Optimizing severe acute respiratory syndrome response strategies: lessons learned from quarantine

Taiwan used quarantine as 1 of numerous interventions implemented to control the outbreak of severe acute respiratory syndrome in 2003. From March 18 to July 31, 2003, 147,526 persons were placed under quarantine. Quarantining only persons with known exposure to people infected with severe acute respiratory syndrome could have reduced the number of persons quarantined by approximately 64%. Focusing quarantine efforts on persons with known or suspected exposure can greatly decrease the number of persons placed under quarantine, without substantially compromising its yield and effectiveness.     

Primary Signet Ring Cell/Histiocytoid Carcinoma of the Eyelid: Somatic Mutations in CDH1 and Other Clinically Actionable Mutations Imply Early Use of Targeted Agents

Primary signet ring cell/histiocytoid carcinoma of the eyelid is a rare ocular malignancy and its diagnosis is often delayed. This neoplasm presents as an insidious, diffusely infiltrative mass in the periocular area that later infiltrates the orbit. An exenteration is usually indicated; however, nearly one-third of patients develop local recurrence or metastasis. Morphologically, it resembles signet ring cell carcinoma of the stomach and breast, raising the possibility of mutations in CDH1, the gene encoding E-cadherin. To determine whether primary signet ring cell/histiocytoid carcinoma harbors the CDH1 mutation or other actionable mutations, we analyzed the tumor tissue via next-generation sequencing. We identified only one case of primary signet ring cell carcinoma of the eyelid with adequate DNA quality for sequencing from the pathological archive during the period 2000 to 2020. A comprehensive evaluation including histopathology, immunohistochemistry, and next-generation sequencing assay was performed on tumor tissue. Immunohistochemically, the tumor exhibited E-cadherin membranous staining with the aberrant cytoplasmic staining of β-catenin. Using next-generation sequencing, we demonstrated the mutation in the CDH1 gene. In addition, other clinically actionable mutations including ERBB2 and PIK3CA were also detected. The alterations in other actionable genes indicate a need for larger studies to evaluate the pathogenesis and potential therapies for primary signet ring cell/histiocytoid carcinoma of the eyelid.     

Screening for cervical cancer among female physicians and their relatives in Taiwan: a population-based comparative study

BACKGROUND: This study compares the practice of having the recommended Pap smear test every 3 years among female physicians, female relatives of physicians, and general women of similar socio-economic background. METHODS: This population-based cohort study followed a total of 5,815,781 Taiwanese women from January 2001 to December 2003, who were 30 years of age or older in 2001. Of the total study population, 1950 were physicians and 27,441 were female relatives of physicians. Multiple logistical regression models were used. RESULTS: After adjusting for age, ethnic status, physical disability status, and place of residence, of those women whose monthly insurable income was greater than $NT 40,000, female physicians (OR 0.54, 95% CI: 0.50-060) were the least likely to have undergone at least one Pap smear test during the three-year study period. The physicians' relatives (OR 0.90, 95% CI: 0.87-0.92) were also significantly less likely to take routine Pap smear tests compared to general women with equivalent socio-economic background. CONCLUSIONS: The female physician is a major player in disease prevention with advanced knowledge of the benefits associated with the Pap smear test, but may not adhere any better to the recommendations than the general population.     

Explaining China's regional health expenditures using LM-type unit root tests

This paper investigates the relationship between health care expenditure, income, and other factors that are not related to income for China with pooled cross-section and time series data. To study the stationarity property of these variables, we use panel Lagrange Multiplier (LM) unit root tests that allow for structural changes. To perform the LM unit root tests, we employ finite-sample critical values derived through the bootstrap method, instead of relying on the critical values from the asymptotic normal distribution. An important finding based on the estimated panel cointegrated regressions is that the government budget deficits have a significant long-run impact on China's health care expenditure. This provides supportive evidence on the differences between rich and poor areas in China's health care financing policy, and the substantial disparities in health service coverage in China.     

Seroprevalence of HBV in immigrant pregnant women and coverage of HBIG vaccine for neonates born to chronically infected immigrant mothers in Hsin-Chu County, Taiwan

This study was carried out to assess the prevalence of HBsAg positivity and coverage rate of antenatal HBV screening among immigrant women. In addition, the extent of administration of HBIG plus HB vaccine #1 to neonates born to chronically infected (HBeAg-positive/HBsAg-positive) mothers was assessed. All pregnant women residing in Hsin-Chu County, Taiwan and giving birth during 2004-2006 were recruited. Among all 16926 cases, the prevalence of HBsAg positivity according to their ethnicities was Mainland Chinese, 11.0% (68/616); Indonesian, 3.5% (15/426); Vietnamese, 7.4% (42/568); aboriginal Taiwanese, 20.6% (109/530); and non-aboriginal Taiwanese 11.5% (1536/13368). Among the HBsAg carriers, the prevalence of HBeAg positivity was Mainland Chinese, 52.9% (36/68); Indonesian, 53.3% (8/15); Vietnamese, 45.2% (19/42); aboriginal Taiwanese, 47.7% (52/109); and non-aboriginal Taiwanese, 26.8% (411/1534). With non-aboriginal Taiwanese as the reference category, results of multiple logistic regression revealed the healthy immigrant phenomenon in the HBsAg carriage state among pregnant women from Indonesia (OR 0.30; CI 95%: 0.18-0.50) and Vietnam (OR 0.68; CI 95%: 0.49-0.93). On the contrary, among chronically infected mothers, Mainland Chinese showed the highest risk for HBeAg positivity (OR 2.79; CI 95%: 1.7-4.58). More efforts should be made to improve HBV infection among aboriginal Taiwanese pregnant women who were more vulnerable to HBsAg positivity (OR 2.15; CI 95%: 1.72-2.68) and HBeAg positivity (OR 1.93; CI 95%: 1.28-2.90). Age was another independent predictor for HBsAg positivity (OR 1.02; CI 95%: 1.01-1.03) and for HBeAg positivity among chronically infected mothers (OR 0.93; CI 95%: 0.91-0.96). The coverage rates of antenatal HBV screening and HBIG plus HB vaccine #1 showed no difference among these multiple ethnic subgroups. In 2006, the overall coverage rate of antenatal HBV screening was 98.7% (5546/5639), with the individual rate being Mainland Chinese, 100% (267/267); Indonesian, 97.2% (106/109); Vietnamese, 99.5% (201/202); aboriginal Taiwanese, 97.0% (196/202); and non-aboriginal Taiwanese, 99.8% (4776/4785). The administration rate of HBIG plus HB vaccine #1 was 100% for all ethnic subgroups.     

Association of idiopathic generalized epilepsy with polymorphisms in the neuronal nicotinic acetylcholine receptor subunits

Idiopathic generalized epilepsy (IGE) refers to a common group of epilepsies, and genetic factors play an important role in the pathogenesis of these disorders. Mutations in CHRNA4 and CHRNB2 are associated with some cases of familial epilepsies classified as autosomal-dominant nocturnal frontal lobe epilepsies. We aimed to evaluate whether polymorphisms of CHRNA4 and CHRNB2 are associated with IGE. A total of 75 children with IGE and 80 normal control subjects were included in the study. Each genetic polymorphism was typed by polymerase chain reaction (PCR)-based restriction analysis. The genotypes and allelic frequencies of each polymorphism were compared between the IGE patients and controls. The results showed that genotype and allelic frequency for CHRNB2 did not differ significantly between the groups. However, the genotype proportion of the CHRNA4 (Ser543Ser) gene in both groups was significantly different (P<0.0001). The T allele frequency was significantly higher (P=0.0126) in patients with IGE compared to healthy controls. The odds ratio (OR) for developing IGE in individuals with the CHRNA4 (Ser543Ser)-T homozygote was 4.9 (95% confidence interval (CI), 1.71-14.04) compared to individuals with two copies of the CHRNA4 (Ser543Ser)-C allele. This study demonstrates that the CHRNA4 gene may be one of the susceptibility factors for IGE.     

Synthesis and biological effects of 2''-fluoro-5-ethyl-1-beta-D-arabinofuranosyluracil.

2'-Fluoro-5-ethyl-1-beta-D-arabinofuranosyluracil (FEAU) was synthesized, and its biological activities were compared with those of 2'-fluoro-5-methyl-1-beta-D-arabinofuranosyluracil (FMAU). Earlier studies indicated that both compounds showed potent anti-herpes simplex virus activity, with a 50% effective dose (ED50) of less than 0.25 microM. In the present study the cell growth inhibitory activity of FEAU (ED50, 200 to 2,060 microM) was found to be about 100-fold less than that of FMAU. With an ED50 ranging from 630 to 3,700 microM, FEAU only weakly inhibited thymidine incorporation into DNA, as compared with FMAU with an ED50 of 9 to 28 microM. Following exposure to [2-14C]FEAU (100 microM), 0.48 pmol/10(6) cells per h was incorporated into the DNA of herpes simplex virus type 1-infected Vero cells, whereas no detectable incorporation was found in uninfected Vero cells or L1210 cells. The Ki of FEAU for thymidine kinase purified from human leukemic cells was greater than 150 microM. For herpes simplex virus type 1- and 2-encoded thymidine kinases, the Kis were 0.6 and 0.74 microM, respectively. Both FEAU and FMAU were relatively nontoxic for mice, with a 50% lethal dose of greater than 800 mg/kg per day (four intraperitoneal doses). However, the lethal dose of FEAU for dogs was 100 mg/kg per day (10 intravenous doses), a dose which is 40- to 80-fold greater than the toxic dose of FMAU. These results suggest that FEAU is a worthy candidate for further development as an antiherpetic agent.     

Myofascial pain and treatment: Editorial a critical overview of the current myofascial pain literature – August 2019

This quarter's overview of the myofascial pain literature includes quite a few basic research papers in addition to the usual high quantity of dry needling (DN) papers. Of particular interest are a study by Fischer and colleagues studying the role of mitochondrial functions in chronic trigger points (TrPs) (Fischer et al 2018), a study by Li and associates who conducted a quantitative proteomics analysis to identify biomarkers of chronic myofascial pain and therapeutic targets of dry needling in a rat model of TrPs (Li et al 2019), and a sonography study by Mitchell et al. looking into the distances from the skin to the pleura in the context of DN (Mitchell et al 2019). A total of 33 papers are included in this overview article.We welcome Dr. Jacob Thorp to our team of authors. Dr. Thorp is a US-based physical therapist. He is Professor and Founding Director of the Physical Therapy Program at Charleston Southern University in North Charleston, SC.