Pleural drainage using central venous catheters

INTRODUCTION: The objective of the present study was to evaluate the use of a single lumen 16 G central venous catheter for the drainage of uncomplicated pleural effusions in intensive care unit patients. METHODS: A prospective observational study was performed in two intensive care units of university-affiliated hospitals. The study involved 10 intensive care unit patients with non-loculated large effusions. A 16 G central venous catheter was inserted at the bedside without ultrasound guidance using the Seldinger technique. The catheter was left in situ until radiological resolution of the effusion. RESULTS: Fifteen sets of data were obtained. The mean and standard deviation of the volumes drained at 1, 6 and 24 hours post catheter insertion were 454 ± 241 ml, 756 ± 403 ml and 1010 ± 469 ml, respectively. The largest volume drained in a single patient was 6030 ml over 11 days. The longest period for which the catheter remained in situ without evidence of infection was 14 days. There were no instances of pneumothorax, hemothorax, re-expansion pulmonary edema and catheter blockage/ disconnections. CONCLUSIONS: The use of an indwelling 16 G central venous catheter is efficacious in draining uncomplicated large pleural effusions. It is well tolerated by patients and is associated with minimal complications. It has the potential to avoid repeated thoracentesis or the use of large-bore chest tubes

The effect of board structure and institutional ownership structure on earnings management

The study examines the role of outside directors and institutional shareholders in constraining the earnings management activities. A sample of 613 firms from construction, industrial products and consumer products sectors were selected from the main board. The time period covered for this study was from year 2001 to 2003. Modified Jones Model with cross sectional approach was employed in this study. The finding shows that magnitude of earnings management in Malaysian listed firms has approximately 16% of prior year total assets. Most firms manage the earnings upward rather than downwards. No relationship was observed between the degree of earnings manipulation and the proportion of outside directors and institutional shareholders. However, there is weak evidence to show that outside directors have some effect in curbing the earnings management in the construction sector. Adding more outside directors in the board and having institutional shareholders may not be able to reduce earnings management practices if the ownership of a firm is highly concentrated and the process of selecting outside directors is not clearly stated and transparent

State-related electroencephalographic deviances in attention deficit hyperactivity disorder

The dynamic security region (DSR) of bulk power system has been accepted more and more in recent years for providing plenty of security information and good prospect in online application. This paper compares three linear approximations for the dynamic security region of network-reduction power systems. The three linear approximations are the Q-linear approximation based on the quadratic approximation of stability region, the L-linear approximation based on the linear approximation of stability region and the L0-linear approximation based on the invariant assumption of the normal vector for the boundary of the stability region corresponding to different control variable. The three linear approximations are all obtained with a same critical point lying just on the boundary of dynamic security region. The critical point is searched with numerical simulation. The accuracy of the three linear approximations is compared, using the linear approximation obtained with the curve fitting approach or the actual boundary of DSR searched as the benchmark. Simulation results in IEEE 3-machine 9-bus system and 10-machine 39-bus New England system show that all the three linear approximations display fairly accurate estimation. Furthermore, from the computational viewpoint, the L-linear and the L0-linear method are two alternative choices to approximate the dynamic security region.link_to_subscribed_fulltex

E6 Protein Expressed by High-Risk HPV Activates Super-Enhancers of the EGFR and c-MET Oncogenes by Destabilizing the Histone

The high-risk (HR) human papillomaviruses (HPV) are causative agents of anogenital tract dysplasia and cancers and a fraction of head and neck cancers. The HR HPV E6 oncoprotein possesses canonical oncogenic functions, such as p53 degradation and telomerase activation. It is also capable of stimulating expression of several oncogenes, but the molecular mechanism underlying these events is poorly understood. Here, we provide evidence that HPV16 E6 physically interacts with histone H3K4 demethylase KDM5C, resulting in its degradation in an E3 ligase E6AP- and proteasome-dependent manner. Moreover, we found that HPV16-positive cancer cell lines exhibited lower KDM5C protein levels than HPV-negative cancer cell lines. Restoration of KDM5C significantly suppressed the tumorigenicity of CaSki cells, an HPV16-positive cervical cancer cell line. Whole genome ChIP-seq and RNA-seq results revealed that CaSki cells contained super-enhancers in the proto-oncogenes EGFR and c-MET. Ectopic KDM5C dampened these super-enhancers and reduced the expression of proto-oncogenes. This effect was likely mediated by modulating H3K4me3/H3K4me1 dynamics and decreasing bidirectional enhancer RNA transcription. Depletion of KDM5C or HPV16 E6 expression activated these two super-enhancers. These results illuminate a pivotal relationship between the oncogenic E6 proteins expressed by HR HPV isotypes and epigenetic activation of super-enhancers in the genome that drive expression of key oncogenes like EGFR and c-MET. Significance: This study suggests a novel explanation for why infections with certain HPV isotypes are associated with elevated cancer risk by identifying an epigenetic mechanism through which E6 proteins expressed by those isotypes can drive expression of key oncogenes.</p

The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis.

Background Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. Purpose We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI. Data source We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI. Study selection Two authors independently reviewed the studies for eligibility. Data extraction Data about studies characteristics, adjusted effect estimates and quality were extracted. Data synthesis Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22–1.7), I2 = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15–1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097). Conclusion In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics

Production of poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) by Ralstonia eutropha in high cell density palm oil fermentations

Improved production costs will accelerate commercialization of polyhydroxyalkanoate (PHA) polymer and PHA-based products. Plant oils are considered favorable feedstocks, due to their high carbon content and relatively low price compared to sugars and other refined carbon feedstocks. Different PHA production strategies were compared using a recombinant strain of Ralstonia eutropha that produces high amounts of P(HB-co-HHx) when grown on plant oils. This R. eutropha strain was grown to high cell densities using batch, extended batch, and fed batch fermentation strategies, in which PHA accumulation was triggered by nitrogen limitation. While extended batch culture produced more biomass and PHA than batch culture, fed batch cultivation was shown to produce the highest levels of biomass and PHA. The highest titer achieved was over 139 g/L cell dry weight (CDW) of biomass with 74% of CDW as PHA containing 19mol% HHx. Our data suggest that the fermentation process is scalable with a space time yield (STY) better than 1 g PHA/L/h. The achieved biomass concentration and PHA yield are among the highest reported for the fermentation of recombinant R. eutropha strains producing P(HB-co-HHx).Malaysia-MIT Biotechnology Partnership Programm

Is an image-based eyelid management service safe and effective?

Introduction: The COVID-19 pandemic created a requirement for reduced patient contact and reduced capacity in clinics. We previously published results of an Image-Based Eyelid Lesion Management Service (IBELMS) which was found non-inferior to traditional face-to-face clinic at diagnosing lesions and identifying eyelid malignancies. We now present first-year safety and efficacy data from this service. Methods: Data were collected retrospectively on all patients seen in NHS Greater Glasgow and Clyde eyelid photography clinics from 30th September 2020 to 29th September 2021, including referral source and diagnosis, time to clinic review, treatment and patient outcomes. Results: 808 patients were included in the study. Chalazion was the most common diagnoses recorded (38.4%). There was a statistically significant decrease in mean time from referral to appointment time between the first 4 months and last 4 months of the service (93 days to 22 days, p ≤ 0.0001). 266 (33%) of patients were discharged following photographs, 45 (6%) were discharged for non-attendance and 371 (46%) were booked for a minor procedure. 13 biopsy-confirmed malignant lesions were identified; only 3 had been referred as suspected malignancy. 23 patients out of 330 with at least 6 months follow up (7%) were re-referred within 6 months of treatment or discharge; however, none of them with a missed periocular malignancy. Discussion: Eyelid photography clinics effectively reduce patient waiting times and maximise clinic capacity. They accurately identify eyelid lesions including malignancies with a low re-referral rate. We propose that an image-based service for eyelid lesions is a safe and effective way of managing such patients

Optimized code design for constrained DNA data storage with asymmetric errors

With ultra-high density and preservation longevity, deoxyribonucleic acid (DNA)-based data storage is becoming an emerging storage technology. Limited by the current biochemical techniques, data might be corrupted during the processes of DNA data storage. A hybrid coding architecture consisting of modified variable-length run-length limited (VL-RLL) codes and optimized protograph low-density parity-check (LDPC) codes is proposed in order to suppress error occurrence and correct asymmetric substitution errors. Based on the analyses of the different asymmetric DNA sequencer channel models, a series of the protograph LDPC codes are optimized using a modified extrinsic information transfer algorithm (EXIT). The simulation results show the better error performance of the proposed protograph LDPC codes over the conventional good codes and the codes used in the existing DNA data storage system. In addition, the theoretical analysis shows that the proposed hybrid coding scheme stores ~1.98 bits per nucleotide (bits/nt) with only 1% gap from the upper boundary (2 bits/nt)