Improvement of morning headache in adults with obstructive sleep apnea after positive airway pressure therapy

The aim of this study was to evaluate the association between obstructive sleep apnea and morning headache and to assess the improvement of morning headache following positive airway pressure therapy. One hundred and sixteen participants were enrolled in this study; all of them received positive airway pressure therapy for at least 3 months. We checked the differences in various sleep apnea-related parameters according to the presence of morning headache and evaluated the improvement of morning headache following positive airway pressure therapy. Among the 116 study participants, 103 were men, with a mean age and body mass index of 50.34 ± 10.23 years and 28.00 ± 4.21 kg/m2, respectively. The severity of morning headache was higher in the severe obstructive sleep apnea group than in the mild to moderate group (2.16 ± 1.70 vs. 1.50 ± 1.57, P = 0.027). However, the various polysomnographic parameters did not significantly differ according to the presence of headache. The Epworth sleepiness scale score was significantly higher in the morning headache presence group than in the absence group (10.90 ± 5.45 vs. 8.13 ± 4.27, P = 0.003). Furthermore, a notable correlation was observed between the reduction in daytime sleepiness and the improvement in morning headache following PAP treatment (r = 0.503, P < 0.001). Morning headache significantly improved following positive airway pressure therapy (prevalence: 53.4-16.4%; severity: 1.92 ± 1.67 vs. 0.86 ± 0.80, all P < 0.001), especially in the patients with morning headache before positive airway pressure therapy. Morning headache is significantly associated with daytime sleepiness and positive airway pressure therapy improves morning headache.

Reliability and validity of PRO-CTCAE® daily reporting with a 24-hour recall period

PURPOSE

The standard recall period for the patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE®) is the past 7 days, but there are contexts where a 24-hour recall may be desirable. The purpose of this analysis was to investigate the reliability and validity of a subset of PRO-CTCAE items captured using a 24-hour recall.

METHODS

27 PRO-CTCAE items representing 14 symptomatic adverse events (AEs) were collected using both a 24-hour recall (24 h) and the standard 7 day recall (7d) in a sample of patients receiving active cancer treatment (n = 113). Using data captured with a PRO-CTCAE-24h on days 6 and 7, and 20 and 21, we computed intra-class correlation coefficients (ICC); an ICC ≥ 0.70 was interpreted as demonstrating high test-retest reliability. Correlations between PRO-CTCAE-24h items on day 7 and conceptually relevant EORTC QLQ-C30 domains were examined. In responsiveness analysis, patients were deemed changed if they had a one-point or greater change in the corresponding PRO-CTCAE-7d item (from week 0 to week 1).

RESULTS

PRO-CTCAE-24h captured on two consecutive days demonstrated that 21 of 27 items (78%) had ICCs ≥ 0.70 (day 6/7 median ICC 0.76), (day 20/21 median ICC 0.84). Median correlation between attributes within a common AE was 0.75, and the median correlation between conceptually relevant EORTC QLQ-C30 domains and PRO-CTCAE-24 h items captured on day 7 was 0.44. In the analysis of responsiveness to change, the median standardized response mean (SRM) for patients with improvement was - 0.52 and that for patients with worsening was 0.71.

CONCLUSION

A 24-hour recall period for PRO-CTCAE items has acceptable measurement properties and can inform day-to-day variations in symptomatic AEs when daily PRO-CTCAE administration is implemented in a clinical trial.

Management of symptomatic cervical facet cyst with cervical interlaminar epidural block: A case report

BACKGROUND

Symptomatic cervical facet cysts are relatively rare compared to those in the lumbar region. These cysts are usually located in the 7^th cervical and 1^st thoracic vertebral (C7/T1) area, and surgical excision is performed in most cases. However, facet cysts are associated with degenerative conditions, and elderly patients are often ineligible for surgical procedures. Cervical interlaminar epidural block has been used in patients with cervical radiating symptoms and achieved good results. Therefore, cervical interlaminar epidural block may be the first-choice treatment for symptomatic cervical facet cysts.

CASE SUMMARY

A 70-year-old man complained of a tingling sensation in the left hand, focused on the 4^th and 5^th fingers, for 1 year, and posterior neck pain for over 5 mo. The patient’s numeric rating scale (NRS) score was 5/10. The patient was diagnosed with symptomatic cervical facet cyst at the left C7/T1 facet joint. Fluoroscopy-guided cervical interlaminar epidural block at the C7/T1 level with 20 mg triamcinolone and 5 mL of 0.5% lidocaine was administered. The patient's symptoms improved immediately after the block, with an NRS score of 3 points. After 3 mo, his left posterior neck pain and tingling along the left 8^th cervical dermatome were relieved, with an NRS score of 2.

CONCLUSION

A cervical interlaminar epidural block is a good alternative for managing symptomatic cervical facet cysts.

Facemask ventilation and vocal cord angle following neuromuscular blockade: a prospective observational study. Anaesthesia 2022;77:1010-1017. [PMID: 35727620 DOI: 10.1111/anae.15786]

Numerous studies support the idea that neuromuscular blockade facilitates facemask ventilation after induction of anaesthesia. Although improved airway patency or pulmonary compliance and a resolution of laryngospasm have been suggested as possible causes, the exact mechanism remains unclear. We aimed to assess whether neuromuscular blockade improves facemask ventilation and to clarify whether this phenomenon is associated with the vocal cord angle. This prospective observational study included patients aged between 20 and 65 years scheduled for elective surgery under general anaesthesia. After induction of anaesthesia, patients' lungs were ventilated with pressure-controlled ventilation using a facemask. During facemask ventilation, a flexible bronchoscope was inserted through a self-sealing diaphragm at the elbow connector attached to the facemask and breathing circuit and positioned to allow a continuous view of the vocal cords. The mean tidal volume and vocal cord angle were measured before and after administration of neuromuscular blocking drugs. Of 108 patients, 100 completed the study. Mean (SD) tidal volume ((11.0 (3.9) ml.kg^-1 vs. 13.6 (2.6) ml.kg^-1 ; p < 0.001) and mean (SD) vocal cord angle (17° (10°) vs. 26° (5°); p < 0.001) increased significantly after neuromuscular blockade. The proportional increase in mean tidal volume after neuromuscular blockade was positively correlated with vocal cord angle (Spearman's ρ = 0.803; p < 0.001). In conclusion, neuromuscular blockade facilitated facemask ventilation, and the improvement was correlated with further opening of the vocal cords.

Effect of intravascular dexamethasone injection after powered intracapsular tonsillectomy and adenoidectomy in children

PURPOSE

To compare postoperative pain, nausea and vomiting, and bleeding between intravascular dexamethasone injection group and control group among children undergoing powered intracapsular tonsillectomy and adenoidectomy (PITA).

MATERIALS AND METHODS

Retrospective review of medical records was performed for pediatric patients who underwent PITA from March 1, 2017, to February 28, 2021, at a tertiary referral medical center in South Korea. Postoperative pain and nausea were measured using the visual analogue scale (VAS) from the postoperative day (POD) 0 to POD 6. The number of analgesics administered and the number of vomiting episodes were recorded in the same period. The repeatedly measured parameters were statistically analyzed between the dexamethasone group and control group.

RESULTS

A total of 71 children with complete questionnaires including 44 boys and 27 girls were included, and the mean age was 7.49 ± 2.44 years. There were 33 patients in the dexamethasone group and 38 in the control group. Postoperative pain (p = 0.169) or nausea (p = 0.460) on the VAS showed no statistically significant difference between the two groups. Postoperative analgesics showed no difference between the groups (p = 0.398), and neither did postoperative vomiting (p = 0.270). In both groups, no child showed signs of postoperative bleeding.

CONCLUSIONS

This study indicates that the beneficial effects of intravascular dexamethasone administration in PITA may not be evident. This might be due to the superior outcome of the PITA technique compared to total extracapsular tonsillectomy. Therefore, otolaryngologists performing PITA may not necessarily need to administer dexamethasone in children before surgery.

Risk factors for the delayed diagnosis of extrapulmonary TB

BACKGROUND: Extrapulmonary TB (EPTB) is more difficult to diagnose than pulmonary TB. The delayed management of EPTB can lead to complications and increase the socio-economic burden.METHODS: Patients newly diagnosed with EPTB were retrospectively enrolled from 11 general hospitals in South Korea from January 2017 to December 2018. The basic characteristics of patients were described. Univariable and multivariable analyses were performed between early and delayed diagnosis groups to identify risk factors for delayed diagnosis and treatment in EPTB.RESULTS: In total, 594 patients were enrolled. Lymph node TB (28.3%) was the predominant form, followed by abdominal (18.4%) and disseminated TB (14.5%). Concurrent lung involvement was 17.8%. The positivity of diagnostic tests showed no significant difference between the two groups. Acute clinical manifestations in disseminated, pericardial and meningeal TB, and immunosuppression were associated with early diagnosis. Delayed diagnosis was associated with outpatient clinic visits, delayed sample acquisition and diagnostic departments other than infection or pulmonology.CONCLUSION: The delay in diagnosis and treatment of EPTB was not related to differences in microbiological characteristics of Mycobacterium tuberculosis itself; rather, it was due to the indolent clinical manifestations that cause referral to non-TB-specialised departments in the outpatient clinic and delay the suspicion of TB and diagnostic testing.

Association between the severity of hearing loss and the risk of dementia within the 2010-2017 national insurance service survey in South Korea

Hearing loss and dementia are highly prevalent neurologic conditions in older adults that can considerably impact the quality of life and create social and familial burdens. To investigate the impact of hearing loss on the risk of developing dementia in a nationwide long-term follow-up study using data obtained from the South Korean National Health Information Database. Retrospective medical data for patients of all ages were extracted from the database between January 2010 and December 2017. According to the national disability registry, the degree of severe-profound hearing loss is classified into six grades. We categorized hearing loss into three groups based on the disability registry severity: (1) severe hearing disability (HD), defined as 1st to 3rd grade disabling hearing loss; (2) non-severe HD, 4th and 5th grade disabling hearing loss; and (3) ipsilateral HD, 6th grade disabling hearing loss. After adjusting for potential confounding variables, the hazard ratio (HR) for all dementia types was 1.336 (95% CI 1.306–1.367) in the severe HD group, 1.312 (95% CI 1.286–1.338) in the non-severe HD group, and 1.257 (95% CI 1.217–1.299) in the ipsilateral HD group. On assessing by the age group, the risk of all dementia types in patients younger than 65 years was as follows: HR 1.933 (95% CI 1.779–2.101), 1.880 (95% CI 1.732–2.041), and 1.601 (95% CI 1.435–1.787) in the severe, non-severe, and ipsilateral HD groups, respectively. This study demonstrates that the impact of hearing loss on dementia incidence is severity-dependent, and the risk increases in patients younger than 65 years of age.

Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation

Background

Appropriate blood component transfusion might differ between intraoperative massive bleeding and traumatic massive bleeding in the emergency department because trauma patients initially bleed undiluted blood and replacement typically lags behind blood loss. We compared these two blood loss scenarios, intraoperative and traumatic, using a computer simulation.

Methods

We modified the multi-compartment dynamic model developed by Hirshberg and implemented it using STELLA 9.0. In this model, blood pressure changes as blood volume fluctuates as bleeding rate and transcapillary refill rate are controlled by blood pressure. Using this simulation, we compared the intraoperative bleeding scenario with the traumatic bleeding scenario. In both scenarios, patients started to bleed at a rate of 50 ml/min. In the intraoperative bleeding scenario, fluid was administered to maintain isovolemic status; however, in the traumatic bleeding scenario, no fluid was supplied for up to 30 min and no blood was supplied for up to 50 min. Each unit of packed red blood cells (PRBC) was given when the hematocrit decreased to 27%, fresh frozen plasma (FFP) was transfused when plasma was diluted to 30%, and platelet concentrate (PC) was transfused when platelet count became 50,000/ml.

Results

In both scenarios, the appropriate ratio of PRBC:FFP was 1:0.47 before PC transfusion, and the ratio of PRBC:FFP:platelets was 1:0.35:0.39 after initiation of PC transfusion.

Conclusion

The ratio of transfused blood component did not differ between the intraoperative bleeding and traumatic bleeding scenarios.

Visual Scene-Aware Hybrid and Multi-Modal Feature Aggregation for Facial Expression Recognition

Facial expression recognition (FER) technology has made considerable progress with the rapid development of deep learning. However, conventional FER techniques are mainly designed and trained for videos that are artificially acquired in a limited environment, so they may not operate robustly on videos acquired in a wild environment suffering from varying illuminations and head poses. In order to solve this problem and improve the ultimate performance of FER, this paper proposes a new architecture that extends a state-of-the-art FER scheme and a multi-modal neural network that can effectively fuse image and landmark information. To this end, we propose three methods. To maximize the performance of the recurrent neural network (RNN) in the previous scheme, we first propose a frame substitution module that replaces the latent features of less important frames with those of important frames based on inter-frame correlation. Second, we propose a method for extracting facial landmark features based on the correlation between frames. Third, we propose a new multi-modal fusion method that effectively fuses video and facial landmark information at the feature level. By applying attention based on the characteristics of each modality to the features of the modality, novel fusion is achieved. Experimental results show that the proposed method provides remarkable performance, with 51.4% accuracy for the wild AFEW dataset, 98.5% accuracy for the CK+ dataset and 81.9% accuracy for the MMI dataset, outperforming the state-of-the-art networks.

Diagnostic Accuracy of MRI-Based Morphometric Parameters for Detecting Olfactory Nerve Dysfunction

BACKGROUND AND PURPOSE

Although olfactory dysfunction is a common cranial nerve disorder, there are no simple objective morphometric criteria to assess olfactory dysfunction. The aim of this study was to evaluate the diagnostic performance of MR imaging morphometric parameters for detecting olfactory dysfunction.

MATERIALS AND METHODS

This prospective study enrolled patients from those presenting with olfactory symptoms who underwent both an olfactory function test and MR imaging. Controls without olfactory dysfunction were recruited during the preoperative work-up for pituitary adenoma. Two independent neuroradiologists measured the olfactory bulb in 3D and assessed olfactory bulb concavity on MR imaging while blinded to the clinical data. Diagnostic performance was assessed using receiver operating characteristic curve analysis.

RESULTS

Sixty-four patients and 34 controls were enrolled. The patients were significantly older than the controls (mean age, 57.8 ± 11.9 years versus 47.1 ± 12.1 years; P < .001). Before age adjustment, the olfactory bulb height was the only olfactory bulb parameter showing a significant difference between patients and controls (1.6 ± 0.3 mm versus 2.0 ± 0.3 mm, P < .001). After age adjustment, all parameters and olfactory bulb concavity showed significant intergroup differences, with the olfactory bulb height having the highest area under the curve (0.85). Olfactory bulb height was confirmed to be the only significant parameter showing a difference in the detection of olfactory dysfunction in 22 pairs after matching for age and sex (area under the curve = 0.87, P < .001). Intraclass correlation coefficients revealed moderate-to-excellent degrees of inter- and intrareader agreement.

CONCLUSIONS

MR imaging morphometric analysis can differentiate patients with olfactory dysfunction, with the olfactory bulb height having the highest diagnostic performance for detecting olfactory dysfunction irrespective of age.

Variation in Sleep Stability with Differences in Severity of Sleep-Disordered Breathing in Children

OBJECTIVES

The aim of this study was to analyze the association between obstructive sleep apnea (OSA) severity and various cardiopulmonary coupling (CPC) parameters in children with OSA.

STUDY DESIGN

Retrospective cross-sectional study.

METHODS

A cross-sectional study was conducted among 117 children (aged 7.96 ± 3.54 years, 86 male) who underwent both full-night polysomnography (PSG) and CPC for suspicion of sleep-disordered breathing (SDB). We analyzed the association between various CPC and PSG findings.

RESULTS

The apnea-hypopnea index (AHI) was negatively correlated with high frequency coupling (HFC, r = -0.374, P < .001) and very low frequency coupling (VLFC, r = -0.192, P = .038) and positively correlated with low frequency coupling (LFC, r = 0.503, P < .001), elevated low frequency coupling (e-LFC, r = 0.475, P < .001), and narrow and broad band e-LFC (e-LFC_NB and e-LFC_BB ; r = 0.221, P = .016 and r = 0.468, P < .001, respectively). The arousal index was negatively correlated with HFC (r = - 0.466, P < .001) and positively correlated with LFC, e-LFC, e-LFC_NB , and e-LFC_BB (r = 0.543, r = 0.460, r = 0.239, and r = 0.445, respectively; all P < .001). In addition, we also found a significant difference in various CPC values according to OSA severity.

CONCLUSION

CPC parameters accurately reflect sleep fragmentation and OSA severity in children. Thus, we can verify objective sleep quality using CPC analysis, which is a simple method of analyzing sleep stability in children with SDB.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:435-439, 2021.

Simultaneous Nodal Superconductivity and Time-Reversal Symmetry Breaking in the Noncentrosymmetric Superconductor CaPtAs

By employing a series of experimental techniques, we provide clear evidence that CaPtAs represents a rare example of a noncentrosymmetric superconductor which simultaneously exhibits nodes in the superconducting gap and broken time-reversal symmetry (TRS) in its superconducting state (below T_{c}≈1.5  K). Unlike in fully gapped superconductors, the magnetic penetration depth λ(T) does not saturate at low temperatures, but instead it shows a T^{2} dependence, characteristic of gap nodes. Both the superfluid density and the electronic specific heat are best described by a two-gap model comprising of a nodeless gap and a gap with nodes, rather than by single-band models. At the same time, zero-field muon-spin relaxation spectra exhibit increased relaxation rates below the onset of superconductivity, implying that TRS is broken in the superconducting state of CaPtAs, hence indicating its unconventional nature. Our observations suggest CaPtAs to be a new remarkable material that links two apparently disparate classes, that of TRS-breaking correlated magnetic superconductors with nodal gaps and the weakly correlated noncentrosymmetric superconductors with broken TRS, normally exhibiting only a fully gapped behavior.

Co-administration of erythropoietin and iron complex improves late-phase liver regeneration

Erythropoietin and iron have individually shown beneficial effects on early-phase liver regeneration following partial hepatectomy (PHx); however, there are limited data on the combined effect on late-phase liver regeneration after PHx. Here we examined combined effects of recombinant human erythropoietin (rhEPO, 3,000 IU/kg) and iron isomaltoside (IIM, 40 mg/kg) on late-phase liver regeneration following PHx and investigated the possible underlying mechanism. Rats administrated with rhEPO showed significantly higher liver mass restoration, interleukin-6 (IL-6, a hepatocyte mitogen) levels, and Ki-67-positive hepatocytes on day 7 after PHx than saline-treated controls. These beneficial effects were further enhanced on days 7 and 14 by co-treatment with IIM. This combination also significantly improved liver function indices, such as increased albumin production and decreased bilirubin levels, but did not alter serum levels of toxic parameters, such as aspartate transaminase and alanine transaminase. This study demonstrates that the combination of rhEPO and IIM synergistically improves late-phase liver regeneration and function after PHx, probably by promoting IL-6-mediated hepatocyte proliferation without adverse effects. Thus, this combination treatment can be a potential therapeutic strategy for patients undergoing resection for hepatic malignancies.

CT and MRI Findings of Glomangiopericytoma in the Head and Neck: Case Series Study and Systematic Review

Glomangiopericytoma is a rare sinonasal mesenchymal tumor of borderline or low malignant potential. We reviewed the CT and MR imaging findings of head and neck glomangiopericytoma via a retrospective case series study and systematic review. Our study revealed that glomangiopericytoma is a well-defined lobulated avidly enhancing soft-tissue mass with erosive bony remodeling that is most commonly found in the sinonasal cavity. Typically, it is hyperintense on T2-weighted images with vascular signal voids, has a high mean ADC value, and a wash-in and washout pattern on dynamic contrast-enhanced MR imaging. Although the CT findings are nonspecific, typical MR imaging findings, including those on the ADC map and dynamic contrast-enhanced MR imaging, may be helpful for differentiating glomangiopericytomas from other hypervascular tumors in the head and neck.

Family medicine vocational training and career satisfaction in Hong Kong

BACKGROUND

Postgraduate vocational training in family medicine (FM) is essential for physicians to build capacity and develop quality primary care. Inadequate standards in training and curriculum development can contribute to poor recruitment and retention of doctors in primary care. This study aimed to investigate: 1) the satisfaction level of doctors regarding vocational training in family medicine and associated demographics; and 2) the satisfaction level of doctors regarding their family medicine career and associated factors.

METHOD

This is a cross sectional study of all family medicine physicians across all government-funded primary care clinics (GOPCs). The study questionnaire consisted of items from a standardized and validated physician survey named the Physician Worklife Survey (PWS) (Konrad et al., Med Care, 1999). We selected three scales (7 items) relating to global job satisfaction, global career satisfaction and global specialty (family medicine) satisfaction with additional items on training and demographics. All significant variables in bivariate analyses were further examined using stepwise logistic regression.

RESULTS

Out of 424 eligible family medicine physicians, 368 physicians successfully completed the questionnaire. The response rate was 86.8%. Most participants were male (52.6%), were aged between 35 and 44 years (55.5%), were FM specialists (42.4%), graduated locally (86.2%), and had postgraduate qualifications. Eighty-two percent (82%) of participants were satisfied with their training. Having autonomy and protected time for training were associated with satisfaction with FM training. Satisfaction with family medicine as a career was correlated with physicians' satisfaction with their current job. Doctors who did not enroll in training (p < 0.001) and physicians who were older (p = 0.023) were significantly less satisfied. Stepwise multivariate regression showed that doctors who subjectively believed their training as "broad and in depth' had higher career satisfaction (p < 0.001).

CONCLUSION

Overall, the satisfaction level of physicians on current family medicine training in Hong Kong was high. Having autonomy and protected time for training is associated with higher training satisfaction levels. Perceiving FM training as "broad and in-depth" is associated with higher family medicine career satisfaction.

Pilot GWAS of caries in African-Americans shows genetic heterogeneity

BACKGROUND

Dental caries is the most common chronic disease in the US and disproportionately affects racial/ethnic minorities. Caries is heritable, and though genetic heterogeneity exists between ancestries for a substantial portion of loci associated with complex disease, a genome-wide association study (GWAS) of caries specifically in African Americans has not been performed previously.

METHODS

We performed exploratory GWAS of dental caries in 109 African American adults (age > 18) and 96 children (age 3-12) from the Center for Oral Health Research in Appalachia (COHRA1 cohort). Caries phenotypes (DMFS, DMFT, dft, and dfs indices) assessed by dental exams were tested for association with 5 million genotyped or imputed single nucleotide polymorphisms (SNPs), separately in the two age groups. The GWAS was performed using linear regression with adjustment for age, sex, and two principal components of ancestry. A maximum of 1 million adaptive permutations were run to determine empirical significance.

RESULTS

No loci met the threshold for genome-wide significance, though some of the strongest signals were near genes previously implicated in caries such as antimicrobial peptide DEFB1 (rs2515501; p = 4.54 × 10- 6) and TUFT1 (rs11805632; p = 5.15 × 10- 6). Effect estimates of lead SNPs at suggestive loci were compared between African Americans and Caucasians (adults N = 918; children N = 983). Significant (p < 5 × 10- 8) genetic heterogeneity for caries risk was found between racial groups for 50% of the suggestive loci in children, and 12-18% of the suggestive loci in adults.

CONCLUSIONS

The genetic heterogeneity results suggest that there may be differences in the contributions of genetic variants to caries across racial groups, and highlight the critical need for the inclusion of minorities in subsequent and larger genetic studies of caries in order to meet the goals of precision medicine and to reduce oral health disparities.

Beam Energy and Centrality Dependence of Direct-Photon Emission from Ultrarelativistic Heavy-Ion Collisions

The PHENIX collaboration presents first measurements of low-momentum (0.4<p_{T}<3  GeV/c) direct-photon yields from Au+Au collisions at sqrt[s_{NN}]=39 and 62.4 GeV. For both beam energies the direct-photon yields are substantially enhanced with respect to expectations from prompt processes, similar to the yields observed in Au+Au collisions at sqrt[s_{NN}]=200. Analyzing the photon yield as a function of the experimental observable dN_{ch}/dη reveals that the low-momentum (>1  GeV/c) direct-photon yield dN_{γ}^{dir}/dη is a smooth function of dN_{ch}/dη and can be well described as proportional to (dN_{ch}/dη)^{α} with α≈1.25. This scaling behavior holds for a wide range of beam energies at the Relativistic Heavy Ion Collider and the Large Hadron Collider, for centrality selected samples, as well as for different A+A collision systems. At a given beam energy, the scaling also holds for high p_{T} (>5  GeV/c), but when results from different collision energies are compared, an additional sqrt[s_{NN}]-dependent multiplicative factor is needed to describe the integrated-direct-photon yield.

Nodeless superconductivity in the cage-type superconductor Sc5Ru6Sn18 with preserved time-reversal symmetry

We report the single-crystal synthesis and detailed investigations of the cage-type superconductor Sc₅Ru₆Sn₁₈, using powder x-ray diffraction (XRD), magnetization, specific-heat and muon-spin relaxation (µSR) measurements. Sc₅Ru₆Sn₁₈ crystallizes in a tetragonal structure (space group I4₁/acd) with lattice parameters a  =  1.387(3) nm and c  =  2.641(5) nm. Both DC and AC magnetization measurements prove the type-II superconductivity in Sc₅Ru₆Sn₁₈ with T _c  ≈  3.5(1) K, a lower critical field [Formula: see text]  =  157(9) Oe and an upper critical field, [Formula: see text]  =  26(1) kOe. The zero-field electronic specific-heat data are well fitted using a single-gap BCS model, with [Formula: see text]  =  0.64(1) meV. The Sommerfeld constant γ varies linearly with the applied magnetic field, indicating s-wave superconductivity in Sc₅Ru₆Sn₁₈. Specific-heat and transverse-field (TF) µSR measurements reveal that Sc₅Ru₆Sn₁₈ is a superconductor with strong electron-phonon coupling, with TF-µSR also suggesting a single-gap s-wave character of the superconductivity. Furthermore, zero-field µSR measurements do not detect spontaneous magnetic fields below T _c, hence implying that time-reversal symmetry is preserved in Sc₅Ru₆Sn₁₈.

Clinical effectiveness of late maxillary protraction in cleft lip and palate: A methods paper

OBJECTIVES

A prospective parallel cohort trial was conducted to compare outcomes of patients treated with maxillary protraction vs LeFort 1 maxillary advancement surgery.

SETTING AND SAMPLE POPULATION

The primary site for the clinical trial is Children's Hospital Los Angeles; the satellite test site is Seattle Children's Hospital. All patients have isolated cleft lip and palate and a skeletal Class III malocclusion.

MATERIAL AND METHODS

A total of 50 patients, ages 11-14, will be recruited for the maxillary protraction cohort. The maxillary surgery cohort consists of 50 patients, ages 16-21, who will undergo LeFort 1 maxillary advancement surgery. Patients with additional medical or cognitive handicaps were excluded from the study.

RESULTS

Current recruitment of patients is on track to complete the study within the proposed recruitment period.

CONCLUSION

This observational trial is collecting information that will examine dental, skeletal, financial and quality-of-life issues from both research cohorts.

Association of support from family and friends with self-leadership for making long-term lifestyle changes in patients with colorectal cancer

The purpose of this study was to examine the association of support from family and friends for adoption of healthy eating habits and performing exercise with improvements of self-leadership in patients with colorectal cancer (CRC). This cross-sectional study examined 251 patients with CRC who received primary curative surgery in South Korea. Demographic and clinical information, receipt of social support for adoption of healthy eating habits and performing exercise and self-leadership were collected. Greater participation by family and the use of rewards for performance of exercise were associated with greater behavioural awareness and volition, greater task motivation and constructive cognition of self-leadership in patients. Patients exercising with friends had greater task motivation in self-leadership. The use of rewards by family was associated with performing and maintaining exercise programme for more than 6 months, and family encouragement to adopt healthy eating habits was associated with excellent quality of diet. Family support for exercising and adopting healthy eating habits had more wide-ranging benefits in self-leadership than support from friends; however, support from each group improved self-leadership. Support from family was valuable for increasing the actual performance of exercise and for helping patients with cancer to adopt healthy diets.

Evaluation of abundance of artificial radionuclides in food products in South Korea and sources

Food samples are collected nationwide from January 2016 to February 2017 and their contents of artificial radionuclides are measured to address the growing concerns regarding the radioactive contamination of food products in Korea. Specifically, 900 food samples are collected for this study and their contents of representative artificial radionuclides ¹³⁴Cs, ¹³⁷Cs, ^239,240Pu, and ⁹⁰Sr are analyzed. The analysis shows that the activity concentrations of ¹³⁷Cs in fish range from minimum detectable activity (MDA) to 340 mBq/kg of fresh weight. The concentration factor (CF) determined for ¹³⁷Cs as a measure of its bioavailability is calculated to be ca. 74 and found to be very similar to that (100) recommended by the International Atomic Energy Agency. With an MDA of <0.221 mBq/kg, the results reveal that ^239,240Pu values in fish are below the MDA. The activity concentrations of ¹³⁷Cs and ⁹⁰Sr are lower than the MDA in both shellfish and seaweed, while the activity concentrations of ^239,240Pu in shellfish range from 0.26 to 2.18 mBq/kg, and for seaweed samples range from 2.07 to 3.38 mBq/kg. The atom ratios of ²⁴⁰Pu/²³⁹Pu in shellfish caught at the Korean coast vary from 0.209 to 0.237, with a mean of 0.227. The higher ²⁴⁰Pu/²³⁹Pu atom ratio determined in shellfish is thought to be caused by the plutonium transported from the Pacific Proving Grounds rather than other sources such as the Fukushima nuclear power plant accident. The activity concentrations of ¹³⁷Cs in mushrooms are found to vary from 1.0 to 21.4 Bq/kg, with the highest concentrations observed in the Oak (shiitake) and Sarcodon asparatus. ¹³⁴Cs is detected in three mushroom specimens collected from Jeju Island and about 3-3.6% of ¹³⁷Cs present in the wild mushrooms native to the Jeju Island are introduced as a result of the Fukushima nuclear plant accident. The annual effective doses of ¹³⁷Cs received through consumption of mushrooms and fish are 2.0 × 10^-4 mSv yr^-1 and 3.9 × 10^-5 mSv yr^-1, and those values are negligible compared to the annual effective doses limit of 1 mSv yr^-1.

Reduced prostate cancer risk with green tea and epigallocatechin 3-gallate intake among Hong Kong Chinese men

BACKGROUND

In vitro and in vivo studies suggested that polyphenol epigallocatechin 3-gallate (EGCG) in tea may have anti-carcinogenic effect on prostate cells, but this protective effect has less been examined in epidemiology studies. We aimed to investigate the association between prostate cancer (PCA) risk and habitual green tea intake among Chinese men in Hong Kong; meanwhile, the relationship with EGCG was also explored.

METHODS

We consecutively recruited 404 PCA cases and 395 controls from the same hospital who had complete data on habitual tea consumption, including green, oolong, black and pu'er tea. We reconstructed the level of EGCG intake according to a standard questionnaire and the analytic values for EGCG extracted from the literature published by Lin et al. in 2003. We calculated odds ratios (ORs) for tea consumption and EGCG intake using unconditional multiple logistic regression, and examined their exposure--response relationships with PCA risk.

RESULTS

A total of 32 cases and 50 controls reported habitual green tea drinking, showing an adjusted OR of 0.60 (95% confidence interval (CI): 0.37, 0.98). A moderate excess risk was observed among the habitual pu'er tea drinkers (OR=1.44, 95% CI: 1.02, 1.91). A significantly lower intake of EGCG was observed among cases (54.4 mg) than the controls (72.5 mg), which resulted in an inverse gradient of PCA risk with the increasing intake of EGCG (test for trend, P=0.015).

CONCLUSION

PCA risk among Chinese men in Hong Kong was inversely associated with green tea consumption and EGCG intake, but these results need to be replicated in larger studies.

Serum 25-hydroxyvitamin D cutoffs for functional bone measures in postmenopausal osteoporosis

This study sought to determine the minimal serum 25-hydroxyvitamin D [25(OH)D] concentration required to maintain bone health in postmenopausal women with low bone mass. A serum 25(OH)D concentration of 20 ng/mL rather than 30 ng/mL was appropriate for bone health.

INTRODUCTION

There is no consensus on the minimal serum 25-hydroxyvitamin D [25(OH)D] concentration required to maintain bone health. The aim of this study was to investigate the relationship between 25(OH)D measured via liquid chromatography-mass spectrometry (LC-MS/MS), which is the current gold standard, and biochemical markers of bone turnover, PTH, and bone mineral densitometry (BMD).

METHODS

The medical records of 750 postmenopausal women newly diagnosed with osteoporosis or osteopenia at Samsung Medical Center from 2009 to 2014 were investigated. Subjects were divided into four groups according to serum 25(OH)D concentration: <10, 10-20, 20-30, and ≥30 ng/mL. Serum concentrations of bone-specific alkaline phosphatase (BS-ALP), carboxy-terminal cross-linking telopeptide of type 1 collagen (CTx), intact PTH (iPTH), and BMD were compared among the four groups using analysis of covariance. Thresholds of 25(OH)D were then assessed using spline plots and locally weighted regression smoothing (LOESS) plots.

RESULTS

25(OH)D was negatively correlated with serum BS-ALP, CTx, and iPTH. Only femur neck and total femur BMD had significant positive relationships with 25(OH)D. Cutoff values of 11.9 and 9.7 ng/mL were estimated from the spline plots of femur neck and total femur BMD, respectively. For iPTH, the LOESS plot showed a steep decrease to a serum 25(OH)D concentration of about 20 ng/mL, followed by a plateau.

CONCLUSIONS

According to this study, a serum 25(OH)D concentration of 20 ng/mL, rather than 30 ng/mL, was appropriate for bone health.

Prevalence and predictors of complications following facial reconstruction procedures

Facial reconstruction procedures are immensely challenging and are done for a multitude of reasons. The purpose of this report is to provide nationally representative estimates of different types of facial reconstructive procedures and to examine prevalence and predictors of a wide range of complications associated with these procedures in the USA. The Nationwide Inpatient Sample, the largest inpatient dataset for the USA, was used. Data for the years 2004-2010 related to facial reconstruction procedures were identified through ICD-9-CM procedure codes. Associated complications were identified using secondary diagnosis field codes. Multivariable logistic regression models were used to examine the association between patient/hospital-level factors and the occurrence of complications. A total 26,374 facial reconstruction procedures were performed. About 20% of all patients who had facial reconstruction procedures developed a complication. Frequently occurring complications included postoperative pneumonia (4.9% of hospitalizations), hemorrhage (3.9%), other infections (3.6%), non-healing wounds (3.5%), and iatrogenically induced complications (3.2%). Significant factors found to be consistently associated with different types of complications included age, co-morbid burden, sex, and type of admission. The reported results are generalizable within limitations and can be used by health care providers to tailor quality improvement initiatives to minimize or better treat complications in the high-risk cohorts.

Measurements of Elliptic and Triangular Flow in High-Multiplicity 3He+Au Collisions at √(s(NN))=200 GeV

We present the first measurement of elliptic (v(2)) and triangular (v(3)) flow in high-multiplicity (3)He+Au collisions at √(s(NN))=200  GeV. Two-particle correlations, where the particles have a large separation in pseudorapidity, are compared in (3)He+Au and in p+p collisions and indicate that collective effects dominate the second and third Fourier components for the correlations observed in the (3)He+Au system. The collective behavior is quantified in terms of elliptic v(2) and triangular v(3) anisotropy coefficients measured with respect to their corresponding event planes. The v(2) values are comparable to those previously measured in d+Au collisions at the same nucleon-nucleon center-of-mass energy. Comparisons with various theoretical predictions are made, including to models where the hot spots created by the impact of the three (3)He nucleons on the Au nucleus expand hydrodynamically to generate the triangular flow. The agreement of these models with data may indicate the formation of low-viscosity quark-gluon plasma even in these small collision systems.

A sheared Racz catheter in cervical epidural space for thirty months: a case report

Percutaneous epidural neuroplasty may lead to complications such as hematoma, infection, epidural abscess, meningitis, hypotension, respiratory depression, urinary and fecal dysfunction, sexual dysfunction and paresthesia. Other technical complications may include shearing or tearing, misplacement, blockage and migration of the catheter. We report a case of a 41-year-old female patient, who underwent surgical removal of a sheared catheter, which was retained for 30 months after cervical Racz neuroplasty.

PPARγ induces growth inhibition and apoptosis through upregulation of insulin-like growth factor-binding protein-3 in gastric cancer cells

Peroxisome proliferator activator receptor-gamma (PPARγ) is a ligand-activated transcriptional factor involved in the carcinogenesis of various cancers. Insulin-like growth factor-binding protein-3 (IGFBP-3) is a tumor suppressor gene that has anti-apoptotic activity. The purpose of this study was to investigate the anticancer mechanism of PPARγ with respect to IGFBP-3. PPARγ was overexpressed in SNU-668 gastric cancer cells using an adenovirus gene transfer system. The cells in which PPARγ was overexpressed exhibited growth inhibition, induction of apoptosis, and a significant increase in IGFBP-3 expression. We investigated the underlying molecular mechanisms of PPARγ in SNU-668 cells using an IGFBP-3 promoter/luciferase reporter system. Luciferase activity was increased up to 15-fold in PPARγ transfected cells, suggesting that PPARγ may directly interact with IGFBP-3 promoter to induce its expression. Deletion analysis of the IGFBP-3 promoter showed that luciferase activity was markedly reduced in cells without putative p53-binding sites (-Δ1755, -Δ1795). This suggests that the critical PPARγ-response region is located within the p53-binding region of the IGFBP-3 promoter. We further demonstrated an increase in PPARγ-induced luciferase activity even in cells treated with siRNA to silence p53 expression. Taken together, these data suggest that PPARγ exhibits its anticancer effect by increasing IGFBP-3 expression, and that IGFBP-3 is a significant tumor suppressor.

Neoadjuvant therapy and vascular resection during pancreaticoduodenectomy: shifting the survival curve for patients with locally advanced pancreatic cancer

BACKGROUND

Neoadjuvant therapy and vascular resection may offer patients with locally advanced pancreatic cancer potential cure.

METHODS

We reviewed medical records of patients with ductal adenocarcinoma who underwent pancreaticoduodenectomy (PD) from 1992 through 2011. We identified patients who received neoadjuvant therapy (NA+) or required vascular resection (VR+) for locally advanced disease and compared outcomes to those who did not.

RESULTS

Of the 643 patients who were initially explored, 506 (143 NA+ and 363 NA- patients) ultimately underwent PD. There were no significant differences in R0 resection or morbidity. Mortality was higher in the NA+ versus NA- group (7.0 vs 3.0 %, p = 0.04). More NA+ patients underwent PD VR+ (p < 0.001). Among VR+ patients, neoadjuvant therapy resulted in significantly lower R1 resection. Among resected patients, survival of NA+ patients was significantly longer than both NA- patients (27.3 vs 19.7 months, p < 0.05) and patients abandoned because of locally advanced disease. Age, tumor grade, lymph node ratio, and R1 resection were independent predictors of poor survival.

CONCLUSIONS

Neoadjuvant therapy and vascular resection offer patients with locally advanced pancreatic cancer the chance for cure with acceptable morbidity and mortality. These patients have improved survival over patients deemed locally inoperable by traditional criteria.

Search for bosonic superweakly interacting massive dark matter particles with the XMASS-I detector

Bosonic superweakly interacting massive particles (super-WIMPs) are a candidate for warm dark matter. With the absorption of such a boson by a xenon atom, these dark matter candidates would deposit an energy equivalent to their rest mass in the detector. This is the first direct detection experiment exploring the vector super-WIMPs in the mass range between 40 and 120 keV. With the use of 165.9 day of data, no significant excess above background was observed in the fiducial mass of 41 kg. The present limit for the vector super-WIMPs excludes the possibility that such particles constitute all of dark matter. The absence of a signal also provides the most stringent direct constraint on the coupling constant of pseudoscalar super-WIMPs to electrons. The unprecedented sensitivity was achieved exploiting the low background at a level 10(-4)  kg-1 keVee-1 day-1 in the detector.

The p66Shc adapter protein regulates the morphogenesis and epithelial maturation of fetal mouse lungs

Many signaling pathways are mediated by Shc adapter proteins that, in turn, are expressed as three isoforms with distinct functions. The p66(Shc) isoform antagonizes proliferation, regulates oxidative stress, and mediates apoptosis. It is highly expressed in the canalicular but not the later stages of mouse lung development, and its expression persists in bronchopulmonary dysplasia, a chronic disease associated with premature birth. These observations suggest that p66(Shc) has a developmental function. However, constitutive p66(Shc) deletion yields no morphological phenotype, and the structure of the Shc gene precludes its inducible deletion. To elucidate its function in lung development, we transfected p66(Shc) or nonsilencing small-interfering RNA (siRNA) into the epithelia of embryonic day 11 mouse lungs that were then cultured for 3 days and analyzed morphometrically. To assess cellular proliferation and epithelial differentiation, lung explants were immunostained and immunoblotted for p66(Shc), proliferating cell nuclear antigen (PCNA), the proximal airway differentiation antigens Clara cell 10-kDa protein (CC10) and thyroid transcription factor (TTF)-1, and the alveolar surfactant proteins (SP)-A, -B, and -C. Explants transfected with nonsilencing siRNA demonstrated specific epithelial uptake and normal morphological development relative to uninjected controls. In contrast, transfection with p66(Shc) siRNA significantly increased lumenal cross-sectional areas, decreased branching, and increased epithelial proliferation (P < 0.05 for all). Relative to controls, the expression of SP-B, SP-C, CC10, and TTF-1 was decreased by p66(Shc) knockdown. SP-A was not expressed in either control or treated lungs. These data suggest that p66(Shc) attenuates epithelial proliferation while promoting both distal and proximal epithelial maturation.

Medium modification of jet fragmentation in Au+Au collisions at √[s(NN)]=200 GeV measured in direct photon-hadron correlations

The jet fragmentation function is measured with direct photon-hadron correlations in p+p and Au+Au collisions at √[s(NN)]=200 GeV. The p(T) of the photon is an excellent approximation to the initial p(T) of the jet and the ratio z(T)=p(T)(h)/p(T)(γ) is used as a proxy for the jet fragmentation function. A statistical subtraction is used to extract the direct photon-hadron yields in Au+Au collisions while a photon isolation cut is applied in p+p. I(AA), the ratio of hadron yield opposite the photon in Au+Au to that in p+p, indicates modification of the jet fragmentation function. Suppression, most likely due to energy loss in the medium, is seen at high z(T). The associated hadron yield at low z(T) is enhanced at large angles. Such a trend is expected from redistribution of the lost energy into increased production of low-momentum particles.

Is stereotactic radiosurgery under-utilised in the treatment of surgically excisable cerebral metastases?

BACKGROUND/OBJECTIVE

Brain metastases are a significant cause of morbidity and mortality. Treatment options included surgery, whole brain radiotherapy and stereotactic radiosurgery alone or in combination. There has been a significant increase in stereotactic radiosurgery (SRS) provision in the UK over the last 5 years. We investigated the proportion of surgically resected brain metastases that would be suitable for SRS.

METHODS

We retrospectively collected data on 116 consecutive patients undergoing surgical resection of brain metastases. Suitable radiological targets for SRS were defined as solid tumours < 30 mm maximum diameter with no hydrocephalus and no symptomatic mass effect.

RESULTS

One hundred and two cases (88%) were solitary metastasis and fourteen (12%) had multiple metastases. Median maximum tumour diameter was 34 mm (range: 12-70 mm). Approximately one-third of patients (n = 41) had surgically resected brain metastasis suitable for SRS. Median OS was 7.7 months for those suitable for SRS and 5.4 months for those not suitable for SRS (Fig. 3; Log Rank: P = 0.52).

CONCLUSIONS

In surgically amenable tumours, day case SRS could also be used in approximately one-third of cases, thereby avoiding craniotomy and reducing length of stay. These data may be useful in planning service provision, and for drawing up business plans for a new SRS services. Nationally agreed guidelines for SRS for brain metastases have been developed and a full health economic analysis warrants further investigation to determine the cost effectiveness of SRS compared to craniotomy.

Effect of complementary and alternative medicine on the survival and health-related quality of life among terminally ill cancer patients: a prospective cohort study

BACKGROUND

We evaluated whether complementary and alternative medicine (CAM) use influenced outcomes [survival and health-related quality of life (HRQOL)] of cancer patients whose condition had just been judged terminal.

PATIENTS AND METHODS

From July 2005 to October 2006, we conducted a prospective cohort study of 481 terminally ill cancer patients at 11 university hospitals and the National Cancer Center in Korea. We assessed how the use of CAM affected HRQOL and survival.

RESULTS

In a follow-up of 481 patients and 163.8 person-years, we identified 466 deceased cases. On multivariate analyses, CAM users did not have better survival compared with nonusers [adjusted hazard ratio (aHR), 0.91; 95% confidence interval (CI) 0.74-1.10]. Among mind-body interventions, prayer showed significantly worse survival (aHR, 1.56; 95% CI, 1.00-2.43). Clinically, CAM users reported significantly worse cognitive functioning (-11.6 versus -1.3; P < 0.05) and fatigue (9.9 versus -1.0; P < 0.05) than nonusers. Compared with nonusers in subgroup analysis, users of alternative medical treatments, prayer, vitamin supplements, mushrooms, or rice and cereal reported clinically significant worse changes in some HRQOL subscales.

CONCLUSION

While CAM did not provide any definite survival benefit, CAM users reported clinically significant worse HRQOLs.

Measurement of direct photons in Au+Au collisions at √(s(NN))=200 GeV

We report the measurement of direct photons at midrapidity in Au+Au collisions at √(s(NN))=200 GeV. The direct photon signal was extracted for the transverse momentum range of 4 GeV/c<p(T)<22 GeV/c, using a statistical method to subtract decay photons from the inclusive photon sample. The direct photon nuclear modification factor R(AA) was calculated as a function of p(T) for different Au+Au collision centralities using the measured p+p direct photon spectrum and compared to theoretical predictions. R(AA) was found to be consistent with unity for all centralities over the entire measured p(T) range. Theoretical models that account for modifications of initial direct photon production due to modified parton distribution functions in Au and the different isospin composition of the nuclei predict a modest change of R(AA) from unity. They are consistent with the data. Models with compensating effects of the quark-gluon plasma on high-energy photons, such as suppression of jet-fragmentation photons and induced-photon bremsstrahlung from partons traversing the medium, are also consistent with this measurement.

Genetic and environmental relationships between Framingham Risk Score and adiposity measures in Koreans: the Healthy Twin study

BACKGROUND AND AIMS

We examined heritability and bivariate analyses for the Framingham Risk Score (FRS) and adiposity measures among Koreans.

METHODS AND RESULTS

We analysed the data from 2496 participants (962 men, 1534 women, age 30-74 years), including 1320 non-twin family members, 468 monozygotic (MZ) and 120 dizygotic (DZ) twin pairs, collected from the Healthy Twin study of Korea. Adiposity measurements comprised BMI, waist circumference (WC), waist-to-hip ratio and waist-to-height ratio (WHTR). Analyses were conducted using the Sequential Oligogenic Linkage Analysis Routines (SOLAR) package software. The co-twin control analyses shows that estimates of within-pair regression coefficients in the relationship between adiposity traits and FRS were attenuated for MZ twin pairs, relative to DZ twin pairs (0.11-0.26 vs. 0.60-0.71). The heritability estimate for FRS was 0.37, and the estimates for adiposity traits ranged from 0.45 to 0.63 (P < 0.001). Bivariate analysis revealed genetic correlations between FRS, and all of the adiposity traits ranged from 0.16 (for WHTR, P > 0.05) to 0.46 (for WC, P < 0.001). The common environmental correlations between FRS and each of the adiposity traits ranged from 0.43 to 0.66 (P < 0.001).

CONCLUSIONS

FRS and each of the obesity traits shared common genetic and environmental relationships. These findings support a pleiotropic action between genes associated with adiposity traits and FRS and a need of further investigations for identifying specific common environmental factors.

Development of decay energy spectroscopy using low temperature detectors

We have developed a high-resolution detection technique for measuring the energy and activity of alpha decay events using low-temperature detectors. A small amount of source material containing alpha-emitting radionuclides was enclosed in a 4π metal absorber. The energy of the alpha particles as well as that of the recoiled nuclides, low-energy electrons, and low-energy x-rays and γ-rays was converted into thermal energy of the gold absorber. A metallic magnetic calorimeter serving as a fast and sensitive thermometer was thermally attached to the metal absorber. In the present report, experimental demonstrations of Q spectroscopy were made with a new meander-type magnetic calorimeter. The thermal connection between the temperature sensor and the absorber was established with annealed gold wires. Each alpha decay event in the absorber resulted in a temperature increase of the absorber and the temperature sensor. Using the spectrum measured for a drop of (226)Ra solution in a 4π gold absorber, all of the alpha emitters in the sample were identified with a demonstration of good detector linearity. The resolution of the (226)Ra spectrum showed a 3.3 keV FWHM at its Q value together with an expected gamma escape peak at the energy shifted by its γ-ray energy.

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSION

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