Predictors of seasonal influenza and COVID-19 vaccination coverage among adults in Tennessee during the COVID-19 pandemic.

Background: The COVID-19 pandemic has convoluted hesitancy toward vaccines, including the seasonal influenza (flu) vaccine. Because of COVID-19, the flu season has become more complicated; therefore, it is important to understand all the factors influencing the uptake of these vaccines to inform intervention targets. This article assesses factors related to the uptake of influenza and COVID-19 vaccines among adults in Tennessee. Methods: A cross-sectional, secondary data analysis of 1,400 adults was conducted in Tennessee. The adult sample came from two data sources: Data source 1 completed a baseline survey from January to March 2022, and data source 2 was completed from May to August 2022. Data on vaccine attitudes, facilitators and barriers, and communication needs were collected via random digit dial by Scientific Telephone Samples (STS). Two multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to predict sociodemographic and overall vaccine-related factors associated with receipt or non-receipt (referent) of COVID-19 and influenza vaccines. Results: Approximately 78% of the adult sample had received the COVID-19 vaccination. A significant positive association for COVID-19 vaccine uptake was seen among those who were older (aged 50-65) (aOR = 1.9; 95% CI: 1.2-3.2), Black (aOR = 2.0; 95% CI:1.3-2.8), and had a college education and higher (aOR = 2.3; 95% CI: 1.5-3.6). However, there was a significant negative association for persons reporting they were extremely religious (aOR = 0.5; 95% CI:0.3-0.9). Over 56% of the adult sample had received the influenza vaccination this season. Those who had a higher annual household income ($80,000+) (aOR = 1.9; 95% CI: 1.3-2.6) and had health insurance (aOR = 2.6; 95% CI: 1.4-4.8) had a significant positive association with influenza vaccine receipt. However, those who were employed part-time or were unemployed had a significant negative association for influenza vaccine receipt (aOR = 0.7; 95% CI: 0.5-0.9). Both COVID-19 and influenza vaccine receipt had strongly significant positive trends with increasing belief in effectiveness and trust (p < 0.0001) and strongly significant negative trends with higher levels of overall vaccine hesitancy (p < 0.0001). Conclusion: Strategies to increase COVID-19 and influenza vaccination should be age-specific, focus on increasing geographical and financial access, and offer tailored messages to address concerns about these vaccines.

[Effects of extramedullary disease on patients with newly diagnosed multiple myeloma].

Objective: To summarize the characteristics of patients with newly diagnosed multiple myeloma (NDMM) admitted at Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine. We compared the clinical characteristics and prognoses among patients with non-extramedullary disease (EMD), bone-related extramedullary (EM-B) disease, and extraosseous extramedullary (EM-E) disease and further explored the effects of autologous hematopoietic stem cell transplantation (ASCT) for EMD. Methods: From January 2015 to January 2022, data of 114 patients (22%) with EMD out of 515 patients with NDMM were retrospectively analyzed; 91 (18%) and 23 (4%) patients comprised the EM-B and EM-E groups, respectively. The clinical characteristics of patients in all groups were compared with the Chi-square test. Progression-free survival (PFS) and overall survival (OS) of patients were analyzed by the Kaplan-Meier method. Independent prognostic factors were determined using multivariate Cox proportional hazard model. Results: There were no significant differences in age, gender, ISS stage, light chain, creatinine clearance, cytogenetic risk, 17p deletion, ASCT, and induction regimens among the three groups. Overall, 13% of EM-E patients had IgD-type M protein, which was significantly higher than that in EM-B patients (P=0.021). The median PFS of patients in the non-EMD, EM-B, and EM-E groups was 27.4, 23.1, and 14.0 months; the median OS was not reached, 76.8 months, and 25.6 months, respectively. The PFS (vs non-EMD, P=0.004; vs EM-B, P=0.036) and OS (vs non-EMD, P<0.001; vs EM-B, P=0.002) were significantly worse in patients with EM-E, while those were not significantly different between patients with EM-B and those with non-EMD. In the multivariate analysis, EM-E was an independent prognostic factor for OS in patients with NDMM (HR=8.779, P<0.001) and negatively impacted PFS (HR=1.874, P=0.050). In those who did not undergo ASCT, patients with EM-B had significantly worse OS than those with non-EMD (median 76.8 months vs. not reached, P=0.029). However, no significant difference was observed in the PFS and OS of patients with EM-B and those with non-EMD who underwent ASCT. Conclusions: Compared to patients with either non-EMD or EM-B, those with EM-E had the worst prognosis. EM-E was an independent risk factor for OS in patients with NDMM. ASCT can overcome the poor prognosis of EM-B.

[Clinical characteristics and prognosis of patients with newly-diagnosed multiple myeloma with t(11;14)].

Objective: To explore the clinical characteristics and prognosis of multiple myeloma (MM) patients with t(11;14). Methods: The clinical data of patients newly diagnosed with MM with t(11;14), which confirmed by fluorescence in situ hybridization (FISH), from January 1, 2016 to May 31, 2021 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine was retrospectively collected. A total of 45 patients were included. Bortezomib based induction therapy were given to 88.9% (40/45) patients, while 11.1% (5/45) received Imids-based therapy. Fourteen patients underwent the autologous hematopoietic stem cell transplantation (AHSCT). The clinical characteristics, overall response rate (ORR), progression free survival (PFS), overall survival (OS) and risk factors affecting survival were analyzed. Results: The average age of patients were (58.8±9.6) years, and 62.2%(28/45)were male. A relatively high incidence of bone lesion 82.2%(37/45)was observed. After 4 cycles induction therapy, the ORR was 66.7% (30/45), and ≥very good partial response (VGPR) was 31.3% (14/45). The rate of ≥VGPR increased to 92.9% (13/14) after AHSCT. The follow-up time [M(Q1,Q3)] was 27(20,42)months. The PFS was 34 (95%CI: 23-45) months, the median OS was 44 (95%CI:33-51) months. Median PFS were 48 (only 3 cases of progressive disease, CI not available) months and 24 (95%CI:13-35) months in the transplantation group and non-transplant group respectively (P=0.115). Median OS were 60 (only 1 case of death, CI not available) months and 48 (95%CI:22-74) months in the transplantation group and non-transplantation group, respectively (P=0.238). Cox regression analysis indicated that the number of plasma cell ≥50% in bone marrow and CD20 expression on myeloma cells were the risk factors for PFS[OR=3.272,95%CI:1.167-9.170,P=0.024;OR=3.480,95%CI:1.082-11.234,P=0.036]. No significant effective factor on OS was found. Conclusions: For multiple myeloma patient with t(11;14), the response rate with novel agents induction therapy is not high, but autologous stem cell transplantation can deepen remission. The high burden of bone marrow plasma cells and the expression of CD20 may be associated with the poor prognosis.

[Application of dural puncture epidural technique for labor analgesia].

Objective: To investigate the effects of dural puncture epidural technique for labor analgesia on mothers and neonates. Methods: From January to June 2019, one hundred healthy and nulliparous women, scheduled for elective labor analgesia in the Second Affiliated Hospital of Wenzhou Medical University, met inclusion criteriaand were recruitedin this prospective study. The inclusion criteria are as follows: American Society of Anesthesiologists physical statusⅠorⅡ, New York Heart Association gradeⅠorⅡ,150-175 cm in height,50-90 kg in weight and 37-45 weeks of gestation. They were randomly divided into epidural analgesia group(group P, n=50)and dural puncture epidural group(group D, n=50) by using random number table. Parturients in group D received epidural catheterization immediate after successful epidural puncture, while parturients in group P received a single dural puncture into subarachnoid space with a 27 gauge needle (successful puncture: outflow of cerebrospinal fluid) before epidural catheterization. Epidural labor analgesia was performed with epidural infusion of 0.1% ropivacaine plus 0.25 µg/ml sufentanil in both groups. The VAS scores were evaluated at the following time points: before epidural infusion, each uterine contraction within 30 min after infusion, 30 min, 60 min and 90 min after infusion and withdrawal of infusion. Labor process, mode of delivery, cases of increased oxytocin using, effective PCA pressings, sufentanil and ropivacaine dosages, complications of analgesia, neonatal status were recorded, as well. Results: There were no significant differences in labor duration, mode of delivery, analgesia complications (nausea and vomiting, itching, headache after delivery and Bromage score for motor block), deceleration of fetal heart rate and neonatal Apgar score between the two groups (P>0.05). The number of effective PCA pressings, sufentanil dosage, ropivacaine dosage and cases of increased using of oxytocin were significantly more in group P(t=8.663,7.024,6.509,χ(2)=4.159,all P<0.05), with (8.6±2.5) times, (29±4) µg,(105±15) mg,28% in group P, compared with (4.6±2.1) times,(23±4) µg,(88±12) mg,10% in group D, respectively. The first four VAS scores of uterine contraction after analgesia in group P(VAS=7.9±1.1,6.8± 0.9, 5.6±0.8, 4.5±0.8)were significantly higher than those in group D (VAS=6.8±0.7,4.7±0.8,3.5±0.8,2.9±0.7,t=5.966,12.332,13.125,10.643,all P<0.05). The VAS scores at 90 min after analgesia and withdrawal of analgesia (VAS=2.7±0.6, 2.9±0.7) in group P were significantly higher than those in group D (VAS=2.4±0.6, 2.5±0.6, t=2.500, 3.068, all P<0.05). Conclusion: Compared with traditional epidural technique, dural puncture epidural technique can provide a rapid and effective analgesia with less analgesics, but without increasing adverse effects on mother and infant.

[Thoughts and principles of diagnosis and treatment of chronic refractory wounds in China].

The correct thoughts and principles of diagnosis and treatment of chronic refractory wounds need to be formulated. Through the relevant domestic and international consensus and based on clinical experience, the Thoughts and principles of diagnosis and treatment of chronic refractory wounds in China is proposed. It is considered that in the diagnosis and treatment of chronic refractory wounds, in the case of fully understanding the patient's medical history, the following thoughts and principles should be complied in order. (1) Pay attention to the cleanliness of the wound after being cleaned. (2) Reasonably perform debridement to avoid being " excessive" or " not thorough". (3) Reasonably perform examination, diagnosis, and differential diagnosis of pathogenic factors. (4) Treat according to etiology. (5) Find comorbidities and prevent adverse outcomes. (6) Select the correct wound treatment method reasonably and timely. When the conservative wound care treatment is considered, pay attention to embodying the concept of etiological treatment, treat the wound according to the principles of safety, phase, selectivity, and effectiveness, and make a reasonable choice of continuing conservative treatment or surgical treatment in time after completing the preparation of the wound bed. When surgical treatment is considered, pay attention to the selection of reasonable surgical method and donor site, pay attention to the healing rate of surgical wound site and the outcome of donor site, and give reasonable protection to the wound site after surgery. (7) Carry out rehabilitation treatment after wound healing and related health education.

Development of an integrated model for energy systems planning and carbon dioxide mitigation under uncertainty - Tradeoffs between two-level decision makers.

A bi-level fuzzy programming (BFLP) method was developed for energy systems planning (ESP) and carbon dioxide (CO2) mitigation under uncertainty. BFLP could handle fuzzy information and leader-follower problem in decision-making processes. It could also address the tradeoffs among different decision makers in two decision-making levels through prioritizing the most important goal. Then, a BFLP-ESP model was formulated for planning energy system of Beijing, in which the upper-level objective is to minimize CO2 emission and the lower-level objective is to minimize the system cost. Results provided a range of decision alternatives that corresponded to a tradeoff between system optimality and reliability under uncertainty. Compared to the single-level model with a target to minimize system cost, the amounts of pollutant/CO2 emissions from BFLP-ESP were reduced since the study system would prefer more clean energies (i.e. natural gas, LPG and electricity) to replace coal fuel. Decision alternatives from BFLP were more beneficial for supporting Beijing to adjust its energy mix and enact its emission-abatement policy. Results also revealed that the low-carbon policy for power plants (e.g., shutting down all coal-fired power plants) could lead to a potentially increment of imported energy for Beijing, which would increase the risk of energy shortage. The findings could help decision makers analyze the interactions between different stakeholders in ESP and provide useful information for policy design under uncertainty.

An integrated bi-level optimization model for air quality management of Beijing's energy system under uncertainty.

In this study, an interval chance-constrained bi-level programming (ICBP) method is developed for air quality management of municipal energy system under uncertainty. ICBP can deal with uncertainties presented as interval values and probability distributions as well as examine the risk of violating constraints. Besides, a leader-follower decision strategy is incorporated into the optimization process where two decision makers with different goals and preferences are involved. To solve the proposed model, a bi-level interactive algorithm based on satisfactory degree is introduced into the decision-making processes. Then, an ICBP based energy and environmental systems (ICBP-EES) model is formulated for Beijing, in which air quality index (AQI) is used for evaluating the integrated air quality of multiple pollutants. Result analysis can help different stakeholders adjust their tolerances to achieve the overall satisfaction of EES planning for the study city. Results reveal that natural gas is the main source for electricity-generation and heating that could lead to a potentially increment of imported energy for Beijing in future. Results also disclose that PM10 is the major contributor to AQI. These findings can help decision makers to identify desired alternatives for EES planning and provide useful information for regional air quality management under uncertainty.

Modeling for regional ecosystem sustainable development under uncertainty--A case study of Dongying, China.

In this study, a superiority-inferiority two-stage stochastic programming (STSP) method is developed for planning regional ecosystem sustainable development. STSP can tackle uncertainties expressed as fuzzy sets and probability distributions; it can be used to analyze various policy scenarios that are associated with different levels of economic penalties when the promised targets are violated. STSP is applied to a real case of planning regional ecosystem sustainable development in the City of Dongying, where ecosystem services valuation approaches are incorporated within the optimization process. Regional ecosystem can provide direct and indirect services and intangible benefits to local economy. Land trading mechanism is introduced for planning the regional ecosystem's sustainable development, where wetlands are buyers who would protect regional ecosystem components and self-organization and maintain its integrity. Results of regional ecosystem activities, land use patterns, and land trading schemes have been obtained. Results reveal that, although large-scale reclamation projects can bring benefits to the local economy development, they can also bring with negative effects to the coastal ecosystem; among all industry activities oil field is the major contributor with a large number of pollutant discharges into local ecosystem. Results also show that uncertainty has an important role in successfully launching such a land trading program and trading scheme can provide more effective manner to sustain the regional ecosystem. The findings can help decision makers to realize the sustainable development of ecological resources in the process of rapid industrialization, as well as the integration of economic and ecological benefits.

Comparative responses in rare minnow exposed to 17beta-estradiol during different life stages.

Present in the excrement of humans and animals, 17beta-estradiol (E(2)) has been detected in the aquatic environment in a range from several nanograms to several hundred nanograms per liter. In this study, the sensitivities of rare minnows during different life stages to E(2) at environmentally relevant (5, 25, and 100 ng l(-1)) and high (1000 ng l(-1)) concentrations were compared using vitellogenin (VTG) and gonad development as biomarkers under semistatic conditions. After 21 days of exposure, VTG concentrations in whole-body homogenates were analyzed; the results indicated that the lowest observed effective concentration for VTG induction was 25 ng l(-1) E(2) in the adult stage, but 100 ng l(-1) E(2) in the larval and juvenile stages. After exposure in the early life stage, the larval and juvenile fish were transferred to clean water until gonad maturation. No significant difference in VTG induction was found between the exposure and control groups in the adults. However, a markedly increased proportion of females and appearance of hermaphrodism were observed in the juvenile-stage group exposed to 25 ng l(-1) E(2). These results showed that VTG induction in the adult stage is more sensitive than in larval and juvenile stages following exposure to E(2). The juvenile stage may be the critical period of gonad development. Sex ratio could be a sensitive biomarker indicating exposure to xenoestrogens in early-life-stage subchronic exposure tests. The results of this study provide useful information for selecting sensitive biomarkers properly in aquatic toxicology testing.

Specification of germ cell fates by FOG-3 has been conserved during nematode evolution.

Rapid changes in sexual traits are ubiquitous in evolution. To analyze this phenomenon, we are studying species of the genus Caenorhabditis. These animals use one of two different mating systems-male/hermaphroditic, like the model organism Caenorhabditis elegans, or male/female, like C. remanei. Since hermaphrodites are essentially females that produce sperm for self-fertilization, elucidating the control of cell fate in the germ line in each species could provide the key to understanding how these mating systems evolved. In C. elegans, FOG-3 is required to specify that germ cells become sperm. Thus, we cloned its homologs from both C. remanei and C. briggsae. Each species produces a single homolog of FOG-3, and RNA-mediated interference indicates that FOG-3 functions in each species to specify that germ cells develop as sperm rather than as oocytes. What factors account for the different mating systems? Northern analyses and RT-PCR data reveal that the expression of fog-3 is always correlated with spermatogenesis. Since the promoters for all three fog-3 genes contain binding sites for the transcription factor TRA-1A and are capable of driving expression of fog-3 in C. elegans hermaphrodites, we propose that alterations in the upstream sex-determination pathway, perhaps acting through TRA-1A, allow spermatogenesis in C. elegans and C. briggsae XX larvae but not in C. remanei.

Methoxy[meso-5,10,15,20-tetrakis-(2,6-difluorophenyl)porphyrinato]-iron(III), [Fe(TDFPP)(OCH3)].

The crystal structure of the title compound, [Fe(C(44)H(20)F(8)N(4))(CH(3)O)], has been determined. The Fe atom lies 0.485 (1) A out of the plane of the four N atoms to which it is coordinated and from the inversion centre at the origin of the unit cell. The methoxy group is axially coordinated to the Fe atom with O-Fe-N angles of 106.3 (2) and 102.4 (2) degrees, a C-O-Fe angle of 128.3 (5) degrees and an Fe-O distance of 1.788 (5) A. Difluorophenyl rings are tilted from the porphyrin (por) plane with torsion angles of -68.1 (6) and 77.7 (5) degrees across the two C(por)-C-C-C(ar) systems.

A cGMP-dependent protein kinase is implicated in wild-type motility in C. elegans.

In mammals, cyclic GMP and cGMP-dependent protein kinases (cGKs) have been implicated in the regulation of many neuronal functions including long-term potentiation and long-term depression of synaptic efficacy. To develop Caenorhabditis elegans as a model system for studying the neuronal function of the cGKs, we cloned and characterized the cgk-1 gene. A combination of approaches showed that cgk-1 produces three transcripts, which differ in their first exon but are similar in length. Northern analysis of C. elegans RNA, performed with a probe designed to hybridize to all three transcripts, confirmed that a major 3.0 kb cgk-1 transcript is present at all stages of development. To determine if the CGK-1C protein was a cGMP-dependent protein kinase, CGK-1C was expressed in SF:9 cells and purified. CGK-1C shows a K(a) of 190 +/- 14 nM for cGMP and 18.4 +/- 2 microM for cAMP. Furthermore, CGK-1C undergoes autophosphorylation in a cGMP-dependent manner and is inhibited by the commonly used cGK inhibitor, KT5823. To determine which cells expressed CGK-1C, a 2.4-kb DNA fragment from the promoter of CGK-1C was used to drive GFP expression. The CGK-1C reporter construct is strongly expressed in the ventral nerve cord and in several other neurons as well as the marginal cells of the pharynx and intestine. Finally, RNA-mediated interference of CGK-1 resulted in movement defects in nematode larvae. These results provide the first demonstration that cGMP-dependent protein kinase is present in neurons of C. elegans and show that this kinase is required for normal motility.

Regulation of cell fate in Caenorhabditis elegans by a novel cytoplasmic polyadenylation element binding protein.

The fog-1 gene of Caenorhabditis elegans specifies that germ cells differentiate as sperm rather than as oocytes. We cloned fog-1 through a combination of transformation rescue experiments, RNA-mediated inactivation, and mutant analyses. Our results show that fog-1 produces two transcripts, both of which are found in germ cells but not in the soma. Furthermore, two deletion mutants alter these transcripts and are likely to eliminate fog-1 activity. The larger transcript is expressed under the control of sex-determination genes, is necessary for fog-1 activity, and is sufficient to rescue a fog-1 mutant. This transcript encodes a novel member of the CPEB family of RNA-binding proteins. Because CPEB proteins in Xenopus and Drosophila regulate gene expression at the level of translation, we propose that FOG-1 controls germ cell fates by regulating the translation of specific messenger RNAs.

A case of spontaneous pneumomediastinum and pneumopericardium in a young adult.

Spontaneous medialstinal emphysema (pneumomediastinum) and pneumopericardium may be defined as the presence of free air or gas in the mediastinal structures and in the pericardial sac without an apparent precipitating cause. It most frequently occurs in young healthy adults without serious underlying pulmonary disease. Although pneumomediastinum and pneumopericardium is often asymptomatic, it may cause pain in the neck and chest, dysphonia and shortness of breath. Treatment is supportive unless the patient has a history of trauma from foreign body aspiration. The course of spontaneous pneumomediastinum and pneumopericardium is usually benign and self-limited. A case of spontaneous pneumomediastinum, pneumopericardium and subcutaneous emphysema in a 20-year-old male is reported in this paper.

In Caenorhabditis elegans, the RNA-binding domains of the cytoplasmic polyadenylation element binding protein FOG-1 are needed to regulate germ cell fates.

FOG-1 controls germ cell fates in the nematode Caenorhabditis elegans. Sequence analyses revealed that FOG-1 is a cytoplasmic polyadenylation element binding (CPEB) protein; similar proteins from other species have been shown to bind messenger RNAs and regulate their translation. Our analyses of fog-1 mutations indicate that each of the three RNA-binding domains of FOG-1 is essential for activity. In addition, biochemical tests show that FOG-1 is capable of binding RNA sequences in the 3'-untranslated region of its own message. Finally, genetic assays reveal that fog-1 functions zygotically, that the small fog-1 transcript has no detectable function, and that missense mutations in fog-1 cause a dominant negative phenotype. This last observation suggests that FOG-1 acts in a complex, or as a multimer, to regulate translation. On the basis of these data, we propose that FOG-1 binds RNA to regulate germ cell fates and that it does so by controlling the translation of its targets. One of these targets might be the fog-1 transcript itself.

Production of biologically active human granulocyte colony stimulating factor in the milk of transgenic goat.

We have developed a transgenic female goat harboring goat beta-casein promoter/human granulocyte colony stimulating factor (G-CSF) fusion gene by microinjection into fertilized one-cell goat zygotes. Human G-CSF was produced at levels of up to 50 microg/ml in transgenic goat milk. Its biological activity was equivalent to recombinant human G-CSF expressed from Chinese hamster ovary (CHO) cell when assayed using in vitro HL-60 cell proliferation. Human G-CSF from transgenic goat milk increased the total number of white blood cells in C57BL/6N mice with leucopenia induced by cyclophosphamide (CPA). The secreted human G-CSF was glycosylated although the degree of O-glycosylation was lower compared to CHO cell-derived human G-CSF.

Anti-HIV-1 activity of trichobitacin, a novel ribosome-inactivating protein.

AIM: To determine whether trichobitacin, a novel ribosome-inactivating protein purified from the root tubers of Trichosanthes kirilowii, possesses the anti-HIV activity. METHODS: The inhibition of syncytial cell formation induced by human immunodeficiency virus type 1 (HIV-1) was determined under microscope, reduction of HIV-1 p24 antigen expression level was measured by ELISA, and decrease in numbers of HIV-1 antigen positive cells in acutely and chronically infected cultures were detected by indirect immunofluorescence assay. RESULTS: Trichobitacin was found to greatly suppress syncytial cell formation induced by HIV-1 and to markedly reduce both expression of HIV-1 p24 antigen and the number of HIV antigen positive cells in acutely but not chronically HIV-1 infected culture. The median inhibitory concentration (IC50) in inhibition of syncytial cell formation and HIV antigen positive cells were 5 micrograms.L-1 (95% confidence limits: 1.3-20 micrograms.L-1) and 0.09 mg.L-1 (95% confidence limits: 0.011-0.755 mg.L-1), respectively. CONCLUSION: Trichobitacin is a novel ribosome-inactivating protein with anti-HIV-1 activity.

Recurrent asystoles associated with vasovagal reaction during venipuncture.

A 17-year-old high school student presented with a history of habitual faintings. On 24-hour Holter monitoring, cardiac asystoles were recorded, the longest lasting approximately 7 or 8 seconds during venipuncture procedures. The asystole associated with venipuncture demonstrated the cardioinhibitory effects of vasovagal reaction with blood-injury phobia. He also had a positive response during head-up tilt test showing hypotension and relative bradycardia after intravenous isoproterenol injection. After administration of oral beta blocker, he did not show further or recurrent cardiac asystole during blood injury procedure on electrocardiographic examination. Venipuncture is the most common invasive medical procedure performed in hospital settings. While venipuncture is considered to be reasonably safe, serious complication may occur even when only a small volume of blood is withdrawn. Therefore, medical personnel should be prepared to provide appropriate care.

Transesophageal echocardiographic detection of thoracic aortic plaque could noninvasively predict significant obstructive coronary artery disease.

OBJECTIVE: Previous pathologic and roentgenographic studies have suggested a relation between aortic plaque and coronary artery disease but have lacked clinical utility. The study was undertaken to elucidate whether atherosclerotic aortic plaque detected by transesophageal echocardiography can be a clinically useful marker for significant obstructive coronary artery disease. METHODS: Clinical and angiographic features and intraoperative transesophageal echocardiographic findings were prospectively analyzed in 131 consecutive patients (58 women and 73 men, aged 17 to 75 years [mean 54 +/- 12]) undergoing open heart surgery. Significant obstructive coronary artery disease was defined as > or = 50% stenosis of > or = 1 major branch. RESULTS: Seventy-six (58%) of 131 patients were found to have obstructive coronary artery disease. In 76 patients with significant coronary artery disease, 71 had thoracic aortic plaque. In contrast, aortic plaque existed in only 10 of the remaining 55 patients with normal or minimally abnormal coronary arteries. The presence of aortic plaque on transesophageal echocardiographic studies had a sensitivity of 93%, a specificity of 82% and positive and negative predictive values of 88% and 90%, respectively, for significant coronary artery disease. There was a significant relationship between the degree of aortic intimal changes and the severity of coronary artery disease (r = 0.74, P < 0.0001). Multivariate logistic regression analysis of patient age, sex, risk factors of cardiovascular disease and transesophageal, echocardiographic findings revealed that atherosclerotic aortic plaque was the most significant independent predictor of coronary artery disease. CONCLUSION: This study indicates that transesophageal echocardiographic detection of atherosclerotic plaque in the thoracic aorta is useful in the noninvasive prediction of the presence and severity of coronary artery disease.

Alpha-momorcharin inhibits HIV-1 replication in acutely but not chronically infected T-lymphocytes.

AIM: To identify the anti-human immunodeficiency virus type 1 (HIV-1) activities of alpha-momorcharin (alpha-MMC) from Momordica charantia in acutely and chronically infected T-lymphocytes. METHODS: The anti-HIV activities of alpha-MMC were examined by 1) the inhibition of syncytia formation induced by HIV-1 III B; 2) reduction of p24 core antigen expression level and decrease in numbers of HIV antigen positive cells in acutely and chronically infected cultures. The cytotoxic effects of alpha-MMC was tested by trypan blue dye exclusion or colorimetric MTT assay. RESULTS: alpha-MMC was found to obviously inhibit HIV-1 III B-inducing C8166 syncytia formation and markedly reduced both expression of p24 core antigen and the numbers of HIV antigen positive cells in acutely but not chronically HIV-1-infected culture. The median effective concentration (EC50) in these assays were 0.016, 0.07, and 0.32 mg.L-1, respectively. CONCLUSION: alpha-MMC is a unique component of momorcharin with anti-HIV activity, and markedly inhibited HIV-1 replication in acutely but not chronically HIV-1-infected T-lymphocytes.