Transforming free-text radiology reports into structured reports using ChatGPT: A study on thyroid ultrasonography

PURPOSE

The importance of structured radiology reports has been fully recognized, as they facilitate efficient data extraction and promote collaboration among healthcare professionals. Our purpose is to assess the accuracy and reproducibility of ChatGPT, a large language model, in generating structured thyroid ultrasound reports.

METHODS

This is a retrospective study that includes 184 nodules in 136 thyroid ultrasound reports from 136 patients. ChatGPT-3.5 and ChatGPT-4.0 were used to structure the reports based on ACR-TIRADS guidelines. Two radiologists evaluated the responses for quality, nodule categorization accuracy, and management recommendations. Each text was submitted twice to assess the consistency of the nodule classification and management recommendations.

RESULTS

On 136 ultrasound reports from 136 patients (mean age, 52 years ± 12 [SD]; 61 male), ChatGPT-3.5 generated 202 satisfactory structured reports, while ChatGPT-4.0 only produced 69 satisfactory structured reports (74.3 % vs. 25.4 %, odds ratio (OR) = 8.490, 95 %CI: 5.775-12.481, p < 0.001). ChatGPT-4.0 outperformed ChatGPT-3.5 in categorizing thyroid nodules, with an accuracy of 69.3 % compared to 34.5 % (OR = 4.282, 95 %CI: 3.145-5.831, p < 0.001). ChatGPT-4.0 also provided more comprehensive or correct management recommendations than ChatGPT-3.5 (OR = 1.791, 95 %CI: 1.297-2.473, p < 0.001). Finally, ChatGPT-4.0 exhibits higher consistency in categorizing nodules compared to ChatGPT-3.5 (ICC = 0.732 vs. ICC = 0.429), and both exhibited moderate consistency in management recommendations (ICC = 0.549 vs ICC = 0.575).

CONCLUSIONS

Our study demonstrates the potential of ChatGPT in transforming free-text thyroid ultrasound reports into structured formats. ChatGPT-3.5 excels in generating structured reports, while ChatGPT-4.0 shows superior accuracy in nodule categorization and management recommendations.

[Diagnostic value of high frequency oscillation in localization of type Ⅱ focal cortical dysplasia epilepsy]

Retrospective analysis was conducted on 9 patients with type Ⅱ focal cortical dysplasia (FCD) who underwent stereo-electroencephalography (SEEG) implantation in the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from November 2020 to February 2023. The onset area, onset time, and frequency of high-frequency oscillations (HFO) were analyzed and the correlation of HFOs with interictal, preictal, and ictal periods. SEEG recordings of 80-500 Hz HFOs were observed in both interictal and ictal periods in 9 patients, with 6 patients exhibiting fast ripples (FR) in the range of 250-500 Hz. Surgical resection of the seizure onset area and FR-generating electrodes was performed, and postoperative follow-up for over 2 years indicated Engel I in 5 cases. 6 patients showed continuous discharge during the preictal period, and the distribution index of continuous discharge was positively correlated with seizure frequency. HFOs in the range of 80-500 Hz were present in all four seizure onset patterns during the ictal period. The onset area and FR-emitting electrode were surgically removed in 6 patients with continuous discharge and overlapping HFOs during the preictal period, with 5 cases of Engel I. Type Ⅱ FCD discharges exhibited complexity, high discharge indices, and a close association with HFOs. Compared with the spike wave, the electrode range of HF is more limited, and the incidence of HF before attack is significantly increased, which is closely correlated with the onset area. The simultaneous occurrence of HFO and the spike waves has higher diagnostic value than the individual occurrence, effectively enhancing surgical efficacy.

Efficacy and safety of bicyclol for treating patients with antituberculosis drug-induced liver injury

BACKGROUND: Bicyclol was used for treating idiosyncratic acute drug-induced liver injury (DILI) in a phase II trial. This study was aimed at evaluating the efficacy and safety of bicyclol 25 and 50 mg thrice a day (TID) for treating acute DILI caused by anti-TB drugs in the light of the trial results.METHODS: We analysed clinical data of patients with TB drug-induced DILI in the trial database. The primary endpoint was reduction in serum alanine aminotransferase (ALT) levels after 4 weeks of treatment compared to baseline.RESULTS: Overall, 148 patients were included, with respectively 48, 52 and 48 patients included in the control (456 mg polyene phosphatidylcholine TID), high-dose (50 mg bicyclol TID) and low-dose (25 mg bicyclol TID) groups. ALT levels decreased by respectively â-"149.0 (IQR â-"299.3 to â-"98.3 (), â-"225.5 (IQR â-"309.3 to â-"181.8 ) and â-"242.5 (IQR â-"364.8 to â-"153.8) U/L in the control, high-dose and low-dose groups (P < 0.001). The ALT normalisation rates at weeks 1, 2, 4, 6 and 8 were higher in the high- and low-dose groups, while adverse events and serious adverse events were similar across groups.CONCLUSIONS: Bicyclol (25 and 50 mg TID) is effective and safe in treating anti-TB DILI, and bicyclol 50 mg TID showed higher efficacy.

Generalizability and Diagnostic Performance of AI Models for Thyroid US

Background Artificial intelligence (AI) models have improved US assessment of thyroid nodules; however, the lack of generalizability limits the application of these models. Purpose To develop AI models for segmentation and classification of thyroid nodules in US using diverse data sets from nationwide hospitals and multiple vendors, and to measure the impact of the AI models on diagnostic performance. Materials and Methods This retrospective study included consecutive patients with pathologically confirmed thyroid nodules who underwent US using equipment from 12 vendors at 208 hospitals across China from November 2017 to January 2019. The detection, segmentation, and classification models were developed based on the subset or complete set of images. Model performance was evaluated by precision and recall, Dice coefficient, and area under the receiver operating characteristic curve (AUC) analyses. Three scenarios (diagnosis without AI assistance, with freestyle AI assistance, and with rule-based AI assistance) were compared with three senior and three junior radiologists to optimize incorporation of AI into clinical practice. Results A total of 10 023 patients (median age, 46 years [IQR 37-55 years]; 7669 female) were included. The detection, segmentation, and classification models had an average precision, Dice coefficient, and AUC of 0.98 (95% CI: 0.96, 0.99), 0.86 (95% CI: 0.86, 0.87), and 0.90 (95% CI: 0.88, 0.92), respectively. The segmentation model trained on the nationwide data and classification model trained on the mixed vendor data exhibited the best performance, with a Dice coefficient of 0.91 (95% CI: 0.90, 0.91) and AUC of 0.98 (95% CI: 0.97, 1.00), respectively. The AI model outperformed all senior and junior radiologists (P < .05 for all comparisons), and the diagnostic accuracies of all radiologists were improved (P < .05 for all comparisons) with rule-based AI assistance. Conclusion Thyroid US AI models developed from diverse data sets had high diagnostic performance among the Chinese population. Rule-based AI assistance improved the performance of radiologists in thyroid cancer diagnosis. © RSNA, 2023 Supplemental material is available for this article.

Identification of SCAR markers for genetic authentication of Dendrobium nobile Lindl

Dendrobium nobile Lindl. is an orcid plant with important medicinal values. This is a colourful houseplant, and also a popular herb in traditional Chinese medicine (TCM). The variants of this plant from different geographic regions might be high, and in this study, we aimed to develop specific sequence characterized amplified region (SCAR) markers for the identification of specific variant of this plant. Different cultivars of D. nobile were collected from nine different places of China, and one cultivar from Myanmar. DNA materials were extracted from the plant samples, random amplified polymorphic DNA (RAPD) were developed, cloned and sequenced for the development of SCAR markers. We have developed four SCAR markers, which are specific to the cultivar from Luzhou China, and clearly distinguishable (genetically) from other cultivars. These SCAR markers are deposited in GenBank (accession number MZ417502, MZ484089, MZ417504 and MZ417505). Four SCAR markers for D. nobile are effective molecular technique to genetically identify the different cultivars or species, and this method is applicable for genetic characterization and identification of other plant species too.

Increased risk of diabetes in cancer survivors: a pooled analysis of 13 population-based cohort studies

BACKGROUND

Diabetes is considered as an established risk factor for cancer development. However, the link between diabetes among cancer survivors remains inconclusive. The hypothesis of this study was to assess the hazard ratio (HR) of incidence of diabetes in cancer survivors compared with the HR in the general population.

PATIENTS AND METHODS

A comprehensive literature search was performed in PubMed, Embase, and the Cochrane Library from database inception to 15 December 2020 for population-based cohort studies. Summary effect estimates were combined using random-effects models. We also performed subgroup analyses to test sources of heterogeneity and the stability of the results stratified by various study and participant characteristics.

RESULTS

Thirteen population-based cohort studies involving 1 686 595 participants were analyzed. The HR for the development of diabetes in cancer survivors was 1.39 [95% confidence interval (CI) 1.29-1.50; I2 = 82.3%; P < 0.001] compared with that in noncancer controls, among which survivors of hematological, gynecologic, breast, colorectal and urinary tract cancer (all P < 0.05) showed consistent significant results, whereas no significant increased risk was observed for other cancer types. The effects were more prominent in populations of shorter cancer survival duration (<1 year) (HR 2.09, 95% CI 1.32-3.32; P = 0.009). Moreover, cancer survivors with a longer follow-up period (>10 years) had a relatively higher risk of diabetes (HR 1.54, 95% CI 1.34-1.77) than those with a shorter follow-up period.

CONCLUSIONS

In this large pooled analysis of population-based cohorts, evidence supports the hypothesis that the risk of developing diabetes is increased in cancer survivors compared with the general population. We should interpret the results with caution for considerable interstudy heterogeneity. However, health policy makers should take this as a challenge for the early prevention and effective intervention of diabetes.

Increased TEAD4 expression and nuclear localization in colorectal cancer promote epithelial-mesenchymal transition and metastasis in a YAP-independent manner

Dysregulation of the Hippo pathway occurs in a variety of cancers and often correlates with a poor prognosis. To further explore the potential role of Hippo pathway dysregulation in tumor development and progression, we investigated its downstream transcription factor TEAD4 in colorectal cancer (CRC). Increased expression and nuclear localization of TEAD4 were found in a significant portion of CRC tissues, in association with metastasis and a poor prognosis. In CRC cells, TEAD4 knockdown induced the mesenchymal-epithelial transition and decreased cell mobility in vitro and metastasis in vivo. Microarray analysis revealed that TEAD4 promoted cell adhesion and upregulated the epithelial-mesenchymal transition-related transcriptome in CRC cells. Vimentin was identified as a new direct target gene mediating TEAD4 function in CRC cells, whereby forced vimentin expression markedly reversed TEAD4-knockdown-induced cell morphological changes and decreased mobility. Interestingly, rescued expression of both WT TEAD4 and a Y429H mutant can reverse the mesenchymal-epithelial transition and increase vimentin expression, cell mobility and metastatic potential in TEAD4-knockdown CRC cells. The discrepant expression of YAP and TEAD4 in CRC tissues, the rescue ability of TEAD4 mutant defect in YAP binding and no effect on vimentin expression by YAP knockdown in CRC cells, all implicated a YAP-independent manner of TEAD4 function in CRC. Furthermore, vimentin positively correlated and CDH1 reversely correlated with the level of TEAD4 in CRC tissues and xenograft tumors. Our results suggest that TEAD4 nuclear expression can serve as a biomarker for CRC progression and poor prognosis. The transcription factor TEAD4 regulates a pro-metastasis transcription program in a YAP-independent manner in CRC, thus providing a novel mechanism of TEAD4 transcriptional regulation and its oncogenic role in CRC, independently of the Hippo pathway.

High-intensity focused ultrasound ablation: an effective and safe treatment for secondary hypersplenism

OBJECTIVE

Hypersplenism is a common disease. The conventional treatment is splenectomy and partial splenic embolization; however, both of them have high complication rates and technical defects. Therefore, safer and more effective techniques should be considered for the treatment of hypersplenism. High-intensity focused ultrasound (HIFU) may provide an effective and safe way for treatment of hypersplenism. Therefore, we conducted this study to assess the safety and efficacy of HIFU in treatment of secondary hypersplenism.

METHODS

A total of 28 patients who suffered from secondary hypersplenism were treated with HIFU ablation. All patients who underwent HIFU were closely followed-up over a year. MRI scan was performed, and the spleens were observed. Blood counts and liver function tests were also carried out.

RESULTS

In the follow-up process, the levels of white blood cells and platelets in the blood after HIFU were significantly higher than those before HIFU, liver function also improved after HIFU treatment. In addition, the symptoms were ameliorated significantly or even disappeared. The MRI showed that the ablation area had turned into a non-perfused volume, and after 12 months of HIFU ablation, the ablated area shrank evidently; the sunken spleen formed a lobulated shape and the splenic volume decreased.

CONCLUSION

HIFU ablation is a safe, effective and non-invasive approach for secondary hypersplenism.

ADVANCES IN KNOWLEDGE

For the first time we used HIFU ablation to treat secondary hypersplenism. It not only expands indications of HIFU but also provides better choice for the treatment of secondary hypersplenism.

Tumour-infiltrating inflammation and prognosis in colorectal cancer: systematic review and meta-analysis

Background:

The role of tumour-infiltrating inflammation in the prognosis of patients with colorectal cancer (CRC) has not been fully evaluated. The primary objective of our meta-analysis was to determine the impact of tumour-infiltrating inflammation on survival outcomes.

Methods:

Ovid MEDLINE and EMBASE were searched to identify studies reporting the prognostic significance of tumour-infiltrating inflammation for patients with CRC. The primary outcome measures were overall survival (OS), cancer-specific survival (CS) and disease-free survival (DFS).

Results:

A total of 30 studies involving 2988 patients were identified. Studies were subdivided into those considering the associations between CRC survival and generalised tumour inflammatory infiltrate (n=12) and T lymphocyte subsets (n=18). Pooled analyses revealed that high generalised tumour inflammatory infiltrate was associated with good OS (HR, 0.59; 95% CI, 0.48–0.72), CS (HR, 0.40; 95% CI, 0.27–0.61) and DFS (HR, 0.72; 95% CI, 0.57–0.91). Stratification by location and T lymphocyte subset indicated that in the tumour centre, CD3⁺, CD8⁺ and FoxP3⁺ infiltrates were not statistically significant prognostic markers for OS or CS. In the tumour stroma, high CD8⁺, but not CD3⁺ or FoxP3⁺ cell infiltrates indicated increased OS. Furthermore, high CD3⁺ cell infiltrate was detected at the invasive tumour margin in patients with good OS and DFS; and high CCR7⁺ infiltrate was also indicated increased OS.

Conclusion:

Overall, high generalised tumour inflammatory infiltrate could be a good prognostic marker for CRC. However, significant heterogeneity and an insufficient number of studies underscore the need for further prospective studies on subsets of T lymphocytes to increase the robustness of the analyses.

Change of cholinergic transmission and memory deficiency induced by injection of beta-amyloid protein into NBM of rats

The change of cholinergic transmission of beta-amyloid protein (beta-AP) treated rats was studied by intracerebral microdialysis sampling combined with HPLC analysis. beta-AP(1-40) was injected into nucleus basalis magnocellularis (NBM). Passive avoidance response test (step-down test) and delayed alternation task were used for memory testing. The impairment of memory after injection of beta-AP(1-40) into NBM exhibited mainly the deficiency of short-term working memory. One week after injection of beta-AP(1-40) the release of acetylcholine (ACh) from frontal cortex of freely-moving rats decreased significantly, and the response of cholinergic nerve ending to the action of high [K(+)] solution was rather weak. In control animals the percentage of increase of ACh-release during behavioral performance was 57%, while in beta-AP(1-40)-treated rats it was 34%. The temporary increase of the ACh-release of the rat put into a new place was also significantly diminished in beta-AP(1-40) -treated rats. The results show that the injection of beta-AP(1-40) into NBM impairs the cholinergic transmission in frontal cortex, and the impairment of cholinergic transmission may be the main cause of the deficit of working memory.

Relation of BMI to fat and fat-free mass among children and adolescents

OBJECTIVE

Although the body mass index (BMI, kg/m2) is widely used as a surrogate measure of adiposity, it is a measure of excess weight, rather than excess body fat, relative to height. We examined the relation of BMI to levels of fat mass and fat-free mass among healthy 5- to 18-y-olds.

METHODS AND PROCEDURES

Dual-energy X-ray absorptiometry was used to measure fat and fat-free mass among 1196 subjects. These measures were standardized for height by calculating the fat mass index (FMI, fat mass/ht2) and the fat-free mass index (FFMI, fat-free mass/ht2).

RESULTS

The variability in FFMI was about 50% of that in FMI, and the accuracy of BMI as a measure of adiposity varied greatly according to the degree of fatness. Among children with a BMI-for-age > or =85th P, BMI levels were strongly associated with FMI (r=0.85-0.96 across sex-age categories). In contrast, among children with a BMI-for-age <50th P, levels of BMI were more strongly associated with FFMI (r=0.56-0.83) than with FMI (r=0.22-0.65). The relation of BMI to fat mass was markedly nonlinear, and substantial differences in fat mass were seen only at BMI levels > or =85th P.

DISCUSSION

BMI levels among children should be interpreted with caution. Although a high BMI-for-age is a good indicator of excess fat mass, BMI differences among thinner children can be largely due to fat-free mass.

Peptide derived from insulin with regulatory activity of dopamine transporter

A nonapeptide derived from the C terminus of the insulin B chain, H(2)N-Arg-Gly-Phe-Phe-Tyr-Thr-Pro-Lys-Ala-COOH, was found to strongly inhibit dopamine (DA) uptake by rat dopamine transporter (DAT) stably expressed in CHO cells (designated D8 cells). The kinetic experiments on D8 cells gave a curve typical of competitive inhibition with an IC(50)=6.9 microM. This inhibitory effect was also confirmed by experiments on striatal synaptosomes. The rat administered with the nonapeptide unilaterally into substantia nigra showed dose-dependent velocity and duration of the round movement contralateral to the nonapeptide-injected side. In addition, the nonapeptide dose-dependently reduced the binding of the tritium-labeled cocaine analog (-)-2 beta-carbomethoxy-3 beta-(4-fluorophenyl)tropane (WIN35,428) to DAT of D8 cells, which suggests that the nonapeptide may inhibit the transport activity of DAT in the way as cocaine does. Meanwhile, the peptide DOI (insulin with 8 amino acid residues deleted at the C terminus of the B chain) shows a significantly stimulating effect on DAT uptake activity in D8 cells. So insulin is proposed as a kind of neuropeptide precursor in the brain and insulin-derived peptides may be involved in the process of regulating the DA system, and these peptides may be developed into new medicines for disorders concerning the DA system such as Parkinson's disease and cocaine addiction.

Molecular studies and prenatal diagnosis of phenylketonuria in Chinese patients

Phenylketonuria (PKU) is one of the most common inborn errors of metabolic disorders. Although PKU induced mental retardation can be prevented after neonatal screening by following treatment with low phenylalanine diet, some parents are seeking prenatal diagnosis. We screened for mutations in exon 3 and 7 of the PAH gene using the DGGE and restriction enzyme method, in combination with STR linkage analysis. Prenatal diagnosis was carried out in 8 PKU families. With this strategy, we are able to make prenatal diagnosis in about 65-70% PKU families. All diagnosis was confirmed in the newborn.

Transgenic expression of CD40L and interleukin-2 induces an autologous antitumor immune response in patients with non-Hodgkin's lymphoma

The malignant B cells of non-Hodgkin's lymphoma (B-NHL cells) express peptides derived from tumor-specific antigens such as immunoglobulin idiotypes, and also express major histocompatibility complex antigens. However, they do not express co-stimulatory molecules, which likely contributes to their protection from host antitumor immunity. To stimulate NHL-specific immune responses, we attempted to transfer the human CD40 ligand (hCD40L) gene to B-NHL cells and enhance their co-stimulatory potential. We found that an adenoviral vector encoding human CD40L (AdhCD40L) was ineffective at transducing B-NHL cells because these cells lack the coxsackievirus B-adenovirus receptor and alpha(v) integrins. However, preculture of the B-NHL cells with the human embryonic lung fibroblast line, MRC-5, significantly up-regulated expression of integrin alpha(v)beta 3 and markedly increased their susceptibility to adenoviral vector transduction. After prestimulation, transduction with AdhCD40L increased CD40L expression on B-NHL cells from 1.3+/-0.2% to 40.8+/-11.9%. Transduction of control adenoviral vector had no effect. Expression of transgenic human CD40L on these CD40-positive cells was in turn associated with up-regulation of other co-stimulatory molecules including B7-1/-2. Transduced B-NHL cells were now able to stimulate DNA synthesis of autologous T cells. However, the stimulated T cells were unable to recognize unmodified lymphoma cells, a requirement for an effective tumor vaccine. Based on previous results in an animal model, we determined the effects of combined use of B-NHL cells transduced with AdhCD40L and AdhIL2 vectors. The combination enhanced initial T-cell activation and generated autologous T cells capable of specifically recognizing and killing parental (unmodified) B-NHL cells via major histocompatibility complex--restricted cytotoxic T lymphocytes. These findings suggest that the combination of CD40L and IL2 gene-modified B-NHL cells will induce a cytotoxic immune response in vivo directed against unmodified tumor cells.

Autologous antileukemic immune response induced by chronic lymphocytic leukemia B cells expressing the CD40 ligand and interleukin 2 transgenes

Although the B cells of chronic lymphocytic leukemia (B-CLL cells) express both tumor-specific peptides and major histocompatibility complex (MHC) class I antigens, they lack the capacity for costimulatory signaling, contributing to their protection against host antitumor immunity. To stimulate CLL-specific immune responses, we sought to transfer the human CD40 ligand (hCD40L) gene to B-CLL cells, using an adenoviral vector, in order to upregulate costimulating factors on these cells. Because efficient gene transduction with adenoviral vectors requires the expression of virus receptors on target cells, including the coxsackievirus B-adenovirus receptors (CAR) and alpha(v) integrins, we cocultured B-CLL cells with human embryonic lung fibroblasts (MRC-5 line). This exposure led to increased expression of integrin alpha(v)beta3 on B-CLL cells, which correlated with higher transduction rates. Using this novel prestimulation system, we transduced B-CLL cells with the hCD40L gene. The Ad-hCD40L-infected cells had higher expression of B7 molecules and induced activation of autologous T cells in vitro, but these T cells could not recognize parental leukemic cells. By contrast, an admixture of Ad-hCD40L-positive cells and leukemic cells transduced with the human interleukin 2 (IL-2) gene produced greater T cell activation than did either immunostimulator population alone. Importantly, this combination generated autologous T cells capable of specifically recognizing parental B-CLL cells. These findings suggest that the combined use of genetically modified CD40L-expressing B-CLL cells in combination with IL-2-expressing B-CLL cells may induce therapeutically significant leukemia-specific immune responses.

Continuation of the decline in prevalence of anemia in low-income infants and children in five states

OBJECTIVE

To examine whether there is a continuation of the decline in prevalence of anemia among low-income infants and children 6.0 to 59.9 months old from the early 1980s to the mid-1990s.

STUDY DESIGN

Cross-sectional trend analysis of data from the Centers for Disease Control and Prevention's Pediatric Nutrition Surveillance System from the 5 states (Colorado, New Mexico, Oklahoma, Utah, and Vermont) that have been using the same laboratory method for anemia screening since 1984 or earlier.

RESULTS

The overall prevalence of anemia decreased substantially in each state from the early 1980s to the mid-1990s as follows: Colorado by 52%; New Mexico by 75%; Oklahoma by 67%; Utah by 57%; and Vermont by 48%. In each state, the prevalence of anemia declined for children of different age groups, birth weights, genders, type of pediatric care visit (screening or follow-up), and most race/ethnic groups.

CONCLUSIONS

The decline in the prevalence of anemia initially observed in the 1980s continued well into the 1990s. This decline is likely attributable to better iron nutrition related to greater usage of iron-fortified products and possibly better iron bioavailability in some of the food products.

Relation between dosage of carbamazepine and concentration in hair and plasma samples from a compliant inpatient epileptic population

Compliance is a problem in all areas of therapeutic medicine. Methods for its assessment are classified as either indirect or direct. Indirect assessment is based on criteria such as pill counts, questionnaires, and self-reporting; direct methods involve the analytic measurement of the drugs in biologic fluids such as plasma or urine. Drugs taken either therapeutically or recreationally become incorporated into hair. This prospective study investigated the relation between the daily intake of the antiepileptic drug carbamazepine and both its trough plasma and hair concentrations in a highly supervised inpatient population of patients with epilepsy during a period of 6 months. Results showed that although there was a significant variation between patients resulting from the substantial range in the daily intake of carbamazepine (800-2400 mg/day), the intrapatient variation in both trough plasma and hair concentrations during the 6-month period were not significantly different. The mean intrapatient percentage coefficient of variation in total plasma and hair concentrations of carbamazepine was 11.5 +/- 4.7 and 15.0 +/- 5.2, respectively, both of which were independent of the daily dosage. This relatively small intrapatient variation in hair concentration over time and its close relation to the plasma concentration suggests that hair analysis may be a complementary and useful technique in monitoring drug-taking behavior.

[Pharyngeal passage tube treatment for obstructive apnea syndrome]

OBJECTIVE

To investigate the therapeutical effect of pharyngeal passage tube for OSAS.

METHODS

Fifty-seven patients were treated during May 1995 to August 1999. All patients were examined by GKD-405 A polysomnography for apnea index (AI), hypnea index (HI), AHI (AI + HI) at cetera 7 items index before and after pharyngeal passage tube treatment.

RESULTS

After treatment, the longest time of apnea shortened from (54.82 +/- 20.83) s to (25.74 +/- 9.50) s, the AHI lessened from 70.82 +/- 18.06 to 30.00 +/- 10.10, the oxygen desaturation increased from (62.36 +/- 11.53)% to (78.68 +/- 12.09)%. After treatment, the recorded parameters showed obvious therapeutical effect (P < 0.05-0.001, t values is from 2.20 to 15.29, the snore loudness of all patients dropped from (84.32 +/- 18.51) dB to (32.64 +/- 10.16) dB. The therapeutical successful rate was 87.72%. The long-term use rate (over 6 months) was 72.73%.

CONCLUSION

The pharyngeal passage tube has obvious effect for patients suffering from severe OSAS. It is recommended for the treatment of OSAS as a conservative method.

Sociodemographic characteristics, care, feeding practices, and growth of cohorts of children born to HIV-1 seropositive and seronegative mothers in Nairobi, Kenya

OBJECTIVES To compare sociodemographic profiles, child care, child feeding practices and growth indices of children born to HIV-1 seropositive and seronegative mothers.

METHODS

A cohort study of 234 children (seropositive and seronegative) born to HIV-1 seropositive mothers and 139 children born to seronegative mothers in Pumwani Maternity Hospital which serves a low-income population in Nairobi, Kenya from December 1991 and January 1994.

RESULTS

With few exceptions, at the time of their birth children in all three cohorts had parents with similar characteristics, lived in similar housing in similar geographical areas, had their mothers as their primary care givers, had similar feeding practices and similar growth status and patterns. However, the HIV-1 seropositive mothers were slightly younger (23.8 years vs. 25.0 years, P < 0.01), if married they were less likely to be their husband's first wife (79% vs. 91%, P = 0.02) and more likely to have a one-room house (75% vs. 63%, P = 0.04). All three cohorts had mean Z-scores in length-for-age and in weight-for-height within the normal range (>/= 2.0 Z-scores) from birth to 21 months with the exception of the length-for-age of the seropositive children at the 18-month visit. In all cohorts length-for-age became more compromised than weight-for-length, dropping to about -1.45 Z-score by 21 months; in contrast, weight-for-length dropped to about -0.5 Z-score by this age. The only statistically significant differences in growth indices among the three cohorts were between the two cohorts of seronegative children: those with seronegative mothers were less compromised in length-for-age at 1.5 months (mean Z-score = -0.19 vs. -0.48, P < 0.05) and more compromised in weight-for-length at 6 months (mean Z-score = 0.10 vs. 0.45, P < 0.05) and at 18 months (mean Z-score = -0.73 vs. -0.16, P < 0.05). 27-34% were exclusively breastfed at 1.5 months; 52-61% consumed solid foods in addition to breast milk by 2.5 months.

CONCLUSIONS

Low-income HIV-1 seropositive- and seronegative-born children were from families with similar characteristics and similar housing environments. Similar growth patterns in the cohorts suggest that the challenging environment and the choice of weaning foods had an impact on all three cohorts. The aggressive care given the children with HIV-1 seropositive mothers and their children may have reduced the progression and impact of HIV-1 disease on the growth of the seropositive children. Further research is needed to corroborate our findings to be certain that our results are not affected by loss to follow-up bias: we lost the same proportion in all three cohorts but cannot verify that the children we lost had the same growth patterns as those who remained in the study.

CDC growth charts: United States

OBJECTIVES

This report presents the revised growth charts for the United States. It summarizes the history of the 1977 National Center for Health Statistics (NCHS) growth charts, reasons for the revision, data sources and statistical procedures used, and major features of the revised charts.

METHODS

Data from five national health examination surveys collected from 1963 to 1994 and five supplementary data sources were combined to establish an analytic growth chart data set. A variety of statistical procedures were used to produce smoothed percentile curves for infants (from birth to 36 months) and older children (from 2 to 20 years), using a two-stage approach. Initial curve smoothing for selected major percentiles was accomplished with various parametric and nonparametric procedures. In the second stage, a normalization procedure was used to generate z-scores that closely match the smoothed percentile curves.

RESULTS

The 14 NCHS growth charts were revised and new body mass index-for-age (BMI-for-age) charts were created for boys and girls (http://www.cdc.gov/growthcharts). The growth percentile curves for infants and children are based primarily on national survey data. Use of national data ensures a smooth transition from the charts for infants to those for older children. These data better represent the racial/ethnic diversity and the size and growth patterns of combined breast- and formula-fed infants in the United States. New features include addition of the 3rd and 97th percentiles for all charts and extension of all charts for children and adolescents to age 20 years.

CONCLUSION

Created with improved data and statistical curve smoothing procedures, the United States growth charts represent an enhanced instrument to evaluate the size and growth of infants and children.

[Residual risk research of HIV infection after blood screening in one county in China]

OBJECTIVE

To estimate the risk of HIV infections from blood transfusions, to evaluate existing blood screening measures, and to make recommendations to improve current blood screening practices.

METHODS

Research was conducted in a county blood station. A statistical model and retrospective method were used to analyse the data.

RESULTS

Between June 1995 and March 1998, 19 blood donors tested positive for HIV antibodies and among them, 7 were repeat blood donors. Twenty - two blood recipients were identified from these 7 donors during six months, 9 are still alive today, while one patient was infected with HIV from a blood transfusion while undergoing an operation. The residual risk of the blood station using a statistical model and retrospective methods were 1/1,773 - 1/28,867 and 1/2,008 - 1/2,730 donations respectively.

CONCLUSION

The residual risk of HIV after screening in the county blood station was high. We recommend further improvements to current blood screening practices.

[Comparison between carboplatin and cisplatin plus etoposide and carboplatin plus etoposide in the treatment of small cell lung cancer.]

BACKGROUND

To evaluate the effect and toxicity of combination chemotherapy with carboplatin and cisplatin plus etoposide (CPE regimen) and carboplatin plus etoposide (CE regimen) in the treatment of small cell lung cancer (SCLC) .

METHODS

Thirty-two patients with SCLC were treated with CPE and CE regimens , and each regimen had 16 cases respectively. There were 10 retreated cases in CPE group and 7 retreated cases in CE group.

RESULTS

The total response rate (CR + PR) was 81. 3 %(13/ 16) in CPE group , and 87. 5 %(14/ 16) in CE group ( P > 0. 05) respectively. The response rate of the retreated cases in CPE group was 60 %(6/ 10) , and 42. 9 %(3/ 7) in CE group ( P < 0. 05) . The bone marrow suppression rate was 71. 9 % in CPE group and 93. 8 % in CE group ( P < 0. 05) . There were no significant differences between other toxicity in both groups ( P > 0. 05) .

CONCLUSIONS

The therapeutic effect of CPE regimen in SCLC is similar to that of CE regimen , but the bone marrow suppression rate of CPE regimen is less severe than that of CE regimen. The therapeutic effect of CPE regimen is better than that of CE regimen for the retreated cases.

[Anatomic investigation of facial canal related to middle ear surgery]

OBJECTIVE

To avoid hurting facial nerve in middle ear surgery.

METHOD

20 adult head cadavers with 40 sides tempotal bone were dissected and investigated.

RESULT

1. Prevalence of dehiscent facial nerve canal was 32.5% (13/40), while 2.5% (1/40), 27.5% (11/40), 7.5%(3/40) incidence facial nerve canal were found in the labyrinthine, horizontal, vertical segment respectively. 2. Distance between the vertical portion of facial nerve and posterior semicircular canal was 0.62-5.08(2.48 +/- 0.63) mm. Interspace between the vertical portion of facial nerve and tympanic chorda was 0-4.62 (2.12 +/- 0.76) mm at the level of tympanic ditch, while interspace between the vertical portion of facial nerve and tympanic ditch was 2.96-8.82 (5.86 +/- 1.62) mm. 3. Distance between horizontal portion of facial nerve and lateral semicircular canal was 0-3.02 (1.92 +/- 0.84) mm. Interspace between horizontal portion of facial nerve and stapedial board was 0.92-4.06(2.14 +/- 0.90) mm.

CONCLUSION

Familiarity with facial nerve procession should be favorable to decrease facial paralysis with middle ear surgery.

[Anatomical consideration for the injury of dacryocyst and nasolacrimal duct during intranasal sinus surgery]

Based on dissection and measurement on 20 adult head cadavers, there is the close relationship between lacrimal duct and lateral wall of the nasal cavity. The cells of anterior ethmoid sinus were classified into three degrees, according to the relationship between the anterior ethmoid sinus and the lacrimal sac fossa. The average distance is 6.74 +/- 1.72 mm between the nasolacrimal duct and the upper part of the uncinate process, 3.44 +/- 0.75 mm and 5.50 +/- 3.73 mm from the nasolacrimal duct to ethmoidal infundibulum and the maxillary ostium. The orifice of the duct most commonly opens under the insertion of the inferior turbinate anteriorly. To perform intranasal sinus surgery, the safest area and key operation approach were discussed.

[Determination of acetylcholine and choline in microdialysates from rat brain by high performance liquid chromatography with electrochemical detection combined with a post-column immobilized enzyme reactor]

In the present work, acetylcholine(ACh) and choline(Ch) in the microdialysates from three brain areas of anesthetized rats and from hippocampus and frontal cortex of freely moving rats were simultaneously measured by high performance liquid chromatography(HPLC) with electrochemical detection combined with a post-column immobilized enzyme reactor(IMER). This assay was based on the separation of ACh and Ch on a polymer gel column followed by passage of the effluent through an IMER, on which the separated ACh and Ch reacted respectively to give each stoichiometric yield of hydrogen peroxide, which was detected electrochemically at a platinum electrode (potential + 0.5 V versus Ag/AgCl). The tip of concentric dialysis probe was made of the semipermeable dialysis membrane of 0.22 mm in outside diameter, and the effective length inserted into rat brain was 3.0 mm. The probe was perfused at a rate of 1 microL/min with Ringer's solution which contained 10 mumol/L (for anesthetized rats) or 1 mumol/L (for freely moving rats) neostigmine, a reversible cholinesterase inhibitor, to elevate ACh level in microdialysate. Before the experiment, the recovery of the probe in vitro was measured at room temperature, and the position of the probe was checked by histological procedure at the end of the experiment. In the range of 0.2-100 mumol/L, the relation between the amounts and the peak areas was linear (r = 0.9988 for ACh and r = 0.9985 for Ch). The detection limit for ACh and Ch, at a S/N ratio of two, was found to be 50 fmol per injection. The probe recoveries(%) for ACh and for Ch were 23.2 +/- 1.4 and 34.3 +/- 3.2(mean +/- SD) respectively. The basal levels of ACh in the microdialysates from striatum and frontal cortex of anesthetized rats as well as from hippocampus and frontal cortex of freely moving rats were 212 +/- 28 and 22 +/- 4 as well as 26 +/- 4 and 83 +/- 7(nmol/L, mean +/- SD, not corrected according to probe recovery) respectively. The perfusion of high concentration K+ (100 mmol/L) through the dialysis probe induced a large increase of ACh in the microdialysates. The critical points for HPLC analysis combined with IMER were briefly discussed.

[The development of reference values for the brachial perimeter and body height in comparison with other indicators used for screening of the nutritional status]

Mid-upper-arm circumference (MUAC) based on a single cut-off value for all children under 5 years of age has been used for many years as an alternative nutritional status index for children during famines or refugee crises, and as an additional screening tool in nonemergencies. However, it has recently been questioned whether MUAC is age- and sex-independent. After reviewing the scientific evidence underlying the use and interpretation of MUAC, a WHO Expert Committee recommended a new MUAC-for-age reference for under-5-year-olds. In some settings, however, it is difficult to assess a child's age and in such circumstances MUAC-for height may be a good alternative. The height-based QUAC stick offers a simple means of adjusting MUAC cut-offs according to height, and the MUAC-for-height reference and construction and use of the QUAC stick are described in this article. Also described is the use of the receiver operating characteristic (ROC) curve method to evaluate the performance of MUAC, MUAC-for-age, and MUAC-for-height in screening malnourished children.

Improving trend of growth of Asian refugee children in the USA: Evidence to support the importance of environmental factors on growth

In order to better define the trends and patterns of growth for children of Asian refugee families residing in the USA, we studied the anthropometric data from 12 states collected by the Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance System (PedNSS) from 1979 to 1993. The Asian refugee children under 5 years of age showed a progressive and significant decline in the prevalence of low height-for-age and low weight-for-age, while those nutritional indices remained stable for low income white children and black children. By 1993, the growth status of Asian refugee children was comparable with that of other ethnic groups. This marked improvement over a short period strongly suggests that the poor growth status earlier observed among recently immigrated Asian children was due to nutritional and health factors related to socioeconomic conditions, rather than to genetic factors, as is often suggested. Detailed analysis of each birth cohort born at different time periods found that low anthropometry during infancy is a strong predicator of smaller body size later in childhood.

Development of a research child growth reference and its comparison with the current international growth reference

OBJECTIVE

To better characterize childhood growth and further assess potential limitations of the current National Center for Health Statistics and World Health Organization international growth reference.

DESIGN

The LMS method was used for curve fitting to summarize the changes in height and weight distributions by 3 curves representing the skewness (L), median (M), and coefficient of variation (S). A series of polynomial regression procedures was applied to smooth the L, M, and S curves.

SETTING

Subset data from 18 states contributing clinic data to the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System were used for this research reference.

METHODS

We chose only those clinics in which the height and weight distributions of children closely matched with those of the first and second National Health and Nutrition Examination Surveys.

RESULTS

Unlike the current international growth reference, the new reference has no disjunction at 24 months of age because it is based on a single data source for children aged 0 to 59 months. The reference also better characterizes the growth for infants than the current international reference, a fact we demonstrated with data from the National Health and Nutrition Examination Surveys, Pediatric Nutrition Surveillance System 1995, and the Davis Area Research on Lactation, Infant Nutrition, and Growth studies.

CONCLUSIONS

The current National Center for Health Statistics and World Health Organization international growth reference needs to be updated. The methods used in this study will be useful to evaluate other data sets and to evaluate future modifications of growth references.

Increasing prevalence of overweight among US low-income preschool children: the Centers for Disease Control and Prevention pediatric nutrition surveillance, 1983 to 1995

OBJECTIVE

To determine whether the prevalence of overweight in preschool children has increased among the US low-income population.

DESIGN

Analysis using weight-for-height percentiles of surveillance data adjusted for age, sex, and race or ethnicity.

SETTING

Data from 18 states and the District of Columbia were examined.

SUBJECTS

Low-income children <5 years of age who were included in the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System.

RESULTS

The prevalence of overweight increased from 18.6% in 1983 to 21.6% in 1995 based on the 85th percentile cutoff point for weight-for-height, and from 8.5% to 10.2% for the same period based on the 95th percentile cutoff point. Analyses by single age, sex, and race or ethnic group (non-Hispanic white, non-Hispanic black, and Hispanic) all showed increases in the prevalence of overweight, although changes are greatest for older preschool children.

CONCLUSION

Overweight is an increasing public health problem among preschool children in the US low-income population. Additional research is needed to explore the cause of the trend observed and to find effective strategies for overweight prevention beginning in the preschool years.

Bacterial LPS and IFN-gamma trigger the tyrosine phosphorylation of vav in macrophages: evidence for involvement of the hck tyrosine kinase

We and others have previously reported that tyrosine kinases play key roles in the activation of macrophages by both bacterial lipopolysaccharide (LPS) and interferon-gamma (IFN-gamma). However, little is known regarding the substrates of tyrosine phosphorylation that mediate macrophage activation and the resultant production of inflammatory mediators. In lymphocytes and other hematopoietic lineages, tyrosine phosphorylation of the proto-oncogene vav appears to be an essential component of cell activation. In this study, we demonstrate that both LPS and rIFN-gamma trigger the prompt, dose-dependent tyrosine phosphorylation of vav in murine RAW 264.7 macrophages. In addition, vav is physically associated with the src-related kinase hck in murine macrophages, and antisense oligonucleotides specific for murine hck block both LPS and rIFN-gamma-mediated vav phosphorylation. These findings suggest that hck probably mediates vav tyrosine phosphorylation during macrophage activation and that LPS and rIFN-gamma-mediated signaling pathways partially overlap.