Transmission of Seasonal Outbreak of Childhood Enteroviral Aseptic Meningitis and Hand-foot-mouth Disease

This study was conducted to evaluate the modes of transmission of aseptic meningitis (AM) and hand-foot-mouth disease (HFMD) using a case-control and a case-crossover design. We recruited 205 childhood AM and 116 HFMD cases and 170 non-enteroviral disease controls from three general hospitals in Gyeongju, Pohang, and Seoul between May and August in both 2002 and 2003. For the case-crossover design, we established the hazard and non-hazard periods as week one and week four before admission, respectively. In the case-control design, drinking water that had not been boiled, not using a water purifier, changes in water quality, and contact with AM patients were significantly associated with the risk of AM (odds ratio [OR]=2.8, 2.9, 4.6, and 10.9, respectively), while drinking water that had not been boiled, having a non-water closet toilet, changes in water quality, and contact with HFMD patients were associated with risk of HFMD (OR=3.3, 2.8, 6.9, and 5.0, respectively). In the case-crossover design, many life-style variables such as contact with AM or HFMD patients, visiting a hospital, changes in water quality, presence of a skin wound, eating out, and going shopping were significantly associated with the risk of AM (OR=18.0, 7.0, 8.0, 2.2, 22.3, and 3.0, respectively) and HFMD (OR=9.0, 37.0, 11.0, 12.0, 37.0, and 5.0, respectively). Our findings suggest that person-to-person contact and contaminated water could be the principal modes of transmission of AM and HFMD

A Window into the Early–Middle Stone Age Transition in Northeastern Africa—A Marine Isotope Stage 7a/6 Late Acheulean Horizon from the EDAR 135 Site, Eastern Sahara (Sudan)

This paper presents the results of the analysis of a late Acheulean horizon from the EDAR 135 site, which was discovered in the Eastern Desert, Sudan, in an area heavily transformed by modern mining activity. A lithic assemblage was discovered there, within a layer of gravel sediments formed by a paleostream in a humid period of the Middle Pleistocene. This layer is OSL dated between 220 ± 12 and 145 ± 20 ka (MIS 7a/6). These dates indicate that the assemblage could be the youngest trace of the Acheulean in northeastern Africa. Technological analysis of the lithics reveals different core reduction strategies, including not only ad hoc ones based on multiplatform cores, but also discoidal and prepared cores. The use of prepared core reduction methods has already been confirmed at other Late Acheulean sites in Africa and the Middle East. Microwear traces observed on lithic artifacts could relate to on-site butchering activities

The Middle Stone Age in the Eastern Desert. EDAR 135 — a buried early MIS 5 horizon from Sudan

Middle Stone Age (MSA) lithic artefacts coming from dated layers preserved in their original stratigraphic position are still rare in Northeast Africa in general and in Sudan in particular. This paper aims to present the results of technological and functional analyses of an assemblage coming from a stratigraphic context, i.e. the upper level of the EDAR (Eastern Desert – Atbara River) 135 site, discovered in an abandoned gold mining pit in the Sudanese Eastern Desert, approximately 70 km east of the town of Atbara. The assemblage, which is based on locally available quartz and rhyolite, comes from a layer bracketed by OSL dates of 116 ± 13 and 125 ± 11 kya. Such dating places it within Marine Isotope Stage 5e–5d. Analysis of the assemblage revealed several characteristics that seem to set it apart from other MSA Northeast African inventories. Among these, the dominance of simple, non-predetermined core reduction strategies and expedient tool types, coupled with the lack of traces of Nubian Levallois technique, are the most conspicuous. Micro-traces of use on animal and plant matter were preserved on some of the tools. EDAR 135 is part of a newly discovered complex of sites that confirms the presence of Middle and Late Pleistocene hominins along one of the possible routes out of Africa towards Eurasia.publishedVersio

A Mismatched Piece in a Cultural Middle Stone Age Puzzle: Traces of Human Activity Dated to 90 kya (MIS 5) at Sites EDAR 134 and 155 in the Eastern Sahara, Sudan

This article presents the results of research carried out at two previously unreported Eastern Desert Atbara River project (EDAR) Middle Stone Age (MSA) sites—EDAR 134 and EDAR 155. Luminescence dating results indicate human activity in this area during the Marine Isotope Stage 5 period (MIS 5), approximately 90 kya. Discussion concerning the affiliation of both analyzed inventories will be provided, including another MSA site from the EDAR area, where an assemblage dated to MIS 6/5e does not have technological features known from other technocomplexes in the eastern Sahara region (EDAR 135). Microscopic analysis of traces of tool use for the EDAR 155 assemblage shows the high impact of post-depositional (aeolian) processes on the state of preservation of lithic material. Sites EDAR 134 and 155 provide evidence for hominin activity during the late Pleistocene within an area only episodically accessible, due to arid conditions prevailing in the Saharan deserts

Beneficial and Adverse Effects of Bosentan Treatment in Korean Patients With Pulmonary Artery Hypertension

Background and Objectives: The purpose of this study was to investigate 1) the beneficial effect of bosentan treatment (125 mg twice daily) on exercise capacity and echocardiographic variables and 2) the profiles and frequency of adverse events in Korean patients with World Health Organization (WHO) class III or IV pulmonary artery hypertension (PAH). Subjects and Methods: Twelve patients who received bosentan treatment were investigated in an open label manner. One patient was excluded in the final analyses due to a prohibited concomitant medication. A 6-minute walk test and echocardiography were performed at baseline and after 12 weeks of treatment. Results: The administration of bosentan for 12 weeks resulted in a significant improvement in exercise capacity (measured with the 6-minute walking distance), WHO functional capacity, and in echocardiographic variables. Bosentan treatment was associated with a decrease in the maximal tricuspid regurgitation jet velocity {from 4.7 m/sec (95% confidence interval, 3.89-5.45) at baseline to 4.4 m/sec (95% confidence interval, 3.61-5.1) at 12 weeks, p=0.03} and systolic pulmonary arterial pressure {from 105 mmHg (95% confidence interval, 74.4-135.6) at baseline to 93 mmHg (95% confidence interval, 66.3-120.1) at 12 weeks, p=0.04}. Treatment with bosentan at a dose of 125 mg twice a day was not associated with life-threatening side effects, although a higher incidence of elevated liver enzymes compared to previous studies was noted. Conclusion: Bosentan at a dose of 125 mg twice daily is considered a clinically optimal, safe dose and can be used as a valuable treatment option in Korean PAH patients with WHO functional capacity III or IV, though close monitoring of liver function is required. Copyright �� 2009 The Korean Society of Cardiology

Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations

OBJECTIVES: This study sought to investigate the incidence and identify the predictors of significant tricuspid regurgitation (TR) development long after left-sided valve surgery. METHODS: Of 615 patients who underwent surgery for left-sided valve disease between 1992 and 1995, 335 patients without significant TR who completed at least 5 years of clinical and echocardiographic follow-up were enrolled. Late significant TR development was assessed by echocardiography with a mean follow-up duration of 11.6 +/- 2.1 years. RESULTS: Significant late TR was found in 90 patients (26.9%). Patients with late TR showed an advanced age (47.6 +/- 13.4 vs 44.3 +/- 13.2 years, P = .04), a higher prevalence of preoperative atrial fibrillation (83.3 vs 46.5%, P < .001), a greater left atrial dimension (56.9 +/- 13.2 vs 52.4 +/- 11.5 mm, P = .006), and a higher prevalence of prior valve surgery (40.0 vs 25.3%, P = .01). In addition, late TR occurred more frequently in patients who had undergone mitral valve surgery than in those who did not (93.3 vs 72.2%, P < .001). However, multivariate analysis showed that the presence of preoperative atrial fibrillation (odds ratio 5.37; 95% CI 2.71-10.65; P < .001) was the only independent factor of late TR development. Patients who developed late TR had a lower event-free survival rate than those who did not (P = .03). CONCLUSIONS: The development of significant TR long after left-sided valve surgery is not uncommon with an estimated incidence of 27% and is closely associated with a poor prognosis. The presence of preoperative atrial fibrillation was identified as the only independent predictor of the development of late TR