Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium

BACKGROUND

Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies.

PATIENTS AND METHODS

Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients).

RESULTS

A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality.

CONCLUSIONS

Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies.

CLINICAL TRIAL IDENTIFIER

NCT04354701.

Cost-effectiveness of bivalent versus monovalent vaccines against hand, foot and mouth disease

OBJECTIVES

Enterovirus 71 (EV71) and coxsackievirus A16 (CA16) were responsible for 43.3% (235 123/543 243) and 24.8% (134 607/543 243) of all laboratory-confirmed hand, foot and mouth disease (HFMD) cases during 2010-2015 in China. Three monovalent EV71 vaccines have been licensed in China while bivalent EV71/CA16 vaccines are under development. A comparative cost-effectiveness analysis of bivalent EV71/CA16 versus monovalent EV71 vaccination would be useful for informing the additional value of bivalent HFMD vaccines in China.

METHODS

We used a static model parameterized with the national HFMD surveillance data during 2010-2013, virological HFMD surveillance records from all 31 provinces in mainland China during 2010-2013 and caregiver survey data of costs and health quality of life during 2012-2013. We estimated the threshold vaccine cost (TVC), defined as the maximum additional cost that could be paid for a cost-effective bivalent EV71/CA16 vaccine over a monovalent EV71 vaccine, as the outcome. The base case analysis was performed from a societal perspective. Several sensitivity analyses were conducted by varying assumptions governing HFMD risk, costs, discounting and vaccine efficacy.

RESULTS

In the base case, choosing the bivalent EV71/CA16 over monovalent EV71 vaccination would be cost-effective only if the additional cost of the bivalent EV71/CA16 compared with the monovalent EV71 vaccine is less than €4.7 (95% CI 4.2-5.2). Compared with the TVC in the base case, TVC increased by up to €8.9 if all the test-negative cases were CA16-HFMD; decreased by €1.1 with an annual discount rate of 6% and exclusion of the productivity loss; and increased by €0.14 and €0.3 with every 1% increase in bivalent vaccine efficacy against CA16-HFMD and differential vaccine efficacy against EV71-HFMD, respectively.

CONCLUSIONS

Bivalent EV71/CA16 vaccines can be cost-effective compared with monovalent EV71 vaccines, if suitably priced. Our study provides further evidence for determining the optimal use of HFMD vaccines in routine paediatric vaccination programme in China.

S-1 plus cisplatin as first-line treatment of patients with advanced non-small cell lung cancer in Taiwan

AIM

S-1 combined with cisplatin is known to be noninferior to taxanes plus platinum as the first-line treatment for patients with advanced nonsmall cell lung cancer (NSCLC) in the Japanese population. This study aimed to evaluate the efficacy and safety profiles of oral S-1 plus cisplatin (SP) in Taiwanese patients.

METHODS

Patients with previously untreated stage IIIB or IV NSCLC were prospectively recruited to receive 40-60 mg of S-1 twice daily on days 1-21 plus 60 mg/m² of cisplatin on day 8 in a 5-week cycle for up to six cycles.

RESULTS

A total of 55 patients from five cancer centers in Taiwan were enrolled. Among the 46 evaluable patients, those administered with SP achieved disease control rate of 69.6% (partial response, 19.6%; stable disease, 50.0%), with median overall survival and progression-free survival (PFS) of 15.1 and 5.7 months, respectively. Moreover, a better survival trend was observed in epidermal growth factor receptor mutation-positive patients versus mutation-negative patients treated with SP (PFS, 8.6 vs 5.6 months). The most commonly observed treatment-related adverse events (AEs) were nausea (41.8%), followed by decreased appetite, anemia, and diarrhea. Grade of ≥3 AEs related to the study treatment occurred in 11 patients (20.0%). No febrile neutropenia or treatment-related death was found in this study.

CONCLUSIONS

This study demonstrated that SP is an effective and safe first-line regimen for Taiwanese patients with advanced NSCLC.

[Application of stretched exponential diffusion-weighted imaging model in quantitative diagnosis of nonalcoholic fatty liver disease: in a rabbit model]

Objective: To evaluate the feasibility of diffusion parameters obtained from mono-exponential and stretched exponential diffusion-weighted imaging models in staging of nonalcoholic fatty liver disease and compare the diagnosis ability of nonalcoholic steatohepatitis. Methods: Thirty-two 12 -week-old male New Zealand rabbits, about 2.5 kg of each, were randomly divided into five groups. To obtained different severity groups of NAFLD, a variety of diet (from standard to high-fat, high cholesterol chow) were feed for different periods before liver diffusion imaging was performed by using 3.0 T MR imaging system (Discovery 750W GE health care), the value of ADC, stretched exponential model parameters distributed diffusion coefficient (DDC) and α (water molecular diffusion heterogeneity index) were measured. Liver specimens were obtained for pathological grading (NAFLD activity scoring system). The diffusion parameters of each group of NAFLD were compared by ANOVA, LSD-t test was utilized to pairwise comparison between different grades of NAFLD. Spearman rank correlation analysis was used to evaluate the correlation between ADC, DDC, α and different severity groups of NAFLD. ROC curve was compared to evaluate the diagnostic efficiency of MR parameters for NASH. Results: α was significant different between borderline and NASH groups (0.65±0.05 vs 0.72±0.07; P<0.05); ADC and DDC showed no statistical difference between borderline and NASH groups (ADC:(1.09±0.14)×10(-3) vs (1.04±0.24)×10(-3) mm(2)/s; DDC: (0.73±0.08)×10(-3) vs (0.66±0.19)×10(-3) mm(2)/s; P>0.05); ADC and DDC were negatively correlated with NAFLD, and the correlation coefficients were -0.552, -0.596, respectively (P<0.05). α was found to be positively correlated with advancement of NAFLD, the correlation coefficient was 0.729 (P<0.05).In terms of the diagnostic efficiency of NASH, the AUC of ADC, DDC and α were 0.736, 0.784, 0.900, respectively, α was significantly greater than ADC in diagnosis of NASH (P<0.05). Conclusion: Stretched exponential model parameter α (water molecular diffusion heterogeneity index) could be utilized to identify NAFLD. α may provide more information and improve the staging of NASH compared with conventional diffusion parameters.

Association of chronic kidney disease with mortality risk in patients with lung cancer: a nationwide Taiwan population-based cohort study

OBJECTIVE

Our population-based research aimed to clarify the association between chronic kidney disease (CKD) and mortality risk in patients with lung cancer.

DESIGN

Retrospective cohort study SETTING: National health insurance research database in Taiwan PARTICIPANTS: All (n=1 37 077) Taiwanese residents who were diagnosed with lung cancer between 1997 and 2012 were identified. Eligible patients with baseline CKD (n=2269) were matched with controls (1:4, n=9076) without renal disease according to age, sex and the index day of lung cancer diagnosis.

METHODS

The cumulative incidence of death was calculated by the Kaplan-Meier method, and the risk determinants were explored by the Cox proportional hazards model.

RESULTS

Mortality occurred in 1866 (82.24%) and 7135 (78.61%) patients with and without CKD, respectively (P=0.0001). The cumulative incidences of mortality in patients with and without chronic renal disease were 72.8% vs 61.6% at 1 year, 82.0% vs 76.6% at 2 years and 88.9% vs 87.2% at 5 years, respectively. After adjusting for multiple confounding factors including age and comorbidities, Cox regression analysis revealed that CKD was associated with an increased risk of mortality (adjusted HR 1.38; 95% CI 1.29 to 1.47). Stratified analysis further showed that the association was consistent across patient subgroups.

CONCLUSION

Comorbidity associated with CKD is a risk factor for mortality in patients with lung cancer.

Effects of Δ(9)-tetrahydrocannabinol (THC) on human amniotic epithelial cell proliferation and migration

BACKGROUND

The deleterious effects of cannabis consumption for fertility and pregnancy outcome are recognized for years. The main psychoactive molecule of cannabis, Δ(9)-tetrahydrocannabinol (THC) is able to cross the placenta barrier and cause alterations in fetal growth, low birth weight and preterm labor. However, the effects of THC on the human placenta amnion are still unknown.

METHODS

The distributions of CB1R and CB2R in human amnion tissues were observed by immunohistochemistry (IHC). Human amniotic epithelial cell proliferation and migration in response to THC treatment were measured by MTS and transwell assays, respectively. The PCR array was performed to study the key regulators involved in the cell migration. The protein levels of CB1R, CB2R in amnion tissues and MMP2, MMP9 in cells were detected by western blotting. Small interfering RNAs (siRNAs) were used to knockdown MMP2 and MMP9 in WISH cells.

RESULTS

Our results indicated that both CB1R and CB2R primarily identified in the epithelial layer of human placental amnion tissue. The CB1R expression in the amnion tissue was higher in the preterm group than normal control. High-dose of THC (30uM, but not 20 and 10uM) significantly inhibited (p<0.01) human amniotic epithelial cell lines (WISH) proliferation. Meanwhile, THC at both 10uM and 20uM (p<0.05) significantly suppressed cells migration in both WISH and primary human amniotic epithelial cells. The PCR array data and siRNA experiments demonstrated that MMP2/9 were tightly involved in the regulation of THC-inhibited cell migration in WISH cells.

CONCLUSION

These results suggested that THC inhibited the migration of human amniotic epithelial cell through the regulation of MMP2 and MMP9, which in turn altered the development of the amnion during the gestation and partially resulted in preterm labor and other adverse pregnancy outcomes.

[Application of swallow tail appearance in patients with Parkinson's disease]

OBJECTIVE

To evaluate the clinical value of swallow tail appearance in detecting the patient with Parkinson's disease at 3.0 T MRI.

METHODS

A total of 42 patients with clinical diagnosis of Parkinson's disease(PD) and 27 age-matched normal controls underwent the brain MR examination with conventional and E-SWAN sequences. Patients were divided into 4 groups based on Hoehn-Yahr stage and 2 groups according the treatment condition (treated, untreated). Substantia nigra (SN) was selected as region of interest (ROI) and observed the swallow tail appearance on magnitude imagines of E-SWAN sequence. Nonparametric test was used for comparison between patients groups and normal controls. There was statistically difference if the P value was lower than 0.05.

RESULTS

The swallow tail appearance lost was significantly correlated with Parkinson's disease (P=0.000). The swallow tail appearance lost was not correlated with the usage of drugs(P=0.833) and Hoehn-Yahr stage(P=0.189). The sensitivity of diagnosis of PD by using the swallow tail disappearance was 95.5% (42/44), the specificity was 83.3% (25/30), the accuracy was 90.5%(67/74).

CONCLUSIONS

Assessing the substantia nigra on E-SWAN for the typical swallow tail appearance has potential to become a new and easy applicable 3.0 T MRI diagnostic tool for PD, however, it was meaningless for prognosis and staging.

Mineralization of sulfamethizole in photo-Fenton and photo-Fenton-like systems

In this investigation, UV/H2O2, UV/H2O2/Fe(2+) (photo-Fenton) and UV/H2O2/Fe(3+) (photo-Fenton-like) systems were used to mineralize sulfamethizole (SFZ). The optimal doses of H2O2 (1-20 mM) in UV/H2O2 and iron (0.1-1 mM) in photo-Fenton and photo-Fenton-like systems were determined. Direct photolysis by UV irradiation and direct oxidation by added H2O2, Fe(2+) and Fe(3+) did not mineralize SFZ. The optimal dose of H2O2 was 10 mM in UV/H2O2 and that of iron (Fe(2+) or Fe(3+)) was 0.2 mM in both UV/H2O2/Fe(2+) and UV/H2O2/Fe(3+) systems. Under the best experimental conditions and after 60 min of reaction, the SFZ mineralization percentages in UV/H2O2, UV/H2O2/Fe(2+) and UV/H2O2/Fe(3+) systems were 16, 90 and 88%, respectively. The UV/H2O2/Fe(2+) and UV/H2O2/Fe(3+) systems effectively mineralized SFZ.

Effect of atorvastatin on plasma NT-proBNP and inflammatory cytokine expression in patients with heart failure

The aim of this study was to explore the effect of atorvastatin intervention on plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and inflammatory cytokine levels in patients with heart failure (HF). One hundred and twenty-three HF patients were selected from our hospital and randomly divided into control (N = 61) and observation (N = 62) groups; the former received conventional treatment, while the latter were given conventional treatment combined with atorvastatin. Plasma NT-proBNP, inflammatory cytokines [high-sensitive C-reactive protein (hs-CRP), interleukin (IL)-6, IL-10] and cardiac function [left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), end-diastolic maximum flow rate ratio (E/A)] were compared among groups. The effective rate of treating HF significantly increased after atorvastatin treatment. The plasma NT-proBNP, IL-6, IL-10, hs-CRP, and LVEDD levels significantly decreased (P < 0.05), while the LVEF and E/A levels significantly increased (P < 0.05) in the observation group compared to the control group and before intervention. The NT-proBNP and cytokine levels significantly differed among patients with different classes of heart function (P < 0.05); the NT-proBNP and cytokine levels increased with the severity of heart function. Pearson's correlation analysis revealed a negative correlation between the NT-proBNP and inflammatory cytokine levels and LVEF and E/A values, and a positive correlation between these factors and LVEDD (P < 0.05). In conclusion, atorvastatin significantly improves cardiac function; the mechanism atorvastatin action was related to the decrease in plasma NT-proBNP and inflammatory cytokine levels.

Preliminary epidemiological assessment of MERS-CoV outbreak in South Korea, May to June 2015

South Korea is experiencing the largest outbreak of Middle East respiratory syndrome coronavirus infections outside the Arabian Peninsula, with 166 laboratory-confirmed cases, including 24 deaths up to 19 June 2015. We estimated that the mean incubation period was 6.7 days and the mean serial interval 12.6 days. We found it unlikely that infectiousness precedes symptom onset. Based on currently available data, we predict an overall case fatality risk of 21% (95% credible interval: 14–31).

Preliminary epidemiological assessment of MERS-CoV outbreak in South Korea, May to June 2015

South Korea is experiencing the largest outbreak of Middle East respiratory syndrome coronavirus infections outside the Arabian Peninsula, with 166 laboratory-confirmed cases, including 24 deaths up to 19 June 2015. We estimated that the mean incubation period was 6.7 days and the mean serial interval 12.6 days. We found it unlikely that infectiousness precedes symptom onset. Based on currently available data, we predict an overall case fatality risk of 21% (95% credible interval: 14–31).

Comparison of the safety and efficacy of a fixed-dose combination regimen and separate formulations for pulmonary tuberculosis treatment

OBJECTIVES

Fixed-dose combination formulations, which simplify the administration of drugs and prevent the development of drug resistance, have been recommended as a standard anti-tuberculosis treatment regimen. However, the composition and dosage recommendations for fixed-dose combination formulations differ from those for separate formulations. Thus, questions about the effectiveness and side effects of combination formulations remain. The aim of this study was to compare the safety and efficacy of these two types of anti-tuberculosis regimens for pulmonary tuberculosis treatment.

METHOD

A prospective, randomized controlled study was conducted using the directly observed treatment short-course strategy. Patients were randomly allocated to one of two short-course regimens. One year after completing the treatment, these patients' outcomes were analyzed. ClinicalTrials.gov: NCT00979290.

RESULTS

A total of 161 patients were enrolled, 142 of whom were evaluable for safety assessment. The two regimens had a similar incidence of adverse effects. In the per-protocol population, serum bilirubin concentrations at the peak level, at week 4, and at week 8 were significantly higher for the fixed-dose combination formulation than for the separate formulations. All patients had negative sputum cultures at the end of the treatment, and no relapse occurred after one year of follow-up.

CONCLUSIONS

In this randomized study, transient higher serum bilirubin levels were noted for the fixed-dose combination regimen compared with the separate formulations during treatment. However, no significant difference in safety or efficacy was found between the groups when the directly observed treatment short-course strategy was used.

Photodegradation of sulfonamide antimicrobial compounds (sulfadiazine, sulfamethizole, sulfamethoxazole and sulfathiazole) in various UV/oxidant systems

This study used Na₂S₂O₈, NaBrO8 and H₂O₂to degrade sulfadiazine (SDZ), sulfamethizole (SFZ), sulfamethoxazole (SMX) and sulfathiazole (STZ) under ultraviolet (UV) irradiation. The initial concentration of sulfonamide and oxidant in all experiments was 20 mg/L and 5 mM, respectively. The degradation rate for sulfonamides satisfies pseudo-first-order kinetics in all UV/oxidant systems. The highest degradation rate for SDZ, SFZ, SMX and STZ was in the UV/Na₂S₂O₈, UV/NaBrO₃, UV/Na₂S₂O₈ and UV/H₂O₂ system, respectively. In the UV/Na₂S₂O₈ system, the photodegradation rate of SDZ, SFZ, SMX and STZ was 0.0245 min⁻¹, 0.0096 min⁻¹, 0.0283 min⁻¹ and 0.0141 min⁻¹, respectively; moreover, for the total organic carbon removal rate for SDZ, SFZ, SMX and STZ it was 0.0057 min⁻¹, 0.0081 min⁻¹, 0.0130 min⁻¹ and 0.0106 min⁻¹, respectively. Experimental results indicate that the ability of oxidants to degrade sulfonamide varied with pollutant type. Moreover, UV/Na₂S₂O₈ had the highest mineralization rate for all tested sulfonamides.

Clinical severity of human infections with avian influenza A(H7N9) virus, China, 2013/14

Assessing the severity of emerging infections is challenging because of potential biases in case ascertainment. The first human case of infection with influenza A(H7N9) virus was identified in China in March 2013; since then, the virus has caused two epidemic waves in the country. There were 134 laboratory-confirmed cases detected in the first epidemic wave from January to September 2013. In the second epidemic wave of human infections with avian influenza A(H7N9) virus in China from October 2013 to October 2014, we estimated that the risk of death among hospitalised cases of infection with influenza A(H7N9) virus was 48% (95% credibility interval: 42-54%), slightly higher than the corresponding risk in the first wave. Age-specific risks of death among hospitalised cases were also significantly higher in the second wave. Using data on symptomatic cases identified through national sentinel influenza-like illness surveillance, we estimated that the risk of death among symptomatic cases of infection with influenza A(H7N9) virus was 0.10% (95% credibility interval: 0.029-3.6%), which was similar to previous estimates for the first epidemic wave of human infections with influenza A(H7N9) virus in 2013. An increase in the risk of death among hospitalised cases in the second wave could be real because of changes in the virus, because of seasonal changes in host susceptibility to severe infection, or because of variation in treatment practices between hospitals, while the increase could be artefactual because of changes in ascertainment of cases in different areas at different times.

Clinical characteristics of Q fever and etiology of community-acquired pneumonia in a tropical region of southern Taiwan: a prospective observational study

Background

The clinical characteristics of Q fever are poorly identified in the tropics. Fever with pneumonia or hepatitis are the dominant presentations of acute Q fever, which exhibits geographic variability. In southern Taiwan, which is located in a tropical region, the role of Q fever in community-acquired pneumonia (CAP) has never been investigated.

Methodology/Principal Findings

During the study period, May 2012 to April 2013, 166 cases of adult CAP and 15 cases of acute Q fever were prospectively investigated. Cultures of clinical specimens, urine antigen tests for Streptococcus pneumoniae and Legionella pneumophila, and paired serologic assessments for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Q fever (Coxiella burnetii) were used for identifying pathogens associated with CAP. From April 2004 to April 2013 (the pre-study period), 122 cases of acute Q fever were also included retrospectively for analysis. The geographic distribution of Q fever and CAP cases was similar. Q fever cases were identified in warmer seasons and younger ages than CAP. Based on multivariate analysis, male gender, chills, thrombocytopenia, and elevated liver enzymes were independent characteristics associated with Q fever. In patients with Q fever, 95% and 13.5% of cases presented with hepatitis and pneumonia, respectively. Twelve (7.2%) cases of CAP were seropositive for C. burnetii antibodies, but none of them had acute Q fever. Among CAP cases, 22.9% had a CURB-65 score ≧2, and 45.8% had identifiable pathogens. Haemophilus parainfluenzae (14.5%), S. pneumoniae (6.6%), Pseudomonas aeruginosa (4.8%), and Klebsiella pneumoniae (3.0%) were the most common pathogens identified by cultures or urine antigen tests. Moreover, M. pneumoniae, C. pneumoniae, and co-infection with 2 pathogens accounted for 9.0%, 7.8%, and 1.8%, respectively.

Conclusions

In southern Taiwan, Q fever is an endemic disease with hepatitis as the major presentation and is not a common etiology of CAP.

High-precision distribution of highly stable optical pulse trains with 8.8 × 10⁻¹⁹ instability

The high-precision distribution of optical pulse trains via fibre links has had a considerable impact in many fields. In most published work, the accuracy is still fundamentally limited by unavoidable noise sources, such as thermal and shot noise from conventional photodiodes and thermal noise from mixers. Here, we demonstrate a new high-precision timing distribution system that uses a highly precise phase detector to obviously reduce the effect of these limitations. Instead of using photodiodes and microwave mixers, we use several fibre Sagnac-loop-based optical-microwave phase detectors (OM-PDs) to achieve optical-electrical conversion and phase measurements, thereby suppressing the sources of noise and achieving ultra-high accuracy. The results of a distribution experiment using a 10-km fibre link indicate that our system exhibits a residual instability of 2.0 × 10⁻¹⁵ at1 s and8.8 × 10⁻¹⁹ at 40,000 s and an integrated timing jitter as low as 3.8 fs in a bandwidth of 1 Hz to 100 kHz. This low instability and timing jitter make it possible for our system to be used in the distribution of optical-clock signals or in applications that require extremely accurate frequency/time synchronisation.

Preparation of immobilized Cu2O using microwave irradiation and its catalytic activity for bisphenol A: comparisons of Cu2O/H2O2 and visible-light/Cu2O/H2O2 systems

This study produced immobilized Cu2O via microwave irradiation. The surface properties of Cu2O were assessed by X-ray diffraction, scanning electron microscopy, and UV-vis spectroscopy. The catalytic activity of the generated Cu2O was examined for bisphenol (BPA) degradation in Cu2O/H2O2 and visible-light/Cu2O/H2O2 systems under various H2O2 concentrations. Cu2O can decompose H2O2 to generate radicals, similar to the Fenton-like process. The BPA degradation rate followed pseudo-first-order kinetics. The optimal H2O2 concentration was 30 mM and the BPA degradation rate under 30 mM H2O2 in the Cu2O/H2O2 and visible-light/Cu2O/H2O2 systems was 1.43 and 2.69 h(-1), respectively. The original Cu2O partly oxidized into CuO in the visible-light/Cu2O/H2O2 system and the BPA degradation percentage declined to 51% from 100% after the fifth cycle.

Highly stable wideband microwave extraction by synchronizing widely tunable optoelectronic oscillator with optical frequency comb

Optical frequency combs (OFCs), based on mode-locked lasers (MLLs), have attracted considerable attention in many fields over recent years. Among the applications of OFCs, one of the most challenging works is the extraction of a highly stable microwave with low phase noise. Many synchronisation schemes have been exploited to synchronise an electronic oscillator with the pulse train from a MLL, helping to extract an ultra-stable microwave. Here, we demonstrate novel wideband microwave extraction from a stable OFC by synchronising a single widely tunable optoelectronic oscillator (OEO) with an OFC at different harmonic frequencies, using an optical phase detection technique. The tunable range of the proposed microwave extraction extends from 2 GHz to 4 GHz, and in a long-term synchronisation experiment over 12 hours, the proposed synchronisation scheme provided a rms timing drift of 18 fs and frequency instabilities at 1.2 × 10⁻¹⁵/1 s and 2.2 × 10⁻¹⁸/10000 s.

Kinetics of serological responses in influenza A(H7N9)-infected patients correlate with clinical outcome in China, 2013

The novel avian influenza A(H7N9) infection has recently emerged to cause severe respiratory illness in China. The objectives of this study were to define the kinetics of the antibody responses in patients with influenza A(H7N9) disease and to correlate these kinetics with clinical outcome. Serial serum samples were obtained at intervals of three to four days from 18 patients with virologically confirmed A(H7N9) disease in Shanghai. We determined the kinetics of the haemagglutination inhibition (HI) and A(H7H9) pseudotype neutralisation antibody (Nab) responses and correlated these with clinical outcomes. Most patients had robust serological responses by both HI and Nab tests. Taking into account censoring due to time of testing and death, the median time from onset of illness to Nab titre ≥1:40 was 14 days (95% confidence interval (CI): 11–18 days) in the fatal cases and 10.5 days (95% CI: 7–12) in the survivors (p=0.003). The two groups did not differ in initial Nab titres, but the rate of increase in Nab titres was significantly faster for survivors by approximately 10-fold per 15 days (p=0.007). Early and rapid induction of Nab was correlated significantly with better clinical outcome.

Genetic diversity of Saccharum spontaneum from geographical regions of China assessed by simple sequence repeats

Saccharum spontaneum is the most variable wild relative of sugarcane with potential for use in sugarcane improvement programs. In order to help preserve and exploit this species, 152 accessions from eight major geographical regions in China, including Hainan, Guangdong, Guangxi, Yunnan, Sichuan, Guizhou, Fujian, and Jiangxi provinces, were investigated by analyzing 20 simple sequence repeats (SSRs), including 11 genomic SSRs (gSSRs) and nine SSRs developed from expressed sequence tags (EST-SSRs). A total of 454 alleles were generated by the 20 SSRs, with 295 and 159 alleles detected by gSSRs and EST-SSRs respectively. The Mantel test showed significant correlation between genetic matrixes among the studied accessions revealed by gSSRs versus EST-SSRs, although the average polymorphism of EST-SSRs (17.7) was much lower than that of gSSRs (26.8). Among the eight provinces, collections from Guizhou were the most diverse and those from Guangdong were the most distinct. Clustering analysis and principal component analysis accordantly classified the accessions into four groups, which were "Southwest group", "Hainan group", "Guangdong group", and "Guangxi group", based on the geographical origin of the major accessions in each group, demonstrating that geographical factors play an important role in the pattern of genetic structure of Chinese S. spontaneum. As two (Guizhou and Yunnan) of the three provinces with highest genetic diversity are located in southwest China, we concluded that southwest China is the region with the highest genetic diversity of S. spontaneum.

Preliminary inferences on the age-specific seriousness of human disease caused by avian influenza A(H7N9) infections in China, March to April 2013

Binary file ES_Abstracts_Final_ECDC.txt matches

Preliminary inferences on the age-specific seriousness of human disease caused by avian influenza A(H7N9) infections in China, March to April 2013

Between 31 March and 21 April 2013, 102 laboratory-confirmed influenza A(H7N9) infections have been reported in six provinces of China. Using survey data on age-specific rates of exposure to live poultry in China, we estimated that risk of serious illness after infection is 5.1 times higher in persons 65 years and older versus younger ages. Our results suggest that many unidentified mild influenza A(H7N9) infections may have occurred, with a lower bound of 210–550 infections to date.

Seroprevalence of antibody to pandemic influenza A (H1N1) 2009 among healthcare workers after the first wave in Hong Kong

During the first wave of an influenza pandemic prior to the availability of an effective vaccine, healthcare workers (HCWs) may be at particular risk of infection with the novel influenza strain. We conducted a cross-sectional study of the prevalence of antibody to pandemic influenza A (H1N1) 2009 (pH1N1) among HCWs in Hong Kong in February–March 2010 following the first pandemic wave. Sera collected from HCWs were tested for antibody to pH1N1 influenza virus by viral neutralisation (VN). We assessed factors associated with higher antibody titres, and we compared antibody titres in HCWs with those in a separate community study. In total we enrolled 703 HCWs. Among 599 HCWs who did not report receipt of pH1N1 vaccine, 12% had antibody titre ≥1:40 by VN. There were no significant differences in the age-specific proportions of unvaccinated HCWs with antibody titre ≥1:40 compared with the general community following the first wave of pH1N1. Under good adherence to infection control guidelines, potential occupational exposures in the hospital setting did not appear to be associated with any substantial excess risk of pH1N1 infection in HCWs. Most HCWs had low antibody titres following the first pandemic wave.

Reducing the impact of the next influenza pandemic using household-based public health interventions

Household-based public health interventions can effectively mitigate the impact of influenza pandemic, and the resources and compliance requirement are realistic and feasible.

Hoarseness as a first manifestation of aortotracheal fistula

Aortotracheal fistula is uncommon but invariably fatal if not diagnosed early and accurately. Most fistulas are related to aneurysm of the thoracic aorta. Massive hemoptysis is reported to occur in more than half of the patients and is often the final event. We report a patient with hoarseness as an initial manifestation due to the painless formation of a pseudoaneurysm of aortic arch, which soon ruptured. Bronchoscopy disclosed a tracheal bulging mass with surface irregularity on the distal end of trachea before massive hemoptysis. We thought, faced with the cardiovocal syndrome accompanied with hemoptysis, lethal aortopulmonary fistula should be highly suspected.

Diagnostic and prognostic values of pleural fluid procalcitonin in parapneumonic pleural effusions

BACKGROUND

The role of procalcitonin (PCT) in parapneumonic pleural effusion (PPPE) as a diagnostic and prognostic biomarker of the outcome has not been examined before.

METHODS

From the emergency department, 82 adult patients with pleural effusions were enrolled in this prospective study and divided into the following two groups: the PPPE group (n = 45); and the non-PPPE group (n = 37). Levels of pleural fluid (PF) PCT and serum (S) PCT were determined in all patients after study enrollment as well as on day 3 only in the PPPE group by a newly developed time-resolved, amplified, cryptate emission assay.

RESULTS

Both PF-PCT and S-PCT levels were significantly higher in the PPPE group than the non-PPPE group (p = 0.01 and 0.0003, respectively). S-PCT had a better diagnostic performance than PF-PCT, with an area under the curve of the receiver operating characteristic of 0.834 for S-PCT and 0.752 for PF-PCT (p = 0.006). In the PPPE group, both PF-PCT and S-PCT levels on days 1 and 3 were significantly higher in patients who were in high-severity risk classes (all p values < 0.05). Day 3 PF-PCT/S-PCT ratios were significantly lower in patients who needed chest tube drainage for > 7.5 days (corrected p = 0.02).

CONCLUSION

S-PCT has higher diagnostic accuracy than PF-PCT in differentiating PPPEs from non-PPPEs. However, both PF-PCT and S-PCT are useful in the severity assessment of patients with PPPEs. The PF-PCT/S-PCT ratio may help to predict prolonged chest tube drainage.

Identification of physical parameters controlling the dominance of algal species in a subtropical reservoir

Eutrophication is a serious problem of water resource management in Taiwan. The occurrence of annoying algal species as well as abnormally abundant algal mass threatens the quality of water supply. The growth and decline of a specific phytoplankton species are affected by environmental factors, including light, nutrients, temperature, etc. There have been many investigations on the effects of individual factors on the abundance and composition of algal populations. However, many analyses on the effects of environmental factors, especially the concentration of nutrients, on phytoplankton failed to identify the controlling factors on the dynamic change of the phytoplankton species. This study used statistical methods to isolate the effect of seasons on the phytoplankton growth and searched for the relationships between the nutrient concentrations and the abundance of different algal species in Feitsui Reservoir based on the data obtained from 1995 to 2003. We found that the dynamic change of dominance of some species of phytoplankton was strongly related to the seasonal factors. The controlling factors of the survival of an algal species were the settling and mobility of the phytoplankton, the mixing depth and the vertical mixing strength of the water bodies. According to our preliminary findings, the influence of physical factors, varying seasonally, outweighs the influence of nutrients on the algal species composition in Feitsui Reservoir in Taiwan.

Occurrence of pathogens in raw and ready-to-eat meat and poultry products collected from the retail marketplace in Edmonton, Alberta, Canada

A total of 800 meat and poultry products were purchased from the retail marketplace in Edmonton, Alberta, Canada. The products consisted of raw ground beef, chicken legs, pork chops, and ready-to-eat fermented sausage, roast beef, processed turkey breast, chicken wieners, and beef wieners. The samples were analyzed to determine the prevalence of Shiga toxin-producing Escherichia coli, Salmonella, Campylobacter spp., and Listeria monocytogenes. Shiga toxin-producing E. coli 022: H8 was found in one raw ground beef sample. Salmonella and Campylobacter were found in 30 and 62% of raw chicken legs, respectively. L. monocytogenes was found in 52% of raw ground beef, 34% of raw chicken legs, 24% of raw pork chops, 4% of fermented sausages, 3% of processed turkey breast, 5% of beef wieners, and 3% of chicken wieners. The occurrence of pathogens in this study is similar to that in retail products in many other international locales.

Syngeneic hematopoietic stem cell transplantation for women with metastatic breast cancer

Metastatic breast cancer has been a common indication for autologous hematopoietic stem cell transplantation (HSCT). Previous reports indicate 3-year survival and progression-free survival (PFS) rates after autotransplant to be about 30 and 15%, respectively. Most deaths are from recurrent disease. One potential cause for high relapse rates is graft contamination with tumor. We describe 14 women with metastatic breast cancer transplanted between 1991 and 1998 with hematopoietic cells from identical twins. Median age was 41 y (range 34-50). Most women (12 of 14) were treated with mastectomy, and all received anthracycline-based regimens in their pretransplant course; nine women also received a taxane, seven radiotherapy and three hormonal therapy. Four women were in complete remission (one CR, three CRU) at transplant, five were in partial remission, two had stable disease and two had progressive disease. Eight women have died, one of treatment-related causes and seven of progressive breast cancer. Three-year survival was 48% (21-71%) and 3-year PFS was 21% (5-45%). Although the number of patients is small, outcomes for women transplanted with syngeneic grafts are similar to those of women receiving autologous grafts. This suggests that residual cancer in the patient is the major contributor to relapse after transplantation for breast cancer.

Annual variation in semen characteristics of pigeons (Columba livia)

The purpose of this study was to evaluate annual semen characteristics of pigeons (Columba livia). Ten selected male pigeons, aged 2 to 5 yr were housed under natural environmental conditions, and semen collection was conducted via a digital massage twice weekly throughout the year. The success rate of semen collection in a total of 920 attempts was 40% (371/920) over the whole year. The highest success rate was 69% (55/80) in March followed by 66% (53/80) in November, whereas the lowest rates were in August (13%,10/80) and September (13%, 8/60) (P < 0.01). Volume of the ejaculate averaged 11.0 +/- 0.9 microL (mean +/- SEM). The greatest volume was obtained in November (13.5 +/- 1.0 microL), whereas the least was obtained in August (7.0 +/- 1.0 microL). The average sperm motility was 72 +/- 2% of all ejaculates, of which the highest motility (82 +/- 2%) was observed in March, whereas the least motility (48 +/- 3%) was in August. Sperm viability and sperm motility were positively correlated (r = 0.91; P < 0.01). Maximum sperm concentration was 4.9 +/- 0.4 x 10(9) sperm/mL noted in March, whereas the minimum was 3.8 +/- 0.2 x 10(9) sperm/mL observed in October. Donors generally exhibited susceptible (54%) or dull submission (43%), whereas resistance to handling was rarely observed (3%). During collections, a red (47%) or pink (44%) cloacal membrane was often observed, whereas during only 9% of the collections, the cloacal membrane was pale. When the ambient temperature decreased below 15 C, semen could not be obtained (0/80). A high amount of semen (>10 microL) was obtained when the temperature ranged between 19 and 24 C. Optimal sperm motility (approximately 80%) and viability (>85%) was observed when the temperature was between 18 and 24 C. At temperatures greater than 28 C, sperm motility and viability decreased. Sperm concentration was not significantly influenced by temperature fluctuations. In summary, annual variation in semen characteristics exhibited two peaks per year with mean motility and viability reaching peak annual values in March and November. Both of these months had mean ambient temperatures between 19 and 24 C, a range associated with maximal ejaculatory volumes.

Tissue remodeling of rat pulmonary artery in hypoxic breathing. I. Changes of morphology, zero-stress state, and gene expression

The remodeling of the pulmonary arterial tissue in response to a step change of the oxygen concentration in the gas in which a rat lives was recorded as function of time and function of O2 concentration. Three steps of changing from 20.9% to 17.2%, 13.6%, and 10% O2 were imposed. Earlier work in our laboratory has shown that pulmonary arterial tissue remodeling is significant in the first 24 h after a step change of oxygen tension. Hence we made measurements in this period. Furthermore, data were obtained for tissue remodeling of circumferential and axial lengths of the pulmonary arteries. We recorded the activities of gene expressions in the lung tissues by microarray, determined the dose response curves of gene expression in the homogenized whole lungs with respect to four levels of O2 concentration, and obtained the time courses of gene expression in the lung parenchyma in 30 days after a step decrease of O2 concentration from 20.9% to 10%. We would like to suggest that the correlation of gene expression with physiological function parameters, i.e., time, O2 tension, blood pressure, opening angle, wall thicknesses, etc., is the way to narrow down the search for specific genes for specific physiological functions.

Tissue remodeling of rat pulmonary artery in hypoxic breathing. II. Course of change of mechanical properties

When cells and the matrix of a tissue remodel, the mechanical properties of the tissue do change. The mechanical properties are expressed by constitutive equations. In this article the remodeling of the constitutive equation of the pulmonary artery is studied. The remodeling was induced in a rat breathing a gas whose oxygen concentration was suddenly decreased as a step function of time and maintained constant (17.2%, 13.6%, or 10%) afterwards. Since the mathematical form of the constitutive equation has been identified in earlier papers, we need to determine only the elastic constants that change in the process of tissue remodeling. We consider arteries subjected to blood pressure and longitudinal stretch, and limit ourselves to two-dimensional problems involving only circumferential and longitudinal stress and strain. In the neighborhood of an in vivo state, the perturbations of stresses and strains are related by linear, anisotropic, tensor equations involving three elastic constants: the incremental Young's modulus in the circumferential direction Ythetaz, that in the longitudinal direction Yzz, and the cross modulus Ythetaz. Over a 24 h period, changes of Ythetatheta between 164 and 187 kN/m2, Yzz between 64 and 92 kN/m2, and Ythetaz between 61 and 88 kN/m2 are statistically insignificant.

Development of an ELISA for the detection of serum chromogranin A (CgA) in prostate and non-neuroendocrine carcinomas

INTRODUCTION

Chromogranin A (CgA) is a glycoprotein found in neuroendocrine cells and may be useful as a tumor marker for neuroendocrine tumors.

METHODS

We developed an enzyme-linked immunosorbent assay (ELISA) for serum CgA on a microtiter plate.

RESULTS

We established a reference range for both women and men of different age groups ranging from 20 to 80 years. Men appeared to have a slightly higher serum CgA concentration than women. This slight increase in serum CgA concentration was also found in both gender groups with advancing age. We also detected increased serum CgA in a variety of cancers and non-endocrine carcinomas: the majority of the increased serum CgA was associated with specimens containing highly increased concentration of tumor markers. In other words, increased serum CgA was found at later, more advanced stages of the disease in these patients. For patients with prostate cancer, serum CgA was increased much earlier than serum PSA in approximately one-third of prostate cancer patients developing resistance to hormonal therapy.

CONCLUSIONS

The early rise of serum CgA provides an early signal for prostate cancer patients who developed resistance to hormonal therapy: this advance signal could create a critical window for therapy changes to be made before diseases progress to a fatal stage.

Modeling and analysis of a virus that replicates selectively in tumor cells

Replication-competent viruses have shown considerable promise in overcoming the inefficient gene transduction experienced by traditional gene therapy approaches to cancer treatment. The viruses infect tumor cells and replicate inside them, eventually causing lysis. Virus particles released during lysis are then able to infect other tumor cells, and, in this way, continuous rounds of infection and lysis allow the virus to spread throughout the tumor. Motivated by this novel cancer treatment, we formulate and analyse a system of partial differential equations that is essentially a radially-symmetric epidemic model embedded in a Stefan problem. We compare three, alternative virus-injection strategies: a fixed fraction of cells pre-infected with the virus are introduced throughout the entire tumor volume, within the tumor core, or within the tumor rim. For all three injection methods, simple and accurate conditions that predict whether the virus will control the tumor are derived.

Reproductive performance of a cow-calf herd following a Neospora caninum-associated abortion epidemic

This study examines the long-term impact of a Neospora caninum-associated abortion outbreak in a large cow-calf herd in northern Alberta. Blood samples were collected 4 times from all bred females and heifer calves born during the spring before the outbreak: (1) at the time of the outbreak, (2) the following spring, (3) the subsequent fall, and, finally, (4) the second spring after the outbreak. The samples were analyzed using a commercially available enzyme-linked immunosorbent assay for N. caninum. Calves born immediately following the outbreak were also monitored. Individual calving or abortion records were available from all cows for 2 calving seasons. All cows and heifers were pregnancy tested after the 2 subsequent breeding seasons. At the time of the abortion outbreak in 1997, 81% of all bred females and 87% of the heifer calves were serologically positive. In spring 1998, 49% of the cows and 47% of the heifer calves remained positive. In fall 1998, 48% of the remaining cows and heifers were serologically positive. After the first breeding season following the outbreak (1998), 13.5% of the heifers and 22.2% of the cows were open (not pregnant). Animals that were serologically positive in the spring were more likely to be open in the fall (odds ratio, 2.0; 95% confidence interval, 1.1 to 3.7). No subsequent associations with increased risk of abortion, stillbirth, or nonpregnancy were identified.