Short- and long-term mortality after intravenous thrombolysis for acute ischemic stroke: A propensity score-matched cohort with 5-year follow-up

It remains unknown whether intravenous thrombolysis (IVT), thrombectomy, or poststroke antithrombotic medication lower short- and long-term mortality in acute ischemic stroke (AIS). This study aimed to investigate the efficacy of IVT in AIS using propensity score matching, to determine whether IVT could reduce short- and long-term mortality, and to identify risk factors influencing short- and long-term mortality in AIS.During 2013 to 2014, the nationwide Korea Acute Stroke Assessment registry enrolled 14,394 patients with first-ever recorded ischemic stroke. Propensity score matching was used to match IVT and control cases with a 1:1 ratio. The primary outcome was survival up to 3 months, 1 year, and 5 years, as assessed using Kaplan-Meier estimates and Cox proportional hazards.In total, 1317 patients treated with IVT were matched with 1317 patients not treated with IVT. Survival was higher in the IVT group (median, 3.53 years) than in the non-IVT group (median, 3.37 years, stratified log-rank test, P < .001). Compared with the non-IVT group, thrombolysis performed within 2 hours significantly reduced the risk of 3-month mortality by 37%, and thrombolysis performed between 2 and 4.5 hours significantly reduced the risk of 3-month mortality by 26%. Thrombectomy significantly reduced the risk of 3-month mortality by 28%. Compared with no poststroke medication, poststroke antiplatelet medication was associated with 51%, 55%, and 52% decreases in 3-month, 1-year, and 5-year mortality risk, respectively. Poststroke anticoagulant medication was associated with 51%, 54%, and 44% decreases in the risk of 3-month, 1-year, and 5-year mortality, respectively.IVT and mechanical thrombectomy showed improvement in short-term survival. To improve long-term outcomes, the use of poststroke antithrombotic medication is important in AIS.

Short and Long-term Outcomes of Subarachnoid Hemorrhage Treatment according to Hospital Volume in Korea: a Nationwide Multicenter Registry

BACKGROUND

Subarachnoid hemorrhage is a potentially devastating cerebrovascular attack with a high proportion of poor outcomes and mortality. Recent studies have reported decreased mortality with the improvement in devices and techniques for treating ruptured aneurysms and neurocritical care. This study investigated the relationship between hospital volume and short- and long-term mortality in patients treated with subarachnoid hemorrhage.

METHODS

We selected subarachnoid hemorrhage patients treated with clipping and coiling from March-May 2013 to June-August 2014 using data from Acute Stroke Registry, and the selected subarachnoid hemorrhage (SAH) patients were tracked in connection with data of Health Insurance Review and Assessment Service to evaluate the short-term and long-term mortality.

RESULTS

A total of 625 subarachnoid hemorrhage patients were admitted to high-volume hospitals (n = 355, 57%) and low-volume hospitals (n = 270, 43%) for six months. The mortality of SAH patients treated with clipping and coiling was 12.3%, 20.2%, 21.4%, and 24.3% at 14 days, three months, one year, and five years, respectively. The short-term and long-term mortality in high-volume hospitals was significantly lower than that in low-volume hospitals. On Cox regression analysis of death in patients with severe clinical status, low-volume hospitals had significantly higher mortality than high-volume hospitals during short-term follow-up. On Cox regression analysis in the mild clinical status group, there was no statistical difference between high-volume hospitals and low-volume hospitals.

CONCLUSION

In subarachnoid hemorrhage patients treated with clipping and coiling, low-volume hospitals had higher short-term mortality than high-volume hospitals. These results from a nationwide database imply that acute SAH should be treated by a skilled neurosurgeon with adequate facilities in a high-volume hospital.

Comparison of Major Clinical Outcomes between Accredited and Nonaccredited Hospitals for Inpatient Care of Acute Myocardial Infarction

Hospital accreditation programs are used worldwide to improve the quality of care and improve patient safety. It is of great help in improving the structure of hospitals, but there are mixed research results on improving the clinical outcome of patients. The purpose of this study was to compare the levels of core clinical outcome indicators after receiving inpatient services from accredited and nonaccredited hospitals in patients with acute myocardial infarction (AMI). For all patients with AMI admitted to general hospitals in Korea from 2010 to 2017, their 30-day mortality and readmissions and length of stay were compared according to accreditation status. In addition, through a multivariate model that controls various patients’ and hospitals’ factors, the differences in those indicators were analyzed more accurately. The 30-day mortality of patients admitted to accredited hospitals was statistically significantly lower than that of patients admitted to nonaccredited hospitals. However, for 30-day readmission and length of stay, accreditation did not appear to yield more desirable results. This study shows that when evaluating the clinical impact of hospital accreditation programs, not only the mortality but also various clinical indicators need to be included, and a more comprehensive review is needed.

Actuating Voltage Waveform Optimization of Piezoelectric Inkjet Printhead for Suppression of Residual Vibrations

After a piezoelectric inkjet printhead jets the first droplet, the actuating membrane still vibrates, creating residual vibrations in the ink channel, which can degrade the inkjet printhead performance. For suppressing these vibrations, an optimized actuating voltage waveform with two pulses must be obtained, of which the first pulse is used for jetting and the second pulse is used to suppress the residual vibrations. In this study, the pressure history within the ink channel of a recirculating piezoelectric inkjet printhead was first acquired using lumped element modeling. Then, for suppressing residual vibrations, a bipolar voltage waveform was optimized via analysis of the tuning time (tt ), dwell time (td2), rising time (tr2), falling time (tf2), and voltage amplitude of the second pulse. Two voltage waveforms, Waveform 01 and Waveform 02, were optimized thereafter. In Waveform 01, tt=2 μs, td2=2 μs, and tr2 and tf2=1 μs were finalized as the optimal parameters; in the case of another waveform, the optimal parameters of td2, tr2, and tf2 were found to be 4, 1, and 1 μs, respectively. The optimal voltage amplitude of the second pulse was found to be 1/3 the amplitude of the first pulse. On the basis of our analysis, the tuning time in Waveform 01 is the most sensitive parameter, and the performance yielded is even poorer than that yielded by standard waveform, if not optimized. Therefore, the other waveform is recommended for the suppression of residual vibrations.

Association between Accreditation and In-Hospital Mortality in Patients with Major Cardiovascular Diseases in South Korean Hospitals: Pre-Post Accreditation Comparison

The direct impact of hospital accreditation on patients' clinical outcomes is unclear. The purpose of this study was to evaluate whether mortality within 30 days of hospitalization for acute myocardial infarction (AMI), ischemic stroke (IS), and hemorrhagic stroke (HS) differed before and after hospital accreditation. This study targeted patients who had been hospitalized for the three diseases at the general hospitals newly accredited by the government in 2014. Thirty-day mortality rates of three years before and after accreditation were compared. Mortality within 30 days of hospitalization for the three diseases was lower after accreditation than before (7.34% vs. 6.15% for AMI; 4.64% vs. 3.80% for IS; and 18.52% vs. 15.81% for HS). In addition, hospitals that meet the criteria of the patient care process domain have a statistically lower mortality rate than hospitals that do not. In the newly accredited Korean general hospital, it was confirmed that in-hospital mortality rates of major cardiovascular diseases were lower than before the accreditation.

Identification of chronic obstructive pulmonary disease subgroups in 13 Asian cities

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition that can differ in its clinical manifestation, structural changes and response to treatment.

OBJECTIVE

To identify subgroups of COPD with distinct phenotypes, evaluate the distribution of phenotypes in four related regions and calculate the 1-year change in lung function and quality of life according to subgroup.

METHODS

Using clinical characteristics, we performed factor analysis and hierarchical cluster analysis in a cohort of 1676 COPD patients from 13 Asian cities. We compared the 1-year change in forced expiratory volume in one second (FEV1), modified Medical Research Council dyspnoea scale score, St George's Respiratory Questionnaire (SGRQ) score and exacerbations according to subgroup derived from cluster analysis.

RESULTS

Factor analysis revealed that body mass index, Charlson comorbidity index, SGRQ total score and FEV1 were principal factors. Using these four factors, cluster analysis identified three distinct subgroups with differing disease severity and symptoms. Among the three subgroups, patients in subgroup 2 (severe disease and more symptoms) had the most frequent exacerbations, most rapid FEV1 decline and greatest decline in SGRQ total score.

CONCLUSION

Three subgroups with differing severities and symptoms were identified in Asian COPD subjects.

Association between volume of surgery for acute hemorrhagic stroke and mortality

This study aimed to investigate the association between volume of surgery and mortality in relation to interventions for acute hemorrhagic stroke, namely craniotomy and trephination.We obtained data on acute hemorrhagic stroke patients for a 5-year period (2009-2013) from the Health Insurance Review and Assessment Service. Hospitals were classified into 3 categories according to volume of surgery (low, medium, high). To avoid intentionally setting a cutoff, we placed the hospitals in order from those with high volume of surgery to those with low volume of surgery and divided them into 3 groups (tertile) according to the number of patients. The covariates were age, sex, hemorrhagic stroke site, type of health insurance, intensive care unit admission, history of hypertension, and Charlson comorbidity index. Multiple logistic regression analysis was performed with statistical significance set at 5%.A total of 41,917 patients who underwent craniotomy (n = 20,982) or trephination (n = 20,935) for acute hemorrhagic stroke were analyzed according to hemorrhage site (subarachnoid and others). The results showed that mortality from acute hemorrhagic stroke decreased with increasing volume of surgery. For subarachnoid hemorrhage, the odds ratios of the medium- and high-volume surgery groups were significantly lower (0.74 and 0.59, respectively) for mortality within 7 days of admission, and were also significantly lower (0.78 and 0.68) for mortality within 30 days of admission than that of the low-volume surgery group. The results for other hemorrhage sites were similar. The association between mortality and volume of surgery was more evident in the craniotomy group. Although this study was limited to a single country (South Korea), it partially addressed the shortcomings of previous studies by analyzing a nationwide database and examining all types of hemorrhagic strokes.

Influence of land development on stormwater runoff from a mixed land use and land cover catchment

Mitigating for the negative impacts of stormwater runoff is becoming a concern due to increased land development. Understanding how land development influences stormwater runoff is essential for sustainably managing water resources. In recent years, aggregate low impact development-best management practices (LID-BMPs) have been implemented to reduce the negative impacts of stormwater runoff on receiving water bodies. This study used an integrated approach to determine the influence of land development and assess the ecological benefits of four aggregate LID-BMPs in stormwater runoff from a mixed land use and land cover (LULC) catchment with ongoing land development. It used data from 2011 to 2015 that monitored 41 storm events and monthly LULC, and a Personalized Computer Storm Water Management Model (PCSWMM). The four aggregate LID-BMPs are: ecological (S1), utilizing pervious covers (S2), and multi-control (S3) and (S4). These LID-BMPs were designed and distributed in the study area based on catchment characteristics, cost, and effectiveness. PCSWMM was used to simulate the monitored storm events from 2014 (calibration: R² and NSE>0.5; RMSE <11) and 2015 (validation: R² and NSE>0.5; RMSE <12). For continuous simulation and analyzing LID-BMPs scenarios, the five-year (2011 to 2015) stormwater runoff data and LULC change patterns (only 2015 for LID-BMPs) were used. Results show that the expansion of bare land and impervious cover, soil alteration, and high amount of precipitation influenced the stormwater runoff variability during different phases of land development. The four aggregate LID-BMPs reduced runoff volume (34%-61%), peak flow (6%-19%), and pollutant concentrations (53%-83%). The results of this study, in addition to supporting local LULC planning and land development activities, also could be applied to input data for empirical modeling, and designing sustainable stormwater management guidelines and monitoring strategies.

Motivating systems-oriented research on environmental and policy changes for obesity prevention

BACKGROUND

Research on the types of interventions needed for population-level prevention of childhood obesity in complex societal systems can benefit from greater use of systems-science concepts and tools.

OBJECTIVES

We report outcomes of a funding programme promoting incorporation of systems-science approaches into studies of imminent policy or environmental changes potentially impacting childhood obesity.

METHODS

Seven funding cycles over 3 years yielded 172 initial submissions from 29 US states and 25 other countries were analyzed.

RESULTS

Submissions focused primarily on aspects of school or child-care settings, parks and recreational settings, or access to healthy food; about half reflected attention to systems perspectives.

CONCLUSIONS

Analysis of initial submissions as well as the 15 funded projects showed some success in motivating use of systems concepts and tools but suggested the need for a more focused effort to educate and prepare the childhood obesity prevention research community for this potentially crucial type of research.

Potential economic burden of carbapenem-resistant Enterobacteriaceae (CRE) in the United States

OBJECTIVES

The Centers for Disease Control and Prevention considers carbapenem-resistant Enterobacteriaceae (CRE) an urgent public health threat; however, its economic burden is unknown.

METHODS

We developed a CRE clinical and economics outcomes model to determine the cost of CRE infection from the hospital, third-party payer, and societal, perspectives and to evaluate the health and economic burden of CRE to the USA.

RESULTS

Depending on the infection type, the median cost of a single CRE infection can range from $22 484 to $66 031 for hospitals, $10 440 to $31 621 for third-party payers, and $37 778 to $83 512 for society. An infection incidence of 2.93 per 100 000 population in the USA (9418 infections) would cost hospitals $275 million (95% CR $217-334 million), third-party payers $147 million (95% CR $129-172 million), and society $553 million (95% CR $303-1593 million) with a 25% attributable mortality, and would result in the loss of 8841 (95% CR 5805-12 420) quality-adjusted life years. An incidence of 15 per 100 000 (48 213 infections) would cost hospitals $1.4 billion (95% CR $1.1-1.7 billion), third-party payers $0.8 billion (95% CR $0.6-0.8 billion), and society $2.8 billion (95% CR $1.6-8.2 billion), and result in the loss of 45 261 quality-adjusted life years.

CONCLUSIONS

The cost of CRE is higher than the annual cost of many chronic diseases and of many acute diseases. Costs rise proportionally with the incidence of CRE, increasing by 2.0 times, 3.4 times, and 5.1 times for incidence rates of 6, 10, and 15 per 100 000 persons.

Isolation and characterization of novel microsatellites for Abies koreana and A. nephrolepis (Pinaceae)

Abies koreana is an endemic and rare species from Korea and is classified as endangered by the International Union for Conservation of Nature. Although the genetic diversity assessment for current population of A. koreana needs to be performed urgently, no microsatellite markers have been developed for this species. In the present study, we developed 22 novel polymorphic microsatellite loci and the characteristics of these loci were determined in A. koreana as well as in Abies nephrolepis, the most closely related species, and these loci were compared with previously reported microsatellite markers developed for the Abies genus. Genomic sequence (161 Mbp; 325,776 reads) was obtained from one individual of A. koreana using Roche 454 GS-FLX Titanium sequencing and 19,258 repeat motifs were identified from it. A total of 288 primer pairs with high copy numbers of di-repeat motifs were evaluated for amplification in A. koreana and A. nephrolepis. A total of 71 primer pairs successfully amplified fragments, of which 22 showed polymorphisms in A. koreana and A. nephrolepis. The average expected diversity was 0.767 and 0.717 in A. koreana and A. nephrolepis, respectively; these heterozygosity levels were moderate compared to the previously reported microsatellite loci from Abies species. This is the first set of microsatellite markers developed for A. koreana as well as A. nephrolepis and further population genetic studies of both species and genetic delimitation can be carried out for the species conservation and management.

Cytokine profiling of docetaxel-resistant castration-resistant prostate cancer

Background:

Docetaxel improves symptoms and survival in metastatic castration-resistant prostate cancer (CRPC). However, ∼50% of patients are chemoresistant. This study examined whether changes in cytokine levels predict for docetaxel resistance in vitro and in a clinical cohort.

Methods:

PC3 cells or their docetaxel-resistant subline (PC3Rx) were co-cultured with U937 monocytes, with and without docetaxel treatment, and cytokine levels were measured. The circulating levels of 28 cytokines were measured pre-/post cycle 1 of docetaxel from 55 men with CRPC, and compared with prostate-specific antigen (PSA) response.

Results:

PC3Rx-U937 co-culture expressed more cytokines, chiefly markers of alternative macrophage differentiation, compared with PC3-U937 co-culture. Docetaxel treatment enhanced cytokine production by PC3Rx-U937 co-culture, while reducing cytokine levels in PC3-U937. In patients, changes in the levels of seven circulating cytokines (macrophage inhibitory cytokine 1 (MIC1), interleukin (IL)-1ra, IL-1β, IL-4, IL-6, IL-12 and IFNγ) after cycle 1 of docetaxel were associated with progressive disease (all P<0.05). The combination of changes in MIC1, IL-4 and IL-6 most strongly predicted PSA response (P=0.002).

Conclusions:

In vitro studies suggest docetaxel resistance is mediated, at least in part, by cytokines induced by the interaction between the docetaxel-resistant tumour cells and macrophages. Early changes in circulating cytokine levels were associated with docetaxel resistance in CRPC patients. When considered together, these data suggest a significant role for the inflammatory response and macrophages in the development of docetaxel resistance in CRPC.

The economics and timing of preoperative antibiotics for orthopaedic procedures

BACKGROUND

The efficacy of antibiotics in preventing surgical site infections (SSIs) depends on the timing of administration relative to the start of surgery. However, currently, both the timing of and recommendations for administration vary substantially.

AIM

To determine how the economic value from the hospital perspective of preoperative antibiotics varies with the timing of administration for orthopaedic procedures.

METHODS

Computational decision and operational models were developed from the hospital perspective. Baseline analyses looked at current timing of administration, while additional analyses varied the timing of administration, compliance with recommended guidelines, and the goal time-interval.

FINDINGS

Beginning antibiotic administration within 0-30 min prior to surgery resulted in the lowest costs and SSIs. Operationally, linking to a pre-surgical activity, administering antibiotics prior to incision but after anaesthesia-ready time was optimal, as 92.1% of the time, antibiotics were administered in the optimal time-interval (0-30 min prior to incision). Improving administration compliance from 80% to 90% for this pre-surgical activity results in cost savings of $447 per year for a hospital performing 100 orthopaedic operations a year.

CONCLUSION

This study quantifies the potential cost-savings when antibiotic administration timing is improved, which in turn can guide the amount hospitals should invest to address this issue.

Circulating microRNAs are associated with docetaxel chemotherapy outcome in castration-resistant prostate cancer

Background:

Docetaxel is the first-line chemotherapy for castration-resistant prostate cancer (CRPC). However, response rates are ∼50% and determined quite late in the treatment schedule, thus non-responders are subjected to unnecessary toxicity. The potential of circulating microRNAs as early biomarkers of docetaxel response in CRPC patients was investigated in this study.

Methods:

Global microRNA profiling was performed on docetaxel-resistant and sensitive cell lines to identify candidate circulating microRNA biomarkers. Custom Taqman Array MicroRNA cards were used to measure the levels of 46 candidate microRNAs in plasma/serum samples, collected before and after docetaxel treatment, from 97 CRPC patients.

Results:

Fourteen microRNAs were associated with serum prostate-specific antigen (PSA) response or overall survival, according to Mann–Whitney U or log-rank tests. Non-responders to docetaxel and patients with shorter survival generally had high pre-docetaxel levels of miR-200 family members or decreased/unchanged post-docetaxel levels of miR-17 family members. Multivariate Cox regression with bootstrapping validation showed that pre-docetaxel miR-200b levels, post-docetaxel change in miR-20a levels, pre-docetaxel haemoglobin levels and visceral metastasis were independent predictors of overall survival when modelled together.

Conclusions:

Our study suggests that circulating microRNAs are potential early predictors of docetaxel chemotherapy outcome, and warrant further investigation in clinical trials.

A computer simulation model of the cost-effectiveness of routine Staphylococcus aureus screening and decolonization among lung and heart-lung transplant recipients

Our objective was to model the cost-effectiveness and economic value of routine peri-operative Staphylococcus aureus screening and decolonization of lung and heart-lung transplant recipients from hospital and third-party payer perspectives. We used clinical data from 596 lung and heart-lung transplant recipients to develop a model in TreeAge Pro 2009 (Williamsport, MA, USA). Sensitivity analyses varied S. aureus colonization rate (5-15 %), probability of infection if colonized (10-30 %), and decolonization efficacy (25-90 %). Data were collected from the Cardiothoracic Transplant Program at the University of Pittsburgh Medical Center. Consecutive lung and heart-lung transplant recipients from January 2006 to December 2010 were enrolled retrospectively. Baseline rates of S. aureus colonization, infection and decolonization efficacy were 9.6 %, 36.7 %, and 31.9 %, respectively. Screening and decolonization was economically dominant for all scenarios tested, providing more cost savings and health benefits than no screening. Savings per case averted (2012 $US) ranged from $73,567 to $133,157 (hospital perspective) and $10,748 to $16,723 (third party payer perspective), varying with the probability of colonization, infection, and decolonization efficacy. Using our clinical data, screening and decolonization led to cost savings per case averted of $240,602 (hospital perspective) and averted 6.7 S. aureus infections (4.3 MRSA and 2.4 MSSA); 89 patients needed to be screened to prevent one S. aureus infection. Our data support routine S. aureus screening and decolonization of lung and heart-lung transplant patients. The economic value of screening and decolonization was greater than in previous models of other surgical populations.

Unusual maternal uniparental isodisomic x chromosome mosaicism with asymmetric y chromosomal rearrangement

Infertile men with azoospermia commonly have associated microdeletions in the azoospermia factor (AZF) region of the Y chromosome, sex chromosome mosaicism, or sex chromosome rearrangements. In this study, we describe an unusual 46,XX and 45,X mosaicism with a rare Y chromosome rearrangement in a phenotypically normal male patient. The patient's karyotype was 46,XX[50]/45,X[25]/46,X,der(Y)(pter→q11.222::p11.2→pter)[25]. The derivative Y chromosome had a deletion at Yq11.222 and was duplicated at Yp11.2. Two copies of the SRY gene were confirmed by fluorescence in situ hybridization analysis, and complete deletion of the AZFb and AZFc regions was shown by multiplex-PCR for microdeletion analysis. Both X chromosomes of the predominant mosaic cell line (46,XX) were isodisomic and derived from the maternal gamete, as determined by examination of short tandem repeat markers. We postulate that the derivative Y chromosome might have been generated during paternal meiosis or early embryogenesis. Also, we suggest that the very rare mosaicism of isodisomic X chromosomes might be formed during maternal meiosis II or during postzygotic division derived from the 46,X,der(Y)/ 45,X lineage because of the instability of the derivative Y chromosome. To our knowledge, this is the first confirmatory study to verify the origin of a sex chromosome mosaicism with a Y chromosome rearrangement.

On the identity of Clistocoeloma balansae A. Milne-Edwards, 1873, and C. tectum (Rathbun, 1914), with description of a new species from the West Pacific (Crustacea: Decapoda: Sesarmidae)

The identity of the mangrove sesarmid crab Clistocoeloma balansae A. Milne-Edwards, 1873, is clarified on the basis of the types from New Caledonia, and fresh material from Vanuatu and the Philippines. Sesarma (Sesarma) tectum Rathbun, 1914, is shown to be a junior subjective synonym of C. balansae A. Milne-Edwards, 1873. A new species, C. melanesicum, superficially similar to C. balansae, is described from Vanuatu, New Caledonia, and, Solomon Islands.

Hypoxia inducible factor-1α gene polymorphisms in Korean patients with pre-eclampsia

BACKGROUND

Placental hypoxia has been implicated in the pathogenesis of pre-eclampsia. Hypoxia inducible factor-1α (HIF-1α) is activated by low oxygen tension and is a key regulator of genes involved in the cellular responses to hypoxia.

AIM

We determined whether maternal blood c.1722C>T (Pro582Ser) and c.1790G>A (Ala588Thr) polymorphisms in exon 12 of the HIF-1α gene are associated with pre-eclampsia.

SUBJECTS AND METHODS

Subjects included 163 pre-eclamptic patients (48 mild and 115 severe preeclampsia) and 194 healthy pregnant women. Polymorphisms were genotyped by PCR and direct DNA sequencing.

RESULTS

There were no significant differences in genotype or allele frequencies of the c.1772C>T and c.1790G>A polymorphisms of the HIF-1α gene among the study groups. Moreover, subgroup analysis according to pre-eclampsia severity revealed no significant differences in genotype or allele frequencies of the HIF-1α c.1772C>T and c.1790G>A polymorphism in mild pre-eclamptic compared to severe pre-eclamptic group. In addition, there were no significant differences in the frequencies of 3 haplotypes (C-G,-G, T-G, and C-A) between the control and pre-eclamptic groups.

CONCLUSIONS

Our results suggest that the HIF-1α gene polymorphisms are not associated with the development of pre-eclampsia in the studied Korean women population.

The potential economic value of screening hospital admissions for Clostridium difficile

Asymptomatic Clostridium difficile carriage has a prevalence reported as high as 51-85 %; with up to 84 % of incident hospital-acquired infections linked to carriers. Accurately identifying carriers may limit the spread of Clostridium difficile. Since new technology adoption depends heavily on its economic value, we developed an analytic simulation model to determine the cost-effectiveness screening hospital admissions for Clostridium difficile from the hospital and third party payer perspectives. Isolation precautions were applied to patients testing positive, preventing transmission. Sensitivity analyses varied Clostridium difficile colonization rate, infection probability among secondary cases, contact isolation compliance, and screening cost. Screening was cost-effective (i.e., incremental cost-effectiveness ratio [ICER] ≤ $50,000/QALY) for every scenario tested; all ICER values were ≤ $256/QALY. Screening was economically dominant (i.e., saved costs and provided health benefits) with a ≥10.3 % colonization rate and ≥5.88 % infection probability when contact isolation compliance was ≥25 % (hospital perspective). Under some conditions screening led to cost savings per case averted (range, $53-272). Clostridium difficile screening, coupled with isolation precautions, may be a cost-effective intervention to hospitals and third party payers, based on prevalence. Limiting Clostridium difficile transmission can reduce the number of infections, thereby reducing its economic burden to the healthcare system.

The economic burden of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA)

The economic impact of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) remains unclear. We developed an economic simulation model to quantify the costs associated with CA-MRSA infection from the societal and third-party payer perspectives. A single CA-MRSA case costs third-party payers $2277-$3200 and society $7070-$20 489, depending on patient age. In the United States (US), CA-MRSA imposes an annual burden of $478 million to 2.2 billion on third-party payers and $1.4-13.8 billion on society, depending on the CA-MRSA definitions and incidences. The US jail system and Army may be experiencing annual total costs of $7-11 million ($6-10 million direct medical costs) and $15-36 million ($14-32 million direct costs), respectively. Hospitalization rates and mortality are important cost drivers. CA-MRSA confers a substantial economic burden on third-party payers and society, with CA-MRSA-attributable productivity losses being major contributors to the total societal economic burden. Although decreasing transmission and infection incidence would decrease costs, even if transmission were to continue at present levels, early identification and appropriate treatment of CA-MRSA infections before they progress could save considerable costs.

Corticotropin-Releasing Hormone Enhances the Invasiveness and Migration of Ishikawa Cells, Possibly by Increasing Matrix Metalloproteinase-2 and Matrix Metalloproteinase-9

Corticotropin-releasing hormone (CRH), synthesized in the hypothalamus, is also produced at several extrahypothalamic sites and in normal endometrial cells. CRH exerts antiproliferative activity on oestrogen-dependent tumour cell lines (Ishikawa cells and breast cancer cells) via the CRH receptor-1. This study investigated the potential role of CRH as a factor affecting endometrial migration and invasion in Ishikawa cells, and the possible mechanisms involved in this process. Increasing concentrations of CRH (1, 10 and 100 nM) significantly reduced the proliferation of Ishikawa cells but increased the invasiveness these cells compared with the control group. All three concentrations of CRH significantly increased matrix metalloproteinase (MMP)-2 and MMP-9 levels in Ishikawa cells. In conclusion, CRH inhibited the growth of Ishikawa cells but enhanced their invasiveness, possibly by increasing MMP-2 and MMP-9 levels. These findings suggest that CRH might induce invasion and migration by upregulating MMP-2 and MMP-9 in endometrial cancer.

The economic burden of Clostridium difficile

Although Clostridium difficile (C. difficile) is the leading cause of infectious diarrhoea in hospitalized patients, the economic burden of this major nosocomial pathogen for hospitals, third-party payers and society remains unclear. We developed an economic computer simulation model to determine the costs attributable to healthcare-acquired C. difficile infection (CDI) from the hospital, third-party payer and societal perspectives. Sensitivity analyses explored the effects of varying the cost of hospitalization, C. difficile-attributable length of stay, and the probability of initial and secondary recurrences. The median cost of a case ranged from $9179 to $11 456 from the hospital perspective, $8932 to $11 679 from the third-party payor perspective, and $13 310 to $16 464 from the societal perspective. Most of the costs incurred were accrued during a patient's primary CDI episode. Hospitals with an incidence of 4.1 CDI cases per 100 000 discharges would incur costs ≥$3.2 million (hospital perspective); an incidence of 10.5 would lead to costs ≥$30.6 million. Our model suggests that the annual US economic burden of CDI would be ≥$496 million (hospital perspective), ≥$547 million (third-party payer perspective) and ≥$796 million (societal perspective). Our results show that C. difficile infection is indeed costly, not only to third-party payers and the hospital, but to society as well. These results are consistent with current literature citing C. difficile as a costly disease.

Transumbilical single-port laparoscopic-assisted vaginal hysterectomy via 12-mm trocar incision site

BACKGROUND

Single-port laparoscopic-assisted vaginal hysterectomy (S-LAVH) uses only one transumbilical incision site and has better cosmetic result than conventional multiport LAVH. This study aimed to evaluate our initial experience with S-LAVH compared with the more conventional three-port LAVH in women with benign uterine diseases.

METHODS

Between April 2009 and April 2010, S-LAVH was attempted on 183 patients with benign uterine diseases through a transumbilical incision for a 12-mm trocar, and conventional LAVH was performed on 275 patients by the same surgeon. The medical records of patients were reviewed. The age, body mass index, operative time, blood loss, and uterine weight on pathologic report were compared.

RESULTS

Two of 183 patients in the S-LAVH group were converted to two- or three-port surgery, compared with none in the conventional group. Data analysis was done for 181 patients in the S-LAVH group and 275 patients in the conventional LAVH group. No major complications, including ureteral or bladder injuries, occurred in any of the patients. No statistically significant differences were found in mean age, mean body mass index, mean operative time, mean anesthesia time, mean estimated blood loss, or mean postoperative days to passage of flatus, but the mean uterine weights on the pathologic reports were significantly reduced in the S-LAVH group.

CONCLUSION

S-LAVH could be a feasible alternative method for removal of the uterus with a better cosmetic outcome resulting from single wound in selected patients. For patients with large-sized uterus, more surgical experience and improvement in instruments suitable for S-LAVH are needed.

The economic value of screening haemodialysis patients for methicillin-resistant Staphylococcus aureus in the USA

Methicillin-resistant Staphylococcus aureus (MRSA) can cause severe infections in patients undergoing haemodialysis. Routine periodic testing of haemodialysis patients and attempting to decolonize those who test positive may be a strategy to prevent MRSA infections. The economic value of such a strategy has not yet been estimated. We constructed a Markov computer simulation model to evaluate the economic value of employing routine testing (agar-based or PCR) at different MRSA prevalence, spontaneous clearance, costs of decolonization and decolonization success rates, performed every 3, 6 or 12 months. The model showed periodic MRSA surveillance with either test to be cost-effective (incremental cost-effectiveness ratio ≤$50 000/quality-adjusted life-year) for all conditions tested. Agar surveillance was dominant (i.e. less costly and more effective) at an MRSA prevalence ≥10% and a decolonization success rate ≥25% for all decolonization treatment costs tested with no spontaneous clearance. PCR surveillance was dominant when the MRSA prevalence was ≥20% and decolonization success rate was ≥75% with no spontaneous clearance. Routine periodic testing and decolonization of haemodialysis patients for MRSA may be a cost-effective strategy over a wide range of MRSA prevalences, decolonization success rates, and testing intervals.

Economic value of Acinetobacter baumannii screening in the intensive care unit

Although Acinetobacter baumannii (A. baumannii) is an increasingly common nosocomial pathogen that can cause serious infections in the intensive care unit (ICU), most ICUs do not actively screen admissions for this pathogen. We developed an economic computer simulation model to determine the potential cost-consequences to the hospital of implementing routine A. baumannii screening of ICU admissions and isolating those patients who tested positive, comparing two screening methods, sponge and swab, with each other and no screening. Sensitivity analyses varied the colonization prevalence, percentage of colonized individuals who had active A. baumannii infections, A. baumannii reproductive rate (R), and contact isolation efficacy. Both screening methods were cost-effective for almost all scenarios tested, yielding cost-savings ranging from -$1 to -$1563. Sponge screening was not cost-saving when colonization prevalence was ≤1%, probability of infection ≤30%, R ≤ 0.25, and contact isolation efficacy ≤25%. Swab screening was not cost-saving under these same conditions when the probability of infection was ≤40%. Sponge screening tended to be more cost-saving than swab screening (additional savings ranged from $1 to $421). Routine A. baumannii screening of ICU patients may save costs for hospitals.

Economic value of norovirus outbreak control measures in healthcare settings

Although norovirus is a significant cause of nosocomial viral gastroenteritis, the economic value of hospital outbreak containment measures following identification of a norovirus case is currently unknown. We developed computer simulation models to determine the potential cost-savings from the hospital perspective of implementing the following norovirus outbreak control interventions: (i) increased hand hygiene measures, (ii) enhanced disinfection practices, (iii) patient isolation, (iv) use of protective apparel, (v) staff exclusion policies, and (vi) ward closure. Sensitivity analyses explored the impact of varying intervention efficacy, number of initial norovirus cases, the norovirus reproductive rate (R(0)), and room, ward size, and occupancy. Implementing increased hand hygiene, using protective apparel, staff exclusion policies or increased disinfection separately or in bundles provided net cost-savings, even when the intervention was only 10% effective in preventing further norovirus transmission. Patient isolation or ward closure was cost-saving only when transmission prevention efficacy was very high (≥ 90%), and their economic value decreased as the number of beds per room and the number of empty beds per ward increased. Increased hand hygiene, using protective apparel or increased disinfection practices separately or in bundles are the most cost-saving interventions for the control and containment of a norovirus outbreak.

Uterine müllerian adenosarcoma with sarcomatous overgrowth and lung metastasis in a 25-year-old woman

Uterine müllerian adenosarcoma with sarcomatous overgrowth (MASO), uncommon in premenopausal women, is a rare variant of uterine adenosarcomas characterized by a sarcomatous portion constituting >25% of the tumor. Uterine MASO often appears as a benign, protruding cervical polyp. However, in contrast to typical müllerian adenosarcomas (MAs), MASO is a highly aggressive tumor, frequently associated with a fatal outcome. Though very rare in premenopausal women, because of the high aggressiveness and malignant potential, uterine MASO should be considered, even in women of a young age with benign-appearing polypoid masses, and treated aggressively at the time of initial diagnosis without delay. We present herein a case of uterine MASO in a 25-year-old woman with lung metastasis who was lost to follow-up for one month after the initial diagnosis had been established.

Altitude mountain sickness among tourist populations: a review and pathophysiology supporting management with hyperbaric oxygen

In the mountain climbing community, conventional prevention of altitude mountain sickness (AMS) relies primarily on a formal acclimatization period. AMS symptoms during mountaineering climbs are managed with medication, oxygen and minor recompression (1524-2438 m altitude) using a portable chamber, such as the Gamow Bag. This is not always an acceptable therapy alternative in a predominantly elderly tourist population. The primary problem with reduced pressure at high altitude is hypoxaemia, which causes increased sympathetic activity, induces pulmonary venous constriction, while increasing pulmonary blood flow and regional perfusion. Rapid assents to altitude contribute to an increased incidence of decompression sickness (DCS). The treatment of choice for DCS is hyperbaric oxygenation, thus, treatment of high-altitude induced hypoxaemia using hyperbaric oxygenation (HBO(2)) is logical. Life Support Technologies group and the Center for Investigation of Altitude Medicine (CIMA, in Cusco, Peru) propose a comprehensive and multidisciplinary approach to AMS management. This approach encompasses traditional and advanced medical interventions including the use of a clinical HBO(2) chamber capable of recompression to three times greater than sea level pressure (3 atmosphere absolute (ATA)). The system uses a series of AMS hyperbaric treatment profiles that LST has previously developed to the US military and NASA, and that take greater advantage of vasoconstrictive effects of oxygen under true hyperbaric conditions of 1.25 ATA. These profiles virtually eliminate AMS rebound after the initial treatment often seen in conventional AMS treatment, where the patient is either treated at altitude, or does not recompress back to sea level or greater pressure (1.25 ATA), but returns directly to the same altitude where AMS symptoms first manifested.

Possible application of hyperbaric oxygen technology in the management of urogenital and renal diseases

The purpose of this report is to explore possible therapeutic use of hyperbaric oxygen (HBO(2)) technology on renal and urogenital diseases. HBO(2) reduces inflammation, immunity and inflammatory cytokines, stimulates wound repair and angioneogenesis, maintains tissue oxygenation, increases antioxidant enzymes and heals tissue hypoxia and radionecrosis. A literature review of peer-reviewed articles that address HBO(2), genitourological diseases, renal disease, and dialysis was performed. The paper reviews complications of renal diseases, dialysis, clinical applications of HBO(2), and effect of HBO(2) on renal and urogenital diseases. HBO(2) was used successfully to treat calcific uraemic arteriolopathy, and in many cases of acute renal failure. This technique is particularly useful in the treatment of intractable haemorrhagic cystitis secondary to pelvic radiation therapy and Fournier's gangrene. Clearly HBO(2) might play a role in the management of urogenital diseases, urinary bladder dysfunction and diseases, testicular pathology, renal diseases, and post-traumatic ischaemic injury and/or impaired wound healing and infections. The possible role of HBO(2) for autoimmune diseases, uraemic osteodystrophy or neuropathy due to chronic renal diseases is discussed. The clinical application of this technology is expanding and the various biological influences of HBO(2) encourage testing its possible benefit in renal and urological diseases.

Derivation of embryonic germ cells from post migratory primordial germ cells, and methylation analysis of their imprinted genes by bisulfite genomic sequencing

The embryonic germ cell (EGCs) of mice is a kind of pluripotent stem cell that can be generated from pre- and post-migratory primordial germ cells (PGCs). Most previous studies on DNA methylation of EGCs were restricted to 12.5 days post coitum (dpc). This study was designed to establish and characterize murine EGC lines from migrated PGCs as late as 13.5 dpc and to estimate the degrees of methylation of their imprinted genes as well as of the non-imprinted locus, Oct4, using an accurate and quantitative method of measurement. We established five independent EGC lines from post migratory PGCs of 11.5-13.5 dpc from C57BL/6xDBA/2 F1 hybrid mouse fetuses. All the EGCs exhibited the typical features of pluripotent cells including hypomethylation of the Oct4 regulatory region. We examined the methylation status of three imprinted genes; Igf2, Igf2r and H19 in the five EGC lines using bisulfite genomic sequencing analysis. Igf2r was almost unmethylated in all the EGC lines irrespective of the their sex and stage of isolation; Igf2 and H19 were more methylated than Igf2r, especially in male EGCs. Moreover, EGCs derived at 13.5 dpc exhibited higher levels of DNA methylation than those from earlier stages. These results suggest that in vitro derived EGCs acquire different epigenotypes from their parental in vivo migratory PGCs, and that sex-specific de novo methylation occurs in the Igf2 and H19 genes of EGCs.

Linker-free directed assembly of high-performance integrated devices based on nanotubes and nanowires

Advanced electronic devices based on carbon nanotubes (NTs) and various types of nanowires (NWs) could have a role in next-generation semiconductor architectures. However, the lack of a general fabrication method has held back the development of these devices for practical applications. Here we report an assembly strategy for devices based on NTs and NWs. Inert surface molecular patterns were used to direct the adsorption and alignment of NTs and NWs on bare surfaces to form device structures without the use of linker molecules. Substrate bias further enhanced the amount of NT and NW adsorption. Significantly, as all the processing steps can be performed with conventional microfabrication facilities, our method is readily accessible to the present semiconductor industry. We use this method to demonstrate large-scale assembly of NT- and NW-based integrated devices and their applications. We also provide extensive analysis regarding the reliability of the method.

Cactus mild mottle virus is a new cactus-infecting tobamovirus

A new cactus-infecting tobamovirus, Cactus mild mottle virus (CMMoV), was isolated from diseased grafted cactus, Gymnocalycium mihanovichii and its molecular properties were characterized. CMMoV is distantly related to known species of the genus Tobamovirus on the basis of serological and sequence analyses. Western blot analysis showed that CMMoV is serologically unrelated to Sammon's Opuntia virus, which is the only known species of the genus Tobamovirus found in cactus plants. The 3'-terminal 2,910 nucleotides of CMMoV have been sequenced. The coat protein (CP) and movement protein (MP) genes encode 161 and 306 amino acids residues, respectively, and the 3' untranslated region (UTR) consists of 229 nucleotides long. The nucleotide and amino acid sequences of the CP of CMMoV were 39.6% to 49.2% and 25.8% to 40.3% identical to other seventeen tobamoviruses, respectively. The MP shared 34.9% to 40.6% and 16.3% to 27.0% and 44.6% to 63.4% identities, respectively, at the amino acid and nucleotide levels with other members of the genus. Percentage identities of nucleotides of the 3' UTR ranged from 42.5% to 63.4%. Phylogenetic tree analyses of the CP and MP suggest the existence of the fifth cactus-infecting subgroup in the genus Tobamovirus. Sequence analyses of these two viral proteins revealed that the highest amino acid sequence identity between the virus and seventeen other tobamoviruses was 40.6%, supporting the view that CMMoV is a new definite species of the genus Tobamovirus.

Genome structure and complete sequence of genomic RNA of Daphne virus S

The complete genomic nucleotide sequence and structure of Daphne virus S (DVS), a daphne-infecting member of the genus Carlavirus, were determined. The genome of DVS was 8,739 nucleotides long, excluding the poly (A) tails. The genome of DVS contained six open reading frames coding for proteins of Mr 227 kDa (viral replicase), 25 kDa, 11 kDa and 7 kDa (triple gene block TGB) proteins 1, 2 and 3), 35 kDa (coat protein; CP), and 12 kDa from the 5' to 3' ends; respectively. This is the typical genome structure of members of the genus Carlavirus. Overall amino acid sequence similarities for the six ORFs of DVS were from 58.5% to 13.2% to those of the other carlaviruses. The 227 kDa replicase of DVS shared 45.5-39.2% amino acid similarities to that of 8 other known carlaviruses. Results from phylogenetic analyses of viral replicases and CPs demonstrated that DVS is a close relative of Helenium virus S and Chrysanthemum virus B. A total of 13 isolates of DVS shared 100-95.9% identities for the amino acid level and 99.5-81.0% identities for the nucleotide level. This is the first report of the complete genome sequence and structure of DVS and supports the conclusion that DVS is a typical species of the genus Carlavirus.

Effect of lumbar sympathectomy on muscle blood flow: distribution of perfusion measured by hydrogen clearance in skeletal muscle

Measurements of local tissue blood flow using a technique of hydrogen clearance were used to examine the effect of lumbar sympathectomy on skeletal muscle blood flow. Polarographic recordings on 25 hydrogen desaturations were obtained with platinized platinum electrodes. Lumbar sympathectomies were done on five canines leaving the contralateral limb as a control. The hydrogen clearance data were modeled with biexponential curves: the initial rapid component and the second slow component yielded a weighted average perfusion through tissue. Average volumetric blood flow in the control limb was 6.08 +/- 0.45 ml/min/100 g tissue while the sympathectomized limb averaged 9.54 +/- 0.61 ml/min/100 g tissue (p less than 0.005). Average blood flow increases ranged from 33 to 83 percent in the sympathectomized limb over the control limb. This significant increase in muscle blood flow following lumbar sympathectomy, if of prolonged duration, may be cause for re-evaluation of the role of sympathectomy in the management of arteriosclerotic occlusive disease.

Characterization of the 3'-terminal nucleotide sequence of two Korean isolates of Daphne virus S support its placement as a distinct species of the genus Carlavirus

This study determined the 3'-terminal nucleotide sequences of two Korean isolates of Daphne virus S (DVS), a tentative member of the genus Carlavirus, causing leaf distortion and chlorotic spot disease symptoms in daphne plants. The 3'-terminal 1,465 nucleotide sequences of the two isolates contained two open reading frames coding for proteins of 36 kDa viral coat protein (CP) and 12 kDa from the 5'-3' end, which is a typical genome structure of the 3'-terminal region of carlaviruses. Both DVS isolates were 98.1% and 93.6% amino acid identical in the CP and 12 kDa, respectively. The CP gene of DVS shares 25.2-55.2% and 42.9-56.1% similarities with that of 19 other carlaviruses at the amino acid and nucleotide levels, respectively. The 3'-proximal 12 kDa gene of DVS shares 20.2-57.8% amino acid identities with that of 18 other members of the genus. The 3' noncoding region of DVS consists of 73 nucleotides with long excluding poly A tract, and shares 69.1-77.1% identities to the known carlaviruses. In the phylogenetic analyses of the two proteins, DVS was closely related to Helenium virus S and Chrysanthemum virus B. This is the first sequence information for the DVS, and further confirms the classification of DVS as a distinct member of the genus Carlavirus.

Induction of cytochrome P450 1A1 gene expression by a vitamin K3 analog in mouse hepatoma Hepa-1c1c7 cells

Nine vitamin K3 analogs were compared with respect to the induction of the cytochrome P450 1A1 (CYP1A1) expression in mouse hepatoma Hepa-1c1c7 cells. 6-(4-Diethylamino)phenyl-7-chloro-5,8-quinolinedione (EA4) caused a significant induction of the CYP1A1-mediated ethoxyresorufin O-deethylase activity in a time- and concentration-dependent manner. The induction was accompanied by an increase of the Cyp1a1 mRNA transcription. The transient expression of the mouse Cyp1a1-CAT gene into cells showed that EA4 induced CAT activity. However, the aryl hydrocarbon receptor and its nuclear partner, aryl hydrocarbon receptor nuclear translocator mRNA transcription, were unaffected by the EA4 treatment. When the cells were incubated with EA4 in the presence of 1 nM TCDD, the ethoxyresorufin O-deethylase activity that was induced by TCDD was significantly suppressed by EA4. Inhibition of protein synthesis by cycloheximide strongly enhanced the EA4-dependent Cyp1a1 mRNA expression. Up-regulation of protein kinase C by a 2 h preincubation with phorbol 12-myristate 13-acetate increased the EA4-dependent expression of the Cyp1a1 gene. In human cells, such as HepG2 (human hepatocarcinoma), MCF-7 (human breast adenocarcinoma cell line), and HL-60 (human promyelocytic cell line), the expression of CYP1A1 mRNA was also induced by EA4 treatment. Moreover, CYP1B1 mRNA was increased by EA4 in MCF-7 cells. These results indicate that EA4 modulates CYP1A1 and CYP1B1 expressions by transcriptional activation. Also, protein kinase C may be involved in the induction mechanism of CYP1A1 by EA4.

Nutritional disorders among workers in North China during national turmoil

Previously undescribed disorders of nutrition of thiamin, niacin and pyridoxin were observed among the poor people of North China during periods of prolonged deprivation. These disorders were often elicited or exacerbated by physical exertion. Thiamin deficiency syndromes included great toe pain, heel pain, temporomandibular joint click, and painful click of the knee. Syndromes of niacin deficiency included pellagral scrotal dermatitis, hypersecretion of ear wax, and night terrors. Episodic nocturnal motor hyperfunction was caused by pyridoxin deficiency. Several cases with cardiovascular diseases were observed in which nutritional debt appeared to occur simultaneously with oxygen debt following severe physical labor. Intramuscular thiamin HCl ameliorated symptoms of impending stroke. Persons with the same symptoms who did not receive thiamin progressed to fatal stroke.

In vitro development of reconstructed bovine embryos and fate of donor mitochondria following nuclear injection of cumulus cells

In this study we examined the developmental potential of reconstructed embryos and the fate of donor mitochondria during preimplantation development after nuclear transfer in cattle. Isolated cumulus cells were used as donor cells in nuclear transfer. Cumulus cells labelled with MitoTracker Green FM fluorochrome were injected into enucleated bovine MII oocytes and cultured in vitro. MitoTracker labelling on donor cells did not have a detrimental effect on blastocyst formation following nuclear transfer. Cleavage rate was about 69% (56/81) and blastocyst formation rate was 6.2% (5/81) at 7 days after nuclear transfer. The labelled mitochondria dispersed to the cytoplasm and became distributed between blastomeres and could be identified up to the 8- to 15-cell stage. Small patches of mitochondria were detected in some 8- to 15-cell stage embryos (5/20). However, donor mitochondria were not detected in embryos at the 16-cell stage and subsequent developmental stages. In the control group, mitochondria could be identified in arrested 1-cell embryos up to 7 days after nuclear transfer. These results suggest that disappearance of the labelled donor mitochondria in nuclear transfer bovine embryos is not due to fading of the fluorochrome marker, but is rather an as yet undefined cytoplasmic event.

Frequencies of fetal chromosomal abnormalities at prenatal diagnosis: 10 years experiences in a single institution

We present frequencies of fetal chromosomal abnormalities in 4,907 prenatal cytogenetic examinations at Samsung Cheil Hospital from 1988 to 1997 for 10 yr duration. Prenatal karyotypes were undertaken in 3,913 amniotic fluid samples, 800 chorionic villi samples, and 194 percutaneous umbilical blood samples. The frequency of fetal abnormal karyotypes was 3.1% (150 cases). Numerical chromosome abnormalities were 87 cases (1.8%) and structural aberrations of chromosomes were 63 cases (1.3%). In the numerical chromosomal abnormalities, the frequency of trisomy 21 was by far the highest (36 cases), followed by trisomy 18 in 22 cases and sex chromosome aneuploidies in 19 cases. In the structural chromosomal aberrations, 5 cases had the inversions in chromosome 2, 7, 17, and Y. Chromosomal deletions in 6 cases and additions in 4 cases were analysed. Of the remaining 47 translocation in abnormal fetuses, reciprocal translocation was in 26 cases and Robertsonian translocation in 21 cases. Among them, 41 cases were balanced translocation and 6 were unbalanced. Thirty five cases of translocation were inherited from one of the parents. Four had de novo chromosome rearrangements, and 8 cases were unknown.

Collection efficiency of metallic contaminants on si wafer by vapor-phase decomposition-droplet collection

The collection efficiency of metallic contaminants on four different types of silicon wafers was investigated. P, p+, n and n(+)-type polished silicon wafers were used for the substrate, and 14 metallic elements (Na, Mg, Al, K, Ca, Cr, Fe, Mn, Co, Ni, Cu, Zn, Mo and Ti) were contaminated on silicon wafer surface. Vapor-phase decomposition-droplet collection (VPD-DC) was employed as the sample preparation procedure. For the collecting solution, HNO3, HF and a mixture of HF and H2O2 were used, respectively. A liquid droplet collecting metallic contaminants during VPD-DC was analyzed by inductively coupled plasma-mass spectrometry (ICP-MS). As a result, it was found that HNO3 and HF were not suitable for collecting Cu. Copper was not collected completely in HNO3 and HF. A mixture of HF and H2O2 is the most effective to collect all of the tested metallic elements, regardless of the dopant concentration and type of substrate.

Toxoplasma gondii: ultrastructural localization of specific antigens and inhibition of intracellular multiplication by monoclonal antibodies

This experiment was focused on the characterization of anti-Toxoplasma monoclonal antibodies (mAbs) and the effect of mAbs on the parasite invasion of mouse peritoneal macrophages. Twenty eight mAbs including M110, M556, R7A6 and M621 were characterized by Ab titer, immunoglobulin isotyping and western blot pattern. Antibody titer (optical density) of 4 mAbs, M110, M556, R7A6 and M621, were 0.53, 0.67, 0.45 and 0.39 (normal mouse serum; 0.19) with the same IgG1 isotypes shown by Enzyme-linked immunosorbent assay (ELISA). Western blot analysis showed that M110, M556, R7A6 and M621 reacted with the 33 kDa (p30), 31 kDa (p28), 43 kDa and 36 kDa protein. Immunogold labelling of mAbs M110, M556, R7A6 and M621 reacted with the surface membrane, dense granules and parasitophorous vacuolar membrane (PVM), rhoptries and cytoplasm of tachyzoite, respectively. For in vitro assay, preincubation of tachyzoites with four mAbs, M110, M556, R7A6 and M621 resulted in the decrease of the number of infected macrophages (p < 0.05) and the suppression of parasite multiplication at 18 h post-infection. Four monoclonal antibodies including M110 (SAG1) were found to have an important role in the inhibition of macrophage invasion and T. gondii multiplication in vitro, and these mAbs may be suitable for vaccine candidates, diagnostic kit and for chemotherapy.

Activation of the IL-10 gene promoter following photodynamic therapy of murine keratinocytes

Photodynamic therapy (PDT), an anticancer treatment modality, has recently been shown to be an effective treatment for several autoimmune disease models including antigen-induced arthritis. PDT was found to induce the expression of IL-10 messenger RNA (mRNA) and protein in the skin, and this expression has similar kinetics to the appearance of PDT-induced suppression of skin-mediated immune responses such as the contract hypersensitivity (CHS) response. Some aspects of the UVB-induced suppression of the immune response have been linked to the induction of IL-10. IL-10 has been shown to inhibit the development and activation of Th1 cells, which are critical for many cell-mediated immune responses, including CHS. We have examined the effect of PDT and UVB irradiation on the activity of the IL-10 gene promoter and on IL-10 mRNA stability using the murine keratinocyte line, PAM 212. In vitro PDT induces IL-10 mRNA and protein expression from PAM 212 cells, which can be correlated with an increase in AP-1 DNA binding activity and activation of the IL-10 gene promoter by PDT. Deletion of an AP-1 response element from the IL-10 gene promoter was shown to abrogate the PDT-induced promoter activity indicating that the AP-1 response element is critical to IL-10 induction by PDT. In addition, PDT results in an increase in IL-10 mRNA stability, which may also contribute to the increased IL-10 expression in PAM 212 cells following PDT. In vitro UVB irradiation also results in activation of the IL-10 promoter. However, in contrast to PDT, UVB-induced activation of the IL-10 promoter is not AP-1 dependent and did not increase IL-10 mRNA stability.

Toxicity and biodegradation of products from polyester hydrolysis

Toxicity of products from polyester hydrolysis such as succinic acid (SA), adipic acid (AA), mandelic acid (MA), terephthalic acid (TA), 1,4-butanediol (1,4-B), ethylene glycol (EG), styrene glycol (SG) and 1,4-cyclohexane dimethanol (1,4-C) was evaluated by phytotoxicity test on germination of young radish seeds and by cytotoxicity test on HeLa cells. The phytotoxicity test revealed SG > MA > 1,4-C > AA approximately SA > TA approximately EG > 1,4-B in order of decreasing toxicity taking into consideration the growth behavior after germination as well as the percentage of germination. Toxicity on HeLa cells decreased in slightly different order compared to that on young radish seeds, i.e. SG > 1,4-C > MA > TA > SA > AA > EG > 1,4-B. Tests for the phytotoxicity and for cytotoxicity indicated that the aromatic compounds were more harmful than the aliphatic ones. Each group of 4 strains which grew most rapidly on each agar plate containing SA, AA, MA, TA, 1,4-B, EG, SG and 1,4-C respectively as a sole carbon source was identified by the fatty acid methyl esters analysis. The modified Sturm test was carried out using the single isolated strain, an activated sludge or a mixed soil to measure the rate of mineralization of the compounds into carbon dioxide. The aliphatic compounds were mineralized more easily than the aromatic compounds. 1,4-C showed the most exceptionally slow degradation. A scrutiny of residual 1,4-C after degradation is required before polyesters containing 1,4-C could be classified into compostable because 1,4-C has detrimental effects on young radish seeds and HeLa cells and has a tendency to accumulate in the environment due to its slow degradability.

Mycobacterium tuberculosis and Legionella pneumophila phagosomes exhibit arrested maturation despite acquisition of Rab7

Rab7 is a small GTPase that regulates vesicular traffic from early to late endosomal stages of the endocytic pathway. Phagosomes containing inert particles have also been shown to transiently acquire Rab7 as they mature. Disruption in the pathway prior to the acquisition of Rab7 has been suggested as playing a role in the altered maturation of Mycobacterium bovis BCG phagosomes. As a first step to determine whether disruption in the delivery or function of Rab7 could play a role in the altered maturation of Legionella pneumophila and M. tuberculosis phagosomes, we have examined the distribution of wild-type Rab7 and the GTPase-deficient, constitutively active mutant form of Rab7 in HeLa cells infected with L. pneumophila or M. tuberculosis. We have found that the majority of L. pneumophila and M. tuberculosis phagosomes acquire relatively abundant staining for Rab7 and for the constitutively active mutant Rab7 in HeLa cells that overexpress these proteins. Nevertheless, despite acquisition of wild-type or constitutively active Rab7, both the L. pneumophila and the M. tuberculosis phagosomes continue to exhibit altered maturation as manifested by a failure to acquire lysosome-associated membrane glycoprotein 1. These results demonstrate that L. pneumophila and M. tuberculosis phagosomes have receptors for Rab7 and that the altered maturation of these phagosomes is not due to a failure to acquire Rab7.

Assessment of Nipah virus transmission among pork sellers in Seremban, Malaysia

Between September 1998 and May 1999, 265 cases of encephalitis were reported from among those involved in pig rearing. A few cases were also reported among abattoir workers. This raised questions of the risk of transmission among those who handled raw pork. A serosurvey was conducted among pork sellers in Seremban town, which is about 20 km from one of the pig rearing areas which had reported cases of encephalitis. It was found that out of the 28 pork sellers tested, only one tested positive for Nipah virus antibodies and that this pork seller also worked in an abattoir in the same district, removing the urinary bladders from slaughtered pigs. Based on these findings, it was concluded that the risk of transmission of the virus from handling raw pork appeared to be low.

Deviant expression of Rab5 on phagosomes containing the intracellular pathogens Mycobacterium tuberculosis and Legionella pneumophila is associated with altered phagosomal fate

The intracellular human pathogens Legionella pneumophila and Mycobacterium tuberculosis reside in altered phagosomes that do not fuse with lysosomes and are only mildly acidified. The L. pneumophila phagosome exists completely outside the endolysosomal pathway, and the M. tuberculosis phagosome displays a maturational arrest at an early endosomal stage along this pathway. Rab5 plays a critical role in regulating membrane trafficking involving endosomes and phagosomes. To determine whether an alteration in the function or delivery of Rab5 could play a role in the aberrant development of L. pneumophila and M. tuberculosis phagosomes, we have examined the distribution of the small GTPase, Rab5c, in infected HeLa cells overexpressing Rab5c. Both pathogens formed phagosomes in HeLa cells with molecular characteristics similar to their phagosomes in human macrophages and multiplied in these host cells. Phagosomes containing virulent wild-type L. pneumophila never acquired immunogold staining for Rab5c, whereas phagosomes containing an avirulent mutant L. pneumophila (which ultimately fused with lysosomes) transiently acquired staining for Rab5c after phagocytosis. In contrast, M. tuberculosis phagosomes exhibited abundant staining for Rab5c throughout its life cycle. To verify that the overexpressed, recombinant Rab5c observed on the bacterial phagosomes was biologically active, we examined the phagosomes in HeLa cells expressing Rab5c Q79L, a fusion-promoting mutant. Such HeLa cells formed giant vacuoles, and after incubation with various particles, the giant vacuoles acquired large numbers of latex beads, M. tuberculosis, and avirulent L. pneumophila but not wild-type L. pneumophila, which consistently remained in tight phagosomes that did not fuse with the giant vacuoles. These results indicate that whereas Rab5 is absent from wild-type L. pneumophila phagosomes, functional Rab5 persists on M. tuberculosis phagosomes. The absence of Rab5 on the L. pneumophila phagosome may underlie its lack of interaction with endocytic compartments. The persistence of functional Rab5 on the M. tuberculosis phagosomes may enable the phagosome to retard its own maturation at an early endosomal stage.

Stress fever magnitude in laboratory-maintained California ground squirrels varies with season

A previous study demonstrated that California ground squirrels (Spermophilus beecheyi) living in the natural environment had, independent of season, a significantly higher mean diurnal body temperature (T(b)) (39.6 degrees C) than either summer (37.5 degrees C) or winter (36.5 degrees C) laboratory maintained animals. Based upon the previous study it has been suggested that California ground squirrels living in the natural environment may have an elevated set-point for body temperature in a manner analogous to a stress fever response. The present study was conducted to determine if season and/or duration of laboratory open-field exposure influenced the magnitude of laboratory open-field stress fever. If stress fever was involved to some extent in the higher body temperature observed in animals from the natural environment, laboratory maintained animals should exhibit a lower magnitude stress fever during the summer months and a higher magnitude stress fever during the winter months. It was hypothesized that laboratory maintained animals would exhibit the same set-point for stress fever T(b) independent of season, and that the duration of open-field exposure would not influence the magnitude of stress fever. Adult California ground squirrels were acclimated to an ambient temperature of 20+/-1.0 degrees C under either LD 14:10 (summer) or LD 10:14 (winter) photoperiod conditions and individuals from both photoperiod conditions were exposed for periods of 2, 4, and 6 h to an open-field arena. An analysis of the data with a two-factor ANOVA demonstrated that season (photoperiod) significantly influenced the magnitude of the stress fever response (1.1+/-0.1 degrees C for summer animals; 2.1+/-0.2 degrees C for winter animals) while there was no significant influence of open-field exposure duration on stress fever magnitude. These results demonstrate that although the set-point for body temperature in unstressed laboratory maintained California ground squirrels varies with season, the set-point for body temperature in open-field stressed animals does not vary with season. These data lend support to the hypothesis that something like stress fever may play some role in the higher body temperature observed in California ground squirrels living in the natural environment.