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.

Nonaqueous capillary electrophoretic separation and thermo-optical absorbance detection of five tricyclic antidepressants and metabolism of amitriptyline by Cunninghamella elegans

We developed a technique based on nonaqueous capillary electrophoresis and laser-based thermo-optical absorbance detection to assay five antidepressants with similar structures and mass-to-charge ratios. A mixture of methanol and acetonitrile with ammonium acetate was essential to achieve baseline resolution of these compounds. We investigated the effects of ammonium acetate concentration, temperature, applied voltage, and capillary length on separation efficiency. The nonaqueous capillary electrophoresis and laser-based thermo-optical absorbance detection technique was used to study the metabolism of amitriptyline by Cunninghamella elegans. Sample preparation procedures were simplified for fast screening of the parent drug and its metabolites. Reproducible electropherograms were obtained from replicate cultures of C. elegans growing in the presence of amitriptyline.

On-line nonaqueous capillary electrophoresis and electrospray mass spectrometry of tricyclic antidepressants and metabolic profiling of amitriptyline by Cunninghamella elegans

An on-line nonaqueous capillary electrophoresis-electrospray mass spectrometry (ESI-MS) technique was developed using a commercial ion spray interface. The nonaqueous capillary electrophoresis ESI-MS system was used to profile tricyclic antidepressants of similar structures and mass-to-charge ratios. We found that pure methanol can be used as a sheath liquid to obtain stable ion spray from nonaqueous capillary electrophoresis. The flow rate of the coaxial nebulizing gas affected baseline signals, separation efficiency, and migration times. Other nonaqueous capillary electrophoresis operating conditions and electrospray parameters were optimized for enhanced baseline separation and high sensitivity detection. The effect of sample stacking on separation and detection was evaluated. The calculated detection limits were approximately 3 pg injected onto the capillary. ESI mass spectra of tricyclic antidepressants from a single quadrupole MS were obtained and elucidated. The information was used to propose fragmentation pathways of the tricyclic antidepressants. The method was also used to analyze the metabolites of amitriptyline produced by the fungus Cunninghamella elegans. Sixteen metabolites were detected and most of them were tentatively identified as demethylated and/or hydroxylated, and/or N-oxidized products.

Alterations of small-molecular-weight antioxidants in the blood of smokers

Plasma alpha-tocopherol, ascorbate, retinol, uric acid, and lipid peroxides were investigated in 39 male smokers and 64 male non-smokers. The average level of plasma alpha-tocopherol of 35-45-year-old smokers (1.74+/-0.49 microg/mg total lipid) was significantly lower than that of age-matched non-smokers (2.55+/-0.88 microg/mg total lipid, P = 0.032). Similarly, the plasma alpha-tocopherol of smokers aged above 45 (1.66+/-0.29 microg/mg total lipid) was lower than that of the age-matched non-smokers (2.38+/-1.26 microg/mg total lipid, P = 0.014). However, no difference in plasma level of alpha-tocopherol was found between smokers and non-smokers below the age of 35. The average concentration of ascorbate in plasma was significantly decreased only in those smokers older than 45 (0.33+/-0.16 mg/dl vs non-smokers 0.53+/-0.19 mg/dl, P = 0.003). The average level of lipid peroxides (measured as malondialdehyde,MDA) in the plasma of smokers (2.77+/-0.51 nmol/ml) was higher than that of non-smokers (2.35+/-0.21 nmol/ml) aged above 45 (P = 0.034). No differences in the plasma levels of uric acid and retinol were noted between smokers and non-smokers in all age groups. Using partial correlation analysis under age control, we found that the plasma level of alpha-tocopherol was negatively correlated with the plasma level of MDA (r = -0.523, P = 0.038). In contrast, the plasma level of ascorbate was only weakly correlated with the plasma level of MDA (r = -0.341, P = 0.094). Moreover, we found a negative correlation between the plasma level of alpha-tocopherol and smoking index (r = -0.414, P = 0.006) under age control, but there was no correlation between plasma level of ascorbate and smoking index (r=0.221, P = 0.193). These results indicate that adequate levels of alpha-tocopherol and ascorbate may protect the plasma from oxidative damage elicited by smoking-mediated reactive oxygen species (ROS) and free radicals in young smokers. However, the antioxidant activities of alpha-tocopherol and ascorbate may be overwhelmed by the long-standing oxidative stress elicited by cigarette smoking in elderly subjects.

Plasma alkaline phosphatase activity in children and adolescents

From February to June in 1996, there were 47,800 students for health examination in Taichung City, Taiwan. The population consisted of the first and fourth graders of primary schools and the first grader of junior high schools. We selected 3,452 healthy students for further study by two stage sampling. In this report, 52.5% of the students were boys, and 47.5% of the students were girls. The mean age of students was 9.9 +/- 2.4 years. Girls at age 7 and age 10 had higher activity of alkaline phosphatase than boys at the same age. The peak of alkaline phosphatase activity in girls occurred at age 10. Alkaline phosphatase activity was significantly related to weight-length index by multiple regression analysis (p < 0.05). Although clinical application as an obesity factor still needs further investigation, in the future it may be well to routinely check this enzyme when assessing childhood obesity.

Urinary N-acetyl-beta-glucosaminidase as an indicator of renal dysfunction in electroplating workers

OBJECTIVES

To investigate chromium-induced renal dysfunction in electroplating workers.

METHODS

A cross-sectional study was used to evaluate four biochemical markers of renal function. A total of 178 workers were divided into 3 comparable groups consisting of 34 hard-chrome plating workers, 98 nickel-chrome electroplating workers. and 46 aluminum anode-oxidation workers, who represented the reference group. Ambient and biological monitoring of urinary chromium were performed to measure exposure concentrations.

RESULTS

Overall, urinary chromium concentrations were highest among hard-chrome plating workers (geometric mean 2.44 microg/g creatinine), followed by nickel-chrome electroplating workers (0.31 microg/g creatinine) and aluminum workers (0.09 microg/g creatinine). Airborne chromium concentrations were also highest in the hard-chrome plating area (geometric mean 4.20 microg/m3), followed by the nickel-chrome electroplating area (0.58 microg/m3) and the aluminum area (0.43 microg/m3). A positive correlation was found between urinary chromium and airborne concentrations (r=0.54, P < 0.01). Urinary concentrations of N-acetyl-beta-D-glucosaminidase (NAG) were also highest among hard-chrome plating workers (geometric mean 4.9 IU/g creatinine), followed by nickel-chrome workers (3.4 IU/g creatinine) and aluminum workers (2.9 IU/g creatinine). The prevalence of "elevated" NAG (>7 IU/g creatinine) was significantly highest among hard-chrome plating workers (23.5%), then among nickel-chrome workers (7.1%) and aluminum workers (8.7%). Differences in beta2-microglobulin, total protein, and microalbumin were not significant.

CONCLUSION

The author's evidence indicates that NAG is an early indicator of renal dysfunction in hard-chrome plating workers.

Quantification of Helicobacter pylori infection: Simple and rapid 13C-urea breath test in Taiwan

The 13C-urea breath test (13C-UBT) is a non-invasive method for detecting Helicobacter pylori. This study was performed to determine the cutoff value and evaluate the sensitivity and specificity of 13C-UBT in Taiwan. 13C-Urea (100 mg of 99% 13C-labeled urea) was dissolved in 50 ml sterile water for the test. The test meal for delaying gastric emptying was 100 ml fresh milk. Patients fasted for at least 6h. A baseline breath sample was collected 5 min after they had the test meal. Two other samples were collected at 15 and 30 min after the patients ingested the 13C-urea. The test was evaluated in 352 patients after routine upper gastrointestinal endoscopy, and the urease test, culture, and histopathology were taken as the gold standards for detecting H. pylori. According to the receiver operating characteristic (ROC) curves, we chose values of 2.8 and 4.2 excess delta 13CO2 per mil as the cut-off values for 15 and 30 min, respectively, post 13C-urea. The sensitivity and specificity of 13C-UBT were 99% and 93% at 15 min, and 98% and 93% at 30 min post 13C-urea, respectively. The 13C-UBT breath test is an efficient non-invasive method of high sensitivity and high specificity for detecting H. pylori infection. We suggest that the use of fresh milk as the test meal and the detection of excess delta 13CO2 15 min after the ingestion of 13C-urea are suitable for the clinical use of 13C-UBT. This test is simple and rapid.

Intraoperative non-puncture laparoscopic examination of contralateral internal inguinal rings is feasible in children with unilateral hydrocele

BACKGROUND

Intraoperative non-puncture laparoscopic examination using the hernia sac as the scope entrance has been successfully conducted in children with unilateral inguinal hernia. This technique selects patients for contralateral inguinal exploration. In spite of the thin and narrow processus vaginalis, children with unilateral hydrocele encounter the same problem of subsequent contralateral inguinal hernia or hydrocele. In this study, we discuss the feasibility of this technique in children with unilateral hydrocele.

METHODS

From July 1993 to September 1995, 91 children with unilateral hydrocele were examined during surgery at our institution. The results, including success rate, complications, patent rate of contralateral internal ring and contralateral subsequent hernia or hydrocele, at at least one year follow-up, were compared with those of 329 children with unilateral hernia undergoing the same examination during this period.

RESULTS

A patent contralateral processus vaginalis was recognized in 31 children and all were confirmed by surgical exploration. The examination failed in three patients, of whom two had a tear in the processus vaginalis and one had retroperitoneal air dissection as a result of false insertion of the laparoscopic sheath. One patient had a postoperative wound infection. No patient with contralateral obliterated processus vaginalis developed inguinal hernia or hydrocele during follow-up of at least one year. The results were similar to those of the 329 children with hernia who underwent the same procedure in the same period.

CONCLUSIONS

Intraoperative non-puncture laparoscopic examination is feasible in children with unilateral hydrocele.

Serum trace elements, glutathione, copper/zinc superoxide dismutase, and lipid peroxidation in epileptic patients with phenytoin or carbamazepine monotherapy

Disturbance of metabolism of trace elements and antioxidants are investigated in epileptic patients with long-term therapy of anticonvulsants. One hundred and fifteen subjects including healthy controls, untreated epileptic patients, and phenytoin (PHT)- or carbamazepine (CBZ)-treated epileptic patients were recruited in this study. Serum malondialdehyde was measured as an index of extracellular lipid peroxidation. The levels of serum copper (S-Cu), serum zinc, copper/zinc superoxide dismutase (CuZn-SOD), and reduced glutathione in the serum were monitored simultaneously. The results showed that malondialdehyde, S-Cu, and CuZn-SOD levels in the serum all were significantly increased, but the glutathione level was significantly decreased, in all the epileptic patients with PHT monotherapy compared with those of the controls. However, no significant differences of these parameters in the epileptic patients with CBZ monotherapy were found except for a mild elevation of the activity of serum CuZn-SOD. We conclude that compared with PHT monotherapy, the CBZ monotherapy induced less disturbance in trace element metabolism, antioxidants, and lipid peroxidation in the serum of epileptic patients.