Prenatal exposure to nickel and atopic dermatitis at age 3 years: a birth cohort study with cytokine profiles

BACKGROUND

Nickel, the fifth most common element on Earth, is the leading inducer of contact allergies in humans, with potent immunological effects. Nickel-induced contact allergies predominantly affect females. Maternal exposure to nickel has been associated with several developmental abnormalities. However, how a maternal nickel exposure affects the development of atopic diathesis and immune abnormalities in children has never been addressed.

OBJECTIVES

We aimed to determine whether maternal Ni exposure affects the development of atopic dermatitis and immune abnormalities in their children.

METHODS

Using a birth cohort study, we analysed 140 mother-child pairs recruited in 2012-2015 from central Taiwan. Maternal exposure to nickel was estimated using urinary nickel levels measured by inductively coupled plasma mass spectrometry (ICP-MS). The serum levels of 65 analytes and IgE in 3-year-old children were profiled with a multiplex ELISA. The correlation between the maternal urinary nickel concentration and serum analyte levels was assessed using Spearmen's correlation. Multivariant regression analysis was performed to evaluate the association between maternal urinary nickel levels and serum analyte concentrations in their children.

RESULTS

The geometric means of the maternal urinary nickel and the children's serum IgE levels were 2.27 μg/L and 69.71 IU/ml, respectively. The maternal nickel exposure was associated with increased serum levels of IL-1β, IL-2, TNF-α, and leukaemia inhibitory factor (LIF) but with decreased serum levels of matrix metalloproteinase-1 (MMP-1), IL-2R, and eotaxin-1 in the children. In addition, the development of childhood atopic dermatitis at 3 years old was significantly associated with the child's serum levels of IgE and IL-2R, but it was negatively associated with the maternal nickel exposure.

CONCLUSIONS

This is the first study showing the potential immunological effects of maternal nickel exposure in their children at an early developmental stage.

P–570 Embryos originating from oocytes with smooth endoplasmic reticulum clusters have a lower euploidy rate via PGT-A testing using next-generation sequencing

Study question

Does the presence of smooth endoplasmic reticulum clusters (sERCs) in oocytes affect the human embryo ploidy?

Summary answer

The euploidy rate of embryos originating from sERCs + oocytes is lower

What is known already

While an expert panel strongly recommended that sERCs+ oocytes should not be inseminated, some normal healthy babies derived from sERCs+ oocytes have been reported. In previous studies have shown that declined fertilization rate and lower proportions of good quality embryos are found in oocytes showing sERCs. The updating findings of the molecular status of sERC+ oocytes elucidated the sERCs+ oocytes may have impaired chromosomal segregation ability. However, no study reveals the relation between sERCs and embryo ploidy.

Study design, size, duration

A retrospective study enrolled 129 preimplantation genetic testing (PGT) cycles from January 2017 to March 2020 at Chang Gung Memorial Hospital, Lonkou.

Participants/materials, setting, methods

ICSI fertilization rate, Day5 usable blastocyst rate (D5UBR), total usable blastocyst rate (TUBR), euploidy rate, mosaic rate, and aneuploidy rate are investigated between embryo originating from sERCs+ and sERCs- oocytes.

Main results and the role of chance

Although higher TBUR in blastocyst derived from sERCs+ oocytes than sERCs- group (73.7% vs. 62.5%) but accompanied lower euploidy rate (7% vs. 29%) and higher aneuploid rate (79% vs. 54%).

Limitations, reasons for caution

Limited sample size, need a large-scale study to confirm the conclusion. The live-birth rate per embryo transfer cycle was not included for analysis. As we did not perform polar body analysis, we cannot state for sure that embryonic aneuploidy was related to the oocyte.

Wider implications of the findings: This study demonstrates that embryos originating from sERCs+ oocytes have a lower euploidy rate.

Trial registration number

CMRPG3H0751

Magnesium oxide and hip fracture in the elderly: a population-based retrospective cohort analysis

Using national insurance claims of Taiwan, we found that magnesium oxide (MgO) use is associated with an increased risk of hip fracture in the elderly. Further studies are warranted to explore the mechanisms associated with MgO use that lead to hip fracture.

PURPOSE

The purpose of this study was to investigate the association between MgO use and hip fracture risk in the elderly (age > 65 years).

METHODS

This nationwide population-based retrospective study was conducted from 1996 to 2013. Individuals with (n = 26,069) and without (n = 26,069) MgO use were enrolled after propensity score matching. Primary outcome was a hip fracture. After adjusting for age, sex, comorbidities, and medications, multivariate Cox proportional hazards regression models were used to calculate incidences and risk of hip fracture [hazard ratio (HR)].

RESULTS

During the mean follow-up duration of 4.8 years in the MgO cohort and 5.7 years in the non-MgO cohort, respectively 1547 and 1107 cases developed a hip fracture. MgO use was identified as a risk factor for hip fracture in both univariate [crude HR, 1.68; 95% confidence interval (CI), 1.55-1.81; p < 0.001] and multivariate [adjusted HR (aHR), 1.66; 95% CI, 1.54-1.80; p < 0.001] Cox proportional hazards regression models. The cumulative incidence of hip fracture was significantly higher in the MgO cohort than in the non-MgO cohort (1.23 per 100 person-years vs. 0.74 per 100 person-years, logrank test, p < 0.001).

CONCLUSION

MgO use is an independent risk factor for hip fracture in the elderly.

SAT0114 IMPACT OF DOSE TAPERING REIMBURSEMENT POLICY ON PRESCRIPTION PATTERN OF ADVANCED THERAPY FOR RHEUMATOID ARTHRITIS IN TAIWAN

Background:

Rheumatoid arthritis (RA) patients treated with advanced therapy (biologic disease-modifying antirheumatic drugs and targeted synthetic disease-modifying antirheumatic drugs) may be considered dose tapering after reaching treatment goal.1In EULAR 2016 recommendations, dose reduction can be considered if patients reach sustained remission.2A dose tapering policy of advanced therapy was introduced in the treatment guideline of RA since 2014 under the National Health Insurance (NHI) in Taiwan. The new reimbursement policy requests the dosage to be tapered in patients who received advanced therapy for 2 years and reached low disease activity defined by DAS28 (ESR).

Objectives:

This retrospective study aims to investigate the impact of dose tapering policy on prescription pattern of advanced therapy for RA patients in Taiwan.

Methods:

This study was an observational retrospective analysis on the population-based National Health Insurance Research Database (NHIRD) in Taiwan. Patients with RA aged ≥18, initiated an index advanced therapy - abatacept, adalimumab, etanercept, golimumab, tocilizumab, or tofacitinib, during 2011-2017 were included (Figure 1). Patients were followed-up until the index advanced therapy was switched/discontinued or the end of data, whichever came first. The 4-week moving average of proportion of days covered (PDC) of the index therapy within each 12-week period were assessed. The outcome variable was whether dose tapering occurred which was defined as PDC being less than 0.5. The odds ratios (ORs) and the 95% confidence intervals (CIs) were estimated using Generalized Estimating Equation (GEE) with logistic specification to examine the independent effect of tapering policy and treatment duration on the probability of dose tapering, after controlling for age, sex, and index advanced therapy.

Figure 1.

Flow chart of patient selection:

Results:

The study comprised 9,094 patients initiated advance treatment for RA, with mean age of 57.3 (SD 13.3) years and 78.8% were female. The median PDC dropped remarkably after 28 months since treatment initiation (Figure 2). Probability of dose tapering increased significantly when treatment duration ≥24-month (OR=2.73,p<0.001). When treatment duration < 24-month, Dose Tapering policy was not significantly associated with tapering prescription. However, implementation of the policy further increased the probability of dose tapering for patients with treatment duration ≥ 24-month, OR for interaction of policy by duration was 1.17, and test for interactionp=0.014. There were about 3 times increase in the odds of dose tapering probability for patient treated longer than 24 months after the policy implemented in April 2014.

Figure 2.

The change of PDC of advanced therapy over the treatment period

Conclusion:

For RA patients, PDC of advanced therapy dropped notably after patients received advanced therapy for more than 24 months. The tapering policy implementation significantly increased the probability of dose tapering of advanced therapy in patients with treatment duration ≥ 24 months.

References:

[1]Lenert A, Lenert P. Clin Rheumatol. 2017;36(1):1-8.

[2]Smolen JS, et al. Ann Rheum Dis. 2017;76(6):960-977.

Table 1.

effect of treatment duration and dose tapering policy on the probability of dose tapering

Odds ratio95%CIp valueEffect of Treatment Duration (in pre-policy period)≥24-month vs <24-month2.73(2.45,3.05)<.001Effect of Dose Tapering policy (in treatment duration <24 months)Post-policy*vs Pre-policy0.94(0.87,1.01)0.110Interaction of Treatment Duration by Dose Tapering policy≥24-month x Post-policy1.17(1.03,1.32)0.014

*Dose Tapering policy was implemented on April 1st, 2014

Acknowledgments :

Research is sponsored by Pfizer Ltd.

Disclosure of Interests:

Chao-Hsiun Tang: None declared, Chia-Li Chang: None declared, Wen-Yi Shau Employee of: Pfizer, Chih-Yi Hsin Employee of: Pfizer, Ko-Jen Li Speakers bureau: Speaker fee from Pfizer, Abbvie, Roche, Bristol-Myers Squibb, Eli Lilly and Johnson & Johnson

Broadband, millimeter-wave antireflection coatings for large-format, cryogenic aluminum oxide optics

We present two prescriptions for broadband ($ {\sim} 77 - 252\;{\rm GHz} $), millimeter-wave antireflection coatings for cryogenic, sintered polycrystalline aluminum oxide optics: one for large-format (700 mm diameter) planar and plano-convex elements, the other for densely packed arrays of quasi-optical elements-in our case, 5 mm diameter half-spheres (called "lenslets"). The coatings comprise three layers of commercially available, polytetrafluoroethylene-based, dielectric sheet material. The lenslet coating is molded to fit the 150 mm diameter arrays directly, while the large-diameter lenses are coated using a tiled approach. We review the fabrication processes for both prescriptions, then discuss laboratory measurements of their transmittance and reflectance. In addition, we present the inferred refractive indices and loss tangents for the coating materials and the aluminum oxide substrate. We find that at 150 GHz and 300 K the large-format coating sample achieves $ (97 \pm 2)\% $ transmittance, and the lenslet coating sample achieves $ (94 \pm 3)\% $ transmittance.

Detection of CMB-Cluster Lensing using Polarization Data from SPTpol

We report the first detection of gravitational lensing due to galaxy clusters using only the polarization of the cosmic microwave background (CMB). The lensing signal is obtained using a new estimator that extracts the lensing dipole signature from stacked images formed by rotating the cluster-centered Stokes QU map cutouts along the direction of the locally measured background CMB polarization gradient. Using data from the SPTpol 500  deg^{2} survey at the locations of roughly 18 000 clusters with richness λ≥10 from the Dark Energy Survey (DES) Year-3 full galaxy cluster catalog, we detect lensing at 4.8σ. The mean stacked mass of the selected sample is found to be (1.43±0.40)×10^{14}M_{⊙} which is in good agreement with optical weak lensing based estimates using DES data and CMB-lensing based estimates using SPTpol temperature data. This measurement is a key first step for cluster cosmology with future low-noise CMB surveys, like CMB-S4, for which CMB polarization will be the primary channel for cluster lensing measurements.

Extensively drug-resistant tuberculosis in Myanmar: burden and mutations causing second-line drug resistance

SETTING

Two tuberculosis (TB) reference laboratories in Myanmar.

OBJECTIVES

To determine the proportion of extensively drug-resistant TB (XDR-TB) cases among multidrug-resistant TB (MDR-TB) cases and the mutations that cause resistance to second-line drugs in Myanmar.

DESIGN

This was a cross-sectional, retrospective study. Multidrug-resistant Mycobacterium tuberculosis isolates were collected during 2015-2016. Phenotypic drug susceptibility testing (DST) was performed and drug-resistant mutations identified by sequencing. Genotypes were determined to explain relationships between drug resistance patterns and genotypes.

RESULTS

Of 89 MDR-TB isolates, 12 were XDR-TB and 24 were pre-XDR-TB, with 21 resistant to fluoroquinolones (FQs) and 3 to second-line injectable agents (SLIDs). High rates of cross-resistance among second-line drugs were observed. Correlations between phenotypic and molecular DST against FQs and SLIDs were 91% in both cases. The most frequent mutation in FQ-resistant isolates was D94G (8/21) in gyrA and A1401G (11/15) in rrs in those resistant to SLIDs. The dominant genotype was the Beijing type (76/89).

CONCLUSION

There were high proportions of XDR-TB and pre-XDR-TB among MDR-TB cases; cross-resistance among second-line drugs was high, with various types of genetic mutations. These data suggest that resistance to second-line anti-tuberculosis drugs should be monitored intensively, and molecular DST should be employed.

HLA-A*33:74N, a novel HLA-A*33 variant, identified by sequence-based typing in a Taiwanese individual

A one nucleotide replacement in codon 803 of HLA-A*33:03:01 results in a novel allele, HLA-A*33:74N.

HLA-B*40:247, a novel HLA-B*40 variant, identified by sequence-based typing in a Taiwanese individual

A one nucleotide replacement in codon 261 of HLA-B*40:01:01 results in a novel allele, HLA-B*40:247.

HLA-A*11:134, a novel HLA-A*11 variant, identified by sequence-based typing in a Taiwanese individual

A one nucleotide replacement in codon 31 of HLA-A*11:01:01 results in a novel allele, HLA-A*11:134.

Ethnicity as an independent predictive factor for the results of computed tomography pulmonary angiography and ultrasonography of the lower limbs

BACKGROUND

Asians, Pacific Islanders and Maori have significantly lower rates of venous thromboembolism (VTE) compared to Europeans, but its clinic implication regarding diagnosis and prevention is unclear.

AIMS

To investigate if ethnicity affects the yield of computed tomography pulmonary angiography (CTPA) and ultrasonography of the lower limbs.

METHODS

Data previously collected for 523 patients from another study were used to analyse the effect of ethnicity on the results of CTPA; 1587 consecutive ultrasonography of lower limbs was retrospectively analysed according to ethnicity. The Wells score was retrospectively calculated to determine the pretest probability of VTE.

RESULTS

The positive rates of CTPA were 23.3% for European patients and 9.3% for non-European patients. The rate ratio was 2.50 (confidence interval [CI] 1.27-4.95). European patients were 2.5 times more likely to have a positive scan result than non-Europeans, given same pretest probability. There was a larger difference among patients with low and moderate pretest probability with a rate ratio of 4.27 (CI 1.62-11.3). The positive rates of ultrasound scans (USS) among European patients were 16.6 and 9.0% for non-European patients. Rate ratio was 1.85 (CI 1.27-4.95). The difference was also more significant amongst patients with low and moderate pretest probability. The rate ratio was 2.31 (CI 1.38-3.86) for European patients compared to non-European patients.

CONCLUSION

Given the same pretest probability according to the Wells score, European patients had significantly higher positive rates of CTPA and ultrasonography of the lower limbs than non-European patients. Further prospective studies are required to confirm our findings and establish an appropriate pretest assessment tool for non-European patients.

Efficacy and safety of LY2963016 insulin glargine in patients with type 1 and type 2 diabetes previously treated with insulin glargine

The safety and efficacy of LY2963016 insulin glargine (LY IGlar) and Lantus insulin glargine (IGlar), products with identical primary amino acid sequences, were assessed in subgroups of patients with type 1 (T1D, n = 452) or type 2 diabetes (T2D, n = 299) reporting prestudy IGlar treatment in 52-week open-label (ELEMENT-1) and 24-week double-blind (ELEMENT-2) studies. At randomization, patients transitioned from their prestudy IGlar to equivalent doses of LY IGlar or IGlar. Primary efficacy (change in glycated haemoglobin from baseline to 24 weeks), other efficacy and select safety outcomes of LY IGlar were compared with those of IGlar. Continuous data were analysed using analysis of covariance, categorical data by Fisher's exact test, and treatment comparisons for hypoglycaemia by Wilcoxon test. No statistically significant treatment differences were identified for efficacy and safety outcomes except for weight change (T1D), overall incidence of detectable insulin antibodies (T2D), and serious adverse events (T2D). These differences were neither consistently observed across both studies nor observed in the total study populations, and their magnitude suggests they were not clinically meaningful. LY IGlar and IGlar show similar efficacy and safety profiles in patients reporting prestudy IGlar treatment.

A novel allele, HLA-B*15:259, was identified in a Taiwanese individual by sequence-based typing

A one nucleotide replacement in codon 24 of HLA-B*15:54 results in a novel allele, HLA-B*15:259.

Applying the Back-Propagation Neural Network model and fuzzy classification to evaluate the trophic status of a reservoir system

The trophic state index, and in particular, the Carlson Trophic State Index (CTSI), is critical for evaluating reservoir water quality. Despite its common use in evaluating static water quality, the reliability of the CTSI may decrease when water turbidity is high. Therefore, this study examines the reliability of the CTSI and uses the Back-Propagation Neural Network (BPNN) model to create a new trophic state index. Fuzzy theory, rather than binary logic, is implemented to classify the trophic status into its three grades. The results show that compared to the CTSI with traditional classification, the new index with fuzzy classification can improve trophic status evaluation with high water turbidity. A reliable trophic state index can correctly describe reservoir water quality and allow relevant agencies to address proper water quality management strategies for a reservoir system.

Cardiac dysfunction and N-terminal pro-B-type natriuretic peptide in exacerbations of chronic obstructive pulmonary disease

Elevated levels of B-type natriuretic peptides among patients with exacerbations of chronic obstructive pulmonary disease (COPD) are associated with higher mortality. The pathophysiology is unclear. To establish if elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) are due to right or left heart dysfunction, we performed echocardiograms in 18 patients admitted to hospital with COPD. Elevated levels of NT-proBNP were associated with both right and left heart dysfunction and indicate that these patients have biventricular dysfunction rather than isolated right ventricular compromise.

Detection of B-mode polarization in the cosmic microwave background with data from the South Pole Telescope

Gravitational lensing of the cosmic microwave background generates a curl pattern in the observed polarization. This "B-mode" signal provides a measure of the projected mass distribution over the entire observable Universe and also acts as a contaminant for the measurement of primordial gravity-wave signals. In this Letter we present the first detection of gravitational lensing B modes, using first-season data from the polarization-sensitive receiver on the South Pole Telescope (SPTpol). We construct a template for the lensing B-mode signal by combining E-mode polarization measured by SPTpol with estimates of the lensing potential from a Herschel-SPIRE map of the cosmic infrared background. We compare this template to the B modes measured directly by SPTpol, finding a nonzero correlation at 7.7σ significance. The correlation has an amplitude and scale dependence consistent with theoretical expectations, is robust with respect to analysis choices, and constitutes the first measurement of a powerful cosmological observable.

Detection and identification of occult HBV in blood donors in Taiwan using a commercial, multiplex, multi-dye nucleic acid amplification technology screening test

BACKGROUND

The ability of a new generation commercial, multiplex, multi-dye test from Roche, the cobas TaqScreen MPX test, version 2.0, to detect and identify occult HBV infections was evaluated using routine donor samples from Kaohsiung Blood Bank, Taiwan.

STUDY DESIGN AND METHODS

A total of 5973 samples were tested by nucleic acid amplification technology (NAT); 5898 in pools of six, 66 in pools of less than six and nine samples individually. NAT-reactive samples were retested with alternative NAT tests, and follow-up samples from the donors were tested individually by NAT and for all the HBV serological markers.

RESULTS

Eight NAT-only-reactive donors were identified, and follow-up samples were obtained from six of the donors. The results indicated that all eight donors had an occult HBV infection with viral loads <12 IU/ml.

CONCLUSION

The cobas(®) TaqScreen MPX test, version 2.0, has an advantage over the current Roche blood screening test, the cobas TaqScreen MPX test, for screening donations in countries with a high prevalence of occult HBV infections since the uncertainty associated with identifying samples with very low viremia is removed by the ability of the test to identify the viral target in samples that are reactive with the cobas TaqScreen MPX test, version 2.0.

Frequency multiplexed superconducting quantum interference device readout of large bolometer arrays for cosmic microwave background measurements

A technological milestone for experiments employing transition edge sensor bolometers operating at sub-Kelvin temperature is the deployment of detector arrays with 100s-1000s of bolometers. One key technology for such arrays is readout multiplexing: the ability to read out many sensors simultaneously on the same set of wires. This paper describes a frequency-domain multiplexed readout system which has been developed for and deployed on the APEX-SZ and South Pole Telescope millimeter wavelength receivers. In this system, the detector array is divided into modules of seven detectors, and each bolometer within the module is biased with a unique ∼MHz sinusoidal carrier such that the individual bolometer signals are well separated in frequency space. The currents from all bolometers in a module are summed together and pre-amplified with superconducting quantum interference devices operating at 4 K. Room temperature electronics demodulate the carriers to recover the bolometer signals, which are digitized separately and stored to disk. This readout system contributes little noise relative to the detectors themselves, is remarkably insensitive to unwanted microphonic excitations, and provides a technology pathway to multiplexing larger numbers of sensors.

Larval dietary wheat germ oil influences age-specific protein expression in adults of the oriental fruit fly

Changes in essential dietary components alter global gene expression patterns in animals. We reported on a proteomics study designed to identify molecular markers of deficiencies in culture media developed for the oriental fruit fly, Bactrocera dorsalis. In that study, we found significant changes in expression of 70 proteins in adults of larvae reared on media lacking wheat germ oil (WGO), compared to media supplemented with WGO. Of these, a gene encoding an insect chitin-binding protein was expressed at about 120-fold higher levels in adult males reared on media supplemented with WGO. We inferred it may be feasible to develop the gene as a molecular marker of dietary lipid deficiency. The work was focused, however, on analysis of 11 day old adults. We have no information on expression of the chitin-binding protein, nor on any other proteins at other adult ages. In this paper we address the idea that the whole animal proteome changes dynamically with age. We reared separate groups of fruit fly larvae on media with and without WGO supplementation and analyzed protein expression in adult males and females age 0, 4, 8 and 12 days old using 2D electrophoresis. Gel densitometry revealed significant increases (by >2-fold) and decreases (by >50%) in expression levels of 29 proteins in females and 10 in males. We identified these proteins by mass spectrometry on MALDI TOF/TOF and bioinformatic analyses of the protein sequences. Two proteins, peroxiredoxin (26-fold increase) and vitellogenin 1 (15-fold increase) increased in expression in day 8 females. The key finding is that most changes in protein expression occurred in day 8 females. We infer that the fruit fly proteome changes with adult age. The natural changes in proteome with adult age is a crucial aspect of developing these and other proteins into molecular markers of lipid deficiency in fruit flies and possibly other insect species.

Seasonal variation and health risk assessment of polycyclic aromatic hydrocarbons in Miaoli city, Taiwan

The ambient PAHs levels in the downtown area of a traditional small city were analyzed for winter and summer seasons. A total of 16 PAHs in gaseous and particulate phase were quantified. The average gaseous PAHs were 2,189 ± 1,194 and 623.8 ± 545.1 ng/m(3) in winter and summer seasons, respectively. For the PAHs in particulate phase, they were 40.32 ± 12.15 and 11.99 ± 5.63 ng/m(3) in winter and summer seasons, respectively. These values were comparable to those reported for large cities or even higher. The estimated BaPeq was 12.32 ± 6.34 ng/m(3). As low-molecular-weight PAHs primarily existed in gaseous phase, high-molecular-weight PAHs in particulate phase became a significant fraction of total particulate phase PAHs. Particulate phase PAHs was significantly inversely associated with the ambient temperature for each individual PAHs species. However, this relationship did not exist for high-molecular-weight PAHs in gaseous phase. The results indicated the photo-degradation of high-molecular-weight PAHs should warrant a further thoughtfully investigation.

Association between the interleukin-18 promoter polymorphism and pulmonary tuberculosis in a Korean population

OBJECTIVE

To examine the role of the -667G/T, -618A/C and -148G/C single nucleotide polymorphisms in the promoter region of the human interleukin (IL) 18 gene in the development of pulmonary tuberculosis (PTB), and its radiographic characteristics and severity.

DESIGN

Differences in the allele and genotype distributions of the -667G/T, -618A/C, and -148G/C polymorphisms between 251 patients with PTB and 225 healthy controls, between patients with single- and multilobe involvement, and between patients with and without cavities were explored. Serum IL-18 levels were measured using an enzyme-linked immunosorbent assay.

RESULTS

The -148G/G genotype was more common in patients with cavities than in those without (82.8% vs. 70.9%, P = 0.04), but an analogous trend was not observed for the -667G/T and -618A/C genotypes. However, there were no significant differences in allele and genotype distributions between patients with PTB and healthy controls, or between patients with single- and multilobe involvement (P > 0.05). Serum IL-18 levels were higher in patients with cavities (P = 0.01) and in patients with the -148G/G genotype (P = 0.02).

CONCLUSION

Considering serum IL-18 levels, the -148G/G genotype is associated with a cavitary formation of PTB rather than its development.

X-Ray spectra and electronic correlations of FeSe(1-x)Te(x)

Critical issues concerning emerging Fe-based superconductors include the degree of electron correlation and the origin of the superconductivity. X-Ray absorption spectra (XAS) and resonant inelastic X-ray scattering spectra (RIXS) of FeSe(1-x)Te(x) (x = 0-1) single crystals were obtained to study their electronic properties that relate to electron correlation and superconductivity. The linewidth of Fe L(2,3)-edges XAS of FeSe(1-x)Te(x) is narrower than that of Fe-pnictides, revealing the difference between their hybridization effects and localization character and those of other Fe-pnictides. While no significant differences exist between the Fe L-edge XAS and RIXS of FeSe(1-x)Te(x) and those of Fe-pnictides, Se K-edge and Te K-edge XAS exhibit substantial edge shift, suggesting that the superconductivity in an Fe-Se superconductor is strongly associated with the ligand states. A comparison of the Se K-edge and Te K-edge spectra reveals that the charge transfer may occur between Se and Te. Given the Coulomb interaction and the bandwidth, the spectral results indicate that FeSe(1-x)Te(x) is unlikely to be a weakly correlated system unlike the Fe-pnictides of the "1111" and "122" families. The spectral results further demonstrate that superconductivity in this class of Fe-based compounds is strongly associated with the ligand 4p hole state.

Fe3O4/MgO Superlattices Grown on MgO(OOl) and Fe/MgO(001) by Molecular Beam Epitaxy

The growth and structural characterization of Fe3O4/MgO superlattices on MgO(001) and Fe-coated MgO(001) are compared. Long modulated coherence and sharp interface are revealed by X-ray diffraction and reflection high energy electron diffraction (RHEED). For the superlattice grown directly on MgO(001), high crystalline quality is comparable to the previous report on the oxide superlattice system. For the superlattice grown on Fe/MgO(001), both chemical and lattice spacing modulations are maintained which is different from the polycrystlline structure of the Fe3O4/NiO grown on Ni-based system. This superiority of the growth on Fe-coated surface results from both the smaller lattice mismatch and the oxidation state of Fe relative to MgO. The changes of the RHEED intensity during the growth of these superlattices are also measured. The evolution of the oxide interface during the growth of Fe3O4/MgO is quantitatively presented.

Dark-recovery experiences, coping strategies, and needs of adult heart transplant recipients in Taiwan

AIMS

The aim of this project was to identify the dark-recovery experiences (DRE) that adult heart transplant recipients (AHTRs) perceived as causing the most suffering after heart transplantation (HT). In artition, we sought to explore the stage-specific difficulties, coping strategies, and helpers for transplant recipients DRE in Taiwan.

METHODS

A qualitative design was employed using a sample group of patients with DRE. Retrospective data collected by face-to-face in-depth interviews were subjected to content analysis.

RESULTS

A total of 20 AHTRs (16 men, 4 women) participated in this research. Their ages ranged from 32-70 years (mean, 46.95 years). Their post-HT timeframe ranged from 3 months-2.10 years. The subjects reported DRE the across preoperative intensive care unit (ICU), postoperative floor unit, and even after the hospital discharge stages. Four major difficulties during DRE were reported: (1) becoming a burden for families (all stages); (2) unfamiliar with medical protocols, environment, and policy (ICU stage); (3) mental and physical discomforts caused by the invasive examinations and unstable health condition (post-ICU to postdischarge stages); and (4) sense of uncertainty about health progression and quality of life in the future (post-ICU to postdischarge stages). Four coping strategies were used for DRE: (1) asking religious support (all stages); (2) changing mindsets and taking positive attitudes to live with difficulties (ICU to postdischarge stages); (3) setting goals for health maintenance and recovery (post-ICU to postdischarge stages); and (4) planning to look for an appropriate job in the future (postdischarge stages). Families and religious persons were cited as helpers (all stages), as well as health professionals (ICU to postdischarge stages), other AHTRs (post-ICU to postdischarge stages), and the social welfare systems (postdischarge stages).

CONCLUSION

DRE, coping strategies, and related helpers in Taiwan were systematically explored in this project. With this information, the transplantation team will be empowered to provide better care for AHTRs during their most vulnerable time.

Experiment and simulation on interface shapes of an yttrium aluminium garnet miniature molten zone formed using the laser-heated pedestal growth method for single-crystal fibers

A two-dimensional simulation was employed to study the melt/air and melt/solid interface shapes of the miniature molten zone formed in a laser-heated pedestal growth (LHPG) system. Using a non-orthogonal body-fitting grid system with the control-volume finite-difference method, the interface shape can be determined both efficiently and accurately. During stable growth, the dependence of the molten-zone length and shape on the heating CO2laser is examined in detail under both the maximum and the minimum allowed powers with various growth speeds. The effect of gravity on the miniature molten zone is also simulated and the possibility of horizontally oriented LHPG is revealed. Such a horizontal system is good for the growth of long crystal fibers.

Optimal strategies for best management practice placement in a synthetic watershed

It is significant to arrange suitable design and placement of best management practices (BMPs) for reaching the aim that can not only satisfy environmental quality standards, but also decrease the total cost of BMPs. This study applied WinVAST model to predict watershed responses. The objective of this work was to discuss both the economic costs and benefits of BMPs and the control efficiency of discharge and pollutant exports, and to create some suitable standards for the optimal BMPs placement strategies. It is significant to find an optimal number and location of BMPs. In the case study herein, the number of BMPs including a detention pond and a grassy swale would be better to be given by four. The number of BMPs should also be determined by the environmental standards. Moreover, the result shows that the optimal location of BMPs placement is in the downstream area near the outlet and on the mainstream of the catchment. When the BMPs are set in these regions, it cannot only reduce the peak flow and peak pollutant exports, but also have slow time to peak watershed responses.

Single aperiodically poled lithium niobate for simultaneous laser Q switching and second-harmonic generation in a 1342 nm Nd:YVO4 laser

We report the design and experimental demonstration of an electro-optically Q-switched intracavity second-harmonic generator (ISHG) based on a single aperiodically poled lithium niobate (APLN) in a 1,342 nm Nd:YVO(4) laser. This intracavity APLN, designed using the aperiodic optical superlattice technique, can perform simultaneously as a laser Q switch and a second-harmonic generator. At approximately 200 VQ-switching voltage and a 5 kHz switching rate, we measured a pulse energy of approximately 5.7 microJ and a peak power of approximately 700 W at 671 nm from the constructed ISHG with a 5.2 W diode power based on 51% fundamental energy depletion.

Cardio-selective and non-selective beta-blockers in chronic obstructive pulmonary disease: effects on bronchodilator response and exercise

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) often have co-existing cardiovascular disease and may require beta-blocker treatment. There are limited data on the effects of beta-blockers on the response to inhaled beta2-agonists and exercise capacity in patients with COPD.

OBJECTIVE

To determine the effects of different doses of cardio-selective and non-selective beta-blockers on the acute bronchodilator response to beta-agonists in COPD, and to assess their effects on exercise capacity.

METHODS

A double-blind, randomized, three-way cross-over (metoprolol 95 mg, propranolol 80 mg, placebo) study with a final open-label high-dose arm (metoprolol 190 mg). After 1 week of each treatment, the bronchodilator response to salbutamol was measured after first inducing bronchoconstriction using methacholine. Exercise capacity was assessed using the incremental shuttle walk test.

RESULTS

Eleven patients with moderate COPD were recruited. Treatments were well-tolerated although two did not participate in the high-dose metoprolol phase. The area under the salbutamol-response curve was lower after propranolol compared with placebo (P=0.0006). The area under the curve also tended to be lower after high-dose metoprolol (P=0.076). The per cent recovery of the methacholine-induced fall was also lower after high-dose metoprolol (P=0.0018). Low-dose metoprolol did not alter the bronchodilator response. Oxygen saturation at peak exercise was lower with all beta-blocker treatments (P=0.046).

CONCLUSION

Non-selective beta-blockers and high doses of cardio-selective beta-blockers may inhibit the bronchodilator response to beta2-agonists in patients with COPD. Beta-blockers were also associated with lower oxygen saturation during exercise. The clinical significance of these adverse effects is uncertain in view of the benefits of beta-blocker treatment for cardiovascular disease.

The impact of watershed delineation on hydrology and water quality simulation

Flood routing is a significant calculation for predicting watershed responses, involving discharge and pollutant exports. The computation of flow routing is highly relative to the relationship between downstream and upstream subbasins. A watershed could always be divided into several subbasins based on its topography and stream distribution. How detailed of the delineation of the stream distribution in a watershed would influence the modeling accuracy of flow routing and the prediction of watershed responses. The objective of this work was to discuss the effect of watershed delineation on runoff and pollutant transport predictions. When the number of divided subbasins increases, the stream distribution could be delineated more clearly. The case area was usually regarded as two subbasins only. In the present study, the case area was divided into 43, 25, 15 and 9 subbasins respectively. If the modeling result under 43 subdivisions is assumed to be the actual situation, the relative error of runoff simulation due to the simplified delineation of stream distribution is only around 25% in two subdivisions. However, the relative error of suspended solids (SS), total nitrogen (TN) and orthophosphate (Orth-P) simulation can reach 85%, 71 and 70% in two subdivisions respectively. The uncertainties or errors induced by too much simplification of watershed delineation could be carried over and amplified to the pollutant transport process and the modeling results of pollutant exports.

Relationship between landscape characteristics and surface water quality

The effects of landscape characteristics on surface water quality were evaluated in terms of land-use condition, soil type and slope. The case area, the Chichiawan stream in the Wulin catchment in Taiwan, is Formosan landlocked salmon's natural habitat. Due to the agriculture behavior and mankind's activities, the water and environmental quality has gradually worsened. This study applied WinVAST model to predict hydrological responses and non-point source pollution (NPSP) exports in the Wulin catchment. The land-use condition and the slope of land surface in a catchment are major effect factors for watershed responses, including flows and pollutant exports. This work discussed the possible variation of watershed responses induced by the change of land-use condition, soil type and slope, etc. The results show that hydrological responses are highly relative to the value of Curve Number (CN); Pollutant exports have large relation to the average slope of the land surface in the Wulin catchment.