Impacts of treatments on the quality of life among esophageal squamous cell carcinoma patients.

This study aims to investigate the effects of treatments on the quality of life for patients with esophageal squamous cell carcinoma patients diagnosed at early and late stages. From a medical center in central Taiwan, patients who had been diagnosed with esophageal squamous cell carcinoma from February 2007 and March 2011 were recruited. Using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the Quality of Life Questionnaire Oesophageal 18 (QLQ-OES18), quality of life scores for 105 esophageal squamous cell carcinoma patients were obtained and assessed. Multivariate analysis was performed on the quality of life scores after stratification by cancer stage. Among early-stage esophageal squamous cell carcinoma patients, those received only surgery (S-only) performed better in physical and social functioning compared with patients who underwent surgery and concurrent chemoradiotherapy (S+CCRT) (ß = 9.0, P = 0.03; ß = 12.1, P = 0.04, respectively). For those that received only concurrent chemoradiotherapy (CCRT-only), they performed worse in role and emotional functioning relative to S+CCRT patients (ß = -17.2, P = 0.02; ß = -15.7, P = 0.05, respectively). Among late-stage patients, CCRT-only treatment gave insignificantly better global health status and functional scale scores and less severe symptoms compared to the S+CCRT option. Better functional scores and less aggravated symptoms are observed in early-stage esophageal squamous cell carcinoma patients who received surgery-only treatment relative to those that underwent both surgery and chemoradiotherapy. For late-stage esophageal cancer patients, the measured difference of quality of life is not significant between CCRT-only and S+CCRT treatments.

Trends in the susceptibility of methicillin-resistant Staphylococcus aureus to nine antimicrobial agents, including ceftobiprole, nemonoxacin, and tyrothricin: results from the Tigecycline In Vitro Surveillance in Taiwan (TIST) study, 2006-2010.

This study investigated the in vitro susceptibilities of methicillin-resistant Staphylococcus aureus (MRSA) to nine antimicrobial agents in Taiwan. A total of 1,725 isolates were obtained from 20 hospitals throughout Taiwan from 2006 to 2010. The minimum inhibitory concentrations (MICs) of the nine agents were determined by the agar dilution method. The MICs of mupirocin and tyrothricin were determined for 223 MRSA isolates collected from 2009 to 2010. For vancomycin, 99.7 % were susceptible; however, 30.0 % (n = 517) exhibited MICs of 2 µg/ml and 0.3 % (n = 6) demonstrated intermediate susceptibility (MICs of 4 µg/ml). Nearly all isolates (≥ 99.9 %) were susceptible to teicoplanin, linezolid, and daptomycin. The MIC90 values were 2 µg/ml for ceftobiprole and 1 µg/ml for nemonoxacin. The MIC90 values of mupirocin and tyrothricin were 0.12 and 4 µg/ml, respectively. MIC creep was noted for daptomycin during this period, but not for vancomycin, teicoplanin, linezolid, or tigecycline. For isolates with vancomycin MICs of 2 µg/ml, the MIC90 values were 2 µg/ml for teicoplanin, 0.5 µg/ml for daptomycin, and 0.5 µg/ml for tigecycline. Those values were four- to eight-fold higher than those among isolates with vancomycin MICs of 0.5 µg/ml (2, 0.06, and 0.12 µg/ml, respectively). Of the nine MRSA isolates exhibiting non-susceptibility to vancomycin (n = 6), teicoplanin (n = 1), daptomycin (n = 2), or tigecycline (n = 1), all had different pulsotypes, indicating the absence of intra-hospital or inter-hospital spread. The presence of a high proportion of MRSA isolates with elevated MICs (2 µg/ml) and MIC creep of daptomycin might alert clinicians on the therapy for serious MRSA infections in Taiwan.

Development of the Brief Geriatric Assessment for the General Practitioner.

OBJECTIVES: The study aimed to develop a brief geriatric assessment (BGA) tool for the general practitioner to evaluate geriatric syndromes in community-dwelling older adults. DESIGN: A cross-sectional study. SETTING: 58 communities from four aging cities in Taiwan. PARTICIPANTS: 1,258 community-dwelling older adults aged 65 years and above. MEASUREMENTS: The BGA targeted physical function impairment, cognitive impairment, and mood impairment. The cutoff values of physical function tests (handgrip strength and 6-meter walk test [6MWT]) were estimated by receiver operating characteristic analysis. Second, the diagnostic validity of the BGA was calculated in terms of sensitivity, specificity, and predictive values, which were compared to corresponding comprehensive geriatric assessment (CGA) items. Third, the associated risk factors of geriatric syndromes were selected using stepwise logistic regression. Finally, we combined items selected from literature and CGA and then proposed a practical BGA framework. RESULTS: The proposed BGA comprised dominant handgrip strength, 6MWT, self-report personal birthday, address, and telephone number, question 'Do you have depressive mood for the past two weeks?', Rinne tuning-fork tests, Snellen scale, and body mass index. It evaluated multidimensional aspects of geriatrics syndromes including physical, cognitive, mood, and sensory impairment, sarcopenia, and nutrition status. Sensitivities in the Taiwan BGA items ranged from 48% for dominant handgrip strength to 97.6% for 6MWT corresponding to physical impairment; 58.3% for cognitive impairment corresponding to Short Portable Mental Status Questionnaire; 62.7% for mood impairment corresponding to Geriatric Depression Scale. The Taiwan BGA for the general practitioner takes less than 10 minutes and is suitable in the community setting. CONCLUSION: Early management of geriatric syndromes in the community is important. The current study demonstrated a practical BGA tool for the general practitioner to comprehensively assess geriatric syndromes in community-dwelling older adults.

HOTAIR promotes myocardial fibrosis through regulating URI1 expression via Wnt pathway.

OBJECTIVE: To investigate whether HOX transcript antisense RNA (HOTAIR) regulates myocardial fibrosis via promoting proliferation of cardiac fibroblasts (CFs) and upregulating the expression levels of fibrotic proteins through activating Wnt signaling pathway. MATERIALS AND METHODS: The expression level of HOTAIR in Ang II-induced cardiac fibroblasts was detected by quantitative Real-time-polymerase chain reaction (qRT-PCR). Overexpression or knockdown of HOTAIR expression was achieved by lentivirus transfection. The effects of HOTAIR on regulating cell proliferation, migration and apoptosis were measured by cell counting kit-8 (CCK-8) test, transwell assay and flow cytometry, respectively. Western blot and qRT-PCR experiments were performed to detect expressions of fibrosis-related genes and Wnt pathway-related genes. Target gene of HOTAIR was predicted by bioinformatics analysis. Rescue assays were conducted to assess whether HOTAIR could regulate cell proliferation and fibrosis by activating Wnt signaling pathway via URI1. RESULTS: QRT-PCR results showed that HOTAIR expression in Ang II-induced CF cells was significantly higher than that in control. HOTAIR overexpression in CF cells can promote cell proliferation and migration, inhibit apoptosis, and promote the expressions of fibrosis-related genes. Western blot results indicated that HOTAIR could upregulate URI1 expression and activate Wnt signaling pathway. In addition, rescue assay demonstrated that overexpression of URI1 reversed the inhibitory effect of HOTAIR knockdown on Wnt pathway. CONCLUSIONS: Highly expressed HOTAIR promoted proliferation and migration of cardiac fibroblasts. HOTAIR remarkably upregulated fibrosis-related genes in CF cells. The mechanism of HOTAIR in regulating myocardial fibrosis might be related to the activation of Wnt signaling pathway through targeting URI1 expression.

Leishmanial infections: a consideration in travellers returning from abroad.

Seven cases of leishmaniasis, including a fatal case of visceral leishmaniasis and 6 cases of dermal leishmaniasis, were seen in Boston over a four-year period. Diagnosis was made by isolation of organisms in culture or by identification of organisms in stained preparations of tissue. Proper management of patients with leishmanial infections requires an appreciation of the geographical strain differences of each species.

Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation.

Thirty-seven consecutive free anterolateral thigh flaps in 36 patients were transferred for reconstruction of head and neck defects following cancer ablation between January of 1997 and June of 1998. The success rate was 97 percent (36 of 37), with one flap lost due to a twisted perforator. The anatomic variations and length of the vascular pedicle were investigated to obtain better knowledge of anatomy and to avoid several surgical pitfalls when it is used for head and neck reconstruction. The cutaneous perforators were always found and presented as musculocutaneous or septocutaneous perforators in this series of 37 anterolateral thigh flaps. They were classified into four types according to the perforator derivation and the direction in which it traversed the vastus lateralis muscle. In type I, vertical musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 56.8 percent of cases (21 of 37), and they were 4.83 +/- 2.04 cm in length. In type II, horizontal musculocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 27.0 percent of cases (10 of 37), and they were 6.77 +/- 3.48 cm in length. In type III, vertical septocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 10.8 percent of cases (4 of 37), and they were 3.60 +/- 1.47 cm in length. In type IV, horizontal septocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 5.4 percent of cases (2 of 37). They were 7.75 +/- 1.06 cm in length. The average length of vascular pedicle was 12.01 +/- 1.50 cm, and the arterial diameter was around 2.0 to 2.5 mm; two accompanying veins varied from 1.8 to 3.0 mm and were suitable for anastomosis with the neck vessels. Reconstruction of one-layer defect, external skin or intraoral lining, was carried out in 18 cases, through-and-through defect in 17 cases, and composite mandibular defect in two cases. With increasing knowledge of anatomy and refinements of surgical technique, the anterolateral thigh flap can be harvested safely to reconstruct complicated defects of head and neck following cancer ablation with only minimal donor-site morbidity.

Sewage sludge ash characteristics and its potential applications.

This study investigated the characteristics of SSA in Taiwan area. The potential applications of SSA reuse were also evaluated. Four major characteristics of SSA, including chemical compositions, pozzolanic properties, physical properties, and surface properties were analyzed. Experimental results found that SSA was a complex mixture of burnt residues of sludge biomass and minerals. The major chemical compositions of SSA were silicon oxide, aluminium oxide, and iron oxide. The most predominant silicon oxide occupied 41.3 to 56.1% of overall SSA weight and approximately 60% weight of silicon oxide in SSA was amorphous type. Due to the effect of amorphous silicon oxide, the SSA exerted pozzolanic activity. The strength activity index (SAI) value of SSA was between 53.6 and 74.3%. The SSA particles were also the agglomeration of finer grains between 0.1 and 1 microm of size. Therefore the SSA was porous with irregular particles with significant pore surface area. Additionally, the SSA exerted negative surface charge and cation-exchange capacity in neutral aqueous phase. Based on the SSA characteristics found in this study, four potential applications of SSA reuse were evaluated. These technologies included reusing as fine aggregate, reusing as pozzolanic material, melting or vitrification treatment, and reusing as adsorbent. In addition, the advantages and disadvantages of the above potential applications of SSA were discussed.

[Application of Ilizarov's external fixator on the basis of biology].

Ilizarov's biology includes that, in the presence of tension and stress, both regeneration of bone and soft tissues with cellular proliferation and their biological synthesis become vigorous. The Ilizarov's external fixator has five functions namely: compression, distraction, de-angulation, derotation and translocation. The principles of this procedure include: corticotomy instead of conventional osteotomy, placement of 4-5 sets of 1.5 mm wires transfixed in the bones at different levels under tension of 70-110 kg on the circular rings without acute diastasis until the 5 th to 7th day, and then, callotasis-callus distraction. The quality and quantity of the regenerated bone within the widening distraction gap are closely related to the maximum preservation of bone marrow and periosseous blood supply, and a distraction of 1 mm per day and preferably done by 4 times 0.25 mm each time should be emphasized. Experiences in 17 cases of pseudarthrosis and unequal length of leg treated with Ilizarov's technique are presented.

New concepts for organocatalysis.

Organocatalysis, catalysis with low-molecular weight catalysts in which a metal is not part of the catalytic principle or the reaction substrate, can be as efficient and selective as metal- or biocatalysis. Important discoveries in this area include novel Lewis base-catalyzed enantioselective processes and, more recently, simple Brønsted acid organocatalysts that rival the efficiency of traditional metal-based asymmetric Lewis acid-catalysts. Contributions to organocatalysis from our laboratories include several new and broadly useful concepts such as enamine catalysis and asymmetric counteranion-directed catalysis. Our laboratory has discovered the proline-catalyzed direct asymmetric intermolecular aldol reaction and introduced several other organocatalytic reactions.

Schistosoma mansoni: the ultrastructure of larval morphogenesis in Biomphalaria glabrata and of associated host-parasite interactions.

An electron microscopic study has been carried out to describe the transformation of the miracidium of S. mansoni into the mother sporocysts in the susceptible B. glabrata and the associated host-parasite interactions. The miracidium enters the snail host without morphological alterations. Within 3 hr after entering, all the ciliary epidermal plates of the miracidium are discarded. A new tegument is quickly formed by 5 hr postinfection by the expansion of epidermal ridges. The rapid formation of the new tegument reflects the participation of membrane-bound vesicles in the ridge cytons. The membranes of these vesicles become the new tegument membranes with the discharge of their electron-dense contents into the snail tissues. The vesicular contents discharged into the tissues apparently prevent snail amoebocytes (phagocytes) from attachment to the parasite tegument and thus prevent their interference with the further development of the postmiracidium. If a postmiracidium fails to mobilize membrane-bound vesicles in the formation of tegument, the parasite becomes surrounded by closely attached concentric layers of fibroblasts formed by amoebocytes and histiocytes within 24 hr. The membrane-bound vesicles are present in small numbers in the ridge cytons of the miracidium and become numerous in the postmiracidium stage and with many migrate to the ridges through connecting bridges within 24 hr. By 3 days postinfection when extensive microvilli have formed on the tegument the vesicles have disappeared and are replaced by mitochondria, ribosomes and complex carbohydrate particles. Many fibroblasts in the snail connective tissues have phagocytic capacities and are regarded as snail tissue histiocytes or fixed amoebocytes that eventually may become hypertrophic and detached.

Establishment of clones of Trypanosoma cruzi and their characterization in vitro and in vivo.

An efficient technique for isolating clones of Trypanosoma cruzi from cultures and from animals has been developed. It is based on the inoculation of one organism, obtained by serial dilutions of cultured epimastigotes or isolated blood stream trypomastigotes, into enriched NNN medium (NNN-F:93). The cloning efficiency (percentage of positive cultures over the number inoculated) was 70% for cultured epimastigotes and 30-40% for blood-stream trypomastigotes. In vitro cultural characteristics of 14 secondary clones of an avirulent strain indicated that 12 clones grew in the F-94 medium primarily as epimastigotes at 27 degrees C and exclusively as amastigotes at 37 degrees C; 2 clones grew in F-94 medium primarily as amastigotes regardless of incubation temperature (27 degrees C or 37 degrees C). In vivo characterization of 7 clones from 2 virulent strains indicated that the virulence of individual clones was low immediately after isolation in NNN-F:93 medium, but the virulence of some clones returned to the level of the parent strain after more than 8 serial passages in CD-1 mice.

Leishmania mexicana: comparative fine structure of amastigotes and promastigotes in vitro and in vivo.

Amastigotes of Leishmania mexicana pifanoi were cultivated by serial transfers in cell-free medium UM-54 at 33 and 35 C. Electron microscopy was used to analyze the structural relationships among promastigotes, axenically cultured amastigotes, and amastigotes in footpads of infected hamsters. These studies revealed very close structural similarities between culture and hamster derived amastigotes. However, both of these amastigotes differed from the promastigotes in the following aspects. The flagellum of promastigotes contained a paraxial rod originating at the axosome level within the flagellar pocket, whereas the flagellum of amastigotes lacks this structure. The flagellar pocket of promastigotes was usually small whereas amastigotes had a distended reservoir. Subpellicular microtubules of promastigotes terminated at the posterior end, whereas those of amastigotes ended subterminally. Membrane bounded vesicles were present only in amastigotes. These results along with the biologic and antigenic comparisons indicate that amastigotes obtained from axenic cultures are related very closely to amastigotes from infected hamster footpads and that their relationship to promastigotes is far more distant.

Chemical transformation of human embryonic nasopharyngeal epithelial cells in vitro.

The association of Epstein-Barr virus (EBV) with poorly differentiated carcinoma of the nasopharynx is well known; however, certain environmental factors, such as nitrosamines, are also important for the development of this cancer (Ho, 1975). N,N'-Dinitrosopiperazine (DNPZ) can induce nasopharyngeal carcinoma in rats and increased sister chromatid exchange frequency in human embryonic nasopharyngeal epithelial (HENE) cells. We have now demonstrated the transformation by DNPZ of HENE cells, which had a prolonged life span, anchorage-independent growth, chromosomal aberrations, tumorigenicity and morphological and ultrastructural alterations. These transformed cells might derive from the columnar epithelium of the nasopharynx, as indicated by the positive histochemical reaction with CAM 5.2 antikeratin antibody. Negative results in an immunofluorescence test for EBV nuclear antigen and Southern hybridization for EBV DNA rule out the participation of this virus in the neoplastic transformation of HENE cells by DNPZ.