Effect of Taiwan's Diabetes Shared Care Program on the risk of periprosthetic joint infection after total joint arthroplasty in patients with type 2 diabetes mellitus: an eight-year population-based study.

BACKGROUND: Periprosthetic joint infection (PJI) is a significant post-arthroplasty complication for diabetic patients, with uncontrolled diabetes identified as a PJI risk factor. Taiwan's Diabetes Shared Care Program (DSCP) was established for holistic diabetes care. AIM: To evaluate the DSCP's impact on PJI incidence and patients' medical costs. METHODS: Data were analysed from Taiwan's National Health Insurance Research Database from 2010 to 2020, focusing on type 2 diabetes mellitus (DM) patients who had undergone arthroplasty. The study group involved DSCP participants, while a comparison group comprised non-participants with matched propensity scores for age, sex, and comorbidities. The primary outcome was the PJI incidence difference between the groups; the secondary outcome was the medical expense difference. FINDINGS: The study group consisted of 11,908 type 2 DM patients who had arthroplasty and joined the DSCP; PJI occurred in 128 patients. Among non-participants, 184 patients had PJI. The PJI incidence difference between the groups was statistically significant (1.07% vs 1.55%). The study group's medical costs were notably lower, regardless of PJI incidence. Multivariate regression showed higher PJI risk in patients in comparison group, aged >70 years, male, or who had obesity, anaemia. CONCLUSION: The study indicates that DSCP involvement reduces PJI risks and decreases annual medical costs for diabetic patients after arthroplasty. Consequently, the DSCP is a recommendable option for such patients who are preparing for total joint arthroplasty.

Antibiotic strategies and clinical outcomes in critically ill patients with pneumonia caused by carbapenem-resistant Acinetobacter baumannii.

OBJECTIVES: This study aimed to investigate antibiotic prescribing patterns and effectiveness of different anti-carbapenem-resistant Acinetobacter baumannii (CRAB) strategies for CRAB pneumonia. METHODS: We conducted a multicentre, retrospective study in three hospitals. During 2010-2015, adult ICU patients with CRAB pneumonia treated with at least one antimicrobial agent covering the CRAB isolate in vitro for more than 2 days were included. We used multivariate logistic regression to analyse the associations of anti-CRAB strategies with ICU mortality and other clinical outcomes. RESULTS: Among 238 patients with CRAB pneumonia, tigecycline monotherapy (84, 35.3%) was the most common antibiotic strategy, followed by tigecycline with colistin (43, 18.1%), colistin monotherapy (34, 14.3%), colistin combination without tigecycline (33, 13.9%), tigecycline combination without colistin (32, 13.4%), and sulbactam-based therapy without tigecycline and colistin (12, 5.0%). In multivariate analysis, tigecycline-based therapy was associated with higher ICU mortality than non-tigecycline therapy (adjusted OR 2.30, 95% CI 1.19-4.46). There was no difference between colistin-based therapy and non-colistin therapy. Compared with tigecycline monotherapy, colistin monotherapy was associated with lower ICU mortality (aOR 0.30, 95% CI 0.10-0.88). Treatment failure analyses showed similar trends. Tigecycline-based therapy was associated with higher treatment failure rate than non-tigecycline therapy (aOR 2.51, 95% CI 1.39-4.54), whereas colistin-based therapy was associated with lower treatment failure rate than non-colistin-based therapy (aOR 0.48, 95% CI 0.27-0.86). CONCLUSIONS: Tigecycline was commonly prescribed for CRAB pneumonia. However, tigecycline-based therapy was associated with higher ICU mortality and treatment failure. Our study suggests that colistin monotherapy may be a better antibiotic strategy for CRAB pneumonia.

Optimization of dietary zinc for egg production and antioxidant capacity in Chinese egg-laying ducks fed a diet based on corn-wheat bran and soybean meal.

The aim of this study was to evaluate the effect of zinc supplementation on productive performance and antioxidant status in laying ducks. Five-hundred-four laying ducks were divided into 7 treatments, each containing 6 replicates of 12 ducks. The ducks were caged individually and fed a corn-soybean meal and wheat bran basal diet (37 mg Zn/kg) or the basal diet supplemented with 15, 30, 45, 60, 75, or 90 mg Zn/kg (as zinc sulfate). During the early laying period of 10 d (daily egg production <80%), egg production, daily egg mass, and FCR increased quadratically with increasing dietary Zn levels (P < 0.05). The highest egg production and daily egg weight were obtained when 30 or 45 mg Zn/kg diet was supplemented, with lowest FCR. Similarly, the highest egg production and daily egg mass were observed in the group supplemented with 30 or 45 mg Zn/kg during the peak laying period of the subsequent 120 d (daily egg production >80%). Average egg weight and feed intake did not differ among the groups of graded Zn supplementation.The egg quality was not affected by dietary Zn, including the egg shape index, Haugh unit, yolk color score, egg composition, and shell thickness. The activities of plasma activities of total superoxide dismutase (T-SOD) and glutathione peroxidase (GSH-PX) increased in a quadratic manner (P < 0.001) with increasing supplemental Zn. Plasma concentration of Zn increased quadratically (P < 0.05) as dietary Zn increased. The hepatic activity of Cu/Zn-SOD and GSH-PX increased quadratically (P < 0.05) with increasing dietary Zn. Plasma Zn concentrations were positively correlated with activities of T-SOD (P < 0.05), and positively with plasma Cu. Plasma concentration of reduced glutathione was correlated with plasma Cu. In conclusion, supplementation of Zn at 30 or 45 mg/kg to a corn-wheat bran and soybean basal diet may improve the productive performance and enhance the antioxidant capacity.

Effects of dietary methionine on performance, egg quality and glutathione redox system in egg-laying ducks.

In this study, 6 dietary DL-methionine (Met) levels (2.5, 3.0, 3.5, 4.0, 4.5 and 5.0 g/kg) were tested to estimate the dietary Met requirements of Longyan ducks from 19 to 46 weeks of age, and to investigate its effect on the glutathione redox system. In total, 1080 Longyan ducks aged 19 weeks were allocated randomly to the 6 dietary treatments, where each treatment comprised 6 replicate pens with 30 ducks per pen. Met had no effects on egg production, yolk weight, yolk colour or the glutathione redox system, but the egg weight, egg mass and feed conversion ratio (FCR) were improved significantly by dietary Met supplementation. As the dietary Met concentration increased, the eggshell thickness and breaking strength decreased significantly, whereas the albumen weight increased significantly. According to broken-line regression analysis, the optimum Met requirements for egg weight, egg mass, FCR and albumen weight are 686, 661, 658 and 731 mg/bird/d, respectively, with a dietary crude protein level of 170 g/kg.

Effects of supplemental nanoparticle trivalent chromium on the nutrient utilization, growth performance and serum traits of broilers.

The aim of this study was to investigate the effect of dietary supplementation of nanoparticle trivalent chromium on nutrient utilization, growth performance and serum traits of broilers. This study included two trials. In trial 1, 32 three-week-old broilers were divided into four groups: the control, chromium chloride (CrCl3), chromium picolinate (CrPic) and nanoparticle chromium picolinate (NanoCrPic). Chromium was added at a 1200 µg/kg level to evaluate the nutrient and chromium utilization. In trial 2, 160 one-day-old broilers were randomly divided into four groups as in trial 1, with four replicates. The results of trial 1 indicated that the chromium utilization is as follows: NanoCrPic > CrPic > CrCl3 and control groups, with significant differences between groups (p < 0.05). Crude fat utilization in CrCl3 group was lower than in that the control group (p < 0.05). The results of trial 2 indicated that feed intake of 4-5 weeks showed better result in the CrCl3 group than that in the CrPic group (p < 0.05). The results of serum traits indicated that the LDL-cholesterol in the NanoCrPic groups was lower than that in the CrPic group (p < 0.05). The NanoCrpic and CrPic groups showed significantly increased serum chromium concentration when compared with the control and CrCl3 groups; the triglyceride level in the CrCl3 group was lower than that in the CrPic group (p < 0.05). This study concluded that compared with CrPic, NanoCrpic supplementation could increase chromium utilization and lower the serum LDL-cholesterol of broilers.

Effects of spray-dried animal plasma on serous and intestinal redox status and cytokines of neonatal piglets.

The study investigated the effects of dietary supplementation with spray-dried animal plasma (SDAP) on growth performance, intestinal morphology, as well as serum and intestinal cytokines and antioxidant indicators of artificially reared neonatal piglets. Three diets, 1) control (a fish meal basal diet), 2) SDAP (containing 10% SDAP), and 3) autoclaved SDAP (auSDAP; containing 10% auSDAP), were fed to 36 weaned piglets (3 d old), which were randomly allotted to 3 groups. At 21 d of age, blood and intestinal mucosal samples were collected from all piglets after they were slaughtered. Compared with the control, both SDAP and auSDAP improved ADFI and duodenal villus height of piglets (P < 0.05), whereas SDAP increased ADG and duodenal villus height to crypt depth ratio (P < 0.05). Piglets fed SDAP and auSDAP had reduced malondialdehyde (MDA) content in mucosa (P < 0.05). The concentration of serum MDA was decreased and mucosal catalase (CAT) activities were increased in piglets fed SDAP diet than those fed the control diet (P < 0.05). In the mucosa, both SDAP and auSDAP decreased tumor necrosis factor α, IL-6, transforming growth factor ß, and soluble IL-2 receptor contents (P < 0.05). Mucosal IL-1ß was decreased in SDAP compared with auSDAP and control groups (P < 0.05). The SDAP and control groups had increased mucosal IL-2 compared with auSDAP group (P < 0.05). The cytokines in serum were not affected by SDAP and auSDAP. The results indicate that both SDAP and auSDAP improved the growth performance of neonatal piglets, whereas the SDAP had a greater effect. The benefits of SDAP probably resulted from the promotion of the intestinal development, which were accompanied by the increased antioxidant capacity and the decreased production of inflammatory factors in the intestinal mucosa.

Dietary supplementation with carnosine improves antioxidant capacity and meat quality of finishing pigs.

This study was conducted to determine the effect of dietary carnosine (ß-alanyl-L-histidine) supplementation on antioxidant capacity and meat quality of pigs. 72 pigs approximately 60 kg were fed a corn- and soybean meal-based diet supplemented with 0, 25, 50 or 100 mg carnosine per kg diet for 8 weeks. Carnosine supplementation did not affect growth performance and carcass traits of pigs. However, the addition of 100 mg carnosine per kg diet increased pH value of muscle at 45 min, 24 h and 48 h postmortem. It also decreased drip loss at 48 h postmortem and increased redness value of muscle at 45 min postmortem (p < 0.05). The addition of 100 mg carnosine per kg diet enhanced glycogen concentration and Ca-ATPase activity at 24 and 48 h postmortem, and reduced malondialdehyde and carbonyl protein complexes concentrations in muscle at 24 h postmortem (p < 0.05). The addition of 100 mg carnosine per kg diet increased glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and catalase (CAT) activities in plasma, liver or muscle, as well as SOD and GSH-Px genes expression in muscle (p < 0.05). Taken together, these findings indicate that carnosine supplementation improves antioxidant capacity and meat quality of pigs.

(-)-Gossypol containing hen sera and a myosin (-)-gossypol conjugate reduces the proliferation of MCF-7 cells.

Sera from chickens that consumed a known level of (-)-gossypol (-)-GP) exhibited bioactivity against human breast cancer cells in vitro. Based on this, it is conceivable that similar anti-breast cancer activities of different magnitudes will be exhibited in biological samples harvested from (-)-GP-fed layer hens. The experimental data generated in this study may influence the fundamental thinking regarding the utilization of low cost agricultural commodities such as (-)-GP cottonseed meal to produce value-added chemopreventive animal products.

Conjugated linoleic acid differentially regulates fat deposition in backfat and longissimus muscle of finishing pigs.

This experiment was conducted to investigate the effects of extracellular CLA on proliferation and differentiation of cultured adipocytes and its dietary supplementation on backfat and intramuscular fat deposition in finishing pigs. Seven-day-old Duroc x Landrace x Large White pigs were killed to obtain adipocytes for culture. Adding 3 forms of CLA (cis-9, trans-11 CLA, trans-10, cis-12 CLA, or CLA mixture) at concentrations of 50, 100, 150, 200, 250, 300, 350, and 400 microM to culture medium for 10 d increased cell differentiation (P < 0.05). In addition, 3 forms of CLA enhanced cell proliferation (P < 0.05) at 50 to 350 microM and inhibited cell proliferation (P < 0.05) at a concentration of 400 microM. Seventy-two Duroc x Landrace x Large White crossbred gilts weighing 60.7 +/- 2.8 kg were randomly assigned to 1 of the 3 dietary treatments (control, 1.25% CLA, and 2.5% CLA). The pigs were slaughtered at 100.0 +/- 5.7 kg. Dietary CLA increased lean percentage (3.5 to 4.7%; P = 0.07), intramuscular fat content (P < 0.05), and shear force (P < 0.05), but reduced 10th- and first-rib backfat depth (P

Effects of dietary glycyl-glutamine on growth performance, small intestinal integrity, and immune responses of weaning piglets challenged with lipopolysaccharide.

The objectives of this study were to determine the effects of dietary glycyl-glutamine (Gly-Gln) on postweaning growth, small intestinal morphology, and immune response of stressed or nonstressed piglets. Pigs (n = 144; initially 4.49 kg and 14 d of age) were randomly allocated to 24 pens (6 pigs/pen) in an environmentally controlled nursery and assigned to Escherichia coli lipopolysaccharide (LPS) challenge (PBS vs. LPS) and Gly-Gln supplementation (0 vs. 0.15%) in a 2 x 2 factorial arrangement of treatments with 6 pens/treatment. The LPS was the stress-inducing agent, and it was injected on d 7 and 14 of the 21-d experiment. Inflammatory challenge with LPS reduced ADG (P < 0.05) and tended to reduce ADFI (P = 0.06) of piglets from d 7 to 21 of the experiment. Supplementation of Gly-Gln increased ADG and G:F from d 0 to 21 (P < 0.05). On d 21 (1 wk after the second LPS injection), there was an LPS challenge x diet Gly-Gln interaction for ADFI (P < 0.05), but it was difficult to ascertain whether Gly-Gln increased ADFI. A trend for an LPS challenge x diet Gly-Gln interaction was observed for ADG (P = 0.07). There were no differences in lymphocyte proliferation among treatments. The LPS challenge increased crypt depth (CD) of the duodenum and decreased the ratio of villus height (VH) to CD of the ileum (P < 0.05) on d 14 (1 wk after the first LPS injection), whereas dietary supplementation of Gly-Gln increased VH of the ileum and VH:CD of the duodenum (P < 0.05). The concentration of peripheral blood IL-1beta was increased by injection of LPS (P < 0.05) and was decreased by dietary Gly-Gln supplementation during the experimental period (P < 0.05); however, there was no interaction of LPS challenge x Gly-Gln addition for IL-1beta concentration. Concentrations of peripheral blood IL-2 tended to increase at d 14 (P = 0.09) and soluble IL-2 receptor tended to decrease at d 7 (P = 0.06) in piglets supplemented with Gly-Gln; therefore, the peripheral blood IL-2/soluble IL-2 receptor system tended to favor the secretion of IL-2 during the first 2 wk of the experiment. In conclusion, considerable suppression of growth and immune function occurred in early weaning piglets challenged with LPS, and such depression could be alleviated by dietary Gly-Gln supplementation independent of the LPS challenge.

Mutagenicity and safety evaluation of water extract of fermented Toona sinensis Roemor leaves.

The purpose of this study was to evaluate the mutagenicity and safety of water extract of fermented Toona sinensis Roemor leaves (WFTS). The WFTS was prepared by fermenting Toona sinensis Roemor leaves anaerobically for 14 d, and then extracting with boiling water. The mutagenic effects of WFTS were investigated using Ames test. No mutagenicity was found toward all tester strains (Salmonella typhimurium TA98, TA100, TA102, TA1535). In the acute oral toxicity study, a single limit dose of 2.5 or 5 g/kg body weight (bw) WFTS was given to male Sprague-Dawley (SD) rats, then the rats were observed for 14 d. No acute lethal effect at a maximal dose of 5 g/kg bw WFTS was observed in rats. In the subacute study, the male rats were administered daily by gavage at a dose of 0.5 or 1 g/kg bw/d of WFTS for 28 d. The results indicated that no significant toxic effect was found in the parameters of body and organ weight, as well as hematological, biochemical, urinary, and pathological parameters between control and the WFTS-treated rats. The level of no observed adverse effect level (NOAEL) of WFTS in male rats was 1 g/kg bw for subacute toxicity study.

Hand-foot skin reaction in patients treated with sorafenib: a clinicopathological study of cutaneous manifestations due to multitargeted kinase inhibitor therapy.

BACKGROUND: Hand-foot skin reaction is a distinctive cutaneous side-effect of antineoplastic kinase inhibitor-targeted therapy. Severe hand-foot skin reaction requires postponement of treatment or dose reduction. Histopathological studies of skin toxicity associated with kinase inhibitors are currently unavailable. OBJECTIVES: To report the clinical and histopathological findings of hand-foot skin reaction produced by the multikinase inhibitor sorafenib. METHODS: Nine patients with metastatic carcinoma-seven with renal cell carcinoma (RCC), one with melanoma and one with hepatocellular carcinoma (HCC)-received continuous, oral sorafenib 400 mg twice daily. Hand-foot skin reaction was defined and graded according to National Cancer Institute Common Toxicity Criteria 3.0. Biopsies from lesions of erythematous scaly or blistering skin were obtained from five cases (four RCC and one HCC). RESULTS: Seven of the nine (78%) patients developed hand-foot skin reaction characterized by well-demarcated, tender, erythematous papules and plaques with greyish blisters or hyperkeratotic, callus-like formations on palmoplantar surfaces and distal phalanges. Skin biopsy of hand-foot skin reaction lesions revealed epidermal acanthosis, papillomatosis, parakeratosis, dispersed dyskeratotic cells and keratinocyte vacuolar degeneration. Other skin toxicities included angular cheilitis, seborrhoeic dermatitis and perianal dermatitis. CONCLUSIONS: The clinical manifestations and histopathological features of sorafenib-induced skin reactions are unique. The most relevant histopathological findings of hand-foot skin reaction include keratinocyte vacuolar degeneration, the presence of intracytoplasmic eosinophilic bodies, and intraepidermal blisters in the stratum malpighii. Further studies are warranted to elucidate the mechanisms of this novel multitargeted kinase inhibitor-associated skin reaction.

Effects of soybean isoflavone on growth performance, meat quality, and antioxidation in male broilers.

To investigate the effects of a synthetic soybean isoflavone (ISF) on growth performance, meat quality, and antioxidation in male broilers, 1,500 birds that were 42 d old were allotted to 5 treatments with 6 replicates per treatment (50 birds per replicate). Birds were fed diets supplemented with 0, 10, 20, 40, or 80 mg of ISF/kg, respectively, for a period of 3 wk ad libitum. The results showed that dietary supplementations with 10 or 20 mg of ISF/kg increased weight gain by 13.6 and 16.2% (P < 0.01) and elevated feed intake by 7.37% (P < 0.05) and 11.2% (P < 0.01), respectively. Addition of 10 mg of ISF/kg decreased feed:gain by 5.5% (P < 0.05). Supplementation with 40 mg of ISF/kg in the diet slightly increased water-holding capacity by 17.24% (P < 0.1), and the addition of 20 or 40 mg/kg of ISF significantly increased the pH value of meat (P < 0.01), although adding 40 or 80 mg of ISF/kg increased the lightness of meat color (P < 0.05). Malondialdehyde production was slightly reduced in plasma of 20 mg of ISF/kg supplemented chickens (P < 0.1) and significantly decreased in breast muscles of 20, 40, or 80 mg of ISF/kg supplemented chickens (P < 0.01). The addition of 40 or 80 mg of ISF/kg significantly increased total antioxidant capability (P < 0.01) and slightly elevated total superoxide dismutase activity (P < 0.1) in plasma of chickens. The dose of 80 mg of ISF/kg slightly improved catalase activity in plasma (P < 0.06). In breast muscle, treatment of birds with 40 or 80 mg of ISF/kg caused an increase of total superoxide dismutase activity by 25.36% (P < 0.05) or 63.93% (P < 0.01). Catalase activity significantly increased by 70.61% by the supplemental ISF at the 40-mg level (P < 0.05). Also, 10, 20, or 40 mg doses of ISF/kg decreased lactic acid production (P < 0.05). The results of this study indicate that dietary ISF could improve growth performance and meat quality by decreasing lipid peroxidation and improving antioxidative status in male broilers.

Single-neuron analysis of human thalamus in patients with intention tremor and other clinical signs of cerebellar disease.

Tremor that occurs as a result of a cerebellar lesion, cerebellar tremor, is characteristically an intention tremor. Thalamic activity may be related to cerebellar tremor because transmission of some cerebellar efferent signals occurs via the thalamus and cortex to the periphery. We have now studied thalamic neuronal activity in a cerebellar relay nucleus (ventral intermediate-Vim) and a pallidal relay nucleus (ventralis oral posterior-Vop) during thalamotomy in patients with intention tremor and other clinical signs of cerebellar disease (tremor patients). The activity of single neurons and the simultaneous electromyographic (EMG) activity of the contralateral upper extremity in tremor patients performing a pointing task were analyzed by spectral cross-correlation analysis. EMG spectra during intention tremor often showed peaks of activity in the tremor-frequency range (1.9-5.8 Hz). There were significant differences in thalamic neuronal activity between tremor patients and controls. Neurons in Vim and Vop had significantly lower firing rates in tremor patients than in patients undergoing thalamic surgery for pain (pain controls). Other studies have shown that inputs to Vim from the cerebellum are transmitted through excitatory connections. Therefore the present results suggest that tremor in these tremor patients is associated with deafferentation of the thalamus from cerebellar efferent pathways. The thalamic X EMG cross-correlation functions were studied for cells located in Vim and Vop. Neuronal and EMG activity were as likely to be significantly correlated for cells in Vim as for those in Vop. Cells in Vim were more likely to have a phase lag relative to EMG than were cells in Vop. In monkeys, cells in the cerebellar relay nucleus of the thalamus, corresponding to Vim, are reported to lead movement during active oscillations at the wrist. In view of these monkey studies, the present results suggest that cells in Vim are deafferented and have a phase lag relative to tremor that is not found in normal active oscillations. The difference in phase of thalamic spike X EMG activity between Vim and Vop may contribute to tremor because lesions of pallidum or Vop are reported to relieve cerebellar tremor.

Calcium currents from jellyfish striated muscle cells: preservation of phenotype, characterisation of currents and channel localisation.

When striated muscle cells of the jellyfish Polyorchis penicillatus were dissociated at 30 degrees C they retained their in vivo morphology and the integrity of ionic currents. This contrasted with cells dissociated at room temperature that rarely expressed any inward currents. Whole-cell, patch-clamp recordings from dissociated muscle cells revealed that the inward component of the total ionic current consisted of only one calcium current. This calcium current activated at -70 mV, peaked at -30 mV, and inactivated within 5 ms. In comparison with barium and strontium ions, calcium ions were the preferred current carriers. Calcium channels can be blocked by dihydropyridines and nickel ions at micromolar levels. Several properties of this current are reminiscent of T-type calcium currents. Localisation of this channel using the fluorescent channel blocker fDHP and the fluorescent dye RH414 indicated that myofibres had a higher density of these channels than the somata.

Localisation of intracellular calcium stores in the striated muscles of the jellyfish Polyorchis penicillatus: possible involvement in excitation-contraction coupling.

When jellyfish striated muscles were stimulated directly, the amplitude of contractile tension increased as the stimulation frequency increased. Application of 10 mmol l(-1) caffeine reduced the amplitude of contractile tension and abolished this facilitatory relationship, indicating that calcium stores participate in excitation-contraction coupling. Calcium stores were identified ultrastructurally using enzymatic histochemistry to localize CaATPases, and potassium dichromate to precipitate calcium. Electron energy-loss spectroscopy was used to verify the presence of calcium in precipitates. Both CaATPase and calcium were localised in membrane-bound vesicles beneath the sarcolemma. We concluded that sub-sarcolemmal vesicles could act as calcium stores and participate in excitation-contraction coupling.

Mitomycin C with weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin in patients with biliary tract and periampullar carcinomas.

We have reported a 33% partial response rate with acceptable toxicity using weekly 24-h infusion of high-dose 5-fluorouracil (5-FU) and leucovorin (LV) in patients with far advanced biliary tract cancers (BTC). In this study, we added mitomycin (MMC) to 5-FU and LV in an attempt to improve the response rate and survival. From July 1997 to September 1999, 25 chemotherapy-naive patients with pathology-proven far advanced BTC and periampullar cancers were enrolled. The regimen consisted of MMC 10 mg/m(2) every 8 weeks combined with 5-FU 2600 mg/m(2) and LV 150 mg at a schedule of 24-h infusion weekly for 6 weeks followed by a 2 week break. There were 10 males and 15 females with a median age of 57 years (range 40-76). The sites of primary tumor were 15 intrahepatic cholangiocarcinomas (CC), one perihilar CCs, three distal BTC, three gallbladder cancers (GB) and three periampullar cancers. A total of 148 sessions of chemotherapy were given with a mean of 8 (range 2-18). Nineteen patients were evaluable for response. The response rate was: 26% (five of 19) partial response, 42% (eight of 19) stable disease and 32% (six of 19) progressive disease. All of the patients were evaluable for toxicity. Toxicities more than grade III-IV were thrombocytopenia 16% (four of 25), leukopenia 12% (three of 25) and vomiting 4% (one of 25). There were four treatment-related deaths. The median time to disease progression was 3 months. The median survival was 6 months. A combination of MMC with weekly high-dose 5-FU and LV in patients with BTC did not improve the response rate, but produced more toxicity than weekly high-dose 5-FU and LV alone.

Coordination exercise and postural stability in elderly people: Effect of Tai Chi Chuan.

OBJECTIVE: To evaluate the effects of coordination exercise on postural stability in older individuals by Chinese shadow boxing, Tai Chi Chuan (TCC). DESIGN: Cross-sectional study. SETTING: Research project in a hospital-based biomechanical laboratory. PARTICIPANTS: The TCC group (n = 25) had been practicing TCC regularly for 2 to 35 years. The control group (n = 14) included healthy and active older subjects. INTERVENTION: Static postural stability test: progressively harder sequential tests with 6 combinations of vision (eyes open, eyes closed, sway-referenced) and support (fixed, sway-referenced); and dynamic balance test: 3 tests of weight shifting (left to right, forward-backward, multidirectional) at 3 speeds. MAIN OUTCOME MEASURES: Static and dynamic balance of Sensory Organization Testing (SOT) of the Smart Balance Master System. RESULTS: In static postural control, the results showed no differences between the TCC or control group in the more simple conditions, but in the more complicated SOT (eyes closed with sway surface, sway vision with sway surface), the TCC group had significantly better results than the control group. The TCC group also had significantly better results in the rhythmic forward-backward weight-shifting test. Duration of practice did not seem to affect the stability of elder people. CONCLUSION: The elderly people who regularly practiced TCC showed better postural stability in the more challenged conditions than those who do not (eg, the condition with simultaneous disturbance of vision and proprioception). TCC as a coordination exercise may reduce the risk of a fall through maintaining the ability of posture control.

Weekly high-dose 5-fluorouracil (5-FU), leucovorin (LV) and bimonthly cisplatin in patients with advanced gastric cancer.

BACKGROUND: A phase II clinical trial was performed to evaluate the activity and toxicity of bimonthly cisplatin and weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin in patients with advanced gastric cancer. PATIENTS AND METHODS: From September 1997 to March 1998, 23 chemo-naive patients of advanced gastric cancer were enrolled in this study. The regimen consisted of weekly 24-h infusion of 5-FU (2,600 mg/m2) and LV 150 mg and bimonthly cisplatin (25-50 mg/m2) bolus for 12 weeks followed by a 2-week break. RESULTS: There were 10 male and 13 female patients with a median age of 52 years. A total of 428 chemotherapy treatments were given with a mean of 11. Seventeen patients were evaluable for response. There were 41% (7/17) partial response, 18% (3/17) stable disease and 41% (7/17) progressive disease. The grade III or IV toxicity included anorexia 35% (8/23), fatigue 26% (6/23), vomiting 17% (4/23) and mucositis 9% (2/23). One patient developed perforated duodenal stump after chemotherapy. One patient died of hyperammonemia-related coma. The median times to disease progression and overall survival were 3.5 and 7 months, respectively. CONCLUSIONS: This regimen showed modest activity against gastric cancer. However, there was no survival advantage and there was greater toxicity than with weekly high-dose 5-FU-LV alone.

The anatomy of the nervous system of the hydrozoan jellyfish, Polyorchis penicillatus, as revealed by a monoclonal antibody.

Dissociated cells from the margin and tentacles of the hydromedusa Polyorchis penicillatus were centrifuged in a Percoll gradient to remove cnidocytes. The resulting formaldehyde-fixed cells were used to inoculate mice to produce monoclonal antibodies. One of the hybridomas, which secreted antibodies against all neurons, was cloned and designated as mAb 5C6. Immunohistochemical labelling with mAb 5C6 of whole-mount preparations and paraffin sections provided a far more complete picture of the organisation of the hydromedusan nervous system than was previously available when using neuronal labelling techniques that restrict labelling to certain neuronal types. Besides confirming anatomical features described in earlier studies these techniques allowed us to discover a number of new structures and to determine connections that were only suspected. Such findings included:1. The discovery of an arch-like connection between the swimming motor neuron network at the apices of the subumbrellar muscle sheets 2. An orthogonal network connecting each pair of radial nerves in each radius 3. Continuity of a central branch of the radial nerve with the radial innervation of the manubrium 4. Details of the sensory neuronal contribution to the microanatomy of the ocelli and cnidocyte batteries 5. Presence of specialised receptor cells in the margin at the bases of tentacles 6. Neurons apparently innervating the radial muscles of the velum 7. Isolated neurons in the peduncle and gonads