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BackgroundThere is little published data on brain imaging and intracranial haemorrhage after hospital inpatient falls. Imaging protocols for inpatient falls have been adopted from head injury guidelines developed from data in patients presenting to the Emergency Department. We sought to describe the use of brain computed tomography (CT) following inpatient falls, and determine the incidence and potential risk factors for intracranial haemorrhage.MethodsWe identified inpatient falls in acute medical wards at Monash Health, a large hospital network in the southeast region of Melbourne in Australia, from the incident reporting system during a 32 month period. We examined the post-fall medical assessment form, neurological observation chart and the diagnostic imaging system for details of the fall and brain CT findings. We used survival analysis to evaluate the timeliness of brain imaging and determined potential risk factors for intracranial haemorrhage by logistic regression.ResultsFrom 934 falls in 789 medical inpatients, 191 brain CT scans were performed. The median age of patients was 77 years. Only 55% of falls were from standing height and 24% experienced a head strike. Less than 10% of patients received an urgent scan within one hour, and timeliness of imaging was influenced by anticoagulation status rather than guideline determination of urgency. The overall incidence of intracranial haemorrhage was 0.9%. The factors associated with intracranial haemorrhage were head strike, anticoagulation, loss of consciousness or amnesia, drop in Glasgow Coma Scale and advanced chronic kidney disease.ConclusionsThe incidence of intracranial haemorrhage was low as most inpatient falls were at low risk for head injury. Research is needed to determine if guidelines specific for hospital inpatients may reduce unnecessary scans without compromising case detection, and improve timeliness of urgent scans.

Background Severe rhabdomyolysis is associated with acute kidney injury, but it is unclear if patients developing rhabdomyolysis after illicit drug use have a higher risk of acute kidney injury compared to other causes. Aims To provide a descriptive analysis of patients admitted with rhabdomyolysis, with a focus on illicit drug use, and to determine if illicit drug use was an independent predictor for acute kidney injury or renal replacement therapy. Methods We conducted a 5-year cohort study of patients admitted to Monash Health, a tertiary referral hospital network. We identified adult patients with muscle injury from ICD-10 AM codes, serum creatine kinase level greater than 1000 U/mL, and a clinical history consistent with rhabdomyolysis. We determined the prevalence and type of illicit drug involved and determined the association between illicit drug use and renal outcomes by logistic regression. Results Of 643 patients, illicit drug use was identified in 12%. Acute kidney injury developed in 51%, and 5% required renal replacement therapy. Compared to the rest of the cohort, patients who used illicit drugs were younger and had higher peak serum creatine kinase, and developed a higher severity of acute kidney injury. In multivariable analysis, the factors associated with acute kidney injury were illicit drug use, peak creatine kinase, cardiovascular disease, concurrent sepsis and a clinically-evident pressure injury. Chronic kidney disease and need for fasciotomy were additional risk factors for renal replacement therapy. Conclusions Illicit drug use was associated with acute kidney injury and renal replacement therapy independent of creatine kinase levels.

S E T T ING: Tuberculosis (TB) is the most common human immunodeficiency virus (HIV) related opportunistic infection and cause of acquired immune-deficiency syndrome related death. TB often affects those from a low socio-economic background. OBJECTIVE : To assess the socio-economic determinants of TB in HIV-infected patients in Asia. DESIGN: This was a matched case-control study. HIVpositive, TB-positive cases were matched to HIVpositive, TB-negative controls according to age, sex and CD4 cell count. A socio-economic questionnaire comprising 23 questions, including education level, employment, housing and substance use, was distributed. Socio-economic risk factors for TB were analysed using conditional logistic regression analysis. RESULT S : A total of 340 patients (170 matched pairs) were recruited, with 262 (77.1%) matched for all three criteria. Pulmonary TB was the predominant type (n ¼ 115, 67.6%). The main risk factor for TB was not having a university level education (OR 4.45, 95%CI 1.50–13.17, P¼0.007). Burning wood or coal regularly inside the house and living in the same place of origin were weakly associated with TB diagnosis. CONCLUS IONS : These data suggest that lower socioeconomic status is associated with an increased risk of TB in Asia. Integrating clinical and socio-economic factors into HIV treatment may help in the prevention of opportunistic infections and disease progression. KEY WORDS : socio-economic; questionnaire; matched; HIV; TB

Introduction: Multiple comorbidities among HIV-positive individuals may increase the potential for polypharmacy causing drug-to-drug interactions and older individuals with comorbidities, particularly those with cognitive impairment, may have difficulty in adhering to complex medications. However, the effects of age-associated comorbidities on the treatment outcomes of combination antiretroviral therapy (cART) are not well known. In this study, we investigated the effects of age-associated comorbidities on therapeutic outcomes of cART in HIV-positive adults in Asian countries. Methods: Patients enrolled in the TREAT Asia HIV Observational Database cohort and on cART for more than six months were analysed. Comorbidities included hypertension, diabetes, dyslipidaemia and impaired renal function. Treatment outcomes of patients ≥50 years of age with comorbidities were compared with those

Background We aimed to project the 10-year future incidence of cardiovascular disease (CVD) and model several intervention scenarios based on a multi-site Asian HIV-positive cohort. Methods Analyses were based on patients recruited to the TREAT Asia HIV Observational Database (TAHOD), consisting of 21 sites in 12 countries. Patients on triple antiretroviral therapy (ART) were included if they were alive, without previous CVD, and had data on CVD risk factors. Annual new CVD events for 2019–2028 were estimated with the D:A:D equation, accounting for age- and sex-adjusted mortality. Modelled intervention scenarios were treatment of high total cholesterol, low high-density lipoprotein cholesterol (HDL) or high blood pressure, abacavir or lopinavir substitution, and smoking cessation. Results Of 3,703 included patients, 69% were male, median age was 46 (IQR 40–53) years and median time since ART initiation was 9.8 years (IQR 7.5–14.1). Cohort incidence rates of CVD were projected to increase from 730 per 100,000 person-years (pys) in 2019 to 1,432 per 100,000 pys in 2028. In the modelled intervention scenarios, most events can be avoided by smoking cessation, abacavir substitution, lopinavir substitution, decreasing total cholesterol, treating high blood pressure and increasing HDL. Conclusions Our projections suggest a doubling of CVD incidence rates in Asian HIV-positive adults in our cohort. An increase in CVD can be expected in any ageing population, however, according to our models, this can be close to averted by interventions. Thus, there is an urgent need for risk screening and integration of HIV and CVD programmes to reduce the future CVD burden.

Introduction Comorbidities including diabetes mellitus (DM) among people living with HIV (PLHIV) are of increasing clinical concerns in combination antiretroviral therapy (cART) era. We aimed to determine the incidence and risk factors of new‐onset DM among PLHIV in Asian settings. Methods PLHIV from a regional observational cohort without DM prior to antiretroviral therapy (ART) initiation were included in the analysis. DM was defined as having a fasting blood glucose ≥126 mg/dL, glycated haemoglobin ≥6.5%, a two‐hour plasma glucose ≥200 mg/dL, or a random plasma glucose ≥200 mg/dL. A Cox regression model, stratified by site, was used to identify risk factors associated with DM. Results and discussion Of the 1927 participants included, 127 were diagnosed with DM after ART initiation. Median follow‐up time from ART initiation to DM diagnosis was 5.9 years (interquartile range (IQR): 2.8 to 8.9 years). The crude incidence rate of DM was 1.08 per 100 person‐years (100 PYS), 95% confidence interval (CI) (0.9 to 1.3). In the multivariate analysis, later years of follow‐up (2011 to 2013: HR = 2.34, 95% CI 1.14 to 4.79, p = 0.02; and 2014 to 2017: HR = 7.20, 95% CI 3.27 to 15.87, p 50 years: HR = 4.19, 95% CI 2.12 to 8.28, p 30 kg/m2 (HR = 4.3, 95% CI 1.53 to 12.09, p = 0.006) compared to BMI

Objectives The aim of the study was to assess the prevalence and characteristics associated with current smoking in an Asian HIV-positive cohort, to calculate the predictive risks of cardiovascular disease (CVD), coronary heart disease (CHD) and myocardial infarction (MI), and to identify the impact that simulated interventions may have. Methods Logistic regression analysis was used to distinguish associated current smoking characteristics. Five-year predictive risks of CVD, CHD and MI and the impact of simulated interventions were calculated utilizing the Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) algorithm. Results Smoking status data were collected from 4274 participants and 1496 of these had sufficient data for simulated intervention calculations. Current smoking prevalence in these two groups was similar (23.2% vs. 19.9%, respectively). Characteristics associated with current smoking included age > 50 years compared with 30–39 years [odds ratio (OR) 0.65; 95% confidence interval (CI) 0.51–0.83], HIV exposure through injecting drug use compared with heterosexual exposure (OR 3.03; 95% CI 2.25–4.07), and receiving antiretroviral therapy (ART) at study sites in Singapore, South Korea, Malaysia, Japan and Vietnam in comparison to Thailand (all OR > 2). Women were less likely to smoke than men (OR 0.11; 95% CI 0.08–0.14). In simulated interventions, smoking cessation demonstrated the greatest impact in reducing CVD and CHD risk and closely approximated the impact of switching from abacavir to an alternate antiretroviral in the reduction of 5-year MI risk. Conclusions Multiple interventions could reduce CVD, CHD and MI risk in Asian HIV-positive patients, with smoking cessation potentially being the most influential.

OBJECTIVES With aging of the HIV-positive population, cardiovascular disease (CVD) increasingly contributes to morbidity and mortality. We investigated CVD-related and other causes of death (CODs) and factors associated with CVD in a multi-country Asian HIV-positive cohort. METHODS Patient data from 2003-2017 were obtained from the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD). We included patients on antiretroviral therapy (ART) with > 1 day of follow-up. Cumulative incidences were plotted for CVD-related, AIDS-related, non-AIDS-related, and unknown CODs, and any CVD (i.e. fatal and nonfatal). Competing risk regression was used to assess risk factors of any CVD. RESULTS Of 8069 patients with a median follow-up of 7.3 years [interquartile range (IQR) 4.4-10.7 years], 378 patients died [incidence rate (IR) 6.2 per 1000 person-years (PY)], and this total included 22 CVD-related deaths (IR 0.36 per 1000 PY). Factors significantly associated with any CVD event (IR 2.2 per 1000 PY) were older age [sub-hazard ratio (sHR) 2.21; 95% confidence interval (CI) 1.36-3.58 for age 41-50 years; sHR 5.52; 95% CI 3.43-8.91 for ≥ 51 years, compared with < 40 years], high blood pressure (sHR 1.62; 95% CI 1.04-2.52), high total cholesterol (sHR 1.89; 95% CI 1.27-2.82), high triglycerides (sHR 1.55; 95% CI 1.02-2.37) and high body mass index (BMI) (sHR 1.66; 95% CI 1.12-2.46). CVD crude IRs were lower in the later ART initiation period and in lower middle- and upper middle-income countries. CONCLUSIONS The development of fatal and nonfatal CVD events in our cohort was associated with older age, and treatable risk factors such as high blood pressure, triglycerides, total cholesterol and BMI. Lower CVD event rates in middle-income countries may indicate under-diagnosis of CVD in Asian-Pacific resource-limited settings.

Community participation in the conservation of tropical fruit trees is one approach taken by the Tropical Fruit Trees Project funded by UNEP/GEF carried out at six sites in Malaysia. Three conservation approaches were implemented at the sites that are diversity block, heritage block and common block. A total of 1550 fruit trees mainly from the genera Mangifera, Garcinia and Nephelium were planted. At Kampung Kakeng, Serian, Sarawak a 5 ha diversity block was established. 110 fruit trees comprising species from the genera Mangifera, Nephelium, Garcinia, Durio, Artocarpus, Anonna, and Musa were planted in the diveristy block. An orchard consisting of many species of old fruit trees at Sibuti was identified as a Heritage Block for conservation and education purposes. A Mangifera pentandra tree aged more than 100 years from the Heritage Block was used as a source of seeds for new plantings. While in Kota Belud, a few binjai (Mangifera caesia) trees 50 - 100 years old were labelled as heritage fruit trees for public awareness as well as for conservation in the Heritage block. At other sites Yan, Papar and Bukit Gantang, fruit trees within the genus Mangifera, Garcinia and Nephelium were planted in the homegardens, orchards and public places such as playground compounds or near riversides.

Abnormal liver function tests are commonly observed with rhabdomyolysis, but the nature of this association is not fully defined. This study aims to determine the functional relationship between serum creatine kinase, as a marker of rhabdomyolysis severity, and liver biochemistry. We used linear regression to model the relationship between liver biochemistry and peak serum creatine kinase. A total of 528 patients with a median age of 74 years were included. The distribution of creatine kinase, bilirubin, alkaline phosphatase, alanine aminotransferase, and &gamma, glutamyl transferase were significantly skewed, and these variables were log-transformed prior to regression. There was a positive linear correlation between log-alanine aminotransferase and log-creatine kinase. In the multiple regression analysis, log-creatine kinase, age, acute kidney injury stage, and chronic liver disease were independently associated with log-alanine aminotransferase. This model explained 46% of the variance of log-alanine aminotransferase. We found no correlation between the log-creatine kinase and the log-bilirubin, log-alkaline phosphatase, or log-&gamma, glutamyl transferase. Serum alanine aminotransferase was not associated with inpatient mortality but a higher creatine kinase-alanine aminotransferase ratio was associated with lower odds of mortality. In conclusion, an isolated elevation in alanine aminotransferase can occur in rhabdomyolysis, and it may be possible to anticipate the level of increase based on the peak creatine kinase.

This project aims to initiate the teaching of user-friendly Excel Visual Basic for Application (VBA) programming in chemical engineering at the Hong Kong University of Science and Technology (HKUST) with the emphasis on relevant examples/projects selected from chemical engineering core courses. The course is designed with the emphasis on not only how to program, but also on problem solving and how to convert a chemical engineering problem into a working program. Several chemical engineering problems were selected as either projects or demonstration programs in order to allow students to experience the advantage of programming in Excel VBA. Comparison to other programming languages students had been previously taught and to other available software packages which do not have any programming requirement (e.g. Polymath) was made in these demonstration examples to let students understand the advantages or disadvantages of programming in Excel VBA.

In regions that are hyperendemic for chronic hepatitis B virus (HBV) infection prevalence of and risk factors associated with isolated anti-hepatitis B core antibody (anti-HBc) in HIV-positive patients are less well described. HIV-positive patients who were tested for hepatitis B surface antigen (HBsAg) anti-hepatitis B surface antibody (anti-HBs) and anti-HBc at designated hospitals for HIV care in Taiwan were included for analysis. HBV DNA was detected by real-time polymerase chain reaction in patients with and without isolated anti-HBc. Of 2351 HIV-positive patients 450 (19.1%) were HBsAg positive 411 (17.5%) were anti-HBc positive alone and 963 (41.0%) for both anti-HBs and anti-HBc. Compared with patients who were positive for both anti-HBs and anti-HBc patients with isolated anti-HBc were older less likely to have anti-hepatitis C virus antibody (anti-HCV) had lower CD4 lymphocyte counts and higher plasma HIV RNA loads. Older age (adjusted odds ratio 1.029; 95% confidence interval 1.015-1.043) and CD4

METSTOICH, a metabolite balancing software package, was developed for use in teaching metabolic pathways and their interactions. Based on the metabolism of Baker's Yeast, the package has been used to examine the relationship between cell yield, cell composition, P/O ratio, and energy (ATP) utilisation during cell growth. Thls paper presents initial results validating the model against experimental data from the literature as well as a more detailed analysis of feasible parameter ranges for cell growth. Initial trials have indicated that the package provides a useful supplement to traditional methods in teaching metabolism

This report studies the accuracy of conjunctival swab polymerase chain reaction (CS-PCR) for the diagnosis of human cytomegalovirus retinitis (HCMV) in AIDS patients. PCR and virus culture were used for the detection of HCMV in conjunctival swab, serum, and urine specimens from 38 AIDS patients between April 1996 and April 1998. The clinical utility of the identification of HCMV retinitis by these 6 different methods was demonstrated by their prediction power to estimate AIDS patients at risk of contracting HCMV retinitis. The sensitivity, specificity, positive predictive value, and negative predictive value of CS-PCR for the detection of HCMV retinitis were 91.5%, 80.9%, 60.8%, and 92.7%, respectively; for serum PCR were 74.3%, 81.7%, 57.2%, and 90.3%; for urine PCR were 100%, 17.3%, 20.4%, and 100%; for conjunctival swab culture were 22.7%, 100%, 100%, and 86%; for serum culture were 27.3%, 98.1%, 75%, and 86.4%; and for urine culture were 90.9%, 44.2%, 25.6%, and 95.8%.

Background: Clinicians often recommend an additional energy intake of 1250 kJ/d to their pregnant patients. Previous studies have shown considerable variation in the metabolic response to pregnancy and thus in the additional energy required to support a pregnancy. Objective: The purpose of this study was to assess how wellnourished women meet the energy demands of pregnancy and to identify factors that predict an individual’s metabolic response. Design: Resting metabolic rate (RMR), diet-induced thermogenesis (DIT), total energy expenditure (TEE), activity energy expenditure (AEE), energy intake (EI), and body fat mass (FM) were measured longitudinally in 10 women preconception; at 8‐10, 24‐26, and 34‐36 wk of gestation; and 4‐6 wk postpartum. Results: Compared with preconception values, individual RMRs increased from 456 to 3389 kJ/d by late pregnancy. DIT varied from 2266 to 110 kJ/meal, TEE from 2105 to 3421 kJ/d, AEE from 22301 to 2929 kJ/d, EI from 2259 to 2176 kJ/d, and FM from a 0.6-kg loss to a 10.6-kg gain. The only prepregnant factor that predicted FM gain was RMR (r = 0.65, P < 0.05). Women with the largest cumulative increase in RMR deposited the least FM (r = 20.64, P < 0.05). Conclusions: Well-nourished women use different strategies to meet the energy demands of pregnancy, including reductions in DIT or AEE, increases in EI, and deposition of less FM than anticipated. The combination of strategies used by individual women is not wholly predictable from prepregnant indexes. The use of a single recommendation for increased energy intake in all pregnant women is not justified. Am J Clin Nutr 1999;69:697‐704.

The effect of maternal energy balance in conjunction with body energy reserves on lactation performance has not been fully elucidated in humans. Energy balance was computed from changes in weight and body composition over 6 mo postpartum in 21 Otomi Indian women with relatively low postpartum body mass indexes (BMIs; in kg/m2, 21.4 +/- 0.9) and 19 with relatively high BMIs (25.7 +/- 1.9). Body fat was determined by deuterium dilution. Milk production was estimated by 24-h test weighing. Macronutrient content of human milk was measured by standard techniques. In both groups weight declined over the 6 mo postpartum (P = 0.04). In the lower BMI group only, body fat (kg, % of wt) decreased significantly (P = 0.04). Milk fat concentration was positively correlated with body fat at 3 and 6 mo (r = 0.32 and 0.40; P = 0.04 and 0.01, respectively). Energy balance was not associated with milk production or composition, nutrient secretion into milk, or infant growth velocity, except at 6 mo, when energy balance was positively correlated with milk energy and fat concentration in the lower BMI group (r = 0.55; P = 0.01). Fat concentration was lower in the lower BMI group (P = 0.04). Because of the inverse correlation between milk production and milk fat at 3 and 6 mo (r = -0.47 and -0.43, respectively; P = 0.01), fat secretion into milk did not differ between groups. Infant growth velocities did not differ significantly between groups. In conclusion, negative energy balance in conjunction with lower energy reserves did not adversely affect lactation performance or infant growth in this population of Otomi Indians.

Clinical outcome and mutations of 96 core-binding factor acute myeloid leukemia (AML) patients 18–60 years old were examined. Complete remission (CR) after induction was 94.6%. There was no significant difference in CR, leukemia-free-survival (LFS) and overall survival (OS) between t(8;21) (N=67) and inv(16) patients (N=29). Univariate analysis showed hematopoietic stem cell transplantation at CR1 as the only clinical parameter associated with superior LFS. Next-generation sequencing based on a myeloid gene panel was performed in 72 patients. Mutations in genes involved in cell signaling were associated with inferior LFS and OS, whereas those in genes involved in DNA methylation were associated with inferior LFS. KIT activation loop (AL) mutations occurred in 25 patients, and were associated with inferior LFS (P=0.003) and OS (P=0.001). TET2 mutations occurred in 8 patients, and were associated with significantly shorter LFS (P=0.015) but not OS. Patients negative for KIT-AL and TET2 mutations (N=41) had significantly better LFS (PP=0.012) than those positive for both or either mutation. Multivariate analysis showed that KIT-AL and TET2 mutations were associated with inferior LFS, whereas age ⩾40 years and marrow blast ⩾70% were associated with inferior OS. These observations provide new insights that may guide better treatment for this AML subtype.

The genes for human complement receptor type 1 (CR1) F and S alleles have been cloned and span a region of 133-160 kb on chromosome 1. The F allele was found to comprise 39 exons and the S allele contains an additional 8 exons. The leader sequence and 5'-untranslated region are contained in one exon. Each of the long homologous repeats (LHR), which contain seven short consensus repeats (SCR), is composed of 8 exons. Within a LHR, SCR 1, 5, and 7 are each encoded by a single exon, SCR 2 and 6 are each encoded by 2 exons, and a single exon codes for SCR 3 and 4. The transmembrane region is encoded by 2 exons and the cytoplasmic domain and the 3'-untranslated regions are coded for by separate exons. The sequences of the eight S allele-specific exons were very similar to those from LHR-A and -B, as was predicted by comparison of the genomic restriction maps. It had previously been suggested that the alleles of CR1 have arisen by a mechanism of unequal crossover. A comparison of intron sequences from LHR-A, -B, -C, and -S revealed data that support this hypothesis. The homologies of intron sequences from LHR-A, -B, and -C indicated that the crossover event between LHR-A and -C that gave rise to LHR-B probably occurred within the fourth exon of these LHR. Likewise, the crossover event between LHR-A and -B that produced LHR-S probably occurred within a 383 bp region around the sixth exon. Analysis of RNA from peripheral blood cells by the S1 nuclease assay indicated that the transcription start site is 111 bp upstream of the translation initiation codon ATG. The 5' rapid amplification of cDNA ends confirmed this position as a transcription start site and revealed another possible start site 29 bp further upstream.

A 10-month-old Chinese boy presented with delayed motor development for seven months. Blood and biochemistry investigations revealed no abnormalities. The physical examination showed poor postnatal growth (below -2 standard deviation from the mean at diagnosis), preservation of the occipitofrontal head circumference with delayed closure of the anterior fontanel, a classical triangular facial phenotype, asymmetry of the lower extremities and other characteristic features that fulfil the diagnostic criteria of Silver-Russell syndrome clinically. As PubMed and web searches revealed no similar findings, we believe that this may be the first case of Silver-Russell syndrome with linea alba hernia and pes varus reported in China, and possibly the world. The genetic deficit responsible for this case is still under investigation.

The saturation current-voltage characteristics of a junction field-effect transistor (JFET) are influenced by the effective conducting channel length of the device. The effective channel length is modulated by the gate voltage and the drain voltage due to the variation of the thicknesses of the depletion layers associated with the top-and bottom-gate of the JFET. For a given gate voltage, the effective channel length will shrink if the drain voltage is increased, a mechanism normally described by the channel-length modulation coefficient k. This paper develops a model for calculating λ, when combined with a recently developed JFET static model, this λ model can be used to predict the saturation behaviour of JFETs. Experimental data are included in support of the model.

In regions that are hyperendemic for chronic hepatitis B virus (HBV) infection, prevalence of and risk factors associated with isolated anti-hepatitis B core antibody (anti-HBc) in HIV-positive patients are less well described. HIV-positive patients who were tested for hepatitis B surface antigen (HBsAg), anti-hepatitis B surface antibody (anti-HBs) and anti-HBc at designated hospitals for HIV care in Taiwan were included for analysis. HBV DNA was detected by real-time polymerase chain reaction in patients with and without isolated anti-HBc. Of 2351 HIV-positive patients, 450 (19.1%) were HBsAg positive, 411 (17.5%) were anti-HBc positive alone and 963 (41.0%) for both anti-HBs and anti-HBc. Compared with patients who were positive for both anti-HBs and anti-HBc, patients with isolated anti-HBc were older, less likely to have anti-hepatitis C virus antibody (anti-HCV), had lower CD4 lymphocyte counts and higher plasma HIV RNA loads. Older age (adjusted odds ratio, 1.029; 95% confidence interval, 1.015-1.043) and CD4100 cells/microL (adjusted odds ratio, 1.524; 95% confidence interval, 1.025-2.265) were independently associated with isolated anti-HBc by logistic regression, while presence of anti-HCV and injecting drug use were not. HBV DNA was detectable in 8.3% of 277 patients with isolated anti-HBc and 14.3% of 56 patients with both anti-HBs and anti-HBc (P = 0.160). In a country hyperendemic for HBV infection, HIV-positive patients at older age and with CD4100 cells/microL were more likely to have isolated anti-HBc, suggesting that compromised immunity plays a role in the presence of this marker.

Human CR1 is composed of tandem long homologous repeating (LHR) segments that encode separate binding sites for C3b or C4b. Homologous recombination with unequal crossover has been proposed as the genetic mechanism that gave rise to the CR1 alleles that differed in their total numbers of LHR. The F allotype has four LHR, named LHR-A, -B, -C, -D, 5' to 3'. The site in LHR-A preferentially binds C4b and those in LHR-B and -C prefer C3b. A previous study revealed the presence of a fifth LHR with sequences similar to LHR-B and a third C3b binding site in the S allotype of higher m.w. In the present study, an 18-kb EcoRV fragment that was associated with the expression of the lower m.w. F' allotype hybridized with a unique pattern of cDNA and intron probes specific for LHR-C. Deletion of LHR-B and one C3b binding site was proposed as the mechanism for the appearance of this F'-specific fragment. Functional differences among the CR1 variants were sought by comparative analyses of soluble rCR1 having one, two or three C3b binding sites. Although these three variants did not exhibit any significant differences in their capacities to act as cofactors for the cleavage of monomeric C3b, their relative affinities for dimeric ligand varied more than 100-fold. Furthermore, the variant with only one C3b binding site was at least 10-fold less effective in the inhibition of the alternative pathway C3 and C5 convertases. These observations suggested that the F' allotype may be impaired in its capacity to bind opsonized immune complexes, to inhibit the formation of the alternative pathway C3 and C5 convertases, and perhaps to mediate other CR1-dependent cellular responses.

Introduction. The Hong Kong Chinese version of the WHOQOL-BREF was designed as a self-administered questionnaire and has limitations in clinical application on subjects who have limitations in reading or writing. An interview version is therefore needed to avoid sampling biases in clinical studies. Since there are significant differences in the written Chinese and spoken Cantonese, which is a dialect commonly spoken among people in Hong Kong, and adaptation process for converting the written Chinese into spoken Cantonese was necessary. The interview version was designed to allow administration in both face-to-face interview and telephone interview mode. Methods. Three members of the research team translated the formal written Chinese in the self-administered version of the WHOQOL-BREF(HK) into colloquial Cantonese separately. Brief notes extracted from the facet definitions of the WHOQOL-100 were added in brackets after some questions to further explain the intention of the questions. Two series of focus groups were conducted and subsequently the field test version was produced. 329 subjects were recruited by convenient sampling method for the field test. Results. The interview version and the self-administered version was found equivalent. The ICC values of the domain scores ranged from 0.73 in the environment domain to 0.83 in the psychological domain. The face-to-face interview and telephone interview mode of administration were also found equivalent. The ICC for the domain scores ranged from 0.76 in the social interaction domain to 0.84 in the psychological domain. The other psychometric properties of the interview version were found comparable to the self-administered version. Conclusion. The self-administered and the interview version of the WHOQOL-BREF are regarded as identical in group comparison. The authors advise that it is acceptable to use different versions on different subjects in the same study, provided that the same version is applied on the same subject throughout the study.

Tea polyphenols, including (+)-catechin, (–)-epicatechin, and (–)-epigallocatechin-3-gallate (EGCG), have been shown to possess potent antioxidant and chemopreventive activities. The aim of this study was to assess the effects of electroporation, iontophoresis, and their combination on the transdermal delivery of tea catechins across porcine skin. The permeation characteristics were investigated using various analogues of catechins, pH values, and modes of electroporation and iontophoresis. The mechanisms by which these catechins were transported via the skin were elucidated by examining the electric conductivity, transepidermal water loss (TEWL), and fusion of stratum corneum lipid liposomes (SCLL). The isomers, (+)-catechin and (–)-epicatechin, showed different behaviors of skin permeation and local skin deposition with the electrically assisted methods. The results suggest evidence of selective skin absorption of (–)-epicatechin over (+)-catechin. A synergistic effect was detected for (+)-catechin but not for (–)-epicatechin after application of electroporation followed by iontophoresis. The presence of a gallic acid ester in the structure of EGCG significantly increased the skin uptake of catechins. However, a negligible amount of or no EGCG molecules permeated across the skin. The mechanisms involved in the enhancement of electroporation may be the skin reservoir effect and an increase in skin permeability. The TEWL profiles suggest that in addition to the force of electrorepulsion, the skin hydration effect and structural alterations may also have contributed to the enhancement by iontophoresis. Electroporation did not influence the skin barrier function, although the skin permeability increased according to the SCLL fusion study.

The extent to which people with mental retardation are benefit from the modern information technology is not well explored. A better understanding on ways that the existing human-computer interface would challenge people with mental retardation would shed light on this issue. This study was investi- gated the neuropsychological functions which are important for enhancing the competence of people with mental retardation to operate on the Internet Ex- plorer (IE) program. Sixty-two participants with mental retardation were invited to conduct a set of neuropsychological tests. Their computer performance was also evaluated. Resulted indicated that some specific neuropsychological func- tions including attention and visual scanning, psychomotor and language were predictive of their overall computer competence. The implication on ways to improve the design for computer programs for this population was discussed.

We studied the effectiveness of unilateral brachiocephalic (BC)-superior vena cava (SVC) metallic stent therapy in malignant SVC obstruction.From November 1998 to February 2002, SVC stenting was performed in 11 patients with symptomatic malignant SVC obstruction. There were 10 males and 1 female, with a mean age of 64.2 years (range, 37 to 78 years). The computed tomography (CT) scan and superior vena cavogram findings of all patients showed malignant SVC obstruction. Both internal jugular veins were patent in all patients by ultrasound. SVC stenting was performed with Wallstent (Boston Scientific, Minneapolis, MN, USA) in 10 patients and Memotherm stent (Bard angiomed, Wachhausstrasse, Germany) in 1 patient. Pressure gradient, duration of the procedure, peri-procedural morbidity and mortality and the general well-being of the patients were reviewed.SVC stenting was performed at a mean duration of 9.6 days (range, 3 to 30 days) after presentation. All were technically successful with 10 across the right BC-SVC and 1 across the left BC-SVC. There was no peri-procedural morbidity or mortality. The entire procedure was completed at a mean duration of 115 minutes (range, 75 to 225 minutes) with good angiographic and pressure results. Immediate symptomatic relief of SVC syndrome was achieved in 10 patients who had received prompt work-up and stenting 3 to 18 days after presentation. The remaining patient, who received work-up and stenting 30 days after presentation, remained dyspnoeic and died of pneumonia 7 days after the procedure.Unilateral BC-SVC metallic stenting is an effective measure in malignant SVC obstruction. Prompt pre-stenting work-up and stenting are recommended to achieve a longer symptomatic relief period.

The molecular mechanisms by which different mutations in actin lead to distinct cardiomyopathies are unknown. Here, actin mutants corresponding to alpha-cardiac actin mutations causing hypertrophic cardiomyopathy [(HCM) P164A and A331P] and dilated cardiomyopathy [(DCM) R312H and E361G] were expressed in yeast and purified for in vitro functional studies. While P164A appeared unaltered compared to wild-type (WT) actin, A331P function was impaired. A331P showed reduced stability in circular dichroism melting experiments; its monomer unfolding transition was 10 degrees C lower compared to WT actin. Additionally, in vitro filament formation was hampered, and yeast cell cultures were temperature sensitive, implying perturbations in actin-actin interactions. Filament instability of the A331P mutant actin could lead to actomyosin dysfunction observed in HCM. Yeast strains harboring the R312H mutation did not grow well in culture, suggesting that cell viability is compromised. The E361G substitution is located at an alpha-actinin binding region where the actin filament is anchored. The mutant actin, though unaltered in the in vitro motility and standard actomyosin functions, had a threefold reduction in alpha-actinin binding. This could result in impairment of force-transduction in muscle fibers, and a DCM phenotype.

Burkholderia cepacia has become an important pathogen of infections in immunocompromised and nosocomial patients. The characteristics of 42 episodes of B. cepacia bacteremia in 40 patients admitted to the Taipei Veterans General Hospital between January 1997 and December 1999 were retrospectively analyzed. Factors that adversely influenced the mortality rate included respiratory failure, an unknown infection source, a period in an intensive care unit, and shock. Most of the patients had serious underlying diseases, such as diabetes mellitus, malignancy, congestive heart failure, and chronic obstructive pulmonary disease. The mean time for a positive blood culture was 45 days after admission. The overall mortality rate was 28.6% (12/42), and 44.4% (12/27) of all deaths were directly related to B. cepacia bacteremia. Polymicrobial bacteremia was found in 5 patients. Ceftazidime was the most effective antimicrobial agent in vitro, whereas chloramphenicol, imipenem, and trimethoprim/sulfamethoxazole were less effective alternatives. Appropriate antibiotic therapy was given to 30 patients, most of whom responded to the therapy except for 5 who died despite receiving appropriate treatment. Although B. cepacia infection develops in a relatively small proportion of hospitalized individuals, it has a major impact on morbidity and mortality. In view of the fact that B. cepacia develops resistance to a wide range of antimicrobial agents, ceftazidime and/or trimethoprim/sulfamethoxazole should be the drug of choice for empiric therapy.

The collection and conversion of 4-color fluorescent genotyping data from capillary array electrophoresis microchip devices and its conversion to a format easily and rapidly analyzed by Genetic Profiler genotyping software is presented. Microchip fluorescence intensity data are acquired and stored as 4-color tab-delimited text. These files are converted to electrophoretic signal data (ESD) files using a utility program (TEXT-to-ESD) written in C. TEXT-to-ESD generates an ESD file by converting text data to binary data and then appending a 632-byte ESD-file trailer. Up to 96 ESD files are then assembled into a run folder and imported into Genetic Profiler, where data are reduced to 4-color electropherograms and analyzed. In this manner, DNA fragment sizing data acquired with our high-speed electrophoretic microchip devices can be rapidly analyzed using robust commercial software. Additionally, the conversion program allows sizing of data with Genetic Profiler that have been preprocessed using other third-party software, such as BaseFinder.