Association of Balance Impairment with Risk of Incident Dementia among Older Adults

BACKGROUND

A growing body of data suggests that balance impairment may be linked to the onset of dementia.

OBJECTIVES

However, a large-scale epidemiologic investigation is needed to clarify its association in older adults.

DESIGN

A retrospective-prospective hybrid database.

SETTING

Cox proportional hazards regression model was used to assess the relationship between balance impairment and the risk of incident dementia, and the results were provided as adjusted hazard ratios (aHR) with 95% confidence intervals (CI). All participants were tracked until the date of incident dementia, death, or 31 December 2019 whichever came first.

PARTICIPANTS

We analyzed 143,788 older adults who had at least one health screening between 2009 and 2019 from the Korea National Health Insurance Service-Senior Cohort.

MEASUREMENTS

A total of 3,774 cases of dementia were discovered throughout 850,425 person-years of follow-up investigation. Balance impairment was associated with a risk of dementia compared to those without balance impairment (adjusted hazard ratio [aHR] 1.83; 95% CI, 1.69-2.00; P value <0.001).

RESULTS

Risks of the Alzheimer's disease (aHR, 1.80; 95% CI, 1.65-1.96; P for trend <0.001) and the vascular dementia (aHR, 2.94; 95% CI, 1.89-4.58; P for trend <0.001) showed comparable trends and findings.

CONCLUSIONS

Balance impairment was found to be independently associated with an increased risk of dementia in older adults.

An extremely energetic cosmic ray observed by a surface detector array

Cosmic rays are energetic charged particles from extraterrestrial sources, with the highest-energy events thought to come from extragalactic sources. Their arrival is infrequent, so detection requires instruments with large collecting areas. In this work, we report the detection of an extremely energetic particle recorded by the surface detector array of the Telescope Array experiment. We calculate the particle's energy as [Formula: see text] (~40 joules). Its arrival direction points back to a void in the large-scale structure of the Universe. Possible explanations include a large deflection by the foreground magnetic field, an unidentified source in the local extragalactic neighborhood, or an incomplete knowledge of particle physics.

Deep Learning vs. Handcrafted Radiomics to Predict Chemoradiotherapy Response for Locally Advanced Cervical Cancer

PURPOSE/OBJECTIVE(S)

To predict CRT response in locally advanced cervical cancer (LACC) with handcrafted radiomics (HCR) and deep learning radiomics (DLR) using pretreatment MRI. Furthermore, we investigate whether the incorporation of clinical factors improves prediction performance.

MATERIALS/METHODS

Two hundred and fifty-two patients with LACC are enrolled. All patients are treated with external beam radiotherapy, followed by high-dose-rate intracavitary brachytherapy with concurrent cisplatin. The patients are randomly divided into two independent groups for the training (167 patients) and test datasets (85 patients). Contrast-enhanced T1- and T2-weighted MR scans are obtained. Patients in the training and test sets have similar characteristics in terms of age, tumor size, FIGO stage, HPV infection status, or CRT response. For HCR analysis, 1890 imaging features are extracted and a support vector machine classifier with a five-fold cross-validation is trained using training dataset to predict CRT response and validated using test dataset. For DLR analysis, a 3-dimensional convolutional neural network was trained and validated using test dataset.

RESULTS

A comparison of the DLR and HCR models reveals that the DLR model exhibits better prediction performance than the HCR model for the test dataset (AUC = 0.721 vs. 0.597, p = 0.097). The incorporation of clinical factors could improve performance in both DLR and HCR models.

CONCLUSION

The DLR models outperform the HCR models in predicting CRT responses in patients with LACC. Combining clinical factors and MRI may improve the prediction performance in both HCR and DLR analyses.

Hierarchical settlement behaviours of coral larvae to common coralline algae

Natural regeneration of degraded reefs relies on the recruitment of larvae to restore populations. Intervention strategies are being developed to enhance this process through aquaculture production of coral larvae and their deployment as spat. Larval settlement relies on cues associated with crustose coralline algae (CCA) that are known to induce attachment and metamorphosis. To understand processes underpinning recruitment, we tested larval settlement responses of 15 coral species, to 15 species of CCA from the Great Barrier Reef (GBR). CCA in the family Lithophyllaceae were overall the best inducer across most coral species, with Titanoderma cf. tessellatum being the most effective species that induced at least 50% settlement in 14 of the coral species (mean 81%). Taxonomic level associations were found, with species of Porolithon inducing high settlement in the genus Acropora; while a previously understudied CCA, Sporolithon sp., was a strong inducer for the Lobophyllidae. Habitat-specific associations were detected, with CCA collected from similar light environment as the coral inducing higher levels of settlement. This study revealed the intimate relationships between coral larvae and CCA and provides optimal coral-algal species pairings that could be utilized to increase the success of larval settlement to generate healthy spat for reef restoration.

Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group

BACKGROUND & AIMS

Autoimmune hepatitis (AIH) has been well characterised and codified through the development of diagnostic criteria. These criteria have been adapted and simplified and are widely used in clinical practice. However, there is a need to update and precisely define the criteria for both treatment response and treatment.

METHODS

A systematic review was performed and a modified Delphi consensus process was used to identify and redefine the response criteria in autoimmune hepatitis.

RESULTS

The consensus process initiated by the International Autoimmune Hepatitis Group proposes that the term 'complete biochemical response' defined as 'normalization of serum transaminases and IgG below the upper limit of normal' be adopted to include a time point at 6 months after initiation of treatment. An insufficient response by 6 months was a failure to meet the above definition. Non-response was defined as '<50% decrease of serum transaminases within 4 weeks after initiation of treatment'. Remission is defined as liver histology with a Hepatitis Activity Index <4/18. Intolerance to treatment was agreed to stand for 'any adverse event possibly related to treatment leading to potential drug discontinuation'.

CONCLUSIONS

These definitions provide a simple and reproducible framework to define treatment response and non-response, irrespective of the therapeutic intervention. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable inter-study comparisons. Future prospective database studies are needed to validate these endpoints.

LAY SUMMARY

Consensus among international experts on response criteria and endpoints in autoimmune hepatitis is lacking. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable the comparison of results between clinical trials. Therefore, the International Autoimmune Hepatitis Group (IAIHG) herein presents a statement on 5 agreed response criteria and endpoints: complete biochemical response, insufficient response, non-response, remission, and intolerance to treatment, which can be used to guide future reporting.

Subtrochanteric atypical femoral fracture induced solely by glucocorticoid without bisphosphonate treatment: a case report

An AFF is a form of stress fracture induced by excessive physiologic repetitive stress over the bone remodeling capacity. Although glucocorticoid administration is a known risk factor for AFF, no case of AFF with glucocorticoid administration as the only risk factor has been previously reported. In this report, we aimed to highlight the risk of AFF associated with long-term administration of glucocorticoids, and the importance of surveillance and correction of risk factors in patients undergoing long-term glucocorticoid therapy. A 58-year-old male patient was diagnosed with subtrochanteric AFF. He had no medical history of any condition that might disrupt bone metabolism and no known risk factors for AFF, except for long-term administration of glucocorticoid. After fixation of the fracture, the glucocorticoid was replaced with an alternative medication. Although AFF is notorious for delayed union or nonunion, complete union of the fracture was obtained at 14 months postoperatively. This case brought to our attention the possibility that glucocorticoids alone may be responsible for inducing AFF and highlighted the importance of regular assessments in case of necessity of glucocorticoid administration. Additionally, correction of risk factors might expedite the union of AFF.

2-O-Methylhonokiol Suppresses HCV Replication via TRAF6-Mediated NF-kB Activation

Hepatitis C virus (HCV) is associated with various liver diseases. Chronic HCV infection is characterized by an abnormal host immune response. Therefore, it is speculated that to suppress HCV, a well-regulated host immune response is necessary. 2-O-methylhonokiol was identified by the screening of anti-HCV compounds using Renilla luciferase assay in Huh 7.5/Con 1 genotype 1b replicon cells. Here, we investigated the mechanism by which 2-O-methylhonokiol treatment inhibits HCV replication using real-time PCR. Our data shows that treatment with 2-O-methylhonokiol activated innate immune responses via nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) pathway. Additionally, the immunoprecipitation result shows that treatment with 2-O-methylhonokiol augmented tumor necrosis factor receptor (TNFR)-associated factor 6 (TRAF6) by preventing p62 from binding to TRAF6, resulting in reduced autophagy caused by HCV. Finally, we reproduced our data with the conditioned media from 2-O-methylhonokiol-treated cells. These findings strongly suggest that 2-O-methylhonokiol enhances the host immune response and suppresses HCV replication via TRAF6-mediated NF-kB activation.

TRENDS IN THE PREVALENCE OF FRAILTY IN JAPAN: A META-ANALYSIS FROM THE ILSA-J

OBJECTIVE

To examine whether age-specific prevalence of frailty in Japan changed between 2012 and 2017.

DESIGN

This study performed meta-analyses of data collected from 2012 to 2017 using the Integrated Longitudinal Studies on Aging in Japan (ILSA-J), a collection of representative Japanese cohort studies.

SETTING

The ILSA-J studies were conducted on community-living older adults.

PARTICIPANTS

ILSA-J studies were considered eligible for analysis if they assessed physical frailty status and presence of frailty in the sample. Seven studies were analyzed for 2012 (±1 year; n = 10312) and eight studies were analyzed for 2017 (±1 year; n = 7010). Five studies were analyzed for both 2012 and 2017.

MEASUREMENTS

The study assessed the prevalence of frailty and frailty status according to 5 criteria: slowness, weakness, low activity, exhaustion, and weight loss.

RESULTS

The overall prevalence of physical frailty was 7.0% in 2012 and 5.3% in 2017. The prevalence of frailty, especially in people 70 years and older, tended to decrease in 2017 compared to 2012. Slight decreases were found in the prevalence of frailty subitems including weight loss, slowness, exhaustion, and low activity between 2012 and 2017, but change in the prevalence of weakness was weaker than other components.

CONCLUSIONS

The prevalence of physical frailty decreased from 2012 to 2017. There are age- and gender-related variations in the decrease of each component of frailty.

Honokiol inhibits hepatoma carcinoma cell migration through downregulated Cyclophilin B expression

Hepatocellular carcinoma (HCC) is the fifth common types of cancer with poor prognosis in the world. Honokiol (HNK), a natural biphenyl compound derived from the magnolia plant, has been reported to exert anticancer effects, but its mechanism has not been elucidated exactly. In the present study, HNK treatment significantly suppressed the migration ability of HepG2 and Hep3B human hepatocellular carcinoma. The treatment reduced the expression levels of the genes associated with cell migration, such as S100A4, MMP-2, MMP-9 and Vimentin. Interestingly, treatment with HNK significantly reduced the expression level of Cyclophilin B (CypB) which stimulates cancer cell migration. However, overexpressed CypB abolished HNK-mediated suppression of cell migration, and reversed the apoptotic effects of HNK. Altogether, we concluded that the suppression of migration activities by HNK was through down-regulated CypB in HCC. These finding suggest that HNK may be a promising candidate for HCC treatment via regulation of CypB.

THU0444 INCIDENCE OF ACUTE GOUT FLARE IN PATIENTS INITIATED ON INTRAVENOUS BUMETANIDE FOR ACUTE CONGESTIVE HEART FAILURE EXACERBATION

Background:

Heart failure is a prevalent and ever-increasing public health concern associated with significant morbidity, mortality, and financial burden. Therefore, identifying any factors that worsen the outcome of patients with heart failure is crucial to the nation’s medical and financial health.

One of the major comorbidities associated with heart failure is gout. Gout is a clinical syndrome of joint inflammation resulting from the deposition of monosodium urate crystals, causing painful and swollen arthritis. Acute gout flares in the context of acute heart failure (AHF) exacerbations result in longer lengths of stay and form an independent risk factor for increased readmissions or death1. The use of loop diuretics in treating patients with AHF exacerbations may cause new onset of gouty arthritis or recurrence of established gout by increasing serum uric acid levels. Uric acid alone is implicated as an independent predictor of mortality in patients with chronic heart failure2.

Objectives:

In this study, we aim to better characterize the incidence of acute gout flares in patients being treated with intravenous bumetanide for AHF exacerbations.

Methods:

This single-center retrospective cohort study included adult patients within an urban tertiary-care center hospital between 5 August 2016 and 30 June 2018. Chart review was performed to identify 130 patients who were hospitalized for AHF exacerbations, received intravenous (IV) bumetanide, and developed an acute gout flare for a total of 176 cases (Figure 1).

Figure 1

Patient Selection

Patients were identified as having an acute gout flare if the primary treating physician(s) documented a clinical picture congruous with acute gout (e.g., onset of a painful, swollen, or erythematous joint) and administered conventional treatment for acute gout including non-steroidal anti-inflammatory agents (NSAIDs), steroids, colchicine, urate-lowering therapies, and/or intra-articular joint injection with symptomatic improvement.

Results:

The annualized incidence of acute gout while receiving IV bumetanide for a heart failure exacerbation is 7.17%.

There was no statistical difference in age, gender, race, or BMI among patients who developed acute gout compared with those who did not develop acute gout while receiving IV bumetanide.

An acute gout flare that occurred during treatment of AHF with IV bumetanide increased hospital length of stay (LOS) by 3 days (mean LOS 15.2 days in those who had acute gout, mean LOS 11.6 days in those who did not [p-value 0.277]).

Patients who received allopurinol during their hospitalization for AHF exacerbation had lower 30-day readmission rates for any cause (p-value 0.017, Table 4). There was no reduction in the 30-day readmission rate in patients who received colchicine without allopurinol during their hospitalization for AHF exacerbation. Those with a history of gout had higher readmission rates than those without a history of gout (p-value 0.007).

Conclusion:

Gout is known to be a weighty contributor to patients’ morbidity and mortality in heart failure, and the occurrence of acute gout flare in AHF exacerbations may be precipitated by the use of loop diuretics. We show that the use of IV bumetanide in patients hospitalized for AHF exacerbations is associated with a 7.17% yearly incidence of acute gout flares. Furthermore, patients with a history of gout were found to have higher readmission rates, and those who received allopurinol during their hospitalization had lower readmission rates.

References:

[1]Thanassoulis G, Brophy JM, Richard H, Pilote L. Gout, Allopurinol Use, and Heart Failure Outcomes.Arch Intern Med. 2019;170(15):1358-1364.

[2]Struthers AD, Donnan PT, Lindsay P, Mcnaughton D, Broomhall J, Macdonald TM. Effect of allopurinol on mortality and hospitalisations in chronic heart failure: a retrospective cohort study.Heart. 2002;87(3):229-234.

Disclosure of Interests: :

None declared

1272Physical activity and mortality with and without cardiovascular disease

Background/Introduction

Physical activity has been shown to reduce mortality in a dose-response fashion. Current guidelines recommend 500 to 1,000 MET-min per week of regular physical activity. However, evidence is limited regarding the specific dose-response relationship in patients with cardiovascular disease.

Purpose

Our aim was to compare the impact of physical activity on mortality in primary versus secondary cardiovascular prevention.

Methods

We analyzed 441,798 individuals with complete information on physical activity levels between 2009 and 2015 were extracted from a population-based cohort (National Health Insurance Service-National Health Screening cohort). Physical activity measured by self-report questionnaires. A rating of 2.9, 4.0, and 7.0 METs were assigned for light-intensity, moderate-intensity, and vigorous-intensity activities, respectively. Physical activity-related energy expenditure (MET-min/week) was calculated by summing the product of frequency, intensity, and duration. The level of physical activity was classified into 0, 0 to 499, 500 to 999, 1,000 to 1,499, and ≥1,500 MET-min/week. Study participants were stratified by the presence of cardiovascular disease, defined as prior myocardial infarction, ischemic heart disease, prior stroke, and/or chronic heart failure. The main study outcome was all-cause mortality. The median follow-up duration was 5.9 years.

Results

Individuals with cardiovascular disease had lower physical activity levels and a higher risk of mortality than those without cardiovascular disease. There was an inverse relationship between the physical activity level and the mortality risk in both groups. The benefit in the secondary prevention group was shown to be greater than that in the primary prevention group: every 500 MET-min/week increase in physical activity resulted in a 14% and 7% risk reduction in mortality in the secondary and primary prevention groups, respectively (interaction P<0.001). In addition, while individuals without cardiovascular disease benefited the most between 0 and 500 MET-min/week of physical activity, the benefit in those with cardiovascular disease continued above 500 to 1,000 MET-min/week. The adjusted mortality risk of individuals with cardiovascular disease who performed a high level of physical activity (≥1,000 MET-min/week) was shown to be comparable to or lower than that of their counterparts without cardiovascular disease.

Adjusted risk of mortality

Conclusion

Individuals with cardiovascular disease may benefit from physical activity to a greater extent than do healthy subjects without cardiovascular disease. Clinicians should encourage patients with cardiovascular disease to maintain a physically active lifestyle as much as possible.

The impact of social media on citation rates in coloproctology

AIM

This study aimed to investigate the association between Twitter exposure and the number of citations for coloproctology articles.

METHOD

Original articles from journals using Twitter between June 2015 and May 2016 were evaluated for the following characteristics: publishing journal; article subject; study design; nationality, speciality and affiliation of the author(s); and reference on Twitter. Citation data for these articles were retrieved from Google Scholar (https://scholar.google.com) in January 2018. We performed a univariate analysis using these data followed by a multivariate, logistic regression analysis to search for factors associated with a high citation level, which was defined as accrual of more than five citations.

RESULTS

Out of six coloproctology journals listed on the InCites JCR database, three (Diseases of the Colon & Rectum, Colorectal Disease and Techniques in Coloproctology) used Twitter, where 200 (49.5%) out of a total of 404 articles had been featured. Citation rates of articles that featured on Twitter were significantly higher than those that did not (11.4 ± 9.2 vs 4.1 ± 3.1, P < 0.001). In multivariate analysis, Twitter exposure (OR 8.6, P = 0.001), European Union nationality (OR 2.4, P = 0.004), Colorectal Disease journal (OR 3.3, P = 0.005) and systematic review articles (OR 3.4, P = 0.009) were associated with higher citation levels.

CONCLUSION

Article exposure on Twitter was strongly associated with a high citation level. Medical communities should encourage journals as well as physicians to actively utilize social media to expedite the spread of new ideas and ultimately benefit medical society as a whole.

Topical applications of an emollient reduce circulating pro-inflammatory cytokine levels in chronically aged humans: a pilot clinical study

BACKGROUND

While increased levels of circulating inflammatory cytokines in chronologically aged humans have been linked to the development of ageing-associated chronic disorders (e.g., cardiovascular disease, type II diabetes, osteoporosis and Alzheimer's disease), approaches that reduce circulating cytokines are not yet available. In chronologically aged mice, we recently demonstrated that epidermal dysfunction largely accounts for age-associated elevations in circulating cytokine levels, and that improving epidermal function reduced circulating cytokine levels.

OBJECTIVE

We performed a pilot study to determine whether improving epidermal function reduces circulating pro-inflammatory cytokine levels in aged humans.

METHODS

Thirty-three aged humans were topically treated twice-daily for 30 days, with ≈ 3 mL of an emollient, previously shown to improve epidermal function, while untreated, aged humans and a cohort of young volunteers served as controls. Changes in epidermal function and levels of three key, age-related, plasma cytokines (IL-1β, IL-6 and TNFα) were measured at baseline and after treatment, using Luminex 200™ system.

RESULTS

We also found significantly higher baseline levels of IL-1β, IL-6 and TNFα in aged vs. young humans (P < 0.001), as previously reported. Topical applications of the barrier repair emollient significantly enhanced epidermal permeability barrier function (P < 0.01) and stratum corneum hydration (P < 0.05). In parallel, circulating levels of IL-1β and IL-6 normalized, while TNFα levels declined substantially.

CONCLUSION

The results of this preliminary study suggest that a larger clinical trial should be performed to confirm whether improving epidermal function also can reduce circulating pro-inflammatory cytokine levels in aged humans, while also possibly attenuating the downstream development of chronic inflammatory disorders in the aged humans.

Abstract P5-01-01: The effectiveness of breast ultrasonography in cancer screening: A comparison with mammography

Purpose

Mammography(MMG) is a measure of screening that is proven to be effective in lowering death rate in breast cancer validated by randomized control trials. Recently, the number of incidence of breast cancer in Korean women is showing ascending tendency, and also as compared to those in North American and European countries, prevalence age tends to be lower. Since they tend to have much dense breast, MMG alone can hardly be considered as a sufficient measure of breast cancer screening.

The purpose of the study is to study the effectiveness of breast ultrasonography(US) in breast cancer screening in Korean women by investigating the ratio of patients who are diagnosed as malignant in breast US over those who are diagnosed as negative or benign(category 1 and 2) and dense breast(category 0) in MMG.

Materials and Methods

We conducted the retrograde study over 2776 female subjects who had undergone screening MMG in single center in South Korea during the period between Jan, 1st 2010 to Dec, 31st 2016. Female patients are categorized according to BI-RAD category. 164 of subjects were previously undergone a breast cancer surgery, which made them eliminated from the list, and 2612 subjects are finally selected.

Results

Some more 33 subjects are excluded from the list and rest 2579 subject had undergone breast US. Among these, 1133 subjects (43.9%, 1133/2579) correspond to dense breast of BI-RADS category 0, while 303 of them are suspected of category 4 or more. The subjects corresponding to category 1 to 3 are 663, 251 and 229 respectively. 307 of 1133 subjects in category 0 are confirmed as having suspicious lesion based on findings of breast US. Among them, 66 subjects are identified as malignant based on biopsy, which accounts for 5.8% (66/1133). 104 subjects in category 1, are confirmed to have lesions based on findings of breast US, where 25 alone were identified as malignant (3.8%, 25/663). Likewise, 10 (4.0%, 10/251) in category 2 and 13 (5.7%, 13/229) in category 3 are identified.

Subject categorization by BI-RAD systemCategory 0dense breast983  dense breast with calcification94  dense breast with probable mass28  others28  total113343.9%Category 1 66325.7%Category 2 2519.7%Category 3 2298.9%Category 4 or more 30311.7%total 2579100.0%

Malignancy ratio of each category after biopsy totalsuspicious lesion on breast USbiopsy     benignmalignantmalignancy ratioCategory 01133307241665.8% (66/1133)Category 1663104792525 3.8% (25/663)Category 22514131104.0% (10/251)Category 32297259135.7% (13/229)

Conclusion

It appears that 43.9% of total 2579 subjects undergone MMG and breast US are confirmed as dense breast in category 0 and 5.8% of them are diagnosed as breast cancer according to breast US and biopsy. Likewise, for those who are considered as either category 1 or 2, which is negative or benign lesion category, 3.8% are diagnosed as breast cancer. As it is appeared in this study, cancer detection can be more effective in parallel measure of MMG and breast US rather than MMG alone, especially for breast cancer screening of Korean female subjects.

Citation Format: Jeong S, Kim Y, Kim K. The effectiveness of breast ultrasonography in cancer screening: A comparison with mammography [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-01-01.

Improvements in epidermal function prevent relapse of psoriasis: a self-controlled study

While therapeutic approaches for psoriasis are widely available, preventive regimens are lacking. We aimed to determine whether improvements in epidermal function could prevent psoriasis relapse. Two self-controlled cohort studies were designed, enrolling two cohorts of patients with psoriasis (n = 30 and n = 60) to be treated topically with an in-house-prepared emollient or ATOPALM^® cream applied twice daily to one forearm for 20 and 30 days, respectively, while the same sites on the contralateral arm served as the untreated control. Epidermal function on both arms was assessed prior to and at the end of the trials. Delayed relapse on the treated arm was seen in 54.5% and 71% of patients in the first and second cohort, respectively. The time of psoriatic relapse correlated with the extent of abnormalities in baseline epidermal function. These results suggest that improvements in epidermal function with topical emollients can prevent/attenuate the development of psoriasis.

A 2.2 NEF Neural-Recording Amplifier Using Discrete-Time Parametric Amplification

This paper proposes a 2.2 noise efficiency factor (NEF) instrumentation amplifier for neural recording applications. A parametric amplifier based on the MOS C-V characteristic is designed as a pre-amplifier stage, lowering the input referred noise of the following stages by 3.4×. Sampling noise is minimized by oversampling the input signal and switching power is reduced by adopting an 8-phase soft-charging technique.

Development of a new analgesic index using nasal photoplethysmography

Although surrogate measures to quantify pain intensity have been commercialised, there is a need to develop a new index with improved accuracy. The aim of this study was to develop a new analgesic index using nasal photoplethysmography data. The specially designed sensor was placed between the columella and the nasal septum to acquire nasal photoplethysmography in surgical patients. Nasal photoplethysmography and Surgical Pleth Index^® (GE Healthcare) data were obtained for 14 min both in the absence (pre-operatively) or presence (postoperatively) of pain in a group of surgical patients, each patient acting as their own control. Various dynamic photoplethysmography variables were extracted to quantify pain intensity; the most accurate index was selected using logistic regression as a classifier. The area under the curve of the receiver-operating characteristic curve was measured to evaluate the accuracy of final model predictions. In total, 12,012 heart beats from 89 patients were used to develop a new Nasal Photoplethysmography Index for analgesic depth quantification. The two-variable model (a combination of diastolic peak point variation and heart beat interval variation) was most accurate in discriminating between the presence and absence of pain (numerical rating scale (NRS) ≥ 3). The accuracy and area under the curve of the receiver-operating characteristic curve for the Nasal Photoplethysmography Index were 75.3% and 0.8018, respectively, and 64.8% and 0.7034, respectively, for the Surgical Pleth Index. The Nasal Photoplethysmography Index clearly distinguished pain (NRS ≥ 3) in awake surgical patients with postoperative pain. The Nasal Photoplethysmography Index performed better than the Surgical Pleth Index. Further validation studies are needed to evaluate its feasibility to quantify pain intensity during general anaesthesia.

Experimental infection of H5N1 and H5N8 highly pathogenic avian influenza viruses in Northern Pintail (Anas acuta)

The wide geographic spread of Eurasian Goose/Guangdong lineage highly pathogenic avian influenza (HPAI) clade 2.3.4.4 viruses by wild birds is of great concern. In December 2014, an H5N8 HPAI clade 2.3.4.4 Group A (2.3.4.4A) virus was introduced to North America. Long-distance migratory wild aquatic birds between East Asia and North America, such as Northern Pintail (Anas acuta), were strongly suspected of being a source of intercontinental transmission. In this study, we evaluated the pathogenicity, infectivity and transmissibility of an H5N8 HPAI clade 2.3.4.4A virus in Northern Pintails and compared the results to that of an H5N1 HPAI clade 2.3.2.1 virus. All of Northern Pintails infected with either H5N1 or H5N8 virus lacked clinical signs and mortality, but the H5N8 clade 2.3.4.4 virus was more efficient at replicating within and transmitting between Northern Pintails than the H5N1 clade 2.3.2.1 virus. The H5N8-infected birds shed high titre of viruses from oropharynx and cloaca, which in the field supported virus transmission and spread. This study highlights the role of wild waterfowl in the intercontinental spread of some HPAI viruses. Migratory aquatic birds should be carefully monitored for the early detection of H5 clade 2.3.4.4 and other HPAI viruses.

Limited pathogenicity and transmissibility of Korean highly pathogenic avian influenza H5N6 clade 2.3.4.4 in ferrets

The pathogenicity and transmissibility of a reassortant clade 2.3.4.4 avian influenza A (H5N6) virus were evaluated in ferrets. Virus excretion was detected in the upper respiratory tract, but the ferrets did not show any clinical signs of infection. Transmission did not occur between cohoused or respiratory droplet-contact ferrets.

Associations among FADS1 rs174547, eicosapentaenoic acid/arachidonic acid ratio, and arterial stiffness in overweight subjects

We aimed to evaluate the longitudinal interaction effects between the minor allele of FADS1 rs174547 and overweight on n-3 and n-6 long-chain polyunsaturated fatty acid (PUFA) levels and pulse wave velocity (PWV). Plasma PUFA levels were measured via GC-MS, and arterial stiffness was determined as brachial-ankle PWV (ba-PWV) at baseline and after a mean follow-up of 3 years. The FADS1 rs174547 T > C genotype was analyzed. At 3-years of follow-up, after adjustment for age, sex, smoking and drinking, there were interaction effects between the FADS1 rs174547 T > C genotype and baseline BMI on the changes (from baseline) in plasma arachidonic acid (AA) levels, in the eicosapentaenoic acid (EPA)/AA ratio, and in ba-PWV (p for interaction = 0.036, 0.022, and 0.001, respectively). There were smaller increases in AA levels from baseline among normal-weight C allele carriers (n = 112) and overweight TT subjects (n = 47) than among normal-weight TT subjects (n = 91). Overweight C allele carriers (n = 37) showed greater reductions in the plasma EPA/AA ratio and greater increases in ba-PWV than the 3 other populations studied. The minor allele of the FADS1 rs174547 polymorphism is associated with age-related decreases in the EPA/AA ratio and increases in ba-PWV among overweight subjects.

Design, fabrication and space suitability tests of wide field of view, ultra-compact, and high resolution telescope for space application

We report on the design, manufacture, and testing of an ultra-compact telescope for 16 unit (16U) CubeSats for Earth and space observation. This telescope provides 1 arcsec resolution at a 2.9 degree field of view. Dimensions are optimized to 230 × 230 × 330mm³ with a mass of less than 6kg including support structure. Our catadioptric 5-element design consists of a full-aperture corrector, a Mangin primary mirror (PM), a secondary mirror (SM), and a 2-lens field corrector. The focal length is 745mm, and squared-circular aperture has an equivalent diameter of 241mm. The designed modulation transfer function (MTF) is 0.275 for the entire unit including baffles at a Nyquist frequency of 161 cycles/mm for the 450-800nm band. As one of the distinguishing features of our state-of-the-art design, all optical surfaces are spherical to simplify adjustment. For the best thermal stability, all optical elements are produced from fused silica. We describe the details of design, adjustment, and laboratory performance tests for space environments in accordance with the requirements for in-orbit operation onboard Earth-observation micro-satellites to be launched in 2018.

Effects of Ketamine on Icam-1 Expression during Lipopolysaccharide Induced Acute Lung Injury in Rats

Introduction

Intercellular adhesion molecule-1 (ICAM-1) serves very important roles in lung injury, and increases in ICAM-1 are associated with severity of lung injury. We intended to examine whether ketamine could have favourable effects on ICAM-1 expression in lipopolysaccharide (LPS)-induced acute lung injury in the rat.

Methods

The acute lung injury was induced by instilling LPS into the tracheas of 72 anaesthetised rats. The animals were divided into four groups including a sham group with intratracheal saline, an LPS group with intratracheal LPS and intraperitoneal saline, and two ketamine treatment groups with intratracheal LPS and treated with 1 mg/kg or 10 mg/kg doses of intraperitoneal ketamine hydrochloride. Half of the animals were sacrificed at three hours and the remaining animals were sacrificed at six hours. Real time PCR was performed on the lung tissues obtained. Concentration of the soluble ICAM-1 was measured in the bronchoalveolar lavage fluid. Expression of ICAM-1 was measured.

Results

The transcriptional activity of ICAM-1 mRNA increased 9.92 fold in the LPS group compared to the sham group but decreased by 84.1% and 83.3%, respectively, in the 1 and 10 mg/kg ketamine treatment groups. The concentration of soluble ICAM-1 in bronchoalveolar lavage fluid increased 2.23 fold in the LPS group compared to the sham group while decreasing by 75.0% and 74.5% respectively in the 1 mg/kg and 10 mg/kg ketamine treatment groups. The intensity of immunohistochemical staining for ICAM-1 was also decreased in both ketamine treatment groups.

Conclusion

Ketamine attenuates ICAM-1 expression during acute lung injury in rats. (Hong Kong j.emerg.med. 2011;18:397-405)