The agreement between self-reporting and clinical diagnosis for selected medical conditions among the elderly in Taiwan

A cross-sectional survey was conducted to consider whether there is agreement between self-report and clinical diagnosis in the prevalence of selected common chronic diseases among elderly Taiwanese. Between July 1992 and June 1993, both face-to-face interview and clinical evaluation were applied to a sample of 228 Taiwanese aged 65 y and older to estimate the prevalence of heart diseases, hypertension and diabetes. The results showed that a self-reported history of diabetes had the highest sensitivity (66. 7%) and specificity (95.2%). The self-report of heart diseases was the least sensitive (20.5%), while self-reports of hypertension was the least specific (82.8%). Multivariate analyses showed that age, education and number of self-reported diseases suffered from, appeared to influence the accuracy of the self reported data. Our data suggest a notable lack of agreement abetween self-report and clinical diagnosis for medical conditions, even for those with clear and unambiguous diagnostic criteria. The elderly in Taiwan tended to under report (with a consistently higher false negative rate than false positive rate) the existence of the three selected medical conditions. This was especially so for heart diseases. Our findings suggest that, if the level of disease prevalence in the population needs to be known for health planning estimates for hypertension and diabetes would not necessarily be a problem. However, the prevalence for heart disease would be seriously under-estimated. We also argue that information obtained by self-report should be validated before use, especially in the case of assessment of the prevalence of medical conditions in the elderly.

Purification and characterization of beta-adrenergic receptor mRNA-binding proteins

Beta-adrenergic receptors (beta-ARs), like other G-protein-coupled receptors, can undergo post-transciptional regulation at the level of mRNA stability. In particular, the human beta(1)- and beta(2)-ARs and the hamster beta(2)-AR mRNA undergo beta-agonist-mediated destabilization. By UV cross-linking, we have previously described an approximately M(r) 36,000 mRNA-binding protein, betaARB, that binds to A/C+U-rich nucleotide regions within 3'-untranslated regions. Further, we have demonstrated previously that betaARB is immunologically distinct from AUF1/heterogeneous nuclear ribonucleoprotein (hnRNP) D, another mRNA-binding protein associated with destabilization of A+U-rich mRNAs (Pende, A., Tremmel, K. D., DeMaria, C. T., Blaxall, B. C., Minobe, W., Sherman, J. A., Bisognano, J., Bristow, M. R., Brewer, G., and Port, J. D. (1996) J. Biol. Chem. 271, 8493-8501). In this report, we describe the peptide composition of betaARB. Mass spectrometric analysis of an approximately M(r) 36,000 band isolated from ribosomal salt wash proteins revealed the presence of two mRNA-binding proteins, hnRNP A1, and the elav-like protein, HuR, both of which are known to bind to A+U-rich nucleotide regions. By immunoprecipitation, HuR appears to be the biologically dominant RNA binding component of betaARB. Although hnRNP A1 and HuR can both be immunoprecipitated from ribosomal salt wash proteins, the composition of betaARB (HuR alone versus HuR and hnRNP A1) appears to be dependent on the mRNA probe used. The exact role of HuR and hnRNP A1 in the regulation of beta-AR mRNA stability remains to be determined.

[Design of a data acquisition circuit for ventricular late potentials and electrocardiogram]

This paper introduces a data acquisition circuit that is able to acquire ventricular late potentials and standard 12-lead electrocardiogram signals. This circuit adopts time interruption acquisition, it has the characteristics of programmed gain, isolated ground, low-noise, high-CMRR, collecting data for a long time.

Surgical outcome of combined phacoemulsification and trabeculectomy

BACKGROUND

A retrospective study was undertaken to evaluate the results of phacoemulsification, intraocular lens implantation, and trabeculectomy in patients with cataracts coexisting with glaucoma.

METHODS

This study consisted of 20 eyes from 19 patients. Fifteen eyes had chronic angle-closure glaucoma and 5 eyes had primary open-angle glaucoma. All cases were followed for a minimum of 6 months (range, 6 to 16 months). The mean preoperative intraocular pressure (IOP) was 17.3 +/- 4.5 mmHg. The mean preoperative visual acuity was 0.05 +/- 0.19. The mean number of preoperative antiglaucoma medications per patient was 2.3.

RESULTS

Postoperatively, all patients except for one no longer required antiglaucoma medication. The mean IOP was 10.7 +/- 3.7 mmHg one month postoperatively and 13.7 +/- 4.3 mmHg at the final follow-up visit. Vision improved in 80% of the patients and remained unchanged in 20%. The failure to achieve improvement was due to advanced optic atrophy. The mean level of surgically induced astigmatism at the final visit was 0.98 +/- 0.91 diopters as calculated by vector analysis. Various extents of fibrin exudate was found in 10 eyes (50%). The most serious postoperative complication, occurring in one eye (5%), was temporary hypotony with moderate choroidal effusion, which later resolved spontaneously.

CONCLUSION

Combined phacoemulsification and trabeculectomy is an effective and safe approach for obtaining good visual rehabilitation and glaucoma control.

Effects of cognitive impairment and loss of physical capacities on survival of the elderly

This study investigates the effects of cognitive impairment and loss of physical capacity on the survival rates of the elderly in Taiwan. Data used for this research were obtained from a longitudinal study in northern Taiwan, where 1,434 elderly respondents were randomly selected and were interviewed in 1993 and 1996. Respondents were categorized into four groups: those with physical disability, those with cognitive impairment, those with neither condition and those with both conditions. The survival rates of these four groups were analyzed and compared. The effects of cognitive impairment and physical disability were assessed separately and jointly. Within the study period, we found that elderly persons with both conditions had the lowest survival rate (0.54, 95% confidence interval (CI) 0.35-0. 73), while those with neither condition had the most favorable survival rate (0.92, 95% CI 0.90-0.93). Results from the Cox proportional hazard model showed that physical disability had a significantly adverse effect on the risk of mortality (relative risk 2.5, 95% CI 1.5-4.2), while cognitive impairment did not. Our results are consistent with previous findings which have shown that the decline in physical function affects mortality more than the decline in cognitive function.

Stress, social relations, and old age mortality in Taiwan

The research analyzed the relationships among stress, social relations, and mortality in a probability sample of 4,049 Taiwanese adults, aged 60 and over. The baseline survey was conducted in 1989 and the survival status of the respondents was ascertained during the subsequent 4 years. Death of a spouse or a child was found to increase the risk of dying directly and indirectly, whereas major financial difficulty during the past 5 years and current financial strain influenced mortality indirectly through their effects on self-rated health disability. In addition to their direct effect on mortality, martial status and work status lowered the probability of dying through decreased disability and subjective ill health. Finally, no buffering effects of social support were substantiated.

Incidence of and predictors for chronic disability in activities of daily living among older people in Taiwan

OBJECTIVES

To estimate the incidence of chronic activities of daily living (ADL) disability and to analyze the sociodemographic, health status, adverse lifestyle, and leisure-time physical activity predictors for chronic ADL disability.

DESIGN

We recruited a cohort of community-dwelling older people in Taipei, Taiwan, who were not ADL disabled in August 1993, and we followed them until August 1996.

SETTINGS AND PARTICIPANTS

The study subjects were 1321 community-dwelling people aged 65 years or older who were ADL intact at the initial interview in August 1993. The study sample was a subset of a probability sample (n = 1583) randomly selected from household registrations in the four districts of the Taipei metropolitan area.

MEASUREMENTS

Baseline information regarding various factors potentially associated with the development of chronic ADL disability was assessed and collected at the beginning of the study. Study participants were assessed annually for ADL function by a structured home interview using a six-item scale. Participants who were unable to perform independently at least one of the six items--eating, bathing, dressing, toileting, transfers, and walking inside the house--for more than 3 months were considered chronically ADL disabled. Cox proportional hazard regression models were utilized to examine the independent effect of the potential predictors on risk of chronic ADL disability.

RESULTS

During the 3-year study period, 145 (11.0%) participants developed chronic ADL disability, 58 (4.4%) participants were lost to follow-up, and 83 (6.3%) participants died. Multiple hazard regression analysis showed that individuals aged 70 to 79 years or older than age 80 had increased risk of ADL disability (relative risk: 2.05 (95% confidence interval (CI), 1.35-3.11) and 3.89 (95%CI, 2.33-6.50), respectively) compared with those participants younger than age 70. Risk of chronic ADL disability was inversely associated with routine exercise (RR = 0.52; 95% CI, 0.39-0.68).

CONCLUSIONS

Age is the most significant predictor of chronic ADL disability. Lack of routine exercise is also a significant predictor of ADL disability in older adults.

The effectiveness of acupressure in improving the quality of sleep of institutionalized residents

BACKGROUND

Elderly people often suffer from disturbed sleep. Because traditional Chinese medicine indicates that acupressure therapy may induce sedation, testing the effectiveness of acupressure in enhancing the quality of sleep of institutionalized residents with a well-designed scientific study is needed.

METHODS

A randomized block experimental design was used. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used as a screening tool to select subjects with sleep disturbance. By matching the effects of hypertension, hypnosis, naps, and exercise, subjects were randomly assigned to an acupressure group, a sham acupressure group, and a control group. Each group had 28 subjects for a total of 84 subjects. The same massage routine was used in the acupressure group and the sham acupressure group, whereas only conversation was employed in the control group.

RESULTS

There were significant differences in PSQI subscale scores of the quality, latency, duration, efficiency, disturbances of sleep, and global PSQI scores among subjects in the three groups before and after interventions. Furthermore, there was a significant reduction in the frequencies of nocturnal awakening and night wakeful time in the acupressure group compared to the other two groups.

CONCLUSIONS

This study confirmed the effectiveness of acupressure in improving the quality of sleep of elderly people and offered a nonpharmacological therapy method for sleep-disturbed elderly people.

Development of improved pUB110-based vectors for expression and secretion studies in Bacillus subtilis

pUb110-based vectors are commonly used for expression and secretion studies in Bacillus subtilis. Two of these plasmids, pUB18P43 and pWB705, have been applies to produce several proteins of interest. To offer greater flexibility and compatibility in this system, the authors have also constructed a pE194-based plasmid vector (pE18). To determine whether the pUB110-based or the pE194-based vector serves as a better expression system, three structural genes encoding cytoplasmic BirA, extracytoplasmic PrsA and extracellular staphylokinase, respectively, were used as models. Production of these products using pUB110-based vectors was consistently 2--3-fold lower than that using the pE194-based vectors. The observed difference in the protein yield did not result from either the rearrangement of the plasmid or the difference in the plasmid copy number. By using three different approaches, the lower production yield from the pUB110-based vectors was found to be due to the transcription interference from the plasmid encoded genes. These findings illustrate that the orientation of the inserted gene in pUB110-based vector can greatly affect gene expression. Two new expression vectors, pUB19P43 and pWB980, were constructed to allow better gene expression.

A double-blind, randomized trial of topiramate as adjunctive therapy for partial-onset seizures in children. Topiramate YP Study Group

OBJECTIVE

To evaluate the efficacy and safety of topiramate 6 mg/kg/day in children (age 2 to 16 years) as adjunctive therapy for uncontrolled partial-onset seizures with or without secondarily generalized seizures in a multicenter, randomized, double-blind, placebo-controlled trial.

METHODS

Patients with at least six partial-onset seizures during the 8-week baseline phase were treated with either topiramate (n = 41) or placebo (n = 45) for 16 weeks.

RESULTS

Topiramate-treated patients had a greater median percent reduction from baseline in average monthly partial-onset seizure rate than placebo-treated patients (33.1% versus 10.5%, p = 0.034), a greater proportion of treatment responders (i.e., patients with a > or = 50% seizure rate reduction; 16 of 41 [39%] versus 9 of 45 [20%], p = 0.080), and patients with a > or = 75% seizure rate reduction (7 of 41 [17%] versus 1 of 45 [2%], p = 0.019), and better parental global evaluations of improvement in seizure severity (p = 0.019). Emotional lability (12% versus 4%), fatigue (15% versus 7%), difficulty with concentration or attention (12% versus 2%), and forgetfulness/impaired memory (7% versus 0%) were more frequent among topiramate-treated than placebo-treated patients. Most treatment-emergent adverse events were mild or moderate in severity. No topiramate-treated patients discontinued the study due to adverse events.

CONCLUSIONS

Topiramate was safe and effective in the treatment of partial-onset seizures in children.

Is serum transferrin receptor a sensitive marker of iron repletion in patients with iron-deficiency anemia and hemodialysis patients?

BACKGROUND

Serum transferrin receptor (sTfR) concentration has been recognized as a reliable laboratory indicator of iron deficiency in recent years. But its response to iron supplementation has not been investigated.

METHODS

We evaluated the sTfR concentrations in 15 patients diagnosed with iron-deficiency anemia, in 30 patients receiving maintenance hemodialysis (HD) with iron repletion and in 31 healthy controls. The serial changes of sTfR concentration and their correlation with serum ferritin in patients with iron deficiency under iron repletion were also examined in three patients.

RESULTS

In patients with iron-deficiency anemia, the sTfR concentration was 5.6 +/- 2.4 mg/ml, significantly higher than that in the control group (1.8 +/- 0.4 mg/ml) and patients receiving maintenance HD with iron repletion (1.7 +/- 0.5 mg/ml). The three patients with iron-deficiency anemia who received eight to 16 weeks of iron supplementation showed steady and significant decreases in sTfR concentration and significant increases in serum ferritin and transferrin saturation. However, the decreases in sTfR concentration did not occur immediately, as did the increases in serum ferritin and transferrin saturation, following iron repletion. There was a four-week delayed response in the decrease of sTfR concentrations as measured against serum ferritin and transferrin saturation.

CONCLUSIONS

sTfR concentration may not be as effective as an early index of iron repletion compared with serum ferritin and transferrin saturation.

Zolpidem distribution in postmortem cases

Zolpidem is the prototype of a class of sedative hypnotic drugs that are derivatives of imidazopyridine and is sold in the United States under the trade name Ambien. Over a four-year period, zolpidem was identified in eight cases investigated by the Office of the Chief Medical Examiner, State of Maryland. Zolpidem was identified by gas chromatography-nitrogen-phosphorus detection (GC-NPD) following an alkaline extraction and was confirmed by full-scan electron impact gas chromatography/mass spectrometry. Zolpidem was quantitated by GC-NPD in all specimens received. Five of the cases presented were deaths due to drug intoxication. In three of these cases, zolpidem was an incidental finding because the drug fatalities resulted from other drugs. In the other two cases of drug intoxication, zolpidem was present in elevated concentrations and was a contributing, but not exclusive cause of the drug intoxication. The remaining three cases were deaths that were not caused by drugs. The blood zolpidem concentrations in these cases were therapeutic (0.28, 0.12 and 0.19 mg/L, respectively). In six of the eight cases where both blood and urine were analyzed, the blood concentration was higher than the urine concentration. The distribution of zolpidem into the liver and kidney failed to identify any sequestration of the drug into either specimen.

Fyn associates with Cbl and phosphorylates tyrosine 731 in Cbl, a binding site for phosphatidylinositol 3-kinase

We have investigated the interaction between Cbl and the Src-related tyrosine kinase Fyn. Fyn was observed to be constitutively associated with Cbl in lysates of several different cell types including the interleukin-3-dependent murine myeloid cell line 32Dcl3, and the prolactin-dependent rat thymoma cell line Nb2. Binding studies indicated that Cbl could bind to glutathione S-transferase (GST) fusion proteins encoding the unique, Src homology domain 3 (SH3), and SH2 domains of Fyn, Hck, or Lyn. Fusion proteins encoding either the SH3 or SH2 domains of Fyn bound to Cbl as effectively as the fusion protein encoding the unique, SH3, and SH2 domains of Fyn. The Fyn SH2 domain bound to both tyrosine-phosphorylated and nonphosphorylated Cbl, implying that this interaction might be phosphotyrosine-independent. Binding of the Fyn SH2 domain to Cbl was not disrupted by the addition of phosphotyrosine, phosphoserine, or phosphothreonine. A GST fusion protein encoding the proline-rich region of Cbl bound to Fyn present in a total cell lysate. Far Western blot analysis also indicated that the SH3 domain of Fyn bound preferentially to the proline-rich region of Cbl. The addition of [gamma-32P]ATP to either anti-Cbl immunoprecipitates or anti-Fyn immunoprecipitates resulted in the phosphorylation of both Cbl and Fyn as demonstrated by immunoprecipitation of the phosphorylated proteins with specific antisera. Fyn directly phosphorylated a GST fusion protein containing the C-terminal region of Cbl (GST-CBL-LZIP). In contrast, immunoprecipitated JAK2 was not able to phosphorylate this same region of Cbl. The GST-CBL-LZIP fusion protein contains a binding site for the SH2 domain of the p85 subunit of phosphatidylinositol 3-kinase, which mapped to Tyr731, which is present in the sequence YEAM. Mutation of Tyr731 in GST-CBL-LZIP eliminated binding of the p85 subunit of phosphatidylinositol 3-kinase and substantially reduced the phosphorylation of this fusion protein by Fyn, despite the presence of four other tyrosine residues in this fusion protein. These data are consistent with the hypothesis that Cbl represents a substrate for Src-like kinases that are activated in response to the engagement of cell surface receptors, and that Src-like kinases are responsible for the phosphorylation of a tyrosine residue in Cbl that may regulate activation of phosphatidylinositol 3-kinase.

Ultrasound measurement of the fetal cavum septi pellucidi

OBJECTIVES

To establish normative data for the width of the fetal cavum septi pellucidi at various gestational ages.

SUBJECTS AND METHODS

A total of 608 consecutive fetuses between 19 and 42 gestational weeks were included in this prospective study. The largest width of the cavum septi pellucidi was measured by two-dimensional ultrasound. Piecewise regression analysis was used to study the relationships between the width of the fetal cavum septi pellucidi, gestational age and biparietal diameter.

RESULTS

The fetal cavum septi pellucidi width increased gradually between 19 and 27 weeks of gestation and then plateaued between 28 weeks and term. Regression analysis revealed significant associations between cavum septi pellucidi width and gestational age, and cavum septi pellucidi width and biparietal diameter.

CONCLUSIONS

The present study provides normative data for fetal cavum septi pellucidi width and useful information about the development of the midline brain structure in the fetus.

Helicobacter pylori in gastric biopsies of Taiwanese patients with gastroduodenal diseases

This study was designed to study the in vivo prevalence and the heterogeneity of H. pylori in patients with gastroduodenal diseases in central Taiwan. H. pylori infection was detected in 74.1% (575/776) of the symptomatic population studied. The prevalence of H. pylori infection increased from 11.1% in those between the ages of one to 20, to 82.9% in those between the ages of 41 and 50, and to 84% in those between the ages of 51 and 60. There was no significant difference in the prevalence of H. pylori infection between men and women. Among different blood types, the prevalence and relative risk of H. pylori infection was significantly higher in blood group O patients (90.3%) than in blood group A (41%), blood group B (27.4%), or blood group AB (62%) patients. Metronidazole resistance was found in 6.7% of the primary isolates. The prevalence of metronidazole-resistant H. pylori strains was higher in women (7.69%) than in men (6.25%), but this difference was not significant. A total of 88% of H. pylori strains were cagA-positive. CagA gene-positive strains were present in 90.1% of duodenal ulcers, 90% of duodenal ulcers combined with gastric ulcer, 85.8% of gastric ulcers, and 69.2% of gastritis patients, and was significantly higher in peptic ulcer disease groups than in the gastritis group. In conclusion, there was a low incidence (6.7%) of metronidazole-resistant H. pylori strains and a high prevalence (88%) of H. pylori cagA-positive strains in central Taiwan. This study also demonstrated a significant in vivo correlation between active H. pylori infection and blood group O-positive patients, and showed a significant association between cagA gene-positive H. pylori strains and the development of peptic ulcers.

Serum transferrin receptor concentration is not indicative of erythropoietic activity in chronic hemodialysis patients with poor response to recombinant human erythropoietin

BACKGROUND

Serum transferrin receptor (sTfR) is a transmembrane glycoprotein derived from erythroid precursors in the bone marrow. Its concentration provides a quantitative measure of total erythropoietic activity and an indication of functional iron deficiency. This study was conducted to investigate whether sTfR is a useful index of erythropoietic activity in chronic hemodialysis patients with poor response to maintenance recombinant human erythropoietin (rHuEPO) therapy.

METHODS

Using an enzyme-linked immunosorbent assay, sTfR concentration was measured in 67 uremic patients who had been on hemodialysis for a mean of 42 months (3-242 months). rHuEPO was administered three times a week to keep the hematocrit above 30%. Hemoglobin, red blood cell indices, serum ferritin, serum total iron binding capacity and unsaturated iron binding capacity were determined. Of the 67 patients, 35 who responded favorably to rHuEPO with hematocrits above 30% were categorized as Group I and 32 who did not attain the target hematocrit were categorized as Group II. As a control group, 31 healthy subjects were also investigated.

RESULTS

The serum iron, ferritin, transferrin iron saturation, dialysis efficiency and nutritional state were not different between groups of hemodialysis patients. The mean sTfR concentration was 2.1 +/- 0.6 micrograms/ml (range, 1.15-3.53 micrograms/ml) in Group I patients, compared with 1.9 +/- 0.9 micrograms/ml (range, 1.03-2.65 micrograms/ml) in Group II. The difference was not significant. In addition, the mean sTfR concentration of 1.8 +/- 0.4 micrograms/ml (range, 0.86-2.76 micrograms/ml) in the healthy controls was not significantly different from Groups I and II.

CONCLUSIONS

sTfR concentration cannot be used to distinguish good from poor rHuEPO responders among chronic hemodialysis patients who have elevated serum ferritin (> 300 micrograms/l) and transferrin iron saturation (> 25%) during the course of maintenance rHuEPO therapy.

Enhanced secretory production of a single-chain antibody fragment from Bacillus subtilis by coproduction of molecular chaperones

Formation of inclusion bodies is a major limiting factor for secretory production of an antidigoxin single-chain antibody (SCA) fragment from Bacillus subtilis. To address this problem, three new strains with enhanced production of molecular chaperones were constructed. WB600BHM constitutively produces the major intracellular molecular chaperones in an appropriate ratio without any heat shock treatment. This strain reduced the formation of insoluble SCA by 45% and increased the secretory production yield by 60%. The second strain, WB600B[pEPP], overproduces an extracytoplasmic molecular chaperone, PrsA. An increase in the total yield of SCA was observed. The third strain, WB600BHM[pEPP], coproduces both intracellular and extracytoplasmic molecular chaperones. This led to a further reduction in inclusion body formation and a 2.5-fold increase in the secretory production yield. SCA fragments secreted by this strain were biologically active and showed affinity to digoxin comparable to the affinity of those secreted by strains without overproduction of molecular chaperones. Interestingly, accumulation of a pool of periplasmic SCA was observed in the PrsA-overproducing strains. This pool is suggested to represent the secreted folding intermediates in the process of achieving their final configuration.

The comparative trial of TCu 380A IUD and progesterone-releasing vaginal ring used by lactating women

The objective of this paper was to compare the efficacy, acceptability, safety, and bleeding pattern of TCu 380A intrauterine device (IUD) and progesterone-releasing vaginal ring used by breastfeeding women. The study population included 97 breastfeeding women using IUD and 100 women using vaginal ring. Of the IUD users, no insertion failure, perforation, or accidental pregnancy occurred in 12 months. There was one IUD expulsion. There were no discontinuations of IUD due to medical reasons other than expulsion. The total discontinuation rate was 2.3%. In the ring group, no accidental pregnancy occurred. The major reasons for discontinuation were ring use-related problems and vaginal problems. The total discontinuation rate was 65.4% within 1 year. The frequency of any one complaint among the ring users was higher than that among the IUD users. There were no differences in the proportion of women having no sexual activity and in the weight of their babies between the two groups. Compared with the IUD users, the median number of bleeding/spotting (B/S) episodes and B/S days of the vaginal ring users were fewer; consequently, the mean length of B/S-free interval was longer in all four reference periods; the mean length of B/S episode and segment were the same; the occurrence of amenorrhea was more frequent; in contrast, the proportions of normal bleeding patterns were fewer. The frequencies of prolonged bleeding, frequent bleeding, and infrequent bleeding patterns did not differ between the two groups. The percentage of irregular bleeding was fewer only in the first two reference periods. It is concluded that the TCu 380A IUD and progesterone-releasing vaginal ring used by breastfeeding women are safe and effective. The higher discontinuation rate of the ring users was mainly because of use-related problems. Breastfeeding women with TCu 380A IUD had better tolerance and acceptability. The TCu 380A IUD does not, but the progesterone-releasing vaginal ring does, suppress the recovery of ovarian function. However, once return of menstruation occurred, there were no differences in bleeding patterns between the two contraceptive methods.

[Factors influencing morale among the elderly in long-term care]

The purpose of this research was to investigate the factors which influence morale among the elderly in long-term care. The sampling criteria for subjects were that they were (1) 65 years old or older and were residents or care recipients at a nursing home, day care or home care center which participated in the experimental project in Department of Health; (2) able to understand the Mandarin or Taiwanese language; (3) capable of verbal communication; and (4) family caregivers whose elder family met the above three requirements. A total sample of 174 subjects consisting of 87 elderly and 87 caregivers were chosen. Research findings revealed: the mean score for morale for elderly in this study was 11.71 out of range 2-19. Except for birthplace and caring models, there was no significant difference among the elderly. The elderly born in Taiwan had significantly higher morale than those born in Mainland China. The elderly in day care had significantly higher morale than those in home care and nursing homes. No significant difference was found among family caregivers, except for family caregivers who had changed their job due to the demands of caring for elderly relations. Elderly in this situation showed significantly lower morale in the elderly whose family caregivers did not change jobs. Correlation analysis showed a positive relationship between the elderly's level of daily activity and their morale level. Higher morale in the elderly was also found to be positively related to perceived higher levels of social support in family caregivers. In multiple regression, morale among the elderly was used as the criterion variable, while the variables of birth place, functional status, caregivers' perceived social support, home care, nursing home, changed job, never having had a job, caregivers' sex caregivers' educational level were used as predictors. The explanation variance achieved using the above research model was 30.78%. Recommendations derived from this study include suggesting the establishment of community adult day care centers to facilitate the elderly being able to stay within their communities, and to provide mental support for caregivers.

Increase of primary HIV-1 production in human peripheral blood mononuclear cells by intermittent medium replenishment

Mitogen-stimulated human peripheral blood mononuclear cells (H-PBMCs) are conventionally used to culture primary human immunodeficiency virus type-1 (HIV-1) isolates in vitro. In this study, we attempt to increase the quality of primary HIV-1 stocks harvested from H-PBMC culture using medium replenishment procedures. Experimental/analysis results indicate that more frequent medium replenishment may not lead to improved quantity and quality of harvested virus stock titers, as determined by the viral core (p24) antigen content, viral infectivity, and viral particle-to-infectious unit ratio. This finding implies the conditioning factor(s) present in H-PBMC culture may be important for primary HIV-1 production. The optimal rate for intermittent medium replenishment to achieve the lowest viral particle-to-infectious unit ratio is around 0.25 volume/volume/day.

Antigenic characterization of nine wild-type Taiwanese isolates of Japanese encephalitis virus as compared with two vaccine strains

The antigenic properties of nine wild-type Japanese encephalitis viruses isolated in Taiwan during 1990 1994 were investigated by comparison with two inactivated vaccine strains (Beijing-1, Nakayama-NIH). All of the nine Taiwanese isolates were found to induce higher cytopathology in Vero cells but showed similar mouse virulence as the two vaccine strains. Antigenic characterization using six E protein-specific monoclonal antibodies shows two of the nine wild-type isolates (i.e. CH1949 and CH2195) presented different antigenic properties of hemagglutination inhibition and plaque reduction neutralization. The E-protein gene nucleotide sequences of CH1949 and CH2195 were determined and compared with other published sequences of the two vaccine strains and other 19 Asian/Taiwanese isolates. Phylogenetic tree analysis indicates these two wild-type Taiwanese isolates are more distant from the two vaccine strains.

Low molecular weight heparin in diabetic and nondiabetic hypercholesterolemic patients receiving long-term hemodialysis

Dyslipidemia is a major factor associated with cardiovascular disease, which is the leading cause of death in hemodialysis patients. Low molecular weight heparin (LMWH) is superior to conventional unfractionated heparin in treating hyperlipidemia in nondiabetic long-term hemodialysis patients and has fewer side-effects. Only a few reports have addressed the influence of LMWH on serum lipids in diabetic patients, although dyslipidemia is common among this population. We investigated the effect of LMWH on serum lipids in 12 nondiabetic and eight diabetic hypercholesterolemic patients receiving long-term hemodialysis. Patients had been receiving hemodialysis with unfractionated heparin for a minimum of 6 months before beginning the study. Continuous LMWH infusion during hemodialysis was administered to all patients for 2 months, followed by unfractionated heparin administration for 2 months. During LMWH treatment, plasma anti-factor Xa activity increased from 0.06 +/- 0.04 IU/mL before dialysis to 0.49 +/- 0.25 IU/mL after 3 hours. Serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and apolipoprotein B (Apo B) in both nondiabetic and diabetic patient groups and lipoprotein (a) (Lp(a)) in patients with higher initial values (> or = 15 mg/mL) decreased significantly after LMWH treatment (TC from 6.38 +/- 1.14 to 5.07 +/- 1.09 mmol/L, LDL-C from 3.08 +/- 0.93 to 2.15 +/- 0.88 mmol/L, Apo B from 100 +/- 18 to 78 +/- 18 mg/dL, all p < 0.01; Lp(a) from 41.8 +/- 34.5 to 28.5 +/- 22.8, p < 0.05). They rebounded to pre-LMWH levels after the 2 months on unfractionated heparin (TC 5.72 +/- 1.11 mmol/L, LDL-C 2.97 +/- 1.01 mmol/L, Apo B 98 +/- 20 mg/dL, Lp(a) 38.1 +/- 29.0 mg/dL). We conclude that continuous infusion of LMWH during dialysis reduces serum total cholesterol, low-density lipoprotein-cholesterol, and apolipoprotein B concentrations in both diabetic and nondiabetic hypercholesterolemic hemodialysis patients, and does not increase the risk of bleeding compared with unfractionated heparin.

Mouse Mesenchyme forkhead 2 (Mf2): expression, DNA binding and induction by sonic hedgehog during somitogenesis

Cloning and sequencing of mouse Mf2 (mesoderm/mesenchyme forkhead 2) cDNAs revealed an open reading frame encoding a putative protein of 492 amino acids which, after in vitro translation, binds to a DNA consensus sequence. Mf2 is expressed at high levels in the ventral region of newly formed somites, in sclerotomal derivatives, in lateral plate and cephalic mesoderm and in the first and second branchial arches. Other regions of mesodermal expression include the developing tongue, meninges, nose, whiskers, kidney, genital tubercule and limb joints. In the nervous system Mf2 is transcribed in restricted regions of the mid- and forebrain. In several tissues, including the early somite, Mf2 is expressed in cell populations adjacent to regions expressing sonic hedgehog (Shh) and in explant cultures of presomitic mesoderm Mf2 is induced by Shh secreted by COS cells. These results suggest that Mf2, like other murine forkhead genes, has multiple roles in embryogenesis, possibly mediating the response of cells to signaling molecules such as SHH.

[Detection of neutralizing antibodies to Japanese encephalitis virus by enzyme-linked immunosorbent assay (ELISA)]

Competitive ELISA was used for the detection of neutralizing antibody to JE. Based on the principle that human serum JE antibody competed with JE monoclonal antibody (MAb) for JE antigen, it was found that 3 JE MAbs (E3-3, NPF-5 and NNN-5) were suitable for competitive ELISA for the detection of JE neutralizing antibody. The sensitivity of cometitive ELISA for 29 JE confirmed serum specimens with titer of plaque reduction neutralization test (PRNT) was checked to be 82.1% (23/28). The specificity of E3-3 MAb to JE used in competitive ELISA was 100%. Correlation coefficient of JE confirmed cases of 57 hemagglutination inhibition (HI) titers in 1995 and 37 PRNT titers in 1994 compared with competitive ELISA were 0.744 and 0.732, respectively. Compared the competitive ELISA titers of 154 sera of healthy people with PRNT titers, the results showed that 70% of the sera could be detected by competitive ELISA which saved a lot of time and manpower.