Synergistic B and T lymphocyte interaction: prognostic implications in non-small cell lung cancer.

While T-cell-mediated immune responses in solid tumors have been well-established and have driven major therapeutic advances, our understanding of B-cell biology in cancer is comparatively less developed. A total of 60 lung cancer patients were included, of which 53% were diagnosed at an early stage while 47% were diagnosed at an advanced stage. Flow cytometry was used to analyze the proportion of T and B cells in all blood samples, and the levels of human serum cytokines were also assessed. Compared to the control group, cancer patients showed lower frequencies of IgD+CD27+ marginal B cells and CD32+ B cells, and higher frequencies of T cells with lower CD8+ T cells and higher central memory and naïve CD4+ T cells. Additionally, advanced-stage cancer patients exhibited higher levels of cytokines, a higher proportion of effector memory CD8+ T cells, and a lower frequency of CD27+CD28+CD4+/CD8+ T cells. Linear regression analysis revealed significant correlations between cancer stage and the frequency of B and T cell subsets, leukocyte count, and cytokine levels. Survival analysis demonstrated that patients with higher frequency of class-switched B cells had a worse prognosis, while patients with higher frequency of CD8+ effector T cells and lower frequency of CD4+57+ T cells appeared to have a better survival rate. These findings provide valuable insight into the immunological changes that occur during lung cancer progression and have the potential to inform the development of new immunotherapeutic strategies.

Predicting Heavy Metal Concentrations in Shallow Aquifer Systems Based on Low-Cost Physiochemical Parameters Using Machine Learning Techniques.

Monitoring ex-situ water parameters, namely heavy metals, needs time and laboratory work for water sampling and analytical processes, which can retard the response to ongoing pollution events. Previous studies have successfully applied fast modeling techniques such as artificial intelligence algorithms to predict heavy metals. However, neither low-cost feature predictability nor explainability assessments have been considered in the modeling process. This study proposes a reliable and explainable framework to find an effective model and feature set to predict heavy metals in groundwater. The integrated assessment framework has four steps: model selection uncertainty, feature selection uncertainty, predictive uncertainty, and model interpretability. The results show that Random Forest is the most suitable model, and quick-measure parameters can be used as predictors for arsenic (As), iron (Fe), and manganese (Mn). Although the model performance is auspicious, it likely produces significant uncertainties. The findings also demonstrate that arsenic is related to nutrients and spatial distribution, while Fe and Mn are affected by spatial distribution and salinity. Some limitations and suggestions are also discussed to improve the prediction accuracy and interpretability.

Tyrosine Kinase Inhibitors Improved Survival of Critically Ill EGFR-Mutant Lung Cancer Patients Undergoing Mechanical Ventilation.

BACKGROUND: Respiratory failure requiring mechanical ventilation is the major reason for lung cancer patients being admitted to the intensive care unit (ICU). Though molecular targeted therapies, especially epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs), have largely improved the survival of oncogene-driven lung cancer patients, few studies have focused on the performance of TKI in such settings. MATERIALS AND METHODS: This was a retrospective cohort study enrolling non-small cell lung cancer (NSCLC) patients who harbored sensitizing EGFR mutation and had received EGFR-TKIs as first-line cancer therapy in the ICU with mechanical ventilator use. The primary outcome was the 28-day ICU survival rate, and secondary outcomes were the rate of successful weaning from the ventilator and overall survival. RESULTS: A total of 35 patients were included. The 28-day ICU survival rate was 77%, and the median overall survival was 67 days. Multivariate logistic regression revealed that shock status was associated with a lower 28-day ICU survival rate independently (odds ratio (OR) 0.017, 95% confidence interval (CI), 0.000-0.629, p = 0.027), and that L858R mutation (L858R compared with exon 19 deletion, OR, 0.014, 95% CI 0.000-0.450, p = 0.016) and comorbidities of diabetes mellitus (DM) (OR, 0.032, 95% CI, 0.000-0.416, p = 0.014)) were independently predictive of weaning failure. The successful weaning rate was 43%, and the median of ventilator-dependent duration was 22 days (IQR, 12-29). CONCLUSIONS: For EGFR mutant lung cancer patients suffering from respiratory failure and undergoing mechanical ventilation, TKI may still be useful, especially in those with EGFR del19 mutation or without shock and DM comorbidity.

Kinetics of oxygen uptake during unassisted breathing trials in prolonged mechanical ventilation: a prospective pilot study.

Few studies have investigated the measurement of oxygen uptake ([Formula: see text]O2) in tracheostomized patients undergoing unassisted breathing trials (UBTs) for liberation from mechanical ventilation (MV). Using an open-circuit, breath-to-breath method, we continuously measured [Formula: see text]O2 and relevant parameters during 120-min UBTs via a T-tube in 49 tracheostomized patients with prolonged MV, and calculated mean values in the first and last 5-min periods. Forty-one (84%) patients successfully completed the UBTs. The median [Formula: see text]O2 increased significantly (from 235.8 to 298.2 ml/min; P = 0.025) in the failure group, but there was no significant change in the success group (from 223.1 to 221.6 ml/min; P = 0.505). In multivariate logistic regression analysis, an increase in [Formula: see text]O2 > 17% from the beginning period (odds ratio [OR] 0.084; 95% confidence interval [CI] 0.012-0.600; P = 0.014) and a peak inspiratory pressure greater than - 30 cmH2O (OR 11.083; 95% CI 1.117-109.944; P = 0.04) were significantly associated with the success of 120-min UBT. A refined prediction model combining heart rate, energy expenditure, end-tidal CO2 and oxygen equivalent showed a modest increase in the area under the receiver operating characteristic curve of 0.788 (P = 0.578) and lower Akaike information criterion score of 41.83 compared to the traditional prediction model including heart rate and respiratory rate for achieving 48 h of unassisted breathing. Our findings show the potential of monitoring [Formula: see text]O2 in the final phase of weaning in tracheostomized patients with prolonged MV.

Numerical assessments of recharge-dominated groundwater flow and transport in the nearshore reclamation area in western Taiwan.

This study employed experimental and numerical methods to assess the behavior of conservative solute transport for a selected temporary solid waste site in a reclamation area in western Taiwan. Calibrating a site-specific numerical model, finite element model of water flow through saturated-unsaturated media (FEMWATER), relies on observations from field- and laboratory-scale hydraulic tests and spatial-temporal monitoring. The field-scale experiment used a modified hydraulic tomography survey (MHTS) to identify near surface aquifer stratifications and estimate the distribution of saturated hydraulic conductivity. The pressure plate experiments provided parameters for the van Genuchten soil characteristic model. Sensitivity analyses were then conducted based on varied recharge rates and dispersivities applied to the calibrated model. Observations of groundwater levels and salinity in the wells indicated that the regional groundwater flow was from southeast to northwest. In addition, a shallow freshwater layer was noted in the study area. The tidal-induced amplitudes for water level fluctuation in the wells ranged from 2 to 20 cm, depending on their distance from the seawater body. MHTS showed clear stratification, similar to that of well loggings at the storage site. The hydraulic conductivity at the test site ranged from 8 to 10 m/day, which is close to that obtained from the laboratory falling head test. The results of particle-tracking modeling showed that the critical recharge rate for the site needed to enhance plume traveling is 1000 mm/year. The increase in dispersivity values induced a decrease in plume travel time of up to 1000 days from the site to the coastal line. A special case for pulse releasing solute at the site shows that the key factor in controlling plume migration is the recharge rate. This is due to the low natural head gradient in the reclamation area. The results therefore suggest that a land drainage system near the site can play an important role in contaminant transport in the reclamation area.

Use of Lactobacillus casei rhamnosus to Prevent Cholangitis in Biliary Atresia After Kasai Operation.

OBJECTIVES: Recurrent cholangitis may aggravate cholestatic liver cirrhosis in biliary atresia (BA) after the Kasai operation. This pilot study aimed to investigate whether Lactobacillus casei rhamnosus has the prophylactic efficacy for recurrent cholangitis in comparison with the conventional neomycin prophylaxis. METHODS: Twenty jaundice-free patients with BA ages 0 to 3 years who underwent a Kasai operation were enrolled and randomized into 2 groups with 10 patients each: neomycin (25 mg · kg · day for 4 days/wk) and L casei rhamnosus (8 × 10 colony-forming unit per day) groups. The treatment duration was 6 months. Bacterial stool cultures were performed before treatment and 1, 3, and 6 months after starting treatment. In addition, 10 patients with BA with similar status but without prophylaxis served as the historical control group. RESULTS: In the Lactobacillus group, 2 patients (20%, mean 0.03 ±â€Š0.07 episodes per month) developed cholangitis during the study period, with the same frequency as in the neomycin group and significantly lower than that in the control group (80%, P = 0.005, mean 0.22 ±â€Š0.16 episodes per month). The mean change in body weight z score during the 6 months in the Lactobacillus group was 0.97 ±â€Š0.59, which was significantly better than that in the control group (-0.01 ±â€Š0.79, P = 0.006). In bacterial stool cultures, the Lactobacillus and Escherichia coli populations significantly increased and decreased, respectively, in the Lactobacillus group. CONCLUSIONS: The use of L casei rhamnosus was as effective as neomycin in preventing cholangitis in patients with BA who underwent Kasai operation, and therefore could be considered as a potential alternative prophylactic regimen.

Decreasing rate of biliary atresia in Taiwan: a survey, 2004-2009.

OBJECTIVES: The pathogenesis of biliary atresia (BA) is unclear, but epidemiological studies may help to elucidate possible causes. The goals of this study were to identify BA incidence changes in Taiwan in 2004-2009 and to survey the factors that might influence incidence changes to elucidate the possible causes of BA. METHODS: A Taiwan national registry system for BA has been established since 2004. By using data from the national registry system for BA, we identified BA incidence changes in 2004-2009. We also evaluated the correlations between BA incidences and estimated rotavirus vaccine coverage rates and between BA incidences and the gross domestic product. RESULTS: A total of 185 patients with BA were identified in 2004-2009 in Taiwan, whereas the number of live births was 1 221 189. Compared with the incidence of BA in 2004-2006 (1.79 cases per 10,000 live births), the incidence of BA in 2007-2009 (1.23 cases per 10,000 live births) was decreased significantly (P = .01). BA incidences were negatively correlated with the gross domestic product (P = .02) and marginally negatively correlated with rotavirus vaccine coverage rates (P = .07). CONCLUSIONS: A significant decrease in BA incidence in Taiwan since 2007 has been noted and may be related to improvements in the general socioeconomic status and the popularity of rotavirus vaccination. Although more evidence is needed to establish a direct correlation, this phenomenon may shed light on possible causes of and preventive interventions for BA.

Heavy metal extraction from PCB wastewater treatment sludge by sulfuric acid.

Heavy metals contaminated wastewater sludge is classified as hazardous solid waste and needs to be properly treated to prevent releasing heavy metals to the environment. In this study, the wastewater treatment sludge from a printed circuit board manufacturing plant was treated in a batch reactor by sulfuric acid to remove the contained heavy metals. The effects of sulfuric acid concentration and solid to liquid ratio on the heavy metal removal efficiencies were investigated. The experimental results showed that the total and individual heavy metal removal efficiencies increased with increasing sulfuric acid concentration, but decreased with increasing solid to liquid ratio. A mathematical model was developed to predict the residual sludge weights at varying sulfuric concentrations and solid to liquid ratios. The trivalent heavy metal ions, iron and chromium were more difficult to be removed than the divalent ions, copper, zinc, nickel, and cadmium. For 5 g/L solid to liquid ratio, more than 99.9% of heavy metals can be removed from the sludge by treating with 0.5M sulfuric acid in 2h.

Prediction of ion-exchange column breakthrough curves by constant-pattern wave approach.

The release of heavy metals from industrial wastewaters represents one of major threats to environment. Compared with chemical precipitation method, fixed-bed ion-exchange process can effectively remove heavy metals from wastewaters and generate no hazardous sludge. In order to design and operate fixed-bed ion-exchange processes successfully, it is very important to understand the column dynamics. In this study, the column experiments for Cu2+/H+, Zn2+/H+, and Cd2+/H+ systems using Amberlite IR-120 were performed to measure the breakthrough curves under varying operating conditions. The experimental results showed that total cation concentration in the mobile-phase played a key role on the breakthrough curves; a higher feed concentration resulted in an earlier breakthrough. Furthermore, the column dynamics was also predicted by self-sharpening and constant-pattern wave models. The self-sharpening wave model assuming local ion-exchange equilibrium could provide a simple and quick estimation for the breakthrough volume, but the predicted breakthrough curves did not match the experimental data very well. On the contrary, the constant-pattern wave model using a constant driving force model for finite ion-exchange rate provided a better fit to the experimental data. The obtained liquid-phase mass transfer coefficient was correlated to the flow velocity and other operating parameters; the breakthrough curves under varying operating conditions could thus be predicted by the constant-pattern wave model using the correlation.

Factorial experimental design for recovering heavy metals from sludge with ion-exchange resin.

Wastewaters containing heavy metals are usually treated by chemical precipitation method in Taiwan. This method can remove heavy metals form wastewaters efficiently, but the resultant heavy metal sludge is classified as hazardous solid waste and becomes another environmental problem. If we can remove heavy metals from sludge, it becomes non-hazardous waste and the treatment cost can be greatly reduced. This study aims at using ion-exchange resin to remove heavy metals such as copper, zinc, cadmium, and chromium from sludge generated by a PCB manufacturing plant. Factorial experimental design methodology was used to study the heavy metal removal efficiency. The total metal concentrations in the sludge, resin, and solution phases were measured respectively after 30 min reaction with varying leaching agents (citric acid and nitric acid); ion-exchange resins (Amberlite IRC-718 and IR-120), and temperatures (50 and 70 degrees C). The experimental results and statistical analysis show that a stronger leaching acid and a higher temperature both favor lower heavy metal residues in the sludge. Two-factors and even three-factor interaction effects on the heavy metal sorption in the resin phase are not negligible. The ion-exchange resin plays an important role in the sludge extraction or metal recovery. Empirical regression models were also obtained and used to predict the heavy metal profiles with satisfactory results.

Extraction kinetics of heavy metal-containing sludge.

In order to remove and recover copper, zinc, cadmium, and chromium from the wastewater treatment sludge generated by an electroplating process, the heavy metal extraction kinetics was studied in a batch reactor using two different extraction agents (nitric and citric acid) at constant agitation speed (150 rpm) and solid to liquid ratio (10 g/L), but varying acid concentrations (0.02-0.10 N), temperatures (25-85 degrees C in nitric acid solution, 25-95 degrees C in citric acid solution), and sludge particle sizes. The shrinking-core model and empirical kinetic model were adopted to analyze the experimental data. Although both models could fit the experimental kinetic data well, the obtained parameters of the shrinking-core model did not show reasonable trends varying with the experimental variables while the empirical model parameters showed significant trends. The experimental and modeling results showed that the metal extraction rates increased with acid concentration, temperature, but decreased with increasing particle size. Nitric acid was found to be more effective than citric acid to extract the heavy metals from the sludge. The extraction activation energies obtained in this study suggested that both a physical diffusion process and a chemical reaction process might play important roles in the overall extraction process.

Factors affecting the mortality of pediatric fulminant hepatic failure in relation to hepatitis B virus infection.

AIM: To investigate the factors affecting the outcome of fulminant hepatic failure (FHF) in children in relation to hepatitis B virus (HBV) infection. METHODS: Retrospective review of a total of 94 cases (61 males and 33 females, aged from 1 month to 15 years) recruited from nine tertiary referral centers in Taiwan from 1985 to 1999. RESULTS: The overall mortality rate was 75%. Patients in the mortality group were of an older age, had higher peak total bilirubin levels, a longer prothrombin time, and a lower percentage of HBV positivity (P < 0.001, P = 0.003, P = 0.0027 and P = 0.042, respectively). Mortality was 65% in the HBV positive (n = 42) and 83% in the HBV negative (n = 52) group (P = 0.05). In the HBV positive group, the prothrombin time was noted to be the single factor affecting outcome (P = 0.036). In the HBV negative group, older age and higher peak value of total serum bilirubin were suggestive of poor survival rate (P < 0.001 and P = 0.006, respectively). Multivariate analysis revealed that total bilirubin was the single factor affecting outcome in the HBV-negative group. The mortality rate of HBV positive children in three consecutive time periods without liver transplantation (1985-1989, 1990-1994, 1995-1999) decreased gradually (91, 67 and 38%, respectively, with P = 0.027). This change was not observed in HBV-negative cases. CONCLUSIONS: Hepatitis B virus positive FHF had a lower mortality rate than HBV negative FHF, with each group having different factors affecting mortality.

Stable seroprevalence of Helicobacter pylori infection in children during 1989-1999 in Taipei, Taiwan.

BACKGROUND: Helicobacter pylori (H. pylori) is thought to be acquired in childhood. The present study aimed to examine the changing seroepidemiology of H. pylori in children in the same area of Taipei city during 1989-1999, and to try to elucidate the possible transmission route of H. pylori in children by comparing hepatitis A virus (HAV) seroprevalence in Taipei during the same decade. METHODS: Sera were collected from the apparently healthy children (965 males and 835 females, aged 0-20 years) from the Chung Cheng District of Taipei city. H. pylori infection status was checked by enzyme-linked immunosorbent assay (ELISA). RESULTS: In 1999, the overall prevalence rate of H. pylori infection was 14.8% with no gender difference (P = 0.115). Children aged 1-3 years had the lowest prevalence rate (2.8%). The prevalence rate then increased steadily after 3 years of age. The annual infection rate was 1.25% after 3 years of age and the seroprevalence rate was 21.5% at 15-18 years. In comparison with the previous H. pylori seroepidemiology study performed at the same district of Taipei city one decade ago, there is no significant cohort effect in H. pylori prevalence in Taipei children during the past decade (Odds ratio = 1.13; 95% confidence interval: 0.74-1.72). The epidemiological pattern between H. pylori and HAV was found to be different. CONCLUSION: The seroprevalence of H. pylori in children did not change significantly in the past decade. This epidemiological feature is different from HAV. The authors propose that there are other transmission routes of H. pylori than fecal-oral.

Pediatric fulminant hepatic failure in endemic areas of hepatitis B infection: 15 years after universal hepatitis B vaccination.

To investigate the role of hepatitis B virus (HBV) infection in pediatric fulminant hepatic failure (FHF) after the launch of universal HBV vaccination, the authors analyzed the data from patients with FHF collected from a nationwide collaborative study group. Children aged 1 month to 15 years who were diagnosed with FHF (62 males and 33 females) between 1985-1999 were included. HBV infection (hepatitis B surface antigen [HBsAg] and/or immunoglobulin M hepatitis B core antibody [IgM anti-HBc] seropositive) accounted for 46% (43 of 95 cases) of all the cases of FHF. The average annual incidence of FHF in the time period 1985-1999 was 0.053/100,000 in the group of patients ages 1-15 years and 1.29/100,000 in those patients age < 1 year. Approximately 61% (58 of 95 cases) of all FHF cases were infants. The percentage of HBV infection was found to be higher in infants (57%) compared with children ages 1-15 years (27%) (P = 0.004). The incidence rate ratio of those patients age < 1 year to those ages 1-15 years was 54.2 for HBV-positive FHF and 15.2 for HBV-negative FHF. Maternal HBsAg was found to be positive in 97% of the infants with HBV-positive FHF, and hepatitis B e antigen (HBeAg) was found to be negative in 84% of these infants. Approximately 74% of all HBV-positive FHF patients and 81% of the infantile HBV-positive patients had been vaccinated. In conclusion, within the first 15 years of universal vaccination, HBV was found to rarely cause FHF in children age > 1 year but remained a significant cause of FHF in infants. HBV-positive FHF was prone to develop in infants born to HBeAg-negative, HBsAg-carrier mothers; these infants had not received hepatitis B immunoglobulin according to the vaccination program in place.

Behçet's disease in childhood: report of one case.

We report on a 6 yr 7 m-old girl who had suffered from recurrent oral ulcers since July, 2000. Anal ulcers were also noted initially, and arthralgia was observed. Skin testing (pathergy test) showed only mild erythematous changes over the test area. HLA typing revealed HLA-B56. Intestinal symptoms included watery diarrhea with occasional blood. No ocular involvement was found. Her ailment was diagnosed as incomplete Behçet's disease with intestinal involvement. Diagnosis of Behçet's disease in childhood is a challenge and there are only a few studies on juvenile Behçet's disease (JBD) in the literature, with only a small number of patients. According to the literature, Behçet's disease in childhood is characterized by a low incidence of ocular lesion and a high incidence of intestinal involvement, as exhibited in this case.

Tc-99m di-isopropyl-iminodiacetic acid cholescintigraphic findings in Rotor's syndrome.

A 10-year-old girl with Rotor's syndrome was studied using Tc-99m di-isopropyl-iminodiacetic acid cholescintigraphy. The findings showed slow hepatic uptake, persistent cardiac blood pool radioactivity, and prominent renal excretion. The contribution of cholescintigraphy and pathophysiology will be discussed via a literature review.