Layer Number-Dependent Raman Spectra of γ-InSe

The two-dimensional layered semiconductor InSe, with its high carrier mobility, chemical stability, and strong charge transfer ability, plays a crucial role in optoelectronic devices. The number of InSe layers (L) has an important influence on its band structure and optoelectronic properties. Herein we present systematic investigations on few-layer (1L-7L) γ-InSe by optical contrast and Raman spectroscopy. We propose three quantified formulas to quickly identify the layer number using optical contrast, the frequency difference of two A₁ modes, and ultralow-frequency Raman spectroscopy, respectively. Moreover, angle-resolved polarization Raman spectra show that γ-InSe is isotropic in the a-b plane. Furthermore, using Raman mapping, we find that the relative strength of the low-frequency interlayer shear modes is particularly sensitive to the interaction between the sample and the substrate.

Magneto-Raman Study of Magnon-Phonon Coupling in Two-Dimensional Ising Antiferromagnetic FePS3

Recently, the coupling between magnons (quanta of spin waves) and phonons (quanta of lattice vibrations) in two-dimensional (2D) antiferromagnet FePS₃ offers a myriad of applications ranging from spintronic devices to quantum information technologies. However, the reported magnon-phonon coupling in the FePS₃ flake using Raman measurements requires an ultrahigh magnetic field up to 30 T. Here, we investigate the magnon-phonon coupling in FePS₃ by near-resonant magneto-Raman spectroscopy under a relatively small magnetic field (|H₀| ≤ 9 T). Under near-resonant excitation, we find more pronounced coupling effects that are absent in non-resonant excitation: three optical phonons sensitive to the applied magnetic field are resolved, two of which show a frequency anti-crossing coupling with magnon, while the other coupled phonon exhibits only a polarization-coupled character without frequency anti-crossing. Besides, our polarized Raman results also show the polarization transferring between coupled magnon-phonon modes. On the basis of a modified theoretical model, we can well explain the measured Raman spectra.

Hydration and nutritional status in patients on home-dialysis-A single centre study

BACKGROUND

Over-hydration (OH) and malnutrition are prevalent among patients on dialysis therapy. The prevalence of OH and malnutrition as well as the risk factors associated with OH and malnutrition in our patients on home peritoneal dialysis (PD) and home haemodialysis (HD) are examined.

DESIGN AND METHODS

This was a cross-sectional study. The hydration and nutritional status of the study groups were assessed by a Body Composition Monitor. Patients who were stable on home dialysis therapy for over one year were invited to participate. Univariate and multivariate analyses were performed to identify associated factors and determine the predictors of OH and malnutrition, respectively.

RESULTS

Eighty-eight patients (41 PD and 47 home HD) were recruited. A 32.95% of our patients on home dialysis therapy were in OH status. There was a significance difference in the prevalence of hydration status between patients on PD and home HD (p = 0.014), as overhydration was more common in patients on PD than home HD (46.34 vs. 21.28%). Dehydration was more common in patients on home HD than PD (29.79 vs. 9.76%). Male gender, decreasing haemoglobin level and presence of diabetes mellitus (DM) were risk factors of OH on multivariable analysis. There was no significance difference in the prevalence of malnutrition between patients on PD and home HD (p = 0.27). Increasing Fat Tissue Index (FTI), height and patients on PD therapy were at higher risk of malnutrition.

CONCLUSION

OH and malnutrition were prevalent patients on home dialysis therapy.

High expression of long non‑coding HOTAIR correlated with hepatocarcinogenesis and metastasis

HOX transcript antisense RNA (HOTAIR), a newly discovered long noncoding RNA (lncRNA), has been reported to be a poor prognostic marker in many types of cancers. The current study attempted to investigate the biological roles and clinicopathlogical implications of HOTAIR in hepatocellular carcinoma (HCC), as well as understand the molecular mechanisms of HOTAIR in HCC progression. HOTAIR expression in 95 HCC patients with paired HCC tissues and adjacent non‑cancer tissues were investigated using quantitative reverse transcription‑polymerase chain reaction. The association between HOTAIR expression and clinicopathological features was assessed. The effects of HOTAIR were examined in vitro assays by silencing the lncRNA. Pathway analyses were performed to illustrate the biological functions of the HOTAIR and coexpression genes. The expression level of HOTAIR was observed significantly higher in the HCC tissue than the adjacent non‑tumor tissue. HOTAIR expression levels were significantly higher in tumor samples from patients with distant metastasis, advanced stage, portal vein tumor embolus, vasoinvasion, tumor capsular infiltration or positive nm23 expression than those from patients without these conditions, correspondingly. The silencing of HOTAIR in liver cancer cells induced the inhibition of cell proliferation and promotion of apoptosis. Several pathways such as extracellular matrix‑receptor interaction, focal adhesion, pathways in cancer were annotated with the HOTAIR and coexpression genes. In summary, the present analysis indicates that HOTAIR might be an oncogene in HCC. It functions though promoting tumor cell growth and inhibiting apoptosis. HOTAIR may potentially be involved in HCC metastatic progression by several pathways correlated to cell adhesion, and may be a therapeutic target in future.

Promising significance of the association of miR-204-5p expression with clinicopathological features of hepatocellular carcinoma

Decreased level of miR-204-5p has been documented in various malignancies. However, the expression and clinical significance of miR-204-5p in hepatocellular carcinoma has not been investigated. The aim of this study is to examine the relationship between miR-204-5p expression and clinicopathological features in hepatocellular carcinoma (HCC) as well as to predict the relevant signaling pathways. The miR-204-5p expression level was detected in HCC and in matched paraneoplastic liver from 95 formalin-fixed paraffin-embedded tissues by the real-time reverse transcription polymerized chain reaction (qRT-PCR). The association of miR-204-5p expression with clinicopathological features as well as the prognosis of HCC was examined. Public data portals including the Gene Expression Omnibus and The Cancer Genome Atlas were used to retrieve the HCC-related data in order to perform a comprehensive meta-analysis. Meanwhile, protein-protein interaction (PPI) and enrichment analyses were performed using predicted target genes. The relative expression of miR-204-5p was remarkably reduced in HCC than that in paraneoplastic hepatic tissues. In HCC, the miR-204-5p expression was downregulated in the metastasis, vasoinvasion, and advanced stage (III and IV) subgroups compared with their counterparts. Furthermore, the meta-analysis based on qRT-PCR data demonstrated that miR-204-5p was markedly downregulated in HCC with a standardized mean difference of -5.19 (P < .001). However, no significant association was observed between miR-204-5p and survival outcomes. The potential target genes of miR-204-5p were significantly enriched in several pathways which might be associated with HCC, such as "cell proliferation" from GO terms and "pathways in cancer" from the KEGG analysis. A PPI network of miR-204-5p potential target genes identified prospective core genes potentially involved in the regulation of HCC oncogenesis and progression. Our findings suggested that miR-204-5p might act as a tumor-suppressive gene in the tumorigenesis and progression of HCC via vital signaling pathways and that miR-204-5p could be regarded as a protective factor in HCC.

Increased risk of strontium ranelate-related SJS/TEN is associated with HLA

Severe adverse drug reactions (ADR) of Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) in some patients receiving strontium ranelate have been reported, but the risk factors are unclear. We show that HLA-A*33:03 and B*58:01 are significantly associated with patients who developed SJS/TEN; and provide the first evidence that genetic risk factors are involved in strontium ranelate-associated SJS/TEN.

INTRODUCTION

In this study, HLA as a genetic risk factor was assessed among osteoporotic patients prescribed with strontium ranelate that developed severe cutaneous adverse drug reactions (SCARs) compared with those who were tolerant.

METHODS

Genomic DNA isolated from peripheral blood mononuclear cells (PBMCs) of patients was HLA typed using sequencing-based typing method to determine their HLA profiles.

RESULTS

Osteoporotic patients who are currently on strontium ranelate were enrolled in the study (n = 76). Tolerant controls were defined as patients who received strontium ranelate for a minimum of 3 months (range 3 months to 8 years) with no reports of any cutaneous reactions as these reactions usually occur within the first 12 weeks after starting treatment. Retrospective cases of SJS/TEN were also identified (n = 5). The majority of the accrued samples were of Han Chinese descent: controls (n = 72) and cases (n = 4). All cases and controls were genotyped at four HLA genes, namely HLA-A, HLA-B, HLA-C, and HLA-DRB1. In comparing the samples of Han Chinese descent (72 controls and 4 cases), we found significant associations with HLA-A*33:03 (p = 0.002) and HLA-B*58:01 (p = 0.023). There was no significant association with any HLA-C or HLA-DRB1 alleles.

CONCLUSIONS

This study reveals that the occurrence of SJS/TEN in Han Chinese patients receiving strontium ranelate is HLA associated. This has important clinical implications for understanding the underlying mechanisms for this ADR as well as evaluating the potential role of genetic pre-screening for osteoporotic patients who may be prescribed strontium ranelate.

The role of intravenous immunoglobulin in toxic epidermal necrolysis: a retrospective analysis of 64 patients managed in a specialized centre

BACKGROUND

Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse drug reaction with a mortality of 40%. Intravenous immunoglobulin (IVIg) is widely used as a specific treatment for this reaction, although evidence of its benefit is conflicting.

OBJECTIVES

We sought to evaluate whether the use of IVIg improved mortality in patients with Stevens-Johnson syndrome (SJS)/TEN overlap and TEN.

METHODS

We retrospectively analysed data for 64 patients with SJS/TEN overlap and TEN who were treated with IVIg at a single referral centre. The primary outcome analysed was in-hospital mortality. Predicted mortality was calculated based on severity-of-illness score for TEN (SCORTEN) values. Secondary analyses of survival based on IVIg dosages and prior corticosteroid exposure were also performed.

RESULTS

There were 28 cases of SJS/TEN overlap and 36 cases of TEN, with a mean SCORTEN value of 2·6. The mean dose of IVIg given was 2·4 g kg(-1) and the mean delay from the onset of epidermal detachment to administration of IVIg was 3·2 days. There were 20 deaths (31%) in our cohort. The standardized mortality rate was 1·10 (95% confidence interval 0·62-1·58). Subgroup analysis comparing survivors and nonsurvivors showed a higher SCORTEN in nonsurvivors (3·4 vs. 2·2). There were no differences with regard to the dosage, delay and duration of IVIg administration. When stratified according to dosage, there was no mortality difference between patients who receive high-dose (≥ 3 g kg(-1) ) vs. low-dose (< 3 g kg(-1) ) IVIg.

CONCLUSIONS

This study shows that the use of IVIg does not yield survival benefits in SJS/TEN overlap and TEN, even when corrected for IVIg dosages.

Systemic lupus erythematosus presenting as Stevens-Johnson syndrome and toxic epidermal necrolysis: a report of three cases

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatological conditions that are characterized by mucositis, epidermal detachment and erosions. The underlying etiology in SJS and TEN is almost invariably secondary to drugs. Rarely, other causes such as systemic lupus erythematosus (SLE), infections and vaccinations have been implicated. This report describes three patients with SLE who presented with manifestations of SJS/TEN without a clear drug causality. All three patients presented with photodistributed macular exanthema, which evolved to target lesions, bullae, erosions or sheet-like detachment. This was associated with oral mucositis and conjunctivitis. The onset of the rash was insidious with a protracted clinical course. Ultraviolet exposure and steroid tapering appear to be precipitating factors. In two of the patients, SJS and TEN were the initial presentation of lupus. Although SJS and TEN are almost invariably due to medications, they may, rarely, be an initial presentation of lupus, particularly when associated with an initial photodistribution, absence of genital involvement and a prolonged clinical course.

Cutaneous adverse drug reactions in hospitalised patients

INTRODUCTION

Serious adverse drug reactions are common in hospitalised patients. There have been few studies examining the clinical presentation, implicated drugs and outcomes in Singapore.

METHODS

The clinical and laboratory data of all inpatient dermatology consultations with a diagnosis of cutaneous adverse drug reaction were retrospectively analysed over a one-year period.

RESULTS

A total of 97 patients were diagnosed with cutaneous adverse drug reactions. Eight different clinical reaction patterns were noted, namely drug exanthems (46.4 percent), drug rash with eosinophilia and systemic symptoms (18.6 percent), Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum (14.4 percent), urticaria/angioedema (11.3 percent), acute generalised exanthematous pustulosis (3.1 percent), fixed drug eruptions (3.1 percent), generalised exfoliative dermatitis (2.1 percent) and drug-induced vasculitis (1.0 percent). The putative medications included antibiotics (50.5 percent), anticonvulsants (11.3 percent), allopurinol (8.2 percent), chemotherapeutic agents (7.2 percent), nonsteroidal anti-inflammatory agents (7.2 percent), intravenous contrasts (3.2 percent), complementary medications (2.1 percent) and various other medications (10.3 percent). 30 patients were admitted primarily for their adverse drug reaction, with an average length of hospital stay of nine days, while the remaining 67 patients developed these reactions as a complication of their inpatient stay. A total of five deaths were recorded.

CONCLUSION

The presentation of cutaneous adverse drug reactions in hospitalised patients is diverse, ranging from self-limiting and benign reaction patterns to those that are life-threatening. Early recognition, accurate diagnosis, withdrawal of putative medications and specific treatments when indicated may improve outcome.

Dermatology referrals in an East Asian tertiary hospital: a need for inpatient medical dermatology

BACKGROUND

Within hospitals, there is a need for dermatological expertise, as hospitalized patients have a wider spectrum of severe and serious dermatological conditions, associated with significant morbidity.

AIM

To characterize the patient profile and referral pattern of inpatient dermatology consultations, and to evaluate the diagnostic accuracy of non-dermatologists.

METHODS

This was a retrospective study reviewing all inpatient referrals for dermatology consultations during a 1-year period from July 2005 to June 2006 (inclusive), at the largest multi-disciplinary tertiary hospital in Singapore.

RESULTS

Of the 731 referrals made for dermatology consultations, 26.9% of patients had ≥ 3 important underlying comorbidities. Eczema/dermatitis (33.1%; n = 242) and cutaneous infections (23.4%; n = 171) accounted for over half of the dermatological consultations, followed by cutaneous adverse drug reactions (12.3%; n = 90). The provisional diagnoses of the referring doctors agreed with the final diagnoses confirmed by dermatologists in only 30.2% of all referrals; incorrect diagnoses were made in 35.2% of cases, and no provisional diagnoses were made in the remaining 34.6% of cases. Most misdiagnosed skin diseases were in fact common dermatoses (such as eczemas, cutaneous infections, drug rash) that required only standard treatment.

CONCLUSION

Our study reiterates the importance of inpatient medical dermatology in terms of both service and education. There should be continual efforts to ensure that dermatologists have the highest level of training and experience in medical dermatology, to provide collaborative optimum care for hospitalized patients with dermatological diseases.

Acute generalised exanthematous pustulosis and toxic epidermal necrolysis induced by carbamazepine

Acute generalised exanthematous pustulosis and Stevens-Johnson syndrome (toxic epidermal necrolysis spectrum of severe cutaneous drug reactions) are believed to have distinct underlying pathophysiologies. Our patient, a 28-year-old Chinese woman, represents the first known reported case of clinically-consistent and histologically-proven acute generalised exanthematous pustulosis and toxic epidermal necrolysis overlap induced by carbamazepine in the English literature.

Possible role of gadolinium in nephrogenic systemic fibrosis: report of two cases and review of the literature

Nephrogenic systemic fibrosis/nephrogenic fibrosing dermopathy (NSF/NFD) is a rare fibrosing disorder that occurs in patients with renal failure. It is associated with significant mortality and morbidity. Patients typically present with painful or pruritic indurated plaques involving the limbs and trunk, with sparing of the face. Severity and rapidity of cutaneous progression correlate with poorer prognosis. To date, the management of NSF/NFD remains anecdotal. The aetiological link in NSF/NFD is also yet to be confirmed, but renal dysfunction seems a common feature. Following recent reports of a possible causative role of gadolinium, we present two patients with histologically confirmed NSF/NFD, who had exposure to gadolinium-containing contrast agents 1-2 months before onset of disease. Severity of renal impairment, lack of immediate dialysis after exposure and cumulative dose of gadolinium are possible factors influencing the development of NSF/NFD. The process of transmetallation of gadolinium chelates may occur in patients with renal impairment, leading to precipitation of free gadolinium in the dermis or other organs, causing tissue injury that ultimately leads to the clinical manifestations of NSF/NFD. Although the causative role is not proven, gadolinium-containing contrast agents should be used only if clearly necessary in patients with renal failure.

Cyclosporin-induced sebaceous hyperplasia in renal transplant patients

INTRODUCTION

Sebaceous hyperplasia is associated with immunosuppressive treatment with cyclosporin in male renal transplant patients. This has not been reported in the local context.

CLINICAL PICTURE

This is a report on 2 Chinese renal transplant patients on cyclosporin who developed sebaceous hyperplasia.

TREATMENT AND OUTCOME

One patient was treated with carbon dioxide laser. The result was good and the patient was satisfied with the procedure.

CONCLUSION

Cyclosporin-induced sebaceous hyperplasia is likely to be a direct and casual effect of cyclosporin, and to be unrelated to immunosuppressive action. However, further studies are needed to find out whether sebaceous hyperplasia is a dysplastic process or tumour progression in genetically susceptible patients under the effect of immunosuppression.

Drawing a qualitative distinction of caring practices in a professional context: the case of Chinese nursing

How to draw a qualitative distinction between nursing work and the work of a servant has been a major concern for nurses in China. This article explains the ways in which nurses in China articulate the meaning of caring in practice situations. Seventy nurses in Beijing were invited to share their experience about what caring meant to them as nurses and examples of caring in practice situations. Van Kaam's phenomenologic method of controlled explication was used to analyze the data. The findings reveal that these Chinese nurses are able to articulate the cheng and jing versions of caring practices that emphasize flexible, pluralist, contextualized, individualized, and subjectively informed practices. To further this study, we would suggest nurses be more proactive in starting a dialogue with society so as to seek nursing's legitimate practice that can foster responsive care to patients and society on the one hand and the professional integrity of nursing on the other.

Holism and caring: nursing in the Chinese health care culture

This article examines the concepts of holism and caring within the historical and cultural context of the development of nursing in China. Data were collected in two research projects on the cultural construction of caring in nursing within different Chinese communities. Grounded in the theory of "systematic correspondence" and in Chinese medical tradition, illness is perceived as a state of disharmony between the individual and the natural and social environment. The interplay of caring and curative processes is seen as pertinent to health maintenance. In Chinese culture, it is the moral duty of family members to take care of their sick. Because of this, questions are posed about ways in which the nurse can relate to patients and their family members. Although lay people view nursing as servant's work, nurses cherish "treating the patient as their own family member." The authors contend that these versions of nursing are inappropriate. It is the intention of this article to stimulate discourse on a third version focusing on the patient and the family as the unit of care within their dynamic, natural, and social environments.

Predicting pressure sore risk with the Norton, Braden, and Waterlow scales in a Hong Kong rehabilitation hospital

BACKGROUND

Numerous pressure sore risk calculators have been developed since the 1960s. Each scale is claimed to have predictive value and applicability in various clinical settings, but it has not been determined which one is more relevant for adoption in a rehabilitation setting.

OBJECTIVES

To compare the predictive power of the three most commonly adopted pressure sore risk calculators: Norton, Braden, and Waterlow scales.

METHOD

One hundred six patients, free of pressure sores at admission, were assessed using the three scales by independent assessors within 48 hours of admission, followed by a daily monitoring of skin condition for at least 14 days to detect any sore that developed.

RESULTS

Both the Norton and Waterlow scales had relatively high sensitivity (81% and 95%, respectively), whereas the Braden Scale had both high sensitivity (91%) and specificity (62%). All three scales had relatively high negative predictive values (>90%), but the Braden Scale had better positive predictive value.

CONCLUSIONS

The Braden Scale is more suitable for use in a rehabilitation hospital.

Role of preoperative urography in benign prostatic hyperplasia

The excretory urograms of 184 consecutive patients admitted to hospital with a diagnosis of benign prostatic hyperplasia who subsequently underwent prostatectomy were reviewed to determine the usefulness of preoperative urography. Of 184 urograms reviewed, 10 were normal, 136 showed changes consistent with benign prostatic hyperplasia, and 38 revealed other abnormalities. Twenty-seven of 184 urograms (14.7 per cent) revealed significant pathologic conditions requiring further consideration, investigation, or treatment, of which 23 would not have been suspected without this radiologic examination.