A global bifurcation theorem for a multiparameter positone problem and its application to the one-dimensional perturbed Gelfand problem

We study the global bifurcation and exact multiplicity of positive solutions for u 00(x) + λ fε(u) = 0, − 1 0 is a bifurcation parameter, ε ∈ Θ is an evolution parameter, and Θ ≡ (σ1, σ2) is an open interval with 0 ≤ σ1 < σ2 ≤ ∞. Under some suitable hypotheses on fε , we prove that there exists ε0 ∈ Θ such that, on the (λ, kuk∞)-plane, the bifurcation curve is S-shaped for σ1 < ε < ε0 and is monotone increasing for ε0 ≤ ε < σ2. We give an application to prove global bifurcation of bifurcation curves for the one-dimensional perturbed Gelfand problem

Hepatocellular carcinoma detected by regular surveillance: Does timely confirmation of diagnosis matter?

AbstractBackgroundAlthough current guidelines recommended surveillance of hepatocellular carcinoma, prognosis in patients undergoing enhanced follow-up has yet to be evaluated.AimsExamine outcomes of hepatocellular carcinoma diagnosed during enhanced follow-up.MethodsDuring 2010–2012, 194 patients underwent ultrasonography surveillance were diagnosed with hepatocellular carcinoma and divided into: (A) immediate diagnosis (N=105, 54.1%) after positive ultrasonography, (B) enhanced follow-up: (N=38, 19.6%) for initial negative recall procedures, (C) late call back: (N=28, 14.4%) recall procedures were deferred after positive ultrasonography, and (D) beyond ultrasonography: (N=23, 11.9%) surveillance ultrasonography had been negative.ResultsMedian time from positive ultrasonography to confirmation of hepatocellular carcinoma were 9.5 months (2–67) in the Group B and 6.5 months (3–44) in the Group C. Stage distribution and 3-year survival rates were similar amongst all Groups. Surveillance intervals longer than 6 months were associated with the non-curative stage (3.7% vs. 12.5%, p=0.04). Nine (4.6%) patients underwent surveillance were diagnosed as Barcelona-Clinic Liver Cancer stage C.ConclusionEnhanced follow-up by current guidelines is appropriate that treatment can be deferred until a definite diagnosis. Despite optimal surveillance interval and recall policies, few non-curative stage diagnoses seemed inevitable under current standard of care

Abdominal Compartment Syndrome

Abdominal compartment syndrome (ACS) is a progressively increasing intraabdominal pressure of more than 20 mm Hg with new-onset thoracoabdominal organ dysfunction. Primary abdominal compartment syndrome means increased pressure due to injury or disease in the abdominopelvic region. Secondary abdominal compartment syndrome means disease originating from outside the abdomen, such as significant burns or sepsis. As the pressure inside the abdomen increases, organ failure occurs, and the kidneys and lungs are the most frequently affected. Managements of ACS are multidisciplinary. Conservative treatment with adequate volume supple and with aggressive hemodynamic support is the first step. Decompressive laparotomy with open abdomen is indicated when ACS is refractory to conservative treatment and complicated with multiple organ failure. ACS can result in a high mortality rate, and successful treatment requires cooperation between physicians, intensivists, and surgeons

The Evolution of Diffuse Radio Sources in Galaxy Clusters

We investigate the evolution and number distribution of radio halos in galaxy clusters. Without re-acceleration or regeneration, the relativistic electrons responsible for the diffuse radio emission will lose their energy via inverse-Compton and synchrotron losses in a rather short time, and radio halos will have lifetimes $\sim$ 0.1 Gyr. Radio halos could last for $\sim$ Gyr if a significant level of re-acceleration is involved. The lifetimes of radio halos would be comparable with the cosmological time if the radio-emitting electrons are mainly the secondary electrons generated by pion decay following proton-proton collisions between cosmic-ray protons and the thermal intra-cluster medium within the galaxy clusters. Adopting both observational and theoretical constraints for the formation of radio halos, we calculate the formation rates and the comoving number density of radio halos in the hierarchical clustering scheme. Comparing with observations, we find that the lifetimes of radio halos are $\sim$ Gyr. Our results indicate that a significant level of re-acceleration is necessary for the observed radio halos and the secondary electrons may not be a dominant origin for radio halos.Comment: 22 pages, 6 figures, ApJ, in press (v2:Corrected typos.

A global bifurcation theorem for a multiparameter positone problem and its application to the one-dimensional perturbed Gelfand problem

We study the global bifurcation and exact multiplicity of positive solutions for u 00(x) + λ fε(u) = 0, − 1 0 is a bifurcation parameter, ε ∈ Θ is an evolution parameter, and Θ ≡ (σ1, σ2) is an open interval with 0 ≤ σ1 < σ2 ≤ ∞. Under some suitable hypotheses on fε , we prove that there exists ε0 ∈ Θ such that, on the (λ, kuk∞)-plane, the bifurcation curve is S-shaped for σ1 < ε < ε0 and is monotone increasing for ε0 ≤ ε < σ2. We give an application to prove global bifurcation of bifurcation curves for the one-dimensional perturbed Gelfand problem

Exploring the heterogeneity of effects of corticosteroids on acute respiratory distress syndrome: a systematic review and meta-analysis

INTRODUCTION: The effectiveness of corticosteroid therapy on the mortality of acute respiratory distress syndrome (ARDS) remains under debate. We aimed to explore the grounds for the inconsistent results in previous studies and update the evidence. METHODS: We searched MEDLINE, Cochrane Central Register of Controlled Trials and Web of Science up to December 2013. Eligible studies included randomized clinical trials (RCTs) and cohort studies that reported mortality and that had corticosteroid nonusers for comparison. The effect of corticosteroids on ARDS mortality was assessed by relative risk (RR) and risk difference (RD) for ICU, hospital, and 60-day mortality using a random-effects model. RESULTS: Eight RCTs and 10 cohort studies were included for analysis. In RCTs, corticosteroids had a possible but statistically insignificant effect on ICU mortality (RD, −0.28; 95% confidence interval (CI), −0.53 to −0.03 and RR, 0.55; 95% CI, 0.24 to 1.25) but no effect on 60-day mortality (RD, −0.01; 95% CI, −0.12 to 0.10 and RR, 0.97; 95% CI, 0.75 to 1.26). In cohort studies, corticosteroids had no effect on ICU mortality (RR, 1.05; 95% CI, 0.74 to 1.49) but non-significantly increased 60-day mortality (RR, 1.30; 95% CI, 0.96 to 1.78). In the subgroup analysis by ARDS etiology, corticosteroids significantly increased mortality in influenza-related ARDS (three cohort studies, RR, 2.45, 95% CI, 1.40 to 4.27). CONCLUSIONS: The effects of corticosteroids on the mortality of ARDS differed by duration of outcome measures and etiologies. Corticosteroids did not improve longer-term outcomes and may cause harm in certain subgroups. Current data do not support routine use of corticosteroids in ARDS. More clinical trials are needed to specify the favorable and unfavorable subgroups for corticosteroid therapy

Persistent surgical wound bleeding: A rare condition related to acquired hemophilia A

SummaryAcquired hemophilia A (AHA) is a rare condition that predisposes affected patients to a bleeding tendency, even after a trivial physical insult. We present our experience with a 45-year-old male patient who was referred to our institute because of persistent bleeding from a left forearm surgical wound after fasciotomy. He was diagnosed as having AHA. Surgical treatment in combination with recombinant activated factor VII (rFVIIa) led to a satisfactory result. Clinical awareness and multidisciplinary professional connections are necessary in the treatment of AHA. Acquired hemophilia should be considered in the differential diagnosis of patients with uncontrolled bleeding episodes

Application of 2,3-Naphthalenediamine in Labeling Natural Carbohydrates for Capillary Electrophoresis

Neutral and acidic monosaccharide components in &lt;em&gt;Ganoderma lucidum&lt;/em&gt; polysaccharide are readily labeled with 2,3-naphthalenediamine, and the resulting saccharide-naphthimidazole (NAIM) derivatives are quantified by capillary electrophoresis (CE) in borate buffer. Using sulfated-α-cyclodextrin as the chiral selector, enantiomers of monosaccharide-NAIMs are resolved on CE in phosphate buffer, allowing a simultaneous determination of the absolute configuration and sugar composition in the mucilage polysaccharide of a medicinal herb&lt;em&gt; Dendrobium&lt;/em&gt; &lt;em&gt;huoshanense&lt;/em&gt;. Together with the specific enzymatic reactions of various glycoside hydrolases on the NAIM derivatives of glycans, the structures of natural glycans can be deduced from the digestion products identified by CE analysis. Though heparin dissachrides could be successfully derived with the NAIM-labeling method, the heparin derivatives with the same degree of sulfation could not be separated by CE

Serum Bone Resorption Markers after Parathyroidectomy for Renal Hyperparathyroidism: Correlation Analyses for the Cross-Linked N-telopeptide of Collagen I and Tartrate-Resistant Acid Phosphatase

Patients on long-term dialysis may develop secondary hyperparathyroidism (SHPT) with increased serum concentrations of bone resorption markers such as the cross-linked N-telopeptide of type I collagen (NTX) and type-5b tartrate-resistant acid phosphatase (TRAP). When SHPT proves refractory to treatment, parathyroidectomy (PTX) may be needed. Renal patients on maintenance HD who received PTX for refractory SHPT (n=23) or who did not develop refractory SHPT (control subjects; n=25) were followed prospectively for 4 weeks. Serum intact parathyroid hormone (iPTH), NTX, TRAP, and bone alkaline phosphatase (BAP) concentrations were measured serially and correlation analyses were performed. iPTH values decreased rapidly and dramatically. BAP values increased progressively with peak increases observed at 2 weeks after surgery. NTX and TRAP values decreased concurrently and progressively through 4 weeks following PTX. A significant correlation between TRAP and NTX values was observed before PTX but not at 4 weeks after PTX. Additionally, the fractional changes in serum TRAP were larger than those in serum NTX at all times examined after PTX. Serum iPTH, TRAP, and NTX values declined rapidly following PTX for SHPT. Serum TRAP values declined to greater degrees than serum NTX values throughout the 4-week period following PTX

Total white blood cell count or neutrophil count predict ischemic stroke events among adult Taiwanese: report from a community-based cohort study

BACKGROUND: Evidence about whether white blood cell (WBC) or its subtypes can act as a biomarker to predict the ischemic stroke events in the general population is scanty, particularly in Asian populations. The aim of this study is to establish the predictive ability of total WBC count or subtypes for long-term ischemic stroke events in the cohort population in Taiwan. METHODS: The Chin-Shan Community Cohort Study began from 1990 to 2007 by recruiting 1782 men and 1814 women of Chinese ethnicity. Following a total of 3416 participants free from ischemic stroke events at baseline for a median of 15.9 years; we documented 187 new incident cases. RESULTS: The multivariate relative risk for the comparison of the participants in the fifth and first WBC count quintiles was 1.67 (95% confidence interval [CI], 1.02–2.73; P for trend=0.03), and the corresponding relative risk for neutrophil count was 1.93 (95% CI, 1.13–3.29; P for trend=0.02). The discriminative ability by WBC and neutrophil counts were similar (area under the receiver operating characteristic curve, 0.600 for adding WBC, 0.610 for adding neutrophils, 0.595 for traditional risk factor model). In addition, the net reclassification improvement (NRI) values between the neutrophil and white blood cell count models were not significant (NRI, =-2.60%, P=0.35), indicating the similar discrimination performance for both WBC and neutrophil counts. CONCLUSIONS: WBC and neutrophil count had a similar ability to predict the long-term ischemic stroke events among Taiwanese