Comparison of presentation and impact on quality of life of gastroesophageal reflux disease between young and old adults in a Chinese population

AIM

To compare the presentation and impact on quality of life of gastroesophageal reflux disease (GERD) in old and young age groups.

METHODS

Data from adult patients with GERD diagnosed by endoscopic and symptomic characteristics were collected between January and November 2009. Exclusion criteria included combined peptic ulcers, malignancy, prior surgery, antacid medication for more than 2 mo, and pregnancy. Enrolled patients were assigned to the elderly group if they were 65 years or older, or the younger group if they were under 65 years. They had completed the GERD impact scale, the Chinese GERD questionnaire, and the SF-36 questionnaire. Data from other cases without endoscopic findings or symptoms were collected and these subjects comprised the control group in our study.

RESULTS

There were 111 patients with GERD and 44 normal cases: 78 (70.3%) and 33 patients (29.7%) were in the younger and elderly groups, respectively. There were more female patients (60.3%) in the younger group, and more males (72.7%) in the elderly group. The younger cases had more severe and frequent typical symptoms than the elderly patients. Significantly more impairment of daily activities was noted in the younger patients compared with the elderly group, except for physical functioning.

CONCLUSION

Elderly patients with GERD were predominantly male with rare presentation of typical symptoms, and had less impaired quality of life compared with younger patients in a Chinese population.

Association of body mass index and depressive symptoms in a Chinese community population: results from the Health Promotion Knowledge, Attitudes, and Performance Survey in Taiwan

BACKGROUND

The association between obesity and depression remains equivocal. The aims of this study were to examine the association between body mass index (BMI) and depressive symptoms in the Chinese adult population.

METHODS

In this study, data from the Health Promotion Knowledge, Attitudes, and Performance Survey, conducted in 2002 among 20,385 Taiwanese adults (aged 18-64 years), were used. Depressive symptoms were assessed by the Taiwanese Depression Questionnaire (cut off point 19). Weight status was categorized as underweight (BMI < 18.5 kg/m²), normal weight (BMI 18.5- 23.9 kg/m²), overweight (BMI 24-26.9 kg/m²), and obese (BMI ≥ 27 kg/m²).

RESULTS

Bivariate analyses revealed that underweight men and women had higher risks of depressive symptoms than normal weight individuals. After controlling for education, income, occupation, smoking status, marital status, presence of chronic disease, exercise, and weight control measures, we found that underweight men were significantly more likely to have depressive symptoms than normal weight men (Adjusted odds ratio [AOR] 2.68, 95% confidence interval [CI] 1.85-3.88). On the contrary, obese women were significantly less likely to have depressive symptoms than normal weight women (AOR 0.62, 95% CI 0.46-0.83).

CONCLUSION

The associations of BMI and depressive symptoms were different between genders. Underweight men ran a higher risk of depression than normal weight men, and overweight women had a lower risk than normal weight women. These findings support the "jolly fat" hypothesis among the adult population in the Chinese community.

IV delivery of induced pluripotent stem cells attenuates endotoxin-induced acute lung injury in mice

BACKGROUND

Induced pluripotent stem (iPS) cells are novel stem cell populations, but the role of iPS cells in acute lung injury (ALI) is not currently known. We investigated the effect of iPS cells in modifying the pathophysiology of endotoxin-induced ALI.

METHODS

Male C57BL/6 8- to 12-week-old mice were enrolled in this study. Mouse iPS cells were delivered through the tail veins of mice 4 h after intratracheal instillation of endotoxin. Lung histopathologic findings, the pulmonary levels of cytokines, and functional parameters were analyzed after either 24 h or 48 h.

RESULTS

More iPS cells integrated into the lungs of mice with ALI than those of the control mice, as demonstrated by in vivo radionuclide imaging and in vitro Hoechst-labeled fluorescent staining. iPS cells significantly diminished the histopathologic changes of ALI and the lung injury score. There was also a significant reduction in the activity of nuclear factor-κB (NF-κB) and neutrophil accumulation in the lung, confirmed by immunostaining, electrophoretic mobility shift assays, and the decrease of myeloperoxidase activity, in the iPS-cell-treated mice with ALI. These protective effects were not replicated by the control cell therapy with fibroblasts. iPS cells mediated a downregulation of the proinflammatory response to endotoxin (reducing tumor necrosis factor-α, IL-6, and macrophage inflammatory peptide-2). In addition, iPS cells rescued the hypoxemia and pulmonary function of ALI. Treatment with a conditioned medium of iPS cells showed effects similar to those of iPS cells, which may suggest the therapeutic benefits of iPS mediated by paracrine factors.

CONCLUSIONS

IV delivery of iPS cells provides a beneficial effect to attenuate the severity of endotoxin-induced ALI and improve physiologic impairment, which is partly mediated by a reduction in NF-κB activity and neutrophils accumulation. The conditioned medium of iPS cells demonstrated effects equal to those of iPS cells.

Comparisons of clinical characters in patients with pneumococcal and Legionella pneumonia

BACKGROUND/PURPOSE

The etiology of pneumonia is usually unknown, but the availability of urinary pneumococcal and Legionella antigen tests can improve the diagnostic yield. Our aim was to provide clinical clues to help clinicians perform the appropriate urinary antigen tests.

METHODS

A retrospective study of patients admitted to the National Cheng Kung University Hospital between July 2006 and June 2008 was conducted. Patients aged over 18 years presenting with clinical symptoms and signs, radiological findings compatible with pneumonia, and a positive pneumococcal or Legionella pneumophila urinary antigen test, were included. Medical records were reviewed for data collection.

RESULTS

Overall, 55 adults with pneumonia, including 42 with pneumococcal pneumonia (PP) and 13 with Legionella pneumonia (LP), were enrolled. On admission, patients with PP tended to be older (73.5 years vs. 59.1 years; p=0.001), had lower body weights (52.0 kg vs. 69.7 kg; p < 0.001), more frequent respiratory symptoms (59.5%vs. 0%; p < 0.001), and lower systolic (123.0 mmHg vs. 141.0 mmHg; p=0.004) and diastolic blood pressures (68.3 mmHg vs. 81.7 mmHg; p=0.008), compared with patients with LP. However, those with LP had higher body temperatures (39.0°C vs. 37.5°C; p < 0.001), a higher incidence of relative bradycardia (45.5%vs. 0%; p < 0.001), diarrhea (15.4%vs. 0%; p= 0.053), and lower platelet counts (178.5 × 10(3)/mm(3)vs. 233.7 × 10(3)/mm(3); p= 0.026). Radiological findings showed that the major abnormality, lobar consolidation, was indistinguishable between LP and PP. The percentage of patients requiring intensive care (35.7%vs. 38.5%) or ventilator support (31%vs. 23.1%) and in-hospital crude mortality rates (9.5%vs. 7.7%) was similar in both groups.

CONCLUSION

Some clinical and laboratory characteristics may be regarded as important clues indicating the need for an appropriate urinary antigen test in patients with pneumonia.

A global analysis of molecular markers and phenotypic traits in local chicken breeds in Taiwan

Molecular and phenotypic data have been combined to characterize the genetic diversity of six local chicken breeds maintained with a long-term conservation programme. Hua-Tung, Hsin-Yi, Ju-Chi and Quemoy originated from Taiwan, Shek-Ki is from South China, and Nagoya is from Japan. Molecular tools included 24 microsatellite markers, melanocortin 1 receptor (alpha melanocyte stimulating hormone receptor) (MC1R), the LEI0258 marker located within the major histocompatibility complex (MHC), and mitochondrial DNA. Performance was recorded on the same individuals for body weight, panting rate in summer and antibody response (antigens: Newcastle disease virus and sheep red blood cells). A multivariate method previously proposed for taxonomy was used to combine the different data sets. Melanocortin 1 receptor (alpha melanocyte stimulating hormone receptor) and the MCW330 marker contributed the most to the first axis of the multiple coinertia analysis of molecular markers. Melanocortin 1 receptor (alpha melanocyte stimulating hormone receptor) showed evidence of selection, probably related to its effect on feather colour. The MHC exhibited a large diversity, with 16 alleles of the LEI0258 marker. Immune response traits contributed the most to the principal component analysis of phenotypic data. Eight mitochondrial DNA haplotypes related to clades A, B, C and E were distributed across breeds and revealed an important contribution of Indian and European breeds to Ju-Chi, Quemoy and Hsin-Yi. Phenotypic data contributed less than molecular data to the combined analysis, and two markers, LEI0258 and LEI0228, contributed the most. The combined analysis could clearly discriminate all breeds, except Ju-Chi, which was similar to Quemoy for many criteria, except immune response.

MafA promotes the reprogramming of placenta-derived multipotent stem cells into pancreatic islets-like and insulin+ cells

MafA is a pancreatic transcriptional factor that controls β-cell-specific transcription of the insulin gene. However, the role of MafA in the regulation of pancreatic transdifferentiation and reprogramming in human stem cells is still unclear. In this study, we investigate the role of MafA in placenta-derived multipotent stem cells (PDMSCs) that constitutively expressed Oct-4 and Nanog. PDMSCs were isolated and transfected with MafA using a lentivector. Our results showed that overexpression of MafA in PDMSCs significantly up-regulated the expression of pancreatic development-related genes (Sox17, Foxa2, Pdx1 and Ngn3). Microarray analysis suggested that the gene expression profile of MafA-overexpressing PDMSCs was similar to that of pancreas and islet tissues. MafA increased the expression levels of the mRNAs of NKx2.2, Glut2, insulin, glucagons and somatostatin, and further facilitated the differentiation of PDMSCs into insulin⁺ cells. The glucose-stimulated responses to insulin and c-peptide production in MafA-overexpressing PDMSCs were significantly higher than in PDMSCs with vector control. Our results indicated that MafA-overexpressing PDMSCs were more resistant to oxidative damage and oxidative damage-induced apoptosis than PDMSCs carrying the vector control were. Importantly, the expression of MafA in PDMSCs xenotransplanted into immunocompromised mice improved the restoration of blood insulin levels to control values and greatly prolonged the survival of graft cells in immunocompromised mice with STZ-induced diabetes. In summary, these data suggest that MafA plays a novel role in the reprogramming of stem cells into pancreatic β-progenitors, promotes the islet-like characteristics of PDMSCs, as well as functionally enhances insulin production to restore the regulation of blood glucose levels in transplanted grafts.

Acute anterior uveitis and optic neuritis as ocular complications of influenza A infection in an 11-year-old boy

The authors describe an 11-year-old boy developing bilateral acute anterior uveitis, papillitis in one eye, and neuroretinitis in the other eye after an upper respiratory tract infection of influenza A virus, possibly H1N1. Steroid pulse therapy resolved these conditions. The authors recommend alertness for visual blurring and ocular inflammation after influenza A infection.

Electrical conductivity enhancement of polymer/multiwalled carbon nanotube (MWCNT) composites by thermally-induced defunctionalization of MWCNTs

We report a thermally-induced increase of electrical conductivity of polymer/multiwalled carbon nanotube (MWCNT) composites using Diels-Alder-adduct-modified MWCNTs as additives. Thermal treatments of the composites induce the defunctionalization of the modified MWCNTs through retro-DA reaction, consequently to recover the electrical conductivity of MWCNTs and to increase the conductivity of PVDF/MWCNT composites. For the composites possessing 0.5 wt % of MWCNTs, thermal treatment increases the electrical conductivity from 2 × 10(-12) S cm(-1) to 4 × 10(-8) S cm(-1) and significantly reduces the value of percolation threshold. Meanwhile, the thermal treatment does not alter the mechanical properties of the composites.

One-year follow-up of relapse to risky behaviors and incidence of syphilis among patients enrolled in the HIV case management program

A longitudinal prospective study was conducted at an AIDS designated hospital in Taiwan. The study aimed to determine the incidence of syphilis and to identify risk factors predicting new onset syphilis and relapse into risky behaviors among 117 patients enrolled in the HIV case management program for 1 year. Having a new episode of syphilis was defined as patients had a fourfold increase of serum rapid plasma reagin titers from baseline to 12-month follow-up. After enrollment, 17% relapsed in unprotected sexual intercourse. New onset syphilis was noted in ten (10.4%) participants, and all were men having sex with men. The incidence of syphilis was 5.8 per 100 person-years. Predictors of a new episode of syphilis were higher CD4 cell counts [hazard ratio (HR), 1.003; 95% confidence interval (CI), 1.00-1.006], and recreational drug use (HR, 18.89; 95% CI, 2.78-128.15). Regular screening for syphilis among patients retaining in HIV care remains necessary.

Increased interleukin-6 level in Taiwanese schizophrenic patients

BACKGROUND

Schizophrenia is accompanied by an activation of the immune/inflammatory system. In the present study, the relationships between serum interleukin (IL)-6, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β1 levels and schizophrenia were explored in a group of Taiwanese inpatients. Furthermore, the serum IL-6, TNF-α, and TGF-β1 levels of patients with schizophrenia were compared before and after 1 month of antipsychotic treatment.

METHODS

The serum IL-6, TNF-α, and TGF-β1 levels of 34 acute stage schizophrenic patients and 30 healthy control subjects were collected. These levels were again collected in the 34 patients after 1 month of antipsychotic treatment. An analysis of covariance (ANCOVA) adjusted for gender was performed to examine the differences in cytokine levels between the schizophrenic patients and the control group. Repeated measures ANCOVA adjusted for gender was performed to examine the differences in cytokine levels of the schizophrenic patients before and after 1 month of treatment.

RESULTS

Using ANCOVA adjusted for gender, significantly increased IL-6 levels were found in schizophrenic patients compared with the control group (p = 0.02), but there were no significant differences in TNF-α and TGF-β1 levels (p = 0.06 and 0.91, respectively). After 1 month of medical treatment, there were no significant differences in IL-6 (p = 0.64), TNF-α (p = 0.48), and TGF-β1 (p = 0.23) levels in the schizophrenic patients, although IL-6 appeared to be normalizing.

CONCLUSION

An increase in the IL-6 level may play a role in the pathophysiology of schizophrenia. A larger sample size and a longer period of follow-up are needed to confirm this finding.

Reprogramming induced pluripotent stem cells in the absence of c-Myc for differentiation into hepatocyte-like cells

Induced pluripotent stem cells (iPSCs) with four reprogramming factors (Oct-4/Sox2/Klf-4/c-Myc) have been shown to differentiate into hepatic lineages. However, it was unclear whether obviation of the c-Myc oncogene in iPSCs affected hepatic differentiation or inhibited in vivo tumor formation. In this study, we demonstrated that iPSCs without c-Myc had the capacity to differentiate into hepatocyte-like cells (iPSC-Heps) with biological functions. As detected using planar-radionuclide imaging and Hoechst labeling assays, these iPSCs and iPSC-Heps tended to mobilize to the injured liver area in thioacetamide (TAA)-treated mice. Intravenous transplantation of both iPSCs and iPSC-Heps but not mouse embryonic fibroblasts (MEFs) reduced the hepatic necrotic area, improved liver functions, and rescued TAA-treated mice from lethal acute hepatic failure (AHF). In addition, microarray-based bioinformatics and quantitative RT-PCR showed high expression of antioxidant genes in iPSCs and iPSC-Heps compared to MEFs. In vivo and in vitro studies of NAC pretreatment confirmed that iPSCs and iPSC-Heps potentially suppressed ROS production and activated antioxidant enzymes in TAA-injured livers. Six months after transplantation in TAA-treated mice, tumor formation was not seen in non-c-Myc iPSC grafts. Therefore, reprogramming adult somatic cells without c-Myc may prevent oxidative stress-induced damage and provide a safer alternative for hepatic regeneration in AHF.

Medical conditions and medications as risk factors of falls in the inpatient older people: a case-control study

OBJECTIVE

The majority of inpatient falls are older people who have various medical conditions and are on several medications. The purpose of this study was to examine the association between medical conditions and medications and falls in older people in hospital.

METHOD

Using a case-control design, we selected older people (aged 65 or over) who were reported to the Taiwan Patient-Safety Reporting System for the fall incidents in a large academic hospital in 2006 (n = 165). They were individually (1:1) matched for gender, age, and period of hospitalization with the control non-faller group. Bivariate and multivariate logistic regressions were used to compare the cases and controls to examine the association of medical conditions and medication exposure within 24 h before the falls.

RESULTS

Bivariate analyses showed that older people with cancer, or exposure medications such as zolpidem, benzodiazepines, narcotics, and antihistamines were significantly more likely to have falls during hospitalization. After controlling for cancer, zolpidem, narcotics, and antihistamine, we found benzodiazepine (Odds ratio (OR) = 2.26, 95% confidence interval (CI) = 1.21-4.23) and benzodiazepine doses ≥1 mg/day in diazepam equivalents (OR = 2.14, 95%CI = 1.04-4.39) were still significantly associated with the falls of older people in the hospital.

CONCLUSIONS

Strategies to prevent falls in older people in hospital should include minimizing the use of zolpidem, benzodiazepine, narcotics, and antihistamines, especially in cancer patients.

Association of serum levels of leptin, ghrelin, and adiponectin in schizophrenic patients and healthy controls

BACKGROUND

Leptin, ghrelin, and adiponectin play important roles in the regulation of body weight, food intake, and energy homeostasis, and have been suggested to be important biomarkers of metabolic syndrome. In this study, we tried to simultaneously investigate the serum levels of leptin, ghrelin, and adiponectin in schizophrenic patients and healthy controls.

METHODS

During a period of 2 years, we recruited 37 schizophrenic patients and 65 healthy controls. The levels of metabolic syndrome-related biomarkers including serum adiponectin, leptin, and ghrelin were measured with an enzyme-linked immunosorbent assay.

RESULTS

On applying analysis of covariance (ANCOVA) with age and body mass index adjustments, the leptin levels of schizophrenic patients (P = 0.038) were found to be higher than those of healthy controls. However, there were no significant differences in the serum levels of ghrelin or adiponectin between these two groups.

CONCLUSION

These results showed that serum leptin levels might be more sensitive than ghrelin or adiponectin levels between schizophrenic patients and healthy controls. However, studies with a large sample size are needed to confirm these results.

Pitfalls in using serum C-reactive protein to predict bacteremia in febrile adults in the ED

OBJECTIVES

The diagnostic performance of serum C-reactive protein (CRP) in prediction of bacteremia among febrile patients visiting an emergency department (ED) was analyzed.

METHODS

During randomly selected 96 days between August 2006 and July 2007, a prospective study of febrile adults visiting the ED of a medical center was conducted to analyze the clinical characters associated with bacteremia.

RESULTS

Of the total 454 febrile adults enrolled, their mean age was 54.1 years, and 232 (54.6%) were women. Major comorbidities included cardiovascular disease (137 patients, or 30.1%) and diabetes mellitus (105, or 23.1%). Seventy-four patients (16.2%) had true bloodstream infections with the predominance of monomicrobial gram-negative bacteremia in 49 patients (10.7%). Four risk factors, including low platelet count (<100 000/mm(3); odds ratio [OR], 4.19; 95% confidence interval [CI], 1.85-9.47; P = .001), high blood urea nitrogen (>20 mg/dL; OR, 4.61; 95% CI, 2.56-8.31; P < .001), high fever (>39.0°C; OR, 3.67; 95% CI, 2.05-6.59; P < .001), and high Pittsburg bacteremia scores (≧4 points; OR, 2.95; 95% CI, 1.01-8.57; P = .04) were independently associated with bacteremic episodes. Of note, high CRP (>150 mg/dL; OR, 1.75; 95% CI, 0.73-3.99; P = .21) was not an independent risk factor. In further analysis, the difference of serum CRP levels between bacteremic and nonbacteremic adults was significant only when the period from fever onset to ED arrival was more than 12 hours.

CONCLUSIONS

The CRP level was not reliable to distinguish the bacteremia from nonbacteremic infection, whereas duration after fever onset was less than 12 hours. Clinicians must consider the history of fever onset to improve the accuracy of early prediction of serum CRP before the microbiological results of blood cultures is available.

Differential antitumor effect of interleukin-12 family cytokines on orthotopic hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is one of the most difficult cancers to treat. The interleukin (IL)-12 family cytokines, including IL-12, IL-23 and IL-27, display overlapping, but not redundant, roles in regulating lymphocyte subpopulations. IL-12 is known as a potent antitumor cytokine, whereas the results of the antitumor effect of IL-23 and IL-27 are inconsistent. The present study aimed to directly compare the relative antitumor efficacy of these three IL-12 family cytokines on HCC.

METHODS

A murine orthotopic BNL HCC model, in which the tumor is located in an environment heavily populated with different lymphocyte subsets, was established. The hepatotropic adeno-associated virus serotype 8 (AAV8) vector was used to deliver the cytokine genes aiming to achieve sustained cytokine expression in the liver.

RESULTS

AAV8/IL-12 treatment significantly reduced hepatic metastases and prolonged survival time, whereas treatment with AAV8/IL-23 or AAV8/IL-27 had only moderate antitumor effects at a high dose. The antitumor efficacy of these cytokines was positively correlated with their ability to regulate hepatic T cells, natural killer cells and natural killer T cells, with IL-12 greatly increasing the number and activation status of these cells, whereas IL-27 had no effect and IL-23 had a negative effect. AAV8/IL-12 treatment also resulted in a marked decrease in tumor vessel density, which was not observed with AAV8/IL-23 and AAV8/IL-27 treatment.

CONCLUSIONS

The data obtained in the present study highlight the importance of local lymphocytes and anti-angiogenesis for influencing the antitumor activity of these three IL-12 family cytokines and suggest that IL-12 is the best candidate for treating HCC.

Prevalence and association of suicide ideation among Taiwanese elderly--a population-based cross-sectional study

BACKGROUND

Elders commit suicide almost twice as frequently as people in the general population. This study aimed to investigate the prevalence and associated factors of suicide ideation among a representative sample of elderly people in Taiwan.

METHODS

We used data from the Health Promotion Knowledge, Attitudes, and Performance Survey in Taiwan and focused on 3,853 subjects with over 65 years old. Univariate and multivariate logistic regression were used to compare subjects with and without suicide ideation in terms of their subject characteristics, smoking, disability, depressive symptoms, physical disorders, and pain symptoms.

RESULTS

The point prevalence of elderly suicidal ideation was 6.1%. Female gender, age over 85 years, low level of of education, single status, unemployment. no income, disability, current smoking, self-perceived bad to very bad health, depressive symptoms, various physical disorders (heart disease, diabetes, asthma, osteoporosis), and pain symptoms (joint pain, lower back pain, neck pain, sciatica, headache) were strongly associated with suicide ideation. Multivariate analyses showed that the female gender, former smoker, no income, depressive symptoms, and heart disease were the predictors of elderly suicide ideation.

CONCLUSION

Elderly subjects who are women, or former smokers, and have depressive symptoms, heart disease or no income should be cautioned about the risk of suicide.