Severe myocardial bridge presenting as paroxysmal atrioventricular block

Chest pain complicated with electrocardiographic changes is not an uncommon scenario in emergency departments, which should be examined cautiously. We describe a 51-years-old man with a myocardial bridge of coronary artery presenting with simultaneous Mobitz type I atrioventricular block on electrocardiography. Echocardiography excluded valvular abnormality and systolic/diastolic dysfunction. Coronary angiography confirmed the diagnosis of a myocardial bridge at the middle segment of the left anterior descending artery, involving the most dominant septal perforator branch with marked systolic compression. The patient underwent coronary artery bypass grafting surgery and was followed up uneventfully at the outpatient department with medical treatment of diltiazem and clopidogrel. The present case is being reported to highlight that clinicians should be alert to such a congenital abnormality as a potential cause of repeated myocardial infarction and conduction abnormality.

Attempted suicide by poisoning of self-prepared arsenic trioxide solution

Introduction:

Arsenic is a traditional poison that has a history extending back to ancient times.

Case presentation:

A 43-year-old male presented to our Emergency Department 50 min after ingestion of 300 mL self-prepared arsenic trioxide solution (砒霜). He produced the solution from heating xionghuang (雄黃), an arsenic sulfide mineral (As4S4) which is a Chinese herb, for academic purposes a few years ago.

Discussion:

Supportive care including fluid replacement and decontamination with gastric lavage and chelation therapy with intravenous dimercaptopropanesulphonate sodium was given to patient. Spot urine arsenic to creatinine ratio significantly decreased from 343,124 nmol/mmol (day 3) to 7116 nmol/mmol (day 5). He had an uneventful course without any neurological deficit.

Conclusions:

Treatment of acute arsenic poisoning includes supportive care, decontamination, and chelation therapy. DMPS is an antidote for arsenic poisoning and its use should be directed by clinical status and urinary arsenic excretion.

Metabolic Acidosis Complicating Ingestion of Disinfectant Floor Cleaner Containing Butoxyethanol

Butoxyethanol intoxication has seldom been reported. We describe a case of ingestion of butoxyethanol-containing cleaner resulting in high anion gap metabolic acidosis, which resolved after treatment with ethanol and haemodialysis. The presentations and treatments of previous cases are highlighted. Discussion is centred on the toxicological pathway of butoxyethanol and the role of alcohol dehydrogenase inhibitor.

Comparison of Mortality among Severe Trauma Patients Treated in a Trauma Centre versus a Non-Trauma Centre

Introduction

In Taiwan, patients with major trauma are often sent to the closest non-trauma centre for initial resuscitation and transferred to distant trauma centres subsequently. This study aimed to evaluate the in-hospital mortality of severe trauma patients treated in a trauma centre versus in a non-trauma centre.

Methods

This prospective observational study reviewed 223 patients with major trauma (defined as Injury Severity Scale [ISS] score >15) who visited either a Level I trauma centre or a non-trauma centre from April 2013 to March 2014. Data of clinical status, trauma mechanisms, laboratory and radiology, interventions, and mortality/survival were evaluated. Logistic regression analysis was performed to assess effects of initial hospital treatment on mortality.

Results

A total of 158 major trauma patients were taken to the trauma centre hospital, and 65 patients were taken to the non-trauma centre. Age > 70 years (odds ratio [OR] 6.24, 95% confidence interval [CI] 1.01 to 38.62, compared to age ≤40 years), Glasgow Coma Scale [GCS] 3-8 (OR 19.00, 95% CI 2.30-157.01, compared to GCS 13-15), GCS 9-12 (OR 28.88, 95% CI 4.40-189.86, compared to GCS 13-15), ISS score >25 (OR 6.95, 95% CI 1.27-38.08) and taken to non-trauma centre initially (OR 30.90, 95% CI 5.00-191.27) were significantly associated with mortality.

Conclusion

Initial treatment of patients with major trauma in a non-trauma centre was associated with increased mortality compared to initial treatment in a trauma centre.

Bleeding Pelvic Fractures: Updates and Controversies in Acute Phase Management

Background

The management of patients with haemodynamic instability related to pelvic fractures is a major challenge with high mortality and morbidity. The treatment priorities have long been a source of debate. Many advocate emergent external fixation (EX-FIX) as the first line of treatment, whereas another school favours the efficacy of transcatheter arterial embolisation (TAE). Decision-making within the ‘Golden Hour’ in the emergency department (ED) is crucial to patients' ultimate outcome. Our aim was to evaluate the current management pathways in our centre and to review the latest literature.

Methods

We present a 2-year case series (from January 2005 to December 2006) of patients with pelvic ring disruption and haemodynamic instability. Data were collected regarding patients' demographics, fracture patterns according to the Young & Burgess classification, concomitant intra-abdominal injuries, treatment pathway and the response to treatment.

Results

There were 7 patients identified. Five were males and 2 were females, with a mean age of 42 years. Fracture types included 3 lateral compression, 1 anteroposterior compression, 2 vertical shear, and 1 combined mechanism. Four patients had significant intraperitoneal haemorrhage identified by Focused Assessment by Sonography for Trauma (FAST). They all needed laporotomy and pelvic packing, initially or subsequently. EX-FIXs were offered to 6 patients as the primary intervention, and 4 of them subsequently required diagnosis with angiography followed by therapeutic embolisation to restore haemodynamic stability. Only 1 patient underwent a second angiographic study to control the arterial bleeding. Two patients died of severe intra-abdominal injuries within 24 hours after admission.

Conclusion

In patients with pelvic fractures and hypotension, EX-FIX is currently the first line of treatment, with variable efficacy. On the other hand, the high successful embolisation rate and reasonable safety profile of TAE in our patients have been impressive. The latter offers a much better alternative to surgical intervention in selected patients. However, precautions should be taken including proper pelvic stabilisation by non-invasive devices, creation of a safe environment in the angiography suite, and early multidisciplinary decision in the ED.

The Use of Glucagon and other Antidotes in a Case of Beta-Blocker and Calcium Channel Blocker Overdose

We report a case of metoprolol and nifedipine overdose complicated by hypotension which responded to intravenous boluses of calcium chloride and glucagon. The blood pressure was subsequently stabilised by continuous glucagon infusion with the aid of an insulin-dextrose drip. The discussion is focused on the role of antidotes and catecholamine inotropes in the management of beta-blocker and calcium channel blocker poisoning.

Work-Related Crushing Injuries with Amputations of Digits, Hands and Forearms

Objective

To review work-related crushing injuries leading to amputation of digits, hands and forearms, by focusing on patients' demographics, and clinical outcomes.

Design

Retrospective descriptive study.

Setting

Regional hospital, Hong Kong.

Patients

Patients with work-related crushing injuries causing amputation of digits, hands or forearms admitted to hospital for treatment from January 2003 to August 2005.

Methods

Patients' age, sex, past medical history, occupations, context of injuries including injuring objects and levels of amputation were studied. During a 9-month follow up period, patients' need for urgent operation, length of hospital stay, duration of sick leave and change of occupational status were analysed.

Results

Eighty-eight patients were studied. The age distribution ranged from 19 to 81 years, with 50% being less than 40 years of age. Most patients (93%) were healthy adult before the injury. Industries frequently involved were construction (24%), manufacturing (17%) and transportation (14%). Machineries and metallic tools were the most common injuring objects. Eighty-four percent of the amputation injuries involved the finger(s), and 13% the thumb. Most patients (91%) required urgent operation. The mean length of hospital stay was 4 days. The mean duration of sick leave was 152 days. The estimated wage loss was around HK$145,000 per accident. Only 42% of the patients could fully resume working without job restriction.

Conclusion

Traumatic amputation as a severe work-related injury is common in Hong Kong. It frequently affects the young and healthy workforce, resulting in devastating physical and psychological disabilities. The clinical, social and economical significances are enormous and far-reaching.

Dramatic band gap reduction incurred by dopant coordination rearrangement in Co-doped nanocrystals of CeO2

A dramatic band gap narrowing of 1.61 eV has been observed in Co-doped nanocrystals of CeO₂ (ceria), as a result of thermal annealing, without changing the ceria crystal structure and the Co concentration. As demonstrated by x-ray absorption fine structures, thermal annealing incurs an oxygen coordination rearrangement around Co atoms from an octahedral coordination to a square-planar coordination. First principle calculation using density functional theory reveals two stable oxygen coordination types surrounding Co, consistent with the experimental observation. The band gap values calculated for the two stable coordination types differ dramatically, reproducing the experimentally observed band gap narrowing. These prominent effects due to local structure rearrangement around dopant atoms can lead to unprecedented methods for band gap engineering in doped nanocrystal oxides.

Effects of lipid form and source on digestibility of fat and fatty acids in growing pigs

The objective of this study was to compare the effect of source (corn DDGS, rice bran, or soybean) or form of oil (extracted or intact) on apparent total tract digestibility (ATTD) and true total tract digestibility (TTTD) of acid-hydrolyzed ether extract (AEE) and fatty acids. The study determined and compared the ATTD or TTTD of AEE and fatty acids in extracted corn oil, rice oil, and soybean oil with intact oil in corn DDGS, full-fat rice bran, and full-fat soybean. Seventy-eight barrows (initial BW = 47.2 ± 3.9 kg; Duroc × Landrace × Yorkshire) were allotted to 1 of 13 dietary treatments in a randomized complete block design with 6 barrows in each dietary treatment. The 13 experimental diets included 1 cornstarch-soybean meal basal diet (AEE, 0.56%) and 3 diets containing 6% extracted oils (corn oil, rice oil, and soybean oil) and 9 diets supplemented with 3 levels of corn DDGS (17%, 34%, and 51%), full-fat rice bran (14%, 28%, and 42%), and full-fat soybean (12%, 24%, and 36%). These diets provided about 2%, 4%, and 6% intact oil, respectively. The barrows were housed in individual metabolism crates and were fed the assigned test diets at 4% of initial BW per day. A 5-d total collection of feces followed a 7-d diet adaptation period. The ATTD of AEE were calculated for each diet. The endogenous flow of AEE associated with each ingredient and values for TTTD were calculated using regression methods. The ATTD of AEE were greater ( < 0.05) for extracted oil than for intact oil. Compared to extracted oil, intact oil had lower ( < 0.01) ATTD of palmitic acid (C16:0), stearic acid (C18:0), oleic acid (C18:1), linoleic acid (C18:2), and linolenic acid (C18:3). However, a source by form interaction ( < 0.01) was observed for ATTD of C18:0, C18:2, and C18:3. The ATTD of C18:0, C18:2, and C18:3 in extracted corn and rice oil were greater compared with intact corn DDGS and rice oil ( < 0.05), while there was no significant difference for the ATTD of C18:0, C18:2, and C18:3 between extracted soybean oil and intact oil in full-fat soybean. In conclusion, lipids that are extracted have a greater digestibility compared with intact lipids, and this is especially true regarding saturated fatty acids. The ATTD of AEE in 2 forms of rice oil (intact oil and extracted oil) was less than the values in corn oil and soybean oil. The TTTD of AEE in corn DDGS and full-fat soybeans were greater than in full-fat rice bran.

Social Cooperation and Disharmony in Communities Mediated through Common Pool Resource Exploitation

It was theorized that when a society exploits a shared resource, the system can undergo extreme phase transition from full cooperation in abiding by a social agreement, to full defection from it. This was shown to happen in an integrated society with complex social relationships. However, real-world agents tend to segregate into communities whose interactions contain features of the associated community structure. We found that such social segregation softens the abrupt extreme transition through the emergence of multiple intermediate phases composed of communities of cooperators and defectors. Phase transitions thus now occur through these intermediate phases which avert the instantaneous collapse of social cooperation within a society. While this is beneficial to society, it nonetheless costs society in two ways. First, the return to full cooperation from full defection at the phase transition is no longer immediate. Community linkages have rendered greater societal inertia such that the switch back is now typically stepwise rather than a single change. Second, there is a drastic increase in social disharmony within the society due to the greater tension in the relationship between segregated communities of defectors and cooperators. Intriguingly, these results on multiple phases with its associated phenomenon of social disharmony are found to characterize the level of cooperation within a society of Balinese farmers who exploit water for rice production.

Concentrations of minerals in pig feed ingredients commonly used in China

Mineral concentrations were determined in 13 different feed ingredients commonly used in swine diets. Ingredients included corn and 4 corn co-products: corn gluten feed, corn gluten meal, corn germ meal, and corn distillers dried grains with solubles (DDGS). Wheat, wheat bran, and wheat shorts were also included, and 5 oilseed meals including soybean meal, rapeseed meal, sunflower meal, cottonseed meal, and peanut meal were used as well. Corn grain contained 88.7% dry matter (DM) and 0.46% K (DM basis). Greater concentrations of DM, ash, Ca, P, nonphytate P, Cu, Fe, Mn, and Zn were observed in corn gluten feed, corn DDGS, and corn germ meal compared with corn grain (P < 0.05). In general, minerals in corn DDGS were approximately three times greater than in corn grain and about 90% of the total P in corn DDGS was in the nonphytate bound form. Corn gluten meal had the least concentrations (P < 0.05) of most minerals, but the greatest (P < 0.05) concentrations of Fe (373.55 mg/kg, DM basis), Cu (11.88 mg/kg, DM basis), and Se (0.92 mg/kg, DM basis). On a DM-basis, concentrations of DM, Ca, P, phytate bound P, and Fe in wheat grain were 88.2%, 0.10%, 0.34%, 0.16%, and 53.48 mg/kg, respectively. Wheat bran contained more (P < 0.05) K, Mg, Cl, Fe, Zn, and Mn compared with wheat and wheat shorts. On a DM-basis, 2.72% K was observed in soybean meal, which was more (P < 0.05) than in the other oilseed meals. However, rapeseed meal had the greatest (P < 0.05) concentration of ash (9.37%), Ca (1.01%), P (1.05%), and Fe (526.49 mg/kg) among the oilseed meals, but only 16.2% of the total P in rapeseed meal was non-phytate P. In contrast, more than 50% of the P in soybean meal and peanut meal was non-phytate P. The least (P < 0.05) concentration of Cu (6.73 mg/kg, DM basis) was observed in rapeseed meal and the greatest (P < 0.05) concentration (32.75 mg/kg) was analyzed in sunflower meal. Concentrations of most minerals in soybean meal, rapeseed meal, sunflower meal, cottonseed meal, and peanut meal varied considerably compared with published values. In conclusion, the concentration of minerals in 13 commonly used feed ingredients were analyzed and results indicated considerable variation among and within feed ingredients for most minerals, which for some minerals may be a result of differences in minerals in the soil in which the ingredients were grown, but processing likely also contributes to differences among ingredients.

Energy content and amino acid digestibility of flaxseed expellers fed to growing pigs

This study was conducted to determine the DE and ME as well as the apparent ileal digestibility (AID) and standardized ileal digestibility (SID) of CP and AA in flaxseed expellers fed to growing pigs. In Exp. 1, the DE and ME were determined using 66 crossbred growing pigs (Duroc × Landrace × Yorkshire; 54.2 ± 2.3 kg BW) fed 1 of 11 diets in a completely randomized design. The diets included a corn-soybean meal basal diet and 10 experimental diets containing 29.16% flaxseed expellers supplemented at the expense of corn and soybean meal. In Exp. 2, 11 growing pigs (35.5 ± 3.4 kg), fitted with a T-cannula at the distal ileum, were assigned to 6 × 11 Youden square design with 6 periods and 11 diets. The diets included a N-free diet based on cornstarch and sucrose and 10 test diets containing 40% flaxseed expellers as the sole source of AA. Chromic oxide (0.3%) was used as an indigestible marker. There was considerable variation in the chemical composition among the 10 flaxseed expellers. The CV were greater than 10% for ether extract (EE), NDF, ADF, crude fiber, and Ca and ranged from 7 to 12% for the AA. On a DM basis, the DE and ME ranged from 2,786 to 3,730 and from 2,588 to 3,530 kcal/kg, respectively. The apparent total tract digestibility of GE ranged from 59.91 to 75.83% (mean = 70.92%). Ether extract, GE, and NDF were the best predictors to determine DE and ME. The best prediction equations were DE = -3,231 + (1.58 × GE) - (25.79 × % NDF) ( = 0.90) or DE = 4,189 + (56.78 × % EE) - (30.59 × % NDF) ( = 0.85) and ME = -2,968 + (1.47 × GE) - (24.82 × % NDF) ( = 0.85) or ME = 3,931 + (53.77 × % EE) - (29.31 × % NDF) ( = 0.82), respectively. In Exp. 2, there were significant differences in the AID and SID of CP and all AA with the exception of Phe ( < 0.05). The AID and SID of CP averaged 70.16 and 78.04%, respectively. For the indispensable AA, the AID and SID of Thr were the least, with average values of 70.70 and 76.68%, respectively. The digestibility of Arg and Met were the greatest, averaging over 88 and 91% for AID and SID, respectively. The AID and SID of Lys ranged from 66.10 to 81.82% (mean = 74.14%) and from 70.90 to 85.41% (mean = 78.13%), respectively. These results indicate that there is significant variability in chemical composition, energy content, and the SID and AID of CP and AA among the selected flaxseed expellers. The DE and ME of flaxseed expellers are primarily related to their EE and NDF concentrations.

The Nutritive Values in Different Varieties of Corn Planted in One Location Fed to Growing Pigs over Three Consecutive Years

This experiment was conducted to determine the effect of variety and planting year on the nutritive values of corn fed to growing pigs. Four corn varieties examined in this experiment were planted in the same village located in Longhua County, Heibei Province, China, in 2012, 2013, and 2014, respectively. During each year, corn was hand-harvested in early October and sun dried to about 14% moisture content. Three batches of twenty-four barrows (33.27±4.30, 31.88±2.93, 34.21±3.81 kg body wight [BW] in 2012, 2013, and 2014, respectively) were used and allotted to a complete block design with 4 diets and 6 replicate pigs per diet. Pigs were individually placed in metabolic crates. The four experimental diets were formulated by mixing each variety of corn and vitamins and minerals, respectively. A five-day collection period followed a seven-day diet acclimation period. The results indicated that variety of corn significantly influenced the available energy content (digestible energy [DE] on dry matter basis, p<0.05; metabolizable energy (ME) on dry matter basis, p<0.05, respectively), and the apparent total tract digestibility (ATTD) of organic matter (p<0.01), dry matter (p<0.05), gross energy (p<0.05), neutral detergent fiber (p<0.01), acid detergent fiber and ether extract (p<0.05). The planting year also significantly influenced the available energy contents (DE on dry matter basis, p<0.05; ME on dry matter basis, p<0.01, respectively) and the ATTD of neutral detergent fiber (p<0.01), acid detergent fiber (p<0.01), crude protein (p<0.01), and ether extract (p<0.01). No interaction was observed between the variety and planting year in DE and ME contents in corn. In conclusion, the variety and planting year significantly influenced the available energy and nutrient digestibility of corn fed to growing pigs.

Unconventional interplay between heterovalent dopant elements: Switch-and-modulator band-gap engineering in (Y, Co)-Codoped CeO2 nanocrystals

We report the experimental observation and theoretical explanation of an unconventional interplay between divalent Co and trivalent Y dopants, both of which incur oxygen vacancies in the CeO₂ host that has predominantly tetravalent Ce cations. The Co dopant atoms were experimentally found to act as a switch that turns on the dormant effect of Y-modulated band-gap reduction. As revealed by density functional theory (DFT) calculations with structures verified by synchrotron-radiation x-ray measurements, a Co 3d band that hybridizes with Ce 4f band was lowered due to reduced O 2p repulsion arising from oxygen vacancies incurred by Y doping and therefore gave rise to the observed band-gap narrowing effect. Such switch-and-modulator scheme for band-gap engineering in nanocrystal materials can lead to important applications in environmental protection and solar energy harvesting technologies.

Alterations in white matter micro-integrity of the superior longitudinal fasciculus and anterior thalamic radiation of young adult patients with depression

BACKGROUND

This study surveyed the characteristics of white matter (WM) micro-integrity in patients who were diagnosed with major depressive disorder (MDD) without co-morbidities.

METHOD

A total of 44 patients with MDD and 27 normal controls were enrolled in our study. Diffusion tensor imaging images of patients and controls were pre-processed and analysed to estimate differences in WM micro-integrity between patients and controls by performing comparisons of the values obtained from fractional anisotropy (FA). FA outputs of patients and controls were compared by a non-parametric permutation-based method with global brain volume, age and gender as covariates. In addition, the between-group differences of radial diffusivity (RD) and axial diffusivity (AD) were assessed to explain the alterations in FA values. Correlations between clinical variables (such as depression severity, anxiety severity, illness duration) and FA values were also estimated in each group and across both groups.

RESULTS

The patients with MDD had significantly lower FA values than the controls, for the left superior longitudinal fasciculus (SLF) and the right anterior thalamic radiation (ATR). The reductions in FA values occurred in combination with elevated RD values in the bilateral SLF and decreased AD values in the bilateral ATR. FA values were negatively correlated with depression severity in the SLF and with illness duration in the right SLF and ATR.

CONCLUSIONS

MDD patients had significant alterations in the WM micro-integrity of the left SLF and the right ATR.

Conduction control at ferroic domain walls via external stimuli

Intriguing functionalities at nano-sized domain walls have recently spawned a new paradigm for developing novel nanoelectronics due to versatile characteristics. In this study, we explore a new scenario to modulate the local conduction of ferroic domain walls. Three controlling parameters, i.e., external electrical field, magnetic field and light, are introduced to the 90° domain walls (90° DWs) of BiFeO₃. Electrical modulation is realized by electrical transport, where the mobility of 90° DWs can be altered by gating voltage. We further use the ferromagnetic/antiferromagnetic coupling to reveal the inherent magnetism at the DWs. With an established magnetic nature, magnetotransport has been conducted to introduce magnetic controlling parameter, where a giant positive magnetoresistance change can be observed up to 200%. In addition, light modulated conduction, a core factor for multifunctional applications, is successfully demonstrated (current enhancement by a factor of 2 with 11 W white lamp). These results offer new insights to discover the tunability of domain wall nanoelectronics.

Establishing the thermal threshold of the tropical mussel Perna viridis in the face of global warming

With increasing recognition that maximum oxygen demand is the unifying limit in tolerance, the first line of thermal sensitivity is, as a corollary, due to capacity limitations at a high level of organisational complexity before individual, molecular or membrane functions become disturbed. In this study the tropical mussel Perna viridis were subjected to temperature change of 0.4 °C per hour from ambient to 8-36 °C. By comparing thermal mortality against biochemical indices (hsp70, gluthathione), physiological indices (glycogen, FRAP, NRRT) and behavioural indices (clearance rate), a hierarchy of thermal tolerance was therein elucidated, ranging from systemic to cellular to molecular levels. Generally, while biochemical indices indicated a stress signal much earlier than the more integrated behavioural indices, failure of the latter (indicating a tolerance limit and transition to pejus state) occurred much earlier than the other indices tending towards thermal extremities at both ends of the thermal spectrum.

Test of genuine multipartite nonlocality without inequalities

In this Letter we propose a set of conditions on the joint probabilities as a test of genuine multipartite nonlocality without inequality. Our test is failed by all nonsignaling local models in which even nonlocal correlations among some observables (not all) are allowed as long as these correlations respect the nonsignaling principle. A pass of our test by a state therefore indicates that this state cannot be simulated by any nonsignaling local models; i.e., the state exhibits genuine multipartite nonlocality. It turns out that all entangled symmetric n-qubit (n≥3) states pass our test and therefore are n-way nonlocal. Also we construct two Bell-type inequalities from our proposed test whose violations indicate genuine multipartite nonlocal correlations.

Highly efficient beamline and spectrometer for inelastic soft X-ray scattering at high resolution

The design, construction and commissioning of a beamline and spectrometer for inelastic soft X-ray scattering at high resolution in a highly efficient system are presented. Based on the energy-compensation principle of grating dispersion, the design of the monochromator-spectrometer system greatly enhances the efficiency of measurement of inelastic soft X-rays scattering. Comprising two bendable gratings, the set-up effectively diminishes the defocus and coma aberrations. At commissioning, this system showed results of spin-flip, d-d and charge-transfer excitations of NiO. These results are consistent with published results but exhibit improved spectral resolution and increased efficiency of measurement. The best energy resolution of the set-up in terms of full width at half-maximum is 108 meV at an incident photon energy tuned about the Ni L3-edge.

Long-term disease-free survival in three ovarian cancer patients with a single relapse

Recurrent ovarian cancer with long-term survival is uncommon and often associated with poor prognosis. We report three cases of patients with advanced ovarian cancer who have achieved long-term disease-free survival following a single prior relapse. Case 1 relapsed with a localized bulky tumor and received a complete surgical resection and chemotherapy. Case 2 had a persistent central pelvic tumor after debulking surgery and second-line chemotherapy, and yet achieved excellent control with concurrent chemoradiation to the true pelvis. Case 3 relapsed with paraaortic lymph node metastasis and probable lung metastasis (subsequently negated by positron emission tomography) and received chemotherapy alone. These three patients have since remained disease-free for 13, 12, and seven years, respectively, since their first relapse. We conclude that select patients can obtain long-term disease-free survival after the first relapse by accurate restaging and aggressive multimodality treatment.

All entangled pure states violate a single Bell's inequality

We show that a single Bell's inequality with two dichotomic observables for each observer, which originates from Hardy's nonlocality proof without inequalities, is violated by all entangled pure states of a given number of particles, each of which may have a different number of energy levels. Thus Gisin's theorem is proved in its most general form from which it follows that for pure states Bell's nonlocality and quantum entanglement are equivalent.

Nationwide population-based epidemiologic study of rheumatoid arthritis in Taiwan

OBJECTIVES

Epidemiological studies of rheumatoid arthritis in Asia are rare. The aim of this research was to study the epidemiology and associated medical expenses of rheumatoid arthritis in Taiwan.

METHODS

Cases of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria, were retrieved from the National Health Insurance Research Database with corresponding International Classification of Diseases, Ninth Revision code (ICD-9) 714.0 from January 2000 to December 2007, and limited to those 16 years and older. Age- and sex-specific incidences were estimated by dividing the incidence number by population data obtained from the Department of Statistics, Ministry of the Interior.

RESULTS

There were a total of 40,995 cases. The average age-adjusted annual incidence rate was 15.8 per 100,000. The adjusted incidence rates were very stable at 20.9-25.2/100,000/year and 7.0-8.2/100,000/year for females and males, respectively, during the study period. The adjusted average incidence ratio of females/males was 3.1. The age-specific incidence peaked in the 60-64 and 70-74 year age groups for females and males, respectively. The adjusted prevalence rate increased steadily during the study period from 57.7/100,000 in 2000 to 99.6/100,000 in 2007. The average total yearly expense per patient increased from 1,155 United States Dollars (USD) in 2000 to 1,821 USD in 2007. Sicca syndrome (ICD-9 code 710.2) was the most common co-existing ICD-9 code.

CONCLUSIONS

This is the first incidence study based on the 1987 American College of Rheumatology criteria in Asia. The prevalence rate based on these criteria was lower than in previous Asia studies. The medical expenses increased continuously.

Network extreme eigenvalue: from mutimodal to scale-free networks

The extreme eigenvalues of adjacency matrices are important indicators on the influence of topological structures to the collective dynamical behavior of complex networks. Recent findings on the ensemble averageability of the extreme eigenvalue have further authenticated its applicability to the study of network dynamics. However, the ensemble average of extreme eigenvalue has only been solved analytically up to the second order correction. Here, we determine the ensemble average of the extreme eigenvalue and characterize its deviation across the ensemble through the discrete form of random scale-free network. Remarkably, the analytical approximation derived from the discrete form shows significant improvement over previous results, which implies a more accurate prediction of the epidemic threshold. In addition, we show that bimodal networks, which are more robust against both random and targeted removal of nodes, are more vulnerable to the spreading of diseases.

Genetic polymorphisms of the DNA repair gene MPG may be associated with susceptibility to rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease and can lead to deformities and severe disabilities, due to irreversible damage of tendons, joints, and bones. A previous study indicated that a DNA repair system was involved in the development of RA. In this study, we investigated the association of four N-methylpurine-DNA glycosylase (MPG) gene polymorphisms (rs3176364, rs710079, rs2858056, and rs2541632) with susceptibility to RA in 384 Taiwanese individuals (192 RA patients and 192 control subjects). Our data show a statistically significant difference in genotype frequency distributions at rs710079 and rs2858056 SNPs between RA patients and control groups (P = 0.040 and 0.029, respectively). Our data also indicated that individuals with the GG genotype at rs2858056 SNP may have a higher risk of developing RA. In addition, compared with the haplotype frequencies between case and control groups, individuals with the GCGC haplotype appeared to be at a greater risk of RA progression (P = 0.003, OR = 1.75; 95&percnt; CI = 1.20-1.55). Our results suggest that rs710079 and rs2858056 polymorphisms and the GCGC haplotype in the MPG gene are associated with the risk of RA progression, and thus may be used as molecular markers of RA if they are confirmed by further research.

Permanent genetic resources added to Molecular Ecology Resources Database 1 October 2010-30 November 2010

This article documents the addition of 277 microsatellite marker loci to the Molecular Ecology Resources Database. Loci were developed for the following species: Ascochyta rabiei, Cambarellus chapalanus, Chionodraco hamatus, Coptis omeiensis, Cynoscion nebulosus, Daphnia magna, Gerbillus nigeriae, Isurus oxyrinchus, Lates calcarifer, Metacarcinus magister, Oplegnathus fasciatus, Pachycondyla verenae, Phaethon lepturus, Pimelodus grosskopfii, Rotylenchulus reniformis, Scomberomorus niphonius, Sepia esculenta, Terapon jarbua, Teratosphaeria cryptica and Thunnus obesus. These loci were cross-tested on the following species: Austropotamobius italicus, Cambarellus montezumae, Cambarellus puer, Cambarellus shufeldtii, Cambarellus texanus, Chionodraco myersi, Chionodraco rastrospinosus, Coptis chinensis, Coptis chinensis var. brevisepala, Coptis deltoidea, Coptis teeta, Orconectes virilis, Pacifastacus leniusculus, Pimelodus bochii, Procambarus clarkii, Pseudopimelodus bufonius, Rhamdia quelen, Sepia andreana, Sepiella maindroni, Thunnus alalunga, Thunnus albacares, Thunnus maccoyii, Thunnus orientalis, Thunnus thynnus and Thunnus tonggol.

Successful salvage treatment of recurrent endometrial cancer with multiple lung and abdominal metastases

The prognosis of recurrent endometrial carcinoma is generally poor except for isolated vaginal or pelvic relapse without previous radiation. Recurrences associated with infield failure or distant metastasis carry a poor prognosis. We report a case of recurrent endometrial carcinoma treated with cytoreductive surgery, targeted radiation to lung metastasis defined by CT and PET and adjuvant chemo-hormone therapy followed by maintenance progestin therapy with a good outcome. This case implied that chemo-hormone therapy with targeted radiation should be evaluated in recurrent endometrial cancer with positive progesterone receptor for salvage treatment.

Measurement and source characteristics of carbonyl compounds in the atmosphere in Kaohsiung city, Taiwan

The concentrations of eighteen atmospheric carbonyls species were measured by the LpDNPH-Cartridge and the microcomputer air sampling device at Nan-Chie (northern part) and Hsiung-Kong (southern part) sites in Kaohsiung city, southern Taiwan. These samples were then analyzed using a high performance liquid chromatography (HPLC). Measurements showed that the highest concentrations of carbonyls were formaldehyde (18.33 and 18.74 microg m(-3)) at the Nan-Chie and Hsiung-Kong site, followed by acetaldehyde (14.90 and 15.71 microg m(-3)). The concentrations of total carbonyls were higher at Hsiung-Kong site (66.96 microg m(-3)) than at Nan-Chie site (60.41 microg m(-3)). The concentrations of total carbonyls at Nan-Chie site (or Hsiung-Kong site) were 74.06 microg m(-3) (89.99 microg m(-3)) in summer and 37.14 microg m(-3) (46.50 microg m(-3)) in winter, due to the fact that photochemical activities are stronger in summer than in winter. The results of principal component analysis (PCA)/absolute principal component scores (APCS) suggest that the primary pollution sources at Nan-Chie were vehicle exhausts (gasoline and diesel engines), stationary emissions (petrochemical and food industry) and restaurant emissions, and the primary pollution sources at Hsiung-Kong were vehicle exhausts (gasoline and diesel engines), stationary emissions (metal assembly and petrochemical industry) and restaurant emissions.

What are the ten new commandments in severe polytrauma management?

This review aims to provide a concise overview of the trauma management evolution in the past decade. 1) Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2) Five stratified levels for DAM have replaced the non-specific conventional Plans A & B. 3) CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4) DPL has virtually been replaced by the FAST USG. 5) Direct whole-body MDCT provides rapid imaging diagnosis & expedites the definitive treatment but carries high radiation hazards. 6) The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7) DCR comprising of permissive hypotension, hemostatic resuscitation & DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP & platelet concentrates improves the outcome in massive blood transfusion. 8) DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9) A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP (pre-peritoneal pelvic packing) may further reduce mortality coupled with the necessary TCAE. 10) Injury prevention is equally important if not more than the trauma resuscitation & operation.

Measurement and receptor modeling of atmospheric polycyclic aromatic hydrocarbons in urban Kaohsiung, Taiwan

The concentrations of 21 individual polycyclic aromatic hydrocarbons (PAHs) and total suspended particles (TSPs) were measured using high-volume air samplers at Tzuo-Yin and Hsiung-Kong sites in Kaohsiung City, Taiwan, for four seasons from 2005 to 2006. The gaseous and particulate phases of individual PAHs were identified using a gas chromatograph with a flame-ionization detector (GC/FID). Measurements show that the concentrations of total (gas+particulate) PAHs generally followed the seasonal variations of the concentrations of TSP (107.2-117.1 microg m(-3)), being the highest in winter (143.9-182.9 ng m(-3)) and lowest in summer (81.4-95.2 ng m(-3)) at both sites. Most PAH species were low-weight PAHs (approximately 80.8-82.0%), followed by high-weight PAHs (10.5-14.6%) and medium-weight PAHs (6.5-6.8%). The fractions of gaseous PAHs decreased with molecular weight or ring number. The particle phase (60.2(73.5%) dominated the high-weight PAHs. Results of receptor model show that industrial combustions (49.1-63.7%) contributed most to ambient PAHs, followed by restaurant emissions (18.4-39.7%) and mobile sources (11.3-22.8%) at the Tzuo-Yin site. At the Hsiung-Kong, mobile sources (49.5-63.3%) contributed most to ambient PAHs, followed by restaurant emissions (19.8-36.6%) and industrial combustions (13.7-27.1%). The differences in the results at the two sites are mainly attributed to the different industries at each site.

Risk factors for extra-pulmonary tuberculosis compared to pulmonary tuberculosis

BACKGROUND

Tuberculosis (TB) continues to be a major global health problem. Extra-pulmonary TB (EPTB) manifests with protean symptoms, and establishing a diagnosis is more difficult than pulmonary TB (PTB).

SETTING

A university-affiliated hospital in southern Taiwan.

OBJECTIVE

To analyse the risk factors for EPTB compared with PTB.

DESIGN

This retrospective study compared patients with EPTB and PTB in southern Taiwan by analysing their demographic data and clinical underlying diseases. Risk factors for EPTB were further analysed.

RESULTS

A total of 766 TB patients were enrolled in this study, with 102 (13.3%) EPTB and 664 (86.7%) PTB cases. Of the 766 patients, 3% of PTB patients had EPTB, while 19.6% of EPTB patients also had PTB. The most frequently involved EPTB site was the bone and joints (24.5%). The incidence of EPTB vs. PTB decreased significantly for each decade increase in patient age. Multivariate logistic regression analysis showed that being female, not being diabetic, having end-stage renal disease and not smoking were independent risk factors for EPTB.

CONCLUSION

This study defines the risk factors for EPTB compared with PTB. Awareness of these factors is essential for physicians to have a high index of suspicion for accurate and timely diagnosis.

Functional and computational assessment of missense variants in the ataxia-telangiectasia mutated (ATM) gene: mutations with increased cancer risk

The functional consequences of missense variants are often difficult to predict. This becomes especially relevant when DNA sequence changes are used to determine a diagnosis or prognosis. To analyze the consequences of 12 missense variants in patients with mild forms of ataxia-telangiectasia (A-T), we employed site-directed mutagenesis of ataxia-telangiectasia mutated (ATM) cDNA followed by stable transfections into a single A-T cell line to isolate the effects of each allele on the cellular phenotype. After induction of the transfected cells with CdCl2, we monitored for successful ATM transcription and subsequently assessed: 1) intracellular ATM protein levels; 2) ionizing radiation (IR)-induced ATM kinase activity; and 3) cellular radiosensitivity. We then calculated SIFT and PolyPhen scores for the missense changes. Nine variants produced little or no correction of the A-T cellular phenotype and were interpreted to be ATM mutations; SIFT/PolyPhen scores supported this. Three variants corrected the cellular phenotype, suggesting that they represented benign variants or polymorphisms. SIFT and PolyPhen scores supported the functional analyses for one of these variants (c.1709T>C); the other two were predicted to be "not tolerated" (c.6188G>A and c.6325T>G) and were classified as "operationally neutral." Genotype/phenotype relationships were compared: three deleterious missense variants were associated with an increased risk of cancer (c.6679C>T, c.7271T>G, and c.8494C>T). In situ mutagenesis represents an effective experimental approach for distinguishing deleterious missense mutations from benign or operationally neutral missense variants.

Nonadditive quantum error-correcting code

We report the first nonadditive quantum error-correcting code, namely, a ((9, 12, 3)) code which is a 12-dimensional subspace within a 9-qubit Hilbert space, that outperforms the optimal stabilizer code of the same length by encoding more levels while correcting arbitrary single-qubit errors. Taking advantage of the graph states, we construct explicitly a complete encoding-decoding circuit for the proposed nonadditive error-correcting code.

Prognostic factors and adjuvant therapy in uterine carcinosarcoma

PURPOSE OF INVESTIGATION

The objective of this retrospective study was to investigate prognostic variables and impact of adjuvant therapy in uterine carcinosarcoma.

METHODS

The clinical information and pathological confirmation were reviewed for cases with uterine carcinosarcoma from 1984 to 2005. A total of 45 patients were eligible for analysis.

RESULTS

The median follow-up for survivors was 84 months. Five-year overall survival and progression-free survival (PFS) rates were 36.5% and 33.8%, respectively for Stage I-IV. Distant site metastasis with/without pelvic failure occurred in 83.3% of those with recurrence/progression. By multivariate analysis, older age (p = 0.001) and more than half of myometrial invasion (p = 0.002) were significant predictors of death, while only myometrial invasion (p = 0.022) was significantly associated with PFS. Stratified analyses demonstrated a monotonic trend of chemotherapy or chemoradiation to decrease death.

CONCLUSIONS

Our results suggested that age and depth of myometrial invasion were significant prognostic factors, and chemotherapy or chemoradiation seemed to be beneficial for uterine carcinosarcoma.

Study on the species-specificity of Isospora michaelbakeri by experimental infection

Isospora michaelbakeri is one of the Isospora species most commonly found in the wild field, which can cause severe infection and mortality in young sparrows. In this study, we selected I. michaelbakeri (Chung Hsing strain) as a pathogen to orally inoculate russet sparrows (Passer rutilans), spotted munia (Lonchura punctulata), canary (Serinus canaria), Java sparrows (Padda oryzivora), chicken (Gallus domesticus), ducks (Anas platyrhynchos) and BALB/c mice. The results indicated that I. michaelbakeri infected only russet sparrows. Infected sparrows displayed lethargy, muscular weakness and fluffy feathers, followed by rapid death. Liver and spleen enlargement was seen in the infected birds. Schizonts were identified in thin smears from the venous blood, enlarged livers and spleens. Histopathological examination revealed schizonts and merozoites from the liver and spleen of infected russet sparrows, but not from other species experimentally inoculated with I. michaelbakeri in the present study.

Supraclavicular lymph node metastases in cervical cancer

PURPOSE OF INVESTIGATION

To evaluate the outcome and prognostic factors of patients with supraclavicular lymph node (SCLN) involvement at primary diagnosis.

METHODS

We reviewed the medical records of cervical cancer patients primarily treated at Chang Gung Memorial Hospital between 1987 and 2005. Thirty-three patients with histologically confirmed SCLN metastasis at primary diagnosis were eligible for analysis. Clinical and pathological features were analyzed for association with outcome.

RESULTS

The 3- and 5-year survival rates of patients with SCLN metastasis were 16.5% and 16.5%, respectively. Multivariate analysis showed the serum level of squamous cell carcinoma antigen (SCC-Ag) < 15 ng/ml at initial diagnosis (p = 0.021) and staging/restaging including [18F] fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) (p = 0.006) to be associated with a better prognosis.

CONCLUSION

Primary SCLN metastasis in cervical cancer is not incurable. The benefit from PET findings might help in selecting appropriate patients for curative primary and/or salvage treatment.

Peritoneal metastasis in primary cervical cancer: a case report

PURPOSE OF INVESTIGATION

Peritoneal metastasis presenting at initial diagnosis of squamous carcinoma of the uterine cervix is extremely rare. However, one such case was treated successfully with curative treatment.

CASE

A 43-year-old woman presented with FIGO Stage IVA cervical carcinoma and underwent concurrent chemoradiation (CCRT) with weekly cisplatin. During CCRT, she suffered from acute lower abdominal pain, high fever, and leukocytosis. Computed tomography (CT) favored a tubo-ovarian abscess, while [18F] fluorodeoxyglucose positron emission tomography (FDG-PET) showed a lesion midway between the umbilicus and symphysis pubis. An exploration by laparoscopy, an omental metastasis adhering to the bladder dome was excised. This patient finished CCRT encompassing the disease extent including the trochar sites and no evidence of disease was noted 50 months after initial diagnosis.

CONCLUSION

Though peritoneal metastasis above the pelvis seems ominous, curative treatment may still be viable in selected patients, even in surgical Stage IVB.

Effects of β-glucan extracted from Saccharomyces cerevisiae on growth performance, and immunological and somatotropic responses of pigs challenged with Escherichia coli lipopolysaccharide1

Three experiments were conducted to investigate the effects of beta-glucan supplementation on pig performance and immune function. In Exp. 1, 100 weaned pigs (8.65 +/- 0.42 kg of BW and 28 +/- 2 d of age) were used in a 35-d experiment to determine the effects of graded levels of beta-glucan. Pigs were randomly allotted to 1 of 5 treatments containing beta-glucan supplemented at 0, 25, 50, 100, or 200 ppm. Each treatment was replicated using 5 pens containing 4 pigs per pen. The ADG of pigs between d 14 to 28 and d 0 to 28 responded to dietary beta-glucan in a quadratic fashion (P < 0.05), whereas beta-glucan had no effect on ADFI and G:F in any period. In Exp. 2, 80 crossbred pigs (8.23 +/- 0.56 kg of BW and 28 +/- 2 d of age) were used in a 35-d experiment. Pigs were allotted to 1 of 2 dietary treatments (0 or 50 ppm of beta-glucan in the diet) using 10 pens with 4 pigs per pen. Pigs treated with beta-glucan had greater ADG in the 14- to 28-d (P = 0.05) and 0-to 28-d (P = 0.035) periods. The ADFI of pigs receiving beta-glucan was increased (P < 0.05) in the periods from 0 to 14, 0 to 28, and 28 to 35 d. The lymphocyte proliferation index in response to phytohemagglutinin (P = 0.051) and concanavalin A (P = 0.052) tended to decrease on d 14 in pigs supplemented with beta-glucan compared with pigs without supplementation. In Exp. 3, 24 barrows (8.89 +/- 0.20 kg of BW and 28 d of age) were used to investigate the immunological and somatotropic responses of pigs challenged with lipopolysaccharide (LPS). Experimental treatments were arranged in a 2 x 2 factorial, with the main effects of LPS challenge (saline vs. LPS) and dietary addition of beta-glucan (0 vs. 50 ppm). Pigs were raised individually in metabolic cages. Pigs were fed 0 or 50 ppm of beta-glucan for 28 d and then challenged with LPS (25 microg/kg of BW) or saline. After LPS injection, blood was obtained at 0, 1.5, 3, 4.5, 6, and 7.5 h to determine cytokine production and the somatotropic response. Dietary beta-glucan increased plasma interleukin-6 at 1.5, 3, and 4.5 h and tumor necrosis factor-alpha at 3 and 4.5 h and increased plasma interleukin-10 from 3 to 7.5 h after LPS challenge. The beta-glucan treatments had no effect on growth hormone. In conclusion, beta-glucan can selectively influence performance and partially offer benefits on somatotropic axis and immune function in weaned piglets challenged with LPS.

Tyrosine kinase receptor immunoreactivity in trigeminal mesencephalic and motor neurons following transection of masseteric nerve of the rat

Neurotrophins are known to promote survival after neural injury. To determine the relative importance of tyrosine kinase receptors on the survival of axotomized trigeminal nuclear neurons, we examined the temporal expression profile of tyrosine kinase A, tyrosine kinase B and tyrosine kinase C receptors in the mesencephalic trigeminal nucleus and the motor trigeminal nucleus following transection of the masseteric nerve in rats. Axotomized neurons in these nuclei were retrogradely identified with FluoroGold. We found increase in tyrosine kinase A-immunoreactive mesencephalic trigeminal nucleus neurons in the second week after axotomy but no change in the number of tyrosine kinase A-immunoreactive motor trigeminal nucleus neurons. There was no change in the number of tyrosine kinase B-immunoreactive mesencephalic trigeminal nucleus neurons but the significant increase of tyrosine kinase B-immunoreactive motor trigeminal nucleus neurons throughout the period of observation (3 weeks) peaked at approximately 1 week after axotomy. There was no alteration in the number of tyrosine kinase C-immunoreactive mesencephalic trigeminal nucleus neurons but significant increase in tyrosine kinase C-immunoreactive motor trigeminal nucleus neurons observable by 4 days post-axotomy was followed by decline to levels lower than the control in 2 weeks. Temporal changes in the expression of individual tyrosine kinase receptors in mesencephalic trigeminal nucleus and motor trigeminal nucleus neurons following transection of the masseteric nerve suggest differential contribution of tyrosine kinase-specific neurotrophins to the survival of these neurons after axotomy.

Differential expression of NMDA and AMPA/KA receptor subunits in the inferior olive of postnatal rats

We have employed immunohistochemistry to determine the expression patterns of receptor subunits of N-methyl-d-aspartate (NMDA-NR1 and NR2A/B) and alpha-amino-3-hydroxy-5-methyl-isoxazole-4-propionic acid/kainic acid (AMPA/KA-GluR1, GluR2, GluR2/3, GluR4, and GluR5/6/7) in the inferior olive of postnatal rats up to adulthood. Immunoreactivity for distinct receptor subunits was predominantly localized in the soma and dendrites of neurons. Semi-quantification showed that the overall immunoreactivity in the inferior olive of adults was intense for GluR1, moderate for NR1 and NR2A/B, and low for GluR2, GluR2/3, GluR4, and GluR5/6/7. At P7, GluR1 was restricted to the dorsomedial cell column, subnucleus beta, principal nucleus and ventrolateral protrusion while the other subunits were found in all subnuclei of the inferior olive. The immunoreactivities for all glutamate receptor subunits ranged from low to moderate. As the rats matured, the immunoreactivity of GluR4 decreased after the second postnatal week, while those of the other subunits showed a general trend of increase, reaching adult level during the third postnatal week. Double immunofluorescence revealed that all NR1-containing neurons exhibited NR2A/B immunoreactivity, indicating that native NMDA receptors comprise of hetero-oligomeric combinations of NR1 and NR2A/B. Furthermore, co-localization of NMDA and AMPA/KA receptor subunits was demonstrated in individual neurons of the inferior olive. All NR1-containing neurons exhibited GluR1 immunoreactivity, and all NR2A/B-containing neurons showed GluR5/6/7 immunoreactivity. Our data suggest that NMDA and AMPA/KA receptors are involved in glutamate-mediated neurotransmission, contributing to synaptic plasticity and reorganization of circuitry in the inferior olive during postnatal development.

Ovarian endometrioid carcinoma with diffuse pigmented peritoneal keratin granulomas: a case report and review of the literature

The presence of keratin granulomas in peritoneal cavity associated with ovarian endometrioid carcinoma, which might be related to leakage from the ovarian tumor, is rarely reported. Its clinical significance has not yet been well investigated. We report a case presenting with intermittent abdominal pain after an acute episode 1 month before a complex adnexal tumor was noted. Comprehensive cytoreductive surgery was performed. The ovarian tumor was an endometrioid adenocarcinoma with squamous differentiation. There were diffuse brownish flecks over the omental surface and pelvic peritoneum, which contained fragments of degenerated squamous cells, keratin, and numerous foreign body giant cells. Extensive multiple sections were examined for these implants. DNA flow cytometry and various immunostaining studies (HER-2/neu, p53, CK-7, and cytokeratin [AE1/AE3]) were performed. Since viable epithelial cells in the implants could be differentially identified against mesothelial or granulomatous components by CK-7 staining and DNA aneuploidy was demonstrated on primary ovarian tumor, four courses of chemotherapy were administered. The patient has been free of disease for 18 months since diagnosis.

Symptomatology and health status in patients with chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a growing health problem worldwide and in Malaysia. Until recently, research on COPD has been slow and difficult, partly due to the huge heterogeneity of this disease, and its variable and imprecise definitions. To perform a descriptive study on a convenient sample of local patients with COPD treated in a state hospital in Malaysia. Fifty-two patients [mean (95% CI) age: 67 (63-70) years; 86% male: 38% Malays, 36% Chinese, 25% Indians; mean (95% CI) PEFR: 45 (40-51) % predicted normal] were interviewed. Clinico-demographic data was collected using a structured questionnaire and health-related quality of life was scored using St George's Respiratory Questionnaire (SGRQ). For analysis, patients were also divided into moderate (n=17) [PEFR 50% to 80%] and severe (n=35) [PEFR < 50%] disease groups. Except for education and total family income, demographic and comorbidity variables were comparable between the two groups of COPD severity. All except 9% of patients were current or ex-smokers. Breathlessness, not chronic bronchitis (i.e. cough and sputum), was the first ranking respiratory symptom in over 70% of the patients, whether currently or at early disease manifestation. Between 5 and 15% of the patients denied any symptom of chronic bronchitis as current or early stage symptoms. Duration of symptoms prior to the diagnosis varied considerably with about 9% having symptoms for over 10 years. Over 80% of the patients smoked for over 15 years before the onset of symptoms. Quality of life in patients with COPI) was generally poor and similar between both COPD severity groups. About one fifth of the patients had exacerbations more than 12 times a year. While many features described in our local patients are well recognized in COPD, the finding that 'chronic bronchitis' is not a prominent symptom in the current or past history may have important implications in the diagnosis of at risk individuals and patients with early disease requiring attention. More research is required to confirm and to understand this.

Semi-constrained total elbow arthroplasty for the treatment of rheumatoid arthritis of the elbow

INTRODUCTION

We retrospectively reviewed the results of total elbow arthroplasty in patients with rheumatoid arthritis of the elbow followed for a minimum of two years.

METHODS

Between September 1999 and March 2001, seven patients with rheumatoid arthritis of the elbow were treated with total elbow arthroplasty using the semi-constrained Coonrad-Morrey elbow replacement prostheses. One patient died 19 months after her surgery and was excluded from the study. Two patients had bilateral total elbow replacements. Eight elbows were thus available for review. The mean age of our patients at the time of surgery was 55.5 years. The indication for surgery was severe pain and stiffness in six elbows, and distal humerus fractures in two elbows.

RESULTS

The mean duration of postoperative hospitalisation stay was 6.6 days. The average length of follow-up was 39.4 months. Six elbows had no pain, while two elbows had mild pain. The mean arc of flexion was 101.3 degrees. The mean Mayo elbow performance score was 93.1 points. Excellent results were achieved in six elbows, while two elbows had good outcome. There was one case of intraoperative lateral condylar fracture treated with internal fixation. One patient developed blisters postoperatively but resolved with dressings and antibiotics.

CONCLUSION

Our small study revealed good to excellent short-term outcome with the use of semi-constrained total elbow arthroplasty for the treatment of rheumatoid arthritis of the elbow in Asian patients.

Effects of β-glucan obtained from the Chinese herb Astragalus membranaceus and lipopolysaccharide challenge on performance, immunological, adrenal, and somatotropic responses of weanling pigs1

A total of 108 crossbred piglets (7.75 +/- 0.24 kg of BW) weaned at 28 d was used to study the interactive effects of beta-glucan obtained from the Chinese herb Astragalus membranaceus (AM) and Escherichia coli lipopolysaccharide (LPS) challenge on performance, immunological, adrenal, and somatotropic responses of weaned pigs. The treatments were in a 2 x 3 factorial arrangement; main effects were level of Astragalus membranaceus glucan (AMG; 0, 500, or 1,000 mg/kg; as-fed basis) and presence of immunological challenge (with or without LPS). The experiment included six replicate pens per treatment and three pigs per pen. Lipopolysaccharide challenges were conducted on d 7 and 21 of the trial. Blood samples were obtained from the vena cava from one pig per pen at 3 h after LPS challenge to determine plasma responses. Weight gain and feed:gain ratio were unaffected by glucan. However, there was a quadratic effect on feed intake (P < 0.05): pigs fed 500 mg of glucan/kg had the highest feed intake. Immunological challenge with LPS decreased weight gain (P = 0.02). An interaction (P = 0.01 to 0.09) between AMG and LPS was observed for glucose, IL-1beta, PGE2, and cortisol. Astragalus membranaceus glucan had a quadratic effect on the plasma concentrations of glucose, IL-1beta, PGE2, and cortisol (P < 0.05) after both LPS challenges. Plasma concentrations of glucose, IL-1beta, PGE2, and cortisol (P < 0.05) were all increased in LPS-challenged pigs compared with the control pigs after both LPS challenges. The IGF-I concentrations were less for LPS-challenged pigs than for unchallenged pigs. The lymphocyte proliferation response of peripheral blood induced by 5 microg of concanavalin A/mL (P < 0.01) and IL-2 bioactivity (P < 0.05) increased linearly with increasing addition of glucan. Pigs challenged with LPS had greater T-lymphocyte proliferation (P = 0.06) and IL-2 bioactivity (P = 0.07) than unchallenged pigs after the first immunological challenge but not after the second. In conclusion, although glucan did not improve pig performance under the conditions of the present experiment, when included at 500 mg/kg, it decreased the release of inflammatory cytokine and corticosteroid and improved the lymphocyte proliferation response of weanling piglets via enhanced IL-2 bioactivity.

Expression of Trk receptors in otolith-related neurons in the vestibular nucleus of rats

The expression of the three Trk receptors (TrkA, TrkB, and TrkC) in otolith-related neurons within the vestibular nuclei of adult Sprague-Dawley rats was examined immunohistochemically. Conscious animals were subjected to sinusoidal linear acceleration along either the anterior-posterior (AP) or interaural (IA) axis on the horizontal plane. Neuronal activation was defined by Fos expression in cell nuclei. Control animals, viz labyrinthectomized rats subjected to stimulation and normal rats that remained stationary, showed only a few sporadically scattered Fos-labeled neurons. Among experimental rats, the number of Fos-labeled neurons and their distribution pattern in each vestibular subnucleus in animals stimulated along the antero-posterior axis were similar to those along the interaural axis. No apparent topography was observed among neurons activated along these two directions. Only about one-third of the Trk-immunoreactive neurons in the vestibular nucleus expressed Fos. Double-labeled Fos/TrkA, Fos/TrkB and Fos/TrkC neurons constituted 85-98% of the total number of Fos-labeled neurons in vestibular nuclear complex and its subgroups x and y. Our findings suggest that Trk receptors and their cognate neurotrophins in central otolith neurons may contribute to the modulation of gravity-related spatial information during horizontal head movements.

Chaotic resonance: two-state model with chaos-induced escape over potential barrier

We consider the resonant effects of chaotic fluctuations on a strongly damped particle in a bistable potential driven by weak sinusoidal perturbation. We derive analytical expressions of chaos-induced transition rate between the neighboring potential wells based on the inhomogeneous Smoluchowski equation. Our first-order analysis reveals that the transition rate has the form of the Kramers escape rate except for a perturbed prefactor. This modification to the prefactor is found to arise from the statistical asymmetry of the chaotic noise. By means of the two-state model and the chaos-induced transition rate, we arrive at an analytical expression of the signal-to-noise ratio (SNR). Our first-order SNR shows that chaotic resonance can correspond directly to stochastic resonance.

Experimental quantum cloning with prior partial information

When prior partial information about a state to be cloned is available, it can be cloned with a fidelity higher than that of universal quantum cloning. We experimentally verify this intriguing relationship between the cloning fidelity and the prior information by reporting the first experimental optimal quantum state-dependent cloner, using nuclear magnetic resonance techniques. Our experiments may further cast important implications into many quantum information processing protocols.

False-positive fluorine-18 fluorodeoxy-D-glucose positron emission tomography imaging caused by retained gauze in a woman with recurrent ovarian cancer: a case report

We report a case of a 47-year-old woman with a false-positive [18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) result caused by retained gauze during resection of liver metastasis for a Stage IV ovarian cancer at primary cytoreductive surgery. She achieved complete remission and remained free of progression for seven years. Owing to elevation of CA-125, computed tomography and PET studies were performed, and both showed two potentially resectable lesions. One was located ventral to the diaphragmatic surface of the left hepatic lobe and the other was around the gauze at the right hepatorenal fossa. During surgical intervention, the left supraheptic tumor was excised and the gauze with surrounding granulation was removed. However, the former proved to be recurrent ovarian cancer with the latter proven false-positive. This case demonstrates that PET results should be interpreted with caution in differentiating a benign inflammatory process from malignant abnormalities, especially in regions with a high probability of granulomatous lesions.

Influence of cultivating conditions on the alpha-galactosidase biosynthesis from a novel strain of Penicillium sp. in solid-state fermentation

AIMS

The work is intended to achieve optimum culture conditions of alpha-galactosidase production by a mutant strain Penicillium sp. in solid-state fermentation (SSF).

METHODS AND RESULTS

Certain fermentation parameters involving incubation temperature, moisture content, initial pH value, inoculum and load size of medium, and incubation time were investigated separately. The optimal temperature and moisture level for alpha-galactosidase biosynthesis was found to be 30 degrees C and 50%, respectively. The range of pH 5.5-6.5 was favourable. About 40-50 g of medium in 250-ml flask and inoculum over 1.0 x 10(6) spores were suitable for enzyme production. Seventy-five hours of incubation was enough for maximum alpha-galactosidase production. Substrate as wheat bran supplemented with soyabean meal and beet pulp markedly improved the enzyme yield in trays.

CONCLUSIONS

Under optimum culture conditions, the alpha-galactosidase activity from Penicillium sp. MAFIC-6 indicated 185.2 U g(-1) in tray of SSF.

SIGNIFICANT AND IMPACT OF THE STUDY

The process on alpha-galactosidase production in laboratory scale may have a potentiality of scaling-up.