101
|
Wu MM, Chiou HY, Wang TW, Hsueh YM, Wang IH, Chen CJ, Lee TC. Association of blood arsenic levels with increased reactive oxidants and decreased antioxidant capacity in a human population of northeastern Taiwan. ENVIRONMENTAL HEALTH PERSPECTIVES 2001; 109:1011-7. [PMID: 11675266 PMCID: PMC1242077 DOI: 10.1289/ehp.011091011] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Arsenic is a notorious environmental toxicant known as both a carcinogen and an atherogen in human beings, but the pathogenic mechanisms are not completely understood. In cell culture studies, trivalent arsenic enhanced oxidative stress in a variety of mammalian cells, and this association may be closely associated with the development of arsenic-related diseases. To investigate the effect of arsenic exposure on oxidative stress in humans, we conducted a population study to determine the relationships of blood arsenic to reactive oxidants and antioxidant capacity at the individual level. We recruited 64 study subjects ages 42-75 years from residents of the Lanyang Basin on the northeast coast of Taiwan, where arsenic content in well water varies from 0 to > or = 3,000 microg/L. We used a chemiluminescence method, with lucigenin as an amplifier for measuring superoxide, to measure the plasma level of reactive oxidants. We used the azino-diethyl-benzthiazoline sulphate method to determine the antioxidant capacity level in plasma of each study subject. We determined arsenic concentration in whole blood by hydride formation with an atomic absorption spectrophotometer. The average arsenic concentration in whole blood of study subjects was 9.60 +/- 9.96 microg/L (+/- SD) with a range from 0 to 46.50 microg/L. The level of arsenic concentration in whole blood of study subjects showed a positive association with the level of reactive oxidants in plasma (r = +0.41, p = 0.001) and an inverse relationship with the level of plasma antioxidant capacity (r = -0.30, p = 0.014). However, we found no significant association (p = 0.266) between levels of plasma reactive oxidants and antioxidant capacity. Our results also show that the lower the primary arsenic methylation capability, the lower the level of plasma antioxidant capacity (p = 0.029). These results suggest that ingestion of arsenic-contaminated well water may cause deleterious effects by increasing the level of reactive oxidants and decreasing the level of antioxidant capacity in plasma of individuals. Persistent oxidative stress in peripheral blood may be a mechanism underlying the carcinogenesis and atherosclerosis induced by long-term arsenic exposure.
Collapse
|
102
|
Zasypkin DV, Lee TC. Food processing on a space station: feasibility and opportunities. LIFE SUPPORT & BIOSPHERE SCIENCE : INTERNATIONAL JOURNAL OF EARTH SPACE 2001; 6:39-52. [PMID: 11541542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
An alternative strategy for processing plants into food on a space or other isolated station including an Advanced Life Support (ALS) system is proposed. Regular gravity (1 G) or hypogravity (< 1 G) has been considered. A key feature of this strategy is to include not only kitchen-scale preparation and processing but small-scale advanced food processing such as thermoplastic extrusion, homogenization, centrifugation, fermentation, etc. These processes are flexible and multifunctional and could significantly increase the variety, palatability, nutritional value, and shelf stability of foods, and the number of menu items based on ALS crops. The processes would minimize the time to process the food items and provide psychological support for the crew. The periodic processing of various crop harvests into shelf-stable foods for long-term storage can be performed. Unit operations as illustrated by various processing flow sheets on the manufacturing of individual products will be discussed in association with the equipment.
Collapse
|
103
|
Liang CL, Lui CC, Lu K, Lee TC, Chen HJ. Atlantoaxial stability in ossiculum terminale. Case report. J Neurosurg 2001; 95:119-21. [PMID: 11453412 DOI: 10.3171/spi.2001.95.1.0119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe a patient with ossiculum terminale. Thin-section three-dimensional computerized tomography reconstructions, magnetic resonance images, and radiographs of the cervical spine were obtained to evaluate the atlantoaxial stability and structures of the ossiculum terminale. Bone had formed between the ossicles and the body of the odontoid process, and good atlantoaxial stability was clearly demonstrated.
Collapse
|
104
|
Liang CL, Lu K, Lee TC, Su TM, Chen HJ. Non-traumatic cerebrospinal fluid rhinorrhea indirectly caused by remote brain tumor: a case report and review of the literature. Clin Neurol Neurosurg 2001; 103:83-6. [PMID: 11516549 DOI: 10.1016/s0303-8467(01)00118-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Non-traumatic cerebrospinal fluid rhinorrhea indirectly caused by a remote brain tumor has rarely been reported. Here we describe a case of non-traumatic cerebrospinal fluid rhinorrhea that occurred as the initial symptom of a posterior falx meningioma. In addition, based on the period of occurrence of cerebrospinal fluid rhinorrhea before or after the tumor operation, we introduced a novel classification for these cases into pre-treatment and post-treatment types. The findings of the present case and the results of our literature research suggest that different treatments should be used for patients with these two types of non-traumatic cerebrospinal fluid rhinorrhea resulting from remote brain tumor. After tumor excision, patients of the pre-treatment type may receive conservative management or cerebrospinal fluid shunting, while patients of the post-treatment type need direct repair of the fistula.
Collapse
|
105
|
|
106
|
Tsai YD, Yu PC, Lee TC, Chen HS, Wang SH, Kuo YL. Superior rectal artery injury following lumbar disc surgery. Case report. J Neurosurg 2001; 95:108-10. [PMID: 11453408 DOI: 10.3171/spi.2001.95.1.0108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Traumatic injury of the aorta, inferior vena cava, and iliac vessels due to penetration of the anterior anulus fibrosus and anterior longitudinal ligament is a recognized complication of lumbar disc surgery. The authors report, to the best of their knowledge, the first case of discectomy-related superior rectal artery injury treated by endovascular intervention.
Collapse
|
107
|
Lee TC, Chen ST, Lee MC, Chang CM, Chen CH, Weng SF, Tseng YH. The early stages of filamentous phage phiLf infection require the host transcription factor, Clp. J Mol Microbiol Biotechnol 2001; 3:471-81. [PMID: 11361081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023] Open
Abstract
Xanthomonas campestris pv. campestris produces great amounts of an exopolysaccharide (EPS), xanthan gum. Eight eps loci involved in biosynthesis of the EPS were previously located in the chromosome map of strain Xc17. In this study, the eps8 region was cloned, sequenced and found to contain a crp homologue whose deduced amino acid sequence possesses similarity to that of the cyclic AMP receptor protein of bacteria, with the highest identity (97%) being shared with the X. campestris pv. campestris B-1459 clp gene previously shown to be involved in pathogenicity and regulation of the production of xanthan, extracellular enzymes, and pigment (de Crecy-Lagard V., Glaser P., Lejeune P., Sismeiro O., Barber C.E., Daniels M.J., and Danchin A., J. Bacteriol. 172:5877-5883, 1990). Based on sequence identity, pleiotropic effects of the mutation, the ability to complement an Escherichia coli cya crp mutant, and Southern hybridization detecting a single copy in the chromosome, we propose this eps8 gene to be the Xc17 clp. In addition to the previously reported properties, a clp mutant (AU56E) cannot be plaqued with filamentous phage phiLf, although it retains the capability to support phiLf DNA replication and release authentic phage particles upon electroporation of the RF DNA. Infective center assays demonstrated that the frequency of infection is 460- to 7,500-fold lower in AU56E compared to that in the wild-type Xc17. Electron microscopy, which showed no surface appendages other than the monotrichous flagellum, confirmed that AU56E drastically diminishes in the efficiency of phage adsorption. These results suggest Clp to be regulating the biosynthesis of the primary receptor, most likely a type IV pilus. Upstream to clp is a homologue of the E. coli speD gene required for spermidine synthesis. Mutation of the clp flanking regions and transcriptional analyses suggest clp to be monocistronic and the only gene contained at the eps8 locus.
Collapse
|
108
|
Chen HJ, Cho CL, Liang CL, Chen L, Chang HW, Lu K, Lee TC. Differential telomerase expression and telomere length in primary intracranial tumors. CHANG GUNG MEDICAL JOURNAL 2001; 24:352-60. [PMID: 11512366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Telomerase activity and telomere length have been shown to be involved in controlling cell proliferation and regulating cell senescence. The authors examined telomerase activity and telomere length in intracranial tumors to determine the clinicopathological behavior of primary intracranial tumors with respect to telomerase expression and alteration of telomere length. METHODS Telomerase activity was examined in 139 brain tumor samples. Telomere length was examined in 138 of the 139 samples. These tumors included 61 meningiomas, 27 schwannomas, 19 high-grade neuroepithelial tumors, and 32 low-grade neuroepithelial tumors. Telomerase activity was measured with a telomerase polymerase chain reaction, enzyme-linked immunosolvent assay kit. Telomere length was examined by Southern blot analysis for the terminal restriction fragment length. RESULTS Telomerase activity was detected in 39.2% (20/51) of the neuroepithelial tumors. Detection rates were 47.4% (9/19) for anaplastic astrocytomas and glioblastomas and 34.4% (11/32) for low-grade neuroepithelial tumors. However, detectable telomerase activity was found in 30.8% (4/13) of atypical or malignant meningiomas, but was not detected in any schwannomas. There was a highly significant difference in the telomerase detection rate in neuroepithelial or non-neuroepithelial tumors (p = 0.001). Telomere elongation was found in 11.7% (7/60) of all meningiomas, 46.1% (6/13) of atypical or malignant meningiomas, and 14.8% (4/27) of schwannomas. Elongation of telomere length was detected in 12.6% (11/87) of the cases and 23.5% (12/51) in neuroepithelial tumors. This difference was also significant (p < 0.05). Telomere length was reduced in the majority, (75%, 3/4) of malignant or atypical meningiomas with detectable telomerase activity, but only 45% (9/20) of the neuroepithelial tumors. CONCLUSION These results indicate that telomerase activation may be a critical step in the pathogenesis of intracranial tumors. Telomere length elongation also indicates a high potential for malignant behavior in these tumors.
Collapse
|
109
|
Liliang PC, Liang CL, Lu CH, Chang HW, Cheng CH, Lee TC, Chen HJ. Hypertensive caudate hemorrhage prognostic predictor, outcome, and role of external ventricular drainage. Stroke 2001; 32:1195-200. [PMID: 11340233 DOI: 10.1161/01.str.32.5.1195] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of the present study was to analyze the outcome and outcome predictors of caudate hemorrhage and role of external ventricular drainage in acute hydrocephalus. METHODS Clinical data from 36 consecutive patients with hypertensive caudate hemorrhage was used in the present study. Age, gender, volume of parenchymal hematoma, hematoma in the internal capsule, initial Glasgow Coma Scale (GCS), hydrocephalus, severity of intraventricular hemorrhage, and hemorrhagic dilatation of the fourth ventricle were analyzed for effect on outcome. Effect of external ventricle drainage for hydrocephalus was evaluated by comparing preoperative and postoperative GCS scores. RESULTS By univariate analyses, poor outcome was associated with a poor initial GCS score (P=0.016), hydrocephalus (P<0.001), intraventricular hemorrhage severity (P<0.01), and hemorrhagic dilatation of the fourth ventricle (P=0.02). By multivariate analysis, stepwise logistic regression revealed that hydrocephalus was the only independent prognostic factor for poor outcome (P<0.001). Postoperative 48-hour GCS score was better than the preoperative score by use of paired-sample t test (P<0.001). CONCLUSIONS Hydrocephalus is the most important predictor of poor outcome. External ventricular drainage response for hydrocephalus was good in the present study, whereas an early decision should be made regarding preoperative neurological condition.
Collapse
|
110
|
Feng J, Schaus BJ, Fallavollita JA, Lee TC, Canty JM. Preload induces troponin I degradation independently of myocardial ischemia. Circulation 2001; 103:2035-7. [PMID: 11319190 DOI: 10.1161/01.cir.103.16.2035] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although global ischemia induces troponin I (TnI) degradation, regional ischemia does not. We hypothesized that this disparity is related to preload-induced proteolysis, which varies as a function of the amount of myocardium at risk of ischemia. METHODS AND RESULTS Isolated rat hearts were buffer-perfused at controlled levels of preload. Increasing preload to 25 mm Hg in the absence of ischemia produced pronounced TnI degradation (27 kDa versus 31 kDa bands: 16.4 +/- 3.6% versus 4.7 +/- 1.9% in immediately excised controls, P<0.05). TnI degradation could be blocked by preventing the activation of endogenous calpains with 25 micromol/L calpeptin (4.3 +/- 0.6%). This improved function, with left ventricular systolic pressure increasing from 103 +/- 4 mm Hg to 137 +/- 7 mm Hg (P<0.05). Eliminating elevations in preload after global ischemia-induced stunning also prevented TnI degradation. CONCLUSIONS Calpain-mediated TnI proteolysis can be dissociated from stunning and arises from elevations in preload rather than ischemia. This raises the possibility that ongoing preload-induced TnI degradation could impair myocardial function long-term.
Collapse
|
111
|
Liang CL, Chang HW, Lu K, Lee TC, Liliang PC, Lu CH, Chen HJ. Early prediction of aphasia outcome in left basal ganglia hemorrhage. Acta Neurol Scand 2001; 103:148-52. [PMID: 11240561 DOI: 10.1034/j.1600-0404.2001.103003148.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The independent predictors of aphasia outcome for patients with left basal ganglia hemorrhage were evaluated. PATIENTS AND METHODS We included 140 patients of 1,036 patients with spontaneous intracerebral hemorrhage admitted to our hospital from January 1993 through December 1997. Aphasia was assessed using the aphasia scale of the Scandinavian stroke scale. Univariate and step-wise logistic regression analyses were performed to assess the relationships between the initial aphasia score, age, gender, blood volume, locations of hematoma and aphasia outcome. RESULTS Step-wise logistic regression analysis revealed that the following two factors were independently associated with the final aphasia outcome: initial aphasia score (P < 0.0001) and location of hematoma involving the posterior limb of the internal capsule (P = 0.004). CONCLUSIONS A particularly high likelihood of poor aphasia outcomes of patients with left basal ganglia hemorrhage are predicted in those who have poor initial aphasia score and whose brain computed tomography shows the hematoma involves the posterior limb of the internal capsule.
Collapse
|
112
|
Liliang PC, Lin YC, Su TM, Rau CS, Lu CH, Chang WN, Lee TC, Chen HJ. Klebsiella brain abscess in adults. Infection 2001; 29:81-6. [PMID: 11339480 DOI: 10.1007/s15010-001-0069-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND We analyzed the clinical manifestations and therapeutic outcomes of Klebsiella brain abscesses. PATIENTS AND METHODS The clinical data of 15 patients with Klebsiella brain abscesses, retrospectively collected over a 14-year period, were studied. RESULTS The 15 patients included 13 cases of Klebsiella pneumoniae infection and two cases of Klebsiella oxytoca. All but one case were community-acquired infections. Locations of all of these abscesses were supratentorial. 12 cases involved a single abscess, and three involved multiple abscesses. Gas formation was also found in two cases (13%). Common predisposing factors included metastatic spread, chronic otitis media and neurosurgical procedures. Among these 15 patients, 11 were treated surgically and four received antibiotics alone. In total, 11 patients survived and four died, with an overall mortality rate of 26.7%. CONCLUSION The clinical presentations and therapeutic outcomes varied according to the different Klebsiella species. While debilitating diseases were common in K. pneumoniae infections, they were not common in K. oxytoca infection. And while metastatic septic abscess is a well-known, devastating complication of K. pneumoniae septicemia, usually seen as a brain abscess with a gas-forming appearance, all of these K. oxytoca infections had both otogenic infections and more favorable outcomes.
Collapse
|
113
|
Lee TC, Midura RJ, Hascall VC, Vesely I. The effect of elastin damage on the mechanics of the aortic valve. J Biomech 2001; 34:203-10. [PMID: 11165284 DOI: 10.1016/s0021-9290(00)00187-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Porcine bioprosthetic heart valves degenerate and fail mechanically through a mechanism that is currently not well understood. It has been suggested that damage to the elastin component of prosthetic valve cusps could be responsible for changes in the mechanical function of the valve that would predispose it to increased damage and ultimate failure. To determine whether damage to elastin can produce the structural and mechanical changes that could initiate the process of bioprosthetic valve degeneration, we developed an elastase treatment protocol that fragments elastin and negates its mechanical contribution to the valve tissue. Valve cusps were mechanically tested before and after digestion to measure the mechanical changes resulting from elastin damage. Elastin damage produced a decrease in radial and circumferential extensibility (from 43 to 18% strain radially and 12 to 7% strain circumferentially), with a slight increase in stiffness (1.3-2.6kN/m for radial and 10.6-11.9kN/m for circumferential directions). Digestions with trypsin, which does not cleave elastin, confirmed that the changes in mechanics of the circumferential samples were likely due to the nonspecific removal of proteoglycans by elastase, while the changes in the radial samples were indeed due to elastin damage. Removing the mechanical contribution of elastin alters the mechanical behavior of the aortic valve cusp, primarily in the radial direction. This finding implies that damage to elastin will distend the cusps, reduce their extensibility, and increase their stiffness. Damage to elastin may therefore contribute to the degeneration and failure of prosthetic valves.
Collapse
|
114
|
Lee TC, Buerkle H, Wang CJ, Liang CL, Lu K, Huang PL, Cheng CH, Yang LC. Effect of isoflurane versus nicardipine on blood flow of lumbar paraspinal muscles during controlled hypotension for spinal surgery. Spine (Phila Pa 1976) 2001; 26:105-9; discussion 109. [PMID: 11148653 DOI: 10.1097/00007632-200101010-00018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study compared the effects of isoflurane and nicardipine on regional blood flow of the lumbar paraspinal muscles. OBJECTIVES The purpose of this study was to determine whether treatment with hypotensive agents result in ischemia of the lumbar paraspinal muscles, thereby facilitating surgical procedures. SUMMARY OF BACKGROUND DATA Despite the general acceptance of controlled hypotension as effective in reducing blood loss during spinal surgery, the changes of blood flow that occur at the lumbar paraspinal muscles when this technique is applied remain unclear. The use of laser Doppler flowmetry allows changes of muscle blood flow to be easily detected in real time with minimal invasion, thereby allowing differences among distinct pharmacological approaches for induction and maintenance of controlled hypotension to be evaluated. METHODS The prehypotensive and hypotensive (reduction of mean arterial pressure by 20 mm Hg) blood flow of the lumbar paraspinal muscles were assessed with a laser Doppler flowmeter in 40 patients undergoing lumbar spinal surgery. The first half of the patients (n = 20) received isoflurane, whereas the second half received nicardipine to achieve arterial hypotension. RESULTS Compared with the prehypotensive state, during the hypotensive state, patients in the isoflurane group exhibited a 17% to 46% (mean, 33.7%) decrease in lumbar paraspinal muscle blood flow, whereas patients in the nicardipine group exhibited a 24% to 177% (mean, 82.5%) increase in lumbar paraspinal muscle blood flow. Statistical analysis showed a significant difference in the changes of flux after induced hypotension between the isoflurane and nicardipine group (P < 0.001). CONCLUSIONS Depending on the pharmacological treatment used to achieve arterial hypotension in spine surgery, there will be either a reduction in paraspinal muscle blood flow (ischemia) or an enhancement of this blood flow (hyperemia).
Collapse
|
115
|
Lu K, Liang CL, Cho CL, Cheng CH, Yen HL, Rau CS, Tsai YD, Chen HJ, Lee TC. Patterns of palmar skin temperature alterations during transthoracic endoscopic T2 sympathectomy for palmar hyperhidrosis. Auton Neurosci 2000; 86:99-106. [PMID: 11269931 DOI: 10.1016/s1566-0702(00)00202-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transthoracic endoscopic T2 sympathectomy has been widely applied to the treatment of a variety of sympathetically mediated disorders. Palmar hyperhidrosis is probably the most common indication for thoracic sympathectomy, especially in certain subtropical areas. Which sympathetic ganglion is to be ablated and how extensive such ablation is enough to eliminate palm sweating are two important issues. Intraoperative monitoring of palmar skin temperature (PST) is the most frequently used method for assessing the accuracy as well as adequacy of ablation of the target sympathetic ganglia. With continuous monitoring of bilateral PST during the operative course of T2 sympathectomy, it was possible to depict the alterations of bilateral PST in response to specific surgical procedures in a real-time manner. For each case, a PST graph was obtained, which represented the graphical expression of intraoperatively recorded bilateral PST data plotted against time. The PST graphs of 93 consecutive cases were analysed. Three types of PST graphs existed, reflecting different responses of bilateral PST to different surgical procedures during the operation. In Type I PST graph pattern, found in 58 cases, skin incision and intercostal muscle dissection caused dramatic bilateral PST drop; and unilateral T2 sympathectomy induced synchronous bilateral PST elevation. Twenty-four cases demonstrated Type II PST graph pattern, in which unilateral T2 sympathectomy caused only ipsilateral PST elevation, although the PST-depressing effect of skin incision and muscle dissection was as significant as in Type I graph pattern. In the 11 cases who showed Type III PST graph pattern, neither skin incision nor T2 sympathectomy induced any apparent changes of PST on either side, giving rise to two rather flat PST curves on the PST graphs. These findings implicate that reciprocal interactions between bilateral sympathetic activities exist in the majority of cases, and that crossover sympathetic modulation may play a role in the neural control of the sudomotor and vasomotor activities of the palms. This study also provides information regarding how PST would possibly change following specific surgical procedures during transthoracic endoscopic T2 sympathectomy, which may be of importance to those who use intraoperative PST monitoring as a guide in determining whether or not the correct sympathetic ganglia are ablated for adequate sympathetic denervation of the palms.
Collapse
|
116
|
Lee TH, Lin CR, Lee TC, Buerkle H, Hsu TY, Mao CC, Yang LC. Failure of prevention against postoperative vomiting by ondansetron or prochlorperazine in patients undergoing gynecological laparoscopy. ACTA ANAESTHESIOLOGICA SINICA 2000; 38:201-5. [PMID: 11392068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Ondansetron has been approved for the treatment and prevention of postoperative emesis. Since it is presumably considered to possess potent antiemetic effect with fewer side effects, the administration of ondansetron to inhibit emesis in patients following gynecological laparoscopic surgery might be recommendable. Hence, we examined the effects of intravenous ondansetron at dosage of 4 and 8 mg in comparison with intravenous prochlorperazine at 5 mg and placebo. METHODS A total of 120 patients were allocated randomly into 3 groups. Group 1 patients who served as control were given NaCl 0.9% 4 mL (placebo) intravenously (i.v.); patients in group 2 and group 3 were given ondansetron 4 mg ondansetron 8 mg i.v. respectively; patients in group 4 were given prochlorperazine 5 mg i.v. Premedication was omitted. RESULTS Logistic regression analysis adjusted for prognostic factors revealed no significant difference between 5 mg prochlorperazine group and 4 mg or 8 mg ondansetron group as compared over the 24 h study period. CONCLUSIONS The results of this study suggest that i.v. 4 or 8 mg ondansetron and 5 mg prochlorperazine were not effective in prevention of postoperative emesis in patients undergoing gynecological laparoscopy. Since the cost of ondansetron is high, its routine use for prevention against postoperative nausea and vomiting is not be recommended clinically because of its uncertain benefit.
Collapse
|
117
|
Sokolove PE, Sgarbossa EB, Amsterdam EA, Gelber R, Lee TC, Maynard C, Richards JR, Valente R, Wagner GS. Interobserver agreement in the electrocardiographic diagnosis of acute myocardial infarction in patients with left bundle branch block. Ann Emerg Med 2000; 36:566-71. [PMID: 11097696 DOI: 10.1067/mem.2000.112077] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To determine the interobserver agreement between cardiologists and emergency physicians in the ECG diagnosis of acute myocardial infarction (AMI) in patients with left bundle branch block (LBBB) using the ECG algorithm previously described by Sgarbossa et al. METHODS Using the Sgarbossa ECG algorithm, 4 cardiologists and 4 emergency physicians independently interpreted a test set of 224 ECGs with LBBB, of which 100 ECGs were from patients with an evolving AMI. A subset of 25 ECGs was reinterpreted by each reader to test intraobserver agreement for AMI as well as interobserver agreement for the degree of ST-segment deviation. Agreement rates for AMI were estimated using the kappa statistic. In addition, the sensitivity and specificity for diagnosing AMI were determined for each reader, using the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO I) enzyme criteria for AMI as the gold standard. The study was conducted at 3 university-affiliated medical centers. The test set contained ECGs from 100 patients enrolled in the GUSTO I trial with LBBB on their initial ECG and an evolving AMI confirmed by serum cardiac enzyme changes, and 124 control patients from the Duke Databank for Cardiovascular Disease who had stable, angiographically documented coronary artery disease and LBBB. RESULTS There was excellent interobserver agreement (kappa=0.81, 95% confidence interval [CI] 0.80 to 0.83) between cardiologists and emergency physicians for diagnosing AMI. Intraobserver agreement kappa values for AMI diagnosis by cardiologists and emergency physicians were 0.81 (95% CI 0.67 to 0.94) and 0.71 (95% CI 0.54 to 0.89). The median sensitivity for diagnosing AMI by cardiologists and emergency physicians was 73% (range 66% to 80%) versus 67% (range 61% to 75%); median specificity was 98% (range 97% to 99%) versus 99% (range 98% to 99%). Spearman rank correlation coefficients for the degree of ST-segment deviation in all 12 leads was 0.86 (95% CI 0.85 to 0.87) among all readers. CONCLUSION There is excellent interobserver agreement between cardiologists and emergency physicians for diagnosing AMI when applying the Sgarbossa ECG algorithm to patients with LBBB. Emergency physicians should be able to reliably use this algorithm when evaluating patients.
Collapse
|
118
|
Yih LH, Lee TC. Arsenite induces p53 accumulation through an ATM-dependent pathway in human fibroblasts. Cancer Res 2000; 60:6346-52. [PMID: 11103796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Arsenic compounds are potent human carcinogens. Accumulated evidence has shown that arsenite-induced cytogenetic alterations are associated with the carcinogenicity of arsenic. Because p53 plays a guarding role in maintaining genome integrity and accuracy of chromosome segregation, the mechanistic effects of arsenite on p53 activation were analyzed. In the present study, arsenite-induced DNA strand breaks were confirmed by alkaline single-cell gel electrophoresis (comet assay) in human fibroblast (HFW) cells. Accompanying the appearance of DNA strand breaks was a significant accumulation of p53 in arsenite-treated HFW cells, as demonstrated by immunoblotting and immunofluorescence techniques. p53 downstream proteins, such as p21 and the human homologue of murine double minute-2, were also significantly induced by arsenite treatment. Cell cycle retardation and G2-M arrest were observed in 5-bromo-2'-deoxyuridine pulse-labeled HFW cells by flow cytometry. Wortmannin, an inhibitor of phosphatidylinositol 3-kinases, inhibited arsenite- or X-ray irradiation-induced p53 accumulation but did not alter UV irradiation- or N-acetyl-Leu-Leu-norleucinal-induced p53 accumulation. p53 phosphorylation on serine 15 was also confirmed by immunoblotting technique in arsenite- and X-ray-treated HFW cells but was not observed in UV- or N-acetyl-Leu-Leu-norleucinal-treated HFW cells. These results suggest the involvement of a phosphatidylinositol 3-kinase-related protein kinase in arsenite-induced p53 accumulation. For confirmation, we demonstrated that arsenite treatment, similar to X-ray irradiation, did not induce p53 accumulation in GM3395 fibroblasts derived from a patient with ataxia telangiectasia. In contrast, UV irradiation did cause p53 accumulation in these cells. Together, these findings infer that arsenite-induced DNA strand breaks may lead to p53 phosphorylation and accumulation through an ataxia telangiectasia mutated-dependent pathway in HFW cells.
Collapse
|
119
|
Kositprapa C, Zhang B, Berger S, Canty JM, Lee TC. Calpain-mediated proteolytic cleavage of troponin I induced by hypoxia or metabolic inhibition in cultured neonatal cardiomyocytes. Mol Cell Biochem 2000; 214:47-55. [PMID: 11195789 DOI: 10.1023/a:1007160702275] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
While ischemic damage to myofibrillar proteins is thought to be responsible in part for depressed cardiac function, the relation between myofilament protein breakdown and chronic hypoxia has not been defined. We previously characterized a chemical hypoxia model of neonatal cardiomyocytes mediated by 1 mM azide that exhibits features of calpain activation (Mol Cell Biochem 178:141-149, 1998). We here show that both hypoxia and azide-mediated metabolic inhibition induced heme oxygenase-1 expression, and caused cell death associated with lipid peroxidation. While blocking calcium influx or inhibiting calpain activity efficiently attenuated hypoxia-induced cell injury, it failed to prevent cell injury caused by adenoviral overexpression of the tumor suppressor protein p53. Inhibitors of caspases, on the other hand, suppressed cell injury caused by p53 overexpression. Hypoxia caused selective cleavage of troponin I (TnI), which could be suppressed by either nifedipine or calpeptin. Other myofilament proteins such as troponin T, myosin heavy chain, and actin appeared to remain largely intact. p53-mediated cell injury exhibited proteolysis of the caspase protein substrate lamin B without appreciable breakdown of TnI. We suggest that calpain-induced TnI breakdown may constitute a unique biochemical marker associated with chronically hypoxic cardiomyocytes.
Collapse
|
120
|
Babaei S, Picard P, Ravandi A, Monge JC, Lee TC, Cernacek P, Stewart DJ. Blockade of endothelin receptors markedly reduces atherosclerosis in LDL receptor deficient mice: role of endothelin in macrophage foam cell formation. Cardiovasc Res 2000; 48:158-67. [PMID: 11033118 DOI: 10.1016/s0008-6363(00)00169-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE We evaluated the direct effects of long-term blockade of ET(A) and ET(B) receptors using a mixed endothelin (ET) receptor antagonist, LU224332, in the low density lipoprotein receptor (LDL-R) knockout mouse model of atherosclerosis. METHODS Four groups of LDL-R deficient mice were studied: control mice fed normal chow (group I); mice fed a high cholesterol (HC, 1.25%) diet alone (group II), HC fed animals treated with LU224332 (group III); and mice fed normal chow treated with the LU compound (group IV). All treatments were continued for 8 weeks at which time the animals were sacrificed and the aortae were removed and stained with oil red O. Atherosclerotic area (AA) was determined by quantitative morphometry and normalized relative to total aortic area (TA). RESULTS Cholesterol feeding resulted in a marked increased in total plasma cholesterol ( approximately 15 fold) and widespread aortic atherosclerosis (AA/TA: group I: 0.013+/-0.007; group II: 0.33+/-0. 11; P<0.001). Atherosclerotic lesions were characterized by immunohistochemistry as consisting mainly of macrophages which also showed high levels of ET-1 expression. Treatment with ET antagonist significantly reduced the development of atherosclerosis (AA/TA: group III: 0.19+/-0.07, P<0.01 vs. group II), without altering plasma cholesterol levels and blood pressure. The direct effect of LU224332 on macrophage activation and foam-cell formation was determined in vitro using a human macrophage cell line, THP-1. Treatment of the THP-1 cells with LU224332 significantly reduced cholesterol ester and triacylglycerol accumulation and foam-cell formation on exposure to oxidized LDL (P<0.01 and P<0.05, respectively). CONCLUSION We conclude that a nonselective ET receptor antagonist substantially inhibited the development of atherosclerosis in a genetic model of hyperlipidemia, possibly by inhibiting macrophage foam-cell formation, suggesting a role for these agents in the treatment and prevention of atherosclerotic vascular disease.
Collapse
|
121
|
Sawchuk CN, Lohr JM, Tolin DF, Lee TC, Kleinknecht RA. Disgust sensitivity and contamination fears in spider and blood-injection-injury phobias. Behav Res Ther 2000; 38:753-62. [PMID: 10937424 DOI: 10.1016/s0005-7967(99)00093-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Disgust has been implicated in the onset and maintenance of blood-injection-injury (BII) and animal phobias. Research suggests that people with these phobias are characterized by an elevated sensitivity to disgust-evoking stimuli separate from their phobic concerns. The disgust response has been described as the rejection of potential contaminants. Disgust-motivated avoidance of phobic stimuli may therefore be related to fears of contamination or infection. The present study compared BII phobics, spider phobics and nonphobics on two measures of disgust sensitivity and two measures of contamination fears. Positive correlations were found between disgust sensitivity and contamination fear. Specific phobics scored higher than nonphobics on all scales and BII phobics scored higher than spider phobics on contamination fear measures. Furthermore, the contamination fear scales were correlated with the blood phobia measure, but not correlated with the spider phobia measure. The results suggest that while both phobias are characterized by elevated disgust sensitivity, contamination fear is more prominent in BII than spider phobia.
Collapse
|
122
|
Ho IC, Yih LH, Kao CY, Lee TC. Tin-protoporphyrin potentiates arsenite-induced DNA strand breaks, chromatid breaks and kinetochore-negative micronuclei in human fibroblasts. Mutat Res 2000; 452:41-50. [PMID: 10894889 DOI: 10.1016/s0027-5107(00)00035-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Numerous reports have shown that oxidative stress is involved in arsenite-induced genetic damage. Arsenite is also a potent inducer of heme oxygenase (HO)-1. To understand whether HO-1 could function as a cellular antioxidant and protect cells from arsenite injury, the effects of tin-protoporphyrin (SnPP), a competitive inhibitor of HO-1, on arsenite-induced genetic damage were examined in human skin fibroblasts (HFW). In the present study, we found that SnPP at 100 microM significantly potentiated arsenite-induced cytotoxicity, DNA strand breaks (assayed by alkaline single cell gel electrophoresis(SCGE)), and chromatid breaks. Although arsenite alone mainly induced kinetochore-plus micronuclei (K(+)-MN), SnPP only synergistically enhanced kinetochore-negative micronuclei (K(-)-MN). The increase in K(-)-MN by SnPP cotreatment was consistent with the increase in DNA strand breaks and chromatid breaks caused by SnPP. However, at higher arsenite doses, K(+)-MN was significantly reduced by SnPP. Pretreatment of HFW cells with hemin, an inducer of HO-1, significantly attenuated the cytotoxicity of arsenite. Therefore, the present results suggest that HO-1 induction by arsenite plays certain roles in protecting cells from arsenite-induced injury.
Collapse
|
123
|
Mullett JH, Shannon F, Noel J, Lawlor G, Lee TC, O'Rourke SK. K-wire position in tension band wiring of the olecranon - a comparison of two techniques. Injury 2000; 31:427-31. [PMID: 10831740 DOI: 10.1016/s0020-1383(00)00014-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tension band wiring is a recognised standard treatment for olecranon fractures. We studied the effect of K-wire position on backing out of the wire in a group of 80 patients with closed transverse olecranon fractures with a minimum follow-up time of 9 months. The rate of wires backing out as seen on X-ray was three times greater in patients who had K-wires passed down the long axis of the ulna rather than across the anterior cortex as recommended by the AO group. There was a corresponding higher rate of local complications in these patients. 42% of this group had to have the metal removed compared with 11.4% of the transcortical group. We compared the biomechanical properties of both K-wires positions in a human cadaveric model. The maximum pull-out strength for each configuration was recorded in 20 elbow joints. The average maximum pullout strength for the intramedullary wires was 56.3 N (range 27. 7-95.6 N) and 122.7 N for the transcortical wires (range 56.7-201.2). The results of both the clinical study and biomechanical data support the routine use of transcortical placement of K-wires in tension-band wiring of transverse olecranon fractures.
Collapse
|
124
|
Kuo HW, Kuo SM, Chou CH, Lee TC. Determination of 14 elements in Taiwanese bones. THE SCIENCE OF THE TOTAL ENVIRONMENT 2000; 255:45-54. [PMID: 10898394 DOI: 10.1016/s0048-9697(00)00448-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
The objective of this study was to measure the concentration of 14 elements in human bone and investigate the affecting factors. This study aims to establish a database of elements in Taiwanese bone. Seventy-seven bone samples were taken from 70 subjects who were undertaking various bone surgeries from a medical center in central Taiwan. Bone samples were pretreated using microwave digestion and then, after determining the optimal conditions for analysis, fourteen elements were analyzed using Inductively Coupled Plasma-Atomic Emission Spectroscopy (ICP-AES). Results showed that Ca had the highest concentration, followed by Mg and Zn. The lowest concentrations were of Mn, followed by Cd and Co. There was a positive correlation between the frequency of seafood intake and presence of all the 14 elements in human bone. There were several elements that had positive inter-correlation: As with Co; Al, Ag and Ca; Ni with Co, Mn and Al; Co with Al, Ag and Ca; Mn with Cr and Cu; Cr with Cu; Mg with Ca; Al with Ag and Ca; Ag with Ca; and also Zn with Mg. There were no significant differences found between concentrations of elements and etiology of bone disease and age. The authors suggest that further studies be conducted to establish a normal value of elements in human bone in Taiwan. This will greatly benefit the understanding of the relationship between disease pattern and elements in human bone.
Collapse
|
125
|
Abstract
STUDY DESIGN A retrospective study of 36 patients with mid- to lower cervical spinal cord injury (CSCI) divided into two groups based on whether delayed apnea developed. OBJECTIVES To determine nonpulmonary risk factors associated with the development of delayed apnea in mid- to lower cervical spinal cord injury. SUMMARY OF BACKGROUND DATA Patients with mid- to lower cervical spinal cord injury are generally at lower risk of developing respiratory failure than those with high cervical spinal cord injury. Respiratory failure manifesting as sudden apnea may occur days or even weeks after injury without any pulmonary complications in such patients. METHODS An index group of eight patients with complete mid- to lower cervical spinal cord injury in whom delayed catastrophic apnea occurred were reviewed. Another group of 28 patients with cervical spinal cord injury of identical magnitude and presentation but without respiratory failure served as the control group. Six parameters presumed to be related to the delayed apnea were analyzed. RESULTS The extent of cord lesions was significantly different, being diffuse in most of the index patients, but focal in the majority of the control patients (P<0.001). Involvement of the C4 segment of cord appeared to be more frequent in the index group; however, the difference was not statistically significant (P = 0.091). The incidence of transient bradycardia (P<0.01) and dyspnea (P<0.001) in the index group was significantly higher than in the control group. Paralytic ileus was a much rarer event and found to be unrelated to the occurrence of apnea. In five of the eight index patients, the apnea occurred during sleep. Six of the eight index patients died of it. CONCLUSIONS Delayed but devastating apnea may develop in patients with mid- to lower cervical cervical spinal cord injury, even when they are clinically stable and free from any pulmonary complications. The presence of diffuse, extensive cord lesions, respiratory distress, or bradycardia with or without associated hypotension, however transient and self-limited, should be regarded as warning signs. Sleep was found to be a risky period of time.
Collapse
|