Reoperative coronary artery bypass grafting without cardiopulmonary bypass

Conventional reoperative coronary artery bypass grafting (CABG) is associated with increased surgical risk. The use of less invasive methods to perform myocardial revascularization may, therefore, be more suitable, especially for high-risk patients. In June 1999, we performed three reoperative CABG surgeries, without the use of cardiopulmonary bypass, through unilateral or bilateral thoracotomy. One patient had single-vessel disease and the other two had multiple-vessel disease. All three patients had uneventful postoperative recovery. During early postoperative follow-up, all three patients were angina-free and were in New York Heart Association functional class I. The results of these three cases suggest that minimally invasive reoperative CABG may reduce morbidity compared with conventional reoperative CABG.

Effect of amino acid mixtures on nasal allergic responses induced by toluene diisocyanate in mice

We studied the effect of various amino acid mixtures on nasal allergy induced by the intranasal application of toluene diisocyanate (TDI) in mice. In Experiment 1 (Exp. 1), mice were fed a 25% casein, soy protein isolate (SPI), egg white protein (EW) or gluten diet. In Experiment 2 (Exp. 2), mice were fed a 25% amino acid mixture diets patterned after casein (AA-casein), SPI (AA-SPI), EW protein (AA-EW) or gluten (AA-gluten). In Experiment 3 3 (Exp. 3) we modified the glutamine/glutamic acid (Gln/Glu) concentrations in the amino acid mixtures. Mice were fed a 25% AA-SPI, low Gln/Glu AA-SPI (LG-AA-SPI), AA-EW or high Gln/Glu AA-EW (HG-AA-EW) diet. At the 5th week, mice were divided into sensitized (sen-) and non-sensitized (ns-) groups. The mice in sensitized groups were treated with two courses of intranasal application of toluene diisocyanate (TDI) in ethyl acetate for 5 consecutive days, separated by 9 days rest. The non-sensitized groups of mice were treated with a vehicle. Nine days after the second sensitization, all mice were provoked by TDI. Nasal responses and serum IgE concentration were studied. The findings of Exp. 1 showed that the sen-EW group exhibited a lower body weight gain, higher nasal symptom score and higher IgE concentration than the other sensitized groups. The findings dings of Exp. 2 showed that the sen-EW group had a lower body weight gain, higher nasal symptom score and higher IgE concentration than the other sensitized groups. In Exp. 3, the AA-EW group showed a higher total nasal score and IgE concentration than the HG-AA-EW group, however, the findings of LG-AA-SPI and AA-SPI were similar. These findings demonstrated that amino acid mixtures affect nasal allergy induced by the intranasal application of TDI in mice.

Peripheral nerve regeneration using silicone rubber chambers filled with collagen, laminin and fibronectin

A 10 mm gap of rat sciatic nerve was created between the proximal and distal nerve stumps, which were sutured into silicone rubber tubes filled with an extracellular gel containing collagen, laminin and fibronectin. Empty silicone rubber tubes were used as controls. Six weeks after implantation, all extracellular elements were completely degraded and absorbed, and 90% of the animals from the extracellular gel group exhibited regeneration across the nerve gaps, whereas only 60% in the control group. Both qualitative and quantitative histology of the regenerated nerves revealed a more mature ultrastructural organization with 28% larger cross-sectional area and 28% higher number of myelinated axons in the extracellular gel group than the controls. These results showed that the gel mixture of collagen, laminin and fibronectin could offer a suitable growth medium for the regeneration of axons.

Amino acids in the second and third intracellular loops of the parathyroid Ca2+-sensing receptor mediate efficient coupling to phospholipase C

To determine the role of amino acids in the second and third intracellular (IC) loops of the Ca(2+)-sensing receptor (CaR) in phospholipase C (PLC) activation, we mutated residues in these loops either singly or in tandem to Ala and assessed PLC activity by measuring high extracellular [Ca(2+)] ([Ca(2+)](o))-induced inositol phosphate accumulation and protein expression by immunoblotting and immunocytochemistry in human embryonic kidney 293 cells. Two CaR constructs in the second IC loop, F707A CaR and to a lesser extent L704A CaR, demonstrated reduced activation of PLC, despite levels of protein expression comparable with the wild-type (wt) CaR. Substitution of Tyr or His for Phe-707, but not Leu, Val, Glu, or Trp, partially restored the ability of high [Ca(2+)](o) to activate PLC. Eight residues in the third IC loop were involved in PLC signaling. The responses to high [Ca(2+)](o) in cells expressing CaRs with Ala substitutions at these sites were <35% of the wt CaR. The L798A, F802A, and E804A CaRs were dramatically impaired in their responses to [Ca(2+)](o) even up to 30 mm. Substitutions of Leu-798 with other hydrophobic residues (Ile, Val, or Phe), but not with acidic, basic, or polar residues, produced reduced responses compared with wt. Phe-802 could be replaced with either Tyr or Trp with partial retention of the ability to activate PLC. Glu-804 could only be substituted with Asp or Gln and maintain its signaling capacity. Cell surface expression of the CaRs mutated at Leu-798 and Phe-802 appeared normal compared with wt CaR. Cell surface CaR expression was, however, reduced substantially in cells expressing several mutants at position Glu-804 by confocal microscopy. These studies strongly implicate specific hydrophobic and acidic residues in the second and third IC loops of the parathyroid CaR (and potentially larger stretches of the third loop) in mediating efficient high [Ca(2+)](o)-induced PLC activation and or CaR expression.

An electron microscopic-cytochemical localization of plasma membrane Ca(2+)-ATPase activity in poplar apical bud cells during the induction of dormancy by short-day photoperiods

Plasma membrane (PM) Ca2+-ATPase activity in poplar apical bud meristematic cells during short-day (SD)-induced dormancy development was examined by a cerium precipitation EM-cytochemical method. Ca2+-ATPase activity, indicated by the status of cerium phosphate precipitated grains, was localized mainly on the interior face (cytoplasmic side) of the PM when plants were grown under long days and reached a deep dormancy. A few reaction products were also observed on the nuclear envelope. When plant buds were developing dormancy after 28 to 42 d of SD exposure, almost no reaction products were present on the interior face of the PM. In contrast, a large number of cerium phosphate precipitated grains were distributed on the exterior face of the PM. After 70 d of SD exposure, when buds had developed a deep dormancy, the reaction products of Ca2+-ATPase activity again appeared on the interior face of the PM. The results seemed suggesting that two kinds of Ca2+-ATPases may be present on the PM during the SD-induced dormancy in poplar. One is the Ca2+-pumping ATPase, which is located on the interior face of the PM, for maintaining and restoring the Ca2+ homeostasis. The other might be an ecto-Ca2+-ATPase, which is located on the exterior face of the PM, for the exocytosis of cell wall materials as suggested by the fact of the cell wall thickening during the dormancy development in poplar.

Risk factors for leukoplakia and malignant transformation to oral carcinoma: a leukoplakia cohort in Taiwan

The effects of betel nut chewing, smoking and alcohol on the occurrence of leukoplakia and its malignant transformation to oral carcinoma were quantified in a leukoplakia cohort (n = 435) from one medical centre between 1988 and 1998 in Taiwan. Sixty oral carcinomas were ascertained in this cohort. A case-control study within the leukoplakia cohort was used to study, risk factors. Using the Weibull survival model, the incidence of malignant transformation of leukoplakia was shown to increase with follow-up years. After adjustment for other relevant risk factors, betel nut chewing (adjusted odds ratio (OR) = 4.59; 95% confidence interval (CI) 1.25-16.86) remained a significant risk factor for malignant transformation. Results from the case-control study showed that the adjusted odds ratios for betel nut chewing and smoking on the occurrence of leukoplakia were 17.43 (95% CI 1.94-156.27) and 3.22 (95% CI 1.06-9.78), respectively. Similar findings were observed when daily frequency and duration were taken into account. This implies that cessation of smoking may reduce by 36% leukoplakia cases, while elimination of betel nuts may prevent 62% of leukoplakia and 26% of malignant transformation to oral carcinoma in the underlying population.

Transformation of Arabidopsis with the codA gene for choline oxidase enhances freezing tolerance of plants

Arabidopsis thaliana was transformed with the codA gene from Arthrobacter globiformis, which encodes choline oxidase, the enzyme that synthesizes glycinebetaine from choline. The transformation enabled the plants to accumulate glycinebetaine in chloroplasts, and significantly enhanced the freezing tolerance of plants. Furthermore, the photosynthetic machinery of transformed plants was more tolerant to freezing stress than that of wild-type plants. Exogenous application of glycinebetaine also increased the freezing tolerance of wild-type plants, suggesting that the presence of glycinebetaine in transformed plants had enhanced their ability to tolerate freezing stress. Northern blotting analysis revealed that the enhancement of freezing tolerance was not related to the expression of four cold-regulated genes. These results suggest that engineering of the biosynthesis of glycinebetaine by transformation with the codA gene might be an effective method for enhancing the freezing tolerance of plants.

Variations of the cystic artery in Chinese adults

The origin and course of the cystic artery related to the Calot triangle were studied in 72 autopsies. The cystic artery arises from many possible origins; the right hepatic artery is the most common origin (76.6%). The Calot triangle (hepatocystic triangle), which is an important imaginary referent area for biliary surgery, is bounded by the common hepatic duct (CHD), the cystic duct, and the cystic artery. Of all the cystic arteries, 86.1% coursed through the Calot triangle, and 100% of the cystic arteries originating from the right hepatic artery coursed through the Calot triangle. However, only 54% of the cystic arteries that originated from the left, bifurcation, proper, and common hepatic arteries ran through the triangle. None of the cystic arteries that originated from the gastroduodenal, celiac, superior mesentery, or superior pancreaticoduodenal arteries passed through the triangle. Furthermore, 72.7% of the cystic arteries that originated from the right hepatic artery ran beneath the CHD as they entered the Calot triangle; the others ran anterior to the CHD. Of the cystic arteries that arose from locations other than the right hepatic artery, 29.4% ran posterior to the CHD, and 11.8% ran anterior to the CHD. The current study provides detailed information about anatomic variance in Chinese adults that may help avoid injury during open or laparoscopic cholecystectomies.

Mutagenesis and expression of the E3-19k lumenal domain of adenovirus type 2

CD8+ T cells recognize viral or tumor antigens of 8-10 residues derived from cytosolic proteins that are bound to the class I molecules of the major histocompatibility complex (MHC). To escape this immune surveillance, adenovirus expresses a protein, E3-19k, that specifically down-regulates the cell surface expression of class I MHC molecules on infected cells. To most effectively manipulate the T-cell response to virus-infected cells, it is essential to understand the mechanism by which viruses, such as adenoviruses, down-regulate the class I MHC function. We have subcloned the lumenal domain of adenovirus E3-19k protein in order to characterize its interactions with the class I MHC molecules. Several point mutations have also been generated on the E3-19k lumenal domain with either the first 96 or 108 amino acids. Attempts to crystallize the complexes between E3-19k and class I MHC molecule had been initiated.

Estimation of sojourn time in chronic disease screening without data on interval cases

Estimation of the sojourn time on the preclinical detectable period in disease screening or transition rates for the natural history of chronic disease usually rely on interval cases (diagnosed between screens). However, to ascertain such cases might be difficult in developing countries due to incomplete registration systems and difficulties in follow-up. To overcome this problem, we propose three Markov models to estimate parameters without using interval cases. A three-state Markov model, a five-state Markov model related to regional lymph node spread, and a five-state Markov model pertaining to tumor size are applied to data on breast cancer screening in female relatives of breast cancer cases in Taiwan. Results based on a three-state Markov model give mean sojourn time (MST) 1.90 (95% CI: 1.18-4.86) years for this high-risk group. Validation of these models on the basis of data on breast cancer screening in the age groups 50-59 and 60-69 years from the Swedish Two-County Trial shows the estimates from a three-state Markov model that does not use interval cases are very close to those from previous Markov models taking interval cancers into account. For the five-state Markov model, a reparameterized procedure using auxiliary information on clinically detected cancers is performed to estimate relevant parameters. A good fit of internal and external validation demonstrates the feasibility of using these models to estimate parameters that have previously required interval cancers. This method can be applied to other screening data in which there are no data on interval cases.

The effect of posterior capsulorrhaphy in primary total hip arthroplasty: a prospective randomized study

Between 1994 and 1997, 180 cases of primary total hip arthroplasty (THA) were performed with the posterior (Moore) approach for a variety of indications and studies prospectively. The cases were separated randomly into 2 groups to evaluate the effect of posterior capsulorrhaphy in the prevention of postoperative dislocation. In group 1 (96 cases), closure of the arthroplasty was performed with a posterior capsulorrhaphy; in group 2 (84 cases), closure was performed without capsulorrhaphy. The follow-up period was 38 months (range, 12-60 months). No dislocations occurred in group 1, whereas 2 dislocations (2.3%) occurred in group 2. Although the factors affecting dislocation in primary THA are many, a posterior capsulorrhaphy may be helpful in the prevention of posterior dislocation of primary THA performed with a posterior approach.

Quantitative trait loci and candidate gene mapping of bud set and bud flush in populus

The genetic control of bud phenology in hybrid poplar was studied by mapping quantitative trait loci (QTL) affecting the timing of autumn bud set and spring bud flush. The founders of the mapping pedigree were collected from widely separated latitudes to maximize segregating variation for dormancy-related traits in the F(2) generation-the female Populus trichocarpa parent is from Washington State (48 degrees N) and the male P. deltoides parent is from Texas (31 degrees N). Bud set and bud flush timing were measured on the F(2) generation in a replicated clonal field trial. Using a linkage map constructed of AFLP and microsatellite markers, three QTL controlling bud set and six QTL controlling bud flush were detected. Additionally, five candidate genes believed to be involved in perception of photoperiod (PHYB1, PHYB2) or transduction of abscisic acid response signals (ABI1B, ABI1D, and ABI3) were placed on the QTL map. PHYB2 and ABI1B were found to be coincident with QTL affecting bud set and bud flush.

Protein kinase C activation blocks calcium receptor signaling in Xenopus laevis oocytes

We examined whether calcium receptor (CaR) signaling is affected by protein kinase C (PKC) activation by assessing the effects of phorbol-12-myristate-13-acetate (PMA) on 45Ca2+ efflux from Xenopus laevis oocytes expressing wild-type (WT) and mutant bovine parathyroid CaRs. Raising extracellular [Ca2+] ([Ca2+]0) from 0.5 to 5.5 mM increased 45Ca efflux (26 +/- 3-fold) in oocytes expressing full-length and C-terminally truncated receptor (amino acid 1-895). These increases in 45Ca efflux were blocked by 88 +/- 3% after PMA treatment for 20 min. Three consensus PKC phosphorylation sites (Thr-647, Ser-795, and Thr-889) were mutated in the context of the full-length and truncated CaR. PMA treatment inhibited high [Ca2+]0-induced responses in oocytes expressing the Ser795Ala CaR (1-895), Thr889Ala CaR (1-895), and Ser795Ala/Thr889Ala CaR (1-895) by 30-40% compared with untreated controls (P < 0.05). A triple mutant of the full-length CaR demonstrated similarly reduced susceptibility to inhibition of 45Ca efflux by PMA. Thus, these sites are important in mediating the effects of PKC activation on CaRs, but other residues and effector molecules are likely to participate in the effects of PKC on CaR-induced signal transduction in target cells.

Expression and signal transduction of calcium-sensing receptors in cartilage and bone

We previously showed that Ca2+-sensing receptors (CaRs) are expressed in chondrogenic RCJ3.1C5.18 (C5.18) cells and that changes in extracellular [Ca2+]([Ca2+]o) modulate nodule formation and chondrogenic gene expression. In the present study, we detected expression of CaRs in mouse, rat, and bovine cartilage and bone by in situ hybridization, immunocytochemistry, immunoblotting, and RT-PCR; and we tested the effects of CaR agonists on signal transduction in chondrogenic and osteogenic cell lines. In situ hybridization detected CaR transcripts in most articular chondrocytes and in the hypertrophic chondrocytes of the epiphyseal growth plate. Expression of CaR transcripts was weak or absent, however, in proliferating and maturing chondrocytes in the growth plate. In bone, CaR transcripts were present in osteoblasts, osteocytes, and bone marrow cells, but rarely in osteoclasts. A complementary DNA was amplified from mouse growth plate cartilage, which was highly homologous to the human parathyroid CaR sequence. Immunocytochemistry of cartilage and bone with CaR antisera confirmed these findings. Western blotting revealed specific bands (approximately 140-190 kDa) in membrane fractions isolated from growth plate cartilage, primary cultures of rat chondrocytes, and several osteogenic cell lines (SaOS-2, UMR-106, ROS 17/2.8, and MC3T3-E1). InsP responses to high [Ca2+]o were evident in C5.18 cells and all osteogenic cell lines tested except for SaOS-2 cells. In the latter, high [Ca2+]o reduced PTH-induced cAMP formation. Raising [Ca2+]o also increased intracellular free [Ca2+] in SaOS-2 and C5.18 cells. These studies confirm expression of CaRs in cartilage and bone and support the concept that changes in [Ca2+]o may couple to signaling pathways important in skeletal metabolism.

Evaluation of a selective screening for colorectal carcinoma: the Taiwan Multicenter Cancer Screening (TAMCAS) project

BACKGROUND

Although the efficacy of mass screening for colorectal carcinoma (CRC) with a fecal occult blood test has been demonstrated in several randomized trials, a mass screening approach used in countries with intermediate or low incidence of CRC might be costly. Screening high risk people may be an alternative approach, to aid in the prevention of death from CRC. However, the efficacy of CRC screening for high risk people in such countries is uncertain.

METHODS

For this study, a multicenter design was devised to identify high risk groups without clinical symptoms related to CRC; these subjects were identified through the study of index cases of CRC in Taiwan. Colonoscopy, in combination with a fecal occult blood test or double-contrast barium enema, was used to screen high risk groups. A total of 8909 subjects were invited to attend screening. Of 8909, 81 with asymptomatic CRC were detected in one-shot screening. Markov models, in conjunction with a simulated approach, were proposed to estimate relevant parameters in relation to disease progression and to assess the effect of the interval between screenings on the efficacy of CRC screening for these high risk groups.

RESULTS

The estimated preclinical incidence rate was 0. 00396 (95% confidence interval [CI], 0.002944-0.004985), which was 21 times that reported from a cancer registry in 1994. The simultaneous estimations of mean sojourn time (the average duration between the preclinical screen-detectable phase and the clinical phase) and sensitivity were 2.8 years (95% CI, 2.15-4.30) and 95.0% (95% CI, 24.4-99.9%), respectively. Predictions of mortality reduction for people who received annual, biennial, and triennial screening regimes compared with controls were 26% (95% CI, 0-50%), 23% (95% CI, 0-48%), and 21% (95% CI, 0-47%), respectively.

CONCLUSIONS

The efficacy of selective colorectal carcinoma screening has been demonstrated in this study. A high preclinical CRC incidence rate also suggests that such a screening strategy might be cost-effective for countries with intermediate or low incidence of CRC. Methods proposed in this study can be used to evaluate the efficacy of CRC screening in similar screening trials.

An in vitro comparison of the motion behavior of different bipolar endoprostheses

The relative motion of 3 different bipolar endoprostheses was evaluated in vitro. A paired fresh acetabulum was frozen at 0 degrees C and defrosted 12 hours before the experiment. Three bipolar endoprostheses were evaluated: UNIQHIP system (United Orthopedics), UHR system (Osteonics), and AML system (Depuy). The surface roughness and spherical roundness of outer shells and inner heads of the bipolar prostheses were measured before the experiments. The acetabulum and outer shell of the bipolar prostheses were fixed on a Bionix 858 material testing system axially by separate fixation tools. The axial load of 1,400 N and 2,800 N was than applied on the specimen. The axis was rotated from 0 degrees to 90 degrees at the speed of 1 degree/s. All 3 outer shells were tested to this paired acetabulum randomly and separately. The frictional torque on the outer bearing surface of the different prostheses was recorded by the material testing system. The frictional torque on the inner bearing surface was also measured by the same procedure as was done for the outer bearing. The final results were statistically compared by the 1-way analysis of variance test method. Bipolar prostheses of the UHR system showed the largest frictional torque on outer bearing when it was loaded with 1,400 N and 2,800 N. The final results showed that all the bipolar prostheses had ideal motion behavior when functioning under the loading of 1,400 N. The frictional torque on the inner bearing was found to be larger than the frictional torque on the outer bearing in some prostheses when the loading was increased to 2,800 N. Thus, the bipolar endoprostheses functioned as unipolar prostheses. The only relative motion remained between the outer bearing surface and the acetabulum. This effect causes complications, such as implant protrusion in the acetabulum.

Distribution of the superficial temporal artery in the Chinese adult

The superficial temporal artery is important in head and neck surgery. Ethnologic variation may affect surgical procedure. In this study, we evaluated the variations of the artery in Chinese adults. We measured its bifurcating location, the diameter of its vessels, and its relationship to nearby structures. A total of 26 cadavers with 52 superficial temporal arteries were examined in 3 consecutive years. The superficial temporal artery ran 1.14 cm anteriorly to the bony external auditory canal. The average diameters of the superficial temporal artery, frontal branch, and parietal branch were 2.14, 1.61, and 1.68 mm, respectively. In 45 of 52 cases (86.5 percent), bifurcation of the artery occurred well above the zygomatic arch. The present study thus demonstrated that the superficial temporal artery in the Chinese adult differs from that in the Caucasian and has provided a detailed anatomic distribution analysis of the superficial temporal artery in Chinese adults, which should benefit the clinician in dealing with operation procedures related to this artery.

Differences in gastric emptying between highly selective vagotomy and posterior truncal vagotomy combined with anterior seromyotomy

Gastric emptying has been reported to be both delayed and unchanged following posterior truncal vagotomy combined with anterior seromyotomy (PTV + AS). When compared to highly selective vagotomy (HSV), our clinical experience was that PTV + AS not uncommonly produced postprandial distress. We studied gastric emptying of both liquids and solids 3 and 12 months following HSV and PTV + AS to determine what if any differences there were in gastric emptying between the two procedures. We compared these results with those from studies done in both normal subjects and unoperated duodenal ulcer patients. In 26 duodenal ulcer patients with perforation (n = 18) or bleeding (n = 8), who were treated with HSV (n = 10) or PTV + AS (n = 16), gastric emptying of liquids and solids was evaluated at 3 months and 12 months postoperatively. At 3 months, gastric emptying of liquids was delayed in both the HSV and PTV + AS groups as compared to values in both normal subjects and unoperated duodenal ulcer patients. The emptying of solids was markedly delayed by PTV + AS in contrast to HSV at 3 months (167.1 +/- 28.4 minutes vs. 79.9 +/- 16.7 minutes; P <0.05). The lag duration was not affected. A limited number of patients studied at 12 months showed similar and near-normal emptying of solids in both the HSV and PTV + AS groups (67.5 +/- 7.0 minutes vs. 70 +/- 6.6 minutes). PTV + AS in contrast to HSV produces more marked delayed emptying of liquids and solids at 3 months; with time (1 year) these values return to near normal.

Treatment of large skeletal defects in the lower extremities using double-strut, free vascularized fibular bone grafting

This article reports on the use of double-strut, free vascularized fibular grafts to treat six patients with infected nonunion or traumatic bone loss in the femur or tibia after prolonged treatment and multiple operations. The defects were 6-13 cm long. Five patients achieved solid union within 6 months, and one patient required additional cancellous grafting to achieve union at the distal end of the fibula. One patient experienced a stress fracture due to strenuous exercise, and union was achieved 3 months after reapplying an external fixator. Although three patients had some restricted knee motion, all patients had a satisfactory outcome in regard to walking, and no limb-length discrepancies were noted in any patient.

Vascularized iliac bone graft for displaced femoral neck fractures in young adults

From November 1989 to September 1994, a total of 26 patients (18 men and 8 women) with acute displaced femoral neck fractures were treated with closed reduction and Knowles pinning combined with vascularized iliac bone grafting. Mean patient age was 37.5 years (range: 24-48 years). The mean time interval from injury to surgery was 3.6 days (range: 1-10 days). One patient experienced loss of the reduction at 6 weeks postoperatively and subsequently went on to hip replacement. Mean follow-up for the remaining 25 patients was 56.2 months (range: 20-78 months). All fractures united within 4 months. The average union time was 3.3 months. Plain radiographs confirmed the presence of avascular necrosis in 2 patients during the final follow-up; 1 of these patients developed systemic lupus erythematous 1 year after the fracture and had been treated with high doses of corticosteroid. Functional and radiographic results were satisfactory in the remaining patients.

Enhanced tolerance to light stress of transgenic Arabidopsis plants that express the codA gene for a bacterial choline oxidase

Arabidopsis thaliana was transformed with the codA gene from Arthrobacter globiformis. This gene encodes choline oxidase, an enzyme that converts choline to glycinebetaine. The photosynthetic activity, monitored in terms of chlorophyll fluorescence, of transformed plants was more tolerant to light stress than that of wild-type plants. This enhanced tolerance to light stress was caused by acceleration of the recovery of the photosystem II (PS II) complex from the photo-inactivated state. The transformed plants synthesized glycinebetaine, but no changes were detected in the relative levels of membrane lipids or in the relative levels of fatty acids in the various membrane lipids. Transformation with the codA gene increased levels of H2O2, a by-product of the reaction catalyzed by choline oxidase, by only 50% to 100% under stress or non-stress conditions. The activity of ascorbate peroxidase and, to a lesser extent, that of catalase in transformed plants were significantly higher than in the wild-type plants. These observations suggest that H2O2 produced by choline oxidase in the transformed plants might have stimulated the expression of H2O2 scavenging enzymes, with resultant maintenance of the level of H2O2 within a certain limited range. It appears that glycinebetaine produced in vivo, but not changes in membrane lipids or in the level of H2O2, protected the PS II complex in transformed plants from damage due to light stress.

Anaerobic treatment of poultry mortalities in a modified LB-UASB system

The efficiency of a modified LB-UASB system in treating poultry mortalities was tested. The anaerobic digestion system consisted of an upflow anaerobic sludge blanket (UASB) and three leachbeds (LB). The LBs were batch-loaded with mortality to be treated. The LBs were sequentially connected to the UASB, one at a time. Leachate from a connected LB was fed to the UASB while effluent from the UASB overflowed to the LB to form a closed loop. When the concentrations of leachate from the first LB became so low that it could no longer support accelerated methanogenesis in the UASB, it was replaced by a second LB containing a new batch of mortality. Concentrated leachate from the second LB allowed the UASB to continue operation at higher loading rates (LR), thus, alleviating the problems of lengthy LR build-up and idling time. Meanwhile, the off-lined LB continued to mature independently. The UASB was connected to a third LB when the second LB entered accelerated methanogenesis phase. Operation of the first LB was stopped when CH4 production rate from it became marginal. The remaining solids material was replaced by a new batch of mortality to start the second cycle. The first cycle was completed when fermentation in the third LB was ended. The modified LB-UASB system performed significantly better than the original system. It took an average of only 86 days to treat one batch of mortality, yet, the methane yield was about 40% higher. The average methane yield was 0.28 m3 (kg wet weight)-1. Strategies to optimize system performances are discussed.

A Markov chain model to assess the efficacy of screening for non-insulin dependent diabetes mellitus (NIDDM)

BACKGROUND

The high prevalence and severe consequences of non-insulin dependent diabetes mellitus (NIDDM) in Taiwan calls for urgent measures to detect this disease in the asymptomatic phase. However, the efficacy of early detection of NIDDM is highly dependent on its natural history from the disease-free state, through the asymptomatic to the symptomatic phase and death from NIDDM or other causes.

METHODS

In order to project the above progression, a five-state illness-and-death Markov chain model was proposed to estimate these transition parameters using data from two rounds of a blood sugar screening programme for NIDDM in Puli, in central Taiwan.

RESULTS

Results showed that the annual incidence for asymptomatic NIDDM was 10.67 per 1000 (95% CI: 8.26-13.79) and the average duration between the asymptomatic and symptomatic phases (the sojourn time) was 8 years (95%CI: 5.74-11.29). The 10-year survival rate for asymptomatic NIDDM (79.35%) was better than that for symptomatic NIDDM (69.45%). Prediction of deaths from NIDDM was performed to assess how the efficacy of screening for NIDDM varied by different screening frequencies (annual, biennial, 4-yearly and the control group). Results indicated there is no substantial difference in mortality reduction from NIDDM among the annual, biennial and 4-yearly screening regimens. However, a 4-yearly screening regimen significantly reduced deaths from NIDDM by 40% (95% CI: 26-51%).

CONCLUSIONS

A long sojourn time and the substantial reduction in mortality suggest that a 4-yearly screening regime for NIDDM would be most effective and feasible in Taiwan. The proposed five-state Markov chain model can be applied to other similar NIDDM screening projects.

Pseudoxanthoma elasticum. Case report

Pseudoxanthoma elasticum is an uncommon disorder of elastin with characteristic skin laxity. Rhytidectomy of the excessive redundant skin is necessary for cosmetic improvement, and reports of surgical management are rare. We report a case of pseudoxanthoma elasticum with involvement of neck, axillae, breasts, abdomen, thighs, and perineum, together with angioid streaking of fundi. Rhytidectomy of the lax cervical skin was undertaken with satisfactory results after a 13 month follow-up. We have reviewed other published reports to obtain a better understanding of the genetics, histopathology, vascular and ophthalmological manifestations, and also the surgical implications of pseudoxanthoma elasticum.

Acute closed humeral shaft fractures treated with dynamic compression plate

BACKGROUND

To define the efficacy of dynamic compression plates (DCPs) for the treatment of closed humeral shaft fractures.

METHODS

A total of 165 patients with closed humeral shaft fractures were studied retrospectively. There were 120 patients who underwent open reduction and internal fixation with DCPs and no bone grafting (BG). Forty-five patients received the same procedures with BG. The mean follow-up period was 93 months.

RESULTS

In the DCP without BG group, the average blood loss was 350 ml, operation time was 105 minutes, hospital stay was 8.5 days and fracture union time was 13.5 weeks. In the DCP with BG group, the average blood loss was 525 ml, operation time was 115 minutes, hospital stay was 7.9 days and fracture union time was 9.2 weeks.

CONCLUSIONS

In our experience, DCPs are effective for surgical fixation of humeral shaft fractures. Prophylactic BG is recommended for cases with more comminution.