Knowledge, attitudes, and behaviours of pregnant women towards COVID-19: a cross-sectional survey.

INTRODUCTION: This study investigated the knowledge, attitudes, and behaviours of pregnant women towards coronavirus disease 2019 (COVID-19), as well as obstetric services provided by public hospitals (eg, universal screening) during the pandemic. METHODS: This cross-sectional survey was performed in the antenatal clinics of Kowloon East Cluster, Hospital Authority. Questionnaires were distributed to pregnant women for self-completion during follow-up examinations. RESULTS: In total, 623 completed questionnaires were collected from 28 July 2020 to 13 August 2020. Within this cohort, 83.1% of the women expressed high levels of worry (41.9% very worried and 41.3% worried) about contracting COVID-19 during pregnancy, 70.5% believed that maternal COVID-19 could cause intrauterine infection of their fetuses, and 84.3% objected to banning husbands from accompanying wives during labour and delivery. Most women (80.6%) agreed with universal screening for COVID-19 at certain points during pregnancy. Logistic regression modelling showed that women who were very worried about contracting COVID-19 (P=0.005) and women in their third trimester of pregnancy (P=0.009) were more likely to agree with universal screening during pregnancy; women with higher income (P=0.017) and women who planned to deliver in a private hospital (P=0.024) were more likely to disagree with such screening. CONCLUSION: Pregnant women expressed high levels of worry about contracting COVID-19 during pregnancy; universal screening during pregnancy was acceptable to a large proportion of our participants. Efforts should be made to specifically include pregnant women when launching any population screening programme for COVID-19.

Collagenofibrotic glomerulopathy- report of a rare renal disease with serial biopsies.

INTRODUCTION: Collagenofibrotic glomerulopathy or collagen type-III glomerulopathy is a rare glomerular disease characterised by the deposition of type III collagen fibres in the subendothelial space and mesangium of the glomerulus. CASE REPORT: Here, we present a case of collagenofibrotic glomerulopathy in a 49-year-old Indian female, the first to be reported from Singapore. Renal biopsy showed PAS (periodic acid-Schiff), silver and Congo red negative, amorphous extracellular material that expanded mesangial and subendothelial regions. Such materials were strongly positive for anti-collagen III immunofluorescent staining. Under electron microscopy, the mesangial and some subendothelial regions were greatly expanded by abundant collagen fibres which were different from normal collagen III fibres in both appearance and periodicity. DISCUSSION: The availability of past renal biopsies for reference offered insight into disease progression. From the initial diagnosis of focal segmental glomerulosclerosis to eventually collagenofibrotic glomerulopathy over a time span of more than 10 years, this case highlights the gradual accumulation of collagen fibres in the glomeruli before classical features are apparent. It also emphasises the importance of electron microscopy in the diagnosis of this disease.

Toxicity profile differences of adjuvant docetaxel/cyclophosphamide (TC) between Asian and Caucasian breast cancer patients.

AIM: For early-stage breast cancer, four cycles of docetaxel and cyclophosphamide (TC) was proven superior to doxorubicin plus cyclophosphamide in the US Oncology 9375 trial. Given primary prophylactic antibiotics, 5% febrile neutropenia was recorded in a population comprising 75.5% Caucasians. Smaller trials and retrospective studies reviewing TC use in Asian patients did not produce similar incidence rates. This study aims to discover the variable hematological toxicities with TC use in Caucasian and Asian patients. METHODS: Breast cancer data was retrospectively reviewed for patients receiving adjuvant docetaxel 60-75 mg/m2 plus cyclophosphamide 600 mg/m2 from six countries (China, Hong Kong, Japan, Taiwan, Italy, and United States). Similar number of patients with relatively balanced baseline characteristics were chosen for analysis of hematological and nonhematological toxicities and survival data. RESULTS: From March 2004 to July 2013, data of 227 patients (127 Asians and 100 Caucasian) patients were analyzed for treatment-related toxicities. During the four cycles of TC, Asians had a significantly higher rate of grade ≥2 neutropenia than Caucasians (45.7% vs 6.0%; P <0.001) and significantly more grade ≥3 neutropenia events were documented (respectively 30.7% vs 4.0%, P <0.001). The prophylactic use of G-CSF was similar; 26.0% in Asians and 28.0% in Caucasian (P = 0.764). There were no differences in nonhematological toxicities. No significant difference in disease-free survival was observed between Asians and Caucasians (log-rank P = 0.910). CONCLUSIONS: Ethnic differences in toxicity profile exist between Asian and Caucasian patients given adjuvant TC. Over 30% Asians but less than 5% Caucasians experienced grade ≥3 neutropenia.

Exaggerated emotional behavior in mice heterozygous null for the sodium channel Scn8a (Nav1.6).

The Scn8a gene encodes the alpha-subunit of Na(v)1.6, a neuronal voltage-gated sodium channel. Mice homozygous for mutations in the Scn8a gene exhibit motor impairments. Recently, we described a human family with a heterozygous protein truncation mutation in SCN8A. Rather than motor impairment, neuropsychological abnormalities were more common, suggesting a role for Scn8a in a more diverse range of behaviors. Here, we characterize mice heterozygous for a null mutation of Scn8a (Scn8a(+/-)mice) in a number of behavioral paradigms. We show that Scn8a(+/-)mice exhibit greater conditioned freezing in the Pavlovian fear conditioning paradigm but no apparent abnormalities in other learning and memory paradigms including the Morris water maze and conditioned taste avoidance paradigm. Furthermore, we find that Scn8a(+/-)mice exhibit more pronounced avoidance of well-lit, open environments as well as more stress-induced coping behavior. Together, these data suggest that Scn8a plays a critical role in emotional behavior in mice. Although the behavioral phenotype observed in the Scn8a(+/-)mice only partially models the abnormalities in the human family, we anticipate that the Scn8a(+/-)mice will serve as a valuable tool for understanding the biological basis of emotion and the human diseases in which abnormal emotional behavior is a primary component.

Compact dimension of denatured states of staphylococcal nuclease.

Fluorescence and circular dichroism stopped-flow have been widely used to determine the kinetics of protein folding including folding rates and possible folding pathways. Yet, these measurements are not able to provide spatial information of protein folding/unfolding. Especially, conformations of denatured states cannot be elaborated in detail. In this study, we apply the method of fluorescence energy transfer with a stopped-flow technique to study global structural changes of the staphylococcal nuclease (SNase) mutant K45C, where lysine 45 is replaced by cysteine, during folding and unfolding. By labeling the thiol group of cysteine with TNB (5,5'-dithiobis-2-nitrobenzoic acid) as an energy acceptor and the tryptophan at position 140 as a donor, distance changes between the acceptor and the donor during folding and unfolding are measured from the efficiency of energy transfer. Results indicate that the denatured states of SNase are highly compact regardless of how the denatured states (pH-induced or GdmCl-induced) are induced. The range of distance changes between two probes is between 25.6 and 25.4 A while it is 20.4 A for the native state. Furthermore, the folding process consists of three kinetic phases while the unfolding process is a single phase. These observations agree with our previous sequential model: N(0) left arrow over right arrow D(1) left arrow over right arrow D(2) left arrow over right arrow D(3) (Chen et al., J Mol Biol 1991;220:771-778). The efficiency of protein folding may be attributed to initiating the folding process from these compact denatured structures.

Transient risk factors for acute traumatic hand injuries: a case-crossover study in Hong Kong.

OBJECTIVES: To identify the remediable transient risk factors of occupational hand injuries in Hong Kong in order to guide the development of prevention strategies. METHODS: The case-crossover study design was adopted. Study subjects were workers with acute hand injuries presenting to the government Occupational Medicine Unit for compensation claims within 90 days from the date of injury. Detailed information on exposures to specific transient factors during the 60 minutes prior to the occurrence of the injury, during the same time interval on the day prior to the injury, as well as the usual exposure during the past work-month was obtained through telephone interviews. Both matched-pair interval approach and usual frequency approach were adopted to assess the associations between transient exposures in the workplace and the short-term risk of sustaining a hand injury. RESULTS: A total of 196 injured workers were interviewed. The results of the matched-pair interval analysis matched well with the results obtained using the usual frequency analysis. Seven significant transient risk factors were identified: using malfunctioning equipment/materials, using a different work method, performing an unusual work task, working overtime, feeling ill, being distracted and rushing, with odds ratios ranging from 10.5 to 26.0 in the matched-pair interval analysis and relative risks ranging between 8.0 and 28.3 with the usual frequency analysis. Wearing gloves was found to have an insignificant protective effect on the occurrence of hand injury in both analyses. CONCLUSIONS: Using the case-crossover study design for acute occupational hand injuries, seven transient risk factors that were mostly modifiable were identified. It is suggested that workers and their employers should increase their awareness of these risk factors, and efforts should be made to avoid exposures to these factors by means of engineering and administrative controls supplemented by safety education and training.

Dynamic gain-tilt compensation using electronic variable optical attenuators and a thin film filter spectral tilt monitor.

An all-optical dynamic gain tilt compensator (DGTC) is proposed and experimentally demonstrated. A single wide-band thin film filter and a pair of photodetector allow the DGTC to distinguish band add/drop position. Power fluctuations from EDFA gain tilt were reduced with fast electronic variable optical attenuators.

Infectious keratitis after photorefractive keratectomy in a comanaged setting.

A 48-year-old man had simultaneous bilateral photorefractive keratectomy (PRK). The surgeon who performed the PRK did not see the patient in follow-up, and there was confusion regarding the comanaging doctor. Therefore, the patient was not examined immediately postoperatively. Several days later, he was hospitalized for an unrelated, painful orthopedic problem and heavily sedated. Seven days after the PRK, an ophthalmologist was consulted for ocular irritation and discharge. Examination showed bilateral, purulent conjunctivitis and severe infectious keratitis in the left eye. The patient was treated with periocular and topical antibiotics. Corneal cultures yielded Staphylococcus aureus. The keratitis resolved slowly, leaving the patient with hand motion visual acuity. A corneal transplant and cataract extraction was performed 15 months later, resulting in a best corrected visual acuity of 20/400 because of glaucomatous optic nerve damage. Severe infectious keratitis may occur after PRK. Poor communication between the surgeon, comanaging doctor, and patient may result in treatment delay.

Early- versus late-onset infectious keratitis after radial and astigmatic keratotomy: clinical spectrum in a referral practice.

PURPOSE: To compare the clinical characteristics of early- versus late-onset keratitis after radial keratotomy (RK) and astigmatic keratotomy (AK). SETTING: Referral subspecialty practice. METHODS: This retrospective review comprised 19 patients with infectious keratitis after RK and AK. Early- versus late-onset groups were analyzed for predisposing conditions; infiltrate location, size, and depth; microbiologic data; and final visual outcome. RESULTS: Ten patients in the early-onset group developed keratitis within a mean of 7.4 days after surgery (range 3 to 14 days). Nine patients in the late-onset group developed keratitis a mean of 5.4 years after surgery (range 1.5 to 15.0 years). Staphylococcus aureus was the predominant organism in the early-onset group and Pseudomonas aeruginosa in the late-onset group. In the early-onset group, most infiltrates occurred in the paracentral aspect of the RK incision and extended to the middle or posterior stroma. In the late-onset group, most infiltrates occurred in the peripheral portion of the RK incision and were localized to the superficial stroma. A hypopyon was present in 7 of 10 ulcers in the early group and in 1 of 9 in the late group. Two patients in the early group developed endophthalmitis. Most patients in the late-onset group had incisional pseudocysts; 2 had other risk factors for keratitis. Final visual acuity was 20/40 or better in 7 of 10 patients in the early group and in 8 of 9 patients in the late group. CONCLUSIONS: Early-onset corneal ulcers after incisional refractive keratotomy were usually paracentral and deep, whereas late-onset ulcers were usually peripheral and superficial. Despite the predominance of Staphylococcus and Pseudomonas in the early- and late-onset groups, respectively, a variety of organisms may be responsible for infections in keratotomy incisions.

Effects of food restriction on mechanical properties of arterial system in adult and middle-aged rats.

The effects of food restriction on the mechanical properties of the vasculature were determined in Long-Evans male rats with different ages. Rats that began food restriction at the ages of 6 months and 12 months were fed on alternate days for 6 months. Rats at the ages of 12 and 18 months were referred to as adult and middle-aged rats and were anesthetized and thoracotomized. The exponentially tapered T-tube model was employed to relate pulsatile pressure and flow signals measured in the ascending aorta. In each age group, food restriction elicited a decrease in body weight as well as basal heart rate but showed no significant change in cardiac output. Arterial blood pressure, total peripheral resistance, and aortic characteristic impedance were not affected by food restriction in middle-aged rats. However, adult food-restricted rats exhibited lower mean arterial blood pressure (99.1 +/- 3.1 mmHg) than did adult ad libitum-fed rats (110.7 +/- 3.0 mmHg). Total peripheral resistance was reduced from 0.645 +/- 0.045 mmHg-min-kg/ml in adult ad libitum-fed rats to 0.492 +/- 0.030 mmHg-min-kg/ml in adult food-restricted rats. Moreover, aortic characteristic impedance of adult food-restricted rats (0.014 +/- 0.001 mmHg-min-kg/ml) was lower than that of adult ad libitum-fed rats (0.024 +/- 0.002 mmHg-min-kg/ml). Neither age nor diet exerted effects on wave transit time and produced no changes in aortic distensibility. In conclusion, food restriction may elicit significant changes in the mechanical properties of both Windkessel vessels and resistance arterioles in adult rats, but not in middle-aged rats.

Age-related changes of arterial mechanical properties in rats: analysis using exponentially tapered T-tube model.

This study was designed to explore the changes of mechanical properties in the rat's arterial system at different ages by using the exponentially tapered T-tube model. Long-Evans male rats at the ages of 6, 12, and 18 months were anesthetized and thoractomized. Rats at the ages of 6, 12, and 18 months were individually referred to as young, adult, and middle-aged rats. The pulsatile pressure and flow signals in the ascending aorta were measured by a high-fidelity pressure sensor and electromagnetic flow probe, respectively. Model parameters, such as aortic characteristic impedance, vascular tapering index, wave transit time, and arterial load compliance, were inferred from the aortic pressure and flow signals to describe the pulsatile nature of blood flows in the vasculature. The static hemodynamic condition in those animals with different ages was characterized by (i) no change in cardiac output and (ii) a decrease in heart rate, arterial blood pressure, as well as total peripheral resistance. As for the pulsatile nature of the arterial system, the wave transit time remained unaltered, indicating there was no change in the aorta's distensibility of rats at those three different ages. The arterial load compliance, which describes the buffering nature of a hollow vessel, also remained unchanged. On the contrary, there was a significant fall in aortic characteristic impedance in those age-related rats. The decline of aortic characteristic impedance without a significant change in arterial distensibility suggests that lumen growth of the aorta and large arteries may occur in rats up to middle age.

Ultrastructure of infection, development and gametocyst formation of Ascogregarina taiwanensis (Apicomplexa: Lecudinidae) in its mosquito host, Aedes albopictus (Diptera: Culicidae).

The life history of the protozoan parasite Ascogregarina taiwanensis in mosquito larvae (Aedes albopictus, collected in southern Taiwan) was shown to consist of two consecutive stages--intracellular and extracellular. Light microscopy showed that most trophozoites moved into the Malpighian tubules and developed into giant trophozoites during the first day pupa. The locomotion may be associated with bristle-like ridges of the trophozoite. The stage for sexual reproduction, i.e., the gamete, was then formed by segmentation of the giant trophozoite and twisting off the anucleate extremities of the body. Sexual reproduction occurred via fertilization by fusion of two resulting gametes, presumably two opposed sexes. The fused gametes finally generate the formation of the gametocyst, within which oocysts develop by budding from the cytoplasmic mass. This type of sexual reproduction has not been reported previously in any gregarine protozoa. We here proposed it as a new hypothesis for further elucidation of the protozoan reproduction.

Rapid diffusion of the lipid phosphorus of phosphatidylglycerol liposomes through polycarbonate membranes is caused by the oxidation of the unsaturated fatty acids.

The lipid phosphorus of phosphatidylglycerol liposomes was found to diffuse extensively, after a lag time of 1 to 2 days, through a 0.1 micron pore size polycarbonate membrane in a two compartment system. Diffusion occurred when either multilamellar or large unilamellar vesicles were studied, even if they were sedimented to eliminate any smaller particles. The lipid of liposomes prepared under sterile conditions also diffused extensively. Diffusion appeared to be related to the age of the vesicles, and could be eliminated by incorporating antioxidants into the liposomes, or by using liposomes prepared from saturated phospholipids (C14 or larger). This indicated that diffusion was caused by phospholipid oxidation, which was confirmed by HPLC analysis. Phospholipid phosphorus that diffused through a membrane appeared more polar, as indicated by its capacity to distribute into the upper phase of a two phase extraction. Phospholipid phosphorus diffusion was preceded by the complete loss of liposomes contents, indicated by the complete diffusion of encapsulated carboxyfluorescein through the membrane. Oxidation of the lipid could be prevented by inclusion of either butylated hydroxytoluene or alpha-tocopherol in the membrane. The best retention of liposomal contents was achieved when both antioxidants and cholesterol were included in the liposome preparation. The antioxidant incorporated in the liposomes remained effective in protecting the phospholipids upon storage at 4 degrees C for 2 months. The inclusion of EDTA in the suspension medium retarded the rapid oxidation, suggesting that the presence of trace amounts of heavy metal ions in the buffer catalyzed the oxidation. Phospholipid oxidation was most effectively inhibited by the presence of serum or chemically defined medium, suggesting that oxidation of liposomal lipids in a biological environment may be minimized if appropriate steps are taken.

A novel series of amphiphilic imidazolinium compounds for in vitro and in vivo gene delivery.

We have developed three catioinic amphiphiles based on the structure 1-[2-(acyloxy)ethyl]-2-alkyl(alkenyl)-3-(2-hydroxyethyl)imidazolinium chloride. Although these three compounds differ only in the structure of the hydrophobic acyl chains, they differ greatly in their ability to mediate in vivo and in vitro gene delivery. Moreover, in vitro efficiency is not predictive of in vivo efficiency. The myristoyl form is the most effective compound in vitro, and the oleoyl form is the most effective compound in vivo. The compounds readily form suspensions in aqueous media, both in the pure form and as mixtures with either cholesterol or dioleoylphosphatidylethanolamine. These suspensions can be sonicated to produce smaller particles. Particle size, electron microscopy, and the ability to capture glucose suggest that these lipids form liposomes on suspension in aqueous media. When mixed with plasmid DNA, the lipid particles appear to fuse and form larger particles. Fusion is maximal at the critical DNA:lipid ratio where extensive aggregation and precipitation are observed. Therefore, these compounds behave similarly to other cationic liposome-forming lipids upon interaction with DNA.

Evaluation of efficacy of four pediculicides against head louse (Pediculus capitis) infestation.

To evaluate the efficacy and to determine the minimum effective dosage of four pediculicides against head louse infestation, as well as to select a safe, effective, practical, and cheap agent, 1,657 infested school children in 25 primary schools in Szu-Hu, Kou-Hu, and Ku-Keng Districts of Yunlin County were treated and 1,611 of them were examined. The overall cure rate was 73% and the rate for boys (84%) was higher than that for girls (71%). The cure rate of Nix (permethrin 1%) cream rinse was 81%. The cure rate for single dosages of 1, 2, 3 and 4 cases/tube (56 gm/tube) was 87%, 83%, 81% and 71%, respectively. The cure rate of Para aerosol (bioallethrine 0.66%) was 78%. The cure rate for single dosages of 30 and 40 cases/tube (90 gm/tube) was 87% and 70%, respectively. The cure rate of Prioderm (malathion 1%) cream shampoo was 64%. The cure rate for single dosages of 10, 15 and 20 cases/tube (40 gm/tube) was 74%, 71% and 52%, respectively. The cure rate of Delice (1% gamma benzene hexachloride) was 71%. The cure rate for single dosages of 5 and 10 ml/case was 64% and 76%, respectively. Of the 226 infested girls, 181 (80%) were found to be infested with 1-10 head lice, 33 (15%) with 11-50 lice, 7(3%) with 51-100 lice and 5 (2%) with over 100 lice. Of the 2,160 head lice collected, 1,788 (83%) were nymphs, 284 (13%) females, and 88 (4%) males. The mean number of head lice in each infested girl was 10 (range 1-137). The low cure rates obtained in the present study may be due to the fact that many school girl & have long hair. In comparison, Nix had the highest cure rate (81%) but the highest price (NT$ 120/case). The cure rate and price of Para aerosol (78%, NT$ 7.2/case) and Delice (71%, NT$ 16.7/case) came next. Prioderm (64%, NT$ 10.0/case) had the lowest rate and a slight offensive smell. Preliminary trials show that based on the cost-effectiveness, Para aerosol is best in head louse infestation control.

Present status of head louse (Pediculus capitis) infestation among school children in Yunlin County, Taiwan.

In December 1990, 35 children in one kindergarten; 7,870 children in twenty-six primary schools and 2,657 students in three junior high schools in Kou-Hu, Ku-Keng and Szu-Hu Districts in Yunlin County, Taiwan, were examined by naked eye observation (NEO) for head louse infestation. The overall infestation rate was 16%. The infestation rate was highest in Kou-Hu (25%) and lowest in Ku-Keng (8%). The rate was higher among primary school children (21%) than among junior high school students (2%). The infestation rate of girls (34% in primary school children and 4% in junior high school students) was higher than that of boys (9%, less than 1% respectively). Among the primary school children the rate was highest in girls in grade 5 (39%) and boys in grade 4 (14%). The lowest rates were in girls in grade 6 (27%) and in boys in grades 5 and 6 (6%). In junior high school students, the rate of grade 1 (4%) was higher than those of grade 2 (less than 1%) and 3 (less than 1%).

[A review of larvivorous fish].

Recently, because of concern about the effects of insecticide on the environment, increased attention is being given to the use of biological agents for controlling the vectors of human disease. Biological control may encompass the use of predators, pathogens, parasites, pheromones, insect growth regulators, and other factors. Of these agents only fish and bacteria have so far been used operationally in mosquito control. Since 1988 fish have been employed for controlling Aedes larvae in water containers in Liuchiu, Pingtung. A review of larvivorous fish (mainly Gambusia affinis) and the present status of the use of fish in mosquito control in Mainland China are thus made for ready reference for the workers in mosquito control in Taiwan.

[Medical entomology in Taiwan].

Following the establishment of the Environmental Protection Administration in 1987 and the occurrence of the dengue epidemic in 1988, resurgent interest and need have been created to promote and support medical entomology in Taiwan. Steps should be taken to strengthen the training of workers in medical entomology, to establish a society for vector ecology and control, to issue periodicals in English, and to coordinate with foreign institution. Items for applied research on vector and best control are suggested.