High-Q lasing via all-dielectric Bloch-surface-wave platform

Controlling the propagation and emission of light via Bloch surface waves (BSWs) has held promise in the field of on-chip nanophotonics. BSW-based optical devices are being widely investigated to develop on-chip integration systems. However, a coherent light source that is based on the stimulated emission of a BSW mode has yet to be developed. Here, we demonstrate lasers based on a guided BSW mode sustained by a gain-medium guiding structure microfabricated on the top of a BSW platform. A long-range propagation length of the BSW mode and a high-quality lasing emission of the BSW mode are achieved. The BSW lasers possess a lasing threshold of 6.7 μJ/mm2 and a very narrow linewidth reaching a full width at half maximum as small as 0.019 nm. Moreover, the proposed lasing scheme exhibits high sensitivity to environmental changes suggesting the applicability of the proposed BSW lasers in ultra-sensitive devices.

Exploring the Benefits of 3D-Printed Bolus in Cone Beam CT for Modified Radical Mastectomy Breast Cancer

PURPOSE/OBJECTIVE(S)

To improve the accuracy of superficial dose coverage for patients undergoing modified radical mastectomy (MRM), boluses are frequently applied to the skin surface of targeted region during radiotherapy. The irregular curvature of MRM breast cases results in discrepancies of dosimetry and poor contact. Additionally, the presence of an air gap causes unnecessary high-dose escalation and uncertainty in dose calculation, making the use of commercial flat bolus problematic. This study evaluated the effectiveness of 3D-printed bolus by comparing it to commercial bolus in setup variations and dosimetric compliance through daily cone-beam computed tomography (CBCT) scans.

MATERIALS/METHODS

Ten patients underwent MRM were divided into 2 groups. 5 patients treated with 0.5 cm commercial bolus as group A while the other 5 patients covered by 3D Bolus as group B. 3D bolus was made of polylactic acid filament (PLA) and contoured in advance with thickness of 0.5 cm on the surface of target. Positional errors were recorded through daily image guidance and compared with the images. Both groups had right-sided breast with neck lymph nodes involved and received 50 Gy in 25 fractions using 4 partial arcs of the volumetric modulated arc therapy (VMAT) technique. The CBCTs were recalculated through treatment planning system (TPS) to assess superficial dose coverage. A two-tailed student's t-test was applied.

RESULTS

Groups A and B pitch angles were -0.203 ± 0.837° and 0.334 ± 0.909° (p = 0.0003). Roll angle were 0.313 ± 0.728° and -0.633 ± 1.286° (p = 0.0000013). Yaw angle were -0.034 ± 0.872° and 0.018 ± 0.883° (p = 0.721). There was a trend of differences in the Z-axis and significant statistical differences in the pitch and roll angles due to aligning gel layers directly with group A's body surface, while 3D bolus rigidly adherence to group B's delineated curve. In the planned target volume (PTV), the CI and HI of group A were 0.9448±0.0208 and 1.2061±0.0448, respectively, while 0.9776±0.0144 and 1.1472±0.0206 (p<0.005) were for group B. As for the superficial region, which is defined from body surface to 0.5cm inside PTV, CI and HI of A were 0.8290±0.0599 and 1.4675±0.2434, while for B, they were 0.9753±0.0214 and 1.1330±0.0126, respectively (p<0.005).

CONCLUSION

The study analyzed the results through image comparison and investigated the CI and HI between two types of boluses. The 3D bolus reduces setup errors and improves dose coverage especially when superficial region is concerned. Better consistency of patient repositioning and dosimetry can be achieved and proved by daily assessment of CBCT scan. The customization of 3D bolus with integration of TPS and CT scans provides a solution to the inadequacies of commercial bolus. The results suggest that the use of 3D bolus is a promising development in radiation therapy for MRM breast cancer patients.

The Effectiveness of Music Interventions for Improving Anxiety Symptoms in Cancer Patients Undergoing Radiation Therapy

PURPOSE/OBJECTIVE(S)

Being alone in the treatment room during radiation therapy (RT) often causes anxiety which may lead to treatment failure. The benefit of music interventions in reducing anxiety among cancer patients during RT simulations is still controversial. The goal of this study is to evaluate the effect of music on anxiety symptoms among patients undergoing initial RT and a randomized trial was conducted.

MATERIALS/METHODS

Patients who received RT for the first time were enrolled and were randomly allocated into groups of experiment and control. The questionnaire of mood thermometer (BSRS-5), distress thermometer (DT), and the Beck Anxiety Inventory (BAI-C) and were given before and after RT. We also measured the changes in physiological symptoms for ten consecutive days since the first day of RT. The experimental group was given music during RT, while the control group was not. The generalized linear mixed model was used to estimate the pre-post difference of music interventions on the BSRS-5, DT, and BAI-C compared with control group after considering the random intercept and the unstructured residual variance-covariance matrix.

RESULTS

A total of 50 patients in the experimental group and 50 patients in the control group were enrolled in this study. The satisfaction degree of treatment in the experimental group was 100%, but it was 96% in control group (p = 0.0048). The pre-test BSRS-5 was 3.4±2.3 for the experimental group versus 2.6±2.3 for the control group (p = 0.0815), the post-test BSRS-5 score was significantly reduced in the experimental group (1.6±1.4 for experimental group versus 2.7±2.2 for the control group, p = 0.0057), the significant pre-post difference of BSRS-5 between group was found (p = 0.0024). When the experimental group withdrew from the music intervention, the BSRS-5 rebounded to 3.7±3.0. The pre-test DT was 4.3±1.5 and 3.4±1.7 in the experimental group and control group (p = 0.0051), and the post-test DT score was significantly reduced in the experimental group (2.7±1.2 for the experimental group and 3.5±1.3 for the control group, p = 0.0021), the significant pre-post difference of DT between group was found (p<.0001). When the experimental group withdrew from the music intervention, the DT rebounded to 3.7±1.4. The pre-test BAI-C was 6.7±11.7 and 7.8±8.5 in the experimental group and control group (p = 0.5878), and the post-test BAI-C score was significantly lower in the experimental group (1.7±3.7 for the experimental group and 7.4±8.0 for the control group, p<.0001), however, the pre-post difference of BAI-C between group was not significant (p = 0.0619). When the experimental group withdrew from the music intervention, the BAI-C rebounded to 6.5±8.7. There is a significantly increased systolic blood pressure in the control group compared with the patients had music intervention.

CONCLUSION

This study's results provide evidence that playing music routinely (music intervention) during RT can be an excellent way to relieve patients' anxiety and improve their comfort.

Stereotactic Radiosurgery for Small Intact Brain Metastasis: A Comparative Evaluation of 3 Different Single Fraction Prescription Doses

PURPOSE/OBJECTIVE(S)

While single-fraction stereotactic radiosurgery (SRS) in the treatment of small brain metastases (SBM, ≤ 2 cm) is well established, prescription dosing varies considerably across institutions and clinical trials. The choice of prescription dose is a delicate balance between local failure (LF) and radiation necrosis (RN) risks. In the modern era, historically-established dosing thresholds may no longer be applicable. To evaluate the impact of prescription dose on outcomes, we performed a comparative analysis of patients with SBM treated with definitive SRS using three different prescriptions, at a single tertiary institution.

MATERIALS/METHODS

Consecutive patients with intact SBM treated with SRS from January 2017 and December 2021 were analyzed. Baseline patient characteristics and dosing parameters were abstracted from the medical record. To limit the integral brain dose when treating multiple brain metastases, the institutional practice was to reduce prescription dose as the total number of lesions increased (i.e., 24 Gy for ≤10 lesions, 22 Gy for 11-20, and 20 Gy for >20). A per lesion analysis, where each lesion was followed from the date of SRS to the last follow-up, was conducted with primary endpoints of LF and RN. Gray's test was used to compare the cumulative incidence of the LF and RN, with death as a competing risk. Factors affecting LF were analyzed using Cox hazard regression analysis.

RESULTS

A total of 1318 SBM in 250 patients received SRS and met the inclusion criteria. The median age was 62 years (range: 18-90), median KPS was 90 (range: 50-100) and 66% were female. The most common primary tumors were lung (55.5%) and breast cancers (26.4%). With a median follow-up of 12 months, 136 (11%) LF in 44 patients and 70 (5.7%) RN events in 46 patients occurred. The actuarial 1-year cumulative rate of LF was lower in lesions treated with 24 Gy (6.4%, 95% CI: 4.7-8.6%) or 22 Gy (5.8%, 95% CI: 3.7-8.7%) compared to 20 Gy (15.4%, 95% CI: 10.9-20.5%) (p<0.01). 22 Gy and 24 Gy prescription doses were associated with a 44% and 52% reduction in risk in LF compared to 20 Gy (HR: 0.56; 95% CI: 0.36-0.9; p = 0.01 and HR: 0.48; 95% CI: 0.31-0.74; p<0.01, respectively). In a subset analysis of radiosensitive tumors, 1-year LF rate was still lower with 24 Gy (7.4%, 95% CI: 5.3-9.9%) and 22 Gy (6.1%, 95% CI: 3.7-9.4%) than 20 Gy (15.7%, 95% CI: 11.2-21%) (p = 0.01). The cumulative 1-year RN rate numerically declined with dose, but was not statistically significantly different, with 3.6% (95% CI: 2.3-5.3%) for 24 Gy, 2.6% (95% CI: 1.3-4.8%) for 22 Gy and 1.4% (95% CI: 0.4-3.7%) for 20 Gy.

CONCLUSION

Patients treated with single fraction SRS to intact SBM were at increased risk of LF with prescription doses of 20 Gy compared to 22-24 Gy, without an increased risk of RN. Even in patients with radiosensitive histologies, higher LF rates were still observed following 20 Gy compared to 22-24 Gy.

Src Kinase Activates Signal Transducer and Activator of Transcription 3 to Enhance Radioresistance in Triple Negative Breast Cancer Cells

PURPOSE/OBJECTIVE(S)

Triple-negative breast cancer (TNBC) is known to be insensitive to radiation therapy, and it requires to development radiosensitizer for TNBC.

MATERIALS/METHODS

We previously established a radioresistant sub-line from MDA-MB-231 cells, called 231-RR, and have demonstrated that 231-RR cells displayed high cancer stem cell (CSC) activity. And 231-RR cells were treated with dasatinib, a Src inhibitor.

RESULTS

In the present study, we discovered that the activation of Src kinase was increased in 231-RR cells. Treatment of dasatinib, an Src inhibitor, sensitized 231-RR cells to radiotherapy, along with the increased p-γH2Axser139, indicated the enhancement of DNA damage. Dasatinib also caused the downregulation of cancer stemness factors, including c-Myc, OCT4, and the Notch intracellular domain, as well as the decrease of phosphorylation of Signal Transducer and Activator of Transcription 3 (STAT3). The treatment of C188-9, a STAT3 inhibitor, also sensitized 231-RR cells toward radiotherapy along with the increased p-γH2Axser139, but without changing the phosphorylation of Src, indicating that STAT3 is a downstream event of Src activation.

CONCLUSION

In conclusion, our data suggests that the inhibitors of Src or STAT3 could function as radiosensitizers or CSC targeting agents for TNBC radiotherapy.

Angular Control of Circularly Polarized Emission from Achiral Molecules via Magnetic Dipoles Sustained in a Chiral Metamirror

Circularly polarized emission (CPE) plays an important role in the designs of advanced displays and photonic integrated circuits. Unfortunately, the control of CPE handedness is limited by the chiral metasurfaces employed to emit chiral light. Particularly, the switching of the handedness with chiral metasurfaces relies on flipping the metasurfaces, which adds some constraints to practical applications. Herein, we propose an angle-sensitive chiral metamirror with Mie resonators to realize handedness switching. The Mie resonator supports a magnetic dipole having large field enhancement. This chiral metamirror is applied to excite CPEs with opposite handedness at emission angles within 10°. In contrast to the conventional methods, this work proposes a more efficient approach to manipulate the handedness of CPE.

Ligand Engineering and Recrystallization of Perovskite Quantum-Dot Thin Film for Low-Threshold Plasmonic Lattice Laser

Solution-process perovskite quantum dots (QDs) are promising materials to be utilized in photovoltaics and photonics with their superior optical properties. Advancements in top-down nanofabrication for perovskite are thus important for practical photonic and plasmonic devices. However, different from the chemically synthesized nano/micro-structures that show high quality and low surface roughness, the perovskite QD thin film prepared by spin-coating or the drop-casting process shows a large roughness and inhomogeneity. Low-roughness and low-optical loss perovskite QD thin film is highly desired for photonic and optoelectronic devices. Here, this work presents a pressure-assisted ligand engineering/recrystallization process for high-quality and well-thickness controlled CsPbBr₃ QD film and demonstrates a low-threshold and single-mode plasmonic lattice laser. A recrystallization process is proposed to prepare the QD film with a low roughness (RMS = 1.3 nm) and small thickness (100 nm). Due to the low scattering loss and strong interaction between gain media and plasmonic nanoparticles, a low lasing threshold of 16.9 µJ cm^-2 is achieved. It is believed that this work is not only important to the plasmonic laser field but also provides a promising and general nanofabrication method of solution-processed QDs for various photonic and plasmonic devices.

Integration of on-chip perovskite nanocrystal laser and long-range surface plasmon polariton waveguide with etching-free process

Perovskite materials prepared in the form of solution-processed nanocrystals and used in top-down fabrication techniques are very attractive to develop low-cost and high-quality integrated optoelectronic circuits. Particularly, integrated miniaturized coherent light sources that can be connected to light-guiding structures on a chip are highly desired. To control light propagating on a small footprint with low-loss optical modes, long-range surface plasmon polariton (LRSPP) waveguides are employed. Herein, we demonstrate an on-chip fabricated photonic-plasmonic hybrid system consisting of a perovskite lasing structure coupled to an LRSPP waveguide achieving a low lasing threshold and a propagation length over 100 μm. Preventing perovskite material degradation and the formation of surface roughness of the laser cavity during fabrication is made possible by designing a fabrication technique without any etching step.

Host Genetic Associations with Salivary Microbiome in Oral Cancer

Despite the growing recognition of a host genetic effect on shaping gut microbiota composition, the genetic determinants of oral microbiota remain largely unexplored, especially in the context of oral diseases. Here, we performed a microbiome genome-wide association study in 2 independent cohorts of patients with oral squamous cell carcinoma (OSCC, n = 144 and 67) and an additional group of noncancer individuals (n = 104). Besides oral bacterial dysbiosis and signatures observed in OSCC, associations of 3 loci with the abundance of genus-level taxa and 4 loci with β diversity measures were detected (q < 0.05) at the discovery stage. The most significant hit (rs10906082 with the genus Lachnoanaerobaculum, P = 3.55 × 10^-9 at discovery stage) was replicated in a second OSCC cohort. Moreover, the other 2 taxonomical associations, rs10973953 with the genus Kingella (P = 1.38 × 10^-9) and rs4721629 with the genus Parvimonas (P = 3.53 × 10^-8), were suggestive in the meta-analysis combining 2 OSCC cohorts. Further pathway analysis revealed that these loci were enriched for genes in regulation of oncogenic and angiogenic responses, implicating a genetic anchor to the oral microbiome in estimation of casual relationships with OSCC. Our findings delineate the role of host genotypes in influencing the structure of oral microbial communities.

Lithographic in-mold patterning for CsPbBr3 nanocrystals distributed Bragg reflector single-mode laser

Extensive studies on lead halide perovskites have shown that these materials are excellent candidates as gain mediums. Recently, many efforts have been made to incorporate perovskite lasers in integrated optical circuits. Possible solutions would be to utilize standard lithography with an etching/lift-off process or a direct laser etching technique. However, due to the fragile nature of the lead halide perovskites which gives rise to significant material deterioration during the lithography and etching processes, realizing a small-size, low-roughness, and single-mode laser remains a challenge. Here, a lithographic in-mold patterning method realized by nanocrystal concentration control and a multi-step filling-drying process is proposed to demonstrate CsPbBr₃ nanocrystals distributed-Bragg-reflector (DBR) waveguide lasers. This method realizes the patterning of the CsPbBr₃ nanocrystal laser cavity and DBR grating without lift-off and etching processes, and the smallest fabricated structures are obtained in a few hundred nanometers. The single-mode lasing is demonstrated at room temperature with a threshold of 23.5 μJ cm^-2. The smallest full width at half maximum FWHM of the laser output is 0.4 nm. Due to the fabrication process and the DBR laser geometry, the lasers can be fabricated in a compact array, which is important for incorporating perovskite-based lasers in complex optoelectronic circuits.

Using the Goldilocks Principle to model coral ecosystem engineering

The occurrence and proliferation of reef-forming corals is of vast importance in terms of the biodiversity they support and the ecosystem services they provide. The complex three-dimensional structures engineered by corals are comprised of both live and dead coral, and the function, growth and stability of these systems will depend on the ratio of both. To model how the ratio of live : dead coral may change, the ‘Goldilocks Principle’ can be used, where organisms will only flourish if conditions are ‘just right’. With data from particle imaging velocimetry and numerical smooth particle hydrodynamic modelling with two simple rules, we demonstrate how this principle can be applied to a model reef system, and how corals are effectively optimizing their own local flow requirements through habitat engineering. Building on advances here, these approaches can be used in conjunction with numerical modelling to investigate the growth and mortality of biodiversity supporting framework in present-day and future coral reef structures.

Diverse Substrate-Mediated Local Electric Field Enhancement of Metal Nanoparticles for Nanogap-Enhanced Raman Scattering

The localized surface plasmon resonance of plasmonic nanoparticles (NPs) can be coupled with a noble metal substrate (S) to induce a localized augmented electric field (E-field) concentrated at the NP-S gap. Herein, we analyzed the fundamental near-field properties of metal NPs on diverse substrates numerically (using the 3D finite-difference time-domain method) and experimentally [using surface-enhanced Raman scattering (SERS)]. We systematically examined the effects of plasmonic NPs on noble metals (Ag and Au), non-noble metals (Al, Ti, Cu, Fe, and Ni), semiconductors (Si and Ge), and dielectrics (TiO₂, ZnO, and SiO₂) as substrates. For the AgNPs, the Al (11,664 times) and Si (3969 times) substrates produced considerable E-field enhancements, with Al in particular generating a tremendous E-field enhancement comparable in intensity to that induced by a Ag (28,224 times) substrate. Notably, we found that a superior metallic character of the substrate gave rise to easier induction of image charges within the metal substrate, resulting in a greater E-field at the NP-S gap; on the other hand, the larger the permittivity of the nonmetal substrate, the greater the ability of the substrate to store an image charge distribution, resulting in stronger coupling to the charges of localized surface plasmon resonance oscillation on the metal NP. Furthermore, we measured the SERS spectra of rhodamine 6G (a commonly used Raman spectral probe), histamine (a biogenic amine used as a food freshness indicator), creatinine (a kidney health indicator), and tert-butylbenzene [an extreme ultraviolet (EUV) lithography contaminant] on AgNP-immobilized Al and Si substrates to demonstrate the wide range of potential applications. Finally, the NP-S gap hotspots appear to be widely applicable as an ultrasensitive SERS platform (∼single-molecule level), especially when used as a powerful analytical tool for the detection of residual contaminants on versatile substrates.

Tipping the immunostimulatory and inhibitory DAMP balance to harness immunogenic cell death

Induction of tumor cell death is the therapeutic goal for most anticancer drugs. Yet, a mode of drug-induced cell death, known as immunogenic cell death (ICD), can propagate antitumoral immunity to augment therapeutic efficacy. Currently, the molecular hallmark of ICD features the release of damage-associated molecular patterns (DAMPs) by dying cancer cells. Here, we show that gemcitabine, a standard chemotherapy for various solid tumors, triggers hallmark immunostimualtory DAMP release (e.g., calreticulin, HSP70, and HMGB1); however, is unable to induce ICD. Mechanistic studies reveal gemcitabine concurrently triggers prostaglandin E2 release as an inhibitory DAMP to counterpoise the adjuvanticity of immunostimulatory DAMPs. Pharmacological blockade of prostaglandin E2 biosythesis favors CD103+ dendritic cell activation that primes a Tc1-polarized CD8+ T cell response to bolster tumor rejection. Herein, we postulate that an intricate balance between immunostimulatory and inhibitory DAMPs could determine the outcome of drug-induced ICD and pose COX-2/prostaglandin E2 blockade as a strategy to harness ICD.

Patterns of COVID-19 on computed tomography imaging

PURPOSE

As the designated tertiary referral centre for infectious diseases in Hong Kong, our hospital received the city's first group of patients diagnosed with coronavirus disease 2019 (COVID-19). Herein, we studied the earliest patients admitted to our centre in order to clarify the typical radiological findings, particularly computed tomography (CT) findings, associated with COVID-19.

METHODS

From 22 January 2020 to 29 February 2020, 19 patients with confirmed COVID-19 underwent high-resolution or conventional CT scans of the thorax in our centre. The CT imaging findings of these patients with confirmed COVID-19 in Hong Kong were reviewed in this study.

RESULTS

Ground-glass opacities (GGO) with peripheral subpleural distribution were found in all patients (100%). No specific zonal predominance was observed. All lobes were involved in 16 (84.2%) patients, focal subsegmental consolidations were observed in 14 (73.7%) patients, and interlobular septal thickening was present in 12 (63.2%) patients. No mediastinal lymph node enlargement, centrilobular nodule, or pleural effusion was detected in any of the patients. Other imaging features present in several patients include bronchial dilatation, bronchial wall thickening, and crazy-paving patterns.

CONCLUSIONS

Peripheral subpleural GGO without zonal predominance in the absence of centrilobular nodule, pleural effusion, and lymph node enlargement were consistent findings in patients with confirmed COVID-19. The observed radiological patterns on CT scans can help identify COVID-19 and assess affected patients in the context of the ongoing outbreak.

Poly(acrylamide-co-acrylic acid) gel polymer electrolyte incorporating with water-soluble sodium sulfide salt for quasi-solid-state quantum dot-sensitized solar cell

Rapid decay of photoanode, leakage from sealant, and evaporation of electrolyte are always the major concerns of quantum dot-sensitized solar cells (QDSCs) based on liquid electrolyte. Subsequently, gel polymer electrolyte (GPE) appears as an attractive solution in addition to lower cost, lighter weight, and flexibility. Poly(acrylamide- co-acrylic acid) (PAAm-PAA) is of special interest to act as a polymer host to entrap liquid electrolyte because it provides high transparency, good gelatinizing properties, and excellent compatibility with the liquid electrolyte. In this work, the electrical and transport properties of PAAm-PAA GPE incorporating with water-soluble sodium sulfide were characterized by impedance spectroscopy. An increment of ionic conductivity was observed with the incorporation of ethylene carbonate (EC) and potassium chloride (KCl). The highest room temperature ionic conductivity of PAAm-PAA GPE is 70.82 mS·cm−1. QDSC based on PAAm-PAA GPE with the composition of 1.3 wt% of KCl, 0.9 wt% of EC, 55.3 wt% of PAAm-PAA, 38.5 wt% of sodium sulfide, and 4.0 wt% of sulfur can present up to 1.80% of light-to-electricity conversion efficiency.

Fuel-Composition Dependent Reactor Antineutrino Yield at RENO

We report a fuel-dependent reactor electron antineutrino (ν[over ¯]_{e}) yield using six 2.8 GW_{th} reactors in the Hanbit nuclear power plant complex, Yonggwang, Korea. The analysis uses 850 666 ν[over ¯]_{e} candidate events with a background fraction of 2.0% acquired through inverse beta decay (IBD) interactions in the near detector for 1807.9 live days from August 2011 to February 2018. Based on multiple fuel cycles, we observe a fuel ^{235}U dependent variation of measured IBD yields with a slope of (1.51±0.23)×10^{-43}  cm^{2}/fission and measure a total average IBD yield of (5.84±0.13)×10^{-43}  cm^{2}/fission. The hypothesis of no fuel-dependent IBD yield is ruled out at 6.6σ. The observed IBD yield variation over ^{235}U isotope fraction does not show significant deviation from the Huber-Mueller (HM) prediction at 1.3 σ. The measured fuel-dependent variation determines IBD yields of (6.15±0.19)×10^{-43} and (4.18±0.26)×10^{-43}  cm^{2}/fission for two dominant fuel isotopes ^{235}U and ^{239}Pu, respectively. The measured IBD yield per ^{235}U fission shows the largest deficit relative to the HM prediction. Reevaluation of the ^{235}U IBD yield per fission may mostly solve the reactor antineutrino anomaly (RAA) while ^{239}Pu is not completely ruled out as a possible contributor to the anomaly. We also report a 2.9 σ correlation between the fractional change of the 5 MeV excess and the reactor fuel isotope fraction of ^{235}U.

Measurement of Reactor Antineutrino Oscillation Amplitude and Frequency at RENO

The RENO experiment reports more precisely measured values of θ_{13} and |Δm_{ee}^{2}| using ∼2200 live days of data. The amplitude and frequency of reactor electron antineutrino (ν[over ¯]_{e}) oscillation are measured by comparing the prompt signal spectra obtained from two identical near and far detectors. In the period between August 2011 and February 2018, the far (near) detector observed 103 212 (850 666) ν[over ¯]_{e} candidate events with a background fraction of 4.8% (2.0%). A clear energy and baseline dependent disappearance of reactor ν[over ¯]_{e} is observed in the deficit of the measured number of ν[over ¯]_{e}. Based on the measured far-to-near ratio of prompt spectra, we obtain sin^{2}2θ_{13}=0.0896±0.0048(stat)±0.0047(syst) and |Δm_{ee}^{2}|=[2.68±0.12(stat)±0.07(syst)]×10^{-3}  eV^{2}.

Manipulating the distribution of electric field intensity to effectively enhance the spatial and spectral fluorescence intensity of fluorescent nanodiamonds

Fluorescent nanodiamonds (FNDs) having nitrogen-vacancy (NV) centers have drawn much attention for their biocompatibility and stable optical properties. Nevertheless, the NV centers are located in the interior of the FNDs, and it has not been possible to increase the fluorescence intensity of FNDs efficiently using previously developed enhancement methods. In this paper, we present a simple nanocavity structure that enhances the fluorescence intensity of FNDs. The designed Al/SiO2 nanocavities are stable and inexpensive, and provide a large region for efficient enhancement of fluorescence that can cover most 100 nm FNDs. By tuning the thickness of the capping SiO2 layer of the Al/SiO2 nanocavities, the distributions of both the spatial and spectral electric field intensities of the FNDs could be controlled and manipulated. In general, the FNDs were excited using a green-yellow laser; the broadband fluorescence of the FNDs comprised the emissions from neutral (NV0) and negatively charged (NV-) NV centers. To enhance the fluorescence intensity from the NV- centers of the FNDs, we designed an Al/70 nm SiO2 nanocavity to function at excitation and emission wavelengths of 633 and 710 nm, respectively, allowing the NV- centers to be excited efficiently; as a result, we achieved an enhancement in fluorescence intensity of 11.2-fold. Moreover, even when we covered 100 nm FNDs with polyglycerol (forming p-FND), the fluorescence intensities of the p-FND particles placed on the nanocavities remained greatly enhanced.

Life-Threatening Bleeding from the Pubic Branch of the Inferior Epigastric Artery after Pubic Ramus Fracture

Isolated pubic ramus fracture with concurrent life-threatening bleeding caused by injury to the inferior epigastric artery (IEA) or its branches has rarely been reported and can frequently be overlooked. This paper reports two cases of isolated pubic ramus fracture with concomitant injury to the pubic branch of the IEA, causing serious bleeding and hemodynamic instability. Pelvic angiography showed leakage of contrast from the pubic branch of the IEA. The complication in both cases was successfully treated with transcatheter arterial embolisation.

Kernohan-Woltman Notch Phenomenon Caused by Acute Traumatic Subdural Haematoma

A 27-year-old man suffered from right hemiparesis after a closed head injury. Computed tomography (CT) revealed a right hemisphere subdural haematoma with midline structure shifted to the left. The CT finding was believed to be mislabeled because the site of haematoma did not correlate with an ipsilateral hemiparesis. Magnetic resonance imaging revealed a right transtentorial uncal herniation and a small lesion within left cerebral peduncle, suggesting Kernohan-Woltman notch phenomenon (KWNP). KWNP has been rarely seen in patients with acute traumatic subdural haemorrhage. Anatomical small maximum tentorial notch width is the possible anatomical factor predisposing our patient to this phenomenon. (Hong Kong j.emerg.med. 2014;21:116-119)

Enhancing Raman signals through electromagnetic hot zones induced by magnetic dipole resonance of metal-free nanoparticles

In this study, we found that the large area of electromagnetic field hot zone induced through magnetic dipole resonance of metal-free structures can greatly enhance Raman scattering signals. The magnetic resonant nanocavities, based on high-refractive-index silicon nanoparticles (SiNPs), were designed to resonate at the wavelength of the excitation laser of the Raman system. The well-dispersed SiNPs that were not closely packed displayed significant magnetic dipole resonance and gave a Raman enhancement per unit volume of 59 347. The hot zones of intense electric field were generated not only within the nonmetallic NPs but also around them, even within the underlying substrate. We observed experimentally that gallium nitride (GaN) and silicon carbide (SiC) surfaces presenting very few SiNPs (coverage: <0.3%) could display significantly enhanced (>50%) Raman signals. In contrast, the Raman signals of the underlying substrates were not enhanced by gold nanoparticles (AuNPs), even though these NPs displayed a localized surface plasmon resonance (LSPR) phenomenon. A comparison of the areas of the electric field hot zones (E ² > 10) generated by SiNPs undergoing magnetic dipole resonance with the electric field hot spots (E ² > 10) generated by AuNPs undergoing LSPR revealed that the former was approximately 70 times that of the latter. More noteworthily, the electromagnetic field hot zone generated from the SiNP is able to extend into the surrounding and underlying media. Relative to metallic NPs undergoing LSPR, these nonmetallic NPs displaying magnetic dipole resonance were more effective at enhancing the Raman scattering signals from analytes that were underlying, or even far away from, them. This application of magnetic dipole resonance in metal-free structures appears to have great potential for use in developing next-generation techniques for Raman enhancement.

Do laryngoscopic findings reflect the characteristics of reflux in patients with laryngopharyngeal reflux?

OBJECTIVE

To analyse the association between 24-hour multichannel intraluminal impedance-pH (24-h MII-pH) parameters and each item of the reflux finding score (RFS) to determine whether the laryngoscopic findings of the RFS could reflect the characteristics of reflux in patients with laryngopharyngeal reflux (LPR).

STUDY DESIGN

Prospective cohort study.

SETTINGS

Tertiary care referral medical centre.

PARTICIPANTS

Patients complaining of LPR symptoms were evaluated via a 24-hour MII-pH. Among them, 99 patients whose LPR was confirmed via 24-hour MII-pH were enrolled in this study.

MAIN OUTCOME MEASURES

Correlations between RFS ratings and 24-hour MII-pH parameters were evaluated and compared between patients with or without each laryngoscopic finding used in the RFS.

RESULTS

Subglottic oedema had a statistically significant positive correlation with number of non-acid LPR and non-acid full column reflux events. Ventricular obliteration and posterior commissure hypertrophy showed a significant correlation with non-acid exposure time and total reflux exposure time. We also found a significant correlation between granuloma/granulation score and number of acid LPR events. The numbers of non-acid LPR and full column reflux events in patients with subglottic oedema were significantly higher than those without subglottic oedema.

CONCLUSION

Among the laryngoscopic findings used in the RFS, subglottic oedema is specific for non-acid reflux episodes, and granuloma/granulation is specific for acid reflux episodes.

Locoregional relapse after gastrectomy with D2 lymphadenectomy for gastric cancer

BACKGROUND

Risk for and site of locoregional relapse have not been well studied in patients undergoing gastrectomy with D2 lymphadenectomy for gastric cancer.

METHODS

Patients who had undergone gastrectomy with D2 lymphadenectomy for gastric cancer between 2004 and 2007 were identified from an institutional database. The locoregional relapse rate was estimated by competing risk analysis, and risk groups were derived according to locoregional relapse risk using recursive partitioning analysis (RPA). The locations of nodal relapses were evaluated according to Japanese Classification of Gastric Carcinoma criteria.

RESULTS

Some 2618 patients were included. With a median follow-up of 78·0 (range 28·5-122·6) months, relapse was diagnosed in 471 of 2618 patients (18·0 per cent). The cumulative incidence of locoregional relapse at 5 years was 8·5 (95 per cent c.i. 7·4 to 9·6) per cent. The 5-year locoregional recurrence rates for high-risk (N3), intermediate-risk (N1-2) and low-risk (N0) groups were 32·4, 12·3 and 1·7 per cent respectively (P < 0·001). Among patients with regional relapse, 90·4 per cent had involvement outside the D2 dissected area, and the most commonly involved site was station 16b1. This pattern was maintained in the RPA risk groups (P = 0·329).

CONCLUSION

Locoregional relapse at 5 years after gastrectomy with D2 lymphadenectomy was 8·5 per cent, and was most often seen outside the D2 dissected area.

Rapidly progressing central-type primitive neuroectodermal tumor of the ovary: a case report

Primitive neuroectodermal tumors (PNET) belong to a group of highly malignant tumors comprised of small round cells of neu- roectodermal origin. These tumors can be either of peripheral-type (Ewing family tumors/PNET) or central-type. A number of case re- ports have described PNET involving the gynecologic organs and the prognosis is generally poor. The authors describe the case of a 53-year-old woman with a rapidly progressing central-type PNET of the ovary.

Self-expandable metal stents for malignant esophageal obstruction: a comparative study between extrinsic and intrinsic compression

Self-expandable metal stents (SEMSs) are effective for malignant esophageal obstruction, but usefulness of SEMSs in extrinsic lesions is yet to be elucidated. This study is aimed at evaluating the clinical usefulness of SEMSs in the extrinsic compression compared with intrinsic. A retrospective review was conducted for 105 patients (intrinsic, 85; extrinsic, 20) with malignant esophageal obstruction who underwent endoscopic SEMSs placement. Technical and clinical success rates were evaluated and clinical outcomes were compared between extrinsic and intrinsic group. Extrinsic group was mostly pulmonary origin. Overall technical and clinical success rate was 100% and 91%, respectively, without immediate complications. Extrinsic and intrinsic group did not differ significantly in clinical success rate. The median stent patency time was 131.3 ± 85.8 days in intrinsic group while that of extrinsic was 54.6 ± 45.1 due to shorter survival after stent insertion. The 4-, 8-, and 12-week patency rates were 90.5%, 78.8%, and 64.9% respectively in intrinsic group, while stents of extrinsic group remained patent until death. Uncovered, fully covered, and double-layered stent were used evenly and the types did not influence patency in both groups. In conclusion, esophageal SEMSs can safely and effectively be used for malignant extrinsic compression as well as intrinsic.

Self-Assembled Silica Nanostructures: Simultaneous Discrimination of Handedness, Pitch and Diameter of Helical Silica Nanotubes

The left- and right-handed helical silica nanostructures were obtained with the aid of organic templates, the formation of the nanostructures might follow a co-operation self-assembly mechanism. The chirality of the organogel self-assemblies was successfully transcribed in to the silica. The helical pitch and pore size of the silica nanotubes sensitively depended on the optical purity of the neutral gelator in the reaction mixtures.

Using nanoimprint lithography to improve the light extraction efficiency and color rendering of dichromatic white light-emitting diodes

Despite the efficiency of gallium nitride (GaN)-based blue light-emitting diodes (LEDs), the light extraction arising from the packaging of the phosphor remains an important issue when enhancing the performance of dichromatic white LEDs. In this study, we employed a simple, inexpensive nanoimprinting process to increase both the light extraction efficiency and color rendering of dichromatic white LEDs. We employed the rigorous coupled wave approach (RCWA) to optimize the light extraction efficiency of yellow and blue light. We found that the presence of the light extracting structures could also improve the color rendering of the dichromatic white LEDs, due to the different light extraction efficiencies of the textured structures at different wavelengths. After fabricating inverted pyramid structures on the surface of the encapsulation layer, the intensity of the blue light at 455 nm increased by 20%. When we further considered the color rendering and correlated color temperature (CCT), the enhancement of blue light was 15% and that of yellow light was 4%. Meanwhile, the light extraction of the intensity dip near 490 nm was enhanced significantly (by 25%), resulting in an increased dip-intensity of light at 490 nm relative to the intensities of the blue and yellow light. Accordingly, the color rendering index (CRI) of this dichromatic white LED increased from 69 to 73. Because it improved both the light extraction efficiency and color rendering of dichromatic white LEDs, this simple method should be very helpful for enhancing their applications in solid state illumination.

The interaction of serum testosterone levels and androgen receptor CAG repeat polymorphism on the risk of erectile dysfunction in aging Taiwanese men

Testosterone has been found to play important roles in men's sexual function. However, the effects of testosterone can be modulated by androgen receptor (AR) CAG repeat polymorphism. It could also contribute to the risk of erectile dysfunction (ED). The aim of this study is to evaluate the interaction of serum testosterone levels and AR CAG repeat polymorphism on the risk of ED in aging Taiwanese men. This cross-sectional data of Taiwanese men older than 40 years were collected from a free health screening held between August 2010 and August 2011 in Kaohsiung city, Taiwan. All participants completed a health questionnaires included five-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptoms Score, received a detailed physical examination and provided 20 cm3 whole blood samples for biochemical and genetic evaluation. The IIEF-5 was used to evaluate ED. Serum albumin, total testosterone (TT), and sex hormone-binding globulin levels were measured. Free testosterone level was calculated. AR gene CAG repeat polymorphism was determined by direct sequencing. Finally, 478 men with the mean age of 55.7 ± 4.8 years were included. When TT levels were above 330 ng/dL, the effect of testosterone level on erectile function seemed to reach a plateau and a significantly negative correlation between AR CAG repeat length and the score of IIEF-5 was found (r = -0.119, p = 0.034). After adjusting for other covariates, the longer AR CAG repeat length was still an independent risk factor for ED in subjects with TT above 330 ng/dL (p = 0.006), but not in TT of 330 ng/dL or below. In conclusion, both serum testosterone levels and AR CAG repeat polymorphism can influence erectile function concomitantly. In subjects with normal TT concentration, those with longer AR CAG repeat lengths have a higher risk of developing ED.

Ministry of Health Clinical Practice Guidelines: Diabetes Mellitus

The Ministry of Health (MOH) have updated the clinical practice guidelines on Diabetes Mellitus to provide doctors and patients in Singapore with evidence-based treatment for diabetes mellitus. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Diabetes Mellitus, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Lipoprotein lipase variants interact with polyunsaturated fatty acids for obesity traits in women: replication in two populations

BACKGROUND AND AIMS

Lipoprotein lipase (LPL) is a candidate gene for obesity based on its role in triglyceride hydrolysis and the partitioning of fatty acids towards storage or oxidation. Whether dietary fatty acids modify LPL associated obesity risk is unknown.

METHODS AND RESULTS

We examined five single nucleotide polymorphisms (SNPs) (rs320, rs2083637, rs17411031, rs13702, rs2197089) for potential interaction with dietary fatty acids for obesity traits in 1171 participants (333 men and 838 women, aged 45-75 y) of the Boston Puerto Rican Health Study (BPRHS). In women, SNP rs320 interacted with dietary polyunsaturated fatty acids (PUFA) for body mass index (BMI) (P = 0.002) and waist circumference (WC) (P = 0.001) respectively. Higher intake of PUFA was associated with lower BMI and WC in homozygotes of the major allele (TT) (P = 0.01 and 0.005) but not in minor allele carriers (TG and GG). These interactions were replicated in an independent population, African American women of the Atherosclerosis Risk in Communities (ARIC) study (n = 1334).

CONCLUSION

Dietary PUFA modulated the association of LPL rs320 with obesity traits in two independent populations. These interactions may be relevant to the dietary management of obesity, particularly in women.

NLRP3 inflammasome activation by mitochondrial ROS in bronchial epithelial cells is required for allergic inflammation

Abnormality in mitochondria has been suggested to be associated with development of allergic airway disorders. In this study, to evaluate the relationship between mitochondrial reactive oxygen species (ROS) and NLRP3 inflammasome activation in allergic asthma, we used a newly developed mitochondrial ROS inhibitor, NecroX-5. NecroX-5 reduced the increase of mitochondrial ROS generation in airway inflammatory cells, as well as bronchial epithelial cells, NLRP3 inflammasome activation, the nuclear translocation of nuclear factor-κB, increased expression of various inflammatory mediators and pathophysiological features of allergic asthma in mice. Finally, blockade of IL-1β substantially reduced airway inflammation and hyperresponsiveness in the asthmatic mice. These findings suggest that mitochondrial ROS have a critical role in the pathogenesis of allergic airway inflammation through the modulation of NLRP3 inflammasome activation, providing a novel role of airway epithelial cells expressing NLRP3 inflammasome as an immune responder.

Heterogeneity of mucosal mast cell infiltration in subgroups of patients with esophageal chest pain

BACKGROUND

Although there is growing evidence that an increase in mucosal mast cells (MMCs) in the small and large intestine is associated with visceral hypersensitivity, few studies have evaluated MMCs in humans with esophageal symptoms. The aim of this study was to investigate esophageal MMC distribution in patients with non-cardiac chest pain (NCCP) and to examine the association between the number of gut MMCs and other functional gastrointestinal disorders.

METHODS

Forty-two consecutive NCCP patients and 10 healthy controls completed a questionnaire for bowel symptoms, chest pain intensity score, and psychologic depression. Esophageal, duodenal, and rectal MMCs were identified immunohistochemically and quantified by image analysis.

KEY RESULTS

Numbers of MMCs were significantly higher in NCCP patients vs healthy controls (11.8 ± 5.6 vs 7.6 ± 3.7 MMCs/high-power field, p = 0.026). In comparison of subgroups classified by 24-h impedance-pH monitoring, esophageal MMC counts were highest in the hypersensitive esophagus group (p < 0.01) and were also significantly increased in the functional chest pain group (p < 0.05). A positive correlation between esophageal and duodenal MMC counts was observed in patients with functional dyspepsia (FD; Spearman ρ = 0.604, p = 0.037). In particular, patients with clinical overlap with irritable bowel syndrome showed a strong positive correlation between esophageal and rectal MMC numbers (Spearman ρ = 0.857, p = 0.010).

CONCLUSIONS & INFERENCES

Among NCCP patients, increased MMC infiltration occurs in subgroups with hypersensitive esophagus and functional chest pain. In subpopulations with overlap with FD or irritable bowel syndrome, esophageal MMC counts demonstrated significant positive correlations with duodenal or rectal MMC counts.

Esophageal mucosal mast cell infiltration and changes in segmental smooth muscle contraction in noncardiac chest pain

Mast cells release potent mediators that alter enteric nerve and smooth muscle functions and may contribute to the pathogenesis of functional gastrointestinal disorders. The goal of this study was to determine if mucosal mast cell infiltration was associated with smooth muscle segmental changes in esophageal contraction. All patients with noncardiac chest pain (NCCP) were divided into two groups consisting of patients with non-erosive reflux disease or functional chest pain (FCP) according to the results of ambulatory 24 hours esophageal pH monitoring and high-resolution manometry. Pressure-volume (PV) was calculated by multiplying the length of the esophageal segment, duration of the contraction, and mean pressure over the entire space-time box (P mean). Quantification of mast cells was performed in five consecutive nonoverlapping immunostained sections. Spearman correlation analysis showed that the distal segment PV correlated with the mast cell count in all of the patients combined and in patients with FCP with correlation coefficients of 0.509 and 0.436, respectively (P = 0.004 and P = 0.042). Similar findings were observed for the segmental ratio of distal to proximal smooth muscle PV in all patients and in patients with FCP (correlation coefficients 0.566; P = 0.001 and correlation coefficients 0.525; P = 0.012, respectively). Mucosal mast cell infiltration was associated with distal esophageal contraction as a key pathophysiologic factor of NCCP.

Highly reflective liquid mirrors: exploring the effects of localized surface plasmon resonance and the arrangement of nanoparticles on metal liquid-like films

In this paper, we describe a high-reflectance liquid mirror prepared from densely packed silver nanoparticles (AgNPs) of two different sizes. We controlled the particle size during the synthetic process by controlling the temperature. Varying the concentration of the ligand also allowed us to optimize the arrangement of the AgNPs to achieve liquid mirrors exhibiting high specular reflectance. Scanning electron microscopy and atomic force microscopy confirmed that the particles of the liquid mirror were well-packed with an interparticle distance of merely 2 nm; thus, the interstices and surface roughness of the NPs were effectively minimized. As a result of decreased scattering loss, the reflectance in the shorter wavelength regime was increased effectively. The AgNP film was also sufficiently thick to reflect the light in the longer wavelength regime. In addition, we used three-dimensional finite-difference time domain simulations and experimental measurements to investigate the relationship between the localized surface plasmon resonance (LSPR) and the specular reflection of the liquid mirrors. By changing the packing density of the AgNPs, we found that the LSPR effect could yield either a specular reflection peak or dip at the LSPR wavelengths in the reflection spectra of the liquid mirrors. Relative to previously reported liquid mirrors, the reflectance of our system is obviously much greater, especially in the shorter wavelength regime. The average reflectance in the range from 400 to 1000 nm could reach 77%, comparable with that of mercury-based liquid mirrors.

BAX inhibitor-1-associated V-ATPase glycosylation enhances collagen degradation in pulmonary fibrosis

Endoplasmic reticulum (ER) stress is considered one of the pathological mechanisms of idiopathic pulmonary fibrosis (IPF). Therefore, we examined whether an ER stress regulator, Bax inhibitor-1 (BI-1), regulates collagen accumulation, which is both a marker of fibrosis and a pathological mechanism of fibrosis. The presence of BI-1 inhibited the transforming growth factor-β1-induced epithelial-mesenchymal transition of epithelial pulmonary cells and bleomycin-induced pulmonary fibrosis in a mouse model by enhancing collagen degradation, most likely by enhanced activation of the lysosomal V-ATPase through glycosylation. We also found a correlation between post-translational glycosylation of the V-ATPase and its associated chaperone, calnexin, in BI-1-overexpressing cells. BI-1-induced degradation of collagen through lysosomal V-ATPase glycosylation and the involvement of calnexin were confirmed in a bleomycin-induced fibrosis mouse model. These results highlight the regulatory role of BI-1 in IPF and reveal for the first time the role of lysosomal V-ATPase glycosylation in IPF.

A Fas-associated via death domain promoter polymorphism (rs10898853, -16C/T) as a risk factor for papillary thyroid cancer

PURPOSE

To determine whether a Fas-associated via death domain (FADD) promoter single-nucleotide polymorphism (SNP) is associated with susceptibility to papillary thyroid cancer (PTC) and clinicopathological features of PTC.

METHODS

To identify a possible association with PTC, 94 patients with PTC and 346 healthy controls were recruited. One promoter SNP (rs10898853, -16C/T) was analyzed by direct sequencing. Multiple logistic regression models (co-dominant, dominant, recessive, and log-additive models) were applied, and odds ratios (ORs), 95% confidence intervals (CIs), and p values were calculated.

RESULTS

The genotype of the promoter SNP (rs10898853) of FADD was found to be significantly associated with PTC in the co-dominant model 2 (T/T vs. C/C; p = 0.002, OR = 2.80, 95% CI = 1.39-5.65), the recessive model (p = 0.003, OR = 2.21, 95% CI = 1.31-3.71), and the log-additive model (p = 0.002, OR = 1.71, 95% CI = 1.20-2.44). Allele frequency analysis showed that the C allele of rs10898853 was significantly associated with an increased risk of PTC (p = 0.002, OR = 1.67, 95% CI = 1.21-2.32).

CONCLUSIONS

Our results suggest that the FADD promoter polymorphism is associated with susceptibility to PTC.

Routine computerised tomography in patients with acute supraglottitis for the diagnosis of epiglottic abscess: is it necessary?--a prospective, multicentre study

OBJECTIVES

To evaluate the predictive factor of epiglottic abscess and to investigate whether routine computerised tomography (CT) in patients with acute supraglottitis are necessary.

DESIGN

A prospective and multicentre study.

SETTINGS

Tertiary care referral medical centre.

PARTICIPANTS

A total of 202 patients with suspected acute supraglottitis were enrolled. All patients underwent CT to confirm the presence of abscess.

MAIN OUTCOME MEASURES

The patients' characteristics, symptoms at presentation, laryngoscopic findings of epiglottic swelling and arytenoid swelling by scope classification and initial laboratory finding were analysed.

RESULTS

Of 202 patients, 158 (78%) had acute supraglottitis and 44 (22%) had epiglottic abscess. There was no significant difference in age between the acute supraglottitis group and the epiglottic abscess group. Men were significantly more frequent in the epiglottic abscess group than females (P = 0.042). When comparing the symptom at presentation, the patients with epiglottic abscess complained of voice change more frequently (P = 0.003). Moderate or severe epiglottic swelling in scope classification was significantly associated with epiglottic abscess (P < 0.001). In logistic regression analysis, voice change [OR = 2.64, 95% CI = 1.29-5.40, P = 0.008] and moderate or severe epiglottic swelling in laryngoscopic findings [OR = 3.94, 95% CI = 1.63-9.53, P = 0.002] were independent predictive factors for epiglottic abscess. The positive predictive values of voice change and moderate or severe epiglottic swelling were 33% and 30%, respectively. The negative predictive values of voice change and moderate or severe epiglottic swelling were 15% and 9%, respectively.

CONCLUSIONS

Routine CT might be suggested for diagnosis of epiglottic abscess in the patients with acute supraglottitis, because of the poor predictive values of symptoms and signs.

The effects of statins on the clinical outcomes of Clostridium difficile infection in hospitalised patients

BACKGROUND

An association between exposure to statin drugs and favourable treatment outcomes for various types of infections has been established.

AIM

To determine the clinical characteristics and treatment outcomes of Clostridium difficile infection (CDI) among hospitalised patients taking statin drugs.

METHODS

The medical records were reviewed for consecutive in-patients with CDI confirmed by positive toxin assay (A or B), C. difficile culture, or the presence of pseudomembrane on endoscopy. Treatment success was defined as the resolution of diarrhoea within 6 days of therapy. The primary end points were assessed by average symptom recovery time and treatment response (success or failure).

RESULTS

Among 949 patients, the overall response to metronidazole was 91.9%. The baseline characteristics showed some differences between statin users and statin non-users with respect to mean disease severity score. In the multivariate analysis, successful treatment response was significantly associated with the absence of exposure to proton pump inhibitors (PPIs) (OR = 0.690, 95% CI = 0.513-0.929, P = 0.014) and with exposure to statins (OR = 1.449, 95% CI = 1.015-2.070, P = 0.041). Contrary to the treatment response, univariate and multivariate analyses failed to show that exposure to PPIs or statins affected symptom recovery times. Sixty-day CDI recurrence rates for those patients with statin exposure were significantly lower compared with those patients without statin exposure (3% vs. 7.3%, respectively; RR = 0.393, 95% CI = 0.167-0.926, P = 0.033).

CONCLUSION

Prior statin exposure in patients with C. difficile infection is associated with a successful response to treatment.

Interleukin 22 polymorphisms and papillary thyroid cancer

BACKGROUND

IL22RA1 (Interleukin 22 receptor-alpha 1), a member of the class II cytokine receptor family, mediates diverse biologic activities and appears to be important in pathogen defense, wound healing, and tissue reorganization. Polymorphisms in genes encoding inflammatory cytokines are associated with increased cancer risk.

AIM

The aim of this study was to evaluate the association between the single nucleotide polymorphisms (SNP) in the IL22 and IL22RA1 and papillary thyroid cancer (PTC), and to assess the relationship between the SNP in the IL22 and IL22RA1 and the clinical parameters of PTC.

MATERIAL AND METHODS

Study enrolled experimental group of 94 PTC patients and 213 controls. PTC patients were grouped and compared for clinical PTC parameters. One promoter SNP of IL22, -429C/T (rs2227485), and one SNP of IL22RA1, Arg518Gly (rs3795299) were analyzed using direct sequencing. Genetic data were analyzed using Helixtree, SNPAnalyzer Pro, SNPStats, and Haploview.

RESULTS

A SNP in IL22 (rs2227485) was significantly associated with PTC (codominant2 model [C/C vs T/T], odds ratio (OR) 2.39, 95% confidence interval (CI) 1.21-4.71, p=0.012; dominant model, OR 1.89, 95% CI 1.08-3.31, p=0.022). The allele T frequency of rs2227485 in IL22 was also associated with PTC (OR 1.59, 95% CI 1.13-2.25, p=0.009). According to clinical parameters, rs2227485 of IL22 was associated with number of cancers (dominant model, OR 3.03, 95% CI 1.02-9.01, p=0.035). By haplotype analysis, TG was associated with PTC (codominant model, OR 1.52, 95% CI 1.07-2.16, p=0.019; dominant model, OR 1.91, 95% CI 1.13- 3.24, p=0.015). Genotype and allele analysis of rs3795299 in IL22RA1 showed no significant differences between PTC patients and controls.

CONCLUSION

The rs2227485 SNP in IL22 might be associated with the risk and the multifocality of PTC.