关键词： Dietary   Herbal   Body Based   Cognitive Behavioral Therapy   Acupuncture   Abdominal Pain  

摘要： BACKGROUND & AIMS: Patients with irritable bowel syndrome (IBS) may pursue complementary and alternative medicine (CAM). We conducted a comprehensive systematic review and meta-analysis examining efficacy of CAM vs. placebo or sham in adults with IBS. METHODS: Publication databases were searched for randomized controlled trials of CAM therapies (herbal therapy, dietary supplements, mind-body based, body-based, and energy-healing) in adults with IBS. Data were extracted to obtain pooled estimates of mean improvement in abdominal pain (standardized mean difference [SMD]) and relative risk (RR) of overall response using random effects models. Sensitivity and subgroup analyses along with quality assessments were completed. RESULTS:Among 2825 articles identified, 66 were included. Herbal therapy (SMD =0.47, 95% CI: 0.20 to 0.75, I-2 =82%) demonstrated significant benefit over placebo for abdominal pain (low confi- dence in estimates). Benefit with mind-body based therapy for abdominal pain was of borderline significance (SMD = 0.29, 95% CI: -0.01 to 0.59, I-2 = 78%). Herbal therapy (RR= 1.57, 95% CI: 1.31 to 1.88, I-2 =77%), dietary supplements (RR = 1.95, 95% CI: 1.02 to 3.73, I-2 = 75%), and mind-body based therapy (RR= 1.67, 95% CI: 1.13 to 2.49, I-2 =63%) showed benefit for overall response compared to placebo (low confidence in estimates). Body-based and energy healing therapies demonstrated no significant benefit over placebo or sham for abdominal pain or overall response. CONCLUSIONS: CAM therapies such as herbal or dietary supplements and mind-body based approaches may be beneficial for abdominal pain and overall response in IBS. However, overall quality of evidence is low. Rigorous, high quality clinical trials are warranted to investigate CAM in IBS.

关键词： cancer   chaperone   heat‐   shock protein   neurodegeneration   PQC   protein aggregate   protein degradation   protein triage   ubiquitin   ubiquitination  

摘要： Protein misfolding is a major driver of ageing-associated frailty and disease pathology. Although all cells possess multiple, well-characterised protein quality control systems to mitigate the toxicity of misfolded proteins, how they are integrated to maintain protein homeostasis ('proteostasis') in health-and how their disintegration contributes to disease-is still an exciting and fast-paced area of research. Under physiological conditions, the predominant route for misfolded protein clearance involves ubiquitylation and proteasome-mediated degradation. When the capacity of this route is overwhelmed-as happens during conditions of acute environmental stress, or chronic ageing-related decline-alternative routes for protein quality control are activated. In this review, we summarise our current understanding of how proteasome-targeted misfolded proteins are retrafficked to alternative protein quality control routes such as juxta-nuclear sequestration and selective autophagy when the ubiquitin-proteasome system is compromised. We also discuss the molecular determinants of these alternative protein quality control systems, attempt to clarify distinctions between various cytoplasmic spatial quality control inclusion bodies (e.g., Q-bodies, p62 bodies, JUNQ, aggresomes, and aggresome-like induced structures 'ALIS'), and speculate on emerging concepts in the field that we hope will spur future research-with the potential to benefit the rational development of healthy ageing strategies.

摘要： BACKGROUND High flow nasal oxygen may better support the vulnerable respiratory state of patients during procedural sedation. OBJECTIVE The objective of this study was to investigate the effects of high flow nasal oxygen in comparison to facemask oxygen on ventilation during cardiac implantable electronic device procedures performed with procedural sedation. DESIGN A randomised controlled trial. SETTING The study was conducted at one academic hospital in Canada. PARTICIPANTS Adults undergoing elective cardiac implantable electronic device procedures with sedation administered by an anaesthesia assistant, supervised by an anaesthesiologist from August 2019 to March 2020. INTERVENTIONS Participants were randomised 1 : 1 to facemask (>= 8 l center dot min(-1)) or high flow nasal oxygen (50 l center dot min(-1) and a 50 : 50 oxygen to air ratio). MAIN OUTCOME MEASURES The primary outcome was peak transcutaneous carbon dioxide. Outcomes were analysed using Bayesian statistics. RESULTS The 129 participants who were randomised and received sedation were included. The difference in peak transcutaneous carbon dioxide was 0.0 kPa (95% CI -0.17 to 0.18). Minor adverse sedation events were 6.4 times more likely to occur in the high flow nasal oxygen group. This estimate is imprecise (95% CI 1.34 to 42.99). The odds ratio for oxygen desaturation for the high flow nasal oxygen group compared with the facemask group was 1.2 (95% CI 0.37 to 3.75). The difference in satisfaction with sedation scores between groups was 0.0 (95% CI -0.33 to 0.23). CONCLUSIONS Ventilation, as measured by TcCO2, is highly unlikely to differ by a clinically important amount between high flow nasal oxygen at 50 l min(-1) or facemask oxygen at 8 l min(-1). Further research with a larger sample size would be required to determine the optimal oxygen:air ratio when using high flow nasal oxygen during cardiac implantable electronic device procedures performed with sedation.

关键词： antivirals   homogeneous liquid-liquid microextraction   plasma   sample preparation   sugaring-out  

摘要： Miniaturization of liquid-liquid extraction is a growing field of sample preparation to reduce solvent consumption, protect the environment, and preserve operators' health. In this work, four different modes of liquid-liquid microextraction have been compared including dispersive liquid-liquid microextraction, binary and ternary salting-out, and sugaring-out induced liquid-liquid microextraction. The extraction efficiency was evaluated by the enrichment factors of 14 different drugs from three pharmacological classes. Compared with the other modes, sugaring-out induced liquid-liquid microextraction was found to be the most efficient and, thus, it was applied for sample preparation of the antivirals in human plasma. Method optimization was performed using response surface methodology for the sugar type and amount (in mg), the sample pH, the equilibration time (in min), and the extractant volume (in mu L). The method was then validated and found linear in the concentration range of 0.10-10 mu g/mL for daclatasvir, 0.05-10 mu g/mL for velpatasvir, and 0.20-10 mu g/mL for ledipasvir, with correlation coefficients in the range 0.996-0.999. These results shows that sugaring-out induced liquid-liquid microextraction could be a more efficient microextraction mode for preparation of biological samples. Compared with other types of microextraction, sugaring-out induced liquid-liquid microextraction is greener, simpler, and cost-effective, with less tendency to affect the sample pH.

关键词： Enclosure convections   Conjugate heat and species transfer   Convective flux lines   Multiple steady flows   Correlations  

摘要： Double-diffusive natural convection in a vertical enclosure containing various solid block arrays is numerically and analytically investigated in present work, where heat and species source and sink are simultaneously attached on the walls. Rayleigh number, buoyancy force ratio, number of inner solid blocks, solid thermal conductivity and mass diffusion coefficient have been varied to observe inherent flow structures and mechanism of thermal and mass transports, regarding of different levels of solid-to-fluid volume ratios. Correlations have been presented for different flow regimes, namely thermal buoyancy driven flow and solutal buoyancy driven flow. Simulation and correlation results demonstrate that influences of thermal conductivity and mass diffusion coefficient of the solid block arrays on average Nusselt and Sherwood numbers are not evident compared with that of Rayleigh number. Furthermore, there is a positive correlation between average Nusselt number and Sherwood number. In addition, under certain values of Rayleigh number, absolute values of buoyancy force ratio close to unity will cause multiple steady solutions in pure natural convection. This research could benefit the future thermal and species management for electronics and built environment.

关键词： Complimentary medicine   Malaysia   South east asia   Rural community health   Gender difference   Cultural influences  

摘要： The choice to take-up specific complimentary and alternative medicine (CAM) modalities is influenced by many factors including cultural background, experience and peer-participation. In this study we investigated the beliefs and attitudes that contributed to CAM choices in a non-urban Malaysian population (N = 700). We found significant differences in the beliefs held by men and women in this population. Specifically, women believed more strongly than men that CAM providers offered healthy lifestyle advice (p = 0.042) and that those who were averse to discomfort from conventional treatments were more likely to take up CAM (p = 0.016). In addition, those individuals who chose to use CAM more strongly believed that CAM products were more healthy than conventional treatments (p = 0.002), that their effects were well understood (p = 0.002) and that CAM products worked with the body (p = 0.017). The data obtained in this study emphasize the lessons that can be learned by conventional healthcare providers in communicating the benefits of treatments to their patients. CAM users also believed that CAM products never caused harm (p = 0.007), which is a concern given that the modes of action of some CAM modalities and their interaction with prescribed treatments are not always well understood.

关键词： whipping cream alternative fat   hydrogenated palm kernel oil   enzymatic acyl migration   fat polymorphism   physicochemical properties  

摘要： We developed an alternative whipping cream fat using shea butter but with low saturation. Enriched stearic-oleic-stearic (SOS) solid fat was obtained from shea butter via solvent fractionation. Acyl migration reactant, which mainly contains asymmetric SSO triacylglycerol (TAG), was prepared through enzymatic acyl migration to obtain the creaming quality derived from the beta'-crystal form. Through enzymatic acyl migration, we obtained a 3.4-fold higher content of saturated-saturated-unsaturated (SSU) TAG than saturated-unsaturated-saturated (SUS) TAG. The acyl migration reactant was refined to obtain refined acyl migration reactant (RAMR). An alternative fat product was prepared by blending RAMR and hydrogenated palm kernel oil (HPKO) at a ratio of 4:6 (w/w). The melting points, solid fat index (SFI), and melting curves of the alternative products were similar to those of commercial whipping cream fat. The alternative fat had a content of total unsaturated fatty acids 20% higher than that of HPKO. The atherogenic index (AI) of alternative fat was 3.61, much lower than those of whipping cream fat (14.59) and HPKO (1220.3), because of its low atherogenic fatty acid content and high total unsaturated fatty acids. The polymorphic crystal form determined by X-ray diffraction spectroscopy showed that the beta'-crystal form was predominant. Therefore, the alternative fat is comparable with whipping cream that requires creaming quality, and has a reduced saturated fat content.

摘要： In August 2014, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) signed a memorandum of understanding with the Accreditation Council for Graduate Medical Education (ACGME) to create the Single Accreditation System (SAS) for graduate medical education (GME) in the United States. The AOA made the decision that it would close its GME accreditation system in response to dramatic growth in colleges of osteopathic medicine, a shortfall in osteopathic GME positions with increasing dependence on the ACGME system, ACGME policy decisions that adversely impacted osteopathic students, and declining osteopathic student interest in primary care. Osteopathic teaching institutions bore responsibility for meeting ACGME accreditation standards between 2015 and 2020, including determining institutional sponsorship, which program applications to submit, program size, educational leadership, and whether to pursue Osteopathic Recognition. Approximately 692 of 954 (72.5%) eligible osteopathic GME programs in 2014-2015 obtained ACGME accreditation by June 1, 2020. There were sharp reductions in surgical and subspecialty programs and a significant drop of DOs in educational leadership positions. A low percentage of ACGME-accredited programs applied for Osteopathic Recognition. In closing its GME accreditation system and joining the ACGME, the AOA gave up control of its direct relationship with osteopathic residents, fellows, and teaching institutions to gain critical GME opportunities. In this article, the author considers whether this gain will offset the risks taken by the AOA, including decreased DO leadership opportunities and role models, lower than expected interest in Osteopathic Recognition, and possible decreased DO interest in osteopathic organizations and osteopathic specialty board certification. Time and the choices of current and future DO trainees in ACGME programs will determine the future of the osteopathic