Observation of D^{+}→K_{S}^{0}a_{0}(980)^{+} in the Amplitude Analysis of D^{+}→K_{S}^{0}π^{+}η

We perform for the first time an amplitude analysis of the decay D^{+}→K_{S}^{0}π^{+}η and report the observation of the decay D^{+}→K_{S}^{0}a_{0}(980)^{+} using 2.93  fb^{-1} of e^{+}e^{-} collision data taken at a center-of-mass energy of 3.773 GeV with the BESIII detector. As the only W-annihilation-free decay among D to a_{0}(980) pseudoscalar, D^{+}→K_{S}^{0}a_{0}(980)^{+} is the ideal decay in extracting the contributions of the W-emission amplitudes involving a_{0}(980) and to study the final-state interactions. The absolute branching fraction of D^{+}→K_{S}^{0}π^{+}η is measured to be (1.27±0.04_{stat}±0.03_{syst})%. The branching fractions of intermediate processes D^{+}→K_{S}^{0}a_{0}(980)^{+} with a_{0}(980)^{+}→π^{+}η and D^{+}→π^{+}K[over ¯]_{0}^{*}(1430)^{0} with K[over ¯]_{0}^{*}(1430)^{0}→K_{S}^{0}η are measured to be (1.33±0.05_{stat}±0.04_{syst})% and (0.14±0.03_{stat}±0.01_{syst})%, respectively.

Incidence of hepatocellular carcinoma in nonalcoholic fatty liver disease without cirrhosis or advanced liver fibrosis

BACKGROUND

HCC can develop in the absence of cirrhosis in patients with NAFLD. We aimed to estimate the incidence of HCC in patients with NAFLD with and without cirrhosis or advanced liver fibrosis.

METHODS

We performed a cohort study to determine the incidence of HCC in patients with NAFLD identified by the International Classification of Diseases 9/10 codes in the electronic health records of a US health care system between 2004 and 2018. The incidence of HCC was stratified by the presence or absence of cirrhosis and by the Fibrosis-4 index (FIB-4) at the time of HCC diagnosis.

RESULTS

Of 47,165 patients with NAFLD aged 40-89 years, 981 (2.1%) developed HCC (mean follow-up 3.4 y). Among patients with HCC, 842 (85.8%) had cirrhosis, while 139 (14.2%) did not. Of the 139 patients with HCC without cirrhosis-related diagnostic codes, 26 (2.7%) had FIB-4 >2.67 (advanced fibrosis likely), whereas 43 (4.4%) had FIB-4 < 1.30 (excluding advanced fibrosis). The annual incidence of HCC in patients with NAFLD with and without cirrhosis was 23.6 and 1.1 per 1000 person-years, respectively. Among patients without cirrhosis, the annual incidence of HCC was 2.8 per 1000 person-years with FIB-4 >2.67 and 0.7 per 1000 person-years with FIB-4 <1.30. Patients with NAFLD and cirrhosis were 31.8 times (95% CI, 23.3-43.4) more likely to develop HCC than those without cirrhosis and FIB-4 <1.30, after adjustment for age and sex.

CONCLUSIONS

Patients with NAFLD without cirrhosis nor advanced fibrosis have a low incidence of HCC.

Low-Carbohydrate Diet Score and the Risk of Colorectal Cancer: Findings from the Singapore Chinese Health Study

BACKGROUND

Colorectal cancer is common cancer with a high mortality rate. Low-carbohydrate diet (LCD) score holistically evaluates the LCD pattern from carbohydrate, protein, and fat intake. Epidemiologic data of LCD-colorectal cancer association are sparse.

METHODS

We evaluated the associations between LCD (i.e., total, animal- and plant-based) and colorectal cancer risk in the Singapore Chinese Health Study, a population-based prospective cohort study including 61,321 Chinese in Singapore who were 45 to 74 years old at baseline. Cox proportional hazard regression model was used to determine the HRs and respective 95% confidence intervals (CI) for colorectal cancer associated with LCD after adjusting for potential confounders, including age, sex, BMI, physical activity, family history of colorectal cancer, etc.

RESULTS

After an average of 19.5 years of follow-up, 2,520 participants developed colorectal cancer (1,608 colon cancer and 912 rectal cancer). Overall, the association between total or plant-based LCD scores with the risk of colorectal, colon, or rectal cancer was null (all Ptrend ≥ 0.28). The animal-based LCD was modestly associated with colon cancer risk (Ptrend = 0.02), but not with rectal cancer. Compared with the lowest quartile, HRs (95% CIs) of colon cancer for quartiles 2, 3, and 4 of animal-based LCD were 1.12 (0.98-1.29), 1.27 (1.10-1.46), and 1.14 (0.99-1.31), respectively.

CONCLUSIONS

A low-level carbohydrate diet with a high level of animal protein and fat was associated with a moderate increase in the risk of colon cancer among Chinese Singaporeans.

IMPACT

High consumption of animal protein/fat and low consumption of carbohydrates may increase colon cancer risk.

Observation of a Strongly Isospin-Mixed Doublet in ^{26}Si via β-Delayed Two-Proton Decay of ^{26}P

β decay of proton-rich nuclei plays an important role in exploring isospin mixing. The β decay of ^{26}P at the proton drip line is studied using double-sided silicon strip detectors operating in conjunction with high-purity germanium detectors. The T=2 isobaric analog state (IAS) at 13 055 keV and two new high-lying states at 13 380 and 11 912 keV in ^{26}Si are unambiguously identified through β-delayed two-proton emission (β2p). Angular correlations of two protons emitted from ^{26}Si excited states populated by ^{26}P β decay are measured, which suggests that the two protons are emitted mainly sequentially. We report the first observation of a strongly isospin-mixed doublet that deexcites mainly via two-proton decay. The isospin mixing matrix element between the ^{26}Si IAS and the nearby 13 380-keV state is determined to be 130(21) keV, and this result represents the strongest mixing, highest excitation energy, and largest level spacing of a doublet ever observed in β-decay experiments.

[Some HBeAg-negative chronic hepatitis B patients treated with nucleos(t)ide analogue can achieve HBsAg loss after drug withdrawal: stop-to-cure may be coming]

Nucleoside/Nucleotide analogues (NAs) are widely used for the antiviral treatment of chronic hepatitis B (CHB), however, it is difficult to achieve serum hepatitis B surface antigen (HBsAg) loss with NAs therapy. In recent years, several prospective trails have reported that HBsAg loss (functional cure or clinical cure) also occurs in a small number of hepatitis B e antigen (HBeAg) negative CHB patients who discontinued long-term treatment with NAs. Accordingly, the "stop-to-cure" strategy is proposed. Although the mechanism has not been fully elucidated, the known factors related to serum HBsAg loss with NAs withdrawal include HBV genotype, duration of NAs treatment, serum HBsAg and HBV RNA levels at end-of-treatment, and ethnic differences. In the review, we discuss the best time to stop NAs therapy, the potential markers for predicting relapse after cessation of NAs and the possible mechanism of "stop-to-cure" in HBeAg-negative CHB patients, and propose some suggestions on the time of retreatment.

Dietary Nonstarch Polysaccharide Intake and Risk of Colorectal Cancer: Findings from the Singapore Chinese Health Study

Dietary fiber or non-starch polysaccharides (NSP) may provide protection from CRC development. Epidemiologic studies on the association between dietary fiber and CRC is inconsistent are limited on NSP as a modifiable risk factor. Using the Singapore Chinese Health Study, a population-based prospective cohort of 61,321 cancer-free middle-aged or older Chinese Singaporeans, we examined the association between dietary fiber and NSP intakes and CRC risk. Fiber and NSP intakes at baseline were obtained using a validated semi-quantitative food frequency questionnaire coupled with the Singapore Food Composition Database. Cox proportional hazard regression model was used to estimate the hazard ratios (HRs) and respective 95% confidence intervals (CIs) for CRC associated with dietary fiber and NSP intakes after adjusting for potential confounders. After an average of 17.5 years of follow-up, 2,140 participants developed CRC. NSP was inversely associated with the risk of CRC in a dose-dependent manner whereas dietary fiber was not associated with risk of CRC overall or histologic subtypes. The multivariable-adjusted HRs (95% CIs) of CRC for quartiles 2, 3 and 4 of dietary NSP intake were 0.99 (0.88-1.11), 0.98 (0.87-1.11) and 0.84 (0.73-0.95), respectively, compared with the lowest quartile (P _trend =0.006). This inverse association was more apparent for colon cancer (HR_{Q4 vs. Q1}=0.79, 95% CI: 0.67-0.93, P _trend =0.003) than rectal cancer (HR _{Q4 vs. Q1}=0.92, 95% CI: 0.74-1.13, P _trend =0.53). Our findings suggested that dietary NSP but not fiber is associated with a reduced risk of colon cancer in Chinese Singaporeans.

Significance

Non-starch polysaccharides may be beneficial for colorectal cancer primary prevention.

Abstract 3667: Composite dietary antioxidant index and the risk of pancreatic cancer: Findings from a prospective cohort study

Background. Composite Dietary Antioxidant Index (CDAI) is a summary score derived from statistical modeling that ranks an individual’s dietary intake of antioxidants in relation to the overall mean of the study population. Antioxidants may offer a beneficial effect on reducing the risk of pancreatic cancer. No prospective epidemiological study has investigated the association between food-based CDAI (fCDAI) and pancreatic cancer risk.

Methods. The fCDAI score was calculated based on dietary intakes of vitamins A, C, and E, manganese, selenium, and zinc from food but not from dietary supplements, for each participant of the Singapore Chinese Health Study, a population-based prospective epidemiological cohort study consisting of 61,321 Chinese men and women in Singapore aged 45-74 years at baseline enrollment during 1993-1998. Intake of antioxidants was derived from self-reported consumption of food items using a validated semi-quantitative food frequency questionnaire and the Singapore Food Composition Table. Incident cases of cancer, including pancreatic cancer, and death were identified through the linkage analysis with the nationwide Singapore Cancer Registry and the Singapore Registry of Birth and Death, respectively. The Cox proportional hazard regression method was used to estimate hazard ratio (HR) and its 95% confidence interval (CI) of pancreatic cancer associated with higher quartiles of fCDAI relative to the lowest quartile with adjustment for multiple potential confounders, including age, sex, dialect group, level of education, smoking status, alcohol consumption, a history of diabetes, sleep duration, physical activity, year of enrollment, and total energy intake.

Results. Overall, 311 participants who were free of cancer at baseline developed pancreatic cancer during an average of 17.7 years of follow-up after baseline assessment of food consumption. Compared with the lowest quartile, the multivariable-adjusted HR of pancreatic cancer for the highest quartile of fCDAI was 0.54 (95% CI: 0.31-.91, P=0.02). This inverse association between the fCDAI and pancreatic cancer risk was more apparent in overweight/obese subjects (HRQ4vsQ1=0.28, 95% CI: 0.13-0.60, Ptrend=0.02), or those without a history of diabetes (HRQ4vsQ1=0.50, 95% CI: 0.29-0.88, Ptrend=0.04). No association was observed between CDAI derived from dietary supplements and the risk of pancreatic cancer.

Conclusions. The inverse association between fCDAI and pancreatic cancer risk supports the notion that overall dietary antioxidants may provide a beneficial effect against the development of pancreatic cancer, specifically overweight/obese individuals and those free of diabetes who may have a long-term persistent dietary pattern. These results highlight the importance of promoting healthy eating for the primary prevention of pancreatic cancer.

Citation Format: Pedram Paragomi, Renwei Wang, Aizhen Jin, Yi-Chuan Yu, Randall E. Brand, Li-Ting Sheng, An Pan, Woon-Puay Koh, Jian-Min Yuan, Hung Luu. Composite dietary antioxidant index and the risk of pancreatic cancer: Findings from a prospective cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3667.

Abstract 3666: Dietary potassium and risk of colorectal cancer: Findings from the Singapore Chinese Cohort Study

Background: Colorectal cancer (CRC) is a commonly diagnosed subtype of cancer with a high mortality rate. Potassium is a necessary trace element in the human boy and is derived mainly from diet. Prior studies found high intakes of potassium was inversely associated with colorectal cancer occurrence in Western population. No such effort has been made in Asian population. Methods: We examined the associations for dietary potassium with the risk of CRC in the Singapore Chinese Health Study (SCHS), a population-based prospective cohort study that includes 61,321 Chinese men and women in Singapore who were 45-74 years of age at baseline. Daily intake of potassium was derived from the self-reported intake of pre-defined food items using a validated semi-quantitative food frequency questionnaire (FFQ) at baseline according to the Singapore Food Composition Table. Cox proportional hazard regression model was used to estimate the hazard ratios (HRs) and respective 95% confidence intervals (CIs) for CRC associated with higher quartile of potassium compared with the lowest quartile with adjustment for potential confounders. Results: After an average of 17.5 years of follow-up, 2,140 participants developed CRC. Dietary potassium was inversely associated with CRC risk. The multivariable-adjusted HR of CRC for the highest relative to the lowest quarter of daily potassium intake was 0.85 (95% CI 0.75-0.96, Ptrend=0.03). The inverse association between high intake of potassium and CRC risk was more apparent among participants with body mass index (BMI) ≥ 23 kg/m2 (HRQ4vsQ1=0.75, 95% CI: 0.63-0.89; Ptrend=0.003) and those with history of type 2 diabetes (HRQ4vsQ1=0.65, 95% CI: 0.42-1.00; Ptrend=0.36).

Conclusions: In a large population-based prospective cohort study of more than 61,000 Chinese Singaporeans, we found inverse associations between dietary potassium intake and CRC risk. Future studies are warranted to elucidate the biological mechanism for the protective effect of potassium on the development of CRC.

Citation Format: Hung N. Luu, Pedram Paragomi, Yi-Chuan Yu, Aizhen Jin, Renwei Wang, Robert E. Schoen, Woon-Puay Koh, Jian-Min Yuan. Dietary potassium and risk of colorectal cancer: Findings from the Singapore Chinese Cohort Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3666.

Abstract 735: Low-carbohydrate diet score and the risk of colorectal cancer: Findings from a prospective cohort study

Background. Colorectal cancer (CRC) is a commonly diagnosed cancer. Glucose intake enhances the secretion of insulin, may contribute to cell growth and proliferation, leading to CRC development. Epidemiologic studies have shown that individuals with diabetes history are at increased risk of CRC. A low-carbohydrate diet, represented by a low-carbohydrate diet (LCD) score, may reduce the risk of diabetes. Yet, little is known about the association between LCD scores and the risk of CRC.

Methods. We evaluated the associations between LCD and CRC risk in the Singapore Chinese Health Study, a population-based prospective cohort study that includes 61,321 Chinese men and women in Singapore who were 45-74 years old at enrollment. Food and dietary supplement consumption were assessed by a validated semi-quantitative food frequency questionnaire. Participants were assigned a score from 0 to 10 according to their rankings by daily intake of calories from carbohydrates, fat and protein, respectively. A score of 0 was assigned to a subject ranked in the highest one-eleventh of calorie intake from carbohydrates or in the lowest one-eleventh of calories from fat or protein, respectively. In contrast, a score of 10 was given to each subject in the lowest one-eleventh of carbohydrate intake or the highest one-eleventh of fat or protein intake. The LCD score for each subject was the sum of the 3 individual ranking scores. The highest possible value was 30, which represented the lowest carbohydrate intake and the highest fat and protein. In addition, animal-based and plant-based LCDs were similarly created from the daily consumption of calories from animal or plant protein and fat, respectively, as well as carbohydrates. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) for CRC according to higher quartiles of LCD scores with adjustment for potential confounders.

Results. After an average of 17.5 years of follow-up, 2,140 participants developed CRC. Overall, there was a null association between total LCD and CRC risk. A moderate positive association was found for animal-based LCD with CRC risk. The multivariable-adjusted HRs(95%CIs) for CRC in quartiles 2, 3, and 4 of animal-based LCD were 1.12(0.99-1.26), 1.18(1.04-1.33), and 1.11(0.98-1.25)(Ptrend=0.06) compared with the lowest quartile. There were no statistically significant differences in the animal-based LCD and CRC risk in subgroups stratified by sex, body mass index, smoking status, and history of type 2 diabetes.

Conclusions. This large population-based prospective cohort study shows that a high animal-based LCD score, which represented low intake of carbohydrates and high intake of animal protein and fat, was associated with ~10% increased risk of CRC. Our findings suggest that replacing low-carbohydrate food with animal-based food may increase the risk of developing CRC.

Citation Format: Yi-Chuan Yu, Pedram Paragomi, Aizhen Jin, Renwei Wang, Robert E. Schoen, Woon-Puay Koh, Jian-Min Yuan, Hung N. Luu. Low-carbohydrate diet score and the risk of colorectal cancer: Findings from a prospective cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 735.

[Quantitative analysis of patellar tendon elasticity of amateur marathon runners after a competition based on shear wave elastography]

Objective: To analyze the changes of patellar tendon elasticity quantitatively of amateur marathon runners by shear wave elastography (SWE) in a half marathon. Methods: A total of 47 amateur marathon runners (31 males and 16 females, aged from 20 to 44 years) were enrolled as the marathon group, and divided into dominant side (47 patellar tendons) and non-dominant side (47 patellar tendons). Grey-scale ultrasound and SWE were performed on the bilateral patellar tendons before and after the half marathon within 2 h and after a period of 1 week. Thirty healthy volunteers (18 males and 12 females, aged from 22 to 39 years) were enrolled as the control group, the SWE-values derived from the patellar tendon were collected and analyzed. Multivariate logistic regression was performed to analyze the relationship between the changes of SWE-values and running age as well as weekly amount of running. Results: None of any runners showed knee pain and sports injury during the test. The dominant side had a higher SWE-values than non-dominant side in marathon group before running [(55.1±15.7) kPa vs (43.8±15.9) kPa, P<0.05]. The marathon group had higher SWE-values than the control group both in dominant side [(55.1±15.7) kPa vs (18.5±3.7) kPa] and non-dominant side [(43.8±15.9) kPa vs (17.4±3.2) kPa], respectively, before running (P<0.05). The SWE-values increased significantly both in dominant side [(80.2±23.2) kPa vs (55.1±15.7) kPa] and non-dominant side [(76.5±26.6) kPa vs (43.8±15.9) kPa] 2 h after running in marathon group. After a week, the SWE-values were not statistically different from those before running (P>0.05). Multivariate logistic regression showed that running age and weekly amount of running were related factors leading to the increase of SWE-values after running. Conclusions: The patellar tendon of amateur marathon runners has higher SWE-values. SWE can dynamically evaluate the changes of patellar tendon during exercise and is helpful for runners in scientific training and avoiding sports injury.

Composite dietary antioxidant index and the risk of colorectal cancer: Findings from the Singapore Chinese Health Study

Colorectal cancer (CRC) is a major contributor to cancer death globally. Several studies showed some protections by certain individual dietary antioxidants against CRC development. Epidemiologic data on the composite dietary antioxidant index (CDAI) in relation to CRC risk are sparse. Using the Singapore Chinese Health Study, an ongoing prospective cohort consisting of 61 321 cancer-free participants aged 45 to 74 years at baseline, a food-based CDAI was calculated according to a previously established and validated method that included six food-sourced antioxidants including vitamins A, C and E, manganese, selenium and zinc. Cox proportional hazard regression method was used to estimate the hazard ratios (HRs) and their 95% confidence intervals (CIs) for CRC associated with various levels of CDAI with adjustment for multiple potential confounders. After an average of 17.5 years of follow-up, 2140 participants developed CRC. HRs (95% CIs) of CRC for quartiles 2, 3 and 4 of CDAI were 0.94 (0.83-1.07), 0.86 (0.75-1.00) and 0.80 (0.66-0.98), respectively, compared to the lowest quartile (P_trend  = .02). This inverse association between CDAI and CRC risk was more apparent in women or those without a history of diabetes, without family history of CRC, never smokers or overweight/obese individuals. However, none of the heterogeneity tests for the CDAI-CRC risk association reached statistical significance. Our findings suggest that food-based antioxidants may be beneficial for reducing the risk of CRC in the general population.

Gradual adoption of needle biopsy for breast lesions in a rural state

Background

Minimally invasive breast biopsy (MIBB) is the standard of care for the diagnosis of breast cancer, with consensus guidelines suggesting MIBB goals of 90% of total biopsies. In a previous study of patients in the rural state of Vermont, USA (population size of 640,000), rural breast cancer patients had open biopsies 42% of the time compared to 29% of urban breast cancer patients. The aim of this study was to assess overall population‐based biopsy trends in Vermont.

Methods

The Vermont Breast Cancer Surveillance System (VBCSS) was used to identify women receiving MIBB and excisional breast biopsies in Vermont. Patient zip code at the time of initial biopsy was used to determine the patient residence rurality by rural–urban commuting area codes (RUCA 2.0™).

Results

There were 9122 diagnostic episodes from 1999 to 2018. MIBB was the initial biopsy method in 7524 (82.5%) cases, while surgical excision was the initial biopsy method in 1598 (17.5%) cases. A linear trend fit estimated an increase of 1.3% per year (p < 0.001, 95% CI 1.1%–1.5%) in the fraction of patients undergoing MIBB. Patients living in rural areas were less likely to receive MIBB (78.5%) than those living in urban areas (94.9%), p < 0.001. Multivariate analysis showed that urban patients and those patients in the years 2014–2018 were more likely to receive MIBB (OR 5.00, 95% CI 4.13–6.05 [p < 0.05] and OR 4.41, 95%CI 3.68–5.28 [p < 0.05], respectively). The rate of MIBB for rural patients increased and met the 90% quality standard in 2013 and ultimately matched urban patient rates of MIBB in 2018.

Conclusions

For the first time, we show that MIBB usage is above 90% in the state of Vermont and that there no longer exist disparities in breast biopsies between urban and rural patients or rural/urban facilities in the state, overall.

Serum Biomarkers of Iron Status and Risk of Hepatocellular Carcinoma Development in Patients with Nonalcoholic Fatty Liver Disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) has become a major contributor to the rising incidence of hepatocellular carcinoma (HCC) in the United States and other developed countries. Iron, an essential metal primarily stored in hepatocytes, may play a role in the development of NAFLD-related HCC. Epidemiologic data on iron overload without hemochromatosis in relation to HCC are sparse. This study aimed to examine the associations between serum biomarkers of iron and the risk of HCC in patients with NAFLD.

METHODS

We identified 18,569 patients with NAFLD using the University of Pittsburgh Medical Center electronic health records from 2004 through 2018. After an average 4.34 years of follow-up, 244 patients developed HCC. Cox proportional hazard regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) of HCC incidence associated with elevated levels of iron biomarkers with adjustment for age, sex, race, body mass index, history of diabetes, and tobacco smoking.

RESULTS

The HRs (95% CIs) of HCC for clinically defined elevation of serum iron and transferrin saturation were 2.91 (1.34-6.30) and 2.02 (1.22-3.32), respectively, compared with their respective normal range. No statistically significant association was observed for total iron-binding capacity or serum ferritin with HCC risk.

CONCLUSIONS

Elevated levels of serum iron and transferrin saturation were significantly associated with increased risk of HCC among patients with NAFLD without hemochromatosis or other major underlying causes of chronic liver diseases.

IMPACT

Clinical surveillance of serum iron level may be a potential strategy to identify patients with NAFLD who are at high risk for HCC.

Abstract 754: Serum iron markers in relation to hepatocellular carcinoma risk among patients with non-alcoholic fatty liver disease

Background: Hepatocellular carcinoma (HCC) is the 6th most commonly diagnosed cancer and the 3rd leading cause of cancer death in the US. Around 85-90% of primary liver cancer is HCC. Besides identified risk factors for HCC including chronic infection with hepatitis B and C virus (HBV and HCV), alcohol abuse, dietary aflatoxin exposure and hereditary hemochromatosis, nonalcoholic fatty liver disease (NAFLD) is as another important risk factor for HCC. NAFLD is a spectrum of liver disease that ranges from hepatic steatosis through non-alcoholic steatohepatitis (NASH) with or without fibrosis and may progress to cirrhosis or HCC. Iron is an essential metal and hepatocytes are its main storage site. Increased body iron from the intestine due to high dietary iron or hereditary or acquired hemochromatosis may result in hepatic iron overload. NAFLD is frequently associated with elevated serum iron indices when hepatic iron in the absence of hemochromatosis. Epidemiologic data on the association between serum iron markers and risk of HCC are sparse. The aim of the study was to examine the association of iron related serum markers with risk of HCC in NAFLD patients. We hypothesized that elevated serum iron levels, which reflects hepatic iron, are associated with increased risk of HCC among NAFLD patients.

Methods: 48,328 patients with NAFLD were identified in the electronic health records (EHR) of the University of Pittsburgh Medical Center (UPMC) between 1/1/2004 to 12/31/2018. Among them, 19,908 had at least one measurement of serum iron, transferrin saturation, total iron binding capacity (TIBC) and serum ferritin. After an average 4.47 years of follow-up, 363 patients with NAFLD were diagnosed with HCC at least 30 days after measurement of iron markers. Cox proportional hazard regression was used to calculate hazard ratios (HRs) and the 95% confidence intervals (CIs) for HCC incidence associated with elevated levels of the four iron markers adjusted for age, sex, race, body mass index, history of diabetes and tobacco smoking.

Results: Serum iron and transferrin saturation were significantly elevated in NAFLD patients who developed HCC compared to others who remained free of HCC during the study. The HR of HCC for elevated serum iron &gt;175 mcg/dl was 3.41 (95% CI 1.48 - 7.85) compared to its normal range at 75-175 mcg/dl. Similarly, the HR for HCC associated with elevated transferrin saturation &gt;35% was 2.56 (95% CI 1.49-4.39) relative to the normal range at 25-35%. The associations were not statistically significant for TIBC and serum ferritin with HCC risk.

Conclusions: Elevated serum iron and transferrin saturation levels, but not TIBC or serum ferritin, were significantly associated with increased risk of developing HCC in NAFLD patients. These findings support future studies evaluating serum iron level in risk stratification of NAFLD patients at risk of HCC and potential links to pathogenesis of HCC.

Citation Format: Yi-Chuan Yu, Renwei Wang, Jaideep Behari, Ada Youk, Nancy W. Glynn, Jian-Min Yuan. Serum iron markers in relation to hepatocellular carcinoma risk among patients with non-alcoholic fatty liver disease [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 754.

Factors associated with mortality in patients with COVID-19 admitted to intensive care: a systematic review and meta-analysis

Identification of high-risk patients admitted to intensive care with COVID-19 may inform management strategies. The objective of this meta-analysis was to determine factors associated with mortality among adults with COVID-19 admitted to intensive care by searching databases for studies published between 1 January 2020 and 6 December 2020. Observational studies of COVID-19 adults admitted to critical care were included. Studies of mixed cohorts and intensive care cohorts restricted to a specific patient sub-group were excluded. Dichotomous variables were reported with pooled OR and 95%CI, and continuous variables with pooled standardised mean difference (SMD) and 95%CI. Fifty-eight studies (44,305 patients) were included in the review. Increasing age (SMD 0.65, 95%CI 0.53-0.77); smoking (OR 1.40, 95%CI 1.03-1.90); hypertension (OR 1.54, 95%CI 1.29-1.85); diabetes (OR 1.41, 95%CI 1.22-1.63); cardiovascular disease (OR 1.91, 95%CI 1.52-2.38); respiratory disease (OR 1.75, 95%CI 1.33-2.31); renal disease (OR 2.39, 95%CI 1.68-3.40); and malignancy (OR 1.81, 95%CI 1.30-2.52) were associated with mortality. A higher sequential organ failure assessment score (SMD 0.86, 95%CI 0.63-1.10) and acute physiology and chronic health evaluation-2 score (SMD 0.89, 95%CI 0.65-1.13); a lower PaO₂ :F_I O₂ (SMD -0.44, 95%CI -0.62 to -0.26) and the need for mechanical ventilation at admission (OR 2.53, 95%CI 1.90-3.37) were associated with mortality. Higher white cell counts (SMD 0.37, 95%CI 0.22-0.51); neutrophils (SMD 0.42, 95%CI 0.19-0.64); D-dimers (SMD 0.56, 95%CI 0.43-0.69); ferritin (SMD 0.32, 95%CI 0.19-0.45); lower platelet (SMD -0.22, 95%CI -0.35 to -0.10); and lymphocyte counts (SMD -0.37, 95%CI -0.54 to -0.19) were all associated with mortality. In conclusion, increasing age, pre-existing comorbidities, severity of illness based on validated scoring systems, and the host response to the disease were associated with mortality; while male sex and increasing BMI were not. These factors have prognostic relevance for patients admitted to intensive care with COVID-19.

MicroRNA-122 as a diagnostic biomarker for hepatocellular carcinoma related to hepatitis C virus: a meta-analysis and systematic review

Objective

MicroRNA-122 (miR-122) has been identified as a biomarker of liver diseases. However, the miR-122 detection accuracy in patients with hepatocellular carcinoma (HCC) associated with hepatitis C virus (HCV) is inconclusive.

Methods

We conducted a systematic literature search of Web of Science, Cochrane Library, PubMed, and Embase to identify studies related to the diagnostic value of miR-122 in HCV-related HCC. We analyzed the results and validated them using data from the Cancer Genome Atlas (TCGA).

Results

Six articles were included in this meta-analysis, comprising 354 cases and 420 controls. The pooled specificity, sensitivity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve were 0.87, 0.83, 5.1, 0.16, 32, and 0.92, respectively. Additional sub-group analyses showed that results for plasma were more sensitive than those for serum. In addition, miR-122 was better at distinguishing between HCV-associated HCC and healthy people or those with HCV than between those with HCV-associated HCC and HCV-related cirrhosis. Small samples (≤100) had better diagnostic odds ratios than larger samples (>100). Analysis of data from TCGA confirmed that miRNA-122 had a high diagnostic value.

Conclusion

This meta-analysis demonstrates that miR-122 may be a useful diagnostic biomarker for HCV-associated HCC.

Ambulatory blood pressure monitoring among emergency medical services night shift workers

OBJECTIVES

Higher 24-hour blood pressure (BP) and blunted BP dipping during sleep and night-time hours are associated with adverse health outcomes. Night shift work may affect 24-hour BP and dipping patterns, but empirical data in emergency medical services (EMS) clinician shift workers are sparse. We implemented ambulatory blood pressure monitoring (ABPM) in EMS workers to characterise BP during night shift work versus a non-workday, and sleep versus wake.

METHODS

Participants worked night shifts. Hourly ABPM and wrist actigraphy (to measure sleep) were collected during two 24-hour periods, one scheduled night shift and one non-workday. Blunted BP dipping was defined as a BP decrease of <10%.

RESULTS

Of 56 participants, 53 (53.6% female, mean age 26.5 (SD 7.5) years) completed the study. During daytime sleep on a workday, 49.1% of participants had blunted systolic BP (SBP) or diastolic BP (DBP) dipping. During night-time sleep on a non-workday, 25% had blunted SBP dipping and 3.9% blunted DBP dipping. Blunted SBP or DBP dipping occurred among all participants who did not nap during the night shift or who napped <60 min. Blunted SBP dipping occurred in only 14.3% of participants who napped 60-120 min.

CONCLUSIONS

During night shift work, the BP dipping of EMS shift workers is blunted; however, most who nap for 60 min or longer experience a healthy dip in BP. The potential health consequences of these observations in EMS clinicians warrant further study.

[Several issues worthy of reference and discussion of 2019 edition of the European Association for the Study of the Liver guideline for drug-induced liver injury]

The 2019 European Association for the Study of the Liver (EASL) Clinical Practice Guidelines (hereinafter referred to as the EASL Guidelines) extracted the required evidence from detailed research materials, and rigorously graded and condensed the varying strengths of evidence into 32 recommendations and 14 statements (recommendations and reminders) for drug-induced Liver Injury (DILI). This guideline has important reference values for helping clinicians to further improve their understanding of DILI and the level of clinical diagnosis, treatment and prevention; however, there are still several issues worthy of further discussion.

[The effect of nutrition intervention on the body composition and blood glucose in newly diagnosed patients with type 2 diabetes mellitus complicated with overweight and obesity]

Objective: To study the effect of nutrition intervention on the body composition and blood glucose in newly diagnosed patients with type 2 diabetes mellitus complicated with overweight and obesity. Methods: A total of 84 newly diagnosed patients with type 2 diabetes mellitus complicated with overweight and obesity were selected from the department of endocrinology in China-Japan Friendship Hospital from April 2015 to December 2016. Basic information and body composition of these patients were collected and measured. Also the food frequency questionnaire (FFQ) was used to investigate the dietary status in the past month, and calculate the intake of energy, three major nutrients and dietary fiber. All patients received nutrition intervention by nutritionist for three months as requested by Diabetes guidelines. After 3-month intervention, blood glucose, body composition and dietary status were examined again. Relevant indicators of patients were compared before and after the intervention. All patients were divided into three groups according to the degree of body mass index (BMI)'s change: <5%, 5%-10% and >10%. The differences of body weight, muscle, body fat rate, visceral fat index and blood glucose level among three groups were quantified. Results: There were 53 male patients with age (41.5±8.9) years and HbA1c (7.5±0.4)%, and 31 female patients with age (40.1±8.5) years with HbA1c (7.6±0.5)%. The intake of energy, carbohydrate and fat of patients were significantly decreased (P<0.05) and dietary fiber was significantly increased (P<0.05) after nutrition intervention. The body weight, muscle mass, fat mass and visceral fat index were also significantly decreased (P<0.05). The average decrease of fat was about 2.8 kg accounting for 73.7% (2.8 kg/3.8 kg) of the total weight loss. The body fat rate decreased from (31.2±3.1)% to (28.8±3.2)% (P<0.05). The fasting blood glucose and postprandial blood glucose were both decreased significantly after intervention (P<0.05). Among three BMI decreased groups, there was no significant difference in body weight and muscle mass (P>0.05), but a significant difference in body fat rate and visceral fat index (P<0.05). The body fat rate, visceral fat index, fasting blood glucose and postprandial blood glucose had more decreases with the greater amount of weight loss (P<0.05). Conclusion: The three-month nutrition intervention could change the dietary habit and components of patients with type 2 diabetes mellitus by reducing the blood glucose, body fat rate and visceral fat index significantly. The degree of reduced BMI is positively related to the decrease of fasting blood glucose and postprandial blood glucose.

Efficacy of betahistine plus cognitive behavioral therapy on residual dizziness after successful canalith repositioning procedure for benign paroxysmal positional vertigo

BACKGROUND

Some patients still complain of residual dizziness after successful canalith repositioning procedure (CRP) for benign paroxysmal positional vertigo (BPPV). Previous study found that compared to the low-dose betahistine, the high-dose betahistine could yield better efficacy in treating residual dizziness. Therefore, this study was conducted to assess whether the addition of cognitive behavioral therapy (CBT) could make low-dose betahistine produce similar results to high-dose betahistine in treating residual dizziness.

METHODS

The recruited patients were randomly assigned to receive either low-dose betahistine (6 mg/time, three times/day) or high-dose betahistine (12 mg/time, three times/day). Patients in the low-dose group also received CBT (twice a week, 1 hour per time). The treatment was continued for 4 weeks. The duration of residual dizziness, 25-item Dizziness Handicap Inventory (DHI), Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) were recorded and analyzed. The duration of residual dizziness and DHI score were the primary outcomes, and the HARS and HDRS scores were the secondary outcomes.

RESULTS

Each group had 50 patients. After treatment, the average DHI scores, HDRS scores, and HARS scores were significantly decreased in both groups. The duration of residual dizziness and average DHI score were nonsignificantly different (P=0.08; P=0.06) between the two groups, although they were lower in the low-dose group. Compared to the high-dose group, the low-dose group had the significantly lower average HDRS score (P=0.007) and HARS score (P=0.02). Meanwhile, four patients in the high-dose group experienced intolerable stomach upset.

CONCLUSION

These results demonstrated that the addition of CBT could make low-dose beta-histine produce similar results to high-dose betahistine in treating residual dizziness. Moreover, the low-dose betahistine plus CBT showed some advantages over high-dose betahistine in relieving depressive and anxiety symptoms and should be further explored.

[Current status and future views of indicators for clinical outcome of antiviral treatment in patients with hepatitis B virus infection]

The optimal clinical outcomes are the original intention and base to form the short-term, long-term and special goals of antiviral treatment in patients with hepatitis B virus (HBV) infection. The immediate indicators for assessment of antiviral clinical outcomes, which usually need prolonged follow-up, include the liver histopathological changes, the occurrence and severity of liver cirrhosis and hepatocellular carcinoma (HCC), mortality and survival rates, survival time and life quality, prevention rates of Mother-to-Child Transmission and HBV reinfection after liver transplantation, etc.

[Application of laparoscopic transection of median hepatic fissure in difficult laparoscopic liver resections]

Objective: The aim was to explore the strategy and clinical value of laparoscopic transection of median hepatic fissure (MHF) in difficult laparoscopic liver resections. Methods: First the MHF was located and marked, then the transection plane of the MHF was set. Next, the laparoscopic Multifuctional Operative Dissector (LPMOD) and the technique of curettage and aspiration were utilized to transect the liver beginning from the middle portion of the gallbladder fossa, in a caudal-to-cranial and anterior-to-posterior direction, until the clear exposure of the anterior surface of the intrahepatic inferior vena cava. Transection of the MHF was accurately achieved. Finally, dissection of the second and third porta hepatis were carefully performed and mobilization of the transected liver was achieved. This technique of laparoscopic transection of MHF was successfully performed in 13 patients in difficult laparoscopic liver resections. Results: Between April 2014 and August 2015, 13 patients received the technique of laparoscopic transection of MHF in difficult laparoscopic liver resections, including 10 cases of laparoscopic right hepatectomy, two cases of laparoscopic left hepatectomy and one case of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). The maximum size of the transected tumor was 15 centimeter. Duration of surgery was 240-430 min[Mean, 324.4±50.0]; the time for transection of the MHF was 40-118 min[mean, 66.4±22.7]. Blood loss was 200-2 000 ml[583.3±452.9]. The length of postoperative hospital stay was 6-25 days[mean, 13.2±5.2]. Seven patients received intraoperative transfusions. No postoperative intraabdominal bleeding, liver failure or other severe postoperative complications occurred. No perioperative death occurred. Conclusions: Application of laparoscopic transection of the MHF in difficult laparoscopic liver resections can help to clearly expose the second and third porta hepatis, especially in patients who have huge tumors and poor exposure for hepatic dissection. Moreover, precise location and transection of the MHF remains very important strategies of applying this technique.

Prolactin plays a stimulatory role in ovarian follicular development and egg laying in chicken hens

The aim of this study was to show a stimulatory role in ovarian follicle development by prolactin (PRL) in chicken hens. In experiment 1, anti-PRL antibodies were generated in hen plasma by intramuscular administrations of recombinant PRL antigen. Egg laying remained at levels lower (P < 0.05) in the PRL-immunized group than in the BSA-immunized group of hens, whereas development of incubation was depressed in the former but not the latter group. Throughout the experiment, plasma PRL concentrations were lower in the PRL-immunized hens than in non-incubating control hens; LH concentrations were similar between the PRL- and BSA-immunized hens until the end of the experiment when LH was lower in the BSA-immunized hens (P < 0.05). In experiment 2, anti-PRL receptor (PRLR) antibodies were raised in hens with the use of immunizations against recombinant PRLR extracellular domain. Immunization against PRLR initially increased the egg-laying rate when measured under the short photoperiod (12 h) but blocked the laying rate increase that occurred in the BSA-immunized control hens when the photoperiod was extended from 12 to 16 h. The development of incubation behavior was not affected by immunization against PRLR nor was plasma PRL or LH concentration. In experiment 3, when the egg-laying rate was depressed in PRL immunization hens, developmental speed of large white follicles was found to be slower than in the BSA-immunized control hens (P < 0.05). These results indicate that immunization against PRL slows down ovarian follicular development and reduces hen egg-laying performance, suggesting that PRL plays a stimulatory role in ovarian follicular development in chicken hens.

Survival time comparison between Hawley and clear overlay retainers: a randomized trial

The objectives of this study were to compare the survival time of the Hawley retainer (HR) and the clear overlay retainer (COR) over one-year follow-up and to analyze risk factors contributing to their breakage. In this randomized, controlled clinical trial, we assigned 120 adolescent patients to receive either the HR or the COR. All specific data on breakage dates, the reasons for breakage, and the broken parts of the retainers were recorded. A survival analysis was used to describe retainer survival over time. No significant differences were observed in survival times between the 2 groups for either the maxillary retainer (p = 0.254) or the mandibular retainer (p = 0.188). Both retainers tended to fracture, but the fracture locations were different. The findings indicate that clinicians should avoid increasing buccal root torque and reinforce the retainer base plates. Breakage rates may not influence the choice of retainer (Trial Registration number is ChiCTR-TRC-00000055).

Effects of immunisation against leptin on feed intake, weight gain, fat deposition and laying performance in chickens

1. Three experiments were conducted to study the effects of leptin on weight gain and body composition in laying hens. 2. The effects of immunisation against chicken leptin on feed intake (FI), fat deposition and laying rate were observed in laying Guangdong yellow-feathered hens. Ten hens were inoculated with leptin immunogen on d 3, 31, 63 and 84, together with 10 control hens immunised with bovine serum albumin (BSA). In the 100-d experiment, immunisation against leptin increased blood anti-leptin antibody titres, slightly reduced plasma T3 concentrations, slightly decreased FI and increased live weight; however, laying rate was significantly depressed and abdominal fat mass was increased by the end of the 100-d experiment. 3. Passive immunisation of 50-d-old pullets with yolk extract containing anti-leptin antibody IgY significantly increased FI within 6 h of treatment compared with physiological saline treated controls. 4. In growing 70-d-old pullets, inoculation with 0.5 (group 1) or 1 (group 2) ml leptin immunogen on d 1 and 28 of the experiment slightly increased FI and significantly increased daily gain compared with BSA-immunised control pullets. Abdominal fat mass on d 49 increased from 48+/-4.5 g in controls to 66+/-3.5 and 80+/-3.1 g in groups 1 and 2, respectively. 5. It was suggested that immunisation against leptin mimicked loss of leptin bioactivity and might become a novel technique to stimulate fat growth in certain types of animal production.

Minimally invasive estimation of systemic vascular parameters

A cardiovascular parameter estimator to identify the systemic vascular parameters was developed using an extended Kalman filter (EKF) algorithm. Measurements from a ventricular assist device (VAD) and arterial pressure were used in the estimator. The systemic vascular parameters are important indices of heart condition. However, obtaining these parameters usually requires invasive measurements, which are difficult to obtain under most clinical environments. Including a VAD model into the estimator and using the signals from a VAD to identify the cardiovascular parameters for VAD patients would minimize the need for indwelling sensors. This paper illustrates the use of a Novacor left ventricular assist system (LVAS) model with a cardiovascular model in the estimator to identify the systemic vascular parameters: characteristic resistance, blood inertance at the aorta, systemic compliance, and systemic resistance. Performance of the estimator was evaluated using data from a computer simulation and from a mock circulatory system experiment. Robustness of the estimator to the available measurements was also described. The estimation results showed that the estimates converged with reasonable accuracy in a limited time when the LVAS pump volume and arterial pressure were used as measurements. These parameter estimates can provide additional diagnostic information for patient and device monitoring and can be used for future VAD control development.

[Parenting stress in women who concieved using assisted reproductive technology]

Infertile women suffer chronic stress, which may negatively impact their parenting relationships if they later succeed in bearing children. The purpose of this study was to explore the parenting stress of mothers attending assisted an reproductive program and to compare it with the parenting stress of mothers with natural pregnancies. A purposive sampling method was used to recruit 54 mothers attending an In Vitro Fertilization/Embryo Transfer and Tubal Embryo Transfer program at an infertility center in central Taiwan. Three instruments were used to collect data: the Demographic Data Form, Parenting Stress Index-Short Form and Family Adaptation Partnership Growth Affective Relation Index. The data were analyzed by descriptive and inferential statistical methods. (1) The results indicated that the highest average score in parenting stress for mothers receiving reproductive technology was for "parental distress". These results revealed that the main source of parenting stress was their parental role. (2) Family function varied significantly with parenting stress. (3) Parenting stress was significantly greater in mothers with natural pregnancy than in mothers attending the assisted reproductive program. Recommendations for clinical application and future research are also made. The implications of the study may be used to assist infertile women in coping with parenting roles. Furthermore, a qualitative study is suggested to understand the factors which cause parenting stress.

Pressure-Volume Relationship of a Pulsatile Blood Pump for Ventricular Assist Device Development

A mathematical model describing the pressure-volume relationship of the Novacor left ventricular assist system (LVAS) was developed. The model consists of lumped resistance, capacitance, and inductance elements with one time varying capacitor to estimate the cyclic pressure generation of the pump using pump volume measurement. The ejection and filling portions of the pump cycle were modeled with two separate functions. The corresponding model parameters were estimated by least squares fit to experimental data obtained in the laboratory. Pressure and volume waveforms obtained from the model were compared with data obtained from laboratory tests and from patients. It performed well in simulating pump operation throughout the entire cycle. This model can be used for the evaluation of LVAS performance, for on-line estimation of an LVAS patient's cardiovascular parameters, for pump controller development, and as a tool for engineer training.

Protein-like molecular architecture: biomaterial applications for inducing cellular receptor binding and signal transduction

The development of biomaterials with desirable biocompatibility has presented a difficult challenge for tissue engineering researchers. First and foremost, materials themselves tend to be hydrophobic and/or thrombogenic in nature, and face compatibility problems upon implantation. To mediate this problem, researchers have attempted to graft protein fragments onto biomaterial surfaces to promote endothelial cell attachment and minimize thrombosis. We envisioned a novel approach, based on the capability of biomolecules to self-assemble into well-defined and intricate structures, for creating biomimetic biomaterials that promote cell adhesion and proliferation. One of the most intriguing self-assembly processes is the folding of peptide chains into native protein structures. We have developed a method for building protein-like structural motifs that incorporate sequences of biological interest. A lipophilic moiety is attached onto a N alpha-amino group of peptide chain, resulting in a "peptide-amphiphile." The alignment of amphiphilic compounds at the lipid-solvent interface is used to facilitate peptide alignment and structure initiation and propagation, while the lipophilic region absorbs to hydrophobic surfaces. Peptide-amphiphiles containing potentially triple-helical or alpha-helical structural motifs have been synthesized. The resultant head group structures have been characterized by CD spectroscopy and found to be thermally stable over physiological temperature ranges. Triple-helical peptide-amphiphiles have been applied to studies of surface modification and cell receptor binding. Cell adhesion and spreading was promoted by triple-helical peptide-amphiphiles. Cellular interaction with the type IV collagen sequence alpha 1(IV) 1263-1277 increased signal transduction, with both the time and level of induction dependent upon triple-helical conformation. Collectively, these results suggest that peptide-amphiphiles may be used to form stable molecular structure on biomaterial surfaces that promote cellular activities and improve biocompatibility.

Epstein-Barr virus-encoded latent membrane protein 1 co-expresses with epidermal growth factor receptor in nasopharyngeal carcinoma

Latent membrane protein 1 (LMP-1) is the only Epstein-Barr virus (EBV)-encoded oncogenic protein that has been detected in nasopharyngeal carcinoma (NPC), a cancer that is closely associated with EBV. Previous in-vitro studies have demonstrated that LMP-1 can upregulate epidermal growth factor receptor (EGFR) in epithelial cells. It was not established whether this cellular effect exists in NPC. To assess the association between LMP-1 and EGFR in NPC tissues, 60 NPC specimens were examined by immunohistochemistry using anti-LMP-1 antibody (CS 1-4) and anti-EGFR antibodies (EGFR 1, EGFR 1005). The results revealed that 41 (68.3%) specimens were immunopositive for LMP-1 and 44 (73.3%) specimens over-expressed EGFR. Morphologically, the expressions of LMP-1 and EGFR were homogeneously distributed in the tumor nests. In addition, the correlation between LMP-1 and EGFR was statistically significant (P<0.001, chi2 test, d.f. = 1). To elucidate further the correlation between LMP-1 and EGFR in vivo and in situ, an indirect dual immunofluorescence assay was conducted, using secondary antibodies conjugated with fluorescein isothiocyanate (FITC) or indocarbocyanine (Cy3). The results disclosed an intimate co-expression of LMP-1 and EGFR. In summary, the data indicate that over-expression of EGFR is a common phenomenon in NPC, and that EGFR is co-expressed with LMP-1 in NPC. Thus, EBV may play a role in the tumorigenesis of NPC through the effects of LMP-1 and EGFR.

[Rabbit facial nerve damager after Nd: YAG laser irradiation: an experimental study]

OBJECTIVE:To investigate the change effects of rabbit facial nerve after Nd:YAG laser irradiation.METHODS: According to therapeutic laser energy density,the facial nerves of 28 rabbits were irradiated by Nd:YAG laser with 5 different laser dosages.RESULTS: The facial nerves were functionally intact with mild degeneration histologically at three weeks postoperatively,when the energy density of Nd: YAG laserlaser lower than 70J/cm(2).In the group with energy density of 140J/cm(2),facial nerve density functionally impaired with moderate degeneration which rehabilitated within six weeks. While the laser power increaseed to more than 240J/cm(2),irreversible nerve damages happened.CONCLUSION: laser thermal effect is the main cause of nerve damage,there is a positive correlation between laser dosage and nerve impairment.

Stepwise chromosome evolution in Drosophila albomicans

A 'stepwise chromosome evolution model' is proposed to elaborate the two stages of the sex chromosome evolution of Drosophila albomicans. To explain the occurrence of both a 3-X and a 3-Y in this species it is proposed that these chromosomes evolved sequentially. The selection forces acting in the two stages are different. The genic composition in the first fused sex chromosome of D. albomicans was supposed to be selectively superior to the primitive unfused chromosomes, thus the fused chromosome could overcome the meiotic structural incompatibility and be maintained in the population during the first stage. When the second fusion occurred, the newly fused sex chromosome was preferentially selected, as it could provide a meiotic pairing partner for the first fusion. The fused sex chromosomes were eventually fixed in the population. Based on this model, we tried to determine which fused chromosome, 3-X or 3-Y, established first. The karyotyping result of four experimental hybrid populations showed that the fused 3-X, as opposed to 3-Y, chromosome has higher fitness values. However, without the coexistence of 3-X, 3-Y is excluded rapidly. Therefore, 3-X is likely to be the first fused chromosome in the stepwise chromosome evolution model. The formation and fixation of the fused 3-Y chromosome occurred subsequently.

Structure and dynamics of peptide-amphiphiles incorporating triple-helical proteinlike molecular architecture

Organized polymeric assemblies that incorporate bioactive sequences and structures are finding important applications for the study of protein structure-function relationships. We have recently described a heteropolymeric peptide-amphiphile system that forms organized structures in solution and on surfaces. While the overall three-dimensional features of peptide-amphiphiles have been studied previously, the precise environment of specific residues, particularly those within biologically active regions, have not been examined in detail. In the present study, we have used heteronuclear single quantum coherence (HSQC) and inverse-detected 1H-15N NMR spectroscopy to examine the structure and dynamics of a peptide and peptide-amphiphile that incorporate the alpha1(IV)1263-1277 ([IV-H1]) amino acid sequence from type IV collagen. Three variants of the sequence (Gly-Pro-Hyp)4-[IV-H1]-(Gly-Pro-Hyp)4 were constructed with a single 15N-labeled Gly placed in the middle of the N-terminal (Gly-Pro-Hyp)4 region (residue Gly7), in the middle of the [IV-H1] sequence (residue Gly19), or in the middle of the C-terminal (Gly-Pro-Hyp)4 region (residue Gly34). These peptides were also N-terminally acylated with hexanoic acid to create an analogous series of 15N-labeled peptide-amphiphiles. HSQC spectra indicated that both the peptide and the peptide-amphiphile were in triple-helical conformation at low temperature, supporting prior circular dichroism (CD) spectroscopic results. The intensities of the triple-helical cross-peaks were stronger for the peptide-amphiphile, consistent with an enhanced triple-helical thermal stability within the peptide-amphiphile construct compared to that of the peptide alone. Relative relaxation values for the peptide-amphiphile monomeric and trimeric species were consistent with those reported previously for other triple-helical peptides. Relaxation measurements indicated that the triple-helical [IV-H1] region did not appear to be dramatically more flexible than the Gly-Pro-Hyp regions. The angle between Gly N-H bonds and the helix dyad axis, determined from the relaxation data, was within the range expected for triple helices. Overall, the peptide headgroup of the C6-(Gly-Pro-Hyp)4-[IV-H1]-(Gly-Pro-Hyp)4 peptide-amphiphile appears to form a continuous triple helix that behaves similarly, in a dynamic sense, to a triple-helical peptide. The enhanced thermal stability of the peptide-amphiphile compared to the analogous triple-helical peptide, along with the multitude of organized structures formed by lipidlike compounds, suggest that peptide-amphiphiles could be utilized as targeted liposomes, sensors, receptors, or enzymes.

Elderly use of the ED in an Asian metropolis

To compare emergency department (ED) use by elderly patients (age 65 yrs or older) with that by younger adult patients (age 15-64 yrs), a prospective consecutive chart review study was conducted from August 1, 1995 through May 31, 1996 in eight designated hospitals in Taipei city (which has 2.6 million residents, 8.4% of whom are 65 yrs or older). Patient age, sex, mode of arrival, living status, triage category, advanced life support (ALS) eligibility, referral, confinement to bed, intensive care unit (ICU) admission, impression, trauma mechanism, and disposition were recorded and compared between the two groups. Of 27,765 adult emergency patients studied during the 10 months, 24% were elderly. The elderly were more likely to be ambulance cases, of high acuity and ALS eligibility, living alone, bed-ridden, and ICU cases (19.4% v 10.5%, 14.8% v 5.5%, 14.7% v 4.3%, 9.7% v 4.1%, 16% v 1.1%, and 4.0 v 1.1%, respectively). The three leading illnesses in the elderly were cerebral vascular accident (6.6%), cancer (5.6%), and cardiovascular disease (5.6%), and the two most common trauma mechanisms were trip (fall from the same level surface) (57.2%) and traffic accident (20.7%). Twenty-seven percent and 22.7% of elderly were disposed to admission and observation, respectively, compared with the 10.9% and 11.4% of the younger patients. Elderly patients have significantly different and more severe presentations to the ED compared with younger adults.

Purification of antibodies from protein mixtures and mouse ascites fluid using Zeolite X

Zeolite A and calcium phosphate modified Zeolite A have been shown to be a new effective packing material in ion exchange chromatography for the purification of immunoglobulin G (IgG) from binary mixtures and mouse ascites fluid. This study was to determine the effectiveness of purifying IgG using Zeolite X and dealuminated Zeolite X with twice the pore size of Zeolite A. Binary mixtures (IgG-albumin and IgG-transferrin) and a mouse ascites fluid were purified in Zeolite X (in Na+, K+, or NH4+ form) chromatographic columns and with dealuminated Zeolite X under a variety of operational conditions. The biological activity of the purified IgG from the mouse ascites fluid was confirmed by ELISA. The characteristics of zeolites in the present study suggest that functional groups of a protein displace the cations of zeolites near the crystal surfaces and create a different strength of affinity. The study demonstrated that Zeolite X and dealuminated Zeolite X are also promising new packing materials for the purification of IgG from biological materials.

Inhibition of RNA synthesis as a therapeutic strategy against Aspergillus and Fusarium: demonstration of in vitro synergy between rifabutin and amphotericin B

We investigated the in vitro antifungal activity of amphotericin B, alone and in combination with rifabutin, an inhibitor of bacterial RNA polymerase, against 26 clinical isolates of Aspergillus and 25 clinical isolates of Fusarium. Synergy or additivism between these drugs was demonstrated against all isolates tested. Amphotericin B MICs were reduced upon combination with rifabutin from a mean of 0.65 microg/ml to a mean of 0.16 microg/ml against Aspergillus, and from a mean of 0.97 microg/ml to a mean of 0.39 microLg/ml against Fusarium (P < 0.000001 for both). Similarly, the MICs of rifabutin were reduced upon combination with amphotericin B from a mean of >32 microg/ml to a mean of 1.1 microg/ml against both fungi (P < 0.000001 for both). These positive interactions were corroborated by a colony count study with two Fusarium isolates, for which treatment with the combination of subinhibitory concentrations of amphotericin B (at concentrations 2- and 4-fold less than the MIC) and rifabutin (at concentrations ranging from 4- to 64-fold less than the MIC) resulted in 3.2-log reductions in colony counts compared to those after treatment with either drug alone. Inhibition of RNA synthesis was shown to be the mechanism of antifungal activity. These results suggest that inhibition of fungal RNA synthesis might be a potential target for antifungal therapy.

Do in vitro susceptibility data predict the microbiologic response to amphotericin B? Results of a prospective study of patients with Candida fungemia

Outcome for 105 patients with candidemia treated with amphotericin B was correlated with amphotericin B in vitro susceptibility results. Thirty-three patients had microbiologic failure, which was defined as persistence of Candida in the bloodstream despite > or = 3 days of amphotericin B. Amphotericin B minimum inhibitory concentrations (MICs) were determined by the National Committee for Clinical Laboratory Standards methodology. After determination of MICs, the minimal lethal concentrations (MLCs) were determined. The isolates tested yielded a narrow range of amphotericin B MICs (0.06-2 microg/mL); only 5% (5/105) exhibited MICs > or = 1 microg/mL. The MLC range, on the other hand, was significantly broader (0.125 to > 16 microg/mL); 24% (25/105) exhibited MLCs > or = 1 microg/mL. The strongest predictor for microbiologic failure was 48-h MLC (P < .001), followed by 24-h MLC (P = .03) and 48-h MIC (P = .11). A resistant break point for amphotericin B of > 1 microg/mL for MLC and > or = 1 microg/mL for MIC could be inferred from this study.

Construction of biologically active protein molecular architecture using self-assembling peptide-amphiphiles

The peptide-amphiphiles described here provide a simple approach for building stable protein structural motifs using peptide head groups. One of the most intriguing features of this system is the possible formation of stable lipid films on solid substrates, or the use of the novel amphiphiles in bilayer membrane systems, where the lipid tail serves not only as a peptide structure-inducing agent but also as an anchor of the functional head group in the lipid assembly. The peptide-amphiphile system potentially offers great versatility with regard to head and tail group composition and overall geometries and macromolecular structures. For building materials with molecular and cellular recognition capacity, it is essential to have a wide repertoire of tools to produce characteristic supersecondary structures at surfaces and interfaces.

Potentiation of antifungal activity of amphotericin B by azithromycin against Aspergillus species

The potential role of azithromycin in combination with amphotericin B against 25 clinical isolates of Aspergillus was assessed. The MIC of amphotericin B was 1 microg/ml for 44% of the isolates, 0.5 microg/ml for 48%, and 0.25 microg/ml for 8%. All isolates were resistant to azithromycin. Synergism, defined as a > or = twofold reduction in the MIC of both drugs upon combination, was demonstrated between amphotericin B and azithromycin for all 25 isolates. To prove that azithromycin exerts its antifungal effect by inhibiting protein synthesis, we studied [35S]-methionine incorporation into protein in one Aspergillus isolate. Neither amphotericin B at 0.125 microg/ml (fourfold below its MIC) nor azithromycin at 16 microg/ml (> or = 16-fold below its MIC) had any effect on protein synthesis when tested alone. Upon combination, however, a 68% inhibition in protein synthesis was evident by the inhibition of [35S]-methionine incorporation.

Controller for an axial-flow blood pump

An axial-flow ventricular assist device (VAD) under development at the authors' facility is intended for use as a long-term implantable device. At high speeds axial-flow VADs can collapse the native ventricle and damage the heart muscle, lung tissue, and blood. A prototype algorithm was developed to maintain physiologic perfusion to the vital organs while preventing ventricular collapse, through analysis of the electrical current waveform of the motor. The premise of the control algorithm is that the hemodynamics of the patient are reflected in the shape of this waveform. This approach is intended to eliminate the need for invasive sensors, thus effectively using the pump itself as a transducer. The control algorithm regulates the speed of the pump by comparing the motor-current waveform with reference waveforms using a matched filter. The matched filter was evaluated by its classification and differentiation performance. Thus far, the authors have been able to classify the waveforms into one of the four physiologic regions (below, within, or above the optimal range, and ventricular suction) with over 90% reliability. Ongoing work is directed toward improving the detection of ventricular suction, as this condition must be strictly avoided.

Effects of moxibustion on blood pressure and renal function in spontaneously hypertensive rats

The aim of this study was to investigate the effects of moxibustion at the meridian points BL-15 (Xin-shu) and BL-27 (Xiao-chang-shu) on renal function, systolic blood pressure, plasma levels of renin activity, aldosterone and atrial natriuretic peptide in spontaneously hypertensive rats. The results showed that urine volume increased significantly after moxibustion at the meridian points BL-15, but decreased at BL-27. Urinary excretion of Na+ decreased after moxibustion at the meridian points BL-15 and BL-27. Systolic blood pressure decreased after moxibustion at the meridian point BL-15. No effect was observed at BL-27. Plasma levels of aldosterone and renin activity increased significantly, but the levels of atrial natriuretic peptide decreased significantly after moxibustion at BL-15. Plasma levels of aldosterone and atrial natriuretic peptide increased significantly after moxibustion at the meridian points BL-27. These results suggest that the meridian points BL-15 and BL-27 are related to the regulation of renal function and the secretion of hormone with body fluid metabolism.

[Surgical approach plus Nd:YAG laser irradiation for the management of hemangioma in deep maxillofacial region]

This article introduces a new method for the management of cavernous hemangioma in deep maxillofacial region.Common surgical approach was carried out to expose the mass of hemangioma,then Nd:YAG laser was irradiated it without tumor removal.Immediatelly shrinking of hemangioma can be seen in all these seven cases.The therapeutic effect was satisfied in 3-12 months follow up.With the basic research of the rabbit facial nerve's Nd:YAG laser injured detecting experiment.We discussed its indication,advantage and interaction between laser and peripheral tissue.Our result shown that this new way is a good method for hemangioma in deep maxillofacial region as its advantages of skin preventing and peripheral normal tissue preserving

Neuroendocrine cells in the cat laryngeal epithelium

The structure and distribution of neuroendocrine cells in the feline laryngeal epithelium were examined using immunohistochemical techniques. Neuroendocrine cells were often spindle shaped, with cytoplasmic processes directed towards the lumen and basement membrane. The apical portion of the cells usually reached the laryngeal lumen with microvillous projections. The cytoplasm always contained variable numbers of electrondense cored vesicles. The number of neuroendocrine cells decreased in the following order: subglottis, posterior glottis, supraglottis, anterior glottis. Neuroendocrine cells contained calcitonin gene-related peptide, substance P and/or 5-hydroxytryptamine. They also showed protein gene product 9.5 or neuron-specific enolase immunoreactivity. These observations suggest that neuroendocrine cells play a part in the regulatory function of the cat larynx by releasing various peptides. These substances may contribute to allergic reactions or control mucus secretion by acting via the endocrine or paracrine pathways and/or neurosecretory pathways.

The effect of endodontic access cavity preparation and subsequent restorative procedures on incisor crown retention

Endodontic treatment often will require access through existing crowns. This study was undertaken to determine whether endodontic access cavity preparation affected the retention of crowns in anterior teeth and then to determine whether this retention can be regained by amalgam or post-retained amalgam restorations. Twenty extracted human incisors were mounted in acrylic blocks and prepared for crowns. Metal copings were fabricated and cemented with zinc phosphate cement and the forces required to displace the copings after various procedures were measured with a tensile testing machine. Retention values for all stages were compared with the initial retentive value for each coping without an access cavity which was set at 100 per cent. Group one specimens had the following means: copings with access cavity, 85.64 +/- 28.65 per cent of the initial values; amalgam flush with lingual dentine, 95.81 +/- 36.2 per cent; amalgam flush with coping, 114.89 +/- 34.5 per cent. Group two means were: copings with access cavity, 89.95 +/- 21.42 per cent; posts and amalgam, 177.37 +/- 77.5 per cent. Statistical analysis with the two sample t test showed that retention with post-retained amalgam restorations showed significantly higher values when compared with access cavities without restorations (p < 0.05). Retention values for post-retained restorations were significantly different from those just using amalgam. This study demonstrated that endodontic access cavities reduced the retention of the crowns, and subsequent restoration with amalgam or a post can regain the retention.(ABSTRACT TRUNCATED AT 250 WORDS)

Intrathoracic extramedullary hematopoiesis simulating posterior mediastinal mass--report of a case in patient with beta-thalassemia intermedia

Intrathoracic involvement of the extramedullary hematopoiesis is a rare condition. It is usually found in patients with thalassemia or hereditary spherocytosis. In the literature, only 79 cases have been reported. Here, in Taiwan, a 22 year-old female patient of beta-thalassemia intermedia presented with posterior mediastinal mass proved as an intrathoracic extramedullary hematopoiesis by thoracoscopic biopsy was reported.