Current technical advancements in plant epitranscriptomic studies

The growth and development of plants are the result of the interplay between the internal developmental programming and plant-environment interactions. Gene expression regulations in plants are made up of multi-level networks. In the past few years, many studies were carried out on co- and post-transcriptional RNA modifications, which, together with the RNA community, are collectively known as the "epitranscriptome." The epitranscriptomic machineries were identified and their functional impacts characterized in a broad range of physiological processes in diverse plant species. There is mounting evidence to suggest that the epitranscriptome provides an additional layer in the gene regulatory network for plant development and stress responses. In the present review, we summarized the epitranscriptomic modifications found so far in plants, including chemical modifications, RNA editing, and transcript isoforms. The various approaches to RNA modification detection were described, with special emphasis on the recent development and application potential of third-generation sequencing. The roles of epitranscriptomic changes in gene regulation during plant-environment interactions were discussed in case studies. This review aims to highlight the importance of epitranscriptomics in the study of gene regulatory networks in plants and to encourage multi-omics investigations using the recent technical advancements.

Twenty years of mining salt tolerance genes in soybean

Current combined challenges of rising food demand, climate change and farmland degradation exert enormous pressure on agricultural production. Worldwide soil salinization, in particular, necessitates the development of salt-tolerant crops. Soybean, being a globally important produce, has its genetic resources increasingly examined to facilitate crop improvement based on functional genomics. In response to the multifaceted physiological challenge that salt stress imposes, soybean has evolved an array of defences against salinity. These include maintaining cell homeostasis by ion transportation, osmoregulation, and restoring oxidative balance. Other adaptations include cell wall alterations, transcriptomic reprogramming, and efficient signal transduction for detecting and responding to salt stress. Here, we reviewed functionally verified genes that underly different salt tolerance mechanisms employed by soybean in the past two decades, and discussed the strategy in selecting salt tolerance genes for crop improvement. Future studies could adopt an integrated multi-omic approach in characterizing soybean salt tolerance adaptations and put our existing knowledge into practice via omic-assisted breeding and gene editing. This review serves as a guide and inspiration for crop developers in enhancing soybean tolerance against abiotic stresses, thereby fulfilling the role of science in solving real-life problems.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11032-023-01383-3.

Acceptability of assisted reproductive technologies in Hong Kong, a very low fertility Asian city

Background

Although advances in medical technologies now allow greater reproductive options, the social acceptance of assisted reproductive technologies (ART) has not been examined in East Asian countries which currently have the lowest fertility rates in the world and highly prohibitive regulations.

Methods

A cross-sectional telephone surveys interviewed 990 among Hong Kong Chinese adults (>18 years of age) in 2015 who were asked about their knowledge and attitudes towards various ART and their inclination to use ART. A focus group was conducted (n = 30) on physicians to examine the perceived barriers and benefits of integrating ART as routine offerings.

Results

Although nearly all adults (>92.0%) were familiar with ART procedures such as in vitro fertilization, sperm banking, and gestational surrogacy, attitudes supporting the use of these services and the inclination to use these services varied widely by socio-demographic attributes. Nearly one-third (31.5%) of women said that they would consider cryopreservation of their oocytes or embryos if they could afford it and 21.9% would encourage their female family members to do so. Although respondents considered sperm donation and embryo preservation to be well-accepted practices, support for these services was noticeably lower than in Western countries for unmarried individuals and homosexuals. Also, the vast majority of respondents were much more disinclined to use anonymous donor gametes than in Western countries. Among medical practitioners, the primary barriers to routine offering of these services to their clients was the perceived lack of cultural acceptance of these types of services.

Conclusions

Public support of assisted reproductive services for genetic offspring is well-accepted for heterosexual couples. Main Messages: Asian countries with sub-replacement fertility levels may consider integrating ART into their mainstream health services and updating their regulatory frameworks.

Key messages

Public support for assisted reproductive technologies is high for married couples only in Hong Kong. Given the sub-replacement fertility levels, cities in East Asia should consider updating regulatory frameworks to allow expansion of ART services.

Effect of time delay on survival in patients with non-small cell lung cancer — A Malaysian study

The prognosis of lung cancer remains poor with overall five year survival figures varying between five and 10% worldwide, However, it has been shown that surgery in patients with early stage disease in non-small cell lung cancer can achieve five year survival rates up to 80%, suggesting that early or delay diagnosis can influence prognosis. Nevertheless, studies addressing this have been inconclusive and mostly derived from Western countries.

Measurements of electron density and temperature profiles in plasma produced by Nike KrF laser for laser plasma instability research

A grid image refractometer (GIR) has been implemented at the Nike krypton fluoride laser facility of the Naval Research Laboratory. This instrument simultaneously measures propagation angles and transmissions of UV probe rays (λ = 263 nm, Δt = 10 ps) refracted through plasma. We report results of the first Nike-GIR measurement on a CH plasma produced by the Nike laser pulse (∼1 ns FWHM) with the intensity of 1.1 × 10(15) W/cm(2). The measured angles and transmissions were processed to construct spatial profiles of electron density (ne) and temperature (Te) in the underdense coronal region of the plasma. Using an inversion algorithm developed for the strongly refracted rays, the deployed GIR system probed electron densities up to 4 × 10(21) cm(-3) with the density scale length of 120 μm along the plasma symmetry axis. The resulting n(e) and T(e) profiles are verified to be self-consistent with the measured quantities of the refracted probe light.

Tay-Sach disease with "cherry-red spot"--first reported case in Malaysia

We present a rare case of Tay-Sachs disease with retinal 'cherry-red spots' in a 19-month-old Malay child. Molecular genetic studies confirmed the diagnosis. The case highlights that 'cherry-red spot' is a useful clinical clue in Tay-Sachs disease and several other lysosomal storage disorders. It serves as an ideal illustration of the eye as a window to inborn error of metabolism.

Left ventricular diastolic function during normal pregnancy: assessment by spectral tissue Doppler imaging

OBJECTIVE

Tissue Doppler imaging (TDI) is an echocardiographic technique for assessing the diastolic function that is relatively independent of preload. Since loading conditions change significantly during pregnancy, a load-independent technique will give a more accurate assessment of diastolic function in pregnant women. The aim of this study was to evaluate maternal diastolic function using tissue Doppler imaging.

METHODS

This was a prospective observational study on 35 healthy pregnant women. M-mode, transmitral inflow (peak transmitral flow velocities during early diastole (E wave) and atrial contraction (A wave)) and TDI studies (peak myocardial velocities during early diastole (Em wave), during atrial contraction (Am wave) and peak systole in ejection phase (Sm)) were performed in each trimester and postpartum. The differences in variables between trimesters were analyzed.

RESULTS

The peak transmitral inflow velocity during early diastole (E wave) was significantly decreased during the third trimester and postpartum. The peak flow velocity during atrial contraction (A wave) was increased in the second trimester, but decreased again in the third trimester and postpartum period. As a result, the E/A ratio progressively reduced as pregnancy advanced. TDI showed that peak myocardial velocities during early diastole (Em) tended to increase during the second trimester, and then decreased significantly in the third trimester or postpartum period. The peak myocardial velocities during atrial contraction (Am) increased significantly with advancing gestational age. As a consequence, both Em/Am and E/Em ratios decreased significantly throughout pregnancy.

CONCLUSIONS

This study demonstrates the changes in myocardial relaxation velocity throughout pregnancy. Because of its advantage of being relatively load-independent, TDI may be a useful non-invasive technique for monitoring maternal cardiac function in high-risk pregnancies to detect the early signs of cardiac failure and to prevent further deterioration with prompt interventions.

The influence of fetal position on amniotic fluid index and single deepest pocket

OBJECTIVE

To evaluate the effect of fetal position on measurement of amniotic fluid index (AFI) and of the single deepest pocket (SDP).

METHODS

This was a prospective observational study, in a university obstetric unit, of women with an uncomplicated singleton pregnancy with longitudinal lie and cephalic presentation at or beyond 28 weeks of gestation. AFI was calculated and SDP measured and the fetal position was characterized in terms of three parameters. These were: the side of the maternal abdomen on which the fetus lay; a numerical representation (laterality score) of the distance that the fetus was from the sagittal midline plane of the maternal abdomen; the orientation of the fetal trunk (ventral anterior, lateral or posterior).

RESULTS

Eighty-one women were recruited into the study. There was a significant relationship between the laterality score and the AFI (P = 0.005) but not the SDP (P = 0.23): AFI was on average 4.35 cm higher in fetuses lying centrally compared with those lying laterally inside the uterus. There was no significant difference for either SDP (P = 0.8) or AFI (P = 0.3) between fetuses lying on the right or the left side of the maternal abdomen. Similarly, there was no significant difference in SDP (P = 0.9) or AFI (P = 1.0) for the different orientations of the fetal trunk.

CONCLUSION

Fetal position affects the measurement of AFI but not that of SDP. Therefore, SDP may be a more consistent parameter for the estimation of amniotic fluid volume.

Expression of divalent metal transporter 1 (DMT1) isoforms in first trimester human placenta and embryonic tissues

BACKGROUND

Divalent metal transporter 1 (DMT1) is a transmembrane glycoprotein which mediates the proton-coupled transport of a variety of divalent metal ions. Two isoforms, which differ by the presence (DMT1-IRE) or absence (DMT1-nonIRE) of an iron-responsive element (IRE) in their 3' untranslated region, are implicated in apical iron transport and endosomal iron transport respectively. Although the expression pattern of DMT1 isoforms is tissue specific in adult, data regarding its expression in embryonic tissues are lacking.

METHODS

Semiquantitative RT-PCR and immunohistochemistry were used to study the mRNA and protein expression of both DMT1 isoforms in embryonic tissues between 8 and 14 weeks gestational age.

RESULTS

DMT1-IRE and DMT1-nonIRE expressions were ubiquitous in embryonic tissues examined. In the lung, statistically significant correlations were found between the levels of DMT1 isoform expression and gestational age. In the placenta, DMT1-IRE was the predominantly expressed isoform. Both isoform proteins were localized in embryonic epithelial cellular membrane.

CONCLUSION

Both DMT1 isoforms are ubiquitously expressed in embryonic tissues in the first trimester. Predominant DMT1-IRE isoform expression in placenta suggests an iron-regulatory mechanism reminiscent of that in the adult duodenum. Epithelial distributions of both DMT1 isoforms are associated with the absorptive or excretory functions of the expressed tissues.

All-optical add-drop node for optical packet-switched networks

We have demonstrated all-optical packet add-drop for all-optical packet-switched networks. Intelligent all-optical add-drop of packets is performed, based on all-optical processing of packet headers. The header and payload rates are 5 and 10 Gbits/s, respectively.

Intrapartum Cesarean Delivery After Successful External Cephalic Version

OBJECTIVE

We sought to estimate whether the risk of intrapartum cesarean delivery is higher in pregnancies after successful external cephalic version.

DATA SOURCES

We searched the MEDLINE, PubMed, EMBASE, and Cochrane Library databases to identify relevant studies. Abstracts of the American College of Obstetricians and Gynecologists Annual Clinical Meeting and the Society for Maternal-Fetal Medicine Annual Meeting were searched by hand.

STUDY SELECTION

Studies published between 1980 and 2002 that provided data allowing us to estimate the cesarean rate in both pregnancies after successful version and spontaneous cephalic-presenting pregnancies were selected.

TABULATION, INTEGRATION, AND RESULTS

Relative risks (RRs) and 95% confidence intervals (CIs) between the 2 compared groups were calculated. We used a meta-analysis to assess the heterogeneity of the studies and to combine the results from the included studies. Six eligible studies were identified. The cesarean rate was 27.6% in pregnancies after successful version and 12.5% in cephalic-presenting pregnancies. The combined RR and 95% CI was 2.04 (1.43-2.91). The increased cesarean rate in pregnancies after successful version was accounted for primarily by a higher incidence of emergency cesarean delivery for dystocia and fetal distress; the RR (95% CI) for these 2 events was 2.19 (1.38-3.48) and 2.10 (1.18-3.75), respectively.

CONCLUSION

The intrapartum cesarean delivery rate after successful version is 2 times that in pregnancies where there is spontaneous cephalic presentation. Pregnancies after successful version should not be considered the same as a normal pregnancy.

An in-vitro study of ginsenoside Rb1-induced teratogenicity using a whole rat embryo culture model

BACKGROUND

Ginseng is a commonly used herbal medicine worldwide. However, there is limited information regarding its effects on the developing embryo.

METHODS

The effect of ginsenoside on the developing embryo during the critical period of organogenesis was investigated using a whole rat embryo culture model. Embryos were exposed to various concentrations of ginsenoside Rb(1) and scored for growth and differentiation at the end of the culture period.

RESULTS

Median total morphological scores in embryos exposed to 30 micro g/ml of ginsenoside Rb(1) was significantly lower (P < 0.05) than that in control embryos (35 versus 45). Morphological scores for flexion, forelimb and hindlimb were also significantly reduced. The median total morphological scores further decreased to 28 when the concentration of ginsenoside Rb(1) was increased to 50 micro g/ml. At this concentration, the embryonic crown-rump length and somite number were also significantly reduced compared with control embryos (2.8 versus 3.0 mm and 16.0 versus 21.0, respectively).

CONCLUSIONS

Our study has demonstrated that ginsenoside exerts direct teratogenic effects on rat embryos. Until more is known about the effects of ginsenoside in women of reproductive age, we suggest its use should be treated with caution.

Indoor air quality investigation at air-conditioned and non-air-conditioned markets in Hong Kong

To characterize indoor air quality at the markets in Hong Kong, three non-air-conditioned and two air-conditioned markets were selected for this study. The indoor air pollutants measured included PM(10) (particulate matters with aerodynamic diameter less than 10 microm), total bacteria count (TBC), carbon monoxide (CO), nitric oxide (NO), nitrogen dioxide (NO(2)) and sulfur dioxide (SO(2)). The indoor and outdoor concentrations of these target air pollutants at these markets were measured and compared. The effects of air conditioning, temperature/relative humidity variation and different stalls on the indoor air quality were also investigated. The results indicated that all of the average indoor concentrations of PM(10), TBC, CO and NO(2) at the markets were below the Hong Kong Indoor Air Quality Objectives (HKIAQO) standards with a few exceptions for PM(10) and TBC. The elevated PM(10) concentrations at Hung Hom, Ngau Tau Kok and Wan Chai markets were probably due to the air filtration of outdoor airborne particulates emitted from vehicular exhaust, whereas high concentrations of airborne bacteria at Sai Ying Pun and Tin Shing markets were linked to the use of air conditioning. Correlation analysis demonstrated that indoor bacteria concentrations were correlated with temperature and relative humidity. The operation of air conditioning did not significantly reduce the levels of air pollutants at the markets. However, the higher indoor/outdoor ratios demonstrated that the operation of air conditioning had influence on the levels of bacteria at the markets. It was found that average PM(10) concentration at poultry stalls was higher than the HKIAQO standard of 180 microg/m(3), and was over two times that measured at vegetable, fish and meat stalls. Furthermore, the concentration of airborne bacteria at the poultry stalls was as high as 1031 CFU/m(3), which was above the HKIAQO standard of 1000 CFU/m(3). The bacteria levels at other three stalls were all below the HKIAQO standard. Statistical analysis indicated that there were no significant differences among the four stalls for CO, NO(x) and SO(2).

Indoor air quality in ice skating rinks in Hong Kong

Indoor air quality in ice skating rinks has become a public concern due to the use of propane- or gasoline-powered ice resurfacers and edgers. In this study, the indoor air quality in three ice rinks with different volumes and resurfacer power sources (propane and gasoline) was monitored during usual operating hours. The measurements included continuous recording of carbon monoxide (CO), carbon dioxide (CO(2)), total volatile organic compounds (TVOC), particulate matter with a diameter less than 2.5 microm (PM(2.5)), particulate matter with diameter less than 10 microm (PM(10)), nitric oxide (NO), nitrogen dioxide (NO(2)), nitrogen oxide (NO(x)), and sulfur dioxide (SO(2)). The average CO, CO(2), and TVOC concentrations ranged from 3190 to 6749 microg/m(3), 851 to 1329 ppm, and 550 to 765 microg/m(3), respectively. The average NO and NO(2) concentrations ranged from 69 to 1006 microg/m(3) and 58 to 242 microg/m(3), respectively. The highest CO and TVOC levels were observed in the ice rink which a gasoline-fueled resurfacer was used. The highest NO and NO(2) levels were recorded in the ice rink with propane-fueled ice resurfacers. The air quality parameters of PM(2.5), PM(10), and SO(2) were fully acceptable in these ice rinks according to HKIAQO standards. Overall, ice resurfacers with combustion engines cause indoor air pollution in ice rinks in Hong Kong. This conclusion is similar to those of previous studies in Europe and North America.

Risk assessment of exposure to volatile organic compounds in different indoor environments

The lifetime cancer risks of exposure of cooks and food service workers, office workers, housewives, and schoolchildren in Hong Kong to volatile organic compounds (VOCs) in their respective indoor premises during normal indoor activities were assessed. The estimated cancer risk for housewives was the highest, and the second-highest lifetime cancer risk to VOC exposure was for the groups of food service and office workers. Within a certain group of the population, the lifetime cancer risk of the home living room was one to two orders of magnitude higher than that in other indoor environments. The estimated lifetime risks of food service workers were about two times that of office workers. Furthermore, the cancer risks of working in kitchen environments were approximately two times higher than the risks arising from studying in air-conditioned classrooms. The bus riders had higher average lifetime cancer risks than those travelling by Mass Transit Railway. For all target groups of people, the findings of this study show that the exposures to VOCs may lead to lifetime risks higher than 1 x 10(-6). Seven indoor environments were selected for the measurement of human exposure and the estimation of the corresponding lifetime cancer risks. The lifetime risks with 8-h average daily exposures to individual VOCs in individual environments were compared. People in a smoking home had the highest cancer risk, while students in an air-conditioned classroom had the lowest risk of cancer. Benzene accounted for about or more than 40% of the lifetime cancer risks for each category of indoor environment. Nonsmoking and smoking residences in Hong Kong had cancer risks associated with 8-h exposures of benzene above 1.8 x 10(-5) and 8.0 x 10(-5), respectively. The cancer risks associated with 1,1-dichloroethene, chloroform, methylene chloride, trichloroethene, and tetrachloroethene became more significant at selected homes and restaurants. Higher lifetime cancer risks due to exposure to styrene were only observed in the administrative and printing offices and air-conditioned classrooms. Higher lifetime cancer risks related to chloroform exposures were observed at the restaurant and the canteen.

Preliminary measurements of aromatic VOCs in public transportation modes in Guangzhou, China

This study examined the exposure level of aromatic volatile organic compounds (VOCs) in public transportation modes in Guangzhou, China. A total of 40 VOC samples were conducted in four popular public commuting modes (subway, taxis, non-air-conditioned buses and air-conditioned buses) while traversing in urban areas of Guangzhou. Traffic-related VOCs (benzene, toluene, ethylbenzene, m/p-xylene and o-xylene) were collected on adsorbent tubes and analyzed by thermal desorption (TD) and gas chromatography/mass-selective detector (GC/MSD) technique. The results indicate that commuter exposure to VOCs is greatly influenced by the choice of public transport. For the benzene measured, the mean exposure level in taxis (33.6 microg/m(3)) was the highest and was followed by air-conditioned buses (13.5 microg/m(3)) and non-air-conditioned buses (11.3 microg/m(3)). The exposure level in the subway (7.6 microg/m(3)) is clearly lower than that in roadway transports. The inter-microenvironment variations of other target compounds were similar to that of benzene. The target VOCs were well correlated to each other in all the measured transports. The concentration profile of the measured transport was also investigated and was found to be similar to each other. Based on the experiment results, the average B/T/E/X found in this study was about (1.0/4.3/0.7/1.4). In this study, the VOC levels measured in evening peak hours were only slightly higher than those in afternoon non-peak hours. This is due to the insignificant change of traffic volume on the measured routes between these two set times. The out-dated vehicle emission controls and slow-moving traffic conditions may be the major reasons leading elevated in-vehicle exposure level in some public commuting journeys.

Characterization of ambient volatile organic compounds at a landfill site in Guangzhou, South China

Ambient air monitoring was conducted at Datianshan landfill, Guangzhou, South China in 1998 to investigate the seasonal and horizontal variations of trace volatile organic compounds (VOCs). Twelve sampling points over the Datianshan landfill were selected and samples were collected simultaneously using Carbontrap(TM) adsorption tubes. Thirty eight VOCs were detected in the winter, whereas 60 were detected in the summer. The VOC levels measured in summer were alkanes, 0.5-6.5 microg/m(3); aromatics, 2.3-1667 microg/m(3); chlorinated species, 0.2-31 microg/m(3); terpines, 0.1-34 microg/m(3); carbonyl species, 0.3-5.6 microg/m(3) and naphthalene and its derivatives, 0.4-27 microg/m(3). Compared to the summer samples the VOC levels in winter were much lower (mostly 1-2 orders of magnitude lower). The aromatics are dominant VOCs in landfill air both in winter and summer. High levels of alkylbenzene and terpines such as methyl-isopropylbenzene (max 1667 microg/m(3)) and limonene (max 162 microg/m(3)) cause undesirable odor. The similar correlation coefficients of BTEX in summer and winter suggest VOCs emissions were from landfill site sources. The variation of BTEX ratio at landfill site is different from that in the urban area of Guangzhou. It shows that the ambient VOCs at landfill site were different from the urban areas.

Demonstration of an all-optical switch by use of a multiwavelength mutual injection-locked laser diode

Error-free all-optical packet switching is demonstrated by use of a multiwavelength mutual injection-locked Fabry-Perot laser diode. A 10-Gbit/s data signal is switched on and off with an extinction ratio of 16.9 dB when an optical control signal is turned off and on with a power difference of only 3 dB.

A study of teratogenicity of hydrosalpinx fluid using a whole rat embryo culture model

BACKGROUND

Hydrosalpinx fluid may be toxic to sperm and early embryo growth. Information concerning the effect of hydrosalpinx fluid on embryo development during organogenesis is lacking.

METHODS

Rat embryos at gestational day 9.5 were cultured for 48 h with 80% rat serum and 20% of either hydrosalpinx fluid (study group) or lactated Ringer's solution (control group). Embryos were scored for growth and development at the end of the culture period.

RESULTS

Hydrosalpinx fluid, collected from 10 patients, was tested for embryotoxicity individually. Median total morphological scores were significantly lower in embryos exposed to hydrosalpinx fluid from three of the 10 patients (43.0 versus 47.0, P = 0.01; 36.0 versus 45.0, P < 0.001; 36.0 versus 46.5, P = 0.003). This was accompanied by a significant reduction in median yolk sac diameter (4.0 versus 5.2 mm, P < 0.001 and 4.0 versus 5.0 mm, P < 0.001) and somite number (17.5 versus 22.5, P < 0.001 and 17.0 versus 21.5, P = 0.008) in the latter two patients.

CONCLUSIONS

Hydrosalpinx fluid in some patients may contain toxin(s) that is potentially teratogenic.

Indoor air quality at restaurants with different styles of cooking in metropolitan Hong Kong

Indoor air quality (IAQ) of a restaurant has increasingly received a lot of public concerns in Hong Kong. Unfortunately, there is limited data about the IAQ of Hong Kong restaurants. In order to characterize the current IAQ of local restaurants, four restaurants in metropolitan Hong Kong including a Korean barbecue style restaurant, a Chinese hot pot restaurant, a Chinese dim sum restaurant and a Western canteen were selected for this study. The results of this study showed that the mean concentrations of CO2 at restaurants with gas stoves for food cooking in dining areas exceeded the range from 40 to 60% indoor CO2 concentrations at restaurants without gas stoves in dining areas. The average levels of PM10 and PM2.5 at the Korean barbecue style restaurant were as high as 1442 and 1167 microg/m3, respectively. At the Korean barbecue and Chinese hot pot restaurants, the levels of PM2.5 accounted for 80-93% of their respective PM10 concentrations. The 1-h average levels of CO observed at Korean barbecue style and hot pot restaurants were 15,100 and 8000 microg/m3, respectively. Relatively high concentrations of CO2, CO, PM10, PM2.5 benzene, toluene, methylene chloride and chloroform were measured in the dining areas of the Korean barbecue style and the Chinese hot pot restaurants. The operations of pan-frying food and boiling food with soup in a hot pot could generate considerable quantities of air pollutants.

Influences of perinatal factors on cord blood thyroid-stimulating hormone level

BACKGROUND

Cord blood thyroid-stimulating hormone level is affected by various perinatal factors. The aim of this study is to investigate the relative impact of these factors on the cord blood thyroid-stimulating hormone results in singleton pregnancies.

METHODS

The study group consisted of 20,086 consecutive singleton deliveries over a 3 year period. The effect of mode of delivery, infant sex, gestation at birth, birth weight, and duration of labor on the incidence of false elevation of cord blood thyroid-stimulating hormone was assessed by univariate analysis and logistic regression.

RESULTS

There was an independent positive association between false elevation of cord blood thyroid-stimulating hormone (> or =15.0 mIU/L) and birth weight (p=0.005), male infant sex (p<0.001), and instrumental delivery (p<0.001). Both elective and emergency cesarean section were negatively associated with elevated cord thyroid-stimulating hormone level (p<0.001). When the cutoff level was raised to 40.0 mIU/L, none of the variables examined were significant. The incidence of false positive tests (> or =15.0 mIU/L) was higher in neonates born by cesarean section for failed instrumental delivery and fetal distress than for failure to progress of labor (34.7% vs 4.5% vs 1.3% respectively, p<0.001).

CONCLUSIONS

While the incidence of false positive screening was significantly affected by various perinatal factors when the thyroid-stimulating hormone cutoff level is low, it was unaffected at a high cutoff level. The present study also provides further evidence that cord blood thyroid-stimulating hormone level reflects fetal response to perinatal stress events.

A study of diclofenac-induced teratogenicity during organogenesis using a whole rat embryo culture model

BACKGROUND

Diclofenac is a non-steroidal anti-inflammatory drug, commonly used by reproductive age women for the treatment of a variety of conditions. However, there is limited information regarding the teratogenic effects of this drug.

METHODS

The effect of diclofenac on the developing embryo during the critical period of organogenesis was investigated by using a whole rat embryo culture model. Embryos were exposed to various concentrations of diclofenac and scored for growth and differentiation at the end of the culture period.

RESULTS

Total developmental score and score for caudal neural tube, flexion and hindlimb were significantly lower in embryos exposed to high concentrations of diclofenac (7.5 and 15.0 microg/ml), but no difference in these parameters was observed when embryos were exposed to low concentration of diclofenac (1.5, 2.5 and 5.0 microg/ml). No significant differences in yolk sac diameter, crown-rump length and number of somites was found between embryos in the experimental and the control group.

CONCLUSIONS

Our study has demonstrated that diclofenac exerts direct teratogenic effects on rat embryos. Until more is known about the effects of diclofenac (especially in moderate to high doses) in women of reproductive age, we suggest its use should be treated with caution.

Pyometra. What is its clinical significance?

OBJECTIVE

To evaluate the clinical outcomes of pyometra.

STUDY DESIGN

Retrospective study conducted between 1993 and 1999 in two regional hospitals.

RESULTS

Pyometra represented 0.038% of gynecologic admissions. Of the 27 women with pyometra, 6 (22.2%) cases were associated with malignancy, 1 (3.7%) was associated with genital tract abnormality, and 20 (74.1%) were idiopathic. Patients with idiopathic pyometra tended to be older and had a higher incidence of concurrent medical conditions. Five (18.5%) women experienced spontaneous perforation of pyometra. A preoperative diagnosis was correctly made in 17 of 22 (77.3%) patients without spontaneous perforation. Most women were treated with dilatation of the cervix and drainage. Nine women (33.3%) had persistent or recurrent pyometra; three of them were asymptomatic.

CONCLUSION

Pyometra is an uncommon condition, but the incidence of associated malignancy is considerable, and the risk of spontaneous perforation is higher than previously thought. Dilatation and drainage is the treatment of choice, and regular monitoring after initial treatment is warranted to detect persistent and recurrent disease.

Derivation of a prediction rule for posttraumatic organ failure using plasma DNA and other variables

The early identification of patients at high risk of developing posttraumatic organ failure would allow preventive therapies to be studied. In this study, highly sensitive and specific guidelines for the early prediction of posttraumatic organ failure (OF) and multiple organ dysfunction syndrome (MODS) using cell-free (plasma) DNA and other predictors of posttraumatic complications were derived. As plasma DNA increases after injury and may be used to predict acute lung injury (ALI), we hypothesized that in combination with other predictors it would predict the later development of OF and MODS. Eighty-three patients (69 males; median age, 36 years) were studied as a consequence of major trauma within 3.5 hours of injury (median time to sampling and assessment, 60 min). Plasma DNA was measured using a real-time, quantitative, polymerase chain reaction assay for the beta-globin gene. OF and MODS occurred in 20/83 (24%) and 9/79 (11%) cases, respectively. At selected cutoff points, the sensitivity of plasma DNA for predicting OF and MODS ranged from 50% to 100%, specificity ranged from 74% to 95%, and the likelihood ratio ranged from 3.89 to 10.50. Other variables studied included serum albumin, creatine kinase, aspartate transaminase, lactate dehydrogenase, leukocyte count, hematocrit, injury severity score, maximal abbreviated injury score, and shock index. Using a classification and regression tree, plasma DNA and aspartate transaminase at optimal cutoffs predicted OF and MODS with an overall correct classification of 93% and 87%, respectively.

Circulating cell-free Epstein-Barr virus DNA levels in patients with EBV-associated lymphoid malignancies

Epstein-Barr virus (EBV) is a human lymphotrophic herpesvirus implicated in the development of several lymphoid malignancies. Recently, detection of cell-free EBV DNA in sera or plasma from patients with EBV-associated malignancies has been reported. However, most published studies are qualitative in nature, with only a few providing quantitative data. We have described the temporal changes of plasma EBV DNA levels in patients with EBV-associated lymphoid malignancies during therapy using quantitative real-time PCR. A close correlation between plasma EBV DNA levels and therapeutic response was observed. Our aim was to update our results and to assess the role of the plasma EBV DNA levels as a molecular marker for disease monitoring in patients with EBV-associated lymphoid malignancies.

Venous thromboembolism in pregnant Chinese women

OBJECTIVE

To evaluate the incidence, disease pattern, and risk factors for thromboembolism in pregnant Chinese women.

METHODS

We conducted a study from January 1998 to December 2000. Women with thromboembolic diseases were identified and their case records retrieved and reviewed. Demographic characteristics were compared between women with and without thromboembolism.

RESULTS

Thirty-two women were diagnosed as having thromboembolic disease during the study period. The total number of deliveries over the study period was 16,993, giving an incidence of 1.88 per 1000 deliveries. There were two cases of pulmonary embolism and one resulted in a maternal death. The others had deep vein thrombosis of which over 80% were limited to calf veins only. The ultrasound examinations requested for suspected deep venous thrombosis before and after the event of maternal death were 1.62 and 10.7 per 1000 deliveries (P <.001); and the corresponding cases of deep venous thrombosis diagnosed were 0.29 and 2.94 per 1000 deliveries, respectively (P <.001). The majority (75%) of cases were diagnosed in the postpartum period, mainly after cesarean delivery. Women with venous thromboembolism were older, had higher body mass index, and a higher incidence of preeclampsia.

CONCLUSION

Thromboembolic disease is not uncommon among pregnant Chinese women. The incidence was similar to that of the white population, although the sites of vascular occlusion were different. The long-standing belief that thromboembolism is rare among Chinese is at least partly because of underdiagnosis.

Effect of mycophenolate mofetil on nitric oxide production and inducible nitric oxide synthase gene expression during renal ischaemia-reperfusion injury

BACKGROUND

Recent animal data suggest that inducible nitric oxide synthase (iNOS) derived nitric oxide (NO) plays an important role in the pathogenesis of renal ischaemia-reperfusion injury (IRI) and that inhibition of iNOS ameliorates IRI. Mycophenolate mofetil (MMF), a lymphocyte selective anti-proliferative agent, has been shown to inhibit NO production in vitro. The aim of this study is to evaluate the effect of MMF on NO production and iNOS gene expression in vivo during renal IRI.

METHODS

Renal IRI was induced by clamping the left renal pedicle of male BALB/c mice for 30 min, followed by 15 min of reperfusion. The mice received placebo or MMF at 40, 80 or 120 mg/kg/day by oral gavage for 5 days before the operation. Sham-operated mice served as the operation control. The amount of NO produced and the level of iNOS gene expression in the kidney tissue during IRI was assessed by spin trapping electron paramagnetic resonance (EPR) spectroscopy and semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) respectively.

RESULTS

In the sham-operated kidneys, only low levels of NO and iNOS mRNA were detected. In mice with renal IRI, the amount of NO detected was significantly increased, which was reduced in a dose dependent fashion by pre-treatment with MMF. Pre-treatment with MMF also substantially reduced iNOS gene expression in the kidney tissue.

CONCLUSIONS

We conclude that pre-treatment with MMF inhibits the production of NO and the induction of iNOS gene expression in the kidney during IRI. These results suggest that MMF might have the potential to ameliorate renal IRI.

Circulating Epstein-Barr virus DNA in the serum of patients with gastric carcinoma

PURPOSE

We investigated the detectability of EBV DNA in the serum of gastric carcinoma patients in Hong Kong. Previous data have shown that approximately 10% of gastric carcinomas in Hong Kong are associated with EBV.

EXPERIMENTAL DESIGN

We recruited 51 patients with gastric carcinoma, 30 patients with gastritis, and 197 apparently healthy controls. For gastric carcinoma patients, blood samples were obtained before surgery. After surgery, the resected tumor samples from the cancer cases were subjected to in situ hybridization for small EBV-encoded RNA (EBER). Serum EBV DNA in all cases was measured by real-time quantitative PCR.

RESULTS

Serum EBV DNA was detectable in 5 of 5 (100%) EBER-positive gastric carcinoma cases (median concentration, 1063 copies/ml), in 13 of 14 (93%) EBER-negative gastric carcinoma cases with EBER-positive infiltrating lymphocytes (median concentration, 50 copies/ml), and in 0 of 32 (0%) EBER-negative cases. In the nontumor controls, serum EBV DNA was detectable in 7 of 30 (23%) gastritis cases (median concentration, 0 copies/ml) and in 7 of 197 (3.6%) apparently healthy individuals (median concentration, 0 copy/ml).

CONCLUSIONS

Our data indicate that serum EBV DNA reflects tumoral EBER status and opens up the possibility that circulating EBV DNA may be used as a tumor marker for the EBER-positive gastric carcinomas. The biological and clinical significance of the presence of low levels of circulating EBV DNA in the minority of gastritis patients and healthy individuals remains to be elucidated.

Indoor air quality at nine shopping malls in Hong Kong

Hong Kong is one of the most attractive shopping paradises in the world. Many local people and international tourists favor to spend their time in shopping malls in Hong Kong. Good indoor air quality is, therefore, very essential to shoppers. In order to characterize the indoor air quality in shopping malls, nine shopping malls in Hong Kong were selected for this study. The indoor air pollutants included carbon dioxide (CO2), carbon monoxide (CO), total hydrocarbons (THC), formaldehyde (HCHO), respirable particulate matter (PM10) and total bacteria count (TBC). More than 40% of the shopping malls had 1-h average CO2 levels above the 1000 ppm of the ASHRAE standard on both weekdays and weekends. Also, they had average weekday PM10 concentrations that exceeded the Hong Kong Indoor Air Quality Objective (HKIAQO). The highest indoor PM10 level at a mall was 380 microg/m3. Of the malls surveyed, 30% had indoor airborne bacteria levels above 1000 cfu/m3 set by the HKIAQO. The elevated indoor CO2 and bacteria levels could result from high occupancy combined with insufficient ventilation. The increased PM10 levels could be probably attributed to illegal smoking inside these establishments. In comparison, the shopping malls that contained internal public transport drop-off areas, where vehicles were parked with idling engines and had major entry doors close to heavy traffic roads had higher CO and PM10 indoor levels. In addition, the extensive use of cooking stoves without adequate ventilation inside food courts could increase indoor CO2, CO and PM10 levels.

Deceptive hyperbilirubinaemia in a newborn with familial lipoprotein lipase deficiency

A rare case of familial lipoprotein lipase (LPL) deficiency in a Chinese newborn who presented with severe hyperbilirubinaemia is described. The falsely high serum bilirubin concentration was subsequently found to be a laboratory analytical error caused by interference of optical measurement of the lipaemic serum. Hypertriglyceridaemia and chylomicronaemia could be safely and effectively controlled by a fat-restricted diet using either modified elementary milk formula fortified with protein, calories and minerals, or the commercially available special milk formula such as Monogen or Portagen. DNA sequence analysis of the patient showed a Leu252Arg mutation in exon 6 of both alleles of the LPL gene. Although the parents were unrelated, both were heterozygous carriers of the same genetic defect. Codon 252 in exon 6 appears to be a common and critical site of mutation in the LPL gene of Chinese, but this important association has not been recognized previously.

Lipodystrophia centrifugalis abdominalis infantilis: two cases from China

We report the first two Chinese patients with lipodystrophia centrifugalis abdominalis infantilis in China. The first patient was a 3-year-old girl who developed an area of hyperpigmented skin depression on the right groin which spread centrifugally to the abdomen and right lower chest. Later, another lesion developed on the neck. The second patient was a 4-year-old girl who developed multiple areas of skin depression on her bilateral groin, periumbilical region, right axilla, and chest. The lesions also extended centrifugally. Erythematous margins and lymphadenopathy were present in both cases. Inflammatory changes were found in the subcutaneous fat. The clinical pictures and histologic features supported the diagnosis of LCAI in both cases.

Surface ozone trends in Hong Kong in 1985-1995

Ozone trends in Hong Kong were assessed from the ozone data recorded at three urban stations and one station in the new development area. Three parameters were selected as the robust trend indicators in the study: monthly mean, monthly averaged daily 1-h maximum, and number of annual hours > 120 microg m(-3). As the ozone data displayed obvious seasonal variation, using deseasonalized monthly average parameters to estimate the ozone trends could smooth out the influence of seasonal fluctuations. The detection of an increase of more than 10% per year in ozone concentration at one station was particularly alarming. Effects of meteorological factors, control programmes of ozone precursors, and long-range transport on the ambient ozone level were examined in the study.

Direct ultrasonic agitation for rapid extraction of organic matter from airborne particulate

Direct ultrasonic extraction (DUE) is proposed as simple and rapid sample pretreatment method. This new approach is applied to the extraction of particulate organic matter (POM) from airborne particulate by using dichloromethane (DCM) or DCM/methanol (90/10, v/v) as extractant. The analytical determination was carried out by weighing the extractable POM on an electrobalance. Total recovery for POM could be obtained when the sample was extracted three times with 25-50 mL extractant each for about 5 min at 50 W ultrasonic power. In comparison with conventional Soxhlet extraction, less extraction time (total 15 min only) and solvent consumption (100 mL) were required by DUE. The efficiency of the DUE was similar or even higher than the routine Soxhlet method. Additionally, the new extractor is very simple and easy to use and can accelerate the extraction procedures of organic components from various solid samples.

Randomized trial of low-dose misoprostol and naproxen vs. nabumetone to prevent recurrent upper gastrointestinal haemorrhage in users of non-steroidal anti-inflammatory drugs

BACKGROUND

Prophylactic misoprostol or non-steroidal anti-inflammatory drugs (NSAIDs) with low gastric toxicity (nabumetone) has been shown to reduce mucosal injury.

AIM

To compare nabumetone vs. co-therapy of naproxen with low-dose misoprostol for secondary prevention of upper gastrointestinal bleeding in NSAID users.

METHODS

NSAID users presenting with upper gastrointestinal bleeding were enrolled if they required long-term NSAIDs. After ulcer healing, they were randomized to receive: naproxen (500-1000 mg/day) and misoprostol (200 microg b.d.), or nabumetone (1000-1500 mg/day) and placebo misoprostol for 24 weeks. The primary end-point was recurrent upper gastrointestinal bleeding. The secondary end-point was the proportion of patients suffering from major gastrointestinal events including ulcer bleeding, symptomatic ulcers and severe dyspepsia.

RESULTS

A total of 90 patients were included in the intention-to-treat analysis (misoprostol/naproxen 45, nabumetone 45). Recurrent bleeding occurred in 10 patients (22.2%) receiving misoprostol/naproxen compared with three (6.7%) receiving nabumetone (relative risk 3.33, 95% CI: 0.98-11.32, P=0.069). The proportion of patients suffering from major gastrointestinal events at 24 weeks was 31.1% in the misoprostol/naproxen group and 28.9% in the nabumetone group.

CONCLUSIONS

Misoprostol/naproxen is not superior to nabumetone for secondary prevention of upper gastrointestinal bleeding. Neither low-dose misoprostol nor nabumetone is adequate for high-risk NSAID users.

Molecular prognostication of nasopharyngeal carcinoma by quantitative analysis of circulating Epstein-Barr virus DNA

We investigated the prognostic implication of pretreatment plasma/serum EBV DNA concentration, as measured by real-time quantitative PCR, in nasopharyngeal carcinoma (NPC). In 91 prospectively recruited NPC patients, those with recurrence or metastasis within the first year after treatment had a higher median plasma EBV DNA concentration than those without events (41,756 copies/ml versus 5,807 copies/ml; P < 0.001, Mann-Whitney rank-sum test). In multivariate logistic regression analysis, plasma EBV DNA was an independent prognostic indicator for early clinical events [relative risk = 3.8 (95% confidence interval, 1.6-9.2 for each 10-fold increase in plasma EBV DNA concentration; P = 0.003)]. In a second cohort of 139 NPC patients followed-up for a median period of 2,027 days (interquartile range, 597-2,335 days), serum EBV DNA was found to be a significant variable associated with NPC-related death in multivariate Cox's regression analysis [relative risk = 1.6 (95% confidence interval, 1.1-2.1 for each 10-fold increase in serum EBV DNA concentration; P = 0.007)]. The quantitation of circulating EBV DNA may thus allow improved prognostication of NPC.

Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure

Epidemiological studies have implicated obstructive sleep apnea (OSA) as an independent comorbid factor in cardiovascular and cerebrovascular diseases. The recurrent episodes of occlusion of upper airways during sleep result in pathophysiological changes that may predispose to vascular diseases, and we postulate that nitric oxide may be one of the mediators involved. This study investigates the levels of circulating nitric oxide (NO), measured as serum nitrites and nitrates, in the early morning in OSA subjects compared with control subjects, and the effect of overnight nasal continuous positive airway pressure (nCPAP) in OSA subjects. Thirty men with moderate to severe OSA (age = 41.9 +/- 9.0; apnea-hypopnea index, AHI = 48.0 +/- 18.1) were compared with 40 healthy men (age = 40.6 +/- 5.4; AHI = 1.4 +/- 1.2). Serum nitrite/nitrate levels were significantly lower in OSA subjects (OSA = 38.9 +/- 22.9 microM, control subjects = 63.1 +/- 47.5 microM, p = 0.015). There was significant negative correlation between serum nitrites/nitrates and the following parameters: AHI (r = -0.389, p = 0.001), oxygen desaturation time (r = -0.346, p = 0.004), and systolic blood pressure (BP) (r = -0.335, p = 0.005). Stepwise multiple linear regression with systolic or diastolic BP as the dependent variable identified serum nitrites/nitrates as the only significant correlate. Twenty-two OSA subjects had measurements of serum NO at baseline and after an overnight application nCPAP. There was significant increase in serum NO after nCPAP (baseline = 30.5 +/- 14.4 microM, after nCPAP = 81.0 +/- 82.1 microM, p = 0.01). This study demonstrates, for the first time, that circulating NO is suppressed in OSA, and this is promptly reversible with the use of nCPAP. The findings offer support for nitric oxide being one of the mediators involved in the acute hemodynamic regulation and long-term vascular remodeling in OSA.

Crusted (Norwegian) scabies in two old-age home residents

Scabies is commonly seen in hospitals, where it frequently affects geriatric and convalescent patients. The clinical features of the classic form of scabies are well recognised. Crusted (Norwegian) scabies, which is a hyperinfestation variant of scabies, is very contagious and can present as other dermatoses, thus delaying the correct diagnosis and management. Two residents of different old-age homes presented with hyperkeratotic skin eruptions, which later proved to be crusted scabies. In both cases, the scabies was initially misdiagnosed as eczema. The delay in making a correct diagnosis led to an outbreak of scabies in the old-age home in which one of the patients was residing.

Spontaneous uterine perforation of pyometra. A report of three cases

BACKGROUND

Spontaneous perforation of pyometra is a rare cause of generalized peritonitis; only 17 cases have been reported.

CASES

Three cases of spontaneous perforation of pyometra occurred; two were associated with carcinoma of the cervix. All were treated with exploratory laparotomy and drainage. The first patient died of recurrent carcinoma of the cervix five months after laparotomy. The second patient died of septic shock shortly after the operation. The third patient made a good postoperative recovery.

CONCLUSION

Pyometra is a serious medical condition, because of both its association with malignant disease and the danger of spontaneous perforation, which carries significant morbidity and mortality. Although rare, ruptured pyometra should be considered in the differential diagnosis of acute abdomen in elderly women, especially those with malignant disorders of the genital tract. The treatment of pyometra rupture is immediate laparotomy, peritoneal lavage and drainage, or simple hysterectomy.

Quantitative analysis of circulating cell-free Epstein-Barr virus (EBV) DNA levels in patients with EBV-associated lymphoid malignancies

Cell-free Epstein-Barr virus (EBV) DNA has recently been detected in the plasma and serum of patients with Hodgkin's disease, post-transplant lymphoproliferative disease (PTLD) and acquired immunodeficiency syndrome-related lymphoma. However, no data are available on the temporal variation of plasma/serum EBV DNA levels in patients with EBV-associated lymphoid malignancies during the course of therapy. Using a real-time quantitative polymerase chain reaction assay, we studied the plasma EBV DNA levels in 13 patients with EBV-associated lymphoid malignancies (six patients with Hodgkin's disease, four with nasal natural killer/T-cell lymphoma, two cases of PTLD and one patient with Burkitt's lymphoma) at presentation and during therapy. Plasma EBV DNA was detected in 12 of the 13 patients (median 2,266 copies/ml; interquartile range 181-8,379 copies/ml), but not in any of 35 healthy control subjects (P < 0.0001). The EBV status in tumour cells was also examined in 12 of these patients using in situ hybridization for EBV-encoded small RNAs (EBERs). EBER positivity was observed in 11 patients, all of whom had EBV DNA detectable in plasma. The one patient who had no detectable plasma EBV DNA was also negative for EBERs in tumour tissue. Serial measurements of plasma EBV DNA levels were performed in nine of the patients during the course of therapy. All patients who responded to therapy demonstrated a significant reduction of plasma EBV DNA to low or undetectable levels, whereas in two patients with ineffective therapy, disease progression was associated with a rapid increase in plasma EBV DNA levels. We concluded that plasma EBV DNA is detectable in a wide range of EBV-associated lymphoid malignancies. As plasma EBV DNA levels correlate well with the therapeutic response, such analysis may be a valuable tool for monitoring clinical progress.