[Analysis of the efficacy and safety of coblation and pulsed radiofrequency in the treatment of cervicogenic headache]

Objective: To explore the efficacy and safety of coblation and pulsed radiofrequency on cervicogenic headache (CEH). Methods: A total of 118 patients with CEH who underwent coblation or pulsed radiofrequency in the Department of Pain Management at Xuanwu Hospital, Capital Medical University from August 2018 to June 2020 was retrospectively collected. Patients were divided into the coblation group (n=64) and the pulsed radiofrequency group (n=54) according to different surgical methods. In the coblation group, there were 14 males and 50 females, aged 29-65 (49.8±10.2) years, while in the pulse radiofrequency group, there were 24 males and 30 females, aged 18-65 (41.7±14.8) years. Visual analogue scale (VAS) score, postoperative numbness in the affected areas and other complications were recorded and compared between the two groups at preoperative 3 d, and 1 month, 3 months and 6 months postoperatively. Results: The VAS score of the coblation group was (7.16±0.91), (3.67±1.13), (1.59±0.91), (1.66±0.84) and (1.56±0.90) before operation, and 3 days, 1 month, 3 months and 6 months after surgery. Likewise, the VAS score of the pulsed radiofrequency group was (7.01±0.78), (1.58±0.88), (1.57±0.94), (3.71±1.08) and (6.92±0.83) at the aforementioned time points. There were statistically significant differences of VAS scores between the coblation group and the pulsed radiofrequency group at 3 days, 3 months and 6 months postoperatively (all P<0.001). Intra-group comparison revealed that VAS scores in the coblation group were significantly lower than those before surgery at all time points after surgery (all P<0.001), while VAS scores in the pulsed radiofrequency group were significantly decreased at 3 days, 1 month and 3 months after surgery (P<0.001). The incidence of numbness was 72% (46/64), 61% (39/64), 6% (4/64) and 3% (2/62) in the coblation group and 7% (4/54), 7% (4/54), 2% (1/54) and 0 (0/54) in the pulsed radiofrequency group, respectively. At 3 days and 1 month after surgery, the incidence of numbness in the coblation group was higher than those in the pulsed radiofrequency group (both P<0.001). In the coblation group, one patient developed pharyngeal discomfort 3 days after surgery, which disappeared spontaneously 1 week after surgery without special treatment. One patient developed vertigo after getting up in the morning at 3 days postoperatively, and the possibility of transient cerebral ischemia was considered. In the pulsed radiofrequency group, one patient developed nausea and vomiting after operation, but spontaneous remission was observed after one hour without special treatment. Conclusions: Both coblation and pulsed radiofrequency are effective and safe in the treatment of CEH. But the VAS scores at 3 and 6 months after coblation is significantly lower than those of pulsed radiofrequency ablation group, and the efficacy is better in those undergoing coblation.

Clinical characteristics and treatments of multi-system inflammatory syndrome in children: a systematic review

OBJECTIVE

Multisystem inflammatory syndrome in children (MIS-C) can occur in association with coronavirus disease 2019 (COVID-19). It is not easy to differentiate MIS-C from severe COVID-19 or Kawasaki disease based on symptoms. The aim of this study was to describe the clinical and laboratory characteristics of MIS-C.

PATIENTS AND METHODS

We searched PubMed/Medline for case series and reports of MIS-C published until June 20, 2020. From a total of nine articles involving 45 cases, various clinical and laboratory data were extracted. Each target case was evaluated by using different diagnostic criteria.

RESULTS

The average age at onset of MIS-C was 8.6 years. In 80% of cases, the age of patients ranged from 5 to 15 years. Fever (100%) and shock (82%) were the most common presenting symptoms. Sixty percent of cases met the diagnostic criteria for typical or atypical Kawasaki disease. Biomarkers indicative of inflammation, coagulopathy, or cardiac injury were characteristically elevated as follows: ferritin (mean: 1,061 ng/mL), CRP (217 mg/L), ESR (69 mm/hr), IL-6 (214.8 pg/mL), TNFα (63.4 pg/mL), D-dimer (3,220 ng/mL), PT (15.5 s), troponin I (1,006 ng/L), and BNP (12,150 pg/mL). Intravenous immunoglobulin was administered in all target cases, and inotropic agents were commonly used as well. No case of death was observed.

CONCLUSIONS

This study demonstrated that MIS-C is a serious condition that presents with fever, rash, as well as cardiovascular and gastrointestinal symptoms. Although it is challenging to differentiate MIS-C from Kawasaki disease or severe COVID-19, initiation of appropriate treatments through early diagnosis is warranted.

[Immunogenicity and influencing factors of hepatitis B vaccination based on different vaccination schedules among chronic kidney disease patients]

Objective: To explore the immunogenicity and influencing factors of hepatitis B vaccination based on different vaccination schedules among chronic kidney disease (CKD) patients. Methods: CKD patients who participated in randomized controlled trials in four hospitals in Shanxi province and completed three doses of 20 µg vaccination (at months 0, 1 and 6) and four doses of 20 µg or 60 µg vaccination (at months 0, 1, 2, and 6) were surveyed from May 2019 to July 2020.According to the ratio of 1∶1∶1, 273 CKD patients were divided into 3 groups randomly. Quantification of the anti-hepatitis B surface antigen-antibody (anti-HBs) in serum samples was performed using chemiluminescent microparticle immunoassay at months 1 and 6 after the entire course of the vaccinations. The positive rate, high-level positive rate, geometric mean concentration (GMC) of anti-HBs, and the influencing factors were analyzed by χ² tests, analysis of variance, unconditional logistic regression analysis. Results: A total of 273 CKD patitents were participants.The positive rates in the CKD patients with four doses of 20 µg vaccination (92.96%,66/71) or 60 µg vaccination (93.15%, 68/73) were higher than that in the CKD patients with three doses of 20 µg vaccination (81.69%, 58/71) at month one after the full course of the vaccinations (P<0.05). The GMCs of anti-HBs showed similar results (2 091.11 mIU/ml and 2 441.50 mIU/ml vs. 1 675.21 mIU/ml) (P<0.05). The positive rate was higher in the CKD patients with four doses of 60 µg vaccination (94.83%,55/58) than in those with three doses of 20 µg vaccination (78.79%,52/66) (P<0.05) at month six after the full course of the vaccinations. And the GMC of anti-HBs in the patients with four doses of 60 µg vaccination (824.28 mIU/ml) was significantly higher than those in the patients with 3 or 4 doses of 20 µg vaccination (639.74 mIU/ml and 755.53 mIU/ml) (P<0.05). After controlling the confounding factors, the positive rate in the CKD patients with four doses of 60 µg vaccination were 3.19 (95%CI: 1.02-9.96) and 5.32 (95%CI: 1.27-22.19) times higher than those in the patients with three doses of 20 µg vaccination at months 1 and 6 after the full course of the vaccinations, respectively. The positive rate in CKD patients without immune suppression or hormone therapy was 3.33 (95%CI: 1.26-8.80) and 4.78 (95%CI: 1.47-15.57) times higher than those in the patients with such therapy, respectively. Conclusions: Four doses of 20 µg or 60 µg hepatitis B vaccination could improve the immunogenicity in patients with CKD. And four doses of 60 µg vaccination might play a positive role in maintaining anti-HBs in this population. The immunogenicity in the CKD patients with immune suppression or hormone therapy was poor.

Suicide associated with COVID-19 infection: an immunological point of view

OBJECTIVE

Coronavirus disease 2019 (COVID-19) is a pandemic and leading cause of death. Beyond the deaths directly caused by the virus and the suicides related to the psychological response to the dramatic changes as socioeconomic related to the pandemic, there might also be suicides related to the inflammatory responses of the infection. Infection induces inflammation as a cytokine storm, and there is an increasing number of studies that report a relationship between infection and suicide.

MATERIALS AND METHODS

We searched the World Health Organization status report and the PubMed database for keywords (COVID-19, suicide, infection, inflammation, cytokines), and reviewed five cytokine pathways between suicide and inflammation using two meta-analyses and two observational studies starting from November 31, 2020, focusing on the relationship between suicide and inflammation by infection. First, we discussed existing evidence explaining the relationship between suicidal behaviors and inflammation. Second, we summarized the inflammatory features found in COVID-19 patients. Finally, we highlight the potential for these factors to affect the risk of suicide in COVID-19 patients.

RESULTS

Patients infected with COVID-19 have high amounts of IL-1β, IFN-γ, IP10, and MCP1, which may lead to Th1 cell response activation. Also, Th2 cytokines (e.g., IL-4 and IL-10) were increased in COVID-19 infection. In COVID-19 patients, neurological conditions, like headache, dizziness, ataxia, seizures, and others have been observed.

CONCLUSIONS

COVID-19 pandemic can serve as a significant environmental factor contributing directly to increased suicide risk; the role of inflammation by an infection should not be overlooked.

Efficacy and safety of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) monotherapy for advanced EGFR-mutated non-small cell lung cancer: systematic review and meta-analysis

OBJECTIVE

It is controversial whether there is efficacy or safety benefit of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in advanced EGFR-mutated non-small cell lung cancer (NSCLC) compared to standard chemotherapy. We aim to assess the efficacy and safety of EGFR-TKIs compared to other chemotherapeutics in EGFR-mutated NSCLC.

MATERIALS AND METHODS

Up to April 27th, 2020, PubMed, Embase, Medline, Scopus, Cochrane library, and ClinicalTrials.gov were searched for articles or trials meeting the inclusion criteria. After filtering, 230 eligible studies were initially identified. Data extraction followed PRISMA and included outcomes were progression-free survival (PFS), overall survival (OS), and severe adverse events (SAEs). Direct and indirect meta-analyses were generated in the context of log-linear mixed-effects models, with fixed effects for each relative comparison and random effects for each study.

RESULTS

The results showed that EGFR-TKI therapy had improved PFS with a hazard ratio (HR) of 0.40 (95% CI: 0.36-0.44, p<0.001) compared to standard chemotherapy. Nevertheless, the EGFR-TKIs showed no benefit on OS (HR: 0.96, 95% CI: 0.83-1.10, p=0.556). In the analysis of adverse events, EGFR-TKIs had fewer SAEs than standard chemotherapy (HR: 0.29, 95% CI: 0.26-0.33, p<0.001).

CONCLUSIONS

Our systemic review indicates that EGFR-TKI therapy has improved PFS, and reduced SAEs compared to standard chemotherapy in advanced EGFR-mutated NSCLC.

[Diagnostic efficacy of a combined diagnostic model based on extreme gradient boosting algorithm in differentiating the pathological grading of gastric neuroendocrine neoplasms]

Objective: To evaluate the diagnostic efficacy of combined diagnostic model based on extreme gradient boosting (XGBoost) algorithm to determine the pathological grading of gastric neuroendocrine neoplasms (NENs). Methods: A total of 81 gastric NENs patients in the First Affiliated Hospital of Zhengzhou University confirmed by definite pathological grading from August 2012 to December 2019 were enrolled. The data of clinical and CT findings were collected. The number of lesions, tumor location, shape, lymph node metastasis, thickness, longitude of tumor and CT values in arterial and venous phase were analyzed. ITK-SNAP software and Python 2.1.0 PyRadiomics software were used to perform the image preprocessing and radiomics features extraction from segmented images. XGBoost algorithm was used to build the CT findings model, radiomics model in arterial phase, radiomics model in venous phase and combined diagnostic model. The diagnostic efficacy of CT imaging model, radiomics model in arterial phase, radiomics model in venous phase and combined diagnostic model were evaluated by accuracy, mean squared error (MSE) and mean absolute error (MAE). Results: The subjects were 28.0 to 78.0 (58.6+10.7) years old, including 56 males (69.1%). The number of lesions, tumor location, shape, lymph node metastasis, thickness and longitude of tumor between G1/G2 and G3 patients showed statistic significances (all P values<0.05), while there were no differences in CT values in arterial and venous phase (both P values>0.05). Six most important features in the combined diagnostic model were A_logarithm_glcm_Imc1, P_squareroot_glcm_Maximum Probability, thickness, longitude, A_wavelet-HHL_glrlm_GrayLevelNonUniformity and P_wavelet-LLL_ngtdm_Contrast, respectively. The accuracy of CT findings model, radiomics model in arterial phase, radiomics model in venous phase and combined diagnostic model were 81.8%, 86.0%, 87.8% and 91.0%, respectively; with MSE were 539.41, 490.08, 429.99 and 371.92, respectively; and MAE were 16.72, 15.25, 14.23 and 12.33, respectively. The MAE value of the combined diagnostic model was lower than those of CT findings model and radiomics model in arterial phase (P<0.001 and 0.004, respectively), while no statistically difference was detected compared to radiomics model in venous phase (P=0.111). Conclusion: The combined diagnostic model based on XGBoost algorithm have a good diagnostic efficiency for the pathological grading of gastric NENs.

Mental health states and influencing factors of risky and problem drinking in South Korean female adolescents

OBJECTIVES

Alcohol is one of the most used and abused psychoactive substances by adolescents. We investigated influencing factors of risky and problem drinking in Korean female adolescents.

STUDY DESIGN

The study design used is a cross-sectional modeling.

METHODS

We used data from the 13th Korean Youth Risk Behavior Web-based Survey (KYRBS) conducted in 2017. KYRBS data were obtained from a stratified, multistage, clustered sample. Risky drinking was binge drinking and problem drinking was drinking with several conflicts association with alcohol consumption.

RESULTS

Among 62,276 participants, the rates of current, risky, and problem drinking among all participants were 16.1%, 8.3%, and 6.1%, respectively. Although all of these rates were higher in males, risky and problem drinking rates among current female drinkers were higher than those of males (55.4 vs 48.5%, 38.9 vs 37.2%, respectively). Problem drinking was most strongly associated with risky drinking (adjusted odds ratio: 17.53 [95% confidence interval: 14.63-21.00]), similarly, risky drinking was most strongly associated with problem drinking in female current drinkers (17.76 [14.84-21.27]). Current smoking was the second strongest risk factor for risky and problem drinking in females (5.22 [3.92-6.95] and 2.93 [2.21-3.89], respectively).

CONCLUSION

Many female adolescents in Korea drink alcohol in an unhealthy manner. The female risky and problem drinking rates among current drinkers were higher than those of males. Risky drinking and problem drinking was most significant influencing factor among females, reciprocally. Public education on abstinence in female adolescents is warranted.

Role of bilateral corticobulbar tracts in dysphagia after middle cerebral artery stroke

BACKGROUND AND PURPOSE

The corticobulbar tract is a potential neural pathway involved in swallowing. The frontal operculum, insular cortex, corona radiata and internal capsule, which are frequently involved in middle cerebral artery (MCA) strokes, are locations in which lesions cause dysphagia. However, it is unclear whether the locations are linked to the corticobulbar tract or whether corticobulbar tract integrity is associated with dysphagia severity. This study aimed to assess the association between corticobulbar tract integrity and dysphagia severity after MCA stroke.

METHODS

Thirty dysphagic patients after MCA stroke and 27 healthy controls were examined. Diffusion tensor imaging (DTI)-derived parameters of the corticobulbar tract were compared between patient and control groups. Next, patients were divided into mild and moderate-to-severe dysphagia groups, and DTI-derived parameters of the corticobulbar tract were compared between the subgroups. Logistic regression analysis was used to determine the association between corticobulbar tract integrity and dysphagia severity.

RESULTS

The tract volume (TV) of the affected corticobulbar tract was lower in dysphagic patients than in healthy controls (P < 0.001). According to dysphagia severity, TV of the unaffected corticobulbar tract was higher in the mild dysphagia group than in the moderate-to-severe dysphagia group (P = 0.012). TV of the unaffected corticobulbar tract was independently associated with dysphagia severity according to the logistic regression model (adjusted odds ratio 0.817, 95% confidence interval 0.683-0.976).

CONCLUSIONS

The corticobulbar tract was affected after MCA stroke and may be associated with dysphagia. A higher corticobulbar TV in the unaffected hemisphere was indicative of better swallowing function in dysphagic patients after MCA stroke.

Gas spectroscopy through multimode self-mixing in a double-metal terahertz quantum cascade laser

A multimode self-mixing terahertz-frequency gas absorption spectroscopy is demonstrated based on a quantum cascade laser. A double-metal device configuration is used to expand the laser's frequency tuning range, and a precision-micromachined external waveguide module is used to enhance the optical feedback. Methanol spectra are measured using two laser modes at 3.362 and 3.428 THz, simultaneously, with more than eight absorption peaks resolved over a 17 GHz bandwidth, which provide the noise-equivalent absorption sensitivity of 1.20×10^-3  cm^-1 Hz^-1/2 and 2.08×10^-3  cm^-1 Hz^-1/2, respectively. In contrast to all previous self-mixing spectroscopy, our multimode technique expands the sensing bandwidth and duty cycle significantly.

Silver-based surface plasmon waveguide for terahertz quantum cascade lasers

Terahertz-frequency quantum cascade lasers (THz QCLs) based on ridge waveguides incorporating silver waveguide layers have been investigated theoretically and experimentally, and compared with traditional gold-based devices. The threshold gain associated with silver-, gold- and copper-based devices, and the effects of titanium adhesion layers and top contact layers, in both surface-plasmon and double-metal waveguide geometries, have been analysed. Our simulations show that silver-based waveguides yield lower losses for THz QCLs across all practical operating temperatures and frequencies. Experimentally, QCLs with silver-based surface-plasmon waveguides were found to exhibit higher operating temperatures and higher output powers compared to those with identical but gold-based waveguides. Specifically, for a three-well resonant phonon active region with a scaled oscillator strength of 0.43 and doping density of 6.83 × 10¹⁵ cm^-3, an increase of 5 K in the maximum operating temperature and 40% increase in the output power were demonstrated. These effects were found to be dependent on the active region design, and greater improvements were observed for QCLs with a larger radiative diagonality. Our results indicate that silver-based waveguide structures could potentially enable THz QCLs to operate at high temperatures.

Theileria buffeli infections in grazing cattle in the Republic of Korea

Theileria infections are encountered worldwide, occasionally resulting in serious economic losses for the livestock industry. This study is an epidemiological survey of Theileria infections in Korean indigenous cattle populations in the Republic of Korea (ROK). Blood samples were collected from 100 cattle in April (n=50) (prior to pastureland grazing), and again four months later, in August (n=50) (half of the cattle put out for grazing and the other half kept in housing). All samples were tested for the presence of Theileria infection based on PCR amplification of the small subunit of ribosomal RNA gene. Twenty-two samples across the whole study were verified as positive for Theileria infection by PCR methods. In August, Theileria infection was markedly increased in grazing cattle (16/25 animals, 64%) compared with indoor cattle (4/25 animals, 16%); affected animals exhibited no clinical signs of infection. The red blood cell, hematocrit, and hemoglobin values were significantly lower in Theileriapositive cattle than in Theileria-negative cattle. Phylogenetic analysis demonstrated that the isolates from this study belonged to the T. buffeli species, and were significantly related to Types A, B, C, and E, and were distinct from T. buffeli Type D, which is known to be more pathogenic. These findings indicate that T. buffeli identified in Korean indigenous cattle have a low-to-mild pathogenicity. These results suggest that the T. buffeli infection is relatively higher in the ROK, and the infection rate may increase following grazing. Taken together, T. buffeli infection may not only be seasonally correlated, but also may be affected by management practices such as pastureland grazing.

Factors associated with the growth of ground-glass opacity nodules on chest computed tomography

e20051

Background: Chest computed tomography (CT) has become increasingly popular for screening and various reasons, and many cases of ground-glass opacity pulmonary nodules (GGN) that cannot be detected by simple chest radiography have been found incidentally. However, the natural history of GGN is not well understood and guidelines for the evaluation and follow-up of GGN have not yet been established yet. The purpose of this study was to investigate the clinical and CT scan characteristics associated with the growth of GGNs. Methods: We retrospectively reviewed GGN on chest CT performed between March 2011 and February 2014 at a tertiary referral hospital. Data were collected for the patient's age, sex, underlying lung disease, history of malignancy or comorbidities, size, border, number of GGN and presence of solid portion in GGN. For each GGN, an increase in size over time was investigated. We applied a Cox regression analysis to identify factors associated with the growth of GGN. Results: In a total of 504 patients, 916 GGN were found on chest CT. The mean age of the subjects was 59.6 years and 37% of men. The mean follow-up was 17.1 months. Cox regression analysis was performed on age, sex, history of malignancy, maximum diameter of GGN, number of GGN, margins of GGN, and presence of solid portion in GGN. History of malignancy (adjusted hazard ratio [HR] 1.770, 95% confidence intervals [CI] 1.049-2.986, p = 0.032), solitary nodule (adjusted HR 2.335, 95% CI 1.401-3.867, p = 0.001), and nodules with the longest diameter of 10 mm or more (adjusted HR 1.833, 95% CI 1.032-3.253, p = 0.039) were associated with the growth of GGN. Conclusions: A history of malignancy, solitary nodule, and nodules with the longest diameter of 10 mm or more may increase in size in the future. Therefore, the history of malignancy and the size and number of nodules should be considered to determine the duration of follow-up and appropriate biopsy timing.

Extraction-controlled terahertz frequency quantum cascade lasers with a diagonal LO-phonon extraction and injection stage

We report an extraction-controlled terahertz (THz)-frequency quantum cascade laser design in which a diagonal LO-phonon scattering process is used to achieve efficient current injection into the upper laser level of each period and simultaneously extract electrons from the adjacent period. The effects of the diagonality of the radiative transition are investigated, and a design with a scaled oscillator strength of 0.45 is shown experimentally to provide the highest temperature performance. A 3.3 THz device processed into a double-metal waveguide configuration operated up to 123 K in pulsed mode, with a threshold current density of 1.3 kA/cm² at 10 K. The QCL structures are modeled using an extended density matrix approach, and the large threshold current is attributed to parasitic current paths associated with the upper laser levels. The simplicity of this design makes it an ideal platform to investigate the scattering injection process.

[Association between genetic polymorphisms of HIF-2α gene and high altitude pulmonary hypertension in Han population]

Objective: To test the hypothesis that the single nucleotide polymorphisms (SNPs) in HIF-2α gene were associated with the susceptibility of high altitude pulmonary hypertension (HAPH) in Han population in China. Methods: Those Han population who emigrated to plateau (average altitude 3 300 m) and have been lived here for more than 20 years were included as the research subjects, the method of cluster random sampling was used to enroll 49 HAPH patients as the case group (HAPH group) and 39 free of HAPH people as the control group. The Sanger chain termination method was used to detect the SNPs of rs1562453, rs1867785, rs4953361, rs7598371 and rs11125068 in HIF-2α gene. Results: The genotype and frequencies of rs1562453 were CC (49.0%), CT (46.9%) and TT (4.1%) in the HAPH group, and the locus's genotype and frequencies were CC (76.9%), CT (17.9%) and TT (5.1%) in the control group. The alleles and frequencies of rs1562453 were C (72.4%) and T (27.6%) in the HAPH group, and the locus's alleles and frequencies were C (85.9%) and T (14.1%) in the control group. Their genotypes and alleles frequencies were of significant difference between the two groups (genotypes P=0.017; allele P=0.031). Meanwhile, The genotype and frequencies of rs1867785 were AA (46.9%), AG (46.9%) and GG (6.1%) in the HAPH group, and the locus's genotype and frequencies were AA (74.4%), AG (25.6%) and GG (0.0%) in the control group. The alleles and frequencies of rs1867785 were A (70.4%) and G (29.6%) in the HAPH group, and the locus's alleles and frequencies were A (87.2%) and G (12.8%) in the control group. Their genotypes and alleles frequencies were of significant difference between the two groups (genotypes P=0.020; allele P=0.008). Genotypes frequencies of the rs1562453 and rs1867785 were analyzed by Logistic Regression which showed that the genotypes frequencies of rs1562453 were also of significant difference between two groups (Wald=9.561, P=0.008), CT vs CC (β=1.720, OR=5.580, P=0.011). Conclusion: The SNPs of rs1562453 in HIF-2α gene may be associated with the development of HAPH among Chinese Han population, and individuals with the genotype CT may be more vulnerable to HAPH than those who carry genotype CC, and allele T may be a risk factor for HAPH.

Isolation and characterization of microsatellite markers for Osmanthus fragrans (Oleaceae) using 454 sequencing technology

Osmanthus fragrans (Oleaceae) is an evergreen shrub or small tree that grows in south China. In this study, Roche 454 FLX+ sequencing combined with the magnetic bead enrichment method was used to isolate microsatellite markers from the genome of O. fragrans. A total of 1471 microsatellites that contained enough flanking sequences for primer pair design were identified from 89,633 raw sequencing reads. One hundred primer pairs were randomly chosen to test primer amplification efficiency. Among these tested primer pairs, 20 yielded polymorphic amplification products across 16 individuals from the Albus, Luteus, and Aurantiacus groups. The number of alleles ranged from 2 to 6, with an average of 3.7. The observed heterozygosity ranged from 0 to 0.813, with an average of 0.460. Shannon's information index ranged from 0.463 to 1.707, with an average of 0.975. Six loci (Of 05, Of 06, Of 08, Of 12, Of 15, and Of 19) deviated significantly from Hardy-Weinberg equilibrium (P < 0.05), which was due to an excess of homozygotes or heterozygotes. Nine pairs of loci (Of 01 and Of 05; Of 04 and Of 05; Of 01 and Of 06; Of 04 and Of 12; Of 02 and Of 13; Of 04 and Of 13; Of 12 and Of 13; Of 04 and Of 19; Of 05 and Of 19) showed significant linkage disequilibrium, which indicated significant allelic association between the loci. This set of microsatellite markers will be valuable for molecular marker-assisted breeding in O. fragrans.

Detection and prevalence of pathogenic Yersinia enterocolitica in refrigerated and frozen dairy products by duplex PCR and dot hybridization targeting the virF and ail genes

Pathogenic Yersinia enterocolitica is involved in yersiniosis through expression of chromosome-borne or plasmid-borne virulence factors. Yersinia enterocolitica is a cold-tolerant pathogen frequently isolated from refrigerated or frozen foods. However, little attention has been focused on the prevalence of pathogenic Y. enterocolitica in refrigerated or frozen dairy samples in China. In this study, we developed a new duplex PCR targeting the plasmid-borne virF gene and chromosome-borne ail gene for detection of pathogenic Y. enterocolitica isolates. We established a detection limit for the duplex PCR of 6.5 × 10(2)cfu/mL in artificially contaminated dairy samples. In addition, the duplex PCR could detect directly 4.5 to 5.7 cfu of Y. enterocolitica in 5 mL of brain heart infusion broth after 6 h of enrichment at 28 °C. A newly developed dot hybridization assay further confirmed specificity of the duplex PCR for detection of virulent Y. enterocolitica. Furthermore, 13 Y. enterocolitica and 5 pathogenic strains, from 88 commercial frozen or refrigerated dairy products, were detected successfully by the China National Standard method (GB/T4789.8-2008) and the duplex PCR, respectively. Finally, biotypes and serotypes of pathogenic Y. enterocolitica strains were further characterized. The duplex PCR developed here is reliable for large-scale screening, routine monitoring, and risk assessment of pathogenic Y. enterocolitica in refrigerated or frozen dairy products.

High-pressure polymorphic transformation of rutile to alpha-PbO2-type TiO2 at {011}R twin boundaries

The presence of nano-scale lamellae of the alpha-PbO2-type polymorph of TiO2 sandwiched between twinned rutile inclusions in jadeite has been confirmed by electron diffraction and high-resolution transmission electron microscopy, backed up by image simulation techniques, from ultrahigh-pressure jadeite quartzite at Shuanghe in the Dabie Mountains, China. The crystal structure is orthorhombic with lattice parameters a=4.58 A, b=5.42 A, c=5.02 A and space group Pbcn. A three-dimensional structural model has been constructed for the rutile to alpha-PbO2-type TiO2 phase transformation based on high-resolution electron microscopic images. Computer image simulation and structural model analysis reveal that rutile {011}R twin interface is a basic structural unit of alpha-PbO2-type TiO2. Nucleation of alpha-PbO2-type TiO2 lamellae 1-2 nm thick is caused by the displacement of one half of the titanium cations within the {011}R twin slab. This displacement reduces the Ti-O-Ti distance and is favored by high pressure.

A comparison of perinatal mortality in Korea on holidays and working days

OBJECTIVE

To examine whether the perinatal mortality of infants born during holidays differs from that of infants born on workdays, and to elucidate its cause.

DESIGN

Cross-sectional study. Setting Vital statistics linked to the National Infant Mortality Survey data for 1999 births in Korea.

POPULATION

In all, 628 485 births in 1999 in Korea.

METHODS

Number of births and perinatal mortality were classified according to the day of the week using the occurrence index. After adjusting for confounding factors, the odds ratios (ORs) for increased holiday mortality were estimated using logistic regression.

MAIN OUTCOME MEASURE

Birthweight-adjusted perinatal mortality.

RESULTS

Births on holidays were 33% fewer and perinatal deaths 24% higher than expected (PMR, Perinatal Mortality Rate, 16.4 versus 12.8; OR, 1.3; 95% CI, 1.2-1.4). After the adjustment of birthweight, gender, plurality and congenital anomalies, the odds ratio for death of infants born during holidays was 1.2 (95% CI, 1.1-1.3).

CONCLUSIONS

The higher perinatal mortality during holidays in Korea appears to be due to different qualities of perinatal care, rather than difference in case-mix.

Domain structures in rutile in ultrahigh-pressure metamorphic rocks from Dabie Mountains, China

According to the HRTEM study, the UHP jadeite-quartzite mineral (Rutile, TiO(2)) in Anhui Province, Dabie Mountains, China, has ultrastructures such as 011 two-dimensional commensurable modulated structures or superstructures, [011] twin domain structures, dislocations and crystal deformations. The SAED patterns and HRTEM images indicate the existence of the deformations and stacking faults on the interface of [011] twin crystal of rutile and its two-dimensional commensurate modulated structures with repetition period 0.753 nm (3d(011)) has tetragonal symmetry, cell parameters a = 3a0 = 1.377 nm (a0 = 0.459 nm), c = c0 = 0.3 nm. The modulated structures of rutile were probably caused by the isomorphic replacement of Ti(4+) and position modulation or occupation modulation of oxygen atoms in different degree; the deformation structures reveal that during the process of crystallization and mineralization, this mineral may be affected by the geological environment (such as temperature, pressure and stress), metamorphism and deformation.

Antioxidant enzymes suppress nitric oxide production through the inhibition of NF-kappa B activation: role of H(2)O(2) and nitric oxide in inducible nitric oxide synthase expression in macrophages

Reactive molecules O(-)(2), H(2)O(2), and nitrogen monoxide (NO) are produced from macrophages following exposure to lipopolysaccharide (LPS) and involved in cellular signaling for gene expression. Experiments were carried out to determine whether these molecules regulate inducible nitric oxide synthase (iNOS) gene expression in RAW264.7 macrophages exposed to LPS. NO production was inhibited by the antioxidative enzymes catalase, horseradish peroxidase, and myeloperoxidase but not by superoxide dismutase (SOD). In contrast, the NO-producing activity of LPS-stimulated RAW264.7 cells was enhanced by the NO scavengers hemoglobin (Hb) and myoglobin. The antioxidant enzymes decreased levels of iNOS mRNA and protein in LPS-stimulated RAW264.7 cells, whereas the NOS inhibitor N(G)-monomethyl-L-arginine as well as Hb increased the level of iNOS protein but not mRNA, indicating that NO inhibits iNOS protein expression. NF-kappa B was activated in LPS-stimulated RAW264.7 cells and the activation was significantly inhibited by antioxidant enzymes, but not by Hb. Similar results were obtained using LPS-stimulated rodent peritoneal macrophages. Extracellular O(-)(2) generation by LPS-stimulated macrophages was suppressed by SOD, but not by antioxidative enzymes, while accumulation of intracellular reactive oxygen species was inhibited by antioxidative enzymes, but not by SOD. Exogenous H(2)O(2) induced NF-kappa B activation in macrophages, which was inhibited by catalase and pyrroline dithiocarbamate (PDTC). H(2)O(2) enhanced iNOS expression and NO production in peritoneal macrophages when added with interferon-gamma, and the effect of H(2)O(2) was inhibited by catalase and PDTC. These findings suggest that H(2)O(2) production from LPS-stimulated macrophages participates in the upregulation of iNOS expression via NF-kappa B activation and that NO is a negative feedback inhibitor of iNOS protein expression.

[The protective effects of tea catechins on the injury of cerebral ischemia and reperfusion in rats]

OBJECT

The protective effects of tea catechins on the injury of cerebral ischemia and reperfusion in rats were observed with rat cerebral ischemia and reperfusion model produced by bilaterally clamping the common carotid arteries and vagus nerves for 60 min and then removing the occlusion for 30 min.

METHOD

Wistar rats were divided into normal control group, model group and catechin group (30 mg.kg-1 and 50 mg.kg-1 i.p., qd x 7 d). The changes of biochemical indications and pathology were observed.

RESULT

The results presented that the concentration of MDA in brain tissue and serum of model rats were higher than that of control rats(P < 0.01). Compared with model group, tea catechin groups could decrease the concentration of MDA in brain tissue and serum, and tea catechin group (50 mg.kg-1 i.p., qd x 7 d) could improve the injury of blood brain barrier.

CONCLUSION

Tea catechins have protective effects on the injury of cerebral ischemia and reperfusion in rats.

Magnesium sulfate does not reduce postoperative analgesic requirements

BACKGROUND

Because magnesium blocks the N-methyl-D-aspartate receptor and its associated ion channels, it can prevent central sensitization caused by peripheral nociceptive stimulation. However, transport of magnesium from blood to cerebrospinal fluid (CSF) across the blood-brain barrier is limited in normal humans. The current study was designed to evaluate whether perioperative intravenous magnesium sulfate infusion affects postoperative pain.

METHODS

Sixty patients undergoing abdominal hysterectomy received 50 mg/kg intravenous magnesium sulfate as a bolus dose followed by a continuous infusion of 15 mg x kg(-1) x h(-1) for 6 h (magnesium group) or the same volume of isotonic saline (control group). At the end of surgery, serum and CSF magnesium concentration were measured in both groups. The cumulative postoperative analgesic consumption was measured to assess the analgesic effect using a patient-controlled epidural analgesia device. Pain intensities at rest and during forced expiration were evaluated at 6, 24, 48, and 72 h postoperatively.

RESULTS

At the end of surgery, patients in the magnesium group had significantly greater postoperative serum magnesium concentrations compared with both preoperative and control group values (P < 0.001). Despite significantly higher serum magnesium concentrations in the magnesium group, there was no significant difference in magnesium concentration measured in postoperative CSF. Cumulative postoperative analgesic doses were similar in both groups. However, there was observed an inverse relation between cumulative postoperative analgesic consumption and the CSF magnesium concentration in both groups. Visual analog pain scores at rest and during forced expiration were similar and less than 4 in both groups.

CONCLUSIONS

Perioperative intravenous administration of magnesium sulfate did not increase CSF magnesium concentration and had no effects on postoperative pain. However, an inverse relation between cumulative postoperative analgesic consumption and the CSF magnesium concentration was observed. These results suggest that perioperative intravenous magnesium infusion may not be useful for preventing postoperative pain.

Identification and characterization of Psx-2, a novel member of the Psx (placenta-specific homeobox) family

Psx (now designated as Psx-1) is a murine placenta-specific homeobox gene. Here, we report the isolation and characterization of a second mouse Psx gene (Psx-2). Although 29bp were absent towards the 3' end of Psx-2, Psx-2 and Psx-1 cDNA had identical 5' and 3' ends. Overall sequence identity between the two cDNAs was 91% at the nucleotide level and 81% at the amino acid level. Both Psx proteins contain 227 amino acids. These results suggest that they arose through a recent gene duplication. A surprising finding is that the 81% sequence identity between Psx-1 and Psx-2 proteins drops at the level of homeodomain to 78%. Further, the amino acid at position 51, which is invariably an asparagine in other homeodomains and is known to contact DNA directly, is a methionine in the homeodomains of both Psx-1 and Psx-2. This suggests that Psx proteins may interact with DNA sequences differently to those bound by other homeodomains. Southern blot analysis indicated that the two Psx genes occur on separate loci in the mouse genome. The Psx-2 gene spans approx. 2. 6kb of mouse genome, and contains four exons and three introns.

Difference in the distribution pattern of Helicobacter pylori and grade of gastritis in the antrum and in the body between duodenal ulcer and benign gastric ulcer patients

OBJECTIVES

To investigate the relationship between the Helicobacter pylori (H. pylori) colonization and the grade of gastritis in the antrum and in the body of patients with duodenal ulcer (DU) or benign gastric ulcer (BGU).

METHODS

This study was performed in H. pylori-positive 220 DU patients and 180 BGU patients. H. pylori density was evaluated by modified Giemsa staining and CLO test, and gastritis grade was graded by H&E staining in the antrum and in the body.

RESULTS

H. pylori grade by Giemsa staining was 1.24 in the antrum and 0.82 in the body for DU group (p < 0.01), and those of BGU group were slightly reversed, 0.83 and 0.87, respectively, but without statistical significance. Similarly H. pylori grade by CLO test was 3.1 in the antrum and 2.8 in the body for DU group (p < 0.01), and those of BGU group 2.3 and 2.6 (p < 0.05), respectively. In contrast, gastritis grade was 1.7 in the antrum and 1.2 in the body for DU group (p < 0.01), and those of BGU group 1.6 and 1.3 (p < 0.01), respectively, similar to those of DU. However, there was a correlation between H. pylori grade and gastritis grade in the antrum and in the body, not only in DU but also in BGU group (p < 0.01).

CONCLUSION

In spite of different distribution patterns of H. pylori between DU group and BGU group, gastritis grade of the antrum was significantly higher than that of the body in both DU and BGU. However, gastritis is correlated with H. pylori density not only in DU but also in BGU patients. It looks like the inflammatory reaction to H. pylori is stronger in the antrum than in the body.

Psx homeobox gene is X-linked and specifically expressed in trophoblast cells of mouse placenta

We previously isolated a cDNA clone for a homeobox-containing gene with its expression restricted to the extraembryonic tissues. In this study, Psx gene expression was further examined using in situ hybridization to determine the cellular distribution of Psx transcripts during embryo development. Psx expression was first detected at embryonic day 8.5 only in trophoblast giant cells and chorionic ectoderm. At E 9.5 and E 13.5, the expression was restricted to the giant cells and the labyrinthine trophoblast layer. In addition, the gene expression was detected in differentiated Rcho-1 trophoblast cells in vitro, which is typical of trophoblast giant cells in vivo, but not in proliferating Rcho-1 cells and HRP-1 cells. Interestingly, rat Psx homologue mRNA is about 200 bp shorter than mouse Psx, suggesting that there is a high degree of sequence divergence between the mouse and rat Psx homologues. The sequence divergence, perhaps as a result of rapid evolution, is further supported by the zoo blot analysis because the Psx gene was detectable only in mouse and rat but not in other vertebrate species tested. Psx is localized to the murine X chromosome. Taken together, our results suggest that Psx gene plays a unique role in the function of differentiated trophoblast cells and also serves as a useful model for studying trophoblast cell lineages and the rapid evolution of homeobox genes.

pp60v-src reactivation inhibits serum-induced accumulation of inositol phosphates and phosphatidylethanol in tsNRK

In tsRSV-infected NRK (tsNRK) cells, pp60(v-src) reactivation by temperature-shift from a nonpermissive temperature, 39 C, to a permissive one, 32 degrees C, induced the production of inositol phosphates (IPt) and phosphatidylethanol (PEt). This was accompanied by an increase in membrane-associated protein kinase C (PKC) activity in the absence of exogenous growth factors. However, with serum-stimulation, the amounts of IPt and PEt at 32 degrees C were less than those at 39 degrees C. Pretreatment with PKC inhibitors, Ro-31-8220 and staurosporine, enhanced the accumulation of IPt but not of PEt at 32 degrees C. The tyrosine phosphorylation of phospholipase Cgamma1 (PLCgamma1) was increased either by serum or by pp60(v-src) reactivation. These results suggest that serum transduces its signal through PLCgamma1 mediation, and that pp60(v-src), possibly through the PKC mediation, negatively affects serum-induced PLCgamma1 activation.

Epidural verapamil reduces analgesic consumption after lower abdominal surgery

In this double-blind study, we administered lumbar epidural bupivacaine or bupivacaine plus verapamil to investigate the possible role of the calcium channel blocker, verapamil, in postoperative pain. One hundred patients (ASA physical class I or II) scheduled for lower abdominal surgery were randomly assigned to one of four groups. Group 1 received 10 mL of 0.5% epidural bupivacaine injected 15 min before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 2 received 10 mL of epidural normal saline injected before incision, followed by 10 mL of 0.5% epidural bupivacaine 30 min after incision. Group 3 received 10 mL of 0.5% epidural bupivacaine plus 5 mg of verapamil injected before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 4 received the same drugs as Group 3, in the reverse order. Pain and mood numeric rating scores, sedation scores, Prince Henry scores, patient-controlled cumulative postoperative analgesic consumption, and the incidence of side effects were assessed 2, 6, 12, 24, and 48 h after the operation in each group. Cumulative postoperative analgesic consumption in Groups 3 and 4 was significantly lower (P < 0.05) than that in Groups 1 and 2 24 and 48 h after surgery. There were no differences in the pain, mood, and sedation scores and the incidence of side effects among the four groups. We conclude that epidural verapamil decreases postoperative pain, possibly by interfering with normal sensory processing and by preventing the establishment of central sensitization.

IMPLICATIONS

Calcium plays an important role in pain physiology at the spinal cord level. We examined the effect of bupivacaine plus verapamil (calcium channel blocker) and of bupivacaine alone. We demonstrated that the combination, administered epidurally, resulted in less postoperative analgesic consumption than bupivacaine alone.

Small-dose fentanyl: optimal time of injection for blunting the circulatory responses to tracheal intubation

This study was designed to examine the optimal time of injection of a small dose of fentanyl during anesthetic induction to attenuate circulatory responses to laryngoscopy and tracheal intubation. One hundred seventy patients were randomly assigned to one of five groups. In Groups II, III, IV, and V, patients received fentanyl (2 microg/kg) 1, 3, 5, or 10 min before tracheal intubation, respectively. Group I patients did not receive fentanyl and served as the control group. In Groups III and IV, blood pressures were not increased, except diastolic pressure in Group III, significantly postintubation compared with preinduction values; but Groups I, II, and V showed a significant increase (P < 0.05). The 1-min postintubation values of systolic, diastolic, and mean arterial pressure in Groups III and IV were less than those in the control group (P < 0.05). Increases of heart rate in Group IV were less (P < 0.05) than those in the control group, but significant differences were not observed in Groups II, III, and V. The number of patients with tachycardia and dysrhythmia was significantly smaller in Group IV than in the control group (P < 0.05). We conclude that the most effective time to administer fentanyl to protect circulatory responses to laryngoscopy and tracheal intubation is 5 min before tracheal intubation.

IMPLICATIONS

Fentanyl is often used to reduce the hemodynamic response to tracheal intubation. However, large doses may cause unwanted side effects. Administration of fentanyl at the optimal time reduces the dose required. Our results indicate that optimal injection time of fentanyl for intubation is 5 min before intubation.

Psx, a novel murine homeobox gene expressed in placenta

To identify homeobox genes involved in mouse embryo development, we have screened a mouse cDNA library prepared from the 13.5-day-old entire conceptus for homeobox-containing sequences using a polymerase chain reaction (PCR) cloning strategy. We identified a mouse homeobox gene that might be the prototype of a new class. The full-length cDNA, designated Psx (placenta specific-homeobox), encodes a protein of 247 amino acids. The expression patterns of the Psx during embryonic development and in adult tissues were studied by Northern blot analysis. The Psx transcript was first detected at embryonic day 8.5 of conceptus and persisted until birth. Psx mRNA is expressed in extraembryonic tissues, mainly in placenta, but not in fetus, pups and adult tissues tested, suggesting that Psx plays an important role in placenta. Psx is a new member of the murine homeobox genes which are expressed in extraembryonic tissues such as placenta and amnion.

Blockade of myocardial ATP-sensitive potassium channels by ketamine

BACKGROUND

The adenosine triphosphate (ATP)-sensitive potassium (KATP) channel underlies the increase in potassium permeability during hypoxia and ischemia. The increased outward potassium current during ischemia may be an endogenous cardioprotective mechanism. This study was designed to determine the effects of ketamine on KATP channel in rat hearts.

METHODS

Inside-out and cell-attached configurations of patch-clamp techniques and 3 M potassium chloride-filled conventional microelectrodes were used to investigate the effect of ketamine on KATP channel currents in single rat ventricular myocytes and on the action potential duration of rat papillary muscles, respectively.

RESULTS

Ketamine inhibited KATP channel activity in rat ventricular myocytes in a concentration-dependent manner. In the inside-out patches, the concentration of ketamine for half-maximal inhibition and the Hill coefficient were 62.9 microM and 0.54, respectively. In a concentration-dependent manner, ketamine inhibited pinacidil- and 2,4-dinitrophenol-activated KATP channels in cell-attached patches. The application of ketamine to the intracellular side of membrane patches did not affect the conduction of single-channel currents of KATP channels. Ketamine increased the action potential duration, which was then shortened by pinacidil in a concentration-dependent manner.

CONCLUSIONS

Ketamine inhibited KATP channel activity in a concentration-dependent manner. These results suggest that ketamine may attenuate the cardioprotective effects of the KATP channel during ischemia and reperfusion in the rat myocardium.

Epidural morphine plus ketamine for upper abdominal surgery: improved analgesia from preincisional versus postincisional administration

Increased postoperative pain may be caused by central nervous system plasticity, which may be related to actions of N-methyl-D-aspartic acid (NMDA) receptors on neurons in the dorsal horn of the spinal cord. Opioids act mainly on presynaptic receptors and reduce neurotransmitter release, while ketamine antagonizes NMDA receptors and prevents wind-up and long-term potentiation. Thus, we postulated that central nervous system sensitization would be prevented more effectively by the preoperative use of these two drugs simultaneously, and the effect of preemptive analgesia would be demonstrated. Ketamine, 60 mg, and morphine, 2 mg, were injected epidurally through an indwelling catheter that was inserted at the T7-8 interspace in 60 ASA physical status class 1-2 patients. The drugs were injected before induction of anesthesia (Group 1; n = 30) or immediately after removal of a surgical specimen (Group 2; n = 30). An additional 2 mg of morphine was injected when the patients complained of resting pain. The analgesic effect was assessed by the time from first analgesic injection to second dose and the number of patients who needed supplemental injections. Complications were also noted. The duration of analgesia was longer (P < 0.01) in Group 1 (31.1 +/- 16.0 h) than in Group 2 (21.1 +/- 12.0 h), and the proportion of patients who needed supplemental injections was decreased (P < 0.05) in Group 1 (56.7%) compared with Group 2 (90.0%). The incidence of adverse effects was not different between the two groups. In conclusion, preoperative administration of morphine and ketamine is more effective in reducing postoperative pain than it is when given during the operation.

Coloanal anastomosis in radical surgery for low rectal carcinoma by intra-anal circular ligation

Using self-made special supporting tube, coloanal anastomosis was performed by intra-anal ligation for radical surgery in 48 patients with low rectal carcinoma. The anastomoses were completed without suturing, and the results were quite satisfactory. Follow-up after operation revealed that the bowel movement and the sphincteric function were excellent in all patients. The anal canal and the anal sphincter were all kept intact and abdominal colostomy was not required for decompression. Anastomosis without suturing, least trauma, and short operation time made blood transfusion unnecessary during the operation. This technique is actually derived from Park's operation, and is considered a promising procedure for coloanal anastomosis in the radical surgery for low rectal carcinoma.

Histopathology and immunohistopathology of lymph nodes of the first autopsy with HIV positivity in China

Nineteen lymph nodes of a HIV-positive boy were studied histologically and immunohistologically. According to Stutte's classification of HIV-related lymphadenopathy, 84% of the lymph nodes were at the third or fourth stages in relation to clinical status ARC/AIDS. Lymph follicle atrophy, angiogenesis, histiocytic proliferation and destruction of the normal reticulum frame were observed. Immunohistochemical studies showed most of the remaining lymphocytes to be T cells and changes in the distribution of S-100 positive cells. Ki 1 positive cells existed mainly at the second stage. The significance of these changes is discussed.

The use of native thick filaments in in vitro motility assays

Native thick filaments from the clam, Mercinaria mercinaria translocate actin filaments both toward and away from the center of the thick filament in an in vitro motility assay. The thick filaments from the adductor muscle are about 10 microns long whereas those from the catch muscle are 30-50 microns long. These thick filaments should prove useful in understanding the mechanism of myosin-dependent movement of actin filaments.

Split gluteus maximus muscle flap in the reconstruction of the external anal sphincter and levator ani

We treated 52 patients with anal and low rectal carcinomas by orthotopic reconstruction of the anus, using an unilateral split gluteus maximum (GM) muscle flap to form the external anal sphincter and levator ani together with invagination of the colon to form the internal sphincter after radical resection of carcinoma. Among the 36 patients who were followed up for over 6 months, 34 (94.4%) exhibited good to excellent continence.

[X-ray diagnosis of primary tumors of the small bowel (report of 24 cases)]

Primary tumors of the small bowel are relatively rare. The 24 cases reported in this paper have been confirmed by operation and pathology. Based on clinical and radiologic findings and review of literature, the main X-ray manifestations of primary tumors of the small bowel were as follows: (1) Stenosis; (2) Filling defect; (3) Stiffness of involved intestinal wall with destruction of mucosa and loss of valvulae conniventes; (4) Intestinal obstruction or intussusception; (5) Dynamic dilatation and reversed peristalsis of the bowel segment proximal to the tumor. The causes of misdiagnosis and failure of detection and the site of predilection of the tumor were discussed. The differential points between benign and malignant tumors, sarcoma and carcinoma, metastatic tumor and primary tumor, Crohn's disease and carcinoma were mentioned.

Clinical analysis of four Chinese hemophiliacs with human immunodeficiency virus infection

Human immunodeficiency virus (HIV) is now considered as the causative agent of acquired immunodeficiency syndrome (AIDS). A high risk of AIDS has been reported among patients with hemophilia who received lyophilized commercial factor VIII and IX concentrates of American origin. At a prevalent survey from September to December 1985, HIV antibodies were found in all four patients with hemophilia treated with the batch number W87307, 955 I.U. of American commercial factor VIII concentrate supplied by Armour Pharmaceutical Company, USA. One of the sero-positive patients developed AIDS-related complex (ARC) and died of cerebral hemorrhage. The other three sero-positive patients had abnormalities in cell-mediated immunity. Of them two developed left lumbosacral radiculopathy and hemorrhagic herpes zoster and one remained well so far.