Use of functional MRI to evaluate correlation between acupoints and brain cortex activites: comparison between conventional and electrical acupuncture

The use of acupuncture therapy in various functional disorders goes back several thousand years in China. Recendy, acupuncture becomes a 'hot' topic in the functional Magnetic Resonance (MR) imaging research studies [1-4]. A majority of these research projects is to study die correlation between the acupuncture points (acupoints) and die corresponding brain cortices, either by conventional acupuncture, electro-acupuncture or laser acupuncture. Cho et al reported mat by stimulating die vision-related acupoints (BL60, BL65, BL66, BL67) at the lateral side of die foot, neural response (i.e. high signal) was obtained at die visual cortex [1]. In this study, we verified Cho et al acupoints using conventional acupuncture and electro-acupuncture.published_or_final_versio

Proton Density-weighted Spinal fMRI Comparison between Sensorimotor Task and Acupoint Stimulation

Proton density-weighted fMRI studies have been carried out in spinal cord in the current study. We compared the spinal cord activation produced by handgripping sensorimotor task and electro-acupuncture stimulation. Activation was detected in both cases localized at spinal levels C6-C7 (11/14 in sensorimotor and 7/11 in acupuncture stimulation). It was observed that the amount of activation in sensorimotor task was in general greater than in electroacupuncture stimulation. The percentage signal changes were found to be similar. Our results indicate that proton density-weighted fMRI in low field MRI system can be used for sensorimotor and acupuncture pathway research.published_or_final_versio

Employees’ behavior in phishing attacks: what individual, organizational and technological factors matter?

Phishing, as a social engineering attack has become an increasing threat to organizations in cyberspace. To prevent this, a well-designed continuous security training and educational program needs to be established and enforced in organizations. Prior studies have focused on phishing attack from a limited view of technology countermeasure, e-mail’s characteristic, information processing, and securing individual’s behaviors to tackle existing gaps. In this research, we developed a theoretical model of factors that influence users in the clicking of phishing e-mails from a broader Socio-Technical perspective. We applied Protection Motivation Theory (PMT) and habit theory for investigating individual factors, Theory of Planned Behavior (TPB) and Deterrence Theory for investigating organizational and technological factors accordingly. The findings revealed habit and protective countermeasure positively affect clicking on phishing e-mails, whereas, no effect of the procedural countermeasures was evident. The results of this study can be used to design phishing simulation exercise and embedded training for vulnerable employees

Performance of the new automated Abbott RealTime MTB assay for rapid detection of Mycobacterium tuberculosis complex in respiratory specimens

The automated high-throughput Abbott RealTime MTB real-time PCR assay has been recently launched for Mycobacterium tuberculosis complex (MTBC) clinical diagnosis. This study would like to evaluate its performance. We first compared its diagnostic performance with the Roche Cobas TaqMan MTB assay on 214 clinical respiratory specimens. Prospective analysis of a total 520 specimens was then performed to further evaluate the Abbott assay. The Abbott assay showed a lower limit of detection at 22.5 AFB/ml, which was more sensitive than the Cobas assay (167.5 AFB/ml). The two assays demonstrated a significant difference in diagnostic performance (McNemar’s test; P = 0.0034), in which the Abbott assay presented significantly higher area under curve (AUC) than the Cobas assay (1.000 vs 0.880; P = 0.0002). The Abbott assay demonstrated extremely low PCR inhibition on clinical respiratory specimens. The automated Abbott assay required only very short manual handling time (0.5 h), which could help to improve the laboratory management. In the prospective analysis, the overall estimates for sensitivity and specificity of the Abbott assay were both 100 % among smear-positive specimens, whereas the smear-negative specimens were 96.7 and 96.1 %, respectively. No cross-reactivity with non-tuberculosis mycobacterial species was observed. The superiority in sensitivity of the Abbott assay for detecting MTBC in smear-negative specimens could further minimize the risk in MTBC false-negative detection. The new Abbott RealTime MTB assay has good diagnostic performance which can be a useful diagnostic tool for rapid MTBC detection in clinical laboratories. © 2015, Springer-Verlag Berlin Heidelberg.postprin

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The sustainability dilemma of China's township and village enterprises: an analysis from spatial and functional perspectives

The spectacular development of China's township and village enterprises (TVEs) has been highly praised by both Chinese and western scholars. The TVEs and rural non-agricultural sector were widely regarded as the most dynamic sector in the Chinese economy during the reform era. However, such a successful story and optimistic view had changed tone since 1997, seemingly from the robust boom to a deep recession. Evidently, China's present TVEs development must be confronted by deep-seated problems that created the fundamental sustainability dilemma. To better understand China's unusual process of TVEs development, this paper focuses on the sustainability dilemma from the functional and spatial perspectives. It analyses the internal conflicts between TVEs development and agricultural production and explains why the present mode of China's TVEs development cannot be sustained. Within the rural economy, agricultural production and the TVEs themselves have created severe conflicts that have led to a fundamental sustainability dilemma: further encouragement of TVEs or maintaining a stable agricultural output, especially of food supply. The underlying causes for the sustainability dilemma are diagnosed, primarily based on a consideration of functional and spatial division. The paper argues that the conflict is inevitable due to the dysfunctional nature created by TVEs in the rural sector. That is, farmers simultaneously perform two different functions: agriculture and industry, both of which should be functionally and spatially separated. According to Lewis's Two-sector Structural-change Model, this paper attempts to seek a possible solution that aims at an overall functional clarification between the urban and rural sectors. © 2002 Elsevier Science Ltd. All rights reserved.link_to_subscribed_fulltex

SLEEP fMRI of the spinal cord

Conference Theme: Integrating Science and Technology in the Healthcare IndustrySection D2 - Medical imaging: no. D2-