Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials

BACKGROUND

Moderate differences in efficacy between adjuvant chemotherapy regimens for breast cancer are plausible, and could affect treatment choices. We sought any such differences.

METHODS

We undertook individual-patient-data meta-analyses of the randomised trials comparing: any taxane-plus-anthracycline-based regimen versus the same, or more, non-taxane chemotherapy (n=44,000); one anthracycline-based regimen versus another (n=7000) or versus cyclophosphamide, methotrexate, and fluorouracil (CMF; n=18,000); and polychemotherapy versus no chemotherapy (n=32,000). The scheduled dosages of these three drugs and of the anthracyclines doxorubicin (A) and epirubicin (E) were used to define standard CMF, standard 4AC, and CAF and CEF. Log-rank breast cancer mortality rate ratios (RRs) are reported.

FINDINGS

In trials adding four separate cycles of a taxane to a fixed anthracycline-based control regimen, extending treatment duration, breast cancer mortality was reduced (RR 0·86, SE 0·04, two-sided significance [2p]=0·0005). In trials with four such extra cycles of a taxane counterbalanced in controls by extra cycles of other cytotoxic drugs, roughly doubling non-taxane dosage, there was no significant difference (RR 0·94, SE 0·06, 2p=0·33). Trials with CMF-treated controls showed that standard 4AC and standard CMF were equivalent (RR 0·98, SE 0·05, 2p=0·67), but that anthracycline-based regimens with substantially higher cumulative dosage than standard 4AC (eg, CAF or CEF) were superior to standard CMF (RR 0·78, SE 0·06, 2p=0·0004). Trials versus no chemotherapy also suggested greater mortality reductions with CAF (RR 0·64, SE 0·09, 2p<0·0001) than with standard 4AC (RR 0·78, SE 0·09, 2p=0·01) or standard CMF (RR 0·76, SE 0·05, 2p<0·0001). In all meta-analyses involving taxane-based or anthracycline-based regimens, proportional risk reductions were little affected by age, nodal status, tumour diameter or differentiation (moderate or poor; few were well differentiated), oestrogen receptor status, or tamoxifen use. Hence, largely independently of age (up to at least 70 years) or the tumour characteristics currently available to us for the patients selected to be in these trials, some taxane-plus-anthracycline-based or higher-cumulative-dosage anthracycline-based regimens (not requiring stem cells) reduced breast cancer mortality by, on average, about one-third. 10-year overall mortality differences paralleled breast cancer mortality differences, despite taxane, anthracycline, and other toxicities.

INTERPRETATION

10-year gains from a one-third breast cancer mortality reduction depend on absolute risks without chemotherapy (which, for oestrogen-receptor-positive disease, are the risks remaining with appropriate endocrine therapy). Low absolute risk implies low absolute benefit, but information was lacking about tumour gene expression markers or quantitative immunohistochemistry that might help to predict risk, chemosensitivity, or both.

FUNDING

Cancer Research UK; British Heart Foundation; UK Medical Research Council.

A dynamic ventilation model for gravity sewer networks

To implement any effective odour and corrosion control technology in the sewer network, it is imperative that the airflow through gravity sewer airspaces be quantified. This paper presents a full dynamic airflow model for gravity sewer systems. The model, which is developed using the finite element method, is a compressible air transport model. The model has been applied to the North Head Sewerage Ocean Outfall System (NSOOS) and calibrated using the air pressure and airflow data collected during October 2008. Although the calibration is focused on forced ventilation, the model can be applied to natural ventilation as well.

Simulation models of obesity: a review of the literature and implications for research and policy

Simulation models (SMs) combine information from a variety of sources to provide a useful tool for examining how the effects of obesity unfold over time and impact population health. SMs can aid in the understanding of the complex interaction of the drivers of diet and activity and their relation to health outcomes. As emphasized in a recently released report of the Institute or Medicine, SMs can be especially useful for considering the potential impact of an array of policies that will be required to tackle the obesity problem. The purpose of this paper is to present an overview of existing SMs for obesity. First, a background section introduces the different types of models, explains how models are constructed, shows the utility of SMs and discusses their strengths and weaknesses. Using these typologies, we then briefly review extant obesity SMs. We categorize these models according to their focus: health and economic outcomes, trends in obesity as a function of past trends, physiologically based behavioural models, environmental contributors to obesity and policy interventions. Finally, we suggest directions for future research.

Ultrasound-assisted percutaneous catheterization of the axillary vein for totally implantable venous access device

BACKGROUND

Placing a totally implantable venous access device (TIVAD) using the classical subclavian vein puncture method carries the risk of certain complications including hemothorax, pneumothorax and pinch-off syndrome. We set out to determine whether percutaneous axillary vein catheterization can decrease the incidence of these complications.

METHOD

This is a prospective, observational, uni-institutional study. We analyzed the outcome of 113 TIVADs performed by ultrasound-assisted percutaneous axillary vein catheterization from Jun. 2008 to Dec. 2008. Junior residents novice to subclavian and axillary vein catheterization performed the procedures. Insertion and indwelling catheter complications were recorded.

RESULT

In our study population, 100% of TIVAD placements were successful. 27 patients (23.9%) required 3 or more repeated punctures; only one patient (0.9%) had clinically insignificant pneumothorax. Neither arterial puncture nor brachial plexus injury was recorded in our study.

CONCLUSION

Ultrasound-assisted percutaneous axillary vein catheterization for TIVAD is a safe and relatively simple method for inexperienced operators.

Stretched inverse opal colloid crystal substrates-induced orientation of fibroblast

Recently, there has been increasing interest in studying the interaction between mammalian cells and nanometer-sized structures. However, the effect of nanostructures on cell behavior, such as cell morphology and alignment, is still largely unknown. Inverse opal colloid crystal substrates, which can be stretched to produce nano-scale pore structures of different degrees of orientation, serve as a convenient model system to study the effect of nanotopography on cell morphology and cell alignment. In this work, we fabricated inverse opal colloidal crystal films that were either unstretched or stretched to three, four or six times their original length, producing pore structures of increasing degree of orientation. Human dermal fibroblast-fetal (HDF-f) cells were seeded and cultured on these four types of substrates. The results from fluorescence microscopy and scanning electron microscopy indicated that cells showed the highest degree of alignment when cultured on inverse opal colloid crystal films that were stretched the most (six times original length). The results also demonstrated that the orientation of nanostructures could affect both the morphology and growth direction of fibroblasts. The ability to control the direction of cell growth through the engineering of nanostructures could have important applications in tissue engineering, especially for tissues with anisotropic structures, such as cardiac muscle, blood vessel, tendon and ligament.

The effects of aging on the strength of surround suppression of receptive field of V1 cells in monkeys

The surround suppression of the receptive field is important for basic visual information processing, such as orientation specificity. To date, the effects of aging on the strength of surround suppression are not clear. To address this issue, we carried out extracellular single-unit studies of the receptive field properties of cells in the primary visual cortex (area V1) in young and old rhesus (Macaca mulatta) monkeys. When presented with the oriented central stimulus, we found that cells in old animals showed reduced orientation and direction selectivity compared with those in young animals. When presented with the oriented central stimulus together with the optimal surround stimulus, more selective cells {orientation bias (OB) >/=0.1; a bias of 0.1 is significant at the P<0.005 level} in animals of both ages showed reduced orientation selectivity compared with the experiment that presented only the oriented central stimulus. When presented with the optimal central stimulus together with the oriented surround stimulus, cells in old animals showed reduced orientation and direction selectivity compared with young animals. Moreover, broadly tuned cells (OB<0.1) in old animals exhibited significantly reduced suppression indices that quantified the strength of the surround suppression of the receptive field, when compared with those in young animals. These results suggest that aging may seriously affect the surround suppression of the receptive field of V1 cells. Thus, the decreased strength of surround suppression of the receptive field may be one possible reason for the decreased stimulus selectivity of V1 cells previously found in the senescent brain. This work will contribute to an understanding of the physiological mechanisms mediating surround suppression of the receptive field.

First Report of Root Rot Caused by Phytophthora sansomeana on Soybean in China

Phytophthora sansomeana E.M. Hansen & Reeser is a newly described species and infects Douglas-fir, alfalfa, and soybean (1). Soybean production is an important part of the local economy in Yili State in Xinjiang Uygur Autonomous Region, northwest China. Unfortunately since 2005, root and stem rot disease has emerged on a number of farms. To identify the causal agent, plant samples with symptoms, including whole plant wilting or yellowing and stunting, were collected from fields during 2005 and 2008. Tissue from the edges of stem lesions was placed on selective lima bean agar (LBA) at 20°C for 3 to 4 days (2,3). Four single zoospore isolates of Phytophthora were obtained and maintained on LBA or 10% V8 juice liquid medium for examination of morphological and physiological characteristics. The colonies on LBA were aerial and rosaceous. The isolates were homothallic, and oogonia and oospores were readily produced in culture after 7 days on LBA plates. Oogonia averaged 38 μm and oospore width ranged from 23 to 48 μm and averaged 31 μm. Antheridia were approximately 15 × 12 μm and predominantly amphigynous in V8 juice. Sporangia were terminal or paragynous on persistent sporangiophores, nonpapillate, ovoid to obpyriform, and measured 52 × 35 μm with an average length/breadth ratio of 1.5. Hyphal swellings were produced in V8 juice 2 days after inoculation. The optimum temperature for growth was approximately 25°C and none occurred at 0 or 35°C. The internal transcribed spacer (ITS) sequence of this Phytophthora species (GenBank FJ966880) agreed 100% with sequences of P. sansomeana isolates deposited in GenBank (GQ853880 and EU925375). Pathogenicity tests were performed by hypocotyl inoculation method (2) using isolate Yili71 and potted soybean cv. Williams. Plants were grown in a growth chamber for 10 days before inoculation in 16-cm-diameter pots (2). Plants were inoculated with 2- × 2-mm plugs of mycelium grown for 4 days on LBA at 25°C, the plugs were adhered to the sides of wounded lower hypocotyls. As controls, plants were inoculated with LBA agar plugs without mycelium (2). Inoculated plants were maintained in a growth chamber at approximately 25°C with a 10-h dark/14-h light cycle and 50% relative humidity and symptom development was monitored daily for 1 week. Wounded stems inoculated with mycelium developed water-soaked lesions, which were similar to those seen on naturally infected plants. A Phytophthora sp. was reisolated from the margins of expanding lesions on wounded stems. To our knowledge, this is the first report of P. sansomeana infection of soybean in China and the threat it may pose to soybean production is unclear. References: (1) E. M. Hansen et al. Mycologia 101:129. 2009. (2) Z. Y. Wang et al. Fungal Genet. Biol. 43:826, 2006. (3) X. B. Zheng. Methods in Phytophthora. Chinese Agriculture Press. Beijing, China, 1995.

Compact optical curvature sensor with a flexible microdisk laser on a polymer substrate

We demonstrate a chip-scale compact optical curvature sensor. It consists of a low threshold InGaAsP microdisk laser on a flexible polydimethylsiloxane polymer substrate. The curvature dependence of lasing wavelength was characterized by bending the cavity at different bending radii. The measurements showed that the lasing wavelength decreases monotonously with an increasing bending curvature. A good agreement between experiment and three-dimensional finite-difference time-domain simulation was also obtained. The sensitivity of the compact device to the bending curvature is -23.7 nm/mm from the experiment.

Molecular dynamics simulation of complex particles in three dimensions and the study of friction due to nonconvexity

We investigate the macroscopic properties of frictionless nonconvex particles using molecular dynamics. The calculations are based on a simple and efficient method to simulate complex-shaped interacting bodies. The particle shape is represented by Minkowski operators. A multicontact time-continuous interaction between bodies is derived using simple concepts of computational geometry. Three-dimensional simulations of hopper flow show that the nonconvexity of the particles strongly affects the jamming on granular flow. Also the model allows the representation of complex bodies with rough surfaces as in friction studies and the reproduction of a wide range of friction and dilatancy angles as in true triaxial tests.

Efficacy and Safety of Valsartan/Hydrochlorothiazide Fixed-dose Combination Compared with Amlodipine Monotherapy as First-line Therapy for Mild to Moderate Hypertension

This double-blind, active- and randomized-controlled study compared the efficacy and safety of a fixed-dose combination of valsartan/hydrochlorothiazide 80 mg/12.5 mg once daily ( n = 32) with amlodipine monotherapy 5 mg once daily ( n = 33) for 8 weeks in patients with mild to moderate hypertension. Non-inferiority of valsartan/hydrochlorothiazide to amlodipine was demonstrated by comparable reductions in sitting systolic blood pressure (SBP), sitting diastolic blood pressure (DBP), and daytime, night-time and 24-h SBP and DBP on ambulatory blood pressure monitoring. Between-group comparisons of adverse events and changes in laboratory parameters did not reach statistical significance, except for uric acid which showed a significant increase in the valsartan/hydrochlorothiazide group compared with the amlodipine group, but was still below the laboratory's upper limit of normal. In conclusion, the use of the fixed-dose combination of valsartan/hydrochlorothiazide 80 mg/12.5 mg once daily as a starting regimen in patients with mild to moderate hypertension was shown to have non-inferior efficacy and comparable safety for daily practice compared with amlodipine 5 mg once daily monotherapy.

Dielectric constants of multiwall carbon nanotubes from direct current to microwave frequencies

A cylindrical rod constructed from a uniform mixture of multiwall carbon nanotubes and alumina powders dissolved in paraffin was inserted in the center of a radio frequency cavity. The real and imaginary dielectric constants of carbon tubes at various frequencies were measured, respectively, from the resonant frequencies and the quality factors, by a resistance-inductance-cacitance (RLC) meter and a microwave network analyzer. The dielectric rod benefits the protection of the sample from adsorbing moisture and preventing the rod from filling with air, thus making accurate measurments. A tunable probe specifically designed for the field pattern of a TM010 mode is delineated to improve the microwave coupling of the dielectric microwave resonator. This refined design is expected to facilitate the measurement yielding a significant manner. The real and imaginary parts of the dielectric constant of carbon nanotubes increase and decrease, respectively as frequencies increase satisfactorily in complying with the description from the free electron Drude model.

Recycle of Alum recovered from water treatment sludge in chemically enhanced primary treatment

An investigation was made to study the feasibility of recovering the Alum from coagulation sludges and reusing it in chemically enhanced primary treatment (CEPT) process to make the CEPT more cost-effective and recover the resource (Alum) efficiently. The optimum condition and efficiency of the acidification method for Alum recovery from coagulation sludge were investigated in the test. The results show that when the recovery rate of Alum reaches its highest level, 84.5%, the reduction rate of sludge is 35.5%. It turns out that the capability of recovered coagulant to remove turbidity, UV(254) and COD are 96%, 46% and 53%, respectively. The results prove that the recovered coagulants could be used in CEPT and the efficiency of recovered coagulant to remove pollutants is similar to that of fresh coagulant. Although some substances will be enriched during recycle, they have little effect on the quality of treated wastewater. The experiments verify that it would be an advisable and cost-effective way to recover Alum from coagulation sludges in water treatment and chemical wastewater treatment, and it could be then recycled to CEPT as well as reduce sludge volume.

Flexible compact microdisk lasers on a polydimethylsiloxane (PDMS) substrate

Compact microdisk cavities were fabricated on a polydimethylsiloxane substrate. The lasing of the flexible compact cavity was achieved with a low threshold power. The whispering-gallery mode of the microdisk was also characterized with three-dimensional finite-difference time-domain simulation. The curvature dependence in output power and threshold was also demonstrated by bending the microdisk cavity.

Effects of alginate coated on PLGA microspheres for delivery tetracycline hydrochloride to periodontal pockets

The effects of alginate coated on tetracycline (Tc) loaded poly (D, L-lactic-co-glycolic acid) (PLGA) microspheres fabricated by double emulsion solvent evaporation technique for local delivery to periodontal pocket were investigated. Alginate coated PLGA microspheres showed smoother surface but enlarged their particle sizes compared with those of uncoated ones. In addition, alginate coated microspheres enhanced Tc encapsulation efficiency (E.E.) from 11.5 +/- 0.5% of uncoated ones to 17.9 +/- 0.5%. Moreover, all of the coated PLGA microspheres even fabricated at different conditions could prolong Tc release from 9-12 days with 50% or higher in cumulative release of Tc compared with those of uncoated ones. The swelling ratios of PLGA microspheres for alginate coated or uncoated ones, one of the possible mechanisms for enhancing Tc release for the coated ones, were measured. The results showed that 20% or higher in swelling ratio for the coated microspheres at the earlier stage of hydration (e.g. < or = 24 h) could be an important factor to result in high Tc release compared to the uncoated ones. In conclusion, alginate coated Tc loaded PLGA microspheres could enhance Tc delivery to periodontal pocket by enhancing drug encapsulated efficiency, released quantities and sustained release period compared with uncoated ones.

First Report of Stalk Rot Caused by Phytophthora tentaculata on Aucklandia lappa in China

Phytophthora tentaculata causes root and stalk rot of Chrysanthemum spp., Delphinium ajacis, and Verbena spp. in nurseries in the Netherlands and Germany (2). In later years, P. tentaculata was isolated from Verbena hybrids (3) and lavender cotton (Santolina chamaecyparissus) in Spain (1). In August 2007, stalk rot symptoms were observed on Aucklandia lappa (Asteraceae), an economically important Chinese medicinal plant, in some fields in Yunnan Province of China. Small groups of infected plants were randomly distributed throughout the fields. Plants showing stalk rot and wilting died rapidly. Diseased tissues were cut into 10-mm pieces and plated onto Phytophthora selective medium, P₅ARP (2), to obtain the pure cultures. Seven isolates were obtained, and five isolates were grown on solidified LBA (60 g of lima bean powder and 15 g of agar per 10,000 ml of distilled water) and 10% V8 juice liquid medium for examination of morphological and physiological characteristics (4). The colony surface texture was uniform and formed sparse, loosely branched mycelium on LBA medium. Radial growth rate was 2 to 3 mm per day at 24°C on LBA. In water, relatively small swellings were formed at hyphal branches. Sporangia were spherical or ovoid to obpyriform and some were distorted and papillate with a narrow exit pore. Approximately 10% of the sporangia were caducous with a short pedicel. Sporangial dimensions were 28 to 47 (35) × 21 to 36 (29) μm, length/breadth ratio 1.2. Chlamydospores formed on LBA after 1 week and were terminal, spherical, thin walled, and 21 to 31 (27) μm in diameter. The isolates were homothallic. Oogonia abundantly formed on LBA and were 25 to 36 (31) μm in diameter. One or two paragynous antheridia (15 × 10 μm) were attached to the oogonia. Oospores were spherical, hyaline, aplerotic, and 20 to 32 (25) μm in diameter. The minimum temperature for mycelium growth was 8°C and maximum temperature was 34°C. The internal transcribed spacer (ITS) region was amplified and sequenced and agreed 100% with sequences of four P. tentaculata isolates deposited in GenBank (Accession Nos. AJ854302, AY881001, DQ335634, and AF266775). Pathogenicity was assessed by flooding three potted A. lappa plants with a 10⁴ ml^-1 zoospore suspension and incubating at 20 to 22°C. As controls, two potted A. lappa plants were flooded with deionized water. All three inoculated A. lappa plants exhibited stalk rot after 15 days, from which the pathogen was reisolated using selective medium, P₅ARP. Controls remained healthy 15 days after inoculation, To our knowledge, this is the first report of P. tetaculata H. Kroeber & R. Marwitz infection of A. lappa in China. We speculate that the pathogen might have been introduced from other countries on seeds. References: (1) L. A. Álvarez et al. Plant Dis. 90:523, 2006. (2) D. C. Erwin and O. K. Ribeiro. Phytophthora Diseases Worldwide. The American Phytopathological Society, St. Paul, MN, 1996. (3) E. Moralejo et al. Plant Pathol. 53:806. 2004. (4) X. B. Zheng. Methods in Phytophthora. Chinese Agriculture Press, Beijing, China, 1995.

Fasting regulates the expression of adiponectin receptors in young growing pigs

Adiponectin is an adipocyte-derived hormone that can improve insulin sensitivity. Its functions in regulating glucose utilization and fatty acid metabolism in mammals are mediated by 2 subtypes of adiponectin receptors (AdipoR1 and AdipoR2). This study was conducted to determine the effect of fasting on the expression of adiponectin and its receptors. The expression of adiponectin was not affected in s.c. adipose tissue, but adiponectin expression increased in visceral adipose tissue after fasting. In contrast, expression of both AdipoR mRNA was increased in the liver and s.c. adipose tissue of 24-h-fasted pigs compared with fed pigs, but the mRNA in muscle and visceral adipose tissue was not affected by fasting. A third putative adiponectin receptor, T-cadherin, was cloned and the mRNA expression was determined. T-Cadherin has been recognized to act as a vascular adiponectin receptor in vascular endothelial and smooth muscle cells. Our data showed that the expression of T-cadherin was decreased in the muscle of fasted pigs, suggesting that the expression of T-cadherin can be regulated by feeding status. In summary, in young pigs, adiponectin mRNA was up-regulated by fasting in visceral, but not s.c., adipose tissue, whereas AdipoR1 and AdipoR2 mRNA were increased in s.c., but not visceral, adipose tissue. The adiponectin receptor, T-cadherin, was expressed in s.c. and visceral adipose tissue and in muscle, but only muscle mRNA expression was decreased by fasting.

Vitamin E and vitamin C supplementation in patients with chronic obstructive pulmonary disease

The purpose of this study was to determine whether vitamin E or vitamin C supplementation alters the DNA damage of whole blood white blood cells (WBC) in patients with chronic obstructive pulmonary disease (COPD). Thirty-five patients with stable COPD were recruited in this randomized and placebo-controlled study. Patients were randomly assigned to placebo (n = 8), 400 mg/day vitamin E (E400, n = 9), 200 mg/day vitamin E (E200, n = 9), or 250 mg/day vitamin C (C250, n = 9) for 12 weeks. The results showed that vitamin E or C supplementation did not significantly change the mean level of endogenous DNA breakages. Whereas, after 12 weeks of vitamin supplementation, the H2O2-induced DNA breakages were significantly suppressed by 45%, 59%, and 52%, respectively, in E400, E250 and C250 groups (p < 0.05). In addition, neither the level of thiobarbituric acid-reactive substances (TBARS) nor spirometric parameters were significantly changed after 12 weeks of supplementation. In conclusion, vitamin E or C supplementation for 12 weeks may improve the resistance of DNA in whole blood WBC against oxidative challenge, although more research is needed to demonstrate the beneficial effect on slowing the decline of lung function in patients with COPD.

Bond cutting in Cs-doped tris(8-hydroxyquinoline) aluminium

A series of Cs 4d and Al 2p spectra associated with valence-band and cut-off spectra have been used to characterize the interaction between caesium and tris(8-hydroxyquinoline) aluminium (Alq(3)) molecules in a Cs-doped Alq(3) layer. The Cs 4d and Al 2p spectra were tuned to be very surface sensitive by selecting a photon energy of 120 eV at the National Synchrotron Radiation Research Center, Taiwan. A critical Cs concentration exists, above which a new Al 2p signal appears next to the Al 2p peak of Alq(3) in the lower binding-energy side. The Al 2p signal was analyzed and assigned as being contributed from a mixture of Alq(2), Alq and Al. Experimental data supported the observation that bond cutting of Alq(3) by the doped Cs atoms occurred at high Cs doping concentration.

Video-recording and time-motion analyses of manual versus mechanical cardiopulmonary resuscitation during ambulance transport

INTRODUCTION

The quality of cardiopulmonary resuscitation (CPR) plays a crucial role in saving lives from out-of-hospital cardiac arrest (OHCA). Previous studies have identified sub-optimal CPR quality in the prehospital settings, but the causes leading to such deficiencies were not fully elucidated.

OBJECTIVE

This prospective study was conducted to identify operator- and ambulance-related factors affecting CPR quality during ambulance transport; and to assess the effectiveness of mechanical CPR device in such environment.

MATERIALS AND METHODS

A digital video-recording system was set up in two ambulances in Taipei City to study CPR practice for adult, non-traumatic OHCAs from January 2005 to March 2006. Enrolled patients received either manual CPR or CPR by a mechanical device (Thumper). Quality of CPR in terms of (1) adequacy of chest compressions, (2) instantaneous compression rates, and (3) unnecessary no-chest compression interval, was assessed by time-motion analysis of the videos.

RESULTS

A total of 20 ambulance resuscitations were included. Compared to the manual group (n=12), the Thumper group (n=8) had similar no-chest compression interval (33.40% versus 31.63%, P=0.16); significantly lower average chest compression rate (113.3+/-47.1 min(-1) versus 52.3+/-14.2 min(-1), P<0.05), average chest compression rate excluding no-chest compression interval (164.2+/-43.3 min(-1) versus 77.2+/-6.9 min(-1), P<0.05), average ventilation rate (16.1+/-4.9 min(-1) versus 11.7+/-3.5 min(-1), P<0.05); and longer no-chest compression interval before getting off the ambulance (5.7+/-9.9s versus 18.7+/-9.1s, P<0.05). The majority of the no-chest compression interval was considered operator-related; only 15.3% was caused by ambulance related factors.

CONCLUSIONS

Many unnecessary no-chest compression intervals were identified during ambulance CPR, and most of this was operator, rather than ambulance related. Though a mechanical device could minimise the no-chest compression intervals after activation, it took considerable time to deploy in a system with short transport time. Human factors remained the most important cause of poor CPR quality. Ways to improve the CPR quality in the ambulance warrant further study.

Outcomes from out-of-hospital cardiac arrest in Metropolitan Taipei: Does an advanced life support service make a difference?

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) is of major medical and public health significance. It also serves as a good indicator in assessing the performance of local emergency medical services system (EMS). There have been arguments for and against the benefits of advanced life support (ALS) over basic life support with defibrillator (BLS-D) for treating OHCA.

AIMS OF THE STUDY

The study was conducted to characterise the outcomes of cardiac arrest victims in an Asian metropolitan city; to evaluate the impacts of ALS versus BLS-D services; and to explore the possible patient and arrest factors that may be associated with the observed differences in the outcomes between the two pre-hospital care models.

MATERIALS AND METHODS

Taipei is an Asian metropolitan city with an area of 272 km(2) and a population of 2.65 million. The fire-based BLS-D EMS system was in the process of phasing in ALS capability. While there were 40 BLS-D teams in the 12 city districts, two ALS teams were set up in the central part of the city. In this prospective study, all adult non-traumatic OHCA from September 2003 to August 2004 were included. Patient, arrest, care, and outcome variables for OHCA victims were collected from prehospital run sheets, automatic defibrillators, and emergency department and hospital records.

RESULTS

Among 1423 OHCA included in the analysis, 1037 (73%) received BLS-D service, and 386 (27%) received ALS services. The initial shockable rhythms and early bystander CPR were strongly associated with better survival for victims of cardiac arrests. Compared to BLS-D, ALS patients had similar age, sex, witness status, the rate of bystander CPR, and response timeliness but more patients in asystole (84% versus 72%, p=0.005). Patients treated by ALS were more likely to result in significantly higher rates of return of spontaneous circulation (29% versus 21%; OR=1.51 (95% CI 1.15-2.00); p=0.002) and survival to emergency department/intensive care unit admission (23% versus 15%; OR=1.66 (95% CI 1.22-2.24); p=0.001), but there was no difference in the rate of survival to hospital discharge (7% versus 5%; OR=1.39 (95% CI 0.84-2.23); p=0.17). The outcome difference from ALS services was more pronounced among patients in asystole and without bystander CPR.

CONCLUSIONS

In this metropolitan EMS in Asia, the implementation of ALS services improved the intermediate, but not the final outcomes. Communities with larger populations and lower incidence of initial shockable rhythms than the OPALS study should also prioritise their resources in setting up and optimising systems of basic life support and early defibrillations. Further studies are warranted to configure the optimal care model for combating cardiac arrest.

Inhibitory effect of Melastoma candidum D. Don acetone extract on foodborne pathogenic bacteria survival in food products

Melastoma candidum D. Don, a Taiwanese folk medicinal plant, has high levels of antibacterial and bactericidal activity. Our aim was to determine whether and to what extent an acetone extract of this plant inhibits the growth of foodborne pathogenic bacteria. M. candidum acetone extract had marked inhibitory effect on test bacteria introduced into sliced pork, which was then stored at 4 degrees C. At the end of storage (day 12), the bacterial concentrations dropped by 1.59 to 2.91 log CFU/g compared with the control. In steamed rice stored at 30 degrees C, a 0.2% extract decreased initial (before storage) concentrations of Bacillus cereus from 2.01 log CFU/g to an undetectable level, which remained for at least 24 h. After 72 to 168 h of storage, test bacterial concentrations were reduced by 2.59 to 5.66 log CFU/g. In fresh noodles stored at 30 degrees C, both initial and final bacterial concentrations were decreased. At the end of storage (72 to 168 h), test bacteria concentrations were reduced by 1.85 to 2.88 log CFU/g. Overall, M. candidum acetone extract had an inhibitory effect on foodborne pathogenic bacteria in different food model systems.

Genetic analysis and molecular mapping of the avirulence gene PRE1, a gene for host-species specificity in the blast fungus Magnaporthe grisea

We analyzed host-species specificity of Magnaporthe grisea on rice using 110 F1 progeny derived from a cross between the Oryza isolate CH87 (pathogenic to rice) and the Digitaria isolate 6023 (pathogenic to crabgrass). To elucidate the genetic mechanisms controlling species specificity in M. grisea, we performed a genetic analysis of species-specific avirulence on this rice population. Avirulent and virulent progeny segregated in a 1:1 ratio on the 2 rice cultivars 'Lijiangxintuanheigu' (LTH) and 'Shin2', suggesting that a single locus, designated PRE1, was involved in the specificity. In a combination between 'Kusabue' and 'Tsuyuake', the segregation of the 4 possible phenotypes of F1 progeny was significantly different from the expected 3:1:3:1 and instead fit a ratio of 2:0:1:1. This indicated that 2 loci, PRE1 and AVR2, were involved in specific parasitism on rice. These results suggest that the species specificity of M. grisea on rice is governed by species-dependent genetic mechanisms that are similar to the gene-for-gene interactions controlling cultivar specificity. Pathogenicity tests with various plant species revealed that the Digitaria isolate 6023 was exclusively parasitic on crabgrass. Genetic linkage analysis showed that PRE1 was mapped on chromosome 3 with respect to RAPD and SSR markers. RAPD marker S361 was linked to the avirulence gene at a distance of ~6.4 cM. Two SSR markers, m677-678 and m77-78, were linked to the PRE1 gene on M. grisea chromosome 3 at distances of 5.9 and 7.1 cM, respectively. Our results will facilitate positional cloning and functional studies of this gene.

Molecular mapping of two cultivar-specific avirulence genes in the rice blast fungus Magnaporthe grisea

Rice blast, caused by the fungus Magnaporthe grisea, is a globally important disease of rice that causes annual yield losses. The segregation of genes controlling the virulence of M. grisea on rice was studied to establish the genetic basis of cultivar specificity in the interaction of rice and M. grisea. The segregation of avirulence and virulence was studied in 87 M. grisea F(1) progeny isolates from a cross of two isolates, Guy11 and JS153, using resistance-gene-differential rice cultivars. The segregation ratio indicated that avirulence and virulence in the rice cultivars Aichi-asahi and K59, respectively, are controlled by single major genes. Genetic analyses of backcrosses and full-sib crosses in these populations were also performed. The chi(2 )test of goodness-of-fitness for a 1:1 ratio indicated that one dominant gene controls avirulence in Aichi-asahi and K59 in this population. Based on the resistance reactions of rice differential lines harboring known resistance genes to the parental isolates, two genetically independent avirulence genes, AVR-Pit and AVR-Pia, were identified. Genetic linkage analysis showed that the SSR marker m355-356 is closely linked to AVR-Pit, on the telomere of chromosome 1 at a distance of approximately 2.3 cM. The RAPD marker S487, which was converted to a sequence-characterized amplified region (SCAR) marker, was found to be closely linked to AVR-Pia, on the chromosome 7 telomere at a distance of 3.5 cM. These molecular markers will facilitate the positional cloning of the two AVR genes, and can be applied to molecular-marker-assisted studies of M. grisea populations.

[Clinical evaluation of HIV-1/2 antibody rapid tests.]

BACKGROUND

To evaluate the sensitivity and specificity of HIV-1/2 antibody rapid tests prior to licensing.

METHODS

Four hundred forty, 264 and 300 blood samples were collected from normal blood donors, drug addicted individuals and HIV infected patients, respectively. All the samples were tested with 17 kinds of HIV-1/2 antibody rapid tests prior to licensing. The sensitivity and specificity of each test were calculated.

RESULTS

The sensitivity for all evaluated rapid tests was 100% for detecting 300 strong positive samples for HIV antibody; the specificity for all evaluated rapid tests was within the range of 97.7%-100% for detecting 440 samples from normal blood donors; the sensitivity and specificity of all tests were within the range of 70.3%-95.1% and 59.1%-100% respectively for detecting 264 samples from HIV high risk population.

CONCLUSION

The sensitivity and specificity of different tests were different and the samples from HIV high risk population may be very useful for evaluation of the quality of HIV-1/2 antibody rapid tests.