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Supplemental material, sj-docx-3-eso-10.1177_23969873231170989 for Interaction between cerebral small vessel disease, blood pressure, and remote ischemic lesions in acute spontaneous intracerebral hemorrhage by Szu-Ju Chen, Hsin-Hsi Tsai, Yen-Ling Lo, Ya-Fang Chen, Sung-Chun Tang, Jiann-Shing Jeng and Li-Kai Tsai in European Stroke Journal

Supplemental material, sj-docx-2-eso-10.1177_23969873231170989 for Interaction between cerebral small vessel disease, blood pressure, and remote ischemic lesions in acute spontaneous intracerebral hemorrhage by Szu-Ju Chen, Hsin-Hsi Tsai, Yen-Ling Lo, Ya-Fang Chen, Sung-Chun Tang, Jiann-Shing Jeng and Li-Kai Tsai in European Stroke Journal

The recovery of gallium (Ga) from gallium arsenide (GaAs) scrap using a leaching-ion exchange method was investigated. The ground GaAs scrap was leached, using 2.0 N nitric acid at 30 &deg, C for 1.0 h, and the dissolution of Ga and arsenic (As) reached 98%. The pregnant solution with a 1/20 dilution ratio was then passed through a weak acid chelating resin Diaion CR-11. Highly charged Ga3+ has the ability to form complexes with the chelating resin and separate from the coexisting H3AsO4 in the leachate with very low pH. The loaded column was eluted with 0.1 M H2SO4, and the final concentrated solution had 4.5 g/L of Ga with 99.3% purity. The effluent from the column was further processed to remove As by ferric arsenicate precipitation, and reused continuously as the dilution water for raw leachate.

Background Sinus mucosa abnormalities on image studies, which is the major diagnostic measure for sinusitis, were investigated in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT). Methods A retrospective review of the MRIs for patients with NPC was conducted. Sinus mucosa abnormalities were staged by the Lund–Mackay system. Results A total of 94 patients were enrolled in this study. The rate and severity of sinus abnormalities were highest on the third postradiotherapy month (p < .005, t test). There was no significant increase in the incidence of abnormalities on the fifth postradiotherapy year (t test). The anterior ethmoid and maxillary sinuses were the most affected sinuses before and after radiotherapy (p < .005, chi-square test). Conclusion Our data showed that the anterior ethmoid and maxillary sinuses were the most vulnerable sinuses for therapeutic toxicity after IMRT in patients with NPC. In the long run, however, the application of IMRT does not significantly increase the incidence of sinus toxicities. © 2015 Wiley Periodicals, Inc. Head Neck 38: 29–35, 2016

BACKGROUND The objectives of this study were to determine the in vitro anti-inflammatory and in vivo antihypertensive effects of fermented pepino (Solanum muricatum) milk by Lactobacillus brevis with the goal of developing functional healthy products. The inflammatory factors of fermented pepino milk with L. brevis were assessed in RAW 264.7 macrophages, including nitric oxide (NO) production. Inflammatory factor genes of cyclooxygenase (COX)-1 and −2, and tumor necrosis factor (TNF)-α were also assayed by a reverse transcription–polymerase chain reaction (RT-PCR). RESULTS Results showed that fermented PE inhibited NO production in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells with 150 mg mL−1 fermented PE completely blocking LPS-induced NO production. The mRNA expressions of COX-1, COX-2, and iNOS were attenuated by treatment with higher concentrations of fermented PE (150 mg/ml). Cells treated with fermented pepino extract (PE) (100 ng mL−1) exhibited strikingly decreased LPS-induced expression of TNF-α mRNA. During the feeding trial, rats treated with 10% fermented pepino milk (100 µg 2.5 mL−1) and 100% fermented pepino milk (1000 µg 2.5 mL−1) exhibited significant decreases in the systolic blood pressure. CONCLUSION Our results showed that fermented pepino milk has wide potential applications for development as a health food. © 2015 Society of Chemical Industry

This study aimed to investigate the occurrences of post-irradiation chronic suppurative otitis media (CSOM), otitis media with effusion (OME), chronic rhinosinusitis (CRS), and their interrelationship in nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy (IMRT). A retrospective review of medical records and magnetic resonance imaging for NPC patients across a 5-year follow-up was conducted. Rhinosinusitis was diagnosed and staged by Lund-Mackay system. A total of 102 patients were enrolled in the study. On the 5th year following IMRT, 8 patients (7.8 %), 30 patients (29.4 %), and 17 patients (16.7 %) suffered from IMRT-induced CSOM, post-irradiation OME, and CRS, respectively. Analysis by logistic regression showed a lack of association between the occurrence of post-irradiation OME and CRS (P = 0.06). These observations indicated that the modern radiotherapy technique exhibits capability in decreasing the incidences of CSOM and CRS comparing to the data of traditional radiotherapy. But post-irradiation OME was still encountered in more than one-quarter of long-term survivors of NPC. Of note, rhinosinusitis in NPC survivors does not predispose to the development of post-irradiation OME, suggesting nasal irrigation might be unnecessary for the management of OME following radiotherapy.

In this study, we examined the possible apoptotic mechanism of pepsin-digested extract of Caulerpa microphysa (CME) in myelomonocytic leukemia (WEHI-3) cells. Flow cytometry demonstrated that CME induced cell cycle arrest in the G0/G1 phase and stimulated reactive oxygen species (ROS) production and calcium release but caused a loss of the mitochondrial membrane potential (MMP). The results indicated that the protein levels of cyclin D, cyclin E, CDK6, CDK2 and Bcl-2 decreased and those of p21, p27, p53, Bax, Bid, GRP78, GADD153, apoptosis-inducing factor (AIF), caspase-3 and caspase-9 increased in WEHI-3 cells after CME treatment. In conclusion, CME induced G0/G1 phase arrest, decreased MMP and increased Ca 2+ release and ROS production in the WEHI-3 cells. The results suggest that CME may have potential as an anticancer agent.

Objectives/Hypothesis Postirradiation otitis media with effusion (OME) is a common adverse otologic effect in nasopharyngeal carcinoma (NPC) patients treated by radiotherapy. The purpose of this study was to determine the long-term incidence of postirradiation OME in NPC patients following intensity-modulated radiotherapy (IMRT) and to evaluate the potential factors associated with the development of this otologic complication. Study Design Retrospective observational study. Methods A retrospective review of NPC patients treated by IMRT between January 2002 and June 2008 was conducted. Otologic complications were regularly evaluated during follow-up. Presence of OME was detected by findings of otoscopic exam, pure-tone audiometry, impedance audiometry, and tympanocentesis. Incidence of postirradiation OME and relevant factors were analyzed. Results A total of 105 patients (210 ears) were enrolled in the study. There were 34 patients (32.4%) with unilateral or bilateral postirradiation OME 3 years or more following radiotherapy. There was no correlation between the complication and the stage of primary tumor. The presence of pretreatment OME, however, was significantly associated with the development of postirradiation OME. Although there was no significant relationship between the radiation dose and post-treatment OME, the link with radiation toxicity was demonstrated by the finding that 28% of postirradiation OME developed in the ears contralateral to the side of primary nasopharyngeal tumor. Conclusions Postirradiation OME remains a common late toxicity in NPC patients treated by modern radiotherapy. Pretreatment injuries by the tumor and radiation-induced damages to the eustachian tube both play a major role in the development of the otologic complication. Level of Evidence Level of Evidence: 3b (nonconsecutive cohort study). Laryngoscope, 123:2148–2153, 2013

Patients with bipolar II disorder (BDII) have a higher prevalence rate of metabolic disturbance. Whether BDII itself, in addition to its current standard treatment, is a risk factor for metabolic syndrome warrants additional study. The dopamine receptor D3 (DRD3) gene, one of the candidate genes for BDII, is also involved in the dopaminergic system. We investigated whether it is related to changes in the metabolic indices of patients with BDII given 12 weeks of standard treatment. Patients with a first diagnosis of BDII (n = 117) were recruited. Metabolic profiles (cholesterol, triglycerides, fasting serum glucose, body mass index) were measured at baseline and at 2, 8, and 12 weeks. The genotype of the DRD3 Ser9Gly polymorphism (rs6280) was determined. Multiple linear regressions with generalized estimating equation methods were used. Seventy-six (65.0%) patients completed the 12-week intervention. Significant differences in triglyceride change were associated with the DRD3 Ser9Gly genotype (P = 0.03). Patients with the Ser/Ser genotype had significantly smaller triglyceride increases and a lower risk of developing metabolic syndrome than did those with the Ser/Gly+Gly/Gly genotype. However, the associations between the DRD3 Ser9Gly polymorphism with changes in triglyceride level become nonsignificant after correcting for multiple comparisons. We conclude that the DRD3 Ser9Gly polymorphism is nominally associated with changes in triglycerides and metabolic syndrome after 12 weeks of standard BDII treatment.

Patients with subthreshold hypomania (SBP; subthreshold bipolar disorder) were indistinguishable from those with bipolar disorder (BP)-II on clinical bipolar validators, but their analyses lacked biological and pharmacological treatment data. Because inflammation and neuroprogression underlies BP, we hypothesized that cytokines and brain-derived neurotrophic factor (BDNF) are biomarkers for BP. We enrolled 41 drug-naïve patients with SBP and 48 with BP-II undergoing 12 weeks of pharmacological treatment (valproic acid, fluoxetine, risperidone, lorazepam). The Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) were used to evaluate clinical responses at baseline and at weeks 0, 1, 2, 4, 8, and 12. Inflammatory cytokines (tumour necrosis factor [TNF]-α, transforming growth factor [TGF]-β1, interleukin [IL]-6, IL-8 and IL-1β) and BDNF levels were also measured. Mixed models repeated measurement was used to examine the therapeutic effect and changes in BDNF and cytokine levels between the groups. HDRS and YMRS scores significantly (P

Objective: Emerging evidence suggests that inflammation and neurodegeneration underlies bipolar disorder. To investigate biological markers of cytokines and brain-derived neurotrophic factor between bipolar I, bipolar II, and other specified bipolar disorder with short duration hypomania may support the association with inflammatory dysregulation and bipolar disorder and, more specifically, provide evidence for other specified bipolar disorder with short duration hypomania patients were similar to bipolar II disorder patients from a biological marker perspective. Methods: We enrolled patients with bipolar I disorder (n=234), bipolar II disorder (n=260), other specified bipolar disorder with short duration hypomania (n=243), and healthy controls (n=140). Their clinical symptoms were rated using the Hamilton Depression Rating Scale and Young Mania Rating Scale. Inflammatory cytokine (tumor necrosis factor-α, C-reactive protein, transforming growth factor-β1, and interleukin-8) and brain-derived neurotrophic factor levels were measured in each group. Multivariate analysis of covariance and linear regression controlled for possible confounders were used to compare cytokine and brain-derived neurotrophic factor levels among the groups. Results: Multivariate analysis of covariance adjusted for age and sex and a main effect of diagnosis was significant ( P

Photobacterium damselae subsp. damselae is a marine bacterium that has the ability to produce histamine. In this study, 26 P. damselae subsp. damselae strains were isolated from Scomber australasicus (mackerel). These strains were assayed for histamine production using a histamine immunoassay test kit. The results demonstrated that all strains were histamine-producing bacteria, and most of them were strong histamine producers, yielding more than ≥1000 ppm histamine. To develop a polymerase chain reaction (PCR)-based method to detect P. damselae subsp. damselae, the random amplified polymorphic DNA (RAPD) method was used to design the specific primers. The 330-bp RAPD fragment present in all the isolated P. damselae subsp. damselae strains was cloned and sequenced. Specific primer sets were designed from this RAPD fragment. These primers were highly specific to P. damselae subsp. damselae and could distinguish it from P. damselae subsp. piscicida. The sensitivity of these primers specific for P. damselae subsp. damselae was approximately 1 fg. For the fish sample system, the specific primers enabled the detection of n × 100 colony forming units P. damselae subsp. damselae cells per gram of fish sample if a 16-h enrichment step was performed prior to PCR. This PCR-based assay of the RAPD fragment could provide a sensitive and specific method for detecting P. damselae subsp. damselae.

Seven species of cultivated and edible seaweeds found in Southern Taiwan—including Enteromorpha intestinalis, Monostorma nitidum, Ulva lactuca, Dictyopteris undulata, Sargassum hemiphyllum var. chinense, Laurencia intermedia, and Porphyra dentate—were used to determine their antioxidant activity by different extraction methods. All seaweeds were extracted using water at 90°C, sterilization at 121°C, homogenization, or enzymatic hydrolysis. Extracts were evaluated for their free radical-scavenging capacity using 1,1-diphenyl-2-pricrylhydrazyl (DPPH), their reducing power, and their superoxide anion scavenging activity. The DPPH-scavenging capacity of S. hemiphyllum var. chinense extracts produced by sterilization (98.59%), homogenization (94.72%), and carbohydrate-degrading enzyme treatment was higher than that of protease extracts, except for U. lactuca. The reducing power of S. hemiphyllum var. chinense water extracts and M. nitidum Viscozyme extracts was better than that of a commercial antioxidant. S. ...

Salmonella enterica serovar Choleraesuis (S.Choleraesuis) can cause salmonellosis in pigs and humans. Currently, the most common method used for the subtyping of this Salmonella serovar is pulsed field gel electrophoresis (PFGE) using XbaI as a DNA digestion enzyme. In this study, we compared and combined PFGE with the randomly amplified polymorphic DNA method, for the typing of 95 S. Choloraesuis strains isolated from diseased pigs. Using PFGE with XbaI, with AvrII, and with SpeI digested DNA, 29, 74, and 40 patterns, respectively, were obtained. Also, 53, 15, and 35 strains, respectively, belong to the major patterns X1, A1, and S1. When these three digestion patterns were combined, 83 PFGE pattern combinations were obtained. On the other hand, using RAPD with selected primer alone generated 76 patterns, and 11 strains which fell within a single X1A1S1 PFGE combination pattern were discriminated into 10 patterns. Thus, for S. Choloraesuis, PFGE with AvrII allowed higher discrimination than PFGE with XbaI, and some of the PFGE groupings obtained by combining the XbaI, AvrII and SpeI digestion patterns were further subdivided by the RAPD method.

Study Objective: To analyze the reasons for postponement or cancellation of surgery in the operating room (OR), and to determine the effect on patient outcomes. Design: Retrospective analysis. Setting: University-affiliated hospital. Measurements: Over a 5-year period, 45,663 surgeries requiring anesthesia occurred. Surgery was postponed or cancelled in the OR for 67 patients (0.15%). Airway problems, change in medical condition, and change in surgical condition were the reasons recorded. Each patient's surgical result was audited using medical charts and telephone calls for at least 6 months. Main Results: 33 cases (49.3%) were postponed from one day to 6 months (range, one to 165 days; median, 8 days). The scheduled surgeries for 21 (31.3%) patients were never performed; and 9 patients (13.4%) died during their hospitalization (range, one to 20 days; mean, 12.7 days). Conclusions: Surgery was postponed or cancelled in the OR mainly for changes in medical condition (70.2%); either medical risk outweighed the benefits of surgery, or alternative treatments were used.

Background Most studies demonstrated that the results of endoscopically directed middle meatal cultures (EDMMC) compare favorable with those of maxillary sinus taps in adults rhinosinusitis. Studies comparing results of EDMMC and antral puncture cultures in pediatric rhinosinusitis, however, revealed a decreased correlation. Sampling by suction aspiration was considered likely to improve the reliability of culture. Objective The aim of this study was to compare the microbiology results obtained by EDMMC using swabs or suction aspiration with the results of maxillary sinus taps in pediatric rhinosinusitis. Methods Thirty-one children with chronic rhinosinusitis were enrolled. Patients enrolled in 2007 (group A), underwent EDMMC using a swab, whereas those enrolled in 2008 (group B) underwent EDMMC using suction aspiration. Results obtained by EDMMC were compared with those of maxillary sinus taps. Results In group A, 29 paired cultures were obtained from 15 patients. In group B, 30 paired cultures were obtained from 16 patients. In group A, EDMMC by swab demonstrated a sensitivity of 52%, a specificity of 100%, and a correlation of 66%. In group B, EDMMC by suction aspiration provided a sensitivity of 86%, a specificity of 100%, and a correlation of 87%. The difference in density of growth between EDMMC with swab and maxillary sinus tap was not significant, but the difference between EDMMC with aspiration and maxillary sinus tap was significant. Conclusion Aspiration technique can significantly enhance the reliability of endoscopy cultures in children with rhinosinusitis, probably by increasing the amount of specimen obtained.

The major phytochemicals and antioxidant properties of taro-scented rice bran (TaiNung 71; TN71) extracts using 3 different solvents are characterized. Some progress is realized in creating an economic value for rice bran that has long been considered an agricultural waste. Various solvent extracts reveal the presence of phenolic compounds, oryzanols, tocopherols, and tocotrienols. Ethyl acetate (EtOAc) can extract more oryzanols (1.55 ± 0.20 g/kg rice bran). Meanwhile, the methanol (MeOH) extract possesses a higher yield in total contents (15.42 ± 1.41 g/kg bran), which includes phenolic compounds (2.69 ± 0.29 g gallic acid equivalent/kg bran), tocopherols (251 ± 26 mg/kg bran) and tocotrienols (111 ± 4 mg/kg bran). The MeOH extract exhibits more effective antioxidant activity against various oxidative systems in vitro, including the inhibition of linoleic acid peroxidation (33.89%), scavenging of DPPH radicals (83.88%), and reducing power. It is found that the yield, total content in phenolic compounds and tocols of the extracts increase with increasing Synder's polarity value and viscosity, which can then be used as the indices in isolation of the desired rice bran phytochemicals extracts. Practical Application: The results from this study have provided essential information concerning the utilization of rice bran extracts in cosmetics or in nutritional medicine.

BACKGROUND: The purpose of this study was to evaluate the functional potential of fermented pepino extract (PE) milk by Lactobacillus strains containing the glutamate decarboxylase (GAD) gene. Three Lactobacillus strains were selected, including L. brevis BCRC 12310, L. casei BCRC 14082 and L. salivarius subsp. salivarius BCRC 14759. The contents of free amino acids, total phenolics content, total carotenoids and the associated functional and antioxidant abilities were analyzed, including angiotensin-converting enzyme (ACE) inhibition activity, 1,1-diphenyl-2-picylhydrazyl (DPPH) radical-scavenging ability and oxygen radical absorbance capacity (ORAC). Cell proliferation of fermented PE milk was also evaluated by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. RESULTS: Compared to the unfermented PE, fermented PE milk from Lactobacillus strains with the GAD gene showed higher levels of total phenolics, γ-aminobutyric acid, ACE inhibitory activity, DPPH, and ORAC. The viability of human promyelocytic leukemia cells (HL-60) determined by the MTT method decreased significantly when the cells were incubated with the PE and the fermented PE milk extracts. CONCLUSION: The consumption of fermented PE milk from Lactobacillus strains with the GAD gene is expected to benefit health. Further application as a health food is worthy of investigation. © 2012 Society of Chemical Industry

In this study, individual selected lactic acid bacteria strains Lactobacillus acidophilus (LA), L. delbrueckii subsp. lactis (LDL), and L. gasseri (LGA) were grown in Chingshey purple sweet potato (CPSP) substrate/media. CPSP is rich in anthocyanin, which possesses antioxidant activity and in vitro cell assay. The antioxidant ability and functional properties of the fermented milk were examined. High-performance liquid chromatographic (HPLC) method was used to analyze the free amino acid, organic acids, and anthocyanin content. Total phenolic compounds, scavenging effects of 1,1-diphenyl-2-picyl-hydrazyl (DPPH) radicals, and scavenging effects of superoxide anion radicals were determined to evaluate the antioxidant ability of the samples. The cell proliferation of the fermented PSP milk was evaluated by 3-(4,5-dimethyldiazol-2-yl)-2,5 diphenyl Tetrazolium Bromide (MTT) assay. The result indicated that the antioxidant ability of the fermented CPSP milk through LA, LDL, and LGA strains was significantly higher than CPSP. The main anthocyanins present in the samples are cyanidin and delphinidin. MTT assay has revealed that incubation with both PSP and fermented CPSP milk prevented the cell death of macrophage-like RAW264.7 cells. The potential health benefit of fermented PSP milk through LA, LDL, and LGA strains makes the further application of CPSP in health food highly worthwhile. Practical Application: (1) In our study, we have employed the γ-aminobutyric acid (GABA), organic acid contents, total phenol content, anthocyanins content, DPPH, oxygen radical absorbance capacity, superoxide dismutase activity assay, and cytotoxicity assay to assess the functional properties of fermented CPSP milk by different lactic acid bacteria. (2) Our results have revealed that the fermented CPSP milk samples possess high GABA concentrations, organic acid contents, anthocyanins contents, and antioxidant activity. This will provide potential opportunity to develop different functional food products from fermented CPSP milk. (3) The potential health benefit of fermented CPSP milk makes the further application of CPSP in health food highly worthwhile.

Salmonella enterica serovar Choleraesuis may cause swine salmonellosis and human infection. Because the conventional method for detection of this Salmonella serovar may take 3 to 5 days, a PCR method for detection was evaluated. By comparing the sequence of the phase 1 flagellin (fliC) gene of Salmonella Choleraesuis with that of other Salmonella serovars and of other bacteria species available in GenBank, two PCR primers (flinC-F and flinC-R) were designed. Using these primers, all 97 Salmonella Choleraesuis strains assayed generated the expected PCR product, with a molecular mass of 963 bp. Except for S. enterica Paratyphi C, Salmonella isolates other than Salmonella Choleraesuis and non-Salmonella isolates, including strains of Enterobacteriaceae, all generated negative PCR results. Salmonella Paratyphi C could be differentiated from Salmonella Choleraesuis through the use of primers designed from the viaB gene. When Salmonella Choleraesuis isolates from swine stool, pork, liver, feed, and human whole blood samples were assayed with a preenrichment step, as low as 1 CFU/g or ml of the original sample could be detected.

Aims: Plasmid profile, phage typing, and pulsed-field gel electrophoresis (PFGE) patterns of 124 Salmonella Enteritidis strains isolated in 1998-2002 in Taiwan were analysed and the results were compared with those of the 63 strains obtained in 1991-1997, so that molecular subtypes and epidemic strains for Salmonella Enteritidis over a 13-year period (1991-2002) could be elucidated. Methods and Results: A total of 124 strains of Salmonella Enteritidis isolated from human in Taiwan between 1998 and 2002 were analysed by PFGE, plasmid analysis and phage typing. The results obtained were compared with those of the 63 strains obtained in 1991-1997, so that the clonal relationships for a total of 187 strains obtained over 13 years could be elucidated. For PFGE, restriction enzymes XbaI, SpeI and NotI were used for chromosomal DNA digestion. Results showed 28 PFGE pattern combinations for the 187 Salmonella strains. Of them, pattern X3S3N3 was the major subtype as 130 strains isolated from different locations during 1991-2002 showed this PFGE pattern. For all these 187 strains, the genetic similarity was higher than 80%. Plasmid analysis showed 17 distinct types, which consist of one to four plasmids and the predominant phage type of those strains was PT4(71(.)6%) and PT6a (13(.)4%). The three methods identified different degrees of polymorphism in the following order: plasmid profile ( 18 types, D 0(.)659) > PFGE (28 types, D 0 512) > phage typing (13 types, D 0 438). As PFGE patterns, phage type and plasmid profile were combined for subtyping, the 187 strains could be grouped into 46 subtypes and the discriminatory index was raised to 0(.)795. For these 46 subtypes, the predominant one was X3S3N3/P1/PT4, which contained 77 (41%) isolates. Conclusions: Most of the Salmonella Enteritidis strains from sporadic cases were with pattern X3S3N3. They were the prevalent and may be the epidemic strains found in Taiwan during 1991-2002. The present study suggested that the several variants were derived from a single clonal line and the genome for strains of Salmonella Enteritidis are highly conserved over a 13-year period (1991-2002). Significance and Impact of the Study: The results obtained here are useful for epidemiolgical study of salmonellosis caused by Salmonella Enteritidis in Taiwan. Comparing the data of the present study with those obtained for strains from other countries, the major subtypes for Salmonella Enteritidis infection in the world can be elucidated

Escherichia coli isolates from humans (n=110) and swine (n=61) and Salmonella enterica serovar Choleraesuis isolates (n=95) from swine in southern Taiwan were characterised for antimicrobial resistance patterns and class 1 integrons. All E. coli isolates and S. Choleraesuis isolates were multidrug resistant and demonstrated high resistance to beta-lactams, aminoglycosides, tetracycline, sulfonamides, spectinomycin, chloramphenicol and nalidixic acid. By polymerase chain reaction and DNA sequencing, 104 (61%) E. coli isolates and 31 (33%) S. Choleraesuis isolates were found to carry class 1 integrons. The gene cassette array dfrA12-orfF-aadA2 was the most prevalent (24%) among the human and swine E. coli isolates, whilst the gene cassette array dfrA12-orfF-aadA2-sul1 was the most prevalent (24%) among S. Choleraesuis strains. For E. coil isolates, all class 1 integrons were located on conjugated plasmids. Meanwhile, human and swine E. coli isolates carrying identical gene cassettes were genetically unrelated. Our results revealed that multidrug resistance and class 1 integrons were widely present in E. coli and S. Choleraesuis isolates obtained in Taiwan and that class 1 integrons might play an important role in contributing to the horizontal transfer of antimicrobial resistance.

Since human infections by Salmonella enterica serovar Enteritidis (Salmonella Enteritidis) have been increasing world-wide over the past years and epidemiological studies have implicated the consumption of meat, poultry, eggs and egg products, elucidation of the predominant subtypes for this Salmonella spp. is important. In this study, 107 poultry and food isolates of Salmonella Enteritidis obtained from Germany were analyzed by pulsed field gel electrophoresis (PFGE), and the subtypes were compared with those of the 124 human isolates obtained in Taiwan. Results showed that for these 107 poultry and food isolates, when XbaI, SpeI and NotI were used for chromosomal DNA digestion followed by PFGE analysis, a total of 19, 20 and 19 PFGE patterns, respectively, were identified. Of them, 51 (47.7%), 52 (48.6%) and 42 (39.3%) strains belong to a single pattern of X3, S3 and N3, respectively, and 34 strains belong to a pattern combination of X3S3N3, which was the major subtype. When PFGE patterns of these 107 German isolates were compared with those of the 124 human isolates obtained in Taiwan, pattern combination of X3S3N3 was found as the most common pattern shared by isolates from both areas. PT4 is a major phage type for German and Taiwan isolates. Although most of the X3S3N3 strains are of this phage type, some strains of other PFGE patterns are also of this phage type. Since strains used in this study were unrelated, i.e., they were isolated from different origins in areas geographically far apart from each other, the PFGE study suggests a major world-wide clone of S. enterica serovar Enteritidis.

A 23-year-old man who had had cardiac murmurs since childhood experienced heart arrest during exercise. Cardiac resuscitation and cardioversion of ventricular fibrillation rescued the patient. Subsequent work-up showed that the patient’s left coronary artery arose from the main pulmonary artery. Transesophageal echocardiography showed …

To the Editor: Supra-stoma granuloma can be treated effectively via rigid bronchoscopy.1 General anesthesia is required and ventilation can be controlled through the bronchoscope’s side port or a cuffed tracheostomy tube. However, rigid bronchoscopy may be impossible in patients with a difficult airway. We describe a modified surgical approach of supra-stoma granuloma removal and our anesthetic management in a patient with a difficult airway. A 60-yr-old patient had speech limitation due to a tracheostomy tube and supra-stoma granuloma. She had a difficult airway, which made two attempts at rigid bronchoscopy abort. To improve her speech, the surgeons planed to remove the granuloma directly through the tracheostomy stoma, followed by insertion of a Montgomery T-tube. However, the tracheostomy tube would be removed and no secure airway existed during the procedure. Under total iv anesthesia, a cuffed tracheostomy tube was first used for ventilation. We inserted a laryngeal mask airway (LMA) as a conduit to introduce the flexible fibrescope, and found the trachea was partially occluded. We then tried to ventilate through the LMA after temporary removal of the tracheostomy tube and occlusion of the stoma, and found that ventilation was possible. The peak inspiratory pressure was 35 cm H2O for a tidal volume of 400 mL with minimal air leakage. We then decided to hyperventilate the lungs via the LMA (HV-LMA) between surgical manipulations, during periods when the airway could not be accessed. After a period of hyperventilation, the surgeons removed the tracheostomy tube and proceeded with removal of the granuloma through the stoma. When the oxygen saturation (SpO2) declined below 95%, HV-LMA was performed. Surgery continued after the SpO2 reached 99%. The procedure lasted about ten minutes and the SpO2 was kept above 92%. In this patient, the success of HV-LMA depended both on partial obstruction by the granuloma, and an excellent seal with the LMA. In a previous report, leak pressure was found to be 29 cm H2O (SD 6) for the ProSeal LMA and 19 cm H2O (SD 4) for the classic LMA.2 The patient’s narrow oropharyngeal/hypopharyngeal space might explain the excellent seal observed. To prevent stomach inflation and aspiration, we used a stethoscope over the epigastrum to monitor stomach inflation. Fortunately, granuloma removal was brief and only two periods of HV-LMA were required, attenuating the risk of gastric inflation. Nevertheless, we were well prepared and would have reinserted a cuffed tracheostomy tube for conditions like uncontrolled airway bleeding, inability to ventilate, or unstable vital signs.

Rats were trained in a fixed-interval, one-minute (FI 1 min) food reinforcement schedule for 1 hour daily at reduced body weight until their lever presses, licks and water intake all became stabilized for 6 days. Two experiments were performed to examine the function of sympathetic activity in schedule-induced polydipsia. In experiment 1, intracerebroventricular injection of clonidine (0.75–37.5 nmol) produced a dose-related suppression of schedule-induced drinking and licking and schedule-dependent lever pressing; these effects were later attenuated by yohimbine (5 nmol) pretreatment. Prazosin (10 nmol) also decreased clonidine-induced suppression of lever pressing, whereas neither prazosin (10 nmol) nor naloxone (10 nmol) caused any alteration in the suppression effects of clonidine on drinking and licking. None of these antagonists alone changed an individual rat's preestablished behavioral baselines. In experiment 2, the endogenous catacholamine levels were determined in frontal cortex, hypothalamus, brainstem, dorsal obex area and adrenal glands. During the SIP situation, both the epinephrine level in adrenal glands and the norepinephrine level in hypothalamus were elevated.