930 SAFETY, TOLERABILITY AND IMMUNOGENICITY OF 15-VALENT PNEUMOCOCCAL CONJUGATE VACCINE + PPV23 12 MONTHS LATER IN HEALTHY ADULTS ≥ 50

Background

Older adults are at increased risk of pneumococcal disease (PD). V114, an investigational 15-valent Pneumococcal Conjugate Vaccine (PCV), contains all serotypes in 13-valent PCV (PCV13) plus serotypes 22F and 33F. This phase 3 trial evaluated the safety, tolerability and immunogenicity of V114 or PCV13 followed 12 months later by PPSV23 in healthy adults aged ≥50 years.

Materials/Method

652 eligible adults were randomised 1:1 to receive V114 or PCV13 followed by PPSV23 12 months later. Solicited and non-solicited adverse events (AEs) were collected after each vaccination. Serotype-specific opsonophagocytic activity (OPA) and immunoglobulin G (IgG) antibodies were measured at Day 1, Day 30, Month 12 and Month 13.

Results

The most common solicited AEs following PCV were injection-site pain, fatigue and myalgia; higher proportions of participants with solicited AEs were observed in the V114 group; however, the differences were not clinically significant, as most AEs were mild and of short duration. The most common solicited AEs following PPSV23 were injection-site pain, injection-site swelling, fatigue and myalgia; these events were comparable across both intervention groups. The proportion of participants with serious AEs were low in both groups and none reported to be vaccine related. No deaths occurred during the study. Serotype-specific OPA geometric mean titres (GMTs) and IgG geometric mean concentrations (GMCs) were comparable between the groups for all 15 serotypes 30 days post-vaccination with PPSV23. OPA GMTs and IgG GMCs were comparable between PCV groups for the 13 shared serotypes and higher in V114 than PCV13 for serotypes 22F and 33F 30 days and 12 months post-vaccination with PCV. V114 elicited an immune response that persisted for at least 12 months.

Conclusion

Sequential administration of V114 and PPSV23 is well tolerated, immunogenic and generally comparable to PCV13 followed by PPSV23 in healthy adults ≥50 years of age.

The risk of anti-osteoporotic agent-induced severe cutaneous adverse drug reactions and their association with HLA

BACKGROUND

There is increasing use of anti-osteoporotic agents (AOA) worldwide for prevention or management of patients with osteoporosis. However, there have been reports of severe cutaneous adverse reactions (SCAR) induced by AOA. A recent study showed weak association between HLA and strontium ranelate (SR)-SCAR.

OBJECTIVE

To characterize patients with AOA-SCAR and investigate the HLA association and utility of in vitro diagnostic methods.

METHODS

We enrolled 16 cases with AOA-cutaneous adverse drug reactions (cADR), including SCAR (n = 10: 8 with Stevens-Johnson syndrome [SJS] and 2 with drug rash with eosinophilia and systemic symptoms [DRESS]) and maculopapular exanthema (MPE) (n = 6) from Taiwan and Hong Kong. We analysed the clinical characteristics, outcomes, HLA alleles and in vitro testing of AOA-SCAR, and tolerability to alternative drugs. We further performed literature review and meta-analysis on the HLA association of AOA-SCAR.

RESULTS

Our data showed strontium ranelate is the most common causality of AOA-SCAR in Asian populations. There was no cross-hypersensitivity of SR-SCAR with other AOA. HLA genotyping showed that SR-SJS was most significantly associated with HLA-A*33:03 (Pc = 5.17 × 10^-3 , OR: 25.97, 95% CI: 3.08-219.33). Meta-analysis showed that HLA-A*33:03 was associated with SR-SJS (P = 5.01 × 10^-5 ; sensitivity: 85.7%) in Asians. The sensitivity of lymphocyte activation test (LAT) for identifying the culprit drug of SR-SJS was 83.3%.

CONCLUSIONS

Strontium ranelate is identified as the most notorious AOA associated with SCAR. The HLA-A*33:03 genetic allele and LAT testing may add benefits to the diagnosis of SR-SCAR in patients whose reaction developed while taking multiple drugs.

Transoral vertical ramus osteotomy fixed with Kirschner pins

Transoral vertical ramus osteotomy (VRO) has been condemned because the condyle has the potential to sag, and because it needs lengthy maxillomandibular fixation. We have therefore introduced a simple method of fixation, and examined its effectiveness and complications. After the osteotomy, the proximal and distal segments are trimmed to adapt to each other. Four Kirschner (K) pins 0.9mm in diameter are inserted percutaneously from the proximal to the distal segment while the condyle is positioned in the glenoid fossa. This is followed by a brief period of maxillomandibular fixation. We have reviewed the records of 95 patients who had unilateral or bilateral vertical ramus osteotomy fixed with K pins, after which the mean (SD) period of fixation was 19 (11) days. Fixation failed in two patients because excursion of the jaw was either too heavy or too early. The fixations were redone. All other fixations remained stable, including the 20 dual-jaw procedures in which VRO preceded maxillary osteotomy. The mean (SD) maximal mouth opening at final follow-up was 44 (7) mm, and in only one patient was it less than 30mm. Numbness of the lip or chin developed in seven patients, five of whom had other anterior mandibular procedures. Four patients had discomfort on palpation of the site of the pins, and one required removal. The new method was effective, and resulted in few complications within its limitations.

Indoor air quality in hairdressing salons in Taipei

To improve indoor air quality and to protect public health, Taiwan has enacted the "Indoor Air Quality Act (IAQ Act)" in 2012. For the general public, the indoor air quality in hair salons is important because it is a popular location that people will often visit for hair treatments. However, only a few exposure assessments regarding air pollutants have previously been performed in hair salons. To assess the air quality of hairdressing environments in Taipei, ten hairdressing salons were included for a walk-through survey in this study. In addition, the airborne concentrations of formaldehyde, volatile organic compounds (VOCs), CO₂ , and phthalate esters were also determined in 5 salons. Charcoal, XAD-2, and OVS-Tenax tubes were used for the air sampling, while the samples were analyzed with gas chromatography/mass spectrometer. It was found that the products used in hair salons contained various chemicals. In fact, from the walk-through survey, a total of 387 different ingredients were found on 129 hair product labels. The hair salons were not well ventilated, with CO₂ levels of 600 to 3576 ppm. The formaldehyde concentrations determined in this study ranged from 12.40 to 1.04 × 10³  μg m^-3 , and the maximum level was above the permissible exposure limit (PEL) of US Occupational Safety and Health Administration (US OSHA). Additionally, 83% of the samples were with levels higher than the standard regulated by Taiwan's IAQ Act. The concentrations of VOCs and phthalate esters were below the occupational exposure limits (OELs), but higher than what was found in general residential environments. The hair products were considered as the major source of air pollutants because significantly higher concentrations were found around the working areas. The number of perming treatments, the number of workers, and the frequency of using formaldehyde releasing products, were found to be associated with the levels of formaldehyde. This study indicates that efforts are needed to improve the indoor air quality in hairdressing salons in Taipei.

Genital Tuberculosis Presenting as Acute Scrotum Mimicking Fournier's Gangrene

Genital tuberculosis usually presents as local symptoms such as lower abdominal pain and a sensation of scrotal bloating. We report a rare case of genital tuberculosis in a 46-year-old man presenting with symptoms that mimic Fournier's gangrene. He had a progressive local symptoms of scrotal tenderness, redness, swelling, and local rise in temperature. The patient underwent emergency open debridement, and pathology confirmed tuberculosis infection. Recovery was uneventful after 6 months of anti-tuberculosis drug treatment. Literature of genital tuberculosis is also reviewed.

Protective effect and antibody response of DNA vaccine against salmonid alphavirus 3 (SAV3) in Atlantic salmon

This work reports the effect of two DNA vaccines against salmonid alphavirus 3 (SAV3) in Atlantic salmon. Presmolts were vaccinated by intramuscular injection of plasmids encoding the SAV3 structural polyprotein C-E3-E2-6K-E2 (pCSP), E2 only (pE2), or plasmid without insert (pcDNA3.3). E2 is expressed at the surface of cells transfected with pCSP and internally in cells transfected with pE2. A commercial vaccine based on inactivated SAV (NCPD) was used for comparison. At 10 weeks post-vaccination, only fish vaccinated with pCSP showed antibody against E2 and virus-neutralizing activity. Vaccinated fish were infected with SAV3 to determine protection by virus quantitation in serum after 7 days and scoring of pathological changes after 21 days. Fish vaccinated with both pCSP and NCPD vaccines showed significant virus reduction in serum, while fish vaccinated with pE2 did not. All fish vaccinated with pcDNA3.3 and pE2 showed pathological changes in organs typical of PD, 60% of fish vaccinated with NCPD showed PD pathology, while fish vaccinated with pCSP did not show PD pathology. Taken together, DNA vaccination with pCSP provided strong protection for salmon against SAV3 infection, which in part may be due to production of virus-neutralizing antibodies.

Blue light-induced immunosuppression in Bactrocera dorsalis adults, as a carryover effect of larval exposure

Detrimental effects of ultraviolet (UV) light on living organisms are well understood, little is known about the effects of blue light irradiation. Although a recent study revealed that blue light caused more harmful effects on insects than UV light and blue light irradiation killed insect pests of various orders including Diptera, the effects of blue light on physiology of insects are still largely unknown. Here we studied the effects of blue light irradiation on cuticular melanin in larval and the immune response in adult stage of Bactrocera dorsalis. We also evaluated the effects of blue light exposure in larval stage on various age and mass at metamorphosis and the mediatory role of cuticular melanin in carryover effects of larval stressors across metamorphosis. We found that larvae exposed to blue light decreased melanin contents in their exoskeleton with smaller mass and delayed metamorphosis than insects reared without blue light exposure. Across metamorphosis, lower melanotic encapsulation response and higher susceptibility to Beauveria bassiana was detected in adults that had been exposed to blue light at their larval stage, thereby constituting the first evidence that blue light impaired adult immune function in B. dorsalis as a carryover effect of larval exposure.

The relationship between high-density lipoprotein cholesterol levels and arterial stiffness in a Taiwanese population

BACKGROUND AND AIMS

There are few studies on the association between HDL-C levels and arterial stiffness (AS). HDL-C levels vary in males and females, and it is not clear whether the relationship between HDL-C levels and AS is influenced by gender. The purpose of this study was to investigate gender differences in the association between HDL-C levels and AS in adults.

METHODS AND RESULTS

After excluding subjects using lipid-lowering agent, 7254 subjects were enrolled. The AS was assessed by measuring the brachial-ankle pulse wave velocity (baPWV) value. The quartiles of HDL-C were <38, 38-45, 45-53 and >53 mg/dL in men and <48, 48-57, 57-69 and >68 mg/dL in women, respectively. In subjects aged <50 years, none of the HDL-C quartiles were associated with baPWV values. In subjects aged ≥50 years, the highest quartile of HDL-C (beta: -37.57, 95% CI: -61.61 to -13.54) was negatively related to baPWV values. When considering gender difference in subjects aged ≥50 years, the highest quartile of HDL-C (Q4 beta: -57.22, 95% CI: -95.63 to -18.81) was inversely associated with baPWV values in women, but none of the HDL-C quartiles were related to baPWV values in men.

CONCLUSIONS

A high HDL-C level was associated with a lower risk of AS in subjects aged ≥50 years in women but not in men, although this relationship was not apparent in subjects aged <50 years. The association between HDL-C level and AS is thus influenced by gender in people aged ≥50 years.

Gallstone disease associated with increased risk of arterial stiffness in a Taiwanese population

Arterial stiffness has similar risk factors to gallstone disease (GSD). However, there are few studies on the association between arterial stiffness and GSD. The aim of this study was to determine the relationship between arterial stiffness and GSD in a Taiwanese population. We enroled 6211 subjects from a health examination centre after excluding those who received medications for diabetes, hypertension and hyperlipidemia or had a history of cardiovascular disease, cerebrovascular disease, cancer, cholecystectomy or ankle-brachial index of ⩽ 0.9 or⩾1.3. Increased arterial stiffness was defined as right brachial-ankle pulse wave velocity (baPWV) ⩾1400 cm s^-1. The diagnosis of GSD was based on ultrasonographic findings. The prevalence of increased arterial stiffness was 47.2 and 31.9 % in subjects with and without GSD (P<0.001). A multiple linear regression analysis revealed that GSD, age, systolic blood pressure, fasting plasma glucose and current smoking were positively associated with baPWV, whereas male gender, BMI, habitual exercise and HDL-C were negatively related to baPWV after adjusting for other clinical variables. In conclusion, subjects with GSD are associated with an increased risk of arterial stiffness.

Cardiac Output Assessed by the Fourth-Generation Arterial Waveform Analysis System Is Unreliable in Liver Transplant Recipients

BACKGROUND

Liver transplant recipients often have violent hemodynamic fluctuation during surgery that may be related to perioperative and postoperative morbidity. Because there are some considerations for the risk of the pulmonary arterial catheter (PAC), the conventional invasive device for cardiac output (CO) measurement, a reliable and minimally invasive alternative is required. We validated the reliability of CO measurements with the use of a minimally invasive FloTrac system with the latest fourth-generation algorithm in liver transplant recipients.

METHODS

Forty liver transplant recipients without atrial fibrillation, valvular pathology, or intracardiac shunt were recruited in this prospective, observational study. CO values measured by use of PAC with continuous thermodilution method (COTh) and FloTrac devices (COFT) were collected simultaneously throughout the operation for reliability validation.

RESULTS

Four hundred pairs of CO data points were collected in total. The linear regression analysis showed a high correlation coefficient (73%, P < .001). However, the percent error between COTh and COFT was 42.2%, which is worse than the established interchangeability criterion of 30%. The concordance rates were calculated at 89% and 59% by 4-quadrant plot and polar plot analysis, respectively. Neither met the preset validation criteria (>92% for the 4-quadrant plot and >90% for polar plot analyses).

CONCLUSIONS

Our study demonstrates that the CO measurements in liver transplant recipients by the latest FloTrac system and the PAC do not meet the recognized interchangeability criterion. Although the result showed improvement in linear regression analysis, it failed to display a qualified trending ability.

Accuracy and Trending of Continuous Noninvasive Hemoglobin Monitoring in Patients Undergoing Liver Transplantation

BACKGROUND

Shift in large fluid volumes and massive blood loss during liver transplantation frequently leads to rapid changes in hemoglobin (Hb) concentration; thus, to ensure adequate tissue oxygenation, accurate and rapid determination of Hb concentration is essential in transplant recipients. The Radical-7 Pulse CO-Oximeter provides a noninvasive and continuous way to monitor Hb concentration (SpHb) in real time and is an ideal candidate for use during liver transplantation. In this study, we assessed the relationship between SpHb and total Hb (tHb) obtained from arterial blood samples during surgery.

METHODS

Forty patients undergoing liver transplantation were enrolled in this study. tHb and time-matched SpHb were measured at 5 different phases throughout surgery. Paired SpHb and tHb levels were assessed using linear regression, Bland-Altman analysis, and the Critchley polar plot method.

RESULTS

A total of 161 paired measurements with sufficient signal quality were analyzed. The correlation between SpHb and tHb was 0.59 (P < .001). Bland-Altman analysis revealed that a bias between SpHb and tHb was 2.28 g/dL, and limits of agreement (LoA) were from -0.78 to 5.34 g/dL. Trending analysis showed that 87% of data were located within the acceptable trending area, indicating that the trending ability was not satisfied.

CONCLUSIONS

The Radical-7 Pulse CO-Oximeter was not sufficient to monitor Hb levels and trends during liver transplantation surgery in our cohort. In particular, in critical patients and in those with low Hb levels, invasive Hb measurement should be used for assessment.

Beware Neck Pain in a Haemodialysis Patient: Spontaneous Spinal Epidural Haematoma

Spontaneous spinal epidural haematoma is a rare and devastating disorder. To the best of our knowledge, only 4 haemodialysis patients with the diagnosis of spontaneous spinal epidural haematoma have been reported in the literature. Here, we reported a 70-year-old male haemodialysis patient who presented with a sudden onset of severe sharp neck pain. Spontaneous spinal epidural haematoma with cord compression from C2 to C6 was diagnosed by magnetic resonance imaging. After emergency surgery, the patient recovered completely from the profound neurological deficits. The relevant literatures were also reviewed.

Xylella taiwanensis sp. nov., causing pear leaf scorch disease

A Gram-stain-negative, nutritionally fastidious bacterium (PLS229T) causing pear leaf scorch was identified in Taiwan and previously grouped into Xylella fastidiosa. Yet, significant variations between PLS229T and Xylellafastidiosa were noted. In this study, PLS229T was evaluated phenotypically and genotypically against representative strains of Xylellafastidiosa, including strains of the currently known subspecies of Xylellafastidiosa, Xylella fastidiosa subsp. multiplex and 'Xylella fastidiosasubsp.pauca'. Because of the difficulty of in vitro culture characterization, emphases were made to utilize the available whole-genome sequence information. The average nucleotide identity (ANI) values, an alternative for DNA-DNA hybridization relatedness, between PLS229T and Xylellafastidiosa were 83.4-83.9 %, significantly lower than the bacterial species threshold of 95 %. In contrast, sequence similarity of 16S rRNA genes was greater than 98 %, higher than the 97 % threshold to justify if two bacterial strains belong to different species. The uniqueness of PLS229T was also evident by observing only about 87 % similarity in the sequence of the 16S-23S internal transcribed spacer (ITS) between PLS229T and strains of Xylellafastidiosa, discovering significant single nucleotide polymorphisms at 18 randomly selected housekeeping gene loci, observing a distinct fatty acid profile for PLS229T compared with Xylellafastidiosa, and PLS229T having different observable phenotypes, such as different susceptibility to antibiotics. A phylogenetic tree derived from 16S rRNA gene sequences showed a distinct PLS229T phyletic lineage positioning it between Xylellafastidiosa and members of the genus Xanthomonas. On the basis of these data, a novel species, Xylella taiwanensis sp. nov. is proposed. The type strain is PLS229T (=BCRC 80915T=JCM 31187T).

Pre-operative serum albumin level substantially predicts post-operative morbidity and mortality among patients with colorectal cancer who undergo elective colectomy

The quantitative relationship between serum albumin level and surgical outcomes has not been clearly established. This study included 3732 patients with colon cancer who underwent a potentially curative colectomy. Post-operative mortality and morbidity were analysed according to the patients' demographic data, pre-operative comorbidities, and tumour-related factors. Age, asthma, renal impairment, and albumin level were significantly associated with post-operative morbidity and mortality in the multivariate analyses. Logistic regression analysis revealed linear relationships of post-operative morbidity and mortality with albumin level. The morbidity and mortality rates decreased by 7.3% and 15.6%, respectively, for each 0.1 g/dL increase in albumin level. This finding remained significant in the hypoalbuminaemia subgroup but not in the normoalbuminaemia subgroup. That is, the morbidity and mortality rates significantly decreased by 8.7% and 17.7%, respectively (both P < 0.001), in the former group and decreased by 2.7% (P = 0.112) and 11.6% (P = 0.092), respectively, in the latter group. This study demonstrated that serum albumin level linearly predicted the post-operative morbidity and mortality among the colorectal cancer patients. Pre-operative serum albumin level may therefore be used as a continuous rather than a categorical marker of disease severity, especially among patients with hypoalbuminaemia.

First Report of a 16SrI Group Phytoplasma Associated with Roselle (Hibiscus sabdariffa) Wrinkled Leaves and Phyllody Disorder in Taiwan

Roselle (Hibiscus sabdariffa L.), an annual plant with acidic taste, has been used for making juice, jelly, and other baking additives in Taiwan. In September 2013, symptoms including phyllody and wrinkled leaves were observed on roselle plants in a field in Tantsu Township, Taichung County, Taiwan. Incidence of the infected plants was estimated to be greater than 80% within a single field. A phytoplasma was recently reported as the causal agent of roselle phyllody and reddening of leaves in India and classified as a group 16SrV-D strain (1). Samples including stems, flowers, and leaves were collected from four symptomatic and one asymptomatic roselle plants from the field. Transmission electron microscopy revealed clusters of phytoplasma cells ranging from 400 to 750 nm in diameter only in phloem sieve elements of petioles and stems of symptomatic plants. These cells were not observed in asymptomatic plants. Total DNA was extracted from plant tissues (100 mg each) including stems, petioles, and mid veins of leaves by a modified CTAB method (2). Analyses by a nested PCR assay using universal primer pairs P1/P7 followed by R16F2n/R16R2 were performed to detect putative phytoplasma (1). Each primer pair amplified a single PCR product 1.8 kb and 1.2 kb long, respectively, only from tissues of the four symptomatic plants. The nested PCR products (1.2 kb) amplified from three independent symptomatic plants were cloned separately and sequenced by automatic DNA sequencing method with ABI3730 DNA Analyzer (Applied Biosystems) at the Biotechnology Center, National Chung Hsing University, Taichung, Taiwan (GenBank Accession Nos. KF923397, KF923398, and KF923399). BLAST analysis of the sequences revealed that they shared 99.8% sequence identity with those of 16SrI group phytoplasma strains, e.g., garlic yellows phytoplasma, torenia yellows phytoplasma, and periwinkle leaf yellowing phytoplasma (AB750363, FJ437568, and GU361754). Moreover, i PhyClassifier software (3) was used to perform sequence comparison and generate a virtual restriction fragment length polymorphism (RFLP) profile for the sequences derived from the symptomatic roselle samples. The 16S rDNA sequences shared 99.6% identity with those of the 'Candidatus Phytoplasma asteris' reference strain (M30790) and the RFLP patterns were identical to that of the 16SrI group. However, this strain may represent a new subgroup because the shared similarity coefficient was only 0.94, which is within the values set for a new subgroup (3). Taken together, these results indicate the phytoplasma infecting roselle in Taiwan is a 'Ca. P. asteris'-related strain belonging to the 16SrI group. To our knowledge, this is the first report of a 16SrI group phytoplasma causing wrinkled leaves and phyllody on roselle in Taiwan. The occurrence of phytoplasma on roselle could have direct implication for the bakery and juice industries in Taiwan. References: (1) C. Biswas et al. Phytoparasitica 41:539, 2013. (2) I. Echevarría-Machado et al. Mol. Biotechnol. 31:129, 2005. (3) W. Wei et al. Int. J. Syst. Evol. Microbiol. 57:1855, 2007.

First Report on the Association of a 16SrII-A Phytoplasma with Sesame (Sesamum indicum) Exhibiting Abnormal Stem Curling and Phyllody in Taiwan

Sesame (Sesamum indicum L.), an annual plant, is grown as an oilseed crop and the seeds are used in bakery products in Taiwan. In June 2013, plants exhibiting symptoms including phyllody and abnormal stem curling were observed in sesame fields in Pitou Township, Changhua County, Taiwan. Incidence of infected plants was estimated to be greater than 90% within a single field. Phytoplasmas associated with sesame exhibiting phyllody, witches'-broom, or virescence have been classified as strains of 16SrI-B in Myanmar (GenBank Accession No. AB558132), 16SrII-A in Thailand (JN006075), 16SrII-D in Oman (EU072505) and India (KF429486), 16SrIV-C in Iran (JF508515), and 16SrVI-A (KF156894) and 16SrIX (KC139791) in Turkey (1). Three symptomatic and four asymptomatic plants were uprooted and transplanted in a greenhouse for further study. Transmission electron microscopy (TEM) revealed clusters of phytoplasma cells ranging from 300 to 800 nm in diameter only in phloem sieve elements of stems of three symptomatic and two asymptomatic plants. Comparable tissues from two other symptomless plants were devoid of phytoplasma cells. Total DNA was extracted with a modified CTAB method (2) from plant tissues (100 mg each) including stem, leaf, petiole, and root from the same plants used for TEM work. Analyses by a nested PCR using universal primer pairs P1/P7 (5'-AAGAGTTTGATCCTGGCTCAGGATT/5'-CGTCCTTCATCGGCTCTT) followed by R16F2n/R16R2 (5'-GAAACGACTGCTAAGACTGG/5'-TGACGGGCGGTGTGTACAAACCCCG) were performed to detect putative phytoplasma DNA (3). Each primer pair amplified a single PCR product of either 1.8 or 1.2 kb, respectively, only from the three symptomatic and two asymptomatic plant tissues that had phytoplasma cells in their sieve elements. It is likely that these two asymptomatic plants were in the early stage of infection before symptoms became noticeable. The nested PCR products (1.2 kb) amplified from the symptomatic plants were cloned separately and sequenced (GenBank Accession Nos. KF923391, KF923392, and KF923393). BLAST analysis of the sequences revealed that they shared 99.2% sequence identity with strains reported from India and Thailand (KF429486 and JN006075), which were classified to the 16SrII-D and 16SrII-A subgroups, respectively. Moreover, iPhyClassifier software (4) was used to perform sequence comparison and generate a virtual restriction fragment length polymorphism (RFLP) profile. The 16S rDNA sequences shared 99.4% identity with that of the 'Candidatus Phytoplasma australasiae' (Y10097) and the RFLP patterns were identical to that of the 16SrII-A subgroup, indicating the Taiwanese strain is a 'Ca. P. australasiae'-related strain. To our knowledge, this is the first report of a 16SrII-A subgroup phytoplasma causing phyllody and abnormal stem curling on sesame in Taiwan. The occurrence of phytoplasma on sesame could have direct implications for the cultivation of this economically important oilseed plant and the bakery industry in Taiwan. References: (1) M. Catal et al. Plant Dis. 97:835, 2013. (2) T. M. Fulton et al. Plant Mol. Biol. Rep. 13:207, 1995. (3) D. E. Gundersen and I. M. Lee. Phytopathol. Mediterr. 35:144, 1996. (4) Y. Zhao et al. Int. J. Syst. Evol. Microbiol. 59:2582, 2009.

Brown-Sequard Syndrome: A Rare Presentation of Spontaneous Cervical Spinal Epidural Haematoma

Spontaneous spinal epidural haematoma is a rare but well-known entity that has been considered a surgical emergency. Brown-Sequard syndrome resulting from spontaneous cervical spinal epidural haematoma is rare. Only 11 cases have been described in the literature. We reported an 85-year-old female who presented with Brown-Sequard syndrome at the right C5 level, and an acute haematoma located from the C3 to C6 level was diagnosed from the series images. Within two weeks after decompressive surgery, the previous neurological deficits had gradually improved. (Hong Kong j.emerg.med. 2014;21:107-111)

Evaluating the protective efficacy of antigen combinations against Photobacterium damselae ssp. piscicida infections in cobia, Rachycentron canadum L

Cobia, Rachycentron canadum L., is a very important aquatic fish that faces the risk of infection with the bacterial pathogen Photobacterium damselae ssp. piscicida, and there are few protective approaches available that use multiple antigens. In the present study, potent bivalent antigens from P. damselae ssp. piscicida showed more efficient protection than did single antigens used in isolation. In preparations of three antigens that included recombinant heat shock protein 60 (rHSP60), recombinant α-enolase (rENOLASE) and recombinant glyceraldehyde-3-phosphate dehydrogenase (rGAPDH), we analysed the doses that elicited the best immune responses and found that this occurred at a total of 30 μg of antigen per fish. Subsequently, vaccination of fish with rHSP60, rENOLASE and rGAPDH achieved 46.9, 52 and 25% relative per cent survival (RPS), respectively. In addition, bivalent subunit vaccines--combination I (rHSP60 + rENOLASE), combination II (rENOLASE + rGAPDH) and combination III (rHSP60 + rGAPDH)--were administered and the RPS in these groups (65.6, 64.0 and 48.4%, respectively), was higher than that achieved with single-antigen administration. Finally, in combination IV, the trivalent vaccine rHSP60 + rENOLASE + rGAPDH, the RPS was 1.6%. Taken together, our results suggest that combinations of two antigens may achieve a better efficiency than monovalent or trivalent antigens, and this may provide new insights into pathogen prevention strategies.

Hepatitis C viral infection and the risk of dementia

BACKGROUND AND PURPOSE

Hepatitis C virus (HCV) infection may cause cognitive impairment, but no studies have focused specifically on cognitive impairment stemming from HCV. The purpose of this study was to investigate the potential increased risk for dementia in HCV-infected patients.

METHODS

A population-based cohort study based on the Taiwan National Health Insurance Research Database was conducted. From all potential participants aged 50 years or more, a total of 58,570 matched (1:1) pairs of HCV-infected patients and non-HCV-infected patients were included. Each subject was individually tracked from 1997 to 2009 to identify incident cases of dementia (onset in 1999 or later). Cox proportional hazards regressions were employed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between HCV infection and dementia.

RESULTS

There were 2989 dementia cases from the HCV-infected cohort during the follow-up period of 533,861.1 person-years; the overall incidence rates of dementia differed from the non-HCV cohort (56.0 vs. 47.7 cases per 10,000 person-years, P < 0.05). The adjusted HR for dementia was 1.36 (95% CI 1.27-1.42) for HCV-infected patients after adjusting for alcohol-related disease, liver cirrhosis, hepatic encephalopathy and hepatocellular carcinoma.

CONCLUSIONS

HCV infection may increase the risk for dementia. Further mechanistic research is needed.

Cardiac autonomic function and insulin resistance for the development of hypertension: a six-year epidemiological follow-up study

BACKGROUND AND AIMS

To explore the impact of cardiac autonomic function (CAF) and insulin resistance (IR) on incident hypertension.

METHODS AND RESULTS

In 1996, 1638 subjects finished baseline examination, which included anthropometry, blood pressures, CAF, blood biochemistry, plasma insulin, urine examination and electrocardiogram. CAF included standard deviation of normal-to-normal intervals or RR intervals (SDNN), low- and high-frequency power spectrum (LF and HF), and LF/HF ratio at supine for 5 min, the RR interval changes during lying-to-standing maneuver, and the ratio between the longest RR interval during expiration and the shortest RR interval during inspiration (E/I ratio). We used homeostasis model assessment to define beta cell function (HOMA-B) and insulin resistance (HOMA-IR). In total, 992 non-hypertensive participants completed the follow-up assessment in 2003 and 959 participants were included for the final analysis. Incident hypertension was determined by blood pressure status at follow-up. In unadjusted model, both square root of HOMA-IR (OR:3.37, 95%CI: 2.10-6.64) and HOMA-B (OR:0.996, 95%CI: 0.992-0.999) were related to incident hypertension. In multivariate model, square root of HOMA-IR (OR:1.97, 95%CI: 1.05-3.70), but not HOMA-B, was associated with incident hypertension. After further adjustment for baseline CAF, the positive relationship between the square root of HOMA-IR and incident hypertension disappeared. In contrast, LF/HF ratio (OR:1.18, 95%CI: 1.01-1.37), HF power (OR:0.98, 95%CI: 0.96-0.999), and E/I ratio (OR:0.71, 95%CI: 0.54-0.95) were each independently associated with incident hypertension after further adjustment for HOMA measures.

CONCLUSION

Sympathovagal imbalance with an apparently decreased parasympathetic tone is an important predictor of incident hypertension independent of IR.

Predicting hospital mortality in adult patients with prolonged stay (>14 days) in surgical intensive care unit

BACKGROUND

The aim of this paper was to identify the factors at surgical intensive care unit (SICU) admission and during the following SICU course that influence hospital mortality of patients with prolonged SICU stay (>14 days).

METHODS

This prospectively-planned study enrolled 1661 patients over 16 years old with prolonged SICU stay in a tertiary-care teaching hospital over a 4-year period. Data at SICU admission, physiologic factors on the 14th SICU day and the indications of prolonged ICU stay were collected. A multivariate logistic regression model with a least absolute shrinkage and selection operator technique was adopted to identify factors associated with hospital mortality in prolonged-stay patients at the 14th SICU day.

RESULTS

Prolonged-stay patients accounted for 9.7% of the total SICU admissions, but consumed 51.7% of total SICU days. The hospital mortality of these patients was 34%. For predicting the hospital mortality in prolonged SICU stay patients, the predictors at ICU admission included gender, longer pre-ICU days, higher Charlson comorbidity index, and not admitted from emergency. Predictors on the 14th SICU day included lower Glasgow coma scale, lower mean arterial pressure, higher dosage of inotropes required, higher serum lactate level, higher serum bilirubin level, lower platelet count, and the use of renal replacement therapy. Among the indications for prolonged SICU stay, predictors included the need for mechanical circulatory support, worsening acute encephalopathy with altered mental status, hemodynamic instability due to bleeding, and sepsis with unstable vital signs.

CONCLUSION

This validated predictive model reached clinically accurate discriminatory power, and may serve to improve patient care and resource utilization in the SICU.

Palmitic acid in chicken granulosa cell death-lipotoxic mechanisms mediate reproductive inefficacy of broiler breeder hens

In vivo and in vitro approaches were used to elucidate mechanisms of palmitate-induced cytotoxicity of follicle granulosa cells in fuel-overloaded broiler hens. In contrast to their energy-restricted counterparts, broiler breeder hens fed ad libitum for 2 wk had dyslipidemia, atresia within hierarchical ovarian follicles, and a 34% reduction in egg production (P < 0.05). Based on vital staining of freshly isolated granulosa cells with annexin V/propidium iodide, there were increases in apoptosis consistent with suppressed Akt activation (P < 0.05). Supplementing primary granulosa cell cultures with 0.5 mM palmitate for 48 or 96 h increased apoptosis (P < 0.05). Palmitate-induced cell death was accompanied by increased acyl-CoA oxidase, carnitine palmitoyl transferase-1, serine palmitoyl transferase, and sphingomyelinase transcripts and increased concentrations of proinflammatory interleukin-1β (P < 0.05). Triacsin-C inhibition of fatty acyl-CoA synthesis blunted interleukin-1β production and rescued granulosa cultures from palmitate-induced cell death. That there was partial to complete prevention of cell death with addition of the free radical scavenger pyrrolidine dithiocarbamate, the sphingomyelinase inhibitor imipramine, or the de novo ceramide synthesis inhibitor fumonisin B1, supported the notion that palmitate-induced granulosa cell cytotoxicity operated through a palmitate-derived metabolite. Palmitoyl-CoA may be channeled into β-oxidation and/or into bioactive metabolites that increase free radical generation, an inflammatory response, and ceramide production. In conclusion, palmitate-derived metabolites activated apoptotic machinery in avian granulosa cells, which caused ovarian follicular atresia and reduced egg production in fuel-overloaded broiler breeder hens.

First Report of a 16SrII-A Subgroup Phytoplasma Associated with Purple Coneflower (Echinacea purpurea) Witches'-Broom Disease in Taiwan

Purple coneflower (Echinacea purpurea), widely grown as an ornamental and medicinal plant, is a perennial flowering plant that is native to eastern North America. In July 2011, symptoms indicative of phytoplasma disease, including floral virescence, phyllody, and witches'-broom (WB), were observed to be affecting plants in coneflower fields in Wufeng, Taichung City, Taiwan. Incidence of infected plants was estimated to be greater than 90% within a single field. Phytoplasmas previously associated with purple coneflower WB disease have all been classified as aster yellows group (16SrI) strains (GenBank Accession Nos. EU333395, AY394856, EU416172, and EF546778) except for pale purple coneflower (Echinacea pallida) WB in Australia, which was identified as a subgroup 16SrII-D member (2). Three diseased plants were uprooted and transplanted in a greenhouse for further study. Transmission electron microscopy revealed clusters of phytoplasma cells ranging from 170 to 490 nm in diameter in phloem sieve elements of virescent and phylloid flowers and stems from diseased plants. Comparable tissues from symptomless plants were devoid of phytoplasma. Total DNA was extracted from plant tissue samples (50 to 100 mg each) including stems, leaves, and flowers by a modified CTAB method (1) from three symptomatic plants as well as from three asymptomatic coneflower plants seedlings. Analyses by a nested PCR using universal primer pairs P1/P7 followed by R16F2n/R16R2 were performed to detect putative phytoplasma (2). Each primer pair amplified a single PCR product of either 1.8 or 1.2 kb, respectively, from diseased plant tissues only. The nested PCR products (1.2 kb) amplified from phylloid flowers of the three diseased plants were cloned separately and sequenced (GenBank Accession Nos. JN885460, JN885461, and JN885462). Blast analysis of the sequences revealed a 99.7 to 99.8% sequence identity with those of Echinacea WB phytoplasma strain EWB5 and EWB6 (GenBank Accession Nos. JF340076 and JF340080), which reportedly belonged to the 16SrII-D subgroup (2). Moreover, iPhyClassifier software (3) was used to perform sequence comparison and generate the virtual restriction fragment length polymorphism (RFLP) profile. The 16S rDNA sequences share a 99.4 to 99.5% similarity with that of the 'Candidatus Phytoplasma australasiae' reference strain (Y10097) and the RFLP patterns are identical to that of the 16SrII-A subgroup. Taken together, these results indicated that the phytoplasma infecting purple coneflower in Taiwan is a 'Ca. Phytoplasma australasiae'-related strain and belongs to the 16SrII-A subgroup. To our knowledge, this is the first report of a 16SrII-A subgroup phytoplasma causing WB disease on purple coneflower in Taiwan. The occurrence of phytoplasma on purple coneflower could have direct implication for the economically important ornamental, medicinal plant, and floral industry in Taiwan, especially to the growers and breeders that eagerly promote the purple coneflower industry. References: (1) T. M. Fulton et al. Plant Mol. Biol. Rep. 13:207, 1995. (2) T. L. Pearce et al. Plant Dis. 95:773, 2011. (3) Y. Zhao et al. Int. J. Syst. Evol. Microbiol. 59:2582, 2009.

Ceramide accumulation and up-regulation of proinflammatory interleukin-1β exemplify lipotoxicity to mediate declines of reproductive efficacy of broiler hens

The study was conducted to delineate fundamental mechanisms that initiate the deleterious effect of fuel overloading on reproductive efficacy of broiler breeder hens. Sixty hens at age 26 wk were fed recommended amounts of feed (160 g/d per hen) or allowed voluntary feeding (approximately 30% more than restriction). At age 35 and 50 wk, hens were sampled for further analyzes. Voluntary feeding resulted in poor egg production, high rate of mortality, and abnormal ovarian structure (mainly overt hierarchical follicle atresia at age 35 wk and ovarian involution at age 50 wk). In contrast to feed-restricted hens, voluntary feeding also induced metabolic dysregulations that comprised enhanced adiposity; hepatic triacylglycerol accumulation; and elevated concentrations of plasma glucose, NEFAs, very low density lipoprotein, triacylglycerol, phospholipids, and sphingomyelin (P < 0.05). Furthermore, hepatic and circulating ceramide and sphingomyelin accumulation, and up-regulation of proinflammatory IL-1β expression in liver and adipose tissues (P < 0.05) systemically manifested the development of lipotoxicity in feed-satiated hens. Lipotoxicity leading to impaired ovarian dysfunctions, including follicle atresia, ovarian regression, and a decline of circulating estradiol levels (P < 0.05) in feed-satiated hens, was further exemplified by ceramide accumulation and up-regulation of IL-1β, serine palmitoyltransferase, and sphingomyelinase transcript abundance, but suppressed protein kinase Akt activation (P < 0.1 to 0.05) within the hierarchical follicles. This study provides the first in vivo evidence of the actions of ceramide and IL-1β in mediating overfeeding-induced follicle atresia and progression of ovarian involution in broiler hens.

The role of EZH2 in tumour progression

Accumulated evidence shows that EZH2 is deregulated in a wide range of cancer types, and it has a crucial role in stem cell maintenance and tumour development. Therefore, blocking EZH2 expression or activity may represent a promising strategy for anticancer treatment. In this review, we address the current understanding of the mechanisms underlying EZH2 regulation alongside the function of EZH2 gene targets that are involved in cancer progression. Finally, we will describe cancer therapies that target EZH2 or its downstream cascades, which could potentially reverse the oncogenic and stemness properties of the tumour cells to suppress cancer progression and recurrence.

Elevated retinol binding protein 4 contributes to insulin resistance in spontaneously hypertensive rats

Retinol binding protein 4 (RBP4) is an adipokine secreted by adipose tissue and liver and contributes to insulin resistance (IR) in animals. Although several human studies indicated that RBP4 is positively correlated with blood pressure and is elevated in untreated hypertensive subjects, the role of RBP4 in IR of hypertensive animals still remains obscure. In this study, spontaneously hypertensive rats (SHR) were used to investigate the relationship between RBP4 levels and IR. We found that at 7 weeks old, SHR had significantly increased plasma RBP4 levels and RBP4 expression in liver and epididymal adipose tissue accompanied by worsening of IR as compared with Wistar-Kyoto (WKY) control rats. Administration of fenretinide in SHR to increase urinary RBP4 excretion significantly decreased plasma RBP4 levels and improved IR. Moreover, treatment with valsartan markedly reduced blood pressure, circulating RBP4 and adiponectin levels, and IR in SHR. Valsartan also reversed the increase of hepatic gluconeogenic enzyme phosphoenolpyruvate carboxykinase (PEPCK) and the decrease of type 4 glucose transporter (GLUT4) in adipose tissue. In conclusion, these results suggest that RBP4 contributes, at least partly, to the pathogenesis of IR in SHR. Furthermore, the decrease of blood pressure caused by valsartan not only decreased RBP4 levels, but also improved IR in SHR.

Changes in mitochondrial respiratory enzyme activity after ischemia-reperfusion injury in living-donor liver transplantation

BACKGROUND

Ischemia-reperfusion (I-R) injury plays an important role in the immediate graft function in living-donor liver transplantation (LDLT). There is growing evidence that mitochondria play a pivotal role in I-R injury. Our aim was to evaluate changes in mitochondrial respiratory enzyme activities after I-R injury in LDLT.

METHODS

Specimens from 8 donor recipient pairs enrolled in this study were obtained from the donor livers before harvest (before I-R injury) and after vascular anastomosis in the recipient (after I-R injury). Histidine-tryptophan-ketoglutarate solution was used to perfuse the organ during the cold ischemic period between harvesting and transplantation. We correlated changes in mitochondrial respiratory enzyme complex activity (succinate cytochrome c reductase [SCCR]; NADH cytochrome c reductase [NCCR]) after I-R injury with clinical data and graft status.

RESULTS

NCCR and SCCR activities did not uniformly decrease after I-R injury. Two of 8 recipients experienced graft dysfunction after transplantation. The decrease in neither NCCR nor SCCR activity correlated with graft dysfunction in these 2 patients. Among the clinical factors, grafts from older donors tended to show decreased NCCR activity after I-R injury.

CONCLUSIONS

In this study, changes in mitochondrial respiratory enzyme activity failed to predict the severity of I-R injury in LDLT. The organ preservation solution may play a protective role on mitochondrial respiratory enzymes during I-R injury.

Cigarette smoking and proteinuria in Taiwanese men with Type 2 diabetes mellitus

AIMS

Cigarette smoking is a well-known risk factor associated with diabetic nephropathy. The objective of this study was to further investigate the dose-response effect of tobacco exposure on proteinuria in males with Type 2 diabetes.

METHODS

Five hundred and nine males with Type 2 diabetes were selected from a cohort participating in a glucose control study in Taiwan. Pack-years of cigarette smoking were calculated to define tobacco exposure. Proteinuria was identified if albumin-to-creatinine ratio was > or = 30 mg/g in at least two of three consecutive urine tests. Logistic regression and trend tests were used to delineate the association between smoking status and proteinuria.

RESULTS

Compared with non-smokers, those who had smoked 15-30 or more than 30 pack-years were respectively 2.78 (95% CI 1.34-5.76, P < 0.01) and 3.20 (95% CI 1.74-5.86, P < 0.001) times more likely to develop proteinuria. The dose-response effect of tobacco exposure on the development of proteinuria is highly significant in all subjects (P = 0.001) and in subgroups with relatively short duration of diabetes mellitus (P < 0.001), good blood pressure control (P = 0.001) and those of young age (P = 0.007).

CONCLUSIONS

The current study shows a clear dose-response effect of cigarette smoking on development of proteinuria in male Type 2 diabetic patients. These findings reinforce the urgent need to encourage diabetic patients to stop smoking regardless of age, duration of diabetes mellitus or status of blood pressure control.

Epidemiological evidence of altered cardiac autonomic function in overweight but not underweight subjects

BACKGROUND

Little is known about the altered cardiac autonomic function (CAF) across different levels of body mass index (BMI), including underweight, normal weight, overweight and obesity. This study provides a thorough analysis to clarify the CAF change in subjects with underweight, overweight and obesity.

METHODS

According to the World Health Organization (WHO) Asia-Pacific BMI cutoffs, a total of 1437 participants were classified as underweight (n=74), normal weight (n=588), overweight (n=313), obesity I (n=390) and obesity II (n=72). CAF was determined by standard deviation of normal-to-normal (SDNN) intervals or RR intervals, power spectrum in low (LF) and high frequency (HF) (LF, 0.04-0.15 Hz; HF, 0.15-0.40 Hz), and LF/HF ratio at supine for 5 min, the ratio between the 30th and the 15th RR interval after standing from the supine position (30/15 ratio) and the average heart-rate change while taking six deep breaths in 1 min (HR(DB)).

RESULTS

There were significant differences in age, gender, socioeconomic status, blood pressure, HOMA insulin resistance index, fasting glucose, cholesterol, triglyceride and high-density lipoprotein (HDL)-C, and the prevalence of hypertension, ischemic/left bundle branch block (LBBB) electrocardiography (EKG) pattern, current smoking and alcohol use among subjects with underweight, normal weight, overweight, obesity I and II. Univariate analysis showed that SDNN, HR(DB), HF power and the square root of the LF/HF ratio differed among these five groups. Multivariate analysis showed that obesity I and II were inverse correlates of HR(DB) and HF power. Overweight, obesity I and II were positively associated with the square root of the LF/HF ratio. No BMI status was related to SDNN, 30/15 ratio or LF power. Underweight was not the independent correlate of any CAF indices.

CONCLUSIONS

The risk for altered CAF is significant in overweight and obese subjects, independent of cardiovascular risk factors. Underweight is not apparently associated with CAF change.

Contribution of somatic cell-associated activation of plasminogen to caseinolysis within the goat mammary gland

Functional regression of the mammary gland is partly reflected by proteolysis of milk protein and tissue protein. The involvement of the plasminogen activation system in degradation of milk protein and mammary tissue damage has been demonstrated under inflammatory conditions. In this study, mammary secretion from 23 dairy goats primarily grouped as lactation (milking twice daily) or involution (milking once daily or less) was used to determine the ratio of gravity-precipitated casein to total milk protein (casein ratio) as an index of caseinolysis, and activities of components of plasminogen activation system as well as their expressions on somatic cells. Based on the casein ratio, lactation goats were subcategorized as very active (71.8 +/- 1.0%) or less active (29.9 +/- 1.0%) in mammary function; involution goats were subcategorized as gradual (21.7 +/- 1.0%) or acute (5.9 +/- 0.2%) involution. This result suggests that caseinolysis occurred during regular lactation as well as during involution. On the other hand, activities of components of the plasminogen activation system in mammary secretion were increased along with the decreasing casein ratio, in contrast to the similar activities of their counterparts in circulation throughout various mammary statuses. Correlation analysis between casein ratio and activities of plasminogen activation system of goat milk indicated a significant negative relationship for plasmin (r = -0.64), plasminogen (r = -0.69), and urokinase-type plasminogen activator (uPA; r = -0.78) during involution but not during lactation. As for the cellular components of plasminogen activation system, there was an increase in immunoreactivity on somatic cells toward both monoclonal antibodies of human uPA and human uPA receptor under involution conditions suggesting their upregulation relative to lactation condition. Collectively, these results suggest that plasminogen activation system within the mammary gland differentially contribute to milk caseinolysis along the various stages of goat lactation. Meanwhile, a somatic cell-mediated local elevation of plasmin activity may be committed to extensive caseinolysis during involution.

Modulation of HER2 expression by ferulic acid on human breast cancer MCF7 cells

BACKGROUND

The molecular mechanisms underlying the mitogenic effect of ferulic acid (FA), an active compound derived from Angelica sinensis, have never been elucidated. It was the aim of this study to investigate the proliferative effect of FA on human breast cancer cell lines and to elucidate its modulation mechanism on HER2 expression in MCF7 line.

MATERIALS AND METHODS

By using MCF7 (oestrogen receptor-positive; ER+, HER2-low), BT474 (ER+, HER2-high), MDAMB231 (ER-, HER2-low) and SKBR3 (ER-, HER2-high) human breast cancer cell lines as in vitro models, the mitogenic effects of FA were assessed by trypan blue dye exclusion assay and DNA flow cytometry. Ferulic acid-modulated cell signalling and HER2 gene expression were evaluated in MCF7 line by Western blot and real-time RT-PCR analysis.

RESULTS

Ferulic acid ER-dependently stimulated cell proliferation on MCF7 cells in a concentration-dependent manner. The HER2 oncogene (one of the prognostic factors of breast cancer) and ESR1 gene (oestrogen receptor-alpha; ERalpha) transcription were markedly up-regulated by FA treatment. Besides, HER2 signalling and its downstream molecules such as AKT and ERK1/2 were involved in FA-modulated ERalpha and cyclin D1 synthesis. Addition of anti-HER2 antibody, trastuzumab, abrogated FA-enhanced proliferative effect on MCF7 cells, indicated a positive feedback control for the action of HER2 in this setting. The fact that the ER antagonist blocked most of the FA-up-regulated HER2 expression, and that trastuzumab down-regulated ERalpha gene expression, suggested a cross-talk between ERalpha and HER2 signalling on MCF7 cells.

CONCLUSION

The authors' conclude that FA causes human breast cancer cell proliferation by up-regulation of HER2 and ERalpha expression.

Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study

The cuff-leak test was widely used for the prediction of post-extubation stridor, but controversial results limit its clinical application. The current study used real-time ultrasonography to evaluate the air-leak and hypothesised that the air-column width, measured by ultrasonography, may be correlated to the development of post-extubation stridor. From June 1, 2001 to March 1, 2002, a total of 51 planned extubations in 51 consecutively intubated patients were included. All of the patients received ultrasonographical examinations of their vocal cords and larynx in addition to an air-column width measurement within 24 h prior to extubation. The overall post-extubation stridor rate was 7.8%. The air-leak volume presented as median (interquartile range) were 300 (350) mL and 25 (20) mL, respectively, for the nonstridor and stridor groups. The air-column width during cuff deflation was 6.4 (2) mm and 4.5 (0.8) mm, respectively. They were found to be statistically significant. In conclusion, the authors demonstrated that laryngeal ultrasonography could be a reliable, noninvasive method, in the evaluation of vocal cords, laryngeal morphology and the ease of airflow, which passed through vocal cords or subglottic area due to laryngeal oedema. The air-column width during cuff deflation was a potential predictor of post-extubation stridor.

Pulse pressure, aortic regurgitation and carotid atherosclerosis: a comparison between hypertensives and normotensives

Pulse pressure (PP) has often been associated with cardiovascular morbidity and mortality. Patients with aortic regurgitation (AR) often have increased PP. The aim of this study is to investigate the associations among PP, AR and extracranial carotid artery (ECCA) carotid atherosclerosis (CA) in hypertensives and age- and sex-matched normotensives. Two hundred and sixty-three hypertensive patients and 270 normotensive subjects from the Chin-Shan Community Cardiovascular Cohort participated in this study in 1996. CA, expressed as maximal common carotid artery intima-media thickness (IMT) > or = 75th percentile and ECCA plaque score > 6, was measured using high-resolution B-mode ultrasonography. The presence of AR was assessed by echocardiography, and their relationships with CA were evaluated. Results showed measurements of CA significantly associated with increased PP. Presence of AR associated with CA, but this relationship was attenuated after controlling for age. Multivariate logistic regression analyses revealed that an ECCA score > 6 significantly increase the risk in conjunction with PP, age and smoking in hypertensives. Correspondingly, CA increased with age, smoking and left ventricular hypertrophy on electrocardiography but not PP in normotensives. In conclusion, higher PP is strongly associated with CA in patients with hypertension. In terms of risk stratification, PP is more important in hypertensives than in normotensives which seem to imply that pulsatile haemodynamic component of BP is crucial in association with atherosclerosis.

Proliferative Activity, Apoptosis and Expression of Oestrogen Receptor and Bcl-2 Oncoprotein in Canine Mammary Gland Tumours

Samples of 39 canine mammary gland tumours (MGTs) were examined immunohistochemically for oestrogen receptor (ER-alpha), Bcl-2 protein and Ki67 antigen, and by TUNEL assay for apoptosis. ER-alpha was expressed by 80% (31/39) of the tumours, including all of the 15 benign tumours and 67% (16/42) of the malignant tumours. ER-alpha expression was greater in the benign than in the malignant tumours (P<0.01). Bcl-2 protein was detected in 62% (24/39) of the MGTs, of which 67% (10/15) were benign and 58% (14/24) malignant. No significant difference in Bcl-2 expression between benign and malignant tumours was detected. The Ki67 and TUNEL indices were greater in malignant than in benign tumours (P<0.01). Correlation analysis suggested that ER-alpha and Bcl-2 expression were related, but this observation lacked statistical significance. The levels of cell proliferation and apoptosis did not appear to be significantly correlated with the expression of Bcl-2. A positive relationship was apparent between cell proliferation and apoptosis, whilst a negative correlation between ER-alpha and cell proliferation was demonstrated. In conclusion, the suggestion of a positive correlation between ER-alpha and Bcl-2 in canine MGTs indicates that ER may be the regulator of Bcl-2 protein, as in human breast cancer. In contrast to cell proliferation and apoptosis, ER-alpha and Bcl-2 expression were greater in benign MGTs than in their malignant counterparts.

Relationship of serum immunoglobulin and IgG subclass levels to race, ethnicity and behavioral characteristics in HIV infection

BACKGROUND

To determine whether demographic and behavioral factors affect immunoglobulin regulation in HIV infection, we studied injection drug users, women, and minority ethnic and racial groups with and without HIV infection.

MATERIAL/METHODS

A prospective cross-sectional study of ambulatory persons with or at risk for HIV infection was conducted. We enrolled 48 injection drug users (IDUs) and 43 non-IDUs seropositive for HIV and 22 seronegative at-risk individuals in the Bronx, New York City. Sixteen HIV-seronegative, non-IDUs controls were also studied. Total serum immunoglobulin levels, IgG subclasses and lymphocyte phenotypes were measured.

RESULTS

Serum IgG, IgA, IgG(1) and IgG(3) were increased in all stages of HIV infection controlling for injection drug use, gender, race and age (p0.05). Serum IgM levels were significantly decreased in HIV seropositives compared to HIV seronegatives (p<0.02). Two patterns of serum immunoglobulin level elevation were found in HIV infection: 1) IgG, IgG(1) and IgG(3) levels were elevated in early and advanced HIV infection; 2) IgA, IgG(2) and IgG(4) levels were elevated only in advanced HIV infection. IgG levels were increased in Blacks compared to Caucasians with HIV infection (p=0.01).

CONCLUSIONS

Serum IgG, IgG(1) and IgG(3) levels are increased in early HIV infection, while serum IgA, IgG(2), and IgG(3) levels are increased only in advanced HIV infection. In contrast, serum IgM levels are decreased in HIV infection. HIV-seropositive Blacks have higher serum IgG levels than HIV-seropositive Caucasians. Further studies are necessary to determine the mechanism(s) underlying the different patterns of immunoglobulin elevation in HIV infection.

Distribution of Xylella fastidiosa in Sycamore Associated with Low Temperature and Host Resistance

Experiments were conducted in the field and laboratory to determine effects of low temperatures on Xylella fastidiosa populations in American sycamore. Roots and shoots from naturally infected trees at two locations were collected monthly. Sap extracted from the samples was tested by enzyme-linked immunosorbent assay for presence of X. fastidosa and was diluted and plated on periwinkle wilt medium to determine populations of viable bacteria. Cumulative rainfall and hours below temperature thresholds (-5 to 10°C) were recorded at each site. Bacterial populations in shoots were negatively correlated with cumulative hours below -5°C air temperature (r= -0.96). In roots, bacterial populations were only weakly correlated with cumulative hours below soil temperature thresholds (-0.61 < r <-0.25). Bacterial populations were not correlated with monthly rainfall. In the laboratory, resistant and susceptible sycamore trees were inoculated with X. fastidiosa and held in the dark at 5°C or 22°C. After 12 weeks, inoculated stem sections were collected and sap was extracted and tested as described previously. Stems that tested positive for X. fastidiosa were divided into additional samples and tested as described above. Results of the laboratory study indicated no significant effects of low-temperature treatment (5°C) or host resistance on viable bacteria. Bacterial detection frequency and population size were greatest near the inoculation point and the primary direction of early bacterial spread was acropetal.

Phase II study of weekly oxaliplatin and 24-h infusion of high-dose 5-fluorouracil and folinic acid in the treatment of advanced gastric cancer

To investigate the efficacy and safety of combining weekly oxaliplatin with weekly 24-h infusion of high-dose 5-fluorouracil (5-FU) and folinic acid (FA) in treatment of patients with advanced gastric cancer. Patients with histologically confirmed, locally advanced or recurrent/metastatic gastric cancer were studied. Oxaliplatin 65 mg m⁻² 2-h intravenous infusion, and 5-FU 2600 mg m⁻² plus FA 300 mg m⁻² 24-h intravenous infusion, were given on days 1 and 8, repeated every 3 weeks. Between January 2001 through January 2002, 55 patients were enrolled. The median age was 64 years (range: 22–75). In all, 52 patients (94.5%) had recurrent or metastatic disease and three patients had locally advanced disease. Among 50 patients evaluable for tumour response, 28 patients achieved partial response, with an overall response rate of 56% (95% confidence interval (CI): 41.8–70.3%). All 55 patients were evaluated for survival and toxicities. Median time to progression and overall survival were 5.2 and 10.0 months, respectively, during median follow-up time of 24.0 months. Major grades 3–4 toxicities were neutropenia in 23 cycles (7.1%) and thrombocytopenia in 16 cycles (5.0%). Treatment was discontinued for treatment-related toxicities in nine patients (16.4%), of whom eight were due to oxaliplatin-related neurotoxicity. One patient (1.8%) died of neutropenic sepsis. This oxaliplatin-containing regimen is effective in the treatment of advanced gastric cancer. Except for neurotoxicity that often develops after prolonged use of oxaliplatin, the regimen is well tolerated.

Guillain-Barré syndrome in southern Taiwan: clinical features, prognostic factors and therapeutic outcomes

To determine the clinical features, prognostic factors, and therapeutic results of Guillain-Barré syndrome (GBS) in order to improve the therapeutic strategy for this disease. We retrospectively reviewed the electrodiagnostic study and medical records of patients with GBS admitted to Chang Gung Memorial Hospital, Kaohsiung, between January 1986 and December 2000. Outcomes and prognosis were followed-up after 1 year. Ninety-six patients were enrolled in this study. According to the clinical and electrophysiological findings, 77 patients were acute inflammatory demyelinating polyradiculoneuropathy, seven were Miller Fisher syndrome, and six were axonal forms, and six were unclassified. At a follow-up of 1 year, 61 patients (64%) recovered, 30 (31%) had residua and five (5%) died. Amongst these 30 had residua, including unassisted gait in 19, assisted gait in four, and wheel/bed bound in seven. According to the statistical analysis, disabilities at the nadir (P < 0.0001) and at admission (P = 0.014) were significant prognostic factors. Variables used for the stepwise logistic regression, and the results revealed that after analysis for all the above variables, only disability at the nadir (P < 0.0001) was independently associated with the treatment failure rate. Our study revealed 27% of cases in need of respiratory support during hospitalization, and 5% of hospital-treated patients die from the complications. Furthermore, 31% had residua at a follow-up of 1 year or more. If prognostic factors are considered, disability at the nadir during hospitalization demonstrates consistently poor therapeutic outcomes. Therefore, early diagnosis, choice of appropriate treatment, and preventing complications during acute stages are essential to maximize the potential for survival.

Cerebral infarction in perinatal and childhood bacterial meningitis

BACKGROUND

Cerebral infarction is an important neurological complication of childhood bacterial meningitis, but little is known about its epidemiology and outcomes.

AIM

To determine the predictive factors, clinical features, causative pathogens, and outcomes of cerebral infarction secondary to perinatal and childhood bacterial meningitis.

DESIGN

Retrospective analysis

METHODS

Over the period 1986-2001, 166 perinatal and childhood patients were identified as having culture-proven bacterial meningitis, of whom 14 had cerebral infarction at admission. The clinical and CSF data of patients with and without cerebral infarctions on admission were compared.

RESULTS

Cerebral infarction patients accounted for 10% (14/166) of bacterial meningitis cases, mostly in the first year of life (11/14, 79%). Salmonella species (n = 4) and Streptococcus pneumoniae (n = 4) were the most frequent causative pathogens, accounting for 57% (8/14) of episodes. Single infarctions were found in four patients and multiple infarctions in 10. At 1 year follow-up, outcome was good in three, but poor in 11. Significant differences between the two patient groups at admission included age bands, presence of seizures, hydrocephalus, disturbed consciousness on admission, and CSF lactate concentration.

DISCUSSION

There was a high prevalence of cerebral infarctions when the disease was caused by S. pneumoniae and Salmonella species. Occurrence was highest in the first year of life, and the prognosis in this patient group is poor. Risk factors associated with cerebral infarction in our patients included age 28-365 days, seizures, hydrocephalus, disturbed consciousness on admission, and high CSF lactate concentrations.

Low body mass index but high percent body fat in Taiwanese subjects: implications of obesity cutoffs

OBJECTIVES

To compare the different correlations of body mass index (BMI) and percent body fat (BF%) with other ethnic groups and to evaluate the appropriateness of Asia-Pacific redefining obesity criteria in the Taiwanese population. The corresponding BF% to BMI cutoffs of overweight and obesity will also be studied.

DESIGN

A cross-sectional epidemiological survey.

SUBJECTS

A total of 509 male and 570 female Taiwanese subjects aged > or =20 y sampled by the systematic stratified clustering sampling method were analyzed.

MEASUREMENTS

BMI was obtained by body weight (kg) divided by squared body height (m(2)). The estimated BMI (BMIe) was deduced from the Caucasian-based four-compartment equation (4C). BF% measured by the methods of dual-energy X-ray absorptiometry (DXA) or Caucasian-based 4C were used and abbreviated as DXA-BF and 4C-BF, respectively.

RESULTS

The curvilinear relationship between age and BMI or DXA-BF was established. When compared by age-stratified groups, Taiwanese subjects had a higher BF% (4C-BF) in any given BMI than Caucasians. That is, the level of 4C-BF for BMI> or =25 kg/m(2) in Taiwanese subjects was similar to BMI> or =30 kg/m(2) in Caucasians. The BMIe values of 25 and 30 kg/m(2) were nearly equal to the BMIs of 23.6 and 25.3 kg/m(2) in males, and 22.7 and 24.8 kg/m(2) in females, respectively. The 4C-BF of 25% was nearly equal to a BMI of 26.2 kg/m(2) in males, and 35% was equal to a BMI of 24.4 kg/m(2) in females. Consequently, the DXA-BF cutoffs for BMIs of 23 and 25 kg/m(2) were compatible to 23 and 25% in males, and 35 and 38% in females, respectively.

CONCLUSION

It was demonstrated that Taiwanese subjects had a relatively lower BMI but a higher BF% than Caucasians. In general, the newly proposed Asia-Pacific BMI cutoffs for overweight (> or =23 kg/m(2)) and obesity (> or =25 kg/m(2)) may be acceptable to both male and female Taiwanese subjects. The corresponding BF% (DXA-BF) cutoffs for obesity would be 25% in male and 38% in female Taiwanese subjects, respectively.

Bacterial brain abscess: microbiological features, epidemiological trends and therapeutic outcomes

BACKGROUND

Despite the advent of modern neurosurgical techniques, new antibiotics, and powerful imaging technologies, brain abscess remains a potentially fatal central nervous system infection.

AIM

To determine the epidemiological trends, prognostic factors, and outcomes of bacterial brain abscess, to improve the therapeutic strategy for this disease.

DESIGN

Retrospective hospital-based epidemiology study.

METHODS

Over a period of 15 years (1986-2000), 123 patients were retrospectively identified as having brain abscesses at Kaohsiung Chang Gung Memorial Hospital. To compare changes over time, the appearance of disease among our patients was divided into two time periods: 1986-1993 and 1994-2000.

RESULTS

The prevalence rate of brain abscesses caused by Gram-negative organisms significantly increased in the second study period. Viridans streptococci and Klebsiella pneumoniae were the two prevalent pathogens associated with haematogenous spread. Metastatic septic abscess, a devastating complication of K. pneumoniae septicaemia, frequently occurs in diabetic patients, with a high mortality rate. Viridans streptococci were the most prevalent pathogens from infection in paranasal sinusitis, but no fatality occurred. In recent years, head trauma and/or post-neurosurgical states have become important predisposing factors, and nosocomial infections also play an important role.

DISCUSSION

Despite the availability of new antibiotics and the development of better neurosurgical techniques, therapeutic outcomes of brain abscess showed no significant change when comparing the two study periods, and only the presence of septic shock influenced outcome.

Rapid screening for taxanes by tandem mass spectrometry

A highly specific and sensitive method is described for determining taxol, cephalomannine, and baccatin III in crude plant extracts. Radical anions of the taxanes are formed by desorption chemical ionization, and a parent tandem mass spectrometric scan is used to recognize these compounds by their characteristic dissociations. The limit of detection of the individual taxanes in typical plant matrices is less than 500 pg when all three species are screened simultaneously. Because of the sensitivity of the method, extraction times can be shortened to 30 min and crude extracts can be examined at the rate of 6/h. Detection of all three taxanes extracted from a single Taxus cuspidata needle in a combined extraction/analysis time of less than 1 h is demonstrated.

Using data mining to address heterogeneity in the Southampton data

When analyzing complex traits such as asthma, heterogeneity needs to be assumed. With this in mind, to identify a more homogeneous group of asthmatic patients, we analyzed the Southampton data using the data mining technique known as the regression tree method and the two most inheritable quantitative phenotypes (LnIgE and RAST) as the target variables. Two-point and multipoint nonparametric linkage analyses were carried out using one of the subgroups as affected. In addition, we performed quantitative trait loci nonparametric linkage analysis using each phenotype as the outcome. The results from the affected-sibpairs method and quantitative linkage analysis were compared.