Conserved haplotype blocks within the sheep MHC and low SNP heterozygosity in the Class IIa subregion

This report describes single-nucleotide polymorphisms (SNPs) in the sheep major histocompatibility complex (MHC) class II and class III regions and provides insights into the internal structure of this important genomic complex. MHC haplotypes were deduced from sheep family trios based on genotypes from 20 novel SNPs representative of the class II region and 10 previously described SNPs spanning the class III region. All 30 SNPs exhibited Hardy-Weinberg proportions in the sheep population studied. Recombination within an extended sire haplotype was observed within the class II region for 4 of 20 sheep chromosomes, thereby supporting the presence of separated IIa and IIb subregions similar to those present in cattle. SNP heterozygosity varied across the class II and III regions. One segment of the class IIa subregion manifested very low heterozygosity for several SNPs spanning approximately 120 Kbp. This feature corresponds to a subregion within the human MHC class II region previously described as a 'SNP desert' because of its paucity of SNPs. Linkage disequilibrium (LD) was reduced at the junction separating the putative class IIb and IIa subregions and also between the class IIa and the class III subregions. The latter observation is consistent with either an unmapped physical separation at this location or more likely a boundary characterized by more frequent recombination between two conserved subregions, each manifesting high within-block LD. These results identify internal blocks of loci in the sheep MHC, within which recombination is relatively rare.

Molecular analysis of congenital adrenal hyperplasia due to 21-hydroxylase deficiency in Hong Kong Chinese patients

BACKGROUND

Congenital adrenal hyperplasia (CAH) caused by 21-hydroxylase deficiency (21OHD) is an autosomal recessive disorder due to mutation in the CYP21A2 gene.

OBJECTIVE

To elucidate the genetic basis of 21-hydroxylase-deficient CAH in Hong Kong Chinese patients.

PATIENTS AND METHODS

Mutational analysis of the CYP21A2 gene was performed on 35 Hong Kong Chinese patients with 21OHD using direct DNA sequencing and multiplex ligation-dependent probe amplification (MLPA).

RESULTS

The genetic findings of 21 male and 14 female patients are the following: c.293-13A/C>G (intron 2 splice site; 20 alleles), p.I172N (13), p.R356W (7), p.Q318X (4). A total of 20 mutant alleles contained gross deletion/conversion of all or part of the CYP21A2 gene. A novel mutation, c.1367delA (p.D456fs), was detected in one patient. One patient had only a heterozygous mutation detected. Out of 35 patients, 16 would have been incorrectly genotyped if either DNA sequencing or MLPA alone was used for molecular analysis.

CONCLUSIONS

The frequency of various mutations in the studied patients differs from those reported in other Asian populations. Gross deletion/conversion accounts for nearly one-third of the genetic defects. Therefore, laboratories must include methods for detecting point mutations as well as gross deletions/conversions to avoid misinterpretation of genotype. Genotyping has increasingly been proven to be a useful tool for supplementing, if not replacing, hormonal profiling for the diagnosis of 21OHD.

Kruger strict morphology and post-thaw progressive motility in cryopreserved human spermatozoa

The purpose of this prospective study was to evaluate Kruger strict morphology and conventional semen analysis in predicting cryosurvival and the progressive motility recovery rate of frozen spermatozoa. Our study included 56 semen samples with >10 million spermatozoa per ejaculate. The main outcome measures were conventional semen analysis, strict morphology analysis by the Kruger method, cryosurvival rate and post-thaw sperm motility. A significant reduction in sperm motility after cryopreservation was demonstrated. The freeze-thawing process caused a 66% reduction in rapid progressive motile spermatozoa, a 45% reduction in slow progressive motile spermatozoa and a 2% reduction in nonprogressive motile spermatozoa. The cryosurvival and progressive motility recovery rates were not correlated with parameters of conventional semen analysis, such as sperm concentration, motility, WHO morphology and total motile count, but the progressive motility recovery rate was significantly correlated with the percentage of spermatozoa exhibiting Kruger normal morphology (P = 0.028). The recovery rate of rapidly progressive motility was profoundly decreased compared with slow progressive motility following the frozen-thaw procedure of semen. Kruger strict morphology assessment was a better predictor of the progressive motility recovery rate following the freezing-thaw procedure than parameters of conventional semen analysis.

A synopsis of current care of thalassaemia major patients in Hong Kong

OBJECTIVE

To provide a synopsis of current thalassaemia major patient care in Hong Kong.

DESIGN

Retrospective study.

SETTING

All haematology units of the Hospital Authority in Hong Kong.

PATIENTS

All patients with thalassaemia major with regular transfusion.

RESULTS

To date, there were 363 thalassaemia major patients under the care of the Hospital Authority. Prenatal diagnosis has helped to reduce the number of indigenous new cases, but in recent years immigrant cases are appearing. The patients have a mean age of 23 (range, 1-52) years, and 78% of them are adults. In 2009, they received 18 782 units of blood. This accounted for 9.5% of all blood consumption from the Hong Kong Red Cross. In the past, cardiac iron overload was the major cause of death (65%) and few patients survived beyond the age of 45 years. The availability of cardiac iron assessment by magnetic resonance imaging (T2 MRI) to direct the use of oral deferiprone chelation has reduced the prevalence of heart failure and cardiac haemosiderosis, which should reduce mortality and improve life expectancy.

CONCLUSION

The future for thalassaemia care in Hong Kong is bright. With better transfusion and chelation, it should be possible to avoid growth and endocrine deficiencies in younger patients.

Clonal spreading of methicillin-resistant SCCmec Staphylococcus aureus with specific spa and dru types in central Taiwan

The goal of this study was to delineate the molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) in Taiwan. Ninety-six MRSA isolates were collected from the blood cultures of different patients during the period July to December of 2008. The spa typing, staphylococcal chromosomal cassette (SCCmec) typing, mec-associated direct repeat unit (dru) copy numbers, and toxin genes (sea, seb, sec, tst, lukS/F) of each isolate were determined. Thirty-eight, 28, 18, and 12 MRSA isolates were SCCmec type II, SCCmec type III, SCCmec type IV, and SCCmec type V, respectively. Most (31/38, 81.6%) of the SCCmec type II isolates were of spa t002 with four dru repeats. Some of them also carried the sec or tst toxin gene (67.7 and 80.6%, respectively). Of the 28 SCCmec type III MRSA isolates, 15 (53.6%) were of t037 with 14 dru repeats, and all also carried the sea gene. Of the 18 SCCmec type IV MRSA isolates, 13 (72.2%) were of t437 with nine dru repeats, and ten of them also had the seb gene. Among the SCCmec type V MRSA isolates, nine were type V(T). Five (55.6%) of them were of t437 with 11 dru repeats, and all contained the lukS/F gene. The clonal spreading of SCCmec MRSA strains with specific spa and dru types was found. Further longitudinal, multiple-site surveillance is required in order to define the MRSA evolution in Taiwan.

Successful endosaccular coiling after a balloon occlusion test of the caudal channel of a double origin of the posterior inferior cerebellar artery originating from the aneurysm neck

Therapeutic strategies for unruptured aneurysms in elective procedures must be carefully planned with respect to safety. We describe the case of a patient who presented with an unruptured aneurysm associated with a double origin of the posterior inferior cerebellar artery (DOPICA), a rare variant of aberrant origin. A three-dimensional rotational angiogram clearly showed that the aneurysm incorporated the origin of the DOPICA caudal channel, which was more dominant than the cranial one. The aneurysm was completely obliterated using detachable coils after a balloon occlusion test (BOT) of the caudal channel was conducted to confirm the tolerance of the patient following sudden interruption of the more prominent flow coming from the caudal channel of the DOPICA. This report affirms the need to suspect anomalies associated with a DOPICA that predispose to intracranial aneurysms and highlights the potential role of a BOT in pretreatment hemodynamic evaluations of unusual aneurysms accompanying a particular developmental anomaly.

A synopsis of current haemophilia care in Hong Kong

OBJECTIVE

To provide a synopsis of current haemophilia care in Hong Kong.

DESIGN

Retrospective survey.

SETTING

All haematology units of the Hospital Authority in Hong Kong.

PATIENTS

All patients with haemophilia A and haemophilia B.

RESULTS

To date, there were 222 mild-to-severe haemophilia patients (192 type A, 30 type B) under regular public care in Hong Kong (43% were considered severe, 33% moderate, and 24% mild), which gave a crude prevalence of 6.8/100 000 male inhabitants. A total of 12.8 million units of Factor VIII and 3 million units of Factor IX were prescribed annually. This amounts to 1.83 units of FVIII per capita of the population, which is comparable to that of other developed countries. Leading causes of mortality were human immunodeficiency virus-related complications (10 cases) and cerebral bleeding (2 cases). The life expectancy of patients with severe haemophilia in Hong Kong is improving; currently the oldest patient is 60 years old. Such improved survival may be due to enhanced factor availability, prompt treatment of bleeding episodes at home, safer factor products, and better antiviral treatment. Primary prophylaxis is the accepted standard of care for severe and moderate cases, and "Factor First" has become hospital policy. However, 12 patients continue to present treatment challenges, due to the documented presence of factor inhibitors. In all, 28, 100, and 14 cases respectively were positive for human immunodeficiency virus, hepatitis C virus, and hepatitis B virus; the youngest patients with the corresponding infections being 28, 13, and 22 years old. Comprehensive care with dedicated physiotherapy, surgical support, and radionucleotide synovectomy may reduce morbidity further.

CONCLUSION

A multidisciplinary approach can further improve the future care for haemophilia patients in Hong Kong.

Contact investigation for tuberculosis in Taiwan contacts aged under 20 years in 2005

OBJECTIVE

To measure the tuberculosis (TB) incidence rate and assess the relative risk of TB disease in contacts based on the tuberculin skin test (TST) and sputum status of index cases.

DESIGN

All contacts aged <20 years who were exposed to a TB case in 2005 were cross-matched using an electronic surveillance system to estimate TB incidence over a 24-month follow-up period.

RESULTS

Among 6959 contacts there were 67 secondary cases (1%). The incidence was highest in the first year after exposure and decreased by half in the second year (P = 0.001). The relative risks of developing TB in contacts aged 0-4, 5-9, 10-14 and 15-19 years were respectively 325, 209, 337 and 53 times greater than for the general population. The hazard ratio of developing TB among contacts with a TST ≥ 15 mm induration was 12 times higher than for those with a TST < 5 mm (P = 0.003).

CONCLUSIONS

The relative risk of developing TB disease within 24 months of exposure was approximately 200-300 times greater for contacts aged <15 years. The majority developed TB within 12 months of exposure.

Sedimentary 12-n-Propylcholestanes, Molecular Fossils Diagnostic of Marine Algae

Certain C(30)-steranes have been used for identifying sedimentary rocks and crude oils derived from organic matter deposited in marine environments. Analysis of a C(30)-sterane from Prudhoe Bay oil indicates that these C(30)-steranes are 24-n-propylcholestanes that apparently are derived from precursor sterols 24-n-propylidene-cholesterols and 24-n-propylcholesterol. These widely occurring sterols are biochemically synthesized in modern oceans by members of an order (Sarcinochrysidales) of chrysophyte algae. These data thus imply that C(30)-sterane biomarkers in sedimentary rocks and crude oils have a marine origin. Screening of a few organic-rich sedimentary rocks and oils from throughout the Phanerozoic suggests that these C(30)-steranes first appeared and, therefore, their source algae evolved between Early Ordovician and Devonian.

Assessment of the clinical outcomes and cost-effectiveness of the management of systolic heart failure in Chinese patients using a home-based intervention

This study was designed to assess the clinical effect of a home-based telephone intervention in Chinese heart failure patients. A total of 550 Chinese heart failure patients were enrolled into either (i) a group that received the usual standard of care (UC group); or (ii) a group that received a home-based heart failure centre management programme using nursing specialist-led telephone consultations (HFC group). The impact of the home-based intervention on admission rate, admission length and medical costs over 6 months was measured. Although the mean left ventricular ejection fraction in HFC patients was 29.3% compared with 34.8% in UC patients, the home-based intervention resulted in a significantly lower all-cause admission rate per person (HFC 0.60 +/- 0.77 times/person; UC 0.96 +/- 0.85 times/person), a shorter all-cause hospital stay (reduced by 8 days per person) and lower total 6-month medical costs (reduced by US$2682 per patient). These results suggest that the home-based intervention with nursing specialist-led telephone consultations may improve the clinical outcome and provide cost-savings for Chinese patients with heart failure.

Short-term influence of phosphate and nitrate on heavy metal accumulation by red alga Acrosorium uncinatum

Heavy metal accumulation (Cu, Zn, Ni, and Pb) in common marine macroalga, Acrosorium uncinatum under nutrient (phosphate and nitrate) enriched (experiment 1) and starved (experiment 2) conditions over a short exposure period (12 h) were examined in this study. Control was maintained in seawater contained nutrient solution without addition of metals and in seawater alone for experiment 1 and 2, respectively. Among the four metals studied, the accumulation of Zn, Ni, and Pb was considerably lower than Cu. The accumulation factor for all metals varies greatly in different nutrient concentrations, but it increases as the exposure of metal concentration decreases in both the experiments. The results of the present findings established that this macroalga is an accumulator of metals Cu, Zn, Ni, and Pb and have the potential to accumulate these metals even in a short time exposure period (12 h). Even though metal accumulation by A. uncinatum largely depends on the available concentration in the medium, nutrients like phosphate and nitrate can affect the accumulation significantly.

Fecundity, nymphal development and longevity of field-collected tropical bedbugs, Cimex hemipterus

This study examined the fecundity, oviposition, nymphal development and longevity of field-collected samples of the tropical bedbug, Cimex hemipterus (Fabricius) (Hemiptera: Cimicidae). Under environmental conditions of 26+/-2 degrees C, 70 +/- 5% relative humidity and a 12-h photoperiod, with bloodmeals provided by a human host, six strains of tropical bedbug had a fecundity of up to 50 eggs per lifetime, over 11-14 oviposition cycles. Increased feeding frequency improved fecundity. After feeding and mating, adult females normally took 2-3 days to produce a first batch of eggs. The oviposition period lasted 2-7 days before cessation of the oviposition cycle. The egg incubation period usually lasted 5-7 days before the emergence of first instars. The nymphs underwent five stadia (the first four of which each took 3-4 days, whereas the last took 4-5 days) before becoming adults at a sex ratio of 1 : 1. More than five bloodmeals were required by the nymphs to ensure a successful moult. Unmated adults lived significantly longer than mated adults (P < 0.05). Unmated females lived up to almost 7 months, but the longevity of mated males and females did not differ significantly (P > 0.05).

Practical considerations in converting from plasma-derived to recombinant hepatitis B vaccines

Plasma-derived and recombinant vaccines have been developed to prevent hepatitis B virus infections. Both types of vaccine perform very well with respect to safety, immunogenicity and protective efficacy. The protection afforded by both types of vaccine is satisfactory for at least 5 to 10 years after vaccination, and a further booster dose is not necessary during this period. However, the plasma-derived vaccine is costly to produce and there is an unjustified but prevalent fear that it may be contaminated by potential pathogens. The supply of human plasma for production of the plasma-derived vaccine cannot be assured once use of hepatitis B vaccines becomes universal. It is therefore inevitable that the recombinant vaccine will replace the plasma-derived vaccine. If necessary, both vaccines can be used in combination. Future directions for hepatitis B vaccine development include: determination of the need for incorporation of pre-S gene products to enhance immunogenicity; defining a practical strategy to combat the problem of escape mutants after vaccination; and development of combination vaccines containing other inactivated antigens to allow complete immunisation against several diseases with a minimal number of injections.

Polymorphism of sheep MHC Class IIb gene TAPASIN

The Major Histocompatibility Complex (MHC) is one of the most gene dense regions in the genome and studies in several species have shown significant associations between the MHC and disease. The endoplasmic reticular glycoprotein, tapasin, is involved in the MHC class I antigen presentation pathway. Sheep TAPASIN is located in the class IIb region of the MHC. Sheep TAPASIN was subcloned from BAC and cosmid genomic clones and DNA sequenced. TAPASIN is 9549bp in length and encodes a protein of 447 amino acids. The structure of sheep TAPASIN was similar to other mammals and consisted of eight exons with a distinctively larger intron between exon three and four. Sheep TAPASIN gene had high sequence identity with other mammalian TAPASINs. The TAPASIN gene sequence is conserved across many mammalian species and is possibly maintained through purifying selection with the average ratio of ds/dn of 3.9. Twenty-six SNPs in sheep TAPASIN were identified.

Interspecific competition between the Smooth cockroach Symploce pallens and the German cockroach Blattella germanica (Dictyoptera: Blattellidae) under different food and water regimes

The interspecific competition between a new cockroach pest species in Southeast Asia, the Smooth cockroach, Symploce pallens (Stephens) and the ubiquitous German cockroach, Blattella germanica (L.) was studied under different food and water regimes (unlimited food and water [control], limited water, limited food and limited food and water). Both species were found to have equal chances to coexist when both food and water are unlimited, when food is a limiting factor, and when both food and water are limited. However, under shorter evaluation periods (eg. 60 and 120 days), the intrinsic rate of increase (rn) of S. pallens appeared to be significantly lower than that of the B. germanica. This is possibly due to the shorter nymphal development period and higher fecundity of the latter species when compared to S. pallens. Both the food and water availability factor showed significant effects on the rn of both species.

Ministry of Health clinical practice guidelines: Management of Rhinosinusitis and Allergic Rhinitis

The Ministry of Health publishes national clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the Ministry of Health clinical practice guidelines on Management of Rhinosinusitis and Allergic Rhinitis, for the information of readers of the Singapore Medical Journal. Chapters, page and figure numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=24046). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Percutaneous transcatheter aortic valve replacement: first transapical implant in Asia

Percutaneous transcatheter implantation of the aortic valve has been demonstrated as an alternative to open heart surgery in high-risk patients with symptomatic severe aortic stenosis (AS) who are not suitable for open surgery. The majority of these new devices are delivered via the transfemoral approach. However, due to the current size of delivery sheaths, the small and tortuous iliofemoral anatomy makes this approach challenging. The transapical approach provides a viable option for this patient subgroup. The first-in-Asia transcatheter aortic valve implantation via the transapical route is described. A 79-year-old Chinese woman with symptomatic severe AS and peripheral arterial disease, who was at high surgical risk, was successfully treated, and had good functional and haemodynamic results at the three-month follow-up.

Use of urinary steroid profiling for diagnosing and monitoring adrenocortical tumours

It has been suggested that urinary steroid profiling may be used to provide information aiding the diagnosis and monitoring of adrenocortical carcinoma. Nonetheless, the abnormal patterns suggestive of adrenal malignancy are not well defined. We retrospectively studied the urinary steroid profiles of five patients with adrenocortical carcinoma at presentation and at follow-up, and compared these results with those from 76 patients with benign adrenocortical adenoma and 172 healthy controls. Three abnormal patterns of urinary steroid excretion were identified in patients with adrenocortical carcinoma at presentation and/or follow-up of residual disease: (1) hypersecretion in multiple steroid axes; (2) excretion of unusual metabolites, notably 5-pregnene-3alpha,16alpha,20alpha-triol, 5-pregnene-3beta,16alpha,20alpha-triol, and neonatal steroid metabolites in the post-neonatal period; (3) increase of tetrahydro-11-deoxycortisol relative to total cortisol metabolites. These preliminary findings offer ways in which urinary steroid profiling performed using gas chromatography-mass spectrometry can be helpful in the diagnosis and monitoring of adrenocortical carcinoma.

White-light electroluminescence from ZnO nanorods/polyfluorene by solution-based growth

We report bright white-light electroluminescence (EL) from a diode structure consisting of a ZnO nanorod (NR) and a p-type conducting polymer of poly(fluorine) (PF) fabricated using a hydrothermal method. ZnO NRs are successfully grown on an organic layer of PF using a modified seeding layer. The EL spectrum shows a broad emission band covering the entire visible range from 400 to 800 nm. White-light emission is possible because the ZnO-defect-related emission from the ZnO NR/PF heterostructure is enhanced to become over thousand times stronger than that from the usual ZnO NR structure. This strong green-yellow emission associated with the ZnO defects, combined with the blue PF-related emission, results in the white-light emission. Enhancement of the ZnO-defect emission is caused by the presence of Zn(OH)(2) at the interface between the ZnO NRs and PF. Fourier transform infrared spectroscopy reveals that the absorption peaks at 3441, 3502, and 3574 cm(-1) corresponding to the OH group are formed at the ZnO NR/PF heterostructure, which confirms the enhancement of defect emission from the ZnO NR/PF heterostructure. The processing procedure revealed in this work is a convenient and low-cost way to fabricate ZnO-based white-light-emitting devices.

Survey of commercially available chocolate- and cocoa-containing products in the United States. 2. Comparison of flavan-3-ol content with nonfat cocoa solids, total polyphenols, and percent cacao

A survey of a broad range of chocolate- and cocoa-containing products marketed in the United States was conducted to provide a more detailed analysis of flavan-3-ol monomers, oligomers, and polymers, which can be grouped into a class of compounds called procyanidins. Samples consisted of the three or four top-selling products within the following six categories: natural cocoa powder, unsweetened baking chocolate, dark chocolate, semisweet baking chips, milk chocolate, and chocolate syrup. Composite samples were characterized for percent fat (% fat), percent nonfat cocoa solids (% NFCS), antioxidant level by ORAC, total polyphenols, epicatechin, catechin, total monomers, and flavan-3-ol oligomers and polymers (procyanidins). On a gram weight basis epicatechin and catechin content of the products follow in decreasing order: cocoa powder > baking chocolate > dark chocolate = baking chips > milk chocolate > chocolate syrup. Analysis of the monomer and oligomer profiles within product categories shows there are two types of profiles: (1) products that have high monomers with decreasing levels of oligomers and (2) products in which the level of dimers is equal to or greater than the monomers. Results show a strong correlation (R(2) = 0.834) of epicatechin to the level of % NFCS and also very good correlations for N = 2-5 oligomers to % NFCS. A weaker correlation was observed for catechin to % NFCS (R(2) = 0.680). Other analyses show a similar high degree of correlation with epicatechin and N = 2-5 oligomers to total polyphenols, with catechin being less well correlated to total polyphenols. A lesser but still good correlation exists between the calculated percent cacao (calcd % cacao) content, a proxy for percent cacao, and these same flavanol measures, with catechin again showing a lesser degree of correlation to calcd % cacao. Principal component analysis (PCA) shows that the products group discretely into five classes: (1) cocoa powder, (2) baking chocolate, (3) dark chocolate and semisweet chips, (4) milk chocolates, and (5) syrup. PCA also shows that most factors group closely together including the antioxidant activity, total polyphenols, and the flavan-3-ol measures with the exception of catechin and % fat in the product, which group separately. Because catechin distribution appears to be different from the other flavan-3-ol measures, an analysis of the epicatechin to catechin ratio was done, indicating there is a >5-fold variation in this measure across the products studied. The cocoa-containing products tested range from cocoa powder with 227.34 +/- 17.23 mg of procyanidins per serving to 25.75 +/- 9.91 mg of procyanidins per serving for chocolate syrup. These results are discussed with respect to other studies on commercial products, the bioavailability of the flavanols, and the possible role of processing on the amount of catechin in products.

Localised heating of tumours utilising injectable magnetic nanoparticles for hyperthermia cancer therapy

This study reports an investigation of hyperthermia cancer therapy utilising an alternating magnetic field to induce a localised temperature increase on tumours by using injectable magnetic nanoparticles. In-vitro and in-vivo experiments represent the feasibility of hyperthermia cancer therapy. A feedback temperature control system was first developed to keep the nanoparticles at a constant temperature to prevent overheating in the tumours such that a safer and more precise cancer therapy becomes feasible. By using the feedback temperature control system, magnetic nanoparticles can be heated up to the specific constant temperatures, 37, 40, 42, 45, 46 and 47 degrees C, respectively, with a variation less than 0.2 degrees C. With this approach, the in-vitro survival rate of tumour cells at different temperatures can be systematically explored. It was experimentally found that the survival rate of cancer cells can be greatly reduced while CT-26 cancer cells were heated above 45 degrees C. Besides, localised temperatures increase as high as 59.5 degrees C can be successfully generated in rat livers by using the proposed method. Finally, complete regression of tumour was achieved. The developed method used injectable magnetic nanoparticles and may provide a promising approach for hyperthermia cancer therapy.

Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position

OBJECTIVES

To determine the prevalence of clinical symptoms associated with Cesarean scar defects, and to determine the association between the size of these defects, clinical complaints, uterine position, and a history of multiple Cesarean sections.

METHODS

In this cross-sectional study, Cesarean scar defects in women with a history of transverse lower-segment Cesarean section were measured by transvaginal ultrasound while being assessed for other gynecological conditions. The relationships between the size of the Cesarean scar defect and the clinical symptoms, uterine position and number of previous Cesarean sections were evaluated. Patients with other uterine pathologies, including endometrial hyperplasia, polyps, malignancy and submucosal myomas, were excluded from the study.

RESULTS

During a 3-year period, 4250 women were assessed by transvaginal sonography, of whom 293 (6.9%) were diagnosed with Cesarean scar defects. Eighty-six patients were excluded due to other uterine pathologies. Altogether, 207 patients with Cesarean scar defects were included in this study. Women who had undergone multiple Cesarean sections tended to have larger scar defects (in width and depth) than did those who had undergone a single Cesarean section. Women with retroflexed uteri also tended to have wider defects than those with anteflexed uteri. Defect width was significantly greater in women with postmenstrual spotting, dysmenorrhea and chronic pelvic pain.

CONCLUSIONS

Multiple Cesarean sections and retroflexed uteri are risk factors for larger Cesarean scar defects. The size of the Cesarean scar defect is associated with clinical symptoms such as postmenstrual spotting, dysmenorrhea and chronic pelvic pain.

Mechanism of insoluble phosphate solubilization by Pseudomonas fluorescens RAF15 isolated from ginseng rhizosphere and its plant growth-promoting activities

AIMS

To investigate the mechanism of insoluble phosphate (P) solubilization and plant growth-promoting activity by Pseudomonas fluorescens RAF15.

METHODS AND RESULTS

We investigated the ability of Ps. fluorescens RAF15 to solubilize insoluble P via two possible mechanisms: proton excretion by ammonium assimilation and organic acid production. There were no clear differences in pH and P solubilization between glucose-ammonium and glucose-nitrate media. P solubilization was significantly promoted with glucose compared to fructose. Regardless of nitrogen sources used, Ps. fluorescens RAF15 solubilized little insoluble P with fructose. High performance liquid chromatography analysis showed that Ps. fluorescens RAF15 produced mainly gluconic and tartaric acids with small amounts of 2-ketogluconic, formic and acetic acids. During the culture, the pH was reduced with increase in gluconic acid concentration and was inversely correlated with soluble P concentration. Ps. fluorescens RAF1 showed the properties related to plant growth promotion: pectinase, protease, lipase, siderophore, hydrogen cyanide, and indoleacetic acid.

CONCLUSION

This study indicated that the P solubility was directly correlated with the organic acids produced.

SIGNIFICANCE AND IMPACT OF THE STUDY

Pseudomonas fluorescens RAF15 possessed different traits related to plant growth promotion. Therefore, Ps. fluorescens RAF15 could be a potential candidate for the development of biofertilizer or biocontrol agent.

Percutaneous transcatheter aortic valve replacement: first transfemoral implant in Asia

Surgical aortic valve replacement (AVR) is the standard of care for patients with symptomatic severe aortic stenosis (AS), providing relief of symptoms and prolonging survival. However, many patients are either denied or not offered surgery due to high surgical risk or non-operability for open AVR. The technology of percutaneous aortic valve implantation emerged in 2002, and has since evolved rapidly with satisfactory results. Currently, almost all the procedures are performed predominantly in Europe and North America. The first-in-Asia percutaneous transcatheter aortic valve implantation via the transfemoral route is described. A 77-year-old man with symptomatic severe AS and at high surgical risk was successfully treated, with sustained clinical improvement and satisfactory haemodynamic results at 30-day follow-up.