Hospital length of stay was significantly shorter for patients undergoing single intraoperative TAP block injection with any analgesic as compared with standard narcotic-based protocols (mean difference= -0.95 days; 95% CI -1.72 to -0.17 days; p = 0.02). Looking at TAP blocks specifically with LB, there was a mean decrease of 0.83 days as compared with the control, which was not statistically significant (95% CI -1.90 to 0.25 days; p = 0.13). CONCLUSION  While the current data support the use of TAP blocks in autologous breast reconstruction, additional studies with more standardized protocols should be performed to determine the most optimal practice. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.A personal memory of the Biophysical Society of Japan 45 years ago is described by a senior member of the society.OBJECTIVES To determine whether levetiracetam is an alternative to fosphenytoin to control Benzodiazepine Refractory Status Epilepticus (BRSE) in pediatric population and also to compare the acute drug related side-effects and ventilation requirement among the both arms of anti-epileptic drug therapy. METHODS All consecutive children admitted with BRSE were randomized to group A, who received fosphenytoin at 20 mg/kg phenytoin equivalents (PE) dose and group B who received levetiracetam at 40 mg/kg over 10 min. Time to terminate seizure (response latency) was measured. If seizure remained refractory after 20 min of test drug administration, appropriate drug escalation was made according to pediatrician's discretion. All primary and secondary outcome measures were compared between the two therapeutic groups. RESULTS Of 61 children enrolled over 18 mo period, 29 (47.5%) were randomized to group A and 32 (52.5%) were randomized to Group B. Baseline characteristics were comparable between the two groups. Among 61 children, 58(98%) required Pediatric Intensive Care Unit (PICU) admission and among those 5(8.2%) children required mechanical ventilation. Duration of PICU stay, hospital stay, the response latency and seizure recurrence were compared between both groups. Significant number of children received additional anti-epileptic drugs (AEDs) in fosphenytoin group [9/29(31%)] compared to levetiracetam group [2/32(7%)] to control seizure. CONCLUSIONS Levetiracetam may be an effective alternative to fosphenytoin in management of BRSE in children but multicentric trials with large sample size are needed to substantiate this observation.OBJECTIVE The World Health Organization recommends that infants unable to feed directly at the breast in low resource settings be cup fed with hand expressed breastmilk. No standard feeding cup exists. The aim of this study was to evaluate the design of the Nifty cup, a newly designed feeding cup, as compared to the paladai and to assess acceptability among mothers and health care providers. METHODS This study was conducted at Sri Ramachandra Medical Center and Research Institute in Chennai. Eligible caregivers were primary caregivers of infants who were less than 12 mo old, born prematurely or with an oral cleft, and who were fed by cup. Health care providers who prescribed cup feeding for infants at least 4 times in the past year were also eligible. Caregivers and health care providers fed each infant with a paladai and a Nifty cup. They completed an interviewer-administered survey. The design and acceptability parameters of the Nifty cup were compared to those of paladai using a Wilcoxon signed rank test. RESULTS Forty three caregivers and 28 health care providers were enroled. Among caregivers, the Nifty cup as compared to the paladai was less problematic on most parameters including spillage, regurgitation, difficulty in use, and duration of feeding (all p-values less then 0.01). Findings were similar for health care providers. CONCLUSIONS The Nifty cup is a promising feeding cup for feeding infants with breastfeeding difficulties to support growth and nutrition.The respiration rate (RR) is a vital sign in physiological measurement and clinical diagnosis. RR can be measured using stretchable and wearable strain gauge sensors which detect the respiratory movements in the abdomen or thorax areas caused by volumetric changes. In different body locations, the accuracy of RR detection might differ due to different respiratory movement amplitudes. Few studies have quantitatively investigated the effect of the measurement location on the accuracy of new sensors in RR detection. Using a stretchable and wearable inkjet-printed strain gauge (IPSG) sensor, RR was measured from five body locations (umbilicus, upper abdomen, xiphoid process, upper thorax, and diagonal) on 30 healthy test subjects while sitting on an armless chair. At each location, reference RR was simultaneously detected by the e-Health sensor, and the measurement was repeated twice. Subjects were asked about the comfortableness of locations. Based on Levene's test, ANOVA was performed to investigate if there is a significant difference in RR between sensors, measurement locations, and two repeated measurements. Bland-Altman analysis was applied to the RR measurements at different locations. The effects of measurement site and measurement trials on RR difference between sensors were also investigated. There was no significant difference between IPSG and reference sensors, between any locations, and between the two measurements (all p > 0.05). As to the RR deviation between IPSG and reference sensors, there was no significant difference between any locations, or between two measurements (all p > 0.05). All the 30 subjects agreed that diagonal and upper thorax positions were the most uncomfortable and most comfortable locations for measurement, respectively. The IPSG sensor could accurately detect RR at five different locations with good repeatability. Upper thorax was the most comfortable location.PURPOSE Recent guidelines on adrenal incidentalomas suggested in patients with an indeterminate adrenal mass and no significant hormone excess that follow up with a repeat noncontrast CT or MRI after 6-12 months may be an option. METHODS We report the case of a 32-year-old woman who presented with a 2.9 × 1.9 cm left adrenal incidentaloma that was stable in size for 4 years. Ten years later the left adrenal mass was a stage IV adrenocortical carcinoma (ACC). RESULTS In 2006, a 32-year-old French Canadian woman was referred to endocrinology for a left 2.9 × 1.9 cm incidentally discovered adrenal mass (31 HU). She had normal hormonal investigation. The patient was followed with adrenal imaging and hormonal investigation yearly for 4 years and the lesion stayed stable in size over the 4 years. Ten years later, in 2016, the patient presented with renal colic. Urological CT unexpectedly revealed that the left adrenal mass was now measuring 9 × 8.2 cm and 2 new hepatic lesions were found. Biochemical workup demonstrated hypercorticism and hyperandrogenemia plasma cortisol after 1 mg overnight DST of 476 nmol/L and DHEA-S of 14.0 μmol/L (N 0.9-6.5). Twenty-four hour urine steroid profiling was consistent with an adrenocortical carcinoma (ACC) co-secreting cortisol, androgens and glucocorticoid precursors. The diagnosis of ACC with hepatic ACC metastases was confirmed at histology. Following genetic analysis, germline heterozygous variant of uncertain significance (VUS) was identified in the exon 16 of the APC gene (c.2414G > A, p.Arg805Gln). https://www.selleckchem.com/products/5-ethynyl-2--deoxyuridine.html Immunohistochemical staining's of the ACC was positive for IGF-2 and cytoplasmic/nuclear β-catenin staining. CONCLUSIONS This case illustrates that (1) small adrenal incidentaloma stable in size may evolve to ACC and (2) better genetic characterization of these patients may eventually give clues on this unusual evolution.BACKGROUND In recent years, long noncoding RNAs (LncRNAs) have been found to play an important role in type 2 diabetes mellitus. However, research on the relationship between LncRNAs and prediabetes is still emerging. OBJECTIVES The study aim was to screen differently expressed LncRNAs and understand their localization and function in patients with prediabetes. METHODS We used microarray analysis to screen LncRNAs in prediabetes participants.To further clarify the localization and function of the expressed mRNAs, we used gene ontology analysis and pathway analysis. Then, internal validations were performed using individual quantitative real-time polymerase chain reaction (qRT-PCR) assays. RESULTS We identified 55 differently expressed LncRNAs and 36 mRNAs in prediabetes participants comparing with controls. Gene ontology analysis indicated that the most enriched transcript terms were multicellular organismal process, plasma membrane, and binding. Pathway analysis indicated that the differently expressed mRNAs were involved in processes such as starch and sucrose metabolism, pantothenate and coenzyme A biosynthesis, and nicotinate and nicotinamide metabolism. The qRT-PCR results showed a trend consistent with the microarray results in 30 patients and 30 healthy controls. CONCLUSIONS We found aberrantly expressed LncRNAs and mRNAs in prediabetes subjects, and demonstrated that these LncRNAs are involved in the entire prediabetes biological process.Berberine (BBR) is routinely prescribed in many Asian countries to treat diarrhea. Evidence from both animal and clinical investigations suggests that BBR exerts diverse pharmacological activities, including antidiabetic, antineoplastic, antihypertensive, and antiatherosclerotic effects. This study aimed to explore the cardioprotective mechanisms of BBR and to elucidate the modulations between autophagy and mitochondrial function during hypoxia/reoxygenation (H/R) in H9c2 cells. The degree of autophagic flux was assessed by pretreating H9c2 cells with BBR prior to H/R exposure and measuring the expression levels of Beclin-1 and green fluorescent protein (GFP)-labeled LC3B fusion proteins as well as the LC3II/LC3I ratio. The mitochondrial membrane potential (△Ψm) in H9c2 cells was evaluated by detecting rhodamine-123 fluorescence using flow cytometry. The results revealed that pretreatment with BBR upregulated autophagic flux and protected against the loss of the △Ψm in H9c2 cells subjected to H/R. We conclude that BBR attenuates mitochondrial dysfunction by inducing autophagic flux.Stress-induced gastric ulcer is one of the common complications affecting patients after trauma, mainly leading to gastrointestinal bleeding and perforation, and severe cases may be life-threatening. However, the molecular mechanism of stress-induced gastric ulcer remains unclear. In the present study, RNA-sequencing was performed on gastric tissues of normal rats (C), stress-induced gastric ulcer rats (T0), and rats recovered from gastric ulcer for 3 days (T3), and bioinformatics analysis was performed to determine changes in gene expression and biological pathways. The protein-protein interaction (PPI) networks of differentially expressed genes (DEGs) were constructed by STRING and visualized by the Cytoscape software. The associated transcriptional factor (TFs)-gene regulatory network of the hub DEGs was also constructed. Pairwise comparisons obtained 103 (T0_C), 127 (T3_T0), and 13 (T3_C) DEGs, respectively. Gene ontology (GO) enrichment analysis indicated DEGs in T0_C and T3_T0 were significantly enriched in response to oxygen-containing compound, response to organic substance, and response to external stimulus.