To determine the frequency of subtelomeric abnormalities in children with idiopathic mental retardation

Background

Cross-sectional study was carried out to determine the frequency of subtelomeric abnormalities in children with idiopathic mental retardation (MR).

Method

Multiplex ligation-dependant probe amplification technique was used to detect subtelomeric abnormalities.

Results

Out of 35 children, 21 (60%) were males. Family history of MR was present in 23%. Main clinical features included speech delay in all motor delay cases (83%) and non-specific dysmorphic features (77%).

Conclusion

Associated clinical features were more in children with intelligence quotient (IQ) < 50 (P < 0.05). Subtelomeric deletion (4q35) was observed in one child.     

Methylation of RAR-β2, RASSF1A, and CDKN2A Genes Induced by Nickel Subsulfide and Nickel-carcinogenesis in Rats

Objective To investigate the expression variation of RAR‐β2, RASSF1A, and CDKN2A gene in the process of nickel‐induced carcinogenesis. Methods Nickel subsulfide (Ni 3 S 2 ) at dose of 10 mg was given to Wistar rats by intramuscular injection. The mRNA expression of the three genes in induced tumors and their lung metastasis were examined by Real‐time PCR. The methylation status of the 5’ region of these genes were detected by Quantitative Real‐time methylation specific PCR. Results The mRNA expressions of t...     

Milk consumption and lactose intolerance in adults

Objective To investigate relations between milk consumption and lactose intolerance (LI) in adults and to explore the effect of milk consumption on lactase activity.Methods Total of 182 subjects aged 20‐70 years were recruited and interviewed by questionnaires,and their accumulative cow's milk intake (AMI) was calculated.LI was evaluated by hydrogen breath test (HBT).Results A negative correlation was found between AMI and severity of observed LI symptom (r=-0.2884;P<0.05).Binary logistic regression analysi...     

Human GSTs polymorphisms in the Hakka population of south China and their associations with family history of several chronic diseases

Objective To investigate the associations of genetic polymorphisms in GSTs genes of the Hakka population of south China with family histories of certain chronic diseases.Methods Five hundred and thirty‐nine healthy Hakka natives of Meizhou city of Guangdong province in south China were involved.The genotypes of GSTM1,GSTT1,GSTP1,GSTM3,and GSTA1 were determined using PCR and restriction fragment length polymorphism analysis.The observed polymorphisms were analyzed by Chi‐square and Hardy‐Weinberg equilibrium...     

Multi-drug resistance and characteristic of integrons in Shigella spp. isolated from China

Objective To investigate the characteristic of integrons and the relationship between integrons and antimicrobial resistance in Shigella spp. Methods Ninety Shigella strains (83 S. flexneri and 7 S. sonnei) were isolated from the stools of patients in China. Susceptibility to 8 antimicrobials was tested for all isolated strains. PCR, RFLP and sequencing analysis of integrons were applied to all of them. Results High prevalence of multi‐drug resistance (95.6%) was identified. Of the isolates 79 (87.8%) carri...     

Manganese superoxide dismutase polymorphism and prostate cancer risk: a meta-analysis

Objective: MnSOD plays a vital role in carcinogenesis, partly in that it converts superoxide radical to oxygen and hydrogen peroxide. The conflicting results of studies on the role of MnSOD polymorphism (Val-9Ala) with the risk of prostate cancer encouraged us to perform a meta-analysis to examine the association. Methods: A comprehensive search was conducted to examine all the eligible studies of MnSOD polymorphism and prostate cancer risk. We used odds ratios (ORs) with 95% confidence intervals (CIs) to assess the strength of the association. The pooled estimates of ORs were computed using the fixed-effects model or random-effects model. Results: Ten eligible studies, including 4 608 cases and 5 861 controls, were included in this meta-analysis. Overall, individuals with Ala/Ala and Ala/Val genotypes have an increased risk of prostate cancer, compared with those carrying the Val/Val genotype (Ala/Ala vs. Val/Val: OR=1.13; 95% CI=1.02～1.25; P = 0.020, Pheterogeneity=0.370; Ala/Val vs. Val/Val: OR=1.14; 95% CI=1.04～1.25; P = 0.004, Pheterogeneity=0.940). This significant association was also found in a dominant model with -9Ala allele (Ala/Ala＋Ala/Val vs. Val/Val: OR=1.12; 95% CI: 1.03～1.22; P = 0.009, Pheterogeneity=0.64). In the subgroup by ethnicity, it was observed that significantly elevated prostate cancer risk was associated with -9Ala allele in Caucasians (Ala/Ala vs. Val/Val: OR=1.14; 95% CI=1.03～1.27; P = 0.01, Pheterogeneity=0.31; Ala/Val vs. Val/Val: OR=1.14; 95% CI=1.04～1.24; P = 0.006, Pheterogeneity=0.87) but not in African-Americans. Furthermore, this meta-analysis showed that the -9Ala allele was associated with both nonaggressive and aggressive prostate cancer risks. Conclusion: Our meta-analysis suggests that MnSOD Val-9Ala polymorphism is associated with prostate cancer risk, especially in Caucasians.     

Comparing of Light Transmittance Aggregometry and Modified Thrombelastograph in Predicting Clinical Outcomes in Chinese Patients Undergoing Coronary Stenting with Clopidogrel

Background:

Several platelet function tests are currently used to measure responsiveness to antiplatelet therapy. This study was to compare two tests, light transmittance aggregometry (LTA) and modified thrombelastography (mTEG), for predicting clinical outcomes in Chinese patients after percutaneous coronary intervention (PCI).

Methods:

Prospective, observational, single-center study of 789 Chinese patients undergoing PCI was enrolled. This study was investigated the correlations between the two tests and performed receiver operating characteristic curve (ROC) analysis for major adverse cardiovascular events (MACEs) at 1-year follow-up.

Results:

MACEs occurred in 32 patients (4.1%). Correlations were well between the two tests in the adenosine diphosphate induced platelet reactivity (Spearman r = 0.733, P < 0.001). ROC-curve analysis demonstrated that LTA (area under the curve [AUC]: 0.677; 95% confidence interval [CI]: 0.643–0.710; P = 0.0009), and mTEG (AUC: 0.684; 95% CI: 0.650–0.716; P = 0.0001) had moderate ability to discriminate between patients with and without MACE. MACE occurred more frequently in patients with high on-treatment platelet reactivity (HPR) when assessed by LTA (7.4% vs. 2.7%; P < 0.001), and by TEG (6.7% vs. 2.6%; P < 0.001). Kaplan–Meier analysis demonstrated that HPR based on the LTA and mTEG was associated with almost 3-fold increased risk of MACE at 1-year follow-up.

Conclusions:

The correlation between LTA and mTEG is relatively high in Chinese patients. HPR measured by LTA and mTEG were significantly associated with MACE in Chinese patients undergoing PCI.     

Expression of co-stimulatory molecules B7-2 and PD-L1 on peripheral blood mononuclear cells in patients with chronic hepatitis B virus infection

Objective

To explore the roles of the expression of the co-stimulatory molecule, B7-2, and the co-inhibitory molecule, PD-L1, on peripheral blood mononuclear cells in the mechanism of immunotolerance in chronic hepatitis B virus infection.

Methods

Thirty HBV infected patients in the immunoreactive phase and 20 patients in the immunotolerant phase were enrolled in the study, while 20 healthy volunteers were used as controls. RT- PCR and real-time PCR methods were used to detect the expression levels of B7-2 and PD-L1 mRNA in peripheral blood mononuclear cells in chronic HBV infected patients.

Results

The B7-2 expression in immunoreactive and immunotolerant patients was significantly lower than that in the controls (P all < 0.01); B7-2 expression in immunoreactive patients was significantly lower than in immunotolerant patients (P < 0.01). PD-L1 expression in immunoreactive patients and immunotolerant patients was significantly higher than that in normal controls (P all < 0.01). The PD-L1/B7-2 ratios in immunoreactive and immunotolerant patients were significantly higher than that of the healthy controls (P all < 0.01); the PD-L1/B7-2 ratio was significantly higher in the immunoreactive patients than in the immunotolerant patients (P < 0.01).

Conclusion

In chronic HBV infection, changes in the expression of co-stimulatory and co-inhibitory molecules imply a protective adjustment against the patient's immune response that may result in increased immunotolerance and persistent HBV infection.     

Effects of a Pharmacist-to-Dose Computerized Request on Promptness of Antimicrobial Therapy

Objectives

To examine the effects of computerized requests for pharmacist-to-dose (PTD), an advanced clinical decision support tool for dosing guidance, on antimicrobial therapy with vancomycin and aminoglycosides, describe PTD request utilization, and identify factors that may prolong this process.

Design

A retrospective review was conducted of patients hospitalized from Jan 2004 to Jun 2006 with suspected pneumonia who received vancomycin, tobramycin, or gentamicin via PTD (study) or routine provider order entry (control).

Measurements

The primary endpoint was time to pharmacist completion of PTD request. Secondary data points included medication turn-around times for first doses of vancomycin or aminoglycosides and for first doses of any antibiotic, dose adjustment for renal dysfunction, medication errors, and time of order entry. Multivariate analysis was conducted to identify predictors of total time to pharmacist verification and time to administration of first doses of vancomycin or aminoglycosides.

Results

Median time for pharmacist completion of PTD requests was 29 minutes. Delays were noted in the study group (n = 49) by comparison with the control group (n = 48) for median time to first dose of vancomycin or aminoglycoside (185 vs. 138 min, p = 0.45) and for any antibiotic (134 vs. 118 min, p = 0.42), respectively. Fewer medication errors were reported in the study group (5 vs. 18 errors, p = 0.002). In a multivariate model, PTD was not significantly predictive of time to pharmacy verification or medication turn-around time.

Conclusions

Pharmacists completed pharmacist-to-dose consultations for dosing guidance of vancomycin and aminoglycosides within a median of 30 minutes. Implementation of a computerized request for clinical pharmacists to provide medication-related clinical decision support increased medication turn-around time of vancomycin and aminoglycosides and reduced medication errors. Consultation of clinical pharmacists by computerized request for initial antibiotic dosing of medications with narrow therapeutic windows is an option for medication-related clinical decision support but providers should be aware that consultation may delay medication turn-around time.     

Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population: Results from a Nationally Representative Survey

Background:

Nontraumatic osteonecrosis of the femoral head (NONFH) is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population.

Methods:

A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging examination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH.

Results:

NONFH was diagnosed in 218 subjects (0.725%) and the estimated NONFH cases were 8.12 million among Chinese people aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females (1.02% vs. 0.51%, χ² = 24.997, P < 0.001). Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents (0.85% vs. 0.61%, χ² = 5.847, P = 0.016). Our multivariate regression analysis showed that high blood levels of triglycerides, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head, heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH.

Conclusions:

Our findings highlight that NONFH is a significant public health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares a number of risk factors with atherosclerosis.     

Obstructive Sleep Apnea Hypopnea Syndrome as a Reason for Active Management of Pulmonary Embolism

Background:

Obstructive sleep apnea hypopnea syndrome (OSAHS) constitutes an independent factor for high warfarin dose for patients with pulmonary embolism (PE). The aim of this study was to investigate whether the 6-month anticoagulation treatment by warfarin is enough for patients with PE complicated by OSAHS.

Methods:

We investigated 97 PE patients, 32 of them had OSAHS and 65 non-OSAHS. Warfarin was administered for 6-month if no abnormal circumstances occurred. All patients were followed up for 18 months. Adverse events (AE) included death, major bleeding, hospitalization due to heart failure or pulmonary hypertension, and recurrence or aggravation of PE (including deep vein thrombosis). Recurrence rate of PE after warfarin cessation was compared between the two groups.

Results:

OSAHS patients required a significantly higher dose of warfarin than their non-OSAHS counterparts (4.73 mg vs. 3.61 mg, P < 0.001). During warfarin treatment, no major bleeding and aggravation of PE occurred among OSAHS patients, and the rates of various AE were not significantly different between the OSAHS and non-OSAHS groups. PE recurrence was higher in OSAHS than non-OSAHS groups after withdrawal of warfarin (21.43% vs. 6.78%, P = 0.047). Compared with non-OSAHS patients, OSAHS group had lower international normalized ratio (INR) value but higher plasminogen on baseline and INR resumed to a relatively low level after warfarin discontinuation.

Conclusions:

OSAHS patients may present with hypercoagulation and relatively high-risk of recurrence of PE after cessation of 6-month warfarin treatment.     

Postoperative Stimulated Thyroglobulin Level and Recurrence Risk Stratification in Differentiated Thyroid Cancer

Background:

Postoperative preablative stimulated thyroglobulin (ps-Tg) has been evaluated in predicting prognosis and success of ablation regarding differentiated thyroid cancer (DTC); however, its relationship with recurrence risk and radioiodine decision-making remains uncertain, especially in Chinese DTC patients. We aimed to evaluate the association between ps-Tg and recurrence risk stratification in DTC, to provide incremental values for ps-Tg in postoperative assessment and radioiodine management.

Methods:

Seven hundred and seven patients with DTC were included; low-risk (L; n = 90), intermediate-risk (I; n = 283), and high-risk (H; n = 334, 117 with distant metastasis [M1]) patients were divided according to recurrence risk stratification. The M1 group was further analyzed regarding evidence of metastasis. Cut-off values of ps-Tg were obtained using receiver operating characteristic analysis.

Results:

Patients with more advanced disease at initial risk stratification were more likely to have higher ps-Tg levels (I vs. L: P < 0.05; H vs. I: P < 0.001; H vs. L: P < 0.001). The corresponding cut-off value of ps-Tg for distinguishing sensitivity and specificity in each of the two groups was 2.95 ng/ml (I vs. L: 61.5%, 63.3%), 29.5 ng/ml (H vs. I: 41.9%, 92.6%), 47.1 ng/ml (M1 vs. M0 in the H group: 79.5%, 88.9%) and 47.1 ng/ml (M1 vs. M0 in all patients: 79.5%, 93.7%). With the cut-off value at 47.1 ng/ml, ps-Tg was the only factor that could be used to identify distant metastases, and consequently if measured before radioiodine therapy would prevent 10.26% of patients with M1 from undertreatment.

Conclusions:

Ps-Tg, as an ongoing reassessment marker, favors differential recurrence risk grading and provides incremental values for radioiodine treatment decision-making.     

Cigarette Smoking Increases Risk for Incident Metabolic Syndrome in Chinese Men—Shanghai Diabetes Study

Objective To determine whether smoking increases the risk for developing metabolic syndrome (MetS) in Chinese men.Methods A total of 693 men with no MetS at baseline were followed for 2.9‐5.5 years.Subjects were divided into nonsmokers,ex‐smokers,and current smokers according to baseline smoking status.Results After adjusting for age,education level,alcohol intake,fasting plasma insulin,HOMA‐IR index,and BMI at baseline and weight change,current smokers were dose‐dependently associated with increased risk f...     

Power to Detect Spatial Disturbances under Different Levels of Geographic Aggregation

Objective

Spatio and/or temporal surveillance systems are designed to monitor the ongoing appearance of disease cases in space and time, and to detect potential disturbances in either dimension. Patient addresses are sometimes reported at some level of geographic aggregation, for example by ZIP code or census tract. While this aggregation has the advantage of protecting patient privacy, it also risks compromising statistical efficiency. This paper investigated the variation in power to detect a change in the spatial distribution in the presence of spatial aggregation.

Methods

The authors generated 400,000 spatial datasets with varying location and spread of simulated spatial disturbances, both on a purely synthetic uniform population, and on a heterogeneous population, representing hospital admissions to three community hospitals in Cape Cod, Massachusetts. The authors evaluated the power of the M-statistic to detect spatial disturbances, comparing the use of exact spatial locations versus twelve different levels of aggregation, where the M-statistic is a comparison of two distributions of interpoint distances between locations.

Results

When the spread of simulated spatial disturbances was contained to a small portion of the study region or affects a large proportion of the population at risk, power was highest when exact locations were reported. If the spatial disturbance was a more modest signal, the best power was attained at an aggregated level.

Conclusions

The precision at which patients' locations are reported has the potential to affect the power of detection significantly.     

The Efficacy and Safety of Wenxin Keli in Patients with Frequent Premature Ventricular Contractions: A Randomized,Double-blind,Placebo-controlled,Parallel-group,Multicenter Trial

Background:

Premature ventricular contractions (PVCs) are common in the general population, and frequent PVCs may result in the poor quality of life or even the damage of cardiac function. We examined the efficacy and safety of a traditional Chinese medicine Wenxin Keli for the treatment of frequent PVCs among a relatively large Chinese cohort.

Methods:

We performed a randomized, double-blind, placebo-controlled, parallel-group, multicenter trial. A total of 1200 eligible participants were randomly assigned in a ratio of 1:1 to receive Wenxin Keli or the placebo for 4 weeks. The primary and secondary endpoint was the change of PVC numbers and PVC-related symptoms after a 4-week treatment compared with baseline, respectively. In addition, vital signs, laboratory values, and electrocardiographic parameters were assessed in a safety analysis.

Results:

At the initial evaluation, no significant differences in the baseline characteristics were observed between the Wenxin Keli group and the placebo group. A smaller number of PVCs was observed after the 4-week treatment than at baseline, in both the Wenxin Keli group (5686 ± 5940 vs. 15,138 ± 7597 beats/d, P < 0.001) and the placebo group (10,592 ± 8009 vs. 14,529 ± 5929 beats/d, P < 0.001); moreover, the Wenxin Keli group demonstrated a significantli greater reduction in the frequency of PVCs than the placebo group (P < 0.001). In a full analysis set, patients in the Wenxin Keli group exhibited significantly higher total effective responses in the reduction of PVCs compared to those in the placebo group (83.8% vs. 43.5%, P < 0.001). The per-protocol analysis yielded similar results (83.0% vs. 39.3%, P < 0.001). Treatment with Wenxin Keli also demonstrated superior performance compared to the placebo with respect to PVC-related symptoms. No severe adverse effects attributable to Wenxin Keli were reported.

Conclusions:

Wenxin Keli treatment effectively reduced the overall number of PVCs and alleviated PVC-related symptoms in patients without structural heart diseases and had no severe side effects.     

Randomized Trial of Immediate Postoperative Pain Following Single-incision Versus Traditional Laparoscopic Cholecystectomy

Background:

We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy (SILC) was more beneficial for reducing postoperative pain than traditional laparoscopic cholecystectomy (TLC). Moreover, the influencing factors of SILC were analyzed.

Methods:

A total of 552 patients with symptomatic gallstones or polyps were allocated randomly to undergo SILC (n = 138) or TLC (n = 414). Data on postoperative pain score, operative time, complications, procedure conversion, and hospital costs were collected. After a 6-month follow-up, all data were analyzed using the intention-to-treat principle.

Results:

Among SILC group, 4 (2.9%) cases required conversion to TLC. Mean operative time of SILC was significantly longer than that of TLC (58.97 ± 21.56 vs. 43.38 ± 19.02 min, P < 0.001). The two groups showed no significant differences in analgesic dose, duration of hospital stay, or cost. Median pain scores were similar between the two groups 7 days after surgery, but SILC-treated patients had a significantly lower median pain score 6 h after surgery (10-point scale: 3 [2, 4] vs. 4 [3, 5], P = 0.009). Importantly, subgroup analyses of operative time for SILC showed that a longer operative time was associated with greater prevalence of pain score >5 (≥100 min: 5/7 patients vs. <40 min, 3/16 patients, P = 0.015).

Conclusions:

The primary benefit of SILC appears to be slightly less pain immediately after surgery. Surgeon training seems to be important because the shorter operative time for SILC may elicit less pain immediately after surgery.     

BHMT gene polymorphisms as risk factors for cleft lip and cleft palate in a Chinese population

Objective Convincing evidence suggests a link between increased risk of nonsyndromic cleft lip with or without cleft palate (NSCL/P) and low intake of folic acid by the mother during pregnancy. The present study was designed to explore if genetic variation in the betaine‐homocysteine methyltransferase (BHMT) gene contributes to NSCL/P. Methods DNA was obtained from 166 individuals with NSCL/P and 285 healthy subjects. Three known single nucleotide polymorphisms (SNPs) present in the BHMT gene (rs651852, rs3...     

Predictors of Student Success in Graduate Biomedical Informatics Training: Introductory Course and Program Success

Objective

To predict student performance in an introductory graduate-level biomedical informatics course from application data.

Design

A predictive model built through retrospective review of student records using hierarchical binary logistic regression with half of the sample held back for cross-validation. The model was also validated against student data from a similar course at a second institution.

Measurements

Earning an A grade (Mastery) or a C grade (Failure) in an introductory informatics course.

Results

The authors analyzed 129 student records at the University of Texas School of Health Information Sciences at Houston (SHIS) and 106 at Oregon Health and Science University Department of Medical Informatics and Clinical Epidemiology (DMICE). In the SHIS cross-validation sample, the Graduate Record Exam verbal score (GRE-V) correctly predicted Mastery in 69.4%. Undergraduate grade point average (UGPA) and underrepresented minority status (URMS) predicted 81.6% of Failures. At DMICE, GRE-V, UGPA, and prior graduate degree significantly correlated with Mastery. Only GRE-V was a significant independent predictor of Mastery at both institutions. There were too few URMS students and Failures at DMICE to analyze. Course Mastery strongly predicted program performance defined as final cumulative GPA at SHIS (n = 19, r = 0.634, r² = 0.40, p = 0.0036) and DMICE (n = 106, r = 0.603, r² = 0.36, p < 0.001).

Conclusions

The authors identified predictors of performance in an introductory informatics course including GRE-V, UGPA and URMS. Course performance was a very strong predictor of overall program performance. Findings may be useful for selecting students for admission and identifying students at risk for Failure as early as possible.     

A Multicentre Prospective Evaluation of the Impact of Renal Insufficiency on In-hospital and Long-term Mortality of Patients with Acute ST-elevation Myocardial Infarction

Background:Numerous previous studies have shown that renal insufficiency (RI) in patients with acute coronary syndrome is associated with poor cardiovascular outcomes.These studies do not well address ...