Optic neuritis (ON) may be the initial manifestation of neuromyelitis optica spectrum disorder (NMOSD). Aquaporin-4 antibody (AQP4 Ab) is used to diagnose NMOSD. This has implications on prognosis ...and is important for optimal management. We aim to evaluate if clinical features can distinguish AQP4 Ab seropositive and seronegative ON patients.
We reviewed patients with first episode of isolated ON from Tan Tock Seng Hospital and Singapore National Eye Centre who tested for AQP4 Ab from 2008 to 2017. Demographic and clinical data were compared between seropositive and seronegative patients.
Among 106 patients (120 eyes) with first episode of isolated ON, 23 (26 eyes; 22%) were AQP4 Ab positive and 83 (94 eyes; 78%) were AQP4 Ab negative. At presentation, AQP4 Ab positive patients had older mean onset age (47.9 ± 13.6 vs 36.8 ± 12.6 years, P < 0.001), worse nadir VA (OR 1.714; 95% CI, 1.36 to 2.16; P < 0.001), less optic disc swelling (OR 5.04; 95% CI, 1.682 to 15.073; p = 0.004), and higher proportions of concomitant anti-Ro antibody (17% vs 4%, p = 0.038) and anti-La antibody (17% vs 1%, p = 0.008). More AQP4 Ab positive patients received steroid-sparing immunosuppressants (74% vs 19%, p < 0.001) and plasma exchange (13% vs 0%, p = 0.009). AQP4 Ab positive patients had worse mean logMAR VA (visual acuity) at 12 months (0.70 ± 0.3 vs 0.29 ± 0.5, p = 0.051) and 36 months (0.37±0.4 vs 0.14 ± 0.2, p = 0.048) follow-up.
Other than older onset age and retrobulbar optic neuritis, clinical features are non-discriminatory for NMOSD. We propose a low threshold for AQP4 Ab serology testing in inflammatory ON patients, particularly in high NMOSD prevalence populations, to minimize diagnostic and treatment delays.
We have synthesized a novel polyfluorene copolymer polyfluorene–bis4‐(diphenylamino)styrylfluorene (PF–DPAS) by orthogonally attaching an amino‐substituted distyrylarylene dye ...bis4‐(diphenylamino)styrylfluorene, onto the C9 position of a fluorene unit. We have investigated this polymer's thermal properties, electronic properties (viz., absorption and photoluminescence), and electrochemical behavior. Photoluminescence studies indicate that color tuning can be achieved through efficient Förster energy transfer from the higher‐energy polyfluorene backbone to the lower‐energy pendant DPAS units. We have fabricated light‐emitting diodes with the structure indium tin oxide (ITO)/poly(3,4‐ethylenedioxythiophene) (PEDOT)/emitting layer/1,3,5‐tris(N‐phenylbenzimidazol‐2‐yl)benzene (TPBI)/Mg:Ag. The devices, based on blends of PF–DPAS in polyfluorene–triphenylamine–oxadiazole (PF–TPA–OXD), exhibit significant improvements in device performance relative to that of the pure PF–TPA–OXD device; we attributed this improvement to both a red‐shift of the electroluminescence (EL) spectra and an enhancement in quantum efficiency. At a blend ratio of 1:20, the EL spectrum is voltage‐independent and stable, and exhibits the characteristic emission of a DPAS moiety: a peak at 461 nm and Commission Internationale de l'Eclairage (CIE) coordinates of (0.15, 0.18). The maximum external quantum efficiency is 2.08 % (2.87 cd A–1) at a bias of 9 V (86.1 mA cm–2) with a brightness of 2467 cd m–2; the maximum brightness (6916 cd m–2) occurred at an applied voltage of 13 V and a current density of 361 mA cm–2.
Color tuning of a light‐emitting polymer is achieved through efficient Förster energy transfer from a higher‐energy polyfluorene (PF) backbone to lower‐energy pendant bis4‐(diphenylamino)styrylfluorene (DPAS) units. An electroluminescent device based on a PF–DPAS blend in PF–triphenylamine–oxadiazole shows a voltage‐independent, stable spectrum (see Figure) with a maximum external quantum efficiency of 2.08 % and a maximum brightness of 6916 cd m–2.
In this study, a series of hydrogenated diamond-like carbon (H-DLC) coatings were deposited using an unbalanced magnetron sputtering system. For hydrogenation, acetylene gas was used as the hydrogen ...source. The typical conditions for preparing DLC coatings were used, with additional acetylene gas being introduced into the depositing chamber. The acetylene flow rate was varied from 0 to 16 sccm at intervals of 4 sccm and finally set at 24 sccm. The chemical composition, microstructure, and phases of the resulting coatings were evaluated. Fourier transform infrared spectrometry, X-ray photoelectron spectroscopy, and Raman analysis were performed, and specific mechanical properties were examined. The results indicated that hydrogenation influenced the H-DLC coatings due to the formation of sp3 bonding. The coating prepared at a flow rate of 8 sccm of acetylene exhibited the highest hardness of 15.4 GPa because it had the highest number of sp3 bonds.
Since early March 2003, the severe acute respiratory syndrome (SARS) coronavirus (CoV) infection has claimed 346 cases and 37 deaths in Taiwan. The epidemic occurred in two stages. The first stage ...caused limited familial or hospital infections and lasted from early March to mid-April. All cases had clear contact histories, primarily from Guangdong or Hong Kong. The second stage resulted in a large outbreak in a municipal hospital, and quickly spread to northern and southern Taiwan from late April to mid-June. During this stage, there were some sporadic cases with untraceable contact histories. To investigate the origin and transmission route of SARS-CoV in Taiwan's epidemic, we conducted a systematic viral lineage study by sequencing the entire viral genome from ten SARS patients. SARS-CoV viruses isolated from Taiwan were found closely related to those from Guangdong and Hong Kong. In addition, all cases from the second stage belonged to the same lineage after the municipal hospital outbreak, including the patients without an apparent contract history. Analyses of these full-length sequences showed a positive selection occurring during SARS-CoV virus evolution. The mismatch distribution indicated that SARS viral genomes did not reach equilibrium and suggested a recent introduction of the viruses into human populations. The estimated genome mutation rate was ≈0.1 per genome, demonstrating possibly one of the lowest rates among known RNA viruses.
Summary
This study assessed the effect of dietary vanadium (V) and vitamin C (VC) on production performance, egg quality and antioxidant status in laying hens. A total of 360 laying hens ...(31‐week‐old) were randomly allotted into a 3 × 3 factorial arrangement treatments (four replicates and 10 chicks per replicate) with three levels of dietary V (0, 5 and 10 mg/kg) and three levels of vitamin C (0, 50 and 100 mg/kg) for 12 weeks. The effect of V and VC did not alter egg production, egg weight, average daily feed intake and feed conversion ratio during 1–12 week. Albumen height and Haugh unit value were linearly decreased (p < 0.001) by addition of V, whereas the effect of 100 mg/kg VC was observed to counteract (p < 0.05) this effect in V‐containing treatments during 1–12 week. Hens fed V‐containing diet laid lighter (linear effect, p < 0.05) coloured eggs (higher lightness value, lower redness and yellowness value), and the VC exerted no influence on it during 1–12 week. The serum superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH‐Px) activities, ability to inhibit hydroxyl radical, were significantly decreased, and the malondialdehyde (MDA) and V contents were increased (p < 0.05) by effect of V during 4, 8 and 12 week. The effect of VC alone and the interactive effect between VC and V were shown to increase serum (p < 0.05) SOD activity in 4 week and decrease MAD levels in 12 week. The result indicate that V decreased the egg quality and caused the oxidative stress at level of 5 mg/kg and 10 mg/kg, and the addition of 100 mg/kg vitamin C can alleviate its egg quality reduction effect and can mitigate the oxidative stress to some extent.
Taiwan's National Health Insurance Research Database (NHIRD) exemplifies a population-level data source for generating real-world evidence to support clinical decisions and health care policy-making. ...Like with all claims databases, there have been some validity concerns of studies using the NHIRD, such as the accuracy of diagnosis codes and issues around unmeasured confounders. Endeavors to validate diagnosed codes or to develop methodologic approaches to address unmeasured confounders have largely increased the reliability of NHIRD studies. Recently, Taiwan's Ministry of Health and Welfare (MOHW) established a Health and Welfare Data Center (HWDC), a data repository site that centralizes the NHIRD and about 70 other health-related databases for data management and analyses. To strengthen the protection of data privacy, investigators are required to conduct on-site analysis at an HWDC through remote connection to MOHW servers. Although the tight regulation of this on-site analysis has led to inconvenience for analysts and has increased time and costs required for research, the HWDC has created opportunities for enriched dimensions of study by linking across the NHIRD and other databases. In the near future, researchers will have greater opportunity to distill knowledge from the NHIRD linked to hospital-based electronic medical records databases containing unstructured patient-level information by using artificial intelligence techniques, including machine learning and natural language processes. We believe that NHIRD with multiple data sources could represent a powerful research engine with enriched dimensions and could serve as a guiding light for real-world evidence-based medicine in Taiwan.
1 Departments of Microbiology & Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China
2 Departments of Pediatrics, College of Medicine, National Cheng ...Kung University, Tainan, Taiwan, Republic of China
3 Departments of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China
Correspondence Huan-Yao Lei hylei{at}mail.ncku.edu.tw
Enterovirus 71 (EV71) infection causes a myriad of diseases from mild hand-foot-and-mouth disease or herpangina to fatal meningoencephalitis complicated with neurogenic pulmonary oedema. Its pathogenesis, especially the CNS involvement, is not clearly understood. The aim of this study was to set up a mouse EV71 infection model with CNS involvement. EV71 virus was administrated orally to neonatal mice. The EV71-infected mice manifested a skin rash at an early stage and hind limb paralysis or death at a later stage. Immunohistochemical staining and virus isolation demonstrated that EV71 replicated in the small intestine, induced viraemia and spread to various organs. Kinetic studies showed that EV71 antigen was first detected in the intestine at 6 h, in the thoracic spinal cord at 24 h, in the cervical spinal cord at 50 h and in the brain stem at 78 h post-infection. Leukocyte infiltration was evident in the spinal cord and brain stem. Furthermore, EV71 virus could be transmitted to littermates within the same cage.
To know the incidence of epidermal growth factor receptor (EGFR) mutations in small cell lung cancer (SCLC) patients who received surgical resection in mainland China. xTAG technology was used to ...detect the EGFR exon 19 and exon 21 mutations of 40 patients with SCLC who received surgical treatment in Zhejiang Cancer Hospital from 1998 to 2010. 2 of 40 cases were found with mutations in exon 19 of the EGFR gene. The mutation in exon 19 of the EGFR gene is in a female and non smoking patient which pathology is SCLC combined adenocarcinoma, and the other is male and smoking patient which pathology is SCLC combined squamous cell carcinoma. The EGFR mutation is rare in SCLC patients, and EGFR mutation might occur more often in combined SCLCs than conventional patients.
Previous studies have reported the relationship between thyroid hormone levels and mortality in dialysis patients. However, little is known about the association of free thyroxine (fT4) and mortality ...in patients on peritoneal dialysis (PD). This study investigated the association between basal and annual variation in fT4 level and mortality in PD patients.
Patients on maintenance PD were enrolled from a prospective multicenter cohort study in Korea; their serum triiodothyronine, fT4, and thyroid-stimulating hormone levels were measured 12 months apart. Patients with overt thyroid disease and those receiving thyroid hormone replacement therapy were excluded from the analysis. Patients were divided into two groups based on the median levels of fT4. The differences of all-cause, infection-related, and cardiovascular mortalities were analyzed between the two groups. The association of basal levels and annual variation with mortality was investigated with Kaplan-Meier curves and Cox proportional hazard models.
Among 235 PD patients, 31 (13.2%) deaths occurred during the mean follow-up period of 24 months. Infection (38.7%) was the most common cause of death. Lower basal fT4 levels were an independent predictor of all-cause and infection-related death (hazard ratio HR = 2.74, 95% confidence interval CI 1.27-5.90, P = 0.01, and HR = 6.33, 95% CI 1.16-34.64, P = 0.03, respectively). Longitudinally, patients with persistently lower fT4 levels during the 12-month period had significantly higher all-cause mortality than those with persistently higher levels (HR = 3.30, 95% CI 1.15-9.41, P = 0.03). The area under the receiver operating characteristic curve of fT4 for predicting all-cause and infection-related mortality was 0.60 and 0.68, respectively.
fT4 level is an independent predictor of mortality and is especially attributable to infection in PD patients. This predictor was consistent when considering both baseline measurements and annual variation patterns. Close attention to infection in PD patients with relatively lower fT4 levels should be considered.
Aim: The Hong Kong Genome Project (HKGP) is the first large-scale genome sequencing (GS) project in the Hong Kong Special Administrative Region. The Hong Kong Genome Institute (HKGI) is entrusted ...with the task of implementing the HKGP. With the aim to sequence 45,000-50,000 genomes in five years, it is the project’s goal to provide participants with more precise diagnosis and personalised treatment, and to drive the application and integration of genomic medicine into routine clinical care.
Methods: The HKGI Laboratory’s hardware and software components were customised to tailor to the needs of the project. Sample handling and storage protocol, DNA extraction, and PCR-free GS workflow were developed and optimised. Quality control indicators and metrics for assessing the quality of samples, sequencing libraries and sequencing data were established.
Results: The Laboratory is designed to facilitate a unidirectional GS workflow to minimise the risk of contamination. The Sample Manager system handles laboratory data generated from the HKGP samples and biobank. The Laboratory handles and analyses approximately 350-500 samples per week, the majority of which are whole blood. During the first 24 months since the launch of the HKGP, 12,937 participants and their family members (6,680 genomes) have been recruited and sequenced. The sequencing capacity of the Laboratory has been further enhanced to include the latest technologies, such as long-read sequencing and multi-omics in order to meet the target of the HKGP.
Conclusion: HKGI Laboratory established a robust GS workflow for the HKGP. The clinical utility of GS will bring precision medicine into routine clinical practice.
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