Asthma management efficacy of school nurses in Taiwan

As the key health care providers in school settings, the school nurses' asthma management efficacy is crucial to children's health and their continued participation in school learning activities. This article describes the psychometric testing of the asthma management efficacy scale (AMES) for use with school nurses. A cross-sectional survey design was used to assess the asthma management efficacy of 60 school nurses in Taipei, Taiwan. Factor analysis resulted in four factor domains including asthma medication administration, asthma pattern identification, school management behaviour, and monitoring peak expiratory flow rate which explained 76.4% of the variance in school nurses' asthma management efficacy. The school nurses' experience in performing school asthma management activities was positively correlated to their asthma management efficacy (r=0.33, p<0.05). School nurses who had experience with the inhaled asthma medicines had significantly higher efficacy scores on the medication administration subscale (t=-2.89, p<0.01) than did the school nurses who lacked this experience. School nurses who had experience in using peak expiratory flow meters had significantly higher efficacy scores on the total AMES (t=-1.90, p<0.05) and on the monitoring peak expiratory flow rate subscale (t=-5.37, p<0.001) than the school nurses who lacked this experience. Given the need to have nurses who are well prepared to provide asthma care in school settings, implications for nursing education, practice, and further research are discussed.

Usefulness of the suspended microbubble sign in differentiating empyemic and nonempyemic hydropneumothorax

OBJECTIVE

The suspended microbubble sign is defined as the image seen on ultrasonography consisting of a pleural effusion strewn with numerous hyperechoic pinpoints and more or less linear shadows that move synchronously with respiration. In this study, we intended to evaluate the clinical usefulness of the suspended microbubble sign in differentiating empyemic and nonempyemic hydropneumothorax.

METHODS

This series consisted of 8 patients with empyemic hydropneumothorax and 23 patients with nonempyemic hydropneumothorax. The finding of the presence of the suspended microbubble signs on ultrasonography was recorded. To further elucidate the generation of the suspended microbubble sign, the interaction between air and pleural fluid of different types was investigated in vitro.

RESULTS

The suspended microbubble sign was shown on ultrasonography in all 8 patients with empyemic hydropneumothorax but was absent in the 23 patients with nonempyemic hydropneumothorax. These findings were supported by the observation that the pus seemed to mix with and trap the air more easily than did the nonpurulent pleural fluid, as shown in vitro. In this selected population, the sensitivity and specificity of the suspended microbubble sign in aiding a diagnosis of empyemic hydropneumothorax were both 100%.

CONCLUSION

The suspended microbubble sign shown on ultrasonography might be of considerable value in differentiating empyemic and nonempyemic hydropneumothorax.

Complex-temperature phase diagrams for the q-state Potts model on self-dual families of graphs and the nature of the q-->infinity limit

Exact calculations of the Potts model partition function Z(G,q,v) have been presented for arbitrary q and temperature-like variable v on self-dual strip graphs G of the square lattice with fixed width L(y) and arbitrarily great length Lx with two types of boundary conditions. Letting Lx-->infinity, the resultant free energy and complex-temperature phase diagram have been computed, including the locus B where the free energy is nonanalytic. Results are analyzed for widths L(y)=1,2,3. These results have been used to study the approach to the large-q limit of B.

Invasive infections due to vancomycin-resistant enterococci in adult patients

Since 1990, vancomycin-resistant enterococci have emerged as important nosocomial pathogens. Invasive infections caused by these organisms have challenged most physicians because they are resistant to multiple antibiotics. We analyzed the clinical characteristics of adult patients with invasive vancomycin-resistant enterococci infections in the National Taiwan University Hospital from January 1993 through December 2000. A total of 11 adult patients were identified, 9 of whom had bacteremia (7 caused by vancomycin-resistant Enterococcus faecalis and 2 by vancomycin-resistant Enterococcus faecium) and one each had thoracic empyema (vancomycin-resistant E. faecium) and peritonitis (vancomycin-resistant E. faecium). Five patients had rectal swab cultures positive for vancomycin-resistant enterococci; 4 of them had underlying malignancies. The majority (91%) of these patients had prolonged hospitalization and prior long-term use of broad-spectrum cephalosporins (ceftriaxone, ceftazidime, or cefepime) or anti-anaerobic agents (clindamycin or metronidazole). The crude mortality rate was 64%. In conclusion, invasive infection caused by vancomycin-resistant enterococci is an emerging problem among hospitalized patients in Taiwan, particularly those with severe underlying diseases and exposure to multiple antibiotics.

Connexin37 gene polymorphism and coronary artery disease in Taiwan

BACKGROUND

A recent study shows that a C1019T polymorphism of the gene encoding the gap junction protein connexin37 contributes to the genesis of atherosclerotic plaques in human carotid artery. However, whether such a polymorphism can be used as a prognostic marker in atherosclerotic disease of other arterial sites, such as coronary artery disease, is not known.

METHODS

We analyzed the allelic status in 177 subjects with coronary artery disease (age, 61+/-11 years; male/female, 120/57) and 102 controls (60+/-11 years; male/female, 70/32). Both groups were matched, before genotype analysis, for a variety of other traditional risk factors, including body mass index, smoking status, levels of blood pressure, sugar, creatinine, and lipid profiles, in addition to age and sex.

RESULTS

The T allele was less frequently seen in the control group, compared to the disease group (10.7 vs. 20.1%, TT+TC vs. CC, P<0.01). Subsequent analysis demonstrated that a significant difference existed in the male (9.2 vs. 22.8%, TT+TC vs. CC, P<0.005), but not in the female. Another finding was that the T allele frequency in all participants was less than 15%, markedly lower than that reported in non-Taiwanese.

CONCLUSIONS

The observation indicates that the polymorphism in the connexin37 gene potentially plays a role in the manifestation of coronary atherosclerosis in Taiwan.

Association between cytomegalovirus-specific reactivity of T cell subsets and development of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome

The association between cytomegalovirus (CMV)-specific reactivity of T cell subsets and development of CMV retinitis (CMV-R) was prospectively studied in 50 CMV-seropositive AIDS patients. The frequency of CMV-specific CD69 expression on CD8 T cells was similar in patients with and patients without CMV-R (median, 1.0% vs. 1.2%; P=.14). However, the frequency of CMV-specific CD69 expression on CD4 T cells was significantly lower in patients with CMV-R than in those without CMV-R (median, 0.4% vs. 2.25%; P<.001). CMV-specific CD4 T cell reactivity in patients who developed CMV-R shortly after starting highly active antiretroviral therapy (HAART) remained low, although the CD4 cell counts increased markedly. Therefore, development of CMV-R is associated with a poor CMV-specific reactivity of CD4 T cells but not with poor reactivity of CD8 T cells. Development of CMV-R after initiation of HAART is associated with a poor reconstitution of CMV-specific immune response, rather than with immune rebound.

Molecular epidemiology of Candida colonizing critically ill patients in intensive care units

BACKGROUND AND PURPOSE

Nosocomial Candida infections are an important cause of morbidity and mortality in critically ill patients. Although there is growing evidence that candidemia develops primarily as a consequence of endogenous colonization, hospital outbreaks of Candida infection are not uncommon. To examine the prevalence and consequence of Candida colonization in critically ill patients and to elucidate the contribution of cross-transmission to the high frequency of nosocomial fungal infection in intensive care units (ICUs), a 6-month prospective surveillance study was conducted.

PATIENTS AND METHODS

A total of 342 adult patients with an expected ICU stay of 48 hours or more were enrolled in the study. Surveillance cultures were taken from the rectal region, oropharynx, and urine on ICU entry and weekly thereafter. The electrophoretic karyotypes (EKs) of all isolates were characterized using pulsed-field gel electrophoresis.

RESULTS

A total of 873 Candida strains were isolated from 208 of the 342 patients (60.8%) during ICU stay. A comparison of the EK patterns generated from Candida strains isolated from different patients demonstrated a variability of karyotypes, and failed to identify predominant clones colonizing or infecting ICU patients. For 62 of 102 patients colonized with multiple isolates of the same Candida spp., the EK patterns of the Candida strains isolated from individual patients were identical or similar, even when isolated from different anatomical sites, and the patterns remained the same for up to 62 days. A total of 57 episodes of Candida infection occurred in 53 (25.5%) of these 208 patients. Thirty-six episodes (63.1%) of Candida infection were preceded by colonization with the same Candida spp. All infecting strains had identical or similar EK patterns to prior colonizing strains.

CONCLUSIONS

While Candida colonization was common in ICU patients, karyotyping did not identify cross-transmission among these patients. Further, only 25.5% of patients with Candida colonization subsequently developed Candida infection. These findings suggest that universal prophylaxis is not warranted in critically ill patients with Candida colonization.

Kinetics of antigen-induced phenotypic and functional maturation of human monocyte-derived dendritic cells

Dendritic cells (DCs), a critical component of innate immunity, are the most potent APCs. When DCs mature, they can elicit strong T cell responses. We studied the kinetics of Ag-induced phenotypic and functional maturation of human monocyte-derived DCs using an in vitro T cell-independent culture system. With this model, we herein show that an Ag that has recently or repetitively been exposed ("exposed Ag") rapidly induces a high level of maturation; however, an Ag that has never or only remotely been exposed ("unexposed Ag") slowly induces a low level of maturation. The kinetics of Ag-induced maturation of DCs possibly implies a novel mechanism for immunological memory that would provide maximal host protection from repetitively invading pathogens in the environment.

A model complex of a possible intermediate in the mechanism of action of peptide deformylase: first example of an (N2S)zinc(II)-formate complex

The synthesis and crystallographic characterization of a new (N2S)zinc-alkyl complex and (N2S)zinc-formate complex is described; the bonding mode of the formate complex has implications for the mechanism of action of the enzyme peptide deformylase.

Modulation of NO and cytokines in microglial cells by Cu/Zn-superoxide dismutase

The activation of microglial cells in response to neuropathological stimuli is one of the prominent features of human neurodegenerative diseases. Cytokines such as IL-1 beta and TNF-alpha and inflammation-related enzymes such as inducible nitric oxide synthase are usually induced during the activation of microglial cells. We investigated the modulation of the activation of microglial cell by transfecting a Cu/Zn-SOD cDNA into BV-2 cells. Parental and transfected BV-2 cells were then subjected to LPS stimulation. The results showed that in Cu/Zn-SOD-transfected BV-2 cells, the expression and activity of Cu/Zn-SOD increased. On the other hand, upon activation by LPS, these cells produced less NO, IL-1 beta, and TNF-alpha than the parental microglial cells. This finding suggests that superoxide may be an early signal triggering the induction of cytokines and that the transfected Cu/Zn-SOD may provide a neuroprotective function via suppression of microglial activation. In addition, this approach may provide a rationale for the development of treatments for neurodegenerative diseases.

Risk factors for ICU mortality in critically ill patients

BACKGROUND AND PURPOSE

Advances in critical care medicine have increased the chances of survival for patients with severe illness or trauma. However, such patients consume a large proportion of medical resources. This study sought risk factors for mortality that have potential to be modified among patients treated in medical or surgical intensive care units (ICUs).

METHODS

This 6-month prospective observational study was conducted in the medical and surgical ICUs of an 1,800-bed university hospital. All adult patients with an expected ICU stay of 48 hours or more were followed up regularly until discharge from the ICUs, or for 10 weeks during their stay in ICUs.

RESULTS

Of 342 patients enrolled, 77 (22.5%) died during a median follow-up period of 5 days (range, 2-70 days). Among a range of variables at the time of ICU entry or developing during stay in ICUs, 17 were associated with higher mortality rate. Multivariate analysis using a logistic regression model demonstrated that the presence of systemic inflammatory response syndrome (SIRS) at the time of ICU entry (adjusted relative risk, ARR, 2.85; 95% confidence interval, CI, 1.16-7.05), Acute Physiological and Chronic Health Evaluation (APACHE) II score on ICU Day 4 (ARR 1.12 with increment of one score; 95% CI 1.01-1.24), Therapeutic Intervention Scoring System (TISS) score on Day 4 (ARR 1.13 with increment of one score; 95% CI 1.05-1.23), parenteral nutrition (ARR 4.97, 95% CI 1.73-14.26), and nosocomial Candida infection (ARR 3.39, 95% CI 1.12-10.23) were independently associated with ICU mortality.

CONCLUSIONS

In addition to SIRS and the APACHE II and TISS scores, this study found that nosocomial Candida infection and parenteral nutrition were independently associated with mortality after control for admission conditions, severity of illness scores, and interventions.

Plate atelectasis: an implication of foreign body aspiration into the lower airways in two adults

Pneumonic patches and atelectatic or bronchiectatic changes in the tributary lung distal to the bronchial foreign body are common radiographic abnormal findings in adults with foreign body aspiration into the lower airways. Nevertheless, plate (plate-like or discoid) atelectasis, a form of peripheral atelectasis, has not been reported to associate with this condition. In this report, we describe two men with the foreign body impacted in the right intermediate bronchus. In both cases, plate atelectasis was found in the base of the right lung and disappeared after successful removal of the foreign body via fiberoptic bronchoscopy. These two cases illustrate that plate atelectasis may be an implication of foreign body aspiration into the lower airways.

Structures of heparin-derived disaccharide bound to cobra cardiotoxins: context-dependent conformational change of heparin upon binding to the rigid core of the three-fingered toxin

Glycosaminoglycans (GAGs) have been suggested to be a potential target for cobra cardiotoxin (CTX) with high affinity and specificity via a cationic belt at the concave surface of the polypeptide. The interaction of GAGs, such as high-molecular weight heparin, with CTXs not only can induce aggregation of CTX molecules but also can enhance their penetration into membranes. The binding of short chain heparin, such as a heparin-derived disaccharide [DeltaUA2S(1-->4)-alpha-D-GlcNS6S], to CTX A3 from Taiwan cobra (Naja atra), however, will not induce aggregation and was, therefore, investigated by high-resolution (1)H NMR. A novel heparin binding site on the convex side of the CTX, near the rigid disulfide bond-tightened core region of Cys38, was identified due to the observation of intermolecular NOEs between the protein and carbohydrate. The derived carbohydrate conformation using complete relaxation and conformational exchange matrix analysis (CORCEMA) of NOEs indicated that the glycosidic linkage conformation and the ring conformation of the unsaturated uronic acid in the bound state depended significantly on the charge context of CTX molecules near the binding site. Specifically, comparative binding studies of several heparin disaccharide homologues with two CTX homologues (CTX Tgamma from Naja nigricollis and CTX A3) indicated that the electrostatic interaction of N-sulfate of glucosamine with NH(3)(+)zeta of Lys12 and of the 2-O-sulfate of the unsaturated uronic acid with NH(3)(+)zeta of Lys5 played an important role. These results also suggest a model on how the CTX-heparin interaction may regulate heparin-induced aggregation of the toxin via the second heparin binding site.

In vitro activity of linezolid against clinical Gram-positive bacterial isolates from Taiwan: an area with a high prevalence of antibiotic resistance

The prevalence of antibiotic-resistant bacteria in Taiwan is due to the heavy use of antimicrobial agents in both animal husbandry and clinical practice over the past decades. Minimum inhibitory concentrations (MICs) of linezolid were established for 371 clinical isolates of staphylococci, pneumococci, enterococci and group A streptococci from Taiwan. All isolates tested including those resistant to beta-lactams, erythromycin, vancomycin and quinupristin-dalfopristin were uniformly susceptible to linezolid, with MICs ranging from 0.125 to 2 mg/l. Our data support the observation that there is no cross-resistance between linezolid and other classes of antimicrobial substances.

In vitro activity of moxifloxacin against common clinical bacterial isolates in Taiwan

The in vitro antimicrobial activities of moxifloxacin were compared with 7 other antimicrobial agents. A total of 707 isolates of 11 common pathogenic bacteria were collected from the National Taiwan University Hospital; antimicrobial activities against these isolates were evaluated by minimum inhibitory concentration using an agar-dilution method. Most common pathogenic bacteria were susceptible to moxifloxacin, including methicillin-susceptible and -resistant Staphylococcus aureus, methicillin-susceptible and -resistant Staphylococcus epidermidis, Streptococcus pneumoniae, Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Burkholderia cepacia, Acinetobacter baumannii, and Stenotrophomonas maltophilia. For many of these bacterial species, moxifloxacin was the most active antimicrobial agent compared with the third- and fourth- generation cephalosporins, carbapenems, monobactam, and other quinolones. Some strains of methicillin-resistant S. aureus and methicillin-resistant S. epidermidis demonstrated very low levels of minimum inhibitory concentration for moxifloxacin, suggesting the potential application of the drug to treat some drug-resistant gram-positive bacterial infections. Moxifloxacin was less active against P. aeruginosa, but was more active against S. maltophilia when compared with other fluoroquinolones. In conclusion, moxifloxacin exhibits an increased potency against gram-positive bacteria as compared with other tested antimicrobial agents, while preserving excellent activity against gram-negative bacteria. The drug appears to be a promising agent expressing activity against a wide variety of bacteria in Taiwan.

Antibacterial activity of leaf essential oils and their constituents from Cinnamomum osmophloeum

The antibacterial activities of the essential oils from leaves of two Cinnamomum osmophloeum clones (A and B) and their chemical constituents were investigated in this study. The nine strains of bacteria, including Escherichia coli, Pseudomonas aeruginosa, Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae, Salmonella sp., and Vibrio parahemolyticus, were used in the antibacterial tests. Results from the antibacterial tests demonstrated that the indigenous cinnamon B leaf essential oils had an excellent inhibitory effect. The MICs (minimum inhibitory concentrations) of the B leaf oil were 500 microg/ml against both K. pneumoniae and Salmonella sp. and 250 microg/ml against the other seven strains of bacteria. Cinnamaldehyde possessed the strongest antibacterial activity compared to the other constituents of the essential oils. The MICs of cinnamaldehyde against the E. coli, P. aeruginosa, E. faecalis, S. aureus, S. epidermidis, MRSA, K. pneumoniae, Salmonella sp., and V. parahemolyticus were 500, 1000, 250, 250, 250, 250, 1000, 500, and 250 microg/ml, respectively. These results suggest that C. osmophloeum leaf essential oil and cinnamaldehyde are beneficial to human health, having the potential to be used for medical purposes and to be utilized as anti-bacterial additives in making paper products.

Purification, molecular cloning and mechanism of action of graminelysin I, a snake-venom-derived metalloproteinase that induces apoptosis of human endothelial cells

Apoptosis, a programmed, physiological mode of cell death, is important in tissue homoeostasis. Here we report that a new metalloproteinase, graminelysin I, purified from Trimeresurus gramineus venom, induced apoptosis of human endothelial cells as examined by electrophoresis and flow cytometry. Graminelysin I contains only a metalloproteinase domain. It is a single-chain proteinase with a molecular mass of 27020 Da. cDNA sequence analysis revealed that the disintegrin-like and cysteine-rich domains of the putative precursor protein of graminelysin I are likely to be processed post-translationally, producing the proteinase domain (graminelysin I). Graminelysin I cleaved the alpha chain of fibrinogen preferentially and cleaved the beta chain either on longer incubation or at higher concentration. Graminelysin I inhibited the adhesion of human umbilical-vein endothelial cells (HUVECs) to immobilized fibrinogen and induced HUVECs detachment in a dose-dependent manner. These effects on HUVECs were abolished when graminelysin I was pretreated with EDTA. However, graminelysin I did not inhibit the adhesion of HUVECs to immobilized collagen. HUVECs were susceptible to death after treatment with graminelysin I when they were cultured on immobilized fibrinogen. In contrast, HUVECs were rather resistant to treatment with graminelysin I if they were cultured on immobilized collagen. Furthermore, graminelysin I induced apoptosis of HUVECs in a dose-dependent manner. Similarly, its apoptosis-inducing activity was blocked if it was treated with EDTA. These results suggest that the catalytic activity of graminelysin I on matrix proteins contributes to its apoptosis-inducing activity.

Antibiotic usage in primary care units in Taiwan after the institution of national health insurance

To understand antibiotic usage in primary care units in Taiwan after the institution of national health insurance, we collected all prescriptions for one week in March each year from 1996 to 1999 from out-patient clinics of randomly sampled public health stations located in various parts of Taiwan. We sampled 114 health stations with 40,891 patient-visits and 68,386 diagnoses made in 1996; 154 health stations were sampled with 53,992 patient-visits and 99,466 diagnoses in 1997; 166 health stations were sampled with 49,112 patient-visits and 96,161 diagnoses in 1998; and 162 health stations were sampled with 46,976 patient-visits and 93,641 diagnoses in 1999. The percentages of total patient-visits that resulted in antibiotic treatment were 14.2%, 12.5%, 14.1% and 13.0% in the four time periods, respectively. Among patient-visits, patient group under the age of 11 received the highest percentage of antibiotic treatment. Common cold was the most frequent diagnosis for which antibiotic was prescribed during the four time periods, accounting for 32.3% of total antibiotic prescriptions. Among patients with the diagnosis of common cold, 31.3% received antibiotic treatment, and the highest figure was among pediatric patients (<16 year of age). Penicillins, cephalosporins and macrolides were the most commonly prescribed classes of antibiotics. They accounted for 35.4%, 26.5% and 21.6% of all prescribed antibiotics in these four study periods. From this study, it was found that, after institution of the national health insurance system, antibiotics are still very commonly used in primary care units in Taiwan and still seem to be overused.

Candida albicans spinal epidural abscess secondary to prosthetic valve endocarditis

A 56-year-old woman, with underlying rheumatic heart disease status post mitral valve replacement, presented with fever, low back pain radiating to right leg, and congestive heart failure. Magnetic resonance imaging detected an L5-S1 spinal epidural abscess. A vegetation on prosthetic mitral valve was found by transesophageal echocardiography. Cultures of epidural aspirate, surgical specimen, and blood all grew Candida albicans. She received surgical drainage of the spinal epidural abscess and i.v. amphotericin B 1 mg/kg/day for eight weeks. Clinical symptoms improved gradually and she was discharged without neurologic sequelae. She remained well and continued to lead an active life two years after discharge.

Injection molding of chondrocyte/alginate constructs in the shape of facial implants

Over one million patients per year undergo some type of procedure involving cartilage reconstruction. Polymer hydrogels, such as alginate, have been shown to be effective carriers for chondrocytes in subcutaneous cartilage formation. The goal of our current study was to develop a method to create complex structures (nose bridge, chin, etc.) with good dimensional tolerance to form cartilage in specific shapes. Molds of facial implants were prepared using Silastic ERTV. Suspensions of chondrocytes in 2% alginate were gelled by mixing with CaSO(4) (0.2 g/mL) and injected into the molds. Constructs of various cell concentrations (10, 25, and 50 million/mL) were implanted in the dorsal aspect of nude mice and harvested at times up to 30 weeks. Analysis of implanted constructs indicated progressive cartilage formation with time. Proteoglycan and collagen constructs increased with time to approximately 60% that of native tissue. Equilibrium modulus likewise increased with time to 15% that of normal tissue, whereas hydraulic permeability decreased to 20 times that of native tissue. Implants seeded with greater concentrations of cells increased proteoglycan content and collagen content and equilibrium and decreased permeability. Production of shaped cartilage implants by this technique presents several advantages, including good dimensional tolerance, high sample-to-sample reproducibility, and high cell viability. This system may be useful in the large-scale production of precisely shaped cartilage implants.

Regulation of the Src homology 2-containing inositol 5-phosphatase SHIP1 in HIP1/PDGFbeta R-transformed cells

It has been shown previously that the Huntingtin interacting protein 1 gene (HIP1) was fused to the platelet-derived growth factor beta receptor gene (PDGFbetaR) in leukemic cells of a patient with chronic myelomonocytic leukemia. This resulted in the expression of the chimeric HIP1/PDGFbetaR protein, which oligomerizes, is constitutively tyrosine-phosphorylated, and transforms the Ba/F3 murine hematopoietic cell line to interleukin-3-independent growth. Tyrosine phosphorylation of a 130-kDa protein (p130) correlates with transformation by HIP1/PDGFbetaR and related transforming mutants. We report here that the p130 band is immunologically related to the 125-kDa isoform of the Src homology 2-containing inositol 5-phosphatase, SHIP1. We have found that SHIP1 associates and colocalizes with the HIP1/PDGFbetaR fusion protein and related transforming mutants. These mutants include a mutant that has eight Src homology 2-binding phosphotyrosines mutated to phenylalanine. In contrast, SHIP1 does not associate with H/P(KI), the kinase-dead form of HIP1/PDGFbetaR. We also report that phosphorylation of SHIP1 by HIP1/PDGFbetaR does not change its 5-phosphatase-specific activity. This suggests that phosphorylation and possible PDGFbetaR-mediated sequestration of SHIP1 from its substrates (PtdIns(3,4,5)P(3) and Ins(1,3,4,5)P(4)) might alter the levels of these inositol-containing signal transduction molecules, resulting in activation of downstream effectors of cellular proliferation and/or survival.

Changes in starch content in oat (Avena sativa) shoot pulvini during the gravitropic response

In order to determine if components of the signal transduction pathway are involved in starch metabolism during the gravitropic response, the effects of inhibitors of phosphoprotein phosphatases and protein kinases (OA), and calcium channel blockers (LaCl3), on gravitropic bending and starch levels in gravisensitive node/pulvini of oat shoots were examined. Among the compounds tested, okadaic acid (OA) and lanthanum chloride (LaCl3) showed the strongest inhibitory effects on the negative gravitropic curvature response in oat shoot node/pulvini. At the same time, they caused a rapid loss of starch in graviresponding pulvini based on a quantitative analysis of starch levels in the bending tissues over 48 h periods. These two compounds act initially to block the net increase in starch content that occurs during the early stages (0-9 h) in graviresponding oat shoot pulvini. As a result, starch levels drop precipitously in shoots treated with OA and LaCl3, starting at time zero of gravistimulation by reorientation. These findings suggest that protein dephosphorylation and calcium play a role in starch metabolism in oat shoot pulvini in response to a gravistimulation signal. They also indicate that the amount of starch present in the chloroplast gravisensors in oat shoot pulvini may determine the rate of upward bending in graviresponding pulvini.

A novel chromosome region maintenance 1-independent nuclear export signal of the large form of hepatitis delta antigen that is required for the viral assembly

Hepatitis delta virus (HDV) is a satellite virus of hepatitis B virus, as it requires hepatitis B virus for virion production and transmission. We have previously demonstrated that sequences within the C-terminal 19-amino acid domain flanking the isoprenylation motif of the large hepatitis delta antigen (HDAg-L) are important for virion assembly. In this study, site-directed mutagenesis and immunofluorescence staining demonstrated that in the absence of hepatitis B virus surface antigen (HBsAg), the wild-type HDAg-L was localized in the nuclei of transfected COS7 cells. Nevertheless, in the presence of HBsAg, the HDAg-L became both nuclei- and cytoplasm-distributed in about half of the cells. An HDAg-L mutant with a substitution of Pro-205 to alanine could neither form HDV-like particles nor shift the subcellular localization in the presence of HBsAg. In addition, nuclear trafficking of HDAg-L in heterokaryons indicated that HDAg-L is a nucleocytoplasmic shuttling protein. A proline-rich HDAg peptide spanning amino acid residues 198 to 210, designated NES(HDAg-L), can function as a nuclear export signal (NES) in Xenopus oocytes. Pro-205 is critical for the NES function. Furthermore, assembly of HDV is insensitive to leptomycin B, indicating that the NES(HDAg-L) directs nuclear export of HDAg-L to the cytoplasm via a chromosome region maintenance 1-independent pathway.

A role for inositol 1,4,5-trisphosphate in gravitropic signaling and the retention of cold-perceived gravistimulation of oat shoot pulvini

Plants sense positional changes relative to the gravity vector. To date, the signaling processes by which the perception of a gravistimulus is linked to the initiation of differential growth are poorly defined. We have investigated the role of inositol 1,4,5-trisphosphate (InsP(3)) in the gravitropic response of oat (Avena sativa) shoot pulvini. Within 15 s of gravistimulation, InsP(3) levels increased 3-fold over vertical controls in upper and lower pulvinus halves and fluctuated in both pulvinus halves over the first minutes. Between 10 and 30 min of gravistimulation, InsP(3) levels in the lower pulvinus half increased 3-fold over the upper. Changes in InsP(3) were confined to the pulvinus and were not detected in internodal tissue, highlighting the importance of the pulvinus for both graviperception and response. Inhibition of phospholipase C blocked the long-term increase in InsP(3), and reduced gravitropic bending by 65%. Short-term changes in InsP(3) were unimpaired by the inhibitor. Gravitropic bending of oat plants is inhibited at 4 degrees C; however, the plants retain the information of a positional change and respond at room temperature. Both short- and long-term changes in InsP(3) were present at 4 degrees C. We propose a role for InsP(3) in the establishment of tissue polarity during the gravitropic response of oat pulvini. InsP(3) may be involved in the retention of cold-perceived gravistimulation by providing positional information in the pulvini prior to the redistribution of auxin.

Antibiotic use in public hospitals in Taiwan after the implementation of National Health Insurance

BACKGROUND AND PURPOSE

Only limited data is available on the patterns of antibiotic use in hospitals in Taiwan before and after the implementation of national health insurance. This study aimed to determine the patterns of use of antibiotics in public hospitals in Taiwan after the implementation of the National Health Insurance program and to compare these with patterns prior to the implementation.

METHODS

Data on the annual use of all antibiotics in public hospitals in Taiwan during the period from fiscal year (FY) 1994-1995 to 1997-1998 were collected and analyzed. Hospitals included seven medical centers, 19 regional hospitals, 53 district hospitals, and eight specialty service hospitals.

RESULTS

The annual cost of antibiotics made up 17.4% of the annual cost of all medication used in these hospitals in FY 1994-1995, and decreased year by year to 12.6% in FY 1997-1998. During the study period, 57.4% of the total cost of antibiotics were incurred by medical centers, 24.6% by regional hospitals, 16.2% by district hospitals, and 1.8% by specialty service hospitals. The most commonly used class of antibiotic was cephalosporins, accounting for 48.0% to 54.3% of total antibiotic costs. The second most commonly used class of antibiotic was penicillins, accounting for 15.9% to 17.4% of total antibiotic costs. In FY 1994-1995, the next most commonly used classes of antibiotics were aminoglycosides, fluoroquinolones, and other beta-lactams, respectively, but by FY 1997-1998 these had changed to fluoroquinolones, glycopeptides, and aminoglycosides, respectively. Among the various cephalosporins used, first-generation cephalosporins accounted for 76.1% of all cephalosporins used in FY 1994-1995, which increased year by year to 84.0% in FY 1997-1998. Second-generation cephalosporins accounted for 20.7% of all cephalosporins used in FY 1994-1995, decreasing to 13.2% in FY 1997-1998.

CONCLUSION

The introduction of the National Health Insurance program in Taiwan brought about a major change in antibiotic use patterns in public hospitals.

Dietary fish oil increases CD8+ T-cells and decreases autoreactive T-cell activity in autoimmune NZB/W F1 mice

To further elucidate the effect of different dietary fats on the pathogenesis of autoimmune diseases, five groups of New Zealand black/white (NZB/W) F1 mice were fed diets containing 200 g of different dietary fats including palm oil, lard-soybean oil (1:1, w/w), soybean oil, canola oil or fish oil. Serum levels of anti-DNA antibodies, proteinuria were followed every month and life span of the mice was determined. After 5 months of the respective diets, mice were killed at the age of 7 months and phenotypic analysis of splenic cells and peritoneal resident cells was performed. The pattern of production of cytokines in splenic T-cells was also investigated. The peritoneal resident cells were isolated for measurement of prostaglandin E2 (PGE2) levels. Significantly lower immunoglobulin G (IgG) anti-single-stranded DNA (ssDNA) and anti-double-stranded DNA (dsDNA) antibody levels were associated with less severe proteinuria and prolonged life span in mice fed dietary fish oil compared to mice fed other dietary oils. Phenotypic analysis of spleen cells showed increased CD8+ T-cells in the mice fed dietary fish oil compared to mice of the other dietary groups, and the percentage of natural killer (NK) cells in the mice fed dietary fish oil was also higher compared to the other dietary groups. The peritoneal resident cells produced lower PGE2 in mice fed fish oil compared to mice in the other dietary groups. To further investigate the effect of fish oil on autoreactive T-cells, splenic T-cells purified using a nylon wool column were stimulated with non-T-cells of young NZB/W F1 mice. Our data suggest that the anti-DNA antibody augmentation ability of T-cells in mice fed dietary fish oil was significantly decreased compared to mice in the other dietary groups. These data indicate that dietary fish oil might maintain the existence of CD8+ T-cells, decrease autoreactive T-cell activity and alleviate subsequent autoimmune processes in autoimmune prone NZB/W F1 mice.

Diagnosis of pulmonary alveolar proteinosis: usefulness of papanicolaou-stained smears of bronchoalveolar lavage fluid

BACKGROUND

The globules (stained green, orange, or orange in the center coated with a green rim) seen in Papanicolaou-stained smears of bronchoalveolar lavage fluid are suggested to be characteristic of pulmonary alveolar proteinosis (PAP).

OBJECTIVE

To evaluate the usefulness of Papanicolaou-stained smears of bronchoalveolar lavage fluid in aiding a diagnosis of PAP.

METHODS

Papanicolaou-stained smears of bronchoalveolar lavage fluid obtained from 7 patients (5 idiopathic, 2 secondary) with PAP were evaluated. To serve as controls, the smears of 11 normal subjects and 128 patients with other pulmonary disorders were also examined. The findings on the presence and number of globules were recorded. To differentiate PAP from other pulmonary disorders, the highest globule value obtained from the control group was chosen as the cutoff point.

RESULTS

The characteristic globules were not found in normal subjects and only found in 6 of 128 patients with other pulmonary disorders. Their clinical diagnoses were Sjögren syndrome in 2 cases; polymyositis, idiopathic pulmonary fibrosis, asbestosis, and hypersensitivity pneumonitis in 1 case each. The numbers of globules in these 6 patients were 1, 3, 17, 7, 3, and 2. In contrast, more than 100 globules were found in all patients with PAP. The number of globules was highly sensitive and specific in aiding a diagnosis of PAP when the cutoff value was set at 18.

CONCLUSION

The globules seen in Papanicolaou-stained smears of bronchoalveolar lavage fluid may be valuable in aiding a diagnosis of PAP, especially when the number of globules is more than 18.

A hospital-acquired outbreak of methicillin-resistant Staphylococcus aureus infection initiated by a surgeon carrier

Methicillin-resistant Staphylococcus aureus (MRSA) has become an important hospital-acquired pathogen, infection with which often leads to major morbidity and mortality. The principal mode of transmission for MRSA is transfer of the organism from a carrier or infected patient to uninfected patients by the hands or clothing of staff. From January 16 1997 to April 2 1997, five patients who had undergone open-heart surgery in a hospital located in northern Taiwan, developed surgical wound infections and mediastinitis caused by MRSA. All patients were hospitalized in two adjacent surgical intensive care units (ICUs) following their respective operations. Consequently, the hospital's infection control team commenced investigation of the outbreak. Pulsed-field gel electrophoresis (PFGE) has been shown to be a good technique for epidemiological typing. By analysing cultures taken from staff by PFGE, it was demonstrated that this outbreak was most likely to be initiated by a surgeon with MRSA carriage. After elimination of the carrier state using topical mupirocin treatment, the outbreak was controlled without further incident.

Regulation of bronchoalveolar lavage fluids cell function by the immunomodulatory agents from Cordyceps sinensis

Cordyceps sinensis (C. sinensis) is one of the well known fungi used in traditional Chinese medicine for treatment asthma and bronchial and lung inflammation. In this study, effects of C. sinensis methanolic extracts on bronchoalveolar lavage fluids (BALF) cells proliferation, inflammatory cytokines production, and genes expression were evaluated. The proliferative response of BALF cells to lipopolysaccharide (LPS) was determined by the tritiated thymidine uptake method. The cell-free supernatants were harvested then tested for interlukin-1beta (IL-1beta), interlukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8), interleukin-10 (IL-10), interleukin-12 (IL-12), and interferon-gamma (IFN-gamma) by the enzyme immunoassay. The results indicated that the CS-19-22 fraction dose dependently suppressed BALF cells proliferation activated by LPS. The CS-19-22 fraction also reduced IL-1beta, IL-6, IL-8, IL-10 and TNF-alpha production in LPS activated BALF cell cultures. Furthermore, the IL-12 and IFN-gamma production in activated BALF cells were enhanced by CS-19-22 treatment. The CS-19-22 fraction did not affect IL-1beta, IL-6, TNF-alpha, and IL-8 mRNAs expression in BALF cells detected by reverse transcription-polymerase chain reaction (RT-PCR). By contrast, the CS-19-22 fraction increased IL-12 and IFN-gamma mRNAs expression and decreased IL-10 mRNA expression in the BALF cells activated with LPS. These results indicated the CS-19-22 fraction suppressed IL-1beta, IL-6, TNF-alpha, and IL-8 cytokines production in BALF cells through other than inhibition of mRNAs expression pathway. These results also demonstrate that the therapeutic activity of C. sinensis in Chinese medicine may be related to modulation of TH1 and TH2 cells functions in bronchial airway.

Perfusionist-transmitted bacterial mediastinitis in a heart transplant recipient

We report the case of a 56-year-old man who developed bacterial mediastinitis with methicillin-resistant Staphylococcus aureus after undergoing heart transplantation. He had a history of insulin-dependent diabetes mellitus and prior cardiac surgery. To find the source of nosocomial infection, we cultured nasal swab specimens from all hospital personnel involved in this operation. We used antibiotic sensitivity profiling and pulsed-field gel electrophoresis to subtype the involved microorganism. The S. aureus isolates from the patient and the perfusionist were identical to each other and were different from the strains previously found in our hospital. It is almost certain that the S. aureus mediastinitis in this patient was transmitted from the perfusionist. We recommend obtaining cultures from hospital staff members when there is an outbreak of staphylococcal infection.

Comparison of antimicrobial susceptibility of Citrobacter freundii isolates in two different time periods

Citrobacter freundii was first identified in 1932, since then it has been reported to cause a variety of infections in aged, immunocompromised, and debilitated patients. With the use of broad-spectrum antibiotics, C. freundii has become increasingly resistant to antimicrobial agents. In order to determine the chronological changes in susceptibility and current susceptibility status of C. freundii, we compared the antimicrobial susceptibility of C. freundii in two different time periods, from 1987 to 1988 and from 1997 to 1998. In both time periods, 61 isolates of C. freundii were randomly selected for study from all clinical isolates at National Taiwan University Hospital. The minimum inhibitory concentrations and susceptible rates of 15 antimicrobial agents were compared, and it was found that most C. freundii isolates were resistant to anti-pseudomonal penicillins, first, second, and third generation cephalosporins, gentamicin, tobramycin, and aztreonam. The results indicate that the susceptible rates of C. freundii to aminoglycosides and ciprofloxacin decreased markedly during the period from 1987 to 1998. Cefepime, cefpirome, imipenem, and meropenem remained the most active agents against C. freundii.

Isolation, purification, and characterization of a killer protein from Schwanniomyces occidentalis

The yeast Schwanniomyces occidentalis produces a killer toxin lethal to sensitive strains of Saccharomyces cerevisiae. Killer activity is lost after pepsin and papain treatment, suggesting that the toxin is a protein. We purified the killer protein and found that it was composed of two subunits with molecular masses of approximately 7.4 and 4.9 kDa, respectively, but was not detectable with periodic acid-Schiff staining. A BLAST search revealed that residues 3 to 14 of the 4.9-kDa subunit had 75% identity and 83% similarity with killer toxin K2 from S. cerevisiae at positions 271 to 283. Maximum killer activity was between pH 4.2 and 4.8. The protein was stable between pH 2.0 and 5.0 and inactivated at temperatures above 40 degrees C. The killer protein was chromosomally encoded. Mannan, but not beta-glucan or laminarin, prevented sensitive yeast cells from being killed by the killer protein, suggesting that mannan may bind to the killer protein. Identification and characterization of a killer strain of S. occidentalis may help reduce the risk of contamination by undesirable yeast strains during commercial fermentations.

Restoration of cellular immunity against tuberculosis in patients coinfected with HIV-1 and tuberculosis with effective antiretroviral therapy: assessment by determination of CD69 expression on T cells after tuberculin stimulation

Whether immunity against opportunistic pathogens can be fully restored by control of HIV-1 replication remains open to question. This longitudinal study was conducted to measure anti-tuberculosis (TB) cellular immunity in 13 HIV-1/TB-coinfected patients effectively treated by highly active antiretroviral therapy (HAART) in a period of 12 months. In this study, anti-TB cellular immunity was assessed by determining the frequencies of CD 69 expression on CD4+ and CD8+ T cells in response to purified protein derivative (PPD) stimulation (abbreviated as %CD4+CD69 to PPD and %CD8+CD69 to PPD). Here, we show that %CD4+CD69 to PPD correlated with the results of tuberculin skin tests and interferon-gamma (IFN-gamma) production from PPD-stimulated CD4+ T cells, and %CD8+CD69 to PPD also correlated with CD8+ T cell-mediated PPD-specific cytolysis. In overall analysis for these 13 patients, both %CD4+CD69 to PPD and %CD8+CD69 to PPD increased significantly during the 12 months (p =. 003 and p <.001, respectively). However, we found %CD4+CD69 to PPD or %CD8+CD69 to PPD failed to increase substantially in some patients (i.e., immunologic nonresponders). A significantly higher proportion of patients whose baseline CD4+ count was <50 cells/mm3 were considered to be CD4+ nonresponders compared with those whose baseline CD4+ count was >50 cells/mm3. Furthermore, baseline CD4+ cell count in nonresponders is significantly lower than that in responders, although the effectiveness of HAART did not differ between them. Our results indicate that PPD-specific frequencies of CD69 expression may be used as surrogate markers of anti-TB cellular immunity. By this method, we show that full reconstitution of anti-TB cellular immunity in HIV-1/TB coinfected patients may not necessarily be achieved by "successful" HAART and may be influenced by the baseline immune status when HAART is started. These data suggest that the decision to discontinue secondary prophylaxis for opportunistic infections should be cautiously made, even when the CD4+ cell count has significantly increased.

Mortality, morbidity, length and cost of hospitalization in very-low-birth-weight infants in the era of National Health Insurance in Taiwan: a medical center's experience

The impact of implementation of the National Health Insurance on the outcome, cost, and length of hospitalization of very-low-birth-weight (VLBW) infants is not clear in Taiwan. These data are important for the planning of medical care and regionalization in this area. This study was an attempt to examine these questions. We retrospectively collected mortality, morbidity, and length and cost of hospitalization data of VLBW (BW < 1500 g) infants between March 1995 and February 1998. There were totally 162 patients enrolled. The overall mortality rate was 21.6%; the birth weight (BW)-specific mortality rate was 72%, 31%, 19%, and 3% for infants with BWs of < 750 g, 750-999 g, 1000-1249 g, and 1250-1499 g, respectively. The incidence of morbidities were: respiratory distress syndrome (74%), patent ductus arteriosus (36%), necrotizing enterocolitis (9%), sepsis (42%), intraventricular hemorrhage (15%), retinopathy of prematurity (31%), failure to pass auditory brainstem response (ABR) (34%), and chronic lung disease (17%). The average length of hospitalization was 67.2 days, and the cost per infant was 62 x 10(4) NT dollars; 108 +/- 38 days, 73 +/- 32 x 10(4) NT dollars if BW < 750 g; 94 +/- 15 days, 99 +/- 35 x 10(4) NT dollars if BW 750-999 g; 66 +/- 23 days, 64 +/- 36 x 10(4) NT dollars if BW 1000-1249 g; and 43 +/- 14 days, 39 +/- 37 x 10(4) NT dollars if BW 1250-1499 g. In conclusion, VLBW infants are associated with high mortality and morbidity rates. They have long lengths and high costs of hospitalization, and therefore deserve attention in the implementation of the National Health Insurance and regionalization.

Disseminated intravascular coagulation in a lung cancer patient after acute myocardial infarction

A 70-year-old man with adenocarcinoma of the lung suffered from an attack of acute myocardial infarction during hospitalization. Eleven days after the heart attack, clinically obvious disseminated intravascular coagulation (DIC) occurred. The intravascular coagulation abnormalities progressed and eventually the patient died. We suspect that both lung adenocarcinoma and the insult of myocardial infarction may have contributed to the development of DIC in this patient.

Polymorphism of transmembrane region of MICA gene and Kawasaki disease

Kawasaki disease is a febrile disease of children complicated with vasculitis of the coronary arteries and potential aneurysm formation. It has been recognized worldwide and appears to be increasing in frequency. Studies have found that Kawasaki disease is associated with major histocompatibility complex (MHC) class I B antigens. The MHC-class-I-chain-related gene A (MICA) is located near HLA-B. It has a triplet repeat microsatellite polymorphism in the transmembrane region. We investigated the microsatellite polymorphism in children with Kawasaki disease and controls. Seventy children (46 boys), age at diagnosis 1.68 +/- 1.69 years, with Kawasaki who were treated with aspirin as well as intravenous gamma-globulin were enrolled. Control subjects consisted of 154 children (87 boys), age 2.81 +/- 2.12 years. Phenotype frequency of allele A4 in patients with aneurysm formation was significantly lower than in patients without aneurysms [relative risk (RR) = 0.06, 95% confidence interval (CI) = 0.01-0.48, p = 0.00469, pc = 0.0232] and showed a similar tendency when compared with controls. Gene frequency of allele A4 was also significantly lower in patients who developed aneurysms than in patients who did not (RR = 0.07, 95% CI = 0.01-0.57, p = 0.0057, pc = 0.0282). Gene frequency of allele A5 showed a tendency to be higher in patients who developed aneurysms than in controls (RR = 2.35, 95% CI = 0.98-5.63, p = 0.0486, pc = 0. 220). Allele A5.1 tended to be negatively associated with Kawasaki disease (RR = 0.57, 95% CI = 0.35-0.93, p = 0.022, pc = 0.105). Our study showed that allele A4 was negatively associated with coronary aneurysm formation in Kawasaki disease. This suggests that allele A4 protects the children with Kawasaki disease from developing coronary aneurysms after aspirin and gamma globulin therapy.

Brassinolide and [26, 28-2H6]brassinolide are differently demethylated by loss of C-26 and C-28, respectively, in Marchantia polymorpha

Metabolism of brassinolide in Marchantia polymorpha was investigated by use of in vivo suspension cultured cells. GC-MS analysis of metabolites derived from non-labelled brassinolide and [26, 28-2H6] brassinolide revealed that brassinolide was converted to 26-norbrassinolide while [26, 28-2H6]brassinolide to [26-2H3]28-norbrassinolide. It seems that Marchantia cells recognized [26, 28-2H6]brassinolide as a xenobiotic rather than brassinolide and deteriums attached to C-28 significantly affect demethylation reaction due to isotopic effect. Thus, demethylation of brassinolide in planta seems to proceed by loss of C-26 rather than C-28. The present finding is the first evidence for demethylation metabolism of brassinosteroids. The biological activity of 26-norbrassinolide was 10-fold reduced as shown by the rice lamina inclination test. However, because of its high biological activity, it remains difficult to conclude whether or not C-26 demethylation serves as an important deactivation process of brassinolide.

Infected chylothorax caused by Streptococcus agalactiae: a case report

Chylothorax is bacteriostatic in nature. Bacterial infection rarely develops in chylothorax and has never been reported in a non-immunocompromised host. A 33-year-old woman was admitted to National Taiwan University Hospital because of fever and right pleuritic pain. Chest roentgenography and computed tomography revealed right pleural effusion. Examination of the pleural effusion revealed a profile compatible with empyema and chylothorax. Culture of the pleural effusion yielded Streptococcus agalactiae. The woman was not immunocompromised. This is the first report of infected chylothorax caused by Streptococcus agalactiae in a non-immunocompromised host.

Roles of the AX(4)GKS and arginine-rich motifs of hepatitis C virus RNA helicase in ATP- and viral RNA-binding activity

The nonstructural protein 3 (NS3) of hepatitis C virus (HCV) possesses protease, nucleoside triphosphatase, and helicase activities. Although the enzymatic activities have been extensively studied, the ATP- and RNA-binding domains of the NS3 helicase are not well-characterized. In this study, NS3 proteins with point mutations in the conserved helicase motifs were expressed in Escherichia coli, purified, and analyzed for their effects on ATP binding, RNA binding, ATP hydrolysis, and RNA unwinding. UV cross-linking experiments indicate that the lysine residue in the AX(4)GKS motif is directly involved in ATP binding, whereas the NS3(GR1490DT) mutant in which the arginine-rich motif (1486-QRRGRTGR-1493) was changed to QRRDTTGR bound ATP as well as the wild type. The binding activity of HCV NS3 helicase to the viral RNA was drastically reduced with the mutation at Arg1488 (R1488A) and was also affected by the K1236E substitution in the AX(4)GKS motif and the R1490A and GR1490DT mutations in the arginine-rich motif. Previously, Arg1490 was suggested, based on the crystal structure of an NS3-deoxyuridine octamer complex, to directly interact with the gamma-phosphate group of ATP. Nevertheless, our functional analysis demonstrated the critical roles of Arg1490 in binding to the viral RNA, ATP hydrolysis, and RNA unwinding, but not in ATP binding.

Ground-state entropy of the potts antiferromagnet with next-nearest-neighbor spin-spin couplings on strips of the square lattice

We present exact calculations of the zero-temperature partition function (chromatic polynomial) and W(q), the exponent of the ground-state entropy, for the q-state Potts antiferromagnet with next-nearest-neighbor spin-spin couplings on square lattice strips, of width L(y)=3 and L(y)=4 vertices and arbitrarily great length Lx vertices, with both free and periodic boundary conditions. The resultant values of W for a range of physical q values are compared with each other and with the values for the full two-dimensional lattice. These results give insight into the effect of such nonnearest-neighbor couplings on the ground-state entropy. We show that the q=2 (Ising) and q=4 Potts antiferromagnets have zero-temperature critical points on the Lx-->infinity limits of the strips that we study. With the generalization of q from Z+ to C, we determine the analytic structure of W(q) in the q plane for the various cases.

Resolution of refractory hepatic hydrothorax after chemical pleurodesis with minocycline

Management of refractory hepatic hydrothorax is a challenge to physicians in clinical practice. We reported two patients with hepatic hydrothorax, non-alcoholic cirrhosis and rapidly recurring pleural effusion. They failed to improve with diuretics and repeated thoracentesis. Refractory hepatic hydrothorax was successfully treated by minocycline-induced pleural symphysis. After pleurodesis, ventilatory function returned to normal in both patients. No recurrence of pleural effusion was noted. We suggest that minocycline pleurodesis is an alternative treatment for refractory hepatic hydrothorax because it is simple, safe and effective.

Safety and efficacy of cefpirome in comparison with ceftazidime in Chinese patients with sepsis due to bacterial infections

BACKGROUND

The safety and efficacy of cefpirome (CPM), a fourth-generation cephalosporin, has not yet been studied in an Asian population.

METHODS

Sixty-nine adult Chinese patients with sepsis due to bacterial infections were enrolled in the study and randomly assigned to receive CPM (2 g i.v. every 12 h) or ceftazidime (2 g i.v. every 8 h).

RESULTS

Both groups were comparable in terms of demographic, clinical and microbiological features. The causative pathogen was Escherichia coli or Klebsiella pneumoniae in the majority of microbiologically documented cases. The rates of clinical response (94 vs. 94%) and bacteriological response (65 vs. 68%) were similar in both groups. Similar adverse events, including rashes, gastrointestinal upset and asymptomatic elevation of hepatic enzymes, occurred in a minority of patients in both groups. All events were self-limited after discontinuation of the drugs.

CONCLUSION

CPM is as safe and effective as ceftazidime in the treatment of sepsis due to bacterial infections in Chinese patients.

Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients

Central venous catheterization represents a significant medical advancement, particularly in the treatment of critical ill. However, there is a high risk of central venous catheters-related infection. A novel antiseptic central venous catheter, made of polyurethane and impregnated with chlorhexidine and silver sulfadiazine, was developed to reduce the risk of catheters-related infection. In this study, we did a randomized clinical study to determine the efficacy by using antiseptic catheters for the prevention of central venous catheters-related infection in the intensive care units. A total of 204 patients with 235 central venous catheters were studied at the surgical intensive care units at National Taiwan University Hospital between November 1998 and June 1999. Participants received either a standard triple-lumen polyurethane catheter or an antiseptic catheter (Arrow International, Reading, Pennsylvania, USA). Both were indistinguishable from each other. Compared to standard polyurethane catheters, antiseptic catheters were less likely to be colonized by microorganisms when they were cultured at the removal (8.0 versus 20.0 colonized catheters per 100 catheters; relative risk 0.34 [95% CI, 0.15 to 0.74]; p<0.01). There was no significant differences between both groups in catheter-related infections (0.9 versus 4.9 infections per 100 catheters; relative risk 0.17 [95% CI, 0.03 to 1.15]; p = 0.07). Gram-positive cocci and fungi were more likely to colonize in the standard polyurethane catheters (p = 0.06 and 0.04, compared to antiseptic catheters respectively). Two of our cases in the control group died directly due to catheter-related candidemia. No adverse reactions such as hypersensitivity or leukopenia were found in the antiseptic catheter group. Our study showed that central venous catheters with antiseptic coating were safe and had less risk of colonization of bacteria and fungi than standard catheters in the critically ill patients.

Social anxiety (phobia) and east Asian culture

Since the introduction of the concept of social anxiety (or phobia) to the American nosological system in DSM-III (1980), it has become increasingly apparent that the condition is also prevalent in other cultures. In Japan, for example, the condition, called taijinkyofusho (usually abbreviated as TKS in English), is widespread and has been extensively discussed since the turn of the century, a fact not well known in the English-speaking psychiatric community. In comparing social phobia in Japanese society (and in other East Asian societies) with North American societies, two questions stand out. First, if TKS is social phobia, why is it so different from the American form of social phobia? In particular, why do typical TKS patients fear the possibility of distressing, and even harming, others, whereas their American counterparts feel anxious at the possibility of being embarrassed by others? In other words, why is TKS other-oriented (allocentric), whereas social phobia is self-oriented (egocentric)? Second, is TKS specific to Japanese culture? In this paper, I suggest that the allocentric nature of TKS reflects those elements of Japanese culture that are common to East Asian societies as seen in their pattern of child-rearing practices, language, and social ideals. In short, TKS is an East Asian cultural patterning of social anxiety (phobia).

Bacteremia due to Campylobacter species: high rate of resistance to macrolide and quinolone antibiotics

BACKGROUND AND PURPOSE

Although the rate of isolation of Campylobacter from stool specimens in Taiwan is similar to those in other developed countries, Campylobacter bacteremia has rarely been reported in Taiwan, and the patterns of antimicrobial susceptibility of blood isolates to various antimicrobial agents remain unknown in the Taiwanese population. The purpose of this study was to determine the clinical characteristics of patients with Campylobacter infection in a university hospital in Taiwan and the antimicrobial susceptibility patterns of the Campylobacter isolates.

METHODS

We retrospectively reviewed medical records of all patients with Campylobacter bacteremia treated in a university hospital between January 1991 and March 1999. Minimum inhibitory concentrations of 13 antimicrobial agents to 10 stored blood isolates were determined using the E-test.

RESULTS

Approximately half (52%) of the 21 patients had chronic liver disease and one-quarter had hepatobiliary or gastrointestinal malignancies. Thirteen (62%) patients had conditions that were associated with gastroenteritis. Other clinical manifestations associated with Campylobacter infection included cellulitis, perinatal sepsis, peritonitis, vascular catheter-related infection, and primary bacteremia. The duration of illness was generally short: approximately half (52%) of the 21 patients had fever lasting for only 1 day. Antimicrobial susceptibility testing of the 10 isolates revealed that most of the blood isolates were resistant to erythromycin and nalidixic acid (100% and 90%, respectively), while the rate of cross-resistance between erythromycin and azithromycin was 70%, and that between nalidixic acid and ciprofloxacin was 67%.

CONCLUSIONS

Our observations suggest that Campylobacter bacteremia should be included in the differential diagnosis of patients with chronic liver disease or malignancies involving the hepatobiliary system or gastrointestinal tract who present with fever and gastroenteritis. Clinicians in Taiwan should be alert to the high rate of resistance of Campylobacter isolates to macrolide and quinolone antibiotics.

Spontaneous bacterial empyema caused by Aeromonas veronii biotype sobria

Spontaneous bacterial empyema is a complication of hepatic hydrothorax in cirrhotic patients. The pathogen, clinical course and treatment strategy are different to the empyema secondary to pneumonia. A 54-year-old man, who was a cirrhotic patient with hepatic hydrothorax, was admitted to National Taiwan University Hospital for fever, dyspnea and right side pleuritic pain. The image study revealed massive right pleural effusion and no evidence of pneumonia. The culture of pleural effusion yielded Aeromonas veronii biotype sobria. The diagnosis of spontaneous bacterial empyema caused by Aeromonas veronii biotype sobria was established. To our best knowledge, Aeromonas veronii biotype sobria had never been reported in English literature as the causative pathogen of spontaneous bacterial empyema.

Klebsiella pneumoniae isolates causing liver abscess in Taiwan

Klebsiella pneumoniae has been the leading cause of pyogenic liver abscess in Taiwan during the period from 1985 to 1999, which is different from other countries. The present study investigated the in vitro antimicrobial susceptibilities of 51 K. pneumoniae isolates collected from blood cultures of patients with liver abscess in Taiwan during the period from 1993-1997, and typed by pulsed-field gel electrophoresis (PFGE). All 51 isolates were resistant to ampicillin, but susceptible to other antimicrobial agents. The minimum inhibitory concentrations (MICs) were less than 1 microg/ml for the third- and fourth-generation cephalosporins, monobactam, carbapenems, and ciprofloxacin. In comparison, 62 isolates of K. pneumoniae from community-acquired bacteremic patients without liver abscess had similar antimicrobial susceptibilities, while 142 isolates from patients with hospital-acquired bacteremia without liver abscess were much less susceptible to all of the tested antimicrobial agents. PFGE molecular epidemiologic analysis found 20 out of 51 isolates belonged to eight clusters of genetically related strains, with two or three isolates in each clusters. The other 31 isolates were genetically distinct strains. This study demonstrated that K. pneumoniae isolates which cause liver abscess in Taiwan remained susceptible to a wide range of antimicrobial agents and that they were not genetically related.