Developing a Cost-Effective Surgical Scheduling System Applying Lean Thinking and Toyota's Methods for Surgery-Related Big Data for Improved Data Use in Hospitals: User-Centered Design Approach

BACKGROUND

Surgical scheduling is pivotal in managing daily surgical sequences, impacting patient experience and hospital resources significantly. With operating rooms costing approximately US $36 per minute, efficient scheduling is vital. However, global practices in surgical scheduling vary, largely due to challenges in predicting individual surgeon times for diverse patient conditions. Inspired by the Toyota Production System's efficiency in addressing similar logistical challenges, we applied its principles as detailed in the book "Lean Thinking" by Womack and Jones, which identifies processes that do not meet customer needs as wasteful. This insight is critical in health care, where waste can compromise patient safety and medical quality.

OBJECTIVE

This study aims to use lean thinking and Toyota methods to develop a more efficient surgical scheduling system that better aligns with user needs without additional financial burdens.

METHODS

We implemented the 5 principles of the Toyota system: specifying value, identifying the value stream, enabling flow, establishing pull, and pursuing perfection. Value was defined in terms of meeting the customer's needs, which in this context involved developing a responsive and efficient scheduling system. Our approach included 2 subsystems: one handling presurgery patient data and another for intraoperative and postoperative data. We identified inefficiencies in the presurgery data subsystem and responded by creating a comprehensive value stream map of the surgical process. We developed 2 Excel (Microsoft Corporation) macros using Visual Basic for Applications. The first calculated average surgery times from intra- or postoperative historic data, while the second estimated surgery durations and generated concise, visually engaging scheduling reports from presurgery data. We assessed the effectiveness of the new system by comparing task completion times and user satisfaction between the old and new systems.

RESULTS

The implementation of the revised scheduling system significantly reduced the overall scheduling time from 301 seconds to 261 seconds (P=.02), with significant time reductions in the revised process from 99 seconds to 62 seconds (P<.001). Despite these improvements, approximately 21% of nurses preferred the older system for its familiarity. The new system protects patient data privacy and streamlines schedule dissemination through a secure LINE group (LY Corp), ensuring seamless flow. The design of the system allows for real-time updates and has been effectively monitoring surgical durations daily for over 3 years. The "pull" principle was demonstrated when an unplanned software issue prompted immediate, user-led troubleshooting, enhancing system reliability. Continuous improvement efforts are ongoing, except for the preoperative patient confirmation step, which requires further enhancement to ensure optimal patient safety.

CONCLUSIONS

Lean principles and Toyota's methods, combined with computer programming, can revitalize surgical scheduling processes. They offer effective solutions for surgical scheduling challenges and enable the creation of a novel surgical scheduling system without incurring additional costs.

Atrial Fibrillation Is Not Associated With Sudden Sensorineural Hearing Loss

OBJECTIVES

The aim of this study is to assess the association between atrial fibrillation (AF) and sudden sensorineural hearing loss (SSNHL).

METHODS

This study was conducted by searching the longitudinal health insurance database of the Taiwan National Health Insurance Program for relevant information from January 1, 2000, to December 31, 2011. Patients with AF were matched with non-AF controls with a 1:1 strategy according to propensity scores. Multiple logistic regression analyses were performed to determine the risk of SSNHL.

RESULTS

In total, 14 698 patients with AF were matched with the same number of non-AF patients as controls. After propensity score matching, the use of antiplatelet or anticoagulation medications and the occurrence of SSNHL were found to have a significant difference between AF and non-AF patients. The occurrence of SSNHL was found to be higher in men, those of 45 to 74 years old, and patients with hypertension in both AF and non-AF groups. Multiple logistic regression analyses revealed that male gender, age between 45 and 74 years, hyperlipidemia, and hypertension are risk factors for SSNHL. The use of aspirin was found to reduce the rate of SSNHL (odds ratio [OR]: 0.67, 95% CI: 0.49-0.94, P = .019), but AF was not found to be a risk factor for SSNHL (OR: 0.89, 95% CI: 0.64-1.23, P = .467).

CONCLUSION

The association between AF and SSNHL is not significant.

Prevalence of Obstructive Sleep Apnea Using Home Sleep Test in Taiwan During the Coronavirus Disease Pandemic

Background

Obstructive sleep apnea syndrome (OSAS) is a common disorder associated with serious sequelae. The current gold standard diagnostic method, polysomnography, is costly and time consuming and requires patients to stay overnight at a facility.

Aim

This study aimed to reveal the prevalence of OSAS in general adult population using a home sleep test (HST) during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

This prospective cohort study was conducted by the Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan, between January 2020 and December 2021. A total of 1372 patients aged 30-70 years completed an HST using a Type 3 portable sleep monitor (PM). The apnea-hypopnea index (AHI) was analyzed to assess the association of OSAS with age, body mass index (BMI), sex, Epworth Sleepiness Scale (ESS) and the Sleep Apnea Risk Assessment questionnaire (STOP-Bang questionnaire) rating.

Results

The mean age of the patients (782 men, 57%; 590 women, 43%) was 49.24 ± 11.04 years. OSAS was detected in 954 (69.5%) patients with 399 (29.1%) mild OSAS; 246 (17.9%) moderate OSAS; and 309 (22.5%) severe OSAS. Among these, the prevalence of moderate-to-severe OSAS was 143 (10.4%) in women and 412 (30.0%) in men. The mean age was the highest (51.29 ± 11.29) in the mild OSAS group and lowest (47.08 ± 10.87) in the healthy group. OSAS severity was greater with increasing BMI, 23.39 ± 3.44 in the healthy group and 29.29 ± 5.01 in the severe OSAS group. A positive correlation was also noted between the ESS/STOP-Bang questionnaire rating and OSAS severity.

Conclusion

The prevalence of OSAS in Taiwan was 69.5% in our study. It showed strong evidence that OSAS has important public health consequences and PMs are simple, fast, feasible, and cost-effective tools for OSAS screening in the home environment, especially during the COVID-19 pandemic.

Epidermal Growth Factor Receptor Mutation Status and the Impact on Clinical Outcomes in Patients with Non-Small Cell Lung Cancer

Epidermal growth factor receptor (EGFR) mutation status differs according to ethnicity, gender, smoking history, and histology types. The present study aimed to evaluate EGFR mutation status in patients with non-small cell lung cancer (NSCLC) and further explore its association with clinical characteristics and prognosis in advanced NSCLC patients (Stage IIIB-IV). 238 NSCLC patients were enrolled in this study from October 2016 through December 2019. Patient characteristics and clinical data including age, gender, smoking history, histology types, tumor stage, survival status, and time were collected via electronic medical record system or telephone. 21 somatic mutations which spanned exons 18-21 of EGFR were detected using the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) method, followed by analysis of links to clinical characteristics, progression-free survival (PFS) and overall survival (OS). 103 patients were detected harboring EGFR mutations among the 238 cases tested (43.3%), and exons 19 and 21 were the highest mutation frequencies, with 20.6% and 19.3% respectively. The EGFR mutation rate was much higher in female versus male (57.4% vs 31.5%, p <0.001), in non-smokers compared to smokers (56.8% vs 25.9%, p <0.001), and in those with adenocarcinoma than other histology types (48.3% vs 3.7%, p <0.001). For patients in advanced stage, median PFS was 11 months in patients harboring EGFR mutations, versus 4 months in patients with wild type EGFR (p <0.001); median OS was 24 versus 12 months (p <0.001). Never smoking (p = 0.042) and adenocarcinoma (p = 0.007) were independent favorable factors for EGFR mutations. Our data strengthen the findings of high prevalence of EGFR mutations in Asian patients with NSCLC. Mutations are prevalent in those patients who are female, adenocarcinoma, and have never smoked. Moreover, advanced EGFR mutation-positive patients have better PFS and OS than those with wild type EGFR.

[Analysis of specific sIgE detection of house dust mites and aspergillus fumigatus in 2 535 patients with respiratory allergic diseases and respiratory infectious diseases in the Guangzhou area]

Objective: To compare the specific IgE positive rates of the patients between allergic respiratory diseases and respiratory infectious diseases in Guangzhou, the relationship between the co-sensitization of house dust mite (HDM) allergen and Aspergillus fumigatus (AF) allergen and asthma, allergic rhinitis with asthma, pneumonia, upper respiratory infections, bronchitis, serum total immunoglobulin E (total Immunoglobulin E, tIgE) and age were analyzed, to provide the basis for the prevention and treatment of respiratory allergic diseases and respiratory infectious diseases in this area. Methods: A total of 2 535 patients with confirmed respiratory allergic diseases and respiratory infectious diseases were selected retrospectively from the outpatient or inpatient department of the First Affiliated Hospital of Guangzhou Medical University from April 2017 to June 2021 and detected HDM and AF specific IgE (sIgE) by the ImmunoCAP system. The age range was 1 to 89 years. The median age was 5 years. The average age was 9. ≤3 years old group n=894, 4-6 years old group n=721, 7-18 years old group n=615, 19-49 years old group n=207, >49 years old group n=98. There were 1 596 males (62.96%) and 939 females (37.04%). There were 1 279 cases of allergic diseases and 1 256 cases of respiratory infectious diseases. The different disease groups were divided into asthma group (411 cases), allergic rhinitis group (458 cases), allergic rhinitis combined with asthma group (410 cases), pneumonia group (463 cases), upper respiratory tract infection group (299 cases) and bronchitis group (494 cases). The difference of specific IgE (sIgE) and tIgE between HDM and AF was analyzed. For statistical analysis, continuous variables were tested by Mann-Whitney U. Classification data by chi-square test or Fisher's exact test. Results: 1 313 (51.79%) patients were sIgE positive for HDM allergen, 65 (2.56%) were sIgE positive for AF allergen, and 50 (1.97%) were both positive. In the respiratory allergic disease group, 877 cases (68.57%,877/1 279) were positive for HDM allergen sIgE, 57 cases (4.46%,57/1 279) were positive for AF allergen sIgE, and 44 cases (3.44%,44/1 279) were both positive; 436 cases (34.71%,436/1 256) of respiratory infectious diseases were positive for HDM allergen sIgE, 8 cases (0.64%,8/1 256) were positive for AF allergen sIgE, and 6 cases (0.48%,6/1 256) were both positive. In monosensitization, the HDM allergen sIgE sensitization rate was the highest in the allergic rhinitis & asthma group, at 80.24% (329/410). The positive rate of HDM allergen sIgE in male patients was 53.76%(858/1 596), and the positive rate in female patients was 46.22%(434/939), and the difference between the two was statistically significant (χ²=13.449, P<0.001). In polysensitization, asthma patients (5.35%,22/411) had the highest positive rate of HDM sensitization with AF, followed by allergic rhinitis patients (3.06%,14/458), allergic rhinitis with asthma (1.95%,8/410). The positive rate of respiratory infectious diseases such as pneumonia (0.43%,2/463), upper respiratory infections (0.33%,1/299), and bronchitis (0.61%,3/494) with AF was extremely low. The positive rate of HDM combined with AF in infants(≤3 years old group,0.34%, 3/894; 4-6 years old group, 0.97%, 7/721)was significantly lower than that in teenagers and adults(7-18 years old group,3.58%, 22/615; 19-49 years old group,6.28%, 13/207;>49 years old group,5.10%, 5/98).In the patients with HDM and AF combined sensitization, HDM sIgE levels were distributed in all grades, and AF sIgE levels were mainly in grades 1, 2, and 3. Conclusion: The positive rate of HDM combined with AF was higher in patients with respiratory allergic diseases such as asthma, allergic rhinitis, and allergic rhinitis combined with asthma, suggesting that clinical attention should be paid to the combination of HDM and AF in patients with asthma and allergic rhinitis, especially adults, more likely to be combined with AF.

The prevalence and demographic features of congenital cytomegalovirus infection in an urban area of East Asia: A population-based study

Congenital cytomegalovirus (cCMV) infection is the leading environmental cause of childhood hearing impairment. However, its significance remains largely undocumented in many regions of the world. The purpose of this study was to investigate the prevalence and clinical features of cCMV infection in East Asia. Neonates born at a municipal hospital in Taipei were prospectively recruited and underwent concurrent hearing and CMV screenings. Those who failed the hearing screening or screened positive for CMV were subjected to a focused audiological and/or virological surveillance. The characteristics of the newborns and their mothers were compared between the CMV-positive and CMV-negative groups. Of the 1,532 newborns who underwent concurrent hearing and CMV screenings, seven (0.46%) were positive for cCMV infection. All seven CMV-positive newborns were asymptomatic at birth, and none of them developed hearing or other symptoms during a follow-up period of 14.4±6.3 months. The mothers of the CMV-positive newborns demonstrated higher gravidity (2.4 ± 1.4 vs. 2.1 ± 1.2) and parity (2.0 ± 1.2 vs. 1.6 ± 0.7) than those in the CMV-negative group; however, the difference did not reach statistical significance. The prevalence of cCMV infection in Taipei newborns was 0.46%, which is slightly lower than that of other populations and that of a previous report in the Taiwanese population. The relatively low prevalence in this study might be attributed to the improved public health system and decreased fertility rate in Taiwan.

Serine Metabolism Controls Dental Pulp Stem Cell Aging by Regulating the DNA Methylation of p16

To investigate the characteristics and molecular events of dental pulp stem cells (DPSCs) for tissue regeneration with aging, we isolated and analyzed the stem cells from human exfoliated deciduous teeth (SHED) and permanent teeth of young (Y-DPSCs) and old (A-DPSCs) adults. Results showed that the stemness and osteogenic differentiation capacity of DPSCs decreased with aging. The RNA sequencing results showed that glycine, serine, and threonine metabolism was one of the most enriched gene clusters among SHED, Y-DPSCs, and A-DPSCs, according to analysis based on the Kyoto Encyclopedia of Genes and Genomes. The expression of serine metabolism-related enzymes phosphoserine aminotransferase 1 (PSAT1) and phosphoglycerate (PHGDH) decreased in A-DPSCs and provided less methyl donor S-adenosylmethionine (SAM) for DNA methylation, leading to the hypomethylation of the senescence marker p16 (CDNK2A). Furthermore, the proliferation and differentiation capacity of Y-DPSCs and SHED decreased after PHGDH siRNA treatment, which reduced the level of SAM. Convincingly, the ratios of PSAT1-, PHGDH-, or proliferating cell nuclear antigen-positive cells in the dental pulp of old permanent teeth were less than those in the dental pulp of deciduous teeth and young permanent teeth. In summary, the stemness and differentiation capacity of DPSCs decreased with aging. The decreased serine metabolism in A-DPSCs upregulated the expression of p16 via attenuating its DNA methylation, resulting in DPSC aging. Our finding indicated that serine metabolism and 1 carbon unit participated in stem cell aging, which provided new direction for stem cell aging study and intervention.

[Preliminary study of auditory cortex resting-state fMRI features for adult post-lingual deafness]

Objective: To understand the auditory cortex resting-state fMRI features for adult post-lingual deafness.Method: The author performed functional connectivity analysis on the study subjects with resting-state fMRI,the region of interest(ROI) of which were based separately on the left and right sides of primary auditory cortex. The data were collected from 8 cases with severe or above sensorineurally post-lingual deafness,compared to a control group of 8 cases with normal hearing. Result: When ROI were based on the left A1 areas of all subjects, the main activating area in the control group was bilateral superior temporal gyrus(STG), while the post-lingual deafness group included the bilateral STG, pre-central gyri, left Transverse temporal gyrus(TTG), post-central gyri and right TTG (P<0.01); when ROI were based on the right A1 areas of all subjects, the main activating area in the control group was the bilateral STG, while the post-lingual deafness group included the bilateral STG, right precentral gyri and post-central gyr i(P<0.01). The data showed statistical significance(P<0.05). Conclusion: After hearing loss functional reorganization takes place in the brains of adults with post-lingual deafness, resulting in possible enhancement of visual sense, tactile sense and other sensory systems in order to compensate information acquisition in daily life. .

Association between influenza vaccination and the reduced risk of acute kidney injury among older people: A nested case-control study

OBJECTIVE

The objective of this study is to determine whether vaccination against influenza is associated with a reduced risk of acute kidney injury (AKI) in a nationwide cohort of adults aged ≥65 years.

METHODS

We investigated a total of 13,270 patients aged ≥65 years who were hospitalized for AKI between 2000 and 2013 from Taiwan's National Health Insurance Research Database. Each AKI case was matched with one control subject according to duration of follow-up, age, sex, monthly income, urbanization level, and baseline comorbidities. Odds ratios (ORs) for AKI associated with exposure to the influenza vaccine in the previous year were calculated in a nested case-control analysis.

RESULTS

Influenza vaccination in the previous year was associated with a lower risk of AKI (adjusted OR 0.67, 95% confidence interval [CI] 0.63-0.72). Compared with a reference group of unvaccinated individuals with no influenza infection, vaccination with no influenza infection was associated with a lower risk of AKI (adjusted OR 0.68, 95% CI 0.64-0.73). Lack of vaccination and presence of influenza infection was associated with a higher risk of AKI (adjusted OR 1.78, 95% CI 1.57-2.01), whereas the risk of AKI was insignificant in vaccinated patients who developed influenza (adjusted OR 1.01, 95% CI 0.69-1.18).

CONCLUSIONS

The risk of AKI was 37% lower among older people who received vaccination against influenza in a real-world setting. Further work is required to clarify causality.

[Diagnosis and treatment of canal conversion during canalith repositioning procedure for benign paroxysmal positional vertigo]

Objective:To investigate the diagnosis and treatment of canal conversion during canalith repositioning procedure for benign paroxysmal positional vertigo.Method:The clinic features, nystagmus characteristics, diagnosis and treatment of the patients with benign paroxysmal positional vertigo who suffered from canal conversion during canalith repositioning procedure were analyzed retrospectively.All patients'positioning test and canalith repositioning procedure were done with the aid of videonystagmography.Result:A total of 186 patients with benign paroxysmal positional vertigo were diagnosed and performed canalith repositioning procedure.Eight patients (4.3%) developed canal conversion after canalith repositioning procedure.Of these 8 patients,5 cases with posterior canal canalolithiasis converted to lateral canal canalolithiasis,2 cases with lateral canal canalolithiasis converted to posterior canal canalolithiasis,and 1 case with posterior canal canalolithiasis converted to anterior canal canalolithiasis. All cases recovered well under the corresponding repositioning procedure.Conclusion:The change of the characteristics of positioning nystagmus is the major diagnostic feature of canal conversion. Accurate diagnosis and targeted repositioning procedure are the key to the success of canal conversion treatment.

[The analysis of the electrode impedance in different periods after cochlear implantation performed with round window insertion in steroid deposition]

Objective:To study the variation of the electrode impedance in different periods after cochlear implantation performed with round window insertion in steroid deposition, and to provide the basis for the postoperative debugging of the speech processor. Method:Detected the electrode impedance of 47 cochlear receivers after operation in steroid deposition from September 2014 to October 2015, compared the impedance values between different periods, and different groups according to their locations. Result:The average impedance of all the electrodes and the 3 subgroups are low after implantation (period A0), peaked at the first month (period A1), then decreased slowly, and then turned to be stable at the sixth month (period A3); the impedance values were no significantly different between the sixth month (period A3) and the twelfth month (period A4) while were significantly different between each of other two periods (P<0.05); the apical group had the highest impedance and the basal group had the lowest impedance in all the 5 periods. Conclusion:The local use of steroid can decrease the impedance of the electrode after implantation. The impedance value were the low during operation, peaked at the first month, then decreased slowly, and turned to be stable at the sixth month. As a result, the cochlear implant should be debugged at regular intervals in 6 months after operation to obtain the best hearing status.

[Clinical observation on human alpha glucosidase in treatment of five patients with glycogen storage disease Ⅱ]

Objective: To evaluate the effect of enzyme replacement therapy (ERT) on glycogen storage disease typeⅡ(GSDⅡ). Method: The clinical data of three juvenile onset and two infant onset GSDⅡpatients were collected from First Affiliated Hospital of Sun Yat-sen University in October 2015 to July 2016.Patient 1 was female, the age of onset was 15 months. Patient 2 was male, the age of onset was 20 months. Patient 3 was female, the sister of patient 2, the age of onset was 47 months. Patient 4 was male, the age of onset was 5 months. Patient 5 was male, the age of onset was 1 month.The age at the start of ERT of the 5 patients was 32, 31, 56, 34, and 3 months respectively and the duration of ERT was 19, 9, 4, 5, 5 doses respectively.ERT was administered at 20 mg/kg every 2 weeks.Dexamethasone was regularly given before each infusion. Result: ERT was well tolerated, only one time, Patient 1 developed tachycardia and hypertension without using dexamethasone.Patient 2 underwent successfully ventilator weaning.Patient 1 underwent a tracheotomy, also needed mechanical ventilation treatment.Patient 4 noninvasive ventilation was tried. Conclusion: Recombinant human alpha-glucosidase treatment was effective and well tolerated in patients with GSDⅡ.

Evaluation of nasal patency by visual analogue scale/nasal obstruction symptom evaluation questionnaires and anterior active rhinomanometry after septoplasty: a retrospective one-year follow-up cohort study

OBJECTIVE

To assess the efficacy of septoplasty and the correlation between the subjective evaluations of a visual analogue scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and active anterior rhinomanometry of the nasal airway after septoplasty.

DESIGN

A retrospective, individual cohort study.

SETTING

Ear, Nose and Throat Department, Taipei City Hospital, Taipei, Taiwan.

PARTICIPANTS

Fifty patients with chronic nasal obstruction were enrolled in the study. All 50 patients underwent septoplasty because of nasal septal deviation. Another 28 patients without nasal symptoms served as controls.

MAIN OUTCOME MEASURES

VAS, NOSE and active anterior rhinomanometry were used to measure the sensation of nasal obstruction. All measurements were performed in both groups preoperatively and then repeated on three postoperative visits (3, 6 and 12 months).

RESULTS

The mean VAS score, NOSE score and the nasal resistance in the narrow side of the nose in the study group showed reduced symptoms at 3, 6 and 12 months postoperatively compared with the respective preoperative measurements (P < 0.001, all). The VAS and NOSE scores did not significantly correlate with total nasal resistance preoperatively or postoperatively. The VAS and nasal resistance in the obstructed nasal cavity correlated significantly preoperatively (P < 0.05), but not postoperatively.

CONCLUSIONS

The subjective and objective symptoms of nasal obstruction had improved 1 year after septoplasty. A significant correlation between VAS scores and nasal resistance in the narrow side of the nose was found before surgery. The subjective and objective measurements of nasal obstruction lacked significant correlation postoperatively.

Obstructive Sleep Apnea and the Subsequent Risk of Chronic Rhinosinusitis: A Population-Based Study

The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) still remains unclear. This retrospective cohort study aimed to investigate the relationship between OSA and subsequent CRS using a population-based dataset. The study used data from the Taiwan Longitudinal Health Insurance Database 2005. We selected 971 patients with OSA for the study cohort and 4855 patients without OSA for the comparison cohort. Each patient was tracked for 5 years to determine those who were subsequently diagnosed with CRS. Stratified Cox proportional hazard regression analyses were performed to examine the association of OSA with subsequent CRS. The results revealed that 161 (2.76%) of the total sampled patients were subsequently diagnosed with CRS. Subsequent incidences of CRS were found in 64 (6.59%) patients with OSA and 97 (2.00%) patients without OSA. The adjusted hazard ratio (HR) of subsequent CRS for patients with OSA was 3.18 (95% confidence interval: 2.27~4.45) compared to those without OSA. Furthermore, the HR for CRS was similar for subjects with OSA for both genders (with an adjusted HR of 3.44 for males and 2.63 for females). We concluded that patients with OSA had a higher risk of subsequent CRS compared to patients without OSA regardless of sex.

A population-based study on the association between chronic periodontitis and sialolithiasis

OBJECTIVES/HYPOTHESIS

Whereas the impression that poor oral hygiene is linked to the development of sialolithiasis may be widely accepted, very few studies provide evidence to support this. This study therefore aimed to evaluate the association between chronic periodontitis (CP) and the subsequent development of salivary gland stone based on a nationwide coverage database.

STUDY DESIGN

A case-control study.

METHODS

A total of 987 subjects with sialolithiasis were included as cases. In a ratio of five controls per case, 4,935 controls matched in terms of sex and age group were selected. Conditional logistic regression analysis was performed to determine the possible association of sialolithiasis with previously diagnosed CP.

RESULTS

The prevalence of prior CP between cases and controls demonstrated that 1,831 (30.9%) out of the 5,922 sampled subjects had prior CP. By Chi-square test, there was a significant difference in the prevalence of prior CP between the cases and controls (36.8% vs. 29.7%, P < 0.001). By conditional logistic regression analysis, the odds ratio (OR) of prior CP for cases was 1.37 (95% confidence interval [CI], 1.19-1.56) compared to the controls after adjusting for geographic location and tobacco use. Further analyzing the relationship between sialolithiasis and prior CP according to sex, sialolithiasis was associated with prior CP regardless of sex. The adjusted OR of prior CP for the cases was 1.34 (95% CI, 1.10-1.64) and 1.41 (95% CI, 1.15-1.73) for males and females, respectively, when compared to controls.

CONCLUSION

This study demonstrates an association between CP and sialolithiasis.

LEVEL OF EVIDENCE

3b.

Tension-type headache associated with obstructive sleep apnea: a nationwide population-based study

BACKGROUND

There is still controversy regarding the association between primary headaches and obstructive sleep apnea. We explored the relationship between tension-type headache (TTH) and obstructive sleep apnea (OSA) using a large nationwide population-based data set in Taiwan.

METHODS

We identified 4759 patients diagnosed with OSA from the Taiwan Longitudinal Health Insurance Database, based on polysomnography, as the OSA group. We then randomly selected 19036 subjects without OSA, matched by sex and age, to serve as the non-OSA group. The multivariate Cox proportional hazards model with matching for age and sex was used to assess the possible associations between TTH and OSA among the patients.

RESULTS

The prevalence of TTH was 10.2% among OSA patients and 7.7% among non-OSA patients (p < 0.001). The multivariate Cox proportional hazards model revealed patients with OSA were more likely to have TTH (hazard ratio, 1.18; 95% CI, 1.06-1.31) (p = 0.003) than patients in the non-OSA group.

CONCLUSION

Patients with OSA had a higher likelihood of developing TTH than patients in the non-OSA group. Further studies of physiological patterns between OSA and TTH are needed to confirm the study findings.

Sudden Sensorineural Hearing Loss Associated with Tension-Type Headache: A Population-Based Study

Objectives: This study explored the relationship between sudden sensorineural hearing loss (SSNHL) and prior tension-type headache (TTH) in a large nationwide population-based data set in Taiwan. Methods: In this case-controlled study in Taiwan, participants with SSNHL (n = 4,683) were identified, and controls (n = 18,732) were randomly selected from the National Health Insurance database. Cases of TTH were identified by having been diagnosed as TTH prior to the index date of SSNHL diagnosis. A conditional logistic regression model was used to estimate the adjusted odds ratio (OR) and 95% confidence intervals (CI) for the association of sudden deafness with TTH among the sampled patients. Results: Among the 23,415 patients, 2.5% (600/23,415) had TTH diagnoses prior to the index date; TTH was diagnosed in 4.5% (209/4,683) of the SSNHL group and 2.1% (391/18,732) of the control group. After adjusting for sociodemographic characteristics and comorbid medical disorders, we found that patients with SSNHL were more likely to have had a previous TTH than controls (OR, 1.86; 95% CI, 1.54-2.24; p < 0.01). Conclusion: Both male and female patients with SSNHL had a higher proportion of prior TTH than controls without SSNHL.

The universal newborn hearing screening program of Taipei City

OBJECTIVES

To establish a hearing screening program with high coverage, low referral rate, high follow-up rate, and early intervention in Taipei City.

METHODS

From September 2009 to December 2010, 85% delivery units in Taipei City, which includes 20 hospitals and 14 obstetrics clinics, were recruited into the screening program in two stages. A total of 15,930 babies were born in these participating hospitals and clinics during the program period. Among these neonates, 15,790 underwent hearing screening test with automatic auditory brainstem response (AABR). The screening was free of charge to the parents. The hearing screening examination was performed 24-36 h after birth. The same test was repeated between 36 and 60 h of age if the baby failed the first hearing test. The neonate was referred to the diagnostic hospitals for further investigations if he failed the second test.

RESULTS

The screening coverage rate was 99.1% (15,790/15,930). The incidence of bilateral moderate to severe and unilateral hearing loss was 1.4 per 1000 (22/15,790) and 1.5 per 1000 (24/15,790), respectively. Four percent (626/15,790) of newborns failed to pass the initial screening test and 1.0% of newborns failed to pass the second screening test. Therefore, 1.0% newborns were referred for diagnostic assessments. The follow-up rate was 94.4% (151/160). Sixty-four percent (14/22) of babies with bilateral hearing loss completed the full diagnostic hearing tests within 3 months of birth.

CONCLUSIONS

The universal newborn hearing screening program is an adequate program for Taipei City with high coverage, low referral rate, and good follow-up rate. Screening fees covered by third parties, two-stage screening steps with AABR strategy, and the stringent monitoring system proved to be effective.

LEVEL OF EVIDENCE

2b, individual cohort study.

Hypoxia induces cysteine-rich 61, vascular endothelial growth factor, and interleukin-8 expressions in human nasal polyp fibroblasts: An implication of neutrophils in the pathogenesis of nasal polyposis

BACKGROUND

The purpose of this article was to elucidate the roles of neutrophils and angiogenesis factors in the pathogenesis of nasal polyposis. The effect of hypoxia on the expressions of angiogenesis factors as cysteine-rich 61 (Cyr61) and vascular endothelial growth factor (VEGF) and neutrophil chemoattractant as interleukin (IL)-8 in nasal polyp fibroblasts (NPFs), and the role of nuclear factor kappa B (NF-kappaB) in this reaction were investigated. The action of Cyr61 on the synthesis of VEGF and IL-8 in NPFs was also examined.

METHODS

Primary cultures of NPFs were established from nasal polyps (NPs). Productions of Cyr61, VEGF, and IL-8 by NPFs under hypoxia were detected by Western blot (Cyr61 and VEGF) or enzyme-linked immunosorbent assay (ELISA; IL-8). Immunohistochemical staining was used to examine the relation between fibroblastic expression of Cyr61 and neovascularization/neutrophil infiltration in NPs.

RESULTS

Western blot showed that the hypoxia inducer CoCl(2) stimulated Cyr61 synthesis in NPFs in a time-dependent manner, reaching a peak at 24 hours. Bay-117082 (a specific NF-kappaB inhibitor) attenuated the levels of Cyr61 stimulated by hypoxia. Cyr61 induced IL-8 secretion and VEGF synthesis by NPFs, as evidenced by Western blot and ELISA analysis. Bay-117082 abolished hypoxia-stimulated IL-8 and VEGF synthesis, whereas Cyr61 restored the stimulative effect of hypoxia readily. Immunohistochemical staining revealed the presence of Cyr61 and IL-8 in NPFs. Neutrophils and capillaries aggregating around these NPFs were frequently found.

CONCLUSION

Under hypoxia, NPFs contribute to NP propagation by expressing Cyr61, which subsequently stimulates VEGF and IL-8 production, leading to angiogenesis and activating neutrophil infiltration in NPs.

Removal of ammonium from rare-earth wastewater using natural brucite as a magnesium source of struvite precipitation

This paper presents a study regarding ammonium removal from rare-earth wastewater by struvite precipitation with natural brucite mineral as a source of magnesium. Experimental results indicated that a pH ranging from 8.5 to 9.5 was the optimum for the removal of ammonium using the soluble form of brucite as a magnesium source. Additionally, when solid brucite was used as a magnesium source as well as an alkali reagent, the initial ammonium concentration of 4,535 mg/L decreased to 239-317 mg/L after an reaction time of 12 h in wastewater treated with the S/L (solid brucite/liquid wastewater) ratios ranging from 31.2 to 63.2 g/L. Furthermore, as some non-reacted brucite still remained in the precipitates obtained at the end of reaction, the precipitates were subjected to reuse. The reuse results demonstrated that the reuse of the precipitates obtained with 63.2 g/L was feasible, and almost half of the brucite dose could be saved.

Reductions in the effects of damping on stress concentration in premolars by post-endodontic restorations: a non-linear finite element study

The aim of this study was to measure the structural damping constants of premolars after treatment with a cast Co-Cr post-core system or permanent root filling, and to evaluate the stress damping effects of these restored premolars. Both the damping ratio and the natural frequency (NF) of the cast Co-Cr post-core restored premolars and the permanent root-filled premolars were detected by in-vitro NF testing experiments. Unprepared premolars served as the control. The damping constants beta of the samples were calculated from the measured damping ratios and natural frequencies. The measured damping constants beta of the test premolars were then used for dynamic finite element (FE) analyses. Stress contours and damping effects of stresses in each treated type of premolar were computed and compared using ANSYS. The measured damping constants beta were 0.75 x 10(-5) for the unprepared premolars, 0.69 x 10(-5) for the root-filled premolars with coronal restoration, and 0.72 x 10(-5) for the cast Co-Cr post-core restored premolars. The unprepared intact premolars demonstrated the highest stress dissipation effects with a ratio of 29.3 per cent at the middle root opposite to the loading side. However, no stress dissipation effects were found in the premolars that had been restored with the cast Co-Cr post-core system. The FE analysis showed that metallic post treatment attenuated the damping properties of the premolar. The effects of damping on stress concentration were significantly lower in restored premolars than in untreated vital premolars. These findings suggest that future research on post material should take the damping property into consideration.

Prenatal risk factors and occurrence of allergic rhinitis among elementary school children in an urban city

OBJECTIVES

To investigate the incidence and prenatal risk factors for allergic rhinitis among elementary school children in an urban city.

STUDY DESIGN

Risk factor data were collected by questionnaire and direct physical examination. Multiple logistic regression analysis was used to calculate the odds ratios of developing allergic rhinitis among children 6-13 years of age.

METHODS

From January 2006 to December 2006, we enrolled 1368 elementary school children in the study. Sampling was done by a multi-stage clustered-stratified random method to determine the study subject. All the children studied attended 12 elementary schools located in the six districts in Taipei, with two schools in each district. Odds ratios were adjusted for the confounding effects of gender, parity, maternal age at childbirth, maternal education, gestational complications, tobacco smokers in the residence, pets, carpets, molds, and air pollution.

RESULTS

The incidence of allergic rhinitis in the study was 50.1% (685/1368). Factors like gender (p<.001), parity (p<.05), carpets (p<.025), and air pollution (p<.001) increased risk, while the other factors did not (p>.05 for all).

CONCLUSION

Gender, parity, carpets, and air pollution increased the risk of developing allergic rhinitis among elementary school children. Other potential factors such as low birth weight, maternal age at childbirth, parental education, gestational complications, presence of tobacco smokers, and exposure to pets and molds did not significantly increase risk of developing allergic rhinitis.

Recycle use of magnesium ammonium phosphate to remove ammonium nitrogen from rare-earth wastewater

This paper presents a recycle MAP process (magnesium ammonium phosphate) to remove NH4-N from a typical rare-earth wastewater. The optimum conditions for the MAP precipitation and recycle use of the MAP with a newly-designed process were investigated in laboratory. The results showed that the pH value and dosages of P (phosphate) and Mg reagents have a significant influence on NH4-N removal, with a maximum removal efficiency of 99.4% at the conditions of pH=9 and Mg:N:P molar ratio=1.2:1:1.2. In the process of recycle use of the MAP, adding some HCl to dissolve MAP decomposition residues could effectively enhance NH4-N removal. The NH4-N removal efficiency reached 99.6% by adding an HCl amount of H+:OH- molar ratio=0.8 into the reused MAP decomposition residues, whereas the NH4-N removal efficiency without addition of HCl was only 96.4%. Moreover, the residual PO4-P from the end of reaction was recovered and the optimum recovery efficiency was achieved at a Mg:P molar ratio=6 and pH=10. Under these optimum conditions, the residual NH4-N and PO4-P concentrations in the treated wastewater, through 6 times of the recycling, were less than 15 mg/L and 1 mg/L, respectively. On the basis of this, an economic evaluation of the recycling MAP was made, and this recycle process could save 48.6% cost used in the chemicals for treating per cubic meter of the rare-earth wastewater, compared to the conventional MAP process.

Effect of endoscopic sinus surgery on irradiation-induced rhinosinusitis in patients with nasopharyngeal carcinoma

OBJECTIVES

We evaluated the effect of endoscopic sinus surgery on irradiation-induced rhinosinusitis of the maxillary-sinus mucosa among patients with nasopharyngeal carcinoma (NPC).

DESIGN

Surgical outcomes were evaluated by changes to the ultrastructure of the antral mucosa and nasomucociliary clearance.

METHODS

Twenty-one NPC patients with irradiation-induced chronic sinusitis were enrolled in the study, along with five controls. Specimens were taken from 42 maxillary sinuses during surgery and 1 year after surgery. Saccharin transit time was measured before the initial surgery and 1 year after surgery.

RESULTS

In the postoperative cases, we found a decrease in the number of the submucosal gland openings (P < 0.05), the cilia in the antral mucosa regenerated (P < 0.05), and the saccharin transit time reduced (P < 0.05); the number of goblet cells did not change.

CONCLUSION

Endoscopic sinus surgery is an effective treatment for irradiation-induced rhinosinusitis in NPC patients, improving ventilation and drainage of the paranasal sinuses, and facilitating regeneration of the sinus mucosa.

Effects of Meropack in the middle meatus after functional endoscopic sinus surgery in children with chronic sinusitis

OBJECTIVES

The aim of the study was to evaluate the effects and morbidities of Meropack, an absorbable hyaluronic acid packing material, placed in the middle meatus after endoscopic sinus surgery in children with chronic sinusitis.

METHODS

Sixty consecutive children with similar degrees of bilateral chronic sinusitis were enrolled in the study. Meropack was randomly inserted into one side of the middle meatus, while the opposite sinus was not packed after functional endoscopic sinus surgery. Patients were investigated 3, 8, and 12 weeks after surgery. The effects and morbidities of nasal dressings in the middle meatus were evaluated with respect to six distinct parameters: blood loss during surgery, postoperative hemorrhage, synechiae, granulation tissue, infection, and patency of the maxillary sinus ostia.

RESULTS

Mean blood loss of packed and unpacked sinuses did not significantly differ (p > 0.05). Twenty-nine (15 packed, 14 unpacked) of the 120 sinuses underwent resection of the lateral wall of concha bullosa. Four of 14 unpacked sinuses had postoperative hemorrhaging, while the 15 packed sinuses did not (p < 0.05). The mean synechiae scores at the first follow-up visit for the Meropack filled and unpacked sinuses differed significantly (p < 0.05). For the 8- and 12-week follow-up visits, severity of adhesions, granulation tissue formation, infection rate, and patency of the maxillary sinus ostia did not differ significantly between the Meropack filled sinuses and the unpacked sinuses (p > 0.05 for all).

CONCLUSION

Meropack dressings effectively prevented postoperative hemorrhage, but did not significantly reduced synechiae after endoscopic sinus surgery. Therefore, we recommend that Meropack packing is not necessary for routine use following pediatric functional endoscopic sinus surgery (FESS). However, it should be reserved for children who are predisposed to develop postoperative hemorrhages or adhesions, such as resection of the concha bullosa, traumatic surgery with the creation of large raw surfaces on the middle turbinate, and revision surgery with preexisting adhesions.

Comparison of microdebrider-assisted inferior turbinoplasty and submucosal resection for children with hypertrophic inferior turbinates

OBJECTIVES

The aim of this study was to compare the effectiveness and safety of microdebrider-assisted inferior turbinoplasty (MAIT) with submucosal resection (SR) for children with hypertrophic inferior turbinates.

MATERIALS AND METHODS

One hundred and twenty children with chronic nasal obstruction due to hypertrophic inferior turbinates were enrolled. These children were randomly assigned to receive SR of the inferior turbinate (n=60) or MAIT (n=60). Ten children who did not appear to display any nasal discomfort served as normal controls. Surgical-outcome was evaluated with respect to four distinct parameters: nasal endoscopy, subjective assessment of nasal symptoms by the patient using a visual analogue scale, anterior rhinomanometry, and saccharin test. These evaluations were conducted before surgery and at 1 week, 1 and 3 months after surgery.

RESULTS

In the SR group, turbinate edema was decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal secretions and crusting were increased significantly (p<0.05) in the SR group at 1 week after surgery and then decreased significantly at 1 and 3 months after surgery. In the MAIT group, turbinate edema and nasal secretions were decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal crusting was not observed after surgery. Subjective complaints including nasal obstruction, sneezing, rhinorrhea and hyposmia were significantly improved in both groups from 1 month after surgery (p<0.05). Rhinomanometric assessment did not reveal significant improvement until 3 months after surgery in both groups. Saccharin transit time was significantly increased (p<0.05) compared to baseline at 1 week after surgery in the SR group but was not significantly different in the MAIT group.

CONCLUSION

MAIT and SR are both effective at relieving nasal obstruction due to the presence of hypertrophic inferior turbinates. MAIT is superior to SR with regard to preserving the nasal mucosa.

Vascular endothelial growth factor and children featuring nasal polyps

BACKGROUND

The aim of this study is to explore the expression of vascular endothelial growth factor within nasal polyps, and the implication of such expression as regards the development of nasal polyps amongst children.

MATERIAL AND METHODS

Sixty children suffering from chronic rhinosinusitis were enrolled in this study. Amongst them, 30 patients featured rhinosinusitis with associated nasal polyps. A biopsy specimen was taken from the stalk or the base of the nasal polyp for nasal-polyp sufferers, and the ethmoid sinus for study participants who featured no nasal polyps. The primary lesions biopsied were immunohistochemically stained with a specific endothelial-cell marker and also stained for the presence of vascular endothelial growth factor. The specific level of vascular endothelial growth factor and the mean number of blood vessels present in a visual microscopic (biopsied-specimen) field were calculated under light microscopy (x400).

RESULTS

The number of vascular endothelial growth factor-expressing cells for the nasal-polyp group and for the sinusitis group was, respectively, 20.8+/-4.0 and 11.5+/-3.4 per visual field. Correspondingly, the mean intra-polyp blood-vessel density for the nasal-polyp group and that for the control group was, respectively, 10.5+/-2.6 and 5.0+/-1.9 per visual field. The mean intra-polyp blood-vessel density and the number of vascular endothelial growth factor-expressing cells proved to be significantly greater amongst individuals from the nasal-polyp group than was the case for their analogs from the sinusitis group (P<0.01, for both). The presence of vascular endothelial growth factor was found to be distributed predominantly within the vascular endothelium and the mast cells of polyp tissue. In addition, the level of vascular endothelial growth-factor expression and the mean blood-vessel count per field correlated significantly for nasal-polyp tissue (P<0.001). Furthermore, the relative size of nasal polyps correlated significantly with the number of (intra-polyp) vascular endothelial-cell growth factor-expressing cells and the mean blood-vessel density (P<0.05, for both).

CONCLUSION

The level of expression of vascular endothelial-cell growth factor (VEGF) and the mean blood-vessel density were shown to be significantly greater within nasal polyps than within corresponding sinusitis mucosa. Clinically, the expression of both of these parameters correlated well with the relative size of nasal polyps. Vascular endothelial growth factor participates in the formation of nasal polyps amongst children suffering from chronic rhinosinusitis (CRS).

Mucosal healing and mucociliary transport change after endoscopic sinus surgery in children with chronic maxillary sinusitis

OBJECTIVES

The aim of the study was to evaluate the effects of endoscopic sinus surgery for chronic maxillary sinusitis in children by investigating ultrastructure element changes in the sinus mucosa and nasal mucociliary clearance before and after operation.

METHODS

Twenty-five children with chronic maxillary sinusitis scheduled to undergo functional endoscopic sinus surgery and another five controls were enrolled. A saccharin transit test was performed before and after the operation for each subject. Forty specimens of diseased maxillary sinus mucosa were classified into edematous and polypoid types, with 20 specimens in each type. The mucosal specimens were taken from the superolateral wall of each maxillary sinus during surgery and at post-operative follow-up when the mucosal recovery had begun and the symptoms had subsided. The specimens were examined with a scanning electron microscope.

RESULTS

A significant increase in number of the submucosal gland openings (GO) was noted for the sinusitis group, of both edematous and polypoid types. In post-operative cases, the number of gland openings decreased, however, it remained higher than for the control group. The number of goblet cells (GC) decreased in the sinusitis cases, and significant difference was not demonstrated compared to postoperative and control groups. After endoscopic sinus surgery, the cilia in both types of antral mucosa were significantly regenerated compared to preoperative variants. Significant differences in postoperative saccharin transit time were demonstrated for both types of antral mucosa compared to the preoperative values.

CONCLUSION

After endoscopic sinus surgery for chronic pediatric sinusitis, the antral mucosa recovered and mucociliary clearance improved for both types of antral mucosa, with improved ventilation and drainage demonstrated for our patients. Based on our specimens, the edematous mucosa appear to regenerate sooner than the polypoid variant, with close post-operative follow-up for more than 2 and 4 months for the edematous and polypoid types of antral mucosa, respectively, necessary to prevent sinusitis relapse.

Design of a stability-detecting device for dental implants

Resonance frequency (RF) analysis technology was used to design a dental implant stability detector. The device uses a miniature-sized electromagnetic triggering rod to elicit vibration in a dental implant. Vibrational signals were recorded via an acoustic receiver. To assess the in vivo performance of the test apparatus, animal models were used. Implants were placed in the left tibia of 12 rabbits using a conventional surgical procedure. Standard 3.2 mm × 8 mm implants were placed in each test tibia with pre-tapping cavities of 3.2 mm and 3.7 mm diameters to simulate either a ‘well-fitting’ or a ‘loosely fitting’ situation. The RF values of the test implants were detected by the newly developed device which was directly mounted on the healing abutments of the implants. The results showed that the RF values of the implants under well-fitting conditions significantly increased (p<0.01) 3 weeks after surgery and reached a plateau at around 6-7 weeks. Meanwhile implants with higher initial RF values had shorter healing times and higher final RF values at the plateau. Based on these findings, it was concluded that the idea of using the current designed device for detecting the degree of bone healing during the osseointegration process seems feasible.

Normalization of maxillary sinus mucosa after functional endoscopic sinus surgery in pediatric chronic sinusitis

OBJECTIVES

To observe the recovery of maxillary sinus mucosa after endoscopic sinus surgery in children with chronic maxillary sinusitis. Functional endoscopic sinus surgery (FESS) was used to perform a middle meatal antrostomy, leaving the antral mucosa intact for later observation.

METHODS

Between January 1998 and December 2003, 43 children with chronic sinusitis were enrolled in the study. Pre-operative patient profiles, including a history of symptoms, signs and allergies, were collected. Phidiatap test was used to check allergy. Saccharine transit time tests were performed for each side of the nasal cavity. Under endoscopic observation, the antral mucosa was macroscopically divided into edematous and polypoid types.

RESULTS

Sixty-four (76.2%) of the 84 antrums had edematous type mucosa in which 73.4% (48/64) of cases were found to have returned to normal within 8 weeks. The polypoid antral mucosa exhibited a slower recovery with 80% (16/20) returning to normal within 4 months. The preoperative saccharine transit time significantly correlated with recovery of the antral mucosa (p < 0.05), but allergy did not (p > 0.05).

CONCLUSION

The antral mucosa in children with chronic maxillary sinusitis was predominantly of the edematous type. Most recovered within 2 months of having FESS. The prolonged saccharine transit time and polypoid type antral mucosa were associated with delayed mucosal recovery, warranting follow-up of more than 4 months.

Natural frequency assessment of stability of root keeper magnetic devices

The aim of the study was to evaluate the potential for using natural frequency (NF) as an indicator for assessing the stability of a magnetic keeper device used in prosthodontic treatment. A three-dimensional finite element (FE) model of a root keeper-cement-dentine system was established for NF analysis. The model was first validated against a series of in vitro experiments. Then, NF values of the first vibrational mode of the FE model with various boundary conditions were calculated. The in vitro results showed that the measured NF values of the root keeper-incisor units decreased significantly (p<0.01) from 9.07 +/- 0.37 to 5.73 +/- 0.10 kHz when the units were embedded in simulated bony tissue. Results obtained from FE simulations demonstrated that the root keeper would fully loosen when the constant values of the spring elements were lower than 10(4) N-m(-1). Furthermore, a linear increase in the NF values of the model was observed from 6.16 to 15.52 kHz, when the constant was increased from 10(4) to 10(7) N-m(-1), and the values then reached a plateau. The results indicate that the NF value of a root keeper has the potential to be used for monitoring the stability of such a device.

[Gene cloning, construction and expression of single-chain Fv (scFv) against the membrane protein of Schistosoma japonicum]

OBJECTIVE

To construct single chain antibody specific to membrane protein of Schistosoma japonicum by genetic engineering technique.

METHODS

The VH (heavy-chain variable region) and VL(light-chain variable region) genes were amplified by PCR from the genomic DNA of NP11-4 cell line, and sequenced by Sanger's method. The ScFv was constructed in pTHA90 vector using VH and VL genes, then expressed by IPTG.

RESULTS

The VH and VL genes were obtained through PCR. The DNA sequences showed that VH and VL were new variable region genes of antibody. They were registered by GenBank. A ScFv gene with (Gly4Ser) 3 intralinker in the pTHA90 vector was successfully constructed. The ScFv was expressed as thioredoxin-fused proteins about 36.2 kDa.

CONCLUSION

A specific ScFv against the membrane protein of Schistosoma japonicum was constructed and expressed.

Growth inhibitory activity of lemnabourside on human prostate cancer cells

Induction of apoptosis and androgen ablation are two major approaches for treating human prostate carcinoma. In a study of the bioactive components of the soft coral Nephthea chabroli, we found that lemnabourside is a 5alpha-reductase inhibitor, as shown by its ability to inhibit the conversion of testosterone into the more potent dihydrotestosterone in rat prostate homogenate. The compound also inhibited the incorporation of tritiated thymidine into human prostate androgen-dependent carcinoma LNCaP cells, and thus blocking the cell proliferation (IC50 = 37.5 microM). The expression of prostate marker genes, including 5alpha-reductase, prostate-specific antigen, prostatic acid phosphatase and androgen receptor, and the anti-apoptotic bcl-2 gene were markedly reduced, but the transcription of apoptosis-related caspase 3 gene showed a dose-dependent increase in lemnabourside-treated LNCaP cells. Immunofluorescent microscopy and flow cytometric analysis further demonstrated apoptotic changes in these cells. Taken all results together, a relatively weak 5alpha-reductase inhibitory activity on LNCaP cells (EC50 > 250 microM), and a similar growth inhibitory activity on both androgen dependent- and independent-prostate cells (IC50 approximately 37.5 microM) indicated that caspase-3 apoptosis pathway is one of the possible antiproliferative activities mediated by lemnabourside.

Assessment of membrane potentials of mitochondrial populations in living cells

Mitochondrial membrane potentials (MMP) reflect the functional status of mitochondria within cells. Fluorescent probes to estimate these potentials within cells have been available for some time, but measurements of populations of mitochondria are not possible by existing methods. Therefore, comparisons between different cell types (e.g., fibroblasts and neuroblastoma), fibroblast cell lines from different patients, or even the same cell following various experimental paradigms are not feasible. The current approach estimates populations of MMP within living cells at 37 degrees C using the combination of conventional fluorescence microscopy and three-dimensional deconvolution by exhaustive photon reassignment. With this method, raw images are acquired rapidly with low-intensity (nonlaser) light with minimal concentrations of fluorescent dye. The method uses the fluorescent dye tetramethylrhodamine methyl ester, which equilibrates in cells according to the Nernst equation and provides a numerical, replicable estimate of MMP for populations of cellular mitochondria. This method can detect either increases or decreases in MMP as small as 5%. Furthermore, MMP in different cell types appear distinct. Values in fibroblasts (-105 +/- 0.9 mV) and N2a cells (-81 +/- 0.7 mV) were very different by this method. This approach bridges investigations of individual mitochondria to those that assess MMP by examining global fluorescence from cells.

Natural frequency analysis of periodontal conditions in human anterior teeth

The purpose of this study was to evaluate the possibility of using natural frequency (NF) analysis to detect the attachment loss of periodontal tissue. In this study, 698 anterior teeth were examined by a conventional probing method and also by NF analysis. The teeth were triggered to vibrate with an impulse hammer, and the vibrational response was detected by an acoustic sensor. Our results demonstrate no significant difference in NF values between the upper-lower/left-right quadrants of the tested teeth, although the mean natural frequency value of central incisors with periodontal disease was found to be 1.24 +/- 0.11 kHz which is significantly lower than that of teeth in a healthy condition (1.34 +/- 0.20kHz; p < 0.01). On the other hand, the mean frequency for periodontal disease involving canines (1.28 +/- 0.09 kHz) was also significantly lower than the corresponding value for healthy analogs (1.35 +/- 0.17 kHz; p < 0.05). These results suggest that NF analysis appears to be an effective method for assessing the periodontal condition of anterior teeth. Moreover, since this method is noninvasive, nondestructive, and necessitates minimal tooth contact, it can serve as an effective method for the early quantifiable testing and prevention of periodontal disease.

Microsized 2D protein arrays immobilized by micro-stamps and micro-wells for disease diagnosis and drug screening

A novel method of protein array immobilization, using micro stamps to pick up proteins from micro wells and deposit them on to a bio-absorption chip, has been developed. This method can potentially transfer several protein spots on to an organized array for applications such as disease diagnosis and drug screening by parallel biological or chemical processes. Fabrication of the micro stamp and the micro well arrays involves thick-photoresist lithography, bulk micromachining, and a molding process, whereas fabrication of the bio-absorption chip involves amino-modification by use of APTS (aminopropyItrimethoxysilane) and surface activation by use of BS3 (bis-sulfosuccinimidyl suberate). Successful transfer of protein on to the bio-absorption surface using the micro stamp-well array has been demonstrated. The size variation between different stamping spots has been shown to be less than 10%, and the APTS-BS3 surface has also been proved to bind the protein efficiently. Appreciable protein retention was achieved during 6-h washing, which shows the binding strength of the bio-absorption surface is sufficient for protein processing.

Auditory abnormalities associated with unilateral renal agenesis

OBJECTIVE

To evaluate the relationship between unilateral renal agenesis and auditory abnormality, and to determine the clinical spectrum of hearing impairment in such patients.

METHODS

Seventy-five children with unilateral renal agenesis underwent auditory examinations. The subjects comprised 35 males and 40 females. Fourteen females had mullerian abnormalities. Another 75 schoolchildren with the same gender profile were selected for audiometric testing as a control group. Children with sonographically evident urogenital system abnormalities were excluded from the control group.

RESULTS

The prevalence of auditory abnormalities in children with unilateral renal agenesis (4/75) (5.3%) was higher than in the control group (0%). The prevalence in children with urogenital anomalies was significantly higher in patients with renal agenesis than in the normal population (28.5%). Audiometric results showed that four of the 75 children manifested ipsilateral sensorineural hearing impairment, particularly in the high-frequency range. All were females with coexisting genital abnormalities. Two were diagnosed with mild sensorineural hearing impairment while the other two had moderate hearing loss.

CONCLUSIONS

The results of our study suggest that neurosensory hearing loss was found to be associated with renal agenesis. Further audiometric follow-up of children with renal agenesis seems worthwhile.

Flexural behaviour of post-cured composites at oral-simulating temperatures

Post-curing treatments have been known to improve the mechanical stability of visible light-cured composites. After individual post-curing treatment, the flexural strength (FS) of four commercial direct/indirect placement composite materials which differ greatly in composition [oligocarbonate dimethacrylate (OCDMA)-based Conquest C & B (CQT), Bisphenol-A glycidyl dimethacrylate (BisGMA)-based Charisma, urethane dimethacrylate (UDMA)-based Concept (CCT), and BisGMA/UDMA-based Dentacolor] was evaluated under water in the temperature range of 12-50 degrees C. A control series was tested in air at room temperature (25 +/- 1 degrees C). Data were analysed using ANOVA and Duncan's test. Flexural strengths overall decreased (20-40%, P < 0.01) with increasing temperatures except with Conquest C & B. Surprisingly, higher FS values were found in wet conditions than in dry conditions at 25 degrees C. UDMA-based materials much more easily undergo softening in water and by temperature change than do BisGMA- or OCDMA-based materials. Post-cured composites can be significantly affected by exposure to oral environments. Different composition determines the degree of influence.

Dichloroacetate exerts therapeutic effects in transgenic mouse models of Huntington's disease

Dichloroacetate (DCA) stimulates pyruvate dehydrogenase complex (PDHC) activity and lowers cerebral lactate concentrations. In the R6/2 and N171-82Q transgenic mouse models of Huntington's disease (HD), DCA significantly increased survival, improved motor function, delayed loss of body weight, attenuated the development of striatal neuron atrophy, and prevented diabetes. The percentage of PDHC in the active form was significantly reduced in R6/2 mice at 12 weeks of age, and DCA ameliorated the deficit. These results provide further evidence for a role of energy dysfunction in HD pathogenesis and suggest that DCA may exert therapeutic benefits in HD.

Dehydroepiandrosterone inhibits lipopolysaccharide-induced nitric oxide production in BV-2 microglia

Levels of dehydroepiandrosterone (DHEA) and its sulfated derivative (DHEAS) decline during aging and reach even lower levels in Alzheimer's disease (AD). DHEA is known to exhibit a variety of functional activities in the CNS, including an increase of memory and learning, neurotrophic and neuroprotective effects, and the reduction of risk of age-related neurodegenerative disorders. However, the influence of DHEA on the immune functions of glial cells is poorly understood. In this study, we investigated the effect of DHEA on activated glia. The production of inducible nitric oxide synthase (iNOS) was studied in lipopolysaccharide (LPS)-stimulated BV-2 microglia, as a model of glial activation. The results showed that DHEA but not DHEAS significantly inhibited the production of nitrite in the LPS-stimulated BV-2 cell cultures. Pretreatment of BV-2 cells with DHEA reduced the LPS-induced iNOS mRNA and protein levels in a dose-dependent manner. The LPS-induced iNOS activity in BV-2 cells was decreased by the exposure of 100 microM DHEA. Moreover, DHEA suppressed iNOS gene expression in LPS-stimulated BV-2 cells did not require de novo synthesis of new proteins or destabilize of iNOS mRNA. Since DHEA is biosynthesized by astrocytes and neurons, our findings suggest that it might have an important regulatory function on microglia.

[Construction, expression and activity test of a reshaping single-chain antibody against human CD3]

Monoclonal antibody (McAb) against human CD3 can adjust human body's immune statement in various ways, so that its clinical potential is highly regarded. In order to overcome the immunogenecity related to the murine McAb, this research effort was focused on constructing a reshaping single-chain antibody(scFv) against human CD3 employing antibody engineering. First, the CDRs of the murine McAb against human CD3 OKT3 was transplanted into the light-chain framework regions (FRs) of human McAb LS1 and the heavy-chain FRs of human McAb Nd respectively, spatial conformation was predicted by computer analysis. Then some particular residues were replaced in FRs basing on the result of conformational prediction to draw out the amino acid sequences of the reshaped VL and VH. The genes were chemically synthesize and inserted into an expression vector pROH80 to construct the reshaping scFv. Inducing the expression of reshaping scFv, the products are mainly as inclusion bodies. The reshaping scFv was expressed in another vector pALM. The inclusion bodies were denatured and then renatured by gel filtration. The renatured products were purified by immobilized metal affinity chromatograph (IMAC). Finally, the antigen-binding activily of the reshaping scFv against human CD3 was testified by the Compelitire in hibilory fluorescenceactivated cell sorting (FACS). The competitive inhibition rate is 18%.

Factors influencing the dynamic behaviour of human teeth

Modal analysis is carried out to test the natural frequencies of certain human teeth, including central incisors (CIs), canines (CAs), first premolars (FPs) and first molars (FMs). A total number of 1007 teeth are tested, taking into account tooth type, oral location, age and gender, to analyse the effects of the above-mentioned factors on the natural frequency of the sample teeth. The results reveal that no significant difference in the natural frequency is noted among teeth in the four different intra-oral quadrants. Nevertheless, tooth type and age elicit an effect upon the value of the natural frequency of teeth. On the other hand, the mean value for the natural frequency of CIs (1.27 +/- 0.15 kHz), CAs (1.30 +/- 0.15 kHz), FPs (1.27 +/- 0.15 kHz) and FMs (1.16 +/- 0.12 kHz) for males are significantly lower (p < 0.01) than the analogous figure for females (1.41 +/- 0.21 kHz for CIs, 1.40 +/- 0.18 kHz for CAs, 1.37 +/- 0.20 kHz for FPs, and 1.25 +/- 0.16 kHz for FMs). Moreover, the natural frequency of teeth in male subjects varies with age (p < 0.05). The highest mean frequency of CIs, CAs and FPs for the male subjects is found for the group aged between 40 and 49 years. On the other hand, the natural frequency for the similar set of teeth for the female subjects is shown to be in no way associated with age.

Giant ethmoid osteoma with orbital extension, a nasoendoscopic approach using an intranasal drill

OBJECTIVE

Ethmoid osteoma is a slow-growing, benign, and encapsulated bony tumor. Symptoms occur earlier than with osteomas of the frontal sinus because of the small volume of the ethmoid sinus. Interestingly, orbital extension is uncommon. Treatment remains controversial, with open procedures typically being used. In this article, we present a less invasive yet safe and effective approach to treatment.

STUDY DESIGN

A nasoendoscopic approach using a Stammberger-Saches intranasal drill was developed for treatment of patients with ethmoid osteoma, with or without orbital extension. Between 1995 to 1999, seven patients underwent the new surgical procedure.

METHODS

All procedures were performed under general anesthesia. Using 0 degrees and 30 degrees endoscopes, surface anesthesia of the nasal mucosa was performed, the anterior ethmoid cell was resected, and the whitish osteoma found. The osteoma was drilled out inferolaterally to superomedially. In the patient with orbital extension, a double-ended blunt elevator was used to separate the remaining osteoma from the lamina papyracea and to push the residual osteoma medially toward the nasal septum. With alternate drilling and elevation, the osteoma was gently removed. The surgical site was then packed.

RESULTS

The method successfully treated all patients. There were no major complications. The single patient with orbital extension had mild postoperative periorbital ecchymoses. Nasoendoscopy showed normal epithelialization 4 to 6 weeks after surgery. Computed tomography showed no residual tumors 6 months after surgery.

CONCLUSION

The 30 degrees nasoendoscopic approach using an intranasal drill provides a good operative field and is a safe and effective technique, with the potential to become the treatment of choice in selected cases.

Resveratrol inhibits interleukin-6 production in cortical mixed glial cells under hypoxia/hypoglycemia followed by reoxygenation

Reactive oxygen intermediates (ROIs) are important mediators of a variety of pathological processes, including inflammation and ischemia/reperfusion injury. Cytokines and chemokines are detected at mRNA level in human and animal ischemic brains. This suggests that hypoxia/reoxygenation may induce cytokine production through generation of ROIs. In this study, we investigated the cytokine induction and inhibition by antioxidants in rat cortical mixed glial cells exposed to in vitro ischemia-like insults (hypoxia plus glucose deprivation). The results showed that interleukin-6 (IL-6) mRNA and protein, but not tumor necrosis factor-alpha (TNF-alpha) or interleukin-1beta (IL-1beta), were induced during hypoxia/hypoglycemia followed by reoxygenation in the mixed glial cells. The accumulation of IL-6 mRNA was induced as early as 15 min after hypoxia/hypoglycemia and its level was further increased after subsequent reoxygenation. Among the antioxidants studied, only resveratrol suppressed IL-6 gene expression and protein secretion in mixed glial cultures under hypoxia/hypoglycemia followed by reoxygenation. These findings suggest that resveratrol might be useful in treating ischemic-induced inflammatory processes in stroke.