We appreciate the thoughtful comments from Chiang et al 1 and Chang et al 2 regarding the methodologies of our study. 3 The study has limitations inherent in the retrospective cohort design. However, for this topic, we believed this design was pretty suitable because a prospective study is not feasible. Minimizing possible bias by optimizing the study method is vital. However, the modification of methodology was a trade-off. In general, we agreed most points in the two letters. Nevertheless, further analyses were not possible because the study project has already ended in 2020.The first important concern was the imbalance between the antihistamine (AH) users and matched non-AH users, especially in some important factors, including liver cirrhosis and the use of nonsteroidal antiinflammatory drug, aspirin, statin, and antiviral agents. 4 Correcting these confounding factors is critical to clarify the effect of AH on the risk of hepatocellular carcinoma (HCC). Thus, these factors were carefully identified and analyzed in our analysis. Two methods were designed initially to minimize the effects of these factors: (1) matching exhaustively, as suggested in the two letters and (2) adjust these factors statistically. The first method would be straighter; however, there was a . 50% reduction in study population when only age and sex were matched. If all these factors were matched, the population would be too small to investigate an end point with a low incidence rate. Therefore, these factors were not included in matching but were adjusted in the multivariate Cox regression model instead. The imbalance of these factors would indeed influence the incidence rate ratio, but their effects on the adjusted hazard ratios of AH would be greatly minimized in the multivariate Cox regression model. Moreover, a dose-dependent effect of AH use was shown in this study. Thus, we believed our finding reliable.

Background: Septic arthritis remains a challenging diagnosis in which the doctor often relies on laboratory tests. Objective: To examine the diagnostic utility of three ancillary tests-namely, white blood cells (WBC), erythrocyte sedimentation rate (ESR) and the WBC in the joint fluid (jWBC)-using likelihood ratios (LRs) and receiver operating characteristic (ROC) curves. Methods: This was a retrospective cohort study at the Jacobi Medical Center. Medical charts of patients who had undergone arthrocentesis were included. Patients who had ''dry taps'' were excluded from the study. Patients were considered to have septic arthritis if they had a positive arthrocentesis culture or operative findings. The primary outcomes of this study were the sensitivities, specificities, LR(+) and LR(2) values of the laboratory tests for septic arthritis. The performance characteristics of the laboratory tests were analysed using ROC curves. Results: 156 patients were enrolled, 16 (10%) had septic arthritis. The sensitivities for WBC, ESR and jWBC were 0.75, 0.75 and 0.50, and the specificities were 0.55, 0.11 and 0.88, respectively. The LR(+) values were 1.7, 0.84 and 4.0, and the LR(2) values were 0.46, 2.4 and 0.57, respectively. In ROC curve analysis, jWBC was the best test (area under the curve (AUC) 0.75, 95% confidence interval (CI) 0.58 to 0.92), followed by WBC (AUC 0.69, 95% CI 0.57 to 0.80) and ESR (AUC 0.55, 95% CI 0.37 to 0.74). A cut-off of jWBC = 17 500 maximised sensitivity and specificity on the ROC curve. Conclusions: jWBC was the best diagnostic test for septic arthritis, WBC and ESR were poor tests. However, no test was diagnostic, and the clinician must be careful with patients with a potential septic joint.

ZFP36 family members include ZFP36, ZFP36L1, and ZFP36L2, which belong to CCCH-type zinc finger proteins with two tandem zinc finger (TZF) regions. Whether ZFP36L1 and ZFP36L2 have antiproliferative activities similar to that of ZFP36 is unclear. In this study, when ZFP36L1 or ZFP36L2 was overexpressed in T-REx-293 cells, cell proliferation was dramatically inhibited and the cell cycle was arrested at the G1 phase. The levels of cell-cycle-related proteins, including cyclin B, cyclin D, cyclin A, and p21, decreased; however, p53 increased in ZFP36L1-or ZFP36L2-overexpressing T-REx-293 cells. Forced expression of ZFP36L1 or ZFP36L2 also inhibited cell proliferation and cyclin D gene expression in three human colorectal cancer cell lines: HCT116 p53+/+, HCT116 p53−/−, and SW620 (mutated p53) cells. However, it increased p53 and p21 expression only in HCT116 p53+/+ cells. Knockdown of ZFP36L1 or ZFP36L2 increased cell proliferation and cyclin D expression; furthermore, the mutation of the TZF of ZFP36L1 or ZFP36L2 caused them to lose their antiproliferative ability, to the extent that they could not inhibit cyclin D expression in these three cell lines. The results indicated that ZFP36L1 and ZFP36L2 play a negative role in cell proliferation; the underlying mechanisms might be mediated through a cyclin D-dependent and p53-independent pathway.

Studies on the clinical efficacy of influenza vaccination on patients with systemic lupus erythematosus (SLE) are scant. The present study compared the incidence of hospitalization, morbidity, and mortality in patients with SLE between cohorts with and without influenza vaccination. We used the Taiwan’s insurance claims data between 2001 and 2012 for identifying annual adult patients with SLE with (N = 1765) and without (N = 8360) influenza vaccination. The incidence rate ratio and hazard ratio (HR) for morbidities and mortality were measured for the vaccine and nonvaccine cohorts. The vaccine cohort had a lower hospitalization rate than did the nonvaccine cohort, with an adjusted HR of 0.82 (95% CI 0.73–0.92). Furthermore, the vaccine cohort was less likely to be admitted to the intensive care unit [adjusted HR 0.55 (95% CI 0.39–0.79)], to be hospitalized for septicemia, bacteremia, or viremia [adjusted HR 0.48 (95% CI 0.32–0.73)], to undergo in-hospital dialysis [adjusted HR 0.40 (95% CI 0.20–0.81)], and were less predisposed to death [adjusted HR 0.41 (95% CI 0.27–0.61)]. In conclusion, influenza vaccination in patients with SLE is associated with a reduced risk of morbidity and mortality.

A bilateral extended scapular (scapular-parascapular) free flap was used in five patients with severe facial burn sequelae for complete resurfacing of the face with the exception of the nose, which was reconstructed in a separate operative procedure. All the flaps survived. Four were utilized for complete face resurfacing and one for neck and partial face resurfacing. The results were classified subjectively according to both patient and surgeon opinion. Good to fair results were obtained. The authors believe that this method might be further explored to obtain better results in these difficult cases.

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Current use of proton pump inhibitors is associated with a greater risk of pyogenic liver abscess.

There was no strong association between patient prognosis and FBXW7 mutations in our large-scale study.