Endometrioid adenocarcinoma: combined multiparametric MRI and tumour marker HE4 to evaluate tumour grade and lymphovascular space invasion.

AIM: To assess the value of semi-quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and quantitative diffusion-weighted imaging parameters combined with human epididymis protein 4 (HE4) in predicting the pathological grade and lymphovascular space invasion (LVSI) of endometrioid adenocarcinoma (EAC). MATERIALS AND METHODS: Between October 2018 and December 2021, 60 women (mean age, 55 [range, 32-77] years) with EAC underwent preoperative pelvic MRI and HE4 level measurements. The positive enhancement integral (PEI), time to peak, maximum slope of increase (MSI), and maximum slope of decrease were measured by manually drawing a region of interest on the neoplastic tissue. The receiver operating characteristic curve was used to calculate the diagnostic efficiency of the single parameter and combined factors. RESULTS: Lower apparent diffusion coefficients (ADCs) were observed in high-grade tumours (G3) than in low-grade tumours (G1/G2). PEI, MSI, and HE4 levels were higher in the high-grade tumours than in the low-grade tumours (p<0.05). The area under the curve (AUC) for G3 diagnosis using multiparametric MRI combined with HE4 was 0.929. ADC values were significantly lower in the EAC with LVSI than in those without LVSI. Tumours with LVSI showed higher PEI and HE4 levels than those without LVSI (p<0.05). The AUC for LVSI-positive diagnosis using multiparametric MRI combined with HE4 was 0.814. CONCLUSION: Semi-quantitative DCE-MRI, ADC values, and serum HE4 levels can be used to predict tumour grade and LVSI, and the prediction efficiency of multiparametric MRI combined with serum HE4 is better than that of any single factor.

[Correlation between contrast-enhanced ultrasound parameters and Crohn's disease activity].

Objective: By investigating the correlation between quantitative parameters of contrast enhanced ultrasound (CEUS) and commonly used activity assessment indicators of Crohn's disease (CD), and comparing the predictive power of laboratory inflammatory indicators with CEUS on Crohn's disease (CD), the significance of CEUS was evaluated. Methods: A case-control study. From October 2019 to December 2021, the clinical data of 67 patients with CD who were diagnosed by endoscopy and underwent contrast-enhanced ultrasonography were retrospectively analyzed in the First Affiliated Hospital with Nanjing Medical University, and their routine ultrasound and CEUS parameters, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin (FC), Crohn's disease activity index (CDAI) and simplified endoscopic score for Crohn's disease (SES-CD) were collected. Using SES-CD as the standard, the patients were divided into a remission group and an active group, and the correlation of laboratory inflammatory indexes and contrast-enhanced ultrasound parameters with CDAI and SES-CD were evaluated. Besides, the ROC curve was used to analyze the predictive efficacy of each index on CD endoscopic activity. Results: A total of 67 patients were included in this study. According to the SES-CD score, there were 17 patients in the remission group and 50 patients in the active group. Except for the coefficient of the enhancement wash in slope and time to peak (TTP), the peak intensity (PI), area under the angiography curve, and laboratory inflammatory indexes were significantly different between the two groups (P<0.05), which also showed a moderate positive correlation with CDAI and SES-CD (P<0.05). ROC analysis showed that among the non-invasive indicators, PI and area under the angiography curve had the highest AUCs for predicting CD endoscopic activity, which were 0.912 and 0.891, respectively; with SES-CD taking >3 as the cut-off value, the corresponding sensitivities were 78.0% and 72.0%, with specificities of 100.0% and 94.1%, respectively. Conclusion: CEUS can objectively and repeatedly evaluate the disease activity of CD patients, and has great clinical application value, which can be used as a reliable imaging method for diagnosis and follow-up of patients with Crohn's disease.

[Antimicrobial resistance and genomic characterization of Campylobacter isolates recovered from retailed poultry meat samples in 20 provinces of China in 2020].

Objective: To understand the antimicrobial resistance and genome characteristics of Campylobacter isolates recovered from retailed poultry meat samples in 20 provinces in China in 2020. Methods: In 2020, 265 Campylobacter strains including 244 Campylobacter jejuni and 21 Campylobacter coli collected from retailed poultry meat samples in China were tested for antimicrobial resistance to 9 antimicrobial compounds by using the agar dilution method. Forty-two selected isolates were sent for whole genome sequencing and 38 high-quality genomes were analyzed for their antimicrobial resistance genes, virulence genes, sequence types and genetic diversity. Results: The resistance rates of Campylobacter isolates from poultry meats to tetracycline, nalidixic acid and ciprofloxacin were the highest (84%-100%), with 53.2% of the isolates showing multidrug resistance in this study. The resistance rates of C. coli to erythromycin, azithromycin, telithromycin, gentamicin and clindamycin were significantly higher than those of C. jejuni (P<0.05). The resistance genes conferring resistance to ß-lactams (100%, 38/38), quinolones (94.7%, 36/38), tetracycline (81.6%, 31/38) and aminoglycosides (50%, 19/38) were the most frequently detected among 38 Campylobacter genomes. C. jejuni carried more virulence genes than C. coli. In total, 19 and 17 sequence types (ST) were obtained from 20 sequenced C. jejuni and 18 C. coli isolates, respectively, including 5 novel STs. The isolates showed a high genetic diversity based on their sequence types. Conclusion: The phenomenon of antimicrobial resistance in Campylobacter from poultry meat sources in China is relatively serious, and resistance and virulence genes are widely distributed in Campylobacter. There is genetic diversity in Campylobacter.

The risk of anti-osteoporotic agent-induced severe cutaneous adverse drug reactions and their association with HLA.

BACKGROUND: There is increasing use of anti-osteoporotic agents (AOA) worldwide for prevention or management of patients with osteoporosis. However, there have been reports of severe cutaneous adverse reactions (SCAR) induced by AOA. A recent study showed weak association between HLA and strontium ranelate (SR)-SCAR. OBJECTIVE: To characterize patients with AOA-SCAR and investigate the HLA association and utility of in vitro diagnostic methods. METHODS: We enrolled 16 cases with AOA-cutaneous adverse drug reactions (cADR), including SCAR (n = 10: 8 with Stevens-Johnson syndrome [SJS] and 2 with drug rash with eosinophilia and systemic symptoms [DRESS]) and maculopapular exanthema (MPE) (n = 6) from Taiwan and Hong Kong. We analysed the clinical characteristics, outcomes, HLA alleles and in vitro testing of AOA-SCAR, and tolerability to alternative drugs. We further performed literature review and meta-analysis on the HLA association of AOA-SCAR. RESULTS: Our data showed strontium ranelate is the most common causality of AOA-SCAR in Asian populations. There was no cross-hypersensitivity of SR-SCAR with other AOA. HLA genotyping showed that SR-SJS was most significantly associated with HLA-A*33:03 (Pc = 5.17 × 10-3 , OR: 25.97, 95% CI: 3.08-219.33). Meta-analysis showed that HLA-A*33:03 was associated with SR-SJS (P = 5.01 × 10-5 ; sensitivity: 85.7%) in Asians. The sensitivity of lymphocyte activation test (LAT) for identifying the culprit drug of SR-SJS was 83.3%. CONCLUSIONS: Strontium ranelate is identified as the most notorious AOA associated with SCAR. The HLA-A*33:03 genetic allele and LAT testing may add benefits to the diagnosis of SR-SCAR in patients whose reaction developed while taking multiple drugs.

[Study on the expression of non-coding microRNA-376b-3p in serum exosomes of patients with malignant glioma and the mechanism of anti-angiogenesis].

Objective: To screen the different microRNAs in the serum exosomes of patients with malignant glioma, to explore the effect of non-coding microRNA-376b-3p (miR-376b-3p) on the proliferation, invasion and tumor vasculogenic mimicry of glioma cells, and to verify its targeting effect on HOXD10. Methods: HiSeq/MiSeq high-throughput sequencing was used to screen the different microRNA expression profiles, target genes and action pathways in the serum exosomes of patients with malignant glioma. Samples were used to evaluate the expression of candidate microRNAs in serum exosomes of high-grade gliomas. The effects of miR-376b-3p on the proliferation, invasion and angiogenesis of glioma cells were detected by MTT assay, Transwell migration assay and Matrigel vasculogenic mimicry assay. The mRNA and protein expression of HOXD10 were detected to evaluate the regulatory effect of miR-376b-3p on it. Results: There were 144 different expression microRNAs in the serum exosomes between malignant glioma and the normal control. Focal adhesion and tumor protein polysaccharides were involved in the regulation of glioma enriched by KEGG(Kyoto Encyclopedia of Genes and Genomes). MiR-376b-3p was down regulated in malignant glioma, and AUC of malignant glioma was 0.85 (P<0.01). MTT test showed that the proliferation ability of miR-376b-3p inhibitor group was higher than that of the control group, and that of miR-376b-3p mimic group was lower than that of the control group. Transwell migration test showed that the number of transmembrane cells in miR-376b-3p inhibitor group was higher than that in NC inhibitor group, and the number of transmembrane cells in miR-376b-3p mimic group was lower than that in NC mimic group. The number of tubes of vasculogenic mimicry in miR-376b-3p mimic group was lower than that in NC mimic group. MiR-376b-3p inhibitor decreased the expression level of HOXD10 mRNA and protein, and miR-376b-3p mimic increased the expression level of HOXD10 mRNA and protein. Conclusions: MiR-376b-3p is down-regulated in the serum exosomes of malignant glioma patients. The up-regulated miR-376b-3p can reduce the proliferation and invasion of glioma cells, inhibit the formation of vasculogenic mimicry, and increase the expression of HOXD10, which is expected to inhibit the formation of two forms of angiogenesis at the same time. MiR-376b-3p may be a new therapeutic target of anti-angiogenesis for malignant glioma.

Serum and blister-fluid elevation and decreased epidermal content of high-mobility group box 1 protein in drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis.

BACKGROUND: High-mobility group box 1 (HMGB1) is a damage-associated molecular-pattern protein. Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) are serious, immune-mediated skin-blistering conditions. OBJECTIVES: To determine serum and/or blister-fluid total HMGB1 levels in SJS/TEN cohorts, and HMGB1 expression in formalin-fixed, paraffin-embedded (FFPE) SJS/TEN skin vs. healthy and maculopapular exanthema (MPE) skin. Methods Serum HMGB1 was quantified in Malawian nevirapine-induced hypersensitivity, Taiwanese SJS/TEN and Spanish SJS/TEN cohorts. FFPE skin (healthy skin, MPE, SJS/TEN) was stained and assessed for HMGB1 expression. RESULTS: Serum total HMGB1 was not significantly elevated in patients with nevirapine-induced SJS/TEN (3·98 ± 2·17 ng mL-1 ), MPE (3·92 ± 2·75 ng mL-1 ) or drug reaction with eosinophilia and systemic symptoms (4·73 ± 3·00 ng mL-1 ) vs. tolerant controls (2·97 ± 3·00 ng mL-1 ). HMGB1 was significantly elevated in Taiwanese patients with SJS/TEN, highest during the acute phase (32·6 ± 26·6 ng mL-1 ) vs. the maximal (19·7 ± 23·2 ng mL-1 ; P = 0·007) and recovery (24·6 ± 25·3 ng mL-1 ; P = 0·027) phases. In blister fluid from Spanish patients with SJS/TEN, HMGB1 (486·8 ± 687·9 ng mL-1 ) was significantly higher than in serum (8·8 ± 7·6 ng mL-1 ; P <0·001). Preblistered SJS/TEN skin showed decreased epidermal nuclear HMGB1 expression in upper epidermis vs. healthy or MPE skin but retained basal/suprabasal expression. CONCLUSIONS: Epidermal HMGB1 expression was decreased in SJS/TEN skin. Retained basal/suprabasal epidermal HMGB1 expression may exacerbate localized injury in SJS/TEN.

Final results of a randomized phase III trial of induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in patients with stage IVA and IVB nasopharyngeal carcinoma-Taiwan Cooperative Oncology Group (TCOG) 1303 Study.

Background: Concurrent chemoradiotherapy (CCRT) is superior to radiotherapy alone for treating locoregionally advanced nasopharyngeal carcinoma (NPC). Whether adding induction chemotherapy (IC) further improves the outcome warrants investigation. Patients and methods: This open-label multicenter phase III trial was conducted at 11 institutions in Taiwan. Patients with stage IVA or IVB NPC were randomized to receive IC followed by CCRT (I-CCRT) or CCRT alone. Patients in the I-CCRT arm received three cycles of mitomycin C, epirubicin, cisplatin, and 5-fluorouracil/leucovorin (MEPFL). All patients received 30 mg/m2 cisplatin weekly during radiotherapy, which was delivered as 1.8-2.2 Gy per fraction with five daily fractions per week, to a total dose of 70 Gy or greater to the primary tumor and 66-70 Gy to the involved neck. The primary end point was disease-free survival (DFS). Results: In this study, 240 and 239 patients were randomized to CCRT and I-CCRT arm, respectively. The most prominent toxicities of induction were leukopenia (grade 3 and 4: 47% and 12%) and thrombocytopenia (grade 3 and 4: 24% and 3%). During radiotherapy, severe mucositis was the major side-effect in both arms; an increased number of patients in the I-CCRT arm had myelosuppression; hence, discontinuation of weekly cisplatin was more common. After a median follow-up of 72.0 months, the I-CCRT arm had significantly higher DFS than that of the CCRT arm [5-year rate 61% versus 50%; hazard ratio=0.739, 95% confidence interval (CI)=0.565-0.965; P = 0.0264], after stratified for N3b and LDH, and adjusted for T stage. Conclusion: Induction with MEPFL before CCRT was tolerable and significantly improved the DFS of patients with stage IVA and IVB NPC though overall survival not improved. Clinical trial information: NCT00201396.

Delayed-type hypersensitivity reactions induced by proton pump inhibitors: A clinical and in vitro T-cell reactivity study.

BACKGROUND: Proton pump inhibitors (PPIs) have been known to induce type I hypersensitivity reactions. However, severe delayed-type hypersensitivity reactions (DHR) induced by PPI, such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), or drug rash with eosinophilia and systemic symptoms (DRESS), are rarely reported. We conducted a study of a large series of PPI-related DHR, followed up their tolerability to alternative anti-ulcer agents, and investigated the T-cell reactivity to PPI in PPI-related DHR patients. METHODS: We retrospectively analyzed patients with PPI-related DHR from multiple medical centers in Taiwan during the study period January 2003 to April 2016. We analyzed the causative PPI, clinical manifestations, organ involvement, treatment, and complications. We also followed up the potential risk of cross-hypersensitivity or tolerability to other PPI after their hypersensitivity episodes. Drug lymphocyte activation test (LAT) was conducted by measuring granulysin and interferon-γ to confirm the causalities. RESULTS: There were 69 cases of PPI-related DHR, including SJS/TEN (n=27) and DRESS (n=10). The LAT by measuring granulysin showed a sensitivity of 59.3% and specificity of 96.4%. Esomeprazole was the most commonly involved in PPI-related DHR (51%). Thirteen patients allergic to one kind of PPI could tolerate other structurally different PPI without cross-hypersensitivity reactions, whereas three patients developed cross-hypersensitivity reactions to alternative structurally similar PPI. The cross-reactivity to structurally similar PPI was also observed in LAT assay. CONCLUSIONS: PPIs have the potential to induce life-threatening DHR. In patients when PPI is necessary for treatment, switching to structurally different alternatives should be considered.

[Therapeutic effect of burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis for ischemic moyamoya disease of adults].

Objective: To explore the therapeutic effect of burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis for ischemic moyamoya disease of adults. Methods: The burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis was performed on 21 adults with ischemic moyamoya disease since January 2013 in the second hospital of Shandong university.All of the patients were followed up for 3 months to 3 years.Digital subtraction angiogram (DSA) reexamination was performed and the cerebral MR perfusion imaging (PWI) was used to observe the perfusion of cerebral ischemic area before and after operation quantificationally, and the KPS scores before and after the surgery were analysed by the statistics.The clinical symptoms of the 21 patients gradually improved after the operation, there was statistical significance by paired t test of the KPS scores (P<0.001). Results: 19 patients were reexamined by DSA and PWI.The DSA results revealed there was apparent neovascularization in 65 burr-holes of total 72 holes , mainly came from the middle meningeal artery and superficial artery, and there was neovascularization in 33 burr-holes of total 35 holes whose arachnoid was completed, there was no statistical significance by χ(2) test (P>0.05). The revascularization of the ischemic cerebral tissue was obtained through the PWI.The postoperative complications included 1 case of subdural hematoma, 3 cases of postoperative temporary neurological deficits. Conclusion: The burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis was effective, the MR perfusion imaging could assessment the effect exactly, there was no significant difference of neovascularization whether or not opening the arachnoid.

[Incidence and risk factors of recurrence after endovascular treatment of vertebrobasilar dissecting aneurysms].

Objective: To evaluate the incidence and risk factors of recurrence after endovascular treatment of vertebrobasilar dissecting aneurysms (VBDAs). Methods: Retrospective analysis was used for the clinical information of 40 cases of vertebrobasilar dissecting aneurysms treated with endovascular methods in our department between January 2007 and December 2015.According to whether recurrence occurred, the patients were divided into recurrence group (10 patients) and non-recurrence group (30 patients). The data of the patients' age, sex, hypertension history, smoking history, aneurismal size, presenting symptoms, degree of embolization, GCS scores, aneurismal localization and treatment methods were analyzed to evaluate the risk factors for recurrence after endovascular treatment. Results: There were 40 patients performed long-term angiographic follow-up.The recurrence rate after endovascular treatment was 25.0% (10/40) in the present study, and they all occurred in reconstructive group.Among the patients who underwent stent-assisted coil embolization, recurrence in aneurismal body occurred in 6 patients, and recurrence in aneurismal neck 3 cases. In these cases, 7 recurrences occurred with complete embolization, and 2 recurrences occurred with partial embolization.Recurrence occurred in 1 case that underwent single stent placement.The incidence of recurrence in reconstructive group was higher than that in destructive group (33.3% vs 0.0) with significant difference. Conclusions: The recurrence rate was high in VBDAs treated with endovascular methods.The only independent risk factor for recurrence was reconstructive methods and that suggests the necessity of long-term angiographic follow-up.

[Endovascular management and classification of the dissecting aneurysms of the vertebral artery].

Objective: To summarize the classifications and optimize endovascular treatment of the dissecting aneurysms of the vertebral artery (DAVA). Methods: The clinical information of 39 cases of DAVA treated with endovascular methods in our department between January 2007 and September 2016 were analyzed retrospectively.According to the location of the aneurysm in relation to the posterior inferior cerebellar artery (PICA), the aneurysms were classified into three types: type pre-PICA, located proximally to the PICA; type in-PICA, located at the PICA origin; and type post-PICA located distally to the PICA.According to the hemodynamics of the contralateral vertebral artery, the aneurysms were classified into two types: compensatory type: including well-developed contralateral vertebral arteries and a guaranteed posterior circulation blood supply following the occlusion of the ipsilateral vertebral artery; and non-compensatory type: including contralateral vertebral arteries that were hypoplastic and provided an inadequate posterior circulation blood supply following ipsilateral vertebral artery occlusion.The choices of reconstructive or destructive methods were made according to the above-mentioned classification, combined with the consideration of morphological features and onset styles.Reconstructive surgery included stent-assisted coil embolization and the placement of multiple overlapping stents (6 patients). Destructive surgery referred to coil embolization combined with proximal coil trapping of the dissected segment of the parent artery (CE+ PT). Results: A total of 16 patients were type pre-PICA, of which 9 patients were compensatory type and 7 were non-compensatory type.In compensatory type, 4 underwent coil embolization combined with proximal coil trapping of the dissected segment of the parent artery (CE+ PT) and 5 underwent stent-assisted coil embolization (stent/coils). In non-compensatory type, 6 underwent stent/coils and 1 underwent multiple overlapping stents placement (stents). Nine patients were type in-PICA, of which 5 patients were compensatory type and 4 were non-compensatory type. In compensatory type, all patients underwent stent/coils.In non-compensatory type, 2 underwent stent/coils and 2 underwent multiple overlapping stents placement (stents). Fourteen patients were type post-PICA, of which 8 patients were compensatory type and 6 were non-compensatory type.In compensatory type, 6 underwent CE+ PT, 1 underwent stent/coils and 1 underwent stents. In non-compensatory type, 4 underwent stent/coils and 2 underwent stents.Totally, there were 10 underwent CE+ PT, 23 underwent stent/coils and 6 underwent stents.The incidence of perioperative complications was 7.7% (3/39), and the death rate associated with these complications was 5.1% (2/39). Of the 36 patients followed with long-term repeated angiographic examinations, 28(77.8%) patients had complete occlusion.Clinical outcome evaluations were performed using the Modified Rankin Scale and resulted in the following scores: 0-2 for 36 patients, 3-6 for 3 patients. Conclusions: The classifications based on location, hemodynamics, morphological features and onset styles of the DAVA is safe and effective for the choice of the endovascular methods.

[Clinical analysis of endovascular strategies in the treatment of vertebrobasilar dissecting aneurysms].

Objective: To evaluate the efficacy and safety of endovascular strategies for vertebrobasilar dissecting aneurysm (VBDA) and analyze advantages and disadvantages of different endovascular methods for the treatment of VBDA through long-term follow-up. Methods: Retrospectively analyzing was used for the clinical information of 45 cases of vertebrobasilar dissecting aneurysms treated with endovascular methods in our department from January 2007 to December 2015. The treatment modalities were classified into reconstructive surgery and destructive surgery that were based on parent artery preservation. Reconstructive surgery included stent-assisted coil embolization (24 patients) and the placement of single or multiple overlapping stents (8 patients). Destructive surgery was coil embolization combined with proximal coil trapping of the dissected segment of the parent artery (CE+ PT, 13 patients). Results: The incidence of perioperative complications was 11.4%, and the mortality associated with these complications was 4.4%. In the patients undergoing reconstructive surgery, one patient suffered from aneurysm rerupture and died, one patient had intraoperative thrombi in the parent artery and resulted in a complete patency after thrombolysis was performed with Tirofiban. Both perioperative complications occurred in patients treated with stent-assisted coil embolization. No complications occurred in patients treated with single or multiple overlapping stents placements. Perioperative brainstem ischemia occurred in three patients who were treated with destructive surgery, and caused one death and two severe disabilities. Clinical outcome evaluations were performed using the Modified Rankin Scale and resulted in the following scores: 0-2 for 41 patients, 3-6 for 4 patients. The prognosis of reconstructive group was better than that of destructive group, with statistical differences (P<0.05). The incidence of perioperative complications in reconstructive group was lower than that in destructive group, without significant differences (P>0.05). Conclusions: Endovascular treatment is effective and safe for VBDAs. The incidence of perioperative complication in reconstructive group is lower and the prognosis is better than that in destructive group.

MicroRNA expression profile of a Malaysian Bajau family with familial mitochondrial neurogastrointestinal encephalomyopathy.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare, autosomal recessive disorder associated with mutations in the thymidine phosphorylase (TYMP) gene. The main objective of this study was to characterize the genetic profiles of the deceased proband's family members (N = 4) using DNA sequencing and to determine miRNA deregulation in MNGIE using miRNA microarray profiling and bioinformatic analysis. We found that the genetic profile of the younger sister showed similar TYMP gene mutations as that of the proband with the exception of a heterozygous mutation in exon 10. The miRNA microarray revealed 55 significantly up-regulated and 65 significantly down-regulated miRNAs. These miRNAs have been implicated in various mitochondrial dynamics such as energy metabolism, Krebs cycle, mitochondria-associated apoptosis, and mitophagy. In conclusion, we demonstrate that blood miRNAs are deregulated in the pathogenesis of MNGIE and these changes may have therapeutic implications. Further experimental studies will be required to elucidate the functional miRNA-mRNA interactions in MNGIE.

Sexual genetic and simple sequence repeat (SSR) analysis for molecular marker development on the all hermaphrodite papaya.

The papaya (Carica papaya L.) is one of the most important economic tropical fruits in the world, and the hermaphrodite is the preferred type in field cultures. We analyzed the sexual ratio of offspring from the cultivar 'Taiwan Seed Station No. 7' (T7) by a self-cross and its cross with Taichung Sunrise (TS). Female progeny from the T7 self-crossing were not observed. This finding may be caused by a lethal gene that is linked to females. In this study, we selected 192 simple sequence repeats (SSRs) to analyze the polymorphism between T7 and TS. A total of 37 SSRs were identified for T7 and TS. In addition, 14 SSRs served as the molecular makers for identification of T7, TS and their hybrid offsprings. Thus, the results show that the genetic similarity between T7 and TS is rather high. This suggests that T7 may be a mutant of TS. Phylogenetic analysis from the SSR polymorphisms of the above parent strains and 15 F1 offspring revealed the genetic distance of the F1 offspring located between T7 and TS. The results of this study may provide an opportunity for elucidating the genetic characteristics of all hermaphrodites via identification of molecular makers.

A higher anti-Müllerian hormone level is associated with an increased chance of pregnancy in patients undergoing controlled ovarian stimulation and intrauterine insemination.

Anti-Müllerian hormone (AMH) level has been found to be a useful marker of ovarian reserve, and a predictor of poor and hyper-responses in patients undergoing controlled ovarian stimulation (COS). The study aimed to determine the association of serum AMH level with achieving pregnancy in patients undergoing COS with intrauterine insemination. The cross-sectional study investigated 204 patients who underwent COS with intrauterine insemination at the Obstetrics and Gynecology Department of Taipei Medical University Hospital, from January 2011 to March 2012. The medical records of these patients were reviewed, and serum AMH levels were evaluated for association with successful clinical pregnancy. The AMH level in the patients who achieved clinical pregnancy was significantly higher than in patients who did not (median 2.7 vs 2.0 ng/ml, p = 0.005). Controlling for factors affecting infertility, AMH level had a significant independent influence on outcome; a higher AMH level was associated with a decreased risk of a non-pregnant outcome (odds ratio, OR = 0.895, p = 0.026). In patients undergoing COS and intrauterine insemination, a low AMH level is associated with a decreased chance of a clinical pregnancy, and this association remains irrespective of the presence or absence of endometriosis.

First Report of Bacterial Root Rot of Ginseng Caused by Pseudomonas aeruginosa in China.

Ginseng (Panax ginseng) is an economically valuable medicinal herb mainly planted in Jilin Province, China. In September 2013, during harvest, suspected bacterial rots were observed on ginseng roots with about 10% incidence in Fusong County, Jilin Province, China (127°29.48' N, 42°11.12' E). Rotted roots completely lost their economic value. Symptoms on roots began as water-soaked lesions, and developed rapidly into a soft, watery, decayed mass within 3 to 5 days. Three diseased root tissues were surface-sterilized in 70% ethanol for 30 s, rinsed 3 times in sterilized water and cut into small pieces (2 to 3 mm). Tissues were then macerated for 5 min in sterilized water, streaked onto nutrient agar (NA) medium, and incubated at 28°C for 2 days. Representative colonies were selected from each plate and further purified by sub-culturing onto NA medium. Five strains of the bacteria were gram-negative, short straight rods, 0.5 to 1.0 × 1.5 to 3.0 µm with a single, polar flagellum. Colonies were round, smooth, translucent, and yellowish green on NA medium. The bacteria were identified based on physiological and biochemical tests as follows (3): They were levan and potato rot negative, oxidase, aerobic, and arginine dihydrolase positive, converted nitrate to N2, hydrolyzed gelatin, produced nitrites from nitrates, produced pyocyanin, and grew at 41°C. Bacterial identity was further confirmed by amplifying the 16S rRNA (1,461 bp), gyrB (1,134 bp), and 16S-23S ITS genes (523 bp) with 27F/1492R, UP1/UP2, and L1/L2 primer sets, respectively. The 16S rRNA gene sequence (NCBI Accession No. KJ156527), gyrB gene sequence (KJ748373), and 16S-23S ITS gene sequence (KJ748374) had 99% identity to that of Pseudomons aeruginosa strain BS01 (JQ229778), ATCC25011 (FJ652721), and ATCC15522 (AB547908), respectively. The strains were also identified by using BD Phoenix-100 Automated Microbiology System (BD Ltd., New Jersey) as P. aeruginosa with 99% confidence. A pathogenicity test was conducted by spraying a suspension of five strains individually (108 CFU/ml) onto 4-year-old ginseng roots (cv. Damaya) wounded with a sterilized needle. Five ginseng roots were inoculated with each strain and five ginseng roots were inoculated with sterilized water as controls. All inoculated plants were maintained at 28°C with 80 to 85% relative humidity. Soft, watery tissue rot symptoms developed 3 to 5 days after inoculation, and were similar to those observed on the diseased plants under natural conditions. In contrast, no symptoms developed on control plants. The bacteria were readily re-isolated from inoculated plants and identified as P. aeruginosa using bacterial colony morphology, physiological and biochemical tests, as well as sequence analysis of the 16S rRNA gene, fulfiling Koch's postulates. The bacterium was not isolated from control plants. P. aeruginosa has been reported to cause diseases in a variety of plants including onion (1,2), arabidopsis, and sweet basil (4). To our knowledge, this is the first report of P. aeruginosa causing ginseng root rot in China. References: (1) E. J. Cother et al. Phytopathology 66:828, 1976. (2) X. J. Hao, and G. L. Xie. J. Plant Pathol. 88:340, 2006. (3) N. W. Schaad et al. Laboratory Guide for the Identification of Plant Pathogenic Bacteria, 3rd edition. APS Press, St. Paul, MN, 2001. (4) T. S. Walker et al. Plant Physiol. 134:320, 2004.

Intensity-modulated radiation therapy for T4 nasopharyngeal carcinoma. Treatment results and locoregional recurrence.

PURPOSE: The purpose of this work was to examine outcomes in patients with T4 nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). METHODS AND MATERIALS: Between 2007 and 2010, 154 patients with nonmetastatic T4 NPC were treated with IMRT to a total dose of 70 Gy in 33-35 fractions. In addition, 97% of patients received concurrent platinum-based chemotherapy. The median follow-up time was 52.8 months. RESULTS: The rates of 5-year actuarial locoregional control, distant metastasis-free survival, progression free-survival, and overall survival (OS) were 81.2, 72.2, 61.9, and 78.1%, respectively. A total of 27 patients had locoregional recurrence: 85.2% in-field failures, 11.1% marginal failures, and 3.7% out-of-field failures. Fourteen patients with locoregional recurrence received aggressive treatments, including nasopharyngectomy, neck dissection, or re-irradiation, and the 5-year OS rate tended to be better (61.9%) compared to those receiving conservative treatment (32.0%, p=0.051). In patients treated with 1 course of radiotherapy, grade ≥3 toxicities of ototoxicity, neck fibrosis, xerostomia, epistaxis, and radiographic temporal lobe necrosis occurred in 18.2, 9.8, 6.3, 2.1, and 5.6% of patients, respectively. Increased ototoxicity, osteonecrosis, severe nasal bleeding, and temporal necrosis were observed in patients treated by re-irradiation. CONCLUSION: IMRT offers good locoregional control in patients with T4 NPC. For patients with locoregional recurrence after definitive radiotherapy, aggressive local treatment may be considered for a better outcome.

Phosphorus removal in a membrane-assisted BNR process with focus on evolutions of PAOs and DPAOs.

A bench-scale UCT (University of Cape Town)-type membrane bioreactor (UCT-MBR) fed with low-strength synthetic wastewater was operated to investigate phosphorus removal with reference to poly-phosphate accumulating organisms (PAOs) and denitrifying poly-phosphate accumulating organisms (DPAOs). A series of kinetic assays of PAOs and DPAOs were also conducted to analyze the metabolic activities of PAOs and DPAOs. Results showed that 93% of chemical oxygen demand (COD) and 77% of total nitrogen could be removed at 0.08 kgCOD kg(-1) MLSS d(-1) and 0.015 kgN kg(-1) MLSS d(-1) loading (MLSS: mixed liquor suspended solids). Removal efficiencies of total phosphorus increased during the experimental phase, with an ultimate removal efficiency of 96.1%. Kano and Kaer increased from 1.95 and 6.29 mgPO4(3-)-P g(-1) MLSS h(-1) to 5.47 and 11.13 mgPO4(3-)-P g(-1) MLSS h(-1) for DPAOs and PAOs respectively, with the increased ratio of DPAOs to PAOs from 31 to 49% implying DPAO metabolic activity increased faster than that of PAOs during the DPAO accumulation phase. Pano-uptake increased by 6.6 mg L(-1) and the ratio of PTano-uptake to PTupt increased from 58.97 to 91.62%. The ratio of DPAOs to PAOs tended to stabilize at around 50% over time.