Height-based formulas for predicting intravascular length of tunnelled neck central venous catheter in paediatric population.

INTRODUCTION: Central venous catheter (CVC) placement is commonly performed in children. We aim to develop simple formulas to predict CVC intravascular length to minimise radiation exposure associated with the procedure. METHODS: 124 paediatric patients who received tunnelled neck CVCs and subsequent CT thorax at Hong Kong Children's Hospital from January 2020 to July 2022 were reviewed retrospectively. Formula development cohorts were subdivided by insertion sites-9 right external jugular vein (REJV), 41 right internal jugular vein (RIJV), 14 left external jugular vein (LEJV), 10 left internal jugular vein (LIJV). Using measurements from CT by two radiologists, formulas predicting the CVC intravascular length based on height and insertion sites were developed using a linear regression model. These formulas were tested with validation cohorts (10 randomly selected cases in REJV and RIJV groups respectively). Validation cohorts were not available for LEJV and LIJV groups due to small sample sizes. RESULT: The goodness-of-fit (R^2) of all formulas are above 0.8. In the validation cohorts, the REJV formula was predictive of intravascular CVC length within 1 cm in 70% of CVC with mean absolute difference of 0.63 cm (SD 0.48 cm), and the RIJV formula was predictive of intravascular CVC length within 1 cm in 80% of CVC with mean absolute difference of 0.67 cm (SD 0.53 cm). CONCLUSION: Intravascular CVC length can be estimated using simple formulas based on height and insertion sites. Further prospective validation of the LEJV and LIJV formulas is needed.

Repeated multi-qubit readout and feedback with a mixed-species trapped-ion register.

Quantum error correction is essential for realizing the full potential of large-scale quantum information processing devices1,2. Fundamental to its experimental realization is the repetitive detection of errors via projective measurements of quantum correlations among qubits, as well as corrections using conditional feedback3. Repetitive application of such tasks requires that they neither induce unwanted crosstalk nor impede further control operations, which is challenging owing to the need to dissipatively couple qubits to the classical world for detection and reinitialization. For trapped ions, state readout involves scattering large numbers of resonant photons, which increases the probability of stray light causing errors on nearby qubits and leads to undesirable recoil heating of the ion motion. Here we demonstrate up to 50 sequential measurements of correlations between two beryllium ion microwave qubits using an ancillary optical qubit in a calcium ion, and implement feedback that allows us to stabilize two-qubit subspaces as well as Bell states, a class of maximally entangled states. Multi-qubit mixed-species gates are used to transfer information within the register from the qubit to the ancilla, enabling readout with negligible crosstalk to the data qubits. Heating of the ion motion during detection is mitigated by recooling all three ions using light that interacts with only the calcium ion, known as sympathetic cooling. A key element of our experimental setup is a powerful classical control system that features flexible in-sequence processing for feedback control. The methods employed here provide essential tools for scaling trapped-ion quantum computing, quantum-state control and entanglement-enhanced quantum metrology4.

Quantum Harmonic Oscillator State Control in a Squeezed Fock Basis.

We demonstrate control of a trapped-ion quantum harmonic oscillator in a squeezed Fock state basis, using engineered Hamiltonians analogous to the Jaynes-Cummings and anti-Jaynes-Cummings forms. We demonstrate that for squeezed Fock states with low n the engineered Hamiltonians reproduce the sqrt[n] scaling of the matrix elements which is typical of Jaynes-Cummings physics, and also examine deviations due to the finite wavelength of our control fields. Starting from a squeezed vacuum state, we apply sequences of alternating transfer pulses which allow us to climb the squeezed Fock state ladder, creating states up to excitations of n=6 with up to 8.7 dB of squeezing, as well as demonstrating superpositions of these states. These techniques offer access to new sets of states of the harmonic oscillator which may be applicable for precision metrology or quantum information science.

Does enhanced diabetes management reduce the risk and improve the outcome of tuberculosis?

SETTING: The Bureau of National Health Insurance (NHI) has implemented a pay-for-performance (p4p) programme for diabetes mellitus (DM) in Taiwan. OBJECTIVE: To investigate whether patients with DM enrolled in the p4p programme (DM-p4p) are less likely to develop tuberculosis (TB) and whether they have a better outcome than patients with DM not enrolled in the p4p programme (DM-non-p4p) if they do develop TB. DESIGN: A random sample of 79,471 DM-p4p, 100,000 DM-non-p4p and 100,000 non-diabetic patients (non-DM) was obtained from the 2008-2009 NHI database, and the patients were matched with the National TB Registry to determine whether they had developed TB by the end of 2010. RESULTS: The average annual incidence of TB was respectively 259.9 (95%CI 230.2-293.4), 137.5 (95%CI 116.4-162.5) and 74.1 (95%CI 59.0-93.0) per 100,000 population among DM-non-p4p, DM-p4p and non-DM patients. The relative risk of death over treatment success was 1.79 (95%CI 1.05-3.04) among DM-non-p4p and 1.69 (95%CI 0.84-3.40) among non-DM patients, relative to DM-p4p patients. CONCLUSIONS: Enhanced case management of DM reduced risk and improved outcomes of TB among patients with DM.

Estimation of a general time-dependent Hamiltonian for a single qubit.

The Hamiltonian of a closed quantum system governs its complete time evolution. While Hamiltonians with time-variation in a single basis can be recovered using a variety of methods, for more general Hamiltonians the presence of non-commuting terms complicates the reconstruction. Here using a single trapped ion, we propose and experimentally demonstrate a method for estimating a time-dependent Hamiltonian of a single qubit. We measure the time evolution of the qubit in a fixed basis as a function of a time-independent offset term added to the Hamiltonian. The initially unknown Hamiltonian arises from transporting an ion through a static laser beam. Hamiltonian estimation allows us to estimate the spatial beam intensity profile and the ion velocity as a function of time. The estimation technique is general enough that it can be applied to other quantum systems, aiding the pursuit of high-operational fidelities in quantum control.

Observation of Quantum Interference between Separated Mechanical Oscillator Wave Packets.

We directly observe the quantum interference between two well-separated trapped-ion mechanical oscillator wave packets. The superposed state is created from a spin-motion entangled state using a heralded measurement. Wave packet interference is observed through the energy eigenstate populations. We reconstruct the Wigner function of these states by introducing probe Hamiltonians which measure Fock state populations in displaced and squeezed bases. Squeezed-basis measurements with 8 dB squeezing allow the measurement of interference for Δα=15.6, corresponding to a distance of 240 nm between the two superposed wave packets.

Quantum optics. Quantum harmonic oscillator state synthesis by reservoir engineering.

The robust generation of quantum states in the presence of decoherence is a primary challenge for explorations of quantum mechanics at larger scales. Using the mechanical motion of a single trapped ion, we utilize reservoir engineering to generate squeezed, coherent, and displaced-squeezed states as steady states in the presence of noise. We verify the created state by generating two-state correlated spin-motion Rabi oscillations, resulting in high-contrast measurements. For both cooling and measurement, we use spin-oscillator couplings that provide transitions between oscillator states in an engineered Fock state basis. Our approach should facilitate studies of entanglement, quantum computation, and open-system quantum simulations in a wide range of physical systems.

Factors correlated with tuberculosis reported after death.

SETTING: Taiwan. OBJECTIVE: To determine factors associated with tuberculosis (TB) reported after death. DESIGN: A retrospective cohort study was conducted of TB patients newly registered between 2006 and 2008. The national TB database was linked with the Vital Registry System and National Health Insurance database for analysis. RESULTS: A total of 1409 (4.0%) TB cases were reported after death. Age ⩾75 years (OR 1.70), chest X-ray (CXR) unknown or not performed (OR 2.41), positive sputum bacteriology (OR 1.74), and comorbidities such as cancer (OR 1.21), chronic liver disease (OR 1.21) and chronic kidney disease (OR 2.58) were associated with the reporting of TB cases after death. More than 30% of TB deaths in elderly persons with chronic kidney disease were TB cases that were reported after death. Abnormal CXR and comorbidities such as chronic obstructive pulmonary disease, stroke and diabetes mellitus were less likely to be associated with the reporting of TB cases after death. CONCLUSIONS: Elderly patients with cancer, chronic liver disease or chronic kidney disease require more attention to prevent delayed diagnosis and early mortality from TB. Elderly patients with chronic kidney disease are at highest risk.

Evaluation of candidate spermatogonial markers ID4 and GPR125 in testes of adult human cadaveric organ donors.

The optimal markers for human spermatogonial stem cells (SSCs) are not known. Among the genes recently linked to SSCs in mice and other animals are the basic helix-loop-helix transcription factor ID4 and the orphan G-protein-coupled receptor GPR125. While ID4 and GPR125 are considered putative markers for SSCs, they have not been evaluated for coexpression in human tissue. Furthermore, neither the size nor the character of the human spermatogonial populations that express ID4 and GPR125, respectively, are known. A major barrier to addressing these questions is the availability of healthy adult testis tissue from donors with no known reproductive health problems. To overcome this obstacle, we have employed healthy testicular tissue from a novel set of organ donors (n = 16; aged 17-68 years) who were undergoing post-mortem clinical organ procurement. Using immunolabelling, we found that ID4 and GPR125 are expressed on partially overlapping spermatogonial populations and are more broadly expressed in the normal adult human testis. In addition, we found that expression of ID4 remained stable during ageing. These findings suggest that ID4 and GPR125 could be efficacious for identifying previously unrecognized human spermatogonial subpopulations in conjunction with other putative human stem cell markers, both in younger and older donors.

Contact investigation for tuberculosis in Taiwan contacts aged under 20 years in 2005.

OBJECTIVE: To measure the tuberculosis (TB) incidence rate and assess the relative risk of TB disease in contacts based on the tuberculin skin test (TST) and sputum status of index cases. DESIGN: All contacts aged <20 years who were exposed to a TB case in 2005 were cross-matched using an electronic surveillance system to estimate TB incidence over a 24-month follow-up period. RESULTS: Among 6959 contacts there were 67 secondary cases (1%). The incidence was highest in the first year after exposure and decreased by half in the second year (P = 0.001). The relative risks of developing TB in contacts aged 0-4, 5-9, 10-14 and 15-19 years were respectively 325, 209, 337 and 53 times greater than for the general population. The hazard ratio of developing TB among contacts with a TST ≥ 15 mm induration was 12 times higher than for those with a TST < 5 mm (P = 0.003). CONCLUSIONS: The relative risk of developing TB disease within 24 months of exposure was approximately 200-300 times greater for contacts aged <15 years. The majority developed TB within 12 months of exposure.

Soluble epoxide hydrolase inhibitors and their potential for treatment of multiple pathologic conditions.

Epoxyeicosanoids, including the epoxyeicosatrienoic acids are signaling molecules which appear to help ameliorate the effects of a wide variety of pathological conditions. The enzyme soluble epoxide hydrolase (sEH) metabolizes these molecules by converting them to their corresponding vicinal diols. Inhibition of sEH either by knockout or chemical inhibitors increases epoxyeicosanoid levels in vivo and provides significant organ protection in models of brain, cardiac, and renal injury. sEH also appears to be involved in modulating inflammation, pain pathways, pulmonary function, hypertension, and diabetes. Potent sEH inhibitors have been developed in academic, pharmaceutical, and biotech laboratories and described in the patent and scientific literature. Most of the inhibitor scaffolds employ a urea or amide which functions as an active-site transition state mimic. Arête Therapeutics compound AR9281 successfully completed phase Ia and 1b studies. A phase IIa proof of concept trial for treatment of impaired glucose tolerance has been completed, but the results are not yet reported.

Comprehensive evaluation of a novel nuclear factor-kappaB inhibitor, quinoclamine, by transcriptomic analysis.

BACKGROUND AND PURPOSE: The transcription factor nuclear factor-kappaB (NF-kappaB) has been linked to the cell growth, apoptosis and cell cycle progression. NF-kappaB blockade induces apoptosis of cancer cells. Therefore, NF-kappaB is suggested as a potential therapeutic target for cancer. Here, we have evaluated the anti-cancer potential of a novel NF-kappaB inhibitor, quinoclamine (2-amino-3-chloro-1,4-naphthoquinone). EXPERIMENTAL APPROACH: In a large-scale screening test, we found that quinoclamine was a novel NF-kappaB inhibitor. The global transcriptional profiling of quinoclamine in HepG2 cells was therefore analysed by transcriptomic tools in this study. KEY RESULTS: Quinoclamine suppressed endogenous NF-kappaB activity in HepG2 cells through the inhibition of IkappaB-alpha phosphorylation and p65 translocation. Quinoclamine also inhibited induced NF-kappaB activities in lung and breast cancer cell lines. Quinoclamine-regulated genes interacted with NF-kappaB or its downstream genes by network analysis. Quinoclamine affected the expression levels of genes involved in cell cycle or apoptosis, suggesting that quinoclamine exhibited anti-cancer potential. Furthermore, quinoclamine down-regulated the expressions of UDP glucuronosyltransferase genes involved in phase II drug metabolism, suggesting that quinoclamine might interfere with drug metabolism by slowing down the excretion of drugs. CONCLUSION AND IMPLICATIONS: This study provides a comprehensive evaluation of quinoclamine by transcriptomic analysis. Our findings suggest that quinoclamine is a novel NF-kappaB inhibitor with anti-cancer potential.

Pilot project in developing community rehabilitation service for migrant workers suffering from pneumoconiosis in Mainland China.

Pneumoconiosis is one of the major occupational health problems in China and increasing numbers of migrant workers suffered from this occupational disease after working in a dusty environment for few years. These migrant workers panicked after being diagnosed as suffering from pneumoconiosis and facing physiological disturbances including progressive dyspnea, respiratory failure or complications like silico-tuberculosis after their return to their rural village. This article reviews the preliminary results of a community rehabilitation pilot project conducted in a rural village in Guizhou, one of the provinces in southwest China. It shares the joint effort of professionals from Guangdong Province and Hong Kong SAR on supporting the migrant workers to manage and cope with this occupational disease. Finally, strategies including early intervention were suggested to help migrant workers to manage the disease. Most importantly, occupational health promotion and prevention were urged as the measures of utmost importance in reducing the risk for migrant workers suffering from pneumoconiosis.

Summary report of action research on occupational rehabilitation and community re-integration of migrant workers with work injuries in Mainland China.

This article is a summary of an action research exploring the strategies to initiate the occupational rehabilitation and community re-integration of migrant workers with work injuries in Guangdong Province, China. Using two cases of rehabilitation intervention for workers with work injury, a case management model of occupational rehabilitation and community re-integration was illustrated, in the different phases of rehabilitation. Finally, some key elements in supporting occupational rehabilitation and community re-integration for migrant workers with work injury in China were highlighted.

Work rehabilitation for migrant workers with work injury--the magic of Chinese paper cutting.

As China has gradually transformed from agricultural economy into industrial economy since 1978, occupational injuries and diseases become a serious social problem in China. For occupational rehabilitation professionals, helping workers with occupational injuries and diseases, return to work and re-integrate to community are the ultimate goals of occupational rehabilitation. This article reports a new indigenous initiative with cultural notions in occupational rehabilitation piloted by Guangdong Provincial Rehabilitation Center. Case studies reflected that by learning and practicing traditional Chinese paper cutting, workers with occupational injury and disease could regain their self confidence, identity their strengths, learn more vocational skills as well as to re-integrate into community.

Surgical complications in parenteral Subutex abusers.

INTRODUCTION: There were anecdotal reports of an increase in the admissions of parenteral Subutex abusers to our hospital over the past five months. This case study aimed to analyse the surgical complications related to parenteral Subutex abuse and describe the demographics of this group of patients. METHODS: We reviewed all admissions to our hospital between July and November 2005. Only parenteral Subutex abusers were included in this case study. RESULTS: A total of 53 parenteral Subutex abusers were admitted during this period. 31 had surgical complications, while 22 presented with medical ones. Of the surgical patients, 12 had cellulitis and thrombophlebitis, six developed abscesses of the limbs, ten were patients with ischaemia and gangrene of the digits and limbs, one had septic arthritis, one had necrotising fasciitis, and one had a pseudoaneurysm of the femoral artery. There were no reported mortalities. Only nine patients needed surgical interventions. Most of the patients are young with a mean age of 34.2 years. There was a male predominance of 92.4 percent (49 out of 53). Malays are more frequently affected (72 percent, n=38), followed by Indians (15 percent, n=8), and Chinese (13 percent, n=7). CONCLUSION: Parenteral Subutex abuse is a rising concern in Singapore. Many patients present to the surgical and orthopaedic departments for limb and vascular complications. Surgery has a limited role in their management, and most are treated conservatively and expectantly. The solution to this emerging trend requires inter-hospital and ministerial collaboration.

Serotonin transporter mRNA expression is decreased by lamivudine and ribavirin and increased by interferon in immune cells.

Clinical reports document that depression as a side effect is more prevalent in hepatic patients given interferon (IFN)-alpha therapy than in those given lamivudine. The mechanisms, however, are poorly understood. Serotonin transporter (5-HTT), via uptake of serotonin (5-HT) into presynaptic serotoninergic neurons, is an initial action site for antidepressants. Real-time polymerase chain reaction (PCR) was used to quantify 5-HTT mRNA expression in immune cells in order to evaluate whether 5-HTT acted as an indicator of depression. Results showed that the 5-HTT mRNA expression was much higher in T-cell and B-cell lines than that in a monocytic cell line. Treatment with either lamivudine or ribavirin reduced the 5-HTT mRNA expression, protein level and 5-HT uptake in T-cell line. Treatment with IFN-alpha, however, increased those levels in the same group. A similar effect was observed in peripheral blood mononuclear cells (PBMC). Mimicking clinical use by treating PBMC with a combination of IFN-alpha and ribavirin increased the 5-HTT mRNA expression level. Our study indicates that these therapeutic drugs regulate 5-HTT expression, which implies that 5-HTT might be a trait marker in IFN-alpha-induced depression after hepatic therapy.

[HOXD13 polyalanine tract expansion in synpolydactyly: mutation detection and prenatal diagnosis in a large Chinese family].

OBJECTIVE: Synpolydactyly (SPD, MIM 186000), also known as syndactyly type II, is a dominantly inherited limb malformation with incomplete penetrance and variable expressivity. Polyalanine tract expansion in HOXD13 has been shown to be the disease-causing mutation in SPD. The present study was designed to identify mutation in HOXD13 and to provide prenatal diagnosis, in a large Chinese SPD family consisting of 54 individuals. METHODS: The proband and 4 other affected individuals in the family were evaluated physically and radiologically to ascertain the SPD phenotype. Genomic DNA was extracted from peripheral blood samples obtained from 18 family members (9 affected and 9 unaffected), and from amniotic fluid and chorionic villus samples obtained from the proband during her two consecutive pregnancies. With the use of a pair of specific primers, a fragment of 161bp was amplified by polymerase chain reaction (PCR) to cover the imperfect GCN triplet repeat sequence in exon 1 of HOXD13 encoding the 15-residue polyalanine tract. The PCR products were detected by agarose gel electrophoresis, and sequenced after cloning into pMD18T vector. To confirm prenatal diagnosis, haplotype analysis was also performed by allele-typing three microsatellite markers, including the intronic CA repeats in HOXD13. RESULTS: Digital and radiographic findings indicated a typical SPD phenotype in the family. These included 3/4 finger syndactyly and 4/5 toe syndactyly with an extra digit in the syndactylous web. Unilateral finger syndactyly in the proband, unilateral toe syndactyly in 2 individuals, bilateral brachydactyly of the fifth toes in 1 individual, and clinodactyly of the fifth fingers in 4 individuals were also observed, indicating variable expressivity. Gel electrophoresis of the PCR products showed an additional longer fragment in all 9 affected individuals but not in the unaffected ones. Sequence analysis of the longer fragment revealed a 9-alanine expansion. The expansion was detectable in DNA from the amniotic fluid and chorionic villus samples. Furthermore, haplotype analysis ruled out potential contamination of the maternal DNA. These suggested that the two fetuses carried the same polyalanine expansion. CONCLUSION: HOXD13 polyalanine expansion was detected in a large Chinese family with SPD and prenatal diagnosis of two affected fetuses was achieved. This is the first report on prenatal diagnosis of SPD by detecting the HOXD13 polyalanine expansion in the Han population of the Chinese mainland.

Selective functional deficit in dendritic cell--T cell interaction is a crucial mechanism in chronic hepatitis B virus infection.

A defect in specific T cell immunity has long been assumed to be the central mechanism of persistent Hepatitis B virus (HBV) infection. Recent studies on HBV transgenic mice have suggested, however, that functional deficit of dendritic cells (DC) was an underlying cause for the T cell dysfunction. The functions of monocyte-derived DC were determined by studying 75 subjects that included chronic hepatitis B patients with low or high HBV load; antibody to hepatitis B surface antigen (anti-HBs) positive individuals who had recovered completely from previous acute HBV infection; healthy donors who had received hepatitis B vaccination and were anti-HBs positive; and immunologically naïve to HBV or the vaccine individual. Impaired interactions between monocyte-derived DC and T cells were shown in chronic HBV infection patients, especially in those with active virus replication. The dysfunctions included: (i) failure of DC to increase human leukocyte antigen (HLA-II), B7 expression and interleukin-12 secretion in responses to hepatitis B surface antigen (HBsAg), (ii) defective induction of T cell proliferative response to HBsAg, (iii) failure to activate T cells to produce cytokines and (iv) deficit in the induction of antigen specific cytotoxic T lymphocytes (CTLs). In vitro treatment of DC with tumour necrosis factor-alpha improved HLA-II and B7 expression, as well as Th cell and CTL responses. It is concluded that defective DC-T cell interactions may account for the specific T cell immune defects in chronic HBV infection. Immunotherapy that aims at restoring DC functions could offer a new opportunity for effectively managing persistent HBV infections.

Rare pulmonary complications after transarterial chemoembolisation for hepatocellular carcinoma: two case reports.

We report two rare cases of acute pulmonary complication after transarterial chemoembolisation for inoperable hepatocellular carcinoma. Both cases involved a large tumour and hepatic vein invasion. The first patient, a 27-year-old man, died of pulmonary tumour embolism 4 days after transarterial chemoembolisation. Acute dyspnoea developed in the second patient, a 63-year-old man, following the procedure due to pulmonary oil embolisation and chemical pneumonitis. The chest condition of this patient improved, but he subsequently died of liver failure 3 weeks later. Our cases illustrate the point that if locoregional treatment is offered as a palliative treatment, patients with hepatic vein invasion should be warned of the possible complications of massive tumour embolism, pulmonary oil embolisation, and subsequent death.