Geraniin inhibits proliferation and induces apoptosis through inhibition of phosphatidylinositol 3-kinase/Akt pathway in human colorectal cancer in vitro and in vivo.

Geraniin, a polyphenolic component isolated from Phyllanthus amarus, has been reported to possess diverse biological activities, including antitumor, antiinflammatory, antihyperglycemic, antihypertensive, and antioxidant. However, the role and underlying mechanisms of geraniin in colorectal cancer still remain unclear. In the present study, we found that geraniin notably inhibited cell proliferation and clonogenic formation of colorectal cancer cell SW480 and HT-29 in a dose-dependent manner by Cell Counting Kit 8, EdU, and colony formation assays, respectively. Additionally, geraniin remarkably induced apoptosis of SW480 and HT-29 cells in a dose-dependent way by Hoechst 33342 staining, flow cytometric analysis, and TdT-mediated dUTP nick-end labeling assays and increased the expressions of Bax, caspase-3, and caspase-9, while decreased the level of Bcl-2. Besides, wound healing, transwell migration, and invasion assays demonstrated that geraniin obviously inhibited the migration and invasion of SW480 and HT-29 cells. Moreover, it also inhibited the levels of phospho (p)-phosphatidylinositol 3-kinase and p-Akt. Furthermore, in-vivo animal study revealed that geraniin had the significant inhibitory effects on tumor growth and promoted cancer cell apoptosis remarkably, which further confirmed the antitumor effect of geraniin. Taken together, the present study exhibited the positive role of geraniin in inhibiting proliferation and inducing apoptosis through suppression of phosphatidylinositol 3-kinase/Akt pathway in colorectal cancer cells in vitro and in vivo, which might provide new insights in searching for new drug candidates of anticolorectal cancer.

Low pH effects on reactive oxygen species and methylglyoxal metabolisms in Citrus roots and leaves.

BACKGROUND: Limited data are available on the responses of reactive oxygen species (ROS) and methylglyoxal (MG) metabolisms to low pH in roots and leaves. In China, quite a few of Citrus are cultivated in acidic soils (pH < 5.0). 'Xuegan' (Citrus sinensis) and 'Sour pummelo' (Citrus grandis) (C. sinensis were more tolerant to low pH than C. grandis) seedlings were irrigated daily with nutrient solution at a pH of 2.5, 3 or 5 for nine months. Thereafter, we examined low pH effects on growth, and superoxide anion production rate (SAP), malondialdehyde (MDA), MG, antioxidants, and enzymes related to ROS and MG detoxification in roots and leaves in order to (a) test the hypothesis that low pH affected ROS and MG metabolisms more in roots than those of leaves, and (b) understand the roles of ROS and MG metabolisms in Citrus low pH-tolerance and -toxicity. RESULTS: Compared with control, most of the physiological parameters related to ROS and MG metabolisms were greatly altered at pH 2.5, but almost unaffected at pH 3. In addition to decreased root growth, many fibrous roots became rotten and died at pH 2.5. pH 2.5-induced changes in SAP, the levels of MDA, MG and antioxidants, and the activities of most enzymes related to ROS and MG metabolisms were greater in roots than those of leaves. Impairment of root ascorbate metabolism was the most serious, especially in C. grandis roots. pH 2.5-induced increases in MDA and MG levels in roots and leaves, decreases in the ratios of ascorbate/(ascorbate+dehydroascorbate) in roots and leaves and of reduced glutathione/(reduced+oxidized glutathione) in roots were greater in C. grandis than those in C. sinensis. CONCLUSIONS: Low pH affected MG and ROS metabolisms more in roots than those in leaves. The most seriously impaired ascorbate metabolism in roots was suggested to play a role in low pH-induced root death and growth inhibition. Low pH-treated C. sinensis roots and leaves had higher capacity to maintain a balance between ROS and MG production and their removal via detoxification systems than low pH-treated C. grandis ones, thus contribute to the higher acid-tolerance of C. sinensis.

Diagnostic value of endoscopic ultrasound elastography for benign and malignant digestive system tumors.

OBJECTIVE: To investigate the effect of endoscopic ultrasound real-time tissue elastography in differential diagnosis of benign and malignant digestive system tumors. METHODS: Forty-two patients with solid tumors of digestive system who were admitted to our hospital between October 2017 and October 2018 were selected. All patients were diagnosed by endoscopic ultrasound real-time tissue elastography. Elastography score was used. The strain ratios (SR) of the lesion and the surrounding control tissues were measured and compared. RESULTS: Lesions with elastography score no more than two points were evaluated as benign, while lesions with elastography score no less than three points were evaluated as malignant. The difference of the elastography score between the benign lesion group and malignant lesion group was statistically significant (P<0.05). The sensitivity, specificity and accuracy of endoscopic ultrasound elastography in the diagnosis of malignant tumors of digestive system were 91.4%, 88.9% and 87.5%, respectively. The SR of the benign lesions ranged from 0.01 to 7.34, with a median SR of 7.33; the SR of the malignant lesions ranged from 1.01 to 47.66, with a median SR of 20.07. The SR of the benign lesions was significantly lower than that of the malignant lesions (P<0.05). CONCLUSION: Elastography of benign and malignant tissues of digestive tract tumors has different image characteristics. Endoscopic ultrasound real-time tissue elastography is effective in differential diagnosis of digestive tract tumors as it can effectively determine whether a tumor is benign or malignant and improve diagnostic accuracy.

Traditional Chinese Medicine Compounds Containing Lonicera japonica, Chrysanthemum morifolium, and Siraitia grosvenorii Inhibits the Growth of Streptococcus mutans.

Postoperative sore throat (POST) is one of the common complications after endotracheal intubation under general anesthesia. This work attempted to design and screen out the traditional Chinese medicine (TCM) compounds containing Lonicera japonica Thunb., Chrysanthemum morifolium Ramat., and Siraitia grosvenorii (Swingle) C. Jeffrey ex A. M. Lu et Z. Y. Zhang, and further explored its antibacterial effect on POST. The antibacterial activities of Lonicera japonica, Chrysanthemum morifolium, and Siraitia grosvenorii on Streptococcus mutans (S. mutans) UA159 was measured. Lonicera japonica (40 mg/mL), Chrysanthemum morifolium (10 mg/mL), and Siraitia grosvenorii (10 mg/mL) effectively inhibited the growth of S. mutans. Then, 5 different TCM compounds were designed using the U5 (53) uniform design experimentation method. TCM compound C3 (50 mg/mL Lonicera japonica, 10 mg/mL Chrysanthemum morifolium, and 15 mg/mL Siraitia grosvenorii) significantly promoted the inhibition zone and inhibited the biofilm formation of S. mutans. In addition, TCM compound C3 exerted great antibacterial effects on S. mutans and had the least effect on cell viability of primary human pharyngeal epithelial cells. In conclusion, this work demonstrated that TCM compound containing Lonicera japonica, Chrysanthemum morifolium, and Siraitia grosvenorii inhibited the growth of S. mutans. Thus, this study provides a theoretical basis for screening out the optimal compatibility of effective components in TCM mouthwash for relieving POST.

Finite element analysis of new headless compression supporting screw for the treatment of unstable femoral neck fracture.

BACKGROUND: Femoral neck fracture is an unsolved challenge in orthopedics. The complication rate in particular is high. There remains a lack of consensus on the optimal choice of internal fixation for unstable femoral neck fracture. OBJECTIVE: The study aimed to develop a new headless compression supporting screw (HCSS) for the treatment of unstable foemoral neck fracture. METHODS: We designed a new HCSS and used a femoral neck fracture (Pauwels III fracture) model (left, fourth-generation composite, Sawbones) and three-dimensional finite element analysis to compare the biomechanical performance of HCSSs with that of cannulated compression screws (CCSs) for treatment of unstable femoral neck fracture. RESULTS: Maximum displacement, peak von Mises stress, peak strain, and rotation for the HCSS were smaller than those for the CCS. The stress was more widely distributed for the HCSS, whereas the stress was concentrated for the CCS. CONCLUSIONS: The HCSS resulted in better biomechanical stability than that from the CCS. For Pauwels III fractures the HCSS exhibits better resistance to shear forces and better support, providing a new clinical treatment.

Oxygen transfer rate control in the production of human-like collagen by recombinant Escherichia coli.

The effects of different methods for elevating the OTR (oxygen transfer rate) during foreign gene expression and the cell growth of recombinant Escherichia coli BL21 were investigated. Two strategies were introduced to control DO (dissolved oxygen) levels in the fermentation broth: (i) increasing fermentor pressure and (ii) supplying oxygen-enriched air. These two methods were compared with the glucose feedback model, which acted as the control. By adopting a fed-batch method of cultivation, the cell yield coefficient (YX/S), accumulation of acetic acid and volumetric product yield (Yp) were measured or estimated. Adoption of these two methods led to an improvement in the OTR. The cell density and volumetric product yield in the cultivation controlled by increasing the fermentor pressure reached 77 g x l(-1) (dry cell weight) and 14 g x l(-1) respectively, which were much higher than those obtained with the strategy of supplying oxygen-enriched air (48 and 6 g x l(-1) respectively) and in the control (46 and 7 g x l(-1) respectively). The results indicate that increasing fermentor pressure is an effective way to enhance the OTR and recombinant protein (human-like collagen) productivity.

Roles of Smad3 and Smad7 in rat pancreatic stellate cells activated by transforming growth factor-beta 1.

BACKGROUND: Pancreatic stellate cells (PSCs) play a major role in promoting pancreatic fibrosis. Transforming growth factor beta 1 (TGF-beta1) is a critical mediator of this process. This study aimed to determine the expression of the Smad3 and Smad7 genes in the process of PSC activation, and explore the mechanisms of chronic pancreatitis. METHODS: The expressions of Smad3 and Smad7 in PSCs before and after TGF-beta1 treatment were detected by reverse transcription-polymerase chain reaction and Western blotting analysis. Smad3 expression was detected in PSCs after treatment with 5 ng/ml of TGF-beta1 for 24 hours. RESULTS: Smad7 expression was decreased in TGF-beta1-activated PSCs (P<0.05) in a dose-dependent manner. When TGF-beta1 concentration reached 10 ng/ml, the expression of p-Smad3, Smad3, and Smad7 was inhibited (P<0.05). CONCLUSIONS: TGF-beta1 promotes the expression of Smad3 and inhibits the expression of Smad7 during the activation of PSCs. In contrast, high-dose TGF-beta1 downregulates the expression of Smad3 in completely activated PSCs.

Effect of redox potential regulation on succinic acid production by Actinobacillus succinogenes.

The effects of redox potential used as a control parameter on the process of succinic acid production in batch cultures of Actinobacillus succinogenes NJ113 have been investigated. In batch fermentation, cell growth and metabolite distribution were changed with redox potential levels in the range of -100 to -450 mV. From the results, the ORP level of -350 mV was preferable, which resulted in high succinic acid yield (1.28 mol mol(-1)), high succinic acid productivity (1.18 g L(-1) h(-1)) and high mole ratio of succinic acid to acetic acid (2.02). The mechanism of redox potential regulation was discussed by metabolic flux analysis and the ratio of NADH/NAD+. We expected that redox potential can be used as a valuable parameter to monitor and control much more anaerobic fermentation production.

Effectiveness and safety of warm needle acupuncture on children with cerebral palsy: Protocol for a systematic review and meta-analysis.

BACKGROUND: Warm needle acupuncture (WNA) is an integral part of the acupuncture therapy, which combines acupuncture and moxibustion. Children with cerebral palsy (CP) is a common disease in children, which seriously affects children's growing development, physical and mental health. The clinical practice indicates that WNA has a therapeutic effect on children with CP. Here we will provide a protocol to explore the effectiveness and safety of WNA for children with CP. METHODS: We will search the randomized controlled trails (RCT) literatures of WNA for children with CP in 5 English databases [PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), and WHO International Clinical Trials Registry Platform (ICTRP)] and 4 Chinese databases [Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database (CBM)]. Activity of Daily Living Scales (ADL) of the patient will be considered as the primary outcome and the secondary outcome will include 88 items of gross motor function scale (GMFM-88), Gesell Growth Table (GGT), Criteria for judging efficacy and adverse events caused by WNA such as dizziness, nausea, vomiting, weariness, etc. The selection of the studies will be performed by EndnoteX7 software. And we will conduct all analyses with RevMan software V5.3. RESULT: This study will provide a rational synthesis of current evidences for WNA on children with CP. CONCLUSION: The conclusion of this study will provide evidence to judge the effectiveness and safety of WNA on children with CP. REGISTRATION: PROS-PERO CRD42019122034.

Effects of Low pH on Photosynthesis, Related Physiological Parameters, and Nutrient Profiles of Citrus.

Seedlings of "Xuegan" (Citrus sinensis) and "Sour pummelo" (Citrus grandis) were irrigated daily with a nutrient solution at a pH of 2.5, 3, 4, 5, or 6 for 9 months. Thereafter, the following responses were investigated: seedling growth; root, stem, and leaf concentrations of nutrient elements; leaf gas exchange, pigment concentration, ribulose-1,5-bisphosphate carboxylase/oxygenase activity and chlorophyll a fluorescence; relative water content, total soluble protein level, H2O2 production and electrolyte leakage in roots and leaves. This was done (a) to determine how low pH affects photosynthesis, related physiological parameters, and mineral nutrient profiles; and (b) to understand the mechanisms by which low pH may cause a decrease in leaf CO2 assimilation. The pH 2.5 greatly inhibited seedling growth, and many physiological parameters were altered only at pH 2.5; pH 3 slightly inhibited seedling growth; pH 4 had almost no influence on seedling growth; and seedling growth and many physiological parameters reached their maximum at pH 5. No seedlings died at any given pH. These results demonstrate that citrus survival is insensitive to low pH. H+-toxicity may directly damage citrus roots, thus affecting the uptake of mineral nutrients and water. H+-toxicity and a decreased uptake of nutrients (i.e., nitrogen, phosphorus, potassium, calcium, and magnesium) and water were likely responsible for the low pH-induced inhibition of growth. Leaf CO2 assimilation was inhibited only at pH 2.5. The combinations of an impaired photosynthetic electron transport chain, increased production of reactive oxygen species, and decreased uptake of nutrients and water might account for the pH 2.5-induced decrease in CO2 assimilation. Mottled bleached leaves only occurred in the pH 2.5-treated C. grandis seedlings. Furthermore, the pH 2.5-induced alterations of leaf CO2 assimilation, water-use efficiency, chlorophylls, polyphasic chlorophyll a fluorescence (OJIP) transients and many fluorescence parameters, root and leaf total soluble proteins, H2O2 production, and electrolyte leakage were all slightly greater in C. grandis than in C. sinensis seedlings. Hence, C. sinensis was slightly more tolerant to low pH than C. grandis. In conclusion, our findings provide novel insight into the causes of low pH-induced inhibition of seedling growth and leaf CO2 assimilation.

Three-Dimensional Analysis of the Curvature of the Femoral Canal in 426 Chinese Femurs.

PURPOSE: The human femur has long been considered to have an anatomical anterior curvature in the sagittal plane. We established a new method to evaluate the femoral curvature in three-dimensional (3D) space and reveal its influencing factors in Chinese population. METHODS: 3D models of 426 femurs and the medullary canal were constructed using Mimics software. We standardized the positions of all femurs using 3ds Max software. After measuring the anatomical parameters, including the radius of femoral curvature (RFC) and banking angle, of the femurs using the established femur-specific coordinate system, we analyzed and determined the relationships between the anatomical parameters of the femur and the general characteristics of the population. RESULTS: Pearson's correlation analyses showed that there were positive correlations between the RFC and height (r = 0.339, p < 0.001) and the femoral length and RFC (r = 0.369, p < 0.001) and a negative correlation between the femoral length and banking angle (r = -0.223, p < 0.001). Stepwise linear regression analyses showed that the most relevant factors for the RFC and banking angle were the femoral length and gender, respectively. CONCLUSIONS: This study concluded that the banking angle of the femur was significantly larger in female than in male.

[Treatment of clavicular fractures using intramedullary nailing or K-wire versus plating fixation: a meta-analysis].

OBJECTIVE: TFo compare the efficacy and complications rate of intramedullary (IM) nailing or K-wire versus plating fixation for clavicular fractures. METHODS: Pubmed, Embase, Cochrane Library databases, CNKI, VIP and Wangfang databases were searched to find all randomized or quasi-randomized controlled trials of clavicle fractures using plating versus IM nailing or K-wire. The methodologic quality of the studies was assessed. After independent study selection by 2 authors ,data were collected and extracted independently. Outcomes of postoperative shoulder functional measurement, the efficacy and information of the operation and complications rate were meta-analyzed using RevMan 5 software. RESULTS: Nine hundreds and seventy-six patients in 10 randomized controlled trials (RCTs) and 3 quasi-RCTs were involved in the meta-analysis,of which 5 studies compared the K-wire and the plating fixations and 8 studies compared the IM nailing and the plating fixations. The overall odds ratio(OR) (with 95% CI) of the operation efficacy for K-wire versus the plating was 3.79 (1.93, 7.46). The overall weighted mean difference (with 95% CI) of Constant Shoulder score for plating versus IM fixation was -1.39 (-3.43, 0.65) in 6 studies. The overall OR of the plating versus IM nailing was 9.34(2.70, 32.32) for the overall major complications in 5 studies and 5.04 (1.52,16.77) for the revision rate in 5 studies. CONCLUSION: The current limited evidences suggested that the IM fixation could reduce the incidences of the overall major complications and the revision surgery, while the post-operative efficacy of the plating was superior to the K-wire. More high quality RCTs are still needed in the future.

Overexpression of CRY1 protects against the development of atherosclerosis via the TLR/NF-κB pathway.

It has been demonstrated that the circadian clock system could be a potential factor involved in inflammation and the progression of atherosclerosis. A previous study has reported that cryptochrome 1 (CRY1), which is a core clock component, is associated with regulating proinflammation. However, whether CRY1 is involved in atherosclerosis is currently unknown. In the present study, we aimed to explore the role of CRY1 in regulating atherosclerosis in apolipoprotein E (ApoE)-deficient mice and the underlying molecular mechanism. We found that CRY1 mRNA expression was significantly decreased in atherosclerotic patients compared to the healthy subjects. Overexpression of CRY1 in the mouse model of atherosclerosis by adenovirus-mediated gene transfer significantly decreased the expression of proinflammatory factors including tumor necrosis factor-α (TNF-α), interleukin (IL)-1, IL-6, and macrophage inflammatory protein-1α (MIP-1α). In addition, the adhesion molecules including vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and E-selectin, were also downregulated by CRY1 overexpression. Furthermore, the plaque area of the aortic sinus and the concentrations of total cholesterol (TC), triglyceride (TG), and low density lipoprotein cholesterol (LDL-C) were also decreased in the atherosclerotic mice by CRY1 overexpression. Moreover, overexpression of CRY1 significantly decreased the protein levels of toll-like receptor (TLR) 2, TLR4 and phosphorylated p65 (p-p65). Additionally, the results of luciferase reporter assay exhibited that CRY1 overexpression was capable of inhibiting the activation of nuclear factor-kappa B (NF-κB). Taken together, our results suggest that overexpression of CYR1 relieves the development of atherosclerosis that may be associated with regulating the TLR/NF-κB pathway.

The effect of using the health smart card vs. CPOE reminder system on the prescribing practices of non-obstetric physicians during outpatient visits for pregnant women in Taiwan.

INTRODUCTION: There is an evidence that pregnant women have been prescribed a significant number of improper medications that could lead to potential damage for a developing fetus due to discontinuity of care. The safety of pregnant women raises public concern and there is a need to identify ways to prevent potential adverse events to the pregnant woman. This study used a health smart card with a clinical reminder system to keep continuous records of general outpatient visits of pregnant women to protect them from potential adverse events caused by improper prescription. METHOD: The health smart card, issued to all 23 million citizens in Taiwan, was used to work with a Computerized Physician Order Entry (CPOE) implemented at a 700-bed teaching medical center in Taipei to provide the outpatient information of pregnant women. FDA pregnancy risk classification was used to categorize the risk of pregnant women. The log file, combined with the physicians' and patients' profiles, were statistically examined using the Mantel-Haenszel technique to evaluate the impact of system in changing physician's prescription behavior. RESULTS: A total of 441 patients ranged in age from 15 to 50 years with 1114 prescriptions involved in FDA pregnancy risk classification C, D, and X during the study period. 144 reminders (13.1%) were accepted by physicians for further assessment and 100 (69.4%) of them were modified. Non-obstetric physicians in non-emergency setting were more intended to accept reminders (27.8%, 4.9 folds than obstetricians). Reminders triggered on patients in second trimester (15.5%) were accepted by all physicians more than third trimester (OR 1.52, p<0.05). CONCLUSION: A health smart card armed with CPOE reminder system and well-defined criteria had the potential to decrease harmful medication prescribed to pregnant patients. The results show better conformance for non-obstetric physicians (26%) and when physicians accepted the alerts they are more likely to went back and review their orders (69%). In sum, reminder criteria of FDA pregnancy risk classification C for obstetricians and reminder based on different trimesters is suggested to be refined to improve system acceptability and to decrease improper prescription.

Selection of reference genes for gene expression studies in PBMC from Bama miniature pig under heat stress.

Heat stress decreases immune function and increases disease susceptibility in stressed animals, which are important factors for industry and public health. We investigated the molecular mechanisms underlying heat stress by profiling the expression of target genes involved in the cellular response in the blood of Bama miniature pigs (Sus scrofa domestica) over 21 days with the use of quantitative RT-PCR (qRT-PCR). Reliable standards were established for the normalization of qRT-PCR. Six potential reference genes were ranked by their stability using the geNorm and NormFinder programs. Ribosomal protein L4 (RPL4) and TATA-box-binding protein (TBP) ranked as the two most stably expressed genes, except on day 21 when beta-2-microglobulin (B2M) was the most stable. Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and ribosomal RNA 18S (18SRNA) were discarded as reference genes due to their unstable expression patterns. When B2M and TBP genes were selected as standards in combination, rather than GAPDH, a significant upregulation in Toll-like receptor 2 (TLR2) expression was observed after 21 consecutive days of heat stress. These findings suggest that selection of an ideal reference gene is a key step in comparison of transcription profiles in Bama miniature pigs.

[Survey on thalassemia among people of reproductive age in Guilin City, Guangxi, China].

OBJECTIVE: To study the present situation of thalassemia among people at reproductive age in Guilin city. METHODS: A complete red blood cell mean cell volume (RBCMCV) was detected as well as hemoglobin electrophoresis analysis were done for all samples. Suspected alpha or beta thalassemia cases, were screened out and alpha and beta thalassemia genes were detected by PCR-RDB. RESULTS: Among 1580 cases, 79 cases were detected a thalassemia gene positive, with the detection rate as 5.00%. The detection rates on a thalassemia were 5.32%, 4.68% in males and females, but no significant difference (chi2 = 3.04, chi2 < chi0.05 (1) = 3.84, P > 0.05). 114 cases were detected carrying beta thalassemia gene with the detection rate as 7.22%. The detection rates on beta thalassemia were 7.85%, 6.58% in males and females, with no significant difference (chi2 = 0.95, chi2 < chi0.05(l) = 3.84, P > 0.05). The overall detection rate of thalassemia was 12.22% (193/1580). Alpha thalassemia were found to have had ten genotypes, with --SEA/alphaalpha the most common one and the detection rate was 3.54%. -Alpha(3.7)/alphaalpha appeared the majority in the static alpha thalassemia and --SEA/alphaalpha took the majority in the light a thalassemia, while --SEA-alphaCS was the major one in the intermedia alpha thalassemia, with gene contributions of 7.59%, 70.88% and 2.53%. Beta thalassemia was detected having seven genotypes,with CD41-42 (-TTCT) the most common one in beta thalassemia, and the detection rate was 3.16%. The commonly seen three mutations, CD41-42 (-TTCT), CD17 (A-->T) and IVS-II-654 (C-->T) were accounted for 87.71% of beta thalassemia. The detection rate on thalassemia a and beta combination was 0.63%. CONCLUSION: The detection rate of thalassemia among people at productive age in Guilin city was relatively high.

The use of a CPOE log for the analysis of physicians' behavior when responding to drug-duplication reminders.

INTRODUCTION: There is evidence that patients are being prescribed a significant number of duplicated prescriptions despite the use of computerized safety reminder systems. Nonetheless, the physicians' behavior with respect to the computer reminders has not been well studied as yet. This problem is important because drug duplication can result in patient overdose with unpredictable or undesirable effects; furthermore, it is also a waste of significant healthcare resources. METHODS: In 2005, a computerized drug-duplication reminder system on the computerized physician order entry (CPOE) was implemented at a 737-bed teaching hospital in northern Taiwan. The log file, combined with the physicians' profiles, was statistically examined using the Mantel-Haenszel technique over the second half of 2005. RESULTS: A total of 11,298 orders (1.26%) involved drug-duplication reminders and this was out of 896,131 orders in 188,182 order set during the study period. The physicians related variables (workload, department, educational background, years in practice at the target hospital and age), policy related variables (intervention from the insurer and hospital administration), the order itself (drug price and medication class) and patients' resistance were found to be most critically related to physicians' behaviors in terms of the reminders. Intervention by Taiwan's National Insurance reimbursement policy appeared to be ineffective as a way of affecting the physicians' behavior. CONCLUSION: The log file appears to be a valuable source for analyzing physicians' behavior on reminders if well designed with the CPOE. Hospitals, clinicians and patients should pay more attention and be seriously concerned about CPOE reminders. It is also important to reexamine the physicians' workload and the insurer reimbursement policy in relation to drug duplication.

New synthesis of zinc tetrakis(arylethynyl)porphyrins and substituent effects on their redox chemistry.

Sonogashira coupling of zinc 5,10,15,20-tetraethynylporphyrin with various phenyl iodides under mild conditions afforded good yields of the corresponding zinc porphyrins. This method is applicable to a variety of aryl iodides including meso-substituted iodoporphyrin to form a conjugated star-shaped multiporphyrin. The UV-Vis spectra show that peak broadening, red shifts, and changes in the oscillator strength of absorptions increase with the extension of pi-conjugation. In the electrochemical measurements, the first oxidation of porphyrins 4-9 occurs at potentials in the range +0.89 to +1.08 V, which are comparable to that of ZnTPP (TPP = tetraphenylporphyrin). The first reduction was observed at potentials from -0.73 to -0.89 V, which is anodically shifted by 390-550 mV as compared to that of ZnTPP, and the second reduction occurs at potentials in the range -1.12 to -1.33 V. The para-substituted tetrakis(phenylethynyl)porphyrins show substituent effects on their redox chemistry and exhibit only slight substituent effects in their emission and absorption maxima.

Intra-atrial thrombolytic therapy for dissolution of chronic left atrial thrombi in patients undergoing balloon mitral commissurotomy.

The purpose of this study was to evaluate the solubility of left atrial thrombi to thrombolytics after failure of long-term anticoagulant therapy in patient with mitral stenosis. One hundred and eighty-one consecutive patients with mitral valve area < or = 1.5 cm(2) and without severe mitral regurgitation were screened with echocardiography; 30 were found to have left atrial thrombi. Follow-up echocardiography performed 7.4 +/- 5.6 months after warfarin therapy revealed that 8/30 of patients had complete dissolution and 3/30 had partial dissolution of the thrombi. Thirteen patients with residual isolated appendageal thrombi underwent balloon mitral commissurotomy and were randomized into four groups at the end of balloon mitral commissurotomy: group A, receiving intra-atrial infusion of heparin and tissue plasminogen activator (t-PA; n = 4); group B, heparin and streptokinase (n = 3); group C, heparin (n = 3); and group D, acting as control (n = 3). It was found that only two patients in the t-PA group had their thrombi either completely or partially dissolved within 48 hr. Thus, this study suggests that t-PA may have the potential of dissolving chronic left atrial thrombi.