Corneal decompensation and graft failure secondary to a broken posterior chamber poly(methyl methacrylate) intraocular lens haptic

A 66-year-old man developed an unexplained corneal decompensation 7 years after extracapsular cataract extraction and implantation of a single-piece poly(methyl methacrylate) (PMMA) posterior chamber intraocular lens (IOL). He had penetrating keratoplasty (PKP). Two years later, he developed corneal graft failure secondary to an IOL haptic fragment in the anterior chamber angle. The patient had a repeat corneal graft and IOL exchange. The broken haptic was examined with scanning electron microscopy. The findings were consistent with late fracture of the haptic within the capsular bag, which was presumably weakened by an improper implantation technique. Fracture of a PMMA haptic should be suspected as a cause of corneal decompensation and corneal graft failure after cataract surgery. This case emphasizes the importance of safe implantation techniques.

Functional magnetic resonance imaging of the visual system

Functional magnetic resonance imaging (fMRI), which is a technique useful for non-invasive mapping of brain function, is well suited for studying the visual system. This review highlights current clinical applications and research studies involving patients with visual deficits. Relevant reports regarding the investigation of the brain's role in visual processing and some newer fMRI techniques are also reviewed. Functional magnetic resonance imaging has been used for presurgical mapping of visual cortex in patients with brain lesions and for studying patients with amblyopia, optic neuritis, and residual vision in homonymous hemianopia. Retinotopic borders, motion processing, and visual attention have been the topics of several fMRI studies. These reports suggest that fMRI can be useful in clinical and research studies in patients with visual deficits.

[Study on high-efficiency gene transfer of pseudotyped HIV vector]

OBJECTIVE

To investigate the high-efficiency of pseudotyped HIV as gene transfer vector.

METHODS

Three plasmids of pseudotyped HIV gene transfer vector system were transferred into packaging cell line 293T by Ca3 (PO4)2 precipitation method. GFP (Green Fluorescence Protein) or HSV-tk gene was constructed in the plasmid pHR'CS respectively (pHR'CS.GFP or pHR'CS.HSV-tk). The pseudotyped HIV particles were observed through electronic microscopy and were measured through spectrofluorophotometer. High titer pseudotyped HIV was harvested from volume of virus-producing cell supernatant and concentrated. Ovarian epithelial cancer cell line SKOV3 and normal human gingival fibroblast cell GF were infected by pseudotyped HIV. PCR and RT-PCR were resorted to demonstrate the successful transduction and transcription of the HSV-tk gene. After administration of GCV, the changes of those cells and apoptosis were observed through optical microscopy. The cytotoxicity efficacy of HSV-tk/GCV system was evaluated by MTT method. The growth inhibition rate (GIR) of cells and inhibition concentration 50 (IC50) were counted.

RESULTS

The above plasmids were effectively transferred into 293T cell. A lot of pseudotyped HIV particles were observed through electronic microscopy. The virus supernatant had a high absorbing value at 510 nm through spectrofluorophotometer, which proved the existence of virus. After pseudotyped HIV infection, SKOV3 and GF had remarkable infection rate. 600 bp strand was seen through PCR and RT-PCR. Changes and apoptosis of cells followed by administration of GCV were observed. The MTT method showed that the cytotoxicity efficacy of GCV was high to SKOV3 and GF cell.

CONCLUSIONS

The pseudotyped HIV is a high-efficiency gene transfer vector.

Effect of genotoxic exposure to chromium among electroplating workers in Taiwan

The objective of this study was to investigate the association between chromium (Cr) concentrations and sister chromatid exchanges (SCE) formation in Cr workers and to assess the effects of susceptible genes (glutathione S-transferase M1 and T1) on the frequency of deletion and SCE/cell. Urinary Cr concentration was significantly elevated in Cr workers (3.67 +/- 3.89 microg/g creatinine) compared to control group (1.21 +/- 1.16 microg/g creatinine, P < 0.01). There was also a significant difference of superoxide dismutase (SOD) levels between Cr workers (6.86 +/- 0.80 U/mg Hb) and controls (7.16 +/- 0.53 U/mg Hb, P < 0.01). The frequencies of SCE and high frequency cells (HFC) were significantly correlated with smoking habits and with duration of exposure to Cr. A significantly higher percentage (50%) of Cr workers had both the null GSTM1 and GSTT1 genotype as compared to 10% of the controls (P < 0.01). However, the chromosomal DNA damage effect of GSTM1 and GSTT1 genotypes, individually or in combination, was not revealed in Cr exposed workers.

Distribution of enantiomers of trans-tramadol and trans-O-demethyltramadol in central nervous system of rats

AIM

To investigate the distribution of the enantiomers of trans-tramadol (trans-T) and its active metabolite, trans-O-demethyltramadol (M1), in the central nervous system (CNS).

METHODS

After a single ip dose of trans-T hydrochloride or M1, the rats were killed by decapitation. A high performance capillary electrophoresis (HPCE) method was used to determine the concentrations of enantiomers of trans-T and M1 in the serum and different brain tissues, including cerebrospinal fluid (CF), cerebral cortex (CC), corpus striatum (CS), hypothalamus (HY), cerebellum (CE), and medulla oblongata (MO).

RESULTS

After ip trans-T hydrochloride, the concentrations of (+)-trans-T were higher than those of (-)-trans-T in the serum and all tested brain tissues; The concentrations of (+)-M1 were lower than those of (-)-M1 in the all tested brain tissues; The concentrations of the enantiomers of trans-T and M1 were the highest in the CC, the lowest in the CF. After ip M1, the concentrations of (+)-M1 were higher than those of (-)-M1 in the serum and all tested brain tissues; The concentrations of the enantiomers of M1 were the highest in the CC, the lowest in the CF.

CONCLUSION

The concentrations of the enantiomers of trans-T and M1 varied in the serum and different brain tissues. The distribution of trans-T and M1 in the CNS of rats was stereoselective. The stereoselectivity in the distribution of M1 after M1 injection was different with that after trans-T injection.

Functional magnetic resonance imaging of eye dominance at 4 tesla

We studied eye dominance in visual cortex and lateral geniculate nucleus (LGN) using functional magnetic resonance imaging (fMRI) at a very high magnetic field (4 tesla). Eight normal volunteers were studied with fMRI at 4 tesla during alternating monocular visual stimulation. The acquisition was repeated twice in 4 subjects to confirm reproducibility. In addition, magnetic resonance signal intensities during three conditions (right eye stimulation, left eye stimulation, and control condition) were compared to determine whether the observed area was truly or relatively monocular in 2 subjects. In both the individual and group analyses, the anterior striate cortex was consistently activated by the contralateral eye more than the ipsilateral eye. Additionally, we found evidence that there were areas in the bilateral LGN which were more active during the stimulation of the contralateral eye than during the stimulation of the ipsilateral eye. The activated areas were reproducible, and the mean ratio of the overlapping area was 0.71 for the repeated scans. The additional experiment revealed that the area in the anterior visual cortex could be divided into two parts, one truly monocular and the other relatively monocular. Our finding confirmed previous fMRI results at 1.5 tesla showing that eye dominance was observed in the contralateral anterior visual cortex. However, the eye dominance in the visual cortex was found not only in the most anterior area corresponding to the monocular temporal crescent but also in the more posterior area, presumably showing the greater sensitivity of the temporal visual field (nasal retina) as compared with the nasal visual field (temporal retina) in the peripheral visual field (peripheral retina). In addition, it is suggested that the nasotemporal asymmetry of the retina and the visual fields is represented in the LGN as well as in the visual cortex.

Hepatic Schistosomiasis japonica in a patient with gallstones and bile duct stones--a case report

Schistosomiasis, a common parasitic disease in many countries, is found as imported cases in Taiwan. Responsible for human infections are five species, one of which, Schistosoma japonicum, is currently endemic in China and South-east Asia. Chronic infection with S. japonicum may lead to the development of liver fibrosis, calcification and portal hypertension. Under investigation by sonography and computed tomography (CT) scan, a peculiar "turtle-back" appearance of liver fibrosis and calcification may be found. Herein, we report a case referred to our department due to jaundice. The sonography of liver showed typical "turtle-back" appearance. Gallstones and bile duct stones were also found in this case. Surgical interventions with percutaneous transhepatic biliary drainage (PTBD), cholecystectomy and choledocholithotomy were performed to relieve the obstructive jaundice and remove the stones. There were no parasitic eggs in the extracted stones or in drained bile juice. However, deposits of calcified S. japonicum eggs in liver parenchyma and portal tracts were identified in liver biopsy. No special treatment was given for the schistosomiasis japonica because the calcified parasitic eggs were the sequelae of past infection.

Hypospadias repair using a double onlay preputial flap

From an anatomical view, a more reasonable blood supply can be achieved in hypospadias repair using a double-faced onlay flap. A urethroplasty was performed in 15 patients with middle or posterior hypospadias using a double-faced onlay preputial flap (DOPF). In this method, the urethral plate is preserved and a double-faced preputial flap is developed. The inner face of the flap is sutured to the urethral plate to create the neourethra and the outer face together with the rest of the dorsal prepuce is used for ventral skin coverage. Postoperative complications occurred in 2 patients: 1 developed a fistula in the subcoronal region and 1 had dorsal skin necrosis and suture disruption of the glanular wings. The overall complication rate was 13%. The DOPF provides a well-vascularized ventral skin cover and reduces the area of avascular dorsal skin. The viability of the neourethra can be evaluated by simply looking at the outer face of the flap. However, the complication rate is similar to that of other techniques.

Self-focusing and frequency broadening of an intense short-pulse laser in plasmas

An intense ultrafast laser pulse propagating through a plasma undergoes self-focusing and self-phase-modulation as a result of relativistic mass nonlinearity. The inclusion of a quartic (r4) term in the expansion of the eikonal in the radial coordinate r allows the modification of the shape of the radial intensity profile. The front of the pulse, under the combined effects of time-dependent self-focusing and frequency downshifting, acquires a severely distorted temporal shape. The radial profile for I(lambda)2(mu) < 2.8 x 1018 W/cm2, where I is the axial laser intensity and lambda(mu), is the laser wavelength in micrometers, is transformed from a Gaussian to a super-Gaussian because of the faster convergence of the marginal rays than the paraxial rays. In the opposite case of I(lambda)(2)(mu) > 2.8 x 10(18) W/cm2 when nonlinear plasma permittivity approaches saturation, the radial profile in the axial region becomes broader than the Gaussian.

Diagnosis of Helicobacter pylori infection by stool antigen test in southern Taiwan

Helicobacter pylori (H. pylori) has been found to be associated with various gastrointestinal diseases. Confirmation of H. pylori infection includes invasive and non-invasive methods. There has been increasing interest in noninvasive tests recently. However, the geographical differences among H. pylori strains have been emphasized recently and the H. pylori strain in Taiwan showed a high cagA positive result and different vacA subtype when compared with those of Western countries. The aim of this study is to access and compare the reliability and the diagnostic accuracy of the stool H. pylori antigen tests by spectrophotometry and by the visual method, especially in Southern Taiwan. Thirty-two patients (18 men and 14 women; age range: 23-91 y/o, mean: 50.5 y/o) who underwent gastroendoscopy at Kaohsiung Medical University Hospital were enrolled in this study. H. pylori infection status was confirmed by culture or two positive test results on CLO test, histology and 13C-urea breath test (13C-UBT). The exclusion criteria included previous gastrointestinal tract surgery, use of antibiotics, proton pump inhibitor or compounds containing bismuth within 1 month of the study. Among them, 14 patients were with duodenal ulcer (DU), 4 with gastric ulcer (GU), 12 with non-ulcer dyspepsia, and 2 with GU and DU. Those patients had their stool collected for ELISA tests of H. pylori stool antigen (HpSA). The HpSA tests were positive in 16 of 18 patients diagnosed as H. pylori positive, and negative in 13 of 14 patients as H. pylori negative. The sensitivity and specificity were 88.9% and 92.9% respectively. The positive and negative predictive values were 94.1% and 86.7% respectively. The concordance of HpSA accessed by spectrophotometry and visual method is 100%, which makes this test even easier and cheaper. We concluded that stool HpSA test is a noninvasive, accurate, reliable, rapid and easy way to diagnose H. pylori infection in Southern Taiwan, either by spectrophotometry or by visual assessment.

Structure formation and tearing of an MeV cylindrical electron beam in a laser-produced plasma

The stability of a cylindrical, solid hot electron beam propagating in a high density plasma has been studied using a two-dimensional, hybrid Darwin code. The initially solid beam evolves into a hollow, annular beam due to the Weibel instability and generates strong magnetic fields on both sides of the annular ring. The annular structure subsequently breaks up into several beamlets via a mechanism similar to a tearing instability. It is found that the magnetic fields parallel to the direction of beam propagation also grow due to the tearing process.

Evaluation of an office-based urine test for detecting Helicobacter pylori: a Prospective Pilot Study

BACKGROUND/AIMS

To ascertain the reliability of a newly developed office-based urine test, the RAPIRUN test, used for detection of H. pylori infection.

METHODOLOGY

Urine specimens from 142 consecutive patients undergoing gastroendoscopy (77 men, 65 women; mean 52.0 years) were tested with RAPIRUN at the same time. The total reaction time for the urine test is 20 min. None of the patients had received any H. pylori eradicating treatment. The H. pylori status was evaluated based on 5 different tests: culture, histology, biopsy urease test, 13C-urea breath test, and the RAPIRUN test. A commercial office-based kit using an immunochromatographic technique was used to examine urine samples for H. pylori antibody. H. pylori status was defined as positive when the culture was positive or if 2 of the other 3 tests (histology, biopsy urease test, and 13C-urea breath test were positive.

RESULTS

Of 93 patients with H. pylori infection, 88 were tested as positive by RAPIRUN (sensitivity 94.6%). Of 48 patients without infection, 43 were found to be negative by RAPIRUN (specificity 89.6%). One case with an invalid urine test was excluded.

CONCLUSIONS

This urine test is a rapid, inexpensive, reliable and easy-to-use tool for the diagnosis of H. pylori infection in untreated patients. It can be used for mass screening of patients' H. pylori status, particularly in children, postgastrectomy patients, uncooperative patients, and patients undergoing bismuth or proton pump inhibitor treatment.

Multidimensional high performance liquid chromatography - capillary electrophoresis separation of a protein digest: An update

The trypsin digest of a mixture of two proteins, namely cytochrome c and myoglobin, was first separated in the first dimension by high-performance liquid chromatography (HPLC). Fractions from the HPLC were collected every 30s with the aid of a fraction collector into a 96-well microtiter plate. After concentration, all the collected fractions were analyzed simultaneaosly in the second dimension by a 96-array capillary electrophoresis system. The labeled peptides were detected by laser-induced fluorescence. An internal standard, allura red, was added to all the fractions, prior to capillary electrophoretic analysis. The internal standard serves two functions, migration time correction and signal intensity correction. The data are presented in two different formats, as an electropherogram of all the fractions and in a two-dimensional (2-D) format. The 2-D plot of the data shows the density of each spot, which corresponds to the concentration of the migrating peptides. The total experimental time for the HPLC and capillary electrophoretic analyses ist less than 1 h, which ist much faster than using 2-D slab-gel electrophoresis or single-capillary capillary electrophoresis.

Biomarkers of DNA damage in patients with end-stage renal disease: mitochondrial DNA mutation in hair follicles

BACKGROUND

DNA damage was noted in patients with end-stage renal disease (ESRD). Mitochondrial DNA (mtDNA) mutations have been proposed as a genomic biomarker in the process of human ageing, degenerative diseases and carcinogenesis.

METHODS

Polymerase chain reaction (PCR) techniques were applied to detect mtDNA deletions in hair follicles, an appendage of skin, from 162 patients with ESRD.

RESULTS

The incidences of the 4977 bp deletion of mtDNA in hair follicles were found to increase with age in normal control and ESRD patients. As compared with normal subjects, ESRD patients had 3.5, 2.3, 2.7, 2.3 and 1.4 times higher incidences of the 4977 bp deletion of mtDNA in the age groups of 20-30, 31-40, 41-50, 51-60 and 61-70 years, respectively. Moreover, the difference in the proportion of mtDNA with the 4977 bp deletion was statistically significant between ESRD patients and normal subjects >50 years of age.

CONCLUSION

We suggest that the 4977 bp deletion of mtDNA in hair follicles may serve as one of the tissue biomarkers of genetic instability of the mitochondrial genome in ESRD patients.

The growth effects of gamma-ray irradiation on third-stage larvae of Angiostrongylus cantonensis in snail

In order to clarify growth effects of gamma-ray irradiation on the third-stage larvae of Angiostrongylus cantonensis, snails naturally infected with larvae of A. cantonensis were irradiated with a cobalt-60 source, and the total dosage of exposure was 0.1 kGy. Third-stage larvae were collected from each group of irradiated and non-irradiated snails and then administered to rats. A significant reduction was observed in the number of recovery worms from rats sacrificed at 45 days after infection compared with the control group. Moreover, there was an increase in the percentage of female worms, and the body length of the irradiated group's worms was significantly shorter than that of the control group. In ultrastructural observations by transmission electron microscope, the cuticle was thickened and the subcuticle showed partial vacuolization and separation from muscle in the irradiated group. In addition, the muscles myofibril became shorter, the microvilli of intestinal mucosa were shorter and irregular, the terminal web disappeared, and the phagocytic vesicles, mitochondria, lysosomes and secretion granules decreased in number, respectively. Focusing on the mitochondria of the epithelial cells of the intestine, there were degenerative changes in the irradiated group showing vacuolization. The gonads of female worms recovered from the irradiated group revealed degenerative vacuolization, and the gonads of male worms could not be found.

Visual activation in functional magnetic resonance imaging at very high field (4 Tesla)

OBJECTIVES

Functional magnetic resonance imaging (fMRI) at very high field strengths provides functional brain mapping with the enhanced signal to noise ratio and the larger blood oxygenation level-dependent (BOLD) effect. We report activated areas in the standard space detected by fMRI at 4 Tesla (T) during simple visual stimulation.

MATERIALS AND METHODS

Twelve healthy young subjects were scanned using a 4 T scanner during binocular flashing visual stimulation. Functional images were realigned to the first scan and then spatially normalized. Individual and group data analyses were performed to identify areas of visual activation.

RESULTS

Activation of the bilateral primary visual cortex (V1/V2) was observed along the entire calcarine fissure in all subjects. The activated area extended to the extrastriate cortex in all subjects. Activation of the bilateral lateral geniculate nucleus (LGN) was detected in all subjects. The group data showed activation of the bilateral primary visual cortex and the bilateral lateral geniculate nucleus.

CONCLUSIONS

Robust activation of the vision-related areas was successfully obtained in all subjects using a 4 T magnetic resonance scanner. These results suggest that fMRI at very high field strengths may be effective in showing visual system physiology, and that it can be a promising method to assess visual function of human subjects.

VP22 enhanced intercellular trafficking of HSV thymidine kinase reduced the level of ganciclovir needed to cause suicide cell death

BACKGROUND

The inefficiency of herpes simplex virus thymidine kinase (TK) gene transfer and toxicity of ganciclovir (GCV) at high concentrations in vivo limits the use of this suicide gene therapy approach for the treatment of cancers in clinical settings. To overcome the problem, we have sought evidence of amplification of cytotoxicity by co-transfer of the TK gene fused with the gene encoding HSV-1 structural protein VP22 which has a remarkable ability for intercellular trafficking.

METHODS

The expression of the fusion proteins from the chimeric VP22-TK or VP22-EGFP genes was shown by Western blot and VP22 promoted TK or EGFP intercellular trafficking by an indirect immunofluorescent assay. The cytotoxicity was demonstrated by a colorimetric cell proliferation assay followed by an assessment of the bystander effect on admixtures of transfected with non-transfected naive cells.

RESULTS

Our results show the expression of the VP22 fusion proteins and their spread to varying numbers of bystander cells (up to 30, observed in viable cells with VP22-EGFP as well as after methanol fixation), confirming that VP22 assisted intercellular trafficking of the fusion proteins. This VP22 promoted TK spreading resulted in killing by 2.5 microg/ml GCV of virtually all cells in cultures that had been transfected at an efficiency of only 27.5%. In contrast, fewer than 80% of cells were killed when transfected with 'tk alone' at the same efficiency. The cell killing effect was exponentially dependent on GCV concentration in cells transfected with 'tk alone' at GCV concentrations between 0.25 and 0.5 microg/ml, but not those transfected with VP22-TK, probably due to the continuously variable, high sensitivity of about 50% of cells. Even at low concentration of GCV (0.2 microg/ml), the enhancement of cell killing by VP22 was four-fold higher in cells transfected with VP22-TK than in cells transfected with 'tk alone'.

CONCLUSIONS

VP22 enhanced intercellular trafficking of TK and amplified the TK/GCV killing effect, especially in the lower range of GCV concentrations. This offers a new strategy to enhance the effectiveness of suicide gene therapy for the treatment of cancers.

Cecal perforation presenting as abdominal-wall necrotizing fasciitis

The preoperative diagnosis of a cecal perforation associated with Salmonella infection as a cause of abdominal-wall necrotizing fasciitis (AWNF) is clinically difficult. Computed tomography of the abdomen is helpful, and can detect the combined presence of a pneumoscrotum and pneumoperitoneum. Its presence indicates a patent processus vaginalis, which acts as the primary route for the spread of the intra-abdominal infectious process into the abdominal wall. An exploratory laparotomy should be done to confirm the presence of intra-abdominal pathology in order to avoid delayed treatment.

Expression of HER-2/NEU oncoprotein in familial and non-familial breast cancer

The HER-2/neu proto-oncogene amplification or oncoprotein overexpression is an important prognostic factor and a predictive factor for resistance to endocrine therapy and adjuvant chemotherapy in breast cancers. Moreover, it is an entry criterion in the assessment of patients for whom Herceptin (Trastuzumab) treatment is considered. The overexpression rate of HER-2/neu oncoprotein has been identified in 10% to 40% of human breast cancers. In Taiwan, a higher grade of pathobiologic characteristics of familial breast cancer was also noted than that found in the non-familial group. It is worthwhile to evaluate whether the overexpression is more frequent in familial breast cancers. Fifty-six familial and 111 non-familial breast cancers were studied between 1990 and 1999 to assess both the overexpression of HER-2/neu oncoprotein immunohistochemically and the correlation with the histological type, grade and stage of breast carcinoma. The overexpression rate is higher in the familial breast cancer group (50.0%) when compared with non-familial breast cancer group (36.9%), which did not prove to be statistically significant (P = 0.1068). However, when the infiltrating ductal carcinomas of both groups are compared, it is statistically significant (52.3% vs. 33.7%, P = 0.0429). Overexpression correlated with node status and histological grade of infiltrating ductal carcinomas in non-familial and overall breast cancers. It also correlated with nuclear pleomorphism and mitotic counts, but not tubule formation or tumor size. All 3 cases of Paget's disease revealed overexpression, whereas all 12 cases of mucinous and one case of metaplastic carcinoma and one case of medullary carcinoma were negative. The overexpression rate was higher both in familial and non-familial intraductal carcinomas (57.1% vs. 73.3%, P = 0.4716). No statistical difference was identified between the 2 subsets. A case of infiltrating ductal carcinoma combined with intraductal carcinoma revealed heterogeneous staining in the component of ductal carcinoma in situ, while the invasive component did not. This suggests that overexpression decreases within individual tumors as they evolve from in situ to invasive lesioins. The HER-2/neu may imply a different role in intraductal carcinoma, Paget's disease and invasive duct carcinoma. Although the overexpression rate of HER-2/neu oncoprotein of familial breast cancer was not significantly higher than that of the non-familial group, it is appropriate to evaluate the rate of HER-2/neu overexpression according to the histological type of breast cancers from familial breast cancer and non-familial breast cancer. The prognoses will be needed for future evaluation.

Comparison of MALT and non-MALT primary large cell lymphoma of the stomach: does histologic evidence of MALT affect chemotherapy response?

BACKGROUND

Although the clinicopathologic features of low grade gastric MALToma (lymphoma of mucosa-associated lymphoid tissue) recently have been well delineated, the significance of identifying histologic evidence of MALT origin in a primary high grade gastric lymphoma is less clear. The authors sought to address this issue and, in particular, to clarify if MALT and non-MALT primary large cell gastric lymphoma might have a different response to systemic chemotherapy.

METHODS

The authors reviewed the pathologic specimens of all patients who had a diagnosis of primary large cell lymphoma of the stomach and who had been treated primarily by systemic chemotherapy in our institutions January 1, 1988-December 31, 1998. The patients were divided into two groups by experienced hematopathologists, based on the presence or absence of histologic features suggestive of MALToma, including typical lymphoepithelial lesions and infiltration of characteristic centrocyte-like cells. Disease staging was done according to the AJCC/UICC system with Musshoff modification. The median number of gastric biopsies for each patient was 7 (range, 1-21).

RESULTS

Seventeen patients with and 26 patients without histologic evidence of MALToma were identified. Clinical features were similar between the two groups except that a greater proportion of patients without evidence of MALToma had elevated levels of serum lactate dehydrogenase (50% vs. 12%, P = 0.01). The median duration of follow-up for the 43 patients was 46.5 months (range, 17-124 mos). All patients received standard systemic chemotherapy including anthracyclines or anthracenedione. The response rate was 88.2% for patients with evidence of MALToma and 57.7% for those without (P = 0.03). The 5-year overall survival rate was 80.5% for patients with evidence of MALToma and 48.9% for those without (P = 0.02). Multivariate analysis indicated that response to chemotherapy, disease stage (Stage I and II-1 vs. Stage II-2, III, and IV), and the presence of MALToma features were independent prognostic factors for overall survival.

CONCLUSION

The results of this relatively small study series suggested that the presence of histologic features of MALToma in patients with primary large cell gastric lymphoma might have been associated with a better response to systemic chemotherapy and a better prognosis. Further studies to consolidate this conclusion are necessary.

University students' attitudes towards mental patients and psychiatric treatment

BACKGROUND

Public attitudes towards mental patients and psychiatric treatment are mostly unfavorable. Mental patients tend to conceal their illness or selectively disclose their treatment histories to someone they trust.

AIMS

To examine the university students' attitudes towards different information regarding a person labeled as mentally ill.

METHODS

We designed seven descriptions of a mentally ill person of varying past and current treatment histories and randomly assigned 308 university undergraduates to read one of the descriptions. Subjects rated their willingness to interact with the hypothetical case using a 19-item social distance scale.

RESULTS

Greater social distance was associated with non-medical field of study, no previous contact with the mentally ill and female gender. Subjects without previous contact with mentally ill individuals kept greater distance from a discharged mental patient receiving psychiatric care than a mental patient who did not require medications nor psychiatric follow-up. In contrast, respondents who had previous contact with the mentally ill were more willing to interact with a discharged mental patient receiving psychiatric care comparing with a person labeled as mentally ill alone and a mental patient who had never been admitted to hospital.

CONCLUSIONS

Implications of our findings in clinical management and designing stigma-reducing programme are discussed.

Hypertension and its related factors in Taiwanese elderly people

BACKGROUND

Our study used data collected in Chung-Hsing Village in May 1998 to evaluate the prevalence of hypertension and its correlates in Taiwanese elderly people.

METHODS

All of individuals aged 65 and over were recruited as study subjects. A total of 1,093 persons, out of 1,774 registered residents, were contacted by face-to-face interview The response rate was 61.6 percent. However, only 586 respondents had blood tests and completed questionnaires. Analysis in this study was based on these 586 subjects. In order to study the significant correlates of hypertension, the t-test, chi-square analysis, and multivariate logistic regression were used.

RESULTS

Our results showed that 66 percent were men and 34 percent were women. The mean age was 73.1 +/- 5.3 years. The proportions of hypertension were 53.09 percent in men and 56.06 percent in women (p > 0.05). After controlling the other covariates, the multivariate logistic regression analysis showed that the significant related factors of hypertension were obesity (OR = 1.88, 95 percent CI = 1.06-3.34, p < 0.05) and renalfunction impairment (OR = 1.69, 95 percent CI = 1.02-2.80, p < 0.05).

CONCLUSIONS

The prevalence of hypertension was high in elderly people. Hypertension is significantly associated with obesity and renalfunction impairment in elderly people.

Functional magnetic resonance imaging of lateral geniculate nucleus at 1.5 tesla

Although activation of the lateral geniculate nucleus has been detected by functional magnetic resonance imaging with magnetic field strengths higher than 2.0 Tesla, there have been no reports of functional magnetic resonance imaging of the lateral geniculate nucleus with the more widely available 1.5 Tesla scanner. The authors used functional magnetic resonance imaging techniques at 1.5 Tesla to detect lateral geniculate nucleus activation in five of seven healthy subjects. This study shows that visual activation of the lateral geniculate nucleus can be obtained with functional magnetic resonance imaging using conventional 1.5 Tesla scanners.

Optical cylinder designs to increase the field of vision in the osteo-odonto-keratoprosthesis

BACKGROUND

The single optical cylinders used in the osteo-odonto-keratoprosthesis (OOKP) are known to produce very small visual fields. Values of 40 degrees are typically quoted. The purpose of this paper is to present designs for new optical cylinders that significantly increase the field of view and therefore improve the visual rehabilitation of patients having an OOKP.

METHODS

Computer ray-tracing techniques were used to design and analyse improved one- and two-piece optical cylinders made from polymethyl methacrylate. All designs were required to have a potential visual acuity of 6/6 before consideration was given to the visual field and optimising off-axis image quality. Aspheric surfaces were used where this significantly improved off-axis image quality.

RESULTS

Single optical cylinders, with increased posterior cylinder (intraocular) diameters, gave an increase in the theoretical visual field of 18% (from 76 degrees to 90 degrees) over current designs. Two-piece designs based on an inverted telephoto principle gave theoretical field angles over 120 degrees. Aspheric surfaces were shown to improve the off-axis image quality while maintaining a potential visual acuity of at least 6/6. This may well increase the measured visual field by improving the retinal illuminance off-axis.

CONCLUSIONS

Results demonstrate that it is possible to significantly increase the theoretical maximum visual field through OOKP optical cylinders. Such designs will improve the visual rehabilitation of patients undergoing this procedure.

Simplified 13C-urea breath test for the diagnosis of Helicobacter pylori infection--the availability of without fasting and without test meal

The conventional 13C-urea breath test (13C-UBT) for detecting Helicobacter pylori infection was performed during fasting state and with a test meal to delay gastric emptying during the test. For the convenience of propagating this test, we assessed the availability of non-fast and without test meal in 13C-UBT for the diagnosis of H. pylori infection. One hundred and five consecutive patients who received endoscopic examination were studied. All of them received endoscopic biopsy for urease test, culture and histopathology to determine whether there was a presence of H. pylori infection. Each patient received four separate 13C-UBT under the following four testing conditions. Test I) fasting state with test meal (100 ml fresh milk), Test II) non-fast (taking usual food) but with test meal, Test III) fasting state without test meal, and Test IV) non-fast and without test meal. The excess delta 13CO2 values were calculated via the breathed samples that were collected at 15 minutes after ingestion of 13C-urea. There were 61 H. pylori positive and 44 negative patients in this study, with an excess delta 13CO2 values 3.0, 4.0, 3.5 and 4.0 as a cut-off value in the four tests respectively, according to the ROC curve. The results of test I, a conventional procedure, had a good correlation with the gold standard. The sensitivity and specificity were 100% and 95% respectively. The alternative procedures in other tests also have high sensitivity and specificity at 15-minute detecting time. The sensitivity of the tests II, III and IV at 15-minute detecting times were 98%, 98% and 100%, and the specificities of those were 95%, 98% and 95% respectively. We therefore suggest that fasting and test meal possibly be omitted when the cut-off value is 4.0 per mil in the simplified 13C-UBT (non-fast and without test meal, and detection at 15 minutes after ingestion of 13C-urea) which is a simple and available procedure for clinical diagnosis of H. pylori infection.

Flexible iris hooks for phacoemulsification in patients with iridoschisis

Flexible iris hooks, or retractors, can be used to facilitate cataract removal by phacoemulsification in patients with primary iridoschisis. This rare condition is associated with fibrillary degeneration of the iris, narrow drainage angles, and cataract. In addition to their conventional use as iris retractors, iris hooks can control the degenerate fibrillary iris stroma to improve the view and access to the lens, preventing further damage during phacoemulsification and cortical cleanup. Iris hooks are widely available, easily handled, and can transform a difficult case into one that is almost routine.

Splice site mutation in the type VII collagen gene (COL7A1) in a Taiwanese family with recessive dystrophic epidermolysis bullosa

BACKGROUND AND PURPOSE

Generalized recessive dystrophic epidermolysis bullosa (RDEB) is a severe inherited disease, in which patients suffer from blistering and scarring of the skin and mucous membranes after minor mechanical trauma. Tight genetic linkage has been established to the type VII collagen gene (COL7A1) at 3p21. The purpose of this study was to identify mutations in COL7A1 in one Taiwanese pedigree with generalized RDEB.

METHODS

Genomic DNA was used as the template for polymerase chain reaction (PCR) amplification of all 118 COL7A1 exons and the flanking splice junctions. PCR was followed by heteroduplex analysis of the products by single-strand conformation polymorphism (SSCP) studies, and direct nucleotide sequencing was used to search for mutations, which were verified by restriction endonuclease digestion.

RESULTS

We identified a homozygous intronic splice-site at the +1 position of intron 5 (682 + 1G-->A) of COL7A1 in the affected individual. His parents, who were cousins, were not affected by this disease. The mother was heterozygous for the mutation; the father had died before the study, of unrelated causes. This mutation results in a frameshift and downstream stop codons on both alleles, indicating an absence of functional protein. Restriction endonuclease BspHI can be used to verify this mutation and screen other members in the same family.

CONCLUSIONS

These molecular findings offer a genetic explanation for the skin fragility in this Taiwanese patient with RDEB. The immediate benefits gained by elucidating mutations in family members include the ability to assess whether they are carriers of this disease and the ability to use this DNA-based method for prenatal testing in subsequent pregnancies.

Familial breast cancer in southern Taiwan

The purpose of this study is to evaluate whether there are pathobiologic differences and differences in overall rates survival between familial and non-familial breast cancer patients in Taiwan. A retrospective study was performed evaluating 76 familial breast cancer patients in 69 families, which included two BRCA1 related cases and six BRCA2 related cases. Patients were compared with 425 non-familial sporadic cases. Familial breast cancer patients had similar ages and stages as non-familial patients (mean, 46.6 years vs 48.9 years, p = 0.306). However, the familial breast cancer patients with BRCA1 and BRCA2 related cases presented at lower stages (p = 0.034) and younger ages than non-familial patients (mean, 45.1 years vs 48.9 years P = 0.042). The occurrence of infiltrating ductal carcinoma and lobular carcinoma in situ was not significantly different in the two groups. Mucinous carcinoma was represented with 6.7% (4/76) and 1.3% (1/76) medullary carcinoma. The overall grade of familial breast cancer, including BRCA1 and BRCA2 related cases in 8 infiltrating ductal carcinoma, was significantly higher than that of controls. The mean follow up was 4.5 years for familial breast cancers. Five- and 10-year overall survival rates were 69% and 61% for those with a family history, compared with 86% and 64% for those in the control group (p = 0.644). There were no statistically significant differences in disease-free survival rates between the two groups at 5 or 10 years (69% vs 78% in 5 years; 48% vs 58% in 10 years) (p = 0.862). Despite the younger ages and earlier stages at presentation in familial breast cancer patients with BRCA1 and BRCA2 related cases, the familial breast cancer patients had higher grade patholobiologic characteristics, but similar prognoses when compared with sporadic breast cancer patients. Owing to the limited number of familial cases in this study, more cases and longer follow up are needed.

Autoantibody against oxidized low-density lipoproteins may be enhanced by cigarette smoking

A total of 59 healthy male subjects (32 smokers and 27 nonsmokers) who had no reported systemic disease and did not take alcohol and vitamin supplementation were included. The levels of autoantibody to oxidized low-density lipoproteins (ox-LDL) in smokers and age-matched nonsmokers were compared. The plasma levels of antioxidants that can affect the formation of ox-LDL were also measured, and correlation analyses between anti ox-LDL IgG and plasma antioxidants, controlling for age and body mass index (BMI), were performed. Plasma alpha-tocopherol and uric acid concentrations of nonsmokers (2.78+/-1.09 microg/mg total lipid and 6.96+/-1.69 mg/dl, respectively) were significantly higher than those of smokers (1.68+/-0.48 microg/mg total lipid and 6.15+/-1.14 mg/dl, respectively) (P<0.05). Although plasma ascorbate and retinol levels were not significantly different between smokers and nonsmokers, smokers older than 45 years old had significantly lower plasma ascorbate levels (0.32+/-0.17 mg/dl) than age-matched nonsmokers (0. 53+/-0.14 mg/dl) (P=0.036). Higher level of plasma anti ox-LDL IgG was noted in the group of smokers compared with nonsmokers (515+/-409 mU/ml vs. 407+/-268 mU/ml, respectively) under the statistic method of Chi-Square test (P=0.049). A significant negative correlation was found between plasma anti ox-LDL IgG and alpha-tocopherol in the combined population as well as in the smoker group (r=-0.26, p=0.047; r=-0.48, p=0.006; respectively). However, there was no correlation between plasma anti ox-LDL IgG and the levels of other antioxidants. These results suggest that reduced concentrations of alpha-tocopherol are associated with cigarette smoking. The significantly negative correlation between plasma anti ox-LDL IgG and alpha-tocopherol in the entire study population as well as in the smoker group suggests that plasma alpha-tocopherol may be partially effective if not totally at protecting LDL from oxidative damage caused by cigarette smoking and dietary supplementation with alpha-tocopherol may provide a protective effect against LDL oxidation, especially in smokers.

Reproducibility of visual activation in functional MR imaging and effects of postprocessing

BACKGROUND AND PURPOSE

Functional MR imaging studies of the brain should be interpreted in the context of their reproducibility. We assessed the reproducibility of visual activation measured by functional MR imaging and analyzed the effect of image transformation to standard space.

METHODS

Seven healthy volunteers were studied twice with echo-planner functional MR imaging at 1.5 T during visual stimulation. The studies were separated by an interval of 2 to 7 days. Functional images were analyzed after spatial normalization to the space described by Talairach and Tournoux and/or after coregistration of the images of the second study with the images of the first study. The number of active voxels for each study was determined at three thresholds. In addition, the change in the center of the mass of activation, the mean change in signal intensity, and the mean t value within the activated area were measured. These reproducibility indexes were calculated for the spatially normalized and nonnormalized data for each subject.

RESULTS

Variations in visual activation were observed between the two studies in the same individual as well as across subjects. There was no evidence of an effect from image transformation on reproducibility on any of the measures.

CONCLUSION

Our findings show that the reproducibility of activation in functional MR imaging may be much more variable across subjects than suggested in previous studies. The use of different types of image transformation (coregistration, spatial normalization) does not significantly affect the reproducibility of visual activation.

Identification of novel human genes evolutionarily conserved in Caenorhabditis elegans by comparative proteomics

Modern biomedical research greatly benefits from large-scale genome-sequencing projects ranging from studies of viruses, bacteria, and yeast to multicellular organisms, like Caenorhabditis elegans. Comparative genomic studies offer a vast array of prospects for identification and functional annotation of human ortholog genes. We presented a novel comparative proteomic approach for assembling human gene contigs and assisting gene discovery. The C. elegans proteome was used as an alignment template to assist in novel human gene identification from human EST nucleotide databases. Among the available 18,452 C. elegans protein sequences, our results indicate that at least 83% (15,344 sequences) of C. elegans proteome has human homologous genes, with 7,954 records of C. elegans proteins matching known human gene transcripts. Only 11% or less of C. elegans proteome contains nematode-specific genes. We found that the remaining 7,390 sequences might lead to discoveries of novel human genes, and over 150 putative full-length human gene transcripts were assembled upon further database analyses. [The sequence data described in this paper have been submitted to the

Clinical analysis of a dysentery outbreak in Taichung

In September 1993, we collected 207 patients due to dysentery, who visited the Department of Pediatrics at China Medical College Hospital. In our report, 67.6% of these patients were amebic dysentery, 19.3% were combined infection with amebic and Shigella sonnei dysentery, and 13.1% were Shigella sonnei dysentery. Therefore, amebic dysentery was the predominant cause during this outbreak. The clinical features of this outbreak were, in descending order, watery stool, fever, abdominal pain, mucinous stool and bloody stool. No concurrent liver abscess was discerned. Because there had not been such a clustering of dysentery in Taichung for so many years, we thought that travel to endemic areas might have been the underlying predisposing cause. Most of the school water supplying system was ground water, which might have been contaminated by a few patients returning from endemic areas. We thought that fecal-oral route by contaminated water might have been the primary transmission route.

Association between serum uric acid and cardiovascular risk factors among elderly people in Taiwan

In order to understand the distribution of serum uric acid and the relationship between serum uric acid and the cardiovascular risk factor among elderly people, a cross-sectional study was conducted in Chung-Shing-Shin-Tseun community in Taiwan in May 1998. All individuals aged 65 and over were collected. A total of 1123 persons, out of 1774 registered residents, were contacted by face-to-face interview. The response rate was 63.3%. However, only 586 respondents had blood tests and completed questionnaires. Analysis in this study was based on these 586 subjects. The mean uric acid values were 7.4 +/- 1.8 mg/dl in men and 6.3 +/- 1.6 mg/dl in women, respectively (p < 0.001). Multivariate linear regression showed that serum uric acid was significantly correlated with sex and body mass index. Simple correlation showed that serum uric acid was significantly correlated with diastolic pressure, total cholesterol, triglyceride and creatinine. Age, systolic pressure and fasting glucose were not related to serum uric acid. In our conclusion, the uric acid values are high among elderly people. The serum uric acid levels are significantly associated with the cardiovascular risk factors among elderly people.

Serum cholesterol levels and prevalence of hypercholesterolemia in school-aged Taiwanese children and adolescents: the Taichung Study

BACKGROUND

Atherosclerosis has become one of the leading causes of death in Taiwan. Hypercholesterolemia is a major risk factor for coronary atherosclerosis. To evaluate the mean total cholesterol values and the prevalence of hypercholesterolemia in school-aged Taiwanese children and adolescents, an epidemiologic survey was conducted.

METHODS

After two-stage sampling of 52 primary schools and 26 junior high schools in Taichung City, we randomly selected 3,924 children (2,070 boys and 1,854 girls). Blood total cholesterol (TC), triglyceride (TG) and high-density lipoprotein (HDL)-cholesterol were measured. Response rate was 86.8%. Subjects' ages ranged from seven to 14 years old.

RESULTS

From this cross-sectional survey, the following characteristics (mean +/- SD) were documented for boys and girls, respectively: TC, 162 +/- 28 and 165 +/- 29 mg/dl; TG, 74 +/- 33 and 80 +/- 32 mg/dl; HDL-cholesterol, 61 +/- 13 and 59 +/- 12 mg/dl; and low-density lipoprotein (LDL)-cholesterol, 87 +/- 24 and 90 +/- 25 mg/dl. The mean TC across all age groups ranged from 149 to 172 mg/dl for boys and 157 to 170 mg/dl for girls. In boys, the TC concentration was highest at age 11 (172 mg/dl), and in girls was highest at age 7 (170 mg/dl). Borderline hypercholesterolemia (TC > 170 mg/dl) was found in 36.5% of boys (13.5-53.1%) and 39.7% of the girls (28.3-48.6%). Hypercholesterolemia (TC > 200 mg/dl) was found in 9.7% of males (3.1-16.6%) and 10.3% of the females (5.0-14.9%).

CONCLUSIONS

The prevalence of borderline hypercholesterolemia was 38.0% for TC and 17.2% for LDL-C, and for hypercholesterolemia, it was 9.9% for TC and 5.8% for LDL-C. The higher TC levels in Taiwanese children were primarily due to higher HDL-C and TG levels.

The advisability of implementing cholesterol screening in school-age children and adolescents with a family history of cardiovascular disease and hyperlipidaemia

BACKGROUND

The family basis of coronary heart disease is well recognized and it is important for family physicians to assess whether children have elevated cholesterol levels.

OBJECTIVES

We aimed to evaluate the advisability of implementing cholesterol screening in children with a family history of cardiovascular disease and hyperlipidaemia.

METHODS

We conducted a cross-sectional study in Taiwan from February to June 1996. There were 47,800 students in the population. A total of 4520 students were recruited by two-stage sampling. All the participants were required to fill out a structured questionnaire.

RESULTS

The response rate was 92.5%. Our results show that 16-18% of the children had a positive family history of cardiovascular disease or hyperlipidaemia. Children with a family history of hyperlipidaemia were significantly more likely to have elevated total cholesterol and low-density lipoprotein cholesterol than those without such a history (both odds ratios: 1.4, P < 0.05). Positive predictive values of hyperlipidaemia were less than 13% based on family history. More than 75% of children with abnormal lipid levels would be missed.

CONCLUSIONS

The data suggest that parents' self-reported family history is an ineffective means of identifying children with elevated serum lipid levels in Taiwan. Further research and modification of current National Cholesterol Education Program Panel guidelines for selective cholesterol screening in children may be warranted.

Identification of five spinocerebellar ataxia type 2 pedigrees in patients with autosomal dominant cerebellar ataxia in Taiwan

OBJECTIVES

The autosomal dominant cerebellar ataxias (ADCAs) are a group of genetically diverse neurological conditions linked by progressive deterioration in balance and coordination. Spinocerebellar Ataxia Type 2 (SCA2) is one of the ADCAs and also belongs to a special group caused by the expansion of an unstable CAG repeat encoding a polyglutamine tract. We aimed to investigate the frequency of SCA2 mutation in the ataxia patients referred to the clinic.

MATERIALS AND METHODS

We screened 58 families with inherent cerebellar ataxia and 57 normal individuals by the use of radioactive genomic polymerase chain reaction (PCR) method. A simple non-radioactive PCR for rapid detection of the expanded SCA2 alleles via agarose gel electrophoresis was also employed.

RESULTS

Eight SCA2 affected patients and 1 at-risk individual in 5 unrelated SCA2 families were identified. The CAG repeats of normal alleles in the sample studied range in size from 16 to 30 repeat units, while those of SCA2 chromosomes are expanded to 34 to 49 repeat units. Our results also showed that unlike SCA 1 and SCA3/MJD, the size distribution of the normal alleles showed few polymorphisms, with the 22 repeat allele accounting for 90.1%. Homozygosity in normal individuals was 80.2%. No overlap in ataxin-2 allele size between normal and expanded chromosomes was observed.

CONCLUSION

This is the first report of the SCA2 gene distributions in the population of Taiwan. The SCA2 mutation accounts for 8.6% of ADCA type I families referred to us, intermediate between SCA1(1.7%) and SCA3/MJD (24%) of the ADCA type I families in our collection.

The relation of white blood cell count and atherogenic index ratio of LDL-cholesterol to HDL-cholesterol in Taiwan school children

White blood cell (WBC) count is an independent coronary risk factor in adults. To clarify the relation of WBC count and atherogenesity in children, we conducted a cross-sectional study in Taiwan from February to June 1996. A total of 3818 subjects were eligible in the final analyses. The ratio of low to high density lipoprotein cholesterol was calculated as atherogenic index. The 75th percentile of atherogenic index was calculated and used as cut-off point for high and low levels. The mean WBC count in children with high atherogenic index (6.82 x 10(9) cells/L) was significantly (p < 0.001) higher than those with low atherogenic index (6.58 x 10(9) cells/L). By multiple logistic regression analysis, higher WBC count (> or = 7.8 x 10(9) cells/L) was found to be an independent risk indicator of atherogenesity (odds ratio: 1.70, 95% confidence interval: 1.20-2.41) among obese children. Other significant factors associated with atherogenesity were gender, obesity, age, triglyceride and total cholesterol level. Our results indicate that obese children with higher WBC count have higher atherogenic index.

Acinetobacter baumannii bloodstream infection: clinical features and antimicrobial susceptibilities of isolates

The number of nosocomial infections caused by Acinetobacter baumannii has increased in recent years. The purposes of this study are to discover the risk factors of transmission to prevent the nosocomial infection of A. baumannii. We retrospectively studied 36 patients with A. baumannii bacteremia at China Medical College Hospital from January 1996 to December 1997. There were 23 males and 13 females. All bacteremia were acquired nosocomially. Malignancy (n = 8) and intracranial hemorrhage (n = 6) were the most common underlying diseases. Only one patient on arterial line disclosed intraarterial catheter-related A. baumannii bacteremia and 3 patients had evidence of A. baumannii pneumonia. Twenty-one patients (58%) had central venous catheters in place at the onset of bacteremia, but none was proven to be catheter-related infection. There were 32 patients (89%) with unknown portal of entry. Multivariate logistic regression analysis revealed that potential risk factors related to A. baumannii bacteremia were prior antimicrobial therapy (P < 0.05). The most common clinical features of A. baumannii bacteremia were, in descending order, fever, leukocytosis, thrombocytopenia and hypotension. Eleven patients (30.6%) died directly from A. baumannii bacteremia. All isolates were resistant to ampicillin, cephalothin, cefonicid and moxalactam. The most alarming evidence was that 19% of isolates showed resistance to imipenem. Our findings emphasized that A. baumannii bacteremia had the following characteristics: usually acquired nosocomially, unknown portal of entry, and high multiresistance, especially the increasing resistance rate to imipenem. Imipenem must be reserved as a last-line agent to treat A. baumannii infections, so we want to suggest that the treatment of choice for A. baumannii is gentamicin, amikacin or ceftazidime.

Image quality in polypseudophakia for extremely short eyes

AIM

To evaluate the image quality produced by polypseudophakia used for strongly hypermetropic and nanophthalmic eyes.

METHODS

Primary aberration theory and ray tracing analysis were used to calculate the optimum lens shapes and power distribution between the two intraocular lenses for two example eyes: one a strongly hypermetropic eye, the other a nanophthalmic eye. Spherical aberration and oblique astigmatism were considered. Modulation transfer function (MTF) curves were computed using commercial optical design software (Sigma 2100, Kidger Optics Ltd) to assess axial image quality, and the sagittal and tangential image surfaces were computed to study image quality across the field.

RESULTS

A significant improvement in the axial MTF was found for the eyes with double implants. However, results indicate that this may be realised as a better contrast sensitivity in the low to mid spatial frequency range rather than as a better Snellen acuity. The optimum lens shapes for minimum spherical aberration (best axial image quality) were approximately convex-plano for both lenses with the convex surface facing the cornea. Conversely, the optimum lens shapes for zero oblique astigmatism were strongly meniscus with the anterior surface concave. Correction of oblique astigmatism was only achieved with a loss in axial performance.

CONCLUSIONS

Optimum estimated visual acuity exceeds 6/5 in both the hypermetropic and the nanophthalmic eyes studied (pupil size of 4 mm) with polypseudophakic correction. These results can be attained using convex-plano or biconvex lenses with the most convex surface facing the cornea. If the posterior surface of the posterior intraocular lens is convex, as is commonly used to help prevent migration of lens epithelial cells causing posterior capsular opacification (PCO), then it is still possible to achieve 6/4.5 in the hypermetropic eye and 6/5.3 in the nanophthalmic eye provided the anterior intraocular lens has an approximately convex-plano shape with the convex surface anterior. It was therefore concluded that consideration of optical image quality does not demand that additional intraocular lens shapes need to be manufactured for polypseudophakic correction of extremely short eyes and that implanting the posterior intraocular lens in the conventional orientation to help prevent PCO does not necessarily limit estimated visual acuity.

Endoscopic hydrogen peroxide spray may facilitate localization of the bleeding site in acute upper gastrointestinal bleeding

BACKGROUND AND STUDY AIMS

A major problem encountered in the emergency endoscopic management of acute upper gastrointestinal (UGI) bleeding is poor localization of the bleeding site, which can be obscured by blood or clots. Traditional attempts to overcome this problem have been by physical methods, which have usually proved unsatisfactory. The aim of this prospective study was to show that hydrogen peroxide can be used as a dissolution agent, resulting in an alteration of the characteristics of blood clots and allowing a clearer visual field.

PATIENTS AND METHODS

Twenty patients with acute UGI bleeding (13 male, seven female) were included in the study. The suspected site of bleeding was initially sprayed with 200 ml of saline and then with 25-175 ml of 3 % H2O2. Pictures of the visual field were taken before and after irrigation with both saline and H2O2. These pictures were evaluated by three gastroenterologists and scored using the following visual clearance scoring system: -3, marked worsening of visual field; -2, moderate worsening; -1, slight worsening; 0, no change; +1, slight improvement; +2, moderate improvement; + 3, marked improvement. In cases of active oozing or spurting, after initial hemostasis was achieved the bleeding point was injected with pure ethanol or cauterized with a heater probe. In order to assess the safety of 3 % H2O2 endoscopic biopsies of the antrum and the duodenal bulb were performed before and 30 minutes after its use and examined by a pathologist.

RESULTS

There was a significant improvement in the mean visual clearance score after irrigation with H2O2 compared to irrigation with saline alone (2.13 vs. 0.43, P<0.001). During endoscopic examination there were 19 patients with active oozing from the ulcer base covered by an adherent blood clot; 12 of these (63.1%) achieved initial hemostasis after H2O2 spraying. Eleven of 18 (61.1 %) patients complained of a mild epigastric burning sensation during H2O2 irrigation. There was no clinically significant change in the histology of the antrum and the duodenal bulb after H2O2 therapy.

CONCLUSIONS

We concluded that H2O2 is a safe and effective way to clear the visual field, facilitating the localization of the bleeding site during emergency endoscopy for acute UGI bleeding, with only mild side effects. In some cases H2O2 therapy can also induce temporary hemostasis. We recommended the use of hydrogen peroxide to improve endoscopic visualization, especially in cases where an adherent blood clot covers the suspected bleeding site.

Age-associated alteration of blood thiol-group-related antioxidants in smokers

Total blood glutathione and nonglutathione free sulfhydryl compounds, glutathione peroxidase, and glutathione S-transferase in erythrocytes and plasma and also lipid peroxides in plasma were investigated in 48 male smokers and 42 male nonsmokers. We found that the level of total blood glutathione was significantly increased in young smokers (age <40) but no such change was noted in aging smokers (age>/=40). The activities of glutathione peroxidase and glutathione S-transferase in plasma were significantly decreased in young smokers and the plasma levels of these two enzymes and nonglutathione free sulfhydryl compounds were more drastically decreased in aging smokers. The average concentration of plasma lipid peroxides of the aging smokers (2.76+/-0.46 nmol/ml) was significantly higher than that of the aging nonsmokers (2.32+/-0. 41nmol/ml, P=0.049). On the other hand, the level of total blood glutathione was negatively correlated with the level of plasma lipid peroxides (r=-0.305, P=0.002) and was positively correlated with the smoking index (r=0.307, P=0.019) of all the study subjects under age control. These results indicate that the activities of glutathione peroxidase and glutathione S-transferase declined to a great extent under smoking-mediated oxidative stress in the blood of both young and aging smokers. Moreover, the compensatory generation of total blood glutathione may effectively prevent plasma lipids from peroxidation in young smokers, although the activities of glutathione peroxidase and glutathione S-transferase in plasma were decreased. By contrast, total blood glutathione was inadequate for such protection in the aging smokers. We suggest that supplementation of thiol-group-related agents may be considered for the prevention or alleviation of oxidative stress in aging smokers, whose capability and capacity for the disposal of smoking-mediated free radicals and reactive oxygen species are compromised.

Epidemiology of obesity in elderly people

Our study used data collected at Chung-Shing-Shin-Tseun community in Taiwan in May 1998 to evaluate the relationship between obesity and the cardiovascular and sociodemographic risk factors in elderly people. Individuals aged 65 and over were recruited as study subjects. A total of 1093 persons, out of 1774 registered residents, were contacted in face-to-face interview. The response rate was 61.6 percent. However only 586 respondents took blood tests and completed questionnaires. Analysis in this study was based on these 586 subjects. The chi-square analysis and multivariate logistic regression were used to study the significant correlates of obesity. Our results showed that 66 percent were men and 34 percent were women. The mean age was 73.1 +/- 5.3 years. The overweight proportions were 24.8 percent in elderly men and 29.7 percent in elderly women. The obesity proportions were 12.7 percent in elderly men and 11.5 percent in elderly women. After controlling the other covariates, the multivariate logistic regression analysis showed that overweight and obesity were associated with hypertension, hypertriglyceridemia, and hyperglycemia. In conclusions, the prevalence of overweight and obesity is high in Taiwanese elderly people. Thus, it is necessary to evaluate other metabolic disorders if one metabolic abnormality is observed.

Hypercholesterolemia and its correlates in Taiwanese elderly people

BACKGROUND

Our study used data collected in Chung-Shing-Shin-Tseun community in Taiwan in May 1998 to evaluate the relationship between hypercholesterolemia and the cardiovascular and sociodemographic risk factors in elderly people.

METHODS

Individuals aged 65 and over were recruited as study subjects. A total of 1,093 persons, out of 1,774 registered residents, were contacted in face-to-face interview. The response rate was 61.6 percent. However, only 586 respondents took blood tests and completed questionnaires. Analysis in this study was based on these 586 subjects. The t-test, chi-square analysis, and multivariate logistic regression were used to study the significant correlates of hypercholesterolemia.

RESULTS

Our results showed that 66 percent were men and 34 percent were women. The mean age was 73.1 +/- 5.3 years. The mean total cholesterol value was 5.1 +/- 1 mmol/l in elderly men and 5.5 +/- 1.3 mmol/l in elderly women. The proportions of hypercholesterolemia were 43.7 percent in elderly men and 59.6 percent in elderly women. After controlling the other covariates, the multivariate logistic regression analysis showed that the significant related factors of hypercholesterolemia were age, hypertriglyceridemia, and hyperuricemia. No significant association was found between hypercholesterolemia and gender, obesity, high systolic pressure, high diastolic pressure, hyperglycemia, educational level, retirement status, or marital status.

CONCLUSION

Hypercholesterolemia is significantly associated with hypertriglyceridemia and hyperuricemia in elderly people. It is important to determine other metabolic disorders if one metabolic disorder is disclosed.

The hemodynamic changes of gastroduodenal regional blood flow after Helicobacter pylori eradication in patients with duodenal ulcer scar

Duodenal ulcer (DU) is frequently accompanied by Helicobacter pylori (Hp) infection and associated with the imbalance of aggressive factors and defensive factors. To investigate the possible relationship between Hp and regional gastric blood flow, 26 endoscopically proved DU (scar stage) and Hp infection patients were included and received triple therapy (colloid bismuth subcitrate 120 mg qid for 4 weeks, amoxicillin 500 mg qid for 2 weeks and metronidazole 250 mg tid for 2 weeks). Regional gastroduodenal blood flow (RGDF) was measured at DU scar area and antrum lesser curvature site by laser Doppler flowmetry during endoscopic examination, before and one month after triple therapy. In 22 patients with Hp eradication the RGDF was significantly elevated at antrum lesser site after triple therapy (p < 0.05) but there was no difference at DU scar area. However, in 4 patients without Hp eradication no difference of RGDF in these two points was found. Therefore, Hp appears to have direct effects on gastric microcirculation.

Value of gamma-glutamyl transpeptidase for early diagnosis of biliary atresia

BACKGROUND

Early diagnosis of congenital biliary atresia (BA) is important because the prognosis is closely related to timing of a hepaticoportoenterostomy. In this study, we discuss whether the elevation of serum gamma-glutamyl transpeptidase (GGT) is accurate for the early differentiation of BA from neonatal hepatitis (NH).

METHODS

The effectiveness of using GGT before the age of 10 weeks and other tools in the differential diagnosis of BA and NH were analyzed retrospectively by reviewing the charts of 29 BA and 12 NH patients. The results of serial liver enzyme studies, abdominal sonography, hepatobiliary scintigraphy and transcutaneous liver biopsy were compared between both groups.

RESULTS

The peak GGT value in BA before 10 weeks of age was significantly higher than that in NH (622.5 +/- 211.9 U/l vs 168.8 +/- 100.3 U/l, respectively, p < 0.001). When a serum GGT concentration greater than 300 U/l was used as a diagnostic criterion for BA in patients younger than 10 weeks of age, the diagnostic accuracy was 85%. When an increase in GGT value (in serial measurements) of greater than 6 U/l/day was used as a criterion, the accuracy was 88%. The diagnostic accuracy of abdominal sonography, hepatobiliary scintigraphy and liver biopsy was 68%, 67% and 79%, respectively.

CONCLUSIONS

GGT concentration is diagnostically valuable when the results of other diagnostic methods are not available, or are controversial, in differentiating between BA and NH.