Effects of exercise and insulin on mitogen-activated protein kinase signaling pathways in rat skeletal muscle

Studies in mammalian cells have established the existence of at least three distinct mitogen-activated protein kinase (MAP kinase) signaling pathways that are activated by a variety of growth factors and/or environmental stressors. We determined whether physical exercise, a physiological stressor, and insulin, a metabolic stimulator and growth factor, activate the c-jun NH2-terminus kinase (JNK), the p38 kinase, and/or the extracellular regulatory kinases (ERK; p42MAPK and p44MAPK) signaling pathways in rat skeletal muscle. Animals were studied immediately after running on a motorized treadmill for 10-60 min (20 m/min, 10% grade) or 5-30 min after an intraperitoneal injection of insulin (20 U/rat). Exercise increased skeletal muscle JNK activity by two- to threefold throughout the time course studied, whereas insulin did not significantly increase JNK activity. The p38 activity was slightly stimulated by exercise and not by insulin. The ERK kinase pathway, as assessed by ribosomal S6 kinase-2 activity assays and phosphospecific p42MAPK/p4NAPK immunoblotting, was stimulated by both exercise and insulin. These data are the first demonstration of exercise stimulating multiple intracellular signaling pathways in skeletal muscle. Activation of these MAP kinase signaling pathways may mediate changes in skeletal muscle growth and metabolism that occur in response to exercise.

Occupational lead exposure and blood pressure

BACKGROUND

To assess the relation between occupational lead exposure and elevated blood pressure with consideration of a possible confounding effect by noise exposure.

MATERIALS AND METHOD

Some 112 male and 110 female workers at two lead battery manufacturing factories were recruited for this 1992 study in Taiwan. Study participants received regular physical examinations, including standard measurement of blood pressure, body height/weight. Current occupational exposures to lead and noise were measured by a personal sampling scheme and instruments, and included individual ambient lead/noise exposure and blood lead level.

RESULTS

Among the 222 battery-factory workers, the average blood lead level was 56.9 +/- 25.5 micrograms/dl (mean +/- standard deviation), the average concentration of ambient lead exposure was 0.190 +/- 0.331 mg/m3, average noise exposure was 85.9 +/- 5.7 dBA, average systolic blood pressure was 125.2 +/- 14.9 mmHg, average diastolic pressure was 80.2 +/- 10.9 mmHg, and average mean arterial pressure was 95.2 +/- 11.1 mmHg. After considering all possible confounding variables, multivariate regression analyses demonstrated that current blood lead level was not a significant predictor for both systolic and diastolic blood pressures in either sex. In the final model, body mass index and years of working in the factory were the only two factors significantly associated with a change in blood pressure. No evidence of an effect of ambient lead exposure or noise exposure on blood pressure were found.

CONCLUSIONS

The present study suggests that short-term lead exposure, either ambient lead exposure or blood lead level, was not related to blood pressure change among workers who had been exposed at work to occupational lead. These results add to the body of evidence indicating that blood lead exposure does not adversely affect blood pressure.

Overexpression of hexokinase II in transgenic mice. Evidence that increased phosphorylation augments muscle glucose uptake

Hexokinase II (HKII) is the predominant isozyme expressed in peripheral insulin-responsive tissues. To explore the role of HKII in muscle glucose metabolism, two lines of transgenic mice were generated where overexpression was restricted to striated muscle; HKII protein levels and activity were increased by 3-8-fold. Oral glucose tolerance, intravenous insulin tolerance, and insulin and lactate levels were unaffected in transgenic mice. There was a trend toward increased levels of muscle glycogen; however, glucose-6-phosphate levels were increased by 43% in transgenic skeletal muscle following in vivo glucose and insulin administration. Using 2-[3H]deoxyglucose as a tracer, in vitro basal and insulin-stimulated glucose uptake were determined in extensor digitorum longus, soleus, and epitrochlearis muscles. Maximal insulin-stimulated glucose uptake was increased by 17% (extensor digitorum longus), 34% (soleus), and 90% (epitrochlearis) in transgenic muscles; basal and submaximal glucose uptake was also modestly increased in soleus and epitrochlearis. These data suggest that increased muscle HKII (corresponding to the upper end of the physiologic range) may not be sufficient to augment net in vivo glucose homeostasis. However, glucose phosphorylation can represent a rate-limiting step for skeletal muscle glucose utilization since muscle glucose-6-phosphate levels are increased during in vivo hyperinsulinemia and hyperglycemia; furthermore, basal and insulin-mediated muscle glucose uptake can be increased by a selective increase in HKII expression.

Giant cell fibroblastoma: a case report

A one-year-old girl with a giant cell fibroblastoma (GCF) of the skin in the left arm is described. The tumor presented as a small, asymptomatic, subcutaneous mass that enlarged relatively slowly. GCF is a rare mesenchymal tumor occurring predominantly in young children. Its unique histopathological feature can lead to a misdiagnosis as sarcoma very easily. We review briefly the clinical and pathological information of 68 documented cases in the literature and discuss the pathogenesis of this peculiar neoplasm.

Transgenic mice with muscle-specific insulin resistance develop increased adiposity, impaired glucose tolerance, and dyslipidemia

Impaired skeletal muscle insulin receptor function is a feature of common forms of insulin resistance, including obesity and noninsulin-dependent diabetes mellitus. However, the extent to which this defect accounts for impaired muscle glucose disposal or altered in vivo glucose homeostasis remains to be established. We recently showed that transgenic mice that overexpress dominant-negative insulin receptors specifically in striated muscle have a severe defect in muscle insulin receptor-mediated signaling and modest hyperinsulinemia. Here we performed hindlimb perfusion studies to determine the impact of this defect on muscle glucose uptake and metabolism. Maximal rates of insulin-stimulated muscle 3-O-methylglucose transport were reduced by 32-40% in transgenic mice with proportional defects involving total hindlimb [14C]glucose uptake, lactate production, and muscle glycogen synthesis. To address the hypothesis that muscle insulin resistance could promote an increase in the accretion of body fat, carcass analysis was performed using two independent lines of transgenic mice. Although body weights were normal, transgenic mice had a 22-38% increase in body fat, with a reciprocal decrease (10-15%) in body protein. Mean gonadal fat pad weight was also increased in transgenic mice. Skeletal muscle histology and fiber type distribution were not affected. To determine whether muscle-specific insulin resistance was sufficient to cause impaired glucose tolerance, oral glucose tolerance tests were performed with 6-month-old transgenic and control mice. Fasting glucose levels were increased by 25%, and peak values were 22-40% higher in transgenic mice. Transgenic mice also had a 37% decrease in plasma lactate levels and modest increases in levels of plasma triglycerides and FFA (29% and 15%, respectively). We conclude that 1) severe defects in muscle insulin receptor function result in impaired insulin-stimulated glucose uptake and metabolism in this tissue; 2) muscle-specific insulin resistance can contribute to the development of obesity; and 3) a "pure" defect in insulin-mediated muscle glucose disposal is sufficient to result in impaired glucose tolerance and other features of the insulin resistance syndrome, including hyperinsulinemia and dyslipidemia.

Ultrasound-guided fluid aspiration and prenatal diagnosis of duplicated hydrometrocolpos with uterus didelphys and septate vagina

We report on a case of duplicated hydrometrocolpos with uterus didelphys, a septate vagina, lower vaginal atresia, a persistent urogenital sinus, left ear agenesis, a single umbilical artery, and an imperforate anus, but without the associated features of McKusick-Kaufman syndrome such as polydactyly and congenital heart defects. Ultrasound-guided fluid aspiration of the fetal intrapelvic cystic mass helped to decompress the distended genital organs, decrease the severity of the urinary tract obstruction, delineate the ultrasonographic image of duplicated hydrometrocolpos to differentiate it from other intrapelvic cystic masses, and obtain fluid for cytological analysis.

Pancreatitis in children--experience with 43 cases

Pancreatitis in children is not common and can be associated with severe morbidity and mortality. We encountered 43 children, ranging in age from 2 to 18 years, with pancreatitis over the past 10 years. The diagnosis of pancreatitis was made in those patients who showed: (1) significant intra-operative pathology or; (2) clinical findings of pancreatic inflammation and laboratory confirmation. More than one third (16 cases) of the cases were due to trauma, other causes included systemic disease (10), structural disease (8), and toxins or drugs (4). Five cases were classified as idiopathic. Most of the patients presented with abdominal pain (95%) and vomiting (56%). Jaundice was found in 7 patients and an abdominal mass in 2. Morbidity included pseudocyst (10), relapse (4), hyperglycaemia (4) and miscellaneous problems. Eight (50%) of the patients with trauma and 6 (86%) of the patients with structural diseases required surgery. Other patients were managed conservatively with bowel rest, gastric decompression, intravenous fluid and total parenteral nutrition. One case had a fatal outcome. All the survivors did well in long term follow up. Relevant literature has been reviewed and the sensitivity of various diagnostic modalities compared and discussed. A lesser known association between pancreatitis and structural anomalies such as choledochal cyst is discussed. To our knowledge, the present review is the first on pancreatitis in Chinese children.

CONCLUSION

Pancreatitis can occur from a wide variety of causes and may result in severe complications. Early diagnosis, close monitoring and aggressive intervention are mandatory to reduce morbidity and mortality.

A program for eradication of hepatitis B from Taiwan by a 10-year, four-dose vaccination program

Approximately 15 percent of the Taiwanese population are chronic carriers of hepatitis B virus (HBV), among the highest rates in Asia. In July 1984, the Taiwanese government initiated a nationwide HBV-vaccination program. The program began with educational efforts and voluntary prenatal screening for HBsAg. Infants of HBsAg-carrier mothers received a four-dose regimen of hepatitis B vaccine. Those born to highly infectious mothers also received a dose of hepatitis-B immune globulin within 24 hours after birth. Seroepidemiologic studies were conducted using a random sample of infants. Serum samples were collected at 18, 24, 36, and 48 months and analyzed via radioimmunoassay for HBsAg, anti-HBs, and anti-HBc. Infants of highly infectious mothers had HBsAg positivity rates of 14.2 percent (vaccine plus HBIG) and 19.7 percent (vaccine only) when on schedule, and 17.0 percent when off schedule. Infants of moderately infectious mothers had an HBsAg positivity rate of 3.0 percent when on schedule and 6.4 percent when off schedule. These low positivity rates persisted throughout the 48-month follow-up period. This represents a dramatic improvement upon the 40 to 96 percent vertical transmission rate seen before the program implementation. This program demonstrates that mass immunoprophylaxis for HBV is feasible, and provides practical strategies for other Asian countries.

Torticollis: a long-term follow-up study

To achieve better guidelines for the future management of torticollis, this study analyzed surgical and nonsurgical management of 253 torticollis patients who were treated in this hospital from 1971 to 1993. Of those, 37 cases received operation only, 78 cases were operated after failed physical therapy, and 138 cases were treated only at the Rehabilitation Department. If free neck movement was considered to be the primary goal of treatment, most parents were satisfied with the results. However, if facial and skull deformities were the serious sequelae of torticollis, then only less than half of the surgical and nonsurgical groups of patients were graded as normal. Further, 10.9% of physical therapy group and 7% of the surgical patients need further operation to release the fibrotic bundle which limited their neck movement. Therefore, it is suggested that torticollis treatment should include early interventions such as adjusting sleep position, careful planning of physical therapy and/or operation and a long term follow-up period as essential for better management of torticollis.

Prospective study of noise exposure during pregnancy on birth weight

To examine the effect of noise exposure during pregnancy on infant birth weight, a well-characterized cohort of 200 pregnant women in the first trimester participating in prenatal care clinics was followed throughout gestation (in Taiwan, 1991). Individual 24-hour noise exposure of all women was prospectively measured, and information regarding possible noise exposure from traffic and occupation was also obtained. Noise exposure during pregnancy was correlated with the birth weights of the women's babies. No association between personal noise exposure measured in decibels (less than 85 dBALeq during pregnancy) and birth weight was found. Possible occupational noise exposure (indicated by working in a manual job), traffic noise exposure (indicated by distance between the home and main streets), and a history of listening to amplified music and using personal listening devices during pregnancy also showed no effect on infant birth weight. Maternal weight, maternal weight gained during pregnancy, gestational age, and infant's sex were the four factors that correlated significantly with birth weight. The noise exposure experienced by women during pregnancy may not be great enough to affect their infants' birth weight.

Lead poisoning caused by contaminated Cordyceps, a Chinese herbal medicine: two case reports

Two cases of lead poisoning, caused by the Chinese herbal medicine Cordyceps, were reported to the Department of Health in a laboratory-based blood lead surveillance program. Such unusual cases of lead poisoning have not been previously reported. These two patients took Cordyceps herbal medicine for treatment of underlying diseases. Loss of appetite and anemic signs of lead poisoning were manifested in one patient with a blood lead level of 130 microg/dl, while the other patient was asymptomatic with a blood lead level of 46 microg/dl. The lead content in the Cordyceps powder was found to be as high as 20 000 ppm. After cessation of intake in the asymptomatic patient, and cessation of intake and treatment with chelating agents in the symptomatic patient, the blood lead levels returned to normal range. This report raises concerns about lead poisoning from unusual herbal medicine worldwide.

Retroperitoneal fibrosis and juvenile rheumatoid arthritis

We describe a 13-year-old girl with juvenile rheumatoid arthritis who developed obstructive uropathy and renal failure. Retroperitoneal fibrosis (RPF) was confirmed by surgery. Although the renal failure and hydronephrosis resolved after surgery, the symptoms of vascular occlusion persisted. We consider that early diagnosis and treatment are essential. In cases of autoimmune disease, RPF should be considered when there is acquired obstructive uropathy accompanied by vascular occlusion syndrome.

Blood lead levels in Taiwanese adults: distribution and influencing factors

Five-thousand nine-hundred thirteen Taiwanese adults were selected by multistage sampling methods to investigate environmental lead exposure in Taiwan. The blood specimens were distributed to six laboratories for blood lead levels (BLL) measurement. The mean BLL of the 5913 Taiwanese adults was 8.28 +/- 5.39 microg/dl, with a maximum level of 57.6 microg/dl. The median was 7.0 microg/dl and 90th percentile was 15.0 microg/dl. BLLs were associated with gender, ethnic group, education level, smoking, alcohol consumption, herbal drug consumption, milk consumption, sources of drinking water, level of urbanization, and occupational lead exposure. These results showed that BLLs in Taiwanese adults were stable during the 2-year study. Most of the influencing factors were consistent with other studies, while local risk factors, such as Chinese herbal drug consumption are important ways of preventing the general population from overexposure to lead.

Three-year survey of blood lead levels in 8828 Taiwanese adults

The purpose of this study was to investigate environmental lead exposure in the general Taiwanese population. A total of 8828 Taiwanese adults selected by a multistage sampling method were investigated. Characteristics of the participants were ascertained by questionnaire and 10 ml venous blood was drawn by public health nurses. The blood specimens were distributed to six laboratories for blood lead level (BLL) measurement. A quality control program was applied during the analysis of the BLLs in order to improve precision and accuracy. The arithmetic mean BLL of the 8828 Taiwanese adults was 7.70 +/- 5.23 micrograms/dl, with a maximal level of 69.1 micrograms/dl. The median was 6.5 micrograms/dl and the 90th percentile was 14.0 micrograms/dl. After logarithmic transformation, the geometric mean was 1.84 +/- 0.67 microgram/dl. This study also found that elevated BLLs were associated with certain personal characteristics, i.e., gender, ethnic group, and education level; life-style factors, such as smoking, alcohol consumption, Chinese herbal drug consumption, milk consumption, and sources of drinking water; residential location, i.e., level of urbanization; and occupational history of lead exposure. However, age, floor level of residence, distance from house to road, and betel nut consumption were not associated with elevated BLLs. These results showed that BLLs in the Taiwanese population were not higher than those in developed and developing countries. Most of the influencing factors were also found in other studies; however, local factors such as ethnic group, Chinese herbal drug consumption, and sources of drinking water are important considerations in Taiwan when examining ways to prevent overexposure to lead in the general population.

Insulin stimulation of mitogen-activated protein kinase, p90rsk, and p70 S6 kinase in skeletal muscle of normal and insulin-resistant mice. Implications for the regulation of glycogen synthase

Skeletal muscles from mice stimulated with insulin in vivo were used to evaluate relationships between the insulin receptor tyrosine kinase, mitogen-activated protein (MAP) kinase, p90rsk, p70 S6 kinase (p70S6k), and glycogen synthase. Two models of insulin resistance were also evaluated: (a) transgenic mice with a severe insulin receptor defect and (b) gold thioglucose (GTG) mice (obesity with minimal insulin receptor dysfunction). In normal mice, insulin stimulated MAP kinase (6-fold), p90rsk (RSK2, 5-fold), p70S6k (10-fold), and glycogen synthase (30-50% increase in fractional velocity). In transgenic mice, stimulation of MAP kinase and RSK2 were not detectable, whereas activation of p70S6k and glycogen synthase were preserved. In GTG mice, activation of MAP kinase, RSK2, p70S6k, and glycogen synthase were impaired. Since p70S6k and glycogen synthase were correlated, rapamycin was used to block p70S6k, and glycogen synthase activation was unaffected in normal mice; however, it was partially impaired in transgenic mice.

CONCLUSIONS

(a) stimulation of p70S6k and glycogen synthase are selectively preserved in muscles with a severe insulin receptor kinase defect, indicating signal amplification in pathways leading to these effects; (b) MAP kinase-RSK2 and p70S6k activation are impaired in obese mice, suggesting multiple loci for postreceptor insulin resistance; (c) glycogen synthase was dissociated from MAP kinase and RSK2, indicating that they are not required for this effect of insulin; and (d) p70S6k is not essential for glycogen synthase activation, but it may participate in redundant signaling pathways leading to this effect of insulin.

Aircraft noise, hearing ability, and annoyance

The relationship between aircraft noise, loss of hearing, and annoyance was explored in a study in two schools located near an international airport in Taiwan. Sixth-grade students (N = 242) were recruited from two schools and were classified into high- and low-noise-exposure groups, based on environmental noise measurements. Personal-equivalent 24-h noise exposure was measured to determine noise exposure at the individual level, and it was compared with hearing threshold level and with aircraft noise measured at the environmental level. Individual hearing threshold levels did not differ between environmental high- and low-noise-exposure groups, as evidenced by the lack of difference between the two groups for noise exposure measured at the individual level. However, the proportion of students who were annoyed by aircraft noise was higher in the environmental high-noise-exposure group, although personal 24-h noise exposure was not a factor for annoyance. The results indicated that environmental noise measurement was not an appropriate criterion for assessment of auditory damage (or noise-induced hearing loss) in Taiwan. As well, aircraft-noise exposure in Taiwan did not appear to affect the hearing threshold but nonetheless annoyed schoolchildren near the airport.

Calcifying aponeurotic fibroma: a report of three cases

Calcifying (juvenile) aponeurotic fibroma (CAF) is a rare disease entity characterized by a tendency to develop in the palms and soles of children and young adults. It has definite histologic features of an ill-circumscribed fibroblastic proliferation, with foci of calcification and chondroid differentiation, as well as a recurring or locally aggressive growth pattern. The commonly accepted mode of treatment is wide excision of the tumor; extensive surgery is usually not necessary even for recurrences. Three cases are reported, all of when were female with the age ranging from 8 to 27 years. All lesions were in the hand or foot, and one of them was recurrent. Immunohistochemical study was performed and the literature reviewed.

Impaired insulin signaling in skeletal muscles from transgenic mice expressing kinase-deficient insulin receptors

Transgenic mice which overexpress kinase-deficient human insulin receptors in muscle were used to study the relationship between insulin receptor tyrosine kinase and the in vivo activation of several downstream signaling pathways. Intravenous insulin stimulated insulin receptor tyrosine kinase activity by 7-fold in control muscle versus < or = 1.5-fold in muscle from transgenic mice. Similarly, insulin failed to stimulate tyrosyl phosphorylation of receptor beta-subunits or insulin receptor substrate 1 (IRS-1) in transgenic muscle. Insulin substantially stimulated IRS-1-associated phosphatidylinositol (PI) 3-kinase in control versus absent stimulation in transgenic muscles. In contrast, insulin-like growth factor 1 modestly stimulated PI 3-kinase in both control and transgenic muscle. The effects of insulin to stimulate p42 mitogen-activated protein kinase and c-fos mRNA expression were also markedly impaired in transgenic muscle. Specific immunoprecipitation of human receptors followed by measurement of residual insulin receptors suggested the presence of hybrid mouse-human heterodimers. In contrast, negligible hybrid formation involving insulin-like growth factor 1 receptors was evident. We conclude that (i) transgenic expression of kinase-defective insulin receptors exerts dominant-negative effects at the level of receptor auto-phosphorylation and kinase activation; (ii) insulin receptor tyrosine kinase activity is required for in vivo insulin-stimulated IRS-1 phosphorylation, IRS-1-associated PI 3-kinase activation, phosphorylation of mitogen-activated protein kinase, and c-fos gene induction in skeletal muscle; (iii) hybrid receptor formation is likely to contribute to the in vivo dominant-negative effects of kinase-defective receptor expression.

Neonatal-onset chronic intestinal pseudo-obstruction syndrome

Between January 1985 and January 1990, six cases of neonatal-onset chronic intestinal pseudo-obstruction syndrome (CIPS) were identified. Failure to gain weight in six cases, abdominal distention in five, and vomiting in five were the most common presenting symptoms. The contrast studies of the gastrointestinal tract demonstrated delayed transit time in 6/6, jejunal or ileal dilatation in 1/6, megaduodenum in 1/6, dilatation of the colon with barium retention in 4/6, and microcolon in 1/6. Urinary tract involvement was noted in three patients. Laparotomy, performed in three patients, revealed no mechanical obstruction. Except for hypoganglionosis in Patient 4, no recognizable neuropathy or myopathy was noted histopathologically. Four patients expired within 2 months after discharge. We conclude that CIPS with neonatal onset should be suspected when infants have urinary retention and abdominal distention or constipation beginning at birth or soon after. The prognosis of CIPS presenting in the newborn period appears worse than that presenting in childhood or adulthood.

Establishment of an occupational diseases surveillance system to monitor blood lead levels in Taiwan

BACKGROUND

Occupational diseases share many common characteristics with infectious diseases. However, the successful approach of using surveillance systems to eradicate infectious diseases has never been applied to the control and prevention of occupational diseases.

METHODS

On the basis of a nationwide survey of blood lead levels in the general population in Taiwan, we (the Ministry of Health, Taiwan) have developed an obligatory surveillance system for blood lead.

RESULTS

This government-administered system, which uses laboratory data as its source of information, enrolls all workers whose blood lead level exceeds regulation points (40 microgram/dl for men and 30 micrograms/dl for women). A Group of Health Promotion of Lead-using Workers (GHPLW) has been organized to be responsible for conducting epidemiological investigations to locate exposure sources in the workplace and to improve the working environment of cases and other workers with the same exposure.

CONCLUSIONS

We emphasize that the accomplishment of the GHPLW's task depends not only on "curing" the case, but also on eradicating the lead exposure source and decreasing the blood lead level of workers in the workplace during long-term follow-up. The system aims to upgrade occupational disease control to the stage of specific prevention and health promotion. The establishment of this system is a historic step in industrial hygiene and occupational disease prevention in Taiwan.

Elements in the long terminal repeat of HIV-1 that interact with nuclear extracts from Jurkat cells persistently infected with vaccinia virus

Previous reports showed transactivation of the long terminal repeat (LTR) of HIV-1 in Jurkat cells persistently infected with vaccinia virus. In this communication, electrophoretic mobility shift assays were used to characterize the elements in HIV-1 LTR which might be responsible for the mechanism of transactivation. The results indicated that two elements, those for binding NF-kB and NFAT-1, were able to interact with nuclear extracts derived from Jurkat cells persistently infected with vaccinia virus, suggesting that they may play a role in the transactivation of HIV-1 LTR.

Blood lead levels in the general population of Taiwan, Republic of China

The purpose of this study was to investigate the environmental lead exposure of the general population in Taiwan. A total of 2919 residents of Taiwan were selected by multistage sampling methods. The participants were characterized by questionnaires and 10 ml venous blood was collected for blood lead measurement. A quality assurance/quality control program was designed during the analysis of blood lead levels. The mean blood lead level of 2719 residents without occupational lead exposure was 8.29 +/- 5.92 micrograms/dl. After adjustment for age and sex distribution to the Taiwan general population, the mean blood lead level was 8.10 micrograms/dl. Adjusted for an 11% underestimation of blood lead levels among the six laboratories, the mean blood lead level was estimated to be 8.99 micrograms/dl. This study also found that blood lead levels were associated with personal characteristics, i.e., gender, ethnic group, education level; lifestyle factors, i.e., smoking, alcohol consumption, sources of drinking water; and residential location, i.e., levels of urbanization, distance of house from the road. However, age, floor of residence, milk consumption, betel nut consumption, and Chinese herbal drug consumption were not found to be associated with blood lead levels. These results show that blood lead levels in Taiwan residents were not higher than in most developed and developing countries. Environmental lead pollution does not seem to be a serious problem in Taiwan.