Effect of ventilation rate on air cleanliness and energy consumption in operation rooms at rest

The interrelationships between ventilation rate, indoor air quality, and energy consumption in operation rooms at rest are yet to be understood. We investigate the effect of ventilation rate on indoor air quality indices and energy consumption in ORs at rest. The study investigates the air temperature, relative humidity, concentrations of carbon dioxide, particulate matter (PM), and airborne bacteria at different ventilation rates in operation rooms at rest of a medical center. The energy consumption and cost analysis of the heating, ventilating, and air conditioning (HVAC) system in the operation rooms at rest were also evaluated for all ventilation rates. No air-conditioned operation rooms had very highest PM and airborne bacterial concentrations in the operation areas. The bacterial concentration in the operation areas with 6-30 air changes per hour (ACH) was below the suggested level set by the United Kingdom (UK) for an empty operation room. A 70% of reduction in annual energy cost by reducing the ventilation rate from 30 to 6 ACH was found in the operation rooms at rest. Maintenance of operation rooms at ventilation rate of 6 ACH could save considerable amounts of energy and achieve the goal of air cleanliness.

Impetigo herpetiformis with gestational hypertension: a case report and literature review

BACKGROUND

Impetigo herpetiformis (IH) is a rare skin disorder that occurs during pregnancy. It was previously associated with high maternal and fetal mortality and morbidity, but now has a better prognosis.

CASE REPORT

We report a case of a pregnant woman with IH who presented with generalized erythematous pustular eruptions in the 32nd week of gestation. The IH progressed rapidly, and gestational hypertension was observed in the 36th week. The lesions did not subside, despite treatment with corticosteroids and phototherapy. She delivered a healthy male baby via cesarean section in the 37th week. One month after her delivery, her skin returned to normal, except for residual pigmentation, with complete recovery 3 months postpartum.

CONCLUSION

An experienced medical team comprising obstetricians, dermatologists, perinatologists and neonatologists is critical to aggressively treat this life-threatening specific dermatosis of pregnancy and to prevent ensuing complications, such as fluid and electrolyte imbalance, secondary infection and placental insufficiency.

Postpartum urinary retention after cesarean delivery

OBJECTIVE

To investigate the incidence of postpartum urinary retention (PUR) after cesarean delivery and determine which obstetric factors contribute to this problem.

METHOD

A prospective study recruited 605 pregnant women who had a cesarean delivery. Each patient's postvoid residual bladder volume (PVRBV) was estimated with an ultrasound scan after first micturition. The women were divided into 2 groups: PUR (PVRBV > or =150 mL) and normal. Patients' characteristics, obstetric parameters, and prevalence of lower urinary tract symptoms at 3 months postpartum were compared.

RESULT

The overall incidence of PUR was 24.1%. The incidence of overt and covert PUR was 7.4% and 16.7%, respectively. Morphine-related postoperative analgesia, multiple pregnancy, and low body mass index were significantly associated with PUR. At 3-month follow-up, 5.0% of patients had obstructive voiding symptoms and 9.1% had irritative voiding symptoms.

CONCLUSION

Our results revealed PUR was a common phenomenon in patients who had a cesarean delivery, and morphine-related postoperative analgesia was the main contributing factor.

Effects of internal medicine residency training in AIDS care in Taiwan

Having contact and interacting with HIV/AIDS patients has long been recognized as a means for improving AIDS-related knowledge and attitudes among physicians and hence for increasing their intention to provide AIDS care. To investigate the impact of one-month residency training in an AIDS inpatient unit on internal medicine residents, this quasi-experimental, pre-post, two-group study, conducted from April 2000 to April 2001, used questionnaires. At follow-up, residents who received training in the AIDS unit (experimental group) were significantly more knowledgeable about HIV/AIDS, had more positive attitudes and greater intention to care for HIV-infected patients than residents who did not receive this training (control group). Results suggest that a one-month AIDS residency training intervention can effectively enhance residents' HIV-related knowledge, attitudes and intention to care for patients infected with HIV.

Distally based sural island flap for the reconstruction of a large soft tissue defect in an open tibial fracture with occluded anterior and posterior tibial arteries—a case report

To repair a 10 x 16 cm soft tissue defect of right lower leg that accompanied with occluded anterior and posterior tibial arteries in a 30-year-old man who sustained comminuted type III(B) Gustilo open tibial and fibular fracture, we present a successful reconstruction by using a large distally based sural island flap perfused by the lowermost perforator of the peroneal artery. This flap is a useful alternative for distal extremity reconstruction when anterior and posterior tibial arteries are occluded, as large flaps can be elevated safely based on only one peroneal perforator.

The regulatory network controlling beta-globin gene switching

The human globin gene cluster, which represents a prototypical eukaryotic multigene locus, has been investigated for more than two decades and is classic model for coordinate control of tissue-specific gene expression. It is well known that globin gene expression is restricted to specific tissues and that globin genes are sequentially switched on during development. What intricate regulatory mechanisms account for tissue-specific transcriptional control of globin gene expression? Previous studies have focused on the interactions of trans-acting factors and cis-acting elements including the locus control region (LCR), which is considered a potent enhancer in globin gene switching. More recent studies have not only focused on the local DNA regulatory elements but also on remodelling of chromatin and transcription at the globin gene cluster within the native genomic context. Moreover, several studies have presented extensive data that address whether the LCR is required to open the chromatin. Although there is increased insight into the regulation of the beta-globin gene switching, many aspects relating to the developmental activation of distinct globin genes remain elusive.

In vivo DNA-protein interactions at hypersensitive site 3.5 of the human beta-globin locus control region

Using ligation-mediated polymerase chain reaction and in vivo footprinting methods to study the status of DNA-protein interactions at hypersensitive site 3.5 (HS3.5) of the locus control region in K562 and HEL cells, we found that there was protein occupancy in vivo at HS3.5 in both cell lines and the status of DNA-protein interaction was different between K562 and HEL. These data provide direct evidence that specific nuclear factor-DNA complexes form in vivo at functionally important sequence motifs of the HS3.5 in erythroid cells. This indicates that HS3.5 may play an important role in the regulation of the beta-globin gene cluster. K562 is a human erythroleukemia cell line in which the embryonic epsilon-globin gene is predominantly expressed, while the HEL cell line expresses predominantly the fetal beta-globin genes. Thus, HS3.5 might also be involved in the regulation of developmental stage-specific expression of beta-globin genes. Our results are also consistent with the model that each hypersensitive site acts as a functional unit and HS3.5 may facilitate the formation of the HS3 functional unit.

Molecular cloning and sequence analysis of full-length cDNAs encoding new group of Cyn d 1 isoallergens

BACKGROUND

Cyn d 1, the major allergen of Bermuda grass pollen, contains some acidic/basic isoforms. The N-terminal amino acid sequences of some acidic Cyn d 1 isoforms were found to be different from those of Cyn d 1 cDNA clones identified previously.

METHODS

A predicted 17-meric oligonucleotide probe was designed to fish the unidentified isoallergen cDNAs out of BGP cDNA library. The reactive clones were isolated and verified by sequencing. Two of them were expressed in the yeast Pichia pastoris to obtain recombinant Cyn d 1 proteins.

RESULTS

All four cDNA clones encode the full-length Cyn d 1 with mature proteins of 244 amino acid residues. A 97-99% identity was found among the deduced amino acids of these four clones while an 86% identity was elicited between the four clones and the ones previously identified. The predicted isoelectric focusing (pI) values of the newly identified Cyn d 1s are acidic while pIs of the previously identified Cyn d 1s are basic. The two recombinant acidic Cyn d 1 proteins possess the epitopes recognized by mouse and rabbit polyclonal anti-Cyn d 1 antibodies, and have human IgE-binding capacity as revealed by immunodot assay.

CONCLUSIONS

The present study identified full-length cDNAs encoding new isoallergens of Cyn d 1, and separated Cyn d 1 gene into an acidic group and a basic group.

The expression of human alpha -like globin genes in transgenic mice mediated by bacterial artificial chromosome

After screening a bacterial artificial chromosome of human genomic DNA library with human HS-40, zeta-, alpha-, and theta-globin probes, a 110-kb clone bearing the whole human alpha-globin gene cluster was obtained and rare restriction endonuclease mapping was performed. The bacterial artificial chromosome DNA was isolated, and transgenic mice were generated. Three founders were detected from 35 newborn mice. The copy numbers were 1, 2, and 2, and the expression of human alpha-globin genes in various tissues at different developmental stages in the transgenic mice was assayed. The human alpha-globin mRNA can be detected in bone marrow, kidney, liver, brain, but not in muscle, testis, or thymus. The human zeta-globin genes were switched off, and the alpha-globin genes were switched at day 11.5 in mouse embryo, indicating that developmental stage-specific expression of the alpha-like globin genes was properly regulated. The human alpha-globin mRNA ranged between 17-68% of the endogenous mouse alpha-globin, suggesting that the expression of human alpha-globin genes is integration site-dependent in transgenic mice. The ratio of human alpha(2)- and alpha(1)-globin gene expression in adult transgenic mouse is about 2.5:1 similar to the expression in human.

Regulation of the transcription factor GATA-1 at the gene and protein level

GATA-1, an important hematopoietic transcription factor, plays a critical role in differentiation and maturation of erythroid and megakaryocytic cell lines. GATA-1 appears to serve as a factor for virtually all characterized erythroid and megakaryocytic-expressed genes. Thus, defining the mechanisms by which the GATA-1 gene and protein are regulated should provide important clues regarding the establishment of erythroid and megakaryocytic programs of gene expression in committed cells and their maintenance thereafter in maturing precursors. This review focuses on the regulation of GATA-1 expression and elucidates the regulation of GATA-1 at the gene and protein levels. Such research is expected to provide insights into the mechanisms involved in hematopoietic commitment.

Prospects of chimeric RNA-DNA oligonucleotides in gene therapy

A strategy called targeted gene repair was developed to facilitate the process of gene therapy using a chimeric RNA-DNA oligonucleotide. Experiments demonstrated the feasibility of using the chimeric oligonucleotide to introduce point conversion in genes in vitro and in vivo. However, barriers exist in the low and/or inconstant frequency of gene repair. To overcome this difficulty, three main aspects should be considered. One is designing a more effective structure of the oligonucleotide. Trials have included lengthening the homologous region, displacing the mismatch on the chimeric strand and inventing a novel thioate-modified single-stranded DNA, which was demonstrated to be more active than the primary chimera in cell-free extracts. The second aspect is optimizing the delivery system. Producing synthetic carriers for efficient and specific transfection is demanding, especially for treatment in vivo where targeting is difficult. The third and most important aspect lies in the elucidation of the mechanism of the strategy. Investigation of the mechanism of strand exchange between the oligonucleotide molecule and double-stranded DNA in prokaryotes may greatly help to understand the mechanism of gene repair in eukaryotes. The development of this strategy holds great potential for the treatment of genetic defects and other purposes.

Insulator: from chromatin domain boundary to gene regulation

An insulator or boundary element is a novel class of regulatory sequence and has properties consistent with a role in limiting enhancer activity; it helps to define the boundary between differentially regulated loci. Originally, an insulator was defined operationally by its ability to protect against positional effects and/or to block distal enhancer activity in transgenic assays, whereas recent experiments have focused on the role of insulators or boundaries in their native context. Many new features have been added to our concept of insulators, thereby revealing the complexity of their function. All these need to be accounted for by successful models. The research of insulator elements should provide new insights into the nature of enhancer function and gene regulation and provide an effective tool in applied gene therapy.

Hot topics in adeno-associated virus as a gene transfer vector

Adeno-associated virus (AAV) is a promising viral vector in treating many kinds of hereditary diseases. The broad host range, low level of immune response, and longevity of gene expression observed with this vector have enabled the initiation of a number of clinical trials using this gene delivery system. Another potential benefit of AAV vectors is their ability to integrate site-specifically in the presence of Rep proteins. However, this virus is not well characterized. To obtain high level, persistent expression of the foreign gene, some problems should be solved. In this article, we will describe the advances in some fields of recombinant AAV technology that overcome certain limitations of the vector as a gene delivery system, such as the transduction efficiency, the production, the package capacity, and elimination of immune responses, as well as the applications involving these recombinant vectors for the treatment of some diseases.

A fast and efficient method for isolation of the BAC end

As a new developmental vector system, the bacterial artificial chromosome (BAC) has been used widely in constructing genomic libraries and in generating transgenic animals. Isolation of the BAC insert end is useful to analyze the BAC clone. Here, we describe a fast and efficient method to obtain the BAC end by ligating the BAC fragments digested with Not I and another selected restriction enzyme into universal cloning vector, followed by determining the correct clones with HindIII digestion. Further DNA sequencing analysis verified the results mentioned above.

Electronic maps for terminal area navigation: effects of frame of reference and dimensionality

Two experiments are reported that contrast rotating versus fixed electronic map displays, which pilots used for a simulated approach to a landing. In Experiment 1, a rotating versus fixed-map display was experimentally crossed with a two-dimensional (2D) versus three-dimensional (3D) view (perspective map) as pilots' ability to maintain the flight path and demonstrate awareness of the location of surrounding terrain features were assessed. Rotating displays supported better flight path guidance and did not substantially harm performance on terrain awareness tasks. 3D displays led to a substantial cost for vertical control but did not differ from 2D displays in lateral control. In Experiment 2, pilots flew with the rotating 2D display and with an improved version of the rotating 3D display, designed to reduce the ambiguity of representing altitude information. Vertical control improved as a result of the 3D display design improvement, but lateral control did not. The results are discussed in terms of the costs and benefits of presenting information in 3D, ego-referenced format for both flight path control and terrain awareness.

Beyond the locus control region: new light on beta-globin locus regulation

The locus control region (LCR) is a novel class of cis-acting regulatory sequences that enable high-level, tissue-specific, copy number-dependent, and chromosomal position-independent gene expression in transgenic mice. Recent studies on endogenous beta-globin locus and other loci have offered new insights either in support of or in contrast to our knowledge of the relationship between chromatin conformation and transcriptional regulation, the long-distance interaction between enhancers and promoters, and the developmental switching of multiple-gene loci. Our perceptions of the regulatory roles for LCR and elements beyond the LCR in beta-globin locus regulation have been challenged and demand re-evaluation. A sound elucidation of gene regulation mechanisms may rely on a fine understanding of functional interplay between cis-acting elements and trans-acting factors that participate in gene silencing and activation in their native genomic, cellular, and developmental state.

Sustained activation of extracellular signal-regulated kinase stimulated by hepatocyte growth factor leads to integrin alpha 2 expression that is involved in cell scattering

We have previously shown that hepatocyte growth factor (HGF) selectively increases the expression of integrin alpha(2) in Madin-Darby canine kidney (MDCK) cells. In this study, we have further investigated the signal transduction pathways responsible for the event and its role in HGF-induced cell scattering. We found that the level of integrin alpha(2)beta(1) expression induced by HGF correlated with the extent of cell scattering and that a functional blocking antibody against integrin alpha(2) at the concentration of 25 microg/ml partially (40%) inhibited the HGF-induced cell scattering. However, in the presence of the specific phosphatidylinositol 3-kinase inhibitor LY294002 or the selective Src family kinase inhibitor PP1, although cells retained their response to HGF for increasing integrin alpha(2) expression, they failed to scatter, indicating that increased expression of integrin alpha(2) alone is not sufficient for cell scattering. Moreover, epidermal growth factor, which induced a transient (1 h) activation of extracellular signal-regulated kinase (ERK) in MDCK cells, only slightly increased integrin alpha(2) expression and failed to trigger cell scattering. Conversely, HGF induced a sustained (at least 12 h) activation of ERK in the cells. Expression of constitutively active ERK kinase (MEK) in MDCK cells led to increased expression of integrin alpha(2) even in the absence of HGF stimulation. In contrast, expression of ERK phosphatase or dominant negative MEK inhibited HGF-induced integrin alpha(2) expression. Taken together, our results suggest that the increased expression of integrin alpha(2)beta(1) by HGF is at least partially required for cell scattering and that the duration of MEK/ERK activation is likely to be a crucial determinant for cells to activate integrin alpha(2) expression and cell scattering.

Targeted correction of the point mutations of beta-thalassemia and targeted mutagenesis of the nucleotide associated with HPFH by RNA/DNA oligonucleotides: potential for beta-thalassemia gene therapy

An RNA/DNA chimeric oligonucleotide was found to be effective in the targeted correction of point mutations in Escherichia coli, plant, and mammalian genomes. This strategy, named chimeraplasty, has the potential for gene therapy of many genetic diseases caused by point mutations. beta-Thalassemia is a very common human genetic disease and in most cases it is caused by point mutations. To test whether the chimeraplasty can be used to correct the point mutations responsible for beta-thalassemia, we introduced one mutated beta-globin gene, betaE, into MEL cells and successfully corrected the point mutation of the betaE gene with the highest correction efficiency of 1.9%. Furthermore, a targeted -202 C-->G mutation of the Ggamma-globin gene, which is associated with the elevated Ggamma-globin gene expression in the adult stage, was introduced into HeLa and CMK cells by an RNA/DNA oligonucleotide. These results indicated that the chimeraplasty has potential for human beta-thalassemia gene therapy.

Ophthalmologic outcome of transvenous embolization of spontaneous carotid-cavernous fistulas: a preliminary report

We give a preliminary report of the ophthalmologic outcome of four patients with transvenous embolization studied for their spontaneous carotid-cavernous fistulas. One of them is a direct type while three of them are indirect dural shunts. In indirect dural shunts, traditional transarterial embolization rarely achieves a complete clinical cure in a short period of time. All cases had an ophthalmologic disturbance justified for endovascular intervention. We performed catheterization, and subsequently embolization with Guglielmi Detachable coils, to the cavernous sinus via the femoral vein and inferior petrosal sinus/superior ophthalmic vein. All four patients achieved clinical and angiographic improvement with a follow-up period range from two to sixteen months except for one patient who had residual bilateral sixth nerve palsy. The transvenous approach offers an effective and safe alternative for the management of spontaneous carotid-cavernous fistula.

End-labeling of long DNA fragments with biotin and detection of DNA immobilized on magnetic beads

To immobilize DNA fragments onto magnetic beads coated with streptavidin for isolation purpose, it is important to label one biotin molecule at one terminus of DNA fragment. After failure to label long DNA with biotin by PCR and filling-in reaction, a 9.2 kb DNA was labeled with biotin by a modified ligation strategy. A simple method is also reported to detect the quantity and integrity of DNA immobilized on the magnetic beads.

Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT)

BACKGROUND

This study was carried out to evaluate the urodynamic and ultrasonographic findings after tension-free vagina tape (TVT) procedure on stress urinary incontinent women.

METHODS

Ninety women suffering from genuine stress incontinence without pelvic relaxation syndrome underwent surgery. Urodynamic measurement, one-hour pad test and introital ultrasonographic evaluation were performed preoperatively and one year after surgery. Additional ultrasonographic surveillance of the urethra was performed immediately after the operation. The position and mobility of the bladder neck was compared pre- and post-operatively in relation to the inferior edge of the pubic symphysis.

RESULT

Eight women were excluded for various reasons. Among the 82 women who completed the study, 76 (93%) were cured, four were improved and two failed. No major intra- or post-operative complications occurred. The position and mobility of the bladder neck showed no significant difference before and after surgery. A urethral knee angle was noted ultrasonographically on cured and improved patients during maximum straining. Nine patients with immediate postoperative voiding difficulty were found to have a pronounced mid-urethra angulation. The symptom and sign were resolved by time after urethra depressing. Urodynamic assessment of the urethral pressure profile and other parameter showed no significant difference before and after the surgery except that a positive pressure transmission in the middle portion of the urethra was noted among 70 (87.5%) of cured and improved subjects.

CONCLUSION

Tension-free vagina tape operation is an effective surgical procedure for the treatment of female urinary stress incontinence. The procedure seems neither to change hypermobility nor to elevate the position of bladder neck. Urinary continence after surgery is most probably achieved by creating a dynamic mid-urethral knee angulation by which the urethra is closed i.e. kinked at stress. Lifting of the mid-urethra resulted in postoperative voiding difficulty. It is the important that the tape is placed tension free under the urethra. Introital ultrasonographic surveillance is a suitable technique to visualize the result of the operation.

Proper Developmental Control of Human Globin Genes Reproduced by Transgenic Mice Containing a 160-kb BAC Carrying the Human β-Globin Locus

Four independent bacterial artificial chromosome (BAC) clones containing the human Beta-globin gene locus were obtained from a human genomic BAC library. A 160-kb clone (186D7) carrying the entire human Beta-globin locus including the Beta-globin gene family, locus control region (LCR), and 3' regulatory elements was used to transform mice. Four transgenic lines were generated by microinjecting the purified BAC DNA into the fertilized eggs. RNase protection analysis showed that the expression of human Beta-globin genes is tissue- and developmental stage-specific and the expression level is similar among the three independent transgenic lines which carry the entire human Beta-globin locus; however, no Beta-globin gene expression was detected in the transgenic mice lacking the LCR region. The results suggest that the transgenic mouse model system that we have produced and that uses BAC to study the complex human Beta-globin gene cluster is stable and reproducible. Our results also indicate that some newly characterized HSs upstream from the LCR appear not to play an important role in globin gene expression and switching, while the traditional LCR can ensure correct human Beta-globin gene expression in transgenic mice. The BAC-mediated transgenic system can be used for further studies to determine which kinds of cis-acting elements are included in regulating the developmental timing and the level of human Beta-globin gene expression.

Comparison of two kinds of methods to determine the titer of recombinant retrovirus containing beta-globin gene based on G418 selection

Four recombinant retrovirus (RV) vectors containing human beta-globin gene and regulatory elements were constructed. To determine the titers of recombinant RV from corresponding producer cell lines, we compared two kinds of method (the simple and the conventional) based on G418 resistance, which is conferred by neo gene of RV vector. The results demonstrated that the simple method shortened the selection period to 3 d instead of 10-12 d with the conventional method and reduced the amount of work; importantly, the titers determined by the simple method were not different significantly from those measured by the conventional method. It can be concluded that the simple method can be used to determine the titers of recombinant RV containing not only cDNA but also genomic DNA with introns and complex regulatory elements instead of the conventional method.

The usefulness of cystoscopy in the staging of cervical cancer

OBJECTIVE

The aim of this study was to clarify the usefulness of cystoscopy in the staging of cervical cancer and to evaluate the clinical indications for performing ureteric catheterization to rule out ureteral obstruction in cervical cancer.

METHODS

Both rigid cystoscopy and CT were performed before treatment in patients with cervical cancer of FIGO stage IB or greater. Cystoscopically directed biopsy specimens were taken from all areas in the bladder which were suspected of cancerous development. If a jet of urine spurting from each ureteral orifice was not found, a ureteric catheter was inserted into the orifice to rule out ureteral obstruction. The cystoscopic findings were compared with a CT examination.

RESULTS

A total of 100 patients were included in the study (mean age 59 years). There were 30 stage IB cancers, 20 stage IIA, 17 stage IIB, 5 stage IIIA, 18 stage IIIB, and 10 stage IV. A total of 90 patients had squamous cell carcinomas and 10 had adenocarcinomas. Cystoscopy identified 8 patients with bladder invasion including 1 stage IIIA, 2 stage IIIB, and 5 stage IV. All of these patients had CT indication of possible invasion. CT indication of possible invasion was proved to be false by cystoscopy in 2 patients. Both the sensitivity and the negative predictive value of CT for bladder invasion were 100%. Of the 14 patients in whom ureteral obstruction was diagnosed by ureteric catheterization, 11 cases were indicated by CT scan, but for the other 3 patients CT found no significant ureteral obstruction.

CONCLUSIONS

The results of this study suggest that cystoscopy is indicated only in cervical cancer patients for whom CT examination indicates possible bladder invasion. In addition, the results suggest that placement of ureteric catheterization using cystoscopy to rule out ureteral obstruction is not indicated in the staging of cervical cancer.

Seroprevalence of Coxiella burnetii infection in southern Taiwan

BACKGROUND AND PURPOSE

The emergence of infection with Coxiella burnetii, the causative organism of Q fever, has been only recently recognized in Taiwan. Several cases of acute Q fever infection have been described, but the prevalence of antibodies to C. burnetii in the general population in Taiwan has not been reported. Thus, we studied the seroprevalence of C. burnetii infection in southern Taiwan.

METHODS

We conducted a retrospective serosurvey to examine the prevalence of C. burnetii infection among subjects admitted to a rural hospital in Taiwan for various reasons, and among presumably healthy attendees of a routine physical examination clinic of an urban public hospital. The diagnosis of C. burnetii infection required the presence of antibodies to both phase I and II antigens (titer > or = 1:16) or only to phase II antigens (titer > or = 1:256), as detected by indirect immunofluorescence assay.

RESULTS

The prevalence of C. burnetii infection was 4.2% in both the in-patient (15/357) and physical examination participant (11/259) populations. None of these subjects had signs compatible with acute Q fever (febrile illness within the past 3 months). The antibody prevalence rate was higher in males than in females, and peaked in persons aged 61 to 70 years.

CONCLUSIONS

These data suggest that C. burnetii infection is not rare in southern Taiwan and does not cause clinical symptoms in all infected patients.

Generation of stable recombinant retroviruses containing the beta-globin genes linked to complex regulatory elements by using transient transfection

A transient packaging method for a retroviral vector containing beta-globin sequences, mediated by Ca3(PO4)2 precipitation, generated stable recombinant beta-globin retroviruses with intact viral genomes. We suggest the use of this method as an alternative means to overcome the production of beta-globin encoding retroviruses with aberrant viral genomes using the routine packaging procedure.

A study of diagnostic failure of loop conization in microinvasive carcinoma of the cervix

OBJECTIVE

The aim of this study was to evaluate the specimen adequacy and the histological interpretation of loop conization for microinvasive cervical carcinoma.

METHODS

We retrospectively reviewed the histopathological findings of the original cone specimens together with the final hysterectomy specimens in patients with microinvasive carcinoma of the cervix. From 1990 to 1995, 63 consecutive patients with microinvasive carcinoma of the cervix were included in the study, of which 35 patients underwent loop conization and 28 underwent cold-knife conization. All patients had a hysterectomy.

RESULTS

The mean width, depth, and cone volume of the conization specimens were 2.44 cm, 2.15 cm, and 3.96 cm3, respectively, in the loop group versus 2.3 cm, 2.35 cm, and 4.38 cm3 in the cold-knife group. No significant differences were seen between the two groups. The application of loop conization was completed in a single slice in 27 patients (77.1%) and multiple slices by the loop in 8 (22.9%), in spite of the attempt to perform conization in a one-pass application when possible. In assessing these cone specimens microscopically, the rate of transection of tissue was significantly higher in the loop cone than in the cold-knife cone (17.1% versus 0%, P = 0.02). Because of transection of tissue and misorientation, pathologic determination of the depth and width of stromal invasion was undetermined in two loop cone specimens compared with none in the cold-knife cones.

CONCLUSION

Our study suggests that cold-knife conization is a preferred method in assessing microinvasive carcinoma of the cervix if multiple applications of loop conization are inevitable.

Measurement and pharmacokinetic study of tetramethylpyrazine in rat blood and its regional brain tissue by high-performance liquid chromatography

We used a rapid, sensitive and reliable high-performance liquid chromatographic method for the determination of tetramethylpyrazine in rat brain tissue and plasma. The lower limit of quantification in plasma and brain tissue was 0.1 microgram/ml and 0.1 microgram/g, respectively, and only a small amount of plasma (100 microliters) or brain tissue (100 micrograms) was required for analysis. The decline in the concentration of tetramethylpyrazine in plasma was generally two-exponential at a dose of 2, 5, or 10 mg/kg administered intravenously. Concentrations of tetramethylpyrazine in various regions of the brain (cerebral cortex, brainstem, striatum, hippocampus, cerebellum and midbrain) were not significantly different at 15 min following drug administration (10 mg/kg, i.v.). In additional analysis, mean concentration of the tetramethylpyrazine in rat plasma was approximately five-times greater than the drug in brain tissue.

Inversion and transposition of Tc1 transposon of C. elegans in mammalian cells

Tc1/mariner transposons are widespread in the eukaryotes. In vitro transposition test indicated that the transposase is the only protein that is needed in transpositions. It was shown later that the reconstructed Tc1-like transposon, "sleeping beauty" in fish, and the Tc1 transposon in C. elegans jumps in human cells. This discovery indicates that the Tc1/mariner transposon may be engineered as a somatic gene therapy vector if coupled with an efficient gene delivery system. We introduced the Tc1 transposon from C. elegans into different mammalian cell lines and detected the transposition events, indicating that Tc1 transposon functions in different mammalian cells. Interestingly, a high inversion frequency of the transposon was also detected, suggesting that this type of transposon may add variations to host genome when it is horizontally transferred into a new species.

Scar endometriosis

BACKGROUND

Scar endometriosis may develop after pelvic operations, such as cesarean section, tubal ligation, hysterotomy and hysterectomy. This prompted us to demonstrate the proper diagnosis; management and prophylactic procedure of scar endometriosis.

METHODS

Twelve patients with scar endometriosis were diagnosed by clinical symptoms and signs, including a painful scar mass related to the menstrual cycle and cyclic bleeding from scars. Preoperative ultrasound needle aspiration cytology was arranged in three patients without painful mass. The management comprised complete surgical excision and selective medical treatment. Postoperative follow-up was scheduled at six-month intervals.

RESULTS

Except for two patients who complained of scar pain but no palpable mass during menstruation, there was no evidence of recurrence in the other 10 patients.

CONCLUSIONS

Diagnosis of scar endometriosis should involve detailed history taking and pelvic examination. Concerning the role of needle aspiration cytology, it still remains controversial. Several prophylactic procedures have been presented to prevent decidual contamination of the wound. Complete surgical excision including the adjacent fascia or skin is the proper treatment of scar endometriosis.

Perinatal transmission of human papillomavirus in infants: relationship between infection rate and mode of delivery

OBJECTIVE

To determine the transmission rate of human papillomavirus (HPV) in newborn infants of HPV-positive women and to assess the relationship between perinatal HPV transmission and mode of delivery.

METHODS

Three hundred one pregnant women were selected: vaginal delivery (n = 160) or cesarean delivery (n = 141). We assessed the presence of the HPV types 16 and 18 DNA sequences in buccal and genital swabs of neonates born to HPV-positive mothers, using the polymerase chain reaction.

RESULTS

The overall frequency of HPV 16/18 infection among the pregnant women was 22.6% (68/301). At birth, the overall frequency of HPV transmission from HPV 16/18-positive mothers to newborns was 39.7% (27/68). A significantly higher rate of HPV 16/18 infection was found at birth when infants were delivered vaginally than when infants were delivered by cesarean (18/35 or 51.4% versus 9/33 or 27.3%, P = .042). However, there was no significant difference in the incidence of perinatal HPV infection between the HPV types 16 and 18 in either vaginal delivery group or in the cesarean delivery group (all P > .100). No significant difference was found between the buccal and genital sites (27/68 versus 21/68, P = .234) or between male and female infants overall (12/36 versus 15/32, P = .255).

CONCLUSION

The findings suggest that neonates are at higher risk for exposure to HPV after vaginal delivery than after cesarean delivery.

The relationship between health locus of control and compliance of hemodialysis patients

Successful treatment of end stage renal disease (ESRD) depends on the patient compliance with therapeutic regimens. This descriptive study was conducted to examine the relationship between the health locus of control (HLC) orientation and compliance with therapeutic regimens. The convenience sample of 86 hemodialysis patients was obtained at two hemodialysis centers of teaching hospitals in southern Taiwan. A Demographic Questionnaire, the Multidimensional Health Locus of Control (MHLC) Scale, and Multimethod Compliance Assessment (including: Laboratory Assessment, Nurse Assessment, and Patient Self-report) were used to collect the data. The average overall rate of compliance with therapeutic regimen was 76.4% by patient self-report and 69.2% by nurse assessment. Examining the three compliance measures, patients were most compliant in following instructions for taking phosphate-binding medication (PBM) and least compliant in limiting fluid intake according to patient self-report and by nurses' assessment. The level of compliance for diet restriction fell between the other two measures. No significant correlations between the three subscales of the multidimensional health locus of control (MHLC) and composite compliance measures were found in this study, except that those with a high score on the subscale of powerful others locus of control were positively correlated with patient self-report (r = 0.388, p < 0.001) and with the laboratory assessment (r = 0.21, p < 0.01). This suggests that the MHLC construct had only a slight influence on measures of compliance in hemodialysis patients of Taiwan. Implications of findings for nursing practice, theory, and research are also discussed.

Obstetrical hysterectomy and placenta previa/accreta: three bladder injury case reports

Pregnancies complicated with placenta previa and a history of cesarean section are well known to be at increased risk for placenta accreta. Bladder injury is occasionally encountered in these patients during operation. From January 1992 to December 1995, 25 obstetrical hysterectomy were performed at Chang Gung Memorial Hospital, Linkou Medical Center. Of these 25 patients three had bladder injury. Ultrasonography is a unique way to screen and detect prenatally the abnormal placentation and intraplacental lacunae. Color Doppler ultrasonic scanning further discloses that the lacunae are mainly venous spaces. Elevated mid-trimester maternal serum x-fetoprotein (MSAFP) frequently leads to a suspicion of the abnormal placentation, and magnetic resonance imaging (MRI) can clearly identify the placenta accreta/increta. Uncontrollable bleeding frequently occurs in these patients during cesarean section, warranting emergency hysterectomy. Emergency obstetrical hysterectomy should be decided upon and performed by an experienced obstetrician. Massive hemorrhage and bladder injury are the major complications encountered in such operations. We review the literature and propose a protocol of management. As the incidence of cesarean section continues to rise world-wide, the problem of placenta previa/accreta is likely to become more common. Obstetricians should be ready to face the late sequelae of today's decision for cesarean section.

Prenatal diagnosis of tetralogy of Fallot with absent pulmonary valve accompanied by hydrops fetalis

Tetralogy of Fallot with absent pulmonary valve is a rare congenital cardiac anomaly. We report on the echocardiographic features of a fetus with such an anomaly and aneurysm of the pulmonary artery associated with hydrops fetalis and polyhydramnios. The prognosis of tetralogy of Fallot with absent pulmonary valve and pulmonary aneurysm is grave, especially in a fetus with intrauterine heart failure. Serial sonographic follow-up is mandatory to detect the signs of hydrops fetalis. Early intervention and intensive treatment should be given to improve the perinatal outcome once the prenatal diagnosis is made.

Squamous cell carcinoma arising in mature cystic teratoma of the ovary

Treatment results of 26 patients with squamous cell carcinoma (SCC) arising in mature cystic teratoma of the ovary were analyzed. Four nulliparous patients with stage Ia tumors underwent conservative salpingo-oophorectomy. Following surgery, 2 patients had successful pregnancies. The remaining 7 patients with stage Ia tumors were observed after hysterectomy and bilateral salpingo-oophorectomy. Fifteen patients with stage Ic-IV tumors underwent cytoreductive surgery followed by cis-platinum-based chemotherapy with or without sequential radiotherapy. The mean survival was 63.9 months. The overall actuarial disease-free survival at 2 years was 69%, and by stage was as follows: stage I, 100% (13/13); stage II, 100% (2/2); stage III, 30% (3/10); and stage IV, 0% (0/1). A significant difference in disease-free survival was noted in stage (P = 0.0001). Optimal versus suboptimal operation was associated with a median Kaplan-Meier survival of 65 months versus 34.8 months, with actuarial disease-free survival at 2 years of 60 and 0%, respectively (P = 0.0210). Our study shows that 67% (16/24) of the patients had SCC antigen levels exceeding 2 ng/ml, which by stage was as follows: stage I, 5/11 (45%); stage II, 1/2 (50%); stage III, 9/10 (90%); and stage IV, 1/1(100%). After completion of treatment, all 8 patients with recurrent lesions had reelevated SCC antigen levels in series SCC antigen monitoring. In conclusion, positive prognostic factors of disease-free survival were optimal cytoreduction and lower FIGO stage. We suggest that multimodality therapy, including aggressive cytoreduction followed by cis-platinum-based chemotherapy with or without sequential radiotherapy, is recommended. In addition, we suggest that serum SCC antigen monitoring may be helpful in early detection of cancer recurrence.

Management of perineal endometriosis

OBJECTIVE

To demonstrate the appropriate diagnosis and management of perineal endometriosis.

METHOD

Six patients with perineal endometriosis were diagnosed according to their clinical symptoms and signs which included cyclic perineal pain and a tender perineal mass coinciding with the menstrual cycle. Diagnostic tools used included ultrasonography, computerized tomography, fine needle aspiration cytology and laparoscopy. Management comprised both surgical and medical treatment. Postoperative follow-up was carried out at 3-monthly intervals.

RESULTS

All six patients were cured following surgical excision of the endometrioma.

CONCLUSION

A detailed history, thorough pelvic examination and sonographic investigation are essential in diagnosing perineal endometriosis. The role of other diagnostic tools remains controversial. Treatment of extrapelvic endometriosis includes surgical intervention and hormonal suppression. If hormonal suppression fails, surgical excision of the perineal endometrioma should be carried out.

Endometriosis in adolescent women

With the aim of determining an effective therapy for adolescent women with endometriosis, the authors analyzed the results of laparotomy performed on 16 cases of female teenagers over a seven-year period. All patients, whose average age of menarche is 12.8, were diagnosed with endometriosis between two months and nine years after the menarche, with an average interval of 5.2 years. The chief symptoms are dysmenorrhea, pelvic pain and abdominal fullness. Of the three patients of unicornuate uterus with rudimentary horn, endometriosis was found only involving the adnexa on the side of the rudimentary horn, two of the three patients had absence of affected side kidney. Conservative operation including six cases of salpingo-oophorectomy and 10 cases of ovarian cystectomy were chosen followed by danazol treatment. One year to seven years after surgical treatment, two patients required subsequent conservative operation for recurrence of endometriosis and two other patients resumed dysmenorrhea. Two married women became pregnant 5 and 10 months after surgical and medical therapy respectively. In conclusion, adolescent endometriosis may occur around five years after menarche and an obstructive uterine anomaly, enhancing retrograde menstruation, increases the occurrence rate. The symptoms and treatment of endometriosis in teenage group do not really differ from that in the older women. In the treatment of endometriosis and for the prevention of recurrence, it is recommended to give three to six months of danazol after surgical treatment.

Conditional and unconditional automaticity: a dual-process model of effects of spatial stimulus-response correspondence

Distributional analyses and event-related brain potential were used to show that effects of irrelevant spatial stimulus-response correspondence consist of 2 qualitatively different automatic components that can be distinguished on the basis of their dependencies on relative response speed and on computational requirements of the primary task. One component reflects priming of the spatially corresponding response by an abrupt stimulus onset that does not depend on the nature of the primary task. This unconditional component exhibits a biphasic pattern, with initial facilitation later turning into inhibition, analogous to that found for spatial cuing in visual detection tasks. The 2nd component reflects automatic generalization of task-defined transformations of relevant stimulus information to spatial codes; this conditional component does not depend on relative response speed. Possible connectionist implementations of the conditional mechanism are discussed.

Conditional and unconditional automaticity: a dual-process model of effects of spatial stimulus-response correspondence

Distributional analyses and event-related brain potential were used to show that effects of irrelevant spatial stimulus-response correspondence consist of 2 qualitatively different automatic components that can be distinguished on the basis of their dependencies on relative response speed and on computational requirements of the primary task. One component reflects priming of the spatially corresponding response by an abrupt stimulus onset that does not depend on the nature of the primary task. This unconditional component exhibits a biphasic pattern, with initial facilitation later turning into inhibition, analogous to that found for spatial cuing in visual detection tasks. The 2nd component reflects automatic generalization of task-defined transformations of relevant stimulus information to spatial codes; this conditional component does not depend on relative response speed. Possible connectionist implementations of the conditional mechanism are discussed.

The G gamma:A gamma ratios in the fetal hemoglobin of newborns of the Man ethnic group and their gamma-globin gene arrangements

The G gamma:A gamma ratios of Hb F were determined in 331 newborn babies of the Man ethnic group in Liaoning Province, P.R. China, using polyacrylamide gel electrophoresis; in 27 cases they were also determined by reversed phase high performance liquid chromatography. The results showed that a high G gamma value (> 80%) was present in four cases (1.21%) and low G gamma values (30-48%) in six cases (1.81%); not a single case with the A gamma T [A gamma 75(E19)Ile->Thr] chain was found. Gene mapping analysis demonstrated that two babies with high G gamma values had the -G gamma-G gamma-/-G gamma-A gamma- (0.60%), and two others the -G gamma-AG gamma-A gamma-/-G gamma-A gamma- (0.60%) arrangements. Two of the four babies with low G gamma values were identified as -A gamma-A gamma-/-G gamma-A gamma- (0.60%) and the other two as -GA gamma-/-G gamma-A gamma- (0.60%). The genotype -A gamma-A gamma- has not been reported before in Chinese.

Influence of bulky side chains of amino acids on the solution conformation of peptide fragment (81-92) derivatives of CD4, TYICEVEDQKEE, as studied by NMR spectroscopy and molecular modeling

Solution conformation of CD4 fragment 81-92 TYICEVEDQKEE and two of its benzylated analogues was determined by two-dimensional 1H NMR spectroscopy, distance geometry and simulated annealing techniques. The structures of both benzylated derivatives are similar but are distinct from that of wild-type dodecapeptide. It is concluded from structural analysis that bulky side chain(s) of amino acid(s) at an appropriate position can have a marked effect on the conformation and thus the functions of a peptide.

Loop excision for cervical intraepithelial neoplasia

We report the results of a prospective trial using a loop electrosurgical excision procedure (LEEP) on 97 patients with cervical intraepithelial neoplasia. In the LEEP group the mean cutting time and whole procedure time were 6.2 +/- 1.9 seconds and 12.7 +/- 3.5 minutes, respectively. The average blood loss was 3.6 +/- 1.9 mL. In the control group (39 cases) using laser conization, the mean cutting time and whole procedure time were 11.7 +/- 3.5 minutes and 44.9 +/- 8.9 minutes, respectively. The average blood loss in the control group was 11.2 +/- 3.1 mL. The differences between the two groups were statistically significant. During LEEP surgery, four cases had accidental vaginal excision. There were three cases of late cervical bleeding after surgery; the surface of the cervix was smooth, and no adhesion or crypt formation was noted after re-epithelialization. Eight patients became pregnant after the loop excision and no cervical incompetence was noted during antenatal care. After a one-year follow-up period in the colposcopy clinic, there was no recurrence of cervical intraepithelial neoplasia in either group. We advise that among the modalities of treatment for cervical intraepithelial neoplasia, LEEP appears to offer patients several benefits such as less bleeding, precise specimens, local anesthesia, less cost and less discomfort. It is particularly suitable for treating younger women who have not yet completed their families.

Cancer of the colon during pregnancy: report of a case and review of the literature

A case of adenocarcinoma of the sigmoid colon during pregnancy is reported. The patient presented with anemia and a painless mass over the left abdomen without gastrointestinal discomfort, making this case different from 25 previously reported cases of colon carcinoma above the peritoneal reflection associated with pregnancy.

Improvement on dynamic elastic interpolation technique for reconstructing 3-D objects from serial cross sections [biomedical application]

An improved method for automatically reconstructing a three-dimensional object from serial cross sections is presented. The method improves the dynamic elastic contour interpolation technique. There are two major improvements: (1) in the case of branching that involves concave contours, instead of pairwise interpolation between the start contour and each goal contour, the goal image is considered globally and local constraints are imposed on the forces exerting upon the vertices; and (2) it takes the continuity of high-order derivatives into consideration and incorporates the schemes of spline theory, quadratic-variation-based surface interpolation, and finite-element-based multilevel surface interpolation to create smoother surfaces of the reconstructed object. Based on the output from the preliminary processing, two alternatives, a quadratic-variation-based surface interpolation algorithm and a finite-element-based multilevel surface interpolation algorithm, can be adopted to obtain the final surface representation.