Mortality and Heart Failure Hospitalization Among Young Adults With and Without Cardiogenic Shock After Acute Myocardial Infarction

OBJECTIVES

To investigate risk factors and outcomes of cardiogenic shock complicating acute myocardial infarction (AMI-CS) in young patients with AMI.

BACKGROUND

AMI-CS is associated with high morbidity and mortality rates. Data regarding AMI-CS in younger individuals are limited.

METHODS AND RESULTS

Consecutive patients with type 1 AMI aged 18-50 years admitted to 2 large tertiary-care academic centers were included, and they were adjudicated as having cardiogenic shock (CS) by physician review of electronic medical records using the Society for Cardiovascular Angiography and Interventions CS classification system. Outcomes included all-cause mortality (ACM), cardiovascular mortality (CVM) and 1-year hospitalization for heart failure (HHF). In addition to using the full population, matching was also used to define a comparator group in the non-CS cohort. Among 2097 patients (mean age 44 ± 5.1 years, 74% white, 19% female), AMI-CS was present in 148 (7%). Independent risk factors of AMI-CS included ST-segment elevation myocardial infarction, left main disease, out-of-hospital cardiac arrest, female sex, peripheral vascular disease, and diabetes. Over median follow-up of 11.2 years, young patients with AMI-CS had a significantly higher risk of ACM (adjusted HR 2.84, 95% CI 1.68-4.81; P < 0.001), CVM (adjusted HR 4.01, 95% CI 2.17-7.71; P < 0.001), and 1-year HHF (adjusted HR 5.99, 95% CI 2.04-17.61; P = 0.001) compared with matched non-AMI-CS patients. Over the course of the study, there was an increase in the incidence of AMI-CS among young patients with MI as well as rising mortality rates for patients with both AMI-CS and non-AMI-CS.

CONCLUSIONS

Of young patients with AMI, 7% developed AMI-CS, which was associated with a significantly elevated risk of mortality and HHF.

[Vogt-Koyanagi-Harada syndrome in the setting of vemurafenib therapy for metastatic melanoma: a case report]

A 53-year-old female patient complained of 1 week of bilateral visual blurring. She was previously diagnosed with metastatic melanoma of the inguinal lymph nodes and treated with the oral targeted drug vemurafenib. She exhibited aqueous flare in the left eye, and her fundus examination revealed optic disc swelling in the left eye and bilateral serious detachment of the retinal neuroepithelial layer. Fluorescein angiography showed multiple pinpoint hyperfluorescence leakage spots in the prometaphase and appeared as multilobular dye pooling in the late phase. We diagnosed her as Vogt-Koyanagi-Harada syndrome and gave glucocorticoid treatment for eyes. Oral vemurafenib was also taken intermittently under the guidance of an oncologist. After treatment, her bilateral vision improved, the anterior segment inflammation disappeared, and the retinal neuroepithelial layer reattached, with presence of the "sunset glow" fundus.

[Altered dynamics of brain spontaneous activity in betel quid dependence chewers]

Objective: To investigate the dynamic characteristics of brain spontaneous activity in betel quid dependence (BQD) chewers and its relationship with clinical indexes. Method: This study was conducted in Hainan General Hospital from April to December 2019 and the data of 53 BQD chewers (37 males and 16 females, aged 20 to 58(38±11) years) and 37 healthy controls (HC) (24 males and 13 females, aged 23-57(42±12) years) were collected. All these subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI) scan. The dynamic characteristics of resting fMRI indexes, including dynamic amplitude of low-frequency fluctuations (ALFF), regional homogeneity (ReHo) and degree centrality (DC) of these subjects were calculated using the sliding time window method, parameters such as age and dynamic local consistency were analyzed and compared between the two groups. Pearson correlation was used to analyze the relationship between dynamic indexes, betel quid dependence score (BQDS) and disease duration in BQD group. Results: BQD chewers showed decreased dynamic ALFF in the left orbital prefrontal cortex (0.138±0.041 vs 0.171±0.070), the right temporal pole superior temporal gyrus (0.277±0.070 vs 0.319±0.086) and the right inferior parietal lobule (0.223±0.052 vs 0.259±0.088) than HC (all P<0.05). For regional homogeneity, BQD chewers showed a decrease dynamic ReHo in the right inferior temporal gyrus (0.055±0.008 vs 0.061±0.009), the orbital prefrontal cortex (0.058±0.005 vs 0.063±0.008), the right inferior frontal gyrus (0.081±0.006 vs 0.087±0.011), the right superior occipital gyrus (0.056±0.007 vs 0.062±0.008), the left precentral gyrus (0.068±0.008 vs 0.074±0.008), and the left superior frontal gyrus (0.058±0.008 vs 0.064±0.009) than HC (all P<0.05). BQD chewers showed an increase dynamic ReHo in the right precuneus (0.095±0.009 vs 0.089±0.008) (P<0.05). There was no significant difference in DC between the two groups (all P>0.05). The relationships between three dynamic ALFF and BQDS (r=-0.104, -0.015, -0.119), seven dynamic ReHo and BQDS (r=-0.099, -0.141, -0.055, -0.078, -0.027, -0.111, -0.090), three dynamic ALFF and disease duration (r=-0.122, -0.095, -0.171), and seven dynamic ReHo and disease duration (r=0.242, -0.252, 0.035, 0.056, 0.047, 0.081, 0.169) were not statistically significant (all P>0.05). Conclusions: BQD chewers showed a decrease dynamic ReHo and/or ALFF in multiple brain regions dominated by prefrontal cortex, and an increase dynamic ReHo in the right precuneus.

[Clinical application of bipolar tweezers-clamp for hepatic parenchymal transection]

Objective: To investigate the clinical value of the bipolar tweezers-clamp for the hepatic parenchymal transection in the resection of hepatocellular carcinoma. Methods: From January 2020 to January 2021,63 patients with the hepatocellular carcinoma for hepatectomy at Department of Hepatopancreatobiliary Surgery,Yuebei People's Hospital Affiliated to Shantou University Medical College were analyzed retrospectively.According to the different instruments used in the hepatic parenchymal transection,the patients were divided into bipolar tweezers-clamp group and ultrasonic scalpel group.There were 32 patients in bipolar tweezers-clamp group,with age of (55.5±10.5)years(range:37 to 78 years),including 22 males and 10 females,tumor size was (6.0±3.4)cm(range:2.4 to 13.4 cm). There were 6 patients with portal vein tumor thrombus and 5 patients with portal hypertension. There were 31 patients in ultrasonic scalpel group,with aged(57.8±10.1)years(range:37 to 79 years),including 27males and 4 females,tumor size was(7.9±5.1)cm(range: 2.4 to 21.3 cm),3 patients with portal vein tumor thrombus and 2 patients with portal hypertension. The preoperative baseline data,operation time,blood loss,postoperative liver function and the complications were compared between two groups using t test,χ² test and Fisher exact probabilityrespectively. Results: The operation was successfully completed in both groups.Compared with the ultrasonic scalpel group,the operation time was significantly shorter((219.3±76.4)minutes vs.(294.0±100.8)minutes,t=-3.322,P=0.002),the blood loss was less((250(475)ml vs. 500(1 050)ml,t=-2.307,P=0.026),the concentrate red blood cells transfusion volume was less(0.92(0.88)U vs. 2.32(4.00)U,Z=-1.987,P=0.047) in the bipolar tweezers-clamp group.The postoperative serum ALB level was higher in the bipolar tweezers-clamp group than that in the ultrasonic scalpel group((33.5±6.1)g/L vs. (29.5±4.2)g/L,t=3.226,P=0.020) on postoperative day 1;((35.7±4.5)g/L vs.(30.1±3.2)g/L,t=5.575,P<0.01) on postoperative day 3;((33.2±3.7)g/L vs. (31.0±4.4)g/L,t=3.020,P=0.004) on postoperative day 7. There was no significant difference in serum ALT,TBIL and PT level between the two groups(all P>0.05).No postoperative bile leakage occurred in both groups.The postoperative complications occurred in 8 cases(25.0%)in the bipolar tweezers-clamp group,including liver failure in one,and in 11 cases(35.5%)in the ultrasonic scalpel group,including liver failure in two(P>0.05). Conclusion: The bipolar tweezers-clamp is a safe and reliable method for the hepatic parenchymal transaction,which is quick and less bleeding during the hepatic resection.

Impact of coronary artery calcium testing on patient management

BACKGROUND

Coronary artery calcium (CAC) scoring can identify individuals who may benefit from aggressive prevention therapies. However, there is a paucity of contemporary data on the impact of CAC testing on patient management.

METHODS

Retrospective cohort study of adults who underwent CAC testing at Brigham and Women's Hospital between 2015 and 2019. Information on baseline medications, follow-up medications, lifestyle modification, and downstream cardiovascular testing within one-year post-CAC were obtained from electronic health records.

RESULTS

Of the 839 patients with available baseline and follow-up data, 376 (45%) had a CAC ​= ​0, 289 (34%) had CAC ​= ​1-99, and 174 (21%) had CAC≥100. The mean age at time of CAC testing was 59 ​± ​9.7 years. Patients with higher CAC scores were more likely to be male, have diabetes and hypertension, and have higher low-density lipoprotein cholesterol and lower high-density lipoprotein cholesterol. A non-zero CAC score was associated with initiation of aspirin (41% increase, p ​< ​0.001), anti-hypertensives (9% increase, p ​= ​0.031), and lipid-lowering therapies (114% increase, p ​< ​0.001), whereas CAC ​= ​0 was not. Among individuals with CAC≥100, 75% were started on new or more intense lipid-lowering therapy. Higher calcium scores correlated with increased physician recommendations for diet (p ​= ​0.008) and exercise (p ​= ​0.004). The proportion of cardiovascular downstream testing following CAC was 9.1%, and the majority of patients who underwent additional testing post-CAC had CAC scores ≥100.

CONCLUSION

Approximately half of individuals referred for CAC testing had evidence of calcified coronary plaque, and of those who had significant calcifications (CAC≥100), nearly 90% were prescribed lipid-lowering therapies post-CAC. Rates of downstream non-invasive testing were low and such testing was mostly performed in patients who had at least moderate CAC.

Natural language processing for the assessment of cardiovascular disease comorbidities: The cardio-Canary comorbidity project

Objective: Accurate ascertainment of comorbidities is paramount in clinical research. While manual adjudication is labor‐intensive and expensive, the adoption of electronic health records enables computational analysis of free‐text documentation using natural language processing (NLP) tools.

Hypothesis: We sought to develop highly accurate NLP modules to assess for the presence of five key cardiovascular comorbidities in a large electronic health record system.

Methods: One‐thousand clinical notes were randomly selected from a cardiovascular registry at Mass General Brigham. Trained physicians manually adjudicated these notes for the following five diagnostic comorbidities: hypertension, dyslipidemia, diabetes, coronary artery disease, and stroke/transient ischemic attack. Using the open‐source Canary NLP system, five separate NLP modules were designed based on 800 “training‐set” notes and validated on 200 “test‐set” notes.

Results: Across the five NLP modules, the sentence‐level and note‐level sensitivity, specificity, and positive predictive value was always greater than 85% and was most often greater than 90%. Accuracy tended to be highest for conditions with greater diagnostic clarity (e.g. diabetes and hypertension) and slightly lower for conditions whose greater diagnostic challenges (e.g. myocardial infarction and embolic stroke) may lead to less definitive documentation.

Conclusion: We designed five open‐source and highly accurate NLP modules that can be used to assess for the presence of important cardiovascular comorbidities in free‐text health records. These modules have been placed in the public domain and can be used for clinical research, trial recruitment and population management at any institution as well as serve as the basis for further development of cardiovascular NLP tools.

Association of Socioeconomic Disadvantage With Long-term Mortality After Myocardial Infarction: The Mass General Brigham YOUNG-MI Registry

Importance

Socioeconomic disadvantage is associated with poor health outcomes. However, whether socioeconomic factors are associated with post-myocardial infarction (MI) outcomes in younger patient populations is unknown.

Objective

To evaluate the association of neighborhood-level socioeconomic disadvantage with long-term outcomes among patients who experienced an MI at a young age.

Design, Setting, and Participants

This cohort study analyzed patients in the Mass General Brigham YOUNG-MI Registry (at Brigham and Women's Hospital and Massachusetts General Hospital in Boston, Massachusetts) who experienced an MI at or before 50 years of age between January 1, 2000, and April 30, 2016. Each patient's home address was mapped to the Area Deprivation Index (ADI) to capture higher rates of socioeconomic disadvantage. The median follow-up duration was 11.3 years. The dates of analysis were May 1, 2020, to June 30, 2020.

Exposures

Patients were assigned an ADI ranking according to their home address and then stratified into 3 groups (least disadvantaged group, middle group, and most disadvantaged group).

Main Outcomes and Measures

The outcomes of interest were all-cause and cardiovascular mortality. Cause of death was adjudicated from national registries and electronic medical records. Cox proportional hazards regression modeling was used to evaluate the association of ADI with all-cause and cardiovascular mortality.

Results

The cohort consisted of 2097 patients, of whom 2002 (95.5%) with an ADI ranking were included (median [interquartile range] age, 45 [42-48] years; 1607 male individuals [80.3%]). Patients in the most disadvantaged neighborhoods were more likely to be Black or Hispanic, have public insurance or no insurance, and have higher rates of traditional cardiovascular risk factors such as hypertension and diabetes. Among the 1964 patients who survived to hospital discharge, 74 (13.6%) in the most disadvantaged group compared with 88 (12.6%) in the middle group and 41 (5.7%) in the least disadvantaged group died. Even after adjusting for a comprehensive set of clinical covariates, higher neighborhood disadvantage was associated with a 32% higher all-cause mortality (hazard ratio, 1.32; 95% CI, 1.10-1.60; P = .004) and a 57% higher cardiovascular mortality (hazard ratio, 1.57; 95% CI, 1.17-2.10; P = .003).

Conclusions and Relevance

This study found that, among patients who experienced an MI at or before age 50 years, socioeconomic disadvantage was associated with higher all-cause and cardiovascular mortality even after adjusting for clinical comorbidities. These findings suggest that neighborhood and socioeconomic factors have an important role in long-term post-MI survival.

Association of inflammatory disease and long-term outcomes among young adults with myocardial infarction: the Mass General Brigham YOUNG-MI Registry

AIMS

Autoimmune systemic inflammatory diseases (SIDs) are associated with an increased risk of cardiovascular (CV) disease, particularly myocardial infarction (MI). However, there are limited data on the prevalence and effects of SID among adults who experience an MI at a young age. We sought to determine the prevalence and prognostic implications of SID among adults who experienced an MI at a young age.

METHODS AND RESULTS

The YOUNG-MI registry is a retrospective cohort study from two large academic centres, which includes patients who experienced a first MI at 50 years of age or younger. SID was ascertained through physician review of the electronic medical record (EMR). Incidence of death was ascertained through the EMR and national databases. The cohort consisted of 2097 individuals, with 53 (2.5%) possessing a diagnosis of SID. Patients with SID were more likely to be female (36% vs. 19%, P = 0.004) and have hypertension (62% vs. 46%, P = 0.025). Over a median follow-up of 11.2 years, patients with SID experienced an higher risk of all-cause mortality compared with either the full cohort of non-SID patients [hazard ratio (HR) = 1.95, 95% confidence interval (CI) (1.07-3.57), P = 0.030], or a matched cohort based on age, gender, and CV risk factors [HR = 2.68, 95% CI (1.18-6.07), P = 0.018].

CONCLUSIONS

Among patients who experienced a first MI at a young age, 2.5% had evidence of SID, and these individuals had higher rates of long-term all-cause mortality. Our findings suggest that the presence of SID is associated with worse long-term survival after premature MI.

Study of lipoprotein(a) and its impact on atherosclerotic cardiovascular disease: Design and rationale of the Mass General Brigham Lp(a) Registry

Lipoprotein(a) [Lp(a)] is independently associated with atherosclerotic cardiovascular disease and calcific aortic valve stenosis. Elevated Lp(a) affects approximately one in five individuals and meaningfully contributes to the residual cardiovascular risk in individuals with otherwise well-controlled risk factors. With targeted therapies in the therapeutic pipeline, there is a need to further characterize the clinical phenotypes and outcomes of individuals with elevated levels of this unique biomarker. The Mass General Brigham Lp(a) Registry will be built from the longitudinal electronic health record of two large academic medical centers in Boston, Massachusetts, to develop a detailed cohort of patients who have had their Lp(a) measured. In combination with structured data sources, clinical documentation will be analyzed using natural language processing techniques to accurately characterize baseline characteristics. Important outcome measures including all-cause mortality, cardiovascular mortality, and cardiovascular events will be available for analysis. Approximately 30 000 patients who have had their Lp(a) tested within the Mass General Brigham system from January 2000 to July 2019 will be included in the registry. This large Lp(a) cohort will provide meaningful observational data regarding the differential risk associated with Lp(a) values and cardiovascular disease. With a new frontier of targeted Lp(a) therapies on the horizon, the Mass General Brigham Lp(a) Registry will help provide a deeper understanding of Lp(a)'s role in long term cardiovascular outcomes.

[Preliminary clinical observations of retina injury in alkaline ocular trauma patients]

Objective: To investigate the features of the full-field electroretinogram (FERG) in patients with ocular surface alkaline injury, and to clarify the clinical significance of FERG examination in alkaline ocular trauma. Methods: Retrospective series of case study. A total of 22 patients with chemical ocular surface injury who were treated in the Department of Ophthalmology of Peking University Third Hospital from May 2018 to January 2020 were selected, including 20 males (25 eyes) and 2 females (2 eyes). The age ranged from 19 to 60 years old (average, 41). There were 17 eyes with alkaline ocular trauma, 7 eyes with thermal burn, and 3 eyes with acid ocular trauma. Seventeen contralateral healthy eyes in patients with unilateral mechanical trauma were used as controls. Fourteen alkaline trauma eyes with visual acuity records were further observed according to the degree of visual impairment. All patients were subjected to different flash intensity stimuli in accordance with a standard of the International Society for Clinical Electrophysiology of Vision for dark-adapted and light-adapted full-field FERG. One-way ANOVA and SNK-q was used for the comparison between groups. The unpaired t test was used for the comparison of patients with different vision. Results: Compared with healthy eyes the injured eyes' amplitude of dark adaption FERG b-wave under the dark stimulation of 0.01 cd·s·m^-2 in alkaline ocular trauma, thermal burn, acid ocular trauma was (135±85), (169±55), and (112±43) versus (341±53) μV, respectively; compared with healthy eyes, the differences were statistically significant (F=31.38; q=8.94, 5.70， 5.45；all P<0.01). Compared with healthy eyes the injured eyes' amplitude of dark adaption FERG a-wave under the dark stimulation of 3.00 cd·s·m^-2 in alkaline ocular trauma, thermal burn, acid ocular trauma was (178±78), (172±35), and (99±53) versus (334±60) μV, respectively; compared with healthy eyes, the differences were statistically significant (F=24.33; q=7.04， 5.60， 5.80；all P<0.01). Compared with healthy eyes the injured eyes' amplitude of dark adaption FERG b-wave under the dark stimulation of 3.00 cd·s·m^-2 in alkaline ocular trauma, thermal burn, acid ocular trauma was (354±79), (342±77), and (352±201) versus (600±78) μV, respectively; compared with healthy eyes, the differences were statistically significant (F=27.68; q=8.11， 6.51， 4.48； all P<0.01). Compared with healthy eyes the injured eyes' amplitude of dark adaption FERG OPs under the dark stimulation of 3.00 cd·s·m^-2 in alkaline ocular trauma, thermal burn, acid ocular trauma was (97±54), (107±41), and (45±22) versus (206±32) μV, respectively; compared with healthy eyes, the differences were statistically significant (F=25.03; q=7.36， 5.13， 5.96； all P<0.01).There was no significant difference in FERG between patients with visual acuity≥0.2 and those with visual acuity<0.2 (P>0.05) after alkaline ocular trauma. Conclusions: By detecting the amplitude change of FERG wave form of chemical ocular trauma, in this study, the amplitude of FERG wave form in alkaline ocular trauma was generally decreased. It's suggested that alkaline ocular trauma can cause damage to the rod and cone systems of retinal. (Chin J Ophthalmol, 2020, 56: 514-518).

Recovery of Left Ventricular Systolic Function and Clinical Outcomes in Young Adults With Myocardial Infarction

BACKGROUND

Left ventricular ejection fraction (EF) recovery is associated with better long-term outcomes after myocardial infarction (MI). However, the association between long-term outcomes and EF recovery among young MI patients has not been investigated.

OBJECTIVES

This study sought to evaluate the prevalence of left ventricular systolic dysfunction among patients who experience their first MI at a young age and to compare outcomes between those who recovered their EF versus those who did not.

METHODS

The YOUNG-MI registry is a retrospective cohort study of patients who experienced an MI at ≤50 years of age. EF at the time of MI and within 180 days post-MI were determined from all available medical records. The primary outcomes were all-cause and cardiovascular mortality.

RESULTS

There were 1,724 patients with baseline EF data: 503 (29%) had EF <50%, whereas 1,221 (71%) had a normal baseline EF. Patients with lower EF were more likely to have experienced ST-segment elevation MI, have higher troponin values, and have more severe angiographic coronary artery disease. Among patients with abnormal baseline EF, information on follow-up EF was available for 216, of whom 90 (42%) recovered their EF to ≥50%. Patients who experienced EF recovery had less severe angiographic disease, lower alcohol use, and a lower burden of comorbidities. Over a median follow-up of 11.1 years, EF recovery was associated with an ∼8-fold reduction in all-cause mortality (adjusted hazard ratio: 0.12; p = 0.001) and a ∼10-fold reduction in cardiovascular mortality (adjusted hazard ratio: 0.10; p = 0.025).

CONCLUSIONS

Nearly one-third of young patients presented with left ventricular dysfunction post-MI. Among them, EF recovery occurred in more than 40% and was independently associated with a substantial decrease in all-cause and cardiovascular mortality.

[Clinical observation of electroretinogram examination in ocular alkali burn]

Objective: To investigate the wave variations of the electroretinography (ERG), and explore the clinical value of using ERG in alkali injury. Methods: A total of 13 patients with alkali burns who were treated in the Department of Ophthalmology of Peking University Third Hospital from May 2018 to October 2019 were selected, including 12 males and 1 female. The age ranged from 19 to 60 years old. A total of 15 injured eyes were used as the alkali burn group, meanwhile, another 15 contralateral eyes with mechanical unilateral trauma were used as the healthy controls. ERG examination was performed to compare the amplitudes of 6 activation-induced responses between the two groups. Results: Compared with control group, b-wave amplitude of dark adaption 0.01 ERG in alkali injury group decreased [(137±23) μV vs (348±14) μV, P<0.001]. Compared with control group [(335±17) μV and (368±19) μV], a-wave amplitude of dark adaption 3.0 ERG and 10.0 ERG in alkali injury groups [(172±20) μV and (220±21) μV] were decreased (both P<0.001). As for b-wave amplitude of dark adaption 3.0 ERG and 10.0 ERG, compared with control group [(610±20) μV and (612±19) μV], those of alkali injury groups [(359±21) μV and (384±21) μV] were decreased (both P<0.001). In terms of oscillatory potentials (OPs) amplitude of dark 3.0 ERG adaption, compared with control group [(209±8) μV], that of alkali injury group [(94±13) μV] was decreased (P<0.001). Compared with normal group [(58±3) μV], a-wave amplitude of light adaption 3.0 ERG in alkali injury group [(40±4) μV] was decreased (P<0.001). As for b-wave amplitude of light adaption 3.0 ERG, compared with control group [(146±6) μV], that of alkali injury group [(90±11) μV] was decreased (P<0.001). In terms of photopic 3.0 flicker 30 Hz of light adaption, compared with control group [(166±10) μV], that of alkali injury group [(93±11) μV] was decreased (P<0.001). Conclusion: Alkali injury can cause ocular surface morphological changes, meanwhile, it leads to the alternations of the visual function.

[Relationship between the suppressor of cytokine signaling 3 expression and antiviral efficacy of nucleos(t)ide and interferon alpha therapy for chronic hepatitis B]

Objective: To investigate the molecular mechanism of poor response of nucleoside and interferon therapy in some patients with chronic hepatitis B (CHB) and the negative regulatory factor of suppressor of cytokine signaling 3 (SOCS3) expression in the interferon-signaling pathway. Also, study the clinical relationship between SOCS3 and antiviral efficacy of nucleoside and interferon. Methods: Peripheral blood and matched liver tissue samples from 54 CHB patients who participated in the OSST study were selected. HBsAg was measured at different time points (baseline and weeks 12, 24, 36, and 48) to observe the antiviral efficacy. Meanwhile, quantitative real-time PCR, and immunohistochemistry were used to detect the expression levels of SOCS3 mRNA in peripheral blood mononuclear cells (PBMCs) and matched liver tissues (baseline and 48 weeks). At the end of the 48-week treatment, patients with HBsAg negative or HBeAg seroconversion were defined as response group, and vice versa. Paired t-tests were used to compare normal distribution variables and the Mann-Whitney U test was used to compare the median differences between groups of non-normally distributed variables. Results: After 48 weeks of treatment, serum HBsAg levels in the Peg-IFN group continued to decline (average decrease of 1.14 log(10) IU / ml at week 48; P = 0.001 compared with baseline), while the entecavir group remained almost unchanged during treatment (average decrease was 0.05 log(10) IU / ml at week 48; compared with baseline P = 0.12). The expression of SOCS3 mRNA (Messenger RNA, mRNA) in peripheral blood and liver tissues of non-responder group was significantly higher than the response group in the course of Peg-IFNα2a treatment. The immunohistochemical results of liver tissue showed that the expression of SOCS3 in the non-responder group was significantly higher than that in the response group at baseline (P = 0.027). After 48 weeks of treatment with Peg-IFNα2a, the expression of SOCS3 in the non-responder group was significantly higher than that in the baseline and response groups (P = 0.003, P = 0.012, respectively). Conclusion: The expression of SOCS3 in peripheral blood mononuclear cells and liver tissues of non-responding CHB patients was significantly higher than that of responding CHB patients during interferon and nucleoside antiviral therapy. We speculated that SOCS3 might affect the antiviral efficacy through negative regulation of JAK-STAT signaling pathway, and partly expose the mechanism of interferon resistance.

Multistage Coupling of Laser-Wakefield Accelerators with Curved Plasma Channels

Multistage coupling of laser-wakefield accelerators is essential to overcome laser energy depletion for high-energy applications such as TeV-level electron-positron colliders. Current staging schemes feed subsequent laser pulses into stages using plasma mirrors while controlling electron beam focusing with plasma lenses. Here a more compact and efficient scheme is proposed to realize the simultaneous coupling of the electron beam and the laser pulse into a second stage. A partly curved channel, integrating a straight acceleration stage with a curved transition segment, is used to guide a fresh laser pulse into a subsequent straight channel, while the electrons continue straight. This scheme benefits from a shorter coupling distance and continuous guiding of the electrons in plasma while suppressing transverse beam dispersion. Particle-in-cell simulations demonstrate that the electron beam from a previous stage can be efficiently injected into a subsequent stage for further acceleration while maintaining high capture efficiency, stability, and beam quality.

[Influence of EDC ethanol solution on dentin shear bond strength with a self-etch adhesive system]

OBJECTIVE

To evaluate the bonding ability of one representative self-etch adhesive system by applying the micro-shear bond strength test method with different concentrations of carbodiimide [1-ethyl-3-(3-dimethylaminopropyl) carbodiimide, EDC] ethanol solution pretreatment.

METHODS

Extracted sound human third molars were collected from patients ranging 18 to 40 years. In the study, 80 molars were first sectioned to prepare a flat middle coronal dentin surface and then were randomly divided into 5 groups (n=16) according to without/with different surface treatments [blank control; 80% (volume fraction) ethanol control; EDC ethanol solution of three concentrations (0.01 mol/L, 0.3 mol/L and 0.5 mol/L)]. Each specimen underwent a micro-shear bond strength test and failure mode observation. The data collected were subjected to statistical analysis using one-way ANOVA and post hoc Tukey's test to analyze the difference of the micro-shear bond strength, and chi-square test/Fisher's exact test for the failure mode frequency of the micro-shear bond strength test specimens at a significance level of P=0.05.

RESULTS

The micro-shear bond strength of the three concentration EDC treatments were (35.29±8.97) MPa (0.01 mol/L EDC treatment group), (40.24±9.68) MPa (0.3 mol/L EDC treatment group), (37.38±9.66) MPa (0.5 mol/L EDC treatment group) separately; and that of the 80% ethanol group was (37.49±7.76) MPa. All micro-shear bond strength value of the above four groups was statistically higher than that of the blank control group [(33.81±7.98) MPa]. The immediate micro-shear bond strength and failure mode was of no statistically significant difference among all the groups. It was noticed that the immediate micro-shear bond strength of 0.3 mol/L was higher than that of all the other groups, especially higher than that of the 80% ethanol pretreatment group despite that there was no significant difference among all the groups. And the test of failure mode indicated that the cohesive failure was more common, while the frequency of adhesive failure was rare in each experimental group.

CONCLUSION

EDC pretreatment had no adverse effect on the immediate micro-shear bond strengths of Clearfil SE Bond. Meanwhile, EDC treatment did not cause more adhesive failure in immediate micro-shear test, which had further denoted what was said above. However, it needs more research to illustrate the anti-enzymatic role of EDC in dentin bonding.

An Unfamiliar “Common” Skin Disease: Poison Ivy Allergic Contact Dermatitis

We present a case of phytodermatitis caused by a poisonous plant known as poison ivy. It is one of the leading causes of allergic contact dermatitis and it causes significant morbidity in the United States. Prevention of the disease is by identification and avoidance of the plant. Barrier protection minimises the chance of contact and prompt rinsing with soap water limits antigen exposure after skin contact. General approach to treatment of allergic contact dermatitis can be applied but special precaution should be taken on the duration of systemic steroid therapy. Too short a course of oral steroid may result in a more severe recurrent flare. High potency topical steroids may limit the development of skin lesions. (Hong Kong j.emerg.med. 2011; 18:335-338)

The effect of acupuncture on chemotherapy-associated gastrointestinal symptoms in gastric cancer

BACKGROUND

Gastrointestinal (gi) symptoms are the most notable side effects of chemotherapeutic drugs; such symptoms are currently treated with drugs. In the present study, we investigated the effect of acupuncture on gi symptoms induced by chemotherapy in patients with advanced gastric cancer.

METHODS

A cohort of 56 patients was randomly divided into an experimental group and a control group. All patients received combination chemotherapy with oxaliplatin-paclitaxel. Patients in the experimental group received 30 minutes of acupuncture therapy daily for 2 weeks. The frequency and duration of nausea, vomiting, abdominal pain, and diarrhea, the average days and costs of hospitalization, and quality-of-life scores were compared between the groups.

RESULTS

Nausea was sustained for 32 ± 5 minutes and 11 ± 3 minutes daily in the control and experimental groups respectively (p < 0.05). On average, vomiting occurred 2 ± 1 times daily in the experimental group and 4 ± 1 times daily in the control group (p < 0.05). Abdominal pain persisted for 7 ± 2 minutes and 16 ± 5 minutes daily in the experimental and control groups respectively (p < 0.05). On average, diarrhea occurred 1 ± 1 times daily in the experimental group and 3 ± 1 times daily in the control group (p < 0.05). The average quality-of-life score was higher in the experimental group than in the control group (p < 0.05). No adverse events were observed for the patients receiving acupuncture.

CONCLUSIONS

Acupuncture, a safe technique, could significantly reduce gi symptoms induced by chemotherapy and enhance quality of life in patients with advanced gastric cancer.

Analysis of symptom clusters in Chinese cervical cancer patients undergoing radiotherapy, chemoradiotherapy, or postoperative chemoradiotherapy

OBJECTIVE

To assess the common symptom clusters in cervical cancer patients treated with radiotherapy alone, chemorachothierapy, or postoperative chemoradiotherapy, and evaluate differences among multi-modality treatment in these symptom clusters.

MATERIALS AND METHODS

Ninety-three patients diagnosed with cervical cancer were recruited to the survey, in which destination time was the fourth friday of radiotherapy. Symptoms of patients were evaluated by the Chinese version of the 13-item M.D. Anderson Symptom Inventory (MDASI).

RESULTS

Among the symptoms, lack of appetite was the most common and the most severe symptome, treatment modalities may have important effects on symptom clusters in cervical cancer patients undergoing radiotherapy.

CONCLUSION

The results offer valuable information for the future development treatment-based symptom cluster intervention.

Impact of asthma, exposure period, and filters on human responses during exposures to ozone and its initiated chemistry products

The impact of asthma, exposure period, and filter condition downstream of the mixing box of air-conditioning system on building occupants' perceptual response, work performance, and salivary α-amylase secretion during exposures to ozone and its initiated chemistry products is studied. The experiments were conducted in a field environmental chamber (FEC) (240 m(3)) simulating an office environment. Experiments were conducted during periods when the air-handling system operated with new or used pleated panel filters at constant recirculation (7/h) and ventilation (1/h) rates. Average ozone and secondary organic aerosols (ozone-initiated chemistry products) measured during non-asthmatic and asthmatic subjects' 3-h exposures in the FEC were in the ranges approximately 20-37 ppb and approximately 1.6-3 μg/m(3), respectively. Asthmatic subjects' perceived odor intensity and sensory (eye, nose, and throat) irritation ratings were generally lower than those of non-asthmatic subjects, possibly explaining why asthmatic subjects accept perceived air quality more than non-asthmatic subjects. However, asthmatic subjects' perceived physiological-like symptom ratings (flu, chest tightness, and headache) and concentrations of secreted salivary α-amylase were generally higher than those of non-asthmatic subjects. Asthmatic subjects had significantly lower accuracy than non-asthmatic subjects in a task that required higher concentration although they had higher work speed. Filter condition did not make any significant difference for subjects' responses.

Inserting the tunneller during an outside-in transobturator tape procedure by syringe-needle guidance

The objective of this study was to determine the feasibility of a novel syringe-needle guidance technique (SNG), and its impact on the perioperative variables and outcomes of patients undergoing an outside-in transobturator tape procedure (TOT). Between November 2006 and May 2008, 48 consecutive women who underwent TOT with SNG were included. Another 25 women without SNG between March 2004 and October 2006 were included as a historical control. There were no significant differences in hospital stays and complication rates between the two groups. However, the operating time was shorter (mean 23.0 vs 28.3 min, p=0.008) in the SNG group than in the control group. The presence of the SNG technique was the sole predictor of the operating time (p=0.003). In conclusion, the SNG technique is a feasible method to provide help in inserting the tunneller of TOT through the transobturator foramen, and did not compromise the outcome.

Generalized reticulated hyperpigmentation induced by lichen planus

A 68-year-old Chinese woman presented with generalized reticulated dark-brown hyperpigmentation on the trunk, face and limbs, oral Wickham's striae, sparse scalp hair and dark-red reticulated streaks on the occiput of the head and on the neck, some dark-red to violaceous papules on the face, scalp and flanks, light-yellow, deep-seated papules on the palms and soles, and small porcelain-white papules on the dorsal and lateral fingers. The histological features were consistent with the diagnosis of lichen planus (LP). To our knowledge, LP-induced generalized reticulated hyperpigmentation is very rare and this is the first report of the clinical features on the fingers, palms and soles.

A review on adolescent childbearing in Taiwan: its characteristics, outcomes and risks

In Taiwan, the age-specific fertility rate for adolescent girls aged 15-19 years has remained at 14-18/1,000 births during the past two decades, which is the highest among developed countries in Asia. There was a surprisingly high age-specific fertility rate for married women aged 15-19 years at 726 per 1,000 in 1994, much higher than that of the United States. Adolescent childbearing causes many adverse outcomes including unwanted and unstable marriage, repeated childbearing during adolescence, and increased risks of having low birth weight and preterm births and neonatal mortality. Studies in Taiwan showed that adolescent childbearing is associated with their poor knowledge but open attitude and behaviour on sexuality, the inadequate contraceptive services for the adolescents in need, some risk-taking behaviors, family dysfunction and low socioeconomic status of the adolescents' families. About two-thirds of the fathers of infants born to adolescent girls were adults, even old adults with a low education level Effective strategies for adolescent childbearing prevention range from sex education, the direct provision of contraceptive supplies, and to life options programmes, especially for the adolescents with high risk of adolescent pregnancy. Reducing the incidence of adolescent childbearing by active use of contraception is more important and practical than prohibiting adolescent sexual activity.

Effect of genotoxic exposure to chromium among electroplating workers in Taiwan

The objective of this study was to investigate the association between chromium (Cr) concentrations and sister chromatid exchanges (SCE) formation in Cr workers and to assess the effects of susceptible genes (glutathione S-transferase M1 and T1) on the frequency of deletion and SCE/cell. Urinary Cr concentration was significantly elevated in Cr workers (3.67 +/- 3.89 microg/g creatinine) compared to control group (1.21 +/- 1.16 microg/g creatinine, P < 0.01). There was also a significant difference of superoxide dismutase (SOD) levels between Cr workers (6.86 +/- 0.80 U/mg Hb) and controls (7.16 +/- 0.53 U/mg Hb, P < 0.01). The frequencies of SCE and high frequency cells (HFC) were significantly correlated with smoking habits and with duration of exposure to Cr. A significantly higher percentage (50%) of Cr workers had both the null GSTM1 and GSTT1 genotype as compared to 10% of the controls (P < 0.01). However, the chromosomal DNA damage effect of GSTM1 and GSTT1 genotypes, individually or in combination, was not revealed in Cr exposed workers.

Apoptosis induced by isoliquiritigenin in human gastric cancer MGC-803 cells

Isoliquiritigenin, which is possibly a principal anti-tumor constituent of licorice, a traditional Chinese herb, was examined for apoptosis-inducing activity in human gastric cancer MGC-803 cells. Typical morphological and biochemical features of apoptosis including cell shrinkage, chromatin condensation, DNA ladder formation, and appearance of apoptotic peaks (subG(1)) were observed in MGC-803 cells with isoliquiritigenin treatment. Using Fluo-3 and Rh123 as fluorescent probes, respectively, it was found that the intracellular free calcium concentration increased and the mitochondrial transmembrane potential (Deltapsi(m)) decreased in a dose-dependent manner in apoptotic cells. These results suggest that isoliquiritigenin induced apoptosis of MGC-803 cells through calcium- and Deltapsi(m)-dependent pathways, indicating that it is potentially useful as a natural anti-cancer agent.

Large drug resistance virulence plasmids of clinical isolates of Salmonella enterica serovar Choleraesuis

Salmonella enterica serovar Choleraesuis generally causes systemic human salmonellosis without diarrhea, and therefore, antimicrobial treatment is essential for such patients. The drug resistance information on this organism is thus of high value. Serovar Choleraesuis usually harbors a virulence plasmid (pSCV) of 50 kb in size. Of the 16 clinical isolates identified to be serovar Choleraesuis, all except one harbored a pSCV and seven of them carried a pSCV of more than 125 kb in size. A pSCV was defined as a plasmid carrying spvC and characteristic deletions detected by PCR and by DNA-DNA hybridization (for the former criterion). The results of PCR, restriction fragment profiles, and Southern DNA-DNA hybridizations of the profiles all indicated that such larger pSCVs were derived from the 50-kb plasmid recombined with non-pSCVs found in some clinical isolates. Fifteen of the 17 strains, including a laboratory strain, were then tested for drug resistance against 16 antibiotics with E-test and the dilution method. The laboratory strain, which harbored a 50-kb pSCV and a 6-kb non-pSCV, was resistant only to sulfonamides (SUL), and its resistance gene, sulII, checked with PCR and DNA-DNA hybridization, was located on the 6-kb non-pSCV. All 14 clinical strains were resistant to multiple drugs. Of the 14, 7 were resistant to SUL, and the resistance gene was located on a plasmid. The sulII gene, but not bla(TEM-1), was carried only on the 6-kb non-pSCV. Of the remaining six large plasmids, three of 90 kb, two of 136 kb, and one of 140 kb, the last three were pSCVs and carried the other SUL gene (sulI) and the bla(TEM-1) gene. The six strains were also resistant to trimethoprim-sulfamethoxazole. None of the 50-kb pSCVs carried resistance genes. These drug resistance genes on the large pSCVs were apparently also acquired through recombination.

Two-photon laser scanning microscopy of epithelial cell-modulated collagen density in engineered human lung tissue

Tissue remodeling is a complex process that can occur in response to a wound or injury. In lung tissue, abnormal remodeling can lead to permanent structural changes that are characteristic of important lung diseases such as interstitial pulmonary fibrosis and bronchial asthma. Fibroblast-mediated contraction of three-dimensional collagen gels is considered an in vitro model of tissue contraction and remodeling, and the epithelium is one factor thought to modulate this process. We studied the effects of epithelium on collagen density and contraction using two-photon laser scanning microscopy (TPLSM). TPLSM was used to image autofluorescence of collagen fibers in an engineered tissue model of the human respiratory mucosa -- a three-dimensional co-culture of human lung fibroblasts (CCD-18 lu), denatured type I collagen, and a monolayer of human alveolar epithelial cell line (A549) or human bronchial epithelial cell line (16HBE14o(-)). Tissues were imaged at days 1, 8, and 15 at 10 depths within the tissue. Gel contraction was measured concurrently with TPLSM imaging. Image analysis shows that gels without an epithelium had the fastest rate of decay of fluorescent signal, corresponding to highest collagen density. Results of the gel contraction assay show that gels without an epithelium also had the highest degree of contraction (19.8% +/- 4.0%). We conclude that epithelial cells modulate collagen density and contraction of engineered human lung tissue, and TPLSM is an effective tool to investigate this phenomenon.

[A controlled clinical study between hepatic arterial infusion with embolized curcuma aromatic oil and chemical drugs in treating primary liver cancer]

OBJECTIVE

To evaluate the effectiveness, toxicity and prospective application of hepatic arterial infusion (HAI) with Embolized Curcuma Aromatic oil (CAO) in treating primary liver cancer (PLC).

METHODS

In the treated group, 32 patients with PLC were treated by HAI with 1-3 ml of embolized CAO and oral administration of Chinese herbal medicine. In the control group, 32 patients with PLC were treated with transcatheter artery chemoembolization (TACE).

RESULTS

In the treated group, one patient attained complete remission (CR) and 13 partial remission (PR), the total effective rate being 43.75%. The level of alpha fetal protein (AFP) turned to normal range in 7 cases and decreased in other 7. In the control group, 10 obtained PR and the total effective rate being 31.25%, AFP level turned to normal in 5 and decreased in 2. There was no statistical significance between the two groups. The incidences of post-embolism syndrome, such as fever, abdominal pain and vomiting were similar between the two groups but no myelosuppression occurred in the treated group with significant difference (P < 0.01) as comparing with that in the control group. The mean survival time, median survival time, 1-, 2- and 3-year survival rate in the treated group was 11.5 months, 10 months, 37.5%, 13.3% and 6.9% respectively, while in the control group was 7.25 months, 6 months, 15.6%, 3.2% and 0 respectively. The treated group was better in mean survival time, median survival time and 1-year survival rate than that of the control group (P < 0.05).

CONCLUSION

HAI with embolized CAO showed a similar favorite effect in treating PLC as that of TACE, but superior than TACE with longer survival time and milder myelosuppression.

Synthesis of a polymeric 4-N-linked sialoside which inhibits influenza virus hemagglutinin

A multiple sialic acid-bearing polymer 7 has been made in which a novel 4-N-substituted sialoside 5 has been coupled to polyacrylamide. The conjugate 7 has been found to inhibit the agglutination of influenza virus to red blood cells with HAI inhibition constants of around 10(-6) M, based on the sialic acid concentration.

Cytogenetic study of workers exposed to chromium compounds

The frequency of sister chromatid exchanges (SCEs), high SCE frequency cells (HFCs), and genetic polymorphism of genotypes glutathione S-transferase (GST) M1 and T1 were analyzed in peripheral lymphocytes of 35 workers occupationally exposed to chromium (Cr) and 35 matched control group. Results showed that workers exposed to Cr showed 6.07 SCE/cell, as compared to 4.76 SCE/cell for the control group (p<0.01). Smokers showed a statistically significant higher frequency of SCE than non-smokers in both groups. The work duration of Cr workers was an important factor. Workers exposed for more than 5 years showed a significantly higher level of SCEs (p<0.05). Workers exposed to Cr for 5 or more years had higher HFC rates (51.4%) than those exposed for less than 5 years (22.9%), with an odds ratio of 4.5 times than those exposed for less than 5 years. In HFC analysis, Cr workers who smoked showed a higher level of HFC (60%) than the control group (5.7%) and also had a higher odds ratio (60.4) compared with the control group. Among non-smokers, the odds ratio was 9.0. Another objective of this study is to investigate the relationship between SCE and genetic polymorphisms of GST M1 and T1 in Cr workers. The results showed that the incidence of GSTM1 null genotype was 60% in the control group and 77.1% in Cr workers, and percentages of GSTT1 deletion were 42.9% and 62.9% in control and exposed individuals, respectively. There was a slightly increased frequency of SCE among Cr workers with GSTM1 null genotype as opposed to non-null genotype individuals. A similar result was seen among the control group; however, there were no statistically significant differences. In conclusion, the current study found the positive induction of SCE in workers who smoked or/and were exposed to Cr. However, different GST genotypes did not influence the level of cytogenetic damage between groups. Despite slight variation in numbers, they all appear to be not different.

Two-dimensional object recognition through two-stage string matching

A two-stage string matching method for the recognition of two-dimensional (2-D) objects is proposed in this work. The first stage is a global cyclic string matching. The second stage is a local matching with local dissimilarity measure computing. The dissimilarity measure function of the input shape and the reference shape are obtained by combining the global matching cost and the local dissimilarity measure. The proposed method has the advantage that there is no need to set any parameter in the recognition process. Experimental results indicate that the hostage string matching approach significantly improves the recognition rates compared to the one-stage string matching method.

A cross-cultural validation of coping strategies and their associations with caregiving distress

Coping strategies were compared among family caregivers of Alzheimer's disease patients in Shanghai, China (n = 110) and San Diego, California (n = 139). Four coping factors were reliably consistent in both samples, supporting their widespread relevance to life adversity; behavioral confronting, behavioral distancing/social support, cognitive confronting, and cognitive distancing. Shanghai and San Diego caregivers endorsed similar rates of coping, but Shanghai caregivers reported fewer symptoms of depression and anxiety. Although coping strategies were similar, cultural ideals promoting family interdependence, veneration of elderly family members, and acceptance of traditional family roles may have reduced the psychological impacts of caregiving in the Shanghai sample.

A study of the active site of influenza virus sialidase: an approach to the rational design of novel anti-influenza drugs

The development of sialidase inhibitor-based potential anti-influenza drugs using rational drug design techniques has been of recent interest. The present study details as investigation of the active site of influenza virus sialidase by using the program GRID in an attempt to design more potent inhibitors in the hope they will eventually lead to anti-influenza drugs. A number of different probes (amino, carboxy, hydroxy, methyl, etc) have been used in an effort to determine the functional groups most likely to improve the binding of the starting template 2-deoxy-2,3-didehydro-N-acetylneuraminic acid (Neu5Ac2en). The data have correctly predicted the binding regions for the carboxylate, acetamido (NH and methyl), and glycerol (OH) groups of N-acetylneuraminic acid. Moreover, the data suggest that the addition of certain functionalities (amino group) at the C-4 position should enhance the overall binding.

Analysis of the double-stranded RNA genome segments among avian reovirus field isolates

Nine isolates of avian reovirus (ARV) from both healthy birds and birds with different clinical illness and one commercially available vaccine strain were selected and characterized by analysis of the migration pattern of their genomic double-stranded RNA (dsRNA) segments following separation by polyacrylamide gel electrophoresis. Different electropherotypes were observed and analyzed. The results show that the dsRNA segments of ARV were markedly polymorphic among isolates within the same serotype as well as among different serotypes. The results also show no correlation between electropherotype and disease state.

National field trial of the Chinese classification and diagnostic criteria of mental disorders: comprehensibility, acceptability and applicability

The Chinese Neurology and Psychiatry Association conducted a national field trial of its Chinese Classification and Diagnostic Criteria of Mental Disorders (CCMD-2) involving 26 provinces and municipalities, 80 psychiatric institutes, and 224 professionals. The results were as follows: (1) 95.2% of researchers considered the comprehensibility of the CCMD-2 diagnostic criteria good. Within the ten major categories, comprehensibility ranged from 85.7% to 100%. (2) Of those surveyed concerning the acceptability of the CCMD-2 diagnostic criteria, 85.9% considered them acceptable. In individual classifications, the rate ranged from 74.1% to 95.2%. (3) 1498 cases were tested. The overall applicability rate which indicated the consistency between the CCMD-2 result and the actual clinical diagnoses was found to be 87.6%, (averaging Kappa = 0.82, P < 0.01), better than those obtained from non-Chinese systems of diagnosis.

Rational design of potent sialidase-based inhibitors of influenza virus replication

Two potent inhibitors based on the crystal structure of influenza virus sialidase have been designed. These compounds are effective inhibitors not only of the enzyme, but also of the virus in cell culture and in animal models. The results provide an example of the power of rational, computer-assisted drug design, as well as indicating significant progress in the development of a new therapeutic or prophylactic treatment for influenza infection.

Inhibition of sialidases from viral, bacterial and mammalian sources by analogues of 2-deoxy-2,3-didehydro-N-acetylneuraminic acid modified at the C-4 position

The inhibition of sialidase activity from influenza viruses A and B, parainfluenza 2 virus, Vibrio cholerae, Arthrobacter ureafaciens, Clostridium perfringens, and sheep liver by a range of 2-deoxy-2,3-didehydro-N-acetylneuraminic acid analogues modified at the C-4 position has been studied. All substitutions tested resulted in a decrease in the degree of inhibition of the bacterial and mammalian sialidases. For sialidases from influenza viruses A and B, on the other hand, most of the substitutions tested either had no significant effect on binding or, in the case of the basic amino and guanidino substituents, resulted in significantly stronger inhibition. The results for parainfluenza 2 virus sialidase were mostly intermediate, in that inhibition was neither significantly increased nor decreased by most of the modifications. We conclude that only the influenza A and B sialidase active sites possess acid groups correctly positioned to participate in charge-charge interactions in the region of C-4 of bound substrate, and that the C-4 binding pockets of the bacterial and mammalian sialidases examined are considerably smaller than is observed for either the influenza virus or parainfluenza virus sialidases.

[A nationwide field trial of the Chinese classification and diagnostic criteria of mental disorders: application and evaluation]

To test the quality and feasibility of the Chinese Classification and Diagnostic Criteria of Mental Disorders (CCMD-2), a nationwide field trial was carried out by 224 professionals from 80 psychiatric facilities. The results showed that the diagnostic criteria of CCMD-2 was clearly understandable and acceptable reported by 95.2% and 85.2% of the researchers. From a survey sample of 1,489 cases of mental disorders, the interrater agreement of criteria diagnosis was 0.96 (K) and the concordance between the diagnosis from clinical records and that based upon the criteria was 0.84(K) indicating the excellent reliability and validity of CCMD-2.

The development of an enzyme-linked immunosorbent assay (ELISA) for cephalexin

Cephalexin was structurally modified by the attachment of a spacer at the carboxylic acid through which it was subsequently covalently attached to BSA. This method permitted the molecule to be attached without cleavage of the beta-lactam ring giving a conjugate distinct from previously described immunogenic preparations of penicillins and cephalosporins. This approach required the development of a novel spacer molecule, and its synthesis and characterisation are reported. Rabbits were used to raise antisera and the antibodies produced were characterised with respect to their reactivity with cephalexin and various analogues, other cephalosporins, and a number of penicillins.

The double porosity model for mass transfer between capillaries and tissues in lung microcirculation

This paper proposes a double porosity model to deal with the mass transfer between capillaries and tissues in the lung microcirculation on the basis of. Utilizing the analytic method of small parameter expansion and the numerical method, the nonlinear governing equations are solved. Comparison shows that the small parameter solution is accurate enough to illustrate the mass exchange between the lung capillary and tissues. Finally the results are used to discuss the mechanism of formation of lung edema.

[Ectopic HCG in transitional cell carcinoma of the bladder by immuno-histochemical survey]

Production of human chorionic gonadotropin (HCG) by transitional cell carcinoma of bladder is considered as a rare phenomenon. Among 60 cases of transitional cell carcinoma of the bladder, six cases were positive for beta-HCG, which were detected with anti-beta-HCG by PAP technique. They were classified as grade III and IV, being provided with 20.68% of all of the grade III and IV cases reported, of these six patients, four died within one year. It is suggested that carcinomas of the bladder bearing the capability of producing HCG tend to have a higher malignancy and poor histological differentiation. The possible origin and histogenesis of HCG are discussed.

[Comparison of the development between the satellite cells of ALD and PLD muscles of adult chicken in vitro]

Satellite cells isolated from the anterior (slow) and posterior (fast) latissimus dorsi of adult chick were cultured separately in the absence of neural factors. The cells were observed under an inverted phase contrast microscope every day. The morphological changes of satellite cells, described by other workers, were seen in these cultures. Furthermore, the difference in the time course of development of the satellite cells from different muscles was found. That is, the transformation of the satellite cells of PLD into the myoblasts and the fusion of the latter delayed about 24 h as compared with ALD. The results support the idea that there may be an intrinsic developmental tendency in the myogenic cells of bird, since it proved possible to see the difference of the myogenic cells even in mononuclear phase.