[Comparative study of medical common data models for FAIR data sharing]

The common data model (CDM) is an important tool to facilitate the standardized integration of multi-source heterogeneous healthcare big data, enhance the consistency of data semantic understanding, and promote multi-party collaborative analysis. The data collections standardized by CDM can provide powerful support for observational studies, such as large-scale population cohort study. This paper provides an in-depth comparative analysis of the data storage structure, term mapping pattern, and auxiliary tools development of the three international typical CDMs, then analyzes the advantages and limitations of each CDM and summarizes the challenges and opportunities faced in the CDM application in China. It is expected that exploring the advanced technical concepts and practical patterns of foreign countries in data management and sharing will provide references for promoting FAIR (findable, accessible, interoperable, reusable) construction of healthcare big data in China and solving the current practical problems, such as the poor quality of data resources, the low degree of semantization, and the inabilities of data sharing and reuse.

Branching of High-Current Relativistic Electron Beam in Porous Materials

Propagation of high-current relativistic electron beam (REB) in plasma is relevant to many high-energy astrophysical phenomena as well as applications based on high-intensity lasers and charged-particle beams. Here, we report a new regime of beam-plasma interaction arising from REB propagation in medium with fine structures. In this regime, the REB cascades into thin branches with local density a hundred times the initial value and deposits its energy 2 orders of magnitude more efficiently than that in homogeneous plasma, where REB branching does not occur, of similar average density. Such beam branching can be attributed to successive weak scatterings of the beam electrons by the unevenly distributed magnetic fields induced by the local return currents in the skeletons of the porous medium. Results from a model for the excitation conditions and location of the first branching point with respect to the medium and beam parameters agree well with that from pore-resolved particle-in-cell simulations.

Nanoscale Electrostatic Modulation of Mega-Ampere Electron Current in Solid-Density Plasmas

Transport of high-current relativistic electron beams in dense plasmas is of interest in many areas of research. However, so far the mechanism of such beam-plasma interaction is still not well understood due to the appearance of small time- and space-scale effects. Here we identify a new regime of electron beam transport in solid-density plasma, where kinetic effects that develop on small time and space scales play a dominant role. Our three-dimensional particle-in-cell simulations show that in this regime the electron beam can evolve into layered short microelectron bunches when collisions are relatively weak. The phenomenon is attributed to a secondary instability, on the space- and timescales of the electron skin depth (tens of nanometers) and few femtoseconds of strong electrostatic modulation of the microelectron current filaments formed by Weibel-like instability of the original electron beam. Analytical analysis on the amplitude, scale length, and excitation condition of the self-generated electrostatic fields is clearly validated by the simulations.

[Effects of modified posteromedial approach combined raft technique for posterior Pilon fractures with collapsed articular surface]

Objective: To evaluate the effects of modified posteromedial approach combined raft technique in the treatment of posterior Pilon fractures with collapsed articular surface. Methods: A retrospective analysis was conducted on the clinical data of 51 patients with posterior Pilon fractures combined with collapsed articular surface treated in West China Hospital between January 2014 and June 2017. There were 30 males and 21 females with an average age of 49 years (range, 19-66 years).Subjective assessment of the results was performed according to the pain visual analog scale (VAS).The general function recovery was assessed with American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale at the latest follow-up. The fracture reduction quality was determined according to Burwell-Charnley imaging standard by the anteroposterior(AP)/mortise X-ray view and three-dimensional CT of the ankle on the 3rd day after operation. The t-test was used to compare the normal distribution parameters. Results: Primary healing of incision and bone were obtained in all patients without loosening, breakage or infection of internal fixation in (3.7±0.7) months (range, 3-6 months). According to the Burwell-Charnley's standards, 50 cases achieved anatomical reduction, 1 case achieved fair reduction. According to AOFAS scales, the results were excellent in 41 cases, good in 9, and fair in 1; the excellent rate was 98.0%. According to the AOFAS scores, the average score was 93.6±2.2. The preoperative VAS score was 7.5±1.1, and the postoperative score was 0.3±0.7, in which the difference was statistically significant (t=31.231, P=0.000). At the last follow-up, the angle of injured side were 13.3°±3.4° in dorsal extension, 33.5°±4.7° in plantar flexion, and 46.9°±6.1° in the range, while angel of uninjured side were 19.8°±2.3°, 36.0°±5.7° and 55.6°±2.7°, respectively; there were significant differences in the up-mentioned indexes between the both sides (t=78.932, 121.231, 113.432, all P<0.05). Conclusion: Excellent short-term effectiveness can be achieved through the modified medial approach in patients with posterior Pilon fractures, which can be used to restore the ankle joint surface under direct vision; and with the raft technique, a small plate is used to fix small fragments firmly with less soft tissue complications.

Abstract GS1-01: Landscape of the breast tumour microenvironment at single-cell resolution

Breast cancers are a complex 'ecosystem' of diverse cell types, whose heterotypic interactions play central roles in defining the aetiology of disease and its response to therapy. The next generation of therapies will likely be based upon an integrated understanding of the malignant, microenvironmental and immune states that define the tumour and inform treatment response. However, our poor understanding of the tumour microenvironment (TME) of breast cancers has limited the development and implementation of new drugs that target stromal and immune cells.

Single cell genomics (SCG) is a remarkable new platform to examine the compositional, gene expression and other parameters of thousands of cells, rapidly and at scale. We have used a multi-dimensional SCG approach to characterise the TME in a unique cohort of early and metastatic breast cancers with rich clinico-pathological annotation. We have conducted single cell RNA-Sequencing on more than 125,000 cells collected from 22 patients.

Malignant cells showed remarkable intra-tumoural heterogeneity for canonical breast cancer features, such as intrinsic subtype, hormone receptor expression and activity, drug targets, drug resistance signatures and transcriptional drivers.

Cancer Associated Fibroblasts (CAFs), which are classically studied as a single cell type, were heterogeneous across primary and metastatic sites. Interestingly we identified a myofibroblast-like subset and an inflammatory-mediator subset and propose multi-faceted roles in regulating malignancy and tumour immunity. Distinct transcription factor networks regulated these polarised states.

We applied a new method known as CITE-Seq to measure cell surface immune markers and checkpoint proteins simultaneous to RNA-Sequencing. We resolve the tumour-immune milieu with high precision and generate new transcriptional signatures of breast tumour-infiltrating leukocytes.

To track lymphocyte clonal dynamics through space and time, we developed a novel method known as RAGE-Seq to permit simultaneous full length lymphocyte receptor- and RNA-sequencing at single cell resolution. We observe clonal expansion and trafficking of CD4+ and CD8+ T lymphocytes between the lymph nodes, blood and tumor of patients. In comparison, B cells were polyclonal, suggesting an absence of antigen-dependent clonal expansion.

This data provides by far the most extensive insights into the cellular landscape of breast cancer and will reveal new biomarkers and opportunities for stromal- and immune-based therapy.

Citation Format: Swarbrick A, Wu SZ, Roden D, Al-Eryani G, O'Toole S, Lim E. Landscape of the breast tumour microenvironment at single-cell resolution [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS1-01.

Activity of Streptococcus mutans VicR Is Modulated by Antisense RNA

The VicRK 2-component system of Streptococcus mutans regulates genes associated with cell wall biogenesis and biofilm formation. A putative RNase III-encoding gene ( rnc) is located downstream from the vicRKX operon. The goals of this study were to investigate the potential role of VicR in the regulation of adjacent downstream genes and evaluate transcription levels of vicR during planktonic and biofilm growth. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to investigate whether vicRKX and adjacent downstream genes were cotranscribed. Binding of purified recombinant VicR protein to promoter regions of vicR, rnc, and syfA genes was confirmed by electrophoretic mobility shift assay and by chromatin immunoprecipitation analyses. VicR antisense (AS vicR) RNA was detected by Northern blotting and qRT-PCR assays. AS vicR overexpression mutants were constructed, and the biofilm biomass was determined by crystal violet microtiter assay. Adjacent downstream genes rnc, smc, syfA, smu.1511, and syfB were cotranscribed with vicRKX. The predicted promoter regions of vicR, rnc, and syfA genes were directly regulated by VicR. An AS vicR RNA transcript was detected upstream of the rnc gene. Expression of the AS vicR RNA transcript was elevated in planktonic cultures and repressed during biofilm growth. In addition, Western blot data showed that expression of the VicR protein decreased by 35% in planktonic as compared with biofilm cultures. Furthermore, we show that overexpression of AS vicR led to a reduction in biofilm formation. The downstream genes rnc, smc, syfA, smu.1511, and syfB are cotranscribed with vicRKX. VicR is autophosphorylated, and rnc and syfA are directly regulated by VicR. Expression of VicR protein correlated inversely with different levels of AS vicR RNA transcript and growth conditions. The biofilm biomass decreased in the AS vicR overexpression mutant. These data suggest a role for the AS vicR RNA transcript in posttranscriptional regulation of VicR protein production in S. mutans.

Production of high-angular-momentum electron beams in laser-plasma interactions

It was shown that in the interactions of ultra-intense circularly polarized laser pulse with the near-critical plasmas, the angular momentum can be transferred efficiently from the laser beam to electrons through the resonance acceleration process. The transferred angular momentum increases almost linearly with the acceleration time t_{a} when the electrons are resonantly accelerated by the laser field. In addition, it is shown analytically that the averaged angular momentum of electrons is proportional to the laser amplitude a_{L}, and the total angular momentum of the accelerated electron beam is proportional to the square of the laser amplitude a_{L}^{2} for a fixed parameter of n_{e}/n_{c}a_{L}. These results are verified by three-dimensional particle-in-cell simulations. This regime provides an efficient and compact alternative for the production of high angular momentum electron beams, which may have many potential applications in condensed-matter spectroscopy, new electron microscopes, and bright x-ray vortex generation.

Relativistic laser hosing instability suppression and electron acceleration in a preformed plasma channel

The hosing processes of a relativistic laser pulse, electron acceleration, and betatron radiation in a parabolic plasma channel are investigated in the direct laser acceleration regime. It is shown that the laser hosing instability would result in the generation of a randomly directed off-axis electron beam and radiation source with a large divergence angle. While employing a preformed parabolic plasma channel, the restoring force provided by the plasma channel would correct the perturbed laser wave front and thus suppress the hosing instability. As a result, the accelerated electron beam and the emitted photons are well guided and concentrated along the channel axis. The employment of a proper plasma density channel can stably guide the relativistically intense laser pulse and greatly improve the properties of the electron beam and radiation source. This scheme is of great interest for the generation of high quality electron beams and radiation sources.

[Pulmonary surfactant protein adenosine triphosphate-binding-cassette-A3 gene composite mutations in infant congenital interstitial lung disease: report of a case and review of literature]

Objective: To report a case of the pulmonary surfactant protein(SP) adenosine triphosphate-binding-cassette-A3 (ABCA3) gene mutations in infant congenital interstitial lung disease(ILD), and review the related literature, to investigate the relationships of ABCA3 gene mutation associated with ILD in infants. Method: A 6-months-old boy was hospitalized in the department of Pediatrics of the First Affiliated Hospital of Guangzhou Medical University. The clinical, radiological, histological information from transbronchial lung biopsy (TBLB) and genetic testing in this case was analyzed; 12 reports retrieved on literature search at Pubmed, OVID databases from 2004 to 2015 by using the ABCA3 as keyword were reviewed and analyzed. Result: (1)The patient, a 6-months-old boy, had progressive tachypnea and dyspnea since 4 months old. Physical examination on admission revealed respiratory rate of 78 times/min , heart rate of 187 times/min, SpO₂ 0.93(mask oxygen-inspiration with 6 L/min), scattered fine moist crackles could be heard over the both lungs, clubbing fingers were found. High-resolution computed tomography(HRCT) revealed diffuse ground-glass opacity, interlobular and intralobular septal thickening. Lung biopsies showed evidences of the alveolar cavity atelectatic changes and interstitial fibrosis. SP-A and SP-B were negative in immunohistochemical stainting. SP-related gene sequence analysis found that there was compound heterozygous missense mutation of ABCA3 gene in c. 1942A>G, c.2701-33G>C and c. 991-105C>A. (2)The review of related literature found that totally 12 cases were reported. The main manifestations were progressive tachypnea and dyspnea, age of onset was between birth and 4 years of age. The imaging characteristics of chest HRCT revealed diffuse infiltration or diffuse ground-glass pattern in the lung.

PROGNOSIS

6 cases died, and 6 cases survived, including 4 cases with pulmonary function disturbance to different degrees; 12 cases had ABCA3 gene mutations, 9 cases had composite ABCA3 gene mutations, in 11 cases the mutation occured in the exon of coding region, in 1 case in the intron, 9 cases had heterozygous mutations, 3 cases had homozygous mutations. Conclusion: The main phenotypes of ABCA3 mutation associated with ILD were full term neonatal respiratory distress syndrome or progressive tachypnea or dyspnea unexplained in infants. The chest HRCT showed two diffuse pulmonary interstitial changes. ABCA3 mutation mainly was multi-site composite mutations and heterozygous mutations in the exon of coding region.

Controlling multiple filaments by relativistic optical vortex beams in plasmas

Filamentation dynamics of relativistic optical vortex beams (OVBs) propagating in underdense plasma is investigated. It is shown that OVBs with finite orbital angular momentum (OAM) exhibit much more robust propagation behavior than the standard Gaussian beam. In fact, the growth rate of the azimuthal modulational instability decreases rapidly with increase of the OVB topological charge. Thus, relativistic OVBs can maintain their profiles for significantly longer distances in an underdense plasma before filamentation occurs. It is also found that an OVB would then break up into regular filament patterns due to conservation of the OAM, in contrast to a Gaussian laser beam, which in general experiences random filamentation.

Characterization of magnetic reconnection in the high-energy-density regime

The dynamics of magnetic reconnection (MR) in the high-energy-density (HED) regime, where the plasma inflow is strongly driven and the thermal pressure is larger than the magnetic pressure (β>1), is reexamined theoretically and by particle-in-cell simulations. Interactions of two colliding laser-produced plasma bubbles with self-generated poloidal magnetic fields of, respectively, antiparallel and parallel field lines are considered. Through comparison, it is found that the quadrupole magnetic field, bipolar poloidal electric field, plasma heating, and even the out-of-plane electric field can appear in both cases due to the mere plasma bubble collision, which may not be individually recognized as evidences of MR in the HED regime separately. The Lorentz-invariant scalar quantity D(e) ≃ γ(e)j · (E + v(e) × B) (γ(e) = [1-(v(e)/c)(2)](-1/2)) in the electron dissipation region is proposed as the key sign of MR occurrence in this regime.

Energetic electron-bunch generation in a phase-locked longitudinal laser electric field

Energetic electron acceleration processes in a plasma hollow tube irradiated by an ultraintense laser pulse are investigated. It is found that the longitudinal component of the laser field is much enhanced when a linear polarized Gaussian laser pulse propagates through the plasma tube. This longitudinal field is of π/2 phase shift relative to the transverse electric field and has a π phase interval between its upper and lower parts. The electrons in the plasma tube are first pulled out by the transverse electric field and then trapped by the longitudinal electric field. The trapped electrons can further be accelerated to higher energy in the presence of the longitudinal electric field. This acceleration mechanism is clearly illustrated by both particle-in-cell simulations and single particle modelings.

Mitigating the relativistic laser beam filamentation via an elliptical beam profile

It is shown that the filamentation instability of relativistically intense laser pulses in plasmas can be mitigated in the case where the laser beam has an elliptically distributed beam profile. A high-power elliptical Gaussian laser beam would break up into a regular filamentation pattern-in contrast to the randomly distributed filaments of a circularly distributed laser beam-and much more laser power would be concentrated in the central region. A highly elliptically distributed laser beam experiences anisotropic self-focusing and diffraction processes in the plasma channel ensuring that the unstable diffractive rings of the circular case cannot be produced. The azimuthal modulational instability is thereby suppressed. These findings are verified by three-dimensional particle-in-cell simulations.

Generation of overdense and high-energy electron-positron-pair plasmas by irradiation of a thin foil with two ultraintense lasers

A scheme for enhanced quantum electrodynamics (QED) production of electron-positron-pair plasmas is proposed that uses two ultraintense lasers irradiating a thin solid foil from opposite sides. In the scheme, under a proper matching condition, in addition to the skin-depth emission of γ-ray photons and Breit-Wheeler creation of pairs on each side of the foil, a large number of high-energy electrons and photons from one side can propagate through it and interact with the laser on the other side, leading to much enhanced γ-ray emission and pair production. More importantly, the created pairs can be collected later and confined to the center by opposite laser radiation pressures when the foil becomes transparent, resulting in the formation of unprecedentedly overdense and high-energy pair plasmas. Two-dimensional QED particle-in-cell simulations show that electron-positron-pair plasmas with overcritical density 10(22) cm(-3) and a high energy of 100s of MeV are obtained with 10 PW lasers at intensities 10(23) W/cm(2), which are of key significance for laboratory astrophysics studies.

Gigabase-scale transcriptome analysis on four species of pearl oysters

Pearl oysters have been found to secrete nacre and form pearls with good quality and significant commercial interest. However, the transcriptomic and genomic resources for pearl oysters are still limited. To improve this situation, transcriptome sequencing was conducted from four species of pearl oysters with Illumina HiSeq™ 2000. There were four gigabase-scale transcriptomes for four species of pearl oysters, ∼26.3 million reads with ∼2.37 gigabase base pairs (Gbp) in Pinctada fucata, ∼26.5 million reads with ∼2.39 Gbp in Pinctada margaritifera, ∼27.0 million reads with ∼2.43 Gbp in Pinctada maxima, and ∼25.9 million reads with ∼2.33 Gbp in Pteria penguin, respectively. After sequence assembly and blastx alignment, the numbers of annotated unigenes ≥200 bp were 33,882 in P. fucata, 30,666 in P. margaritifera, 26,420 in P. maxima, and 29,928 in P. penguin. Based on these annotated unigenes among four species of pearl oysters, CDSs were extracted and predicted and furthermore, analyses of GO and KEGG assignments were performed. In addition, 60 putative genes of growth factors and their receptors from four species of pearl oysters were predicted. This study established an excellent resource for gene discovery and expression in pearl oysters, but also offered a significant platform for functional genomics and comparative genomic studies for mollusks.

Interleukin-17 in pearl oyster (Pinctada fucata): molecular cloning and functional characterization

IL-17 from pearl oyster Pinctada fucata, one of mollusk, was identified and characterized, and its genomic structure and promoter were analyzed. The full-length cDNA of P. fucata IL-17 (PfIL-17) is 907 bp with an open reading frame of 585 bp encoding a putative protein of 194 amino acids. The deduced PfIL-17 contains a 19 amino acid signal peptide and a conserved IL-17 domain. Multiple sequence alignments and phylogenetic analysis revealed that PfIL-17 has lower similarity with other invertebrate IL-17 and was clustered with CgIL-17, but not clustered with other invertebrate IL-17. Gene expression analysis indicated that PfIL-17 took part in the immune response to LPS and poly(I:C) stimulation, and dual-luciferase reporter assays showed that PfIL-17 could active vertebrate target genes containing the NF-κB binding site and involve NF-κB signal pathway in HEK293 cells. Combined with the results mentioned above, it is suggested that PfIL-17 might involve and activate NF-κB signal pathway against extracellular pathogens.

Molecular characterization of interferon regulatory factor 2 (IRF-2) homolog in pearl oyster Pinctada fucata

Interferon regulatory factors (IRFs) control many facets of the innate and adaptive immune responses, regulate the development of the immune system itself and involve in reproduction and morphogenesis. In the present study, the IRF-2 homology gene, PfIRF-2 from pearl oyster Pinctada fucata was cloned and its genomic structure and promoter were analyzed. PfIRF-2 encodes a putative protein of 350 amino acids, and contains a highly conserved N-terminal DNA-binding domain and a variable C-terminal regulatory domain. Comparison and phylogenetic analysis revealed that PfIRF-2 shared a relatively higher identity with other mollusk but relatively lower identity with vertebrate IRF-2, and was clustered with IRF-1 subfamily composed of IRF-2 and IRF-1. Furthermore, gene expression analysis revealed that PfIRF-2 involved in the immune response to LPS and poly(I:C) stimulation. Immunofluorescence assay showed that the expressed PfIRF-2 was translocated into the nucleus and dual-luciferase reporter assays indicated that PfIRF-2 could involved and activate interferon signaling or NF-κB signal pathway in HEK293 cells. The study of PfIRF-2 may help better understand the innate immune in mollusk.

Gene cloning and function analysis of cytokine-induced suppressor of cytokine signaling (SOCS) from pearl oyster Pinctada fucata

Cytokine-induced suppressor of cytokine signaling (SOCS) family acts as a negative regulator of cytokine receptor signaling to control excessive cytokine effects and inhibit a variety of signal transduction pathways, particularly the Janus kinases/signal transducers and activators of transcription (JAK/STAT) pathway. In present study, SOCS-2 homolog (PfSOCS-2) from pearl oyster Pinctada fucata was cloned and its gene has no intron. Multiple sequence alignments and phylogenetic analysis showed that PfSOCS-2 was clustered with other mollusk SOCS-2. LPS or polyI:C challenge and gene expression analysis revealed that PfSOCS-2 involved the innate immune response against bacterial and viral infections and that induction of PfSOCS-2 was varied with the different challenge stimulations. Furthermore, Dual-luciferase reporter assays showed that PfSOCS-2 involved in the regulation of vertebrate target genes containing the IFN-stimulated response element or NF-κB binding site in vitro. These results indicated that SOCS-2 from P. fucata plays a regulatory role against the stimulation.

Molecular cloning and characterization of class I NF-κB transcription factor from pearl oyster (Pinctada fucata)

NF-κB transcription factors play central roles in many important physiological and pathological processes including innate immune responses. Here we report the cloning of an NF-κB transcription factor, PfRelish from pearl oyster Pinctada fucata, one of the most important bivalve mollusks for seawater pearl production. PfRelish full-length cDNA is 3916 bp with an open reading frame of 3558 bp encoding a putative protein of 1186 amino acids. The deduced PfRelish contains a N-terminal RHD, a nucleus localization signal, an IκB-like domain with six ankyrin repeats and a death domain at the C-terminus, which is similar to class I NF-κB transcription factors. Comparison and phylogenetic analysis revealed that class I NF-κBs in mollusks including PfRelish might have most distant relationship to the arthropod Relish. Further expression analysis showed that PfRelish was apparently upregulated after Vibrio alginolyticus injection, which suggested that PfRelish was involved in the immune response to V. alginolyticus.

Molecular cloning, characterization and expression analysis of tumor necrosis factor receptor-associated factor 3 (TRAF3) from pearl oyster Pinctada fucata

TRAF3 is a highly versatile regulator that negatively regulates JNK and alternative nuclear factor-κB signalling, but positively controls type I interferon production. To investigate TRAF3 function in innate immune responses among invertebrate especially mollusk, we characterized TRAF3 (PfTRAF3) from pearl oyster Pinctada fucata, one of the most important bivalve mollusks for seawater pearl production. PfTRAF3 cDNA is 2261 bp with an open reading frame of 1623 bp encoding a putative protein of 541 amino acids. The deduced PfTRAF3 contains a RING finger domain, two TRAF domains with zinc finger domains and a conserved C-terminal meprin and TRAF homology (MATH) domain. Comparison and phylogenetic analysis revealed that PfTRAF3 from mollusk shared a higher identity with Ciona intestinalis TRAF3 from urochordata, Branchiostoma belcheri TRAF3 from cephalochordate, and even TRAF3 from vertebrate than with insect homologues. Furthermore, gene expression analyses suggested that PfTRAF3 was involved in the immune response to Vibrio alginolyticus.

[The outcomes of restraint reduction program in nursing homes]

One of the problems in nursing home care in Taiwan is resident restraint, including physical and chemical restraints. This pre-experimental study was conducted to investigate whether a restraint reduction program could reduce the prevalence of restraint in nursing homes. Three registered nursing homes were randomly selected from nursing homes in the Kaohsiung area. Staff and residents of these nursing homes were educated in restraint alternatives, balance training and managing behavior problems in one month of interventions. Three days before and after interventions, prevalence of restraints, falls, and of pressure sores, balance reaction, frequency of agitation, use of psychotic drugs, as well as the restraint knowledge of the nursing staff, was measured. After the restraint reduction program, the prevalence of restraint and frequency of resident agitation decreased significantly. The prevalence of falls and pressure sores of residents was not changed significantly. The restraint knowledge of the nursing staff significantly increased after the restraint reduction program. The information from this study led to a better strategy to reduce restraint for the elderly in nursing homes. The results could also provide a model to improve the quality of care in nursing homes in Taiwan.

Study on genital tract Chlamydia trachomatis and gonococcal infection in Han and minority (Naxi and Dai) women in China's two provinces

OBJECTIVES

To estimate the prevalence of lower female genital tract chlamydial (GTC) and gonococcal infection in 3 different ethnic groups in China, and to analyze the risk factors influencing these infections.

METHODS

A cross-sectional survey + physical and laboratory examinations. 1,800 married women aged 18-35 Han (600, from Dujiangyan city, Sichuan), Naxi (600, from Yanyuan county, Sichuan), and Dai (600, from Jinghong Prefecture, Yunnan) were investigated between March 1996 to March 1997. Information was obtained about their personal history, socioeconomic status, medical history, STDs, sexual history, contraceptive history, results of both examinations. Tabulation, t-test, Chi-square test, multiple-logistic models were used to analyze the data.

RESULTS

3.2% of Han, 12.8% of Naxi and 4.5% of Dai women tested positive for gonococci; and 9.1% of Han, 16.7% of Naxi and 27.5% of Dai women tested positive for GTC infection. The differences of GTC and gonococcal infections between Han and Naxi, and Han and Dai women were significant.

CONCLUSIONS

STDs are common in China today; both GTC and gonoccocal infections are related to non-use of condom, having sexual partners other than husband, number of abortions, and low education; and condom has a function in prevention of STDs.

Distinct roles for the small GTPases Cdc42 and Rho in endothelial responses to shear stress

Shear stress, the tangential component of hemodynamic forces, plays an important role in endothelial remodeling. In this study, we investigated the role of Rho family GTPases Cdc42 and Rho in shear stress-induced signal transduction and cytoskeleton reorganization. Our results showed that shear stress induced the translocation of Cdc42 and Rho from cytosol to membrane. Although both Cdc42 and Rho were involved in the shear stress-induced transcription factor AP-1 acting on the 12-O-tetradecanoyl-13-phorbol-acetate-responsive element (TRE), only Cdc42 was sufficient to activate AP-1/TRE. Dominant-negative mutants of Cdc42 and Rho, as well as recombinant C3 exoenzyme, attenuated the shear stress activation of c-Jun NH2-terminal kinases (JNKs), suggesting that Cdc42 and Rho regulate the shear stress induction of AP-1/TRE activity through JNKs. Shear stress-induced cell alignment and stress fiber formation were inhibited by the dominant-negative mutants of Rho and p160ROCK, but not by the dominant-negative mutant of Cdc42, indicating that the Rho-p160ROCK pathway regulates the cytoskeletal reorganization in response to shear stress.

Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors

OBJECTIVE

The goals were to critically review all complications resulting within 30 days after craniotomies performed for excision of intra-axial brain tumors relative to factors likely to affect complication rates and to assess the value of these data in predicting the risk of surgical morbidity, particularly for surgery in eloquent brain regions.

METHODS

Neurosurgical outcomes were studied for 327 patients who underwent 400 craniotomies for removal of intra-axial parenchymal brain neoplasms in a 21-month period. Tumors removed included gliomas (206 tumors) and metastases (194 tumors) located both supratentorially (358 tumors) and infratentorially (42 tumors).

RESULTS

The major complication incidence was 13%, and the operative mortality rate was 1.7%. The overall morbidity rate was 32%, but more types of complications were considered than in previous studies. The major neurological morbidity rate was 8.5%. Based on pre- versus postoperative (at 4 wk) Karnofsky Performance Scale scores, 9% of patients deteriorated neurologically, 32% improved, and 58% showed no change. The median postoperative hospital stay was 5 days. Tumors were defined as Grade I, II, or III based on their location relative to brain function, and this tumor functional grade was the most important variable affecting the incidence of any neurological deficit. Patients with tumors in eloquent (Grade III) or near-eloquent (Grade II) brain areas incurred more neurological deficits than did patients with tumors in noneloquent areas (Grade I). Neither repeat surgery for recurrent disease nor extent of surgical resection affected outcome significantly. Although most tumors in this study, including those in eloquent regions, were removed by gross total resection, this did not lead to more major neurological deficits. Regional complications (at the surgical sites) and systemic complications (medical) were more prevalent among older patients (age >60 yr) with lower preoperative Karnofsky Performance Scale scores (< or = 50) and posterior fossa masses. We showed how our data can be used to predict the total risk of surgical morbidity for a given patient, to facilitate patient counseling and surgical decision-making.

CONCLUSION

The finding that gross total resections could be performed in eloquent brain regions with an acceptable level of neurological impairment suggested that the mere presence of a tumor in eloquent brain does not automatically contraindicate surgery. Our results have practical risk-predictive value, and they should aid in the construction of subsequent outcome studies, because we have identified the key areas to monitor.

Psychological long-term effects of sterilization on anxiety and depression

Two-thousand cases (500 women and 500 men with sterilization; 500 women and 500 men without sterilization) in two counties and two cities in Sichuan, China, were investigated between 15 September 1992 and 30 April 1993. Information was obtained about their age, parity, marriage, contraceptives, social behavior, and present psychological characteristics. CES-D, SAS, and E.P.Q. scales were used to assess the depressive symptomatology, anxiety, and personality of the subjects. The results revealed that sterilization psychologically affected the depressive symptoms and anxiety under the neutral personality. In addition, depressive symptoms and anxiety were related to the subjects' age, educational level, income, operative doctors' attitudes to sterilization acceptors, and subjects' understanding of the sterilization.

A follow-up study of first trimester induced abortions at hospitals and family planning clinics in Sichuan province, China

Four-thousand women aged 18-40 underwent an early induced abortion at hospitals and family planning clinics in six counties in Sichuan province, China, between 1 July 1990 and 30 June 1991. The subjects were followed-up three times, on days 15, 90 and 180 after the operation. Information was obtained about their age, parity, contraceptive use, social behaviors, and gynecological and psychological characteristics before and after the abortion. The results indicate that induced abortion is safe when provided by medically trained personnel in health facilities such as hospitals or clinics. Depressive symptomatology was assessed by the CES-D and SCL-90 scales. The depressive symptoms declined over time. A substantial proportion of the abortions were to unmarried women or resulted from non-use of contraception or contraceptive failure, implying that the incidence of unintended pregnancies and induced abortions could be reduced by more effective and accessible contraception.

Induced abortion among unmarried women in Sichuan province, China

This report describes the social and demographic characteristics of 457 unmarried women who underwent a first trimester induced abortion at hospitals and family planning clinics in Sichuan province, China. The data show a very low level of medical complications. However, improved access to contraception for unmarried women is needed in order to reduce the incidence of unintended pregnancies and induced abortion.

Prognostic significance of proteolytic enzymes in human brain tumors

Proteases and their inhibitors have been shown to play roles in tumor invasion and metastasis in a number of experimental models. Recently, relative increases in the amounts of urokinase type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) in tumor samples have been correlated with poorer, pathological grade, shorter disease-free interval, and shorter survival. To date, all studies investigating the prognostic significance of proteases and their inhibitors have been limited to extracranial cancer. In this article, we review the literature and present our data on the prognostic significance of proteases in human brain tumors. High levels of uPA were seen in malignant glioma and metastatic tumors (n = 82), whereas normal levels of uPA were found in low-grade gliomas. Analysis with magnetic resonance imaging (MRI) demonstrated a significant correlation between high levels of uPA and necrosis and edema (n = 50; P < 0.05). Similarly, patients with high levels of uPA had shorter survival than did patients with low levels of uPA. Tissue-type plasminogen activator (tPA), which was virtually absent in glioblastoma multiforme (GBM), colon lung, and breast metastasis, was found in normal quantities in anaplastic astrocytoma (AA), low-grade glioma (LGG), and meningioma. Melanoma had significantly more tPA activity than normal brain did. A reverse correlation was found between tPA and MRI findings of necrosis, enhancement, and edema. Similarly, patients with no detectable tPA activity had shorter survival than did patients with detectable tPA activity. We conclude that high levels of uPA and absent tPA activity correlate with histologically malignant brain tumors, aggressive characteristics, and shorter survival.

Therapeutic effects of an androgenic preparation on myocardial ischemia and cardiac function in 62 elderly male coronary heart disease patients

The elevated estradiol/testosterone (E2/T) ratio had been proved to be a risk factor for coronary heart disease (CHD) in elderly men. We conducted a randomized placebo controlled crossover study on the effects of a new androgenic preparation "Andriol" in 62 elderly men with CHD over a period of 2.5 months. The results showed significant differences between Andriol- and placebo-treated groups at the end of this period: in the former, serum T level was elevated significantly (P < 0.001), E2 level was unchanged (P > 0.05), E2/T ratio was reduced (P < 0.05), angina pectoris (AP) was relieved (total effective rate, 77.4%), and myocardial ischemia in ECG and Holter recordings were improved (total effective rate, respectively 68.8% and 75%). Doppler echocardiography showed that 12 parameters of cardiac function were unchanged in both groups. No obvious side effect was found in those who took Andriol.

[Antianginal and lipid lowering effects of oral androgenic preparation (Andriol) on elderly male patients with coronary heart disease]

Sixty-two elderly men with coronary heart disease (CHD), 54 of them also suffering from hyperlipidemia, were treated with a new oral androgenic preparation (Andriol) through crossover study. The results showed that after oral Andriol administration for one month, serum estradiol/testosterone (E2/T) ratio was reduced, (P < 0.05) symptom of angina pectoris was relieved (total effective rate, 77.4%), signs of myocardial ischemia in ECG and Holter monitoring were improved (total effective rate, 68.8% and 75% respectively), serum total cholesterol (TC) and triglyceride (TG) levels were reduced dramatically (both P < 0.001) and the serum level of high density lipoprotein cholesterol (HDL-ch) was increased (P < 0.05), but the blood levels of apolipoprotein-AI (APO-AI) and B (APO-B) remained unchanged. No significant side effect of Andriol was observed.

Plasma fibrinolytic profile in patients with brain tumors

Changes in the fibrinolytic and coagulation values measured preoperatively in brain tumor patients have not been done systematically using individual rather than global assays. Such measurements can provide meaningful information on the status of tumor-host interactions and could potentially help in predicting thromboembolic and hemorrhagic tendencies. A complete fibrinolytic profile including total fibrinolytic activity (TFA), tissue plasminogen activator (t-PA), plasmin inhibitor (PI), plasminogen activator inhibitor (PAI), protein C (PC) and plasminogen (PLG) was obtained preoperatively in 114 brain tumor patients. PLG and PI did not show much variation among the groups. TFA was slightly reduced (15%) in patients with malignant brain tumors. t-PA, however, was abnormally low in several patients and in almost 40% of patients with brain metastasis. PAI was above the upper limit of normal in approximately 50% of the patients but particularly in glioma, glioblastoma and metastasis patients. Finally, mean PC was abnormally increased in the glioblastoma and metastasis groups (p less than 0.001). This is the first study that has measured protein C in brain tumor patients. In conclusion, plasma fibrinolytic levels show marked changes in a substantial number of brain tumor patients prior to surgery--suggesting an ongoing tumor-host interaction.

The relationship between the capillary structure and hemorrhage in gliomas

A 48-year-old man was admitted with the sudden onset of symptoms of stroke caused by hemorrhage in an oligodendroglioma. Despite surgery and antiedema treatment, the patient died. Histological evaluation revealed an oligodendroglioma with calcified capillaries of the retiform type. To further investigate this phenomenon, a total of 160 gliomas were reviewed: 90 glioblastomas multiforme, 30 oligodendrogliomas, and 40 astrocytomas. Sufficient data were available for clinical evaluation in 100 cases. Of these, 5% (two oligodendrogliomas and three glioblastomas multiforme) were related to clinically significant hemorrhages. Of the remaining cases, microhemorrhages were found in 53.0% of the glioblastomas, in 56.7% of the oligodendrogliomas, and in 10.0% of the astrocytomas. In each case reviewed, the capillaries were assigned to one of three groups: axial, retiform, or glomeruloid. Statistical analysis revealed a significant association between hemorrhages and retiform capillaries in all three types of tumors, except that in oligodendrogliomas the statistical significance held true when calcification of the capillaries was also present. Glomeruloid-type capillaries were only weakly associated with hemorrhages, and no association was found for axial capillaries. A large-scale prospective study is necessary to more precisely assess the role of each of the three types of capillaries in hemorrhages of gliomas. Based on data available so far, patients with glial tumors with retiform capillaries, confirmed on biopsy, should be carefully monitored to exclude possible intratumoral hemorrhage.

[Chemotherapy combined with selective resection in small cell lung cancer--analysis of 239 patients]

From 1957 to 1976, 143 patients with small cell lung cancer (SCLC) were treated with surgical resection followed by chemotherapy. The 5 year survival rates were 38.7%, 8.7% and 3.5% in stages I, II and III. The prognostic factors were clinical stage and chemotherapy. 4 stage I and 1 stage II patients without chemotherapy have survived for more than 5 years. It seems to suggest that SCLC in stage I be indicated for surgery. 4 stage III have survived for more than 5 years, all of whom had received postoperative chemotherapy for more than 4 courses. From 1980 to 1982, 96 patients with SCLC were treated, 37 of whom by chemotherapy combined with surgery. 11/37 patients were alive for more than 2 years, 7 for more than 3 years and 4 for more than 4 years. In the preoperative chemotherapy followed by selective resection plus postoperative chemotherapy group (13 patients), the mean survival time was 22.7 months, but in the postoperative chemotherapy group (24 patients), it was 11.0 months. It indicates that full-dose chemotherapy before and after operation may be superior to the postoperative chemotherapy alone.

Electrophrenic respiration following anastomosis of phrenic with branchial nerve in the cat

Patients with high spinal cord injuries may be totally dependent on artificial ventilation. Prolonged use of mechanical devices requires intensive care, which restricts the mobility of these patients. Electrophrenic respiration has been used with success to overcome this difficulty. However, a prerequisite for electrophrenic respiration is a viable phrenic nerve. Patients with spinal cord injuries at the C-3 to C-5 levels do not have a viable phrenic nerve due to gradual degeneration of axons in these nerves. In the present study on cats, the authors caused degeneration in one of the phrenic nerves by sectioning it low in the neck. Then the distal end of the phrenic nerve was anastomosed to the proximal segment of a sectioned brachial nerve. Sixteen to 32 weeks were allowed for the growth of brachial axons into the anastomosed phrenic nerve. Each cat served as its own control because one of the phrenic nerves was left intact. It was observed that pacing of the anastomosed phrenic nerve produced respiration comparable to spontaneous respiration or to respiration induced by pacing the intact phrenic nerve. Lack of rhythmic bursts of electrical activity in the anastomosed phrenic nerve and electromyographic activity in the ipsilateral hemidiaphragm confirmed that the anastomosed phrenic nerve remained disconnected from the respiratory motoneurons. Abundance of collagen matrix in the electron micrographs of the anastomosed phrenic nerve indicated that degeneration of the axons of phrenic motoneurons had occurred and the brachial nerve had grown into the phrenic nerve stump. These results indicate that electrophrenic respiration may be possible in patients with spinal cord injuries at the C-3 to C-5 vertebral levels if the phrenic nerve is kept viable by anastomosing it to a branch of the brachial nerve.

External carotid occlusion as a cause of recurrent ischemia after carotid endarterectomy

Our experiences with a patient who developed recurrent hemispheric transient ischemic attacks 3 1/2 years after ipsilateral carotid endarterectomy are described. Although repeat arteriography demonstrated smooth and unobstructed common and internal carotid arteries and a normal intracranial circulation, there was complete occlusion of the external carotid artery at its origin, which appeared as a stump or diverticulum at the origin of the internal carotid artery. This stump was filled with atherothrombotic debris and served as a source of emboli to the adjacent and patent internal carotid artery. Excision of the stump effected complete relief of the recurrent ischemic symptoms. The pernicious potential of an external carotid obstruction when adjacent to a patent internal carotid artery should be recognized. To prevent this avoidable complication of carotid endarterectomy, we recommend that the origin of the external carotid artery be treated with the same standards of technical perfection as those customarily applied to the internal and common carotid arteries during this procedure.