Clinical narrative-aware deep neural network for emergency department critical outcome prediction

Since early identification of potential critical patients in the Emergency Department (ED) can lower mortality and morbidity, this study seeks to develop a machine learning model capable of predicting possible critical outcomes based on the history and vital signs routinely collected at triage. We compare emergency physicians and the predictive performance of the machine learning model. Predictors including patients' chief complaints, present illness, past medical history, vital signs, and demographic data of adult patients (aged ≥ 18 years) visiting the ED at Shuang-Ho Hospital in New Taipei City, Taiwan, are extracted from the hospital's electronic health records. Critical outcomes are defined as in-hospital cardiac arrest (IHCA) or intensive care unit (ICU) admission. A clinical narrative-aware deep neural network was developed to handle the text-intensive data and standardized numerical data, which is compared against other machine learning models. After this, emergency physicians were asked to predict possible clinical outcomes of thirty visits that were extracted randomly from our dataset, and their results were further compared to our machine learning model. A total of 4,308 (2.5 %) out of the 171,275 adult visits to the ED included in this study resulted in critical outcomes. The area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC) of our proposed prediction model is 0.874 and 0.207, respectively, which not only outperforms the other machine learning models, but even has better sensitivity (0.95 vs 0.41) and accuracy (0.90 vs 0.67) as compared to the emergency physicians. This model is sensitive and accurate in predicting critical outcomes and highlights the potential to use predictive analytics to support post-triage decision-making.

Search for Flavor-Changing Neutral Current Interactions of the Top Quark and Higgs Boson in Final States with Two Photons in Proton-Proton Collisions at sqrt[s]=13 TeV

Proton-proton interactions resulting in final states with two photons are studied in a search for the signature of flavor-changing neutral current interactions of top quarks (t) and Higgs bosons (H). The analysis is based on data collected at a center-of-mass energy of 13 TeV with the CMS detector at the LHC, corresponding to an integrated luminosity of 137  fb^{-1}. No significant excess above the background prediction is observed. Upper limits on the branching fractions (B) of the top quark decaying to a Higgs boson and an up (u) or charm (c) quark are derived through a binned fit to the diphoton invariant mass spectrum. The observed (expected) 95% confidence level upper limits are found to be 0.019% (0.031%) for B(t→Hu) and 0.073% (0.051%) for B(t→Hc). These are the strictest upper limits yet determined.

Improved diffusion and storage of lithium ions via recrystallization induced conducting pathways in a Li:Ta2O5-based electrolyte for all-solid-state electrochromic devices with enhanced performance

In this study, we have investigated the improvements in the performance of an all-solid-state complementary electrochromic device (ECD) by using the proposed high pressure treatment (HPT). The Li:Ta₂O₅electrolyte layer was recrystallized by the HPT utilizing pressurized CO₂gas (∼200 atm) and at low temperature (<60 °C), which enhanced the coloration performance of the WO₃/Li:Ta₂O₅/NiO complementary ECD by ∼20%. The reliability and durability of the ECD were confirmed by long term transmittance retention measurements, which indicated an improvement in the coloration performance by ∼14% upon the release of the bias voltages. The ability of the devices that were fabricated with and without the HPT process to withstand high temperature environments was also verified. In addition, photoluminescence (PL) and transmittance measurements were carried out to examine the effects of the bonding between WO₃and NiO. To determine the differences in lithium-ion (Li⁺) injection, electrical measurements were performed by utilizing varying pulse rising speeds to confirm device characteristics. The materials were characterized in terms of their composition and structure using high-resolution transmission electron microscopy along with energy-dispersive x-ray spectroscopy. Finally, a mechanistic model has been proposed to explain the improved EC characteristics based on the amorphous to crystalline transition accompanying the HPT process.

[A mini-incision on the anterior hip for pediatric femur neck fractures of type Delbet Ⅱ]

Objective: To investigate the early clinical outcomes of hip anterior short incision and open reduction and internal fixation for the treatment of children with Delbet Ⅱ femoral neck fracture. Methods: A retrospective analysis of 12 children with DelbetⅡ femoral neck fractures was performed with the anterior short incision approach at Department of Pediatric Orthopaedic, Children's Hospital, Nanjing Medical University from January 2014 to August 2016. There were 7 males and 5 females including 8 cases at left side and 4 cases at right side,aged (11.5±0.8) years (range: 8-14 years).Patients underwent surgery in (12.0±0.9) hours (range: 6-20 hours) after the injury. Displaced fractures were treated by open reduction if closed reduction failed.The surgical incision was performed with the anterior inferior iliac spine centered on, extending along the groin crease, and the length was 3 to 4 cm. The interval between the sartorius and the tensor fascia latae was applied, and the direct and indirect head of rectus femoris were resected to visualize the hip joint capsule. T-shaped incision was made in the capsule. After the reduction was obtained, two or three compression canulated screws were used to fix the fracture site. The healing time, complications and corresponding record outcome by X-ray and clinical examination were recorded. At the latest follow-up,the results were analyzed using the Ratliff criteria and clinical outcomes were assessed by pain, restrictive hip movement, normal activity or the avoidance of games, and the femoral neck in the radiograph. Results: Twelve patients had been followed-up for (30.0±4.1)months(range: 24-36 months). X-ray showed the fractures' healing time was (8.0±0.4) weeks(range: 7-9 weeks). Ten of the 12 fractures healed after one operation and were associated with no evidence of osteonecrosis of the femoral head. One case occurred premature physeal closure. There were no cases with fracture relocation, coaxvara, delayed union and nonunion or any significant postoperative complications. There was no infection, flexible internal fixation or ruptures. According to Ratliff grade, 9 cases of 12 patients were fine and 3 cases was acceptable. Conclusions: Satisfactory short-term effects can be achieved by a mini-incision on the anterior hip for Delbet Ⅱ pediatric femur neck fractures. The anterior incision has the advantage of less trauma, smaller incision scar, better fracture reduction and fixation, and less wound complications.

[Effects and mechanism of allogeneic platelet rich plasma on collagen synthesis in wound healing]

Objective: To investigate the effects and mechanism of allogeneic platelet rich plasma (PRP) on collagen in wound surface at different time. Methods: A total of 50 clean 7-week rats were selected for this study, including 10 rats for platelet-rich blood plasma preparation, 20 rats for PRP group and 20 rats for control group, 0.1 ml allogenic PRP and 0.1 ml saline were smeared respectively on wound surfaces of PRP and control group, wound regeneration and healing were examined. Cellular and histological morphology alteration was observed via Masson staining, type Ⅰ and type Ⅲ collagen protein and mRNA expression level were detected by Western blot and real-time PCR. T test was applied for comparison between two samples and one-way ANOVA was utilized for comparison between two groups. Results: The wound healing rate of PRP group was higher than that of control group on 3(rd,) 6(th,) 10(th) and 15(th) day (30.33±3.35 vs.18.35±2.04, 55.51±2.74 vs.36.83±2.34, 79.64±1.40 vs.56.92±1.44, 86.88±2.12 vs.65.80±1.76) after wound surface formation, there were statistic differences (t=13.66-50.48, all P<0.05). The wound collagen of PRP group form faster and coarser, and the fibers arrayed more densely in Masson staining. The protein expression of type Ⅰ collagen(1.92±0.09 vs.1.18±0.11) and type Ⅲ collagen(1.16±0.05 vs.0.74±0.11) of PRP group were higher than that of control group (t=22.99, P<0.01; t=17.62, P<0.05); the mRNA expression of type Ⅰ collagen(5.17±0.11 vs.1.79±0.18, 6.97±0.09 vs.1.96±0.08, 6.00±0.26 vs.2.10±0.05, 4.95±0.11 vs.3.58±0.09)and type Ⅲ collagen(2.35±0.08 vs.1.44±0.05, 3.08±0.05 vs.1.84±0.06, 3.48±0.07 vs.2.36±0.09, 4.42±0.07 vs.2.77±0.10) were higher than that of control group on 3(rd,) 6(th,) 10(th) and 15(th) day after wound surface formation, there were significant differences (t=43.37-188.37, all P<0.05). Conclusion: The allogeneic platelet rich plasma may promote fibroblasts secreted collagen by activated and releasing all kinds of growth factors, especially type Ⅰ and type Ⅲ collagen to accelerate the wound healing.

Resistance Switching Characteristics Induced by O2 Plasma Treatment of an Indium Tin Oxide Film for Use as an Insulator in Resistive Random Access Memory

In this study, an O₂ inductively coupled plasma (ICP) treatment was developed in order to modify the characteristics of indium tin oxide (ITO) film for use as an insulator in resistive random access memory (RRAM). After the O₂ plasma treatment, the previously conductive ITO film is oxidized and becomes less conductive. In addition, after capping the same ITO material for use as a top electrode, we found that the ITO/ITO(O₂ plasma)/TiN device exhibits very stable and robust resistive switching characteristics. On the contrary, the nontreated ITO film for use as an insulator in the ITO/ITO/TiN device cannot perform resistance switching behaviors. The material analysis initially investigated the ITO film characteristics with and without O₂ plasma treatment. The surface was less rough after O₂ plasma treatment. However, the molar concentration of each element and measured sheet resistance results for the O₂-plasma-treated ITO film were dramatically modified. Next, electrical measurements were carried out to examine the resistance switching stability under continuous DC and AC operation in this ITO/ITO(O₂ plasma)/TiN device. Reliability tests, including endurance and retention, also proved its capability for use in data storage applications. In addition to these electrical measurements, current fitting method experiments at different temperatures were performed to examine and confirm the resistance switching mechanisms. This easily fabricated device, using a simple material combination, achieves excellent performance by using ITO with an O₂ plasma treatment and can further the abilities of RRAM for use in remarkable potential applications.

Determination of the thermal, oxidative and photochemical degradation rates of scintillator liquid by fluorescence EEM spectroscopy

The thermal, oxidative and photochemical stability of the scintillator liquid proposed for the SNO+ experiment has been tested experimentally using accelerated aging methods. The stability of the scintillator constituents was determined through fluorescence excitation emission matrix (EEM) spectroscopy and absorption spectroscopy, using parallel factor analysis (PARAFAC) as an multivariate analysis tool. By exposing the scintillator liquid to a well-known photon flux at 365 nm and by measuring the decay rate of the fluorescence shifters and the formation rate of their photochemical degradation products, we can place an upper limit on the acceptable photon flux as 1.38 ± 0.09 × 10^-11 photon mol L^-1. Similarly, the oxidative stability of the scintillator liquid was determined by exposure to air at several elevated temperatures. Through measurement of the corresponding activation energy it was determined that the average oxygen concentration would have to be kept below 4.3-7.1 ppb_w (headspace partial pressure below 24 ppm_v). On the other hand, the thermal stability of the scintillator cocktail in the absence of light and oxygen was remarkable and poses no concern to the SNO+ experiment.

[Analysis of the influence factors of school-age children's refractive status]

Objective: To analyze the influence of the eye biological parameters, height, and weight on the school-age children's refractive status. Methods: Cross-sectional study. A total of 1 656 children (1 656 eyes), aged from 7 to 14 years, were selected from 8 schools in Wenzhou during June 2012 and June 2013. The height and weight of each child were measured, and the body mass index (BMI) was calculated. The eye biological parameters, including axial length (AL), corneal power (C=1/CR), anterior chamber depth (ACD), and white to white (WTW), were measured by IOLMaster (version 5.0, Carl Zeiss, Germany), and the AL/CR was calculated. Refraction was measured by fast cycloplegic retinoscopy, and the spherical equivalent (SE) was calculated. Only right eyes were included in the analysis. SPSS16.0 was used to analyze the data. The correlations of the equivalent spherical power, the eye biological parameters, height, weight, and BMI were evaluated. Linear regression analysis was used for the SE, AL, and AL/CR. Results: The prevalence of myopia in 7- to 14-year-old school-age children was 50.2% on the average, 48.4% in boys, and 51.7% in girls. The average SE was (-1.07±1.74) D. With adjustment of the age, gender, urban and rural areas, there was an association between the SE and AL, AL/CR, ACD, height and weight. The correlation coefficient was -0.663, -0.730, -0.416, -0.365, and -0.281, respectively (P<0.05). There was no significant correlation between the SE and WTW, corneal power and BMI. Regarding the different refractive statuses, there was a stronger correlation between the SE and AL, AL/CR in children with hyperopia, moderate myopia or high myopia than those with emmetropia or mild myopia (P< 0.01). In the older children, the correlation between the SE and AL, AL/CR was stronger. Linear regression analysis showed SE= 26.55-9.11·AL/CR and 23.0-1.02·AL. Conclusions: There was an association between the SE and AL, AL/CR, ACD, height and weight in school-age children. In children with hyperopia, moderate myopia, high myopia or at an older age, the correlation was more significant between the SE and AL, AL/CR. (Chin J Ophthalmol, 2016, 52:831-835).

Deep brain stimulation in the globus pallidus externa promotes sleep

The basal ganglia, a network of subcortical structures, play a critical role in movements, sleep and mental behavior. Basal ganglia disorders such as Parkinson's disease and Huntington's disease affect sleep. Deep brain stimulation (DBS) to treat motor symptoms in Parkinson's disease can ameliorate sleep disturbances. Our series of previous studies lead the hypothesis that dopamine, acting on D2 receptors on the striatopallidal terminals, enhances activity in the globus pallidus externa (GPe) and promotes sleep. Here, we tested if DBS in the GPe promotes sleep in rats. We found that unilateral DBS (180 Hz at 100 μA) in the GPe in rats significantly increased both non-rapid eye movement and rapid eye movement sleep compared to sham DBS stimulation. The EEG power spectrum of sleep induced by DBS was similar to that of the baseline sleep, and sleep latency was not affected by DBS. The GPe is potentially a better site for DBS to treat both insomnia and motor disorders caused by basal ganglia dysfunction.

Improvement of glycemic control in streptozotocin-induced diabetic rats by Atlantic salmon skin gelatin hydrolysate as the dipeptidyl-peptidase IV inhibitor

In our previous study, Atlantic salmon skin gelatin hydrolysed with flavourzyme possessed 42.5% dipeptidyl-peptidase (DPP)-IV inhibitory activity at a concentration of 5 mg mL(-1). The oral administration of the hydrolysate (FSGH) at a single dose of 300 mg per day in streptozotocin (STZ)-induced diabetic rats for 5 weeks was evaluated for its antidiabetic effect. During the 5-week experiment, body weight increased, and the food and water intake was reduced by FSGH in diabetic rats. The daily administration of FSGH for 5 weeks was effective for lowering the blood glucose levels of diabetic rats during an oral glucose tolerance test (OGTT). After the 5-week treatment, plasma DPP-IV activity was inhibited; the plasma activity of glucagon-like peptide-1 (GLP-1), insulin, and the insulin-to-glucagon ratio were increased by FSGH in diabetic rats. The results indicate that FSGH has the function of inhibiting GLP-1 degradation by DPP-IV, resulting in the enhancement of insulin secretion and improvement of glycemic control in STZ-induced diabetic rats.

Development and Appraisal of Multiple Accounting Record System (Mars)

The aim of the system is to achieve simplification of workflow, reduction of recording time, and increase the income for the study hospital.

METHODS

The project team decided to develop a multiple accounting record system that generates the account records based on the nursing records automatically, reduces the time and effort for nurses to review the procedure and provide another note of material consumption. Three configuration files were identified to demonstrate the relationship of treatments and reimbursement items.

RESULTS

The workflow was simplified. The nurses averagely reduced 10 minutes of daily recording time, and the reimbursement points have been increased by 7.49%.

CONCLUSION

The project streamlined the workflow and provides the institute a better way in finical management.

User's Satisfaction of Multiple Accounting Record System

The study hospital had developed a multiple account recording system that generates the accounting information of the consumed materials based on daily nursing records. A questionnaire survey was delivered to further investigate the impact of the system.

METHODS

Four concepts of the system were investigated. (1) Supportive and time saving; (2) impact on workflows and job satisfactions; (3) ease of use; and (4) overall satisfactions.

RESULTS

The system scored 4.03 out of 5 as the highest for helpfulness for daily practices, 3.98 for decrease the time for recording material consumptions, 3.98 for actually changed the way they work.

DISCUSSION

Users mostly expressed positive attitude towards the system.

Effects of low amplitude pulsed radiofrequency stimulation with different waveform in rats for neuropathic pain

Pulsed-radiofrequency (PRF) electrical stimulation has been widely used for chronic pain treatment. It has been demonstrated with advantages of low temperature over traditional continuous radiofrequency (CRF) lesions with higher amplitude and mono polar electrode to treat pain in clinics (frequency 500 KHz, Pulse duration 20 msec, Amplitude 45 V, Treatment 2 min). We compare the effects of different pulse waveforms and PRF parameters (Pulse duration 25 ms, Treatment duration 5 min, low amplitude of 2.5/1.25 V) with a miniature bi-polar electrode on Dorsal root ganglion (DRG). The pain relief effect due to PRF is evaluated by using Von Frey method for the pain threshold index based on behavior response to mechanical stimulus of various strengths. Experimental results of Von Frey Score show that the sinusoidal group has higher responses than the square wave one. Both fast and secondary expressed proteins of c-fos and pp38 are measured from spinal cord tissue sectioning slides to characterize the pain associated inflammatory responses and their responses due to PRF stimulation.

Cortical neuronal activity does not regulate sleep homeostasis

The neural substrate of sleep homeostasis is unclear, but both cortical and subcortical structures are thought to be involved in sleep regulation. To test whether prior neuronal activity in the cortex or in subcortical regions drives sleep rebound, we systemically administered atropine (100mg/kg) to rats, producing a dissociated state with slow-wave cortical electroencephalogram (EEG) but waking behavior (e.g. locomotion). Atropine injections during the light period produced 6h of slow-wave cortical EEG but also subcortical arousal. Afterward, rats showed a significant increase in non-rapid eye movement (NREM) sleep, compared to the same period on a baseline day. Consistent with the behavioral and cortical EEG state produced by systemic atropine, c-Fos expression was low in the cortex but high in multiple subcortical arousal systems. These data suggest that subcortical arousal and behavior are sufficient to drive sleep homeostasis, while a sleep-like pattern of cortical activity is not sufficient to satisfy sleep homeostasis.

Physical and chemical mechanisms in oxide-based resistance random access memory

In this review, we provide an overview of our work in resistive switching mechanisms on oxide-based resistance random access memory (RRAM) devices. Based on the investigation of physical and chemical mechanisms, we focus on its materials, device structures, and treatment methods so as to provide an in-depth perspective of state-of-the-art oxide-based RRAM. The critical voltage and constant reaction energy properties were found, which can be used to prospectively modulate voltage and operation time to control RRAM device working performance and forecast material composition. The quantized switching phenomena in RRAM devices were demonstrated at ultra-cryogenic temperature (4K), which is attributed to the atomic-level reaction in metallic filament. In the aspect of chemical mechanisms, we use the Coulomb Faraday theorem to investigate the chemical reaction equations of RRAM for the first time. We can clearly observe that the first-order reaction series is the basis for chemical reaction during reset process in the study. Furthermore, the activation energy of chemical reactions can be extracted by changing temperature during the reset process, from which the oxygen ion reaction process can be found in the RRAM device. As for its materials, silicon oxide is compatible to semiconductor fabrication lines. It is especially promising for the silicon oxide-doped metal technology to be introduced into the industry. Based on that, double-ended graphene oxide-doped silicon oxide based via-structure RRAM with filament self-aligning formation, and self-current limiting operation ability is demonstrated. The outstanding device characteristics are attributed to the oxidation and reduction of graphene oxide flakes formed during the sputter process. Besides, we have also adopted a new concept of supercritical CO2 fluid treatment to efficiently reduce the operation current of RRAM devices for portable electronic applications.

Integrated one diode-one resistor architecture in nanopillar SiOx resistive switching memory by nanosphere lithography

We report on a highly compact, one diode-one resistor (1D-1R) nanopillar device architecture for SiOx-based ReRAM fabricated using nanosphere lithography (NSL). The intrinsic SiOx-based resistive switching element and Si diode are self-aligned on an epitaxial silicon wafer using NSL and a deep-Si-etch process without conventional photolithography. AC-pulse response in 50 ns regime, multibit operation, and good reliability are demonstrated. The NSL process provides a fast and economical approach to large-scale patterning of high-density 1D-1R ReRAM with good potential for use in future applications.

First Report of the Root-Knot Nematode Meloidogyne arenaria Infecting Noni in China

Noni (Morinda citrifolia) is an important medicinal plant and its fruit and root are of high value. In recent years, noni has been cultivated widely on Hainan Island, China. A survey of eight commercial noni fields in four counties found that most fields had plants with symptoms consistent with damage caused by root-knot nematodes. Above-ground symptoms included reduced vigor, plant stunting, and chlorosis. Affected roots were galled, swollen, cracked, and rotten. Fruit loss associated with diseased plants was quantified as 85%. In each field, three samples were taken consisting of 15 cm wide × 20 cm deep soil (containing roots). The nematode population was extracted and quantified according to Barker (1). Nematodes were found in all soil and root samples with population densities ranging from 450 to 835 eggs and second-stage juveniles (J2s) per 200 g subsample of soil, and 685 to 985 eggs and J2s per 10 g sub-sample of fresh roots. Three single egg masses were respectively hand-picked from one sample of diseased noni roots and inoculated onto tomato plants grown with sterilized soil at 20 to 28°C in the greenhouse. After 8 weeks, nematodes were extracted from the roots of tomato plants and identified by morphology, enzyme analysis, and molecular characterization. Morphology of the female perineal patterns showed a low dorsal arch with large lateral lines separating the striae of the dorsal and ventral sectors, leading to the tail terminus; and wavy, coarse striae with forking at lateral lines and short irregular striae near the lateral lines. Enzyme analysis of the esterase phenotype was also typical of the A1 phenotype in M. arenaria. Based on the perineal pattern and esterase phenotype, the Meloidogyne species was identified as M. arenaria (Est A1) (3). Total genomic DNA was extracted from ca. 10 μl of packed second-stage juveniles (J2s) using the method of Cenis (2). The primers C2F3 (5'-GGTCAATGTTCAGAAATTTGTGG-3') and 1108 (5'-TACCTTTGACCAATCACGCT-3') (4) was used to amplify the intergenic region between COII and LrRNA genes of the mtDNA and an amplification product (1,700 bp) was obtained, similar to M. hispanica, M. incognita, and M. javanica. Root-knot nematodes (Meloidogyne spp.) have been reported to be cause disease on noni in Hawaii. However, to our knowledge, this is the first report of M. arenaria (Est A1) infecting noni in China. References: (1) K. R. Barker. Pp. 19 in: An Advanced Treatise on Meloidogyne. Vol. II, Methodology. K. R. Barker et al. eds. North Carolina State University Graphics, Raleigh, 1985. (2) J. L. Cenis. Phytopathology 83:76,1993. (3) P. E. Esbenshade and A. C. Triantaphyllou. J. Nematol. 17:6,1990. (4) T. O. Power and T. S. Harris J. Nematol. 25:1,1993.

Cetuximab plus chemotherapy as first-line treatment for metastatic colorectal cancer: effect of KRAS mutation on treatment efficacy in Taiwanese patients

Cetuximab, either alone or in combination with chemotherapy, is approved for treatment of patients with metastatic colorectal cancer (mCRC). We reviewed retrospectively records of 50 patients with mCRC from a single center in Taiwan. All patients had ECOG performance status grade 2, histological diagnosis of advanced CRC based on RECIST criteria, and were given at least three cycles of chemotherapy plus cetuximab. We compared the effectiveness of therapy in patients with wild-type and mutant KRAS genes, assessed the overall response (OR) rate of patients with locally advanced or metastatic non-resectable CRC, and assessed the progression-free survival (PFS) time. The ten patients with KRAS mutations had poorer response rates than the 40 patients with the wild-type KRAS gene. Patients with the wild-type and mutant genes had similar progression free survival (PFS) status and median time to PFS. The median overall survival time was significantly greater in patients with the wild-type gene than in those with the mutant gene (28.77 ± 6.43 months vs. 15.13 ± 0.50 months, p=0.014). Taiwanese patients with mCRC respond better to a cetuximab plus chemotherapy regime if their tumors have the wild-type KRAS gene.

Cryopreservation of germinal vesicle stage porcine oocytes based on intracellular ice formation assessment

This study aimed at evaluating the feasibility of slow freezing for cryopreservation of germinal vesicle (GV) stage porcine oocytes. In this study, intracellular ice formation (IIF) characteristics of GV porcine oocytes were investigated by using a thermoelectric cooling (TEC) cryomicroscope system. This cryomicroscope system used a thermoelectric cooling (TEC) chip in its cold stage as a heat sink and employed a PID control algorithm to achieve accurate temperature control. The temperature was controlled to a range between 70 degree C and -55 degree C with an accuracy of +/- 0.5 degree C. Five constant cooling rates of 24, 12, 6, 3 and 1.5 degree C/min were tested in experiments in freezing GV porcine oocytes from 20 degree C to -50 degree C in an NCSU-23 medium plus 2.0 M DMSO. The IIF temperature of each individual oocyte was recorded and cumulative IIF probabilities were calculated for each cooling rate. The total cumulative probabilities of IIF temperature distribution were 100 percent, 100 percent, 50.0 percent, 54.3 percent and 58.6 percent at cooling rates of 24, 12, 6, 3 and 1.5 degree C/min, respectively. A Weibull distribution model was found to adequately describe the distribution of IIF temperatures of GV porcine oocytes for the cooling rates tested (R2 = 0.858 +/- 0.09). The IIF experimental results indicate that cooling rates of 6, 3 and 1.5°C/min could be considered as possible cryopreservation protocols. Further experiments were performed to examine the feasibility of using these protocols to cryopreserve GV porcine oocytes. After 44 h of in-vitro maturation in NCSU-23, the survival of thawed oocytes was checked. Porcine oocytes developed from the GV stage to the MII stage by using Hoechst 33258 staining, followed by Lacmoid staining as a secondary check. Normalized survival rates of 37.7 +/- 4.6 percent, 45.0 4.4 percent and 45.4 +/- 5.9 percent were obtained for GV oocytes frozen at 1.5, 3 and 6 degree C/min, respectively. The experimental results indicate that slow freezing is a feasible approach for cryopreservation of GV porcine oocytes when cooling rate is properly selected. This study also demonstrated an efficient approach for investigating optimal cooling rates by assessing the IIF characteristics of GV porcine COCs.

Chlamydial infection during trachoma monitoring: are the most difficult-to-reach children more likely to be infected?

OBJECTIVES

During mass antibiotic distributions for trachoma, certain individuals are difficult to locate and go untreated. These untreated individuals may serve as a source of community reinfection. The importance of this difficult-to-locate, untreated population is unclear. We sought to determine whether individuals who are difficult to locate were more likely to be infected with ocular chlamydia than those who were easier to locate.

METHODS

We monitored 12 Ethiopian communities 1 year after a third annual mass azithromycin treatment for trachoma. Conjunctival swabbing for chlamydial RNA was performed in a random sample of children from each community. If insufficient numbers of children were enrolled on the first monitoring day, we returned on subsequent days.

RESULTS

Of the 12 communities, 10 required more than one monitoring day. On average, 16.1% (95% CI 7.9-30.0) of children were enrolled after the initial day. Evidence of chlamydia was found in 7.1% (95% CI 2.7-17.4) of 0- to 9-year-old children. No ocular swabs collected after the initial day were positive for chlamydial RNA. Children examined after the initial monitoring day were significantly less likely to have ocular chlamydial infection than children seen on the initial day; Mantel-Haenszel common OR = 0 (95% CI 0-0.77).

CONCLUSIONS

In a setting of repeated annual mass azithromycin treatments, after approximately 80% of individuals have been located in a community, extra efforts to find absent individuals may not yield significantly more cases of ocular chlamydia.

Decolourization performance in C. I. Vat Yellow 1 aqueous suspension using hydrophobically modified poly(acrylic acid)

A series of hydrophobically modified poly(acrylic acid) (PAA), poly(2-phenoxyethyl acrylate-co-acrylic acid) (poly(PHEA-co-AA)), have been synthesized and characterized by Ubbelohde type viscometry, Nuclear Magnetic Resonance (1H NMR) spectrometry and Differential Scanning Calorimetry (DSC). The shear thinning Non-Newtonian fluid behavior of their aqueous solution and the dependence on pH and hydrophobic group contents were found through apparent viscosity and rheological property investigating. Decolourization performance in C. I. Vat Yellow 1 aqueous suspension was evaluated through visible absorbance data. Decolourization performance of hydrophobically associated polymer indicates two times better than that of PAA. The quantitative relationship was mainly studied.

Self-efficacy, foreign language anxiety as predictors of academic performance among professional program students in a general English proficiency writing test

Questionnaires were administered to 120 students. Cluster analysis was used to examine whether specific groups could be described by a writing self-efficacy scale, English writing anxiety scale, and a written General English Proficiency Test. Three clusters were observed. Demographic variables were compared for each cluster, including age, sex, program of study, years of English instruction, native language, and number of English speaking acquaintances. Efforts to reduce writing anxiety and promote writing self-efficacy could enhance writing scores of participants.

Dyspeptic symptoms and water load test in patients with functional dyspepsia and reflux disease

OBJECTIVE

Hypersensitivity to gastric distension has been reported in functional dyspepsia (FD). The aim of this study was to assess the perception to gastric distension and its relationship to specific symptoms using the water load test (WLT) in FD and gastroesophageal reflux disease (GERD).

MATERIAL AND METHODS

A 5-min WLT was used to evaluate sensitivity of gastric distension in 47 FD and 61 GERD subjects, and 49 healthy controls (HC). A visual analogue scale (VAS) measuring symptom severity was obtained from all subjects and its relationship with the maximal ingested volume was determined. The maximal ingested volume was registered and the subjective symptoms were assessed at baseline and 30 min after the WLT.

RESULTS

The maximal ingested volume by HC was 597 +/- 33 ml, which was statistically greater than that of FD (422 +/- 22 ml, p < 0.001) and GERD (504 +/- 23 ml, p < 0.02) subjects. The maximal ingested volume did not differ significantly between FD and GERD. The maximal ingested volume correlated well with nausea (r = -0.49, p < 0.01) and fullness (r = -0.33, p < 0.05) in FD. Male subjects ingested more water than females in the HC (p < 0.01) and GERD groups (p < 0.05), but not in FD (p = NS).

CONCLUSIONS

Both FD and GERD subjects have altered perception to gastric fullness induced by the WLT compared to healthy controls. Good correlations have been observed between the WLT and dyspeptic symptoms such as early satiety and postprandial fullness, but not in GERD.

Clinical evaluation of postoperative sinonasal surgical patients

Rhinosinusitis is a very common upper respiratory illness. Functional endoscopic sinus surgery has been successfully utilized in the surgical treatment of medically refractory rhinosinusitis. The endoscopic approach has also been extended to various skull base lesion and sinonasal neoplasms. This paper provides a brief overview of the clinical aspect of evaluating sinonasal surgical patients. Judicious use of nasal endoscopy and importance of CT imaging of the sinuses are discussed. Emphasis is placed on establishing communication between the sinus surgeon and radiologist to facilitate evaluation of the sinonasal surgical patients. liming and specific types of imaging studies before any revision sinus surgery are discussed. Major complications associated with endoscopic sinus surgery are reviewed.

Combined bronchoalveolar lavage and polymerase chain reaction in the diagnosis of pulmonary tuberculosis in smear-negative patients

SETTING

The polymerase chain reaction (PCR) may be sensitive and specific for the diagnosis of tuberculosis, but most reports are of studies conducted in well-controlled laboratories. A study to evaluate the clinical value of bronchoalveolar lavage (BAL) combined with PCR was necessary.

OBJECTIVE

One hundred and thirty one patients were recruited into the study from March 1994 to February 1997.

DESIGN

Patients with a positive acid-fast stain on sputum smear were recruited into group A as positive controls, patients with lung cancer and a negative acid-fast stain on sputum smear were put into group B as negative controls, and patients who had clinical symptoms of pulmonary TB without sputum or with negative smear results were the investigating group. PCR was performed on the sputum samples from group A and B patients and on the BAL fluid from those in group C.

RESULTS

The sensitivity of PCR was 96% in group A, and the specificity was 100% in group B. The sensitivity of PCR in the BAL fluid from the group C patients was 36% and the specificity was 96%; the positive predictive value was 94% and the negative predictive value was 45%.

CONCLUSION

BAL plus PCR is useful in the rapid diagnosis of pulmonary TB in non-productive or smear-negative patients.

Implications of sonographic identification of duplex kidney in adults

BACKGROUND

Duplication of the renal pelvis and ureter constitutes the most common anomalies of the upper urinary tract. Most patients are asymptomatic and don't need treatment. However, the associated anomaly and acquired renal disease may cause morbidity and mortality. The aim of this study was to investigate the prevalence of duplex kidney in sonographic examinations and the predictive capability of this method. An analysis of patients with urography-confirmed duplication anomaly was also performed.

METHODS

During a period of 9 year (from 1988 to 1996), sonographic examination records of 19,287 patients were reviewed. Patients with a diagnosis of duplex kidney were enrolled. Their clinical characteristics and radiological images were recorded and evaluated.

RESULTS

One hundred and sixty-three patients were found by sonography to have duplex kidney, for an prevalence of 0.85%. Urography studies were done on 64 (39.2%) patients, and 42 patients were proven to have duplex kidney. The positive predictive rate of sonography was 65.6%. Eighty percent of patients with duplex kidney had associated ureteral duplication. No associated anomalies were found. Four patients had urolithiasis, and 3 patients had recurrent urinary tract infection. One patient had coexisting uroepithelial malignancy, and 1 patient had refractory gross hematuria.

CONCLUSIONS

Duplex kidney is an uncommon finding during adult sonographic examinations. The sensitivity and specificity of sonography in identifying this anomaly are controversial. An experienced hand with good knowledge of the anomaly and its sonographic signs is helpful in more accurately diagnosing this anomaly.

Effect of occlusal trauma on healing of periapical pathoses: report of two cases

AIM

To present two clinical cases and demonstrate that occlusal trauma may affect healing of periapical pathoses.

SUMMARY

Two teeth with periradicular disease did not respond successfully to conventional root canal treatment or endodontic surgery. Occlusal adjustment was finally performed on both cases. After occlusal adjustment, uncomplicated healing and periapical repair occurred in both cases. The findings in these two cases suggest that occlusal trauma may play a role in the healing of periapical pathoses.

KEY LEARNING POINTS

Occlusal trauma is positively correlated with changes in periodontal tissues. Although experiments in animals have shown that application of forces to teeth will not induce further periodontal destruction, we believe that some failures of root canal treatment may be due to the presence of occlusal trauma modulating the responses of inflamed periapical tissues or apical pathoses with persistent infection.

Reversible infra-Hisian atrioventricular block in acute myocarditis

Symptomatic second- or third-degree atrioventricular (AV) block at any anatomical level is a class I indication for permanent pacemaker implantation. We describe a 44-year-old male with acute viral myocarditis who suffered from syncope followed by a seizure attack associated with AV conduction disturbance. His initial electrocardiogram in our emergency room revealed sinus tachycardia with 2:1 AV conduction and a right bundle branch block QRS morphology with a ventricular rate of 60 beats/min. Because of episodic slowing of the heart rate below 40 beats/min, he received 1 mg atropine intravenously which increased the atrial rate but further worsened the AV conduction, resulting in ventricular asystole for more than 30 seconds associated with loss of consciousness and seizure-like activity. He was immediately paced transcutaneously and transferred to the catheterization laboratory to receive temporary transvenous cardiac pacing. The cardiac catheterization study showed a normal coronary angiogram and very mild diffuse hypokinesis. Electrophysiological studies revealed advanced infra-Hisian AV block. The infra-Hisian AV block, however, resolved rapidly in 2 days. The patient did not receive a permanent pacemaker and remained asymptomatic with normal electrocardiogram over 1 year of follow-up. We suggest that symptomatic infra-Hisian AV block due to viral myocarditis can be reversible, and implantation of a permanent pacemaker may not be necessary.

Effect of primary angioplasty on total or subtotal left main occlusion: analysis of incidence, clinical features, outcomes, and prognostic determinants

BACKGROUND

Although acute left main coronary artery (LMCA) occlusion is a rare clinical entity, it carries a very high mortality rate. The purposes of this study were to evaluate the effect of primary angioplasty for a severely obstructed or totally occluded LMCA, and to determine the incidence, clinical features, outcome, and prognostic determinants in this clinical setting.

MATERIALS AND METHODS

Between May 1993 and July 2000, a total of 740 patients with acute myocardial infarction underwent primary angioplasty in our hospital. Eighteen of 740 patients (2.4%) with a severely obstructed or totally occluded LMCA constituted the population of this study.

RESULTS

Seventeen of 18 patients (94.4%) experienced pulmonary edema (including 14 patients in cardiogenic shock). Six patients (33.3%) sustained sudden death due to malignant ventricular tachyarrhythmias. Coronary angiography showed that there were variable grade flow of intercoronary collaterals in 12 patients (66.7%), a totally occluded LMCA in 8 patients (44.4%), an incompletely occluded LMCA in 10 patients (55.6%), and a dominant right coronary artery (RCA) in 16 patients (88.9%). Primary angioplasty of the LMCA was performed with a 72.2% procedural success rate. Four patients (22.2%) received coronary artery bypass surgery after angioplasty. Six patients (33.3%) died in the hospital. Two patients died after discharge. Ten of 18 patients (55.6%) survived in long-term follow-up (mean +/- SD, 44 +/- 14 months). Those patients who survived to be discharged had significantly higher combined coexisting incidence of intercoronary collaterals, dominant RCA, and incompletely occluded LMCA (100% vs 0.0%, p = 0.0006) than those patients who died in the hospital.

CONCLUSIONS

Acute obstructive LMCA disease generally presented as pulmonary edema, cardiogenic shock, or sudden death. Only those who had combined coexistence of intercoronary collaterals, a dominant RCA, and an incompletely occluded LMCA could survive to be discharged. Our experience suggests that primary LMCA angioplasty is a feasible and effective procedure, and it may save lives in this clinical setting.

Characteristics of mutations in the p53 gene in oral squamous cell carcinoma associated with betel quid chewing and cigarette smoking in Taiwanese

p53 mutations are etiologically associated with the development of oral squamous cell carcinomas (OSCCs) or are associated with exposure to specific carcinogens. In this study, we used PCR-single strand conformation polymorphism and DNA sequencing to analyze the conserved regions of the p53 gene (exons 5-9) in OSCC tumor specimens from 187 patients with varied histories of betel quid, tobacco and alcohol use. Ninety-one of the 187 OSCCs (48.66%) showed p53 gene mutations at exons 5-9. The incidence of p53 mutations was not associated with age, sex, TNM stage, status of cigarette smoking or betel quid chewing. However, alcohol drinkers exhibited a significantly higher incidence (57/101, 56.44%) of p53 mutations than non-users (39.53%, 34/86) (P = 0.02). The effect of alcohol on the incidence of p53 mutations was still statistically significant (RR = 2.24; 95% CI, 1.21-4.15) after adjustment for cigarette smoking and betel quid (BQ) chewing. G:C to A:T transitions were the predominant mutations observed and associated with BQ and tobacco use. Alcohol drinking could enhance these transitions. After adjustment for cigarette smoking and BQ chewing, alcohol drinking still showed an independent effect on G:C to A:T transitions (RR = 2.41; 95% CI, 1.01-5.74). These findings strongly suggest an important contributive role of tobacco carcinogens to p53 mutation in this series of Taiwanese OSCCs and alcohol might enhance these mutagenic effects. As safrole-DNA adducts have been detected in 77% (23/30) of the OSCC tissues from Taiwanese oral cancer patients with a BQ chewing history, we cannot rule out the possibility that safrole or other carcinogens present in the BQ may cause a similar pattern of mutagenesis. Determination of the role of safrole and other carcinogens present in BQ on the pattern of p53 gene mutation in OSCC will require further study.

Computed tomography and angiography in hepatic tuberculosis mimicking liver tumor

Tuberculosis is one of the most common and well-documented infectious diseases, with a vast variety of clinical manifestations. A case of isolated hepatic tuberculosis mimicking liver tumor is presented. The patient was a 44-year-old man who had suffered from intermittent epigastralgia for about 2 years. Abdominal computed tomography demonstrated a low density mass with internal calcification over the left lobe of the liver. Celiac angiography showed encasement of the hepatic propia and occlusion of the left hepatic artery. Abnormal tortuous vascular structures were found at the hepatic hilar region. The patient underwent surgical intervention under the impression of left liver tumor. Microscopically, the resected liver tissue specimen revealed tuberculosis.

Atrial size reduction as a predictor of the success of radiofrequency maze procedure for chronic atrial fibrillation in patients undergoing concomitant valvular surgery

INTRODUCTION

Previous studies showed that the surgical maze procedure can restore sinus rhythm and atrial transport function in patients with chronic atrial fibrillation (AF). However, no previous studies discussed the association of atrial size reduction and the success of sinus conversion by the radiofrequency (RF) maze procedure for chronic AF.

METHODS AND RESULTS

A total of 119 chronic AF patients undergoing valvular operations were included in this study. Sixty-one patients received RF and cryoablation to create lesions in both atria to simulate the surgical maze II or III procedure (RF maze II or RF maze III; 13 patients, group 1) or a modified maze pattern (RF maze "IV"; 48 patients, group 2). The other 58 patients who underwent valvular operations alone without the maze procedure served as control (group 3). At 3-month follow-up after operation, sinus rhythm was restored in 73%, 81%, and 11% of patients in groups 1, 2 and 3, respectively. Preoperative left and right atrial sizes were not statistically significant predictors of sinus conversion by the RF maze procedure. However, as a result of postoperative reduction of atrial sizes, postoperative left atrial diameter was significantly smaller in patients who had sinus conversion by the RF maze procedure than in patients who did not regain sinus rhythm (45.0+/-7.0 mm vs 51.0+/-8.0 mm; P = 0.03). Postoperative right atrial area of patients who had sinus conversion by the RF maze procedure also was significantly smaller than that of patients who did not regain sinus rhythm (18.1+/-4.4 cm2 vs 28.5+/-8.2 cm2; P = 0.008).

CONCLUSION

Atrial size reduction appears to predict the success of sinus conversion with the RF maze procedure used in conjunction with valvular surgery.

Activation of the hypothalamus characterizes the acupuncture stimulation at the analgesic point in human: a positron emission tomography study

We performed a positron emission tomography study, using regional cerebral blood flow as the index of brain activity, to address the specificity of brain activation pattern by acupuncture stimulation of short duration at the classical analgesic point. Needling manipulation at 2 Hz was performed at a classical point of prominent analgesic efficacy (Li 4, Heku) and a near-by non-classical/non-analgesic point, respectively, in normal subjects. Regions activated by acupuncture stimulation at Li 4 included the hypothalamus with an extension to midbrain, the insula, the anterior cingulate cortex, and the cerebellum. Of note, it was only the stimulation at Li 4 that activated the hypothalamus under the similar psychophysical ratings of acupuncture sensation (deqi) as elicited by the stimulation at the two points, respectively. The data suggested that the hypothalamus might characterize the central expression of acupuncture stimulation at the classical analgesic point and serve as one key element in mediating analgesic efficacy of acupuncture stimulation.

Structure and expression of an amylopullulanase gene from Bacillus stearothermophilus TS-23

An amylopullulanase gene (apuTS) from Bacillus stearothermophilus TS-23 was cloned and characterized. apuTS consisted of an open reading frame of 6054 bp encoding a protein of 2018 amino acids with a calculated M(r) of 223811. The deduced amino acid sequence revealed four highly conserved regions that are common among amylolytic enzymes. In the C-terminal region, a six-amino-acid sequence (Pro-Gly-Ser-Gly-Thr-Thr) is repeated nine times. It shared the highest degree of homology with the amylopullulanase of Bacillus sp. XAL601. The enzyme also had moderate homology with amylopullulanases from thermophilic anaerobic bacteria. Low levels of homology were observed between the ApuTS of B. stearothermophilus TS-23 and amylopullulanases of Pyrococcus abyssi Orsay, P. furiosus and Bacillus sp. KSM1378. When the intact coding region of apuTS was expressed in Escherichia coli under the control of the lac promoter, the product was degenerate, as revealed by amylase activity staining after SDS/PAGE. The largest active polypeptide had an M(r) of about 220000, while the smallest one had an M(r) of about 105000. Upstream of the apuTS gene, a gene orfX was fortuitously cloned. The putative OrfX protein was weakly related to the myosin heavy chain. It was predicted to contain a central, 179-residue-long, coiled-coil domain.

No sex and age influence on the expression pattern and activities of human gastric alcohol and aldehyde dehydrogenases

BACKGROUND

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) are the principal enzymes responsible for ethanol metabolism in humans. The stomach is involved in the metabolism of alcohol during absorption. Conflicting reports exist with regard to the influence of sex and age on the activity of ADH in the human gastric mucosa. The purpose of the present study was to determine the effects of age and sex on the expression pattern and activities of stomach ADH and ALDH.

METHODS

A total of 115 endoscopic gastric biopsy specimens were investigated from Han Chinese men (n = 70) and women (n = 45) aged 20-79 years with approximately even distribution among 10-year age intervals. The expression patterns of ADH and ALDH were identified by isoelectric focusing, and the activities were assayed spectrophotometrically.

RESULTS

The expression patterns of gastric ADH and ALDH remained unchanged with respect to sex and age. At 33 mM or 500 mM ethanol, pH 7.5, the ADH activities did not differ significantly among the various age groups or between men and women. At 200 microM or 20 mM acetaldehyde, the ALDH activities did not differ significantly in relation to sex and age. No correlations were found between the ADH or ALDH activities at both the high and low substrate concentrations and the ages in men and women.

CONCLUSIONS

The results indicate that there is no significant effect of either sex or age on the expression pattern and activity of ADH and ALDH in the human gastric mucosa. The stomach ADH seems unlikely to account for possible variations in the first-pass metabolism of alcohol with regard to sex and age.

Cloning and characterization of zfBLP1, a Bcl-XL homologue from the zebrafish, Danio rerio

The importance of the Bcl-2 family proteins in normal vertebrate embryogenesis is being recognized; however, their regulatory mechanism is poorly understood. We report here the cloning and characterization of a novel zebrafish Bcl-2 family protein, zfBLP1. The zfBLP1 cDNA is 1942 nucleotides long, encoding a polypeptide of 238 amino acids. The primary sequence of zfBLP1 shares 50% identity to human Bcl-XL, and contains all four conserved BH domains of the Bcl-2 family proteins. Primary sequence analysis identified a consensus ER retention signal at the C-terminal end of zfBLP1. Northern blot analysis indicated that there were two major and two minor zfBLP1 mRNA species expressed during embryonic development. Among the two major mRNA species, the short one, approx. 3 kb in size, was expressed throughout embryonic development, while the long one, approx. 7 kb long, was not detectable until the gastrula stage. These results suggest that zfBLP1 is a novel Bcl-2 family protein under complicated regulations, and is likely to play an important role in zebrafish oogenesis and embryogenesis.

Rat hepatic natural killer cells (pit cells) express mRNA and protein similar to in vitro interleukin-2 activated spleen natural killer cells

Pit cells are liver-specific natural killer (NK) cells that can be divided into high- (HD) and low-density (LD) subpopulations. The characteristics of pit cells were further investigated in this report. LD and HD pit cells express the specific NK-activation markers gp42, CD25, and ANK44 antigen. LD cells and IL-2-activated NK cells have a high mRNA expression of perforin, granzymes, interferon-gamma, and tumor necrosis factor-alpha. LD pit cells, unlike spleen NK cells, have a weak response to IL-2 with regard to proliferation, cytotoxicity, and production of NK-related molecules. The characteristics of HD cells are intermediate between LD and spleen NK cells. These results show that pit cells, especially LD cells, possess characteristics similar to IL-2-activated NK cells. This is the first evidence on a molecular level that pit cells could be considered in vivo activated NK cells.

Evidence for an association between polymorphism in the serotonin-2A receptor variant (102T/C) and increment of N100 amplitude in schizophrenics treated with clozapine

Using event-related potentials (ERPs), a reduction in the auditory N100, N200 and P300 amplitude has been found in schizophrenic patients and may represent some pathophysiological deficit. Therefore, we investigated whether the genetic variant of the serotonin-2A receptor is associated with ERP change after clozapine treatment in schizophrenic patients. Ninety-nine schizophrenic patients were included in the study. The results demonstrated that patients with 102C/C genotype have higher N100 amplitude than other patients after clozapine treatment. Our findings suggested that serotonin-2A receptor polymorphism may relate to clozapine response in schizophrenic patients. An objective and reliable tool like ERPs to assess patients' treatment response may afford more consistent results in pharmacogenetic studies.

Seroprevalence of canine distemper virus in cats

A seroepidemiological survey of canine distemper virus (CDV) infection in Asian felids revealed that the prevalence of antibodies varied depending on region and, in some cases, exposure to dogs. The serologic pattern in cats with antibodies indicated that they had likely been exposed to field strains rather than typical CDV vaccine strains.

Primary angioplasty in acute inferior myocardial infarction with anomalous-origin right coronary arteries as infarct-related arteries: focus on anatomic and clinical features, outcomes, selection of guiding catheters and management

BACKGROUND

Inferior wall myocardial infarction caused by obstruction of an anomalous-origin right coronary artery (RCA) is a rare angiographic finding; primary angioplasty to an anomalous-origin RCA has never been reported.

METHODS

In 185 patients with acute inferior wall myocardial infarction resulting from RCA occlusion who underwent primary angioplasty, eight patients (4.3%) had anomalous-origin RCAs.

RESULTS

Coronary angiography showed that all 8 patients had a dominant RCA. Six patients (75%) had an anomalous-origin RCA arising from the anterior aspect of the ascending aorta above the sinotubular line and the other 2 patients (25%) had an anomalous-origin RCA arising from the left sinus of Valsalva with a separate ostium from the left main coronary artery. The standard Judkins right guiding catheter did not offer adequate support in these patients. In the group of 6 patients, an Amplatz guiding catheter offered good support, while a standard Judkins left guiding catheter was adequate in the other 2 patients. Obstruction of the proximal RCA occurred in 6 patients (75%). Successful reperfusion was achieved in 6 patients (75%), resulting in an uneventful clinical course and long-term survival (mean follow-up, 24.9 +/- 16.5 months). Two patients (25%) had unsuccessful reperfusion and died from cardiogenic shock.

CONCLUSIONS

In this small series, anomalous-origin RCAs were the dominant artery and predisposed to atherosclerosis at the proximal portions. We suggest that appropriate guide catheter selection and careful manipulation are essential for the success of revascularization. Complete reperfusion results in an excellent clinical and long-term outcome in patients with anomalous-origin RCAs.

Sonographic features of small-bowel intussusception in pediatric patients

OBJECTIVE

Small-bowel intussusception (SBI) for pediatric patients is unusual and difficult to diagnose preoperatively. This study sought to determine the sonographic findings of pediatric SBI.

METHODS

The sonographic features and surgical findings of 13 pediatric patients (7 boys, 6 girls; age range 4 months-15 years; average age 4 years and 2 months) with SBI encountered in the authors' hospital over a 12-year period were retrospectively reviewed.

RESULTS

Most of the patients presented with nonspecific symptoms, including vomiting, abdominal pain, and/or irritable crying. Sonographic screening in the emergency department revealed a doughnut or crescent-in-doughnut sign, or a multiple-concentric-rings sign for 11 of the 13 patients, and the lesions appeared short. Eight lesions were found in the paraumbilical or left abdominal regions. Sonographic measurement of the size of the lesions from these 11 patients ranged from 2 cm to 3.7 cm (average 2.77 cm). Subsequent barium enemas were performed for these 11 patients, none of which revealed colon lesions. Surgery revealed ileoileal intussusceptions for eight cases, jejunoileal for three, and jejunojejunal for the remaining two. Bowel ischemia or necrosis and pathologic lead points were demonstrated for seven and six patients, respectively, although none were recognized preoperatively.

CONCLUSIONS

Small-bowel intussusception is often over-looked due to nonspecific clinical presentations. Sonographic demonstration of a 2-3-cm sized, short, doughnut-like lesion, especially in the left abdomen or paraumbilical regions, should lead to strong suspicion of SBI.

Randomized comparison of local versus epidural anesthesia for tension-free vaginal tape operation

PURPOSE

We determine the difference between local anesthesia and epidural blockade for the tension-free vaginal tape operation.

MATERIALS AND METHODS

Between November 1995 and November 1997, 73 women who had genuine stress incontinence in the absence of pelvic prolapse underwent a prospective randomized study. The study was conducted using a standardized protocol for different types of anesthesia for the tension-free vaginal tape procedure. A formal pain scale was used to determine the pain score for the patients during the operation. Additionally an anxiety scale was used to measure the anxiety level of the subjects immediately after admission to the ward and before discharge from the hospital.

RESULTS

One woman was excluded from study due to loss at followup. The comparisons of pain score, duration of procedure and anxiety level of the 2 different types of anesthesia were not significantly different in the 72 study subjects. There was no significant difference in the amount of blood loss, while initial spontaneous voiding occurred significantly earlier (3.5 +/- 2.3 versus 5.8 +/- 0.1 hours, p <0.01), the number of patients in whom initial spontaneous voiding occurred more than 6 hours postoperatively was fewer (2 versus 10, p =0.01), amount of post-void residual during hospitalization was significantly less (98 +/- 63 versus 155 +/- 56 ml., p <0.01) and length of hospital stay was significantly shorter (3.4 +/- 1.4 versus 5.5 +/- 1.6 days, p <0.01) in the local anesthesia compared to epidural group. Subjective and objective success rates were not significantly different in these 2 groups.

CONCLUSIONS

Both anesthetic methods can be equally effectively used for the tension-free vaginal tape operation. Local may be better than epidural anesthesia but its clinical significance needs to be proved by further study.

Monocyte chemoattractant protein-1 is expressed in pancreatic islets from prediabetic NOD mice and in interleukin-1 beta-exposed human and rat islet cells

AIMS/HYPOTHESIS

Monocyte chemoattractant protein-1 (MCP-1) attracts monocytes and T lymphocytes, and could thus contribute to mononuclear cell infiltration in Type I (insulin-dependent) diabetes mellitus. Cytokines induce MCP-1 mRNA expression in pancreatic rat beta cells. To investigate this issue, we analysed the signal transduction for IL-1 beta-induced MCP-1 expression in rat beta cells and in vitro MCP-1 mRNA expression and protein release by human islets as well as in vivo islet MCP-1 mRNA expression in prediabetic non-obese diabetic mice.

METHODS

Fluorescence-activated cell sorting-purified rat beta cells were cultured for 6 h with IL-1 beta (30 U/ml) or MAPK inhibitors or both. Human islets were cultured for 6-72 h with the cytokines IL-1 beta, IFN-gamma or the inducible nitric oxide synthase (iNOS) inhibitor NG-methyl-L-arginine or both. We measured MCP-1 mRNA by RT-PCR and protein by ELISA. The MCP-1 mRNA expression in islets from male and female non-obese diabetic mice (2-12 weeks of age) was measured by real time reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS

Interleukin-1 beta induced MCP-1 mRNA expression in rat beta cells, with a maximum induction after 6 h. A combination of p38 and ERK1/2 inhibitors decreased MCP-1 expression by 70%. IL-1 beta induced both MCP-1 mRNA expression and a threefold increase in medium MCP-1 protein accumulation in human islet cells. This effect was not prevented by iNOS blockers. In vivo there was an age-related increase in MCP-1 mRNA expression in islets from male and female non-obese diabetic mice, reaching a peak at 8 weeks.

CONCLUSIONS/INTERPRETATION

In rat and human islet cells MCP-1 mRNA is induced by IL-1 beta. Both ERK1/2 and p38 MAPK, but not nitric oxide, contribute to MCP-1 expression. In non-obese diabetic mice MCP-1 mRNA expression increases with age, peaking at the early phases of insulitis. The production of MCP-1 by pancreatic beta cells could contribute to the recruitment of mononuclear cells into pancreatic islets in early Type I diabetes.