Study of Water Relative Permeability in Fractures Using Well Tests and Radon: Gas Bubbles Effect.

Few published data are available for two-phase flow in fractures from field studies. All measurements of relative permeability reported in the literature were done in laboratory-scale. The in situ water saturations are normally not known for multiphase flow in natural fractures; therefore, the direct measurements of relative permeability are difficult in field-scale. With the help of a case study before and after the 2008 Mw 5.4 Antung earthquake, groundwater radon was used as a tracer to determine the gas and water saturations in a small naturally fractured aquifer. Well tests were also conducted to estimate aquifer transmissivity before and after the 2008 Antung earthquake. Anomalous declines in both groundwater radon concentration and transmissivity were observed precursory to the 2008 Antung earthquake. Both declines are two precursory phenomena having a common effect of gas bubbles. Using the data from well tests and radon tracer, one data point of water relative permeability can be obtained for in situ fractures. This data point reveals strong phase interference between water and gas bubbles for multiphase flow in natural fractures. Both the data of well tests and radon tracer are essential to gain an improved understanding of mass transfer behavior of groundwater-dissolved gases between water and gas phases.

Validation of the Chinese Version of Dementia Quality of Life Measure - Proxy in Care Home Residents with Dementia.

OBJECTIVE: To evaluate psychometric properties of the Chinese version of Dementia Quality of Life Measure - Proxy (C-DEMQoL-Proxy). METHODS: Care home residents aged ≥60 years who were diagnosed with dementia or demonstrated impairment in cognition were recruited from four care facilities in Hong Kong. Caregivers of these participants were also invited to participate. The original DEMQoL-Proxy was translated into Chinese (Cantonese) by a trained translator. The forward-translated version was reviewed by an expert panel of six experienced healthcare professionals. Revisions were made based on comments. The instrument was back-translated to English to check whether further changes were necessary. Demographic data (age, sex, type and severity of dementia, and Mini-Mental State Examination [MMSE] score) were collected from medical records of participants with dementia. Caregivers were interviewed by an occupational therapist or personnel supervised by the occupational therapist using the C-DEMQoL-Proxy and the Chinese version of Quality of Life-Alzheimer's Disease-Proxy (C-QoL-AD-Proxy). Acceptability, reliability, and validity of the C-DEMQoL-Proxy were evaluated using standard psychometric methods. RESULTS: 90 individuals (82.2% women) with dementia aged 72 to 102 years were included. Their diagnosis included Alzheimer's disease (23.3%), vascular dementia (15.6%), mixed and other types of dementias (51.1%), and missing (10%). Severity was mild in 12.2%, moderate in 62.2%, and severe in 25.6%. The mean MMSE score was 12.0 ± 4.9. 20% of the caregivers were family members and the rest were professional carers. The C-DEMQoL-Proxy had good acceptability, with no floor or ceiling effects or missing data. It had good internal consistency (Cronbach alpha = 0.91) and test-retest reliability (intraclass correlation coefficients = 0.83). It was mildly correlated with C-QoL-AD-Proxy (r = 0.29, p < 0.01). Age and sex were not correlated with C-DEMQoL-Proxy scores. C-DEMQoL-Proxy scores were not significantly different between dementia types, severity levels, or between those with higher or lower MMSE scores. CONCLUSION: The C-DEMQoL-Proxy is a valid and reliable instrument to assess health-related quality of life in individuals with dementia.

The Risk Factors of mTORi-Associated Posttransplant Proteinuria.

Treatment with mammalian target of rapamycin inhibitors (mTORi) has been associated with an increased incidence of proteinuria after kidney transplantation as compared to other immunosuppressive agents. Proteinuria after mTORi use may occur in different clinical conditions and the precise mechanism remains unclear. The objective of this study was to investigate the related risk factors for proteinuria after mTORi treatment in kidney transplant recipients. This retrospective observational study population consisted of kidney transplant recipients followed up in a medical center in Southern Taiwan from January 1999 to April 2016. The baseline characteristics and transplantation-related profiles were collected at the time of enrollment. We examined risk factors for mTORi-associated proteinuria using a multivariate logistic regression analysis. P < .05 was considered as statistically significant. Hyperlipidemia and obesity at the initiation of mTORi treatment were strong predictors for proteinuria. Earlier identification of these risk factors may assist physicians in deciding the best candidate for mTORi conversion in order to optimize transplantation outcomes.

Risk Factors Associated With Mammalian Target of Rapamycin Inhibitor Withdrawal in Kidney Transplant Recipients.

BACKGROUND: Mammalian target of rapamycin inhibitors (mTORi) play an essential role as novel immunosuppressive agents in kidney transplantation (KT). Treatment cessation usually occurs after adverse effects occur. We investigated the risk factors associated with withdrawal of mTORi in KT recipients and evaluated the outcomes related to the withdrawal. METHODS: The study enrolled KT recipients being followed up in a medical center in southern Taiwan from January 1999 through December 2014. RESULTS: Risk factors associated with mTORi withdrawal were initial proteinuria level, higher initial serum creatinine level posttransplantation, and history of glomerulonephritis as the primary etiology of renal failure. mTORi withdrawal was associated with increased risk of graft failure (hazard ratio [HR], 9.97 [95% confidence interval (CI), 1.03-96.8]; P = .047). Higher body mass index (HR, 11.2 [95% CI, 1.63-76.6]; P = .01) and tacrolimus usage (HR, 8.30 [95% CI, 1.14-60.7]; P = .037) were associated with increased risk of new-onset diabetes after transplantation in mTORi withdrawal groups. CONCLUSIONS: Proteinuria, poor graft function, and primary glomerulonephritis were associated with cessation of mTORi treatment. Earlier identification of these risk factors may prevent further adverse events and optimize transplantation outcomes after mTORi conversion.

Comprehensive mutational analysis of primary and relapse acute promyelocytic leukemia.

Acute promyelocytic leukemia (APL) is a subtype of myeloid leukemia characterized by differentiation block at the promyelocyte stage. Besides the presence of chromosomal rearrangement t(15;17), leading to the formation of PML-RARA (promyelocytic leukemia-retinoic acid receptor alpha) fusion, other genetic alterations have also been implicated in APL. Here, we performed comprehensive mutational analysis of primary and relapse APL to identify somatic alterations, which cooperate with PML-RARA in the pathogenesis of APL. We explored the mutational landscape using whole-exome (n=12) and subsequent targeted sequencing of 398 genes in 153 primary and 69 relapse APL. Both primary and relapse APL harbored an average of eight non-silent somatic mutations per exome. We observed recurrent alterations of FLT3, WT1, NRAS and KRAS in the newly diagnosed APL, whereas mutations in other genes commonly mutated in myeloid leukemia were rarely detected. The molecular signature of APL relapse was characterized by emergence of frequent mutations in PML and RARA genes. Our sequencing data also demonstrates incidence of loss-of-function mutations in previously unidentified genes, ARID1B and ARID1A, both of which encode for key components of the SWI/SNF complex. We show that knockdown of ARID1B in APL cell line, NB4, results in large-scale activation of gene expression and reduced in vitro differentiation potential.

Metaplastic up-regulation of LTP in the rat visual cortex by monocular visual training: requirement of task mastery, hemispheric specificity, and NMDA-GluN2B involvement.

"Metaplasticity" is defined as an alteration of synaptic plasticity properties or mechanisms by a priming event without actual changes in synaptic strength. For example, visual discrimination training of rats leads to a facilitation of the subsequent induction of long-term potentiation (LTP) between the lateral geniculate nucleus (LGN) and the primary visual cortex (V1). Here, rats received visual discrimination training in a modified water maze, with one eye occluded during training to create monocular viewing conditions; 63% of rats acquired the task under these conditions. Following training, in vivo electrophysiology was used to examine LTP of field postsynaptic potentials (fPSPs) in V1 elicited by LGN stimulation. Rats that had successfully learned the task showed significantly greater LTP in the "trained V1" (contralateral to the open, trained eye) relative to the "untrained" hemisphere. Rats that underwent training but failed to acquire the task did not show this lateralized plasticity enhancement and had similar levels of LTP in both cerebral hemispheres. Cortical application of the NMDA receptor-GluN2B subunit antagonist Ro 25-6981 (2 mM) reversed the training-induced LTP facilitation without affecting LTP in the untrained V1. Whole-cell patch clamp recordings of V1 (layers II/III) pyramidal cells in vitro demonstrated that pharmacologically isolated NMDA currents exhibit a greater sensitivity to GluN2B blockade in the trained relative to the untrained V1. Together, these experiments reveal a surprising degree of anatomical (only in the hemisphere contralateral to the trained eye) and behavioral specificity (only in rats that mastered the task) for the effect of visual training to enhance LTP in V1. Further, cortical GluN2B subunits appear to be directly involved in this metaplastic facilitation of thalamocortical plasticity, suggesting that NMDA subunit composition or functioning is, at least in part, regulated by the exposure to behaviorally significant stimuli in an animal's sensory environment.

Age-related effects on perceptual and semantic encoding in memory.

This study examined the age-related subsequent memory effect (SME) in perceptual and semantic encoding using event-related potentials (ERPs). Seventeen younger adults and 17 older adults studied a series of Chinese characters either perceptually (by inspecting orthographic components) or semantically (by determining whether the depicted object makes sounds). The two tasks had similar levels of difficulty. The participants made studied or unstudied judgments during the recognition phase. Younger adults performed better in both conditions, with significant SMEs detected in the time windows of P2, N3, P550, and late positive component (LPC). In the older group, SMEs were observed in the P2 and N3 latencies in both conditions but were only detected in the P550 in the semantic condition. Between-group analyses showed larger frontal and central SMEs in the younger sample in the LPC latency regardless of encoding type. Aging effect appears to be stronger on influencing perceptual than semantic encoding processes. The effects seem to be associated with a decline in updating and maintaining representations during perceptual encoding. The age-related decline in the encoding function may be due in part to changes in frontal lobe function.

A bacteria injection scheme for in situ bioaugmentation.

This article presents an innovative design for inoculating the desired organisms to stratified geological layers at desired rates during in-situ bioaugmentation. The new delivery system consists of intermittent porous tubes connected in series with impermeable polyethylene tubes that run horizontally in each stratified layer of a contaminated aquifer. A bioaugmentation test using the new delivery system was conducted to inject an enriched culture of Escherichia coli (E. coli). Results of the test indicated that the distribution of E. coli through each porous tube was fairly uniform. A mathematical model previously developed to calculate the distribution of water flow through each porous tube was modified to calculate the distribution of E. coli. Geological layers often have different hydraulic conductivities. By controlling the permeability and the length of porous tubes placed in stratified layers, the new design provides a means to selectively deliver aqueous bacteria to various layers at desired rates according to aquifer heterogeneity.

Relapse of imported vivax malaria despite standard-dose primaquine therapy: an investigation with molecular genotyping analyses.

Taiwan CDC investigated four cases of recurrent imported vivax malaria during 2003-2010. Molecular genotyping results and the lack of inter-episodes travel history indicated that two of the patients, who acquired vivax malaria in Indonesia and the Solomon Islands, respectively, suffered relapses after an interval of 3-4 months, despite completing standard-dose primaquine therapy (30 mg/day for 14 days) for the first episode. Treatment with a higher dose of primaquine (60 mg/day for 14 days) prevented further relapse in both patients. This finding calls for further monitoring of the therapeutic efficacy of primaquine in treating Plasmodium vivax acquired in southeast Asia and Oceania.

A nutrient injection scheme for in situ bio-remediation.

Geological layers often have different hydraulic conductivities. This paper presents an innovative design for delivering aqueous substrates and nutrients to various stratified layers at desired rates during in-situ bio-stimulation. The new delivery system consists of intermittent porous tubes connected in series with impermeable polyethylene tubes that run horizontally in each stratified layer of a contaminated aquifer. Results of the tracer test indicated that the distribution of tritium through each porous tube was fairly uniform. A mathematical model was also developed to calculate the distribution of water flow through each porous tube. By controlling the permeability and the length of porous tubes placed in stratified layers, the new design provides a means to selectively deliver nutrients to various layers at desired rates according to aquifer heterogeneity.

Are structural characteristics of programs and hospitals associated with 100-day readmission of hematopoietic SCTs in Taiwan?

Hematopoietic SCT (HSCT) is one treatment modality for hematological malignancies. It is increasingly common but remains centralized in certain hospitals wherein procedures and protocols can vary. This study examined 100-day readmission for patients with hematological malignancies undergoing HSCT in Taiwan from the years 2001 to 2006. Of particular interest was an examination of how HSCT program characteristics might influence outcomes. This population-based retrospective cohort study with longitudinal follow-up used Taiwan's National Health Insurance Research Database. A generalized linear model with a logistic-dependent variable representing being admitted or not admitted was used to model 100-day readmission, adjusting for the nested design. There were 718 HSCT recipients for hematological malignancies in the 5-year study period from 10 HSCT programs. In spite of the average length of stay of 43.71 days (s.d.=25.75) days, 52% of recipients were readmitted within 100 days of discharge. Ownership status, the number of HSCT hematologists, and the ratio of HSCT procedures to HSCT hematologists independently predicted 100-day readmission after adjusting for clustered data and controlling for recipient characteristics.

Input-selective potentiation and rebalancing of primary sensory cortex afferents by endogenous acetylcholine.

Acetylcholine (ACh) plays important roles in the modulation of activity and plasticity of primary sensory cortices, thus influencing sensory detection and integration. We examined this in urethane-anesthetized rats, comparing cholinergic modulation of short latency, large amplitude field postsynaptic potentials (fPSPs) in the visual cortex (V1) evoked by stimulation of the ipsilateral lateral geniculate nucleus (LGN), reflecting direct thalamocortical inputs, with longer latency, smaller amplitude fPSPs elicited by contralateral LGN stimulation, reflecting indirect, polysynaptic inputs. Basal forebrain (BF) stimulation (100 Hz) produced a significant (approximately 45%), gradually developing potentiation of the smaller, contralateral fPSPs, while ipsilateral fPSPs showed less enhancement (approximately 15%), shifting the relative strength of dominant/ipsi- and weaker/contralateral inputs to V1. Systemic or local, cortical blockade of muscarinic receptors (scopolamine) reduced potentiation of contralateral fPSP without affecting ipsilateral enhancement, thus preventing the relative amplification of contralateral inputs following BF stimulation. Systemic nicotinic receptor blockade (mecamylamine) resulted in depression of ipsilateral, and reduced enhancement of contralateral fPSPs after BF stimulation. N-methyl-D-aspartate receptor blockade (systemic MK-801) abolished ipsilateral fPSP enhancement without affecting contralateral potentiation. Neither drug reduced the amplification of contralateral relative to ipsilateral signals in V1. In a second experiment in the barrel cortex, BF stimulation enhanced multiunit activity elicited by whisker deflection in a muscarinic-sensitive manner. Similar to the observations in V1, this effect was more pronounced for weaker multiunit activity driven by a surround whisker than activity following principal whisker deflection. These experiments demonstrate that ACh release following BF stimulation exerts surprisingly selective effects to amplify non-dominant inputs to sensory cortices. We suggest that, by diminishing the imbalance between different afferent signals, ACh release during states of behavioral activation acts to induce a long-lasting facilitation of the detection and/or integration of signals in primary sensory fields of the cortical mantle.

Role of serum sodium in assessing hospital mortality in cancer patients with spontaneous tumour lysis syndrome inducing acute uric acid nephropathy.

Spontaneous tumour lysis syndrome (STLS) inducing acute uric acid nephropathy, a rare and neglected disease, presents more insidiously than conventional post-treatment tumour lysis syndrome. Although STLS is a serious and potentially fatal complication in patients with neoplastic disorders, few investigations have addressed the relevance of clinical and laboratory features in assessing prognosis. A retrospective study was conducted, reviewing the records of all patients who developed acute renal failure (ARF) at Chang Gung memorial hospital between 1 July 1999 and 30 June 2003. STLS-induced acute uric acid nephropathy was identified in 12 of 1072 ARF patients (1.1%) during the study period. All patients had advanced stage tumours with large tumour burden, and 66.7% of cases had abdominal organ involvement. All 12 hyperuricemic patients became oliguric despite conservative therapy, and remained hyperuricemic (21.6 +/- 5.2 mg/dl) before dialysis therapy. Diuresis developed in eight patients (66.7%), with associated resolution of hyperuricemia, azotemia and metabolic derangements following dialysis initiation. Overall hospital mortality was 58.3%. Death in most patients was related to hyponatremia and hypoalbuminemia on admission. The serum sodium was found to have the best Youden index (0.86) and highest overall prediction accuracy (93%). Moreover, serum sodium and serum albumin for individual patients were significantly and positively correlated (r = 0.617, p = 0.032). This investigation confirms a grave prognosis for cancer patients with STLS inducing acute uric acid nephropathy. Hyponatremia and hypoalbuminemia on the first day of admission indicate poor prognosis in such patients.

RUNX1 mutations are frequent in chronic myelomonocytic leukemia and mutations at the C-terminal region might predict acute myeloid leukemia transformation.

Runt-related transcription factor 1 (RUNX1) is essential for normal hematopoiesis. RUNX1 mutations have rarely been reported in chronic myelomonocytic leukemia (CMML). We examined RUNX1 mutations in 81 patients with CMML at initial diagnosis. Mutational analysis was performed on bone marrow samples by direct sequencing of all reverse transcription PCR products amplified with three primer pairs that cover the entire coding sequences of RUNX1b. Thirty-two RUNX1 mutations were detected in 30 patients (37%); 23 mutants were located in the N-terminal part and 9 in the C-terminal region. The mutations consisted of 9 missense, 1 silent, 7 nonsense and 15 frameshift mutations. Two patients had biallelic heterozygous mutations. There was no difference in overall survival between patients with and without RUNX1 mutations, but a trend of higher risk of acute myeloid leukemia (AML) progression was observed in mutation-positive patients (16/30 vs 17/51, P=0.102), especially in patients with C-terminal mutations (P=0.023). The median time to AML progression was 6.8 months in patients with C-terminal mutations compared with 28.3 months in those without mutations (P=0.022). This study showed for the first time a high frequency of RUNX1 mutations in CMML. C-terminal mutations might be associated with a more frequent and rapid AML transformation.

Complications impaired endothelial progenitor cell function in Type 2 diabetic patients with or without critical leg ischaemia: implication for impaired neovascularization in diabetes.

AIMS: This study tested the hypothesis that migratory function of endothelial progenitor cells (EPCs) is impaired in Type 2 diabetic patients with or without critical leg ischaemia. METHODS: Seventy-four patients were classified into four groups: Type 2 diabetic (n = 21) and non-diabetic patients (n = 10) with critical leg ischaemia and Type 2 diabetic patients without lower extremity vascular disease (n = 30) and healthy subjects (n = 13). The number and functional activity of circulating and cultured EPCs were determined. RESULTS: The migratory function of cultured EPCs was significantly impaired in diabetic patients without (median, 48, interquartile range, 46, 49 count/view/well) and with (median, 51, interquartile range, 46, 60 count/view/well) critical leg ischaemia and non-diabetic patients with critical leg ischaemia (median, 49, interquartile range, 47, 55 count/view/well) compared with healthy subjects (median, 63, interquartile range, 57, 65 count/view/well) (P < 0.0001). The number of circulating EPCs was lower in Type 2 diabetic patients without lower extremity vascular disease (median, 3500, interquartile range, 1600, 6600/10(6) cytometric events) than Type 2 diabetic patients with critical leg ischaemia (median, 5300, interquartile range, 2400, 11,100/10(6) cytometric events), non-diabetic patients with critical leg ischaemia (median, 5550, interquartile range, 2000, 32,100/10(6) cytometric events) and healthy subjects (median, 5400, interquartile range, 2700, 8700/10(6) cytometric events) (P = 0.413). CONCLUSIONS: The migratory function of EPCs is impaired in patients with Type 2 diabetes, even in those without critical leg ischaemia. These findings present an important new insight into the pathogenesis of impaired neovascularization and critical limb ischaemia in diabetic patients and provide avenues of future clinical study.

A model and experimental study for dissolution efficiency of gaseous substrates through in situ sparging.

Delivering electron acceptors, electron donors, and nutrients in gas state has been practiced for in situ bioremediation. A mathematical model based on air-channel concept was developed in this paper to assess the dissolution transient behavior of gaseous substrates for an in situ sparging process using their chemical and physical properties, aquifer-media characteristics, and field operating conditions. Using toluene as an example, the model was verified with experimental data obtained at field sparging rates ranging from 40 to 80Lair/min. The verified model is a useful means of predicting the dissolution behavior of gaseous substrates during sparging in an unconfined aquifer.

Aristolochic acid nephropathy due to herbal drug intake manifested differently as Fanconi's syndrome and end-stage renal failure--a 7-year follow-up.

Aristolochic acid (AA) may reduce glomerular or proximal tubular function, or both. We report a married couple taking AA-containing herbal drugs. The man developed Fanconi's syndrome (FS) whereas his wife reached end-stage renal failure (ESRF). He was a 36-year-old alcoholic cirrhotic patient who had taken the Chinese herbal drugs for 6 years, presenting with muscle weakness and laboratory findings of FS; the renal pathological findings were compatible with the diagnosis of aristolochic acid nephropathy (AAN). His 38-year-old wife, who took a lower cumulative amount of the same herbal drug for a shorter duration, developed advanced renal failure and severe anemia with pathological findings of extensive tubular atrophy, interstitial fibrosis but spared glomeruli. AA-I was detected in one of the herbal drugs. The wife has been on hemodialysis for 7 years, but the husband is still at the stage of slowly progressive chronic renal failure and persistent FS. None of their 5 children ever took the herbal drug, and none had renal problems during follow-up. It is important to trace the history of herbal drug intake in all the family members because of the possibility of sharing of drugs within a family. In addition to the effect of cumulative doses of AAs and the potentially higher susceptibility of females to AAN, the roles of liver cirrhosis and related vasodilators in the protection of the renal interstitium from fibrosis are questions that warrant further study.

Semicontinuous microcosm study of aerobic cometabolism of trichloroethylene using toluene.

A semicontinuous slurry-microcosm method was applied to mimic trichloroethylene (TCE) cometabolic biodegradation field results at the Que-Jen in-situ pilot study. The microcosm study confirmed the process of aerobic cometabolism of TCE using toluene as the primary substrate. Based on the nucleotide sequence of 16S rRNA genes, the toluene-oxidizing bacteria in microcosms were identified, i.e. Ralstonia sp. P-10 and Pseudomonasputida. The first-order constant of TCE-degradation rate was 0.5 day(-1) for both Ralstonia sp. P-10 and P.putida. The TCE cometabolic-biodegradation efficiency measured from the slurry microcosms was 46%, which appeared pessimistic compared to over 90% observed from the in-situ pilot study. The difference in the TCE cometabolic-biodegradation efficiency was likely due to the reactor configurations and the effective time duration of toluene presence in laboratory microcosms (1 days) versus in-situ pilot study (3 days). The results of microcosm experiments using different toluene-injection schedules supported the hypothesis. With a given amount of toluene injection, it is recommended to maximize the effective time duration of toluene presence in reactor design for TCE cometabolic degradation.