Assessing the impact of direct-acting antivirals on hepatitis C complications: a systematic review and meta-analysis

Direct-acting antivirals (DAA) have become the treatment of choice for hepatitis C. Nevertheless, efficacy of DAA in preventing hepatitis C complications remains uncertain. We evaluated the impact of DAA on hepatocellular carcinoma (HCC) occurrence and recurrence, all-cause mortality, liver decompensation and liver transplantation as compared to non-DAA treated hepatitis C and the association to baseline liver status. A systematic search for articles from March 1993 to March 2022 was conducted using three electronic databases. Randomized, case-control and cohort studies with comparison to non-DAA treatment and reporting at least one outcome were included. Meta-analysis and sub-group meta-analysis based on baseline liver status were performed. Of 1497 articles retrieved, 19 studies were included, comprising of 266,310 patients (56.07% male). DAA reduced HCC occurrence significantly in non-cirrhosis (RR 0.80, 95% CI 0.69-0.92) and cirrhosis (RR 0.39, 95% CI 0.24-0.64) but not in decompensated cirrhosis. DAA treatment lowered HCC recurrence (RR 0.71, 95% CI 0.55-0.92) especially in patients with baseline HCC and waiting for liver transplant. DAA also reduced all-cause mortality (RR 0.43, 95% CI 0.23-0.78) and liver decompensation (RR 0.52, 95% CI 0.33-0.83) significantly. However, DAA did not prevent liver transplantation. The study highlighted the importance of early DAA initiation in hepatitis C treatment for benefits beyond sustained virological response. DAA therapy prevented HCC particularly in non-cirrhosis and compensated cirrhosis groups indicating benefits in preventing further worsening of liver status. Starting DAA early also reduced HCC recurrence, liver decompensation, and all-cause mortality.

Iron-based biomarkers for personalizing pharmacological ascorbate therapy in glioblastoma: insights from a phase 2 clinical trial

BACKGROUND

Pharmacological ascorbate (intravenous delivery reaching plasma concentrations ≈ 20 mM; P-AscH-) has emerged as a promising therapeutic strategy for glioblastoma. Recently, a single-arm phase 2 clinical trial demonstrated a significant increase in overall survival when P-AscH- was combined with temozolomide and radiotherapy. As P-AscH- relies on iron-dependent mechanisms, this study aimed to assess the predictive potential of both molecular and imaging-based iron-related markers to enhance the personalization of P-AscH- therapy in glioblastoma participants.

METHODS

Participants (n = 55) with newly diagnosed glioblastoma were enrolled in a phase 2 clinical trial conducted at the University of Iowa (NCT02344355). Tumor samples obtained during surgical resection were processed and stained for transferrin receptor and ferritin heavy chain expression. A blinded pathologist performed pathological assessment. Quantitative susceptibility mapping (QSM) measures were obtained from pre-radiotherapy MRI scans following maximal safe surgical resection. Circulating blood iron panels were evaluated prior to therapy through the University of Iowa Diagnostic Laboratory.

RESULTS

Through univariate analysis, a significant inverse association was observed between tumor transferrin receptor expression and overall and progression-free survival. QSM measures exhibited a significant, positive association with progression-free survival. Subjects were actively followed until disease progression and then were followed through chart review or clinical visits for overall survival.

CONCLUSIONS

This study analyzes iron-related biomarkers in the context of P-AscH- therapy for glioblastoma. Integrating molecular, systemic, and imaging-based markers offers a multifaceted approach to tailoring treatment strategies, thereby contributing to improved patient outcomes and advancing the field of glioblastoma therapy.

Neoantigen Cancer Vaccine for Immunologically Cold Microsatellite-stable Colorectal Cancer

PURPOSE/OBJECTIVE(S)

Immunotherapies, such as immune checkpoint inhibitors (ICIs), have revolutionized management of some cancers but have little benefit for microsatellite-stable colorectal cancer patients (MSS-CRC). This is, in part, due to the low mutations and neoantigen expression in this immunogenically "cold" MSS-CRC. Therefore, we aim to develop novel shared neoantigen-based therapeutic cancer vaccine to reinvigorate antitumor immunity and enhance the therapeutic benefit of radiotherapy in MSS-CRC.

MATERIALS/METHODS

To identify novel highly expressed and shared neoantigens, we collected 40 match-paired adjacent normal and tumor tissues from MSS-CRC patients for WES-seq, RNA-seq, and liquid chromatography-MS/MS (LC-MS/MS). By incorporating these databases, we established Neoantigen Discovery and Validation (NeoDiva) system to identify a cluster of highly expressed and shared neoantigens derived from non-coding regions and evaluate its immunogenicity by HLA-A*11 transgenic mice. We then develop a neoantigen-based therapeutic cancer vaccine by an engineered adenovirus-associated virus (AAV) to evaluate its therapeutic efficacy in combination with radiotherapy in MSS-CRC animal model.

RESULTS

We identified a cluster of highly expressed and shared neoantigens (HLA-A*11-restricted) derived from non-coding regions. The immunogenicity of these novel neoantigens was demonstrated by HLA-A*11 transgenic mice and ex vivo stimulation. Moreover, the engineered AAV-based neoantigen cancer vaccine significantly eradicates cancer cells, prevents distant metastasis, prolong survival period in combination with radiotherapy. By flow cytometry, ELISPOT and MHC-I-tetramer assay, we demonstrated the recruitment of tumor-infiltrating lymphocytes was remarkably increased and neoantigen-specific T cell response was enhanced. Moreover, these isolated neoantigen-specific T cells can recognize cancer cells and produce IFNg to kill cancer cells.

CONCLUSION

Neoantigens identified by our NeoDiVa platform, via the combination of radiotherapy and a novel AAV vaccine delivery system, boosted antigen-specific T-cell function and improve tumor control of limnologically "cold" MSS colorectal cancer in vivo. We are in the process of obtaining an IND and initiating Phase I/II clinical trial to validate safety and efficacy of these exciting findings.

First molecular detection of porcine circovirus type 4 (PCV4) in Malaysia

Porcine circovirus type 4 (PCV4) is the newest member in the porcine circovirus family, first reported in 2020. To date, the presence of PCV4 has only been reported in China, South Korea and most recently in Thailand. Detection of PCV4 have been reported in various production stages of pigs from piglets, finishers to sows; associated with a myriad of clinical manifestations including porcine dermatitis and nephropathy syndrome (PDNS), postweaning multisystemic wasting syndrome (PMWS), respiratory, enteric and neurological diseases. While successful virus isolation and culture has yet to be reported, pathogenicity of PCV4 has been demonstrated through infectious clone studies. The objective of this study is to investigate the presence of PCV4 in Malaysian porcine population to update the epidemiology of porcine circoviruses in Malaysia. A total of 49 samples from commercial intensive pig farms, abattoir and wild boar population were subjected to conventional polymerase chain reaction assay to detect PCV4 capsid (cap) genome. Resulting cap nucleotide sequences were analyzed for maximum likelihood phylogeny relationship. Results revealed that PCV4 is present in Peninsular Malaysia at a molecular prevalence of 4.08% (2 / 49 samples). Both PCV4 positive samples originated from clinically healthy finishers. Malaysian PCV4 strains were classified as genotype PCV4b, and were found to be phylogenetically distinct from the China, South Korea and Thailand strains. With this latest update of the novel PCV4 in Malaysia, it is clear that more attention needs to be given to the investigation of novel porcine circoviruses (PCV) and management of PCV diseases.

Comparing the efficacy of tocilizumab with corticosteroid therapy in treating COVID-19 patients: a systematic review and meta-analysis

PURPOSE

Tocilizumab has shown equivocal outcomes in reducing mortality in COVID-19. The corticosteroids appear to be an affordable alternative to tocilizumab. This study aims to estimate the efficacy of tocilizumab and the corticosteroids particularly dexamethasone and methylprednisolone and to identify possible determinants of their efficacy.

METHODS

Five electronic databases were searched for studies involving tocilizumab, dexamethasone, and methylprednisolone in treating COVID-19. We included case-control and randomized or partially randomized trials. Meta-regression for patient baseline characteristics, co-medications, and tocilizumab dose regimens was performed to identify contributing factors to drug efficacy.

RESULTS

Thirteen randomized controlled trials (RCTs) and twenty-four case-control studies were included in our meta-analysis involving 18,702 patients. Meta-analysis among the RCTs showed that a summary estimate favoring mortality reduction (OR 0.71, 95%CI 0.55 - 0.92) contributed mainly by tocilizumab and dexamethasone. Among case-control studies, meta-analysis showed mortality reduction (OR 0.52, 95%CI 0.36 - 0.75) contributed by tocilizumab and tocilizumab-methylprednisolone combination. Methylprednisolone alone did not reduce mortality except for one study involving high dose pulse therapy. Meta-analysis also found that all three drugs did not significantly reduce mechanical ventilation (OR 0.72, 95%CI 0.32 - 1.60).

CONCLUSION

Tocilizumab and dexamethasone emerge as viable options in reducing mortality in severe COVID-19 patients. A tocilizumab-corticosteroid combination strategy may improve therapeutic outcome in cases where single therapy fails.

N-Doped Graphene Quantum Dots/Titanium Dioxide Nanocomposites: A Study of ROS-Forming Mechanisms, Cytotoxicity and Photodynamic Therapy

Titanium dioxide nanoparticles (TiO2 NPs) have been proven to be potential candidates in cancer therapy, particularly photodynamic therapy (PDT). However, the application of TiO2 NPs is limited due to the fast recombination rate of the electron (e−)/hole (h+) pairs attributed to their broader bandgap energy. Thus, surface modification has been explored to shift the absorption edge to a longer wavelength with lower e−/h+ recombination rates, thereby allowing penetration into deep-seated tumors. In this study, TiO2 NPs and N-doped graphene quantum dots (QDs)/titanium dioxide nanocomposites (N-GQDs/TiO2 NCs) were synthesized via microwave-assisted synthesis and the two-pot hydrothermal method, respectively. The synthesized anatase TiO2 NPs were self-doped TiO2 (Ti3+ ions), have a small crystallite size (12.2 nm) and low bandgap energy (2.93 eV). As for the N-GQDs/TiO2 NCs, the shift to a bandgap energy of 1.53 eV was prominent as the titanium (IV) tetraisopropoxide (TTIP) loading increased, while maintaining the anatase tetragonal crystal structure with a crystallite size of 11.2 nm. Besides, the cytotoxicity assay showed that the safe concentrations of the nanomaterials were from 0.01 to 0.5 mg mL−1. Upon the photo-activation of N-GQDs/TiO2 NCs with near-infrared (NIR) light, the nanocomposites generated reactive oxygen species (ROS), mainly singlet oxygen (1O2), which caused more significant cell death in MDA-MB-231 (an epithelial, human breast cancer cells) than in HS27 (human foreskin fibroblast). An increase in the N-GQDs/TiO2 NCs concentrations elevates ROS levels, which triggered mitochondria-associated apoptotic cell death in MDA-MB-231 cells. As such, titanium dioxide-based nanocomposite upon photoactivation has a good potential as a photosensitizer in PDT for breast cancer treatment.

Systematic Review and Meta-Analysis of Diabetes Knowledge among Type 2 Diabetes Patients in Southeast Asia

OBJECTIVE

Recognition of patient baseline knowledge is important in educating patients with type 2 diabetes mellitus (T2D) to manage their disease effectively. The purpose of this study is to review current evidence on the level of diabetes knowledge among T2D patients and determine factors affecting their knowledge.

METHODS

A systematic search of English language articles published between 1990 and June 2019 was conducted using six electronic databases. Only quantitative studies that assessed knowledge of T2D patients in Southeast Asian countries were included. Data were extracted and a meta-analysis was conducted.

RESULTS

A total of 6210 articles were retrieved; seven articles met the inclusion criteria, comprising 1,749 T2D patients. The calculated mean knowledge score was 55.6% (95% CI: 7.6 to 103.6). Five types of assessment tools were identified ranging from five to 41 questions that focused on disease specifics, treatment, and nutrition. Age, education level, and glycemic control were the most common factors impacting knowledge.

CONCLUSIONS

The level of knowledge among T2D patients in Southeast Asia was unsatisfactory, especially in older patients with low education levels and poor glycemic control. Hence, an appropriate educational plan should be prioritized to these groups.

Impact of COVID-19 on TB epidemiology in South Korea

SETTING: Five referral hospitals, South Korea.OBJECTIVE: To assess epidemiological changes in TB before and during the COVID-19 pandemic.DESIGN: This was a multicentre cohort study of 3,969 patients diagnosed with TB.RESULTS: We analysed 3,453 patients diagnosed with TB prior to the COVID-19 pandemic (January 2016-February 2020) and 516 during the pandemic (March-November 2020). During the pandemic, the number of patients visits declined by 15% from the previous 4-year average, and the number of patients diagnosed with TB decreased by 17%. Patients diagnosed during the pandemic were older than those diagnosed before the pandemic (mean age, 60.2 vs. 56.6 years, P < 0.001). The proportion of patients to have primary TB at a younger age (births after 1980) among those diagnosed with TB was significantly lower during the pandemic than before (17.8% in 2020 vs. 23.5% in 2016, 24.0% in 2017, 22.5% in 2018, 23.5% in 2019; P = 0.005).CONCLUSIONS: The COVID-19 pandemic resulted in a reduction in the number of visits to respiratory departments, leading to fewer patients being diagnosed with TB. However, our results suggest that universal personal preventive measures help to suppress TB transmission in regions with intermediate TB burden.

Comparing the cost, glycaemic control and medication adherence of utilizing patients' own medicines (POMs) versus usual dispensing among diabetic patients in an outpatient setting

BACKGROUND

Millions worth of unused drugs particularly those indicated for chronic diseases such as diabetes were returned and disposed leading to substantial wastage. Use of patients' own medications (POMs) in the inpatient setting has reduced wastage and saved cost. The impact of utilizing POMs in the outpatient setting has hitherto not been determined.

PURPOSE

This study aims to compare the cost, medication adherence and glycaemic control of utilizing POMs versus usual dispensing.

METHODS

Prospective randomized controlled study was conducted among diabetic patients that required monthly medication refill in the Outpatient Pharmacy in 2017. Patients who consented were equally divided into POMs and control groups. Both groups brought excess medications from home at week-0 and week-12. Patients in the POMs group brought excess medications monthly and sufficient amount of drugs were added until the next refill date. Drugs were dispensed as usual in the control group. Total cost consisting of the cost of drugs, staff and building was calculated. Glycosylated haemoglobin (HbA1c) was measured at baseline and week-12. Adherence was measured based on pill counting.

RESULTS

Thirty patients aged 56.77 ± 14.67 years with 13.37 ± 7.36 years of diabetes participated. Baseline characteristics were similar between the groups. POMs minimized the total cost by 38.96% which translated to a cost saving of USD 42.76 ± 6.98, significantly different versus USD 0.02 ± 0.52 in the control group, p = 0.025. Mean HbA1c reduced significantly (-0.79%, p = 0.016) in the POMs group but not significant in the control group (-0.11%, p = 0.740). Medication adherence improved significantly in both groups at week-12 (p < 0.010). Nevertheless, patients in the POMs group were more adherent, 87.20% vs. 66.32%, p = 0.034.

CONCLUSION

Utilizing POMs resulted in cost saving, improved adherence and better glycaemic control. Use of POMs should be practiced in the outpatient pharmacy to reduce wastage and cost.

Telomere-led meiotic chromosome movements: recent update in structure and function

In S. cerevisiae prophase meiotic chromosomes move by forces generated in the cytoplasm and transduced to the telomere via a protein complex located in the nuclear membrane. We know that chromosome movements require actin cytoskeleton [13,31] and the proteins Ndj1, Mps3, and Csm4. Until recently, the identity of the protein connecting Ndj1-Mps3 with the cytoskeleton components was missing. It was also not known the identity of a cytoplasmic motor responsible for interacting with the actin cytoskeleton and a protein at the outer nuclear envelope. Our recent work [36] identified Mps2 as the protein connecting Ndj1-Mps3 with cytoskeleton components; Myo2 as the cytoplasmic motor that interacts with Mps2; and Cms4 as a regulator of Mps2 and Myo2 interaction and activities (Figure 1). Below we present a model for how Mps2, Csm4, and Myo2 promote chromosome movements by providing the primary connections joining telomeres to the actin cytoskeleton through the LINC complex.

Simple and rapid LC-MS/MS method for simultaneous determination of flavoxate and 3-methyl-flavone-8-carboxylic acid in human plasma: Application to a bioequivalence study

A simple, rapid, sensitive, and reproducible LC-MS/MS method was developed for simultaneous quantification of flavoxate and 3-methyl-flavone-8-carboxylic (MFCA) in human plasma, using diphenhydramine HCl as internal standard (IS). The chromatographic separation was achieved using Agilent Poroshell 120 EC-C18 - Fast LC column (100 × 2.1mmID, 2.7 μm) fitted with UHPLC Guard Poroshell 120 EC-C18 (5 × 2.1 mmID, 2.7 μm). The mobile phase consisted of 0.1 % v/v formic acid and acetonitrile (30:70, v/v) run at a flow rate of 0.40 mL/min. The standard calibration curve was linear over the concentration range of 2.00 - 2,000.31 ng/mL and 240.00 - 24,000.04 ng/mL for flavoxate and MFCA. For flavoxate and MFCA, the within-run precision was 0.81-6.67 % and 1.68-4.37 %, while accuracy was 100.21-108.25 % and 103.99-110.28 %. The between-run precision was 2.01-9.14 % and 2.31-11.11 %, and accuracy was 96.09-103.33 % and 102.37-109.52 %. The extended run precision was 7.78-11.04 % and 2.22-3.33 %, while accuracy was 100.72-101.88 % and 102.34-105.60 %. Flavoxate and MFCA in plasma were stable 4 h at bench top (short term), 24 h in autosampler and instrumentation room (post-preparative), after 7 freeze-thaw cycles, and 89 days in the freezer. Both analytes and IS stock solutions were stable for 31 days when kept at room temperature (25 ± 4 °C) and refrigerated (2-8 °C). The validated method was successfully applied to a bioequivalence study of two flavoxate formulations involving 24 healthy volunteers.

Differentially expressed genes on the growth of mouse Leydig cells treated with standardised Eurycoma longifolia extract

Eurycoma (E.) longifolia Jack (Tongkat Ali) is a widely applied medicine that has been reported to boost serum testosterone and increase muscle mass. However, its actual biological targets and effects on an in vitro level remain poorly understood. Therefore, the present study aimed to investigate the effects of a standardised E. longifolia extract (F2) on the growth and its associated gene expression profile in mouse Leydig cells. F2, even at lower doses, was found to induce a high level of testosterone by ELISA. The level was as high as the levels induced by eurycomanone and formestane in Leydig cells. However, Leydig cells treated with F2 demonstrated reduced viability, which was likely due to the diminished cell population at the G0/G1 phase and increased cell population arrested at the S phase in the cell cycle, as assessed by MTT assay and flow cytometry, respectively. Cell viability was revived when the treatment time‑point was prolonged to 96 h. Genome‑wide gene analysis by reverse transcription‑quantitative PCR of F2‑treated Leydig cells at 72 h, when the cell growth was not revived, and 96 h, when the cell growth had started to revive, revealed cyclin‑dependent kinase‑like 2 (CDKL2) to be a potential target in regulating the viability of F2‑treated Leydig cells. Functional analysis, as analysed using GeneMANIA Cytoscape program v.3.6.0 (https://genemania.org/), further suggested that CDKL2 could act in concert with Casitas B‑lineage lymphoma and sphingosine kinase 1 interactor‑A‑kinase anchoring protein domain‑containing genes to regulate the viability of F2‑treated Leydig cells. The findings of the present study provide new insights regarding the potential molecular targets associated with the biological effect of E. longifolia extract on cell growth, particularly on the cell cycle, which could aid in enhancing the bioefficacy and reducing the toxicity of this natural product in the future.

A case of arrhythmogenic right ventricular cardiomyopathy with right ventricle thrombus: A case report

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare inherited cardiomyopathy characterised by right ventricular dysfunction, ventricular arrhythmias and increased risk of sudden cardiac death. Due to the replacement of myocardium with fibro-fatty and fibrous tissue, patients with ARVC are prone to develop ventricular tachycardia. Histologically, it is often reported as the 'triangle of dysplasia' involving the inflow tract, outflow tract and apex of the right ventricle.2 We describe a 20-years-old patient who collapsed during a futsal match and was subsequently diagnosed to have ARVC with a right ventricular thrombus from cardiac magnetic resonance imaging.

A spontaneous missense mutation in the chromodomain helicase DNA-binding protein 8 (CHD8) gene: a novel association with congenital myasthenic syndrome

AIMS

Congenital myasthenic syndromes (CMS) are characterized by muscle weakness, ptosis and episodic apnoea. Mutations affect integral protein components of the neuromuscular junction (NMJ). Here we searched for the genetic basis of CMS in female monozygotic twins.

METHODS

We employed whole-exome sequencing for mutation detection and Sanger sequencing for segregation analysis. Immunohistology was done with antibodies against CHD8, rapsyn, β-catenin (βCAT) and golgin on fi-bro-blasts, human and mouse muscle. We recorded superresolution images of the NMJ using 3D-structured illumination microscopy.

RESULTS

We discovered a spontaneous missense mutation in CHD8 [chr14:g.21,884,051G>A, GRCh37.p11 | c.1732C>T, NM_00117062 | p.(R578C)], the gene encoding chromodomain helicase DNA-binding protein 8. This is the first missense mutation affecting Duplin, the short 110 kDa isoform of CHD8. It is known that CHD8/Duplin negatively regulates βCAT signalling in the WNT pathway and plays a role in chromatin remodelling. Inactivating CHD8 mutations are associated with autism spectrum disorder and intellectual disability in combination with facial dysmorphism, overgrowth and macrocephalus. No muscle-specific phenotype has been reported to date. Co-immunostaining with rapsyn on human and mouse muscle revealed a strong presence of CHD8 at the NMJ being located towards the sarcoplasmic side of the rapsyn cluster, where it co-localizes with βCAT.

CONCLUSION

We hypothesize CHD8 to have a role in the maintenance of the structural integrity and function of the NMJ. Both patients benefited from treatment with 3,4-diaminopyridine, a reversible blocker of voltage-gated potassium channels at the nerve terminal that prolongs the action potential and increases acetylcholine release.

A titanium dioxide/nitrogen-doped graphene quantum dot nanocomposite to mitigate cytotoxicity: synthesis, characterisation, and cell viability evaluation

Titanium dioxide nanoparticles (TiO₂ NPs) have attracted tremendous interest owing to their unique physicochemical properties. However, the cytotoxic effect of TiO₂ NPs remains an obstacle for their wide-scale applications, particularly in drug delivery systems and cancer therapies. In this study, the more biocompatible nitrogen-doped graphene quantum dots (N-GQDs) were successfully incorporated onto the surface of the TiO₂ NPs resulting in a N-GQDs/TiO₂ nanocomposites (NCs). The effects of the nanocomposite on the viability of the breast cancer cell line (MDA-MB-231) was evaluated. The N-GQDs and N-GQDs/TiO₂ NCs were synthesised using a one- and two-pot hydrothermal method, respectively while the TiO₂ NPs were fabricated using microwave-assisted synthesis in the aqueous phase. The synthesised compounds were characterised using Fourier transform infrared (FTIR) spectroscopy, high-resolution transmission electron microscopy (HRTEM), field emission scanning electron microscopy (FESEM) and UV-visible spectrophotometry. The cell viability of the MDA-MB-231 cell line was determined using a CellTiter 96® AQueous One Solution Cell Proliferation (MTS) assay. The obtained results indicated that a monodispersed solution of N-GQDs with particle size 4.40 ± 1.5 nm emitted intense blue luminescence in aqueous media. The HRTEM images clearly showed that the TiO₂ particles (11.46 ± 2.8 nm) are square shaped. Meanwhile, TiO₂ particles were located on the 2D graphene nanosheet surface in N-GQDs/TiO₂ NCs (9.16 ± 2.4 nm). N-GQDs and N-GQDs/TiO₂ NCs were not toxic to the breast cancer cells at 0.1 mg mL⁻¹ and below. At higher concentrations (0.5 and 1 mg mL⁻¹), the nanocomposite was significantly less cytotoxic compared to the pristine TiO₂. In conclusion, this nanocomposite with reduced cytotoxicity warrants further exploration as a new TiO₂-based nanomaterial for biomedical applications, especially as an anti-cancer strategy.

Cytotoxicity mitigation using titanium dioxide/nitrogen-doped graphene quantum dot nanocomposites.

Acute myocarditis mimicking ST-elevation myocardial infarction: A diagnostic challenge for frontline clinicians

The clinical presentation of acute myocarditis is highly variable ranging from no symptoms to cardiogenic shock. Despite considerable progress, it remains a challenge for frontline physicians to discriminate between acute myocarditis and myocardial infarction, especially in the early phase. Our case serves as a reminder that acute presentation of myocarditis could resemble ST elevation myocardial infarction potentially misdirecting the therapeutic decision. The clinical presentation, electrocardiographic and laboratory findings of the patient are not specific enough to distinguish acute myocarditis from myocardial infarction. The gold standard tests such coronary angiography and cardiovascular magnetic resonance (CMR) can reliably differentiate the two entities.

3052Non-vitamin K antagonist oral anticoagulants are safe and effective alternatives to warfarin across subgroups by renal function: results from Danish registries

Background

All non-vitamin K antagonist oral anticoagulants (NOACs) have some degree of renal excretion, and patients with severely reduced renal function have been excluded from randomized controlled clinical trials of stroke prevention in atrial fibrillation (AF). Influence of renal function on outcomes has not been assessed in previous real-world studies of NOACs in AF.

Purpose

To assess influence of renal function on efficacy and safety of dabigatran, rivaroxaban or apixaban vs. warfarin.

Methods

Using nationwide registries, we identified all Danish AF patients who initiated warfarin, dabigatran, rivaroxaban or apixaban between 2012 and 2016. We included patients with a plasma creatinine measurement within 14 days from drug initiation and calculated estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Hazard ratio (HR) of stroke/thromboembolism (TE) or major bleeding according to oral anticoagulation was calculated using multivariable-adjusted Cox regression analyses with warfarin as reference.

Results

We included 14,673 AF patients who started first-time oral anticoagulation within 14 days from AF diagnosis, and our study population comprised 2482 (16.9%) initiators of dabigatran (median age 72, 44.5% women), 3806 (25.9%) initiators of rivaroxaban (median age 75, 48.0% women), 5067 (34.5%) initiators of apixaban (median age 76, 48.8% women), and 3318 (22.6%) initiators of warfarin (median age 75, 45.4% women). eGFR was >50, 30–50 and 15 to <30 mL/min/1.73m2 in 10,281 (83.1%), 2079 (14.2%) and 404 (2.8%) patients at baseline. After adjustment for age, sex, year of inclusion, income, cohabitation status, eGFR, hemoglobin, medications and comorbidities, the HRs for stroke/TE compared to warfarin were 0.94 (95% confidence interval (CI) 0.74–1.20) for dabigatran, 1.06 (CI 0.84–1.34) for rivaroxaban, and 1.10 (CI 0.88–1.36) for apixaban. There were no significant heterogeneities in HRs of stroke/TE across subgroups by eGFR. Apixaban (HR 0.74, CI 0.62–0.89) was associated with lower risk of major bleeding compared to warfarin, rivaroxaban (HR 1.06, CI 0.88–1.27) with risk of major bleeding comparable to warfarin, and there were no significant heterogeneities in risk of major bleeding with rivaroxaban or apixaban across subgroups by eGFR. Dabigatran was associated with lower risk of bleeding among patients with eGFR >50 mL/min/1.73m2, but not among patients with eGFR 30–50 mL/min/1.73m2 (interaction P=0.03).

Conclusions

In a large real-world cohort, renal function had no significant influence on efficacy or safety of apixaban or rivaroxaban when compared with warfarin. Dabigatran was associated with lower risk of bleeding among patients with normal or mildly decreased renal function, but not among patients with moderately decreased renal function.

Acknowledgement/Funding

This study was funded by an unrestricted grant from the Capital Region of Denmark, Foundation for Health Research.

P4779High facility preference for rivaroxaban in atrial fibrillation increases risk of major bleeding compared to facility preference for apixaban

Background

No randomized trial has compared efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF). Previous real-world comparisons could be biased by patient characteristics of importance for treatment selection, but instrumental variables could potentially account for measured and unmeasured confounders.

Purpose

To compare efficacy and safety of rivaroxaban and apixaban using facility preference for type of NOAC as instrumental variable.

Methods

AF patients started on apixaban or rivaroxaban were identified using nationwide registries. We categorized patients according to facility preference for type of NOAC, measured as percentage of the prior 20 AF patients started on rivaroxaban in the same facility. Occurrence of stroke/thromboembolism (TE), major bleeding, myocardial infarction and all-cause mortality during two years of follow-up were investigated using adjusted Cox regressions. To further examine general frailty according to facility preferences we also investigated occurrence of cancer, urogenital tract infection, dehydration and fracture.

Results

We analyzed 6264 AF patients initiated on rivaroxaban or apixaban. Compared with patients treated in facilities that used rivaroxaban in 0–20% of cases, the adjusted hazard ratio for bleeding was 1.05 when treated in a facility with 25–40% use; 1.40 with 45–60% use; 1.50 with 65–80% use; and 1.81 for 85–100% use (Ptrend=0.002). Higher facility level use of rivaroxaban was not associated with increased risk of stroke/TE (Ptrend=0.06), myocardial infarction (Ptrend=0.87) or all-cause mortality (Ptrend=0.91), and there was no association between facility preference for rivaroxaban and risk of cancer (Ptrend=0.83), urogenital tract infection (Ptrend=0.49), dehydration (Ptrend=0.91) or fracture (Ptrend=0.47).

Characteristics by facility preference Percent of previous AF patients from facility started on rivaroxaban P for trend 0–20% 25–40% 45–60% 65–80% 85–100% No. of patients 1406 1421 1551 930 956 Received rivaroxaban, (%) 279, (19.8) 499, (35.1) 711, (45.8) 632, (68.0) 774, (81.0) <0.001 Standard dose, (%) 1216, (86.5) 1232, (86.7%) 1366, (88.1%) 793, (85.3%) 824, (86.2%) 0.62 Median age, (interquartile range) 70, (63.3–74) 69, (63–74) 70, (64–74) 70, (64–75) 70, (63–75) 0.11 Below median income, (%) 740, (52.6) 699, (49.2) 764, (49.3) 458, (49.3) 471, (49.3) 0.31 Prior stroke, (%) 99, (7.0) 115, (8.1) 134, (8.6) 69, (7.4) 74, (7.7) 0.56 Prior bleeding, (%) 136, (9.7) 141, (9.9) 163, (10.5) 91, (9.8) 97, (10.1) 0.51 Antiplatelet therapy, (%) 445, (31.7) 465, (32.7) 491, (31.7) 303, (32.6) 317, (33.2) 0.49

Rate of events according to instrument

Conclusion

High facility preference for rivaroxaban increases risk of major bleeding compared to facility preference for apixaban.

Acknowledgement/Funding

This study was funded by an unrestricted grant from the Capital Region of Denmark, Foundation for Health Research.

Selection of best reference genes for qRT-PCR analysis of human neural stem cells preconditioned with hypoxia or baicalein-enriched fraction extracted from Oroxylum indicum medicinal plant

Whilst the potential of neural stem cell (NSC)-based treatment is recognized worldwide and seems to offer a promising therapeutic option for stroke treatments, there is currently no full understanding regarding the effects of hypoxic and baicalein-enriched fraction (BEF) preconditioning approaches on the therapeutic potential of these cells for stroke. The potential of preconditioned NSC can be determined based on the expression of several key neuroprotective genes using qRT-PCR technique. However, prior to that, it is imperative and extremely important to carefully select reference gene(s) for accurate qRT-PCR data normalization to avoid error in data interpretation. This study aimed to evaluate the stability of ten candidate reference genes via comprehensive analysis using three algorithms software: geNorm, NormFinder and BestKeeper. Our results revealed that HPRT1 and RPL13A were the most reliable reference genes for BEF-preconditioned NSCs, but ironically, HPRT1 was ranked as the least stable reference gene for hypoxic-preconditioned NSCs. On the other hand, RPLP1 and RPL13A were selected as the most stably expressed pair of reference genes for hypoxic-preconditioned NSCs. In conclusion, this study has pointed out the importance of identifying valid reference genes and has presented the first significant validation on best reference genes recommended for qRT-PCR study involves NSC preconditioned with hypoxia or with BEF extracted from Oroxylum indicum medicinal plant.

Hyperprogressive disease during PD-1/PD-L1 blockade in patients with non-small-cell lung cancer

BACKGROUND

Immune checkpoint blockade with Programmed cell death 1 (PD-1)/PD-L1 inhibitors has been effective in various malignancies and is considered as a standard treatment modality for patients with non-small-cell lung cancer (NSCLC). However, emerging evidence show that PD-1/PD-L1 blockade can lead to hyperprogressive disease (HPD), a flair-up of tumor growth linked to dismal prognosis. This study aimed to evaluate the incidence of HPD and identify the determinants associated with HPD in patients with NSCLC treated with PD-1/PD-L1 blockade.

PATIENTS AND METHODS

We enrolled patients with recurrent and/or metastatic NSCLC treated with PD-1/PD-L1 inhibitors between April 2014 and November 2018. Clinicopathologic variables, dynamics of tumor growth, and treatment outcomes were analyzed in patients with NSCLC who received PD-1/PD-L1 blockade. HPD was defined according to tumor growth kinetics (TGK), tumor growth rate (TGR), and time to treatment failure (TTF). Immunophenotyping of peripheral blood CD8+ T lymphocytes was conducted to explore the potential predictive biomarkers of HPD.

RESULTS

A total of 263 patients were analyzed. HPD was observed in 55 (20.9%), 54 (20.5%), and 98 (37.3%) patients according to the TGK, TGR, and TTF. HPD meeting both TGK and TGR criteria was associated with worse progression-free survival [hazard ratio (HR) 4.619; 95% confidence interval (CI) 2.868-7.440] and overall survival (HR, 5.079; 95% CI, 3.136-8.226) than progressive disease without HPD. There were no clinicopathologic variables specific for HPD. In the exploratory biomarker analysis with peripheral blood CD8+ T lymphocytes, a lower frequency of effector/memory subsets (CCR7-CD45RA- T cells among the total CD8+ T cells) and a higher frequency of severely exhausted populations (TIGIT+ T cells among PD-1+CD8+ T cells) were associated with HPD and inferior survival rate.

CONCLUSION

HPD is common in NSCLC patients treated with PD-1/PD-L1 inhibitors. Biomarkers derived from rationally designed analysis may successfully predict HPD and worse outcomes, meriting further investigation of HPD.

Molecular detection of Haemophilus parasuis serotypes 4, 5 or 12 and 13 in Peninsular Malaysia

Although the economic importance of Haemophilus parasuis infection causing Glasser's disease is prevalent throughout pig farms in Peninsular Malaysia, there is a dearth of knowledge on its actual nature. In this study, a multiplex PCR was performed to screen for three major predominant virulent strains of H. parasuis, which are serotypes 4, 5 or 12 and 13. A total of 175 tissues or bodily fluid samples of various parts were collected from diseased animals from October, 2016 to February, 2018; with total of 62.9% positive detection of H. parasuis. The highest detection was found to be in the pericardial sac fibrin (90.9%) followed by pleural fibrin, lung, pleural fluid, tonsil, pericardial sac, peritoneal fluid, abdominal fibrin, joint fluid, brain and pericardium. Serotype 13 was the highest (40/110) followed by serotype 4(37/110), serotype 5(31/110) and 12 samples were nontypable (12/110). The presence of untypable serotype also drives to further identification of other serotypes in Malaysia.

Diagnostic value of electrocardiogram in cardiac tamponade

INTRODUCTION

We aim to study the diagnostic value of electrocardiogram (ECG) in cardiac tamponade.

METHODS

This study was a single centre, retrospective casecontrol study. We recruited 42 patients diagnosed with cardiac tamponade of various aetiologies confirmed by transthoracic echocardiography and 100 controls between January 2011 and December 2015. The ECG criteria of cardiac tamponade we adopted was as follows: 1) Low QRS voltage in a) the limb leads alone, b) in the precordial leads alone or, c) in all leads, 2) PR segment depression, 3) Electrical alternans, and 4) Sinus tachycardia.

RESULTS

Malignancy was the most common causes of cardiac tamponade, the two groups were of similar proportion of gender and ethnicity. We calculated the sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of each ECG criteria. Among the ECG abnormalities, we noted the SN of 'low voltage in all chest leads' (69%), 'low voltage in all limb leads' (67%) and 'sinus tachycardia' (69%) were higher as compared to 'PR depression' (12%) and 'electrical alternan' (5%). On the other hand, 'low voltage in all chest leads' (98%), 'low voltage in all leads' (99%), 'PR depression' (100%) and 'electrical alternans' (100%) has highest SP.

CONCLUSION

Our study reaffirmed the findings of previous studies that electrocardiography cannot be used as a screening tool for diagnosing cardiac tamponade due to its low sensitivity. However, with clinical correlation, electrocardiography is a valuable adjuvant test to 'rule in' cardiac tamponade because of its high specificity.

Immunohistochemical and molecular analysis of spitzoid neoplasms with pulverocyte subclones

BACKGROUND

Clonal naevi are characterized by a focal proliferation of pigmented melanocytes in an otherwise banal naevus. These subclones are often composed of aggregates of larger, epithelioid melanocytes with nuclear atypia and dusty-grey cytoplasmic pigmentation, which are referred to as 'pulverocytes', and this finding may lead to a misdiagnosis of malignant melanoma (MM).

AIM

To characterize the significance of subclones of dusty-grey pigmented epithelioid melanocytes within spitzoid neoplasms.

METHODS

We studied the histological and molecular features of a series of 20 spitzoid neoplasms with pulverocyte subclones encountered in our practice, including both atypical Spitz tumours (ASTs) and invasive MMs.

RESULTS

Pulverocytes were predominantly dermal, and the percentage of subclones ranged from 2% to 40%, with a median of 10% in ASTs and 25% in lesions we classified as MM. In cases with > 10% subclones, there was an increased odds of fluorescence in situ hybridization positivity (OR = 12; 95% CI 1.2-293.4; P = 0.03) and an increased odds of homozygous 9p21 deletion (OR = 3.6; 95 CI 0.28-89.82; P = 0.33), although the latter did not reach statistical significance.

CONCLUSIONS

We consider spitzoid lesions with a small subclone population to be a variant of a clonal naevus with indolent behaviour, whereas lesions with larger pulverocyte populations are more likely to have chromosomal copy number aberrations and in some cases may represent malignant transformation.

Co-clinical trials demonstrate predictive biomarkers for dovitinib, an FGFR inhibitor, in lung squamous cell carcinoma

Background

We conducted co-clinical trials in patient-derived xenograft (PDX) models to identify predictive biomarkers for the multikinase inhibitor dovitinib in lung squamous cell carcinoma (LSCC).

Methods

The PDX01-02 were established from LSCC patients enrolled in the phase II trial of dovitinib (NCT01861197) and PDX03-05 were established from LSCC patients receiving surgery. These five PDX tumors were subjected to in vivo test of dovitinib efficacy, whole exome sequencing and gene expression profiling.

Results

The PDX tumors recapitulate histopathological properties and maintain genomic characteristics of originating tumors. Concordant with clinical outcomes of the trial enrolled-LSCC patients, dovitinib produced substantial tumor regression in PDX-01 and PDX-05, whereas it resulted in tumor progression in PDX-02. PDX-03 and -04 also displayed poor antitumor efficacy to dovitinib. Mutational and genome-wide copy number profiles revealed no correlation between genomic alterations of FGFR1-3 and sensitivity to dovitinib. Of note, gene expression profiles revealed differentially expressed genes including FGF3 and FGF19 between PDX-01 and 05 and PDX-02-04. Pathway analysis identified two FGFR signaling-related gene sets, FGFR ligand binding/activation and SHC-mediated cascade pathway were substantially up-regulated in PDX-01 and 05, compared with PDX-02-04. The comparison of gene expression profiles between dovitinib-sensitive versus -resistant lung cancer cell lines in the Cancer Cell Line Encyclopedia database also found that transcriptional activation of 18 key signaling components in FGFR pathways can predict the sensitivity to dovitinib both in cell lines and PDX tumors. These results highlight FGFR pathway activation as a key molecular determinant for sensitivity to dovitinib.

Conclusions

FGFR gene expression signatures are predictors for the response to dovitinib in LSCC.

Modelling end-pumped passively Q-switched Nd-doped crystal lasers: manifestation by a Nd:YVO4/Cr4+:YAG system with a concave-convex resonator

A theoretical model for the passively Q-switched (PQS) operation which includes the spatial overlapping between the pump and lasing modes under the thermal lensing effect is developed to give a transcendental equation that can directly determine the critical parameters such as pulse energy, pulse repetition rate, and pulse width for the PQS performance. More importantly, an analytical function which gives the approximate solution for the transcendental equation as well as a specific critical criterion for good PQS operation are derived for practical analyses and design. A Nd:YVO₄/Cr⁴⁺:YAG system with a concave-convex resonator which can achieve fairly stable PQS pulse trains even at a high pump level is further exploited to manifest the proposed spatially dependent model. The good agreement between the experimental results and the theoretical predictions is verified to show the feasibility of the proposed model for designing high-power PQS lasers with high accuracy.

Generation of terahertz optical beating from a simultaneously self-mode-locked Nd:YAG laser at 1064 and 1123 nm

The reflectivity of the output coupler is designed to achieve the synchronously self-mode-locked operation at 1064 and 1123 nm in a diode-end-pumped Nd:YAG laser. Numerical analyses are performed to confirm that the designed output coupler can lead the emission lines to be predominant at 1064 and 1123 nm. Moreover, the crossover of the threshold pump powers for the 1064 and 1123 nm emission lines can be exploited to obtain the single central wavelength of 1064 nm or the single central wavelength of 1123 nm or, simultaneously, dual-central-wavelength self-mode-locked operation by finely adjusting the cavity alignment. For the dual-central-wavelength mode-locked emissions, the pulse repetition rate and the pulse duration are 4.5 GHz and 50.8 ps, respectively. The maximum output power can be up to 2.47 W at a pump power of 7.5 W. The synchronization of the 1064 and 1123 nm mode-locked pulses generates the optical beating pulse trains with repetition rates up to 14.7 THz.

Exploiting concave-convex linear resonators to design end-pumped solid-state lasers with flexible cavity lengths: Application for exploring the self-mode-locked operation

The characteristics of a convex-concave linear resonator under the thermal lensing effect are theoretically analyzed to find an analytical model for designing end-pumped solid-state lasers with flexible cavity lengths. By exploiting the design model, the power scaling for continuous-wave operation under strong thermal lensing can be easily achieved in the proposed resonator with different cavity lengths. Furthermore, the proposed resonator is applied to explore the exclusive influence of cavity length on the self-mode-locked (SML) operation. It is discovered that the lasing longitudinal modes will split into multiple groups in optical spectrum to lead to a multi-pulse mode-locked temporal state when the cavity length increases. Finally, a theoretical model is derived to reconstruct the experimental results of SML operation to deduce a simple relationship between the group number of lasing modes and the cavity length.

Monolithic dual-polarization self-mode-locked Nd:YAG 946-nm lasers: controlling beat frequency and observation of temporal chaos

The self-mode-locked (SML) operation at 946 nm can be achieved with a monolithic Nd:YAG crystal when the pump power is above the threshold of the multiple-longitudinal-mode generation. The SML output is further found to include two orthogonal polarization components with a beat frequency coming from the birefringence effect in the laser crystal. The beat frequency can be widely adjusted in the range of 5-220 MHz by controlling the cooling temperature. The present experiment also confirms the theoretical prediction that the two-mode operation generally exhibits the chaotic dynamics when the frequency difference is sufficiently close to the relaxation frequency.

Effects of dietary supplementation of bacteriophages against enterotoxigenic Escherichia coli (ETEC) K88 on clinical symptoms of post-weaning pigs challenged with the ETEC pathogen

The present study was performed to investigate the effects of dietary supplementation of bacteriophages (phages) against enterotoxigenic Escherichia coli (ETEC) K88 as a therapy against the ETEC infection in post-weaning pigs. Two groups of post-weaning pigs aged 35 days, eight animals per group, were challenged with 3.0 × 10¹⁰ colony forming units of ETEC K88, a third group given the vehicle. The unchallenged group and one challenged group were fed a basal nursery diet for 14 days while the remaining challenged group was fed the basal diet supplemented with 1.0 × 10⁷ plaque forming units of the phage per kg. Average daily gain (ADG), goblet cell density and villous height:crypt depth (VH:CD) ratio in the intestine were less in the challenged group than in the unchallenged group within the animals fed the basal diet (p < 0.05); the reverse was true for rectal temperature, faecal consistency score (FCS), E. coli adhesion score (EAS) in the intestine, serum interleukin-8 (IL-8) and tumour necrosis factor-α (TNF-α) concentrations and digesta pH in the stomach, caecum and colon. The ETEC infection symptom within the challenged animals was alleviated by the dietary phage supplementation (p < 0.05) in ADG, FCS, EAS in the jejunum, serum TNF-α concentration, digesta pH in the colon, goblet cell density in the ileum and colon and VH:CD ratio in the ileum. Moreover, the infection symptom tended to be alleviated (p < 0.10) by the phage supplementation in rectal temperature, EAS in the ileum and caecum, and VH:CD ratio in the duodenum and jejunum. However, EAS in the colon, digesta pH in the stomach and caecum, and goblet cell density in the jejunum did not change due to the dietary phage. Overall, results indicate that the phage therapy is effective for alleviation of acute ETEC K88 infection in post-weaning pigs.

The effect of anticonvulsant use on bone mineral density in non-ambulatory children with cerebral palsy

INTRODUCTION

Studies showed that use of anticonvulsants (antiepileptic drugs) might be associated with reduced bone mineral density. The primary objective of this study was to evaluate the effect of anticonvulsants on bone mineral density in non-ambulatory children with cerebral palsy. The secondary objective was to identify their risk factors for low bone mineral density.

METHODS

This case series with internal comparisons was conducted in a paediatric residential rehabilitation centre in Hong Kong. Overall, 32 patients were enrolled. The study group comprised 18 patients (6 males, 12 females) aged 5.0 to 19.5 years (mean ± standard deviation, 13.8 ± 4.7 years); all were prescribed anticonvulsant therapy for more than 2 years. The comparison group comprised 14 patients (6 males, 8 females) aged 7.0 to 19.1 years (mean, 16.4 ± 3.0 years) who were concomitant non-ambulatory residents with cerebral palsy and were not prescribed any anticonvulsant therapy prior to study recruitment. Patients underwent a physical examination, blood tests, nutritional assessment, and dual-energy X-ray absorptiometry scan of the total body less head. Z-scores were calculated.

RESULTS

There was no significant difference in Z-scores of total body less head between groups. Among children with low bone mineral density (Z-scores ≤-2.0) and normal bone mineral density, multivariate analysis revealed that higher weight-for-age Z-score (adjusted odds ratio=0.015) and presence of puberty (adjusted odds ratio=0.027) were independent factors for bone mineral density improvement. Hosmer-Lemeshow goodness of fit test (P=0.315) was not significant. Nagelkerke R(2) was 0.677, signifying a relatively well-fitting model.

CONCLUSION

There was no evidence that anticonvulsant therapy has any detrimental effect on bone mineral density in non-ambulatory children with cerebral palsy. A low weight-for-age Z-score was associated with low bone mineral density. Early nutritional intervention to optimise body weight may help to increase bone mineral density.

Generation of orthogonally polarized self-mode-locked Nd:YAG lasers with tunable beat frequencies from the thermally induced birefringence

The simultaneous self-mode-locking of two orthogonally polarized states in a Nd:YAG laser is demonstrated by using a short linear cavity. A total output power of 3.8 W can be obtained at an incident pump power of 8.2 W. The beat frequency Δfc between two orthogonally polarized mode-locked components is observed and measured precisely. It is found that the beat frequency increases linearly with an increase in the absorbed pump power. The origin of the beat frequency can be utterly manifested by considering the thermally induced birefringence in the Nd:YAG crystal. The present result offers a promising approach to generate orthogonally polarized mode-locked lasers with tunable beat frequency.

Theoretical and experimental studies for high-repetition-rate disordered crystal lasers with harmonic self-mode locking

A harmonically self-mode-locked Nd:Sr3Y2/(BO3)4 disordered crystal laser with subpicosecond pulse duration is demonstrated. We exploit the damped harmonic oscillator model to numerically verify that the mode spacing of the laser cavity can be modified to be the harmonics of the free spectral range of the Fabry-Perot cavity when the optical length of the laser cavity is close to a commensurate ratio of the optical length of the Fabry-Perot cavity. In experiment, the Fabry-Perot cavity can be formed by the pump facet of the disordered crystal and the front mirror. A 110 GHz single-pulse harmonically mode-locked pulse train with pulse duration of 857 fs is experimentally achieved under optical lengths of 27.19 and 4.08 mm for the laser cavity and Fabry-Perot cavity respectively, corresponding to a fractional number of 20/3. A maximum output power of 162 mW is obtained at an incident pump power of 3.1 W.

Apparent diffusion coefficient in differentiation between malignant and benign breast masses: does size matter?

AIM

To determine whether lesion size affects the diagnostic performance of apparent diffusion coefficient (ADC) in the evaluation of breast masses.

MATERIALS AND METHODS

Consecutive breast lesions detected at magnetic resonance imaging (MRI) from June 2010 to July 2013 were retrospectively reviewed. Differences in the ADCs of benign and malignant mass lesions were compared. Receiver operating characteristics analysis was performed to evaluate diagnostic performance of ADC regarding lesion size (≤ 1 cm or >1 cm) and their T2W signal intensities.

RESULTS

Seventy-four malignant lesions (77.9%) and 21 (22.1%) benign lesions were included. Twenty-two of the 95 (23.2%) masses measured ≤ 1 cm (mean 0.73 ± 0.4; range 0.51-0.8 cm) and 73/95 (76.9%) masses measured >1 cm (mean 2.11 ± 0.1; range 1.1-3.3 cm). The mean ADC was significantly lower for malignant than for benign lesions (mean for malignant lesion, 0.89 ± 0.29 × 10(-3) mm(2)/s; mean for benign lesions, 1.27 ± 0.42 × 10(-3) mm(2)/s; p<0.01). The optimal ADC cut-off for differentiating benign and malignant lesion was 1.088 × 10(-3) mm(2)/s with a sensitivity of 85.9% and specificity of 77% for lesions >1 cm. The sensitivity and specificity were lowered to 60% and 50%, respectively, for lesions of size ≤ 1. Maximal sensitivity and specificity were reached when the ADC value was used to evaluate T2-dark lesions.

CONCLUSION

Diffusion-weighted MRI is useful for characterizing masses that are hypointense on T2-weighted images. Lower sensitivity and specificity were found for breast lesions ≤ 1 cm.

Aetiological bases of 46,XY disorders of sex development in the Hong Kong Chinese population

OBJECTIVE

Disorders of sex development are due to congenital defects in chromosomal, gonadal, or anatomical sex development. The objective of this study was to determine the aetiology of this group of disorders in the Hong Kong Chinese population.

SETTING

Five public hospitals in Hong Kong.

PATIENTS

Patients with 46,XY disorders of sex development under the care of paediatric endocrinologists between July 2009 and June 2011.

MAIN OUTCOME MEASURES

Measurement of serum gonadotropins, adrenal and testicular hormones, and urinary steroid profiling. Mutational analysis of genes involved in sexual differentiation by direct DNA sequencing and multiplex ligation-dependent probe amplification.

RESULTS

Overall, 64 patients were recruited for the study. Their age at presentation ranged from birth to 17 years. The majority presented with ambiguous external genitalia including micropenis and severe hypospadias. A few presented with delayed puberty and primary amenorrhea. Baseline and post-human chorionic gonadotropin-stimulated testosterone and dihydrotestosterone levels were not discriminatory in patients with or without AR gene mutations. Of the patients, 22 had a confirmed genetic disease, with 11 having 5α-reductase 2 deficiency, seven with androgen insensitivity syndrome, one each with cholesterol side-chain cleavage enzyme deficiency, Frasier syndrome, NR5A1-related sex reversal, and persistent Müllerian duct syndrome.

CONCLUSIONS

Our findings suggest that 5α-reductase 2 deficiency and androgen insensitivity syndrome are possibly the two most common causes of 46,XY disorders of sex development in the Hong Kong Chinese population. Since hormonal findings can be unreliable, mutational analysis of the SRD5A2 and AR genes should be considered the first-line tests for these patients.

Effects of a juvenile hormone analogue pyriproxyfen on monogynous and polygynous colonies of the Pharaoh ant Monomorium pharaonis (Hymenoptera: Formicidae)

To evaluate the effects of the juvenile hormone analogue pyriproxyfen on colonies of the Pharaoh ant Monomorium pharaonis (L.), peanut oil containing different concentrations (0.3, 0.6, or 0.9%) of pyriproxyfen was fed to monogynous (1 queen, 500 workers, and 0.1 g of brood) and polygynous (8 queens, 50 workers, and 0.1 g of brood) laboratory colonies of M. pharaonis. Due to its delayed activity, pyriproxyfen at all concentrations resulted in colony elimination. Significant reductions in brood volume were recorded at weeks 3 - 6, and complete brood mortality was observed at week 8 in all treated colonies. Brood mortality was attributed to the disruption of brood development and cessation of egg production by queens. All polygynous colonies exhibited significant reduction in the number of queens present at week 10 compared to week 1. Number of workers was significantly lower in all treated colonies compared to control colonies at week 8 due to old-age attrition of the workers without replacement. At least 98.67 ± 1.33% of workers were dead at week 10 in all treated colonies. Thus, treatment with slow acting pyriproxyfen at concentrations of 0.3 - 0.9% is an effective strategy for eliminating Pharaoh ant colonies.

Intracavity continuous-wave multiple stimulated-Raman-scattering emissions in a KTP crystal pumped by a Nd:YVO(4) laser

Intracavity continuous-wave (CW) multiple stimulated-Raman-scattering emissions have been successfully demonstrated in a KTP crystal pumped by a Nd:YVO(4) 1064-nm laser for the first time. Three different output couplers (OCs) with high-reflection (HR) coating in the range of 1-1.1, 1-1.13, and 1-1.15 μm are employed in the experiment to generate lasing wavelengths at 1095 (the first-Stokes emission of the 266 cm(-1) Raman shift), 1095 + 1128 (the first- and second-Stokes emission of the 266 cm(-1) Raman shift), and 1095 + 1128 + 1149 nm (the first two Stokes emissions of the 266 cm(-1) Raman shift and the first-Stokes emission of the 694 cm(-1) Raman shift), separately. This Raman laser paves a way to produce more-closely spaced set of CW emission in the green-yellow region.

Factors influencing sexually transmitted infections among adolescents in South Korea

BACKGROUND

No data exist regarding the sexually transmitted infection (STI) rate in adolescents aged 12-15 in South Korea. Only a Korean few studies have attempted to investigate the factors influencing sexually transmitted infections among adolescents.

AIM

The purpose of this study was to investigate the self-reported sexually transmitted infection contraction rate and analyse individual and family factors that influence this rate among middle school students aged 12-15 in South Korea.

METHODS

Using statistics from the 8th Korea Youth Risk Behavior Web-based Survey, secondary data analysis was conducted. The study sample consisted of 714 individuals who had reported initiating sexual intercourse.

RESULTS

The rate of self-reported sexually transmitted contraction was 13.5%. The following factors predicted STI contraction: second year of middle school, excellent academic achievement, habitual or purposeful drug use, first intercourse before middle school, intercourse after drinking alcohol, weekly allowance, and living without family predicted sexually transmitted infection contraction.

LIMITATIONS

The parental data were collected by the self-reported surveys in a cross-sectional manner and questions of STI contraction and intercourse after drinking may have confused the subjects.

CONCLUSION

We need to utilize these predictors in providing adolescents with sexual health interventions and establishing adolescent sexual health policies.

IMPLICATIONS FOR NURSING AND HEALTH POLICIES

Increased sex education and employment of a school nurse in each middle school are needed. High-risk students need to be monitored given the predictors of sexually transmitted infection contraction, and the school health personnel need to inform female students and their parents the importance of seeing a gynaecologist for regular check-ups.

Cryogenically monolithic self-Raman lasers: observation of single-longitudinal-mode operation

A cryogenically monolithic Nd:YVO4 self-Raman laser is experimentally explored and theoretically analyzed. The variation of the stimulated Raman scattering (SRS) threshold on the temperature is found to be nonlinear because the reduction of thermal lensing enlarges the cavity mode size. In spite of the nonlinear variation of the SRS threshold on the temperature, the overall SRS output power can be efficiently increased from 0.78 to 1.36 W for temperature decreasing from 285 to 80 K at an absorbed power of 17.2 W. More interestingly, the single-longitudinal-mode operation is experimentally achieved when temperature is lower than 125 K.

Establishment of a prediction model for the miRNA-based heading date characteristics of rice in the booting stage

Rice (Oryza sativa L.) is one of the most important food crops in the world. In Taiwan, due to the warm climate, there are two harvests annually. However, the yield and quality of rice can vary between each crop season in any given year. Previous reports have shown that microRNAs (miRNAs) play a crucial role in many developmental and physiological processes in plants. In this study, the heading date characteristics of 167 rice cultivars from the second crop season were recorded, and 27 rice cultivars were selected for preliminary microarray analysis. A total of 14 miRNAs from different heading date characteristics in 21 cultivars were selected based on significant differences in their expression profiles. Using a correlation analysis between the heading date and selected miRNA expression obtained from real-time polymerase chain reaction (PCR) assays, we developed a heading date prediction model. The model includes nine miRNA genes with corresponding R2 values of 0.8. To confirm the model, a real-time PCR analysis was performed on an additional 27 rice cultivars and we found the model predicted the heading date with accuracy. Therefore, the developed prediction may be useful in further studies aimed at confirming the reliability of the use of miRNA in molecular breeding and to increase the selection efficiency of rice cultivars and breeding.

24-W cryogenically cooled Nd:YAG monolithic 946-nm laser with a slope efficiency >70

A high-power efficient monolithic Nd:YAG 946-nm laser is demonstrated at the cryogenic temperature. By exploring the absorption and the fluorescence spectra of the Nd:YAG crystal, it reveals the fact that the absorption bandwidth at 808 nm is narrowing and the fluorescence intensity at 1061 nm is significant enhanced when the temperature is decreased. The temperature dependence of the lasing threshold at 946 nm is found to display a minimum value near a temperature of 170 K. At an incident pump power of 34.5 W, the local heating leads the optimum temperature to be approximately 120 K and the maximum output power can reach 24.4 W with the conversion efficiency of 71% as well as the slope efficiency up to 75%.

Sexual genetic and simple sequence repeat (SSR) analysis for molecular marker development on the all hermaphrodite papaya

The papaya (Carica papaya L.) is one of the most important economic tropical fruits in the world, and the hermaphrodite is the preferred type in field cultures. We analyzed the sexual ratio of offspring from the cultivar 'Taiwan Seed Station No. 7' (T7) by a self-cross and its cross with Taichung Sunrise (TS). Female progeny from the T7 self-crossing were not observed. This finding may be caused by a lethal gene that is linked to females. In this study, we selected 192 simple sequence repeats (SSRs) to analyze the polymorphism between T7 and TS. A total of 37 SSRs were identified for T7 and TS. In addition, 14 SSRs served as the molecular makers for identification of T7, TS and their hybrid offsprings. Thus, the results show that the genetic similarity between T7 and TS is rather high. This suggests that T7 may be a mutant of TS. Phylogenetic analysis from the SSR polymorphisms of the above parent strains and 15 F1 offspring revealed the genetic distance of the F1 offspring located between T7 and TS. The results of this study may provide an opportunity for elucidating the genetic characteristics of all hermaphrodites via identification of molecular makers.

A novel mutation in pseudohypoparathyroidism type 1a in a Chinese woman and her son with hypocalcaemia

Pseudohypoparathyroidism is a rare genetic disorder characterised by end-organ resistance to parathyroid hormone due to a defect of the guanine nucleotide-binding protein alpha that simulates activity of the polypeptide 1 (GNAS) gene. Patients with type 1a pseudohypoparathyroidism display different features of Albright's hereditary osteodystrophy as well as multi-hormone resistance. We describe a Chinese woman and her son, who presented with different symptoms of pseudohypoparathyroidism and clinically manifested different degree of Albright's hereditary osteodystrophy. Genetic study detected a mutation [NM_000516.4(GNAS):c682C>T (p.Arg228Cys)] in the GNAS gene.

Characterisation of Physicochemical Properties of Propionylated Corn Starch and Its Application as Stabiliser

A series of propionylated starches with different degrees of substitution (DS) was synthesised and their physicochemical properties and application as a stabiliser were investigated. Starch propionates with moderate DS were prepared by esterification of native corn starch with propionic anhydride. By varying the reaction times of the esterification process, twelve starch propionates with DS of 0.47 to 0.94 were prepared. FTIR and NMR confirmed the introduction of propionyl groups to the starch. X-ray diffraction pattern showed reduced crystallinity in the starch propionates. The contact angle was found to increase proportionately with the increase in DS. Swelling power results showed that starch propionates were able to swell more than native corn starch at low temperature (40 °C). Oil-in- -water (O/W) emulsions prepared using starch propionates (DS of 0.64 to 0.86) showed exceptional stability when challenged by centrifugation stress test. These stable O/W emulsions had viscosities in the range of 1236.7-3330.0 mPa·s. In conclusion, moderately substituted short-chain (propionylated) starches could be a promising cold swelling starch, thickener and O/W emulsion stabiliser in food, pharmaceutical and cosmetic industries.