Predictive cut-off values for the triglyceride-to-high-density lipoprotein cholesterol ratio to predict metabolic syndrome in the middle-aged Korean population

BACKGROUND AND AIMS

The triglyceride-to-high density lipoprotein cholesterol (TG/HDL) ratio is associated with insulin resistance related diseases, including metabolic syndrome (MetS). However, specific TG/HDL values that can predict MetS have not been well identified. In this study, we analyzed both cross-sectional and longitudinal data from two national Korean datasets to obtain TG/HDL cut-off values that can identify MetS and predict its occurrence.

METHODS AND RESULTS

To distinguish the presence and occurrence of MetS, the cut-off values were determined using the maximum F-score calculated through a logistic regression analysis. To predict new-onset MetS within 10 years, Cox proportional hazard models were used to consider the time of occurrence. The TG/HDL cut-off values of 3.97, 3.24, and 3.24 were optimal for identifying current MetS and predicting new-onset MetS within 10 years and five years, respectively, in Korean men. In Korean women, the optimal values for each task were 3.18, 2.38, and 2.26, respectively.

CONCLUSIONS

We suggest the TG/HDL ratio as a potential candidate predictor for MetS. Therefore, we anticipate that future studies will apply individual lipid levels as well as their combinatory values to establish models that predict the prevalence and occurrence of MetS, diabetes, and cardiovascular disease.

Comparative analysis of the relationship between four hepatic steatosis indices and muscle mass

Several studies have attempted to validate the relationship between hepatic steatosis and sarcopenia. The crucial limitation is to establish the status of hepatic steatosis by costly or invasive methods. Therefore, several models predicting non-alcoholic fatty liver disease (NAFLD) have been developed but have exhibited heterogeneous results. In this study, we aimed to review and compare four representative models and analyze their relationship with the risk of low muscle mass. Korea National Health and Nutrition Examination Surveys from 2008 to 2011 were used to confirm our hypothesis. Dual-energy X-ray absorptiometry was used to measure the amount of skeletal muscle mass. We used four hepatic steatosis indices: hepatic steatosis index (HSI), Framingham steatosis index (FSI), liver fat score (LFS), and fatty liver index (FLI). Multivariate linear and logistic regressions were used to reveal the relationship between NAFLD and low skeletal muscle index (LSMI). Pairs of FSI-FLI and HSI-FLI exhibited the best and second-best correlations among all possible pairs. The four hepatic steatosis models were associated with increased risk for LSMI. After removing the body mass index effect, HSI and FLI remained robust predictors for LSMI. NAFLD was a significant and potent risk factor for low skeletal muscle.

Association of triglyceride/high-density lipoprotein cholesterol ratio with subclinical inflammation and 10-year cardiovascular disease risk as determined by Framingham risk scores in Korean male smokers

Various risk factors and the multifactorial pathophysiology of cardiovascular disease (CVD) have been studied. We focused on the interaction between insulin resistance and inflammatory processes. Thus, we analyzed the association of triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio with subclinical inflammation and CVD risk in male smokers. We retrospectively reviewed medical records from the Health Promotion Center of Severance Hospital in Korea between 2015 and 2017. Subjects were currently smoking men aged 30 to 59, with leukocyte counts within the normal range, for a total of 1,566. We grouped participants into four groups using the median TG/HDL ratio and the median leukocyte count. The odds ratio (OR) of high Framingham 10-year CVD risk (≥10%) was calculated using multiple logistic regression. The median Framingham 10-year CVD risk increased significantly from Group 1 (low leukocyte count, low TG/HDL ratio) to Group 4 (high leukocyte count, high TG/HDL ratio). The OR for Group 4 was 2.46 compared with Group 1 after adjusting for various CVD risk factors. In subgroup analysis, the OR of the highest leukocyte group was 1.57 compared to the lowest leukocyte group after adjusting for other variables. In conclusion, TG/HDL ratio and subclinical inflammation were positively related to CVD risk in Korean male smokers.

Association of triglyceride/high-density lipoprotein cholesterol ratio with subclinical inflammation and 10-year cardiovascular disease risk as determined by Framingham risk scores in Korean male smokers

Various risk factors and the multifactorial pathophysiology of cardiovascular disease (CVD) have been studied. We focused on the interaction between insulin resistance and inflammatory processes. Thus, we analyzed the association of triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio with subclinical inflammation and CVD risk in male smokers. We retrospectively reviewed medical records from the Health Promotion Center of Severance Hospital in Korea between 2015 and 2017. Subjects were currently smoking men aged 30 to 59, with leukocyte counts within the normal range, for a total of 1,566. We grouped participants into four groups using the median TG/HDL ratio and the median leukocyte count. The odds ratio (OR) of high Framingham 10-year CVD risk (≥10%) was calculated using multiple logistic regression. The median Framingham 10-year CVD risk increased significantly from Group 1 (low leukocyte count, low TG/HDL ratio) to Group 4 (high leukocyte count, high TG/HDL ratio). The OR for Group 4 was 2.46 compared with Group 1 after adjusting for various CVD risk factors. In subgroup analysis, the OR of the highest leukocyte group was 1.57 compared to the lowest leukocyte group after adjusting for other variables. In conclusion, TG/HDL ratio and subclinical inflammation were positively related to CVD risk in Korean male smokers.

Serum leptin level and incidence of CKD: a longitudinal study of adult enrolled in the Korean genome and epidemiology study(KoGES)

Background

Chronic kidney disease(CKD) is a major public health issue and is highly prevalent in the general population. Leptin is an adipose tissue-derived endocrine factor that has been associated with several metabolic factors involved in cardiovascular diseases. Several studies have investigated the association between leptin and renal diseases so far. But the results are conflicting between the studies. The objective of our study was to verify the direct association of serum leptin level with CKD development.

Methods

This prospective cohort study included 2646 adult aged 40–70 without CKD in the Korean Genome and Epidemiology Study(KoGES) across South Korea from November 2005 to February 2012. The primary outcome was the development of CKD as defined by National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI). Multivariate stepwise logistic regression analysis was done to assess the independent associations, for with the incident of CKD as the dependent variable, in tertiles of leptin values.

Results

Among 1100 men and 1546 women with 2.8 mean years of follow-up, incidence of CKD was 18(1.63%) for men and 50(3.23%) for women. In the multivariate logistic regression models, individuals in the highest serum leptin tertile showed significant associations with risk of CKD after adjustment compared to the lowest tertiles in the population. The crude odds ratio for trend was 2.95(p = 0.004) for men. After adjusting for age, baseline eGFR variables showed correlation with statistical significance (OR for trend = 2.25, p = 0.037) for men. The same trends were also seen observed in all population and women also, but no statistical significance was found.

Conclusions

Higher plasma leptin levels are associated with the incidence of CKD, independent of traditional factors such as age, baseline eGFR. Our results suggest that leptin may partly explain part of the reported association between obesity and kidney disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-022-02795-7.

The Effects of Korean Red Ginseng on Biological Aging and Antioxidant Capacity in Postmenopausal Women: A Double-Blind Randomized Controlled Study

Postmenopausal women are vulnerable to aging and oxidative stress due to reduced estrogen. Previous studies have shown that Korean red ginseng (KRG) has beneficial effects on aging and antioxidant capacity. Therefore, we evaluated the effects of KRG on biological aging and antioxidant capacity in postmenopausal women. This study conducted a double-blinded, placebo-controlled clinical trial. The participants were randomly administered KRG or a placebo, and the following metrics were measured: mitochondria DNA (mtDNA) copy number as an indicator of biological aging and, total antioxidant status (TAS) as a marker of antioxidant capacity. Clinical symptoms of fatigue, as measured by the fatigue severity scale, were assessed before and after KRG administration. There were 63 participants, of whom 33 received KRG and 30 received a placebo. The mtDNA copy number (KRG group: 1.58 ± 2.05, placebo group: 0.28 ± 2.36, p = 0.023) and TAS (KRG group: 0.11 ± 0.25 mmol/L, placebo group: −0.04 ± 0.16 mmol/L, p = 0.011) increased and the fatigue severity scale (KRG group: −7 ± 12, placebo group: −1 ± 11, p = 0.033) decreased significantly more in the KRG group than the placebo group. KRG significantly increased the mtDNA copy number, total antioxidant status, and improved symptoms of fatigue in postmenopausal women.

Fatty Liver Index as a Simple and Useful Predictor for 10-year Cardiovascular Disease Risks Determined by Framingham Risk Score in the General Korean Population

BACKGROUND AND AIMS

The fatty liver index (FLI) is a simple and non-invasive method for the diagnosis of fatty liver disease with an increased risk of cardiovascular disease (CVD) as well as liver-related mortality. We examined the association between FLI and 10-year CVD risk as determined by the Framingham risk score.

METHODS

This cross-sectional study included 7,240 individuals aged 30 to 69 years who underwent a health examination between 2015 and 2017. The FLI was calculated using an algorithm based on triglyceride, γ-glutamyltransferase, body mass index (BMI), and waist circumference. Multiple linear and logistic regression analyses were performed to assess independent relationships between the FLI and Framingham risk score after adjusting for confounding variables.

RESULTS

The overall prevalence of fatty liver disease among study participants as assessed by an FLI ≥ 60 was 19.7%. Compared with non-hepatic steatosis (FLI < 30), the odds ratio (95% confidence interval) for a high Framingham 10-year CVD risk ≥ 10% in individuals with hepatic steatosis (FLI ≥ 60) was 2.56 (1.97-3.33) after adjusting for age, gender, fasting plasma glucose, high-density and low-density lipoprotein cholesterol, blood pressure, C-reactive protein, regular exercise, alcohol-drinking, and current smoking.

CONCLUSIONS

The FLI was positively and independently associated with a Framingham 10-year CVD risk in the general Korean population. Our findings suggest that the FLI, a simple, useful, and economical index, may be an indicator of CVD events.

Compared to serum triglyceride alone, the association between serum triglyceride to high-density lipoprotein cholesterol ratio and 10-year cardiovascular disease risk as determined by Framingham risk scores in a large Korean cohort

BACKGROUND

The incidence of cardiovascular disease (CVD) has gradually increased to the extent that it has become the most common cause of mortality worldwide, and triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio, a surrogate marker of insulin resistance, has emerged as an independent predictor of CVD. Additionally, several recent studies have reported an independent association between triglyceride-rich lipoproteins and CVD risk. The present study was conducted to investigate the association between the CVD risk determined by the Framingham risk score and the TG alone and TG/HDL ratio in a large Korean cohort.

METHODS

This cross-sectional study included 6,995 participants aged 30 to 69 years that participated in a health examination program. TG/HDL ratio quartiles and TG quartiles were categorized as follows: Q1: ≤ 1.25, Q2: 1.26-2.07, Q3: 2.08-3.48, and Q4: ≥3.49; Q1: ≤ 71, Q2: 72-105, Q3: 106-159, and Q4: ≥160, respectively. Odds ratios (ORs) and 95% confidence intervals (CI) for high Framingham 10-year CVD risk (≥10%) were calculated across TG/HDL ratio quartiles and TG quartiles using multiple logistic regression analysis after adjusting for confounding variables.

RESULTS

The mean values of most cardiometabolic variables including body mass index, blood pressure, fasting plasma glucose levels, leukocyte count, median CRP levels, and Framingham 10-year CVD risk scores increased gradually with TG/HDL ratio quartiles. The OR (95% CI) of the highest TG/HDL ratio quartile and TG quartile as compared with the lowest TG/HDL ratio quartile and TG quartile for high Framingham 10-year CVD risk was 9.27 (6.68-12.86) and 0.97 (0.69-1.36) after adjusting for confounding variables, respectively.

CONCLUSION

Compared to TG, the TG/HDL ratio was found to be positively and independently associated with Framingham 10-year CVD risk in a large Korean cohort.

Nonalcoholic fatty liver disease, diastolic dysfunction, and impaired myocardial glucose uptake in patients with type 2 diabetes

AIMS

To investigate whether degree of nonalcoholic fatty liver disease (NAFLD) is associated with myocardial dysfunction related to impaired myocardial glucose uptake in patients with type 2 diabetes.

MATERIALS AND METHODS

In total, 131 patients with type 2 diabetes from a tertiary care hospital were included in this study. Myocardial glucose uptake was assessed using [¹⁸ F]-fluorodeoxyglucose-positron emission tomography. Hepatic steatosis and fibrosis were determined using transient liver elastography. Echocardiography was performed to evaluate cardiac structure and function.

RESULTS

Patients with NAFLD had cardiac diastolic dysfunction with higher left ventricular filling pressure (E/e' ratio) and left atrial (LA) volume index than patients without NAFLD (all P < 0.05). Hepatic steatosis correlated with E/e' ratio and LA volume index, and hepatic fibrosis also correlated with E/e' ratio (all P < 0.05). Even after adjusting for confounding factors, a higher degree of hepatic steatosis (r² = 0.409, P = 0.041) and a higher degree of fibrosis (r² = 0.423, P = 0.009) were independent contributing factors to a higher E/e' ratio. Decreased myocardial glucose uptake was associated with a higher degree of steatosis (P for trend = 0.084) and fibrosis (P for trend = 0.012). At the same time, decreased myocardial glucose uptake was an independent contributing factor for a higher E/e' ratio (r² = 0.409; P = 0.040).

CONCLUSIONS

Hepatic steatosis and fibrosis were significantly associated with diastolic heart dysfunction in patients with type 2 diabetes coupled with impaired myocardial glucose uptake.

High triglyceride to HDL cholesterol ratio is associated with low testosterone and sex hormone-binding globulin levels in Middle-aged and elderly men

Objective: We investigated the association between the triglycerides to high-density lipoprotein cholesterol (TG/HDL) ratio and low testosterone and sex hormone-binding globulin (SHBG) levels in middle-aged and elderly men.Methods: This cross-sectional study included 1055 men aged ≥45 years who underwent a medical examination. The cutoff points for low testosterone and SHBG levels were determined as 12.2 and 29.4 nmol/L, which corresponded to the 25th percentile of the current sample. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for low testosterone and SHBG levels were calculated after adjusting for confounding variables across TG/HDL ratio quartiles (Q1: ≤ 1.70, Q2: 1.71-2.54, Q3: 2.55-3.77, Q4: ≥3.78) using multiple logistic regression analysis.Results: The proportion of subjects with low testosterone and SHBG levels significantly increased in accordance with TG/HDL ratio quartile. The ORs (95% CIs) of the lowest TG/HDL ratio quartile compared to the highest TG/HDL ratio quartile for low levels of testosterone and SHBG were 1.96 (1.13-2.75) and 3.90 (2.38-6.38), respectively, after adjusting for age, body mass index, smoking status, alcohol drinking, regular exercise, diastolic blood pressure, fasting plasma glucose, and total cholesterol level.Conclusions: The TG/HDL ratio was inversely associated with testosterone and SHBG levels in middle-aged and elderly Korean men.

Nonalcoholic Fatty Liver Disease as a Risk Factor for Prolonged Corrected QT Interval in Apparently Healthy Korean Women

Background and Aims: Nonalcoholic fatty liver disease (NAFLD) is clinically important because of its association with an increased risk of sudden cardiac death as well as liver-related mortality. Most cases of sudden cardiac death could be mediated by an arrhythmogenic process. Thus, we aimed to determine the association between NAFLD and corrected QT (QTc) interval in apparently healthy Korean women. Methods: This cross-sectional study included 764 women aged 20 to 74 years old who underwent a health examination program between 2014 and 2015. The QTc interval was calculated using Bazett’s formula (QTc = QT/√RR). Multiple linear and logistic regression analysis were performed to assess independent relationships between NAFLD and QTc interval and prolonged QTc (≥ 450 milliseconds) was calculated after adjusting for confounding variables. Results: The overall prevalence of NAFLD was 23.5% in general healthy women. The standardized β coefficient (95% confidence interval) of the QTc increment in patients with NAFLD was 6.4 milliseconds (1.2–11.8) through multiple linear regression analysis after adjusting for age, body mass index, smoking status, and regular exercise as well as mean arterial pressure, fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, aspartate aminotransferase, alanine aminotransferase, calcium, potassium levels and menopause status. Similarly, the odds ratio (95% confidence interval) of NAFLD for prolonged QTc was 2.05 (1.13–3.71) according to multiple logistic regression analysis after adjusting for the same covariables in women aged 20 to 74 years old. Conclusion: We demonstrated the arrhythmogenic potential of NAFLD, implying that careful monitoring of patient electrocardiograms is necessary to evaluate the possible arrhythmic risk in general healthy women with NAFLD. 

A Review of the Pharmacological Efficacy and Safety of Licorice Root from Corroborative Clinical Trial Findings

Since ancient times, licorice, the root of Glycyrrhiza glabra, has been known to have a wide spectrum of therapeutic effects. Glycyrrhizin is cleaved to glycyrrhizic acid, which is subsequently converted to glycyrrhetic acid by human intestinal microflora. Glycyrrhetic acid is a potent inhibitor of 11β-hydroxysteroid dehydrogenase (11β-HSD) and performs a range of corticosteroid-like activities. The pharmacologic effects of licorice contribute to its anti-inflammatory, antioxidative, anti-allergenic, and antimicrobial properties. Licorice has been used to treat liver disease, gastrointestinal disorders, oral disease, and various skin disorders and has been used in gum, candy, herbs, alcoholic beverages, and food supplements. Licorice and its extracts, especially glycyrrhizin, can be taken orally, through the skin (in the form of gels and oils), and intravenously. Licorice demonstrates mineralocorticoid-like activity not only by inhibiting 11β-HSD2, but also by binding to a mineralocorticoid receptor, leading to potentially adverse risks of mineralocorticoid-like overactivity. Chronic use of licorice can lead to hypokalemia and hypertension, and some people are more sensitive to licorice exposure. Based on clinical trials, this review summarizes the positive effects of licorice and other reported side effects.

Association between circadian preference and blood lipid levels using a 1:1:1 propensity score matching analysis

BACKGROUND

Previous studies indicate that circadian preference is associated with various energy metabolism and metabolic disorders. However, little is known about the associations between a circadian rhythm and blood lipid levels, especially in humans.

OBJECTIVE

The aim of the study was to investigate whether the circadian rhythm affects serum lipid levels in Korean adults.

METHODS

We designed a cross-sectional study to evaluate the associations between circadian preference and blood lipid levels in Korean adults. A total of 1984 participants (range of age 19-81 years) were included in this study. Propensity scores were calculated using logistic regression with age, sex, and body mass index. A total of 435 subjects were evaluated by propensity score matching analysis, equally distributed into morningness, intermediate, and eveningness groups, each with 145 subjects. Circadian preference was evaluated by the Morningness-Eveningness Questionnaire.

RESULTS

Participants with the evening preference had significantly higher levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol (non-HDL-C) when compared with those with morning or intermediate preference, after adjusting for confounding variables. Regarding other lipid parameters, both total cholesterol/HDL-C and low-density lipoprotein cholesterol/HDL-C in the evening preference are significantly higher than those of other circadian preferences. Evening preference was also significantly associated with a higher atherogenic index of plasma.

CONCLUSION

Our study demonstrates that there is a significant association between circadian preference and blood lipid levels. Our findings suggest that individuals with evening preference could have a greater risk of atherosclerotic cardiovascular diseases.

Early detection of colorectal cancer based on presence of methylated syndecan-2 (SDC2) in stool DNA

Background

Colorectal cancer (CRC) screening can effectively reduce disease-related mortality by detecting CRC at earlier stages. We have previously demonstrated that the presence of SDC2 methylation in stool DNA is significantly associated with the occurrence of CRC regardless of clinical stage. The aim of this study was to evaluate the clinical performance of stool DNA-based SDC2 methylation test for CRC.

Methods

Aberrant SDC2 methylation in stool-derived DNA was measured by linear target enrichment (LTE)-quantitative methylation-specific real-time PCR (qMSP). Duplicate reactions of meSDC2 LTE-qMSP test were performed for stool samples obtained from CRC patients representing all stages (0–IV) and asymptomatic individuals who were subsequently underwent colonoscopy examination. To determine the diagnostic value of test in CRC and control groups, sensitivity and specificity were evaluated by receiver operating characteristic curve analysis.

Results

Of 585 subjects who could be evaluated, 245 had CRC, 44 had various sizes of adenomatous polyps, and 245 had negative colonoscopy results. Stool DNA-based meSDC2 LTE-qMSP showed an overall sensitivity of 90.2% with AUC of 0.902 in detecting CRC (0–IV) not associated with tumor stage, location, sex, or age (P > 0.05), with a specificity of 90.2%. Sensitivity for detecting early stages (0-II) was 89.1% (114/128). This test also detected 66.7% (2/3) and 24.4% (10/41) of advanced and non-advanced adenomas, respectively.

Conclusions

Results of this study validated the capability of stool DNA based-SDC2 methylation test by LTE-qMSP for early detection of CRC patient with high specificity.

Trial registration

ClinicalTrials.gov, NCT03146520, Registered 10 May 2017, Retrospectively registered; however, control arm was prospectively registered.

Transfer printing of vertical-type microscale light-emitting diode array onto flexible substrate using biomimetic stamp

We report the transfer printing of GaN-based microscale vertical-type light-emitting diodes (μ-VLEDs) using a functional layer and a biomimetic stamp. An oxide-based functional layer is inserted onto the structure of a μ-VLED and used to separate the chip from the μ-VLED wafer by absorbing the pulse of a UV pulse laser during pick-up of the transfer printing process. Polydimethylsiloxane (PDMS)-based biomimetic stamps have been fabricated to mimic the gecko lizard cilia for improved adhesion and repeatability. The biomimetic stamp has an adhesion force of 25.6 N/cm², which is 12 times the adhesion of a flat stamp; an adhesion force of 10 N/cm² or more was maintained after 100,000 repeated adhesion tests. A flexible 10 × 10 prototype array on a polyimide substrate was fabricated, and its bending test results indicated that the strain effect on the forward voltage and the output power was less than 1%. The stable bending test results of the prototype indicate that μ-VLEDs using biomimetic stamps allow the necessary stability for practical transfer printing.

High triglyceride to high-density lipoprotein cholesterol ratio and arterial stiffness in postmenopausal Korean women

The ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL) is positively linked to insulin resistance, and it has emerged as an independent predictor of cardiovascular disease. Menopause is characterized by various detrimental metabolic and vascular changes that may lead to high TG with low HDL cholesterol and arterial stiffness. Several epidemiological studies have reported that high TG/HDL ratio has a positive association with arterial stiffness in both adult and adolescent populations; it is not known whether TG/HDL ratio is related to brachial-ankle PWV (baPWV) in postmenopausal women. Thus, the authors aimed to investigate the association between TG/HDL ratio and arterial stiffness as measured by baPWV in 434 postmenopausal women. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for high baPWV were calculated after adjusting for confounding variables across TG/HDL ratio quartiles using multiple logistic regression analysis. The mean values of meaningful cardiometabolic variables increased with TG/HDL ratio quartiles. The adjusted baPWV (SEs) significantly increased with TG/HDL quartiles: Q1 = 1412 (22.1), Q2 = 1469 (21.4), Q3 = 1482 (21.0), and Q4 = 1505 (21.6) cm/s after adjusting for age, body mass index (BMI), and systolic blood pressure. The OR (95% CI) of the highest TG/HDL ratio quartile as compared to the lowest TG/HDL ratio quartile for high PWV was 2.77 (1.16-6.63) after adjusting for age, BMI, smoking status, regular exercise, mean arterial pressure, fasting plasma glucose, total cholesterol level, hypertension, log-transformed C-reactive protein, and the use of antihypertensive and lipid-lowering drugs. The TG/HDL ratio was positively and independently associated with arterial stiffness in postmenopausal Korean women.

Diet changes alter paternally inherited epigenetic pattern in male Wild guinea pigs

Epigenetic modifications, of which DNA methylation is the most stable, are a mechanism conveying environmental information to subsequent generations via parental germ lines. The paternal contribution to adaptive processes in the offspring might be crucial, but has been widely neglected in comparison to the maternal one. To address the paternal impact on the offspring's adaptability to changes in diet composition, we investigated if low protein diet (LPD) in F0 males caused epigenetic alterations in their subsequently sired sons. We therefore fed F0 male Wild guinea pigs with a diet lowered in protein content (LPD) and investigated DNA methylation in sons sired before and after their father's LPD treatment in both, liver and testis tissues. Our results point to a 'heritable epigenetic response' of the sons to the fathers' dietary change. Because we detected methylation changes also in the testis tissue, they are likely to be transmitted to the F2 generation. Gene-network analyses of differentially methylated genes in liver identified main metabolic pathways indicating a metabolic reprogramming ('metabolic shift'). Epigenetic mechanisms, allowing an immediate and inherited adaptation may thus be important for the survival of species in the context of a persistently changing environment, such as climate change.

The association of pulse pressure with metabolic syndrome in Korean elderly: A nationwide population-based study

AIMS

Metabolic syndrome (MetS) is one of the most important issues in elderly people because of its association with ensuing cardiovascular disease (CVD). The components of MetS play a key role in the pathogenesis of arterial thickness and stiffness. Pulse pressure (PP), an easily accessible parameter in a basic health evaluation, has been documented as a marker of arterial stiffness and widespread atherosclerosis. The aim of our study was to assess the association between PP and MetS in Korean elderly people.

METHODS

A nationwide cross-sectional study was conducted to examine the relationship between PP and MetS among 6187 participants (2687 men and 3500 women) aged 60years older Korean people using the Korean National Health and Nutrition Examination Survey. The odds ratios (ORs) and 95% confidence intervals (CIs) for MetS were calculated across PP quartiles using multiple logistic regression analyses.

RESULTS

There was a positive relationship between PP and MetS in a dose-response manner. The prevalence of MetS significantly increased with increasing PP quartile in both men and women (p<0.001). Compared with the lowest PP quartile group, the ORs (95% CIs) for MetS of the highest PP quartile was 2.60 (1.91-3.52) for men and 1.97 (1.48-2.59) for women after adjusting for age, cigarette smoking, alcohol intake, regular exercise and mean arterial blood pressure. These associations remained valid after additionally adjusting for hypertension and diabetes medications.

CONCLUSION

We found a positive relationship between PP and MetS among Korean elderly men and women.

Cold atmospheric plasma jet-generated RONS and their selective effects on normal and carcinoma cells

Cold atmospheric helium plasma jets were fabricated and utilized for plasma-cell interactions. The effect of operating parameters and jet design on the generation of specific reactive oxygen and nitrogen species (RONS) within cells and cellular response were investigated. It was found that plasma treatment induced the overproduction of RONS in various cancer cell lines selectively. The plasma under a relatively low applied voltage induced the detachment of cells, a reduction in cell viability, and apoptosis, while the plasma under higher applied voltage led to cellular necrosis in our case. To determine whether plasma-induced reactive oxygen species (ROS) generation occurs through interfering with mitochondria-related cellular response, we examined the plasma effects on ROS generation in both parental A549 cells and A549 ρ(0) cells. It was observed that cancer cells were more susceptible to plasma-induced RONS (especially nitric oxide (NO) and nitrogen dioxide (NO2(-)) radicals) than normal cells, and consequently, plasma induced apoptotic cell responses mainly in cancer cells.

Evolutionary origins of the placental expression of chromosome 19 cluster galectins and their complex dysregulation in preeclampsia

INTRODUCTION

The dysregulation of maternal-fetal immune tolerance is one of the proposed mechanisms leading to preeclampsia. Galectins are key regulator proteins of the immune response in vertebrates and maternal-fetal immune tolerance in eutherian mammals. Previously we found that three genes in a Chr19 cluster encoding for human placental galectin-13 (PP13), galectin-14 and galectin-16 emerged during primate evolution and may confer immune tolerance to the semi-allogeneic fetus.

MATERIALS AND METHODS

This study involved various methodologies for gene and protein expression profiling, genomic DNA methylation analyses, functional assays on differentiating trophoblasts including gene silencing, luciferase reporter and methylation assays. These methods were applied on placental specimens, umbilical cord blood cells, primary trophoblasts and BeWo cells. Genomic DNA sequences were analyzed for transposable elements, transcription factor binding sites and evolutionary conservation.

RESULTS AND DISCUSSION

The villous trophoblastic expression of Chr19 cluster galectin genes is developmentally regulated by DNA methylation and induced by key transcription factors of villous placental development during trophoblast fusion and differentiation. This latter mechanism arose via the co-option of binding sites for these transcription factors through promoter evolution and the insertion of an anthropoid-specific L1PREC2 transposable element into the 5' untranslated region of an ancestral gene followed by gene duplication events. Among placental Chr19 cluster galectin genes, the expression of LGALS13 and LGALS14 is down-regulated in preterm severe preeclampsia associated with SGA. We reveal that this phenomenon is partly originated from the dysregulated expression of key transcription factors controlling trophoblastic functions and galectin gene expression. In addition, the differential DNA methylation of these genes was also observed in preterm preeclampsia irrespective of SGA.

CONCLUSIONS

These findings reveal the evolutionary origins of the placental expression of Chr19 cluster galectins. The complex dysregulation of these genes in preeclampsia may alter immune tolerance mechanisms at the maternal-fetal interface.

A validation study of the Chinese wearing off questionnaire 9-symptom for Parkinson's disease

OBJECTIVE

Development of wearing off (WO) often goes unnoticed for both patients with Parkinson's disease (PD) and physicians due to the complexity of this phenomenon. A brief 9-symptom WO questionnaire (WOQ-9) was recently found to be highly sensitive in its detection. We aimed to validate a Chinese version WOQ-9 (CWOQ-9) among Chinese patients with PD.

METHODS

We recruited 101 literate Chinese PD patients among 4 different neurology or movement disorders clinics in Hong Kong to participate in this study by completing the CWOQ-9. Clinical judgment by the specialists was considered the gold standard for diagnosing WO.

RESULTS

The mean age (±SD) of the patients was 61 (±9) years and 35 (34.7%) of them were female. The disease duration was 7.4 (±5.4) years and 69 (68.3%) of them were diagnosed clinically to have WO by the specialists. The positive and negative predictive values, sensitivity and specificity of CWOQ-9 were 86%, 71%, 87%, and 69% respectively. The area under curve (AUC) was 0.78 (p<0.001).

CONCLUSION

This simple patient questionnaire is a valid tool for the detection of WO among Chinese PD patients.

Clinical and biological implications of MYC activation: a common difference between MGUS and newly diagnosed multiple myeloma

Events mediating transformation from the pre-malignant monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM) are unknown. We analyzed gene expression data sets generated on the Affymetrix U133 platform from 22 MGUS and 101 MM patients using gene-set enrichment analysis. Genes overexpressed in MM were enriched for cell cycle, proliferation and MYC activation gene sets. Upon dissecting the relationship between MYC and cell-cycle gene sets, we identified and validated an MYC activation signature dissociated from proliferation. Applying this signature, MYC is activated in 67% of myeloma, but not in MGUS. This was further confirmed by immunohistochemistry (IHC) using membrane CD138 and nuclear MYC double staining. We also showed that almost all tumors with RAS mutations expressed the MYC activation signature, and multiple mechanisms may be involved in activating MYC. MYC activation, whether assessed by gene-expression signature or IHC, is associated with hyperdiploid MM and shorter survival even in tumors that are not proliferative. Bortezomib treatment is able to overcome the survival disadvantage in patients with MYC activation.

Feasibility of electroflotation to separate solids and liquid in an activated sludge process

In this study, electroflotation (EF) has been applied as a secondary clarification in the activated sludge process to improve the efficiency of the solids-liquid separation, which is essential in maintaining effluent quality. The effects of sludge settleability were examined through a series of batch and semi-continuous experiments. The results of the batch experiments revealed that thickening efficiencies using EF were 2.6 to 9.2 times higher than those with gravity settling (GS). In addition, clarification efficiencies were not significantly influenced by sludge settling properties, as compared with GS as a control. In the semi-continuous EF experiments, the concentrations of solids in the float layer were maintained above 10 g L(-1) during flotation, regardless of variations in sludge settleability. Furthermore, the volumetric gas proportion in the float layer increased as the gas to solids (G/S) ratio rose. This allowed the float layer to be more stably suspended against gravity at the top of the reactor. Based on the results obtained from these batch and semi-continuous experiments, an anoxic/oxic (AO) reactor combined with EF clarifier remained in successful continuous operation for four months. In comparison with conventional AO processes using a GS clarifier, enhanced clarification and thickening efficiencies were achieved through the EF-AO system. In addition, higher mixed liquor suspended solids concentrations (averaging 5300 mg L(-1)) in the bioreactor (EF-AO) were maintained via the return of highly concentrated sludge (averaging 16,400 mg L(-1)) from the EF clarifier. These findings suggest that EF could be a promising and effective alternative for the solids-liquid separation of poorly settling sludge.

Three point method to characterize low-pressure electronegative discharges using electrostatic probe

Electrostatic probe measurements for low-pressure inductively coupled SF(6) plasmas are performed. From the current-voltage (I-V) curves of probe, the saturation currents of the positive ions and electrons and the electron temperature are measured. The electronegativity and the negative ion density are deduced by using the ratios of these parameters at three adjacent pressure points. The positive ion density is calculated by the orbital-motion-limited theory, and the electron temperatures are given either by the slope of the I-V curves or by the electron energy distribution function with the second derivative of I-V curves. The variations in the charged species density with pressure and power are investigated.

Granulation in an upflow anaerobic sequencing batch reactor treating disintegrated waste activated sludge

An upflow anaerobic reactor operated with a sequencing batch mode to enhance high rate digestion of raw and thermally disintegrated waste activated sludge with formation of granules. The gas production rate doubled when disintegrated waste activated sludge was introduced. Gradual granulation took place and the dispersed particles become coarse granulation as the operation continued. The granular sludge showed relatively higher specific methanogenic activity than the dispersed sludge. Bacterial morphology by a scanning electron microscope showed diversity of bacteria such as filamentous, rod and spherical shape in the section of granules. Filamentous bacteria, which might support the frame of a granule, were observed as long chains at the outer surface. Meanwhile, rod and spherical bacteria, which might play a role in the initial stage of granule formation, were observed from the inner surface of the granule. High rate digestion of sludge along with efficient liquid-solids separation was achieved due mainly to development of sludge granules within the upflow reactor.

Effect of enzymatic pretreatment on solubilization and volatile fatty acid production in fermentation of food waste

Food waste can be a valuable carbon source in biological nutrient removal (BNR) systems because of the high C/N and C/P ratio. However, pretreatment is necessary to promote hydrolysis of food waste because of the high concentration of volatile solids associated with organic matter. The influence of the enzymatic pretreatment on acid fermentation of food waste was investigated in this study. Solubilization of particulate matter in food waste was carried out using commercial enzymes. The acidification efficiency and the volatile fatty acid (VFA) production potential of enzymatically pretreated food waste were examined. The highest volatile suspended solid (VSS) reduction was obtained with an enzyme mixture ratio of 1:2:1 for carbohydrase: protease: lipase. An optimum enzyme dosage for solubilization of food waste was 0.1% (V/V) with the enzyme mixture ratio of 1:2:1. In the acid fermentation of enzymatically pretreated food waste, the maximum VFA production and the highest VFA fraction in soluble COD (SCOD) were also achieved at 0.1% (V/N) of total enzyme dosage. Increase in VFA production at this level of enzyme dosage was over 300% compared with the control fermenter. The major form of VFA produced by fermentation was n-butyrate followed by acetate.

Effect of pretreatment on acid fermentation of organic solid waste

The effect of various pretreatment methods on acidogenesis of food waste from a cafeteria was investigated. Thermal, enzymatic, and combined thermal-enzymatic batch pretreatment were conducted. Solubilization of food waste in thermal or enzymatic pretreatment increased with either increasing thermal duration or enzyme dosage, respectively. An optimal condition in thermal or enzymatic pretreatment was 60 min of thermal processing or 0.1% (v/v) of enzyme dosage level, respectively, based on volatile suspended solids (VSS) reduction. In the combined pretreatment, increased thermal duration also increased VSS reduction and the solubilization efficiency was higher than that in only enzymatic or thermal pretreatment. The maximum volatile fatty acids (VFAs) production and the highest VFAs fraction in soluble COD in the acid fermentation were achieved with the food waste after 60 min of thermal processing followed by 0.1% (v/v) enzymatic treatment. Increase in VFAs production of the fermenter was over 380% compared to the control fermenter without any pretreatment.

Quantitative analysis of biological effect on membrane fouling in submerged membrane bioreactor

The objective of this study is to investigate solids concentration and extracellular polymeric substance (EPS) effects on the membrane fouling in the submerged membrane bioreactor. The relationship between the solids retention time (SRT) and the amount of EPS is observed in three lab-scale MBRs. Additionally, the EPS effect on membrane fouling is quantified by calculating the specific cake resistance (alpha) using an unstirred batch cell test. By observing the sludge over a long period under various SRT scenarios, a wide range of EPS and membrane fouling data is obtained. These observations provide sufficient evidence of the functional relationship between SRT, EPS and alpha. As SRT decreases, the amount of EPS bound in sludge floc becomes higher in the high MLSS condition (> 5,000 mg/L). The amount of EPS in the sludge floc has positive influence on alpha. A sigmoid trend between EPS and alpha is observed and the functional relationship obtained by dimensional analysis is consistent with the experimental results.

Determination of nanogram level of VSCs using GC-SCD and an adsorption tube

A quantitative analytical method was used for detection of low level of volatile sulfur compounds (VSCs) using GC with a sulfur chemiluminescence detector (SCD) in this study. A linear response over the range of 2-90 ngS injected was obtained with a good repeatability or reproducibility. Equimolar response for H2S, DMS, MeSH, and EtSH was obtained by use of SCD and the response of the SCD is nearly equimolar for different sulfur compounds. It was possible to quantify the total VSCs as well as individual VSC using one of the standard VSCs. VSC recovery was measured with respect to some storing methods. An adsorption tube packed with molecular sieve 5A showed almost perfect recovery for both H2S and dimethyl sulfide (DMS) during 6 days at a dark state below 2 degrees. Whereas, with a gas tight pyrex vial or tedlar bag, it was impossible to obtain the recovery of 50% after 6 days. It is strongly recommended to use the adsorption tube for determination of nanogram levels of volatile sulfur compounds and for storing and concentrating VSCs effectively with a minimum experimental error.

Strong nitrogenous and agro-wastewater: current technological overview and future direction

Nitrogen input to our environment has increased tremendously during the last four decades. It has been recognized that most of the nitrogenous wastes are produced from animal farms and agro-industries, which discharge a large amount of nitrogen as well as organics. Various biological and physico-chemical means are considered or applied for nitrogen removal. Particularly, biological nitrite nitrification and denitrification, and struvite precipitation have received more attention as applicable processes for strong nitrogenous waste treatment. The advanced oxidation process appears to be more attractive than activated carbon adsorption in terms of the removal of refractory organics when a further treatment of biologically treated effluent is required. Technologies using membrane bioreactors were very effective for solids separation, while reverse osmosis was found to be efficient for water reuse purpose with sufficient removal of refractory organics and nitrogen along with biological treatment. Reuse or recycling of strong nitrogenous wastes and agro-wastewater will be a desirable direction for the future in order to prevent the nitrogenous and organic pollution.

Systematic review of antidepressant therapies in Parkinson's disease☆

Depression is the most common psychiatric disturbance in Parkinson's disease. We conducted a Cochrane systematic review to assess the efficacy and safety of antidepressant therapies in idiopathic Parkinson's disease. Relevant trials were identified from electronic databases, reference lists and queries to antidepressant manufacturers. Three randomised controlled trials examined oral antidepressants in 106 patients with Parkinson's disease. No eligible trials of electroconvulsive or behavioural therapy were found. In the first arm of the crossover trial by Andersen et al. (n=22), nortriptyline treated patients showed a larger improvement than placebo in a unique depression rating scale after 16 weeks although significance levels were not provided. A parallel group trial by Wermuth et al. (n=37) did not show any significant difference between citalopram and placebo in Hamilton score after 52 weeks. Rabey et al. (n=47) performed an open-label trial comparing fluvoxamine with amitriptyline. Similar numbers in each group had a 50% reduction in Hamilton score after 16 months. Major side effects including visual hallucinations and confusion were reported with fluvoxamine and amitriptyline. Insufficient data on the effectiveness and safety of antidepressant therapies in Parkinson's disease are available on which to make recommendations for their use. Large scale randomised controlled trials are urgently required.

Expression of bisecting N-acetylglucosaminyltransferase-III in human hepatocarcinoma tissues, fetal liver tissues, and hepatoma cell lines of Hep3B and HepG2

In this paper, uridine diphosphate (UDP)-N-acetylglucosamine/beta-D-mannoside beta-1,4 N-acetylglucosaminyltransferase III (GlcNAc-transferase-III C 2.4.1.144) activity was determined in human hepatoma cell lines of Hep3B and HepG2, and also compared with those of normal liver tissues and primary hepatocytes. GlcNAc-transferase-III enzymes of Hep3B and HepG2 were mainly detected in the membrane fraction. When GlcN,GlcN-biant-PA and UDP-GlcNAc were used as substrates, the Km values (4.7 mM for UDP-GlcNAc and 1.1 mM for GlcN, GlcN-biant-PA) of Hep3B GlcNAc-transferase-III were distinguishable from those of HepG2 GlcNAc-transferase-III (6.8 mM for UDP-GlcNAc and 3.4 mM for GlcN,GlcN-biant-PA). Furthermore, Hep3B enzyme in membrane fraction showed about 1.5-fold higher specific activity (1423 pmol/hr/mg) than that of HepG2 (1066 pmol/hr/mg). Normal liver cells and primary adult hepatocytes are characterized by a very low level of GlcNAc-transferase-III activity, whereas human hepatoma cells exhibited high activities. These data were supported by reverse transcription-polymerase chain reaction results, showing that expression of the GlcNAc-transferase-III mRNA increased in proportion to the enzymatic activities. Although the mechanism underlying the induction of this enzyme is unknown, lectin blot analysis showed that oligosaccharides in many glycoproteins were observed in hepatoma cells. By treating hepatocarcinoma cultures that express GlcNAc-transferase-III with inhibitors (tunicamycin, deoxymannojirimycin, and swainsonine) of different steps of the glycosylation, we provide evidence that expression of GlcNAc-transferase-III mRNA is dependent on glycosylation of cellular proteins.

Synthesis and mechanistic study of fused 2-pyrrolines via thermolysis of 6-substituted-3,5-hexadienyl azidoformates

Thermolysis of 3,5-hexadienyl azidoformates at 300 degrees C, 0.05 Torr, led to a fused 2-pyrroline regiospecifically, regardless of the configuration E or Z between the C-3 and C-4 double bond. Thermolysis of 6-substituted-3,5(E)-hexadienyl azidoformates yielded a kinetically controlled 2-pyrroline with cis configuration between H-1 and H-8a whereas 6-substituted-3,5(Z)-hexadienyl azidoformates produced a cis and trans mixture. The mechanism was proposed as the loss of nitrogen to form an acyl nitrene, then addition to a double bond to produce an aziridine. Finally the cleavage of the C-C bond generated a vinylazomethine ylide followed by recyclization to a fused 2-pyrroline.

Performance characterization of anaerobic sequencing batch reactor process for digestion of night soil

Laboratory experiments were conducted to investigate the performance of an anaerobic sequencing batch reactor (ASBR) process for night soil treatment. Performances of the reactors were evaluated at an equivalent hydraulic retention time (HRT) of 10 days with an equivalent loading rate of 2.6 kgVS/m3/d (3.1 kgCOD/m3/day) at 35 degrees C. Digestion of a night soil was possible using the ASBR at an HRT of 10 days in spite of high concentration of ammonia nitrogen and settleable solids. Solids were accumulated rapidly in the ASBRs, and their concentrations were 2.3-2.4 times higher than that in a completely mixed control reactor. Remarkable increases in gas production were observed in the ASBRs compared with the control reactor. Average increases in equivalent daily gas production from the ASBRs were 205-220% compared with that from the control run. The ASBR with reaction period/thickening period ratio (R/T ratio) of 1 showed a little higher gas production and organic removal efficiency than that with R/T ratio of 3. Volatile solids removals based on supernatant of the ASBRs were 12-14% higher than that of the control reactor. Thus, the ASBR was a stable and effective process for the treatment of night soil having high concentration of settleable organics and ammonia nitrogen.

Can the expression of histocompatibility antigen be changed by lithium?

OBJECTIVES

This study attempted to determine whether human leukocyte antigen (HLA) type changes would be caused by lithium.

METHODS

A total of 15 patients were chosen as subjects (4 males, 11 females) and completed tests in class I. Eight of the 15 patients completed tests in class II. Their mean age was 27 +/- 7 years. For an average of 51 +/- 17 days, lithium, 600-1,200 mg/day (mean daily dose: 920 +/- 211 mg) was administered for the HLA testing and then compared with the HLA type prior to the time the drug was administered. Class I type test was performed according to the Terasaki microcytotoxicity method and class II type by the Erlich polymerase chain reaction method.

RESULTS

Of the 15 subjects, 11 had changes in HLA-A, B, C types and two of the eight subjects had changes in HLA DR type.

CONCLUSION

Lithium, in the therapeutic dose, is considered to bring about changes in HLA expressions in as short a time period as 2 months.

N-cadherin/catenin-based costameres in cultured chicken cardiomyocytes

N-cadherin is a member of the Ca(2+)-dependent cell adhesion molecules and plays an important role in the assembly of the adherens junction in chicken cardiomyocytes. In addition to being present at the cell-cell junction, N-cadherin is associated with costameres in extrajunctional regions. The significance of the N-cadherin-associated costameres and whether catenins are components of costameres in chicken cardiomyocytes are not known. In this study, double-labeling immunofluorescence microscopy was used to determine the extrajunctional distribution of both N-cadherin and its cytoplasmic associated proteins, alpha- and beta-catenins, and their relationship to myofibrillar Z-disc alpha-actinin. N-cadherin, alpha-, and beta-catenins were all found to be present at the extrajunctional region and, in some cases, were codistributed with myofibrillar alpha-actinin exhibiting a periodic staining pattern. Confocal microscopy confirmed that both N-cadherin and beta-catenin colocalized with peripheral myofibrillar alpha-actinin on the dorsal surface of cardiomyocytes as components of the costameres. Intracellular application of antibodies specific for the cytoplasmic portions of N-cadherin, alpha-, and beta-catenin, either by electroporation or microinjection, resulted in myofibril disorganization and disassembly. These results suggest the existence of N-cadherin/catenin-based costameres in the dorsal surface of cultured chicken cardiomyocytes in addition to the integrin/vinculin-based costameres found in the ventral surface and indicate that the former set of costameres is essential for cardiac myofibrillogenesis.

Protective antitumor activity through dendritic cell immunization is mediated by NK cell as well as CTL activation

Dendritic cells (DCs) are potent professional antigen-presenting cells (APC) capable of inducing the primary T cell response to antigen. Although tumor cells express target antigens, they are incapable of stimulating a tumor-specific immune response due to a defect in the costimulatory signal that is required for optimal activation of T cells. In this work, we describe a new approach using tumor-DC coculture to improve the antigen presenting capacity of tumor cells, which does not require a source of tumor-associated antigen. Immunization of a weakly immunogenic and progressive tumor cocultured with bone marrow-derived DCs generated an effective tumor vaccine. Immunization with the cocultured DCs was able to induce complete protective immunity against tumor challenges and was effective for the induction of tumor-specific CTL (cytotoxic T lymphocyte) activity. Furthermore, high NK cell activity was observed in mice in which tumors were rejected. In addition, immunization with tumor-pulsed DCs induced delayed tumor growth, but not tumor eradication in tumor-bearing mice. Our results demonstrate that coculture of DCs with tumors generated antitumor immunity due to the NK cell activation as well as tumor-specific T cell. This approach would be useful for designing tumor vaccines using DCs when the information about tumor antigens is limited.

Dynamic process response to sludge thickening behaviors in the anaerobic sequencing batch reactor treating high-solids-content waste

Solid-liquid separation and its type greatly affected the stability and performance of the anaerobic sequencing batch reactor (ASBR) for municipal sludge digestion. Flotation thickening occurred in mesophilic ASBR, while solid-liquid separation in thermophilic ASBR followed a gravity thickening. The hydraulic retention time (HRT) and cycle period as well as the type of thickening were key parameters governing sludge thickenability and critical solids accumulation. Thickened sludge volume was a critical operating variable in the ASBR with the gravity thickening, which had a poor performance because of the loss of thickened solids, and sludge interface disruption or instability of sludge bed due to internal gas evolution. A cyclic mutual effect between thickened volume and gas production was a serious in the gravity thickening, whereas it was insignificant in the flotation thickening.

Compliance with hormone replacement therapy in Chinese women in Hong Kong

Compliance with hormone replacement therapy (HRT) has been extensively studied in western countries. However, there is little data concerning women in Asian countries. A retrospective study was performed to determine compliance in a group of Hong Kong Chinese women who commenced HRT over a 2 year period. Two years after the commencement of HRT, 68.3% were still taking HRT, although not always in the original formulation. The highest drop out rate occurred during the first 6 months. Factors which were associated with a higher degree of compliance were young age at menopause and at the time of initial consultation and the use of unopposed HRT. A number of significant medical problems were identified during the 2 years of follow up which may have remained otherwise undetected. Compliance with HRT appears to be comparable to that reported in other western specialist centres. Nearly 9% of women who stopped HRT did so because other doctors told them that they did need the treatment and another 6.5% because of the fear of breast cancer.

[Median nerve somatosensory evoked potential monitoring during carotid endarterectomy-report of one case]

Carotid endarterectomy was performed on a 64 y/o female patient who had been suffering from multiple transient ischemic attacks caused by the stenosis of right common carotid artery at its bifurcation. Median nerve somatosensory evoked potential (SSEP) was utilized for monitoring cerebral function during and after operation. Latency, amplitude and central conduction time (CCT) of bilateral N13 (CV2) and N20 (C3', C4') were measured as an aid for management of anesthesia, surgical procedure and postoperative care. The results showed SSEP which is sensitive for detection of cerebral ischemia and could help the surgeon and anesthesiologist maintaining optimal cerebral perfusion, but yields little information about postoperative hyperperfusion state. Besides evaluating the efficacy of SSEP, we discussed the problems encountered during the SSEP monitoring.