Usefulness of transesophageal echocardiography for the detection of left atrial thrombi in patients with rheumatic heart disease

Transesophageal (TEE) and transthoracic (TTE) echocardiograms were performed in 110 patients with rheumatic heart disease to evaluate the usefulness of these methods for the detection of left atrial thrombi. TEE was better than TTE for detecting left atrial thrombi (21 vs 9). The thrombi not detected by TTE were in the left atrial appendage in ten and over the left atrial posterior wall in two. Patients with left atrial thrombi had significantly smaller mitral valve area (P less than 0.01) and greater left atrial dimension (P less than 0.05) than those without. All patients with left atrial thrombi had atrial fibrillation. Thirty-one patients underwent surgical intervention and 13 were found to have left atrial thrombi. TEE detected left atrial thrombi in all 13 patients with a sensitivity of 100%, specificity of 100%, and accuracy of 100%, while TTE detected left atrial thrombi in only nine of these 13 patients with a sensitivity of 69.2%, specificity of 100%, and accuracy of 87.1%. Thus, TEE is superior to TTE for the detection of left atrial thrombi, especially for those thrombi located in the left atrial appendage and along the left atrial posterior wall.     

A Multicentre Evaluation of the Role of the Prostate Health Index (PHI) in Regions with Differing Prevalence of Prostate Cancer: Adjustment of PHI Reference Ranges is Needed for European and Asian Settings

Asians have a lower incidence of prostate cancer (PC). We compared the performance of the Prostate Health Index (PHI) for 2488 men in different ethnic groups (1688 Asian and 800 European men from 9 sites) with PSA 2–20 ng/ml and PHI test and transrectal ultrasound-guided biopsy results available. Of these, 1652 men had PSA 2–10 ng/ml and a normal digital rectal examination and underwent initial biopsy. The proportions of PC (Gleason ≥6) and higher-grade PC (HGPC, Gleason ≥7) across different PHI ranges were compared. The performance of PSA and PHI was compared using the area under the receiver operating characteristic curve (AUC) and decision curve analyses (DCA). Among Asian men, HGPC would be diagnosed in 1.0%, 1.9%, 13%, and 30% of men using PHI thresholds of <25, 25–35, 35–55, and >55, respectively. At 90% sensitivity for HGPC (PHI >30), 56% of biopsies and 33% of Gleason 6 PC diagnoses could have been avoided. Among European men, HGPC would be diagnosed in 4.1%, 4.3%, 30%, and 34% of men using PHI thresholds of <25, 25–35, 35–55, and >55, respectively. At 90% sensitivity for HGPC (PHI >40), 40% of biopsies and 31% of Gleason 6 PC diagnoses could have been avoided. AUC and DCA confirmed the benefit of PHI over PSA. The benefit of PHI was also seen at repeat biopsy (n = 397) and for PSA 10–20 ng/ml (n = 439). PHI is effective in cancer risk stratification for both European and Asian men. However, population-specific PHI reference ranges should be used.

The SF‐36v2 and SF‐12v2 health surveys in New Zealand: norms,scoring coefficients and cross‐country comparisons

Objective : To provide New Zealand population norms for version 2 of the SF‐36 and SF‐12 health surveys and report scoring coefficients that enable the construction of Physical and Mental Component Summary scores from New Zealand SF‐36v2 and SF‐12v2 data. Approach : Norms for the SF‐36v2 and scoring coefficients for the Physical and Mental Component Summary scores are estimated using 2006/07 New Zealand Health Survey data, which included 12,488 adults (aged 15 years and over). Norms for the SF‐12v2 are derived from 2008 New Zealand General Social Survey data, including 8,721 adults. Comparisons are made between New Zealand norms for versions 1 and 2 of the SF‐36 instrument. In addition, New Zealand SF‐36v2 and SF‐12v2 norms and the scoring coefficients are compared with those for the United States and South Australia. Conclusion : Differences between: 1) New Zealand population norms for the SF‐36 versions 1 and 2; and 2) SF‐36v2 and SF‐12v2 population norms for New Zealand and those for the United States and South Australia highlight the importance of using version‐specific and country‐specific population norms. Implications: The analysis reported here allows for the appropriate use of the SF‐36v2 and SF‐12v2 instruments in New Zealand.     

The Synthesis of α-MoO3 by Ethylene Glycol

This study investigated the use of ethylene glycol to form α-MoO₃ (molybdenum trioxide) from ammonium molybdate tetrahydrate at various sintering temperatures for 1 h. During the sintering process, the morphologies of the constituents were observed using scanning electron microscopy (SEM), and Fourier transform infrared (FTIR) spectroscopy was used to explain the reaction process. In this work, the results obtained using X-ray photoelectron spectroscopy (XRD) demonstrated that, when the molybdenum trioxide powder was treated thermally at 300 °C, the material exhibited crystallinity. The peaks were indexed to correspond with the (110), (040), (021), (111), and (060) crystallographic planes, and the lattice parameters of a, b, and c were about 3.961, 13.876, and 3.969 Å. Using these observations, we confirmed that orthorhombic α-MoO₃ was formed for sintering temperatures from 300 to 700 °C. Pattern images were obtained by the selected area electron diffraction pattern (SAED) technique, and the d distance of the high resolution transmission electron microscopy (HRTEM) images were almost 0.39 and 0.36 nm, and the Mo 3d_5/2, Mo 3d_3/2, and O 1s of X-ray photoelectron spectroscopy (XPS) were located at 233.76, 237.03, and 532.19 eV, which also demonstrated that α-MoO₃ powder had been synthesized.     

Metal Exposure for Residents Near Diesel Transport Routes

For the past few years, a large number of diesel vehicles carrying gravel and sand have shuttled back and forth every day on the main route (Tai-16 and Tai-21 highways) from Shuili to Shinyi in Nantou County, Taiwan, in support of a river-dredging project. Five stations along Tai-16 and three stations along Tai-21 were selected as the exposure sites. Two very small villages located about 9 and 12 kilometers, respectively, away from the diesel transport routes were selected as the control sites. In this study, five exposure pathways, i.e., ingestion from drinking water, household dust, rice, non-rice dishes, and inhalation from airborne particles, were considered. The daily intake doses of metals varied significantly among the five exposure pathways. There was a significant difference between the exposure and control sites regarding the doses of metals obtained from the exposure pathways of household dust and aerosols. However, regarding the exposure pathways of rice, non-rice dishes, and drinking water, no significant difference between the exposure and the control sites was observed for most metals. Residents who lived within 30 meters of diesel transport roads at the exposure sites were selected as the exposure groups for urine sampling, while residents of the control sites were selected as the control groups. The metal concentrations in the urine of the exposure groups were all higher than those of the control groups. With regards to the urinary metals Fe, Pb, Cu, Ni, and Mo, the levels of urinary metals in residents and the daily intakes of metals from the five exposure pathways showed that the exposure pathways from environmental media (i.e., drinking water, aerosols, and household dust) were a greater factor than food pathways (i.e., rice and non-rice dishes) in the resulting comparative differences between urinary concentration levels of Fe, Pb, Cu, and Mo in exposure groups and control groups. However, the food exposure pathways, rather than the environmental pathways, led to greater comparative differences between the urinary concentration levels of Mn within the two groups.     

Male breast cancer after finasteride therapy for benign prostate hyperplasia

Finasteride has been used for the treatment of benign prostate hyperplasia (BPH) for years, but some side effects, including male breast cancer (MBC), have been reported. We report a case of breast cancer in a male patient who received finasteride therapy for BPH, and to our knowledge, our report is believed to be the first in Taiwan. The patient was a 59-year-old man who received finasteride therapy for BPH for 4 years. He found a palpable mass in his left breast 2 months prior to diagnosis. Ultrasound-guided core biopsy showed invasive ductal carcinoma. A simple mastectomy was performed followed by chemotherapy with tamoxifen.