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The effects of replacing pork meat with yellow mealworms on the physicochemical properties and sensory characteristics of frankfurters were investigated in this study. The control (50% pork ham), T1 (45% pork ham + 5% yellow mealworm), T2 (40% pork ham + 10% yellow mealworm), T3 (35% pork ham + 15% yellow mealworm), T4 (30% pork ham + 20% yellow mealworm), T5 (25% pork ham + 25% yellow mealworm), and T6 (20% pork ham + 30% yellow mealworm) were prepared, replacing lean pork meat with yellow mealworm. The moisture content, lightness, sarcoplasmic protein solubility, hardness, gumminess, chewiness, and apparent viscosity of frankfurters with yellow mealworm were lower than those of the control ( p <0.05), whereas the content of protein and ash, pH, and yellowness of frankfurters with yellow mealworm were higher than those of the control ( p <0.05). The fat content of frankfurters in T1 ( p <0.05) was the highest, and the fat content of treatments decreased with increasing yellow mealworm concentrations ( p <0.05). Frankfurters with increasing yellow mealworm concentrations had lower color, flavor, off-flavor, and juiciness scores. The overall acceptability was not significantly different in the control, T1, and T2 ( p >0.05). Thus, the results of this study showed that replacing lean pork meat with up to 10% yellow mealworm successfully maintained the quality of frankfurters at a level similar to that of the regular control frankfurters.

Background: Substantial aortic calcification is known to be associated with aortic stiffening and subsequent left ventricular (LV) hypertrophy. This study examined whether the thoracic aorta calcium score (TACS) is related to LV hypertrophy and whether it leads to an adverse prognosis in patients with severe aortic stenosis (AS) after aortic valve replacement (AVR)., Methods: We retrospectively reviewed 47 patients (mean age, 64 ± 11 years) with isolated severe AS who underwent noncontrast computed tomography of the entire thoracic aorta and who received AVR. TACS was quantified using the volume method with values becoming log transformed ( log [TACS+1]). Transthoracic echocardiography was performed before and 1 year after the operation., Results: Preoperative LV mass index (LVMI) displayed significant positive correlations with male gender (r = 0.430, p = 0.010) and log (TACS+1) (r = 0.556, p = 0.003). In multivariate linear regression analysis, only log (TACS+1) was independently associated with LVMI, even after adjusting for age, gender, transaortic mean pressure gradient, and coronary or valve calcium score. Independent determinants for postoperative LVMI included log (TACS+1) and preoperative LVMI after 1 year of follow-up echocardiography, adjusting for age, gender, indexed effective orifice area, and coronary or valve calcium score. During a median follow-up period of 54 months after AVR, there were 10 events (21%), which included 4 deaths from all-causes, 3 strokes, 2 inpatient admissions for heart failure, and 1 myocardial infarction. The event-free survival rate was significantly lower for patients with TACS of 2,257 mm 3 or higher compared with those whose TACS was lower than 2,257 mm 3 (log-rank p < 0.001)., Conclusions: High TACS was associated with increased LVMI among patients with severe AS. Further, high TACS usefully predicted less regression of LVMI and poor clinical outcomes after AVR. TACS may serve as a useful proxy for predicting LV remodeling and adverse prognosis in patients with severe AS undergoing AVR., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

This study was conducted to investigate the effect of duck skin on cooking loss, emulsion stability, pH, color, protein solubility, texture profile analysis (TPA), apparent viscosity, and sensory characteristics of press type duck ham with different ratio of duck breast meat and duck skin. Five duck ham formulations were produced with the following compositions: T1 (duck breast 70% + duck skin 30%), T2 (duck breast 60% + duck skin 40%), T3 (duck breast 50% + duck skin 50%), T4 (duck breast 40% + duck skin 60%), and T5 (duck breast 30% + duck skin 70%). The cooking loss and fat separation were lower in T1, and the total expressible fluid separations were lower in T1 and T2 than others. The pH ranged from 6.48 to 6.59, with the highest values in T4 and T5. T5 had the highest CIE L*-value, and T1 and T2 had the highest CIE a*-values; however, CIE b*-values did not differ significantly between the duck ham samples. The protein solubility and TPA (hardness, springiness, cohesiveness, gumminess, and chewiness) were the highest in T1. T1 and T2 had higher scores for color, tenderness, and overall acceptability. T1, T2, and T3 showed significantly higher values, but there were no significant differences for flavor and juiciness. Regarding apparent viscosity properties, T1 and T2 had higher viscosity values than the other formulations. In conclusion, the T1 (duck breast 70% + duck skin 30%) and T2 (duck breast 60% + duck skin 40%) duck hams show the highest quality characteristics.

In this study, a complete mitochondrial genome of a nudibranch species, Sakuraeolis japonica was sequenced and analyzed. The mitochondrial genome size is 15,059 bp with 28.1% A, 14.9% C, 19.3% G, and 37.7% T nucleotide distributions. This is the eighth record for complete mitochondrial genome of the Nudibranchia and first record for the genus. Furthermore, phylogenetic relationship of S. Japonica in the Nudibranchia was investigated by using protein-coding genes of complete mitochondrial genome. The present study suggests that S. japonica belongs to the family Facelinidae and it is placed in monophyletic Nudibranchia. The closest species to S. japonica are Chromodoris magnifica and Chromodoris quadricolor that belong to the family Chromodorididae., (© 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Purpose: This study investigated (1) the prevalence of pain following breast cancer treatment including moderate-to-severe persistent pain and (2) the association of risk factors, present 1 month following surgery, with pain at 21 months following surgery. This information may aid the development of clinical guidelines for early pain assessment and intervention in this population., Methods: This study was a retrospective analysis of core and breast modules of the European Organisation for Research and Treatment of Cancer (EORTC) questionnaire from 121 participants with early breast cancer. The relationships between potential risk factors (subscales derived from the EORTC), measured within 1 month following surgery, and pain at 21 months following surgery were analysed using univariable and multi-variable logistic regression., Results: At 21 months following surgery, 46.3 % of participants reported pain, with 24 % categorised as having moderate or severe pain. Prevalence of pain was similar between those who underwent axillary lymph node dissection versus biopsy. Univariate logistic regression identified baseline pain (odds ratio (95 % CI): 2.7 (1.1 to 6.4)); baseline arm symptoms (11.2 (1.4 to 89.8)); emotional function (0.4 (0.1 to 0.8)) and insomnia (2.3 (1.1 to 4.7) as significantly associated with pain at 21 months. In multi-variable analysis, two factors were independently associated with pain at 21 months-baseline arm symptoms and emotional subscale scores., Conclusion: Pain is a significant problem following breast cancer treatment in both the early post-operative period and months following surgery. Risk factors for pain at long-term follow-up included arm symptoms and higher emotional subscale scores at baseline.

Background: Carotid intima media thickness (CIMT) and the presence of carotid plaque have been used for risk stratification of cardiovascular disease (CVD). To date, however, the association between multi-directional functional properties of carotid artery and CVD has not been fully elucidated. We sought to explore the multi-directional mechanics of the carotid artery in relation to cardiovascular risk., Methods: Four hundred one patients who underwent carotid ultrasound were enrolled between January 2010 and April 2013. A high risk of CVD was defined as more than 20% of 10-year risk based on the Framingham risk score. Using a speckle-tracking technique, the longitudinal and radial movements were analyzed in the B-mode images. Peak longitudinal and radial displacements, strain and strain rate were also measured. Beta stiffness and elastic modulus index were calculated from the radial measurements., Results: Of the overall sample, 13% (52) of patients comprised the high-risk group. In multivariate logistic regression, CIMT and elastic modulus index were independently associated with a high-risk of CVD {odds ratio (OR): 1.810 [95% confidence interval (CI) 1.249-2.622] and OR: 1.767 (95% CI: 1.177-2.652); p = 0.002, 0.006, respectively}. The combination of CIMT and elastic modulus index correlated with a high-risk of CVD more so than CIMT alone., Conclusion: The elastic modulus index of the carotid artery might serve as a novel surrogate marker of high-risk CVD. Measurement of the multi-directional mechanics of the carotid artery using the speckle tracking technique has potential for providing further information over conventional B-mode ultrasound for stratification of CVD risk.

The Kidney Disease Quality of Life-36 Questionnaire (KDQOL-36™), modified by RAND, has been widely used for measurement of quality of life among hemodialysis or peritoneal dialysis patients. The purpose of this study was to refine and evaluate, by using confirmatory factor analysis, the structure of the KDQOL-36™ when the questionnaire was used to evaluate chronic kidney disease patients in Stages 1 to 5 in Taiwan. The psychometric properties of the translated version were determined among Mandarin-speaking adults (N = 428). Because the sample data did not fit the hypothetical model, one item was deleted and nine error terms were estimated. After improving the model fit, the modified model was presented as follows: χ(2) = 1390.903, χ(2)/df = 2.711, p < .001, goodness-of-fit index = .833, adjusted goodness-of-fit index = .806, root mean square error of approximation = .063. According to the study results, the researchers suggest that because of content overlap, some items may be deducted from the KDQOL-36™., (© The Author(s) 2016.)

Unlabelled: NF-κB and TGFβ play critical roles in renal inflammation and fibrosis, and their regulation in the kidney is thus of great interest. Early growth response-1 (Egr-1), a transcription factor belonging to the immediate early gene family, has been found to regulate inflammation and fibrosis in non-kidney tissues, but its role in renal failure has not been clear. In this study, wild-type and Egr1 (-/-) mice were fed with an adenine-enriched diet to induce tubulointerstitial nephritis (TIN), and primary tubular epithelial cells (PTECs) were treated with pro-inflammatory and pro-fibrotic cytokines. Kidney tissues from patients with or without renal failure were stained for Egr-1. Our results showed that Egr-1 expression was upregulated in the kidney with TIN, and the tubular epithelial cell is the primary site for Egr-1 upregulation and nuclear translocation. Egr1 (-/-) mice were protected from renal failure, reflected by low levels of serum urea and creatinine. The protective effect was related to an attenuation of tubular injury, immune cell infiltration, NF-κB activity, and cytokine/chemokine expressions in the kidney. Renal fibrotic area and TGFβ signaling were also reduced in Egr1 (-/-) mice. In vitro study showed that Egr-1 deficiency attenuated the ordinary responses of PTECs to TNFα and TGFβ. Importantly, Egr-1 is of clinical significance since the activity of Egr-1 in renal tubular cells was upregulated in renal failure patients. Our study highlights the integrative role of Egr-1 in renal inflammation and fibrosis. Thus, Egr-1 may serve as a therapeutic target for human kidney diseases., Key Messages: Renal failure activates Egr-1 in human and mouse tubular cells. Egr-1 deficiency attenuates NF-κB and TGFβ-mediated renal inflammation/fibrosis. Egr1 (-/-) PTECs respond weakly to pro-inflammatory or pro-fibrotic stimulation.

Although treatment for the dialysis population is resource intensive, a cost-effectiveness analysis comparing hemodialysis (HD) and peritoneal dialysis (PD) by matched pairs is still lacking. After matching for clinical characteristics and propensity scores, we identified 4,285 pairs of incident HD and PD patients from a Taiwanese national cohort during 1998-2010. Survival and healthcare expenditure were calculated by data of 14-year follow-up and subsequently extrapolated to lifetime estimates under the assumption of constant excess hazard. We performed a cross-sectional EQ-5D survey on 179 matched pairs of prevalent HD and PD patients of varying dialysis vintages from 12 dialysis units. The product of survival probability and the mean utility value at each time point (dialysis vintage) were summed up throughout lifetime to obtain the quality-adjusted life expectancy (QALE). The results revealed the estimated life expectancy between HD and PD were nearly equal (19.11 versus 19.08 years). The QALE's were also similar, whereas average lifetime healthcare costs were higher in HD than PD (237,795 versus 204,442 USD) and the cost-effectiveness ratios for PD and HD were 13,681 and 16,643 USD per quality-adjusted life year, respectively. In conclusion, PD is more cost-effective than HD, of which the major determinants were the costs for the dialysis modality and its associated complications.

The complete mitochondrial genome sequenced from a xanthid crab, Leptodius sanguineus which was collected from a rocky intertidal area in Chuuk lagoon. The mitochondrial genome size of L. sanguineus evaluated as 15,480 bp with 33.6% A, 24% C, 11.2% G and 31.2% T and mitochondrial gene order of L. sanguineus is typical to brachyuran species. Phylogenetic analysis shows that the family Xanthidae has sister group relationship with a lineage including the families Portunidae and Menippidae in the subsection Heterotremata. This is the first report for the complete mitochondrial genome from the xanthid crabs., Competing Interests: The authors report no conflict of interest., (© 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

A complete mitochondrial genome was sequenced from a grapsid crab, Grapsus tenuicrustatus (Herbst 1783), which was collected from a rocky intertidal zone of Chuuk lagoon. The size of mitochondrial genome is 15,858 bp with 31.9% A, 22.8% C, 12.2% G and 33.1% T distribution. Furthermore phylogenetic relationships of the Grapsoidea evaluated due to mitochondrial protein-coding genes. As per the obtained results, the families Grapsidae and Varunidae have sister group relationship in the superfamily Grapsoidea., Competing Interests: The authors report no conflict of interest., (© 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Complete mitochondrial genome of the knobbed rock shell sea snail Menathais tuberosa (Röding, 1798) has been sequenced and phylogenetic relationships evaluated due to mitochondrial protein coding genes. The size of mitochondrial genome for M. tuberosa is 15,294 bp and the nucleotide composition of the mitochondrial genome is 28.4% A, 16.5% C, 17.6% G and 37.5% T. Reconstructed phylogenetic tree of the Neogastropoda showed that M. tuberosa is in the monophyletic Muricidae. This is the first record of complete mitochondrial genome from the genus., Competing Interests: The authors report no conflict of interest., (© 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Complete mitochondrial genome of smooth-handed ghost crab Ocypode cordimanus (Latreille, 1818) has been sequenced and phylogenetic relationships evaluated due to mitochondrial protein coding genes. This is the second record of complete mitochondrial genome from the genus. The size of mitochondrial genome for O. cordimanus is 15,604 bp and the nucleotide distribution of the mitochondrial genome is 31.8% A, 21.8% C, 11.9% G and 34.5% T., Competing Interests: The authors report no conflict of interest., (© 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: In patients with pulmonary arterial hypertension (PAH), the mechanical complications of pulmonary artery (PA) enlargement are related to sudden cardiac death (SCD). The aim of this study was to investigate the prevalence of PA enlargement, the correlation of main PA (MPA) diameter with other echocardiographic parameters, and the role of transthoracic echocardiography in screening for such complications., Methods: Among 298 patients who were followed for PAH, patients with PA enlargement (>40 mm) by transthoracic echocardiography were consecutively enrolled in a prospective manner. The presence of left main and airway compression, PA dissection, or PA thrombus was determined with cardiac computed tomography., Results: Forty-six patients (15.4%; mean age, 49 ± 14 years; 32.6% men) with dilated MPAs were enrolled. Mechanical complications were present in 16 patients (34.8%). Those with complications had more dilated MPAs compared with patients without (mean PA diameter, 55.6 ± 12.2 vs 46.7 ± 4.3 mm; P = .012). Other echocardiographic parameters of the right heart, such as right ventricular systolic pressure, showed no differences (P > .05 for all). The area under the receiver operating characteristic curve for MPA diameter was 0.750 (95% CI, 0.577-0.923; P = .009), with the highest sensitivity and specificity values for the presence of complications being 85.7% and 58.6%, respectively, according to an MPA diameter of 46.5 mm., Conclusions: Mechanical complications related to sudden cardiac death in patients with PAH with dilated PAs are common. The overall performance of transthoracic echocardiography as a screening tool for predicting such complications appears reasonable. Given the burden of sudden cardiac death, measurement of PA diameter should be routinely included over the course of follow-up, especially in patients with PAH., (Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

The effects of reducing pork fat level from 30 to 25 and 20% by partially substituting pork fat with 1 and 2% apple pomace fiber were investigated based on the evaluation of physicochemical properties and textural properties of uncured, reduced-fat chicken sausages. Increased fat level resulted in decreased moisture content, cooking loss, total expressible fluid separation, fat separation, and yellowness of uncured, reduced-fat chicken sausages, whereas, an increase in fat content, caloric energy, pH, lightness, redness, hardness, cohesiveness, gumminess, and chewiness was observed. The results showed that uncured, reduced-fat chicken sausage samples with increased apple pomace fiber level had lower cooking loss, total expressible fluid separation, fat separation, pH, and redness. The results from this study show that inclusion of apple pomace fiber in the formulation will successfully reduce fat content in emulsion sausages, while improving quality characteristics relative to regular-fat (30%) control., (© 2016 Poultry Science Association Inc.)

PPARγ modulates energy metabolism and inflammation. However, its specific functions in the balance of immunity in vivo have been explored incompletely. In this study, by the age of 14 mo, Pparg(C/-) mice with PPARγ expression at 25% of the normal level exhibited high autoantibody levels and developed mesangial proliferative glomerulonephritis, which resembled systemic lupus erythematosus (SLE)-like autoimmune disease. These symptoms were preceded by splenomegaly at an early age, which was associated with increases in splenocyte accumulation and B-cell activation but not with relocation of hematopoiesis to the spleen. The mechanism of splenic lymphocyte accumulation involved reduced sphingosine-1-phosphate receptor 1 (S1P1) expression and diminished migration toward S1P in the Pparg(C/-) splenocytes, which impeded lymphocyte egression. Mechanistically, increased Th17 polarization and IL-17 signaling in the Pparg(C/-) CD4(+) T cells contributed to B-cell hyperactivation in the spleen. Finally, the activation of the remaining PPARγ in Pparg(C/-) mice by pioglitazone increased S1P1 levels, reduced the Th17 population in the spleen, and ameliorated splenomegaly. Taken together, our data demonstrated that reduction of Pparg expression in T-helper cells is critical for spontaneous SLE-like autoimmune disease development; we also revealed a novel function of PPARγ in lymphocyte trafficking and cross talk between Th17 and B cells.

Millimeter waves are electric waves between 30 and 300 GHz. They are known to affect microbial growth. Here, the effects of millimeter waves on the microbiological and physicochemical properties of Makgeolli irradiated during fermentation were investigated. Millimeter waves at 60 and 70 GHz were used, and the fermentation was carried out at 30°C. The numbers of both lactic acid bacteria and yeasts have changed with similar pattern each then during the fermentation, but the effect of milimeter wave treatment was not critical as growth patterns were independent of both irradiation period and wave frequency. Furthermore, pH and total acidity did not change during fermentation. Although irradiation drastically increased sugar production during the initial stage of fermentation, the change was not frequency dependent. At the end of fermentation, the alcohol content in irradiated Makgeolli was definitely higher than that in un-irradiated Makgeolli , and the difference was frequency dependent.

Many studies have been conducted to promote germination in brown rice in order to improve its nutritional value in terms of enzymes, protein quality, and micronutrient content. The purpose of this study was to investigate the effect of millimeter wave on germination. Millimeter wave is a form of electromagnetic radiation with frequency between 30 and 300 GHz, and is also called 'biomicrowave'. Millimeter wave significantly stimulated germination. Total polyphenol content and DPPH radical scavenging activity also increased, especially at high frequency and prolonged dose. However, γ-aminobutyric acid content was diminished.

Annual influenza vaccination is recommended, but its efficacy in dialysis population is still controversial. Here we aimed to compare the dynamic changes of immune response between various influenza vaccination protocols in hemodialysis patients. A 18-week open label, non-randomized, controlled trial was conducted during 2011-2012. The efficacy between unvaccinated, one- and two-dose regimens were evaluated in 175 hemodialysis patients. Immunogenic profiles were assessed by hemagglutination-inhibition assays. At 3-9 weeks post-vaccination, antibody responses were similar between the one- and two-dose regimens, while the seroprotection rates (antibody titer ≥1:40) for influenza A were 55.6-82.5% in the adult (18-60 years) and 33.3-66.7% in the elderly (>60 years). Meanwhile, the seroprotection rates for influenza B were low (4.0-25.0%). By 18 weeks post-vaccination, the seroprotection rates for influenza A and B declined (0.0-33.3%) in both the adult and elderly receiving one- or two-dose regimens. Of dialysis patients, at most 2.4% developed moderate to severe adverse effects(myalgia and headache) after vaccination. In conclusion, the two-dose regimen could not improve immune responses than the one-dose regimen in hemodialysis patients; meanwhile the induced protective antibodies of both regimens could not be maintained for more than 4 months. Modification of current influenza vaccination strategy in dialysis population should be re-considered.

Parathyroidectomy is recommended by the clinical guidelines for dialysis patients with unremitting secondary hyperparathyroidism (SHPT). However, the survival advantage of parathyroidectomy is debated because of the selection bias in previous studies. To minimize potential bias in the present nationwide cohort study, we enrolled only dialysis patients who had undergone radionuclide parathyroid scanning to ensure all patients had severe SHPT. The parathyroidectomized patients were matched with the controls based on propensity score for parathyroidectomy. Mortality hazard was estimated using multivariate Cox proportional hazard models adjusting for comorbidities before scanning (model 1) or over the whole study period (model 2). Our results showed that among the 2786 enrolled patients, 1707 underwent parathyroidectomy, and the other 1079 were controls. The crude mortality rates were lower in the parathyroidectomized patients than in the controls. In adjusted analyses for the population matched on propensity score, parathyroidectomy was associated with a significant 20% to 25% lower risk for all-cause mortality (model 1: hazard ratio 0.76, 95% confidence interval 0.61 to 0.94; model 2: hazard ratio 0.80, 95% confidence internal 0.64 to 0.98). We concluded that parathyroidectomy was associated with a reduced long-term mortality risk in dialysis patients with severe SHPT.

The effects of reducing pork fat levels from 20% to 15% or 10% by partially substituting pork back fat with wheat sprout fiber in reduced-fat chicken patties were investigated. Approximate composition, energy value, pH, color, cooking loss, reduction in diameter, reduction in thickness, shear force, and sensory properties were determined. Moisture content, ash contents, yellowness of uncooked and cooked reduced-fat chicken patties with wheat sprout were higher than those in the control, while displaying fat content, calorie content, and pH of uncooked and cooked lower in reduced-fat chicken patties than in the control. Cooking loss, reduction in diameter, and reduction in thickness were the highest in the reduced-fat chicken patties with 10% fat level. Cooking loss, reduction in diameter, and reduction in thickness were decreased when fat levels and wheat sprout levels were increased. Control samples without wheat sprout dietary fiber had significantly ( p <0.05) higher color and flavor scores compared to reduced-fat chicken patties containing wheat sprout dietary fiber. The overall acceptability of the control and treatment with 15% fat and 2% wheat sprout dietary fiber (T3) was the highest. Therefore, 15% fat level in reduced-fat chicken patties with the addition of 2% wheat sprout dietary fiber can be used to improve the quality and sensory characteristics of regular-fat chicken patties containing 20% fat level.

The effects of five different cooking methods (boiling, steaming, grilling, microwaving, and superheated steaming) on proximate composition, pH, color, cooking loss, textural properties, and sensory characteristics of chicken steak were studied. Moisture content and lightness value (L*-value) were higher in superheated steam cooked chicken steak than that of the other cooking treatments such as boiling, steaming, grilling and microwaving cooking (p<0.05), whereas protein content, redness value (a*-value), hardness, gumminess, and chewiness of superheated steam cooked chicken steak was lower than that in the other cooking treatments (p<0.05). Fat content and ash content, springiness, and cohesiveness were not significantly different among the chicken steak cooked using various methods (p>0.05). Among the sensory characteristics, tenderness score, juiciness score and overall acceptability score were the highest for the superheated steam samples (p<0.05), whereas no difference in flavor scores were observed among the other treatments (p>0.05). These results show that marinated chicken steak treated with superheated steam in a preheated 250℃ oven and 380℃ steam for 5 min until core temperature reached 75℃ improved the quality characteristics and sensory properties the best. Therefore, superheated steam was useful to improve cooked chicken steak.

The effect of reducing pork meat concentrations from 50% to 30% and replacing it with up to 20% pork head meat on chemical composition, cooking characteristics, physicochemical and textural properties, apparent viscosity, and sensory characteristics of frankfurters was determined. The highest moisture content in frankfurters was found in the control and T1 (frankfurter with 45% pork meat + 5% pork head). Protein and fat contents in frankfurters with pork head meat added were significantly (p<0.05) higher than those in the control. When the concentration of pork head meat was increased from 0% to 20%, cooking loss, total expressible fluid separation, fat separation, and pH of frankfurters were increased, while the lightness, redness, yellowness, and apparent viscosity of frankfurters were decreased. Ash contents, cohesiveness, color, and tenderness of sensory characteristics of frankfurters added with different amounts of pork meat or pork head meat were not significantly (p>0.05) different from those of the control or there treatments. Frankfurters in T4 (frankfurter with 30% pork meat + 20% pork head) had the lowest (p<0.05) hardness and gumminess. The hardness and gumminess of frankfurters in other treatments were not significantly different (p>0.05) from that in the control. Frankfurters with higher pork head meat concentrations had lower flavor, juiciness, and overall acceptability scores. Therefore, replacing pork meat with pork head meat in the formulation could successfully produce results similar to those of control frankfurters. The best results were obtained when 10% pork head meat was used to replace pork meat.

Objective: Throughout the past several years, there have been a number of entertainment celebrity suicides in South Korea. The aim of this study was to investigate the clustering of suicides following celebrities' suicides in South Korea from 2005 to 2008, particularly according to certain characteristics., Methods: Seven celebrity suicides were examined and defined using the Korean Integrated Newspaper Database System (KINDS) and from these, we considered four affected periods occurring 28 days after each celebrity's suicide. A Poisson time-series autoregression model was used to estimate the relative risk of the total suicide number for each affected period from 2005 to 2008. Logistic regression analysis was performed to investigate whether there were specific increases in the numbers of suicides in subgroups matching each celebrity., Results: There were significant increases in the risk of suicide during the affected periods. Remarkable increases were found in the subgroups matching each celebrity, especially in the group in which all factors (sex, age, and method) were similar., Conclusion: This study provides confirmation that a significant copycat effect was induced by these celebrities' suicides, especially among people who identified more with the celebrities. This implies that countermeasures for upright media coverage of celebrity suicides should be discussed and practiced properly in South Korea.

Background: To explore the prognostic performance of coronary computed tomography angiography (CCTA) and exercise electrocardiography (XECG) in asymptomatic subjects., Methods: We retrospectively enrolled 812 (59 ± 9 years, 60.8% male) asymptomatic subjects who underwent CCTA and XECG concurrently from 2003 through 2009. Subjects were followed-up for major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, unstable angina, and revascularization after 90 days from index CCTA., Results: The prevalence of occult coronary artery disease (CAD) detected by CCTA was 17.5% and 120 subjects (14.8%) had positive XECG. During a mean follow-up of 37 ± 16 months, nine subjects experienced MACE. In multivariable Cox-regression analysis, only the presence of CAD by CCTA independently predicted future MACE (p = 0.002). Moreover, CAD by CCTA improved the predictive value when added to a clinical risk factor model using the likelihood ratio test (p < 0.001). Notably, the prognostic value of CCTA persisted in the moderate-to-high-risk group as classified by the Duke treadmill score (p = 0.040), but not in the low-risk group (p = 0.991)., Conclusion: CCTA provides incremental prognostic benefit over and above XECG in an asymptomatic population, especially for those in a moderate-to-high-risk group as classified by the Duke treadmill score. Risk stratification using XECG may prove valuable for identifying asymptomatic subjects who can benefit from CCTA.

Caffeoylquinic acid (CQA) derivatives are known to possess antioxidative potential and have many beneficial effects on human health. The present study compared the CQA contents and antioxidant activities of aerial parts of sweet potato plants. The effects of drying methods (freeze drying, and drying at 30°C, 70°C, and 100°C) on these two parameters of the first fully expanded leaves were also assessed. The results indicated that the CQA derivatives were detectable in leaves, stem, and flowers of sweet potato plants (varied from 39.34 mg/g dry weight to 154.05 mg/g dry weight), with the leaves (particularly expanding and first fully expanded leaves) containing more CQA derivatives than other aerial plant parts. The expanding and first fully expanded leaves also exhibited greater antioxidant activities than other aerial plant parts, possibly due to their higher contents of CQA derivatives. Drying method significantly affected the content of CQA derivatives in dried sweet potato leaf tissues. Drying treatments at both 70°C and 100°C significantly reduced the CQA derivative content and antioxidant activity in the first fully expanded leaves. Among the tested drying methods, the freeze-drying method demonstrated the preservation of the highest amount of CQA derivatives (147.84 mg/g) and antioxidant property. However, 30°C cool air drying was also a desirable choice (total CQA derivative content was reduced to only 129.52 mg/g), compared to 70°C and 100°C hot air drying, for commercial-scale processing of sweet potato leaves, if the higher operation cost of freeze drying was a major concern., (Copyright © 2014. Published by Elsevier B.V.)

Increased urinary albumin excretion is not simply an aftermath of glomerular injury, but is also involved in the progression of diabetic nephropathy (DN). Whereas Toll-like receptors (TLRs) are incriminated in the renal inflammation of DN, whether and how albumin is involved in the TLR-related renal inflammatory response remains to be clarified. Here, we showed that both TLR2 and TLR4, one of their putative endogenous ligands [heat shock protein 70 (HSP70)] and nuclear factor-κB promoter activity were markedly elevated in the kidneys of diabetic mice. A deficiency of TLR4 but not of TLR2 alleviated albuminuria, tubulointerstitial fibrosis and inflammation induced by diabetes. The protection against renal injury in diabetic Tlr4(-/-) mice was associated with reduced tubular injuries and preserved cubilin levels, rather than amelioration of glomerular lesions. In vitro studies revealed that albumin, a stronger inducer than high glucose (HG), induced the release of HSP70 from proximal tubular cells. HSP70 blockade ameliorated albumin-induced inflammatory mediators. HSP70 triggered the production of inflammatory mediators in a TLR4-dependent manner. Moreover, HSP70 inhibition in vivo ameliorated diabetes-induced albuminuria, inflammatory response and tubular injury. Finally, we found that individuals with DN had higher levels of TLR4 and HSP70 in the dilated tubules than non-diabetic controls. Thus, activation of the HSP70-TLR4 axis, stimulated at least in part by albumin, in the tubular cell is a newly identified mechanism associated with induction of tubulointerstitial inflammation and aggravation of pre-existing microalbuminuria in the progression of DN., (© 2015. Published by The Company of Biologists Ltd.)

Peritoneal dialysis (PD) is one type of renal replacement therapy, but potential peritoneal damage and gastrointestinal (GI) tract adverse effects during long-term exposure to bio-incompatible dialysate remain a concern. Although GI disease frequently occurs in dialysis patients, whether the risk of GI diseases differs among PD and hemodialysis (HD) or non-uremic groups is still uncertain.In this retrospective cohort study, data were obtained from the National Health Insurance Research Database, which includes almost all dialysis patients in Taiwan. Between 2000 and 2009, a total of 1791 PD and 8955 HD incident patients were enrolled and matched for age and sex or for propensity score. In addition, a comparison cohort of 8955 non-uremic patients was also selected. Individuals were monitored for the occurrence of common GI diseases until 2010, and data were analyzed using several different models.Generally speaking, the results showed that the risk of gastroesophageal reflux, intestinal obstruction or adhesions, and abdominal hernia was significantly higher in the PD group, whereas the risk of peptic ulcer disease and lower GI diverticula and bleeding was significantly greater in the HD group. Meanwhile, the risk of mesenteric ischemia, liver cirrhosis, and acute pancreatitis was higher in dialysis patients, but was not significantly different between the PD and HD groups; moreover, the risk of appendicitis in the PD group appeared to be lower than that in the HD group.In conclusion, dialysis patients have a higher risk of most common GI diseases, and PD and HD modalities are associated with different GI diseases.

Despite the recent enormous advances in medicine, high mortality and morbidity rates among the chronic kidney disease (CKD) patients remain an important but unresolved issue. Cardiovascular disease is a major cause of mortality and morbidity in patients with CKD. Abnormal left ventricular geometry and functions are common in this patient group and have been proven to be correlated with a high cardiovascular mortality/morbidity and all-cause mortality. For this reason, echocardiographic study plays an important role in evaluating cardiac structure and functions as well as in stratifying prognostic risk. We here summarize the reported findings on the usefulness of echocardiographic methodologies and identify their roles in diagnostic and prognostic clinical approaches., (Copyright © 2015. Published by Elsevier B.V.)

Several studies have reported the therapeutic use of caffeoylquinic acid (CQA) derivatives in the management of hyperglycemia. This study used a simulated in vitro gastrointestinal digestion model to assess the inhibitory effects of CQA derivatives-rich sweet potato leaf extract (SPLE) and a commercially produced green coffee bean extract (GCBE), each with total polyphenols contents of 452 mg g -1 and 278 mg g -1 , respectively, against starch digestion. The changes in the amounts of total polyphenols and total CQA derivatives during in vitro gastrointestinal digestion were also examined. The results indicated that both extracts contained substantial levels of CQA derivatives (136 mg g -1 and 83.5 mg g -1 of extract for SPLE and GCBE, respectively). The amounts of total polyphenols and total CQA derivatives in 20 mg of SPLE and GCBE samples decreased from 9.04 mg to 0.58 mg and from 5.56 mg to 0.58 mg, and from 2.72 mg to 0.16 mg and from 1.67 mg to 0.10 mg, respectively, following in vitro gastrointestinal digestion and subsequent dialysis. When SPLE and GCBE were accompanied with starch for in vitro digestion test, they both exhibited inhibitory effect against starch digestion during simulated intestinal digestion, with estimated half maximal inhibitory concentration (IC 50 ) values of 4.91 mg and 6.06 mg polyphenols, respectively. The amount of glucose permeated through dialysis membrane also decreased significantly in comparison with the extract-negative control. Thus, both SPLE and GCBE were capable of modulating the release of glucose from starch digestion in simulated intestinal tract. The observed inhibitory effects against glucose release were presumably due in part to the presence of CQA derivatives in the tested extracts. The SPLE had higher inhibitory effect against in vitro starch digestion than the commercially prepared reference GCBE. Therefore, the SPLE might be used to manage hyperglycemia over the long term., (Copyright © 2015. Published by Elsevier B.V.)

Objective: Selective catheter-directed intracoronary contrast injected coronary computed tomography angiography (selective CCTA) has recently been introduced for on-site evaluation of coronary artery disease during coronary artery catheterization. In this study, we aimed to develop a feasible protocol for selective CCTA using ultralow-dose contrast medium as compared with conventional intravenous CCTA (IV CCTA)., Materials and Methods: A novel combined system incorporating coronary angiography and a 320-detector row computed tomographic scanner was used to study 4 swine (35-40 kg) under animal institutional review board approval. A selective CCTA scan was simultaneously performed with an injection of 13.13 mgI/mL of modulated contrast medium at multiple different injection rates including 2, 3, and 4 mL/s and different total injection volumes of either 20 or 30 mL. Intravenous CCTA was performed with 60 mL of contrast medium, followed by 30 mL of saline chaser at 5 mL/s. Coronary mean and peak intensity, transluminal attenuation gradient, as well as 3-dimensional maximum intensity projections were obtained., Results: Attenuation values (mean ± standard error, in Hounsfield units [HUs]) of selective CCTA for the left anterior descending (LAD) and right coronary artery (RCA) using the various combinations of injection rates and total injection volumes were as follows: 20 mL at 2 mL/s (LAD, 270.3 ± 20.4 HU; RCA, 322.6 ± 7.4 HU), 20 mL at 3 mL/s (LAD, 262.9 ± 20.4 HU; RCA, 264.7 ± 7.4 HU), 30 mL at 3 mL/s (LAD, 276.8 ± 20.4 HU; RCA, 274.0 ± 7.4 HU), 20 mL at 4 mL/s (LAD, 268.0 ± 20.4 HU; RCA, 277.7 ± 7.4 HU), and 30 mL at 4 mL/s (LAD, 251.3 ± 20.4 HU; RCA, 334.7 ± 7.4 HU). The representative protocol of the selective CCTA studies produced results within the optimal enhancement range (approximately 250-350 HU) for all segments, and comparison of transluminal attenuation gradient data with selective CCTA and IV CCTA studies demonstrated that the former method was more homogenous (-1.5245 and -1.7558 for LAD as well as 0.0459 and 0.0799 for RCA, respectively). Notably, the volume of iodine contrast medium used for selective CCTA was reported to be 1.09% (0.2 g) of IV CCTA (24 g)., Conclusions: The current findings demonstrate the feasibility of selective CCTA using ultralow-dose intracoronary contrast injection. This technique may provide additional means of coronary evaluation in patients who may require strategic planning before a procedure using a combined modality system.

Background: This study aimed to explore whether echocardiographic measurements during the early postoperative period can predict persistent left ventricular systolic dysfunction (LVSD) after aortic valve surgery in patients with chronic aortic regurgitation (AR)., Methods: We prospectively recruited 54 patients (59 ± 12 years) with isolated chronic severe AR who subsequently underwent aortic valve surgery. Standard transthoracic echocardiography was performed before the operation, during the early postoperative period (≤2 weeks), and then 1 year after the surgery., Results: Twelve patients with preoperative LVSD demonstrated LVSD at early after the surgery. Of the 42 patients without LVSD at preoperative echocardiography, 15 patients (36%) developed early postoperative LVSD after surgical correction. All 27 patients without LVSD at early postoperative echocardiography maintained LV function at 1 year after surgery. In the other 27 patients with postoperative LVSD, 17 patients recovered from LVSD and 10 patients did not at 1 year after surgery. Multiple logistic analysis demonstrated that postoperative left atrial volume index (LAVI) was the only independent predictor for persistent LVSD at 1 year after surgery in patients with postoperative LVSD (OR 1.180, 95% CI, 1.003-1.390, P = 0.046). The optimal LAVI cutoff value (>34.9 mL/m(2) ) had a sensitivity of 80% and a specificity of 88% for the prediction of persistent LVSD., Conclusion: Prevalence of early postoperative LVSD was relatively high, even in the patients without LVSD at preoperative echocardiography. Postoperative LAVI could be useful to predict persistent LVSD after aortic valve surgery in patients with early postoperative LVSD., (© 2014, Wiley Periodicals, Inc.)

Aim: Prior evidence observed no predictive utility of coronary CT angiography (CCTA) over the coronary artery calcium score (CACS) and the Framingham risk score (FRS), among asymptomatic individuals. Whether the prognostic value of CCTA differs for asymptomatic patients, when stratified by CACS severity, remains unknown., Methods and Results: From a 12-centre, 6-country observational registry, 3217 asymptomatic individuals without known coronary artery disease (CAD) underwent CACS and CCTA. Individuals were categorized by CACS as: 0-10, 11-100, 101-400, 401-1000, >1000. For CCTA analysis, the number of obstructive vessels-as defined by the per-patient presence of a ≥50% luminal stenosis-was used to grade the extent and severity of CAD. The incremental prognostic value of CCTA over and above FRS was measured by the likelihood ratio (LR) χ(2), C-statistic, and continuous net reclassification improvement (NRI) for prediction, discrimination, and reclassification of all-cause mortality and non-fatal myocardial infarction. During a median follow-up of 24 months (25th-75th percentile, 17-30 months), there were 58 composite end-points. The incremental value of CCTA over FRS was demonstrated in individuals with CACS >100 (LRχ(2), 25.34; increment in C-statistic, 0.24; NRI, 0.62, all P < 0.001), but not among those with CACS ≤100 (all P > 0.05). For subgroups with CACS >100, the utility of CCTA for predicting the study end-point was evident among individuals whose CACS ranged from 101 to 400; the observed predictive benefit attenuated with increasing CACS., Conclusion: Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)

This study investigated the effect of added freeze-dried mulberry fruit juice (FDMJ) (1, 3 and 5%) on the antioxidant activity and fermented characteristic of yogurt during refrigerated storage. A decrease in pH of yogurt and increase in acidity was observed during fermentation. The yogurts with FDMJ exhibited faster rate of pH reduction than control. Initial lactic acid bacteria count of yogurt was 6.49-6.94 Log CFU/g and increased above 9 Log CFU/g in control and 1% in FDMJ yogurt for 24 h. The total polyphenol and anthocyanin content of FDMJ yogurt was higher than that of control due to the presence of phytochemical contents in mulberry. Moreover, antioxidant activity such as DPPH and reducing power was highest 5% FDMJ yogurt. During cold storage, pH decreased or remained constant in all yogurts with values ranging from 4.08 to 4.78 units. In sensory evaluation, the score of 1% FDMJ yogurt was ranked higher when compared with other yogurts. It is proposed that mulberry fruit juice powder can be used to improve sensory evaluation and enhance functionality of yogurt.

Aim: In addition to type 2 diabetes, an elevated Lp(a) level is known to be a surrogate biomarker of cardiovascular disease. However, recent studies have demonstrated that the Lp(a) levels are lower in type 2 diabetic patients than in non-diabetic subjects. Therefore, we sought to evaluate the prognostic value of elevated lipoprotein(a) [Lp(a)] in type 2 diabetic patients with symptomatic coronary artery disease (CAD)., Methods: A total of 1494 diabetic patients with CAD (62.3% men, mean age: 63.5 ± 10.3 years) were enrolled. CAD was diagnosed using invasive coronary angiography, and laboratory values for lipid parameters, including Lp(a), were obtained on the day of coronary angiography. The patients were divided into tertile groups according to the individual Lp(a) level. The baseline characteristics, coronary angiographic findings, duration of follow-up and major adverse cardiovascular events (MACEs) were recorded., Results: Over a mean follow-up period of 4.4 ± 2.6 years, there were 59 MACEs (35 cardiac deaths and 24 cases of non-fatal myocardial infarction), for an event rate of 3.9%. A survival probability plot according to the Lp(a) tertile revealed that an elevated Lp(a) level was associated with a worse prognosis (p = 0.008), after adjusting for age, gender, hypertension, hyperlipidemia, smoking and the extent of CAD. Furthermore, the addition of an elevated Lp(a) level to the reference model improved the integrated discrimination improvement (0.0216, p ＜ 0.001), continuous net reclassification improvement (NRI) (0.5721, p = 0.012) and NRI (0.1549, p = 0.004) values., Conclusions: In terms of the prognosis, elevated Lp(a) is associated with worse outcomes in type 2 diabetic patients with symptomatic CAD. Furthermore, an elevated Lp(a) level has incremental prognostic value in type 2 diabetic patients with symptomatic CAD.

Patient with diabetes (DM) and chronic kidney disease (CKD) are at a higher risk of developing acute coronary syndrome (ACS). However, only a few studies have investigated the separate and joint effects of DM and CKD on the risk of ACS, especially population-based studies under age-, sex- and various cardiovascular risk factor-stratifications. By using a national diabetes cohort derived from the Taiwan National Health Insurance Research Database, we identified a total of 416,143 DM and 541,724 non-DM patients, including 51,208 DM/CKD and 8,894 non-DM/CKD patients, in 2000 who did not have a history of ACS (ICD-9: 410.X, 413.9, 411.1) before 2000. We then prospectively investigated the incidence of ACS by linking to inpatient claims data from 2000 to 2007. A Cox proportional hazard model was used to estimate the relative risk of ACS in individuals with DM and/or CKD under various stratifications. Age- and sex-specific incidence rates were similar between the non-DM/CKD and DM/non-CKD groups, except for female patients under 45 years, in whom DM was associated with a higher risk of ACS than CKD (8.21 vs. 3.82 per 1000 person-years). In the group aged <45 years, the DM/non-CKD patients were associated with a higher relative hazard of ACS than those in the non-DM/CKD group when compared with the non-DM/non-CKD group (men: adjusted hazard ratios [AHR]:1.77; 95% confidence interval [CI]:1.61-1.93 vs. 1.42 [95% CI: 0.73-2.73]; women 1.97 [95% CI: 1.76-2.20] vs. 1.13 [95% CI: 0.36-3.52]). This discrepancy in AHR was reduced with increasing age. The co-existence of DM and CKD further enhanced the AHR in a multiplicative independent manner. A significant age-modification effect was noted in the DM individuals regardless of their CKD status, but not in the non-DM/CKD group. In stratification by various cardiovascular risk factors, diabetes had a higher risk of ACS than CKD in patients with ≤2 selected risk factors, with the exception of the hyperlipidemia and hypertension subgroup. When all three selected risk factors were included, CKD was associated with a higher risk of ACS than DM (AHR: 1.43 [1.27-1.60] vs. 1.25 [1.22-1.29]). In conclusion, DM and CKD were associated with different levels of risk for ACS according to age, sex and certain cardiovascular risk factors. Strategies aimed at preventing ACS should therefore be individualized according to the presence of DM, CKD and various cardiovascular risk factors.

We investigated the adjunctive role of preoperative serum thyroglobulin (Tg) in the diagnosis of thyroid nodules. A retrospective study was performed on 374 thyroid nodules (363 benign and 11 malignant) in 360 patients (296 women and 64 men; mean age, 50.1 years; range, 16-86 years) between December 2010 and July 2011. We evaluated clinicopathologic characteristics of patients and ultrasonographic (US) features of the lesions including presurgical Tg levels. Univariate and multivariate analysis were used to determine independent predictors of malignancy. Serum Tg was positively correlated with nodule size and thyroid volume (P < 0.001). There was no difference in serum Tg levels between malignant and benign nodules. Suspicious US features of thyroid nodules were the only independent predictors of malignancy (P< 0.001). Preoperative serum Tg was not useful in differentiating thyroid cancer from benign nodules. Suspicious US features were the only predicting factors for malignancy.

Background: Dried roots of Sophora flavescens Aiton contain many phytochemicals that exhibit beneficial effects on human health. This study examined and compared the karyological, morphological and phytochemical characteristics of three S. flavescens populations collected from the Danda, Hualien and Yuli of Taiwan and a population collected from Gansu, China., Results: Karyotypes of the four populations were similar, with a diploid number of 2n = 18. The Hualien population produced more roots but with less matrine and oxymatrine contents in its root tissue than others. However, only the root of Danda population had a measurable level of naringenin. The dried root of Yuli population had greater ferric reducing antioxidant power and trolox equivalent antioxidant capacity than that of the other populations., Conclusions: Thus, the collected S. flavescens populations, particularly the population collected from Danda, have the potential to be used in breeding programs.

Effective antiretroviral therapy (ART) blunts viraemia, which enables HIV-1-infected individuals to control infection and live long, productive lives. However, HIV-1 infection remains incurable owing to the persistence of a viral reservoir that harbours integrated provirus within host cellular DNA. This latent infection is unaffected by ART and hidden from the immune system. Recent studies have focused on the development of therapies to disrupt latency. These efforts unmasked residual viral genomes and highlighted the need to enable the clearance of latently infected cells, perhaps via old and new strategies that improve the HIV-1-specific immune response. In this Review, we explore new approaches to eradicate established HIV-1 infection and avoid the burden of lifelong ART.

This study used a simulated in vitro gastrointestinal digestion procedure to assess the bioavailability of a freeze-dried cranberry bean hydroalcoholic extract (polyphenol content of 28.73mgg -1 ). The amount of polyphenols in 200mg of cranberry bean extract increased from 5.73 (non-digested original) to 11.39mg following gastric digestion, but decreased to 6.05mg during intestinal digestion. When cranberry bean extract was accompanied with starch for the digestion tests, the added cranberry bean extract exhibited a potent inhibitory effect against glucose release during simulated intestinal digestion, with IC 50 values of 472mg cranberry bean extract or 13mg polyphenols. A significant decrease in polyphenols was observed for the sample collected from dialysis phase, with only 11% of non-digested original polyphenols permeating through the dialysis membrane (0.63mg) and preserving an inhibitory effect against α-glucosidase to some extent. Therefore, polyphenol-rich cranberry bean extract may be used to manage postprandial hyperglycemia., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background/purpose(s): To identify the clinical characteristics of cytomegalovirus (CMV) disease in chronic kidney disease (CKD) patients., Methods: Patients from two sources were reviewed: (1) a retrospective study of hospitalized patients admitted between January 1990 and February 2009 was performed at a tertiary hospital in Taiwan; (2) the English literature from 1990 to 2009 was reviewed for additional cases, and adults with CKD and histopathologically documented cytomegalovirus disease were included., Results: Seven CKD patients from our hospital and seven from the literature were included. Nine (64.3%) patients were males, and the mean age was 66 years. Histopathologically proven CMV disease was present in the gastrointestinal (GI) tract of 13 (92.9%) and in the skin of one (7.1%) patient. GI symptoms included bleeding (78.6%), abdominal pain (35.7%), and diarrhea (28.6%).The most common comorbidities were diabetes mellitus (7, 50%) and hypertension (8, 57.1%). Thirteen patients had CMV GI disease. The endoscopic gross features of the GI tract lesions included single or multiple ulcers and a large polypoid or uneven surface mass. Of the seven cases with available data, a low body mass index (22.3 ± 1.3 kg/m(2)) and hypoalbuminemia (25 ± 7.0 g/L) were noted. Twelve patients had received ganciclovir or valganciclovir therapy. Five (35.7%) patients died, and the death of two patients was directly related to bowel perforation caused by CMV colitis., Conclusion: CMV disease may occur in CKD patients without the presence of overt immunodeficiency. The gastrointestinal tract is the most common site of involvement. Clinicians should be aware of this possibility in CKD patients who have GI symptoms., (Copyright © 2013. Published by Elsevier B.V.)

Heterogeneous echogenicity and micro-nodulations of diffuse thyroid disease on ultrasonography (US) might influence the diagnostic performance of pre-operative US staging, especially the detection of multi-focality. This study was designed to determine whether heterogeneous echogenicity of the thyroid parenchyma influences the diagnostic performance of US in the detection of multi-focality in papillary thyroid carcinoma. Between December 2010 and April 2011, 811 patients underwent pre-operative staging US for papillary thyroid carcinoma and surgery. Twelve radiologists performed the pre-operative US for T and N staging. Underlying parenchymal echogenicity and unilateral and bilateral multi-focality of the thyroid nodules were also evaluated. Patients were divided into two groups on the basis of the underlying echogenicity of the thyroid gland. To evaluate the diagnostic accuracy of US with respect to underlying echogenicity, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated and compared between the two groups. Among the 811 patients included, US revealed underlying heterogeneous echogenicity of the thyroid parenchyma in 204 (25.2%) and underlying homogeneous echogenicity of the thyroid parenchyma in 607 (74.8%). There were no significant differences between the two groups in the diagnostic performance of pre-operative staging US in predicting unilateral multi-focality and bilaterality. Underlying heterogeneous echogenicity in a thyroid gland with Hashimoto's thyroiditis does not significantly influence the detection of multi-focality in papillary thyroid cancer on pre-operative US staging., (Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to compare the diagnostic performance of gray-scale ultrasound (US), elastography and a combination of gray-scale ultrasound and elastography (US-E) in differentiating benign and malignant thyroid nodules with respect to the level of physician experience. Three hundred fifty-eight patients with 367 thyroid nodules who underwent both gray-scale US and elastography, from November 2011 to January 2012, were included in this study. The diagnostic performance of US performed by experienced and less experienced physicians was compared. Comparisons of the diagnostic performance of US, elastography and US-E were evaluated for each group separately. Of 367 nodules, 121 were malignant and 246 were benign. When we compared the diagnostic performance of the experienced and less experienced physician groups, specificity was statistically higher in the experienced physician group for both US alone (p = 0.001) and US-E (p = 0.048). However, the experienced and less experienced physician groups did not differ significantly on other measures of diagnostic performance, regardless of modality. For the experienced physicians, the specificity and positive predictive value US were 88.0% and 76.8%, respectively; both of them were significantly higher than the corresponding values for US-E. For the less experienced physicians, specificity was significantly higher on elastography (93.8%) than on US (71.4%) (p < 0.001). However, diagnostic performance did not differ significantly between US and US-E for the less experienced physicians. Experienced physicians had superior specificity compared with less experienced physicians. The diagnostic performance of elastography and US-E was inferior compared with that of US alone, irrespective of the level of experience of the physician., (Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study is to explore the differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation (MR). Two-dimensional color Doppler echocardiography-based MR quantification has well-documented limitations., Methods and Results: We consecutively enrolled 221 patients with MR. Adequate image quality was obtained by 2D- and 3D-color Doppler echocardiography in 211 (95.5%) patients. The quantitative differences between the MR volumes obtained by 2D- and 3D-proximal isovelocity surface area (PISA) were analyzed in various MR subgroups. In the validation cohort (n=52), MR volume obtained by 3D-PISA showed a better agreement with phase-contrast cardiac MRI than 2D-PISA (r=0.97 versus 0.84). In all 211 patients, 2D-PISA underestimated the MR volume when compared with 3D-PISA (52.4±19.6 versus 59.5±25.6 mL; P=0.005). A total of 33.3% with severe MR based on 3D-PISA were incorrectly assessed by 2D-PISA as having nonsevere MR. In the subgroup analysis, the MR severity (odds ratio, 6.96; 95% confidence interval, 3.04-15.94; P<0.001) and having an asymmetrical orifice (odds ratio, 11.48; 95% confidence interval, 3.72-35.4; P<0.001), and an eccentric jet (odds ratio, 3.82; 95% confidence interval, 1.27-11.48; P=0.017) were predictors of significant difference in MR volume (>15 mL) between 2D- and 3D-PISA methods., Conclusions: Quantification of MR by 3D-PISA method is clinically feasible and more accurate than the current 2D-PISA method. MR quantification by 2D-PISA significantly underestimated MR volume with severe, eccentric MR with an asymmetrical orifice. This article demonstrates that 3D-color Doppler echocardiography could be used as a valuable tool to confirm treatment strategy in patients with significant MR., (© 2014 American Heart Association, Inc.)

PCR coupled with electrospray ionization mass spectrometry (PCR/ESI-MS) was compared with culture for pathogen detection in peritoneal dialysis (PD)-related peritonitis. Of 21 samples of PD effluent, PCR/ESI-MS identified microorganisms in 18 (86%) samples, including Mycobacterium tuberculosis in 1 culture-negative sample. Of 15 double-positive samples, PCR/ESI-MS and culture reached levels of agreement of 100% (15/15) and 87.5% (7/8) at the genus and species levels, respectively. PCR/ESI-MS can be used for rapid pathogen detection in PD-related peritonitis.

Background: Patients undergoing maintenance dialysis are at increased risk of stroke., Study Design: We performed a nationwide retrospective cohort study to determine the risks for ischemic stroke and hemorrhagic stroke among incident hemodialysis (HD) and peritoneal dialysis (PD) patients in comparison to a reference group in Taiwan., Setting & Participants: Data for 74,192 HD patients, 5,974 PD patients, and 669,773 nondialysis individuals who were older than 18 years and had no history of stroke or cancer were retrieved from the National Health Insurance Research Database for 1998-2009., Predictors: Patient demographics, comorbid conditions., Outcome: First hospitalization for stroke, defined as a diagnosis at discharge (either primary or 1 of 4 secondary diagnoses) of ischemic or hemorrhagic stroke using International Classification of Diseases, Ninth Revision, Clinical Modification codes., Results: HD and PD patients had higher incidences of hospitalized ischemic stroke (102.6 and 100.1/10,000 person-years) and hemorrhagic stroke (74.7 and 59.4/10,000 person-years) in comparison to the age- and sex-matched reference cohort (42.4 and 13.0/10,000 person-years, respectively). In addition to HD and PD therapy, older age, male sex, diabetes, and hypertension were found to be independent risk factors for both ischemic and hemorrhagic strokes. Using the HD group as the comparison group, we found that PD patients had a lower risk of hemorrhagic stroke (HR, 0.75; 95% CI, 0.58-0.96), and there was no significant difference in risks of ischemic stroke between PD and HD patients after adjusting for all potential confounders and competing risk of death, and matched by propensity scores., Limitations: This was a retrospective study, and some important variables were not available., Conclusions: Patients undergoing dialysis are at elevated risk of stroke. Patients undergoing PD appear to be less likely to develop hemorrhagic stroke than those undergoing HD. Comprehensive control of hypertension and diabetes is necessary when delivering dialysis treatment., (Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: High circulating interleukin (IL)-18 level predicts a higher hospitalization rate among dialysis patients, possibly through cardiovascular mechanisms; however, whether higher IL-18 level is associated with mortality in dialysis patients is less clear. In addition, its impacts on left ventricular (LV) function are also unknown. We conducted a cohort study to examine the impacts of IL-18 level on LV function and prognosis among clinically stable hemodialysis patients., Methods: Clinically stable patients undergoing maintenance hemodialysis (≥ 3 months) were prospectively enrolled from December 2008 to January 2009, and were followed up for 31 months. The enrolled patients (41% male, 66.4 ± 10.9 years of age) received 2-dimensional echocardiography and myocardial deformation (strain) analysis, including LV peak systolic longitudinal strain (GLS) and circumferential strain (CS). Laboratory measurements were also performed. Cox regression analysis was used to investigate prognostic factors., Results: Seventy-five patients were stratified into 2 groups by the median value of IL-18 (654.2 pg/ml). Between these 2 groups, there was no significant difference in baseline characteristics including LV ejection fraction. The high IL-18 group had a worse LV systolic function as demonstrated by reduced GLS and CS. Seventeen patients (22.7%) died during the follow-up period. Multivariate Cox regression analysis showed that low serum albumin, the presence of hypertension, high serum IL-18, and less negative GLS (>-15%) were independently associated with all-cause mortality. No significant interaction between IL-18 and less negative GLS was noted in the final Cox model., Conclusion: Hemodialysis patients with high IL-18 levels tend to have worse LV systolic function and higher mortality rate. However, elevated serum IL-18 level is predictive of poor prognosis among stable hemodialysis patients, independently of LV dysfunction. This suggests an additional value of IL-18 to echocardiographic study in predicting all-cause mortality, and IL-18 may be helpful in early risk stratification of hemodialysis patients.