[Construction of natural population cohort on telephone follow-up management quality control system and discussion regarding critical issues by REDCap system]

With completing a baseline survey of a large natural population cohort, conducting regular follow-up has become a key factor in further improving the quality of cohort construction and ensuring its sustainable development. Typical cohort follow-up methods include repeat surveys, routine monitoring, and community-oriented surveillance. However, in practical applications, there are often issues such as high costs, difficulty, and high error rates. Telephone follow-up is an important supplementary method to the methods mentioned above, as it has the characteristics of low cost, fast response, and high quality. However, the with difficult organization, quality control is challenging, response rates are low, and management levels vary widely, which limits its widespread use in large-scale population cohort studies. Given the above problems, this study draws on customer relationship management based on the actual needs of the China Northwest Cohort follow-up. It relies on the REDCap electronic data collection platform to build a telephone follow-up management and quality control system. Targeted solutions are provided for key issues in telephone follow-up implementation, including organizational structure, project management, data collection, and process quality control, to improve the quality control level of telephone follow-up comprehensively and thereby enhance the quality and efficiency of follow-up. We hope to provide standardized follow-up programs and efficient quality control tools for newly established and existing cohort studies.

m6A Reader YTHDC1 Inhibits Ferroptosis and Radiosensitivity by Promoting SREBF1 mRNA Nuclear Export in Nasopharyngeal Carcinoma

PURPOSE/OBJECTIVE(S)

Radioresistance is the main reason for nasopharyngeal carcinoma (NPC) recurrence leading to treatment failure, and inducing ferroptosis has gradually been a new way to enhance radiosensitivity. N6-methyladenosine (m6A) is involved in regulation of numerous biological processes. However, whether m6A affects ferroptosis in NPC is still unclear. In this study, we conducted a siRNA library screening to identify m6A reader YTHDC1 as an essential oncogene that suppressed ferroptosis and radiosensitivity by promoting SREBF1 mRNA nuclear export in nasopharyngeal carcinoma.

MATERIALS/METHODS

The expression and function of YTHDC1 were assessed via CCK8 cell viability assay, immunostaining, real-time PCR, western blot, radiation clonogenic assay and fluorescence in situ hybridization assay. Ferroptosis was determined by detecting cell viability, lipid peroxidation, abnormal mitochondrial and cell death rate. The in vivo effects of YTHDC1 were examined with RSL3 treatment or lentivirus modification of YTHDC1 expression in radiated mouse models.

RESULTS

Based on RSL3-induced ferroptotic cell death model and a siRNA library about m6A modification associated gene screening, we identified m6A reader YTHDC1 could inhibit ferroptosis as well as radiosensitivity of NPC, both in vivo and in vitro. Mechanistically, YTHDC1 protein could recognize m6A sites in the CDS region and 3' untranslated region (3'UTR) of SREBF1 mRNA and promote SREBF1 mRNA nuclear export, which finally resulted in transcriptional upregulation of genes key to ferroptosis such as SCD and FASN. Furthermore, the high expression of YTHDC1 was negatively regulated by ZNF598 via ubiquitination and associated with unfavorable survival in NPC patients due to radioresistance.

CONCLUSION

Our findings reveal the critical role of YTHDC1 specifically in inhibiting ferroptosis and radiosensitivity via m6A-dependent mechanism and provide an exploitable target and therapeutic strategy for overcoming radioresistance in NPC.

[A predictive model based on risk factors for early mortality in patients with newly diagnosed multiple myeloma]

目的

分析影响初治多发性骨髓瘤（NDMM）患者早期死亡（EM）的因素，建立其预测模型，以期识别EM风险。

方法

回顾性分析2009年5月至2017年1月吉林大学白求恩第一医院收治的275例NDMM患者，对6个月（EM6）、12个月（EM12）及24个月（EM24）内死亡患者初诊时基线特征进行单因素分析，并根据多因素分析结果建立EM的预测模型。

结果

本研究中EM6、EM12及EM24的发生率分别是5.5%、12.7%和30.2%；最常见的死亡原因为疾病复发/进展，在EM6、EM12及EM24中分别占60.0%、77.1%及84.3%。影响EM6的因素包括经白蛋白校正的血清钙（校正钙）>2.75 mmol/L和PLT<100×10⁹/L；影响EM12的因素包括年龄>75岁、国际分期系统（ISS） Ⅲ期、修订版国际分期系统（R-ISS） Ⅲ期、校正钙>2.75 mmol/L、血清肌酐>177 µmol/L、PLT<100×10⁹/L及骨髓浆细胞比例≥60%；影响EM24的因素中，除上述影响EM12的因素外，还包括男性和染色体核型1q+。多因素分析尚未发现EM6和EM12的独立预后因素。在EM24的多因素分析中，年龄>75岁、PLT<100×10⁹/L和染色体核型1q+是EM24的独立预后因素。根据Logistic回归系数赋分：年龄>75岁：1分；PLT<100×10⁹/L：2分；染色体核型1q+：1分，建立EM24预测模型，ROC曲线下面积为0.709（95%CI 0.626~0.793）。积分≥3分的患者24个月内死亡风险是0~2分患者的26倍，积分0~4分的NDMM患者中位总生存期分别为59、41、22、17.5及16个月（P<0.001）。

结论

年龄>75岁、PLT<100×10⁹/L和染色体核型1q+为EM24的独立预后因素，依据上述变量构建的EM24预测模型有助于识别EM风险和预测生存，具有较好标准度与区分度。

[The prognostic significance of dynamic monitoring of minimal residual disease (MRD) status in patients with newly-diagnosed multiple myeloma]

Objective: To evaluate the prognostic value of kinetic changes in minimal residual disease (MRD) status, as well as its relationship with risk stratification, therapeutic response and treatment in patients with newly-diagnosed multiple myeloma (MM) . Methods: A total of 135 patients with newly-diagnosed MM were screened, and 105 patients who achieved VGPR or more as the best responses were included into this study. The MRD status was determined by multiparameter flow cytometry (MFC) at multiple intervals after two cycles of treatment until clinical relapse, death, or last follow-up. The statistical methods included Kaplan-Meier analysis, Cox regression, etc. Results: ①In all 135 patients, 57.8% (78/135) patients achieved MRD negativity (MRD(-)) after treatment. In 105 patients who achieved VGPR and thus included in this study, the MRD(-) rate was 72.4% (76/105) , with a median interval of 3 months from starting treatment to achievement of MRD(-) status. ②The 2-year PFS rate of patients with MRD(-) status was significantly higher than that of MRD(+) status (62.2% vs 41.3%, P=0.001) , while MRD persistence (MRD(+)) was an independent factor for poor prognosis (multivariate analysis for PFS: P=0.044, HR=3.039, 95%CI 1.029-8.974) . ③Loss of MRD(-) status (i.e., MRD reappearance) showed inferior outcomes compared with MRD sustained negative ones, the PFS was 18 months versus not reach (P<0.001) and the OS was not reach for both (P=0.002) . ④The 2-year PFS and OS rates of patients with duration of MRD(-)status≥12 months were significantly higher than those of the control group (PFS: 77.7% vs 36.7%, P<0.001; OS: 96.4% vs 57.9%, P<0.001 respectively) . Duration of MRD(-) status was associated with a marked reduction in risk of relapse or death (univariate analysis for PFS: P<0.001, HR=0.865, 95%CI 0.815-0.918; for OS: P=0.001, HR=0.850, 95%CI 0.741-0.915 respectively) . ⑤Moreover, even in patients carrying high-risk cytogenetic abnormalities (CA) or ineligible for ASCT, MRD negativity remained its prognostic value to predict PFS (high-risk CA medianPFS: not reach vs 19 months, P=0.006; ineligible for ASCT medianPFS: not reach vs 25 months, P=0.052 respectively) . ⑥Last, treatment with the bortezomib-based regimens contributed to prolonged MRD(-) duration (median MRD(-) duratio: 25 months vs 10 months, P=0.034) . Conclusion: Our findings supported MRD(+) status as an independent poor prognostic factor in MM patients, which implicated that duration of MRD(-) status also played a significant role in evaluation of prognosis, while loss of MRD(-)status might serve as an early biomarker for relapse. Therefore, monitoring of MRD kinetics might more precisely predict prognosis, as well as guide treatment decision, especially for when to start retreatment in relapsed patients.

[Adverse effects of double-hit combining ISS-Ⅲ stage and 1q gain or del (17p) on prognosis of patients with newly diagnosed multiple myeloma]

Objective: To evaluate the prognostic significance of combining ISS-Ⅲ and high risk cytogenetic abnormalities [HRCAs, including 1q gain/amplification and del (17p) ] in patients with newly-diagnosed multiple myeloma (NDMM) . Methods: The clinical characteristics and relevant variables were retrospectively analyzed in a total of 270 NDMM patients diagnosed between November 2009 and May 2018. ISS-Ⅲ stage and HRCAs [detected by FISH, including 1q gain/amplification and del (17p) ] were defined as risk factors (hit) . Based to the number of hit per case, these patients were divided into four groups carrying 0 to 3 risk factors, respectively. Progress-free survival (PFS) and overall survival (OS) were then analyzed using the Kaplan-Meier estimator. Results: Patients who carried single hit (n=120, 44.4%) had shorter median PFS (23.0 vs 28.9 months; P>0.05) and OS (42.3 vs 53.7 months; P>0.05) than those with no risk factors (n=66, 24.4%) . Of note, the outcome of patients who had two or more risk factors (double/triple, n=84, 31.1%) was much worse than those with either no or one risk factor, indicated by significantly reduced median PFS (14.5 months; HR=1.584, 95%CI 1.082-2.319; P=0.003 for double/triple vs single hit) and OS (18.4 months, HR=2.299, 95%CI 1.485-3.560; P<0.001 for double/triple vs single hit) . Strikingly, patients who had three risk factor (triple hit, n=5, 1.9%) displayed the poorest survival with extraordinarily shorter PFS (0.9-15.1 months) and OS (0.9-18.9 months) compared to those carrying two risk factors (double hit) . Analogous results were obtained when different combinations of ISS stages and HRCAs were analyzed. Conclusion: These results suggest a potential but rather important role of combining multiple (e.g. double or triple) adverse factors determined via the routine ISS staging and FISH detection of cytogenetic abnormalities in risk stratification and prognostic prediction, which might be helpful to identify high risk patients more precisely at diagnosis. It also raised a possibility that a small group of ISS-Ⅲ patients carrying both 1q gain/amplification and del (17p) might represent an "extremely-high risk" subset of MM.

[Prognostic analysis of 182 newly diagnosed multiple myeloma patients with high risk cytogenetic abnormalities]

Objectives: To evaluate the clinical characteristics and prognosis of high risk cytogenetic abnormalities (HRCA) and various combinations of cytogenetic abnormality in patients with newly-diagnosed multiple myeloma (NDMM) . Methods: This retrospective study collected 182 NDMM patients in the First Affiliated Hospital of Jilin University between Nov. 2009 and May 2018. HRCA included 1q+, del (17p) , t (4;14) , and t (14;16) detected by FISH, and non-HRCA included del (13q) , t (11;14) detected by FISH. The clinical characteristics among three groups, including cases who carrying a single HRCA, 1 HRCA in combination with non-HRCA and cases carrying two or more HRCAs (double/triple-hit) were observed. Kaplan-Meier curve was used to analyze both progression-free survival (PFS) and overall survival (OS) for the three groups. Results: The survivals of patients with 1 HRCA in combination with non-HRCA were similar to those with two or more HRCAs (double/triple-hit) , the median PFS (mPFS) was 19.1 m vs 12.1 m (P=0.248) and median OS (mOS) was 29.6 m vs 29.3 m (P=0.774) . Furthermore, the prognosis of these two groups were both inferior to patients with a single HRCA, respectively. (mPFS: 32.2 m, P=0.040, P=0.001; mOS: 42.3 m, P=0.021, P=0.041) . Strikingly, both the mPFS and the mOS of patients with 1 HRCA in combination with non-HRCA (regardless of high risk or not) were significantly shorter than that of cases with a single HRCA (mPFS: 15.1 m vs 32.2 m, HR=2.126, 95%CI 1.176-3.843, P=0.005; mOS: 29.3 m vs 42.3 m, HR=1.442, 95%CI 0.705-2.950, P=0.011) . Conclusion: It is of prognostic significance value for detecting double/triple-hit based on FISH cytogenetics in NDMM.

Using the entrapped bioprocess as the pretreatment method for the drinking water treatment receiving eutrophic source water

Control of organic matter, nutrients and disinfection byproduct formation is a major challenge for the drinking water treatment plants on Matsu Islands, Taiwan, receiving source water from the eutrophic reservoirs. A pilot entrapped biomass reactor (EBR) system was installed as the pretreatment process to reduce organic and nitrogen contents into the drinking water treatment plant. The effects of hydraulic retention time (HRT) and combination of preceding physical treatment (ultraviolet and ultrasound) on the treatment performance were further evaluated. The results showed that the EBR system achieved higher than 81%, 35%, 12% and 46% of reduction in chlorophyll a (Chl a), total COD (TCOD), dissolved organic carbon (DOC) and total nitrogen (TN), respectively under varied influent concentrations. The treatment performance was not significantly influenced by HRT and presence/absence of physical pretreatment and the effluent water quality was stable; however, removal efficiencies and removal rates of Chl a, TCOD and DOC showed strong correlation with their influent concentrations. Excitation-emission matrix (EEM) fluorescence spectroscopy identified fulvic-like and humic-like substances as the two major components of dissolved organic matter (DOM) in the reservoir, and decreased intensity of the major peaks in effluent EEM fluorescence spectra suggested the effective removal of DOM without production of additional amount of soluble microbial products in the EBR. Through the treatment by EBR, about 10% of reduction of total trihalomethane formation potential for the effluent could also be achieved. Therefore, the overall results of this study demonstrate that EBR can be a potential pretreatment process for drinking water treatment plants receiving eutrophic source water.

Entrapped biomass for removal of organics and total nitrogen from anaerobic reactor effluents

Anaerobic processes have been applied to treat low-strength domestic wastewaters with significant energy saving. However, anaerobic process effluents must be further removed of residual organics and total nitrogen before discharge. Reported here are an aerobic entrapped bio-technology (EBT) system and an EBT coupled with activated sludge (EBT + AS) system being tested as a post-anaerobic treatment. Both systems have been operated under aerobic condition to provide organics and total nitrogen removal, achieving COD removal by 74-88% and TN removal by 58-65% at hydraulic retention times of 8-24 h. ΔCOD/ΔNO₃ ratios that represent the carbon usage efficiency as electron donors for denitrification were 1.82-1.93 in the EBT and 2.01-2.02 in the EBT + AS systems, with both ratios being lower (i.e. more efficient) than 6 typically required in traditional activated sludge bioreactors. Both systems demonstrate promise for polishing removal of COD and TN.

Acute pulmonary embolism caused by highly aggregated intravenous immunoglobulin

BACKGROUND AND OBJECTIVES

Six patients died and one patient survived following infusion of a specific lot of intravenous immunoglobulin (IVIG) within half an hour in May 2008. This study elucidated the underlying pathogenesis.

MATERIALS AND METHODS

A variety of protein fractionation and identification approaches were employed to determine the abnormal components in IVIG products obtained from the hospital where the patients were treated. Animal studies using mice and monkeys were conducted to elucidate the pathophysiological mechanisms. In animal experiments, the effect and distribution of immunoglobulin was investigated using HE staining and immunohistochemistry (IHC) separately, while platelets and fibrinogen depletion were utilized to determine a possible link between thromboembolism formation in animals and the lethal effect of the IVIG. The size and distribution of the protein aggregates were determined with Coulter Counter Multisizer-3 after the dilution of the IVIG with plasma, and the lethal effect of the protein aggregates was simulated with artificial microparticles.

RESULTS

The IVIG retrieved from the hospital was found to have striking similarities to the heat-treated IVIG in terms of protein aggregation profiles and lethal effects. Post-mortem examination indicated that immunoglobulin aggregates were mainly found in the lung of the animals, while depletion of platelets and fibrinogen from the IVIG preparations failed to prevent the death of the animals. Similar amount of artificial microparticles caused animal death in similar fashion.

CONCLUSIONS

Our findings indicate that the retrieved IVIG exerted its lethal effects by blocking the pulmonary circulation without markedly altering the coagulation cascade or immunological events.

[Effect of comprehensive intervention of schistosomiasis control in construction workers in Poyang Lake region]

After the implementation of the comprehensive schistosomiasis control measures centering on health education for 3 years, the awareness rate of schistosomiasis control increased by 96.56% in construction workers of Dechang highway construction engineering projects in Poyang Lake region, the number of workers adopting preventive measures increased significantly, and no schistosome infection occurred. It is suggested that the comprehensive measures focusing on health education, combined with environment depollution and public administration can prevent schistosome infection effectively among construction workers.

Optical and electrical properties of Ga-doped ZnO nanorod arrays fabricated by thermal evaporation

Well-aligned Ga-doped ZnO nanorod arrays with high optical and electrical property were fabricated by catalyst-free thermal evaporation on p-silicon substrate. As the Ga/Zn atom ratio in the source material was tuned from 0 to 0.2, wurtzite structure ZnO nanorod arrays were realized with length of -6 microm and growth direction along c-axis. With the addition of Ga, the intensity of the near-band-edge emission was enhanced and the deep-level emissions maintained neglectable. As the Ga/Zn atom ratio increased from 0 to 0.1, the red shift of the near-band-edge emission occurred due to Ga-doping induced band gap renormalization effect related with the enhancement of the carrier density, while the blue shifts of the emission were found once the Ga/Zn ratio is higher than 0.1 resulting from Burstein-Moss effect. The configuration of the vertical-aligned Ga-doped ZnO nanorod arrays on p-Si substrate makes it straightforward for the fabrication of p-n nanodiode, which shows an excellent rectifying characteristic with threshold voltage as low as -4.7 V with the Ga/Zn atomic ratio of 0.2.

Reduced membrane fouling in a novel bio-entrapped membrane reactor for treatment of food and beverage processing wastewater

A novel Bio-Entrapped Membrane Reactor (BEMR) packed with bio-ball carriers was constructed and investigated for organics removal and membrane fouling by soluble microbial products (SMP). An objective was to evaluate the stability of the filtration process in membrane bioreactors through backwashing and chemical cleaning. The novel BEMR was compared to a conventional membrane bioreactor (CMBR) on performance, with both treating identical wastewater from a food and beverage processing plant. The new reactor has a longer sludge retention time (SRT) and lower mixed liquor suspended solids (MLSS) content than does the conventional. Three different hydraulic retention times (HRTs) of 6, 9, and 12 h were studied. The results show faster rise of the transmembrane pressure (TMP) with decreasing hydraulic retention time (HRT) in both reactors, where most significant membrane fouling was associated with high SMP (consisting of carbohydrate and protein) contents that were prevalent at the shortest HRT of 6 h. Membrane fouling was improved in the new reactor, which led to a longer membrane service period with the new reactor. Rapid membrane fouling was attributed to increased production of biomass and SMP, as in the conventional reactor. SMP of 10-100 kDa from both MBRs were predominant with more than 70% of the SMP <100 kDa. Protein was the major component of SMP rather than carbohydrate in both reactors. The new reactor sustained operation at constant permeate flux that required seven times less frequent chemical cleaning than did the conventional reactor. The new BEMR offers effective organics removal while reducing membrane fouling.

Biodegradation and bio-sorption of antibiotics and non-steroidal anti-inflammatory drugs using immobilized cell process

In the present study, the removal mechanisms of four antibiotics (sulfamethoxazole, sulfadimethoxine, sulfamethazine, and trimethoprim) and four non-steroidal anti-inflammatory drugs (acetaminophen, ibuprofen, ketoprofen, and naproxen) in immobilized cell process were investigated using batch reactors. This work principally explores the individual or collective roles of biodegradation and bio-sorption as removal routes of the target pharmaceuticals and the results were validated by various experimental and analytical tools. Biodegradation and bio-sorption were found as dominant mechanisms for the drug removal, while volatilization and hydrolysis were negligible for all target pharmaceuticals. The target pharmaceuticals responded to the two observed removal mechanisms in different ways, typically: (1) strong biodegradability and bio-sorption by acetaminophen, (2) strong biodegradability and weak bio-sorption by sulfamethoxazole, sulfadimethoxine, ibuprofen and naproxen, (3) low biodegradability and weak bio-sorption by sulfamethazine and ketoprofen, and (4) low biodegradability and medium bio-sorption by trimethoprim. In the sorption/desorption experiment, acetaminophen, sulfamethoxazole and sulfadimethoxine were characterized by strong sorption and weak desorption. A phenomenon of moderate sorption and well desorption was observed for sulfamethazine, trimethoprim and naproxen. Both ibuprofen and ketoprofen were weakly sorbed and strongly desorbed.

Bioprocessing papaya processing waste for potential aquaculture feed supplement--economic and nutrient analysis with shrimp feeding trial

Papaya processing waste (PPW), a major fruit processing waste in the Hawaii islands, served as substrate for yeast (Saccharomyces cerevisiae) growth. The fermented PPW products containing nutrients of 45% crude protein and various fat, fiber, lignin, cellulose, and minerals were advantages to nutrients of yeast alone. Three experimental diets controlled at 35% protein formulation containing different levels of inclusion of PPW products and a commercial control diet were fed to shrimps for 8 weeks. The 50% inclusion of PPW diets were comparable to commercial feed in weight, growth, feed conversion ratio (FCR) and survival rate. Such bioprocess treatment system would be economically feasible with the control of annual cost and increase of the amount of PPW treated. The selling price of PPW products and annual operation and maintenance cost were the most influential factors to additional profits. This study presented a promising alternative for environmental-friendly treatment of organic wastes as well as the sustainability of local agriculture and aquaculture industries.

Removal of antibiotics and non-steroidal anti-inflammatory drugs by extended sludge age biological process

Removal of four antibiotics (sulfamethoxazole, sulfadimethoxine, sulfamethazine and trimethoprim) and four non-steroidal anti-inflammatory drugs (acetaminophen, ibuprofen, ketoprofen and naproxen) using extended sludge age biological process was investigated. The sludge age of the biological system was greater than 200d. Hydraulic retention time of 12h was maintained throughout the experiment. The extended sludge age biological process is able to treat pharmaceuticals with good and steady removal efficiencies: 64-93% removal for antibiotics over 1-5microgL(-1) influent concentrations and 94% to complete removal for acetaminophen and ibuprofen with a wide range of influent concentrations 1-100microgL(-1). For ketoprofen and naproxen the removal efficiencies are 79-96% over a range of 1-15microgL(-1) influent concentrations. The removal efficiency decreases with increasing initial concentrations for all target compounds except for ibuprofen. This indicates that the initial influent concentration is an important parameter for the studies of fate of pharmaceuticals. The amount of bio-mass and size of the reactor required to achieve good and steady removal efficiencies for known influent pharmaceutical concentrations are also suggested in this study.

[Establishment and application of school-based health promotion and intervention model of schistosomiasis in lake-type endemic area]

OBJECTIVE

To establish an intervention model of school health promotion, and apply it in developing "schistosomiasis-free schools".

METHODS

At the pilot stage, all students of Henghu primary school and Banshan primary school in Xinjian County of Jiangxi Province were selected as experiment group and control group, respectively. A baseline survey covered knowledge and attitude on schistosomiasis control, water contact behaviors and Schistosoma japonicum infection rate. Two health promotion intervention models, i.e. "information communication + training of protection skill + reward & punishment" (model A, 1993-1999) and "information communication + behavior participation + encouragement" (model B, 2000-2007), were implemented in Henghu school. The effect of two models was compared by infection rate. At the application stage, all students of 8 schools in Xinjian County, Nanchang County, and Jinxian County were chosen for evaluation of the effectiveness of Model B with same methods and index.

RESULTS

Before intervention there was no significant statistical difference on the passed rate of anti-schistosomiasis knowledge, correct rate of anti-schistosomiasis attitude, frequency of infested water exposure and the infection rate between Henghu and Banshan schools (P > 0.05). In Henghu school, the intervention showed significant effect on the scores of knowledge and attitude after one year (P < 0.01), raised from 9.0% and 55.1% before intervention to 94.4% and 98.9% after intervention, respectively. The frequency of infested water exposure and the infection rate significantly decreased from 14.6% and 13.5% before intervention to 1.9% and 2.3%, respectively (P < 0.01). In 2-7 years after intervention, there were only one or two schistosomiasis cases each year. At the application stage, no schistosomiasis cases were found among Model B target population in two successive years after intervention.

CONCLUSION

The practice of Model B can be extended to other schools in endemic area to develop "schistosomiasis-free schools".

Intermittently aerated EMMC-Biobarrel (entrapped mixed microbial cell with Bio-barrel) process for concurrent organic and nitrogen removal

The PEMMC-Biobarrel (packed-bed of entrapped mixed microbial cells with Bio-barrel) process and MEMMC-Biobarrel (moving EMMC-Biobarrel) process were investigated for enhancing concurrent organic and nitrogen removal with applied intermittent aeration. For the PEMMC-Biobarrel process, the EMMC-Biobarrel carriers were employed at a packing ratio of 20%. In the MEMMC-Biobarrel process, the EMMC-Biobarrel carriers with a packing ratio of 10% were added along with the activated sludge (AS) in the bioreactor. Three different hydraulic retention times (HRTs) of 9, 6 and 4 h were applied. Aeration was provided intermittently at time schedules of 1 h air on/1 h air off, 1 h on/1.5 h off and 1 h on/2 h off. Nitrogen removal in the PEMMC-Biobarrel system was not improved by increasing the intermittent non-aeration time period. On the other hand, the MEMMC-Biobarrel process enhanced nitrogen removal with increasing non-aeration time even though the SCOD/N(TIN) ratio decreased from 6 to 4. Significant denitrification during the aeration cycle was observed in the MEMMC-Biobarrel process. The MEMMC-Biobarrel process demonstrated the most efficient organic and nitrogen removal at an HRT of 6 h with an intermittent aeration time schedule of 1 h on/2 h off. Nitrogen removal of 80% was achieved, which was about 15% higher compared to the AS system. TCOD and SCOD removal efficiencies were 80% and 75%, respectively.

Integrated advanced natural wastewater treatment system for small communities

A study was conducted to evaluate the nutrient removal capability of an existing and successfully operated overland flow and wetland wastewater treatment system following a waste stabilization pond. Seasonal temperature effects on performance were also investigated. The treatment system studied consists of a two-cell waste stabilization pond followed by an overland flow system and a wetland system. The influent and effluent samples were analyzed for BOD5, suspended solids (SS), pH, temperature, ammonia nitrogen, nitrate nitrogen, and total phosphorus. The results of the study indicate that the combined pond, overland flow and wetland system provided excellent treatment of municipal wastewater. The overall average BOD5 removal by the entire treatment system was about 90.0% and the overall average suspended solids removal was about 93.4%. The ammonia nitrogen and total phosphorus removal efficiencies of the entire treatment system were 90.7% and 84.2%, respectively.

Removal of organic and nitrogen and molecular weight distribution of residual soluble organic from entrapped mixed microbial cells and activated sludge processes

The simultaneous removal of organic and nitrogen and molecular weight distribution (MWD) of residual soluble chemical oxygen demand (RSCOD) in final effluent were investigated using entrapped mixed microbial cells (EMMC) and conventional activated sludge processes. Two different types of processes using EMMC carriers demonstrated better organic and nitrogen removal performance because of the high solids retention time (SRT) compared with the activated sludge process. Regarding the RSCOD, the longer SRT process (EMMC) was affected by reducing the hydraulic retention time, resulting in the increase of high-molecular-weight materials. On the other hand, reducing the aeration period had significantly affected the MWD in the shorter SRT process (activated sludge), resulting in an increase of low-molecular-weight materials.

Development of an effective sample preparation approach for proteomic analysis of silkworm eggs using two-dimensional gel electrophoresis and mass spectrometry

Sample preparation is still the first and important step toward successful two-dimensional gel electrophoresis (2DE) and identification in proteomics study. The 2DE profiling of eggs of silkworm species by using conventional one-step extraction, however, is unsatisfactory because high-abundance proteins such as egg-specific protein (ESP) and No 30 family (30 KP) in the extract lead to difficulties in detecting most of biologically relevant proteins. Based on the tendency of these abundant proteins to be soluble in Tris-HCl buffer, we report herein a robust approach in which the extract enriched in ESP and 30 KP was fractionationed and mixed with the re-extract of residual pellet in an optimal proportion. In comparison with the one-step method, the 2DE pattern was improved by this new method with over one-third enhancement in spots. A total of 48 unique proteins obtained have been furthermore identified by mass spectrometry (MS) and MS/MS. The identified proteins are found to include heat shock proteins families, ribosomal proteins, disulfide isomerase proteins, Glutathione S-transferase, and elongation factor, etc., which are mainly involved in some important processes. To our knowledge, this is the first time that the several proteins have been detected in silkworm eggs by proteomics means. This simple and reproducible approach would raise the opportunity of discovering and identifying more biomarkers and determining their possible roles in further studies.

Comparative proteome analysis of rat brain and coronary microvascular endothelial cells

The endothelium of different organs displays a remarkable heterogeneity, although it presents many common functional and morphological features. However, despite our knowledge of heterogeneity among endothelial cells from different sites, the differences between brain microvascular endothelial cells (BMEC) and coronary microvascular endothelial cells (CMEC) are poorly defined. The aim of this study was to investigate whether BMEC are distinct from CMEC at the protein level. Using the proteomic approach, we comparatively analyzed the proteome of cultured BMEC and CMEC. We reproducibly separated over 2000 polypeptides by using two-dimensional electrophoresis (2-DE) at pH range of 3-10. Using PDQuest software to process the 2-DE gel images, forty-seven protein spots were differentially expressed in the two-endothelial cells. Of these, thirty-five proteins are highly expressed in BMEC, whereas twelve proteins are highly expressed in CMEC. Fifteen proteins in BMEC and seven proteins in CMEC were identified with high confidence by matrix-associated laser desorption ionization time-of-flight mass spectrometer (MALDI-TOF-MS). Our data suggested that BMEC and CMEC were different in several aspects including cytokine and growth-related molecules, stress-related proteins, metabolic enzymes, signal transduction proteins and others. The identification of a set of proteins preferentially expressed in BMEC and CMEC provided new data on the heterogeneity of the endothelium.

Bio-anaerobic treatability study for PCBs-contaminated oil

This study investigated the bio-treatability of PCB contaminated oil for the development of design and operational parameters for the bioreactor. Input of external carbon and nutrient source in the aqueous phase was found to be required for the treatment of polychlorinated biphenyls (PCBs)-contaminated oil. Addition of surfactant was investigated for the emulsification of oil to reduce interference of contact with microorganisms and PCBs. The ratio of surfactant to oil was empirically optimized to 1 : 1. The higher PCB removal efficiency was obtained at 30 days of hydraulic retention time (HRT) in the semi-batch reactor study without cell recycle. The removal efficiency measured in mixed liquor was maintained at over 85% on average at 32 +/- 2 degrees C and 30% at 22 +/- 2 degrees C. More than 0.2 g/l/d of the organic loading rate was suggested to be maintained for various PCB loading rates (0.02-0.6 mg-PCB/l/d). For high biomass retaining and easy collection of treated oil, an Anaerobic Sequencing Batch Reactor (ASBR) was investigated. The removal of Aroclor was observed as more than 50% in the oil phase with 3 days reaction time and about 40% in overall phases, i.e. oil, liquid, biomass phases at 22 +/- 2 degrees C. US EPA verification results on the process performance are included in this presentation.

Two-stage entrapped mixed microbial cell process for simultaneous removal of organics and nitrogen for rural domestic sewage application

A two-stage entrapped mixed microbial cell ((2S)EMMC) process which separates nitrification and denitrification phases by the installation of the anoxic and oxic EMMC reactors packed with EMMC carriers was operated with 6, 4, 3, and 2 hours of hydraulic retention time (HRT) using simulated domestic wastewater. The activated sludge was immobilized using cellulose acetate for the EMMC carriers. Similar soluble chemical oxygen demand (SCOD) removal efficiencies of 90-97% were observed for all HRTs (SCOD loading rate of 0.84-2.30 g/L/d) applied. In order to achieve more than 80% of TN removal efficiency, the HRT should be maintained higher than 4 hours (less than 0.24 g/L/d of TN loading rate). Denitrification was a rate-limiting step which controlled overall TN removal efficiency at TN loading rate of 0.15-0.31 g/L/d although nitrification efficiencies achieved 97-99%. The effluent TSS of less than 25 mg/L in the (2S)EMMC process was maintained at the SCOD loading rate of less than 1.23 g/L/d with back-washing intervals of 5 and 10 days in the anoxic and oxic EMMC reactors, respectively. The minimum HRT of 4 hours is required for high removal efficiencies of organics (average 95.6%) and nitrogen (average 80.5%) in the (2S)EMMC process with 3 times of recirculation ratio.

EMMC process for combined removal of organics, nitrogen and an odor producing substance

In order to improve the process performance regarding the removal of organics, nitrogen, and an odor-causing compound (sulfide) contained in domestic wastewater, an entrapped-mixed-microbial cell (EMMC) with and without humic substances for both fixed and moving carrier reactors and conventional suspended growth culture (i.e. conventional activated sludge process) were investigated simultaneously. Both synthetic (simulated to the organics concentration of general domestic sewage) and actual domestic wastewater were investigated under operational conditions of 12 h of hydraulic retention time (HRT) with 1 h of aeration and 1 h of non-aeration, and 6 h of HRT with continuous aeration, at a room temperature of 25 +/- 2 degrees C. It was found that entrapping humic substances in the EMMC carriers had no impact on the removal of organics, nitrogen, and the odor-producing compound. Additionally, the performance of the EMMC moving carrier system for the removal of these pollutants is similar to that of the EMMC fixed carrier system. In general, the EMMC associated systems which provide high solids retention time achieve a better removal of chemical oxygen demand (COD), nitrogen, and the odor-producing substance than the suspended growth system for both HRTs of 6 h (continuous aeration) and 12 h (1 h of aeration and 1 h of non-aeration). Both the fixed and moving carrier EMMC processes, therefore, have the potential for improvement or replacement of the existing conventional activated sludge process with regard to improving the effluent qualities (such as COD, nitrogen and odor-producing compound) for reuse/disposal.

Integrating entrapped mixed microbial cell (EMMC) process for biological removal of carbon and nitrogen from dilute swine wastewater

An entrapped mixed microbial cells (EMMC) process was used to investigate the simultaneous removal of carbon and nitrogen from dilute swine wastewater. Cellulose triacetate was used as the matrix for entrapping the mixed microbial cells. The EMMC process was tested with various oxygen supply conditions (ratios of aeration to non-aeration times) and two types of carrier sizes (large and medium). Also, various pre-treatments with chemical coagulation, screen separation and ammonium crystallization prior to the EMMC process, and post-treatment after the EMMC process were investigated. It was found that at a hydraulic retention time of 30 h and one hour of aeration and one hour of non-aeration, the EMMC process packed with medium carriers after the pretreatment of ammonium crystallization, exhibited the best total nitrogen removal efficiency of 95.1 +/- 1.0% when compared to the other two pre-treatment methods. The total chemical oxygen demand (TCOD) and soluble chemical oxygen demand removal efficiencies were 83.5 +/- 2.2% and 84.1 +/- 1.1%, respectively. Lime post-treatment provided TCOD and total phosphorus removal efficiencies of 59.6 +/- 2.7% and 98.0 +/- 0.5%, respectively. Thus, a cost analysis for ammonium crystallization pre-treatment, EMMC process, and post-treatment with lime was conducted. The unit cost for a 2000 pig operation is approximately dollars 4.91/pig/year. For the application of the EMMC process with the proposed pre- and post-treatments, a suitable farm size needs to be greater than a 2000 pig operation. Because of the high efficiency and the simple operation of simultaneous carbon and nitrogen removal, the EMMC process has the potential for treatment of dilute swine wastewater in a land-limited area and can be manufactured as pre-fabricated wastewater treatment units.

Catalytic ozonation of 2-dichlorophenol by metallic ions

This research is mainly to explore functional improvement by adding various kinds of metallic ions in the ozonation of 2-chlorophenol solution. During the experiment, various kinds of metallic ions (Pb+, Cu2+, Zn2+, Fe2+, Ti2+, and Mn2+) were added; it was found that the reaction rate increased in all cases. The best result was obtained by using manganese ions, followed by iron and titanium ions. At pH = 3 and 1 ppm Mn2+ concentration, the reaction rate was increased by three times. TOC removal rate was also increased from 12.6% to 38% at 60 min reaction time. Ozone self-decomposition with various kinds of metallic ions alone was tested. It was found the ozone self-decomposition coefficient is highly dependent on the reaction rate constant for ozonation of 2-chlorophenol. The improvement of reaction was relevant to the mechanism of reaction between ozone and metallic ions. Furthermore, the effect of adding manganese ions was studied. With the initial manganese concentration at 0-2 ppm, after gas exposure for 20 min the removal rate can be increased from 38% to 93%. TOC removal rate was increased from 11% to 38%. The reaction rate was improved more greatly at the initial pH = 3.

Levels of interferon-gamma and interleukin-2 receptor-alpha for bronchoalveolar lavage fluid and serum were correlated with clinical grade and treatment of pulmonary tuberculosis

OBJECTIVE

We investigated possible correlations for interferon-gamma (IFN-gamma) and soluble interleukin-2 receptor-alpha (sIL-2R-alpha) levels in bronchoalveolar lavage fluid (BALF), and clinical grade of pulmonary tuberculosis (TB), which is determined by factors such as extent of pulmonary involvement, fever and loss of body weight.

DESIGN

In order to explore these correlations and address associated questions, BALF was collected from 45 patients presenting with active pulmonary TB and 14 healthy controls. Repetitive BALF was collected in 17 patients after 3 months of anti-tuberculosis chemotherapy. The epithelial lining fluid (ELF) levels for IFN-gamma and sIL-2R-alpha were measured using enzyme-linked immunosorbent assay (ELISA) after standardization with urea.

RESULTS

Patients with higher-grade pulmonary TB (i.e., with more advanced pulmonary involvement, fever or body weight loss), revealed significantly higher ELF levels for IFN-gamma and sIL-2R-alpha compared to those with lower grade pulmonary TB. Similar results were also determined for sIL-2R-alpha serum levels, but not for IFN-gamma serum levels. After anti-tuberculosis chemotherapy the elevated cytokine levels for ELF and serum significantly decreased in accordance with radiographic improvement.

CONCLUSIONS

ELF levels of IFN-gamma and sIL-2R-alpha were correlated with disease grading of pulmonary TB and decreased after anti-tuberculosis chemotherapy.

Entrapped mixed microbial cell process for combined secondary and tertiary wastewater treatment

An entrapped mixed microbial cell (EMMC) process was investigated for simultaneous removal of carbon and nitrogen from a synthetic wastewater in a single bioreactor. The influent had a soluble chemical oxygen demand (SCOD)/nitrogen ratio varying from 4 to 15 and an alkalinity of 140 and 230 mg/L as calcium carbonate. An alternating schedule of intermittent aeration was used for two sizes of carriers: 10 x 10 x 10 mm3 and 20 x 20 x 20 mm3. The medium carrier (10 x 10 x 10 mm3) was found to achieve higher removals of nitrogen, chemical oxygen demand, and 5-day biochemical oxygen demand of 92, 95, and 97%, respectively. These higher removal rates occurred at a 12-hour hydraulic retention time (HRT), an aeration/ nonaeration ratio of 0.5:2 hours, and an SCOD/nitrogen ratio of 15 in the influent. Influent alkalinity concentrations of 140 and 230 mg/L as calcium carbonate were found to have minimum effect on the removal of carbon and nitrogen. However, the oxidation-reduction potential, ranging from -100 to 400 mV (during air-off period), provides better nitrogen removal efficiency to maintain the total nitrogen (nitrate, nitrite, and ammonium) less than 10 mg/L when an SCOD/nitrogen ratio of 10 or 15 is maintained in the influent. Nitrogen removal efficiency increased with increasing ratios of SCOD/nitrogen in the influent (i.e., SCOD/ nitrogen ratio of 15 > 10 > 7 > 4.0). The results of actual wastewater operation based on a study of synthetic wastewater show that organics removal efficiencies (94.6 and 94.2%) and nitrogen removal efficiencies (61.0 and 60.9%) are similar for reactors packed with medium and large carriers, respectively, when they are operated with a 9-hour HRT, an air on/air off ratio of 1 hour:2 hours and an SCOD/nitrogen ratio of 4.6.

Klebsiella pneumoniae bacteremia: community-acquired vs. nosocomial infections

BACKGROUND

This study attempted to determine the clinical manifestations and influential factors affecting the prognosis of patients with community-acquired and nosocomial bacteremia of Klebsiella pneumoniae (K. pneumoniae).

METHODS

We retrospectively reviewed the medical records of 211 patients who had a clinically significant episode of K. pneumoniae bacteremia from January 1997 until December 1999.

RESULTS

Most reports describe K. pneumoniae bacteremia as typically nosocomial, but in our study approximately 3 of 4 episodes were community-acquired. Without including "unknown origin", the most common infectious site for both community-acquired and nosocomial bacteremia was the hepatobiliary tract. The overall mortality for all 211 patients with K. pneumoniae bacteremia was 25.1%. Significantly higher mortality rates occurred in patients who were elderly (> 65 years), had a nosocomial infection, for whom the respiratory tract was the portal of entry, and ultimately fatal conditions or acute complications were due to shock or renal insufficiency.

CONCLUSIONS

Patients with community-acquired and nosocomial bacteremia had different types of underlying diseases. Isolates from nosocomial infections were significantly more frequently resistant to aminoglycosides, antipseudomonal penicillin, and all three generations of cephalosporins. In this regard, an aggressive empirical therapeutic approach to infections of K. pneumoniae is suggested.

Evaluation of direct removal of nitrate with entrapped mixed microbial cell technology using ethanol as the carbon source

Biological denitrification from simulated contaminated groundwater using ethanol as an external carbon source was investigated with an entrapped mixed microbial cell (EMMC) system. Ethanol was used as an external carbon source to serve both as the energy source for the nitrate removal reaction and substrate for microorganisms in the system. The hydraulic retention time and chemical oxygen demand (COD)/nitrogen ratio significantly affect nitrate removal performance and, therefore, must be monitored carefully to achieve high rates of nitrate and COD removal. The effect of packing ratios of carriers in the reactor on nitrate removal performance was also investigated. The removal of nitrate and COD in reactors with various carrier packing ratios (12, 22, and 35%) is not significantly different during steady-state operation. However, the start-up periods in these three reactors are significantly different. The highest packing ratio can result in a fast removal of nitrate during the start-up periods. Results of solids retention time (SRT) analysis indicate that a long SRT in the EMMC system contributes to the stable removal of nitrate and to fast start up of the system. The increase of SRT is related to the increase in days of operation, SRT is maintained at a level of more than 200 days.

Fatal and non-fatal chromobacterial septicemia: report of two cases

Chromobacterium violaceum is frequently found in soil and water in tropical and subtropical regions. The organism rarely causes infection in humans, but is associated with a high mortality rate when it occurs. Septicemia associated with abscess in multiple organs such as the liver, skin, lungs, spleen, lymph nodes, and brain has been reported. We report on 2 patients with systemic infections with Chromobacterium violaceum. One presented with a fulminant course with multiple organ involvement and died 78 days later. The other presented with a milder course and survived after antibiotic therapy. In conclusion, infection with Chromobacterium violaceum is rare but its course is usually fulminant with high mortality especially in patients with sepsis and multiple organ involvement. We hope this report will provide additional information to physicians in the treatment of this disease.

Transplant of cultured autologous pure melanocytes after laser-abrasion for the treatment of segmental vitiligo

Segmental vitiligo is a special type of vitiligo with unilateral distribution of lesions and has a stable course. Clinically, many patients with segmental vitiligo have unsatisfactory responses to topical corticosteroid or UV phototherapy. We have developed a technique for the isolation of melanocytes from a small specimen of normally pigmented skin obtained via a suction blister. The melanocytes can be proliferated in culture and then replanted onto laser-abrased vitiliginous areas. We used this procedure to treat 25 patients with segmental vitiligo that were refractory to medical therapy. The repigmented portion of the total treated area amounted to 95-100% in 21 patients and 65 to 94% in 4 patients. The response rate to treatment was 100% in this study. No scarring or other side-effects developed. The results of this study demonstrate that this method is a valuable tool for the treatment of patients with segmental vitiligo.

Carbofuran-induced delayed neuropathy

BACKGROUND

Although carbamates have been widely used in the world for many years, carbamate-induced delayed neuropathy is rare. We report what appears to be delayed neuropathy caused by poisoning with carbofuran, a cholinesterase-inhibiting carbamate, although the certainty of diagnosis is somewhat limited by the lack of a sural nerve biopsy and spinal fluid examination.

CASE REPORT

A 23-year-old man attempted suicide by ingesting 100 mL of carbofuran (2,3-dihydro-2,2-dimethyl-7-benzofuranyl methylcarbamate). After recovering from acute cholinergic toxicity, he had notable paresthesia in his lower limbs and difficulty walking. Electrophysiologic findings revealed sensorimotor neuropathy. Recovery began at 1 week and continued for 4 months. A similar delayed neuropathy has been described with carbamate, 1-naphthyl N-methylcarbamate, and m-tolyl methylcarbamate, but not with carbofuran insecticides.

Development of a prefabricated treatment plant for diluted pig wastewater

In order to develop a prefabricated treatment and reuse plant for diluted pig wastewater, an entrapped-mixed-microbial-cell (EMMC) process was evaluated for its process performance and economic analysis. At the hydraulic retention time (HRT) of 30 hrs (loading rate of 1.0 g TCOD/L/d) and intermittent aeration of 1 hr of aeration and 1 hr of non-aeration, it was found that, by using the pretreatment of the ammonium crystallization, both the medium and large carriers were able to reduce TCOD, SCOD, and T-N by 83.51, 84.11, and 95.10%, respectively. The EMMC unit and lime post-treatment followed by ammonium crystallization can reduce BOD5, TCOD, SCOD, TSS, T-N, and T-P, respectively by 99.22, 93.85, 92.67, 97.73, 96.43, and 97.27%. The treated wastewater, after disinfection, is able to meet the requirements of the standards issued by the USEPA for reuse of food crops. The economic analysis indicates that based on the process performance of the EMMC unit, a prefabricated wastewater treatment plant for 2000 pigs has comparable net present worth (NPW) comparing intermittent aerated biological systems and less operation and maintenance and land requirement than conventional biological processes for removal carbon and nitrogen. A farm operation of more than 2000 pigs meets the unit cost of US$4.91/pig/yr. This will minimize the problems pertaining to technical factors or considerations that heavily influence planning, construction and operation of a pig wastewater treatment system.

Aberrant infrarenal inferior vena cava as a hindrance to percutaneous transvenous mitral valvuloplasty in a patient with mitral stenosis: case report

Cardiac catheterization and percutaneous transvenous mitral commissurotomy using the Inoue technique were attempted in a 44-year-old woman with mitral stenosis. The pulmonary arterial wedge pressure was 25 mmHg, mean transmitral diastolic pressure gradient 20.3 mmHg, cardiac index 1.80 L/min/m2, and mitral valve area 0.70 cm2. After the diagnostic catheterization, the guide wire for the transseptal procedure was checked in the middle of the inferior vena cava (IVC). A 7-French end-holed Bermann catheter was then used to detect the course of the IVC. It was found that the IVC coursed along the left border of the 4th and 5th lumbar vertebrae, to the left of the abdominal aorta. At the upper border of the third lumbar vertebra, the IVC returned to the right side of the vertebra. In consideration of the inability to pass the Brockenbrough needle through the detoured infrarenal IVC and the risk of rupturing the vessel, the transseptal procedure and attempted percutaneous transvenous mitral commissurotomy were aborted. Therefore, the patient underwent open mitral commissurotomy instead.

In-shoe pressure measurements with a viscoelastic heel orthosis

OBJECTIVE

To detect the mechanical effect of a viscoelastic heel orthosis.

DESIGN

Two-factor analysis of variance with interactions between the orthosis and the subjects. The number of subjects was determined by presuming the effect of the orthosis to be twice as large as the error-free standard deviation (SD) of the interactions, the step-to-step SD four times as large as the error-free SD of the interactions, type 1 error probability equal to .05, and type 2 error probability equal to .20.

SETTING

A gait laboratory in a university hospital.

SUBJECTS

Twenty-two consecutive patients with treated heel pain.

MAIN OUTCOME MEASURES

Peak pressure (PP), pressure-time integral (PTI), and foot-to-sensor contact time (CoT) measured for five steps at 24 discrete sensors of predetermined positions in the foot with treated heel pain.

RESULTS

The orthosis reduced PPs, PTIs, and CoT (p < .05) in the median midfoot and lateral midfoot; reduced PPs and PTIs (p < .05) in the posterior heel and medial midfoot; increased PP and PTI (p < .05) in the anterior part of the first metatarsal head; and increased PTI (p < .05) in the lateral part of the hallux. The ratios of the estimated step-to-step SDs to the estimated error-free SDs of the interactions of PPs, PTIs, and CoT were less than four at all the sensors.

CONCLUSION

Proper design and estimation of the variations ensured that there was sufficient power to detect the effect of an a priori specified size as statistically significant: the orthosis reduced the mechanical loads in the posterior heel and the midfoot and increased the mechanical loads in the anterior part of the first metatarsal head and the lateral part of the hallux during walking.

Identification of a novel strain of hepatitis E virus responsible for sporadic acute hepatitis in Taiwan

Hepatitis caused by the hepatitis E virus (HEV) is a self-limited disease and occurs most frequently as epidemic or sporadic hepatitis in developing countries. The role of HEV in sporadic acute hepatitis in areas without a history of hepatitis E epidemics is obscure. Recently, it was found that more than 10% of the patients with acute non-A, non-B, non-C hepatitis in Taiwan were associated with an acute HEV infection. Nucleotide sequences of the regions within the first open reading frame of HEV were determined in four cases and were 96.7-100% identical to each other. As compared to the isolates from China, Pakistan, Burma, India, Africa, and Mexico, the similarities were, however, only 71.7-79.3%. Phylogenetic analysis revealed that the four Taiwan isolates were categorized as a novel HEV group (the Taiwan strain), which was distinct from all of the strains isolated from other parts of the world. In addition, the isolates from China, Burma, India, and Pakistan were catalogued as the second genotype of HEV (the Asian strain), and the Mexican isolate as the third (the Mexican strain). The African isolate was more related to the Asian type and might be a subtype of the Asian strain. A simple genotyping method by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) is described. The findings also support the hypothesis that HEV may be responsible for some sporadic acute non-A, non-B, non-C hepatitis in other developed countries.

Variations in gene expression and genomic stability of human hepatoma cells integrated with hepatitis B virus DNA

The association of hepatitis B virus (HBV) infection with human hepatoma is well established. However, no consensus regarding the etiology of hepatocellular carcinoma was elucidated. In this paper, the genomic stability and gene expression of HBV DNA-integrated and non-integrated hepatoma cells by Transcript Profile (TP)-PCR and RT-PCR are characterized. The additional DNA bands generated from TP-PCR of HBV integrated genomes were not correlated with the sequence of HBV, suggesting that the variations may result from genomic instability of the host cells. Moreover, differential genes expressed in HBV DNA-integrated cells were sequenced. A cDNA generated from the integrated cells exhibited 99.3% homology with the sequences of ATP synthase 6 and cytochrome C oxidase III, but the sequences were abnormally linked together. Since HBV infection may alter the energy metabolism of the cell, the results suggest that the integration may cause mitochondriae defects in the ATP synthase 6 and cytochrome C oxidase III genes.

Bioactive kaurane diterpenoids from Annona glabra

Phytochemical analysis of the fruits of Annona glabra yielded two new kaurane diterpenoids, annoglabasin A (methyl-16 beta-acetoxy-19-al-ent-kauran-17-oate)(1) and annoglabasin B (16 alpha-hydro-19-acetoxy-ent-kauran-17-oic acid)(2), along with 11 known kaurane derivatives (3-13). The structures of the new compounds were established by spectral and chemical evidence. Among these, methyl-16 alpha-hydro-19-al-ent-kauran-17-oate (11) exhibited mild activity against HIV replication in H9 lymphocyte cells, and 16 alpha-17-dihydroxy-ent-kauran-19-oic acid (4) showed significant inhibition of HIV-reverse transcriptase.

Sonography of pigmented villonodular synovitis in the ankle joint

Pigmented villonodular synovitis is a benign proliferative disorder of the synovium that results in villous nodule formation in joints, tendon sheaths, and bursae. We present a case of pigmented villonodular synovitis of the ankle joint that was diagnosed by sonography with color Doppler imaging. The sonograms revealed hypoechoic synovial proliferation, and hypervascularity was visible on color Doppler images. The differential diagnosis of a synovial thickening or mass is also discussed.

Cloning and characterization of the extreme 5'-terminal sequences of the RNA genomes of GB virus C/hepatitis G virus

The extreme 5'-terminal sequences of the GB virus C/hepatitis G virus (GBV-C/HGV), containing elements essential for regulation of viral gene expression and replication, have not been determined. By using a RNA-ligase-mediated RACE (rapid amplification of the cDNA ends) procedure, we have cloned the extreme 5'-terminal sequences of the viral genome from the serum of three Taiwanese patients. Sequence analysis of the 5' noncoding region in alignment with one West African and two American isolates showed that (i) a consensus 5'-end sequence was cloned; (ii) about 97% of sequences were homologous among the three Taiwan isolates and also between the two American isolates, whereas about 90% of sequences were homologous among the isolates from the three different geographic areas; (iii) the sequence heterogeneity related to geographic separation is confined mainly to three domains; and (iv) a potential hairpin structure, resembling the hairpin structure found in the 5' end of hepatitis C virus genome, was detected in the 5' end of the noncoding region. Our data support the hypotheses that (i) the extreme 5' end of the hepatitis GBV-C/HGV viral genome has been cloned, (ii) there are different genotypes correlated with geographic separation, and (iii) the viral translation and replication mechanisms may be similar to that of hepatitis C virus and pestiviruses. Our data have not only shed light on the viral replication mechanism but also offer information for selection of optimal primer sequences for the detection and genotyping of the hepatitis GBV-C/HGV virus by PCR assays.

Cloning of a human insulin-stimulated protein kinase (ISPK-1) gene and analysis of coding regions and mRNA levels of the ISPK-1 and the protein phosphatase-1 genes in muscle from NIDDM patients

Complementary DNA encoding three catalytic subunits of protein phosphatase 1 (PP1 alpha, PP1 beta, and PP1 gamma) and the insulin-stimulated protein kinase 1 (ISPK-1) was analyzed for variations in the coding regions related to insulin-resistant glycogen synthesis in skeletal muscle of 30 patients with non-insulin-dependent diabetes mellitus (NIDDM). The human ISPK-1 cDNA was cloned from T-cell leukemia and placental cDNA libraries and mapped to the short arm of the human X chromosome. Single-strand conformation polymorphism (SSCP) analysis identified a total of six variations in the coding regions of the PP1 genes: two in PP1 alpha at codons 90 and 255; one in PP1 beta at codon 67; and three in PP1 gamma at codons 11,269, and 273, respectively. All were, however, silent single nucleotide substitutions. SSCP analysis of the ISPK-1 gene identified one silent polymorphism at codon 266 and one amino acid variant at codon 38 (Ile-->Ser). This variant was primarily found in one male NIDDM patient. This subject, however, did not exhibit an impairment of muscle insulin-stimulated glycogen synthase activation. No significant differences were found in mRNA levels in muscle of the four genes between 15 NIDDM patients and 14 healthy subjects. Our findings suggest that 1) genetic abnormalities in the coding regions of PP1 alpha, PP1 beta, PP1 gamma, and ISPK-1 are unlikely to be frequently occurring causes of the reduced insulin-stimulated activation of the glycogen synthesis in muscle from the analyzed group of NIDDM patients; 2) the mRNA levels of PP1 alpha, PP1 beta, PP1 gamma, and ISPK-1 are normal in muscle from the NIDDM patients; and 3) putative inherited defects in insulin-stimulated activation of muscle glycogen synthesis in patients with insulin-resistant NIDDM may be located further upstream of ISPK-1 in the insulin action cascade.

Role of the ribozyme of hepatitis delta virus on the transcription after polyadenylation

We have previously demonstrated that the ribozyme located 34 nucleotides downstream of the polyadenylation site on the antigenomic RNA of the hepatitis delta virus can stabilize the downstream transcript after polyadenylation. Here, we have reports on further investigations of the molecular mechanism of this stabilization effect and the potential role of the small and large delta antigens. We found that the downstream transcripts after polyadenylation were stabilized by the ribozyme independently of either the small or large delta antigen. The stabilization effect was abolished as the ribozyme activity was eliminated by mutations on either the enzyme domain or target site of the ribozyme. These findings suggested that it was the ribozyme activity rather than the RNA structure or the delta antigens that contributed to the stabilization effect.

Polyadenylation of the mRNA of hepatitis delta virus is dependent on the structure of the nascent RNA and regulated by the small or large delta antigen

During the hepatitis delta virus (HDV) RNA replication, synthesis of either the mRNA for the delta antigen (HDAg) or the full-length antigenomic RNA is determined by selective usage of the potent poly(A) signal on the antigenome. To elucidate the regulatory mechanism, HDV cDNA cotransfection system was used to examine the potential effect of the secondary structure of the nascent RNA and that of the HDAg on HDV polyadenylation in transfected cells. We found that when the nascent RNA species could fold itself to form the rodlike structure, the HDV polyadenylation was suppressed 3 to 5 fold by the HDAg. In addition, we observed that the small and the large HDAg exerted a similar suppressive effect on the HDV polyadenylation, though they played different roles in HDV replication. We concluded that the HDV polyadenylation could be regulated by the structure of the nascent antigenomic RNA and by either the small or large HDAg.