Post-stroke dysphagia and ambient air pollution are associated with dementia

Introduction

This cohort study aimed to explore the potential association between ambient air pollution and dementia incidence in adults who have experienced a stroke. Additionally, the study aimed to determine dysphagia as a predictive factor for the subsequent development of dementia in patients with stroke.

Materials and methods

This retrospective nested case-control study used data from the Kaohsiung Medical University Hospital Database in Taiwan. Data collected include average ambient air pollution concentrations within 3 months and 1 year after the index dysphagia date. The primary outcome includes incident dementia in patients with or without dysphagia. Logistic regression analysis was performed to examine the association between significant air pollution exposure and the risk of dementia while controlling for baseline demographic characteristics (age and sex), and comorbidities.

Results

The univariable regression models revealed a higher likelihood of dementia diagnosis in patients with dysphagia (odds ratio = 1.493, 95% confidence interval = 1.000-2.228). The raw odds ratios indicated a potential link between air pollution exposure and elevated dementia risks in the overall study population and patients with stroke without dysphagia, except for O3. Particulate matter (PM)2.5 and nitrogen oxides (NOx) exhibited significant effects on the risk of dementia in the stepwise logistic regression models.

Conclusion

The presence of dysphagia following a stroke may pose a risk of developing dementia. Additionally, PM2.5 and NOx exposure appears to elevate the risk of dementia in patients with stroke.

Acidosis-related pain and its receptors as targets for chronic pain

Sensing acidosis is an important somatosensory function in responses to ischemia, inflammation, and metabolic alteration. Accumulating evidence has shown that acidosis is an effective factor for pain induction and that many intractable chronic pain diseases are associated with acidosis signaling. Various receptors have been known to detect extracellular acidosis and all express in the somatosensory neurons, such as acid sensing ion channels (ASIC), transient receptor potential (TRP) channels and proton-sensing G-protein coupled receptors. In addition to sense noxious acidic stimulation, these proton-sensing receptors also play a vital role in pain processing. For example, ASICs and TRPs are involved in not only nociceptive activation but also anti-nociceptive effects as well as some other non-nociceptive pathways. Herein, we review recent progress in probing the roles of proton-sensing receptors in preclinical pain research and their clinical relevance. We also propose a new concept of sngception to address the specific somatosensory function of acid sensation. This review aims to connect these acid-sensing receptors with basic pain research and clinical pain diseases, thus helping with better understanding the acid-related pain pathogenesis and their potential therapeutic roles via the mechanism of acid-mediated antinociception.

Oxidative stress involves phenotype modulation of morbid soreness symptoms in fibromyalgia

OBJECTIVES

Muscle soreness occurs after exercise and also in musculoskeletal diseases, such as fibromyalgia (FM). However, the nosography and pathoetiology of morbid soreness in FM remain unknown. This study aimed to investigate the morbid soreness of FM, evaluate its therapeutic responses and probe its pathophysiology with metabolomics profiling.

METHODS

Patients with newly diagnosed FM were prospectively recruited and completed self-report questionnaires pertaining to musculoskeletal symptoms. The phenotypes and metabotypes were assessed with variance, classification and correlation analyses.

RESULTS

Fifty-one patients and 41 healthy controls were included. Soreness symptoms were prevalent in FM individuals (92.2%). In terms of manifestations and metabolomic features, phenotypes diverged between patients with mixed pain and soreness symptoms (FM-PS) and those with pain dominant symptoms. Conventional treatment for FM did not ameliorate soreness severity despite its efficacy on pain. Moreover, despite the salient therapeutic efficacy on pain relief in FM-PS cases, conventional treatment did not improve their general disease severity. Metabolomics analyses suggested oxidative metabolism dysregulation in FM, and high malondialdehyde level indicated excessive oxidative stress in FM individuals as compared with controls (p=0.009). Contrary to exercise-induced soreness, lactate levels were significantly lower in FM individuals than controls, especially in FM-PS. Moreover, FM-PS cases exclusively featured increased malondialdehyde level (p=0.008) and a correlative trend between malondialdehyde expression and soreness intensity (r=0.337, p=0.086).

CONCLUSIONS

Morbid soreness symptoms were prevalent in FM, with the presentation and therapeutic responses different from FM pain conditions. Oxidative stress rather than lactate accumulation involved phenotype modulation of the morbid soreness in FM.

TRIAL REGISTRATION NUMBER

NCT04832100.

The association between white matter changes and development of malignant middle cerebral artery infarction: A case-control study

ABSTRACT

Disrupted blood-brain barrier (BBB) in patients with ischemic stroke plays a critical role in malignant middle cerebral artery infarction (MMI) development.Cerebral white matter changes (WMC), particularly in the deep subcortical area or in severe one, may be also underlain by disrupted BBB. It is unclear whether the presence of WMC with potential premorbid disruption of BBB makes patients susceptible to MMI. Therefore, this study aimed to clarify any putative relationship between the MMI and WMC in terms of their severity and locations.In this case-control study, patients with infarction in the middle cerebral artery territory were retrospectively reviewed. Brain magnetic resonance images were analyzed according to Fazekas scale, and identified WMC were divided into periventricular WMC (PV-WMC) and deep subcortical WMC (deep-WMC). Patients were scored as having WMC, PV-WMC, deep-WMC, severe PV-WMC, and severe deep-WMC according to the severity and locations. Patients were defined as having MMI if either a progressive conscious disturbance or signs of uncal herniation was recorded in combination with a midline shift >5 mm identified on the follow-up computed tomography.Among 297 patients admitted between July 2009 and February 2015, 92 patients were eligible for final analysis. Compared to patients without MMI, patients with MMI had a higher score of National Institutes of Health Stroke Scale, a larger infarct volume, and an increasingly greater proportion of severe PV-WMC, deep-WMC, and severe deep-WMC, respectively. After adjustment for sex, age, infarct volume, and history of hypertension, severe deep-WMC (odds ratio [OR] = 6.362, 95% confidence interval [CI] = 1.444-28.023, P = .0144) and severe PV-WMC (odds ratio = 5.608, 95% confidence interval = 1.107-28.399, P = .0372) were significantly associated with MMI development.MMI and WMC are significantly associated such that MMI development is more likely when PV-WMC or deep-WMC is more severe. We hypothesize that Fazekas scale-defined severe deep-WMC and PV-WMC may be considered as clinically approachable predictors of MMI development. These findings support that the WMC with potential premorbid disrupted BBB may make patients susceptible to MMI, and further prospective study should be conducted to clarify this hypothesis.

Activation of acid-sensing ion channel 3 by lysophosphatidylcholine 16:0 mediates psychological stress-induced fibromyalgia-like pain

OBJECTIVES

Fibromyalgia is commonly considered a stress-related chronic pain disorder, and daily stressors are known triggers. However, the relation between stress and pain development remains poorly defined by clinical approaches. Also, the aetiology remains largely unknown.

METHODS

We used a newly developed mouse model and lipidomic approaches to probe the causation and explore the biological plausibility for how perceived stress translates into chronic non-inflammatory pain. Clinical and lipidomic investigations of fibromyalgia were conducted for human validation.

RESULTS

Using non-painful sound stimuli as psychological stressors, we demonstrated that mice developed long-lasting non-inflammatory hyperalgesia after repeated and intermittent sound stress exposure. Elevated serum malondialdehyde level in stressed mice indicated excessive oxidative stress and lipid oxidative damage. Lipidomics revealed upregulation of lysophosphatidylcholine 16:0 (LPC16:0), a product of lipid oxidisation, in stressed mice. Intramuscular LPC16:0 injection triggered nociceptive responses and a hyperalgesic priming-like effect that caused long-lasting hypersensitivity. Pharmacological or genetic inhibition of acid-sensing ion channel 3 impeded the development of LPC16:0-induced chronic hyperalgesia. Darapladib and antioxidants could effectively alleviate the stress-induced hyperalgesia by inhibiting LPC16:0 synthesis. Clinical investigations showed that excessive oxidative stress and LPC16:0 expression also exist in patients with fibromyalgia. Moreover, LPC16:0 expression was correlated with pain symptoms in patients with high oxidative stress and disease severity.

CONCLUSIONS

Our study provides experimental evidence for the causal effect of psychological stressors on chronic pain development. The findings identify a possible pathophysiological mechanism of stress-induced chronic non-inflammatory pain at molecular, behavioural and clinical levels that might indicate a new therapeutic approach for fibromyalgia.

0671 Combination Of Transoral Robotic Surgery And Oropharyngeal Myofunctional Therapeutic Training For Patients With Obstructive Sleep Apnea

Introduction

Obstructive Sleep Apnea (OSA) is a type of sleep disorder characterized by intermittent, partial or complete upper airway collapse. Mostly, moderate to severe OSA cases were recommended to treat with continuous positive airway pressure, however, some of them were withdrawn. Transoral robotic surgery (TORS) was considered for OSA patient with tongue base hypertrophy, but the success rate was only 66.9% and the symptoms might relapse because of aging and gaining weights. Myofunctional therapeutic training (MFTT) was also an alternative treatment for patients with mild to moderate OSA. In our study, we investigated the effect of TORS surgery and oropharyngeal MFTT for OSA patients.

Methods

Seven adult patients were recruited, who were newly diagnosed with moderate to severe OSA (Apnea-hypopnea Index, AHI, 49.8±27.7/h). Polysomnography, questionnaire (Pittsburgh sleep quality index, PSQI; Snore Outcomes Survey, SOS), and the muscle strengths over tongue and jaw-opening were assessed before TORS surgery, 6-week and 18-week after surgery. The components of MFTT program involved jaw opening, tongue protrusion, tongue left, tongue right, tongue up and tongue down. It began at 6th week after surgery and these patients underwent 12 weeks of the home-based oropharyngeal MFTT. During the training intervention period, subjects were interviewed every week for adjusting the treatment intensity.

Results

Mean age was 45.9 years old (SD 9.8) and body mass index (BMI) was 26.6 (SD 3.6). After combination treatment of TORS surgery and MFTT, AHI-supine was significantly decreased from 66.3/h to 26.8/h (p<0.05). PSQI and SOS scores were significantly improved (-2.1, 28.8, respectively). Compared with different components of MFTT program, muscle strength of tongue protrusion was the only significant predictor of AHI-supine reduction.

Conclusion

Our study presented that combination of TORS surgery and oropharyngeal MFTT could improve OSA severity and symptoms.

Support

This work was supported by National Cheng-Kung University Hospital (grant number NCKUH-10802018).

Evaluating soreness symptoms of fibromyalgia: Establishment and validation of the Revised Fibromyalgia Impact Questionnaire with Integration of Soreness Assessment

BACKGROUND

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain. A common complaint is soreness. However, until now, no assessment tool is available to address soreness and evaluate its impact on disease severity. We aimed to establish a questionnaire for soreness assessment and to evaluate its validity in fibromyalgia patients.

METHODS

Patients diagnosed with fibromyalgia per the American College of Rheumatology criteria (2011) were recruited. The Revised Fibromyalgia Impact Questionnaire with an integration of Soreness Assessment (FIQRS) was established by adding five items pertinent to soreness sensation to the existing FIQR. The participants were asked to evaluate their soreness symptoms by filling out the FIQRS twice. The test-retest reliability and internal consistency were assessed. Construct validity was evaluated by correlations with the FIQR and fibromyalgia symptom severity (SS) score.

RESULTS

Sixty-two patients with fibromyalgia were recruited, including 57 females (91.9%; mean age: 51.4 years). The intraclass correlation coefficient (ICC) of test-retest reliability was 0.92 for the FIQRS overall score. The Cronbach's α of all the items in the FIQRS was 0.93. The correlation coefficient of the FIQRS total score with the FIQR was 0.97 (p < 0.0001) and that with the fibromyalgia SS scale was 0.52 (p < 0.0001).

CONCLUSION

The FIQRS has good reliability and internal consistency for the assessment of disease impact on fibromyalgia patients, thus providing a reliable tool for soreness evaluation. Future studies are warranted for further validation regarding its correlation with other psychometric properties and life quality measurements.

Quasi-Static Current Measurement with Field-Modulated Spin-Valve GMR Sensors

A non-contact current measurement device comprised of a GMR sensor and a ferrite ring core was investigated. The sensor chip employed a high-sensitivity spin-valve full-bridge GMR sensor of which the direct output has non-negligible hysteresis and a limited linear range. By applying an AC modulation current to modulate the output of the GMR sensor, the hysteresis was reduced, and the linear range was over ±0.5 A. The resolution for DC and quasi-static current measurement was 0.1 mA at a 10 Hz bandwidth. The output in proportion to the measured current was obtained either by demodulating the current-sensitive AC signal or by employing the filtered output of the intrinsically nonlinear spin-valve response. The proposed current sensing scheme is suitable for quasi-static current measurement from DC to over 100 Hz.

Sensing acidosis: nociception or sngception?

Background

Sensing tissue acidosis is an important function of the somatosensory nervous system to response to noxious stimuli.

Main body

In the pain clinic, acid or soreness sensation is a characteristic sensory phenotype of various acute and chronic pain syndromes, such as delayed onset muscle soreness, fibromyalgia, and radicular pain. However, soreness sensation is a sign of successful analgesia for acupuncture and noxipoint therapy. Thus, the nature of acid or soreness sensation is not always nociceptive (or painful) and could be anti-nociceptive. To facilitate the investigation of the molecular and neurobiological mechanisms of soreness sensation, we propose a concept called “sngception (sng- ception)” to describe the response of the somatosensory nervous system to sense tissue acidosis and to distinguish it from nociception. “Sng” is a Taiwanese word that represents the state of soreness while at the same time imitates the natural vocalization of humans feeling sore.

Conclusion

Here we propose sngception as a specific somatosensory function that transmits the acid sensation from the peripheral to the central nervous system. Sngception could partially overlap with nociception, but it could also transmit antinociception, proprioception, and pruriception.

Clinical and radiological findings suggesting disorders other than tolosa-hunt syndrome among ophthalmoplegic patients: a retrospective analysis

OBJECTIVE

To investigate clinical and radiological features of Tolosa-Hunt syndrome (THS) and examine their diagnostic value, and to propose clinical and radiological features that indicate other symptomatic painful ophthalmoplegias (SPOs) in order to distinguish them from THS.

BACKGROUND

Clinical presentations of THS are nonspecific and may overlap with many etiologies. Therefore, excluding other SPOs is essential for correct diagnosis. At the present time, the predictive value of the current International Classification of Headache Disorders (ICHD) criteria is not well established, and specific imaging markers that can discriminate SPOs from THS are lacking.

METHODS

Patients referred with painful ophthalmoplegia over 12 years were recruited retrospectively and allocated into THS or SPO groups. Typical symptoms (episodic unilateral orbital pain preceding or developing with diplopia) and imaging of THS (inflammatory lesions in the cavernous sinus/orbit by magnetic resonance imaging) were proposed based on ICHD-3 beta criteria and previous literature. Atypical clinical and radiological features suggesting alternative diagnoses were also proposed to predict SPO. Initial presentations and imaging findings were registered and correlated with diagnostic outcomes. The predictive value of clinical and imaging findings was then evaluated.

RESULTS

Of the 61 referred cases, 25 were classified as THS and 36 as SPO. Of the SPO cases, 52.8% manifested typical THS symptoms at onset. Patients with SPOs were prone to have atypical symptoms (47.2%) and radiographical findings (82.1%) in comparison to those with THS (4.0% and 4.2%, respectively; both P < .001). Both typical symptoms and imaging findings predicted a diagnosis of THS with high sensitivity (95.8% and 100%, respectively) but low specificity (47.2% and 28.6%, respectively). High sensitivity (82.1%) and specificity (95.8%) were achieved using atypical imaging features to predict SPO.

CONCLUSION

A diagnosis of THS based strictly on clinical presentations or imaging results is not completely reliable. Identification of atypical imaging features may have a useful role in discriminating SPOs and thus avoid erroneous diagnoses of THS. Future studies with larger sample sizes are warranted to evaluate their validity in general population.

Painful ophthalmoplegia with normal cranial imaging

Background

Painful ophthalmoplegia with normal cranial imaging is rare and confined to limited etiologies. In this study, we aimed to elucidate these causes by evaluating clinical presentations and treatment responses.

Methods

Cases of painful ophthalmoplegia with normal cranial MRI at a single center between January 2001 and June 2011 were retrospectively reviewed. Diagnoses of painful ophthalmoplegia were made according to the recommendations of the International Headache Society.

Results

Of the 58 painful ophthalmoplegia cases (53 patients), 26 (44.8%) were diagnosed as ocular diabetic neuropathy, 27 (46.6%) as benign Tolosa-Hunt syndrome (THS), and 5 (8.6%) as ophthalmoplegic migraine (OM). Patients with ocular diabetic neuropathy were significantly older (62.8 ± 7.8 years) than those with benign THS (56.3 ±12.0 years) or OM (45.8 ± 23.0 years) (p < 0.05). Cranial nerve involvement was similar among groups. Pupil sparing was dominant in each group. Patients with benign THS and OM responded exquisitely to glucocorticoid treatment with resolved diplopia, whereas patients with ocular diabetic neuropathy didn’t (p < 0.05). Patients with OM recovered more rapidly than the other groups did (p < 0.05). Overall, most patients (94.8%) recovered completely during the follow-up period.

Conclusions

Ocular diabetic neuropathy and benign THS accounted for most of the painful ophthalmoplegias in patients with normal cranial imaging. Patient outcomes were generally good.

A comparison of benign and inflammatory manifestations of Tolosa-Hunt syndrome

BACKGROUND

Tolosa-Hunt syndrome (THS) manifests as a benign or an inflammatory type disease. The nosography differences between these types remain to be elucidated. We aimed to analyze and compare the clinical presentations of benign and inflammatory THS.

METHODS

The ward patients who presented with THS from January 1990 to May 2011 were retrospectively reviewed. THS was diagnosed according to the recommendations of the International Headache Society.

RESULTS

Of the 53 THS cases (49 patients), 30 (56.6%) were classified as benign and 23 (43.4%) as inflammatory THS. There were strong similarities between the groups in terms of clinical manifestations, laboratory findings, responses to glucocorticoid treatment, and outcomes. However, patients with inflammatory THS tended to be younger (mean age, 43.4 years; P 0.05) and have optic nerve dysfunction (56.5%; P 0.05) and longer disease duration (2.3 ± 1.0 months; P 0.05) compared to those with benign THS (mean age, 56.4 years; mean disease duration, 1.6 ± 0.7 months). The patients with additional involvement of both the optic nerve and the second division of the trigeminal nerve experienced a longer disease duration ( P 0.05). Additionally, patients with orbital pseudotumors had diplopia that responded poorly to treatment with glucocorticoids ( P 0.05). High-dose (>0.5 mg/kg/day) and low-dose (≤0.5 mg/kg/day) prednisolone were equally effective in relieving symptoms in both groups ( P > 0.05).

CONCLUSION

Benign and inflammatory THS were highly similar in terms of nosography. The responses to glucocorticoid treatment were generally good except in patients with orbital pseudotumors.

Biostabilization assessment of MSW co-disposed with MSWI fly ash in anaerobic bioreactors

Municipal solid waste incinerator (MSWI) fly ash has been examined for possible use as landfill interim cover. For this aim, three anaerobic bioreactors, 1.2m high and 0.2m in diameter, were used to assess the co-digestion or co-disposal performance of MSW and MSWI fly ash. Two bioreactors contained ratios of 10 and 20 g fly ash per liter of MSW (or 0.2 and 0.4 g g(-1) VS, that is, 0.2 and 0.4 g fly ash per gram volatile solids (VS) of MSW). The remaining bioreactor was used as control, without fly ash addition. The results showed that gas production rate was enhanced by the appropriate addition of MSWI fly ash, with a rate of approximately 6.5l day(-1)kg(-1)VS at peak production in the ash-added bioreactors, compared to approximately 4l day(-1)kg(-1)VS in control. Conductivity, alkali metals and VS in leachate were higher in the fly ash-added bioreactors compared to control. The results show that MSW decomposition was maintained throughout at near-neutral pH and might be improved by release of alkali and trace metals from fly ash. Heavy metals exerted no inhibitory effect on MSW digestion in all three bioreactors. These phenomena indicate that proper amounts of MSWI fly ash, co-disposed or co-digested with MSW, could facilitate bacterial activity, digestion efficiency and gas production rates.

A Comparative Efficacy and Safety Study of Long-Acting Risperidone Injection and Risperidone Oral Tablets Among Hospitalized Patients: 12-Week Randomized, Single-Blind Study

OBJECTIVE

The superiority of risperidone long-acting injection (RLAI) over oral typical and atypical antipsychotics demonstrated in previous studies may be related to the improved drug compliance. The aim of the 12-week randomized, single-blind study was to test whether the superiority of RLAI remained among hospitalized patients that drug compliance could be optimally controlled.

METHODS

Fifty hospitalized stable schizophrenic patients, who had maintained on oral risperidone for more than 3 months, were randomized to the RLAI and oral risperidone group. Finally 49 patients (98 %) completed the study, and no dose change of oral risperidone, or RLAI was noted among all patients.

RESULTS

The RLAI group showed significantly increased positive score of Positive and Negative Syndrome Scale (PANSS) than the risperidone group (0.72 +/- 3.52 vs. -1.24 +/- 3.81, p = 0.022), but without significance difference for the PANSS total, negative and general psychopathology scores. The RLAI group also showed a significantly improved Udvalg for Kliniske Undersogelser (UKU) Scale (p = 0.037), social life domains of Short-Form Health Survey (SF-36) (p = 0.011), and reduced prolactin level (p = 0.001).

CONCLUSION

The results indicated that with optimal controlling of drug compliance among hospitalized patients, RLAI showed no benefit of efficacy over oral risperidone, but with advantages of improved side-effect profiles, social life ratings, and reduced prolactin levels.

Prevalence and clinical implications of hepatitis B virus genotypes in southern Taiwan

BACKGROUND

Hepatitis B virus (HBV) infection is a major health problem. HBV genotypes may be associated with progression of liver disease. The distribution and clinical implications of HBV genotypes in southern Taiwan are evaluated.

METHODS

We used a polymerase chain reaction-restriction fragment length polymorphism genotyping method to determine HBV genotypes.

RESULTS

The genotype distribution for 265 patients with chronic HBV infection was as follows: A, 3 (1%); B, 158 (60%); C, 90 (34%); D, 7 (2.5%); E, 0: F, 0; and unclassified, 7 (2.5%). Compared with genotype B patients, genotype C patients had a higher hepatitis B e antigen positive rate and higher fibrosis score. There was no significant difference in the mean age between genotype B and genotype C patients with hepatocellular carcinoma (HCC). However, when patients were stratified by age, the prevalence of genotype C was significantly higher in young HCC patients (<50 years of age) than in age-matched asymptomatic carriers (40% versus 10%, P < 0.001). Using multivariate analysis, the significant risk factors for advanced liver disease (cirrhosis or HCC) for patients with chronic HBV infection were old age, male gender and genotype C.

CONCLUSIONS

These results suggest that genotype C is associated with more severe liver diseases than the B variant.

Synthesis and crystal structure of 2,3,12,13-tetraalkoxy-21, 23-dithiaporphyrins

21,23-Dithiaporphyrins with methoxy, butoxy, octyloxy and dodecyloxy substituents at beta-thiophene carbons were synthesised for the first time and the crystal structure of the butoxy derivative indicated that the substituents at the beta-thiophene carbons induce more planarity in the porphyrin ring.

Presence of Rhodocyclus in a full-scale wastewater treatment plant and their participation in enhanced biological phosphorus removal

The objective of this research was to assess the relevance of organisms related to Rhodocyclus in enhanced biological phosphorus removal in full-scale wastewater treatment plants. The presence of these organisms in full-scale plants was first confirmed by fluorescent in situ hybridization. To address which organisms were involved in phosphorus removal, a method was developed which selected polyphosphate-accumulating organisms from activated sludge samples by DAPI staining and flow cytometry. Sorted samples were characterized using fluorescent in situ hybridization. The results of these analyses confirmed the presence of organisms related to Rhodocyclus in full-scale wastewater treatment plants and supported the involvement of these organisms in enhanced biological phosphorus removal. However, a significant fraction of the polyphosphate-accumulating organisms were not related to Rhodocyclus.

Cytotoxic butanolides from the stem bark of Formosan Lindera communis

Two new butanolides, lincomolide A (1), lincomolide B (2), along with seven known compounds, isolinderanolide E, sepesteonol, beta-sitosterol, beta-sitosterol-beta-glucoside, tetradecane, nonanoic acid and decanol, were isolated from the chloroform-soluble portion of the stem bark of Lindera communis. Compound 1 showed cytotoxicity against P-388, KB16 and A549, and 2 exhibited cytotoxicity against P-388 cancer cell lines. Moreover, 1 showed marginal activity against HT-29, and 2 against KB16, A549 and HT-29 cancer cell lines. The structures of these compounds were determined by spectral analyses.

The effects of postpartum stress and social support on postpartum women's health status

BACKGROUND

Eastern sociocultural systems differ in many ways from Western ones, and these differences influence many aspects of the postpartum period.

AIM

The purpose of this study was to determine postpartum women's health status in the wider social context of the Taiwanese family after women return home from the hospital or clinic.

METHOD

A longitudinal study was conducted with data collected at the first, the third, and the fifth weeks of the postpartum period. Five hundred and twenty-six postpartum women were included in the study using stratified sampling from clinics and hospitals in Kaohsiung City in the southern part of Taiwan. The Hung Postpartum Stress Scale (HPSS), Smilkstein's Social Support Scale, and the Chinese Health Questionnaire were used to obtain information about the women's postpartum stress, social support, and health status at each time point. Data were analysed with factor analysis, repeated measures MANOVA, and multiple logistic regression.

RESULTS

Three factors associated with postpartum stress were identified by factor analysis: (1) maternity role attainment, (2) lack of social support, and (3) body changes. Furthermore, the level of postpartum stress at the third and the fifth postnatal weeks was higher than at the first. Social support scores at this postnatal week were the highest among the three points in time. In addition, 29%, 41% and 41% of the women at the first, third, and fifth weeks, respectively, had minor psychiatric morbidity.

CONCLUSIONS

Because the postpartum women's self-reported stress is relatively low whereas the social support is relatively high, especially from the family, this confirms Pillsbury's conclusion regarding the significance of social support during the Chinese women's postpartum period. The study also showed that the three factors associated with postpartum stress were important predictors of postpartum women's health status. Future studies should compare the level of postpartum stress, social support, and women's health status in both Western and Eastern cultures.

Sequence, transcriptional analysis and chromosomal location of the Xanthomonas campestris pv. campestris uvrB gene

The uvrB gene of Xanthomonas campestris pv. campestris, a Gram-negative plant pathogenic bacterium inhabiting soil and infected plants, was cloned and sequenced. This gene has the capacity to encode a polypeptide of 673 amino acid residues with a calculated molecular mass of 75.9 kDa. Its deduced amino acid sequence shows a high degree of similarity and possesses domain conservation to those of bacterial UvrB. The uvrB mutant, isolated by gene replacement, is extremely sensitive to ultraviolet irradiation. Like the situation in the X. campestris pv. campestris recA gene, no SOS box is present upstream of the uvrB gene. Northern blotting and transcriptional fusion assay with lacZ indicated that X. campestris pv. campestris uvrB is expressed constitutively at high levels and cannot be further induced by UV irradiation. These results suggest a regulatory mechanism different from that for the expression of Escherichia coli uvrB. Using a gene-tagging strategy in conjunction with pulsed-field gel electrophoresis, the uvrB gene was located near 1 o'clock on the X. campestris pv. campestris 17 chromosome (4.8 Mb) map, which is far apart from the lexA-recA-recX cluster near 5 o'clock.

A single dose of nebulized budesonide decreases exhaled nitric oxide in children with acute asthma

This study was conducted to investigate whether a single dose of nebulized budesonide effectively decreased airway inflammation as demonstrated by exhaled nitric oxide (eNO) levels. A single dose of nebulized budesonide, but not nebulized terbutaline, rapidly decreased eNO levels in 6 hours. The decrease in eNO levels induced by nebulized budesonide was correlated to an increase in peak expiratory flow rate.

Sonographic features of hepatic adenomas with pathologic correlation

BACKGROUND

We compared the sonographic characteristics of hepatic adenomas with pathologic findings.

METHODS

Information over 10 years was collected on 12 patients (six men, six women; mean age = 47 years) with surgically proven hepatic adenomas. Clinical data, sonographic features, and histopathologic findings were reviewed.

RESULTS

The tumors in males were smaller and simpler than those in women (p < 0.05, Fisher's exact test). Four of the six larger tumors (>5 cm) showed mixed-echoic patterns corresponding with pathologically intratumoral hemorrhage and necrosis. Four homogeneously hypoechoic tumors had less change in tumor composition. Three homogeneously hyperechoic tumors had evident fatty changes inside. One isoechoic tumor had a hypoechoic rim, that correlated mostly to the tumor itself and compressed liver parenchyma. Seven of the 12 tumors had thin fibrous capsules that were not seen on sonography.

CONCLUSION

Hepatic adenomas have variable sonographic appearances depending on changes in the tumor. Hypoechoic, hyperechoic, and mixed-echoic patterns represent simple adenoma, adenoma with fatty metamorphosis, and hemorrhagic necrosis, respectively, in tumors.

Evaluation of different nebulized bronchodilators on clinical efficacy and hypokalemia in asthmatic children

Acute asthma attack continues to be a major cause for children admitted to the emergency room. Nebulized beta 2-adrenergic agonists are still the first-line drugs for a rapid bronchodilation effect and an easily administered drug during acute asthma attack. The bronchodilator-induced hypokalemia is thought significant in adult group, but is often ignored in children group. In this study, we conducted a randomized study to compare the laboratory and clinical effects between nebulized salbutamol and terbutaline. We found that both salbutamol and terbutaline nebulization induced a significant hypokalemia (p < 0.05). Terbutaline nebulization also significantly improved the peak expiratory flow rate (PEFR) and respiratory rate (RR), but not venous partial pressure of oxygen (PvO2), venous carbon dioxide tension (PvCO2) and O2 saturation in venous blood (SvO2). In contrast, salbutamol improved not only PEFR and RR, but also PvO2, PvCO2, and SvO2 30 minutes of administration. In conclusion, the nebulized salbutamol, although induced a hypokalemic effect which is similar to terbutaline group, has a better effect on improving O2 saturation than nebulized terbutaline with the same dose 30 minutes after administered for children with acute asthma attack.

Validity and reliability testing of the Hung Postpartum Stress Scale

This article presents the design and validation of the Hung Postpartum Stress Scale, a device that was initially constructed to measure postpartum stress during the 42 days of the postpartum period after women's discharges from clinics and hospitals. A data collection at the 3rd week of the postpartum period included 512 postpartum women. They were recruited in the study using proportional stratified quota sampling by birth rate from clinics and hospitals in Kaohsiung City in the southern part of Taiwan. Exploratory common factor analysis, confirmatory oblique item clustering, and second-order factor analysis were applied. Three dimensions of postpartum stress were found: maternity role attainment, lack of social support, and body changes. Moreover, the generalizability of the factors across subgroups within the population was examined. The Hung Postpartum Stress Scale's use in practice and research is discussed.

Abrin triggers cell death by inactivating a thiol-specific antioxidant protein

Abrin A-chain (ABRA) inhibits protein synthesis by its N-glycosidase activity as well as induces apoptosis, but the molecular mechanism of ABRA-induced cell death has been obscure. Using an ABRA mutant that lacks N-glycosidase activity as bait in a yeast two-hybrid system, a 30-kDa antioxidant protein-1 (AOP-1) was found to be an ABRA(E164Q)-interacting protein. The interaction was further confirmed in vitro by a glutathione S-transferase pull-down assay. The colocalization of endogenous AOP-1 and exogenous ABR proteins in the cell was demonstrated by confocal immunofluorescence. We also demonstrated that ABRA attenuates AOP-1 antioxidant activity in a dose-dependent manner and the intracellular level of reactive oxygen species (ROS) increases in ABR-treated cells. Moreover, ROS scavengers N-acetylcysteine and 4-hydroxy-2,2,6,6-tetramethylpiperidine-1-oxyl delayed programmed cell death. This indicates that ROS are important mediators of ABR-induced apoptosis. When ectopically expressed, AOP-1 blocked the release of cytochrome c and prevented apoptosis in ABR-treated cells. These findings suggest that the binding of ABRA to AOP-1 promotes apoptosis by inhibiting the mitochondrial antioxidant protein AOP-1, resulting in the increase of intracellular ROS and the release of cytochrome c from the mitochondria to the cytosol, which activates caspase-9 and caspase-3.

Chronic granulomatous disease: a case report

Chronic granulomatous disease is one form of the phagocyte function disorder. Unlike most patients with chronic granulomatous disease who develop signs and symptoms of chronic and recurrent pyogenic infections during the first 2 years of life, patients with mild forms of the disease may not present until the teenage years or even adulthood. Thus, the diagnosis in these mild-form patients is often delayed. This paper describes a patient with the mild form of chronic granulomatous disease. A 7-year-old boy was admitted to our ward with intermittent high fever and a left neck mass present for about 1 week. He had a history of persistent infection in the bilateral lower face lasting for about 1 year during his fourth year of life. Family history was unremarkable except that the patient's elder sister had a history of persistent oral mucosal wound infection for about 1 year during the fifth year of life. On physical examination, there were scars over the patient's bilateral lower face. Bacterial culture of pus drained from the neck mass revealed Burkholderia cepacia, a rare species in patients without immunodeficiency. A series of antibiotics, including oxacillin, clindamycin, and piperacillin, was given, and two incision operations for drainage and debridement were performed. The neck mass resolved completely about 1.5 months later. This history indicated that the patient might have chronic granulomatous disease. A definite absence of superoxide activity in the patient's granulocytes detected by chemiluminescence and nitroblue tetrazolium dye test confirmed this diagnosis.

Enhancement of sindbis virus self-replicating RNA vaccine potency by linkage of herpes simplex virus type 1 VP22 protein to antigen

Recently, self-replicating and self-limiting RNA vaccines (RNA replicons) have emerged as an important form of nucleic acid vaccines. Self-replicating RNA eventually causes lysis of transfected cells and does not raise the concern associated with naked DNA vaccines of integration into the host genome. This is particularly important for development of vaccines targeting proteins that are potentially oncogenic. However, the potency of RNA replicons is significantly limited by their lack of intrinsic ability to spread in vivo. The herpes simplex virus type 1 protein VP22 has demonstrated the remarkable property of intercellular transport and provides the opportunity to enhance RNA replicon vaccine potency. We therefore created a novel fusion of VP22 with a model tumor antigen, human papillomavirus type 16 E7, in a Sindbis virus RNA replicon vector. The linkage of VP22 with E7 resulted in a significant enhancement of E7-specific CD8+ T-cell activities in vaccinated mice and converted a less effective RNA replicon vaccine into one with significant potency against E7-expressing tumors. These results indicate that fusion of VP22 to an antigen gene may greatly enhance the potency of RNA replicon vaccines.

Photocatalytic degradation of azo dye in TiO2 suspended solution

The photocatalysis of azo dye, Orange G, by P-25 anatase TiO2 was investigated in this research. The experiments were conducted in a batch reactor with TiO2 powder suspension. Four near-UV lamps were used as the light source. The experimental variables included solution pH level, amount of TiO2, illumination light intensity, and reaction time. A pseudo-first order reaction kinetic was proposed to simulate the photocatalytic degradation of Orange G in the batch reactor. More than 80% of 10 mg/L Orange G decomposition in 60-minute reaction time was observed in this study and fast decomposition of Orange G only occurred in the presence of both TiO2 and suitable light energy. Faster degradation of Orange G was achieved under acid conditions. The degradation rates of Orange G at pH = 3.0 were about two times faster than those at pH = 7.0. Faster degradation of azo dye was observed for greater irradiated light intensity and more TiO2 present during the reaction. The reaction rates were proportional to TiO2 concentration and light intensity with the power order of 0.726 and 0.734, respectively.

The effect of acid cleaning on a fine pore ceramic diffuser aeration system

Fine pore ceramic diffuser aeration, a very competitive high efficiency system, is widely used in aerobic biological processes for providing dissolved oxygen and mixing. Concern has been registered regarding the maintenance of these systems and their susceptibility to diffuser fouling. Selected ceramic diffusers, removed from the Madison Metropolitan Sewage District (MMSD) Nine Springs Wastewater Treatment Plant, Wisconsin, U.S.A., were fractured and analyzed in an attempt to identify the elemental components of the internal foulants and to evaluate the effect of acid cleaning on diffuser performance. The fouling condition of diffusers were initially characterized by dynamic wet pressure (DWP) measurements. Microimages taken from the non acid-treated diffuser profile using scanning electronic microscopy revealed the structural difference of internal foulants which may correspond to the stage of foulant formation. For diffuser samples from the MMSD facility, calcium phosphate minerals were predominant foulants, although some calcium carbonate and organic carbon have also accumulated. The clogging of diffuser internal void space was verified by observing thin sections of diffuser cross-sections. Selected diffusers were then treated with strong acid to study its effectiveness in removing internal foulant by acid soaking. Even though the acid treated diffusers showed significant reduced DWP values, acid treatment, the common diffuser cleaning technique, does not completely remove these internal foulants. This may be the reason why the acid-treated diffusers never reached like-new conditions. Furthermore, once these acid-treated diffusers are installed back to the aeration tank, these dewatered foulant sections may very well behave as seed for future clogging.

Subglottic hemangioma associated with cutaneous and cerebellar hemangiomas detected by MRI: report of one case

Subglottic hemangioma (SGH) is a benign neoplasm that may cause severe and life-threatening respiratory obstruction in infants. However, patients usually present with inspiratory stridor in the first few months of life and may be mistakenly diagnosed as recurrent or persistent croup. Definitive diagnosis is made by image studies, endoscopic examination and biopsy or all. We report a 2-month-old female infant of SGH with initial clinical manifestations of dyspnea and inspiratory stridor co-existing with cutaneous and cerebellar hemangiomas. Clinicians must be alert the possibility of SGH when associated with cutaneous hemangioma. This patient has received oral steroid treatment for more than two months with improvement of the airway obstruction. Although purplish patch lesions over left side of face, eyelid, cheek, and peri-oral regions regressed, the size of the SGH on the followed MRI was slightly enlarged. The diagnosis and various treatments of SGH are discussed and reviewed in this paper.

Xanthoma of bone in a normolipidemic child: report of one case

Xanthoma invasion of the bone is a very rare disease especially in normolipidemic children. Bone erosion can be found in patients with this disease. However, due to the similarity of the symptoms of xanthoma with many other diseases including malignancy, the other diseases may initially be to be suggested and xanthoma may not even be considered. In this paper, we present an 8-year-old normolipidemic male child with a parietal bone xanthoma proved using tissue diagnosis. The clinical, radiographic and histological findings are also reviewed.

Cerebral infarction in newborns: report of two cases

Neonates with cerebral infarction do not present with specific symptoms and the condition is usually insidious, so many atypical cases are not diagnosed properly during the neonatal stage. Normal neurological examination results may be found in newborns who have actually had a cerebral infarction insidiously. We present two newborns with cerebral infarction. One had clinical symptoms of seizures. Brain computed tomography showed a low-attenuated area and magnetic resonance angiography showed a decreased caliber and number of cerebral artery branches. The other had normal neurological examination results. He was referred to our hospital due to cyanosis. Brain sonography revealed a focal hyperechoic area and T2 weighted magnetic resonance image showed an increased signal intensity area. The incidence, etiologies, clinical and radiographic findings are also reviewed.

The occurrence rate and correlation factors of thumb-in-palm posture in newborns

Bilateral fisting of hands, including adduction and infolding of the thumbs (cortical thumbs), is an expected finding in term infants. Clinically, the cortical thumb position is a transient and normal, but not general, hand posture in newborns. The aim of this study was to analyze the rate of occurrence and the factors possibly affecting the cortical thumb (thumb-in-palm) posture in term newborns. We enrolled 197 low-risk term newborns and observed the posture of their hands once daily from the day of birth for 3 consecutive days. The occurrence rates of the thumb-in-palm posture of the right hand on the first, second, and third days were 62.8%, 60.9%, and 50%, respectively, and those of the left hand were 60.3%, 55.8% and 53.2%, respectively. There was a significant reduction on a day-to-day basis in the right hand and an insignificant reduction in that of the left hand. Factors including sex, gestation age, birth weight, method of delivery, and alertness were analyzed, and no relationship was evident between these factors and the occurrence rates of the cortical thumb posture. Our observations suggest that the cortical thumb posture is indeed a predominant hand posture in our hospital, yet it is not a general phenomenon in all term newborns.

Cyclic monoterpene extract from cardamom oil as a skin permeation enhancer for indomethacin: in vitro and in vivo studies

The in vitro and in vivo effect of pretreatment by cardamom oil, a crude drug extract, in ethanol/water vehicles on the transdermal delivery of indomethacin was investigated. The cyclic monoterpene components in cardamom oil were also determined and quantified in this study. The permeation of indomethacin was significantly enhanced after pretreatment of cardamom oil both in the in vitro and in vivo studies. The result of various pre-treatment periods showed that the indomethacin flux decreased as the length of the pretreatment increased. Both natural cardamom oil and a cyclic monoterpene mixture composed of the components of the oil showed similar enhancement on indomethacin permeation, indicating cyclic monoterpenes are the predominant components altering the barrier property of stratum corneum. The results also showed that three minor components in cardamom oil (alpha-pinene, 6.5%; beta-pinene, 4.8%; alpha-terpineol, 0.4%) had a synergistic effect with 1,8-cineole (59.3%) and d-limonene (29.0%) to enhance the permeation of indomethacin.

Leukocyte adhesion deficiency disorder: report of one case

In this paper, a case of leukocyte adhesion deficiency disorder confirmed by flow cytometry and leukocyte chemotaxis assays is reported. The 32-day-old female infant was admitted to our ward on account of delayed umbilical cord detachment and omphalitis. After admission, hemogram revealed severe leukocytosis (white blood cell (WBC) counts: 86,800/cumm), and there was poor clinical response to several kinds of antibiotics. The above history indicated that the patient might be a case of leukocyte adhesion deficiency disorder. A definite absence of CD11b/CD18 adhesion molecule on the patient's granulocytes and severe defects of leukocyte function demonstrated by chemotaxis, chemokinesis and zymosan-induced respiratory burst assays confirmed this diagnosis.

Kinetics and modeling of autotrophic thiocyanate biodegradation

The biokinetic parameters for autotrophic systems are difficult to obtain and are often mistakenly determined because the size of the autotrophic population in mixed (i.e., heterotrophic and autotrophic) cultures cannot be accurately estimated. This article presents a systematic approach, combining bioenergetic calculations and experimental data, to obtain values of the biokinetic parameters pertinent to the aerobic, autotrophic biodegradation of thiocyanate. Nonlinear regression techniques were employed using both initial thiocyanate utilization rate data and single thiocyanate depletion curves. Both types of data were necessary to overcome the problems arising from the linear nature of the substrate depletion curves and the high correlation of the biokinetic model parameters inherent in nonlinear regression analysis. The aerobic biodegradation of thiocyanate followed a substrate inhibition pattern that was successfully described by the Haldane-Andrews model. Although regression analysis did not yield unique biokinetic parameter estimates, the following parameter value ranges were obtained: maximum specific substrate utilization rate (k), 0.26 to 0.44 mg SCN-/mg biomass h; half-saturation coefficient (Ks), 2.3 to 7.1 mg SCN-/L; and inhibition coefficient (Ki), 28 to 109 mg SCN-/L. Based on the estimated biokinetic parameter values, a design and operation diagram was constructed that depicts the steady-state thiocyanate concentration as a function of solids retention time for a completely mixed, continuous-flow reactor.

Chromosome map of Xanthomonas campestris pv. campestris 17 with locations of genes involved in xanthan gum synthesis and yellow pigmentation

No plasmid was detected in Xanthomonas campestris pv. campestris 17, a strain of the causative agent of black rot in cruciferous plants isolated in Taiwan. Its chromosome was cut by PacI, PmeI, and SwaI into five, two, and six fragments, respectively, and a size of 4.8 Mb was estimated by summing the fragment lengths in these digests. Based on the data obtained from partial digestion and Southern hybridization using probes common to pairs of the overlapping fragments or prepared from linking fragments, a circular physical map bearing the PacI, PmeI, and SwaI sites was constructed for the X. campestris pv. campestris 17 chromosome. Locations of eight eps loci involved in exopolysaccharide (xanthan gum) synthesis, two rrn operons each possessing an unique I-CeuI site, one pig cluster required for yellow pigmentation, and nine auxotrophic markers were determined, using mutants isolated by mutagenesis with Tn5(pfm)CmKm. This transposon contains a polylinker with sites for several rare-cutting restriction endonucleases located between the chloramphenicol resistance and kanamycin resistance (Kmr) genes, which upon insertion introduced additional sites into the chromosome. The recA and tdh genes, with known sequences, were mapped by tagging with the polylinker-Kmr segment from Tn5(pfm)CmKm. This is the first map for X. campestris and would be useful for genetic studies of this and related Xanthomonas species.

Hypokalemia and salbutamol therapy in asthma

Hypokalemia is a common side effect in adult asthmatic patients on beta 2 adrenergic therapy. There is limited information in regard to hypokalemia and its relation to the clinical responses following administration of beta 2 agonist therapy in children with asthma. We observed that salbutamol inhalation significantly improved asthmatic symptoms as demonstrated by increases in peak expiratory flow (PEF: 122.37+/-75.38 vs. 152.59+/-80.29; P < 0.001) and venous oxygen tension (Pv,O2: 33.24+/-4.95 vs. 58.16+/-2.31; P < 0.001), and decreases in respiratory rate (RR: 36.39+/-3.78 vs. 28.62+/-3.12; P< 0.01), clinical scores (CS: 3.59+/-1.28 vs. 1.59+/-0.71), and venous PCO2 tensions (Pv,CO2: 40.84+/-2.67 vs. 34.75+/-2.31; P < 0.001). Salbutamol-induced hypokalemia was correlated with a decrease in RR, and an increase of Pv,O2 and PEF. These findings suggest that the same mechanism is involved in eliciting hypokalemia and bronchodilatation.

[The effect of husband's childbirth participation on perinatal couples' psychological responses]

The purpose of this study was to examine couples' psychological responses toward husband's childbirth participation over time and to confirm the function of the curtain in the delivery room. By a quasi-experimental and prospective longitudinal study, data were collected at three points of time from 73 couples who planned to deliver their first child at one medical center in southern Taiwan. The Zung's Self-rating Anxiety scale and Zung's Self-rating Depression Scale, the Chinese Health Questionnaire, a Social Support Scale, and the Postpartum Stress Scale were used. The two-way ANOVA with repeated measures was used to compare the means of psychological responses between experimental and control groups at each point in time. The level of wife's depression was influenced by the interaction of groups and times significantly. However, the main effect of husband's childbirth participation on couples' anxiety, depression, health status, social support and the wife's postpartum stress was not found and the limitations of the study were discussed.

Renal abscess: report of two cases

Renal abscess, a very uncommon renal disease in the pediatric patient is often complicated by irrelevant antibiotics treated urinary tract infection or due to other unknown reasons. In this paper, two cases of renal abscess were reported though they had been treated with antibiotics. The diagnosis had been made soon by sonography and computed tomography (CT). In addition, during the period of treatment, a series of sonography were performed to monitor resolution of abscess. In one, the lesion was resolved by antibiotics alone for 2 months duration, the other nearly disappeared 3 weeks later after antibiotics treatment combined with tube-drainage. These imaging techniques permit a prompt diagnosis as well as percutaneous drainage performed if antibiotic treatment dose not lead to resolution of the abscess.

Dimerization of the N-terminal amphipathic alpha-helix domain of the fungal immunomodulatory protein from Ganoderma tsugae (Fip-gts) defined by a yeast two-hybrid system and site-directed mutagenesis

A fungal immunomodulatory protein (Fip-gts) was purified from Ganoderma tsugae. The DNA encoding Fip-gts was isolated from a cDNA library of G. tsugae by reverse transcriptase-polymerase chain reaction. The complete amino acid sequence of Fip-gts, deduced from the nucleotide sequence of the cDNA, was the same as LZ-8 isolated from Ganodermn lucidum. Recombinant Fip-gts was expressed as a glutathione S-transferase fusion protein in Escherichia coli with a yield of 20 mg/liter of culture. Recombinant Fip-gts, purified to homogeneity, had the same blast formation stimulatory activity to human peripheral blood lymphocytes as native Fip-gts. The yeast two-hybrid system and site-directed mutagenesis were used to determine whether dimerization of Fip-gts occurred. Deletion analysis of the N-terminal amphipathic alpha-helix domain of Fip-gts identified a sequence of about 10 amino acids responsible for inducing immunomodulatory activity. Non-functional Fip-gts deletion mutants did not form dimers, whereas wild type Fip-gts did as determined by gel filtration. A mutant with deletions at Leu-5, Phe-7, and Leu-9 lost the amphipathic characteristics of the N-terminal domain and the ability to form dimers as well as its immunomodulatory activity. Fusion of Fip-gts with the DNA binding and the transactivation domains of GAL4 resulted in the activation of the lacZ activator gene, indicating the interaction of Fip-gts with it itself. The dimerization domain was further defined by analyzing the ability of the N-terminal 13 amino acids or Leu-5, Phe-7, and Leu-9 deletion mutants of Fip-gts to interact with the wild type Fip-gts. These experiments confirmed the N-terminal amphipathic alpha-helix as the dimerization domain and suggest that the dimerization of Fip-gts may play an important role in Fip-gts immunomodulatory activity.

Identification of amino acid residues of abrin-a A chain is essential for catalysis and reassociation with abrin-a B chain by site-directed mutagenesis

Abrin is a toxic protein consisting of two subunits, an enzymatic A chain (ABRaA) and a lectin-active B chain (ABRaB), linked by a disulfide bond. Site-directed mutagenesis was performed using PCR to study how the conserved amino acid residues, Tyr74, Tyr113, Glu164 and Trp198, around the active site of ABRaA are involved in enzyme catalysis, enzyme-substrate recognition and reassociation of ABRaA with ABRaB. The protein biosynthesis inhibitory activities of Y74F, Y113F and W198F were decreased moderately to that of wild type reABRaA, while that of E164Q decreased dramatically. Kinetic analysis showed that the kat of Y74F, Y113F and W198F resembled that of wild type, while the Km increased significantly. W198F did not reassociate with ABRaB to form heterodimers, while Y74F, Y113F and E164Q did. SDS-PAGE analysis of ABRaA treated with trypsin showed that reABRaA, Y74F, Y113F and E164Q survived digestion, whereas W198F was not protected from digestion. CD spectra revealed that W198F showed significant conformational changes. These observations suggest that E164 is directly involved in catalysis, and Tyr74, Tyr113 and Trp198 in substrate binding, while Trp198 also plays an important role in maintaining the conformation of ABRaA required for its reassociation with ABRaB.

[Correlates of couples' attitudes toward husband's childbirth participation]

The purpose of this study was to explore the couples' attitude toward husband's childbirth participation and its context. By a cross-sectional study, data were collected from 100 couples who plant to deliver at one medical center in southern Taiwan. The modified version of individual Traditionality-Modernity Scale, a Social Support Scale, Zung's Self-rating depression scale and Zung's Self-rating Anxiety Scale, and the Chinese Health Questionnaire were used. Findings indicated that 73.0% wives and 80.0% husbands showed a favorable attitude toward husband's childbirth participation. Four factors were identified to be associated with couples' favorable attitude: (1) wife's mental support; (2) welcome for newborn's coming; (3) share in the childbirth with the wife together; (4) curiosity about the labor. In contrast, four factors related to unfavorable attitude were found: (1) unhelpful for the wife; (2) folk taboo; (3) husband's psychological impact; and (4) wife's negative body image. Moreover, logistic multiple regression indicated that those wives who desired a boy or a girl and those husbands who had junior college or below education tended to anticipate husband's childbirth participation or tended to childbirth participation. In response to the social trend, it is necessary to conduct more childbirth classes and encourage husbands to be present in the delivery room in order to promote family-oriented care in our health care system.