[Value of endoscopic ultrasound in early diagnosis of gastroesophageal varices in patients with liver cirrhosis]

Objective: To investigate the value of endoscopic ultrasound in the early diagnosis of gastroesophageal varices in patients with liver cirrhosis. Methods: A total of 74 patients with liver cirrhosis who were not found to have esophageal or gastric varices by conventional endoscopic examination were enrolled. Endoscopic ultrasound was performed to evaluate its value in the early diagnosis of gastroesophageal varices in patients with liver cirrhosis. The Mann-Whitney U test was used for comparison of non-parametric data between groups, and a one-way analysis of variance was used for comparison between multiple groups; the Pearson simple correlation coefficient was used for correlation analysis. Results: Among the 74 patients with liver cirrhosis, 3(4.1%)were not found to have esophageal and gastric submucosal varices, peripheral varices, or perforating branches by endoscopic ultrasound. Among the 71 patients with liver cirrhosis who underwent endoscopic ultrasound, 16(22.5%)had esophageal submucosal varices, and 22(31.0%)had gastric submucosal varices; 58 patients(81.7%)were found to have at least one type of esophageal peripheral varices. The numbers of patients detected to have paraesophageal varices, periesophageal varices, paragastric varices, and perigastric varices were 29(40.8%), 24(33.8%), 28(39.4%), and 22(31.0%), respectively, which were significantly different from the number in patients with chronic liver diseases(P < 0.05). Among the 71 patients with liver cirrhosis who underwent endoscopic ultrasound, 20(28.2%)were found to have perforating branches with esophageal and gastric submucosal varices or peripheral varices, which showed a significant difference from the number in patients with chronic liver diseases(P < 0.05). In patients with liver cirrhosis, esophageal and gastric peripheral varices were associated with esophageal and gastric submucosal varices(P < 0.05). Conclusion: Endoscopic ultrasound has a certain value in the early diagnosis of esophageal and gastric varices in patients with liver cirrhosis.

Severe exacerbation and pneumonia in COPD patients treated with fixed combinations of inhaled corticosteroid and long-acting beta2 agonist

Background

It remains unclear whether severe exacerbation and pneumonia of COPD differs between patients treated with budesonide/formoterol and those treated with fluticasone/salmeterol. Therefore, we conducted a comparative study of those who used budesonide/formoterol and those treated with fluticasone/salmeterol for COPD.

Methods

Subjects in this population-based cohort study comprised patients with COPD who were treated with a fixed combination of budesonide/formoterol or fluticasone/salmeterol. All patients were recruited from the Taiwan National Health Insurance database. The outcomes including severe exacerbations, pneumonia, and pneumonia requiring mechanical ventilation (MV) were measured.

Results

During the study period, 11,519 COPD patients receiving fluticasone/salmeterol and 7,437 patients receiving budesonide/formoterol were enrolled in the study. Pairwise matching (1:1) of fluticasone/salmeterol and budesonide/formoterol populations resulted in to two similar subgroups comprising each 7,295 patients. Patients receiving fluticasone/salmeterol had higher annual rate and higher risk of severe exacerbation than patients receiving budesonide/formoterol (1.2219/year vs 1.1237/year, adjusted rate ratio, 1.08; 95% CI, 1.07–1.10). In addition, patients receiving fluticasone/salmeterol had higher incidence rate and higher risk of pneumonia than patients receiving budesonide/formoterol (12.11 per 100 person-years vs 10.65 per 100 person-years, adjusted hazard ratio [aHR], 1.13; 95% CI, 1.08–1.20). Finally, patients receiving fluticasone/salmeterol had higher incidence rate and higher risk of pneumonia requiring MV than patients receiving budesonide/formoterol (3.94 per 100 person-years vs 3.47 per 100 person-years, aHR, 1.14; 95% CI, 1.05–1.24). A similar trend was seen before and after propensity score matching analysis, intention-to-treat, and as-treated analysis with and without competing risk.

Conclusions

Based on this retrospective observational study, long-term treatment with fixed combination budesonide/formoterol was associated with fewer severe exacerbations, pneumonia, and pneumonia requiring MV than fluticasone/salmeterol in COPD patients.

[The Value of SMI in the Evaluation of interventional therapy of liver cancer]

Objective: To evaluate the value of super microvascular imaging(SMI) for evaluating the effect of interventional therapy of liver cancer. Methods: A total of 30 patients with 40 leisions were enrolled in this study, from the tumor intervention department in the third affiliated hospital of suzhou university.This patients were underwent TACE, after the treatment 1 month, CDFI, SMI, and CT were study respectively. Using the continuity correction McNemar matching chi-square test, with P < 0.05 for the standard , CDFI and SMI shows the difference in monitoring the microvascular imaging in and around the tumors leisions. Results: A total of 30 patients, 12 cases were primary liver cancer (7 cases combined with liver cirrhosis), 18cases were metastatic liver cancer; 30 cases including 25 single and 5 multiple. Significant difference were found between CT and SMI in detecting blood flows inside the lesion (χ² = 8.642 9, P < 0.05), and were also found between CT and CDFI in detecting blood flows inside the lesion (χ² = 16.961 5, P < 0.05). The AUROC, sensitivity, specificity, accuracy, PPV and NPV of CDFI were 0.647, 29.4%、100%、29.4%、100%、20.0%, while in SMI were 0.809, 61.8%、100%、61.7%、100%、31.5%, respectively. Conclusions: SMI SMI can detect the microvascular inside the lesions. This new method was superior to CDFI, achieving the same effect as CT.

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan.

Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan.

Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery

IMPORTANCE

Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS).

OBJECTIVE

To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality).

DESIGN, SETTING, AND PARTICIPANTS

Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries; follow-up finished in December 2013.

EXPOSURES

Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement.

MAIN OUTCOMES AND MEASURES

A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-day mortality of 3% or higher. To determine potential diagnostic criteria for MINS, regression analyses ascertained if postoperative hsTnT elevations required an ischemic feature (eg, ischemic symptom or electrocardiography finding) to be associated with 30-day mortality.

RESULTS

Among 21 842 participants, the mean age was 63.1 (SD, 10.7) years and 49.1% were female. Death within 30 days after surgery occurred in 266 patients (1.2%; 95% CI, 1.1%-1.4%). Multivariable analysis demonstrated that compared with the reference group (peak hsTnT <5 ng/L), peak postoperative hsTnT levels of 20 to less than 65 ng/L, 65 to less than 1000 ng/L, and 1000 ng/L or higher had 30-day mortality rates of 3.0% (123/4049; 95% CI, 2.6%-3.6%), 9.1% (102/1118; 95% CI, 7.6%-11.0%), and 29.6% (16/54; 95% CI, 19.1%-42.8%), with corresponding adjusted HRs of 23.63 (95% CI, 10.32-54.09), 70.34 (95% CI, 30.60-161.71), and 227.01 (95% CI, 87.35-589.92), respectively. An absolute hsTnT change of 5 ng/L or higher was associated with an increased risk of 30-day mortality (adjusted HR, 4.69; 95% CI, 3.52-6.25). An elevated postoperative hsTnT (ie, 20 to <65 ng/L with an absolute change ≥5 ng/L or hsTnT ≥65 ng/L) without an ischemic feature was associated with 30-day mortality (adjusted HR, 3.20; 95% CI, 2.37-4.32). Among the 3904 patients (17.9%; 95% CI, 17.4%-18.4%) with MINS, 3633 (93.1%; 95% CI, 92.2%-93.8%) did not experience an ischemic symptom.

CONCLUSIONS AND RELEVANCE

Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality.

Risk of Fracture in Primary Aldosteronism: A Population-Based Cohort Study

Primary aldosteronism (PA) is associated with increased urinary calcium excretion and osteoporosis prevalence. We studied the long-term effect of hyperaldosterone on fracture risk and possible risk mitigation via treatments, by comparing PA patients and their essential hypertension (EH) counterparts extracted by propensity score match. We used a longitudinal population database from the Taiwan National Health Insurance, and used a validated algorithm to identify PA patients diagnosed in 1997-2010. Our sample included 2533 PA patients, including 921 patients with aldosterone-producing adenoma (APA). Our methods for assessing excessive fracture risk included multivariable Cox regression and the competing risk regression. The incidence rate of fracture at any site was 14.4 per 1000 person-years for PA, and 11.2 per 1000 person-years for APA. In contrast, the incidence rate of fracture at any site was 8.3 per 1000 person-years in EH controls for PA, and 6.5 per 1000 person-years in EH controls for APA. Mineralocorticoid receptor antagonist (MRA) treatment might be associated with higher risk of osteoporotic fracture in the whole female PA cohort (subdistribution hazard ratio [SHR] = 2.12, p = 0.008) as well as female APA patients (SHR = 1.15, p = 0.049). As to fracture at any site, MRA treatment was also associated with higher risk; the SHR was 1.88 (p < 0.001) in the whole female PA cohort, and 2.17 (p = 0.019) in female APA patients. PA is tightly associated with higher risk of bone fracture, even in the case where the competing risk of death was controlled. Particularly, female PA patients treated with MRA were confronted with significantly higher risk in bone fracture than their EH controls. © 2017 American Society for Bone and Mineral Research.

A pilot study of ultrasound evaluation of gastric emptying in patients with end-stage renal failure: a comparison with healthy controls

This prospective study was designed to evaluate gastric volume and content in patients with renal failure and healthy controls after an overnight fast, immediately after a light meal and at 6 h after the meal. Thirty subjects in each group were recruited. At each scanning session, gastric antral cross-sectional area was measured in the supine recumbent and right lateral decubitus positions, and a qualitative assessment of gastric contents was made using the Perlas three-point grading system. Six hours after the meal, the mean (SD) antral cross-sectional area in the supine position was 471 (195) mm² in patients with renal failure and 319 (106) mm² in healthy controls (p = 0.028), whereas in the right lateral position it was 756 (320) and 521 (180) mm² , respectively (p = 0.21). In terms of the qualitative assessments of gastric contents, all subjects had an empty stomach after an overnight fast. Five patients with renal failure and no controls had Perlas grade 2 images, indicating significant gastric contents, 6 h after a meal (p = 0.026). This study supports the use of bedside gastric ultrasound as a point-of-care test for patients with known risk factors for delayed gastric emptying.

DC-STAMP Is an Osteoclast Fusogen Engaged in Periodontal Bone Resorption

Dendritic cell-specific transmembrane protein (DC-STAMP) plays a key role in the induction of osteoclast (OC) cell fusion, as well as DC-mediated immune regulation. While DC-STAMP gene expression is upregulated in the gingival tissue with periodontitis, its pathophysiological roles in periodontitis remain unclear. To evaluate the effects of DC-STAMP in periodontitis, anti-DC-STAMP-monoclonal antibody (mAb) was tested in a mouse model of ligature-induced periodontitis ( n = 6-7/group) where Pasteurella pneumotropica ( Pp)-reactive immune response activated T cells to produce receptor activator of nuclear factor kappa-B ligand (RANKL), which, in turn, promotes the periodontal bone loss via upregulation of osteoclastogenesis. DC-STAMP was expressed on the cell surface of mature multinuclear OCs, as well as immature mononuclear OCs, in primary cultures of RANKL-stimulated bone marrow cells. Anti-DC-STAMP-mAb suppressed the emergence of large, but not small, multinuclear OCs, suggesting that DC-STAMP is engaged in the late stage of cell fusion. Anti-DC-STAMP-mAb also inhibited pit formation caused by RANKL-stimulated bone marrow cells. Attachment of ligature to a second maxillary molar induced DC-STAMP messenger RNA and protein, along with elevated tartrate-resistant acid phosphatase-positive (TRAP+) OCs and alveolar bone loss. As we expected, systemic administration of anti-DC-STAMP-mAb downregulated the ligature-induced alveolar bone loss. Importantly, local injection of anti-DC-STAMP-mAb also suppressed alveolar bone loss and reduced the total number of multinucleated TRAP+ cells in mice that received ligature attachment. Attachment of ligature induced significantly elevated tumor necrosis factor-α, interleukin-1β, and RANKL in the gingival tissue compared with the control site without ligature ( P < 0.05), which was unaffected by local injection with either anti-DC-STAMP-mAb or control-mAb. Neither in vivo anti- Pp IgG antibody nor in vitro anti- Pp T-cell response and resultant production of RANKL was affected by anti-DC-STAMP-mAb. This study illustrated the roles of DC-STAMP in promoting local OC cell fusion without affecting adaptive immune responses to oral bacteria. Therefore, it is plausible that a novel therapeutic regimen targeting DC-STAMP could suppress periodontal bone loss.

Cytomegalovirus colitis in hospitalized inflammatory bowel disease patients in Taiwan: a referral center study

BACKGROUND

Colitis is exacerbated in patients with concurrent cytomegalovirus (CMV) infection and inflammatory bowel disease (IBD). We assessed the prevalence and clinical features of CMV colitis in hospitalized IBD patients.

METHODS

A retrospective study reviewed the data from January 1, 1998 through December 31, 2013 compiled at the National Taiwan University Hospital. The CMV colitis patients' demographic data, clinical information, treatment regimens, pathologic findings, and outcome were analyzed.

RESULTS

A total of 673 IBD patients were hospitalized during the study period. There were 312 patients diagnosed with Crohn's disease (CD) and 361 with ulcerative colitis (UC). CMV colitis was diagnosed as having positive inclusion bodies in colonic tissue. Six of the 312 CD patients (1.9%) and five of the 361 UC patients (1.4%) were diagnosed with CMV colitis. Compared to CD patients without CMV colitis, patients with CMV colitis were more often older (p < 0.005). Higher steroid usage was noted in the CMV positive group compared to age and gender matched CMV negative IBD patients (81.8% vs. 51.5%). Eight patients received ganciclovir treatment. Three patients who did not receive antiviral treatment had colitis flare-ups after the index admission.

CONCLUSIONS

The prevalence of CMV colitis in hospitalized IBD inpatients was 1.6% in Taiwan. Two associated factors for CMV colitis in hospitalized IBD patients were that they were elderly in CD and were on higher doses of steroids. Routine histopathology studies and/or PCR for refractory colitis patients are suggested to diagnose CMV colitis. Once the diagnosis is made, antiviral treatment is recommended to decrease the colitis relapse rate.

Tube-side mass transfer for hollow fibre membrane contactors operated in the low Graetz range

Transformation of the tube-side mass transfer coefficient derived in hollow fibre membrane contactors (HFMC) of different characteristic length scales (equivalent diameter and fibre length) has been studied when operated in the low Graetz range (Gz<10). Within the low Gz range, mass transfer is generally described by the Graetz problem (Sh=3.67) which assumes that the concentration profile comprises a constant shape over the fibre radius. In this study, it is experimentally evidenced that this assumption over predicts mass transfer within the low Graetz range. Furthermore, within the low Gz range (below 2), a proportional relationship between the experimentally determined mass transfer coefficient (K_ov) and the Graetz number has been identified. For Gz numbers below 2, the experimental Sh number approached unity, which suggests that mass transfer is strongly dependent upon diffusion. However, within this diffusion controlled region of mass transfer, tube-side fluid velocity remained important. For Gz numbers above 2, Sh could be satisfactorily described by extension to the Lévêque solution, which can be ascribed to the constrained growth of the concentration boundary layer adjacent to the fibre wall. Importantly this study demonstrates that whilst mass transfer in the low Graetz range does not explicitly conform to either the Graetz problem or classical Lévêque solution, it is possible to transform the experimentally derived overall mass transfer coefficient (K_ov) between characteristic length scales (d_h and L). T_his was corroborated by comparison of the empirical relationship determined in this study (Sh=0.36Gz) with previously published studies operated in the low Gz range. This analysis provides important insight for process design when slow tube-side flows, or low Schmidt numbers (coincident with gases) constrain operation of hollow fibre membrane contactors to the low Gz range.

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For the low Graetz range (<2), a proportional relationship between Sh and Gz is found.

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For Gz<2, Sh depends on diffusion but fluid velocity remains important.

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For Gz numbers above 2, Sh satisfactorily described by extension to Lévêque.

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Experimental K_ov can be transformed between length scales (d_h and L) at low Gz.

[The analysis of systemic concomitant disease in sudden deafness patients]

Objective:To investigate the clinical characteristics of patients with underlying disease in sudden deafness.Method:One hundred and seventy-three inpatients suffered from sudden deafness were included in this study. We analyzed the underlying disease of these patients retrospectively.Result:The underlying disease of sudden deafness patients mainly include atherosclerosis risk factors (hypertension, diabetes, hyperlipemia, hyperhomocystinemia, hyperuricemia) 79.8%, cervical vertebra disease 26.6%, ear disease 19.1%, thyroid disease 13.9%.Conclusion:The characteristics of underlying disease may plays a crucial role in pathogenesis and treatment in sudden deafness patients.

[Polycyclic aromatic hydrocarbons exposure and birth defects]

Birth defects are one of the most common adverse birth outcomes, which create a heavy economic burden to the country, society and family. And they are also one of the biggest problems facing public health today. Polycyclic aromatic hydrocarbons (PAHs) are a group of toxic pollutants existing in the environment widely, resulting from incomplete organic matter combustion, and can be taken into the body through various ways including the digestive tract, respiratory tract and so on. Recent researches suggest that the exposure of PAHs may be associated with various birth defects, while the special mechanism isn't very clear. This paper is a review of the relationship between PAHs and birth defects from the aspects of epidemiological data, experimental evidence on animals, which indicates that exposure of PAHs during pregnancy may be associated with birth defects including congenital heart defects, neural tube defects and cleft lip/plate. Furthermore, we explored the possible mechanism, including oxidative stress, oxidative damage and the changes of signal transduction pathway in order to provide some recommendations and suggestions on the future work.

The association between inhaled corticosteroid and pneumonia in COPD patients: the improvement of patients' life quality with COPD in Taiwan (IMPACT) study

To investigate the association between inhaled corticosteroid (ICS) exposure patterns and the risk of pneumonia in chronic obstructive pulmonary disease (COPD) patients, we performed a nested case-control study. Between 1998 and 2010, 51,739 patients, including 19,838 cases of pneumonia, were matched to 74,849 control subjects selected from a cohort of COPD patients using ICSs via risk-set sampling of the database constructed by the National Health Research Institutes of Taiwan. After adjusting for covariates, the current use of ICSs was associated with a 25% increase in the risk of pneumonia (odds ratio [OR] =1.25, 95% confidence interval [CI] =1.20–1.30), and there was an increase in the OR with increase in the average daily dosage. Additionally, users of fluticasone/salmeterol, fluticasone, and either fluticasone/salmeterol or fluticasone were more likely to be at a higher risk of pneumonia (OR =1.35, 95% CI =1.28–1.41; OR =1.22, 95% CI =1.10–1.35; and OR =1.33, 95% CI =1.27–1.39, respectively). In contrast, there were no statistically significant associations between the risk of pneumonia and the use of budesonide/formoterol, budesonide, or either budesonide/formoterol or budesonide. In conclusion, ICSs are significantly associated with an increased risk of pneumonia in COPD patients. The effect is prominent for fluticasone-containing ICSs but not for budesonide-containing ICSs.

[Determination of 1-hydroxy-2-butanone in urine by gas chromatography]

Objective: To establish a method for the determination of 1-hydroxy-2-butanone in urine by gas chromatography. Methods: Urine samples were acidified with hydrochloric acid, and then stored in the refrigerator . After thawing under natural conditions, urine volume of 2.0 ml was extracted by C₁₈ solid phase, using methanol volume of 2.0 ml elution, detected by gas chromatography with FID detector and quantified by external standard method. Results: The measurement range of method is 0.986 ~32.88 μg/ml, correlation coefficient (r) =0.999 7, detection limit is 0.13 μg/ml; The recovery is 88.1% ~92.2% ; The precision is 1.4% ~3.2%. Conclusion: This method has a high sensitivity and simple processing. All technical indicators can meet the requirements of the determination method.

CIP2A is a poor prognostic factor and can be a diagnostic marker in papillary thyroid carcinoma

Papillary thyroid carcinoma (PTC) is the most common type of thyroid carcinoma. CIP2A has recently been described as a prognostic marker in many cancers. In this study, we assessed the value of this novel prognostic marker in PTC. A total of 178 surgical specimens of both benign and malignant thyroid tumors were collected. Immunohistochemical staining for CIP2A, HBME-1, galectin-3, and CK19 was performed. Western blotting for CIP2A was also performed. CIP2A was expressed in 85.3% of malignant tumors and 12.1% of benign tumors. ROC analysis showed that the AUC for CIP2A was higher than those for other tumor markers. Western blotting showed that CIP2A expression was higher in PTC than in other tumors. Poor progression-free survival was observed in the high-CIP2A expression group. High CIP2A expression is a poor prognostic factor and can be a diagnostic marker in PTC. The presence of any two of the three indicated makers (CIP2A, galectin-3, and HBME-1) is strongly correlated with the diagnosis of PTC.

Mapping QTLs for drought tolerance in an F2:3 population from an inter-specific cross between Gossypium tomentosum and Gossypium hirsutum

Cotton is one of the most important natural fiber crops in the world. Its growth and yield is greatly limited by drought. A quantitative trait locus (QTL) analysis was therefore conducted to investigate the genetic basis of drought tolerance in cotton (Gossypium spp) using 188 F2:3 lines developed from an inter-specific cross between a wild cotton species, G. tomentosum, and an upland cotton, G. hirsutum (CRI-12). A genetic map was constructed using 1295 simple sequence repeat markers, which amplified 1342 loci, distributed on 26 chromosomes, covering 3328.24 cM. A field experiment was conducted in two consecutive years (2014 and 2015) and 11 morphological and physiological traits were recorded under water-limited (W1)/well-watered (W2) regimes at three growth stages (bud, flowering, and full boll). The traits measured included chlorophyll content, plant height, leaf area, leaf number, leaf fresh weight, leaf dry weight, boll weight, number of bolls per plant, and the number of fruiting branches. Sixty-seven and 35 QTLs were found under the W1 and W2 conditions, respectively. Of these, the majority exhibited partial dominance or over-dominance genetic effects for increasing the trait values. Four consistent QTLs were found under the W1 treatment on chromosomes 5, 8, 9, and 16, whereas no consistent QTL was found in W2. Thirteen QTL clusters were also identified on nine chromosomes (2, 3, 5, 6, 9, 14, 15, 16, and 21). These results will help to elucidate the genetic basis of drought tolerance in cotton.

Microsatellite markers reveal genetic divergence among wild and cultured populations of Chinese sucker Myxocyprinus asiaticus

Studies of genetic diversity and genetic population structure are critical for the conservation and management of endangered species. The Chinese sucker Myxocyprinus asiaticus is a vulnerable monotypic species in China, which is at a risk of decline owing to fluctuations in effective population size and other demographic and environmental factors. We screened 11 microsatellite loci in 214 individuals to assess genetic differentiation in both wild and cultured populations. The single extant wild population had a higher number of alleles (13) than the cultured populations (average 7.3). High levels of genetic diversity, expressed as observed and expected heterozygosity (HO = 0.771, HE = 0.748, respectively), were found in both wild and cultured populations. We also report significant differentiation among wild and cultured populations (global FST = 0.023, P < 0.001). Both STRUCTURE analysis and neighbor-joining tree revealed three moderately divergent primary genetic clusters: the wild Yangtze population and the Sichuan population were each identified as an individual cluster, with the remaining populations clustered together. Twenty-two samples collected from the Yangtze River were assigned to the cultured population, demonstrating the efficacy of artificial propagation to avoid drastic reduction in the population size of M. asiaticus. These genetic data support the endangered status of the M. asiaticus and have implications for conservation management planning.

[Predictive and prognostic value of monitoring lymphocyte subsets in peripheral blood before and after chemotherapy in patients with metastatic breast cancer]

OBJECTIVE

To detect the proportion of lymphocyte subsets in peripheral blood of the advanced breast cancer patients before and after chemotherapy with docetaxel and thiotepa, as well as the association between the proportion of peripheral blood lymphocyte subsets with the response rate and prognosis.

METHODS

The proportions of lymphocyte subsets (CD3+ T cell, CD3+/CD4+ T cell, CD3+/CD8+ T cell, CD3-/CD16+56+ NK cell, CD3+/CD16+56+ T cell, CD19+ B cell, CD4+/CD25+ T cell, CD8+/CD28- T cell, CD8+/CD28+ T cell) in the peripheral blood of 86 patients were analyzed with flowcytometry before and after chemotherapy. The result was analyzed in combination with clinicopathological data.

RESULTS

The proportion of regulatory T cells (Treg) after chemotherapy in the disease control patients decreased significantly compared with that of the progressive patients (P=0.034). The difference of the proportions of Treg before and after chemotherapy affected significantly the overall survival (OS). The OS of the patients with decreased proportion of Treg was significantly longer than that of the patients with increased proportion of Treg, which was 23.5 and 9.4 months respectively (P<0.05).

CONCLUSION

The patients with decreased proportion of Treg after chemotherapy had higher response rate and better survival benefit.

SET antagonist enhances the chemosensitivity of non-small cell lung cancer cells by reactivating protein phosphatase 2A

SET is known as a potent PP2A inhibitor, however, its oncogenic role including its tumorigenic potential and involvement in the development of chemoresistance in non-small cell lung cancer (NSCLC) has not yet been fully discussed. In present study, we investigated the oncogenic role of SET by SET-knockdown and showed that SET silencing impaired cell growth rate, colony formation and tumor sphere formation in A549 cells. Notably, silencing SET enhanced the pro-apoptotic effects of paclitaxel, while ectopic expression of SET diminished the sensitivity of NSCLC cells to paclitaxel. Since the SET protein was shown to affect chemosensitivity, we next examined whether combining a novel SET antagonist, EMQA, sensitized NSCLC cells to paclitaxel. Both the in vitro and in vivo experiments suggested that EMQA and paclitaxel combination treatment was synergistic. Importantly, we found that downregulating p-Akt by inhibiting SET-mediated protein phosphatase 2A (PP2A) inactivation determined the pro-apoptotic effects of EMQA and paclitaxel combination treatment. To dissect the critical site for EMQA functioning, we generated several truncated SET proteins. By analysis of the effects of EMQA on the binding affinities of different truncated SET proteins to PP2A-catalytic subunits, we revealed that the 227-277 amino-acid sequence is critical for EMQA-induced SET inhibition. Our findings demonstrate the critical role of SET in NSCLC, particularly in the development of chemoresistance. The synergistic effects of paclitaxel and the SET antagonist shown in current study encourage further validation of the clinical potential of this combination.

Exploring Northwest China's agricultural water-saving strategy: analysis of water use efficiency based on an SE-DEA model conducted in Xi'an, Shaanxi Province

Worldwide, water scarcity threatens delivery of water to urban centers. Increasing water use efficiency (WUE) is often recommended to reduce water demand, especially in water-scarce areas. In this paper, agricultural water use efficiency (AWUE) is examined using the super-efficient data envelopment analysis (DEA) approach in Xi'an in Northwest China at a temporal and spatial level. The grey systems analysis technique was then adopted to identify the factors that influenced the efficiency differentials under the shortage of water resources. From the perspective of temporal scales, the AWUE increased year by year during 2004-2012, and the highest (2.05) was obtained in 2009. Additionally, the AWUE was the best in the urban area at the spatial scale. Moreover, the key influencing factors of the AWUE are the financial situations and agricultural water-saving technology. Finally, we identified several knowledge gaps and proposed water-saving strategies for increasing AWUE and reducing its water demand by: (1) improving irrigation practices (timing and amounts) based on compatible water-saving techniques; (2) maximizing regional WUE by managing water resources and allocation at regional scales as well as enhancing coordination among Chinese water governance institutes.

Construction and characterization of a bacterial artificial chromosome library for the allotetraploid Gossypium tomentosum

Gossypium tomentosum is a wild allotetraploid species with the (AD)5 genome. It is characterized by many useful traits including finer fiber fineness, drought tolerance, and Fusarium and Verticillium resistance. We constructed the first bacterial artificial chromosome library for Gossypium tomentosum. With high quality and broad coverage, this library includes 200,832 clones, with an average insert size of about 122 kb and fewer than 3% empty clones. Our library is approximately 10-fold the size of the (AD)5-genome (2400 Mb) and provides a 99.7% probability of isolating genes of interest or their sequences. Seven of eight simple sequence repeats markers that are located on five different chromosomes and linked with resistance to Verticillium wilt could amplify the 50 superpools and obtained one to five hits. This high capacity library will be an important genomic resource for classifying and analyzing the evolution of allotetraploid cotton species as well as for isolating disease-resistance and drought-tolerance genes.

Afatinib induces apoptosis in NSCLC without EGFR mutation through Elk-1-mediated suppression of CIP2A

Afatinib has anti-tumor effect in non-small cell lung carcinoma (NSCLC) with epidermal growth factor receptor (EGFR) mutation. We found afatinib can also induce apoptosis in NSCLC cells without EGFR mutation through CIP2A pathway. Four NSCLC cell lines (H358 H441 H460 and A549) were treated with afatinib to determine their sensitivity to afatinib-induced cell death and apoptosis. The effects of CIP2A on afatinib-induced apoptosis were confirmed by overexpression and knockdown of CIP2A expression in the sensitive and resistant cells, respectively. Reduction of Elk-1 binding to the CIP2A promoter and suppression of CIP2A transcription were analyzed. In vivo efficacy of afatinib against H358 and H460 xenografts tumors were also determined in nude mice. Afatinib induced significant cell death and apoptosis in H358 and H441 cells, but not in H460 or A549 cells. The apoptotic effect of afatinib in sensitive cells was associated with downregulation of CIP2A, promotion of PP2A activity and decrease in AKT phosphorylation. Afatinib suppressed CIP2A at the gene transcription level by reducing the promoter binding activity of Elk-1. Clinical samples showed that higher CIP2A expression predicted a poor prognosis and Elk-1 and CIP2A expressions were highly correlated. In conclusion, afatinib induces apoptosis in NSCLC without EGFR mutations through Elk-1/CIP2A/PP2A/AKT pathway.

Genetic diversity and relationship analysis of Gossypium arboreum accessions

Simple sequence repeat techniques were used to identify the genetic diversity of 101 Gossypium arboreum accessions collected from India, Vietnam, and the southwest of China (Guizhou, Guangxi, and Yunnan provinces). Twenty-six pairs of SSR primers produced a total of 103 polymorphic loci with an average of 3.96 polymorphic loci per primer. The average of the effective number of alleles, Nei's gene diversity, and Shannon's information index were 0.59, 0.2835, and 0.4361, respectively. The diversity varied among different geographic regions. The result of principal component analysis was consistent with that of unweighted pair group method with arithmetic mean clustering analysis. The 101 G. arboreum accessions were clustered into 2 groups.

Characterization and development of chloroplast microsatellite markers for Gossypium hirsutum, and cross-species amplification in other Gossypium species

Cotton is an important economic crop worldwide; its fiber, commonly known as cotton lint, is the main natural source for the textile industry. Sixty chloroplast microsatellites were identified and characterized from the complete sequence of the Gossypium hirsutum chloroplast genome using a bioinformatic approach. Twenty chloroplast microsatellite loci were polymorphic in the 66 Gossypium germplasm accessions. A total of 85 alleles were detected, with allele numbers varying from 2-7 per locus. Polymorphism information content varied from 0.02-0.66, with a mean of 0.48. Additionally, transferability of the 20 polymorphic chloroplast microsatellite primers was evaluated in other 31 Gossypium species. Sixteen markers were successfully amplified across all species tested, while the remaining 4 markers cross-amplified in most species tested. These polymorphic chloroplast microsatellite markers may be useful tool for studies of individual identification, genetic diversity, evolution, conservation genetics, and molecular breeding in Gossypium.

miR-71b regulation of insulin/IGF-1 signaling during starvation in planarians

Planarians, which have a large population of stem cells called neoblasts, are molecularly tractable model systems used in the study of regeneration. However, planarians have strong resistance to hunger and have developed growth arrest strategies. For example, they can change their size and undergo growth regression during starvation periods. The results of the current study show that the microRNA, miR-71b, and the insulin/IGF-1 signaling pathway have important functions in the development of starvation-induced planarians. We demonstrate tissue-specific expression of miR-71b using in situ hybridization. By employing real-time polymerase chain reaction, we provide evidence that miR-71b is upregulated in starvation-induced planarians. Furthermore, we validate and verify the target genes of miR-71b.

INPP4B is an oncogenic regulator in human colon cancer

Inositol polyphosphate 4-phosphatase type II (INPP4B) negatively regulates phosphatidylinositol 3-kinase signaling and is a tumor suppressor in some types of cancers. However, we have found that it is frequently upregulated in human colon cancer cells. Here we show that silencing of INPP4B blocks activation of Akt and serum- and glucocorticoid-regulated kinase 3 (SGK3), inhibits colon cancer cell proliferation and retards colon cancer xenograft growth. Conversely, overexpression of INPP4B increases proliferation and triggers anchorage-independent growth of normal colon epithelial cells. Moreover, we demonstrate that the effect of INPP4B on Akt and SGK3 is associated with inactivation of phosphate and tensin homolog through its protein phosphatase activity and that the increase in INPP4B is due to Ets-1-mediated transcriptional upregulation in colon cancer cells. Collectively, these results suggest that INPP4B may function as an oncogenic driver in colon cancer, with potential implications for targeting INPP4B as a novel approach to treat this disease.

The effect of a forced-air warming blanket on patients' end-tidal and transcutaneous carbon dioxide partial pressures during eye surgery under local anaesthesia: a single-blind, randomised controlled trial

Surgical drapes used during eye surgery are impermeable to air and hence risk trapping air underneath them. We investigated the effect of a forced-air warming blanket on carbon dioxide accumulation under the drapes in patients undergoing eye surgery under local anaesthesia without sedation. Forty patients of ASA physical status 1 and 2 were randomly assigned to either the forced-air warmer (n = 20) or a control heated overblanket (n = 20). All patients were given 1 l.min(-1) oxygen. We measured transcutaneous and end-tidal carbon dioxide partial pressures, heart rate, arterial pressure, respiratory rate, temperature and oxygen saturation before and after draping, then every 5 min thereafter for 30 min. The mean (SD) transcutaneous carbon dioxide partial pressure in the forced-air warming group stayed constant after draping at 5.7 (0.2) kPa but rose to a maximum of 6.4 (0.4) kPa in the heated overblanket group (p = 0.0001 for the difference at time points 15 min and later). We conclude that forced-air warming reduces carbon dioxide accumulation under the drapes in patients undergoing eye surgery under local anaesthesia.

Abstract 2924: Suppressing SET reactivates PP2A function in EGFR wide-type NSCLC and synergizes with taxol to exert anti-cancer effects

Background:

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-associated death in the world. Conventional chemotherapy is the standard-of-care for majority of patients with advance NSCLC and tyrosine kinase inhibitors of epithelial growth factor receptor (EGFR) only benefit patients with tumor containing specific mutation forms of EGFR. However, high disease recurrence rate after currently available therapeutics limited patient's survival. Therefore, there is a timely need to improve current treatment for patients with NSCLC, especially those with EGFR wide type tumors.

Protein phosphatase 2A (PP2A) is an important tumor suppression whose function is inhibited in tumor tissue by the appearance of SET. In current study, we showed that inhibiting SET binding to PP2A by a novel small molecular compound significantly improved the chemosensitivity of EGFR wide-type NSCLC cells.

Method:

EGFR wide-type NSCLC cell lines, including A549, H358 and H460, were treated with taxol and a novel quinzoline derivative, PA, which was designed and developed to interrupt the binding of SET to PP2A. Apoptosis of cancer cell, signal transduction and phosphatase activity were analyzed after treatments. Combination index (CI) was applied to determine the synergistic effects of PA and taxol. Co-immunoprecipitation (co-IP) and proximity ligation assay (PLA) were used to identify in vivo binding between SET and PP2A. In vivo anti-tumor effects of treatment containing PA and taxol were also determined in A549 xenografted mice.

Results:

After treating the cancer cells with PA and taxol, apoptosis of cancer cells, in concordance with enhancing PP2A-dependent p-Akt downregulation, were observed in a dose-dependent manner in all EGFR wide-type NSCLC cell lines. CI determined by the results of sub-G1 analysis confirmed the synergy between PA and taxol. Overexpression of Akt and inhibition of PP2A diminished the therapeutic effects of this combination. By two different strategies, co-IP and PLA, we found that this combination treatment inhibited the association of SET and PP2A within lung cancer cells. When overexpression SET in treated cancer cells, the therapeutic effects of this combination were abolished. The anti-tumor effects of treatment combining PA and taxol were also validated in A549 xenografted mice. Our data suggested that PP2A inactivation determines the drug sensitivity of taxol in lung cancer cells, and by interfering the binding of SET and PP2A, PA significantly promote PP2A activity and increase the cytotoxic effects of taxol in EGFR wide-type NSCLC.

Conclusion:

By interfering the binding of SET to PP2A, the novel PP2A enhancer, PA, is shown to reactivate PP2A and work synergistically with taxol for the treatment of EGFR wide-type NSCLC.

Citation Format: Man-Hsin Hung, Chung-Wai Shiau, Yung-Jen Hsiao, Hui-Chuan Yu, Wei-Tien Tai, Chun-Yu Liu, Cheng-Yi Wang, Kuen-Feng Chen. Suppressing SET reactivates PP2A function in EGFR wide-type NSCLC and synergizes with taxol to exert anti-cancer effects. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2924. doi:10.1158/1538-7445.AM2015-2924

Abstract 4447: Targeting SET oncoprotein reactivates the tumor-suppressor PP2A and shows synergy with sorafenib in hepatocellular carcinoma

Background:

Hepatocellular carcinoma (HCC) is the fifth major cancer in the world. Sorafenib is the first and only approved targeted therapy for patients with advanced HCC that brought only a 3-month additive survival benefit to patient. Thus, there is an unmet need for developing effective treatment against HCC. Protein phosphatase 2A (PP2A) is an important tumor suppressor whose functions are suppressed by the presence of its cancerous inhibitor, such as SET/I2PP2A and cancerous inhibitor of PP2A (CIP2A). Previously, we’ve shown that enhancing PP2A activity by inhibiting CIP2A promotes apoptosis of HCC (Oncogene 2010, MCT 2011). Here, we report the anti-HCC potential of a new approach to reactivate PP2A by interrupting the binding between SET and PP2A.

Method:

Using the quinzoline backbone, we designed and developed a novel PP2A activator, PA. HCC cell lines were treated with PA alone or in combination with sorafenib, and apoptosis, signal transduction and phosphatse activity were analyzed. Combination index (CI) was used to evaluate the synergy of combining PA and sorafenib. Small interference RNA was applied to silence gene; co-immunoprecipitation (co-IP) and proximity ligation assay (PLA) were used to determine the association of SET and PP2A within tumor cells. In vivo anti-HCC effects of PA and combination therapy of PA and sorafenib were tested in xenografted nude mice.

Results:

PA induced apoptosis, in association with reactivation of PP2A and downregulation of p-AKT, in a dose-dependent manner in HCC cell lines (PLC5, Hep3B, SK-Hep1, Huh7). Overexpression of Akt and knockdown of PP2A abolished the anti-HCC effects of PA. Using co-IP and PLA, we found that PA interrupts the binding of SET and PP2A within HCC cells in a dose-dependent and time-dependent manner. These data indicated that inhibition of SET-associated PP2A inactivation mediated the downregulation of p-Akt and the cytotoxic effects of PA against HCC. In addition, adding PA to sorafenib significantly induced more potent cell death than sorafenib alone in all HCC cell lines tested. CI suggested good synergy between PA and sorafenib under the combination ratio of 1:5. Importantly, the anti-tumor effects of PA and PA combining with sorafenib were validated in PLC5 xenografted tumors.

Conclusion:

In the current study, we showed that interfering the binding of SET to PP2A induce potent cellular death through PP2A-dependent p-Akt downregulation. This novel approach demonstrates great potency of PP2A enhancer and its synergy with sorafenib for the treatment of HCC.

Citation Format: Man-Hsin Hung, Chung-Wai Shiau, Chih-Ting Shin, Hui-Chuan Yu, Wei-Tien Tai, Chun-Yu Liu, Cheng-Yi Wang, Kuen-Feng Chen. Targeting SET oncoprotein reactivates the tumor-suppressor PP2A and shows synergy with sorafenib in hepatocellular carcinoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4447. doi:10.1158/1538-7445.AM2015-4447

GC-MS analysis of two types of mixed oils, a comparison of composition and weathering patterns

In order to compare the effects of weathering on two types of mixed oil, simulated weathering experiments were performed. The first sample was a mixture of two fresh oils and the second sample was a mixture of one fresh oil and another oil sample that had undergone a serious weathering process. Comparative studies evaluated decay rates and changes in diagnostic ratios of some fingerprinting biomarkers. Results showed that the mixing process affected the weathering rate of some compounds in the oils and also that certain diagnostic ratios are more suitable for estimating mixing proportions. A Pr/n-C17 versus Ph/n-C18 plot can be used to identify the end-numbers of mixed oils and the (C13+C14)/(C25+C26) ratio is a useful diagnostic ratio to detect the degree of weathering. Finally, hopane, sterane, and alkylated PAH fingerprints were found to give useful insights about the sources of the mixed oils.

Changes in expression of BDNF and its receptors TrkB and p75NTR in the hippocampus of a dog model of chronic alcoholism and abstinence

Chronic ethanol consumption can produce learning and memory deficits. Brain-derived neurotrophic factor (BDNF) and its receptors affect the pathogenesis of alcoholism. In this study, we examined the expression of BDNF, tropomyosin receptor kinase B (TrkB) and p75 neurotrophin receptor (p75NTR) in the hippocampus of a dog model of chronic alcoholism and abstinence. Twenty domestic dogs (9-10 months old, 15-20 kg; 10 males and 10 females) were obtained from Harbin Medical University. A stable alcoholism model was established through ad libitum feeding, and anti-alcohol drug treatment (Zhong Yao Jie Jiu Ling, the main ingredient was the stems of watermelon; developed in our laboratory), at low- and high-doses, was carried out. The Zhong Yao Jie Jiu Ling was effective for the alcoholism in dogs. The morphology of hippocampal neurons was evaluated using hematoxylin-eosin staining. The number and morphological features of BDNF, TrkB and p75NTR-positive neurons in the dentate gyrus (DG), and the CA1, CA3 and CA4 regions of the hippocampus were observed using immunohistochemistry. One-way ANOVA was used to determine differences in BDNF, TrkB and p75NTR expression. BDNF, TrkB and p75NTR-positive cells were mainly localized in the granular cell layer of the DG and in the pyramidal cell layer of the CA1, CA3 and CA4 regions (DG>CA1>CA3>CA4). Expression levels of both BDNF and TrkB were decreased in chronic alcoholism, and increased after abstinence. The CA4 region appeared to show the greatest differences. Changes in p75NTR expression were the opposite of those of BDNF and TrkB, with the greatest differences observed in the DG and CA4 regions.

Acetobacter bacteria are found in Zhenjiang vinegar grains

Zhenjiang vinegar, the grains of which contain a unique microbial flora, is one of the four famous traditional Chinese vinegars. We investigated the components of Zhenjiang vinegar grains. Unique acetic acid bacteria were randomly isolated from Zhenjiang vinegar grains, and the obtained strains were qualitatively analyzed to compare their capacities for acetate decomposition and acid production. Acetic acid bacteria with a high acid-producing rate were identified by 16S rDNA sequencing, and further confirmation was performed using the Basic Local Alignment Search Tool comparison method. Six significant strains of acetic acid bacteria were isolated. Qualitative analysis showed that these strains produced no brown precipitate and had a capacity for acetate decomposition. Based on physiological and biochemical evaluation, the two strains with the highest acid yield were sequenced, and the results identified strain W1 as Acetobacter aceti and strain W6 as A. pasteurianus.

Treatment with 1,25(OH)2D3 induced HDAC2 expression and reduced NF-κB p65 expression in a rat model of OVA-induced asthma

Recent evidence indicates that a deficiency of 1,25-dihydroxyvitamin D₃ (1,25[OH]₂D₃) may influence asthma pathogenesis; however, its roles in regulating specific molecular transcription mechanisms remain unclear. We aimed to investigate the effect of 1,25(OH)₂D₃ on the expression and enzyme activity of histone deacetylase 2 (HDAC2) and its synergistic effects with dexamethasone (Dx) in the inhibition of inflammatory cytokine secretion in a rat asthma model. Healthy Wistar rats were randomly divided into 6 groups: control, asthma, 1,25(OH)₂D₃ pretreatment, 1,25(OH)₂D₃ treatment, Dx treatment, and Dx and 1,25(OH)₂D₃ treatment. Pulmonary inflammation was induced by ovalbumin (OVA) sensitization and challenge (OVA/OVA). Inflammatory cells and cytokines in the bronchoalveolar lavage (BAL) fluid and histological changes in lung tissue were examined. Nuclear factor kappa B (NF-κB) p65 and HDAC2 expression levels were assessed with Western blot analyses and quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR). Enzyme activity measurements and immunohistochemical detection of HDAC2 were also performed. Our data demonstrated that 1,25(OH)₂D₃ reduced the airway inflammatory response and the level of inflammatory cytokines in BAL. Although NF-κB p65 expression was attenuated in the pretreatment and treatment groups, the expression and enzyme activity of HDAC2 were increased. In addition, 1,25(OH)₂D₃ and Dx had synergistic effects on the suppression of total cell infusion, cytokine release, and NF-κB p65 expression, and they also increased HDAC2 expression and activity in OVA/OVA rats. Collectively, our results indicated that 1,25(OH)₂D₃might be useful as a novel HDAC2 activator in the treatment of asthma.

The secular trends in the incidence rate and outcomes of out-of-hospital cardiac arrest in Taiwan--a nationwide population-based study

OBJECTIVE

This study investigated the trends in incidence and mortality of out-of-hospital cardiac arrest (OHCA), as well as factors associated with OHCA outcomes in Taiwan.

METHODS

Our study included OHCA patients requiring cardiopulmonary resuscitation (CPR) upon arrival at the hospital. We used national time-series data on annual OHCA incidence rates and mortality rates from 2000 to 2012, and individual demographic and clinical data for all OHCA patients requiring mechanical ventilation (MV) care from March of 2010 to September of 2011. Analytic techniques included the time-series regression and the logistic regression.

RESULTS

There were 117,787 OHCAs in total. The overall incidence rate during the 13 years was 51.1 per 100,000 persons, and the secular trend indicates a sharp increase in the early 2000s and a decrease afterwards. The trend in mortality was also curvilinear, revealing a substantial increase in the early 2000s, a subsequent steep decline and finally a modest increase. Both the 30-day and 180-day mortality rates had a long-term decreasing trend over the period (p<0.01). For both incidence and mortality rates, a significant second-order autoregressive effect emerged. Among OHCA patients with MV, 1-day, 30-day and 180-day mortality rates were 31.3%, 75.8%, and 86.0%, respectively. In this cohort, older age, the female gender, and a Charlson comorbidity index score ≥ 2 were associated with higher 180-day mortality; patients delivered to regional hospitals and those residing in non-metropolitan areas had higher death risk.

CONCLUSIONS

Overall, both the 30-day and the 180-day mortality rates after OHCA had a long-term decreasing trend, while the 1-day mortality had no long-term decline. Among OHCA patients requiring MV, those delivered to regional hospitals and those residing in non-metropolitan areas tended to have higher mortality, suggesting a need for effort to further standardize and improve in-hospital care across hospitals and to advance pre-hospital care in non-metropolitan areas.

Seminar Report From the 2014 Taiwan Society of Inflammatory Bowel Disease (TSIBD) Spring Forum (May 24th, 2014): Crohn's Disease Versus Intestinal Tuberculosis Infection

Since Taiwan is an endemic area for tuberculosis (TB), differential diagnosis between the intestinal TB and Crohn's disease is an important issue. The steering committee of Taiwan Society of Inflammatory Bowel Disease (TSIBD) has arranged a seminar accordingly on May 24th, 2014 and the different point of views by gastroenterologist, radiologist, pathologist and infectious disease specialist were suggested to help the proper diagnosis and management of these two diseases.

HLA-B*58:63, a novel allele identified by sequence-based typing in a Chinese bone marrow voluntary donor

HLA-B*58:63 differs from HLA-B*58:01:01 by one nucleotide at position 248 resulting in a single amino acid change.

imDC: an ensemble learning method for imbalanced classification with miRNA data

Imbalances typically exist in bioinformatics and are also common in other areas. A drawback of traditional machine learning methods is the relatively little attention given to small sample classification. Thus, we developed imDC, which uses an ensemble learning concept in combination with weights and sample misclassification information to effectively classify imbalanced data. Our method showed better results when compared to other algorithms with UCI machine learning datasets and microRNA data.

Allelopathy of the invasive plant Bidens frondosa on the seed germination of Geum japonicum var. chinense

Five gradient concentrations (0.02, 0.04, 0.06, 0.08, and 0.10 g/mL) of leaching liquors from the roots, stems, and leaves of the invasive plant Bidens frondosa were used as conditioning fluid to examine its influence on seed germination conditions of the native plant Geum japonicum var. chinense in Huangshan. All leaching liquors of organs suppressed the seed germination of Geum japonicum var. chinense and reduced the final germination percentage and rate, and increased the germination inhibition rate, with a bimodal dependence on concentration. The leaching liquor inhibited the seed germination significantly at the concentration of 0.02 g/mL respectively. The seed germination was also inhibited as the concentration reached to 0.04 g/mL and beyond. Hence the allelopathic effects of the organs were significantly enhanced respectively. This phenomenon represented the presence of allelopathy substances in the root, stem and leaf of Bidens frondosa.

The Chinese First-Episode Schizophrenia Trial: background and study design

Schizophrenia is a complex illness with unknown aetiology and pathogenesis. Currently, a considerable number of patients with schizophrenia do not receive standardised and systematic treatment in China. In the past years, many controlled trials have been conducted in chronic schizophrenia. In contrast, research on first-episode schizophrenia is lacking. This paper describes the background and design of the Chinese First-Episode Schizophrenia Trial project--a multicentre, randomised, open-label clinical trial. A total of 600 first-episode schizophrenia patients were randomly divided into 3 groups and treated with risperidone, aripiprazole, and olanzapine for 1 year. During the study period, only 1 medication change of the 3 antipsychotic medications was allowed.

Effect of different antipsychotic drugs on short-term mortality in stroke patients

The safety, tolerability, and efficacy data for antipsychotic drugs used in the acute phase of stroke are limited. The primary aim of this study was to examine the effectiveness and safety of typical and atypical antipsychotics on acute ischemic stroke mortality.This observational study was conducted in a retrospective cohort of patients selected from the 2010-2011 National Health Research Institute database in Taiwan. Patients were tracked for 1 month from the time of their first hospitalization for acute ischemic stroke. A nested case-control analysis was used to estimate the odds ratio (OR) of 30-day mortality associated with antipsychotic drug, adjusted for age, gender, disease severity, and comorbidities.The study cohort included 47,225 subjects with ischemic stroke, including 9445 mortality cases and 37,780 matched controls. After adjustment for the covariates, antipsychotics users before ischemic stroke are associated with a 73% decrease in the rate of mortality (OR 0.27; 95% CI 0.23-0.31). After ischemic stroke, the use of antipsychotics is associated with 87% decrease in the rate of mortality (OR 0.13; 95% CI 0.1-0.16). The users of conventional antipsychotics are associated with a 78% decrease in the rate of mortality (OR 0.22; 95% CI 0.18-0.26). The users of atypical antipsychotics are also associated with a 86% decrease in the rate of mortality (OR 0.14; 95% CI 0.12-0.17).We found that 1-month mortality among acute stroke patients treated with antipsychotics is significantly lower. The benefit on lower mortality was found not only among ischemic stroke patients who had received antipsychotics previously but also among patients who start antipsychotics after their stroke.

Safety and Efficacy of Adalimumab for Patients With Moderate to Severe Crohn's Disease: The Taiwan Society of Inflammatory Bowel Disease (TSIBD) Study

BACKGROUND/AIMS

Only moderate to severe Crohn's Disease (CD) patients without a satisfactory conventional therapy effect are eligible to get reimbursement from the National Health Insurance of Taiwan for using adalimumab. These are more stringent criteria than in many Western countries and Japan and Korea. We aim to explore the efficacy of using adalimumab in CD patients under such stringent criteria.

METHODS

A retrospective analysis was conducted in nine medical centers in Taiwan and we collected the results of CD patients receiving adalimumab from Sep 2009 to Mar 2014. The clinical characteristics, response measured by CDAI (Crohn's Disease Activity Index), adverse events and survival status were recorded and analyzed. CR-70, CR-100, and CR-150 were defined as attaining a CDAI decrease of 70, 100 or 150 points compared with baseline.

RESULTS

A total of 103 CD patient records were used in this study. Sixty percent of these patients received combination therapy of adalimumab together with immunomodulators. CR-70 was 68.7%, 74.5% and 88.4% after week 4, 8 and 12 of treatment, respectively. The steroid-free rate, complications and survival were 47.6%, 9.7% and 99% of patients, respectively. In considering the mucosal healing, only 25% patients achieve mucosal healing after treatment for 6 to 12 months. Surgery was still needed in 16.5% of patients. Combination treatment of adalimumab with immunomodulators further decreased the level of CDAI at week 8 when compared with the monotherapy.

CONCLUSIONS

Even under the stringent criteria for using adalimumab, the response rate was comparable to those without stringent criteria.