Suppression of presynaptic corticostriatal glutamate activity attenuates L-dopa-induced dyskinesia in 6-OHDA-lesioned Parkinson's disease mice

A common adverse effect of Parkinson's disease (PD) treatment is L-dopa-induced dyskinesia (LID). This condition results from both dopamine (DA)-dependent and DA-independent mechanisms, as glutamate inputs from corticostriatal projection neurons impact DA-responsive medium spiny neurons in the striatum to cause the dyskinetic behaviors. In this study, we explored whether suppression of presynaptic corticostriatal glutamate inputs might affect the behavioral and biochemical outcomes associated with LID. We first established an animal model in which 6-hydroxydopamine (6-OHDA)-lesioned mice were treated daily with L-dopa (10 mg/kg, i.p.) for 2 weeks; these mice developed stereotypical abnormal involuntary movements (AIMs). When the mice were pretreated with the NMDA antagonist, amantadine, we observed suppression of AIMs and reductions of phosphorylated ERK1/2 and NR2B in the striatum. We then took an optogenetic approach to manipulate glutamatergic activity. Slc17a6 (vGluT2)-Cre mice were injected with pAAV5-Ef1a-DIO-eNpHR3.0-mCherry and received optic fiber implants in either the M1 motor cortex or dorsolateral striatum. Optogenetic inactivation at either optic fiber implant location could successfully reduce the intensity of AIMs after 6-OHDA lesioning and L-dopa treatment. Both optical manipulation strategies also suppressed phospho-ERK1/2 and phospho-NR2B signals in the striatum. Finally, we performed intrastriatal injections of LDN 212320 in the dyskenesic mice to enhance expression of glutamate uptake transporter GLT-1. Sixteen hours after the LDN 212320 treatment, L-dopa-induced AIMs were reduced along with the levels of striatal phospho-ERK1/2 and phospho-NR2B. Together, our results affirm a critical role of corticostriatal glutamate neurons in LID and strongly suggest that diminishing synaptic glutamate, either by suppression of neuronal activity or by upregulation of GLT-1, could be an effective approach for managing LID.

Sire pedigree error estimation and sire verification of the Taiwan dairy cattle population by using SNP markers

Information regarding the correct pedigree of and relationship between animals is useful for managing dairy breeding, reducing inbreeding, estimating breeding value, and establishing correct breeding programs. Additionally, the successful implementation of progeny testing is crucial for improving the genetics of dairy cattle, which depends on the availability of correct pedigree information. Incorrect pedigree information leads to bias in bull evaluation. In this study, Neogen GeneSeek Genomic Profiler (GGP) 50K SNP chips were used to identify and verify the sire of Taiwanese Holstein dairy cattle and analyze the reasons that lead to incorrect sire records. Samples were collected from 2,059 cows of 36 dairy farms, and the pedigree information was provided by breeders. The results of sire verification can be divided into three categories: submitted unconfirmed sire, submitted confirmed sire, and incorrectly submitted verified sire. Data on the sires of 1,323 (64.25%) and 572 (27.78%) dairy cows were verified and discovered, respectively. Sires of 1,895 (92.03%) dairy cattle were identified, which showed that the paternal pedigree of dairy cattle could be discovered and verified through genetic testing. An error-like analysis revealed that the data of 37 sires were incorrectly recorded because the bull's NAAB code number was incorrectly entered into the insemination records: for 19 sires, the wrong bull was recorded because the frozen semen of a bull placed in the wrong storage tank was used, 6 had no sire records, and for 12 sires, the NAAB code of the correct bull was recorded but with a wrong stud code, marketing code, or unique number for the stud or breed. To reduce recorded sire error rates by at least 27.78%, automated identification of the mated bull must be adopted to reduce human error and improve dairy breeding management on dairy farms.

Association of Body mass index and clinical outcomes in patient with coronary artery disease undergoing percutaneous coronary intervention

Funding Acknowledgements

Type of funding sources: None.

Background

Most of the world"s population lives in countries in which overweight status and obesity issues cause more morbidity and mortality than underweight status. Mortality increased as BMI increased above 25 kg/m², and the lowest mortality existed in a population with ideal body weight. Recently, the BMI or obesity paradox was widely discussed. The lower future risk was observed in these overweight subjects, not normal weight or lower BMI population, in patients with cardiovascular disease.

Purpose 

The association of body weight and adverse outcomes in patients with coronary artery disease, undergoing percutaneous coronary intervention (PCI), has not yet been clearly established. The purpose of our study was to investigate the outcome of patients undergoing PCI, stratified by body mass index (BMI). 

Methods

Moreover, 5,427 patients with established coronary artery disease (CAD) were enrolled while undergoing successful PCI from 2005 to 2015. The primary outcome, or total cardiovascular (CV) events, was the composite of cardiac death, nonfatal myocardial infarction, stroke, and hospitalization for congestive heart failure (CHF). 

Results

During an average 65.06 ± 32.1 month follow-up, there were 573 total cardiovascular (CV) events (18.95%), 315 major adverse cardiovascular events (MACEs) (10.42%), 105 cardiac deaths (3.47%), 169 acute myocardial infarction (MI) (5.59%), 69 ischemic strokes (CVAs) (2.28%), 314 heart failure hospitalizations (10.39%) recorded. There was a "J-shape" curve association between BMI and future adverse events. Being overweight (BMI = 25-29.9 kg/m²) was associated with significantly lower risk of future total CV events (HR: 084, 95% CI:0.72-0.98), MACEs (0.76, 95% CI:0.63-0.93), acute MIs (0.76, 95%CI:0.58-1.00), and CVAs (HR:0.61, 95%CI:0.39-0.95). 

Conclusion

A J-shape relationship exists between baseline BMI and future adverse events in CAD patients undergoing PCI, with the overweight (BMI = 25-29.9 kg/m²) group associated with the lowest risk of total CV events.

[Tough choice of surgical treatment for duodenal gastrointestinal stromal tumor: pancreaticoduodenectomy or local resection?]

The therapeutic choice of duodenal gastrointestinal stromal tumor (GIST) has always been the focus of surgeons because of its special anatomy location. So far, surgery is the preferable treatment for primary duodenal GIST, including pancreaticoduodenectomy (PD) and local resection (LR). Researches reveal that the prognosis of duodenal GIST is determined by the pathologic factors of the tumor itself, and is not significantly associated with the surgical procedure. The intervention with targeted drugs such as imatinib has given the duodenal GIST more opportunities for LR. Meanwhile, the technique development of the laparoscopy combined with endoscopic surgery and robotic surgery ensures the steps of minimally invasive treatment for duodenal GIST into a new era.

AccuMeter noninstrumented quantitative assay of high-density lipoprotein in whole blood

A novel noninstrumented technology (ChemTrak AccuMeter) for the quantitative measurement of analytes in biological fluids was reported at the 1990 Oak Ridge Conference (Clin Chem 1990;36:1591-7). This instrument-free technology has been adapted for the quantitative measurement of high-density lipoprotein (HDL). An in situ lipoprotein separation method has been developed and incorporated into the test for HDL determination. The sensitivity of the assay system has been adjusted so that HDL is measured over a clinically significant range of 250 to 1000 mg/L. This compares to a range of 1000 to 4000 mg/L for the total cholesterol in the earlier reported assay. Like the AccuMeter total cholesterol test, the Accumeter HDL test system is self-contained and consolidates blood separation, lipoprotein separation, and specimen measurement into a single step. The test procedure is simple, and the results are accurate.

Micro-autologous Fat Transplantation (MAFT) for Forehead Volumizing and Contouring

Background

Frontal fullness in Asians is often considered to indicate one’s public popularity and leadership skills. Numerous materials and techniques have been applied clinically to recontour or volumize the frontal area, with variable results. The micro-autologous fat transplantation (MAFT) technique proposed by Lin et al. (2nd academic congress of Taiwan Cosmetic Association Taipei, Taiwan) in 2007 has demonstrated its feasibility in facial rejuvenation. In the present study, we used an innovative instrument to apply the MAFT technique to frontal augmentation with fat grafting and reported the results.

Methods

MAFT was performed on 178 patients (167 female, 11 male) during a 5-year period starting in January 2010. Fat was harvested by liposuction, processed and refined by centrifugation at 1200×g for 3 min. The purified fat was micro-transplanted for frontal contouring with the assistance of an instrument, the MAFT-GUN. The patients were followed up regularly, and photographs were taken for comparison.

Results

On average, the MAFT procedure took 52 min to complete. The average amount of delivered fat was 10.2 mL. The follow-up period was 34 months on average. No complications, including neurovascular injury, skin necrosis, abscess, nodulation, calcification or irregularity, were noted. A patient-rated satisfaction 5-point Likert scale demonstrated that 83.1% of all patients had favorable results (48.3% were satisfied, and 34.8% were very satisfied).

Conclusion

The concept and technique of MAFT has changed fat grafting from an operation with unpredictable clinical results to an easy, reliable and consistent procedure. Furthermore, the use of a precisely controlled instrument enabled surgeons to perform highly accurate micro-fat grafting. In comparison with other strategies for volume restoration, the MAFT procedure demonstrated high patient satisfaction with the long-term results. Therefore, the use of MAFT as an alternative approach to forehead contouring and volumizing was addressed.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Electronic supplementary material

The online version of this article (doi:10.1007/s00266-017-0883-2) contains supplementary material, which is available to authorized users.

Epidemiology of Enterobius vermicularis infection among elementary school children in Hualien, Taiwan from 2007 to 2012

Enterobius vermicularis is the most common human intestinal parasite, and its control among school children is an important public health issue. The objective of this study was to document the present situation of E. vermicularis infection in school children in Hualien. The administrative divisions in Hualien county include 13 districts (3 in a mountainous area, 10 in a rural/urban area). Between 2007 and 2012, a total of 41,191 children in 13 districts in Hualien were examined using consecutive 2-day adhesive cellophane paper perianal swabs. Our results showed Enterobius egg-positive infection rates of 5.79% (452/7,089) in 2007, 6.25% (457/7,312) in 2008, 5.37% (385/7,173) in 2009, 4.98% (330/6,804) in 2010, 4.91% (301/6,133) in 2011, and 4.68% (279/5,960) in 2012. Compared to the previously reported national average in Taiwan (range, 1.53-2.23%), the prevalence of E. vermicularis in Hualien is relatively high. The infection rates were 7.55-29.10% in mountainous areas and 0.50- 12.43% in rural/urban areas. All first and fourth grade students in elementary schools in Hualien were selected as study participants. The average infection rate of the first grade students (6.71%) was higher than that of the fourth grade students (4.23%). These results indicate that enterobiasis remains an important parasitic disease among school children in Hualien, especially those in mountainous areas.

A solid-state cation exchange reaction to form multiple metal oxide heterostructure nanowires

Metal oxide nanostructures have been investigated extensively due to their wide range of physical properties; zinc oxide is one of the most promising materials. It exhibits fascinating functional properties and various types of morphologies. In particular, ZnO heterostructures have attracted great attention because their performance can be modified and further improved by the addition of other materials. In this study, we successfully transformed ZnO nanowires (NWs) into multiple ZnO/Al₂O₃ heterostructure NWs via a solid-state cation exchange reaction. The experiment was carried out in situ via an ultrahigh vacuum transmission electron microscope (UHV-TEM), which was equipped with a video recorder. Moreover, we analyzed the structure and composition of the heterostructure NWs by Cs-corrected STEM equipped with EDS. Based on these experimental results, we inferred a cation exchange reaction ion path model. Additionally, we investigated the defects that appeared after the cation reaction, which resulted from the remaining zinc ions. These multiple heterostructure ZnO/Al₂O₃ NWs exhibited excellent UV sensing sensitivity and efficiency.

Factors Affecting the Incidence of Angel Wing in White Roman Geese: Stocking Density and Genetic Selection

The present study investigated stocking density and genetic lines, factors that may alter the severity and incidence of angel wing (AW), in White Roman geese. Geese (n = 384) from two genetically selected lines (normal- winged line, NL, and angel-winged line, AL, respectively) and one commercial line (CL) were raised in four pens. Following common commercial practice, low-stocking-density (LD), medium-stocking-density, and high-stocking-density treatments were respectively administered to 24, 32, and 40 geese per pen at 0 to 3 weeks (1.92 m²/pen) and 4 to 6 weeks (13.2 m²/pen) of age and to 24, 30, and 36 geese at 7 to 14 weeks (20.0 m²/pen) of age. The results revealed that stocking density mainly affected body weight gain in geese younger than 4 weeks, and that geese subjected to LD had a high body weight at 2 weeks of age. However, the effect of stocking density on the severity score of AW (SSAW) and incidence of AW (IAW) did not differ significantly among the treatments. Differences were observed among the genetic stocks; that is, SSAW and IAW were significantly higher in AL than in NL and CL. Genetic selection generally aggravates AW, complicating its elimination. To effectively reduce IAW, stocking density, a suspected causal factor, should be lower than that presently applied commercially.

Right mini-parasternotomy may be a good minimally invasive alternative to full sternotomy for cardiac valve operations-a propensity-adjusted analysis

AIM

Limited realworld data existed for miniparasternotomy approach with good sample size in Asian cohorts and most previous studies were eclipsed by case heterogeneity. The goal of this study was to compare safety and quality outcomes of cardiac noncoronary valve operations by miniparasternotomy and full sternotomy approaches on riskadjusted basis.

METHODS

From our hospital database, we retrieved the cases of non-coronary valve operations from 1 January 2005 to 31 December 2012, including re-do, emergent, and combined procedures. Estimated EuroScore-II and propensity score for choosing mini-parasternotomy were adjusted for in the regression models on hospital mortality, complications (pneumonia, stroke, sepsis, etc.), and quality parameters (length of stay, ICU time, ventilator time, etc.). Non-complicated cases, defined as survival to discharge, ventilator use not over one week, and intensive care unit stay not over two weeks, were used for quality parameters.

RESULTS

There were 283 miniparasternotomy and 177 full sternotomy cases. EuroScore-II differed significantly (medians 2.1 vs. 4.7, p<0.001). Propensity scores for choosing miniparasternotomy were higher with lower EuroScore-II (OR=0.91 per 1%, p<0.001), aortic regurgitation (OR=2.3, p=0.005), and aortic non-mitral valve disease (OR=3.9, p<0.001). Adjusted for propensity score and EuroScore-II, mini-parasternotomy group had less pneumonia (OR=0.32, p=0.043), less sepsis (OR=0.31, p=0.045), and shorter non-complicated length of stay (coefficient=7.2 (day), p<0.001) than full sternotomy group, whereas Kaplan-Meier survival, non-complicated ICU time, non-complicated ventilator time, and 30-day mortality did not differ significantly.

CONCLUSION

The propensity-adjusted analysis demonstrated encouraging safety and quality outcomes for mini-parasternotomy valve operation in carefully selected patients.

Identification of a symbiotic fungus from blue-green alga and its extracellular polysaccharide

A previously unknown symbiotic fungus DT06 has been isolated from the single-celled blue-green alga Chroococcus sp. The sequences of ITS1, 5.8S rDNA and ITS2 regions of DT06 have a high similarity with that of Simplicillium (98%), which is closely related to Simplicillium lanosoniveum based on further phylogenetic analysis. However, DT06 produces unusual exocellular crystals with its conidium size twice that of S. lanosoniveum. Hence, DT06 is proposed to be a varietas of S. lanosoniveum and named as S. lanosoniveum var. Tianjinienss. Dong. (Type specimen was deposited at China General Microbiological Culture Collection Center, Number: CGMCC4460.). The striking character of DT06 is its massive production of a unique extracellular polysaccharide, which is composed of glucose and galactose and linked by 1-4 and 1-6 glycoside bonds according to UV, IR and NMR analysis. Therefore, DT06 may represent a new source of bioactive products, and also, its unusual symbiotic partnership with blue-green algae provides a model for investigating the interaction between photoautotrophic and heterotrophic micro-organisms in aquatic ecosystems.

SIGNIFICANCE AND IMPACT OF THE STUDY

A novel fungus (Simplicillium) symbiotic with a single-celled blue-green alga Chroococcus sp. and its major primary metabolite have been isolated and identified. These findings broaden the scope of symbiotic fungi and provide a unique extracellular polysaccharide with potential applications in food industry.

PTEN, tau-AP-3, thymidylate synthase immunohistochemistry scoring expression in patients with uterine leiomyomas, uterine smooth muscle tumors of uncertain malignancy potential and uterine leiomyosarcomas

Uterine smooth muscle tumors are frequently classified as benign and malignant. However, an assortment of mitotic counts and nuclear atypia can be indecisive between uncertain malignant potential, and malignant uterine smooth muscle tumors. We applied three immunohistochemical parameters to distinguish between cases of benign, malignant, and those with uncertain malignant histology.

Absolute lymphocyte count is a novel prognostic indicator in extranodal natural killer/T-cell lymphoma, nasal type

BACKGROUND

extranodal natural killer (NK)/T-cell lymphoma (ENKL) is a heterogeneous entity with poor survival, requiring risk stratification in affected patients. We proposed absolute lymphocyte count (ALC) as a new prognostic factor in ENKL.

PATIENTS AND METHODS

we retrospectively analyzed 128 patients newly diagnosed with ENKL. Independent prognostic factors of survival were determined by Cox regression analysis.

RESULTS

patients with low ALC (<1.0 × 10(9)/l) at diagnosis tended to have more adverse clinical features. Patients with high ALC (≥1.0 × 10(9)/l) at diagnosis had better overall survival (OS; P < 0.0001) and progression-free survival (PFS; P<0.0001), and achieved higher complete remission rates (P=0.001). Multivariate analysis with known prognostic factors showed that ALC, B symptoms and advanced stage were independent predictors for OS and PFS. Using the International Prognostic Index, Prognostic Index for Peripheral T-cell lymphoma unspecified, or Korean Prognostic Index for nasal NK/T-cell lymphoma, the majority of patients were in the low-risk category (with no or one adverse factor). ALC was helpful to differentiate the low-risk patients with different survival outcomes (P < 0.0001).

CONCLUSIONS

our data suggest that ALC at diagnosis is a novel, powerful predictor of prognosis in ENKL. Immune status at diagnosis might have an important influence on survival in patients with ENKL.

Redshift of edge emission from AlGaInP light-emitting diodes and correlation with electron-hole recombination lifetime

The edge emission from AlGaInP light-emitting diodes showed a red-shifted peak in addition to the peak of surface emission. This shift resulted from the quantum-well absorption of the guided wave. Although the shift degrades the color quality and the extraction efficiency of the device, it helps elucidate many important optical properties of the material and the dynamics of carrier recombination, including the electron-hole recombination lifetime, the optical joint density of state, the spontaneous emission spectrum and the absorption spectrum. A simple concept of the bimolecular recombination is established. The corresponding coefficient can be expressed by a simple formula and was therefore determined.

Expression profile of metastasis-related genes in invasive oral cancers

We used suppression subtractive hybridization (SSH) and oligonucleotide microarray to differentiate expression profiles of metastasis-related genes and to evaluate their clinical significance in patients with invasive oral cancer (OCa). Overexpression of the specific genes was confirmed by reverse transcription-PCR (RT-PCR). Cells expressing the gene were identified by immunohistochemistry in pathology specimens. Clinical correlation and significance were analyzed statistically. Using these methods, we detected increased expressions of MMP-1, -3, -7, -9, -10 and interleukin (IL)-8 in invasive OCa. Moreover, our data showed that overexpressions of MMP-1, -3, -7, -10 and IL-8 were associated with reduced survival.

Seroprevalence and risk factors for human papillomavirus in Taiwan

The aim of the study was to tailor a future Human papillomavirus (HPV) vaccine campaign and to help perform early primary prevention of HPV infection in Taiwan, where the incidence of cervical cancer is high. A cross-sectional survey was conducted of 826 female students, ages 10, 13, 16 and 19-22 years. A self-administered questionnaire was used to collect information on risk factors for HPV infection. Serum samples were tested for antibodies to HPV 16 capsids using a virus-like particle-based enzyme-linked immunosorbence assay. The age-adjusted odds ratio of HPV seropositivity was calculated for each risk factor by multiple logistic regression analysis. HPV 16 antibodies were detected in 13 (1.6%) of 826 participants. The HPV 16 seroprevalence was 0.35% (1/287), 0.85% (2/235), 3.2% (6/185) and 3.4% (4/119), respectively, for age groups of 10, 13, 16 and 19-22 years. In the multiple regression analysis, the history of having sexual activity was the most significant risk predictor for HPV 16 seropositivity. The seroprevalence of HPV 16 increased dramatically among high school seniors and university students, and was significantly associated with sexual activity. Vaccination against HPV is suggested to be undertaken in early adolescence, before 16 years of age and prior to sexual debut.

Enhancement of electrokinetic remediation of hyper-Cr(VI) contaminated clay by zero-valent iron

This paper investigated the effectiveness of incorporating zero-valent iron (ZVI) into electrokinetic (EK) to remediate hyper-Cr(VI) contaminated clay (2497 mg/kg). A ZVI wall was installed in the center of the soil specimen and was filled with 1:1 (w/w) ratio of granular ZVI and sand. Results show that transport of H(+) is greatly retarded by the strong opposite migration of anionic chromate ions, whereupon a revered electroosmosis flow (EO) was resulted and alkaline zone across the specimen was developed promoting the release of Cr(VI) from the clay. Chromium removal was characterized by high Cr(VI) concentration occurred in the anolyte and the presence of Cr(III) precipitates in the catholyte. The Cr(VI) reduction efficiencies for the process without ZVI wall were 68.1 and 79.2% for 1 and 2V/cm, respectively. As ZVI wall was installed, the corresponding reduction efficiencies increased to 85.8 and 92.5%. The costs for energy and ZVI utilized in this process are US$ 41.0 and 57.5 per cubic meter for the system with electric gradient of 1 and 2V/cm, respectively. The role of ZVI wall effectively reducing Cr(VI) contamination and the operation simultaneous collection of Cr(VI) from the electrode reservoirs are two major advantages of this process.

Strong luminescence from strain relaxed InGaN/GaN nanotips for highly efficient light emitters

Semiconductor heterostructures represent the most important building block for current optoelectronic devices. One of the common features of semiconductor heterostructures is the existence of internal strain due to lattice mismatch. The internal strain can tilt the band alignment and significantly alter the physical properties of semiconductor heterostructures, such as reducing the internal quantum efficiency of a light emitter. Here, we provide a convenient route to release the internal strain by patterning semiconductor heterostructures into nanotip arrays. The fabrication of the nanotip arrays was achieved by self-masked dry etching technique, which is simple, low cost and compatible with current semiconductor technologies. By implementing our approach to InGaN/GaN multiple quantum wells, we demonstrate that the light emission can be enhanced by up to 10 times. Our approach renders an excellent opportunity to manipulate the internal strain, and is very useful to create highly efficient solid state emitters.

Integron-associated imipenem resistance in Acinetobacter baumannii isolated from a regional hospital in Taiwan

We investigated the genetic properties of imipenem-resistant Acinetobacter baumannii collected from a regional hospital in Taiwan. Pulsed-field gel electrophoresis demonstrated that the isolates were genetically diverse. Polymerase chain reaction, DNA sequencing, and DNA-DNA hybridisation showed that the bla(IMP-1) gene resided as a cassette in a plasmid-borne class 1 integron in two isolates. The majority of the resistant isolates were plasmid-less and carried no bla(IMP), bla(VIM) or bla(CFI) genes, indicating that other uncharacterised metallo-beta-lactamases or mechanisms other than enzyme production are involved in carbapenem resistance in this group of A. baumannii. We conclude that multidrug resistance of A. baumannii was a combined effect of lateral gene transfer and clonal spread of multiple resistant clones. Strict measures should be implemented to control the further spread of resistance.

Scoring system for empyema thoracis and help in management

OBJECTIVE

To evaluate the implications of a newly defined severity scoring of empyema in children for the prediction of surgical management and to compare the length of hospitalization as an outcome measure of patients treated using medical therapy, salvage video-assisted thoracoscopic surgery (VATS) vs early elective VATS.

METHODS

A retrospective chart review of parapneumonic empyema of patients below 18 years of age admitted to a tertiary children's hospital in northern Taiwan from April 1993 to December 2002 was performed. Patients were categorized into a medical group who received antibiotic therapy, needle aspirations with/without tube thoracostomy; a salvage VATS group when the patients required surgery for the relief of persistent fever > 38 degrees C, chest pains or dyspneic respirations despite initial medical therapy; an early VATS group when the patients received elective surgery early after admission. The demographic data, clinical features, laboratory findings, and duration of hospitalization were compared using a severity score of empyema (SSE).

RESULTS

Streptococcus pneumoniae was the most common infecting organism, followed by Staphylococcus aureus, Pseudomonas aeruginosa. No organisms were recovered in 39% of patients. A pleural pH < 7.1 increases the odds of requiring surgical intervention by 6 times among this cohort. Children who required decortication of empyema had a higher severity score (mean 4.8 vs 3.0, p < 0.005). The duration of hospitalization for patients having early VATS showed a shortening stay (mean 18 vs 28 days) as compared to salvage VATS.

CONCLUSION

A pleural pH < 7.1 and a newly designed clinical severity score of empyema 4 are two predictors of surgical intervention for fibrinopurulent empyema in the present study. Early elective VATS may be adopted not later than 7 days after failure of appropriate antibiotic therapy and adequate drainage of empyema to decrease the length of stay and minimize morbidity.

Re-emergence of meningococcal disease in Taiwan: circulation of domestic clones of Neisseria meningitidis in the 2001 outbreak

The annual incidence of meningococcal disease (meningitis and septicaemia) in Taiwan was 0.94/10(5) population in 1953. It then declined to below 0.001 from 1980 to 1987, and re-emerged in 2000 with a rate of 0.07/10(5) population. In 2001 there was a further increase in incidence (43 cases, 0.19/10(5)). Of 43 isolates of Neisseria meningitidis available for this study, including 41 from patients treated in 2001, three (7.0%) were penicillin insensitive (MIC > or = 0.12 microg/ml), though all were beta-lactamase negative: 16 (37.2%) were resistant to trimethoprim-sulphamethoxazole (MIC > or = 4/76 microg/ml). Serogrouping and genotype analysis revealed nine domestic clones. None of the 43 patients had any relationship (travel or contact history) with the 2000 or 2001 Hajj pilgrimage. Epidemiological information and typing results suggested wide dissemination of a limited number of domestic clones of N. meningitidis, manifesting as serogroups W-135, B and Y. Two clones of serogroup W-135 involved in the outbreak were genetically distinct from the 2000 or 2001 Hajj-related W-135 clone.

Thresholdless, hysteresis-free, V-shaped, electro-optical switching for a ferroelectric liquid crystal cell

A ferroelectric liquid crystal (FLC) cell can be modeled as a combination of capacitors and resistors. In accordance with the properties of the FLC cell, external electric elements, such as capacitors and resistors, are usually connected to achieve a V-shaped performance at a driving inversion frequency fi. However, the inversion frequency is strongly dependent on the external electric elements and the applied voltage. In this paper, the relation between the inversion frequency and the applied voltage is discussed. Additionally, the inversion frequency is found to be approximately proportional to (ReqCeq)(-0.52), where Req and Ceq are equivalent resistance and capacitance, respectively. Based on the above properties, a useful driving scheme is proposed to achieve thresholdless, hysteresis-free, V-shaped characteristics for FLC cells at a driving frequency of 100 Hz. The driving scheme can be applied to fast-response FLC display.

Methicillin-resistant Staphylococcus aureus bacteraemia in neonatal intensive care units: an analysis of 90 episodes

AIM

To delineate the clinical features of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in infants hospitalized at the neonatal intensive care unit.

METHODS

Episodes of MRSA bacteraemia in Chang Gung Children's Hospital neonatal intensive care unit from 1997 to 1999 were reviewed for incidence, predisposing factors, clinical presentations, treatment and outcome.

RESULTS

Ninety episodes of MRSA bacteraemia were identified. The overall rate of MRSA bacteraemia was 1.05 per 1000 patient days during the 3-y period. Most of the patients were premature infants (76%), with prior operation or invasive procedures (39%), had an indwelling intravascular catheter (79%) and exposure to antibiotic therapy (96%). A localized cutaneous infection was found in 53.3% of the episodes. The most common clinical diagnoses were catheter-related infections (54.4%), skin and soft tissue infections (21.1%), bacteraemia without a focus (20%) and pneumonia (16.7%). Metastatic infection occurred in 18% of these infants. Among the patients treated with vancomycin for < or = 14 d, 88.7% did not develop any complications, and 11.3% developed a recurrence.

CONCLUSIONS

MRSA is an established pathogen in our NICU. MRSA bacteraemia in the neonates predominantly presented as catheter-related infections, and metastatic infections were not infrequently seen. In uncomplicated MRSA bacteraemia, treatment with vancomycin for < or = 14 d seems to be adequate.

Isolation of Salmonella enterica serotype choleraesuis resistant to ceftriaxone and ciprofloxacin

Salmonella enterica serotype choleraesuis (S choleraesuis) usually causes systemic infections in man that need antimicrobial treatment. We isolated a strain of S choleraesuis that was resistant to ceftriaxone and ciprofloxacin from a patient with sepsis. Ciprofloxacin resistance was associated with mutations in gyrA and parC, whereas the ampC gene (bla(CMY-2)), responsible for ceftriaxone resistance, was carried by a transposon-like mobile element. This element was found inserted into finQ of a potentially transmissible 140 kb plasmid, with an 8 bp direct repeat flanking the junction regions. The appearance of this resistant S choleraesuis is a serious threat to public health, and thus constant surveillance is warranted.

Comparative evaluation of the BACTEC MGIT 960 system with solid medium for isolation of mycobacteria

SETTING

The utilisation of new, rapid methods of diagnosis of tuberculosis is currently of great interest for tuberculosis control. This study was carried out in a teaching hospital in the eastern region of Taiwan.

OBJECTIVE

The BACTEC MGIT 960 system was evaluated and compared with Lowenstein-Jensen (LJ) medium and Middlebrook 7H11 plate for recovery rate and time to detection of mycobacteria.

DESIGN

A total of 1396 sputum samples were tested for the presence of mycobacteria. Specimens were processed and inoculated separately in the BACTEC MGIT 960 system, on LJ medium and 7H11 for comparative study.

RESULTS

The BACTEC MGIT 960 detected 235 isolates (100%), followed by LJ with 205 isolates (87.2%) and 7H11 with 178 isolates (75.7%). The mean time to detection of Mycobacterium tuberculosis complex was 11.6 days with MGIT 960, 20.1 days with LJ, and 18.7 days with 7H11. The contamination rates were 15.1% with MGIT 960, 10.1% with LJ and 9.7% with 7H11.

CONCLUSION

The BACTEC MGIT 960 system is a sensitive, rapid mycobacterial culturing system. However, the high contamination rate is a concern that should be carefully evaluated in the clinical setting.

Short-term ceftriaxone therapy for treatment of severe non-typhoidal Salmonella enterocolitis

AIM

To evaluate the clinical efficacy of a short-course ceftriaxone therapy in the treatment of paediatric patients with severe non-typhoidal Salmonella enterocolitis.

METHODS

During a 1 y period, all paediatric patients who were suspected having Salmonella enterocolitis by the presentation of bloody and/or mucoid diarrhoea with or without fever were eligible for the study. Patients with either negative stool cultures or bacteraemia were excluded. Severe enterocolitis was defined as a bloody and/or mucoid diarrhoea associated with high fever persisting for longer than 48 h and signs of moderate or severe dehydration. The patients with severe enterocolitis were assigned to treatment with ceftriaxone (50 mg kg(-1) d(-1)) for 3-5 d, while the rest were given supportive treatment only. Before treatment all study patients received blood testing for white blood cell (WBC) count, C-reactive protein (CRP) level and blood culture. The duration of the fevers was recorded. Patients were followed up after clinical recovery for the possibility of relapse.

RESULTS

Seventy-three patients with culture-confirmed Salmonella enterocolitis without bacteraemia were analysed. The duration of fever was longer in severe cases who were treated with ceftriaxone than those who were not. However, rapid defervescene was found after short-course ceftriaxone therapy in those patients with severe enterocolitis. CRP was significantly higher in severe cases. There was no significant difference in the WBC count between the two groups of patients. No relapse was found in these patients.

CONCLUSION

High CRP, prolonged high fever and signs of moderate or severe dehydration appear appropriate to define severe cases of Salmonella enterocolitis. Short-course ceftriaxone therapy is clinically beneficial to these patients. Neither clinical nor microbiological relapse was seen after therapy.

Different proinflammatory reactions in fatal and non-fatal enterovirus 71 infections: implications for early recognition and therapy

AIM

The mechanism of pulmonary oedema, a life-threatening manifestation of enterovirus 71 (EV71) encephalitis, is unclear. Our aim was to assess the relationship of proinflammatory cytokines to EV71-related pulmonary oedema.

METHODS

Proinflammatory responses in 33 EV71 patients with various complications and 21 normal healthy children were measured using an enzyme-linked immunosorbent assay.

RESULTS

EV71 patients with both encephalitis and pulmonary oedema were found to have much higher levels of blood interleukin-6 (IL-6) (947 +/- 1239 vs 4.9 +/- 3.1 pg/ml, p = 0.0003), tumour necrosis factor-alpha (TNF-alpha) (22.4 +/- 29.5 vs 5.3 +/- 1.0 pg/ml, p = 0.0035), interleukin Ibeta (IL-1beta) (48.4 +/- 85.2 vs 4.9 +/- 10.1 pg/ml, p = 0.01), white blood cell count (28.3 +/- 7.6 vs 15.5 +/- 6.8 10(9)/L, p > or = 0.0001) and blood glucose (501 +/- 186 vs 165 +/- 117 mg/dL, p = 0.0009) than patients with EV71 encephalitis alone. In fact, the cytokine levels in patients with encephalitis only or in those without complications were not significantly different from the levels found in normal children. The sensitivity, specificity, positive and negative predictive values of IL-6 > 70 pg/ml for EV71 encephalitis with pulmonary oedema were all 100%.

CONCLUSION

Patients with EV71-related encephalitis combined with pulmonary oedema were found to have significantly elevated levels of proinflammatory cytokines and the best predictor for this complicated condition was found to be the level of serum IL-6.

School-aged children with Kawasaki disease: high incidence of cervical lymphadenopathy and coronary artery involvement

OBJECTIVE

We describe 10 school-aged children with Kawasaki disease (KD) with a high incidence of cervical lymphadenopathy and coronary abnormality.

METHODS

Based on a database of 1002 children with KD in Chang Gung Children's Hospital from January 1983 to March 2001, 10 (1%) school-aged patients (five boys, five girls) who met the diagnostic criteria of KD were included for analysis.

RESULTS

Cervical lymphadenopathy was noted in all (100%) of these patients. Unilateral neck mass mimicking acute suppurative infections not responding to antibiotic therapy was the initial presentation in nine (90%) of the 10 patients. The mean interval between disease onset and diagnosis was 9.9 +/- 3.3 days (range, 6-15 days). Seven (70%) of these patients responded to one course of high-dose intravenous immunoglobulin (IVIG) therapy (2 g/kg) and oral aspirin (80-100 mg/kg per day), two (20%) required a second course of IVIG, and one (10%) responded to high-dose aspirin treatment only. Coronary artery abnormality (dilatation or aneurysm) was documented by echocardiography in seven (70%) patients (four boys, three girls). In six patients, the coronary artery abnormalities resolved in 1 year, while one patient had persistent right coronary artery aneurysm, which necessitated continued anticoagulant and low-dose aspirin therapy.

CONCLUSION

The incidence of school-aged children among patients with KD is about 1% in our hospital. These patients are notable for the high incidence of initial manifestations of unilateral neck mass and coronary artery involvement. This disease should be listed as the differential diagnosis in school-aged children presenting with fever and neck mass that do not respond to antibiotic therapy.

Clinical and radiographic spectrum of septic pulmonary embolism

AIMS

To review the clinical presentation, radiographic findings, and outcome of therapy in children with septic pulmonary embolism.

METHODS

Retrospective analysis of patients in a tertiary paediatric facility in northern Taiwan.

RESULTS

Ten children were identified with septic pulmonary emboli in a four year retrospective chart review between 1998 and 2001. Seven were immunocompetent, two were premature infants, one had beta thalassemia major. Seven had community acquired staphylococcal infections and bacteraemia, of which six were methicillin resistant Staphylococus aureus (MRSA) isolates. Five had soft tissue infections, two bone infections, one suppurative otitis media, one catheter related infection, and one unknown foci of infection. Multiple and bilateral nodular pulmonary parenchymal lesions were common on plain chest radiographs, but chest computed tomography scans showed the additional findings of a "vessel sign" and central cavitations, confirming the existence of septic pulmonary embolism.

CONCLUSIONS

Community acquired MRSA infections occurred in seven patients with septic pulmonary embolism but without predisposing high risk factors. Critically ill children with skin, soft tissue, or bone infections, when associated with septic pulmonary embolism in an area with a high rate of MRSA, should be empirically treated with glycopeptides (such as vancomycin or teicoplanin) before susceptibility results are known, in order to minimise morbidity and avoid mortality.

Deep neck infections in children

From December 1989 through 1998, a total of 68 children with deep neck infection were enrolled into this study. The mean age was 5.9 years (range, 1 month-15.8 years). Infections in the retropharyngeal space (36.7%) were most common, followed by parapharyngeal space (30.8%), peritonsillar space (20.6%), and submandibular space (11.9%). Fever, neck pain, and swelling were the most frequent symptoms. The most common pathogens were viridans streptococci (41%, 16/39) and Staphylococcus aureus (26%, 10/39). Other isolates included Prevotella spp., Veillonella spp., Klebsiella pneumoniae, Escherichia coli, Morganella spp., and Enterobacter spp. Mixed infection was found in 46% (18/39) of patients. The mean duration of hospitalization was 12.4 days (range, 2-45 days). Complete resolution was achieved in 61 (89.7%) children. Complications occurred in 7 patients, including recurrence, mediastinal spread, bacteremia, and suppurative thyroiditis; the patient with mediastinal spread plus bacteremia died. Five patients had congenital cyst and 4 of them had complications or recurrence/relapse. In conclusion, infections in the retropharyngeal space and polymicrobial infections were most common in deep neck infection of Taiwan children.

Detection of cytomegalovirus infection in a patient with febrile ulceronecrotic Mucha-Habermann's disease

BACKGROUND

Febrile ulceronecrotic Mucha-Habermann's disease (FUMHD) is a severe and very rare variant of pityriasis lichenoides et varilioformis acuta, which is characterized by large coalescing, and ulceronecrotic maculopapules or plaques. Morphological changes of the skin accompanied by persistent high fever and several constitutional symptoms have suggested virus infection in patients with FUMHD. However, the available information of viral origin is limited. In this study we investigated the relationship of cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 8 (HHV8), type I human T-cell lymphotropic virus (HTLV-I), and parvovirus B19 (PVB19) with FUMHD in a Taiwanese patient.

METHODS

The existence of CMV, EBV, HHV8, HTLV-I, and PVB19 was determined by polymerase chain reaction (PCR). The presence of CMV in the endothelial cells was characterized by in situ hybridization (ISH) and immunohistochemistry (IHC).

RESULTS

Serologic immunoglobulin to CMV and IHC identification of CMV late gene in the biopsy specimen indicated that the patient was infected with CMV. Detection of CMV was confirmed by PCR and ISH.

CONCLUSIONS

These results indicate that FUMHD is associated with dermal CMV manifestation. Nonetheless, the induction mechanism of FUMHD with CMV infection has yet to be determined.

Characteristics of group A streptococcal bacteremia with comparison between children and adults

This retrospective study aimed to compare the characteristics of group A streptococcal bacteremia in children and adults. A total of 76 (12 children and 64 adults) patients with group A streptococcal bacteremia treated from October 1995 through September 2000 at the Linko Chang Gung Memorial Hospital were included. The mean age was 47.6 years (range, 12 days-90 years). Forty-four (57.9%) patients had predisposing medical conditions. Malignant cancer (23.7%) and diabetes (22.4%) were the 2 most common conditions, which occurred only in adults. Two (16.7%) children had chickenpox associated with secondary group A streptococcal bacteremia. Skin and soft tissue infection (60.5%) was the most common clinical manifestation. The mortality rate related to group A streptococcal bacteremia was 25%. Twelve patients met the criteria of streptococcal toxic shock syndrome and 6 (50%) were children (p<0.05). Despite immediate and aggressive treatment, mortality due to streptococcal toxic shock syndrome was 66.7%. The incidence of streptococcal toxic shock syndrome was much higher in children (50%) than in adults (9.4%). Early diagnosis of invasive group A streptococcal infections and streptococcal toxic shock syndrome requires awareness of the presentations and a high level of suspicion. For fulminant group A streptococcal infection, a combination of a beta-lactam antibiotic plus clindamycin and/or adjuvant therapy with intravenous immunoglobulin is recommended.

Duration of enterovirus shedding in stool

Excretion of enterovirus (EV) may persist for months after an EV infection; the exact duration of excretion, however, is not yet known. Twelve children who were infected with EV between September 1998 and June 1999 were enrolled into this study. The patients included 4 boys and 8 girls, aged from 1 month to 5 years. Six patients were asked to join this virus isolation program, and the other 6 were followed-up regularly. Only 2 of the patients were infected with EV 71. To delineate the duration of EV shedding in each case, throat swabs for virus isolation were performed every 1 or 2 weeks for at least 1 month, and stools were analyzed for at least 2 months following the same schedule. After the infection, EV was identifiable in the throat in 4 patients for 1 to 2 weeks. Excretion of EV through stool was evidenced for up to 7 weeks in 6 patients, 8 weeks in 3, and 11 weeks in 1. In the 2 patients who failed to show up for follow-up visits from the 7th week, excretion of EV through stool was recorded for at least 7 weeks. Different serotypes of EV could be isolated from the same patient who was not experiencing febrile illness in 2 instances in a series of virus cultures. Coexistence of vaccine poliovirus and non-polio EV, both isolated from stool, was evidenced in 2 patients. Results from this study suggest that EV may not be identified from the throat 2 weeks after the infection, but its excretion through stool can persist for up to 11 weeks. This study also demonstrated that subclinical EV coinfection could occur, and that live vaccine poliovirus did not interfere with the invasion of other non-polio EV.

Direct transfer of Ku between DNA molecules with nonhomologous ends

The Ku protein is an essential protein for DNA double-strand-break repair by the pathway of nonhomologous DNA end-joining (NHEJ). A previous study showed that Ku bound to one DNA molecule could transfer directly to another DNA molecule without being released into the solution first. Direct transfer requires the two DNA molecules having homologous cohesive ends with a minimum of four complementary bases. Results of this study reveal that direct transfer activity of Ku is regulated by NaCl and MgCl2. Increasing either one of the two cations can decrease the required amount of the other. However, the DNA end-binding activity of Ku is not affected by changing the concentration of the cations, indicating that the two activities are regulated independently. Most importantly, the results also show that Ku can transfer directly from one DNA molecule to another one with nonhomologous ends under the condition of 200 mM NaCl and 5mM MgCl2. The ability of direct transfer between DNAs with nonhomologous ends suggests that Ku can align or juxtapose two DNA ends during NHEJ.

Amphetamine induces differential changes in the gene expression of metabotropic glutamate receptor 5 in cultured cortical and hippocampal neurons

Mechanisms underlying the short-term effects of amphetamine (AMPH) were examined by monitoring the expression of metabotropic glutamate receptor 5 (mGluR5) in cultured rat neurons. The cortical and hippocampal neurons were incubated with 0.1-100 microM of AMPH for 1 h or 1 microM of AMPH for 10 min to 3 h. Immunocytochemical and in situ hybridization (ISH) analyses revealed that the levels of mGluR5 immunoreactivity and mRNA in the cortical neurons were initially increased with the treatment time and dosage, to reach maximal elevations of 34 and 53% from control values following 1 h incubation of 1 microM, and then returned toward the controls. When the cortical neurons were preincubated with the antagonist, alpha-methyl-4-carboxyphenylglycine (MCPG) to mGluRs, before treated with 1 M of AMPH for 1 h, the levels of mGluR5 protein and mRNA became 120 and 116% of control values. In hippocampal neurons, the AMPH treatment persistently upregulated the mGluR5 protein by 50-62%; however, the mRNA responded with the bell-shaped pattern to the treatment times and doses, with 20-43% increases from controls. These modifications of the receptor were reversible, since removal of AMPH resulted in regular levels of the receptor. Notably, the AMPH-generated increases in mGluR5 protein and mRNA were completely blocked by the pretreatment with cycloheximide and actinomycin D, respectively. The data indicate differential responsive patterns of mGluR5 in the cortical and hippocampal neurons to the drug perturbation. The action of AMPH may involve regulation to transcriptional and translational events in the neurons, and the activation of the MCPG-sensitive receptors.

Childhood and adolescent tuberculosis in northern Taiwan: an institutional experience during 1994-1999

This study evaluated the clinical characteristics of childhood and adolescent tuberculosis (TB) at the end of the twentieth century in a referral children's hospital in northern Taiwan. The hospital charts were reviewed retrospectively of children/adolescents aged less than 18 y who were seen in a children's hospital in northern Taiwan between 1994 and 1999 and diagnosed with TB. A total of 62 individuals was diagnosed during this period. The patients' demographic data, presenting symptoms, clinical features, bacteriological results, drug susceptibility and tuberculin skin-test results were analysed. Most diagnosed cases lay in one of two main age ranges, younger than 5 y and adolescents. The presenting symptoms of study subjects were typically non-specific. Bone involvement occurred for 21 patients (33.9%) and was the most common extrapulmonary manifestation. Mycobacterium tuberculosis was isolated from 47 patients (75.8%). Five isolates were resistant to pyrazinamide, three to streptomycin and one to isoniazid, but no multidrug resistant isolates of TB were detected from culture-proven cases. Seventeen of 47 (36.2%) culture-proven patients revealed negative acid-fast staining initially but, subsequently, M. tuberculosis was isolated from various clinical specimens using a standard method at a later date. The tuberculin skin test was positive for 24 of 32 patients (75%) who received such an examination.

CONCLUSION

Extrathoracic TB was more common in children below 5 y of age than their adolescent counterparts, and chiefly involved the peripheral long bones. The potential drug resistance of M. tuberculosis in childhood and adolescent TB did not appear to have been a major problem in northern Taiwan before the year 2000.

Fluconazole therapy in neonatal candidemia

We reviewed 62 episodes (from 59 infants) of neonatal candidemia that occurred between January 1994 and June 1999. Except 5 term babies, all infants were premature (median gestational age [GA], 30 weeks) and birth weight was less than 2,500 g (median, 1,300 g). Most infants had reported risk factors and other neonatal problems. The age at onset of candidemia ranged from 15 to 173 days with a median of 34 days. In addition to catheter removal, all but one infants received antifungal agents and candidemia was eradicated subsequently in 46 episodes (75%). Eighteen infants with 19 episodes ever received fluconazole therapy. Fluconazole was administered as the first line agent in 6 episodes and successfully cleared candidemia in 5 episodes. Fluconazole was used as an alternative agent in an additional 13 episodes after amphotericin B (am B) +/- flucytosine were given for a period without a satisfactory result and eradication of candidemia was achieved in 8 episodes subsequently. All 18 infants tolerated fluconazole well and no withdrawal was required on account of its adverse effect. In contrast, am B alone was administered as the first line agent in 55 episodes and successfully cleared candidemia in 32 episodes (58%). This retrospective analysis suggests that fluconazole appears to be safe in neonates and can be used as an alternative agent in treating neonatal candidemia. A large-scaled prospective study may be needed.

Outer membrane protein change combined with co-existing TEM-1 and SHV-1 beta-lactamases lead to false identification of ESBL-producing Klebsiella pneumoniae

Nine isolates of Klebsiella pneumoniae, obtained from one colonized and eight bacteraemic patients on a paediatric ward, were shown to be identical by PFGE, indicating an outbreak. Screening for extended-spectrum beta-lactamase (ESBL) production using the double-disc synergy test, Etest for ESBLs and agar diffusion tests indicated ESBL production. The isolates showed reduced susceptibility to cefotaxime but not to other third-generation cephalosporins. Molecular studies revealed production of TEM-1 and SHV-1 but no ESBLs were identified. Deficiency in expression of an outer membrane protein (OmpK35) was also observed. These observations led us to postulate that the extremely low level of OmpK35 expression and the co-existence of TEM-1 and SHV-1 resulted in an increased MIC of cefotaxime and the false designation of the isolates as ESBL producers. All the infected infants were treated with either third-generation cephalosporins alone or multiple antibiotics including a third-generation cephalosporin, and recovered and were discharged without sequelae.

Delayed airway obstruction secondary to inadvertent arterial puncture during percutaneous central venous cannulation

We report a case of fatal respiratory complication secondary to central venous cannulation in a 63-year-old male patient, which came up gradually and insidiously following an accidental puncture of carotid artery in an attempt to cannulate the right internal jugular vein. He died 14 h after the mishap due to severe upper airway obstruction. The nature of the vascular laceration was still obscure.

Carriage of antibiotic-resistant pneumococci among Asian children: a multinational surveillance by the Asian Network for Surveillance of Resistant Pathogens (ANSORP)

To investigate the nasal carriage of antibiotic-resistant pneumococci by children, anterior nasal swabs were done for 4963 children <5 years old in 11 countries in Asia and the Middle East. In total, 1105 pneumococci isolates (carriage rate, 22.3%) were collected, 35.8% of which were found to be nonsusceptible to penicillin. Prevalence of penicillin nonsusceptibility was highest in Taiwan (91.3%), followed by Korea (85.8%), Sri Lanka (76.5%), and Vietnam (70.4%). Penicillin resistance was related to residence in urban areas, enrollment in day care, and a history of otitis media. The most common serogroups were 6 (21.5%), 23 (16.5%), and 19 (15.7%). The most common clone, as assessed by pulsed-field gel electrophoresis, was identical to the Spanish 23F clone and to strains of invasive isolates from adult patients. Data in this study documented the high rate of penicillin or multidrug resistance among isolates of pneumococci carried nasally in children in Asia and the Middle East and showed that this is due to the spread of a few predominant clones in the region.

Antifungal susceptibility testing and the correlation with clinical outcome in neonatal candidemia

The objective of this article is to assess the distribution of minimal inhibition concentrations (MIC) for candidal isolates from bloodstreams in neonates and to assess the correlation of clinical outcome with antifungal susceptibility testing. Of the 62 episodes of neonatal candidemia in a Children's Hospital between January 1994 and July 1998, 38 stocked isolates from 38 infants' bloodstreams were available and underwent antifungal susceptibility test according to National Committee for Clinical Laboratory Standards M27-A document. Correlation of clinical response with in vitro results was assessed in 37 patient-episode-isolate events. No less than 90% of these isolates tested were susceptible to amphotericin B, flucytosin, and fluconazole. The ranges of amphotericin B MICs and flucytosin MICs were narrow, ranging from 0.25 to 2 microg/mL, respectively. The range of fluconazole MICs was broad, ranging from 0.25 to >64 microg/mL. Successful therapy was achieved in 18 (62%) of 29 amphotericin B-treated patient-episode-susceptible isolate (MIC < or =1 microg/mL) events and 9 (64%) of 14 fluconazole-treated patient-episode-susceptible isolate events, respectively. Most isolates from the bloodstreams of neonates with candidemia were susceptible to antifungal agents tested but a low MIC of the antifungal agent did not predict successful therapy in this study. Correlating MICs with clinical outcome in neonatal candidemia requires complex evaluation of other factors.

A family cluster of streptococcal toxic shock syndrome in children: clinical implication and epidemiological investigation

BACKGROUND

Most invasive group A streptococcal (GAS) disease occurs sporadically. Reports of family clusters of these infections are scanty, and most invasive disease occurs in adults. We describe a family cluster of streptococcal toxic shock syndrome (STSS) involving 3 children and present the results of an epidemiologic investigation.

PATIENTS AND METHODS

During a 16-day period, 3 children in a family developed STSS with an interval of 7 and 9 days, respectively, between the onset of disease. Cases 2 and 3 had GAS isolated from blood culture. Case 2 was fatal. Pharyngeal culture survey of the family members and schoolchildren was conducted. Antibiogram, serotyping, detection of exotoxin genes, and random amplified polymorphic DNA patterns of the disease strains and survey strains were examined.

RESULTS

One of 15 family members sampled-the sister of the index case-and 7 (5.6%) of 125 schoolchildren sampled had GAS isolated from pharyngeal cultures. Of the 10 strains examined, 2 isolates from the patients, 1 from the sister of index case, and 2 from the classmates of case 2 (the fatal case) had an identical pattern of both genotype and phenotype.

CONCLUSION

We describe a family cluster of STSS involving 3 children caused by a single clone and provide additional data regarding invasive GAS infection subsequent to household contact. Additional studies should be conducted in conjunction with surveillance to define better the magnitude of risk in household contacts and to identify settings in which subsequent infections may occur.

Developmental regulation of transcription by a tissue-specific TAF homolog

Alternate forms of the general transcription machinery have been described in several tissues or cell types. However, the role of tissue-specific TBP-associated factors (TAF(II)s) and other tissue-specific transcription components in regulating differential gene expression during development was not clear. Here we show that the cannonball gene of Drosophila encodes a cell type-specific homolog of a more ubiquitously expressed component of the general transcription factor TFIID. cannonball is required in vivo for high level transcription of a set of stage- and tissue-specific target genes during male gametogenesis. Regulation of transcription by cannonball is absolutely required for spermatogenesis, as null mutations block meiotic cell cycle progression and result in a complete failure of spermatid differentiation. Our results demonstrate that cell type-specific TAF(II)s play an important role in developmental regulation of gene expression.

Kawasaki disease presenting as cervical lymphadenitis or deep neck infection

OBJECTIVE

To describe a group of patients with Kawasaki disease who had cervical lymphadenopathy as their dominant initial presentations.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 14 children who were admitted to Chang-Gung Children's Hospital between May 1996 and July 1998 with the initial impression of cervical lymphadenitis, cellulitis, and/or deep neck infection but for which a diagnosis of Kawasaki disease was established later.

RESULTS

Five (35.7%) patients were less than 5 months of age, and 8 (57.1%) patients were more than 53 months of age. The mean duration for establishing a diagnosis of Kawasaki disease from the onset of illness was 8.2 (6 to 20) days. Initially, empiric antibiotics were prescribed in each case with unsatisfactory response. Intravenous immune gamma globulin (2 g/kg) was administered in 13 patients. Three (21.4%) patients developed coronary artery lesions.

CONCLUSION

If a child less than 6 months or more than 4 years of age has a fever and an enlarged cervical lymph node and is unresponsive to empiric antibiotics, Kawasaki disease should be considered.

Overexpression of dihydrodiol dehydrogenase as a prognostic marker of non-small cell lung cancer

By using mRNA differential display to examine specimens of non-small cell lung cancer (NSCLC), we have identified overexpression of dihydrodiol dehydrogenase (DDH) that was not detected in the corresponding normal lung tissue. Normally DDH is associated with catalysis of polycyclic aromatic hydrocarbons (PAHs) in the liver; in NSCLC cells, DDH expression would implicate an association with disease progression. In this study we investigated the prognostic significance of DDH expression in patients with NSCLC. By using immunohistochemistry, we measured DDH expression in 381 patients with NSCLC. The relationship between DDH expression and clinicopathological parameters (age, gender, smoking history, mitotic index, histological type, stage, cell differentiation, and lymphovascular invasion) was analyzed by chi2 analysis. Survival curves were plotted with the method of Kaplan-Meier, and statistical difference of survivals between different groups was compared by a log-rank test. Our results showed that DDH overexpression could be detected in 317 (83.2%) of 381 pathological sections and in 77.9% (60 of 77) of metastatic lymph nodes. Expression of DDH was confirmed by immunoblotting. Compared with patients with DDH overexpression in tumors, patients with low DDH expression had significantly lower incidence of early tumor recurrence and distant organ metastasis (46.7 versus 29.7%; P = 0.045). Interestingly, survival was also significantly better in patients with low DDH expression than in those with DDH overexpression (P = 0.0017). Using univariate analysis, we correlated three important factors, DDH overexpression, tumor stages, and gender, with poor prognosis for NSCLC patients. Nevertheless, biological function and involvement of DDH in the disease progression of NSCLC require additional studies.

Altered cellular but not humoral reactions in children with complicated enterovirus 71 infections in Taiwan

Enterovirus 71 (EV 71) infections have high neurovirulence and fatality. Immune responses were assessed in 78 patients with EV 71 infection. EV 71 meningoencephalitis occurred more frequently in younger children and in boys. C-reactive protein levels were not elevated, although total leukocyte counts were increased in these patients. The CD40-ligand expression on T cells significantly decreased in children with meningoencephalitis (P=.041). Polymorphism of the cytotoxic T lymphocyte antigen-4 (CTLA-4) at position 49 of exon 1 showed a higher frequency of G/G genotype in patients with EV 71 meningoencephalitis than in those without meningoencephalitis (18/31 vs. 14/47; P=.045) and in control subjects (18/31 vs. 25/93l; P=.007). Specific EV 71 neutralizing antibody titers were detectable but did not differ in children with and without meningoencephalitis in the acute and convalescent stages. Results from this study suggest that younger children with a certain CTLA-4 polymorphism and altered cellular but not humoral response may be linked to EV 71 meningoencephalitis.