[Prevalence of frailty and related factors in middle-aged and elderly people in island and mountainous areas of Taizhou, Zhejiang Province]

Objective: To compare the prevalence of frailty and related factors in middle-aged and elderly people aged ≥45 years in island and mountainous areas of Taizhou, Zhejiang Province. Methods: Based on cross-sectional design, stratified cluster sampling and quota sampling methods were adopted. One administrative district was randomly selected from each of six coastal and three inland administrative districts in Taizhou during July to August, representing two different geographical terrains. In the island area (Jiaojiang District), all residents aged ≥45 years were included by cluster sampling. In the mountainous area (Xianju County), participants were selected through quota sampling, with same gender and age distributions. Data about their demographic characteristics, lifestyle and health-related factors were collected through questionnaire surveys and laboratory examinations. The prevalence of frailty was assessed using the Fried frailty phenotype scale. Hierarchical analysis and multivariate logistic regression analysis were used to compare the influencing factors of frailty. Results: A total of 1 011 local residents were studied, in whom island and mountainous residents accounted for 48.1% (486/1 011) and 51.9% (525/1 011) respectively; men and women accounted for 45.9% (464/1 011) and 54.1% (547/1 011) respectively. Middle-aged (45-49 years), younger elderly (60-74 years), and older elderly (≥75 years) residents accounted for 38.6% (390/1 011), 44.6% (451/1 011), and 16.8% (170/1 011) respectively. The overall prevalence rate of frailty was 3.6% (36/1 011), the prevalence rate was 3.7% (17/464) in men and 3.5% (19/547) in women. The prevalence rates in age groups 45-59,60-74 years and ≥75 years were 0.3% (1/390), 2.2% (10/451), and 14.7% (25/170), respectively. The prevalence rates of frailty and pre-frailty in island area were 6.0% (29/486) and 39.1% (190/486), respectively, which was higher than those in mountainous area (1.3%, 7/525) and (30.9%, 162/525). After adjusting for potential confounding factors, the risk for frailty in island residents was significantly higher than that in mountainous residents (aOR=1.55,95%CI: 1.07-2.25,P=0.019). In island area, older age (60-74 years:aOR=2.52,95%CI: 1.56-4.13; ≥75 years:aOR=11.65,95%CI:5.38-26.70), being women (aOR=1.94,95%CI: 1.20-3.17), suffering from depression (aOR=1.09,95%CI:1.02-1.17) were associated with frailty symptoms. In mountainous area, older age was also associated with an increased risk of frailty symptoms, but the OR value was lower than those in island area (60-74 years: aOR=1.74,95%CI:1.04-2.94;≥75 years: aOR=4.78,95%CI:2.45-9.50). Polydrug use (aOR=2.08,95%CI: 1.14-3.80) and suffering from depression (aOR=1.10,95%CI: 1.02-1.18) had significant positive association with frailty symptoms. Higher education level had significant negative association with frailty symptoms (junior high school: aOR=0.40,95%CI: 0.21-0.75; senior high school and technical secondary school: aOR=0.29,95%CI: 0.15-0.53; college or above:aOR=0.22,95%CI: 0.11-0.42). Conclusions: The prevalence of frailty in middle-aged and elderly community residents was significantly higher in island area than in mountainous area in Taizhou. The frailty-related factors varied with area. The elderly people (≥75 years) and women in island area had higher risk for frailty. Older age and suffering from depression were the independent risk factors for frailty. It is necessary to pay attention to the health risk factors and special environment in island area, and take comprehensive intervention measures to delay the process of debilitation and improve the quality of life of middle-aged and elderly people.

[Analysis on death causes of HIV/AIDS patients in Taizhou, Zhejiang Province, 1998-2022]

Objective: To understand the incidence and causes of HIV/AIDS death patients in Taizhou from 1998 to 2022. Methods: The data were collected from the AIDS Integrated Prevention and Control Information System of China Information System for Diseases Control and Prevention and Taizhou Chronic Disease Information Management System. By the end of 2022, a total of 5 126 HIV/AIDS patients living in Taizhou for a long time were included, SAS 9.4 was used for Kruskal-Wallis test, χ2 test and trend analysis. Results: From 1998 to 2022, a total of 796 HIV/AIDS patients died, with a fatality rate of 15.53% (796/5 126), in whom 52.26% (416/796) died within one year after confirmation. The proportion of HIV/AIDS patients who died within one year decreased (trend χ2=5.60, P<0.001). For the constituent of death causes, there were 140 (17.59%) deaths of AIDS, 237 (29.77%) deaths of malignant tumors, 99 (12.44%) deaths of cardiovascular disease, 58 (7.29%) deaths caused by injuries, 160 (20.10%) deaths due to other causes, and 102 (12.81%) deaths due to unknown causes. The constituent ratio of deaths of malignant tumor, cardiovascular disease and other causes increased over time (trend χ2=1.92, P=0.028; trend χ2=2.81, P=0.003; trend χ2=2.07, P=0.020). There were differences in the distribution of death causes in HIV/AIDS cases in terms of age, occupation, marital status, ethnic group, educational level and mode of transmission (all P<0.05). The average age of the death cases due to cardiovascular disease was higher than other death cases, the cases who died from AIDS had shorter survival time and the lower initial CD4+T cells after confirmation compared with all other death cases, and the time interval from confirmation to treatment in HIV/AIDS patients with unknown death causes was longer than those of all other death cases (all P<0.05). Conclusions: The constituent ratio of non-AIDS related deaths in HIV/AIDS patients in Taizhou was relatively high and showed an upward trend during 1998-2022. It is necessary to further strengthen the early screening, prevention and treatment of chronic non infectious diseases.

Octahedral Distortion and Displacement-Type Ferroelectricity with Switchable Photovoltaic Effect in a 3d^{3}-Electron Perovskite System

Because of the half-filled t_{2g}-electron configuration, the BO_{6} octahedral distortion in a 3d^{3} perovskite system is usually very limited. In this Letter, a perovskitelike oxide Hg_{0.75}Pb_{0.25}MnO_{3} (HPMO) with a 3d^{3} Mn^{4+} state was synthesized by using high pressure and high temperature methods. This compound exhibits an unusually large octahedral distortion enhanced by approximately 2 orders of magnitude compared with that observed in other 3d^{3} perovskite systems like RCr^{3+}O_{3} (R=rare earth). Essentially different from centrosymmetric HgMnO_{3} and PbMnO_{3}, the A-site doped HPMO presents a polar crystal structure with the space group Ama2 and a substantial spontaneous electric polarization (26.5  μC/cm^{2} in theory) arising from the off-center displacements of A- and B-site ions. More interestingly, a prominent net photocurrent and switchable photovoltaic effect with a sustainable photoresponse were observed in the current polycrystalline HPMO. This Letter provides an exceptional d^{3} material system which shows unusually large octahedral distortion and displacement-type ferroelectricity violating the "d^{0}-ness" rule.

[Neurocognitive impairment and characteristics of neurocognitive performance among people with HIV on antiretroviral treatment]

Objective: Using two measuring tools to examine the prevalence and correlates of neurocognitive impairment (NCI) as well as characteristics of neurocognitive performance among people with HIV (PWH) on antiretroviral treatment (ART). Methods: A total of 2 250 treated PWH from the Comparative HIV and Aging Research in Taizhou (CHART) were recruited in Taizhou, Zhejiang province. The Chinese version of the Mini-mental State Examination (MMSE) and the International HIV Dementia Scale (IHDS) were used to evaluate their neurocognitive performance. Cluster analysis was conducted on the seven cognitive domains in the scale. Results: Among 2 250 treated PWH, 48.0% (1 080/2 250) were aged 45 to 89, 79.2% (1 782/2 250) were male, and 37.8% (852/2 250) had primary school education or below. The prevalence of neurocognitive impairment judged by MMSE and IHDS among HIV-infected people was 14.3% (321/2 250) and 31.8% (716/2 250), respectively. Aged 60 to 89 (aOR=2.63, 95%CI:1.52-4.56), depressive symptoms (aOR=5.58, 95%CI:4.20-7.40) and treatment with EFV (aOR=2.86, 95%CI:1.89-4.34) were main risk factors of NCI diagnosed by MMSE. Male (aOR=0.71, 95%CI:0.51-1.00), overweight (aOR=0.63, 95%CI:0.44-0.89), and high education level (aOR=0.11, 95%CI:0.05-0.25) were protective factors of NCI diagnosed by MMSE. Aged 60 to 89 (aOR=3.10, 95%CI:2.09-4.59), depressive symptoms (aOR=1.78, 95%CI:1.44-2.20) and treatment with EFV (aOR=1.79, 95%CI:1.41-2.29) were risk factors of NCI diagnosed by IHDS. Male (aOR=0.75, 95%CI:0.58-0.97), underweight (aOR=0.67, 95%CI:0.47-0.96), baseline CD4⁺ T lymphocyte (CD4) counts ≥350 cells/μl (aOR=0.69, 95%CI:0.53-0.91) and high education level (aOR=0.23, 95%CI:0.14-0.39) were protective factors of NCI diagnosed by IHDS. The neurocognitive performance of HIV-infected people can be divided into four main types. Among four types, age, gender, education level, alcohol drinking, depressive symptoms, waist-to-hip ratio, hypertension, diabetes, baseline CD4 counts and treatment with EFV were different statistically (all P<0.05). Conclusions: There are four main types of neurocognitive performance in treated PWH. The prevalence of NCI is high among this population, underscoring the need for tailored prevention and intervention.

[Correlation between HIV infection, club drug use and anal canal human papillomavirus infection in men who have sex with men in Taizhou]

Objective: To explore the correlation between club drug use and anal canal human papillomavirus (HPV) infection in HIV-negative and HIV-positive men who have sex with men (MSM) in Taizhou. Methods: A cross-sectional survey was conducted in Taizhou. HIV-negative MSM were recruited by convenient sampling in voluntary counseling and testing clinics of Taizhou prefectural CDC from August 2016 to October 2017, and HIV-positive MSM were recruited through the routine follow-up and management by Taizhou prefectural CDC from August 2016 to June 2019. A face-to-face questionnaire interview was conducted to collect the information about the socio-demographic characteristics, sexual orientation, sexual behavior, club drug use and other information of the participants. Anal canal swabs were collected for HPV genotyping. The correlation between club drug use and the prevalence of HPV infection were evaluated with χ² test and logistic regression analysis. Results: A total of 69 HIV-negative and 345 HIV-infected MSM were included. The prevalence of any type of anal canal HPV infection in HIV-negative MSM (27.5%, 19/69) was lower than that in HIV-positive MSM (66.4%, 229/345) (χ²=36.114,P<0.001). The prevalence of self-reported club drug use in HIV-negative MSM was higher (17.4%, 12/69) than that in HIV-positive MSM (7.0%, 24/345) (χ²=7.886, P=0.005). For HIV-negative MSM, the prevalence of club drug use was higher in MSM who had homosexual group sex (P=0.036); the prevalence of HPV infection was 50.0% (6/12) in club drug users and 22.8% (13/57) in non-club drug users (χ²=3.674, P=0.055). For HIV-positive MSM, the prevalence of HPV infection was 70.8% (17/24) in club drug users and 66.0% (212/321) in non-club drug users (χ²=0.230, P=0.632). Multivariable logistic regression model showed that HPV infection in MSM was positively correlated with HIV infection (OR=5.42, 95%CI: 2.92-10.06), and the association between HPV infection and club drug use (OR=1.66, 95%CI: 0.75-3.71) was not significant. Conclusions: HIV infection was positively correlated with anal canal HPV infection in MSM in Taizhou. Club drug use was positively correlated with high-risk sexual behaviors, while its association with HPV infection needs further study.

[Machine learning and its epidemiological applications]

As an important branch of artificial intelligence, machine learning is widely used in various fields. Machine learning has similarity to classical statistical methods, but can solve many problems which are difficult for traditional statistics, so it is one of the important tools in epidemiological research. This paper introduced 9 common algorithms of machine learning and summarized their characteristics and applications in epidemiological research. Readers could choose appropriate machine learning method according to the research purpose for the better application of machine learning in epidemiological research.

[HIV-1 drug resistance and subtypes in newly reported HIV/AIDS patients before antiretroviral therapy in Taizhou city, 2016-2018]

Objective: To explore the HIV-1 drug resistance and subtypes in newly reported HIV/AIDS patients before antiretroviral therapy (ART) in Taizhou city. Methods: A cross-sectional study of HIV-1 drug resistance was conducted among newly reported HIV/AIDS patients before ART in Taizhou from January 2016 to December 2018. HIV-1 pol gene sequences were obtained by RT-PCR. The sequences were submitted to the Stanford University drug resistance database. The drug resistance mutation and the sensitivity of HIV-1 strains to antiretroviral drugs were determined according to WHO Guidelines on HIV drug resistance surveillance of 2014. Results: A total of 806 HIV-1 pol gene sequences were obtained successfully. The overall HIV-1 drug resistance rate was 2.9% (23/806), 1.9% for non-nucleoside reverse transcriptase inhibitors (NNRTIs), 0.6% for nucleoside reverse transcriptase inhibitors (NRTIs), and 0.0% for protease inhibitors (PIs), respectively. From 2016 to 2018, the HIV-1 drug resistance rate was 1.6%, 1.8%, and 4.8%, respectively. The resistance mutations of NNRTIs and NRTIs were mainly K103 N (0.7%) and M184I/V (0.5%). HIV-1 subtypes were mostly CRF01_AE (42.7%,344/806),CRF07_BC (28.9%,233/806) and CRF08_BC (11.2%,90/806).HIV-1 subtypes among homosexually transmitted infections were mostly CRF01_AE (53.3%, 136/255) and CRF07_BC (32.2%, 82/255), and HIV-1 subtypes among heterosexually transmitted infections were mainly CRF01_AE (37.7%, 203/539), CRF07_BC (27.5%, 148/539) and CRF08_BC (16.1%, 87/539). Conclusion: HIV-1 drug resistance rate among newly reported HIV/AIDS patients before ART remained low in Taizhou during 2016 to 2018, an increasing trend seemed to be notifiable and warrants continuous surveillance of HIV-1 drug resistance.

[Prevalence and correlates of plasma cytomegalovirus viremia among newly reported HIV/AIDS patients in Taizhou city, 2017-2018]

Objective: To study the prevalence and correlates of plasma cytomegalovirus (CMV) viremia among newly reported antiretroviral therapy (ART)-naive HIV/AIDS patients in Taizhou during 2017-2018. Methods: CMV DNA was measured in plasma specimens of newly reported ART-naive HIV/AIDS patients by quantitative PCR. Both univariable and multivariable logistic regression analyses were carried out to evaluate CMV viremia correlations among the individuals. Results: Of 612 HIV/AIDS patients, 480 (78.4%) were male, 125 (20.4%) were over 60 years old, 177 (28.9%) were infected via homosexual transmission, and 430 (70.3%) via heterosexual transmission. The prevalence of CMV viremia among HIV/AIDS patients was 13.4% (82/612). Multivariable logistic regression analysis showed that the risk of CMV viremia in CD₄⁺ lymphocyte cells counts (CD₄⁺) ≤200 cells/μl group was higher than CD₄ counts >500 cells/μl (OR=5.10, 95%CI:1.74-14.96, P=0.003); The median CMV DNA level (log₁₀) of 82 viremic patients was 1.57 (P₂₅,P₇₅:1.04,2.13); Viremic patients with CD₄ counts ≤200 cells/μl had the highest CMV viral load (P<0.01). Conclusions: Among ART-naive HIV/AIDS patients, the prevalence of CMV viremia was significantly associated with immunodeficiency status. Further research is needed to evaluate the association between CMV viremia and the course of HIV infection.

[Influencing factors of antiretroviral therapy and its association with immunological effect among HIV/AIDS patients in Taizhou city, 2006-2019]

Objective: To analyze influencing factors of instant antiretroviral therapy (ART) and explore associution between strategies of ART and immunological effects among HIV/AIDS patients in Taizhou city during 2006-2019. Methods: A retrospective cohort study was conducted on HIV/AIDS patients under ART, and a logistic regression model was used to analyze factors of instant ART. The student t-test and chi-square test were used to compare immunological effect of different ART strategies while the Kaplan-Meier method was used to generate a survival curve. Results: A total of 2 971 HIV/AIDS patients were enrolled with 1 786 cases (60.1%) having instant ART strategy. The proportion of instant ART were 77.8% (1 170/1 504) during 2016 to 2019. The treatment success rate of the instant ART group (87.4%, 1 561/1 786) were higher than the delayed ART group (84.4%, 1 000/1 185). The results of multivariate logistic regression model indicated that male (aOR=1.28, 95%CI: 1.03-1.59), married (aOR=1.71, 95%CI: 1.33-2.19) and baseline CD(4)(+)T lymphocyte cells (CD(4)) counts ≤200 cells/μl (aOR=1.60, 95%CI: 1.27-2.02) were factors positively related to instant ART while 31-40 years old (aOR=0.63, 95%CI: 0.48-0.84), infected through heterosexual transmission(aOR=0.60, 95%CI: 0.49-0.74) and diagnosed before 2015 (aOR=0.20, 95%CI: 0.17-0.23) were inversely related to instant ART. The increase of the CD(4)/CD(8) ratio was greater, and the cumulative ART success rate was higher each year in the instant ART group than in the delayed ART group (P<0.05). Conclusions: The instant ART strategy has been well implemented in Taizhou city during 2006-2019, and the immunological effect was better in instant ART group. The proportion of instant ART were more than 60.0% among HIV/AIDS patients. Instant ART strategy needs to be strengthened for those who are 31-40 years old, women, unmarried, and infected through heterosexual transmission in an attempt to further increase treatment level and improve treatment effect.

[Risk analysis of immunological failure of antiretroviral therapy in HIV/AIDS patients in Taizhou prefecture, 2006-2019]

Objective: To analyze the immunological failure of antiretroviral therapy (ART), its association with baseline anemia and related factors in HIV/AIDS patients in Taizhou prefecture, during 2006-2019. Methods: A retrospective cohort study was conducted among HIV/AIDS patients under ART. Cox regression model was used to analyze predictors of immunological failure and logistic regression model was used to analyze factors of baseline anemia. Results: A total of 2 904 HIV/AIDS patients were enrolled with a median time of 28 (P(25)-P(75):12-53) months follow-up of ART, in which 177 cases (6.1%) were identified as immunological failure with a failure rate of 2.17 per 100 person-years. The cumulative incidence rates of immunological failure in the first, third, fifth, and tenth years were 5.49%, 6.94%, 7.30% and 8.82%, respectively. Results of multivariate logistic regression analysis showed that for the risk of baseline anemia, ≥66 years old group had 4.17 times higher risk than 18-25 years old group (95%CI: 1.68-10.33), males had 0.67 times higher risk than females (95%CI: 0.50-0.89), and CD(4)(+)T cell counts (CD(4))<200 cells/μl group had 4.35 times higher risk than CD(4)≥350 cells/μl group (95%CI: 2.81-6.72), baseline white blood cells<4.0×10(9) cells/L group had 1.73 times higher risk than 4.0×10(9) cells/L-9.9×10(9) cells/L group (95%CI: 1.31-2.29), baseline platelet counts <100×10(9) cells/L and >300×10(9) cells/L groups had 2.02 times and 4.45 times higher risk than 100×10(9) cells/L-299×10(9) cells/L group (95%CI: 1.36-3.01, 95%CI: 3.05-6.50), respectively. WHO classified stage Ⅲ/Ⅳ group had 2.15 times higher risk than WHO classified stageⅠ/Ⅱ group (95%CI: 1.61-2.87), while heterosexual transmission group had 2.03 times higher risk than homosexual transmission group (95%CI: 1.42-2.92). Results of multivariate cox proportional risk regression showed that for the risk of immunological failure, baseline anemia group had 1.77 times higher risk than no anemia group (95%CI: 1.20-2.60), WHO classified stage Ⅲ/Ⅳ group had 1.66 times higher risk than WHO classified stage Ⅰ/Ⅱ group (95%CI: 1.10-2.48), and withdrawal of follow up and death groups had 3.18 times and 4.61 times higher risks than treatment group (95%CI: 1.96-5.19, 95%CI: 2.98-7.13), respectively. Conclusions: The immunological effect of ART among HIV/AIDS patients in Taizhou prefecture was affected by multiple factors, including anemia, clinical stage and follow-up status. Enhancing surveillance of baseline anemia and timely correction of anemia in elder group can help improve treatment outcome of HIV/AIDS patients.

Role of active cycle of breathing technique for patients with chronic obstructive pulmonary disease: A pragmatic, randomized clinical trial

BACKGROUND

While active cycle of breathing technique for chronic obstructive pulmonary disease patients with more sputum can improve clinic outcomes, less is known about sputum viscosity and sputum production of the intervention.

OBJECTIVE

The purpose of our study was to explore the effect of active cycle of breathing technique on sputum viscosity and production among patients with chronic obstructive pulmonary disease.

DESIGN

This was a two-arms, parallel, randomized clinical trial.

SETTING

Study enrollment, randomization and implementation were conducted in the department of respiratory medicine inpatient at the Medical Center in Changchun, China.

PARTICIPANTS

Hospitalized patients due to chronic obstructive pulmonary disease who met additional eligibility criteria were randomized to active cycle of breathing technique (n = 50) or usual care group (n = 50).

METHODS

Patients in the intervention group received a week-long intervention from an experienced physical therapist. Patients in the usual care group received usual care as well as information and advice in the light of their health plan from respiratory medicine. The primary outcome was the changes on sputum viscosity and production.

RESULTS

Among one hundred patients who were randomized (mean [SD] age, 54.89 [12.06] years; females, 58%), ninety-six participants completed the study. No significant differences were found between two groups on the changes of sputum viscosity (t = 0.277, P = 0.782). And there were insignificant differences between groups in the average amount of sputum among 1 h (Z=-1.848, P = 0.065) and significant differences in the average amount of sputum among 24 h (Z=-2.236, P = 0.025). From admission to one week recovery, the changes in ratio of forced expiratory volume in 1 s to forced vital capacity (Z=-4.511, P<0.0001) and arterial oxygen saturation (Z=-2.997, P = 0.003) were better in active cycle breathing technique group. Total Chronic Obstructive Pulmonary Disease Assessment Test scale were similar among two groups (Z=-1.818, P = 0.069). No adverse events occurred during the study.

CONCLUSION

For patients with chronic obstructive pulmonary disease, active cycle of breathing technique can significantly result in sputum production and respiratory function, especially those of Global Initiative for Chronic Obstructive Lung Disease classification level 3, but did not result in the short-term improvement of sputum viscosity, quality of life and cost effectiveness. Registration number: ChiCTR2000033068.

The effect of orbital-lattice coupling on the electrical resistivity of YBaCuFeO5 investigated by X-ray absorption

Temperature-dependent X-ray absorption near-edge structures, X-ray linear dichroism (XLD) and extended X-ray absorption fine structure (EXAFS) spectroscopic techniques were used to investigate the valence state, preferred orbital and local atomic structure that significantly affect the electrical and magnetic properties of a single crystal of YBaCuFeO5 (YBCFO). An onset of increase of resistivity at ~180 K, followed by a rapid increase at/below 125 K, is observed. An antiferromagnetic (AFM)-like transition is close to the temperature at which the resistivity starts to increase in the ab-plane and is also observed with strong anisotropy between the ab-plane and the c-axis. The XLD spectra at the Fe L3,2-edge revealed a change in Fe 3d eg holes from the preferential [Formula: see text] orbital at high temperature (300-150 K) to the [Formula: see text] orbital at/below 125 K. The analysis of the Fe K-edge EXAFS data of YBCFO further revealed an unusual increase in the Debye-Waller factor of the nearest-neighbor Fe-O bond length at/below 125 K, suggesting phonon-softening behavior, resulting in the breaking of lattice symmetry, particularly in the ab-plane of Fe-related square pyramids. These findings demonstrate a close correlation between electrical resistivity and coupling of the preferred Fe 3d orbital with lattice distortion of a single crystal of YBCFO.

[Prevalence of alcohol use and related factors in HIV positive and HIV negative males]

Objective: To understand the prevalence of alcohol use and related factors in HIV positive and HIV negative males. Methods: Baseline data were from the prospective cohort study of comparative HIV and aging research in Taizhou of Zhejiang province from January to December, 2017. The information about alcohol use in the last month was collected through a face-to-face questionnaire interview. Participants were categorized into non-current drinkers, light/moderate drinkers and heavy drinkers according to the US National Institute on Alcoholism and Alcohol Abuse (NIAAA) standard. Results: A total of 1 367 HIV positive males and 2 418 HIV negative males were included. Current alcohol use rate (35.2%, 481/1 367) and heavy alcohol use rate (5.0%, 24/481) were significantly lower in HIV positive males than in HIV negative males (48.0%, 1 161/2 418; 23.5%, 273/1 161), but the proportion of drinking wine and yellow rice wine were significantly higher (21.8%, 105/481; 9.1%, 44/481) in HIV positive males than in HIV negative males (13.5%, 157/1 161; 5.8%, 67/1 161). The multivariate multinomial logistic regression analysis results showed that larger waist circumference, current smoking and regular physical exercise were associated with heavy alcohol use behavior in HIV positive males, and age ≥30 years, current smoking, regular physical exercise, higher score of depressive symptoms, heterosexual transmission route and baseline CD(4)(+)T cells counts of 200-499 cells/μl were significantly associated with mild/moderate alcohol use behavior in HIV positive males. Conclusions: The alcohol use rate was significantly lower in HIV positive males than in HIV negative males in Taizhou. It is important to strengthen intervention on alcohol drinking behavior and chronic disease risk factors, such as larger waist circumference, smoking and so on.

Superconductivity in a unique type of copper oxide

The mechanism of superconductivity in cuprates remains one of the big challenges of condensed matter physics. High-T c cuprates crystallize into a layered perovskite structure featuring copper oxygen octahedral coordination. Due to the Jahn Teller effect in combination with the strong static Coulomb interaction, the octahedra in high-T c cuprates are elongated along the c axis, leading to a 3dx 2-y 2 orbital at the top of the band structure wherein the doped holes reside. This scenario gives rise to 2D characteristics in high-T c cuprates that favor d-wave pairing symmetry. Here, we report superconductivity in a cuprate Ba2CuO4-y , wherein the local octahedron is in a very exceptional compressed version. The Ba2CuO4-y compound was synthesized at high pressure at high temperatures and shows bulk superconductivity with critical temperature (T c ) above 70 K at ambient conditions. This superconducting transition temperature is more than 30 K higher than the T c for the isostructural counterparts based on classical La2CuO4 X-ray absorption measurements indicate the heavily doped nature of the Ba2CuO4-y superconductor. In compressed octahedron, the 3d3z 2-r 2 orbital will be lifted above the 3dx 2-y 2 orbital, leading to significant 3D nature in addition to the conventional 3dx 2-y 2 orbital. This work sheds important light on advancing our comprehensive understanding of the superconducting mechanism of high T c in cuprate materials.

miRNA-185 regulates retained fetal membranes of cattle by targeting STIM1

Retained fetal membranes (RFM) of cows is an important reproductive disturbance, and is related to miRNA-185. Stromal interaction molecule 1 (STIM1), a potential target gene of miRNA-185, could influence placenta release via regulating Ca²⁺ concentration intracellular. The aim of this study was to explore the mechanism of RFM by investigating the regulatory relationship between miRNA-185 and STIM1 in primary uterine caruncel epithelial (UCE) cells. Serum samples of healthy Holstein dairy cows (n = 20) and RFM cows (n = 12), with a similar age, parity, weight, and milk yield, were collected to detect Ca²⁺ concentration at prepartum 1-5 d and postpartum 6, 12 and 24 h. Caruncle tissues were collected from healthy (n = 6) and RFM cows (n = 6) at 12 h after calving. Quantitative polymerase chain reaction (Q-PCR) and western blotting (WB) were performed to detect the mRNA and protein levels of STIM1, respectively. UCE cells were cultured by the explant culture method, further purified, and subsequently treated with PmirGLO-STIM1-Mut + miRNA-185 mimics and mirGLO-STIM1-Mut + miRNA-185 NC. Q-PCR and WB were performed to detect mRNA and protein levels of STIM1 with treated miRNA-185 mimics. Serum levels of Ca²⁺ from RFM cows were abnormally decreased at prepartum 1 d and postpartum 6, 12 and 24 h. Expression level of STIM1 was down-regulated in the caruncle tissue of RFM cows. The luciferase activity was decresed about 30.9% by miRNA-185 mimics (p < 0.01), and the mRNA and protein levels of STIM1 were downregulated miRNA-185-mimics. It was suggesting that miRNA-185 might play an important role in RFM through regulating the expression of STIM1.

Pharmacogenomics study of thiazide diuretics and QT interval in multi-ethnic populations: the cohorts for heart and aging research in genomic epidemiology

Thiazide diuretics, commonly used antihypertensives, may cause QT interval (QT) prolongation, a risk factor for highly fatal and difficult to predict ventricular arrhythmias. We examined whether common single-nucleotide polymorphisms (SNPs) modified the association between thiazide use and QT or its component parts (QRS interval, JT interval) by performing ancestry-specific, trans-ethnic and cross-phenotype genome-wide analyses of European (66%), African American (15%) and Hispanic (19%) populations (N=78 199), leveraging longitudinal data, incorporating corrected standard errors to account for underestimation of interaction estimate variances and evaluating evidence for pathway enrichment. Although no loci achieved genome-wide significance (P<5 × 10-8), we found suggestive evidence (P<5 × 10-6) for SNPs modifying the thiazide-QT association at 22 loci, including ion transport loci (for example, NELL1, KCNQ3). The biologic plausibility of our suggestive results and simulations demonstrating modest power to detect interaction effects at genome-wide significant levels indicate that larger studies and innovative statistical methods are warranted in future efforts evaluating thiazide-SNP interactions.

Elevated Aminotransferases are Predictors of Hepatic Injury in Blunt Abdominal Trauma Patients

Objective

Computed tomography (CT) scan is currently the most commonly used tool for evaluating solid-organ injuries in trauma management. However, liberal use of CT scanning increases the risk of excess radiation exposure and toxicity from contrast material. Animal studies and clinical research on the paediatric population indicated that liver enzymes elevations were related to hepatic injury. The present study was undertaken to determine whether elevated liver enzymes were associated with the occurrence of hepatic injury in adult patients with blunt abdominal trauma.

Methods

This is a cross-sectional study from August 2003 to October 2006. All adult patients with blunt injury to abdomino-pelvic organs documented by CT or surgery who were admitted to Chi-Mei Medical Centre in the captioned period were included. The study population sorted to hepatic injury (HI) and no hepatic injury (NHI) groups according to the presence or absence of hepatic injury. Variables including liver enzymes were compared between the groups.

Results

Totally 419 patients were included, including 150 patients in the HI group and 269 patients in the NHI group. The HI group was younger and had a lower rate of laparotomy (36.3 years old vs 41.4 years old; 26% vs 42%, respectively). The mean levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the HI group were significantly higher than levels in the NHI group (439.6 IU/L vs 104.7 IU/L; 353.5 IU/L vs 76.6 IU/L, p<0.01). We define AST >200 IU/L or ALT level >125 IU/L as abnormal according to previous studies. The diagnostic characteristics of hepatic injury were 87.3% sensitivity, 80.3% specificity, 71.2% positive predictive value, and 91.9% negative predictive value.

Conclusion

In adults who have experienced blunt abdominal trauma, AST >200 U/L or of ALT >125 U/L are practical predictors of hepatic injury. Screening serum aminotransferases will have a role in detecting occult hepatic injury and may reduce the hazards of excessive CT scanning. (Hong Kong j.emerg.med. 2013;20:337-342)

Severe Hyperemesis Gravidarum Masking the Presentations of Hyperthyroidism

Hyperemesis gravidarum may present with weight loss and tachycardia secondary to dehydration. Its severity correlates with the level of the serum chorionic gonadotropin which can interfere with the assay of the thyroid stimulating hormone. Therefore, hyperemesis gravidarum are at times difficult to be distinguished from hyperthyroidism. Missing hyperthyroidism during pregnancy results not only in inappropriate maternal care, but adverse neonatal outcomes including low birth weight. The authors report a case of hyperemesis gravidarum complicated by the concurrence of hyperthyroidism. Goiter and refractory tachycardia are the useful clues to detect occult hyperthyroidism in patients with hyperemesis gravidarum.

Biochemical characteristics of newborns with carnitine transporter defect identified by newborn screening in California

Carnitine transporter defect (CTD; also known as systemic primary carnitine deficiency; MIM 212140) is due to mutations in the SLC22A5 gene and leads to extremely low carnitine levels in blood and tissues. Affected individuals may develop early onset cardiomyopathy, weakness, or encephalopathy, which may be serious or even fatal. The disorder can be suggested by newborn screening. However, markedly low newborn carnitine levels can also be caused by conditions unrelated to CTD, such as the low carnitine levels often associated with normal pregnancies and some metabolic disorders occurring in the mother. In order to clarify the biochemical characteristics most useful for identification of CTD in newborns, we examined California Department of Public Health newborn screening data for CTD from 2005 to 12 and performed detailed chart reviews at six metabolic centers in California. The reviews covered 14 cases of newborn CTD, 14 cases of maternal disorders (CTD, 6 cases; glutaric aciduria, type 1, 5; medium-chain acyl CoA dehydrogenase deficiency, 2; and cobalamin C deficiency, 1), and 154 false-positive cases identified by newborn screening. Our results show that newborns with CTD identified by NBS exhibit different biochemical characteristics, compared to individuals ascertained clinically. Newborns with CTD may have NBS dried blood spot free carnitine near the lower cutoff and confirmatory plasma total and free carnitine levels near the normal lower limit, particularly if obtained within two weeks after birth. These findings raise the concern that true cases of CTD may exist that could have been missed by newborn screening. CTD should be considered as a possible diagnosis in cases with suggestive clinical features, even if CTD was thought to be excluded in the newborn period. Maternal plasma total carnitine and newborn urine total carnitine values are the most important predictors of true CTD in newborns. However, biochemical testing alone does not yield a discriminant rule to distinguish true CTD from low carnitine in newborns due to other causes. Because of this biochemical variability and overlap, molecular genetic testing is imperative to confirm CTD in newborns. Additionally, functional testing of fibroblast carnitine uptake remains necessary for cases in which other confirmatory testing is inconclusive. Even with utilization of all available diagnostic testing methods, confirmation of CTD ascertained by NBS remains lengthy and challenging. Incorporation of molecular analysis as a second tier step in NBS for CTD may be beneficial and should be investigated.

[Investigation of group sex in men who have sex with men in Taizhou, Zhejiang province, 2013-2015]

Objective: To understand the prevalence of group sex in men who have sex with men (MSM) and related factors in Taizhou, Zhejiang province. Methods: From March 2013 to September 2015, a cross-sectional survey was conducted among MSM recruited from gay bars or bath houses in Taizhou by using questionnaire to collect the information about their sexual behavior and HIV test. Results: A total of 1 435 MSM were recruited, 179 of them (12.5%) were HIV infected, 231 (16.1%) reported group sex during the past year. Compared with MSM without group sex, more MSM with group sex had more than ten male sexual partners (53.7% vs. 19.0%, χ(2)=125.527, P<0.01), had both male and female sexual partners (86.6% vs. 68.2%, χ(2)=31.935, P<0.01), used no condom at sex with female partners during the past year (28.1% vs. 19.8%, χ(2)=6.540, P<0.05). After adjusted for educational level and occupation, group sex was associated with age[≥50 years old vs. ≤24 years old, adjusted odds ratio (aOR)=2.25, P=0.027], marriage with female (divorced or widowedvs. unmarried, aOR=0.29, P=0.001), census registering (local resident vs. non-local resident, aOR=1.56, P=0.023), number of male seuxal partners (≥21 vs. 2-5, aOR=8.06, P<0.001; 11-20 vs. 2-5, aOR=3.25, P<0.001) and number of female seuxal partners (≥6 vs. 0, aOR=2.63, P=0.005; 2-5 vs. 0, aOR=2.58, P=0.001; 1 vs. 0, aOR=2.01, P=0.010). Conclusion: The prevalence of group sex in MSM was high in Taizhou, and their poor condom use and complex sex behaviors would result in higher HIV infection rate and risk of transmission.

[Use of noninvasive high-frequency oscillatory ventilation in very low birth weight infants]

Objective: To evaluate the effectiveness and safety of the use of noninvasive high-frequency oscillation ventilation (nHFOV) in very low birth weight infants. Method: A total of 36 cases received nHFOV between January 2016 and October 2016 in Children's Hospital, Zhejiang University School of Medicine, including 24 males and 12 females, with the gestational age of (27.5±2.5) weeks and birth weight of(980±318)g. The data of the ventilator settings, side effects, and changes of the respiratory function before and after nHFOV were collected and analyzed retrospectively. Nonparametric tests or t tests or χ(2) tests were used. Result: Thirty-two (89%) out of the 36 cases successfully avoided intubation or re-intubation after using of nHFOV. nHFOV was used as the rescue treatment after failure of other noninvasive ventilation in 17 cases, and as the prophylactical treatment preventing re-intubation after extubation in the remaining 19 cases. There were significant decreases in the incidences of apnea and desaturation(SpO(2)<0.85), the level of PaCO(2, )and the FiO(2) 24 h after the initiation of the nHFOV as the rescue therapy((1.2±1.1)vs.(6.3±2.1)episodes , (1.1±1.2) vs.(4.3±1.5) episodes, (43±8) vs.(56±10) mmHg, 0.30±0.07 vs. 0.39±0.11, respectively; 1 mmHg=0.133 kPa, t=7.562, 8.913, 4.179, 3.437 respectively, all P<0.01). No significant changes were found in FiO(2) and PaCO(2) levels 24 h after initiation of nHFOV as the prophylactical therapy after extubation (0.42±0.12 vs.0.40±0.10, (49±8)vs.(48±7)mmHg, t=0.872 and 0.501 respectively, both P>0.05), except for the significant decreases in the mean airway pressure ((7.9±2.6)vs.(9.6±1.6)cmH(2)O, 1 cmH(2)0=0.098 kPa, t=2.198, P=0.041). There were 4 cases suffered from nasal septum injury, while no other nHFOV related complications were noted. Conclusion: nHFOV can be applied in preterm infants as a rescue treatment after the failure of other noninvasive ventilation, or prophylactically used in patients who have high risk of re-intubation.

[Visual impact of sub-tenon's anesthesia during surgery for retinal detachment]

Objective: To investigate the visual impact and influence factors of sub-Tenon's anesthesia in retinal detachment patients during pars plana vitrectomy (PPV) or combined phacoemulsification and PPV surgery. Methods: In this prospective case series study, 104 consecutive patients who underwent PPV or combined phacoemulsification and PPV under sub-Tenon's anesthesia between October 2012 and December 2013 were enrolled. Intraoperatively, the patients were asked whether they could see the light of the operating microscope or not at 5 minutes after sub-Tenon's anesthesia, and at the end of phacoemulsification, core vitreous removal, peripheral vitreous removal and the whole surgery, with their contralateral eyes being covered tightly and no photobleaching. The best corrected visual acuity and visual evoked potentials were examined and compared with each other preoperatively and at 1.5 months and 3 months postoperatively. Chi-square test was used to compare the detection rate of amaurosis between different modus operandi and whether covered contra-lateral eye. Student-t test was used to compare the difference of age and preoperative BCVA between the patients with or without experienced amaurois. Lastly, BCVA between different times were tested by one-way ANOVA analysis. Results: Without covering the contralateral eyes, the incidence of no light perception in various surgical steps was 0%, while it was 72.1%(75/104), 93.8%(75/80), 96.2%(100/104), 96.2%(100/104) and 86.5%(90/104) at the five timepoints, respectively, when the contralateral eyes were covered tightly. The incidence was 51.9%(54/104), 85.0%(68/80), 85. 6%(89/104), 84.6%(69/104) and 66.3%(88/104), respectively, after photobleaching was excluded. Approximately 95.2%(99/104) of patients reported no light perception at least once, 54.5%(54/99) reported no light perception 5 minutes after sub-Tenon's anesthesia, and 30.3%(30/99) recovered light perception when the surgery was finished. All eyes recovered to at least light perception on the first postoperative day. The best corrected visual acuity and visual evoked potentials at 1.5 months and 3 months postoperatively were significantly better than those before surgery. The BCVA was 1.75±0.78 preoperative, 0.96±0.63 1.5 months after operation, and 0.92±0.57 3 months after operation. There was a significant statistical difference between preoperative BCVA and postoperative BCVA (F=50.61, P<0.01) . In patients without waveform detection preoperatively, PVEP waveform could be found in 43.6% and 61.4% of the pactients at 1.5 months and 3 months after operation respectively. In those had certain waveform preoperatively, PVEP amplitudes rise significantly after surgery (t(1.5)=-2.69, t(3)=-2.97, P<0.05) . Conclusions: No light perception was detected in various surgical steps of vitrectomy under sub-Tenon's anesthesia in most patients. The blocking of optic nerve conduction may be caused by sub-Tenon' s anesthesia. Photobleaching can also have some effect. The incidence of no light perception during the surgery was not correlated with preoperative visual acuity, age and gender. Moreover, the effect was transient and harmless to visual function.(Chin J Ophthalmol, 2017, 53: 332-337).

Concurrent hypopituitarism and leukemic retinopathy in a child with B-precursor acute lymphoblastic leukemia and isolated central nervous system relapse

Hypopituitarism in leukemia is very rare. In addition, central nervous system (cns) relapse and leukemic retinopathy in childhood acute lymphoblastic leukemia (all) have declined with the use of modern systemic chemotherapy that includes cns prophylaxis. Here, we report the case of a 4-year-old girl who received chemotherapy and intrathecal therapy without cns radiation after a diagnosis of B-precursor all without cns involvement. Three months after chemotherapy completion, she presented with lower-extremity weakness and was diagnosed with an isolated cns relapse. Concurrent hypopituitarism and leukemic retinopathy were also found. After receiving craniospinal radiotherapy and systemic chemotherapy, her retinopathy and vision improved. She is now in complete remission, and she is still on chemotherapy according to the guideline from the Pediatric Oncology Group. Although rare, hypopituitarism and leukemic retinopathy should be taken into consideration in patients with cns involvement by leukemia.

Proteomic changes in maize as a response to heavy metal (lead) stress revealed by iTRAQ quantitative proteomics

Lead (Pb), a heavy metal, has become a crucial pollutant in soil and water, causing not only permanent and irreversible health problems, but also substantial reduction in crop yields. In this study, we conducted proteome analysis of the roots of the non-hyperaccumulator inbred maize line 9782 at four developmental stages (0, 12, 24, and 48 h) under Pb pollution using isobaric tags for relative and absolute quantification technology. A total of 252, 72 and 116 proteins were differentially expressed between M12 (after 12-h Pb treatment) and CK (water-mocked treatment), M24 (after 24-h Pb treatment) and CK, and M48 (after 48-h Pb treatment) and CK, respectively. In addition, 14 differentially expressed proteins were common within each comparison group. Moreover, Cluster of Orthologous Groups enrichment analysis revealed predominance of the proteins involved in posttranslational modification, protein turnover, and chaperones. Additionally, the changes in protein profiles showed a lower concordance with corresponding alterations in transcript levels, indicating important roles for transcriptional and posttranscriptional regulation in the response of maize roots to Pb pollution. Furthermore, enriched functional categories between the successive comparisons showed that the proteins in functional categories of stress, redox, signaling, and transport were highly up-regulated, while those in the functional categories of nucleotide metabolism, amino acid metabolism, RNA, and protein metabolism were down-regulated. This information will help in furthering our understanding of the detailed mechanisms of plant responses to heavy metal stress by combining protein and mRNA profiles.

Clinical manifestations in patients with alpha-fetoprotein-producing gastric cancer

BACKGROUND

Patients with alpha-fetoprotein (afp)-producing gastric cancer have a high incidence of liver metastasis and poor prognosis. There is some controversy about clinical manifestations in these patients.

METHODS

Our study enrolled patients who, before surgery, had gastric cancer with serum afp exceeding 20 ng/mL [afp>20 (n = 58)] and with serum afp 20 ng/mL or less [afp≤20 (n = 1236)]. Clinical manifestations were compared between the groups.

RESULTS

Early gastric cancer was more frequent (30.1% vs. 4%) and advanced gastric cancer was less frequent (69.9% vs. 96%) in the afp≤20 group than the afp>20 group (p < 0.001). Liver and lymph node metastasis occurred less frequently in the afp≤20 group (4.4% vs. 27.6%, p < 0.001, and 60.7% vs. 91.4%, p < 0.001, respectively). The 1-, 3-, 5-, and 10-year survival rates of afp≤20 patients were 75.2%, 53.4%, 45.8%, and 34.6% respectively. The 1-, 3-, 5-, and 10-year survival rates of patients with afp greater than 20 ng/mL, but 300 ng/mL or less, were 46.7%, 28.9%, 17.8%, and 13.3% respectively. The 1-, 3-, and 5-year survival rates of patients with serum afp greater than 300 ng/mL were 15.4%, 7.7%, and 0% respectively. The independent predictors for survival time were afp concentration, age, peritoneal seeding, liver metastasis, lymph node metastasis, vascular invasion, TNM stage, curative surgery, serosal invasion, and Lauren classification.

CONCLUSIONS

Patients with high serum afp had a high frequency of liver and lymph node metastasis and very poor prognosis. More aggressive management with multimodal therapy (for example, chemotherapy, radiotherapy) might be needed when treating such patients.

Ferromagnetic interfacial interaction and the proximity effect in a Co2FeAl/(Ga,Mn)As bilayer

The magnetic properties of a Co2FeAl/(Ga,Mn)As bilayer epitaxied on GaAs (001) are studied both experimentally and theoretically. Unlike the common antiferromagnetic interfacial interaction existing in most ferromagnet-magnetic semiconductor bilayers, a ferromagnetic interfacial interaction in the Co2FeAl/(Ga,Mn)As bilayer is observed from measurements of magnetic hysteresis and x-ray magnetic circular dichroism. The Mn ions in a 1.36 nm thick (Ga,Mn)As layer remain spin polarized up to 400 K due to the magnetic proximity effect. The minor loops of the Co2FeAl/(Ga,Mn)As bilayer shift with a small ferromagnetic interaction field of +24 Oe and -23 Oe at 15 K. The observed ferromagnetic interfacial coupling is supported by ab initio density functional calculations. These findings may provide a viable pathway for designing room-temperature semiconductor spintronic devices through magnetic proximity effect.

Cerebral “eThrombosis”: Cerebral Venous Sinus Thrombosis Associated with Prolonged Sitting in Front of a Computer

Venous thromboembolism caused by prolonged sitting during air travel has been recognised as economy-class syndrome for more than 30 years. Since 2003, the term “eThrombosis” has been proposed to describe the 21st Century variant of venous thromboembolism associated with immobilisation. We reported a case of cerebral venous sinus thrombosis presenting with severe headache after a prolonged period of sitting for over 12 hours in front of a computer for recreational purpose. We described this case as cerebral “eThrombosis”. Considering the widespread use of computers for many purposes including working, recreation and communications in the present digital era, we would like to put forward that prolonged immobilisation associated with computer use is a possible provoking risk factor of cerebral venous sinus thrombosis.

Severe Hyperemesis Gravidarum Masking the Presentations of Hyperthyroidism

Hyperemesis gravidarum may present with weight loss and tachycardia secondary to dehydration. Its severity correlates with the level of the serum chorionic gonadotropin which can interfere with the assay of the thyroid stimulating hormone. Therefore, hyperemesis gravidarum are at times difficult to be distinguished from hyperthyroidism. Missing hyperthyroidism during pregnancy results not only in inappropriate maternal care, but adverse neonatal outcomes including low birth weight. The authors report a case of hyperemesis gravidarum complicated by the concurrence of hyperthyroidism. Goiter and refractory tachycardia are the useful clues to detect occult hyperthyroidism in patients with hyperemesis gravidarum.

Capnography: An Accurate Method to Assess the Position of the Feeding Tube in a Porcine Model

Objective

To test the accuracy of capnography in the differential placement of feeding tubes into the trachea versus the oesophagus.

Method

Nineteen pigs were anesthetised, and feeding tubes were placed into their tracheas and oesophagi. A naïve examiner attached a capnography to the tube and evaluated the presence or absence of flow waveforms on the capnography. In the next step experiment, we gave 20 intentional oesophageal ventilations to the animals to create a distended stomach. The feeding tubes were reinserted, and examined by a naïve examiner by capnography.

Results

Capnography demonstrated continuous flow waveforms for the feeding tubes placed in the tracheas, but no waveforms were observed for those placed in the oesophagi. In the next step experiment, we found the same results.

Conclusion

Capnography can be used to accurately determine the placement of tracheal versus oesophageal feeding tubes based on the presence or absence of flow waveforms.

Orthorhombic BiFeO3

A new orthorhombic phase of the multiferroic BiFeO3 has been created via strain engineering by growing it on a NdScO(3)(110)(o) substrate. The tensile-strained orthorhombic BiFeO3 phase is ferroelectric and antiferromagnetic at room temperature. A combination of nonlinear optical second harmonic generation and piezoresponse force microscopy revealed that the ferroelectric polarization in the orthorhombic phase is along the in-plane {110}(pc) directions. In addition, the corresponding rotation of the antiferromagnetic axis in this new phase was observed using x-ray linear dichroism.

Microscopic origin of the giant ferroelectric polarization in tetragonal-like BiFeO(3)

We report direct experimental evidence for a room-temperature, ∼130  μC/cm(2) ferroelectric polarization from the tetragonal-like BiFeO(3) phase. The physical origin of this remarkable enhancement of ferroelectric polarization has been investigated by a combination of x-ray absorption spectroscopy, scanning transmission electron microscopy, and first principles calculations. A large strain-induced Fe-ion displacement relative to the oxygen octahedra, combined with the contribution of Bi 6s lone pair electrons, is the mechanism driving the large ferroelectric polarization in this tetragonal-like phase.

Extremely high phenylalanine levels in a newborn on parenteral nutrition: phenylketonuria in the neonatal intensive care unit

A 1890-g newborn on total parenteral nutrition (TPN) had phenylalanine levels reaching 4164 μM indicating phenylketonuria (PKU). Review of 64 PKU cases from the California Newborn Screening Program disclosed another newborn diagnosed while on TPN. Phenylalanine levels rose five times faster with TPN, as estimated from rates in these infants. Thus, TPN use is associated with very high phenylalanine levels in newborns with PKU. When starting TPN soon after birth (for example, on day 1), early detection of PKU-by newborn screening 12 to 24 h after infusions are begun-should be helpful in limiting exposures to toxic levels of phenylalanine.

Effects of temperature and dissolved oxygen on sludge properties and their role in bioflocculation and settling

Effects of temperature (mesophilic (35 °C) vs. thermophilic (55 °C)) and dissolved oxygen (DO) concentration (under thermophilic conditions) on sludge properties and their role in bioflocculation and settling were studied using well-controlled sequencing batch reactors fed with a synthetic wastewater comprised of glucose and inorganic nutrients. Under a similar DO level, thermophilic sludge had a poorer bioflocculating ability and settleability than that of mesophilic sludge. Under a thermophilic condition, an increase in DO level led to a poorer settleability and a slightly improved bioflocculating ability. A poorer settleability was related to a higher level of filaments. Analysis of bound extracellular polymeric substances (EPS) indicates that thermophilic sludge had a higher level of total bound EPS content than that of mesophilic sludge under a similar DO level, and an increase in DO resulted in an increase in total bound EPS content in thermophilic sludge. Surface analysis of sludge by X-ray photoelectron spectroscopy (XPS) suggests that significant differences in the surface concentrations of elements N, C, O were observed between thermophilic and mesophilic sludge, implying significant differences in bound EPS composition. The results of gel permeation chromatography indicate that the weight-averaged molecular weight (M(w)) of bound EPS covered a range of 1159 Da to 13220 Da. The distribution of EPS "species" at floc surfaces was shown by transmission electron microscopy (TEM) to be uneven; different kinds of nanoscale materials were distributed in a patchy manner at the floc-water interface. The results suggest that it is the role of specific EPS molecules rather than the quantity of bound EPS that determine the difference in bioflocculation behavior between thermophilic and mesophilic sludge. The strategy of increasing the DO level could not solve the biomass separation problems associated with thermophilic sludge.

Effects of temperature and dissolved oxygen on sludge properties and their role in bioflocculation and settling

Effects of temperature (mesophilic (35 °C) vs. thermophilic (55 °C)) and dissolved oxygen (DO) concentration (under thermophilic conditions) on sludge properties and their role in bioflocculation and settling were studied using well-controlled sequencing batch reactors fed with a synthetic wastewater comprised of glucose and inorganic nutrients. Under a similar DO level, thermophilic sludge had a poorer bioflocculating ability and settleability than that of mesophilic sludge. Under a thermophilic condition, an increase in DO level led to a poorer settleability and a slightly improved bioflocculating ability. A poorer settleability was related to a higher level of filaments. Analysis of bound extracellular polymeric substances (EPS) indicates that thermophilic sludge had a higher level of total bound EPS content than that of mesophilic sludge under a similar DO level, and an increase in DO resulted in an increase in total bound EPS content in thermophilic sludge. Surface analysis of sludge by X-ray photoelectron spectroscopy (XPS) suggests that significant differences in the surface concentrations of elements N, C, O were observed between thermophilic and mesophilic sludge, implying significant differences in bound EPS composition. The results of gel permeation chromatography indicate that the weight-averaged molecular weight (M(w)) of bound EPS covered a range of 1159 Da to 13220 Da. The distribution of EPS "species" at floc surfaces was shown by transmission electron microscopy (TEM) to be uneven; different kinds of nanoscale materials were distributed in a patchy manner at the floc-water interface. The results suggest that it is the role of specific EPS molecules rather than the quantity of bound EPS that determine the difference in bioflocculation behavior between thermophilic and mesophilic sludge. The strategy of increasing the DO level could not solve the biomass separation problems associated with thermophilic sludge.

Characteristics of different fractions of microbial flocs and their role in membrane fouling

Characteristics of different fractions (small flocs vs. large flocs) of sludge flocs from a submerged anaerobic membrane bioreactor treating thermomechanical pulping (TMP) whitewater were determined using various analytic techniques, including extraction and chemical analysis of extracellular polymeric substances (EPS), particle size analyzer, and polymer chain reaction (PCR)-denaturing gradient gel electrophoresis (DGGE). The results showed that the fraction of smaller flocs contained a higher level of bound EPS and had a higher fractal dimension as compared to the fraction of larger flocs. PCR-DGGE analysis indicated that there were significant differences in microbial community between the fraction of smaller flocs and large flocs. The microbial community of the smaller flocs was similar to that of the sludge cake layers, indicating the pioneering role of the microbial community in smaller flocs in membrane fouling. These findings provide a new insight in the difference of membrane fouling potential between smaller flocs and larger flocs fraction.

Construction of root library by SSH and preliminary analysis of genes responsible for phosphorus deficiency in maize

An elite maize inbred line with high tolerance to low phosphorus, 178, was studied for constructing root library and analyzing some genes closely related to phosphorus (P) deficiency using SSH and Semi-quantitative RT-PCR. As a result, 3648 preliminary clones were obtained for root library under stress of P deficiency. By DNA sequencing of 34 random clones, we obtained 23 unique EST sequences which are involved in functions of root cell structure, tolerance and defense, protein modification and composition, transcription regulation, metabolism, and other unknown aspects. Five representative genes were further analyzed for their expression models. The results suggested that the molecular mechanism to adapt P deficiency in maize, performed by multi-genes with different contributions, is similar to rice, Arabidopsis and soybean. The expression order of 5 low P tolerant genes in maize root was PAP, GCS, TOM, PDI and AIP. And it was considered preliminarily that physiological and biochemical changes were prior to morphologic changes in maize root and the essential tolerance to low P may be determined by extending absorption of P to wide soil range through adaption of root architecture and root secretions, which is the greatest difference between tolerant and sensitive maize varieties under low P stress.

Performance and fouling characteristics of a submerged anaerobic membrane bioreactor for kraft evaporator condensate treatment

Submerged anaerobic membrane bioreactor (SAnMBR) technology was studied for kraft evaporator condensate treatment at 37 +/- 1 degrees C over a period of 9 months. Under tested organic loading rates of 1-24 kg COD/m3/day, a chemical oxygen demand (COD) removal efficiency of 93-99% was achieved with a methane production rate of 0.35 +/- 0.05 L methane/g COD removed and a methane content of 80-90% in produced biogas. Bubbling of recycled biogas was effective for in-situ membrane cleaning, depending on the biogas sparging rate used. The membrane critical flux increased and the membrane fouling rate decreased with an increase in the biogas sparging rate. The scanning electron microscopy images showed membrane pore clogging was not significant and sludge cake formation on the membrane surface was the dominant mechanism of membrane fouling. The results suggest that the SAnMBR is a promising technology for energy recovery from kraft evaporator condensate.

Treatment of kraft evaporator condensate using a thermophilic submerged anaerobic membrane bioreactor

The feasibility of using a thermophilic submerged anaerobic membrane bioreactor (SAnMBR) for kraft evaporator condensate treatment was studied at 55+/-1 degrees C over 6.5 months. Under tested organic loading rate of 1-7 kg COD/m(3) day, a soluble COD removal efficiency of 85-97% was obtained. The methane production rate was 0.35+/-0.1 L methane/g COD and the produced biogas was of excellent fuel quality with 80-90% methane. A higher membrane fouling rate was related to the presence of a larger portion of fine colloidal particles (1-10 mum). The thermophilic SAnMBR was sensitive to the presence of toxic compounds in feed and unexpected pH probe failure (leading to a higher pH). Feed toxic shock caused sludge deflocculation and thus deteriorated membrane performance. Operating the reactor as a conventional anaerobic reactor to waste some of the fine flocs in treated effluent during the start-up process was an effective strategy to reduce membrane fouling. The experimental results from this study indicate that treatment of kraft evaporator condensate is feasible in terms of COD removal and biogas production using thermophilic SAnMBRs but pre-treatment may be needed to remove toxic sulfur compounds and membrane fouling caused by the large portion of fine particles may be a challenge.

Decrease of bone morphogenetic protein-7 (BMP-7) and its type II receptor (BMP-RII) in kidney of type 1-like diabetic rats

Bone morphogenetic protein-7 (BMP-7) expression is known to be protective for renal damage during diabetic nephropathy and disappears early during the progression of diabetic nephropathy. However, changes in expression of BMP-7 and BMP-7 type II receptor (BMP-RII) during kidney nephropathy response to high glucose-induced oxidative stress remain unclear. In this study, we used streptozotocin-induced diabetic rats with diabetic nephropathy and treated them with insulin, phloridzin, or antioxidant tiron. The insulin, phloridzin, or tiron treatment improved the renal function and decreased fibronectin expression in the streptozotocin-induced diabetic rats. Both insulin and phloridzin could reverse the attenuation effects of hyperglycemia on BMP-7 and BMP-RII expressions in the kidneys of streptozotocin-induced diabetic rats through the correction of hyperglycemia. However, the decrease of BMP-7 and BMP-RII expressions in kidney of streptozotocin-induced diabetic rats could be reversed by tiron through decreasing the high glucose-induced oxidative stress but not through changing the levels of glucose. We further confirmed the effect on reversing the BMP-7 and BMP-RII expressions through decreasing oxidative stress by tiron treatment in high glucose exposed mesangial cells. Thus, we suggest that a decrease in oxidative stress is responsible for the improvement of renal function and recovery of renal BMP-7 and BMP-RII expression in streptozotocin-induced diabetic rats.

Sludge properties and their effects on membrane fouling in submerged anaerobic membrane bioreactors (SAnMBRs)

Two submerged anaerobic membrane bioreactors (SAnMBRs) (thermophilic vs. mesophilic) were operated for a period of 3.5 months with kraft evaporator condensate at a feed chemical oxygen demand of 10,000 mg/L. The results show that the filtration behavior of the two systems was significantly different. The filtration resistance in the thermophilic SAnMBR was about 5-10 times higher than that of the mesophilic system when operated under similar hydrodynamic conditions. Comparison of sludge properties and cake layer structure from the two systems was made to elucidate major factors governing the different filtration characteristics. There were more soluble microbial products (SMP) and biopolymer clusters (BPC) produced and a larger portion of fine flocs (<15 microm) in the thermophilic SAnMBR. Analysis of bound extracellular polymeric substances (EPS) showed that the thermophilic sludge had a higher protein/polysaccharide ratio in EPS, as compared to that in the mesophilic sludge. A series of analyses, including Fourier transform infrared (FTIR) spectroscopy, energy dispersive X-ray spectroscopy (EDX), confocal laser scanning microscopy (CLSM), scanning electron microscopy (SEM), atomic force microscopy (AFM) and particle size analyzer showed that the cake layer formed in the thermophilic SAnMBR contained higher levels of both organic and inorganic foulants, smaller particle sizes, and especially, a denser and more compact sludge cake structure. These results indicate that floc size, SMP, BPC, bound EPS as well as cake layer structure are the major factors governing membrane fouling in SAnMBR systems.

A Bayesian hierarchical model for classifying craniofacial malformations from CT imaging

Single-suture craniosynostosis is a condition of the sutures of the infant's skull that causes major craniofacial deformities and is associated with an increased risk of cognitive deficits and learning/language disabilities. In this paper we adapt to classification of synostostic head shapes a Bayesian methodology that overcomes the limitations of our previously published shape representation and classification techniques. We evaluate our approach in a series of large-scale experiments and show performance superior to those of standard approaches such as Fourier descriptors, cranial spectrum, and Euclidian-distance-based analyses.

Thermally or magnetically induced polarization reversal in the Multiferroic CoCr2O4

We report the unexpected evolution, with thermal and magnetic-field (H) variations, of the interrelation between the polarization P, magnetization M, and spiral wave vector Q in CoCr2O4, which has a ferrimagnetic conical-spiral magnetic order. For example, P suddenly jumps and changes its sign at the magnetic lock-in transition (T_{L}) with thermal variation, or with isothermal variation of H (without changing its direction) at T_{L}, which surprisingly occurs without change in spiral handedness (i.e., the sign of Q). The presence of multiple spiral sublattices may be behind this unusual behavior.

Detection of oesophageal intubations using cuff pressures in a pig trachea–oesophagus model

BACKGROUND

The cuff pressures may be different in oesophageal and tracheal intubations. We conducted a study to evaluate if cuff pressures of endotracheal tubes (ETTs) could provide information to distinguish tracheal or oesophageal intubations in a pig trachea-oesophagus model.

METHODS

In each preparation of pig trachea-oesophagus model, the trachea and the oesophagus were intubated separately with a cuffed ETT, and the cuff pressures were measured after each 1 ml increment of air (1-10 ml) during inflation. The cuff pressures and the pressure-volume relationships in both intubations were compared.

RESULTS

The cuff pressures of oesophageal intubations were significantly higher than those of tracheal intubations in all comparisons from 1 to 10 ml of cuff volumes (P < 0.05). The cuff pressure-volume curve was steeper in the oesophageal intubation group, and the difference between the two curves was the largest when the cuff volume was 4-5 ml.

CONCLUSIONS

We conclude that the cuff pressures may be useful in detecting oesophageal intubations. This method is faster than other confirmation measures as it can detect inadvertent oesophageal intubations at the time of inflating the cuffs.

Predicting neuropsychological development from skull imaging

Craniosynostosis is a serious and common pediatric disease caused by the premature fusion of sutures of the skull. Although studies have shown an increase in risk for cognitive deficits in patients with isolated craniosynostosis, the causal basis for this association is still unclear. It is hypothesized that an abnormally shaped skull produces a secondary deformation of the brain that results in the disruption of normal neuropsychological development. In this paper, we conduct a comparative analysis of our newly developed shape descriptors in an attempt to understand the impact of skull deformations on neurobehavior. In particular, we show that our scaphocephaly severity indices and symbolic shape signatures are predictive of mental ability and psychomotor functions, respectively, which suggests the possibility that secondary deformation could influence neuro-developmental status.

Inhibition of nuclear factor κB is associated with neuroprotective effects of glycyrrhizic acid on glutamate-induced excitotoxicity in primary neurons

Glycyrrhizic acid is an herbal drug with a broad spectrum of antiviral activities and pharmacological effects and multiple sites of action. We investigated whether glycyrrhizic acid protects against glutamate-induced excitotoxicity and the underlying mechanisms. We found that glycyrrhizic acid protected against neurotoxicity in rat primary neuronal cultures and hippocampal slices by suppression of the glutamate-induced apoptosis. Glycyrrhizic acid conferred neuroprotective properties in a concentration-dependent manner, as determined by cell survival, apoptosis, and Ca(2+) influx. Glycyrrhizic acid selectively inhibited the Ca(2+) influx activated through N-methyl-D-aspartate (NMDA) receptor by glutamate, but not through membrane depolarization elicited by high K(+) induction. Glycyrrhizic acid treatment also diminished glutamate-induced DNA fragmentation and cleavage of poly (ADP-ribose) polymerase (PARP). Electrophoretic mobility shift assay (EMSA) indicated that glycyrrhizic acid inhibited the binding activity of nuclear factor kappaB (NF-kappaB) to its target elements. Western blot analysis of NF-kappaB inhibitor (IkappaBalpha) protein revealed that the inhibitory effect of glycyrrhizic acid on glutamate-induced activation of NF-kappaB activity was attributable to the inhibition of IkappaB kinase activity. Thus, the site of action of glycyrrhizic acid could be a downstream consequence of Ca(2+)entry through NMDA receptors and that NF-kappaB may be one downstream target in this process. These observations suggest that glycyrrhizic acid may be of therapeutic value for the prevention of cerebral damage elicited by the glutamate.

Functional assays of HLA A2-restricted epitope variant of latent membrane protein 1 (LMP-1) of Epstein-Barr virus in nasopharyngeal carcinoma of Southern China and Taiwan

Human leukocyte antigen (HLA) A2 was consistently associated with increased risk for nasopharyngeal carcinoma (NPC) in Chinese populations. Previously we have reported that an Epstein-Barr virus (EBV) strain carrying an HLA A2-restricted epitope variant of LMP-1 is prevalent in NPC in southern China and Taiwan (Lin et al., J. Gen. Virol. 85: 2023-2034, 2004). The variant has mutation selectively involved one of the two anchor residues in position 2 (125 L-->F) and an additional mutation in position 5 (129 M-->I). Functional assays of the epitope variant were carried out in the present work. The stabilization assay on T2 cells indicated that the variant peptide YFL (YFLEILWRL) prevalent in NPC binds to HLA A2 molecules less efficiently than the prototype peptide YLL (YLLEMLWRL). A dose-dependent binding of the HLA A2 molecules with added peptides was observed. In ex vivo cytotoxic T lymphocyte (CTL) assays with CD8-enriched effectors from A2-positive donors revealed that the YLL-specific CTL was able to lyse EBV-infected B cells expressing HLA A2, whereas the CTL recognition was abrogated with the peptide YFL. Cytokine (IFN-gamma) responses, measured both by intracytoplasmic staining and ELISPOT assays after peptide stimulation, also indicated that the variant epitope peptide failed to give an IFN-gamma response. The IFN-gamma response was almost entirely restricted to those tetramer-positive cells. These results show that EBV isolates from NPC of southern China and Taiwan is dominated by an HLA A2-restricted 'epitope-loss variants' of LMP-1, which would allow the virus to resist immune recognition and may in part contribute to the prevalence of NPC in these populations.

CNS stem and progenitor cell differentiation into functional neuronal circuits in three-dimensional collagen gels

The mammalian central nervous system (CNS) has little capacity for self-repair after injury, and neurons are not capable of proliferating. Therefore, neural tissue engineering that combines neural stem and progenitor cells and biologically derived polymer scaffolds may revolutionize the medical approach to the treatment of damaged CNS tissues. Neural stem and progenitor cells isolated from embryonic rat cortical or subcortical neuroepithelium were dispersed within type I collagen, and the cell-collagen constructs were cultured in serum-free medium containing basic fibroblast growth factor. The collagen-entrapped stem and progenitors actively expanded and efficiently generated neurons, which developed neuronal polarity, neurotransmitters, ion channels/receptors, and excitability. Ca2+ imaging showed that differentiation from BrdU+/TuJ1- to BrdU-/TuJ1+ cells was accompanied by a shift in expression of functional receptors for neurotransmitters from cholinergic and purinergic to predominantly GABAergic and glutamatergic. Spontaneous postsynaptic currents were recorded by patch-clamping from precursor cell-derived neurons and these currents were partially blocked by 10-microM bicuculline, and completely blocked by additional 10 microM of the kainate receptor antagonist CNQX, indicating an appearance of both GABAergic and glutamatergic synaptic activities. Staining with endocytotic marker FM1-43 demonstrated active synaptic vesicle recycling occurring among collagen-entrapped neurons. These results show that neural stem and progenitor cells cultured in 3D collagen gels recapitulate CNS stem cell development; this is the first demonstration of CNS stem and progenitor cell-derived functional synapse and neuronal network formation in a 3D matrix. The proliferative capacity and neuronal differentiating potential of neural progenitors in 3D collagen gels suggest their potential use in attempts to promote neuronal regeneration in vivo.

Endoscopic haemoclip versus heater probe thermocoagulation plus hypertonic saline-epinephrine injection for peptic ulcer bleeding

BACKGROUND

Treating patients of bleeding peptic ulcers with heater probe thermocoagulation and haemoclip is considered to be safe and very effective. Yet, there is no report comparing the haemostatic effects of endoscopic haemoclip versus heater probe thermocoagulation plus hypertonic saline-epinephrine injection in these patients.

AIM

To compare the clinical outcomes of both therapeutic modalities in patients with peptic ulcer bleeding.

METHODS

A total of 93 patients with active bleeding or non-bleeding visible vessels were randomised to receive either endoscopic haemoclip (n = 46) or heater probe thermocoagulation plus hypertonic saline-epinephrine injection (n = 47). Five patients from the haemoclip group were excluded because of the inability to place the haemoclip.

RESULTS

Initial haemostasis was achieved in 39 patients (95.1%) of the haemoclip group and 47 patients (100%) of the heater probe group (P > 0.1). Rebleeding occurred in four patients (10.3%) of the haemoclip group and three patients (6.4%) of the heater probe group (P > 0.1). The volume of blood transfused after entry into the study, duration of hospital stay, number of patients requiring urgent surgery and the mortality rates were not statistically different between the two groups.

CONCLUSIONS

If the haemoclip can be applied properly, the clinical outcomes of the haemoclip group would be similar to those of the heater probe group in patients with peptic ulcer bleeding. However, if the bleeders are located at the difficult-to-approach sites, heater probe plus hypertonic saline injection is the first choice therapy.