Helicobacter pylori infection and age on the development of intestinal metaplasia--a multiple logistic regression analysis

BACKGROUND/AIMS

Both intestinal metaplasia (IM) and Helicobacter pylori (H. pylori) infection have been linked to gastric carcinogenesis in an age-dependent manner. However, their relationship remains ill defined, especially with respect to age.

METHODOLOGY

Three hundred and two asymptomatic subjects (167 males and 135 females; mean age 44.3+/-11.1 years) underwent complete endoscopic examination and biopsy at the antrum and the corpus. H. pylori infection was diagnosed according to histopathology and serology, while IM was determined by histopathology.

RESULTS

Eighty-four patients (27.8%) had IM, while 185 patients (61.3%) were seropositive to H. pylori. The frequency of IM was higher in patients with gastric ulcer (9/14, 64.3%) than in those with minimal change (68/229, 29.7%) or duodenal ulcer (7/59, 11.9%), both p<0.01. Patients with IM had a higher mean age (49.5+/-14.1 vs. 42.3+/-9.0, p<0.01) and a higher H. pylori prevalence than those without IM (61/84, 72.6% vs. 124/218, 56.9%, p<0.01). The concordance rate of H. pylori infection between histopathologic and serologic diagnosis was lower in patients with IM (67/84, 79.8%) than those without (196/218, 89.9%, p<0.05). Using logistic regression analyses, the development of IM was noted to be independently related to both H. pylori infection (odds ratio=1.97, 95% confidence interval: 1.1(3.53)) and age (odds ratio = 1.93, 95% confidence interval: 1.51(2.47)).

CONCLUSIONS

These data suggest that age and H. pylori infection are independent risk factors for the development of IM. Furthermore, H. pylori infection may have been underestimated in patients with IM because of the use of a single method of detection.

Overexpression of p53 in different subtypes of intestinal metaplasia and gastric cancer

p53 immunostaining was evaluated in cancerous epithelia and adjacent intestinal metaplasia of 135 gastric cancer specimens. The differential p53 overexpression in different subtypes of intestinal metaplasia and gastric cancer suggests that type III intestinal metaplasia is the commonest lesion in dysplasia-carcinoma transition, particularly in the intestinal type of gastric cancer.

Impacted aural foreign body requiring endaural incision and canal widening for removal

Foreign bodies of the ear are a common finding in children. The majority of these can be removed relatively easily. We present a case which required endaural incision and widening of the external meatus before the foreign body could be successfully removed. Entrapment of the hard, oval-shaped, smooth and slippery foreign body deep to the hour-glass narrowing of the external canal, proximity of the object to the tympanic membrane and localised tissue oedema were the indications for the surgery. This case demonstrates the danger of unskillful attempts to remove aural foreign bodies.

Gastric cancer risk in relation to Helicobacter pylori infection and subtypes of intestinal metaplasia

Helicobacter pylori (H. pylori) infection and intestinal metaplasia (IM) are each associated with an increased risk of gastric cancer (GC). To explore further the influences of H. pylori and IM on GC, H. pylori and subtypes of IM were evaluated in 135 sex and age-matched case and control pairs. Odds ratios (ORs) with 95% confidence intervals of developing GC were calculated for each risk factor using multiple logistic regression analysis. ORs for H. pylori infection and IM were 2.43 (1.29-4.65) and 4.59 (2.58-8.16), respectively, and those for different IM subtypes gave values of 0.82 (0.28-2.36) for type I, 2.03 (0.95-4.34) for type II and 39.75 (14.34-110.2) for type III. Stratification analysis by histological subtype and stage of GC showed a particularly high OR for IM in intestinal type (12.8, 4.73-34.83) and early GC (6.40, 2.25-18.18). Our data indicate that both H. pylori and IM are related to GC risk. Type III IM is a more specific marker of premalignancy, with relevance, in particular, to the early and intestinal type of GC.

Underregistration of neonatal deaths: an empirical study of the accuracy of infantile vital statistics in Taiwan

STUDY OBJECTIVE

The accuracy of the official statistic on infant deaths in Taiwan has been questioned. This study aimed to survey infant deaths nationwide, to measure associated vital statistics, and compare them with the official statistics to assess accuracy.

DESIGN AND PARTICIPANTS

A nationwide survey of all gestational outcomes occurring at > or = 20 weeks' gestation over a three day study period (15-17 May 1989) was conducted to collect data from 23 counties and cities nationwide using a two stage data collection procedure.

MAIN RESULTS

The survey derived infant death rate was 9.72 per 1000 live births, which was higher than the reported official statistic of 5.71 per 1000 live births. A more detailed examination of data on infant deaths showed that the estimated neonatal death rate of 6.68 per 1000 live births (95% confidence intervals: 3.33, 11.96 per 1000 live births) was significantly higher than the published official statistic of 1.94 per 1000 live births, while the postneonatal mortality of 3.04 per 1000 live births was comparable to the reported statistic of 3.37 per 1000 live births.

CONCLUSIONS

This study empirically documented the underregistration of infant deaths in Taiwan, particularly those occurring during the first 27 days of life.

Sex difference in the mortality trends of acute myocardial infarction in Taiwan, 1974 to 1993

The mortality patterns of coronary heart disease (CHD) vary among countries. Although the mortality rates from this disease are decreasing in the majority of developed nations, most developing countries are experiencing upward trends, especially among men. The mortality trends of acute myocardial infarction (AMI) in Taiwan have not been reported. The purpose of this study was to investigate the effects of age, chronicle period, and birth cohort on the AMI mortality rates using computerized vital statistics data from 1974 through 1993. Compared with the age-adjusted AMI mortality rates in 1974, the mortality rates in 1993 were 2.4 times higher for men and 2.2 times higher for women. When the log-linear Poisson model was used to assess age, birth cohort, and chronicle period simultaneously, women had no elevated relative risk of dying from AMI in different periods. The relative risk of dying from AMI increased 2.5 times for men in the 1955-1959 birth cohort compared with those in the 1890-1894 birth cohort, while the relative risk for females declined by 3.7 times for the corresponding birth cohorts. Based on birth cohort, the trends in mortality differ substantially between sexes in Taiwan. These results may help to generate hypotheses regarding the possible factors, prevention, and control of mortality from AMI in Taiwan.

Surgical results in patients with dual hepatitis B- and C-related hepatocellular carcinoma compared with hepatitis B- or C-related hepatocellular carcinoma

BACKGROUND

The purpose of our study was to report on the surgical outcomes of patients with hepatocellular carcinoma (HCC) with dual hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and to assess the differences in the surgical results between those patients and the patients with hepatitis B- or hepatitis C-related HCC.

METHODS

The operative outcomes of 13 patients with hepatitis B surface antigen (HBsAg)-positive and hepatitis C antibody (HCV Ab)-positive (the BC-HCC group) results, 57 patients with HBsAg-positive and HCV Ab-negative (the B-HCC group) results, and 34 patients with HBsAg-negative and HCV Ab-positive (the C-HCC group) results, who had undergone hepatic resection from 1991 to 1995, were compared.

RESULTS

The operative mortality rate within 1 month after operation for patients with BC-HCC was 7.7%. No statistically significant difference was found compared with the patients with B-HCC and C-HCC (5.3% and 5.9%, respectively). The postoperative course of patients with BC-HCC was complicated by liver failure, postoperative ascites, and wound infection in one patient each. Also, no statistically significant difference was found among the groups (23.1%, 22.8%, and 20.5% for patients with BC-HCC, B-HCC, and C-HCC, respectively). The overall 1-, 3-, and 5-year survival rates of patients with BC-HCC in this series were 75%, 50%, and 40%, respectively. The postoperative recurrence rate was 66.7%. No statistically significant differences were found between the various groups of the virus-related HCC on the overall survival rate and disease-free survival rate.

CONCLUSIONS

Hepatic resection for HCC in patients with dual HBV and HCV infections was associated with slightly higher operative morbidity and mortality rates, but there were no statistical differences compared with hepatitis B- or C-related HCC regarding the survival and recurrence rates.

Risk of leukemia in children living near high-voltage transmission lines

We conducted a study to examine the risk of leukemia between 1987 and 1992 among children living near high-voltage transmission lines (HVTL) in three urban districts of northern Taiwan. Twenty-eight cases of leukemia among some 120,696 children aged 14 years or less were reported to the national cancer registry between 1987 and 1992. Compared with children living in households more than 100 meters away from HVTL, children living in households less than 100 meters from HVTL experienced an essentially elevated risk of leukemia (7 versus 2.88, standardized incidence ratio [SIR] = 2.43, 95% confidence interval [CI] = 0.98-5.01). The elevated risk stands when compared with all children of Taiwan alternatively (7 versus 2.60, SIR = 2.69, 95% CI = 1.08-5.55). Such elevated risk was particularly noteworthy among children aged 5-9 years. The findings suggest that children living near HVTL tend to experience an elevated risk of leukemia. Further investigations are undoubtedly needed to unveil whether such tendency may have implied the putative association between exposure to elevated magnetic fields and risk of childhood leukemia.

The association of cigarette smoking and alcohol consumption with other cardiovascular risk factors in men from Seoul, Korea

PURPOSE

To explore the effects of cigarette smoking and alcohol consumption on cardiovascular disease risk factors such as hypertension, dyslipidemia, and glucose intolerance in Korean men.

METHODS

In this cross-sectional study, we gathered the smoking and drinking history by self-administered questionnaire between June 1994 and May 1995 among 1053 men, age 20-77, who visited a prevention center for a multiphasic health check at St. Mary's Hospital, Seoul.

RESULTS

Cigarette smoking had a significant inverse association with systolic and diastolic blood pressure. Adjusted for age, body mass index (BMI), and alcohol consumption, the odds ratio of hypercho-lesterolemia (> or = 240 mg/dl) was 1.30 (95% confidence interval (CI) 1.09-1.55), lower high density lipoprotein (HDL) cholesterol (< 40 mg/dl) was 1.29 (95% CI 1.08-1.54), higher low density lipoprotein (LDL) cholesterol (> or = 160 mg/dl) was 1.30 (95% CI 1.07-1.56), and hypertriglyceridemia (> or = 200 mg/dl) was 1.40 (95% CI 1.16-1.68) among men who smoked 21-30 cigarettes per day compared with nonsmokers. Adjusted for age. BMI, and cigarette smoking in men who consumed 90-179 and 180-269 g/week of alcohol compared with nondrinkers, the odds ratio of hypertension was 1.73 (95% CI 1.01-3.00) and 1.48 (95% CI 1.01-2.17), respectively. Alcohol consumption had a significant protective effect (adjusted odds ratio: 0.60-0.78) against lower HDL cholesterol in all categories > or = 90 g of alcohol per week compared with nondrinkers. The adjusted odds ratio of hypertriglyceridemia was 1.17 (95% CI 1.04-1.31), and glucose intolerance (fasting blood sugar (FBS) > or = 120 mg/dl) was 1.27 (95% CI 1.11-1.14) among those who consumed > or = 360 g/week of alcohol compared with nondrinkers.

CONCLUSIONS

In this Korean population study, although alcohol consumption increased HDL cholesterol, which might have a protective effect on coronary heart disease, cigarette smoking was associated with decreased blood pressure, smoking was confirmed to have dyslipidemic effect such as increasing total cholesterol, LDL cholesterol, triglyceride and decreasing HDL cholesterol, and alcohol consumption was confirmed to be associated with hypertension, hypertriglyceridemia, and glucose intolerance as in Caucasian. Further prospective intervention studies are needed for evaluating cardiovascular effects after cessation of smoking and drinking.

Complications of palatoplasty for snoring or sleep apnoea

A questionnaire was sent to consultant Otolaryngologists (483) throughout the UK to identify any mortality associated with uvulopalatoplasty and other forms of palatoplasties for snoring and/or obstructive sleep apnoea. The response rate was 76.8 per cent (371). Six intra- and post-operative deaths were reported and four were known to have obstructive sleep apnoea. Life-threatening morbidity occurred in at least seven patients (three known apnoeic), two required immediate tracheostomy and two were managed in the intensive care unit. This suggests that the apnoeic patients undergoing palatoplasties experienced significant mortality and morbidity. Pre-operative sleep study should be performed in all snoring patients to identify the apnoeic subgroup. Continuous positive airway pressure, management of excessive obesity, elective tracheostomy and other strategies should be first considered before palatoplasties in these patients.

Assessment of dialysis adequacy using the dialysate urea monitor: preliminary experience of the dialysate urea monitor

Numerous studies have identified a strong linkage between the delivered dialysis dose (Kt/V) and the survival of hemodialysis (HD) patients. However, the current method used to calculate Kt/V requires multiple blood samples and the process is complex and time consuming. We evaluate the performance of a recently developed on-line monitor (Biostat 1000 dialysate urea monitor, Baxter) that measures the urea concentration in the effluent dialysate and displays Kt/V and nPCR immediately after hemodialysis. To verify the performance of the urea monitor, we selected 21 hemodialysis patients, calculated their Kt/V and nPCR values from blood samples obtained during each hemodialysis, and compared the results with data obtained using the urea monitor. The Kt/V and nPCR values calculated by the urea monitor were both significantly correlated with those obtained using blood samples (R = 0.804, p < 0.001 in Kt/V and R = 0.749, p < 0.001 in nPCR). Our results suggest that the urea monitor may be used for on-line assessment of dialysis adequacy and obviates the need for blood sampling.

Protein separation using non-porous sorbents

This article overviews the development of non-porous sorbents having small particle diameters which have proven effective for rapid analysis and micropreparative separation of proteins by liquid chromatography. Much attention is given to the preparation and application of silica- and polystyrene-based non-porous packings for various chromatographic modes, especially affinity chromatography. Modeling works on the prediction and parameter estimation for the dynamics of protein adsorption using non-porous sorbents are reviewed and briefly described. To conclude this review, future prospects of the application of non-porous sorbents are also presented.

Immobilization of beta-fructofuranosidases from Aspergillus on methacrylamide-based polymeric beads for production of fructooligosaccharides

beta-Fructofuranosidases from Aspergillus niger ATCC 20611 and Aspergillus japonicus TIT-KJ1 were purified and immobilized covalently onto methacrylamide-based polymeric beads. The porous, oxriane-containing support was reactive and could bind enzymes in a buffered solution at room temperature with a density up to 0.4 mg of protein g-1 of support with 100% immobilized yield. Neither the optimum temperature for the highest enzymatic activities nor the batch reaction pattern for fructooligosaccharides formation catalyzed by beta-fructofuranosidases was changed by immobilization. The amount of fructooligosaccharides produced from 50% (w/w) sucrose solution using the prepared immobilized enzymes was determined to be approximately 60% of the total sugars in the reaction mixtures. This level of fructooligosaccharides produced by the immobilized enzymes was comparable to that resulting from processes employing other immobilized biocatalysts as shown in the literature. The fraction of total fructooligosaccharides presented in the final mixture increased with the initial sucrose concentration, while fractions of glucose and fructose decreased with an increase sucrose concentration.

Local and regional anesthesia for functional endoscopic sinus surgery

An effective topical and regional anesthetic technique using 25% cocaine paste combined with intravenous midazolam hydrochloride was used in 554 patients undergoing functional endoscopic sinus surgery. The operative fields were excellent and all procedures were completed with little patient disturbance. Patients recovered rapidly from sedation and were usually fit for discharge on the same day. There were no anesthetic complications. The major surgical complication rate was 0.5%.

Quantifying the future impact of disease on society: life table-based measures of potential life lost

OBJECTIVES

Quantifying health status in human populations by means of an index such as "years of potential life lost" has recently received attention. However, such an index, being cross-sectional in nature, only measures the current burden to society resulting from a specific cause of death.

METHODS

The author proposes new indices of potential life lost to quantify future impacts on society of particular causes of death. These indices also properly reflect the effects of competing risks. The computation is simple, requiring no more than a standard life-table calculation. Real-world as well as hypothetical data are used to illustrate the method.

RESULTS

The new indices convey valuable health status information about a population that is not revealed by traditional indices.

CONCLUSIONS

The new indices are promising alternatives as measures of future potential life lost.

Hepatic portal venous gas associated with acute mesenteric infarction--a case report

Hepatic portal venous gas (HPVG) is considered as an ominous prognostic sign and indicates the need for urgent surgical intervention. It has been associated with a wide variety of abdominal catastrophes, but the commonest and most serious one is infarcted bowel. This disease entity is difficult to be detected by conventional radiography. Ultrasonography and computed tomography have been reported to be more valuable methods in detecting HPVG and its cause. We report a case of HPVG associated with acute mesenteric infarction, which was detected early by ultrasonography. The computed tomography done later not only showed typical features of HPVG, but also disclosed intramural gas in the small intestine and gas in the superior mesenteric veins, which were diagnostic clues for acute mesenteric infarction. The patient survived after urgent surgery.

One-step HPLC purification procedure for porcine brain 90-kDa heat shock protein

The 90-kDa heat shock protein (HSP90) was purified from porcine brain by a novel single-step purification procedure using diethylaminoethyl high-performance liquid chromatography (HPLC). About 4.8 mg of HSP90 was isolated from 25 g wet wt porcine brain tissue. The purified protein possessed a single moiety on one- and two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by silver staining. Western blotting using monoclonal antibody prepared against human HSP90 confirmed its identity as HSP90. These results indicate that small-scale HPLC purification of HSP90 from porcine brain tissue can be readily accomplished, with high yield, using a convenient one-step purification method. The procedure described in this paper represents a significant improvement in current purification methods for the isolation of HSP90 from porcine brain.

Transforming activity and mitosis-related expression of the AKT2 oncogene: evidence suggesting a link between cell cycle regulation and oncogenesis

The AKT2 oncogene encodes a protein-serine/threonine kinase containing a pleckstrin homology domain characteristic of many signaling proteins. Recently, it was shown that AKT2 kinase activity can be induced by platelet-derived growth factor through phosphatidylinositol-3-OH kinase, suggesting that AKT2 may be an important signal mediator that contributes to the control of cell proliferation. We previously reported amplification and overexpression of AKT2 in human cancers. To investigate the transforming activity of AKT2, we used a retrovirus-based construct to express AKT2 in NIH3T3 cells. Overexpression of AKT2 was found to transform NIH3T3 cells, as determined by growth in soft agar and tumor formation in nude mice. The oncogenic activity of AKT2 was diminished by truncation of a 70-amino acid proline-rich region at the carboxyl-terminus. To facilitate the characterization of AKT2, we generated monoclonal and polyclonal antibodies against this protein. AKT2 was localized to the cytoplasm by cell fractionation experiments, immunocytochemistry, and immunofluorescence. Protein levels were more abundant in mitotic cells than in interphase cells. Western blot analysis of synchronized pancreatic cancer cells demonstrated that the expression level of AKT2 protein in mitotic cells is three to fivefold higher than in their interphase counterparts. A time-course study of phytohemagglutinin-stimulated lymphocytes revealed that AKT2 mRNA and AKT2 protein levels are highest 48-72 h after addition of mitogen, when cells are actively dividing. These data suggest that AKT2 could play a significant role in cell cycle progression and that the oncogenic activity of overexpressed AKT2 may be mediated by aberrant regulation of cellular proliferation.

Characterizing exposure-disease association in human populations using the Lorenz curve and Gini index

To characterize exposure-disease association in human populations, epidemiologists have long relied upon such indices as "relative risk' and/or 'attributable risk'. However, the relative risk is not in a common unit which permits comparison across different exposures or different diseases and the attributable risk may not adequately catch and describe the variation of disease risks in populations. The present paper discusses the possibility of using the summary index of the Lorenz curve, the Gini index, as an alternative measure of exposure-disease association. It is found that this index can be interpreted in several ways (as the coefficient of deviation in disease risk or relative risk, the information content of the exposure, the impact fraction of an exposure-lowering programme, and the averaged impact fraction) and is a promising alternative as a fundamental measure in epidemiology. Further studies are warranted to investigate its statistical properties.

Immobilization of whole-cell penicillin G acylase by entrapping within polymethacrylamide beads

Escherichia coli ATCC 11105 containing the periplasmic penicillin G acylase was entrapped within a copolymer of methacrylamide and N,N'-methylenebisacrylamide. A solution of monomer that was made up from methacrylamide and N,N'-methylenebisacrylamide dissolved in buffer was mixed with lyophilized cells and ammonium persulfate. This suspension was then pumped drop by drop into in soybean oil supplemented with 0.06% (v/v) 3-(dimethylamino)-propionitril. During submerging in the oil phase, the droplets were hardened and induced to polymerize within the droplets. Particles with a volume ranging from 0.013-0.017 mL per bead containing a biomass concentration up to 38.0 g/L were prepared. The optimal condition for the deacylation of penicillin G to 6-aminopencillanic acid (6-APA) catalyzed by the immobilized whole-cell penicillin G acylase was found to be 45 degrees C and pH 8.0. Product inhibition of this enzyme by 6-APA could be eliminated by controlling pH value at 8 during the course of penicillin G hydrolysis using a pH-stat. Conversion determined by the pH-stat method were 0.3% higher than that by p-dimethylaminobenzaldehyde method. Cell concentration in the matrix was found to be an important factor influencing the maximum velocity and the specific activity retained in the matrix. A kinetic model, in which the mass transfer resistances as a result of external film mass transfer and pore diffusion were assumed to be negligible, could properly describe the hydrolysis of penicillin G by the cells entrapped within the polymethacylamide beads.

Immobilization of enzymes on methacrylamide-based copolymers

A series of reactive polymeric supports for the covalent binding of enzymes was prepared from methacrylamide in conjunction with various copolymerized monomers. In all cases the specific surface area of the prepared copolymer particles increased with the ratio of crosslinker to monomer. The polymers containing oxirane and aldehyde groups were promising for direct binding of beta-galactosidase, whereas the supports containing amino groups also qualified for enzyme immobilization with glutaraldehyde.

Unusual presentation of a small hepatocellular carcinoma: a case report

Most small hepatocellular carcinomas are asymptomatic. While small hepatocellular carcinomas do have symptoms, these symptoms are usually related to the underlying liver disease, not to the tumor itself. We encountered a 63-year-old male patient with a small hepatocellular carcinoma, 2.5 cm in diameter, presenting with fever, abdominal pain and sensation of abdominal fullness. These were unusual clinical manifestations related to the small hepatocellular carcinoma itself and challenged the diagnosis.