New-onset atrial fibrillation-related ischemic stroke occurring after hospital discharge in septicemia survivors.

BACKGROUND: Sepsis will induce stroke, new-onset atrial fibrillation (AF) increase ischemic stroke (IS) in in-hospitalization and long-term period after sepsis. Physicians must alert this condition and given suitable treatment. AIM: The associated of IS and new-onset AF in septicemia survivors after discharge have to be evaluated. DESIGN: The inpatient data was used of the Taiwan National Health Insurance Database (NHIRD) in 2010. We identified patients suffered their first occurrence of septicemia (International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] is 038, 003.1, 036.1) and excluded less than 18 years old. Patients had AF (ICD-9-CM to 427.3×) during the same admission or after septicemia hospitalization discharged were defined as new-onset AF. The outcome was IS happened after septicemia discharge (ICD-9-CM as 433-437). METHODS: The factors related to IS after septicemia survival were established using multivariate logistic regression with forward stepwise selection. RESULTS: There were 1286 new-onset AF and 1026 IS happened after septicemia discharge. The crude odds ratio (OR) were 3.88 (95% confidence interval [C.I.]: 1.69-8.89) and 1.62 (95% C.I.: 1.14-2.3) in middle-aged and elderly septicemia survivors with new-onset AF induced IS. The risk of IS after septicemia survivors was noticed adjusted OR 1.74 (95% C.I.: 1.26-2.41) for new-onset AF. CONCLUSION: The middle-aged and elderly septicemia survivors suffered from new-onset AF had increased incidence of IS within three months. New-onset AF was a mediator factor of IS in septicemia survivors of Asian population.

Sjögren's syndrome associated with protein losing gastroenteropathy manifested by intestinal lymphangiectasia successfully treated with prednisolone and hydroxychloroquine.

Protein-losing gastroenteropathy (PLGE), a rare manifestation of primary Sjögren's syndrome (SS), is characterized by profound edema and severe hypoalbuminemia secondary to excessive serum protein loss from the gastrointestinal tract and is clinically indistinguishable from nephrotic syndrome. We report a case of a 30-year-old Taiwanese woman with PLGE-associated SS. In addition to a positive Schirmer's test, she had eye-dryness, thirst, and high levels of anti-SSA antibodies, fulfilling SS criteria. PLGE diagnosis was highly appropriate given the clinical profile of hypoalbuminemia, hypercholesterolemia, pleural effusion, and ascites, with absent cardiac, hepatic, or renal disease. We were unable to perform technetium-99 m-labeled human serum albumin scintigraphy ((99m)Tc-HAS). However, the patient's edema and albumin level improved dramatically in response to a 3-month regime of oral prednisolone followed by oral hydroxychloroquine.

Pulsed radiofrequency inhibited activation of spinal mitogen-activated protein kinases and ameliorated early neuropathic pain in rats.

Background: Pulsed radiofrequency (PRF) has been widely used to treat chronic pain, but the effectiveness and mechanisms in preventing early neuropathic pain have not been well explored. Even fewer knowledge is available in its impact on glia-mediated nociceptive sensitization. This study aims to elucidate the modulation of PRF on nerve injury-induced pain development and activation of spinal mitogen-activated protein kinases (MAPKs). Methods: In a rat spinal nerve ligation (SNL) model, a low-volt PRF treatment was applied to the L5 dorsal root ganglion after nerve injury. Nociceptive behaviours were measured by von Frey and heat withdrawal tests at multiple time points. MAPK activations, including p-ERK and p-p38, as well as TNF-á level in the spinal dorsal horn were assessed and the cell types that expressed MAPK activation were identified by double immuno fluorescence staining.Results: We found that SNL promptly induced neuropathic pain in the affected hind limb for over 1 week as well as increased p-ERK and p-p38 in the spinal dorsal horn. PRF significantly attenuated SNL-induced mechanical allodynia and thermal hyperalgesia for 5­7 days. PRF also inhibited ERK and p38 activations, which were found majorly located within neurons and microglia, respectively. Besides, PRF significantly suppressed expression of TNF-á in the spinal dorsal horn throughout the course. Conclusions: Low-volt PRF significantly ameliorated SNL-induced acute pain. Inferentially, PRF may inhibit spinal sensitization by down-regulating spinal MAPK activations and activation-mediated cytokine release.We demonstrated that early PRF treatment in acute nerve injury helps to ameliorate neuropathic pain development.

Effects of the apolipoprotein E ε4 allele on functional MRI during n-back working memory tasks in healthy middle-aged adults.

BACKGROUND AND PURPOSE: APOE4 is the best-documented genetic risk factor for sporadic AD. Previous research showed that APOE4 is associated with increased risk of occurrence and earlier onset of AD in a gene dose-dependent manner. However, the specific role of APOE4 in processing of brain functions requires further investigation. Investigators have used fMRI to measure brain activity on the basis of the blood oxygen level-dependent contrast. This study investigates the effects of APOE4 on fMRI during n-back WM tasks in healthy middle-aged adults. MATERIALS AND METHODS: From 110 participants, 81 individuals without objective or subjective cognitive impairment underwent APOE genotyping. Nine APOE4 carriers and 9 age- and sex-matched non-APOE4 controls were recruited for fMRI examinations during WM tasks. RESULTS: Both groups displayed increased brain activation in response to increases in WM loads. During low-WM-load tasks, the APOE4 carriers recruited significantly greater additional processing resources than the non-APOE4 carriers. During moderate- and high-WM-load tasks, the APOE4 carrier group displayed fewer increases in activation than the non-APOE4 carrier group. CONCLUSIONS: APOE genetic polymorphisms may affect brain functioning in subjects without dementia. The patterns of brain activation during different levels of WM load suggest possible subclinical impairment of WM capacity in APOE4 carriers (ClinicalTrials.gov registration: NCT01287819).

Developing an NLP and IR-based algorithm for analyzing gene-disease relationships.

OBJECTIVES: High-throughput techniques such as cDNA microarray, oligonucleotide arrays, and serial analysis of gene expression (SAGE) have been developed and used to automatically screen huge amounts of gene expression data. However, researchers usually spend lots of time and money on discovering gene-disease relationships by utilizing these techniques. We prototypically implemented an algorithm that can provide some kind of predicted results for biological researchers before they proceed with experiments, and it is very helpful for them to discover gene-disease relationships more efficiently. METHODS: Due to the fast development of computer technology, many information retrieval techniques have been applied to analyze huge digital biomedical databases available worldwide. Therefore we highly expect that we can apply information retrieval (IR) technique to extract useful information for the relationship of specific diseases and genes from MEDLINE articles. Furthermore, we also applied natural language processing (NLP) methods to do the semantic analysis for the relevant articles to discover the relationships between genes and diseases. RESULTS: We have extracted gene symbols from our literature collection according to disease MeSH classifications. We have also built an IR-based retrieval system, "Biomedical Literature Retrieval System (BLRS)" and applied the N-gram model to extract the relationship features which can reveal the relationship between genes and diseases. Finally, a relationship network of a specific disease has been built to represent the gene-disease relationships. CONCLUSIONS: A relationship feature is a functional word that can reveal the relationship between one single gene and a disease. By incorporating many modern IR techniques, we found that BLRS is a very powerful information discovery tool for literature searching. A relationship network which contains the information on gene symbol, relationship feature, and disease MeSH term can provide an integrated view to discover gene-disease relationships.

Theoretical simulation of holographic polymer-dispersed liquid-crystal films via pattern photopolymerization-induced phase separation.

A theoretical simulation has been performed to elucidate the emergence of nematic domains during pattern photopolymerization-induced phase separation in holographic polymer-dispersed liquid crystals. We consider a reference system consisting of a single-component nematic, namely, 4-n-heptyl-4(')-cyanobiphenyl (T(NI)=42 degrees C), and a polymer network made from multifunctional monomers. To mimic pattern photopolymerization, the reaction rate was varied periodically in space through wave mixing. In the theoretical development, the photopolymerization kinetics was coupled with the time-dependent Ginzburg-Landau model C equations by incorporating the local free energy densities pertaining to isotropic liquid-liquid mixing, nematic ordering, and network elasticity. The simulated morphological patterns in the concentration and orientation order parameter fields show discrete layers of liquid-crystal droplets alternating periodically with polymer-network-rich layers. The Fourier transforms of these patterns show sharp diffraction spots arising from the periodic layers. As the layer thickness is reduced, the liquid-crystal molecules are confined in the narrow stripes. The liquid-crystal domains appear uniform along the stripes, which in turn gives rise to sharper diffraction spots in Fourier space. Of particular interest is that our simulated stratified patterns are in qualitative agreement with reported experimental observations.

The relationship of late potentials to assessment of heart rate variability in post-infarction patients.

In order to investigate the relationship of late potential (LP) to assessment of heart rate variability (HRV) after acute myocardial infarction (AMI), we studied 101 Chinese patients with AMI (10+/-2.4 days) in Taiwan by collecting 24-h ECG from a Holter tape recorder and signal-averaged ECG from a high-resolution ECG cart. Of the 101 patients, 36 patients had LP (LP group) and 65 patients did not (NLP group). The mean heart rate was significantly lower in the LP group than in the NLP group (P<0.05). The LP group had a significantly increased high-frequency (HF) spectral component of HRV compared with the NLP group (P<0.005), but their low-frequency (LF) to HF ratio (LF/HF) was lower (P<0.05). Analysis of the circadian variation of HRV revealed significant difference of morning SDRR (standard deviation of normal RR intervals) compared with noon SDRR (P<0.05 in the LP group, P<0.005 in the NLP group) and evening SDRR (P<0.05 in the LP group, P<0.005 in the NLP group). In the NLP group, morning HF (normalized unit, nu) was 0.258+/-0.098 compared with noon HF (nu) of 0.219+/-0.83 (P<0.05) and evening HF (nu) of 0. 225+/-0.085 (P<0.05). Nine patients died during follow-up from cardiac causes, three (8.3%) in the LP group and six (9.2%) in the NLP group. In post-MI patients, there was higher vagal tone in patients with late potentials compared to those without late potentials. NLP patients had more circadian change in vagal tone compared with LP patients.

Esophageal PP intervals for analysis of short-term heart rate variability in patients with atrioventricular block before and after insertion of a temporary ventricular inhibited pacemaker.

Heart rate variability (HRV) analysis is a useful method for assessment of the activities of autonomic nervous system. The RR intervals in ECG is measured for this purpose. However, RR intervals are not suitable for HRV analysis in atrioventricular block (AV) block patients with ventricular inhibited (VVI) pacemaker, as the intervals will be fixed by the ventricular pacemaker. Thus we used an esophageal lead to detect PP intervals for analysis of HRV. The aim of this study was to evaluate the short-term HRV by using an esophageal electrode to detect the atrial signal and PP intervals in AV block patients. Fifteen AV block patients before and after temporary VVI pacemaker and 15 subjects with normal AV conduction (control group) were enrolled in this study. The atrial signals from esophageal lead, ECG and intraatrial lead were recorded. The duration was 10 min. We compared correlation coefficient of PP intervals from different leads in AV block patients and the control group. We also compared the PP interval's variability parameters between the control group and AV block patients, before and after insertion of a temporary ventricular inhibited pacemaker. The esophageal PP intervals were excellently correlated with intraatrial AA intervals (r=0.98+/-0.01). The HRV using esophageal PP intervals with time domain demonstrated a significant decrease in patients with AV block (standard deviation of all PP intervals (SDNN) (s)=0.022+/-0.014; percentage difference between adjacent PP intervals that are greater than 50 ms (pNN-50) (%)=0.052+/-0.038; square root of the mean of squares of differences between duration of neighboring PP intervals (r-MSDD) (s)=0.322+/-0.082) but this returned to normal after insertion of a temporary ventricular inhibited pacemaker (SDNN (s)=0.035+/-0.009; pNN-50 (%)=2.540+/-1.682; r-MSDD (s)=0.542+/-0.190). However, the ratio of low frequency/high frequency (LF/HF) still increased (LF/HF=4.120+/-1.802). The result of this short-term HRV analysis suggested that withdrawal of vagal tone or increased sympathetic activity in AV block patients compared with the control group. This appearance was normalized after insertion of a temporary VVI pacemaker. however, abnormal sympathovagal balance still remained.

Heart rate variability in patients with atrioventricular block.

BACKGROUND: Heart rate variability (HRV) analysis has been an established method for assessment of the activities of autonomic nervous system. Conventionally, the RR intervals from the surface electrocardiogram (ECG) are used for HRV analysis, however, analysis of the RR intervals may not be suitable in patients with atrioventricular (AV) node dysfunction, particularly in patients with certain degree of AV block. We used an esophageal electrode to detect PP intervals for HRV analysis in these patients. METHODS: Seven AV block patients and 13 subjects with normal AV conduction (control group) were enrolled in this study. The signals from esophageal lead, surface lead and intraatrial lead were recorded. Correlation coefficient of heart beat intervals from different leads was analyzed. Then we compared the HRV parameter recorded by esophageal lead between AV block patients and the control group. RESULTS: The AA intervals in intraatrial ECG and the PP intervals in surface ECG were poorly correlated (r = 0.489) in the AV block patients. However, intraatrial ECG was correlated well with esophageal ECG (r = 0.968). HRV with time domain decreased significantly in patients with AV block. The standard deviation of NN intervals (SDNN), pNN-50 and r-MSSD in the control group and the AV block patients were 0.035 +/- 0.006 vs. 0.021 +/- 0.016 seconds (p = 0.002), 3.210 +/- 3.120 vs. 0.050 +/- 0.040% (p = 0.027) and 0.577 +/- 0.181 vs. 0.318 +/- 0.084 seconds (p = 0.009), respectively. CONCLUSIONS: The esophageal lead recording is a non-invasive, easy and safe method to detect HRV of AV block patients whose vagal activity is abnormal.

Systemic trichomoniasis in a squab operation.

Systemic trichomoniasis was responsible for severe morbidity and mortality in a commercial squab operation. Squabs of 1 to 3 weeks of age were primarily affected. Extensive caseous necrosis of the liver, heart, lung, and intestinal mesentery was observed grossly. Histologically, extensive heterophilic inflammation surrounded the necrotic areas and was observed perivascularly in areas that were uninvolved grossly. Numerous trichomonads were demonstrated in affected tissues with Bodian's silver stain.