Relationships between obesity and the clinical severity of psoriasis in Taiwan.

BACKGROUND: Obesity has been found to be associated with an increased risk of psoriasis in general population. However, studies addressing the relationship between obesity and clinical severity of psoriasis are still scarce, especially in Asian people. OBJECTIVES: In this study, we investigated the relationship between levels of obesity and the clinical severity of psoriasis in Taiwanese psoriasis patients. METHODS: This was a hospital-based cross-sectional study. A total of 399 patients with chronic plaque psoriasis were recruited. Their body mass index (BMI) was calculated as weight in kilograms divided by height in metres squared and was categorized into four groups (BMI < 24, normal; 24 or= 30, moderate-to-severe obesity). Disease severity was assessed by Psoriasis Area and Severity Index. Cumulative logistic regression models were used to estimate the association between BMI and Psoriasis Area and Severity Index. RESULTS: After adjusting for potential confounders (age, gender, cigarette smoking and duration of disease), moderate-to-severe obesity was significantly associated with an increased risk of clinically more severe psoriasis when compared with normal BMI [odds ratio, 2.70; 95% confidence interval,1.42-5.11]. There is a significant linear trend for clinically more severe psoriasis across increasing of BMI categories (P for trend = 0.004). The effect of obesity on the severity of psoriasis was greater in men than in women (test for interaction, P = 0.03). CONCLUSIONS: In psoriasis patients, obesity is associated with a more severe disease, especially in men. Bodyweight control may be important for the management of psoriasis.

Improvement in the growth performance of white shrimp, Litopenaeus vannamei, by a protease-producing probiotic, Bacillus subtilis E20, from natto.

AIMS: To isolate and identify a benefic bacterium, Bacillus subtilis E20, from natto (fermented soybeans), and incorporate it into shrimp feed to promote shrimp growth performance. METHODS AND RESULTS: A protease-producing bacterium, E20, isolated from natto was identified as B. subtilis by an API 50 CHB kit and the 16S rDNA sequence. B. subtilis E20 was able to grow at a broad range of temperatures (10-50 degrees C), pH values (5-10), and NaCl levels (0-9%). The best culture conditions for B. subtilis E20 to produce the protease were 40 degrees C, a pH of 6-8 and 0% NaCl. No shrimp died after being injected with B. subtilis E20 [up to 10(9) colony-forming units (CFU) per shrimp]. Bacillus subtilis E20 was incorporated in diets at the levels of 0 (control), 10(6), 10(7), and 10(8) CFU kg(-1) for shrimp grow-out culture, and results showed that after feeding on B. subtilis E20-containing diets (10(8) CFU kg(-1) of diet), shrimp had excellent growth performance and production compared to the control because protease activities in the digestive tract were improved by B. subtilis E20. CONCLUSIONS: Bacillus subtilis E20 isolated from natto is a great protease producer and is able to improve shrimp growth performance through increasing the digestibility of food. SIGNIFICANCE AND IMPACT OF THE STUDY: Results suggest that B. subtilis E20 is a potential candidate for use as a probiotic to improve shrimp growth performance, and consequently reduce feed costs.

Implementation of a stable, high-power optical lattice for quantum gas microscopy.

We describe the design and implementation of a stable high-power 1064 nm laser system to generate optical lattices for experiments with ultracold quantum gases. The system is based on a low-noise laser amplified by an array of four heavily modified, high-power fiber amplifiers. The beam intensity is stabilized and controlled with a nonlinear feedback loop. Using real-time monitoring of the resulting optical lattice, we find the stability of the lattice site positions to be well below the lattice spacing over the course of hours. The position of the harmonic trap produced by the Gaussian envelope of the lattice beams is stable to about one lattice spacing and the long-term (six-month) relative root-mean-square stability of the lattice spacing itself is 0.5%.

Prevalence of hospital infection and antibiotic use at a university medical center in Hong Kong.

Hospital infection prevalence surveys were performed in our 1400-bed University medical centre in Hong Kong from 1985 to 1988. We investigated the rates of four major hospital-acquired infections (HAIs) (pneumonia, symptomatic urinary tract infection, surgical site infection and laboratory-confirmed bloodstream infection) in order to identify current distribution and any changes after 15 years. A one-day point prevalence study was performed on 7 September 2005. All inpatients were surveyed for HAIs, community-acquired infections (CAIs), risk factors, pathogenic isolates and antibiotics prescribed. Infections were diagnosed according to Centers for Disease Control and Prevention (CDC) criteria. In total, 1021 patients were surveyed; of these, 41 had 42 HAIs (4% prevalence) and 389 (38%) were receiving antibiotics. The commonest HAI was pneumonia (1.4%) followed by bloodstream infection (0.9%) and symptomatic urinary tract infection (0.8%). The prevalence of postoperative surgical site infection was 5.6%. The nosocomial prevalence rate was highest in the Intensive Care Unit, followed by the Pediatric and Neonatal Intensive Care Units, Children's Cancer Centre/Bone Marrow Transplant Unit and Orthopaedics with Traumatology. Meticillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa were the commonest pathogens. The rates are significantly lower than previously and reflect the increased resources for infection control made available following the outbreak of severe acute respiratory syndrome (SARS).

Foreign body-induced aorto-oesophageal fistula: a review of five cases and their management.

Foreign body-induced aorto-oesophageal fistula is a rare cause of massive upper gastro-intestinal bleeding and, in the absence of a timely diagnosis and surgical intervention, can be fatal. During a period of 25 years, five patients with foreign body-induced aorto-oesophageal fistula underwent surgery in our department. Three patients survived. All survivors required more than one surgical intervention. The clinical course of these five patients and the management of this potentially fatal condition are reviewed.

Effects of biatrial pacing in prevention of postoperative atrial fibrillation after coronary artery bypass surgery.

BACKGROUND: Atrial fibrillation (AF) is common after coronary artery bypass surgery (CABG) and results in prolonged hospitalization. The purpose of this study was to evaluate the efficacy of biatrial pacing in preventing post-CABG AF compared with single-site atrial pacing. METHODS AND RESULTS: A total of 132 patients who had no history of AF and who underwent CABG were randomized to 1 of the following 4 groups: biatrial pacing (BiA), left atrial pacing (LA), right atrial pacing (RA), or no pacing (control) in postoperative period. Overdrive atrial pacing was performed for 5 days. The incidence of AF was significantly reduced in the BiA group (12.5%) compared with the other 3 groups (LA, 36.4%; RA, 33.3%; control, 41. 9%; P<0.05). The mean length of hospital stay was significantly reduced in the BiA group. At baseline, the mean P-wave duration (P(dur)) and dispersion (P(dis)) were not prolonged. BiA pacing resulted in the most significant percentage of reduction in P(dis) when compared with the LA or RA groups (BiA, 42+/-8%; LA, 13+/-6%; RA, 10+/-9%; P<0.05 for BiA versus LA or RA). No significant differences existed in mean P(dur) and P(dis) between patients who developed AF and those who remained in sinus rhythm at baseline. However, only those patients who remained in sinus rhythm had a significant reduction in mean P(dur) and P(dis) after pacing therapy. CONCLUSIONS: Biatrial overdrive pacing is more effective in preventing post-CABG AF than single-site atrial pacing; this therapy also results in a shortened hospital stay. The overall reduction in atrial activation time with BiA pacing was reflected in the reduction in P(dis).

Necrotic cardiac haemangioma masquerading as sepsis with disseminated intravascular coagulation.

Cardiac haemangiomas are exceptionally rare benign vascular tumours. We report a case of cardiac haemangioma presenting with pyrexia of unknown origin and clinical features simulating sepsis with disseminated intravascular coagulation. The clinical course was complicated by systemic embolism.

Single-molecule fluorescence observed with mercury lamp illumination.

We demonstrate that it is possible to observe single fluorescent molecules using a standard fluorescence microscope with mercury lamp excitation and an inexpensive cooled charge-coupled device (CCD) camera. With this equipment, we have been able to observe single molecules of tetramethyl-rhodamine, rhodamine 6G, fluorescein isothiocyanate and green fluorescent protein. Immobilized molecules were observed both in air and in aqueous solution.

Analysis of indications for surgical closure of subarterial ventricular septal defect without associated aortic cusp prolapse and aortic regurgitation.

Subarterial ventricular septal defect (VSD) is relatively common in Orientals. We reviewed the outcome of 214 patients (137 males) who were followed for 8.6 +/- 5.2 years (range 0.1 to 24.3) and addressed the issue regarding the necessity and optimum timing of closing subarterial defects before development of aortic valve deformities. Demographic data, transthoracic and transesophageal echocardiographic findings, cardiac catheterization results, and operative findings were reviewed. Kaplan-Meier actuarial analysis was performed to assess the development of aortic valve complications over time. Seventy-five patients with heart failure and pulmonary hypertension underwent surgical closure of VSD at the age of 2.4 +/- 2.9 years. No patient had aortic cusp prolapse before operation and none developed aortic cusp prolapse or aortic regurgitation (AR) on follow-up. In contrast, of the 139 asymptomatic patients managed conservatively, 102 (73%) developed aortic cusp prolapse, 78% of whom (80 of 102) developed AR. The prevalence of aortic cusp prolapse and AR at 1, 5, 10, and 15 years old was 8%, 30%, 64%, and 83%, and 3%, 24%, 45%, and 64%, respectively. Significant prolapse or AR prompted surgical closure of VSD with (n = 22) or without (n = 26) valvoplasty in 48 of 102 patients (47%). The size of the VSD was significantly larger in patients with heart failure (9.6 +/- 3.3 mm) or aortic cusp prolapse (11.7 +/- 4.1 mm) compared with those without heart failure (4.5 +/- 1.4 mm, p <0.001). All patients with aortic cusp prolapse and all but 1 with heart failure had a defect size of > or =5 mm. In conclusion, subarterial VSD of > or =5 mm should be closed as early as possible to prevent development of aortic cusp prolapse and AR. Asymptomatic patients with small defects <5 mm could be managed conservatively.

An unusual lethal complication of preservation of chordae tendineae in mitral valve replacement.

In two patients, several chordae tendineae of the mural leaflet were preserved during mitral valve replacement. Hemorrhagic necrosis and spontaneous rupture of the preserved posterior papillary muscle led to disc entrapment and the death of both patients.

Mediastinal irradiation for graft-versus-host disease in a heart-lung transplant recipient.

Graft-versus-host disease in solid organ transplantation is very rare, but the prognosis is poor when the condition causes pancytopenia. We report a case of graft-versus-host disease in a heart-lung transplant recipient who at 2 weeks after transplantation had development of features of graft-versus-host disease, including bone marrow aplasia, that could not be attributed to drugs or viral infections. The diagnosis was confirmed by skin biopsy and demonstration of chimerism of peripheral lymphocytes. Augmentation of immunosuppression with intravenous methylprednisolone resulted in improvement in liver function but had no effect on the pancytopenia. Mediastinal irradiation was given with increase in both white blood cell and platelet counts. Unfortunately the patient eventually died of gastrointestinal bleeding and fungemia.

Single-molecule measurements calibrate green fluorescent protein surface densities on transparent beads for use with 'knock-in' animals and other expression systems.

Quantitative aspects of synaptic transmission can be studied by inserting green fluorescent protein (GFP) moieties into the genes encoding membrane proteins. To provide calibrations for measurements on synapses expressing such proteins, we developed methods to quantify histidine-tagged GFP molecules (His6-GFP) bound to Ni-NTA moieties on transparent beads (80-120 microm diameter) over a density range comprising nearly four orders of magnitude (to 30000 GFP/microm2). The procedures employ commonly available Hg lamps, fluorescent microscopes, and CCD cameras. Two independent routes are employed: (1) single-molecule fluorescence measurements are made at the lowest GFP densities, providing an absolute calibration for macroscopic signals at higher GFP densities; (2) known numbers of His6-GFP molecules are coupled quantitatively to the beads. Each of the two independent routes provides linear data over the measured density range, and the two independent methods agree with root mean square (rms) deviation of 11-21% over this range. These satisfactory results are obtained on two separate microscope systems. The data can be corrected for bleaching rates, which are linear with light intensity and become appreciable at intensities > approximately 1 W/cm2. If a suitable GFP-tagged protein can be chosen and incorporated into a 'knock-in' animal, the density of the protein can be measured with an absolute accuracy on the order of 20%.

Left subclavian arterioesophageal fistula induced by a foreign body.

A left subclavian arterioesophageal fistula was diagnosed in a 35-year-old man at exploratory thoracotomy for suspected aortoesophageal fistula. After successful closure of the arterial fistula the patient developed a mediastinal abscess and esophagopleural fistula. The latter was successfully managed by retrosternal jejunal esophagoplasty followed by excision of the thoracic esophagus. This report documents a case of left subclavian arterioesophageal fistula and illustrates the importance of early diagnosis and surgical intervention of arterial perforation secondary to a foreign body in the esophagus.

Coronary artery fistulas: long-term results of surgical correction.

BACKGROUND: Opinions vary as to whether operation should be offered patients with coronary artery fistula, particularly to those who are asymptomatic. Published studies lacked long-term follow-up data. METHODS: We studied 41 patients with coronary artery fistula operated in our unit in the past 30 years with restudies including coronary angiograms in those who agreed to the investigation. RESULTS: There was no operative mortality and operative morbidity was low. The mean duration of follow-up was 9.1 years and 96.9% of the patients were asymptomatic. Twenty-one patients had a coronary angiogram. The native coronary artery either remained dilated and tortuous, or more frequently had thromboses with a short proximal stump. (None of these patients had evidence of myocardial ischemia.) Four patients had demonstrable recurrence fistula but without hemodynamic disturbance. CONCLUSIONS: We advocate operation for all patients with coronary artery fistulas and demonstrable shunting in view of minimal operative risks. Small asymptomatic fistulas without demonstrable shunting should be left alone. The relatively high incidence of residual or recurrent fistula makes long-term follow-up mandatory.

Reproducibility of natural head position.

The orientation of the head, when the natural head position was adopted, was measured relative to the true vertical on standardized black and white profile photographs. Two methods of obtaining the natural head position were compared and their reproducibility tested. No statistically significant difference was found between the two different methods or at different sittings.

Left ventricular rupture after mitral valve replacement.

BACKGROUND: What are the immediate and long term outcomes of patients who had rupture of the left ventricle after mitral valve replacement? EXPERIMENTAL DESIGN: A retrospective study with a 20-year follow-up. SETTING: Experience in a single tertiary referral cardiothoracic surgery hospital. PARTICIPANTS: 20 out of 3105 patients that received mitral valve replacement. INTERVENTION: All these 20 patients received re-exploration for a trial of repair of left ventricular rupture either by an internal or an external or a combined repair. MEASURES: Operative mortality and long term outcome of the survivals. RESULTS: Most patients (16.80%) were female and had rheumatic mitral valve disease. The mean age of the patients was 58.1 years. All patients underwent attempted repair, usually by removal of the prosthesis and reconstitution of the ventricle from within the left atrium (75%). Thirteen (65%) patients died. Two late deaths were of unrelated cause. One surviving patient developed a late ventricular false aneurysm but did not undergo repeat surgery. One patient developed severe mitral regurgitation due to tissue failure of the bioprosthesis 12 years after surgery and she underwent a successful reoperation. CONCLUSIONS: We believe that all patients should be placed back on cardiopulmonary bypass for an internal repair. The long term outcome of the survivals is satisfactory.

Surgical resection of pulmonary metastases.

BACKGROUND: To review the results of complete surgical resection of pulmonary metastasis -- a ten-year experience. SETTING: Retrospective analysis of all patients with lung secondaries who received complete surgical resection of pulmonary metastases (from 1984 to 1995) in Grantham Hospital, Hong Kong. Sixty patients over a 10-year period were studied. METHODS: Eighty thoracotomies were performed with 88 tumour nodules excised. The follow-up period ranged from 5 months to 111 months. RESULTS: Thirteen (14.8%) specimens were found to have tumour size greater than 5.0 cm. This may reflect late detection of metastatic tumour and probably accounts for the higher percentage of our patients receiving more major lung resections (63.3%) than just wedge resections (36.6%). The mean survival period for the subgroup with hepatocellular carcinoma was 28.2 months and for the nasopharyngeal carcinoma group was 25 months. The mean survival of the whole group was 26.4 months. CONCLUSIONS: The favourable outcome for hepatocellular carcinoma and nasopharyngeal carcinoma could be due to the result of selection of patients with more favourable prognosis for surgery. The latent period, using 12 months as a break-off point, did not affect patient survival in our study.

Synthesis of fuzzy model-based designs to synchronization and secure communications for chaotic systems.

This paper presents synthesis approaches for synchronization and secure communications of chaotic systems by using fuzzy model-based design methods. Many well-known continuous and discrete chaotic systems can be exactly represented by T-S fuzzy models with only one premise variable. According to the applications on synchronization and signal modulation, the general fuzzy models may have either i) common bias terms; or ii) the same premise variable and driving signal. Then we propose two types of driving signals, namely, fuzzy driving signal and crisp driving signal, to deal with the asymptotical synchronization and secure communication problems for cases i) and ii), respectively. Based on these driving signals, the solutions are found by solving LMI problems. It is worthy to note that many well-known chaotic systems, such as Duffing system, Chua's circuit. Rassler's system, Lorenz system, Henon map, and Lozi map can achieve their applications on asymptotical synchronization and recovering messages in secure communication by using either the fuzzy driving signal or the crisp driving signal. Finally, several numerical simulations are shown to verify the results.

Automated rodent in situ muscle contraction assay and myofiber organization analysis in sarcopenia animal models.

Age-related sarcopenia results in frailty and decreased mobility, which are associated with increased falls and long-term disability in the elderly. Given the global increase in lifespan, sarcopenia is a growing, unmet medical need. This report aims to systematically characterize muscle aging in preclinical models, which may facilitate the development of sarcopenia therapies. Naïve rats and mice were subjected to noninvasive micro X-ray computed tomography (micro-CT) imaging, terminal in situ muscle function characterizations, and ATPase-based myofiber analysis. We developed a Definiens (Parsippany, NJ)-based algorithm to automate micro-CT image analysis, which facilitates longitudinal in vivo muscle mass analysis. We report development and characterization of translational in situ skeletal muscle performance assay systems in rat and mouse. The systems incorporate a custom-designed animal assay stage, resulting in enhanced force measurement precision, and LabVIEW (National Instruments, Austin, TX)-based algorithms to support automated data acquisition and data analysis. We used ATPase-staining techniques for myofibers to characterize fiber subtypes and distribution. Major parameters contributing to muscle performance were identified using data mining and integration, enabled by Labmatrix (BioFortis, Columbia, MD). These technologies enabled the systemic and accurate monitoring of muscle aging from a large number of animals. The data indicated that longitudinal muscle cross-sectional area measurement effectively monitors change of muscle mass and function during aging. Furthermore, the data showed that muscle performance during aging is also modulated by myofiber remodeling factors, such as changes in myofiber distribution patterns and changes in fiber shape, which affect myofiber interaction. This in vivo muscle assay platform has been applied to support identification and validation of novel targets for the treatment of sarcopenia.