Perioperative Stroke Following General Surgery

AbstractPerioperative stroke is rare; however, patients undergoing cardiovascular surgery are considered to be at high risk for perioperative stroke. Here, we outline a case where perioperative stroke occurred following total hip replacement surgery. The risk factors and possible causes of the stroke in this patient are discussed. In addition, we reiterate the appropriate management approaches needed to prevent perioperative stroke. Briefly, the importance of precise preoperative evaluation and of proper intraoperative and postoperative management should not be overlooked. Finally, it is important to realize that decreasing perioperative strokes and the disabilities associated with them will lower the financial burden on families and the community

Web Services for forward integration in international tourism supply chains: A case study of tourism in Thailand

International tourism is a highly competitive and information-intensive industry. Customers need volumes of information for decision aids. Moreover, the decision-making processes are quite sensitive to the variables of personal preferences, the tourist industrial ecosystem, the legal regulations and political environments of destinations, the regional or global economic situations, the natural matters, and so on. Hence, the owners of tourism are motivated to upgrade the competitiveness of their businesses with information technologies. This paper intends to design the architecture of Web Services in international tourism, which can contribute to the forward integration in international tourism supply chains. First, the authors conduct an in-depth case study of a regional tour operator in Thailand. In the case study, we examine the strength, weakness, challenges visions, and strategic approaches of international tourism, and their relationships with the information systems in the tourist business. Then, this paper designs the architecture of Web Services in international tourism. The architecture is expected to improve the information transparency through the global tourism supply chain, construct business-to-business collaboration mechanism, provide efficient and effective information to tourists, and consequently contribute to forward integration in international tourism supply chains

Regulation of CLC-1 chloride channel biosynthesis by FKBP8 and Hsp90β.

Mutations in human CLC-1 chloride channel are associated with the skeletal muscle disorder myotonia congenita. The disease-causing mutant A531V manifests enhanced proteasomal degradation of CLC-1. We recently found that CLC-1 degradation is mediated by cullin 4 ubiquitin ligase complex. It is currently unclear how quality control and protein degradation systems coordinate with each other to process the biosynthesis of CLC-1. Herein we aim to ascertain the molecular nature of the protein quality control system for CLC-1. We identified three CLC-1-interacting proteins that are well-known heat shock protein 90 (Hsp90)-associated co-chaperones: FK506-binding protein 8 (FKBP8), activator of Hsp90 ATPase homolog 1 (Aha1), and Hsp70/Hsp90 organizing protein (HOP). These co-chaperones promote both the protein level and the functional expression of CLC-1 wild-type and A531V mutant. CLC-1 biosynthesis is also facilitated by the molecular chaperones Hsc70 and Hsp90β. The protein stability of CLC-1 is notably increased by FKBP8 and the Hsp90β inhibitor 17-allylamino-17-demethoxygeldanamycin (17-AAG) that substantially suppresses cullin 4 expression. We further confirmed that cullin 4 may interact with Hsp90β and FKBP8. Our data are consistent with the idea that FKBP8 and Hsp90β play an essential role in the late phase of CLC-1 quality control by dynamically coordinating protein folding and degradation

Effects of a simulation-based blended training model on nurses’ treatment decision-related knowledge about oral cancer in Taiwan: a pilot survey

The present study aimed to evaluate the effects of virtual reality (VR) simulations combined with bedside assignments on nurses’ self-efficacy in providing pre-treatment educational services. Between March 2019 and November 2020, we conducted a study of VR educational materials that were developed to cover information about the treatment of oral cancers. The effects of the VR simulation, the thinking-path tracking map method, and bedside assignments on the nurses’ treatment decision-related knowledge were evaluated in a ward for oral cancer patients at Taipei Veterans General Hospital, Taipei, Taiwan. The blended training model significantly increased nurses’ familiarity (P<0.01) and confidence (P<0.03) regarding their knowledge of treatments and treatment decision-related knowledge. This model also significantly increased their confidence in their skills in bedside pre-treatment education for admitted oral cancer patients (P<0.002). Oral cancer-specific VR materials enhanced the effectiveness of skills training among nurses in the oral cancer ward

Future change in extreme precipitation in East Asian spring and Mei-yu seasons in two high-resolution AGCMs

Precipitation in the spring and Mei-yu seasons, the main planting and growing period in East Asia, is crucial to water resource management. Changes in spring and Mei-yu extreme precipitation under global warming are evaluated based on two sets of high-resolution simulations with various warming pattern of sea surface temperature (SST'spa). In the spring season, extreme precipitation exhibits larger enhancements over the northern flank of the present-day prevailing rainy region and a tendency of increased occurrence and enhanced intensity in the probability distribution. These changes imply a northward extension of future spring rainband. Although the mean precipitation shows minor change, enhanced precipitation intensity, less total rainfall occurrence, and prolonged consecutive dry days suggest a more challenging water resource management in the warmer climate. The projected enhancement in precipitation intensity is robust compared with the internal variability related to initial conditions (σˆint) and the uncertainty caused by SST'spa (σˆΔSST). In the Mei-yu season, extreme precipitation strengthens and becomes more frequent over the present-day prevailing rainband region. The thermodynamic component of moisture flux predominantly contributes to the changes in the spring season. In the Mei-yu season, both the thermodynamic and dynamic components of moisture flux enhance the moisture transport and intensify the extreme precipitation from southern China to northeast Asia. Compared with spring season, projecting future Mei-yu precipitation is more challenging because of its higher uncertainty associated with 1) the σˆint and σˆΔSST embedded in the projections and 2) the model characteristics of present-day climatology that determines the spatial distribution of precipitation enhancement.publishedVersio

LrrA, a novel leucine-rich repeat protein involved in cytoskeleton remodeling, is required for multicellular morphogenesis in Dictyostelium discoideum

AbstractCell sorting by differential cell adhesion and movement is a fundamental process in multicellular morphogenesis. We have identified a Dictyostelium discoideum gene encoding a novel protein, LrrA, which composes almost entirely leucine-rich repeats (LRRs) including a putative leucine zipper motif. Transcription of lrrA appeared to be developmentally regulated with robust expression during vegetative growth and early development. lrrA null cells generated by homologous recombination aggregated to form loose mounds, but subsequent morphogenesis was blocked without formation of the apical tip. The cells adhered poorly to a substratum and did not form tight cell–cell agglomerates in suspension; in addition, they were unable to polarize and exhibit chemotactic movement in the submerged aggregation and Dunn chamber chemotaxis assays. Fluorescence-conjugated phalloidin staining revealed that both vegetative and aggregation competent lrrA− cells contained numerous F-actin-enriched microspikes around the periphery of cells. Quantitative analysis of the fluorescence-stained F-actin showed that lrrA− cells exhibited a dramatically increase in F-actin as compared to the wild-type cells. When developed together with wild-type cells, lrrA− cells were unable to move to the apical tip and sorted preferentially to the rear and lower cup regions. These results indicate that LrrA involves in cytoskeleton remodeling, which is needed for normal chemotactic aggregation and efficient cell sorting during multicellular morphogenesis, particularly in the formation of apical tip

Dreyfus scale-based feedback increased medical students’ satisfaction with the complex cluster part of a interviewing and physical examination course and improved skills readiness in Taiwan

Purpose In contrast to the core part of the clinical interviewing and physical examination (PE) skills course, corresponding to the basic, head-to-toe, and thoracic systems, learners need structured feedback in the cluster part of the course, which includes the gastrointestinal, neuromuscular, and musculoskeletal systems. This study evaluated the effects of using Dreyfus scale-based feedback, which has elements of continuous professional development, instead of Likert scale-based feedback in the cluster part of training in Taiwan. Methods Instructors and final-year medical students in the 2015–2016 classes of National Yang-Ming University, Taiwan comprised the regular cohort, whereas those in the 2017–2018 classes formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback, rather than Likert scale-based feedback, was used in the cluster part of the course. Results In the cluster part of the course in the regular cohort, pre-trained standardized patients rated the class climate as poor, and students expressed low satisfaction with the instructors and course and low self-assessed readiness. In comparison with the regular cohort, improved end-of-course group objective structured clinical examination scores after the cluster part were noted in the intervention cohort. In other words, the implementation of Dreyfus scale-based feedback in the intervention cohort for the cluster part improved the deficit in this section of the course. Conclusion The implementation of Dreyfus scale-based feedback helped instructors to create a good class climate in the cluster part of the clinical interviewing and PE skills course. Simultaneously, this new intervention achieved the goal of promoting medical students’ readiness for interviewing, PE, and self-directed learning