Describing the quality of life of boys with haemophilia in China: Results of a multicentre study using the CHO-KLAT

INTRODUCTION

The treatment of haemophilia varies across countries and across regions within some countries. Similar variation has been observed in health-related quality of life (HR-QoL). Relatively little is known about the HR-QoL of boys with haemophilia in China.

AIM

The aim of this study was to describe the HR-QoL of boys with haemophilia in China using the Canadian Haemophilia Outcomes-Kids Life Assessment Tool (CHO-KLAT).

METHODS

Boys (4-18 years of age) with haemophilia and their parents were enroled in a cross-sectional study. All parents/guardians of study subjects were requested to complete a CHO-KLAT questionnaire during a clinic visit, and report on several other clinical and socioeconomic factors in the past year. Boys who were > 7 years also completed the CHO-KLAT.

RESULTS

A total of 269 parents of boys with haemophilia, from 13 hospitals in 12 provinces, were enroled during 2014. The boys ranged from 4.0 to 17.9 years of age; 91% had haemophilia A, most had moderate (52%) or severe (36%) disease, and most were receiving sub-optimal on-demand therapy or low-dose prophylactic therapy. Child self-report CHO-KLAT scores were available for 171 boys ≥7 years of age and ranged from 24.2 to 85.3 with a mean of 57.6 (n = 171). Parent proxy-reported CHO-KLAT scores ranged from 25.0 to 88.7 with a mean of 55.1 (n = 269).

CONCLUSION

HR-QoL scores in boys with haemophilia in China were substantially lower than reported from Canadian and European boys with haemophilia. Longer term prospective studies are required to examine the factors impacting the HR-QoL for boys with haemophilia in China.

[Epilepsy Electroencephalogram Signal Analysis Based on Improved k-nearest Neighbor Network]

The study of complex networks has become a hot research area of electroencephalogram signal.Electroencephalogram time series generated by the network keeps node information of network,so studying the time series from the network can also achieve the purpose of study epileptic electroencephalogram.In this paper,we propose a method to analyze epileptic electroencephalogram based on time series which is based on improved k-nearest neighbor network.The results of the experiment showed that studying power spectrum of time series from network was easier than power spectrum of time series directly generated from the original brain data to distinguish between normal controls and epileptic patients.In addition,studying the clustering coefficient of improved k-nearest neighbor network was able to distinguish between normal persons and patients with epilepsy.This study can provide important reference for the study of epilepsy and clinical diagnosis.

[Application of disparity discriminating accuracy test in evaluating the stereopsis of postoperative intermittent exotropia]

OBJECTIVE

To discuss the application of disparity discriminating accuracy test in evaluating the stereopsis of postoperative intermittent exotropia.

METHODS

Patients with intermittent exotropia who underwent surgery during July 2011 to June 2013 were followed up. The stereoacuity was examined by Titmus Stereotest, Randot Stereotest and Frisby Stereotest. Twenty adult cases whose stereoacuity reached normal were chosen as experimental group. Twenty healthy adults were selected as normal control group. Both groups were examined with disparity discriminating accuracy test. Discriminating accuracy of the two groups were analyzed with Two-Way ANOVA method. Test-retest reliability was analyzed with Intraclass Correlation Coefficient analysis.

RESULTS

The test-retest reliability of disparity discriminating accuracy test is excellent (ICC=0.99, P<0.01) . Discriminating accuracy under different disparities in experimental group were 0.56±0.09, 0.67±0.14, 0.77±0.15, 0.82±0.14, 0.85±0.11, 0.85±0.14, 0.87±0.10, 0.84±0.16, while those in control group were 0.77±0.09, 0.88±0.09, 0.93±0.08, 0.91±0.09, 0.95±0.08, 0.96±0.05, 0.97±0.06, 0.96±0.04. There were statistically significant differences between them (F=38.06, P<0.01) . The discriminating ability of group grating in both groups was affected by the size of disparity. Under situation of small disparity, a large difference was found between the experimental group (0.67±0.12)and control group(0.86±0.07) (F=4.84, P<0.05).

CONCLUSIONS

Stereoscopic function can be evaluated comprehensively with disparity discriminating accuracy test. Use this test, a certain degree of dysfunction in stereopsis can still be found in postoperative intermittent exotropic patients who reached normal stereoacuity examined with traditional stereotests. (Chin J Ophthalmol, 2016, 52: 584-588).

MRI findings in intraspinal mature teratoma

AIM

To characterise and evaluate magnetic resonance imaging (MRI) images for their clinical value in diagnosing and assessing intraspinal mature teratoma.

MATERIALS AND METHODS

MRI images obtained from eight patients with a histopathologically verified intraspinal mature teratoma were analysed retrospectively regarding tumour location, size, and margins. Additionally, the signal intensity and enhancement pattern on MRI and other associated malformations were also assessed.

RESULTS

Three cases that contained fatty tissue showed markedly heterogeneous hyperintense signalling on T1-weighted images, and mixed hyperintense and hypointense signalling on T2-weighted images and fat-suppression sequences. All three of those cases showed an irregular peripheral fatty tissue signal, and one case showed additional patches of an interspersed calcification signal. The remaining five cases without fatty tissue displayed heterogeneous hyperintense signalling on T1-weighted images and T2-weighted images, and also on fat-suppression sequences. Four of the five cases showed additional patches of interspersed nodular calcification signals. Contrast-enhanced MRI images showed only slight enhancement (n=3).

CONCLUSIONS

MRI is regarded as the reference standard diagnostic technique to reveal the location of teratomas and the degree of spinal cord involvement. In most cases, MRI provides accurate anatomical and histological information, which is necessary for patients with suspected intraspinal mature teratoma.

Investigation into Feasibility of Congestive Heart Failure Diagnosis Based on Analysis of Very Short-term Heart Rate Variability

The analysis parameters for the characterization of heart rate variability(HRV)within a very short time(< 1min)usually exhibit complicate variation patterns over time,which may easily interfere the judgment to the status of the cardiovascular system.In this study,long-term HRV sequence of 41 cases of healthy people(control group)and 25 cases of congestive heart failure(CHF)patients(experimental group)was divided into multiple segments of very short time series.The variation coefficient of the same HRV parameter under multiple segments of very short time series and the testing proportion with statistically significant differences under multiple interclass t-test were calculated.On this account,part of HRV analysis parameters under very short time were discussed to reveal the stability of difference of the cardiovascular system function under different status.Furthermore,with analyzing the receiver operating characteristic(ROC)curve and modeling the artificial neural network(ANN),the classification effects of these parameters between the control group and the experimental group were assessed.The results demonstrated that1 the indices of entropy of degree distribution based on the complex network analysis had a lowest variation coefficient and was sensitive to the pathological status(in 79.75% cases,there has statistically significant differences between the control group and experimental group),which can be served as an auxiliary index for clinical doctor to diagnose for CHF patient;2after conducting ellipse fitting to Poincare plot,in 98.5% cases,there had statistically significant differences for the ratio of ellipse short-long axis(SDratio)between the control group and the experimental group;when modeling the ANN and solely adopting SDratio,the classification accuracy to the control group and experimental group was 71.87%,which demonstrated that SDratio might be acted as the intelligent diagnosis index for CHF patients;3 however,more sensitive and robust indices were still needed to find out for the very-short HRV analysis and for the diagnosis of CHF patients as well.

KRAS status and resistance to epidermal growth factor receptor tyrosine-kinase inhibitor treatment in patients with metastatic colorectal cancer: a meta-analysis

AIM

This study reviewed the association between KRAS mutation and resistance to treatment with epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitors (TKIs) in patients with metastatic colorectal cancer (mCRC).

METHOD

A search was carried out of PubMed, MEDLINE, EMBASE and the Cochrane Library databases (to November 2013) without language restrictions.

RESULTS

Ten studies were included in the final meta-analysis, consisting of 1339 patients with mCRC, of whom 427 (32%) had a KRAS mutation. The objective response rate (ORR) of mCRC patients with KRAS mutation was 8% (33/427), whereas the ORR of mCRC patients with wild-type KRAS was 34% (306/912). The overall pooled response rate (RR) for the ORR was 1.297 (95% CI 1.244-1.353, P < 0.01). Subgroup analysis comparing cetuximab monotherapy treatment with cetuximab plus chemotherapy, showed a pooled RR of 1.26 (95% CI 1.12-0.63, P < 0.01) and 1.30 (95% CI 1.25-1.36, P < 0.01), respectively. For patients receiving anti-EGFR with monoclonal antibodies (mAb) given as first-line treatment or not, the pooled RRs were 1.34 (95% CI 1.23-1.46, P < 0.01) and 1.29 (95% CI 1.23-1.35, P < 0.01). The data on progression-free survival from five studies in the meta-analysis gave a hazard ratio (HR) of 1.99 with a 95% CI of 1.69-2.29. Finally, the data for overall survival in mCRC patients were pooled from the only three studies reporting the HR (1.80; 95% CI 1.50-2.10). None of the results had any evidence of heterogeneity.

CONCLUSION

All the results favoured a stronger link between mutant KRAS and anti-EGFR mAb, but due to a mutually exclusive relationship between KRAS and other gene mutations the clinical usefulness of KRAS mutation as a selection marker for sensitivity to EGFR TKIs in mCRC is limited.

Combination of equiprobable symbolization and time reversal asymmetry for heartbeat interval series analysis

Symbolic dynamics method and time reversal asymmetry analysis are both important approaches in the study of heartbeat interval series. However, there is limited research work reported on combining these two methods. We provide a method of time reversal asymmetry analysis which focuses on the differences between the forward and backward embedding "m words" after the operation of equiprobable symbolization. To investigate the total amplitude as well as the distribution features of the difference, four indices are proposed. Based on the application to simulation series, we found that these measures can successfully detect time reversal asymmetry in chaos series. With application to human heartbeat interval series (RR series), it is suggested that the distribution features of the forward-backward difference can sensitively capture the dynamical changes caused by diseases or aging. In particular, the index E(D), which reflects the random degree of the forward-backward difference distribution, can significantly discriminate healthy subjects from diseased ones. We conclude that RR series from healthy subjects show more asymmetry in temporal structure on the original time scale from the perspective of equiprobable symbolization, whereas diseases account for loss of this asymmetry.

Seasonal changes in antifreeze protein gene transcription and water content of beetle Microdera punctipennis (Coleoptera, Tenebrionidae) from Gurbantonggut desert in Central Asia

Desert beetle Microdera punctipennis (Coleoptera: Tenebriondae) is a special species in Gurbantonggut Desert in Central Asia. To investigate the possible strategy it employs for cold survival, seasonal changes in supercooling point (SCP), body water content, haemolymph osmolality and antifreeze protein gene (Mpafp) expression were measured over 13 months. Our results show SCPs in M. punctipennis adults changed from -8.0°C in summer to -18.7°C in winter. During winter, adults endured modest water loss; total water decreased from 65.4 percent in summer to 55.9% in winter. Mpafp mRNAs level increased by 13.1 fold from summer to early winter, and haemolymph osmolality increased accordingly from 550 mOsm to 1486 mOsm. Correlation coefficient of Mpafp mRNAs level and SCP indicates that Mpafp mRNA explained 65.3 percent of the variation in SCPs. The correlation between Mpafp mRNA level and total water reflected an indirect influence of antifreeze protein on water content via reducing SCP.

Application of monitored natural attenuation to remediate a petroleum-hydrocarbon spill site

Contamination of groundwater by petroleum-hydrocarbons is a serious environmental problem. The Monitored Natural Attenuation (MNA) approach is a passive remediation to degrade and dissipate groundwater contaminants in situ. In this study, a full-scale natural bioremediation investigation was conducted at a gasoline spill site. Results show that concentrations of major contaminants (benzene, toluene, ethylbenzene, and xylenes) dropped to below detection limit before they reached the downgradient monitor well located 280 m from the spill location. The results also reveal that natural biodegradation was the major cause of the observed contaminant reduction. The calculated natural first-order attenuation rates for BTEX and 1,2,4-trimethylbenzene (1,2,4-TMB) ranged from 0.051 (benzene) to 0.189 1/day (1,2,4-TMB). Evidence for the occurrence of natural attenuation includes the following: (1) depletion of dissolved oxygen, nitrate, and sulfate; (2) production of dissolved ferrous iron, sulfide, and CO2; (3) decreased BTEX concentrations and BTEX as carbon to TOC ratio along the transport path; (4) increased alkalinity and microbial populations; (5) limited spreading of the BTEX plume; and (6) preferential removal of certain BTEX components along the transport path. Additionally, the biodegradation capacity (44.73 mg/L) for BTEX and 1,2,4-TMB was much higher than other detected contaminants within the plume. Hence, natural attenuation can effectively contain the plume, and biodegradation processes played an important role in contaminant removal.

A member of the Y-box protein family interacts with an upstream element in the alpha1(I) collagen gene

Transforming growth factor beta (TGF-beta) stimulates protein complex formation on a TGF-beta response element (TAE) found in the distal portion (-1624) of the collagen alpha 1(I) promoter. To identify the fibroblast proteins in this complex, an expression library constructed from human embryonic lung fibroblasts mRNA was screened using a tetramer of TAE. Y-box binding protein (YB-1), was identified as a protein in the TAE-protein complex. The protein expressed by phage clones formed a specific complex with labeled TAE but not mutated TAE (mTAE) similar to the complex formed with nuclear protein. Nuclear protein-TAE complexes isolated from native gels contained YB-1 by Western analysis. TGF-beta treatment increased the amount of YB-1 protein in nuclear extracts, decreased its amount in cytoplasm, but did not alter the steady state levels of YB-1 mRNA. A full-length YB-1 protein expressed in human lung fibroblasts was primarily located in the nucleus with punctate staining in cytoplasmic regions. The expression of YB-1 decreased in the cytoplasm after 2 h of TGF-beta treatment. Therefore, the increased binding activity seen in TGF-beta-stimulated nuclear extracts was due primarily to relocalization of YB-1 from the cytoplasm to the nuclear compartment. Co-transfection of YB-1 cDNA with a collagen promoter-reporter construct caused a dose-dependent activation of collagen promoter activity in rat fibroblasts whereas the promoter with a mutation in the TAE element was not sensitive to YB-1 co-expression. In conclusion, we have identified YB-1 as a protein that interacts with a TGF-beta response element in the distal region of the collagen alpha 1(I) gene. YB-1 protein activates the collagen promoter and translocates into the nucleus during TGF-beta addition to fibroblasts, suggesting a role for this protein in TGF-beta signaling.

Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: a 10-year study

The current study examines the risk-inducing effects of unemployment and the protective effects of language facility on the mental health of Southeast Asian refugees resettling in Canada. Rates of depression and of unemployment declined dramatically during the first decade after arrival. Although language fluency also improved during this period, approximately 8% of the sample spoke no English even after 10 years in the country. Initial depression was a strong predictor of subsequent depression. For males, job experience in Canada was the strongest predictor of subsequent employment whereas, for women, depression proved an important predictor of employability. For men in particular, unemployment was a potent risk factor for depression. During the initial period of resettlement, English-speaking ability had no effect on depression or on employment. However, by the end of the first decade in Canada. English language fluency was a significant predictor of depression and employment, particularly among refugee women and among people who did not become engaged in the labor market during the earliest years of resettlement. Study results demonstrate that the mental health salience of risk and protective factors changes according to the phase of resettlement.

[A randomized, controlled clinical trial of meropenem and imipenem/cilastatin in the treatment of acute bacterial infections]

OBJECTIVE

Meropenem is a new carbapenem antibiotic developed by Sumitomo Pharmaceuticals and shown to resist degradation by renal dehydropeptidase I (DPH-I), an enzyme which exists chiefly in the kidneys and decomposes carbapenem antibiotics. It has a powerful antibacterial activity with broad antibacterial spectrum. The objective of the study is to evaluate the efficacy and safety of meropenem.

METHODS

A randomized, open-label, controlled study was conducted for treating patients with bacterial infections. A total of 112 hospitalized patients were enrolled in the study. 55 patients received meropenem 500 mg every 12 hours (or 1g every 12 hours if necessary) and 57 patients received imipenem/cilastatin 500 mg/500 mg every 12 hours (or 1g/1g every 12 hours if necessary) intravenously. The duration of treatment was 7-14 days in both groups.

RESULTS

42 of the 55 cases receiving meropenem and 41 of the 57 cases receiving imipenem/cilastatin were assessable for clinical efficacy. The overall efficacy rate was 88.1%(37/42) for the meropenem group and 85.4%(35/41) for the imipenem/cilastatin group, whereas the bacterial eradication rate was 81.1%(30/37) and 84.2%(32/38), respectively. 47(69.1%) of 68 strains isolated from patients produced beta-lactamase. Adverse drug reaction was evaluated in 44 cases of the meropenem group and 41 cases of the imipenem/cilastatin group. The adverse drug reaction rate was 13.6%(6/44) and 12.2%(5/41), respectively. The results showed that there were no statistical differences between these two groups (P > 0.05).

CONCLUSION

Meropenem and imipenem/cilastatin were effective and safe for the treatment of lower respiratory tract infections and urinary tract infections and other infections caused by beta-lactamase-producing strains.

Non-specific deadenylation and deguanylation of naked RNA catalyzed by ricin under acidic condition

Ricin A-chain catalyzes the hydrolysis of the N-glycosidic bond of a conserved adenosine residue at position 4324 in the sarcin/ricin domain of 28S RNA of rat ribosome. The GAGA tetraloop closed by C-G pairs is required for recognition of the cleavage site on 28S ribosomal RNA by ricin A-chain. In this study, ricin A-chain (reduced ricin) exhibits specific depurination on a synthetic oligoribonucleotide (named SRD RNA) mimic of the sarcin/ricin domain of rat 28S ribosomal RNA under neutral and weak acidic conditions. Furthermore, the activity of intact ricin is also similar to that of ricin A-chain. However, under more acidic conditions, both enzymes lose their site specificity. The alteration in specificity of depurination is not dependent on the GAGA tetraloop of SRD RNA. A higher concentration of KCl inhibits the non-specific N-glycosidase activity much more than the specific activity of ricin A-chain. In addition, characterization of depurination sites by RNA sequencing reveals that under acidic conditions ricin A-chain can release not only adenines, but also guanines from SRD RNA or 5S ribosomal RNA. This is the first report of the non-specific deadenylation and deguanylation activity of ricin A-chain to the naked RNA under acidic conditions.

[Expression of Fas on monocytes and the level of plasma soluble FasL in patients with chronic renal failure]

OBJECTIVE

The dysfunction of monocytes in uremic patients has been demonstrated to be associated with monocyte accelerated apoptosis. The study was conducted toelucidate the mechanisms by which monocyte apoptosis was induced.

METHODS

Seven non-dialyzed chronic uremic patients and 18 hemodialysis (HD) patients were enrolled in the study. Fifteen healthy volunteers were selected as controls. The expression of Fas and Fas ligand (FasL) was examined by immunofluorescent staining and flow cytometer analysis. The levels of soluble FasL (sFasL) in plasma were analyzed by enzyme-linked immunosorbent assay (ELISA). The percentage of apoptotic cells in monocytes cultured in vitro with recombinant human FasL (rHu-FasL) was quantitated by DNA content analysis after extraction of the degraded DNA. Monocyte survival rate was analyzed by 5-diphenyl tetrazolium bromide (MTT) staining.

RESULTS

Expression of Fas on monocytes was significantly higher in uremic and HD patients than that in healthy subjects. Higher levels of Fas expression were demonstrated on monocytes from HD as patients compared with those from non-dialyzed patients. There was no difference in monocyte Fas expression between pre- and post-dialysis session and between patients using polysulfone and cellulose dialyzer. There was no detectable FasL expression on monocytes from both uremic patients and healthy controls. Plasma sFasL could be detected in uremic and HD patients, but not in healthy controls. There was no significant difference in levels of plasma sFasL between non-dialyzed and HD patients, pre- and post-dialysis session, and patients treated with polysulfone and cellulose dialyzer. When monocytes were cultured in vitro with rHu-FasL for 2 hours, higher levels of apoptosis and lower survival rate were found in monocytes from HD patients as compared with those from healthy controls.

CONCLUSION

The up-regulated expression of functional Fas on monocytes and the presence of sFasL in plasma may contribute to the accelerated apoptosis of monocytes seen in uremic patients.

Enhanced oxidant stress in synovial vessels of patients on hemodialysis

OBJECTIVE

To test the hypothesis that the susceptibility of synovial vessels to redox uncoupling which could result in oxidative damage capable of promoting beta 2-microglobulin (beta 2 m) deposition.

METHODS

The expression of oxidative markers by microvascular endothelial cells in hemodialysis (HD) patients, non-uremic patients and normal subjects was determined using immunostaining and Northern blotting.

RESULTS

Synovial vascular endothelial cells of HD patients exhibited evidence of oxidant stress: induction of malondialdehyde (MDA) epitopes and heme oxygenase. These oxidative markers were not detectable in microvascular endothelial cells of other tissues from HD patients, as well as in the synovial vessels of non-uremic or normal controls. Higher levels of heme oxygenase mRNA in synovia were seen in patients with beta 2 m deposition compared with patients without beta 2 m deposition.

CONCLUSIONS

Oxidative damage of the synovial microvasculature in uremic patients may be one of the factors which can promote deposition of beta 2 m in osteoarticular tissue.