Late diagnosis of HIV infection at two academic medical centers: 1994-2004

Over the last decade, there has been increased attention to the role of earlier HIV testing in the United States. Our objective was to determine if this has translated into changes in the proportion of inpatients with advanced disease at the time of initial HIV diagnosis. We identified inpatients discharged with a new diagnosis of HIV infection or AIDS between 1994 and 2004 at two academic medical centers. We examined trends in initial CD4 count at diagnosis over three time periods: 1994-1996, 1997-2000 and 2001-2004. Between 1994 and 2004, 235 inpatients were newly diagnosed with HIV infection or AIDS in the two centers. For the 217 patients with available CD4 count data, the median initial CD4 count was 41/microl (interquartile range 19-138/microl). Of the 217 patients, 184(85%) had CD4 < or =200/microl and 119/217 (55%) had CD4 < or =50/microl. There were no significant differences in median CD4 count by time period. A large majority of inpatients with newly diagnosed HIV infection at two academic medical centers between 1994 and 2004 had signs of advanced immunodeficiency. Over this recent 11-year period there was no evidence that inpatients with a new HIV diagnosis were identified at earlier stages of disease.

Estimation of bioconcentration factors using molecular electro-topological state and flexibility

Bioconcentration assessment is important in the scientific evaluation of risks that chemicals may pose to humans and environment and is a current focus of regulatory effort. In this work, a new QSAR model by adopting electronic topological properties and flexibility of chemicals to predict the bioconcentration factor (BCF) in fish was established based on a large number of diverse compounds. Multiple linear regression (MLR) and partial least squares (PLS) were used to build reliable QSARs, which were evaluated with internal five cross-validations (Qcv2) and an external validation (Qex2). The proposed MLR model showed reasonable predictivity of BCF (Qcv2 = 0.79,Qex2 = 0.79) and included seven molecular descriptors, namely SsCl, SaasC, SaaaC, SsNH2, Hmin, SssO, and Phia. The PLS model (Qcv2 = 0.83, Qex2 = 0.80) was shown to be slightly better than the MLR one in prediction accuracy, using six PLS latent components. In addition, the relationship between the log BCF and the theoretical calculated log Kow was extensively investigated. These studies may help to understand the factors influencing the bioconcentration process of chemicals and to develop alternative methods for prescreening of environmental toxic compounds.

Iron-generated hydroxyl radicals kill retinal cells in vivo: effect of ferulic acid

Siderosis bulbi is vision threatening. An investigation into its mechanisms and management is crucial. Experimental siderosis was established by intravitreous administration of an iron particle (chronic) or FeSO4 (acute). After siderosis, there was a significant dose-responsive reduction in eletroretinogram (a/b-wave) amplitude, and an increase in •OH level, greater when caused by 24 mM FeSO4 than that by 8 mM FeSO4. Furthermore, the FeSO4-induced oxidative stress was significantly blunted by 100 μM ferulic acid (FA). Siderosis also resulted in an excessive glutamate release, increased [Ca++]i, and enhanced superoxide dismutase immunoreactivity. The latter finding was consistent with the Western blot result. Obvious disorganization including loss of photoreceptor outer segments and cholinergic amacrines together with a wide-spreading ferric distribution across the retina was present, which were related to the eletro-retinographic and pathologic dysfunctions. Furthermore, b-wave reduction and amacrine damage were respectively, significantly, dose-dependently, and clearly ameliorated by FA. Thus, siderosis stimulates oxidative stress, and possibly, subsequent excitotoxicity, and calcium influx, which explains why the retina is impaired electro-physiologically and pathologically. Importantly, FA protects iron toxicity perhaps by acting as a free radical scavenger. This provides an approach to the study and treatment of the iron-related disorders such as retained intraocular iron and Alzheimer disease.

An attempt to measure the spread of emergency medicine internationally

OBJECTIVE

To determine the feasibility of using the internet to track the spread of emergency medicine internationally.

OVERVIEW

This was an attempt to perform a descriptive cross-sectional study employing a web-based survey.

SUBJECTS

Potential respondents were identified from multiple sources.

OBSERVATIONS

The primary outcome was the response to 16 questions about EM care and the setting in which it was delivered for acute cardiac, paediatric, obstetrical illnesses and trauma. The questions were divided into six general areas and elicited for urban, semi-urban and rural settings. A series of four e-mails soliciting completion of the survey were sent to potential respondents.

ANALYSIS

Simple descriptive statistics.

RESULTS

We identified 358 potential respondents with valid e-mail addresses over a period of three years. Overall, 145 (41%) responded and 117 (33% 95% CI 28-38%) of them were complete and interpretable. There was one response from 54 and two responses from 29 countries, representing an overall response rate by country surveyed of 65% (95% CI 57-73%), but of all existing countries of only 43% (95% CI 36-50%). Based on sparse data, it appears that in urban areas, 47% (obstetrics) to 65% (paediatric) of acutely sick or injured patients are taken to an ED-equivalent. For rural areas, this range was 19% (obstetrical) to 40% (trauma). CT scans are available in 78% of urban ED-equivalents but 12% of rural ones. Haematocrits are available in 72% of rural settings. In 60% of responding nations, some type of EM training was available, and in 42% physicians went abroad to study EM.

CONCLUSIONS

A survey of international EM is challenging to achieve because of difficulty in both identifying and in contacting potential respondents. Based on sparse data, population density (urban, rural) appears to be related to both the location to which acutely ill patients are taken for their care and to the level of technology available. The specialty of EM is now recognised internationally and education in EM is common.

Identification of a novel allele HLA-DQB1*0622

A novel human leukocyte antigen-DQ allele, DQB1*0622, was identified in a bone marrow transplantation candidate. DQB1*0622 differs from DQB1*0609 by two nucleotide differences in exon 2, position 122 (A-->T) and 177 (A-->G). The difference at position 122 resulted in an amino acid change (Tyrosine to Phenylalanine). However, the difference at position 177 did not cause any amino acid change.

The type I Lanyu pig has a maternal genetic lineage distinct from Asian and European pigs

The Lanyu pig is an indigenous breed from Lanyu Islet, located south-east of Taiwan, with phenotypic characteristics distinctive from other pig breeds in Asia and Europe. Based on geographic considerations, the Lanyu pig may have originated from mainland China, Austronesia or the Ryukyu Islands. In the present study, polymorphism of the mitochondrial DNA control region sequence was used to clarify phylogenetic relationships among two herds of Lanyu pigs imported before 1980 from Lanyu Islet into Taiwan and reared in isolation on two different farms. Two distinct mitochondrial control region haplotypes were found. The type I Lanyu sequence appeared independently as a unique clade different from Asian and European pig sequences, while the type II Lanyu sequence was clustered within the major Asian clade. The pairwise distances between the major Asian clade vs. the type I Lanyu and European clades were 0.01726 +/- 0.00275 and 0.01975 +/- 0.00212 changes per site respectively. Estimates of divergence time suggest that the type I Lanyu sequence split from the major Asian pig clade in prehistoric times. The type II Lanyu mtDNA shares a close genetic lineage with Japanese Satsuma and New Zealand Kune Kune mtDNA with pairwise distances of 0.00095 +/- 0.00000 and 0.00192 +/- 0.00000 respectively, indicating gene flow between Lanyu Islet, Japan and Oceania in recent times. Together these results indicate that the type I Lanyu pig has a genetic lineage separate from Asian-type pigs, while the type II Lanyu sequence may represent a more recent introgression of modern Asian pigs.

Vitamin D levels and early mortality among incident hemodialysis patients

Vitamin D deficiency is associated with cardiovascular disease, the most common cause of mortality in hemodialysis patients. To investigate the relation between blood levels of 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D) with hemodialysis outcomes, we measured baseline vitamin D levels in a cross-sectional analysis of 825 consecutive patients from within a prospective cohort of incident US hemodialysis patients. Of these patients, 78% were considered vitamin D deficient with 18% considered severely deficient. Calcium, phosphorus, and parathyroid hormone levels correlated poorly with 25D and 1,25D concentrations. To test the association between baseline vitamin D levels and 90-day mortality, we selected the next 175 consecutive participants who died within 90 days and compared them to the 750 patients who survived in a nested case-control analysis. While low vitamin D levels were associated with increased mortality, significant interaction was noted between vitamin D levels, subsequent active vitamin D therapy, and survival. Compared to patients with the highest 25D or 1,25D levels who received therapy, untreated deficient patients were at significantly increased risk for early mortality. Our study shows that among incident hemodialysis patients, vitamin D deficiency is common, correlates poorly with other components of mineral metabolism and is associated with increased early mortality.

Trauma to erythrocytes induced by long term in vitro pumping using a roller pump

The objective of this study is to investigate the impact of trauma on erythrocyte caused by long term in vitro pumping using roller pump. Ten bags of human blood (400 ml each) were provided by a local blood bank and they were divided into two groups with five bags in each group. Each blood bag was subject to pumping in a closed circuit, which was composed of silica gel tubes and a roller pump. Polystan and COBE pumps were used for the two groups, respectively. The blood was pumped for 16 h in vitro. Free hemoglobin (FHb), platelets (PLT), erythrocyte fragility (EF), and morphological analysis of erythrocytes observed under scanning electron microscope were measured to evaluate the impact of trauma on erythrocytes. A small amount of blood was collected for analysis before pumping, at the end of the 4th hour and then every 2 h till the end of the 16th hour. Some blood samples were also collected for electron microscope scanning before pumping and every 4 h during pumping. It was found that FHb and PLT linearly increased with the pumping time. There was a significant correlation between the two parameters (r=0.7745, p<0.001). The hemolysis indexes of the two groups were 0.296 and 0.3993 mg/L/h, respectively, with no significant difference. During the pumping process, EF changed slightly. The observation of scanning electron microscopy showed various deformed erythrocytes after pumping, including the distortion of cell membrane and the appearance of echinocytes, which increased with pumping time. This study demonstrated that long term pumping using roller pump not only caused the immediate rupture of red blood cells, i.e. the immediate hemolysis, but also caused sub-trauma to a large number of erythrocytes, which led to the delayed hemolysis. The change of erythrocyte morphology was the basis of the delayed hemolysis.

Magnetic resonance imaging of traumatic intervertebral disc extrusion in dogs

This retrospective study evaluated the magnetic resonance (mr) images of traumatic disc extrusions in 11 dogs. The findings included a reduction in the volume and signal intensity of the nucleus pulposus, focal hyperintensity within the overlying spinal cord on T (2)-weighted mr images, and subtle spinal cord compression, extraneous material or signal change within the vertebral canal. The largest area of hyperintensity in the spinal cord was directly over or close to the affected disc space, appeared asymmetrical and in the majority of cases was less than one vertebra in length. Parenchymal spinal cord haemorrhage was identified in four of the dogs. Vacuum phenomena, evident as a signal void in the centre of the disc, were identified in two of the dogs. The mr images were distinct from those reported for other causes of spinal cord dysfunction.

From hematopoietic stem cells to platelets

Megakaryocytopoiesis is the process that leads to the production of platelets. This process involves the commitment of multipotent hematopoietic stem cells toward megakaryocyte (MK) progenitors, the proliferation and differentiation of MK progenitors, the polyploidization of MK precursors and the maturation of MK. Mature MK produce platelets by cytoplasmic fragmentation occurring through a dynamic and regulated process, called proplatelet formation, and consisting of long pseudopodial elongations that break in the blood flow. Recent insights have demonstrated that the MK and erythroid lineages are tightly associated at both the cellular and molecular levels, especially in the transcription factors that regulate their differentiation programs. Megakaryocytopoiesis is regulated by two types of transcription factors, those regulating the differentiation process, such as GATA-1, and those regulating proplatelet formation, such as NF-E2. The humoral factor thrombopoietin (TPO) is the primary regulator of MK differentiation and platelet production through the stimulation of its receptor MPL. Numerous acquired or congenital pathologies of the MK lineage are now explained by molecular abnormalities in the activity of the transcription factors involved in megakaryocytopoiesis, in the Tpo or c-mpl genes, as well as in signaling molecules associated with MPL. The recent development of MPL agonists may provide efficient agents for the treatment of some thrombocytopenias.

The use of complementary and alternative medicine in patients with terminal cancer in Korea: Nationwide cross-sectional study

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Background: Although the use of complementary and alternative medicine(CAM) is widespread among patients with chronic diseases including cancer, little is known about CAM use in terminal cancer patients. Methods: This study included 4,042 families of cancer patients who died at 17 hospitals in Korea between January and December 2004. We conducted with telephone survey to decedents’ families. The response rate was 41.1%. The questionnaire included whether cancer patients had used CAM during last one year before death, type of modality, motivation for use, attitudes to CAM, and consultation with doctors. Results: CAM use of cancer patients was reported by 36.3% (604 of 1,662) and the average rate of CAM cost was 32% of total medical costs during one year before patient’s death. CAM use was more likely to death at hospitals (adjusted Odds Ratio: 1.35, 95% Confidential Interval: 1.15–1.58), residence in rural (aOR:1.26, 95%CI:1.08–1.47), need consultations about care (aOR:1.65, 95%CI:1.30–2.09) and religious support (aOR:1.3, 95% CI:1.11–1.53), diagnosis except liver/gallbladder cancer (aOR:0.67, 95%CI:0.55–0.81), and longer disease period (aOR:1.85, 95% CI:1.5–2.2). Use was greatest for mushrooms (41.6%), vegetable juice (25.6%), ginseng (21.8%) and Chinese medicine (16.4%). The motivation for CAM use was the recommendations from family members or friends (83.5%) and internet or advertisement (16.1%) but physicians’ recommendation or education (1.4%) was rare. The 37.4% of families of CAM-used patients were satisfied with CAM because of but feeling better or comfortable (79.3%), not cure (5.4%). And otherwise, the 62.1% of them were unsatisfied with CAM because of no effect (87.3%). Only 41.7% CAM users consulted with their physician. Conclusions: This study revealed a high prevalence of CAM use among terminal cancer patients without recommendation from doctors. Medical staffs should evaluate patients’ CAM use and inform accurately about CAM to terminal cancer patients and family for quality of care improvement.

No significant financial relationships to disclose.

Cervical cancer patients’ preferences and use of various cancer information sources in South Korea

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Background: Accessing appropriate facts is important in enabling cancer patients cope with the disease. This study focused on the utilization and preferences of cancer information sources by cervical cancer patients in terms of ease in receiving and searching the available data. Methods: The study included 830 women over the age of 18 years treated for cervical cancer at six hospitals in South Korea between 1983 and 2004. All the participants provided written informed consent, and the Institutional Review Board of the National Cancer Center approved the protocol. A questionnaire addressed the patients’ use of and preferences for sources and forms of cancer information. Data were collected by mail. Results: Television and/or the radio were the the most frequently cited sources of cancer information by the middle and oldest age groups: 45–64 years (52.0%), =65 years (47.3%), while patients in the youngest age group (<45 years) used the Internet (38.8%). Booklets and/or pamphlets (24.0%) were the source of cancer information preferred by the youngest age group, while patients in the middle and oldest age groups preferred TV/radio: 45–64 years (35.7%) and =65 years (55.0%). Life notes and/or experiences (43.2%), that is, personal accounts, comprised the most easily understood form of information regardless of age group. Conclusions: Our findings indicate that cervical cancer patients’ utilization of and preferences for sources of cancer information vary according to patient age. Tailored educational materials that consider the users’ age and condition should be customized to best fit their specific preferences.

No significant financial relationships to disclose.

Application of serum proteomic patterns by ProteinChip SELDI system in diagnosis of gastric cancer

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Background: Gastric cancer is one of the most common malignancy in the world and one of the leading causes of cancer related death in Korea. Most treatments for advanced gastric cancer have limited efficacy. So early detection of gastric cancer could have profound impact on the successful treatment. Application of multiple biomarkers may improve the diagnostic prediction to distinguish cancer from non-cancer. ProteinChip Surface-Enhanced Laser Desorption/Ionization Time-of-flight Mass Spectrometry (SELDI-TOF-MS) system is one of the currently used techniques to identify biomarkers for cancers. In this study, we have explored whether the serum proteomic patterns by ProteinChip SELDI system can differentiate gastric cancers from non-cancer cohorts. Methods: We have screened protein profiles of 100 serum samples obtained from 60 gastric cancer patients and 40 healthy individuals. Protein expression profiles were expressed on ProteinChip Array and analyzed by PreoteinChip Reader. Peak intensities were normalized by total ion currency and analyzed by the Biomarker Wizard Software to identify the peaks showing significantly different intensities between normal and cancer groups. Classification analysis and construction of decision trees were done with the Biomarker Pattern Software. Results: SELDI -TOF-MS by averaging 50 laser spots collected at a laser intensity setting of 160, a detector sensitivity of 6, and mean mass range of 30 kDa. Seventeen protein peaks shown significant differences between two groups were chosen to make a protein biomarker pattern. The decision tree which gives the highest discrimination included four peaks at 5,919, 8,583, 10,286, and 13,758 as splitters. The sensitivity and the specificity for classification of with the decision tree giving the highest discrimination were 96.7% (58/60) and 97.5% (39/40), respectively. When the protein biomarker pattern was tested with the blinded test set including 30 gastric cancer patients and 20 healthy individuals and, it yielded a sensitivity of 93.3% (28/30) and a specificity of 90% (18/20). Conclusions: These results suggest that serum-protein profiling pattern by SELDI system may distinguish gastric cancer patients from normal counterparts with relatively high sensitivity and specificity.

No significant financial relationships to disclose.