Adult immunization--a neglected issue in Southeast Asia

Adult immunization is a neglected and underpublicised issue in Southeast Asia. Vaccine-preventable diseases cause unnecessary morbidity and mortality among adults in the region, while inadequate immunization results in unnecessary costs, including those associated with hospitalization, treatment, and loss of income. Childhood vaccination coverage is high for the EPI diseases of diphtheria, tetanus and pertussis; however, unvaccinated, undervaccinated, and aging adults with waning immunity remain at risk from infection and may benefit from vaccination. Catch-up immunization is advisable for adults seronegative for hepatitis B virus, while immunization against the hepatitis A and varicella viruses may benefit those who remain susceptible. Among older adults, immunization against influenza and pneumococcal infections is likely to be beneficial in reducing morbidity and mortality. Certain vaccinations are also recommended for specific groups, such as rubella for women of child-bearing age, typhoid for those travelling to high-endemicity areas, and several vaccines for high-risk occupational groups such as health care workers. This paper presents an overview of a number of vaccine-preventable diseases which occur in adults, and highlights the importance of immunization to protect those at risk of infection.     

Differential effects of tumor necrosis factor-alpha on protein kinase C isoforms alpha and delta mediate inhibition of insulin receptor signaling

Tumor necrosis factor-alpha (TNF-alpha) is a multifunctional cytokine that interferes with insulin signaling, but the molecular mechanisms of this effect are unclear. Because certain protein kinase C (PKC) isoforms are activated by insulin, we examined the role of PKC in TNF-alpha inhibition of insulin signaling in primary cultures of mouse skeletal muscle. TNF-alpha, given 5 min before insulin, inhibited insulin-induced tyrosine phosphorylation of insulin receptor (IR), IR substrate (IRS)-1, insulin-induced association of IRS-1 with the p85 subunit of phosphatidylinositol 3-kinase (PI3-K), and insulin-induced glucose uptake. Insulin and TNF-alpha each caused tyrosine phosphorylation and activation of PKCs delta and alpha, but when TNF-alpha preceded insulin, the effects were less than that produced by each substance alone. Insulin induced PKCdelta specifically to coprecipitate with IR, an effect blocked by TNF-alpha. Both PKCalpha and -delta are constitutively associated with IRS-1. Whereas insulin decreased coprecipitation of IRS-1 with PKCalpha, it increased coprecipitation of IRS-1 with PKCdelta. TNF-alpha blocked the effects of insulin on association of both PKCs with IRS-1. To further investigate the involvement of PKCs in inhibitory actions of TNF-alpha on insulin signaling, we overexpressed specific PKC isoforms in mature myotubes. PKCalpha overexpression inhibited basal and insulin-induced IR autophosphorylation, whereas PKCdelta overexpression increased IR autophosphorylation and abrogated the inhibitory effect of TNF-alpha on IR autophosphorylation and signaling to PI3-K. Blockade of PKCalpha antagonized the inhibitory effects of TNF-alpha on both insulin-induced IR tyrosine phosphorylation and IR signaling to PI3-K. We suggest that the effects of TNF-alpha on IR tyrosine phosphorylation are mediated via alteration of insulin-induced activation and association of PKCdelta and -alpha with upstream signaling molecules.     

Blood pressure indices and cardiovascular disease in the Asia Pacific region: a pooled analysis

This article aims to compare the importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) as risk factors for stroke and ischemic heart disease and to assess whether the patterns are consistent by age and gender. Cox proportional-hazards regression, adjusted for cholesterol and smoking, was used to assess the associations of the 4 BP indices with stroke and ischemic heart disease by age and gender. The relative importance of individual indices was assessed with a hazard ratios for a 1-SD change in BP and by likelihood-ratio chi2 tests. The influence of >1 BP index in the Cox model was also estimated. The analyses demonstrated similar associations of SBP, DBP, and MAP with both fatal stroke and ischemic heart diseases, which were stronger than those of PP. Both SBP and MAP tended to be more important in the regression model than DBP or PP. In Cox models including DBP, addition of SBP improved the goodness of fit at all ages and for both genders. However, in Cox models including SBP, addition of DBP typically resulted in little incremental benefit over and above that of SBP alone. These data suggest that if time or resources are highly constrained, such as in much-needed epidemiologic surveys in developing countries, very little is lost from only measuring SBP.     

The Relationship Between Heteronormative Beliefs and Verbal Sexual Coercion in College Students

Heteronormative standards for sex and romance situate men and women in a hierarchical relationship that characterizes masculinity as active and persistent and femininity as passive and responsive to male sexuality. Individuals who endorse heteronormative beliefs, such as the belief that men should dominate women sexually or that men are always ready for sex, may therefore be more approving of and experienced with behaviors that involve one partner exerting sexual pressure on the other. In the present study, we investigated the relationship between the endorsement of heteronormative beliefs and men’s and women’s approval of and experience with verbal sexual coercion (both as a perpetrator and as a victim). We first established a gender-neutral higher-order construct representing heteronormative beliefs consisting of multiple measures of gender norms for sexuality and relationships in a sample of 555 heterosexual college students (292 women, 263 men) primarily of Hispanic origin. We next found that endorsement of heteronormative beliefs was positively correlated with personal acceptance of verbal sexual coercion strategies and personal experience as the victim and perpetrator of verbal sexual coercion for both men and women. While men reported more overall support for heteronormative beliefs and more experience as a victim and perpetrator of verbal sexual coercion, there were minimal gender differences in how heteronormative beliefs related to verbal sexual coercion variables. The positive association found between heteronormative beliefs and sexual coercion in young men’s and women’s relationships represents an important step towards better understanding the antecedents and consequences of intimate partner violence.     

快-慢综合征的临床特点及射频消融治疗

目的分析快-慢综合征的临床特点,探讨其发生机制及治疗.方法术前停用抗心律失常药物至少5个半衰期,常规进行心脏彩超及动态心电图检查,年龄＞50岁者行冠状动脉造影检查,进行全面的心内电生理检查和射频消融术.结果9例患者皆成功进行射频消融术.其中房室旁道5例,左、右房速各1例,房室结双径路1例,Ⅰ型房扑1例.结论快-慢综合征以阵发生室上性心律失常及反复晕厥为表现,中老年人多见,各种电生理机制参与其间,病理机制不明,常不合并冠心病,处理措施首选射频消融术.     

Patient characteristics from a regional multicenter database of acute decompensated heart failure in Asia Pacific (ADHERE International-Asia Pacific)

BackgroundHeart failure (HF) is a leading cause of hospitalization. Although a number of multicenter international HF hospital registries have been published, there are limited data for the Asia Pacific region.MethodsADHERE (ie, Acute Decompensated Heart Failure Registry) International–Asia Pacific is an electronic web-based observational database of 10,171 patients hospitalized with a principal diagnosis of HF from 8 Asia-Pacific countries between January 2006 and December 2008.ResultsThe median age (67 years) varied by more than 2 decades across the region. Fifty-seven percent of patients were male. Ninety percent of patients were Asian and 8.4% were white. Dyspnea was the presenting symptom in 95%, with 80% having documented rales. During the index hospitalization, left ventricular function was assessed in 50%, and intravenous therapies included diuretics (85%), vasodilators (14%), and positive inotropes (15%). In-hospital mortality was 4.8%. Discharge medications included angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (63%), β-blockers (41%), and aldosterone antagonists (31%).ConclusionsCompared with other multicenter registries, patients hospitalized with acute HF in the Asia Pacific region tend to present with more severe clinical symptoms and signs and are younger, especially in countries at an earlier stage in their epidemiological transition. Echocardiography and disease-modifying medications are used less often, highlighting potential opportunities to improve outcomes.     

Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation

Background.?Bacteremia is a frequent complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). It is unclear whether changes in the intestinal microbiota during allo-HSCT contribute to the development of bacteremia. We examined the microbiota of patients undergoing allo-HSCT, and correlated microbial shifts with the risk of bacteremia. Methods.?Fecal specimens were collected longitudinally from 94 patients undergoing allo-HSCT, from before transplant until 35 days after transplant. The intestinal microbiota was characterized by 454 pyrosequencing of the V1-V3 region of bacterial 16S ribosomal RNA genes. Microbial diversity was estimated by grouping sequences into operational taxonomic units and calculating the Shannon diversity index. Phylogenetic classification was obtained using the Ribosomal Database Project classifier. Associations of the microbiota with clinical predictors and outcomes were evaluated. Results.?During allo-HSCT, patients developed reduced diversity, with marked shifts in bacterial populations inhabiting the gut. Intestinal domination, defined as occupation of at least 30% of the microbiota by a single predominating bacterial taxon, occurred frequently. Commonly encountered dominating organisms included Enterococcus, Streptococcus, and various Proteobacteria. Enterococcal domination was increased 3-fold by metronidazole administration, whereas domination by Proteobacteria was reduced 10-fold by fluoroquinolone administration. As a predictor of outcomes, enterococcal domination increased the risk of Vancomycin-resistant Enterococcus bacteremia 9-fold, and proteobacterial domination increased the risk of gram-negative rod bacteremia 5-fold. Conclusions.?During allo-HSCT, the diversity and stability of the intestinal flora are disrupted, resulting in domination by bacteria associated with subsequent bacteremia. Assessment of fecal microbiota identifies patients at highest risk for bloodstream infection during allo-HCST.     

Stability of right visual field advantage in an international lateralized lexical decision task irrespective of participants’ sex,handedness or bilingualism

ABSTRACT

In lateralized lexical decision tasks (LDTs), accuracy is higher and reaction times (RTs) are faster for right visual field (RVF) than left visual field (LVF) presentations. Visual field differences are thought to demonstrate the left hemisphere's (LH) dominance for language. The use of different tasks and words between studies and languages make direct comparisons difficult. We performed a lateralized LDT for which we selected four to six letter words that are used in three languages of Switzerland (French, German, and Italian) and English and Dutch. We accounted for the potential moderating roles of sex, handedness and multilingualism (early acquisition versus late acquisition of at least one second language). One hundred participants were tested at a French-speaking University in Switzerland. All performed a French vocabulary knowledge task [Brysbaert (2013 Brysbaert, M. (2013). Lextale_FR a fast, free, and efficient test to measure language proficiency in French. Psychologica Belgica, 53(1), 23–27. Retrieved from http://hdl.handle.net/1854/LU-4373981[Crossref] , [Google Scholar]). Lextale_FR a fast, free, and efficient test to measure language proficiency in French. Psychologica Belgica, 53(1), 23–27. Retrieved from http://hdl.handle.net/1854/LU-4373981]. Results showed a RVF over LVF advantage (accuracy, RTs and signal detection theory measures) for all groups, that is, irrespective of participants’ sex, handedness and how many languages they spoke. We observed, however, that enhanced vocabulary knowledge related to a right hemisphere shift in early bilinguals and a LH shift in late bilinguals. We discuss how the current observations can inform future studies suitable for the validation of the current task using an “international” vocabulary.