Mycobacterium tuberculosis
(Mtb) in sputum originates from lung cavities in tuberculosis (TB) patients. But drug susceptibility testing (DST) of sputum Mtb can not be conducted the same as in the ...lung because mutagenesis of bacilli may be happening in the lung during treatment and result in the possibility of the presence of heterogeneous drug-resistant subpopulations in the different lung lesions. This could be one of the reasons for low cure rates for multi-drug resistant (MDR)-TB. We studied the resected lungs of nine surgery patients with chronic TB. The isolates isolated from the sputum and different lung lesions of each patient were tested for phenotypic DST and genotyped using restriction fragment length polymorphism (RFLP) typing method. Genetic analysis to resistance to first and second line drugs was also performed. Five of nine patients were MDR-TB and three XDR-TB. DST results for ten anti-TB drugs were in accordance among different lung lesions in eight patients. However, only three of these eight patients showed the concordance of DST with sputum. Even though the isolates were heteroresistant, genotyping them by RFLP showed the clonal population in each individual patient. Six of eight followed-up patients achieved successful cure. In conclusion, the heteroresistance between sputum and lung lesions and a clonal population without mixed infection might provide useful information in establishing treatment regimen and surgery decision for MDR- and XDR-TB.
The disturbance of a rock due to a blasting impact or stress redistribution can significantly influence the overall performance of an underground excavation. In order to investigate the ...characteristics of the EDZ (Excavation Damaged Zone) developed during the construction of the KAERI underground research tunnel in Korea (KURT), which is an underground research tunnel for a Korean high-level radioactive waste disposal program, various in situ and laboratory tests were carried out. A Goodman jack test showed that the deformation modules were influenced by a blasting to a depth of 1.5–2
m. With empirical equations, the EDZ could be predicted as 0.3–2.3
m. The average RQD from the rock cores at 0–2
m, where the blasting impact was significant, was 17% lower than that from the deeper regions. From the laboratory tests, the EDZ size could be estimated to be around 0.9–1.5
m. The elastic modules in the EDZ were decreased by about 56%. From a borehole radar reflection survey and a subtracting technique, it was possible to detect the new reflectors generated by a tunnel blasting. By using the determined EDZ size and the properties from the laboratory and in situ tests, a sensitivity analysis was performed. From the sensitivity analysis with seven parameters, it was possible to determine that the in situ stress ratio, Young’s modules, and EDZ size were the three main parameters.
Objective
To compare the efficacy of two types of progestogen therapy for preventing preterm birth (PTB) and to review the relevant literature.
Design
A multicentre, randomised, open‐label, ...equivalence trial and a meta‐analysis.
Setting
Tertiary referral hospitals in South Korea.
Population
Pregnant women with a history of spontaneous PTB or short cervical length (<25 mm).
Methods
Eligible women were screened and randomised at 16‒22 weeks of gestation to receive either 200 mg of vaginal micronised progesterone daily (vaginal group) or an intramuscular injection of 250 mg 17α‐hydroxyprogesterone caproate weekly (IM group). Stratified randomisation was carried out according to participating centres and indications for progestogen therapy. This trial was registered at ClinicalTrials.gov (NCT02304237).
Main outcome measure
Preterm birth (PTB) before 37 weeks of gestation.
Results
A total of 266 women were randomly assigned and a total of 247 women (119 and 128 women in the vaginal and IM groups, respectively) were available for the intention‐to‐treat analysis. Risks of PTB before 37 weeks of gestation did not significantly differ between the two groups (22.7 versus 25.8%, P = 0.571). The difference in PTB risk between the two groups was 3.1% (95% CI −7.6 to 13.8%), which was within the equivalence margin of 15%. The meta‐analysis results showed no significant differences in the risk of PTB between the vaginal and IM progestogen treatments.
Conclusion
Compared with vaginal progesterone, treatment with intramuscular progestin might increase the risk of PTB before 37 weeks of gestation by as much as 13.8%, or reduce the risk by as much as 7.6%, in women with a history of spontaneous PTB or with short cervical length.
Tweetable
Vaginal and intramuscular progestogen showed equivalent efficacy for preventing preterm birth before 37 weeks of gestation.
Tweetable
Vaginal and intramuscular progestogen showed equivalent efficacy for preventing preterm birth before 37 weeks of gestation.
This study was to investigate the nutrient ileal digestibility of dried mealworm (Tenebrio molitor) larvae and compare with those of three animal protein by-products in growing pigs.
A total of 12 ...crossbred (Landrace×Yorkshire×Duroc) growing pigs with average body weights of 24.12±0.68 kg were surgically equipped with simple T-cannulas after being deprived of feed for 24 h according to published surgical procedures. These pigs had a recovery period of two weeks. A total of 12 pigs were assigned to individual metabolic crates and allotted to one of four treatments with 3 replicates in a fully randomized design. Dietary treatments included the following: i) Fish meal, corn-vegetable by-product basal diet+9.95% fish meal; ii) Meat meal, corn-vegetable by-product basal diet+9.95% meat meal; iii) Poultry meal, corn-vegetable by-product basal diet+9.95% poultry meal; iv) Tenebrio molitor, corn-vegetable by-product basal diet+9.95% dried Tenebrio molitor larvae.
Results showed that the apparent ileal digestibility (AID) of Lys was higher (p<0.05) in pigs fed Tenebrio molitor diet than that in pigs fed fish meal diet. Pigs fed Tenebrio molitor diet showed increased (p<0.05) AID of His and Arg compared to pigs fed Fish meal or Meat meal diet. The AID of Cys was increased (p<0.05) in pigs fed poultry meal and Tenebrio molitor diets compared to that in pigs fish meal diet. Pigs fed meat meal, poultry meal, and Tenebrio molitor diets showed higher (p<0.05) standardized ileal digestibility (SID) of total energy compared to pigs fed fish meal diet. The SID of Arg was higher (p<0.05) in pigs fed Tenebrio molitor diet than that in pigs fed fish meal or meat meal diet. Furthermore, pigs fed poultry meal or Tenebrio molitor diets showed increased (p<0.05) SID of Cys compared to pigs fed fish meal diet.
In conclusion, providing pigs with diets that contained Tenebrio molitor larvae meal improved AID and SID of nutrients as well as essential and non-essential amino acids. The digestibility of dried mealworm larvae protein and its utilization in vivo are also good. Therefore, dried mealworm larvae protein can be used as protein source at 10% level in growing pigs.
Summary
Background
There are increasing reports of paradoxical psoriasiform diseases secondary to anti‐tumour necrosis factor (TNF) agents.
Aims
To determine the risks of paradoxical psoriasiform ...diseases secondary to anti‐TNF agents in patients with inflammatory bowel disease (IBD).
Methods
A nationwide population study was performed using the Korea National Health Insurance Claim Data. A total of 50 502 patients with IBD were identified between 2007 and 2016. We compared 5428 patients who were treated with any anti‐TNF agent for more than 6 months (anti‐TNF group) and 10 856 matched controls who had never taken anti‐TNF agents (control group).
Results
Incidence of psoriasis was significantly higher in the anti‐TNF group (36.8 per 10 000 person‐years) compared to the control group (14.5 per 10 000 person‐years) (hazard ratio HR 2.357, 95% confidence interval CI 1.668‐3.331). Palmoplantar pustulosis (HR 9.355, 95% CI 2.754‐31.780) and psoriatic arthritis (HR 2.926, 95% CI 1.640‐5.218) also showed higher risks in the anti‐TNF group. In subgroup analyses, HRs for psoriasis by IBD subtype were 2.549 (95% CI 1.658‐3.920) in Crohn's disease and 2.105 (95% CI 1.155‐3.836) in ulcerative colitis. Interestingly, men and younger (10‐39 years) patients have significantly higher risks of palmoplantar pustulosis (HR 19.682 95% CI 3.867‐100.169 and HR 14.318 95% CI 2.915‐70.315, respectively), whereas women and older (≥40 years) patients showed similar rates between the two groups.
Conclusions
The risks of psoriasiform diseases are increased by anti‐TNF agents in patients with IBD. Among psoriasiform diseases, the risk of palmoplantar pustulosis shows the biggest increase particularly in male and younger patients.
Linked ContentThis article is linked to Pariente and Blondeaux, and Lee et al papers. To view these articles visit https://doi.org/10.1111/apt.14903 and https://doi.org/10.1111/apt.14917.
In this paper, using the multisatellite (the Van Allen Probes and two GOES satellites) observations in the inner magnetosphere, we examine two electromagnetic ion cyclotron (EMIC) wave events that ...are triggered by Pdyn enhancements under prolonged northward interplanetary magnetic field quiet time preconditions. For both events, the impact of enhanced Pdyn causes EMIC waves at multiple points. However, we find a strong spatial dependence that EMIC waves due to enhanced Pdyn impact can occur at multiple points (likely globally but not necessarily everywhere) but with different wave properties. For Event 1, three satellites situated at a nearly same dawnside zone but at slightly different L shells see occurrence of EMIC waves but in different frequencies relative to local ion gyrofrequencies and with different polarizations. These waves are found inside or at the outer edge of the plasmasphere. Another satellite near noon observes no dramatic EMIC wave despite the strongest magnetic compression there. For Event 2, the four satellites are situated at widely separated magnetic local time zones when they see occurrence of EMIC waves. They are again found at different frequencies relative to local ion gyrofrequencies with different polarizations and all outside the plasmasphere. We propose two possible explanations that (i) if triggered by enhanced Pdyn impact, details of ion cyclotron instability growth can be sensitive to local plasma conditions related to background proton distributions, and (ii) there can be preexisting waves with a specific spatial distribution, which determines occurrence and specific properties of EMIC waves depending on satellite's relative position after an enhanced Pdyn arrives.
Key Points
Examined EMIC waves at multiple points in the inner magnetosphere for enhanced dynamic pressure
Wave occurrences, frequencies, and polarizations differ significantly at different spatial points
Suggest explanations for the sensitive spatial dependence
Therapeutic guidelines have not yet been established for low-grade gastric adenomas/dysplasias (LGD), which have a low risk of progression to high-grade adenomas/dysplasias (HGD) or to invasive ...carcinomas. This study aimed to evaluate risk factors for HGD/carcinoma that indicate a need for resection in biopsy-proven LGD lesions.
In total, 236 LGD lesions from 208 consecutive patients treated with endoscopic resection (ER) were retrospectively studied between 2004 and 2008. The Vienna classification was used for histological diagnosis. A generalized estimating equation (GEE) logistic regression model was used for multivariate analysis.
Among the 236 LGD lesions, the final pathology diagnosed 9 (3.8 %) as invasive carcinoma (category 5), 71 (30.1 %) as HGD (category 4), 148 (62.7 %) as LGD (category 3), and 8 (3.4 %) as negative/indefinite for dysplasia (category 1/2). Lesions ≥ 1 cm were classified as HGD/carcinoma in 39.4 % of patients (65/165). Multivariate analysis indicated that size of ≥ 1 cm (OR 1.93 95 % CI, 1.06 - 3.52), depressed morphology (OR 3.81 95 % CI, 1.22 - 11.9), and erythema (OR 2.49 95 % CI, 1.31 - 4.72) were significantly associated with HGD/carcinoma. The OR increased to 47.6 (95 % CI, 4.27 - 530.65) when the risk factors were all positive. The sensitivity and negative predictive value for ≥ 1 risk factors were 93.8 % and 90.9 %, respectively. As the number of risk factors of a lesion increased, the specificity and positive predictive value also increased.
Endoscopic resection can be recommended if a low-grade dysplastic lesion has at least one of the following risk factors: depressed morphology, surface erythema, or a size of 1 cm or greater. For lesions that have none of the three risk factors, follow-up endoscopy is recommended.
The influence of Ti addition on the development of acicular ferrite microstructure during the γ/α transformation in C–Mn steels has been studied. The optical microstructures of the heat-treated ...specimens with different Ti concentrations were characterized. Transmission electron microscopy analysis with thin foil specimens was carried out to investigate the phase composition of non-metallic inclusions and the local variation of chemical composition around the inclusions. It has been found that an acicular ferrite dominant microstructure could be produced when the Ti concentration is higher than about 50 ppm. The transition from the conventional bainitic microstructure to the interlocking acicular ferrite microstructure occurs in response to the change in the main-component of the non-metallic inclusions from Mn–Si oxide to Ti
2O
3. The Mn depleted zones around Ti
2O
3 particles were detected, which could explain how the intragranular nucleation is facilitated on Ti
2O
3 particles.
Summary
Background
Helicobacter pylori eradication is recommended for early gastric cancer (GC) patients after resection.
Aim
To evaluate whether H. pylori eradication improves glandular atrophy and ...intestinal metaplasia (IM) in GC patients undergoing subtotal gastrectomy.
Methods
This randomised, double‐blind trial was performed in tertiary care setting. Distal GC patients with H. pylori infection were randomised to receive proton pump inhibitor‐based triple therapy or placebo. The histology was evaluated using the updated Sydney system before and at 36 months after surgery. The endpoints were the comparison of atrophy and IM score changes between the allocated groups and according to final H. pylori status.
Results
Overall, 190 patients were randomised to the treatment and placebo groups. For lesser curvature of the corpus, mean atrophy and IM scores did not differ between the treatment and placebo groups. However, the H. pylori‐eradicated patients had significantly lower mean scores than the H. pylori‐persistent patients regarding atrophy (0.55 ± 0.95 vs. 1.05 ± 1.10 respectively; P = 0.0046) and IM (0.66 ± 0.99 vs. 1.05 ± 1.16 respectively; P = 0.0284). The percentage change from baseline was more marked in the H. pylori‐negative than in the H. pylori‐positive groups (−58.6% vs. −11.0% for atrophy and −60.5% vs. −35.6% for IM respectively). For greater curvature, mean atrophy score was lower in the H. pylori‐negative group than in the H. pylori‐positive group (0.14 ± 0.50 vs. 0.41 ± 0.75 respectively; P = 0.0281). The percentage change was −36.4% vs. 86.3%.
Conclusion
Helicobacter pylori eradication in GC patients is beneficial, as reflected by lower scores of atrophy and IM at 36 months after subtotal gastrectomy. (ClinicalTrials.gov number, NCT01002443).
Summary
Background
Metformin use has been associated with a decreased incidence and mortality of various cancers.
Aim
To evaluate the association between metformin use and gastric cancer.
Methods
We ...randomly selected 100 000 type 2 diabetic patients from the 2004 Korean National Health Insurance claim database, and assessed gastric cancer incidence among 39 989 patients (aged 30–97 years) who were regularly treated with anti‐diabetic drugs and followed‐up from 2004 to 2010. In total, 26 690 patients had used metformin out of 32 978 diabetics who had not regularly used insulin (insulin non‐users), and 5855 patients had used metformin out of 7011 regular insulin users.
Results
Patients who used metformin showed a lower incidence of gastric cancer than those who did not use metformin, in insulin non‐users (P = 0.047, log‐rank test). However, in patients on regular insulin, there was no difference of gastric cancer incidence according to metformin use. In insulin non‐users, the adjusted hazard ratio (AHR) for metformin use was 0.73 (95% confidential interval CI, 0.53–1.01) with borderline statistical significance (P = 0.059). Duration of metformin use was associated with the reduction in gastric cancer risk (AHR, 0.88; 95% CI 0.81–0.96, P = 0.003), especially in patients who used metformin for more than 3 years (AHR, 0.57; 95% CI, 0.37–0.87; P = 0.009).
Conclusion
Metformin use >3 years in type 2 diabetics who do not use insulin is associated with a significantly reduced gastric cancer risk.
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