malignancies and solid organ transplant. We present a 55-year-old female with a mucormycosis infection primarily affecting the paranasal sinuses after liver transplantation. The patient presented with a one-week history of right-sided occipital headache and gradual loss of vision in the right eye just 6 months after liver transplantation. Imaging studies revealed a right-sided sphenoiditis with orbital apex involvement. The patient underwent endoscopic sinus surgery and the histology confirmed the diagnosis of mucormycosis. Aggressive surgical ablation of the infected parts, along with antifungal treatment and adjustment of her immunosuppressive maintenance resulted in a good outcome and long-term survival.

Evidence of a precursor superconducting phase at temperatures as high as 180 K in RBa2Cu3O(7-δ) (R=Y, Gd, Eu) superconducting crystals from infrared spectroscopy

We show that a multilayer analysis of the infrared c-axis response of RBa2Cu3O(7-δ) (R=Y, Gd, Eu) provides important new information about the anomalous normal-state properties of underdoped cuprate high temperature superconductors. In addition to competing correlations which give rise to a pseudogap that depletes the low-energy electronic states below T*≫T(c), it enables us to identify the onset of a precursor superconducting state below T(ons)>T(c). We map out the doping phase diagram of T(ons) which reaches a maximum of 180 K at strong underdoping and present magnetic field dependent data which confirm our conclusions.

Incommensurate magnetic order and dynamics induced by spinless impurities in YBa(2)Cu(3)O(6.6)

We report an inelastic-neutron-scattering and muon-spin-relaxation study of the effect of 2% spinless (Zn) impurities on the magnetic order and dynamics of YBa(2)Cu(3)O(6.6), an underdoped high-temperature superconductor that exhibits a prominent spin pseudogap in its normal state. Zn substitution induces static magnetic order at low temperatures and triggers a large-scale spectral-weight redistribution from the magnetic resonant mode at 38 meV into uniaxial, incommensurate spin excitations with energies well below the spin pseudogap. These observations indicate a competition between incommensurate magnetic order and superconductivity close to a quantum critical point. Comparison to prior data on La(2-x)Sr(x)CuO(4) suggests that this behavior is universal for the layered copper oxides and analogous to impurity-induced magnetic order in one-dimensional quantum magnets.

Acute fulminant colon cancer metastasis after renal transplantation

We report a 52-year-old male with no family history of colonic cancer, who was found to have advanced colonic cancer with metastases two months post renal transplantation. With this case, we highlight the possibility of acute fulminant cancer metastases within short period after renal transplantation and the importance of periodic colorectal cancer screening pre-transplant. To our knowledge, this case is not yet reported in the literature, especially with such presentation of acute fulminant colonic cancer metastases post renal transplantation.

Specific heat measurements of Ba(0.68)K(0.32)Fe2As2 single crystals: evidence for a multiband strong-coupling superconducting state

The specific heat of high-purity Ba(0.68)K(0.32)Fe2As2 single crystals with the highest reported superconducting Tc=38.5 K was studied. The electronic specific heat Cp below Tc shows two gap features, with Δ1≈11 meV and Δ2≈3.5 meV obtained from an α-model analysis. The reduced gap value, 2Δ(max)/kBTc≈6.6, the magnitude of the specific-heat jump, ΔCp(Tc)/Tc, and its slope below Tc exhibit a strong-coupling character. We also show that an Eliashberg model with two hole and two electron bands gives the correct values of Tc, the superconducting gaps, and the free-energy difference.

Is there an excitonic interaction or antenna system in bacteriorhodopsin?

The presence of a biphasic circular dichroism (CD) observed in the visible absorption spectrum of retinal in bacteriorhodopsin (bR) has been believed for many years to be due to excitonic-type interaction within the trimeric structure of the retinal in the protein membrane. In the present work, we present data and discuss previous observations that strongly suggest the absence of such an excitonic interaction. The magnetic CD spectrum of the trimer is found to be similar to that of the monomer and shows no sign of absorption to the doubly degenerate state predicted to be present from the exciton theory. This, together with the previous observations on the CD spectra of the photocycle intermediates of bR as well as the linear polarization studies of the fluorescence and the daughter absorption, sheds doubt on the presence of exciton interaction and thus suggests the presence of neither an antenna system nor a viable special reaction center in bR. Possible explanation for the observed biphasic nature of the CD spectrum is given in terms of having more than one type of bR with different protein conformations around the retinals in the trimer giving each similar absorption maximum but opposite signs for its rotary dispersion power.

A recurrent self-organizing neural fuzzy inference network

A recurrent self-organizing neural fuzzy inference network (RSONFIN) is proposed in this paper. The RSONFIN is inherently a recurrent multilayered connectionist network for realizing the basic elements and functions of dynamic fuzzy inference, and may be considered to be constructed from a series of dynamic fuzzy rules. The temporal relations embedded in the network are built by adding some feedback connections representing the memory elements to a feedforward neural fuzzy network. Each weight as well as node in the RSONFIN has its own meaning and represents a special element in a fuzzy rule. There are no hidden nodes (i.e., no membership functions and fuzzy rules) initially in the RSONFIN. They are created on-line via concurrent structure identification (the construction of dynamic fuzzy if-then rules) and parameter identification (the tuning of the free parameters of membership functions). The structure learning together with the parameter learning forms a fast learning algorithm for building a small, yet powerful, dynamic neural fuzzy network. Two major characteristics of the RSONFIN can thus be seen: 1) the recurrent property of the RSONFIN makes it suitable for dealing with temporal problems and 2) no predetermination, like the number of hidden nodes, must be given, since the RSONFIN can find its optimal structure and parameters automatically and quickly. Moreover, to reduce the number of fuzzy rules generated, a flexible input partition method, the aligned clustering-based algorithm, is proposed. Various simulations on temporal problems are done and performance comparisons with some existing recurrent networks are also made. Efficiency of the RSONFIN is verified from these results.

Self-energy effects and electron-phonon coupling in Fe-As superconductors

Doping and temperature dependent studies of optical phonon modes in Fe-122 pnictides are performed using Raman scattering experiments and compared with model calculations to elucidate the role of electron-phonon and spin-phonon interaction in this family of compounds. The frequency and linewidth of the B(1g) mode at around 210 cm(-1) is highlighted as appreciable anomalies at the superconducting and spin density wave transitions are observed that strongly depend on composition. We give estimates of the electron-phonon coupling related to this renormalization and calculate the phonon self-energy on the basis of a four-band model comparing different symmetries of the order parameters. In addition, we observe a pronounced quasi-elastic Raman response for the undoped compound, suggesting persisting magnetic fluctuations in the spin density wave state.

Unusual right upper quadrant Stump Appendicitis

Stump appendicitis is often not considered in patients with a surgical history of appendectomy. We report an unusual case of right upper quadrant stump appendicitis after previous operation for intussusception with incidental appendectomy. Abdominal computed tomographic scan is more efficient to make an early diagnosis of stump appendicitis to prevent further complications and prolonged hospitalization.

Reductions in the effects of damping on stress concentration in premolars by post-endodontic restorations: a non-linear finite element study

The aim of this study was to measure the structural damping constants of premolars after treatment with a cast Co-Cr post-core system or permanent root filling, and to evaluate the stress damping effects of these restored premolars. Both the damping ratio and the natural frequency (NF) of the cast Co-Cr post-core restored premolars and the permanent root-filled premolars were detected by in-vitro NF testing experiments. Unprepared premolars served as the control. The damping constants beta of the samples were calculated from the measured damping ratios and natural frequencies. The measured damping constants beta of the test premolars were then used for dynamic finite element (FE) analyses. Stress contours and damping effects of stresses in each treated type of premolar were computed and compared using ANSYS. The measured damping constants beta were 0.75 x 10(-5) for the unprepared premolars, 0.69 x 10(-5) for the root-filled premolars with coronal restoration, and 0.72 x 10(-5) for the cast Co-Cr post-core restored premolars. The unprepared intact premolars demonstrated the highest stress dissipation effects with a ratio of 29.3 per cent at the middle root opposite to the loading side. However, no stress dissipation effects were found in the premolars that had been restored with the cast Co-Cr post-core system. The FE analysis showed that metallic post treatment attenuated the damping properties of the premolar. The effects of damping on stress concentration were significantly lower in restored premolars than in untreated vital premolars. These findings suggest that future research on post material should take the damping property into consideration.

Magnetic-field-enhanced incommensurate magnetic order in the underdoped high-temperature superconductor YBa2Cu3O6.45

We present a neutron-scattering study of the static and dynamic spin correlations in the underdoped high-temperature superconductor YBa2Cu3O6.45 in magnetic fields up to 15 T. The field strongly enhances static incommensurate magnetic order at low temperatures and induces a spectral-weight shift in the magnetic-excitation spectrum. A reconstruction of the Fermi surface driven by the field-enhanced magnetic superstructure may thus be responsible for the unusual Fermi surface topology revealed by recent quantum-oscillation experiments.

Two-gap superconductivity in Ba1-xKxFe2As2: a complementary study of the magnetic penetration depth by muon-spin rotation and angle-resolved photoemission

We investigate the magnetic penetration depth lambda in superconducting Ba1-xKxFe2As2 (Tc approximately 32 K) with muon-spin rotation (microSR) and angle-resolved photoemission (ARPES). Using microSR, we find the penetration-depth anisotropy gamma lambda=lambda c/lambda ab and the second-critical-field anisotropy gammaHc2 to show an opposite T evolution below Tc. This dichotomy resembles the situation in the two-gap superconductor MgB2. A two-gap scenario is also suggested by an inflection point in the in-plane penetration depth lambda ab around 7 K. The complementarity of microSR and ARPES allows us to pinpoint the values of the two gaps and to arrive to a remarkable agreement between the two techniques concerning the full T evolution of lambdaab. This provides further support for the described scenario and establishes ARPES as a tool to assess macroscopic properties of the superconducting condensate.

Temperature and doping-dependent renormalization effects of the low energy electronic structure of Ba1-xKxFe2As2 single crystals

We investigate the low energy electronic structure of Ba1-xKxFe2As2 (x=0; 0.3, T_{c}=32 K) single crystals by angle-resolved photoemission spectroscopy with a focus on the renormalization of the dispersion. A kink feature is detected at E approximately 25 meV for the doped compound which vanishes at T=200 K but stays virtually constant when T_{c} is crossed. Our experimental findings rule out the magnetic resonance mode as the origin of the kink and render conventional electron-phonon coupling unlikely. They put stringent restrictions on the dominant source of the electronic interaction channel.

Electronic phase separation in the slightly underdoped iron pnictide superconductor Ba1-xKxFe2As2

Here we present a combined study of the slightly underdoped novel pnictide superconductor Ba1-xKxFe2As2 by means of x-ray powder diffraction, neutron scattering, muon-spin rotation (microSR), and magnetic force microscopy (MFM). Static antiferromagnetic order sets in below T{m} approximately 70 K as inferred from the neutron scattering and zero-field-microSR data. Transverse-field microSR below Tc shows a coexistence of magnetically ordered and nonmagnetic states, which is also confirmed by MFM imaging. We explain such coexistence by electronic phase separation into antiferromagnetic and superconducting- or normal-state regions on a lateral scale of several tens of nanometers. Our findings indicate that such mesoscopic phase separation can be considered an intrinsic property of some iron pnictide superconductors.

Porphyromonas gingivalis fimbriae-dependent interleukin-6 autocrine regulation by increase of gp130 in endothelial cells

BACKGROUND AND OBJECTIVE

Local persistent infection by Porphyromonas gingivalis leads to inflammatory systemic diseases, such as atherosclerosis. We have reported previously that avirulent P. gingivalis fimbriae-dependent invasion into endothelial cells might be involved in progression of atherosclerosis. Although interleukin-6 (IL-6) regulates progression of atherosclerosis, little is known about the relationship of P. gingivalis fimbriae-dependent invasion to IL-6 regulation in endothelial cells.

MATERIAL AND METHODS

We examined the secretion of IL-6 and the expression of the IL-6 signal transducer gp130 in human umbilical vein endothelial cells (HUVEC) infected with the wild-type FDC381 strain of P. gingivalisand a fimbriae-deficient mutant (fimA) by enzyme-linked immunosorbent assay, quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and flow cytometry (fluorescence-activated cell sorting, FACS) analysis.

RESULTS

Coculture of HUVEC with P. gingivalis resulted in increase of IL-6 secretion at 24 h postinfection. Interestingly, the increase was inhibited significantly in HUVEC infected with the P. gingivalis fimA mutant. In addition, the increase of IL-6 secretion induced by P. gingivalis infection was significantly impaired by the meiosis specific kinase 1 inhibitor, PD98059, or the nuclear factor kappaB inhibitor, Bay11-7082. Furthermore, we demonstrated that gp130 expression increased with P. gingivalis infection. Importantly, gp130 expression was significantly impaired by P gingivalis fimA mutant infection compared with wild-type P. gingivalis infection, as assessed by both quantitative RT-PCR and FACS analysis.

CONCLUSION

Our findings indicate that P. gingivalis fimbriae are important factors in the autocrine regulation of IL-6, by increasing gp130 in endothelial cells.

(pi, pi) electronic order in iron arsenide superconductors

The distribution of valence electrons in metals usually follows the symmetry of the underlying ionic lattice. Modulations of this distribution often occur when those electrons are not stable with respect to a new electronic order, such as spin or charge density waves. Electron density waves have been observed in many families of superconductors, and are often considered to be essential for superconductivity to exist. Recent measurements seem to show that the properties of the iron pnictides are in good agreement with band structure calculations that do not include additional ordering, implying no relation between density waves and superconductivity in these materials. Here we report that the electronic structure of Ba(1-x)K(x)Fe(2)As(2) is in sharp disagreement with those band structure calculations, and instead reveals a reconstruction characterized by a (pi, pi) wavevector. This electronic order coexists with superconductivity and persists up to room temperature (300 K).