Sustained acute kidney injury as an independent risk factor for neurodevelopmental and growth outcomes in a single NICU center

PURPOSE

Acute kidney injury (AKI) is commonly seen in neonatal intensive care units (NICUs) and is potentially associated with adverse prognoses in later stages of life. Our study evaluated the impact of sustained AKI (SAKI) on both neurodevelopmental impairment (NDI) and early growth restriction (EGR) in neonates.

METHODS

This case-control study retrospectively analyzed the medical records of neonates diagnosed with SAKI in the NICU of a tertiary medical center during the period from January 2007 to December 2020. Cases without subsequent follow-up and those resulting in death were excluded. We analyzed demographic, biochemical, and clinical outcome data.

RESULTS

Of the 93 neonates with SAKI, 51 cases (54.8%) were included in this study, while 42 cases (45.2%) were excluded due to a lack of follow-up or death. An age-matched control group comprised 103 neonates, who had never experienced AKI or SAKI, were selected at random. In total, 59 (38.3%) cases were identified as NDI and 43 (27.9%) as EGR. Multivariate analysis revealed that patients with SAKI had significantly higher risks of developing NDI (odds ratio, [OR] = 4.013, p = 0.001) and EGR (OR = 4.894, p < 0.001). The AKI interval had an area under the receiver operating characteristic curve of 0.754 for NDI at 9.5 days and 0.772 for EGR at 12.5 days.

CONCLUSIONS

SAKI is an independent risk factor for both NDI and EGR in neonates. Consequently, regular monitoring, neurological development assessments, and appropriate nutritional advice are crucial to these infants who have experienced renal injury.

The pathological spectrum of pediatric kidney disease: 18-Year experience from a single tertiary care center in northern Taiwan

BACKGROUND

Glomerular disease is one of the leading causes of chronic kidney disease in children worldwide. Recent studies outlined the changing spectrum of glomerular disease in certain countries. Therefore, our study aimed to evaluate the histopathological patterns and changes in pediatric kidney disease over the past 18 years in northern Taiwan.

METHODS

This was a retrospective chart review study of pediatric patients (≤18 years of age) undergoing percutaneous renal biopsies (PRBs) of native kidneys between January 2002 and July 2020 from a Pediatric Care Center at Chang Gung Memorial Hospital, Taoyuan, Taiwan.

RESULTS

This study analyzed a total of 339 pediatric native PRBs. The mean age of the subjects was 13.7 ± 7.0 years (184 girls and 155 boys). The most common indications of PRBs included acute nephritic syndrome (55.7%), idiopathic nephrotic syndrome (22.7%), persistent asymptomatic hematuria (13.9%), and unexplained renal failure (7.7%). Our study revealed that proliferative lupus nephritis (LN), minimal change disease (MCD)-related nephrotic syndrome, and IgA nephropathy (IgAN) were the most frequent biopsy-proven pediatric glomerular diseases. In addition, we showed that severe acute post-streptococcal glomerulonephritis (APSGN) was infrequent and has not even been diagnosed since 2010.

CONCLUSION

Our result revealed that the spectrum of biopsy-proven pediatric kidney disease has not changed significantly over the past two decades. Furthermore, proliferative LN, MCD, and primary IgAN continue to be the most common histopathological diagnoses among Taiwanese children.

Serum electrolyte abnormalities in pediatric patients presenting to an emergency department with various diseases: Age-related differences

BACKGROUND

This study evaluated the prevalence and frequency of serum electrolyte abnormalities (SEAs) in children presenting to a pediatric emergency department (PED) with various diseases.

METHODS

Pediatric patients (≤18 years) with blood electrolyte panels obtained in the PED of Lin-Kou Chang Gung Memorial Hospital, Taiwan, in the 5 years from January 1, 2016, to August 31, 2021, were enrolled in this retrospective observational study. Patients were divided into three age groups: Group A, < 4 years; Group B, 4-11 years; and Group C, 12-18 years. The associations between SEAs and clinical diseases in children and age-related differences were assessed.

RESULTS

This study included 182,058 pediatric patients visiting our PED over a 5-year period. A total of 250 (0.14%) patients with SEAs were included in the analysis. The study population consisted of 127 boys and 123 girls with a median (IQR) age of 9.0 (3.2-14.1) years. Hospital admission was required in 86.4% (n = 216) of the patients, and 32.4% (n = 81) of them were admitted to the pediatric intensive care unit (PICU). The median (IQR) hospital stay and PICU stay was 6.5 (4.0-11.0) and 4.0 (3.0-8.0) days, respectively. The PICU stay was longer in Group A (p < 0.05) and shorter in group C (p < 0.05). Hyponatremia was the most common SEA in group A (46.3%, n = 31), while hypokalemia was common in groups B (54.2%, n = 52) and C (32.2%, n = 28). Gastrointestinal, renal, and endocrine diseases were common clinical conditions associated with SEAs in pediatric patients in our PED.

CONCLUSION

The detection rate of SEAs in patients in the PED was 0.14%. Hyponatremia was a common SEA in pediatric patients aged <4 years, while the most common electrolyte disorder in those >4 years old was hypokalemia. In infants and young children, SEAs were associated with a longer PICU stay.

Impact of kidney size on the outcome of diabetic patients receiving hemodialysis

Introduction

Diabetic patients normally have enlarged or normal-sized kidneys throughout their lifetime, but some diabetic uremic patients have small kidneys. It is uncertain if kidney size could have any negative impact on outcome in hemodialysis patients.

Methods

This longitudinal, observational cohort study recruited 301 diabetic hemodialysis patients in 2015, and followed until 2019. Patients were stratified into two subgroups according to their kidney sizes before dialysis, as small (n = 32) or enlarged or normal (n = 269). Baseline demographic, hematological, biochemical, nutritional, inflammatory and dialysis related data were collected for analysis.

Results

Patients with small kidney size were not only older (P<0.001) and had lower body mass index (P = 0.016), but had also higher blood uric acid concentration (P<0.001) compared with patients with enlarged or normal kidney size. All patients received adequate doses of hemodialysis since the Kt/V and urea reduction ratio was 1.7±0.3 and 0.7±0.1, respectively. Patients with small size kidneys received higher erythropoietin dose than patients with enlarged or normal kidney size (P = 0.031). At the end of analysis, 92 (30.6%) patients expired. Kaplan-Meier analysis revealed no survival difference between both groups (P = 0.753). In a multivariate logistic regression model, it was demonstrated that age (P<0.001), dialysis duration (P<0.001), as well as blood albumin (P = 0.012) and low-density lipoprotein (P = 0.009) concentrations were significantly correlated with mortality.

Conclusions

Small kidney size on starting hemodialysis was not related with an augmented risk for death in diabetic patients receiving hemodialysis. Further studies are necessary.

[Progress of researches on serine protease inhibitors for zoonotic cestode family Taeniidae]

Serine protease inhibitor, a protein superfamily that inhibits the serine protease activity, protects hosts from parasitic infections. This review describes the spatial structure and classification of serine protease inhibitor, mechanisms underlying the interplay between serine protease inhibitor and host immune responses and current advances in serine protease inhibitor of zoonotic cestode family Taeniidae, so as to provide insights into the diagnosis of zoonotic tapeworm infections, discovery of therapeutic targets and screening of vaccine candidates.

Urine metabolic phenotyping in children with nocturnal enuresis and comorbid neurobehavioral disorders

Nocturnal enuresis (NE) is a common problem among 10% school-aged children. The etiologies underlying childhood NE is complex and not fully understood nowadays. Nevertheless, increasing evidence suggests a potential link between neurobehavioral disorders and enuresis in children. In this study, we aimed to explore novel metabolomic insights into the pathophysiology of NE and also, its association with pediatric psychiatric problems. Urine collected from 41 bedwetting children and 27 healthy control children was analyzed by using ¹H-nuclear magnetic resonance spectroscopy from August 2017 to December 2018. At regular follow-up, there were 14 children with refractory NE having a diagnosis of attention deficient hyperactivity disorder (ADHD) or anxiety. Eventually, we identified eight significantly differential urinary metabolites and particularly increased urinary excretion of betaine, creatine and guanidinoacetate linked to glycine, serine and threonine metabolism were associated with a comorbidity of neurobehavioral disorders in refractory bedwetting children. Notably, based on physiological functions of betaine acting as a renal osmolyte and methyl group donor, we speculated its potential role in modulation of renal and/or central circadian clock systems, becoming a useful urinary metabolic marker in diagnosis of treatment-resistant NE in children affected by these two disorders.

Management of nocturnal enuresis in Taiwan: Consensus statements of the Taiwan enuresis expert committee

Nocturnal enuresis causes significant psychological distress to affected children and their family and requires appropriate management. A 12-member expert committee of pediatric urologists and pediatric nephrologists in Taiwan with extensive experience in treating enuresis was established to develop consensus statements and a recommended treatment algorithm for the management of patients with nocturnal enuresis in Taiwan after careful consideration of current evidence, existing guidelines, and expert opinion as well as local practice and culture. The finalized consensus statements were reviewed by and have received endorsement from the Taiwan Urological Association and the Taiwan Pediatric Association. Patients with suspected enuresis should undergo a thorough initial assessment to fully evaluate urinary signs and symptoms and to rule out underlying causes of diurnal and nocturnal incontinence. Behavioral therapy is recommended throughout the course of management. Desmopressin in the fast-melting formulation is the recommended first-line pharmacological treatment. Combination therapy may be effective in patients who have failed first-line treatment. These consensus statements and a recommended treatment algorithm were created by the expert committee to provide practical support for clinical decision making by physicians in Taiwan.

Risk of peripheral arterial occlusive disease in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is associated with atherosclerosis. However, the relationship between RA and peripheral arterial occlusive disease (PAOD) remains unclear. We used a national health insurance database to identify a cohort of 30,812 patients diagnosed with RA between 2000 and 2011. Each RA patient was frequency-matched according to age and sex with a patient without RA from a control cohort. A multivariate Cox proportional hazards model was used to analyse the adjusted risk of PAOD. The incidence of PAOD was 1.73-fold higher (95 % confidence interval [CI] = 1.57–1.91) in the RA cohort than in the non-RA cohort. The adjusted risk of PAOD was the highest in the patients with RA aged ≤ 49 years (hazard ratio [HR] = 3.39, 95 % CI = 2.66–4.32). Patients with RA and various comorbidities showed a significantly higher risk of PAOD (HR = 9.62, 95 % CI = 4.86–19.1) compared with control patients without comorbidity. The risk of PAOD increased during the first year of follow-up. In conclusion, patients with RA have an independently higher risk of PAOD compared with the general population. Patients with RA and various comorbidities and those at a young age and early stage of the disease have an increased risk of PAOD.

Polycystic kidney disease is significantly associated with dementia risk

OBJECTIVE

Data on the risk of neurodegenerative diseases, including Alzheimer disease (AD) and Parkinson disease (PD), in patients with polycystic kidney disease (PKD) are lacking.

METHODS

A total of 4,229 patients who were aged ≥20 years and had received a diagnosis of PKD were included in the PKD cohort. For each PKD case identified, 1 participant aged ≥20 years without a history of PKD, dementia, or PD was selected from the comparison cohort. For each patient with PKD, the corresponding controls were selected 1:1 on the basis of the nearest propensity score calculated using logistic regression.

RESULTS

The incidence density rates of dementia were 4.31 and 2.50 per 1,000 person-years in the PKD and control cohorts, respectively. A 2.04-fold higher risk of dementia was observed in patients with PKD than in controls (adjusted hazard ratio [aHR] 2.04; 95% confidence interval [CI] 1.46-2.85). Regarding the risk of different dementia subtypes, including AD and vascular dementia (VaD), the aHR for AD and presenile dementia was 2.71 (95% CI 1.08-6.75) and that for VaD was 0.90 (95% CI 0.43-1.87) in patients with PKD compared with controls, after adjustment for age, sex, and comorbidities. Compared with controls, the risk of PD increased by 1.78-fold (95% CI 1.14-2.79) in patients with PKD.

CONCLUSIONS

In clinical practice, health care professionals should be aware of the risk of neurodegenerative diseases in patients with PKD.

Effect of the Functional Groups of Racemic Rodlike Schiff Base Mesogens on the Stabilization of Blue Phase in Binary Mixture Systems

Four series of rodlike racemic Schiff base mesogens possessing different alkyl chains and two types of linkages, ester and alkynyl linkages, were synthesized and applied to induce cubic blue phases (BPs) in simple binary mixture systems. The mesophases of these Schiff base mesogens were confirmed by variable-temperature X-ray diffraction and the characteristic texture from polarized optical microscopy (POM). In general, when chiral additive S-(+)-2-octyl 4-(4-hexyloxybenzoyloxy)benzoate (S811; 20-40 wt %) is added into the rodlike racemic salicylaldimine-based mesogens, the cubic BPs could be observed and its temperature range is larger than 20 K. The widest temperature range of the cubic BP (35 K) can be observed in the blending mixture composed of rodlike racemic salicylaldimine-based mesogen OH-TI_n possessing alkynyl linkage and 35-40 wt % S811. However, Schiff base mesogens possessing alkynyl linkage show a direct isotropic to chiral nematic transition when equal amount of chiral dopant is added. Notably, the termination temperature of BPs is very close to room temperature (ca. 35 °C) after 40.0 wt % S811 is added into the salicylaldimine-based mesogens possessing terminal alkyl chains and ester linkage. Interestingly, wide BPs (>30 K) can also be induced by adding chiral additive 1,4:3,6-dianhydro-2,5-bis[4-(n-hexyl-1-oxy)benzoic acid]sorbitol (ISO(6OBA)₂) with a high helical twisting power into the racemic Schiff base mesogen possessing ester linkage. Cubic BPI and BPII can be confirmed by reflectance spectra and POM. The results of reflectance spectra indicate that the binary mixture composed of salicylaldimine-based mesogens and S811 easily exhibits a supercooling effect and induces BPI. However, only BPII can be observed in all binary mixtures containing Schiff base mesogens. On the basis of our experimental results and molecular modeling, we suppose that the values of biaxiality, polarizability, and the dipole moment of molecular geometry are the main factors that affect BP stabilization.

Broad temperature range of cubic blue phase present in simple binary mixture systems containing rodlike Schiff base mesogens with tolane moiety

Four simple rodlike Schiff base mesogens with tolane moiety were synthesized and applied to stabilize cubic blue phases (BPs) in simple binary mixture systems for the first time. When the chiral additive or was added into a chiral salicylaldimine-based compound, the temperature range of the cubic BP could be extended by more than 20 °C. However, when the chiral Schiff base mesogen was blended with chiral dopant possessing opposite handedness, , BPs could not be observed. Interestingly, the widest temperature range of the cubic BPs (∼35 °C) could be induced by adding the rodlike chiral dopant or into the rodlike racemic Schiff base mesogen with hydroxyl group. On the basis of our experimental results and molecular modeling, the appearance and temperature range of the BPs are affected by the dipole moment and the biaxiality of the molecular geometry. Accordingly, we demonstrated that the hydroxyl group and the methyl branch in this type of Schiff base mesogen play an important role in the stabilization of BPs.

New-onset Atrial Fibrillation is Associated With Polycystic Kidney Disease: A Nationwide Population-based Cohort Study

Cardiovascular complications remain the major problems contributing to morbidity and mortality in patients with polycystic kidney disease (PKD). Therefore, the authors hypothesized that atrial fibrillation (AF) is closely associated with PKD. The authors conducted a nationwide population-based cohort study to investigate the risk of AF in patients with PKD. Using data from inpatient claims, the authors enrolled 7203 patients aged over 20 years who were diagnosed with PKD from 1998 to 2010 with no history of AF as the PKD cohort. They randomly selected 28,739 people without PKD as controls and frequency matched them with patients with PKD according to their age, sex, and baseline comorbidity. In total, 247 PKD patients were diagnosed with AF, representing an incidence of 7.08 per 1000 person-years, whereas 807 cases of AF occurred in the comparison cohort, yielding an incidence of 4.98 per 1000 person-y, with an adjusted HR (aHR) of 1.31 (95% CI = 1.14-1.51). The risk of AF increased from an aHR of 1.59 (95% CI = 1.15-2.21) to 3.64 (95% CI = 1.93-6.85) when the number of risk factors increased from 1 to more than 5 in comparison with patients without risk factors. A remarkably high incidence rate and risk was observed in patients with PKD when multiple risk factors were combined. A high index of suspicion should be maintained when examining PKD patients with irregular betas. Early prophylactic therapy is warranted in these patients.

Risk of Peripheral Arterial Occlusive Disease in Patients With Systemic Lupus Erythematosus: A Nationwide Population-Based Cohort Study

Systemic lupus erythematosus (SLE) is associated with atherosclerosis, but the relationship between SLE and peripheral arterial occlusive disease (PAOD) remains unclear. We sought to investigate this relationship by comparing cardiovascular complications in patients with and without SLE.Data on patients from 2000 to 2011 were collected from the National Health Insurance Research Database of Taiwan. The SLE cohort was frequency-matched according to age, sex, and history of diabetes mellitus (DM) with patients without SLE (control cohort). We evaluated the risk of cardiovascular complications, including hypertension, DM, stroke, chronic obstructive pulmonary disease, heart failure, coronary artery disease, and hyperlipidemia.The study included 10,144 patients with SLE and 10,144 control patients. The incidence of PAOD was 9.39-fold higher (95% confidence interval [CI] = 7.70-11.15) in the SLE cohort than in the non-SLE cohort. Moreover, SLE was an independent risk factor for PAOD. The adjusted risk of PAOD was highest in patients with SLE who were aged ≤34 years (hazard ratio = 47.6, 95% CI = 26.8-84.4). The risk of PAOD was highest during the first year of follow-up and decreased over time.Patients with SLE exhibit a higher incidence and an independently higher risk of PAOD compared with the general population. The PAOD risk is markedly elevated in patients with SLE who are young and in whom the disease is at an early stage.

Percutaneous ultrasound-guided renal biopsy in children: The need for renal biopsy in pediatric patients with persistent asymptomatic microscopic hematuria

BACKGROUND

Percutaneous renal biopsy (PRB) is essential for the diagnosis, prognosis, and management of children with unknown kidney disease. In this study, the safety and efficacy of PRB is investigated, and also the common etiologies of childhood kidney disease, based on histological findings. In addition, we explored the role of PRBs in the diagnosis of children who presented with persistent asymptomatic hematuria.

METHODS

By chart review, from July 2005 to July 2009, a total of 99 PRBs were performed on 91 children (43 girls and 48 boys; mean age, 10.9 ± 4.4 years) under ultrasound (US) guidance, by a doctor, using an automated 18-gauge biopsy needle following the same protocol, at a medical center in northern Taiwan.

RESULTS

The accuracy of the histological diagnosis was excellent. The most common post-biopsy complications were perirenal hematoma (11.1%) and asymptomatic gross hematuria (3.0%), respectively. Nevertheless, these complications resolved spontaneously, and none had major bleeding episodes. Histological results showed that lupus nephritis, minimal change disease, and IgA nephropathy (IgAN) could be the current leading causes of childhood kidney diseases in Taiwan.

CONCLUSIONS

Automated ultrasound (US)-guided PRB is a safe and reliable method of assessing childhood renal disease. A recent study shows that the presence of persistent asymptomatic isolated microhematuria in adolescents is a predictive marker of future end-stage renal disease. Hence, the emphasis of renal biopsy on children with persistent asymptomatic hematuria is beneficial for the early diagnosis of IgAN or other glomerulonephritis (GN), which tends toward progressive kidney disease in adulthood without prompt therapeutic intervention.

Selective Targeting of a Disease-Related Conformational Isoform of Macrophage Migration Inhibitory Factor Ameliorates Inflammatory Conditions

Macrophage migration inhibitory factor (MIF), a proinflammatory cytokine and counterregulator of glucocorticoids, is a potential therapeutic target. MIF is markedly different from other cytokines because it is constitutively expressed, stored in the cytoplasm, and present in the circulation of healthy subjects. Thus, the concept of targeting MIF for therapeutic intervention is challenging because of the need to neutralize a ubiquitous protein. In this article, we report that MIF occurs in two redox-dependent conformational isoforms. We show that one of the two isoforms of MIF, that is, oxidized MIF (oxMIF), is specifically recognized by three mAbs directed against MIF. Surprisingly, oxMIF is selectively expressed in the plasma and on the cell surface of immune cells of patients with different inflammatory diseases. In patients with acute infections or chronic inflammation, oxMIF expression correlated with inflammatory flare-ups. In addition, anti-oxMIF mAbs alleviated disease severity in mouse models of acute and chronic enterocolitis and improved, in synergy with glucocorticoids, renal function in a rat model of crescentic glomerulonephritis. We conclude that oxMIF represents the disease-related isoform of MIF; oxMIF is therefore a new diagnostic marker for inflammation and a relevant target for anti-inflammatory therapy.

Interleukin-10 gene promoter polymorphism and risk of liver cirrhosis

We conducted a hospital-based case-control study to assess the association between IL-10-592 A/C, IL-10-819 C/T, and IL-10-1082 A/G polymorphisms and the risk of liver cirrhosis in a Chinese population. This 1:1-matched case-control study included 192 patients from the Chinese PLA General Hospital. Genotypes of IL-10-592 A/C, IL-10-819 C/T, and IL-10-1082 A/G were detected by polymerase chain reaction amplification-restriction fragment length polymorphism analysis. Conditional regression analysis showed that individuals carrying the IL-10-1082 G allele had an only slightly increased risk of liver cirrhosis, with an adjusted odds ratio (95% confidence interval) of 2.14 (0.97-1.68). However, we did not identify a significant association between polymorphisms in IL-10-592 A/C and IL-10-819 C/T and the risk of liver cirrhosis. These findings may provide important clues for future studies of early detection screening of liver cirrhosis.

Influenza vaccination coverage and factors affecting adherence to influenza vaccination among patients with diabetes in Taiwan

The purpose of this study was to investigate influenza vaccination coverage and the factors influencing acceptance of influenza vaccination among patients with diabetes in Taiwan using the Health Belief Model (HBM). From January 1 to February 28, 2012, 700 patients with diabetes who visited National Cheng Kung University Hospital were invited to participate in the study. A total of 691 (99%) patients with diabetes were enrolled in the study. The mean age of the subjects was 64.7 years (SD = 10.7). The percentages of patients with diabetes who received seasonal influenza vaccination were 31%, 33%, and 35% in 2009-2010, 2010-2011, and 2011-2012, respectively. Multiple regression analyses revealed that patients with diabetes who were female, were older, had comorbidities, had a more positive perception of the benefits of the influenza vaccine and had lower perceived barriers to influenza vaccination were more likely to receive the influenza vaccine in 2011-2012 (adjusted R(2) = 0.47; Chi-square = 276.50; P<0.001). Patients with diabetes perceived the risk of swine influenza to be similar to that of seasonal influenza. Consequently, in the absence of an increase in the perceived risk of influenza, a low level of actual vaccination against seasonal influenza is forecasted. Strategies to improve the uptake of influenza vaccination include interventions that highlight the risk posed by pandemic influenza while simultaneously offering tactics to ameliorate this risk.

Impact of hepatitis C virus infection on bone mineral density in renal transplant recipients

BACKGROUND

The average prevalence of hepatitis C virus (HCV) infection in renal transplant recipients is 10%. Studies of these patients with HCV infection usually focuses on long-term graft survival and patient survival. Studies of the correlation between HCV infection and bone mineral density (BMD) in renal transplant patients are limited. The aim of this study was to investigate whether HCV infection is a risk factor for BMD change during a short follow-up period.

METHODS

Seventy-six renal transplant recipients underwent 2 separate dual-energy X-ray absorptiometry (DXA) scans during a mean period of 14 months. Fifteen patients were HCV infection. First bone mineral density (BMD) at the lumbar spine, hip, and femoral neck was determined using dual-energy X-ray absorptiometry (DXA) between September 2008 and March 2009. After that, 34 patients took alendronate sodium 70 mg per week. Subgroups risk factors analysis was also performed into with or without alendronate. Immunosuppressive agents, bisphosphonates, patient characteristics, and biochemical factors were analyzed to identify associations with BMD.

RESULTS

After 14 months, in 76 patients, BMD of the lumbar spine had significantly increased (from 0.9 g/cm² to 0.92 g/cm², p<0.001), whereas BMD of the hip and femoral neck had not. Multiple linear regression analysis showed that HCV infection was negatively associated with BMD change in the lumbar spine ( β: -0.247, 95% CI, -0.035 to -0.002; p = 0.028). Moreover, in subgroup analysis, among 42 patients without alendronate, multiple linear regression analysis showed HCV infection was a risk factor for adverse BMD change of the lumbar spine ( β: -0.371, 95% CI, -0.043 to -0.003; p = 0.023).

CONCLUSION

HCV infection in renal transplant recipients was a negative risk factor for BMD change in the lumbar spine. Moreover, alendronate may be able to reverse the negative effect of HCV infection on bone in renal transplant recipients.

Arterial stiffness is not increased in teens with early uncomplicated type 1 diabetes mellitus

People with type 1 diabetes mellitus are at an increased risk of cardiovascular mortality. Studies comparing arterial stiffness between subjects with type 1 diabetes and nondiabetic controls have provided controversial findings.We investigated brachial–ankle pulse wave velocity (baPWV) in 87 teenagers with type 1 diabetes mellitus and in 21 matched healthy controls. Our data show that baPWV was not increased in teenagers after a median illness of 5 years.

Smoking as an independent risk factor for hepatocellular carcinoma: the Singapore Chinese Health Study

Background:

Given the close correlation between smoking and alcohol intake in most epidemiologic studies, it is difficult to exclude the residual confounding effect of alcohol in the association between smoking and hepatocellular carcinoma (HCC).

Method:

We evaluated the association between smoking and risk of HCC in the Singapore Chinese Health Study, a prospective cohort with a low prevalence of alcohol intake. Information on cigarette smoking and alcohol consumption was obtained through in-person interviews conducted at enrolment.

Results:

After a mean of 11.5 years of follow-up, there were 394 incident cases of HCC. Participants who consumed more than two alcoholic drinks per day showed an increased risk for HCC (hazard ratio (HR)=2.24; 95% confidence interval (CI)=1.46–3.41). After adjusting for alcohol consumption and other potential confounders, current vs never smokers had a statistically significant, increased risk of HCC (HR=1.63; 95% CI=1.27–2.10) that was dose-dependent (number of cigarettes per day, P for trend<0.001). The observed tobacco–HCC association also was duration-dependent (years of smoking in ever smokers, P for trend=0.002). When we excluded daily drinkers from the analysis, all risk estimates remained essentially the same and statistically significant.

Conclusion:

Our findings strongly implicate tobacco smoke as a causal factor of HCC development.

Body mass index and smoking-related lung cancer risk in the Singapore Chinese Health Study

BACKGROUND

Smokers with low body mass index (BMI) may be more susceptible to lung cancer.

METHODS

We prospectively examined the association between baseline BMI and lung cancer risk in the Singapore Chinese Health Study, a cohort of 63 257 Chinese enrolled between 1993 and 1998.

RESULTS

After adjustment for smoking intensity and duration, BMI was inversely associated with risk of lung cancer among current smokers (P for trend=0.0004). Current smokers at different dosage of smoking with low BMI had significantly higher risk for lung cancer than those with high BMI. Hazard ratios (95% confidence intervals) of lung cancer for heavy smokers with BMI of > or =28, 24-<28, 20-<24, and <20 kg m(-2) were 6.37 (2.10-19.30), 9.01 (5.04-16.10), 8.53 (6.35-11.5), and 11.12 (6.60-18.70), respectively, as compared with nonsmokers. BMI had no modifying effects on lung cancer risk among nonsmokers and former smokers.

CONCLUSION

Smokers with lower BMI may experience an enhanced risk of lung cancer. The findings have significant public-health implication given the increase in smoking prevalence in developing countries, where people still have relatively low BMI.

Association between peritoneal dialysate effluent leukocytosis and amlodipine besylate

Dialysate effluent leukocytosis is consistent with a greater degree of infection or inflammation in patients receiving peritoneal dialysis. This study describes a girl aged 2 years 9 months with end-stage renal disease resulting from crescent glomerulonephritis and severe interstitial nephritis who developed leukocytosis with a predominance of lymphocytes in the dialysate effluent, and in whom the effluent cell count normalized 1 week after discontinuation of amlodipine besylate therapy. Rechallenge confirmed that amlodipine was the offending agent causing effluent leukocytosis.

Multiple organ failure following lamp oil aspiration

CASE REPORT

A 26-month-old previously healthy boy of 15 kg was admitted to our hospital due to cyanosis following the aspiration of lamp oil. Aspiration resulted from the patient's father inducing emesis by digital stimulation of the boy's throat after the patient had ingested an unknown amount of lamp oil. Endotracheal intubation was done on the second hospital day in the Pediatric Intensive Care Unit (PICU) due to respiratory failure manifested by hypercapnia and hypoxemia. Mechanical ventilation, including high frequency oscillatory ventilation (HFOV) with iNO at 20 ppm, was started. However, he developed a spiked fever and developed an acute respiratory distress syndrome, a pneumothorax, and diffuse subcutaneous emphysema. His course was further complicated by anuric renal failure, rhabdomyolysis, severe hepatitis, pancytopenia, elevation of cardiac enzymes, and disseminated intravascular coagulation over the following days. He died on the ninth day of hospitalization because of multiorgan failure.

Insulin-like growth factor-1 promoter polymorphisms and colorectal cancer: a functional genomics approach

RATIONALE

Insulin-like growth factor-1 (IGF1) has been proposed to mediate the obesity-related carcinogenic effects of "Western lifestyle". While genetic factors explain at least half of inter-individual IGF1 variation, the IGF1 polymorphisms hypothesised to underlie the variation in cancer incidence rates remain ill-defined.

METHODS

We used a comparative genomics approach to identify putative regulatory polymorphisms in the IGF1 promoter region within a rapidly westernising population, the Singapore Chinese. Association of IGF1 genotype with colorectal cancer risk was assessed among 298 colorectal cancer cases and 1142 controls nested within the Singapore Chinese Health Study.

RESULTS

We identified a common (minor allele frequency = 0.36) single-nucleotide polymorphism (SNP), IGF1-2995 C/A, within a consensus domain for an octamer binding factor (Oct1/Oct2) transcription factor binding site. Possession of one or two copies of the minor allele (genotypes AA and CA) conferred an approximate 40% decrease in risk in comparison to genotype CC (odds ratio, 0.59; 95% confidence interval, 0.45 to 0.77). This association was stronger for colon cancer than for rectal cancer (p(heterogeneity)<0.001) and for those who were physically active versus inactive (p(interaction) = 0.05). Models including other previously identified promoter polymorphisms did not provide a better prediction of colorectal cancer risk.

CONCLUSIONS

Our results support the hypotheses that IGF1 plays a role in colonic carcinogenesis and that genetically inherited variation in IGF1 expression influences risk of colorectal cancer.

Molecular epidemiology of genital chlamydial infection among male patients attending an STD clinic in Taipei, Taiwan

OBJECTIVE

To assess the epidemiology of genital Chlamydia trachomatis infection among men attending an STD clinic in Taipei, Taiwan.

STUDY

Between July 2004 and June 2005, a total of 426 first-void urine specimens from male patients were tested for C. trachomatis by using a urine-based PCR DNA amplification assay.

RESULTS

The overall prevalence of genital C. trachomatis infection was 16.4%. Youth, current symptoms, the presence of N. gonorrhoeae infection, and inconsistent use of condoms were positively associated with C. trachomatis infection. The most common chlamydia strain present was genotype E, followed by D and Da, F, K, J, G, and H.

CONCLUSIONS

C. trachomatis genital infection was prevalent among male patients attending a STD clinic in Taipei. Young Taiwanese men attending STD clinics should be counselled on condom use.

Staphylococcus aureus pericardial abscess in a child with beta-thalassemia major following double-unit unrelated cord blood transplantation

The authors describe a 10-year-old boy with beta-thalassemia major who received double-unit unrelated cord blood transplantation and had a rocky post-transplantation course that included an episode of massive pericardial effusion. Pericardial tube drainage was performed for evacuating fluid. Results showed hemorrhagic pericardial effusion. A Staphylococcus aureus pericardial abscess eventually developed despite antibiotics coverage. Temporary drain placement was unsuccessful and the patient underwent radical pericardiectomy. Although cyclosporine therapy had to be stopped before the 6-month withdrawal, the patient did well with full donor chimerism 14 months post-transplant.

Cigarettes and alcohol in relation to colorectal cancer: the Singapore Chinese Health Study

The relations were examined between colorectal cancer and cigarette smoking and alcohol consumption within the Singapore Chinese Health Study, a population-based, prospective cohort of 63 257 middle-aged and older Chinese men and women enrolled between 1993 and 1998, from whom baseline data on cigarette smoking and alcohol consumption were collected through in-person interviews. By 31 December 2004, 845 cohort participants had developed colorectal cancer (516 colon cancer, 329 rectal cancer). Compared with nondrinkers, subjects who drank seven or more alcoholic drinks per week had a statistically significant, 72% increase in risk of colorectal cancer hazard ratio (HR)=1.72; 95% confidence interval (CI)=1.33-2.22). Cigarette smoking was associated with an increased risk of rectal cancer only. Compared with nonsmokers, HRs (95% CIs) for rectal cancer were 1.43 (1.10-1.87) for light smokers and 2.64 (1.77-3.96) for heavy smokers. Our data indicate that cigarette smoking and alcohol use interact in the Chinese population in an additive manner in affecting risk of rectal cancer, thus suggesting that these two exposures may share a common etiologic pathway in rectal carcinogenesis.

Production of High-content Galacto-oligosaccharide by Enzyme Catalysis and Fermentation with Kluyveromyces marxianus

Of three beta-galactosidases from Aspergillus oryzae, Kluyveromyces lactis and Bacillus sp., used for the production of low-content galacto- oligosaccharides (GOS) from lactose, the latter produced the highest yield of trisaccharides and tetrasaccharides. GOS production was enhanced by mixing beta-galactosidase glucose oxidase. The low-content GOS syrups, produced either by beta-galactosidase alone or by the mixed enzyme system, were subjected to the fermentation by Kluyveromyces marxianus, whereby glucose, galactose, lactose and other disaccharides were depleted, resulting in up to 97% and 98% on a dry weight basis of high-content GOS with the yields of 31% and 32%, respectively.

Quantitative analysis of associations between DNA hypermethylation, hypomethylation, and DNMT RNA levels in ovarian tumors

How hypermethylation and hypomethylation of different parts of the genome in cancer are related to each other and to DNA methyltransferase (DNMT) gene expression is ill defined. We used ovarian epithelial tumors of different malignant potential to look for associations between 5'-gene region or promoter hypermethylation, satellite, or global DNA hypomethylation, and RNA levels for ten DNMT isoforms. In the quantitative MethyLight assay, six of the 55 examined gene loci (LTB4R, MTHFR, CDH13, PGR, CDH1, and IGSF4) were significantly hypermethylated relative to the degree of malignancy (after adjustment for multiple comparisons; P < 0.001). Importantly, hypermethylation of these genes was associated with degree of malignancy independently of the association of satellite or global DNA hypomethylation with degree of malignancy. Cancer-related increases in methylation of only two studied genes, LTB4R and MTHFR, which were appreciably methylated even in control tissues, were associated with DNMT1 RNA levels. Cancer-linked satellite DNA hypomethylation was independent of RNA levels for all DNMT3B isoforms, despite the ICF syndrome-linked DNMT3B deficiency causing juxtacentromeric satellite DNA hypomethylation. Our results suggest that there is not a simple association of gene hypermethylation in cancer with altered DNMT RNA levels, and that this hypermethylation is neither the result nor the cause of satellite and global DNA hypomethylation.

Childhood exposure to environmental tobacco smoke and chronic respiratory symptoms in non-smoking adults: the Singapore Chinese Health Study

BACKGROUND

Childhood exposure to environmental tobacco smoke has been extensively associated with childhood respiratory illness; fewer studies have addressed the effects on adults.

METHODS

Childhood environmental tobacco smoke exposure in relation to chronic cough, phlegm, and asthma diagnosis was studied in never smokers from a cohort of Singaporeans of Chinese ethnicity aged 45-74 years at enrollment from 1993 to 1998. From 1999 to 2004 subjects were interviewed regarding environmental tobacco smoke exposure before and after the age of 18 and the presence and duration of current symptoms of chronic cough and phlegm production and asthma diagnosis.

RESULTS

Among 35,000 never smokers, fewer had smoking mothers (19%) than fathers (48%). Although few subjects currently lived (20%) or worked (4%) with smokers, 65% reported living with a daily smoker before the age of 18 years. Living with a smoker before the age of 18 increased the odds of chronic dry cough (149 cases, odds ratio 2.1, 95% CI 1.4 to 3.3) and, to a lesser extent, phlegm, after adjustment for age, sex, dialect group, and current and past exposure to smokers at home and at work after the age of 18. Associations strengthened with higher numbers of smokers in childhood. There was no association with asthma or chronic bronchitis. There was evidence to suggest a stronger association among subjects with a lower adult intake of fibre which has previously been found to be protective for respiratory symptoms.

CONCLUSIONS

In this large study of non-smokers, living with a smoker in childhood was associated with chronic dry cough and phlegm in adulthood, independent of later exposures to environmental tobacco smoke.

Interaction between cyclooxygenase-2 gene polymorphism and dietary n-6 polyunsaturated fatty acids on colon cancer risk: the Singapore Chinese Health Study

This case–control study of 310 colorectal cancer cases and 1177 controls in a nested prospective, population-based cohort of Singapore Chinese subjects found a statistically significant association between the cyclooxygenase (COX)-2 −765G>C gene polymorphism and colon cancer risk among high consumers of dietary n-6 polyunsaturated fatty acids (odds ratio=2.38, 95% confidence interval=1.23–4.59).

Wheat germ lectin induces G2/M arrest in mouse L929 fibroblasts

Wheat germ lectin (WGA) is a cytotoxic lectin for many cell lines [Wang et al., 2000], but its underlying mechanism is not clear. In this report, we found that incubation of synchronized mouse L929 fibroblasts with WGA resulted in a dose-dependent reduction of intracellular incorporation of 3H-thymidine and MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide)-conversion activity (IC50 congruent with 0.4 microM). Fluorescein-conjugated WGA was demonstrated to transport from the cell surface into the paranuclear region of cultured L929 cells within 30 min, and subsequently evoked lipid peroxidation of plasma membrane and vacuolation in the cytoplasm of these cells. Studies with tritiated thymidine incorporation, immunofluorescence microscopy, immunoblotting analysis and flow cytometry revealed that WGA inhibited cell cycle progression after one replication, resulting in G2/M arrest and alteration of cell cycle regulatory proteins, particularly activation of p21Cip1/WAF1 and suppression of cyclin B and cdc 2. Although there was an increase of cytosolic caspase 3 and bax protein expression, no apoptotic bodies were observed by both fluorescence and transmission electron microscopy. These results suggest that WGA arrested L929 proliferation after one cell cycle in the G2/M phase through activation of the p21Cip1/WAF1 and suppression of Cyclin B-Cdc2.

Opposing effects of dietary n-3 and n-6 fatty acids on mammary carcinogenesis: The Singapore Chinese Health Study

We investigated the effects of individual fatty acids on breast cancer in a prospective study of 35 298 Singapore Chinese women aged 45–74 years, who were enrolled during April 1993 to December 1998 (The Singapore Chinese Health Study). At recruitment, each study subject was administered, in-person, a validated, semiquantitative food frequency questionnaire consisting of 165 food and beverage items. As of December 31, 2000, 314 incident cases of breast cancer had occurred. We used the Cox regression methods to examine individual fatty acids in relation to breast cancer risk, with adjustment for age at baseline interview, year of interview, dialect group, level of education, daily alcohol drinking, number of live births, age when menstrual periods became regular, and family history of breast cancer. Consumption of saturated, monounsaturated or polyunsaturated fat overall was unrelated to risk. On the other hand, high levels of dietary n-3 fatty acids from fish/shellfish (marine n-3 fatty acids) were significantly associated with reduced risk. Relative to the lowest quartile of intake, individuals in the higher three quartiles exhibited a 26% reduction in risk (relative risk (RR)=0.74, 95% confidence interval (CI)=0.58, 0.94)); RRs were similar across the top three quartiles of intake (0.75, 0.75, 0.72, respectively). Overall, there was no association between n-6 fatty acids and breast cancer risk. However, among subjects who consumed low levels of marine n-3 fatty acids (lowest quartile of intake), a statistically significant increase in risk was observed in individuals belonging to the highest vs the lowest quartile of n-6 fatty acid consumption (RR=1.87, 95% CI=1.06–3.27); the corresponding RR for advanced breast cancer was 2.45 (95% CI=1.20–4.97, P for trend=0.01). To our knowledge, these are the first prospective findings linking the intake of marine n-3 fatty acids to breast cancer protection.

Phenobarbital use and bladder cancer risk

BACKGROUND

Two epidemiologic studies have reported an inverse association between use of phenobarbital (PB) and bladder cancer development. It was proposed that PB use protects against bladder cancer by inducing enzymes that participate in the detoxification of human bladder carcinogens, such as the aminobiphenyls and naphthylamines, which are found in cigarette smoke.

METHODS

A population-based case-control study was conducted in Los Angeles, California, involving 815 incident bladder cancer cases and an equal number of controls who were matched to the index cases by neighborhood, sex, date of birth (within 5 years), and race. Detailed information on lifetime use of PB was collected through in-person interviews.

RESULTS

Ever use (20 or more times over lifetime) of PB was not associated with risk of bladder cancer (OR: 0.86; 95% CI: 0.54, 1.39). Regular use of PB also was not associated with risk of bladder cancer in either men or women, in either smokers or non-smokers, although the number of regular users in cases and controls were relatively small (21 cases vs. 15 controls, OR: 1.20; 95% CI: 0.59, 2.45). In fact, compared with non-users, subjects in the highest category of lifetime PB consumption were at a non-significant 2.46-fold increased risk of bladder cancer (95% CI: 0.90, 6.78).

CONCLUSIONS

The present study did not observe a protective role of PB use in bladder cancer development in the general population.

Pseudohypoaldosteronism presenting as acute gastroenteritis: report of one case

Pseudohypoaldosteronism type I, a disorder of mineralocorticoid resistance, usually presents with excessive renal sodium wasting and subsequent poor growth. We report a 1-month-old male baby who suffered from recurrent vomiting, diarrhea and dehydration. Biochemical investigations showed hyponatremia, hyperkalemia, hypochloremia, metabolic acidosis and large amount of urinary sodium excretion. Owing to persistent electrolyte abnormalities and renal salt loss, hormone studies were done and revealed elevated concentrations of cortisol, adrenocorticotropic hormone, aldosterone, renin and 17-hydroxyprogesterone. Blood pressure and plasma sugar were normal. The external genitalia were normal without hyperpigmentation. The laboratory data coupled with clinical presentations suggested pseudohypoaldosteronism type I. Aggressive sodium replacement and fluid therapy were started, with good response.

Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease

Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58,515 women with invasive breast cancer and 95,067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for >/=45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver.

Singapore Chinese Health Study: development, validation, and calibration of the quantitative food frequency questionnaire

This report describes the development and validation/calibration of a structured food frequency questionnaire for use in a large-scale cohort study of diet and health in Chinese men and women aged 45-74 years in Singapore, the development of a food composition database for analysis of the dietary data, and the results of the dietary validation/calibration study. The present calibration study comparing estimated intakes from 24-hour recalls with those from the food frequency questionnaires revealed correlations of 0.24-0.79 for energy and nutrients among the Singapore Chinese, which are comparable to the correlation coefficients reported in calibration studies of other populations. We also report on the nutritional profiles of Singapore Chinese on the basis of results of 1,880 24-hour dietary recalls conducted on 1,022 (425 men and 597 women) cohort subjects. Comparisons with age-adjusted corresponding values for US whites and blacks show distinct differences in dietary intakes between the Singapore and US populations. The Singapore cohort will be followed prospectively to identify dietary associations with cancer risk and other health outcomes.

Metabolic gene polymorphism frequencies in control populations

Using the International Project on Genetic Susceptibility to Environmental Carcinogens (GSEC) database containing information on over 15,000 control (noncancer) subjects, the allele and genotype frequencies for many of the more commonly studied metabolic genes (CYP1A1, CYP2E1, CYP2D6, GSTM1, GSTT1, NAT2, GSTP, and EPHX) in the human population were determined. Major and significant differences in these frequencies were observed between Caucasians (n = 12,525), Asians (n = 2,136), and Africans and African Americans (n = 996), and some, but much less, heterogeneity was observed within Caucasian populations from different countries. No differences in allele frequencies were seen by age, sex, or type of controls (hospital patients versus population controls). No examples of linkage disequilibrium between the different loci were detected based on comparison of observed and expected frequencies for combinations of specific alleles.

Hemosuccus pancreaticus from a traumatic gastroduodenal pseudoaneurysm: an unusual cause of upper gastrointestinal bleeding

Hemosuccus pancreaticus, blood entering the gastrointestinal tract through the pancreatic duct, is a rare and elusive form of gastrointestinal bleeding with diagnostic difficulties. We report a 37-year-old man who had recurrent gastrointestinal bleeding from erosion of a pseudoaneurysm of the gastroduodenal artery into the pancreatic duct. The lack of history of pancreatitis, associated symptoms, equivocal endoscopic findings, and the rarity of this entity resulted in a delay in diagnosis. Pancreatic duct stenosis detected during surgery suggested the lesion might have been caused by blunt abdominal trauma. A nearly total pancreatectomy and splenectomy were performed. The patient remained symptom-free 8 months after the operation. This obscure cause of gastrointestinal bleeding should be considered when common causes of bleeding have been ruled out, even in the absence of pancreatitis.

Fish and shellfish consumption in relation to death from myocardial infarction among men in Shanghai, China

Between 1986 and 1989, 18,244 men aged 45-64 years in Shanghai, China, participated in a prospective study of diet and cancer. All participants completed an in-person, structured interview and provided blood and urine samples. As of September 1, 1998, 113 deaths from acute myocardial infarction were identified. After analyses were adjusted for age, total energy intake, and known cardiovascular disease risk factors, men who consumed >or=200 g of fish/shellfish per week had a relative risk of 0.41 (95% confidence interval: 0.22, 0.78) for fatal acute myocardial infarction compared with men consuming <50 g per week. Similarly, dietary intake of n-3 fatty acids derived from seafood also was significantly associated with reduced mortality from myocardial infarction. Neither dietary seafood nor n-3 fatty acid intake was associated with a reduced risk of death from stroke or ischemic heart disease other than acute myocardial infarction. However, approximately a 20% reduction in total mortality associated with weekly fish/shellfish intake was observed in the study population (relative risk = 0.79, 95% confidence interval: 0.69, 0.91). These prospective data suggest that eating fish and shellfish weekly reduces the risk of fatal myocardial infarction in middle-aged and older men in Shanghai, China.