Occurrence Ratio Research Articles

Effect of Resin-based and Bioceramic Root Canal Sealers on Postoperative Pain: A Split-mouth Randomized Controlled Trial

IntroductionThe aim of this study was to compare the effect of resin-based and bioceramic root canal sealers on the occurrence and intensity of postoperative pain in patients with asymptomatic apical periodontitis (AAP). MethodsPatients presenting with AAP in previously endodontically treated teeth were included in this split-mouth blinded randomized controlled trial. For each patient, 2 single-rooted teeth were retreated and obturated using the warm vertical condensation technique and different obturation materials (ie, a gutta-percha point with resin-based sealer and a bioceramic-coated gutta-percha point with bioceramic sealer). Treatment of 1 root canal was performed in a single visit. Postoperative pain was recorded by a visual analog scale (VAS) at 24 hours, 48 hours, 72 hours, and 7 days after obturation. ResultsOf the 61 included patients, 57 individuals presenting 114 teeth completed the study. There was no statistically significant difference between the tested root canal sealers regarding postoperative pain at any time points assessed (P > .05). In total, 20 (35%) patients perceived pain. Only 1 patient reported severe pain. VAS scores of 80 and 70 were reported in the AH Plus (Dentsply Maillefer, Ballaigues, Switzerland) and Total Fill (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) groups, respectively. Pain intensity decreased about 2-fold in both groups at 48 hours after treatment. There were no reports of pain since 72 hours after obturation. The odds ratio for pain occurrence in the lower premolars was 7.2 (95% confidence interval, 1.708–30.352) compared with the upper front teeth. ConclusionsAH Plus and Total Fill perform similarly in terms of the occurrence and intensity of postoperative pain in teeth with AAP with no material extrusion beyond the apex.

Three phase-ictal scalp EEG patterns in patients with seizures arising from the cortex facing the interhemispheric fissure

ObjectiveIctal scalp EEG patterns have been reported to vary across onset regions. We assessed the sequential EEG changes during seizure events on scalp EEG, and tested our hypothesis that patients with focal seizures arising from the cortex facing the interhemispheric fissure (IHF cortex) would be specifically characterized by 3 phase-EEG patterns (3Ph-EEG). MethodsPatient inclusion criteria were: 1) focal epilepsy and 2) ictal onset records on scalp and intracranial video-EEG. Patients were classified into one of the three groups: the IHF group, mesial temporal (MT) group, or lateral convexity (LC) group, based on the localization of the ictal onset zone (IOZ) on intracranial video-EEG. We defined 3Ph-EEG on ictal scalp EEG as follows: phase 1, brief spike/fast wave burst; phase 2, diffuse attenuation; and phase 3, focal rhythmic activity with evolution. We determined if the occurrence ratios of 3Ph-EEG and each of the three phases differed between the groups (IHF and others). ResultsWe studied 36 patients aged 8–59 years (mean, 30 years). Ten patients were classified as IHF, 16 as MT, and 10 as LC group from 303 ictal events on intracranial EEG. 193 seizures on scalp EEG consisted of 79 seizures in IHF; 58 in MT; 56 in LC group. Sixty-nine seizures (92%) in nine patients (90%) in IHF group showed 3Ph-EEG, whereas none of the seizures in MT and LC groups showed the 3Ph-EEG. Multivariate logistic regression analysis suggested that the presence of 3Ph-EEG (p < 0.01) and phase 2 (p = 0.03) components were predictive of IHF scalp EEG onset. SignificanceThe 3Ph-EEG may be observed preferentially in patients with focal seizures from IHF cortex. Observation of the ictal phases on scalp EEG may warrant consideration of intracranial EEG sampling for the presurgical evaluation.

Two-point measurement of amylase in drainage fluid predicts severe postoperative pancreatic fistula after gastric cancer surgery.

Early identification of patients at risk of postoperative pancreatic fistula (POPF) allows appropriate management after gastrectomy. Although some reports have suggested a correlation between POPF and the concentration of amylase in drained abdominal fluid (D-AMY), this has not been proven to impact sufficiently on clinical decision-making. A sustained high level of D-AMY is often assumed to be due to unsatisfactory drainage or excessive pancreatic leakage. We assessed the clinical utility of measuring D-AMY on postoperative day (POD) 1 and POD3 for prediction of POPF. Starting in April 2014, 801 patients who underwent radical gastrectomy with prophylactic drain placement were consecutively enrolled. We routinely measured D-AMY on POD1 and POD3, and compared the incidence of problematic POPF and clinical factors including D-AMY. We also attempted to clarify whether such two-point D-AMY measurement was clinically useful for patient management after gastrectomy. Fifty-one of the patients (6.4%) developed Clavien-Dindo grade III or worse POPF. Using D-AMY cutoffs of 2218IU/L on POD1 and 555IU/L on POD3, the patients were successfully classified. The highest risk group, in which D-AMY was higher than the cut-off value on both POD1 and POD3, showed a significantly high rate of occurrence (33/105, 31.4%) and high positive likelihood ratio (6.74). Multivariate analysis showed that classification into this highest risk group was an independent risk factor for development of severe POPF (odds ratio 15.2, 95% CI 7.92-29.0). Two-point measurement of D-AMY may be an efficient tool for achieving individualized management of POPF following radical gastrectomy.

Milling characteristics of cutting type rice milling machine (I) – Characteristics of milling in accordance with blowing velocity

This study was to identify proper blowing velocity conditions to remove rice bran during milling. The milling characteristics were measured at four levels of blowing velocity 20, 25, 30, 35 m/s.The rise of grain temperature of milled rice was the lowest, 16.9 °C at 35 m/s. The differences of cracked ratio and broken rice occurrence ratio between before and after milling were found to be slightly lower at 35 m/s than other blowing velocities. Turbidity was decreased at high blowing velocity, and showed the lowest value at 35 m/s.

Abstract TMP50: Smoking Increases Risk of Ischemic Stroke in Young Men

Introduction: There is a strong dose-response relationship between smoking and risk of ischemic stroke (IS) in young women, but there are few data examining this association in young men. We examined the dose-response relationship between the quantity of cigarettes smoked and the odds of developing an IS in men under age 50. Methods: The Stroke Prevention in Young Men Study is a population-based case-control study of risk factors for IS in 1145 men ages 15-49. Controls were identified by random-digit dialing and were balanced to cases for geographic region of residence, age, and ethnicity. Logistic regression models were used to calculate the odds ratio for IS occurrence comparing smokers to never smokers. In the first model, we adjusted solely for age. In the second model, we adjusted for potential confounding factors, including age, race, education, hypertension, myocardial infarction, angina, diabetes mellitus and body mass index. Interaction terms were used to examine potential effect modification by other risk factors. Statistical tests were 2-tailed and P-values less than 0.05 were considered statistically significant. Results: The table shows that IS risk increased with amount of current smoking and that 2 packs per day current smokers had over a 5-fold increased risk of IS. There were no significant interactions with other risk factors. Conclusions: We found a strong dose-response relationship between the number of cigarettes smoked daily and IS among young men. While complete smoking cessation is the goal, even reducing the number of cigarettes smoked may reduce the risk of IS in young men.

Infodemiology of antiphospholipid syndrome: Merging informatics and epidemiology.

To investigate trends in Internet search volumes linked to Antiphospholipid Syndrome (APS), using Big Data monitoring and data mining. Based on the large amount of data generated by Google Trends and scientific search tools (SCOPUS, Medline/Pubmed, and ClinicalTrails.gov), we performed a longitudinal analysis based on the term "antiphospholipid" in a 5-year web-based research. Google Trends captured that APS-related digital interest was generally steady in the study period (Relative Search Volume [RSV] mean value 71.1±9.3% [95%CI 55.6-89.4], median 72.0), with no significant peak based on different seasons (e.g. winter vs. summer time). When comparing the APS-related digital interest with search volumes generated in the same time period for Inherited Thrombophilias (IT) and Systemic Lupus Erythematosus (SLE), we found a digital interest 35-times higher for APS than for IT (RSV mean value 71.1±9.3% [95%CI 55.6-89.4] vs. 2±3.2% [95%CI 0.7-7.4]). When compared to SLE, APS reached a similar RSV, showing a comparable digital interest (RSV mean value 71.1±9.3% [95%CI 55.6-89.4] vs. 87±11.8% [95%CI 60.7-107.9]). When adjusting for relative search volumes of Google Trends, we found a relative prevalence of search volumes of 35.5% in Europe, 12.3% in the United States, 11.5% in South America, 11.2% in Australia, 9.2% in Canada, 9.2% in Japan, and 5.1% in India. We observed an overall similar distribution of search volumes from Google Trends compared to results from Medline/Pubmed, SCOPUS, and ClinicalTrials.gov. In brief, the United States and Europe (mainly Italy, the United Kingdom, Spain, France, and Germany) presented the higher RSV. Similarly, these countries showed a higher number of research publications and on-going trials in the field of APS. In this study, we demonstrated that the interest in APS is not equally distributed globally. Thus, geopolitical differences might represent a challenge when attempting to estimate the prevalence of APS or designing worldwide investigations in APS. Combining the expanding framework of infodemiology with scientific networking collaborative efforts, such as AntiPhospholipid Syndrome Alliance For Clinical Trials and InternatiOnal Networking (APS ACTION), will help better define the syndrome in terms of prevalence, event occurrence ratios, and thrombosis risk assessment.

Association Between Timed Up and Go Test and Future Dementia Onset.

This study evaluated whether baseline results of the Timed Up and Go (TUG) test is associated with future dementia occurrence. Using the Korean National Health Insurance Service-National Health Screening Cohort database, we identified 49,283 subjects without a dementia diagnosis who participated in the National Screening Program for Transitional Ages at 66 years of age during 2007-2012. Gait impairment was defined as taking longer than 10 seconds to perform the TUG test. Dementia occurrence was defined by the first prescription for acetylcholinesterase inhibitors or N-Methyl-D-Aspartate receptor antagonist with an International Classification of Diseases 10th Revision (ICD-10) code for dementia (F00, F01, F02, F03, G30, F051, or G311) during 2007-2013. Cox proportional hazard regression models were used to assess the hazard ratios for dementia occurrence according to baseline TUG test results. Mean follow-up period was 3.8 years. Incidence rates of dementia were 4.6 and 6.8 cases per 1,000 person-years in the normal and impaired TUG groups, respectively. The impaired TUG group showed a higher risk of total dementia incidence (adjusted hazard ratio [aHR], 1.34; 95% confidence interval [95% CI], 1.14-1.57). Subtype analysis showed that the impaired TUG group had a higher risk of Alzheimer's disease (aHR, 1.26; 95% CI, 1.06-1.51) and vascular dementia (aHR, 1.65; 95% CI, 1.19-2.30). The TUG test result was associated with future dementia occurrence. More vigilant follow-up and early intervention to prevent dementia would benefit elderly people with impaired TUG test result.

我国草地螟发生间歇期的区域格局变化

PDF HTML阅读 XML下载 导出引用 引用提醒 我国草地螟发生间歇期的区域格局变化 DOI: 10.5846/stxb201703010329 作者: 作者单位: 全国农业技术推广服务中心,全国农业技术推广服务中心,全国农业技术推广服务中心 作者简介: 通讯作者: 中图分类号: 基金项目: 公益性行业（农业）科研专项（201303026） The regional pattern of Loxostege sticticalis L. varied during a new occurrence intermission in China Author: Affiliation: National Agro-Technical Extension and Service Centre,, Fund Project: 摘要 | 图/表 | 访问统计 | 参考文献 | 相似文献 | 引证文献 | 资源附件 | 文章评论 摘要:2010-2016年我国草地螟一直维持总体轻发态势。为从长时间序列上分析连续轻发年份的历史地位，以1979年以来第2、3个暴发周期及其之间的间歇期为对照，分析了2010-2016年草地螟连续轻发的特点，即全国种群规模维持在历史低位，西北地区发生面积和比率加大，发生区域向西部缩减，提示我国草地螟种群发生已进入间歇期。分析了1979-2016年时间序列上华北、东北、西北3个地区的发生情况对全国的影响，结果表明：（1）华北地区、东北地区的发生面积自然对数值与全国发生面积自然对数值呈极显著的线性正相关，即华北、东北地区与全国发生趋势的年际波动完全一致；（2）西北地区发生面积自然对数值与全国的线性相关性达显著水平，但在不同的历史阶段西北地区与全国的波动趋势有明显差别；（3）自第3个暴发周期的2005年以后，西北地区的波动曲线逐渐与全国趋同，推测这一变化与新疆种群的建立和发展有关。 Abstract:In China, the occurrence trend of the meadow moth Loxostege sticticalis L. remained low during the period 2010-2016. In order to reveal the historical status of these low-occurrence years, we analyzed the temporal and spatial characteristics of this new period, using second and third outbreak periods (1979-1985 and 1996-2009) and the intermission between them (1986-1995) as controls. Our results indicated that the new occurrence period (2010-2016) showed the same characteristics as intermission period by significance analysis of difference among four periods. (1) On comparison of the annual occurrence area in China among the four periods, we detected no significant difference between the 2010-2016 and 1986-1995 period, whereas there was a significant difference between these two periods and the other two outbreak periods. (2) On comparison of the annual occurrence areas in North China (NC), Northeast China (NEC), and Northwest China (NWC) among the four periods, we found that NC and NEC showed the same trend as the whole country, as the annual mean occurrence area in the 1996-2009 and 1979-1985 periods was significantly higher than that in the 1986-1995 and 2010-2016 periods. However, NWC showed obvious inconsistencies with the whole country, as its annual mean occurrence area was highest in the 2010-2016 period, moderate in the 1996-2009 and 1979-1985 periods, and lowest in the 1986-1995 period. (3) On comparison of the annual occurrence ratios of NC, NEC, and NWC with that in the whole country among the four periods, we found that NC sustained a considerably high occurrence ratio in each period, although the differences were not significant. Furthermore, the occurrence ratio of NEC in the 1996-2009 period was significantly higher than that in the 1986-1995 and 2010-2016 periods, and the occurrence ratio of NWC in the 2010-2016 period was significantly higher than that in the other three periods. The analysis of annual occurrence regions (counties) and the ratio of NC, NEC and NWC in 2010-2016 compared with 2006 (low occurrence) and 2009 (high occurrence), revealed a northwestward reduction in the occurrence distribution during the new period. These results indicated that the meadow moth had already entered a new intermission period after 2010 in China. In the time period from 1979 to 2016, the correlations of occurrence in NC, NEC and NWC with that in the whole of China were individually analyzed. The results obtained were as follows. (1) The natural logarithm (ln) of the occurrence area in NC and NEC was positively correlated with that of the whole China, showing the same fluctuating pattern in annual dynamics. (2) The ln of the occurrence area in NWC was also positively correlated with that of the whole China, but showed different fluctuations during some periods. (3) Since 2005, the fluctuation in NWC occurrence has gradually approached that of the whole China, which was deduced in connection with the establishment and development of a population in Xinjiang. 参考文献 相似文献 引证文献

Effects of Ethanol Blends on Performance of Spark Ignition Engine-A Review

Bio-fuels have grabbed attention of engine researchers ever since the oil crisis and increasing cost of crude oil in the 70’s. Ethanol has been the most widely researched alcoholic fuel in IC engine. The present paper discusses the effect of ethanol-gasoline blends as a bio-fuel in the conventional spark- ignition engine. The paper reviews and brings into light the properties of ethanol, production procedure and the effect of various ethanol blends on the performance of engine. The parameters focused for this study are the engine brake torque, engine volumetric efficiency and thermal efficiency with the effect on the exhaust emissions, which is one of the present prime concerns. The merits as well as the disadvantages of using ethanol as a fuel in Spark Ignition Engines also discussed. It has been seen that with the increasing proportion of ethanol in the blend, the overall thermal efficiency, heat release rate, engine volumetric efficiency and cylinder gas pressure increases. The requirement of compression ratio for occurrence of ignition also rises with the proportion of ethanol in the blend.

Use of anticoagulant or antiplatelet agents is not related to epistaxis in patients undergoing transnasal endoscopy.

Background and study aims Unsedated transnasal endoscopy (uTNE) has become accepted as a safe and tolerable method for upper gastrointestinal tact examinations. Epistaxis is 1 of the major complications of TNE, though its risk factors have not been elucidated. Generally, patients administered an anticoagulant or antiplatelet drug are considered to have an increased risk of epistaxis during TNE. Here, we investigated risk factors of epistaxis in patients undergoing uTNE, with focus on those who received antithrombotic agents. Patients and methods We enrolled 6860 patients (average age 55.6 ± 12.97 years; 3405 males, 3455 females) who underwent uTNE and received the same preparations for the procedure. Epistaxis was evaluated using endoscopic images obtained while withdrawing the scope through the nostril. We also noted current use of medications including anticoagulant or antiplatelet agents prior to the endoscopic examination. Results Epistaxis occurred in 3.6 % of the enrolled patients (245/6860), and that rate was significantly higher in younger patients (average age 49.31 ± 11.8 years for epistaxis group vs. 55.83 ± 13.0 years for no epistaxis group, P < 0.01) as well as females (4.78 % vs. 2.35 %, P < 0.01). The odds ratio for occurrence of epistaxis was 2.31 (95 %CI: 1.746 – 3.167) in the younger patients and 2.02 (95 % CI: 1.542 – 2.659) in females. In contrast, there was no significant difference for rate of epistaxis between patients with and without treatment with an antithrombotic agent (3.0 % vs. 3.6 %). Conclusions The rate of epistaxis was higher in younger and female patients. Importantly, that rate was not significantly increased in patients who were administered an antithrombotic agent.

Effect of CD4 T-lymphocyte count and human immunodeficiency virus (HIV) infection stage on the prevalence and pattern of rheumatologic disease in HIV-infected patients in Zaria, North-Western Nigeria

Introduction Human immunodeficiency virus (HIV) infection is a scourge of the modern time. Occurring with high frequency in patients of all ages and both genders, and across all strata of the society, HIV being a systemic disease can affect the musculoskeletal system, and therefore, musculoskeletal disease maybe a presenting symptom of HIV infection. There is paucity of research on the effect of different stages of HIV and CD4 T-lymphocyte count on HIV rheumatological manifestations among Nigerian patients. This study aims at evaluating the effect of CD4 T-lymphocyte count and the stages of HIV on the prevalence and pattern of rheumatological disease in Nigerian patients with HIV infection. Objective To determine the effect of CD4 T-lymphocyte count and HIV stage on the occurrence and pattern of rheumatologic diseases among patients attending HIV clinic at Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods Between February 2011 and March 2012, 200 HIV-seropositive patients [consisting of 100 patients on combined antiretroviral therapy (cART) and 100 cART naive patients] and 200 age and gender-matched HIV-negative controls were screened for the presence of rheumatologic disease, using a validated interviewer administered questionnaire. Information gathered on patients included sociodemographic characteristics, risk factors for HIV infection, clinical and laboratory parameters. CD4 T-lymphocyte of HIV patients and controls were quantified using flow cytometry method. CD4 categorization of patients was performed using the Centre for Disease Control Criteria, and HIV staging was done using World Health Organization criteria. Those with rheumatologic diseases were diagnosed using the American College of Rheumatology classification criteria or, where not available, other well validated rheumatological classification criteria. Data obtained were analyzed using Statistical Package for Social Sciences window software version 17.0. A P value of Results Rheumatological disease was diagnosed in 56 (28%) of HIV-positive patients and 15 (7.5%) of HIV-negative control. The odd ratio for occurrence of rheumatologic disease in HIV-positive patients compared to control was 4.8 [95% confidence interval (CI) = 2.61–8.82, P = 0.001]. In 3% of HIV infected patients, rheumatologic disease was the reason for their 1st presentation. The spectrum of rheumatic disease seen in HIV-positive patients is as follows: HIV-associated polyarthritis in 13 (16.5%) patients, polyarthralgia in 10 (5%) patients, undifferentiated spondyloarthropathy and reactive arthritis in nine (4.5%) patients each, septic arthritis in five (2.5%), and Tuberculosis (TB) of the spine and pyomyositis in three (1.5%) patients each. CD4 T-lymphocyte count and HIV stages were independent determinants of HIV-associated rheumatologic disease. Conclusion Rheumatologic diseases occur more frequently in HIV-seropositive patients compared to HIV-negative controls, and low CD4 T-lymphocyte counts and advanced HIV stage are associated with higher prevalence of rheumatologic diseases.

Liquefaction Occurrence Ratio Estimation Considering Strong Ground Motion Duration and Regional Characteristics

Liquefaction Occurrence Ratio Estimation Considering Strong Ground Motion Duration and Regional Characteristics

Effects of Cadmium Exposure on Age of Menarche and Menopause.

Cadmium exposure can cause several adverse health effects. Animal studies have also shown that cadmium exposure can affect menarche or menopause. However, data is limited in humans. We conducted a retrospective study to assess whether cadmium exposure was associated with different ages of menarche and menopause in a Chinese population. A total of 429 women living in control (n = 137) and two cadmium-polluted areas (n = 292) were included in this study. A total of 223 and 206 subjects were included in the analysis for menarche and menopause, respectively. The median menarche age of population living in the heavily cadmium-polluted area was significantly younger than those in the control area (14.0 vs. 15.0, p < 0.01). Logistic regression showed that the odds ratio (OR) of early occurrence of menarche (<13 years) in the population living in the heavily polluted area and moderately polluted area was 3.7 (95% confidence interval (CI): 1.5–9.7) and 1.3 (95% CI: 0.7–2.6) compared with control, respectively. No significant difference was observed in the age of menopause in the population of these three areas. In conclusion, our data indicated that cadmium exposure may cause early menarche.

Two Leading ENSO Modes and El Niño Types in the Zebiak–Cane Model

Modern instrumental records reveal that El Niño events differ in their spatial patterns and temporal evolutions. Attempts have been made to categorize them roughly into two main types: eastern Pacific (EP; or cold tongue) and central Pacific (CP; or warm pool) El Niño events. In this study, a modified version of the Zebiak–Cane (MZC) coupled model is used to examine the dynamics of these two types of El Niño events. Linear eigenanalysis of the model is conducted to show that there are two leading El Niño–Southern Oscillation (ENSO) modes with their SST patterns resembling those of two types of El Niño. Thus, they are referred to as the EP and CP ENSO modes. These two modes are sensitive to changes in the mean states. The heat budget analyses demonstrate that the EP (CP) mode is dominated by thermocline (zonal advective) feedback. Therefore, the weak (strong) mean wind stress and deep (shallow) mean thermocline prefer the EP (CP) ENSO mode because of the relative dominance of thermocline (zonal advective) feedback under such a mean state. Consistent with the linear stability analysis, the occurrence ratio of CP/EP El Niño events in the nonlinear simulations generally increases toward the regime where the linear CP ENSO mode has relatively higher growth rate. These analyses suggest that the coexistence of two leading ENSO modes is responsible for two types of El Niño simulated in the MZC model. This model result may provide a plausible scenario for the observed ENSO diversity.

Occurrence of Intestinal Parasites in Pigs in Poland - the Influence of Factors Related to the Production System.

IntroductionThe aim of study was to estimate the prevalence and intensity of intestinal parasite infections in pigs in Poland and evaluate the influence of factors related to the production system on the infection intensity.Material and MethodsA total of 70 pig farms of all Polish provinces, differing in the herd size and production system, were selected for the study. Fresh faecal samples were collected from all age groups: suckling piglets, weaners, fatteners, and lactating sows. Moreover, data were obtained regarding the size of the herd, the use of paddock and all-in/all-out system, the presence of diarrhoea, and the type of flooring.ResultsParasite eggs or oocysts were detected in 57 of the 70 examined pig farms. Oesphagostomum spp. eggs were found in the largest number of farms (68.6%). Moreover, coccidia (42.9%), Ascaris suum(28.6%), Trichuris suis (21.4%), and Strongyloides spp. (11.4%) were detected. The highest prevalence of coccidia and Strongyloides spp. was found in suckling piglets, A. suum and T. suis in fatteners, and Oesphagostomum spp. in sows. Higher prevalence of parasites was detected in small farms than in medium and large farms, except the prevalence of coccidia, which was the highest in medium farms. Simultaneous infection with several parasites was more often detected than with one parasite. Odds ratio of parasites occurrence was higher in farms with paddock and litter floor and in farms which do not use all-in/all-out system.ConclusionRelatively high prevalence of intestinal parasites was found in pigs in Poland. Moreover, specific distribution of parasites in different age groups and farms of different size was observed. Influence of breeding factors on parasite prevalence was identified.

H558R, a common SCN5A polymorphism, modifies the clinical phenotype of Brugada syndrome by modulating DNA methylation of SCN5A promoters.

BackgroundA common SCN5A polymorphism H558R (c.1673 A > G, rs1805124) improves sodium channel activity in mutated channels and known to be a genetic modifier of Brugada syndrome patients (BrS). We investigated clinical manifestations and underlying mechanisms of H558R in BrS.Methods and resultsWe genotyped H558R in 100 BrS (mean age 45 ± 14 years; 91 men) and 1875 controls (mean age 54 ± 18 years; 1546 men). We compared clinical parameters in BrS with and without H558R (H558R+ vs. H558R- group, N = 9 vs. 91). We also obtained right atrial sections from 30 patients during aortic aneurysm operations and compared SCN5A expression and methylation with or without H558R. H558R was less frequent in BrS than controls (9.0% vs. 19.2%, P = 0.028). The VF occurrence ratio was significantly lower (0% vs. 29.7%, P = 0.03) and spontaneous type 1 ECG was less observed in H558R+ than H558R- group (33.3% vs. 74.7%, P = 0.01). The SCN5A expression level was significantly higher and the methylation rate was significantly lower in sections with H558R (N = 10) than those without (0.98 ± 0.14 vs. 0.83 ± 0.19, P = 0.04; 0.7 ± 0.2% vs. 1.6 ± 0.1%, P = 0.004, respectively). In BrS with heterozygous H558R, the A allele mRNA expression was 1.38 fold higher than G allele expression.ConclusionThe SCN5A polymorphism H558R may be a modifier that protects against VF occurrence in BrS. The H558R decreased the SCN5A promoter methylation and increased the expression level in cardiac tissue. An allelic expression imbalance in BrS with a heterozygous H558R may also contribute to the protective effects in heterozygous mutations.

Gastroenteritis outbreaks on cruise ships: contributing factors and thresholds for early outbreak detection.

When an increased number of acute gastroenteritis (AG) cases is detected among tourists staying at the same accommodation, outbreak management plans must be activated in a timely manner to prevent large outbreaks. Syndromic surveillance data collected between 1 January 2010 and 31 December 2013 by five seagoing cruise ships were analysed to identify attack rate thresholds for early outbreak detection. The overall incidence rate of AG was 2.81 cases per 10,000 traveller-days (95% confidence interval (CI): 0.00–17.60), while the attack rate was 19.37 cases per 10,000 travellers (95% CI: 0.00–127.69). The probability of an outbreak occurring was 11% if 4 per 1,000 passengers reported symptoms within the first 2 days of the voyage, and this increased to 23 % if 5 per 1,000 passengers reported such within the first 3 days. The risk ratio (RR) for outbreak occurrence was 2.35, 5.66 and 8.63 for 1, 2 and 3 days’ delay of symptoms reporting respectively, suggesting a dose–response relationship. Shipping companies’ policies and health authorities’ efforts may consider these thresholds for initiating outbreak response measures based on the number of cases according to day of cruise. Efforts should focus on ensuring travellers report symptoms immediately and comply with isolation measures.

Potentially high-risk cardiac arrhythmias with focal to bilateral tonic-clonic seizures and generalized tonic-clonic seizures are associated with the duration of periictal hypoxemia.

To investigate potentially high-risk cardiac arrhythmias (PHAs) following focal to bilateral tonic-clonic seizures (FBTCSs) and generalized tonic-clonic seizures (GTCSs) and to study the association of PHAs with seizure characteristics and the severity of associated ictal respiratory dysfunction. Electrocardiographic (EKG) and pulse oximetry (SpO2 ) data were recorded concurrently with video-electroencephalographic telemetry in the epilepsy monitoring unit (EMU). One minute of preictal EKG, the ictal EKG, and 2min of ictal/postictal data were reviewed for each seizure. Nonsustained ventricular tachycardia, bradyarrhythmia, and/or sinus pauses were considered as PHAs. FBTCSs/GTCSs with PHAs were compared to those that had only ictal sinus tachycardia. Data from 69 patients with 182 FBTCSs/GTCSs with usable SpO2 and EKG recordings were available. There were 10 FBTCSs/GTCSs in 10 patients with a PHA. The presence of PHAs was not associated with seizure duration or SpO2 nadir. FBTCSs/GTCSs with a PHA were significantly associated with the duration of oxygen desaturation < 90% when compared with FBTCSs/GTCSs with only sinus tachycardia (Mann-Whitney, p=0.042). Desaturation duration of <100s was not significantly associated with occurrence of PHAs (p=0.110) when compared with seizures that had only sinus tachycardia. The odds ratio for occurrence of PHA was 7.86 for desaturation durations ≥ 125s versus desaturations < 125s (p=0.005). The odds ratio increased to 13.09 for desaturation durations ≥ 150s (p<0.001). Preictal and ictal/postictal arrhythmias occurred with focal seizures that did not progress to FBTCSs. Four patients with focal seizures had ictal/postictal PHAs without preictal PHAs. Two of these patients had evidence for prior cardiac disturbance. PHAs following a single FBTCS/GTCS in the EMU are significantly associated with the duration of ictal/postictal hypoxemia. It is possible that FBTCS/GTCS-associated hypoxemia may trigger fatal cardiac arrhythmias in a subset of susceptible patients dying of sudden unexpected death in epilepsy.

Risk factors for early metachronous tumor development after endoscopic resection for early gastric cancer.

BackgroundMetachronous gastric tumor (MGT) is one of major concerns after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Optimal follow-up strategy has not been yet well-established. The aim of this study was to identify the different clinical features of the patients according to the time interval to development of MGT.MethodsAmong 1,780 consecutive patients with EGC who underwent ESD between 2005 and 2014, 115 patients with MGT were retrospectively reviewed. MGT was defined as secondary gastric cancer or dysplasia detected > 1 year after initial ESD. Clinicopathological factors associated with early development of MGT were evaluated.ResultsThe median interval to development of MGT was 37 months. In univariate analysis, the median interval to MGT was shorter if EGC lesion was non-elevated type (39.4 vs 57.0 months, p = 0.011), or synchronous primary lesion was absent (39.8 vs 51.4 months, p = 0.050). In multivariate Cox’s proportional hazards analysis, the hazard ratios for early occurrence of MGT were 1.966 (95% CI: 1.141–3.386, p = 0.015) and 1.911 (95% CI: 1.163–3.141, p = 0.011), respectively. There was no significant difference in overall survival after diagnosis of MGT between the early occurrence group and the late occurrence group.ConclusionsNon-elevated gross type and absence of synchronous gastric tumor were independent risk factors for early development of MGT. Meticulous endoscopic inspection is especially important for the detection of MGT during the early follow-up period in patients with these initial tumor characteristics.

The occurrence of resin canals in branches of Cedrus deodara with different inclination angles

Resin canals play an important role in gymnosperm taxonomy, and the initiation of the resin canals in branches of C. deodara remains controversial. Therefore, the common wood anatomical method was used to investigate the existence of resin canals in the C. deodara branch with different inclining angles (45°, 90° and 135°), and the regularity of its occurrence is summarized by describing its radial and axial distribution pattern. It shows that the ratio of occurrence of resin canals (RORC) gradually decreases from pith to phloem in the branch base. Meanwhile, RORC is increasing generally from the base of the branch to the tip. Furthermore, the main distributing area of resin canals existed at the third or fourth growth ring at beginning, and it moved towards the bark until it arrived at around the twentieth growth ring along with the axial position moving from the tip of the branch to the base. Besides that, it was found that branches with an inclining angle of 45° have more resin canals than other angles, and it also happens to compression zones when compared to other peripheral positions. Variance analysis showed that both inclining angle and peripheral position had significant effect on the RORC.