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Gender Affirming Surgery in Nonbinary Patients: A Single Institutional Experience

  • Allison C. Hu;Mengyuan T. Liu;Candace H. Chan;Saloni Gupta;Brian N. Dang;Gladys Y. Ng;Mark S. Litwin;George H. Rudkin;Amy K. Weimer;Justine C. Lee
    • Archives of Plastic Surgery
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    • v.50 no.1
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    • pp.63-69
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    • 2023
  • Background An increasing number of nonbinary patients are receiving gender-affirming procedures due to improved access to care. However, the preferred treatments for nonbinary patients are underdescribed. The purpose of this study was to investigate the goals and treatments of nonbinary patients. Methods A retrospective study of patients who self-identified as nonbinary from our institutional Gender Health Program was conducted. Patient demographics, clinical characteristics, surgical goals, and operative variables were analyzed. Results Of the 375 patients with gender dysphoria, 67 (18%) were nonbinary. Over half of the nonbinary patients were assigned male at birth (n = 57, 85%) and nearly half preferred the gender pronoun they/them/theirs (n = 33, 49%). A total of 44 patients (66%) received hormone therapy for an average of 2.5±3.6 years, primarily estrogen (n = 39). Most patients (n = 46, 69%) received or are interested in gender-affirming surgery, of which, almost half were previously on hormone therapy (n = 32, 48%). The most common surgeries completed or desired were facial feminization surgery (n = 15, 22%), vaginoplasty (n = 15, 22%), mastectomy (n = 11, 16%), and orchiectomy (n = 9, 13%). Nonbinary patients who were assigned male at birth (NB-AMAB) were more often treated with hormones compared to nonbinary patients assigned female at birth (NB-AFAB) (72% vs. 30%, p = 0.010). Conversely, patients who were AFAB weremore likely to complete or desire surgical intervention than those who were AMAB (100% vs. 63.0%, p < 0.021). Conclusion Majority of nonbinary patients were assigned male at birth. NB-AFAB patients all underwent surgical treatment, whereas NB-AMAB patients were predominantly treated with hormone therapy.

Effect of chloride ions on the catalytic properties of human pancreatic α-amylase isozyme produced in Pichia pastoris (Pichia pastoris에서 생산된 인체 췌장 α-아밀레이스 동질효소의 촉매활성에 대한 염소이온의 영향)

  • Kim, Min-Gyu;Kim, Young-Wan
    • Korean Journal of Food Science and Technology
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    • v.48 no.4
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    • pp.341-346
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    • 2016
  • The AMY2B gene, encoding human pancreatic ${\alpha}$-amylase isozyme (HPA II), was expressed in Pichia pastoris, and the effects of chloride ions on HPA II activity toward starch substrates were investigated. As seen with chloride ion-dependent ${\alpha}$-amylases-including HPA I, the isozyme of HPA II-chloride ions increased enzyme activity and shifted the optimal pH to an alkaline pH. The activity enhancement by chloride was more significant at pH 8 than that at pH 6, suggesting that the protonation state of the general acid/base catalyst of HPA II was important for the hydrolysis of starches at an alkaline pH because of the increase in its $pK_a$ by chloride ions. The turnover values for cereal starches as the substrates markedly increased in the presence of chloride by up to 7.2-fold, whereas that for soluble starch increased by only 1.7-fold. Chloride inhibited substrate hydrolysis at high substrate concentrations, with $K_i$ values ranging from 6 to 15 mg/mL.

Ethnic Variation in Consumption of Traditional Tobacco Products and Lung Cancer Risk in Nepal

  • Raspanti, Greg A;Hashibe, Mia;Siwakoti, Bhola;Wei, Mei;Thakur, Binay Kumar;Pun, Chin Bahadur;Milrod, Charles;Adhikari, Subodh;Lee, Yuan-Chin Amy;Sapkota, Amir
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.14
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    • pp.5721-5726
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    • 2015
  • Lung cancer is the leading contributor to cancer deaths in the developing world. Within countries, significant variability exists in the prevalence of lung cancer risk, yet limited information is available whether some of the observed variability is associated with differences in the consumption pattern of local tobacco products with differing potency. We recruited 606 lung cancer cases and 606 controls from the B.P. Koirala Memorial Cancer Hospital in Nepal from 2009-2012. We estimated odds ratios (ORs) and 95% confidence intervals (CI) for lung cancer risk associated with different tobacco products, using unconditional logistic regression. Unfiltered cigarettes tended to be the most frequently used products across ethnic subgroup with about 53.7% of Brahmins, 60.1% of Chettris, and 52.3% of Rai/Limbu/Magar/others. In contrast, about 39.9% of Madishe/Tharu smokers reported using bidi compared with only 27.7% who smoked unfiltered cigarettes. Among those who only smoked one type of product, choor/kankat smokers had the highest lung cancer risk (OR 10.2; 95% CI 6.2-16.6), followed by bidi smokers (OR 5.6; 95% CI 3.6-8.7), unfiltered cigarettes (OR 4.9; 95% CI 3.4-7.2), and filtered cigarettes (OR 3.4; 95% CI 2.2-5.3). A clear dose-response relationship was observed between increased frequency of smoking and lung cancer risk across all ethnic subgroups. These results highlight the important role of traditional tobacco products on lung cancer risk in the low income countries.

Estimation of methane emissions from local and crossbreed beef cattle in Daklak province of Vietnam

  • Ramirez-Restrepo, Carlos Alberto;Van Tien, Dung;Le Duc, Ngoan;Herrero, Mario;Le Dinh, Phung;Van, Dung Dinh;Le Thi Hoa, Sen;Chi, Cuong Vu;Solano-Patino, Cesar;Lerner, Amy M.;Searchinger, Timothy D.
    • Asian-Australasian Journal of Animal Sciences
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    • v.30 no.7
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    • pp.1054-1060
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    • 2017
  • Objective: This study was aimed at evaluating effects of cattle breed resources and alternative mixed-feeding practices on meat productivity and emission intensities from household farming systems (HFS) in Daklak Province, Vietnam. Methods: Records from Local $Yellow{\time}Red$ Sindhi (Bos indicus; Lai Sind) and 1/2 Limousin, 1/2 Drought Master, and 1/2 Red Angus cattle during the growth (0 to 21 months) and fattening (22 to 25 months) periods were used to better understand variations on meat productivity and enteric methane emissions. Parameters were determined by the ruminant model. Four scenarios were developed: (HFS1) grazing from birth to slaughter on native grasses for approximately 10 h plus 1.5 kg dry matter/d (0.8% live weight [LW]) of a mixture of guinea grass (19%), cassava (43%) powder, cotton (23%) seed, and rice (15%) straw; (HFS2) growth period fed with elephant grass (1% of LW) plus supplementation (1.5% of LW) of rice bran (36%), maize (33%), and cassava (31%) meals; and HFS3 and HFS4 computed elephant grass, but concentrate supplementation reaching 2% and 1% of LW, respectively. Results: Results show that compared to HFS1, emissions ($72.3{\pm}0.96kg\;CH_4/animal/life$; least squares $means{\pm}standard$ error of the mean) were 15%, 6%, and 23% lower (p<0.01) for the HFS2, HFS3, and HFS4, respectively. The predicted methane efficiencies ($CO_2eq$) per kg of LW at slaughter ($4.3{\pm}0.15$), carcass weight ($8.8{\pm}0.25kg$) and kg of edible protein ($44.1{\pm}1.29$) were also lower (p<0.05) in the HFS4. In particular, irrespective of the HSF, feed supply and ratio changes had a more positive impact on emission intensities when crossbred 1/2 Red Angus cattle were fed than in their crossbred counterparts. Conclusion: Modest improvements on feeding practices and integrated modelling frameworks may offer potential trade-offs to respond to climate change in Vietnam.

Is Diabetes a Contraindication to Lower Extremity Flap Reconstruction? An Analysis of Threatened Lower Extremities in the NSQIP Database (2010-2020)

  • Amy Chen;Shannon R. Garvey;Nimish Saxena;Valeria P. Bustos;Emmeline Jia;Monica Morgenstern;Asha D. Nanda;Arriyan S. Dowlatshahi;Ryan P. Cauley
    • Archives of Plastic Surgery
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    • v.51 no.2
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    • pp.234-250
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    • 2024
  • Background The impact of diabetes on complication rates following free flap (FF), pedicled flap (PF), and amputation (AMP) procedures on the lower extremity (LE) is examined. Methods Patients who underwent LE PF, FF, and AMP procedures were identified from the 2010 to 2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP®) database using Current Procedural Terminology and International Classification of Diseases-9/10 codes, excluding cases for non-LE pathologies. The cohort was divided into diabetics and nondiabetics. Univariate and adjusted multivariable logistic regression analyses were performed. Results Among 38,998 patients undergoing LE procedures, 58% were diabetic. Among diabetics, 95% underwent AMP, 5% underwent PF, and <1% underwent FF. Across all procedure types, noninsulin-dependent (NIDDM) and insulin-dependent diabetes mellitus (IDDM) were associated with significantly greater all-cause complication rates compared with absence of diabetes, and IDDM was generally higher risk than NIDDM. Among diabetics, complication rates were not significantly different across procedure types (IDDM: p = 0.5969; NIDDM: p = 0.1902). On adjusted subgroup analysis by diabetic status, flap procedures were not associated with higher odds of complications compared with amputation for IDDM and NIDDM patients. Length of stay > 30 days was statistically associated with IDDM, particularly those undergoing FF (AMP: 5%, PF: 7%, FF: 14%, p = 0.0004). Conclusion Our study highlights the importance of preoperative diabetic optimization prior to LE procedures. For diabetic patients, there were few significant differences in complication rates across procedure type, suggesting that diabetic patients are not at higher risk of complications when attempting limb salvage instead of amputation.

A Study on etiological factors, symptoms of a disease, and treatments of obesity based on Dong-Yi Bo Gam (동의보감(東醫寶鑑)을 위주(爲主)로한 비만의 원인(原因), 증상(症狀), 치료법(治療法) 연구)

  • Kim, Seok;Jin, Seng-Hee;Kim, Tae-Hee
    • The Journal of Korean Medicine
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    • v.19 no.2
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    • pp.125-136
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    • 1998
  • This study is on the etiological factors of the obesity, symptoms of a disease caused by the etiological factors and the method of medical treatment resulted from symptoms of a disease, it is based on Dong-Yi Bo Gam. The conclusion of this study is as follows. 1. The final metabolic of fat is depend on the defensive energy. The shape of fatty layer is changed by the point where the defensive energy is replenish or not. So 'Goin(暠人)' 'Bein(肥人)' and 'Yuckin(肉人)' is made a discriminated and there is defferent between 'Besudaeso(肥瘦大小)' and 'Herlqidaso(血氣多少)'. 2. Etiological factors of obesity is ; essential substance from cereals overcome the primodial energy, spleen and stomach are strong at once, spleen and stomach are weak at once, spleen is disturbed by evil energy, retention of phlegm and fluid, muscle is weak, blood is excess but energy (qi)is weak, hua-sid(華食) eating the sweat food very often, a rich fatty diet. 3. To investigate each syndrome as etiological factons, essential substance from cereals overcome primodial energy is divided into two case: one is the food increase itself because of the weakness of stomach energy (qi), the other is not to digest the food because liver overact spleen by seven emotion. The obesity because of strengthen of the spleen and stomach at once do not feel hungry very well and spleen and stomach do not damaged easily by overacting. The obesity because of weakness of spleen and stomach at once, and disturbace in spleen cause by evil energy, gain the weight even if they eat food a little. Also it is hard to move four limbs. Weakness of muscle is weakness of spleen and stomach. Weakness of muscle is caused by weakness of spleen and stomach. That is the case of faining the weight because of eating food with an empty stomach. The obsity caused by retention of fluid has intestine rumbling and gain the weight suddenly. 4. The method of medical treatment fallowing to the etiological factors: The food is inclined to increase itself caused by weakness of stomach energy, In case of the obseity caused by this phenomenon. We can use Decoction for Reinforcing Middle wanner and Replenishing Qi(補中益氣湯), five tastes il-going-san(左味異功散) and so on. The method of medical treatment on obsity caused by strengthen of spleen and stomach is not referred yet. But we must investigate about using peptic powder(平胃散), ji-chul-huan(枳朮丸) for strengthen of stomach qi (胃氣). If the obesity appear caused by weakness of spleen and stomach and disturbance in spleen as to evil energy, and in the same time stomach qi is weak, we can use li-gong san(異功散). If not only obesity but also indigestion, we can use Decoction for naurishing the stomach and promotion eating(養胃進食湯). If not only obesity but also weakness of spleen and stomach, we can use Decoction for Reinforcing Middle warmer and replenishing Qi(補中益氣湯). The energy being weak, we can use Decoction for six noble drugs(六君子湯). If the obesity appear because of retention of fluid, we can use sin-chul-huan(神朮丸). On the obesit, caused by excess of blood and weakness of qi(血管氣虛), there is not method of mectical treatment yet, but the method of medical treatment that we count of first important maybe to invigorate the spleen and the lung qi and to disperse and recitify the depressed liver energy(疏肝利氣). The method of medical treament about the obesity caused by a rich fatty diet is not mentioned yet, but it is important to improve the lifestyle of food and we think that invigorate the spleen, and the lung-qi(補疏肝氣) and disperse and recitify the depressed liver-energy (??肝利機) amy count of first important. 5.There is useful medicine for weight down for example Herb tea(茶), red bean, wax gourd, etc. 6.The etiological factors of the obesity that revive frequently is weakness of qi(氣虛), from 形成氣衰, deficiency of yang, hasty of qi, damp and so on. The symptoms and sign of a disease that revive frequently to the obesity is appoplexia(中風), leucorrhea, reddish and whitish turbid, feeling of fullness in the upper abdomen, diabetes and so on.

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Family History of Cancer and Head and Neck Cancer Risk in a Chinese Population

  • Huang, Yu-Hui Jenny;Lee, Yuan-Chin Amy;Li, Qian;Chen, Chien-Jen;Hsu, Wan-Lun;Lou, Pen-Jen;Zhu, Cairong;Pan, Jian;Shen, Hongbing;Ma, Hongxia;Cai, Lin;He, Baochang;Wang, Yu;Zhou, Xiaoyan;Ji, Qinghai;Zhou, Baosen;Wu, Wei;Ma, Jie;Boffetta, Paolo;Zhang, Zuo-Feng;Dai, Min;Hashibe, Mia
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.17
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    • pp.8003-8008
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    • 2015
  • Background: The aim of this study was to investigate whether family history of cancer is associated with head and neck cancer risk in a Chinese population. Materials and Methods: This case-control study included 921 cases and 806 controls. Recruitment was from December 2010 to January 2015 in eight centers in East Asia. Controls were matched to cases with reference to sex, 5-year age group, ethnicity, and residence area at each of the centers. Results: We observed an increased risk of head and neck cancer due to first degree family history of head and neck cancer, but after adjustment for tobacco smoking, alcohol drinking and betel quid chewing the association was no longer apparent. The adjusted OR were 1.10 (95% CI=0.80-1.50) for family history of tobacco-related cancer and 0.96 (95%CI=0.75-1.24) for family history of any cancer with adjustment for tobacco, betel quid and alcohol habits. The ORs for having a first-degree relative with HNC were higher in all tobacco/alcohol subgroups. Conclusions: We did not observe a strong association between family history of head and neck cancer and head and neck cancer risk after taking into account lifestyle factors. Our study suggests that an increased risk due to family history of head and neck cancer may be due to shared risk factors. Further studies may be needed to assess the lifestyle factors of the relatives.

Development of Composite Flours and Their Products Utilizing Domestic Raw Materials -Part VI. Effect of Additives on the Bread-making Quality with Composite Flours- (국산원료(國産原料)를 활용(活用)한 복합분(複合粉) 및 제품개발(製品開發)에 관한 연구(硏究) -제6보 복합분(複合粉)에 의한 제(製)빵에 있어서 첨가제(添加劑)의 영향(影響)-)

  • Kim, Hyong-Soo;Lee, Hee-Ja
    • Korean Journal of Food Science and Technology
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    • v.9 no.2
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    • pp.106-115
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    • 1977
  • In order to study the baking properties of various composite flours, naked barley flour, corn flour, potato flour, and sweet potato flour were added to the hard wheat flour respectively in a ratio of 3 : 7. Using above composite flours, effects of glyceryl monosterate (GMS), sodium stearyl lactylate (SSL), calcium stearyl lactylate (CSL), xanthan gum (XG) and polysaccharide (PS) were also examined in terms of sedimentation test, viscosity by amylograph and baking test. The results are as follows: 1) Sedimentation value decreased in the order of hard wheat flour (58), corn flour (47), potato flour (46), sweet potato flour (33). and barley flour (23). Significant effects of additives were observed for all of flours as well as for the composite flours. The most prominant result of additives was obtained with the composite flour of barley and wheat. Among the additives, mixtures of GMS and SSL at 1% final concentration and that of GMS and SSL at the same concentration increased the sedimentation value considerably. No sedimentation measurement, however, was possible for XG since the compound was precipitated by acid during experiment of sedimentation. 2) Effects of additives on the viscosity were determined by amylograph. The mixtures of GMS 1%+SSL 1% and GMS 1%+CSL 1% increased gelatinization point,maximum viscosity and cooling viscosity. GMS 1%+XG 1% or GMS 1%+PS 1% showed less effects. 3) GMS 1%+CSL 0.5% increased the specific loaf volume of bread produced from the composite flour of naked barley and wheat, and appearance, taste and texture of the product were very similar to those of the standard bread produced from wheat flour. GMS 1%+SSL 0.5%, however, increased the loaf volume of bread produced from the composite flours of corn, potato and sweet potato, and wheat. No effects were obtained with XG and PS, except slight improvement of the texture of bread. 4) No specific loaf volume of bread produced from the composite flour of barley and wheat was increased when 1% of SSL, CSL, XG or PS was used separately.

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Trend and Further Research of Rice Quality Evaluation (쌀의 품질평가 현황과 금후 연구방향)

  • Son, Jong-Rok;Kim, Jae-Hyun;Lee, Jung-Il;Youn, Young-Hwan;Kim, Jae-Kyu;Hwang, Hung-Goo;Moon, Hun-Pal
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.47
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    • pp.33-54
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    • 2002
  • Rice quality is much dependent on the pre-and post harvest management. There are many parameters which influence rice or cooked rice qualitys such as cultivars, climate, soil, harvest time, drying, milling, storage, safety, nutritive value, taste, marketing, eating, cooking conditions, and each nations' food culture. Thus, vice evaluation might not be carried out by only some parameters. Physicochemical evaluation of rice deals with amy-lose content, gelatinizing property, and its relation with taste. The amylose content of good vice in Korea is defined at 17 to 20%. Other parameters considered are as follows; ratio of protein body-1 per total protein amount in relation to taste, and oleic/linoleic acid ratio in relation to storage safety. The rice higher Mg/K ratio is considered as high quality. The optimum value is over 1.5 to 1.6. It was reported that the contents of oligosaccharide, glutamic acid or its derivatives and its proportionalities have high corelation with the taste of rice. Major aromatic compounds in rice have been known as hexanal, acetone, pentanal, butanal, octanal, and heptanal. Recently, it was found that muco-polysaccharides are solubilized during cooking. Cooked rice surface is coated by the muco-polysaccharide. The muco-polysaccharide aye contributing to the consistency and collecting free amino acids and vitamins. Thus, these parameters might be regarded as important items for quality and taste evaluation of rice. Ingredients of rice related with the taste are not confined to the total rice grain. In the internal kernel, starch is main component but nitrogen and mineral compounds are localized at the external kernel. The ingredients related with taste are contained in 91 to 86% part of the outside kernel. For safety that is considered an important evaluation item of rice quality, each residual tolerance limit for agricultural chemicals must be adopted in our country. During drying, rice quality can decline by the reasons of high drying temperature, overdrying, and rapid drying. These result in cracked grain or decolored kernel. Intrinsic enzymes react partially during the rice storage. Because of these enzymes, starch, lipid, or protein can be slowly degraded, resulting in the decline of appearance quality, occurrence of aging aroma, and increased hardness of cooked rice. Milling conditions concerned with quality are paddy quality, milling method, and milling machines. To produce high quality rice, head rice must contain over three fourths of the normal rice kernels, and broken, damaged, colored, and immature kernels must be eliminated. In addition to milling equipment, color sorter and length grader must be installed for the production of such rice. Head rice was examined using the 45 brand rices circulating in Korea, Japan, America, Australia, and China. It was found that the head rice rate of brand rice in our country was approximately 57.4% and 80-86% in foreign countries. In order to develop a rice quality evaluation system, evaluation of technics must be further developed : more detailed measure of qualities, search for taste-related components, creation and grade classification of quality evaluation factors at each management stage of treatment after harvest, evaluation of rice as food material as well as for rice cooking, and method development for simple evaluation and establishment of equation for palatability. On policy concerns, the following must be conducted : development of price discrimination in conformity to rice cultivar and grade under the basis of quality evaluation method, fixation of head rice branding, and introduction of low temperature circulation.