Waveforms of the ductus venosus blood flow in normal human fetuses aged 8-38 weeks

BACKGROUND

We attempted to establish normal Doppler flow velocity waveform patterns in the human fetal ductus venosus (DV), and also to establish a standardized measurement technique.

METHODS

Ductus venosus blood flow was measured in a prospective study involving 545 fetuses aged between 8 and 38 weeks in utero, the mothers of whom received prenatal care in Kaohsiung Chang Gung Memorial Hospital in a 12-month period in 1998-1999. Several DV hemodynamic parameters were assessed, including peak systolic velocity (DVP), peak systolic/diastolic (S/D) ratio, time-averaged velocity (TAMX), maximum velocity during atrial contraction (DVM), pulsatility index (PI), Pourcelot's resistance index (RI), and fetal heartbeat (FHB).

RESULTS

Technically acceptable ductus venosus blood flow velocity waveform patterns were collected from 490 of 545 pregnant women (89.9%). The mean +/- SD value for the peak systolic DV velocity during the time period of 8 to 38 weeks in utero was 0.33 +/- 0.11 meters/sec (m/s), the TAMX being 0.24 +/- 0.09 m/s. The maximum velocity during atrial contraction was 0.15 +/- 0.09 m/s, and the peak S/D velocity ratio was 2.5 +/- 1.01. The PI, Pourcelot's RI and fetal heart beat were, 0.67(+/- 0.21), 0.64 (+/- 0.11), and 163.3 (+/- 18.82 bpm), respectively. Significant increases in DVP, TAMX, and DVM with advancing gestational age were established, and decreases in PI, RI, S/D, and FHB with advancing gestational age were also observed.

CONCLUSIONS

Further investigation of DV hemodynamics throughout pregnancy may enable a greater understanding of normal placental perfusion, the fetal venous return to the heart and associated cardiac function.

Nonsteroidal anti-inflammatory drugs for treatment of advanced gastric cancer: cyclooxygenase-2 is involved in hepatocyte growth factor mediated tumor development and progression

Surgical treatment of gastric cancer patients is dismal because advanced tumor is often noted at diagnosis. In order to obtain better adjuvant therapy for gastric cancer patients after operation, it is important to understand the mechanism of invasion and metastasis. It is well known that binding of hepatocyte growth factor (HGF) to its receptor (c-Met) regulates gastric cancer progression and metastasis. Recently, HGF was found to up-regulate the expression of cyclooxygenase-2 (COX-2) gene and increase prostaglandin (PG)synthesis in gastric mucosa cells. Over-expression of COX-2 and increased PG secretion have also been found to be involved in the growth and metastasis of gastric cancer. These results together suggest that the signaling pathway of HGF and c-Met may be mediated through ERK2 activation, up-regulation of COX-2 and increased production of PGE(2)in gastric cancer cells. In view of the fact that c-Met is over-expressed in the majority of gastric cancer patients with poor prognosis, COX-2 specific inhibitors may provide beneficial effects in these patients.

Salicylates inhibit flavivirus replication independently of blocking nuclear factor kappa B activation

Flaviviruses comprise a positive-sense RNA genome that replicates exclusively in the cytoplasm of infected cells. Whether flaviviruses require an activated nuclear factor(s) to complete their life cycle and trigger apoptosis in infected cells remains elusive. Flavivirus infections quickly activate nuclear factor kappa B (NF-kappaB), and salicylates have been shown to inhibit NF-kappaB activation. In this study, we investigated whether salicylates suppress flavivirus replication and virus-induced apoptosis in cultured cells. In a dose-dependent inhibition, we found salicylates within a range of 1 to 5 mM not only restricted flavivirus replication but also abrogated flavivirus-triggered apoptosis. However, flavivirus replication was not affected by a specific NF-kappaB peptide inhibitor, SN50, and a proteosome inhibitor, lactacystin. Flaviviruses also replicated and triggered apoptosis in cells stably expressing IkappaBalpha-DeltaN, a dominant-negative mutant that antagonizes NF-kappaB activation, as readily as in wild-type BHK-21 cells, suggesting that NF-kappaB activation is not essential for either flavivirus replication or flavivirus-induced apoptosis. Salicylates still diminished flavivirus replication and blocked apoptosis in the same IkappaBalpha-DeltaN cells. This inhibition of flaviviruses by salicylates could be partially reversed by a specific p38 mitogen-activated protein (MAP) kinase inhibitor, SB203580. Together, these results show that the mechanism by which salicylates suppress flavivirus infection may involve p38 MAP kinase activity but is independent of blocking the NF-kappaB pathway.

[Detection of cytomegalovirus infection in recipients of renal transplantation]

OBJECTIVE

To investigate infection of cytomegalovirus (CMV) in recipients of renal transplantation (RT).

METHODS

167 recipients of RT were screened for the occurrence of CMV infection by using ELISA to test anti-CMV IgG, IgM from serum samples, using immunohistochemistry method to test CMV antigen expression and nest PCR to amplify CMV DNA from blood samples.

RESULTS

Of these samples, 165 and 3 came out positive of IgG and IgM with the positive rate being 98.8% and 1.8% respectively. 79 samples resulted in antigen expression (47.3%) with the average antigen index being (3.2, 3.1)/5, 104 WBC. Besides, 85 samples were found to be positive by nest-PCR with the positive rate being 50.9%.

CONCLUSIONS

The results indicate that the infection of RT so the detection CMV is common in recipients of RT. So detection of CMV-antibody, CMV antigen and CMV DNA after renal transplantation is very important in early diagnosis of CMV infection.

Molecular characterization of Newcastle disease viruses isolated from recent outbreaks in Taiwan

A reverse transcription-polymerase chain reaction (RT-PCR) was described which amplified a portion of the F and HN genes of Newcastle disease virus (NDV) isolated from recent outbreaks in Taiwan. The F protein plays an important role in determining the virulence of NDV strains. Sequencing of a region specifying the F protein cleavage site was therefore undertaken and this verified the correlation between deduced amino sequences and pathogenicity. Analysis of the deduced amino acid sequences of the F protein cleavage site showed that all recent Taiwanese isolates in 1999 were velogenic viruses. All the virulent viruses have the amino acid sequence 112RRQKR116 for the C-terminus of the F2 protein and phenylanine (F) at the N-terminus of the F1 protein, residue 117. A phylogenetic tree based on the nucleotide sequences of the F gene revealed that recent Taiwanese NDV isolates responsible for recent outbreaks were classified into two distant genotypes (VI and VII). Genotype VI virus is the first finding in Taiwan and has a highly genetic similarity to European isolates, suggesting that they might have originated from a common ancestor.

Insulin action and insulin secretion in newly diagnosed type 2 diabetic patients

To clarify the insulin action and insulin secretion in newly diagnosed type 2 diabetic subjects, we investigated insulin and C-peptide response to an oral glucose tolerance test (OGTT) in 15 newly diagnosed type 2 diabetic patients and 17 healthy subjects. For insulin action, we found fasting hyperinsulinemia (8.4 +/- 0.8 vs. 6.0 +/- 0.5 microIU/ml, p = 0.014), higher insulin resistance by homeostasis model assessment (HOMA) (4.33 +/- 0.2 vs. 1.34 +/- 0.1 microIU/ml.mmol/l, p < 0.001), and lower insulin sensitivity index (ISI) (51.0 +/- 0.7 vs. 104.0 +/- 0.8, p < 0.001) in newly diagnosed diabetic patients compared to normal subjects. For insulin secretion, the increments of AUCI (area under curve of insulin) and AUCC-P (area under curve of C-peptide) (increment of AUCI: 26.1 +/- 1.4 vs. 82.8 +/- 4.5 microIU/ml.hour, p < 0.001; increment of AUCC-P: 3.9 +/- 0.2 vs. 11.4 +/- 0.6 ng/ml.hour, p < 0.001), insulin secretion by HOMA model (20.7 +/- 1.2 vs. 79.1 +/- 3.8 IU/mol, p < 0.001), and ratio of 30 min increment of fasting insulin to glucose during OGTT (1.14 +/- 0.1 vs. 13.1 +/- 0.5 IU/mol, p < 0.001) were significantly lower in the newly diagnosed diabetic patients than normal subjects. In addition, body mass index (BMI) in our type 2 diabetes is relatively lower (24 +/- 0.65 kg/m2) than those in western countries. These findings revealed poor insulin action and decreased insulin secretion in relatively less obese Taiwanese with newly diagnosed type 2 diabetes.

Bifunctional effects of heparin-binding protein HBp17 on DNA synthesis in cells

A 17 kD heparin-binding protein (HBp17) has a biphasic dose-dependent effect on DNA synthesis in 3T3 cells. Maximal stimulation of DNA synthesis occurs at 8 ng/ml HBp17, but a half-maximal inhibition occurs at approximately 500 ng/ml. This inhibition can easily be reversed by addition of 400 pg/ml aFGF or 100 pg/ml bFGF, whereas EGF had no effect. This biphasic action of HBp17 was also seen in human umbilical vein endothelial cells (HUVEC), whereas it was not found in the malignant cell line, A431-AJC. The functional relationship between HBp17 and FGF is discussed.

Inhibition of LZIP-mediated transcription through direct interaction with a novel host cell factor-like protein

Host cell factor 1 (HCF-1) is a cellular transcriptional coactivator which coordinates the assembly of enhancer complex through direct interactions with viral and cellular trans-activators such as VP16, Oct-1, LZIP, and GA-binding protein. These interactions are mediated by the beta-propeller domain comprising the first 380 residues of HCF-1 with six kelch repeats. Here we describe the identification and characterization of a novel HCF-like kelch repeat protein, designated HCLP-1. HCLP-1 is a ubiquitously expressed nuclear protein which is composed almost entirely of a six-bladed beta-propeller. HCLP-1 selectively interacts with LZIP but not with VP16. The physical interaction between HCLP-1 and LZIP leads to the repression of the LZIP-dependent transcription. The HCLP-1-binding domain of LZIP maps to residues 109-315, which contain the bZIP DNA-binding motif. Electrophoretic mobility shift assay demonstrates that HCLP-1 indeed interferes with the binding of LZIP to its DNA target. Thus, HCLP-1 serves a transcriptional co-repressor function mediated through its inhibitory interaction with the LZIP transcription factor. Our findings suggest a new mechanism for transcriptional regulation by HCF-like proteins.

[Effect of simulated weightlessness on the apoptosis of thymus cells in tail-suspended mice]

OBJECTIVE

To investigate the effect of simulated weightlessness on apoptosis of thymus cells in mice.

METHOD

Tail-suspended mice were used as an animal model of simulated weightlessness; chromosome breakage was measured by PI staining, and changes of cell membrane were determined by Annexin-V analysis.

RESULT

As compared with the control, there was no obvious chromosome breakage; the total number of apoptotic cells and number of early apoptotic cells increased in 1 d suspended group; the number of early apoptotic cells increased significantly and the total number of apoptotic cells increased very significantly in 2d suspended groups.

CONCLUSION

These results suggested that simulated weightlessness could promote apoptosis of thymus cells.

Cytotoxic neolignans and butanolides from Machilus obovatifolia

From the chloroform-soluble portion of the stem wood of Machilus obovatifolia, one new neolignan, perseal F (1), four known neolignans, perseal G (2), licarin A, licarin B, acuminatin, two butanolides, linderanolide E and isolinderanolide E, two steroids, beta-sitosterol, beta-sitosterol-beta-D-glucoside, and syringaldehyde were isolated. Perseal F (1) and G (2) are neolignans that have a C-1' formyl side chain instead of a propenyl group. Compound 2 was isolated in a mixture with acuminatin. The structure of 2 was identified by comparison with the product formed by the Lemieux-von Rudloff oxidation of licarin B. Two minor oxidative by-products, 2a and 2b, were also obtained. Linderanolide E showed cytotoxicities against P-388, KB16, A549 and HT-29, 1 against P-388, KB16 and HT-29, and isolinderanolide E against P-388, cancer cell lines, respectively. All structures were identified by means of spectroscopic analyses.

IMPACT: image-based physiological artifacts estimation and correction technique for functional MRI

Functional MRI (fMRI) signal variation induced by respiratory and cardiac motion affects the activation signal and limits the accuracy of analysis. Current physiological motion correction methods require either synchronization with external monitoring of respiration and heartbeat, specialized pulse sequence design, or k-space data. The IMage-based Physiological Artifacts estimation and Correction Technique (IMPACT), which is free from these constraints, is described. When images are acquired fast enough to sample physiological motion without aliasing, respiratory and cardiac signals can be directly estimated from magnitude images. Physiological artifacts are removed by reordering images according to the estimated respiratory and cardiac phases and then subtracting the Fourier-fitted variation from magnitude images. Compared with the k-space-based method, this method can efficiently and effectively reduce the overall signal fluctuation in the brain and increase the activated area. With this new technique, physiological artifacts can be reduced using traditional fMRI pulse sequences, and existing data can be corrected and reanalyzed without additional experiments.

In vivo magnetic resonance (MR) study of fatty liver: importance of intracellular ultrastructural alteration for MR tissue parameters change

Fatty liver is thought to have a shorter T1 relaxation time than normal liver tissue, due to the accumulation of triglyceride. Previous studies regarding T1 and T2 relaxation times, however, show widely different results. In order to elucidate the mechanism responsible for the changes and diversity of relaxation times in fatty liver, we created two animal models in 14 rabbits, one acute form (N = 6) and the other chronic form (N = 8). Four rabbits were taken as a control group. Tissue relaxation times and the magnetization transfer (MT) effect of the liver tissue in these two models were measured. The results were correlated with biochemical analysis of water and fat content and histological examination, including findings in light microscopy and electron microscopy. Although the fatty ratio in both forms of fatty liver was similar, their tissue relaxation rate and MT effect were significantly different. The acute form showed prolongation of both T1 and T2 relaxation times (512 +/- 51 msec vs. 710 +/- 95 msec and 39 +/- 1.8 msec vs. 48 +/- 3.7 msec, respectively) and a decrease of the MT effect (50 +/- 5.1% vs. 38 +/- 6.3%), compared to those of the control group and preinduction liver. The chronic form showed shorter T1 and T2 values (526 +/- 36 msec vs. 406 +/- 56 msec and 36 +/- 1.6 msec vs. 33 +/- 2.3 msec, respectively) and a stronger MT effect (21 +/- 0.9% vs. 26 +/- 2.3%). In acute form fatty liver, electron microscopic examination revealed dramatic subcellular changes, such as vesicular transformation, a markedly increased amount of smooth endoplasmic reticulum (SER), and disruption of the crista. These changes were not found in the chronic form fatty liver. From this study, we concluded that the ultrastructural alteration in the subcellular organelles of hepatocyte might play a crucial role for the chameleonic presentation of MR tissue parameters in fatty liver.

Regulation of Ecdysteroid Signaling: Cloning and Characterization of Ecdysone Oxidase

One route of inactivation of ecdysteroids in insects involves ecdysone oxidase-catalyzed conversion into 3-dehydroecdysteroid followed by irreversible reduction by 3-dehydroecdysone 3alpha-reductase to 3-epiecdysone. We have purified from Spodoptera littoralis the first ecdysone oxidase and subjected it to limited amino acid sequencing. A reverse-transcriptase polymerase chain reaction-based approach has been used to clone the cDNA (2.8 kilobases) encoding this 65-kDa protein. Northern blotting showed that the mRNA transcript was expressed in midgut during the prepupal stage of the last larval instar at a time corresponding to an ecdysteroid titer peak. Conceptual translation of the ecdysone oxidase cDNA and data base searching revealed that the enzyme is an FAD flavoprotein that belongs to the glucose-methanol-choline oxidoreductase superfamily. Ecdysone oxidase represents the only oxidase in eukaryotic animals known to catalyze oxygen-dependent oxidation of steroids; by contrast, oxidation of steroids in vertebrates occurs via NAD(P)(+)-linked dehydrogenases. The injection of RH-5992, an ecdysteroid agonist, induced the transcription of ecdysone oxidase, suggesting that ecdysone oxidase is an ecdysteroid-responsive gene. The gene encoding this enzyme, consisting of five exons, has also been isolated. Sequences similar to the binding motifs for Broad-Complex and FTZ-F1 have been found in the 5'-flanking region. Southern blotting indicated that ecdysone oxidase is encoded by a single-copy gene. We have determined the kinetic characteristics of this novel recombinant ecdysone oxidase produced using a baculovirus expression system.

Local thermodynamic stability scores are well represented by a non-central student's t distribution

Local folding in mRNAs is closely associated w ith biological functions. In this study, we reveal the whole distribution of local thermodynamic stability in the complete genome of the poliovirus P3/Leon/37 and the single-stranded RNA sequences that corresponds to the nucleotide sequence of the complete genome sequence (1 667 867 bp) of Helicobacter pylori (H. pylori) strain 26695. Local thermodynamic stability in the RNA sequences is measured by two standard z -scores, significance score and stability score. To estimate the distribution of thermodynamic stability, a model based on the non-central Student's t distribution has been developed. Significant patterns of extremes that are either much more stable or unstable than expected by chance are detected. Our results indicate that the highly stable and statistically more significant folding regions are predominantly in non-coding sequences in the two genome sequences. Moreover, the highly unstable folding regions, on the contrary, are predominantly in the protein coding sequences of H. pylori. The observed differences across the complete genomic sequences are statistically very significant by a chi2-test. These extreme patterns may be useful in searching for target sequences for long-chain antisense RNA and for locating potential RNA functional elements involved in the regulation of gene expression including translation, mRNA localization and metabolism.

Increased nitric oxide production in nasal epithelial cells from allergic patients--RT-PCR analysis and direct imaging by a fluorescence indicator: DAF-2 DA

BACKGROUND

Nitric oxide (NO) is believed to participate in the regulation of airway clearance and non-specific cellular immunity. Recent studies have suggested that airway epithelial cells of allergic and non-allergic individuals may differ in their ability to produce this molecule.

OBJECTIVE

The aim of this study was to detect the difference in NO production in human nasal epithelial cells between normal subjects and patients with perennial allergic rhinitis (AR), and to assess the relationship between the expression of nitric oxide synthase (NOS) isoforms and the severity of the disease.

METHODS

Nasal epithelial cells were obtained from the inferior turbinate. The expression of mRNAs encoding constitutive endothelial NOS (eNOS) and inducible NOS (iNOS) was studied by reverse transcription-polymerase chain reaction (RT-PCR). Direct NO production in living cells was visualized and quantified by a fluorescent indicator, DAF-2 DA.

RESULTS

RT-PCR analysis demonstrated that AR patients with a RAST score of 5 or 6 showed significant increases in the levels of iNOS mRNA and slight reductions in those of eNOS mRNA. Patients with a RAST score of 2-4 also revealed the same tendency however, the difference was not significant. DAF-2 DA imaging demonstrated that epithelial cells, especially the ciliated cells, produced a larger amount of NO than non-epithelial inflammatory cells. Preincubation with L-NAME resulted in an approximate 40% decrease in both groups.

CONCLUSION

These results directly indicate that nasal epithelial cells of AR patients overall produce higher levels of NO through the concomitant expression of different NOS isoforms. Continuous NO production by the epithelial cells in normal subjects further support the hypothesis that NO derived from epithelium may play dual roles in the regulation of nasal airway clearance and in the host defense. In addition, the use of DAF-2 DA provides a reliable method to visualize and quantify the direct NO production of living cells.

On the pyrolysis kinetics of scrap automotive tires

Pyrolysis kinetics of scrap tires of passenger car and truck have been investigated thermogravimetrically under heating rates of 5, 10, 20 and 30K/min and temperature range 373-1273K in nitrogen. The results show that the initial reaction temperatures are 482-521K for the tire of passenger car and 458-511K for truck tire. Both tires exhibit similar behaviors that the initial reaction temperature decreases, but reaction range and reaction rate increase when heating rate is increased. The overall rate equation for each tire can be modeled satisfactorily by a simple one equation from which the kinetic parameters such as the activation energy (E), the pre-exponential factor (A), and the reaction order (n) of unreacted material based on Arrhenius form are determined using Friedman's method. The results show that two tires behave similarly and the average kinetic parameters of two tires are E = 147.95 +/- 0.21kJ/mol, A = (6.295 +/- 1.275)x10(10)min(-1), and n = 1.81 +/- 0.18. The predicted rate equations compare fairly well with the measured data.

Coexistence of tuberculous constrictive pericarditis and right atrial tuberculoma: a case report

Tuberculous constrictive pericarditis is a rare condition with a high mortality rate. The coexistence of constrictive pericarditis and intracardiac tuberculoma has not previously been reported. We report the case of a 65-year-old man presenting with left-side pleural effusion and signs of systemic venous congestion for 2 months. Echocardiography and computerized tomography showed a thickened pericardium and a mass in the right atrium. Pericardiectomy and excision of the right atrial mass were performed. Pathologic examination of the pericardium and the right atrial mass both revealed chronic granulomatous inflammation with acid-fast bacilli and confirmed the diagnosis of tuberculous constrictive pericarditis and right atrial tuberculoma. This case reminds us of the possibility of this type of rare combination of tuberculous constrictive pericarditis and intracardiac right atrial tuberculoma, and the need for complete imaging studies when such cases are encountered.

Asymptomatic arterio-biliary fistula after transarterial chemoembolization of metastatic liver tumors

Arterio-biliary fistula is a rare clinical condition resulting from various causes such as iatrogenic injury and ischemic change of the bile duct. Serious clinical symptoms occur due to the shunting of high-pressure blood from the hepatic artery into the bile duct. Here we report a case of arterio-biliary fistula demonstrated by angiographic examinations. The communication appeared after repeat transarterial chemoembolization of metastatic liver tumors. The interesting point of this case was that the patient did not have any obvious clinical symptoms related to the fistula. The mechanisms responsible for this rare manifestation are discussed.

Thrombolysis effect with FIIa from Agkistrodon acutus venom in different thrombosis model

AIM

A fibrinolytic enzyme from Agkistrodon acutus venom, called FIIa, was tested for thrombolytic activity in animals.

METHODS

Carotid thrombosis model in rats and rabbits and middle cerebral artery (MCA) thrombosis model in rats were used.

RESULTS

Intravenous administration of FIIa, at a dosage of 0.625 mg/kg, resulted in thrombolysis of carotid thrombi. However, in middle cerebral artery thrombosis, the effective thrombolysis dose was 1.25 mg/kg. When the dosage of FIIa increased, the thrombolytic effect was stronger. Histological examination of kidney, liver, heart, and lung tissue showed no hemorrhage.

CONCLUSION

It shows that FIIa from Agkistrodon acutus venom is able to solubilize thrombus in vivo without hemorrhage at an effective dose for thrombolysis.

Minimal change nephrotic syndrome in children with intrauterine growth retardation

It has been well established that intrauterine growth retardation (IUGR) is associated with greater morbidity and mortality rates during perinatal and adult life. The aim of this study is to clarify whether IUGR, defined as a birth weight less than the 10th percentile for gestational age, influences the clinical course of minimal change nephrotic syndrome (MCNS) in children. The study included 50 children aged 1 to 13 years at the onset of MCNS. The diagnosis of MCNS was confirmed by renal biopsy in 25 children (50%). Eight children (16%) had IUGR at birth. Comparisons between children with and without IUGR showed significant differences in mean number of relapses (13.0 +/- 3.5 versus 3.4 +/- 3.0 relapses; P < 0.0001) and relapse rates (relapses per year, 1.6 +/- 0.3 versus 0.5 +/- 0.4; P < 0.0001). We also observed a greater incidence of steroid dependence (100% versus 21.4%; P < 0.001) in children with than without IUGR. In addition, children with IUGR underwent treatment with cytotoxic agents and cyclosporine more frequently than those without IUGR. There was a significantly greater incidence of complications and concomitant diseases of nephrotic syndrome in children with IUGR; results show that MCNS in children with IUGR had a more unfavorable course and outcome. It is important for clinicians to be aware that IUGR may help in the early identification of children at greater risk for frequent relapses and the development of steroid dependence and/or steroid resistance. More aggressive therapy may be indicated for these children.

Review of telemedicine projects in Taiwan

Taiwan is a heavily populated country, with a small land area and many mountains and isolated islands. Because medical resources are unequally distributed, high quality accessible medical care is a major problem in rural areas. Medical personnel are unwilling to practice in rural areas because of fear of isolation from peers and lack of continuing medical education (CME) in those areas. Telemedicine provides a timeless and spaceless measure for teleconsultation and education. The development of telemedicine in Taiwan began under the National Information Infrastructure (NII) Project. Distance education and teleconsultation were the first experimental projects during the initiation research stage. The cost and effectiveness of the hardware and network bandwidth were evaluated. In the promotion research stage, applications in different medical disciplines were tested to promote multipoint videoconference, electronic journals and VOD. Investigation of user satisfaction put on more emphasis on improving application functions. In 1998, a new Cyber Medical Center (CMC) international collaboration project was begun, integrating technologies of multimedia, networking, database management, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the web. A Taiwan mirror site of Virtual Hospital and two international telemedicine trials through Next Generation Internet (NGI) were done at the end of 1998. In the future, telemedicine systems in Taiwan are expected to combine the Internet and broadband CATV, ADSL, and DBS networking to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend to every household.