Repetitive transcranial magnetic stimulation (rTMS) has been used as an investigative and therapeutic tool in neuropsychiatry and is advocated as a therapy for the treatment of psychiatric disorders, particularly adult depression. The therapeutic efficacy of current antidepressants applied to children or adolescents is unsatisfactory; thus innovative treatments such as rTMS are in demand. Large-scale clinical studies are required to determine the safety of rTMS for this age group. The present case report describes a 15-year-old female with depression who had seizure and hypomania during the first session of rTMS concomitant to sertraline 100 mg/day orally. The patient continued on this regimen of sertraline therapy but rTMS was not repeated. Subsequent electroencephalogram (EEG) examination detected no abnormalities and no longterm complications were observed. We suggest that rTMS should be used cautiously to treat adolescents with depressive disorders, particularly when used concomitant to antidepressant treatment.

The iron oxide scales exfoliated from the inner wall of a boiler tube and a main steam pipe is known to cause solid-particle erosion on the control-stage nozzle. A combined experimental and numerical investigation was conducted to explore the optimization method of end-wall contouring for reducing the nozzle's erosion damage most effectively. The results indicate that increasing the end-wall contraction ratio and (or) decreasing the distance between the starting point of end-wall contouring and the trailing edge can significantly reduce the erosion-induced weight-loss of the nozzle, and can slightly improve the nozzle efficiency, irrespective of the variation in the particles size distribution and the aerodynamic parameters of a steam turbine. A main reason of erosion reduction is that the movement of loading towards the rear of the nozzle cascade caused by these contoured end walls has reduced the incident velocity of particles. In this study, the weight-loss of the nozzle was reduced by 40—50 per cent, and the nozzle efficiency was improved by 0.4—0.5 per cent by improving the end-wall contouring of the nozzle according to the methods mentioned above.

In the steam turbine, solid particle erosion on a nozzle cascade is known to damage the profile and surface smoothness of the cascade, which increases the flow loss of steam. The present study aims to make clear the relations between nozzle loss and surface degradation, aerodynamic parameters, as well as the shape, location, and size of the erosion notch. A series of numerical simulations were conducted to model the aerodynamic performance of various existing eroded nozzles. The results indicate that the nozzle loss caused by the surface degradation shows an approximate linear decrease with an increase in notch depth. The nozzle loss caused by the erosion notch increases with either a decrease in the exit Mach number or an increase of the notch area. For the same erosion-induced weight loss of the nozzle, the asymmetric notch and local notch cause more nozzle loss than the symmetric notch and quasi-global notch. This means that the performance deterioration can be reduced to a minimum value if the erosion is uniform along the span-wise of the nozzle. In addition, a combined experimental and numerical investigation is conducted to explore the erosion damage process of the nozzle. The result suggests that the eroded nozzle should be replaced by a new nozzle before the notch begins to propagate.

The value of serum C-reactive protein, lactate dehydrogenase isoenzymes and erythrocyte sedimentation rate in predicting the outcome of acute pancreatitis was evaluated for 57 episodes in 54 patients. Serum C-reactive protein levels on day 2, 4 and 7 after admission were significantly higher in 19 episodes of severe attacks than in 38 episodes of mild attacks (13.71 +/- 9.68, 9.00 +/- 7.54, 6.02 +/- 3.83 vs 4.78 +/- 3.91, 3.30 +/- 3.61, 1.43 +/- 2.08 mg/dL; P less than 0.0001, P less than 0.005, P less than 0.0001, respectively). The sensitivity, specificity and accuracy of predicting a severe attack were 94, 76 and 82% using C-reactive protein greater than or equal to 8 mg/dL on day 2; 67, 92 and 84% using C-reactive protein greater than or equal to 5 mg/dL on day 7; and 59, 76 and 70% using Ranson's criteria greater than or equal to 3. Increases in LDH-4 and LDH-5 isoenzymes were found in both groups, with LDH-4 being slightly higher in severe attacks than in mild attacks. There was no significant difference of erythrocyte sedimentation rate between both groups. When compared with Ranson's criteria, lactate dehydrogenase isoenzymes and erythrocyte sedimentation rate, C-reactive protein is more valuable in the early assessment of the severity of acute pancreatitis.

Morphological changes of hepatocyte death have so far only been described on cells in culture or in tissue sections. Using a high-resolution and high-magnification multiphoton microscopic system, we recorded in living mice serial changes of acetaminophen (APAP)-induced hepatocyte necrosis in relevance to metabolism of a fluorogenic bile solute. Initial changes of hepatocyte injury included basal membrane disruption and loss of mitochondrial membrane potential. An overwhelming event of rupture at adjacent apical membrane resulting in flooding of bile into these hepatocytes might ensue. Belbs formed on basal membrane and then dislodged into the sinusoid circulation. Transmission electron microscopy disclosed a necrotic hepatocyte depicting well the changes after apical membrane rupture and bile flooding. Administration of the antidote N-acetylcysteine dramatically reduced the occurrence of apical membrane rupture. The present results demonstrated a hidden but critical step of apical membrane rupture leading to irreversible APAP-induced hepatocyte injury.