Energy intake at different times of the day: Its association with elevated total and LDL cholesterol levels.

BACKGROUND AND AIMS: This study examined the association between macronutrient intake at different times of the day and blood lipid levels. METHODS AND RESULTS: The study was based on the Nutrition and Health Survey in Taiwan, a cross-sectional study of non-institutionalized and non-pregnant healthy adults (≥19-years-old). A one-day (24 h) dietary recall assessed participants' food intake. Fasting plasma triglycerides, total cholesterol, and high-density lipoprotein (HDL) cholesterol were determined. Low-density lipoprotein (LDL) cholesterol was estimated based on the Friedewald formula. According to the data of eligible subjects (n = 1283), the time of energy intake was categorized into three meal times 0500-0929 (morning), 1130-1329 (noon), and 1730-2029 (evening), along with three snack times 0930-1129 (mid-morning), 1330-1729 (afternoon), and 2030-0459 (night). Energy and macronutrient intake were calculated for the 6 time periods, based on 24 h recall data. An adjusted regression model showed that by transferring 100 kcal intake at night to the morning or noon, LDL cholesterol would be lower by 1.46 (95% CI: 2.42-0.50) and 1.27 mg/dL (95% CI: 2.24-0.30), respectively. Transferring 100 kcal of fat intake at night to earlier periods was associated with a lower LDL cholesterol level, especially transferring to noontime (significantly lower by 5.21 mg/dL, 95% CI: [7.42-2.99]) and evening (significantly lower by 3.19 mg/dL, 95% CI: [6.29-0.08]). CONCLUSIONS: Total cholesterol and LDL cholesterol had the same pattern of association with the timing of energy intake. The study showed that elevated total and LDL cholesterol were positively associated with nighttime energy and fat intake.

Overexpression of miR-101-2 in donor cells improves the early development of Holstein cow somatic cell nuclear transfer embryos.

Accumulating studies have suggested that microRNA play a part in regulating multiple cellular processes, such as cell proliferation, apoptosis, the cell cycle, and embryo development. This study explored the effects of miR-101-2 on donor cell physiological status and the development of Holstein cow somatic cell nuclear transfer (SCNT) embryos in vitro. Holstein cow bovine fetal fibroblasts (BFF) overexpressing miR-101-2 were used as donor cells to perform SCNT; then, cleavage rate, blastocyst rate, inner cell mass-to-trophectoderm ratio, and the expression of some development- and apoptosis-related genes in different groups were analyzed. The miR-101-2 suppressed the expression of inhibitor of growth protein 3 (ING3) at mRNA and protein levels, expedited cell proliferation, and decreased apoptosis in BFF, suggesting that ING3, a target gene of miR-101-2, is a potential player in this process. Moreover, by utilizing donor cells overexpressing miR-101-2, the development of bovine SCNT embryos in vitro was significantly enhanced; the apoptotic rate in SCNT blastocysts was reduced, and the inner cell mass-to-trophectoderm ratio and SOX2, POU5F1, and BCL2L1 expression significantly increased, whereas BAX and ING3 expression decreased. Collectively, these findings suggest that miR-101-2 promotes BFF proliferation and vitality, reduces their apoptosis, and improves the early development of SCNT embryos.

Reproductive biology of female striped marlin Kajikia audax in the western Pacific Ocean.

Length and mass data for 1260 (536 females, 683 males, 41 sex unknown) striped marlin Kajikia audax were collected at the fish markets of Tungkang, Singkang and Nanfangao from July 2004 to September 2010. Of these samples, 534 gonads (236 females and 298 males) ranging from 95 to 206 cm in eye-to-fork length (LEF ) and 8 to 88 kg in round mass (MR ), were collected. Chi-square tests indicated sex ratios were homogeneous among months in 2004 and 2006-2008, but not in 2005, 2009 and 2010; and there were significant differences in sex ratio by size. The overall sex ratio (RS ) differed significantly from the expected 0·5. Kajikia audax are sexually dimorphic and the proportions of females increased with size between 140 and 210 cm LEF . Reproductive activity was assessed using a gonado-somatic index (IG ), external appearance of the gonads and histological examination and results indicated that the spawning season occurred from April to August with a peak in June to July. Based on histological observations and the distribution of oocyte diameters, K. audax are multiple spawners and their oocytes develop asynchronously. The estimated length-at-50% maturity (LEF50 ) was c. 181 cm (c. 4·8 years of age) for females. The proportion of reproductively active females in the spawning season with ovaries containing postovulatory follicles (0·27) indicated that they spawned every 3·7 days on average. The hydrated oocyte method estimated mean ± S.D. batch fecundity (FB ) to be 4·4 ± 2·02 million eggs; average relative fecundity was 53·6 ± 13·9 oocytes g-1 MR ; and the average annual fecundity was 181·3 ± 48·3 million eggs. The parameters estimated in this study are key information for stock assessments of K. audax in the north-western and central Pacific and will contribute to the conservation, management and sustainable yield of this species.

Body mass index and depressive symptoms in adolescents in Taiwan: testing mediation effects of peer victimization and sleep problems.

BACKGROUND: Despite recognition of the link between body mass index (BMI) and depression in adolescence, the underlying mechanisms behind this association remain understudied. This study aims to examine three mediational pathways from BMI to depressive symptoms through peer victimization and sleep problems. Sex differences in the mediating effects were also explored. METHODS: Data came from 1893 adolescents participating in a multi-wave longitudinal study from grade 9 to 12 in northern Taiwan were analyzed. Measures included BMI in 2009, peer victimization in 2010, sleep problems in 2011, depressive symptoms in 2012 and other covariates (sex, age, parental education, family structure, family economic stress, stressful life events, pubertal development and previous scores of focal study variables). A series of multiple regression models were conducted to test mediation hypotheses. A bootstrapping approach was applied to obtain confidence intervals for determining the significance of indirect effects. RESULTS: The association between BMI and depressive symptoms was significantly mediated by peer victimization and sleep problems. Higher BMI predicted more peer victimization and sleep problems, each of which led to higher levels of depressive symptoms. Our results further showed that higher BMI was associated with more peer victimization, which led to greater sleep problems and in turn resulted in increased depressive symptoms. No sex differences was found for the indirect effects of BMI on depressive symptoms through either peer victimization or sleep problems. CONCLUSIONS: Peer victimization and sleep problems partly explain the link between BMI and depressive symptoms. Interventions to prevent or manage depressive symptoms may yield better results if they consider the effects of these two psychosocial factors rather than targeting BMI alone.

Interpenetration of CH3NH3PbI3 and TiO2 improves perovskite solar cells while TiO2 expansion leads to degradation.

Perovskite solar cells have drawn much attention and achieved efficiencies over 22%, but relatively little is known about the long-term stability under photovoltaic operation. So far, stability studies have reported about the importance of degradation of each layer, but little to no consideration has been given to the whole device architecture. We investigated the stability of perovskite solar cells in order to fundamentally understand the mechanism behind efficiency improvement/degradation during device operation. We found that during operation the interfaces of the perovskite and the electron-transport layer (ETL), meso-porous TiO2, further intermix with each other, which leads to improved power conversion efficiency (PCE) during the initial operation of these solar cells. The operation-induced structural changes are examined directly by X-ray photoelectron spectroscopy (XPS) with in situ low-energy Ar+ sputtering and time-of-flight secondary ion mass spectrometry (ToF-SIMS) with C60 sputtering. In addition, this study describes that the primary cause of irreversible degradation during operation is due to the expansion of TiO2 and ion migration throughout the perovskite solar cell.

Has Choosing Wisely® affected rates of dual-energy X-ray absorptiometry use?

UNLABELLED: Reducing overuse of tests such as dual-energy X-ray absorptiometry (DXA) scans in younger women is an important quality issue. We evaluated trends in DXA ordering before and after Choosing Wisely recommendations were released. We found no significant difference in ordering trends suggesting that other initiatives are needed to change behavior. INTRODUCTION: Reducing overuse of tests such as dual-energy X-ray absorptiometry (DXA) scans in younger women is an important quality issue, but trends in care are difficult to change. We evaluated (1) trends in DXA ordering before and after the Choosing Wisely recommendation release and (2) patterns of key characteristics that indicate a potentially appropriate DXA scan order. METHODS: We performed a retrospective longitudinal analysis of electronic health record data at a multi-specialty, ambulatory care network of 34 practices across Maryland and Washington, DC. Since the Choosing Wisely DXA recommendation was released April 2012, the study periods were April-December 2011 (pre-initiative) and April-December 2012 (post-initiative). Women between 50 and 64 years with primary care encounters, and primary care providers who saw ten or more women in the study population in both pre and post periods were included. RESULTS: For 42,320 eligible patients, the mean provider ordering rate was 2.6 % pre-initiative and 2.0 % post-initiative; there was no significant difference in trend over time. Over 70 % of the population had no characteristics associated with potentially appropriate DXA ordering. Low body mass index, current smoker status, and osteopenia were the most common characteristics indicating potentially appropriate DXA orders. Patients with any of these three characteristics had DXA ordering rates between 3-20 %. CONCLUSIONS: The trend in provider ordering rates of DXA scans did not decrease after the release of the DXA Choosing Wisely recommendation. Targeted initiatives addressing providers with high ordering rates will be needed to change behavior.

Skeletal muscle mass and risk of death in an elderly population.

BACKGROUND AND AIM: Body mass index (BMI) has a U-shaped relationship with mortality among the elderly, in contrast to the general adult population. Skeletal muscle mass may be more appropriate than BMI for classifying mortality risk among the elderly. We investigated the relationship between skeletal muscle mass and mortality among elderly Chinese persons. METHOD AND RESULTS: A total of 1512 elderly from the Nutrition and Health Survey in Taiwanese Elderly (1999-2000) was enrolled, and the survival status was followed using data from the National Death Registry. The skeletal muscle mass index (SMMI) was calculated by dividing skeletal muscle mass by height in meters squared. The Cox proportional hazard model was used to estimate the association between SMMI and mortality. During the follow-up (average time: 7.9 years), one-third elderly died (n = 506) by any cause and 25% of them was cardiovascular mortality (ICD-9-CM: between 390 and 459). The total mortality and cardiovascular mortality were 4.23 and 1.07 per 100 person-years. Elderly participants with the lowest SMMI had the highest total mortality and cardiovascular mortality among the four quartiles (6.72, 3.76, 3.25 and 3.50 per 100 PY for total mortality; 1.81, 0.76, 0.87, 0.93 for cardiovascular mortality). Those with a low (1st quartile) SMMI had a 2-fold increase in total mortality (1.96; 1.63-2.35) and cardiovascular mortality (2.16; 1.51-3.08) risk compared to those with a normal [2nd, 3rd, or 4th quartile] SMMI. CONCLUSIONS: The threshold relationship between SMMI and mortality is contrast to the reverse J-shaped relationship between BMI and total mortality. Therefore, skeletal muscle mass measurement may be considered with a high priority to identify elderly individuals with a high mortality risk.

Effects of high thoracic epidural anesthesia on ischemic cardiomyopathy cardiac function and autonomic neural function.

We aimed at observing the effects of high thoracic epidural anesthesia (HTEA) on cardiac structure and function, heart rate variability (HRV), and QT interval variation (QTV) in ischemic cardiomyopathy (ICM) patients with chronic heart failure. We divided 30 ICM patients into HTEA (N = 16) and control (N = 14) groups.The control group was treated with medication, and the HTEA group was treated with HTEA and medication for 4 weeks. We measured the changes in the left-ventricular end-diastolic diameter (LVEDd) and left-ventricular ejection fraction (LVEF) before and after treatment by using echocardiography and examined changes in HRV and QTV using ambulatory electrocardiogram. HTEA significantly narrowed the LVEDd, improved LVEF, significantly increased the HRV, and significantly reduced the QTV in the ICM group compared to the control group. HTEA significantly narrowed the ventricular chamber diameter size of ICM patients, enhanced myocardial contractility, increased myocardial electrical stability, and improved the cardiac structure and function.

Association between serum ferritin and microalbuminuria in Type 2 diabetes in Taiwan.

AIMS: Serum ferritin has been found closely related with diabetes and glucose metabolism, but its impact on diabetic nephropathy remains unknown. This study aimed to explore the association between serum ferritin and microalbuminuria in Type 2 diabetes. METHODS: Eight hundred and fifty-one subjects with Type 2 diabetes were selected from a cohort participating in a glycaemic control study in Taiwan in 2008. We used urine albumin:creatinine ratio to define microalbuminuria; serum ferritin was divided into quartiles for analysis. Logistic regression and trend tests were used to delineate the association between serum ferritin and microalbuminuria. RESULTS: Subjects with diabetes with higher ferritin tended to have more metabolic disorders, higher high-sensitivity C-reactive protein and higher prevalence of microalbuminuria. Compared with those in the lowest quartile, subjects with diabetes in the highest ferritin quartile were 55% (P = 0.029) more likely to have microalbuminuria. After controlling for demographics, metabolic profiles and other inflammatory markers, the association between serum ferritin levels and microalbuminuria remained significant (P for trend < 0.001). This independent relationship was not changed either for those who had better glycaemic control or those who had not used an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. CONCLUSIONS: The current study shows hyperferritinemia may be an independent risk factor of nephropathy in patients with Type 2 diabetes.

Preceding pain symptoms and Parkinson's disease: a nationwide population-based cohort study.

BACKGROUND AND PURPOSE: Painful sensations are recently reported to be a non-motor feature of Parkinson's disease (PD). The non-steroidal anti-inflammatory drug ibuprofen is a common painkiller and was reported to be associated with a decreased risk of PD. The aim of the present study was to examine the relationship amongst preceding pain symptoms, use of ibuprofen and risk of PD in a nationwide population-based cohort. METHODS: The data of participants who were free of PD at baseline were obtained from two large National Health Interview Surveys (NHIS) in Taiwan, conducted in 2001 and 2005. The information regarding pain status included severity and location of pain. Information regarding pain status, use of ibuprofen, comorbidity of depression and PD-associated risk/protective behaviors was adjusted using proportional hazards models. RESULTS: Amongst 33 388 participants, 32 cases of incident PD were identified after a mean follow-up of 3 years. After adjusting for the use of ibuprofen and other PD risk factors, subjects with preceding pain symptoms had a higher incidence of PD than those without pain at baseline, and the hazard ratio was 1.79 (95% CI: 0.71-4.51, P = 0.21) for mild pain and 2.88 (95% CI: 1.05-7.86, P = 0.04) for moderate or severe pain. The PD risk increased by 34% with each additional increment in pain score [hazard ratio = 1.34 (1.03-1.75), P = 0.03], showing a dose-response relationship. CONCLUSIONS: These findings support the hypothesis that pain is associated with PD in the pre-motor stage of the disease. Further research is needed to clarify the role of sensory system involvement in the pre-motor phase of PD.

The effectiveness of kinesio taping for athletes with medial elbow epicondylar tendinopathy.

Kinesio taping has also been used for athletes with Medial Elbow Epicondylar Tendinopathy (MET) as an additional treatment method. The purpose of this study was to determine the clinical effectiveness of Kinesio tape on maximal grip strength and absolute and related force sense in athletes with MET when applied to the medial forearm. 27 male athletes who voluntarily participated in this study were divided into a healthy group (n=17) and a MET group (n=10). All subjects were assessed for the maximal grip strength and grip force sense (absolute and related force sense) under 3 taping conditions: 1) without taping; 2) with placebo Kinesio taping; and 3) with Kinesio taping. No significant interaction was found between groups and taping condition in maximal grip force and related force sense error, except for absolute force sense error (p=0.04). Both groups with absolute force sense measurements had significantly decreased errors in the placebo Kinesio taping and Kinesio taping conditions. Both taping may enhance discrimination of magnitude of grip force control (absolute force sense) in both groups when applied to the forearm. However, Kinesio taping did not change maximal grip strength in either group. The effects of Kinesio taping on other muscle functions remain to be studied.

Nucleotide mismatches of foot-and-mouth disease virus during replication.

As there is a lack of error correction mechanisms during RNA replication, foot-and-mouth disease virus (FMDV) has a very high mismatch rate, which leads to a high mutation rate, in the range of 10(-3) to 10(-5) per nucleotide site per genome replication. We examined the nucleotide mismatch of FMDV during replication, based on the whole genomes of the 7 serotypes retrieved from NCBI. With the Mega bio-software, SPSS, and Microsoft Excel, we studied the nucleotide differences compared to the sequence in the RefSeq database, and developed two probable mutation models, i.e., once mutation model and complication mutation model. Further analysis on the nucleotide mismatch during replication was made. We found that FMDV share similar difference rates between nucleotide and reverse differences, for example the mutation U→C and C→U. We also found that each nucleotide has its domain mismatch, and the virus kept a constant nucleotide composition during mutations.

Reproductive biology of female bigeye tuna Thunnus obesus in the western Pacific Ocean.

The reproductive biology of female bigeye tuna Thunnus obesus was assessed by examining 888 fish (ranging from 84·9 to 174·4 cm fork length, LF ) caught by Taiwanese offshore longliners in the western Pacific Ocean from November 1997 to November 1998 and November to December 1999 and 258 gonad samples from these fish. The overall sex ratio of the catch during the sampling differed significantly from 0·5, but males were predominant in sizes >140 cm LF . Reproductive activity (assessed by histology), a gonado-somatic index, and the size-frequency distributions of whole oocytes indicated that spawning occurred throughout the year and the major spawning season appeared to be from February to September. The estimated sizes at 50% maturity (LF50 ) of females was 102·85 cm (95% c.i.: 90·79-110·21 cm) and the smallest mature female was 99·7 cm LF . They are multiple spawners and oocytes develop asynchronously. The proportion of mature (0·63) and reproductively active (0·70) females with ovaries containing postovulatory follicles indicated that they spawn almost daily. Batch fecundity for 15 females with the most advanced oocytes (>730 µm) ranged from 0·84 to 8·56 million eggs (mean ± s.d. = 3·06 ± 2·09). The relationships between batch fecundity (FB , in millions of eggs) and LF (cm) and round mass (MR , kg) were FB=9·91×10-14LF6·38 (r(2) = 0·84) and FB=8·89×10-4MR2·05 (r(2) = 0·80), respectively. The parameters estimated in this study are key information for stock assessments of T. obesus in the western Pacific Ocean and will contribute to the conservation and sustainable yield of this species.

Sarcopenia Screened with SARC-F and Subjective Memory Complaints Are Independently Associated with Increased Risk of Incident Dementia among Cognitively Unimpaired Older Adults.

OBJECTIVES: The main aim of this study was to examine the association of sarcopenia and subjective memory complaints with the incidence of dementia in a population-based cohort of cognitively unimpaired older adults. DESIGN: Three-year longitudinal study. SETTINGS AND PARTICIPANTS: A total of 2163 community-dwelling persons aged 65 years or older who participated in the National Health Interview Survey in Taiwan, 2017. MEASUREMENTS: Sarcopenia was determined based on SARC-F, a self-reported symptom-based questionnaire that includes five components: strength, assistance walking, rise from a chair, climb stairs, and falls. Two questions ("Do you have difficulties with your memory or attention?" and "Do you have difficulties with your memory only or attention only or both?") were used to screen for subjective memory complaints (SMCs). The incidence of dementia was determined by data linkage to the Taiwan National Health Insurance claims database from 2018 to 2020. RESULTS: Among the 2163 participants without dementia at baseline, 135 had incident dementia during the 3-year follow-up, giving a crude incidence rate of 6.2% (135/2163). Compared to participants free from sarcopenia and SMCs, the adjusted hazard ratio for incident dementia was 1.83 (95% confidence interval [CI]: 1.23-2.72) for SMCs alone, 2.40 (95% CI: 1.17-4.93) for sarcopenia alone, and 2.49 (95% CI: 1.21-5.11) for coexisting SMCs and sarcopenia. CONCLUSIONS: Our results indicate that sarcopenia screened with SARC-F and SMCs independently predict the cognitively unimpaired older adults at risk of incident dementia. Our findings highlight the importance of screening not only for cognitive but also muscle deficits to identify those at increased risk of incident dementia.

HbA1c variability is associated with microalbuminuria development in type 2 diabetes: a 7-year prospective cohort study.

AIMS/HYPOTHESIS: HbA(1c) variability has been shown to be an independent risk factor for nephropathy in patients with type 1 diabetes. In this study, we aimed to explore the association between HbA(1c) variability and microalbuminuria development in patients with type 2 diabetes. We also intended to test the applicability of serially measured HbA(1c) over 2 years for this risk assessment. METHODS: Between 2003 and 2005, we recruited 821 middle-aged normoalbuminuric individuals with type 2 diabetes and followed them through to the end of 2010. The average follow-up time was 6.2 years. We defined microalbuminuria as a urine albumin to creatinine ratio of 30 mg/g (3.4 mg/mmol) or higher. HbA(1c) variability was calculated by the SD of serially measured HbA(1c). The Cox proportional hazards model was used to evaluate the association between HbA(1c) SD quartile and development of microalbuminuria. RESULTS: The incidence of microalbuminuria for the overall population was 58.4, 58.6, 60.8 and 91.9 per 1,000 person-years for Q1- to Q4-adjusted HbA(1c) SD, respectively (p for trend = 0.042). Compared with patients in Q1, those in Q4 were about 37% more likely to develop microalbuminuria. The HR derived from a series of 2 year HbA(1c) measurements was similar to that from data collection for longer than 4 years. CONCLUSIONS/INTERPRETATION: In addition to mean HbA(1c) values, HbA(1c) variability, even measured as early as 2 years, is independently associated with the development of microalbuminuria in patients with type 2 diabetes.

Ipr1 gene mediates RAW 264.7 macrophage cell line resistance to Mycobacterium bovis.

Tuberculosis caused by Mycobacterium bovis (M. bovis) seriously affects efficiency of animal production with impacts on public health as well. Effective programmes of prevention and eradication of M. bovis infection therefore are urgently needed. Intracellular pathogen resistance gene 1 (Ipr1) is well known to mediate innate immunity to Mycobacterium tuberculosis (MTB), but there are no reports as to whether Ipr1 can enhance the phagocytic ability of macrophage against M. bovis. In this investigation, RAW 264.7 macrophage was transduced with lentiviral vector carrying Ipr1 (named Lenti-Ipr1); transgenic cells were identified by RT-PCR and western blotting. Transgenic positive cells (R-Ipr1) were then infected with an M. bovis virulent strain, with non-transduced cells used as control. When cell proliferation, viability and apoptosis of the two groups were investigated, it was found that infected RAW 264.7 died by necrosis whereas R-Ipr1 underwent apoptosis. Furthermore, the numbers of intracellular bacteria in R-Ipr1 were lower than those in control cells (P < 0.05). To identify the role of Ipr1, we measured the genes of Casp3, Mcl-1 and NOS2A which associated with macrophage activation and apoptosis by real-time quantitative PCR. The results demonstrated that Ipr1 gene expression can enhance anti-M. bovis infection of macrophage. This establishes a basis for the future production of Ipr1-transgenic cattle to strengthen the tuberculosis resistance.

A retrospective study of pulmonary infarction in patients with systemic lupus erythematosus from southern Taiwan.

Since large-scale reports of pulmonary infarction in systemic lupus erythematosus (SLE) are limited, a retrospective study was performed for this manifestation in 773 hospitalized patients in southern Taiwan from 1999 to 2009. Pulmonary infarction was defined as the presence of pulmonary embolism, persistent pulmonary infiltrates, and characteristic clinical symptoms. Demographic, clinical, laboratory, and radiological images data were analyzed. There were 12 patients with pulmonary embolism and 9 of them had antiphospholipid syndrome (APS). Six patients (19 to 53 years, average 38.2 ± 12.6) with 9 episodes of lung infarction were identified. All cases were APS and four episodes had coincidental venous thromboembolism. There were four episodes of bilateral infarction and seven episodes of larger central pulmonary artery embolism. Heparin therapy was routinely prescribed and thrombolytic agents were added in two episodes. Successful recovery was noted in all patients. In conclusion, there was a 0.8% incidence of pulmonary infarction in patients with SLE, all with the risk factor of APS. Differentiation between pulmonary infarction and pneumonia in lupus patients should be made; they have similar chest radiography with lung consolidation but require a different clinical approach in management. Although this report is a retrospective study with relatively small numbers of lupus patients with lung infarcts, our observation might provide beneficial information on the clinical features and radiological presentations during the disease evolution of pulmonary infarction in SLE with APS.

Psychosocial problems in children with allergic diseases: a population study in Taiwan.

BACKGROUND: A few studies had pointed out the relationship between a single allergic disease and children's psychosocial problems; however, all of these researchers considered the allergic diseases separately. Therefore, this study aimed to investigate the relationship between collective allergic diseases and psychosocial problems among 4- to 12-year-old children in Taiwan. METHODS: The data were generated from the 2005 Taiwan National Health Interview Survey. A total of 2955 parents or guardians completed the answers for their 4- to 12-year-old children. We used logistic regressions to investigate the association of allergic diseases and the psychosocial problems. RESULTS: About 40.62% children had at least one allergic disease in the past year, and 17.75% children had a score of psychosocial problems higher than or equal to the 75th percentile. After controlling for demographic factors, the risk of having high-level psychosocial problem for children with any allergic disease was 1.84 times of those without allergy. For those who had one, two or more than two allergic diseases, the risks of having psychosocial problems were 1.56, 2.20 and 3.39 times of those had no allergy disease respectively. Children with asthma, dermatitis and rhinitis simultaneously had the highest psychosocial impact (odds ratio = 5.10). CONCLUSIONS: Collective allergic diseases were associated with psychosocial problems in children, and the effect was gradient. Parents and paediatricians should pay attention to psychosocial problems in children with allergic diseases and vice versa.

RmpA regulation of capsular polysaccharide biosynthesis in Klebsiella pneumoniae CG43.

Sequence analysis of the large virulence plasmid pLVPK in Klebsiella pneumoniae CG43 revealed the presence of another mucoid factor encoding gene rmpA besides rmpA2. Promoter activity measurement indicated that the deletion of rmpA reduced K2 capsular polysaccharide (CPS) biosynthesis, resulting in decreased colony mucoidy and virulence in mice. Introduction of a multicopy plasmid carrying rmpA restored CPS production in the rmpA or rmpA2 mutant but not in the rcsB mutant. Transformation of the rmpA deletion mutant with an rcsB-carrying plasmid also failed to enhance CPS production, suggesting that a cooperation of RmpA with RcsB is required for regulatory activity. This was further corroborated by the demonstration of in vivo interaction between RmpA and RcsB using two-hybrid analysis and coimmunoprecipitation analysis. A putative Fur binding box was only found at the 5' noncoding region of rmpA. The promoter activity analysis indicated that the deletion of fur increased the rmpA promoter activity. Using electrophoretic mobility shift assay, we further demonstrated that Fur exerts its regulatory activity by binding directly to the promoter. As a result, the fur deletion mutant exhibited an increase in colony mucoidy, CPS production, and virulence in mice. In summary, our results suggested that RmpA activates CPS biosynthesis in K. pneumoniae CG43 via an RcsB-dependent manner. The expression of rmpA is regulated by the availability of iron and is negatively controlled by Fur.