Urinary non-albumin protein-creatinine ratio is an independent predictor of mortality in patients with type 2 diabetes: a retrospective cohort study

Albuminuria is a well-known predictor of chronic kidney disease in patients with type 2 diabetes mellitus (DM). However, proteinuria is associated with chronic complications in patients without albuminuria. In this retrospective cohort study, we explored whether non-albumin proteinuria is associated with all-cause mortality and compared the effects of non-albumin proteinuria on all-cause mortality between patients with and without albuminuria. We retrospectively collected data from patients with type 2 DM for whom we had obtained measurements of both urinary albumin-to-creatinine ratio (UACR) and urinary protein-to-creatinine ratio (UPCR) from the same spot urine specimen. Urinary non-albumin protein-creatinine ratio (UNAPCR) was defined as UPCR-UACR. Of the 1809 enrolled subjects, 695 (38.4%) patients died over a median follow-up of 6.4 years. The cohort was separated into four subgroups according to UACR (30 mg/g) and UNAPCR (120 mg/g) to examine whether these indices are associated with all-cause mortality. Compared with the low UACR and low UNAPCR subgroup as the reference group, multivariable Cox regression analyses indicated no significant difference in mortality in the high UACR and low UNAPCR subgroup (hazard ratio [HR] 1.189, 95% confidence interval [CI] 0.889-1.589, P = 0.243), but mortality risks were significantly higher in the low UACR and high UNAPCR subgroup (HR 2.204, 95% CI 1.448-3.356, P < 0.001) and in the high UACR with high UNAPCR subgroup (HR 1.796, 95% CI 1.451-2.221, P < 0.001). In the multivariable Cox regression model with inclusion of both UACR and UNAPCR, UNAPCR ≥ 120 mg/g was significantly associated with an increased mortality risk (HR 1.655, 95% CI 1.324-2.070, P < 0.001), but UACR ≥ 30 mg/g was not significantly associated with mortality risk (HR 1.046, 95% CI 0.820-1.334, P = 0.717). In conclusion, UNAPCR is an independent predictor of all-cause mortality in patients with type 2 DM.

Hepatitis C virus antibody seropositivity is associated with albuminuria but not peripheral artery disease in patients with type 2 diabetes

Hepatitis C virus (HCV) infection is prevalent in patients with type 2 diabetes mellitus (DM). We aimed to investigate whether HCV antibody (Ab) seropositivity is associated with diabetic micro- and macro-vascular diseases. In this hospital-based cross-sectional study, we retrospectively collected data from patients who participated in the diabetes pay-for-performance program and underwent HCV Ab screening in the annual comprehensive assessment between January 2021 and March 2022. We examined the relationships of HCV Ab seropositivity with the spot urinary albumin-to-creatinine ratio (UACR) and ankle-brachial index (ABI) in patients aged ≥ 50 years with type 2 DM. A total of 1758 patients were enrolled, and 85 (4.83%) of the enrolled patients had HCV Ab seropositivity. Multivariable regression analyses revealed that albuminuria showed a dose-dependent association with HCV Ab seropositivity (UACR [30-299 mg/g]: odds ratio [OR] = 1.463, 95% confidence interval [CI] 0.872‒2.456); UACR [≥ 300 mg/g]: OR = 2.300, 95% CI 1.160‒4.562; P for trend = 0.015) when compared with normal albuminuria (UACR < 30 mg/g). However, the proportion of patients with peripheral arterial disease, defined as an ABI ≤ 0.9, was not significantly different between the groups with and without HCV Ab seropositivity (3.5% vs. 3.9%, P = 0.999). In conclusion, severely increased albuminuria, but not the ABI, showed a significant association with HCV Ab seropositivity in patients aged ≥ 50 years with type 2 DM.

Depressive Symptoms Associated with Peripheral Artery Disease and Predicting Mortality in Type 2 Diabetes

This retrospective cohort study aimed to assess the mortality risk in patients with type 2 diabetes mellitus (DM) by screening for depressive symptoms and peripheral artery disease (PAD). We enrolled patients aged ≥60 years who had undergone assessments of both the ankle-brachial index (ABI) and the five-item Geriatric Depression Scale (GDS-5). PAD and depression were defined as ABI ≤ 0.90 and GDS-5 ≥ 1, respectively. The primary endpoint was total mortality. In 1673 enrolled patients, the prevalence of PAD was higher in those with depression than in those without depression (8.9% vs. 5.7%, p = 0.021). After a median follow-up of 56.6 months (interquartile range: 47.0-62.3 months), a total of 168 (10.0%) deaths occurred. The patients in the depression and PAD subgroup had the highest hazard ratio of mortality, followed by the PAD without depression subgroup and the depression without PAD subgroup (2.209, 95%CI: 1.158-4.217; 1.958, 95%CI: 1.060-3.618; and 1.576, 95%CI: 1.131-2.196; respectively) in comparison to the patients without depression and PAD after adjustment for associated factors. In conclusion, a combination of depression and PAD predicted the highest mortality risk. Screening for depression and PAD is recommended in patients aged ≥60 years with type 2 DM.

Plasma aryl hydrocarbon receptor associated with epicardial adipose tissue in men: a cross-sectional study

BACKGROUND

Epicardial adipose tissue (EAT) is a type of ectopic fat with endocrine and paracrine functions. Aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor that responds to environmental stimuli. AhR expression is associated with obesity. In this cross-sectional study, we aimed to determine the relationship between circulating AhR concentrations and EAT.

METHODS

A total of 30 men with obesity and 23 age-matched men as healthy controls were enrolled. Plasma AhR concentrations were determined at fasting. The EAT thickness was measured on the free wall of the right ventricle from the basal short-axis plane by magnetic resonance imaging.

RESULTS

The participants with obesity had a higher plasma AhR level than the controls (81.0 ± 24.5 vs. 65.1 ± 16.4 pg/mL, P = 0.010). The plasma AhR level was positively correlated with EAT thickness (correlation coefficient = 0.380, P = 0.005). After adjusting for fasting glucose levels, plasma AhR levels were still significantly associated with EAT thickness (95% CI 0.458‒5.357, P = 0.021) but not with body mass index (P = 0.168).

CONCLUSION

Plasma AhR concentrations were positively correlated with EAT thickness on the free wall of the right ventricle in men. Further investigations are needed to evaluate the causal effects and underlying mechanisms between AhR and EAT.

Factors associated with viral rebound among COVID-19 patients receiving oral antivirals

BACKGROUND

COVID-19 rebound is usually reported among patients experiencing concurrent symptomatic and viral rebound. But longitudinal viral RT-PCR results from early stage to rebound of COVID-19 was less characterized. Further, identifying the factors associated with viral rebound after nirmatrelvir-ritonavir (NMV/r) and molnupiravir may expand understanding of COVID-19 rebound.

METHODS

We retrospectively analyzed clinical data and sequential viral RT-PCR results from COVID-19 patients receiving oral antivirals between April and May, 2022. Viral rebound was defined by the degree of viral load increase (ΔCt ≥ 5 units).

RESULTS

A total of 58 and 27 COVID-19 patients taking NMV/r and molnupiravir, respectively, were enrolled. Patients receiving NMV/r were younger, had fewer risk factors for disease progression and faster viral clearance rate compared to those receiving molnupiravr (All P < 0.05). The overall proportion of viral rebound (n = 11) was 12.9%, which was more common among patients receiving NMV/r (10 [17.2%] vs. 1 [3.7%], P = 0.16). Of them, 5 patients experienced symptomatic rebound, suggesting the proportion of COVID-19 rebound was 5.9%. The median interval to viral rebound was 5.0 (interquartile range, 2.0-8.0) days after completion of antivirals. Initial lymphopenia (<0.8 × 10⁹/L) was associated with viral rebound among overall population (adjusted odds ratio [aOR], 5.34; 95% confidence interval [CI], 1.33-21.71), and remained significant (aOR, 4.50; 95% CI, 1.05-19.25) even when patients receiving NMV/r were considered.

CONCLUSION

Our data suggest viral rebound after oral antivirals may be more commonly observed among lymphopenic individuals in the context of SARS-CoV-2 Omicron BA.2 variant.

Impact of the synergistic effect of pneumonia and air pollutants on newly diagnosed pulmonary tuberculosis in southern Taiwan

BACKGROUND

An increased incidence of pulmonary tuberculosis (PTB) among patients with pulmonary diseases exposed to air pollution has been reported.

OBJECTIVE

To comprehensively investigate the association between pneumonia (PN) and air pollution with PTB through a large-scale follow-up study.

METHODS

We conducted a retrospective study using data from the Kaohsiung Medical University Hospital Research Database and the Taiwan Air Quality Monitoring Database. We included adult patients with PN, PTB and other comorbidities according to ICD-9 codes. Control subjects without PN were matched by age, sex and ten comorbidities to each PN patient at a ratio of 4:1.

RESULTS

A total of 82,590 subjects were included. The PTB incidence rate was significantly higher in the PN group (2,391/100,000) than in the control group (1,388/100,000). The crude hazard ratio (HR) of PN-associated PTB incidence decreased with time, and the overall 7 years the HR (95% confidence interval; CI) was 1.74 (1.55-1.96). The overall adjusted HR and 95% CI of PN-related PTB in the multivariate Cox regression analysis was 3.38 (2.98-3.84). In addition, there was a cumulative lag effect of all air pollutants within 30 days of exposure. The peak adjusted HRs for PTB were noted on the 3rd, 8th, 12th and 12th days of PM_2.5, O₃, SO₂ and NO exposure, respectively. The overall peak HRs (95% CI) of PM_2.5, O₃, SO₂ and NO were 1.145 (1.139-1.152), 1.153 (1.145-1.161), 1.909 (1.839-1.982) and 1.312 (1.259-1.367), respectively, and there was a synergistic effect with pneumonia on the risk of PTB.

CONCLUSIONS

A strong association was found between past episodes of PN and the future risk of PTB. In addition, air pollutants including PM_2.5, SO₂, O₃ and NO, together with previous episodes of PN, had both long-term and short-term impact on the incidence of PTB.

Primary hypothyroidism with an episode of ventricular tachycardia in a patient with COVID-19: A case report

RATIONALE

Coronavirus disease 2019 (COVID-19) is a systemic disease with major clinical manifestations in the respiratory system. However, thyroid involvement has also been reported. We present a case of hypothyroidism with ventricular tachycardia following diagnosis with COVID-19.

PATIENT CONCERNS

A 77-year-old man was admitted to the isolation ward due to COVID-19. After respiratory support and medical treatment, the patient was successfully weaned off the ventilator. However, an episode of short-run ventricular tachycardia was detected, and primary hypothyroidism was also diagnosed.

DIAGNOSIS

Ventricular tachycardia was detected by electrocardiography.

INTERVENTIONS

Intravenous amiodarone administration and oral levothyroxine replacement.

OUTCOMES

No arrhythmia detected following treatment.

LESSONS

Awareness of the association between hypothyroidism and COVID-19 is important in preventing possible complications.

Field Study of Postural Characteristics of Standing and Seated Smartphone Use

Prior investigations have been primarily conducted in a laboratory to examine the effects of the smartphone use on the neck and head positions, whether these results are applicable to actual conditions is still unknown. This field survey thus analyzed the neck flexion (NF), head flexion (HF), gaze angle (GA), and viewing distance (VD) of smartphone users in public areas in Taipei, Taiwan. Six hundred smartphone users (300 men and 300 women) were photographed sagittally in standing, supported sitting, or unsupported sitting postures while using a smartphone. Results showed that women had significantly less NF and HF and shorter VDs than male users. Regardless of gender, higher NF was observed for standing than for sitting. Women had similar NF and HF while sitting supported and unsupported, but both were significantly lower than those while standing. By contrast, male users had higher NF and HF during unsupported sitting than during supported sitting. The NF (45°-50°) was much greater than the recommended maximum safe NF of 15°. Women may be at higher risk of visual strain because of shorter VD.

Duration of Treatment in a Weight Loss Program Using a Mobile App is Associated with Successful Weight Loss During the COVID-19 Pandemic

PURPOSE

We aimed to explore the independent factors associated with successful weight loss using a mobile app during the COVID-19 pandemic.

PATIENTS AND METHODS

For this retrospective cohort study, we collected data from 45 adults in a weight loss program using a mobile app. We defined successful weight loss as a weight reduction by ≥ 5% of the baseline weight. Multivariate logistic analysis was used to assess potential factors influencing successful weight loss.

RESULTS

All subjects showed a mean 4.1 ± 4.4 kg reduction of baseline weight after using the app for a mean duration of 11 weeks (P < 0.001). Subjects in the successful weight loss group displayed a longer duration of treatment (14.6 ± 6.5 weeks vs 6.9 ± 6.0 weeks, P < 0.001), greater number of dietary records (109.2 ± 84.7 vs 54.7 ± 58.8, P = 0.002), and greater number of outpatient visits (6.1 ± 2.7 vs 3.7 ± 2.3, P < 0.001) than those in the unsuccessful weight loss group. Multivariate logistic analysis showed that duration of treatment was an independent factor associated with successful weight loss (odds ratio = 1.23, 95% confidence interval: 1.08-1.41, P = 0.003).

CONCLUSION

In a weight management program using a mobile app during the COVID-19 pandemic, the duration of treatment was found to be an independent factor of successful weight loss.

Simplified orthognathic surgical treatment using non-surgical asymmetric maxillary expansion: A case report

BACKGROUND

Transverse problems can be exacerbated by highly compensated occlusion in patients with skeletal asymmetry, which makes pre-surgical decompensation harder to achieve.

OBJECTIVE

This case report describes a case of combined orthognathic surgery with facial asymmetry. We used pre-orthodontic surgical simulation to visualize the goal for presurgical orthodontics, planning for a one-jaw surgical treatment option.

METHODS

The planned asymmetric expansion was performed using a maxillary skeletal expander (MSE II) with surgical corticopuncture over only the left side before MSE activation. Surgery was performed to achieve mandibular left outward yaw rotation to correct the patient's facial asymmetry after the planned amount of expansion was reached.

RESULTS

The results showed substantial improvement of facial aesthetics as well as skeletal symmetry. Cooperation and communication between surgeon and orthodontist ensured that the final results were satisfactory.

Synergistic Association of Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 on the Risk of Abnormal Glucose Regulation

PURPOSE

Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are tumor-associated antigens. An increased serum level of CEA and CA19-9 separately has been reported in diabetes. In this study, we examined the composite effect of elevated serum levels of both CEA and CA19-9 on subjects with type 2 diabetes and prediabetes.

PATIENTS AND METHODS

A total of 3568 adults who attended a health examination were enrolled into this cross-sectional study. Subjects were grouped into four groups according to the median serum CEA and CA19-9 levels.

RESULTS

Subjects with high CEA and high CA19-9 levels had the highest proportions of diabetes (43.9%) and prediabetes (33.04%). There was a statistically significant trend in the proportion of diabetes across the four groups (P < 0.001). Multivariable logistic regression analysis revealed higher risks of type 2 diabetes in subjects with high CEA and low CA19-9 levels (odds ratio [OR] = 2.10, 95% confidence interval [CI]: 1.39-3.18, P < 0.001) and in those with high CA19-9 and low CEA levels (OR = 2.18, 95% CI: 1.42-3.34, P < 0.001) than in those with low CEA and low CA19-9 levels; among these four groups, the highest risk of type 2 diabetes was observed in subjects with high CEA and high CA19-9 levels (OR = 2.65, 95% CI: 1.81-3.88, P < 0.001). The risk of prediabetes was significantly higher only in subjects with high CEA and high CA19-9 levels compared to those with low CEA and low CA19-9 levels (OR = 1.32, 95% CI: 1.08-1.61, P = 0.006).

CONCLUSION

CEA and CA19-9 had a synergistic ability to increase the risk of type 2 diabetes and prediabetes.

367 Combinational use of sodium butyrate and phytogenics on intestinal health of nursery pigs

The effects of encapsulated sodium butyrate (SB), phytogenics (PH), or a combination were studied on intestinal health of nursery pigs. Phytogenics were blends of dry herbs and essential oil components. Forty-eight weaned pigs (21-d-old; 6.9 ± 0.6 kg BW) were individually housed, blocked by initial BW and sex, allotted to 4 dietary treatments (n = 12) in a RCBD, and fed for 33-d (P1: 0–7; P2: 7–19; and P3: 19–33). Treatments were arranged by 2 factors: SB (P1: 0.2% and P2: 0.1%) and PH (P3: 0.033%). Diets were formulated to meet or exceed NRC (2012) nutrient requirements and pigs were fed ad libitum. For each phase, ADG, ADFI, and G:F were measured. Fecal scores were assessed during d 3–19 and d 26–33. Blood samples were drawn in P2 and P3 to measure tumor necrosis factor alpha (TNF-α), IL-6, and immunoglobulin G (IgG). Four pigs at P2 and 8 pigs in P3 from each treatment were euthanized to collect jejunal tissue, jejunal mucosa, and ileal digesta to measure gut histology, TNF-α, IL-6, myeloperoxidase (MPO), malondialdehyde (MDA), and protein carbonyl. Data were analyzed using PROC MIXED of SAS. Fixed effects were treatments and random effects were blocks. In P2 and P1-2, SB decreased (P &lt; 0.05) ADFI whereas no effect on ADG and G:F. In P2, SB tended to decrease (P = 0.063) villus height to crypt depth ratio (VH:CD) whereas increased (P &lt; 0.05) enterocyte proliferation in P3. In P3 and overall, PH increased (P &lt; 0.05) G:F. No changes were found in TNF-α, IL-6, MPO, MDA, IgG, and protein carbonyl. Conclusively, SB and a combinational use of SB and PH showed minimal effects on growth performance and gut health when added to the diets of nursery pigs. However, PH supplementation increased feed efficiency of nursery pigs during 19–33 d post-weaning.

126 Evaluation of true ileal amino acid digestibility of fermented soybean meal fed to nursery pigs

Fermented soybean meal (FSBM) has smaller peptides and reduced anti-nutritional factors compared with those in conventional SBM. Apparent and true ileal digestibilities (AID and TID) of AA in FSBM were measured using both a direct method and a substitution method. Forty eight (24 barrows and 24 gilts) pigs at 7 kg BW were allotted to 4 dietary treatments (n = 12) based on a randomized complete block design with sex and initial body weight as blocks. Treatments includes NFD (semi-purified N free diet to measure endogenous AA loss), NFSB (NFD with 20% FSBM; Genebiotech Co., Ltd. and Nutraferma, Inc), CBD (corn basal diet), and CBSB (CBD at 80% and FSBM at 20%). NFD and NFSB were used to directly measure AID and TID AA of FSBM, whereas NFD, CBD, and CBSB were used to indirectly calculate AID and TID AA of FSBM using a substitution method. Experimental diets included TiO2 (0.4%). Pigs were fed experimental diets for 10 days. Feed allowance was based on 0.09 x BW0.75 kg per day. All pigs were euthanized at the end of the experiments to collect ileal digesta. Diets and ileal digesta were used to quantify TiO2 and AA. Data were analyzed using Mixed Procedure of SAS 9.4. Dietary treatment was the main effect and blocks were random effects. Endogenous AA loss was 2.48 g. When measured by a direct method, AID and TID of Lys, Met, Thr, and Trp were 72.1 and 89.8%, 74.9 and 92.1%, 61.0 and 88.5%, and 72.2 and 92.2%, respectively. When measured by a substitution method, AID and TID of Lys, Met, Thr, and Trp were 64.7 and 84.4%, 60.5 and 77.9%, 36.2 and 57.0%, and 58.2 and 81.0%, respectively. Overall, a direct method showed higher AID and TID AA in FSBM than those measured by a substitution method.

Treating an intramuscular abscess following toothpick injury in a diabetic patient: A case report and literature review (CARE Complaint)

RATIONALE

Toothpick puncture (TPP) is a penetrating injury that can result in bringing pathogens to the deep space. Such penetrating wounds are typically of pinpoint size with initial symptoms appearing subtle. Consequently, the injury itself is often neglected by patients, or is not detected during physical examinations by medical doctors. Reported complications from such injuries include osteomyelitis and septic arthritis, mostly due to delayed treatment.

PATIENT CONCERNS

A diabetic patient aged 83-year-old presented a 2-day history of skin redness, swelling, and tenderness over his forearm following a TPP a week earlier. Laboratory investigations showed leukocytosis with neutrophilic predominance and a high level of C-reactive protein. Before his operation, cultures of aspirated fluid from the injured site revealed the presence of Streptococcus anginosus, Streptococci viridans, Prevotella intermedia, and Pavimonas (Peptostreptococcus) micra.

DIAGNOSIS

Intramuscular abscess associated with toothpick injury.

INTERVENTIONS

Surgical irrigation with debridement and adjunctive antibiotics of ceftriaxone and clindamycin were given with a satisfactory response. Cultures of debrided tissue showed the presence of P intermedia and P (Peptostreptococcus) micra.

OUTCOMES

A split-thickness skin graft was done. Patient was discharged on the 30th postoperative day.

LESSONS

Toothpick injury, initial symptoms of which are subtle, can in some cases, lead to serious complications especially when managements are delayed. In such situations (including the present case), surgical irrigation and debridement are administrated for the eradication of infections, removal of potentially retained toothpick, and tissue cultures analyzed. Adjunctive antibiotics is recommended to combat both the aerobic and anaerobic microorganisms of the gastrointestinal tract, skin surface, and oral cavity.

[Investigation of the cognition and behavior on drug safety in Beijing middle school students]

OBJECTIVE

To understand the cognition and behavior of drug safety in Beijing middle school students and provide advice for relevant education.

METHODS

A cross-sectional survey using paper questionnaires was carried out on the student body of nine Beijing middle schools. Multi-stage proportionate stratified cluster sampling was adopted to enroll participants. In addition to demographic questions, the questionnaire included 17 questions assessing the cognition and behavior of safe drug use, prioritizing questions that aligned with the health education guideline for primary and secondary school students from Chinese Ministry of Education. Descriptive statistical methods were applied using the SAS 9.2 software.

RESULTS

Of the 4 220 students investigated, 2 097(49.7%) were males and 2 123(50.3%) were females. The average age was (14.3±1.7) years. 2 030(48.1%) students were from downtown areas, 1 511(35.8%) were from urban-rural linking areas and 679(16.1%) were from rural areas. Half (51.5%) of the respondents were junior high school students, and the others were from senior high schools (34.2%) and vocational high schools (14.3%). Most of the students (89.6%) lived off campus. The awareness rate of drug safety knowledge was 74.4%, the median score of drug safety behavior was 4 points (full score was 5 points) and there was a statistically positive correlation between the two (Spearman's correlation coefficient was 0.156, P<0.001). Both the awareness rates and the drug safety behavior scores were statistically different among the students in different regions, different school types and different residence types (P<0.001). Multiple factors analysis demonstrated the correlation between the cognition degrees of both drug safety knowledge, behavior and the above factors. Of all the students, 80.4% agreed that any drug could have adverse drug reactions; 40.5% were aware that antibiotics couldn't kill viruses; as many as 49.6% mistook aspirin as antibiotic; 97.4% would read drug instructions before taking them; Only 42.4% put expired drugs into special recycling bins; 49.8% would deviate from the suggested dosage and frequency of their medication when they were sick with common diseases.

CONCLUSION

Overall, the cognition of drug safety in Beijing middle school students is good, but problems still exist in medication adherence, the management of expired drugs and the antibiotics cognition, which need to be fixed through specific, pointed way of education. And more efforts should be made to improve the cognition in rural regions, vocational high schools and on campus students.

Abstract P5-16-09: Overall survival of patients with non-metastatic triple negative breast cancer who received neoadjuvant vs adjuvant chemotherapy: Cohort analysis of National cancer data base (NCDB) 2010 - 2011

Background: One of the benefits of neoadjuvant approach to the treatment of breast cancer is early microscopic disease control, which should translate to improved survival. However, clinical trials have not yet shown a survival benefit for neoadjuvant approach in even high risk patients, such as triple negative cases. Few studies have been performed outside of clinical trials.

Purpose: The objective of our study was to compare the overall survival of Stage I-III triple negative breast cancer patients who received neoadjuvant vs adjuvant chemotherapy within the NCDB, a prospectively collected, large, nationwide, hospital-based cancer outcomes database which contains information for more than 1,500 Commission on Cancer-accredited cancer programs in the U.S.

Patient and Method: We identified a cohort of women, aged &gt; 18 year-old at diagnosis, with clinical stage I-III triple negative breast cancer diagnosed in 2010-2011, who received either neoadjuvant chemotherapy only or adjuvant chemotherapy only. Patients with incomplete or missing vital status, receptors status and treatment information were excluded. Demographic (age at diagnosis, race, ethnicity, comorbidities, insurance, median income, urbanicity), tumor (clinical stage, histology, grade) and treatment (breast surgery, surgical margin, radiation) factors were examined. Stabilized inverse proportion weights were developed and assigned to balance the neoadjuvant and adjuvant groups on all demographic, tumor and treatment covariates. Unadjusted and adjusted overall survival was calculated using the Kaplan-Meier method and compared using the log-rank test.

Results: Among the 15,483 women with triple negative breast cancer, 4,335 (28%) received neoadjuvant chemotherapy and 11,148 (72%) received adjuvant chemotherapy. Most of the demographic, tumor and treatment factors were similarly distributed among neoadjuvant and adjuvant groups except age at diagnosis and clinical stage. Compared to patients received adjuvant chemotherapy, patients received neoadjuvant chemotherapy were more likely to be younger (45% vs. 31% &lt; 50 year-old, p&lt;0.0001) and have a higher clinical stage (35% vs. 6% stage III, p&lt;0.0001). The unadjusted 4-year overall survival of patients received neoadjuvant vs adjuvant approach was 75.8% (95% CI 74.4%-77.4%) and 87.5% (95% CI 87.1%-87.9%), respectively. After adjusting for demographic, tumor and treatment factors, the 4-year overall survival of patients received neoadjuvant vs adjuvant approach was 81.9% (95% CI 79.5%-84.3%) and 85.3% (95% CI 85.2%-85.4%), respectively.

Conclusion: In this NCDB study, the overall survival of triple negative breast cancer patients received neoadjuvant chemotherapy was inferior to those received adjuvant chemotherapy, even after adjusting for demographic, tumor and treatment factors. However, information regarding the chemotherapy regimen used and whether a full course of chemotherapy was delivered (2 factors that affect disease response and outcome) was not available. Patient and tumor factors at the time of disease presentation that are important in determining which triple negative patients will benefit from neoadjuvant approach remain to be defined.

Citation Format: Cheng YC, Smith E, Yen T. Overall survival of patients with non-metastatic triple negative breast cancer who received neoadjuvant vs adjuvant chemotherapy: Cohort analysis of National cancer data base (NCDB) 2010 - 2011 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-09.

[Clinical observation on human alpha glucosidase in treatment of five patients with glycogen storage disease Ⅱ]

Objective: To evaluate the effect of enzyme replacement therapy (ERT) on glycogen storage disease typeⅡ(GSDⅡ). Method: The clinical data of three juvenile onset and two infant onset GSDⅡpatients were collected from First Affiliated Hospital of Sun Yat-sen University in October 2015 to July 2016.Patient 1 was female, the age of onset was 15 months. Patient 2 was male, the age of onset was 20 months. Patient 3 was female, the sister of patient 2, the age of onset was 47 months. Patient 4 was male, the age of onset was 5 months. Patient 5 was male, the age of onset was 1 month.The age at the start of ERT of the 5 patients was 32, 31, 56, 34, and 3 months respectively and the duration of ERT was 19, 9, 4, 5, 5 doses respectively.ERT was administered at 20 mg/kg every 2 weeks.Dexamethasone was regularly given before each infusion. Result: ERT was well tolerated, only one time, Patient 1 developed tachycardia and hypertension without using dexamethasone.Patient 2 underwent successfully ventilator weaning.Patient 1 underwent a tracheotomy, also needed mechanical ventilation treatment.Patient 4 noninvasive ventilation was tried. Conclusion: Recombinant human alpha-glucosidase treatment was effective and well tolerated in patients with GSDⅡ.

The effects of relationship maintenance and relationship investment on self-service technology relationship performance

Purpose

– The purpose of this paper is to extend the utilitarian value of the dedication-based relationship maintenance mechanism of social exchange theory and customer perceived relationship investment to investigate the relationship performance of a retailer launching a self-service technology (SST). Computer anxiety and time consciousness are hypothesized to moderate the effects among these relationships.

Design/methodology/approach

– The results of the structural equation model, with in-store kiosk use experience data collected for 211 respondents, supported the research model. Multiple regression analysis was used for testing the moderating effects.

Findings

– The utilitarian value of dedication-based relationship maintenance is related to perceived relationship investment. Higher levels of customer-perceived relationship investment impact relationship performance. Computer anxiety and time consciousness act separately as both partial and full moderators.

Research limitations/implications

– First, this study did not consider different kinds of products/services to have different effects with regard to customer cognition. Second, most of the respondents were students, and this is a limitation in business research, because of such factors as lower incomes and higher information technology ability as compared to individuals with other occupations. Third, it is difficult to distinguish whether the level of perceived convenience is due to the convenience stores per se or the in-store kiosks that they have. Future research may thus consider analyzing in more detail how perceived convenience is evoked. Finally, future research can consider constraint-based relationship maintenance mechanisms with regard to operating in-store kiosk businesses.

Practical implications

– Retailers who are willing to continually launch SSTs should tie such efforts to their relationship marketing strategies. Moreover, retailers who are willing to launch e-businesses should establish strategies designed to enhance customer experience with regard to the use of technology. Finally, launching SSTs should involve the continual development of an effective purchasing process and functional relationship marketing strategies.

Originality/value

– This paper can help managers organize relationship maintenance mechanisms, especially with regard to the development of user utilitarian value, in order to obtain improved relationship performance.

Heritability of young- and old-onset ischaemic stroke

BACKGROUND AND PURPOSE

Although the genetic contribution to stroke risk is well known, it remains unclear if young-onset stroke has a stronger genetic contribution than old-onset stroke. This study aims to compare the heritability of ischaemic stroke risk between young and old, using common genetic variants from whole-genome array data in population-based samples.

METHODS

This analysis included 4050 ischaemic stroke cases and 5765 controls from six study populations of European ancestry; 47% of cases were young-onset stroke (age < 55 years). To quantify the heritability for stroke risk in these unrelated individuals, the pairwise genetic relatedness was estimated between individuals based on their whole-genome array data using a mixed linear model. Heritability was estimated separately for young-onset stroke and old-onset stroke (age ≥ 55 years).

RESULTS

Heritabilities for young-onset stroke and old-onset stroke were estimated at 42% (±8%, P < 0.001) and 34% (±10%, P < 0.001), respectively.

CONCLUSIONS

Our data suggest that the genetic contribution to the risk of stroke may be higher in young-onset ischaemic stroke, although the difference was not statistically significant.

Beam focalization in reflection from flat dielectric subwavelength gratings

We experimentally demonstrate the recently predicted effect of near-field focusing for light beams from flat dielectric subwavelength gratings (SWGs). This SWGs were designed for visible light 532 nm and fabricated by direct laser writing in a negative photoresist, with the refractive index n=1.5 and the period d=314  nm. The laterally invariant gratings can focus light beams without any optical axis to achieve the transversal invariance. We show that focal distances can be obtained up to 13 μm at normal reflection for TE polarization.

Association of stroke with the receptor-binding profiles of antipsychotics-a case-crossover study

BACKGROUND

Previous research suggests a link between antipsychotic use and stroke, but the relationships between receptor-binding profiles of antipsychotics and the risk of cerebrovascular events are unclear.

METHODS

A total of 14,584 patients with incident stroke were enrolled in the National Health Insurance Research Database in Taiwan from 1998 to 2007. We conducted a case-crossover study to compare the rates of antipsychotic use. The effects of receptor-binding profiles of antipsychotics on stroke risk were estimated, while the moderating effects of age, sex, presence of dementia, and duration of antipsychotic treatment were evaluated by stratified analyses.

RESULTS

The adjusted odds ratio of stroke risk with antipsychotics exposure was 1.60 (95% confidence interval, 1.51-1.69) using a 14-day time window. The use of antipsychotics with a high binding affinity of M1 muscarinic and α2 adrenergic receptors was associated with a greater risk of stroke than the use of other types of antipsychotics. An increased risk of stroke with antipsychotic use was noted in the patients who were older and/or who suffered from dementia. Moreover, our results showed that stroke risk with antipsychotic use was in a dose-related relationship.

CONCLUSIONS

Our findings suggest an association between stroke risk and high M1 muscarinic and α2 adrenergic affinity. The clinical implication is to start antipsychotics treatment at low dosages and to closely monitor the side effects in the initial treatment, particularly for individuals with older age and the presence of dementia.

The origin of the pseudogap in α-Ga

Density functional theory, the free-electron empty lattice approximation and the nearly free-electron approximation are employed to investigate the electronic properties of partially covalent α-Ga. Whereas free-electron-like properties are revealed over a large energy range, a deep pseudogap at the Fermi level is characteristic of α-Ga. We explain the origin of the pseudogap in terms of a delicate interplay between the electronic states and the specific Brillouin zone geometry.

Association of cerebrovascular events with antidepressant use: a case-crossover study

OBJECTIVE

The authors sought to assess the risk of cerebrovascular events associated with use of antidepressant medications.

METHOD

The authors conducted a case-crossover study of 24,214 patients with stroke enrolled in the National Health Insurance Research Database in Taiwan from 1998 to 2007. The authors compared the rates of antidepressant use during case and control time windows of 7, 14, and 28 days. Adjustments were made for time-dependent variables, such as health system utilization and proposed confounding medications. Stratified analyses were performed for valuing the interaction between the stroke risk of antidepressant use and age, sex, presence of mood disorder, stroke type, severity of chronic illness, and duration of antidepressant treatment. A conditional logistic regression model was used to determine the odds of antidepressant use during case time windows.

RESULTS

The adjusted odds ratio of stroke risk with antidepressant exposure was 1.48 (95% confidence interval=1.37-1.59) using 14-day time windows. Stroke risk was negatively associated with the number of antidepressant prescriptions reported. Use of antidepressants with high inhibition of the serotonin transporter was associated with a greater risk of stroke than use of other types of antidepressants.

CONCLUSIONS

These findings suggest that antidepressant use may be associated with an increased risk of stroke. However, the underlying mechanisms remain unclear.

GaN epitaxial layers prepared on nano-patterned Si(001) substrate

We report the growth of GaN epitaxial layer on Si(001) substrate with nano-patterns prepared by dry etching facility used in integrated circuit (IC) industry. It was found that the GaN epitaxial layer prepared on nano-patterned Si(001) substrate exhibits both cubic and hexagonal phases. It was also found that threading dislocation observed from GaN prepared on nano-patterned Si(001) substrate was significantly smaller than that prepared on conventional unpatterned Si(111) substrate. Furthermore, it was found that we can reduce the tensile stress in GaN epitaxial layer by about 78% using the nano-patterned Si(001) substrate.

Addition of GM-CSF to trastuzumab stabilises disease in trastuzumab-resistant HER2+ metastatic breast cancer patients

Background:

One of the proposed mechanisms of trastuzumab-induced regression of human epidermal growth factor receptor 2-positive (HER2+) tumours includes facilitation of antibody-dependent cell-mediated cytotoxicity (ADCC). Granulocyte-macrophage colony-stimulating factor (GM-CSF) mediates ADCC. We presented our pilot study of adding GM-CSF to trastuzumab in patients with trastuzumab-resistant HER2+ metastatic breast cancer.

Methods:

Patients with HER2+ metastatic breast cancer that progressed after trastuzumab +/− chemotherapy were continued on trastuzumab 2 mg kg^–1 intravenous weekly and GM-CSF 250 μg m^–2 subcutaneous daily. Patients were assessed for response every 8 weeks. Treatment was continued until disease progression or intolerable toxicity.

Results:

Seventeen patients were evaluable (median age 48 years, range 27–75 years). The median number of metastatic sites was 2 (range 1–3); the most common site was the liver (n=10). The median number of prior regimens for metastatic disease was 2 (range 1–5). No objective disease response was observed, but five patients (29%) had stable disease for a median duration of 15.8 (range 10–53.9) weeks. The most common adverse event was rash at the injection site. No grade 4 or irreversible adverse event was seen.

Conclusion:

The addition of GM-CSF to trastuzumab alone had a modest clinical benefit and acceptable safety profile in heavily pretreated patients with trastuzumab-resistant HER2+ metastatic breast cancer.

Quaternary ZnCdSeTe nanowires

We report the growth of needle-like high density quaternary ZnCdSeTe nanowires on oxidized Si(100) substrate using vapor-liquid-solid mechanism by molecular beam epitaxy with an Au-based nanocatalyst. It was found that average length and average diameter of the nanowires were 1.3 microm and 91 nm, respectively. It was also found that the as-grown ZnCdSeTe nanowires exhibit mixture of cubic zinc-blende and hexagonal wurtzite structures. Energy depersive results indicate that composition ratio of our nanowire should be Zn0.87Cd0.13Se0.98Te0.02, which agrees excellently with the designated composition ratio of Zn0.87Cd0.13Se0.98Te0.02.

Allogeneic hematopoietic cell transplantation for metastatic breast cancer

We reviewed 66 women with poor-risk metastatic breast cancer from 15 centers to describe the efficacy of allogeneic hematopoietic cell transplantation (HCT). Median follow-up for survivors was 40 months (range, 3-64). A total of 39 patients (59%) received myeloablative and 27 (41%) reduced-intensity conditioning (RIC) regimens. More patients in the RIC group had poor pretransplant performance status (63 vs 26%, P=0.002). RIC group developed less chronic GVHD (8 vs 36% at 1 year, P=0.003). Treatment-related mortality rates were lower with RIC (7 vs 29% at 100 days, P=0.03). A total of 9 of 33 patients (27%) who underwent immune manipulation for persistent or progressive disease had disease control, suggesting a graft-vs-tumor (GVT) effect. Progression-free survival (PFS) at 1 year was 23% with myeloablative conditioning and 8% with RIC (P=0.09). Women who developed acute GVHD after an RIC regimen had lower risks of relapse or progression than those who did not (relative risk, 3.05: P=0.03), consistent with a GVT effect, but this did not affect PFS. These findings support the need for preclinical and clinical studies that facilitate targeted adoptive immunotherapy for breast cancer to explore the benefit of a GVT effect in breast cancer.

Spontaneous fractures in nursing home residents

OBJECTIVES

To evaluate spontaneous long bone fractures occurring in nursing home residents and to identify what factors put them at risk for fractures.

DESIGN

Retrospective study.

SETTING

Department of Orthopaedics and Traumatology of a pubic hospital in Hong Kong.

PATIENTS

A total of 30 nursing home residents who developed spontaneous long bone fractures between 1994 and 2005 were reviewed.

MAIN OUTCOME MEASURES

Demographic data, mechanism of injury, pattern of fractures, associated risk factors, complications, outcomes, and post-treatment status.

RESULTS

The mean age of patients was 84 years. Co-morbidities were as follows: 22 patients were bedridden, 21 required long-term feeding by Ryle's tube, 19 had a history of cerebrovascular accident and 18 of whom had a long bone fracture on the side of the hemiplegia, 15 had dementia, and 25 had lower limb contractures. Closed supracondylar fractures of the femur occurred in 23 patients, 17 of whom presented with limb deformity. In 21 patients, fractures were treated successfully with hinged braces. In one patient, the fracture changed from closed to open. In five patients, the fractures were complicated by sacrum or heel sores, and in one by infected nonunion. In 28 patients, the fractures eventually healed without further complications. Three formerly bedridden patients were able to sit after their fractures had been treated.

CONCLUSIONS

Female nursing home residents who require long-term Ryle's tube feeding, have dementia, hemiplegia, lower limb contractures, osteoporosis, or are bedridden, are at high risk for spontaneous fractures.

Fabrication and field emission property of a Si nanotip array

Using a Si-based porous anodic alumina membrane as a mask, we demonstrate a way to pattern Si surface. After removing the SiO(2) nanoislands formed during anodization of the Al/Si interface, we obtain a Si nanotip array on the surface of a Si wafer. This array shows an excellent field emission property with a low turn-on field of 8.5 V µm(-1). The Fowler-Nordheim plot obtained is linearly dependent, indicating that the emission current arises from the quantum tunnelling effect. The Si nanotip array can be expected to have important applications in nanoelectronic devices.

Optical properties and carrier dynamics of self-assembled GaN/Al(0.11)Ga(0.89)N quantum dots

GaN quantum dots were grown on an Al(0.11)Ga(0.89)N buffer layer by using flow rate modulation epitaxy. The Stranski-Krastanov growth mode was identified by an atomic force microscopy study. The thickness of the wetting layer is about 7.2 monolayers. The temperature dependent photoluminescence studies showed that at low temperature the localization energy, which accounts for de-trapping of excitons, decreases with the reducing dot size. The decrease in emission efficiency at high temperature is attributed to the activation of carriers from the GaN dot to the nitrogen vacancy (V(N)) state of the Al(0.11)Ga(0.89)N barrier layer. The activation energy decreases with reducing dot size.

Coherence in the B800 ring of purple bacteria LH2

We study the quantum coherence in the B800 ring and how it affects the dynamics of excitation energy transfer (EET) in photo-synthetic light-harvesting systems. From an analysis of the spectrum, we determine the disorder parameters for the B800 ring and show that the relatively weak electronic coupling between B800 pigments subtly changes the dynamics of EET and improves the uniformity and robustness of B800 --> B850 EET at room temperature, an example of how a multichromophoric assembly can exploit coherence to optimize the efficiency of photosynthesis. A molecular-level description for the dynamics of EET in the light-harvesting system may prove useful for understanding other nanoscale molecular assemblies and designing efficient nanoscale optical devices.

Markovian Approximation in the Relaxation of Open Quantum Systems

In this paper, we examine the validity of the Markovian approximation and the slippage scheme used to incorporate short time transient memory effects in the Markovian master equations (Redfield equations). We argue that for a bath described by a spectral function, J(omega), that is dense and smoothly spread out over the range omega(d), a time scale of tau(b) approximately 1/omega(d) exists; for times of t > tau(b), the Markovian approximation is applicable. In addition, if J(omega) decays to zero reasonably fast in both the omega --> 0 and omega --> infinity limits, then the bath relaxation time, tau(b), is determined by the width of the spectral function and is weakly dependent on the temperature of the bath. On the basis of this criterion of tau(b), a scheme to incorporate transient memory effects in the Markovian master equation is suggested. Instead of using slipped initial conditions, we propose a concatenation scheme that uses the second-order perturbation theory for short time dynamics and the Markovian master equation at long times. Application of this concatenation scheme to the spin-boson model shows that it reproduces the reduced dynamics obtained from the non-Markovian master equation for all parameters studied, while the simple slippage scheme breaks down at high temperatures.

Neuroradiological findings in atypical teratoid/rhabdoid tumor of the central nervous system

PURPOSE

To evaluate the computed tomography (CT) and magnetic resonance imaging (MRI) findings of atypical teratoid tumor/rhabdoid tumor (AT/RT) of the central nervous system (CNS).

MATERIAL AND METHODS

Twenty cases of CNS AT/RT have been found over the past 23 years in our hospital; these involving 11 boys and 9 girls whose mean age at diagnosis was 5.5 years. Their clinical data, the CT, and MRI findings were reviewed retrospectively.

RESULTS

AT/RT was located in the cerebellum in 15 cases. Four cases arose from the supratentorial region, while only one occurred primarily in the lumbar spinal cord. Almost all cases revealed heterogeneous intensity and heterogeneous enhancement. Peripheral cystic components were common. Survival time ranged from 2 months to 3 years, with a mean survival of 11.6 months.

CONCLUSION

Most cases of AT/RT are located in the cerebellum. The radiologic manifestations are non-specific. The diagnosis mainly depends on the pathologic findings. However, AT/RT should still remain in the differential diagnosis of brain tumors in young children, especially those located in the cerebellar hemisphere and with eccentric cysts.

Process modeling of the lipase-catalyzed dynamic kinetic resolution of (R, S)-suprofen 2,2,2-trifluoroethyl thioester in a hollow-fiber membrane

A Candida rugosa lipase immobilized on polypropylene powder was employed as the biocatalyst for the enantioselective hydrolysis of (R, S)-suprofen 2,2,2-trifluorothioester in cyclohexane, in which trioctylamine was added as the catalyst to perform in situ racemization of the remaining (R)-thioester. A hollow-fiber membrane was also integrated with the dynamic kinetic resolution process in order to continuously extract the desired (S)-suprofen into an aqueous solution containing NaOH. A kinetic model for the whole process (operating in batch and feed-batch modes) was developed, in which enzymatic hydrolysis and deactivation, lipase activation, racemization and non-enantioselective hydrolysis of the substrate by trioctylamine, and reactive extraction of (R)- and (S)-suprofen into the aqueous phase in the membrane were considered. Theoretical predictions from the model for the time-course variations of substrate and product concentrations in each phase were compared with experimental data.

Animal models for the study of HBV infection and the evaluation of new anti-HBV strategies

BACKGROUND

Our aim was to evaluate the anti-HBV activity of a novel L-nucleoside analog, 2',3'-dideoxy-2',3'-didehydro-beta-L-5-fluorocytidine (beta-L-Fd4C), in study models of HBV infection.

METHOD

Its mechanism of action was evaluated on the in vitro expressed duck HBV (DHBV) reverse transcriptase and in primary hepatocyte cultures of duck and human origin. The capacity of antiviral therapy to clear viral infection was analyzed in vivo in the duck and woodchuck models.

RESULTS

beta-L-Fd4C-TP exhibited a more potent inhibitory effect on the RT activity of the DHBV polymerase than other cytidine analogs (lamivudine-TP, ddC-TP, beta-L-FddC-TP). In primary duck hepatocyte cultures, beta-L-Fd4C exhibited a long-lasting inhibitory effect on viral DNA synthesis but could not clear viral cccDNA. In vivo treatment with beta-L-Fd4C in infected ducklings and woodchucks, induced a greater suppression of viremia and intrahepatic viral DNA synthesis than with lamivudine. However, covalently closed circular DNA persistence explained the relapse of viral replication after treatment withdrawal. Viral spread was strongly reduced in the case of early therapeutical intervention, but the number of infected cells did not decline when therapy was started during chronic infection. Liver histology analysis showed a decrease in the inflammatory activity of chronic hepatitis while no ultrastructural modification of liver cells was observed in electron microscopy studies. Furthermore, in human primary hepatocyte cultures, beta-L-Fd4C induced a significant inhibition of HBV DNA synthesis.

CONCLUSION

beta-L-Fd4C is a potent inhibitor of hepadnavirus RT and inhibits viral DNA synthesis in hepatocytes both in vitro and in vivo. These experimental studies allowed as to show that beta-L-Fd4C is a promising anti-HBV agent. Combination therapy should be evaluated to eradicate viral infection.

L-Nucleoside analogues against cancer-causing viruses have potential in the prevention, delayed onset and treatment of viral associated cancers

It has been established that several types of cancers have a strong association with viruses. Thus, a potent antiviral compound without toxicity upon long-term usage will be useful not only for the treatment of viral diseases but also for the prevention or the delayed onset of those cancers that have a strong association with viruses. These compounds, depending upon their mechanism of action, could also potentially be useful for the treatment of those viral-associated cancers. L(-)Deoxynucleoside analogues were discovered in my laboratory and by others as an important class of antiviral and anti-cancer chemical entities. L(-)SddC (3TC, lamivudine), L(-)FTC, L(-)Fd4C, and L(-)FMAU are compounds with potent activity against hepatitis B virus (HBV), but with different biological and pharmacological profiles. These compounds may be useful in the prevention or delayed onset of hepatocellular carcinoma associated with HBV. L(-)I-OddU is a potent anti-Epstein-Barr virus (EBV) compound without cytotoxicity and animal toxicity upon long-term dosing, which allows drug concentration in plasma that are much higher than those that are antivirally active. This compound may have the potential to prevent B-cell lymphoma associated with patients undergoing organ transplants in addition to its potential use for the treatment of EBV infection. Furthermore, it may also be useful for the treatment of EBV-associated cancers. In this manuscript, the metabolism, mechanism of action and the resistance, as well as the potential use of this class of compounds targetted against HBV, will be discussed.

Synthesis of halogen-substituted 3-deazaadenosine and 3-deazaguanosine analogues as potential antitumor/antiviral agents

Various 2-halogen-substituted analogues (38, 39, 43 and 44), 3-halogen-substituted analogues (51 and 52), and 2',3'-dihalogen-substituted analogues (57-60) of 3-deazaadenosine and 3-halogen-substituted analogues (61 and 62) of 3-deazaguanosine have been synthesized as potential anticancer and/or antiviral agents. Among these compounds, 3-deaza-3-bromoguanosine (62) showed significant cytotoxicity against L1210, P388, CCRF-CEM and B16F10 cell lines in vitro, producing IC50 values of 3, 7, 9 and 7 microM, respectively. Several 3-deazaadenosine analogues (38, 51, 57 and 59) showed moderate to weak activity against hepatitis B virus.

Predicting BOLD signal changes as a function of blood volume fraction and resolution

The appropriate choice of resolution in fMRI remains an open question. To address this issue, we simulate the signal change between activated and resting states as a function of blood volume fraction (lambda). From these results, the relative contrast-to-noise ratio (CNR) from the resting to the activated state can be calculated as a function of resolution. We consider different vessel orientations and note that, in most cases, the most efficient scanning procedure is for low resolution imaging. To overcome this limitation, a T(1) enhancing contrast agent is proposed to increase the signal from the blood and, hence, the intravascular contribution to the BOLD effect. We show that this effect dramatically increases both the signal changes and the efficiency of high-resolution imaging and should lead to much better visualization and localization of parenchymal changes.

Were there enough physicians in an emergency department in the affected area after a major earthquake? An analysis of the Taiwan Chi-Chi earthquake in 1999

STUDY OBJECTIVE

The purpose of this study was to evaluate physician manpower and mobilization in an urban emergency department receiving patients after a major earthquake.

METHODS

Patient charts were reviewed. The workload of physicians was assessed semiquantitatively before and after a major earthquake. The physicians' mobilization in the postearthquake emergency response was assessed by using a confidential questionnaire.

RESULTS

In the 3 days after the earthquake, 566 patients with earthquake-related illnesses or injuries were sent to the urban ED. Three hundred one (53.2%) patients arrived within the initial 10 hours. In the initial hours, there was no significant difference between the number of patients per physician per hour before and after the earthquake. Workloads of wound treatment and advanced life support procedures were significantly higher after the earthquake compared with before the earthquake, during the first to sixth hour and second to fifth hour, respectively. Sixty-five percent of the hospital's physicians did not assist in either the ED or in any other parts of the hospital in the initial 6 hours after the earthquake.

CONCLUSION

The number of physicians in the ED was insufficient in the initial hours after the earthquake because of the sudden influx of a large number of patients. Future disaster planning must address the issue of physicians' behavior with regard to their priorities immediately after a major earthquake and include greater provision for efficient mobilization of physicians.

Synthesis and biological evaluation of L- and D-configurations of 2',3'-dideoxy-4'-C-methyl-3'-oxacytidine analogues

Novel L- and D-configuration 2',3'-dideoxy-4'-C-methyl-3'-oxacytidine and their 5-fluoro analogues have been synthesized from 1-benzyloxy-2-propanone and L-ascorbic acid in eight steps and evaluated for biological activity.

An exact form for the magnetic field density of states for a dipole

We present an analytical form for the density of states for a magnetic dipole in the center of a spherical voxel. This analytic form is then used to evaluate the signal decay as a function of echo time for different volume fractions and susceptibilities. The decay can be considered exponential only in a limited interval of time. Otherwise, it has a quadratic dependence on time for short echo times and an oscillatory decaying behavior for long echo times.

Sox8 gene expression identifies immature glial cells in developing cerebellum and cerebellar tumours

Sox8 is a member of the E subgroup of Sox genes, the other members of which are Sox9 and Sox10, both of which are implicated in specific human disorders. Recently, Sox8 homologues have been cloned in chick, mouse and human and have been shown to be strongly expressed in the embryonic and adult brain. Nevertheless, the cell types that express Sox8 have not been determined. We show here that Sox8 is expressed in immature glia in the developing cerebellum. Sox8 is also expressed in scattered cells in the cerebellar tumour, medulloblastoma. This gene therefore provides an early glial marker that may provide more detailed insight into the cellular makeup and consequent behaviour of medulloblastomas.

Prenatal diagnosis of cleft palate by three-dimensional ultrasound

Prenatal diagnosis of cleft palate is very important to prenatal consultation and management after birth. To examine if three-dimensional (3-D) ultrasound (US) is an accurate diagnostic method for clinical use, we analyzed our experience in detecting cleft palate by 3-D US. From June 1996 to January 2000, 21 fetuses with facial clefts were scanned by 2-D US, as well as by 3-D US. The coronal and oblique planes were reconstructed by 3-D US to detect the cleft palate. In addition, level II US was performed to find any possibly associated anomalies. All the scans were recorded on optic disks for final analysis. In our study, the gestational age when prenatal diagnosis was made by US initially was between 20 and 34 weeks. The accuracy for prenatal diagnosis of cleft lip with or without cleft palate by 3-D US was 100%, which was superior to that by 2-D US (p < 0.05). In addition, we proposed a novel method to evaluate the cleft palate systemically by 3-D US. In conclusion, from our study, fetuses with cleft lip combined with or without cleft palate can be easily differentiated by 3-D US. The reconstruction of coronal and oblique planes by 3-D US is a powerful tool for detecting cleft palate.

Dysfunctional regulation of endothelial nitric oxide synthase (eNOS) expression in response to exercise in mice lacking one eNOS gene

BACKGROUND

Previous data suggest that 1 endothelial NO synthase (eNOS) gene is sufficient to allow normal expression and function of eNOS under basal conditions. We hypothesized that this might not hold true for conditions known to increase eNOS gene expression, such as exercise.

METHODS AND RESULTS

Male mice heterozygous for a disruption of the eNOS gene (eNOS(+/)(-)) and normal C56Bl/6J mice (eNOS(+/+)), 3 to 4 months of age, underwent exercise training for 3 weeks. Nontrained mice were exposed to the exercise environment (noise and vibration of the treadmill) without exercise for an identical period. In eNOS(+/+) mice (n=7), exercise increased aortic eNOS protein expression by 3.4+/-0.4-fold (P<0.002). This was associated with a greater vascular cGMP accumulation on stimulation with acetylcholine (P<0.05). Furthermore, exercise training increased eNOS mRNA (1.78+/-0.4-fold) and protein (1.76+/-0.17-fold) in left ventricular tissue, as determined by competitive reverse transcription-polymerase chain reaction and Western analysis (P<0.05 for both). In striking contrast, exercise had no effect on aortic eNOS expression and cGMP accumulation in eNOS(+/)(-) mice (P>0.05). Thus, although eNOS expression appears to be normal in eNOS(+/)(-) mice under basal conditions, these mice are unable to increase eNOS expression during exercise.

CONCLUSIONS

These findings show that regulation of eNOS expression during exercise requires the presence of both alleles of the gene and may have implications for conditions in which polymorphisms of eNOS are present in only 1 allele in humans. These individuals may have a normal vascular reactivity under basal conditions but may be unable to adapt their vascular reactivity in response to exercise training.