Unusual capitate fracture with dorsal shearing pattern and concomitant carpometacarpal dislocation with a 6-year follow-up: A case report

BACKGROUND

Isolated capitate fractures are rare carpal fractures. Following high-energy injuries, capitate fractures are usually associated with other carpal fractures or ligament injuries. The management of capitate fractures depends on the fracture pattern. Here, we report an unusual capitate fracture with a dorsal shearing pattern and concomitant carpometacarpal dislocation, with a 6-year follow-up. To the best of our knowledge, this fracture pattern and surgical management have not been previously reported.

CASE SUMMARY

A 28-year-old man presented with left-hand volar tenderness and decreased grip strength that persisted for one month after a traffic accident. Radiography showed a distal capitate fracture with carpometacarpal joint incongruence. Computed tomography (CT) revealed a distal capitate fracture with carpometacarpal joint dislocation. The distal fragment was rotated by 90° in the sagittal plane, and an oblique shearing fracture pattern was noted. Open reduction and internal fixation (ORIF) with a locking plate were performed using the dorsal approach. The imaging studies performed 3 mo and 6 years following surgery revealed a healed fracture, and the Disabilities of the Arm, Shoulder, and Hand and visual analog scale scores were significantly improved.

CONCLUSION

CT can detect capitate fractures with dorsal shearing pattern and concomitant carpometacarpal dislocation. ORIF using a locking plate are possible.

Calcaneal lengthening using ipsilateral fibula autograft in the treatment of symptomatic pes valgus in adolescents

Background

Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conservative treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteotomy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents.

Methods

We retrospectively examined 23 ft of 13 adolescents who underwent surgery between July 2014 and January 2018. The radiological and clinical outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores) were assessed during a mean follow-up of 49.7 (range, 30.9–73.4) months. The mean distance of the lengthening site was measured to evaluate graft sinking or collapse. The Goldberg scoring system was used to determine the degree of union at the donor and recipient sites.

Results

The calcaneal pitch and the anteroposterior and lateral talo-first metatarsal (Meary) angles showed significant correction, from 14.4 to 19.6 (p < 0.001), and from 14.5 to 4.6 (p < 0.001) and 13.5 to 8.5 (p < 0.001), respectively. The mean distance of the lengthening site showed no significant change (p = 0.203), suggesting no graft sinking or postoperative collapse. The lateral distal tibial angle showed no significant difference (p = 0.398), suggesting no postoperative ankle valgus changes. Healing of the recipient and donor sites occurred in 23 and 21 ft, respectively. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved significantly, from 68.0 to 98.5 (p < 0.001).

Conclusions

Evans calcaneal lengthening using an ipsilateral mid-fibula bone autograft resulted in significant improvement in clinical and radiological outcomes without ankle valgus deformity. Hence, it could be a treatment option for lateral column calcaneal lengthening in adolescents.

Dairy cattle with bovine leukaemia virus RNA show significantly increased leukocyte counts

Infection with bovine leukaemia virus (BLV), a retrovirus, causes dysfunction of the immune system and can have a marked economic impact on dairy industries due to decreased milk production and reduced lifespan in affected dairy cattle. The presence of proviral DNA has been the major diagnostic indicator of BLV infection. However in the course of BLV infection, the viral genome can be dormant, without detectable gene expression, resulting in limited impact on infected animals. At present, there is limited knowledge regarding haematological indices in dairy cattle that could indicate activation of the BLV genome and suggest reactivated BLV infection. In this study, BLV infection and BLV genome reactivation were evaluated based on the presence of BLV DNA and BLV env gene transcripts, respectively. BLV RNA transcription was confirmed. Among 93 whole blood samples obtained from asymptomatic dairy cattle, the prevalence of BLV proviral DNA and transcripts was 93.5% (n = 87/93) and 83.9% (n = 78/93), respectively. Between groups with and without BLV, the mean counts of white blood cells and lymphocytes in whole blood were significantly associated with the presence of BLV RNA (P < 0.05), but not with BLV proviral DNA. These results shed light on the activation status of the BLV genome and should be taken into account when evaluating the possible impact of BLV on cattle.

Cryptococcus neoformans var grubii meningoencephalitis in a patient on fingolimod for relapsing-remitting multiple sclerosis: Case report and review of published cases

INTRODUCTION

Fingolimod, a sphingosine-1-phosphate modulator used in the treatment of relapsing-remitting multiple sclerosis, has been associated with several cases of cryptococcosis.

CASE REPORT

We present a case of Cryptococcal meningoencephalitis attributable to Cryptococcus neoformans var. grubii, in a 58-year-old bird-keeper from Australia, after 7 years of fingolimod therapy. We discuss this in the context of previously reported cases, our understanding of fingolimod immune modulation, and known Cryptococcus pathobiology.

CONCLUSION

We suggest consideration of harm minimisation behaviours in patients requiring fingolimod, particularly in those with profound CD4 lymphopenia. Furthermore, we echo the call for improved post-marketing surveillance systems to determine the epidemiology of atypical infections with novel immunomodulatory treatments.

Unique Access to u-Channel Physics: Exclusive Backward-Angle Omega Meson Electroproduction

Backward-angle meson electroproduction above the resonance region, which was previously ignored, is anticipated to offer unique access to the three quark plus sea component of the nucleon wave function. In this Letter, we present the first complete separation of the four electromagnetic structure functions above the resonance region in exclusive ω electroproduction off the proton, ep→e^{'}pω, at central Q^{2} values of 1.60, 2.45  GeV^{2}, at W=2.21  GeV. The results of our pioneering -u≈-u_{min} study demonstrate the existence of a unanticipated backward-angle cross section peak and the feasibility of full L/T/LT/TT separations in this never explored kinematic territory. At Q^{2}=2.45  GeV^{2}, the observed dominance of σ_{T} over σ_{L}, is qualitatively consistent with the collinear QCD description in the near-backward regime, in which the scattering amplitude factorizes into a hard subprocess amplitude and baryon to meson transition distribution amplitudes: universal nonperturbative objects only accessible through backward-angle kinematics.

P2817Efficacy and safety of ticagrelor monotherapy in patients with complex percutaneous coronary intervention: insights from the Global Leaders trial

Background/Introduction

Purpose

Methods

The Global Leaders trial recruited 15,991 patients treated by default with a biolimus A9-eluting stent, and randomised in a 1:1 ratio either to the experimental strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) or to the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy). Complex PCI includes at least one of the following characteristics; left main and/or multivessel PCI, long stenting (defined as total stent length≥46mm), and bifurcation treatment with two stents. The present sub-analysis of the trial evaluated at two years the primary endpoint (composite of all-cause death and new Q-wave myocardial infarction [MI] centrally adjudicated with the Minnesota code). In addition, the patient-oriented composite endpoint (POCE) (composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also evaluated at two years.

Results

Of 15,450 patients included in the present analysis, 5,188 (26.7%) patients underwent complex PCI. The experimental strategy, when compared with the reference one, had a significantly lower risk of the primary endpoint (3.56% vs. 5.33%, HR: 0.66; 95% CI: 0.51–0.86; p-value= 0.002; p-value for interaction= 0.019) in patients with complex PCI. Similarly, the experimental treatment was associated with a significantly reduced risk of POCE (14.41% vs. 16.88%, HR: 0.84; 95% CI: 0.74–0.97; p=0.016, p-value for interaction= 0.099) and NACE (15.77% vs. 18.37%, HR: 0.85; 95% CI: 0.74–0.97; p=0.014; p-value for interaction= 0.096). The reduction in ischemic events was predominantly observed in patients with 2 or more characteristics of complex PCI (Figure). In contrast, there was no significant difference in the risk of BARC type 3 or 5 bleeding between the two regimens (2.40% vs. 2.38%, HR: 1.01; 95% CI: 0.71–1.44; p-value=0.956; p-value for interaction= 0.935).

Central illustration

Conclusion

Together with other well-established clinical risk factors, the extent and complexity of stenting should be taken into account in tailoring antiplatelet regimens for secondary prevention. The 1-month DAPT followed by 23-month ticagrelor monotherapy reduced the ischemic events without increasing the risk of bleeding in patients who underwent complex PCI, when compared with the conventional DAPT.

Acknowledgement/Funding

The Global Leaders trial was supported by the resource from AstraZeneca, Biosensors, and The Medicines Company.

P2695ABSORB bioresorbable scaffold versus Xience metallic stent in acute coronary syndromes with treated with percutaneous coronary intervention. A subanalysis of the COMPARE-ABSORB trial

Background

The safety and efficacy of the ABSORB scaffold in ACS patients remain unclear. The COMPARE-ABSORB trial compares the ABSORB to the Xience stent in lesions and patients at high risk for restenosis Patients with STEMI and urgent PCI for non-STEMI were not excluded.

Methods

Patients included in the COMPARE-ABSORB trial undergoing PCI for ACS were eligible. Predefined implantation techniques for ABSORB was mandatory. Primary endpoint is target lesion failure (TLF) at 1 year, defined as a composite of cardiac death, target vessel myocardial infarction and clinically indicated target lesion revascularization.

Results

Of 1670 patients, 842 were treated for ACS. At 1-year, TLF occurred in 22 patients (5.0%) of the ABSORB group and in 14 patients (3.5%) of the Xience group (HR 1.44%; 95% CI 0.74%-2.82%, P=0.284). Definite device thrombosis occurred in 9 patients (2.0%) of the ABSORB group and in 2 patients (0.5%) of the Xience group (HR 4.10%; 95% CI 0.89%-18.9%, P=0.071).

Baseline characteristics ABSORB (n=442) XIENCE (n=400) Age, years (SD) 60.7 (9.6) 61.3 (9.1) Male 350/442 (79.2%) 313/400 (78.3%) Current smoker 159/439 (36.2%) 126/397 (31.7%) Diabetes mellitus 152/440 (34.5%) 138/399 (34.6%) Hypertension 298/442 (67.4%) 266/400 (66.5%) Hypercholesterolemia 255/442 (57.7%) 232/400 (58.0%) Family history of coronary artery disease 147/442 (33.3%) 103/400 (25.8%) Previous MI 61/442 (13.8%) 67/400 (16.8%) Established Peripheral Vascular Disease 27/442 (6.1%) 15/400 (3.8%) Previous PCI 83/442 (18.8%) 86/400 (21.5%) Previous CABG 1/442 (0.2%) 4/400 (1.0%) Previous stroke 15/442 (3.4%) 21/400 (5.3%) Renal Insufficiency 9/442 (2.0%) 13/400 (3.3%) Clinical presentation   Unstable angina 149/442 (33.7%) 141/400 (35.3%)   Non-ST elevation myocardial infarction 183/442 (41.4%) 156/400 (39.0%)   ST elevation myocardial infarction 110/442 (24.9%) 103/400 (25.7%)

KM plot for target lesion failure

Conclusion

The COMPARE-ABSORB trial showed no difference in the primary endpoint at one year for the ACS subgroup. The signal for increased thrombosis remained, even with the optimized implantation protocol

Acknowledgement/Funding

Maasstad Hospital, Rotterdam, the Netherlands

P2811Impact of ticagrelor monotherapy on two-year clinical outcomes in patients with long stenting: insights from the Global Leaders trial

Background/Introduction

Data on the efficacy and safety of different antiplatelet regimens are limited in patients with increasing total stent length (TSL).

Purpose

To evaluate the impact of the experimental strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) vs. the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in patients with increasing TSL.

Methods

The present post-hoc analysis of the Global Leaders trial evaluated the primary endpoint (the composite of the all-cause death and new Q-wave myocardial infarction [MI]) at two years in patients with increasing TSL. In addition, the patient-oriented composite endpoint (POCE) (the composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (the composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also assessed.

Results

The cohort of 15,450 patients treated with a biolimus-eluting biodegradable polymer stents were included in this analysis. In the longer TSL group (≥46mm), the experimental strategy significantly reduced the risk of the primary endpoint (3.78% vs. 5.68%, hazard ratio (HR): 0.67, 95% confidence interval (CI): 0.49–0.90, p=0.008, P interaction=0.042) as well as POCE (14.57% vs. 18.11%, HR: 0.79, 95% CI: 0.67–0.92, p=0.003, P interaction=0.010) and NACE (16.07% vs. 19.64%, HR: 0.80, 95% CI: 0.69–0.93, p=0.004, P interaction=0.012) at two years. The risk of BARC type 3 or 5 bleeding at two years was similar between the two antiplatelet regimens.

KM in patients with long stenting

Conclusion

Ticagrelor monotherapy significantly reduced the risk of the primary endpoint, POCE and NACE with a similar risk of BARC type 3 or 5 bleeding at two years in patients with the longer TSL.

Acknowledgement/Funding

The Global Leaders trial was supported by unrestricted grants from AstraZeneca, Biosensors, and The Medicines Company. ECRI (European Cardiovascular R

P2812Ischemic efficacy and bleeding safety of ticagrelor monotherapy in patients with multivessel percutaneous coronary intervention: insights from the Global Leaders trial

Background/Introduction

The optimal duration of DAPT after coronary stent implantation remains a matter of debate and a novel antiplatelet regimen without an increased risk of bleeding while maintaining an anti-ischemic efficacy is of paramount importance in patients at higher risk of ischemia.

Purpose

The aim of the present sub-study of the Global Leaders trial is to evaluate the efficacy and safety of the experimental antiplatelet strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) vs. the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in patients with multivessel percutaneous coronary intervention (PCI).

Methods

The Global Leaders trial enrolled 15,991 patients treated by default with a biolimus A-9 eluting stent. The present sub-study of the trial sought to evaluate the impact of the long-term ticagrelor monotherapy on the primary endpoint (composite of all-cause death and new Q-wave myocardial infarction [MI] centrally adjudicated with the Minnesota code) at two years. In addition, the patient-oriented composite endpoint (POCE) (composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also evaluated at two years.

Results

A total of 15,845 patients was included in this analysis, of whom 3,576 patients received multivessel PCI. At two years, the experimental strategy significantly reduced a risk of the primary endpoint (the composite of all-cause death and new Q-wave myocardial infarction [MI]) (3.05% vs. 4.85%, HR: 0.62, 95% CI: 0.44–0.88, p=0.006, Pinteraction=0.031) in patients with multivessel PCI. Similarly, the experimental treatment had a significant risk reduction in the patient-oriented composite endpoint (POCE), defined as the composite of all-cause death, any stroke, any MI, and any revascularization (13.37% vs. 16.74%, HR: 0.78, 95% CI: 0.66–0.93, p=0.005, Pinteraction=0.020) and the net adverse clinical events (NACE), defined as the composite of POCE and Bleeding Academic Research Consortium [BARC] defined bleeding type 3 or 5 (14.65% vs. 18.38%, HR: 0.78, 95% CI: 0.66–0.92, p=0.003, Pinteraction=0.014) at two years. There was no significant difference in BARC type 3 or 5 bleeding (2.44% vs. 2.65%, HR: 0.92, 95% CI: 0.61–1.39, p=0.685, Pinteraction=0.754) at two years between the two regimens.

KM in patients with multivessel PCI

Conclusion

The present study has demonstrated the experimental antiplatelet strategy, when compared with the reference regimen, could potentially have a favourable balance between ischemic efficacy and bleeding safety in patients who underwent multivessel PCI.

Acknowledgement/Funding

The Global Leaders trial was supported by unrestricted grants from AstraZeneca, Biosensors, and The Medicines Company. ECRI (European Cardiovascular R

Patients with chronic urticaria have a higher risk of psychiatric disorders: a population-based study

BACKGROUND

The prevalence of psychiatric comorbidities in patients with chronic urticaria (CU) in a national population is largely unknown.

OBJECTIVES

To investigate the prevalence of psychiatric disorders and psychiatric medication use in patients with CU in Taiwan.

METHODS

Data were sourced from Taiwan's National Health Insurance Research Database for 2011. Patients who had a primary/secondary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of 708·1, 708·8 or 708·9 during 2011 with at least two outpatient visits and an antihistamine prescription were identified as CU cases. Patients with CU were classified into three disease severity groups according to their medication types. Psychiatric disorders were identified by patients having three outpatient visits with a primary or secondary diagnosis of a given psychiatric disease. Psychiatric medication use was defined by having at least four outpatient visits with prescriptions for anxiolytics, antidepressants or sleeping pills in 2010 or 2011.

RESULTS

Of the 167 132 patients with CU, 82·5% had mild CU, 17·0% had moderate CU and 0·4% had severe CU. Patients with CU had a higher prevalence of psychiatric disorders and psychiatric medication prescription than control groups. The relative risk (RR) of psychiatric disorders was 1·43 for patients with mild, 1·50 for patients with moderate and 2·32 for patients with severe CU vs. the controls (P < 0·001). For psychiatric medication prescription, the RRs were 1·95, 2·70 and 2·09, respectively, vs. controls (P < 0·001).

CONCLUSIONS

Patients with CU had a higher prevalence and risk of psychiatric disorders and psychiatric medication prescription than control groups. What's already known about this topic? Previous studies have shown a high prevalence of psychiatric comorbidities in patients with chronic urticaria (CU), with rates ranging from 35% to 60%. Anxiety, depression and somatoform disorders have been reported as the most prevalent mental disorders in patients with CU. What does this study add? Patients with CU had a higher prevalence of psychiatric disorders and psychiatric medication use than control groups in the general population. The relative risk (RR) of psychiatric disorders was 1·43 for those with mild CU, 1·50 for those with moderate CU and 2·32 for those with severe CU vs. controls. The RR for psychiatric medication use was 1·95 for those with mild CU, 2·70 for those with moderate CU and 2·09 for those with severe CU vs. controls. Mental health evaluations and management are important elements in CU management.

Skin eruption induced by dieting - an underdiagnosed skin disease in Malaysia

Prurigo pigmentosa is an inflammatory dermatosis characterized by a pruritic, symmetrically distributed erythematous papular or papulo-vesicular eruption on the trunk arranged in a reticulated pattern that resolves with hyperpigmentation. It is typically non-responsive to topical or systemic steroid therapy. The exact etiology is unknown, but it is more commonly described in the Far East countries. Dietary change is one of the predisposing factors. We report on nine young adult patients with prurigo pigmentosa, among whom five were on ketogenic diets prior to the onset of the eruptions. All cases resolved with oral doxycycline with no recurrence. We hope to improve the awareness of this uncommon skin condition among general practitioners and physicians so that disfiguring hyperpigmentation due to delayed diagnosis and treatment can be avoided.

Heavy Physics Contributions to Neutrinoless Double Beta Decay from QCD

Observation of neutrinoless double beta decay, a lepton number violating process that has been proposed to clarify the nature of neutrino masses, has spawned an enormous world-wide experimental effort. Relating nuclear decay rates to high-energy, beyond the standard model (BSM) physics requires detailed knowledge of nonperturbative QCD effects. Using lattice QCD, we compute the necessary matrix elements of short-range operators, which arise due to heavy BSM mediators, that contribute to this decay via the leading order π^{-}→π^{+} exchange diagrams. Utilizing our result and taking advantage of effective field theory methods will allow for model-independent calculations of the relevant two-nucleon decay, which may then be used as input for nuclear many-body calculations of the relevant experimental decays. Contributions from short-range operators may prove to be equally important to, or even more important than, those from long-range Majorana neutrino exchange.

Aging may negatively impact movement smoothness during stair negotiation

Stairs represent a barrier to safe locomotion for some older adults, potentially leading to the adoption of a cautious gait strategy that may lack fluidity. This strategy may be characterized as unsmooth; however, stair negotiation smoothness has yet to be quantified. The aims of this study were to assess age- and task-related differences in head and body center of mass (COM) acceleration patterns and smoothness during stair negotiation and to determine if smoothness was associated with the timed "Up and Go" (TUG) test of functional movement. Motion data from nineteen older and twenty young adults performing stair ascent, stair descent, and overground straight walking trials were analyzed and used to compute smoothness based on the log-normalized dimensionless jerk (LDJ) and the velocity spectral arc length (SPARC) metrics. The associations between TUG and smoothness measures were evaluated using Pearson's correlation coefficient (r). Stair tasks increased head and body COM acceleration pattern differences across groups, compared to walking (p < 0.05). LDJ smoothness for the head and body COM decreased in older adults during stair descent, compared to young adults (p ≤ 0.015) and worsened with increasing TUG for all tasks (-0.60 ≤ r ≤ -0.43). SPARC smoothness of the head and body COM increased in older adults, regardless of task (p < 0.001), while correlations showed improved SPARC smoothness with increasing TUG for some tasks (0.33 ≤ r ≤ 0.40). The LDJ outperforms SPARC in identifying age-related stair negotiation adaptations and is associated with performance on a clinical test of gait.

Anesthesia for patients with tracheal bronchus

Tracheal bronchus is a congenital anatomical variant of patients with accessory bronchus in the right upper lobe deriving directly from the supracarinal trachea. Pre-operative consultation with the anesthesiologist is important for patient safety and can avoid adverse effects induced by endotracheal intubation. In this report, we described a case of tracheal bronchus in which general anesthesia was performed for video-assisted thoracoscopic surgery. We discussed some of the issues surrounding to complications in tracheal bronchus.

Continuous ambulatory hand force monitoring during manual materials handling using instrumented force shoes and an inertial motion capture suit

Hand forces (HFs) are commonly measured during biomechanical assessment of manual materials handling; however, it is often a challenge to directly measure HFs in field studies. Therefore, in a previous study we proposed a HF estimation method based on ground reaction forces (GRFs) and body segment accelerations and tested it with laboratory equipment: GFRs were measured with force plates (FPs) and segment accelerations were measured using optical motion capture (OMC). In the current study, we evaluated the HF estimation method based on an ambulatory measurement system, consisting of inertial motion capture (IMC) and instrumented force shoes (FSs). Sixteen participants lifted and carried a 10-kg crate from ground level while 3D full-body kinematics were measured using OMC and IMC, and 3D GRFs were measured using FPs and FSs. We estimated 3D hand force vectors based on: (1) FP+OMC, (2) FP+IMC and (3) FS+IMC. We calculated the root-mean-square differences (RMSDs) between the estimated HFs to reference HFs calculated based on crate kinematics and the GRFs of a FP that the crate was lifted from. Averaged over subjects and across 3D force directions, the HF RMSD ranged between 10-15N when using the laboratory equipment (FP + OMC), 11-18N when using the IMC instead of OMC data (FP+IMC), and 17-21N when using the FSs in combination with IMC (FS + IMC). This error is regarded acceptable for the assessment of spinal loading during manual lifting, as it would results in less than 5% error in peak moment estimates.

A critical period for antidepressant-induced acceleration of neuronal maturation in adult dentate gyrus

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used medications for mood and anxiety disorders, and adult neurogenesis in the dentate gyrus has been shown to be involved in the behavioral effects of SSRIs in mice. Studies have shown the varied effects of chronic treatment with SSRIs on adult neurogenesis. One such effect is the acceleration of neuronal maturation, which affects the functional integration of new neurons into existing neuronal circuitry. In this study, we labeled new neurons by using GFP-expressing retroviral vectors in mice and investigated the effect of an SSRI, fluoxetine, on these neurons at different time points after neuronal birth. Chronic treatment with fluoxetine accelerated the dendritic development of the newborn neurons and shifted the timing of the expression of the maturational marker proteins, doublecortin and calbindin. This accelerated maturation was observed even after sub-chronic treatment, only when fluoxetine was administered during the second week of neuronal birth. These results suggest the existence of a 'critical period' for the fluoxetine-induced maturation of new neurons. We propose that the modified functional integration of new neurons in the critical period may underlie the behavioral effects of fluoxetine by regulating anxiety-related decision-making processes.

[Analysis of the correlation between deep medullary veins and clinical prognosis of middle cerebral artery stroke]

Objective: To investigate the relativity between the distribution of deep medullary vein (DMV) in patients with middle cerebral artery stroke and clinical prognosis by using susceptibility-weighted imaging (SWI). Methods: A total of 144 cases of middle cerebral artery stroke patients and 55 healthy volunteers were retrospectively analyzed from January 2015 to October 2015 in order to investigate the symmetrical characteristic and the classification of DMV, then 30 cases were followed up. Kappa test was used to consider the consistency of judging DMV symmetry and type data by two radiologists. Results:Kappa value in DMV symmetry and DMV type were 0.875 and 0.852. Chi-square test analysis revealed a statistically significant difference of DMV symmetry between healthy control and stroke group(χ(2)=31.046, P=0.000). There was correlation between DMV type and NIHSS score in stroke group (r(s)=0.208, P=0.025). There was no statistically significant difference of DMV distribution in the different periods of stroke group (P=0.110). But there was statistically significant difference of DMV distribution between acute and chronic stroke (P=0.018). Among 30 follow-up cases, 18 cases with asymmetry DMV changed into symmetry after stroke therapy. In 8 cases with symmetry DMV, the diameter of DMV became smaller after treatment. In 4 cases, DMV had no changes. Conclusions: DMV in patients of MCA stroke are mostly asymmetry distribution. DMV classification can be used as an imaging standard to predict the prognosis of stroke patients.

[Preliminary study on assessment of lexiscan-induced blood-brain barrier opening and its level by CT perfusion imaging]

Objective: To evaluate the level of lexiscan-induced blood-brain barrier opening of healthy rabbits via CT perfusion weighted imaging (PWI) scan. Methods: Between November 2014 and May 2015, thirty New Zealand white rabbits were randomly assigned into three groups: the experimental group A1 which received one injection of lexiscan(1 ml/kg); the experimental group A2 which received three times injection of lexiscan(total dose: 1.5 ml/kg), finished within 15 minutes; the control group B which was injected the same volume normal saline(1 ml/kg), after 30 minutes, CT PWI scan was performed. Then cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and permeability surface(PS) of the region of interest of each group were acquired and compared statistically. Five cases of each group were injected with 2% Evans blue intravenously posterior to imaging. After one hour of infusion, all the animals were killed. Their brains were examined for the determination of Evans blue distribution. Results: Both the values of CBF and CBV and the staining with Evans blue of the group A1(CBF: (89.88±2.21), (81.42±4.28) ml·(100 g)^-1·min^-1; CBV: (3.97±0.43), (3.66±0.16) ml/g)and group A2 (CBF: (75.16±0.84), (63.66±7.21) ml·(100 g)^-1·min^-1; CBV: (4.07±0.01), (3.75±0.05) ml/g) were higher than those of the group B(CBF: (20.08±5.08), (14.58±8.62) ml·(100 g)^-1·min^-1; CBV: (0.85±0.04), (0.65±0.17) ml/g), the differences were all statistically significant (all P<0.01). While there was no statistically difference between group A1 and group A2(P>0.05). The value of PS of the group A2((22.43±8.09), (20.20±7.01)ml·(100 g)^-1·min^-1 )was higher than that of group A1((13.82±4.44), (10.12±2.44)ml·(100 g)^-1·min^-1) and group B(0.00, 0.00)(the lowest one), the differences were all statistically significant(all P<0.01). The value of MTT of the group A1((2.50±0.82, 2.47±0.10) s) had no statistical difference with group A2 and group B, while the value of group A2((4.50±0.17), (4.72±0.15) s) was higher than that of group B((1.88±0.09), (1.99±0.00) s), the differences were all statistically significant (P<0.05). Conclusion: Changes in hemodynamics of lexiscan-induced blood-brain barrier opening can be monitored by CT PWI scan. When the total dose of lexiscan increasing, the level of the BBB opening is higher with significantly increased CBF, CBV, PS and MTT.

Risk of infective endocarditis in patients with systemic lupus erythematosus in Taiwan: a nationwide population-based study

Objectives Patients with systemic lupus erythematosus are considered vulnerable to infective endocarditis and prophylactic antibiotics are recommended before an invasive dental procedure. However, the evidence is insufficient. This nationwide population-based study evaluated the risk and related factors of infective endocarditis in systemic lupus erythematosus. Methods We identified 12,102 systemic lupus erythematosus patients from the National Health Insurance research-oriented database, and compared the incidence rate of infective endocarditis with that among 48,408 non-systemic lupus erythematosus controls. A Cox multivariable proportional hazards model was employed to evaluate the risk of infective endocarditis in the systemic lupus erythematosus cohort. Results After a mean follow-up of more than six years, the systemic lupus erythematosus cohort had a significantly higher incidence rate of infective endocarditis (42.58 vs 4.32 per 100,000 person-years, incidence rate ratio = 9.86, p < 0.001) than that of the control cohort. By contrast, the older systemic lupus erythematosus cohort had lower risk (adjusted hazard ratio 11.64) than that of the younger-than-60-years systemic lupus erythematosus cohort (adjusted hazard ratio 15.82). Cox multivariate proportional hazards analysis revealed heart disease (hazard ratio = 5.71, p < 0.001), chronic kidney disease (hazard ratio = 2.98, p = 0.034), receiving a dental procedure within 30 days (hazard ratio = 36.80, p < 0.001), and intravenous steroid therapy within 30 days (hazard ratio = 39.59, p < 0.001) were independent risk factors for infective endocarditis in systemic lupus erythematosus patients. Conclusions A higher risk of infective endocarditis was observed in systemic lupus erythematosus patients. Risk factors for infective endocarditis in the systemic lupus erythematosus cohort included heart disease, chronic kidney disease, steroid pulse therapy within 30 days, and a recent invasive dental procedure within 30 days.

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.

Evaluation of New Biphasic Calcium Phosphate Bone Substitute: Rabbit Femur Defect Model and Preliminary Clinical Results

Autogenous bone grafting, used to repair bone defects, is limited and the donor site can experience complications. Compared to autogenous bone graft, artificial bones have different porosity, which might make them suitable alternatives to bone grafts. Here, two porous biphasic calcium phosphate bone substitutes, namely Bicera™ and Triosite™, are used in an animal study and clinical practice to find a suitable porosity for implantation. Bicera™ and Triosite™ consist of 60 wt% hydroxyapatite and 40 wt% β-tricalcium phosphate, with the porosity of Bicera™ (82%) being higher than that of Triosite™ (70%). In the animal study, the implantation procedure was carried out on twenty-four female New Zealand rabbits. 12 weeks after implantation, the new bones were well infiltrated into the Bicera™ and Triosite™ bone grafts. In the clinical study, patients with comminuted fracture, fracture nonunion, or arthrodesis were included in the study of bone substitution with Bicera™. 27 patients underwent fracture fixation treatment. Bone healing of 22.22% (6/27) of patients happened within 3 months after the surgery, and that of 66.67% (18/27) of patients happened within 6 months. These results reveal that Bicera™ has good incorporation with host bone, and that new bone is able to grow within the porous structure, giving it high potential in the treatment of bone defects.

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.

Characterization of tissue scaffolds for time-dependent biotransport criteria - a novel computational procedure

This study aims to establish a new computational framework that allows modeling transient oxygen diffusion in tissue scaffolds more efficiently. It has been well known that the survival of cells strongly relies on continuous oxygen/nutrient supply and metabolite removal. With optimal design in scaffold architecture, its ability to sustain long distance oxygen supply could be improved considerably. In this study, finite element based homogenization procedure is first used to characterize the initial effective biotransport properties in silico. These initial properties are proper indicators to prediction of the on-going performance of tissue scaffolds over time. The transient model by adopting an edge-based smoothed finite element method with combination of mass-redistributed method is then established to more efficiently simulate the transient oxygen transfer process in tissue scaffolds. The proposed new method allows large time steps to model the oxygen diffusion process without losing numerical accuracy, thereby enhancing the computational efficiency significantly, in particular for the design optimization problems which typically require numerous analysis iterations. A number of different scaffold designs are examined either under net diffusion without cell seeding, or under cellular oxygen/nutrient uptake with or without considering cell viability. The association between the homogenized effective diffusivity of net scaffold microstructures and corresponding transient diffusion and time-dependent cellular activities is divulged. This study provides some insights into scaffold design.

Estimating 3D L5/S1 moments and ground reaction forces during trunk bending using a full-body ambulatory inertial motion capture system

Inertial motion capture (IMC) systems have become increasingly popular for ambulatory movement analysis. However, few studies have attempted to use these measurement techniques to estimate kinetic variables, such as joint moments and ground reaction forces (GRFs). Therefore, we investigated the performance of a full-body ambulatory IMC system in estimating 3D L5/S1 moments and GRFs during symmetric, asymmetric and fast trunk bending, performed by nine male participants. Using an ambulatory IMC system (Xsens/MVN), L5/S1 moments were estimated based on the upper-body segment kinematics using a top-down inverse dynamics analysis, and GRFs were estimated based on full-body segment accelerations. As a reference, a laboratory measurement system was utilized: GRFs were measured with Kistler force plates (FPs), and L5/S1 moments were calculated using a bottom-up inverse dynamics model based on FP data and lower-body kinematics measured with an optical motion capture system (OMC). Correspondence between the OMC+FP and IMC systems was quantified by calculating root-mean-square errors (RMSerrors) of moment/force time series and the interclass correlation (ICC) of the absolute peak moments/forces. Averaged over subjects, L5/S1 moment RMSerrors remained below 10Nm (about 5% of the peak extension moment) and 3D GRF RMSerrors remained below 20N (about 2% of the peak vertical force). ICCs were high for the peak L5/S1 extension moment (0.971) and vertical GRF (0.998). Due to lower amplitudes, smaller ICCs were found for the peak asymmetric L5/S1 moments (0.690-0.781) and horizontal GRFs (0.559-0.948). In conclusion, close correspondence was found between the ambulatory IMC-based and laboratory-based estimates of back load.

Pulmonary Cryptococcosis

Inhalation of Cryptococcus into the respiratory system is the main route of acquisition of human infection, yet pulmonary cryptococcosis goes mostly unrecognized by many clinicians. This delay in diagnosis, or misdiagnosis, of lung infections is due in part to frequently subtle clinical manifestations such as a subacute or chronic cough, a broad differential of diagnostic possibilities for associated pulmonary masses (cryptococcomas) and, on occasion, negative respiratory tract cultures. Hematogenous dissemination from the lung can result in protean manifestations, the most severe of which is meningoencephalitis. There are few clinical studies of pulmonary cryptococcosis and its pathogenesis is poorly understood. The main purpose of this review is to describe the epidemiology, clinical presentation, diagnosis, and treatment of pulmonary cryptococcosis to increase clinician's awareness of this diagnostic possibility and to enhance clinical management. Useful pointers to the approach and management of pulmonary cryptococcosis and the implications of disseminated disease are included, together with recommendations for future research.

Introduction to the updated Australian and New Zealand consensus guidelines for the use of antifungal agents in the haematology/oncology setting, 2014

This article introduces the second revision of the Australian and New Zealand consensus guidelines for the use of antifungal agents in the haematology/oncology setting. The current update occurs within the context of a growing population at risk of invasive fungal disease, improved understanding of risk factors, availability of new diagnostic tests, a much-expanded evidence base and changing clinical paradigms. Here, we provide an overview of the history and purpose of the guidelines, including changes in scope since the last clinical update was published in 2008. The process for development, and for enabling review of draft recommendations by end-users and other relevant stakeholders, is described. The approach to assigning levels of evidence and grades of recommendation is also provided, along with a comparison to international grading systems.

Consensus guidelines for the treatment of yeast infections in the haematology, oncology and intensive care setting, 2014

Pathogenic yeast forms are commonly associated with invasive fungal disease in the immunocompromised host, including patients with haematological malignancies and patients of haemopoietic stem cell transplants. Yeasts include the Candida spp., Cryptococcus spp., Pneumocystis jirovecii and some lesser-known pathogens. Candida species remain the most common cause of invasive yeast infections (and the most common human pathogenic fungi). These guidelines present evidence-based recommendations for the antifungal management of established, invasive yeast infections in adult and paediatric patients in the haematology/oncology setting. Consideration is also given to the critically ill patient in intensive care units, including the neonatal intensive care unit. Evidence for 'pre-emptive' or 'diagnostic-driven antifungal therapy' is also discussed. For the purposes of this paper, invasive yeast diseases are categorised under the headings of invasive candidiasis, cryptococcosis and uncommon yeast infections. Specific recommendations for the management of Pneumocystis jirovecii are presented in an accompanying article (see consensus guidelines by Cooley et al. appearing elsewhere in this supplement).

Consensus guidelines for implementation of quality processes to prevent invasive fungal disease and enhanced surveillance measures during hospital building works, 2014

Healthcare-associated fungal outbreaks impose a substantial economic burden on the health system and typically result in high patient morbidity and mortality, particularly in the immunocompromised host. As the population at risk of invasive fungal infection continues to grow due to the increased burden of cancer and related factors, the need for hospitals to employ preventative measures has become increasingly important. These guidelines outline the standard quality processes hospitals need to accommodate into everyday practice and at times of healthcare-associated outbreak, including the role of antifungal stewardship programmes and best practice environmental sampling. Specific recommendations are also provided to help guide the planning and implementation of quality processes and enhanced surveillance before, during and after high-risk activities, such as hospital building works. Areas in which information is still lacking and further research is required are also highlighted.

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.

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.

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%.

Assessment of autonomic nervous system by using empirical mode decomposition-based reflection wave analysis during non-stationary conditions

Arterial blood pressure (ABP) is an important indicator of cardiovascular circulation and presents various intrinsic regulations. It has been found that the intrinsic characteristics of blood vessels can be assessed quantitatively by ABP analysis (called reflection wave analysis (RWA)), but conventional RWA is insufficient for assessment during non-stationary conditions, such as the Valsalva maneuver. Recently, a novel adaptive method called empirical mode decomposition (EMD) was proposed for non-stationary data analysis. This study proposed a RWA algorithm based on EMD (EMD-RWA). A total of 51 subjects participated in this study, including 39 healthy subjects and 12 patients with autonomic nervous system (ANS) dysfunction. The results showed that EMD-RWA provided a reliable estimation of reflection time in baseline and head-up tilt (HUT). Moreover, the estimated reflection time is able to assess the ANS function non-invasively, both in normal, healthy subjects and in the patients with ANS dysfunction. EMD-RWA provides a new approach for reflection time estimation in non-stationary conditions, and also helps with non-invasive ANS assessment.

Separated response function ratios in exclusive, forward π(±) electroproduction

The study of exclusive π(±) electroproduction on the nucleon, including separation of the various structure functions, is of interest for a number of reasons. The ratio RL=σL(π-)/σL(π+) is sensitive to isoscalar contamination to the dominant isovector pion exchange amplitude, which is the basis for the determination of the charged pion form factor from electroproduction data. A change in the value of RT=σT(π-)/σT(π+) from unity at small -t, to 1/4 at large -t, would suggest a transition from coupling to a (virtual) pion to coupling to individual quarks. Furthermore, the mentioned ratios may show an earlier approach to perturbative QCD than the individual cross sections. We have performed the first complete separation of the four unpolarized electromagnetic structure functions above the dominant resonances in forward, exclusive π(±) electroproduction on the deuteron at central Q(2) values of 0.6, 1.0, 1.6  GeV(2) at W=1.95  GeV, and Q(2)=2.45  GeV(2) at W=2.22  GeV. Here, we present the L and T cross sections, with emphasis on RL and RT, and compare them with theoretical calculations. Results for the separated ratio RL indicate dominance of the pion-pole diagram at low -t, while results for RT are consistent with a transition between pion knockout and quark knockout mechanisms.

Postoperative adverse outcomes after non-hepatic surgery in patients with liver cirrhosis

BACKGROUND

Postoperative adverse outcomes in patients with liver cirrhosis are not completely understood. This study evaluated the association between liver cirrhosis and adverse outcomes after non-hepatic surgery.

METHODS

Reimbursement claims were used to identify patients with preoperative liver cirrhosis who underwent non-hepatic surgery from 2004 to 2007. Control patients without cirrhosis were matched by age, sex, type of surgery and anaesthesia. The adjusted odds ratios (ORs) and 95 per cent confidence intervals (c.i.) of postoperative adverse events associated with liver cirrhosis were analysed by multivariable logistic regression.

RESULTS

Thirty-day mortality rates among 24 282 patients with cirrhosis and 97 128 control patients were 1·2 per cent (299 deaths) and 0·7 per cent (635 deaths) respectively. Liver cirrhosis was associated with postoperative 30-day mortality (OR 1·88, 95 per cent c.i. 1·63 to 2·16), acute renal failure (OR 1·52, 1·34 to 1·74), septicaemia (OR 1·42, 1·33 to 1·51) and intensive care unit admission (OR 1·39, 1·33 to 1·45). Postoperative mortality increased in patients who had liver cirrhosis with viral hepatitis (OR 2·87, 1·55 to 5·30), alcohol dependence syndrome (OR 3·74, 2·64 to 5·31), jaundice (OR 5·47, 3·77 to 7·93), ascites (OR 5·85, 4·62 to 7·41), gastrointestinal haemorrhage (OR 3·01, 2·33 to 3·90) and hepatic coma (OR 5·11, 3·79 to 6·87).

CONCLUSION

Patients with liver cirrhosis had increased mortality and complications after non-hepatic surgery, particularly those with cirrhosis-related clinical indicators.

PPARα-mediated responses in human adult liver stem cells: In vivo/in vitro and cross-species comparisons

The peroxisome proliferator-activated receptor α (PPARα) is a ligand-activated transcription factor that regulates a variety of biological processes including lipid metabolism and energy homeostasis. Peroxisome proliferators (PPs) are carcinogens in rodents, while humans are resistant to peroxisome proliferation and carcinogenesis. In this study, we examined the differential gene expression elicited by clofibrate (CLO) and WY-14,643 (WY) in C57BL/6 mouse liver compared to responses in human HepG2 hepatoma and HL1-1 adult stem cells. Mice were gavaged with sesame oil, 300mg/kg CLO or WY for 2, 4, 8, 12, 18 or 24h, or daily for 4 or 14 days. Although no significant changes in body weight gain were observed, WY induced relative liver weight at 4 and 14 days. Genome-wide hepatic gene expression analysis identified 719 and 1443 differentially expressed unique genes elicited by CLO and WY, respectively (|fold change|>1.5, P1(t)>0.99). Functional analysis associated the gene expression changes with lipid metabolism, transport, cell cycle and immune response. Most differentially expressed genes were in common to both treatments and clustered together only at early time points (2-8h). Complementary QRT-PCR studies in human HL1-1 and HepG2 cells treated with 50μM WY or DMSO for 1, 2, 4, 8, 12, 24 or 48h identified a minimal number of conserved orthologous responses (e.g., Pdk4, Adfp and Angptl4) while some genes (i.e., Bmf, a tumor suppressor) exhibited induction in human cells but repression in mice. These data suggest that PPs elicit species-specific PPARα-mediated gene expression.

A novel baculovirus vector shows efficient gene delivery of modified porcine reproductive and respiratory syndrome virus antigens and elicits specific immune response

Porcine reproductive and respiratory syndrome (PRRS) is an economically devastating epizootic of porcine species. Current vaccines are inadequate to control the disease burden and outbreaks in the field. We report a novel baculovirus vaccine vector with White spot syndrome virus immediate early 1 shuttle promoter, with strong activity in both insect cells and mammalian cells, for immunization against PRRSV. The insect cell cultured baculovirus vector produces PRRSV envelope glycoproteins ORF2a, ORF3, ORF4 and ORF5, which are similar to the antigens in the infectious PRRS virion, and these antigens are stably incorporated on the surface of the baculovirus. Further, the baculovirus vector efficiently transduces these antigens in cells of porcine origin, thereby simulating a live infection. The baculovirus vectored PRRSV antigens, upon inoculation in mice, elicits robust neutralizing antibodies against the infective PRRS virus. Further, the experiments indicate that hitherto under emphasized ORF2a and ORF4 are important target antigens for neutralizing PRRSV infectivity.

Adverse postoperative outcomes in surgical patients with immune thrombocytopenia

Background

Patients with immune thrombocytopenia (ITP) are likely to have various medical co-morbidities, yet their global features regarding adverse postoperative outcomes and use of medical resources when undergoing major surgery are unknown. The objective of this study was to validate whether ITP is an independent risk factor for adverse postoperative outcomes, and to explore the potential clinical predictors of outcomes after major surgery among patients with ITP.

Methods

A retrospective population-based cohort study was conducted using Taiwan's National Health Insurance Research Database, controlling for preoperative co-morbidities by means of multiple logistic regression. Major postoperative complication and mortality rates, and in-hospital medical costs were analysed.

Results

The study included 11 085 surgical patients with ITP and 44 340 controls without ITP matched for sex, age, and type of surgery and anaesthesia. Surgical patients with ITP had a higher risk of postoperative death (odds ratio (OR) 1·89, 95 per cent confidence interval 1·57 to 2·27), and overall postoperative complications (OR 1·47, 1·39 to 1·56), and increased hospital stay (OR 1·90, 1·80 to 2·01), admission to the intensive care unit (OR 1·73, 1·63 to 1·83) and medical costs (OR 1·89, 1·79 to 1·99). Amount of preoperative platelet and/or red blood cell transfusion, emergency visits and admission to hospital for ITP care were identified as risk factors for adverse postoperative outcomes.

Conclusion

Patients with ITP undergoing surgery are at increased risk of adverse perioperative events, particularly if blood or blood product transfusion are required preoperatively, or the procedure is done as an emergency.

The structure of acyl coenzyme A-cholesterol acyltransferase and its potential relevance to atherosclerosis

Acyl coenzyme A-cholesterol acyltransferase (ACAT) catalyzes the formation of intracellular cholesterol esters. It is present in a variety of tissues and is believed to play significant roles in cholesterol homeostasis. Under pathologic conditions, accumulation of the ACAT reaction product as cytoplasmic cholesterol ester lipid droplets within macrophages and smooth muscle cells is a characteristic feature of early lesions of human atherosclerotic plaques. ACAT is a membrane protein located in the endoplasmic reticulum. Its activity is susceptible to inactivation by detergents, and it has never been purified to homogeneity; no antibodies directed against it have been reported. Through a somatic cell and molecular genetic approach, we have recently succeeded in molecular cloning and functional expression of a human macrophage ACAT cDNA. This cDNA contains an open reading frame of 1650 base pairs encoding an integral membrane protein of 550 amino acids. Protein homology analysis shows that the predicted protein sequence shares short regions of homology with other enzymes involved in the catalysis of acyl adenylate formation with subsequent acyl thioester formation and acyl transfer. The ACAT cDNA will enable the investigation of ACAT biochemistry and molecular biology. It will speed up the design of specific ACAT inhibitors as drugs that may provide more effective therapeutic treatment or prevention of atherosclerosis. In addition, studies on the physiologic roles of ACAT in various tissues can now be undertaken through transgenic animal research.

A novel approach for normalizing the photoreflectance spectrum by using polymer-dispersed liquid crystal

This study developed a novel type of normalization procedure for modulation reflectance spectroscopy experiments to obtain the relative change in the reflectance spectrum, ΔR/R. This technique uses a polymer-dispersed liquid crystal to ensure that the dc component of the signal from the detector remained constant by varying the intensity of the light striking the sample. This method is particularly useful for photoreflectance measurement, which may encounter background problems because of scattered pump light and/or photoluminescence. It does not require a change in the gain of the detector or the use of a variable neutral density filter mounted on a servo-motor.

Comorbidities associated with psoriasis - data from the malaysian psoriasis registry

All around the world, there is growing evidence of the association between psoriasis and comorbidities which increase the risk of cardiovascular disease. This study aims to determine the prevalence of various comorbidities among adult psoriasis patients in Malaysia. A cross-sectional study was conducted among patients in the Malaysian Psoriasis Registry from January 2007 to December 2008. A total of 2,267 adult patients with psoriasis from 13 dermatology centers were included. Prevalence of various comorbidities were: hypertension 25.9%, diabetes mellitus 17.7 %, dyslipidaemia 17.8%, overweight 33.2%, obesity 20.7%, ischaemic heart disease 5.8% and cerebrovascular disease 1.4%. These comorbidities were more prevalent in patients with psoriasis of late-onset and longer duration. Active screening of these comorbidities in all adult psoriasis patients is recommended.

Routine drainage is not necessary after laparoscopic gastric bypass

INTRODUCTION

Routine intra-abdominal drainage has been recommended for detecting surgical complications, such as anastomotic leaks or intra-abdominal hemorrhage, after laparoscopic gastric bypass for morbid obesity. The aim of this study was to determine whether routine drainage after laparoscopic gastric bypass is indeed necessary.

METHODS

Patients undergoing laparoscopic gastric bypass with intra-abdominal drainage (D-group) were compared with those without drainage (N-group) in a retrospective study. The main outcome measures were postoperative course and complications.

RESULTS

No differences were observed in the postoperative complications. Both groups had one major complication of leakage (1/90, 1.1%). Minor complications occurred in six D-group patients (6/90, 6.7%) and eight N-group patients (8/90, 8.9%) (P=0.578). No difference was observed in postoperative analgesic dose usage (mean ± SD: 63 ± 37 mg vs 60 ± 31 mg; P=0.963) or length of stay hospital (5.2 ± 2.6 d vs 4.7 ± 1.8 d; P=0.135). However, the N-group had a shorter time to flatus passage compared to the D-group (1.6 ± 0.7 d vs 1.2 ± 0.5 d; P=0.006).

CONCLUSION

Routine abdominal drainage is not necessary after a successful laparoscopic gastric bypass for morbidly obese patients. Drainage omission may contribute to a quicker recovery without additional surgical complications.

Leucinopine, a characteristic compound of some crown-gall tumors

An unusual compound has been found in crowngall tumors induced by those Agrobacterium tumefaciens strains that utilize neither octopine nor nopaline. The compound has been isolated and shown by proton and carbon-13 NMR spectroscopy and by synthesis to be N(2)-(1,3-dicarboxypropyl)-L-leucine, which also exists in a cyclized (i.e., lactam) form. This compound, which we name "leucinopine," was not detected in octopine tumors, nopaline tumors, or the tumors induced by A. tumefaciens strains 181 and EU6.

Ornitholimnology: Effects of grazing by the Andean flamingo (Phoenicoparrus andinus)

Experimental exclusion of the Andean flamingo (Phoenicoparrus andinus) from shallow water areas of a salt lake in the Bolivian Andes caused large increases in the biomass of microorganisms inhabiting the surface sediments, especially a large diatom (Surirella wetzeli), amebas, ciliates, and nematodes. This is a conservative demonstration of the influences that water birds in general exert on the structure of aquatic ecosystems.

The analysis of decomposition methods for support vector machines

The support vector machine (SVM) is a new and promising technique for pattern recognition. It requires the solution of a large dense quadratic programming problem. Traditional optimization methods cannot be directly applied due to memory restrictions. Up to now, very few methods can handle the memory problem and an important one is the "decomposition method." However, there is no convergence proof so far. In this paper, we connect this method to projected gradient methods and provide theoretical proofs for a version of decomposition methods. An extension to bound-constrained formulation of SVM is also provided.We then show that this convergence proof is valid for general decomposition methods if their working set selection meets a simple requirement.

Synergistic growth inhibition of anaplastic large cell lymphoma cells by combining cellular ALK gene silencing and a low dose of the kinase inhibitor U0126

Abnormal expression of anaplastic lymphoma kinase (ALK) gene is an important pathogenic factor for anaplastic large cell lymphoma (ALCL). To study the function of ALK, an inducible short hairpin RNA (shRNA) system was stably introduced into cultured human ALCL cells. Inducing shRNA expression in the generated cells resulted in cellular ALK gene silencing and led to inactivation of multiple signaling pathways and growth arrest. Interestingly, a combination of ALK gene silencing with U0126, a kinase inhibitor specific for the extracellular signal-regulated kinases 1/2 pathway, resulted in an augmented reduction in cellular JunB expression. Functional studies indicated that combining ALK gene silencing with U0126 treatment provided a synergistic growth inhibition, which occurred faster and was more profound than with either treatment alone. This synergistic effect was also observed when measuring cell proliferation, apoptosis, and in vitro cell colony formation. Importantly, the combination of ALK gene silencing and U0126 had a prolonged inhibitory effect, preventing recovery of ALCL cell growth even after treatments were removed. Moreover, this synergistic inhibitory effect was confirmed in vivo using a mouse model with xenografted ALCL tumors. Our findings indicate that combining cellular ALK gene silencing with a low dose of U0126 may prove to be an effective and more specific therapeutic approach to treating ALCL.

N-3 vs. saturated fatty acids: effects on the arterial wall

Cardiovascular disease is a leading cause of death worldwide. Atherosclerosis and unstable plaques are underlying causes for cardiovascular diseases. Cardiovascular disease is associated with consumption of diets high in saturated fats. In contrast there is increasing evidence that higher intakes of dietary n-3 fatty acids decrease risk for cardiovascular disease. Recent studies are beginning to clarify how n-3 compared with saturated fatty acids influence cardiovascular disease risk via pathways in the arterial wall. In this paper we will review studies that report on mechanisms whereby dietary fatty acids affect atherosclerosis through modulation of arterial wall lipid deposition, inflammation, cell proliferation, and plaque vulnerability.