Parathyroidectomy slows renal function decline in patients with primary hyperparathyroidism.

PURPOSE: Primary hyperparathyroidism has deleterious effects on health and causes nephrolithiasis and osteoporosis. However, it remains unclear whether parathyroidectomy benefits kidney function among patients with primary hyperparathyroidism. METHODS: In this retrospective study, patients with primary hyperparathyroidism receiving parathyroidectomy in a tertiary medical center between 2003 and 2017 were followed up until December 31 2017, death, or requiring renal replacement therapy. Impact of parathyroidectomy on kidney function was examined using longitudinal estimated glomerular filtration rate (eGFR) change scales: single, average, absolute difference, percent change, annual decline rate, and slope. We applied linear mixed-effect model to determine the effect of parathyroidectomy on kidney function. RESULTS: During study period, 167 patients with primary hyperparathyroidism were identified from 498 parathyroidectomized patients, and finally, 27 patients fulfilled our stringent criteria. Median follow-up duration was 1.50 years (interquartile range 1.05-1.81) before surgery and 2.47 years (1.37-6.43) after surgery. Although parathyroidectomy did not affect amount of proteinuria and distribution of eGFR, parathyroidectomy significantly slowed decline rate of eGFR compared with that before surgery (- 1.67 versus - 2.73 mL/min/1.73 m2/year, p < 0.001). More importantly, parathyroidectomy made more beneficial effects on kidney function in patients with age < 65 years and those without chronic kidney disease or hypertension. CONCLUSIONS: Our study showed that parathyroidectomy slows renal function decline irrespective of age or comorbidities, which offers novel insight into the revision of guidelines for surgical indications in primary hyperparathyroidism. Given small sample size, further large-scale controlled studies are warranted to confirm our findings.

Low-voltage and wide-band tuning of lasing in a dye-doped liquid-crystal sandwich structure.

This paper reports the electrical tuning of a lasing in a liquid crystal (LC) sandwich structure. A dye-doped nematic LC (NLC) layer is sandwiched between two CLC layers to act as a phase retarder with the CLC layers acting as cavity mirrors, for the selective reflection of light in the photonic band with the same sense of helix handedness as that of the CLC layers. The transmittance spectrum of the sandwich cell provides a large range of modulation due to the wavelength dependent nature of phase retardation between the optical eigenmodes in the NLC layer. Lasing occurs at wavelengths corresponding to the maximum transmittance within the reflection band of the CLC layers. The application of voltage to the NLC layer makes it possible to shift the wavelengths of maximum transmittance, thereby tuning the wavelength of lasing. In these experiments, an applied voltage of 1.25 V was sufficient to shift the lasing peak wavelength by approximately 47 nm.

Association between herpes zoster and end stage renal disease entrance in chronic kidney disease patients: a population-based cohort study.

The association between herpes zoster (HZ) infection and subsequent risk of end stage renal disease (ESRD) in chronic kidney disease (CKD) patients is unknown. We aim to conduct a population-based cohort study to investigate the risks of developing ESRD after a HZ attack in CKD patients. From the Taiwan National Health Insurance Research Database, we identified 1,144 CKD patients who had HZ over the period 1997-2008 as HZ cohort. We selected 3,855 age- and sex-matched CKD patients without HZ as comparison cohort. All subjects were followed until the end of 2008 or censored. Cox-proportional hazard regression model was used to estimate the effects of HZ on ESRD risks. A total of 396 patients developed ESRD during the follow-up period, of which 108 subjects were from the HZ cohort and 288 from the comparison cohort. The log-rank test demonstrated that the HZ cohort had significantly higher risk of developing ESRD than the comparison cohort (P = 0.0071). The adjusted hazard ratio of subsequent ESRD in the HZ cohort was 1.36 (95 % CI 1.09-1.70) and the hazard ratio increased to 8.71 (95 % CI 5.23-14.5) if the HZ cohort was with concomitant diabetes and hypertension. CKD patients with HZ are at an increased risk of subsequent ESRD. CKD patients with HZ, diabetes, and hypertension have extremely high risk of developing ESRD.

Transmission and strain variation of Shigella flexneri 4a after mass prophylaxis in a long-stay psychiatric centre.

Shigella flexneri 4a caused sustained outbreaks in a large long-stay psychiatric centre, Taiwan, 2001-2006. Trimethoprim-sulphamethoxazole (SXT) prophylaxis was administered in 2004. We recovered 108 S. flexneri 4a isolates from 83 symptomatic (including one caregiver) and 12 asymptomatic subjects (11 contacts, one caregiver). The isolates were classified into eight antibiogram types and 15 genotypes (six clusters) by using antimicrobial susceptibility testing and pulsed-field gel electrophoresis of NotI-digested DNA, respectively. These characteristics altered significantly after SXT prophylaxis (P < 0·05), with concomitant emergence of SXT-resistant isolates in two antibiogram types. P01 (n = 71), the predominant epidemic genotype, caused infection in two caregivers and five patients under their care; two P01 isolates were recovered from the same patient 6 months apart. These results indicate the importance of sustained person-to-person transmission of S. flexneri 4a by long-term convalescent, asymptomatic or caregiver carriers, and support the emergence of SXT-resistant strains following selective pressure by SXT prophylaxis.

Patient-reported outcomes in the practice-based opportunities for weight reduction (POWER) trial.

PURPOSE: To evaluate effects of two behavioral weight-loss interventions (in-person, remote) on health-related quality of life (HRQOL) compared to a control intervention. METHODS: Four hundred and fifty-one obese US adults with at least one cardiovascular risk factor completed five measures of HRQOL and depression: MOS SF-12 physical component summary (PCS) and mental component summary; EuroQoL-5 dimensions single index and visual analog scale; PHQ-8 depression symptoms; and PSQI sleep quality scores at baseline and 6 and 24 months after randomization. Change in each outcome was analyzed using outcome-specific mixed-effects models controlling for participant demographic characteristics. RESULTS: PCS-12 scores over 24 months improved more among participants in the in-person active intervention arm than among control arm participants (P < 0.05, ES = 0.21); there were no other statistically significant treatment arm differences in HRQOL change. Greater weight loss was associated with improvements in most outcomes (P < 0.05 to < 0.0001). CONCLUSIONS: Participants in the in-person active intervention improved more in physical function HRQOL than participants in the control arm did. Greater weight loss during the study was associated with greater improvement in all PRO except for sleep quality, suggesting that weight loss is a key factor in improving HRQOL.

The impact of metabolic syndrome on the responsiveness to α1-blocker in men with BPH/LUTS.

AIMS: Increasing evidence has proposed the components of metabolic syndrome (MtS) as risk factors for the development of benign prostate hyperplasia (BPH); therefore, it is thought that MtS may play a role in lower urinary tract symptoms related to BPH (BPH/LUTS) aetiology. Considering the closed relationships between MtS and BPH/LUTS, it is possible that patients with MtS might have different drug responsiveness in men with BPH/LUTS. We prospectively investigated the impact of MtS on responsiveness to α1-blocker in men with BPH/LUTS. METHODS: We enrolled a total of 109 patients with a mean (SD) age of 59.8 (9.0) years, having a prostate volume of 20 cm(3) or greater with moderate to severe LUTS. All patients received doxazosin GITS (gastrointestinal therapeutic system) 4 mg once daily for a 12-week period of treatment. The efficacy measurement was assessed by the changes from baseline in the total IPSS, maximum urinary flow rate and postvoid residual urine volume. The drug responders were defined as those who had a total IPSS decrease of more than 4 points from baseline after 12 weeks of treatment. RESULTS: Using multiple logistic regression analysis, our results showed that MtS was an independent factor for drug non-responder (OR = 4.26, p = 0.002). The rate of drug responder and total IPSS improvements in patients with MtS significantly decreased as the number of MtS components increased (p = 0.012 and p = 0.026). Among the MtS components, abnormal fasting blood glucose (FBG) was the most significantly independent factor for drug non-responder (OR = 3.17, p = 0.020). CONCLUSION: This study suggested that the presence of MtS had a significantly negative impact on the responsiveness to α1-blocker in men with BPH/LUTS. Our results are important for BPH/LUTS patients who did not initially respond to α1-blocker or who strive to reduce these metabolic risk factors.

First Report of Lasiodiplodia theobromae Causing Dieback of Aquilaria sinensis in Taiwan.

Incense trees (Aquilaria sinensis (Lour.) Gilg) belong to a plant family used for alternative medicine in China and the production of wood. In the summer of 2012, at a nursery in Niaosong district, Kaohsiung City, Taiwan, more than 30% of a total of 400 incense trees had dieback symptoms on twigs with leaves attached, leading to eventual death of the entire plant. Symptomatic twigs and trunk pieces from six trees were collected and discolored tissues were excised, surface sterilized in 0.5% sodium hypochlorite solution, rinsed in sterilized distilled water, dried on sterilized filter paper, and then placed in petri dishes containing 2% water agar (WA). The dishes were incubated at room temperature for 1 to 2 days to obtain fungal strains from diseased tissues. The hyphal tips from developing fungal colonies were transferred to potato dextrose agar (PDA, Difco) dishes and placed under UV light (12 h/day) at 30°C. The purified colonies were used as inoculum in the pathogenicity tests. Pathogenicity tests were performed on 2-month-old A. sinensis seedlings, each treatment had three plants. Each plant was wounded by removing bark of the twigs with a disinfected scalpel enough to place a mycelium plug (about 5 × 10 mm2) of 7-day-old fungal isolate on the wound. The inoculated area was wrapped with a wet paper towel and Parafilm. Control plants were treated with PDA plugs. The symptoms described above were observed on inoculated plants 4 to 8 days after inoculation whereas control plants did not show symptoms. Diseased twigs were cut and placed in a moist chamber 21 days after inoculation and conidia oozing from pycnidia were observed. The same fungal pathogen was reisolated from inoculated plants, but not from the control. To identify the pathogen, the fungus was cultured as described above. The colonies were initially white with green to gray aerial mycelium after 5 to 6 days and eventually turned darker. Immature conidia were hyaline and one-celled, but mature conidia were dark brown, two-celled, thin-walled, and oval-shaped with longitudinal striations. The average size of 100 conidia was 25.23 ± 1.97 × 13.09 ± 0.99 µm with a length/width ratio of 1.92. For the molecular identification, the internal transcribed spacer (ITS) region of ribosomal DNA was PCR amplified with primers ITS1 and ITS4 (2) and sequenced. The sequences were deposited in GenBank (Accession No. JX945583) and showed 99% identity to Lasiodiplodia theobromae (HM346871, GQ469929, and HQ315840). Hence, both morphological and molecular characteristics confirmed the pathogen as L. theobromae (Pat.) Griffon & Maubl (1). To the best of our knowledge, this is the first report of L. theobromae causing dieback on Incense tree. This disease threatens tree survival and may decrease the income of growers. References: (1) W. H. Ko et al. Plant Dis. 88:1383, 2004. (2) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, New York, 1990.

First Report of Myrothecium roridum Causing Myrothecium Leaf Spot on Dieffenbachia picta 'Camilla' in Taiwan.

Dumb cane (Dieffenbachia picta (Lodd.) Schott 'Camilla'), family Araceae, is a popular houseplant in Taiwan. During the winter of 2012, dumb canes with dark brown concentric spots on leaves and bright yellow borders were found in a protected ornamental nursery in Wandan township, Pingtung County, Taiwan. On diseased leaves, fungal fruiting bodies were sometimes observed in the concentric lesions and a fungal isolate was consistently isolated from the lesions. A single spore isolate, myr 2-2, was maintained on potato dextrose agar (PDA) for further tests. To fulfill Koch's postulates, the spores of myr 2-2 were suspended in sterilized distilled water containing 0.05% of Tween 20, 1 × 105 conidia ml-1, and then sprayed on leaves of D. picta 'Camilla' growing in polypropylene plant pots (about 7 cm in diameter), three plants per treatment. For the control, three plants were sprayed with sterilized distilled water containing 0.05% of Tween 20. Both inoculated and non-inoculated plants were covered with plastic bags and incubated in a growth chamber at 26 ± 1°C. Nine to 12 days after inoculation, symptoms described above were observed on inoculated plants whereas the plants in control remained healthy. The same fungus was reisolated from inoculated plants but not from the controls. Furthermore, the fungal pathogen was identified using its physiological, morphological, and molecular characteristics. In the mycelial growth test, the diameter of the fungal colony reaches 58.2 mm on PDA at 25°C after 14 days. The colonies were floccose, white to buff, and sporulate in concentric zones with olivaceous black to black sporodochia bearing viscid masses of conidia. Conidia were narrowly ellipsoid with rounded ends. The average size of 100 conidia was 6.25 ± 0.04 × 1.63 ± 0.02 µm. For molecular identification, the rDNA internal transcribed spacer (ITS) of isolate myr 2-2 was PCR amplified using ITS1 (5'-TCCGTAGGTGAACCTGCGG-3') and ITS4 (5'- TCCTCCGCTTATTGATATGC-3') primer pairs (3) and sequenced. The rDNA sequence was deposited in GenBank (KC469695) and showed 100% identity to the Myrothecium roridum isolates BBA 71015 (AJ302001) and BBA 67679 (AJ301995) (4). According to the physiological, morphological (1,2), and molecular characteristics, the fungal isolate was identified as M. roridum Tode ex Fr. To the best of our knowledge, this is the first report of Myrothecium leaf spot caused by M. roridum on D. picta 'Camilla' in Taiwan. References: (1) D. F. Farr and A. Y. Rossman. Fungal Databases, Systematic Mycology and Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , January 31, 2013. (2) M. Tulloch. Mycol. Pap. 130: 1-42, 1972. (3) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, New York, 1990. (4) Y. X. Zhang et al. Plant Dis. 95:1030, 2011.

First Report of Chrysoporthe deuterocubensis Causing Canker on Syzygium samarangense in Taiwan.

Wax apple (Syzygium samarangense Merr. & Perry, syn. Eugenia javanica Lam.) belongs to the Myrtaceae family is an important economical tree fruit in Taiwan. The total production acreage of wax apple was 5,266 ha in which more than 77% were located in Pingtung County, southern Taiwan, in 2012. Since the winter of 2010, symptoms of withering leaves and cracking branches on wax apple trees were observed in some orchards in Nanjhou and Linbian Townships, Pingtung County. Diseased trees declined gradually and resulted in reduced fruit production. On the bark of diseased twigs and branches, black conidiamata with yellowish orange conidia were usually observed. For diagnosis, tissues from symptomatic branches were excised, surface sterilized with 0.5% sodium hypochlorite, and placed on 2% water agar in petri dishes. A total of four identical fungal isolates were obtained and maintained on potato dextrose agar (PDA). To fulfill Koch's postulates, three twigs of a wax apple tree were wounded with scalpel and inoculated with each of the four isolates, one tree per isolate. A 7-day-old hyphal mat (about 7 × 18 mm) of each fungal isolate was attached on the wound, wrapped with a wet absorbent cotton and Parafilm, and then covered with a layer of aluminum foil. For the control, the twigs of a wax apple tree were inoculated with PDA plugs. The pathogenicity test was repeated once. After 30 days, withering leaves and cracking twigs were observed on inoculated twigs and the same pathogen was reisolated. Conversely, all of the non-inoculated plants remained healthy. Identification of the pathogen was conducted using its morphological, physiological, and molecular characteristics. On malt extract agar, the colony was floccose and white with hazel hues. The optimal temperature for the mycelial growth was 30°C. Conidia were hyaline, and oblong, with the average size of 4.7 ± 0.6 × 2.7 ± 0.2 µm (100 conidia). Ascostromata were semi-immersed in the bark with fusoid asci, eight ascospores per ascus. Ascospores were hyaline, 2-celled, and tapered in both ends, with the average length of 6.8 ± 0.7 × 2.4 ± 0.3 µm (100 ascospores). For molecular identification, the internal transcribed spacer (ITS) of ribosomal DNA and ß-tubulin genes was amplified using the ITS1/ITS4 (3), Bt1a/Bt1b, and Bt2a/Bt2b (1) primer pairs. The gene sequences were deposited in GenBank (Accessions KC792616, KC792617, KC792618, and KC792619 for the ITS region; KC792620, KC792621, KC792622, and KC792623 for Bt1 region, and KC812732, KC812733, KC812734, and KC812735 for Bt2 region) and showed 99 to 100% identity to the Chrysoporthe deuterocubensis isolate CMW12745 (DQ368764 for ITS region; GQ290183 for Bt1 region, and DQ368781 for Bt2 region). In addition, the Bt1 region of the ß-tubulin gene consisted of two restriction sites for AvaI and one restriction site for HindIII. This is identical to the description of C. deuterocubensis, a cryptic species in C. cubensis, by Van Der Merwe et al. (2). According to these results, the pathogen was identified as C. deuterocubensis Gryzenh. & M. J. Wingf. To the best of our knowledge, this is the first report of canker disease caused by C. deuterocubensis on S. samarangense in Taiwan. References: (1) N. L. Glass and G. C. Donaldson. Appl. Environ. Microbiol. 61:1323, 1995. (2) N. A. Van Der Merwe et al. Fungal Biol. 114:966, 2010. (3) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

Potassium intake and risk of incident type 2 diabetes mellitus: the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

AIMS/HYPOTHESIS: Serum potassium has been found to be a significant predictor of diabetes risk, but the effect of dietary potassium on diabetes risk is not clear. We sought to determine if dietary potassium is associated with risk of incident type 2 diabetes in young adults. METHODS: We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Potassium intake was measured by (1) an average of three 24 h urinary potassium collections at the 5-year study visit, and (2) the CARDIA dietary assessment instrument at baseline. Incident type 2 diabetes cases were ascertained on the basis of use of diabetes medication and laboratory measurements. Analyses were adjusted for relevant confounders including intake of fruit and vegetables and other dietary factors. RESULTS: Of 1,066 participants with urinary potassium measurements, 99 (9.3%) developed diabetes over 15 years of follow-up. In multivariate models, adults in the lowest urinary potassium quintile were more than twice as likely to develop diabetes as their counterparts in the highest quintile (HR 2.45; 95% CI 1.08, 5.59). Of 4,754 participants with dietary history measurements, 373 (7.8%) developed diabetes over 20 years of follow-up. In multivariate models, African-Americans had a significantly increased risk of diabetes with lower potassium intake, which was not found in whites. CONCLUSIONS/INTERPRETATION: Low dietary potassium is associated with increased risk of incident diabetes in African-Americans. Randomised clinical trials are needed to determine if potassium supplementation, from either dietary or pharmacological sources, could reduce the risk of diabetes, particularly in higher-risk populations.

Diabetes and cancer (2): evaluating the impact of diabetes on mortality in patients with cancer.

In this paper we address methodological aspects of aetiological importance in the link between diabetes and mortality in patients with cancer. We identified nine key points on the cancer pathway at which confounding may arise-cancer screening use, stage at diagnosis, cancer treatment selection, cancer treatment complications and failures, peri-treatment mortality, competing risks for long-term mortality, effects of type 2 diabetes on anti-cancer therapies, effects of glucose-lowering treatments on cancer outcome and differences in tumour biology. Two types of mortality studies were identified: (1) inception cohort studies that evaluate the effect of baseline diabetes on cancer-related mortality in general populations, and (2) cohorts of patients with a cancer diagnosis and pre-existing type 2 diabetes. We demonstrate, with multiple examples from the literature, that pre-existing diabetes affects presentation, cancer treatment, and outcome of several common cancer types, often to varying extents. Diabetes is associated with increased all-cause mortality in cancer patients, but the evidence that it influences cancer-specific mortality is inconsistent. In the absence of data that address the potential biases and confounders outlined in the above framework, we caution against the reporting of cancer-related mortality as a main endpoint in analyses determining the impact of diabetes and glucose-lowering medications on risk of cancer.

Spatially band-tunable color-cone lasing emission in a dye-doped cholesteric liquid crystal with a photoisomerizable chiral dopant.

This study investigates a spatially band-tunable color-cone lasing emission (CCLE) based on a dye-doped cholesteric liquid crystal with a photoisomerizable chiral dopant (IBM). Experimental results show that the lasing band of the formed CCLE of the cell with a photoinduced pitch gradient can be spatially tuned among various color regions by adjusting the pumped position of the cell. The spatially band tunability of the laser results from the UV-irradiation-induced decrease of the helical twisting power of IBM via trans-->cis isomerization, accordingly shrinking the pitch of the cholesteric-liquid-crystal host. The total spatially tunable wavelength range for the laser exceeds 100 nm.

Influence of predialysis comorbidity and damage accrual on mortality in lupus patients treated with peritoneal dialysis.

OBJECTIVE: Although there have been many studies on systemic lupus erythematosus (SLE) patients, there are few data about survival analysis of lupus patients receiving dialysis. Therefore, the objective of this study is to analyze risk factors predicting mortality in lupus patients treated with peritoneal dialysis (PD). In addition, we also delineate the relationship between predialysis comorbid illnesses, damage accrual, and mortality in lupus patients undergoing PD. METHODS: This longitudinal cohort study included 38 lupus patients undergoing PD between 1990 and 2008. The clinical parameters, disease activity (non-renal SLEDAI, nrSLEDAI), comorbid illnesses, and damage accrual were collected. We applied the Charlson Comorbidity Index (CCI), Khan Index, and Davies Index to elucidate the impact of predialysis comorbidity on mortality. Moreover, we examined prognostic value of predialysis SDI (Systemic Lupus International Collaborating Clinics Disease Damage Index) for lupus PD patients. RESULTS: There were 33 women and five men included for analysis. The mean age at PD entry was 32.2 +/- 10.4 years and mean duration of PD was 39.7 +/- 22.4 months. The nrSLEDAI score during PD significantly decreased, compared to the predialysis one (2.13 +/- 2.09 vs. 4.00 +/- 3.08, p < 0.001). All comorbidity indices and SDI scores were significantly and positively correlated with each other (p < 0.001). Univariate Cox regression analysis showed that serum creatinine level, date at PD entry, and the CCI were predictors for mortality. The predialysis nrSLEDAI and SDI scores did not have roles in predicting mortality of lupus PD patients. CONCLUSIONS: The predialysis CCI, instead of SDI, determines an increased risk for mortality in lupus patients treated with PD. The prognosis of lupus patients treated with PD largely depends on the severity of predialysis comorbidity, especially cardiovascular diseases.

Band-tunable color cone lasing emission based on dye-doped cholesteric liquid crystals with various pitches and a pitch gradient.

This study elucidates, for the first time, a novel band-tunable color cone lasing emission (CCLE) based on dye-doped cholesteric liquid crystal (DDCLC) films with various pitches. For several CLC cells with different pitches it was shown experimentally that the lasing band on the CCLE can be tuned among various color regions measured within different angular ranges. Some important features of the tunable CCLE are also identified and discussed. A spatially band-tunable color cone laser, based on a single DDCLC with a gradient pitch, is developed as a real application.

Color cone lasing emission in a dye-doped cholesteric liquid crystal with a single pitch.

This work investigates a novel color cone lasing emission (CCLE) based on a one-dimensional photonic crystal-like dye-doped cholesteric liquid crystal (DDCLC) film with a single pitch. The lasing wavelength in the CCLE is distributed continuously at 676.7-595.6 nm, as measured at a continuously increasing oblique angle relative to the helical axis of 0-50 degrees . This work demonstrates that lasing wavelength coincides exactly with the wavelength at the long wavelength edge of the CLC reflection band at oblique angles of 0-50 degrees . Simulation results of dispersion relations at different oblique angles using Berreman's 4X4 matrix method agrees closely with experimental results. Some unique and important features of the CCLE are identified and discussed.

Injectable silicone biomaterial (PTQ) is more effective than carbon-coated beads (Durasphere) in treating passive faecal incontinence--a randomized trial.

OBJECTIVE: Both injectable silicone biomaterial (PTQ) and pyrolytic carbon-coated beads (Durasphere) have been shown to be effective in treating passive faecal incontinence due to internal sphincter dysfunction. This is a randomized study to evaluate their relative safety and efficacy. METHOD: Forty patients (mean age 59.5 years vs 58.9 years) were randomized to have inter-sphincteric injection of PTQ or submucosal injection of Durasphere. Patients were assessed with anorectal physiology, endoanal ultrasound, a validated incontinence score and quality of life questionnaires. RESULTS: In the Durasphere group, complications included rectal pain (5%), erosion through rectal mucosa (10%), and type III hypersensitivity reaction (5%). No complications occurred in the PTQ group. Compared with PTQ, Durasphere group has a more rapid action, with improved continence at 2 weeks after injection. In both groups, faecal continence significantly improved 6 weeks after injection, and continued to improve significantly up to 6 months in both groups (P < 0.0001). At 6 weeks, 6 and 12 months after injection, significantly more PTQ patients achieved greater than 50% improvement in Wexner's continence score than Durasphere patients (respectively, P = 0.01; P < 0.0001; P = 0.001). There was a significant improvement in faecal incontinence quality of life scale and the 12-month physical health scale of Short Form-12 health survey in the PTQ group but not in the Durasphere group. CONCLUSION: In patients with internal sphincter dysfunction, injectable silicone biomaterial was safer and more effective than Durasphere.

The relationship between chronic hepatitis B infection and bone mineral, metabolism in peritoneal dialysis patients.

OBJECTIVE: Abnormality of bone mineral metabolism is a common complication in chronic liver disease and/or chronic renal disease patients. We designed this study to evaluate the relationship between chronic hepatitis B infection and bone mineral metabolism in peritoneal dialysis patients. PATIENTS AND METHODS: Serum calcium[adj], phosphorus, calcium and phosphorus product (Ca x P), along with intact parathyroid hormone (iPTH) levels were compared in peritoneal dialysis patients with and without chronic hepatitis B infection. RESULTS: A total of 220 patients (142 female, 78 male) with a mean age of 56.30 +/- 14.28 (range 19 - 86) years old were recruited, 23 showed chronic hepatitis B infection and 197 showed none. No statistically significant difference in serum calcium[adj] levels (9.90 +/- 0.85 mg/dl vs. 10.08 +/- 0.80 mg/dl, p = 0.354), phosphorus levels (5.26 +/- 1.58 mg/dl vs. 5.21 +/- 1.35 mg/dl, p = 0.879) and calcium and phosphorus product (Ca x P) (52.23 +/- 17.54 mg(2)/dl(2) vs. 52.42 +/- 14.16 mg(2)/dl(2), p = 0.960) between groups with and without chronic hepatitis B infection was observed. Serum iPTH levels were significantly lower in chronic hepatitis B patients (median 143 pg/ml, range 3.42 - 889) than in the control group (median 235 pg/ml, range 3 - 2381) (p = 0.035). As analyzed by multi-variable linear regression, chronic hepatitis B was a predictor of lower serum iPTH levels (beta = -0.271; p = 0.030) after adjustments for age, gender, serum calcium and phosphorus levels and diabetes. CONCLUSION: No significant difference in serum calcium[adj]), phosphorus and calcium and phosphorus product (Ca x P) levels appeared between peritoneal dialysis patients with and without chronic hepatitis B infection. Serum iPTH levels proved to be definitely lower in chronic hepatitis B infection patients.

Coupling confocal fluorescence detection and recirculating microfluidic control for single particle analysis in discrete nanoliter volumes.

The recent proliferation of platforms designed to handle arrays of nano- and picolitre volumes is in response to the need to perform biological assays on discrete entities, such as single cells. However, a critical challenge associated with this trend for in vitro compartmentalization is the need for highly sensitive, yet low-volume detection platforms. In this paper, we coupled confocal fluorescence detection with recirculating microfluidic control to perform single particle DNA assays within five nL chambers. The performance of this low-volume assay was shown to match that of traditional single molecule detection platforms. However, volume requirements per measurement were nearly 3 orders of magnitude less than conventional systems, enabling future integration with lab-on-a-chip systems that require discrete or digitalized sample processing.

Missed opportunities in diabetes management: a longitudinal assessment of factors associated with sub-optimal quality.

BACKGROUND: In diabetic adults, tight control of risk factors reduces complications. OBJECTIVE: To determine whether failure to make visits, monitor risk factors, or intensify therapy affects control of blood pressure, glucose, and lipids. DESIGN: A non-concurrent, prospective study of data from electronic files and standardized abstraction of hard-copy medical records for the period 1/1/1999-12/31/2001. PARTICIPANTS: Three hundred eighty-three adults with diabetes managed in an academically affiliated managed care program. MEASUREMENTS: Main exposure variable: Intensification of therapy or failure to intensify, reckoned on a quarterly basis. MAIN OUTCOME MEASURE: Hemoglobin A1c (A1c), systolic blood pressure (SBP), and LDL-cholesterol at the end of the interval. RESULTS: In this visit-adherent cohort, control of glycemia and lipids showed improvement over 24 months, but many patients did not achieve targets. Only those with the worst blood pressure control (SBP >or=160 mmHg) showed any improvement over 2 years. Failure to intensify treatment in patients who kept visits was the single strongest predictor of sub-optimal control. Compared to their counterparts with no failures of intensification, patients with failures in >or=3 quarters showed markedly worse control of blood glucose (A1c 1.4% higher: 95% CI: 0.7, 2.1); hypertension (SBP 22.2 mmHg higher: 95% CI: 16.6, 27.9) and LDL cholesterol (LDL 43.7 mg/dl higher: 95% CI: 24.1, 63.3). These relationships were strong, graded, and independent of socio-demographic factors, baseline risk factor values, and co-morbidities. CONCLUSIONS: Failure to intensify therapy leads to suboptimal control, even with adequate visits and monitoring. Interventions designed to promote appropriate intensification should enhance diabetes care in primary practice.

Birth weight is not related to risk of diabetic retinopathy in type 2 diabetes: the Atherosclerosis Risk in Communities Study.

PURPOSE: Low birth weight has been suggested as a risk factor for diabetes. Whether it is related to diabetic retinopathy is unclear and is examined in this study. MATERIALS AND METHODS: We examined 609 adults with type 2 diabetes from the population-based Atherosclerosis Risk in Communities Study. Retinal photographs were graded for diabetic retinopathy. Birth weight was assessed by self-report. RESULTS: Retinopathy was present in 116 (19%) participants (113 non-proliferative and 3 proliferative). After adjusting for age, sex, race, education level, body mass index, fasting glucose, duration of diabetes, glycosylated hemoglobin A1c, family history of diabetes, serum total cholesterol, and blood pressure, there was no evidence of either a linear or non-linear relationship between birthweight and diabetic retinopathy. CONCLUSIONS: Birth weight was not associated with diabetic retinopathy.